text:
/* Licensed under the Apache License, Version 2.0 (the "License");
 * you may not use this file except in compliance with the License.
 * You may obtain a copy of the License at
 *
 *      http://www.apache.org/licenses/LICENSE-2.0
 *
 * Unless required by applicable law or agreed to in writing, software
 * distributed under the License is distributed on an "AS IS" BASIS,
 * WITHOUT WARRANTIES OR CONDITIONS OF ANY KIND, either express or implied.
 * See the License for the specific language governing permissions and
 * limitations under the License.
 */
package org.camunda.spin;

import java.io.Writer;

import org.camunda.spin.json.SpinJsonNode;
import org.camunda.spin.spi.DataFormat;
import org.camunda.spin.xml.SpinXmlElement;

/**
 *
 * @author Sebastian Menski
 * @author Daniel Meyer
 */
public abstract class Spin<T extends Spin<?>> {

  /**
   * Creates a spin wrapper for a data input of a given data format.
   *
   * @param input the input to wrap
   * @param format the data format of the input
   * @return the spin wrapper for the input
   *
   * @throws IllegalArgumentException in case an argument of illegal type is provided (such as 'null')
   */
  public static <T extends Spin<?>> T S(Object input, DataFormat<T> format) {
    return SpinFactory.INSTANCE.createSpin(input, format);
  }

  /**
   * Creates a spin wrapper for a data input of a given data format.
   *
   * @param input the input to wrap
   * @param dataFormatName the data format name of the input
   * @return the spin wrapper for the input
   *
   * @throws IllegalArgumentException in case an argument of illegal type is provided (such as 'null')
   */
 public static <T extends Spin<?>> T S(Object input, String dataFormatName) {
   return SpinFactory.INSTANCE.createSpin(input, dataFormatName);
 }

  /**
   * Creates a spin wrapper for a data input. The data format of the
   * input is auto detected.
   *
   * @param input the input to wrap
   * @return the spin wrapper for the input
   *
   * @throws IllegalArgumentException in case an argument of illegal type is provided (such as 'null')
   */
  public static <T extends Spin<?>> T S(Object input) {
    return SpinFactory.INSTANCE.createSpin(input);
  }

  /**
   * Creates a spin wrapper for a data input. The data format of the
   * input is assumed to be XML.
   *
   * @param input the input to wrap
   * @return the spin wrapper for the input
   *
   * @throws IllegalArgumentException in case an argument of illegal type is provided (such as 'null')
   */
  public static SpinXmlElement XML(Object input) {
    return SpinFactory.INSTANCE.createSpin(input, DataFormats.xml());
  }

  /**
   * Creates a spin wrapper for a data input. The data format of the
   * input is assumed to be JSON.
   *
   * @param input the input to wrap
   * @return the spin wrapper for the input
   *
   * @throws IllegalArgumentException in case an argument of illegal type is provided (such as 'null')
   */
  public static SpinJsonNode JSON(Object input) {
    return SpinFactory.INSTANCE.createSpin(input, DataFormats.json());
  }

  /**
   * Provides the name of the dataformat used by this spin.
   *
   * @return the name of the dataformat used by this Spin.
   */
  public abstract String getDataFormatName();

  /**
   * Return the wrapped object. The return type of this method
   * depends on the concrete data format.
   *
   * @return the object wrapped by this wrapper.
   */
  public abstract Object unwrap();

  /**
   * Returns the wrapped object as string representation.
   *
   * @return the string representation
   */
  public abstract String toString();

  /**
   * Writes the wrapped object to a existing writer.
   *
   * @param writer the writer to write to
   */
  public abstract void writeToWriter(Writer writer);

  /**
   * Maps the wrapped object to an instance of a java class.
   *
   * @param type the java class to map to
   * @return the mapped object
   */
  public abstract <C> C mapTo(Class<C> type);

  /**
   * Maps the wrapped object to a java object.
   * The object is determined based on the configuration string
   * which is data format specific.
   *
   * @param type the class name to map to
   * @return the mapped object
   */
  public abstract <C> C mapTo(String type);
}

redpajama_set_name: RedPajamaGithub


J.D. Power and Associates has ranked American Express the top credit card company among the eleven biggest in the U.S. in its latest annual Credit Card Customer Satisfaction study. It is the seventh consecutive year in which AmEx has topped the chart, with Discover once again finishing a close second and HSBC once more finishing up in last place and doing so in an abysmal fashion. Overall, American consumers' satisfaction with their credit cards has improved for the fourth year in a row, following a decline in 2009, the year immediately following the financial collapse of 2008, we learn.
Once again, the study finds that the huge banks, which are issuing the MasterCard- and Visa-branded credit cards — all of them among the biggest in the world — are lagging far behind the two leaders. In fact, the distance is so big that Chase is the only Visa and MasterCard issuer whose score is above the industry average. In the previous years we speculated on the possible causes for the discrepancy and got some help from the study's author. As data accumulate, evidence is piling up indicating ever more strongly that the simplified transaction process, associated with American Express and Discover payments, as opposed to Visa and MasterCard ones, is hugely benefiting these two companies. Let's take a look at the latest survey.
J.D. Power and Associates is using six broad factors in calculating consumer satisfaction with credit cards: interaction, credit card terms, billing and payment process, rewards, benefits and services and problem resolution. The average industry score for 2013 was 767 on a 1,000-point scale, up from 753 in 2012, which itself was up from 731 in 2011, 714 in 2010 and 705 in 2009.
American Express topped the chart with 816 points, up from 807 in 2012, ahead of Discover, which scored 812, up from 799 a year ago. Just as was the case last year, Chase and Barclaycard are ranked third and fourth, but this year only the former issuer has scored above the industry average. In the race to the bottom, Citi has displaced GE Capital Retail Bank to rank second to last with a score of 741, but it still has quite some way to go, before it can challenge HSBC, which is still in firm control of the last spot.
Customers who use their card's benefits spend an average of $400 more per month on their card, compared with those who are aware of benefits but do not use them, so clearly this is an area of importance to card issuers… While most customers change cards for a better rewards program, they often don't fully understand the rewards offered with their current card. There is a clear opportunity for issuers to better communicate rewards programs and benefits to not only keep customers loyal, but also to attract new customers.
Miller adds that the improving economy is helping consumers feel better about their financial situation, which, in turn, helps improve satisfaction with credit card issuers and that is very likely the case. We learn that 27 percent of credit card holders have said that they are better off in 2013, up from 23 percent in 2012 and 20 percent in 2011. Conversely, 17 percent have reported that they are worse off, down from 23 percent in 2012 and 29 percent in 2011.
With which one of these credit card brands are you most satisfied?
Why Is the AmEx / Discover Way Better than the Visa / MasterCard Approach?
So you can immediately see that the AmEx / Discover approach is a much more simplified version of the one developed by their larger rivals. And that is significant, because being able to both issue your cards and process your transactions makes it much easier to address your customers' inquiries and resolve disputes in a quicker and more efficient manner, as you don't need to turn to yet another bank for assistance. The complete control that both American Express and Discover exercise over the whole card transaction process would directly affect the interaction, billing and payment process and problem resolution components of J.D. Power and Associates' survey model and that could be enough to account for the results.
American Express and Discover overcommunicate: they both use multiple communication channels (mail, email, collateral, statements, website, etc.) to inform their customers of changes, new products / services and just communicate relatively simple, focused messages on an ongoing basis.
Their cardholders have a better grasp of what they get by being a customer: AmEx customers, for example, have stated (back in 2011) that they get over 5 benefits from their card, versus only 3.3 benefits for cardholders of other brands. This is key when it comes time to pay the annual fee.
Strong brand image: both AmEx and Discover excel in J.D. Power's assessment of brand image. Measured across 7 attributes, both companies average (again, this is back in 2011) over 0.5 points higher (on a 7 point scale) than the Visa / MasterCard issuers. This customer view of the companies as being more customer-focused, proactive, friendly and financially stable is critical to sustaining high marks in overall satisfaction and customer commitment.
To summarize, there seem to be very good reasons for AmEx and Discover to outperform Visa and MasterCard issuers across the board.
So, once again, the J.D. Power survey paints a picture of complete dominance by American Express and Discover over their Visa / MasterCard rivals, at least in the eyes of their customers. However, it should be noted that all eleven issuers have scored better in this year's survey than they did last year. Moreover, most of the Visa / MasterCard issuers have registered greater improvements, in relative terms, than the two leaders. Still, they have much more work left to do to close the gap.
It should also be said that, following the historic lows reached in the wake of Lehman's collapse, customer satisfaction indices could only have gone up. And as delinquency and charge-off rates continue to fall, these indices are likely to keep rising. After all, when fewer people are behind on their bills, there are fewer stern notices demanding immediate payments and threatening unpleasant consequences otherwise. Whoever receives such a letter is unlikely to give a high mark to the issuer of her card, whatever the specific questions may be, isn't she?
American express live in their own world. The rates are quite high and a lot of merchants complain about that.
However for their customers the argument may be extremely different.


