Aspects of the disclosure generally relate to a patient visualization system in connection with pressure injuries.
Pressure injuries, otherwise known as decubitus ulcers, pressure ulcers or bedsores, are lesions developed when a localized area of soft tissue of a subject is compressed between a bony prominence and an external surface for a prolonged period of time. Pressure injuries could appear in various areas of the body, such as elbows and knees. Development of pressure injuries based on a combination of factors, such as, unrelieved pressure, friction, shearing forces, humidity, and temperature.
Hospitalized patients often suffer from pressure injuries. However, pressure injuries are not limited to hospitalized patients. Individuals confined to wheelchairs are prone to suffer from pressure injuries, especially in their pelvis, lower back, and ankles. Although easily preventable or treatable if found early, if a pressure injury lingers, it becomes painful and treatment is both difficult and expensive. In many cases, pressure injuries can prove fatal, even under the auspices of medical care. According to one estimate, 2.5 million people suffer from pressure injuries in the United States each year, resulting in over 60,000 deaths annually.
An effective way of dealing with pressure injuries is to prevent their formation. A common preventive approach is maintaining a strict routine of repositioning, e.g., rotating and/or turning, a subject to offload, to eliminate, to alleviate and/or to reduce pressure every two (2) to three (3) hours. Research studies have shown that the effectiveness of caregiver repositioning techniques of patients is not adequate regardless of the level of experience and knowledge of the caregiver.
In one embodiment, a system is disclosed. The system includes a processor, communicatively coupled to a pressure sensor device to periodically receive pressure sensor data experienced by a subject at locations on the pressure sensor device. The processor programmed to receive input indicative of an intervention resulting in a pressure lowering of a body area of the subject during a first high-pressure situation at a first time; and responsive to determining a second high-pressure situation at the body area of the subject at a second time later than the first time, display an indication of the input of the intervention in connection with the first high-pressure situation. Using the body position data and the associated pressure sensor data, the processor can calculate pressure experienced by one or more of the body areas of the subject over a period of time.
In another embodiment, a non-transitory computer-readable medium is disclosed. The non-transitory computer-readable medium has computer-readable instructions stored thereon that are configured to be executed by a processor to: receive input indicative of an intervention resulting in a pressure lowering of a body area of the subject during a first high-pressure situation at a first time; and responsive to determining a second high-pressure situation at the body area of the subject at a second time later than the first time, display an indication of the input of the intervention in connection with the first high-pressure situation.
In a third embodiment, a method is disclosed. The method includes receiving input indicative of an intervention resulting in a pressure lowering of a body area of the subject during a first high-pressure situation; and responsive to determining a second high-pressure situation at the body area of the subject at a second time later than the first time, displaying an indication of the input of the intervention in connection with the first high-pressure situation.
For a better understanding of the embodiments and to show how it may be carried into effect, reference will now be made, purely by way of example, to the accompanying drawings.
With specific reference now to the drawings in detail, it is stressed that the particulars shown are by way of example and for purposes of illustrative discussion of selected embodiments only, and are presented in the cause of providing what is believed to be the most useful and readily understood description of the principles and conceptual aspects. In this regard, no attempt is made to show structural details in more detail than is necessary for a fundamental understanding. The description taken with the drawings makes apparent to those skilled in the art how the several selected embodiments may be put into practice. In the accompanying drawings:
As required, detailed embodiments of the present invention are disclosed herein; however, it is to be understood that the disclosed embodiments are merely exemplary of the invention that may be embodied in various and alternative forms. The figures are not necessarily to scale; some features may be exaggerated or minimized to show details of particular components. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a representative basis for teaching one skilled in the art to variously employ the present invention.
Aspects of the disclosure generally relate to a patient visualization system in connection with pressure injuries. Research studies have shown that the effectiveness of caregiver repositioning techniques of patients is not adequate regardless of the level of experience and knowledge of the caregiver. Available computer pressure monitors are not sufficient because they do not provide computer user interfaces with the pressure history of patients from the operating room to the intensive care unit to the general population. What is needed is a patient visualization computer system that provides real-time, electronic delivery and display of actionable data that empowers medical staff to identify critical pressure injury situations, respond proactively and assist in the prevention of pressure injuries. The patient visualization computer system disclosed in embodiments of the present invention provides a technical solution to the technical drawbacks of currently proposed computer pressure monitors.
