From stars to patients: Lessons from space science and astrophysics for health care informatics

Big Data are revolutionizing nearly every aspect of the modern society. One area where this can have a profound positive societal impact is the field of Health Care Informatics (HCI), which faces many challenges. The key idea behind this study is: can we use some of the experience and technical and methodological solutions from the fields that have successfully adapted to the Big Data era, namely astronomy and space science, to help accelerate the progress of HCI? We illustrate this with examples from the Virtual Observatory framework, and the NCI EDRN project. An effective sharing and reuse of tools, methods, and experiences from different fields can save a lot of effort, time, and expense. HCI can thus benefit from the proven solutions to big data challenges from other domains

A distributed simulation methodology for large-scale hybrid modelling and simulation of emergency medical services

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonHealthcare systems are traditionally characterised by complexity and heterogeneity. With the continuous increase in size and shrinkage of available resources, the healthcare sector faces the challenge of delivering high quality services with fewer resources. Healthcare organisations cannot be seen in isolation since the services of one such affects the performance of other healthcare organisations. Efficient management and forward planning, not only locally but rather across the whole system, could support healthcare sector to overcome the challenges. An example of closely interwoven organisations within the healthcare sector is the emergency medical services (EMS). EMS operate in a region and usually consist of one ambulance service and the available accident and emergency (A&E) departments within the coverage area. EMS provide, mainly, pre-hospital treatment and transport to the appropriate A&E units. The life-critical nature of EMS demands continuous systems improvement practices. Modelling and Simulation (M&S) has been used to analyse either the ambulance services or the A&E departments. However, the size and complexity of EMS systems constitute the conventional M&S techniques inadequate to model the system as a whole. This research adopts the approach of distributed simulation to model all the EMS components as individual and composable simulations that are able to run as standalone simulation, as well as federates in a distributed simulation (DS) model. Moreover, the hybrid approach connects agent-based simulation (ABS) and discrete event simulation (DES) models in order to accommodate the heterogeneity of the EMS components. The proposed FIELDS Framework for Integrated EMS Large-scale Distributed Simulation supports the re-use of existing, heterogeneous models that can be linked with the High Level Architecture (HLA) protocol for distributed simulation in order to compose large-scale simulation models. Based on FIELDS, a prototype ABS-DES distributed simulation EMS model was developed based on the London EMS. Experiments were conducted with the model and the system was tested in terms of performance and scalability measures to assess the feasibility of the proposed approach. The yielded results indicate that it is feasible to develop hybrid DS models of EMS that enables holistic analysis of the system and support model re-use. The main contributions of this thesis is a distributed simulation methodology that derived along the process of conducting this project, the FIELDS framework for hybrid EMS distributed simulation studies that support re-use of existing simulation models, and a prototype distributed simulation model that can be potentially used as a tool for EMS analysis and improvement.MATCH Programm

p-medicine: a medical informatics platform for integrated large scale heterogeneous patient data

Secure access to patient data is becoming of increasing importance, as medical informatics grows in significance, to both assist with population health studies, and patient specific medicine in support of treatment. However, assembling the many different types of data emanating from the clinic is in itself a difficulty, and doing so across national borders compounds the problem. In this paper we present our solution: an easy to use distributed informatics platform embedding a state of the art data warehouse incorporating a secure pseudonymisation system protecting access to personal healthcare data. Using this system, a whole range of patient derived data, from genomics to imaging to clinical records, can be assembled and linked, and then connected with analytics tools that help us to understand the data. Research performed in this environment will have immediate clinical impact for personalised patient healthcare

Precision global health in the digital age.

