An Integrated Framework to Achieve Interoperability in Person-Centric Health Management

The need for high-quality out-of-hospital healthcare is a known socioeconomic problem. Exploiting ICT's evolution, ad-hoc telemedicine solutions have been proposed in the past. Integrating such ad-hoc solutions in order to cost-effectively support the entire healthcare cycle is still a research challenge. In order to handle the heterogeneity of relevant information and to overcome the fragmentation of out-of-hospital instrumentation in person-centric healthcare systems, a shared and open source interoperability component can be adopted, which is ontology driven and based on the semantic web data model. The feasibility and the advantages of the proposed approach are demonstrated by presenting the use case of real-time monitoring of patients' health and their environmental context

Trends in Net Survival from Vulvar Squamous Cell Carcinoma in Italy (1990–2015)

Objective: In many Western countries, survival from vulvar squamous cell carcinoma (VSCC) has been stagnating for decades or has increased insufficiently from a clinical perspective. In Italy, previous studies on cancer survival have not taken vulvar cancer into consideration or have pooled patients with vulvar and vaginal cancer. To bridge this knowledge gap, we report the trend in survival from vulvar cancer between 1990 and 2015. (2) Methods: Thirty-eight local cancer registries covering 49% of the national female population contributed the records of 6274 patients. Study endpoints included 1- and 2-year net survival (NS) calculated using the Pohar-Perme estimator and 5-year NS conditional on having survived two years (5|2-year CNS). The significance of survival trends was assessed with the Wald test on the coefficient of the period of diagnosis, entered as a continuous regressor in a Poisson regression model. (3) Results: The median patient age was stable at 76 years. One-year NS decreased from 83.9% in 1990–2001 to 81.9% in 2009–2015 and 2-year NS from 72.2% to 70.5%. Five|2-year CNS increased from 85.7% to 86.7%. These trends were not significant. In the age stratum 70–79 years, a weakly significant decrease in 2-year NS from 71.4% to 65.7% occurred. Multivariate analysis adjusting for age group at diagnosis and geographic area showed an excess risk of death at 5|2-years, of borderline significance, in 2003–2015 versus 1990–2002. (4) Conclusions: One- and 2-year NS and 5|2-year CNS showed no improvements. Current strategies for VSCC control need to be revised both in Italy and at the global level

A Smart Space Application to Dynamically Relate Medical and Environmental Information

This paper presents a cross-domain application for ambient and health monitoring. The system architecture is intended to be openly extensible in order to fulfil unanticipated needs. Our implementation addresses several user groups, from those requiring heart related monitoring, which could be dependent on the environmental conditions, to those who need to maximize environmental comfort under specified energy consumption constraints. In this application the ambient information is used to nrich the biomedical data and provide a more complete picture to the information consumers, such as doctors and building superintendents. The cross-domain nature of the scenario requires data interoperability, which is ensured by a shared Smart Space. The Smart Space represents the information in Resource Description Framework and its semantics are ontology driven. A simple ontology for the addressed information domain is also presented. The Smart Space platform is provided by the JTI Artemis SOFIA project

Case study: Context-aware supervision of a smart maintenance process

The “smartness” of applications is heavily based on their ability to use context information for behaving in a way that perfectly matches the situation in which the application is being used and running. However, achieving situation-based behavior is not straightforward; the situation has to be identified; the functionality that provides the best fit (not always the optimal one) has to be selected from a set of options; and the smart environment has to be configured so that the primary goal can be achieved. This paper introduces a solution for context monitoring and context sharing among software agents. The concept has been implemented as part of the maintenance process of a smart building. It is still a challenge to achieve a context that can dynamically update and expand itself

COVID-19 Pandemic-Adapted Radiotherapy Guidelines: Are They Really Followed?

Background: In our department, we provided guidelines to the radiation oncologists (ROs) regarding the omission, delay, or shortening of radiotherapy (RT). The purpose was to reduce the patients’ exposure to the hospital environment and to minimize the departmental overcrowding. The aim was to evaluate the ROs’ compliance to these guidelines. Methods: ROs were asked to fill out a data collection form during patients’ first visits in May and June 2020. The collected data included the ROs’ age and gender, patient age and residence, RT purpose, treated tumor, the dose and fractionation that would have been prescribed, and RT changes. The chi-square test and binomial logistic regression were used to analyze the correlation between the treatment prescription and the collected parameters. Results: One hundred and twenty-six out of 205 prescribed treatments were included in this analysis. Treatment was modified in 61.1% of cases. More specifically, the treatment was omitted, delayed, or shortened in 7.9, 15.9, and 37.3% of patients, respectively. The number of delivered fractions was reduced by 27.9%. A statistically significant correlation (p = 0.028) between younger patients’ age and lower treatment modifications rate was recorded. Conclusion: Our analysis showed a reasonably high compliance of ROs to the pandemic-adapted guidelines. The adopted strategy was effective in reducing the number of admissions to our department

