Development of an alternative transport appraisal technique: the transport quality of life model

This thesis justifies, designs and tests a new transport appraisal technique – the Transport Quality of Life (TQoL) model. In the United Kingdom the New Approach to Transport Appraisal (NATA) is presently used to appraise the economic, environmental and social impacts of transport projects. Although recently updated, NATA still does not include the assessment of individual’s travel experience – and yet, to make fully informed decisions on the impact of future schemes, it is important to understand more about passenger’s current journey quality. This thesis thus explores the potential of Quality of life (QoL) techniques as one means of addressing this gap in appraisal methods and scope. For the purposes of this thesis, TQoL is defined as the passenger experience of travel. Through the thesis a TQoL model was progressively refined and developed –from an initial Mark I model to a more evolved and developed Mark III model - to produce an appraisal tool that highlights differences in journey experience. To develop the model and to determine whether a TQoL approach was a valuable addition to transport appraisal, QoL techniques were applied to the transport networks of Glasgow and Manchester. In each city three modes of public transport were analysed to identify the mode providing the highest TQoL. A two-part household survey was used to gather data. The first survey was city-wide to gain the weightings for the TQoL indicators. The second was collected from selected transport corridors to evaluate TQoL. The results were quantified and presented in spider diagrams. T-tests were then used to identify the significant differences in TQoL. Factor analysis on the data from both Glasgow and Manchester showed that a TQoL model can be based on five factors - access and availability, sustainable transit, environment, personal safety and transport costs. Applying the final TQoL model showed that in both locations fixed modes - particularly Light Rapid Transport - provide a significantly higher TQoL compared to bus TQoL. By evaluating transport from the passenger’s viewpoint, the TQoL model can make transport appraisal more comprehensive. The thesis therefore concludes that the TQoL model should be used to supplement existing techniques to enable policy makers and practitioners make better informed decisions about improving the quality of transport

The factors influencing car use in a cycle-friendly city: the case of Cambridge.

Encouraging people out of their cars and into other modes of transport, which has major advantages for health, the environment and urban development, has proved difficult. Greater understanding of the influences that lead people to use the car, particularly for shorter journeys, may help to achieve this. This paper examines the predictors of car use compared with the bicycle to explore how it may be possible to persuade more people to use the bicycle instead of the car. Multivariable logistic regression was used to examine the socio-demographic, transport and health-related correlates of mode choice for work, shopping and leisure trips in Cambridge, a city with high levels of cycling by UK standards. The key findings are that commuting distance and free workplace parking were strongly associated with use of the car for work trips, and car availability and lower levels of education were associated with car use for leisure, shopping and short-distanced commuting trips. The case of Cambridge shows that more policies could be adopted, particularly a reduction in free car parking, to increase cycling and reduce the use of the car, especially over short distances

Artificial intelligence-ready skin cancer alchemy:transforming routine teledermatology data into metadata-embedded DICOM files

Most skin artificial intelligence (AI) classifiers are trained only on images with diagnostic labels. However, the addition of clinical information can improve predictive accuracy. Recent interest has been stimulated in incorporating clinical data into image files, using the well-established international Digital Imaging and Communication in Medicine (DICOM) standards (Caffery L, Weber J, Kurtansky N et al. DICOM in dermoscopic research: experience report and a way forward. J Digit Imaging 2021; 34: 967–73). We have developed an automated process of creating metadata-embedded DICOM files, directly from a live teledermatology system, described below. Through our Community and Locality Imaging Centre (CLIC) model, patients referred from primary care are triaged to CLIC for high-quality image capture. There, trained health professionals use a mobile application to capture standardized DICOM information for each lesion. Each lesion dataset contains images (macroscopic, dermoscopic) and clinical metadata (patient and lesion information). Datasets are transferred to an image management system, for teledermatology and verification of ground-truth diagnoses by a consultant dermatologist. On completion of diagnoses, datasets are flagged for conversion into DICOM format, where metadata are embedded in the image files. Flagged datasets are cleaned and clinical metadata are mapped to DICOM attributes. Datasets are converted into metadata-embedded DICOM files, and reviewed for conformance to the DICOM standard using the open-source fo-dicom library (v5). These files are further tested for conformance to DICOM standard using the dciodvfy validator tool. Compliant DICOM files are then transferred to a trusted research environment for research. To test whether these DICOM files are usable for AI research, they are examined using the DICOM viewing software 3D Slicer (https://www.slicer.org/), ensuring images are usable and metadata are correctly translated. Image pixel data and clinical metadata are extracted using pydicom, into a format suitable for AI algorithm development. In our pilot work, 658 lesion datasets have been converted into metadata-embedded DICOM files. Conversion on existing hardware [virtual Intel central processing units with 2.60 GHz (two processors) and 8 GB of memory] took < 1 s per image. Metadata-embedded DICOM files were approximately 0.2 kB bigger than the original JPEG files. For 3-MB images, this represented a negligible 0.003% increase in storage requirement. Testing has shown that these files can be successfully handled by algorithms within an AI research environment. In summary, we have demonstrated the feasibility of automating the conversion of routine teledermatology data into AI-ready image files encoded with clinical metadata. Future work is planned to evaluate the utility of this output on the performance of AI classifiers

Autonomous Gait Event Detection with Portable Single-Camera Gait Kinematics Analysis System