The computer science course focuses on developing research skills using technology as a tool. Students work on a number of in-class projects, culminating in a multimedia presentation. As they work on their presentation, students learn how to take full advantage of e-mail, network folders, and Internet and online database research, and they develop and enhance skills in the use of Microsoft Word, Excel, and PowerPoint.


Hope your having a fabulous Thanksgiving Day.
I've have a huge stash of fabric, and have given myself a deadline on fabric purchases. No more fabric into the house after November 30th. This morning I visited Hawthorne Threads, and got some Foliage from the Prospect Park fabric line. Can't wait to get it.


Topic: Is Dzogchen really beyond cause and effect?
Topic: Best meditation for my circumstance? Maybe someone can help?
Re: Best meditation for my circumstance? Maybe someone can help?
Your post shows more similarities between Tantras and Sutras than differences. Why were the Tantras called "Tantras" instead of "Sutras"? Their format is similar to the Sutras and they contain discussions on Dharma, practices, moral discussions etc just as Sutras do.
How can substances alter consciousness?
Topic: Why Spiritual Countries have more Suffering/Demons?
Re: Why Spiritual Countries have more Suffering/Demons?
Topic: Samantabhadra - Bodhisattva or Buddha or AdiBuddha?
Re: Samantabhadra - Bodhisattva or Buddha or AdiBuddha?


text:
Omar Quintanilla Signs With New York Mets
By Russ Oates Jan 3, 2012, 9:31am MST
Share All sharing options for: Omar Quintanilla Signs With New York Mets
Former Colorado Rockies infielder Omar Quintanilla has signed a minor league contract with the New York Mets, reports Adam Rubin of ESPN New York. Quintanilla has spent the majority of his career with the Colorado Rockies, playing in the organization from 2005-2010.
He first saw action with the Rockies in 2005 and peaked in 2008 with 81 games at the big league level. He hit .220/.277/.290 as a backup infielder over five seasons. He moved over to the Texas Rangers in 2011 and appeared in 11 major league games.

redpajama_set_name: RedPajamaCommonCrawl


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Folks are diverted. College athletes are currently bringing in enormous quantities of earnings for those schools.
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The conversation Grace is referring to is whether student athletes ought to be paid. We have some dogs on this defense. And athletes who say they would like to be the very best and that they would like to grind.
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A. obviously, you understand, I'm friends with a couple guys that perform precisely the same position as me. I friends with a great deal of the members of the former coaching staff.
It's been among the top programs in the country the last few years. Most of what is sold in the work of sport and training education won't help athletes become far better. The way by which admissions officers decide which students to accept is simply appalling as it's often solely dependent on the student's financial capital rather than their academic standings.
The very first guy off the bus may not have the beard next calendar year, Judy laughed. We have some dogs on this defense. He's a great dude and a great athlete.
You'll be a newcomer, but they're likely to treat you enjoy a rookie but I think he mature and will grow at a fast pace. I'll allow you to know, how well these guys fought the whole season to the finish, He explained. We held three men out or two, a guy on every side of the ball.
Because athletics take as much moment. If paid on salary, the athlete will probably blow the money, and they'll be unable to afford their college. It is the way you train when there are not any games to play that scholarship athletes are created.
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Christian considers that, in contrast to students which aren't athletes and who operate but since they must pay tuition, athletes deserve to go compensated due to their significant time commitment in scholarship. The third, Brands that are Contender is a thing development company and this is precisely what I would like to concentrate on today.
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The shooting happened around 4:30 p.m. on Thursday. Witnesses say at least two shots were fired.
One of the victim's friends says the victim was a 23-year-old man from Beach Park who co-owns a pawn shop in that community.
The victim's friend says the victim was in the parking lot waiting to meet people to buy two iPhones.
Police have not released any details on suspects or a motive at this time.


text:
Featured Golf News
Lee-Anne Pace Ready For SuperSport Ladies Challenge
February 18, 2015 February 18, 2015 Lali Stander Australia, Australian Open, Cape Town Ladies, Cell C, China, Dimension Data Ladies Pro-Am, Dubai, Inbee Park, Investec Cup for Ladies, ISPS Handa, Jessica Korda, Ladies European Tour, Lee-Anne Pace, LPGA Tour, Lydia Ko, Melissa Eaton, Michelle Wie, Nicole Garcia, Pearl Valley, RACV Ladies Masters, Royal Melbourne Golf Club, Shanshan Feng, South Africa, South African Women's Open, Stacy Bregman, Sunshine Ladies Tour, SuperSport Challenge, Zwartkop Country
World number 29 Lee-Anne Pace will launch her 2015 Chase to the Investec Cup for Ladies campaign by hunting a podium finish in the SuperSport Challenge, which tees off at Zwartkop Country Club on 10 March. 'I hope to hit the ground running and make my mark quickly,' said Pace from Australia, where she claimed a joint sixth place in the RACV Ladies Masters on the weekend. The Pearl Valley golfer won the inaugural Investec Cup for Ladies title in March last year and celebrated back-to-back victories with two international titles in the space of nine days in October.
Pace won the Cell C South African Women's Open on home soil and held off the likes of Inbee Park, Lydia Ko, Jessica Korda, Shanshan Feng and Michelle Wie to capture her first LPGA title at the Blue Bay LPGA in China a week later. 'It was a really good time for me. I interrupted my schedule in China to fly to South Africa and support our local Open. It was very important to me to compete, because winning the Cell C SA Women's Open has always been a major priority for me. It was incredibly special for me to win, but I was quite drained when I arrived back in China. My expectations were low, but I was striking the ball very well. Once I found myself in contention, I drew on the victory in South Africa and the competitive juices just started to flow. Both titles meant the world to me and it was a fantastic way to end the season,' said Pace. Pace began the 2014 season with a conditional card on the LPGA Tour and had to take numerous last-minutes flights across the Atlantic when she received a late call to start, but the nine-time Ladies European Tour champion took advantage of her limited opportunities.
Following the mid-season re-rank, Pace earned more starts and the South African posted solid results in the last six months of the year to finish the season ranked 38th on the LPGA Money List with earnings of $469,559. Pace took an extended break to relax and refresh after the season-finale in Dubai and feels ready to challenge again. 'I needed to relax and to get my head straight again, but now I really feel hungry again,' Pace said.
Pace will be gunning for a title in LPGA's ISPS Handa Women's Australian Open at Royal Melbourne Golf Club this week. 'I've been keeping my eye on the Sunshine Ladies Tour scoring and the girls have been busy. Stacy (Bregman), Nicole (Garcia) and Melissa Eaton have closed the gap on me in the Chase to the Investec Cup for Ladies and I will slip even further back after the Dimension Data Ladies Pro-Am and Cape Town Ladies Open. I definitely don't expect to be leading, but I intend to hit the ground running. I had a solid start in Australia and I am keen to do well at Royal Melbourne this week. It's important to carry some good form into the SuperSport Challenge to keep myself in the running for the Investec Cup for Ladies in March,' she said.
Photo: Lee-Anne Pace
Photo credit: Catherine Kotze / SASPA
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text:
James Alphonse – DREAM TOUR
In this Dream Tour segment, the electropop artist, James Alphonse, reveals who he would want on his ultimate tour lineup.
In this Dream Tour segment, the electropop artist, James Alphonse, reveals who he would want on his ultimate tour lineup. You can check out their picks, after the break.
When asked about my dream tour before, I've given an answer that seems to shock most people. I love music, in fact, most people find it odd to know that I find myself listening to rock, classic, metal, pop (yes Justin Bieber and the Jonas Brothers too), soul, dubstep, folk, R&B, jazz, nature sounds, country and more. Where does that leave me as an artist? Well, for one thing, I love a good blend of music, and I doubt that many people would say they don't as well. So, the first thing that I have to say to preface my dream tour, is that the genre doesn't matter. What would matter is the listener experience. I would want to know that the attendees leave with a smile and a unique experience, but this still isn't the most shocking part of my response regarding my dream tour…
To me, people are the centre of music. My team and the people who have invested in me are most important and I want to bring them into my experience. I want to celebrate their talents and share them, but how do you do this? I'm going to tell you, but, to start, you have to know that my dream tour involves sharing the stage with other new acts. I've been very blessed to receive mentorship in a variety of ways from people like Mark Daum (inventor of the piantar), Nick Blagona (Deep Purple, April Wine, the Police, etc.), Andre Kaden Black (Francesco Yates, Fefe Dobson, etc), Tal Vaisman (TV writer, Kadeema, the Ascot Royals), Scott Anderson (Finger 11), Mike Northcott (music supervisor at Corus Entertainment, Franklin theme song) and Duncan Coutts (Our Lady Peace). Each of these people invested in me when I was nothing. As incredibly successful, busy, talented human beings, they took time and invested in me. Moreover, there are incredible companies and people like Digital Tour Bus, Brian Peel, and Johno, who try to help musicians like me by shining some spotlight on them. I can't begin to express how much their time means to me, and I feel a compulsion to pay this forward to them and other new artists. Now, for the question of how to do this…
For my incredible writing team and music consultants, if I had some sort of connection to a massive tour, I'd love to collaborate with other artists that they are working with. In this way, I could share the amazing work that they've done and help to contribute to their success. They're amazing people, and I need to show that to the world. Some people who come to mind are Riley Michaels, Abby Hall, and Christine Pallazolo (Christee Palace). These are individuals who dedicate their time to their craft, write amazing music, and have worked with my team. This is part one of my four-part plan…
Next, I'd want to reach out to up and coming artists. To me, these are others, like myself, who needed someone to believe in them and to offer their time. In the same way that others offered their time, I'd aim to follow the ethos of my previous mentors to pay homage to the great things they've done for me. To this end, I've really enjoyed the work of Sam Magliazza (Sam Louis), Spencer Heslop (Taabu), and Graham Ko. They're three incredibly talented individuals that give their all and write great songs.
After, I'd need a headliner to help bring a crowd that is representative of the tour group and their dedication to their craft. I'm democratic, so I'd like the tour team to reach a decision together. I'm also pretty nerdy, so a research-based approach would be part of that democratic approach. It would be one that considers the interests of the people that are involved. (Oh and I love supporting local, so I'd prefer a Canadian).
Finally, I'd have to make shout-outs to the amazing people that supported me along the way and I'd ask my tour group to join me in doing that. This means shout-outs to Brian, Johno, Digital Tour Bus, and anyone else who played a role in my success. I may be sounding overly positive/brown noser-ish here, but it really isn't about that. Take a second to consider the busy, daily lives of these people. They have full-time jobs, families and even pandemics to worry about. What do they do? They take their time to write about musicians with dreams… They offer consultation to new artists… They believe in you and take time on you. If you can't understand how amazing it is that they take time out of their day, you'd never understand me and why my perfect tour involves a structured way to thank them from the bottom of my heart. This is my dream tour. These are incredible people. They deserve more than just our thanks. Their vision at one point was me as an artist. If I ever become that vision, you better believe that I'll be thanking them any way I can.
Keep up with him on Facebook, Instagram and Twitter.


