Publications by authors named "Maged N Kamel Boulos"

69 Publications

Smart city lifestyle sensing, big data, geo-analytics and intelligence for smarter public health decision-making in overweight, obesity and type 2 diabetes prevention: the research we should be doing.

Int J Health Geogr 2021 Mar 3;20(1):12. Epub 2021 Mar 3.

Department of Geography, The University of Hong Kong, Pokfulam RD, Hong Kong, China.

The public health burden caused by overweight, obesity (OO) and type-2 diabetes (T2D) is very significant and continues to rise worldwide. The causation of OO and T2D is complex and highly multifactorial rather than a mere energy intake (food) and expenditure (exercise) imbalance. But previous research into food and physical activity (PA) neighbourhood environments has mainly focused on associating body mass index (BMI) with proximity to stores selling fresh fruits and vegetables or fast food restaurants and takeaways, or with neighbourhood walkability factors and access to green spaces or public gym facilities, making largely naive, crude and inconsistent assumptions and conclusions that are far from the spirit of 'precision and accuracy public health'. Different people and population groups respond differently to the same food and PA environments, due to a myriad of unique individual and population group factors (genetic/epigenetic, metabolic, dietary and lifestyle habits, health literacy profiles, screen viewing times, stress levels, sleep patterns, environmental air and noise pollution levels, etc.) and their complex interplays with each other and with local food and PA settings. Furthermore, the same food store or fast food outlet can often sell or serve both healthy and non-healthy options/portions, so a simple binary classification into 'good' or 'bad' store/outlet should be avoided. Moreover, appropriate physical exercise, whilst essential for good health and disease prevention, is not very effective for weight maintenance or loss (especially when solely relied upon), and cannot offset the effects of a bad diet. The research we should be doing in the third decade of the twenty-first century should use a systems thinking approach, helped by recent advances in sensors, big data and related technologies, to investigate and consider all these factors in our quest to design better targeted and more effective public health interventions for OO and T2D control and prevention.
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http://dx.doi.org/10.1186/s12942-021-00266-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926080PMC
March 2021

Mobile physical activity planning and tracking: a brief overview of current options and desiderata for future solutions.

Mhealth 2021 20;7:13. Epub 2021 Jan 20.

State University of New York College at Cortland, Cortland, NY, USA.

Consistent and enjoyable physical activity (PA) can be a crucial component to improving or maintaining one's overall health status. Using advanced features on smartphones (GPS, Bluetooth, motion sensing, etc.) coupled with an app or game that is able to assist mobile users to not only track location, but also to interact socially with others based in real-life (IRL), virtual reality (VR), or alternate-reality (ARG), has the potential to give health experts better tools to encourage higher compliance to protocols, rehabilitation, behaviour change and health outcomes. This paper outlines the available mHealth apps that capitalize on pervasive smartphone features coupled with sensors, and suggests which features might impact future PA patterns. The authors argue that the ultimate mobile PA planning and tracking app/platform will be the one capable of supporting both precision and accuracy health (offering truly individualized PA advice and coaching while preserving user privacy) and precision and accuracy public health (providing public health decision makers with community-level PA indicators obtained from app data aggregates of user populations).
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http://dx.doi.org/10.21037/mhealth.2020.01.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882264PMC
January 2021

Opportunistic atrial fibrillation screening and detection in "self-service health check-up stations": a brief overview of current technology potential and possibilities.

Mhealth 2021 20;7:12. Epub 2021 Jan 20.

South West Cardiothoracic Centre and University Hospitals Plymouth NHS Trust, Plymouth, Devon PL6 8DH, UK.

Up to a fifth of patients who suffer a stroke had undiagnosed atrial fibrillation (AF). About 30% of AF patients are asymptomatic and remain undiagnosed, so there are no obvious (to the patient) forewarnings. Opportunistic screening for AF applied to the above clinical situation can save lives, since the strokes that occur as a result of AF are often large, severely debilitating or fatal. Today, anyone can buy a good, FDA-approved mobile electrocardiogram (ECG) device/smartwatch for AF detection on Amazon for €100-400, but not very many asymptomatic AF patients, particularly older patients, will do so on their own. In this article, we introduce the concept and potential benefits of opportunistic AF screening and detection in a community setting using the latest generation of affordable digital ECG capture and interpretation solutions integrated into easy-to-use "self-service health check-up stations" installed in public spaces, such as supermarkets and pharmacies. A comprehensive trial of the proposed self-service health check-up stations for AF screening is needed to produce more evidence to convince decision makers to fully buy into the idea of a nation-wide screening programme using these kiosks.
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http://dx.doi.org/10.21037/mhealth-19-204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882265PMC
January 2021

Geographical tracking and mapping of coronavirus disease COVID-19/severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic and associated events around the world: how 21st century GIS technologies are supporting the global fight against outbreaks and epidemics.

Int J Health Geogr 2020 03 11;19(1). Epub 2020 Mar 11.

Esri (Environmental Systems Research Institute), 380 New York St, Redlands, CA, 92373, USA.

In December 2019, a new virus (initially called 'Novel Coronavirus 2019-nCoV' and later renamed to SARS-CoV-2) causing severe acute respiratory syndrome (coronavirus disease COVID-19) emerged in Wuhan, Hubei Province, China, and rapidly spread to other parts of China and other countries around the world, despite China's massive efforts to contain the disease within Hubei. As with the original SARS-CoV epidemic of 2002/2003 and with seasonal influenza, geographic information systems and methods, including, among other application possibilities, online real-or near-real-time mapping of disease cases and of social media reactions to disease spread, predictive risk mapping using population travel data, and tracing and mapping super-spreader trajectories and contacts across space and time, are proving indispensable for timely and effective epidemic monitoring and response. This paper offers pointers to, and describes, a range of practical online/mobile GIS and mapping dashboards and applications for tracking the 2019/2020 coronavirus epidemic and associated events as they unfold around the world. Some of these dashboards and applications are receiving data updates in near-real-time (at the time of writing), and one of them is meant for individual users (in China) to check if the app user has had any close contact with a person confirmed or suspected to have been infected with SARS-CoV-2 in the recent past. We also discuss additional ways GIS can support the fight against infectious disease outbreaks and epidemics.
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http://dx.doi.org/10.1186/s12942-020-00202-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065369PMC
March 2020

An overview of GeoAI applications in health and healthcare.

