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Hyperalphalipoproteinemia and Beyond: The Role of HDL in Cardiovascular Diseases
Multi-Wavelength Photobiomodulation Therapy Combined with Static Magnetic Field on Long-Term Pulmonary Complication after COVID-19: A Case Report
Comparative Analysis of Flavonoid Metabolites in Foxtail Millet (Setaria italica) with Different Eating Quality
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10.3390/life11060580
Luisa Zupin
Sergio Crovella
de Matos, B. Thaynne Lima
Buchaim, D. Vieira
Pomini, K. Torres
Barbalho, S. Maria
Guiguer, E. Landgraf
Reis, C. Henrique Bertoni
Bueno, C. Rodrigo de Souza
Cunha, M. Rodrigues da
Pereira, E. de Souza Bastos Mazuqueli
Buchaim, R. Leone
Open AccessReview
Photobiomodulation Therapy as a Possible New Approach in COVID-19: A Systematic Review
Brenda Thaynne Lima de Matos
Daniela Vieira Buchaim
Karina Torres Pomini
Sandra Maria Barbalho
Elen Landgraf Guiguer
Carlos Henrique Bertoni Reis
Cleuber Rodrigo de Souza Bueno
Marcelo Rodrigues da Cunha
Eliana de Souza Bastos Mazuqueli Pereira
Rogerio Leone Buchaim
Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, SP, Brazil
Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marilia (UNIMAR), Marília 17525-902, SP, Brazil
Department of Human Anatomy and Neuroanatomy, University Center of Adamantina (UniFAI), Medical School, Adamantina 17800-000, SP, Brazil
Department of Biochemistry and Nutrition, School of Food Technology of Marília, Marília 17506-000, SP, Brazil
Faculty of Medicine of Jundiaí, Jundiaí 13202-550, SP, Brazil
Life 2021, 11(6), 580; https://doi.org/10.3390/life11060580
Received: 19 May 2021 / Revised: 10 June 2021 / Accepted: 16 June 2021 / Published: 18 June 2021
(This article belongs to the Special Issue Photobiomodulation Therapy: Novel Medical Applications and New Insight into the Intracellular Molecular Impact)
COVID-19 is a viral disease characterized as a pandemic by the World Health Organization in March 2020. Since then, researchers from all over the world have been looking for ways to fight this disease. Many cases of complications arise from insufficient immune responses due to low immunity, with intense release of pro-inflammatory cytokines that can damage the structure of organs such as the lung. Thus, the hypothesis arises that photobiomodulation therapy (PBMT) with the use of a low-level laser (LLLT) may be an ally approach to patients with COVID-19 since it is effective for increasing immunity, helping tissue repair, and reducing pro-inflammatory cytokines. This systematic review was performed with the use of PubMed/MEDLINE, Web of Science, Scopus and Google Scholar databases with the following keywords: "low-level laser therapy OR photobiomodulation therapy AND COVID-19". The inclusion criteria were complete articles published from January 2020 to January 2021 in English. The exclusion criteria were other languages, editorials, reviews, brief communications, letters to the editor, comments, conference abstracts, and articles that did not provide the full text. The bibliographic search found 18 articles in the Pubmed/MEDLINE database, 118 articles on the Web of Science, 23 articles on Scopus, and 853 articles on Google Scholar. Ten articles were included for qualitative synthesis, of which four commentary articles discussed the pathogenesis and the effect of PBMT in COVID-19. Two in vitro and lab experiments showed the effect of PBMT on prevention of thrombosis and positive results in wound healing during viral infection, using the intravascular irradiation (ILIB) associated with Phthalomethyl D. Two case reports showed PBMT improved the respiratory indexes, radiological findings, and inflammatory markers in severe COVID-19 patients. One case series reported the clinical improvement after PBMT on 14 acute COVID-19 patients, rehabilitation on 24 patients, and as a preventive treatment on 70 people. One clinical trial of 30 patients with severe COVID-19 who require invasive mechanical ventilation, showed PBMT-static magnetic field was not statistically different from placebo for the length of stay in the Intensive Care Unit, but improved diaphragm muscle function and ventilation and decreased the inflammatory markers. This review suggests that PBMT may have a positive role in treatment of COVID-19. Still, the necessity for more clinical trials remains in this field and there is not sufficient research evidence regarding the effects of PBMT and COVID-19 disease, and there is a large gap.
COVID-19; SARS-CoV-2 infection; immunity; inflammation; low-level laser therapy; photobiomodulation therapy; systematic review
COVID-19 (SARS-CoV-2) is a viral disease discovered in December 2019, in the Chinese city of Wuhan, and spread to several continents, which led the World Health Organization (WHO) to characterize the disease as a pandemic 11 March 2020 [1]. This fact demonstrates the considerable speed of propagating this infectious pathogen, spreading around the world in a few months because on average, one infected person spreads the infection to three other people [2]. The forms of contamination are varied, such as through droplets of saliva, contaminated objects and surfaces, coughing, and sneezing. Thus, social distance and hygiene measures are essential to reduce contamination by the virus, with social isolation being the most effective method [3,4].
The most common symptoms of COVID-19 are cough, fever, anosmia, ageusia, difficulty breathing, and in more severe cases, pneumonia. Some conditions, such as diabetics, cardiac and hypertensive individuals, are more susceptible to presenting more severe conditions. This is also observed in people with low immunity since immunity is a great ally to the fight against coronavirus in the human body [5,6].
However, although high immunity is a good ally, its low levels can intensify the inflammation process. In the case of a defective immune response against COVID-19, an accumulation of immune cells in the lungs can occur, causing an exacerbated production of pro-inflammatory cytokines, which can damage the lung structure. With this excess of cytokines, it can spread to other locations, causing damage to multiple organs. In a healthy immune response, virus-specific T cells target inflammation and eliminate infected cells, preventing the virus from spreading, leading to minimal damage. Thus, stimulation of immunity is critical to approach the new coronavirus [7].
There are several ways to increase immunity that can be conducted by practicing physical activity and having good eating habits, which have been shown to affect immune sensitivity and inflammation [8]. There is also the possibility of using Vitamin D and Zinc in capsules, which in the body have beneficial immunomodulatory and anti-inflammatory effects in infections caused by viruses. Still, in the context of COVID-19, there is no scientific evidence to prove the effectiveness of these elements [9].
Another way of modulating the immune system is the use of photobiomodulation therapy (PBMT), which can stimulate immune cells to clump together at the site of the affected cells and assist them in survival through greater anti-inflammatory cytokine expression and decreased pro-inflammatory. In precursor studies, it was observed that laser light in low doses accelerated the healing of excisional wounds, called laser biostimulation [10]. There was a clear lack of consensus on the terminology for this therapy. The term most often used is low-level laser therapy (LLLT). ''Laser'' is not the most appropriate term as other light devices such as LEDs are currently used for this application. The ideal term and its definition must be precise and emphasize its scientific basis, with photobiomodulation being the term of choice to describe this use, meaning light therapy that uses non-ionizing forms of sources including lasers, LEDs, and broadband light in the spectrums visible and infrared [11].
The effect of PBMT is due to its absorption by tissues through photoreceptors, facilitating events such as mitochondrial respiration, calcium transport—which results in more significant cell proliferation—repairing, and regenerating tissues [12,13,14,15]. PBMT has to assist in the recovery process from nerve [16,17,18], bone [19,20,21], respiratory tract [22,23,24,25], and other injuries involved in functional rehabilitation, favoring the patient's recovery. LLLT can be used with the ILIB technique (Intravascular Laser Irradiation of Blood), which increases immunity, inducing positive effects on the expression of immunoglobulins (IgA, IgM and IgG) and modulation of inflammation. Therefore, this technique can be used to treat various pathogens such as infectious diseases, bronchitis, and pneumonia [26].
Given the great importance of biological mechanisms for the prevention, treatment, and rehabilitation of diseases such as COVID-19, the aim of this systematic review was to analyze the use of PBMT as a possible new approach as a complementary therapy in the treatment of patients affected by COVID-19.
Four databases were searched, PubMed/MEDLINE, Web of Science, Scopus, and Google Scholar, using the following as keywords: "low-level laser therapy OR photobiomodulation therapy AND COVID-19". The collection of articles was carried out considering the period of publication from January 2020 to 31 January 2021, by two evaluators previously used to the evaluation of the criteria to avoid bias in the selection.
2.1. Inclusion Criteria
Full-text articles;
English language.
2.2. Exclusion Criteria
Editorials;
Review articles;
Brief communications;
Letters to the editor;
Comments;
Congress abstracts;
Articles that do not provide full text;
Other languages than English.
The studies that presented titles and abstracts related to the theme of the initial research were verified, using the variables low-level laser therapy or photobiomodulation therapy and their use in the pandemic resulting from the new coronavirus SARS-CoV-2 (COVID-19). The next step was to evaluate the full text of the articles previously selected by the abstract. The methodology, results, and relevance were considered for listing the choice of articles.
For inclusion in the research, the articles were necessarily accessed in their full content. Analysis and synthesis of reflective and consistent texts on the subject were carried out.
The phases of the bibliographic search were organized by the Prisma Flow Diagram [27] (Figure 1).
The bibliographic search found 18 articles in the Pubmed/MEDLINE database, of which 13 were excluded because they were outside the eligibility criteria. We also found 118 articles on the Web of Science and selected one article (after excluding duplicates), 23 articles on Scopus and selected one article, and, finally, 853 articles on Google Scholar and selected three articles.
