To develop effective interventions to improve population health requires an understanding of what works, for whom, under what circumstances and why? This necessitates the development of epidemiologically and social scientifically informed complex and multi-factorial interventions that are effective across settings and behaviours; the rigorous evaluation of complex interventions, often using pragmatic controlled trial designs with nested process evaluation and including natural experiments of new policy programmes and the use of routine data to develop and target interventions and to provide sources of data on contexts and long term outcomes for intervention studies. The centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) brings together a team of world class researchers with expertise in a wide variety of quantitative and qualitative evaluation methods and intervention technologies to address these issues. Building on a strong track record in working with partners from public health policy and practice, and in public involvement in research, we will develop, test, evaluate and then implement interventions that are effective in improving the health of the population across settings and behaviours and which address health inequalities, with a particular focus on children and young people. DECIPHer's aims are to conduct research that: 1. will lead to measurable improvements in the health of children and young people 2. identifies policies and interventions that are readily adopted, implemented and maintained in the real world and are effective in improving health and reducing health inequalities. We will also provide high quality training programmes to develop the skills and careers of public health researchers, and a focal point for collaboration with policy and practice. For its second five-year period of funding, DECIPHer's core Centre resources will be focussed on developing a high quality cadre of early career researchers who, with a multidisciplinary team of senior scientists will take forward four research programmes: The first will examine multiple risk behaviours in young people and their antecedents to develop complex interventions which address multiple risk behaviours and their causes. The second will develop and conduct a programme of research on organisational approaches to promoting health in schools and other youth settings. The third will focus on further development of methods to develop and evaluate complex interventions, with an emphasis on applying randomised trials and other high quality research designs to evaluating interventions in a way that produces rigorous evidence that is useful to public health decision makers. The fourth programme is also methodological in nature, and is concerned with maximising the use of routine data from population surveys and other administrative sources to improve our understanding of the determinants of population health and facilitate the evaluation of interventions without the need for expensive collection of new data. These four complementary programmes will provide a platform for multiple applied research projects, funded through additional competitive grant funding, which will be strategically co-ordinated within and across three broad priority areas relating to the health of children and young people: Tobacco, Alcohol, Drugs; Obesity, Physical activity, Diet; Mental health and wellbeing. DECIPHer will address health behaviour in its widest sense, encompassing individual risk and protective behaviour and the contexts and structures that improve, sustain or undermine health and well-being. Adopting a socio ecological approach, the focus will be on multiple behaviours and on the design and evaluation of interventions that take full account of the interdependencies between individual, social, family, community, organisational and policy factors.

Violence causes harms to health. The harms to mental health can be more long-lasting than the immediate harms to physical health and have consequences that reverberate through a person's life impacting on their functioning in society. Reducing such 'upstream' determinants of poor mental health would significantly improve the health of the population. This would reduce health inequalities since being a victim of violence is more prevalent among those who are already disadvantaged. The Consortium would investigate the effectiveness of interventions to reduce violence and, thus, reduce health inequalities. Within the field of violence, we have special interest in domestic and sexual violence because these are significant causes of inequalities in mental health, which have been relatively neglected in the scientific and statistical evidence base. We address how to mainstream these issues across multiple sectors rather than seeing them as only of specialised concern. Multiple institutions are relevant to preventing violence. They include not only health services, but also criminal law enforcement (most violence is a crime), civil law (e.g. domestic protection orders), specialised services (Third Sector organisations that help victim/survivors of violence), and governmental bodies concerned with law, policy and data quality. The connections between violence and ill health are complicated since they are mediated by many of these institutions. Identifying these connections would aid the development of more effective interventions while a complex systems analysis captures the adaptive behaviour between these systems. The data needed to assess the effectiveness and cost-effectiveness of interventions is currently weak. This is partly because each specialised academic discipline and profession has a different way of measuring violence, which makes cooperation across these differences difficult. Not only do we need harmonised core metrics for the evaluation of interventions and cross-sector cost-benefit comparisons, we also need to adapt and extend our metrics to capture newly identified forms of abuse such as that facilitated by technology. The Consortium aims to improve the measurement framework and data availability to aid the evaluation of interventions. This is premised on cooperation between academics and practitioners. The project seeks to identify profiles of persons and incidents exposed to violence and link data from multiple services and surveys. We would assist services to make their own data more useable and more available. This involves care and attention to issues of data protection and the development of bespoke agreements on data sharing that respect communities that generate data. We would unlock the potential in multiple data sources rather than collect new data. These datasets include major national surveys such as the Adult Psychiatric Morbidity Survey, and the Crime Survey for England and Wales, and also administrative data sets from professions and practitioners, including the police, solicitors, health and specialised services. These datasets will be linked in a new integrated dataset and provide an evidence base upon which a cost-benefit framework and risk assessment tools can be developed. With the linked data and new tools, we would assess key interventions. These are interventions at the level of institutions and systems. Our focus is the prevention of violence in the population rather than the treatment of trauma in individuals. The Consortium seeks to mainstream evidence of the significance of violence for health in policy making. We would engage with decision-makers concerned with the commissioning of services and policy makers concerned with priorities for public expenditure, as well as wider publics. The aim is to reduce the harm to health, especially mental health, by identifying the most effective and cost-effective interventions to reduce violence in the population.

