text:
\section{Introduction}

Compositional data analysis can be applied to color images in the context of image processing and analysis. Color images are stored as triplets of non-negative integers representing the additive primary colors red, green and blue (referred as RGB channels). Once the color image is formed, the transformation from RGB to hue, saturation and intensity (HSI) coordinate system is an often used first step to improve the image visualization \citep{Smith1978, Ledley1990, Grasso1993} (for the mathematical expression of this transformation see Appendix~\ref{RGB2HSI}). HSI color space is commonly used in computer applications because of the commonly accepted property of its components relating to human color perception \citep{Joblove1978, Levkowitz1993, Pohl2016}. Hue relates to the dominant component of the primary colors (red, green, blue) in the mixture, saturation relates to the distance from an equal mixture (gray), and intensity relates to distance from total darkness (black to white). In this article, inspiration is drawn from RGB to HSI color space transformation to propose an analogous and more general method based on compositional data analysis. During this process, a simple vector decomposition is outlined to justify the use of compositional data analysis \citep{Aitchison1982, Pawlowsky-Glahn2015} and the simplex space is leveraged to manipulate vector fields to perform image enhancement. The proposed method is demonstrated using a magnetic resonance imaging (MRI) dataset. The results are also visualized using a digital color photograph to provide a general intuition. Due to the interdisciplinary nature of this work a glossary is provided in ~Appendix~\ref{glossary} to accompany readers from different fields.

\section{Materials and Methods}

\subsection{MRI data acquisition and preprocessing} \label{data_and_preproc}

Whole head T1 weighted (T1w), proton density weighted (PDw) and T2* weighted (T2*w) images at 0.7 mm isotropic volumetric cubic element (voxel) resolution were acquired in one male participant using a three dimensional magnetization prepared rapid acquisition gradient echo sequence with a 32-channel head coil (Nova Medical) on a 7 Tesla whole-body scanner (Siemens) in Maastricht Brain Imaging Center. These measurements reflect different intrinsic properties of the tissues, for instance T1w image shows the optimal contrast between white matter and gray matter, PDw image shows the density of the hydrogen atoms, T2*w image shows the iron content. For the detailed report of the data acquisition parameters see ~Appendix~\ref{mri_parameters}. For a review on ultra high field MRI (($\geq7$ Tesla)) see \cite{Ugurbil2014}.

As a standard preprocessing step, a masking operation was performed based on the PDw image using FSL-BET software (version 2.1; \cite{Smith2002, Smith2004}). The resulting volumetric mask was applied to all images in order to discard parts containing non-brain tissues (e.g. bones, muscles, skin, air). This masking step was necessary to reduce the overall processing time in the following analyses by reducing the total number of voxels from 26214400 ($320\times320\times256$) to $\sim4.5$ million (4543582 to be exact). Measurements (T1w, PDw and T2*w) stored at each one of the $\sim4.5$ million voxels are considered as components of three separate scalar fields constituting a vector field when combined.

\subsection{Barycentric decomposition} \label{methods_bary_decomp}

The image analysis illustrated in this paper starts from the following vector decomposition, where the real space of $n$ dimensions is indicated with $\mathbb{R}^n$ and the simplex space is indicated with $\mathbb{S}^n$ symbols:
\begin{align} \label{bary_decomp}
  & \vec{v} = [v_1, v_2, \ldots, v_D] \text{, where } v_1, v_2, \ldots, v_D \in \mathbb{R}^D_{>0},\nonumber\\
  & \vec{v} = \frac{1}{k} C(\vec{v}) s \text{, where } C(\vec{v}) \in \mathbb{S}^D \text{, and } s \in \mathbb{R}^1_{>0},
\end{align}
where $\mathbb{R}^D_{>0}$ indicates positive real numbers, $k$ is an arbitrary scalar and the letter $C$ stands for the closure operation used in compositional data analysis \citep{Aitchison2002, Pawlowsky-Glahn2015}:
\begin{equation} \label{closure}
  C(\vec{v}) = k \frac{\vec{v}}{s}.
\end{equation}
The letter $s$ is another scalar that is the sum of the vector components:
\begin{equation} \label{intensity}
  s = \sum_{i=1}^D v_i.
\end{equation}
Note that $k$ disappears from the expression in ~Eq.~\ref{bary_decomp} and \ref{closure} when selected as one. The decomposition (Eq.~\ref{bary_decomp}) of the vector $\vec{v}$ into its barycentric coordinates ($C(\vec{v})$) and a scalar ($s$) allows the application of the compositional data analysis to the barycentric coordinates. Historically, the closure operation was used by August Ferdinand Mobius \citep{fauvel1993} and the resulting vector was interpreted as relating to the barycenter (center of mass) of a simplex, hence giving the name to the vector decomposition (Eq~\ref{bary_decomp}) demonstrated here.

\subsection{Compositional image analysis} \label{methods_coda}

In this section, operations performed on the the barycentric coordinates are laid out. These operations are mostly adapted from \cite{Pawlowsky-Glahn2015} to fit the context of the analyzed vector field. Tensor notation is used for explicit formulations:

Let $A$ be a tensor with three dimensions, $A_{x, y, z}$, where the coordinates $x, y, z$ of an element represents the spatial location. As mentioned the in Section \ref{data_and_preproc}, there are $\sim4.5$ million tensors (i.e. voxels) of interest in total.

Let the superscript of tensor $A$ indicate different MRI measurements acquired at every voxel; $A_{x,y,z}^{T1w}$, $A_{x,y,z}^{PDw}$, $A_{x,y,z}^{T2^*w}$. As the first step, all three tensors are vectorized (flattened):
\begin{equation} \label{coda_start}
  \mathsf{vec}(A^t) = [a_{1,1,1},\ \hdots,\ a_{x,1,1}, a_{1,2,1},\ \hdots,\ a_{1,y,1}, a_{1,2,2},\ \hdots,\ a_{1,2,z}]^T.
\end{equation}
$T$ stands for the transpose operator and $ t \in T1w, PDw, T2^*w$.

Concatenation denoted by $\Vert$ is used to matricize the vectorized tensors as the next step:
\begin{equation}
  V = \mathsf{vec}(A^{T1w})\ \Vert \ \mathsf{vec}(A^{PDw})\ \Vert \ \mathsf{vec}(A^{T2w}),
\end{equation}
where number of rows of the matrix $V$ is $x \times y \times z$ ($n = \sim4.5$ million), and the number of columns is $3$. These operations are done for convenient indexing in the following equations.

Let $V$ indicate the set of voxels where the vector $v_i$ is the composition of T1w, PDw and T2*w measurements:
\begin{equation}
  V = [v_i,\ \hdots,\  v_{n}] \text{ where } i \in [1, 2,\ \hdots,\ n] \text{ and } v_i = [v_{i}^{T1w}, v_{i}^{PDw}, v_{i}^{T2^*w}].
\end{equation}
At this stage, $V \in \mathbb{R}^3$. Voxel-wise (i.e. row-wise) closure is applied to $V$ to acquire the barycentric coordinates of every composition:
\begin{equation}  \label{barycentric_component}
  X = C(V) = [C(v_i),\ \hdots,\  C(v_n)],\ X \in \mathbb{S}^3.
\end{equation}
The set of compositions $X$ was centered by finding the \textit{sample center} and \textit{perturbing} each composition with the inverse of the sample center:
\begin{equation} \label{centering}
  \hat{X} = X \oplus \mathbf{\mathsf{cen}(X)^{-1}},
\end{equation}
where $\oplus$ denotes the perturbation operator (analogous to addition in real space):
\begin{equation}
  x \oplus y = C[x_{T1w}\mathbf{y}_1, x_{PDw}\mathbf{y}_2, x_{T2^*w}\mathbf{y}_3].
\end{equation}
Multipliers of the components are indicated with $\mathbf{y}_1$, $\mathbf{y}_2$ and $\mathbf{y}_3$. The term $\mathsf{cen}(X)$ is a vector that stands for the component-wise (i.e. column-wise) geometric mean  across all voxels:
\begin{equation}
  \mathsf{cen}(X) = [\mathbf{g}_{T1w}, \mathbf{g}_{PDw}, \mathbf{g}_{T2^*w}] = \left( \prod_{i=1}^{n} x_{ij} \right) ^ {1/n}, j = [T1w, PDw, T2^*w].
\end{equation}
After centering, the data is standardized:
\begin{equation}  \label{standardize}
  \hat{\hat{X}} = \hat{X} \odot \mathsf{totvar}[X]^{-1/2},
\end{equation}
where $\odot$ symbol stands for the power operator (analogous to scaling in real space). The exponent $p$ is applied to every component:
\begin{equation}
  x\odot p = C[x_{T1w}^p, x_{PDw}^p, x_{T2*w}^p],
\end{equation}
and the total variance is computed by:
\begin{equation}
  \mathsf{totvar}[X] =  \frac{1}{n} \sum_{i=1}^{n} d_a^2(x_i,\ \mathsf{cen}(X)),
\end{equation}
where $d_a^2$ indicates squared Aitchison distance:
\begin{equation}
  d_a(x, y) = \sqrt{\frac{1}{2D} \sum_{j=1}^D \sum_{k=1}^D \left( \ln\frac{x_j}{x_k} - \ln\frac{y_j}{y_k} \right)^2}.
\end{equation}
In the current example $D=3$ because of operating on a set of three part compositions $X$ (see ~Equation~\ref{barycentric_component}).

At this stage some visual intuition could be gained with regards to the vector field (MR images) that is decomposed and processed via compositional data analysis methods. For illustration purposes, this is done by generating virtual image contrasts computed through metrics of simplex space (see Figure~\ref{Fig2}).

The norm in $S^3$ image in Figure~\ref{Fig2} is generated by computing Aitchison norm voxel-wise:
\begin{equation}
  \parallel X \parallel _{a} = [ \parallel x_i \parallel _a,\ \hdots,\ \parallel x_n \parallel _a].
\end{equation}
The subscript $a$ stands for the vector norm defined in simplex space (analogous to Euclidean norm in real space). Following \cite{Pawlowsky-Glahn2015}, Aitchison norm is defined as:
\begin{equation} \label{a_norm}
  \parallel x \parallel _a = \sqrt{\frac{1}{2D} \sum_{j=1}^D \sum_{k=1}^D \left( \ln\frac{x_j}{x_k} \right)^2},
\end{equation}
where $D = 3$ considering three different MRI measurements (T1w, PDw, T2*w).

