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Journal articleGaras G, Cingolani I, Patel V, et al., 2019,
Evaluating the implications of Brexit for research collaboration and policy: A network analysis and simulation study
, BMJ Open, Vol: 9, Pages: 1-11, ISSN: 2044-6055Objective To evaluate the role of the European Union (EU) as a research collaborator in the United Kingdom (UK)’s success as a global leader in healthcare research and innovation and quantify the impact that Brexit may have. Design Network and regression analysis of scientific collaboration, followed by simulation models based on alternative scenarios. Setting International real world collaboration network among all countries involved in robotic surgical research and innovation.Participants 772 organisations from industry and academia nested within 56 countries and connected through 2,397 collaboration links.Main outcome measures Research impact measured through citations, innovation value measured through the innovation index, and an array of attributes of social networks to measure brokerage and geographical entropy at national and international levels.Results Globally, the UK ranks third in robotic surgical innovation, and the EU constitutes its prime collaborator. Brokerage opportunities and collaborators’ geographical diversity are associated with a country’s research impact (c=211.320 and 244.527, respectively;p-value<0·01) and innovation (c=18.819 and 30.850, respectively;p-value<0·01). Replacing EU collaborators with United States (US)’ ones is the only strategy that could benefit the UK, but on the condition that US collaborators are chosen among the top-performing ones, which is likely to be very difficult and costly, at least in the short term. Conclusions This study suggests what has long been argued, namely that the UK-EU research partnership has been mutually beneficial and that its continuation represents the best possible outcome for both negotiating parties. However, the uncertainties raised by Brexit necessitate looking beyond the EU for potential research partners. In the short-term, the UK’s best strategy might be to try and maintain its academic links with the EU. In the longer-term, strategic r
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Journal articleMiraldo M, Goiana-da-Silva F, Cruz-e-Silva D, et al., 2019,
Disrupting the landscape: how the Portuguese National Health Service built an omnichannel communication platfor
, Public Health Panorama, Vol: 5, Pages: 314-323, ISSN: 2412-544XNoncommunicable diseases (NCDs) are the leading causes of death, disease and disability in the WHO European Region and are largely preventable. The private sector has long been using marketing to influence and change people’s lifestyles. In some cases, particularly the food sector, health-compromising content is prioritized over health-promoting content. However, this case study aims to illustrate how governments working on tight budgets can partner with private media companies to their own advantage in order to increase the impact of health messages and thus improve the health literacy of the population. The omnichannel communication platform and associated campaigns initiated by the Portuguese government and described in this case study serve as a practical example of a national health literacy initiative successfully reaching a wide audience. Indeed, the Portuguese National Health Service entered high on the list of the most impactful communication campaigns in Portugal.This might have implications for other countries as although further progress is required to analyse any impact of the campaigns, this example showcases the potential advantages of partnering with the media in that by using the same communication channels as multinational food and tobacco companies, governments may be able to level the playing field in terms of influence through marketing and communication, which might help to reverse unhealthy lifestyles among their populations.
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Conference paperEzzat A, Thakkar R, Kogkas A, et al., 2019,
Perceptions of surgeons and scrub nurses towards a novel eye-tracking based robotic scrub nurse platform
, International Surgical Congress of the Association-of-Surgeons-of-Great-Britain-and-Ireland (ASGBI), Publisher: WILEY, Pages: 81-82, ISSN: 0007-1323 -
Conference paperAvery J, Runciman M, Darzi A, et al., 2019,
Shape sensing of variable stiffness soft robots using electrical impedance tomography
, International Conference on Robotics and Automation (ICRA), Publisher: IEEE, Pages: 9066-9072, ISSN: 1050-4729Soft robotic systems offer benefits over traditional rigid systems through reduced contact trauma with soft tissues and by enabling access through tortuous paths in minimally invasive surgery. However, the inherent deformability of soft robots places both a greater onus on accurate modelling of their shape, and greater challenges in realising intraoperative shape sensing. Herein we present a proprioceptive (self-sensing) soft actuator, with an electrically conductive working fluid. Electrical impedance measurements from up to six electrodes enabled tomographic reconstructions using Electrical Impedance Tomography (EIT). A new Frequency Division Multiplexed (FDM) EIT system was developed capable of measurements of 66 dB SNR with 20 ms temporal resolution. The concept was examined in two two-degree-of-freedom designs: a hydraulic hinged actuator and a pneumatic finger actuator with hydraulic beams. Both cases demonstrated that impedance measurements could be used to infer shape changes, and EIT images reconstructed during actuation showed distinct patterns with respect to each degree of freedom (DOF). Whilst there was some mechanical hysteresis observed, the repeatability of the measurements and resultant images was high. The results show the potential of FDM-EIT as a low-cost, low profile shape sensor in soft robots.