Int J Health Geogr 2019 05 2;18(1). Epub 2019 May 2.

Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Ave, Boston, MA, 02115, USA.

The moulding together of artificial intelligence (AI) and the geographic/geographic information systems (GIS) dimension creates GeoAI. There is an emerging role for GeoAI in health and healthcare, as location is an integral part of both population and individual health. This article provides an overview of GeoAI technologies (methods, tools and software), and their current and potential applications in several disciplines within public health, precision medicine, and Internet of Things-powered smart healthy cities. The potential challenges currently facing GeoAI research and applications in health and healthcare are also briefly discussed.
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http://dx.doi.org/10.1186/s12942-019-0171-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6495523PMC
May 2019

Effective uses of social media in public health and medicine: a systematic review of systematic reviews.

Online J Public Health Inform 2018 21;10(2):e215. Epub 2018 Sep 21.

Alexander Graham Bell Centre for Digital Health, University of the Highlands and Islands, Elgin, United Kingdom.

Introduction: Research examining the effective uses of social media (SM) in public health and medicine, especially in the form of systematic reviews (SRs), has grown considerably in the past decade. To our knowledge, no comprehensive synthesis of this literature has been conducted to date.

Aims And Methods: To conduct a systematic review of systematic reviews of the benefits and harms ("effects") of SM tools and platforms (such as Twitter and Facebook) in public health and medicine. To perform a synthesis of this literature and create a 'living systematic review'.

Results: Forty-two (42) high-quality SRs were examined. Overall, evidence of SM's effectiveness in public health and medicine was judged to be minimal. However, qualitative benefits for patients are seen in improved psychosocial support and psychological functioning. Health professionals benefited from better peer-to-peer communication and lifelong learning. Harms on all groups include the impact of SM on mental health, privacy, confidentiality and information reliability.

Conclusions: A range of negatives and positives of SM in public health and medicine are seen in the SR literature but definitive conclusions cannot be made at this time. Clearly better research designs are needed to measure the effectiveness of social technologies. For ongoing updates, see the wiki "Effective uses of social media in health: a living systematic review of systematic reviews". http://hlwiki.slais.ubc.ca/index.php/Effective_uses_of_social_media_in_healthcare:_a_living_systematic_review_of_reviews.
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http://dx.doi.org/10.5210/ojphi.v10i2.8270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194097PMC
September 2018

Head-Mounted Virtual Reality and Mental Health: Critical Review of Current Research.

JMIR Serious Games 2018 Jul 6;6(3):e14. Epub 2018 Jul 6.

The Alexander Graham Bell Centre for Digital Health, Moray College UHI, University of the Highlands and Islands, Elgin, United Kingdom.

Background: eHealth interventions are becoming increasingly used in public health, with virtual reality (VR) being one of the most exciting recent developments. VR consists of a three-dimensional, computer-generated environment viewed through a head-mounted display. This medium has provided new possibilities to adapt problematic behaviors that affect mental health. VR is no longer unaffordable for individuals, and with mobile phone technology being able to track movements and project images through mobile head-mounted devices, VR is now a mobile tool that can be used at work, home, or on the move.

Objective: In line with recent advances in technology, in this review, we aimed to critically assess the current state of research surrounding mental health.

Methods: We compiled a table of 82 studies that made use of head-mounted devices in their interventions.

Results: Our review demonstrated that VR is effective in provoking realistic reactions to feared stimuli, particularly for anxiety; moreover, it proved that the immersive nature of VR is an ideal fit for the management of pain. However, the lack of studies surrounding depression and stress highlight the literature gaps that still exist.

Conclusions: Virtual environments that promote positive stimuli combined with health knowledge could prove to be a valuable tool for public health and mental health. The current state of research highlights the importance of the nature and content of VR interventions for improved mental health. While future research should look to incorporate more mobile forms of VR, a more rigorous reporting of VR and computer hardware and software may help us understand the relationship (if any) between increased specifications and the efficacy of treatment.
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http://dx.doi.org/10.2196/games.9226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6054705PMC
July 2018

Geospatial blockchain: promises, challenges, and scenarios in health and healthcare.

Int J Health Geogr 2018 07 5;17(1):25. Epub 2018 Jul 5.

Lipscomb University College of Pharmacy and Health Sciences, Nashville, TN, 37204-3951, USA.

A PubMed query run in June 2018 using the keyword 'blockchain' retrieved 40 indexed papers, a reflection of the growing interest in blockchain among the medical and healthcare research and practice communities. Blockchain's foundations of decentralisation, cryptographic security and immutability make it a strong contender in reshaping the healthcare landscape worldwide. Blockchain solutions are currently being explored for: (1) securing patient and provider identities; (2) managing pharmaceutical and medical device supply chains; (3) clinical research and data monetisation; (4) medical fraud detection; (5) public health surveillance; (6) enabling truly public and open geo-tagged data; (7) powering many Internet of Things-connected autonomous devices, wearables, drones and vehicles, via the distributed peer-to-peer apps they run, to deliver the full vision of smart healthy cities and regions; and (8) blockchain-enabled augmented reality in crisis mapping and recovery scenarios, including mechanisms for validating, crediting and rewarding crowdsourced geo-tagged data, among other emerging use cases. Geospatially-enabled blockchain solutions exist today that use a crypto-spatial coordinate system to add an immutable spatial context that regular blockchains lack. These geospatial blockchains do not just record an entry's specific time, but also require and validate its associated proof of location, allowing accurate spatiotemporal mapping of physical world events. Blockchain and distributed ledger technology face similar challenges as any other technology threatening to disintermediate legacy processes and commercial interests, namely the challenges of blockchain interoperability, security and privacy, as well as the need to find suitable and sustainable business models of implementation. Nevertheless, we expect blockchain technologies to get increasingly powerful and robust, as they become coupled with artificial intelligence (AI) in various real-word healthcare solutions involving AI-mediated data exchange on blockchains.
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http://dx.doi.org/10.1186/s12942-018-0144-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033217PMC
July 2018

Measuring management's perspective of data quality in Pakistan's Tuberculosis control programme: a test-based approach to identify data quality dimensions.

