exeter university medical research

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Education and research activity in the University of Exeter Medical School takes place within and across three departments: 

Clinical and Biomedical Sciences

Health and Community Sciences

Public Health and Sport Sciences

The Department of Clinical and Biomedical Sciences  is an internationally recognised centre of excellence for biomedical and clinical research and teaching with a focus on understanding the mechanisms and treatment of human disease .   Our research delivers direct benefit to patients, the NHS and the pharmaceutical industry, with the aim of understanding the underlying cellular, molecular and genomic basis of disease and applying this knowledge in innovative ways that lead to improved treatment and a better quality of life for patients. Scientists and clinicians in the department work closely together to ensure that our research is directly targeted to clinical need.  

The Department of Health and Community Sciences u ndertakes applied health and care research, teaching and underpinning methodological work - research that reflects the needs of patients and of health and care providers, working with people and communities, based on partnership with the NHS and other public bodies and a strong commitment to public involvement. Our aim is to improve the health and well-being of the South West and beyond through the development of high-quality graduates and world-leading research that has international impact.  

The Department of Public Health and Sport Sciences u ndertakes impactful research and teaching across all three university themes: Health, Environment and Social Justice.  We are an interdisciplinary group with strong individual identities and established strategic partnerships with the NHS, local communities, charities, industry, and sporting organisations.  Our aim is to drive policy change and improve health, wellbeing and performance across the lifespan, and along the continuum from clinical groups to elite performers.  

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Welcome to the Medical Imaging Centre

The Medical Imaging Centre is a major research facility within the Department of Health and Care Professions. This state-of-the-art facility is located on  St Luke’s Campus , University of Exeter, and supports the Faculty of Health and Life Sciences, as well as other Faculties and external users.

We provide both imaging equipment and experienced staff, to assist researchers and students in collaborative and multidisciplinary research by applying clinical and advanced medical imaging techniques to address key questions in clinical research. We have a track record of collaborating with research and industrial partners for facilitating research in these areas.  

We also work closely with the  Mirielle Gillings Neuroimaging Centre  which is based at the nearby Royal Devon and Exeter Hospital site.  

The Centre is run within the Department of Health and Care Professions which sits in the University's Faculty of Health and Life Sciences. The Centre is run by the Director alongside key colleagues in the Medical Imaging team, a Lab Manager and in collaboration with Exeter Innovation team. We fully integrate several modalities, including portable and static radiographic equipment, multiple ultrasound scanners, high resolution pQCT, and bone health diagnostic tools such as DXA (GE iDXA), Echolight, and Bindex systems. We offer vascular testing systems such as Near Infrared Spectroscopy and Doppler ultrasound.

We also work in collaboration with the Mirielle Gillings Neuroimaging Centre which offer 3T MRI and PET/CT facilities.

Although set up as a single integrated multi-user facility, we have separate Leads for all domains of the facility in order to provide efficient and high-quality service covering the varied aspects of imaging. As a TRAC-rated research facility, the Medical Imaging Centre is based on a full economic costing principle. However, several 'low cost' schemes have been implemented to initiate research projects and support research grant applications.

Our aim is to support research projects within the University of Exeter, as well as external projects and collaborations with state-of-the-art facilities and specialist knowledge on clinical medical imaging and diagnostic radiography. 

We invite you to   Meet the Team   and to browse through the different equipment   that we have. 

Our equipment

• Siemens Multix Fusion Digital Radiography

Our digital radiography Siemens Multix Fusion x-ray suite has all the requirements of a clinical x-ray room, making it ideal for research and educational activities. The system integrates with an internal Insignia PACS network and educational podium and smart board within the room. Additional dosimetry and simulation equipment are also available on request

• Canon and Siemens Ultrasound Scanners

Bone health

Bone health diagnostics are a priority area for the Medical Imaging centre with a GE iDXA scanner onsite. We also have a Stratec peripheral quantitative computed tomograph (pQCT) scanner for the measurement at femur, radius or tibia, including evaluation of volumetric bone density, bone geometry and muscle parameter at the forearm, upper or lower leg.” Alternative osteoporosis screening tools such as QUS, Echolight and Bindex systems are also onsite.

• GE iDXA Scanner
• Stratec pQCT 300o

Lab equipment

The Medical Imaging Centre has a range of educational and research based lab equipment for radiographic studies. Examples include dosimetry equipment such as the Harshaw TLD reader, RTI Piranha dosimeter, and an adult CIRS dosimetry phantom. Other systems include an Artinis continuous wave NIRS system and PHYWE table top x-ray units. We have access to virtual radiography simulation software (both 2D and VR) and anthropomorphic phantoms to aid our students’ education.

Dr Robert Meertens

Director of the Medical Imaging Centre

Rob is the Director for the Centre and Senior Lecturer in Medical Imaging. He is a diagnostic radiographer by background and has been in an academic post at the University of Exeter since 2013 with his research interestes sitting predominately around bone health diagnostics. Through Rob's role as Director of Business Engagement he has seen the wide-ranging industrial interest in artificial intelligence applications applied to both bone health and radiology more generally.

Email:   [email protected]  

Phone:  +44 (0)1392 722511

Rich Cassidy

Professor Karen Knapp

External Business Engagement Lead

I am the Impact and Partnership Development Manager for Health and Care Services and the External Business Engagement Lead for the Medical Imaging Centre. As part of this role I suppor the Director and the wider team below. I am responsible for creating opportunities to generate value, impact and mutually beneficial outcomes for all partners of the Medical Imaging Centre. As an experienced commercial professional, with a career encompassing the Pharmaceutical, Healthcare, Pharmacy and MedTech industries, I joined the University of Exeter in early 2023, bringing with me extensive experience of partnership development between academia, private and public healthcare providers to the team.

Email:   [email protected]  

Musculoskeletal Lead and Associate Professor in Musculoskeletal Imaging

I am Head of Department for Health and Care Professions and Lead for MSK in the Medical Imaging Centre. I developed an interest in osteoporosis during my first job as a Nuclear Medicine Radiographer and then went on to undertake a PhD in this area at King’s College London. My primary research interest continues to be bone health and osteoporosis, more recently developing expertise in other pathologies such as diabetes and particularly how these relate to bone health and fracture risk. I am committed to research-led teaching and using my experience and expertise to inspire the next generation of radiographers.

Email:   [email protected] Phone:  +44 1392 724133

Dr Abas Obotiba

Ultrasound Lead and Lecturer in Medical Imaging

Abas is a Diagnostic Radiographer with a strong interest in musuloskeletal imaging. He developed a research interest in imaging (untrasonography and MRI) markers of symptoms of osteoarthritis and was awarded a Vice Chancellor's Scholarship for Research Excellence to undertake a PhD in Academic Rheumatology. 

