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Have you ever heard or read about the salary increment rules and regulations in Saudi Arabia? I have been questioned several times about this subject from numerous readers of the blog and finally I have decided to spare sometime to write an article about it. You may have met many people in Saudi Arabia who came here decades ago and still working on the same package. It seems that their employers don't even think that inflation and other price hikes are in the society. According to report published by the International Monetary Fund (IMF) the inflation rate in Saudi Arabia is around 3%. So employee should be compensated at least for the inflationary increase in prices even if there is no promotion.
Rule for Salary Increment in Saudi Arabia
Unfortunately, there is no law governing Salary Increment in Saudi Arabia. It purely depends upon the mutual agreement and contract of the employee and employer to determine the remuneration. When employees ask about the salary increment, employers don't entertain the requests. Saudi Authorities do not think it to be appropriate to come into the issue of salary determination of employee. However, I personally think that they should come at least to rescue the employees who are paid very low. There should be a law governing minimum salary of expatriate employees as there is a law protecting minimum salary of Saudi employees. Minimum salary of Saudi employees is SR 3,000/- in Saudi Arabia.
What to do if Salary Increment is not received?
If employer is not giving any salary increment to employee or he is dissatisfied with the employer due to any other reason. The Saudi Labor Law allows expatriate workers to go for final exit or transfer sponsorship to a new employer after completing the contract. It is not advisable to leave the employer within the term of the contract as it may lead to penalties and fines for the violation of the law. I have explained it in this link "Fixed and Indefinite Contract".
Job Continuation under Saudi Labor Law
- Rights of Expatriates in Saudi Arabia
- Right of Air Ticket as per Saudi Labor Law
- Rules regarding Emergency Leave in Saudi Arabia
- Rule for Salary Increment in Saudi Arabia
- Rights of Employees in Absence of Contract in Saudi Arabia
- Vacations (Leaves) under Saudi Labor Law
- Leave Encashment under Saudi Labor Law
- Working Hours and Overtime in Saudi Arabia
- Fixed Term and Indefinite Contract


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I love Saturdays. You see, I have an only child and he's 10, so he's hit the age of can't-get-me-up-even-if-you-tried. Whoo hoo! I get to sleep in. On school days, even if I don't get a last minute phone call to go to work, still means I have to get up at 7 am to get Kevin off to school. He's not an organized child and likely wouldn't ever get up if I didn't stand over him and playfully whack him with a stuffie.
Today it's bright, sunny, hot, and has loads of promise to be a good day. I usually grocery shop on Saturday. Not today. Are you kidding? It's a day for the beach. I may pack Kevin up and take off to one of the many in the area. I think he has plans to visit friends though, so that could change mine. If he would rather take off with them, that's okay. Another part of (although not so nice) of being a mom to an only. I'm not his playmate anymore, and his friends are starting to take precedence. Which is okay with me. I'm thrilled he has friends.
Readers have been asking about the teacher's tea. It went wonderfully! The only sad thing was that Kevin's actual teachers (two great guys) couldn't come. But everyone else did and we had about 6 people over for cheesecake, tea, fruit, brownies, etc. I didn't read Heart of Gold out loud, because none of us wanted to have a cry fest. But they all loved it. :) Kevin was so thrilled to have them over that he gave them the tour of the entire house, including our messy garage. (hee hee) Then the next day we delivered a plate of goodies to his teachers that couldn't come, and they were sooooo happy. The nice thing was that most of them had been run off their feet all day and coming to our house was a great chance to just sit and relax. I know how that is at the end of the school year, so I was glad to do it for them. I must say though that they seemed a little overwhelmed that we wanted to thank them that much. But many of them don't know the whole story.
One week to go until school is out. We have begun planning our vacation now, even though it's in August. Last summer we spent the whole summer recovering from major stress. This summer? Now it's time to have fun!
Saturday, June 24, 2006
It's Saturday!
Posted by Karen Humphrey at 9:45 AM Labels: nonsensical rambling

