Research publications
Browse through all publications from the Institute of Global Health Innovation, which our Patient Safety Research Collaboration is part of. This feed includes reports and research papers from our Centre.
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Journal articleLasala A, Fiorentino MC, Bandini A, et al., 2026,
Two-step latent diffusion modelling for morphology-guided synthesis of glioma intraoperative ultrasound images
, Biomedical Signal Processing and Control, Vol: 120, ISSN: 1746-8094Intraoperative ultrasound (iUS) is increasingly used in neurosurgery to monitor tumour margins during resection. The adoption of iUS is still limited by low image quality, noise, and heterogeneous echogenicity, which makes surgeons’ interpretation of surgical margins challenging. While deep learning can aid automatic margin delineation, the lack of annotated datasets limits the development of robust methods. To address this challenge, we propose a two-step generative framework based on latent diffusion models that consist of (i) an unconditional tumour-mask generator that learns geometric features of real tumours, and (ii) a conditional iUS image generator that synthesizes realistic iUS images by using the generated tumour masks as a prior. Morphological fidelity is assessed through tailored quantitative and qualitative metrics. The performance of automatic tumour margin segmentation algorithms is evaluated through data augmentation experiments to determine whether the inclusion of synthetic data can improve segmentation performance. Compared to state-of-the-art conditional generative models, including diffusion-based approaches (ControlNet) and generative adversarial networks (Pix2Pix), the proposed framework achieves superior qualitative and quantitative performance in representing tumoural and non-tumoural tissue. Performance evaluated using a 5-fold cross-validation protocol yields statistically significant improvements in morphological fidelity (Dice Similarity Coefficient: 0.851; Hausdorff Distance: 16.21). The analysis shows that introducing synthetic data significantly improves boundary delineation performance using nn-UNet, reducing the average Hausdorff Distance from 33.97 to 30.72 in the test set. These results indicate that the proposed framework helps mitigate the scarcity of annotated iUS data by providing realistic samples to support training in neurosurgical image segmentation.
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Journal articleReka H, van Kessel R, Mossialos E, et al., 2026,
Private health insurance in Gulf Cooperation Council countries: A scoping review.
, Health Policy Open, Vol: 10Private Health Insurance (PHI) in Gulf Cooperation Council (GCC) countries has experienced rapid growth over the past two decades, driven by demographic and economic changes. Although various analyses at the country level have been reported, no study has reviewed PHI systems in the GCC through a methodological approach. We provide a conceptual framework to review, describe and document the development of PHI in the GCC, based on literature from the scoping review. As of December 2023, all GCC countries have laws in place or have promulgated laws establishing mandatory PHI schemes. Most of these schemes are designed for expatriate populations residing in these countries, but there is a trend to extend them to nationals working in the private sector. The health system context plays a role in how PHI emerged and is designed in terms of role, eligibility, and coverage. PHI markets in the region are concentrated and dominated by local companies with performance levels that could be further improved. These markets are maturing and subject to more robust technical and prudential regulations as governments seek to enhance competition. Governments in the region must ensure the sustainable growth of these schemes and a more strategic alignment with health system objectives. Lessons learned from more mature markets are critical for future developments.
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Journal articleKhan S, Albers J, Vorobyev A, et al., 2026,
Critical point drying of brain tissue for X-ray phase-contrast imaging.
, J Synchrotron RadiatX-ray phase-contrast tomography can efficiently image brain tissue at subcellular resolution. However, current sample preparation methods are not optimized to exploit the full potential of X-ray contrast mechanisms. Here we propose to replace interstitial material by air to enhance X-ray phase contrast of the ultrastructural features. Critical point drying (CPD) of heavy-metal-stained mouse brain tissue produced samples with preserved ultrastructure, a nanofoam-like material that remains compatible with follow-up conventional resin embedding. Using two synchrotron-based setups, namely, a high-throughput microtomography beamline and a nanoscale holographic tomography beamline, we found that CPD samples consistently showed 2-4× stronger phase-shift signal than samples embedded in resin. CPD offers a versatile route for preparing tissue for subcellular and ultrastructural-resolution X-ray imaging. It retains structural detail while improving signal, and is compatible with follow-up protocols involving femtosecond laser milling or electron microscopy, paving the path for biological tissue imaging beyond the mm3 scale.
