A new collaboration led by Southampton researchers is aiming to change national policy and practice to routinely assess risk of fractures in the community. Every year over 500,000 older people in the UK suffer breaks due to the weakening of the bones through osteoporosis. This costs over £5 billion annually. Southampton-led research has demonstrated that systematic risk screening through GP surgeries significantly reduces the number of hip fractures. If such an approach were used nationwide, it would substantially impact the burden of fractures on our NHS. The new partnership, led by NIHR Southampton BRC researcher Professor Nicholas Harvey, will disperse the findings of this trial to drive new practice across the UK. It includes the MRC Lifecourse Epidemiology Centre, University of Southampton, University of Sheffield and the UK Royal Osteoporosis Society. Identifying people at high risk The partnership will drive a consultation to gather evidence and produce a policy report. This will highlight the benefits of automated systematic identification of people at high fracture risk in primary care. This project will be delivered with the UK Royal Osteoporosis Society as the lead partner, capitalising on the charity’s substantial expertise and experience of policy work. This includes its key role in the UK All Party Parliamentary Group on Osteoporosis and Bone Health. Professor Nicholas Harvey, Professor of Rheumatology and Clinical Epidemiology & Honorary Consultant Rheumatologist, said: “We are hugely grateful to the Medical Research Foundation for their support of this important work, which gives us a real opportunity to alter UK policy in a way that would achieve a step change in our ability to detect individuals at high fracture risk in the community and thus prevent potentially life changing outcomes in older people.” Screening for osteoporosis The new partnership builds on findings from the MRC-funded Screening for Osteoporosis in Older People (SCOOP) trial, led by the University of Southampton. Recommendations will be presented in a report to policymakers such as the UK Screening Programme Committee and National Institute for Health and Care Excellence. Professor Cyrus Cooper, Director and Professor of Rheumatology, MRC LEC, University of Southampton and President of the International Osteoporosis Foundation, said: “This important collaboration between our academic institutions and the Royal Osteoporosis Society demonstrates the huge value in the synthesis of expertise across academic understanding and policy development, and is entirely congruent with the mission of the International Osteoporosis Foundation, which is delighted to support this work.”

Southampton researchers will lead one of several new national research networks helping tackle challenges in ageing. The MyAge network will focus on pathways of muscle development, differentiation and decline. Over the course of the two-year project, scientists aim to build new directions and collaborations for future research. They will also develop a roadmap of changes that can help people live independently for longer. Bringing experts together Previous reviews of how to boost ageing research in the UK have found efforts to be fragmented, focusing on single aspects of ageing. The 11 new national networks announced this week will become strong platforms to integrate expertise and knowledge. They are funded by the Biotechnology and Biological Sciences Research Council (BBSRC) and Medical Research Council (MRC). MyAge is directed in Southampton by Professor Keith Godfrey, Professor Karen Lillycrop and Professor Peter JS Smith. It is also led by Professor Carolyn Greig (Birmingham), Dr Kambiz Alavian (Imperial College), and Dr Mathew Piasecki (Nottingham). Professor Godfrey, Nutrition Theme Lead in the NIHR Southampton Biomedical Research Centre, said: “Our team is well advanced in exploring why the changes in the muscle energy-producing pathways occur and are looking at nutritional factors that could improve muscle function in later life. MyAge provides an important opportunity to bring together leading researchers in the UK to tackle one of the major influences on multiple long-term conditions in older people.” Remaining healthy in later life One of the most prominent changes associated with ageing is the loss of muscle mass and function. Up to half of muscle mass is lost by the eighth decade of life. This leads to impaired mobility, falls, fractures, physical disability, and serious socioeconomic consequences. Muscle ageing is affected not just by genetic factors, but also by people's physical and social environment. Professor Lillycrop, Professor of Epigenetics at the University of Southampton, said: “Promoting healthy muscle ageing is recognised as a fundamental aspect of helping people to stay in good health as they grow older. Having identified differences in activity in key energy-producing pathways within muscle cells we can now start to develop interventions that will hopefully help many more people to remain active and healthy in later life.” UK as a ‘global research power’ MyAge will combine experts from different disciplines and sectors to understand the fundamental mechanisms behind muscle ageing. The network will work alongside the public, industry partners, charities, policymakers and health practitioners. Professor Smith, Director of the Institute for Life Sciences, said, “This is a fantastic opportunity for the UK Ageing Networks to come together, not only to address the pressing issues of ageing and associated health inequities, but also to identify points of intervention to help us live longer, healthier lives. “This insightful funding from the BBSRC and MRC will reinforce the UK’s role as a global research power in an area of acute socioeconomic need.”