In embodiments of the present invention, the features of the patient visualization system may include real time monitoring and tracking of pressure injuries, tracking of body positioning and repositioning, tracking of pressure to those areas of the body that are susceptible to pressure injuries, tracking and measuring nurse/caregiver compliance, and providing nurses and patients with line of sight and actionable information that together allow nurses, primarily, but also, patients and their families/friends to make correct decisions and to take correct actions in effectively offloading patients. In certain embodiments, this includes computer user interfaces that show pressure experienced on specific body areas susceptible to pressure injuries over time. With this specific purpose software, the system allows clinicians to trend pressure exposure on specific body areas, and allows hospitals to trend pressure data to combat pressure injuries.
As one feature, the patient visualization system may detect and observe pressure experienced by a subject's body against a pressure detection mat or other detection surface. The system may provide a caregiver with a visual representation of the pressure experienced by the subject across the surface. The system may also provide a representation of pressure experienced by a body area over a designated period of time. Using the information regarding pressure to a body area over a period of time, a caregiver may take appropriate action, such as to reposition, e.g., rotate and/or turn, a subject to offload pressure to the body area.
To accurately measure pressure to a body area over a period of time, the system may be configured to associate pressure sensed by a pressure detection mat with a body area of a subject. For instance, the pressure detection mat senses pressure sensor data experienced by a subject over a period of time, the system determines the various levels of pressure over time based on the pressure sensor data and pixel pressure algorithm, the system determines body position over time based on the pressure sensor data over time and a body position algorithm, and the system associates the pressure over time and the body position over time to determine a pressure to a body area over a period of time. The body areas may be selected from a group of body areas susceptible to pressure injuries, e.g., head, left shoulder, right shoulder, left elbow, right elbow, tailbone, left hip, right hip, left knee, right knee, left foot, and right foot. In one embodiment, the system assigns a pressure for each of the body areas susceptible to pressure injuries even for such body areas that are not in contact with the pressure detection sheet. The associated sensor data may include sensor data indicative of an absence of pressure sensor data associated with one or more of the number of body areas, e.g., the body area is not in contact with the pressure sensor device during a period of time when the pressure sensor is collected, as opposed to other periods of time when the body area is in contact with the pressure sensor device.
A subject may change from a first body position to a second body position to a third body position. Within the first and third body positions, a body area may not be in contact with the pressure detection sheet, while the body area may be in contact with the pressure detection sheet. The system records a value indicative of an absence of pressure sensor data during the periods when the subject is in the first and third body positions and records a value indicative of the pressure sensor data while the subject is in the second body position. In one embodiment, these values are recorded continuously between changes in body position. By registering a value indicative of the lack of contact between the body area and the pressure detection sheet when a subject is not in bed or a certain body area is not experiencing pressure or very low levels of pressure is highly informative of offloading decisions.
The system may be further configured to provide a computer graphical representation of the various pressures to a body area over a period of time. As an example, for each tracked body area, e.g., a body area susceptible to pressure injury, the system displays a pie chart or other graph indicating the various levels of pressure to a body area over a period of time, e.g., over the last two (2) hours. The system may also be configured to display a peak pressure, signifying the value of the highest pressure pixel within a body area. Using these representations for the tracked body areas, a caregiver has useable information to determine body areas of concern for pressure injuries and to make educated decisions as to whether any of a subject's body areas susceptible to pressure injuries require offloading.
By using the results of the body position algorithm applied to the pressure sensor data, the system may be configured to display a body position history and reposition history over a certain period of time, e.g., the last three (3), six (6) or twelve (12) hours. The system can also be configured to display a representation within the body position history to identify and highlight when a reposition has not taken place during a required period of time, e.g., two (2) hours. Using this visualization, the caregiver has accurate information over time to determine when offloading should take place, or if it has not occurred. The system may also be configured to display a representation of body area pressure history that displays individual body area pressure history for a certain period of time, e.g. the last three (3), six (6) or twelve (12) hours. This representation provides pressure data over whatever the selected period of time is for each body area prone to pressure injuries.
