Obsessive compulsive disorder (OCD) affects 1-2 % of the population. It is characterised by intrusive unwanted thoughts and compulsive behaviours that vary in intensity, frequency and character. The standard treatment is cognitive behaviour therapy (CBT) aimed at enabling patients to gain better control of their obsessive thoughts and compulsive acts and therefore spend less time being distracted by them and function more normally in everyday life. Patients may also benefit from medication (serotonin re-uptake inhibitors) which is thought to act on the brain circuitry that is considered abnormal in OCD. However, these treatments are ineffective in up to 40% and symptoms in this subgroup can be sufficiently severe that patients are unable to perform activities of daily living, sustain work or maintain relationships. The English NHS National Specialised Commissioning Group funds services to provide assessment and intensive CBT and pharmacotherapy for such patients. Although these have good results there remains a truly refractory subgroup with significant disability. Deep brain stimulation (DBS) is a technique which has proved safe and very successful in helping people with movement disorders such as Parkinson's disease and dystonia. It is thought to act by modifying abnormal processing in particular brain circuits which are functioning abnormally. DBS has the advantage that stimulation can be adjusted to optimise benefits and minimise adverse effects and it is also reversible in that stimulation can be switched off if the response is unsatisfactory and electrodes can be removed. DBS is now being studied in other disorders such as medically-refractory chronic, severe headache and severe depression. There have been several studies of DBS for OCD and the results suggest that two thirds are helped, although patients remain symptomatic. More research is required to determine the best brain target for DBS and to understand more about the mechanisms of action as this might help us improve upon the current response rate and reduce symptom severity even further. Although CBT will not have previously been effective in these treatment-refractory patients, DBS may reduce symptoms enough to enable them to use CBT more effectively and the combination may result in a better outcome than DBS alone. To address these gaps in our knowledge we have brought together a network of specialist OCD clinicians, leading OCD cognitive neuroscientists and expert DBS clinicians to undertake the first UK study of DBS for severe, medically intractable OCD. We propose to study 6 patients with severe, treatment refractory OCD who will be recruited through the specialised service for severe OCD and who will already have undergone the treatments involved in that care pathway. The study will fully comply with UK clinical governance procedures. The overarching aim is to compare the effects of DBS in two brain areas previously found to reduce OCD symptoms - the ventral striatum /ventral capsule (VS/VC) and the subthalamic nucleus (STN) - in the same patients. We will test the hypothesis, grounded in evidence from cognitive neuroscience, that DBS at both sites is better than either site alone for treating the symptom dimensions of OCD. Specifically, we will employ novel cognitive paradigms and neurophysiological measures of cortical synaptic function to test the hypothesis that VS/VC and STN DBS have different mechanisms of action and that alleviation of OCD symptoms is mediated by improvement in mood/anxiety with VS/VC DBS and by directly interrupting obsessions and compulsions with STN DBS. We will additionally determine whether adjunctive CBT enhances the response to DBS because it provides the cognitive and behavioural skills to optimise their symptom management and thereby improve daily function. At the end of the study the patients will remain on the optimum DBS treatment parameters and will continue to be monitored by our team.

Abstracts are not currently available in GtR for all funded research. This is normally because the abstract was not required at the time of proposal submission, but may be because it included sensitive information such as personal details.

UK policy is for safe, personalised maternity care. However, during COVID-19 tests and visits have been reduced in some places, and some women with worrying symptoms are not going to hospital. Other places are trying new solutions, including remote access technologies. Some Trusts have reduced community maternity services, including home and birthcentre births; barred birth companions in early labour; and separated mothers, babies, and partners during labour, and in neonatal units. There are reports of women giving birth at home without professional help, possibly due to fear of infection, or of family separation. In contrast, the Netherlands has a policy of increased community maternity services during COVID-19. We want to find out how best to provide care for mothers, babies, and partners during and after a pandemic. We will look at what documents and national leads say about service organisation in the UK and the Netherlands, and at women's and parents experiences. We will also look in detail at what happened in 8 UK Trusts during the pandemic. We will find out how their services have been organised during COVID-19, what parents and staff think, and what the outcomes are, including infections. We will then share the findings with key stakeholders to agree a final organisational model that can be used to ensure safe, personalised routine and crisis maternity care, now, and in future. This will include useful resources and links relating to innovative best practices that we find out about during the study.

