Pain is one of the most important symptoms of Rheumatoid Arthritis and many other conditions. Pain is the most obviously significant signal that something is wrong. However, pain is also the most difficult symptom to measure.
Since pain is such an important indicator that something is "wrong," we ought to find better ways to measure pain and more meaningful ways to relate pain to disease activity. Obviously, pain is mostly invisible. I say mostly because pain can be seen on the face with a furrowed brow or winced eyes, especially in people who strive to be quiet about their pain.
Helping people to quantify their pain in a way that is as objective as possible so that it's meaningful to care-givers (personal and professional).
Having a trusted scale that allows care-givers to take patients at their word.
Looking over the inadequate pain scale examples from the NIH Pain Consortium is discouraging; something better is obviously needed.
For healthcare professionals, the ultimate challenge is to determine the meaningfulness of pain. The pain scale is only a means to this understanding. A good doctor or nurse needs to know how a patient's pain is associated with disease activity. The pain scale can only help the provider to discern disease activity as he appreciates what a patient's pain is like and deduces what the origin of it may be.
"Pain follows the same pattern of development as other parameters of disease activity in groups of patients with RA," Assessment of Pain in Rheumatic Diseases.
The provider has another difficulty that has nothing to do with a particular patient or pain scale used: His own experience or lack of experience with pain is the only means that he has to relate to pain. His ability to comprehend various levels of pain is helped or hindered by his experiences.
I've seen pain scales on the wall at doctors' offices, but I've never been asked to use a pain scale. Does that mean the doctors I've seen haven't experienced much pain?
Another difficulty with measuring pain is that people who live with severe pain such as Rheumatoid Arthritis tend to adapt to it. They increase their tolerance to pain out of necessity. This is the reason that people living with RA often complain that pain scales "don't work because they don't go high enough." RA pain is often starts out as the most severe pain a person has ever experienced, so they might rate it with a high number. But, then, if pain worsens or occurs in numerous joints at a time, they wish for a bigger number. Consequently, they adapt their personal pain threshold and now rate the pain which was previously a "9" as a "7" in order to be sure to fit all of their pain onto the scale. RA patients tend to continually increase their pain tolerance in this way.
Can we make pain scales make sense?
What would be your model pain scale? Please post about it in the comments or on your own blog. Let's make this our next great blog carnival! Just send me an email at Kelly @ rawarrior.com with the link to your blog post about pain scales and I'll post them all here in two weeks (December 28th). Let's see what our imaginations can create! Please put "CARNIVAL" in the subject of your email.
Read the awesome entries of this pain scale blog carnival – click here.
Stanford Pain Visual Numeric scale from 1-10.
The Comparative Pain Scale has detailed categories, but this is not specific to rheumatology.
MIT's Technology Review published An Objective Way to Measure Pain complete with brain images.
The Hypochondria of RA Pain: Do I Smell an Elephant?
Click here for more blog carnival posts.
I LOVE this article, Kelly! As a physician asssistant who is no longer working because of health issues, including RA, measuring pain was always a difficult task in the various patient care settings where I worked.
The most "accurate" type of pain scale that I found useful was one that was the most similar to the second scale above, "The Comparative Pain Scale." I feel that it is essential for a patient to reflect on his or her pain as it relates to the ability to function in home and work settings, if applicable. The ability to function is KEY and often helps a patient quantify pain more objectively. Time and time again I would have a patient who was obviously very comfortable sitting in the exam room stating that he or she was currently having pain at an 8 or 9 level, yet was able to read or text without difficulty. In order that I could treat these patients without judgment, I had to remind myself that often the pain scale has been explained to patients using the example that "0 is no pain and 10 is the worst pain you've ever felt." It could be that these patients had never experienced what many of us can remember as "Level 10" pain so when they feel their pain is at an 8 or 9, it very may well be to them.
My last PA position was at a large psychiatric hospital where I was part of the general medicine team. We provided general medical care for the inpatients which spanned six inpatient units, including children/adolescents, four adult units, and an older adult unit. It was also our responsibility to address and manage pain which was often a challenge. Before I had to resign my position, I was working on addressing just this issue: the issue of "what is the best way to objectively measure pain" and the pain chart I was working on creating was most like the second one above. I really felt that including a measurement of ability to function in daily life would help patients assess their pain most objectively.
Of course, there is the issue of how to answer these questions when at an office visit. I'm sure we all have felt the dilemma of "well, what if I don't feel as good or bad right now as I have over the last few weeks or months?" How should that question most accurately be answered? There is no great way to answer that as a patient, but my pain management physician's staff always asks what the lowest and highest pain numbers I have had since my last visit. I guess that helps a little bit.
Kudos to you, Kelly, for opening, or reopening, this subject of pain as it relates to RA. Way to go! I obviously don't have any great insights to add, but wanted to share my thoughts.
Thank you for sharing the perspective of the professional, Erika. These are very helpful and specific comments. I'd love to see your pain chart ideas.
Hey Kelly! I never even knew until today that you replied. Sorry! I will try to take a picture of the pain chart I was starting to use before I resigned my position and email it to you. 🙂 Have a blessed day!
As I read down the comments below, my scale was very similar to the one posted by Cindy. That scale measures ability to function, too, which I feel is key; it takes out the subjectivity of tolerance or "worst pain ever felt" and gives the patient the "benefit of the doubt".
I find those pain scales particularly useless – may I refer you in the interest of laughter to : http://hyperboleandahalf.blogspot.com/2010/02/boyfriend-doesnt-have-ebola-probably.html.
A better pain scale (adult language may be used). I understand her pain scale is also available as a poster – perhaps we could provide one to each of our rheumys!
Yes, in our research for images last night we noticed that popular old blog post about pain scales (like you said, with adult language). We're hoping we might do something creative in our community that moved this conversation forward especially as it relates to rheumatology, not to take anything away from something someone already wrote a while back.
I hate the pain scale with a passion! If I rate my pain with a lower number- I feel like the doctor/nurse is wondering why I am even there (haven't had to rate my pain at the Rheumy). If I rate it higher I feel like they are thinking I am faking, looking for pain pills (which is funny because I never ask for pain pills and usually decline them because I hate the way they make me feel), or am just a huge wussy. Plus pain scales are so objective. My worst pain ever (before RA)was gallbladder surgery which to one of my friends with a cronic illness said gallbladder surgery was a walk in the park compare to her lung biosy.
Thanks for posting on this, Kelly! I HATE the pain scale. I've been wanting to do a blog post on this topic, too, so I'll put something together for the blog carnival — great idea!!
I can't wait for yours, Dana! You are an artist!
What a great post! I can relate to the "pain scale" discussion, especially the part about RA's and pain tolerance. I live most days now with a level of pain that would have been very high on the scale a few years ago. It's now my "normal," and doctors don't understand. Just because I've had to live with it doesn't mean it's not important. Now I'm going to go off and work on my chart!
Me, too, Fred. I would love to see what you come up with.
I can only guess that they have nothing to compare it too. So they have no real idea. That is part of what makes this so hard. It's not just that we have different "tolerance" like we hear all the time – it's that we have different actual experiences. I knpw some very lucky people who've had very little pain – they are not very sympathetic and they are very grumpy with slight pain.
More on this later…I'm leaving myself breadcrumbs to an idea.I think that there are so many factors, different types, tolerances…it does make it difficult. If a doctor asked me to rate my pain I would say which one, the burning, the sharp, the ache, the ripping sensation….I have several going on at different levels. I'm wondering if a flow chart that relates pain somehow as opposed to an absolute number ….going to have to think. Interesting question, Kelly.
I finally realized how much pain I am in on a regular basis after I was in a head-on collision (totaled my car, but everyone was ok). People kept telling me how sore I was going to be the next day and were totally surprised when I still showed up for an event I had been looking forward to the day after the accident. However, the pain in my neck, shoulders, arms and back was on the same level or less than RA pain, just more in the muscles and I had impressive bruises where the seatbelt went, instead in my joints. I finally had a description for my pain that was meaningful.
I wonder how much acclimation to pain also affects the scales and descriptions. Pain that most would put higher on the scale, I tend rate lower, because it's just something I've unfortunately gotten used to.
I LOVED YOUR BLOG! And I too, HATE pain scales. I do like the one in the circle,it's something most people,even those who haven't experienced pain, can understand. I had major back surgery last Feb. and everyone told me how long I 'd be laid up. HA! I was up and walking (with help) the day of surgery. They say pain is relative. I guess so when you have to deal with it ad nauseum (literally!) Unless you've been there, it's really hard to understand pain every day. And again, pain is so subjective. How can one really measure it?
If a ten is the worst pain you could possibly imagine, at a 5+ you'd be crying and at 7+ you'd be screaming too much to talk ( if we go with ten being the wort thing imaginable, like lava or velociraptors).
What i mean, I think, is that they're too relative. My 10 might not be your 10. We need a baseline or a reference point. Something like, if the pain you feel from walking into a table (because who hasn't done that) is a five, rate your pain out of ten.
Mild Pain – Nagging, annoying, but doesn't really interfere with daily living activities.
1 – Pain is very mild, barely noticeable. Most of the time you don't think about it.
2 – Minor pain. Annoying and may have occasional stronger twinges.
3 – Pain is noticeable and distracting, however, you can get used to it and adapt.
Moderate Pain – Interferes significantly with daily living activities.
4 – Moderate pain. If you are deeply involved in an activity, it can be ignored for a period of time, but is still distracting.
5 – Moderately strong pain. It can't be ignored for more than a few minutes, but with effort you still can manage to work or participate in some social activities.
6 – Moderately strong pain that interferes with normal daily activities. Difficulty concentrating.
Severe Pain – Disabling; unable to perform daily living activities.
7 – Severe pain that dominates your senses and significantly limits your ability to perform normal daily activities or maintain social relationships. Interferes with sleep.
8 – Intense pain. Physical activity is severely limited. Conversing requires great effort. Has been compared to natural childbirth.
9 – Excruciating pain. Unable to converse. Crying out and/or moaning uncontrollably.
10 – Unspeakable pain. Bedridden and possibly delirious. Very few people will ever experience this level of pain.
This good Cindy because it's very specific..