subset: commoncrawl


text: Motorola Solutions looks to mission and business critical intelligence 24 Nov 2014 03:09 PM Mission critical communications networks are beginning to change as traditional networks designed around voice look to incorporate data services. Paul Steinberg, CTO at Motorola Solutions, sees a change in approach happening, as he explains to Wireless editor James AtkinsonMotorola Solutions has been supplying mission and business critical solutions for over 50 years, but Paul Steinberg, chief technology officer, Motorola Solutions, sees a shift happening.'The simplest way I can describe it is that what mission and business critical communications means today is mission and business critical intelligence,' says Steinberg, 'and you leverage whatever technologies are best to deliver that intelligence.'We are looking to deliver intelligence led public safety solutions,' he continues, 'and bring real time information to bear to the practitioner. That means real time access to data on the people and the environment around public safety professionals. Our job is to help public safety organisations mobilise that intelligence and get it back out to their people in a way that makes the most sense to them in the situation they are in.'It's about how get intelligence to them in the most suitable way, so they get the right information, at the right time, in the right way with the right play,' affirms Steinberg.'We have to look at how to mobilise the network solutions and then how we architect the service enablement layer so we can extract contextual information, such as location-based information, video or biometric information from sensor worn by first responders, and then we need to manage the quality of performance and then move that out,' he says. Devices are, of course, a key part of enabling this, so how to evolve the traditional rugged two-way radio to handle data? When it comes to communication devices Steinberg says it is unrealistic to think first responders will walk around with the consumer devices of today. 'But when we design rugged mission critical devices capturing the user experience and feeding it into the design is a very important part of the process.'Things get smarter,' says Steinberg. 'Weapons get smarter, the responders are wearing biometric sensors and heads-up displays and the smart vehicles are not just there for transportation, but become a smart partner as well, perhaps by using mesh technology to relay broadband data to the first responders. How do we make that work? How do we take all that real time data that can be captured on the individual and make sensible use of it?'Heads-up display glassesThe company is exploring these new ideas partly by itself and partly through partners via its investment arm Motorola Solutions Ventures, which puts funding into start ups. For example, Steinberg says it has worked with Recon Instruments, best known for producing heads-up display (HUD) units for use in sporting and outdoor environments. Motorola and Recon have been working on a smart glasses prototype that is designed to be less clunky and geeky than Google's product. Steinberg says: 'The heads-up display is on the right side. It is designed to work with a forward facing camera and to provide information snacking; you just look down and pick up what you need and disable it you're not looking at it. If you look down it says; here's what I have for you.'It could be used to tell you what radio channel a user is on, or to make a police database enquiry. It could also snap a photo snap a photo, package it up and send it back to control. Information could be pushed to it, such as the location of the nearest fellow officer. By seeing that information in the heads-up unit, the receiving officer does not need to pull out his device and look at the screen. Adoption barriersSteinberg says the next step is to incorporate augmented reality, which will probably be mostly used for training purposes. 'The line in the sand for end users is, if you give me something that forces me to change my procedures I won't use it, but I might use it in training and for experimenting.'It is not just cultural and social barriers we have to deal with,' continues Steinberg, 'but policy and legal system barriers too. In some countries they would not allow the camera on the glasses, as it is seen as an invasion of privacy issue. That's inevitably the way and that is why co-creation with end users is very important. We've got to get in the police, fire, ambulance and other end user feedback as we develop products.'He cites the lesson of 'The Lean Start Up' by Eric Ries, which shows how you can fall foul of spending a lot of time and money on trying to go to market with the 'perfect' product. It may be perfect at what it does, but if it is the wrong product for the market it will fail. 'What you need to do is build as little as you can, as fast as you can, develop the product on the hoof and keep adding the latest iterations,' says Steinberg. Citing the heads-up display glasses, he says: 'We are working with on this kind of thing with 10 different partners.'LEX L10 mission critical LTE hand portableAnother new product out in the States is the LEX L10 mission critical LTE Android hand portable device (pictured below), which joins the LEX755. It is aimed at public safety personnel and provides them with the kind of mission critical applications that are normal to two-way radio systems, but unavailable on consumer-grade smartphones.A key feature is its PSX (public safety experience) user interface that is customisable to meet the needs of particular roles or to adapt to changing requirements. It intelligently aggregates and prioritises information to only present what is critical for the user, based on their current status and activity.It is designed for one-handed operation with a no-slip grip and a 4.7-inch touch screen. It features dual 1 Watt front-facing speakers, tri-microphone noise and echo cancellation, and a dedicated PTT button. It can also operate in covert mode and in the US it can be securely touch-paired with Motorola APX P25 radios via mission-critical Bluetooth. It uses a removable battery that enhances long-term usage in the field.The LEX L10 is secured with hardware encryption and security enhanced Android OS to meet public safety FIBS (Federal Information Processing Standard) Publication 140-2 encryption standards. 'It has very good audio and a great form factor, but the screen is slightly bigger than the Lex755,' says Steinberg. 'The base screen is designed for a police officer and it advances with context. So, if the officer is assigned to an event, a relevant map pushed to the device comes up automatically. You can also create talk groups dynamically in a number of different ways.'The device also uses colours to highlight emergency events. It knows by context if the user is in covert mode and only provides audio if the user is wearing an earpiece. It is also a dual SIM device, so it can also be used as a personal device. Steinberg adds that being an LTE device it can stream video for situational awareness. Street video cameras can be overlaid on maps and clicked on to get the video stream from that particular camera.'You can also edit the video on the device, which of course is a no no for court evidence – a complete log would be kept for the court - but you can do edited highlights to cut out the non-interesting bits for others to see,' says Steinberg.Future mission critical communications networksSteinberg notes that TEDS (TETRA enhanced data services) can carry most of what broadband can provide, but he thinks the likes of TETRA and P25 will co-exist in tandem with broadband LTE services for some time yet. 'You leverage TETRA and P25 for voice and low speed data and broadband where you can,' he says. 'They sit side by side and you use LTE broadband where you need it. We are trying to make things transparent through our software layer, so you can use what is available, whatever is the optimum network. 'We see them as complementary,' continues Steinberg. 'We continue to invest in TETRA and the radio side. We see no reason to back away from TETRA now, but we will balance it out with other technologies.'Motorola is working with Ericsson to develop a mission critical LTE offering where the two companies have favoured an over the top approach to adding mission critical functions to the LTE standard ahead of these being written (not expected until 2018 at the earliest). Steinberg believes an OTT approach, as opposed to embedding solutions deeper in the network, keeps things flexible and makes it easier to add features and adapt the offering.Ericsson is looking after the LTE RAN (eNodeB base stations etc), the lower LTE core (MME - mobility management entity; and serving gateway); and the upper LTE core (HSS – home subscriber server, PGW – packet data gateway, PS PCRF/QoS broker – public safety specialised policy rules function/quality of service). Motorola is concentrating its expertise on the two layers above: the first covers interoperability services, including mobile VPN, priority manager/unified services, land mobile radio interworking and potentially IMS (IP multimedia services).The second comprises the application layer covering regional and national public safety apps including legacy apps, broadband apps, NextGen 911/999 calling, multimedia computer aided dispatch, messaging, video, maps/LBS, RMS and PSTN. Key functions, such as group calling, are handled by enhanced multimedia broadcast multicast services (E-MBMS), which provides transport features for sending the same content information to all the users in a cell via LTE networks. Steinberg says the Motorola Solutions/Ericsson mission critical LTE solution is ready to use. In the meantime, it and others in the mission critical community are trying to bring their expertise to bear on 3GPP and other standards bodies involved in writing the mission critical LTE standards over the next few years. 'There's a lot to do there,' acknowledges Steinberg. 'But 3GPP has been leaning into these issues over the last nine months and we are seeing some kind of convergence around there and with the system architecture group, so that is encouraging. The push-to-talk application seems to be the one area that will take a bit longer.'Evolution of mission critical networks'There are many different scenarios playing out here,' observes Steinberg. 'The UK is at one end of the spectrum, moving everything over to a commercial LTE network provider, others have gone for a dedicated network, like FirstNet in the US. Others may adopt a hybrid or shared network approach. Any and all of those can work, but it depends how they are enabled.'It is not so much a technology issue, it is about policy and economics,' he notes. 'What does it make sense for a mobile network operator (MNO) to do; how much spectrum do they have and so on? A lot of what the MNOs want to do is very possible, but the tricky bit is extending coverage in a way that makes sense economically. In addition, their coverage tends to be uplink limited. Public safety users upload a lot more material than consumers do.'Motorola Solutions continues to evolve its traditional two-way radio portfolio in P25, TETRA and DMR (Mototrbo) and is increasingly adding more and more applications. It is also developing infrastructure and device solutions for what now seems to be the inevitable move to 4G LTE solutions for future mission critical networks. There is clearly plenty to come yet.James Atkinson EditorLinkedIn |Google + |Email Leave a CommentPlease write code to prove you're humanMore on... Smart CitiesNokia unveils wireless router for power distribution networks ETSI forms new industry group for smart city solutionsMore on... EricssonMWC17: Ericsson expands 5G access and transport portfolioOperators trial intercontinental 5G roaming using network slicing Public safetyTCCA pinpoints key focus areas for LTE-based critical communicationsMotorola launches all-in-one single site TETRA digital radio system Southern Tyrol TETRA network gets a workout at Biathlon World Cup


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Leisure Lawns Collection
Our Amish Outdoor Recycled Poly lumber Bar Stool is beautiful outdoor patio furniture that will last a lifetime. Looks great by the pool, on your patio or even for an outdoor restaurant or bar area. This patio furniture is made in the USA. Pair it with our Poly half round bar table.
© Copyrights 2003 - 2017 DutchCrafters All rights reserved.


text:
Furious - Zayatz Rolls MP3
Please listen in HQ! This track also includes two parts of "Jefferson Airplane - White Rabbit".
Zayatz Rolls (Original Mix) MP3
Provided to YouTube by Base79 Zayatz Rolls (Original Mix) · Furious Amonit People ℗ Copyright Control Released on: 2007-05-15 Unknown: Pavel Kulyabin, ...
Guangzhou Highway MP3
video: sukojiro audio: furious - zayatz rolls Goin' back home.


