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BACKGROUND CONTEXT: The development of muscle fat infiltration (MFI) in the neck muscles is associated with poor functional recovery following whiplash injury. Custom software and time-consuming manual segmentation of magnetic resonance imaging (MRI) is required for quantitative analysis and presents as a barrier for clinical translation. PURPOSE: The purpose of this work was to establish a qualitative MRI measure for MFI and evaluate its ability to differentiate between individuals with severe whiplash-associated disorder (WAD), mild or moderate WAD, and healthy controls. STUDY DESIGN/SETTING: This is a cross-sectional study. PATIENT SAMPLE: Thirty-one subjects with WAD and 31 age-and sex-matched controls were recruited from an ongoing randomized controlled trial. OUTCOME MEASURES: The cervical multifidus was visually identified and segmented into eighths in the axial fat/water images (C4-C7). Muscle fat infiltration was assessed on a visual scale: 0 for no or marginal MFI, 1 for light MFI, and 2 for distinct MFI. The participants with WAD were divided in two groups: mild or moderate and severe based on Neck Disability Index % scores. METHODS: The mean regional MFI was compared between the healthy controls and each of the WAD groups using the Mann-Whitney U test. Receiver operator characteristic (ROC) analyses were carried out to evaluate the validity of the qualitative method. RESULTS: Twenty (65%) patients had mild or moderate disability and 11 (35%) were considered severe. Inter- and intra-rater reliability was excellent when grading was averaged by level or when frequency of grade II was considered. Statistically significant differences (pamp;lt;.05) in regional MFI were particularly notable between the severe WAD group and healthy controls. The ROC curve, based on detection of distinct MFI, showed an area-under-the curve of 0.768 (95% confidence interval 0.59-0.94) for discrimination of WAD participants. CONCLUSIONS: These preliminary results suggest a qualitative MRI measure for MFI is reliable and valid, and may prove useful toward the classification of WAD in radiology practice. (C) 2017 Elsevier Inc. All rights reserved.
Inflammation is one of the hallmarks of carcinogenesis. High mammographic density has been associated with increased risk of breast cancer but the mechanisms behind are poorly understood. We evaluated whether breasts with different mammographic densities exhibited differences in the inflammatory microenvironment.Postmenopausal women attending the mammography-screening program were assessed having extreme dense, n = 20, or entirely fatty breasts (nondense), n = 19, on their regular mammograms. Thereafter, the women were invited for magnetic resonance imaging (MRI), microdialysis for the collection of extracellular molecules in situ and a core tissue biopsy for research purposes. On the MRI, lean tissue fraction (LTF) was calculated for a continuous measurement of breast density. LTF confirmed the selection from the mammograms and gave a continuous measurement of breast density. Microdialysis revealed significantly increased extracellular in vivo levels of IL-6, IL-8, vascular endothelial growth factor, and CCL5 in dense breast tissue as compared with nondense breasts. Moreover, the ratio IL-1Ra/IL-1 was decreased in dense breasts. No differences were found in levels of IL-1, IL-1Ra, CCL2, leptin, adiponectin, or leptin:adiponectin ratio between the two breast tissue types. Significant positive correlations between LTF and the pro-inflammatory cytokines as well as between the cytokines were detected. Stainings of the core biopsies exhibited increased levels of immune cells in dense breast tissue.Our data show that dense breast tissue in postmenopausal women is associated with a pro-inflammatory microenvironment and, if confirmed in a larger cohort, suggests novel targets for prevention therapies for women with dense breast tissue.
Anonymization of medical images is necessary for protecting the identity of the test subjects, and is therefore an essential step in data sharing. However, recent developments in deep learning may raise the bar on the amount of distortion that needs to be applied to guarantee anonymity. To test such possibilities, we have applied the novel CycleGAN unsupervised image-to-image translation framework on sagittal slices of T1 MR images, in order to reconstruct, facial features from anonymized data. We applied the CycleGAN framework on both face-blurred and face-removed images. Our results show that face blurring may not provide adequate protection against malicious attempts at identifying the subjects, while face removal provides more robust anonymization, but is still partially reversible.
Förvaltningsrapporten fokuserar på Snomed CT, eftersom det redan i dag finns rutiner för förvaltningar av termbanken och nationella hälsorelaterade klassifikationer. Ett särskilt utvecklingsarbete kommer att krävas för dessa delar.
Rapporten tar upp syfte och mål med förvaltningen. Utöver det redogör rapporten för vilka konkreta ansvarsområden som ingår i förvaltningen av Snomed CT. Målet för förvaltningen är att Socialstyrelsen regelbundet ska kunna tillhandahålla en kontrollerad och uppdaterad release av Snomed CT. Det skulle möjliggöra användning inom vård och omsorg. Rapporten tar även upp behovet av kompetens, utbildning och finansiella resurser.
Technologies in image acquisition have developed and often provide image volumes in more than two dimensions. Computer tomography and magnet resonance imaging provide image volumes in three spatial dimensions. The image enhancement methods have developed as well and in this thesis work 3D image enhancement with filter networks is evaluated.
The aims of this work are; to find a method which makes the initial parameter settings in the 3D image enhancement processing easier, to compare 2D and 3D processed image volumes visualized with different visualization techniques and to give an illustration of the benefits with 3D image enhancement processing visualized using these techniques.
The results of this work are;
1. a parameter setting tool that makes the initial parameter setting much easier and
2. an evaluation of 3D image enhancement with filter networks that shows a significant enhanced image quality in 3D processed image volumes with a high noise level compared to the 2D processed volumes. These results are shown in slices, MIP and volume rendering. The differences are even more pronounced if the volume is presented in a different projection than the volume is 2D processed in.
Fruit has since long been advocated as a healthy source of many nutrients, however, the high content of sugars in fruit might be a concern.
To study effects of an increased fruit intake compared with similar amount of extra calories from nuts in humans.
Thirty healthy non-obese participants were randomized to either supplement the diet with fruits or nuts, each at +7 kcal/kg bodyweight/day for two months. Major endpoints were change of hepatic fat content (HFC, by magnetic resonance imaging, MRI), basal metabolic rate (BMR, with indirect calorimetry) and cardiovascular risk markers.
Weight gain was numerically similar in both groups although only statistically significant in the group randomized to nuts (fruit: from 22.15±1.61 kg/m2 to 22.30±1.7 kg/m2, p = 0.24 nuts: from 22.54±2.26 kg/m2 to 22.73±2.28 kg/m2, p = 0.045). On the other hand BMR increased in the nut group only (p = 0.028). Only the nut group reported a net increase of calories (from 2519±721 kcal/day to 2763±595 kcal/day, p = 0.035) according to 3-day food registrations. Despite an almost three-fold reported increased fructose-intake in the fruit group (from 9.1±6.0 gram/day to 25.6±9.6 gram/day, p<0.0001, nuts: from 12.4±5.7 gram/day to 6.5±5.3 gram/day, p = 0.007) there was no change of HFC. The numerical increase in fasting insulin was statistical significant only in the fruit group (from 7.73±3.1 pmol/l to 8.81±2.9 pmol/l, p = 0.018, nuts: from 7.29±2.9 pmol/l to 8.62±3.0 pmol/l, p = 0.14). Levels of vitamin C increased in both groups while α-tocopherol/cholesterol-ratio increased only in the fruit group.
Although BMR increased in the nut-group only this was not linked with differences in weight gain between groups which potentially could be explained by the lack of reported net caloric increase in the fruit group. In healthy non-obese individuals an increased fruit intake seems safe from cardiovascular risk perspective, including measurement of HFC by MRI.
The aim of this thesis work has been to develop signal analysis methods for a computerized cardiac auscultation system, the intelligent stethoscope. In particular, the work focuses on classification and interpretation of features derived from the phonocardiographic (PCG) signal by using advanced signal processing techniques.
The PCG signal is traditionally analyzed and characterized by morphological properties in the time domain, by spectral properties in the frequency domain or by nonstationary properties in a joint time-frequency domain. The main contribution of this thesis has been to introduce nonlinear analysis techniques based on dynamical systems theory to extract more information from the PCG signal. Especially, Takens' delay embedding theorem has been used to reconstruct the underlying system's state space based on the measured PCG signal. This processing step provides a geometrical interpretation of the dynamics of the signal, whose structure can be utilized for both system characterization and classification as well as for signal processing tasks such as detection and prediction. In this thesis, the PCG signal's structure in state space has been exploited in several applications. Change detection based on recurrence time statistics was used in combination with nonlinear prediction to remove obscuring heart sounds from lung sound recordings in healthy test subjects. Sample entropy and mutual information were used to assess the severity of aortic stenosis (AS) as well as mitral insufficiency (MI) in dogs. A large number of, partly nonlinear, features was extracted and used for distinguishing innocent murmurs from murmurs caused by AS or MI in patients with probable valve disease. Finally, novel work related to very accurate localization of the first heart sound by means of ECG-gated ensemble averaging was conducted. In general, the presented nonlinear processing techniques have shown considerably improved results in comparison with other PCG based techniques.
