Clinical Academic Training

Projects

2025 Research Projects can be found on the full job description on the East Midlands Deanery website.

Projects by topic

Cardiology

Medication compliance in patients with heart failure referred for device therapy

Supervisors: Dr Shirley Sze (kyss1@leicester.ac.uk) and Professor Ian Squire (is11@leicester.ac.uk)

Medication non-compliance is associated with a higher risk of recurrent HF hospitalisation and poorer survival. It also increases the need for costly advanced device therapies and even cardiac transplantation. The prevalence of medication non-compliance has been reported to range between 5% and 60% in different cohorts of HF patients, but it is uncertain which subgroups of HF patients are at highest risk of medication non-compliance. Many factors have been postulated to contribute to poor compliance and these include higher number of comorbidities, complexity of medical regimen, cognitive impairment, depression and socio-economic status, but the evidence has been inconsistent. Despite its significant relation to adverse clinical outcomes, medication compliance is not assessed routinely in clinical practice.

Leicester is a national centre for drug adherence and has established a novel technique to directly measure drug levels using liquid chromatography-tandem mass spectrometry (LC-MS) assays to provide objective evidence of medication non-compliance. We have demonstrated its diagnostic and therapeutic utility along with its cost-effectiveness in patients with hypertension.

In this project, the ACF will aim to use this technique to explore medication compliance in HF patients referred for device therapy. We will also aim to identify factors related to poor compliance and study the relation between poor compliance and clinical outcomes.

Findings from this study would build towards a competitive doctoral research fellowship to the British Heart Foundation (BHF) or National Institute for Health and Care Research (NIHR), investigating strategies to optimise medication compliance and improve clinical outcomes in patients with heart failure.

Phenotyping patients with frailty and heart failure

Supervisors: Dr Shirley Sze (kyss1@leicester.ac.uk) and Professor Ian Squire (is11@leicester.ac.uk)

Multimorbidity, the presence of 2 or more chronic medical conditions in an individual, is highly prevalent in patients with heart failure (HF) and frailty. Polypharmacy is inevitable in these patients. Multimorbidity contributes to the progression of HF and frailty and may alter the response to treatment. Both cardiovascular and non-cardiovascular comorbidities maybe determining factors in the differentiation of the different types of HF and frailty and their impact on health outcomes.

Most prior clinical studies have focused on individual comorbidities in isolation without considering the interrelations among them. There is a real need to investigate the multimorbidity patterns that cause the greatest burden in HF.

In this project, the ACF will perform a large-scale population study based on electronic health records from real world patients with an aim to characterise the comorbidities of HF in men and women, to explore their clustering into multimorbidity patterns, and to measure the impact of such patterns on negative health outcomes. Patients with frailty and heart failure is a heterogenous population, we hypothesize that the heterogeneity may be partially attributable to a difference in comorbidity patterns. Understanding how comorbidities cluster in HF patients and its impact on patient outcomes may be an important step towards personalizing HF treatment strategies for better outcome.

In silico modelling of RCTs of prehabilitation interventions using routinely collected healthcare data

Supervisors: Professor Gavin Murphy (gjm19@leicester.ac.uk), Dr Muhammed Rashid (mr467@leicester.ac.uk) and Dr Weiqi Liao (weiqi.liao@leicester.ac.uk)

To develop key skills in the use of routinely collected healthcare data, modern machine learning methods, and in silico clinical trial design.
To prepare a high quality submission for an external fellowship application within the lifetime of the post.
To pilot a novel research resource for trial development as part of the National Cardiac Surgery Clinical Trials Initiative

Research question: Can pharmacological prehabilitation in people with cardiovascular disease prevent organ injury and death following major surgery.

Interventions: Weight loss interventions including GLP-1 antagonists, anti-ageing interventions including SGLT2i and metformin, and interventions targeting chromatin remodelling including sodium valproate.

Data Sources: CPRD and HES data in partnership with the Leicester Real World Evidence Centre

Statistical Methods: The research will develop the in silico trial methods developed by our team (doi:10.1093/eurheartj/ehac670), that capitalise in the regional variation in the roll out of interventions to model potential RCTs of pre-surgery interventions in cardiac and other major surgical procedures.

Research Team: The research is undertaken in partnership with the Leicester CTU, the Leicester Real World Evidence Centre and statisticians based in the Department of Cardiovascular Sciences at the University of Leicester.

The use of pathway analysis to explore the trajectory of immune cells in inflammageing using bone marrow and myocardial tissue from cardiac surgery patients

Supervisors: Professor Gavin Murphy (gjm19@leicester.ac.uk), Professor Veryan Codd (vc15@leicester.ac.uk) and Professor Tom Webb (tw126@leicester.ac.uk)

The clinical problem: Inflammageing is a key determinant of outcome following cardiac surgery but the underlying processes are poorly understood.

Hypothesis: Chromatin adaptations to biological ageing in bone marrow cells determine cellular lineages and the development of inflammageing in cardiac tissue.

Aims:

To develop key skills in the use of high precision transcriptomics and genomic data and modern bioinformatic methods to study immunosenescence and biological ageing in human tissue.
To use modern informatic methods to identify underlying disease processes in bone marrow and myocardium, and to identify novel therapeutics.
To prepare a high quality submission for an external fellowship application within the lifetime of the post.

Participants: People undergoing coronary artery bypass grafting who have provided simultaneous myocardial biopsies and sternal bone marrow isolates for analysis.

Data sources: single nuclei RNA sequencing (snRNAseq) and transposase-accessible chromatin with sequencing (ATAC-Seq) data from bone marrow and myocardial tissue from previous studies.

Methods: Bioinformatic methods will include differential gene expression analysis, pathway analyses, cell-cell interaction, and regulon analyses. Pathway analysis will assess changes in cellular gene expression and chromatin remodelling over pseudotime (PhenoAge, a biological ageing score).

The results will be validated using Mendellian Randomisation in UK Biobank.

Research Team: The research is undertaken in partnership with the internationally leading Cardiovascular Genomics (Codd, Samani) and Functional Genomics (Webb Solomon) groups at the University of Leicester. External collaborators include the Universities of Oxford and Humanitas in Milan.

Maternal Cardiovascular profiling for precision stratification of pregnant women with early onset type 2 diabetes (EOT2D)

Supervisors: Professor Tommy Mousa (hm282@leicester.ac.uk) and Professor Claire Meek (cm881@leicester.ac.uk)

Background: Diabetes mellitus is one of the most common medical disorders in pregnancy, affecting up to 5% of pregnancies in the United Kingdom (UK). Pregnancy in women with early-onset type 2 diabetes (EOT2D; diagnosis <40 years old) is increasingly common and associated with increased risk of placental-mediated diseases, such as pregnancy-induced hypertension (PIH) and preeclampsia (PET), and features of endothelial dysfunction, even in the absence of obesity or hypertension. This suggests that maladaptation of the cardiovascular system in pregnancy may be an important pathophysiological mechanism in EOT2D.

Our Leicester Maternal Haemodynamic Research Group have examined and reported on changes in maternal haemodynamic profiles, including arterial stiffness, a recognised cardiovascular risk factor, among pregnant women with gestational diabetes. We observed unique changes in arterial stiffness suggesting that vascular health may also be important in the development of complications in EOT2D.

Aims: This project will assess longitudinal changes in maternal haemodynamics among pregnant women with EOT2D and will evaluate its role in the aetiology of pregnancy complications, as part of a large multicentre observational study (Leicester Diabetes Research Centre project led by Professor Meek; DOMINO study).

Hybrid closed loops and risk of placental-mediated diseases in women with type 1 diabetes (T1D) in pregnancy.

Supervisors: Professor Tommy Mousa (hm282@leicester.ac.uk) and Professor Claire Meek (cm881@leicester.ac.uk)

Background: Women with type 1 diabetes (T1D) in pregnancy have increased risk of placental-mediated diseases (Hypertension, pre-eclampsia, fetal growth restriction), preterm delivery, birthweight extremes, congenital anomaly, stillbirth and neonatal death. Hybrid closed loops (HCL), novel automated insulin delivery systems, are now the standard of care for pregnant women with T1D. HCLs improve maternal glycaemia, but their effect upon perinatal outcomes has not been assessed in real-world clinical practice.

Our Leicester Maternal Haemodynamic Research Group have identified that the type of therapy influences longitudinal changes in maternal haemodynamic profile among pregnant women with diabetes. However, it is unclear if HCLs are associated with improved maternal haemodynamics and reduced rates of vascular complications.

Aims: This project will assess the real-world effect of HCL use on perinatal complications, maternal glycaemia and cardiovascular health in women with T1D. This project will be embedded in a large multicentre observational study (Leicester Diabetes Research Centre project led by Prof Meek; DOMINO study) providing opportunities for publications, presentations and to learn about the end-to-end clinical research process.