Our proposal aims to use secondary analysis to provide evidence for user-centred quality improvement in health and social care. It builds on two existing initiatives: 1. An archive of 3000 qualitative video and audio interviews on over 80 topics with users about their health and illness experiences held by the Health Experiences Research Group (HERG), University of Oxford (and disseminated publicly on www.healthtalkonline.org run by the DIPEx Charity) 2. Experience-Based Co-Design (EBCD), a participatory action research approach which actively involves service users in service design and has been implemented in over 60 care services in six different countries since being piloted in 2006. Past evaluations have shown it to be effective in achieving quality improvement and cultural change. Both initiatives include video-recorded in-depth interviews with people talking about their experiences. HERG interviews are nationally collected and wide-ranging, whereas EBCD interviews are collected locally with a more specific focus on 'touchpoints' - key interactions between users and services where quality improvements can be made - in each care setting. In EBCD analysis of these touchpoints is used to create a 'trigger' film which staff and users watch together to start a discussion about improving care locally, before setting up co-design working groups to plan and implement changes together. These two initiatives have already collaborated on a recent study for the National Institute for Health Research (NIHR) which demonstrated EBCD in two care pathways based on secondary analysis of HERG interviews rather than new local interviews worked just as well, saving time and cost. This provides a strong evidence base to propose further secondary analysis to support care organisations seeking to apply experience-based quality improvement in an affordable and timely way across more conditions. We will reanalyse ten of our existing interview collections. In each case the primary research question for the secondary analysis will be: What touchpoints do users identify in their experiences of care where quality could be improved? The HERG collections are generally focused around a particular condition or health topic. However, there is much material in the collections that could inform service settings and integration of care across sectors. Alongside the analysis for touchpoints in each condition, we will also ask: What are the touchpoints for a) outpatient care and b) interactions between health and social care across a range of different conditions which could be used to redesign services? The secondary analyses will involve a researcher going back to the full transcript collection to identify touchpoints. On healthtalkonline, we also have a set of lay summaries identifying key topics of importance to interview participants in each condition (though not specifically analysed for touchpoints). A key further empirical question to ask is therefore: What touchpoints would emerge from a re-analysis of the website summaries, compared to re-analysis of the full transcripts? Can further time savings be made in identifying touchpoints by this method or is too much lost in the process? We will also involve service users in the secondary analysis process, supporting them in analysing both selected transcripts and selected website summaries, and discussing with them similarities and differences in the touchpoints they identify compared to the social science researcher. We will disseminate findings from the secondary analysis in the form of a series of trigger films made in collaboration with the DIPEx Charity, using our existing video recordings to illistrate the touchpoints we identify, and make these available through both www.healthtalkonline.org and the Point of Care Foundation online EBCD toolkit. With the close and active support of NHS England our findings will have a clear route to impact on policy and practice

With a growing ageing population and changes in lifestyles, non-communicable diseases (NCD), e.g. heart disease, diabetes, and cancer, have become extremely prevalent in our society, and the situation is more challenging in UK compared to other developed countries. Population health monitoring is fundamental block for public health services, and profiling population-scale prevalence of multiple NCD across different regions (e.g., building the spatially fine-grained morbidity rate map) is one of the most important tasks. However, traditional public health data collection and prevalence profiling approaches, such as clinic-visit-based data integration and health surveys, are often very costly and time-consuming. This project proposes a novel paradigm, called compressive population health (CPH for short), to reduce the data collection cost during the profiling of prevalence to the maximum extent. The basic idea CPH is that a subset of areas is intelligently selected for data collection and population health profiling in the traditional way, while leveraging inherent data correlations to perform data inference for the rest of the areas. CPH is facilitated by the exploitation of the following types of inherent data correlations found by epidemiologists. (a) Intra-Disease Spatial Correlations. That is, regions are more similar in the prevalence rate of some diseases when they are neighbouring, or share certain common environmental, socioeconomic, and demographical attributes. (b) Inter-Disease Correlations. Multimorbidity, commonly defined as the co-presence of two or more chronic conditions, demonstrates that statistics for different types of disease may also correlate with each other. For example, regions with higher obesity rate are more likely to have higher rates of heart disease and cancers. In order to realize this idea, this project develops three technical work packages to accomplish the following technical goals: (1) Investigate and extract latent data correlations and further utilize them to build learning models for prevalence inference on the target geographical grids. (2) Design intelligent algorithms for selecting traditional-sensed areas for each disease with multi-objective optimization goals including cost, reliability, and latency. (3) Evaluate and interpret the inference results of prevalence rate to ensure the reliability and robustness of the approach. The proposed CPH is a novel solution to a public health data collection challenge enabled by data science and artificial intelligence. It opens the door for a disruptive population health monitoring paradigm with potential significant cost reductions for public health authorities. By closely working with partners from public health sector, including NHS England and Public Health at Warwickshire County Council, we will evaluate the feasibility of this approach based on multiple public health datasets together with relevant demographic/geographic statistics in the same regions.