The process of reverse innovation, where ideas originating in low resource settings are adopted by higher income countries, challenges the notion of developed countries as the instigators of healthcare transformation. 1 Between 1985 and 2009, the annual growth rate of patent applications in low and middle income countries was 19%, leading them to double their share of global patent applications (from roughly 4% to 8%). 2 As healthcare services increasingly seek to optimise their cost effectiveness, the efficient and scalable solutions used in lower resource environments provide an opportunity for wider learning. Reverse innovation is a broad term, encompassing innovations that have been ideated, trialled, tested, and adopted in low and middle income countries, before being used by healthcare providers in high income countries. 2-4 The term itself has problems, arguably perpetuating the view that innovation normally flows from high to low income settings, thereby undermining the shift in knowledge translation that it seeks to promote. 5 Nevertheless, reverse innovation presents a broad range of opportunities and challenges in healthcare. Several reverse innovations have the potential to provide considerable efficiency benefits and cost savings to the NHS.

Background: Descriptive studies examining publication rates and citation counts demonstrate a geographic skew toward high-income countries (HIC), and research from low-or middle-income countries (LMICs) is generally underrepresented. This has been suggested to be due in part to reviewers' and editors' preference toward HIC sources; however, in the absence of controlled studies, it is impossible to assert whether there is bias or whether variations in the quality or relevance of the articles being reviewed explains the geographic divide. This study synthesizes the evidence from randomized and controlled studies that explore geographic bias in the peer review process. Methods: A systematic review was conducted to identify research studies that explicitly explore the role of geographic bias in the assessment of the quality of research articles. Only randomized and controlled studies were included in the review. Five databases were searched to locate relevant articles. A narrative synthesis of included articles was performed to identify common findings. Results: The systematic literature search yielded 3501 titles from which 12 full texts were reviewed, and a further eight were identified through searching reference lists of the full texts. Of these articles, only three were randomized and controlled studies that examined variants of geographic bias. One study found that abstracts attributed to HIC sources elicited a higher review score regarding relevance of the research and likelihood to recommend the research to a colleague, than did abstracts attributed to LIC sources. Another study found that the predicted odds of acceptance for a submission to a computer science conference were statistically significantly higher for submissions from a "Top University." Two of the studies showed the presence of geographic bias between articles from "high" or "low" prestige institutions. Conclusions: Two of the three included studies identified that geographic bias in some form was impacting on peer review; however, further robust, experimental evidence is needed to adequately inform practice surrounding this topic. Reviewers and researchers should nonetheless be aware of whether author and institutional characteristics are interfering in their judgement of research.

ObjectiveKangaroo Mother Care (KMC) is a frugal innovation improving newborn health at a reduced cost compared with incubator use. KMC is widely recommended; however, in the UK, poor evidence exists on KMC, and its implementation remains inconsistent.DesignThis Systematic Review and Realist Synthesis explores the barriers and facilitators in the implementation of KMC in the UK.Data sourceOVID databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Google Scholar were searched.Eligibility criteriaStudies were UK based, in maternity/neonatal units, for full-term/preterm children. First screening included studies on (1) KMC, Kangaroo Care (KC) or skin-to-skin contact (SSC) or (2) Baby Friendly Initiative, Small Wonders Change Program or family-centred care if in relation to KMC/KC/SSC. Full texts were reviewed for evidence regarding KMC/KC/SSC implementation.ResultsThe paucity of KMC research in the UK did not permit a realist review. However, expanded review of available published studies on KC and SSC, used as a proxy to understand KMC implementation, demonstrated that the main barriers are the lack of training, knowledge, confidence and clear guidelines.ConclusionThe lack of KMC implementation research in the UK stands in contrast to the already well-proven benefits of KMC for stable babies in low-income contexts and highlights the need for further research, especially in sick and small newborn population. Implementation of, and research into, KC/SSC is inconsistent and of low quality. Improvements are needed to enhance staff training and parental support, and to develop guidelines to properly implement KC/SSC. It should be used as an opportunity to emphasise the focus on KMC as a potential cost-effective alternative to reduce the need for incubator use in the UK.