It should be noted that this norm image is analogous to saturation dimension in the aforementioned RGB to HSI color space transformation (see Appendix \ref{RGB2HSI}).

The angular difference in $S^3$ image in Figure~\ref{Fig2} is the voxel-wise angular difference ($\angle$) between the set of compositional vectors ($X$) and a reference vector ($r$):
\begin{equation}
  X_\measuredangle = [\angle{x_i r},\ \hdots,\ \angle{x_n r}],
\end{equation}
where
\begin{equation} \label{angular_diff}
  \angle{x_ir} = \arccos \left( \frac{\langle x_i, r \rangle _a}{\parallel x_i \parallel _a \parallel r \parallel _a} \right).
\end{equation}
$\parallel x \parallel _a$ stands for Aitchison norm of the vector $x$ as defined in ~Equation~ \ref{a_norm} and $\langle x, r \rangle _a$ stands for inner product in simplex space:
\begin{equation}
 \langle x, r \rangle _a = \frac{1}{2D} \sum_{j=1}^D \sum_{k=1}^D \ln\frac{x_j}{x_k} \ln\frac{r_j}{r_k}.
\end{equation}
Here, $D = 3$ again and it should be noted that the choice of the reference vector $r$ is arbitrary. In this example the reference vector is selected as $r = [0.05, 0.9, 0.05]$. This angle difference image is similar to hue dimension in RGB to HSI color space transformation (see Appendix \ref{RGB2HSI}).

Recognizing the similarity of norm and angular difference in simplex space to saturation and hue dimensions of HSI color space at this stage leads to the proposal of a color balance algorithm which is used together with centering (Eq. \ref{centering}) and standardization (Eq. \ref{standardize}) to generate the color image in Figure~\ref{Fig3} lower row:
\begin{equation}  \label{truncate}
  \mathsf{truncate}(x) =
  \begin{cases}
  x \odot \left( \dfrac{\parallel x \parallel _a}{\lambda} \right) &, \parallel x \parallel _a > \lambda \\
  x &, \parallel x \parallel _a \leq \lambda
  \end{cases}
\end{equation}
This method is inspired from other simple color balance methods that makes use of the dynamic range of RGB channels of color images \citep{Limare2011}. Truncate function is useful when when there are a small amount of outliers compositions. In essence this functions pulls the compositions that are too far away from the center of the simplex space towards the center. In the current work, distance threshold was arbitrarily chosen $\lambda = 3$ based on visual inspection of the resulting color enhancement. It is conceivable that other operations based on percentiles can also be used to the make the decision less arbitrary (e.g. $99^{th}$ percentile of Aitchison norm distribution consisting of all vectors of $X$).

The ilr transformation \citep{Egozcue2003,Pawlowsky-Glahn2015} was performed voxel-wise to acquire real space coordinates (ilr coordinates) of the set compositions to generate Figure~\ref{Fig3} right column:
\begin{equation}
  X_{\mathsf{ilr}} = [\mathsf{ilr}(x_i),\ \hdots,\ \mathsf{ilr}(x_n)],
\end{equation}
where the ilr transformation is defined as:
\begin{equation} \label{ilr_transformation}
  \mathsf{ilr}(x_i) = \ln(x_i) \cdot \mathbf{H}.
\end{equation}
$\mathbf{H}$ indicates the Helmert sub-matrix, chosen by following \cite{Tsagris2011,Lancaster1965}. In this case $\mathbf{H}$ consists of 3 rows and 2 columns and selected as the following:
\begin{equation} \label{helmert_matrix}
\mathbf{H} =
  \begin{bmatrix}
    \frac{1}{\sqrt{2}}  &  \frac{1}{\sqrt{6}} \\
    -\frac{1}{\sqrt{2}} &  \frac{1}{\sqrt{6}} \\
    0                   & -\sqrt{\frac{2}{3}}
  \end{bmatrix}
.
\end{equation}

To explore the usefulness of the ilr coordinates and probe physically interpretable compositional characteristics, a real-time interactive visualization method is used with joint ilr-coordinates and image space representations of the data. This method is similar to using pre-defined modulation transfer functions for mapping the bins of a 2D histogram data representation to 3D image space used in volume rendering software \citep{Kniss2005}. Major brain tissues such as gray matter, white matter, cerebrospinal fluid arteries and sinuses are identified manually by the author and delineated in both ilr-coordinates and brain images using neuro-anatomical expertise.

All analysis steps demonstrated in this work are implemented in a free and open source Python package (available at https://github.com/ofgulban/compoda; \cite{compoda0pt3pt1}) using Numpy \citep{numpy2011}, Scipy \citep{scipy2001}, Matplotlib \citep{matplotlib2007}, Nibabel \citep{nibabel2017} and scikit-image \citep{scikit-image} as auxiliary scientific libraries. The joint exploration of tissues in ilr-coordinates and image space is performed by using a specialized software developed by the author \citep{segmentator1pt3pt0}.

\section{Results}

\begin{figure}[hbt]
  \begin{center}
    \includegraphics[width=\textwidth]{figure_1.pdf}
    \caption{\label{Fig1}Visual demonstration of the similarity between RGB to HSI transformation and the corresponding analogous concepts laid out in ~Sections~\ref{methods_bary_decomp} and \ref{methods_coda}. In the first row the original image consisting of three channels and each of its channels can be seen. The second row shows hue, saturation and intensity components after RGB-HSI transformation [\ref{RGB2HSI}]. The third row shows angular difference in simplex space (analogous to hue), norm in simplex space (analogous to saturation) and derived by using compositional data methods (Equations~\ref{coda_start}-\ref{angular_diff} and the scalar component in real space (Equation~\ref{intensity}). Color maps of all scalar images range between the minimum and the maximum values of the corresponding image (darker shades are assigned to low values). The image is acquired from official SpaceX photo gallery (https://www.flickr.com/photos/spacex) licensed under CC0 1.0 public domain.}
  \end{center}
\end{figure}
Figure~\ref{Fig1} shows the similarity between HSI and the analogous metrics demonstrated in methods section. When comparing Fig.~\ref{Fig1} rows 2-3 column 1 to column 3, it can be seen that hue and angular difference in simplex space are both invariant to intensity gradient visible in the sky (brightness change from upper right corner to lower left). The same observation can also be made for the saturation and norm in simplex space images (compare Fig.~\ref{Fig1} rows 2-3 column 2 to column 3). These observations can be related to the scale invariance principle of compositional data analysis. By applying the barycentric decomposition (Eq.\ref{bary_decomp}) to color triplets in each pixel, scale information is separated, revealing compositional vectors invariant to the underlying multiplicative scalar field (i.e. brightness). These image contrasts based on compositional metrics are useful in object recognition tasks, see how the clouds are invisible in hue and angular difference images or the well-defined tip of the rocket in saturation and norm images.
\begin{figure}[hbt]
  \begin{center}
    \includegraphics[width=\textwidth]{figure_2.png}
    \caption{\label{Fig2}T1w, PDw and T2*w MR images rendered together with angular difference in simplex space (~Eq.~\ref{angular_diff}), norm in simplex space (~Eq.~\ref{a_norm}) and scalar channel sum component (~Eq.~\ref{intensity}). Left panel shows the sagittal slices (y-z plane) and the right panel shows a coronal slices (x-z plane) of the 3D images. Arrows with one asterisk (*) indicates the parts of the images that are too bright and arrows with two asterisks (**) indicates the parts that are too dim as a result of data acquisition imperfections. The legends on the upper left corner in left panel shows the colors bars which are also valid for the images in right panel.}
  \end{center}
\end{figure}
Figure~\ref{Fig2} depicts two different slices of the 3D brain images visualized in gray scale depicting different image contrasts. It can be seen that the smooth, artefactual multiplicative scalar field (referred as bias field in MRI literature, see arrows with asterisks in Fig.~\ref{Fig2}) is separated from the compositional components (compare Fig.~\ref{Fig2} rows 1-2 column 2 with row 3 column 2 in both panels). This is similar to the separation of the brightness gradient in the sky in ~Fig.~\ref{Fig1} as mentioned in the previous paragraph. The compositional image contrasts can be considered as virtual contrasts which enhance the visual appearance by being invariant to certain artefactual features. It should be mentioned that other image contrasts can be generated by changing the reference vector in angular difference images (see Eq.~\ref{angular_diff}) to highlight specific tissues. Similarly, the compositions can also be perturbed (see Eq.\ref{centering}) differently to generate different contrasts in norm images. The generation of task-specific virtual contrasts could potentially be useful in medical imaging applications since the input channels and the virtual contrasts are physically interpretable.

For the physical interpretation of the compositional vectors, a joint representation of color images and ilr coordinates of compositional vectors are presented in Figure~\ref{Fig3}. The difference between the rows in left column demonstrates the effect of color balance (see Equations~\ref{centering} and \ref{standardize}). It can be seen that the image contrast is enhanced to the level of easily recognizing major brain tissues by associating them to different colors. This is a more convenient visualization compared to inspecting T1w, PDw, T2*w image contrasts individually considering that the color image contains information from all three inputs at the same time. Right column in Fig.~\ref{Fig3} shows the 2D histograms of the ilr coordinates (see Eq.~\ref{ilr_transformation}) of the vector compositions. The effect of color balance becomes apparent when the compositions are interpreted with regards to the embedded RGB color cube primary axes (real space axes). For instance most of the clusters are on the left hand side of the center, close to the green arrow (PDw). This indicates that PDw measurements were initially dominating the compositions causing the green heavy color image. After the color balance, compositions spread more equally along the primary color axes, indicating that color contrast in the image will be richer (i.e. less dominated by a single component). The color balanced visualization is more useful for human observers in terms of intuitively recognizing the tissues. For instance the arteries have mostly reddish-white colors and the sinuses appear in green, which corresponds to the areas delineated for these tissues in ilr coordinates when the positions of clusters are considered relative to the embedded primary axes of RGB color cube. Although both of these are blood vessels, the difference between arteries and sinuses is meaningful because sinuses contain mostly deoxygenated hemoglobin, leading to a rapid decay of the MRI signal. In contrast, arteries contain oxygenated blood with slower MR signal decay. The difference in signal decay times of blood vessels effects T2*w and PDw measurements separating the compositional properties in relation of T1w images. Similarly the compositional change from white matter to gray matter to cerebrospinal fluid can be seen as an approximately straight line which corresponds to the change from red-heavy color of white matter to cyan of cerebrospinal fluid. It can be seen that these tissues are not dispersed towards PDw or T2*w axes, which can be intepreted as PDw and T2*w measurements not revealing different compositions in relation to T1w measurements when white matter, gray matter and cerebrospinal fluid is considered.