text:
20th Anniversary Open House & Food Drive
Happy Tails Pet Sanctuary
Saturday, October 19, 2013 from 12:00 PM to 6:00 PM (PDT)
Who's Going
San Francisco, California
London, United Kingdom
Florence, Italy
Event Details
Join us in celebrating 20 years of saving lives!
*Food & Drinks* *Pet Adoptions* *Prizes*
*Pet Food Drive* *Vendor Fair*
Coincides with the Empty Our Shelters Project where all cat & kitten adoptions are just $20!!
Local Radio Station KHITS will be broadcasting live from our parking lot!
When & Where
Happy Tails Pet Sanctuary
6001 Folsom Blvd
Saturday, October 19, 2013 from 12:00 PM to 6:00 PM (PDT)
Add to my calendar
Happy Tails Pet Sanctuary
No Kill, Volunteer Run, Cage Free
Founded in 1993, Happy Tails Pet Sanctuary is a no-kill animal rescue group dedicated to protecting and improving the lives of homeless and abused animals throughout the Sacramento area. Needy cats and dogs are rescued, nurtured, and provided shelter and medical care (including spaying and neutering) before being placed in safe, loving, permanent homes. After adoption, Happy Tails animals may be returned at any time, no questions asked.
Adult cats (one year and older) are up for adoption at the Happy Tails "Patricia L. Holmes Adoption Center" located at 6001 Folsom Blvd. in East Sacramento. Additional cats plus kittens and dogs are cared for in our network of foster homes and are put up for adoption on the weekends at the PetSmart store near the corner of Watt Avenue and Arden Way.
As an almost all-volunteer organization, Happy Tails is grateful for the work of over 200 dedicated volunteers. Assistance programs help the pets of elderly, homeless and low-income individuals. Through our extensive feral cat program, Happy Tails maintains several altered, healthy feral cat colonies. This effort is one more step in helping to solve the Sacramento area's serious pet overpopulation problem. Funding includes monetary donations from our dedicated and generous benefactors, as well as grants, bequests, fundraising events and adoption fees. Federal and state tax authorities recognize Happy Tails as a tax-exempt, 501(c)(3) Nonprofit Public Benefit Corporation.
The Happy Tails Pet Sanctuary
Board of Directors


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The Things We Keep Ichi small necklace in brass and sterling silver
The Things We Keep Ichi small necklace in brass and sterling silver
Small brass ring necklace with sterling silver chain. Sits right below the collar bone. Materials: Brass, sterling silver Origin: Made in USA Care: Wipe clean with jewelry cloth
Vert & Vogue
Nadira and Ryan Hurley, the founders of Vert & Vogue, met in 2001 at a Parisian men's boutique that Nadira managed. After buying an entire new wardrobe from her, Ryan mustered the courage to ask Nadira on a date. A year later, they were married and, a year after that, living in New York. Vert & Vogue is the child born out of this love story, a combination of Ryan's passion for sustainable business and Nadira's fashion savvy. Look for thoughtfully curated clothing, footwear and home goods.
Do you have questions about this product? We're here to help!


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Medicare Home Health
January 14, 2011 by staff
Medicare Home Health, (AP) – Medicare beneficiaries could see significant new charge out-of-pocket for home health visits if Congress follows a recommendation made Thursday by its own advisory committee.
Until now, home health visits by nurses and other providers were free to patients. But the Medicare Payment Advisory Commission says a share is necessary to discourage overuse of a service whose cost to taxpayers is almost 20 billion per year because of fears that fraudsters also benefit.
The committee did not prescribe an amount, but his staff suggested this load and 150 for a series of related visits. Medicare requires co-payments for many services; home health has therefore been the exception rather than the rule.
Defying opposition by AARP, the seniors lobby, the committee appointed Congress voted 13-1 to recommend that the legislature impose the new fee. Two commissioners abstained and one was absent.
"In extreme cases, this advantage can turn into a support system for long-term social care," said Commission Chairman Glenn Hackbarth. "A modest co-payment is a tool to help solve this problem."
The advice comes as lawmakers face a difficult budget year. A slowing economy and tax cuts are draining revenues while the deficit amounted to ranges widely regarded as unsustainable. Republicans took control of the House on a promise to cut spending, but there is little hope that if Congress and the president can agree on ways to limit costs of health care.
Over 3 million elderly and disabled people using the services of Medicare home health – nursing visits, personal care workers and therapists available to those who can not easily out of the house.
Home Health was once considered a cost saver, because it is clearly cheaper than admitting patients to hospital. But it has been reported as a budget problem because of rapidly rising costs and big differences in how communities across the country using the service.
Part of the problem seems to be widespread fraud. In some counties of home health admissions exceeds the number of residents on Medicare.
Several commissioners expressed concern about the impact of a new burden on older people with modest incomes. Numerous studies have shown that even small allocations may discourage patients from receiving medical services.
The levy will be collected for each admission home health agency, not for each visit by a nurse or a supplier. Patients may be under the care of home health for several weeks at a time.
The recommendation exempts low-income patients, whose shares would be covered by Medicaid, as well as those just discharged from hospital. More than 30 million beneficiaries in traditional Medicare would be directly subject to tax. Implications for the elderly in private Medicare Advantage plans are uncertain.
The commission was created by Congress to provide impartial expert advice on complex issues of health insurance benefits and financing. It is also known as MedPAC.
Copyright © 2011 The Associated Press. All rights reserved.
Please feel free to send if you have any questions regarding this post , you can contact on
Disclaimer: The views expressed on this site are that of the authors and not necessarily that of U.S.S.POST.


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Ask These Interview Questions
Ask These Interview Questions
May 22, 2010
Mary Jeanne Vincent
Executive Career Coach,
Career Coach MJV
Job Interviews
An interview is a conversation between two or more individuals with all parties involved in the process. Asking and answering questions is fair game for everyone. Unfortunately, sometimes job seekers and hiring managers alike are so uncomfortable with the interview process that they ask the wrong questions or forego their opportunity to ask questions entirely.
As a job seeker, it is your responsibility to communicate to the hiring manager the information she needs to make a smart decision. That means asking questions that engage the interviewer and give you insight into the organization's needs and values.
Here are five questions you should commit to asking during every interview. Keep in mind that the specific language you use to ask the questions may vary.
Your goal is to elicit the information you need to make a smart decision, and at the same time engage the hiring manager in a meaningful business conversation that explores the possibilities and pluses of working together.
What would you like to see accomplished by the next person who fills this position?
This is a needs assessment question and is best asked early in the conversation since the response will dictate the specific information you provide throughout the conversation.
What is the organization's most pressing problem?
If you have done your homework, you have a clue about what this might be; however, you want to confirm what your research turned up before you launch into how you can add value/offer solutions to their business challenges.
This is also a needs assessment question. It helps you identify what they need that you can provide. For the rest of the conversation, make sure you tailor your answers to respond to the needs the interviewer identified.
What skills are necessary to succeed in this position? What skills are necessary for success in this company?
These two questions both get at the dual issues of skill and fit. The answers will help you determine if this is a good match for you. Does the position or company require the technical, political and people skills you possess or would you be walking into a minefield? Now is the time to sort that out.
How do my qualifications match your requirements?
This is a "testing the waters" question. You can believe the hiring manager has an opinion about how well you fit, and it is to your benefit to hear what it is. Her answer may be positive, neutral or negative.
If you are interested in the position, you must be prepared to respond appropriately to each of these scenarios. Your role is to confirm her good sense in thinking you are well-qualified or convince her to rethink the mistaken impression that you are not an ideal candidate.
What's the next step in the process? Or, when do you expect to make a decision?
If the interviewer doesn't offer this information, ask for it! Don't leave the interview without an understanding of what you can expect to happen and when. However, never assume that things will happen on the timetable the interviewer proposes; things change.
Do ask, "Would it be OK if I followed up by telephone just to answer any other questions you may have about my background or experience?" Then follow up before the drop-dead date she gives you. If you wait too long, her decision has been made and you didn't influence it.
By the way, I snuck in a couple of extra questions worth asking during your next interview.
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text:
What We Do
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Never again lose keys nore access control ...
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text:
"Greg has phenominal abilities in coaching and Indian cricket will have dominant years under him," Lillee, who was described by Chappell as one of the tough players whom he had handled while captaining the Australian side.
Lillee, who is in Chennai on his routine annual visit to the MRF Pace Foundation to select the Indian boys for training, said: "Greg had shown great leadership abilities as captain of the Australian team. No doubt that his cricketing experience will help India to be a dominant force in world cricket."
The legendary bowler, however, declined to respond when asked to give his comments on players like Sourav Ganguly and Sachin Tendulkar. "I cannot comment on them."
As for the coming Ashes series between England and Australia, Lillee said "England look a well-knit team now and the series is going to be a close affair."