I do think that some people who experience severe acute pain frequently (such as unrelenting RA flares without treatment) do "adjust" as it says on number 3, even higher up the scale. I think what patients have been describing is that they slide the scale downward in order to cope. So when they find they frequently have a 5 or 6 for example, they try to redefine it to themselves as a 3 or 4 and learn to ignore more severe pain than they could ignore previously.
Thanks for posting about this issue. When I'm in a flare, at a certain point the pain becomes my "normal". With immense strength of will and medication, I can look fairly normal (ie, not in much pain) for 1/2 hr-1 hr. For example, during my rheum. appt, I may feel like vomiting / sobbing / shivering / etc from the pain, but that would distract from the 10 min. I have with my dr. So I calmly discuss how the pain affects me (can't hardly get out of bed, hard to do the simplest things like make a sandwich), while projecting a normal outward appearance. I'm sure actions like mine make dr's wonder if the pain is exaggerated, but what is one supposed to do?
What a good way to explain how that works. I wonder if anyone has ever studied how the many patients who are always in "flare" manage to adjust their "normal" on a more pernanent basis.
Kelly, I tend to rate my pain by what I am capable of doing. I can sweep my floor today but I can't scrub the stove because my hands hurt. I can walk to the car but not around the store once I get there.
Also, I think something missing from the pain scale is that our pain is chronic. All of the choices listed are ACUTE: a bee sting is over and done, surgery is a few days and done. My pain never goes away — only the position and intensity changes.
I love the pain scale at the beginning of your post. It made me laugh out loud.
I've been a nurse for more than 20 years (although recently going on disability), and thus have dealt with pain scales for years; they became a monitored parameter in nursing, and were expected to be part of a patient assessment.
That's it! We were taught to listen to the patient. Whether or not you see signs like frowning or wincing, you should believe whatever the patient tells you and treat accordingly.
I agree completely Meliann with the quote. That is what matters in the end is what the patient experiences.
The image was created especially for this post by my daughter and I thank you very much for commenting on it!
This blog is so relevant to RA patients. Over time I have noticed that my tolerance for pain has increased dramatically. This is because we learn to live with the constant pain day in and day out. Because of this, I believe I am playing down my current condition of my RA, which is not benefiting me at all in my care.
When I first visited the Pain Management Clinic before my first nerve block, they had a pain scale chart posted. When I read through the chart, I was amazed at what they felt the characteristics were for high pain and what I thought was high pain. I have been dramatically under estimating my pain levels, especially when I communicate them to my rheumatologist.
What I know now is fighting through the pain is what we do as warriors. That does not lessen it or reduce the impact that it has on our lives. We must accurately communicate our pain levels to our doctors and not speak to lower numbers just because we have learned to tolerate it.
As always Kelly nice job!
I really like your picture circle at the beginning because the pictures make it easy to relate to. I also like the other pain scales listed, becuase it is easy for me to relate to, having experienced some of the 8 and 9 level pain scenarios. However, childbirth is fleeting, and quickly becomes a memory. Broken bones heal, and again become a memory. Migraines recur, pain due to endometriosis and other conditions such as the relating pelvic adhesions, joint, skeletal and muscular pain from innumerable conditions never ever go away, they just wax and wane, instigated or mitigated by time, the weather, nsaids and pain medication, or even the foods that we consume. If you have the pain of a bee sting, or 10 or 20 bee stings all day, it is exhausting and eventually does interfere with daily life, bumping that bee sting up to a level 3 or 4, or even a 5, if it is repeated for multiple days on end. That's when it is hard for the people around you to understand what you are experiencing. Even though you know it could be much, much worse. And sometimes, that is the light at the end of the tunnel.
A winner, Kelly. Now that I see your visual representation, I can now describe my pain. I'm thinking of taking it to the rheumy next time. Brilliant! Absolutly brilliant.
My rhuemy asked me the other day about my pain. I again still feel very fortunate as my rhuematoid waxes and wanes. But pain is weird, I don't like the word for Ra patients. Pain to me would be a headache that made you sick. Or having a baby. Now that is pain. But I hurt when flaring and am lucky my flares don't last for weeks. sometimes by afternoon, I am achey and tired. Achey yes, but horrific pain NO! Right now all my inflamation markers are staying lower, that is good. I still have chronic swelling. I still keep thinking the tests made a mistake on me, until I have one of my flaring days that make me so tired.
So how do you describe ACHEY??
thanks Kelly, your a jewel!!
I think the reason most people either can't or don't want to understand the type of pain RA can cause is that the pain is constant, unpredicatable, and incapacitating. To most people this sounds like torture, and most people I know are uncomfortable discussing torture and they want to find a way to end it. This includes doctors, and the doctors don't want to acknowledge it because it makes them feel powerless. So we are left with bad pain scales because no one wants to spend the time researching something that they either cannot comprehend, or don't want to believe is happening to a person right in front of them.
Sorry if this is rambling, bad pain day.
Good points, China. It can help us to look for answers if we know what the problem is.
I find it difficult to categorize pain levels. I've always had a high tolerance for pain, and sometimes don't notice pain until it impacts my mobility. For example, a day after a nine-hour cancer and reconstructive surgery, I was taken back into surgery for another couple of hours due to a complication. When I was brought back to the room, the nurses forgot to reconnect the automatic morphine pump. Since I never press the button for extra morphine after surgeries, I didn't notice until I needed to get up for the first time for a trip to the bathroom and couldn't move. It was only then–because I couldn't make my body move–that I realized that I was hurting, and the mistake was discovered. This complicated my RA diagnosis last year, I think, because I never told doctors my joints were hurting when I suddenly fell sick. Since my onset began with a sudden spiking of my blood pressure and I didn't mention the pain, the initial testing was for cardiac and other issues. Now, I know the RA pain is worse when I realize I'm hunched over at my desk and can't easily rise, that I stumble into walls when I do rise from my desk, that managing the pain is exhausting my body, even if I haven't "felt" it. That's when I go to bed. It's only a few minutes later, when the pain eases a little, that I actually feel the pain and can identify the particular joints that hurt the most, if that makes sense. I actually think now that my onset was not my real onset, and that I've been dealing with this for a much longer period. That might be the reason why I tolerate pain without acknowledging it, because I've just been feeling some level of pain constantly for a long time. So, a 1-10 pain scale is useless for me.
Now that I am done being a smart alec, here's my thoughts. I've never found that straight 1 to 10 very helpful – what is a 2 to me might easily be an 8 to someone else with no context. Cindy's scale makes a lot of sense to me – it has context. It also made me realize that what I had been reporting as a 2 was in fact a 3 or a 4. We have a number of problems with the reporting of pain. First, it is subjective. Only the patient knows what their pain is and their ability to communicate that is limited. The pain scale that Cindy displayed helps with that communication. Second is experience. Many caregivers have limited experience with pain and their judgement of the patient's pain is colored by their own experience. Third is that our pain is chronic rather than acute in most cases. Chronic pain can do two things. It can force you to tolerate higher and higher levels of pain as the new normal in your life, under reporting your pain levels to your caregivers and receiving less pain treatment than you should have. Chronic pain, even at low levels, can wear you down; untreated chronic pain is disabling. Again, most caregivers don't have experience with chronic pain and don't understand the impact that unremitting constant pain can have.
I think you are right on the money when you say we need a better pain scale. Context is the key I think. We also need a better discussion of pain in treating rheumatic disease – this is a primary component of these diseases. I have a LOT of trouble with any rheumatologist that says they don't treat pain.
Hi Leslie. Yourre rigtt that we need a better discussion of pain generally. You make several good points that would be helpful to professional or lay caregivers who are reading. It will never be possible to force anyone to have empathy of course, but we can educate! How can we take your ideas and say David's for example and others to create a sliding scale? We could use some kind of factor to adjust for pain that is chronic or for people who know that their scale of 10 is greatly enlarged by having tolerated extreme pain in the past. There could be questions we ask that become part of a simple formula to get a more realistic gauge. Also, we need to ask the patient between appointments – just like everything else. It's not just – what is your pain while you sit here in your slacks, but what was it last week when you couldn't even move? We forget severe pain intentionally – the mind tries to paper over pain as a defense mechanism. This affects reporting AND empathy. But if we talk about it we can do better. We have learned to be empathetic to so many things – we can learn it about pain.
I entered a comment on the MIT Technology Review article. I won't reproduce it here – copyright problems and all that – but in essence I wondered if their technology would account for long-term chronic pain – and what changes in the fMRI of the brain would occur in the presence of long-term chronic pain.
Back in the late 60's, early 70's there was some research into pain measurement using a "dolorimeter" – an instrument for measuring pain in labor. The studies all had the same problem – there was less objectivity than they thought there would be. How these studies and the instrument would relate to the grinding, chronic pain of RA is anyone's guess. I would suggest there is no relationship.
I also suggest the "standard" pain scales bear no relationship to our pain and disability!
I was recently in the hospital for foot reconstruction surgery(damage caused by RA) and naturally I was constantly being asked about my level of pain. What I found helpful was to tell them that I live at a level 5 or so daily, so they "reset" their calibrations to allow for my normal chronic pain. So, when they neglected to administer the nerve block or install the morphine pump after surgery, and my pain level jumped to a 9, they worked to get it back down to my "comfort level" of 5. I was satisfied with this accommodation for my chronic pain vs. acute post-surgical pain.
When it comes to rating what type of pain the RA patient has instead of rating from one to ten. maybe we can describe it in detail; IE.."It feels like someone is constantly cracking my fingers". The ratings of one to ten mean nothing to me. Id be asking, "…and what part of my body, that hurts right now, am I supposed to be rating, as my hip hurts and my toes, and my hands…. Each one of these body parts all have different pain, and all at the same time. My hips for one would and are at present, excruciating as if I had slipped and fallen on ice. Where as my toes feel like i have been cracking their knuckles, and that small nagging pain will not go away.
This is so true! Love the little drawings and totally agree with the pain tollerance. I can not fit and will not fit my pain into a 1-10 scale cause, generally, for me that's just not where it is at. Thanks for this post. 🙂 It's great!
1) Composure – Do I look like a calm, peaceful guru (that would be a 1), or like a deer caught in the in headlights (10).
2) Apparent Age – Am I pleased that I look young and alert? (1) or do I look like my grandfather near the end? (10). I think how exhausted I look goes in this category. Old and tired go together.