Understanding progression from asymptomatic type 2 diabetes towards heart failure with preserved ejection fraction through multidimensional phenotyping

Supervisors: Professor Gerry McCann (gpm12@leicester.ac.uk), Dr Emer Brady (emb29@leicester.ac.uk), and Dr Gaurav Gulsin (gg149@leicester.ac.uk)

demonstrated early deleterious myocardial alterations that precede HFpEF symptomology (termed stage B HF (SBHF)). We have been awarded £1.387 million in funding from the British Heart Foundation to characterise the trajectory of SBHF in T2D towards symptomatic HFpEF and identify specific biological pathways that drive progression. This work is an extension to our recently completed clinical cohort study the 'Prevalence and Determinants of SubclInical Cardiovascular Dysfunction in Adults with Type 2 Diabetes – The PREDICT Study' (NCT03132129). In PREDICT, over 500 people with T2D (stage A and SBHF) were comprehensively phenotyped with advanced multidimensional multi-organ imaging, cardiopulmonary exercise testing and multi-omics. We will be inviting 200 participants back for repeat testing to assess disease progression and central and peripheral drivers of exercise intolerance, the signature and debilitating symptom of HFpEF.

The successful candidate will contribute to the development of, and have access to, this world-leading bioresource. They will use this rich data for the identification of distinct endotypes in T2D with variable progression of SBHF to inform targeted intervention trials for the prevention of symptomatic HF.

Investigating the clinical phenotypes and pathophysiology of uncommon coronary artery diseases

Supervisor: Professor David Adlam (da134@leicester.ac.uk)

We are interested in improving our understanding of the pathophysiology of rare causes of acute coronary syndromes. We have had British Heart Foundation funded research project to study patients with SCAD, a condition which primarily afflicts young women, particularly in the peri-partum period. We are also seeking to expand this approach to study patients with CAE. CAE and SCAD have a spectrum of clinical presentations ranges from chest pain syndromes to myocardial infarction and sudden death.

The UK/EU SCAD research portal was established in 2013 and is operated by the NIHR Leicester Cardiovascular BRU. More than 2,000 patients have registered for research and consenting patients are now undergoing comprehensive clinical and imaging-based phenotyping, epidemiological follow-up and biobanking. This ACF would be focused on enhanced clinical phenotyping of patients from the SCAD study and working with the European SCAD Study Group to collate data from the ESC-EORP SCAD study, particularly in light of our increased understanding of the genetic predisposition to this condition, recruiting patients to the SCAD and CAE studies including clinical trials. Precise details can be moulded to candidates clinical and research interests and to the state of the art at the time point of commencement of research work.

Clinical Education

General Psychiatry

A structured educational program on metabolic monitoring in people with Severe Mental Illness (SMI) for medical students, psychiatry trainees and non-medical staff; and its evaluation

Supervisors: Dr Hari Subramaniam (hs504@leicester.ac.uk), Dr Lucy Beishon (lb330@leicester.ac.uk), Dr Rachel Winter (rw205@leicester.ac.uk) and Professor Elizabeta Mukaetova Ladinska (eml12@leicester.ac.uk)

Physical ill health is the most significant factor in the widening mortality gap between SMI and the general population (1). Cardiovascular disease (CVD) is the leading cause of mortality worldwide (2). a major cause of death in SMI (3) with CVD increasing with age (4). The relationship is bidirectional, and those with CVD are also at higher risk of adverse mental health (4). People on antipsychotic drugs suffer adverse physical and metabolic outcomes. Improved understanding of cardiovascular and metabolic risks associated with drugs used to treat SMI have identified that much of these risks are modifiable through better provision and access to physical healthcare in patients with SMI. This needs a targeted and focussed approach to improve training and education of professionals.

Few structured medical education training programmes for doctors and other professionals include teaching in assessing and managing cardiometabolic risks in SMI patients. This project involves the development of a structured educational program for medical students, psychiatry trainees and non-medical staff to improve skills in the assessment and management of cardiometabolic syndromes and their risk factors in psychiatric patients and to evaluate its implementation and outcomes. The Fellow will explore the methods of learning used by patients and professionals and what techniques help with retaining the learning long term.

The Fellow will develop research skills in systematic reviews, qualitative interviews, and implementation of the learning. They will co-produce the teaching programme with educators and the provider NHS trust. By the end of the ACF, the Fellow will have a number of peer-reviewed articles, helping advancement in their career and may have opportunities to undertake applications to obtain funding for a PhD.

Empathy all specialities

Supervisor: Professor Jeremy Howick (jh815@leicester.ac.uk)

The transformative Stoneygate Centre for Empathic Healthcare at the University of Leicester is a dynamic Centre for Excellence revolutionizing medical education, professional development, and NHS culture. Early Centre successes include influential publications, the Centre opening by Professor Sir Jonathan Van Tam, as well as influence with local NHS leaders and the Department of Health and Social Care (DHSC).

As an Academic Clinical Fellow (ACF) under Professor Jeremy Howick’s supervision, you’ll develop research skills in randomized trials, systematic reviews, qualitative interviews, and implementation studies. You’ll contribute to one of the Centre’s innovative research streams:

AI and Empathy: Explore how artificial intelligence can enhance empathy and empathy training in healthcare.
Empathy in Professional Development: Design and evaluate empathy-focused courses for healthcare professionals.
Empathic Leadership: Advance leadership strategies that foster empathy within healthcare.

By the end of the fellowship, you’ll have:

Published at least one peer-reviewed article
Advanced your clinical academic career with (if desired) potential PhD funding.
Enhanced your ability to deliver compassionate, patient-centered care.
Developed your teaching portfolio.

The Centre team and Director have a strong track record in mentoring and developing junior clinical academics’ methodological and academic skills.

Endocrinology and Diabetes

Understanding progression from asymptomatic type 2 diabetes towards heart failure with preserved ejection fraction through multidimensional phenotyping

Supervisors: Professor Gerry McCann (gpm12@leicester.ac.uk), Dr Emer Brady (emb29@leicester.ac.uk) and Dr Gaurav Gulsin (gg149@leicester.ac.uk)

Type 2 diabetes (T2D) is a major risk factor for heart failure with preserved ejection fraction (HFpEF), with an insidious, progressive and multifactorial pathophysiology. Several imaging studies have demonstrated early deleterious myocardial alterations that precede HFpEF symptomology (termed stage B HF (SBHF)). We have been awarded £1.387million in funding from the British Heart Foundation to characterise the trajectory of SBHF in T2D towards symptomatic HFpEF and identify specific biological pathways that drive progression. This work is an extension to our recently completed clinical cohort study the “Prevalence and Determinants of SubclInical Cardiovascular Dysfunction in Adults with Type 2 Diabetes – The PREDICT Study” (NCT03132129). In PREDICT, over 500 people with T2D (stage A and SBHF) were comprehensively phenotyped with advanced multidimensional multi-organ imaging, cardiopulmonary exercise testing and multi-omics. We will be inviting 200 participants back for repeat testing to assess disease progression and central and peripheral drivers of exercise intolerance, the signature and debilitating symptom of HFpEF.

Impact of diabetes technology on rates of hypoglycaemia

Supervisors: Professor Pratik Choudhary (pratik.choudhary@leicester.ac.uk), Professor Claire Meek (cm881@leicester.ac.uk) and Dr Jonah Thomas (jjct1@leicester.ac.uk)

There have been huge advances in diabetes therapies and technology which have been shown to reduce the risk of hypoglycaemia in randomised clinical trials. However, access to these technologies is variable, and must also be viewed in the context of an ageing population who are often living with multiple long-term conditions.

The ACF will evaluate the impact of novel diabetes technologies and therapies on admissions to hospital with hypoglycaemia at both a local and national level. The project will first utilise local data to explore underlying factors that predict repeat hospital admissions. National databases such as CPRD and HES will then be used to explore national trends in hospital admissions, and the potential impact of diabetes therapies and comorbidities. The overarching aim of this project is to use this information to develop a risk score based on information available in routine databases, possibly using machine learning techniques.

Targeting obesity in type 1 diabetes

Supervisors: Professor Pratik Choudhary (pratik.choudhary@leicester.ac.uk), Professor Tom Yates (ty20@leicester.ac.uk) and Dr Dimitris Papamargaritis (dp421@leicester.ac.uk)

People living with type 1 diabetes (T1D) continue to have a 2-3 times higher risk of developing premature cardiovascular disease than the general population. This is increasingly exacerbated by comorbidities more typically associated with type 2 diabetes, including living with obesity. People with T1D are also less likely to be active (due to fear of hypoglycaemia). Changes in insulin therapy and risk of hypoglycaemia make weight loss and exercise without hypoglycaemia challenging in this group.

Recent advances in continuous glucose monitoring (CGM) may help to manage this. Furthermore, newer generations of glucose lowering therapies developed primarily for type 2 diabetes have the potential to help with substantial weight loss and improved cardiovascular health. There is an opportunity to explore how such therapies can be used in the management of T1D to help people lose weight, improve their cardiovascular health and adopt a more active lifestyle.

This project aims to work with experts in the field to design new management options and programmes for T1D and pilot them to form the basis for a competitive fellowship. The applicant will also have access to rich clinical data to further explore the phenotype of obesity and cardiovascular risk in T1D.

Exploring the use of novel technology in type 2 diabetes management

Supervisors: Professor Pratik Choudhary (pratik.choudhary@leicester.ac.uk), Professor Claire Meek (cm881@leicester.ac.uk) and Professor David Webb (drw17@leicester.ac.uk)

Diabetes technology has revolutionised the lives and care of people living with type 1 diabetes, and there is considerable growing interest in digital health as a means of delivering care and providing support for individuals with type 2 diabetes. The success of flash glucose monitoring on improving glycaemic control and patient-reported outcome measures in type 1 diabetes is notable at this point, though the evidence-base that wearable technology facilitates behaviour change in other types of diabetes is sparse. This project will explore the use of novel technologies within type 2 diabetes management.

