Modelado experimental de un sistema de e-Salud aplicado en cooperación al desarrollo

Los Objetivos de Desarrollo del Milenio comprometieron a los países con una nueva alianza mundial de alcanzar gradualmente una cobertura universal de los niveles mínimos de bienestar en los países en desarrollo (reducir la pobreza y el hambre y dar respuesta a problemas como la mala salud, las desigualdades de género, la falta de educación, el acceso a agua salubre y la degradación ambiental). Para dar continuidad a esta iniciativa, recientemente en septiembre de 2015, la ONU promulgó la declaración de los Objetivos de Desarrollo Sostenible. Los ODM sitúan la salud en el corazón del desarrollo y establecen un novedoso pacto mundial que vincula a los países desarrollados y los países en desarrollo por medio de obligaciones claras y recíprocas. En este sentido, diversos organismos de cooperación a través de sus programas de cooperación internacional, tratan de mejorar el acceso a la asistencia sanitaria, especialmente a la población vulnerable que vive en zonas rurales de países en desarrollo. Con el fin de ayudar a cumplir los ODM que apoyan los temas de salud en dicha población, estos organismos desarrollan proyectos que despliegan sistemas de e-salud. Las intervenciones se enfrentan a múltiples retos: condicionantes de los países en desarrollo, las necesidades y demandas de los sistemas sanitarios y la complejidad de implantar las TIC en entornos complejos y altamente dinámicos como son los países en desarrollo. Estos condicionantes ocasionan la mayoría de proyectos fallidos que terminan convirtiéndose en soluciones aisladas, que anteponen la tecnología a las necesidades de la población y no generan el impacto esperado en su desarrollo. En este contexto tuvo origen esta tesis doctoral, que persigue como objetivo analizar, planificar, diseñar, verificar y validar un marco arquitectónico de implantación de sistemas de e-salud en áreas rurales de países en desarrollo, que promueva el mejoramiento de la calidad de vida de la población vulnerable de estas regiones y la efectividad de las intervenciones de e-salud en el marco de proyectos de cooperación al desarrollo. Para lograrlo, tomé como punto de partida, diversas estrategias, modelos, metodologías de implantación de e-salud, modelos de gestión de proyectos propuestos por distintos organismos internacionales y propuse una instanciación de estos modelos a proyectos de implantación de sistemas de e-salud en países en desarrollo. Apliqué la metodología action research y los enfoques twin track, middle out y design thinking que me permitieron el refinamiento iterativo del modelo propuesto en la tesis doctoral mediante el trabajo de campo realizado en dos zonas rurales de países de Centroamérica: Jocotán (Guatemala) y San José de Cusmapa (Nicaragua). Como resultado obtuve un modelo experimental basado en cuatro componentes: un modelo de referencia tipo, un modelo conceptual de e-salud, los procesos de gestión y de implantación de sistemas de e-salud en países en desarrollo y una arquitectura de referencia. El modelo experimental resultante aporta herramientas importantes para el despliegue de sistemas de e-salud en países en desarrollo. Se ha propuesto un modelo de referencia que proporciona una visión holística del contexto del país en desarrollo donde se desarrollarán las intervenciones. Un modelo conceptual de e-salud que representa los principales conceptos involucrados en un sistema de e-salud. Los procesos ii- de gestión del proyecto y de implantación del sistema que proporcionan a los grupos de cooperación, herramientas para el análisis, diseño, desarrollo y despliegue de los sistemas de e-salud en áreas rurales de países en desarrollo. Y finalmente la arquitectura de referencia que sienta las bases para la aplicación de estos procesos a un contexto en particular. Las líneas futuras de trabajo sugieren extender el modelo a más casos de estudio que permitan su refinamiento y evaluar los futuros usos que pueden surgir de los sistemas de e-salud resultantes. ABSTRACT Millennium Development Goals (MDGs) committing the countries with a new global partnership to achieve universal coverage of minimum levels of well-being in Developing Countries (for addressing extreme poverty in its many dimensions-income poverty, hunger, disease, lack of adequate housing, and exclusion-while promoting gender equality, education, and environmental sustainability). From September 2015, these goals are replaces with Sustainable Development Goals (SDGs). The MDG place health at the heart of development and establish a novel global compact, linking developed and developing countries through clear, reciprocal obligations. Many public and private institutions promote international cooperation programs to support in achieving the MDGs. Some of these cooperation programs deal improving access to healthcare to poor people living in isolated areas from developing countries. In order to accomplish this goal organizations perform projects (interventions or cooperation projects) that deploy e-health systems in these zones. Nevertheless, this kind of projects face multiple challenges that dismiss the effectiveness of the projects results. In particular, cooperation teams face issues such as constraints in developing countries, lack of electrical and ICT infrastructure, scarce transport, extreme climate conditions, lack ICT capacity, lack of access to healthcare and inefficient delivery methods, etc. Hence, these issues increase the complexity of implementing e-health in developing countries and then causes the most projects fail. In other words, the solutions do not meet population needs and do not generate the expected impact on development. This context is the starting point of this doctoral thesis, which deals with analysing, planning, designing, testing and validating an architectural framework in order to implement e-health systems in rural areas from developing countries, promote development of the population in these regions, and thus improve the impact of interventions of development cooperation projects. To achieve this goal, I took as a starting point the strategies, models, e-health implementation methodologies and projects management models proposed by various international agencies. Then I proposed an instantiation of these models to manage the intervention and implement e-health systems in developing countries. I applied the action research methodology and the approaches twin track, middle out and design thinking which allowed me the iterative refinement of the model proposed in this doctoral thesis. The proposed framework was validated by running two cases studies in rural areas of Central America: Jocotán (Guatemala) and San José de Cusmapa (Nicaragua). As a result, I obtained an experimental model based on four components: a Type reference model, an e-health conceptual model, both process management and implementation e-health systems in developing countries and a reference architecture. The resulting experimental model provides important tools for the deployment of e-health systems in developing countries. The model become as reference model that provides a holistic view of the developing countries context where the interventions will be running. The conceptual model of e-health represents the main concepts involved into an e-health system. The project management and implementation processes of the iv- system provide to the cooperation teams with tools for analysing, designing, developing and deploying e-health systems in rural areas from developing countries. Finally, the reference architecture provides the basis for the implementation of these processes into a particular context. The future research suggest the extension the model to other cases studies in order to refine and evaluate the viability the model.