With over two decades of evidence available including from randomised clinical trials, we explore whether the use of low-cost mosquito net mesh for inguinal hernia repair, common practice only in low-income and middle-income countries, represents a double standard in surgical care. We explore the clinical evidence, biomechanical properties and sterilisation requirements for mosquito net mesh for hernia repair and discuss the rationale for its use routinely in all settings, including in high-income settings. Considering that mosquito net mesh is as effective and safe as commercial mesh, and also with features that more closely resemble normal abdominal wall tissue, there is a strong case for its use in all settings, not just low-income and middle-income countries. In the healthcare sector specifically, either innovations should be acceptable for all contexts, or none at all. If such a double standard exists and worse, persists, it raises serious questions about the ethics of promoting healthcare innovations in some but not all contexts in terms of risks to health outcomes, equitable access, and barriers to learning.

There is increasing interest within Higher Education Institutions (HEIs) to examine curricula for legacies of colonialism or empire that might result in a preponderance of references to research from the global north. Prior attempts to study reading lists for author geographies have employed resource-intensive audit and data collection methods based on manual searching and tagging individual reading list items by characteristics such as author country or place of publication. However, these manual methods are impractical for large reading lists with hundreds of citations that change over instances the course is taught. Laborious manual methods may explain why there is a lack of quantitative evidence to inform this debate and the understanding of geographic distribution of curricula. We describe a novel computational method applied to 568 articles, representing 3166 authors from the Imperial College London Masters in Public Health programme over two time periods (2017–18 and 2019–20). Described with summary statistics, we found a marginal shift away from global north-affiliated authors on the reading lists of one Masters course over two time periods and contextualise the role and limitations of the use of quantitative data in the decolonisation discourse. The method provides opportunities for educators to examine the distribution of course readings at pace and over time, serving as a useful point of departure to engage in decolonisation debates.

Central to the decolonial debate is how high-income countries (HICs) have systematically negated ways of knowing from low- and middle-income countries (LMICs), and yet the paucity of empirical decolonization studies leaves educators relatively unsupported as to whether, and how, to address privilege in higher education. Particularly in science, technology, engineering, mathematics and medicine (STEMM) institutions, there are few published examples of attempts to engage faculty in these debates. In 2018–19, we invited faculty on a master’s in public health course to engage with the decolonization debate by providing: (1) descriptive reading list analyses to all 16 module leads in the master’s programme to invite discussion about the geographic representation of readings; (2) an implicit association test adapted to examine bias towards or against research from LMICs; (3) faculty workshops exploring geographic bias in the curriculum; and (4) interviews to discuss decolonization of curricula and current debates. These initiatives stimulated debate and reflection around the source of readings for the master’s course, a programme with a strong STEMM focus, and the possibility of systemic barriers to the inclusion of literature from universities in LMICs. We propose the notion of epistemic fragility, invoking DiAngelo’s (2011) ‘white fragility’, because some of the responses appeared to result from the challenge to perceived meritocracy, centrality, authority, individuality and objectivity of the HIC episteme that this initiative invites. We posit that the effortful reinstatement of a status quo regarding knowledge hierarchies in the global context, although not a representative reaction, can lead to a significant impact on the initiative in general. Efforts to decolonize curricula require actions at both the individual and organizational levels and, in particular, a managed process of careful engagement so that fragility reactions, if and where they occur, are given the time and space to be navigated in the open. Based on our experiences, we offer recommendations for policy and practice for those engaged in this movement and potential research questions to explore epistemic fragility in higher education.

Analyses of reading lists by some UK Higher Education institutions in attempt to identify bias in curricula have found a prevalence of articles from the global north. However, previous studies have employed resource-intensive audit and data collection methods such as the authors or volunteers manually searching for and tagging individual reading list items by characteristic such as author country or place of publication. This can be prohibitive to repeating the study at different time periods or on large reading list data sets, which leads to a gap in evidence-based data to support and inform curriculum decolonisation. We describe a novel computational method applied to 568 articles, representing 3,166 authors from the Imperial College London Masters in Public Health (MPH) programme over two time periods (2017-18 and 2019-20). Using summary statistics, we found a shift in composite geographic distribution of reading lists sources across the two time periods studied and relate this to interventions to decolonise the curriculum at Imperial. Our approach to applying a computational method to produce data as evidence in decolonisation toolkits is discussed.

Collections from medical societies which are not connected with a university or another public institution cannot be legitimized on the basis of the argument of conserving historical heritage. Even the museum itself with its many tasks and classical site of scientific communication comes into public view and becomes a topic of scientific interest.