Healthcare associated infections (HAIs) caused by pathogens (infectious agents) such as MRSA, Norovirus, and Clostridium Difficile are a substantial problem in developed and developing countries and within the NHS. In addition to the distress caused to patients who are infected, the cost of HAIs to acute services in NHS Scotland was estimated in the 2007 national prevalence survey at £183 million. The World Health Organisation (2014) global surveillance report on antimicrobial resistance shows that "a post-antibiotic era - in which common infections and minor injuries can kill - far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century". Within this ambit, work to prevent and control Healthcare Associated Infections can in no way rely solely on the production of new antibiotics. Rather, new thinking, new research and development, and new knowledge transfer activities are needed, drawing on knowledge from beyond traditional biomedical science. The applicants' prior AHRC funded 'Visualising the Invisible' (vis-invis) project is a good example of the contribution that the arts and humanities can begin to make through relevant multidisciplinary working. The vis-invis project investigated ways of making pathogens 'visible' in the context of the hospital ward in a multi-disciplinary collaboration involving a team from design, art, nursing and clinical microbiology. In the study, the team explored conceptions and perceptions of pathogens in relation to clinical settings, and produced prototype digital visualisations which aimed to make the pathogens 'visible' in the context of the hospital ward. From this project, through a series of workshops with key stakeholders including infection control leads, nurses and domestic staff, one of the key findings was that the adaptation of the visualisations for use in training software for healthcare staff would have significant value. This was not foreseen at the outset of the project but emerged through the development of the prototypes and in response to feedback from the workshops. It was clear from these discussions that using the visualisations as part of training would extend the potential of this earlier work to impact in a timely and valuable way - especially given the current scale of the HAI problem and the threat of increasing resistance of pathogens to antibiotics. Working with a leading UK commercial company in the area of infection control, which specialises in the manufacture of antimicrobial products and infection-control training, two NHS Trusts and a leading microbiology specialist, this follow-on project proposal will create a visual training application, running on a tablet device, which can innovatively exploit existing context-relevant data about the nature, location and prevalence of the pathogens associated with HAIs. The visualisations will make clear the direct relationship between the ward setting and the location, behaviour, causes of spread, and prevention of spread of pathogens. The NHS project partners will be closely involved in the specification, co-design, development and evaluation of the training tool to ensure it satisfies the requirements of current NHS training programmes and to maximise the opportunities for its adoption.

Speech Sound Disorders (SSDs) are the most common communication impairment in childhood; 16.5% of eight year olds have SSDs ranging from problems with only one of two speech sounds to speech that even family members struggle to understand. SSDs can occur in isolation or be part of disability such as Down syndrome, autism or cleft palate. In 2015, the James Lind Alliance identified improving communication skills and investigating the direction of interventions as the top two research priorities for children with disabilities. Our programme of research aims to fulfil this need by developing technology which will aid the assessment, diagnosis and treatment of SSDs. Currently in Speech and Language Therapy, technological support is sparse. Through our previous work in the Ultrax project we showed that by using ultrasound to image the tongue in real-time, children can rapidly learn to produce speech sounds which have previously seemed impossible for them. Through this project, we developed technology that enhances the ultrasound image of the tongue, making it clearer and easier to interpret. Ultrax2020 aims to take this work forward, by further developing the ultrasound tongue tracker into a tool for diagnosing specific types of SSDs and evaluating how easy it is to use ultrasound in NHS clinics. The ultimate goal of our research is that Ultrax2020 will be used by Speech and Language Therapists (SLTs) to assess and diagnose SSDs automatically, leading to quicker, more targeted intervention. Normally speech assessment involves listening to the child and writing down what they say. This approach can miss important subtleties in the way children speak. For example, a child may try to say "key" and it may be heard as "tea". This leads the SLT to believe the child cannot tell the difference between t and k and select a therapy designed to tackle this. However, ultrasound allows us to view and measure the tongue, revealing that in many cases children are producing imperceptible errors. In the above example, an ultrasound scanner placed under the chin shows that the child produces both t and k simultaneously. Identification of these errors means that the SLT must choose a different therapy approach. However, ultrasound analysis is a time consuming task which can only be carried out by a speech scientist with specialist training. It is a key output of Ultrax2020 to develop a method for analysing ultrasound automatically, therefore creating a speech assessment tool which is both more objective and quicker to use. Building on the work of the Ultrax project, where we developed a method of tracking ultrasound images of the tongue, Ultrax2020 aims to develop a method of classifying tongue shapes to form the basis of an automatic assessment and a way of measuring progress objectively. We are fortunate to already have a large database of ultrasound images of tongue movements from adults and primary school children, including those with speech disorders, on which to base the model of tongue shape classification and to test its performance. At the same time, we will evaluate the technology we develop as part of Ultrax2020 by partnering with NHS SLTs to collect a very large database of ultrasound from children with a wide variety of SSDs. In three different NHS clinics, SLTs will record ultrasound from over 100 children before and after ultrasound-based speech therapy. This data will be sent to a university speech scientist for analysis and feedback to clinicians recommending intervention approaches. Towards the end of the project, we will be able to compare this gold-standard hand-labelled analysis with the automatic classification developed during the project. At the conclusion of our research project we will have developed and validated a new ultrasound assessment and therapy tool (Ultrax2020) for Speech and Language Therapists to use in the diagnosis and treatment of SSDs.

