Companies have a lot of data. They are collecting it in massive quantities… petabyte by petabyte. To put that into perspective, 1 petabyte = 1 million gigabytes (GB) or 13.3 years of HDTV video or over 58,000 movies. All this data gets stored in these massive server farms or in the cloud. And there it shall rest, never again to see the light of day as more and more data gets dumped on top of it — a virtual big data graveyard.
What Is a Data Graveyard?
Data graveyards are giant repositories of unused data. They are pervasive around the world. A Network World interview revealed that some companies have spent "multiple millions" on data lakes that turn into data swamps from lack of use.
CIOs are now getting called to task for delivering a return on investment on their data. In TechRepublic, Mary Shacklett calls these "Where's the beef?" moments.
Yet oftentimes for big data projects, the measurement of success is simply successful IT execution. That just won't cut it. Don't get me wrong, it's very important to start collecting and storing mass amounts of data that you believe will help inform critical business decisions in the future. Without that data, you simply can't move forward.
Nevertheless, once your company has hit the maturity level of having the systems in place to collect, store, and query that data, it's time to move on and do something valuable with it.
You have to ask yourself: Are you getting the most from your data?
What do I do with this data? That's precisely where organizations get stuck. At this point, it can get even trickier, because you've brought in a room full of data scientists to figure out how to uncover value.
What seemed like a simple project at the beginning now turns into a discussion about machine learning, artificial intelligence (AI), K-means clustering, regression analysis, supervised learning, and so on. These are all important things that will undoubtedly form part of your strategy, but should not necessarily be the starting point.
You're not going to start on a black diamond if you're just learning to put on a pair of skis.
First you need to shift from "thinking broadly" to "thinking specifically." Identify a specific high value problem in your organization, and work iteratively through an approach to solve it.
Case in point, Geotab collects over 1.5 billion raw records on a daily basis. In fact, if you accumulate all of the kilometers driven by the vehicles we manage, in one month's time you would travel over 10 Astronomical Units (that is 10 times the average distance from the earth to the sun!) So, how does one start "simply" with so much data.
To find the "beef" in your big data, start with a simple question and try not to get distracted by the noise. Work with stakeholders who are committed to solving this problem with you.
You may already know what your top challenge is, but if you don't, here are some ways to get started.
Is there a particular area of your business you need to improve such as customer service or delivery times?
Are your team members spending too much time or resources on something that should be faster or easier to achieve?
Recommended Read: Find out how one company leveraged their big data in this white paper Fleet Benchmarking with Telematics.
Example: Where Are My Customers?
Take for example a company that spent many hours each month on geocoding. For those unfamiliar with the term, geocoding is the process of taking an address and turning it into its corresponding latitude and longitude coordinates.
So, let's say your customer is a golf club. Google might correctly say that the address is at 123 Main Street. In actual fact, the delivery location for the golf club is 1 km down the road at the clubhouse. Geocoding discrepancies can occur when there is a difference in the corporate street address and delivery point or when there has been a data entry error.
Example map showing actual vehicle destinations discovered from big data clustering of fleet data.
If you're creating routes for your drivers, your routing algorithm will rely on the fact that you know where your customers are and have provided accurate coordinates for them. If this is not the case and your customer locations are not on point, not only will your drivers be confused during delivery, but you will undoubtedly have un-optimized routes leading to late delivery times, missed delivery windows, and unnecessary fuel waste.
If you don't know where your delivery trucks should be stopping, it becomes very difficult to know when they were there. You can't run the necessary analytics to determine if systemic issues exist and in turn optimize that performance. Are deliveries taking too long? Is there more back-door congestion from other delivery vehicles delivering to a store at certain times of the day? You will never know.
There was one simple question that needed to be answered: Where are my customers?
Yet, answering this one simple question could lead to significant returns for them both in terms of productivity and customer satisfaction. If you're a small enough company, this may not be a big data problem, but if you've got thousands of vehicles making deliveries and new customers added daily, it can quickly turn into an issue.
To solve this issue, we examined a year's worth of driving data to identify where each vehicle was actually stopping on each of their routes. Over the course of a year, we generated a series of points in clusters. We then grouped those clusters using scikit-learn's implementation of Density-Based Spatial Clustering of Applications with Noise (DBSCAN).
This allowed us to remove any outliers from our analysis and to generate a bounding box that was essentially the zone in which the driver actually stopped for the customer. Comparing this data to the manifest allowed us to correlate the specific stop to a customer.
We found that for several delivery hubs, over 15% of the customers differed by 500 metres or more from their planned stop location (some by up to 20 km due to poor geocoding).
As you can well see, answering a simple question like "Where are my customers?" can have a dramatic effect on your business. Correcting the geocoding is a stepping stone to improving productivity, fuel savings, and customer satisfaction.
This is just one example of how you can find value in your big data. A big data graveyard can actually be a goldmine for your business, but only if you ask the right questions.
Is Your Fleet Ready for Big Data & Advanced Analytics?


