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 articleAbuga KM, Muriuki JM, Mutua AM, et al., 2027, , Lancet Glob Health
BACKGROUND: Severe anaemia is a major cause of hospital admission and mortality in children living in sub-Saharan Africa, but data on its association with invasive bacterial infection are sparse. We aimed to characterise severe anaemia and its association with invasive bacterial infection in Kenyan children. METHODS: In this retrospective observational study, we systematically collected admission data for children aged 1 month to 14 years admitted to Kilifi County Hospital, Kenya, between Aug 1, 1998, and July 31, 2024. We excluded children with missing haemoglobin data. We examined prevalence, trends, and factors associated with severe anaemia and very severe anaemia, and the association between severe or moderate anaemia and odds of bacteraemia. Anaemia severity was defined using WHO age-specific thresholds. FINDINGS: Of the 84 348 admissions, representing 64 499 unique children (28 232 [43·8%] females and 36 265 [56·2%] males), included in our analysis, 16 715 (19·8%) admissions had severe anaemia. Severe anaemia was associated with multiple, co-occurring risk factors, including sickle cell disease, malaria, HIV, and malnutrition. As malaria transmission declined (2004-09), the age distribution of severe anaemia shifted towards older children; cases in children aged 5-14 years increased from 16·4% during the high-transmission era (1998-2003) to 44·7% during the low-transmission era (2010-24). Compared with mild or no anaemia, severe anaemia was associated with higher odds of in-hospital mortality (adjusted odds ratio 2·1 [95% CI 1·9-2·3]) and bacteraemia (2·7 [2·5-3·0]), particularly with non-typhoidal Salmonella (6·1 [4·6-8·1]), Escherichia coli (5·7 [4·2-7·7]), Haemophilus influenzae (4·3 [3·0-6·4]), Streptococcus pneumoniae (3·5 [2·9-4·2]), and Klebsiella pneumoniae (
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Journal articleLau SSS, Fong JWL, Lawrance EL, et al., 2026, , Global Environmental Change, Vol: 99, ISSN: 0959-3780
Personal 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 articleAggarwal A, Erridge S, Varadpande M, et al., 2026, , Neuropsychopharmacol Rep, Vol: 46
INTRODUCTION: Autism spectrum disorder (ASD) is a neurodevelopmental disorder associated with distressed behaviors and psychological challenges. This study aims to evaluate the change in health-related quality of life (HRQoL), anxiety, and sleep quality in autistic individuals prescribed cannabis-based medicinal products (CBMPs). METHOD: This observational case series analyzed data from the UK Medical Cannabis Registry on autistic adults treated with CBMPs. Demographic and clinical data were collected at baseline, with patient-reported outcome measures assessed up to 18 months. Primary outcomes included changes in anxiety (GAD-7), sleep quality (SQS), and HRQoL (EQ-5D-5L). Secondary outcomes included the incidence of adverse events. Statistical significance was indicated by p < 0.050. RESULTS: One-hundred and thirty individuals met the inclusion criteria. GAD-7 (p < 0.001) and SQS (p < 0.001) scores improved from baseline to 18 months. EQ-5D-5L index values showed improvement from baseline (0.43 ± 0.30) to 18 months (0.51 ± 0.32, p < 0.001), and PGIC scores increased from 1 month (5.43 ± 1.49) to 18 months (5.65 ± 1.32, p = 0.013). Twenty-five participants (19.23%) reported a total of 232 (178.46%) adverse events, with most being mild (n = 88; 67.69%) or moderate (n = 99; 76.15%). CONCLUSION: Treatment with CBMPs was associated with improvements in HRQoL, anxiety, and sleep outcomes in autistic patients over an 18-month period. Given the absence of a control group, these findings represent associations rather than proven treatment effects. Further high-quality randomized controlled trials are needed to confirm the long-term efficacy and safety of CBMPs in ASD.