Analysis of house prices to assess economic impacts of new public transport infrastructure: Madrid metro line 12.

Transportation infrastructure is known to affect the value of real estate property by virtue of changes in accessibility. The impact of transportation facilities is highly localized as well, and it is possible that spillover effects result from the capitalization of accessibility. The objective of this study was to review the theoretical background related to spatial hedonic models and the opportunities that they provided to evaluate the effect of new transportation infrastructure. An empirical case study is presented: the Madrid Metro Line 12, known as Metrosur, in the region of Madrid, Spain. The effect of proximity to metro stations on housing prices was evaluated. The analysis took into account a host of variables, including structure, location, and neighborhood and made use of three modeling approaches: linear regression estimation with ordinary least squares, spatial error, and spatial lag. The results indicated that better accessibility to Metrosur stations had a positive impact on real estate values and that the effect was marked in cases in which a house was for sale. The results also showed the presence of submarkets, which were well defined by geographic boundaries, and transport fares, which implied that the economic benefits differed across municipalities.

EU support mechanisms to promote public private partnerships for financing Trans-European transport infrastructure

Since the mid 80ies the Trans ‐European Transport Network (TEN‐T) policy has been setting the framework for the development of infrastructure for the smooth functioning of the internal market within the European Union (EU). Public Private Partnerships (PPPs) have always been regarded by the EU as a key instrument to promote the TEN‐T.

Transportation infrastructure impacts on firm location: the effect of a new metro line in the suburbs of Madrid

Firm location patterns emerge as a consequence of multiple factors, including firm considerations, labor force availability, market opportunities, and transportation costs. Many of these factors are influenced by changes in accessibility wrought by new transportation infrastructure. In this paper we use spatial statistical techniques and a micro-level data base to evaluate the effects of Madrid?s metro line 12 (known as Metrosur) expansion on business location patterns. The case study is the municipality of Alcorcon, which is served by the new metro line since 2003. Specifically, we explore the location patterns by different industry sectors, to evaluate if the new metro line has encouraged the emergence of a ?Metrosur spatial economy?. Our results indicate that the pattern of economic activity location is related to urban accessibility and that agglomeration, through economies of scale, also plays an important role. The results presented in this paper provide evidence useful to inform efficient transportation, urban, and regional economic planning.

