A series of posts featuring BU’s impact case studies for REF 2021. (These are edited versions of the final submissions – the full impact case studies will be published online in 2022.)

Improving the lives of sex workers in Brazil

Research area/s: Physical culture, mediated spectacles

Staff conducting research: Professor Michael Silk, Dr Amanda De Lisio

Background: Media speculation often points to heightened demand for sexual services around sporting mega events (SMEs), such as the Olympics. These reports tend to be used to justify policing and rationalise displacing sex work from the public spaces. Professor Silk had argued that SMEs are highly mediated commodity spectacles, during which governments seek to erase and/or hide from view those who are antithetical to market ‘logics’. However, there was a dearth of relevant data on the sexual landscapes associated with the Olympics or on the impact of large-scale sporting events on vulnerable populations of sex workers.

With funding from the Economic and Social Research Council (ESRC), Professor Silk and academic collaborators from Rio de Janeiro, Toronto and Kings College London undertook the first ever funded academic study that looked at the impact of the Olympics on sex workers. The project was centred on Rio de Janeiro during the 2016 Olympics and carried out with two Rio-based partners: the Observatorio Da Prostituicao (ODP), who had been collecting data on sex work in Rio for more than 10 years, and Davida, an NGO that supports sex workers in Brazil. Ethnographic data was collected from more than 100 sex workers, while interviews took place with key stakeholders such as clients, sex workers, venue managers, security personnel, police and local support groups. Observational data was collected from sex-related businesses and – in conjunction with the sex workers – field diaries and audio-visual data were recorded during and after the 2016 Olympics.

The project found that, within the Brazilian context:

• Public discourse was once again focused on anti-trafficking strategies, which conflated forced migration and sexual exploitation with adult, consensual sex work.
• Sex workers were forcibly evicted and displaced, with women unable to access justice without first asserting themselves as victims of sexual exploitation and sex trafficking – although they refused to lie about their consensual involvement in adult sex work.
• Labour rights were denied, due to the conflation of sex work with sex trafficking and sexual exploitation.
• The expected boom in ‘sex tourism’ did not materialise.
• There was a heightened security presence in the street.

The final report made several key recommendations, including:

• Stopping the conflation of prostitution with trafficking and sexual exploitation in law, public policies and popular discourse.
• Creating opportunities for sex workers to add to the SME narrative.
• Developing strategies to recognise and act against state-sanctioned violence faced by sexual minorities, and to guarantee social and spatial justice for those marginalised in the development process.

The impact:

Displacing sex workers during SMEs can have wide-reaching consequences for their safety, particularly in Brazil, where sex work is a legal profession.  By providing an evidence base on the spatial regulation of informal sex economies during SMEs, this project elevated the voice of sex workers in Brazil and shaped policy.

Changing policy

The research informed a submission by Davida to the United Nations Human Rights Council in October 2016, which documented human rights violations against sex workers in Brazil during the staging of SMEs. The report highlighted the eviction of approximately 200 women from a sex venue in 2014, with one evicted woman providing data on the eviction, denial of access to justice and the need for empirical evidence in the creation and execution of policies and strategies surrounding sex work. As a result of the report, she was invited to attend the EU Human Rights Defenders First Annual Meeting in November 2016. Subsequently, the UN referenced the Davida report in its Universal Periodic Review (Brazil) of February 2017 and adopted the following recommendations for the Brazilian government:

• Improving the under-reporting of sexual violence/harrassment and developing policies to punish and prevent such actions.
• Protecting human rights defenders and their families by implementing a national programme, policy and/or plan.
• Combating police violence against women through training.

In September 2017, the Brazilian government enacted these recommendations into federal law, committing themselves to including human rights education in schools, creating domestic violence centres across the country, running an awareness campaign and setting up a hotline to report cases of violence against women.

Improving the lives and working conditions of sex workers

The project enabled Davida to reach a generation of women involved in sex work and the organisation has used the data to influence discourse around child labour exploitation, enhance ties with the Brazilian government’s anti-trafficking committee and ensure less conflation of sex work with sexual exploitation/trafficking at government level.

The ESRC team collaborated with local partners to develop a sex worker-author exhibition, documenting everyday work and life during the Olympics.  Participants curated their own pages for the online exhibition: “It was such an innovative, motivating process… I feel full of hopes and expectations… I feel like I achieved something”. As a result of the project, two of the trans sex worker photographers have developed careers in the arts.