The articles selected to compose this systematic review are shown in Table 1.
This systematic review was carried out to evaluate the published literature, against the established descriptors and the inclusion and exclusion criteria of the articles, in an attempt to identify patterns and trends on the association of COVID-19 and PBMT, as well as to identify possible gaps and trends new areas of research. Although there are still few studies, our results shown that PBMT can bring benefits for COVID-19 patients since it is related to modulating the immune system, to the reduction of inflammation, and other beneficial activities for the restoration of health.
SARS-CoV-2 leads to the death of cells attacked by it, causing a blockage in the airways with its waste, making breathing more difficult with the accumulation of dead cells and fluids in the lungs [38]. The immune reaction in the infected patient usually causes inflammation and fever. With vasodilation at the site of infection, the lungs accumulate fluid [39]. This exaggerated immune response is called cytokine storm, which causes Acute Respiratory Distress Syndrome (ARDS), fever, multiple organ failure, and death [33]. The effect of laser therapy is related to the amount of laser energy per cm2. The minimum therapeutic dose for a biostimulant effect for the red and infrared laser is 0.01 J/cm2, while for the blue, ultraviolet, and green lasers it is 0.001 J/cm2. The effective stimulation dose is 1 J/cm2 and doses greater than 10 J/cm2 can produce inhibitory effects, used in conditions that require inhibition and suppression, such as, for example, suppressing the inflammatory response in an attempt to avoid or minimize the storm of pro-inflammatory cytokines [33].
The use of phototherapy in treating illnesses has been reported since Ancient Greece, initially called Heliotherapy, and consisted of leaving the sick exposed to the sun to cure their ailments, as shown in Table 1 [29]. In 1918, during the crisis caused by the Spanish flu, phototherapy proved to be a great ally in the treatment of this disease, being pointed out as one of the most significant factors in reducing mortality. Since then, several studies have been carried out to understand better the beneficial effects of light, especially blue, violet, red, and infrared light [29].
These studies found blue and violet light effects such as virus inactivation, including coronavirus and the common flu virus, and antimicrobial effect. These effects can be used, respectively, for cleaning, avoiding contagion by a coronavirus from infected surfaces, and mitigating opportunistic bacteria in the treatment of COVID-19 [29,40,41]. In addition, therapeutic effects of red and infrared light have also been found effective in treating various diseases such as pneumonia, decreasing inflammation, pulmonary edema, and fibrosis in the lung. These effects are important to avoid many complications of COVID-19, with ARDS the leading cause of death from the disease [29]. From this, more technological and specific lasers were developed, giving rise to photobiomodulation, which can be a great ally to the treatment of COVID-19.
Moreover, the effects of the blue laser go beyond the antimicrobial and anti-inflammatory capabilities. Its irradiation in the blood also favors hormonal harmonization, pain reduction, and the release of hemoglobin nitric oxide (HbNO), which has a powerful antibacterial effect and causes the destruction of microorganisms of all types in the blood. This can be used in antimicrobial photodynamic therapy with the combination of Riboflavin, a photosensitizer, for bacterial, viral, and parasitic diseases. The production of nitric oxide (NO) in the immune system is key to the capabilities and characteristics of immune cells and having cytotoxic and cytoprotective, antiviral, antimicrobial effects, and stimulating and suppressing the immune system. With the blue laser increasing the level of NO, mitochondrial biogenesis in different types of cells and oxygen connection to red blood cells is also increased (Figure 2) [5,30,39]. However, the use of lasers in viral mortality is not widespread, but there is evidence that the 405 nm LED light has antiviral activity [29]. Thus, the coronavirus could be killed or altered to be used in the preparation of vaccines. For this, the maximum irradiation takes 10 min with a power of 2 mW [5,30].
Since the onset of the disease, there is a consensus among clinicians and researchers about the role of the SARS-CoV-2 virus in pulmonary complications, which can lead to a severe respiratory syndrome. Nitric oxide (NO) is beneficial in low concentrations, but it can produce reactive nitrogen species (RNS), such as peroxynitrite, in high concentrations. Both ROS (species that react to oxygen) and RNS are destructive at high doses. In pulmonary inflammation, the increased influx of neutrophils produces high levels of ROS and RNS, damaging the lung tissue (Figure 2). PBMT can reduce ROS formation [42,43], reduce pulmonary edema, neutrophil influx, and promote lung tissue regeneration and better oxygenation to all related organs [44].
As for the type of laser, infrared is preferred due to the greater capacity of penetrating the lung tissue [45]. The dosimetry of adequate energy density is 9.5–10.5 J/cm2. Continuous irradiation at different points in the respiratory system can be helpful in the treatment of COVID-19 pneumonia. PBMT can be used as a preventive approach in high-risk, elderly, or comorbid patients receiving pre-treatment PBMT while still at an early stage of the disease [40]. In addition, PBMT can be considered a therapeutic approach in hospitalized patients before their condition worsens enough to require ICU admission [44].
Moreover, in addition to the damage to lung tissues, SARS-CoV-2 also favors the formation of thrombi. Nitric oxide has the potential to treat thrombosis associated with mechanical devices due to its ability to reduce platelet activation and due to the central role of platelet adhesion in device thrombosis [28]. One study, shown in Table 1, reports the effects of nitrite, distant red light, and their combination in various measures of blood clotting using a variety of agonists. The authors concluded that the combination of extreme red light and nitrite treatment decreased the coagulation measures in all cases [28]. It is believed that the radiation from the infrared laser near the red (R/NIR) can stabilize the membrane of red blood cells (RBC) by increasing its resistance to destructive factors, reducing trauma in the use of equipment, such as extracorporeal circulation [41].
Likewise, there are techniques for increasing the efficiency of light, such as PDT, since its penetration into tissues is limited. One technique is the association of PDT with phototherapy agents, which sensitize specific molecules to absorb light better. PDT has been clinically validated in several esophageal pathologies and some lung cancers and can be used to destroy pathogenic microorganisms such as bacteria and viruses [29,46]. This can also be seen in the association of PDT with Phthalocyanines, a phototherapeutic agent that makes incorporation by target cells easier. The use of phototherapeutic agent Phthalomethyl D shows promising effects if used with the aim of leading to immunological improvement, cure, and repair against viral induction [32].
In this scenario, with the use of PDT by the ILIB technique through radial artery for 30 min at a wavelength of 660–460 nm, 100 mW output power, and in continuous wave mode for point irradiation (Ecco Fibras, São Paulo, SP, Brazil) and the use of Phthalomethyl D administered orally or introduced into the digestive tract, wound healing and the systemic inflammatory process were improved. It can be suggested that, at low doses, phagocytic activity increases, and cell viability decreases after the execution of this technique. Thus, the relationship between the action of the laser and the activation of monocytic cells may explain the process of resolving systemic inflammation with more efficient wound closure. Thus, its contribution to the anti-inflammatory response during viral infection may be an approach to SARS-CoV-2 [32].
Clinical study using PDT in 300 patients, methylene blue (MB) photosensitizer and 660 nm red light applied in the oral and nasal cavity, compared to placebos, led to significant decreases in morbidity and reduced mortality rates, contributing to the immune response [47]. In vitro, PDT with MB and Radachlorin, using continuous laser with wavelength 662 nm at doses of 16 J/cm2 and 40 J/cm2 of laser irradiation, shows high antiviral activity against SARS-CoV-2 [48].
Furthermore, COVID-19 mainly attacks the lung and heart tissues. This is because the coronavirus binds to the cell through the angiotensin-converting receptor, which is highly expressed in lung and heart cells. Thus, it is vital that the receptor is not available to bind to the coronavirus, and for that, Vitamin D, which also binds to that receptor, can help. There are no acute cases of heart attack at balanced levels of Vitamin D due to COVID-19 [31]. In addition, Vitamin D has a broad spectrum of immunomodulatory, antifibrotic, anti-inflammatory and antioxidant actions [9,49].
One of the safest ways to increase Vitamin D levels in the body is the use of the 50 mW 589 nm yellow laser, which can be applied through the nose or acupuncture points (acupuncture laser) [31]. In addition, Vitamin D deficiency has been found, to be related to increased mortality and disease progression. It was also observed that the expression of inflammatory cytokines was inhibited by Vitamin D, and its insufficiency was related to the overexpression of cytokines and that it plays an important role in cardiovascular diseases and diabetes mellitus, risk factors for the disease [45]. Therefore, ways to obtain good Vitamin D levels in the body can be a preventive approach to complications of COVID-19 [31,49].
In severe SARS-CoV-2 infections, recent histopathological studies have emphasized the important role of Endothelial Cells (EC) in immune-thrombosis, vascular dysfunction, and inflammation. The storm of pro-inflammatory cytokines, commonly seen in irregular immune responses, can also cause endothelial dysfunction (EnD). The endothelitis caused by COVID-19 can explain the impairment of the systemic microcirculatory function of different organs and is highly harmful [50]. The endothelium performs multiple functions, such as regulating the transport of biologically active substances, barrier, participation in phagocytosis, and control of the diffusion of fluids, electrolytes, metabolic products, and platelet adhesion. Therefore, EnD can be catastrophic, becoming a primary cause of high mortality and the development of diseases or complications that disrupt a fully human life, so preventing the development of EnD is paramount [37,50].