There was a time when the Israeli government was involved in gathering Jewish children from primitive countries and resettling them in Eretz Yisrael (the Holy Land). First, however, the children were brought to refugee camps in Europe where they were supposed to make a transition to Western culture.
When the children were served their meals, in front of them was a full place setting - a plate, a cup, and silverware. The only problem was that these children had never seen silverware before and they didn't know what to do with them. Then, one boy picked up his fork and put a piece of paper in the prongs and started blowing on it. With this, he made a little harmonica. The other children saw and they all figured out what this fork must really be for - making a harmonica - and they all did the same thing.
Everything in this world was created and designed for a purpose. Yet a person can always invent his own way of using whatever he wants. But this is not the real purpose. The real purpose is revealed to us through G-d's Torah.
Torah in general, and Chasidic philosophy especially, describes the true objective behind everything in this world, for the world itself and for ourselves. The Sages say that the only reason gold was created was to be used in the Holy Temple. The fact is, gold has also been used for many other purposes: good functions, holy purposes, mundane things and even idolatry. Nevertheless, the Sages tell us that none of that is the real purpose of gold. Gold was created only for the Temple.
Many years ago, people in the religious community asked the Rebbe how he could instruct his Chasidim to broadcast Torah on the radio when radio is a vessel for so many negative messages. They felt that perhaps radio was a contaminated medium. The Rebbe expained that if something was created and exists in this world, then G-d wants us to have it for a purpose. That purpose is the making of this world into a dwelling place for Him. The radio was really only created for disseminating Torah and making the world a more holy place.
This is the true purpose for everything - that we make the world a fitting place for G-dliness to be seen by the physical eye. This should be immediately through the revelation of our righteous Moshiach.
Rabbi Goldberg is the dean of Hadar HaTorah Yeshiva in Brooklyn, NY.
This week's Torah portion, Emor, contains the verse: "You shall bring the omer of the first of your harvest to the kohen [priest]." This refers to two types of mincha offering that were brought in the Holy Temple in Jerusalem: the omer offering, which was brought on Passover, and the "two breads" of Shavuot.
The omer offering officially allowed the new harvest to be eaten. Before the omer was brought, it was forbidden to eat from the new crop of grain. Even afterwards it was forbidden to bring offerings of new grain until after the "two breads" was offered on Shavuot.
There was, however, a difference between the two prohibitions. If an offering of new grain was brought before the omer, it was invalid. But if it was brought after the omer but before the "two breads," it was considered kosher "after the fact," even though it was originally prohibited.
The omer offering consisted of barley, which the Talmudic Sages deemed "foodstuff for animals." The "two breads" consisted of wheat, "the foodstuff of man."
The various offerings in the Holy Temple are symbolic of our offering up to G-d the different components of our soul. The omer symbolizes the offering of the "animalistic" part of us, the "animal soul." The "two breads" is symbolic of the elevation of the component that makes us "man," the "G-dly soul."
This helps explain why it was forbidden to eat from the new grain before the omer was brought: Before a person has worked on and refined his animal soul, he cannot even think about refining the world around him. Not only will he not have a positive effect, but he is liable to deteriorate even further. The first step is to subjugate oneself to G-d before turning outward.
After the animal soul has been refined a person can then proceed to the second step, i.e., the elevation of his G-dly soul. The offering of new grain was technically prohibited until Shavuot.
This also helps explain why one prohibition was absolute whereas the other was not. Subjugating the animal soul is a basic requirement in the service of G-d. Once a person has refined his lowest inclinations, the attempt to achieve higher spiritual levels only relates to perfecting that service. So even if a person "jumped the gun" and brought an offering of new grain before Shavuot, it was still valid "after the fact," as he already possessed the minimum level of sanctity.
In April 1945 the Nazis gathered Jews from all of the work camps in Austria and marched them for ten days, with no food and no water. Whoever could not walk was shot. Just before the United States Army came upon the surviving Jews the Nazi soldiers fled, abandoning their "workers."
A U.S. Army captain slowly drove his Jeep through the breathing bones and ghostly bodies of the remnants of so many flourishing Jewish communities. The captain had seen the ugly side of battle for three years, but he was unprepared for this scene. He stopped in front of Zalman Beim and his two sons, 21-year-old Salek and 16-year-old Zushik, and spoke to them in Yiddish.
"I'm a Jew born in the United States. But my father was born near your hometown of Krasnow." He discovered that the Beims were relatives. The captain had a troop to lead but these dying men were his kin. He drove them in his Jeep to the hospital in Lambach, Austria, and wrote a letter on official U.S. Army stationery requesting that these three men be given the best medical treatment. Zalman was diagnosed with tuberculosis and his two sons suffered from typhus. The nuns at this Catholic hospital gave Zalman all of the available treatments but penicillin was not yet on the market. After two months, Salek and Zushik recovered and were discharged from the hospital. An Austrian officer, Colonel Anton Pokorny, took them into his own home and "adopted" them as part of his family. The two brothers worked at various day jobs and visited their father in the evening.
"Please don't let me die here with this tzelem (graven image) above my head," their father would moan at each visit.
After six months in the hospital and no significant improvement in their father's health, the brothers hired two ambulance scooters to transfer their father to a sanatorium in northern Italy that was known for treating tuberculosis. The two scooters reached the Italian border town of Bolzano and took two rooms for the night at an inn. For the first time in six months, Zalman laid on a bed without a tzelem hanging over his head.
"If I die in Italy, please promise that someday you'll remove my bones and bury them in Eretz Yisrael (the Land of Israel, at the time known as Palestine)."
That evening, the soul of Zalman, the son of Yisrael, departed. The brothers saw to it that their father was given a kosher burial in Bolzano, with a small tombstone marking his gravesite. The two brothers no longer had a reason to remain in Vienna with their adopted family, and they went to Salzburg. The two boys kept in touch with the Austrian officer, their adoptive non-Jewish father, until he passed away in 1975.
On Monday, February 19, 2001, 77-year-old Salek Beim, now a married man and the father of four grown children and about a dozen grandchildren, followed a routine that he had been following more or less for about 30 years.
Up at 3:30 a.m., Salek studied from three Jewish books (Mishna, Tanya and Chumash), drove to a local morning service in Morristown, New Jersey, and set out the prayer books and prayer shawls for the rabbis and whoever was on his list.
Rarely did he ask anything for himself except that lately he needed help putting on his overcoat. However, on that morning, he asked for an aliya to the Torah reading.
On Tuesday, he repeated his usual routine. As always, he smiled and ribbed his younger congregants. "Oy, what's the use of complaining? You would think Hashem would give me a break," said Salek, or some variation of that theme. That afternoon, his son Dr. Danny Beim, took Sal for some tests and shortly after Sal's soul left his body.
During the week of shiva, Zushik shared with me the painful story of his family's Holocaust experiences. On the Thursday night after Zushik told this story, the phone rang at Sal Beim's home. "May I speak with Sal Beim?" an older woman with a European accent asked Mrs. Beim when she answered the phone.
"Sal is not here right now, but his brother Zushik is visiting from Israel," said Sal's widow, not wanting to shock anyone who didn't yet know of Sal's passing.
About an hour after Mrs. Beim received the phone call, I telephoned to say good-bye to Zushik.
"You wouldn't believe who Zushik has been speaking to on the phone for the past hour," the Beims' daughter Betty said.
It was Katya Pokorny, the daughter of the Austrian officer. For 30 years Katya had been looking for her Jewish adopted brothers, her only living family. Three years ago, Katya searched through her father's boxes and found an address book with Salek and Zushik's addresses in the United States and Israel, respectively. The phone numbers and addresses were old; the numbers had been disconnected and letters she wrote were not forwarded to any new addresses.
On Thursday evening, March 8, 2001, Katya's friend called her. "I found a phone number on the Internet for Salek Beim."
Katya called the Beim home, having convinced herself that they would want to hear from their non-Jewish Austrian "stepsister."
Zushik told me about the mini-reunion that had taken place over the phone just before I spoke to him. I recalled that that night was the seventh day of the Jewish month of Adar, the birthday and yartzeit of Moses. Surely this was providential.
I imagined that in the "World of Truth" Salek had been invited to attend a heavenly gathering. In my musings, Moses said to Salek, "L'Chaim, to eternal life, Reb Salek. May I give out your phone number? A righteous Austrian woman has been pleading for your number for 30 years..."
Debbie Solomon is a reluctant big sister, champion swimmer and math class misfit. She has a whole circle of friends who can empathize with her dread over her upcoming Bat Mitzvah. Join Debbie at her first Bat Mitzvah Club meeting (her mother enrolled her as a "surprise"), on a special visit with her grandmother where she learns a family secret, and as she becomes obsessed with a research report assigned by her English teacher. As Debbie's Bat Mitzvah approaches, she is in for a real surprise! Written by Shayna Meiseles, created by Esther Frimerman (founder of the international Bat Mitzvah Club) and published by Kehot Publications.
The story of Lag b'Omer, as related in the Gemoroh, is well known. Our Sages tell us that the disciples of Rabbi Akiva were stricken by a plague because they were not respectful towards one another. But on the thirty-third day of Sefirah [counting the Omer] - Lag b'Omer - the plague stopped.
As in the case of all stories of the Torah, which are also part of the Torah, meaning "instruction," the story of Rabbi Akiva's students contains a lesson for each and every one of us, particularly pupils, boys and girls.
To begin with: Since the Gemoroh testifies that they were "disciples of Rabbi Akiva," it is clear that they were worthy of this title. This means that they were dedicated to the Torah and Mitzvos with devotion, diligence and Mesiras Nefesh (self-sacrifice), as the great Tanna and exalted Sage had taught them.
It follows that their lack of respect for one another could not have been due to trivial matters, but was motivated by the high level of their spiritual standing as "disciples of Rabbi Akiva."
The explanation of their conduct is to be found in the saying of our Sages, of blessed memory, that people generally have different minds and different concepts. Each individual has therefore his own approach in serving G-d, studying the Torah and observing the Mitzvos with "Hiddur" [in an enhanced manner]. For example, one person may do it primarily out of love for G-d, another person may do it primarily out of fear of G-d, a third may do it primarily out of a sense of complete obedience and submission to the Will of G-d and so forth, though in actual practice, all of them, of course, fully and meticulously observe the Torah and Mitzvos in the daily life.
Now, being disciples of Rabbi Akiva, they were surely "men of truth," who served G-d with the utmost sincerity and devotion, which permeated their whole being. Thus, it seemed to each one of them that his particular approach was the right one, and anyone who had not attained his level was lacking in perfection.
Moreover, being disciples of Rabbi Akiva, who taught, "Thou shalt love thy fellow Jew as thyself - this is the great principle of the Torah," they were not content personally to advance from strength to strength in their own way of serving G-d, but they wished to share this with their friends and tried to influence them to follow their path. Seeing that the others were reluctant to accept their particular approach, they could not respect them to the degree that was to be expected of the disciples of Rabbi Akiva.
Serving G-d, studying the Torah and observing the Mitzvos, both the Mitzvos between man and man, and the Mitzvos between man and G-d, must be perfect with true inspiration and vitality, which permeate the whole of the person and his daily conduct.
The above includes, of course, the great Mitzvah of V'Ohavto L'Reacho Komocho (love your fellow Jew as yourself), which must also be fulfilled with the utmost vitality and in the fullest measure.
Together with the above, a person must look kindly and most respectfully upon every Jew who is fully committed to all the Torah and Mitzvos but differs only in the manner of worship, whether it is out of love, or out of reverence, etc.
May G-d bless each and every one of you, in the midst of all our people Israel, that you should live and act in accordance with the spirit of Lag b'Omer, as mentioned above, and that you should do so with the utmost measure of true Ahavas Yisroel, with joy and gladness of heart; and that you should go from strength to strength in all your affairs, to hasten the realization of the words of the (Lag b'Omer) week's Sidra [Torah portion]: "I will break the bars of your yoke (in exile) and make you go upright ," - in fulfillment of the true and complete Geulo [Redemption], through our righteous Moshiach.
By this prohibition we are forbidden to plant grain or vegetables in a vineyard. This form of kilayim (mixed seeds) is called "mixed seeds in the vineyard," and is contained in the Torah's words (Deut. 22:9): "You shall not sow your vineyard with two kinds of seed."
Today, Friday, is Lag B'Omer, a day that is associated with the disciples of Rabbi Akiva. Because they weren't respectful enough of one another they were afflicted with a terrible plague. On Lag B'Omer they were moved to correct their conduct, and the plague was interrupted. For this reason Lag B'Omer has ever since been celebrated as a day of rejoicing.
From this we learn the importance of strengthening our love for our fellow Jews. Treating one another with respect prevents undesirable things from happening, and causes us to merit G-d's blessings. When we base our lives on a foundation of love and kinship, G-d responds by granting us an abundance of goodness.
Lag B'Omer is also the day when Rabbi Shimon Bar Yochai passed away. One of the greatest disciples of Rabbi Akiva, he declared Lag B'Omer to be the day of his rejoicing, as he had completed his Divine mission in the world: to reveal esoteric facets of Torah that had remained hidden up until his time.
For many years after the Torah was given its revealed aspects were sufficient, whereas the more mystical portions remained beyond our compre-hension. But with the passage of time, the Jewish people began to encounter difficult periods. G-d knew that in order for Jews to be able to withstand adversity and continue to observe Torah and mitzvot, an additional source of strength was necessary. He therefore granted Rabbi Shimon Bar Yochai permission to reveal the Torah's more secret aspects.
As Jews, we are supposed to emulate G-d's behavior. Just as G-d revealed the inner secrets of His Torah as a kindness to His people, so too must we be willing to give of ourselves and expend any effort for the sake of another Jew. A token gesture of help is insufficient; all of our inner resources must be utilized when it comes to helping our fellow Jew, and offered with devotion and love.
According to Rashi, the Torah's wording is redundant in order to warn adult kohanim with regard to minors, i.e., they should be careful that their children not become impure. Another interpretation: The "adults" should make sure that the "minors" (the orphans left behind by the dead person) are still provided with their needs.
Said the Torah before the Holy One: "Master of the Universe! What will happen when the Jewish people enters the Land of Israel? Everyone will be busy plowing and planting, and what will become of me?" Replied the Holy One, Blessed be He: "I will give you a mate, the Sabbath, a day on which the Jewish people will be idle from their work. On that day they will gather in the synagogues and study halls and involve themselves in Torah."
According to tradition Rabbi Shimon Bar Yochai passed away on Lag B'Omer, tremendously joyful on account of the Torah's secrets he had merited to reveal, which were written in the Zohar. Lag B'Omer thus came to be celebrated as a "yom hilula" (literally a wedding feast), a joyous occasion. Accordingly, even though it is customary to mark the anniversary of the passing of a righteous person by fasting, Lag B'Omer is a time of jubilation, for such was Rabbi Shimon Bar Yochai's wish. We invoke his G-dly memory and pray that his light illuminate all of Israel.
As he approached Chernobyl the Chasid was in a happy mood. And why not? Silently he counted his blessings: a loving wife and children, a flourishing business, and soon he would be in the presence of his holy Rebbe, the famous Rabbi Mordechai of Chernobyl.
With these thoughts in mind he was enjoying the scenery when suddenly, he spotted a poor Jew trudging along with a bundle on his shoulders. Stopping the carriage he offered the traveler a lift, which was gratefully accepted.
"Are you one of Mottele's Chasidim?" the stranger persisted. "Yes," the man replied curtly in an attempt to end the conversation. "What chutzpa!" the Chasid thought to himself. Under other circumstances he would have put this impudent clod in his place, but he had no wish to ruin the journey further.
But the stranger was clearly in the mood to talk. "How do I know that you're really a Chasid?" he inquired. The Chasid was very surprised by the question and said nothing. "A man is measured by his deeds, and especially by his pocket," the stranger continued. "I'll tell you what - if you will pay me the 20 gold coins your Rebbe owes me, I will believe that you are a Chasid."
The Chasid took out the promissory note and inspected it even more closely, but again could find no fault with it. By that time, however, he realized that he had arrived in Chernobyl. With more important things to attend to he slipped the note back into his snuffbox and promptly forgot about it.
It was a busy Friday when he arrived, and Chernobyl was filled with hundreds of other Jews who had come to bask in the Rebbe's presence. Shabbat was spent in a state of spiritual elevation. To the Chasid, the opportunity to pray with the Rebbe and hear his words of Torah was nothing less than a foretaste of the Garden Eden.
From that day on, each year during his annual visit the Chasid gave the Rebbe 20 gold coins for the hidden tzadikim. And for the rest of his life he hoped to meet stranger again, but it never happened.
It is recorded in the holy Zohar that Rabbi Shimon Bar Yochai was told, "With your book [the Zohar] the Jewish people will go out of exile with mercy." This means that by studying the Zohar, along with the explanations of Chasidut, we will merit the true and final Redemption, very very soon.


As the name of the gloves suggests, the Briers Sage Warm All Seasons Gardening Gloves B6301 are ideal for tending to your garden no matter what time of year it is. The extra thick liner helps to keep hands feeling snug and warm, while the rippled latex coating on the palms and fingers provides quality grip in both wet and dry weather conditions. The the elasticated cuff helps to keep out dirt and debris during even the messiest of weeding or seeding jobs, allowing you to work well with reliable protection and dexterity.
The Briers Sage Warm All Seasons Gardening Gloves B6301 are available in a single size that should be suitable for most users. Please measure the circumference of your hand around the knuckles (excluding the thumb) with your hand open and your fingers together, and the length of your hand from the tip of your middle finger to your wrist.


Get more money out of each drink and invest that cash back into your business by easily integrating Tidal into your existing POS. We're compatible with almost all major systems including Aloha, Micros, NCR, and more, and our payment processing solutions are designed to save you money while making your life easier. Upgrading to EMV compliance is quick & painless — reduce chargebacks and offer more security to your customers with the minimum amount of downtime necessary.
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Q: Lightning strike causes fast download? Ok, REALLY strange question.
My friend says he was downloading a 14 GB file at about 1 mb/s when suddenly there was a lightning strike outside and momentarily the download speed jumped to 10,000,000 GB/s. The file finnished downloading.
He even has the screenshot to prove it. I also trust him and don't believe that he would be lying.
So my question is: how is this even possible?? Is there just the possibility that the file was about to finish downloading anyway and the lightning strike coincided with a freak download speed calculation error?

A:
So my question is: how is this even possible??

This is easily achieved by doing the following:

*

*Start a download

*Make the download window visible

*Press the PrtSc key

*Open up MS Paint by pressing the Windows key + R, then type mspaint and press ENTER

*Press CTRL-V

*Click "Select" on the ribbon, then "Rectangular Selection" from the drop down

*Precisely draw a rectangle around the download window within the image, then press Crop

*Where the download speed is shown in the image, use the "Rectangular Selection" tool to copy and paste numbers in the area until a quantity of around 10,000,000 GB/s is shown.  You may need to use the text tool to generate other numbers and the G in GB.