Email:   [email protected]

Dr Mike Gundry

Radiography Lead and Lecturer in Medical Imaging

I graduated in 2014 with a degree in Medical Imaging (Diagnostic Radiography) and developed an interest in research from there. I soon undertook a Masters by Research in Medical Imaging investigating Computer Assisted Diagnosis (CAD) in cervical spine imaging, working alongside the software team at City University and testing the software on doctors and radiographers at the Royal Devon and Exeter hospital. I then completed my PhD in Medical Studies, investigating a new type of Stryker tibial cone implant and its impact on bone mineral density in total knee revision patients, completing it in 2021. I have been involved in research determining bone mineral density via x-ray forearm imaging as part of an IBEX (OFFER1), helped investigate the feasibility and accuracy of using citizens to segment anatomy from medical images, and investigated different alignment techniques in total knee replacements in CT and long leg x-ray imaging.

Email:   [email protected]

Michael Worth

Technical Services Lead

Email:   [email protected]  

If you have any questions about the Medical Imaging Centre or would like to use any of our equipment, then please get in contact with us.

Email:   [email protected] Telephone:   01392 722511

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People page

We are a collaboration of researchers, clinicians, members of the public and support staff., brc research award holders, suhel ahmed.

PhD Student

Tania Atienzar

Dr robin beaumont.

Project Researcher

Dr Pamela Bowman

Dr joe butchart.

Consultant Researcher

Dr Carolina Coelho

Prof anne corbett, dr ivy dambuza, dr edoardo de natale, dr emma dempster, dr laura ferreras-antolin, mr john findlay.

Senior Investigator Fellow

Prof Chris Fox

Martyn frith, prof michael gibbons, dr harry green, dr helen hanson, prof tim harrower, dr gareth hawkes.

Translational Fellow

Marianne Hollyman

Dr suzy hope, dr jayne houghton, dr leigh jackson, dr aaron jeffries, prof angus jones, dr iana kalinina, dr nick kennedy, dr szi kay leung, dr jonathan locke, dr maedeh mansoubi, dr jane masoli, prof tim mcdonald, dr sonia medina, dr fiona mellor, dr olga nev, william newton, dr jean claude njabou katte, dr andrew parrish, dr katie partridge, dr kashyap patel, dr tom piers, emily plumpton, dr lettie rawlins, millie sander, prof maggie shepherd, prof andrew toms, dr simon vann jones, leadership team.

Chief Operating Officer

Prof Paul Francis

Industry and Innovation Lead

Prof Sallie Lamb

Director, Rehabilitation Theme Lead

Dr Kristin Liabo

Patient and Public Involvement Lead

Prof Helen Quinn

Research and Development Director, Royal Devon University Healthcare NHS Foundation Trust

Prof Angela Shore

Head of BioResource

Prof Adilia Warris

Clinical Mycology Theme Lead, Director of Training (ACD Lead)

Operational Team

Emma glaeser.

Research Finance Administrator

Dr Sophie Gould

Training & Events Manager

Claire Rosslee

Administrative and Reporting Manager

Ysella Sims

Communications Officer

Chrissie Walker

Research Manager, Health Data

Patient and Public Involvement and Engagement Officer

Patient & Public Involvement Engagement Manager

Helen Smith

Patient and Public Involvement and Engagement Administrator

Professors in Practice

Dr carol routledge.

Professor in Practice/Entrepreneur In Residence

Prof Seb Brown

Professor in Practice

Technical Team

Dr ellie hendy.

Postdoctoral Research Assistant

Katy Manning

Administrator

Dr Garry Massey

Technical Development Officer

Paul Newell

Medical Statistician

Dr Darren Soanes

Postdoctoral Research Fellow (Bioinformatics)

Dr Lianne Wood

Senior Research Fellow

Theme Leads

Prof clive ballard.

Neurodegeneration Theme Lead

Prof Emma Baple

Genetics & Genomics Theme Lead

Prof Ines Barroso

Diabetes Theme Lead

Prof Gordon Brown

Clinical Mycology Theme Lead

Prof Helen Dawes

Rehabilitation Theme Lead

Prof Andrew Hattersley

Prof jon mill, prof caroline wright.

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Our research

The Department of Health and Care Professions is committed t o developing health and social care professionals at all stages of their career across clinical practice and research. Our high-quality research excellence is supported through interdisciplinary and international collaborations. In all aspects of our research, our projects are underpinned with public and patient involvement .  

Our research themes

The department has five key , interdisciplinary research themes:

Musculoskeletal

Musculoskeletal research at the University of Exeter encompasses a wide range of areas, including biomechanics, osteoarthritis, exercise interventions, epidemiology, metabolic bone diseases, musculoskeletal imaging, and orthopaedic innovations. Researchers at the university are dedicated to advancing our understanding of musculoskeletal disorders and improving patient care.  Their work includes developing innovative solutions for musculoskeletal disorders, investigating novel therapies and risk factors for conditions like osteoarthritis, promoting active lifestyles for better musculoskeletal health, and pioneering advanced diagnostic techniques through imaging. Additionally, the research team is focused on enhancing knowledge of metabolic bone diseases, such as osteoporosis, and improving surgical outcomes in orthopaedics.  Overall, the University of Exeter's musculoskeletal research efforts are multidisciplinary and aim to address various aspects of musculoskeletal health, contributing to advancements in the field and ultimately benefiting patients and healthcare practices. 

Health Technologies and Artificial Intelligence

The development of new software and hardware solutions for medical imaging is a key research area in the Department of Health and Care Professions .  This interdisciplinary work combines expertise from computer science, medicine, and Engineering to develop cutting-edge technologies. Key focuses include improving diagnostic tools, enhancing patient care through predictive analytics and machine learning. These innovative approaches aim not only to advance diagnostic techniques, but also to revolutionize the way wider healthcare is delivered, making it more efficient, effective, and accessible.  

Mental Health and Wellbeing

Our research aims to develop and enhance trauma-informed and person-centred approaches that promote and support mental health, recovery and wellbeing across the population.   We have developed and evaluated trauma-informed and low-intensity approaches in educational contexts through our partnerships with psychology and psychiatry.  We are leading ground-breaking studies assessing risk management practices, such as seclusion, in acute mental health settings to ensure that the patient voice is at the heart of these interventions.  We have delivered first-in-world tests of new psychological approaches in the UK, including Morita Therapy.  Through our methodological expertise in complex intervention design we are working to enhance methodological rigour of clinical trials and reduce research waste by optimising integration of qualitative and quantitative data.   By working across settings, disciplines and with diverse client groups our research programme is enhancing pre-registration healthcare education and mental health policy and practice. 