Thus, with LLLT, at the systemic level, it is possible to activate microcirculation and metabolism, better regeneration of lung tissue, increased local immunity, and improved muscle support for the respiratory act. As a result, laser illumination using the ILIB technique has been widely used to correct endothelial function. The "classic" way of using this method is with a wavelength of 635 nm, 2–3 mW of lighting power at the fiber outlet, 10–20 min of exposure. With this technique, in seven daily sessions, patients with mild illness (six people) achieved an overall improvement in health, relief of chest pain during cough, and improvement in sputum discharge due to the increased effectiveness of the cough impulse [37,51].
One patient, with a severe disease course, used five combined laser therapy procedures: ILBI-525 intravenous laser blood illumination + LUVBITM violet laser ultra-blood illumination (525 nm wavelength, green spectrum, 2 mW lighting power, 5 min exposure per zone + 365 nm wavelength, UV spectrum, 2 mW of illumination and 5 min exposure per zone on alternate days) and exposure to pulsed IR LLLT (904 nm wavelength with light pulse duration of 100 ns, pulsed power of 15 W, power density of 10–15 W/cm2, frequency of 80 Hz and 1.5 min of exposure). With this approach, in the fifth procedure, the patient noticed a significant improvement in general health and the disappearance of shortness of breath with moderate physical effort [37,51,52].
Knowing that LLLT is effective against the cytokine storm and ARDS, promoting tissue healing and regeneration, experimental models in animals have shown a decrease in inflammation without impairing lung function in the case of acute lung injuries, which could be an approach to pulmonary inflammatory diseases [25]. In this experimental study, the effect of LLLT on chronic obstructive pulmonary disease was evaluated. The results demonstrated that LLLT significantly reduced the number of inflammatory cells and the secretion of pro-inflammatory cytokines as IL-1 β, IL-6, and TNF-α in bronchoalveolar lavage (BAL). It was also observed that LLLT decreased collagen deposition and the expression of the purinergic P2X7 receptor. Thus, LLLT is considered a promising treatment for other lung diseases, such as COVID-19 [25].
In addition, prolonged time on ventilators causes lung injuries, which can further aggravate the disease. For this, the use of LLLT is shown to minimize this side effect. This was proven in experimental models of ventilator-induced lung injury in rats, and with the use of LLLT there was an anti-inflammatory effect via decreased lung injury scores and lower neutrophil counts in alveoli, interstitial, and bronchial lavage [42]. Modulation of inflammatory factors and a drive for healing are needed to help patients get off the ventilators. Thus, LLLT is a safe and non-invasive technique that has been used for decades in the treatment of pain, wound healing, and health conditions, including diseases of the respiratory system. LLLT combined with standard medical care to optimize response to treatments, reduce inflammation, promote healing, and speed recovery times is a promising approach [33].
Another technique that can be useful in this scenario is PBMT when used alone or combined with the static magnetic field (PBMT-sMF). In a study, with patients with severe COVID-19 that required mechanical ventilation were randomly assigned to receive PBMT-sMF (six sites on the lower chest—189 J in total and two sites in the neck area—63 J in total) or PBMT-sMF placebo daily for the entire ICU stay, it was noted that PBMT-sMF was able to improve some ventilatory parameters, in addition to the infectious process, and immune response [36]. Thus, these techniques suggest that treatment with PBMT-sMF or LLLT may reduce the burden on the hospital and health systems and the use of scarce health care resources during this pandemic [33,36].
PBMT techniques in the hospital were observed in the clinical case of patient with severe COVID-19 [34]. This was the case of a 32-year-old Asian woman with morbid obesity and a body mass index of 52, and a history of excision of meningioma and asthma presented to the emergency room with a positive COVID-19 test and shortness of breath, cough, and diarrhea. The patient presented hypoxia with oxygen saturation via pulse oximetry (SpO2) of 88% in room air, tachypneic with a respiratory rate of 35, feverish temperature of 100.5 ºF, pulse rate 89, and blood pressure 106/84. The condition was considered severe, and was worsened, leading to her admission to the ICU. As a result, treatment with LLLT was started. During the first laser treatment, her SpO2 increased from 92% to 97% at 3 L/min of oxygen within 10 min of starting treatment. After the second laser treatment, the patient was breathing without dyspnea. After treatments, her respiratory rate returned abnormally 19–20 breaths/min. After the fourth treatment, the patient was able to ambulate independently and improved the ability to perform activities of daily living. The patient was discharged two days after her last treatment with 1 L/min of oxygen [34].
Another case was that of a 57-year-old African American man with severe COVID-19 who received four sessions of PBMT once a day by a laser scan and with pulsed modes of 808 nm and super pulses of 905 nm for 28 min [35]. Oxygen saturation (SpO2) increased from 93–94% to 97–100%, while oxygen demand decreased from 2–4 L/min to 1 L/min. The RALE score improved from 8 to 5. The Pneumonia Severity Index improved from Class V (142) to Class II (67). Additional pulmonary indium (Brescia-COVID and SMART-COP) decreased from 4 to 0. CRP normalized from 15.1 to 1.23. This patient tolerated all 4 treatments daily and observed a significant improvement in breathing immediately after each treatment. Paroxysmal coughing fits were resolved after the third treatment. Upon completion of the fourth treatment, the patient was able to ambulate with physical therapy. The next day after his final treatment, the patient was discharged to an acute rehabilitation facility with oxygen at 1 L/min [35].
Perhaps soon, the results of clinical trials currently underway should contribute to the assessment of PBMT efficacy for improving respiratory, inflammatory, coagulation and morbidity-mortality parameters in patients undergoing these studies.
The use of photobiomodulation therapy, through the low-level laser, in the initial stage of COVID-19, which can evolve to more severe stages, has been shown to be beneficial in treating the disease complications. Clinical trials and studies with a larger sample population are needed to confirm this approach, both in terms of prevention and treatment assistance. Photobiomodulation is promising as an approach to COVID-19 because previous studies show its effectiveness, mainly in reducing inflammation levels, which may favor the control of the exacerbated reaction caused by SARS-CoV-2, mainly in the lungs.
Conceptualization: B.T.L.d.M. and R.L.B.; formal analysis: D.V.B. and K.T.P.; methodology: S.M.B. and E.L.G.; supervision: R.L.B. and M.R.d.C.; visualization: C.H.B.R., E.d.S.B.M.P., and C.R.d.S.B.; writing of original draft: B.T.L.d.M., R.L.B., and S.M.B.; writing—review and editing: R.L.B. and D.V.B. All authors have read and agreed to the published version of the manuscript.
The authors would like to acknowledge the National Council for Scientific and Technological Development (B.T.L.d.M. scholarship holder from PIBIC/CNPq/2020/2021—Brazil).
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Figure 1. Flow diagram showing the study selection [27].
Figure 2. The schematic diagram illustrates COVID-19 infection in the human body, followed by rapid spread from viral sanctuary sites. Early innate host immune response dictates viral load at the acute phase. Photobiomodulation therapy (PBMT) acts on transmembrane receptors present in the mitochondria with specific cellular functions, modulating cells with functional deficits, such as blood cells and lung tissue, promoting signaling by the absorptivities of electromagnetic rays. These chromophores convert electromagnetic energy into adenosine triphosphate, and then induce increased macrophage activity, modulation of plasma hormone levels, decreased proinflammatory cytokines, modulated expression of IgA, IgM, and IgG immunoglobulins, and increase of the HbNO synthesis. The results are positive with the synthesis of cytotoxic molecules to microbial membranes, which leads to the destruction of microorganisms of all types in the blood and cytoprotective effect to human cells.
Table 1. Articles selected according to the eligibility criteria.
Human/Animal
Wajih et al., 2021 [28] Experimental, in vitro research Human blood Evaluation of nitrite, extreme red light, and its combination on various measures of blood clotting using a variety of agonists. Platelet-rich plasma turbidity assays, platelet activation using flow cytometry analysis of a fluorescently labeled antibody to the activated platelet fibrinogen binding site, platelet aggregometry based on multiple impedance, and evaluation of platelet adhesion to collagen coated flow-through microslides. The combination of extreme red light and nitrite treatment decreased the coagulation measures, but in some cases, the mono-treatment with nitrite or light alone showed no effects. It was observed that platelet adhesions were inhibited by the combination of nitrite and light treatment, while nitrite alone and extreme red light alone led to decreased adhesion. These results support the potential of the combined treatment of extreme red light and nitrite for the prevention of thrombosis in extracorporeal devices or with shallow-tissue depth, where extreme red light can penetrate. Given the role of thrombosis in COVID-19, application to the treatment of patients infected with SARS-Cov-2 can also be considered.
Enwemeka et al., 2020 [29] Perspective study Not applicable This study relates phototherapy throughout history, initially called heliotherapy, where sunlight was used as a treatment for various diseases, which was of great help in the 1918 pandemic against the Spanish flu. It also reports the beneficial effect of blue/violet light, red and infrared light. With the development of lasers and the evolution of phototherapy, laser therapy originated and is currently called photobiomodulation. It was observed inactivation of many viruses, including the common flu coronavirus, and antimicrobial effect. Red and infrared light have important therapeutic value, as they are effective in the treatment of various diseases, reducing, for example, inflammation and fibrosis in the lung. Blue/violet light has potential use in treatments, mitigating opportunistic bacteria, and aiding in hygiene. The effects of red light are effective in treating complications of COVID-19, such as inflammation, pulmonary edema, pneumonia, and acute respiratory distress syndrome (ARDS), which are its leading causes of death.
