Contemporary healthcare is being hugely challenged by the reality of aging populations and the logistics of care provision. Manifestations of these challenges include stretched services and the compromised management of complex health outcomes, problems exacerbated by and contributing to inequality. If we are to improve this situation, greater understanding of the factors important for health upstream of morbidity is paramount. However, this research need faces an evidence gap which can only be filled in the short term by prospective studies which already have a rich catalogue of life course resources. The Avon Longitudinal Study of Parents and Children (ALSPAC) is such a study. It has the benefits of continuity and efficiency, is a leader in generating resources to meet age specific and multi-domain research needs and is poised to remain a valued asset in the current biomedical research era. ALSPAC is a pregnancy cohort that recruited women living in the former County of Avon in the Southwest of England with an expected delivery date between April 1991 and December 1992 (>14500 viable pregnancies). The study has followed the lives of participants and provided data, biosamples and infrastructure to improve understanding of factors contributing to health and disease. Over three decades, 28 age specific face-to-face clinics, >140 questionnaires and a multitude of data linkages and bespoke studies have generated a vast collection of data and biosamples available to bona fide researchers. ALSPAC provides unrivalled opportunities to study sociodemographic, lifestyle, patho-physiological, genomic and molecular factors that influence health and is active. The study has an engaged participant base and continues to record life course health and wellbeing events and factors pertinent to the original children ("Generation 1"), their new offspring ("G2") and their parents ("G0"). Over the next 5 years, ALSPAC moves into a new phase where the defining focus will be characterisation of G1 participants as they move through their fourth decade. A programme of work has been designed to efficiently collect new data and biosamples that chart this, including life stage tailored approaches that will record new events and connect these to health trajectories and linked records. Critically, ALSPAC can measure the health and wellbeing related factors pertinent to an under studied demographic (adults in their 30s), who themselves will become the next wave of health service consumers. The structure of ALSPAC also means that measurements and biosamples taken around these events can include key players in G1 lives - G2 and G0. Therefore, deploying collection now enables unbroken longitudinal research and presents specific windows into the aetiology of multi-generational life course health. Our objective is to ensure ALSPAC delivers this and remains an internationally leading longitudinal population study (LPS). Infrastructure support will mean that ALSPAC does not miss an important life stage and that opportunities to extend records of health and social factors, capture time sensitive events and describe a moment when assumed health may conceal transitions to ill-health, are all taken. Enabled research will have personal, societal and economic implications and regular integration of ALSPAC into a connected national and international LPS landscape will enhance diversity and generalisability. ALSPAC will also be able to continue to act as a widely recognised platform for new research. This will lever the value of this proposal and allow ALSPAC to respond to the diverse needs of stakeholders over coming years.

The holy grail of a cure for Parkinson's disease has been held back for decades by the extreme difficulty of measuring whether proposed new drugs actually improve the patient's symptoms and daily life. The TORUS research programme aims to solve that problem through a novel platform of sensing technologies for use in patients' own homes along with an advanced data fusion and machine learning pipeline that measures changes in specific mobility-related behaviours over weeks and months. Neurological disorders are the single largest cause of disability - in the UK alone there are 150,000 people with Parkinson's disease, the fastest-growing neurological condition. Parkinson's disease is incurable, and symptoms worsen over time, severely reducing quality of life and creating heavy burdens on the patient's family. The cost to the NHS each year is £375M, with families and social services contributing a further £877M (Centre for Health & Social Care Research, 2017). The number of people with Parkinson's disease in the UK is expected to nearly double by 2040. To get a new drug to market, pharmaceutical (pharma) companies need to evidence by a clinical trial whether the drug improves symptoms such as freezing when walking, tremor and the ability to undertake daily tasks such as standing up from sitting or moving between rooms. Currently, to gather this evidence, each patient in the trial must travel to hospital to be observed performing standardised tests by a clinician. However, these (at most) monthly "snapshot" samples of symptoms are a poor representation of the hour-by-hour variation of the patient's true symptoms. The vision of TORUS is therefore to create the capability to autonomously, continuously and objectively measure symptoms of illness (mobility-related activities of daily living) many times every day during the clinical trial of a new drug, in the patient's own home and for months at a time TORUS will achieve this goal by using a wrist-worn wearable integrated synergistically with AI-enabled cameras. The data from the wearable and cameras is fused to give metrics of the quality of mobility-related activities. The programme concluses with a clinical proof of concept.