A study led by Southampton researchers has shed new light on the role of the placenta in managing the relationships between maternal vitamin D and foetal development The results, published in the journal eLife, demonstrate a complex interplay between vitamin D and the placenta. They could help inform future initiatives that use vitamin D to support the development of unborn babies and enable women’s bodies to adapt well to pregnancy. Lifelong health benefits As vitamin D is unable to be produced by an unborn baby (a foetus), it must be transferred across the placenta. This is important for both their health in the womb and in later life. Maternal vitamin D concentrations are positively associated with foetal bone growth and birth weight. These associations continue to hold true after birth and as they grow up. Active not passive Previous work has suggested that maternal vitamin D transfers passively across the placenta, but the current study challenges this idea. “Research in kidneys has questioned the role of passive diffusion in the uptake of vitamin D,” explains Dr Claire Simner, Research Assistant at the University of Southampton. “It has instead shown that this uptake is driven primarily by endocytosis of vitamin D, where the vitamin is bound to the binding protein albumin and introduced into the organ tissue cells.” Simner is a co-first author of the study, alongside Dr Brogan Ashley, who was also at the University of Southampton at the time the work was carried out. “We proposed that a similar endocytic mechanism exists in the placenta, suggesting that this organ plays an active role in the delivery of vitamin D to the foetus.” Using real placentas To explore this idea further, the team designed a study to find out how maternal vitamin D is taken up, metabolised and mediates gene expression within the human placenta. They used a perfusion model – involving the use of human placental samples collected from term pregnancies immediately after delivery – and placental fragment cultures to study the behaviour of the organ tissue. These methods contrast with cell-model approaches of previous research into how vitamin D transfers across the placenta. To determine the mechanisms of placental vitamin D uptake, the team incubated fresh term human placental fragments with vitamin D alongside albumin for eight hours. They then analysed the gene expression of the fragments using a technique called quantitative rtPCR. Active uptake with albumin Their analysis revealed a significant increase in the expression of the CYP24A1 gene – which is involved in controlling the amount of vitamin D in the body – in the fragments following incubation, compared to fragments that were incubated with vitamin D only. This suggests that albumin might enable vitamin D uptake. Professor Nicholas Harvey, Professor of Rheumatology and Clinical Epidemiology and NIHR Southampton Biomedical Research Centre researcher, was a co-senior author of the study, alongside Dr Jane Cleal, Lecturer in Epigenetics at the University of Southampton. First to show active transfer Additionally, the team demonstrated that vitamin D exposure leads to rapid effects on the full set of messenger RNA molecules (the transcriptome) and of proteins (the proteome) expressed by the placenta. Their results revealed that the underlying epigenetic landscape of the placenta – the interaction between the genes and the environment – helps to dictate this transcriptional response to vitamin D treatment. “This is the first quantitative study demonstrating the active transfer and metabolism of vitamin D by the human placenta, with widespread effects on the placenta itself,” Dr Cleal concludes. “As our data are generated from term placenta only, additional studies are needed to determine how our findings relate to earlier stages of gestation. “Together, the insights from our work and future research will be helpful for identifying potential new options for targeted interventions to improve pregnancy outcomes.”

Protective personal respirator hoods developed in Southampton have received UK approval for use beyond the COVID-19 pandemic. The PeRSo hood is now certified for all use as PPE by the British Standard Institute. Researchers at Southampton rapidly designed the personal respirator at the start of the pandemic. Widespread hospital use was swiftly approved and thousands have been used since across the UK. Developing a respirator hood The COVID-19 pandemic created a global shortage of personal protective equipment (PPE), particularly facemasks. This combined with the discomfort and maximum one-hour of continuous use of these masks, created extra pressures for frontline teams. Experiencing these challenges first-hand, NIHR Southampton BRC investigator Professor Paul Elkington and his engineering colleague Professor Hywel Morgan took initial sketches for a simple, cost-effective respirator hood to a working prototype in just one week. The prototype was driven into production in under a month. By January 2021, over 10,000 respirators had been provided to NHS Trusts from the south of England to Scotland after it received approval for use during the COVID-19 pandemic. This new certification means it is now an approved method of PPE for all use. Professor Elkington said: “We are delighted that PeRSos have now been fully approved for use beyond the current pandemic. During the second wave, over 3,500 University Hospital Southampton (UHS) staff used a PeRSo, leading to lower staff absence than other hospitals. This showed the benefit of highly effective reusable PPE. “This approval means we will be prepared for any future variant or respiratory pandemic. It is all due to the highly effective collaboration between the hospital, university and local industry underpinned by the BRC.” Effective, sustainable and cost-effective The respirators have a waist-mounted rechargeable battery powered unit. This filters air before blowing it into a hood with a clear visor. A recent study, published in Frontiers in Medical Technology, recommended the hoods as an effective, sustainable and cost-effective form of PPE. It found staff preferred the PeRSo hoods to standard facemasks. They reported feeling safer and more comfortable. Patients also preferred the hoods as they could see their carers’ faces, making communication much easier. Further analysis showed widespread PeRSo use to be cost-saving after only ten weeks. As they are reusable, the hoods are better for the environment. They were also not affected by supply chain issues like disposable facemasks.