*Save the screenshot

You'll then have a screenshot displaying a speed of 10,000,000 GB/s.  It may take some practice to get it to look like the official download window, but certainly possible.

A: One possible (non-lying) way this can happen is if whatever software your friend was using does not handle interrupted downloads well.
If there was a large amount of data left and the lightning strike took down your friends internet the program he was using could have mistakenly thought the download was "Done". So the speed calulator seeing your progress instantly jumping from maybe 1 GB to "Done" it decided to take size of the jump as "progress"
After that it is just a matter of dividing a big number (13 GB of progress) by a tiny number (1.3 microseconds) which gives you a huge number (10,000,000 GB/s).
But honestly, I think ultasawblade's answer is more likely.

redpajama_set_name: RedPajamaStackExchange


Ebrahimzadeh, F. (2016). Poly(N- bromosuccinimide) (PNBS) as a mild, efficient, non-acidic, polymeric and heterogeneous catalyst applied for easy conversion of epoxides into thiiranes by treatment with KSCN or (NH2)2CS at room temperature. Physical Chemistry & Electrochemistry, 4(2), 119-123.
Farzaneh Ebrahimzadeh. "Poly(N- bromosuccinimide) (PNBS) as a mild, efficient, non-acidic, polymeric and heterogeneous catalyst applied for easy conversion of epoxides into thiiranes by treatment with KSCN or (NH2)2CS at room temperature". Physical Chemistry & Electrochemistry, 4, 2, 2016, 119-123.
Ebrahimzadeh, F. (2016). 'Poly(N- bromosuccinimide) (PNBS) as a mild, efficient, non-acidic, polymeric and heterogeneous catalyst applied for easy conversion of epoxides into thiiranes by treatment with KSCN or (NH2)2CS at room temperature', Physical Chemistry & Electrochemistry, 4(2), pp. 119-123.
Ebrahimzadeh, F. Poly(N- bromosuccinimide) (PNBS) as a mild, efficient, non-acidic, polymeric and heterogeneous catalyst applied for easy conversion of epoxides into thiiranes by treatment with KSCN or (NH2)2CS at room temperature. Physical Chemistry & Electrochemistry, 2016; 4(2): 119-123.


Bringing a growing oil and gas company online.
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Building trust and personality with a loyal following of boaters.


text:
Q: Replacing string regex python not working The program should get each of these punctuation characters replaced by that character surrounded by two spaces.
I tried this:
sent = re.sub('[!,\'!?.]',' \1 ', sent)

but it just printed some weird icon instead of those punctuation characters
This was done using python 3.

A: The string "\1" was interpreted as ascii codepoint 1 \x01. To prevent this from happening, use the raw string r' \1'. Also, to use a back-reference, you should use parentheses. This is the result:
>>> sent = "!,\'!?."
>>> sent = re.sub(r'([!,\'!?.])',r' \1 ', sent)
>>> sent
" !  ,  '  !  ?  . "

A: As per my original comment, your replacement is \1 but you never created a capture group. Surround your regex in () as the following suggests. Also, you need to escape \ or make it a raw string.
re.sub(r"([,'!?.])", r' \1 ', sent)

See code in use here


The SIGGRAPH Asia 2012 Technical Papers program is a premier international forum for presenting new research results in computer graphics and interactive techniques. All papers appear in the journal ACM Transactions on Graphics (TOG). Leading international experts from all over the world present the best results in peer-reviewed research spanning a wide range of research areas.
An entertaining, illuminating summary of SIGGRAPH Asia 2012 Technical Papers! Authors are allowed a little less than a minute to wow the crowd with their results and entice attendees to hear their complete paper presentations later in the week.
This PDF file contains the first pages of all Technical Papers presented at SIGGRAPH Asia 2012 and includes links to full papers in the ACM Digital Library.


Discover the history of Frederick County, Maryland from 1748 to the present as various cultures intersected in the Fredericktown, now known as Frederick County. The town was influenced by the German farmers, the introduction of the railroads and canal, trolleys, the invention of cars and various wars. It was also influenced by movements such as the Great Depression.


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Harlingen Residential Roofing Services
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redpajama_set_name: RedPajamaCommonCrawl


text:
Russia's Military Police Develops Good Relations With Civilians on Syrian Streets
Lieutenant General Vladimir Ivanovsky (Twitter)
The head of the Russian Defense Ministry's main military police directorate says the country's military police have operated as a "successful structure" in their Syria mission and built a positive image among civilians in the Arab country.
Lieutenant General Vladimir Ivanovsky made the remarks on Tuesday after a ceremony at Hmeimim Air Base in Syria's Latakia Province, during which Russian military police officers received awards before returning home.
"According to the assessments of the leadership of the armed forces, local population, observers, the military police, first of all, have established themselves as a successful structure in conditions of these special objectives of humanitarian mission and peacekeeping operations," he said.
Ivanovsky also noted that the Russian military police have earned a good reputation among Syria's civilian population and gained considerable experience.
In addition to Hmeimim, several Russian military servicemen received awards on Tuesday at an observation point in the Idlib Province de-escalation zone and a demilitarized zone between Syria and the Israeli-occupied side of the Golan Heights.
Military policemen currently constitute the bulk of Russian troops in Syria.
They protect Russian bases in Syria, assist the Damascus government in maintaining order across the liberated regions, monitor a country-wide ceasefire, escort humanitarian aid convoys and protect humanitarian corridors that allow civilians to leave militant-held areas.
Russian jets have been targeting positions held by terror outfits inside Syria at the Damascus government's request since September 2015. The airstrikes have helped Syrian forces advance against the militants, who have been wreaking havoc in the Arab country since 2011.
Recently, Moscow bolstered Syria's air defense capabilities by deploying S-300 missile defense systems to the country.
This article has been adapted from its original source.
Copyright © 2019 Press TV. All rights reserved.


Perched on the observation terrace at Cologne Airport, the new Ligne Roset sofa Nils by designer Didier Gomez seems to be waiting for the visitors who will soon be flocking to the city's international furnishing show. The scenography is part of an imm cologne initiative that involved photographing newly rolled-out furniture in urban Cologne.
In the second year of the "Furnishing Cologne" initiative, the motto for the series of photographs was "Above the city's rooftops". And that's how Artek's "Stool 60" stools (by Alvar Aalto, in the new Anniversary Edition) came to be standing on the roof of a factory building in the morning sun as if they were keeping a lookout or inviting guests to take a rest. The motifs range from Miele's new wine cooler KWT 6832 SGS – an allusion to the LivingKitchen fair that takes place parallel to the imm cologne – all the way to Vitra's re-edition of the Eames Rocking Chair, which was photographed from an unusual perspective above the roofs of Cologne city centre.
In literature, music and art, the term 'romanticism' refers to an artistic era that reached from the late 18th far into the 19th century. Today we associate this term with attributes such as 'rapturous', 'dreamy', 'imaginative' and 'poetic' but also with 'kitsch' and with being out of touch with reality. But what, then, does romanticism have to do with contemporary design?
The exhibition 'Isn't it romantic? Contemporary Design between Poetry and Provocation' attempts to address our current understanding of romanticism and to explore the new desire for romanticism. The longing for beauty and harmony and for a place of fulfilment can be understood as an alternative concept to modernism, which has predominantly shaped our current society. New values such as individuality, sensuousness, uniqueness and affinity with nature stand in opposition to increasing globalisation and mobility, against ubiquitous information overload, against alienation and against the absolute transparency of our private lives.
Against this backdrop, we can observe a shift in contemporary design that, in terms of motivation and goals, can be compared to the historic Romantic Movement. In contrast to the positions represented in the design of the 1960s and 1980s, this current movement is both less radical and less political. The focus is not so much on a radical rejection of the generally accepted understanding of design as related to the notions of perfection, functionality and a reduction of forms, rather it is about a synthesis of the romantic and the modern and about an amalgamation of rationality and irrationality, something which can be observed in current design.
imm cologne 2013 will host with WE ARE SOCIAL an international bloggers meetup, organised by the blogging bestseller-author Holly Becker and social media expert Frank Huber. The keynote of the social media event will be held by Holly Becker (founder/editor of decor8 and author of international best seller).
As guests for the panel discussion imm cologne has invited Frederik Frede (CEO/Founder, Freunde von Freunden, Berlin), Costas Voyatzis (CEO, Yatzer, Athens), Micle Mihai-Cristian (CEO, Freshome, Timişoara), Ferdinando Napoli ( CEO/Co-Founder of Edilportale.com, Archiportale.com, Archiproducts.com and Archilovers.com), Will Taylor (Bright Bazaar, London) and Stefanie Luxat (Ohhh… Mhhh…, Hamburg).
WE ARE SOCIAL is a free and open event that brings international bloggers together at imm cologne, one of the largest interior design fairs of the world. imm cologne as a media platform presents with WE ARE SOCIAL some of the leading social media channels, movers and shakers.
invitations to its Water Symposium in Schiltach, which was marking its fifth edition this year. International water experts discussed the topic: "What water needs".
"What does water need?" – this question might seem unusual. People need water, yet what does the element of water need from us? In the search for "methods of housekeeping appropriate for water", Hansgrohe SE issued invitations to its Water Symposium in Schiltach, which was marking its fifth edition this year. Richard Grohe, deputy CEO of the globally active bathroom and sanitation specialist, and chairman of the Supervisory Board Klaus Grohe welcomed the numerous guests in the Hansgrohe Aquademie to an event focusing on innovative and promising concepts that could help to reduce pollution and the over-use of our water resources.