The ACF will experience a range of clinical trials, and have the opportunity to support and participate in a number of academic and commercial trials around the use of technology in diabetes. We will provide training in data analysis and experimental medicine techniques, such as insulin clamps and other detailed physiological assessments.

Physical activity, chronotype and multiple long-term conditions: The Step In Time Project

Supervisors: Professor Melanie Davies (mjd34@leicester.ac.uk), Professor Shahrad Taheri (st607@leicester.ac.uk), Dr Andrew Hall (ah747@leicester.ac.uk) and Dr Joseph Henson (jjh18@leicester.ac.uk)

Although physical activity is a cornerstone treatment for the management of type 2 diabetes (T2DM) and obesity, its application is often based on a one-size-fits-all approach. Moreover, there is considerable variability in how individuals respond. It is hypothesised that the intra-individual variability is partly driven by chronotype, which is closely related to the circadian system, controlling 24-hour cycles of behaviour and physiology. Indeed, those living with T2DM demonstrate signs indicative of clock disruption, which can lead to impaired glucose control. Although light is the most important time cue to realign the circadian system, physical activity may also act as a potent environmental cue to foster chrono-biological homeostasis which is constantly being challenged by modern 24/7 society. Despite holding great translational potential, the impact of such an approach in those living with diabetes and obesity is unknown. Therefore, the aim of this project is to evaluate whether the timing of physical activity, in accordance with the circadian rhythm effects health outcomes in individuals living with T2DM and obesity.

Preventing early-onset type 2 diabetes (EOT2D) after gestational diabetes mellitus (GDM): improving risk stratification in multi-ethnic populations

Supervisors: Professor Claire Meek (cm881@leicester.ac.uk) and Dr Claire Gillies (clg13@leicester.ac.uk)

Background: A previous diagnosis of gestational diabetes mellitus (GDM) is one of the strongest risk factors for the development of early-onset type 2 diabetes (EOT2D), a disease characterised by severe and early macrovascular and microvascular complications. Although preventing EOT2D is crucial for individual and population health, very little research has focussed on risk stratification or interventions for women with previous GDM.

GDM is typically diagnosed at 24-28 weeks of pregnancy using an oral glucose tolerance test. However, some women meet the criteria for gestational diabetes earlier in pregnancy, with evidence of hyperglycaemia from the first trimester (Early GDM). Previous work in Professor Meek’s group in the Leicester Diabetes Centre using a secondary analysis of the DiGest clinical trial population suggests that women with Early GDM have increased risk of prediabetes or type 2 diabetes postnatally, suggesting that they could be prioritised for early intervention efforts. However, this has not been assessed in a large multi-ethnic clinical population.

Aims: This project will assess if Early GDM is associated with increased risk of prediabetes or early-onset type 2 diabetes in clinical practice, using assessment of real-world data, systematic review and clinical trial data.

Impact: Improved risk stratification could support tailored intervention strategies to reduce risk of EOT2D after GDM.

Contraception, ethnicity and pre-pregnancy planning in women with early onset type 2 diabetes (EOT2D)

Supervisors: Professor Claire Meek (cm881@leicester.ac.uk), Professor Melanie Davies (mjd34@leicester.ac.uk) and Dr Michelle Hadjiconstantinou (mh333@leicester.ac.uk)

Background: Pregnancy in women with early onset type 2 diabetes (EOT2D) is increasingly common, but clinical outcomes are often suboptimal. Around 30% of affected women have a miscarriage and if glucose levels are high at conception, a further 10% experience a late stillbirth or neonatal death. Diabetes and obesity are also both risk factors for maternal death in pregnancy, a rare but catastrophic outcome for the whole family. Tragically, maternal and perinatal deaths occur more commonly in people in low-income families or from Black or Asian backgrounds.

Despite the high risks of having a pregnancy with EOT2D, many women do not choose to take contraception. Contraception can be used to prevent pregnancy entirely, or to provide time for optimisation of glycaemia and weight, in order to have a safer, planned pregnancy later. We hypothesise that different attitudes towards contraception may contribute to inequalities in pregnancy outcomes in women from different ethnic and socioeconomic groups.

Aims: This project will assess attitudes towards family size, contraception and pregnancy planning in women with EOT2D using assessment of real-world data, systematic review and qualitative interviewing.

Impact: A more nuanced, culturally-sensitive understanding of barriers to contraception in women with EOT2D will allow clinicians to provide relevant health information and more equitable care in future.

Continuous glucose monitoring and neonatal complications in women with type 1 diabetes in pregnancy

Supervisors: Professor Claire Meek (cm881@leicester.ac.uk), Professor Elaine Boyle (eb124@leicester.ac.uk) and Professor Tilly Pillay (tp170@leicester.ac.uk)

Background: Women with type 1 diabetes (T1D) in pregnancy are at increased risk of suboptimal perinatal outcomes. Affected neonates are more likely to develop neonatal hypoglycaemia, a common cause of admission to the neonatal intensive care unit (NICU). The accurate diagnosis and management of neonatal hypoglycaemia is essential, as untreated, it is associated with metabolic sequelae and neurocognitive dysfunction in later life.

In the NHS, infants of mothers with diabetes are screened for neonatal hypoglycaemia three times in the first 24 hours after birth, using heel-prick capillary glucose testing. However, recent work in Professor Meek’s team in the Leicester Diabetes Centre suggested that this strategy may miss episodes of hypoglycaemia. The team identified that continuous glucose monitoring (CGM), a novel technology, could improve the identification of neonatal hypoglycaemia. Indeed, CGM could also have a role in prevention of hypoglycaemia in the highest-risk infants.

The aim of this project is to identify if CGM could be used to prevent neonatal hypoglycaemia after a pregnancy affected by T1D. In partnership with the department of neonatology, the study will involve qualitative work to ascertain if CGM is acceptable to parents and HCPs involved in neonatal care, and a pilot randomised, controlled trial using CGM to prevent neonatal hypoglycaemia.

Pharmacotherapy and lifestyle interventions, alone or in combination, for the management of obesity

Supervisors: Dr Dimitris Papamargaritis (dp421@le.ac.uk), Professor David Webb (david.webb@uhl-tr.nhs.uk), Professor Melanie Davies (melanie.davies@uhl-tr.nhs.uk) and Professor Shahrad Taheri (st607@leicester.ac.uk)

The prevalence of obesity – a major risk factor for several long-term conditions such diabetes and cardiovascular disease – is increasing rapidly. Lifestyle interventions such as physical activity and low energy diets are considered first-line obesity management strategies, although weight loss is often less than expected and can be challenging to maintain. Newer generations of weight loss therapies are emerging and are achieving weight loss which rivals surgical approaches, but with potential for much greater scalability. However, their impact on a range of wider health outcomes such as vascular health, cardiac function, obstructive sleep apnoea, and fertility requires investigation. Furthermore, the effectiveness of these therapies alone and in combination with lifestyle interventions across diverse populations that vary in age, ethnicity, and disease status remain unclear. This project will include a range of research methodologies including evidence synthesis/systematic reviews, analysis of existing datasets (from real-world evidence and previous clinical trials), and experimental medicine through existing clinical trials, including the OPAL trial.

General Practice

Evaluating and Optimising Weight Loss Interventions in Primary Care for Patients with Type 2 Diabetes and Obesity.

Supervisor: Professor Samuel Seidu (sis11@leicester.ac.uk)

This academic clinical fellowship is dedicated to assessing the availability and effectiveness of weight loss interventions within the primary care setting, with a particular focus on patients who have both Type 2 diabetes (T2D) and obesity. The research aims to evaluate and optimise current weight management strategies, including both pharmacological treatments such as GLP-1 receptor agonists and non-pharmacological approaches like lifestyle modifications and behavioural therapies. By analysing the effectiveness of these interventions, the project seeks to identify which strategies are most successful in achieving and maintaining weight loss, thereby improving glycaemic control and overall health outcomes in patients with T2D and obesity. The fellowship will explore how these interventions can be tailored and integrated into community-based models of care, ensuring that they are both accessible and culturally sensitive. This approach acknowledges the diverse needs of patients in primary care and aims to design comprehensive care models that can be sustainably implemented at the community level. The ultimate goal is to develop effective, patient-centred weight management programmes that not only address obesity and its associated health risks but also enhance the management of Type 2 diabetes, reducing the burden of these interrelated conditions on both patients and healthcare systems.

Optimising Type 2 Diabetes Management in people with chronic kidney disease: Cost-Effective Continuous Glucose Monitoring Across Diverse Phenotypes and Health Outcomes

Supervisor: Professor Samuel Seidu (sis11@leicester.ac.uk)

This academic clinical fellowship focuses on evaluating the cost-effectiveness of continuous glucose monitoring (CGM) across various phenotypes of Type 2 diabetes and chronic kidney disease (CKD), particularly within diverse and underserved populations. The research will investigate how CGM technology, by enabling real-time glucose monitoring and data-driven insights, can enhance the management of both Type 2 diabetes and CKD through personalised interventions tailored to individual patient needs. By examining the economic impact of widespread CGM adoption, including potential reductions in long-term healthcare costs and improvements in quality of life, this project aims to demonstrate the value of CGM in improving personalised care and mitigating disparities in outcomes for these chronic conditions. The aim is to provide evidence supporting the integration of CGM as a cost-effective tool in the comprehensive management of both Type 2 diabetes and CKD, especially for those at increased risk of complications due to socio-economic challenges.