BMC Res Notes 2018 Jan 16;11(1):40. Epub 2018 Jan 16.

Monitoring, Evaluation and Learning Unit, Mercy Corps, Pak Palace, Rawal Chowk, Murree Road, Islamabad, Pakistan.

Background: Data quality is core theme of programme's performance assessment and many organizations do not have any data quality improvement strategy, wherein data quality dimensions and data quality assessment framework are important constituents. As there is limited published research about the data quality specifics that are relevant to the context of Pakistan's Tuberculosis control programme, this study aims at identifying the applicable data quality dimensions by using the 'fitness-for-purpose' perspective.

Results: Forty-two respondents pooled a total of 473 years of professional experience, out of which 223 years (47%) were in TB control related programmes. Based on the responses against 11 practical cases, adopted from the routine recording and reporting system of Pakistan's TB control programme (real identities of patient were masked), completeness, accuracy, consistency, vagueness, uniqueness and timeliness are the applicable data quality dimensions relevant to the programme's context, i.e. work settings and field of practice.

Conclusion: Based on a 'fitness-for-purpose' approach to data quality, this study used a test-based approach to measure management's perspective and identified data quality dimensions pertinent to the programme and country specific requirements. Implementation of a data quality improvement strategy and achieving enhanced data quality would greatly help organizations in promoting data use for informed decision making.
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http://dx.doi.org/10.1186/s13104-018-3161-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5771188PMC
January 2018

From urban planning and emergency training to Pokémon Go: applications of virtual reality GIS (VRGIS) and augmented reality GIS (ARGIS) in personal, public and environmental health.

Int J Health Geogr 2017 02 20;16(1). Epub 2017 Feb 20.

Department of Computer Science, University College London, 66-72 Gower Street, London, WC1E 6EA, England, UK.

The latest generation of virtual and mixed reality hardware has rekindled interest in virtual reality GIS (VRGIS) and augmented reality GIS (ARGIS) applications in health, and opened up new and exciting opportunities and possibilities for using these technologies in the personal and public health arenas. From smart urban planning and emergency training to Pokémon Go, this article offers a snapshot of some of the most remarkable VRGIS and ARGIS solutions for tackling public and environmental health problems, and bringing about safer and healthier living options to individuals and communities. The article also covers the main technical foundations and issues underpinning these solutions.
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http://dx.doi.org/10.1186/s12942-017-0081-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319160PMC
February 2017

On the road to personalised and precision geomedicine: medical geology and a renewed call for interdisciplinarity.

Int J Health Geogr 2016 Jan 28;15. Epub 2016 Jan 28.

Department of Earth Science and Engineering, Imperial College London, South Kensington, London, SW7 2AZ, England, UK.

Our health depends on where we currently live, as well as on where we have lived in the past and for how long in each place. An individual's place history is particularly relevant in conditions with long latency between exposures and clinical manifestations, as is the case in many types of cancer and chronic conditions. A patient's geographic history should routinely be considered by physicians when diagnosing and treating individual patients. It can provide useful contextual environmental information (and the corresponding health risks) about the patient, and should thus form an essential part of every electronic patient/health record. Medical geology investigations, in their attempt to document the complex relationships between the environment and human health, typically involve a multitude of disciplines and expertise. Arguably, the spatial component is the one factor that ties in all these disciplines together in medical geology studies. In a general sense, epidemiology, statistical genetics, geoscience, geomedical engineering and public and environmental health informatics tend to study data in terms of populations, whereas medicine (including personalised and precision geomedicine, and lifestyle medicine), genetics, genomics, toxicology and biomedical/health informatics more likely work on individuals or some individual mechanism describing disease. This article introduces with examples the core concepts of medical geology and geomedicine. The ultimate goals of prediction, prevention and personalised treatment in the case of geology-dependent disease can only be realised through an intensive multiple-disciplinary approach, where the various relevant disciplines collaborate together and complement each other in additive (multidisciplinary), interactive (interdisciplinary) and holistic (transdisciplinary and cross-disciplinary) manners.
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http://dx.doi.org/10.1186/s12942-016-0033-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4730661PMC
January 2016

Digital games for type 1 and type 2 diabetes: underpinning theory with three illustrative examples.

JMIR Serious Games 2015 Mar 18;3(1):e3. Epub 2015 Mar 18.

The Alexander Graham Bell Centre for Digital Health, Moray College UHI, University of the Highlands and Islands, Elgin, United Kingdom.

Digital games are an important class of eHealth interventions in diabetes, made possible by the Internet and a good range of affordable mobile devices (eg, mobile phones and tablets) available to consumers these days. Gamifying disease management can help children, adolescents, and adults with diabetes to better cope with their lifelong condition. Gamification and social in-game components are used to motivate players/patients and positively change their behavior and lifestyle. In this paper, we start by presenting the main challenges facing people with diabetes-children/adolescents and adults-from a clinical perspective, followed by three short illustrative examples of mobile and desktop game apps and platforms designed by Ayogo Health, Inc. (Vancouver, BC, Canada) for type 1 diabetes (one example) and type 2 diabetes (two examples). The games target different age groups with different needs-children with type 1 diabetes versus adults with type 2 diabetes. The paper is not meant to be an exhaustive review of all digital game offerings available for people with type 1 and type 2 diabetes, but rather to serve as a taster of a few of the game genres on offer today for both types of diabetes, with a brief discussion of (1) some of the underpinning psychological mechanisms of gamified digital interventions and platforms as self-management adherence tools, and more, in diabetes, and (2) some of the hypothesized potential benefits that might be gained from their routine use by people with diabetes. More research evidence from full-scale evaluation studies is needed and expected in the near future that will quantify, qualify, and establish the evidence base concerning this gamification potential, such as what works in each age group/patient type, what does not, and under which settings and criteria.
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http://dx.doi.org/10.2196/games.3930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382565PMC
March 2015

'Social, innovative and smart cities are happy and resilient': insights from the WHO EURO 2014 International Healthy Cities Conference.