Precision global health is an approach similar to precision medicine, which facilitates, through innovation and technology, better targeting of public health interventions on a global scale, for the purpose of maximising their effectiveness and relevance. Illustrative examples include: the use of remote sensing data to fight vector-borne diseases; large databases of genomic sequences of foodborne pathogens helping to identify origins of outbreaks; social networks and internet search engines for tracking communicable diseases; cell phone data in humanitarian actions; drones to deliver healthcare services in remote and secluded areas. Open science and data sharing platforms are proposed for fostering international research programmes under fair, ethical and respectful conditions. Innovative education, such as massive open online courses or serious games, can promote wider access to training in public health and improving health literacy. The world is moving towards learning healthcare systems. Professionals are equipped with data collection and decision support devices. They share information, which are complemented by external sources, and analysed in real time using machine learning techniques. They allow for the early detection of anomalies, and eventually guide appropriate public health interventions. This article shows how information-driven approaches, enabled by digital technologies, can help improving global health with greater equity

Joseph Jones, M.D.: Scientist of the Old South

Of the many books written over the past century about the Old South and the American Civil War, a very few explore the scientific history of the South or the medical history of the war itself. In the first volume of this impressive biography of Joseph Jones, Mr. Breeden does much to illuminate the development of scientific thought and of medicine in the nineteenth-century South. Jones was far in advance of most of his fellow physicians. The thoroughness of his research, the tenacity of his effort, and the brilliance of his findings won him respect while he was still a very young scholar. When the war came, he showed himself fiercely patriotic as a soldier but coldly empirical as a scientific investigator of many infectious diseases. In the course of the biography the author illumines the development of modern medicine in this country and the state of the nation\u27s medical schools in the middle of the nineteenth century. The greater part of this volume is devoted to Jones\u27s wartime service, which was mainly behind the battle lines in the hospitals and prison camps. The growth of the problem of gangrene among the wounded—a horrifying result of overcrowding and lack of sanitation—is examined in particularly telling detail; the ravaging of the Andersonville prison camp by this and other diseases was the subject of some of Jones\u27s most controversial research, and his written report as a reluctant witness in the trial of the Southerners held responsible. At the outset of the war, Joseph Jones was an energetic and well trained young doctor with considerable experience in teaching and research; by its end he was perhaps the foremost expert on infectious diseases in the South or in the nation. James O. Breeden is an associate professor of history at Southern Methodist University. He was educated at the University of Virginia and Tulane University.https://uknowledge.uky.edu/upk_history_of_science_technology_and_medicine/1006/thumbnail.jp

How does moulage contribute to medical students' perceived engagement in simulation?:A mixed-methods pilot study

Introduction: Moulage is used frequently in simulation, with emerging evidence for its use in fields such as paramedicine, radiography and dermatology. It is argued that moulage adds to realism in simulation, although recent work highlighted the ambiguity of moulage practice in simulation. In the absence of knowledge, this study sought to explore the impact of highly authentic moulage on engagement in simulation.Methods: We conducted a randomised mixed-methods study exploring undergraduate medical students' perception of engagement in relation to the authenticity moulage. Participants were randomised to one of three groups: control (no moulage, narrative only), low authenticity (LowAuth) or high authenticity (HighAuth). Measures included self-report of engagement, the Immersion Scale Reporting Instrument (ISRI), omission of treatment actions, time-to-treat and self-report of authenticity. In combination with these objective measures, we utilised the Stimulated Recall (SR) technique to conduct interviews immediately following the simulation.Results: A total of 33 medical students participated in the study. There was no statistically significant difference between groups on the overall ISRI score. There were statistically significant results between groups on the self-reported engagement measure, and on the treatment actions, time-to-treat measures and the rating of authenticity. Four primary themes ((1) the rules of simulation, (2) believability, (3) consistency of presentation, (4) personal knowledge ) were extracted from the interview analysis, with a further 9 subthemes identified ((1) awareness of simulating, (2) making sense of the context (3) hidden agendas, (4) between two places, (5) dismissing, (6) person centredness, (7) missing information (8) level of training (9) previous experiences).Conclusions: Students rate moulage authenticity highly in simulations. The use of high-authenticity moulage impacts on their prioritisation and task completion. Although the slower performance in the HighAuth group did not have impact on simulated treatment outcomes, highly authentic moulage may be a stronger predictor of performance. Highly authentic moulage is preferable on the basis of optimising learning conditions.</p

