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.
Results
- Showing results for:
- Reset all filters
Search results
-
Conference paperDaly C, Russo S, Ekanayake J, et al., 2027,
Bridging the Markerless Tracking Validation Gap: Intraoperative X-Ray Workflow Integration
, Pages: 95-105, ISSN: 0302-9743Markerless intraoperative tracking of spinal anatomy via RGB-D sensors is a promising alternative to invasive bone-anchored fiducials, yet no existing clinical dataset provides independent subsurface ground truth for validating these methods. We address this gap with a clinically viable pipeline that derives per-vertebra 6-DoF pose from routine intraoperative C-arm fluoroscopy, co-registered to the RGB-D camera frame through a multimodal fiducial array detectable in both imaging modalities. Critically, the pipeline requires no invasive instrumentation contacting the patient, no additional radiation, or deviation from standard surgical workflows, relying solely on the fluoroscopic images already acquired during routine level checks. A calibrated transform chain links the vertebral pose recovered via multi-view 2D–3D CT-to-fluoroscopy registration to the RGB-D coordinate frame, enabling direct comparison of any markerless registration estimate against a subsurface reference. Ex vivo validation against optically tracked ovine vertebrae confirms end-to-end accuracy of 2.06 ± 0.29 mm and 3.35 ± 0.93<sup>∘</sup>, sufficient to serve as independent ground truth for methods with substantially larger errors. We demonstrate the pipeline’s utility by evaluating two markerless registration strategies on clinical data spanning 11 vertebrae across 1,500 frames from three surgical sequences: the first such evaluation against an independent subsurface reference in a clinical setting. The proposed framework provides reusable infrastructure for benchmarking emerging markerless tracking methods on real surgical data.
-
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, Vol: 26, 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.
-
Journal articlevan Kessel R, Carter AW, Nasir K, et al., 2026,
Artificial intelligence needs better health systems to reduce inequalities
, Npj Digital Medicine, Vol: 9Artificial Intelligence (AI) technologies are increasingly prevalent in healthcare, yet without adaptive governance, even well-designed systems risk exacerbating health inequalities. This perspective examines five interconnected governance domains: legal frameworks, evidence generation, regulation and market access, workforce readiness, and public trust. We argue these form a cyclical governance chain in which weaknesses cascade across domains, and identify critical gaps and system-level reforms to ensure AI reduces rather than amplifies disparities.
-
Journal articleAnderson M, O'Neill E, Ljungqvist G, et al., 2026,
Designing eligibility and evaluation criteria for antibacterial pull incentives: a comparative review of implemented and emerging initiatives
, Lancet Regional Health Europe, Vol: 70Background: Pull incentives aim to improve the commercial viability of antibacterials, but the criteria determining which products and companies qualify have not been compared across countries. We compared product and company eligibility and evaluation criteria across these incentives. Methods: We conducted an umbrella review of MEDLINE and Embase for English-language reviews of pull incentives targeting antibacterial innovation and access (2014 to 14 October 2024), supplemented by grey literature searches and the Global AMR R&D Hub dashboard (December 2025). Two reviewers independently extracted criteria from official documentation, using a framework of six product domains (high-priority medical need, relative effectiveness, unmet clinical need, innovative characteristics, health-system impact, and other) and five company domains (antibacterial sustainability, patient access, environmental health, economic criteria, and other). Findings: We identified 28 pull incentives: 20 implemented (UK, Sweden, Germany, France, Italy, US, Japan, and EU) and 8 proposed or in development (US, Japan, Canada, Australia, Switzerland, and EU). As mechanisms overlapped within countries, the 20 implemented incentives were analysed as nine groups. All nine targeted high-priority medical need and seven (78%) included unmet clinical need. Relative effectiveness featured in six (67%), economic criteria in five (56%), and innovative characteristics, health-system impact, patient access, and antibacterial sustainability in four each (44%); environmental health in two (22%). The UK Subscription Model applied all 11 domains and Sweden's Annual Revenue Guarantee eight (73%). Priority pathogen lists were widely referenced but varied in breadth. Interpretation: Eligibility and evaluation criteria vary substantially across countries in scope and specificity. Company-level obligations on stewardship, access, and environmental safeguards are applied inconsistently, and most comprehensive in the
-
Journal articleDattani R, Pierce B, Muktadir G, et al., 2026,
