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Matter of Velasquez-Rios, 27 I&N Dec. 470 (BIA 2018): BIA Assesses Maximum Possible Sentence at Time Conviction Occures
Introduction: Matter of Velasquez-Rios, 27 I&N Dec. 470 (BIA 2018)
Factual and Procedural History: 27 I&N Dec. at 470-71
Board's Analysis and Conclusions: 27 I&N Dec. at 471
On October 4, 2018, the Board of Immigration Appeals (BIA) published an immigration precedent decision in Matter of Velasquez-Rios, 27 I&N Dec. 470 (BIA 2018) [PDF version]. In the decision, the Board held that the retroactive amendment of a criminal statute reducing the maximum sentence that could be imposed from 365 days (i.e., one year) to 364 days does not affect the determination that the an alien's past conviction, prior to the amendment, was for a crime involving moral turpitude for which a sentence of one year or more could be imposed (covered by section 237(a)(2)(A)(i)(II) of the Immigration and Nationality Act (INA)).
In this article, we will examine the factual and procedural history of Matter of Velasquez-Rios, the Board's analysis and conclusions, and what the decision means going forward.
Please see our relevant sections on site to learn more about criminal aliens [see category] and removal and deportation defense [see category]. To read about other BIA precedent decisions, please see our growing collection of articles [see category].
The respondent, a native and citizen of Mexico, entered the United States without inspection at an unknown time and place.
On July 22, 2003, the respondent was convicted of possession of a forged instrument in violation of section 475(a) of the California Penal Code. The respondent was sentenced to 12 days' incarceration.
At the time of the respondent's conviction and the Immigration Judge's decision, the maximum sentence that could be imposed for a conviction in violation of section 475(a) of the California Penal Code was 365 days of (i.e., one year) imprisonment. You may read the text of the first version of the amendment below:
The Department of Homeland Security (DHS) initiated removal proceedings against the respondent based on his being inadmissible under section 212(a)(6)(A)(i) of the INA for being present in the United States without having been admitted or paroled. The respondent conceded removability, but he sought cancellation of removal under section 240A(b)(1) of the INA. Section 240(b)(1)(C) provides that no alien who has been convicted of an offense under section 237(a)(2) of the INA [see article] is eligible for cancellation of removal under section 240A(b)(1). Although the respondent had only been sentenced to 12 days in prison upon his conviction for possession of a forged instrument in violation of section 475(a) of the California Penal Code, the immigration judge determined that the respondent's conviction was a crime involving moral turpitude for which a sentence of one year or more in prison could be imposed, as described in section 237(a)(2)(A)(i) of the INA. Accordingly, the Immigration Judge found that the respondent was ineligible for cancellation of removal and ordered him removed on December 11, 2014.
Subsequent to the respondent's appealing the Immigration Judge's decision, California amended section 18.5 of the California Penal Code. Under the amendment, the maximum term of imprisonment under section 475(a) and other statutes became 364 days instead of 365. This amendment took effect on January 1, 2015. This amendment was potentially significant with respect to the respondent's conviction because section 237(a)(2)(A)(i) of the INA only addresses crimes involving moral turpitude for which a sentence of one year or more can be imposed.
Notwithstanding the enactment of section 18.5 of the California Penal Code, the Board initially dismissed the respondent's appeal in an unpublished decision. The Board noted that, at the time of the respondent's conviction, the maximum sentence that could be imposed was one year. The section 18.5 amendment did not take effect until well after the respondent's conviction. Furthermore, the Board observed that nothing in the language of section 18.5 suggested that it had retroactive effect.
The respondent filed a petition for review of the BIA's decision with the United States Court of Appeals for the Ninth Circuit. While the petition was pending before the Ninth Circuit, California amended section 18.5 to "apply retroactively" to all convictions, including those that occurred before January 1, 2015. This amendment took effect on January 1, 2017. The Government filed a motion before the Ninth Circuit asking for the case to be remanded to the BIA in order to allow the Board to address the new amendment. The Ninth Circuit granted the motion, returning the case to the Board.
As we discussed, section 240(b)(1)(C) renders ineligible for cancellation of removal an applicant who was convicted of an offense under section 237(a)(2) of the INA. In order for a crime involving moral turpitude to render an alien removable under section 237(a)(2)(A)(i)(I), the conviction must be in violation of a statute for which a sentence of one year or longer could be imposed, regardless of the actual length of the sentence imposed. The Board agreed with the immigration judge that the respondent's forgery offense was clearly a crime involving moral turpitude within the meaning of section 237(a)(2)(A)(i)(I), although it noted in a footnote that the offense qualified for the "petty offense exception," under section 212(a)(2)(A)(ii)(II), from the inadmissibility provision for crimes involving moral turpitude at .
For the following reasons, the Board concluded that, notwithstanding the most recent version of section 18.5 of the California Penal Code, the respondent's conviction was for a crime involving moral turpitude under section 237(a)(2)(A)(i)(I) of the INA.
The Board recognized that section 18.5 retroactively modified the maximum possible sentence for the respondent's conviction under California law. However, the Board held that "it does not affect the immigration consequences of his conviction under section 237(a)(2)(A)(i)(II) of the [INA], a Federal law."
The Board explained that section 237(a)(2)(A)(i)(II), "[b]y its plain terms … is concerned with whether an alien has been convicted of a crime involving moral turpitude for which a sentence of 1 year or longer 'may be imposed.'" The Board explained that this statutory language "calls for a backward-looking inquiry into the maximum possible sentence the alien could have received for his offense at the time of his conviction." The Board concluded that the amendment to section 18.5 of the California Penal Code did not change the fact that the respondent could have been sentenced to 365 days of imprisonment at the time of his conviction, and thus it did not alter the applicability of section 237(a)(2)(A)(i)(II) of the INA to that conviction. The Board noted that its conclusion was consistent with its "long-standing practice of examining the statute of conviction and applicable penalty that existed under the law in effect at the time the conviction was entered," citing to Matter of Esfandiary, 16 I&N Dec. 659, 660 (BIA 1979) [PDF version]; and Matter of A-, 4 I&N Dec. 378, 381 (C.O. 1951).
The Board found support for its conclusion in the decision of the Ninth Circuit in United States v. Diaz, 838 F.3d 968 (9th Cir. 2016) [PDF version], cert. denied sub non. Vasquez v. United States, 137 S.Ct. 840 (2017). Diaz concerned the applicability of 21 U.S.C. 841(b)(1)(A) (2006), a Federal sentence enhancement statute which applies to defendants convicted of a Federal offense following the commission of multiple State drug felonies. In this case, California had retroactively reclassified certain State drug felonies as misdemeanors. On this basis, the petitioner argued that he had not been convicted of two or more State drug felonies and that, without these predicate offenses, 21 U.S.C. 841(b)(1)(A) did not apply. However, the Ninth Circuit rejected this logic, holding that "federal law, not California law," was the pertinent consideration for determining whether the Federal sentence enhancement provision applied. Id. at 972.
The Ninth Circuit explained that the only consideration when weighing the applicability of 21 U.S.C. 841(b)(1)(A) was whether the defendant had been convicted of two or more State felony drug offenses prior to his Federal offense. The Ninth Circuit concluded that the California amendment left unchanged "the historical fact that, for purposes of [section] 841, the defendant had been convicted of a felony in the past." Id. at 973. It added that California's decision to retroactively reclassify certain drug offenses as misdemeanors had "no bearing on whether [section] 841's requirements [were] satisfied." Id. at 972. While it noted that California's decision to give its amendment retroactive effect was relevant in the context of California State law, it held that it did not render the petitioner's felony convictions misdemeanors for the purpose of Federal law.
In Diaz, the Ninth Circuit relied heavily upon the decision of the Supreme Court of the United States in McNeill v. United States, 563 U.S. 816 (2011) [PDF version]. McNeill concerned 18 U.S.C. 924(e)(2)(A)(ii) (2006), another Federal sentence enhancement statute which covered State serious drug offense crimes for which a maximum sentence of ten years or more is prescribed by law. At the time of the petitioner's conviction, the maximum term of imprisonment for his conviction was at least ten years. However, subsequent to his conviction, North Carolina reduced the maximum sentence to less than 10 years. Based on this reduction, the petitioner argued that his conviction no longer qualified as a serious drug offense for purposes of 18 U.S.C. 924(e)(2)(A)(ii). However, a unanimous Supreme Court rejected the petitioner's argument, finding that "the maximum sentence applicable to a defendant's previous drug offense at the time of his conviction for that offense…" controlled. Id. at 820. The Court added that consulting current State law rather than the State law in effect at the time of the conviction would lead to "absurd results…" Id. at 822.
The Board concluded that the logic of the decisions in McNeill and Diaz "applies with equal force to this case." It explained that it "must use Federal law, rather than State law, to determine the immigration consequences of the respondent's California conviction." For this reason, it held that "[s]ection 237(a)(2)(A)(i)(II) … requires a backward-looking inquiry into the maximum possible sentence the respondent could have received for his forgery offense at the time of his conviction."
At the time of the respondent's conviction in 2003, "the maximum possible sentence for the crime was 365 days." Because the Board held that it must look at the maximum possible sentence at the time of the conviction, it concluded that the subsequent enactment of section 18.5 had no effect on the applicability of section 237(a)(2)(A)(i)(II) to the respondent's 2003 forgery offense. For this reason, the Board held that the respondent's forgery conviction remained a crime involving moral turpitude for which a sentence of one year or more could be imposed, and that he was, as a consequence, ineligible for cancellation of removal. Thus, the Board dismissed the respondent's appeal.
The Board's conclusion in Matter of Velasquez-Rios is significant in light of many states changing their criminal laws to minimize the potentially adverse immigration consequences of convictions. In the decision, the Board made clear that the relevant concern when assessing whether a State offense falls under an INA provision is the language of the State statute at the time of conviction. Thus, in the instant case, the pertinent maximum sentence was that which was in effect at the time the sentence was imposed. While California's provision limiting the maximum sentence imposed applies retroactively in the State context, it does not change the immigration consequences of prior convictions.
An alien facing removal proceedings should consult with an experienced immigration attorney immediately. An experienced attorney will be able to assess the facts of the alien's specific case and the most current laws and precedents and assist the alien throughout proceedings.