\begin{figure}[hbt]
  \begin{center}
    \includegraphics{figure_3.pdf}
    \caption{\label{Fig3}MRI measurements rendered as a color image. Red channel is assigned to T1w, green to PDw and blue to T2*w measurements. Left column shows the 2D histograms of the corresponding ilr coordinates (Eq.~\ref{ilr_transformation}). The projection of primary axes of RGB color cube (in $R^3$) to ilr coordinates are embedded to provide an intuitive reference for the characteristics of the compositions. The effect of centering and standardization inside the simplex (Eq. ~\ref{centering}, \ref{standardize}) and the compositional truncation (Eq. \ref{truncate}) is visible as color balance improvement in the rendered brain slice. The labels pointing to the tissues in brain image and circles in 2D ilr coordinate histograms shows the relation of the compositional characteristics with the coloration. The circles in 2D histograms are the edges of the 2D transfer functions used to manually probe the tissue-ilr coordinate relationship.}
  \end{center}
\end{figure}

\section{Discussion}

In this work, compositional data analysis methods are used to reformulate RGB-HSI color space transformation. It is visually demonstrated that the compositional metrics such as angular difference and norm in simplex space relate to hue and saturation concepts in color space literature. This reformulation of hue and saturation would be advantageous for having a well-principled framework when operating on images with n-dimensions. For instance, a potential future application would be to analyze MRI datasets with more than three types of measurements by adding cerebral blood volume measurements \citep{Uludag2017} or multi-echo echo planar imaging \citep{Poser2009} to T1, T2 and PD weighted measurements at ultra high fields. Another application area would be processing of multi-spectral images for image fusion purposes \citep{Pohl2016}. In cases where more than three measurements are acquired for each element in an image, dimensionality reduction methods such as principal component analysis in simplex space \citep{Wang2015} would become relevant to maximize the visualized information content of color images. This is the disadvantage of being limited to three primary additive colors for color image rendering. However the virtual image contrasts (scalar images) could still be explored without dimensionality reduction. For instance the norm in simplex space can still be straightforwardly computed for n-dimensional compositions or the angular difference images can be explored can be explored by selecting different reference vectors to track the positions of n-dimensional compositions on an n-sphere.

The disadvantages of compositional metrics presented here should also be mentioned. If the signal to noise ratio of the acquired images are low, compositional image contrasts would become less useful. For instance, the parts of images where only the measurement noise is recorded (e.g. thermal noise) the compositional metrics would carry no meaning. In such cases the angular difference and norm in simplex space would return enhanced noise patterns therefore the local brightness (i.e. intensity) should be taken into account before the compositional image analysis. The domain-specific exploration of the parameter spaces are also needed. For instance what is the extent of the usefulness of the compositional image processing when the noise properties are dissimilar between different types of measurements or when the measurements have different spatial scales (e.g. images with different resolutions). Further investigation is necessary to establish the relevance of the proposed application of compositional data analysis specifically to MRI data and generally to image processing and image fusion.

\section{Acknowledgements}

The data was acquired thanks to Federico De Martino, under the project supported by NWO VIDI grant 864-13-012. The author O.F.G. was also supported by the same grant. I thank Ingo Marquardt for language editing in the initial version of the manuscript and Alberto Cassese for the advice on mathematical notations in Section \ref{methods_bary_decomp}. In addition, I wish to express my appreciation for the comments and suggestions of the anonymous reviewers which I believe have helped to improve the manuscript.

\section{Appendix}

\subsection{Glossary} \label{glossary}

\textbf{Barycentric coordinates}: Center of mass-centric coordinates. Used in relation to the center of mass of an n-simplex.

\textbf{Color balance}: Used to indicate centering and standardizing compositional vectors in this work.

\textbf{HSI}: A three dimensional space with named axes relating to human color perception: hue, saturation, intensity.

\textbf{MRI}: Magnetic resonance imaging.

\textbf{PDw}: Proton density weighted MRI signal acquisition. Indicates density of the hydrogen atoms in different tissues.

\textbf{RGB}: A three dimensional space with named axes relating to color cube: red, green, blue

\textbf{Simplex}: Generalized geometrical notion of triangles. For example, 0-simplex is a point, 1-simplex is a line segment, 2-simplex is a triangle, 3-simplex is a tetrahedron etc.

\textbf{T1w}: T1 weighted MRI signal acquisition. Optimized to give the highest image contrast between white matter and gray matter brain tissues.

\textbf{T2*w}: T2* weighted MRI signal acquisition. Optimized to give the highest image contrast related to iron concentration between brain tissues.

\textbf{Voxel}: Volumetric cubic element, in other words a three dimensional pixel.

\subsection{RGB to HSI transformation} \label{RGB2HSI}

\begin{equation*}
  Intensity = I = \left(\frac{R}{\max(R,\ G,\ B)} + \frac{G}{\max(R,\ G,\ B)} + \frac{B}{\max(R,\ G,\ B)}\right) \div 3.
\end{equation*}

\begin{equation*}
Saturation = S =
  \begin{cases}
    0 &, I=0 \\
    1 - \dfrac{\min(R,\ G,\ B)}{I} &, I > 0.
  \end{cases}
\end{equation*}

\begin{equation*}
Hue = H =
  \begin{cases}
    0^\circ &, \Delta=0\\
    60^\circ \times \left( \dfrac{G' - B'}{\Delta}\mod6 \right) &, C_{max} = R'\\
    60^\circ \times \left( \dfrac{B' - R'}{\Delta} + 2 \right) &, C_{max} = G'\\
    60^\circ \times \left( \dfrac{R' - G'}{\Delta} + 4 \right) &, C_{max} = B'
  \end{cases}
\end{equation*}

\begin{equation*}
  \text{where } \Delta = \max(R,\ G,\ B) - \min(R,\ G,\ B)
\end{equation*}

\begin{equation*}
 \text{ and } R' = \frac{R}{\max(R,\ G,\ B)},\ G' = \frac{G}{\max(R,\ G,\ B)},\ B' = \frac{B}{\max(R,\ G,\ B)}.
\end{equation*}

\subsection{MRI data acquisition parameters and ethics statement} \label{mri_parameters}
Whole head images were acquired using a three dimensional magnetization prepared rapid acquisition gradient echo (MPRAGE) sequence. The data consisted of a T1w image (repetition time [TR] $= 3100\ ms$; time to inversion [TI] $= 1500\ ms$ [adiabatic non-selective inversion pulse]; time echo [TE] $= 2.42\ ms$; flip angle $= 5^\circ$; generalized auto-calibrating partially parallel acquisitions [GRAPPA] = 3 \citep{Griswold2002}; field of view [FOV] $= 224 \times 224\ mm^2$; matrix size $= 320 \times 320$; 256 slices; 0.7 mm isotropic voxels; pixel bandwidth $= 182$ Hz/pixel; first phase encode direction anterior to posterior; second phase encode direction left to right), a PDw image (0.7 mm isotropic) with the same 3D-MPRAGE sequence but without the inversion pulse (TR $= 1380\ ms$; TE $= 2.42\ ms$; flip angle $ = 5^\circ$; GRAPPA $= 3$; FOV $= 224 \times 224\ mm$; matrix size $= 320 \times 320$; 256 slices; 0.7 mm isotropic voxels; pixel bandwidth $= 182$ Hz/pixel; first phase encode direction anterior to posterior; second phase encode direction left to right), and a T2*w anatomical image using a modified MPRAGE sequence TR ($= 4910\ ms$; TE $= 16\ ms$; flip angle $= 5^\circ$; GRAPPA $= 3$; FOV $= 224 \times 224 mm$; matrix size $= 320 \times 320$; 256 slices; 0.7 mm isotropic voxels; pixel bandwidth $= 473$ Hz/pixel; first phase encode direction anterior to posterior; second phase encode direction left to right). Only magnitude images are stored after reconstruction.

The experimental procedures were approved by the ethics committee of the Faculty for Psychology and Neuroscience at Maastricht University, and were performed in accordance with the approved guidelines and the Declaration of Helsinki. Informed consent was obtained from the participant before conducting the data acquisition.