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Journal articleRayner C, Smith N, Milne R, et al., 2026,
'What Do People With Long Covid Want From Healthcare Services?' A Qualitative Exploration From Lived Experience.
, Health Expect, Vol: 29BACKGROUND: Long COVID (LC) is a chronic, multisystem condition affecting millions globally, with significant personal, social and economic consequences. Despite increasing recognition of its impact, healthcare services for LC remain inconsistent with patients frequently encountering fragmented services, scepticism and delays leading to patient-voiced frustration. Therefore, understanding patient priorities is crucial for optimising service provision. OBJECTIVES: To explore what individuals with LC want from healthcare services-drawing on their lived experience and collaborative insights with clinicians and researchers, to inform principles for improving care delivery, barriers to access, expectations for service improvement, and the role of multidisciplinary care in managing LC. METHODS: A qualitative study using thematic analysis was conducted, incorporating multiple data sources, including semi-structured interviews, workshops, and a patient-led audit. Key themes were identified, focusing on healthcare access, clinical assessments, treatment options, and service organisation. STUDY PARTICIPANTS: Twenty-seven LC sufferers from the LOCOMOTION Patient Advisory Group (PAG) and Patient Advisory Network (PAN), along with clinicians and researchers involved in LC service provision across the United Kingdom, participated in the study. RESULTS: Three major themes emerged: (1) Who the services are for: Equity of access for all those with LC. Barriers such as stigma, inequitable access and lack of clinician awareness need to be addressed. (2) What services should do: Consistent and standardised assessments and diagnostic clarity-particularly for modifiable conditions like autonomic dysfunction-and an emphasis on the need for early medical intervention, not just rehabilitation. (3) How services should operate: Care should be coordinated, proactive and adaptable to evolving evidence. Patients should not be discharged without ongoing review. Multidisciplinary collaboration sho
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Journal articleRanque B, Tshilolo L, Williams TN, 2026,
The Epidemiology of Sickle Cell Disease in Sub-Saharan Africa: Current Knowledge and Gaps to be Filled.
, Am J Hematol, Vol: 101 Suppl 1, Pages: 5-16Sickle Cell Disease (SCD) is highly prevalent in sub-Saharan Africa. Epidemiological data remain sparse, but regional screening and research initiatives are expanding. Due to genetic, environmental, and socioeconomic factors, the disease course differs markedly from that in high-income countries. Although mortality is improving and can be further lowered with simple interventions, it remains high, especially among undiagnosed children. Genetic factors, poor healthcare infrastructure, and poverty contribute to disease severity. While recent collaborative programs like SickleInAfrica offer hope, national policies that foster the training of healthcare workers, newborn screening, and access to treatment are crucial to reducing the burden of SCD across the region.