Shawkenesis grew jealous of the creator's new children and made children of its own, these were not peaceful creatures as are the creator's Ko Tari. Sanktori is what they are called. The Sanktori are pure elemental rage with a physical form. Shawkenesis soon learned the prison that held it, did not stop the Sanktori from entering Arcana, though their power was diminished there. The Sanktori reveled in destruction of life and chief among the Sanktori was Nornarauco, a giant of flame, cunning and ruthless, he seemed to have the greatest capacity for ruin among all the Sanktori.
He closes the book and returns it to the pile. He grabs another, at the bottom of the stack, the rest of them fall, he curses. He flips through the pages until one catches his eye.
The Eldar Elemental God is not known to many, or at least it is not known how to become its follower. Shawkenesis is often referred to in the masculine simply do to its power and destructiveness. His followers are typically wiped out whenever they are found as they are always trying to release him into the world which would destroy every thing. Shawkenesis is bent on the complete freedom of the elemental planes to exist on every plane. His mad plans would have him rule everything. He was locked away long ago in a great war between the pantheon and himself. During this process the four elemental gods (Ur, Nor, Vavia, Earen) were created and set as the guardians of the lock. The Eldar Elemental God is completely chaotic and has no real direction or from, he can appear as nearly anything. His followers slowly go mad trying to please him and though they usually wield incredible power he asks many horrible and difficult tasks of them.
There is a knock at the door and he jumps. A young woman walks in.
My Lord, we will be closing in a few minutes.
He nods and gathers his things.


When Dr. Prus was sidelined with an athletic injury over 20 years ago, he was out of the office almost 11 months. Under normal circumstances the wisdom of the day said being out of the office for one month would have patients running for the exit doors to find another doctor, and that concerned Dr. Prus greatly as his return would take almost a year. It was a great shock and gratifying surprise that he returned to find not a single patient had left the practice. That was the cornerstone experience that has dictated his philosophy of practicing dentistry throughout his career: Do it with Integrity, utilize your Experience for patient benefit and do it with a Personal Touch. Each is a valuable component to his thriving dentist-patient relationship.
The accident also provided an insight into life that does not happen to everyone. He quickly recognized how quickly things can change in life and to value what he has: his life, his good health, great wife and family and wonderful staff and his loyal patients.
Dr. Prus also had the enviable opportunity to have had as one of his patients in Manhattan an individual woman who has been in the forefront of leadership education, from the Girl Scouts of American, the Peter Drucker Foundation and Leader to Leader Institute which has as its mission the goal of providing guidance in the leadership field for non-profit organizations and other institutions and organizations world-wide. Her empirical and steadfast goals of acting in behalf of others have influenced Dr. Prus in every aspect of his life. He brought that attitude into his treatment of his patients. He wants the best for them as he would for himself. If he suggests a treatment it would be the same for himself of a family should they be in the same situation. The patient testimonials attest to that (Testimonials). He believes in going the extra mile for them. In his mind good dentistry is NOT good enough; only excellence is.
Personally he credits the origination of that attitude to his mother and it was further nurtured when he met his wife, Susanne, who, along with her own mother, epitomize the values of honesty, love and effort in the behalf of others. EVERYBODY loves his Susi. They have been married an all too quick 41 years and have two grown sons.
Dr. Prus is a highly active person loving sports both for the fun of it and for the long-life value of it. His mom is a feisty 97 in January, 2016 and the family tree is similarly blessed with many of them 95 or older. He intends to keep up the family legacy. He has been a strong and avid biker for over 40 years and loves skiing, hiking and enjoys multi-day backpacking with his grown sons. Throw a surf wave in front of him and he will probably do that too. In his mind being in nature rejuvenates the soul and keeps you grounded. He expects to be around a long time doing the dentistry he is so dedicated to and lives his life in concert with that feeling.
Dr. Prus is a Georgetown University graduate from both the College and Dental School. He is dedicated to his work and making life better for others. He has written frequently for newspapers and other publications on consumer topics in dentistry, how to be and stay healthy and be a smart consumer of dental services: Southern Dutchess News, Northern Dutchess News, Beacon Free Press, Hudson Valley Magazine (see Ask the Experts online), the New York Times Healthcare insert and others. Follow some of his writings here on this website in the 'In the News' (link). He has lectured nationally and internationally on evolving dental technologies and is constantly on the lookout for emerging technologies that will provide benefits for his patients and are not mere marketing fads.
Dr. Prus has been elected as a Top Dentist in the Hudson Valley since he first arrived in Hopewell Junction. It demonstrates the commitment and dedication he has to his work and his patients' health and well being.


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Obukhovo () is a rural locality (a village) in Staroselskoye Rural Settlement, Vologodsky District, Vologda Oblast, Russia. The population was 1 as of 2002.

Geography
The distance to Vologda is 49 km, to Striznevo is 8 km.

References

Rural localities in Vologodsky District

redpajama_set_name: RedPajamaWikipedia


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redpajama_set_name: RedPajamaCommonCrawl