text:
Olga Tolkmit
Nationalities : Russia
Representation : Guy Barzilay Artists
Website : None
Olga Tolkmit - "Si, mi chiamano Mimi" (La Bohème -...
Nedda PAGLIACCI Helikon-Opera Jan 2018
Tatyana EUGENE ONEGIN Helikon-Opera Dec 2017 - Jan 2018
Liú TURANDOT Helikon-Opera Sep 2017
BRIGITTA Iolanta / Undine Theater an der Wien Feb 2019
MARIA Mazeppa Theater an der Wien Feb 2019
Lauded by the Financial Times for her "resonant, bright-voiced soprano," Olga Tolkmit joins the Helikon Opera ensemble this season for Micaela in Carmen, Tatyana in Eugene Onegin and Nedda in I Pagliacci.
She was recently a member of the ensemble of the Mikhailovsky Theatre where her roles included the title role of Iolanta, Mimì in La bohème, and Gianetta in L'elisir d'amore.
Other roles from previous seasons include Tatyana in Eugene Onegin and Prilepa in Pikovaya Dama, Brigitta in Iolanta.
Her performances of Mimì in 2012 garnered a nomination for the prestigious Golden Mask Award from the Theatre Union of Russia Federation.
The soprano made her American debut in 2013 as Electra in Sergei Taneyev's Oresteia at the Bard Summerscape Festival, a recording of which is now available via the American's Symphony Orchestra's private label, The Orchard.
Also last season, she sang solo performances of arias and songs of Handel, Bach, Schubert, and Giordani on a tour to cities throughout Japan.
Her previous international recitals include performances in Finland, Norway, Italy, and Germany.
Ms. Tolkmit was a finalist in the 2011 Elena Obraztsova International Competition for Young Opera Singers and holds a degree from the Rimsky-Korsakov Saint Petersburg State Conservatory.
Parterre Box
02 August 18 12:43
with : Thaddeus Strassberger , LEON BOTSTEIN , Olga Tolkmit , Andrey Valentiy , Alexander Nesterenko
I'm no angel
I'm no angel Bard's cultish Summerscape series continues to test our esoteric limits with Demon, Anton Rubinstein's little-known opera about a demon who hankers for a Georgian princess. The work, which debuted in 1875, was for many years a sellout at the


Dart was the fastest growing programming language at Google in 2016 with millions of lines of code written. It also made it to TIOBE Index Top 20 this month (see TIOBE's methodology).
It takes time to build something as ambitious as Dart and, in some ways, Dart is still in its infancy. But we're glad the hard work is starting to pay off.
Many thanks to our amazing community!
We're going to celebrate by ... releasing 1.22 next week (as per our usual 6 week release schedule).


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Home / Naturopathic News / Meta-Analysis Shows Omega-3s Lower Risks of Cardiovascular Disease
Meta-Analysis Shows Omega-3s Lower Risks of Cardiovascular Disease2019-12-272019-12-19https://ndnr.com/wp-content/uploads/2015/09/ndnr-logo-with-web1-300x169-copy.pngNaturopathic Doctor News and Reviewhttps://ndnr.com/wp-content/uploads/2019/12/94259104_m.jpg200px200px
People who received omega-3 fish oil supplements in randomized clinical trials had lower risks of heart attack and other cardiovascular disease (CVD) events compared with those who were given placebo, according to a new meta-analysis from Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital. Researchers found an association between daily omega-3 supplementation and reduced risk of most CVD outcomes, including heart attack, death from coronary heart disease, and death from CVD, but did not see benefit for stroke. In addition, higher doses of omega-3 fish oil supplements appeared to provide even greater risk reduction. The study was published online in the Journal of the American Heart Association.
Association found between daily omega-3 supplementation and reduced risk of most CVD outcomes
"This meta-analysis provides the most up-to-date evidence regarding the effects of omega-3 supplementation on risk of multiple CVD outcomes. We found significant protective effects of daily omega-3 supplementation against most CVD outcome risks and the associations appeared to be in a dose-response manner," said first author Yang Hu, a postdoctoral fellow in the Department of Nutrition at Harvard Chan School.
While observational studies have shown an association between fish consumption and lower heart disease risk, results from randomized controlled trials (RCTs) have been inconsistent. Two reviews published last year did not find clear evidence for benefit.
Updated meta-analysis included three recently completed large-scale trials, which increased the sample size by 64%
In this new analysis, the researchers did an updated meta-analysis that included three recently completed large-scale trials, which increased the sample size by 64%. The total population analyzed by Hu and colleagues included more than 120,000 adults in 13 randomized trials worldwide. The analysis included the VITAL trial, the largest randomized trial of omega-3s to date.
What the findings showed
The findings showed that people who took daily omega-3 fish oil supplements, compared with those who took a placebo, lowered their risk for most CVD outcomes except stroke, including an 8% reduced risk for heart attack and coronary heart disease (CHD) death. The association was particularly evident at higher doses of omega-3 fish oil supplementation. This finding may suggest that marine omega-3 supplementation dosage above the 840 mg/day used in most randomized clinical trials may provide greater reductions in CVD risk. Given that several million people experience these CVD events worldwide each year, even small reductions in risk can translate into hundreds of thousands of heart attacks and CVD deaths avoided, according to the researchers.
Study suggests the following
"Although public health recommendations should focus on increasing fish consumption, having an overall heart-healthy diet, being physically active, and having other healthy lifestyle practices, this study suggests that omega-3 supplementation may have a role in appropriate patients," said senior author JoAnn Manson, chief of the Division of Preventive Medicine at Brigham and Women's Hospital and professor in the Department of Epidemiology at Harvard Chan School. Manson is also the Director of the large-scale VITAL trial of omega-3s.
"Marine Omega-3 Supplementation and Cardiovascular Disease: An Updated Meta-Analysis of 13 Randomized Controlled Trials Involving 127,477 Participants," Yang Hu, Frank B. Hu, JoAnn E. Manson, JAHA, online Sept. 30, 2019, doi: 10.1161/JAHA.119.013543
Node Smith, ND, is a naturopathic physician in Humboldt, Saskatchewan and associate editor and continuing education director for NDNR. His mission is serving relationships that support the process of transformation, and that ultimately lead to healthier people, businesses and communities. His primary therapeutic tools include counselling, homeopathy, diet and the use of cold water combined with exercise. Node considers health to be a reflection of the relationships a person or a business has with themselves, with God and with those around them. In order to cure disease and to heal, these relationships must be specifically considered. Node has worked intimately with many groups and organizations within the naturopathic profession, and helped found the non-profit, Association for Naturopathic Revitalization (ANR), which works to promote and facilitate experiential education in vitalism.
cardiovascular disease (CVD), CVD outcome risks, death from coronary heart disease, fish consumption, Heart Attack, heart disease risk, heart-healthy diet, lower heart disease risk, omega-3 fish oil, omega-3 fish oil supplements, omega-3 supplementation, randomized controlled trials (RCTs, Stroke
Clinical Focus – GI Health
Physical Activity Changes Risk of Heart Disease in Menopausal Women
Need for Better Communication on Vulvovaginal HealthNaturopathic News
Gender-Affirming Surgery: Conflicting Viewpoints or Silent Questions?Naturopathic News