When the system identifies a reduction in pressure on a tracked body area without a corresponding change in body position of the patient, the system may request information from the caregiver regarding what action, commonly referred to as “intervention,” was performed to provide for the reduction in pressure. The system may provide a message including a listing of predefined choices from which the caregiver may select (e.g., lowered head of bed, raised head of bed, placed pillow/wedge under body area, removed foreign object, implemented a micro-shift of the top sheet, other, etc.). This action information may be retained by the system as part of the historical record for the subject, and may be viewable at a later date to allow caregivers to understand actions that were previously performed to the subject for offloading purposes.
The system may also use the recorded action information to provide predictive recommendations to the caregiver. In an example, responsive to the system identifying high pressure to a specific body area in a specific body position, the system may access subject historical data to locate similar conditions of body area and/or body position where the pressure was lowered by caregiver action. If a similar condition is identified, the system may present a message to the user indicating the intervention that was done to resolve the historical condition. Accordingly, the system may provide the caregiver with information regarding previous actions used to address high-pressure situations, without recommending any actions to be performed by the caregiver in the detected situation.
Reference is now made to the block diagram of
The sensors 32 may be arranged at different locations on the pressure-detection device 30. In an example, the sensors 32 may be arranged in a two-dimensional grid across the surface of the pressure detection device 30. The driver 20 may supply voltage to the sensors 32 in the pressure detection device 30, and the processor 50 may measure the potential across the sensors 32, calculate impedance values for each sensor 32, and store the data in a data storage unit 60. The stored data may be further processed, analyzed, and displayed on the display unit 70, such as a computer screen, laptop, personal digital assistant (PDA), tablet device, mobile phone screen, printed sheet, or integrated display screen. Although presented in the block diagram of
Referring now to
The remote control center 500 may include a data storage unit 560 for storing data from the sub-systems 100a-100h and a display unit 570 for presenting and/or displaying the data as required. The remote control center 500 may additionally provide processing and driving functionality for controlling multiple sub-systems. Optionally, each sub-system 100a-100h may have its own dedicated display unit 170a-h for processing, storing and displaying data locally.
Reference is now made to
The sensors 210 incorporated in the pressure detection sheet 200 may provide measurements based on the capacitance between the sections of the conducting strips 222, 224 overlapping at each “intersection” of a vertical conductive strip with a horizontal conductive strip. These capacitive sensors 210 may be configured such that pressure on the surface of the pressure detection sheet 200 changes the spacing between the two conductive layers 220a and 220b, and consequently changes the capacitance of the intersections of the strips 222, 224.
The driver 20 may provide an oscillating electric potential across each sensor 210 and may measure the alternating current produced. For instance, the driver 20 may provide an electric potential to one of the strips (e.g., strip 222) and may measure the electrical potential on the other strip (e.g., strip 224), such that the capacitance of the overlapping section (i.e., capacitive sensors 210) may be determined. Thus, the driver 20 may calculate the impedance of the intersection of the strips 222, 224 and determine the capacitance of the intersection from the impedance. Accordingly, where the mechanical properties of the sensors 210 are known, the driver 20 may deduce the pressure on the sensors 210 of the pressure detection sheet 200.
To make a stable reading of impedance values from a row of sensors 32, little or no movement should be made by the subject during the taking of readings from the sensors 32. Accordingly, in certain embodiments, the time taken for readings may be of the order of tens or hundreds of milliseconds, during which movement of the subject is generally insignificant. In applications where the subject is largely immobile, longer reading times may be used.
In some embodiments, the materials for the conductive layers 220a, 220b and insulating layers 230 are flexible. The insulation material may be a compressible sponge-like, airy or porous material (e.g., foam), allowing for a change in density when pressure is applied to it.
