Our research takes a multidisciplinary approach to addressing health problems, with emphasis on utilising modern technologies to advance our understanding of and address health concerns. This involves incorporating health informatics, bench science, mathematics, statistics, and social sciences into classical and molecular epidemiology to develop a better understanding disease transmission dynamics from network-, transmission event-, individual- and environmental-level analyses and utilising these findings to develop more innovative and effective health solutions.
Work within my group tends to be directly translational to support policy and public health intervention that will result in reduction of infectious disease burden within communities and specialised settings, such as healthcare facilities. As such, our work is conducted together with Public Health England and the Cambridge University Hospitals Foundation Trust and other NHS trusts. We have applied these methods to the study of HIV, sexually transmitted infections, hepatitis C, tuberculosis, hepatitis A, influenza, norovirus and other healthcare associated infections (HCAIs).
Current areas of active research include:
- Addenbrookes eHospital and community NHS data – research and capacity building in clinical informatics with the overarching aim to automate the processing, management and integration of vast amounts of routinely collected health information to facilitate more efficient and effective medical and public health research and enable higher quality interventions and critical evaluation of efficacy and effectiveness of interventions. This work is being undertaken within the Health Informatics Theme of the Cambridge BRC and involves data from a wide range of NHS systems.
- Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance – modelling the use and application of NHS healthcare worker absence and illness data for infectious disease surveillance, early alerts, preparedness and improved infection prevention planning.
- Norovirus and C. difficile infection and carriage – examination norovirus and C.difficile co-infection and co-circulation to determine prevalence, if co-infection exacerbates the clinical outcome and if particular C.difficile ribotypes circulate with particular norovirus genogroupsbiobanking. This is done through testing and genetic analysis of anonymised stool samples from patients at a West London trust linked to anonymised clinical data.
- Norovirus mapping – phylogenetic analysis of norovirus samples worldwide by timing and location of sampling to understand the patterns of norovirus spread and evolution.
- NoRS (Norovirus Reservoirs Study) – examining 1) viral, 2) host and 3) environmental factors that promote norovirus reservoirs in the hospitals, and 4) how shedding and symptoms are influenced virologically. This is a longitudinal observational study of patients and healthcare workers involving laboratory analysis and sequencing of norovirus isolated from participants, data collection on symptoms and health history, and modelling of the transmission and acquisition of norovirus infection in relation to symptomatology, viral load and genetic similarity of viruses.
- Norovirus and C. difficile infection and carriage Behaviour among healthcare workers – see above under clinical informatics.
Behaviour among healthcare workers
- APED (Antimicrobial Prescribing Education among Doctors) – A four-arm, randomised, controlled trial to test the efficacy of a learner-centred short course and a serious game for changing knowledge, attitudes and behaviours of antimicrobial prescribing among junior doctors.
- Hand Hygiene – A series of studies using mixed methods to understand when, why and how hand hygiene is performed and recorded during observation; including observations, questionnaires and qualitative interviews.
Invasive Fungal Infections
- Understanding Pulmonary Aspergillosis in Lung Transplant Recipients- Determination of the predictive utility of immunogenetic markers for invasive pulmonary aspergillosis among lung transplant recipients including developing a better understanding of risk factors associated with invasive infection and resistant aspergillosis infection.
- Diagnostics and Risk Factors in Invasive Aspergillosis – a randomised, controlled open test trial (RCT) to determine if aspergillus PCR, aspergillus galactomannan, and novel FDA-approved aspergillus lateral flow device combination testing enables earlier treatment, reduced empiric therapy and improved outcomes from invasive aspergillosis.
Small Area Mapping and Network analysis
- Spatial and Temporal Distribution of Healthcare Associated Infections – investigation of behavioural, structural and environmental factors associated with the clustering of HCAIs in the acute care setting.
- Men’s network study (MeNS) – Use of Priorities of Local AIDS Control Efforts (PLACE) sampling methods to understand how venues structure social and sexual networks for HIV risk among men who have sex with men.