Razzaghi and Kamani, 2020 [30] In vitro study Human The authors defend the use of the blue laser, which has antimicrobial and anti-inflammatory effects, positive for the immune system. Blood irradiation has a positive influence on the release of hemoglobin nitric oxide (HbNO), with antibacterial effects. This can be used for Photodynamic Therapy (PDT) in combination with Riboflavin as a photosensitizer in order to reduce inflammation of the lungs, increase the amount of nitric oxygen, which will increase the body's immunity, and improve the supply of oxygen to the blood and tissues, used as a treatment for COVID-19. It has been observed that LED light has an antiviral effect and that nitric oxide production is the key to many of the capabilities and characteristics of immune cells, such as dendritic cells, Natural Killer cells (NKs exterminators), mast cells, macrophages and other phagocytes and has a cytotoxic and cytoprotective, antiviral effect, antimicrobial, stimulating and suppressing the immune system. With the results on blue light and the effects of nitric oxide on the immune system along with the emergence of a treatment for COVID-19, the authors discussed a preventive approach using these devices. The form and possible beneficial effects for the treatment of COVID-19 have been described for a laboratory study to be carried out.
Kamani, 2020 [31] In vivo study Human In this study, this was associated with the LLLT and acupuncture technique. The yellow laser light increases Vitamin D and serotonin levels through application to the nose and acupuncture points. The laser acupuncture method has been irradiated perpendicularly to the top of the skin and is a safer way than taking Vitamin D tablets. The results were different at different acupuncture points. For example, at LR14, activation of the temporal cortexes, frontal cortex, right parietal cortex, and deactivation in the temporal cortex in the bilateral superior temporal gyrus and the limbic cortex. In KI3, there was no significant activation or deactivation. The author took a preventive approach recognizing the properties of light and studies in this area and its possibility of becoming a treatment for COVID-19.
Pinto et al., 2020 [32] Experimental, in vivo research Animal/mice This study aimed to characterize the PDT associated with the phototherapeutic agent Phthalomethyl D in the process of immunological improvement, cure and repair against SARS-CoV-2. The study used 69 rats submitted to surgery for viral induction and separated into two groups, one treated with ILIB laser and the other with this technique added to the association of Phthalomethyl D. As a result, both groups achieved a high rate of partial incision closure and acute inflammatory control. In the group treated with the ILIB technique associated with Phthalomethyl D, there was a greater amount of fundamental amorphous substance, fibrocytes, fibroblasts, and giant cells, and the number of keratinocytes, the amount of keratin and the epidermal thickness was reduced concerning the group treated only with the ILIB technique. Thus, with positive results using the ILIB technique associated with Phthalomethyl D, which obtained satisfactory results in increasing healing, repair, and immunomodulation during viral infection, contributing to the anti-inflammatory response, the use of this treatment in the approach to SARS-CoV-2 is possible.
Mokmeli and Vetrici, 2020 [33] Study based on clinical experience, peer-reviewed studies and solid laboratory data in experimental animal models. Not applicable This study aimed to provide a protocol for the use of low-level laser therapy (LLLT) to prevent disease progression, minimize the time required to use a ventilator, improve healing and shorten recovery time. This technique was chosen because it has strong anti-inflammatory effects and attenuates the cytokine storm and being a safe, effective, low-cost technique with no side effects. LLLT has therapeutic potential for the respiratory syndrome, with the ability to reduce pain and heal wounds in health areas. In addition, it is also used to treat pneumonia by veterinarians. Based on clinical experience, peer-reviewed studies, and laboratory data in experimental animal models, LLLT mitigates the cytokine storm at various levels and reduces inflammatory metabolites. As the mortality of COVID-19 is closely related to respiratory syndrome and cytokine storm, in addition to the presence of lesions in the lungs caused by the use of a ventilator for longer than expected, LLLT is a resource that can be associated with the treatment and recovery COVID-19, still needing clinical trials to assess this approach objectively.
Sigman; Mokmeli; Vetrici, 2020 [34] Case report Human This case report demonstrated the use of low-level laser therapy (LLLT) applied to a 32-year-old patient, morbidly obese with severe COVID-19. The patient received four sessions once a day using a laser scanner. Pulsed laser beams of 808 nm and 905 nm were applied to the posterior part of the chest for 28 min. Before treatment, oxygen saturation (SpO2) via pulse oximetry was 88–93% with 5–6 L of oxygen. The patient was evaluated before and after LLLT and showed significant improvement. Increasing the SPO2 increased to 97–99% with 1–3 L of oxygen. The RALE score was reduced from 8 to 3, Brescia COVID from 4 to 0, and SMART-COP from 5 to 0. Interleukin-6 decreased from 45.89 to 11.7 pg/mL, ferritin from 359 to 175 ng/mL and CRP from 3.04 to 1.43 mg/dL. In addition, the patient noticed a considerable improvement in respiratory symptoms. Due to the improvement in the respiratory indexes in a few days, radiological findings and inflammatory markers, the case report suggests that the adjunctive LLLT may be an ally to the conventional treatment of patients with severe COVID-19 and morbid obesity.
Sigman et al., 2020 [35] Case report Human In this case report of a severe case of pneumonia caused by COVID-19, PBMT was used in in a 57-year-old man who received four sessions of PBMT once a day using a pulsed 808 nm and super laser scanner pulsed at 905 nm for 28 min. The patient was evaluated before and after treatment utilizing radiological assessment of lung edema (RALE), pulmonary severity indices, blood tests, oxygen requirements, and questionnaires. After treatment, oxygen saturation increased from 93–94% to 97–100%, while the oxygen requirement decreased from 2–4 L/min to 1 L/min. The RALE score improved from 8 to 5. The Pneumonia Severity Index improved from Class V (142) to Class II (67). The additional pulmonary indices (Brescia-COVID and SMART-COP) decreased from 4 to 0. CRP normalized from 15.1 to 1.23. In addition, the patient reported significant improvement in the Community-Acquired Pneumonia assessment. With PBMT, respiratory rates, oxygen requirement, and radiological findings improved significantly over the days, and there was no need for a ventilator, suggesting the use of PBMT as a complementary treatment for patients with pneumonia due to COVID-19, requiring further clinical trials to assess the effects.
Marchi et al., 2020 [36] Randomized placebo-controlled trial research Human This study investigated whether PBMT-sMF is able to decrease the length of stay in the Intensive Care Unit (ICU) and to reduce the mortality rate of patients with severe COVID-19 who require invasive mechanical ventilation. Patients were randomly assigned to receive PBMT-sMF (6 sites on the lower chest—189 J in total and 2 sites in the neck area—63 J in total) or PBMT-sMF placebo daily for the entire ICU stay. The 30 patients were submitted to randomization (15 receiving PBMT-sMF and 15 placebos). There was no statistical difference between the groups for the length of stay in the ICU. Regarding secondary studies, statistical differences were observed in favor of PBMT-sMF for diaphragm thickness, the fraction of inspired oxygen, partial pressure of oxygen/fraction of inspired oxygen, reactive protein C, lymphocyte count, and hemoglobin. The study demonstrated that for patients with severe COVID-19 who require invasive mechanical ventilation, PBMT-sMF was not statistically different from placebo for the length of stay in the ICU, but improved diaphragm muscle function, ventilation and led to decreased levels of C-reactive protein (PCR) and hemoglobin count, in addition to increased lymphocyte count.
Moskvin; Askhadulin; Kochetkov, 2021 [37] Review and experimental, in vivo research Human 106 patients were treated at two health centers in Russia. A total of 22 had SARS pneumonia and were admitted for pulsed infrared rehabilitation; 14 patients had acute forms of COVID-19 and were treated with the LASMIK device, wavelength 904 nm, pulsed mode, externally and ILBI-525 (intravenous laser blood illumination) + LUVBI (ultraviolet laser blood illumination); 70 people have taken preventive non-invasive LLLT courses. LLLT is effective in preventing the development of endothelial dysfunction. Clinically, there was good tolerability of the treatment and improvement in sputum discharge and general health. In the fifth procedure, the severity of general hypoxia decreased, and in the prevention procedures, there was good tolerance, and there were no cases of COVID-19. LLLT is a treatment method that promotes lung tissue regeneration and mitigates the consequences of COVID-19. Thus, LLLT can be used for both prevention and treatment in patients with COVID-19.
de Matos, B.T.L.; Buchaim, D.V.; Pomini, K.T.; Barbalho, S.M.; Guiguer, E.L.; Reis, C.H.B.; Bueno, C.R.d.S.; Cunha, M.R.d.; Pereira, E.d.S.B.M.; Buchaim, R.L. Photobiomodulation Therapy as a Possible New Approach in COVID-19: A Systematic Review. Life 2021, 11, 580. https://doi.org/10.3390/life11060580
de Matos BTL, Buchaim DV, Pomini KT, Barbalho SM, Guiguer EL, Reis CHB, Bueno CRdS, Cunha MRd, Pereira EdSBM, Buchaim RL. Photobiomodulation Therapy as a Possible New Approach in COVID-19: A Systematic Review. Life. 2021; 11(6):580. https://doi.org/10.3390/life11060580
de Matos, Brenda Thaynne Lima, Daniela Vieira Buchaim, Karina Torres Pomini, Sandra Maria Barbalho, Elen Landgraf Guiguer, Carlos Henrique Bertoni Reis, Cleuber Rodrigo de Souza Bueno, Marcelo Rodrigues da Cunha, Eliana de Souza Bastos Mazuqueli Pereira, and Rogerio Leone Buchaim. 2021. "Photobiomodulation Therapy as a Possible New Approach in COVID-19: A Systematic Review" Life 11, no. 6: 580. https://doi.org/10.3390/life11060580
Life, EISSN 2075-1729, Published by MDPI