3) I ask my wife how I'm doing. She can see things I don't.
4) (This one might not be for everybody.) I try to sing the note A and then play it on a piano or guitar. If I'm perfect that's a 1, a little flat is 2-3 etc. but sharp means terrible and several notes too high is a 10.
These ideas might sound silly but I know when I walk up to the mirror I usually have no idea what I'll look like. I got up and checked while writing this and didn't do well on the composure scale (a slight "deer in the headlights" look. Hmm could you see that coming?). I really do believe that these or similar ideas might be made into a useful tool to aid in the assessment of our condition. I'd love to hear of other ideas and see a bunch of us keep logs. We can figure out which ideas work and also get some understanding of how quickly we change e.g. hourly?, daily?.
Love this post on your blog….being a nurse from the 80's I remember when the Joint Commission insisted us nurses document pain by using the 1 to 10 scale…how little I knew then about how it is now that I am on the "other side of the coin" with daily chronic pain how difficult it is for me to give an answer to that question! I have learned to tolerate my pain. If I answer 8 it means I am in big trouble and need help. Thankfully, my pain management doc understands that and mainly notices that I am fidgeting, standing up to massage my back, etc. I am thinking about starting a blog called "Living on the "other side of the coin"….a Nurse's perspective on living in chronic pain.
Thanks Marianne. I'd love to hear more about comparing what you were taught with what you experience. Good idea.
Love this….there really is no way to explain the pain. Every joint is different. I had a Rheumatologist (who is no longer in practice) tell me when I put a pain level of 8 on my paper that he had patients with deformed hands worse than mine that didnt have a pain scale that high. He had no clue!
Comparing patients to one another is unkind – an unprofessional – in my opinion. At least that's what I told a dear friend when she told me her rheum did that too. And deformity does not correlate with pain levels – that is an immature and simplistic notion of evaluating pain. Uninitiated people see a deformity and assume it currently is very painful – when it probably hurt more as it was deforming – an invisible and painful process.
I hate pain scales….as my pain is pretty "relative" and hard to describe to someone else. I'm pretty newly diagnosed to RA and was in a flare when the diagnosis was made. In looking back a few years I believe that I've had alot of flares, only didn't know it at the time that was what was happening to me. I'd had "false" diagnosis' made by a neurologist, a chiropractor and then just ???? from my at-the-time-primary and one other doctor. Then I moved to a new state and it was here that I finally had my answers given. THEN the question of pain on a scale was asked and quite frankly it was hard to say. IF I could or would be able to compare it to "something" (but what??) that may help. Right now I have random 'aches and pains'—can't put these on any type of scale. How much would they weigh?? (a pun intended) Sometimes I wish my health-care-providers also had RA so they'd be able to relate alot better to what I'm going through, along with their other patients. Just my humble opinion.
Accurately measuring pain let alone communicating it effectively for those that are always is some sort of discomfort and at times in varying degrees of pain is a huge challenge. Same as the frequent question of "how long do you experience stiffness in the morning" so subjective, different daily and hard to accurately make an assessment on. Really looking forward to reading the responses here. Excellent topic.
I agree about the subjectivity of pain scales. I have a very high threshold for pain, because before RA my menstrual cycles caused me excruciating pain and I learned to live with it. Although the pain from RA is very different from menstrual pain I realize that I often down play my levels of pain when asked or when completing a pain scale at my rheumy.
I think part of the problem is that when people ask you how you are feeling to prevent yourself from sounding like a whiner or complainer we have learned to pretend that everything is rosy. Do people really want to know the truth when they politely ask you how you are doing? I don't think so, so we learn to deny/ignore acknowledging our pain.
The various pain scales used by my rheumy has confused the admin law judge in my SSD case. So we have to wait for him to submit a written clarification before she can make a ruling (other issues that my lawyer didn't take care of too).
Pain is so subjective; can any scale reflect the reality of our every person's pain level?
I was diagnosed with RA in June 2007 and had been in pain mostly in my feet and knees for almost 6 months before diagnosis. The pain started gradually and built up over those months until it wasn't just pain anymore which I seemed to have been finding ways to live with, but I was feeling horrible, feverish, exhausted and "floaty" by then which WAS affecting my life. Anyway – the actual first time I was ever asked about pain on a pain scale was about 2 weeks after I started on the RA meds. After 2 weeks on prednisone, I was feeling just great! I remember driving to work that morning thinking, wow – this is the best I've felt in a long time. A half hour later, I felt a really sharp pain in my ovary area – by the end of the day, I was writhing in pain and blacking out in the Emergency Room – which turned out to be sepsis from a burst ovarian cyst – but no one knew that yet. Anyway – I remember laying there in the worst pain I have ever felt, begging for pain medication and the nurse asked me where I was on the pain scale. Despite my pain and the fog I was in, I hesitated for a minute because I didn't know how to answer that. I was thinking, well, this is the worst pain I've ever felt, but I knew there was pain that could be worse and do they want me to base my current pain on the worst I've personally felt or the worst I think it could be? Isn't that stupid? I laugh at it now because here I am in really bad shape and I stopped to analyze what I should say for the answer to the pain scale. I think I ended up saying 7 or 8 and before I blacked out again, I remember my husband looking at me in frustration and saying 7 or 8??? You're obviously a 10! I still don't really know how to give an appropriate answer on a pain scale.
I guess i am lucky when it comes to the pain scale. The only time my rheumy or GP use it is when I am doing an equally useless survey. They ask me how my pain is and they can equate that with my blood pressure. When I am in severe pain, my blood pressure goes up. They know what my normal bp is with my normal pain level to compare them. Because I have had the pain for so long it has become my norm. When i had my foot fused at the arch, I didnt need pain peds because compared to what i had been living with, i was then painless, even when i fell because i tried to walk without help the first day i came home after the surgery. My ortho surgeon & GP were amazed.
I think that how people experience pain, as well as a comparison to major, relatively common (within a lifetime) pain events, may be useful, more so for the medical professionals who struggle to understand what we mean. So okay, use the scale based on your most painful event so far, define what that is (sprain, severe sinus, childbirth, RA, whatever) then use a series of questions to calibrate it – do you think it is more or less severe than; broken bone, migraine, childbirth, major surgery, etc. This allows us to use (and be encouraged to use) a completely subjective scale for ourselves (so every visit might be 10) whilst we can acknowledge that this may not be the way others would perceive the pain. It also sneakily provides the medical professionals with a comparator they may understand – either personally or via a member of family.
I forgot to say – I recently told my GP my pain levels are 4. What I meant was that they are about the same as when I broke my leg (except at that level in in most joints), but not as bad as when I had a ceasar and they kept forgetting to give me pain medication after about 12 hours (7 to 8 on the scale, could not speak), and definitely not as bad as I can imagine.
For me, these are all recent peaking type pains ( newbie), so I don't even know how you could address the additional pain tolerance.
This is an excellent idea Jen and I'd like to see it worked out into a chart.
I LOVE this! I never know what to say when asked, but I'm printing this & taking it to the doctor each time I go!
Pain scale charts are way to subjective in the way different nurses/doctors interpret them. When I had back surgery, the nurse said that she asked mothers if the pain was as bad as childbirth to rate the worst pain. If only she and other professionals really knew how to help patients rate pain levels. Labor pains come and go. Really bad flares come and take up residence in your body, and sometimes patients never have any relief without powerful pain relievers.
good point that it's harder when it never stops – or always comes back – or is in numerous places at once. and some (my mom) say labor didn't hurt very much. not sure if it's genetic or memory, but it is really hard to make comparisons.
I am new to posting…in fact I have just begun reading articles on RA..mainly because I am afraid. I have to tell you that going over the illustrated pain scale, I began to laugh. When I saw run over by a bus I was laughing so hard I cried. Ok, I know this sounds strange.
I was diagnosed 6 years ago with RA.
I am currently on Plaquenil, Methotrexate injections (just switched a month ago from tablets), folic acid, Prednisone, calcium, and thyroid meds. August, 2011, I was in remission. My daughter and some of her friends were visiting my husband and me in New Orleans. We had been out and about all day and my daughter and her friends wanted to go to Jackson Square and I chose to sit and have coffee and read at a favorite coffee shop and wait on them. When they finished their tour, they called for me to come pick them up. I grabbed my coffee and was walking across the street to get my car, when I reached the middle of the street (all clear, no cars) an 18 year old girl (on her cellphone) took off from a stop sign (not looking) and ran over me with an F250 pick up truck!!! Luckily the "only" serious injury I had was a broken femur. I was taken to Tulane Hospital and was operated on the next morning. Had a rod from my hip to my knee. I will tell you after having 3 children, this accident was the worst pain I have ever felt! I was hopitalized for a week and then transferred to Tulane's rehab center for phyiscal therapy for two weeks. Needless to say I went through a lot of pain when I returned home. Began outpatient physical therapy until the RA returned in the fall. I was told by my RA doctor that usually the RA flares immediately with such a trauma, but of course, in my case, it waiting a few months.
The point of all this is, I really liked your pain scale because I can truly relate to being hit by a bus!!!!
I use mostly a functional scale for pain because it makes more sense to me. Here's kinda an example of how I rate my pain (1-10).
1. Barely noticeable… Not even sure it's there.
2. Noticable but easily ignored.
4. Can't really ignore it, but it's not effecting my ability to function.
5. Can't ignore it, it is effecting my ability to function but I can tolerate it. I'm probably grabbing for something to provide some relief.
6. I'm starting to wonder why the hell it hurts like this. It is effecting my ability to function… I don't want to do anything. I want relief and will happily down a double dose of naproxen.
7. Having a strong impact on my ability to function. I might be swearing. I'm desperate for relief and tasks are done o only out of sure stubbornness (cus someone's gotta do them). I want to lay in bed… I can no longer tolerate this pain.
8. I am probably crying it hurts so bad. I am desperate for relief and would sell you my kidney if you'd make this stop. I'm making absurd vocalizations and sound like a dying moose.
9. Take me to the ER… PLEASE dear God make it stop. I am writhing I'm pain. Thinking is difficult. I am likely hyperventilating.
10. I think I might be dying. I need to go to the ER now. I cannot do anything but think about how much it hurts. Pain is all consuming and I cannot move other than to writhe in pain. I cannot recall basic facts (like my phone number or how to spell my name). There is a small possibility that I might scream… and I am crying like an exhausted, hungry, overstimulated newborn.