Int J Health Geogr 2015 Jan 14;14. Epub 2015 Jan 14.

Kuopio Innovation Ltd, Viestikatu 7, FI-70600, Kuopio, Finland.

This paper provides a brief overview of, and elaborates on, some of the presentations, discussions and conclusions from Day 4 of the 'WHO EURO 2014 International Healthy Cities Conference: Health and the City - Urban Living in the 21st Century', held in Athens, Greece on 25 October 2014. The Internet of Things (IoT) is made of sensors and other components that connect our version of the world made of atoms, i.e., humans/our bodies, our devices, vehicles, roads, buildings, plants, animals, etc., with a mirror digital version made of bits. This enables cities and regions to be self-aware and dynamically reconfigurable in real- or near-real-time, based on changes that are continuously monitored and captured by sensors, similar to the way the internal biological systems of a living being operate and respond to their environment (homeostasis). Data collected by various IoT sensors and processed via appropriate analytics can also help predict the immediate future with reasonable accuracy, which enables better planned responses and mitigation actions. Cities and regions can thus become more adaptable and resilient in face of adversity. Furthermore, IoT can link atoms (humans) to other atoms (humans) (again via bits), resulting in the formation of 'smart(er) communities' that are socially connected in new ways and potentially happier. Cities, but also less urbanised regions and the countryside, could all benefit from, and harness the power of, IoT to improve the health, well-being and overall quality of life of the local populations, actively engage citizens in a smarter governance of their region, empower them to better care for one another, promote stronger social inclusion, and ensure a greener, sustainable and more enjoyable environment for all. Technology can also help reverse the 'brain drain' from the countryside and smaller towns to larger metropolises by making the former more attractive and connected, with better services akin to those found in larger cities. The article also discusses some ways of measuring and benchmarking the performance of smart cities and their impact on well-being. However, it should be emphasised that technology is not a panacea and that other factors are equally important in creating happier and healthier cities and regions.
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http://dx.doi.org/10.1186/1476-072X-14-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417221PMC
January 2015

Mobile medical and health apps: state of the art, concerns, regulatory control and certification.

Online J Public Health Inform 2014 5;5(3):229. Epub 2014 Feb 5.

Dermatology Service, Denver VA Medical Center, Denver, CO 80220, USA.

This paper examines the state of the art in mobile clinical and health-related apps. A 2012 estimate puts the number of health-related apps at no fewer than 40,000, as healthcare professionals and consumers continue to express concerns about the quality of many apps, calling for some form of app regulatory control or certification to be put in place. We describe the range of apps on offer as of 2013, and then present a brief survey of evaluation studies of medical and health-related apps that have been conducted to date, covering a range of clinical disciplines and topics. Our survey includes studies that highlighted risks, negative issues and worrying deficiencies in existing apps. We discuss the concept of 'apps as a medical device' and the relevant regulatory controls that apply in USA and Europe, offering examples of apps that have been formally approved using these mechanisms. We describe the online Health Apps Library run by the National Health Service in England and the calls for a vetted medical and health app store. We discuss the ingredients for successful apps beyond the rather narrow definition of 'apps as a medical device'. These ingredients cover app content quality, usability, the need to match apps to consumers' general and health literacy levels, device connectivity standards (for apps that connect to glucometers, blood pressure monitors, etc.), as well as app security and user privacy. 'Happtique Health App Certification Program' (HACP), a voluntary app certification scheme, successfully captures most of these desiderata, but is solely focused on apps targeting the US market. HACP, while very welcome, is in ways reminiscent of the early days of the Web, when many "similar" quality benchmarking tools and codes of conduct for information publishers were proposed to appraise and rate online medical and health information. It is probably impossible to rate and police every app on offer today, much like in those early days of the Web, when people quickly realised the same regarding informational Web pages. The best first line of defence was, is, and will always be to educate consumers regarding the potentially harmful content of (some) apps.
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http://dx.doi.org/10.5210/ojphi.v5i3.4814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3959919PMC
March 2014

On the Internet of Things, smart cities and the WHO Healthy Cities.

Int J Health Geogr 2014 Mar 27;13:10. Epub 2014 Mar 27.

Plymouth University, Devon, United Kingdom.

This article gives a brief overview of the Internet of Things (IoT) for cities, offering examples of IoT-powered 21st century smart cities, including the experience of the Spanish city of Barcelona in implementing its own IoT-driven services to improve the quality of life of its people through measures that promote an eco-friendly, sustainable environment. The potential benefits as well as the challenges associated with IoT for cities are discussed. Much of the 'big data' that are continuously generated by IoT sensors, devices, systems and services are geo-tagged or geo-located. The importance of having robust, intelligent geospatial analytics systems in place to process and make sense of such data in real time cannot therefore be overestimated. The authors argue that IoT-powered smart cities stand better chances of becoming healthier cities. The World Health Organization (WHO) Healthy Cities Network and associated national networks have hundreds of member cities around the world that could benefit from, and harness the power of, IoT to improve the health and well-being of their local populations.
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http://dx.doi.org/10.1186/1476-072X-13-10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987056PMC
March 2014

Google Scholar is not enough to be used alone for systematic reviews.