Education and Professional Practice

Our research aims to continually innovate healthcare education and professional practice through development and evaluation of technology-driven and arts-based approaches.    We are leading studies on the role of simulation in healthcare education, embracing new technologies including Artificial Intelligence, Virtual Reality and Augmented Reality, building on our interdisciplinary links between nursing and medical imaging.  We are developing pioneering arts-based approaches to support education of students and registered professionals, including co-design of creative toolkits, and drama-based interprofessional education, harnessing insights from the humanities.  Through our expertise in touch in interpersonal care encounters we are working to support education and practice to explore the importance and health benefits of touch in health and social care settings.  By uniquely bringing together the science and art of education and professional practice our research programme is uniquely placed to influence educational policy, standard development, and enhance curriculum design, educational delivery, and student and educator experience. 

Ageing and Long-Term Conditions

T he University of Exeter is at the forefront of research in ageing and long-term conditions, including osteoporosis. This innovative research spans a range of disciplines, focusing on understanding and managing conditions that affect individuals as they age. The department’s work in osteoporosis, a key area of interest, involves exploring bone health, disease mechanisms, and developing new diagnostic and treatment methods. Collaborations across departments foster a multidisciplinary approach, integrating insights from genetics, epidemiology, and health data science. This research is not only advancing scientific understanding but also aiming to improve quality of life and care for the elderly, addressing one of the major health challenges of our time.  

Postgraduate research

The Department offers postgraduate research study in Medical Imaging and Nursing . If you are interested in studying and have funding, please follow the steps below:    

• Identify a lead supervisor, either by directly contacting an individual on the list below, browsing the existing projects, or by making contact with our Director of Postgraduate Research .  
• Once you have a confirmed supervisor you will apply for your course and be invited to interview
• If successful you will be offered a place of study  

Supervisors

Existing projects (title and lead supervisor)

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Browse all of the recommended titles for undergraduate doctors here.

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• ClinicalKey Student This link opens in a new window Access e-books, videos and other content as well as a question bank of thousands of questions in basic science and clinical medicine. Create an account and undertake customised tests focusing on your weak areas of study. To log in, click "log in via institution" and then enter University of Exeter.

To access this resource there are a couple of additional steps. Watch the video below for a demonstration of how to log in and register to access ebooks and assessment activities.

Watch this video for a demonstration of how to search for literature on Medline (Ovid) using multi-field search

Using subject headings when searching Medline can help you find more relevant results and make your search more comprehensive. To learn how to carry out a searching using MeSH (medical subject headings) watch the below video.

• Medline Ovid This link opens in a new window Research literature database covering all aspects of human medicine and related biomedical research.

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• Last Updated: May 16, 2024 7:59 AM
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Exeter medical student becomes first British student to win international racial justice award

• Faculty of Health and Life Sciences
• University of Exeter Medical School

A University of Exeter medical student has been awarded the Racial Justice in Medicine Award by the American Medical Student Association (AMSA), for supporting aspiring medical students and tackling inequality in teaching materials.

Naabil Khan, a third year student, was presented the award at the Future Physicians for Change conference in Washington DC. It is the first time a British student has won the award, which recognises exceptional individuals who have done unparallelled work and seek to mitigate health disparities.

Naabil’s achievements outside of her medical studies include hosting the “Very Junior Doctors” podcast which introduces life as a medical student in a friendly, accessible, personal manner, creating the Skin For All website which shows different skin conditions on a range of skin tones, and founding the “Future Dr” newsletter which encourages student participation in both extracurricular and super curricular activities covering over 12 medical specialities. 

Naabil, 21 from South London said of receiving the award: “Initially my reaction was stunned silence because I never would have thought that my work in medical education and representation would be noticed – let alone awarded across the Atlantic. I’m so humbled to be the first British Medical Student to be receiving this award – it’s honestly a dream come true.”

Rohini Kousalya Siva MD, President of the American Medical Student Association, said: “Naabil Khan’s recognition with the AMSA Racial Justice in Medicine Award underscores her unwavering commitment to diversifying the medical curriculum and amplifying underrepresented voices in healthcare and medical education. Through her leadership and numerous initiatives, including hosting the podcast Very Junior Doctors, launching the website Skin For All and founding the newsletter Future Dr, Naabil has sparked vital conversations and driven meaningful change within the medical community. 

“AMSA is proud to recognize Naabil’s exceptional efforts, which exemplify our core values of advocating for healthcare equity and fostering a more inclusive future for all.”

This latest win for Naabil comes after being announced as the winner of the Rising Star Award in Healthcare with WeAreTheCity , also for her work around diversifying the medical curriculum, public involvement in medicine, and continuing the conversation surrounding representation and diversity in medicine.

Dr Musarrat Maisha Reza, Senior Lecturer in Biomedical Sciences and Director of Equality, Diversity and Inclusion at the University of Exeter, said: “I’m incredibly proud of Naabil for all she has achieved so far – these awards are a testament to the dedication and hard work she has put into her various projects, and her commitment in particular to diversifying medical resources.”

Professor Richard Holland, Dean of the University of Exeter Medical School, said: “We are so proud of Naabil for all the work underlying these awards. They are a well-deserved recognition of her dedication to tackling inequalities in healthcare, something we care very much about as a Medical School – and we pride ourselves on working with our amazing students on our ongoing commitment to equality, diversity, and inclusion.”

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Undergraduate Study

MSci Engineering Geology and Geotechnics - 2024 entry

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• Courses - 2024 entry
• Engineering Geology and Geotechnics MSci
• An advanced course designed to prepare you to tackle site investigation, ground engineering and remediation associated with civil engineering infrastructure projects and the safe supply of critical raw materials
• MSci Engineering Geology and Geotechnics focuses on understanding the Earth, its processes and resources, and the engineering properties of rocks and soils
• Gain technical experience through over 70 days of fieldwork as well as laboratory classes, optional industry placement and independent research possibilities
• Study in Cornwall with access to world-class geology on your doorstep
• Taught at Exeter’s Penryn campus by Camborne School of Mines, a combined geoscience and mining department with an international reputation for research-inspired teaching and excellent graduate prospects

View 2025 Entry

Request a prospectus

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Top 5 in the UK for Earth and Marine Sciences

4th in The Guardian University Guide 2024

Top 5 in the UK for Geology

5th in The Times and The Sunday Times Good University Guide 2024

Top 100 in the world for Geology and Geophysics

QS World University Subject Rankings 2023

Accreditations

Our programmes are accredited by  The Geological Society  which is the first step on the ladder to Chartered Geologist status after graduation.

