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 articleAlian A, Avery J, Mylonas G, 2026,
Electrical Impedance Tomography and Neural Networks for Shape Sensing in Soft Continuum Endoscopic Robots
, IEEE Robotics and Automation Letters, Vol: 11, Pages: 6544-6551Soft robotics offer biocompatibility, dexterity, and safe tissue interaction in surgery, providing potential alternatives to conventional tools such as colonoscopes. However, their nonlinear behaviour demands closed-loop control with structure-compatible feedback. This work presents a scalable 3D shape-sensing method based on Electrical Impedance Tomography (EIT), unifying actuation and sensing of a hydraulically actuated soft robot within a neural network framework. A soft continuum manipulator (14.6 mm in diameter) with saline-pressurised chambers and embedded kirigami-inspired FPCs was evaluated in free motion and ex vivo porcine colon trials. A multilayer perceptron (MLP) predicted the full 3D shape, achieving tip RMSEs of 0.46, 0.20, and 0.40 mm (x, y, z) in free motion, and 1.96, 0.86, and 0.89 mm in ex vivo. This letter marks the first ex vivo validation of EIT-based shape sensing in soft endoscopy and demonstrating its potential for closed-loop surgical control.
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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 articleBower M, Filia K, Lawrance EL, et al., 2026,
Climate change and social health.
, Nat Hum BehavSocial health-our ability to access and maintain meaningful human relationships-is recognized as a critical determinant of population health and climate change resilience, yet it is poorly integrated into climate change policy and research. This narrative Review synthesizes interdisciplinary evidence of the bidirectional and nuanced relationship between climate change and social health: climate change disrupts key social conditions (including housing stability and community cohesion), while widespread social disconnection limits our collective capacity to address the climate crisis. We unpack how social health can function as both a climate vulnerability and a lever for climate action. We present a new conceptual framework, describing the pathways through which social health and climate outcomes interact. Finally, we highlight existing evidence gaps and opportunities for public policy development and call for climate and health governance to centre social health as a key pillar of resilience in a changing world.
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Journal articleKyriopoulos I, Mossialos E, 2026,
Patient-physician sex concordance in cardiovascular care: context matters.
, Eur Heart J Qual Care Clin Outcomes -
Journal articleOdedra R, Mayer E, 2026,
Understanding how language barriers in the paediatric emergency care setting influences safety of care delivery: a scoping review
, Emergency Medicine Journal, ISSN: 1472-0205Background: Communication in a family’s primary language can support safe care. Vital steps within the care delivery process are contingent upon successful communication, including reporting symptoms, clinical decision-making, informed consent, discharge communication, and follow-up coordination. The importance of effective information exchange is particularly pronounced in paediatric emergency care, and complex interactions may arise as parents or carers advocate on behalf of children. This scoping review aimed to identify and map existing research indicating where along the care journey communication-related risks for safety lie during paediatric emergency care and what strategies exist to mitigate them. Methods: We searched MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Cochrane Library for studies which examined the influence of language barriers on patient safety in paediatric emergency care, as well as studies that evaluated interventions. Bibliographic database searches were executed on 18/12/2024; retrieved records were independently screened by two authors at title and abstract level followed by full text level. Data on study objectives, population characteristics, study design, and their key findings were extracted. Results: 1578 articles were identified, of which 33 were included and mapped according to (i) studies reporting safety risks linked to language barriers in paediatric emergency care (n = 24) and (ii) existing interventions designed to mitigate these risks (n = 9). Studies highlighted that language barriers can influence safety at multiple stages of the emergency care pathway, with discharge most frequently reported as a point of risk for paediatric patient safety. Interventions focused primarily on usage, uptake, and documentation of professional interpreter services.Conclusion: Addressing misunderstandings around follow-up and home-care advice during medical safety netting are priority areas for intervention. Future research should
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Journal articleBrandt L, De Prisco M, Nocera D, et al., 2026,
Climate-Related and Nature-Based Interventions for Mental Health: An Umbrella Review and Meta-Analysis.