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OSA Publishing > Biomedical Optics Express > Volume 11 > Issue 9 > Page 5352
Christoph Hitzenberger, Editor-in-Chief
Effect of skin optical absorption on speckleplethysmographic (SPG) signals
Tyler B. Rice, Bruce Yang, and Sean White
Tyler B. Rice,* Bruce Yang, and Sean White
Laser Associated Sciences, Inc., CA 92612, USA
*Corresponding author: tylerrice@laserassociatedsciences.com
Tyler B. Rice https://orcid.org/0000-0003-4366-0175
T Rice
B Yang
S White
•https://doi.org/10.1364/BOE.403501
Tyler B. Rice, Bruce Yang, and Sean White, "Effect of skin optical absorption on speckleplethysmographic (SPG) signals," Biomed. Opt. Express 11, 5352-5361 (2020)
Comparison of speckleplethysmographic (SPG) and photoplethysmographic (PPG) imaging by Monte Carlo simulations and in vivo measurements (BOE)
Wearable speckle plethysmography (SPG) for characterizing microvascular flow and resistance (BOE)
Momentum transfer Monte Carlo for the simulation of laser speckle imaging and its application in the skin (BOE)
Optical Biosensors
Laser Doppler velocimetry
Laser imaging
Near infrared radiation
Optical absorption
Original Manuscript: July 22, 2020
Revised Manuscript: August 21, 2020
Manuscript Accepted: August 23, 2020
Recent advances in optical technology have emerged for measuring blood flow in the extremities using speckleplethysmography (SPG), which may address needs in vascular medicine and other fields. SPG has demonstrated a highly linear response with flow rate, but the susceptibility to differences in skin tone is unclear. Two validation studies using skin-simulating phantoms and a simple clinical protocol were conducted to determine the impact of absorbing skin layers on SPG measurements. Benchtop results demonstrated that the coefficient of determination between known flow rate and SPG was highly linear (R2 = 0.990) and was unaffected by the addition of skin-phantom layers with variable absorption (R2 = 0.996-0.999). Additionally, no significant trend was found between the fit residuals of SPG and flow rate with increasing skin-phantom absorption (R2=0.025, p = 0.29). In clinical testing, no significant difference was found using both a 4-way ANOVA between demographic classifications (F = 0.89, p = 0.45), and a 2-way ANOVA test between lower- and higher-melanin subclassifications (F = 0.4, p = 0.52).
© 2020 Optical Society of America under the terms of the OSA Open Access Publishing Agreement
The nature of blood flow in the extremities is highly dynamic and a key metric of systemic tissue health. Abnormalities in the peripheral flow often manifest as the first response to more serious vascular impairment [1]. For example, Critical Limb Ischemia (CLI), caused by Peripheral Artery Disease (PAD), is the highest contributor to lower limb amputation, representing significant cost burden to the US healthcare system [2]. Improved diagnosis and daily monitoring has been shown to reduce the number of amputations by over 50% [3]. Blood flow to the extremities is also relevant in dialysis [4], sleep apnea [5], endothelial dysfunction [6], and sports medicine [7].
Despite its importance, current technologies used to measure peripheral blood flow have significant drawbacks that hinder adoption. One common optical technique, Laser Doppler Flowmetry (LDF), directly monitors the movement of red blood cells in the microvasculature using dynamic light scattering [8]. However, LDF is a reflectance measurement and thus restricted to monitoring superficial cutaneous blood flow [9]. LDF lacks repeatability caused by spatial inhomogeneity in the flow signal and skin thickness [10,11]. Photoplethysmography (PPG) is a measurement of hemoglobin absorption but is often claimed to be a proxy to blood flow. However, PPG relies on the elastic expansion and contraction of vessels during the cardiac cycle and is not a direct measurement of flow. During periods of significant vasoconstriction and low perfusion, PPG amplitude becomes significantly reduced or may entirely disappear [12].
An increasingly common technique, Laser Speckle Imaging (LSI), has recently been used in a transmission geometry to record blood flow in the extremities. LSI utilizes a laser source and image sensor to record the interference pattern, referred to as speckle, generated by scattered coherent light. The transmission geometry provides highly diffuse signals that probe the full tissue thickness, and flow is determined using metrics of pixel contrast to gauge the speckle fluctuation rate [13,14]. Ghijsen et al. demonstrated that transmission LSI was highly linear (R2 = 0.98) with flow rate in a benchtop validation test under controlled flow conditions [15]. When tested in vivo, the technique produced a high-resolution waveform of flow during the cardiac cycle, referred to as the Speckleplethysmogram (SPG). In a study of volunteers undergoing a cold pressor challenge, the SPG waveform maintained a robust signal-to-noise ratio (SNR) under conditions of significant vasoconstriction relative to PPG, which failed to provide any reading [15,16]. SPG has also shown improved accuracy in determining heart rate variability over PPG [17].
SPG analysis is a promising new diagnostic tool to assess both the adequacy and dynamics of blood flow in the extremities. However, little is known about the impact of turbid skin layers on the accuracy of measured flow values. In the visible and near infrared light spectrum, melanin is a significant optical absorber in skin. Melanin varies in concentration among demographic groups, which may affect the accuracy of some spectroscopic techniques due to the resulting variation in light absorption [18]. The impact of melanin concentration on SPG is important to assess for continued clinical adoption of the technology.
Generally, reflectance-based LSI technologies are sensitive to absorbing surface layers with static scattering components such as skin [13]. Researchers have previously attempted to compensate for static layers through Monte Carlo modeling techniques [19]. In contrast, transmissive LSI may be naturally resistant to these effects since detected photons have necessarily traveled through a dynamic scattering layer [20,21]. Herein we examine the empirical effect (or lack thereof) of turbid skin layers with varying absorption on measured flow readings. Use of SPG as a clinical diagnostic tool is also discussed. Results are collected from both a benchtop validation model using skin simulating phantoms and a clinical feasibility study.
2.1 SPG instrument
The instrument used to generate the SPG waveform was a commercially available device based on Affixed Transmission Speckle Analysis (ATSA) technology (FlowMet-R, Medtronic PLC, Minneapolis, MN). ATSA is an embodiment of LSI that allows for robust generation of SPG waveforms because the source and detector are integrated into the housing and affixed directly to the sample. This improves consistency of placement and reduces motion artifact when compared to a non-contact imager [15]. An illustration of the instrument clipped onto a toe is shown in Fig. 1. Within the housing are a CMOS sensor array and a 785 nm laser diode placed opposite one another in a transmission geometry. Images were recorded at approximately 240 Hz. Speckle contrast was calculated and converted to flow values using techniques ubiquitous in LSI [13,15]. The resulting flow waveform, SPG, was then saved for analysis.
Fig. 1. Illustration of the SPG instrument clipped onto a subject's great toe. Coherent light from the laser diode scatters within the tissue (indicated by the red arrow) and is recorded by an image sensor on the opposing side.
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2.2 Benchtop test setup