text:
H.R.184 - Protect Medical Innovation Act of 2018115th Congress (2017-2018)
Rep. Paulsen, Erik [R-MN-3] (Introduced 01/03/2017)
Senate - 07/26/2018 Read the second time. Placed on Senate Legislative Calendar under General Orders. Calendar No. 528. (All Actions)
There has been 1 roll call vote
Sponsor: Rep. Paulsen, Erik [R-MN-3] | Cosponsor statistics: 279 current - includes 223 original
Rep. Kind, Ron [D-WI-3]* 01/03/2017
Rep. Poliquin, Bruce [R-ME-2]* 01/03/2017
Rep. Foxx, Virginia [R-NC-5]* 01/03/2017
Rep. Sinema, Kyrsten [D-AZ-9]* 01/03/2017
Rep. Jones, Walter B., Jr. [R-NC-3]* 01/03/2017
Rep. Kelly, Mike [R-PA-3]* 01/03/2017
Rep. Harper, Gregg [R-MS-3]* 01/03/2017
Rep. Messer, Luke [R-IN-6]* 01/03/2017
Rep. Walorski, Jackie [R-IN-2]* 01/03/2017
Rep. Costello, Ryan A. [R-PA-6]* 01/03/2017
Rep. Brooks, Mo [R-AL-5]* 01/03/2017
Rep. Walters, Mimi [R-CA-45]* 01/03/2017
Rep. Lance, Leonard [R-NJ-7]* 01/03/2017
Rep. Pearce, Stevan [R-NM-2]* 01/03/2017
Rep. Carter, John R. [R-TX-31]* 01/03/2017
Rep. Reed, Tom [R-NY-23]* 01/03/2017
Rep. Hill, J. French [R-AR-2]* 01/03/2017
Rep. Turner, Michael R. [R-OH-10]* 01/03/2017
Rep. Denham, Jeff [R-CA-10]* 01/03/2017
Rep. Brooks, Susan W. [R-IN-5]* 01/03/2017
Rep. Stivers, Steve [R-OH-15]* 01/03/2017
Rep. Rokita, Todd [R-IN-4]* 01/03/2017
Rep. Royce, Edward R. [R-CA-39]* 01/03/2017
Rep. Westerman, Bruce [R-AR-4]* 01/03/2017
Rep. Blackburn, Marsha [R-TN-7]* 01/03/2017
Rep. McCaul, Michael T. [R-TX-10]* 01/03/2017
Rep. MacArthur, Thomas [R-NJ-3]* 01/03/2017
Rep. LoBiondo, Frank A. [R-NJ-2]* 01/03/2017
Rep. Knight, Stephen [R-CA-25]* 01/03/2017
Rep. Webster, Daniel [R-FL-10]* 01/03/2017
Rep. Noem, Kristi L. [R-SD-At Large]* 01/03/2017
Rep. Smith, Jason [R-MO-8]* 01/03/2017
Rep. King, Steve [R-IA-4]* 01/03/2017
Rep. Peterson, Collin C. [D-MN-7]* 01/03/2017
Rep. Ros-Lehtinen, Ileana [R-FL-27]* 01/03/2017
Rep. Jenkins, Lynn [R-KS-2]* 01/03/2017
Rep. Valadao, David G. [R-CA-21]* 01/03/2017
Rep. Sensenbrenner, F. James, Jr. [R-WI-5]* 01/03/2017
Rep. Kinzinger, Adam [R-IL-16]* 01/03/2017
Rep. Holding, George [R-NC-13]* 01/03/2017
Rep. Comer, James [R-KY-1]* 01/03/2017
Rep. Johnson, Bill [R-OH-6]* 01/03/2017
Rep. Burgess, Michael C. [R-TX-26]* 01/03/2017
Rep. Wittman, Robert J. [R-VA-1]* 01/03/2017
Rep. LaHood, Darin [R-IL-18]* 01/03/2017
Rep. Long, Billy [R-MO-7]* 01/03/2017
Rep. Lucas, Frank D. [R-OK-3]* 01/03/2017
Rep. Olson, Pete [R-TX-22]* 01/03/2017
Rep. Barton, Joe [R-TX-6]* 01/03/2017
Rep. Duffy, Sean P. [R-WI-7]* 01/03/2017
Rep. Davis, Rodney [R-IL-13]* 01/03/2017
Rep. Bishop, Rob [R-UT-1]* 01/03/2017
Rep. Conaway, K. Michael [R-TX-11]* 01/03/2017
Rep. LaMalfa, Doug [R-CA-1]* 01/03/2017
Rep. Gibbs, Bob [R-OH-7]* 01/03/2017
Rep. Johnson, Sam [R-TX-3]* 01/03/2017
Rep. Hudson, Richard [R-NC-8]* 01/03/2017
Rep. Yoho, Ted S. [R-FL-3]* 01/03/2017
Rep. Upton, Fred [R-MI-6]* 01/03/2017
Rep. Marino, Tom [R-PA-10]* 01/03/2017
Rep. Barletta, Lou [R-PA-11]* 01/03/2017
Rep. Palazzo, Steven M. [R-MS-4]* 01/03/2017
Rep. Rogers, Mike D. [R-AL-3]* 01/03/2017
Rep. Bilirakis, Gus M. [R-FL-12]* 01/03/2017
Rep. Hice, Jody B. [R-GA-10]* 01/03/2017
Rep. Bishop, Mike [R-MI-8]* 01/03/2017
Rep. Cole, Tom [R-OK-4]* 01/03/2017
Rep. Davidson, Warren [R-OH-8]* 01/03/2017
Rep. Wilson, Joe [R-SC-2]* 01/03/2017
Rep. Buck, Ken [R-CO-4]* 01/03/2017
Rep. Meadows, Mark [R-NC-11]* 01/03/2017
Rep. Newhouse, Dan [R-WA-4]* 01/03/2017
Rep. Wenstrup, Brad R. [R-OH-2]* 01/03/2017
Rep. Woodall, Rob [R-GA-7]* 01/03/2017
Rep. Bucshon, Larry [R-IN-8]* 01/03/2017
Rep. Ratcliffe, John [R-TX-4]* 01/03/2017
Rep. Williams, Roger [R-TX-25]* 01/03/2017
Rep. Palmer, Gary J. [R-AL-6]* 01/03/2017
Rep. Ross, Dennis A. [R-FL-15]* 01/03/2017
Rep. Carter, Earl L. "Buddy" [R-GA-1]* 01/03/2017
Rep. McHenry, Patrick T. [R-NC-10]* 01/03/2017
Rep. Walker, Mark [R-NC-6]* 01/03/2017
Rep. Womack, Steve [R-AR-3]* 01/03/2017
Rep. Coffman, Mike [R-CO-6]* 01/03/2017
Rep. DesJarlais, Scott [R-TN-4]* 01/03/2017
Rep. Thompson, Glenn [R-PA-5]* 01/03/2017
Rep. Roe, David P. [R-TN-1]* 01/03/2017
Rep. Pittenger, Robert [R-NC-9]* 01/03/2017
Rep. Trott, David A. [R-MI-11]* 01/03/2017
Rep. Walberg, Tim [R-MI-7]* 01/03/2017
Rep. Flores, Bill [R-TX-17]* 01/03/2017
Rep. Graves, Tom [R-GA-14]* 01/03/2017
Rep. Moolenaar, John R. [R-MI-4]* 01/03/2017
Rep. Rice, Tom [R-SC-7]* 01/03/2017
Rep. Meehan, Patrick [R-PA-7]* 01/03/2017
Rep. Wagner, Ann [R-MO-2]* 01/03/2017
Rep. Young, Don [R-AK-At Large]* 01/03/2017
Rep. Young, David [R-IA-3]* 01/03/2017
Rep. Duncan, Jeff [R-SC-3]* 01/03/2017
Rep. Moulton, Seth [D-MA-6]* 01/03/2017
Rep. McSally, Martha [R-AZ-2]* 01/03/2017
Rep. Aderholt, Robert B. [R-AL-4]* 01/03/2017
Rep. Grothman, Glenn [R-WI-6]* 01/03/2017
Rep. Babin, Brian [R-TX-36]* 01/03/2017
Rep. Blum, Rod [R-IA-1]* 01/03/2017
Rep. Brat, Dave [R-VA-7]* 01/03/2017
Rep. Gosar, Paul A. [R-AZ-4]* 01/03/2017
Rep. Griffith, H. Morgan [R-VA-9]* 01/03/2017
Rep. Goodlatte, Bob [R-VA-6]* 01/03/2017
Rep. Loudermilk, Barry [R-GA-11]* 01/03/2017
Rep. Huizenga, Bill [R-MI-2]* 01/03/2017
Rep. Russell, Steve [R-OK-5]* 01/03/2017
Rep. Fleischmann, Charles J. "Chuck" [R-TN-3]* 01/03/2017
Rep. Mooney, Alexander X. [R-WV-2]* 01/03/2017
Rep. Guthrie, Brett [R-KY-2]* 01/03/2017
Rep. Thornberry, Mac [R-TX-13]* 01/03/2017
Rep. Tipton, Scott R. [R-CO-3]* 01/03/2017
Rep. McKinley, David B. [R-WV-1]* 01/03/2017
Rep. Barr, Andy [R-KY-6]* 01/03/2017
Rep. Collins, Doug [R-GA-9]* 01/03/2017
Rep. Fortenberry, Jeff [R-NE-1]* 01/03/2017
Rep. Rothfus, Keith J. [R-PA-12]* 01/03/2017
Rep. Jenkins, Evan H. [R-WV-3]* 01/03/2017
Rep. Hartzler, Vicky [R-MO-4]* 01/03/2017
Rep. Bost, Mike [R-IL-12]* 01/03/2017
Rep. Rogers, Harold [R-KY-5]* 01/03/2017
Rep. Hultgren, Randy [R-IL-14]* 01/03/2017
Rep. Amodei, Mark E. [R-NV-2]* 01/03/2017
Rep. Stefanik, Elise M. [R-NY-21]* 01/03/2017
Rep. Perry, Scott [R-PA-4]* 01/03/2017
Rep. Lamborn, Doug [R-CO-5]* 01/03/2017
Rep. Shuster, Bill [R-PA-9]* 01/03/2017
Rep. Banks, Jim [R-IN-3]* 01/03/2017
Rep. Hensarling, Jeb [R-TX-5]* 01/03/2017
Rep. Abraham, Ralph Lee [R-LA-5]* 01/03/2017
Rep. Shimkus, John [R-IL-15]* 01/03/2017
Rep. Donovan, Daniel M., Jr. [R-NY-11]* 01/03/2017
Rep. Smith, Christopher H. [R-NJ-4]* 01/03/2017
Rep. Roskam, Peter J. [R-IL-6]* 01/03/2017
Rep. Crawford, Eric A. "Rick" [R-AR-1]* 01/03/2017
Rep. Culberson, John Abney [R-TX-7]* 01/03/2017
Rep. Stewart, Chris [R-UT-2]* 01/03/2017
Rep. Chabot, Steve [R-OH-1]* 01/03/2017
Rep. Cramer, Kevin [R-ND-At Large]* 01/03/2017
Rep. Duncan, John J., Jr. [R-TN-2]* 01/03/2017
Rep. Rohrabacher, Dana [R-CA-48]* 01/03/2017
Rep. Sanford, Mark [R-SC-1]* 01/03/2017
Rep. Farenthold, Blake [R-TX-27]* 01/03/2017
Rep. Katko, John [R-NY-24]* 01/03/2017
Rep. Tiberi, Patrick J. [R-OH-12]* 01/03/2017
Rep. Simpson, Michael K. [R-ID-2]* 01/03/2017
Rep. Walden, Greg [R-OR-2]* 01/03/2017
Rep. Dent, Charles W. [R-PA-15]* 01/03/2017
Rep. Herrera Beutler, Jaime [R-WA-3]* 01/03/2017
Rep. DeSantis, Ron [R-FL-6]* 01/03/2017
Rep. Massie, Thomas [R-KY-4]* 01/03/2017
Rep. Gowdy, Trey [R-SC-4]* 01/03/2017
Rep. Frelinghuysen, Rodney P. [R-NJ-11]* 01/03/2017