, JAMA Psychiatry, Vol: 83, Pages: 499-509IMPORTANCE: Climate change is associated with increasing mental health morbidity and mortality. However, an umbrella review to classify and quantify the global evidence on climate-related and nature-based mental health interventions is lacking. OBJECTIVE: To assess associations of climate-related and nature-based mental health interventions with mental health outcomes. DATA SOURCES: PubMed, PsycINFO, Web of Science, and Cochrane databases were searched from inception to November 17, 2024. STUDY SELECTION: Systematic reviews with meta-analyses (SRMAs) with controlled climate-related or nature-based mental health interventions and mental health outcomes were included. DATA EXTRACTION AND SYNTHESIS: Standardized mean differences (SMDs; intervention vs control) and 95% CIs were synthesized, evidence was stratified according to the level of credibility, and associations were assessed using meta-regression. MAIN OUTCOMES AND MEASURES: Outcomes were mental disorders, psychiatric symptoms, and positive mental health. RESULTS: Twenty-eight SRMAs were included that examined 344 studies and 91 associations between psychosocial or nature-based interventions and outcomes. Of the 91 associations, 10 (11%) had a moderate credibility of evidence and 81 (89%) had low or very low credibility. Psychosocial interventions addressing climatic impact drivers were associated with very low credibility, based on limited data. Nature-based interventions were associated with reductions in tension (SMD, -0.87; 95% CI, -1.31 to -0.43), fatigue (SMD, -0.80; 95% CI, -1.16 to -0.44), confusion (SMD, -0.65; 95% CI, -1.12 to -0.19), and negative affect (SMD, -0.51; 95% CI, -0.85 to -0.16), as well as increases in positive affect (SMD, 0.98; 95% CI, 0.65 to 1.30), vigor (SMD, 0.83; 95% CI, 0.37 to 1.28), and well-being (SMD, 0.40; 95% CI, 0.07 to 0.73), with moderate credibility of evidence and not addressing climatic impact drivers. Older participants and study locations with lower tree cover, better
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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 articleLatif A, Al Janabi N, Joshi M, et al., 2026,
Feedback from wearable devices accelerates recovery after breast cancer surgery.
, Eur J Surg Oncol, Vol: 52BACKGROUND: Axillary surgery for breast cancer is frequently associated with upper-limb morbidity, impacting quality of life. Structured exercise improves outcomes, but access to physiotherapy is inconsistent. Wearable devices offer objective post-operative monitoring and the potential for real-time rehabilitation support. This study aims to assess the impact of wearable-driven feedback on upper-limb recovery after axillary surgery, and to evaluate the usability, adherence, and acceptability of wearables during post-operative rehabilitation. METHODS: In this prospective observational cohort study, patients undergoing axillary surgery at a tertiary breast unit were equipped with wearable devices to monitor upper-limb activity. Participants were allocated to basic-feedback (BF; fixed 60-min goal) or dynamic-feedback (DF; personalised weekly clinician-adjusted goals). Recovery was defined as post-operative activity relative to pre-operative baseline. An earlier prospective no-feedback (NF) cohort served as comparator. RESULTS: Forty-nine patients were included: 10 DF, 10 BF, and 29 NF. Adherence was high (mean compliance 89.4%, SD 17.9). By postoperative day (POD) 8, DF patients exceeded baseline activity (103.2%, SD 30.6), outperforming BF (80.2%, SD 13.9) and NF (86.2%, SD 55.8). Recovery plateaued earliest in DF (POD 4), followed by BF (POD 5) and NF (POD 7). Among SLNB-only patients, DF recovered faster than NF, while BF and NF showed similar trajectories. CONCLUSIONS: Clinician-guided, wearable-driven feedback significantly accelerates upper-limb recovery following axillary surgery. These findings support further evaluation of this approach in larger randomized trials to determine clinical and cost-effectiveness.
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Journal articleBracey S, Ainsworth B, Alderman J, et al., 2026,
The 'Hippocratic Oath' for AI-based clinical decision support systems
, BMC Medical Informatics and Decision Making, ISSN: 1472-6947BackgroundThe implementation of Artificial Intelligence assisted Clinical Decision Support Systems (AI-CDSS) shows significant potential to improve healthcare. However, implementing AI-CDSS has many associated challenges. This article introduces the ‘Hippocratic Oath’ for AI which promotes safe and effective AI-CDSS development and implementation.MethodsThis paper summarises discussions which took place during the Turing-Roche Clinical AI Interest Group Joint Workshop. The workshop began with scoping lectures from AI experts, leading into focus group discussions of key themes surrounding AI-CDSS implementation. These include the ethics, trust, evaluation, regulation, human factors and challenges involved with implementing AI-CDSS into healthcare settings. Focus group outcomes, alongside insight from lectures, were used to formulate the arguments in this paper.ResultsThis article presents a consensus definition of AI-CDSS and outlines a comprehensive table of implementation challenges alongside mitigation measures. It introduces the ‘Hippocratic Oath for AI’ and discusses its potential to promote safe and effective AI-CDSS implementation through addressing human factors and explainability.ConclusionsThe ‘Hippocratic Oath for AI’, can be used by AI-CDSS implementers and developers as a framework to mitigate challenges involved with implementing AI-CDSS into healthcare settings. This framework is likely to promote safe and effective implementation and maximise HCP uptake of the AI-CDSS. Through facilitating AI-CDSS use, this oath can transform health care practice via reducing medical errors, healthcare costs and improving patient outcomes.
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