In 2010 the applicant completed a piece of work funded by the AHRC which looked at the spiritual needs and lives of people with profound learning disability. Understanding the spiritual lives of people with profound and complex learning disabilities: a community oriented action research approach. AH/F011482/1. A product that came unexpectedly out of this study was the ASSFAP: a seven stepped facilitated action plan. This educational and process tool/system was specifically designed to be used by communities to explore, understand and respond to the spiritual needs of people with severe intellectual and cognitive impairments through the use of an action planning system of spiritual care development and delivery. Whilst there are recognisable differences between the two populations, it was felt that this process could be transferred and applied to other settings and that it could provide for the needs of a wide range of people with profound communication difficulties. People with advanced dementia are a group of people, like those with profound learning difficulties, who are often overlooked and can be the subject of poor care through a lack of knowing what to do and how to be with them. This resource provides a method of "doing and being" for those who care for them professionally and within families, which enhances the quality of life of both the carers and the people with communication difficulties. The project presented here focuses on making this resource (ASSFAP) available to the community of carers who look after people with advanced dementia; either those who live either at home, in residential care or in hospital. It comes at a time when the care of frail elderly people has been spotlighted by The Care Inspectorate (formerly the Care Commission) as requiring urgent attention. There is growing concern that care of older people, particularly those with advanced dementia, is being reduced to what has been called "bed and body work" to the enormous detriment of the older person and shame of our society.

A key component of the NHS (and global) response to the COVID-19 pandemic has been to reinforce acute and critical care capacity, through an unprecedented re-deployment of personnel from different care pathways into fluid teams consisting of volunteers, student doctors and nurses, and in some cases military personnel [1-4]. These COVID-teams provide a unique opportunity to examine the interaction of many of the established factors for successful delivery of medical teamwork and care. Current evidence suggests that without common teamwork, shared communication patterns and clear leadership structures, the ad-hoc and fluid nature of these COVID-teams increases risk to patient outcomes, delivery of care [5-9] and team member resilience, mental-health and retention [10,11]. This project will examine how non-technical factors for healthcare delivery (leadership, social support & cohesion, communication, shared mental models, co-ordination) and expected moderating factors (occupational background, preparedness, work-life balance, home situation, proximity, workforce allocation models) impact on perceived COVID-teamworking and performance, individual team member well-being and team member employment retention intentions. It will be a mixed methods cross-sectional exploratory study of COVID-team members, clinical directors and senior hospital managers across a wide range of partnered NHS Trusts. Qualitative interviews will identify key themes and will be followed up by a more widely recruited confirmatory survey examining longer term individual well-being and retention intentions. Throughout, there will be a high emphasis on rapid dissemination of results to NHS partners and wider medical and other stakeholders to inform evidence-based workforce guidance and accelerate team-working theory, practice and policy.