Southampton researchers have made a breakthrough in Chlamydia genetics. The findings overcome a significant challenge in the field and pave the way for future research that can inform new vaccines or new treatments. The project, led by the University of Southampton, included support from NIHR Southampton Biomedical Research Centre researcher Dr David Cleary. The multi-team effort combined expertise from Southampton’s Chlamydia Research Group, the WISH Laboratory, the Wellcome Trust Sanger Institute and Duquesne University. Challenges of confronting Chlamydia Chlamydia is the most common bacterial sexually transmitted infection. It causes infertility, pelvic inflammatory disease and chronic pain in women around the world. It is also the most prevalent cause of infectious blindness in developing countries. The best hope to prevent its ongoing spread is through vaccination. However, research in understanding the bacterium’s biology has been hampered by its unusual developmental cycle. It only grows inside human cells, raising specific technical challenges that make it harder to study. As a result, scientists have had difficulty in delivering DNA to the bacterial cells – a process that makes analysing gene function much easier. ‘Jumping’ into the genome In a new study, Southampton researchers introduced a new technique to Chlamydia research. It is called Transposon Directed Insertion Site Sequencing (TraDIS). This method allows small pieces of DNA to “jump” into the bacterium’s genome at a specific time point in the Chlamydia growth cycle. These then randomly mutate and inactivate genes. Working with Dr Jade Forster in the Southampton WISH lab, the team applied cutting edge sequencing technology to identify the genes that were mutated. The study identified 36 unique mutated sites within the Chlamydia genome, gaining proof of principle of the methodology. The findings will inspire further studies that assess which genes are essential to survival under different growth conditions. Finding targets for vaccine development The study was funded by the Wellcome Trust and published in Wellcome Open Research. Dr Colette O’Neill, study lead, said: “Our work is the first mutagenesis approach that will enable us to mutate each and every gene in the chlamydial genome using a jumping gene called a transposon. “This will hopefully give us more information on the genes of this important human pathogen, so we can identify which are essential for growth and therefore can become a target for vaccine development or new treatments.” The success of this project has led to a three-year grant from the Wellcome Trust to refine the technique. This will share the mutants through the Chlamydia Biobank established in Southampton. Image credit: Rachel Skilton Confocal microscope image of immunofluorescently stained Chlamydia-infected eukaryotic cells. Green = chlamydia; blue = eukaryotic cell DNA; red = eukaryotic cell membrane.

Professor Mike Grocott, Director Designate of Southampton NIHR Biomedical Research Centre (BRC), has once again been recognised as one of the most prominent health researchers in the UK. Professor Grocott has been re-appointed as an NIHR Senior Investigator. The prestigious honour from the National Institute for Health Research (NIHR) underlines his status as an outstanding leader of patient and people-based research. He is one of only 200 members of the NIHR College of Senior Investigators. The College includes seven other senior researchers from Southampton. Professor Grocott is an international leader in Perioperative Medicine, the medical care of patients from contemplating surgery until full recovery. Optimising surgery and critical care More than five million surgical procedures are performed in the UK every year. These account for a third of hospital admissions and 18% of deaths. UK critical care units admit 300,000 patients annually with a mortality of 25%. Demand is increasing for surgery and critical care. For the past decade Professor Grocott has driven anaesthesia, perioperative and critical care research within Southampton with a particular focus on experimental medicine. The research is helping reduce death and minimise harm through individualised care and shared decision making. The programme has grown into the Perioperative and Critical Care theme within the planned 2022-27 NIHR Southampton BRC. Professor Grocott, Professor of Anaesthesia and Critical Care Medicine at the University of Southampton and Consultant in Critical Care Medicine at University Hospital Southampton, said: “I am honoured to receive this personal recognition from the NIHR. It reflects the pioneering work that we are growing at NIHR Southampton BRC. We are determined to continue growing this high-achieving research culture across our themes in the coming years. “Working closely together with patients and the public, we will drive research that is ever-more relevant to people’s needs, delivered faster and adopted more readily.” Triple Southampton success Professor Grocott is one of three Southampton researchers to be selected in the 15th NIHR Senior Investigators Competition. Professor Peter Griffiths has been re-appointed as a senior leader, while Professor Catherine Bowen has been recognised for the first time. Their terms will last until March 2026. NIHR Senior Investigator responsibility brings an enhanced role in providing thought leadership and support in developing the UK’s research capacity. There are eight current NIHR Senior Investigators based in Southampton. They include professors Saul Faust, Keith Godfrey, Robert Read and Alison Richardson from NIHR Southampton BRC.