Development of a methodology and tool to evaluate the impact of ICT measures on road transport emissions

The paper presents the main elements of a project entitled ICT-Emissions that aims at developing a novel methodology to evaluate the impact of ICT-related measures on mobility, vehicle energy consumption and CO2 emissions of vehicle fleets at the local scale, in order to promote the wider application of the most appropriate ICT measures. The proposed methodology combines traffic and emission modelling at micro and macro scales. These will be linked with interfaces and submodules which will be specifically designed and developed. A number of sources are available to the consortium to obtain the necessary input data. Also, experimental campaigns are offered to fill in gaps of information in traffic and emission patterns. The application of the methodology will be demonstrated using commercially available software. However, the methodology is developed in such a way as to enable its implementation by a variety of emission and traffic models. Particular emphasis is given to (a) the correct estimation of driver behaviour, as a result of traffic-related ICT measures, (b) the coverage of a large number of current vehicle technologies, including ICT systems, and (c) near future technologies such as hybrid, plug-in hybrids, and electric vehicles. The innovative combination of traffic, driver, and emission models produces a versatile toolbox that can simulate the impact on energy and CO2 of infrastructure measures (traffic management, dynamic traffic signs, etc.), driver assistance systems and ecosolutions (speed/cruise control, start/stop systems, etc.) or a combination of measures (cooperative systems).The methodology is validated by application in the Turin area and its capacity is further demonstrated by application in real world conditions in Madrid and Rome.

Energy consumption and intensity of toll highway transport in Spain

We estimate the energy consumption of toll highway transport on a number of Spanish roads. Regression parameters are balanced according to coefficients from an empirical analysis based on survey data by vehicle type. The mean energy consumption and subsequent CO2 emissions on the toll highway sections are estimated as 1895 MJ/h/lane-km and 0.15 tCO2 eq./h/lane-km, values that increase to 2644 and 0.22 when energy and carbon emissions of transport infrastructure are considered based on the life cycle energy consumption for toll highway construction and use. If the energy intensity of infrastructure construction is allocated to the users according to traffic, it is much higher for motorcycles than for cars, and is significantly lower for articulated trucks than for vans.

Beyond the Regional Development Paradigm: The Limits of Transport-Based Policies in Spain

This paper reviews the transport and economic development trends for the last 20 years in Spain at a detailed (province or NUTS3) level. As Spain has sustained a significant transport investment effort in this period, with the support of EU funding, this review offers an excellent perspective to put some further light on how the transport-and-regional-development paradigm has shaped decision-making in the transport sector. The paper reviews changes in gross domestic product (GDP), population and motorway endowment for the 47 provinces in mainland Spain. Regional development trends seem to be closely associated to particular local conditions, not clearly associated to transport (motorway) infrastructure endowment. This is consistent with the fact that transport infrastructure has not generally been a critical bottleneck for trade and economic activity during this period. The paper concludes that, in general terms, transport infrastructure investment does not seem to be clearly associated to the otherwise substantial differences in regional development among Spanish mainland provinces during this period.

Aerodynamic study of a blended wing body, comparison with a conventional transport airplane.

Blended-wing-body (BWB) aircraft are being studied with interest and effort to improve economic efficiency and to overcome operational and infrastructure related problems associated to the increasing size of conventional transport airplanes. The objective of the research reported here is to assess the aerodynamic feasibility and operational efficiency of a great size, blended wing body layout, a configuration which has many advantages. To this end, the conceptual aerodynamic design process of an 800 seat BWB has been done completed with a comparison of performance and operational issues with last generation of conventional very large aircraft. The results are greatly encouraging and predict about 20 percent increase in transport productivity efficiency, without the burden of new or aggravated safety or operational problems.

Methodologies to measure and to manage the decarbonisation of road transport: the case of Spain