When the Abbey Group of Milwaukee needed creative help, they turned to Creative Director Mike Farley at JSH&P to assist.
The project is as big as they come… helping generate interest, visitors, donors, and ultimately fundraise for the Crazy Horse Memorial. The monument, a work in progress by the Ziolkowski Family (Korczak Ziolkowski was one of the original sculptors of Mt. Rushmore), is the world's largest mountain carving located in the Black Hills of South Dakota. It is considered The Eighth Wonder of the World in progress — the entirety of Mt. Rushmore fits under of Crazy Horse's armpit!
"Storytellers" is the branded name for those who contribute to the mission of the Crazy Horse Memorial. JSH&P helped create the logo design, brochure design and copy editing, as well as full stationery package and fundraising kit, and posters designs — both for resale and as a coloring poster for kids.


If you need any additional motivation to donate money to the victims of the tsunami, these satellite photos of the disaster area show the horrific differences before and after the waves hit land. For example Banda Aceh shore. More here.


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Provincial Politics
Ontario auditor general addresses environment, casinos and education in 2022 report. Here are the highlights
Bonnie Lysyk released her annual report on Wednesday. Here are the key points.
By Kris RushowyQueen's Park Bureau
Wed., Nov. 30, 2022timer2 min. read
Highlights from the 2022 auditor general's report from Bonnie Lysyk:
Ontario Lottery and Gaming Corporation need to boost efforts to clamp down on potential money laundering in provincial casinos after undercover operatives were able to "wash" money by playing table games and slots and obtaining "casino cheques with large amounts of cash, without anyone confirming where the money came from."
Poor co-ordination among four provincial agencies may lead to the increased risk of flooding, which could cause damage to millions of homeowners' properties as drainage systems get "overwhelmed."
There's not enough staff to "properly monitor and protect" the ecologically sensitive Niagara Escarpment.
The government "could do more to improve consumer protection" in the auto industry sector, where rates still wildly vary depending on where motorists live.
Government delays in managing invasive species "has increased the risk of introduction and spread." The report notes that risk assessments for 12 invasive species added to the list in 2022 "were completed on average almost four years before the species were ultimately listed and regulated, with just one staff member "regularly" assigned to do that work. Invasive species have a $3.6 billion impact on the economy, but the province spends just $4 million to fight them.
Dangerous invasive plants are unregulated and "several are available to buy in Ontario." The Ministry of Natural Resources and Forestry, it adds, "has left at least 30 harmful terrestrial invasive plants (plants that grow on land) and their pathways unassessed and unregulated," including the "tree-of-heaven" that houses an invasive insect that poses a threat to vineyards, fruit and vegetable trees and hardwood.
The Ministry of Transportation's "business case" for axing tolls on Highway 412 and 418 and licence plate sticker fees did not follow provincial guidelines.
Ontario universities are relying too much on international students to boost their coffers, which is risky because of outside factors including availability of or restrictions on visas. The auditor also found "weaknesses in universities' financial management practices."
By allowing colleges to grant degree programs and universities to offer certificate programs, "over time the originally intended purposes of Ontario's post-secondary institutions have blurred and now overlap, creating confusion in differentiating between these two types of institutions, and could impact their ability to sustain themselves in the long term."
While car insurance rates varies greatly between communities, on average they increased to $1,642 in 2021, a 14 per cent increase — making it the highest in Canada, even though injuries from crashes in the province are among the lowest.
With files from Rob Ferguson and Robert Benzie
AG report says doctors paid 5 times more than nurses to give COVID injections, slams Ford for 'ignoring' own experts to plow ahead with Highway 413
Ontario casinos need to improve their anti-money laundering enforcement, auditor general says
Ontario's auditor general sent undercover agents to test money laundering safeguards at casinos. Here's what happened