The UK currently spends 70% of its entire health and social care budget on long term ("chronic") health conditions. These include diabetes, dementia, obesity, depression, COPD, arthritis, hypertension and asthma. We need to be better at: -- Understanding the cause of these illnesses -- Helping a person to avoid developing them -- Creating new treatments -- Helping the patient self-manage their conditions All these require working with a patient over months or years, outside of a traditional hospital environment. In a very real way, we need healthcare to go where the patient goes; the single place that most people spend most of their time is their home. Consequently, SPHERE project is seeking to develop non-intrusive home-based technologies for measuring health related behaviours at home over long periods of time. The requirements for these technologies are: -- They should require little or no action from the patient, since our daily lives are busy; being ill is distressing and time-consuming; and when the benefit may take months or years to achieve, there is often not much day to day motivation to be bothered with measurements or devices. -- They should work reliably in the home; a home is not a hospital or a laboratory - it is smaller, full of furniture, pets and people, often not brightly-lit and often challenging to get wireless network coverage everywhere. This poses lots of problems for researchers. -- They should be acceptable; bringing healthcare home with us doesn't mean we want to turn our homes into hospital and it definitely doesn't mean we want people spying on us! Since 2013 this has been the SPHERE vision and we have worked with scientists, doctors, engineers and more than 200 members of the public to achieve the project's initial goal of creating a cheap sensor system that can be installed in a home. More than 30 people have had the experience of living with the sensors over periods from days to months and, by the end 2017 we expect more than 200 people will have had SPHERE sensors in their own home, in many cases for months. Although the first-generation system was only completed in late 2016 and at the time of writing is still under test in the first "pilot" homes, the system is already moving into real patient applications - we are applying for ethical permission from the NHS to use SPHERE for patients recovering from surgery. Later in 2017 we will be applying for ethical permission to use SPHERE with a group of dementia patients. The initial testing of the sensor system has gone well but, especially as we start to think about large scale use of the SPHERE system across potentially hundreds or thousands of people, the team have learnt a lot from the early pilots and have some priorities for significant improvements: 1. The SPHERE video system needs to be better at evaluating the quality of someone's movement, such as getting out of a chair, even when the view of the person is blocked by items of furniture. Evaluating quality of movement is important in physical and mental health conditions. 2. The SPHERE wristband lasts for over a month on a single charge, however we want to remove as far as possible the need to charge it at all, because the more ill someone is, the less likely they are to do this. 3. Digital data gathered from sensors needs to be turned into understanding for doctors; this is especially difficult in a home environment because every home and every household is different. These are major research issues and will be the focus of the technology parts of the SPHERE programme, while the clinical parts move forward with patient populations. The NHS itself has recently said: "if the UK fails to get serious about prevention then recent progress in healthy life expectancies will stall, health inequalities will widen, and our ability to fund beneficial new treatments will be crowded-out by the need to spend billions of pounds on wholly avoidable illness."

