Distributed Contact and Identity Management

Contact management is a twofold problem involving a local and global level where the separation between them is rather fuzzy. Locally, users need to deal with contact management, which refers to a local need to store, organize, maintain up to date, and find information that will allow them contacting or reaching other people, organizations, etc. Globally, users deal with identity management that refers to peers having multiple identities (i.e., profiles) and the need of staying in control of them. In other words, they should be able to manage what information is shared and with whom. We believe many existing applications try to deal with this problem looking only at the data level and without analyzing the underlying complexity. Our approach focus on the complex social relations and interactions between users, identifying three main subproblem: (i) management of identity, (ii) search, and (iii) privacy. The solution we propose concentrates on the models that are needed to address these problems. In particular, we propose a Distributed Contact Management System (DCM System) that: Models and represents the knowledge of peers about physical or abstract objects through the notion of entities that can be of different types (e.g., locations, people, events, facilities, organizations, etc.) and are described by a set of attributes; By representing contacts as entities, allows peers to locally organize their contacts taking into consideration the semantics of the contact’s characteristics; By describing peers as entities allows them to manage their different identities in the network, by sharing different views of themselves (showing possibly different in- formation) with different people. The contributions of this thesis are, (i) the definition of a reference architecture that allows dealing with the diversity in relation with the partial view that peers have of the world, (ii) an approach to search entities based on identifiers, (iii) an approach to search entities based on descriptions, and (iv) the definition of the DCM system that instantiates the previously mentioned approaches and architecture to address concrete usage scenarios

Thoracic Electrical Impedance Tomography—The 2022 Veterinary Consensus Statement

Electrical impedance tomography (EIT) is a non-invasive real-time non-ionising imaging modality that has many applications. Since the first recorded use in 1978, the technology has become more widely used especially in human adult and neonatal critical care monitoring. Recently, there has been an increase in research on thoracic EIT in veterinary medicine. Real-time imaging of the thorax allows evaluation of ventilation distribution in anesthetised and conscious animals. As the technology becomes recognised in the veterinary community there is a need to standardize approaches to data collection, analysis, interpretation and nomenclature, ensuring comparison and repeatability between researchers and studies. A group of nineteen veterinarians and two biomedical engineers experienced in veterinary EIT were consulted and contributed to the preparation of this statement. The aim of this consensus is to provide an introduction to this imaging modality, to highlight clinical relevance and to include recommendations on how to effectively use thoracic EIT in veterinary species. Based on this, the consensus statement aims to address the need for a streamlined approach to veterinary thoracic EIT and includes: an introduction to the use of EIT in veterinary species, the technical background to creation of the functional images, a consensus from all contributing authors on the practical application and use of the technology, descriptions and interpretation of current available variables including appropriate statistical analysis, nomenclature recommended for consistency and future developments in thoracic EIT. The information provided in this consensus statement may benefit researchers and clinicians working within the field of veterinary thoracic EIT. We endeavor to inform future users of the benefits of this imaging modality and provide opportunities to further explore applications of this technology with regards to perfusion imaging and pathology diagnosis

Evaluation of three tidal volumes (10, 12 and 15 mL kg −1 ) in dogs for controlled mechanical ventilation assessed by volumetric capnography: a randomized clinical trial

OBJECTIVE: To evaluate three routinely used tidal volumes (VT; 10, 12 and 15 mL kg-1) for controlled mechanical ventilation (CMV) in lung-healthy anaesthetized dogs by assessing alveolar ventilation (VTalv) and dead space (DS). STUDY DESIGN: Prospective, randomized clinical trial. ANIMALS: A total of 36 client-owned dogs. METHODS: Dogs were randomly allocated to a VT of 10 (G10), 12 (G12) or 15 (G15) mL kg-1. After induction CMV was started. End-tidal carbon dioxide tension was maintained at 4.7-5.3 kPa by changing the respiratory frequency (fR; 6<fR<30 breaths minute-1). After 29 minutes, cardiovascular and respiratory variables were recorded for 3 minutes using a multiparameter monitor, volumetric capnography (VCap) and a blood gas analyser. The ratios of VTalv to body weight (VTalv kg-1) and airway DS to VT (VDaw/VT), Bohr's DS (VDBohr), Enghoff's DS (VDBE) and the volume of expired carbon dioxide per breath (VTCO2,br) were calculated. Mean airway pressure (MawP), fR and peak inspiratory pressure (PIP) were recorded. Data were analysed using one-way anova and Student-Newman-Keuls tests with a statistical significance set at p<0.05. RESULTS: No differences were observed for demographic data and cardiovascular variables between groups. A total of three dogs were excluded because of technical difficulties and one because of fR>30. VTalv kg-1 (p=0.001) increased and VDBohr (p=0.002) decreased with greater VT. VTCO2,br (p=0.017) increased and VDaw/VT (p=0.006), VDBE (p=0.008) and fR (p=0.002) decreased between G10 and G15. PIP (p=0.013) was significantly higher in G15 compared with that in G10 and G12. No changes were observed in MawP. CONCLUSIONS AND CLINICAL RELEVANCE: A VT of 15 mL kg-1 is most appropriate for CMV in lung-healthy dogs (as evaluated by respiratory mechanics and VCap) and does not impair cardiovascular variables

Custom made EIT electrode belt with 32 electrodes.