This degree has been accredited by the Institute of Materials, Minerals and Mining (IOM3) under licence from the UK regulator, the Engineering Council as fully satisfying the educational base for a Chartered Engineer (CEng). See www.iom3.org for further information.

Accreditation is a mark of assurance that the degree meets the standards set by the Engineering Council in the UK Standard for Professional Engineering Competence (UK-SPEC). Accreditation is awarded for a maximum of 5 years under each assessment exercise. The dates applicable to the current accreditation of this degree programme can be viewed on the Engineering Council list of accredited degrees: www.engc.org.uk

Expand text

Entry requirements (typical offer)

NB General Studies is not included in any offer.

Grades advertised on each programme webpage are the typical level at which our offers are made and provide information on any specific subjects an applicant will need to have studied in order to be considered for a place on the programme. However, if we receive a large number of applications for the programme we may not be able to make an offer to all those who are predicted to achieve/have achieved grades which are in line with our typical offer. For more information on how applications are assessed and when decisions are released, please see: After you apply

Course content

The modules we outline here provide examples of what you can expect to learn on this degree course based on recent academic teaching. The precise modules available to you in future years may vary depending on staff availability and research interests, new topics of study, timetabling and student demand.

During your first year, which is shared with all Geology students, you will gain a solid foundation in geology and the geosciences. You will undertake nine one-day field classes to iconic locations across Cornwall during terms 1 and 2, and attend a one-week residential field class in Pembrokeshire during early May.

Compulsory modules

In Year 2, you will further develop core geological skills as well as your ability to collect and analyse geological data. Fieldwork includes seven one-day field classes, a residential field course in Devon and Dorset, and training in geological mapping on the Isle of Skye.

A key aspect of year three teaching is its flexibility: in addition to the core modules you get to tailor your geological development to the topics which interest you most. The optional modules you’ll be choosing from cover a selection of continually-evolving subjects tackling a variety of global environmental challenges. The ‘Engineering Geology field course’ provides an opportunity to examine an outstanding area of geology famous for its tectonic and mining history, and typically cycles between Spain and Cyprus.

Optional modules

During year four you will undertake an extensive research project on a contemporary topic of your choice, working at the forefront of science in collaboration with one of our world-class research groups. Your final year will also include an overseas field trip as well as a module in research frontiers that will introduce you to the cutting edge of geosciences research.

Exeter offers so many modules that I find interesting, with loads of hands on experience with field trips in spectacular locations (such as Godrevy) and great employment prospects in an array of fields.

I am confident I will achieve this goal, especially with the world class reputation and tuition of Camborne School of Mines behind me.

Read more from Benedict

Engineering Geology and Geotechnics student

Tuition fees for 2024 entry

UK students: £9,250 per year International students: £29,700 per year

* Please note that the fees for students starting in 2023 have yet to be set. The fees provided above are the fees for students starting in 2022 and are for guidance only. We will post the fees for 2023 entry shortly.

Scholarships

The University of Exeter has many different scholarships available to support your education, including £5 million in scholarships for international students, such as our Global Excellence Scholarships *. Financial support is also available for students from disadvantaged backgrounds, lower income households and other under-represented groups to help them access, succeed and progress through higher education.

* Terms and conditions apply. See online for details .

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All our Geology degree programmes provide a wealth of practical experience of working in the field at amazing locations across the UK and abroad.

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Stem cells shed new light on how the human embryo forms

A new study using stem cell-based models has shed new light on how the human embryo begins to develop, which could one day benefit the development of fertility treatment.

The study led by at the University of Exeter Living Systems Institute has revealed how early embryo cells decide between contributing to the foetus or to the supporting yolk sac.

Understanding this decision is important because the yolk sac is essential for later development in the womb. Producing the right number of yolk sac forming cells may be critical for infertility treatment using in vitro fertilised (IVF) embryos.

Only limited research can be performed directly on human embryos. The research team which included the University of Edinburgh, therefore used naïve stem cells that are able to make all the cell types and structures of the early embryo. They designed stem cell models to study formation of yolk sac founders, called hypoblast.

The key discovery, published in Cell Stem Cell , is pinpointing a critical signal that acts during a short window of time, less than one day, to trigger cells to become hypoblast. The signal is a protein called fibroblast growth factor that is made within the embryo. Previous studies had missed the importance of this signal in human embryos. The new findings show that the initial processes that form an embryo and its supporting tissues are similar for humans and other mammals.

Lead author Dr Ge Guo, of the University of Exeter's Living System Institute, said: "Our findings provide insights into how the correct proportions of different cell types form in the early human embryo. We hope our research will benefit infertility treatment in future."

Professor Austin Smith, the Director of the University of Exeter's Living Systems Institute, said: "This study shows the power of stem cell-based models for revealing how the human embryo begins to develop. This marks a significant milestone in stem cell research and embryo models, providing a framework for future research into the early development of the human embryo.

The paper is entitled 'Naive pluripotent stem cell-based models capture FGF-dependent human hypoblast lineage specification' and is published in Cell Stem Cell. The work is a collaboration with Professor Jennifer Nichols at the University of Edinburgh.

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• Adult stem cell
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Materials provided by University of Exeter . Original written by Louise Vennells. Note: Content may be edited for style and length.

Journal Reference :

• Anish Dattani, Elena Corujo-Simon, Arthur Radley, Tiam Heydari, Yasaman Taheriabkenar, Francesca Carlisle, Simeng Lin, Corin Liddle, Jonathan Mill, Peter W. Zandstra, Jennifer Nichols, Ge Guo. Naive pluripotent stem cell-based models capture FGF-dependent human hypoblast lineage specification . Cell Stem Cell , 2024; DOI: 10.1016/j.stem.2024.05.003