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text:
Mike Mathison
Tuesday, 06 September 2022 / Published in All Posts, Inmarsat, Intelligence News & Updates., Technology
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The goal of Fleet Safety is to modernize maritime safety communications and raise safety standards in international shipping. Inmarsat is the market leader in global, mobile satellite communications. The formal launch, which has been in the works for a number of years as a replacement for the industry-leading Inmarsat C maritime safety service, comes after the completion of Fleet Safety sea trials successfully.
After being evaluated by the International Mobile Satellite Organization, Fleet Safety received approval from the International Maritime Organization (IMO) in accordance with GMDSS regulations (IMSO).
Inmarsat has updated documents and developed training materials in the wake of the introduction of RescueNET and SafetyNET II in order to make sure the industry is prepared for the new safety service. Fleet Poll, a new data reporting service for Long Range Identification Monitoring (LRIT), Vessel Monitoring Systems (VMS), asset tracking, and Ships Security Alert System, has also been added by Inmarsat. Getting Flag State permission is the next step before adoption is widespread in the maritime sector.
Peter Broadhurst, Senior Vice President of Safety and Regulatory, Inmarsat Maritime, said "To this day, Inmarsat C forms the backbone of the GMDSS, with more than 100,000 marine terminals having safeguarded the lives of seafarers for over 30 years. However, as we move further into the digital era of shipping, technology can be used for enhanced safety and also provides new ways of tackling emerging challenges. The launch of Fleet Safety marks a turning point in the way satellite communications ensure the preservation of life at sea."
With the inclusion of a Maritime Safety Terminal, Fleet Safety is delivered via the company's already-existing FleetBroadband or Fleet One voice and data services. It provides unmatched network availability and worldwide coverage. In addition to being more user-friendly, its redesigned interface makes it simpler for sailors to access vital functionality and get in touch with Maritime Rescue Coordination Centers (MRCCs) in an emergency. Now, a network of more than 60 global MRCCs can be reached instantly by voice call or instant message.
Additionally, Fleet Safety has a Distress Chat feature and a cutting-edge Maritime Safety Information (MSI) interface. The MSI feature enables users to manage the MSI broadcast stream and download previous transmissions, which include weather, navigational, and search-and-rescue alerts. The Distress Conversation feature, meanwhile, allows for the establishment of chat rooms between ships in distress, aiding in faster response/resolution times from both vessels and MRCCs.
Because Fleet Safety users have access to so many capabilities and functionalities, Inmarsat has also made an investment in training sailors to assist them to fully utilize the system. The strategy intends to educate sailors on the value of being proactive in marine distress communications, going above and beyond user guidance.
"In a precarious situation, notifying rescue authorities early can prove pivotal in saving the ship and, more importantly, the lives of the crew on board," said Broadhurst. "Seafarers will generally do their utmost to rectify an issue before requesting assistance, but Inmarsat's Fleet Safety facilitates a culture for personnel to report situations early, rather than wait until events get beyond their control."
Inmarsat's DNA includes a focus on maritime safety. The IMO established the business in 1979 with the goal of creating a satellite communications network to safeguard the lives of sailors. Inmarsat contributed to design the IMO's GMDSS, a set of standards for maritime safety, and with the launch of Inmarsat C in 1991, it became the first satellite operator to meet its strict requirements for ship security warning systems.
Sinnatt , J. (2022, September 5). Maritime safety communication modernised as INMARSAT launches fleet safety. Inmarsat Corporate Website. Retrieved September 6, 2022, from https://www.inmarsat.com/en/news/latest-news/maritime/2022/maritime-safety-communication-fleet-safety-launched.html
Tagged under: Inmarsat, Maritime Safety
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redpajama_set_name: RedPajamaCommonCrawl


The CIPD, the professional body for HR and people development, has announced the programme for its 70th Annual Conference and Exhibition, taking place at Manchester Central on 8-9 November 2017.
As the major HR conference of the year, the CIPD Annual Conference and Exhibition attracts thousands of national and international attendees. The theme for this year is embracing the new world of work, and the conference will focus on the major shifts that are affecting organisations, the people profession, and the world of work at large. Leading commentators, academics and practitioners will share practical insights through keynotes, case studies and debates on how to modernise people practices to succeed in the changing realities of work, and shape a positive future that will benefit everyone.
Baroness Martha Lane-Fox, co-founder of Lastminute.com and former UK Digital Champion will deliver the opening keynote on creating a fair and inclusive digital world that works for everyone. She will address the responsibility of organisations in modernising practices to enable a digital future, the role of digital understanding and accountability, and the importance of ethical, sustainable, inclusive and responsible technology.
Professor Gernot Schulz, a conductor and former member of the Berlin Philharmonic Orchestra, will close the conference accompanied by a classical orchestra to demonstrate how leaders can enable optimal performance. Through a combination of musical performance and inspirational talk, the closing keynote will address the fine balance between guidance and autonomy, the conditions for seamless integration and collaboration, and the importance of leading through emotion and intuition.
Running alongside the conference is the CIPD Exhibition, in which more than 180 leading HR and L&D suppliers will be showcasing their latest innovations and solutions. The exhibition features a free programme of bite-sized learning sessions and insight from suppliers, synchronised with the key themes of the conference agenda. CIPD experts and conference speakers will also be sharing their knowledge and expertise on how to understand and approach current and future challenges in work and working lives.
Peter Cheese, CIPD Chief Executive, comments: "We are already seeing many changes in the world of work from digitisation and the impact of rising automation, to the changing expectations and demographics of our workforces, and the ongoing change and uncertainty in the socio-political landscape. At the same time, we need to make real progress on the ongoing challenges of greater inclusion, well-being and engagement, fairness and opportunity, but also the business imperatives of improving productivity, innovation and agility. These will be key to how organisations respond and thrive in the future, and creating the environments, roles and support to get the best out of people really must be at the centre of the debate.
Book your place at the CIPD 2017 Annual Conference and Exhibition here.


The Australian pharmaceutical industry comprises domestic and international enterprises. Foreign-owned multinationals dominate overall, and while Australia is a relatively small market in terms of population, it is ranked within the top 20 markets worldwide.
Australia's Medicare national public health program covers a high percentage of the cost of a variety of pharmaceuticals and medical services, as well as the costs of public hospital care nationwide. The Australian Federal Government also subsidises private health cover through an income-tested rebate system. Private health insurance provides extended cover for private hospitals, broader medical services and pharmaceuticals beyond the costs covered by Medicare.
Australia's regulatory medical body, the Therapeutic Goods Administration (TGA), is responsible for the registration of therapeutic goods in Australia. TGA-approved pharmaceuticals may be subsidised under the Australian Pharmaceutical Benefits Scheme (PBS), or for vaccines, via the National Immunisation Program (NIP), and are administered by Medicare. TGA-approved pharmaceutical products are registered on the Australian Register of Therapeutic Goods (ARTG).
Recommendations for PBS reimbursement of ARTG products are provided by the Pharmaceutical Benefits Advisory Committee (PBAC), an independent statutory body which reports to the Federal Department of Health. The PBAC accepts established product safety and efficacy as a condition of ARTG registration.
The PBAC also reviews the recommendation of expensive life-saving medications for supply under the Life Saving Drugs Programme (currently in review) and medications that require restricted supply through public and private hospitals such as the PBS Section 100: Highly Specialised Drugs Program or the PBS Section 100: Efficient Funding of Chemotherapy.
Other notable influencers include Medicines Australia, which influences pharmaceutical industry reputation and regulates the advertising and promotion of prescription products, and NPS MedicineWise, which is responsible for prescribing behaviour in Australia. In particular, the NPS MedicineWise RADAR program, published three times per annum to coincide with PBAC recommendations, offers health professionals necessary information regarding new PBS-listed treatments.
The pricing and reimbursement process for medicines in Australia is often long and complex. It is based on clinical benefit, comparison to medicines in the same therapeutic class, cost-effectiveness and budgetary implications.
Clinical and economic evaluations are initially reviewed by the PBAC's Pharmaceutical Evaluation Section and Economic Sub-Committee (ESC).
Companies must provide major submissions 17 weeks prior to a PBAC meeting, while minor submissions are required 11 weeks prior. Sponsors are verbally informed of outcomes within one week, and in writing within three weeks post PBAC meetings.
In the instance where the PBAC must enter into treatment cost negotiations with the manufacturer, such as for PBS Section 100 listings, PBS listing may be delayed or postponed.
In general, new PBS listings are available on the first day of each calendar month prior to a subsequent PBAC meeting and products may receive listing as early as the calendar month immediately post- PBAC review.
The PBS currently covers up to 80 per cent of prescriptions dispensed in community pharmacies. However, consumers do carry an out-of-pocket cost or co-pay for their medications. The PBS co-payment scheme is adjusted annually every January in line with the Consumer Price Index.
As of January 2015, the Australian Government implemented a four-year program aimed at achieving sustainability of the PBS. Under the revised program, the amount consumers pay for medicine has increased. While the Government envisages the increased consumer contributions will allow for PBS cost efficiencies that will subsequently enable new medications to be listed, consumer and pharmacy industry groups believe such changes will impact consumer access to medicine.
Within a therapeutic group, the PBS subsidises medicines up to the cost of the lowest-priced drug in the group. Those extra costs for medicines carrying a therapeutic group premium are at the expense of the consumer and do not contribute to the consumer's PBS safety net threshold. Under Therapeutic Group Premium Policy, drug substitution by pharmacists is not permitted (note, under Brand Premium Policy as relates to generics, drug substitution is permitted with consumer consent). As a result, cost-effectiveness plays an important role, not only in determining whether or not a treatment is PBS listed, but how a brand fits within a tightly regulated pricing scheme.
In order for manufacturers to build and sustain brand value, they must be willing to reach agreements with Government, invest in life-cycle value management initiatives and build relationships and advocacy networks with physicians and prescribers.
Offering key players best available data, maintaining ongoing brand awareness, reinforcing brand value proposition and understanding the nuances of the Australian reimbursement environment can help a brand team sustain volume and value throughout the brand lifecycle.
GLOBALHealthPR can help you map out and implement your strategy for engaging and communicating to these key players at all levels in Australia.


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Best answer: Why did the Roman Empire not tolerate Christianity and what was the result?
How did the Roman Empire react to Christianity?
How did Christianity affect the fall of Rome?
Why was Christianity a threat in ancient Rome?
Why did the Romans accept Christianity?
What caused the downfall of Rome?
What was the effect of the fall of the Roman Empire?
What were the causes and effects of the fall of Rome?
What conditions in the Roman Empire allowed Christianity to grow while the Empire declined?
Although it is often claimed that Christians were persecuted for their refusal to worship the emperor, general dislike for Christians likely arose from their refusal to worship the gods or take part in sacrifice, which was expected of those living in the Roman Empire.
Christians were occasionally persecuted—formally punished—for their beliefs during the first two centuries CE. But the Roman state's official position was generally to ignore Christians unless they clearly challenged imperial authority.
When Christianity became the state religion, the Church reduced the state resources by acquiring large pieces of land and keeping the income for itself. The society had to support various members of the Church hierarchy like monks, nuns, and hermits. Thus, probably leading to the fall of the Roman Empire.
Christians were seen as a threat to society because of Rome's disapproval of Pagan practices. At the height of anti-Christianity the majority of Romans were Polytheistic. The Christian religion itself, when compared to others of the time, might be regarded as a relatively aggressive and predatory religion.
THIS IS INTERESTING: What happens at the ordination of a Catholic priest?
Constantine knew that the old system was insufficient for what the Empire was facing, and so he looked to craft something better. His solution was to use Christianity as the glue to hold the Roman Empire together.
Invasions by Barbarian tribes
The most straightforward theory for Western Rome's collapse pins the fall on a string of military losses sustained against outside forces. Rome had tangled with Germanic tribes for centuries, but by the 300s "barbarian" groups like the Goths had encroached beyond the Empire's borders.
Perhaps the most immediate effect of Rome's fall was the breakdown of commerce and trade. The miles of Roman roads were no longer maintained and the grand movement of goods that was coordinated and managed by the Romans fell apart.
External military threats were a major cause of Rome's fall, and its effects spread across the empire. … They kept the pressure on the Roman Empire, while nations such as Russia became powerful and sophisticated. What had been barbarian villages in Germany soon turned into 2,300 walled towns and cities.
The conditions in the Roman empire that allowed Christianity to grow while the empire declined were the Edict of Milan which opened the way for Christianity throughout the empire.
THIS IS INTERESTING: Are churches considered employers?


