Prone Positioning in Severe Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome (ARDS) is a major clinical problem with high morbidity and mortality Diffuse alveolar damage (DAD) is considered the histological hallmark for the acute phase o

Acute Respiratory Distress Syndrome and Diffuse Alveolar Damage. New Insights on a Complex Relationship

Acute respiratory distress syndrome (ARDS) is defined by the association of bilateral infiltrates and hypoxaemia following an initial insult. Although a new definition has been recently proposed (Berlin definition), there are various forms of ARDS with potential differences regarding their management (ventilator settings, prone positioning use, corticosteroids). ARDS can be caused by various aetiologies, and the adequate treatment of the responsible cause is crucial to improve the outcome. It is of paramount importance to characterize the mechanisms causing lung injury to optimize both the aetiological treatment and the symptomatic treatment. If there is no obvious cause of ARDS or if a direct lung injury is suspected, bronchoalveolar lavage (BAL) should be strongly considered to identify microorganisms responsible for pneumonia. Blood samples can also help to identify microorganisms and to evaluate biomarkers of infection. If there is no infectious cause of ARDS or no other apparent aetiology is found, second-line examinations should include markers of immunologic diseases. In selected cases, open lung biopsy remains useful to identify the cause of ARDS when all other examinations remain inconclusive. CT scan is fundamental when there is a suspicion of intra-abdominal sepsis and in some cases of pneumonia. Ultrasonography is important not only in evaluating biventricular function but also in identifying pleural effusions and pneumothorax. The definition of ARDS remains clinical and the main objective of the diagnostic workup should be to be focused on identification of its aetiology, especially a treatable infection.

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Diagnostic workup for ARDS patients

In cloud computing environments in software as a service (SaaS) level, interoperability refers to the ability of SaaS systems on one cloud provider to communicate with SaaS systems on another cloud provider. One of the most important barriers to the adoption of SaaS systems in cloud computing environments is interoperability. A common tactic for enabling interoperability is the use of an interoperability framework or model. During the past few years, in cloud SaaS level, various interoperability frameworks and models have been developed to provide interoperability between systems. The syntactic interoperability of SaaS systems have already been intensively researched. However, not enough consideration has been given to semantic interoperability issues. Achieving semantic interoperability is a challenge within the world of SaaS in cloud computing environments. Therefore, a semantic interoperability framework for SaaS systems in cloud computing environments is needed. We develop a semantic interoperability framework for cloud SaaS systems. The capabilities and value of service oriented architecture for semantic interoperability within cloud SaaS systems have been studied and demonstrated. This paper is accomplished through a number of steps (research methodology). It begins with a study on related works in the literature. Then, problem statement and research objectives are explained. In the next step, semantic interoperability requirements for SaaS systems in cloud computing environments that are needed to support are analyzed. The details of the proposed semantic interoperability framework for SaaS systems in cloud computing environments are presented. It includes the design of the proposed semantic interoperability framework. Finally, the evaluation methods of the semantic interoperability framework are elaborated. In order to evaluate the effectiveness of the proposed semantic interoperability framework for SaaS systems in cloud computing environments, extensive experimentation and statistical analysis have been performed. The experiments and statistical analysis specify that the proposed semantic interoperability framework for cloud SaaS systems is able to establish semantic interoperability between cloud SaaS systems in a more efficient way. It is concluded that using the proposed framework, there is a significant improvement in the effectiveness of semantic interoperability of SaaS systems in cloud computing environments.

A semantic interoperability framework for software as a service systems in cloud computing environments

The Presence of Diffuse Alveolar Damage on Open Lung Biopsy Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

To demonstrate that among patients with acute respiratory distress syndrome (ARDS), the presence of diffuse alveolar damage (DAD) at histological examination, as compared to its absence, defines a specific subphenotype. We studied 149 patients who died in our ICU with the clinical diagnosis of ARDS according to the Berlin Definition (BD) and who had autopsy examination. We compared the change over time of different clinical variables in patients with (n = 49) and without (n = 100) DAD. A predictive model for the presence of DAD was developed and validated in an independent cohort of 57 patients with ARDS and postmortem examination (21 of them with DAD). Patients with DAD, as compared to patients without DAD, had a lower PaO2/FiO2 ratio and dynamic respiratory system compliance, and a higher SOFA score and INR, and were more likely to die of hypoxemia and less likely to die of shock. In multivariate analysis, variables associated with DAD [odds ratio, 95 % confidence interval (CI)] were PaO2/FiO2 ratio [0.988 (0.981–0.995)], dynamic respiratory system compliance [0.937 (0.892–0.984)] and age [0.972 (0.946–0.999)]. Areas under the ROC curve (95 % CI) for the classification of DAD using the regression model or the BD were, respectively, 0.74 (0.65–0.82) and 0.64 (0.55–0.72) (p = 0.03). In the validation cohort, the areas under the ROC curve for the diagnosis of DAD were 0.73 (0.56–0.90) and 0.67 (0.54–0.81) for the regression model and the BD, respectively. The presence of DAD appears to define a specific subphenotype in patients with ARDS. Targeting patients with DAD within the population of patients with the clinical diagnosis of ARDS might be appropriate to find effective therapies for this condition.

Acute respiratory distress syndrome in patients with and without diffuse alveolar damage: an autopsy study

Grounding is the process in charge of linking requests and responses of web services with the semantic web services execution platform, and it is the key activity to automate their execution in a real business environment. In this paper, the authors introduce a practical solution for data grounding. On the one hand, we need a mapping language to relate data structures from services definition in WSDL documents to concepts, properties and instances of a business domain. On the other hand, two functions that perform the lowering and lifting processes using these mapping specifications are also presented.

/pdf/towards-a-practical-solution-for-data-grounding-in-a-1x5u37ov7i.pdf

Towards a Practical Solution for Data Grounding in a Semantic Web Services Environment

los archivos de una lista de correo (la recopilacion de los mensajes enviados hasta el momento) son a menudo publicados en la Web e indexados por los motores de busqueda convencionales. Almacenan una inmensa cantidad de conocimiento. No obstante, con esta forma de publicacion se pierde la capacidad de reconocer y procesar automaticamente esta informacion. Como resultado tienen un uso muy limitado y es dificil hacer determinado tipo de consultas. SWAML hace uso de las tecnologias de la Web Semantica para tratar de minimizar esta perdida de informacion, permitiendo que nuevas herramientas puedan explotar todo este conocimiento de una manera mucho mas eficiente

Diego Berrueta Muñoz

Papers

Acute respiratory distress syndrome in patients with and without diffuse alveolar damage: an autopsy study

Towards a Practical Solution for Data Grounding in a Semantic Web Services Environment

Mundo estudiantil y jóvenes profesionales. SWAML, Semantic Web Archive of Mailing Lists