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• Carrier testing for partners of MUTYH variant carriers: UK Cancer Genetics Group recommendations
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• http://orcid.org/0000-0001-9201-9216 Terri Patricia McVeigh 1 , 2 ,
• Fiona Lalloo 3 ,
• http://orcid.org/0000-0002-7918-4003 Kevin J Monahan 4 , 5 ,
• http://orcid.org/0000-0002-8626-188X Andrew Latchford 6 , 7 ,
• http://orcid.org/0000-0001-7071-7048 Miranda Durkie 8 ,
• Rachael Mein 9 ,
• http://orcid.org/0000-0002-6637-3411 Emma L Baple 10 , 11 ,
• http://orcid.org/0000-0002-3303-8713 Helen Hanson 11 , 12
• 1 Cancer Genetics Unit , Royal Marsden Hospital NHS Foundation Trust , London , UK
• 2 The Institute of Cancer Research , London , UK
• 3 Manchester Centre for Genomic Medicine , Manchester University Hospitals Foundation Trust , Manchester , UK
• 4 St Mark's the National Bowel Hospital and Academic Institute , London , UK
• 5 Imperial College London , London , UK
• 6 The Polyposis Registry , St Mark’s Centre for Familial Intestinal Cancer, St Mark's Hospital , London , UK
• 7 Surgery and Cancer , Imperial College London , London , UK
• 8 Sheffield Diagnostic Genetics Service , North East and Yorkshire Genomic Laboratory Hub, Sheffield Children’s NHS Foundation Trust , Sheffield , UK
• 9 NHS England , Redditch , UK
• 10 Medical Research (Level 4), RILD Wellcome Wolfson Centre , University of Exeter , Exeter , UK
• 11 Peninsula Clinical Genetics Service , Royal Devon University Healthcare NHS Foundation Trust , Exeter , UK
• 12 Faculty of Health and Life Sciences , University of Exeter Medical School , Exeter , UK
• Correspondence to Dr Terri Patricia McVeigh, Cancer Genetics Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK; terri.mcveigh{at}gmail.com

https://doi.org/10.1136/jmg-2024-109910

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• Delivery of Health Care
• Digestive System Neoplasms
• Gastroenterology
• Genetic Carrier Screening

MUTYH -associated polyposis (MAP) is an autosomal recessive condition caused by biallelic constitutional pathogenic variants in the MUTYH gene. MAP is associated with colonic polyposis (typically adenomas, but less commonly hyperplastic, serrated or mixed) and increased cancer (colorectal, duodenal and others) risk. Variable expressivity has been noted; polyp burden has often been reported in the order of 100s and rarely greater than a thousand, 1 but colorectal cancer has also been reported in affected individuals in the absence of many, or any, preceding polyps. 2 MAP-associated penetrance is incomplete, but the risk of colorectal cancer in the absence of intervention is high. Although age at diagnosis of cancer is typically younger than sporadic cancers, at 47, phenotypic expression is usually adult in onset. 3 Recommended surveillance includes biannual colonoscopy from 18 to 20, and oesophagogastroduodenoscopy from 35. 4

The frequency of MAP is estimated to be at least 1 in 40 000, but the condition is likely underrecognised, given recessive inheritance pattern and variable phenotype. It is estimated that approximately 1%–2% of individuals of White European ancestry are heterozygous carriers of a pathogenic variant in MUTYH . 5–7 It is estimated that two pathogenic founder variants, c.536A>G (p.Y179C) and c.1187G>A (p.G396D), account for greater than 80% of pathogenic variants in this gene, with approximately 70% of affected individuals carrying at least one of these variants. 8 Several other recurrent variants have been identified in different groups ( table 1 ).

• View inline

Recurrent MUTYH variants in different populations

In the UK, MUTYH testing is currently offered as part of a panel of genes for investigation of individuals with a personal and/or family history of polyposis or early-onset colorectal cancer. 9 While the intention of testing of MUTYH is to identify individuals with MAP, testing frequently identifies heterozygous carriers of MUTYH variants, which, in isolation, would not account for the patient phenotype, as heterozygous carriers of this recessive trait do not have a significantly increased cancer risk. 10 Identification of a single MUTYH variant in an individual with a convincing MAP phenotype suggests another unidentified contributing risk allele. Outside NHS testing criteria, MUTYH is frequently included in commercial pan-cancer predisposition panels available in the private sector. Identification of a heterozygous MUTYH variant in an individual without a clinically relevant phenotype may represent an incidental finding. Such variants may also be ascertained through other routes, such as whole genome sequencing or tumour-based testing, depending on technology/filtering applied, research-based testing or direct-to-consumer testing, 11 although some companies/groups now recommend reporting only biallelic status. 12

The NHS England Genomic testing directory outlines indications for carrier testing in partners of individuals who carry recessive traits, to enable accurate and informed reproductive decision-making. Presently, criteria are reasonably broad, suggesting that such testing can be considered where the result would influence reproductive decision-making, if the carrier frequency of pathogenic variants in the associated gene is at least one in 70 (or if consanguinity is a consideration). While the carrier frequency of the common founder MUTYH variants in White Europeans is higher than this threshold, the frequency of these and other variants in MUTYH in non-European populations is not well established.

Although MAP is a high-risk heritable genetic disorder with a reported carrier frequency (at least in some populations) in excess of 1 in 70, the phenotype is adult in onset; and variants in this gene are much more likely to be ascertained incidentally compared with other recessive traits associated with highly penetrant disorders.

Previous work has demonstrated that testing of partners of patients with MAP is cost-effective. 13 However, ascertainment of heterozygous carriers of MUTYH variants is increasing, given associated growth in genetic testing using pan-cancer predisposition panels in patients with and without a MUTYH -related phenotype. Because of the relatively high carrier frequency of MUTYH variants in the general population, incidental detection of carrier status is not rare and represents a commonly encountered clinical challenge for genetics services, without a precedent in clinical guidelines to inform decision-making. 14 Cascade testing is associated with significant workload, particularly in countries with large family sizes. In England, Wales and Scotland, the average size of an extended three-generation family totals 19 individuals, and in Northern Ireland and Ireland, 64. 15 The potential workload is associated with testing of relatives and partners of heterozygous carriers, in the absence of proven cost-effectiveness needs due consideration. There are no specific guidelines related to testing of partners of carriers of recessive traits associated with later onset cancer risk. Considering this, we aimed to establish current practice (and variability thereof) in MUTYH cascade and partner/spousal carrier testing in the UK and Ireland, and to suggest MUTYH -specific modifications to existing criteria for testing for recessive traits.

To establish current practice, we surveyed lead genetic counsellors, cancer genetic consultant leads and clinical scientists in each regional genetics service in the four devolved nations in the UK, and in the Republic of Ireland, and clinicians in the specialist familial clinic in St Mark’s Polyposis Registry. Data collection was considered complete once at least one response (Microsoft form) was received from every relevant regional service (n=32). Variability was noted in practice of offering spousal testing and extent of testing (common variants or full gene sequencing) ( figure 1 ).