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Journal articleVlaev I, King D, Darzi A, et al., 2019,
Changing health behaviors using financial incentives: a review from behavioral economics
, BMC Public Health, Vol: 19, ISSN: 1471-2458BackgroundIncentives are central to economics and are used across the public and private sectors to influence behavior. Recent interest has been shown in using financial incentives to promote desirable health behaviors and discourage unhealthy ones.Main textIf we are going to use incentive schemes to influence health behaviors, then it is important that we give them the best chance of working. Behavioral economics integrates insights from psychology with the laws of economics and provides a number of robust psychological phenomena that help to better explain human behavior. Individuals’ decisions in relation to incentives may be shaped by more subtle features – such as loss aversion, overweighting of small probabilities, hyperbolic discounting, increasing payoffs, reference points – many of which have been identified through research in behavioral economics. If incentives are shown to be a useful strategy to influence health behavior, a wider discussion will need to be had about the ethical dimensions of incentives before their wider implementation in different health programmes.ConclusionsPolicy makers across the world are increasingly taking note of lessons from behavioral economics and this paper explores how key principles could help public health practitioners design effective interventions both in relation to incentive designs and more widely.
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Journal articleModi HN, Singh H, Fiorentino F, et al., 2019,
Association of residents' neural signatures with stress resilience during surgery
, JAMA Surgery, Vol: 154, ISSN: 2168-6254Importance: Intraoperative stressors may compound cognitive load, prompting performance decline and threatening patient safety. However, not all surgeons cope equally well with stress, and the disparity between performance stability and decline under high cognitive demand may be characterized by differences in activation within brain areas associated with attention and concentration such as the prefrontal cortex (PFC). Objective: To compare PFC activation between surgeons demonstrating stable performance under temporal stress with those exhibiting stress-related performance decline. Design, Setting, and Participants: Cohort study conducted from July 2015 to September 2016 at the Imperial College Healthcare National Health Service Trust, England. One hundred two surgical residents (postgraduate year 1 and greater) were invited to participate, of which 33 agreed to partake. Exposures: Participants performed a laparoscopic suturing task under 2 conditions: self-paced (SP; without time-per-knot restrictions), and time pressure (TP; 2-minute per knot time restriction). Main Outcomes and Measures: A composite deterioration score was computed based on between-condition differences in task performance metrics (task progression score [arbitrary units], error score [millimeters], leak volume [milliliters], and knot tensile strength [newtons]). Based on the composite score, quartiles were computed reflecting performance stability (quartile 1 [Q1]) and decline (quartile 4 [Q4]). Changes in PFC oxygenated hemoglobin concentration (HbO2) measured at 24 different locations using functional near-infrared spectroscopy were compared between Q1 and Q4. Secondary outcomes included subjective workload (Surgical Task Load Index) and heart rate. Results: Of the 33 participants, the median age was 33 years, the range was 29 to 56 years, and 27 were men (82%). The Q1 residents demonstrated task-induced increases in HbO2 across the bilateral ventrolateral PFC (VLPFC) and right dorsolateral P
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Journal articleRunciman M, Darzi A, Mylonas G, 2019,
Soft robotics in minimally invasive surgery
, Soft Robotics, Vol: 6, Pages: 423-443, ISSN: 2169-5172Soft robotic devices have desirable traits for applications in minimally invasive surgery (MIS) but many interdisciplinary challenges remain unsolved. To understand current technologies, we carried out a keyword search using the Web of Science and Scopus databases, applied inclusion and exclusion criteria, and compared several characteristics of the soft robotic devices for MIS in the resulting articles. There was low diversity in the device designs and a wide-ranging level of detail regarding their capabilities. We propose a standardised comparison methodology to characterise soft robotics for various MIS applications, which will aid designers producing the next generation of devices.
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Conference paperFathi J, Vrielink TJCO, Runciman MS, et al., 2019,
A Deployable Soft Robotic Arm with Stiffness Modulation for Assistive Living Applications
, International Conference on Robotics and Automation (ICRA), Publisher: IEEE, Pages: 1479-1485, ISSN: 1050-4729 -
Journal articleGeeson C, Wei L, Franklin BD, 2019,
Development and performance evaluation of the Medicines Optimisation Assessment Tool (MOAT): a prognostic model to target hospital pharmacists' input to prevent medication-related problems
, BMJ QUALITY & SAFETY, Vol: 28, Pages: 645-656, ISSN: 2044-5415- Author Web Link
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Journal articleEspinosa-González AB, Delaney BC, Marti J, et al., 2019,
The impact of governance in primary health care delivery: a systems thinking approach with a European panel
, Health Research Policy and Systems, Vol: 17, Pages: 1-16, ISSN: 1478-4505Enhancing primary health care (PHC) is considered a policy priority for health systems strengthening due to PHC’s ability to provide accessible and continuous care and manage multimorbidity. Research in PHC often focuses on the effects of specific interventions (e.g. physicians’ contracts) in health care outcomes. This informs narrowly designed policies that disregard the interactions between the health functions (e.g. financing and regulation) and actors involved (i.e. public, professional, private), and their impact in care delivery and outcomes. The purpose of this study is to analyse the interactions between PHC functions and their impact in PHC delivery, particularly in providers’ behaviour and practice organisation.
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