Online J Public Health Inform 2013 1;5(2):214. Epub 2013 Jul 1.

UBC Library, UBC iSchool, Canada.

Background: Google Scholar (GS) has been noted for its ability to search broadly for important references in the literature. Gehanno et al. recently examined GS in their study: 'Is Google scholar enough to be used alone for systematic reviews?' In this paper, we revisit this important question, and some of Gehanno et al.'s other findings in evaluating the academic search engine.

Methods: The authors searched for a recent systematic review (SR) of comparable size to run search tests similar to those in Gehanno et al. We selected Chou et al. (2013) contacting the authors for a list of publications they found in their SR on social media in health. We queried GS for each of those 506 titles (in quotes "), one by one. When GS failed to retrieve a paper, or produced too many results, we used the allintitle: command to find papers with the same title.

Results: Google Scholar produced records for ~95% of the papers cited by Chou et al. (n=476/506). A few of the 30 papers that were not in GS were later retrieved via PubMed and even regular Google Search. But due to its different structure, we could not run searches in GS that were originally performed by Chou et al. in PubMed, Web of Science, Scopus and PsycINFO®. Identifying 506 papers in GS was an inefficient process, especially for papers using similar search terms.

Conclusions: Has Google Scholar improved enough to be used alone in searching for systematic reviews? No. GS' constantly-changing content, algorithms and database structure make it a poor choice for systematic reviews. Looking for papers when you know their titles is a far different issue from discovering them initially. Further research is needed to determine when and how (and for what purposes) GS can be used alone. Google should provide details about GS' database coverage and improve its interface (e.g., with semantic search filters, stored searching, etc.). Perhaps then it will be an appropriate choice for systematic reviews.
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http://dx.doi.org/10.5210/ojphi.v5i2.4623DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733758PMC
August 2013

Exergames for health and fitness: the roles of GPS and geosocial apps.

Int J Health Geogr 2013 Apr 5;12:18. Epub 2013 Apr 5.

University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA, UK.

Large numbers of children and adolescents in Canada, UK and USA are not getting their recommended daily dose of moderate to vigorous physical activity, and are thus more prone to obesity and its ill health effects. Exergames (video games that require physical activity to play) are rapidly gaining user acceptance, and may have the potential to increase physical activity levels among young people. Mobile exergames for GPS (global positioning system)-enabled smartphones and mini-tablets take players outdoors, in the open air, unlike console exergames, e.g., Xbox 360 Kinect exergames, which limit players to playing indoors in front of a TV set. In this paper and its companion 'Additional file 1', we review different examples of GPS exergames and of gamified geosocial apps and gadgets (mobile, location-aware apps and devices with social and gamification features), and briefly discuss some of the issues surrounding their use. Further research is needed to document best practices in this area, quantify the exact health and fitness benefits of GPS exergames and apps (under different settings and scenarios), and find out what is needed to improve them and the best ways to promote their adoption by the public.
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http://dx.doi.org/10.1186/1476-072X-12-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657542PMC
April 2013

Expert System Shells for Rapid Clinical Decision Support Module Development: An ESTA Demonstration of a Simple Rule-Based System for the Diagnosis of Vaginal Discharge.

Healthc Inform Res 2012 Dec 31;18(4):252-8. Epub 2012 Dec 31.

Faculty of Health, Education and Society, Plymouth University, Devon, UK.

Objectives: This study demonstrates the feasibility of using expert system shells for rapid clinical decision support module development.

Methods: A readily available expert system shell was used to build a simple rule-based system for the crude diagnosis of vaginal discharge. Pictures and 'canned text explanations' are extensively used throughout the program to enhance its intuitiveness and educational dimension. All the steps involved in developing the system are documented.

Results: The system runs under Microsoft Windows and is available as a free download at http://healthcybermap.org/vagdisch.zip (the distribution archive includes both the program's executable and the commented knowledge base source as a text document). The limitations of the demonstration system, such as the lack of provisions for assessing uncertainty or various degrees of severity of a sign or symptom, are discussed in detail. Ways of improving the system, such as porting it to the Web and packaging it as an app for smartphones and tablets, are also presented.

Conclusions: An easy-to-use expert system shell enables clinicians to rapidly become their own 'knowledge engineers' and develop concise evidence-based decision support modules of simple to moderate complexity, targeting clinical practitioners, medical and nursing students, as well as patients, their lay carers and the general public (where appropriate). In the spirit of the social Web, it is hoped that an online repository can be created to peer review, share and re-use knowledge base modules covering various clinical problems and algorithms, as a service to the clinical community.
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http://dx.doi.org/10.4258/hir.2012.18.4.252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548154PMC
December 2012

Xbox 360 Kinect Exergames for Health.

Games Health J 2012 Oct 18;1(5):326-30. Epub 2012 Sep 18.

Faculty of Health, University of Plymouth , Drake Circus, Plymouth, Devon, United Kingdom .

This "eye-opener" review briefly surveys the current Kinect exergame titles for the Xbox 360 (Microsoft, Redmond, WA) (up to July 2012), focusing on possible uses by different age groups, from kids to older people, for improving players' physical, mental/cognitive, and psychological/emotional health and fitness. A quick survey of existing related research is also provided, and links are made to it. There are already many published studies about digital exergames in general, but very little about Kinect exergames. More research is needed to establish the evidence base concerning the latter (e.g., in relation to obesity management [pediatric and adult] or cognitive state improvement in older people, etc.): What works in each condition, what does not, and under which settings and criteria.
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http://dx.doi.org/10.1089/g4h.2012.0041DOI Listing
October 2012

Real-time locating systems (RTLS) in healthcare: a condensed primer.

Int J Health Geogr 2012 Jun 28;11:25. Epub 2012 Jun 28.

Faculty of Health, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK.