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Libel and Slander: What's the Difference?
10/21/2019 4:00 AM - JD Haas - Civil Litigation, Lawyer, Slander, Libel - 0 Comments
Free speech is one of the values that America was founded on. After all, the original colonizers fled Great Britain to come here and practice free speech. It seems a little strange, then, that there exist punishments for certain types of speech and civil litigation lawyers to handle these cases.
It might not seem as strange when we consider what words truly can do: ruin somebody's reputation, leave permanent psychological scars, even make it difficult for somebody to find a job in the future. There therefore exist laws and civil lawyers to protect Americans everywhere.
But this begs the question: how do you know if what you're saying can get you in trouble under the laws of free speech? JD Haas, a civil lawyer near you, has the answers below.
Defamation: The Umbrella Category
In America, you're free to say what you'd like, so long as it doesn't unjustly harm someone's reputation—to do so would be called "defamation," or a statement that damages somebody's public reputation and which the speaker knew to be false. Defamation comes in many forms, two of the most common being libel and slander. Though hurting somebody's reputation is grounds for both libel and slander cases, the two have a couple key differences.
Slander Defined
Slander is, essentially, speaking false words that harm someone's public reputation. Nothing needs to be officially written or published; simply an utterance is grounds for slander.
In slander cases, the burden of proof falls to the plaintiff. In plainer terms, the person whose reputation was harmed needs to prove that the statements made against them are not entirely true. If the plaintiff is a public figure (such as a celebrity or a public official), however, they will also need to prove that the statement was made with "actual malice," or reckless disregard for the truth—though the exact definition of actual malice varies between state jurisdictions.
Libel Defined
Libel is similar to slander in that it damages one's reputation. However, in a libel case, the damaging material must be published, such as in a newspaper. In a libel case, just like in slander, under federal law, the plaintiff must prove the statements made against them were false. As a bit of trivia, publishing defamatory statements on the internet can be considered both libelous or slanderous, depending on the situation; however, under federal law, expressing one's opinion is never grounds for libel.
Still Confused? JD Haas is Here to Help
Law is complicated! If you or your business find yourself in the midst of an accusation of libel or slander, call the business attorneys at JD Haas today. You can reach our Bloomington office at 952-345-1025.
TAGS: Slander, Libel, Civil Litigation, Lawyer
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Strike ballot rules must be overhauled, says CBI
The Confederation of British Industry wants the rules for strike ballot to be changed. The want at least 40% of the workforce to have to vote. The law only calls for a majority or those who vote to vote for a strike. The CBI says that this rules causes strikes based on only a few members' wishes. A spokesman said that the job losses ahead means that the government should make it harder to strike. They also wan the government to cut the number of days that employees can consult on redundancies to 30 days, in order for workforces to respond quicker to changes in demand. A spokesman for the TUC union said that the United Kingdom has very tight restrictions on the right to strike, and further restrictions would violate human rights.
See Louisa Peacock, The Daily Telegraph (UK), June 20, 2010
PrevPreviousGreece's Largest Unions Plan Paralyzing Strike For June 29
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Peruvians begin to put tragedy behind
ICA, Peru – The evening before his 12th birthday, Denis Sulca stood near the end of a line of more than 100 children, hoping for a ration of milk. Eight days earlier, Aug. 15, a magnitude 8 earthquake destroyed the adobe house where his family lived in a shantytown in this city of about 300,000 people on Peru's southern coast.
"We're sleeping in a tent in the street," said Denis, the oldest of six children. "My little brothers are sick."
Three minutes of violent tremors shattered the dreams of tens of thousands of families who have migrated from the Andes Mountains to Ica and the neighboring towns of Pisco and Chincha over the past two decades in search of jobs and an education for their children. Some lost family members in the earthquake, which killed at least 530 people. Those who escaped harm as the adobe walls and ceilings of their homes crumbled must now start over.
"People are putting a lot of hope in the aid promised by the government," said Father Victor Cupe, whose parish spans Parcona, a district of 40,000 people that includes a sprawling shantytown and scattered rural communities.
President Allen Garcia has promised vouchers worth about $1,900 to families whose homes were destroyed in the quake. While some people in Father Cupe's parish have gone to live with relatives, many others are camped out in tents in front of what remains of their homes. Since the earthquake, they have spent their days helping each other clear away the rubble.
Bishop Guido Brena Lopez of Ica has accompanied his flock through droughts, floods and earth tremors in his nearly 34 years in the diocese, but never expected a disaster like the earthquake that struck on the feast of the Assumption of the Blessed Virgin Mary.
"It went on for so long that I thought my life was over," he said. "At the same time, I thought of the entire diocese. The lights went out. I couldn't see anything, but I knew that many things had happened."
His fears were confirmed when he turned on the radio and learned that the epicenter of the huge quake was near Pisco, about 42 miles north of Ica.
"That was when I began to realize the magnitude of the destruction," he said.
Residents of Pisco, Ica and Chincha are slowly trying to put the disaster behind them. They have buried the dead, the most seriously injured have been evacuated to hospitals in Lima, the Peruvian capital, and emergency shelters are providing food and medical care.
Most of the aid, however, is being distributed in the towns' central plazas. On the periphery and in the countryside, where most houses are precarious structures built of bricks made by hand and dried in the sun, there is still a sense of desperation.
At a makeshift warehouse in a Catholic school on the outskirts of the city, Father Marco Martinez was overseeing the distribution of truckloads of supplies arriving from the national Caritas office in Lima – the local affiliate of the Caritas Internationalis Catholic network of charities – and other dioceses around the country that have taken up collections for the earthquake victims.
So far, about a dozen trucks have arrived, each carrying about 15 tons of supplies.
For a day or two after the disaster, the greatest need was for warm clothes and blankets for the people who had lost their homes and were sleeping in the street or plazas, he said, but now the most critical need is food.
When a truck arrives, he calls each pastor to collect his parish's rations.
Immediately after the earthquake, every pastor drew up a list of families whose homes had been lost or damaged. Groups of families organized to cook meals in a common pot with beans, lentils, rice, noodles and other food items provided by the church.
Distributing the food to organized groups instead of handing it out to individual families ensures that it gets to those who need it most, said Father Walter Avalos, the pastor of two parishes where more than 100 groups of families are receiving food to cook together.
Father Cupe said the parish network is more efficient than the government-run distribution system, which was not well organized.
That was evident in Denis' neighborhood. While he waited for milk Aug. 23, a line of adults, mostly women, snaked around the block. Government emergency workers handed out mattresses, water, blankets and other goods from a tractor-trailer, but it seemed unlikely that there would be enough to go around.
Several women waiting in line said it was the first time a truck had been sent to their neighborhood. They did not know what items they would receive but hoped for food. To ensure that no one went through the line twice, police used felt-tipped pens to mark numbers on their arms – the same system used to keep track of visitors in Peruvian prisons.
"You see people in the plazas, outside government offices, clamoring for assistance," Father Cupe said. Although people know the parishes are receiving supplies, "You don't see anyone outside the parish offices, because they know the food will reach them," he said. "Even if it's just a little, people are happy because they know someone cares about them."
Although food and emergency shelter will be the priorities for several weeks, Bishop Brena and Father Martinez are already planning their next step. As people return to work, the need for emergency rations will taper off, but elderly people and the poorest families will have a hard time rebuilding their lives.
They will need long-term assistance, "but we don't want to create dependence," Bishop Brena said.
He takes heart from both his faith and the people's resilience.
"They tell me, 'We're not going to cry. We may be a little afraid, but we have to get back on our feet,'" he said.


My name is Larry and I purchased a 1973 Volkswagen Westfalia Bus several years ago from the previous owner who was located in Powdersville, Georgia. She had inherited it from her uncle who purchased the bus new from a dealership in Jacksonville, Florida.
But for now, follow me along the trail to restoring her back to her original beauty…with maybe a few other upgrades.
Hello – Have any good insight on a 73 VW sportsmoble engine removal? Did you do that? I have a bug as well and have removed the engine a few times so I think I can do the Bus. Just wondering if you had any good advice. Nice blog too man!
Unfortunately, I don't. Have you checked Richard Atwell's site yet? Here is one article: http://www.ratwell.com/technical/EngineRemoval.html Also, make sure to visit thesamba.com! Good luck!


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Q: Pandas : Data Frame Pruning I have a data frame as given below:
data = [['1','tom',1,0],['1','tom',0,1],['2','lynda',0,1],['2','lynda',0,1]]
df = pd.DataFrame(data, columns = ['ID','NAME', 'A','B'])

df.head()

I want to transform the dataframe to look like the below:
where in logical OR is taken for columns A and B. ID and NAME will always have same pair-values irrespective of how many times they appear but columns A and B can change(00,10,11,01).
So at the end I want ID,NAME,A,B.