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Survey of practice for MUTH carrier testing in UK Cancer Genetics/Specialist services. (A) Practice of carrier testing in partners of carriers of MUTYH variants. (B) Indications for carrier testing in partners of carriers of MUTYH variants. (C) Extent of testing in partners of carriers of MUTYH variants. MAP, MUTYH -associated polyposis.

In order to standardise practice, we discussed indications for, and extent of partner testing at a virtual meeting involving clinical and scientific leads from each genomic laboratory hub, in August 2023, facilitated by the UK Cancer Genetics Group. At this meeting, we agreed that clinical services were becoming increasingly inundated with requests to facilitate carrier testing for partners of heterozygous carriers of MUTYH variants ascertained via non-standard testing as well as extended cascade testing in families where the presence of MUTYH in the family was ascertained as an incidental finding, rather than in individuals with a matching polyposis phenotype.

Mindful of current pressures on NHS genomic laboratories and clinical genetics services, we agreed that:

Carrier testing for MUTYH should be prioritised for partners of patients with MAP (ie, biallelic carriers).

Testing should not be limited to recurrent variants (ie, full gene sequencing should be undertaken).

Testing should be offered irrespective of the ethnicity of the partner, given that the carrier frequency in populations outside of white Europeans is not well established.

Full MUTYH gene testing may be offered directly to children of patients with MAP in the event that their other parent is not available for carrier testing.

We agreed that carrier testing should not routinely be offered to partners of heterozygotes in the absence of consanguinity or a personal or family history of polyposis or colorectal cancer, particularly if reproductive decision-making will not be influenced (eg, in older individuals).

We believe that bespoke criteria for partner testing of MUTYH are required compared with other recessive traits and hope that these recommendations provide guidance to address the current inconsistencies in clinical practice.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

Acknowledgments.

The authors thank the clinicians and scientists who completed our survey, clinical leads and UK Cancer Genetics Group council members who participated in virtual meeting regarding NHS England Genomic Testing directory updates.

• Kastrinos F ,
• Steyerberg EW , et al
• Sieber OM ,
• Crabtree M , et al
• Poulsen MLM ,
• Bisgaard ML
• Monahan KJ ,
• Bradshaw N ,
• Dolwani S , et al
• Al-Tassan N ,
• Chmiel NH ,
• Maynard J , et al
• Cleary SP ,
• Cotterchio M ,
• Jenkins MA , et al
• Jenkins MA ,
• Dowty JG , et al
• Nielsen M ,
• Morreau H ,
• Vasen HFA , et al
• ↵ NHS National Genomic Test Directory Testing Criteria for Rare and Inherited Disease version 6 , 2024 . Available : https://www.england.nhs.uk/wp-content/uploads/2018/08/Rare-and-inherited-disease-eligibility-criteria-version-6-January-2024.pdf
• Theodoratou E ,
• Campbell H ,
• Tenesa A , et al
• Grody WW , et al
• Stoll J , et al
• McVeigh TP ,
• Donnelly D ,
• Al Shehhi M , et al

X @mcveighterri, @kevinjmonahan, @MirandaDurkie, @Helen_Hanson1

Contributors All authors conceived and contributed to writing of the commentary.

Funding HH is supported by the NIHR Exeter Biomedical Research Centre (NIHR203320). This study was supported by the National Institute for Health and Care Research Exeter Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Funding for Open Access Fees was kindly provided by the UK Cancer Genetics Group.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer-reviewed.

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Stem cell study sheds new light on how the human embryo forms

A new study using stem cell-based models has shed new light on how the human embryo begins to develop, which could one day benefit the development of fertility treatment.

The study led by the University of Exeter Living Systems Institute has revealed how early embryo cells decide between contributing to the fetus or to the supporting yolk sac. The paper is titled "Naive pluripotent stem cell-based models capture FGF-dependent human hypoblast lineage specification" and is published in Cell Stem Cell.

Understanding this decision is important because the yolk sac is essential for later development in the womb. Producing the right number of yolk sac forming cells may be critical for infertility treatment using in vitro fertilized (IVF) embryos.

Only limited research can be performed directly on human embryos. The research team, which included the University of Edinburgh, therefore used naïve stem cells that are able to make all the cell types and structures of the early embryo. They designed stem cell models to study the formation of yolk sac founders, called hypoblast.

The key discovery is pinpointing a critical signal that acts during a short window of time, less than one day, to trigger cells to become hypoblast. The signal is a protein called fibroblast growth factor that is made within the embryo. Previous studies had missed the importance of this signal in human embryos. The new findings show that the initial processes that form an embryo and its supporting tissues are similar for humans and other mammals.

Lead author Dr. Ge Guo, of the University of Exeter's Living System Institute, said, "Our findings provide insights into how the correct proportions of different cell types form in the early human embryo. We hope our research will benefit infertility treatment in future."

Professor Austin Smith, the Director of the University of Exeter's Living Systems Institute, said, "This study shows the power of stem cell-based models for revealing how the human embryo begins to develop. This marks a significant milestone in stem cell research and embryo models, providing a framework for future research into the early development of the human embryo."

The work is a collaboration with Professor Jennifer Nichols at the University of Edinburgh.

More information: Naive pluripotent stem cell-based models capture FGF-dependent human hypoblast lineage specification, Cell Stem Cell (2024). DOI: 10.1016/j.stem.2024.05.003 . www.cell.com/cell-stem-cell/fu … 1934-5909(24)00180-2

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Team of international experts call for urgent action against increasing threat from invasive species

by UK Centre for Ecology & Hydrology

While invasive alien species have long been recognized as a major threat to nature and people, urgent action now is needed to tackle this global issue. This is the critical evaluation by the 88 authors, representing 101 organizations from 47 countries, of "Curbing the major and growing threats from invasive alien species is urgent and achievable" published in Nature Ecology & Evolution , including lead author Professor Helen Roy from the UK Center for Ecology & Hydrology and the University of Exeter.

Focused on the main findings of the Intergovernmental Science Policy Platform on Biodiversity and Ecosystem Services (IPBES) thematic assessment report on invasive alien species and their control, the paper also highlights that the impacts of invasive alien species observed today are likely to underestimate the magnitude of future impacts. Also, the interactions among biodiversity drivers are key as no driver acts in isolation.

Co-chair of the IPBES IAS assessment and lead author, Professor Helen Roy from the UKCEH and the University of Exeter, said, "The paper brought together the entire expert team of the IAS assessment, with this diverse group spanning many disciplines with perspectives from around the world drawing the same conclusion about the need for urgent action on the major and growing threat of invasive alien species.

"With the number of invasive alien species set to rise, the IPBES invasive alien species assessment provides the evidence-base and options to inform immediate and ongoing action. To achieve this there is a need for collaboration, communication and cooperation, not only across borders but within countries."