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PULSE OXIMETER BASED TECHNIQUES FOR CONTROLLING ANESTHESIA LEVELS AND VENTILATION LEVELS IN SUBJECTS
Medical devices and techniques derive breath rate, breath distention, and pulse distention measurements of a subject from a pulse oximeter system coupled to the subject. These parameters together with the conventional physiologic parameters obtained from a pulse oximeter system can be used to assist in controlling the ventilation levels and the anesthesia levels of the subject. The development has human applications and particular application for animal research.
Starr, Eric W. (Allison Park, PA, US)
Hete, Bernard F. (Kittanning, PA, US)
Ayers, Eric J. (Alliquippa, PA, US)
STARR Life Sciences Corp. (Oakmont, PA, US)
128/204.23
A61M16/01
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20070246049 Humidifying Device and Oxygen Concentrating System October, 2007 Takeda et al.
CHOI, JEFFREY
BLYNN L. SHIDELER (WEXFORD, PA, US)
1. A non-invasive pulse oximetry system for controlling anesthesia levels in subjects comprising: A light source adapted to be attached to an external appendage of a subject and configured to emit at least two distinct wavelengths of light directed at the appendage; and A receiver adapted to be attached to the external appendage of a subject and configured to receive the light from the light source that has been directed at the appendage and generating received signals there from, wherein the pulse oximetry system derives a plurality of physiologic parameters of the subject from the received signals, and wherein the system will signal at least one alarm when the physiologic parameters are indicative of improper anesthesia levels in the subject.
2. The non-invasive pulse oximetry system of claim 1 wherein the plurality of physiologic signals include the breath rate and the heart rate of the subject, and wherein at least one alarm associated with anesthesia levels is based upon the ratio of the heart rate and the breath rate.
3. The non-invasive pulse oximetry system of claim 2 wherein the parameter-based alarms associated with anesthesia levels which are based upon the ratio of the heart rate and the breath rate include an alarm when the heart rate per breath rate of the subject exceeds about 7.5 and an alarm when the heart rate per breath rate of the subject is below about 3.5.
4. The non-invasive pulse oximetry system of claim 1 wherein the system calculates arterial pulse distention measurements and arterial breath distention measurements and wherein an alarm is based upon a comparison of the arterial distention measurements.
5. The non-invasive pulse oximetry system of claim 4 wherein the parameter-based alarms associated with anesthesia levels which are based upon the comparison of the arterial distention measurements include an alarm when the breath distention of the subject exceeds the pulse distention of the subject and an alarm when the breath distention of the subject is less than about twenty percent of the pulse distention of the subject.
6. The non-invasive pulse oximetry system of claim 1 wherein the physiologic parameters derived by the system include at least heart rate, blood oxygenation, breath distention measurements and breath rate of the subject and wherein an increase in the breath distention measurement coupled with a decrease in the blood oxygenation and a drop in one or both of the breath rate and the heart rate is considered to be indicative of the subject moving to a higher or deeper anesthesia level.
7. The non-invasive pulse oximetry system of claim 1 wherein the physiologic parameters derived by the system include at least breath and pulse distention measurements and wherein a breath distention measurement that is less than the pulse distention is indicative of proper anesthesia levels.
8. The non-invasive pulse oximetry system of claim 1 wherein the physiologic parameters derived by the system include at least breath and pulse distention measurements and wherein an increase in the breath distention measurement relative to the pulse distention measurement is used as an indicator for possible improper anesthesia levels.
9. A method for controlling anesthesia levels in subjects comprising: Attaching a light source and receiver to an external appendage of a subject; Emitting at least two distinct wavelengths of light directed at the appendage from the light source; Receiving the light from the light source that has been directed at the appendage at the receiver; Generating received signals from the light received at the receiver; Deriving a plurality of physiologic parameters of the subject from the received signals; and Controlling anesthesia levels based upon at least some of the physiologic parameters.
10. The method for controlling anesthesia levels according to claim 9 further including the step of generating at least one alarm when the physiologic parameters are indicative of improper anesthesia levels in the subject.
11. The method for controlling anesthesia levels according to claim 10 wherein the plurality of physiologic signals include the breath rate and the heart rate of the subject, and wherein at least one alarm associated with anesthesia levels is based upon the ratio of the heart rate and the breath rate.
12. The method for controlling anesthesia levels according to claim 10 wherein the system calculates arterial pulse distention measurements and arterial breath distention measurements and wherein an alarm is based upon a comparison of the arterial distention measurements.
13. A non-invasive pulse oximetry system comprising: A light source adapted to be attached to an external appendage of a subject and configured to emit at least two distinct wavelengths of light directed at the appendage; A receiver adapted to be attached to the external appendage of a subject and configured to receive the light from the light source that has been directed at the appendage and generating received signals there from, wherein the pulse oximetry system derives at least a heart rate and a breath rate of the subject from the received signals; and An alarm configured to be signaled when the ratio of heart rate and breath rate is beyond preset thresholds.
14. The non-invasive pulse oximetry system of claim 13 wherein the system calculates arterial pulse and breath distention measurements, and further including an alarm configured to be signaled when a comparison of pulse distention and breath distention is beyond preset thresholds.
15. The non-invasive pulse oximetry system of claim 14 wherein the alarm comparing distention measurements is signaled when the breath distention of the subject exceeds the pulse distention of the subject and when the breath distention of the subject is less than about twenty percent of the pulse distention of the subject.
16. The non-invasive pulse oximetry system of claim 14 wherein the alarm based upon the ratio of the heart rate and the breath rate is signaled when the heart rate per breath rate of the subject exceeds about 7.5 and when the heart rate per breath rate of the subject is below about 3.5.
17. A method of controlling at least one of the anesthesia level or ventilators settings of a subject that is receiving at least one of anesthesia or respiratory support through a ventilator, the method comprising the steps of providing a non-invasive sensor system configured to calculate arterial distention measurements of the subject, and using the measured arterial distention measurements as indicators for at least one of proper and improper levels of anesthesia or proper and improper ventilator control settings.
18. The method according to claim 17 wherein the non-invasive sensor system further calculates breath distention measurements and breath rate of the subject and wherein an increase in the breath distention measurement coupled with a decrease in the blood oxygenation and a drop in one or both of the breath rate and the heart rate is considered to be indicative of the subject moving to a higher or deeper anesthesia level.
19. The method according to claim 17 wherein the non-invasive sensor system further calculates breath and pulse distention measurements and wherein a breath distention measurement that is less than the pulse distention is indicative of proper anesthesia levels and/or proper ventilation settings.
20. The method according to claim 17 wherein the non-invasive sensor system further calculates breath and pulse distention measurements and wherein an increase in the breath distention measurement relative to the pulse distention measurement is used as an indicator for possible improper anesthesia levels and/or ventilation settings.
The present application claims the benefit of provisional patent application Ser. No. 60/826,530 entitled "Medical Devices and Techniques for Deriving Cardiac and Breathing Parameters from Extra-thoracic Blood Flow Measurements and for Controlling Anesthesia Levels and Ventilation Levels in Subjects" filed Sep. 21, 2006.
The present invention relates to pulse oximeter based techniques for controlling the ventilation levels and the anesthesia levels of a subject based upon said measurements, in particular the invention relates to medical devices and techniques for deriving breath rate, breath distention, and pulse distention measurements of a subject from a pulse oximeter system coupled to the subject for controlling the ventilation levels and the anesthesia levels based upon such measurements.
2. Background Information
As background, one type of non-invasive physiologic sensor is a pulse monitor, also called a photoplethysmograph, which typically incorporates an incandescent lamp or light emitting diode (LED) to trans-illuminate an area of the subject, e.g. an appendage, which contains a sufficient amount of blood. FIG. 1 schematically illustrates the photoplethysmographic phenomenon. The light from the light source 10 disperses throughout the appendage, which is broken down in FIG. 1 into non-arterial blood components 12, non-pulsatile arterial blood 14 and pulsatile blood 16, and a light detector 18, such as a photodiode, is placed on the opposite side of the appendage to record the received light. Due to the absorption of light by the appendage's tissues and blood 12, 14 and 16, the intensity of light received by the photodiode 18 is less than the intensity of light transmitted by the LED 10. Of the light that is received, only a small portion (that effected by pulsatile arterial blood 16), usually only about two percent of the light received, behaves in a pulsatile fashion. The beating heart of the subject, and the breathing of the subject as discussed below, creates this pulsatile behavior. The "pulsatile portion light" is the signal of interest and is shown at 20, and effectively forms the photoplethysmograph. The absorption described above can be conceptualized as AC and DC components. The arterial vessels change in size with the beating of the heart and the breathing of the patient. The change in arterial vessel size causes the path length of light to change from dmin to dmax. This change in path length produces the AC signal 20 on the photo-detector, IL to IH. The AC Signal 20 is, therefore, also known as the photo-plethysmograph.
The absorption of certain wavelengths of light is also related to oxygen saturation levels of the hemoglobin in the blood transfusing the illuminated tissue. In a similar manner to the pulse monitoring, the variation in the light absorption caused by the change in oxygen saturation of the blood allows for the sensors to provide a direct measurement of arterial oxygen saturation, and when used in this context the devices are known as oximeters. The use of such sensors for both pulse monitoring and oxygenation monitoring is known and in such typical uses the devices are often referred to as pulse oximeters. These devices are well known for use in humans and large mammals and are described in U.S. Pat. Nos. 4,621,643; 4,700,708 and 4,830,014 which are incorporated herein by reference.
Current commercial pulse oximeters do not have the capability to measure breath rate or other breathing-related parameters other than blood oxygenation. An indirect (i.e. not positioned within the airway or airstream of the subject), non-invasive method for measuring breath rate is with impedance belts.
It is well established that it is critical to properly control anesthesia levels of a patient, or subject. In dealing with non-human subjects in animal research applications, having specialized anesthesiologists or specialized equipment is simply not an option for researchers. The use of breath-related parameters and heart-related parameters from easily applied non-invasive sensors to automate or assist in the control of proper anesthesia levels of a subject would be of great assistance. In a similar manner, simple, easy feedback for proper ventilation control from non-invasive, easily applied sensors in animal research applications would be very beneficial. Obviously, such advances would not be limited to animal research as non-invasive physiologic measurements can be very useful for human applications as well.