Investigating the Impact of Pharmacological Agents on Glycaemic Control in Afro-Caribbean Individuals with Type 2 Diabetes in the UK, Focusing on Chronic Kidney Disease and Cardiovascular Disease.

Supervisor: Professor Samuel Seidu (sis11@leicester.ac.uk)

This academic clinical fellowship is dedicated to investigating the impact of different pharmacological agents on glycaemic control within the Afro-Caribbean population in the UK. The research will focus on understanding how various diabetes medications influence glycaemic outcomes, considering the unique genetic, physiological, and socio-economic factors that affect this population. Through a combination of epidemiological studies, clinical trials, and community-based research, the project aims to identify the most effective and culturally appropriate pharmacological interventions for managing Type 2 diabetes in Afro-Caribbean individuals. The goal is to develop tailored treatment strategies that improve glycaemic control and reduce the risk of complications in this underserved population.

Implementation of comprehensive geriatric assessment (CGA) in primary care settings: a realist evaluation

Supervisors: Dr Lucy Beishon (lb330@leicester.ac.uk), Dr Sion Scott (s.scott@leicester.ac.uk), Professor Gregory Maniatopoulous (gregory.maniatopoulos@leicester.ac.uk) and Dr Harini Sathnapally (hw326@leicester.ac.uk)

Comprehensive Geriatric Assessment (CGA) is a holistic care model that uses a multidisciplinary approach to assess medical, psychological and social function to provide coordinated and integrated care and treatment for older people. CGA improves the number of people living at home after discharge from acute hospitals, and quality of life, reducing care-giver burden. CGA is also cost-effective in community and ambulatory settings. The James Lind Alliance research priorities for older people with multiple conditions highlight the need to trial CGA in other care settings. The British Geriatrics Society have produced a comprehensive toolkit to support primary care providers to deliver CGA into primary care services. However, there is no guidance regarding how to implement the toolkit into existing service(s) and as such, its implementation in primary care settings has not been evaluated.

A realist evaluation methodology framework will be employed to understand the conditions affecting the implementation of CGA in primary care settings. Realist evaluation is a theory-driven approach to evaluation that aims to explain why interventions work (or not), for whom, and under which circumstance. In so doing, the project will explore the contextual factors and mechanisms that affect implementation and outcomes and develop a package to support primary care organisations to implement CGA in primary care settings.

ImPreSs-Care Study

Supervisors: Dr Lucy Beishon (lb330@le.ac.uk) and Professor Tom Robinson (tgr2@leicester.ac.uk)

People of all ages with serious mental illness experience reduced life expectancy compared to the general population known as “the stolen years”. Older people have a number of unique physical health challenges due to higher rates of frailty, cognitive and physical impairments, multimorbidity, polypharmacy and complex social needs. Mental and physical health services are fragmented, and access to physical healthcare remains patchy across the country.

The ImPreSs-Care study is a mixed methods study using a combination of qualitative, semi-structured interviews and a large quantitative dataset from NHS England to develop service recommendations to improve access to physical healthcare for older people in mental health settings. This project is in collaboration with Age UK, University of Loughborough and Nottingham with opportunities to model different pathways of care for polder people. Within this project there is scope to investigate a number of related themes including but not limited to:

Deprescribing approaches to physical health medications in mental health settings;
Managing frailty and multimorbidity in mental health settings;
Advanced care planning and end of life care;
Use of digital technologies and improving care transitions.

Understanding the facilitators and barriers to clinical trial recruitment in an integrated care setting

Supervisors: Dr Rupert Major (rwlm2@le.ac.uk), Professor James Burton (jb343@leicester.ac.uk) and Dr Nil Sanganee.

The Leicester, Leicestershire and RUtland Chronic Kidney Disease Integrated Care Delivery Project (LUCID) is a national-leading, Leicester, Leicestershire and Rutland (LLR) integrated care system-wide project to embed early disease management for individuals living with CKD and other long-term conditions. Understanding the facilitators and barriers to implementation of integrated care, including clinical research, remains poorly understood despite being central to the NHS Long Term Plan.

The Clinical Fellow would work within the Social Science APPlied Healthcare and Improvement REsearch (SAPPHIRE) group to study the facilitators and barriers to implementing clinical research into an integrated care. There would be additional opportunities to develop the Fellow’s skills in clinical trials including recruitment into multi-centred trials in CKD including vasculitis and IgA nephropathy. This project would be suitable for a Renal Medicine or General Practice Fellow and would form a strong foundation to a future, externally funded higher degree clinical fellowship.

General Surgery

Decision-making for pouch surgery in patients with Ulcerative Colitis

Supervisor: Dr Farhad Peerally (m.f.peerally@leicester.ac.uk)

This study aims to investigate the decision-making process for ileal pouch-anal anastomosis (IPAA) in ulcerative colitis (UC) patients, focusing on standardizing assessment criteria and improving patient outcomes. The research will employ a mixed-methods approach, combining quantitative analysis of surgical outcomes with qualitative health services research.

Objectives:

Develop standardized criteria for patient eligibility and pouch assessment
Evaluate the impact of surgical volume on IPAA outcomes
Assess short- and long-term quality of life post-IPAA
Explore patient experiences and support needs in the community

Methods:

Multi-centre retrospective analysis of IPAA procedures and outcomes
Qualitative interviews with patients, surgeons, and multidisciplinary team members

Expected outcomes:

Development of a standardized assessment tool for IPAA candidacy.
Evidence-based criteria for IPAA patient selection and assessment
Recommendations for optimizing IPAA service delivery
Improved understanding of patient experiences and support need

This research will contribute to the standardization of IPAA care, improving surgical outcomes and patient quality of life. The findings will inform clinical practice guidelines and health service delivery models for UC patients considering IPAA.

Breast Surgery

Supervisors: Mr Tim Rattay (tr104@le.ac.uk), Professor Christopher Talbot (cjt14@le.ac.uk) and Ms Monika Kaushik (Monika.Kaushik@uhl-tr.nhs.uk)

Breast surgery at Leicester has a track record in survivorship research and the investigation of long-term effects of treatment. Thankfully, breast cancer survival in the UK is high. Our research is designed to help breast cancer survivors the best possible long-term outcomes with minimal treatment side-effects. With major funding from Innovate UK and Horizon Europe, we have recruited a large follow-up cohort of over 2,000 breast cancer patients with available clinical, treatment, genomic, toxicity and survival data, and we are currently involved in a multi-national study of developing an AI application to predict side-effects from surgery and radiotherapy to inform patients of their individual risk. Our research is supported by the NIHR Leicester Biomedical Research Centre cancer theme, bringing together academics at the University of Leicester and clinicians from University Hospitals of Leicester NHS Trust.

Successful applicants in General Surgery will be able to choose from a range of research projects going on in Leicester using a range of research methodologies. Examples include:

epidemiological studies of breast cancer survivors;
genetic association studies of treatment outcomes;
qualitative research in survivorship;
randomised-controlled trials of supportive interventions including psychological support;
application of AI and machine learning to prediction and risk modelling.

ACFs in Breast Surgery will have the opportunity to collaborate with other researchers from across the University, in particular the Departments of Psychology, Computer Science and Mathematics, Genetics, Genomics and Cancer Sciences, and Population Health Sciences. The supervisory team have an established track record of hosting ACFs, MD/PhD students, and research fellows, and full research training and support will be provided.

Geriatric Medicine

Minimising morbidity in acute intracerebral haemorrhage

Supervisor: Jatinder Minhas (jm591@leicester.ac.uk)

The increase in stroke burden is attributed to a combination of population growth and an increasing ageing population. Age is a non-modifiable risk factor for stroke and people aged over 80 have an increased risk of frailty and multiple co-morbidities leading to more severe strokes and more complex management. Acute intracerebral haemorrhage (ICH) is a stroke sub-type with higher morbidity and mortality. This ACF will build on learnings from inter-disciplinary studies assessing escalations of care, adverse physiological changes early in ICH, therapeutic variation and novel interventions to improve outcome. Most recently, the team have been exploring the development of remote ischaemic lesions post ICH (Study Details | Ischaemic Lesions in Acute Intracerebral Haemorrhage | ClinicalTrials.gov).

The ACF will work within the Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Group in Leicester. The ACF will develop expertise in transcranial Doppler ultrasound, logistic modelling and assessing cerebral autoregulation in acute cerebrovascular disease states.

The CHiASM investigators have an established record with high-impact publications, Fellowships and grants. The research environment is well developed with a demonstrated track record of development from ACF to Clinical Lectureships via externally funded Fellowships.

Implementation of comprehensive geriatric assessment (CGA) in primary care settings: a realist evaluation

Supervisors: Dr Lucy Beishon (lb330@leicester.ac.uk), Sion Scott (s.scott@leicester.ac.uk), Professor Gregory Maniatopoulous (gregory.maniatopoulos@leicester.ac.uk) and Dr Harini Sathnapally (hw326@leicester.ac.uk)

ImPreSs-Care Study

Supervisors: Dr Lucy Beishon (lb330@le.ac.uk) and Professor Tom Robinson (tgr2@leicester.ac.uk)

Deprescribing approaches to physical health medications in mental health settings;
Managing frailty and multimorbidity in mental health settings;
Advanced care planning and end of life care;
Use of digital technologies and improving care transitions.