In modern health care, auscultation has found its main role in primary or in home health care, when deciding if special care and more extensive examinations are required. Making a decision based on auscultation is however difficult, why a simple tool able to screen and assess murmurs would be both time- and cost-saving while relieving many patients from needless anxiety. In the emerging field of telemedicine and home care, an intelligent stethoscope with decision support abilities would be of great value.
We have previously developed a method for localization of the first heart sound (S1) using wavelet denoising and ECG-gated peak-picking. In this study, an additional enhancement step based on cross-correlation and ECG-gated ensemble averaging (EA) is presented. The main objective of the improved method was to localize S1 with very high temporal accuracy in (pseudo-) real time. The performance of S1 detection and localization, with and without EA enhancement, was evaluated on simulated as well as experimental data. The simulation study showed that EA enhancement reduced the localization error considerably and that S1 could be accurately localized at much lower signal-to-noise ratios. The experimental data were taken from ten healthy subjects at rest and during invoked hyper- and hypotension. For this material, the number of correct S1 detections increased from 91% to 98% when using EA enhancement. Improved performance was also demonstrated when EA enhancement was used for continuous tracking of blood pressure changes and for respiration monitoring via the electromechanical activation time. These are two typical applications where accurate localization of S1 is essential for the results.
In aortic valve stenosis (AS), heart murmurs arise as an effect of turbulent blood flow distal to the obstructed valves. With increasing AS severity, the flow becomes more unstable, and the ensuing murmur becomes more complex. We hypothesize that these hemodynamic flow changes can be quantified based on the complexity of the phonocardiographic (PCG) signal. In this study, sample entropy (SampEn) was investigated as a measure of complexity using a dog model. Twenty-seven boxer dogs with various degrees of AS were examined with Doppler echocardiography, and the peak aortic flow velocity (Vmax) was used as a reference of AS severity. SampEn correlated to Vmax with R = 0.70 using logarithmic regression. In a separate analysis, significant differences were found between physiologic murmurs and murmurs caused by AS (p < 0.05), and the area under a receiver operating characteristic curve was calculated to 0.96. Comparison with previously presented PCG measures for AS assessment showed improved performance when using SampEn, especially for differentiation between physiological murmurs and murmurs caused by mild AS. Studies in patients will be needed to properly assess the technique in humans.
Heart murmurs are often the first signs of pathological changes of the heart valves, and they are usually found during auscultation in the primary health care. Distinguishing a pathological murmur from a physiological murmur is however difficult, why an "intelligent stethoscope" with decision support abilities would be of great value. Phonocardiographic signals were acquired from 36 patients with aortic valve stenosis, mitral insufficiency or physiological murmurs, and the data were analyzed with the aim to find a suitable feature subset for automatic classification of heart murmurs. Techniques such as Shannon energy, wavelets, fractal dimensions and recurrence quantification analysis were used to extract 207 features. 157 of these features have not previously been used in heart murmur classification. A multi-domain subset consisting of 14, both old and new, features was derived using Pudil's sequential floating forward selection (SFFS) method. This subset was compared with several single domain feature sets. Using neural network classification, the selected multi-domain subset gave the best results; 86% correct classifications compared to 68% for the first runner-up. In conclusion, the derived feature set was superior to the comparative sets, and seems rather robust to noisy data.
Heart sounds (HS) obscure the interpretation of lung sounds (LS). This letter presents a new method to detect and remove this undesired disturbance. The HS detection algorithm is based on a recurrence time statistic that is sensitive to changes in a reconstructed state space. Signal segments that are found to contain HS are removed, and the arising missing parts are replaced with predicted LS using a nonlinear prediction scheme. The prediction operates in the reconstructed state space and uses an iterated integrated nearest trajectory algorithm. The HS detection algorithm detects HS with an error rate of 4% false positives and 8% false negatives. The spectral difference between the reconstructed LS signal and an LS signal with removed HS was 0.34/spl plusmn/0.25, 0.50/spl plusmn/0.33, 0.46/spl plusmn/0.35, and 0.94/spl plusmn/0.64 dB/Hz in the frequency bands 20-40, 40-70, 70-150, and 150-300 Hz, respectively. The cross-correlation index was found to be 99.7%, indicating excellent similarity between actual LS and predicted LS. Listening tests performed by a skilled physician showed high-quality auditory results.
Phonocardiographic signals contain bioacoustic information reflecting the operation of the heart. Normally there are two heart sounds, and additional sounds indicate disease. If a third heart sound is present it could be a sign of heart failure whereas a murmur indicates defective valves or an orifice in the septal wall. The primary aim of this thesis is to use signal processing tools to improve the diagnostic value of this information. More specifically, three different methods have been developed:
• A nonlinear change detection method has been applied to automatically detect heart sounds. The first and the second heart sounds can be found using recurrence times of the first kind while the third heart sound can be found using recurrence times of the second kind. Most third heart sound occurrences were detected (98 %), but the amount of false extra detections was rather high (7 % of the heart cycles).
• Heart sounds obscure the interpretation of lung sounds. A new method based on nonlinear prediction has been developed to remove this undesired disturbance. High similarity was obtained when comparing actual lung sounds with lung sounds after removal of heart sounds.
• Analysis methods such as Shannon energy, wavelets and recurrence quantification analysis were used to extract information from the phonocardiographic signal. The most prominent features, determined by a feature selection method, were used to create a new feature set for heart murmur classification. The classification result was 86 % when separating patients with aortic stenosis, mitral insufficiency and physiological murmurs.
The derived methods give reasonable results, and they all provide a step forward in the quest for an intelligent stethoscope, a universal phonocardiography tool able to enhance auscultation by improving sound quality, emphasizing abnormal events in the heart cycle and distinguishing different heart murmurs.
The 3rd heart sound (S3) is normally heard during auscultation of younger individuals, but it is also common in many patients with heart failure. Compared to the 1st and 2nd heart sounds, S3 has low amplitude and low frequency content, making it hard to detect (both manually for the physician and automatically by a detection algorithm). We present an algorithm based on a recurrence time statistic which is sensitive to changes in a reconstructed state space, particularly for detection of transitions with very low energy. Heart sound signals from ten children were used in this study. Most S3 occurrences were detected (98 %), but the amount of false extra detections was rather high (7% of the heart cycles). In conclusion, the method seems capable of detecting S3 with high accuracy and robustness.
Mild sclerotic thickening of the aortic valve affects 25% of the population, and the condition causes aortic valve stenosis (AS) in 2% of adults above 65 years. Echocardiography is today the clinical standard for assessing AS. However, a cost effective and uncomplicated technique that can be used for decision support in the primary health care would be of great value. In this study, recorded phonocardiographic signals were analyzed using the first local minimum of the auto mutual information (AMI) function. The AMI method measures the complexity in the sound signal, which is related to the amount of turbulence in the blood flow and thus to the severity of the stenosis. Two previously developed phonocardiographic methods for assessing AS severity were used for comparison, the murmur energy ratio and the sound spectral averaging technique. Twenty-nine patients with suspected AS were examined with Doppler echocardiography. The aortic jet velocity was used as a reference of AS severity, and it was found to correlate with the AMI method, the murmur energy ratio and the sound spectral averaging technique with the correlation coefficient R = 0.82, R = 0.73 and R = 0.76, respectively.
The 3(rd) heart sound (S3) is normally heard during auscultation of younger individuals, but it is also common in many patients with heart failure. Compared to the 1(st) and 2(nd) heart sounds, S3 has low amplitude and low frequency content, making it hard to detect (both manually for the physician and automatically by a detection algorithm). We present an algorithm based on a recurrence time statistic which is sensitive to changes in a reconstructed state space, particularly for detection of transitions with very low energy. Heart sound signals from ten children were used in this study. Most S3 occurrences were detected (98%), but the amount of false extra detections was rather high (7% of the heart cycles). In conclusion, the method seems capable of detecting S3 with high accuracy and robustness.
