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 articleLau SSS, Fong JWL, Lawrance EL, et al., 2026,
Extreme weather salience as a climate crisis signal: Examining the role of extreme weather fear in adaptive and maladaptive responses to eco-anxiety
, Global Environmental Change, Vol: 99, ISSN: 0959-3780Personal salience regarding extreme weather events may be crucial for recognising the profound effects of anthropogenic climate change. However, efforts to understand how individuals attribute extreme weather events to anthropogenic climate change, and their implications for eco-anxiety, have not effectively integrated psychological perspectives. Following Hong Kong’s wettest storm on record in 2023, we recruited a cross-sectional sample of adults (n = 376, ages 18–83) immediately after typhoon season onset (from 3 June to 11 September) in 2024. We aimed to examine (1) how extreme weather experiences and socio-demographic factors influence individuals’ subjective attribution of extreme weather to anthropogenic climate change, and (2) how extreme weather fear (i.e. storm fear), weather salience, uncertainty intolerance, anxiety control, nature connectedness, and future risk awareness of local climate disasters are associated with two distinct subdimensions of eco-anxiety, conceptualised as ‘habitual ecological worry’ and ‘negative consequences of eco-anxiety’, which may be associated respectively with adaptive and maladaptive responses to eco-anxiety. Our results suggest that only the personal salience of day-to-day local weather patterns significantly affected respondents’ subjective attribution of local weather patterns to anthropogenic climate impacts, rather than their extreme weather event experiences. Future risk awareness and nature connectedness were mainly associated with adaptive responses to eco-anxiety, while only storm fear was strongly associated with both adaptive and maladaptive responses. This finding underscores the dual effects of extreme weather fear, namely motivating action-oriented aspects of eco-anxiety and exacerbating functionally impairment of eco-anxiety. Promoting future risk awareness and increasing nature connectedness – independent of fear – could improve urbanised populations
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Journal articleBackeljauw P, Tomlinson G, Smart LR, et al., 2026,
Growth and puberty in African children with sickle cell anemia treated with hydroxyurea.
, Blood Adv, Vol: 10, Pages: 4483-4494Children with sickle cell anemia (SCA) have poor growth and pubertal development. REACH (Realizing Effectiveness Across Continents with Hydroxyurea) is a prospective trial evaluating the feasibility, safety, and benefits of hydroxyurea at maximum tolerated dose (MTD) for children with SCA in sub-Saharan Africa. Children aged 1 to 10 years received open-label hydroxyurea with longitudinal follow-up. Height, weight, and pubertal staging were collected over 7 years of treatment. Biomarkers included insulin-like growth factor I (IGF-I), IGF-binding protein 3, luteinizing hormone, follicle-stimulating hormone, and anti-Mullerian hormone (AMH). Hydroxyurea commenced at an average (mean ± 1 standard deviation [SD]) age of 5.9 ± 2.4 years (range, 1.6-10.2) for girls (n = 296) and 5.4 ± 2.4 years (range, 1.3-10.1) for boys (n = 310). Using natural history SCA-specific reference curves, the mean weight-for-age z score improved from 0.47 ± 0.90 at enrollment to 0.69 ± 1.00 on hydroxyurea treatment. Height increased from 0.26 ± 0.90 to 0.42 ± 1.00 on treatment, and body mass index from 0.46 ± 1.00 to 0.85 ± 1.20. IGF-I remained low in many participants. Puberty was delayed in 25% to 30% of children, with gradual progress on treatment. AMH was low (<2.5th percentile) in 4% of girls, whereas 52% of boys had low AMH at baseline and 28% at follow-up. Long-term hydroxyurea treatment at MTD is associated with beneficial effects on growth with improved weight and height, and does not negatively affect pubertal developmenty in children with SCA in sub-Saharan Africa. This study was registered at www.clinicaltrials.gov initially as NCT01966731 and is now registered as NCT06171217 for long-term follow-up.
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Journal articleJones O, Linton N, Bissett S, et al., 2026,
Tau20-RETROmapping System Identifies Driver-Like Activation Patterns in Real-Time During Persistent Atrial Fibrillation.