A: You can always sum and compare to 0.
data = [['1','tom',1,0],['1','tom',0,1],['2','lynda',0,1],['2','lynda',0,1]]
df = pd.DataFrame(data, columns = ['ID','NAME', 'A','B'])

g_df = (df.groupby(['ID', 'NAME']).sum() >0).astype(float)

g_df.reset_index()

redpajama_set_name: RedPajamaStackExchange


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Princess Beatrice 'Can't Wait to Have Kids' With New Husband Edoardo
July 22, 2020	 Celebs, Celebrity Moms
First comes love, then comes marriage, then comes Princess Beatrice with a baby carriage? The newlywed wants to start a family with her husband, Edoardo Mapelli Mozzi, sooner rather than later.
Royal Family: Meet the Next Generation Read article
"Bea can't wait to have kids of her own," a source exclusively reveals in the new issue of Us Weekly. "She's planning to start a family with Edo very soon and is hoping it'll happen this year."
The couple tied the knot on Friday, July 17, at Windsor Great Park in Berkshire, England. The "private wedding ceremony … took place in accordance with all relevant government guidelines" amid the coronavirus pandemic, Buckingham Palace confirmed to Us in a statement at the time.
Basketball Wives' CeCe Gutierrez and Byron Scott, More Celeb Weddings of 2020 Read article
"Close family" attended the pair's nuptials, including Queen Elizabeth II, Princess Eugenie and Prince Andrew, an insider told Us.
In March, Buckingham Palace told Us that Beatrice's May 29 wedding at The Chapel Royal on the grounds of St James's Palace in London had been postponed due to the COVID-19 spread.
"Princess Beatrice and Mr. Mapelli Mozzi are very much looking forward to getting married but are equally aware of the need to avoid undertaking any unnecessary risks in the current circumstances," the statement read, noting that the couple were concerned about "both the well-being of older family members and large gatherings of people" and "carefully consider[ing] government advice before deciding whether a private marriage might take place amongst a small group of family and friends."
Edoardo proposed to the princess in September 2019 in Italy. "We are both so excited to be embarking on this life adventure together and can't wait to be married," the engaged couple said in a statement at the time. "We share so many similar interests and values and we know this will stand us in great stead for the years ahead, full of love and happiness."
Kids Come 1st! Khloe, Tristan and More Celeb Couples Crush Coparenting Read article
The engagement came 10 months after Us confirmed that they were dating. Edoardo was previously engaged and shares a son named Christopher with his ex-fiancée, architect Dara Huang.
For more on Beatrice and Edoardo's nuptials, watch the video above and check out the latest issue of Us Weekly, on newsstands now.
With reporting by Natalie Posner
Listen to Us Weekly's Hot Hollywood as each week the editors of Us break down the hottest entertainment news stories!
Read More About: Princess Beatrice 'Can't Wait to Have Kids' With New Husband Edoardo
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ePlus + Press Releases
Take a minute to catch up on our latest public news and announcements.
Home + About Us + Press Releases + Press Releases Details
ePlus Publishes Study Highlighting Prevalence of Data Center, Cloud, and Security Challenges in the Wake of COVID-19
HERNDON, VA – November 16, 2020 – ePlus inc. (NASDAQ NGS: PLUS – news) today announced that data center capacity constraints, increased cloud spend, and security concerns lead the list of organizational challenges resulting from the COVID-19 pandemic, according to a recently released study conducted by ePlus.
The report, titled Navigating Disruption, is a Special Report compiled by ePlus to quantify the technology impact of COVID-19 and provide guidance around how IT organizations can be agile and prepared for the future. The report is based on a survey of 135 technology professionals from customer organizations across multiple industries and was designed to provide insight into the most significant technology challenges companies are facing as a result of the changes brought on by the pandemic.
According to the report, organizations struggle with data center capacity for several reasons. Nearly one-third (30%) of capacity issues were caused by the expanded requirements for new services, such as virtual desktop infrastructure (VDI). Another sixteen percent (16%) of struggles were tied to supply chain problems and the inability to acquire new infrastructure.
The survey revealed the strain on data center capacity and the need for new services had a direct impact on cloud spending. Within the first 90 days of the pandemic, a quarter (25%) of the organizations experienced an increase in cloud spending. And almost one in ten (9.9%) saw their cloud spend jump by more than 20%.
Security is also a concern for many. Only thirty-nine percent (39%) of organizations are "very confident" in their security controls, according to the report, with 57% saying they are only "somewhat confident."
"While organizations expeditiously adjust to the pandemic, an unexpected disruption of this magnitude presents new challenges to implement technology solutions that are effective, affordable and sustainable," said Darren Raiguel, COO and president of ePlus Technology. "The survey results clearly show that many organizations are still feeling a strain on resources, operations, and budgets. They'll need to remain nimble and identify cost-effective solutions to meet future challenges in key areas such as cloud, security and collaboration. ePlus is ready and able to assist."
The report not only shows the most significant technology challenges organizations are facing because of the disruption caused by the pandemic, but it also outlines the importance of flexible infrastructure and adaptive security.
"The pandemic highlighted the importance of an agile infrastructure to minimize disruption to the operations of most organizations," continued Raiguel. "Companies need flexible technology, the ability to pivot quickly to sudden market transitions and adaptive security controls capable of sensing and responding to threats continuously and proactively. We may not know what or when the next big disruption will be, but companies can take steps now to implement technology solutions to be better prepared."
To access the survey results, learn how ePlus can help you navigate the next, and receive a copy of the report, please visit: www.eplus.com/next.
About ePlus inc.
ePlus is a leading consultative technology solutions provider that helps customers imagine, implement, and achieve more from their technology. With the highest certifications from top technology partners and lifecycle services expertise across key areas including security, cloud, data center, collaboration, networking and emerging technologies, ePlus transforms IT from a cost center to a business enabler. Founded in 1990, ePlus has more than 1,400 associates serving a diverse set of customers in the U.S., Europe, and Asia-Pac. The Company is headquartered at 13595 Dulles Technology Drive, Herndon, VA, 20171. For more information, visit www.eplus.com, call 888-482-1122, or email info@eplus.com. Connect with ePlus on Facebook, LinkedIn, Twitter and Instagram. ePlus, Where Technology Means More®.
ePlus®, Where Technology Means More®, and ePlus products referenced herein are either registered trademarks or trademarks of ePlus inc. in the United States and/or other countries. The names of other companies, products, and services mentioned herein may be the trademarks of their respective owners.
Statements in this press release that are not historical facts may be deemed to be "forward-looking statements." Actual and anticipated future results may vary materially due to certain risks and uncertainties, including, without limitation, risks related to COVID-19, including but not limited to its possible effects on the availability of and demand for our products and services, our ability to efficiently and flexibly manage our business amid uncertainties related to COVID-19, and its impact on the economy, possible adverse effects resulting from financial market disruption and fluctuations in foreign currency rates, and general slowdown of the U.S. economy such as our current and potential customers delaying or reducing technology purchases or put downward pressure on prices, increasing credit risk associated with our customers and vendors, reduction of vendor incentive programs, and restrictions on our access to capital necessary to fund our operations; our ability to consummate and integrate acquisitions; the possibility of goodwill impairment charges in the future; significant adverse changes in, reductions in, or losses of relationships with major customers or vendors; the demand for and acceptance of, our products and services; our ability to adapt our services to meet changes in market developments; our ability to implement comprehensive plans to achieve customer account coverage for the integration of sales forces, cost containment, asset rationalization, systems integration and other key strategies; our ability to reserve adequately for credit losses; our ability to secure our electronic and other confidential information or that of our customers or partners; future growth rates in our core businesses; our ability to protect our intellectual property; the impact of competition in our markets; the possibility of defects in our products or catalog content data; our ability to adapt to changes in the IT industry and/or rapid change in product standards; our ability to realize our investment in leased equipment; our ability to hire and retain sufficient qualified personnel; and other risks or uncertainties detailed in our reports filed with the Securities and Exchange Commission. All information set forth in this press release is current as of the date of this release and ePlus undertakes no duty or obligation to update this information.


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package com.voudeonibus.views.cards;

import android.view.ViewGroup;
import com.voudeonibus.R;

public class CardSearchButton extends CardDefault {

    public CardSearchButton(ViewGroup parent) {
        super(parent, R.layout.card_search_button);
    }

    @Override
    public void setLayoutElements() { }
}

redpajama_set_name: RedPajamaGithub


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Awards Ceremony & Tickets
1(0)8 5425 5897
About family firms
The National Family Business Awards were founded by our Chairman, Anita Brightley-Hodges, 10 years ago. As a second generation company ourselves, we felt it was vital for family-owned businesses to be recognised and celebrated for their extraordinary contribution to the Britain & Irish economies. Since 2008, our team has grown (mainly due to cake) and are dedicated to putting family firms on the map.
As 2nd generation herself, Amalia is passionate about raising the profile of brilliant young entrepreneurs in family businesses.
Amalia Brightley-Gillott
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How many public sector banks are there in India in 2018?
How many public sector banks are there in India 2019?
How many public sector banks are there in India?
How many govt banks are there in India in 2021?
How many banks are Nationalised in 1969?
Which bank is public sector banks?
Which is the largest public sector banks in India?
Which is the central bank of India?
How many private sector banks are there in India in 2020?
How many banks are there in India after merger?
How many banks are merged in India?
Dena Bank and Vijaya Bank were merged with Bank of Baroda in 2019. With this, the total number of PSBs in India came down from 27 in 2017 to 12. These 12 banks now consist of six merged banks – SBI, Bank of Baroda, Punjab National Bank, Canara Bank, Union Bank of India and Indian Bank.
As of today, India has 12 Public Sector Banks, including Bank of Baroda and State Bank of India.
Currently, India has 12 Public sector banks and RBI is the central authority that manages all the banking operations in India.
Before the economic liberalisation
The majority of these banks was profitable, with only one out of the 21 public sector banks reporting a loss.
IT\'S AMAZING: Which country called small India?
List of Government Banks in India | 12 Public Sector Banks. Government Banks or Public Sector Banks are the banks that are owned by the government of the day. In such banks, the Government of the country is the major shareholder with possession of more than 51% share of the bank. Check hare the updated list of govt.
In 1969, the Government of India nationalised 14 major private banks; one of the big banks was Bank of India. In 1980, 6 more private banks were nationalised. These nationalised banks are the majority of lenders in the Indian economy.
Public sector banks
1 Bank of Baroda Details
2 Bank of India Details
3 Bank of Maharashtra Details
4 Canara Bank Details
SBI is India's largest public sector bank and is ranked 232nd on the Fortune Global 500 list of the world's biggest corporations.
The Reserve Bank of India (RBI) is the central bank of India, which was established on Apr. 1, 1935, under the Reserve Bank of India Act. The Reserve Bank of India uses monetary policy to create financial stability in India, and it is charged with regulating the country's currency and credit systems.
Private-sector banks
At present, there are 22 private banks in India, as of 1 January 2022.
IT\'S AMAZING: You asked: Can I use US Mac in India?
After a series of mergers, the number of public sector banks has come down to 12, from 27 in 2017. Following are the 12 government-owned banks in India in 2021.
To improve the condition of public sector banks, the Modi government adopted the process of merger in two different phases. In 2019, 10 public sector banks were merged. A total of six weak banks were merged into four big banks. Oriental Bank of Commerce and United Bank of India were merged with Punjab National Bank.
Categories Traveling in India


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Maria Lucília Estanco Louro (1922-2018) was a Portuguese pacifist and opponent of the authoritarian Estado Novo regime, who became known as a teacher and political activist.