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Home/Government and politics/Florida Votes/Keith Perry and Rodney Long compete to represent District 9 in Senate
Keith Perry and Rodney Long compete to represent District 9 in Senate
By Emma Behrmann
October 28, 2022 Florida Votes, Government and politics
Residents of District 9 will choose between Republican Sen. Keith Perry and Democrat Rodney Long to represent them in the state Legislature in the upcoming election Tuesday, Nov. 8.
Here is what voters need to know about the candidates and their viewpoints before they head to the polls.
Keith Perry
Perry, 63, is the state senator for District 8. Redrawn districts, a result of the last legislative session, would now make Perry a representative of District 9, if elected. He's been involved in state government for 12 years.
He served in the Florida House of Representatives from 2010-2016 before he was elected to the Florida Senate in 2016. He was re-elected in 2018 and seeks his final term in Tallahassee this November.
Perry moved to Gainesville at age 4, and his father was a University of Florida professor. He graduated from F.W. Buchholz High School in 1976 and started his own roofing company, Perry Roofing, at 18.
"When I was a kid growing up in Gainesville, almost every single business was owned by an individual," Perry said. "Now, the majority of the businesses are run by large corporations or franchises. What we've done is we've created a regulatory and legal environment that will keep almost all young people from owning their own business."
He said his goal is to increase the opportunities for the next generation, including his two daughters, through tax and regulation reductions.
Perry was arrested 38 years ago for drug possession. Now, he has founded and supports House of Hope, an organization that provides housing, job opportunities and rehabilitation to former inmates.
His campaign has raised $281,132 as of Oct. 21, according to the Florida Department of State Division of Elections. But Perry said his campaign will spend around $500,000 in both hard and soft money, in which soft funds are not directly contributed to a candidate and are unregulated. He spent about $4.5 million on his last race.
Rodney Long
Long, 65, was born and raised in Gainesville, and his public service extends to time on both the Gainesville City and Alachua County Commission. He served two terms as a city commissioner from 1988 to 1994, and three terms as a county commissioner from 2000 to 2011.
He has a long list of experience beyond these commissioner roles, including as president of the Florida Association of Counties and president of the Florida MLK Commission. Long also has experience as a small business owner as CEO of Rodney Long Bail Bonds and Rodney Long Realty. He also founded The Long Foundation, a nonprofit dedicated to reducing poverty.
"When people see that you've been invested in the community, they begin to trust your judgment," Long said. "I've had the opportunity to actually serve and be elected."
His next step, he said, is the state.
He ran and lost against his friend Yvonne Hinson to represent District 20 in the Florida House of Representatives in 2020. He said he did not want to run against Hinson again and decided to campaign for Senate.
"I want to start bringing civility back to governance in Tallahassee," Long said. "And that's on both sides of the house."
Long's campaign has raised $51,154 as of Oct. 21, according to the Florida Department of State Division of Elections.
Education, environment, health care, including women's reproductive rights, and the cost of living are issues both Perry and Long prioritize.
Education-centric bills were common in the last legislative session. The Parental Rights in Education bill, also known as the Don't Say Gay bill, garnered national attention.
Perry voted to pass this legislation, which Gov. Ron DeSantis signed into law. He said public schools are government entities, and he supports parents' choices in their child's education.
"I don't believe the government has any role, or should have any role, in educating young children on any sexual issues: heterosexual, homosexual, trans issues," Perry said.
Long disagrees.
"I trust the people who are elected by local people as school board members to do what is in the best interest of the people that they were elected to serve," Long said. "And one size does not fit all."
Education funding is a top priority for both candidates.
Long said he wants to remove the state from the bottom percentile of funding and improve teacher pay from No. 48 in the nation.
Perry said he wants to expand school choice and scholarship opportunities, so parents can decide where their children attend school, public or private, without financial obstacles.
Perry, for the last five years, has prioritized music in elementary education. He introduced Senate Bill 156, which became law, to extend the Early Childhood Music Education Incentive Pilot Program. The state sends funds to schools that participate in the program as well as to the UF College of Education to research the program's effects.
Both candidates favor funding for environmental protection.
Perry supports conservation and has passed expanded budgets that allocate funds to environmental protection such as Everglades restoration and springs restoration.
"My concern always has been we get judged by how much money we spend," Perry said. "We don't really get judged by outcomes."
Long, as county commissioner, supported Alachua County Forever, a program intended to acquire and protect land with water resources and natural areas through taxpayer dollars. He also supports Florida Forever funding.
"I am a strong believer in climate change," Long said. "I support strongly the Inflation Reduction Act, which will bring dollars to the state when it comes to alternative means of energy."
Women's reproductive rights came to the forefront of political debate with the overturn of Roe v. Wade in June. Now, states decide the legality of abortion access within their borders.
Perry voted to pass the Reducing Fetal and Infant Mortality bill, which prohibits abortion after 15 weeks.
Long promises to oppose any legislation that further restricts a woman's freedoms, including reproductive rights. If Republicans hold two-thirds of the House and Senate, they could amend the state constitution and eliminate the privacy right and a woman's access to abortion.
"Our democracy truly would be under attack," Long said.
In the broader scope of health care, Perry opposes an expansion of Medicaid, whereas Long supports it.
"Florida is one of 12 states that has not expanded Medicaid to the 2.6 million eligible," Long said. "And they are the poorest of the poor."
If elected, Long said he has two health care goals: to expand Medicaid and to establish a health care facility in Levy County, which District 9 represents.
Perry is concerned with fewer choices for the individual when it comes to insurance. Wealth disparities, he said, will affect the quality of care. But he does not think Medicaid expansion is the answer.
Inflation is a top issue in midterm elections nationwide. Both candidates vying to represent District 9 say they are passionate about affordable housing.
Perry opposes government subsidy programs. As a blue-collar worker with blue-collar employees, he said, his workers reject government reliance. Subsidy programs are not a solution to the problem, he said.
Instead, he supports decreasing government regulations that increase the cost of building.
"When you have a regulatory environment that your starting point is $75,000, you're not going to be able to afford to build affordable housing," Perry said. In this environment, homebuilding becomes consolidated.
Long said the government is a facilitator, and its role is to provide social services, so he does not oppose government subsidy programs like his opponent does.
The challenge of affordable housing, Long said, is partially a result of SB 2512, passed in 2021 and approved by Perry. This legislation prohibits full funding of the Sadowski Trust Fund, which became law in 1992, was funded through stamp tax fees from real estate deals and supported affordable housing projects.
"As the next state senator for Senate District 9, I want to work with like-minded people across the aisle who believe in the American dream and home affordability to repeal Senate Bill 2512," Long said.
Message to Voters
Both candidates ask their voters to do their research before voting on or earlier than Nov. 8.
"I implore them to research," Perry said. "They can agree or disagree with me, but they shouldn't agree or disagree based on a headline or based on a party affiliation."
Long said voters should pay attention to his district-specific issues like a toll road through Marion and Levy, which he opposes.
"I encourage people to visit my website, www.rodneylongsenatedistrict9.com," Long said. "I want them to view my qualifications, my experience, as well as my issues."
District 9 voters will choose who represents them by Nov. 8.
Keith Perry, Rodney Long graphic
abortion affordability Affordable housing Alachua Alachua County Alachua County Commission bill Bills Buchholz High School building business climate climate change community conservation constitution County Commission democrat DeSantis District 8 education Election elections energy environment Expansion facility Florida Florida House Florida House of Representatives Florida Senate Gainesville Gov. Ron DeSantis government health high school Keith Perry Land legislation legislative session Levy County local Marion Medicaid music nonprofit poverty projects Regulations republican Research road Rodney Long Ron DeSantis school schools Senate Senator springs state teacher UF University of Florida voting water 2022-10-28
Emma Behrmann
Tags abortion affordability Affordable housing Alachua Alachua County Alachua County Commission bill Bills Buchholz High School building business climate climate change community conservation constitution County Commission democrat DeSantis District 8 education Election elections energy environment Expansion facility Florida Florida House Florida House of Representatives Florida Senate Gainesville Gov. Ron DeSantis government health high school Keith Perry Land legislation legislative session Levy County local Marion Medicaid music nonprofit poverty projects Regulations republican Research road Rodney Long Ron DeSantis school schools Senate Senator springs state teacher UF University of Florida voting water
About Emma Behrmann
Emma is a reporter for WUFT News who can be reached by calling 352-392-6397 or emailing news@wuft.org.
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The Point, Jan. 27, 2023: WUFT Special Report: Behind the bet: consequences
WUFT | Statement
A Statement From WUFT's Leadership.