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What is JotForm?
JotForm is a free online form builder which helps you create online forms without writing a single line of code. No sign-up required.
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Create a FormAsked by Velu on May 06, 2016 at 08:10 AM
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text:
- Description
American Eagle DT-C568-Set Modern 5pcs White Black Dining SetIncludes
1 Dining Table and 4 White Black Dining ChairsDimensions
Dining Table(DT-C568), 53" x 31" x 30"H
Dining Chair(CK-C21), 18" x 17" x 39"H
- Additional Information
Additional Information
SKU 15710431 MPN DT-C568-SET GTIN N/A Brand American Eagle Collection No Assemble Length No Assemble Width No Assemble Height No Assembly Required No Material Wood Finish No Sizes No Styles Modern Shapes No Shipping Time 2-3 Weeks Free Shipping No
- Reviews
Disclaimer: Pictures displayed may include optional products not included in the price. Computer monitors often display color variations. Color swatches are shown if alternative colors are available. Please call us or email us if you have any questions!


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Photographer Matthew Myatt took to the skies recently to take stock photos for the flying school Airborne Aviation. He was soaring over Greenham Common near Newbury and discovered a surprise when he pulled the images off his camera. According to Sky News, Myatt realized one of his photos featured a partially built Millennium Falcon and a X-wing fighter, presumably being made for Star Wars: Episode VII.
Best surprise ever? Possibly.
See the photo after the break along with a short video from the set.
How a photographer accidentally took snaps of the new Star Wars set http://t.co/DqHFgj60Il pic.twitter.com/xMdVdHkAcW
— Sky News (@SkyNews) September 10, 2014


text:
The aorta - the largest artery in the human body, directing the oxygenated blood from the left ventricle to the systemic circulation. All kinds of pathologies of the aorta, including aneurysm, dissection of the aorta, the outer gap and bleeding, requires immediate surgical intervention.
Aortic aneurysm is a bulging of the walls of the aorta pathological. The main causes of aortic aneurysms are atherosclerosis, high blood pressure, a hereditary abnormality of tissue (Marfan syndrome and Ehlers-Danlos syndrome) and congenital heart defects and vascular diseases.
Aortic aneurysm is difficult and dangerous disease characterized by an increased risk of sudden death. Symptoms of aortic aneurysms are associated with impaired circulation of blood and bodies with compression of the surrounding aorta. In some cases, the aneurysm develops completely asymptomatic.
Diagnosis of aortic aneurysms involves defining the structural changes of the aorta with the use of various imaging techniques. The main treatment for aortic aneurysms is surgical intervention. Therapeutic treatment is applied to reduce the rate of progression of atherosclerosis and to prevent complications. Operations on the aorta are the most difficult in all cardiac surgery.
Over the years, activity in the cardiac center of Sheba Hospital created a highly professional framework for the effective treatment of an aortic aneurysm, and today it is the largest and most advanced center in Israel for the treatment of this complex disease.
After surgery, the patient comes to the aorta for 1-2 days in the intensive care unit cardiac branch, and then complete his recovery at the Department of hospitalization for three days. At discharge from the hospital, the patient receives advice on further treatment with your doctor. These recommendations provide clear guidance on the necessary measures, such as continuous monitoring of blood pressure, regular checks of the status of the aorta, the organization of right living, drug treatment with beta-blockers and, of course, constant supervision from a family physician.


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(Sveriges Ekokommuner) The National Association of Swedish Eco-municipalities
The Swedish Association of Eco-municipalities is a network for municipalities, countries and regions. The vision is a sustainable Sweden, founded on a balanced ecosystem as the basis for a sustainable economic and social development.
100% Förnybart
"100% renewable energy" is a network of companies and organisations cooperating with the common goal of making Sweden´s energy system sustainable and entirely based on renewable energy.
See the video with Lena Lindahl, a member of Sustainable Sweden talking about energy and the connection between our associations. (In Swedish)


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Coloured Chikan top with Full front Embroidery in silk thread chikan embroidery
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text:
The Hopedfore Double Diamond is a priceless gem on display at the Natural History Museum.
Scooby-Doo! (DC Comics)
It was the target of a jewel thief.
- Scooby-Doo! (DC Comics)
- #17(a). Monster Museum
- The name is a play on the famous Hope Diamond. The real one was featured in another case, The Frozen Fate of the Hope Diamond.


