UK Research and Innovation

Abstract Background: Detection of circulating tumour DNA (ctDNA) in plasma predicts future recurrence in early breast cancer (EBC). Previous studies have relied on tumour-informed approaches with personalised assays. In this study, we performed orthogonal testing on plasma samples collected prospectively in the c-TRAK-TN study to compare a tissue-free assay with digital droplet PCR (ddPCR) for ctDNA analysis. Methods: c-TRAK-TN recruited 161 patients with early triple negative breast cancer (TNBC) deemed clinically high risk of relapse. Patients underwent ctDNA analysis by ddPCR starting within 4 weeks of completion of treatment and continuing every 3 months for up to 2 years. ddPCR tracked 1 or 2 patient specific variants as previously described. We further analysed 1062 timepoints from a total of 159 patients (median 7 per patient, range 1-11) using Guardant Reveal assay, a tissue-free approach that exploits differential methylation patterns in breast cancer compared with normal tissue. Results: Samples were successfully analysed from 95.3% (1012/1062) timepoints from 159 patients with the tissue-free Reveal assay. CtDNA was detected in 34.0% (54/159) of patients in at least 1 timepoint, with a median methylation tumour fraction of 0.266% (range 0.002 to 51.0%). Detection of ctDNA with the tumour agnostic assay strongly associated with future risk of relapse (HR 20.62, p<0.0001; logrank). Of patients who relapsed by 24 months follow up, 89.5% (34/38) of relapses were detected by prior ctDNA analysis. There were 159 patients available for comparison between ddPCR and the tissue-free assay (Reveal), in 1005 timepoints (median 7 per patient, range 1-11). Concordant test results were observed in 950/1005 timepoints with an overall agreement rate of 94.5%. In this cohort, 63.5% (101/159) of patients did not have ctDNA detected by either assay; 26.4% (42/159) had ctDNA detected by both assays and 10.1% (16/159) had discordant results. Of those detected, 44.8% (26/58) were detected by the tissue-free assay first and 6.9% (4/58) by ddPCR (p<0.0001, Fisher exact test). The median time from first detection of ctDNA to relapse for the tissue-free assay was 7.9 months (95% confidence interval (CI): 5.7-10.5 months) compared to ddPCR assay with 5.7 months (95% CI: 2.9-9.7 months) (HR = 0.6, p=0.0574; mixed effects cox model). Conclusion: Detection of ctDNA with a tissue-free assay anticipated relapse with high accuracy, in patients with early TNBC. The tissue-free assay frequently detected ctDNA at an earlier timepoint than ddPCR, trending towards a longer lead time from detection of ctDNA to relapse. Tissue-free approaches might offer simpler workflows for ctDNA analysis than tumour-informed approaches, and further assessment in clinical trials is warranted. Citation Format: N. Cunningham, R. J. Cutts, C. Swift, K. Dunne, M. Dewan, L. Kilburn, K. Goddard, P. Hall, C. Harper-Wynne, T. Hickish, I. Macpherson, A. Okines, A. Wardley, S. Waters, C. Palmieri, M. Winter, J. Bliss, D. Dustin, M. Ellis, I. Garcia- Murillas, N. C. Turner. Tissue-free circulating tumour DNA detection in patients with early triple negative breast cancer from the c-TRAK-TN trial [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr RF3-05.