, Circ Arrhythm ElectrophysiolBACKGROUND: Conventional activation mapping of atrial fibrillation (AF) during clinical procedures is limited by low-amplitude, fractionated electrograms and cycle length variability. The Tau20-RETROmapping stimulator-recorder system (TauRhythm Therapies, United Kingdom) is an investigational device used to identify nonpulmonary vein AF drivers by real-time, high-density activation mapping of uniform wavefronts during AF. We validated the accuracy of the system and applied it to left atrial mapping for evidence of AF drivers. METHODS: Left atrial geometry was acquired using a 3-dimensional electroanatomic mapping system with high-density mapping catheters (CARTO 3 with Optrell, or EnSite X with HD Grid). Electrograms were recorded for 30 seconds at multiple left atrial sites. The Tau20-RETROmapping system generates activation maps of organized wavefronts. System performance was manually validated against randomly sampled local electrograms using a grid sweep of thresholds to identify Pareto-optimal parameters in sinus rhythm, atrial pacing, atrial tachycardia (AT), and AF. The system was then applied to identify putative driver activation patterns during persistent AF. RESULTS: We studied 24 patients undergoing pulmonary vein isolation for AF. Six patients presented in sinus rhythm or AT, in whom the system demonstrated a sensitivity of 100.0% (95% CI, 80.5%-100.0%) and a specificity of 100.0% (85.2%-100.0%). Eighteen patients were mapped in AF: the system had a sensitivity of 94.4% (86.2%-98.4%) and a specificity of 97.1% (89.9%-99.6%) when identifying organized AF wavefronts, and accurately identified the earliest activation in 89.6% (79.7%-95.7%) of waves. Stable propagation originating from the left atrial appendage (LAA) was observed in 3/18 patients, while 8/18 demonstrated competing propagation toward and away from the LAA. Conduction away from the LAA was detected along the anterior (8/18 patients), lateral (8/18 patients), and posterior (7/18 patients) wall
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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 articleBorvorntanajanya K, Leung FF, Shi J, et al., 2026,
Data-efficient modeling of hysteresis and crosstalk for inverse kinematics of soft manipulators
, IEEE Robotics and Automation Letters, Vol: 11, Pages: 8284-8291, ISSN: 2377-3766Nonlinearities in soft continuum manipulators, arising from material hysteresis and intersegmental coupling in multi-segment robots, present significant challenges for accurate open-loop inverse kinematics (IK) control. In particular, morphable pneumatic chambers adjust their shape and stiffness with internal pressure, increasing force output but also introducing nonlinearities that complicate control. This paper introduces a sequence based machine learning approach that is data-efficient, modeling and compensating for both hysteresis and crosstalk in systems with morphable chambers. Through systematic comparison of Long Short-Term Memory (LSTM) and Transformer architectures under data-limited conditions, we demonstrate the effectiveness of sequence-based models in capturing temporal dependencies. We then propose a Recursive Segment-wise Crosstalk Compensation(RSCC) pipeline that decomposes control of multi-segment robots into independent single-segment subproblems, with each constituent model trained using 500 samples. Applied to a two-segment morphable-chamber manipulator, RSCC achieves approximately 11% normalized positional error and outperforms a monolithic multi-segment LSTM baseline trained on 2000 samples within the same workspace, highlighting its potential for precise open-loop control in minimally invasive surgical applications.
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Journal articleKang S, Quaire--Merlin L, Thompson A, et al., 2026,
Plasmon-induced optothermal manipulation of colloidal particles and biological entities resilient to saline environments
, Advanced Optical Materials, ISSN: 2195-1071 -
Journal articleEzzat A, Zhu Z, Roddan A, et al., 2026,
Label-free classification of breast cancer subtypes in ex vivo human tissues using Raman spectroscopy and machine learning
, Scientific Reports, ISSN: 2045-2322Breast conserving surgery (BCS) aims to excise breast tumors whilst preserving breast-related quality of life, but is complicated by the challenge of accurately identifying the margin between healthy and cancerous tissue. Raman spectroscopy (RS) has been shown to distinguish between normal breast tissue and breast cancer. Thus, this study aimed to further evaluate the diagnostic performance of RS in ex vivo breast tissue subtype classification via investigation of signals from healthy tissues and three breast cancer subtypes (invasive ductal carcinoma, IDC; invasive lobular carcinoma, ILC; and ductal carcinoma in situ, DCIS). A total of 80 tissue samples (46 normal and 34 cancerous) from 71 individuals were measured using a confocal Raman microscope. Spectral signatures wereinvestigated, and supervised classification was performed for both two-class (healthy vs. cancer) and four-class (healthy vs. IDC vs. ILC vs. DCIS) classification tasks. RS successfully differentiated cancerous from normal breast tissue (97.84% sensitivity, 97.18% specificity). For four-class classification, RS achieved in-class sensitivity ranging from 83-96% and specificity from 93-99%. These findings demonstrate that RS can accurately distinguish normal from cancerous tissue and capture clinically relevant differences among histological including invasive and pre-invasive disease, supporting its promise for intraoperative tissue characterization during BCS.
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Journal articleKang S, Quaire--Merlin L, Thompson A, et al., 2026,
Plasmon-induced optothermal manipulation of colloidal particles and biological entities resilient to saline environments
, Advanced Optical Materials, ISSN: 2195-1071 -
Journal articleAlyacoubi S, Hong SP, Patel N, et al., 2026,
Correction: The current state of endoscopic submucosal dissection in the UK: a nationwide cross-sectional survey.
, Surg Endosc -
Journal articleBatcup C, Almukhtar A, Menon A, et al., 2026,
Exploring the overuse of non-sterile gloves in operating theatres: a cross-sectional survey and interview study
, BMJ Open, ISSN: 2044-6055Objectives: To identify factors influencing unnecessary non-sterile glove use in operating theatres, and to estimate how common these factors are across the UK.Design: Mixed-methods study using interviews and a cross-sectional survey.Setting: Imperial College Healthcare Trust for interviews, and nationally across the UK for the survey. Participants: 19 interviewees and 329 survey respondents, all clinical staff working in UK operating theatres.Outcome measures: Barriers and facilitators to unnecessary non-sterile glove use in operating theatres.Results: The findings highlight a combination of key drivers leading to the unnecessary use of non-sterile gloves: (1) lack of prioritisation of sustainability, (2) fears around negative patient outcomes, (3) strong social influences such as norms to use gloves, (4) the absence of clear guidelines and limited training on glove use, (5) availability of alternatives and quality of gloves, and (6) beliefs about personal safety and habitual glove use. Respondents also suggested potential intervention strategies.Conclusions: 67% of participants reported using gloves unnecessarily. Our findings highlight the role of habitual behaviour, social influences and unclear guidelines in driving this practice. Interventions should address these factors, for example by clearly communicating when gloves should and should not be worn, encouraging changes to local social norms towards waste reduction, improving access to hand gel, and supporting habit change to reduce unnecessary glove use and associated environmental impact.
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