redpajama_set_name: RedPajamaCommonCrawl


A taste of Mexican in the Lake District, Ulverston, Cumbria, with restaurant, cellar bar and courtyard. Eating out and places to eat in Ulverston - Amigos restaurant and bar. Welcome to the Dos Amigos Tortas Your next meal awaits at Dos Amigos Tortas in Highland. Homemade Tortillas, Amazing Aguas Frescas, Authentic Micheladas and only the freshest ingredients always makes Dos Amigos Tortas #1! With food this good, you'll be running back for more! Dine in and enjoy. For those in a. Tortilleria El Buen Amigo, Scranton, Pennsylvania. K likes. tortilleria EL BUEN AMIGO nos especialisamos en la mejor calidad y la frescura diaria en.
Excited by college foursome couple of Mexican acquaintances and a fondness for fresh, bold simple flavours and the relaxed way of sharing dishes, Amigos was born. Our very own sticky hot chilie, garlic homemade amigo beer marinade coats these succulent pork ribs. Restaurants 64 Hotels 12 Things to Do A medley of creamy seafood and re-fried beans are packed into this large flour tortilla. Welcome to the Dos Amigos Tortas Your next meal awaits at Dos Amigos Tortas in Highland. Homemade Tortillas, Amazing Aguas Frescas, Authentic Micheladas and only the freshest ingredients always makes Dos Amigos Tortas #1! With food this good, you'll be running back for more! Dine in and enjoy. For those in a. Description: Amigo Burrito is located in the Murray Hotel on Mackinac Island, Michigan right across the street from the Arnold Line Dock. Amigo Burrito is a Mexican grill that serves made-to-order burritos, tacos, quesadillas, and salads with fresh, homemade ingredients. It's a great, healthy option for a quick and delicious. I had the idea of dressing up my family in a Homemade Three Amigos Group Costume for YEARS. It just took the right party for me to decide to get every thin.