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A BREAST cancer sufferer is backing Fleet's first News and Mail sponsored Cancer Research UK Race for Life.
Isabelle Marshall (pictured left) has a special reason for taking part in the event at Tweseldown racecourse in Church Crookham on May 18.
She was diagnosed with breast cancer two years ago, when she was just 24, and underwent a left mastectomy and six months of chemotherapy followed by radiotherapy.
"I've been 'all clear' for about a year now but when I was unwell, I felt like I was the only young person with breast cancer as it does tend to be an older women's disease," said Isabelle, who lives on the Zebon Copse estate in Church Crookham.
"I did the Guildford Race for Life last year with my mum and when I went on the internet to join up for this year's race I saw the Fleet one so decided to enter that one instead.
"Last year's event was just amazing with lots of people taking part in memory and celebration of loved ones. I'm really looking forward to it."
Women of all ages will be taking part in the Church Crookham event, one of 130 throughout the country that will raise millions of pounds for Cancer Research UK.
Now in its tenth year, Race for Life is a unique series of events across the country where women walk or run 5km (3.1 miles) together in a bid to help cure cancer.
The events start with a mass aerobic warm-up and everyone taking part gets a medal and goody bag.
The facts about cancer can be daunting, with one in four people in the UK dying of the disease.
But there is some good news too, as the death rate from cancer has fallen by 15% in the last ten years thanks in part to earlier detection and better treatments.
Cancer Research UK helps thousands of people survive and overcome cancer but it needs millions of pounds to do it.
Race for Life is a vital source of funds and has raised an incredible £35 million since it started in 1994.
This year's target is £17.5 million — nearly 10% of Cancer Research UK's annual spend.
But women are being urged to act fast as races fill up quickly and entries are not taken on the day. The closing date for entries in the Tweseldown event is May 11.
But even if you cannot take part in the race you could still volunteer to help on the day, with both men and women welcome.
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University of California, Irvine, Beckman Laser Institute and Medical Clinic, 1002 Health Sciences Road East, Irvine, California 92612, United States
University of California, Irvine, Department of Dermatology, 118 Medical Surge 1, Irvine, California 92697, United States
Skin is a highly structured tissue, raising concerns as to whether skin pigmentation due to epidermal melanin may confound accurate measurements of underlying hemodynamics. Using both venous and arterial cuff occlusions as a means of inducing differential hemodynamic perturbations, we present analyses of spectra limited to the visible or near-infrared regime, in addition to a layered model approach. The influence of melanin, spanning Fitzpatrick skin types I to V, on underlying estimations of hemodynamics in skin as interpreted by these spectral regions are assessed. The layered model provides minimal cross-talk between melanin and hemodynamics and enables removal of problematic correlations between measured tissue oxygenation estimates and skin phototype.
Techniques based on diffuse optical spectroscopic (DOS) principles can be applied to tissue to extract in vivo optical properties from tissue (i.e., absorption and reduced scattering coefficients).1–3 These techniques may be deployed in a variety of measurement geometries ranging from probe-based point spectroscopy to wide-field imaging approaches and utilize a number of illumination/detection schema to exploit temporal and/or spatial responses from light interactions with tissue.4–10
Once these approaches characterize and isolate the effects of scattering, the remaining absorption properties are often interpreted as due to a linear superposition of chromophores in tissue, such as hemoglobin species (in either oxygenated or deoxygenated states), melanin, lipids, and water. The decomposition of tissue absorption spectra typically employs fitting methods (least-squares for example) resulting in estimates of chromophore concentrations or volume fractions relative to the total volume of tissue interrogated by the detected photons.
Spatial frequency domain techniques are, in general, based on DOS principles; these are noncontact techniques that entail the projection of structured illumination onto turbid media, such as skin. Camera-based imaging is used to detect the spatial frequency-dependent reflectance from the medium, at wavelengths of interest. Absorption and scattering can then be decoupled from reflectance measurements as each optical property will exhibit a differential response as a function of spatial frequency of illumination. This wide-field imaging approach has been applied for monitoring of port wine stain treatments and tissue transfer flap reperfusion and for assessments of burn wounds and nonmelanoma skin cancers.11–21
Spatial frequency domain spectroscopy (SFDS) (which we have formerly referred to as spatially modulated quantitative spectroscopy) is a spatial frequency domain method for which the detection scheme employs a fiber coupled spectrometer rather than a two-dimensional camera, thereby trading spatial resolution in favor of high spectral resolution (∼1 nm) and spectral range (∼400 to 1100 nm). As with many other diffuse optical measurement methods, SFDS has been validated through homogeneous optical phantoms of known optical properties, demonstrating that this technique is capable of quantifying the absorption and scattering properties of turbid media in both visible and near-infrared (NIR) wavelength regimes.22
Unlike the homogeneous phantoms used to validate these optical techniques, skin is a highly structured organ, consisting of several layers whose composition and function are differentiated. In the context of typical diffuse spectroscopic measurements, the detected spectral contributions from these stratified layers become a function of the thickness of each layer relative to the total volume of tissue interrogated by the optical technique. In the context of this work, we will refer to this as a partial volume effect.
Melanin is problematic in this case, as it has a relatively featureless absorption spectrum, typically described as a power-law spectral dependence,23 yet can vary greatly in terms of its concentration and the partial volume it may occupy relative to the total volume interrogated by reflectance-based measurement techniques. These factors can present opportunities for cross-talk in spectral decomposition methods between determinations of melanin concentration and that of hemoglobin species. For example, errors in dermal oxygen saturation have been reported in regions of tissue underlying normal pigmented nevi as a consequence of incorrect accounting for epidermal melanin.24 Similarly, in normal skin, the average local tissue oxygen saturation has been shown to trend inversely with the amount of melanin in the skin as assessed across different skin colors (corresponding to pigmentation differences spanning Fitzpatrick types I to V), providing a clear indication that melanin can directly influence the interpretation of spectral signatures from blood.25,26
SFDS can also estimate the site-specific melanin layer thickness and the layer-specific concentration of melanin in skin based on its spectral response.27 This approach does not assume any layer thickness, but rather leverages the differential penetration depth of visible and NIR wavelengths.28 Fitting for chromophores in these two regions will produce concentrations of melanin and hemoglobin species, relative to the entire volume interrogated. By determining the absorption and reduced scattering coefficient at each wavelength, however, it is possible to also estimate the site-specific penetration depth, δ, from those spectral regions.29 In the case of skin, visible light typically interrogates ∼100 μm whereas NIR wavelengths can penetrate millimeters through this spatial frequency approach. Assuming that melanin and hemoglobin are respectively confined within upper and lower layer structures, the differential determinations of melanin concentration by visible and NIR regimes can be used to describe the layer thickness in which melanin must reside in order to satisfy its respective concentration "detected per volume interrogated" in each regime. Whereas our previous study demonstrated that SFDS could characterize melanin with respect to multiphoton microscopy methods,27 the question remains as to whether this method could then also produce optical properties that are truly faithful to the underlying physiology (e.g., hemodynamics in skin), once melanin is characterized.
In this study, we used both venous and arterial arm cuff occlusion paradigms to induce hemodynamic perturbations in the forearm. These occlusion paradigms have been used previously to illustrate and/or validate the sensitivity of optical methods in the context of monitoring hemodynamic changes in skin.30 Whereas the occlusion paradigm will modulate tissue hemodynamics, our specific interest in this investigation is to assess the influence and potential sources of error that variations in skin pigmentation may impart in the determination of underlying hemoglobin. The accuracy and limitations of this approach are discussed within the context of quantitative, in vivo studies of skin hemodynamics.
We will interpret data collected by SFDS under these induced hemodynamic perturbations in three distinct ways: (1) homogenous fits (least-squares) in the visible regime (450 to 600 nm), (2) homogenous fits in the NIR regime (650 to 1000 nm), and (3) our own layered model approach (450 to 1000 nm).28 From this single measurement platform, we are able to investigate the spectroscopic-based correlation between melanin and tissue hemodynamics independent from influences of differing measurement geometries or instrumentation sensitivity and performance.