redpajama_set_name: RedPajamaCommonCrawl


Lamina DieMax™ L Die springs are mechanical springs designed to produce the maximum amount of force with minimal volume. This is the Heavy Duty series that provides greater force than the red Lamina springs and has shorter travel to solid. The gold (yellow) color code and 97 standard sizes are similar to the Raymond Gold Die Springs. But the coils are formed into an optimal rectangular wire design and made of spring-quality Chromium Silicon alloy, high-tensile strength steel in accordance with ASTMA A1000-99 specifications. DieMax L springs are manufactured in an ISO9001-2008 facility.


Presbyterian Historical Society, Museum Without Walls Calder Statues sign, installed August 2018. Photo courtesy of Presbyterian Historical Society.
Presbyterian Historical Society reading room, January 2018. Photo courtesy of Presbyterian Historical Society.
Presbyterian Historical Society, "Presbyterians and the American Revolution" exhibit, April 2018. Photo courtesy of Presbyterian Historical Society.
Organized in 1852, the Presbyterian Historical Society is the oldest denominational archives in the United States and serves as the national archives for the Presbyterian Church (U.S.A.) and many predecessor denominations. It exists to collect, preserve, and share the story of the American Presbyterian and Reformed experience with Presbyterians, the scholarly community, and the general public. The society's holdings include more than 250,000 titles reflecting the history of the Presbyterian tradition in America and over 30,000 cubic feet of official records and personal papers. A 2018 Center grant supports collaborative research projects that introduce Community College of Philadelphia students to rare historical materials, leading to exhibitions that examine the notion of accessibility and representation in archives.