It is an object of the present invention to minimize the drawbacks of the existing systems and to provide medical devices and techniques for deriving cardiac and breathing parameters of a subject from extra-thoracic blood flow measurements and for controlling the ventilation levels and the anesthesia levels of a subject based upon said measurements.
It is noted that, as used in this specification and the appended claims, the singular forms "a," "an," and "the" include plural referents unless expressly and unequivocally limited to one referent. For the purposes of this specification, unless otherwise indicated, all numbers expressing any parameters used in the specification and claims are to be understood as being modified in all instances by the term "about." All numerical ranges herein include all numerical values and ranges of all numerical values within the recited numerical ranges.
The various embodiments and examples of the present invention as presented herein are understood to be illustrative of the present invention and not restrictive thereof and are non-limiting with respect to the scope of the invention.
At least some of the above stated objects are achieved with a method of utilizing a conventional pulse oximeter signal to derive breath rate. As understood by those of ordinary skill in the art a pulse oximeter is applied to the subject with a simple externally applied clip. Thus, in addition to getting oxygen saturation and heart rate from a pulse oximeter, the pulse oximeter according to the present invention can derive breath rate.
A measurement of breath rate from a pulse oximeter was first made commercially available in December 2005 by the assignee of the present application, Starr Life Sciences and is provided in the MouseOX™ device that was particularly designed for use with small mammals, namely rats and mice. In this device, the breath rate is obtained by screening out the frequency band around the heart rate point on the Fast Fourier Transform (known as FFT) that is used to identify the heart rate. The next largest amplitude to the left (or lower frequency) of the heart rate rejection band on the FFT was considered to be the breath rate. The value is then simply averaged then displayed on the screen to the user. Although useful there is room to greatly improve this calculation methodology to assure consistent accurate results.
The currently preferred breath rate algorithm works, in a general sense, by selectively filtering the heart rate from the light signal, then reconstructing the breath signal in the absence of the heart rate.
In addition to calculating a numerical breath rate using only pulse oximeter inputs, the present invention also provides a display of the breath rate signal, which is presented as the Breath Pleth (short for plethysmograph). The signal is derived from the inverse FFT of the calculations described above. It is preferred if the Breath Pleth signal is illustrated congruently with the heart signal. The reason for displaying the signals congruently is to avoid confusion over which signal represents breathing, and to illustrate the underlying breathing waveform in conjunction with the heart signal. The utility of this plot is to provide a visual sense of the relative breath rate as compared with heart rate, and to allow the user to see that the heart rate and breathing signals are superimposed on the raw infrared light signal. One can also deduce a relative magnitude between the signal strength due to the heart pulse, and that due to breathing.
In addition to the breath rate calculation from the pulse oximeter measurements, the present system provides additional breath and heart-related parameters other than the conventional heart rate and blood oxygenation. Namely the present system can calculate and display arterial distention measurements. The distention measurements are calculated using Beer's Law mathematics, in conjunction with the current calculation of oxygen saturation. There are two types of distention. The first, called pulse distention, is a measurement of the arterial distention which results from the blood pulse to the periphery due to cardiac pumping. The second, called breath distention, is a measurement of the arterial distention which results from the pulse of blood to the periphery due to breathing effort and its effect on thoracic arterial vasculature.
As will be described below, these measurements can be particularly useful to assist in control of anesthesia levels and ventilation controls. The user can employ the measured distention to assess the strength and quality of signals for making all sensor measurements. Further, the distention measurements, such as pulse distention, can be used to assess changes in peripheral blood flow either by changes in cardiac output or by changes in vaso-active response. The breath distention measurements may be used to assess intrapleural or intrathoracic pressure. The breath distention measurements may be used to assess work of breathing of the subject. The distention measurements may have many other clinical and research applications.
A measurement of pulse distention from a pulse oximeter was first made commercially available in December 2005 by the assignee of the present application, Starr Life Sciences and provided in the MouseOX™ device that was particularly designed for use with small mammals, namely rats and mice. Breath distention measurements from pulse oximetry systems have not been previously commercially available.
Preferably the measured pulse and breath distention measurements are displayed together on the same plot to the user. The utility of showing them together is that pulse distention can be used as a sort of baseline. The relative level of breath distention can then be used as an indicator of work of breathing. Since both are derived from changes in peripheral blood flow due to their respective mechanisms, if they both have the same magnitude, then both are affecting the peripheral blood flow by the same amount. In the general case, one would expect the blood pulse to provide a greater peripheral blood flow than would breathing effort. However, if breath distention is greater than pulse distention, the subject is likely laboring hard to breathe, a condition that often results form too much anesthesia.
The applicants have found that an increase in the breath distention measurement coupled with a decrease in the blood oxygenation and a drop in one or both of the breath rate and the heart rate is indicative of the subject moving to a higher or deeper anesthesia level. The technician can observe such trends and compensate accordingly. Additionally, appropriate thresholds can be incorporated into the system to provide alarms and/or automated anesthesia controls to automate the process. These parameters are also indicative of the subject moving to an undesired lower anesthesia level and the present system provides this information to the user as well. Alarms and/or automated anesthesia controls can be incorporated in response to detected significant movements in the anesthesia levels.
The applicants have found that "gasping" of the subject can be detected and is also typically indicative of a too high or deep of a level of anesthesia, and this can be used to control the anesthesia levels by giving appropriate feedback to the user. Further, applicants have found that, at least in mice, a breath distention measurement that is roughly equal to or less than the pulse distention is indicative of proper anesthesia levels and proper ventilation settings. An increase in the breath distention measurement relative to the pulse distention measurement can be used as an indicator for possible improper ventilation settings. Note that it is not necessary to compare pulse and breath distention measurements simultaneously to draw such conclusions, but viewing them together can show that the effect is only on one or the other distention measurement, and not both. The relative ratio between the breath distention and the pulse distention measurements and the blood oxygenation measurement can be used to indicate proper ventilator setting with thresholds being set to automate the system (i.e. measurements beyond the set thresholds will activate "alarms" and/or automate adjustments to the ventilator).
In one non-limiting embodiment of the present invention a non-invasive pulse oximetry system is utilized for controlling anesthesia levels in subjects; wherein a light source is adapted to be attached to an external appendage of a subject and configured to emit at least two distinct wavelengths of light directed at the appendage, and wherein a receiver is adapted to be attached to the external appendage of a subject and configured to receive the light from the light source that has been directed at the appendage and generating received signals there from, and wherein the pulse oximetry system derives a plurality of physiologic parameters of the subject from the received signals, and wherein the system will signal at least one alarm when the physiologic parameters are indicative of improper anesthesia levels in the subject.
The plurality of physiologic signals may include the breath rate and the heart rate of the subject, and wherein at least one alarm associated with anesthesia levels is based upon the ratio of the heart rate and the breath rate. The parameter-based alarms associated with anesthesia levels which are based upon the ratio of the heart rate and the breath rate may include an alarm when the heart rate per breath rate of the subject exceeds about 7.5 and an alarm when the heart rate per breath rate of the subject is below about 3.5. The system may calculate arterial pulse distention measurements and arterial breath distention measurements and have an alarm that is based upon a comparison of the arterial distention measurements.
The parameter-based alarms associated with anesthesia levels which are based upon the comparison of the arterial distention measurements may include an alarm when the breath distention of the subject exceeds the pulse distention of the subject and an alarm when the breath distention of the subject is less than about twenty percent of the pulse distention of the subject. The physiologic parameters derived by the system may include at least heart rate, blood oxygenation, breath distention measurements and breath rate of the subject and wherein an increase in the breath distention measurement coupled with a decrease in the blood oxygenation and a drop in one or both of the breath rate and the heart rate is considered to be indicative of the subject moving to a higher or deeper anesthesia level.
The physiologic parameters derived by the system may include at least breath and pulse distention measurements and wherein a breath distention measurement that is less than the pulse distention is indicative of proper anesthesia levels. The physiologic parameters derived by the system include at least breath and pulse distention measurements and wherein an increase in the breath distention measurement relative to the pulse distention measurement is used as an indicator for possible improper anesthesia levels.
One non-limiting embodiment of the present invention may provide a method for controlling anesthesia levels in subjects comprising the steps of attaching a light source and receiver to an external appendage of a subject; emitting at least two distinct wavelengths of light directed at the appendage from the light source; receiving the light from the light source that has been directed at the appendage at the receiver; generating received signals from the light received at the receiver; deriving a plurality of physiologic parameters of the subject from the received signals; and controlling anesthesia levels based upon at least some of the physiologic parameters. The method may further include the step of generating at least one alarm when the physiologic parameters are indicative of improper anesthesia levels in the subject.
One non-limiting embodiment of the invention provides a non-invasive pulse oximetry system comprising a light source adapted to be attached to an external appendage of a subject and configured to emit at least two distinct wavelengths of light directed at the appendage; a receiver adapted to be attached to the external appendage of a subject and configured to receive the light from the light source that has been directed at the appendage and generating received signals there from, wherein the pulse oximetry system derives at least a heart rate and a breath rate of the subject from the received signals; and an alarm configured to be signaled when the ratio of heart rate and breath rate is beyond preset thresholds.