All subjects were treated in strict compliance with the declaration of Helsinki and the US Code of Federal Regulations for the protection of human subjects. The experiments were conducted with the full consent of each subject using a protocol approved by the internal review board (IRB) for human experiments in University of California, Irvine. Nine healthy subjects were enrolled under an IRB approved protocol (HS#2008-6307) (average age=35.6±8.3 years, 3 female/6 male). Each subject was clinically assessed for skin type based on the Fitzpatrick scale31 and ranged from skin type I to V. This skin-typing assessment method includes visual assessment of skin color, yet also considers hair color, eye color, and ethnic heritage (i.e., genetic disposition). Drs. Kelly and Sharif also clinically interviewed the subjects on (a) their tendency to burn and (b) the amount of sun exposure they receive (i.e., reaction to sun exposure and tanning habits) prior to assignment of a Fitzpatrick scale value. It is worth noting that this scale is not a direct descriptor of pigmentation, but rather a scale used to describe skin's response to sun exposure. Additionally, this assessment is qualitative and subjective. However, one predominant factor involved in this skin type assessment is the appearance of the amount of pigmentation, and for that reason alone, all subjects were classified by this scale. The spectroscopic measurements of melanin are not intended to be directly correlated to this scale, but to provide a general illustration of the range of pigmentation investigated in this study.
A blood pressure cuff occlusion protocol was used in this study as a means to externally perturb the hemodynamics of the forearm. In this study, we used an automated blood pressure cuff (E20, D. E. Hokanson, Inc.), which would inflate to 90 mmHg for venous occlusion and 200 mmHg for arterial occlusion. While venous pressure can be lower than 90 mmHg, we chose to work at this pressure in order to apply a consistent experimental protocol for all subjects and assure venous occlusions in all healthy subjects enrolled in this study. The imaging head of our instrument was placed over the volar forearm to monitor the distal effects of the cuff occlusion to the spectroscopic optical properties of the tissue. For each type of occlusion, the total acquisition sequence lasted 9 min, where each phase of the occlusion (i.e., baseline, occlusion, and release) lasted 3 min.
The specific instrument used in this study (Fig. 1), an illumination source, a 100-W quartz-tungsten-halogen (QTH) light source (Moritex, MHF-D100LR) that was coupled to a digital micromirror device (DMD) (Texas Instruments, Inc. DLP) with a pattern projection area of 22×17 mm. From this projection configuration, tissue was illuminated with a sequence of sinusoidal intensity patterns that can span across a range of spatial frequencies up to 0.5 mm−1. Remitted light from a 1-mm-diameter spot from tissue, centrally located in the illumination pattern projection area was collected by a fiber (NA 0.39, 1 mm core, Thorlabs, Inc.). Collected light was delivered to an Oriel spectrometer (Oriel 77480). The spectral response from tissue was recorded as a function of the spatial frequency at three evenly spaced phases (0 deg, 120 deg, and 240 deg) as we have previously described.22
System diagram and experimental setup: broadband illumination is delivered to the imaging head from a 100-W QTH lamp via a liquid light guide. The digital DMD then encodes the light into sinusoidal intensity patterns which are projected onto the surface of the volar forearm. Diffusely reflected light is delivered to the spectrometer via an optical fiber. An automated blood pressure cuff provides modulation of distal hemodynamics through either venous or arterial occlusions.
Four evenly spaced spatial frequencies were employed, ranging from 0 to 0.3 mm−1. A total of 12 spectral measurements were taken for a given data acquisition time point (four spatial frequencies, acquired at three evenly spaced phases per frequency). An autoexposure routine was performed prior to every occlusion time course series to ensure that the data collected uses the full dynamic range of the 16-bit detector. Additionally, three replicate accumulations were acquired and averaged at each projected pattern to help minimize noise. In its current configuration, this resulted in total acquisition times ranging from 10 to 30 s, depending on the amount of pigmentation present.
A three-phase demodulation scheme was employed at each spatial frequency to isolate the spatial frequency-dependent response from tissue from that of ambient light (e.g., ambient light, stray light from the instrument). Described in greater detail previously,8 the demodulated raw reflectance signals at each spatial frequency were calibrated against a diffuse tissue simulating phantom of known optical properties to produce diffuse reflectance spectra as a function of spatial frequency. The calibration phantom is based in a polydimethylsiloxane medium with India ink as the absorbing agent and titanium oxide at the scattering agent, where absorption (μa) and reduced scattering (μs′) coefficients are 0.02 and 1 mm−1 at 650 nm, respectively.32 The response to spatial frequency was independently modeled at every wavelength to uniquely describe the absorption and reduced scattering coefficient at each wavelength. As this quantitative spectroscopic method spans both the visible and NIR domains, Monte Carlo methods were employed to comprehensively describe and solve for light transport in both diffusive (NIR) and nondiffusive regimes (visible). This approach has been independently validated for the determination of optical properties in homogeneous media.22
From this measurement platform, we have developed a layered model method to interpret these quantitative optical properties as a depth-segmented, two-layer system.28 We have tested this model-based, depth-segmented approach in layered tissue simulating phantoms,33in vivo benign pigmented lesions, correlating the mean depths of pigmentation in vivo to high-frequency ultrasound,34 as well as correlating melanin concentration and depth distribution in normal skin with multiphoton microscopy.27 These previous studies have shown that this layered model approach can determine not only absolute depth-segmented concentrations of chromophores to within ∼±15% but also the layer thickness that differentiates where these chromophores reside to within ∼±15 μm. For this study, we used the spectral regions of 450 to 600 nm and 650 to 950 nm to represent the visible and NIR spectral regions in the aforementioned method. The outputs of this method are the top layer (optical) thickness (as determined by the absorption signature of melanin, relative to the mean photon pathlength traveled through the tissue) and the chromophore concentrations specific to the respective layers. The results of determining melanin concentration and top layer thickness are discussed in a previous study.27 In the context of this investigation, however, we are interested in evaluating whether accounting for "layer-specific melanin concentration" and "melanin layer (mean distribution) thickness" would significantly impact the spectroscopic interpretation of underlying hemodynamics.
As the current SFDS instrument measured spatial frequency-dependent reflectance from 450 to 1000 nm, we evaluated the performance of multiple, standard spectral decomposition methods in the context of the same measurement geometry (avoiding inconsistencies derived from varied instrument configurations/calibrations and or other potential sources of variances). Once the SFDS data were processed and bulk absorption (μa) and reduced scattering (μs′) coefficients are derived, we evaluated the performance of isolating and quantifying of hemodynamic trends from that of melanin when using (1) NIR spectra (650 to 1000 nm), (2) visible spectra (450 to 600 nm), or (3) our custom layer model method, using spectral information spanning both regimes (450 to 1000 nm).
For this investigation, we have chosen to present our results in two ways: (1) to demonstrate the isolation of detected melanin concentration from externally induced hemodynamic changes and (2) to illustrate the impact of this isolation of melanin in terms of physiologically relevant parameters related to the quantification of underlying hemoglobin. Whereas there are many ways to formulate metrics that would potentially address the performance and efficacy of this model-based approach in the context of tissue physiology, we have selected two specific metrics that would provide, in our estimation, the most unbiased, yet easily interpretable measures to evaluate the initial objectives of this investigation.
Isolation of detected melanin concentration from hemodynamics: Though the magnitude and temporal response of induced hemodynamics in these occlusion studies will vary from subject to subject, it is clearly understood that melanin concentration is physiologically invariant from these induced hemodynamic changes. Therefore, any changes detected in the determined concentration of melanin during these experiments are an indication of "cross-talk" between depth-specific chromophores present in skin (i.e., melanin versus hemoglobin concentration). We define Δmelanin as a metric to characterize the average change in melanin concentration estimation during the respective occlusions, relative to its baseline value Display Formula
Tissue oxygenation: Whereas the Δmelanin metric provides a measure of the relative cross-talk during the measurement, it does not describe any pre-existing cross-talk between chromophores at every measurement time point, independently. StO2 is an optically derived measure of oxygen present in tissue based on the relative amounts of oxygenated and deoxygenated hemoglobin detected in the tissue microvasculature based on their distinct spectral features in both visible and NIR red regimes.35 The use of this metric in the context of this investigation is not to validate one approach over another, but to examine the dependence of StO2 as function of skin type and any general bias as a function of partial volume/depth of interrogation from specific wavelength regions Display Formula