Recurrence plots (RP) visualize multi-dimensional state spaces and represent the recurrence of states of a system. Recurrence points can be divided into true recurrence points and false recurrence points (also called sojourn points). We introduce the true recurrence point recurrence plot, TRP, a variant of the traditional RP excluding the sojourn points. This is a cleaned up RP free from recurrence points originating from tangential motion, and hence a more robust representation of unstable periodic orbits. The method is demonstrated with three simple systems, a periodic sine wave, a quasi-periodic torus and the x-component of the chaotic Lorenz system
It is sometimes difficult to differentiate between innocent murmurs and pathological murmurs during auscultation. In these difficult cases, an intelligent stethoscope with decision support abilities would be of great value. In this study, using a dog model, phonocardiographic recordings were obtained from 27 boxer dogs with various degrees of aortic stenosis (AS) severity. As a reference for severity assessment, continuous wave Doppler was used. The data were analyzed with recurrence quantification analysis (RQA) with the aim to find features able to distinguish innocent murmurs from murmurs caused by AS. Four out of eight investigated RQA features showed significant differences between innocent murmurs and pathological murmurs. Using a plain linear discriminant analysis classifier, the best pair of features (recurrence rate and entropy) resulted in a sensitivity of 90% and a specificity of 88%. In conclusion, RQA provide valid features which can be used for differentiation between innocent murmurs and murmurs caused by AS.
The objective of this exploratory study is to investigate if lane departures are associated with local sleep, measured via source-localized electroencephalography (EEG) theta power in the 5-9 Hz frequency range. Thirty participants drove in an advanced driving simulator, resulting in 135 lane departures at high levels of self-reported sleepiness. These lane departures were compared to matching non-departures at the same sleepiness level within the same individual. There was no correspondence between lane departures and global theta activity. However, at the local level an increased risk for lane departures was associated with increased theta content in brain regions related to motor function.
There is a growing interest in nonlinear analysis of respiratory sounds (RS), but little has been done to justify the use of nonlinear tools on such data. The aim of this paper is to investigate the stationarity, linearity and chaotic dynamics of recorded RS. Two independent data sets from 8 + 8 healthy subjects were recorded and investigated. The first set consisted of lung sounds (LS) recorded with an electronic stethoscope and the other of tracheal sounds (TS) recorded with a contact accelerometer. Recurrence plot analysis revealed that both LS and TS are quasistationary, with the parts corresponding to inspiratory and expiratory flow plateaus being stationary. Surrogate data tests could not provide statistically sufficient evidence regarding the nonlinearity of the data. The null hypothesis could not be rejected in 4 out of 32 LS cases and in 15 out of 32 TS cases. However, the Lyapunov spectra, the correlation dimension (D2) and the Kaplan-Yorke dimension (DKY) all indicate chaotic behavior. The Lyapunov analysis showed that the sum of the exponents was negative in all cases and that the largest exponent was found to be positive. The results are partly ambiguous, but provide some evidence of chaotic dynamics of RS, both concerning LS and TS. The results motivate continuous use of nonlinear tools for analysing RS data. © 2005 Elsevier Ltd. All rights reserved.
Severe blood pressure changes are well known in hemodialysis. Detection and prediction of these are important for the well-being of the patient and for optimizing treatment. New noninvasive methods for this purpose are required. The pulse wave transit time technique is an indirect estimation of blood pressure, and our intention is to investigate whether this technique is applicable for hemodialysis treatment. A measurement setup utilizing lower body negative pressure and isometric contraction was used to simulate dialysis-related blood pressure changes in normal test subjects. Systolic blood pressure levels were compared to different pulse wave transit times, including and excluding the cardiac preejection period. Based on the results of these investigations, a pulse wave transit time technique adapted for dialysis treatment was developed and tried out on patients. To determine systolic blood pressure in the normal group, the total pulse wave transit time was found most suitable (including the cardiac preejection period). Correlation coefficients were r = 0.80 ± 0.06 (mean ± SD) overall and r = 0.81 ± 0.16 and r = 0.09 ± 0.62 for the hypotension and hypertension phases, respectively. When applying the adapted technique in dialysis patients, large blood pressure variations could easily be detected when present. Pulse wave transit time is correlated to systolic blood pressure within the acceptable range for a trend-indicating system. The method's applicability for dialysis treatment requires further studies. The results indicate that large sudden pressure drops, like those seen in sudden hypovolemia, can be detected. © The Japanese Society for Artificial Organs 2005.
Heart sounds (HS) obscure the interpretation of lung sounds (LS). This letter presents a new method to detect and remove this undesired disturbance. The HS detection algorithm is based on a recurrence time statistic that is sensitive to changes in a reconstructed state space. Signal segments that are found to contain HS are removed, and the arising missing parts are replaced with predicted LS using a nonlinear prediction scheme. The prediction operates in the reconstructed state space and uses an iterated integrated nearest trajectory algorithm. The HS detection algorithm detects HS with an error rate of 4% false positives and 8% false negatives. The spectral difference between the reconstructed LS signal and an LS signal with removed HS was 0 34 0 25, 0 50 0 33, 0 46 0 35, and 0 94 0 64 dB/Hz in the frequency bands 20–40, 40–70, 70–150, and 150–300 Hz, respectively. The cross-correlation index was found to be 99.7%, indicating excellent similarity between actual LS and predicted LS. Listening tests performed by a skilled physician showed high-quality auditory results.
The effects of driver sleepiness are often quantified as deteriorated driving performance, increased blink durations and high levels of subjective sleepiness. Driver sleepiness has also been associated with increasing levels of electroencephalogram (EEG) power, especially in the alpha range. The present exploratory study investigated a new measure of driver sleepiness, the EEG fixation-related lambda response. Thirty young male drivers (23.6 +/- 1.7 years old) participated in a driving simulator experiment in which they drove on rural and suburban roads in simulated daylight versus darkness during both the daytime (full sleep) and night-time (sleep deprived). The results show lower lambda responses during night driving and with longer time on task, indicating that sleep deprivation and time on task cause a general decrement in cortical responsiveness to incoming visual stimuli. Levels of subjective sleepiness and line crossings were higher under the same conditions. Furthermore, results of a linear mixed-effects model showed that low lambda responses are associated with high subjective sleepiness and more line crossings. We suggest that the fixation-related lambda response can be used to investigate driving impairment induced by sleep deprivation while driving and that, after further refinement, it may be useful as an objective measure of driver sleepiness.
The prevalence of mobile phone usage in traffic has been studied by road-side counting, naturalistic driving data, surveillance cameras, smartphone logging, and subjective estimates via surveys. Here, we describe a custom-made smartphone logging application along with suggestions on how future such applications should be designed. The developed application logs start and end times of all phone interactions (mobile phone applications, incoming/outgoing phone calls and text messages, audio output, and screen activations). In addition, all movements are automatically classified into transport, cycling, walking, running, or stationary. The capabilities of the approach are demonstrated in a pilot study with 143 participants. Examples of results that can be gained from smartphone logging include prevalence in different transportation modes (here found to be 12% while driving, 4% while cycling, and 7% while walking), which apps are being used (here found to be 19% navigation, 12% talking, 12% social media, and 10% games) and on which road types (rural, urban, highway etc.). Smartphone logging was found to be an insightful complement to the other methods for assessing phone use in traffic, especially since it allows the analyses of which apps are used and where they are used, split into transportation mode and road type, all at a relatively low cost.
BACKGROUND: Deep brain stimulation (DBS) in patients with severe, refractory Tourette syndrome (TS) has demonstrated promising but variable results thus far. The thalamus and anteromedial globus pallidus internus (amGPi) have been the most commonly stimulated sites within the cortico-striato thalamic circuit, but an optimal target is yet to be elucidated.
OBJECTIVES: This study of 15 patients with long-term amGPi DBS for severe TS investigated whether a specific anatomical site within the amGPi correlated with optimal clinical outcome for the measures of tics, obsessive compulsive behaviour (OCB), and mood.
METHODS: Validated clinical assessments were used to measure tics, OCB, quality of life, anxiety, and depression before DBS and at the latest follow-up (17-82 months). Electric field simulations were created for each patient using information on electrode location and individual stimulation parameters. A subsequent regression analysis correlated these patient-specific simulations to percentage changes in outcome measures in order to identify any significant voxels related to clinical improvement.
RESULTS: A region within the ventral limbic GPi, specifically on the medial medullary lamina in the pallidum at the level of the AC-PC, was significantly associated with improved tics but not mood or OCB outcome.
CONCLUSIONS: This study adds further support to the application of DBS in a tic-related network, though factors such as patient sample size and clinical heterogeneity remain as limitations and replication is required.
Therapeutic induction of blood vessel growth (angiogenesis) in ischemic tissues holds great potential for treatment of myocardial infarction and stroke. Achieving sustained angiogenesis and vascular maturation has, however, been highly challenging. Here, we demonstrate that alginate: collagen hydrogels containing therapeutic, pro-angiogenic FGF-2, and formulated as microspheres, is a promising and clinically relevant vehicle for therapeutic angiogenesis. By titrating the amount of readily dissolvable and degradable collagen with more slowly degradable alginate in the hydrogel mixture, the degradation rates of the biomaterial controlling the release kinetics of embedded proangiogenic FGF-2 can be adjusted. Furthermore, we elaborate a microsphere synthesis protocol allowing accurate control over sphere size, also a critical determinant of degradation/release rate. As expected, alginate: collagen microspheres were completely biocompatible and did not cause any adverse reactions when injected in mice. Importantly, the amount of pro-angiogenic FGF-2 released from such microspheres led to robust induction of angiogenesis in zebrafish embryos similar to that achieved by injecting FGF-2-releasing cells. These findings highlight the use of microspheres constructed from alginate: collagen hydrogels as a promising and clinically relevant delivery system for pro-angiogenic therapy.