Early life
Maria Lucília Estanco Louro was born in Beja, Portugal on 27 January 1922, daughter of Albertina Emília Freire and Manuel Francisco Estanco Louro. She graduated in Historical-Philosophical Sciences from the Faculty of Letters of the University of Lisbon in 1944. Her thesis, entitled "Paul Gauguin seen in the light of Characterology - Life and Work", sparked controversy as she was the first in the Faculty to write about Art, then considered then a poor relative of History.

Portuguese women's peace association
Between 1940 and 1944 Louro was a member of the board of the Associação Feminina Portuguesa para la Paz (Portuguese women's peace association - AFPP) and its Secretary for three of those years. With Cândida Ventura, a colleague from the Faculty of Arts of Lisbon, she collaborated in the mobilization of artists, writers, actors and poets to contribute to the work of the AFPP. She was part of a group that organized small packages with cigarettes and food that were sent to prisoners of war, in collaboration with Socorro Vermelho Internacional (International Red Aid), an aid organization established by the Communist International.

Teaching
Obtaining teaching qualifications in 1948 Louro taught at high schools in Faro, Beja, Évora, Oeiras and Lisbon. She made major contributions to the teacher movement that was trying to reform the outdated teaching methods supported by the Estado Novo. Many of these discussions were, of necessity, held clandestinely. After the April 25, 1974 Carnation Revolution that overthrew the Estado Novo, Louro joined with many other teachers to propose revisions to the teaching curriculum. Targeted at children in their 6th and 7th years at school, the teaching material was initially supported by the Ministry of Education. However, some of the teachers' ideas were deemed too revolutionary and were not published.

Later life
Although sympathetic to the communist cause from the 1940s, she did not join the Portuguese Communist Party until the 1970s. She also then became a member of the Portuguese Council for Peace and Cooperation (CPCC). In the 1990s, she offered the Neo-realism Museum in Vila Franca de Xira a small collection (brochures, programs, etc.) on the organization of the AFPP. On her 90th birthday, Louro was honoured by Portugal's Não Apaguem a Memória movement (Don't erase the memory - NAM), which works to ensure that the events of the struggle against the Estado Novo are remembered. She died on 27 December 2018.

References

External links
  Video of Maria Lucília Estanco Louro talking of her experiences (in Portuguese)

Portuguese anti-fascists
Portuguese communists
1922 births
People from Beja, Portugal
2018 deaths
People from Lisbon
University of Lisbon alumni