Figures 2(a) and 2(c) present the quantitative absorption spectra collected from a single subject (Fitzpatrick skin type III) during both venous and arterial occlusion time courses. Blue spectra represent the baseline absorption prior to inflation of the cuff, red spectra represent the absorption during the occlusion, and green spectra represent the post-cuff-release absorption. In the case of venous occlusion, a gradual increase in absorption is observed during the occlusion phase. This trend is correlated with the expected blood pooling in the extremity (venous blood flow is stopped, yet arteries continue to pump blood into the arm). This increase is most obvious in the 530 to 580 nm region of the spectra, where there are distinct absorption features specific to hemoglobin.35 Upon cuff release, these absorption spectra return to baseline values, consistent with expected physiological behavior.36
Data from one subject (skin type II/III, plotted at type 2.5). (a) Measured absorption spectra from venous occlusion (90 mmHg), (b) relative, model-based change in melanin concentration determination as a function of time, during venous occlusion experiment, (c) measured absorption spectral from arterial occlusion (200 mmHg), (d) relative, model-based change in melanin concentration determination as a function of time, during arterial occlusion.
In the case of arterial occlusion, total hemoglobin concentration remains constant, as both venous and arterial blood flow is stopped. This is evidenced in the measured spectra, as there is no significant increase in overall absorption during the occlusion phase. Rather, there is an expected, gradual depletion of oxygen from blood. This is most obviously observed in the 530 to 580 nm region where the double absorption band of oxygenated hemoglobin transitions to the single band, characteristic of deoxygenated hemoglobin. Upon release, arterial occlusions are typically characterized by a hyperemic response: a large bolus of oxyhemoglobin to accommodate the high demand for oxygen in tissue that was depleted during the occlusion period.37 This is evidenced in the measured spectra by the dramatic, dual absorption feature in the 530 to 580 nm region, associated with oxyhemoglobin.
Figures 2(b) and 2(d) present the relative change in determined melanin concentration by the three methods described in the previous section [i.e., using only NIR data (650 to 1000 nm), visible wavelength data (450 to 600 nm), and our layered model approach (450 to 1000 nm)]. In the venous occlusion case [Fig. 2(b)], both NIR and visible regime data produced increases in melanin concentration that mimicked trends produced by increases in total hemoglobin. However, when the layered model is applied, the melanin concentration estimation is held to within 2% of baseline. In the arterial occlusion case, there was a negative deviation in melanin concentration estimation using NIR spectra during the occlusion period. There were also negative deviations in melanin for both NIR and visible spectra upon cuff release that followed similar trends to the hyperemic response in blood. The layered model showed only minimal fluctuation in its estimate of melanin throughout all time periods of this occlusion experiment.
As Fig. 3 shows, there are highly disparate values reported for melanin concentration when differing spectral regions/models are employed. This is largely due to the fact that light will interrogate tissues not just containing melanin but also tissues that underlie it. As a result, absorption signatures from melanin will only occupy a fraction of the total spectral signature detected from tissue (i.e., partial volume). Diffusely reflected light in the visible may penetrate hundreds of microns, whereas NIR may reach several millimeters, when planar illumination methods are employed.28 The melanin concentration values determined by the layered model method, however, are consistent with volar arm mesurements reported across skin types in our previous validation study.27
Total melanin concentration (from baseline) determined by each respective spectral decomposition method. Note that as the magnitudes of the reported values scale differently between homogeneous and layered methods, visible and NIR data are scaled to the left y-axis, whereas the layer model data are scaled to the right y-axis.
From Fig. 3, it is also evident that the range of reported melanin values are also different, i.e., the differentiation in melanin values are not merely a scale factor. Increases in melanin concentration will additionally reduce the effective penetration depth, thereby increasing the relative contribution from superficial tissues (e.g., melanin) toward the total spectral signal measured.
Although the primary aims of this particular investigation were to compare the performance of three methods for interpreting spectral data, the layer model is unique in that it can also determine melanin layer thickness. This study measured the spectral response from the volar forearm and the layered model determined that the melanin layer thickness was 96±3 μm, averaged across all subjects. This was in agreement with previous studies27 as expectations for epidermal thickness would reside between values from volar upper arm and dorsal forarm (locations measured in previous study and correlated to multiphoton microscopy). Additionally, these thickness values did not exhibit any correlation with phototype. As discussed in that publication, it is important to note that these thickness values are reported in terms of optical pathlength and not physical thickness.
Figures 4(a) and 4(b) show the relative percent changes from baseline melanin concentration for NIR only, Vis only, and our layered model approach across all skin types imaged in this study. The magnitude of errors are larger in the venous occlusion case, given the greater change (increase) in the overall tissue absorption due to the blood pooling that occurs during the occlusion phase of the measurements. Averaging across all skin types, there was 8.1±6.5% cross-talk error derived from using NIR spectra only, 4.4±1.4% from visible spectra, whereas the layered model produced mean errors of 1.4±0.8%. As total hemoglobin concentration is kept approximately constant during the arterial occlusion phase, total absorption values did not change significantly. There was a transition from spectral features of oxygenated to deoxygenated hemoglobin. In these arterial occlusions, the overall magnitudes of cross-talk errors were lower; however, the mean errors from the NIR regime decomposition remained relatively higher than the other methods, while the layer model approach provided the minimal error. Here, the mean cross-talk errors were 4.0±2.4%, 2.0±1.5%, and 0.6±0.3% for the NIR regime, visible regime, and layered model, respectively.
ΔMelanin metric shown for each individual subject as a function of their assessed Fitzpatrick skin type. (*) depict values determined through homogeneous model fits in the NIR, (o) visible, and (Δ) depict those resulting from the layered model method.
Figure 5 shows the baseline tissue oxygen saturation percentages (StO2) as determined using NIR only, Vis only, and our layered model approach across all skin types imaged in this study. When only the NIR wavelength range is used to determine StO2, not only is there a large variance between specific subjects observed but also there is an apparent correlation between tissue oxygenation and skin type. Here, NIR determined StO2 declines as skin pigmentation increases. When only a visible spectral range is considered, StO2 does not appear to vary significantly as a function of skin type (pigmentation); however, these values are tightly bound between 50% and 60%, which is lower than expected from the literature.38–40 The layered model results also appear independent from skin type; however, these values are bounded within the range of 80% to 90%, which is slightly higher than previously published, optically derived values reported in the literature. The interpretation of these results will be discussed in the following section.
Baseline tissue oxygenation (StO2) from both venous (o) and arterial (*) occlusion measurements. Error bars represent the standard deviation of StO2 from every time point acquired during baseline. Each measurement for venous occlusions for each subject was not acquired from the same precise tissue location as for the arterial occlusion for the same subject.
The goal of this investigation is to evaluate sources of error and cross-talk based on the interpretation of "quantitative" spectral data collected from a single instrument/measurement geometry. Venous and arterial cuff occlusions were used in these experiments as they will induce a perturbation in the hemodynamics that can be temporally controlled and the generalized hemodynamic effects of these two types of occlusions are well understood, i.e., venous occlusions will induce blood pooling (increase total hemoglobin concentration) and arterial occlusions will result in a deoxygenation of hemoglobin followed by a hyperemic response upon cuff release. Whereas the magnitude of these changes is not controlled and is often subject specific, the central hypothesis of the particular study is based on the assertion that both the melanin concentration and spatial distribution remain invariant to these hemodynamic changes, irrespective of the individual magnitudes of these hemodynamic changes.
Based on this, we have developed an initial metric to evaluate whether a choice of spectral regime or layer model would be most effective in minimizing variance in the determination of melanin when deliberate hemodynamic events are produced. The ΔMelanin metric is a descriptor of how homogeneous fitting routines will induce errors (cross-talk) between depth-distributed chromophores in tissue.