Altering perceptions of sex work in the context of SMEs

The ‘What You Don’t See’ virtual exhibition was curated into a physical exhibition, shown in London, New York and Bournemouth.  The exhibition was converted into a film narrated by sex workers (and project participants), which offered accounts of the banality of everyday life, oppression and prejudice, bringing to life the project findings and challenging sensationalist media accounts of sex work during SMEs.  The film debuted at the MoMA PS1 Sex Workers’ Festival of Resistance in New York City, attended by 1,000 people, all of whom received a newsletter summarising the ESRC project. Davida stated that the project “broadened cultural and political sensibilities, which might have never expected to see the work of Brazilian women involved in sexual commerce celebrated in art galleries”. Davida is currently incorporating the data into a project that is digitising sex work histories in Brazil for the State Archives of Rio de Janeiro.

Creating internationally recognised standards for crowdsourced systems

Research areas: Computing & Informatics, Software Engineering, Cyber Psychology

Staff conducting research: Dr Marios Angelopoulos, Professor Raian Ali, Professor Keith Phalp, Dr Jacqui Taylor

Background: Crowdsourcing can be defined as the practice of soliciting input from the general public. Crowdsourced systems incorporate devices provided by the public to opportunistically supplement their infrastructure. In crowdsourced systems, members of the general public permit the system to access and use the resources of their devices in return for an incentive; this can either be intrinsic (e.g. for social good) or extrinsic (e.g. receiving a service, a micropayment, etc).

However, the highly personal nature of devices like smartphones poses significant trust and privacy issues. Since crowdsourced systems are characterised by the network effect (their efficacy increases as the number of their users increases), such issues can hinder their adoption and development. In addition, the community has lacked a common understanding of which systems can be classified as crowdsourced systems and how such systems can be built following a trustworthy and transparent method.

BU researchers conducted a systematic survey of crowdsourcing research to extract and describe the taxonomy of features which characterise crowdsourcing. They analysed 652 papers, identifying 113 papers (72 academic and 41 from industry) as providing definitions on crowdsourcing. The paper detailed the methodology that was assumed in order to elicit the key features of the concept of crowdsourcing and the corresponding definition, which was adopted in the International Telecommunications Union (ITU-T) standard. The model identified the four fundamental constituents of crowdsourcing: the crowd, the crowdsourcer, the crowdsourced task, and the crowdsourcing platform, and formed the basis for the reference architecture for crowdsourced systems specified in the ITU-T standard.

BU and European collaborators also assessed how crowdsourcing methods and tools can be used in designing systems (particularly in requirements engineering) and how these can be applied in industrial contexts. Dr Angelopoulos’ research underpinned the discussions within the ITU-T study group about implementation aspects of crowdsourced systems and corresponding use cases, and eventually helped shape the final text of the standard. These included architectural approaches for crowdsourced systems in a variety of applications, such as localised distributed computer infrastructure, crowd-enabled IoT systems and crowdsourced systems as enablers for citizen science.

The impact:

The International Telecommunications Union (ITU) is the United Nations’ special agency for information and communication technologies, with global membership including 193 member states, as well as some 900 companies, universities, international and regional organisations, and 20,000 industry professionals. Its recommendations act as an international standard and common point of reference globally to enable members to develop policies at a local or national level.

The ITU accepted the definitions and reference architecture developed through BU research as the formal definitions for crowdsourced systems. Angelopoulos led the BU delegation for the recommendation throughout its lifetime, as part of ITU-T Study Group 20 (SG20), which develops recommendations in the field of Internet of Things (IoT) and smart cities and communities. The terms defined were accepted by the Standardisation Committee for the Vocabulary and form part of official ITU terminology, which acts as a reference point for the international community. The recommendation was formally ratified by the ITU in February 2019 during the SG20 meeting held in China

Defining processes and attributes, and producing a standardised framework for the ways in which such systems are developed, helps to increase their transparency and provides a guarantee with regards to privacy and cybersecurity issues. This, in turn, helps increase public trust towards crowdsourced systems and, consequently, promotes their use. By helping to provide this formal, standardised framework – accepted by the global community through the ITU – BU has delivered a foundation of common understanding that will facilitate the growth and further adoption of crowdsourced systems and reference architecture, as well as identifying and addressing relevant security, privacy and trust issues.