One non-limiting embodiment of the present invention provides a method of controlling at least one of the anesthesia level or ventilators settings of a subject that is receiving at least one of anesthesia or respiratory support through a ventilator, the method comprising the steps of providing a non-invasive sensor system configured to calculate arterial distention measurements of the subject, and using the measured arterial distention measurements as indicators for at least one of proper and improper levels of anesthesia or proper and improper ventilator control settings.
These and other advantages of the present invention will be clarified in the brief description of the preferred embodiment taken together with the drawings in which like reference numerals represent like elements throughout.
FIG. 1 schematically illustrates the photoplethysmographic phenomenon as generally known in the art;
FIG. 2 is a schematic view of a pulse oximeter system according to one aspect of the present invention in which the pulse oximetry system is designed for small mammals such as mice and rats;
FIGS. 3-4 are perspective views of the pulse oximeter of FIG. 2 coupled to a subject, namely a mouse;
FIG. 5 is a graph of a representative signal of the raw-time domain signal from the pulse oximeter of FIGS. 2-4;
FIG. 6 is a graph of an FFT of the signal of FIG. 5;
FIG. 7 is a graph of the FFT of FIG. 6 with the heart components thereof filtered out in accordance with the present invention;
FIG. 8 is a graph of the FFT of FIG. 7 with the breath component filter applied in accordance with one aspect of the present invention;
FIG. 9 is a graph of a calculated breath signal from the FFT of FIG. 8;
FIG. 10 is a representative sample of a combined display of the calculated breath signal and combined heart signal from the system according to the present invention;
FIG. 11 is a representative example of a display of the pulse distention measurements and breath distention measurement in accordance with the system of the present invention;
FIG. 12-14 are representative screen shots of the displayed parameters for properly anesthetized, under anesthetized and over anesthetized subjects, respectively.
FIG. 15 is a representative sample of a combined display of the calculated breath signal and combined heart signal from the system according to the present invention illustrating a gasping subject;
FIG. 16 is the raw-time domain signal from the pulse oximeter of FIGS. 2-4, associated with the gasping subject of FIG. 15;
FIG. 17 is raw-time domain signal from the pulse oximeter of FIGS. 2-4, associated with normal response for comparison with the gasping subject of FIG. 16.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
FIGS. 2-4 illustrate a pulse oximeter system 100 according to one aspect of the present invention in which the pulse oximetry system 100 is designed for subjects 110, namely small mammals such as mice and rats. The system 100 includes a conventional light source 120, conventionally a pair of LED light sources one being infrared and the other being red. The system 100 includes a conventional receiver 130, typically a photo-diode. The light source 120 and receiver 130 are adapted to be attached to an external appendage of a subject 110, and may be secured to a spring-biased clip 140 or other coupling device such as tape adhesives or the like. FIGS. 2-4 illustrate a specialized clip from Starr Life Sciences that is configured to securely attach to the tail of a subject 110, but any conventional clip could be used. The system 100 is also coupled to a controller and display unit 150, which can be a lap top computer. The use of a lap top computer as opposed to a dedicated controller and display system 150 has advantages in the research environment.
The system 100 will calculate the heart rate and blood oxygenation for the subject 110 as generally known in the art of photoplethysmograghy, and does not form the basis of the present invention. Where the subject 110 is a rodent, such as a mouse or rat, care must be taken to obtain accurate heart rate and oxygenation readings with conventional pulse oximeters due to the physiology of the subjects. Starr Life Sciences have developed pulse oximeters that accommodate rodents under the MouseOx™ brand name. For the purpose of this application the calculation of the pulse rate, pulse signal, and blood oxygenation will be considered as conventional.
A first measurement of breath rate from a pulse oximeter was first made commercially available in December 2005 by the assignee of the present application, Star Life Science and provided in the MouseOx™ device that was particularly designed for use with small mammals, namely rats and mice. In this first method, an FFT, represented in FIG. 6, is created for a received signal from the infrared LED in the time-domain, represented in FIG. 5. The breath rate is obtained by screening out the frequency band around the heart rate point on the FFT, represented in FIG. 6, which is used to identify the heart rate. The heart rate is effectively the largest peak shown in the FFT. The peak to the right of the FFT represents a first harmonic of the heart rate. The peak to the left of the heart rate on the FFT represents the measured breath rate.
The frequency band around the heart rate peak is preferably proportional (through a linear function or other relationship) to the heart rate itself, whereby the band will become larger for larger heart rates. This expanding filter band will accommodate the spreading of the illustrated peak that is expected at the higher measured heart rates. The filtering of the band is required to be sure that the peak measuring algorithm does not merely select the cut-off point of the heart rate peak as a calculated, but erroneous, breath rate. The next largest amplitude to the left (or lower frequency) of the heart rate rejection band on the FFT is considered to be the breath rate in this original methodology. The breath rate value is then simply averaged then displayed on the screen to the user. Although useful there is room to greatly improve this breath rate calculation methodology to assure consistent accurate results.
A preferred breath rate algorithm works, in a general sense, by selectively filtering the heart rate from the infrared light signal, then reconstructing the breath signal in the absence of the heart rate.
Specifically, the algorithm for obtaining a breath signal is as follows: Similar to the first method, an FFT, represented in FIG. 6, is created for a received signal from the infrared LED in the time-domain, represented in FIG. 5. In FIG. 6, the large spike is the heart rate, the small spike to the right is a harmonic of the heart rate, and the small spike to the left is the breathing signal. Consequently, the frequency located at the highest amplitude point in the FFT is considered to represent the heart rate. Because data used in the FFT occur over a span of time, the heart rate can naturally drift during this period, causing the frequency content at the peak amplitude point on the FFT to be spread over a few surrounding frequency bins.
The preferred breathing rate calculation method is to first remove all heart rate-derived frequency content from the FFT signal, called heart components of the signal. The algorithm chooses a lower threshold to the lower end of the peak heart rate frequency that defines the point above which all content will be removed. This can be done by digital filtering, but also by simply zeroing all frequency bins to the right of the lower threshold cutoff of the heart rate spike all the way to the end of the FFT. The lower threshold is chosen by an algorithm that is based on the mean value of the heart rate. The lower threshold is farther from the heart rate (i.e., the heart rate band of the FFT is larger) at high heart rates, and closer to the heart rate peak at low heart rates. It is desired to have the heart rate band to be as narrow as possible, in order to retain the largest possible breathing frequency spectrum. FIG. 7 illustrates a sample of the heart components removed from the FFT in the breathing rate calculation method of the present invention.
A peak detection algorithm is then used to identify the largest peak remaining in the FFT. The largest remaining peak is believed to be indicative of the breathing rate, however the preferred method performs a "breathing component filtering" on this remaining data.
This filtering application operates as follows: the initial breathing peak is compared with the rest of the remaining bandwidth. If the chosen breathing peak is "significantly stronger" than the others, then the breathing filtering is effectively a zeroing of all frequency bins a minimum number of bins to the right of this peak. The minimum number of bins has been found to be 0-3 and most preferably 2. This result is shown in FIG. 8. Significantly stronger means that the value of the "breathing peak" is greater than a predetermined factor of ALL of the other values with the heart components removed. 1.5 has been used effectively as the predetermined factor for calculating the relative strength of the breathing peak. If the chosen peak is only "moderately stronger" than the remaining peaks, then the next highest peak to the left of the strongest breathing peak is selected, and then all points on the FFT a minimum number to the right of this new peak are zeroed out resulting, effectively, in a graph as shown in FIG. 8 (except the Breathing filter has "pushed" the remaining breathing signal components to the lower frequencies). "Moderately stronger" means that less than a critical number, such as ½, of all the remaining points (but at least some of the remaining points) fail to satisfy the significantly stronger requirement discussed above. Finally, if the original chosen breathing peak is only "weakly stronger" than the remaining peaks, then the breathing component filter will identify the next two highest peaks to the left of the strongest peak, choose the one further to the left, then zero all points a minimum number of bins to the right of this new peak. Weakly stronger will mean that more than a critical number, such as ½, of all the remaining points fail to satisfy the significantly stronger requirement discussed above.
The next step in the process is to conduct an inverse FFT on the remaining frequency content as shown in FIG. 8. The breathing frequency is then contained in this time-domain signal, as represented in FIG. 9. A peak and valley detection algorithm, graphically shown in FIG. 9, is then used to find the breath rate. This breathing rate value is calculated from a number of separate, serial FFT-inverse FFT pairs, and is displayed on the screen to the user.
In addition to calculating a numerical breath rate, the present invention also provides a display of the breath rate signal, which is called the Breath Pleth (short for plethysmograph). The signal is derived from the inverse FFT calculations described above. An example of the Breath Pleth screen is given in FIG. 10. In this picture, there are two plots. The underlying wave-shape represents the breathing waveform or signal. As it is depicted here, the actual plot of the breathing signal would be the envelope of that wave shape. The reason for displaying it in this manner is to avoid confusion over which signal represents breathing, and to illustrate the underlying breathing waveform in conjunction with the combined heart signal. This heart signal is presented in the other line waveform (at a significantly higher frequency). This signal contains not only the heart rate, but all frequency content in the received infrared light signal, and thus is referred to in this application as the combined heart signal and also the raw signal. The utility of this combined plot is to provide a visual sense of the relative breath rate as compared with heart rate, and to allow the user to see that the heart rate and breathing signals are superimposed on the raw infrared light signal. One can also deduce a relative magnitude between the signal strength due to the heart pulse, and that due to breathing.
In addition to the breath rate calculation from the pulse oximeter measurements, the present system 100 provides additional breath and heart-related parameters other than the conventional heart rate and blood oxygenation. Namely the present system can calculate and display arterial distention measurements. Distention measurements are calculated using Beer's Law mathematics, in conjunction with the current calculation of oxygen saturation. There are two types of distention. The first, called pulse distention, results from the blood pulse to the periphery due to cardiac pumping. The second, called breath distention, results from the pulse of blood to the periphery due to breathing effort and its effect on thoracic arterial vasculature.