The model for testing the effect of skin on flow readings described herein was developed based upon the validation setup implemented by Ghijsen et al. [15], where the linearity of transmission LSI measurements were compared against known volumetric flow rates in the physiological range. First, a finger analog was synthesized using silicone rubber tubing encased in skin-simulating layers of varying absorption values, as illustrated in Fig. 2. A blood-simulating fluid phantom was then created that could be pumped through the tube at specified flow rates. The fluid and skin-simulating phantom media optical properties were chosen to mimic the averages of bulk tissue at 785 nm [22,23], and set using specific concentrations of absorbing nigrosine dye and scattering intralipid particulates described in the biomedical optics literature [24,25]. Specifically, the fluid scattering and absorption properties were set at µs'=1.0 mm−1 and µa'=0.1 mm−1 using a dilution of 1% intralipid and 0.005% nigrosine dye, respectively. The skin-simulating phantom layers were created with a base of silicone rubber cast to 1.1 mm thick, approximating epidermal-dermal thickness of human digits (0.8–1.44 mm) [26]. The scattering coefficients of the skin phantom layers were set mixing titanium dioxide to µs'=1.0 mm−1 [24]. The absorption coefficients of the skin phantom layers were varied using differing concentrations of powdered nigrosin dye. To ensure the full range of melanin values were encompassed in the test, the absorption coefficients of the analogs were varied empirically to achieve target reductions in transmitted light intensity. Mean transmitted intensity was measured through five different analogs chosen to encompass the dynamic range of the FlowMet specification, from 20 to 200 counts, equating to a normalized absorption range of 0-90%. This absorption range is set to fully encompass the possible range due to melanin absorption, which has been estimated to be 0-31%, depending on epidermal thickness [27]. A tubing diameter of 19 mm was chosen to approximate the average diameter of a human digit [28], and connected in series to a syringe pump (Pump Systems, Inc.). The blood-simulating fluid medium was pumped through the tube at flow rates approximating the physiological range of a human digit (2–20 ml/min), in steps of 2 ml/min [29]. For each skin phantom layer, flow was varied every 10 seconds in intervals of 2 mL/min up to a maximum 20 mL/min using the electronic controls of the syringe pump. The flow response and correlation to absorption values was then determined.
Fig. 2. Benchtop validation setup. The SPG instrument is placed on a tube with known flow. Silicone phantom layers of increasing absorption are placed around the tube to simulate varying skin types.
2.3 Clinical test protocol
A cross-sectional pilot study was conducted at an outpatient vascular clinic in Orange, CA. All measurements were performed with IRB approval (Western IRB, Pallyup MA). Any patient visiting for routine noninvasive arterial assessment was eligible for participation. The approved protocol was conducted in a vascular lab where SPG measurements were obtained during routine standard of care. Basic demographic information was collected from participants enrolled in the study who then received vascular testing and an SPG recording.
2.3.1 Demographics
Standard demographic information was collected and used to estimate skin melanin content. Participant classification groups included: White/Caucasian, Asian, Black/African American, and nonwhite Hispanic/Latino. Although the distribution of melanin content can overlap between classifications, mean differences in spectral intensity due to melanin volume fraction has been reported in the literature among the standard demographics [30,31]. To maximize statistical power, a binary classification with wider demographic groupings of lower melanin (White/Caucasion) and higher melanin (Asian, African American, and nonwhite Hispanic/Latino) was also performed.
2.3.2 Vascular tests
Patients were first acclimated for five minutes in a resting state according to standard of care for obtaining lower extremity pressure measurements [32]. Following the rest period, a 30-second SPG measurement was acquired from the great toe using the FlowMet device. This site was chosen based on its direct clinical applicability for patients with peripheral artery disease (PAD) where physicians seek to evaluate blood flow quality in the lower extremity digits. Mean flow data was calculated across the full length of the measurement. Toe pressure measurements were then obtained using standard pressure cuffs and a doppler probe to record pulses.
Because flow is proportional to toe pressure values for a given vascular resistance, toe pressure measurements were used to control for any demographic bias of blood flow values. For example, there may be significant correlations between demographic group and decreased toe pressure and blood flow values due to a higher prevalence of peripheral artery disease (or other natural physiological variability). Significant flow differences between groups that are not reflected in toe pressure are thus possible measurement errors arising from skin tone.
2.4 Statistical analysis
Quantitative variables are reported as mean and standard deviation (SD). Categorical variables are reported as frequency and percentage. The R2 value between flow measurements and syringe pump output was determined for each skin analog absorption value through a simple linear regression and compared. The correlation coefficient between skin analog absorption values and measured flow was also compared. Flow and toe pressure measurements taken from the clinical protocol were classified according to demographic breakdown as described above. Analysis of Variance (ANOVA) tests were performed for mean flow and toe pressure measurements within and between each ethnic group. An additional ANOVA test was conducted between the lowest melanin (white) and higher melanin (nonwhite) groups. Toe pressures were used to control for potential demographic bias of PAD prevalence.
3.1 Benchtop validation
Mean intensity absorption for each of the five skin phantoms tested showed normalized reductions of 41%, 55%, 73%, 78% and 90%. Flow response curves as measured by the SPG device for each of the skin analogs and the no-analog (0%) case are shown alongside the linear best fit of the aggregate data in Fig. 3(a). The fit was found to be highly linear (R2=0.99, p<0.01), in line with the specification provided by the manufacturer. Individual response curves for the five skin phantom cases showed no significant reduction in linearity (R2=0.996-0.999, p<0.01). Possible systemic bias between the flow response and skin phantom absorption values is visualized in the residuals plot in Fig. 3(b). Here, differences in recorded flow values from the best fit are plotted as a function of phantom absorption value at each flow rate. A second linear fit of the residuals plot found no significant linear correlation between the absorption of the skin phantom and measured flow (R2=0.025, p=0.29).
Fig. 3. Benchtop validation results. (a) SPG measurements (blue symbols) are plotted against known flow for skin phantoms of increasing absorption. The trendline (dashed red) demonstrated strong linearity (R2 = 0.99). (b) Residuals plot of flow values (blue circles) as a function of skin phantom absorption show no significant linear trend (dashed red; R2 = 0.025, p=0.29). *Indicates strong statistical significance (p<0.01)
3.2 Clinical validation
Of 100 patients seen at the vascular clinic, a total of 167 limbs were measured with both toe pressure and the FlowMet device. Thirty-three limbs were excluded from the study due to amputation, metallic nail polish, or inability to secure the clip or pressure cuff. Of these, six were found to have low intensity below manufacturer limits, with five classified as White/Caucasian and one as Asian. Of 167 limbs included, 139 were classified as White/Caucasian, 12 as Asian, 23 as nonwhite Hispanic/Latino, and 3 as African American. For the binary stratification, 139 were classified in the lower melanin subcategory and 28 in the higher melanin subcategory. Flow and toe pressure values classified into lower- and higher-melanin subcategories are shown in a box and whiskers plot in Fig. 4. The 4-way demographic ANOVA test of toe pressure and flow values yielded an F-value of 0.89 (p = 0.45) and 1.31 (p=0.27), respectively. The 2-way ANOVA test between low- and high-melanin groups yielded an F-value of 0.4 (p = 0.52) and 3.68 (p=0.06), respectively. Both tests indicate that the variability of flow and toe pressures between demographic groups was not significantly different from the variability within the groups.
Fig. 4. (a) Box plot of the measured flow values from the low- and high- melanin subcategories showing significant overlap. (b) Box plot of the measured toe pressure values from the low- and high- melanin subcategories showing significant overlap.
Benchtop and in vivo studies were conducted to determine the impact of turbid skin layers with variable absorption on SPG signals. Because SPG relies on transmission LSI, all photons that enter the detector have necessarily traversed the dynamic layer. Therefore, contribution of static skin layers to the speckle contrast image are not necessarily expected assuming adequate diffusion. The empirical approach taken herein appears to confirm this assumption: static absorbing layers were not found to have a significant effect on the accuracy of SPG signals.
In the benchtop test where SPG was compared against known flow in the absence of a skin phantom, the observed trendline R2 value was found to be nearly identical to prior literature (R2=0.99 vs R2=0.98) [15]. No decline in R2 was observed with the addition of increasingly absorbing phantom layers, indicating a lack of additive effects on contrast or substantial changes in the signal-to-noise ratio due to added absorber. Note that transmitted intensity through the darkest layer remained above the specified minimum of 20 counts. Below this level, shot and dark noise may become a concern, and the SPG signal to noise ratio may be reduced.