Laboratory-based nonwearable motion analysis systems have significantly advanced with robust objective measurement of thelimb motion, resulting in quantified, standardized, and reliable outcome measures compared with traditional, semisubjective,observational gait analysis. However, the requirement for large laboratory space and operational expertise makes these systemsimpractical for gait analysis at local clinics and homes. In this paper, we focus on autonomous gait event detection with our bespoke,relatively inexpensive, and portable, single-camera gait kinematics analysis system. Our proposed systemincludes video acquisitionwith camera calibration, Kalman filter + Structural-Similarity-based marker tracking, autonomous knee angle calculation, videoframe-identification-based autonomous gait event detection, and result visualization. The only operational effort required is themarker-template selection for tracking initialization, aided by an easy-to-use graphic user interface.The knee angle validation on10 stroke patients and 5 healthy volunteers against a gold standard optical motion analysis system indicates very good agreement.The autonomous gait event detection shows high detection rates for all gait events. Experimental results demonstrate that theproposed system can automatically measure the knee angle and detect gait events with good accuracy and thus offer an alternative,cost-effective, and convenient solution for clinical gait kinematics analysis

Neighbourhood, Route and Workplace-Related Environmental Characteristics Predict Adults' Mode of Travel to Work

Commuting provides opportunities for regular physical activity which can reduce the risk of chronic disease. Commuters' mode of travel may be shaped by their environment, but understanding of which specific environmental characteristics are most important and might form targets for intervention is limited. This study investigated associations between mode choice and a range of objectively assessed environmental characteristics.Participants in the Commuting and Health in Cambridge study reported where they lived and worked, their usual mode of travel to work and a variety of socio-demographic characteristics. Using geographic information system (GIS) software, 30 exposure variables were produced capturing characteristics of areas around participants' homes and workplaces and their shortest modelled routes to work. Associations between usual mode of travel to work and personal and environmental characteristics were investigated using multinomial logistic regression.Of the 1124 respondents, 50% reported cycling or walking as their usual mode of travel to work. In adjusted analyses, home-work distance was strongly associated with mode choice, particularly for walking. Lower odds of walking or cycling rather than driving were associated with a less frequent bus service (highest versus lowest tertile: walking OR 0.61 [95% CI 0.20–1.85]; cycling OR 0.43 [95% CI 0.23–0.83]), low street connectivity (OR 0.22, [0.07–0.67]; OR 0.48 [0.26–0.90]) and free car parking at work (OR 0.24 [0.10–0.59]; OR 0.55 [0.32–0.95]). Participants were less likely to cycle if they had access to fewer destinations (leisure facilities, shops and schools) close to work (OR 0.36 [0.21–0.62]) and a railway station further from home (OR 0.53 [0.30–0.93]). Covariates strongly predicted travel mode (pseudo r-squared 0.74).Potentially modifiable environmental characteristics, including workplace car parking, street connectivity and access to public transport, are associated with travel mode choice, and could be addressed as part of transport policy and infrastructural interventions to promote active commuting

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Automation enhancement and accuracy investigation of a portable single-camera gait analysis system

While optical motion analysis systems can provide high-fidelity gait parameters, they are usually impractical for local clinics and home use, due to high cost, requirement for large space, and lack of portability. In this study, the authors focus on a cost-effective and portable, single-camera gait analysis solution, based on video acquisition with calibration, autonomous detection of frames-of-interest, Kalman-filter + structural-similarity-based marker tracking, and autonomous knee angle calculation. The proposed system is tested using 15 participants, including 10 stroke patients and 5 healthy volunteers. The evaluation of autonomous frames-of-interest detection shows only 0.2% difference between the frame number of the detected frame compared to the frame number of the manually labelled ground truth frame, and thus can replace manual labelling. The system is validated against a gold standard optical motion analysis system, using knee angle accuracy as metric of assessment. The accuracy investigation between the RGB- and the greyscale-video marker tracking schemes shows that the greyscale system suffers from negligible accuracy loss with a significant processing speed advantage. Experimental results demonstrate that the proposed system can automatically estimate the knee angle, with R-squared value larger than 0.95 and Bland-Altman plot results smaller than 3.0127° mean error

The purpose of primary physical education: The views of teacher educators

This paper reports on the first phase of a longitudinal project investigating the perceived purposes that different stakeholders have for primary physical education (PE). In the study, the views of 19 teacher educators from seven countries across Europe were sought. While teacher educators may have some influence across the layers of an education system, little is known about this stakeholder group and their views about primary PE. Analysis of focus group conversations depicts that, while the teacher educators come from a wide range of contexts, their views on the purposes of primary PE were more similar than different. With primary PE in danger of disconnecting into different schools of thought, this finding is important because it suggests that more coherent and connected approaches have the potential to be developed. In line with most government policies from the seven countries, similarities focused on both an educational and outward-looking view of primary PE. Significantly, while the teacher educators recognised the key role of physical learning in primary PE, they also highlighted how children's social, emotional, and cognitive learning form part of an integrated view of primary PE. Teacher educators recognised the importance of primary PE expanding beyond the hall/gymnasium and into classroom, school, and community settings. However, some concerns were voiced about the influence of outsourcing and sport agendas that currently dominate. The views of these teacher educators offer a useful starting point for further investigation, particularly as they present the purposes of primary PE from both an integrated and educational perspective