To describe the physical meaning of a distention, one must first consider the column of light that passes between the LED and photodetector located on either side of the sensor clip. This light is absorbed by all intervening tissue, but we are interested only in arterial blood. Restricting received light information to arterial blood is done by looking for a change in light signal strength at either heart or breathing frequencies. This change literally corresponds to a change in local blood flow between the sensor heads that occurs as a result of either a cardiac output pulse, or a breath effort effect on the thoracic vasculature.
Next consider a cylindrical volume of arterial blood, where the cross-sectional area of the cylinder is defined by the lateral dimensions of the light column, while the height is defined by the quantity of arterial blood in the direction of the light path within that lateral area. Distention is then simply the change in height of the cylinder between the peak and valley of the attendant change mechanism (heart pulse or breath effort). In other words, if looking at pulse distention, which is derived from the cardiac pulse, the distention is due to the height of the blood flow change between systole and diastole. Likewise, the breath distention is the change in height derived from the endpoints of the breathing effort from inhale to exhale. Both distention measurements are given in linear dimensional units (e.g. μm). Current commercial pulse oximeters, other than the current MouseOX™ product of Starr Life Sciences, do not provide the user the capability to measure either of these distention values, and there is no known alternative method for making either of these measurements.
Pulse distention can be used by the operator to assess the strength and quality of signals for making all sensor measurements to evaluate the operation of the system. Further, it can be used to assess changes in peripheral blood flow either by changes in cardiac output or by changes in vaso-active response. Pulse distention is calculated from Beer's Law. It uses the light strength measured at systole and diastole in its calculation. The algorithm is as follows: (a) All signal filtering, both analog and digital is removed from the received raw infrared light signal; (b) The peaks and valleys of the received infrared light signal are detected; (c) For every peak and valley pair, the ratio of the peak and valley magnitude is used in the Beer's Law formulation to obtain pulse distention; and a few pulse distention values are averaged, then displayed both numerically and graphically.
Breath distention is a new parameter for researchers to utilize. The utility of breath distention includes that it can be used to assess intrapleural or intrathoracic pressure, and that it may be used to assess work of breathing. Further, it may be used to assess the level of anesthesia. Breath distention is also calculated from Beer's Law. The breath distention is calculated from the inverse FFT signal as described above. A simple algorithm of its derivation is given as follows: (a) From the description of the breath rate calculation algorithm given above, we start with the FFT signal from which the heart rate is removed only (FIG. 7), before additional frequency content clipping occurs with the breathing component filtering. Starting with this FFT, all original signal filtering, both analog and digital is removed by compensating the FFT amplitudes at each frequency bin, based on original filtering; (b) Once the filtering has been compensated, an inverse FFT is conducted; (c) The peaks and valleys of the inverse FFT time-domain breathing signal are identified; (d) All of the valid peaks are averaged, then all of the valid valleys are averaged; (e) From the average peak and valley pair for each FFT dataset, the Beer's Law calculation is used to find the breath distention; and (f) A few breath distention values are averaged, then displayed both numerically and graphically.
Pulse and breath distention will be displayed together on the same plot in the Monitor Subject screen such as the display of the lap top 150, which is shown in FIG. 11. The utility of showing the distention measurements together is that pulse distention can be used as a sort of baseline. The relative level of breath distention can then be used as an indicator of work of breathing. Since both are derived from changes in peripheral blood flow due to their respective mechanisms, if they both have the same magnitude, then both are affecting the peripheral blood flow by the same amount. In the general case, one would expect the blood pulse to provide a greater peripheral blood flow than would breathing effort. However, if breath distention is greater than pulse distention, the animal is likely laboring hard to breathe, a condition that often results form too much anesthesia.
The present system 10 effectively provides a method of controlling the anesthesia level and/or ventilator settings of a subject that is receiving anesthesia and/or respiratory support through a ventilator. The method comprises the steps of providing the non-invasive sensor system 100 configured to calculate arterial pulse distention measurements of the subject, and using the measured arterial pulse distention measurements as indicators for at least one of proper and improper levels of anesthesia or proper and improper ventilator control settings. This method may be clarified in a review of FIGS. 12-17.
The applicants have found that an increase in the breath distention measurement coupled with a decrease in the blood oxygenation and a drop in one or both of the breath rate and the heart rate is indicative of the subject moving to a higher or deeper anesthesia level. The technician can observe such trends and compensate accordingly. Additionally, appropriate thresholds can be incorporated into the system to provide alarms and/or automated anesthesia controls to automate the process. The alarms may be visual or audible or both as is generally known in the art. These parameters are also indicative of the subject moving to an undesired lower anesthesia level and the present system provides this information to the user as well. Alarms and/or automated anesthesia controls can be incorporated in response to detected significant movements in the anesthesia levels.
FIG. 12 is a screen clipping of the display of the system 100 for a subject, specifically a mouse, that is properly anesthetized. The pulse and breath distention are basically the same, the breath rate is stable and in the proper range. FIG. 13 is a screen clipping of a subject, again a mouse, that is too lightly anesthetized. This mouse is getting ready to wake up. The breath rate is increasing and the breath distention is much less than the pulse distention. FIG. 14 shows a screen clipping of a subject, again a mouse, that is too heavily anesthetized. This mouse is gasping and breathing at a very slow rate. This screen shot represents an extreme case and the breathing is very difficult to calculate because it is so slow. This results in that the breath distention is not updating often. However, when breath distention is able to update, as shown it is much higher than pulse distention providing important feedback to the operator.
The applicants have found that "gasping" of the subject can be detected and is also typically indicative of a too high or deep of a level of anesthesia, and this can be used to control the anesthesia levels by giving appropriate feedback to the user. Further, the applicants have found that, at least in mice, a breath distention measurement that is roughly equal to or less than the pulse distention is indicative of proper anesthesia levels and proper ventilation settings. An increase in the breath distention measurement relative to the pulse distention measurement can be used as an indicator for possible improper ventilation settings. The relative ratio between the breath distention and the pulse distention measurements and the blood oxygenation measurement can be used to indicate proper ventilator setting with thresholds being set to automate the system (i.e. measurements beyond the set thresholds will activate "alarms" and/or automate adjustments to the ventilator). For example, consider FIGS. 15 and 16, which illustrate the graphical displays indicative of a deeply anesthetized subject, again a mouse. The screen clipping of the breath pleth window display of FIG. 15 shows a subject mouse that is too heavily anesthetized. This mouse is gasping and breathing at a very slow rate. The user can see in this window is that the mouse is gasping by the effect on the pulse signal. The pulse signal displayed here actually contains both of the distentions. The pulse distention is low for most of these heart beats then it will calculate high for this gasping beat. The breath distention will be high because it only looks at the effects caused by breathing. These parameters can be effectively used as guidance for both anesthesia levels and ventilation control.
For parameter based alarms associated with anesthesia levels which are based upon the ratio of the heart rate and the breath rate, an alarm may be signaled when the heart rate per breath rate of the subject exceeds about 7.5 which is indicative of the anesthesia level being too high. An alarm may be signaled when the heart rate per breath rate of the subject is below about 3.5 which is indicative of the anesthesia level being too low. For parameter based alarms associated with anesthesia levels which are based upon based upon a comparison of the arterial distention measurements, an alarm may be signaled when the breath distention of the subject exceeds the pulse distention of the subject which is indicative the anesthesia level being too high. An alarm may be signaled when the breath distention of the subject is less than about twenty percent of the pulse distention of the subject the anesthesia level being too low.
The present system 100 is not intended to be restrictive of the invention. For example, all of these parameters can be measured using a partially-deflated blood pressure cuff, impedance belts or an arterial line. Further, the filtering is described above using inverse FFTs, but it can be done also with traditional digital and analog filtering methods. Additionally, reflective oximetry sensors, implanted sensors, clip-less sensor, etc could be used. Only a light source (e.g., LED) and receiver (e.g., photodiode) are required.
Although the present invention has been described with particularity herein, the scope of the present invention is not limited to the specific embodiment disclosed. It will be apparent to those of ordinary skill in the art that various modifications may be made to the present invention without departing from the spirit and scope thereof. The scope of the present invention is defined in the appended claims and equivalents thereto.
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Gina Cortese was a 20-year-old college student majoring in education at Kent State University when she first felt a numbness in her left toe.
When initial blood work did not reveal anything serious, Gina brushed it off and went back to her life. However, the numbness rapidly began to progress, travelling up her leg and into her arm. When her leg gave out during class one day, she knew something was very wrong. That was January 25, 2012, the day when an MRI revealed Gina had a mass in her brain.
The mass turned out to be a brain tumor. Gina was diagnosed with a rare and aggressive form of cancer called giant cell glioblastoma.
Gina immediately underwent brain surgery, and when she awoke, her left side was paralyzed. She had to relearn how to do many things, including walking, talking and writing.
After her surgery, Gina underwent intense radiation and chemotherapy and was eventually declared cancer-free. But eight months later, another MRI revealed that the cancer was back, and she had to go through it all over again. After several more rounds of treatment, Gina beat cancer again and remains cancer-free today.
Although Gina had to drop out of college during her cancer treatment, she was at long last able to graduate in December 2015, although her experience inspired her to choose a different career path. She now hopes to dedicate her life to helping other cancer patients.
Gina has started a charity called Gina's Journey, which collects hats for cancer patients. After she lost her hair due to radiation, Gina struggled to find attractive and affordable hats, and she wanted to make that burden easier for other cancer patients. Gina's Journey collects the hats through a series of donation boxes located throughout Northeast Ohio. The hats are then professionally cleaned and distributed to children and adult patients at UH Seidman Cancer Center and UH Rainbow Babies & Children's Hospital.
You can learn more about Gina's charity and how you can donate at GinasJourney.org.