Under-recognition of metabolic syndrome in North West London (2000–2023): a 23-year retrospective analysis
, BMJ Public Health, ISSN: 2753-4294Introduction:Metabolic syndrome (MetS) is a cluster of cardiometabolic risk factors associated with increased morbidity and mortality. Despite the rising prevalence of obesity, hypertension, dyslipidaemia and glucose dysregulation, MetS remains inconsistently recognised and coded within electronic health records (EHRs). We aimed to determine the extent of under-recognition of MetS within North West London (NWL) over a 23-year period.Methods:The Discover-NOW London Secure Data Environment dataset was retrospectively analysed between 1 January 2000 and 31 July 2023. Adults aged ≥18 years were identified as having MetS if coded within EHRs or if they met ≥3 of 5 American Heart Association/ (AHA) 2005 diagnostic criteria. An Extended AHA definition incorporating BMI and HbA1c was also applied to reflect routine clinical practice.Results:Among 2,096,480 adults registered in NWL during the study period, 975 individuals (0.04%) had a clinician-coded diagnosis of MetS. In contrast, 594,325 individuals (21.2%) met AHA-defined criteria and 875,993 (31.3%) met Extended AHA-defined criteria. Women, individuals of Black or Black British ethnicity, and those from more deprived areas were under-represented in the coded cohort relative to algorithm-defined cohorts.Conclusion:Metabolic syndrome is substantially under-recorded within routine clinical coding in NWL. Recognition of the true prevalence of MetS within healthcare datasets may support improved risk stratification, enable population level surveillance, and facilitate evaluation of MetS related morbidity and healthcare utilisation.
-
Journal articleCarter E, Ahmad R, Aylin P, et al., 2026,
Prevalence, management, and outcomes of urinary tract infections in older adults living in care homes versus older adults living outside care homes in the UK: a propensity score-matched case-control analysis.
, Lancet Healthy LongevBACKGROUND: Globally, rising drug-resistant urinary tract infections (UTIs) affect older populations disproportionally. We aimed to assess the incidence, management, and patient outcomes of UTIs in English care homes. METHODS: Using linked primary, secondary, social care, and pathology data covering 2·5 million patients in London between 2018 and 2023, we matched older adults with UTIs living in care homes with older adults living outside care homes using propensity scores. We performed a time-series analysis of incidence and compared urine culture turnaround time and results (including antimicrobial resistance). We assessed UTI-related patient outcomes, including death, complications, recurrent infection, and antibiotic re-prescription within 60 days, using generalised estimating equations, adjusted for demographic and other risk factors. FINDINGS: We identified 91 501 UTI cases, including 6648 (7·3%) in care homes. In care homes, 4678 (70·4%) of the 6448 UTIs occurred in women and 3779 (56·8%) involved individuals aged 85 years or older. The older adults living in care homes were older (median age: 86 years [IQR 80-91] vs 76 years [71-83]) and more frequently White (70·3% vs 56·7%) than older adults living outside care homes. The incidence rate of community-acquired UTIs was 1909·4 per 100 000 person-months in care homes (increasing by 3·7 [95% CI 0·8-6·6] per month), as compared with 543·5 outside care homes (decreasing by 1·3 [-1·8 to -0·7] per month). Urine cultures were used less (1366 [20·5%] of 6648 [95% CI 19·6-21·5] vs 24 699 [29·1%] of 84 853 [28·8-29·4]), were more likely to be polymicrobial (suggesting contamination; 416 [30·4%] of 1366 [28·1-32·9] vs 4325 [17·5%] of 24 699 [17·0-18·0]), and had a longer turnaround time (52·9% turnar
-
Journal articleLi Z, Zhou Z, Lou H, et al., 2026,
A novel pouch-based tension sensor array for soft Cable-Driven Parallel Surgical Robot
, Measurement Journal of the International Measurement Confederation, Vol: 288, ISSN: 0263-2241Endoscopic Submucosal Dissection (ESD) is an advanced, minimally invasive procedure for the removal of tumors or lesions from the gastrointestinal tract. While robot-assisted surgery has enhanced the safety and efficacy of ESD, a significant limitation of current robot systems is the lack of force feedback capabilities. This deficiency increases the risk of excessive force being exerted on tissue. To address this challenge, this study proposes a soft Cable-Driven Parallel Robot (CDPR) integrated with a novel pouch-based sensor array that is disposable and has simple structure. This system utilizes hydraulic pressure sensors and pouch structures to estimate both cable tension and the three-dimensional forces at the end-effector, thereby providing the surgeon with crucial force feedback. During an ex vivo experiment, the mean absolute errors between the estimated forces and the ground truth values were 0.0267 N, 0.0659 N, and 0.0509 N for the x, y, and z axes, respectively. These results demonstrate the potential of the proposed CDPR for future clinical applications.