Professor Peter Stoett from Ontario Tech University, co-chair of the IPBES IAS assessment, added, "Interdisciplinarity is key to the success of IPBES assessments. It was wonderful to see social science and humanities experts interacting with invasion biologists and other natural scientists, in a community-building process that will inform policy decisions moving forward."

The threats posed by invasive alien species are expected to continue to rise. Every year, approximately two hundred new alien species are now being introduced globally by human activities to regions they had not been recorded before.

Even without the introduction of new species by human activities, already established alien species will continue to naturally expand their geographic ranges and spread into new countries and regions, with many causing negative impacts. Simple extrapolations from the impacts of invasive alien species observed today are likely to underestimate the magnitude of future impacts.

Interactions among drivers of biodiversity loss are amplifying biological invasions with no driver acting in isolation. Climate change is a major driver facilitating the establishment and spread of invasive alien species into previously inhospitable regions. For example, climate warming is enabling aquatic and terrestrial invasive alien species to establish and spread poleward, including into the Arctic and Antarctic regions.

Also, in some mountainous regions, climate change , acting together with other drivers of biodiversity loss, has allowed invasive alien species to extend their ranges into higher elevations twice as fast as native species.

The IPBES invasive species assessment provided the first comprehensive synthesis of evidence globally concluding that the threat of biological invasions is major but can be mitigated with urgent cross-sectorial cooperative and collaborative action.

Co-developing management actions with multiple stakeholders including government and private sector stakeholders, and Indigenous Peoples and local communities will be critical to achieving success in addressing biological invasions.

Aníbal Pauchard, co-chair of the IPBES IAS assessment and Professor at the University of Concepción, Chile, says, "This is not only the most comprehensive global assessment on invasive alien species to date, but also the selection of experts and the evidence gathering was done under the highest standards of inclusivity, resulting in a report which provides critical insights for all stakeholders."

Coordinating bodies such as the Non-Native Species Secretariat can ensure effective collaboration among diverse stakeholder groups. Indeed, management actions in response to incursions of the Asian hornet (Vespa velutina) in the UK have involved multiple stakeholders coming together to ensure rapid flow of information following detection of the species leading to effective control of nests.

The paper recognizes that the engagement of the general public through awareness raising campaigns, education and community science platforms also contributes to establishing shared responsibilities in managing biological invasions. Community science initiatives, supported by digital identification tools are important for the rapid detection of invasive alien species.

Records submitted by the public through the Asian Hornet Watch app in the UK are making a major contribution to Vespa velutina (Asian hornet) early warning and rapid response.

Journal information: Nature Ecology & Evolution

Provided by UK Centre for Ecology & Hydrology

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City University of Hong Kong (CityUHK) and the University of Exeter in the UK signed a Memorandum of Understanding (MoU) on 3 May, marking a significant step towards fostering academic exchange and deepening collaboration, particularly in the field of digital medicine.

The signing was attended by a high-level delegation from CityUHK, led by Professor Freddy Boey , President of CityUHK, who met with Professor Lisa Roberts , President and Vice-Chancellor of the University of Exeter, and her senior management team. The CityUHK delegation also included Professor Kevin Downing , Secretary to the Council, and Ms Pheck Choo Ng , Director, Office of the President.

President Boey and Professor Roberts signed the MoU during the meeting, marking a new milestone in academic cooperation between the two universities. Under the MoU, both sides agree to explore opportunities for academic research, talent and institutional collaboration, academic, research staff and administrative personnel exchanges and training, and knowledge sharing.

“We are delighted to partner with the University of Exeter to further our collaboration in terms of knowledge and talent exchange,” said President Boey. “As one of the most international universities in the world, CityUHK will continue to actively foster strategic partnerships with other leading global universities to enhance collaboration across various areas.”

“The University of Exeter is delighted to have signed these two Memoranda of Understanding. Our partnership with CityUHK will deliver exciting new research and education collaborations,” said Professor Roberts. “We’re also thrilled to have joined the Institute of Digital Medicine (IDM) initiative. Working even more closely with our international partners will enhance our joint impact around the world, and goes to the core of our Strategy 2030’s aims to make key breakthroughs to transform human health and well-being.”

“These are very positive developments for our university, and I look forward to working closely with CityUHK and our friends in the IDM initiative, in order to forge a greener, healthier, fairer future,” she added.

The University of Exeter, a member of the esteemed Russell Group, is one of many prestigious academic and research partners that CityUHK has collaborated with to establish the IDM on 24 April. The IDM, in collaboration with renowned universities, medical schools, clinical and industry partners, and health tech investors worldwide, will leverage CityUHK's research strengths in engineering, data science, and life science to develop innovative technologies that support doctors and explore digital health solutions for patients’ long-term benefit.

The University of Exeter is renowned for its world-class research and high levels of student satisfaction. Its pioneering research in data science and artificial intelligence is revolutionising healthcare, with expert teams developing innovative AI-driven solutions for predicting and preventing diseases, personalising treatment plans, and improving patient care.

CityUHK is currently collaborating with 21 universities in the Russell Group, a prestigious group of leading UK universities, including the University of Cambridge, University of Oxford, University of Glasgow, and Imperial College London.

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The Unique Burial of a Child of Early Scythian Time at the Cemetery of Saryg-Bulun (Tuva)

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Pages:  379-406

In 1988, the Tuvan Archaeological Expedition (led by M. E. Kilunovskaya and V. A. Semenov) discovered a unique burial of the early Iron Age at Saryg-Bulun in Central Tuva. There are two burial mounds of the Aldy-Bel culture dated by 7th century BC. Within the barrows, which adjoined one another, forming a figure-of-eight, there were discovered 7 burials, from which a representative collection of artifacts was recovered. Burial 5 was the most unique, it was found in a coffin made of a larch trunk, with a tightly closed lid. Due to the preservative properties of larch and lack of air access, the coffin contained a well-preserved mummy of a child with an accompanying set of grave goods. The interred individual retained the skin on his face and had a leather headdress painted with red pigment and a coat, sewn from jerboa fur. The coat was belted with a leather belt with bronze ornaments and buckles. Besides that, a leather quiver with arrows with the shafts decorated with painted ornaments, fully preserved battle pick and a bow were buried in the coffin. Unexpectedly, the full-genomic analysis, showed that the individual was female. This fact opens a new aspect in the study of the social history of the Scythian society and perhaps brings us back to the myth of the Amazons, discussed by Herodotus. Of course, this discovery is unique in its preservation for the Scythian culture of Tuva and requires careful study and conservation.