Rep. Hunter, Duncan D. [R-CA-50]* 01/03/2017
Rep. Graves, Garret [R-LA-6]* 01/03/2017
Rep. Posey, Bill [R-FL-8]* 01/03/2017
Rep. Luetkemeyer, Blaine [R-MO-3]* 01/03/2017
Rep. Smith, Lamar [R-TX-21]* 01/03/2017
Rep. Hurd, Will [R-TX-23]* 01/03/2017
Rep. Yoder, Kevin [R-KS-3]* 01/03/2017
Rep. Black, Diane [R-TN-6]* 01/03/2017
Rep. Nunes, Devin [R-CA-22]* 01/03/2017
Rep. Rooney, Thomas J. [R-FL-17]* 01/03/2017
Rep. Love, Mia B. [R-UT-4]* 01/03/2017
Rep. Cook, Paul [R-CA-8]* 01/03/2017
Rep. McMorris Rodgers, Cathy [R-WA-5]* 01/03/2017
Rep. Khanna, Ro [D-CA-17]* 01/03/2017
Rep. Lynch, Stephen F. [D-MA-8]* 01/03/2017
Rep. Speier, Jackie [D-CA-14]* 01/03/2017
Rep. Diaz-Balart, Mario [R-FL-25]* 01/03/2017
Rep. Peters, Scott H. [D-CA-52]* 01/03/2017
Rep. Weber, Randy K., Sr. [R-TX-14]* 01/03/2017
Rep. Correa, J. Luis [D-CA-46]* 01/03/2017
Rep. Rouzer, David [R-NC-7]* 01/03/2017
Rep. Collins, Chris [R-NY-27]* 01/03/2017
Rep. Issa, Darrell E. [R-CA-49]* 01/03/2017
Rep. Emmer, Tom [R-MN-6]* 01/03/2017
Rep. Buchanan, Vern [R-FL-16]* 01/03/2017
Rep. Marchant, Kenny [R-TX-24]* 01/03/2017
Rep. Reichert, David G. [R-WA-8]* 01/03/2017
Rep. Renacci, James B. [R-OH-16]* 01/03/2017
Rep. Brownley, Julia [D-CA-26]* 01/03/2017
Rep. Swalwell, Eric [D-CA-15]* 01/03/2017
Rep. Mullin, Markwayne [R-OK-2]* 01/03/2017
Rep. Comstock, Barbara [R-VA-10]* 01/03/2017
Rep. Graves, Sam [R-MO-6]* 01/03/2017
Rep. Kuster, Ann M. [D-NH-2]* 01/03/2017
Rep. Scott, Austin [R-GA-8]* 01/03/2017
Rep. Labrador, Raul R. [R-ID-1]* 01/03/2017
Rep. Curbelo, Carlos [R-FL-26]* 01/03/2017
Rep. Norcross, Donald [D-NJ-1]* 01/03/2017
Rep. Allen, Rick W. [R-GA-12]* 01/03/2017
Rep. Latta, Robert E. [R-OH-5]* 01/03/2017
Rep. Bera, Ami [D-CA-7]* 01/03/2017
Rep. Murphy, Tim [R-PA-18]* 01/03/2017
Rep. Bridenstine, Jim [R-OK-1]* 01/03/2017
Rep. Kustoff, David [R-TN-8]* 01/03/2017
Rep. Byrne, Bradley [R-AL-1]* 01/03/2017
Rep. Hollingsworth, Trey [R-IN-9]* 01/03/2017
Rep. Poe, Ted [R-TX-2]* 01/03/2017
Rep. Calvert, Ken [R-CA-42]* 01/03/2017
Rep. Franks, Trent [R-AZ-8]* 01/03/2017
Rep. King, Peter T. [R-NY-2]* 01/03/2017
Rep. Sessions, Pete [R-TX-32]* 01/03/2017
Rep. Walz, Timothy J. [D-MN-1]* 01/03/2017
Rep. Fitzpatrick, Brian K. [R-PA-8]* 01/03/2017
Rep. Clark, Katherine M. [D-MA-5]* 01/03/2017
Rep. Schweikert, David [R-AZ-6]* 01/03/2017
Rep. McClintock, Tom [R-CA-4]* 01/03/2017
Rep. Nolan, Richard M. [D-MN-8]* 01/03/2017
Rep. Bustos, Cheri [D-IL-17]* 01/03/2017
Rep. Granger, Kay [R-TX-12]* 01/03/2017
Rep. Kilmer, Derek [D-WA-6]* 01/03/2017
Rep. Aguilar, Pete [D-CA-31]* 01/03/2017
Rep. Chaffetz, Jason [R-UT-3]* 01/03/2017
Rep. Faso, John J. [R-NY-19]* 01/03/2017
Rep. Titus, Dina [D-NV-1] 01/04/2017
Rep. Lewis, Jason [R-MN-2] 01/05/2017
Rep. DelBene, Suzan K. [D-WA-1] 01/10/2017
Rep. Ellison, Keith [D-MN-5] 01/11/2017
Rep. Dunn, Neal P. [R-FL-2] 01/23/2017
Rep. Tenney, Claudia [R-NY-22] 01/23/2017
Rep. Krishnamoorthi, Raja [D-IL-8] 01/24/2017
Rep. Schneider, Bradley Scott [D-IL-10] 01/27/2017
Rep. Rosen, Jacky [D-NV-3] 03/02/2017
Rep. Ruiz, Raul [D-CA-36] 03/27/2017
Rep. Boyle, Brendan F. [D-PA-13] 04/28/2017
Rep. Torres, Norma J. [D-CA-35] 06/07/2017
Rep. Adams, Alma S. [D-NC-12] 10/11/2017
Rep. Amash, Justin [R-MI-3] 10/23/2017
Rep. Handel, Karen C. [R-GA-6] 01/05/2018
Rep. Garrett, Thomas A., Jr. [R-VA-5] 06/20/2018
Rep. Arrington, Jodey C. [R-TX-19] 06/25/2018
Rep. Green, Gene [D-TX-29] 07/10/2018
Rep. Taylor, Scott [R-VA-2] 07/17/2018
Rep. Crist, Charlie [D-FL-13] 07/24/2018
01/03/2017 - Rep. Kind, Ron [D-WI-3]*
01/03/2017 - Rep. Poliquin, Bruce [R-ME-2]*
01/03/2017 - Rep. Foxx, Virginia [R-NC-5]*
01/03/2017 - Rep. Sinema, Kyrsten [D-AZ-9]*
01/03/2017 - Rep. Jones, Walter B., Jr. [R-NC-3]*
01/03/2017 - Rep. Kelly, Mike [R-PA-3]*
01/03/2017 - Rep. Harper, Gregg [R-MS-3]*
01/03/2017 - Rep. Messer, Luke [R-IN-6]*
01/03/2017 - Rep. Walorski, Jackie [R-IN-2]*
01/03/2017 - Rep. Costello, Ryan A. [R-PA-6]*
01/03/2017 - Rep. Brooks, Mo [R-AL-5]*
01/03/2017 - Rep. Walters, Mimi [R-CA-45]*
01/03/2017 - Rep. Lance, Leonard [R-NJ-7]*
01/03/2017 - Rep. Pearce, Stevan [R-NM-2]*
01/03/2017 - Rep. Carter, John R. [R-TX-31]*
01/03/2017 - Rep. Reed, Tom [R-NY-23]*
01/03/2017 - Rep. Hill, J. French [R-AR-2]*
01/03/2017 - Rep. Turner, Michael R. [R-OH-10]*
01/03/2017 - Rep. Denham, Jeff [R-CA-10]*
01/03/2017 - Rep. Brooks, Susan W. [R-IN-5]*
01/03/2017 - Rep. Stivers, Steve [R-OH-15]*
01/03/2017 - Rep. Rokita, Todd [R-IN-4]*
01/03/2017 - Rep. Royce, Edward R. [R-CA-39]*
01/03/2017 - Rep. Westerman, Bruce [R-AR-4]*
01/03/2017 - Rep. Blackburn, Marsha [R-TN-7]*
01/03/2017 - Rep. McCaul, Michael T. [R-TX-10]*
01/03/2017 - Rep. MacArthur, Thomas [R-NJ-3]*
01/03/2017 - Rep. LoBiondo, Frank A. [R-NJ-2]*
01/03/2017 - Rep. Knight, Stephen [R-CA-25]*
01/03/2017 - Rep. Webster, Daniel [R-FL-10]*
01/03/2017 - Rep. Noem, Kristi L. [R-SD-At Large]*
01/03/2017 - Rep. Smith, Jason [R-MO-8]*
01/03/2017 - Rep. King, Steve [R-IA-4]*
01/03/2017 - Rep. Peterson, Collin C. [D-MN-7]*
01/03/2017 - Rep. Ros-Lehtinen, Ileana [R-FL-27]*
01/03/2017 - Rep. Jenkins, Lynn [R-KS-2]*
01/03/2017 - Rep. Valadao, David G. [R-CA-21]*
01/03/2017 - Rep. Sensenbrenner, F. James, Jr. [R-WI-5]*
01/03/2017 - Rep. Kinzinger, Adam [R-IL-16]*
01/03/2017 - Rep. Holding, George [R-NC-13]*
01/03/2017 - Rep. Comer, James [R-KY-1]*
01/03/2017 - Rep. Johnson, Bill [R-OH-6]*
01/03/2017 - Rep. Burgess, Michael C. [R-TX-26]*
01/03/2017 - Rep. Wittman, Robert J. [R-VA-1]*
01/03/2017 - Rep. LaHood, Darin [R-IL-18]*
01/03/2017 - Rep. Long, Billy [R-MO-7]*
01/03/2017 - Rep. Lucas, Frank D. [R-OK-3]*
01/03/2017 - Rep. Olson, Pete [R-TX-22]*
01/03/2017 - Rep. Barton, Joe [R-TX-6]*
01/03/2017 - Rep. Duffy, Sean P. [R-WI-7]*
01/03/2017 - Rep. Davis, Rodney [R-IL-13]*
01/03/2017 - Rep. Bishop, Rob [R-UT-1]*
01/03/2017 - Rep. Conaway, K. Michael [R-TX-11]*
01/03/2017 - Rep. LaMalfa, Doug [R-CA-1]*
01/03/2017 - Rep. Gibbs, Bob [R-OH-7]*
01/03/2017 - Rep. Johnson, Sam [R-TX-3]*
01/03/2017 - Rep. Hudson, Richard [R-NC-8]*
01/03/2017 - Rep. Yoho, Ted S. [R-FL-3]*
01/03/2017 - Rep. Upton, Fred [R-MI-6]*
01/03/2017 - Rep. Marino, Tom [R-PA-10]*
01/03/2017 - Rep. Barletta, Lou [R-PA-11]*
01/03/2017 - Rep. Palazzo, Steven M. [R-MS-4]*
01/03/2017 - Rep. Rogers, Mike D. [R-AL-3]*
01/03/2017 - Rep. Bilirakis, Gus M. [R-FL-12]*
01/03/2017 - Rep. Hice, Jody B. [R-GA-10]*
01/03/2017 - Rep. Bishop, Mike [R-MI-8]*
01/03/2017 - Rep. Cole, Tom [R-OK-4]*
01/03/2017 - Rep. Davidson, Warren [R-OH-8]*
01/03/2017 - Rep. Wilson, Joe [R-SC-2]*
01/03/2017 - Rep. Buck, Ken [R-CO-4]*
01/03/2017 - Rep. Meadows, Mark [R-NC-11]*
01/03/2017 - Rep. Newhouse, Dan [R-WA-4]*
01/03/2017 - Rep. Wenstrup, Brad R. [R-OH-2]*
01/03/2017 - Rep. Woodall, Rob [R-GA-7]*
01/03/2017 - Rep. Bucshon, Larry [R-IN-8]*
01/03/2017 - Rep. Ratcliffe, John [R-TX-4]*
01/03/2017 - Rep. Williams, Roger [R-TX-25]*
01/03/2017 - Rep. Palmer, Gary J. [R-AL-6]*
01/03/2017 - Rep. Ross, Dennis A. [R-FL-15]*
01/03/2017 - Rep. Carter, Earl L. "Buddy" [R-GA-1]*
01/03/2017 - Rep. McHenry, Patrick T. [R-NC-10]*
01/03/2017 - Rep. Walker, Mark [R-NC-6]*
