Development of a FHIR Layer on Top of the OMOP Common Data Model for the CAPABLE Project.

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The Case Manager: Driving Medical Reasoning in a Distributed Environment for Home Patient Monitoring.

The CAPABLE project has been funded by the EU Horizon 2020 Programme over the years 2020-24 to support home care. A system is being designed and implemented supporting remote monitoring and virtual coaching for cancer patients. The system is based on a distributed modular architecture involving many components encapsulating various knowledge. The Case Manager has been designed as a separate component with the aim of coordinating the problem solving strategies. A first version of the Case Manager has been released and used by the components in a prototypical scenario shown at the first project review

Mapping and Assessment of Ecosystems and their Services: An EU ecosystem assessment

This report presents an ecosystem assessment covering the total land area of the EU as well as the EU marine regions. The assessment is carried out by Joint Research Centre, European Environment Agency, DG Environment, and the European Topic Centres on Biological Diversity and on Urban, Land and Soil Systems. This report constitutes a knowledge base which can support the evaluation of the 2020 biodiversity targets. It also provides a data foundation for future assessments and policy developments, in particular with respect to the ecosystem restoration agenda for the next decade (2020-2030). The report presents an analysis of the pressures and condition of terrestrial, freshwater and marine ecosystems using a single, comparable methodology based on European data on trends of pressures and condition relative to the policy baseline 2010. The following main conclusions are drawn: - Pressures on ecosystems exhibit different trends. - Land take, atmospheric emissions of air pollutants and critical loads of nitrogen are decreasing but the absolute values of all these pressures remain too high. - Impacts from climate change on ecosystems are increasing. - Invasive alien species of union concern are observed in all ecosystems, but their impact is particularly high in urban ecosystems and grasslands. - Pressures from overfishing activities and marine pollution are still high. - In the long term, air and freshwater quality is improving. - In forests and agroecosystems, which represent over 80% of the EU territory, there are improvements in structural condition indicators (biomass, deadwood, area under organic farming) relative to the baseline year 2010 but some key bio-indicators such as tree-crown defoliation continue to increase. This indicates that ecosystem condition is not improving. - Species-related indicators show no progress or further declines, particularly in agroecosystems. The analysis of trends in ecosystem services concluded that the current potential of ecosystems to deliver timber, protection against floods, crop pollination, and nature-based recreation is equal to or lower than the baseline value for 2010. At the same time, the demand for these services has significantly increased. A lowered potential in combination with a higher demand risks to further decrease the condition of ecosystems and their contribution to human well-being. Despite the wide coverage of environmental legislation in the EU, there are still large gaps in the legal protection of ecosystems. On land, 76% of the area of terrestrial ecosystems, mainly forests, agroecosystems and urban ecosystems, are excluded from a legal designation under the Bird and Habitat Directives. Freshwater and marine ecosystems are subject to specific protection measures under the Water Framework and Marine Strategy Framework Directives. The condition of ecosystems that are under legal designation is unfavourable. More efforts are needed to bend the curve of biodiversity loss and ecosystem degradation and to put ecosystems on a path to recovery. The progress that is made in certain areas such as pollution reduction, increasing air and water quality, increasing share of organic farming, the expansion of forests, and the efforts to maintain marine fish stocks at sustainable levels show that a persistent implementation of policies can be effective. These successes should encourage us to act now and to put forward an ambitious plan for the restoration of Europe’s ecosystems.JRC.D.3-Land Resource

The Case Manager: An Agent Controlling the Activation of Knowledge Sources in a FHIR-Based Distributed Reasoning Environment

Background Within the CAPABLE project the authors developed a multi-agent system that relies on a distributed architecture. The system provides cancer patients with coaching advice and supports their clinicians with suitable decisions based on clinical guidelines.Objectives As in many multi-agent systems we needed to coordinate the activities of all agents involved. Moreover, since the agents share a common blackboard where all patients' data are stored, we also needed to implement a mechanism for the prompt notification of each agent upon addition of new information potentially triggering its activation.Methods The communication needs have been investigated and modeled using the HL7-FHIR (Health Level 7-Fast Healthcare Interoperability Resources) standard to ensure proper semantic interoperability among agents. Then a syntax rooted in the FHIR search framework has been defined for representing the conditions to be monitored on the system blackboard for activating each agent.Results The Case Manager (CM) has been implemented as a dedicated component playing the role of an orchestrator directing the behavior of all agents involved. Agents dynamically inform the CM about the conditions to be monitored on the blackboard, using the syntax we developed. The CM then notifies each agent whenever any condition of interest occurs. The functionalities of the CM and other actors have been validated using simulated scenarios mimicking the ones that will be faced during pilot studies and in production.Conclusion The CM proved to be a key facilitator for properly achieving the required behavior of our multi-agent system. The proposed architecture may also be leveraged in many clinical contexts for integrating separate legacy services, turning them into a consistent telemedicine framework and enabling application reusability

CAncer PAtients Better Life Experience (CAPABLE) First Proof-of-Concept Demonstration

The CAncer PAtient Better Life Experience (CAPABLE) project combines the most advanced technologies for data and knowledge management with a socio-psychological approach, to develop a coaching system for improving the quality of life of cancer patients managed at home. The team includes complementary expertise in data- and knowledge-driven AI, data integration, telemedicine and decision support. The time is right to fully exploit Artificial Intelligence for cancer care and bring the benefits right to patients’ homes. CAPABLE relies on predictive models based on both retrospective and prospective data, integrated with computer interpretable guidelines and made available to oncologists. CAPABLE’s Virtual Coach component identifies unexpected needs and provides patient-specific decision support and lifestyle guidance to improve mental and physical wellbeing of patients. The demo, designed around a use-case scenario developed with clinicians involved in the project, addresses the ESMO Diarrhea guideline. It revolves around a prototypical fictional patient named Maria. Maria, 66, is affected by renal cell carcinoma and moderate insomnia. The demo follows Maria during the first three days of using the CAPABLE system. This allows the audience to understand the scope and innovation behind this AI-based decision-support and coaching system that personalizes lifestyle and medication interventions to patients, their carer and clinicians