No systemic effects in the response curve of SPG were observed when additional absorption was added to the skin phantom layers. Specifically, as shown in Fig. 3(b), no significant linear trend is seen between measured flow rate and skin phantom absorption. This suggests a lack of correlation between increasing or decreasing skin absorption and residual error. The figure does show possibilities of positive or negative bias in the residuals of individual phantoms. The authors speculate this may be due to slight variations in placement between data acquisitions, which highlights the importance of properly clipping the probe to ensure full volume sampling.
The in vivo study appears to further corroborate the benchtop validation study. Participants classified by estimated melanin concentration did not show any significant difference in mean SPG according to two ANOVA tests. Toe pressure values were used as a control against participant selection bias. However, both toe pressure and SPG signals did not indicate bias according to the ANOVA results. There may be two factors that work to reduce the bias of SPG signal in vivo. For one, drawing on the benchtop results, SPG measurements appear to be agnostic to the absorption of static layers. Second, prior studies have found the relative weight of melanin absorption on transmitted intensity is reduced as the thickness of the sample is increased. For tissue thicknesses greater than 3 mm, the impact of melanin becomes trivial compared to absorption effects from hemoglobin and photon scattering [27]. This may be supported by examining subjects where the signal intensity was overly attenuated. Five of six digits excluded from the study due to low intensity levels were classified in the lower melanin subcategory. While the sample is small it suggests that characteristics other than melanin contributed to this reduction, for example abnormal digit shape or improper clip placement.
Limitations of this study may include the validity of the benchtop model and the accuracy of the demographic classifications in predicting skin type. In future work, the digit analog and skin phantoms may be improved by including a smaller network of randomized flow that better simulate human microvascular structure. Additionally, in vivo studies may benefit from a more rigorous classification of skin melanin, such as the Fitzpatrick scale, and the intra-group variability of melanin could be evaluated at the measurement site [33]. The toe was chosen as the measurement site based on its clinical applicability for physicians treating PAD. However, the nail bed and plantar aspect of the toe may contain less melanin than other regions of the body. Therefore, an interesting avenue of future study would be to examine SPG transmitted through sun-exposed skin folds or other areas with high relative melanin content.
A benchtop experiment of skin-simulating phantoms demonstrated that SPG measurements from transmission laser speckle imaging are not significantly affected by static scattering layers with variable absorption. In vivo data of individuals with differing skin melanin content appeared to empirically corroborate benchtop results that SPG is not significantly affected by melanin absorption in a study of 167 human subjects.
Laser Associated Sciences.
The authors thank the Vascular and Interventional Specialist of Orange County (VISOC) clinical staff for their support in data collection for the in vivo study.
At the time the research was performed the authors were full-time employees of Laser Associated Sciences and are now employees of Medtronic.
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27. L. Souza-Barros, G. Dhaidan, M. Maunula, V. Solomon, S. Gabison, L. Lilge, and E. L. Nussbaum, "Skin color and tissue thickness effects on transmittance, reflectance, and skin temperature when using 635 and 808 nm lasers in low intensity therapeutics," Lasers Surg. Med. 50(4), 291–301 (2018). [CrossRef]
28. S.-C. Jee, Y. S. Lee, J. H. Lee, S. Park, B. Jin, and M. H. Yun, "Anthropometric Classification of Human Hand Shapes in Korean Population," in Proceedings of the Human Factors and Ergonomics Society Annual Meeting, (SAGE Publications Sage CA: Los Angeles, CA, 2016), 1200–1204.
29. M. Klarhöfer, B. Csapo, C. Balassy, J. Szeles, and E. Moser, "High-resolution blood flow velocity measurements in the human finger," Magn. Reson. Med. 45(4), 716–719 (2001). [CrossRef]
30. G. Jori and D.-P. Hader, Biophysical and Physiological Effects of Solar Radiation on Human Skin (Royal Society of Chemistry, 2007).
31. T. Tadokoro, N. Kobayashi, B. Z. Zmudzka, S. Ito, K. Wakamatsu, Y. Yamaguchi, K. S. Korossy, S. A. Miller, J. Z. Beer, and V. J. Hearing, "UV-induced DNA damage and melanin content in human skin differing in racial/ethnic origin," The FASEB Journal 17(9), 1177–1179 (2003). [CrossRef]
32. M. D. Gerhard-Herman, H. L. Gornik, C. Barrett, N. R. Barshes, M. A. Corriere, D. E. Drachman, L. A. Fleisher, F. G. R. Fowkes, N. M. Hamburg, and S. Kinlay, "2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines," J. Am. Coll. Cardiol. 69(11), 1465–1508 (2017). [CrossRef]
33. S. Sachdeva, "Fitzpatrick skin typing: applications in dermatology," Indian J. Dermatol. Venereol. 75(1), 93 (2009). [CrossRef]
Article Order
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L. C. Rogers, L. A. Lavery, and D. G. Armstrong, "The Right to Bear Legs—An Amendment to Healthcare: How Preventing Amputations Can Save Billions for the US Health-care System," J. Am. Podiatr. Med. Assoc. 98(2), 166–168 (2008).
L. Norgren, W. R. Hiatt, J. A. Dormandy, M. R. Nehler, K. A. Harris, and F. G. R. Fowkes, "Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II)," Eur. J. Vasc. Endovasc. Surg. 33(1), S1–S75 (2007).
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P. A. Oberg, "Laser-Doppler flowmetry," Critical reviews in biomedical engineering 18, 125–163 (1989).
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J. Y. A. Foo and S. J. Wilson, "A computational system to optimise noise rejection in photoplethysmography signals during motion or poor perfusion states," Med. Biol. Eng. Comput. 44(1-2), 140–145 (2006).
D. A. Boas and A. K. Dunn, "Laser speckle contrast imaging in biomedical optics," J. Biomed. Opt. 15(1), 011109 (2010).
B. Choi, N. M. Kang, and J. S. Nelson, "Laser speckle imaging for monitoring blood flow dynamics in the in vivo rodent dorsal skin fold model," Microvasc. Res. 68(2), 143–146 (2004).
M. Ghijsen, T. B. Rice, B. Yang, S. M. White, and B. J. Tromberg, "Wearable speckle plethysmography (SPG) for characterizing microvascular flow and resistance," Biomed. Opt. Express 9(8), 3937–3952 (2018).
C. E. Dunn, B. Lertsakdadet, C. Crouzet, A. Bahani, and B. Choi, "Comparison of speckleplethysmographic (SPG) and photoplethysmographic (PPG) imaging by Monte Carlo simulations and in vivo measurements," Biomed. Opt. Express 9(9), 4306–4316 (2018).
C. E. Dunn, D. C. Monroe, C. Crouzet, J. W. Hicks, and B. Choi, "Speckleplethysmographic (SPG) estimation of heart rate variability during an orthostatic challenge," Sci. Rep. 9(1), 1–9 (2019).
J. R. Feiner, J. W. Severinghaus, and P. E. Bickler, "Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender," Anesth. Analg. 105(On Line Suppl.), S18–S23 (2007).
T. B. Rice, E. Kwan, C. K. Hayakawa, A. J. Durkin, B. Choi, and B. J. Tromberg, "Quantitative, depth-resolved determination of particle motion using multi-exposure, spatial frequency domain laser speckle imaging," Biomed. Opt. Express 4(12), 2880–2892 (2013).
J. K. Meisner, J. Niu, S. Sumer, and R. J. Price, "Trans-illuminated laser speckle imaging of collateral artery blood flow in ischemic mouse hindlimb," J. Biomed. Opt. 18(9), 096011 (2013).
J. Dunn, K. Forrester, L. Martin, J. Tulip, and R. Bray, "A transmissive laser speckle imaging technique for measuring deep tissue blood flow: an example application in finger joints," Lasers Surg. Med. 43(1), 21–28 (2011).
B. W. Pogue and M. S. Patterson, "Review of tissue simulating phantoms for optical spectroscopy, imaging and dosimetry," J. Biomed. Opt. 11(4), 041102 (2006).
J. L. Sandell and T. C. Zhu, "A review of in-vivo optical properties of human tissues and its impact on PDT," J. Biophotonics 4(11-12), 773–787 (2011).
F. Ayers, A. Grant, D. Kuo, D. J. Cuccia, and A. J. Durkin, "Fabrication and characterization of silicone-based tissue phantoms with tunable optical properties in the visible and near infrared domain," in Design and Performance Validation of Phantoms Used in Conjunction with Optical Measurements of Tissue, (International Society for Optics and Photonics, 2008), 687007.
L. Spinelli, M. Botwicz, N. Zolek, M. Kacprzak, D. Milej, P. Sawosz, A. Liebert, U. Weigel, T. Durduran, and F. Foschum, "Determination of reference values for optical properties of liquid phantoms based on Intralipid and India ink," Biomed. Opt. Express 5(7), 2037–2053 (2014).
L. Weiss, Cell and Tissue Biology (Urban & Schwarzenberg, 1988).