Real-time locating systems (RTLS, also known as real-time location systems) have become an important component of many existing ubiquitous location aware systems. While GPS (global positioning system) has been quite successful as an outdoor real-time locating solution, it fails to repeat this success indoors. A number of RTLS technologies have been used to solve indoor tracking problems. The ability to accurately track the location of assets and individuals indoors has many applications in healthcare. This paper provides a condensed primer of RTLS in healthcare, briefly covering the many options and technologies that are involved, as well as the various possible applications of RTLS in healthcare facilities and their potential benefits, including capital expenditure reduction and workflow and patient throughput improvements. The key to a successful RTLS deployment lies in picking the right RTLS option(s) and solution(s) for the application(s) or problem(s) at hand. Where this application-technology match has not been carefully thought of, any technology will be doomed to failure or to achieving less than optimal results.
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http://dx.doi.org/10.1186/1476-072X-11-25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408320PMC
June 2012

Accuracy of geographically targeted internet advertisements on Google AdWords for recruitment in a randomized trial.

J Med Internet Res 2012 Jun 20;14(3):e84. Epub 2012 Jun 20.

Faculty of Health, Education, and Society, University of Plymouth, Plymouth, United Kingdom.

Background: Google AdWords are increasingly used to recruit people into research studies and clinical services. They offer the potential to recruit from targeted control areas in cluster randomized controlled trials (RCTs), but little is known about the feasibility of accurately targeting ads by location and comparing with control areas.

Objective: To examine the accuracy and contamination of control areas by a location-targeted online intervention using Google AdWords in a pilot cluster RCT.

Methods: Based on previous use of online cognitive behavioral therapy for depression and population size, we purposively selected 16 of the 121 British postcode areas and randomized them to three intervention and one (do-nothing) control arms. Two intervention arms included use of location-targeted AdWords, and we compared these with the do-nothing control arm. We did not raise the visibility of our research website to normal Web searches. Users who clicked on the ad were directed to our project website, which collected the computer Internet protocol (IP) address, date, and time. Visitors were asked for their postcode area and to complete the Patient Health Questionnaire (depression). They were then offered links to several online depression resources. Google Analytics largely uses IP methods to estimate location, but AdWords uses additional information. We compared locations assessed by (1) Analytics, and (2) as self-identified by users.

Results: Ads were shown 300,523 times with 4207 click-throughs. There were few site visits except through AdWord click-throughs. Both methods of location assessment agreed there was little contamination of control areas. According to Analytics, 69.75% (2617/3752) of participants were in intervention areas, only 0% (8/3752) in control areas, but 30.04% (1127/3752) in other areas. However, according to user-stated postcodes, only 20.7% (463/2237) were in intervention areas, 1% (22/2236) in control areas, but 78.31% (1751/2236) in other areas. Both location assessments suggested most leakage from the intervention arms was to nearby postcode areas. Analytics data differed from postcodes reported by participants. Analysis of a subset of 200/2236 records over 10 days comparing IP-estimated location with stated postcode suggested that Google AdWords targeted correctly in just half the cases. Analytics agreed with our assessment that, overall, one-third were wrongly targeted by AdWords. There appeared little evidence that people who bothered to give their postcode did not answer truthfully.

Conclusions: Although there is likely to be substantial leakage from the targeted areas, if intervention and control areas are a sufficient distance apart, it is feasible to conduct a cluster RCT using online ads to target British postcode areas without significant contamination.

Trial Registration: Clinicaltrials.gov NCT01469689; http://clinicaltrials.gov/ct2/show/NCT01469689 (Archived by WebCite at http://www.webcitation.org/681iro5OU).
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http://dx.doi.org/10.2196/jmir.1991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3414907PMC
June 2012

Do adverts increase the probability of finding online cognitive behavioural therapy for depression? Cross-sectional study.

BMJ Open 2012 16;2(2):e000800. Epub 2012 Apr 16.

School of Nursing and Midwifery, Plymouth University, Plymouth, UK.

Objective: To estimate the effect of online adverts on the probability of finding online cognitive behavioural therapy (CBT) for depression.

Design: Exploratory online cross-sectional study of search experience of people in the UK with depression in 2011. (1) The authors identified the search terms over 6 months entered by users who subsequently clicked on the advert for online help for depression. (2) A panel of volunteers across the UK recorded websites presented by normal Google search for the term 'depression'. (iii) The authors examined these websites to estimate probabilities of knowledgeable and naive internet users finding online CBT and the improved probability by addition of a Google advert.

Participants: (1) 3868 internet users entering search terms related to depression into Google. (2) Panel, recruited online, of 12 UK participants with an interest in depression.

Main Outcome Measures: Probability of finding online CBT for depression with/without an advert.

Results: The 3868 users entered 1748 different search terms but the single keyword 'depression' resulted in two-thirds of the presentations of, and over half the 'clicks' on, the advert. In total, 14 different websites were presented to our panel in the first page of Google results for 'depression'. Four of the 14 websites had links enabling access to online CBT in three clicks for knowledgeable users. Extending this approach to the 10 most frequent search terms, the authors estimated probabilities of finding online CBT as 0.29 for knowledgeable users and 0.006 for naive users, making it unlikely CBT would be found. Adding adverts that linked directly to online CBT increased the probabilities to 0.31 (knowledgeable) and 0.02 (naive).

Conclusions: In this case, online CBT was not easy to find and online adverts substantially increased the chance for naive users. Others could use this approach to explore additional impact before committing to long-term Google AdWords advertising budgets.

Trial Registration: This exploratory case study was a substudy within a cluster randomised trial, registered on http://www.clinicaltrials.gov (reference: NCT01469689). (The trial will be reported subsequently).
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http://dx.doi.org/10.1136/bmjopen-2011-000800DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3332262PMC
October 2012

Crowdsourcing, citizen sensing and sensor web technologies for public and environmental health surveillance and crisis management: trends, OGC standards and application examples.

Int J Health Geogr 2011 Dec 21;10:67. Epub 2011 Dec 21.

University of Plymouth, Drake Circus, Plymouth, Devon, UK.