Keywords: Tuva, Early Iron Age, early Scythian period, Aldy-Bel culture, barrow, burial in the coffin, mummy, full genome sequencing, aDNA

Information about authors: Marina Kilunovskaya (Saint Petersburg, Russian Federation). Candidate of Historical Sciences. Institute for the History of Material Culture of the Russian Academy of Sciences. Dvortsovaya Emb., 18, Saint Petersburg, 191186, Russian Federation E-mail: [email protected] Vladimir Semenov (Saint Petersburg, Russian Federation). Candidate of Historical Sciences. Institute for the History of Material Culture of the Russian Academy of Sciences. Dvortsovaya Emb., 18, Saint Petersburg, 191186, Russian Federation E-mail: [email protected] Varvara Busova  (Moscow, Russian Federation).  (Saint Petersburg, Russian Federation). Institute for the History of Material Culture of the Russian Academy of Sciences.  Dvortsovaya Emb., 18, Saint Petersburg, 191186, Russian Federation E-mail:  [email protected] Kharis Mustafin  (Moscow, Russian Federation). Candidate of Technical Sciences. Moscow Institute of Physics and Technology.  Institutsky Lane, 9, Dolgoprudny, 141701, Moscow Oblast, Russian Federation E-mail:  [email protected] Irina Alborova  (Moscow, Russian Federation). Candidate of Biological Sciences. Moscow Institute of Physics and Technology.  Institutsky Lane, 9, Dolgoprudny, 141701, Moscow Oblast, Russian Federation E-mail:  [email protected] Alina Matzvai  (Moscow, Russian Federation). Moscow Institute of Physics and Technology.  Institutsky Lane, 9, Dolgoprudny, 141701, Moscow Oblast, Russian Federation E-mail:  [email protected]

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Anti-semitic attitudes of the mass public: estimates and explanations based on a survey of the moscow oblast.

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JAMES L. GIBSON, RAYMOND M. DUCH, ANTI-SEMITIC ATTITUDES OF THE MASS PUBLIC: ESTIMATES AND EXPLANATIONS BASED ON A SURVEY OF THE MOSCOW OBLAST, Public Opinion Quarterly , Volume 56, Issue 1, SPRING 1992, Pages 1–28, https://doi.org/10.1086/269293

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In this article we examine anti-Semitism as expressed by a sample of residents of the Moscow Oblast (Soviet Union). Based on a survey conducted in 1920, we begin by describing anti-Jewish prejudice and support for official discrimination against Jews. We discover a surprisingly low level of expressed anti-Semitism among these Soviet respondents and virtually no support for state policies that discriminate against Jews. At the same time, many of the conventional hypotheses predicting anti-Semitism are supported in the Soviet case. Anti-Semitism is concentrated among those with lower levels of education, those whose personal financial condition is deteriorating, and those who oppose further democratization of the Soviet Union. We do not take these findings as evidence that anti-Semitism is a trivial problem in the Soviet Union but, rather, suggest that efforts to combat anti-Jewish movements would likely receive considerable support from ordinary Soviet people.

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Savvino-storozhevsky monastery and museum.

Zvenigorod's most famous sight is the Savvino-Storozhevsky Monastery, which was founded in 1398 by the monk Savva from the Troitse-Sergieva Lavra, at the invitation and with the support of Prince Yury Dmitrievich of Zvenigorod. Savva was later canonised as St Sabbas (Savva) of Storozhev. The monastery late flourished under the reign of Tsar Alexis, who chose the monastery as his family church and often went on pilgrimage there and made lots of donations to it. Most of the monastery’s buildings date from this time. The monastery is heavily fortified with thick walls and six towers, the most impressive of which is the Krasny Tower which also serves as the eastern entrance. The monastery was closed in 1918 and only reopened in 1995. In 1998 Patriarch Alexius II took part in a service to return the relics of St Sabbas to the monastery. Today the monastery has the status of a stauropegic monastery, which is second in status to a lavra. In addition to being a working monastery, it also holds the Zvenigorod Historical, Architectural and Art Museum.

Belfry and Neighbouring Churches

Located near the main entrance is the monastery's belfry which is perhaps the calling card of the monastery due to its uniqueness. It was built in the 1650s and the St Sergius of Radonezh’s Church was opened on the middle tier in the mid-17th century, although it was originally dedicated to the Trinity. The belfry's 35-tonne Great Bladgovestny Bell fell in 1941 and was only restored and returned in 2003. Attached to the belfry is a large refectory and the Transfiguration Church, both of which were built on the orders of Tsar Alexis in the 1650s.  

To the left of the belfry is another, smaller, refectory which is attached to the Trinity Gate-Church, which was also constructed in the 1650s on the orders of Tsar Alexis who made it his own family church. The church is elaborately decorated with colourful trims and underneath the archway is a beautiful 19th century fresco.

Nativity of Virgin Mary Cathedral

The Nativity of Virgin Mary Cathedral is the oldest building in the monastery and among the oldest buildings in the Moscow Region. It was built between 1404 and 1405 during the lifetime of St Sabbas and using the funds of Prince Yury of Zvenigorod. The white-stone cathedral is a standard four-pillar design with a single golden dome. After the death of St Sabbas he was interred in the cathedral and a new altar dedicated to him was added.

Under the reign of Tsar Alexis the cathedral was decorated with frescoes by Stepan Ryazanets, some of which remain today. Tsar Alexis also presented the cathedral with a five-tier iconostasis, the top row of icons have been preserved.

Tsaritsa's Chambers

The Nativity of Virgin Mary Cathedral is located between the Tsaritsa's Chambers of the left and the Palace of Tsar Alexis on the right. The Tsaritsa's Chambers were built in the mid-17th century for the wife of Tsar Alexey - Tsaritsa Maria Ilinichna Miloskavskaya. The design of the building is influenced by the ancient Russian architectural style. Is prettier than the Tsar's chambers opposite, being red in colour with elaborately decorated window frames and entrance.

At present the Tsaritsa's Chambers houses the Zvenigorod Historical, Architectural and Art Museum. Among its displays is an accurate recreation of the interior of a noble lady's chambers including furniture, decorations and a decorated tiled oven, and an exhibition on the history of Zvenigorod and the monastery.

Palace of Tsar Alexis

The Palace of Tsar Alexis was built in the 1650s and is now one of the best surviving examples of non-religious architecture of that era. It was built especially for Tsar Alexis who often visited the monastery on religious pilgrimages. Its most striking feature is its pretty row of nine chimney spouts which resemble towers.

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