L. Souza-Barros, G. Dhaidan, M. Maunula, V. Solomon, S. Gabison, L. Lilge, and E. L. Nussbaum, "Skin color and tissue thickness effects on transmittance, reflectance, and skin temperature when using 635 and 808 nm lasers in low intensity therapeutics," Lasers Surg. Med. 50(4), 291–301 (2018).
S.-C. Jee, Y. S. Lee, J. H. Lee, S. Park, B. Jin, and M. H. Yun, "Anthropometric Classification of Human Hand Shapes in Korean Population," in Proceedings of the Human Factors and Ergonomics Society Annual Meeting, (SAGE Publications Sage CA: Los Angeles, CA, 2016), 1200–1204.
M. Klarhöfer, B. Csapo, C. Balassy, J. Szeles, and E. Moser, "High-resolution blood flow velocity measurements in the human finger," Magn. Reson. Med. 45(4), 716–719 (2001).
G. Jori and D.-P. Hader, Biophysical and Physiological Effects of Solar Radiation on Human Skin (Royal Society of Chemistry, 2007).
T. Tadokoro, N. Kobayashi, B. Z. Zmudzka, S. Ito, K. Wakamatsu, Y. Yamaguchi, K. S. Korossy, S. A. Miller, J. Z. Beer, and V. J. Hearing, "UV-induced DNA damage and melanin content in human skin differing in racial/ethnic origin," The FASEB Journal 17(9), 1177–1179 (2003).
M. D. Gerhard-Herman, H. L. Gornik, C. Barrett, N. R. Barshes, M. A. Corriere, D. E. Drachman, L. A. Fleisher, F. G. R. Fowkes, N. M. Hamburg, and S. Kinlay, "2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines," J. Am. Coll. Cardiol. 69(11), 1465–1508 (2017).
S. Sachdeva, "Fitzpatrick skin typing: applications in dermatology," Indian J. Dermatol. Venereol. 75(1), 93 (2009).
Arie Shlitner, M.
Armstrong, D. G.
Ayers, F.
Bahani, A.
Bakker, J.
Balassy, C.
Barrett, C.
Barshes, N. R.
Beer, J. Z.
Benjamin, E. J.
Bickler, P. E.
Blaise, S.
Bloch, P. H.
Boas, D. A.
Botwicz, M.
Boushel, R.
Bray, R.
Calbet, J. A.
Choi, B.
Corriere, M. A.
Cracowski, J.
Crouzet, C.
Csapo, B.
Cuccia, D. J.
DeMasi, R. J.
Dhaidan, G.
Dormandy, J. A.
Drachman, D. E.
Dunn, A. K.
Dunn, C. E.
Dunn, J.
Durduran, T.
Durkin, A. J.
Feiner, J. R.
Fleisher, L. A.
Foo, J. Y. A.
Forrester, K.
Foschum, F.
Fowkes, F. G. R.
Fredriksson, I.
Gabison, S.
Gayle, R. G.
Gerhard-Herman, M. D.
Ghijsen, M.
Goff, C. D.
Gonzalez-Alonso, J.
Gornik, H. L.
Grant, A.
Gregory, R. T.
Hader, D.-P.
Hamburg, N. M.
Harris, K. A.
Hayakawa, C. K.
Hearing, V. J.
Helge, J. W.
Hiatt, W. R.
Hicks, J. W.
Ito, S.
Jakobsson, A.
Jee, S.-C.
Jin, B.
Jori, G.
Kacprzak, M.
Kang, N. M.
Kinlay, S.
Klarhöfer, M.
Kobayashi, N.
Korossy, K. S.
Kuo, D.
Kwan, E.
Larsson, M.
Lavery, L. A.
Lee, J. H.
Lee, Y. S.
Lertsakdadet, B.
Liebert, A.
Lilge, L.
Lima, A.
Martin, L.
Maunula, M.
Meier, G. H.
Meisner, J. K.
Milej, D.
Miller, S. A.
Millet, C.
Monroe, D. C.
Moser, E.
Munch-Andersen, T.
Nehler, M. R.
Nelson, J. S.
Nilsson, G.
Niu, J.
Norgren, L.
Nussbaum, E. L.
Oberg, P. A.
Parent, F. N.
Park, S.
Patterson, M. S.
Pogue, B. W.
Price, R. J.
Reuven Kedar, B.
Rice, T. B.
Rogers, L. C.
Roustit, M.
Sachdeva, S.
Saltin, B.
Sandell, J. L.
Sato, D. T.
Sawosz, P.
Severinghaus, J. W.
Solomon, V.
Søndergaard, H.
Souza-Barros, L.
Spinelli, L.
Strömberg, T.
Sumer, S.
Szeles, J.
Tadokoro, T.
Tromberg, B. J.
Tulip, J.
Wakamatsu, K.
Weigel, U.
Weiss, L.
Wheeler, J. R.
White, S. M.
Wilson, S. J.
Yamaguchi, Y.
Yang, B.
Yun, M. H.
Zhu, T. C.
Zmudzka, B. Z.
Zolek, N.
Anesth. Analg. (1)
Ann. Vasc. Surg. (1)
Biomed. Opt. Express (4)
Critical reviews in biomedical engineering (1)
Eur. J. Vasc. Endovasc. Surg. (1)
Indian J. Dermatol. Venereol. (1)
Intensive Care Med. (1)
J. Am. Coll. Cardiol. (1)
J. Am. Podiatr. Med. Assoc. (1)
J. Appl. Physiol. (1)
J. Biomed. Opt. (4)
J. Biophotonics (1)
Lasers Surg. Med. (2)
Magn. Reson. Med. (1)
Med. Biol. Eng. Comput. (2)
Microvasc. Res. (2)
Sci. Rep. (1)
The FASEB Journal (1)
Trends Cardiovasc. Med. (1)
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text:
Fakultet for medisin og helsevitenskap (MH)
Institutt for sirkulasjon og bildediagnostikk
Bleeding after adult cardiac surgery: Clinical and genetic risk factors and effect of prophylactic treatment with tranexamic acid
dc.contributor.author Greiff, Guri
dc.identifier.isbn 978-82-326-0981-9
dc.identifier.uri http://hdl.handle.net/11250/2364430
dc.description.abstract Background: Postoperative excessive bleeding is still one of the most common complications in cardiac surgery and is associated with increased morbidity and mortality. Major bleeding is a partially modifiable risk factor, and adequate preventive treatment strategies should be used to reduce the incidence of this complication. Prophylactic drug treatments can reduce postoperative bleeding. Prediction modelling strategies can be used for identifying patients at higher risk of bleeding after cardiac surgery and thereby contribute to implementation of prophylactic therapies and early interventions. Genetic variation may contribute to postoperative bleeding after cardiac surgery, and genetic information could make the prediction of excessive postoperative bleeding more precise. Aims: The overall aim of the thesis was to contribute to better patient care through increased knowledge about postoperative bleeding and about the treatment of this complication in high-risk groups. More specifically, the aim in Study I was to investigate the effects of tranexamic acid on postoperative blood loss and transfusion requirements in elderly patients undergoing complex cardiac surgery. In Study II the aims were 1) to investigate if risk prediction for postoperative bleeding was possible using clinical variables, by validating the Papworth Bleeding Risk Score and by developing local risk prediction models, and 2) to compare the usefulness of the universal definition of postoperative bleeding proposed by Dyke et al with the definition used in the Papworth Bleeding Risk Score. In Study III the main aim was to validate some earlier identified genetic polymorphisms associated with bleeding after cardiac surgery, and to explore other functional polymorphisms central in the coagulation and fibrinolysis systems or in plateletmembrane receptors related to postoperative bleeding. A secondary aim was to evaluate the additional predictive ability with inclusion of genetic information in risk prediction models based only on clinical variables, thereby investigating whether genetic susceptibility is a clinically relevant factor for further studies. Methods: A prospective, randomized, double-blind, placebo-controlled, parallel-group trial was used to investigate the effect of tranexamic acid in patients, 70 years or older, undergoing aortic valve replacement (AVR) or coronary artery bypass grafting (CABG). For Study II and III we used a prospectively recorded local database. All patients included in the studies underwent cardiac surgery with cardiopulmonary bypass at St. Olavs University Hospital, Trondheim, Norway. The predictive ability of the Papworth Bleeding Risk Score was validated, using the universal definition of perioperative bleeding proposed by Dyke et al and the definition used to develop the Papworth Bleeding Risk Score. Clinical prediction models were constructed using multivariate logistic regression analyses, using the two mentioned endpoints. Genetic associations were performed using allelic association tests and logistic regression. Multivariate logistic regression was used to evaluate whether the genetic information could improve the model with clinical variables. Results: The total number of red cell transfusions given was significantly larger in the placebo group of elderly patients compared with the tranexamic acid group (5 vs. 3 respectively, p = 0.049). When using both the Papworth Bleeding Risk Score and the locally developed risk prediction models, the positive predictive value was low (0.15 and 0.12 respectively) in the high-risk group and the negative predictive value was high (0.98 and 0.95 respectively) in the low-risk group. We identified five significant SNPs associated with postoperative bleeding. Addition of the genetic covariates to a logistic regression model with clinical variables significantly improved the model (p<0.01). Conclusions: Tranexamic acid reduced the need for red cell transfusion in elderly patients undergoing combined AVR and CABG surgery. Neither the Papworth Bleeding Risk Score nor the locally developed risk prediction models were suitable for identifying the patients at high risk of severe postoperative bleeding after cardiac surgery, but could more precisely identify patients at low risk of bleeding. None of the two endpoint definitions for postoperative bleeding were clearly preferable. We identified five SNPs associated with postoperative bleeding. Inclusion of genetic information to a risk prediction model with only clinical variables improved the model, indicating that genetic predisposition is relevant for postoperative bleeding after cardiac surgery. nb_NO
dc.language.iso eng nb_NO
dc.publisher NTNU nb_NO
dc.relation.ispartofseries Doctoral thesis at NTNU;2015:162
dc.title Bleeding after adult cardiac surgery: Clinical and genetic risk factors and effect of prophylactic treatment with tranexamic acid nb_NO
PhD_Greiff_Guri.pdf
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Institutt for sirkulasjon og bildediagnostikk [1289]