<p>(A) Each electrode comprised of 4 x 4 gold plated blunt pins with sufficient length to reach through the hair coat. (B) The electrodes did not cause any discomfort to conscious dogs.</p

Averaged functional EIT images showing the regression coefficient (Pearson R) for each pixel that significantly correlated with the reference respiratory signal.

<p>Pixels with red colour positively correlate with respiration (respiratory signals) but those with blue colour inversely correlate. Inverse respiratory signals occupy only a few pixels on the sides of the images and these are most likely artefacts. Unlike in horses, there is no indication that abdominal gas pockets would affect thoracic EIT images in dogs. See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0183340#pone.0183340.g001" target="_blank">Fig 1</a> for more explanation.</p

Physiologic Factors Influencing the Arterial-To-End-Tidal CO2 Difference and the Alveolar Dead Space Fraction in Spontaneously Breathing Anesthetised Horses

The arterial to end-tidal CO2 difference (P(a-ET)CO2) and alveolar dead space fraction (VDalvfrac = P(a-ET)CO2/PaCO2), are used to estimate Enghoff’s “pulmonary dead space” (V/QEng), a factor which is also influenced by venous admixture and other pulmonary perfusion abnormalities and thus is not just a measure of dead space as the name suggests. The aim of this experimental study was to evaluate which factors influence these CO2 indices in anesthetized spontaneously breathing horses. Six healthy adult horses were anesthetized in dorsal recumbency breathing spontaneously for 3 h. Data to calculate the CO2 indices (response variables) and dead space variables were measured every 30 min. Bohr’s physiological and alveolar dead space variables, cardiac output (CO), mean pulmonary pressure (MPP), venous admixture (Q˙s​/​Q˙t), airway dead space, tidal volume, oxygen consumption, and slope III of the volumetric capnogram were evaluated (explanatory variables). Univariate Pearson correlation was first explored for both CO2 indices before V/QEng and the explanatory variables with rho were reported. Multiple linear regression analysis was performed on P(a-ET)CO2 and VDalvfrac assessing which explanatory variables best explained the variance in each response. The simplest, best-fit model was selected based on the maximum adjusted R2 and smallest Mallow’s p (Cp). The R2 of the selected model, representing how much of the variance in the response could be explained by the selected variables, was reported. The highest correlation was found with the alveolar part of V/QEng to alveolar tidal volume ratio for both, P(a-ET)CO2 (r = 0.899) and VDalvfrac (r = 0.938). Venous admixture and CO best explained P(a-ET)CO2 (R2 = 0.752; Cp = 4.372) and VDalvfrac (R2 = 0.711; Cp = 9.915). Adding MPP (P(a-ET)CO2) and airway dead space (VDalvfrac) to the models improved them only marginally. No “real” dead space variables from Bohr’s equation contributed to the explanation of the variance of the two CO2 indices. P(a-ET)CO2 and VDalvfrac were closely associated with the alveolar part of V/QEng and as such, were also influenced by variables representing a dysfunctional pulmonary perfusion. Neither P(a-ET)CO2 nor VDalvfrac should be considered pulmonary dead space, but used as global indices of V/Q mismatching under the described conditions

Variation Between Multidisciplinary Tumor Boards in Clinical Staging and Treatment Recommendations for Patients With Locally Advanced Non-small Cell Lung Cancer

Background: Accurate diagnosis and staging are crucial to ensure uniform allocation to the optimal treatment methods for non-small cell lung cancer (NSCLC) patients, but may differ among multidisciplinary tumor boards (MDTs). Discordance between clinical and pathologic TNM stage is particularly important for patients with locally advanced NSCLC (stage IIIA) because it may influence their chance of allocation to curative-intent treatment. We therefore aimed to study agreement on staging and treatment to gain insight into MDT decision-making. Research Question: What is the level of agreement on clinical staging and treatment recommendations among MDTs in stage IIIA NSCLC patients? Study Design and Methods: Eleven MDTs each evaluated the same 10 pathologic stage IIIA NSCLC patients in their weekly meeting (n = 110). Patients were selected purposively for their challenging nature. All MDTs received exactly the same clinical information and images per patient. We tested agreement in cT stage, cN stage, cM stage (TNM 8th edition), and treatment proposal among MDTs using Randolph's free-marginal multirater kappa. Results: Considerable variation among the MDTs was seen in T staging (κ, 0.55 [95% CI, 0.34-0.75]), N staging (κ, 0.59 [95% CI, 0.35-0.83]), overall TNM staging (κ, 0.53 [95% CI, 0.35-0.72]), and treatment recommendations (κ, 0.44 [95% CI, 0.32-0.56]). Most variation in T stage was seen in patients with suspicion of invasion of surrounding structures, which influenced such treatment recommendations as induction therapy and type. For N stage, distinction between N1 and N2 disease was an important source of discordance among MDTs. Variation occurred between 2 patients even regarding M stage. A wide range of additional diagnostics was proposed by the MDTs. Interpretation: This study demonstrated high variation in staging and treatment of patients with stage IIIA NSCLC among MDTs in different hospitals. Although some variation may be unavoidable in these challenging patients, we should strive for more uniformity