Clinical microbiology laboratories undertake thousands of tests in order to identify what pathogen is present in a clinical sample. When looking for bacteria, it is common to grow these organisms on selective media and report back to the clinician as to whether the test is positive or negative. However, for many bacteria, and for some samples in which there are several bacteria present, there is either no culture media available or due to the mixed nature of the sample, the results are confusing and difficult to interpret. Furthermore, depending on the organism which is being detected, the test can take 3 to 4 days before the clinician will be informed of the results and then make a decision on how to proceed with treatment. Additionally, several different tests may need to be undertaken before a positive result is reported. The application of molecular-based methods, which detect a DNA signal, have been used for many years in clinical microbiology laboratories to identify the presence of viruses. More recently, such DNA-based approaches have started to be adopted for the detection of bacterial pathogens in stool samples from patients with diarrhoea. However, these tests are specifically targeted at known pathogens, and in order to identify what pathogen is present, several tests have to be undertaken before a positive signal is detected. Next-generation sequencing platforms can provide a solution to these problems, they can allow for high throughput screening samples to detect pathogens and at the same time, no pre-knowledge is required as to what pathogen needs to be detected. The next generation sequencing technology can provide clinical microbiology laboratories with a one-stop solution to identifying pathogens in clinical specimens. This FLIP proposal aims to take this technology, which is currently being used for understanding how microbial fuel cells work (on developing it further), so it can be applied in a clinical setting. The interchange, Dr Ann Smith who is a computer scientist, will apply the knowledge of next-generation sequencing, and by Informatics pipelines will develop a simple user-friendly interface for analysing these datasets, and provide clinical microbiologists with access to this enabling technology.

Secondary schools are important settings for health improvement, providing access to young people during a critical period when health risk behaviours markedly increase. Yet despite sustained effort to promote health through schools, the evidence for school-based interventions that effectively address issues such as obesity, smoking, alcohol use and mental health is limited. Health improvement research in school settings is challenging, with trials currently implemented in an ad hoc and inefficient manner. This is in stark contrast to research in primary care, which was greatly enhanced by the advent of primary care research networks (PCRNs) which facilitated an increase in the quantity and quality of randomised trials, improved research capacity and provided support for practitioner-led research. Such a step change is urgently needed to advance school-based research in the UK. The project aims to improve the quantity, quality and efficiency of public health research in schools by developing and evaluating a School Health Action Research Partnership and Network (SHARPEN). The research to evaluate and refine SHARPEN has 3 strands. In the first, researchers from Cardiff, Bristol, Oxford and Swansea universities will work in partnership with the Welsh Government, Cancer Research UK, Public Health Wales and Cardiff and Vale University Health Board to establish a network of up to 90 secondary schools that are 'trial ready', by developing more efficient recruitment, consent and data linkage procedures. We will identify the infrastructure and processes necessary to make the network efficient, effective, acceptable and rewarding for both schools and researchers. We will explore the barriers and facilitators to making the network sustainable. Students in network schools will complete the Health Behaviour in School-Aged Children (HBSC) survey, a school environment schedule will be completed for each school, and we will pilot a system that uses these data as a basis for providing regular, tailored feedback to schools on pupil health behaviours and the school environment. In the second strand we will test the feasibility of establishing school-based action research partnerships to see whether they add significant value to the network model. Five schools will each form an action group of pupils, teachers, parents, health professionals and academics and over the course of a year each group will review their HBSC survey and school environemnt data, identify health priority areas, discuss the links between health and educational outcomes and develop and implement a school health action plan. Action plans will draw on the project partners and local resources and adopt a whole-school approach to health