Haematology

Determinants of response to immunotherapeutic strategies in aggressive lymphomas

Supervisors: Dr Matthew Ahearne (mja40@leicester.ac.uk), Dr Harriet Walter (hw191@leicester.ac.uk) and Professor Martin Dyer (mjsd1@leicester.ac.uk)

Targeting of tumour antigens with T cell engagers is a recognised cancer treatment strategy in B cell malignancies. Whilst CD20xCD3 bispecific antibodies and CD19 CAR T-cell therapies have transformed clinical outcome in relapsed/refractory disease, the clinical determinants of response and optimal sequencing strategies remain unknown. Multiple studies are ongoing to assess activity in combination and in earlier treatment settings.

Additional studies are required to understand how target antigen expression affects response and how antigen loss through cell surface remodelling and/or mutations can result in resistance. Importantly, the tumour cell surface is central to interactions with the microenvironment and is thus key to diagnosis, biological understanding, and revealing new strategies for immunotherapeutic strategies.

Aligning to existing workflows and outputs from the Dyer/Walter/Ahearne laboratory, the Fellow will explore longitudinal dynamic changes in target antigen expression during treatment using multi-omic approaches. The following methodologies will be applied:

Multicolour flow cytometry
Unbiased cell surface proteomics
Imaging of the immune synapse
RNA sequencing
WES

The Fellow will have the opportunity to enhance and apply computational skills by working with pre-collected datasets, data generated from wet lab experiments, and clinical datasets, all of which can be aligned with their specific skills, experience, and interests.

Liquid biopsy for aggressive lymphoma

Supervisors: Dr Matthew Ahearne (mja40@leicester.ac.uk), Dr Harriet Walter (hw191@leicester.ac.uk) and Professor Martin Dyer (mjsd1@leicester.ac.uk)

Improving outcomes in aggressive lymphoma requires tools to detect and track molecular changes during therapy, enabling early prediction of therapy response and the implementation of precision medicine strategies.

Circulating tumour DNA (ctDNA), often called “liquid biopsies”, shows significant promise for non-invasive molecular profiling. Liquid biopsies can be easily repeated during therapy, allowing treatment to be tailored to individual patients.

Building on Leicester’s established expertise in ctDNA, our research aims to develop and validate novel ctDNA-based tests to predict lymphoma relapse, identify mechanisms of resistance, and personalize lymphoma treatment. An ongoing ctDNA project in T-cell lymphoma, supported by recent MRC funding, will also extend to a further study starting in 2025 focused on improving the diagnosis of lymphoma in acutely unwell patients using liquid biopsy techniques.

The successful Fellow will leverage these and other ctDNA datasets to investigate several key research themes, including:

Clinical utility of liquid biopsy versus conventional diagnostic testing.
Modelling clinical risk prediction using longitudinal analysis
Enhanced ctDNA detection through computational enrichment
Integration of multi-modal ctDNA detection approaches (mutation panel, shallow whole genome, methylation)

The research plan can be tailored to align with the Fellow’s specific interests and skill set. This project will enable the Fellow to generate preliminary data, forming the foundation of a PhD/MD fellowship.

Medical Microbiology and Infectious Diseases

Disentangling environmental, demographic and biological factors associated with transmission of SARS-CoV-2 in the households of healthcare workers

Supervisors: Professor Manish Pareek (manish.pareek@leicester.ac.uk), Professor Michael Barer (mrb19@leicester.ac.uk) and Dr Daniel Pan (dp440@leicester.ac.uk)

Transmission of SARS-CoV-2 continues to occur in highly vaccinated populations. Current vaccines against COVID-19 help reduce the impact of severe disease, but not the risk of infection or transmission.

Our group has developed a new technology to identify those who are most infectious with SARS-CoV-2, involving the use of specialised strips embedded within duckbilled facemasks (termed facemask sampling, FMS). Analysis of viral load from FMS shows a stronger relationship to household transmission in pilot studies, compared to upper respiratory tract sampling (URTS). Transmission of respiratory viruses however, is complex and depends on a combination of host, environmental and biological factors.

The ACF will undertake two main projects:

Systematic review and meta-analysis, investigating what are the main contributors to transmission of SARS-CoV-2 within highly vaccinated and infected populations.
Analysis of a routine household transmission study dataset containing FMS and URTS viral load, identify their contribution to transmission.

Ultimately, this data will be used to submit an application for a doctoral research fellowship. Analysis of the above data will identify key factors that are under-investigated so far – eg, host immunity in exhaled breath/mucosa; ethnic differences in household size; or quality of ventilation within the households. The candidate will then design a transmission study taking these factors into account in their application.

Understanding ethnic differences in the risk of SARS-CoV-2 breakthrough infection using analysis of SARS-CoV-2 antibody neutralisation assays

Supervisors: Professor Manish Pareek (manish.pareek@leicester.ac.uk) and Dr Christopher Martin (cm712@leicester.ac.uk)

SARS-CoV-2 continues to cause breakthrough infection, despite high levels of vaccination and previous infection. This is thought to be due to waning immunity to infection, and the constant emergence of new SARS-CoV-2 variants.

Our group has been on the forefront of research into ethnic differences in SARS-CoV-2 infection. We have a longitudinal dataset of >600 healthcare workers (HCWs) across four years; where repeated immunological measurements have been obtained across a period of one year shortly before, and following the HCW’s booster vaccine.

The ACF will undertake two main projects:

Systematic review and meta-analysis, investigating ethnic differences in the risk of SARS-CoV-2 breakthrough infection and how immunology (quantitative antibodies, neutralisation data, T-cell data and mucosal immunology) may contribute to the differences in these outcomes
Analysis of the routine HCW dataset, to identify key immunological markers of SARS-CoV-2 breakthrough infection across different ethnic groups and how this may contribute to differences in breakthrough infection.

Ultimately, this data will be used to submit an application for a doctoral research fellowship, where the ACF will undertake prospective sampling studies to investigate whether immunological correlates of protection identified in their pilot work could be used to guide when HCWs receive their next booster vaccination.

Ethnic differences in the risk of cardio-metabolic comorbidities in people living with HIV

Supervisors: Professor Manish Pareek (manish.pareek@leicester.ac.uk) and Dr Joshua Nazareth (jn208@leicester.ac.uk)

HIV infection, alongside certain HIV medications, accelerates the development of cardiovascular disease (CVD) compared to HIV negative individuals. Furthermore, persons living with HIV (PLWH) often fail to achieve the evidence-based treatment goals for the prevention of CVD, and the reasons for this are currently poorly understood.

The infectious diseases team in Leicester looks after >1,500 PLWH, which contains a high degree of ethnic diversity. It is well known that those from ethnic minority groups are often at higher risk of cardio-metabolic disease; therefore, identifying and understanding how ethnicity may contribute to cardio-metabolic disease in PLWH is of critical public health importance.

The ACF will undertake two main projects:

Systematic review and meta-analysis, investigating ethnic differences in HIV outcomes and how multimorbidity may contribute to these differences
Analysis of the routine HIV dataset, to identify ethnic differences in HIV outcomes and the reasons for this (including identification of key cardiometabolic comorbidities within our cohort)

Ultimately, this data will be used to submit an application for a doctoral research fellowship, where the ACF will undertake prospective studies to confirm their pilot data findings, and potentially implement a complex intervention to address these differences in outcomes.

Tuberculosis Research

Supervisor: Dr Pranab Haldar (ph62@le.ac.uk)

The Clinical Tuberculosis (TB) research programme at Leicester provides a diverse range opportunities for Academic Clinical Fellows. Projects may be quantitative or qualitative and focus on contributing research that addresses challenges associated with heterogeneity of M.tuberculosis infection. This is manifest in people with TB infection having a variable risk of developing disease in the future as well as those with disease expressing a breadth of clinical phenotypes. The host immune response play is a key driver of heterogeneity that underpins much of the research at Leicester.

Projects are available in the following areas:

Development and evaluation of novel biomarkers to support TB diagnosis and identify those at risk of developing the disease
Evaluating PET-CT as a novel tool for visualising M.tuberculosis infection;
Investigating epidemiological factors that associate with clinical disease expression;
Supporting development of new clinical pathways to improve TB care, including qualitative studies to understand the unmet health needs of this vulnerable patient group.

Development of Phage Therapy for the Treatment of Prosthetic Joint Infections

Supervisors: Dr Melissa Haines(mh508@leicester.ac.uk) and Mr Daniel Howard

Prosthetic Joint Infections (PJIs) are costly to the NHS – approximately £36,000 per infection, and they are difficult-to-treat in the long-term. A new collaboration between the University Hospitals of Leicester Orthopaedics Department and the Leicester Centre for Phage Research aims to support the development of promising alternative treatment options.

Bacteriophages (phages) are a potential alternative treatment for infections caused by bacteria. The clinical use of phages to treat infections is known as phage therapy. Phages are currently being explored globally and the demand for phage therapy is increasing, in countries such as Australia, Belgium, France, Georgia, Poland and the USA. This project aims to bridge the gap between laboratory research/compassionate use and use within the NHS.