Survival benefit of Helicopter Emergency Medical Services (HEMS) attended major trauma remains inadequately quantified across injury severity. We evaluated HEMS performance and identified predictors of survival. Retrospective observational analysis of 3225 trauma patients attended by a regional HEMS in South-East England (2013-2022). Survival was assessed using W-statistic (Ws ) methodology stratified by probability of survival (Ps ) bands. Multivariable logistic regression identified predictors of 30-day mortality in major trauma (injury severity score (ISS) ≥15). Sub-analysis examined unexpected survival predictors and return of spontaneous circulation (ROSC) rates in traumatic cardiac arrest (TCA). Among 2125 patients meeting Ws analysis criteria, observed (O) 30-day survival exceeded expected (E) survival (84.7% vs 81.3%; O/E ratio 1.04), yielding adjusted Ws of 5.23 (95% CI 3.27 to 7.19), representing 5.23 excess survivors per 100 patients. Survival benefit was greatest in severely injured patients with moderate survival probability (Ps 25-45%: 3.33 excess survivors per 100, 95% CI 1.37 to 5.29). Among patients with low probability of survival (Ps <50), 38.7% survived unexpectedly; younger ages and higher presenting Glasgow Coma Scale scores were key predictors of unexpected survival. Pre-hospital emergency anaesthesia (PHEA) was independently associated with unexpected survival in this group (adjusted OR 2.01, 95% CI 1.12 to 3.72, p=0.023). TCA ROSC rates demonstrated an annual improvement (6.3% increased odds per year, 95% CI 1.02 to 1.10, p=0.002). HEMS attendance to major trauma in this regional service was associated with survival exceeding case-mix adjusted predictions, and was most pronounced in severely injured patients. PHEA was associated with survival benefit in low probability patients, supporting the value of advanced pre-hospital interventions.

Background/Aims Mouth care in care homes is a challenge. Existing evidence and behaviour change theory can be used to help improve mouth care outcomes. This article describes the final phase of a broader research initiative, the Caring Optimally: promoting effective Mouth MInuTes in care homes (COMMIT) study. The aim of this study was to develop a guiding principles resource to support care home staff with delivering mouth care. Methods Researchers with clinical (nursing and dental) and care home expertise drafted the guiding principles resource using mouth care evidence and behaviour change theory. Care home relatives and staff from care homes, dental and health sector settings (n=26) reviewed and developed the resource through taking part in online (n=4) and in-person (n=2) workshops. Results Participants feedback was used to develop and refine the guiding principles resource. Participants suggested additional ways of disseminating evidence and raised topics for further work in this area. Conclusions The guiding principles resource describes the capabilities, opportunities and motivation that care staff need to deliver mouth care. The resource has been developed collaboratively with the care home, dental/health sectors, is accessible and engaging, and available to download. Implications for practice At the care home level, there is a need to consider how the guiding principles resource can be integrated into existing systems, such as staff training programmes and digital care software. For instance, digital prompts could be used to remind staff which mouth care products to use, helping embed good practice into daily routines.

Abstract Offshore and onshore wind turbine blades present significant inspection, maintenance and repair challenges arising from location, economic drivers, environment and the specific blade architecture concerned. In-situ tasks have traditionally been undertaken by people abseiling from the tower or use of gantries. Harsh conditions associated with windy environs, along with pressures to limit downtime, have led to a range of new technologies becoming available. This paper presents results from the use of ultrasonic nondestructive testing (NDT) measurements of subsurface blade topography arising from in situ and static blade inspection for a range of wind turbine types. The measurements have been enabled using a hexapod robot that can accommodate NDT scanners within its chassis and can, using pneumatic suction for the robot pedipulators, navigate the convex, concave, and flexing form of in situ wind turbine blades. The arising NDT tomographic scans provide detailed information on blade integrity, the presence or otherwise of bonding materials, and local feature condition. Measurements, presented over a 600 mm traverse span, have confirmed the reliability of the robotic platform to deliver high-quality, consistent, and reliable data to be acquired with limited NDT experience and to allow subsurface inspections to be performed and analyzed remotely. In addition to detailed measurement of subsurface blade features, the robot system has also demonstrated the capacity to undertake functions such as lightning protection system verification.

Science today operates in a rapidly changing environment, where more traditional notions of academic excellence are being challenged by new expectations for openness, impact, and accountability. This panel will explore several dimensions of this shift shaping the future of research and scholarly communication. First, we ask what “excellence” should mean in the 21st century and how that concept is evolving across disciplines and contexts. Second, we examine research culture and the design of reward systems: how incentives can foster integrity, collaboration, and societal relevance, and what accountability looks like for stakeholders in the system. Finally, we turn to the dissemination of research, considering what role peer review and a consideration of audiences can and should play in the evolution of academic publishing.