The pressure detection sheet 200 may be placed underneath or otherwise integrated with other material layers 240a, 240b such as used in standard bed sheets. The additional materials may confer further properties as needed for a particular application. The conductive material of the sensors 210 may be wrapped by an isolating, water resistant, breathable cover sheet or the like, allowing minimum discomfort to the subject resting on the sheet.
With reference now to
With reference to
With reference to
The processor 50 may be implemented as a combination of hardware and software, and may include one or more software applications, modules, or processes stored in memory for causing one or more computing devices to perform the operations described herein. The body position algorithm 504, pixel pressure algorithm 508, body area pressure algorithm 512, and other operations and algorithms described with respect to the data flow of
The pressure sensor data 502 may include data indicative of the pressure exerted on each of the sensors 32 of the pressure detection device 30. In an example, the pressure sensor data 502 may include a pressure distribution image or data set having a set of readings taken from each of the sensors 32 of the pressure detection device 30. In another example, the processor 50 may form the pressure sensor data 502 into a pressure distribution histogram (sometimes referred to as a pressure distribution signature vector) by creating a one-dimensional array, or vector, of the pressure sensor data 502 relating to a pressure image feature.
Various approaches may be used by the processor 50 to generate pressure distribution signature vectors from pressure distribution images. As an example, a signature vector of a maximum point distance feature may be obtained by: removing pixels having pressure values below a first threshold; identifying local maxima by selecting pixels whose pressure values are greater than or equal to all bordering pixels; clustering the local maxima into sets of a given size; obtaining a point average for each set of maxima, perhaps by calculating a spatial average therefor. Accordingly, an output vector may be generated arraying the distances between the local maxima average points. Another approach may be used for generating a pressure distribution signature vector including a histogram of pressure values. Optionally, the pressure value of each pixel may be arrayed into a histogram of total pressure values. Alternatively, or additionally, a partial pressure histogram may be generated by: calculating a spatial average for all values below a threshold value, the values being weighted for their positions; calculating the spatial averages; choosing a square of twice the standard deviation of data relative to the average position point; calculating a histogram of values out of this square. Still another approach may be used for generating a pressure distribution signature vector based upon the position of the pixels. The values of pixels may be selected where the pixel location is within a defined range.
The body position 506 may be an indication of the body position of a subject recumbent on the pressure detection device 30. In an example, the body position 506 may include a back-side resting body position, a right side resting body position, a stomach or front-side resting body position, an out of bed position, or a left side resting body position. In one or more embodiments, the body position 506 may further indicate one or more position variants of the identified body position. For instance, the body position 506 may indicate an amount of lean of the subject to the right or to the left, an amount of shift or angle of one or more limbs of the subject, and/or an amount of turn of the head of the subject.
The position library may include a set of reference pressure images corresponding to various body positions. Each image of the position library may include data representative of a model of a body position and an association of the data with an identifier of the body position represented by the data. The data of the reference pressure images may include a pressure distribution image and/or a pressure distribution histogram. To create the position library, an operator may record samples of subjects adopting known body positions and may store the pressure images or their associated pressure histograms in the position library.
The body position algorithm 504 may utilize the pressure sensor data 502 and the position library to identify the body position 506 of the subject. The identification may enable body features (e.g., body areas) to be recognized as well as for the pressure sensor data 502 to be associated with a body coordinate system. In an example, the body position algorithm 504 may compare the pressure sensor data 502 to the reference position images of the position library, and may determine which of the reference position images of the position library best matches the pressure sensor data 502. The body position algorithm 504 may further identify a period of time during which the subject is in each recorded position.
The body position algorithm 504 may implement one or more of various comparison algorithms to compare the recorded pressure image of the pressure sensor data 502 to the candidate images of the position library. These comparison algorithms may include, for example, particle component analysis, support vector machine, K-mean, two-dimensional fast Fourier analysis, earth movers distance, and the like.
As a more specific example, the body position algorithm 504 may compare the recorded pressure image of the pressure sensor data 502 and the candidate images of the position library by comparing pressure distribution histograms of the recorded image and the candidate image. The histogram may serve as a signature of the pressure image features, and the body position algorithm 504 may utilize a comparison method to provide a similarity rating between feature signatures.