The Leicester Centre for Phage Centre has successfully built clinical collections for urinary tract infections, COPD, and C. diff infection. This project will involve building a collection of clinical bacterial strains taken from PJIs, laboratory experiments to find and assess the phages for effective killing of the PJIs from clinical isolate collection, and analysis of implant-associated biofilm breakdown. The resultant phage collection will have to potential to be used clinically.

Obstetrics and Gynaecology

Diet and Lifestyle Intervention in Early Pregnancy to Mitigate the Development of Women with Gestational Diabetes

Supervisor: Professor Bee Tan (bee.k.tan@leicester.ac.uk)

To undertake preliminary research in terms of setting up a research project for a research fellowship leading to a PhD on the topic of Gestational Diabetes.

A systematic review on this topic is in progress and we hope to publish this work soon.

This will form the basis to design a study of diet and lifestyle intervention in early pregnancy to mitigate the development of gestational diabetes in different ethnic groups.

The trainee will:

Actively participate in designing a pilot RCT of diet and lifestyle intervention in early pregnancy (10 to 12 weeks gestation); the specific diet and lifestyle intervention would be based on the outcome of our systematic review. The trainee will also work with statisticians with respect to statistical aspects of the study such as power calculations of the study, what data to be collected and how analysed.
Actively participate in the ethical (as well as other approvals) application process together with supervisor.

Maternal Cardiovascular profiling for precision stratification of pregnant women with early onset type 2 diabetes (EOT2D)

Supervisors: Professor Tommy Mousa (hm282@leicester.ac.uk) and Professor Claire Meek (cm881@leicester.ac.uk)

Background: Diabetes mellitus is one of the most common medical disorders in pregnancy, affecting up to 5% of pregnancies in the United Kingdom (UK). Pregnancy in women with early-onset type 2 diabetes (EOT2D; diagnosis <40 years old) is increasingly common and associated with increased risk of placental-mediated diseases, such as pregnancy-induced hypertension (PIH) and preeclampsia (PET), and features of endothelial dysfunction, even in the absence of obesity or hypertension. This suggests that maladaptation of the cardiovascular system in pregnancy may be an important pathophysiological mechanism in EOT2D.

Aims: This project will assess longitudinal changes in maternal haemodynamics among pregnant women with EOT2D and will evaluate its role in the aetiology of pregnancy complications, as part of a large multicentre observational study (Leicester Diabetes Research Centre project led by Prof Meek; DOMINO study).

Hybrid closed loops and risk of placental-mediated diseases in women with type 1 diabetes (T1D) in pregnancy

Supervisors: Professor Tommy Mousa (hm282@leicester.ac.uk) and Professor Claire Meek (cm881@leicester.ac.uk)

Background: Women with type 1 diabetes (T1D) in pregnancy have increased risk of placental-mediated diseases (Hypertension, pre-eclampsia, fetal growth restriction), preterm delivery, birthweight extremes, congenital anomaly, stillbirth and neonatal death. Hybrid closed loops (HCL), novel automated insulin delivery systems, are now the standard of care for pregnant women with T1D. HCLs improve maternal glycaemia, but their effect upon perinatal outcomes has not been assessed in real-world clinical practice.

Aims: This project will assess the real-world effect of HCL use on perinatal complications, maternal glycaemia and cardiovascular health in women with T1D. This project will be embedded in a large multicentre observational study (Leicester Diabetes Research Centre project led by Prof Meek; DOMINO study) providing opportunities for publications, presentations and to learn about the end-to-end clinical research process.

Ethnic differences in Postpartum haemorrhage

Supervisor: Manjiri Khare (mk537@leicester.ac.uk)

Postpartum haemorrhage is one of the leading causes of maternal mortality and morbidity. Black and Asian women are more likely to die during or after childbirth compared to the Caucasian women.

Differences in iron stores, dietary habits, cultural and social differences may increase risks for postpartum haemorrhage. Risk stratification could be improved by customising to the maternal height, weight, ethnicity, indirect assessments of intravascular and extravascular fluid assessments by non-invasive techniques in labour.

The project will include pregnant women from Asian, Black and White backgrounds over one year. The risk factors, quantification and resuscitation will be included in the comparison for the three groups. There will be a short survey of staff about their knowledge about any differences in the management of postpartum haemorrhage in the different ethnic groups of women. The findings of the study will help in understanding any strategies to reduce the differences in the outcome following postpartum haemorrhage between the various groups and also have a customised approach in management based on the differences.

The project will contribute to the colleges research strategy as this is an innovative approach to the management of postpartum haemorrhage focussing on what matters to transform lives.

Identification of biomarkers to personalise management of uterine cancer

Supervisor: Dr Esther Moss (em321@le.ac.uk)

Uterine cancer is the most common gynaecological cancer in the UK with nearly 10,000 new cases every year. There is great concern that the uterine cancer mortality rate is rising. Reasons for this worrying trend are multifactorial but are impacted by a lack of efficacious treatments for advanced/recurrent disease. There is a need for the identification of biomarkers to guide treatment options for metastatic uterine cancer.

This study will explore the genomic and molecular profile of uterine cancers and drug resistance/sensitivity in order to identify biomarkers that can predict response. This will include collection and analysis of patient samples, multiplex immunofluorescence, and genomic analysis.

The results will give new insights into the potential role of a biomarkers to predict drug response enabling personalisation of uterine cancer management, with a view to improving survival.

Ophthalmology

Natural History Study of Developmental Retinal Disorders in Preparation for Clinical Trials

Supervisors: Dr Mervyn Thomas (mt350@leicester.ac.uk), Dr Zhanhan Tu (zhanhan.tu@leicester.ac.uk) and Artur Boronat (artur.boronat@leicester.ac.uk)

This project proposes a comprehensive natural history study of developmental foveal disorders, aimed at understanding disease progression and identifying critical time points for intervention. By collecting longitudinal data from patients with these disorders, the study will establish a detailed baseline of disease trajectories, which is essential for designing future clinical trials. This data will inform the selection of endpoints, patient stratification criteria, and timing of interventions.

The project will also involve creating a biorepository of patient samples for future genetic and biomarker studies, using state-of-the-art high-resolution imaging techniques for novel biomarker characterization. The ACF will gain valuable experience in longitudinal research, data analysis, and clinical trial preparation, positioning them strongly for fellowship funding in ophthalmology and rare disease research.

Additionally, the ACF will have the opportunity to develop and validate objective core outcome sets (COS) for ophthalmology clinical trials, focusing on high-resolution imaging techniques and patient and public involvement and engagement (PPIE) approaches. Standardising outcome measures across studies will enhance the quality of evidence and ensure patient perspectives are central to trial design and implementation, ultimately improving the relevance and impact of future clinical trials.

Paediatrics

Understanding variation in the use and duration of non-invasive ventilation in paediatric intensive care units across the United Kingdom and Ireland

Supervisor: Dr Sarah Seaton (sarah.seaton@leicester.ac.uk)

Over time there have been changes in the respiratory treatments provided to children in paediatric intensive care units (PICU), moving from use of invasive ventilation towards non-invasive ventilation including high-flow nasal cannula therapy. A recent randomised controlled trial (FIRST-ABC: FIRST-line support for assistance in breathing in children) concluded that amongst children who required non-invasive respiratory support, use of high flow was no worse than CPAP (continuous positive airway pressure) when considering days until the child was free of all respiratory support. However, there are large variations between PICUs in the provision of non-invasive ventilation, with high flow use ranging from 5% to 40% of admissions.

Objective: Explore and quantify the potential reasons for variation in provision of non-invasive ventilation between PICUs

Methods:

Epidemiological analysis of large-scale data routinely collected from PICUs to explore the variation in use of high flow after accounting for differences in the children (e.g. age, diagnosis). Likely statistical approaches could include logistic/binomial regression and hierarchical modelling.
Survey study of each PICU to understand differences in current policies which may explain variation
To explore if variations in use of non-invasive ventilation have led to differences in children’s outcomes (e.g. survival and length of stay)

Identifying novel therapeutic targets in glomerular disease- a multi-omics approach

Supervisors: Professor Jonathan Barratt (jb81@leicester.ac.uk) and Dr Haresh Selvaskandan (hs328@leicester.ac.uk)

Glomerular diseases are an important global cause of kidney failure in children and young adults and there are few effective and safe treatments for most of these diseases. By combining whole gene sequencing, single cell transcriptomics and imaging mass cytometry it is now possible to study complex kidney diseases in an unprecedented level of detail, offering the opportunity to identify novel biochemical pathways associated with disease. In Leicester we have access to an extensive biorepository of clinical samples, from local, national and international studies in glomerular disease and from our collaborators in Paediatric Nephrology. We work closely with the pharmaceutical industry on drug discovery studies, including joint PhD studentships, and have a number of in vivo models available to us to test novel therapies. The ACF will work on a study, in a glomerular disease of their choosing, that combines wet lab -omics training alongside bioinformatic training with our collaborators at The European Bioinformatics Institute (EMBL-EBI), Cambridge. The ACF will be trained by post-doctoral scientists who have extensive experience of training Specialised Foundation Doctors, NIHR ACFs (Adult and Paediatric Nephrology) and NIHR CLs. All completed NIHR ACFs have successfully been awarded personal training Fellowships (MRC, Wellcome Trust, KRUK).