A series of posts featuring BU’s impact case studies for REF 2021. (These are edited versions of the final submissions – the full impact case studies will be published online in 2022.)

Creating a global market for a novel medical device: how BU
research helped make it happen

Research areas: Orthopaedics, Exercise Physiology

Staff conducting research: Professor Robert Middleton, Associate Professor Tom Wainwright, Louise Burgess, Shayan Bahadori, Dr James Gavin, Tikki Immins

The geko™ neuromuscular electrical stimulator

Background: The geko™ and the technology behind it is the only product of Firstkind Ltd: a battery-powered, disposable, neuromuscular electro-stimulation device designed to increase blood flow in the veins of the legs. Firstkind Ltd approached Professors Middleton and Wainwright to design and conduct the first ever study of the device in patients following hip replacement surgery. The randomised control trial (RCT) compared the geko™ with compression stockings in order to prevent deep vein thrombosis (DVT) and oedema post-surgery. Results showed that not only was the device safe, tolerable for patients, and effective in preventing DVT, but that it significantly reduced oedema.

Before the trial, the device settings had been informed by research on healthy subjects in a seated position; Middleton and Wainwright’s research discovered that the device settings did not always work optimally for patients with oedema or neuropathy, or for patients in bed whose knee was extended. Further research confirmed this and highlighted the opportunity to optimise the device further.

BU’s research built on data from a study carried out by Firstkind, which looked at patients who had not responded well to the geko™ T1 device. BU’s TEDs2 study replicated the methodology from the earlier study, with additional blood flow measurements, and used the next generation of geko™ devices. This showed that the updated devices increased blood flow, were effective in preventing DVT, and significantly reduced oedema.

Middleton and Wainwright also conducted a pilot RCT on patients with ankle sprains, which showed that the device reduced swelling. It was the first clinical trial undertaken at home, with patients applying it themselves and wearing it for at least eight hours a day for seven days, and patients showed no adverse effects.

The impact:

Benefits for patients

Before BU’s involvement, the device was designed for use in athletes and healthy individuals to aid their recovery from sport, or to prevent DVTs while flying. Wainwright and Middleton’s research led to the device being used to help patients in a wide variety of clinical settings: e.g 28 NHS Trusts are working to adopt the device for acute stroke patients at high risk of blood clots, and more than 4,700 devices have been ordered by the NHS to prevent DVTs as a potential side effect of Covid-19.

In addition, a study of post-stroke patients showed that 2.4% of those treated with Intermittent Pneumatic Compression (IPC) alone suffered from DVT within 90 days, compared with 0% of those prescribed the geko™. Patients had no adverse events and reported a greater tolerance of the geko™ than IPC.

In Canada, the device has been rolled out for chronic wound patients, leading to some experiencing complete healing, where other treatments were unsuccessful.

Approvals in the UK and USA

• BU’s research demonstrating the effectiveness of the geko™ device led to Firstkind Ltd receiving approval from the US Food and Drug Administration to use it for venous thrombosis and oedema.
• The device has also been approved for use by the UK’s National Institute for Health and Care Excellence (NICE). In its guidance, NICE estimated the cost-saving per patient using the device to be £197 (compared with those receiving no treatment) representing a significant saving to the NHS.

Firstkind Ltd acknowledged that BU’s research was pivotal in achieving both FDA and NICE approvals. Consequently, employing a specialist in medical device registration is essential to avoid any potential pitfalls that may arise during the process. https://andamanmed.com/regulatory-services/medical-device-registration/philippines/ offers expert services to help you navigate the complex regulatory landscape and ensure that your product meets all necessary requirements.

Benefits for Firstkind Ltd

The NHS and FDA approvals have expanded potential markets for the device on every continent. Firstkind Ltd. references BU’s research extensively in its brochures, demonstrating its importance in its day-to-day marketing, driving sales and commercial expansion into new markets. More than 700,000 individual units have been sold to date in at least 14 countries, and, in 2020, Firstkind Ltd. won the International Life Sciences award for the Most Innovative MedTech Company.