The pixel pressure algorithm 508 may be configured to determine pixel pressure 510 exerted on the pressure detection device based on the pressure sensor data 502. In an example, the pixel pressure algorithm 508 may assign pressure values from the pressure sensor data 502.
The body area pressure algorithm 512 determines pressure to a body area over a period of time based on pixel pressure 510, body position 506 and body areas. The body area pressure algorithm 512 may assign body areas in which there is an absence of pressure sensor data a pressure value indicative of this absence.
The result of the process and algorithms set forth in
The body areas may include a listing of body areas that are susceptible to pressure injuries. These body areas may include bony prominences, which are areas in which bones are close to the surface of the body. In an example, the body areas may include the head, shoulders, hips, knees, feet, tailbone, elbows, heels, and spine. The body areas selection may include identification of the predefined body areas that are selected by a caregiver, e.g., body areas that have a pressure injury currently or in the recent past.
In one embodiment, a pressure signature algorithm can record a pressure signature of a subject to determine whether or not the same patient is lying on the device 30 after not lying on the device 30. The pressure signature algorithm can determine from the current pressure signature and a historic pressure signature whether the same patient is lying on the pressure detection device 30 within a margin of error, e.g., 5.0%, 1.0%, 0.1% to 0.01%. If the determination is within the margin of error, then the system 10 assumes that the same subject is present. If the determination is outside of the margin of error, the system uses its defaults settings, e.g., if there is no patient lying on the device 30 for more than a time threshold, e.g., 2 hours, then the system defaults to a new person is lying on the device 30, and if it is less than the time threshold, e.g., 2 hours, then the system defaults to the same person lying on device 30.
Upon selection of the edit control 606, user interface 600-B of
As shown in the user interface 600-B, the tailbone body area control 610-C has been selected. As depicted by a selector icon 612, a user is in the process of selecting right elbow body area control 610-I. Once selected, a pressure injury icon 602-B is displayed on the right elbow body area of representation 603 as shown in
The user interface 600-D of
Representation 603 of
The user interface 700-A may include a body area pressure representation 702 indicating current subject body area pressure values based on the pressure sensor data 502, to allow the caregiver to understand which areas are of greater or lesser pressure as part of a live pressure assessment. The body area pressure representation 702 may distinguish areas of different pressure according to various visual mechanisms. For instance, areas of higher pressure are displayed in different colors or patterns as compared to areas of lower pressure. The values of the body area pressure representation 702 may be specified along a scale illustrated by a legend 704. In an example, the legend 704 may specify values or ranges of high pressure in red, and values of decreasing pressure as colors along a red-orange-yellow-green-blue color spectrum, for example. In one embodiment, a red range is 75+ mmHg, an orange range is 60-74 mmHg, a yellow range is 45-59 mmHg, a green range is 30-44 mmHg, a light blue range is 15-29 mmHg, a blue range is 1-14 mmHg and a black value is 0 mmHg.
The user interface 700-A includes body area pressure history indications 706 associated with the pressure representation 702 of the subject.
For each tracked body area, e.g., the right elbow body area and the tailbone body area as shown in
As shown in the user interface 700-A, each body area pressure history indication 706 may include a mark surrounding the corresponding tracked body area to which the graphical representations of the pressure over time is linked, e.g., by a lead line.
The user interface 700-A includes pressure injury indications 710 for those body areas previously identified by the caregiver during setup as currently having pressure injuries. For instance, the body area pressure history indications 710-A and 710-B are indicated as currently having a pressure injury. In one embodiment, those body area pressure indications associated with a current pressure injury are always displayed on user interface 700-A.
The user interface 700-A may also include side indications 712 to aid the caregiver in understanding the positioning of the subject. As shown in
The user interface 700 may also include a subject identifier 714 to indicate to the caregiver the name and/or identifier of the subject. The user interface 700 may also include further controls, such as a reposition timer 716 indicating when the subject should next be repositioned. It should be noted that the user interface 700 are merely examples, and more, fewer, or different layouts of controls including body area pressure history indications 706 may be used.