text:
Q: ComboBox из XML-файла. Есть Xml-файл с таким содержимым:
<Student Id="0">
<FirstName>Robert</FirstName>
<Last>Jarman</Last>
<Age>21</Age>
<Gender>0</Gender>

<Student Id="1">
<FirstName>Leona</FirstName>
<Last>Menders</Last>
<Age>20</Age>
<Gender>1</Gender>

И так еще много студентов
Задачей является вывести все значения в ComboBox, или любые подходящие поля.
Прочитать смог таким образом: XDocument doc = XDocument.Load(path);
А как их впихнуть в разные поля Combobox?
Спасибо =)

A: Хоть я в XML и не спец, но давайте попробуем так:

*

*Загрузим наш файл в строку: var xmlStr = File.ReadAllText("temp.xml");.

*Загрузим в XElement нашу строку: var str = XElement.Parse(xmlStr);

*Хм, а что же дальше? А дальше давайте создадим небольшой список, который будет в себе иметь всех студентов: var students = str.Elements("Student");

*Отлично, есть студенты, в удобном списке. Давайте пройдемся по ним, хм, циклом, но перед этим создадим необходимый элемент, в который мы будем добавлять наших студентиков, пусть будет ComboBox. В Xaml: <ComboBox x:Name="ComboBox1" />

*Отлично, теперь дело цикла!:

foreach (var student in students)
{
    var id = student.FirstAttribute.Value;
    var FirstName = student.Element("FirstName")?.Value;
    var Last = student.Element("Last")?.Value;
    var Age = student.Element("Age")?.Value;
    var Gender = student.Element("Gender")?.Value == "0" ? "Дядя" : "Тетя";
    ComboBox1.Items.Add($"[{id}] {FirstName} {Last} это {Gender} и за плечами {Age} г. ");
}

p.s. Не форматировался код без цитаты, если кто сможет, уберите ее.

Что мы тут видим? Хм, а нечего сверх сложного, просто у каждого объекта, который найдется для нашего цикла, мы отберем необходимые нам параметры, дальше мы их попросту добавим в наш ComboBox1.

A: Вы делаете как-то слишком вручную. Выучите MVVM на досуге!
Имея класс Student из этого вопроса, проблема решается совсем просто.
<ComboBox ItemsSource="{Binding Students}">
    <ComboBox.ItemTemplate>
        <DataTemplate DataType="{x:Type local:Student}">
            <TextBlock>
                <Run Text="{Binding FirstName, Mode=OneWay}"/>
                <Run Text="{Binding Last, Mode=OneWay}"/>
                <!-- и так далее -->
            </TextBlock>
        </DataTemplate>
    </ComboBox.ItemTemplate>
</ComboBox>

redpajama_set_name: RedPajamaStackExchange


Mangoes are made from cucumbers, melons, peppers, tomatoes and peaches.
half grown melons and large green cucumbers, tomatoes, or peppers.
sweetened with a pound or more of sugar to the gallon to suit the taste.
If they are not keeping properly pour over again fresh hot vinegar.
packthread; put them in jars, and pour over boiling spiced vinegar.
Large cucumbers may be pickled in the same way.
plenty of vinegar. All pickles are spoiled, if not well covered.
several hours to swell out.
must pour off the liquor and boil it up as at first.
turn out green enough, the vinegar must be boiled again.


text:
class Beer:
	def __init__(self, abv=None, ibu=None, name=None, desc=None):
		self.abv=self.sanitize(abv)
		self.ibu=self.sanitize(ibu)
		self.name=self.sanitize(name)
		self.desc=self.sanitize(desc)

	def sanitize(self, value):
		return value.encode('ascii','ignore').strip()

redpajama_set_name: RedPajamaGithub


Notes: Finally! The last time I started a chapter in this project was almost two years ago!
Extra notes: Kye and I saw, for the second time, Fantastic Beasts: The Crimes of Grindelwald. We tried going last Friday, but the show had sold out. We were hoping it would still be at Brookings' only theatre--a very lovely venue--and it was.
The movie doesn't focus on just one grotesque evil, which most do. No, we have the villain, Grindelwald, but we also have the fascists working at the various Ministries of Magic, ever eager to oppress and suppress the citizenry ostensibly in the face of the threat he represents. Which one is ultimately worse remains in doubt, just as it did in the original Harry Potter series.
I've said it many times before, and I'll say it again: great evil is always corporate. It requires many people to make evil great (as in overwhelming or large, not good), be it Ministries of Magic or Death Eaters or Maniacal Pure Bloods or the willful looking away of the populace to the atrocities the participants are willing to commit for whatever reason they're willing to commit them. In my fifteen-minutes-later imagination, Dolores Umbridge is serving multiple life sentences in Azkaban, as is every Death Eater not killed in action who fought alongside Voldemort.
I have decided that I'm going to get two tattoos in the next year, both of them aecxes from Melody and the Pier to Forever. If you knew me, you'd know what a big deal that is.
I wear a pendant and I have a gold hoop in my left ear, one that I got way back in 1999. I've never liked "body art," mostly because it too is almost always corporate--a rose or a raven or "Momma" or an anchor or tiger or ... you get the picture. Rearrange them any way you want, warp them or whatever, but they're still corporate art inked into your person. That's been, and always will be, distasteful to me.
Almost no one on this planet knows what "aecxes" are. They are sigils that have come to me via the story, and are thus completely unique. They aren't corporate art.
Brookings apparently has a top-shelf tattoo artist, so I think the time is right. I'll let you know how it's going.


The Saddle Bag is a convenient way to keep all of those essential items that don't really fit anywhere else close at hand. Designed with pencils, rules, dividers and such in mind, the Saddle Bag can be mounted to nearly any vertical wooden surface. It mounts using four brass screws(included) through leather reinforced hanging points.
One of the unique features on the Saddle Bag are the two pass through pockets on each end. Designed with combination squares in mind, the pass through pockets allow longer items to be stored in the Saddle Bag without any issues.
The Saddle Bag will be available in all four colors of waxed canvas that we offer. Like all of our items, the Saddle Bag is constructed using our proven combination of waxed canvas, double stitched seams, and hand peened copper rivets. The price of the Saddle Bag will be $70.
We are going to approach Saddle Bag sales a little differently to start off. I'm still working on streamlining the production process to make it as efficient as possible. The best way for me to accomplish this is by making larger batches, instead of taking orders for them and making them as required. So, as soon as we get back home from Handworks I plan on making a large run of these, maybe two dozen or so. Those will then be listed on the website for sale. Once that batch sells out, I'll make another. Stay tuned to this blog or my social media posts for further info regarding availability. Come see us at Handworks this Friday and Saturday in Amana, Iowa to see the Saddle Bag in person! We have a dozen in stock, maybe you can bring one home with you!!


text:
Justerini & Brooks Ltd. è una distilleria facente capo al gruppo britannico Diageo.

Fondata nel 1749 a Londra dall'italiano Giacomo Justerini, è nota per il marchio di whisky J&B.