The symbol of star reaches across many cultures and traditions, but it always lifts up spirits and brings joy with its magical shape and the promise of sparkling shine. Explore our collection of star-themed jewelry, from a Star of David necklace to crescent moon and star earrings. View our star necklace selection and find an elegant gold Star of David pendant, a fun and shiny star fish pendant – and plenty in between!


We are a Kent based independent insurance broker specialising in Professional Indemnity and Liability insurance for private individuals, SMEs, Large businesses and PLCs. To attain the highest... professional standards, all members of our team undertake internal and external training to provide you with the latest advice in commercial insurance. In addition, we encourage all members of our team to study for Professional Qualifications. We are authorised and regulated by the Financial Conduct Authority.
At Independent Insurance Services we have access to many insurers and are able to offer a variety of insurance products, whether personal or commercial. Our main objective is to offer you a service... based on value for money, a first-class service and a wide choice of cover tailored to suit your needs. We can quote for various types of insurance and have access to specialist schemes.
Eclipse Insurance Services, based in Swalecliffe, Whitstable, Kent was established in 1977. We provide people and businesses of any size with independent insurance advice and services, both locally... and nationally. We are firm believers in the personal touch. Whether you deal with our Insurance Services over the phone, via the internet or in person, we are dedicated to providing you with a friendly and efficient service.
Marsh Down Insurance Brokers was established in 1980 and has developed a wealth of knowledge and expertise in the insurance industry. The business prides itself on providing a personal, friendly and... professional broking service across all classes of insurance. We specialise in commercial insurances. We aim to provide a solution for every risk presented to us no matter how large or small, complex or unusual. We act as an Independent Intermediary, which means we are NOT tied to one or two insurers.


text:
Барье́рныe острова́ — острова в виде относительно узких полос песка, расположенных вблизи и параллельно побережью материка. Как правило, они расположены в виде цепи, состоящей из нескольких островов, иногда более десятка. Длина и ширина барьерных островов связаны с параметрами побережья, включая приливы, энергию волн, уровень моря и состав грунта. Некоторые барьерные острова достигают протяженности более ста километров, самый длинный и широкий — остров Падре. Форма, площадь и само существование барьерных островов изменчивы — они могут появляться и исчезать в короткое (в геологических масштабах) время.

В России, в Море Лаптевых есть острова, которые не только являются барьерными, но и имеют имя собственное Барьерные острова.

Примечания

Ссылки

Острова

redpajama_set_name: RedPajamaWikipedia


text:
Main > News > German Finance Minister warns of UK's tax position after leaving the EU
German Finance Minister warns of UK's tax position after leaving the EU
By adminin News
In an interview with the Financial Times, German Finance Minister & Politician, Mr Wolfgang Schauble has claimed that the current G20 regulations regarding tax avoidance would limit the UK's aptitude to give tax breaks to companies where due after leaving the European Union.
He noted that the UK would still be subject to the international regulations on investment incentives, pointing out that as a member of the G20 there was a continuing obligation to stop tax avoidance, which would impact the ability to offer tax breaks in the coming years after the break away.
"The rules still apply to everyone, whether members of the EU or not. The UK is a country which has always notoriously upheld the relevant rulings, laws & treaties." Mr Schauble stated.
"Until the UK's exit is complete, they will certainly have to continually fulfil its commitments. Perhaps there will be some obligations that last beyond the exit, at this point we cannot rule out that they will remain until 2030, and the EU is in no position to grant any rebates." he finally warned.


text:
using System;
using System.IO;
using System.Threading;

using Mono.Unix;

using Hyena;
using Hyena.Jobs;

using Banshee.ServiceStack;
using Banshee.Sources;

namespace Banshee.Library
{
    public abstract class ThreadPoolImportSource : IImportSource
    {
        private bool importing;
        private UserJob user_job;
        private readonly object user_job_mutex = new object ();

        private void CreateUserJob ()
        {
            lock (user_job_mutex) {
                if(user_job != null) {
                    return;
                }

                user_job = new UserJob (UserJobTitle, UserJobTitle, Catalog.GetString ("Importing Songs"));
                user_job.SetResources (Resource.Cpu, Resource.Disk, Resource.Database);
                user_job.PriorityHints = PriorityHints.SpeedSensitive | PriorityHints.DataLossIfStopped;
                user_job.IconNames = IconNames;
                user_job.CancelMessage = CancelMessage;
                user_job.CanCancel = CanCancel;
                user_job.Register ();
            }
        }

        private void DestroyUserJob ()
        {
            lock(user_job_mutex) {
                if(user_job == null) {
                    return;
                }

                user_job.Finish ();
                user_job = null;
            }
        }

        protected void UpdateUserJob (int processed, int count, string artist, string title)
        {
            user_job.Title = String.Format(
                Catalog.GetString("Importing {0} of {1}"),
                processed, count);
            user_job.Status = String.Format("{0} - {1}", artist, title);
            user_job.Progress = processed / (double)count;
        }

        protected void LogError (string path, Exception e)
        {
            LogError (path, e.Message);
        }

        protected void LogError (string path, string msg)
        {
            ThreadAssist.ProxyToMain (delegate {
                ErrorSource error_source = ServiceManager.SourceManager.MusicLibrary.ErrorSource;
                error_source.AddMessage (path, msg);

                Log.Error (path, msg, false);
            });
        }

        protected bool CheckForCanceled ()
        {
            lock(user_job_mutex) {
                return user_job != null && user_job.IsCancelRequested;
            }
        }

        private string user_job_title;
        protected virtual string UserJobTitle {
            get {
                if (user_job_title == null) {
                    user_job_title = String.Format (Catalog.GetString ("Importing From {0}"), Name);
                }
                return user_job_title;
            }
        }

        private string cancel_message = Catalog.GetString ("The import process is currently running. Would you like to stop it?");
        protected virtual string CancelMessage {
            get { return cancel_message; }
        }

        protected virtual bool CanCancel {
            get { return true; }
        }

#region IImportSource

        public abstract string Name { get; }

        public virtual string ImportLabel { get { return null; } }

        public abstract string[] IconNames { get; }

        public abstract int SortOrder { get; }

        public virtual bool CanImport {
            get { return true; }
        }

        public void Import ()
        {
            if (importing || !ConfirmImport ()) {
                return;
            }

            importing = true;
            CreateUserJob ();
            ThreadPool.QueueUserWorkItem (ImportCore);
            importing = false;
        }

#endregion

        private void ImportCore (object o)
        {
            ImportCore ();
            DestroyUserJob ();
        }

        protected virtual bool ConfirmImport ()
        {
            return true;
        }

        protected abstract void ImportCore ();

    }
}

redpajama_set_name: RedPajamaGithub


Bathing suit Cover-ups required. Shorts, T-shirts, and denim allowed.
Dressy Casual. Long pants, dressy denim or dressy shorts allowed. Collared shirts are required. No T-shirts or torn, frayed or excessively worn denim allowed.
Bare feet and tank tops are not permitted in the Club at any time. Shirts are required at all times. Gentlemen are expected to remove their hats in the Dining Room.