Store reps very friendly and helpful.
I found the battery that I needed and he installed it in my watch for half of what they wanted at the jewelry store.
I was unaware of the wide selection of batteries the store offers! It is close to my office and I will use the store more often!
They have great quality and I love the support for all my battery needs. The personnel are very professional and helpful.


Moulded wild cherry wood secretaire fitted with a drawer, a fall front and two leafs. Engaged, fluted columns supports with tapered feet. Fall front sheathed with leather (damaged) concealing two pigeon homes, six drawers and a secret compartment.


text:
import { MensagemPage } from './../mensagem/mensagem';
import { UsuarioService } from './../../providers/service/usuario-service';
import { EmpresaService } from './../../providers/service/empresa-service';
import { CtdFuncoes } from './../../shared/ctdFuncoes';
import { MensagemService } from './../../providers/service/mensagem-service';
import { EmpresaVO } from './../../model/empresaVO';
import { Component } from '@angular/core';
import { NavParams, ViewController, Events, LoadingController, ModalController, ToastController } from 'ionic-angular';

@Component({
  selector: 'page-guia-contato',
  templateUrl: 'guia-contato.html'
})
export class GuiaContatoPage {

  public empresa: EmpresaVO = null;
  public exibirBtnEnviarMensagem:boolean = false;
  public toastAlert:any;

  constructor(private navParams: NavParams,
    private viewCtrl: ViewController,
    private mensSrv: MensagemService,
    private events: Events,
    private loadingCtrl: LoadingController,
    private emprSrv: EmpresaService,
    private mdlCtrl: ModalController,
    private usuaSrv: UsuarioService,
    private toastCtrl: ToastController) {

    this.empresa = navParams.get("empresa");
    this. verificarStatusBtnMensagem();
  }

  public discar(number: string) {
    CtdFuncoes.discarTelefone(number);
  }

  public openMensagem() {
    let self = this;
    let loader = this.loadingCtrl.create({
      content: 'Aguarde...',
      dismissOnPageChange: true
    });

    loader.present();

    let userCurrent = this.usuaSrv.getLoggedInUser();
    this.usuaSrv.getUserDetail(userCurrent.uid)
      .then((snapUserFrom) => {
        self.emprSrv.getUsuarioPorEmpresa(self.empresa.empr_sq_id)
          .then((snapKeyUserTo) => {
            if (snapKeyUserTo.exists()) {
              let chaveKey: string = Object.keys(snapKeyUserTo.val())[0];
              self.usuaSrv.getUserDetail(chaveKey)
                .then((snapUserTo) => {

                  let mensParam = {
                    usua_sq_logado: userCurrent.uid,
                    usua_sq_id_to: snapUserTo.key,
                    usua_nm_usuario_to: snapUserTo.val().usua_nm_usuario,
                    usua_sq_id_from: snapUserFrom.key,
                    usua_nm_usuario_from: snapUserFrom.val().usua_nm_usuario,
                    mens_nm_enviado: self.empresa.empr_nm_razaosocial,
                    mens_tx_logo_enviado: self.empresa.empr_tx_logomarca
                  };

                  let totalMensage: number = 0;
                  self.usuaSrv.getMensagens().then((snapMsg) => {
                    snapMsg.forEach(element => {

                      if (element.val() == true) {
                        totalMensage++;
                      }

                      self.events.publish('mensagem:nova', totalMensage - 1);
                    });
                  });

                  loader.dismiss();
                  let loginModal = self.mdlCtrl.create(MensagemPage, mensParam);
                  loginModal.present();
                });
            }
            else {
              loader.dismiss();
              self.createAlert("Ops!!! Não existe usuário para está empresa.");
            }
          });
      });
  }

public verificarStatusBtnMensagem() {
    this.exibirBtnEnviarMensagem = false;
    let usuaEmprKey: string;
    let userCurrent = this.usuaSrv.getLoggedInUser();

    this.emprSrv.getUsuarioPorEmpresa(this.empresa.empr_sq_id)
    .then((snapKeyUserTo) => {
        if (snapKeyUserTo.exists()) {
          usuaEmprKey = Object.keys(snapKeyUserTo.val())[0];

          if (this.empresa.empr_in_mensagem == true
            && userCurrent.uid != usuaEmprKey) {
            this.exibirBtnEnviarMensagem = true;
          }
        }
        else {
          this.exibirBtnEnviarMensagem = false;
        }
      });
  }

  createAlert(errorMessage: string) {

    if (this.toastAlert != null) {
      this.toastAlert.dismiss();
    }

    this.toastAlert = this.toastCtrl.create({
      message: errorMessage,
      duration: 3000,
      position: 'top'
    });

    this.toastAlert.present();
  }

  dismiss() {
    this.viewCtrl.dismiss();
  }
}


Rare opportunity to own a large single family home owned by the same family for over 60 years. The first floor has a formal living room with bow windows looking out onto East Broadway, The 12 foot ceilings are adorn with intricate crown molding and a plaster medallion. Opposite the windows is a beautiful original marble mantel. The Dinning room has the same crown molding, and medallion and another marble mantel. Original hardwood floors throughout. The kitchen floods with natural sunlight in the morning and stays bright throughout the day.There is a deck off the kitchen that leads to the backyard. The second floor has 2 extra large bedrooms with 10 foot ceilings and crown molding and one full Bathroom. The third floor has 3 more bedrooms and an office and 9 foot ceilings. The unfinished basement has an additional 800 sq feet with 8 foot ceilings and a separate entrance. There is lots of potential for this space. This is a must see home with lots of period details.
There may be an option to rent parking separately across the street. Call listing agent for details.
Listing courtesy of Cosmopolitan Realty Advisors.


Ruffles and tunic length tops are some of the most feminine things about fashion this season. Get ready to get noticed.
This Long Sleeve Layered Tunic Top from Beaded Creations is designed for high-volume presence.
Tiered pleats and ethereal fabric adds an extra swing to every step.
Pair with your favourite pair of jeans, or just wear as a mini dress.
Soft material easy to wear, pull over style.
Versatile design that can be worn as a dress or tunic top.


The statutory registers of divorces, of civil partnerships and of dissolutions of a civil partnership are indexed by personal name. Images of the register entries are not available to view online in accordance with the National Record of Scotland's policy on protecting the privacy of individuals.
To order a certificate for offical or legal purposes please go to certificates and copies for guidance about online ordering.
Divorces, civil partnerships and dissolutions are record types in the advanced search record category statutory registers. Search results include an order certificate option.
Prior to 1 May 1984 divorces in Scotland, of couples who had married in Scotland, were recorded in the Register of Corrected Entries. The record guide statutory register of marriages includes an example. For information about the related court papers and a history of divorce in Scotland please go to the divorce and separation records guide on the National Records of Scotland website.


text:
Home World Travel between Britain and France resumes amid truck congestion
Travel between Britain and France resumes amid truck congestion
It will take days, however, to move the thousands of freight trucks stranded on the British side of the English Channel as the drivers are all tested.
British Home Secretary Priti Patel tweeted Wednesday that mass testing has begun and that the "priority is to get lorries moving." She urged people to avoid traveling to Kent due to major congestion, saying that an increase in travelers now "will slow things down."
Housing Secretary Robert Jenrick estimated that at least 4,000 trucks were parked around the Kent region and said the military would manage testing sites, including one at Manston airport where many of the trucks are located.
"It's a significant number to work through. . . . I think it will take a few days," he said to Sky News.
TV footage showed angry drivers scuffling with police and honking their horns in protest after being stranded for days, often far from even the most basic hygienic facilities. Many now face the prospect of missing Christmas with their families.
In interviews with local television, truckers picketing the port town of Dover said there was no movement, no apparent testing and no facilities provided for them.
"What we've got this morning is very, very angry truckers in Dover," Rod McKenzie of the Road Haulage Association told the BBC. "They're tired, frustrated, desperately want to get home for Christmas."
Kent Police tweeted Wednesday that they have responded to "disturbances in Dover and Manston this morning involving individuals hoping to cross the Channel" and made one arrest.
In his morning television appearances, Jenrick also said there were no shortages of food at supermarkets and urged everyone to avoid panic-buying. Many locations have reported empty supermarket shelves.
Britain's main supermarket chains, Tesco and Sainsbury's, however, warned on Monday that some fresh food could run out if freight did not start moving soon. Late Tuesday, Tesco announced the rationing of certain products in an email to customers, including toilet paper, rice, soap and eggs, to ensure there would be enough for everyone.
Britain's newspapers, meanwhile, were dominated with images of thousands of trucks lined up in Manston, amid reports that more of the country could go into harsher lockdowns as soon as Saturday to stop the spread of the virus. While Jenrick would not comment on any plans, he did tell the BBC that the new variant was spreading and a "game-changer."
The announcement by British Health Secretary Matt Hancock on Sunday that a new mutant variant of the coronavirus could be even more contagious and was "out of control" in the country prompted swift travel bans from much of Europe and dozens of countries abroad.
France was unique in banning freight across one of Europe's busiest travel corridors, a step that Jenrick on Wednesday singled out as "relatively unusual."
British officials tightened restrictions in some regions, closing all nonessential businesses such as shops, restaurants, gyms and salons.
Amid the sudden enforced isolation from the rest of the world — which comes as Britain is attempting to negotiate the terms of its future relations with the European Union — much of the country is experiencing a harsh new lockdown coinciding with Christmas and the banning of most gatherings.
As many European countries rushed to impose new rules on travelers from Britain, the European Commission on Tuesday urged member states to coordinate their response and lift bans on flights, trains and freight, citing "the need to ensure essential travel and avoid supply chain disruptions."
Some countries chose to move forward with bans anyway. Germany and Ireland extended their bans, and Hungary has barred passengers flights from Britain until February. On Wednesday, Singapore and the Philippines announced they, too, would ban flights from Britain.
Belgium, meanwhile, said essential travelers from Britain would be allowed to enter between Dec. 23 and Jan. 1. Starting Dec. 25, however, all nonresidents will be required to present evidence of a negative PCR swab conducted within 48 hours of their arrival in Belgium.
The Netherlands also eased its ban, requiring a negative PCR test for passengers arriving from Britain or South Africa, where a similar variant has been detected.
Siobhán O'Grady contributed to this report.
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