Characterization of accidents at work in the operating room services of the portuguese public hospitals

The care provided in Operating Room Services (ORS) are highly specific and using high and sophisticated technology, exposing the workers to increased risks. To characterize the accidents occurred in the ORS of portuguese public hospitals. Retrospective epidemiological study relating to accidents at work occurred in ORS of portuguese public health institutions in the period of January 1, 2009 to December 31, 2010. The information was obtained using the computerised registration notifi cation of work accidents from the ACSS, referring to 1201 workers. Work accidents occurred in the ORS represented 10.1% of the total accidents recorded. There were higher frequencies of accidents in 2010, 54.1%, in ARS de Lisboa e Vale do Tejo, 47.4%, in females, 77.2%, in the professional category of nurses, 41.6%, in the age group 25-29 years, 20.8%, with length of service more than 10 years, 45.3% and practice timetable for shifts, 59.0%. On average the accidents occurred at 12.5 hours, between the 3rd and 6th hour of the beginning of work, 37.6%, and in the 3rd day after weekly rest, 37.9%. The action of most prevalent lesion was the needlestick/object-cutting, 66.3%, the type of injury was wounds, 52.3% and the body part most affected were the hands, 66.2%. Used personal protective equipment 50.4% of workers. Absenteeism resulted in 22.5% with a total of 7203 lost working days. There was a high prevalence of needlestick injuries/ cuts on nurses that could be preventable by which suggests the implementation of training measures and monitoring these situations in order to reduce them

Histology independent drug development - Is this the future for cancer drugs?

The Cancer Drug Development Forum (CDDF)’s ‘Histology independent drug development – is this the future for cancer drugs?’ workshop was set up to explore the current landscape of histology independent drug development, review the current regulatory landscape and propose recommendations for improving the conduct of future trials.The first session considered lessons learnt from previous trials, including innovative solutions for reimbursement. The session explored why overall survival represents the most valuable endpoint, and the importance of duration of response, which can be captured with swimmer and spider plots.The second session on biomarker development and treatment optimisation considered current regulations for companion diagnostics, FDA guidance on histology independent drug development in oncology, and the need to establish cut-offs for the biomarker of tumour mutational burden to identify the patients most likely to benefit from PDL1 treatment.The third session reviewed novel trial designs, including basket, umbrella and platform trials, and statistical approaches of hierarchical modelling where homogeneity between study cohorts enables information to be borrowed between cohorts. The discussion highlighted the need to agree ‘common assessment standards’ to facilitate pooling of data across studies.In the fourth session, the sharing of data sets was recognised as a key step for improving equity of access to precision medicines across Europe. The session considered how the European Health Data Space (EHDS) could streamline access to medical records, emphasizing the importance of introducing greater accountability into the digital space.In conclusion the workshop proposed 11 recommendations to facilitate histology agnostic drug development.</p

Pharmaceutical research in paediatric populations and the new EU Paediatric Legislation: an industry perspective

A large proportion of medicines used in children are prescribed off-label, and children have often been denied access to new or innovative medications. Because such situation is unethical, the need to obtain paediatric information for medicines used in children seems nowadays a matter of consensus on a global basis. Based on this, it was clear in EU, like what has happened in the US, that there was a need for a legal obligation for Pharmaceutical Companies to perform studies. This new European Paediatric Regulation that entered into force in 2007 opens a new era of European drug regulatory history and will offer a major opportunity to improve children's health through advancements in research by providing a new framework for evaluating the efficacy and safety of medicines for children. But, paediatric development remains challenging and the hurdles of conducting research in paediatric population are numerous. The article presents the new European Paediatric Regulation, illustrates its rationale through paediatric psychopharmacology, and discusses some of its consequences on paediatric research from an industry perspective. Recommendations for further international collaboration are also suggested to make global paediatric development plans