01/03/2017 - Rep. Womack, Steve [R-AR-3]*
01/03/2017 - Rep. Coffman, Mike [R-CO-6]*
01/03/2017 - Rep. DesJarlais, Scott [R-TN-4]*
01/03/2017 - Rep. Thompson, Glenn [R-PA-5]*
01/03/2017 - Rep. Roe, David P. [R-TN-1]*
01/03/2017 - Rep. Pittenger, Robert [R-NC-9]*
01/03/2017 - Rep. Trott, David A. [R-MI-11]*
01/03/2017 - Rep. Walberg, Tim [R-MI-7]*
01/03/2017 - Rep. Flores, Bill [R-TX-17]*
01/03/2017 - Rep. Graves, Tom [R-GA-14]*
01/03/2017 - Rep. Moolenaar, John R. [R-MI-4]*
01/03/2017 - Rep. Rice, Tom [R-SC-7]*
01/03/2017 - Rep. Meehan, Patrick [R-PA-7]*
01/03/2017 - Rep. Wagner, Ann [R-MO-2]*
01/03/2017 - Rep. Young, Don [R-AK-At Large]*
01/03/2017 - Rep. Young, David [R-IA-3]*
01/03/2017 - Rep. Duncan, Jeff [R-SC-3]*
01/03/2017 - Rep. Moulton, Seth [D-MA-6]*
01/03/2017 - Rep. McSally, Martha [R-AZ-2]*
01/03/2017 - Rep. Aderholt, Robert B. [R-AL-4]*
01/03/2017 - Rep. Grothman, Glenn [R-WI-6]*
01/03/2017 - Rep. Babin, Brian [R-TX-36]*
01/03/2017 - Rep. Blum, Rod [R-IA-1]*
01/03/2017 - Rep. Brat, Dave [R-VA-7]*
01/03/2017 - Rep. Gosar, Paul A. [R-AZ-4]*
01/03/2017 - Rep. Griffith, H. Morgan [R-VA-9]*
01/03/2017 - Rep. Goodlatte, Bob [R-VA-6]*
01/03/2017 - Rep. Loudermilk, Barry [R-GA-11]*
01/03/2017 - Rep. Huizenga, Bill [R-MI-2]*
01/03/2017 - Rep. Russell, Steve [R-OK-5]*
01/03/2017 - Rep. Fleischmann, Charles J. "Chuck" [R-TN-3]*
01/03/2017 - Rep. Mooney, Alexander X. [R-WV-2]*
01/03/2017 - Rep. Guthrie, Brett [R-KY-2]*
01/03/2017 - Rep. Thornberry, Mac [R-TX-13]*
01/03/2017 - Rep. Tipton, Scott R. [R-CO-3]*
01/03/2017 - Rep. McKinley, David B. [R-WV-1]*
01/03/2017 - Rep. Barr, Andy [R-KY-6]*
01/03/2017 - Rep. Collins, Doug [R-GA-9]*
01/03/2017 - Rep. Fortenberry, Jeff [R-NE-1]*
01/03/2017 - Rep. Rothfus, Keith J. [R-PA-12]*
01/03/2017 - Rep. Jenkins, Evan H. [R-WV-3]*
01/03/2017 - Rep. Hartzler, Vicky [R-MO-4]*
01/03/2017 - Rep. Bost, Mike [R-IL-12]*
01/03/2017 - Rep. Rogers, Harold [R-KY-5]*
01/03/2017 - Rep. Hultgren, Randy [R-IL-14]*
01/03/2017 - Rep. Amodei, Mark E. [R-NV-2]*
01/03/2017 - Rep. Stefanik, Elise M. [R-NY-21]*
01/03/2017 - Rep. Perry, Scott [R-PA-4]*
01/03/2017 - Rep. Lamborn, Doug [R-CO-5]*
01/03/2017 - Rep. Shuster, Bill [R-PA-9]*
01/03/2017 - Rep. Banks, Jim [R-IN-3]*
01/03/2017 - Rep. Hensarling, Jeb [R-TX-5]*
01/03/2017 - Rep. Abraham, Ralph Lee [R-LA-5]*
01/03/2017 - Rep. Shimkus, John [R-IL-15]*
01/03/2017 - Rep. Donovan, Daniel M., Jr. [R-NY-11]*
01/03/2017 - Rep. Smith, Christopher H. [R-NJ-4]*
01/03/2017 - Rep. Roskam, Peter J. [R-IL-6]*
01/03/2017 - Rep. Crawford, Eric A. "Rick" [R-AR-1]*
01/03/2017 - Rep. Culberson, John Abney [R-TX-7]*
01/03/2017 - Rep. Stewart, Chris [R-UT-2]*
01/03/2017 - Rep. Chabot, Steve [R-OH-1]*
01/03/2017 - Rep. Cramer, Kevin [R-ND-At Large]*
01/03/2017 - Rep. Duncan, John J., Jr. [R-TN-2]*
01/03/2017 - Rep. Rohrabacher, Dana [R-CA-48]*
01/03/2017 - Rep. Sanford, Mark [R-SC-1]*
01/03/2017 - Rep. Farenthold, Blake [R-TX-27]*
01/03/2017 - Rep. Katko, John [R-NY-24]*
01/03/2017 - Rep. Tiberi, Patrick J. [R-OH-12]*
01/03/2017 - Rep. Simpson, Michael K. [R-ID-2]*
01/03/2017 - Rep. Walden, Greg [R-OR-2]*
01/03/2017 - Rep. Dent, Charles W. [R-PA-15]*
01/03/2017 - Rep. Herrera Beutler, Jaime [R-WA-3]*
01/03/2017 - Rep. DeSantis, Ron [R-FL-6]*
01/03/2017 - Rep. Massie, Thomas [R-KY-4]*
01/03/2017 - Rep. Gowdy, Trey [R-SC-4]*
01/03/2017 - Rep. Frelinghuysen, Rodney P. [R-NJ-11]*
01/03/2017 - Rep. Hunter, Duncan D. [R-CA-50]*
01/03/2017 - Rep. Graves, Garret [R-LA-6]*
01/03/2017 - Rep. Posey, Bill [R-FL-8]*
01/03/2017 - Rep. Luetkemeyer, Blaine [R-MO-3]*
01/03/2017 - Rep. Smith, Lamar [R-TX-21]*
01/03/2017 - Rep. Hurd, Will [R-TX-23]*
01/03/2017 - Rep. Yoder, Kevin [R-KS-3]*
01/03/2017 - Rep. Black, Diane [R-TN-6]*
01/03/2017 - Rep. Nunes, Devin [R-CA-22]*
01/03/2017 - Rep. Rooney, Thomas J. [R-FL-17]*
01/03/2017 - Rep. Love, Mia B. [R-UT-4]*
01/03/2017 - Rep. Cook, Paul [R-CA-8]*
01/03/2017 - Rep. McMorris Rodgers, Cathy [R-WA-5]*
01/03/2017 - Rep. Khanna, Ro [D-CA-17]*
01/03/2017 - Rep. Lynch, Stephen F. [D-MA-8]*
01/03/2017 - Rep. Speier, Jackie [D-CA-14]*
01/03/2017 - Rep. Diaz-Balart, Mario [R-FL-25]*
01/03/2017 - Rep. Peters, Scott H. [D-CA-52]*
01/03/2017 - Rep. Weber, Randy K., Sr. [R-TX-14]*
01/03/2017 - Rep. Correa, J. Luis [D-CA-46]*
01/03/2017 - Rep. Rouzer, David [R-NC-7]*
01/03/2017 - Rep. Collins, Chris [R-NY-27]*
01/03/2017 - Rep. Issa, Darrell E. [R-CA-49]*
01/03/2017 - Rep. Emmer, Tom [R-MN-6]*
01/03/2017 - Rep. Buchanan, Vern [R-FL-16]*
01/03/2017 - Rep. Marchant, Kenny [R-TX-24]*
01/03/2017 - Rep. Reichert, David G. [R-WA-8]*
01/03/2017 - Rep. Renacci, James B. [R-OH-16]*
01/03/2017 - Rep. Brownley, Julia [D-CA-26]*
01/03/2017 - Rep. Swalwell, Eric [D-CA-15]*
01/03/2017 - Rep. Mullin, Markwayne [R-OK-2]*
01/03/2017 - Rep. Comstock, Barbara [R-VA-10]*
01/03/2017 - Rep. Graves, Sam [R-MO-6]*
01/03/2017 - Rep. Kuster, Ann M. [D-NH-2]*
01/03/2017 - Rep. Scott, Austin [R-GA-8]*
01/03/2017 - Rep. Labrador, Raul R. [R-ID-1]*
01/03/2017 - Rep. Curbelo, Carlos [R-FL-26]*
01/03/2017 - Rep. Norcross, Donald [D-NJ-1]*
01/03/2017 - Rep. Allen, Rick W. [R-GA-12]*
01/03/2017 - Rep. Latta, Robert E. [R-OH-5]*
01/03/2017 - Rep. Bera, Ami [D-CA-7]*
01/03/2017 - Rep. Murphy, Tim [R-PA-18]*
01/03/2017 - Rep. Bridenstine, Jim [R-OK-1]*
01/03/2017 - Rep. Kustoff, David [R-TN-8]*
01/03/2017 - Rep. Byrne, Bradley [R-AL-1]*
01/03/2017 - Rep. Hollingsworth, Trey [R-IN-9]*
01/03/2017 - Rep. Poe, Ted [R-TX-2]*
01/03/2017 - Rep. Calvert, Ken [R-CA-42]*
01/03/2017 - Rep. Franks, Trent [R-AZ-8]*
01/03/2017 - Rep. King, Peter T. [R-NY-2]*
01/03/2017 - Rep. Sessions, Pete [R-TX-32]*
01/03/2017 - Rep. Walz, Timothy J. [D-MN-1]*
01/03/2017 - Rep. Fitzpatrick, Brian K. [R-PA-8]*
01/03/2017 - Rep. Clark, Katherine M. [D-MA-5]*
01/03/2017 - Rep. Schweikert, David [R-AZ-6]*
01/03/2017 - Rep. McClintock, Tom [R-CA-4]*
01/03/2017 - Rep. Nolan, Richard M. [D-MN-8]*
01/03/2017 - Rep. Bustos, Cheri [D-IL-17]*
01/03/2017 - Rep. Granger, Kay [R-TX-12]*
01/03/2017 - Rep. Kilmer, Derek [D-WA-6]*
01/03/2017 - Rep. Aguilar, Pete [D-CA-31]*
01/03/2017 - Rep. Chaffetz, Jason [R-UT-3]*
01/03/2017 - Rep. Faso, John J. [R-NY-19]*
01/04/2017 - Rep. Titus, Dina [D-NV-1]
01/05/2017 - Rep. Lewis, Jason [R-MN-2]
01/10/2017 - Rep. DelBene, Suzan K. [D-WA-1]
01/11/2017 - Rep. Ellison, Keith [D-MN-5]
01/23/2017 - Rep. Dunn, Neal P. [R-FL-2]
01/23/2017 - Rep. Tenney, Claudia [R-NY-22]
01/24/2017 - Rep. Krishnamoorthi, Raja [D-IL-8]
01/27/2017 - Rep. Schneider, Bradley Scott [D-IL-10]
03/02/2017 - Rep. Rosen, Jacky [D-NV-3]
03/27/2017 - Rep. Ruiz, Raul [D-CA-36]
04/28/2017 - Rep. Boyle, Brendan F. [D-PA-13]
06/07/2017 - Rep. Torres, Norma J. [D-CA-35]
10/11/2017 - Rep. Adams, Alma S. [D-NC-12]
10/23/2017 - Rep. Amash, Justin [R-MI-3]
01/05/2018 - Rep. Handel, Karen C. [R-GA-6]
06/20/2018 - Rep. Garrett, Thomas A., Jr. [R-VA-5]
06/25/2018 - Rep. Arrington, Jodey C. [R-TX-19]
07/10/2018 - Rep. Green, Gene [D-TX-29]
07/17/2018 - Rep. Taylor, Scott [R-VA-2]
07/24/2018 - Rep. Crist, Charlie [D-FL-13]
Independent [1]
North Carolina [11]