New research suggests breastfeeding could help protect against long-lasting health issues in children whose mothers have gestational diabetes. Prof Keith Godfrey was part of a study in Singapore which found six-year-olds whose mothers had diabetes in pregnancy had less fat in their muscles and liver, and lower blood fat levels if they were breastfed. The findings have been published in the European Journal of Nutrition. Breastmilk different after gestational diabetes Gestational diabetes develops during pregnancy, causing high blood sugar. It happens when the woman’s body is unable to produce enough insulin – a hormone which helps control blood sugar – to counteract the extra demands of pregnancy hormones, making it hard for the body to use insulin properly. The condition can cause problems for the woman and baby during pregnancy and after birth. Some research has suggested the baby may be more likely to develop diabetes or become obese later in life. However, the risks of gestational diabetes can be reduced if the condition is detected early and well managed. Mothers’ bodies adjust breastmilk according to their baby’s needs, changing for example at different stages of development. It is known to be different in women with gestational diabetes, but whether this difference helps the baby’s growth and development was unclear. Less fat in breastfed children The researchers used data from the Growing up in Singapore Towards Healthy Outcomes (GUSTO) cohort, following a group of mothers during pregnancy and their children from birth. They studied 827 babies, all born around their due date, and their mothers. They used fasting plasma glucose (FPG) - part of the standard test for gestational diabetes - to measure the mothers’ blood sugar levels and their body’s ability to control it. They assigned each mother-child pair to either a ‘low’ or ‘high/intermediate’ group, depending how often they breastfed and whether they also gave formula milk. When the child was six years old, they used magnetic resonance imaging (MRI) scans to measure the amount of fat in their abdomen, muscles and liver. They also measured their body’s response to insulin, their total body fat, the amount of fats in their blood and their blood pressure. Children who had been breastfed more had lower levels of fat in their muscles, liver and blood. Prof Godfrey, Professor of Epidemiology & Human Development at the University of Southampton and nutrition theme lead at the NIHR Southampton Biomedical Research Centre, said: “This research adds to the evidence that breastfeeding can help prevent childhood obesity. It shows it may even help to counteract the long-term effects that gestational diabetes can have on a child’s health.”

The asthma, allergy and immunology service in Southampton has once again been named as a World Centre of Excellence for clinical innovation and research. The endorsement means Southampton will continue to lead training, research and education internationally until 2026. The recognition comes from the World Allergy Organisation. A number of the centre’s experts drive cutting-edge research in the NIHR Southampton Biomedical Research Centre and its Respiratory and Allergy theme. The University Hospital Southampton (UHS) department is one of the largest allergy and immunology centres in the country. It was the first centre in the world to be awarded Centre of Excellence status in 2014. Asthma and allergy research The department has an extensive research programme alongside hospital care. This aims to discover new ways to prevent the development of asthma and allergy, as well as finding better treatments for sufferers. Projects include studying the effects of both genetic and environmental factors and how changes in the make-up of genes can play a role in altering the risk of allergic disease to see how the process could be reversed. Partners at the University of Southampton also offer one of only two MSc Allergy programmes in the world. It is the only one that is fully online and provides quality education for healthcare professionals, which is core to delivering quality clinical care for patients with allergy. Three decades of excellence The renewal bid was led by Professor Hasan Arshad with Dr Mich Lajeunesse and Professors Graham Roberts and Judith Holloway. Professor Arshad, a UHS consultant and chair of allergy and clinical immunology at the University of Southampton, said: “Southampton allergy experts have been at the forefront of the field for more than 30 years. We are in a unique position to be able to take our basic scientific discoveries through clinical trials and into the patient clinic. “We are delighted to be named as a world centre of excellence, which is a testament to the hard work of our researchers and clinicians who are dedicated to improving patient care and research.”