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Guess what I'm not doing? Breathing.
Guess what Dru's doing? Apparently breathing. The dumbass. Did no one tell her vampires don't need to breathe?
Are you pondering what I'm pondering?
Angel 5.1: Conviction
Against my better judgment, I watched the Angel season five premiere. And, for the record, it wasn't as painful as I thought it would be . Don't get me wrong, it's not the fantastic new beginning I've seen touted from here to kingdom come, but it didn't suck. I like the new liaison to the powers of darkness, Eve. I don't hate Harmony. I think it's stupid she's willingly off the smack, but I don't hate her. I miss Lindsey still, but I'm coping. And most importantly I didn't hate the plot. Considering I skipped the last half of season four because it was so inane I couldn't handle it anymore, that's, like, a seriously glowing compliment from me.
But what actually happened?
Well, if you missed the first few minutes, you missed Fred filling ya'll in on that in her "cute" run-ony way. So you're lucky. Basically, for those of you that skipped last season and aren't spoiler whores like us (for though we skipped the episodes, we know everything that happened. So it's almost like we watched it, without the actual inflicting of physical pain on ourselves.), the Fang Gang got offered the LA office of the multi-dimensional law firm Wolfram & Hart to do with as they see fit. Now, instinctually they'd shut the puppy down, but as Eve points out, if they do that, they lose their in. So instead they have to get all "shades of gray" on our asses and go through their client list, deciding who's really evil, who's evil evil and who's just sort of naughty. Not an easy task.
Now, uh, the vampire that you terminated, he actually did work for one of your clients.
So, but, hey! First week, no one will squawk, ok?.
All this, while dealing with the fact that they're not sure why they're there and they're worried about turning evil and what really matters here is that Holden's back. Oh, sure, he's called something else…possibly Knox, but it's still our Holden. Sadly, he's Fred's lab assistant, so it seems that to see him I'll also have to deal with Fred, but for Holden? I'll make it through a thousand rambling sentences of idiocy. I'm just that kind of girl.
What, because we're crusaders against evil and now the law firm that represents most of the evil in the world has given us its L.A. branch to run however we want, probably in an attempt to corrupt, divide, or destroy us, and we all said yes in, like, 3 minutes?
Moving on, Cordy's in a coma and I'd care, because it's fucked up she's gone and all since she helped start this show, but they destroyed her character so totally and completely that I'm not really shedding a tear or anything. Connor, the albatross around Angel's mopey neck, is gone. Angel traded himself or his soul or something to kill Connor to give him a normal life. Or something. I didn't actually see the episode, but I hear he stabbed him and then Connor was a normal boy in a normal family and he doesn't remember the Fang Gang and they don't remember him. Woo! Angel does, of course, because he needs a reason to mope, and Eve knows, presumably so she has something to annoy him with. Oh, and Harmony is back, hand-picked by Wesley to be Angel's secretary. And if that's not Wesley trying to drive Angel up the fucking wall, I don't know what is.
So let's see, Angel's the boss boss with necro-tinted glass, meaning ME has finally found a way to just completely ignore that pesky daylight thing they painted themselves into a corner with nigh on 8 years ago, Fred's the brilliant head of the brilliant science department that does good as well as evil, Gunn isn't really anything until they send him to some cheesy brain dude who straps a contraption that looks like it came straight out of Pinky and the Brain to his head and fills it with every legal fact ever. So he's a lawyer. Who knows all the works of Gilbert and Sullivan, because Eve feels it's good for elocution. Wesley heads the library or something, I'm not really sure, and Lorne heads the entertainment division.
Angel's new morally-difficult job comes with perks: his own wetworks squad, 11 cars or so with the previously mentioned stupid tinted glass, a private elevator, a big office and what seems to be an apartment in his office. I'm gonna miss that big, empty hotel. I am. But then again, I just saw part of Room with a Vu on TNT, and realized that I miss the old office too. And the old Cordy. And Doyle. And a show that was cool and didn't suck. So I'm all nostalgic and stuff, and I'm sure this whole hotel missing thing will pass.
Fuck, people, I miss Kate. It's just wrong.
Anyway, a case comes up. Someone whose name I didn't bother to learn because he won't be back, is going to be convicted of bad things. Of course he did said bad things, but if they don't clear him, he's going to unleash a virus or something on the entire city by just saying a magic word. Instead of finding ways to make him mute, the gang scrambles to their own respective specialties (Fred to the lab to freak out on poor Holden's ass because she thinks the lab created the very bad thing, and maybe it did but leave Holden the fuck alone, Wesley to his books, because he's not actually allowed to be cool ever, and Angel goes to kick some ass) and sends Lorne to watch the proceedings of the court, to report back and stuff.
Don't get someone on it, have someone on it. Did we build this thing? Do we have an antidote? Do—do we have an Antidote Department? Do you do anything besides pretending you're running an evil Radio Shack?
Angel goes to a guy who made a magical container for the bad man with no name. The guy likes to be called Spanky, and he likes to spank things. Presumably women, since he tells Angel he doesn't spank men. Angel does, though, and bitch slaps his ass across the room to get the information he wants. But before this, I would just like to point out that Spanky attempts to choke Angel, a la Spike choking Dru until she passed out in Becoming 2, and Angel blithely says he's not using his windpipe. I just sort of, you know, wanted to point that out and all. No reason.
Turns out, the Spanky dude made a vessel to hold the really bad thing, and the vessel was somehow this very bad man's son. I don't know if he cast a spell on the boy, or if he created the boy, or if the boy's a walking talking robot type boy who doesn't know he's not really a real boy but actually a vessel for evil, but any way you slice it, Angel's pissed. Because of his own love for his own very special boy, you know. So Angel takes it all personally and goes to the school to quarantine the boy in his very own helicopter. Oh yeah, he has a helicopter. Just one more perk to balance out the non-perks, ie working for evil, having lawyers follow you as you try to rescue people and making them sign waivers thereby diminishing your cool factor, etc.
Now, don't worry, he hasn't gone all shallow and taken the copter to show off, but rather because the wet works team eavesdropped on him and decided to go on in and take out anyone in, oh, a 50 meter radius or something. I don't remember, I wasn't really listening. Angel beats them, because he's the conflicted good guy, somehow empties the school, and kicks the shit out of the wet works team. He kills the head wet works dude before he can tell us how tradition works because he's all out of mercy, which saddens me but does save the ME team with having to make something up, so I guess that works out for everyone involved. But me. But whatever.
You really think you can solve the problem? Come into Wolfram and Hart and make everything right? Turn night into glorious day? You pathetic little fairy.
Back at the courthouse, Gunn struts on in to save the day, all suited up and tarty. He messes with the judge in some very abstract way having to do with obscure stocks she holds which create a conflict of interest and gets the trial called off until another judge can be found. Gunn feels he can hold this out for years, and the very bad man will have to behave until it's all settled, giving the Fang Gang time to work out the whole virus/vessel thing and Eve's real proud of all of them—especially Gunn who, she points out, did it violence-free. Woo!
To ensure that this episode does not end on a high note, we are then treated to Angel opening up an envelope containing the Amulet of saving-Buffy's-ass and, of course, in a swirl of wind, up comes Spike. Yay.
Blondie bear?
angel 5.2: just rewards