El sector del transporte por carretera es uno de los principales contribuyentes de consumo de combustible y emisiones de España. Por lo tanto, la evaluación de los impactos ambientales del tráfico rodado es esencial para los programas de mitigación del cambio climático y la eficiencia energética. Sin embargo, uno de los retos en la planificación del transporte y el diseño de políticas consiste en la aplicación de metodologías de evaluación de emisiones consistentes, el diseño de estrategias y la evaluación de su eficacia. Las metodologías existentes de evaluación de las emisiones del transporte por carretera, utilizan diferentes niveles de análisis y períodos. Sin embargo, estos análisis son puntuales y no existe una continuidad en el análisis de diferentes estrategias o políticas. Esta tesis doctoral proporciona conocimientos y herramientas para el análisis de las políticas destinadas a reducir las emisiones de tráfico, tomando España como caso de estudio. La investigación se estructura en dos partes: i) el desarrollo y aplicación de metodologías para el análisis de factores y políticas que contribuyen en la evolución de las emisiones GEI del transporte por carretera en España; desde una perspectiva nacional; y ii) el desarrollo y aplicación de un marco metodológico para estimar las emisiones del tráfico interurbano y de evaluar estrategias centradas en la operación del tráfico y en la infraestructura. En resumen, esta tesis demuestra la idoneidad de utilizar diferentes herramientas para analizar las emisiones de tráfico desde diferentes puntos de vista. Desde el diseño de políticas de mitigación y eficiencia energética a nivel nacional, a estrategias centradas en la operación del tráfico interurbano y la infraestructura. Road transport is one of the major contributors to fuel consumption and emissions in Spain. Consequently, assessing the environmental impacts of road traffic is essential for climate change mitigation and energy efficiency programs. However, one of the key challenges of policy makers and transport planners consists of implementing consistent assessment emissions methodologies, applying mitigation strategies, and knowing their effectiveness. Current state-of-the-art emissions assessment methodologies estimate emissions from different levels and periods, using different approaches. Nevertheless, these studies are timely and they usually take different methodologies for analysing different strategies or policies, regardless of the assessment as a whole. This doctoral thesis provides knowledge and methodologies for analysing policies designed to reduce road traffic emissions, using the case study of Spain. The research procedure consists of two main scopes: i) the development and application of methodologies for analysing key factors and policies driving the GHG emissions of road transport in Spain; from a national perspective; and ii) the development and application of a road traffic emissions model for assessing operational and infrastructure strategies of the interurban road network at segment level. In summary, this thesis demonstrates the appropriateness to use different tools to analyse road traffic emissions at different levels: from appropriate nationwide mitigation and energy efficiency policies, to strategies focused on the operation of interurban traffic and infrastructure.

TITIM GIS-tool: A GIS-based decision support system for measuring the territorial impact of transport infrastructures

To achieve sustainability in the area of transport we need to view the decision-making process as a whole and consider all the most important socio-economic and environmental aspects involved. Improvements in transport infrastructures have a positive impact on regional development and significant repercussions on the economy, as well as affecting a large number of ecological processes. This article presents a DSS to assess the territorial effects of new linear transport infrastructures based on the use of GIS. The TITIM ? Transport Infrastructure Territorial Impact Measurement ? GIS tool allows these effects to be calculated by evaluating the improvement in accessibility, loss of landscape connectivity, and the impact on other local territorial variables such as landscape quality, biodiversity and land-use quality. The TITIM GIS tool assesses these variables automatically, simply by entering the required inputs, and thus avoiding the manual reiteration and execution of these multiple processes. TITIM allows researchers to use their own GIS databases as inputs, in contrast with other tools that use official or predefined maps. The TITIM GIS-tool is tested by application to six HSR projects in the Spanish Strategic Transport and Infrastructure Plan 2005?2020 (PEIT). The tool creates all 65 possible combinations of these projects, which will be the real test scenarios. For each one, the tool calculates the accessibility improvement, the landscape connectivity loss, and the impact on the landscape, biodiversity and land-use quality. The results reveal which of the HSR projects causes the greatest benefit to the transport system, any potential synergies that exist, and help define a priority for implementing the infrastructures in the plan

Transport interchange and local urban environment integration

Among the different interchange design aspects, integrated land use and infrastructure planning is maybe one of the most problematic fields in practice, given that a joint transport and urban planning spills over the regular scope of action of interchange developers, whereas it involves the cooperation and agreement of various authorities. Not only this, but the very issue of land use-transport integration seems to be a long-standing mantra in planning and transport research, lacking scientific evidence. This paper is an output of an ongoing European research project called ?NODES - New tOols for Design and OpEration of Urban Transport InterchangeS?. Its aim is to start re-focusing the academic-scientific evidence on the question and to foresee a specific and practical framework to approach the problem. The underlying hypothesis is that the interchange could be a catalyst of life and security in the city.

Smart and sustainable public transport systems through improving level and quality of service

Buses are considered a slow, low comfort and low reliability transport system, thus its negative and por image. In the framework of the 3iBS project (2012), several examples of innovative and/or effective solutions regarding the Level of Service (LoS) were analysed aiming to provide operators, practitioners and policy makers with a set of Good Practice Guidelines to strengthen the competitiveness of the bus in the urban environment. The identification of the key indicators regarding vehicles, infrastructure and operation was possible through the analysis of a set of case studies -among which Barcelona (Spain), Cagliari (Italy), London (United Kingdom), Paris and Nantes (France). A cross comparison between the case studies was carried out for contrasting the level of achievement of the different criteria considered. The information provided on Regulatory, Financial and Technical issues allows the identification of a number of specific factors influencing the implementation of a high quality transport scheme, and set the basis for the elaboration of a set of Guidelines for the implementation of an intelligent, innovative and integrated bus system, including the main barriers to be tackled.