Storia
Le origini della società partono nel 1749, quando il bolognese Giacomo Justerini, dopo essersi innamorato del soprano Margherita Bellino decide di trasferirsi a Londra con lei.
Essendo nipote di un droghiere, emigrando aveva portato con sé degli appunti che includevano ricette per la preparazione di bevande alcoliche, e notando come gli inglesi avessero una grande passione per il consumo di liquori dolci, intuendo la possibilità di sviluppare affari nel business cercò un socio che potesse sostenerlo economicamente. Venne così in contatto con George Johnson, un investitore nipote di un attore che aveva conosciuto tramite Margherita Bellino. Entrambi decisero perciò di fondare uno spaccio di vini e liquori che venne chiamato Johnson & Justerini, dal nome dei due proprietari. L'attività riscuote abbastanza successo, data anche l'abilità di Justerini nel cimentarsi nella creazione di elisir alcolici; tuttavia questi nel 1760 decide di tornare a Bologna e ritirarsi a vita privata. L'attività viene così continuata dal solo Johnson, il quale viene affiancato da suo nipote Augustus. L'espansione dell'attività non si arresta, e la Johnson & Justerini tramite relazioni lavorative con fornitori e grossisti diventa uno dei maggiori esportatori di bevande alcoliche in Europa continentale. Nel 1761, dopo aver fornito i vini per l'incoronazione di Re Giorgio III e per il matrimonio reale, la Corona Britannica attribuisce alla Johnson & Justerini il riconoscimento di fornitori di vino esclusivi del nuovo Re, e subito dopo, conferisce alla ditta il Royal Warranty, onorificenza che le sarà mantenuta da altre otto monarchie consecutive. Nel 1785 George muore, e le redini della ditta passano in mano a suo figlio Augustus, il quale nel 1831 decide di vendere l'azienda a un uomo d'affari, Alfred Brooks, che decide di rinominare l'azienda Justerini & Brooks. Nel 1858 la Regina Vittoria viene proclamata Imperatrice d'India; ciò consente all'azienda, ben vista dalla Corona, di espandere il suo business anche nei territori internazionali governati dall'Impero Britannico. Nel 1866 viene decisa l'apertura di una sede a New York per il commercio con l'estero. Nel 1876 Alfred Brooks decide di cedere la guida dell'azienda a suo genero William Cole, il quale per continuare lo sviluppo della ditta organizza gli acquisti di grosse quantità di stock di vino novello. Nel 1884 Justerini & Brooks è una delle prime ditte inglesi ad acquistare grossi quantitativi di malto scozzese per la produzione di blended whisky; nello stesso anno Alfred Brooks viene in contatto con Andrew Usher, un mercante di distillati di Edimburgo tra i primi a commercializzare i blended whisky. Usher, coadiuvato dal suo socio James Anderson, mira a creare insieme a Brooks uno Scotch Whisky di un gusto particolare, mirante soprattutto a conquistare il favore di nuovi consumatori: nasce così il J&B Club. Visto il successo ottenuto, l'azienda si concentra sul business dei whisky, mettendo in secondo piano quello dei liquori. Nel 1889 William Cole, poco prima della sua morte decide di vendere la Justerini & Brooks alla Anderson & Newbiggin, azienda di proprietà di Usher e Anderson. Nel 1908 Sarcey, uno champagne di pregio della società, comincia ad essere fornito a Re Eduardo VII. Nel 1914 Justerini & Brooks inizia la vendita diretta senza aggiunta di imposte dei propri prodotti dalle proprie cantine di Londra ai consumatori. Nel 1929 Eddie Tatham, amico di famiglia di Anderson, diventa direttore della compagnia; nel 1930, durante il proibizionismo, decide di partire per gli Stati Uniti per rifornire clienti americani facoltosi che avevano effettuato ordini con la Justerini per dei campioni di una nuova miscela di whisky. Tatham sarà però arrestato alla Grand Central Station di New York e liberato successivamente su cauzione. Poco dopo, Tatham incontra Charlie Julian, un miscelatore molto famoso; insieme, partendo dalla miscela di Eddie, iniziano la creazione del nuovo whisky J&B Rare. Nel 1932 il prodotto viene messo in commercio per la prima volta. Il J&B Rare era stato appositamente studiato per il consumo del pubblico americano: nel 1937 viene siglato un accordo con Charlie Guttmann e la sua compagnia Paddington Corporation di New York, per l'esportazione dei prodotti Justerini & Brooks oltreoceano; si
calcola che nella metà degli anni cinquanta la società effettuasse spedizioni per circa 25.000 casse all'anno, prevalentemente negli stati della Costa Orientale. Poco dopo la società si fonde con la distilleria Twiss & Browning & Hallowes Ltd., e si trasforma in United Wine Traders. Nell'operazione viene anche rilevata e inglobata nel gruppo la distilleria Charlie, Richards & Co. Nel 1962 la società si fonde con la W&A Gilbey Ltd., prendendo così il nome di International Distillers and Vintners Ltd.. La nuova entità permette tra l'altro alla vecchia Justerini & Brooks di prendere il controllo della Gilbey's Scotch Whisky distilleries e quindi il possesso di un segmento che non aveva mai avuto prima di allora. IDV allargò il suo orizzonte commerciale verso Australia e Sudafrica e nel resto d'Europa diventando presto la secondo produttrice mondiale di Scotch Whisky. Nel 1972 IDV viene rilevata dal produttore di birra britannico Watney Mann, la quale a sua volta viene poco dopo rilevata dalla multinazionale alimentare britannica  Grand Metropolitan. Viene appositamente rinominata la divisione del gruppo per il business scozzese, IDV Scotch Whisky Operations Unit, in J&B Scotland Ltd, per mantenere verso i consumatori la radice e l'origine del gruppo. Nel 1997 Grand Metropolitan si fonde con il gruppo irlandese delle birre Guinness, dando vita al gigante britannico delle bevande alcoliche Diageo.

Situazione attuale
 il brand J&B è posizionato al quarto posto nel mercato dei whisky più venduti al mondo, con una particolare incidenza nei mercati dell'area del Mediterraneo (Spagna, Portogallo, Francia), in Sudafrica e negli Stati Uniti. Le vendite annuali si aggirano intorno alle sei milioni di casse vendute. Anche dopo la fusione in Diageo, Justerini & Brooks ha continuato, perlopiù attraverso canali di vendita privati, la sua attività di rifornimento e produzione di vini Chateaux tra i quali: Domaine du Comte Liger-Belair, Petrus, Lafleur, Bruno Clair, Didier,  Dagueneau, J L Chave, J. J. Prum, Domaine Weinbach, Elio Altare, e  Heitz Cellars, oltre a distribuire vini e bevande alcoliche pregiate per ristoranti e alberghi del Regno Unito. La divisione di Diageo ha riportato nel 2019 ricavi per $4m (£3.261m.); gli impiegati sono pari a 24 unità.

Note

Voci correlate
 Diageo

Altri progetti

Collegamenti esterni

Aziende alimentari britanniche


text:
Altrade is een wijk in het Nijmeegse stadsdeel Nijmegen-Oost. Het aantal inwoners van de wijk is  (). Het noordelijk gedeelte van de wijk ligt binnen de zogenaamde 19e-eeuwse schil; in het zuiden van de wijk liggen de Schildersbuurt en de Componistenbuurt. In Altrade is relatief veel middenstand en horeca gevestigd. Het studiehuis met kapel is in 1928 ontworpen door architect H.M. Zoetmulder.

In de wijk liggen de monumentale begraafplaats Daalseweg en het Julianapark. Hier ligt ook de Wedren, de start en finish van de Nijmeegse Vierdaagse.

Naamgeving
Altrade komt van Alt-Radelant, Altrade lant en betekent oud gerooid land. De naam Altradelant komt reeds in de 15e eeuw voor. De ligging wordt genoemd in een protocol van 1550: 'bij den Joedenkerkckhof in het Hooge velt'." (Hendriks 1987) Altradelant was voor de ontginning van de heide ten zuiden van Nijmegen buiten de stadswallen in 't Hooge Velt gelegen, tussen de Groesbeekseweg en de oude weg naar Ubbergen.

In deze streek werden omstreeks 1700 de lunetten Kijk in de Pot en Stenen Kruis gebouwd naar het plan van Menno van Coehoorn. Tussen 1861 en 1865 werden de lunetten Kijk in de Pot tot fort omgebouwd. De straatnaam Fort Kijk In De Potstraat verwijst nog naar het fort dat hier heeft gestaan. De naam is verwant met 'Kiek in de Kök' of 'Kiek in de Köken', de namen van de oude militaire torens in Tallinn, Danzig en Maagdenburg. Vanuit de hoge toren konden de soldaten letterlijk een kijkje in de keuken van de vijand nemen. Met de stadsuitleg van Nijmegen werd het fort rond 1880 gesloopt en rond 1895 gemeentelijk bezit.

Fort de Verbrande Molen heeft in het zuidoosten van de wijk gelegen, waar de Fortstraat ligt. Het dankte zijn naam aan de afgebrande molen 'De Goede Hoop' die hier stond.

Ontstaan wijk
April 1874 werd de Vestingwet aangenomen. Deze bepaalde opheffing van de vestingstatus van een aantal steden, waaronder van Nijmegen. Daarmee kwam de weg vrij voor ontmanteling van de vestingwerken en een explosieve groei van Nijmegen. Er werden brede singels aangelegd. Op de stervormige pleinen werden rijen fraaie en statige huizen voor de gegoede burgerij gebouwd in de stijl van de art nouveau en art deco tot eclectische stijl met neorenaissance-elementen. Duidelijke voorbeelden hiervan zijn te vinden aan de Johannes Vijghstraat, Groesbeeksedwarsweg, Waldeck Pyrmontsingel en de Wilhelminasingel.

De '19e eeuwse schil' is in 2013 tot beschermd stadsbeeld verklaard.

Trivia
Bekend in wijde omgeving is het jaarlijks terugkerende smartlappenfestival, de 'Troost van Oost'.

Afbeeldingen

Zie ook
Negentiende-eeuwse schil (Nijmegen)

Wijk in Nijmegen


I am looking to buy a food business, Pizzeria or Bagel shop in central NJ.
I currently have 50k with me and the businesses i am looking at are around 175k. I don't have any experience with the food business but i am going to work at the place before i buy one to gain some experience.
First of all i don't see anyother way to finance the new business other than SBA loan, please correct me if my assumption is incorrect?
Let me know you would like me to provide any further information.
i also want to include that my credit score is around 760+.