Abstract Background We conducted a multisite retrospective cohort analysis of 414,500 assisted reproductive technology (ART) procedures from ten clinics using a barcode-based electronic witnessing system. Identity management is fundamental to ART safety and is emphasised in international laboratory guidance on patient identification and traceability issued by professional societies and regulators. Estimates of error frequency vary across detection methods (manual witnessing, barcode, and radio-frequency identification [RFID]) and settings using these systems. Results Among 414,297 analysed procedures drawn from 414,500 total barcode-based electronic witnessing system (EWS) procedures, we observed 2,399 true identity-related errors (overall rate 0.58%, 95% confidence interval [CI] 0.56%–0.60%) after excluding 203 non-clinical system entries (175 Error events and 28 Incomplete cycles). Subtype as a share of true errors counts and were reported as: no match (unclassified) 1,452 (60.5%); wrong patient 718 (29.9%); wrong item 146 (6.1%); too many barcodes 83 (3.5%). Conclusions Within barcode-EWS-using clinics, identity-related mismatches were detected at approximately 0.58% of procedures. Because 60.5% of true errors were unclassified in historic exports, clinical prioritisation should be cautious. Findings apply to ART laboratories using similar barcode-EWS and should not be generalised to non-EWS laboratories. Transparent limitations regarding vendor-specific data, selection bias, and lack of chart-level adjudication are detailed. Importantly, in this dataset, no identity mismatch progressed to a completed procedure with the wrong patient; the EWS blocked progression until the mismatch was resolved.

Skin is both the most visible and most environmentally exposed organ, with apparent aging phenotypes. DNA methylation clocks faithfully capture the progression of aging, but so far have been limited to training on abundant in vitro material or invasively collected samples to generate narrow methylomes using microarray platforms. Here, we demonstrate that skin biological age can be measured directly from a person's face with superior accuracy, using non-invasive tape-stripping. We developed two clocks, MitraSolo, based on single CpGs, and MitraCluster, on regions, trained on the largest enzymatic methyl-sequencing dataset of human epidermis (n = 462). Our models were validated on independent, longitudinal, and external datasets and were compared against established clocks. They predict age accurately, with an error of approximately 4 years, outperforming others on epidermal samples. They maintain high accuracy at low sequencing depths, enabling cost-effective scalability and show intra-individual prediction variation <2 years, highlighting their reproducibility. Their predictive capacity generalised across anatomical sites, conversion and sampling methodologies and on in vitro material. They also successfully captured the rejuvenating effects of Yamanaka factor treatment. MitraSolo and MitraCluster represent a new class of epigenetic clocks optimised for human skin with characteristics that support their use in clinical research, intervention monitoring, and skincare innovation.

The Boston Spa Energy Efficiency Trial (BEET) uses smart meter voltage measurements to control the 11kV system voltage at two 33/11kV (primary) substations supplying circa 15,000 customers in Yorkshire, Great Britain. The voltage on the low voltage (LV) network is normally operated towards the high end of statutory limits (216.2 – 253.0V) in order to account for the voltage drop on the network under winter peak demand conditions and/or during network outages. By taking voltage measurements from smart meters located at LV customers’ points of supply it is possible to regulate the 11kV system voltage in near real time in order to lower customers’ LV supply voltage. The key benefits are conservation voltage reduction (CVR) and providing the opportunity to connect additional demand and generation without going beyond statutory limits. BEET provides a novel way to implement CVR without the need for capital expenditure on 11kV/LV on-load tap changing transformers or LV voltage regulators. It also provides immediate bill reductions and carbon savings to customers whether they have a smart meter installed or not. BEET provides new learning on the retrieval and use of smart meter voltage data in real-time.