Researchers have found that people who often sleep badly could be more likely to develop non-alcoholic fatty liver disease (NAFLD). Prof Christopher Byrne from the NIHR Southampton Biomedical Research Centre contributed to the large South Korean study. The results, published in the Journal of Personalized Medicine, show getting a better night’s sleep may help protect against NAFLD. Preventing liver disease NAFLD is the term for a range of conditions caused by a build-up of fat in the liver. Usually seen in people who are overweight or obese, it’s estimated to affect around 25% of the world’s population. It has four stages, where the liver becomes progressively more damaged. The first stage, steatosis, involves a largely harmless build-up of fat in the liver. Most people do not know they have it. However, if untreated it can progress to more serious stages. Non-alcoholic steatohepatitis (NASH) sees the liver become inflamed. During fibrosis, scar tissue forms around the liver. Cirrhosis, the final stage, is where the liver becomes permanently damaged and stops working properly. Large-scale research Overall, 86,530 Korean adults without NAFLD and or liver scarring took part. The researchers assessed their liver health and sleep quality soon after they joined and an average of 3.6 years later. Participants were asked to complete a survey known as the Pittsburgh Sleep Quality Index at the initial and follow-up sessions. This was used to estimate the amount and quality of their sleep. Both times they had ultrasound scans to look for a build-up of fat in the liver. These scans use high-frequency sound waves to produce images, and are the same as those used in pregnancy. Participants also had a blood test, which was used to estimate liver scarring. Sleep quality affects risk The researchers found 12,127 participants, around 14 percent, had developed steatosis (the first stage of NAFLD). In 559, this had progressed to fibrosis (the third stage). Participants with persistently poor sleep quality were more likely to develop NAFLD, compared to those who usually slept well. Those who slept an hour or more less or had worse sleep quality at the follow-up session than they did at the start were also more at risk. Prof Byrne, Professor of Endocrinology and Metabolism at the University of Southampton and Honorary Consultant Diabetologist & Metabolic Physician, said: “Sleep is extremely important for our health and wellbeing. This large-scale study suggests that prioritising good sleep could be important to help protect against NAFLD, an increasingly common disease.”

Researchers have found people who drink up to three cups of coffee a day could have a healthier heart and a lower risk of dying of any cause. An international team, including NIHR Southampton Biomedical Research Centre’s Prof Nicholas Harvey, assessed the long-term impact of drinking daily coffees. The results, published in the European Journal of Preventive Cardiology, found that between half and three cups a day could be beneficial, showing links between moderate coffee drinking and a healthier heart. Using big data The researchers used data from the UK Biobank, a unique ongoing cohort study comprising half a million UK adults of middle to older age. The information included detailed assessment of many factors such as health, lifestyle, physical activity, medications and diet, including coffee intake. Researchers used this to establish how many cups of coffee, and what type (decaffeinated, ground, instant or other), were usually drank each day. They then linked this information to data on new cardiovascular events, such as a heart attack or related death during the following 11 years. A subset of 30,650 participants had cardiovascular magnetic resonance (CMR) scans – which use a strong magnetic field to create detailed images – to assess the health of their heart. Beneficial effect in moderation The study found that people who drank between half a cup and three cups of coffee each day had a lower risk of death, compared to those who didn’t regularly drink coffee. They also showed signs of having a healthier heart, with the left ventricle having thicker muscular walls and the heart pumping more blood in each beat. Those who drank more than three cups had stronger hearts, but not a lower risk of death. The NHS advises people not to drink more than four cups a day, as it may increase your blood pressure. The study was jointly led by Prof Steffen Petersen from the NIHR Barts Biomedical Research Centre in London and Dr Pál Maurovich-Horvat from Semmelweis University in Budapest. It was funded by the Thematic Excellence Programme of the Ministry for Innovation and Technology in Hungary. Prof Harvey, Professor of Rheumatology and Clinical Epidemiology, and Deputy Director at the MRC Lifecourse Epidemiology Centre, University of Southampton, said: “The findings from this study are intriguing, and provide further support for current recommendations. Further work will be needed to understand whether there is a direct benefit of coffee on health or whether these findings are simply due to the wide range of other health and lifestyle factors associated with coffee drinking, which in turn might influence health outcomes.”