In this position paper we briefly introduce SmartEnv ontology which relies on SEmantic Sensor Network (SSN) ontology and is used to represent different aspects of smart and sensorized environments. We will also talk about E-carehome project aiming at providing an IoT-based health-care system for elderly people at their homes. Furthermore, we refer to the role of SmartEnv in Ecarehome and how it needs to be further extended to achieve semantic interoperability as one of the challenges in development of autonomous health care systems at home.
It was demonstrated in recent studies that Complementary Limb Motion Estimation (CLME) is robust approach for controlling active knee prostheses. A wearable sensor system is then needed to provide inputs to the controller in a real-time platform. In the present work, a wearable sensor system based on magnetic and inertial measurement units (MIMU) together with a simple calibration procedure were proposed. This sensor system was intended to substitute and extend the capabilities of a previous device based on potentiometers and gyroscopes. The proposed sensor system and calibration were validated with an Optical Tracking System (OTS) in a standard gait lab and first results showed that the proposed solution had a performance comparable to similar studies in the literature.
Outcome assessment should consist of two basic steps - "selection of a meaningful outcome" and "determination of what caused the outcome". The latter step requires comparisons, and therefore information about the initial status of the patients. Severity ratings attempt to group patients with similar initial status so that outcome comparisons are meaningful. They are consequently an essential ingredient in outcome assessment.
This thesis aims at expanding the knowledge about outcome measurement focusing on the severity of a case with regard to definitions and applications of severity measures. Further, theoretical knowledge is integrated with practical needs for outcome assessment and methodology is developed for modelling the use of resources and interpreting the association between different severity measures.
As with illness and disease, severity of illness and severity of disease are interchangeable terms in medical literature. Based on a holistic theory of health, these terms were differentiated. Severity of a case was described by two basic components - severity of disease and severity of illness. Essentially, severity of illness concerns suffering and disability, and severity of disease concerns risk of death, risk of suffering and risk of disability. These definitions were the core of a set of criteria for classifying severity measures or outcome measures.
The role of a disease severity score in explaining resources use (e.g., intensity of technology utilization and length of hospital stay) in a neonatal intensive care unit was investigated. A disease severity score based on the death risk of the initial diagnosis was found to be an indicator of intensity of therapeutic technology together with gestational age and Apgar score. However, it does not show statistical significance to explain length of stay, which was explained by intensity of diagnostic technology and birthweight.
The demand for patient classification systems (standard systems to describe a patient's condition) on a national and local level was investigated. There is little experience in the use of these systems, but at the same time there is a demand from the nurse managers for standard measures of a patient's need for care.
There is still little knowledge about the association between severity of illness and severity of disease. This association was studied for patients with ulcerative colitis using data analysis techniques for dimension reduction such as cluster analysis, homogeneity analysis and non linear principal components analysis. A non linear relationship between illness and disease severity measures was found. The overall clinical judgement of disease activity was more related to illness patterns than symptoms or endoscopy and laboratory findings. In addition, the two measures of illness severity (Sickness Impact Profile and Rating Form for Inflammatory Bowel Disease Patient Concerns) were found to represent complementary information about a patient's illness experience. This illustrates the importance of conceptual knowledge in the selection process of an illness measure for outcome evaluations. These findings also reinforce the need for the development of systems to support interpretation of these kinds of complex associations, as traditional statistics have been shown to be of limited value under these circumstances.
MobileMe is a recently developed system for monitoring and recording physiological variables. It is wireless, and can therefore be suitable for field research, for example when measuring motion sickness symptoms.
The aim of this thesis was to conclude whether the MobileMe recording system was valid for research studies. A validation study, consisting of two parts and including 10 subjects, was performed. The first part was a laboratory study, where data from MobileMe and a reference equipment were compared. A field study was also performed, onboard a combat boat, to determine the equipment's validity in uncontrolled environments. Furthermore, the field study included an investigation of motion sickness symptoms, and provided data for evaluation of motion sickness rating scales.
Statistical results from the laboratory study, and results from evaluation of data from the field study, showed that MobileMe was valid in both controlled and uncontrolled environments.
Deep brain stimulation (DBS) is an established surgical therapy for movement disorders such as Parkinson's disease (PD) and essential tremor (ET). A thin electrode is implanted in a predefined area of the brain with the use of stereotactic neurosurgery. In the last few years new DBS electrodes and systems have been developed with possibilities for using more parameters for control of the stimulation volume.
In this thesis, simulations using the finite element method (FEM) have been developed and used for investigation of the electric field (EF) extension around different types of DBS lead designs (symmetric, steering) and stimulation modes (voltage, current). The electrode surrounding was represented either with a homogeneous model or a patient-specific model based on individual preoperative magnetic resonance imaging (MRI). The EF was visualized and compared for different lead designs and operating modes.
In Paper I, the EF was quantitatively investigated around two lead designs (3389 and 6148) simulated to operate in voltage and current mode under acute and chronic time points following implantation.Simulations showed a major impact on the EF extension between postoperative time points which may explain the clinical decisions to change the stimulation amplitude weeks after implantation. In Paper II, the simulations were expanded to include two leads having steering function (6180, Surestim1) and patient-specific FEM simulations in the zona incerta. It was found that both the heterogeneity of the tissue and the operating mode, influence the EF distribution and that equivalent contact configurations of the leads result in similar EF. The steering mode presented larger volumes in current mode when using equivalent amplitudes. Simulations comparing DBS and intraoperative stimulation test using a microelectrode recording (MER) system (Paper III), showed that several parallel MER leads and the presence of the non-active DBS contacts influence the EF distribution and that the DBS EF volume can cover, but also extend to, other anatomical areas.
Paper IV introduces a method for an objective exploitation of intraoperative stimulation test data in order to identify the optimal implant position in the thalamus of the chronic DBS lead. Patient-specific EF simulations were related to the anatomy with the help of brain atlases and the clinical effects which were quantified by accelerometers. The first results indicate that the good clinical effect in ET is due to several structures around the ventral intermediate nucleus of the thalamus.
Background: Deep brain stimulation (DBS) systems in current mode and new lead designs are recently available. To switch between DBS-systems remains complicated as clinicians may lose their reference for programming. Simulations can help increase the understanding.
Objective: To quantitatively investigate the electric field (EF) around two lead designs simulated to operate in voltage and current mode under two time points following implantation.
Methods: The finite element method was used to model Lead 3389 (Medtronic) and 6148 (St Jude) with homogenous surrounding grey matter and a peri-electrode space (PES) of 250 μm. The PES-impedance mimicked the acute (extracellular fluid) and chronic (fibrous tissue) time-point. Simulations at different amplitudes of voltage and current (n=236) were performed using two different contacts. Equivalent current amplitudes were extracted by matching the shape and maximum EF of the 0.2 V/mm isolevel.
Results: The maximum EF extension at 0.2 V/mm varied between 2-5 mm with a small difference between the leads. In voltage mode EF increased about 1 mm at acute compared to the chronic PES. Current mode presented the opposite relationship. Equivalent EFs for lead 3389 at 3 V were found for 7 mA (acute) and 2.2 mA (chronic).
Conclusions: Simulations showed a major impact on the electric field extension between postoperative time points. This may explain the clinical decisions to reprogram the amplitude weeks after implantation. Neither the EF extension nor intensity is considerably influenced by the lead design.
New deep brain stimulation (DBS) electrode designs offer operation in voltage and current mode and capability to steer the electric field (EF). The aim of the study was to compare the EF distributions of four DBS leads at equivalent amplitudes (3 V and 3.4 mA). Finite element method (FEM) simulations (n = 38) around cylindrical contacts (leads 3389, 6148) or equivalent contact configurations (leads 6180, SureStim1) were performed using homogeneous and patient-specific (heterogeneous) brain tissue models. Steering effects of 6180 and SureStim1 were compared with symmetric stimulation fields. To make relative comparisons between simulations, an EF isolevel of 0.2 V/mm was chosen based on neuron model simulations (n = 832) applied before EF visualization and comparisons. The simulations show that the EF distribution is largely influenced by the heterogeneity of the tissue, and the operating mode. Equivalent contact configurations result in similar EF distributions. In steering configurations, larger EF volumes were achieved in current mode using equivalent amplitudes. The methodology was demonstrated in a patient-specific simulation around the zona incerta and a "virtual" ventral intermediate nucleus target. In conclusion, lead design differences are enhanced when using patient-specific tissue models and current stimulation mode.