This is a strong, thick old soul didge. Nice dense wood with a beautiful curve that sits perfectly as you play. I always love working these thick bigger bore didges. This one has good bass to it and nice strong vocals and overtones mixed with the strong drone. When I was crafting the mouthpiece I wanted to mimic the colors of the desert and love the way it came out. Also have a nice inlaid turquoise at the base. If you are looking for a bigger bore didge, some of my favorites, this could be a great fit.
I love the shape and taper on this one. With that great big bell and taper it has some extremely explosive qualities. I just finished this one so playing it for the recording was when I realized how quick it can play, The overtones are really easy as well with its taper and the vocals explode out of the bell. I love the look of the mouthpiece on this one. It has a little smaller opening at a little over 1 1/8″ for those that prefer that size. C is the root chakra and the only crystal bowl I have is in this key. I feel that grounding notes are so important especially in this time were we have so much mental stimulation.
I have played this one more than any on the site at the moment. It has such a great feel to it and is a rhythm machine. It has a nice clear drone and the response is superb. Really great vocal abilities and the overtones are so easy on this one. C# has always been one of my favorite keys, maybe why I have played this one so much. This one just keeps calling you back and opens up more each time I play it. This would be great for a player that likes to do percussive style playing mixing in the overtones and is really great for quick rhythms. Also is great at playing in a more ambient style of playing. This would be great for a beginner to grow as a player quickly with its unbelievable responsiveness and ease of play. The most advanced will have a blast playing this one and be able to really make it sing.
A# is one of the most popular and fastest selling keys. Partly because they are hard to find as they require more length and they are more time consuming to make. This one measures in at over 6 feet in length and has some really nice thick dense wood. It plays with ease and requires very little breath with really nice back pressure. It has the ability to excel in a a slow ambient style but also can play in a fast tempo with ease. A really nice quality to have with the deeper notes. A# is the pineal or third eye chakra. One of the reasons these are so popular is that these deep notes are so good for meditation and sound healing. The third eye chakra is associated with inner wisdom and intuition. A great choice for a player wanting to utilize the didge for its healing and meditative properties.
If you haven't played a deep keyed didgeridoo you are in for a real treat. A# is one of my favorite notes for playing a more meditative ambient style of playing. With it's light weight, thin walls, and deep resonance this would be perfect didge for players using it for sound healing. These deep keys require very little breath and a slight adjustment in lip buzz as it has so much back pressure. Once it is figured out it is amazing where these deep meditative sounds take the player. With its thin walls it produces quite a bit of volume despite having a smaller bell. Overtones are so easy as well with its taper and length. A#'s are hard to find especially ones that are more portable and weigh so little. A steal at this price for a rare note to find.
I was so excited when I found this agave and was the first I worked on when I got back home from that day collecting. I absolutely love these thick old souls for the way the way they play and look. I am guessing this was waiting out in the desert for a few years waiting to be transformed into an instrument. While out there it became a home for many insects that created a ton of opportunities for me to inlay turquoise throughout. This one has such a great taper and has perfect back pressure. It responds to any tiny manipulation of sound and has such a good feel to the drone. The vocals are clear and loud and the overtones with its bore taper, wall thickness, and length make the overtones a cinch. This would be great for a beginner to the most advanced as it is so easy to play but has so many capabilities.


GREENACRES, Fla., Apr 16, 2019 (SEND2PRESS NEWSWIRE) -- The City of Greenacres recently accepted a vision and strategic action plan created by the award-winning redevelopment firm, RMA (www.rma.us.com). The city, located in the heart of Palm Beach County, has already begun prioritizing key elements of the plan for implementation to realize the vision and strategic goals. In addition, RMA provided the City with several new logo designs; the final selection will be determined following receipt of comments from a citizen's focus group.
"We see tremendous economic growth opportunities in Greenacres," stated Sharon McCormick, RMA's Director of Business Attraction & Marketing. "Our team spent months studying the city and meeting with residents and stakeholders. After analyzing a vast array of data, we crafted a baseline of facts and a comprehensive strategy for revitalization and branding summed up in a new vision statement and brand promise."
Greenacres will be known as a vibrant and welcoming city that celebrates and promotes its location, parks and natural assets and business and residential diversity. Greenacres is dedicated to surpassing its founder's motto as "a good place to live" and will foster neighborhood community pride and pedestrian connections, promote strategic partnerships to enhance professional and personal opportunities, and support economic growth while maintaining Greenacres' authentic community character.
* Economic (re)development support outlining strategic partnership opportunities and funding resources.
"RMA has been an outstanding partner in planning the redevelopment of our City," said Andrea McCue, City Manager. "The plan they presented provides us with a blueprint to strategically continue our work creating a vibrant city for our residents, enhancing quality of life and place, and showcasing our welcoming environment for new businesses."
Greenacres is the 8th largest municipality of 39 in Palm Beach County. There are over 40,000 residents and over 1,000 businesses. With a land area of approximately six square miles, Greenacres is located in the central part of Palm Beach County and was originally incorporated in 1926. The City is home to 9 public schools, 11 parks with a combined area of over 93 acres and the City's Community Center is host to a variety of youth, adult and senior classes and activities. Additionally, the City has been recognized as one of the "100 Best Communities for Young People" in the nation by America's Promise-The Alliance for Youth, the nation's largest alliance dedicated to children and youth.
Founded in 2009 by Kim Briesemeister and Chris Brown, RMA is comprised of a phenomenal team of redevelopment experts passionate about building better communities. RMA is the most experienced full-service economic redevelopment consulting and management firm, headquartered in the state of Florida, specializing in revitalizing core areas and corridors for cities, counties and special districts nationwide. The co-founders are also the authors of one of the definitive books about city redevelopment, "Reinventing Your City: 8 Steps to Turn Your City Around." Learn more: http://www.rma.us.com/.


text:
using System;
using System.Collections.Generic;
using System.Linq;
using System.Text;
using System.Threading.Tasks;

using Xamarin.Forms;
using Xamarin.Forms.Xaml;

namespace CustomXamarinCalendar.Views
{
    [XamlCompilation(XamlCompilationOptions.Compile)]
    public partial class MonthView : ContentView
    {
        public MonthView()
        {
            InitializeComponent();
        }
    }
}


As the CMO of Universal CDN, I have direct contact with some fascinating entrepreneurs who conquer the digital content world every day!
What do I mean by Entrepreneurs? I mean people, who come-up with a stuff to do for money on their own. It's that simple.
Well…the full picture might be a little more complicated.
I know – it's not productive, it's counter-intuitive, it's psychological suicide and a free time-killer.
And yet – They are lovin' it!
I'm pretty sure you do too… If you are consuming this content, then chances are you are the same breed as them – the entrepreneurial.
Not necessarily a company owner or a freelancer.
Yes you could be entrepreneur in somebody else's company! You create, innovate, push and amaze every day, so that somebody-else's business could flourish. And that's OK! Not just OK. Because of people like this, we have companies like Apple, Google, Microsoft, Tesla and many more!
It is not about their famous leaders! Or at least not everything is about them.
It is equal contribution between people like you – "corporate entrepreneurs" and them!
On the other hand – you could not even think of it like entrepreneurship – you might just have a blog on a side and you write or "vlog" there regularly about stuff that fascinates you and you are not thinking of making any money out of it…yet.
It doesn't matter! What matters is that you understand the feeling. The feeling of being entrepreneur.
So, being two of a kind, you and them – you are probably going pretty much trough the same rough challenges in today's digital era.
What I'm going to do with these episodes is – I'm gonna' try to make your lives easier, by sharing every step of our client's entrepreneurial journey and everything that I learned in the processes, concerning the enormous subject of content.
Why content…? Because as you already know – content is "the new black".
But there is so little about delivering it. And I mean delivering it in a technical terms.
What I didn't say yet is that the client that I picked to talk about, is NOT a tech guy! Honestly – he is pretty lame!
As an entrepreneur in our time, he have no choice but to get along with technological trends, must-knows and every-day social media knowledge. But beside that – he faces regular challenges trying to do digital business.
This is how the idea of these episodes came up – If he has troubles, probably every non-tech entrepreneur has too!
So that said, let's get back to the content topic – delivering the content.
I will walk the whole process – from the first Idea of a business in the content field, trough the research and all the relevant knowledge about what make sense to know and what is totally worthless, and all the way to the finalization of the process of delivering the content to the end customer!
Please feel free to send me ( n.markov@ucdn.com ) any additional questions, cases and / or anything connected to the discussed subjects, that you believe will help the digital, but non-tech entrepreneurs in their tech journey!