Southampton researchers have found that a variety of psychological and social factors appear to influence older people’s physical activity. We all know exercise is good for our health, but it can be hard to do. In older age being active helps people stay fit, energetic, and independent. Yet adults over the age of 65 spend an average of 10 hours each day sitting or lying down, making them the most inactive age group. New research, led by Dr Wendy Lawrence, Dr Jean Zhang and Dr Ilse Bloom from the NIHR Southampton Biomedical Research Centre and MRC Lifecourse Epidemiology Centre, has identified which factors have the strongest influence on older people to get them exercising more. Exploring what influences older people In 2014, the researchers conducted a series of focus groups with 92 people in Hertfordshire aged between 74 and 83 years. They recorded and transcribed the discussions, and later analysed them to pick out key themes. Their results, published in PLOS ONE, show six key themes that influence older people’s physical activity. These were past life experiences, significant life events, getting older, physical activity environment, psychological/personal factors and social capital. The researchers suggest that initiatives to promote physical activity in older people which build a person’s confidence in their own ability, motivate them and encourage socialising are most likely to succeed. Informing future exercise programmes These findings will help to inform the design of more successful future physical activity programmes aimed at older people. This could help more people to get fit and stay healthy in later life. The researchers also suggest that initiatives are more likely to be successful if the researchers include older people in the design process. Dr Wendy Lawrence, Associate Professor of Health Psychology at the University of Southampton, said: “It’s so important to stay active in later life to maintain health, yet often people do less and less exercise as they get older. “This study identifies some of the factors that appear to be most influential for this age group, allowing programmes to be designed that support people to get up and moving.”

Dr Katrina Cathie and Dr Nisreen Alwan received their MBEs at ceremonies held at Windsor Castle. Dr Nisreen Alwan, Associate Professor in Public Health at the University of Southampton and Honorary Consultant at University Hospital Southampton, was presented with her medal for services to medicine and public health during the pandemic by Prince Charles. It comes after they were included in the Queen’s New Year’s Honours list for 2021 in January. Caring for children during the pandemic Dr Cathie works in general paediatrics, caring for children and families, supporting 24/7 cover on wards and covering outpatient clinics. She developed a specialist interest in children with secondary epilepsy, and now works as part of a multi-disciplinary team which has dramatically improved the service. In the first months of the COVID-19 crisis, she volunteered to be redeployed from research to cover clinical shifts in paediatric and short-stay units, as well as covering colleague sickness and organising new shifts and rotas for the paediatric team. COVID-19 vaccine research During the pandemic, Dr Cathie was quick to apply her knowledge and expertise from vaccine studies in children to help lead research into COVID-19 vaccines. Since the COVID-19 vaccine study was introduced at the University of Southampton (in collaboration with Oxford) she has shared oversight of it. She supports the large team involved from a medical perspective, working with research staff, nurses and fellows from around the region to recruit hundreds of participants to the trials. She helped to spearhead the vaccine project. Since November 2019, she has been the lead principal investigator locally for the Janssen COVID-19 vaccine trial. She is also a member of the paediatric steering group for the national RECOVERY trial, testing non-vaccine treatments for the virus, and part of recruiting children to this study. Dr Cathie said: “It was a wonderful occasion, and I couldn't have achieved it without the support of family, friends and colleagues.” COVID19 testing and long COVID Dr Nisreen Alwan’s persistent scientific and public advocacy has been instrumental in the recognition of Long COVID on a national and international level. Her frequent calls for further resources and investigations into the effects of long COVID have been a prevalent theme of her engagements on social media, mainstream media, webinars and journal articles. Throughout the pandemic, she has also highlighted the role of social factors like ethnicity, gender and deprivation in the pandemic’s impact on individuals and different groups, and the importance of addressing ethnic and socioeconomic inequalities. In Spring 2020, Dr Alwan co-led a proposal of COVID-19 universal weekly testing published in the Lancet which was the critical spark for the saliva testing pilot in Southampton. She was part of the core team developing a partnership between the University of Southampton, Southampton City Council and the NHS to deliver this pilot which has later developed into the Hampshire and Isle of Wight Saliva Testing Programme. Dr Alwan said: “I really enjoyed the day at Windsor Castle, which was made extra special by having my mother there with me. I am honoured to be recognised as a helper and I want to thank all the wonderful people I worked with along the way.” Image credits: Dr Cathie and Dr Alwan from @katrinacathie and @ClarenceHouse on Twitter.