The success of deep brain stimulation (DBS) relies primarily on the localization of the implanted electrode. Its final position can be chosen based on the results of intraoperative microelectrode recording (MER) and stimulation tests. The optimal position often differs from the final one selected for chronic stimulation with the DBS electrode. The aim of the study was to investigate, using finite element method (FEM) modeling and simulations, whether lead design, electrical setup, and operating modes induce differences in electric field (EF) distribution and in consequence, the clinical outcome. Finite element models of a MER system and a chronic DBS lead were developed. Simulations of the EF were performed for homogenous and patient-specific brain models to evaluate the influence of grounding (guide tube vs. stimulator case), parallel MER leads, and non-active DBS contacts. Results showed that the EF is deformed depending on the distance between the guide tube and stimulating contact. Several parallel MER leads and the presence of the non-active DBS contacts influence the EF distribution. The DBS EF volume can cover the intraoperatively produced EF, but can also extend to other anatomical areas. In conclusion, EF deformations between stimulation tests and DBS should be taken into consideration as they can alter the clinical outcome
Despite an increasing use of deep brain stimulation (DBS) the fundamental mechanisms of action remain largely unknown. Simulation of electric entities has previously been proposed for chronic DBS combined with subjective symptom evaluations, but not for intraoperative stimulation tests. The present paper introduces a method for an objective exploitation of intraoperative stimulation test data to identify the optimal implant position of the chronic DBS lead by relating the electric field (EF) simulations to the patient-specific anatomy and the clinical effects quantified by accelerometry. To illustrate the feasibility of this approach, it was applied to five patients with essential tremor bilaterally implanted in the ventral intermediate nucleus (VIM). The VIM and its neighborhood structures were preoperatively outlined in 3D on white matter attenuated inversion recovery MR images. Quantitative intraoperative clinical assessments were performed using accelerometry. EF simulations (n = 272) for intraoperative stimulation test data performed along two trajectories per side were set-up using the finite element method for 143 stimulation test positions. The resulting EF isosurface of 0.2 V/mm was superimposed to the outlined anatomical structures. The percentage of volume of each structure's overlap was calculated and related to the corresponding clinical improvement. The proposed concept has been successfully applied to the five patients. For higher clinical improvements, not only the VIM but as well other neighboring structures were covered by the EF isosurfaces. The percentage of the volumes of the VIM, of the nucleus intermediate lateral of the thalamus and the prelemniscal radiations within the prerubral field of Forel increased for clinical improvements higher than 50% compared to improvements lower than 50%. The presented new concept allows a detailed and objective analysis of a high amount of intraoperative data to identify the optimal stimulation target. First results indicate agreement with published data hypothesizing that the stimulation of other structures than the VIM might be responsible for good clinical effects in essential tremor. (Clinical trial reference number: Ref: 2011-A00774-37/AU905)
The success of the deep brain stimulation (DBS) therapy relies primarily in the localization of the implanted electrode, implying the need of utmost accuracy in the targeting process. Intraoperative microelectrode recording and stimulation tests are a common procedure before implanting the permanent DBS lead to determine the optimal position with a large therapeutic window where side effects are avoided and the best improvement of the symptoms is achieved. Differences in dimensions and operating modes exist between the exploration and the permanent DBS electrode which might lead to different stimulation fields, even when ideal placement is achieved. The aim of this investigation is to compare the electric field (EF) distribution around the intraoperative and the chronic electrode, assuming that both have exactly the same position.
3D models of the intraoperative exploration electrode and the chronically implanted DBS lead 3389 (Medtronic Inc., USA) were developed using COMSOL 5.2 (COMSOL AB, Sweden). Patient-specific MR images were used to determine the conductive medium around the electrode. The exploration electrode and the first DBS contact were set to current and voltage respectively (0.2mA(V) - 3 mA(V) in 0.1 mA(V) steps). The intraoperative model included the grounded guide tube used to introduce the exploration electrode; for the chronic DBS model, the outer boundaries were grounded and the inactive contacts were set to floating potential considering a monopolar configuration. The localization of the exploration and the chronic electrode was set according to the planned trajectory. The EF was visualized and compared in terms of volume and extension using a fixed isocontour of 0.2 V/mm.
The EF distribution simulated for the exploration electrode showed the influence of the parallel trajectory and the grounded guide tube. For an amplitude of e.g. 2 mA/2 V, the EF extension of the intraoperative was 0.6 mm larger than the chronic electrode at the target level; the corresponding difference in volume was 76.1 mm3.
Differences in the EF shape between the exploration and the chronic DBS electrode have been observed using patient-specific models. The larger EF extension obtained for the exploration electrode responds to its higher impedance and the use of current controlled stimulation. The presence of EF around the guide tube and the influence of the parallel trajectory require further experimental and clinical evaluation.
Objective: To quantitatively compare the electric field generated by voltage and current controlled deep brain stimulation systems.
Background: Traditionally deep brain stimulation (DBS) systems have used voltage control however more recently, current controlled systems have been approved to treat Parkinson's disease and related movement disorders. In the endeavor of understanding the behavior of DBS systems a common approach is the use of computer models suitable to simulate the electric field, current density and other related electric parameters.
Methods: 2D finite element models based on commercially available DBS systems have been built for each system: I. Model 3389, Medtronic Inc., USA for voltage control; and II. Model 6142, St Jude Medical Inc. USA for current control. The brain tissue has been simplified to homogeneous and isotropic medium. The electric settings correspond to a monopolar configuration, using one of the four contacts available as the active electrode and the outer boundary of the tissue as the reference. Three simulations were performed to mimic different stages of the leads implantation: a) an original stage where the brain tissue is considered as pure gray matter, b) an acute stage that simulates the leakage of cerebral spinal fluid immediately after the electrodes' insertion; and c) a chronic stage mimicking fibrous tissue created around the electrodes some weeks after implantation. Both systems were submitted to the same conditions using as active electrode the third contact from the tip of the lead. The comparison is based on the maximal distance reached by the isopotential of 0.2 V/mm.
Results: The simulations showed that voltage controlled stimulation systems are more susceptible to changes in the electrical conductivity of the medium i.e. change over time of the tissue around the electrode. This agrees with the adjustment of the stimulation amplitude often necessary a few weeks postoperatively. Current controlled stimulation in turn, presented a linear behavior of the distance reached at different stimulation amplitudes at all stages.
Conclusions: Current controlled stimulation might be a good option due to its linear behavior over time, nevertheless more studies including a more realistic brain model, different designs of DBS electrodes and different electric parameter, are needed to encourage the use of this type of systems.


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The School of Community Health and Midwifery has state-of-the-art clinical skills laboratories. You will use them throughout your course to develop your skills in a safe environment, practicing again and again until you feel confident to try them out, under supervision, in practice. We have a wide range of equipment in the skills laboratories and 'drop-in' sessions are also provided by Practice Learning Instructors.
These facilities are complemented by the UCLan Library which provides comfortable, flexible study spaces and offers a wealth of excellent learning resources, extensive collections of information sources and expert help and support from Library staff.
The Placement Learning Support Unit is responsible for managing and co-ordinating the practice experiences of over four thousand students. A number of developments have been introduced to help students, mentors and link lecturers enhance the quality of practice learning.
Comensus (Community Engagement and Service User Support) is service user and carer led and has been developed to embed their voices within health and social care practice. Comensus provides a central hub for co-ordination and facilitation of user and carer involvement in the Schools.

subset: commoncrawl


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I do many stop while biking to take pictures of animals and nature. Today I present the elegant sandhill crane!
Category: Birds
What it is the subject of this picture?
Sometimes the un-focus part is the most important. Weekly Photo Challenge: Focus
Heron's Evening
Green Heron Tricolor Heron Great Blue Heron Juvenile Black-crowned Night Heron


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Tuesday, February 8, 2011
In Re: Chevron Corp.
Feb 3: In the U.S. Court of Appeals, Third Circuit, Case No. 10-2815. On Appeal from the United States District Court for the District of New Jersey. In this complicated case involving an environmental damages action in Ecuador, South America and a New Jersey environmental consulting firm, the Appeals Court explains, this matter comes on before this Court on appeal from a District Court's order entered June 15, 2010, granting Chevron Corporation the opportunity to engage in discovery pursuant to its application under 28 U.S.C. § 1782. Section 1782(a) provides in material part that "[t]he district court of the district in which a person resides or is found may order him to give his testimony or statement or to produce a document or other thing for use in a proceeding in a foreign or international tribunal[.]"