Trends in Liver Cancer Incidence and Survival in Italy by Histologic Type, 2003-2017

(1) Background: Liver cancer in Italy is characterised by one of the highest incidence rates worldwide outside of Asia coupled with comparatively favourable survival figures. The objective of this study was to evaluate the most recent epidemiologic trends of the disease. (2) Methods: Thirteen cancer registries covering a population of about 12,740,000 (21% of the national population) made available the records of 35,574 cases registered between 2003 and 2017. Trends in age-standardised (Europe 2013) incidence rates were analysed using the results of age-drift models. Trends in survival were analysed using 1-year, 2-year, 5-year and 10-year net survival (NS) and 5|1-year and 5|2-year conditional NS. (3) Results: Over the study period, the average annual incidence rates per 100,000 persons were 29.4 (men) and 9.4 (women) for total liver cancer; 14.6 and 3.5 for hepatocellular carcinoma (HCC); 1.8 and 1.1 for intrahepatic cholangiocarcinoma (ICC); and 13.0 and 4.8 for the 'other liver cancer types' group. The incidence of total liver cancer and HCC decreased significantly for both sexes. For total liver cancer, the estimated average annual percent change was -1.6% among men and -2.1% among women. For HCC, the change was -1.3% among men and -2.7% among women. ICC followed an opposite trend. For men, the risk of HCC had two peaks, one in the birth cohorts of 1928 and 1933 and another, more moderate peak in the cohort of 1958. Men and women exhibited comparable improvements in both early and mid-term conditional NS from HCC. In 2013-2017, 5-year NS was 28.9% (95% CI: 27.3%; 30.6%) for men and 30.1% (95% CI: 26.9%; 33.5%) for women. The uptrend in survival from ICC was less pronounced and was weakly significant, with a 5-year NS in 2013-2017 of 13.9% (95% CI: 10.8%; 17.3%) for men and 17.4% (95% CI: 13.5%; 21.7%) for women. (4) Conclusions: The opposite incidence trends of HCC and ICC confirm a pattern observed in other populations. The generalised, albeit slow, improvement in survival from HCC indicates a trend towards earlier detection coupled with improvements in treatments

Principles for the application of life cycle sustainability assessment

PURPOSE AND CONTEXT: This paper aims to establish principles for the increased application and use of life cycle sustainability assessment (LCSA). Sustainable development (SD) encompassing resilient economies and social stability of the global system is growingly important for decision-makers from business and governments. The “17 SDGs” emerge as a high-level shared blueprint for peace, abundance, and prosperity for people and the planet, and “sustainability” for supporting improvements of products and organizations. A “sustainability” interpretation—successful in aligning stakeholders’ understanding—subdivides the impacts according to a triple bottom line or three pillars: economic, social, and environmental impacts. These context and urgent needs inspired the LCSA framework. This entails a sustainability assessment of products and organizations in accordance with the three pillars, while adopting a life cycle perspective. METHODS: The Life Cycle Initiative promotes since 2011 a pragmatic LCSA framework based on the three techniques: LCSA = environmental life cycle assessment (LCA) + life cycle costing (LCC) + social life cycle assessment (S-LCA). This is the focus of the paper, while acknowledging previous developments. Identified and reviewed literature shows challenges of addressing the three pillars in the LCSA framework implementation like considering only two pillars; not being fully aligned with ISO 14040; lacking interconnectedness among the three pillars; not having clear criteria for results’ weighting nor clear results’ interpretation; and not following cause-effect chains and mechanisms leading to an endpoint. Agreement building among LCSA experts and reviewing processes strengthened the consensus on this paper. Broad support and outreach are ensured by publishing this as position paper. RESULTS: For harmonizing practical LCSA applications, easing interpretation, and increasing usefulness, consensed ten LCSA principles (10P) are established: understanding the areas of protection, alignment with ISO 14040, completeness, stakeholders’ and product utility considerations, materiality of system boundaries, transparency, consistency, explicit trade-offs’ communication, and caution when compensating impacts. Examples were provided based on a fictional plastic water bottle CONCLUSIONS: In spite of increasing needs for and interest in SD and sustainability supporting tools, LCSA is at an early application stage of application. The 10P aim to promote more and better LCSA applications by ensuring alignment with ISO 14040, completeness and clear interpretation of integrated results, among others. For consolidating its use, however, more consensus-building is needed (e.g., on value-laden ethical aspects of LCSA, interdependencies and interconnectedness among the three dimensions, and harmonization and integration of the three techniques) and technical and policy recommendations for application