Across the world, growing population sizes and increasing urbanisation cause transportation networks to reach their capacity limits. In addition, the environmental impact of the transport sector, contributing an estimated 33% of carbon dioxide emissions in the UK for 2018, needs to decrease. Thus, environmental considerations and transportation needs necessitate an increase in trips completed by active, low-emission transport, such as walking. Walking is healthy, sustainable and plays a crucial role in how urban places of work, leisure and living are accessed and used. According to the National Travel Survey 2017 for England over 80% of trips under one mile are completed on foot and considering that over 70% of trips between one and five miles long are completed by car, the potential for an increase in walking is substantial. Getting more people to walk requires better infrastructure or policy interventions, such as clean air schemes, parking fees, or incentives for walking. Currently, planners and policy makers have to make do with data from surveys or localised pedestrian counts to inform their work. However, to decide which policies or infrastructure investments will work best in promoting walking, it is necessary to consider how pedestrian traffic varies over time across the entire street network of cities. For example, making walking more attractive in one part of a city centre may influence the footfall in other, potentially unexpected locations and possibly only at certain times, such as outside of rush-hour. Despite the evident use for such information, pedestrian traffic is currently not mapped over time for cities. This project aims to change this and develop a theoretical framework for robustly constructing time-dependent pedestrian traffic maps at the scale of cities. To future-proof the methodology, it will use pedestrian counts observed at distinct locations. These can be recorded via different, privacy-preserving technologies and do not rely on the voluntary participation of individuals or private sector service providers, as is the case for data obtained from personal devices, such as mobile phones. Crucially, to ensure the traffic maps are robust to sensor failures and the occurrence of events or unscheduled disruptions, the theoretical framework will incorporate several predictive methods, each of which contributes different desirable properties, such as accurately capturing regular patterns based on historic data, efficiently interpolating between count locations and the capability to predict traffic dynamics from initial values without further data input. To directly inform the deployment of measurement devices, suitable data collection protocols will be established. Outputs of this project will be useful beyond traffic monitoring. The ability of the methodology to forecast changes in pedestrian traffic caused by construction projects will be demonstrated and the relevance of pedestrian maps for assessing pedestrian exposure to poor air quality and for evaluating the success of businesses relying on passing trade will be shown. This project will develop our understanding of city-wide pedestrian traffic and will therefore be directly useful for monitoring, across large spatial scales, long-term transport developments, short-term effects of disruptions or planned alterations and it will help the economy by informing the positioning and running of businesses that rely on passing trade, for example.

Serious illness and bereavement affect us all, but our experiences of them are not equal. People living in the poorest areas of the UK are less likely to get the care and support they need if they become seriously ill or a loved one dies. They are also more likely to be socially isolated and lonely - which can be made even worse by serious illness or bereavement. This project is based in Weston-super-Mare, a deprived coastal town in North Somerset. Nine of its neighbourhoods are among the poorest 10% in the country. The population is growing, getting older and living with more frailty and long-term, complex health conditions. There are also high levels of mental health and addiction problems. The project team will create a strong group with a shared aim ('a consortium') that unites health and social care workers, people providing community assets (collective resources which are available to individuals and communities, e.g. arts organisations, charities and community groups), academics, and people with lived experience to work together to reduce health inequities in Weston-super-Mare and the North Somerset region. Our consortium will focus on inequities related to end-of-life care, bereavement support, social isolation and loneliness. During the 9 months of the project, we will hold 3 consortium meetings and work together to: 1. create a directory of community assets and interview key people to understand how health and social care and community assets can best work together 2. design and evaluate creative and cultural activities to be held over Dying Matters Awareness Week (DMAW, May 2023), with members of the public employed as co-researchers 3. hold creative workshops with local groups (people with drug and alcohol addiction problems, young people, and older men) to facilitate conversations about grief and illness, raise awareness of local support, and help inform our DMAW events 4. review existing evaluation data from arts/creative organisations working in Weston-super-Mare over the last 5 years (2017-2022) to identify what activities have best engaged and benefitted the community, and draw on this in designing DMAW events 5. map available health and social care data and determine how it can be used to help understand, measure and reduce inequities 6. hold a final consortium meeting to: review all our work; consider how we can apply our findings in other deprived coastal towns; and agree research questions and methods for a future joint funding application The project will benefit: 1) the Integrated Care System (ICS), strengthening their relationships with community organisations and the public in Weston-super-Mare and providing information (community asset directory, map of datasets) to enable equitable end-of-life care and bereavement support; 2) community organisations, by bringing recognition and funding (via linking with the ICS) and helping them reach more people (via linking with the consortium and awareness raising at events); 3) creative and cultural organisations, by enabling them to engage and empower local community members in an evidence-based way, providing training to artists and increasing links with the ICS and community organisations; 4) members of the public, who will learn about the care and support available to them via the ICS and community assets and benefit from opportunities to express their experiences and socialise in creative workshops, attend free events, participate as co-researchers and at consortium meetings; 5) academic researchers, by modelling new multidisciplinary, collaborative ways of creating research and building evidence about how community assets can help reduce health inequities; 6) policy makers, by making recommendations for how ICSs can best harness community assets. We will engage with these groups via consortium meetings, blogs, the project website, journal articles, reports, presentations at community/ICS events and a policy brief.