The user interface 700 may also include additional controls to allow for navigation to other user interfaces with the system 10. The user interface 700-A may include menu controls 718 and 720. Upon selection of menu control 718, a dashboard user interface (as shown in
The user interface 900 may include a body position history 902 configured to indicate to the caregiver the relative amounts of time that the subject spent in each of a set of predefined body positions. For instance, as shown the body position history 902 includes indication of the amount of time that the subject spent within each of a number of body positions, e.g., back-side resting body position, a right side resting body position, a stomach or front-side resting body position, an out of bed position, or a left side resting body position. The body position history 902 indicates that the subject was on his/her back 68% of the time, on his/her right side 19% of the time, on his/her left side 0% of the time, on his/her front side 0% of the time, and out of the bed 13% of the time. A body area pressure history 904 indicates pressure of individual body areas over time in a pie chart representation. As shown below in
The user interface 1000 of
Responsive to the reposition timer 716 falling below the threshold value, the system 10 may display a reposition alert 1202 on the user interface 1200. In an example, the reposition alert 1202 may be configured to display in a conspicuous manner, e.g., pulse in yellow, to draw the attention of a caretaker. The reposition alert 1202 may automatically dismiss responsive to a change in the body position 506. In other embodiments, the alert 1202 may be an audible alert or an alert transmitted to a caregiver's station or caregiver directly.
As shown in
As shown in the balloon indication 1504, the notification includes a description 1506 indicating that pressure was reduced on one of the body area of the subject (in this example, the left foot). The user interface 1500 also includes a graphical indication 1508 associated with the location of the pressure representation 702 where the pressure was reduced. As shown, the intervention controls 1510 may include: an add/adjust pillow intervention control 1510-A that may be selected to indicate that a pillow was used to address a high pressure situation, an add/adjust wedges intervention control 1510-B that may be selected to indicate that a wedge was used to address a high pressure situation, a lower head of bed intervention control 1510-C that may be selected to indicate that the head of the bed was lowered to address a high pressure situation, a microshifting intervention control 1510-D that may be selected to indicate that microshifting was performed to address a high pressure situation, an adjust-inflation intervention control 1510-E that may be selected to indicate that settings of the air bed were adjusted to address a high pressure situation, an object-removed intervention control 1510-F that may be selected to indicate that a wedge, pillow or other object was removed to address high pressure situation, and an “other” intervention control 1510-G that may be selected to allow for text or voice entry of a description of an action that was performed that is not listed by the other intervention controls 1510.
Thus, the system 10 may save the received action information in connection with data regarding the lowering of pressure in a body area, such that when similar situations occur in the future, the system may present to the caregiver information regarding the actions that were indicated as being performed to address the situations in the past.
In the illustrated example interface 1600, the patient view includes the body area pressure representation 702 of the subject and the legend 704 indicating the values of the body area pressure history 702. The patient view may also display the reposition timer 1602 indicating when the subject should be moved. However, the patient view does not display the details related to body areas, such as the body area pressure history, peak pressure value indications, body position history, and/or body reposition history timeline 1004, shown in other user interfaces.
The user interface 1600 may also include a patient view label 1604 to indicate to users that the user interface 1600 is for the subject to view, and does not include the additional medical details available in the nurse views. As the user interface 1600 is for patients and not medical caregivers, the user interface 1600 includes a tutorial control 1606 that, when selected, presents a tutorial explaining the functionality of the display unit 70 in a manner appropriate for the subject. The user interface 1600 also includes a nurse view control 1608 that, when selected, transitions the user interface 1600 from the patient view to the nurse view, e.g., from the user interface 1600 to a user interface such as one of the user interfaces 700. In some cases, credentials such as a login/password or biometrics may be required to be provided to the display unit 70 or other system 10 element to transition the user interface back to the nurse/caretaker view.
This application is related to U.S. application Ser. No. 15/343,747 filed Nov. 4, 2016, and is herein incorporated by reference in its entirety.