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Introduction to Marine Biology
George Karleskint
INTRODUCTION TO MARINE BIOLOGY sparks curiosity about the marine world and provides an understanding of the process of science. Taking an ecological approach and intended for non-science majors, the text provides succinct coverage of the content while the photos and art clearly illustrate key concepts. Studying is made easy with phonetic pronunciations, a running glossary of key terms, end-of-chapter questions, and suggestions for further reading at the end of each chapter. The open look and feel of INTRODUCTION TO MARINE BIOLOGY and the enhanced art program convey the beauty and awe of life in the ocean. Twenty spectacular photos open the chapters, piquing the motivation and attention of students, and over 60 photos and pieces of art are new or redesigned.
toxins are also problematic. Solutions to these problems should ultimately help marine biologists better understand the causes of these harmful blooms and help them find ways to control or prevent them. Ù Sanford Berry/Visuals Unlimited Many kinds of marine algae undergo rapid population increases under conditions that are still poorly understood. Some are macroscopic algae such as the exotic Caulerpa taxifolia that has invaded the Mediterranean Sea and continues to expand its coverage of the
seaweeds, sometimes eliminating them from zones along the shore. (b) Some of the clearest examples of seaweed zonation can be found in the intertidal zones of rocky shores. On this Scottish shore, brown algae grow in an upper zone and green algae in a lower zone. The growth of green algae here is partly due to nutrient enrichment from nearby seabird colonies. In general, the distribution of seaweeds by depth is not explained by their possession of different combinations of photosynthetic pigments
measuring primary productivity. Primary productivity refers to the rate at which energy-rich food molecules (organic compounds) are being produced from inorganic materials. If you look at the equation for photosynthesis in Figure 2-16, you will notice that it would be possible to measure the amount of photosynthesis that is taking place by measuring either how much carbon dioxide and water are being used in the process or how much carbohydrate (glucose) and oxygen are being produced. This is the
endoplasmic reticulum functions in the synthesis of lipids and carbohydrates and the detoxification of harmful substances. Organelles called Golgi apparatuses function in the modification of molecules and place membranes around them. These packages of chemicals may be stored for later use or released from the cell. Lysosomes are an example of the membrane-bound sacs produced by the Golgi apparatus. Lysosomes contain enzymes that function in digestion. Vacuoles are structures surrounded by a
salmon) and invertebrates in mariculture operations (shrimp, oysters), papillomas in green turtles and manatees, morbillivirus (related to distemper, measles, and mumps) in seals and whales, and poultry viruses in seabirds (penguins). Scientists attribute the increased incidence of mass mortality and the emergence of new viral diseases to environmental stress on immune systems of marine animals. Marine viral populations probably are controlled by several abiotic and biotic factors. Near the
Once and Future Giants: What Ice Age Extinctions Tell Us About the Fate of Earth's Largest Animals
Scientific Thought in Context (In Context Series)


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Yonkers Diner has new menu with a Mexican twist
Yonkers Diner is under new management and it's putting a Mexican spin on traditional diner food.
Yonkers Diner has new menu with a Mexican twist Yonkers Diner is under new management and it's putting a Mexican spin on traditional diner food. Check out this story on lohud.com: https://www.lohud.com/story/news/local/westchester/yonkers/2018/03/12/yonkers-diner-new-menu/394387002/
Ernie Garcia, elgarcia@lohud.com Published 6:30 p.m. ET March 12, 2018
The counter at Yonkers Diner March 12, 2018. The restaurant re-opened in December under new management and has added some Mexican dishes to the traditional diner favorites.(Photo: Tania Savayan/The Journal News)Buy Photo
YONKERS - A longtime restaurant under new management is putting a Mexican spin on diner food.
Yonkers Diner at 337 Saw Mill River Road quietly opened in December and celebrated its ribbon-cutting ceremony on Jan. 23. Its three new co-owners are relatives who have revamped the menu and added original dishes designed to appeal to contemporary tastes.
"It's a take on traditional diner food and our background," said Edwin Aguilar, 30, of Yonkers, whose father Pablo Aguilar is one of the co-owners.
Traditional Mexican means that on the weekend, the restaurant offers barbacoa de chivo, a slow-cooked goat stew that is typically eaten as a taco filling. The Aguilars have also tried to lighten up some of their diner offerings.
"We've had really positive reviews of the mango salad ($13.95-$14.95), which is actually fresh mangoes...chicken...greens. It's beautifully decorated," said Edwin Aguilar.
Yonkers Diner's cook used to work at the former Athena Restaurant in Mount Vernon's Fleetwood neighborhood.
The standard diner fare includes Greek moussaka ($11.95), a roasted half chicken with stuffing ($13.95) and tuna salad platter ($9.95).
The Yonkers Panini ($10.95), a press-toasted sandwich filled with salmon, avocado and chipotle sauce, at Yonkers Diner March 12, 2018. The restaurant re-opened in December under new management and has added some Mexican dishes to the traditional diner favorites. (Photo: Tania Savayan/The Journal News)
Then there are Mexican-inspired fusion dishes, like the Yonkers Panini ($10.95), a press-toasted sandwich filled with salmon, avocado and chipotle sauce. The Yonkers Panini is crunchy on the outside and spicy on the inside, with the chipotle sauce's smoky flavor combining well with the salmon.
The Yonkers Panini is served with a pickle and a small cup of coleslaw, whose mayonnaise dressing soothes the chipotle sauce's burn.
Yonkers Diner has nine green salads, plus six mostly mayonnaise-based salad platters.
A low-calorie option is the Yonkers Diner Fresh Salad ($6.45), a fresh-spinach salad topped with strawberries and orange slices,avocado, onions, tomatoes and cucumbers. The spinach salad paired well with a balsamic vinaigrette, served on the side for calorie counters.
The Yonkers Diner Fresh Salad ($6.45), a fresh-spinach salad topped with strawberries and orange slices, avocado, tomatoes and cucumbers, at Yonkers Diner March 12, 2018. The restaurant re-opened in December under new management and has added some Mexican dishes to the traditional diner favorites. (Photo: Tania Savayan/The Journal News)
THE ATMOSPHERE
The diner is freshly painted with pastel lavender walls decorated with art and white ceilings. There are flat-screen televisions throughout the establishment. The dining areas have 14 booths for couples and four, in addition to tables and chairs in the back dining area, which is more spacious than the front. There is free parking in a lot across Saw Mill River Road.
A waitress serves customers at Yonkers Diner March 12, 2018. The restaurant re-opened in December under new management and has added some Mexican dishes to the traditional diner favorites. (Photo: Tania Savayan/The Journal News)
What: Yonkers Diner.
Where: 337 Saw Mill River Road, Yonkers.
Hours: 7 a.m. to 10 p.m. Monday through Sunday.
Contact: 914-375-0600.
Twitter: @ErnieJourno
The menu at Yonkers Diner March 12, 2018. The restaurant re-opened in December under new management and has added some Mexican dishes to the traditional diner favorites. (Photo: Tania Savayan/The Journal News)
More Yonkers food news
CARIBBEAN: Manny Mofongo serves Dominican dishes
EUROPEAN: Francey Brady's offers Irish flavors
MEDITERRANEAN: The Greek Spot grills kebabs
Read or Share this story: https://www.lohud.com/story/news/local/westchester/yonkers/2018/03/12/yonkers-diner-new-menu/394387002/


Am I Old Enough for Hearing Aids?
How old are you? Do you think you're old enough for hearing aids? Or is there really a right age to start wearing hearing aids?
We used to hear so many people with suspected hearing loss say this. Thank goodness we have moved away from the societal notion that only elderly people wear hearing aids!
Wearing hearing aids has become more popular and more common than ever before. This is all thanks to today's amazing hearing aid technology and the fact that many young people experience noise induced hearing loss. We no longer need to be ashamed or be in denial that we have hearing loss. In fact, the moment you suspect you have hearing loss, you should go to an audiologist for a hearing screen.
It's important to treat hearing loss early!
If you want to be able to enjoy and fully experience every bit of your life, you have to have all senses, including your hearing sense, functioning well. If it's not working right, you have to remedy the situation as soon as possible. When you wear hearing aids to treat sensorineural hearing loss, it helps to keep the brain from losing the ability to process speech. This is the reason why you shouldn't wait until you're older (based on your misconception of the "right age") to wear hearing aids when you know you need them.
Hearing well means living well!
At one time, our patient database was comprised of mostly "over 65" patients, but now on any given day, we may have an office of "40-something" patients, or younger, who want to live life to the fullest. These people want to be able to participate in conversations in noisy environments, listen to nature sounds while enjoying the great Colorado outdoors, stream Bluetooth music or phone calls into their hearing devices, hear well at conferences, and the list goes on and on.
Weekly, we hear patients tell us that they love their hearing aids! Enjoying a healthy and engaged lifestyle helps us all feel and appear younger, so if you suspect that you have hearing loss, please call us today for a free hearing screen and consultation.