Portable oscillometry in the diagnosis of asthma in children with preschool wheeze

Supervisors: Dr Erol Gaillard (eag15@le.ac.uk), Dr David Lo (dkhl1@le.ac.uk) and Professor Damian Roland (dr98@leicester.ac.uk)

The problem: Severe wheezing attacks are common in preschool children and result in frequent emergency department visits and hospitalizations. This is a significant health care burden worldwide. Our current strategies of management of preschool wheezing disorders are ineffective.

Unmet need: Diagnosis and biomarkers

A key problem is the lack of a diagnostic test because young children are rarely able to perform spirometry. Portable oscillometry is a new technology that shows promise in preschool children. Oscillometry measures airway resistance and impedance and an increase in both parameters is associated with asthma. The test is quick, non-invasive and importantly does not require any effort on the part of the child. Additionally, further phenotyping is required to establish the best way to treat preschool children. Many do not respond to corticosteroids. Objective biomarkers and the assessment of treatable traits including allergic sensitisation, and an assessment of airway infections are needed.

Research plan: Observational study recruiting children with acute preschool wheeze from children’s ED, obtain oscillometry measurements pre and post bronchodilator and phenotype severe preschool wheeze on the basis of blood biomarkers and airway infection to pave the way for a clinical trial.

The ACF will also be expected to complete a systematic review.

This project fits with the research strategy of the Biomedical Research Centre especially with the biomarker and phenotyping in respiratory disease theme and the respiratory infection theme

We hold an NIHR fellowship (data focussed) in the department (Dr Lo) in the field of preschool wheezing. We also have international collaborations with leaders in the field of oscillometry and lead the UK nationally in the implementation of objective testing to diagnose asthma

Congenital diaphragmatic hernia

Supervisor: Dr David Lo (dkhl1@le.ac.uk)

Congenital diaphragmatic hernia (CDH) is a life-threatening congenital anomaly, with an incidence of approximately 1:2,500 live births. Mortality rate remains around 40–50% and in follow-up studies, multiple complications including pulmonary damage, cardiovascular disease, gastro-intestinal disease, failure to thrive, neurocognitive defects and musculoskeletal abnormalities have been described.

Despite this, there is no consensus on how these children should be monitored long-term. Previous follow up studies have also been based on small case series’ and there is limited longitudinal data beyond the first 3-5 years of life.

Objectives:

To describe the current follow-up arrangements for CDH in UK tertiary paediatric centres
To explore long term outcomes relating to CDH in children using a large primary care database linked to hospital data

Methods:

Survey study of UK tertiary centres
Epidemiological study using routinely collected health data

Rationale:

Identify whether there are differences/inequalities in the way children with CDH are managed in the UK.
Describe long-term prognosis of children with CDH from birth to early adulthood
The above information will be utilised to inform the development of consensus guidance for the follow-up of children with CDH

Renal Medicine

Identifying novel therapeutic targets in glomerular disease- a multi-omics approach

Supervisors: Professor Jonathan Barratt (jb81@leicester.ac.uk) and Dr Haresh Selvaskandan (hs328@leicester.ac.uk)

Understanding the clinical utility of regular symptom screening using Patient Reported Outcome Measures (PROMs) in the dialysis population

Supervisors: Professor James Burton (jb343@le.ac.uk) and Dr Katherine Hull (kh326@le.ac.uk)

Dialysis patients have an incredibly high symptom burden, reporting at least 6 and as many as 20 different symptoms. These symptoms are intrusive and affect life participation, as well as being associated with increased rates of depression, hospital admission and mortality.

The SONG-HD study (Standard Outcomes in Nephrology) clearly identified symptom management as of critical importance to patients, caregivers, clinical staff and commissioners of care, but despite this, incorporation of tools that assess the range and impact of symptoms is not routine. The reasons behind this are multifaceted. Using itch as an example; despite the fact that as many as 40% of dialysis patient report moderate to severe itch, with a significant impact on life, 17% of patients do not report this symptom to anyone and nephrologists estimate the number to be <5%.

This project will assess:

The routine use of PROMs (including electronic PROMs) to assess symptom burden and their acceptability to patients and staff
Ways to ensure the clinical information collected is easily available to the clinical decision maker for review
Ongoing use of PROMs to assess response to treatment and evolving symptom burden
The relevance of symptom clusters and optimum treatment for multiple symptoms

Professor Burton is a leading authority in the management of people with advanced chronic kidney disease. He has published research in the field of symptom management, including uraemic pruritis and symptom clusters. He recently joined an international guideline consensus meeting (KDIGO) on symptom management for dialysis patients and has a number of UK collaborators (NHS and industry), including those working towards incorporation of ePROMs into routine practice nationally. As a result, this would be a perfect project to move forward to a PhD Fellowship.

Dr Hull is a member of the NIHR Academy, currently doing her PhD funded through the NIHR. As a second supervisor, she would not only be getting experience in supervision of clinical academic but also be able to offer real insight into the NIHR processes at the ACF stage.

Describe the prevalence and pathophysiology of sleep disordered breathing in people with advanced chronic kidney disease

Supervisors: Professor James Burton (jb343@le.ac.uk) and Dr Daniel March

People on haemodialysis have a very high symptom burden and both sleep and disordered breathing are common and of critical importance to patients. In people with heart failure, sleep apnoea syndrome can be divided into two forms: obstructive sleep apnoea syndrome and central sleep apnoea syndrome, of which CSAS is the most common. Interestingly, the SERVE-HF study showed an increase in mortality and cardiovascular events in individuals with heart failure and reduced ejection fraction assigned to treatment with non-invasive ventilation at night linked to an increase in sudden cardiac death. Given the similarities between people with heart failure and those on dialysis, we postulate that a lack of evidence behind sleep disordered breathing may be contributing to the high levels of sudden cardiac death in the haemodialysis population.

This project will involve assessing the prevalence of sleep disordered breathing on the Leicestershire dialysis units and correlating this with referral and treatment patterns. The academic trainee will also liaise with the sleep service to describe the proportion of dialysis patients with central versus obstructive sleep apnoea diagnosed over the last decade and interrogate their outcomes based on treatment modality.

In summary this project will:

assess the prevalence of sleep disordered breathing in the dialysis population using a systematic screening approach
describe the treatment pathway for those identified with sleep disordered breathing
understand the underlying mechanism of disordered breathing (central vs obstructive)
evaluate the management and potential for elevated risk of sudden cardiac death

Professor Burton is a leading authority in the management of people with advanced chronic kidney disease. He has published research in the field of symptom management, including uraemic pruritis and symptom clusters. He recently joined an international guideline consensus meeting (KDIGO) on symptom management for dialysis patients and has a number of UK collaborators. With Dr March, he is undertaking a systematic review of sleep disordered breathing in the dialysis population and this would be the perfect topic for a PhD project.

Evaluating paradoxical hypertension during ultrafiltration in a large UK haemodialysis cohort

Supervisors: Professor James Burton (jb343@le.ac.uk) and Dr Katherine Hull (kh326@le.ac.uk)

Cardiovascular disease is the leading cause of death for individuals with end-stage kidney disease requiring maintenance haemodialysis. The burden of cardiovascular disease in this population is reflected by the Standardised Outcomes in Nephrology (SONG-HD) initiative identifying cardiovascular disease as a core outcome measure for trials involving individuals on haemodialysis. Although prevalent, traditional risk factors alone do not account for the significant cardiovascular morbidity and mortality in this population.

Blood pressure management of individuals requiring maintenance haemodialysis is challenging due to medication resistance, adherence, co-morbidities, interdialytic weight gain (volume overload), and ultrafiltration during haemodialysis. Symptomatic intradialytic hypotension is a frequent encounter on the dialysis unit. However, a subset of individuals experience intradialytic hypertension and paradoxical rises in their blood pressure during ultrafiltration (i.e. post-ultrafiltration blood pressures greater than pre-ultrafiltration blood pressures). This cohort of individuals are usually asymptomatic and as a result, go largely unnoticed. However, this paradoxical rise in blood pressure has been associated with nearly a 2-fold increase in cardiovascular mortality.

This ACF project provides the opportunity to evaluate the presence of paradoxical hypertension during ultrafiltration in one of the largest haemodialysis cohorts in the UK. This will enable:

the definition of paradoxical hypertension be determined;
identification of associated patient characteristics;
identification of associated cardiovascular outcomes.

This work will enhance our understanding of the factors unique to individuals on haemodialysis that increase cardiovascular morbidity and mortality which are not amenable by standard preventative measures. The observations will be hypothesis generating and help to develop biologically plausible mechanisms for the occurrence of paradoxical hypertension during ultrafiltration, which could be explored and evaluated as a personal fellowship and higher degree following the ACF.

Exploring relationships between cardiovascular disease and muscle wasting (sarcopaenia) in kidney disease

Supervisor: Dr Matthew Graham-Brown (mgb23@le.ac.uk)

Cardiovascular disease remains the leading cause of death for patients with CKD, patients on dialysis and patients with a kidney transplant. This excess cardiovascular risk is driven by clustering of traditional and non-traditional (kidney specific) risk factors for cardiovascular disease. Muscle wasting is common and severe in patients with kidney disease and is thought to directly mediate aspects of cardiovascular health. Exercise, activity and rehabilitation interventions have been shown to improve prognostically powerful measures of cardiovascular disease as well as muscle function, strength and size in patients with kidney disease, but the mechanisms through which these improvements are mediated are not known. One proposed mechanism is microRNA (that are produced by skeletal muscle cells in response to exercise) are packaged in exosomes and are circulated through the cardiovascular system, leading to beneficial cardiovascular adaptations.

