E-infrastructures fostering multi-centre collaborative research into the intensive care management of patients with brain injury

Clinical research is becoming ever more collaborative with multi-centre trials now a common practice. With this in mind, never has it been more important to have secure access to data and, in so doing, tackle the challenges of inter-organisational data access and usage. This is especially the case for research conducted within the brain injury domain due to the complicated multi-trauma nature of the disease with its associated complex collation of time-series data of varying resolution and quality. It is now widely accepted that advances in treatment within this group of patients will only be delivered if the technical infrastructures underpinning the collection and validation of multi-centre research data for clinical trials is improved. In recognition of this need, IT-based multi-centre e-Infrastructures such as the Brain Monitoring with Information Technology group (BrainIT - www.brainit.org) and Cooperative Study on Brain Injury Depolarisations (COSBID - www.cosbid.de) have been formed. A serious impediment to the effective implementation of these networks is access to the know-how and experience needed to install, deploy and manage security-oriented middleware systems that provide secure access to distributed hospital based datasets and especially the linkage of these data sets across sites. The recently funded EU framework VII ICT project Advanced Arterial Hypotension Adverse Event prediction through a Novel Bayesian Neural Network (AVERT-IT) is focused upon tackling these challenges. This chapter describes the problems inherent to data collection within the brain injury medical domain, the current IT-based solutions designed to address these problems and how they perform in practice. We outline how the authors have collaborated towards developing Grid solutions to address the major technical issues. Towards this end we describe a prototype solution which ultimately formed the basis for the AVERT-IT project. We describe the design of the underlying Grid infrastructure for AVERT-IT and how it will be used to produce novel approaches to data collection, data validation and clinical trial design is also presented

Investing in breastfeeding – the world breastfeeding costing initiative

BACKGROUND Despite scientific evidence substantiating the importance of breastfeeding in child survival and development and its economic benefits, assessments show gaps in many countries' implementation of the 2003 WHO and UNICEF Global Strategy for Infant and Young Child Feeding (Global Strategy). Optimal breastfeeding is a particular example: initiation of breastfeeding within the first hour of birth, exclusive breastfeeding for the first six months; and continued breastfeeding for two years or more, together with safe, adequate, appropriate, responsive complementary feeding starting in the sixth month. While the understanding of "optimal" may vary among countries, there is a need for governments to facilitate an enabling environment for women to achieve optimal breastfeeding. Lack of financial resources for key programs is a major impediment, making economic perspectives important for implementation. Globally, while achieving optimal breastfeeding could prevent more than 800,000 under five deaths annually, in 2013, US$58 billion was spent on commercial baby food including milk formula. Support for improved breastfeeding is inadequately prioritized by policy and practice internationally. METHODS The World Breastfeeding Costing Initiative (WBCi) launched in 2013, attempts to determine the financial investment that is necessary to implement the Global Strategy, and to introduce a tool to estimate the costs for individual countries. The article presents detailed cost estimates for implementing the Global Strategy, and outlines the WBCi Financial Planning Tool. Estimates use demographic data from UNICEF's State of the World's Children 2013. RESULTS The WBCi takes a programmatic approach to scaling up interventions, including policy and planning, health and nutrition care systems, community services and mother support, media promotion, maternity protection, WHO International Code of Marketing of Breastmilk Substitutes implementation, monitoring and research, for optimal breastfeeding practices. The financial cost of a program to implement the Global Strategy in 214 countries is estimated at US$17.5 billion ($130 per live birth). The major recurring cost is maternity entitlements. CONCLUSIONS WBCi is a policy advocacy initiative to encourage integrated actions that enable breastfeeding. WBCi will help countries plan and prioritize actions and budget them accurately. International agencies and donors can also use the tool to calculate or track investments in breastfeeding.The project was possible through financial support from SAFANSI (South Asia Food and Nutrition Security Initiative) project and a contribution by DFID (Department for International Development) and AusAID (Australian Agency for International Development)

Deliverable JRA1.1: Evaluation of current network control and management planes for multi-domain network infrastructure

This deliverable includes a compilation and evaluation of available control and management architectures and protocols applicable to a multilayer infrastructure in a multi-domain Virtual Network environment.The scope of this deliverable is mainly focused on the virtualisation of the resources within a network and at processing nodes. The virtualization of the FEDERICA infrastructure allows the provisioning of its available resources to users by means of FEDERICA slices. A slice is seen by the user as a real physical network under his/her domain, however it maps to a logical partition (a virtual instance) of the physical FEDERICA resources. A slice is built to exhibit to the highest degree all the principles applicable to a physical network (isolation, reproducibility, manageability, ...). Currently, there are no standard definitions available for network virtualization or its associated architectures. Therefore, this deliverable proposes the Virtual Network layer architecture and evaluates a set of Management- and Control Planes that can be used for the partitioning and virtualization of the FEDERICA network resources. This evaluation has been performed taking into account an initial set of FEDERICA requirements; a possible extension of the selected tools will be evaluated in future deliverables. The studies described in this deliverable define the virtual architecture of the FEDERICA infrastructure. During this activity, the need has been recognised to establish a new set of basic definitions (taxonomy) for the building blocks that compose the so-called slice, i.e. the virtual network instantiation (which is virtual with regard to the abstracted view made of the building blocks of the FEDERICA infrastructure) and its architectural plane representation. These definitions will be established as a common nomenclature for the FEDERICA project. Other important aspects when defining a new architecture are the user requirements. It is crucial that the resulting architecture fits the demands that users may have. Since this deliverable has been produced at the same time as the contact process with users, made by the project activities related to the Use Case definitions, JRA1 has proposed a set of basic Use Cases to be considered as starting point for its internal studies. When researchers want to experiment with their developments, they need not only network resources on their slices, but also a slice of the processing resources. These processing slice resources are understood as virtual machine instances that users can use to make them behave as software routers or end nodes, on which to download the software protocols or applications they have produced and want to assess in a realistic environment. Hence, this deliverable also studies the APIs of several virtual machine management software products in order to identify which best suits FEDERICA’s needs.Postprint (published version

Implementation-effectiveness trial of an ecological intervention for physical activity in ethnically diverse low income senior centers.