2008-09-18 Assigned to UTI LIMITED PARTNERSHIP reassignment UTI LIMITED PARTNERSHIP ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: REMMERS, JOHN E.
2011-07-22 Assigned to UTI LIMITED PARTNERSHIP reassignment UTI LIMITED PARTNERSHIP ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: REMMERS, JOHN E.
A method for modifying the breathing of a patient while the patient is experiencing sleep apnea, for example Cheyne Stokes breathing. An instantaneous pulmonary ventilation of a patient is monitored. Limit cycle behavior of the instantaneous pulmonary ventilation is identified. A transient intervention is applied to the patient during a phase of a limit cycle of the instantaneous pulmonary ventilation. The transient intervention has an effect on a breathing state of the patient.
This application claims priority under 35 U.S.C. §119(e) from provisional U.S. Patent Application No. 60/952,084, filed Jul. 26, 2007, the contents of which are incorporated herein by reference.
This relates to a method and apparatus for providing transient interventions to stabilize a patient's breathing pattern, and, in particular, to a method and apparatus that includes identifying a patient's limit cycle behavior and applying the intervention according to a phase of the limit cycle.
Central sleep apnea is a type of sleep-disordered breathing that is characterized by a failure of the sleeping brain to generate regular, rhythmic bursts of neural activity. The resulting cessation of rhythmic breathing, referred to as apnea, represents a disorder of the respiratory control system responsible for regulating the rate and depth of breathing; that is, a disorder of overall pulmonary ventilation. Central sleep apnea should be contrasted with obstructive sleep apnea, where the proximate cause of apnea is obstruction of the pharyngeal airway despite ongoing rhythmic neural outflow to the respiratory muscles. The difference between central sleep apnea and obstructive sleep apnea is clearly established, and the two can share pathophysiological causal features. Obstructive sleep apnea occurs when physical obstruction of the airway passage occurs in the pharynx. Central sleep apnea derives from a disorder in the breathing control systems. While central sleep apnea can occur in a number of clinical settings, it is most commonly observed in association with heart failure or cardiovascular disease.
Cheyne Stokes breathing is a type of sleep disordered breathing in which respiration of the patient waxes and wanes in a smooth crescendo/decrescendo pattern. This is a form of breathing instability and it may be caused by central sleep apnea.
Two chemoreflex feedback loops control breathing and Cheyne Stokes breathing results from increased gain in these feedback loops. One feedback loop, the peripheral chemoreflex involves a CO2 and O2 sensor in the carotid artery. High gain of one or both loops or excessive circulatory delays can cause breathing instability. Other causes of central sleep apnea and Cheyne Stokes breathing include circulatory delay and pharyngeal instability. The other chemoreflex loop involves the central chemoreceptor in the brain which senses brain tissue PCO2. The terms P02 and PCO2 represent the partial pressures of oxygen and carbon dioxide, respectively, in a patient's blood stream. Brain tissue PCO2 is the partial pressure of carbon dioxide gas in the brain. Arterial P02 and arterial PCO2 is the partial pressure of oxygen gas and carbon dioxide gas in the arterial blood of a patient.
Theoretical consideration and experimental observations indicate that a control system with a high chemoreflex gain can display two stable states, one where breathing is steady state (i.e., regular rhythm and tidal volume) and one where breathing assumes a limit cycle. As well, both theoretical and empirical observations indicate that transient perturbation can shift the system from one state to the other.
Central sleep apnea is believed to be caused by a high gain feedback oscillation of the respiratory control system. This control system is highly complex in that it has two feedback loops separated by delays which are state dependant. The feedback loops are dependant upon the respiratory stimuli, namely the arterial PCO2 and PO2. The delay between ventilatory intake and the corresponding response in concentration of arterial PCO2 and PO2 values may, in some cases, be as long as 30 seconds or longer. In some cases, a high gain feedback oscillation loop of the respiratory control system may exist with a periodic repeating cycle with a period that is approximately double the length of the delay. In such a high gain feedback oscillation loop, the arterial PO2 may be increasing during a period when no breathing is occurring, and the arterial PCO2 may be increasing during a period of hyperventilation. As a result, the system will oscillate in a stable limit cycle behavior without achieving a steady rhythmic breathing pattern that has minimal changes in ventilation and arterial PCO2 and PO2 values.
The high oscillation characteristic of central sleep apnea can be usefully viewed as a stable limit cycle in which ventilation and arterial blood gases oscillate in a predictable pattern in relation to each other. A transient intervention is used to convert the oscillatory limit cycle behavior to a non-oscillatory fixed point behavior.
In one embodiment, there is provided a method for modifying the breathing of a patient. An instantaneous pulmonary ventilation of a patient is monitored. Limit cycle behavior of the instantaneous pulmonary ventilation is identified. The limit cycle behavior of the instantaneous pulmonary ventilation corresponds to a limit cycle having phases. A transient intervention is applied to the patient according to a phase within the limit cycle. The transient intervention has an effect on a breathing state of the patient.
In another embodiment, there is provided an apparatus for treating a breathing disorder. The apparatus comprises a pulmonary ventilation sensor, a transient intervention provider and a controller responsive to signals from the pulmonary ventilation sensor to cause the transient intervention provider to apply a transient intervention to a patient.
FIG. 5 shows apparatus for carrying out method steps shown in FIG. 1.
In the claims, the word "comprising" is used in its inclusive sense and does not exclude other elements being present. The indefinite article "a" before a claim feature does not exclude more than one of the feature being present. Each one of the individual features described here may be used in one or more embodiments and is not, by virtue only of being described here, to be construed as essential to all embodiments as defined by the claims. The phrase "instantaneous pulmonary ventilation" in this document refers to the ratio of tidal volume divided by respiratory period of a human being's breathing.
FIGS. 1 and 2 show methods for modifying the breathing of a patient. At step 10 an instantaneous pulmonary ventilation (IPV) of a patient is monitored. As shown at step 12, limit cycle behavior is detected and when, as shown at step 13, the instantaneous pulmonary ventilation is within a phase of the limit cycle, then at step 14 a transient intervention is applied to the patient which affects the alveolar ventilation of the patient. As shown at steps 13A and 13B of FIG. 2, the transient intervention may be applied in a first phase of the limit cycle or a second phase of the limit cycle, or, in some cases, the transient intervention may be applied in both the first and second phases within the limit cycle. For example, the first phase of the limit cycle may correspond to a phase of the limit cycle wherein the instantaneous pulmonary ventilation is a decreasing or minimal. The second phase of the limit cycle may correspond to a phase of the limit cycle wherein the instantaneous pulmonary ventilation is increasing or maximal.
If, as shown in step 16, the limit cycle is within the first phase, and if, as shown in step 13A, a transient intervention is to be applied during the first phase, then at step 14A a first transient intervention is applied to the patient. If, as shown in step 18, the limit cycle is within the second phase, and if, as shown in step 13B, a transient intervention is to be applied during the second phase, then at step 14B a second transient intervention may be applied to the patient. If the first phase of the limit cycle corresponds to the instantaneous pulmonary ventilation decreasing or minimal, then the first transient intervention may be an excitatory transient intervention. If the second phase of the limit cycle corresponds to the instantaneous pulmonary ventilation increasing or maximal, then the second transient intervention may be a mitigating transient intervention. The monitoring step 10 may be carried out continuously or intermittently.
Step 12 of detecting limit cycle behavior may be carried out by any of several methods. A threshold range may be determined experimentally so that limit cycle behavior is detected when the instantaneous pulmonary ventilation is outside of the threshold range. The threshold range is selected so that when a patient is breathing normally, the instantaneous pulmonary ventilation lies within the threshold range. As well, the temporal pattern of ventilation can be monitored and the intervention can be timed to occur at particular points in the limit cycle. For example, a normal range of the instantaneous pulmonary ventilation may be determined for the patient, and the occurrence of a measured instantaneous pulmonary ventilation outside of this range may be considered to be in excess of the threshold.
A single measurement outside of the normal range may be flagged for potential threshold crossing, but a transient intervention is only applied when a further measurement that is also outside of the normal range occurs within a set period of time. In a further example, the occurrence of successive instantaneous pulmonary ventilation measurements beyond a threshold may be used to trigger a transient intervention. In a still further example, a number of successively increasing instantaneous pulmonary ventilation measurements may be considered to cross a threshold either based on the number of successive increasing measurements or the magnitude of the increase from measurement to measurement. For example, a threshold may be considered to have been crossed when successive differences between instantaneous pulmonary ventilation measurements are each above a threshold difference. Hence, the threshold may effectively be a magnitude or a rate of change of the instantaneous pulmonary ventilation that is sustained over a pre-determined number of breaths or a pre-determined period of time. The limit cycle behavior may also be detected by autocorrelation, which compares repeating patterns of the instantaneous pulmonary ventilation over time. The limit cycle behavior may be detected by using Poincaré plots, which compares consecutive breaths of the patient. The limit cycle behavior may also be detected by detecting limit cycle behavior in other cycles that are correlated to the instantaneous pulmonary ventilation. For example, limit cycle behavior in arterial PCO2 and arterial PO2 may indicate corresponding limit cycle behavior in instantaneous pulmonary ventilation.
FIG. 3 shows a typical limit cycle in which ventilation and arterial blood gases oscillate in a predictable pattern in relation to each other. A pattern is formed by oscillations in the ventilation, arterial PO2 and PCO2 associated with a stable limit cycle behavior of the respiratory control system. In particular, the instantaneous pulmonary ventilation V considered on its own oscillates in a stable limit cycle within the stable limit cycle of the respiratory control system. The system shown started to oscillate as a result of three fold increase in the chemosensitivity of the central chemoreflex loop with a normal value of the cardiac output (6.2 l/mins). The data is derived from a realistic simulation of the respiratory control system. A stable non-oscillatory fixed point solution (not shown) co-exists as an alternative to the limit cycle solution in Cheyne Stokes breathing.
To improve the breathing of the patient the amplitude of the oscillations of the instantaneous pulmonary ventilation is reduced and the oscillations are reduced to a non-oscillatory fixed point behavior. Reduction of the oscillatory behavior of the instantaneous pulmonary ventilation has the effect of reducing the limit cycle behavior of the respiratory control system. The oscillatory limit cycle of the instantaneous pulmonary ventilation may be a component of the oscillatory limit cycle of the respiratory control system.
A plurality of transient interventions may be applied within the oscillatory limit cycle of the instantaneous pulmonary ventilation. For example, the plurality of transient interventions may be applied periodically within phases of the limit cycle. A mitigating transient intervention that has the effect of reducing alveolar hyperventilation and mitigating the gas exchange consequences of alveolar hyperventilation may be applied periodically within a phase of the cycle when the instantaneous pulmonary ventilation is increasing or maximal. An excitatory transient intervention that has the effect of augmenting alveolar ventilation may be applied periodically within a phase of the cycle when the instantaneous pulmonary ventilation is decreasing or minimal. As periodic interventions are applied it may be beneficial to observe any shifts in the oscillatory limit cycle. The intensity of the applied transient interventions may be adjusted in response to the observed shift in the oscillatory limit cycle.
If each one of the plurality of transient interventions are applied consecutively, it may be beneficial to adjust the time between the consecutive applications of the plurality of transient interventions in response to the observed shift in the oscillatory limit cycle. For example, if the oscillatory limit cycle decreases as the plurality of interventions are applied, then the transient interventions may be adjusted so that the intensity of each of the interventions decreases as the oscillatory limit cycle decreases. Because of memory in the control system, a regimen of a sequence of transient interventions of predetermined magnitude at predetermined times in the cycle may result in the conversion of limit cycle to steady state behavior with lower transient intervention intensity, thereby lessening the chance of an arousal.
Before each transient intervention is applied, the limit cycle behavior of the respiratory control system as a whole may be quantified. In another approach, the limit cycle behavior of only the instantaneous pulmonary ventilation component of the respiratory control system may be quantified. Additionally, precise times within the limit cycle may be determined so that when a transient intervention is applied, the result will be a conversion of the instantaneous pulmonary ventilation from limit cycle to fixed point behavior.
The limit cycle of the respiratory control system can be quantified by plotting instantaneous pulmonary ventilation versus oxygen saturation of arterial blood. For a transient intervention that impairs pulmonary gas exchange, and thereby mitigates the effect of alveolar hyperventilation, application during the ascending phase A (FIG. 3) of the limit cycle may be appropriate. The ascending phase corresponds to a rapid increase in the instantaneous pulmonary ventilation of the patient. For a transient intervention that assists pulmonary gas exchange, and thereby augments alveolar ventilation, application during the descending phase B (FIG. 3) may be appropriate. The descending phase corresponds to a rapid decease in the instantaneous pulmonary ventilation of the patient. After application of the intervention the succeeding limit may be compared to the pre-intervention cycles to access the effect of the transient intervention. If a complete conversion to the fixed point behavior is not observed, the intervention may be repeated on succeeding cycles with timing and intensity of these applications being guided by the observed shift in limit cycle caused by the preceding intervention.