In order to account for subject-specific variance, we can look at the relative improvement (i.e., reduction in ΔMelanin) on an individual subject basis. As each analysis method uses data collected at the same time points from the same measurement geometry (instrument configuration), differences between these analyses methods for any individual subject or measurement sequence will only be derived from the method alone. In this case, the layered method consistently produced lower ΔMelanin values on a subject by subject basis than those calculated when using only the NIR portion of the spectrum. This includes the ΔMelanin results under both venous and arterial occlusion conditions (n=18). The layered method also outperformed the visible regime ΔMelanin results during venous and arterial occlusions with only one exception. This one case occurred with the darkest skin pigmentation subject under the venous occlusion condition. This case represented the most extreme amount of absorption measured in the study due to the combination of highest degree of skin pigmentation along which the greatest increases of hemoglobin concentration. Even in this case, the layered model value for ΔMelanin remained within 1% of that calculated using just the visible spectrum alone.
ΔMelanin illustrates the magnitude of cross-talk error between melanin and hemoglobin; however, it remains unclear from this metric alone as to whether these errors, which were all <10%, would provide any significant impact on the calculation of actual physiologic parameters. To that end, we also examined the estimation of tissue oxygenation, StO2, at baseline as a means to assess whether these errors in chromophore calculation would present source of concern when attempting to characterize tissue physiology through spectroscopic methods.
NIR regime-derived estimations of StO2 values exhibit a negative correlation with skin type (pigmentation). As shown in Fig. 4, baseline StO2 values will decrease when the amount of pigmentation (melanin) increases. This trend is contrary to expected physiology, as there is no correlation between oxygenation and degree of pigmentation. This is an indication that the NIR regime is particularly sensitive to depth dependence, spectral cross-talk artifacts between the decomposition. Given that the spectral features of hemoglobin species as well as melanin in this spectral region are both relatively weak and featureless, it is not surprising that decomposition methods may find it difficult to completely isolate these chromophores from each other. The total volume of interrogation will also change as a function of wavelength in this spectral regime. Given the depth-distributed nature of these chromophores, the resulting measured absorption spectrum is not simply a linear superposition of basis spectra; rather, it also encodes its relative, wavelength-dependent partial volume contribution toward the total signal detected. This demonstrates that, in this case, superficial pigmentation can affect measurement of tissue oxygenation, as determined by diffuse reflectance-based optical methods.
Using visible wavelengths alone, there was significantly less variation in the determined melanin concentration than was observed in the NIR regime. Given that hemoglobin absorption spectra exhibit more distinct features in the visible than in the NIR, the ability to separate these features from the relatively featureless melanin spectrum is far more robust. The amount of cross-talk present in the least-squares decomposition is significantly reduced. Similarly, the variation in interrogation depth in the visible regime is also lower than is observed in the NIR, indicating that there is little volume-based distortion of the detected spectral features in this regime. Visible light, however, is significantly limited in the depth into which it can interrogate tissue. So while it might be more robust in isolating the optical effects of hemodynamics from that of melanin, it will typically only interrogate the most superficial volumes of the dermis.
Unlike homogeneous model-based spectral decomposition methods used in this study, the layered model approach presents an opportunity to directly address the concerns identified in both visible and NIR spectroscopy. This layer model addresses difficulties associated with superficial pigmentation by segmenting tissue in depth based on the distinct spectral properties specific to layered structures in skin. Not only does this tissue segmentation account for the partial volume effects from melanin, but also this method also accounts for the spectral distortion, realizing that the contribution of melanin absorption at every wavelength will change as a function of the total volume of tissue interrogated and not just as a function of its absorption coefficient at that wavelength. As a result of these features, the layered method is able to provide a distribution of StO2 values that have no apparent correlation with skin pigmentation.
It is worth noting, however, that these StO2 values are higher than those derived from visible spectra alone. As noted in the discussion of the visible regime StO2 results, the depth of penetration of detected light in the visible spectral region is significantly limited (100 μm) due to the relatively high absorption and scattering values in this window. In contrast, the layered model approach utilizes spectral information from both visible and NIR regimes. Hence, when this method determines hemoglobin concentrations, it is derived over tissue volumes several millimeters deep. The respective volume differences probed by these two methods may provide some justification as to why StO2 values appear so disparate (50% to 60% versus 80% to 90%). It has been suggested that oxygenation within dermal tissue may not be a singular value, but rather a gradient as a function of depth.41,42 Superficial dermal tissue may exhibit a significantly lower StO2 relative to values found within deeper dermal tissue.
Other groups have developed three-layered models of skin as a direct result.43–45 Spectral reflectance from skin is interpreted as contributions from the epidermal layer (melanin), as well as upper and lower dermal layers, each of which contain differing concentration of hemoglobin species. The resulting calculations of StO2 values from this study support the results presented by these other groups.
The layered model employed in our study presents a significant opportunity to provide noninvasive, quantitative optical measurements of tissue hemodynamics, independent of an individual's skin pigmentation. The distinct advantage of this particular measurement paradigm and layered model interpretation is that it provides a quantitative measure of melanin concentration and thickness,27 which is necessary to decouple the optical effects of melanin from that of underlying tissue chromophores. From the SFDS spectroscopic platform, we have the additional opportunity to not just interpret deep dermal tissue oxygenation and hemodynamics but also use the layer model segmentation in order to correct the visible regime data for the partial volume imparted by superficial melanin (thereby reducing the slight pigmentation dependence of visible regime calculation of hemodynamics and oxygenation).
However, for these concepts to advance and become rigorously validated, we must also acknowledge the assumptions and limitations of this current layered model. In its present form, this model assumes that the scattering of tissue is homogeneous in depth. In the model employed here, it is only distinct chromophore absorption features that differentiate layered structures. This model, as used here, also assumes that melanin can be described by a single, invariant absorption spectrum.27
Developing optical methods that directly address both the spectral and structural aspects of tissue are critical toward advancing imaging tools for all skin types. There are distinct advantages and significant improvement in isolating melanin from underlying hemodynamics when using a layered model approach over classic homogeneous model interpretation of skin spectra. In this study, we demonstrate that utilizing a simple, semiempirical layered model approach minimizes cross-talk between melanin and hemoglobin concentration, outperforming methods that utilize visible or NIR spectra alone.
We thankfully recognize support from the Beckman Foundation and the NIH, including P41EB015890 (A Biomedical Technology Resource) from NIBIB and R42GM077713 from NIGMS. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIBIB or NIH.
Rolf B. Saager is currently a project scientist specializing in biomedical imaging and spectroscopy at the Beckman Laser Institute, University of California (UC), Irvine. He received his PhD in optics at the University of Rochester.
Ata Sharif is currently an assistant project scientist at the Beckman Laser Institute, UC, Irvine. He received his MD from Iran, and his MBA from UC, Irvine.
Kristen M. Kelly is a professor of dermatology and surgery at the UC, Irvine. She graduated from the UC, Los Angeles Medical School and completed her Dermatology Residency at UC Irvine and a fellowship in photomedicine at the Beckman Laser Institute.
Anthony J. Durkin is currently an associate professor in the Departments of Biomedical Engineering and Surgery at the University of California, Irvine, with a primary appointment in the Beckman Laser Institute. He received his PhD in biomedical engineering from the University of Texas at Austin.
Rolf B. Saager ; Ata Sharif ; Kristen M. Kelly and Anthony J. Durkin"In vivo isolation of the effects of melanin from underlying hemodynamics across skin types using spatial frequency domain spectroscopy", J. Biomed. Opt. 21(5), 057001 (May 03, 2016). ; http://dx.doi.org/10.1117/1.JBO.21.5.057001
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