ARGOS policy brief on semantic interoperability

Semantic interoperability requires the use of standards, not only for Electronic Health Record (EHR) data to be transferred and structurally mapped into a receiving repository, but also for the clinical content of the EHR to be interpreted in conformity with the original meanings intended by its authors. Accurate and complete clinical documentation, faithful to the patient’s situation, and interoperability between systems, require widespread and dependable access to published and maintained collections of coherent and quality-assured semantic resources, including models such as archetypes and templates that would (1) provide clinical context, (2) be mapped to interoperability standards for EHR data, (3) be linked to well specified, multi-lingual terminology value sets, and (4) be derived from high quality ontologies. Wide-scale engagement with professional bodies, globally, is needed to develop these clinical information standards

Biomechanics-based in silico medicine: The manifesto of a new science

In this perspective article we discuss the role of contemporary biomechanics in the light of recent applications such as the development of the so-called Virtual Physiological Human technologies for physiology-based in silico medicine. In order to build Virtual Physiological Human (VPH) models, computer models that capture and integrate the complex systemic dynamics of living organisms across radically different space–time scales, we need to re-formulate a vast body of existing biology and physiology knowledge so that it is formulated as a quantitative hypothesis, which can be expressed in mathematical terms. Once the predictive accuracy of these models is confirmed against controlled experiments and against clinical observations, we will have VPH model that can reliably predict certain quantitative changes in health status of a given patient, but also, more important, we will have a theory, in the true meaning this word has in the scientific method. In this scenario, biomechanics plays a very important role, biomechanics is one of the few areas of life sciences where we attempt to build full mechanistic explanations based on quantitative observations, in other words, we investigate living organisms like physical systems. This is in our opinion a Copernican revolution, around which the scope of biomechanics should be re-defined. Thus, we propose a new definition for our research domain “Biomechanics is the study of living organisms as mechanistic systems”

Policy needs and options for a common approach towards modelling and simulation of human physiology and diseases with a focus on the virtual physiological human.

Life is the result of an intricate systemic interaction between many processes occurring at radically different spatial and temporal scales. Every day, worldwide biomedical research and clinical practice produce a huge amount of information on such processes. However, this information being highly fragmented, its integration is largely left to the human actors who find this task increasingly and ever more demanding in a context where the information available continues to increase exponentially. Investments in the Virtual Physiological Human (VPH) research are largely motivated by the need for integration in healthcare. As all health information becomes digital, the complexity of health care will continue to evolve, translating into an ever increasing pressure which will result from a growing demand in parallel to limited budgets. Hence, the best way to achieve the dream of personalised, preventive, and participative medicine at sustainable costs will be through the integration of all available data, information and knowledge

Modelling the environmental justice of the spatial distribution of air quality

PhD ThesisRelationships between air pollution, health and deprivation potentially result in the highest cost to both the public and the government in terms of increased mortality and morbidity; hence establishing links between them is important and justifiable. The concept of Environmental Justice (EJ) questions whether certain socio-economic groups bear a disproportionate burden of environmental externalities, and whether policy and practice are equitable and fair. This research presents an innovative air quality modelling framework to map the EJ of the spatial distribution of air quality; and the impact of air quality management measures on existing EJ concerns. To assist in this goal, a modelling approached has been developed which enables the assessment of traffic management solutions that may create only subtle changes in the traffic flow regimes; and accurately assesses the impact of a reduction in vehicle kilometres travelled (VKT). Strong evidence of environmental injustice in the current distribution and production of poor air quality has been provided in the literature. However, the overwhelming majority of existing studies have concentrated on the analysis of current or historic associations. As a result their methodologies do not allow for the analysis of future strategies therefore, a gap exists in understanding the EJ implications of air quality strategies or schemes designed to improve air quality. Recent years have seen heightened political focus on policy and attempts to improve air quality. Whilst it is broadly suggested in the literature that improving air quality also will improve existing EJ concerns, evidence to date shows that even in situations where air quality is improving, the rate of concentration improvement is lowest for the poor. This research presents a suite of linked models of traffic, emission, dispersion, and geodemographic models (the modelling framework) that together allow not only more accurate assessment of the existing EJ situation to be established over using traditional techniques, but also the assessment of future air quality strategies and schemes designed to improve air quality which may improve or exacerbate the existing EJ relationship. ii The use of microsimulation traffic modelling in conjunction with an instantaneous emissions model (IEM) is a well-established emissions modelling technique. However, the use of IEMs is generally confined to exploration of emissions outputs and not the subsequent dispersion of emissions in order to determine air quality. This research successfully combines advanced microscale modelling techniques and applies them in the context of an EJ study in order to produce an original modelling framework capable of household level EJ analysis. This research has established that, at a city level, there is no linear relationship between air quality and deprivation in the North East cities of Durham, Newcastle and Gateshead. However, analysis of geodemographic data at the household and postcode levels has provided evidence of environmental injustice in air quality across all three study areas. Additionally, this research has explored the impact of reductions in VKT as a proposed air quality management measure. Thereby, the reductions required in VKT (over 2010 traffic flows) in one study area, Durham, have been established in order to meet both EU air quality limits and future carbon targets. Incremented 5% VKT reduction changes were made to the base-case 2010 scenario until all considered targets were met. Based on a 2010 vehicle fleet, a 50% reduction in traffic through Durham’s AQMA is required to meet all EU air quality targets. Similarly, a 25% reduction in VKT is required assuming a 2020 vehicle fleet, and by 2025 a 15% reduction in VKT would ensure Durham met its air quality targets. Moreover, a 10% reduction in VKT by 2020, and 25% reduction by 2025 would ensure carbon dioxide (CO2) reductions across the study area equal to those set out in the carbon budget. Furthermore, it has been established that the reductions in VKT to meet both EU air quality limits and future carbon targets eliminates the identified EJ issue in Durham. Moreover, if future VKT is constrained to 2010 levels, the spatial distribution of air quality will be environmentally just in both the 2020 and 2025 assessment yearsEngineering and Physical Sciences Research Council (EPSRC) for funding this work. Also, thanks are given to Durham County Council for additional funding