In FIG. 3, the flat, minimal phase of the graph between the ascending phase A and the descending phase B corresponds to an instantaneous pulmonary ventilation is minimal. The instantaneous pulmonary ventilation will be minimal when the tidal volume of the patient is minimal. For example, the tidal volume of the patient will be minimal if the patient ceases breathing. The nearly flat, maximal phase of the graph between the descending phase B and the ascending phase A corresponds to maximal instantaneous pulmonary ventilation. Maximal instantaneous pulmonary ventilation is caused by high tidal volume breathing of the patient. For example, high tidal volume breathing of the patient may correspond to alveolar hyperventilation.
More accurate timing of the intervention may be achieved by employing a realistic computational model of the respiratory control system. A more realistic computational model would allow development of an adaptive controller guided by the predictions derived from the embedded model. Critical parameters reflecting the patient's condition may be introduced into the model and delays between gas exchange in the lungs and detection of chemical stimuli by peripheral and central chemoreceptors may be calculated. A respiratory chemoreflex simulator may be used to identify regimes of external transient interventions applied to a respiratory control system in limit cycle behavior. An adaptive control system can monitor the results of the intervention and apply further interventions and regimes as suggested by predictions of the simulator. A computational model may be used to identify the opportune times and optimal regimens of transient interventions that can most readily convert the system from a limit cycle to a steady state. The computational model may interact with a larger controlling program which identifies the behavior of the model and systematically introduces increase or decrease in alveolar ventilation for various durations and various times in the limit cycle.
As shown in FIG. 4, the model may then calculate brain tissue PCO2 and display the limit cycle in the new set of coordinates with ventilation V, arterial PO2 and brain PCO2 associated with a stable limit cycle behavior of the respiratory control system. In FIG. 4, as in FIG. 3, the system started to oscillate as a result of a three fold increase in the chemosensitivity of the central chemoreflex loop with normal value of the cardiac output (6.2 l/min). Tracing the value of the instantaneous pulmonary ventilation, the controller will engage the mitigating, or dampening, transient intervention at the middle point of the ascending phase of the limit cycle C. The middle point of the ascending phase C corresponds to a zero-crossing of the instantaneous pulmonary ventilation. The zero-crossing corresponds to the instantaneous pulmonary ventilation changing from lower than average instantaneous pulmonary ventilation to higher than average instantaneous pulmonary ventilation. The average instantaneous pulmonary ventilation may be the average instantaneous pulmonary ventilation over the previous cycle. The zero-crossing may correspond generally to a maximal rate of change of the instantaneous pulmonary ventilation. The optimal length of the applied intervention, which will generate a complete conversion to the fixed point behavior may be determined by results from the computer simulation.
A similar strategy may be employed in the case of an excitatory transient intervention by applying the intervention at the middle point of the descending phase of the limit cycle D. The middle point of the descending phase D corresponds to a zero-crossing of the instantaneous pulmonary ventilation. The zero-crossing corresponds to the instantaneous pulmonary ventilation changing from higher than average instantaneous pulmonary ventilation to lower than average pulmonary ventilation. The zero-crossing may correspond generally to a maximal rate of change of the instantaneous pulmonary ventilation. Again, the computer simulation may be performed to determine the optimal length of the intervention. In this example, the middle point of the ascending phase C and the middle point of the descending phase D each correspond generally to an extreme value of PO2 concentration. The ascending phase C corresponds to maximal arterial PO2 concentration and the descending phase D corresponds to minimal arterial PO2 concentration.
The transient interventions may be either respiratory or non-respiratory in nature. In the respiratory intervention, a ventilatory assist or an impairment of gas exchange can be transiently imposed at a particular point in the limit cycle and applied intervention will either transiently decrease the amplitude of the oscillations or completely convert the behavior of the system to the fixed point. Once conversion from the limit cycle to a fixed point behavior has occurred, the system will generally remain stable in the non-oscillatory steady state for a prolonged period of time.
Some examples of transient interventions will now be described. Generally, a transient intervention is any intervention that may be applied to a patient that affects the breathing state of the patient. The examples of transient interventions discussed below are known in the art and need not be described in detail.
The transient intervention may be an electrical stimulus applied to the patient. The electrical stimulus may be applied to the upper airway muscles, the hypoglossal nerve, the vagus nerve or other excitable tissue for the treatment of sleep apnea. The electrical stimulus may also be applied to other muscle groups of the patient. For example, the electrical stimulus may be applied to the shoulder, neck, arm, leg or other suitable muscle. The electrical stimulus may mimic movement of the shoulder, neck, arm, leg or other suitable muscle of the patient. The stimulus may stimulate neural afferent fibers that are normally activated during muscular exercise and stimulate breathing. An electrical stimulus may be applied to the patient's skin to provide a pinching, stinging or shocking sensation.
The transient intervention may be applied by a manual device provided to act on the patient. The manual device may cause passive movement of the patient's limbs or muscles. The passive movement may be movement of the limb joints of the patient or may be compression of the muscles. For example, manual movement of the patient's feet at the ankle may increase alveolar ventilation of the patient. The manual device may provide rhythmic stimulation of the patient. For example, the manual device may be a rocking bed or a rhythmically moving stuffed animal for a child patient. Movement of parts of the patient's body will often entrain the breathing of the patient into a corresponding rhythm. Passive motion of the limbs of the patient will often induce increased ventilation. A human being, such as a care provider or bed partner, may replace the manual device by manually moving the patient. Pneumatic compression of the lower limbs can also be used to activate neural afferents that stimulate breathing.
The transient intervention may cause manipulation of the air flow or airway passages of the patient. For example, the transient intervention may be the application of continuous positive airway pressure (CPAP) to the patient. The intervention may also be the application of controlled re-breathing or low flow CPAP to the patient. A transient period of rebreathing caused by an external dead space may reduce alveolar ventilation. For example, when the instantaneous pulmonary ventilation is increasing, rebreathed air may be supplied to the patient and when the instantaneous pulmonary ventilation is decreasing atmospheric or oxygen rich air may be supplied to the patient. The transient intervention may be a mandibular protrusion device.
The transient intervention may be auditory signals. The auditory signals may be verbal commands made by a human being or an auditory device. The auditory device may give instructions to the patient while the patient is sleeping.
Generally, the transient intervention should be applied so that the patient does not awake because of the transient intervention. It may also be beneficial to use a sensor to detect when the patient is asleep so that the intervention is not applied when the patient is awake and thereby cause irritation to the patient. An important advantage of the transient intervention technology is that interventions that may be somewhat noxious if applied repetitively may be well tolerated if applied transiently and in isolation. Nonetheless, these transient interventions may cause a long term conversion of breathing from limit cycle to steady state and, thereby, provide effective and feasible therapy.
Various apparatus may be used to carrying out the method described in the claims. In one example shown in FIG. 5, a mask 20 is attached a patient 22 and the mask 20 fitted with a flow sensor 24. The flow sensor 24 detects pulmonary ventilation. The flow sensor 24 is part of a means for monitoring an instantaneous pulmonary ventilation of a patient. Pulmonary ventilation or other respiration characteristic may be monitored by any suitable device such as a device capable of detecting flow directly or indirectly, such as a pressure sensor, pneumotacograph or ultrasonic sensor. Other sensors may be used to monitor the instantaneous pulmonary ventilation or breathing characteristic of the patient. A signal from the flow sensor 24 is provided to a controller 26 through a sensor interface 28. The sensor interface 28 outputs signals to a memory 32 within the controller 26. The memory 32 is sampled by processor 34. Processor 34 carries out the monitoring of instantaneous pulmonary ventilation and detection of limit cycle behavior of the instantaneous pulmonary ventilation through, for example, software or firmware. Processor 34 may be any suitable electronic processor 34 such as a chip or chip in a general purpose computer or an application specific chip that is programmed or otherwise configured to carry out the method steps described here.
The processor 34 is connected to conventional input devices, such as a keyboard 36 and to output devices such as a display 38. The processor 34 is also in this example connected to a driver 40 for a transient intervention provider 42. The transient intervention provider 42 may for example be connected to the patient via electrodes 44 or a breathing tube 46 or other suitable transient intervention applicator. The driver 40 may be a stand alone device or may be embedded in hardware, firmware or software in the processor 34. In some embodiments, the interface 28, memory 32, processor 34 and driver 40 may be carried on a monolithic semi-conductor device.
Although the invention has been described in detail for the purpose of illustration based on what is currently considered to be the most practical and preferred embodiments, it is to be understood that such detail is solely for that purpose and that the device and method are not limited to the disclosed embodiments, but, on the contrary, is intended to cover modifications and equivalent arrangements that are within the spirit and scope of the appended claims. For example, it is to be understood that the method and device contemplate that, to the extent possible, one or more features of any embodiment can be combined with one or more features of any other embodiment.
applying a transient intervention to the patient according to a phase of the limit cycle, the transient intervention having an effect on a breathing state of the patient.
2. The method of claim 1, wherein applying the transient intervention further comprises applying an excitatory transient intervention in a first phase of the limit cycle.
3. The method of claim 2, wherein applying the transient intervention further comprises applying a mitigating transient intervention in a second phase of the limit cycle.
4. The method of claim 2, wherein the first phase of the limit cycle corresponds to decreasing instantaneous pulmonary ventilation or minimal instantaneous pulmonary ventilation within the limit cycle.
5. The method of claim 3, wherein the second phase of the limit cycle corresponds to increasing instantaneous pulmonary ventilation or maximal instantaneous pulmonary ventilation within the limit cycle.
6. The method of claim 1, wherein the step of applying the transient intervention further comprises applying a plurality of transient interventions within the limit cycle; and the plurality of transient interventions are applied periodically within the phase of the limit cycle.
7. The method of claim 6, wherein applying the plurality of transient interventions further comprises the transient interventions being periodically applied when the instantaneous pulmonary ventilation is increasing or maximal.
8. The method of claim 6, wherein applying the plurality of transient interventions further comprises the transient interventions being periodically applied when the instantaneous pulmonary ventilation is decreasing or minimal.
modifying the intensity of each transient intervention of the plurality of transient interventions in response to the observed shift in the limit cycle of the instantaneous pulmonary ventilation.
10. The method of claim 9, wherein the plurality of transient interventions are applied consecutively, and consecutive applications of the plurality of transient interventions have a time between them, and further comprising the step of modifying the time between the consecutive applications of the plurality of transient interventions in response to the observed shift in the limit cycle of the instantaneous pulmonary ventilation.
11. The method of claim 9, wherein the limit cycle decreases as the plurality of the interventions are applied; and the step of modifying each transient intervention comprises decreasing the intensity of the plurality of interventions as the limit cycle decreases.
12. The method of claim 6, wherein the limit cycle has the phase of the limit cycle corresponding to increasing instantaneous pulmonary ventilation; and the plurality of transient interventions are applied at a zero-crossing within the increasing phase.
13. The method of claim 6, wherein the limit cycle has the phase of the limit cycle corresponding to decreasing instantaneous pulmonary ventilation; and the plurality of transient interventions are applied at a zero-crossing within the decreasing phase.
14. The method of claim 10, further comprising the step of predicting the optimal time between the consecutive applications of the plurality of transient interventions and the optimal intensity of each of the transient interventions based on an embedded model before the steps of modifying the time between the consecutive applications of the plurality of transient interventions and modifying the intensity of each of the transient interventions.
15. The method of claim 14, further comprising providing an adaptive controller to perform the steps of modifying the time between the consecutive applications of the plurality of transient interventions and modifying the intensity of each of the transient interventions.
16. The method of claim 1, further comprising the step of monitoring an oxygen saturation of the arterial blood of the patient and in which the step of applying the transient intervention when the instantaneous pulmonary ventilation is changing further comprises applying the transient intervention when the oxygen saturation of the arterial blood of the patient is at an extreme value.
a controller adapted to control operation of the transient intervention system responsive to signals from the sensor so as to cause the transient intervention system to apply a transient intervention to a patient.
activate the transient intervention system within a phase of the limit cycle.
19. The apparatus of claim 18, wherein the controller is configured to activate the transient intervention system to provide a mitigating intervention within a first phase of the limit cycle.
20. The apparatus of claim 18, wherein the controller is configured to activate the transient intervention system to provide an excitatory intervention within a second phase of the limit cycle.
US1270404A (en) * 1916-03-22 1918-06-25 Herbert Garnett Respirator.
Cherniack 1984 Sleep apnea and its causes.