'Wikification of GIS by the masses' is a phrase-term first coined by Kamel Boulos in 2005, two years earlier than Goodchild's term 'Volunteered Geographic Information'. Six years later (2005-2011), OpenStreetMap and Google Earth (GE) are now full-fledged, crowdsourced 'Wikipedias of the Earth' par excellence, with millions of users contributing their own layers to GE, attaching photos, videos, notes and even 3-D (three dimensional) models to locations in GE. From using Twitter in participatory sensing and bicycle-mounted sensors in pervasive environmental sensing, to creating a 100,000-sensor geo-mashup using Semantic Web technology, to the 3-D visualisation of indoor and outdoor surveillance data in real-time and the development of next-generation, collaborative natural user interfaces that will power the spatially-enabled public health and emergency situation rooms of the future, where sensor data and citizen reports can be triaged and acted upon in real-time by distributed teams of professionals, this paper offers a comprehensive state-of-the-art review of the overlapping domains of the Sensor Web, citizen sensing and 'human-in-the-loop sensing' in the era of the Mobile and Social Web, and the roles these domains can play in environmental and public health surveillance and crisis/disaster informatics. We provide an in-depth review of the key issues and trends in these areas, the challenges faced when reasoning and making decisions with real-time crowdsourced data (such as issues of information overload, "noise", misinformation, bias and trust), the core technologies and Open Geospatial Consortium (OGC) standards involved (Sensor Web Enablement and Open GeoSMS), as well as a few outstanding project implementation examples from around the world.
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http://dx.doi.org/10.1186/1476-072X-10-67DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271966PMC
December 2011

Web GIS in practice X: a Microsoft Kinect natural user interface for Google Earth navigation.

Int J Health Geogr 2011 Jul 26;10:45. Epub 2011 Jul 26.

This paper covers the use of depth sensors such as Microsoft Kinect and ASUS Xtion to provide a natural user interface (NUI) for controlling 3-D (three-dimensional) virtual globes such as Google Earth (including its Street View mode), Bing Maps 3D, and NASA World Wind. The paper introduces the Microsoft Kinect device, briefly describing how it works (the underlying technology by PrimeSense), as well as its market uptake and application potential beyond its original intended purpose as a home entertainment and video game controller. The different software drivers available for connecting the Kinect device to a PC (Personal Computer) are also covered, and their comparative pros and cons briefly discussed. We survey a number of approaches and application examples for controlling 3-D virtual globes using the Kinect sensor, then describe Kinoogle, a Kinect interface for natural interaction with Google Earth, developed by students at Texas A&M University. Readers interested in trying out the application on their own hardware can download a Zip archive (included with the manuscript as additional files 1, 2, &3) that contains a 'Kinnogle installation package for Windows PCs'. Finally, we discuss some usability aspects of Kinoogle and similar NUIs for controlling 3-D virtual globes (including possible future improvements), and propose a number of unique, practical 'use scenarios' where such NUIs could prove useful in navigating a 3-D virtual globe, compared to conventional mouse/3-D mouse and keyboard-based interfaces.
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http://dx.doi.org/10.1186/1476-072X-10-45DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226357PMC
July 2011

Innovations in health care services: the CAALYX system.

Int J Med Inform 2013 Nov 9;82(11):e307-20. Epub 2011 Apr 9.

Instituto de Engenharia Sistemas e Computadores do Porto, Porto, Portugal. Electronic address:

Purpose: This paper describes proposed health care services innovations, provided by a system called CAALYX (Complete Ambient Assisted Living eXperiment). CAALYX aimed to provide healthcare innovation by extending the state-of-the-art in tele-healthcare, by focusing on increasing the confidence of elderly people living autonomously, by building on the knowledge base of the most common disorders and respective characteristic vital sign changes for this age group.

Methods: A review of the state-of-the-art on health care services was carried out. Then, extensive research was conducted on the particular needs of the elderly in relation to home health services that, if offered to them, could improve their day life by giving them greater confidence and autonomy. To achieve this, we addressed issues associated with the gathering of clinical data and interpretation of these data, as well as possibilities of automatically triggering appropriate clinical measures. Considering this initial work we started the identification of initiatives, ongoing works and technologies that could be used for the development of the system. After that, the implementation of CAALYX was done.

Findings: The innovation in CAALYX system considers three main areas of contribution: (i) The Roaming Monitoring System that is used to collect information on the well-being of the elderly users; (ii) The Home Monitoring System that is aimed at helping the elders independently living at home being implemented by a device (a personal computer or a set top box) that supports the connection of sensors and video cameras that may be used for monitoring and for interaction with the elder; (iii) The Central Care Service and Monitoring System that is implemented by a Caretaker System where attention and care services are provided to elders, where actors as Caretakers, Doctors and Relatives are logically linked to elders. Innovations in each of these areas are presented here.

Conclusions: The ageing European society is placing an added burden on future generations, as the 'elderly-to-working-age-people' ratio is set to steadily increase in the future. Nowadays, quality of life and fitness allows for most older persons to have an active life well into their eighties. Furthermore, many older persons prefer to live in their own house and choose their own lifestyle. The CAALYX system can have a clear impact in increasing older persons' autonomy, by ensuring that they do not need to leave their preferred environment in order to be properly monitored and taken care of.
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http://dx.doi.org/10.1016/j.ijmedinf.2011.03.003DOI Listing
November 2013

How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX.

Biomed Eng Online 2011 Apr 5;10:24. Epub 2011 Apr 5.

Faculty of Health, University of Plymouth, Drake Circus, Plymouth, Devon PL4 8AA, UK.