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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 articleKang S, Quaire--Merlin L, Thompson A, et al., 2026, , Advanced Optical Materials, ISSN: 2195-1071
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Journal articleBackeljauw P, Tomlinson G, Smart LR, et al., 2026, , Blood Adv, Vol: 10, Pages: 4483-4494
Children 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 articleSounderajah V, Guni A, Liu X, et al., 2026, , Nat Med
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Journal articleJin K, Rubio-Solis A, Naik R, et al., 2026, , Sensors, Vol: 26, Pages: 4427-4427
<jats:p>Electrocardiography (ECG)-only workload-state classification offers a lower-burden physiological sensing route than denser multimodal, multi-sensor physiological, or neuroimaging setups for controlled laparoscopic training research. This study evaluated whether ECG-only representations can classify condition-derived cognitive workload states during a controlled laparoscopic peg transfer task performed under Control and auditory N-back conditions (N0, N1, and N2). Twenty surgical trainees from an advanced surgical-skills course completed the task protocol, and 17 participants entered ECG modelling after ECG quality-control exclusions. The retained ECG modelling dataset comprised 268 task blocks (Control/N0/N1/N2: 68/68/68/64), evaluated as held-out task-block predictions in a known-participant four-fold leave-one-round-out (LOTO) evaluation. Branch-specific raw ECG windows, recurrence-plot sequences, and heart-rate/time-domain heart-rate-variability inputs are detailed in the Methods, and model metrics were computed after reduction to task-block predictions. The primary endpoint was Surgery Task Load Index (SURG-TLX)-aligned low/high workload, defined as Control plus N0 versus N1 plus N2. Four-class and three-level endpoints were retained as secondary views. Raw ECG, recurrence-plot (RP)-derived, hybrid score-level fusion, and conventional heart-rate/time-domain heart-rate-variability Random Forest (HRV-RF) models were compared using a locked evaluation protocol, leakage-aware train-fold-only preprocessing, participant-clustered confidence intervals, and planned paired tests for the primary endpoint. On the primary low/high endpoint, raw ECG achieved the highest macro-F1/balanced accuracy (0.865/0.865), followed by the hybrid branch (0.847/0.847) and HRV-RF (0.648/0.649). Raw ECG and hybrid were supported over RP-derived and HRV-RF under the planned paired tests. On selected secondary endpoints, hybrid achieved higher macro-F1 values than raw ECG, consi
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Journal articleGao Q, Cicek M, Hayhoe B, et al., 2026,
Mapping quality of primary care among 0.5 million people with multiple long-term conditions in England, 2015–2024: a retrospective cohort study using electronic health records
, BMC Medicine, ISSN: 1741-7015Background As the number of people with multimorbidity continues to increase, the traditional medical care model – based on single disease models - has become increasingly unsuitable to meet current challenges, leading to concerns about the quality of primary care for patients with multimorbidity. This study aimed to evaluate the quality of care for people with multimorbidity in primary care, using quality indicators identified in Electronic Health Records (EHR) data.Methods This study used EHR from the Discover-NOW Hub for April 2015-2024, covering 95% of northwest London’s population. Through review of literature and clinical guidelines, we identified eight generic and six multimorbidity-specific quality indicators (QIs) for primary care, with consideration of the availability of indicators within EHR data. The final list was derived following discussion with people with lived experience of multimorbidity and clinicians. We used heat maps to report the QI attainment levels and conducted Ordinary Least Squares and logistic regression analyses to assess sociodemographic and health-related inequalities in relation to generic and multimorbidity-specific QI.Results This study included 509,782 adult patients with multimorbidity. Attainment on generic QIs (range 23.5%-79.8%) was generally higher than multimorbidity-specific indicators (<30%). QIs were generally stable over the past decade, but significantly reduced during the COVID-19 pandemic and fluctuated across individual QIs. Compared with healthier multimorbidity groups, those living with more comorbidities, polypharmacy and more severe frailty had higher levels of QI scores and had higher odds of uptake of individual QIs. Notably, we found socioeconomic inequalities, especially regarding ethnicity and neighbourhood deprivation, though this varied by QI.Conclusions This study provides real-world evidence of the quality of primary care among multimorbidity patients. There was lower attainment on multi
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Journal articleDemircali AA, Zhao J, Aktas A, et al., 2026, , Advanced Materials Technologies, ISSN: 2365-709X
<jats:title>ABSTRACT</jats:title> <jats:p>High鈥恆spect鈥恟atio polymer materials are widely utilized in applications ranging from everyday materials to specialized equipment in industrial and medical fields. Traditional fabrication methods, such as extrusion and molding, face challenges in integrating diverse materials and achieving complex geometries. Thermal drawing transforms macroscale preforms into long, thin fibers while preserving cross鈥恠ectional geometry, but preform fabrication remains a key limitation for producing complex and functional fiber architectures. Here, commercially available 3D printing is used as a fast, low鈥恈ost route for fabricating polymer preforms for thermal drawing. By optimizing printing parameters, fibers with diameters down to 100 µm are produced while preserving complex cross鈥恠ectional features at the micron scale. This capability enables miniaturization of interlocking fiber geometries designed for steerable catheter concepts. Beyond amorphous thermoplastics, semi鈥恈rystalline polypropylene preforms are drawn to produce fibers that exhibit a fivefold greater tendon鈥恉riven bending response than comparable polycarbonate fibers. Functional material integration is further demonstrated using magnetically loaded filament to produce magnetically responsive fibers for robotic applications. Longitudinal periodicity engineered into the preform produces tapered fibers with programmable stiffness gradients in a single fabrication run. This approach supports rapid translation from preform design to thermally drawn polymer fibers with complex geometries, broader material selection, and application鈥恠pecific functionality.</jats:p>
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