Geospatial and statistical methods to model intracity truck crashes

In recent years, there has been a renewed interest in statistical ranking criteria to identify hot spots on road networks. These criteria potentially represent high crash risk zones for further engineering evaluation and safety improvement. Many studies also focused on the development of crash estimation models to quantify the safety effects of geometric, traffic, and environmental factors on expected number of total, fatal, injury, and/or property damage crashes at specific locations. However, freight safety, specifically truck safety, was meagerly addressed. Trucks and long-combination vehicles (LCVs) that carry approximately 70% freight have significant potential in triggering crash occurrences on roads, mostly severe crashes. Truck transportation is therefore attracting more and more attention due to its effect on safety and operational performance as well as rapid industrial growth. Most of the past research on truck safety focused on intercity or Interstate truck trips. Intracity truck safety related studies or research was hardly pursued. The major research objectives of this dissertation are: 1) to develop a geospatial method to identify high truck crash zones, 2) to evaluate the use of different ranking methods for prioritization and allocation of resources, 3) to investigate the relations between intracity truck crash occurrences and various predictor variables (on- and off-network characteristics) to provide greater insights regarding crash occurrence and effective countermeasures, and 4) to develop truck crash prediction models. The prioritization of high truck crash zones was performed by identifying truck crash hot spots and ranking them based on several parameters. Geospatial methods along with statistical methods were deployed to understand the relationships between geometric road conditions, land use characteristics, demographic, and socio-economic characteristics and truck crashes. Truck crash estimation models were then developed using selected on- and off- network characteristics data. To assess the suitability of these models, several goodness-of-fit statistics were computed. The geospatial methods and development of truck crash estimation models are illustrated using data for the city of Charlotte, North Carolina for the year 2008. It was found that on-off network characteristics, socio-economic characteristics and demographic characteristics that are within the 0.5-mile proximity have a vital influence on truck crash occurrence. The findings from the research are expected to provide information and methods on identifying truck crash zones and the likelihood of a truck crash occurrence due to intracity trips and its relationship with on- and off-network characteristics of a region. Furthermore, this research is expected to aid significantly in the process of selecting meaningful countermeasures to improve safety of users on roads

Assessing travel time savings and user benefits of automated driving – A case study for a commuting relation

Combining cooperative vehicle driving behavior of Connected and Automated Vehicles with supporting information infrastructure, is expected to increase the capacity of roadway infrastructure, which in turn results in travel time savings and user benefits. Automated driving also relieves the driver from steering the car, allowing to conduct other activities during the trip, which is likely to generate further user benefits. In order to assess the magnitude of automated driving on travel time-related user benefits, a typical commuting relation is analyzed, considering three route options as well as level 4 and 5 vehicle automation. The impacts on travel times are estimated by microscopic traffic flow simulations. The simulations reveal that around 27% of the travel time can be saved on a commuting relation due to road automation according to level 5. For level 4 vehicles the travel time savings amount to up to 20%. User benefits that accrue from time savings and the passenger\u27s option of using travelling time for activities other than conducting the car, are expected at a relevant magnitude. Even under consideration of higher operating costs of an automated car, significant user benefits accrue: 1,310–2,240 € p.a. for level 4 and 2,770–3,440 € p.a. for level 5 vehicles during a passenger car\u27s typical depreciation period. Thus, automated driving will decrease the commuters\u27 generalized user costs for individual motorized mobility, which is likely to enhance the urban hinterland\u27s attractiveness as residential area. This pattern and inherent second-order effects pose challenges for transport, land use and urban planners. Furthermore, it represents a challenge for transport research: to elaborate appropriate concepts that allow for exploiting the benefits of use of automated vehicles while countervailing undesirable socio-economic effects, as well as strains on the transport system and land use

Unconventional Intersection Designs for Improving Traffic Operation Along Arterial Roads