In general, computing systems and/or devices may employ any of a number of computer operating systems, including, but by no means limited to, versions and/or varieties of the Microsoft Windows™ operating system, the Unix operating system (e.g., the Solaris™ operating system distributed by Oracle Corporation of Redwood Shores, Calif.), the AIX UNIX operating system distributed by International Business Machines of Armonk, N.Y., the Linux operating system, the Mac OS X and iOS operating systems distributed by Apple Inc. of Cupertino, Calif., the BlackBerry OS distributed by Research In Motion of Waterloo, Canada, and the Android operating system developed by the Open Handset Alliance.
Computing devices generally include computer-executable instructions, where the instructions may be executable by one or more computing devices such as those listed above. Computer-executable instructions may be compiled or interpreted from computer programs created using a variety of programming languages and/or technologies, including, without limitation, and either alone or in combination, Java.™, C, C#, C++, Visual Basic, Java Script, Perl, etc. In general, a processor or microprocessor receives instructions, e.g., from a memory, a computer-readable medium, etc., and executes these instructions, thereby performing one or more processes, including one or more of the processes described herein. Such instructions and other data may be stored and transmitted using a variety of computer-readable media.
A computer-readable medium (also referred to as a processor-readable medium) includes any non-transitory (e.g., tangible) medium that participates in providing data (e.g., instructions) that may be read by a computer (e.g., by a processor of a computer). Such a medium may take many forms, including, but not limited to, non-volatile media and volatile media. Non-volatile media may include, for example, optical or magnetic disks and other persistent memory. Volatile media may include, for example, dynamic random access memory (DRAM), which typically constitutes a main memory. Such instructions may be transmitted by one or more transmission media, including coaxial cables, copper wire, and fiber optics, including the wires that comprise a system bus coupled to a processor of a computer. Common forms of computer-readable media include, for example, a floppy disk, a flexible disk, hard disk, magnetic tape, any other magnetic medium, a CD-ROM, DVD, any other optical medium, punch cards, paper tape, any other physical medium with patterns of holes, a RAM, a PROM, an EPROM, a FLASH-EEPROM, any other memory chip or cartridge, or any other medium from which a computer can read.
Databases, data repositories, or other data stores described herein may include various kinds of mechanisms for storing, accessing, and retrieving various kinds of data, including a hierarchical database, a set of files in a file system, an application database in a proprietary format, a relational database management system (RDBMS), etc. Each such data store is generally included within a computing device employing a computer operating system such as one of those mentioned above, and are accessed via a network in any one or more of a variety of manners. A file system may be accessible from a computer operating system, and may include files stored in various formats. An RDBMS generally employs the Structured Query Language (SQL) in addition to a language for creating, storing, editing, and executing stored procedures, such as the PL/SQL language mentioned above.
In some examples, system elements may be implemented as computer-readable instructions (e.g., software) on one or more computing devices (e.g., servers, personal computers, etc.), stored on computer readable media associated therewith (e.g., disks, memories, etc.). A computer program product may include such instructions stored on computer readable media for carrying out the functions described herein. Such instructions may be provided as software that when executed by the processor provides the operations described herein. Alternatively, the instructions may be provided as hardware or firmware, or combinations of software, hardware, and/or firmware.
With regard to the processes, systems, methods, heuristics, etc. described herein, it should be understood that, although the steps of such processes, etc. have been described as occurring according to a certain ordered sequence, such processes could be practiced with the described steps performed in an order other than the order described herein. It further should be understood that certain steps could be performed simultaneously, that other steps could be added, or that certain steps described herein could be omitted. In other words, the descriptions of processes herein are provided for the purpose of illustrating certain embodiments, and should in no way be construed so as to limit the claimed invention.
While exemplary embodiments are described above, it is not intended that these embodiments describe all possible forms of the invention. Rather, the words used in the specification are words of description rather than limitation, and it is understood that various changes may be made without departing from the spirit and scope of the invention. Additionally, the features of various implementing embodiments may be combined to form further embodiments of the invention.
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