Section 1782(a), however, includes the limitation that "[a] person may not be compelled to give his testimony or statement or to produce a document or other thing in violation of any legally applicable privilege." The District Court, following a hearing that consisted of arguments of counsel, found that it was appropriate for it to grant a portion of Chevron's section 1782 application. In reaching its result the Court rejected a privilege issue raised in the proceeding by appellants, the plaintiffs in an environmental damages action in Ecuador and a New Jersey environmental consulting firm, Uhl, Baron, Rana & Associates, Inc. (UBR), engaged by the plaintiffs in the Ecuadorian case as a non-testifying environmental consultant. The Court in rejecting the claim of privilege held that "[t]o the extent that any privilege or immunity from disclosure would otherwise apply to some or all of the discovery sought by Chevron pursuant to its Application, any such privilege has been waived and/or does not apply pursuant to the crime-fraud exception[.]"2 App. at 3.
The Appeals Court ruled, "We now hold that the District Court applied the appropriate standards in considering Chevron's section 1782 application and correctly determined that the provision of documents to an Ecuadorian court-appointed expert to assess damages resulted in a waiver of any work-product protections and attorney-client privileges that might otherwise have precluded discovery of those documents. We limit our opinion, however, because we also hold that the District Court's ruling that the crime-fraud exception to the attorney-client privilege was applicable, to the extent that the privilege was not waived, was too sweeping and has the potential to pierce the attorney-client privilege for documents that were not created or used in furtherance of the alleged fraud and thus are not subject to disclosure through the application of the exception. We therefore will vacate the District Court's determination with respect to the crime-fraud exception to the attorney-client privilege and will remand the case to the District Court so that it can conduct an in camera review of the relevant documents and determine whether the crime-fraud exception to the attorney-client privilege is applicable to any of the documents and, if so, which ones."
Access the complete opinion (click here).
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At Steroplast Healthcare, we offer a wide range of medical products, and operate within an ever-increasing range of markets. In fact, we often surprise people with the breadth of industries that we thrive in. Beyond the well-known areas of Emergency or Sport.
What are these markets? Well, we're currently supplying products into business sectors that include dentists, opticians, care homes, GP surgeries, medical centres, schools/crèche/nurseries, airlines, offshore, commercial shipping, podiatry, beauty treatments, TV and film (location medical) and events. We also supply to a selection of niche areas that use or sell medical equipment, disposables and infection control products.
Steroplast Healthcare is also licensed by MHRA to sell pharmacy items and prescription medicines to authorised companies. This means we can supply POM (Prescription Only Medicines) to holders of a valid wholesale dealers license, or on receipt of a POM Authorisation Form signed by a Doctor, registered Nurse (authorised by a Doctor), or a registered Paramedic.
PHA (Pharmacy Medicines) are restricted under the supervision of a Pharmacist, and GSL (General Sales List) products are available for general sale. Call us with your requirements on 0161 902 3030.
You could even be 40,000 feet up, and come across our products. This is because we supply to some of the UK's leading charter airlines – everything from occupational health products and everyday first-aid items to burn treatments and diagnostic equipment.
Fingers crossed you don't, but if you did ever find yourself with a medical problem, either in inside an airport or up in the sky, you'll be in very safe hands.
Beauty and Cosmetics
One of our local beauty treatment customers is Manchester's premier specialist in laser tattoo and hair removal – Maria Patricia. Maria uses many of our products in her clinic.
From dressings and wipes to Sterofreeze instant ice packs, all of which help her to minimise patient discomfort. We also supply many companies in other areas of the beauty industry, from sterile wipes for acupuncture to Sterocrepe bandages used for mud wrap treatments.
You may be surprised to know that Steroplast works closely with many dental practices – we offer a wide range of products that help with infection control, vital to the protection of patients and staff. Our offering in this area is influenced by insights provided by Dr Ben Atkins, owner of Revive Dental Care and Trustee of the Oral Health Foundation Charity. Ben wrote a great piece about infection control practices in dentistry, published in Dental Nursing (you can read it here), and we have worked closely with him to establish which products practices need most.
GPs and Medical
We also supply to GP and Medical Centres. As these become more independent, and responsible for their own finances, they have to be certain they are using proven, hospital-quality products in their surgeries – without overspending on their budgets. This is where Steroplast can help. We can provide them with all their medical consumables and disposables, from spot plasters and tongue depressors, to infection control products, stethoscopes, blood pressure monitors and much much more – all of the very highest quality, and at the most competitive prices.
Many large offshore companies take a full range of our first-aid products and consumables. Because they're so far from land, they hold stock of items such as first-aid kits, bandages, burn treatments and haemostatic dressings. Also, due to the nature of their environment and the potentially dangerous working conditions, it's important that they are prepared for possible emergency situations. This means that they keep airway management, diagnostic, patient handling and emergency first aid equipment on hand to cover any and every eventuality.
We are very proud to be the suppliers of a wide range of infection control products to one of the UK's largest optician groups, via one of our distributors. With our products in their premises and by using these daily, opticians minimise the risk of infections, through the spread of germs, bugs and bacteria.
By keeping their environment clean, through constant disinfection of surfaces, equipment and tools, the possibility of cross-contamination is kept as low as possible, and even minimised.
Location Medical and Events
This industry is serviced by companies which specialise in providing first aid and ambulance cover for film and TV productions, and other large-scale events. These companies supply the medical staff and equipment required to comply with health and safety regulations, both on location and in the studio. To provide this service, they need to be fully equipped with ambulances which meet NHS specifications, advanced life support and paramedic equipment, and a full range of appropriate medicines and drugs. Many of these companies turn to Steroplast to help them meet their needs.
Podiatrists need to be confident in the products they're using, to help get their patients back on their feet (sorry). Our branded tapes, strappings, bandages and dressings give them the assurance they need.
In fact, we supply all major podiatry distributors in the UK with a wide range of first aid, medical and infection control consumables. Furthermore, our gloves and infection control range can be found in most clinics, helping to alleviate the day-to-day concern of the spread of bacteria.
Rehab and Physio
Did you know that our products feature heavily in rehabilitation and physiotherapy? For example, our branded tapes and strappings are used by all top sports physios and athletes for long- and short-term injury treatment. That's because our products are widely recognised as the best in the industry for both durability and quality. We're currently work closely with Firesport UK, the England and Manchester football teams for the emergency services, and their physio team. Take a look at our growing sports range here, you will be surprised as to what we can offer.
Schools and Education
From nurseries to pre-school, all the way through to Universities, you'll find our products in first-aid kits and nurse's rooms. They're popular because they're all CE marked, which means they have been tried and tested, and conform with current healthcare regulations. That's why more and more educational establishments are turning to Steroplast to fulfil their healthcare needs. With Steroplast, you can always be sure that your child is being treated using hypoallergenic, latex free products.


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Some Chinese developers haven't fully optimized their apps on Google Play because the Internet giant has not allowed them to list their paid apps. But that will soon change as Google finally allowed the Chinese geeks to offer paid apps and in-app purchases to more than 130 countries. Just recently, Google added more countries with Developer and Google Wallet Merchant registrations. It's finally coming to China which means developers can start selling their apps to majority of the Android users spread out in 130 countries.
Previously, only free apps can be listed by Chinese Google developers. This is a great development because it only shows Google is becoming more open to a lot people. It's not really surprising because China is considered an emerging market. The more products are being manufactured in China, the more the country is progressing. It's definitely a huge market and Google has yet to prove itself there even if it's already taken over most of the world. You see, Google and the government of China have been fighting for year about different issues. Maybe it's time Google forgets about them and offer more support. At the same time, we also hope that the Chinese government officials be more gracious with Google.
If you're an Android developer in China, you can visit play.google.com/apps/publish to register as a developer. You can submit your apps, sell them, and offer in-app products to make some money. But first, you need to have a Google Wallet merchant account. Feel free to set prices on the apps and wait for people to download and try your apps. Hope that you'll earn not just hundreds to thousands but millions if you think your app is too awesome.
SOURCE: Android Developers


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South African archbishop prays for Mandela, wishes for peaceful "end" for former president
JOHANNESBURG – A South African archbishop who visited Nelson Mandela in a hospital has offered a prayer in which he wishes for a "peaceful, perfect, end" for the former president and anti-apartheid leader.
Thabo Makgoba, the Anglican archbishop of Cape Town, posted the prayer on Facebook on Tuesday night after visiting the 94-year-old Mandela, who is critically ill.
In the prayer, Makgoba asks for courage to be granted to Mandela's wife, Graca Machel, and others who love him "at this hard time of watching and waiting."
The archbishop says: "Grant him, we pray, a quiet night and a peaceful, perfect, end."