The main objective of this paper is to evaluate the effect of implementing four Unconventional Arterial Intersection Designs (UAIDs) including median U-Turn, Superstreet, Jughandle and Single Quadrant Intersection on a major arterial road using SYNCHRO microscopic simulation software. For this purpose, Wadi Saqra Signalized Intersection on Shaker Bin Zaid major arterial road in Amman, Jordan was selected. The simulation results showed that only the Jughandle improved the intersection Level of Service (LOS) slightly, F–E. Nevertheless, the intersection delay was significantly reduced by 64.81%, 76.6%, 91.28% and 75.60% on the proposed Median U-Turn, Superstreet, Jughandle and Single Quadrant unconventional intersection design, respectively. This indicated that these UAIDs don't perform well under heavy traffic volumes. Also, since the Jughandle was the only UAID which improved the LOS on the main intersection, the operational performance of Prince Shaker Bin Zaid arterial after implementing the Jughandle at the main intersection was evaluated including the main intersection: Wadi Saqra intersection, one prior to the main intersection and one after the main intersection. It was found that the use of the Jughandle increased the average travel speed by 35% and decreased the average stopped delay by 28.68% on the arterial road. Also, this paper evaluated the current transportation system and road user's attitude towards UAIDs' implementation through a questionnaire survey. The results indicated high acceptance of UAIDs. Finally, the construction cost for each UAID type was estimated. It was found that the Jughandle had the highest construction cost due to its high acquisition cost

Influence of Accessibility, Land Use and Transport Policies on the Transport Energy Dependence of a City

Abstract Transports can be considered as the main contributors of climate change and cities' total energy consumption. In order to reduce transport energy, which is mainly influenced by urban form and available systems, three strategies can be adopted: a land use distribution lowering the need of motorized mobility; adoption of measures fostering low impact transport modes; promotion of energy efficient vehicle fleets. The aim of this paper is to evaluate the suitability of accessibility measures as a planning tool to evaluate the effectiveness of integrated transport and land use policies adopted to reduce the transport energy dependence of an urban area

Human papillomavirus vaccination in national immunization programs: impact and perspectives

Human Papillomaviruses are present in virtually all cases of cervical cancer and are also linked with anogenital warts and other precancerous lesions which can be primarily prevented by HPV vaccination. We searched the PubMed, Scopus, Web of Science and Embase databases (between January 1st, 2011 and February 28th, 2017) and WHO (World Health Organization) and countries’ health organizations websites for data on HPV vaccination programs and its effectiveness. For the review on the Brazilian Immunization program, we additionally searched SciELO database and websites of the Brazilian Ministry of Health and the Information System of the National Immunization Program (SI-PNI). As of April 2017, about 40% of the countries had introduced HPV vaccines in their national immunization programs, targeting almost always children and teenage females between 9 and 13 years of age. Most of these are high-income countries but low- and middle-income countries are recently implementing the vaccination program with financial support of public and private organizations. Since the introduction of HPV vaccination, numerous articles present data on its effectiveness in real world supporting the effectiveness of an immunization program in the prevention of HPV infection and related diseases in both genders. The Brazilian HPV vaccination program began in 2014 for 9-13 years old girls and has recently been expanded to include boys and young males. This review aims to update information on HPV vaccination programs worldwide highlighting the Brazilian immunization program. Data on the impact and effectiveness of HPV vaccines on infection and related diseases is presented. Moreover, the reasons for different coverage rates, reflected in low-vaccine uptake, are discussed. Finally, the present review addresses the socioeconomic barriers as well as the key determinants of long-term program success and strategies to improve access and adherence to HPV vaccination.O Papilomavírus Humano (HPV) está presente em praticamente todos os casos de câncer do colo do útero e também em verrugas anogenitais e outras lesões pré-cancerígenas diversas, que podem ser prevenidos primariamente via vacinação. Até abril de 2017, cerca de 40% dos países já haviam introduzido a vacina de HPV em seus programas nacionais de imunização, tendo por alvo quase sempre meninas entre 9 e 13 anos de idade. A maioria desses países são de alta renda, mas países de média e baixa renda têm implementado recentemente programas de vacinação com o apoio de organizações de financiamento públicas e privadas. Desde a introdução da vacinação de HPV, inúmeros artigos apresentam dados sobre sua efetividade no mundo real, apoiando a efetividade de um programa de imunização na prevenção da infecção e na redução das doenças relacionadas ao HPV em ambos os sexos. O programa brasileiro de vacinação contra o HPV iniciou-se em 2014 para meninas de 9 a 13 anos de idade e, recentemente, foi ampliado para meninos. Este artigo de revisão visa atualizar os dados de implementação de vacina de HPV em diferentes países do mundo, enfatizando o programa brasileiro. Além disso, são apresentados os dados de impacto e efetividade da vacina de HPV em relação à redução de infecções e doenças causados pelos tipos de HPV contidos nas vacinas. Ainda, são apontadas as razões para as diferentes taxas de cobertura e dificuldades observadas na implementação dos programas, considerando barreiras sociais e econômicas. Finalmente, são discutidos os principais determinantes de sucesso a longo prazo e estratégias para melhorar o acesso e a aderência aos programas de vacinação