BackgroundAs the US population ages, there is an increasing need for evidence based, peer-led physical activity programs, particularly in ethnically diverse, low income senior centers where access is limited.Methods/designThe Peer Empowerment Program 4 Physical Activity' (PEP4PA) is a hybrid Type II implementation-effectiveness trial that is a peer-led physical activity (PA) intervention based on the ecological model of behavior change. The initial phase is a cluster randomized control trial randomized to either a peer-led PA intervention or usual center programming. After 18 months, the intervention sites are further randomized to continued support or no support for another 6 months. This study will be conducted at twelve senior centers in San Diego County in low income, diverse communities. In the intervention sites, 24 peer health coaches and 408 adults, aged 50 years and older, are invited to participate. Peer health coaches receive training and support and utilize a tablet computer for delivery and tracking. There are several levels of intervention. Individual components include pedometers, step goals, counseling, and feedback charts. Interpersonal components include group walks, group sharing and health tips, and monthly celebrations. Community components include review of PA resources, walkability audit, sustainability plan, and streetscape improvements. The primary outcome of interest is intensity and location of PA minutes per day, measured every 6 months by wrist and hip accelerometers and GPS devices. Secondary outcomes include blood pressure, physical, cognitive, and emotional functioning. Implementation measures include appropriateness & acceptability (perceived and actual fit), adoption & penetration (reach), fidelity (quantity & quality of intervention delivered), acceptability (satisfaction), costs, and sustainability.DiscussionUsing a peer led implementation strategy to deliver a multi-level community based PA program can enhance program adoption, implementation, and sustainment.Trial registrationClinicalTrials.gov, USA ( NCT02405325 ). Date of registration, March 20, 2015. This website also contains all items from the World Health Organization Trial Registration Data Set

An agent-based architecture for managing the provision of community care - the INCA (Intelligent Community Alarm) experience

Community Care is an area that requires extensive cooperation between independent agencies, each of which needs to meet its own objectives and targets. None are engaged solely in the delivery of community care, and need to integrate the service with their other responsibilities in a coherent and efficient manner. Agent technology provides the means by which effective cooperation can take place without compromising the essential security of both the client and the agencies involved as the appropriate set of responses can be generated through negotiation between the parties without the need for access to the main information repositories that would be necessary with conventional collaboration models. The autonomous nature of agents also means that a variety of agents can cooperate together with various local capabilities, so long as they conform to the relevant messaging requirements. This allows a variety of agents, with capabilities tailored to the carers to which they are attached to be developed so that cost-effective solutions can be provided. </p

London SynEx Demonstrator Site: Impact Assessment Report

The key ingredients of the SynEx-UCL software components are: 1. A comprehensive and federated electronic healthcare record that can be used to reference or to store all of the necessary healthcare information acquired from a diverse range of clinical databases and patient-held devices. 2. A directory service component to provide a core persons demographic database to search for and authenticate staff users of the system and to anchor patient identification and connection to their federated healthcare record. 3. A clinical record schema management tool (Object Dictionary Client) that enables clinicians or engineers to define and export the data sets mapping to individual feeder systems. 4. An expansible set of clinical management algorithms that provide prompts to the patient or clinician to assist in the management of patient care. CHIME has built up over a decade of experience within Europe on the requirements and information models that are needed to underpin comprehensive multiprofessional electronic healthcare records. The resulting architecture models have influenced new European standards in this area, and CHIME has designed and built prototype EHCR components based on these models. The demonstrator systems described here utilise a directory service and object-oriented engineering approach, and support the secure, mobile and distributed access to federated healthcare records via web-based services. The design and implementation of these software components has been founded on a thorough analysis of the clinical, technical and ethico-legal requirements for comprehensive EHCR systems, published through previous project deliverables and in future planned papers. The clinical demonstrator site described in this report has provided the solid basis from which to establish "proof of concept" verification of the design approach, and a valuable opportunity to install, test and evaluate the results of the component engineering undertaken during the EC funded project. Inevitably, a number of practical implementation and deployment obstacles have been overcome through this journey, each of those having contributed to the time taken to deliver the components but also to the richness of the end products. UCL is fortunate that the Whittington Hospital, and the department of cardiovascular medicine in particular, is committed to a long-term vision built around this work. That vision, outlined within this report, is shared by the Camden and Islington Health Authority and by many other purchaser and provider organisations in the area, and by a number of industrial parties. They are collectively determined to support the Demonstrator Site as an ongoing project well beyond the life of the EC SynEx Project. This report, although a final report as far as the EC project is concerned, is really a description of the first phase in establishing a centre of healthcare excellence. New EC Fifth Framework project funding has already been approved to enable new and innovative technology solutions to be added to the work already established in north London