Our group has a wealth of data in mature datasets from clinical trials testing exercise interventions in patients on dialysis, patients with CKD and patients with a kidney transplant. These participants have been deeply phenotyped with cardiac MRI scans, muscle MRI and ultrasound scans, physical function tests, strength tests, cardiopulmonary fitness tests and blood profiling.

This project will support a Fellow to explore these data to assess the relationships between imaging, blood biomarkers of cardiovascular disease (including microRNA sequencing should they wish) and measures of muscle function. These data will generate hypotheses for testing in appropriately designed future studies that would form the basis of a PhD/MD Fellowship.

This project is inter-disciplinary, utilising expertise from across the College, including researchers from the new Centre for Muscle Health. It involves a group of patients with multiple long-term health conditions for whom the effects of multi-morbidity are significant and wide-reaching. A Fellow can expect hands-on support with training with all techniques and analysis relevant to the project (including laboratory, imaging and statistical). Significant time will be devoted to supporting the preparation and production of manuscripts for publication and abstracts for national/international presentations.

The research environment we provide will support a successful Fellow to develop the skills they need to explore this area of research as well as pilot data to secure an external doctoral fellowship to further develop their research career.

Optimising cardiovascular pharmacotherapy in end stage kidney disease

Supervisor: Dr Matthew Graham-Brown (mgb23@le.ac.uk)

Cardiovascular disease is the leading cause of death for patients with CKD, patients on dialysis and patients with a kidney transplant. This excess cardiovascular risk is driven by clustering of traditional and non-traditional (kidney specific) risk factors for cardiovascular disease. Heart failure (including patients with heart failure with preserved ejection (HFpEF) fraction and heart failure reduced ejection fraction (HFrEF)) is common for patients with end stage kidney disease (ESKD) on dialysis, but many of the medications that are of proven benefit for these patients (ACE inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, neprilysin inhibitors, SGLT2 inhibitors) can adversely affect renal function, cause critical electrolyte disturbance (particularly hyperkalaemia), or induce side-effects. It is not known what ‘optimal pharmacotherapy’ consists of for patients with ESKD on dialysis, or indeed whether patietns of different cardiovascular phenotype receive different (or appropriate) pharmacotherapy.

In this project the Fellow will use existing datasets of patients from previous clinical trials who have been phenotyped with detailed cardiac MRI scans to describe the different cardiovascular phenotypes of patients with ESKD. They will review and describe the pharmacotherapy that these patients were prescribed and establish current prescribing practice patterns for patients of different phenotype (HFpEF vs HFrEF) and evaluate the extent to which these patterns align to recommendations for prescribed pharmacotherapy for patients with HFrEF or HFpEF. There is also the opportunity to look at adherence to cardiovascular pharmacotherapy in patients on ESKD to see if prescribed medications are actually taken.

This project is inter-disciplinary, utilising expertise from across the College. It involves a group of patients with multiple long-term health conditions for whom the effects of multi-morbidity are significant and wide-reaching. A Fellow can expect hands-on support with training with all techniques and analysis relevant to the project (including laboratory, imaging and statistical). Significant time will be devoted to supporting the preparation and production of manuscripts for publication and abstracts for national/international presentations.

Trauma and Orthopaedics

The relationship between contracture and function in patients with Dupuytren’s disease – further analysis of the DISC (Dupytrens Interventions: Surgery versus Collagenase) trial

Supervisors: Mr Nick Johnson (nj94@le.ac.uk) and Professor Joe Dias (jd96@le.ac.uk)

Dupuytren’s contracture is caused by nodules and cords which pull the fingers towards the palm of the hand. The DISC trial recruited 672 patients who were randomised to surgery (limited fasciectomy) or collagenase injection, and showed that collagenase delivered in an outpatient setting is less effective but more cost-saving than limited fasciectomy. Those treated with collagenase considered the outcome to be acceptable, though not perfect. It is not understood what amount of finger deformity is acceptable to patients with Dupuytrens contracture and what factors influence this.

All patients in the trial had PROMS, clinical photographs and goniometric joint measurements taken at regular intervals. The ACF will join this project to use the large data set from the DISC study to investigate the relationship between deformity, function and other patient factors (eg. age, gender, occupation). In addition, they will carry out work using a visual classification system (from clinical photographs) to assess recurrence and progression rates.

Experience from these projects would allow the ACF to apply for future grants to assess longer term follow up of patients in the DISC study, and to provide useful information to clinicians and patients about disease progression, recurrence rates and when intervention is likely to be required.

Development of Phage Therapy for the Treatment of Prosthetic Joint Infections

Supervisors: Dr Melissa Haines (mh508@leicester.ac.uk) and Mr Daniel Howard

Dynamic measurement of range, rhythm and rate of shoulder motion for evaluating shoulder diseases

Supervisor: Dr Harvinder Pal Singh (hps9@le.ac.uk)

Objective measurement of the shoulder range of movement (ROM) is an important element of assessment for diagnosing shoulder pathology. Measurement of only extremes of movements of the shoulder joint provides a limited picture of the static ability of the joint to move in the orthogonal planes. Exploring alternate, feasible methods to measure the range of movement during the activity can provide greater insight into the total capacity of shoulder function, which can translate into improved recovery from shoulder impairments.

Any mobile phone/ computer camera using Kemtai software has been developed to provide high resolution 3D imaging for a variety of industrial applications. It uses any camera as sensor’s depth camera that generates a speckle pattern and detects the reflections from objects. The accuracy of the software which does not require the attachment of markers to determine limb position has been validated in comparison with marker-based systems. It is therefore possible to develop it further to provide immediate, in-clinic visual feedback to patients on shoulder mechanics pre- and post-surgical intervention. We have conducted a feasibility study on 10 patients with the physiotherapy department to look at the compliance with prescribed physiotherapy and results are encouraging.

The ACF will join this project where we intend to develop a simple yet effective motion detection approach using the mobile phone/ computer camera using Kemtai software, which would enable us to distinguish the movement of a normal shoulder with that of a shoulder with pathology such as arthritis, adhesive capsulitis (also known as frozen shoulder) and impingement syndrome. We will be studying patients and normal volunteers(matched for age and gender) with no previous history of any upper limb disease or pain affecting the shoulder joint. After gaining consent, each participant in the study would have their shoulder movements measured using mobile phone or computer camera virtually using Kemtai software. Statistical analysis would then be carried out to determine if the measurements obtained from the mobile phone or computer camera with Kemtai software can be used to identify and differentiate shoulder diseases, and be used to develop a targeted treatment approach to expedite recovery after shoulder surgery.

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Projects

Projects by topic

Cardiology

Medication compliance in patients with heart failure referred for device therapy

Phenotyping patients with frailty and heart failure

In silico modelling of RCTs of prehabilitation interventions using routinely collected healthcare data

The use of pathway analysis to explore the trajectory of immune cells in inflammageing using bone marrow and myocardial tissue from cardiac surgery patients

Maternal Cardiovascular profiling for precision stratification of pregnant women with early onset type 2 diabetes (EOT2D)

Hybrid closed loops and risk of placental-mediated diseases in women with type 1 diabetes (T1D) in pregnancy.

Understanding progression from asymptomatic type 2 diabetes towards heart failure with preserved ejection fraction through multidimensional phenotyping

Investigating the clinical phenotypes and pathophysiology of uncommon coronary artery diseases

Clinical Education

General Psychiatry

A structured educational program on metabolic monitoring in people with Severe Mental Illness (SMI) for medical students, psychiatry trainees and non-medical staff; and its evaluation

Empathy all specialities

Endocrinology and Diabetes

Understanding progression from asymptomatic type 2 diabetes towards heart failure with preserved ejection fraction through multidimensional phenotyping

Impact of diabetes technology on rates of hypoglycaemia

Targeting obesity in type 1 diabetes

Exploring the use of novel technology in type 2 diabetes management

Physical activity, chronotype and multiple long-term conditions: The Step In Time Project

Preventing early-onset type 2 diabetes (EOT2D) after gestational diabetes mellitus (GDM): improving risk stratification in multi-ethnic populations

Contraception, ethnicity and pre-pregnancy planning in women with early onset type 2 diabetes (EOT2D)

Continuous glucose monitoring and neonatal complications in women with type 1 diabetes in pregnancy

Pharmacotherapy and lifestyle interventions, alone or in combination, for the management of obesity

General Practice

Evaluating and Optimising Weight Loss Interventions in Primary Care for Patients with Type 2 Diabetes and Obesity.

Optimising Type 2 Diabetes Management in people with chronic kidney disease: Cost-Effective Continuous Glucose Monitoring Across Diverse Phenotypes and Health Outcomes

Investigating the Impact of Pharmacological Agents on Glycaemic Control in Afro-Caribbean Individuals with Type 2 Diabetes in the UK, Focusing on Chronic Kidney Disease and Cardiovascular Disease.

Implementation of comprehensive geriatric assessment (CGA) in primary care settings: a realist evaluation

ImPreSs-Care Study