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Journal articleMonfort Sanchez E, Mandal N, Mwiinga M, et al., 2026,
Non-invasive measurement of intestinal barrier function in environmental enteropathy using transcutaneous fluorescence sensing
, Gut Science, ISSN: 2978-1833BackgroundUndernutrition represents a critical global health concern and is associated with a multifaceted breakdown in gut function – termed environmental enteropathy (EE) –which leads to increased intestinal permeability, inflammation and nutrient malabsorption. Current clinical approaches to assess intestinal permeability arecostly, invasive, unreliable and/or difficult to perform in certain populations.ObjectivesWe used transcutaneous fluorescence spectroscopy (TFS) – a novel method for non-invasive assessment of gut function – to investigate intestinal barrier function in EE.DesignVolunteers were recruited in a Zambian community where EE is prevalent, and in the UK to undergo TFS measurements in a cross-sectional study. Data were compared between groups and were correlated with the lactulose:rhamnose (LR) test.ResultsTFS demonstrated significant differences in intestinal barrier function between UK and Zambian volunteers. Both peak fluorescence intensity (p=0.003) and area under fluorescence curves (p=0.02) were higher in Zambian than UK participants, suggesting increased permeation of TFS contrast agent. No differences were observed in time taken to reach peak, indicating no differences in factors affecting uptake rate (e.g. gastric emptying). Finally, fluorescence kinetics and regression analysis revealed strong correlations between TFS data and urinary recoveries of lactulose and rhamnose (Spearman’s r ≥ 0.78; p < 0.002).ConclusionsTFS reveals population differences in permeability. It also allows simultaneous assessment of multiple elements of gut function (intestinal barrier integrity and gastric emptying) using a rapid, sample-free methodology. Combined with correlation to the LR test, this implies potential to advance studies of gut health and to improve clinical monitoring.
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Journal articleLam K, Yiu A, 2026,
Video Analysis in Surgery: Lessons From the Pitch?
, Surg Innov -
Journal articleAlagha MA, Gupta R, Jordan C, et al., 2026,
The effect of impaction energy and bone quality on cementless femoral implant fixation and femoral periprosthetic fracture risk
, Bone & Joint Research, ISSN: 2046-3758 -
Journal articleLu JM, Cherla AJ, Carter AW, et al., 2026,
Securitization as a means to pay for cell and gene therapies for orphan diseases: a simulation study.
, Gene TherCell and gene therapies may provide life-extending treatments for patients. However, paying for these therapies using a single upfront payment will be challenging because of uncertainty about long-term clinical effectiveness and affordability. Developers, recognizing the challenges of paying for these therapies, have offered payers 5-year outcomes-based installment plans. The short length of these plans, however, does little to address uncertainties about the cost-effectiveness of paying for these therapies. Instead, we propose to offer 30-year performance-based annuities that shift payments to match the expected accrual of clinical benefits more closely. Using securitization techniques combined with long-term performance-based annuities, we demonstrate that in the case of the gene therapy Zolgensma, this mechanism is effective at mitigating concerns over value and affordability for payers. In summary, our proposal for financing cell and gene therapies creates a viable incentive for developers, while also balancing long-term effectiveness and budget impact concerns from payers and access challenges for patients.
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Journal articleKelly CJ, Wilson M, Warren LM, et al., 2026,
Diagnostic accuracy, fairness and clinical implementation of AI for breast cancer screening: results of multicenter retrospective and prospective technical feasibility studies
, Nature Cancer, ISSN: 2662-1347Artificial intelligence (AI) promises to enhance breast cancer screening. Here we evaluated Google's mammography AI system (version 1.2) across two phases: a retrospective study using 115,973 mammograms from five National Health Service screening services with 39-month follow-up and prospective noninterventional feasibility deployment at 12 sites (9,266 cases). The primary endpoint was AI sensitivity and specificity versus first reader using a 5% noninferiority margin. The secondary endpoints were performance versus second or consensus readers and breast-level analyses. Retrospectively, AI achieved superior sensitivity (0.541 versus 0.437 for first reader, P < 0.001) and noninferior specificity (0.943 versus 0.952, P < 0.001). Cancer detection rate increased from 7.54 to 9.33 per 1,000 women, with AI detecting 25.0% of interval cancers. Performance was particularly strong for first screens (39.3% fewer recalls, 8.8% higher detection) and invasive cancers. No systematic demographic disparities were observed. Simulated second-reader replacement reduced reading time by 32% while increasing detection by 17.7%. Prospective deployment confirmed technical feasibility but revealed a distribution shift requiring threshold recalibration. Implementation requires adaptive calibration and continuous monitoring to ensure safety and equity.
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