Optimising Structured P2P Networks for Complex Queries

With network enabled consumer devices becoming increasingly popular, the number of connected devices and available services is growing considerably - with the number of connected devices es- timated to surpass 15 billion devices by 2015. In this increasingly large and dynamic environment it is important that users have a comprehensive, yet efficient, mechanism to discover services. Many existing wide-area service discovery mechanisms are centralised and do not scale to large numbers of users. Additionally, centralised services suffer from issues such as a single point of failure, high maintenance costs, and difficulty of management. As such, this Thesis seeks a Peer to Peer (P2P) approach. Distributed Hash Tables (DHTs) are well known for their high scalability, financially low barrier of entry, and ability to self manage. They can be used to provide not just a platform on which peers can offer and consume services, but also as a means for users to discover such services. Traditionally DHTs provide a distributed key-value store, with no search functionality. In recent years many P2P systems have been proposed providing support for a sub-set of complex query types, such as keyword search, range queries, and semantic search. This Thesis presents a novel algorithm for performing any type of complex query, from keyword search, to complex regular expressions, to full-text search, over any structured P2P overlay. This is achieved by efficiently broadcasting the search query, allowing each peer to process the query locally, and then efficiently routing responses back to the originating peer. Through experimentation, this technique is shown to be successful when the network is stable, however performance degrades under high levels of network churn. To address the issue of network churn, this Thesis proposes a number of enhancements which can be made to existing P2P overlays in order to improve the performance of both the existing DHT and the proposed algorithm. Through two case studies these enhancements are shown to improve not only the performance of the proposed algorithm under churn, but also the performance of traditional lookup operations in these networks

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Metabolomic Profiling in the Characterization of Degenerative Bone and Joint Diseases

Osteoarthritis and inflammatory arthropathies are a cause of significant morbidity globally. New research elucidating the metabolic derangements associated with a variety of bone and joint disorders implicates various local and systemic metabolites, which further elucidate the underlying molecular mechanisms associated with these destructive disease processes. In osteoarthritis, atty acid metabolism has been implicated in disease development, both locally and systemically. Several series of rheumatoid arthritis patients have demonstrated overlapping trends related to histidine and glyceric acid, while other series showed similar results of increased cholesterol and glutamic acid. Studies comparing osteoarthritis and rheumatoid arthritis reported elevated gluconic acid and glycolytic- and tricarboxylic acid-related substrates in patients with osteoarthritis, while lysosphingolipids and cardiolipins were elevated only in patients with rheumatoid arthritis. Other bone and joint disorders, including osteonecrosis, intervertebral disc degeneration, and osteoporosis, also showed significant alterations in metabolic processes. The identification of the molecular mechanisms of osteoarthritis and inflammatory arthropathies via metabolomics-based workflows may allow for the development of new therapeutic targets to improve the quality of life in these patient populations