He also appeals for divine guidance for the doctors treating Mandela, who was taken to a hospital in Pretoria on June 8 with what the government described as a lung infection.


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In the recent years, the only way you could access free games to play was going to a physical casino around you. With the development of free slot games, this has completely changed. Free fun online games come with many benefits. For one, you can play all kinds of online free games such as free online poker and free Tetris without having to leave the comfort of your home.
"The best online slots" offer an exciting and entertaining gaming experience that every player seeks.
Are you ready to play best rated Free Slots Now? Here are the best free slots online games currently available on the market, enjoy!
All you need to access the free games to play is your tablet, phone, or computer connected to the internet. With the continuous development of the free slots games, players can now access them on different platforms every day. Such platforms include Linux and Windows computers and on Mobile Slots iPhone and iPad, Android, and phone systems. They have merely become more interactive. The benefits of the free slots games include the following;
The free to play games also exposes the player to an environment where there are no worries about losing money. They are perfect games for the casual players who only play online free games for fun. Also some players also prefer slots free with bonus which is always good way to start playing. We have over 2000 free games for you ready for play, reviews by our professionals. Do not forget to bookmark us or subscribe to our news-letter, since we continuously add new games and update the reviews – you do don't want to miss any free slots games, don't you.
The free games to play continue to gain popularity because players can use them as a safe practice run when preparing to take a trip to the casino. These free slots games familiarize you with what games to expect at the casino without facing the risk of losing money. The free slot games prepare you by giving you the feel for the game The ways that free slot games acquaint players before reaching the casino are; allowing the player to decide whether the game they will choose suits their needs in slot play, gets the player used to the symbols, and allows the player to see the lucrative bonuses they can get when playing the real money games at the slot machine.
The sheer variety of the free online games to play is a massive plus for the free slot games. There is a wide variety of best rated free slots that you can choose. So whether your interest is playing free online games based on your favorite films or TV shows or games based on a character from a comic book, you will find a slot machine for you. It explains why some people play free online games not because they usually gamble, but because they are hooked with their favorite movie characters in the game.
If it is your first time to a slot machine, then you will be completely juggled up with what key to press or direction to follow. However, for the online free games such as the free online poker, you will easily upgrade from a newbie to a pro. The free slot games are easy to follow and play that you will need no one to guide you.
Most entertainments will always have their time limits, which is time to open and time to close. However, for the free slot games, this is not the case. You can play these online games whenever you want, and even you don't have to worry about the time of the day. And of course, you can access the online free games from any location with the internet connection.


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Services and facilities
Our Central Coast students benefit from outstanding facilities, many of which are purpose-built to replicate industry situations.
Our spaces
At Ourimbah, we are particularly proud of our unique, state-of-the-art teaching and learning spaces for our degrees in Exercise and Sport Science, Podiatry, Oral Health Therapy, Nursing and Food Science and Human Nutrition.
Before venturing out into business and community placements, our students develop their practical and theoretical skills in purpose-built teaching facilities including:
- Exercise science and exercise physiology testing facilities - part of the new $7.7million Exercise and Sport Science and Psychology building.
- Clinical laboratories for nursing, oral health and podiatry - students develop skills in settings that simulate hospital wards.
- Sara Lee Test Kitchen - students develop and test food product concepts
Our library
The Ourimbah Library is a vibrant learning and community hub on the Central Coast.
Libraries have changed and are no longer just about books. At UON Central Coast, students and staff have access to:
- 276 computers and a range of printing/scanning services
- Eight study rooms with access to computers and screens
- Wireless and power connections for laptops and other devices
- A service-desk offering 24 hour support from library staff
- A student 'Rover' service that provides peer-assisted library and basic IT support
- Cafe, lounge, parents' room and outdoor meeting spaces
Our clinics
We are proud to offer a number of clinics on the Central Coast. The services provided by these clinics benefit staff, students and the broader community.
Podiatry Clinic
Located at Wyong Hospital, the UON and Central Coast Local Health District Podiatry Clinic is a student teaching clinic providing care for public and private patients at minimal cost.
Psychology Clinic
The Psychology Clinic provides both a service to the community and a training facility for the postgraduate students within the School of Psychology at the University of Newcastle.
Oral Health Clinic
The UON Oral Health Centre is a student teaching clinic open to the general public. Current Bachelor of Oral Health students provide a range of services, under the direct supervision of qualified dental practitioners, at minimal or no cost. A free community mobile oral health service is also available to seniors and current Health Care Card holders
Ourimbah Gym Clinic
Students and staff can access high quality exercise equipment within the Exercise Sports Science and Psychology Building. As part of the clinic, users can complete a health screen and fitness testing and also take advantage of health and fitness programming.


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March is always a good month for music in San Diego because it seems like we get a bunch of bands on their way to or from the musical conference in Austin, Texas, known as SxSW. I'm happy to announce that I'll be going again and reporting on behalf of the SoundDiego team. But seriously though, just take a look at March -- it's insane. And now that Kaaboo has been announced, San Diego sure has a lot going on!
March 2: Gone Baby Gone, Cedar Fire, Pharmacy, Zombie Barbie, DJ Total Recluse at Casbah. Grrrls gone wild -- as in Riot Grrls!
March 3: Second Cousins, Paper Days, Lightworks at Casbah. I booked this night and the two previous ones at the Casbah -- please support local artists.
March 4: Swervedriver, Gateway Drugs at Casbah. Adam Franklin has played solo many times, now it's with his legendary band, Swervedriver!
March 5: Molly Ringwald at Martinis Above Fourth Table + Stage. The Molly Ringwald!
March 6: The Crawdaddys, the New Kinetics, the Bassics, DJ Tony the Tyger at Casbah. SD's own British rhythm & blues band that formed in 1978 reunites! Long live Country Dick, who used to play drums for them.
March 7: Viet Cong at Soda Bar. Epic post-punk from Canada.
March 8: The Districts at Casbah. Philly-based indie-rock band on Fat Possum Records.
March 9: Brian Ellis' Reflection, the Verigolds, Whiskey Circle at Casbah. All-local bill!
March 10: Howlin' Rain, the Blank Tapes at Casbah. Howlin' Rain is "watermelon rock, psychedelic, heavy jams, mellow jams, ethereal dung, sci-fsxploitation, bong rock and liquor store soul" according to their Facebook page.
March 11: A Place to Bury Strangers at Casbah. Experimental psych rock!
March 12: Maryjane's Underground showcase featuring Boychick, Casanova Frankenstein at Hard Rock Hotel. RSVP here, it's FREE!
March 13: 2:54, Honeyblood at the Hideout. London-based indie-rock band.
March 14: CRSSD Festival at Waterfront Park with Empire of the Sun (and many others). All-day electronic music festival.
March 15: CRSSD Festival at Waterfront Park with Chromeo (and many others). All-day electronic music festival.
March 16: Bandalier, Diamond Lakes, Botanico Chango at Casbah. All-local bill! Gotta love those Diamond Lakes!
March 17: K. Flay at Casbah. As heard on 91x.
March 18: The Juiliana Hatfield Three at Belly Up. The band is back after 21 years!
March 19: Trampled by Turtles, Honeyhoney at Observatory North Park. Great bluegrass from Minnesota.
March 20: Moon Hooch at Soda Bar. They call it "cave music."
March 21: Mrs. Henry, Schitzophonics, the Paragraphs, Erik Canzona & the Narrows at Casbah. All-local bill!
March 22: Robyn Hitchcock, John Doe, Exene Cervenka at Belly Up. Hitchcock's a legend in his own right, but he was also in the Soft Boys.
March 23: The Last Bison, Neulore at Casbah. Alternative-folk rockers.
March 24: Tweedy at Balboa Theatre. Yes, Jeff Tweedy from Wilco.
March 25: Gang of Four at Belly Up. Kings of post punk.
March 26: Jeff the Brotherhood at Soda Bar. The band's new single, "Black Cherry Pie," features a flute solo by Jethro Tull's Ian Anderson.
March 27: SoundDiego LIVE party with Prayers, Idyll Wild, Glass Spells at Air Conditioned Lounge. Cholo-goth rockers Prayers absolutely enlighten, and local faves Idyll Wild open up the next SoundDiego LIVE party, which Robin Roth is hosting ahead of an after-party set by Glass Spells. It's FREE with RSVP here!
March 28: The Loons, Misunderstood with Glenn Campbell, Schitzophonics at Casbah. Sixties psych-rock from people that know the genre pretty well.
March 29: Tsu Shi Ma Mire, Quorum, the Fin, Pleasure Fix, the Bloodflowers at Casbah. It's the traditional "Japan Nite" at the Casbah, with bands from the region on their way home from SxSW.
March 30: Death Eyes, Little Dove, Kata, Foreign Bodies at Casbah. All-local bill!