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Back to Journals » Clinical, Cosmetic and Investigational Dermatology » Volume 8
Study of lipid profile in adult women with acne
Authors da Cunha M, Batista A, Macedo M, Filho C, Fonseca FLA
Received 20 February 2015
Accepted for publication 28 April 2015
Published 17 August 2015 Volume 2015:8 Pages 449—454
DOI https://doi.org/10.2147/CCID.S83248
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Jeffrey Weinberg
Download Article [PDF]
Marisa Gonzaga da Cunha,1 Anna Luiza Fonseca Batista,1 Marzia Silva Macedo,1 Carlos D'Aparecida Santos Machado Filho,1 Fernando Luiz Affonso Fonseca2
1Dermatology Department, Faculdade de Medicina do ABC (FMABC), Santo André, São Paulo, Brazil; 2Biological Sciences Department, Universidade Federal de São Paulo (UNIFESP), Diadema, São Paulo, Brazil
Objective: The aim of this study was to establish the lipid profile of female patients with acne in the Acne-in-Adult-Women Ambulatory Care Clinic in order to observe the prevalence of dyslipidemia in those patients.
Methods: This is a retrospective transversal study that evaluated the medical records of 416 patients who attended at the Acne-in-Adult-Women Ambulatory Care Clinic, at the Dermatology Department, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil, in the year 2012. Relevant data included age and clinical classification of acne. The lipid profile was analyzed according to the results of laboratory tests ordered during outpatient visits, which included total and fractionated cholesterol levels and triglycerides.
Results: The epidemiological study sample was of 219 patients, with ages ranging from 21 to 61 years (mean of 32.23 years). The predominant clinical grade was papule-pustule acne (grade II) with 156 patients (71%). Regarding the lipid profile of the patients, there was a high increase in total cholesterol levels in 17.35% of the cases. High-density lipoprotein levels were low in 11.42% of the patients, with normal prevalence in 194 subjects. Low-density lipoprotein levels were normal in most patients (60.27%). Very-low-density lipoprotein values were normal in almost all patients (94.06%) and increased in only 13 patients (5.94%). Only 18 patients presented high levels of triglycerides (8.22%).
Conclusion: The conclusion was that patients with grades II and III acne are more likely to have total cholesterol and low-density lipoprotein altered. A correct and early diagnosis can be an important measure for the prevention of the metabolic syndrome in these patients.
Keywords: acne, hyperandrogenism, dyslipidemia, cholesterol, triglycerides
Acne is one of the major concerns during dermatology consultations owing to its high incidence and influence on patient sociability and self-esteem.1 Its physiopathology includes increase in sebum production, follicular hyperkeratinization, Propionibacterium acnes colonization, and release of inflammatory mediators in adjacent follicles and dermis.2–4 These phenomena are related to the increase in the production of androgens, synthesized by the ovaries and the adrenal glands from cholesterol in females, along with their conversion in peripheral tissues.5 Levels of circulating androgens may be normal; however, local conversion may be increased due to a higher sensitivity of the receptors.4,6
Androgens can stimulate sebum production through many mechanisms: through androgen antagonism in the sebaceous glands, through inhibition of female gonadal hormone production by means of negative feedback, or through direct stimulation of lipid production.7
Although acne incidence peaks during adolescence, 40%–55% of the population over 25 years of age presents episodes of acne.8 "Acne in adult women" is defined as a persistent or new onset of acne lesions after the age of 21.9 Some authors consider 15 years as the age limit, since an improvement in acne scarring is expected 2 years after the first menarche.10 In this group, hyperandrogenism plays a fundamental role, affecting 5%–10% of childbearing-age females all over the world.11
Clinically speaking, hyperandrogenism manifests in females as hirsutism, acne, seborrhea, alopecia, menstrual irregularities, and ovulatory dysfunction.12 Polycystic ovary syndrome (PCOS) is its main cause and represents two-thirds of the diagnosis.9,12
Among women, this is the most common endocrine disorder with a prevalence of 6%–10%, based on the National Institute of Health criteria, and of 15%, according to the Rotterdam criteria. Both consensus standards are used for the diagnosis of PCOS.13
In addition to the acne condition, PCOS is also associated with plurimetabolic syndrome manifestations, like hyperinsulinemia, glucose intolerance, dyslipidemia, and visceral obesity.9,14,15 Recent evidences show a low-grade chronic inflammatory activity in PCOS. It may be considered as one of the potential relations between the syndrome and metabolic and cardiovascular complications in the long run due to the vicious circle that is established with the continuous release of inflammatory mediators, which are responsible for the development of peripheral resistance to insulin, dyslipidemia, and endothelial dysfunction.16
The PCOS etiopathogeny is not fully known yet. However, its association with abnormal steroidogenesis and insulin resistance has been described in the literature.6,17 Insulin resistance is present in 50%–70% of the women with PCOS, regardless of the coexisting obesity, and it is a triggering factor for hyperandrogenism owing to hepatic alterations and the direct stimulation of ovarian androgen hypersecretion as a consequence of the compensatory hyperinsulinemia.4,13,15,16,18,19
Dyslipidemia is the most common metabolic abnormality in women with PCOS, since 70% of these patients have alterations in lipid profiles similar to those mentioned in insulin-resistant patients.13,20–24 Among lipid alterations, high-density lipoprotein (HDL) seems to be the best risk indicator for cardiovascular diseases in the PCOS.13,24 The most known effect of androgens on lipid metabolism is related to HDL catabolism; in other words, androgens can increase hepatic lipase activity, which coincides with the increase observed during its activity in the PCOS.21,24
The increase in levels of plasma cholesterol leads to the androgen production increase, which, in turn, is one of the major predisposing factors for the onset of acne lesions.25
Studies on the relation between dyslipidemia and the onset of acne have divergent results, and therefore they are not clearly related in the literature. Some of them reveal that the lipid profile in adult women with acne shows an increase of total cholesterol (TC) and low-density lipoprotein (LDL) and a decrease in HDL,25 namely the same profile described in the PCOS. Another study indicates that levels of TC as well as of triglycerides (TG) in patients with acne, when compared with control group, were not significantly different. Alterations were restricted to HDL levels, which significantly decrease in patients with lesions, and to LDL levels, which increase as the acne condition becomes more severe.26
In view of the lack of studies and consensus on the relationship between dyslipidemia and acne in the literature, this study aims to establish the lipid profile of female patients with acne in the Acne-in-Adult-Women Ambulatory Care Clinic of ABC Medical School (FMABC), Santo André, São Paulo, Brazil, in order to observe the prevalence of dyslipidemia in those patients.
This is a retrospective transversal study that evaluates the medical records of 416 patients who attended at FMABC Dermatology Department, in the Acne-in-Adult-Women Ambulatory Care Clinic in Santo André, São Paulo, Brazil, over a period of 1 year. Dr Marisa Gonzaga da Cunha, who is in charge of the ambulatory, supervised the project.
Studied population
The study included records of patients who attended the ambulatory care unit between the period of January and December of 2012.
Inclusion criteria: female patients aged ≥21 years with papule-pustule or nodule-cystic acne cases.
Exclusion criteria: patients aged <21 years, patients whose laboratory evaluations were incomplete, patients with comedogenic acne given the fact this is an event that can be triggered by occlusive external agents like the inadequate topic use of comedogenic products.
Analyzed parameters
The data that were taken into consideration included age and the following clinical classification of acne: comedogenic acne, with prevalence of comedones – grade I; papule-pustule acne, with inflammatory lesions topped with pustules or not – grade II; nodule-cystic acne, with prevalence of inflammatory nodules – grade III.27
The lipid profile was analyzed according to the results obtained from the laboratory exams requested during patients' first visit. Exams included levels of TC and fractions (HDL, very-low-density lipoprotein [VLDL], LDL) and TG. Reference ranges, according to the Clinical Analysis Laboratory at the FMABC, were:
TC (>19 years) – desirable <200 mg/dL; borderline high 200–239 mg/dL; high ≥240 mg/dL.
HDL (>19 years) – ≥40 mg/dL.
LDL (>20 years) – optimal <100 mg/dL; near optimal 100–129 mg/dL; borderline high 130–159 mg/dL; high 160–189 mg/dL; very high >189 mg/dL.
VLDL – ≤50 mg/dL.
TG (>19 years) – optimal <150 mg/dL; borderline high 150–200 mg/dL; high 201–499 mg/dL; very high ≥500 mg/dL.
TC, HDL, and TG were determined using an enzymatic colorimetric test, which measured oxidase and peroxidase activities. LDL and VLDL values were calculated by the Friedewald formula following the criteria of the III Brazilian Guidelines on Dyslipidemia and Prevention of Atherosclerosis – 2011. Laboratory analyses were carried out according to the Good Clinical Laboratory Practices and the recommendations established by the Brazilian Society of Clinical Pathology/Laboratory Medicine.
The data were described in tables, with frequencies and measures of dispersion of lipids and the establishment of clinical indicators.
A total of 416 medical records of patients from the Acne-in-Adult-Women Ambulatory Care Clinic (FMABC) were evaluated between the period of January and December of 2012. The epidemiological study sample was of 219 patients, ages ranging from 21 to 61 years (mean of 32.23 years). From this total, 197 records (47.36%) were excluded given the fact those patients met one or more exclusion criteria.
The predominant clinical grade was papule-pustule acne (grade II) with 156 patients (71%), followed by grades I and III, with 38 (17%) and 25 (12%) patients, respectively. Patients with comedogenic acne were excluded from laboratory analyses (Figure 1). There was no significant difference between the grade of acne and patients' lipid profile as seen in Table 1, where means and standard deviations of cholesterol and TG levels are compared with grades II and III acne.
Figure 1 Clinical distribution of acne lesions among patients.
Table 1 Lipid profile of adult women with acne compared with grades II and III acne
Note: Data are presented as mean ± SD.
Abbreviations: TC, total cholesterol; HDL, high-density lipoprotein; LDL, low-density lipoprotein; VLDL, very-low-density lipoprotein; TG, triglycerides.
TC had a mean of 204.5 mg/dL (Table 1), with altered levels in 112 patients (51.14%): 33.79% borderline high and 17.35% high. The other 107 patients (48.65%) found themselves within the desirable range (Table 2). HDL mean was of 56.6 mg/dL (Table 1), with low levels in 11.42% of the patients and normal levels in 194 patients (88.58%) (Table 3). LDL levels in 132 patients (60.27%) were normal: 29.68% were within the optimal range and 30.59% were within near optimal. Altered levels of LDL reached 39.72%: 52 patients (23.74%) were within borderline high range, 19 (8.68%) were within high range and 16 (7.30%) were within very high (Table 4) with a mean of 125.2 mg/dL (Table 1). VLDL levels were normal in the great majority of the patients (94.06%), and only 13 patients (5.94%) were within the high range (Table 5) with a mean of 24.7 mg/dL (Table 1).
Table 2 Total cholesterol profile of adult women with acne
Note: *Total = total of the sample.
Table 3 HDL profile of adult women with acne
Abbreviation: HDL, high-density lipoprotein.
Table 4 LDL profile of adult women with acne
Abbreviation: LDL, low-density lipoprotein.
Table 5 VLDL profile of adult women with acne
Abbreviation: VLDL, very-low-density lipoprotein.
Finally, TG had a mean of 114.6 mg/dL (Table 1), with optimal levels in 175 women (79.91%). Altered levels reached 20.09% of the patients: 26 were within borderline high range, only 18 (8.22%) were within high range and none of them were within very high range (Table 6).
Table 6 Triglycerides profile of adult women with acne
In the current study, the prevalence of dyslipidemia in the Acne-in-Adult-Women Ambulatory Care Clinic could be observed. Some parameters indicate a possible causal association between acne and dyslipidemia.
The lipid profile of women with grade II and III acne was analyzed, considering the importance of hyperandrogenism in events of adult women with acne.10,28 When compared with these mentioned grades, there were no significant alterations in the lipid profile, a fact that complies with the literature.17
The major alterations observed were in regards to TC, with 51.14% of the patients, followed by LDL, with rates as high as 39.72%, and TG, with 20.09% of the values. HDL and VLDL profiles had fewer abnormal values, with altered rates in 11.42% and 5.94% of the cases, respectively. These results, especially of TC and LDL, call the attention to the fact that there seems to be a positive association between dyslipidemia and an acne breakout since an expressive number of the studied patients presented some sort of alteration in their lipid profile. These findings are in consonance with other studies in the literature.25,26
One of these studies was performed with 60 female patients who were divided into two groups, namely, acute acne vulgaris and control group. Patients with acne had higher levels (mean±standard deviation) of both TC (214.83±5.19 mg/dL) and LDL (161.3±3.08 mg/dL) when compared with control group, complying with the final results of this study.25 However, low HDL was the most significant alteration (31.57±0.83 mg/dL), a fact that was not observed here.25
Another study including 166 patients with acne also had divergent results. When compared with control group, no significant alterations in TC levels in patients with acne could be observed. Moreover, there was an expressive decrease in HDL levels and an increase in LDL levels.26
Regarding TG, no significant alterations in patients with acne were observed in this study or in the others found in the literature.25,26
The current study aimed to relate dyslipidemia to acne and hyperandrogenism regardless of the presence of PCOS. The literature shows that an increase in androgen levels is a characteristic of the PCOS.6,12 According to some studies, TC and LDL levels are high whereas HDL levels are low in patients with PCOS.24,29
Nevertheless, the purpose of this study was to evaluate patients with acne from the Acne-in-Adult-Women Ambulatory Care Clinic regardless of the presence of PCOS, which may explain the variation in the lipid profile results like the ones observed in the literature.
The increase of androgen levels, insulin secretion, PCOS as well as dyslipidemia are under genetic control according to what has been established in familial studies.13,20,21 Still, the genetic factor was not evaluated here. In a previous study, it was estimated that families of patients with PCOS are up to 2.7 times more likely to develop metabolic disorders than control-group families and that the relative risk to develop dyslipidemia is 1.8 in family members of patients with PCOS.21 Therefore, a further investigation on the genes related to dyslipidemia in this group of patients, comparing the results with the ones found in women of the same age group without acne, would be interesting so that a better analysis on a possible causal association between acne and dyslipidemia would be made possible.
The conclusion was that patients with grades II and III acne are more likely to have TC and LDL elevated regardless of their family history, which may be related to the presence of PCOS. Its correct and early diagnosis can be an important measure for the prevention of the metabolic syndrome in these patients.
The authors report no conflicts of interest in this work.
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Moura HHG, et al. Síndrome do ovário policístico: abordagem dermatológica. [Polycystic ovary syndrome: dermatological approach]. Anais Brasileiros de Dermatologia. 2011; 86(1):111–119. Portuguese.
Westerveld HE, Hoogendoom M, de Jong AWF, et al. Cardiometabolic abnormalities in the polycystic ovary syndrome: pharmacotherapeutic insights. Parmacol Ther. 2008;119:223–241.
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da Cunha MG, Fonseca FL, Machado CD. Androgenic hormone profile of adult women with acne. Dermatology. 2013;226(2):167–171. doi:10.1159/000347196. Epub May 16, 2013.
Perkins AC, Maglione J, Hillebrand GG, Myamoto K, Kimball AB. Acne vulgaris in women: prevalence across the life span. J Womens Health. 2012;21(2):223–230.
Yarak S, Bagatin E, Hassun K, Parada M, Filho ST. Hiperandrogenismo e pele: síndrome do ovário policístico e resistência periférica à insulina. [Hyperandrogenism and skin: polycystic ovary syndrome and insulin resistance]. An Bras Dermatol. 2005;80(4):395–410. Portuguese.
Fauser BC, Tarlatzis BC, Rebar RW, et al. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril. 2012;97(1):28–38. e25.
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Diamanti-Kandarakis E, Christakou CD, Kandaraki E, Economou FN. Metformin: an old medication of new fashion: evolving new molecular mechanisms and clinical implications in polycystic ovary syndrome. Eur J Endocrinol. 2010;162(2):193–212.
Palomba S, Falbo A, Zullo F, Orio Jr F. Evidence-based and potential benefits of metformin in the polycystic ovary syndrome: a comprehensive review. Endocr Rev. 2009;30(1):1–50.
Diamanti-Kandarakis E, Papavassiliou AG, Kandarakis SA, Chrousos GP. Pathophysiology and types of dyslipidemia in PCOS. Trends Endocrinol Metab. 2007;18(7):280–285.
Halperin IJL, Kumar SS, Stroup DF, Laredo SE. The association between the combined oral contraceptive pill and insulin resistance, dysglycemia and dyslipidemia in women with polycystic ovary syndrome: a systematic review and meta-analysis of observational studies. Hum Reprod. 2011;26(1):191–201.
Massicote MH, Langlois F, Baillargeon JP. Current procedures for managing polycystic ovary syndrome. Expert Rev Obstet Gynecol. 2010;5(1):77–91.
Westerveld HE, Hoogendoorn M, de Jong AW, Goverde AJ, Fauser BC, Dallinga-Thie GM. Cardiometabolic abnormalities in the polycystic ovary syndrome: pharmacotherapeutic insights. Pharmacol Ther. 2008;119(3):223–241.
Arora MK, Seth S, Dayal S. The relationship of lipid profile and menstrual cycle with acne vulgaris. Clin Biochem. 2010;43(18):1415–1420. Epub September 27, 2010.
El-Akawi Z, Abdel-Latif N, Abdul-Razzak K, Al-Aboosi M. The relationship between blood lipids prolife and acne. J Health Sci. 2007;53(5): 596–599.
Kaminer MS. The many faces of acne. J Am Acad Dermatol. 1995;32(3): S6–S14.
Shaw JC. Acne: effect of hormones on pathogenesis and management. Am J Clin Dermatol. 2002;3(8):571–578.
Diamanti-Kandarakis E, Papavassiliou AG, Kandarakis SA, Chrousos, GP. Pathophysiology and types of dyslipidemia in PCOS. Trends Endocrinol Metab. 2007;18:280–285.
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