Delivering analytical capacity and advice to inform government of the effects of Brexit and future trade arrangements on UK food prices

Research area: Economics

Staff conducting research: Professor Tim Lloyd

Background: In 2017, Professor Lloyd was commissioned, with Exeter University colleagues, to undertake a confidential UK food pricing project for the Department for Environment Food and Rural Affairs (Defra) to assess the impact of Brexit on food prices in Britain. The econometric models at the core of the project drew on expertise developed by Professor Lloyd over two decades of collaboration with Exeter’s Professor Steve McCorriston. They found that domestic food price inflation is significantly affected by world food commodity prices, the exchange rate and oil prices, rather than domestic demand pressures and food chain costs, and that food inflation in the EU may be influenced by differences in the food sector across the Union, particularly barriers to competition. The quality and impact of the research led to Professor Lloyd being called as an expert witness as part of a House of Lords EU Committee enquiry into food price spikes.

Underlying the econometric modelling of food inflation is price transmission – the mechanism describing how price changes move through a supply chain.  Much of Professor Lloyd’s research career has been devoted to understanding the theory, methods and data that economists rely on to analyse the price transmission mechanism. In his 2016 Presidential Address to the Agricultural Economics Society, he set out this literature and his contribution to it, including the econometric methodology he helped pioneer to quantify the speed, magnitude and asymmetry of price transmission in agricultural and food markets, much of which emphasised the importance of imperfect competition (e.g. dominant retailers) in modern food chains. Professor Lloyd’s food industry expertise led to his appointment to Defra’s panel of expert advisors in 2012 and reappointment in 2018 as Brexit withdrawal negotiations intensified.

Food prices and Brexit

After the 2016 referendum, Defra commissioned the confidential development of a new food inflation model to assess the dynamic impact of the potential trade scenarios arising from Brexit. This included the impact of food prices on consumers at different levels of income, i.e. disadvantaged groups, and a detailed examination of trade in processed food and agricultural commodities.

For the first time, the project provided data that was able to provide a more accurate representation of the types and sources of UK food imports. Using these new data, Professor Lloyd led the development of econometric models that quantified the impact of agricultural and food import prices on the price of food in the UK high street, as well as other factors such as domestic agricultural product prices, manufacturing costs and most importantly, exchange rates. The work demonstrated that the geography and type of food imported into Britain impacted retail food inflation markedly, implying that the changes in trade and trade policy arising from Brexit could impact food prices significantly

The impact:

Informing Brexit negotiations: a new scenario modelling tool

The researchers used results from their econometric modelling to develop the bespoke software interface STEFI (Scenario Tool Exeter Food Inflation). With a simple, user-friendly interface, STEFI enabled non-specialists in Defra to calculate the dynamic effects of various trade scenarios. The user manual featured a step-by-step guide to inputting alternative policy scenarios and interpreting the results, filling an important analytical gap in government at the time.

Four innovative features allowed Defra to assess the food price impacts of Brexit in ways that were previously impossible, by incorporating: (i) the origin of trade; (ii) trade in both raw agricultural materials and processed food products (iii) macroeconomic factors that determine retail food prices including effective exchange rates and unemployment and (iv) manufacturing costs in the food chain.

STEFI has been used since 2019 as part of the government’s assessment of Brexit – most notably in October 2019 when a ‘no deal’ exit became a realistic prospect, and again in January 2020, to simulate the Prime Minister’s Brexit plan. The potential impact of both these scenarios on food prices helped inform the government’s position in trade negotiations. The outputs from the Brexit pricing project continue to be used by Defra in trade negotiations and policy making.

Minimising the impact on low-income consumers

Defra asked for an econometric analysis to be undertaken to assess the effect of rising food prices on consumers across the income distribution. Numerical results quantified the effects, particularly for low-income consumers, who stand to lose the most from Brexit-related price shocks. These concerns were heightened by the potentially acute impact of Covid-19 on the availability and price of food. Amid concerns over panic buying in the early stages of the pandemic, Defra repurposed STEFI to provide objective evidence to support and inform the government’s response.

Enhancing Defra’s capacity: cutting-edge research

Defra acknowledged the impact of the research by Professors Lloyd and McCorriston, stating it was ‘impossible to overemphasise the enormous contribution’ their development of STEFI had made to its capacity, and that it was ‘unparalleled in understanding food prices’. The tool remains in regular use and Defra stated it will be used to analyse other domestic and global issues in the future, such as future bilateral trade negotiations and the coronavirus pandemic.