March 31: Shlomo at Casbah. Beatboxer! Members include "Shlomo and his mental mouth!" according to Facebook.
That's all I got for you, but don't take my word for it. You should do some research on your own or take a look at what Robin Roth or Rosemary Bystrak post too, because they are two ladies that know our town! Have a great March and wish me -- my liver, mainly -- luck in Austin at SxSW!
Tim Pyles, a longtime local who grew up in La Jolla, is the unofficial mayor of local music and hosts Loudspeaker on 91x every Sunday from 7 to 10 p.m. He also books local acts at the Casbah, hosts the weekly Anti-Monday League, books/hosts the monthly Maryjane's Underground at the Hard Rock Hotel and is an entertainment writer for Pacific San Diego Magazine. Check out his website thelocalpyle.com and and follow him on Twitter @thelocalpyle. You can reach him directly here firstname.lastname@example.com


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Those of you that know me know that politics are not my normal area of activity, but education and "the next generation" certainly is.
Since we have the opportunity to vote for four candidates for the Atlanta Board of Education, one from our district and three at-large, I wanted to share this with you.
I have known Cynthia Briscoe Brown, one of the candidates for the 2 at-large positions for about 15 years. A lawyer by training, she has the knowledge, intelligence, the objectivity and and determination to make a difference.
I hope you will vote for her and take into consideration the endorsement the other two candidates.
Please also read the email below from a long time educator and friend who I have known for about 15 years. I highly respect her judgement. So I wanted to share her thoughts on these Board of Education races,
The bottom line is that she suggests these:
– Nancy Meister (District 4)
– Cynthia Briscoe Brown (at-large)
– Courtney English (at-large)
Thank you,
Begin forwarded message:
From: nancy.cunningham
Date: October 19, 2013 at 10:11:56 AM PDT
Subject: Candidates for Atlanta Board of Education
Several friends have asked about the up-coming election for the Atlanta Board of Education, so I am sharing this information with you.
On November 5 we will be asked to vote for four positions on the Atlanta Board of Education (ABE). Since this comes around only every four years, it is easy to forget the way the board is set up. The city is divided into six districts, and each district has one representative. (I happen to be in District 4 which is currently represented by Nancy Meister.)
In addition, the ABE has three At Large Districts which are composed as follows:
Districts 1 & 2 are represented by At- Large District 7
Districts 3 & 4 are represented by At -Large District 8
Districts 5 & 6 are represented by At-Large District 9
Thus, the board member from At-Large District 7 is elected city-wide but must reside in either District 1 or District 2. We will be asked to vote for At-Large Districts 7, 8, and 9 in addition to our local district member.
In case you are interested, I have chosen the following candidates:
District 4: Nancy Meister (I first knew Nancy when I taught her sons at Sutton many years ago and knew her then as a supportive, passionate parent who was willing to roll up her sleeves and make a difference at Sutton.)
At-Large District 7: Courtney English
At-Large District 8: Cynthia Briscoe-Brown (I have known Cynthia for at least 20 years. She has been a tireless worker and advocate for our schools in Districts 3 & 4 and has served at all levels of parent support groups. Additionally, she has worked for all our APS districts in her work with APPLE Corps. Her children have gone all the way through APS schools (Brandon, Sutton, North Atlanta) and she knows things inside and out! Finally, I have known her as a faithful, committed member at FPC Atlanta.
At-Large District 9: This one is not as clear for me, and I would especially appreciate feedback on this one. I have two recommendations from respected sources. If I were voting today, I would vote for Ed Johnson. A second choice is Jason Esteves.
You can leave a response, or trackback from your own site.


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Join us from any location, on your own schedule, for a 3 part Online Video Course on the fascinating subject of Or Nué. Our online classes allow students to learn at their own pace, as there is no deadline for viewing material. And after you finish watching the videos for the first time, you will continue to have access to them to refer back to. Our online courses cost a little more than our live, group setting classes because students will have continued access to the curriculum, access to print outs and links, and of course we need to be able to pay a company for the service of hosting all these wonderful videos.
Or Nué – Medieval Goldwork Embroidery
This obscure embroidery technique uses glittering gold and vibrant shimmering silk to paint a picture in thread. Or Nué dates back to the medieval era where it was used primarily in religious vestments and altar cloths. Today we can use the technique to create beautiful artwork or even exquisitely detailed jewelry!
No prior embroidery experience is necessary, but patience and a willingness to work in a small scale is helpful!
I have been teaching beading and embroidery classes since 2000, but I am now making the big leap of offering my classes online. Help me get the ball rolling and spread the love for historical and couture beading and embroidery arts by registering for my class in advance! I am offering a limited time Early Registry Pricing option for students to save $50 by signing up before all the content is live. The first video lesson is already live and lesson 2 will follow shortly! There will be 3 video segments total.
Learn more by watching this video!
Students will need to purchase their own materials for the online classes. This listing covers the instruction only. Chapter Two of our series will discuss materials and provide a detailed supply list.
Or if you prefer, an Or Nué supply kit is available here for preorder:
PREORDER -Or Nué Kit – Pinwheel Pendant Design (MATERIALS ONLY!)
- If you have taken one of my live, group Or Nué classes in Columbus, Ohio, you are eligible for a discounted price for this more in depth course. Just send me an email with your name and receipt, and I will send you a discounted invoice for the online course.
All online class sales are final.
Questions or comments may be directed to: sales (at) oldetownebead (dot) com .


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Thank you all for your continued support, our raffle was drawn Monday night and all winners have been notified.
Author Archives: ambershome
Raffle Winners
Filed under Uncategorized
Gun Raffle
Freedom Farm for Vets is holding a gun raffle, there are only 500 tickets being sold for $10 each. The drawing will be held on April 15th at 7pm, winner will be notified via phone. All proceeds from this raffle will go back into the Farm to keep us operating. Tickets are available at the Freedom Farm 13155 W Hart Street Wadsworth, Il 60083. Please feel free to message us on here, email us at: email@example.com or call us 224-399-7464 with any questions. Thank you for your continued support.
Just a note
From time to time, we have to leave the farm for lunch, supplies, and even to assist other Veterans. The sign on the gate will give you a number to call to find out how long until we return. We apologize for the inconvenience, this only happens during our winter months when volunteers are few. Thank you for your patience, support and understanding.
Filed under In the News
Fall Festival 2018
Sunday, October 14th we held our annual Fall Festival at the Freedom Farm. The weather held out this year for us, making it a cool but wonderful day on the Farm. If you were able to come out and spend some time with us on the Farm and see what we are all about, thank you for joining us! If you didn't make it this year, we welcome you to the Farm anytime! Thank you to Patch 22 for bringing their ponies again this year and donating pony rides for a few hours. Thank you to Lake County Farm Heritage Association for spending your afternoon with us as well as donating your barrel train rides. It was such a wonderful afternoon: we had games for the kids, pumpkin painting (paint a pumpkin that we will delivery to the VA on our Rose Delivery Sunday Halloween Week), we had a wonderful band who kept our guests entertained and dancing to such tunes as Neil Diamond's "Sweet Caroline" . Thank you to Lake County Harm Heritage Associate as well as the Chris Patterson Memorial Foundation for your donations to our organization. We thank you to all who came out and spent the afternoon with us, to all of our volunteers who helped get ready for the event and most importantly to our Veterans and their families, we are here for you! For photos from the event, please click on the following link to our Facebook page, if you have any photos you would like added, please message us on the Facebook page or send them to: firstname.lastname@example.com.
US Cellular Spends the Day on the Farm
Friday Sepember 14th, our friends at U.S. Cellular came and spent the day with us.
They stained all our our buildings, cleaned the pasture & picked all the produce that was ready. They all did an Outstanding Job helping us get ready for Fall Fest, what a fine group again Thank You So Much.
Fall Festival 2018
Please come and join us on Sunday October 14th from 1 to 7pm for our annual Fall Festival. This is a free event on our Farm open to anyone and everyone! Our event will happen rain or shine. We will have something for everyone! Pumpkin painting, bake sale, pie eating contest, a live band, just to name a few things. Parking will be on site in our pasture. Please come spend your Sunday afternoon and see our Farm and what we are all about. Please email or call with any questions you may have.
Farmer's Market Season
Come join us at Wadsworth Farmer's Market every Wednesday starting July 11th from 3 to 7pm. Be sure to "like" and "follow" us on Facebook, Twitter, and Instagram as we will be posting each week what we will have available. Thank you all for your support, looking forward to a great Market season.
Filed under Events, In the News, Wadsworth Farm


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to Learn... to Serve... to Lead & Succeed
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Please visit our Remote Learning Page for all updates regarding COVID-19.
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Classes begin at 8:15am. Day ends at 2:50pm
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Monthly Calendar


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