improvement. We will evaluate the action research partnerships to capture how they worked, the factors that hindered and helped them, and whether schools and other stakeholders found them feasible and useful. During this strand, student and parent views on data linkage will also be sought. Issues around informed consent and anonymity will be discussed with students and parents and if possible, data linkage will be piloted. The aim of the third strand is to scope the potential for sustaining the network and expanding it in Wales and for transferring the network model to secondary schools in England. Lessons from the first two strands will be fed back to key stakeholders in England and Wales and their views will be sought on network sustainability and its potential for expansion. The development of new school health research networks in England and Wales has significant potential to coordinate, increase and strengthen school-based research and inform evidence-based school health activity, thereby contributing to young people's health in the UK.

The aim of the Centre for Improving Population Health through E-Health Research (CIPHER) is to carry out research that will improve the health of the nation. It will do this by developing new methods to anonymise, link and analyse healthcare and similar data, to answer a wide range of important research questions. We will often work with researchers who have established large cohort studies, helping them make their cohorts more powerful, longer lasting, and cheaper to operate. E-health research is a new field and so CIPHER will be focussing on training researchers in how to use these data and methods. CIPHER has four core research programmes: The first focuses on developing robust new methods to allow health and other information to be anonymised and analysed. For example, developing ways in which researchers accessing data cannot possibly identify the individuals involved, thereby ensuring that privacy is protected. CIPHER's other three research programmes focus on the impact on people's lives of (1) injury and the built environment; (2) mental health and substance use; and (3) infection. CIPHER researchers will undertake a range of studies to provide better insight into the causes of disease and injury, the consequences of these conditions on individuals and the population, and evaluations of treatments and policies which are designed to improve health. Knowledge of the longer term individual and societal impact of many conditions and treatments is currently very limited, as long term studies are very expensive. CIPHER's work will enable the long term follow up of outcomes using anonymised data, answering these questions effectively but at far less cost. Within its research programmes CIPHER will address many scientific questions, including: How effective are fall-prevention initiatives for older people? What is the impact of giving Vitamin D supplements to people in care homes in reducing hip fractures? Can linked data be used to help Fire and Rescue services prevent more home fires? Have interventions to make homes warmer reduced the number of deaths in winter? How much does substance use in young adults contribute to mental health problems? Does opiate substitution therapy in prison reduce the risk of death following prison release? Can linked routine data be used to identify opportunities to intervene in pathways to harm for people who self-harm or die by suicide? How can information be better used to reduce antibiotic resistant infections? Are the different micro-organisms we carry in our bowels involved in the development of serious health conditions? CIPHER will work with the NHS to develop better ways to measure patients' experiences and treatment outcomes. CIPHER will also develop methods to enable linkage of anonymised treatment data to important social outcomes such as staying in work, continuing in education, or being able to live independently at home. Such information will help the NHS design its services to meet a broader range of patients' needs. CIPHER's believes it is important to communicate effectively with patients, patient groups and the public at large about its research. A significant part of our work therefore will be setting up ways to aid this communication. We will have public representatives involved in our research throughout and they will help guide us and help us communicate effectively with wider groups. CIPHER will be one of a small number of similar Centres that is being set up in the UK and we will be working together to train researchers in these new methods and making sure universities have suitable jobs for them. CIPHER aims to be an internationally recognised centre of expertise in the use of electronic health and associated records for research and, along with other network members, position the UK as the world leader in the field, improving the population's health, increasing UK research income, and improving the economy.