-
Journal articleMarshall CR, Wang M, Lawrance EL, et al., 2026,
Beta Oscillations and Pupil-Linked Arousal Regulate the Updating of Cognitive Models.
, J Neurosci, Vol: 46The beta rhythm (neural oscillations in the range 13-30 Hz) is associated with the control of movement. Discrete movements (such as a button press) are bounded by a premovement dip in beta power and a postmovement beta rebound, which are thought to release and terminate the action, respectively. However, an additional or alternative role has been suggested for the beta rebound in regulating the extent to which sensory feedback updates the task model. Using EEG and pupillometry in human volunteers of both sexes, we developed a task that dissociates updating of a cognitive model from motor control. We found that beta oscillations were modulated in two independent modes-phasic and tonic-with distinct computational correlates. When abstract task models are updated by integrating the outcomes of several actions, there is a tonic suppression of the beta rhythm, which originates at the time of the postmovement rebound, spans multiple trials, and is measurable at both the pre- and postmovement stages. Independently, phasic trial-to-trial fluctuations in beta power, primarily measurable in the premovement phase, were associated with motor readiness. The decrease in tonic beta power during model updating was mediated by an increase in tonic pupil dilation, a known correlate of model updating often considered a proxy for neuromodulatory tone.
-
Journal articleWray B, Vercammen A, Zeitz L, et al., 2026,
Best practices for engaging lived experience experts in dialogues about climate change and mental health: lessons learned from a global effort.
, BMC Glob Public Health, Vol: 4BACKGROUND: The Connecting Climate Minds global initiative sought to advance research and action at the intersection of climate change and mental health by centering the voices of people with lived experience. METHODS: Through a series of regional and thematic dialogues, Connecting Climate Minds engaged nearly 1,200 participants across seven global regions, including Indigenous communities, smallholder farmers and fisher peoples, and youth. A Lived Experience Working Group guided the integration of lived experience throughout all project components, from co-designing research agendas to producing multimedia storytelling outputs. This perspective reflects on the methodologies, challenges, and lessons learned from Connecting Climate Minds' lived experience engagement, drawing on two global debriefing workshops and extensive project documentation. RESULTS: Key principles that emerged include the importance of appropriately resourcing relationship building ("moving at the speed of trust"), reciprocity, cultural sensitivity, ethical storytelling, and the need for researcher training. The perspective also highlights systemic barriers to meaningful engagement, such as rigid funding structures and institutional resistance to, or inappropriate systems for, power-sharing with impacted communities. By documenting both successes and missteps, this perspective offers practical guidance for researchers, funders, and policymakers committed to inclusive, justice-oriented approaches in climate and mental health research. Ultimately, Connecting Climate Minds demonstrates that centering lived experience not only enriches research quality and relevance but also fosters more equitable and transformative outcomes.
-
Journal articleHine J, Bush A, De Simoni A, et al., 2026,
Experiences of financial incentives to improve medication adherence for children and young people with asthma: a qualitative study.
, Arch Dis Child
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.