The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development. This paper provides a brief state-of-the-art overview of health and healthcare smartphone apps (applications) on the market today, including emerging trends and market uptake. Platforms available today include Android, Apple iOS, RIM BlackBerry, Symbian, and Windows (Windows Mobile 6.x and the emerging Windows Phone 7 platform). The paper covers apps targeting both laypersons/patients and healthcare professionals in various scenarios, e.g., health, fitness and lifestyle education and management apps; ambient assisted living apps; continuing professional education tools; and apps for public health surveillance. Among the surveyed apps are those assisting in chronic disease management, whether as standalone apps or part of a BAN (Body Area Network) and remote server configuration. We describe in detail the development of a smartphone app within eCAALYX (Enhanced Complete Ambient Assisted Living Experiment, 2009-2012), an EU-funded project for older people with multiple chronic conditions. The eCAALYX Android smartphone app receives input from a BAN (a patient-wearable smart garment with wireless health sensors) and the GPS (Global Positioning System) location sensor in the smartphone, and communicates over the Internet with a remote server accessible by healthcare professionals who are in charge of the remote monitoring and management of the older patient with multiple chronic conditions. Finally, we briefly discuss barriers to adoption of health and healthcare smartphone apps (e.g., cost, network bandwidth and battery power efficiency, usability, privacy issues, etc.), as well as some workarounds to mitigate those barriers.
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http://dx.doi.org/10.1186/1475-925X-10-24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3080339PMC
April 2011

Web GIS in practice IX: a demonstration of geospatial visual analytics using Microsoft Live Labs Pivot technology and WHO mortality data.

Int J Health Geogr 2011 Mar 16;10:19. Epub 2011 Mar 16.

Faculty of Health, University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK.

The goal of visual analytics is to facilitate the discourse between the user and the data by providing dynamic displays and versatile visual interaction opportunities with the data that can support analytical reasoning and the exploration of data from multiple user-customisable aspects. This paper introduces geospatial visual analytics, a specialised subtype of visual analytics, and provides pointers to a number of learning resources about the subject, as well as some examples of human health, surveillance, emergency management and epidemiology-related geospatial visual analytics applications and examples of free software tools that readers can experiment with, such as Google Public Data Explorer. The authors also present a practical demonstration of geospatial visual analytics using partial data for 35 countries from a publicly available World Health Organization (WHO) mortality dataset and Microsoft Live Labs Pivot technology, a free, general purpose visual analytics tool that offers a fresh way to visually browse and arrange massive amounts of data and images online and also supports geographic and temporal classifications of datasets featuring geospatial and temporal components. Interested readers can download a Zip archive (included with the manuscript as an additional file) containing all files, modules and library functions used to deploy the WHO mortality data Pivot collection described in this paper.
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http://dx.doi.org/10.1186/1476-072X-10-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068070PMC
March 2011

Geospatial resources for supporting data standards, guidance and best practice in health informatics.

BMC Res Notes 2011 Jan 26;4:19. Epub 2011 Jan 26.

Faculty of Health, The University of Plymouth, Drake Circus, Plymouth, Devon, PL4 8AA, UK.

Background: The 1980s marked the occasion when Geographical Information System (GIS) technology was broadly introduced into the geo-spatial community through the establishment of a strong GIS industry. This technology quickly disseminated across many countries, and has now become established as an important research, planning and commercial tool for a wider community that includes organisations in the public and private health sectors.The broad acceptance of GIS technology and the nature of its functionality have meant that numerous datasets have been created over the past three decades. Most of these datasets have been created independently, and without any structured documentation systems in place. However, search and retrieval systems can only work if there is a mechanism for datasets existence to be discovered and this is where proper metadata creation and management can greatly help.This situation must be addressed through support mechanisms such as Web-based portal technologies, metadata editor tools, automation, metadata standards and guidelines and collaborative efforts with relevant individuals and organisations. Engagement with data developers or administrators should also include a strategy of identifying the benefits associated with metadata creation and publication.

Findings: The establishment of numerous Spatial Data Infrastructures (SDIs), and other Internet resources, is a testament to the recognition of the importance of supporting good data management and sharing practices across the geographic information community. These resources extend to health informatics in support of research, public services and teaching and learning.This paper identifies many of these resources available to the UK academic health informatics community. It also reveals the reluctance of many spatial data creators across the wider UK academic community to use these resources to create and publish metadata, or deposit their data in repositories for sharing.The Go-Geo! service is introduced as an SDI developed to provide UK academia with the necessary resources to address the concerns surrounding metadata creation and data sharing. The Go-Geo! portal, Geodoc metadata editor tool, ShareGeo spatial data repository, and a range of other support resources, are described in detail.

Conclusions: This paper describes a variety of resources available for the health research and public health sector to use for managing and sharing their data. The Go-Geo! service is one resource which offers an SDI for the eclectic range of disciplines using GIS in UK academia, including health informatics.The benefits of data management and sharing are immense, and in these times of cost restraints, these resources can be seen as solutions to find cost savings which can be reinvested in more research.
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http://dx.doi.org/10.1186/1756-0500-4-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224535PMC
January 2011

An eight-year snapshot of geospatial cancer research (2002-2009): clinico-epidemiological and methodological findings and trends.

Med Oncol 2011 Dec 30;28(4):1145-62. Epub 2010 Jun 30.

Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt.

Geographic information systems (GIS) offer a very rich toolbox of methods and technologies, and powerful research tools that extend far beyond the mere production of maps, making it possible to cross-link and study the complex interaction of disease data and factors originating from a wide range of disparate sources. Despite their potential indispensable role in cancer prevention and control programmes, GIS are underrepresented in specialised oncology literature. The latter has provided an impetus for the current review. The review provides an eight-year snapshot of geospatial cancer research in peer-reviewed literature (2002-2009), presenting the clinico-epidemiological and methodological findings and trends in the covered corpus (93 papers). The authors concluded that understanding the relationship between location and cancer/cancer care services can play a crucial role in disease control and prevention, and in better service planning, and appropriate resource utilisation. Nevertheless, there are still barriers that hinder the wide-scale adoption of GIS and related technologies in everyday oncology practice.
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http://dx.doi.org/10.1007/s12032-010-9607-zDOI Listing
December 2011