She did it! Our Projects' Coordinator and her friend Amanda James completed a 52 mile Bike Ride around East Sussex in aid of Music as Therapy International.
So far they have raised over £1200, with more sponsorship trickling in. An amazing effort and we are all so impressed!


Admittedly, this book would appeal to a small audience, Chicago White Sox devotees. I have been with the author a few times. When I picked up this book, I expected a lot of editorial comment and pro White Sox Management propaganda. I was pleasantly surprised by the LACK of editorial comment. The book was published in 1994. It is a well researched magnificent history of the Chicago White Sox with a focus on the deterioration of Comiskey Park and the political machinations that took place in building a new State funded ballpark for the White Sox.Obviously, the economic times have changed greatly since 1994, and the idea of taxpayer money being used to build stadiums for billionaires who are paying ballplayers millions of dollars while schools and infrastructure are ignored is finally being scrutinized and frowned upon, but the optimism of the author about the project at the time the book was written is perfectly understandable.This is a fabulous history. Pure Chicago. A must read for a Sox Fan.


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Someone else's neglect shouldn't become your responsibility, but it can if you don't take action. We'll take care of all the legal concerns to relieve the stress of dealing with a lawsuit, so you can focus on healing and getting your life back to normal. Contact us today for a free consultation!


When you make a purchase or attempt to make a purchase through the online store, I collect certain personal information from you, including your name, billing address, shipping address, payment information, and email address.
- I use Shopify to power my online store -- you can read more about how Shopify uses your Personal Information here: https://www.shopify.com/legal/privacy.
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- Fulfill any orders placed through the online store (including processing your payment information, arranging for shipping, and providing you with invoices and/or order confirmations).
- Understand how people browse and interact with my website so I can improve the user experience and analyse the effectiveness of my marketing.
I respect your privacy and do not sell your personal information or share it with any other parties, except for those mentioned above.
However, I may also share your personal information when required to do so in order to comply with applicable laws and regulations, to respond to a subpoena, search warrant or other lawful request for information we receive, or to otherwise protect my rights.
Additionally, if you are a European resident I note that I am processing your information in order to fulfill contracts I might have with you (for example if you make an order through the Site), or otherwise to pursue my legitimate business interests listed above. Additionally, please note that your information may be transferred outside of Europe, including to Canada and the United States.


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Q: My app icon scales differently in two different folders I created an icon (.ico) which includes the following sizes:
16x16, 32x32, 48x48, 64x64, 96x96, 128x128, 256x256
The original files that I used are png with transparency.
When I created the icon file, I imported the files
so that my icon editor also shows transparency for each 'page' of the icon.
The opaque area is in the center (a rectangle) with transparent areas above and below (to complete the square size format - kind of like Letterbox for movies)
I added the ico file to my project from Properties > Application > Icon and Manifest > Icon/browse.
It gets added to the project and is visible in the Solution Explorer and for its Properties, Build Action = Embedded Resource.
After I build my project, and look in the  'Project' > bin > debug folder, the icon appears correct for all views (Detail, Small Icon, Large Icon, etc.)
However, if I copy the exe to my desktop, the icon shows up scaled to eliminate the transparent areas thereby appearing in the wrong aspect.
When I look in the 'Project' > obj > debug folder, the icon appears scaled (like on the desktop) for all views.
Can someone explain why this is happening and how to fix it?

A: I found the solution - I simply used Build > Clean Solution
and the icons are correct now wherever I view them.

redpajama_set_name: RedPajamaStackExchange


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My Q&A bit for The Romance Review's Blog Hop happens next Tuesday, so I want to be ready for it. You will be able to find the answer in this short excerpt from my debut contemporary.
Excerpt from Blame It On The Brontes.
Suddenly, Liam took hold of her hand and pulled her up off the bench. "Let's go to The Quack. I'm heading back out to the lobster grounds in the morning, and I think we should have a beer before I go."
They made their way into The Quacking Puffin, which had been inhabited by both locals and tourists for as long as Emily remembered. The place hadn't been updated in more than thirty years, which was part of its charm, but the place was always clean. The lights were dim, except for the purple glow emanating from the jukebox. They ordered their drinks at the bar and then took refuge in a booth, where they surveyed the selections on the tabletop individual juke.
Here's a bit more about the book, which occupies the #1 spot on the Goodread's list for Best Baby Boomer Books.
This novel was inspired by a jewelry-making class taught by a woman who has spent years collecting beach glass on the shores of Lake Erie and turning those rare pieces of glass into beautiful necklaces and bracelets. By the look of the necklace she tried to teach me to make, I realized at the end of the class that my talent was with the written word, not with the creation of jewelry. The novel is set in coastal Maine.
Three separate love stories intertwine around a central theme, as fractious sisters Charlotte, Emily and Anne Bronson, each in her forties, are in Puffin Bay, ME for their mother's funeral. Each is ready to sink her claws into the fortune their mother left behind. But their mother has other plans. Her substantial fortune won't be divided until the trio return to their childhood home and live together for a year.
It's a request that pits sister against sister but could unite them in a common goal to find the friendship they shared as children, to create a family jewelry business and to win over the men of Puffin Bay. They have a year to figure it all out.
Labels: Becky Lower, Blame It On The Brontes, Soul Mate Publishing, The Romance Reviews, Year-End Blog Hop
Rebecca March 5, 2020 at 9:33 PM
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text:
Tender Offer Statement Pursuant to Section 14(d)(1) or 13(e)(1)
(Amendment No. 4)
(Name of Subject Company)
PAPYRUS ACQUISITION CORP.
(Offeror)
SMITH & NEPHEW CONSOLIDATED, INC.
SMITH & NEPHEW PLC
(Parent of Offeror)
(Names of Filing Persons)
Common stock, par value $0.001 per share
(Title of Class of Securities)
68827R108
(CUSIP Number of Class of Securities)
15 Adam Street
London, WC2N 6LA
(Name, Address and Telephone Number of Person Authorized to Receive Notices and Communications on Behalf of Filing Persons)
Scott A. Barshay
David Klein
CALCULATION OF FILING FEE

Transaction Valuation*
Amount of Filing Fee**
$660,491,753.54
Calculated solely for purposes of determining the filing fee. The calculation of the transaction value is determined by adding the sum of (i) 34,528,289 shares of common stock, par value $0.001 per share, of Osiris Therapeutics, Inc., multiplied by the offer price of $19.00 per share, and (ii) 590,751 shares subject to issuance pursuant to granted and outstanding stock options with an exercise price less than $19.00 per share, multiplied by $7.54, which is the offer price of $19.00 per share minus the weighted average exercise price for such options of $11.46. The calculation of the filing fee is based on information provided by Osiris Therapeutics, Inc., as of March 18, 2019.
The filing fee was calculated in accordance with Rule 0-11 under the Securities Exchange Act of 1934, as amended, and Fee Rate Advisory No. 1 for Fiscal Year 2019, issued August 24, 2018, by multiplying the transaction valuation by 0.0001212.
Check box if any part of the fee is offset as provided by Rule 0-11(a)(2) and identify the filing with which the offsetting fee was previously paid. Identify the previous filing by registration statement number, or the form or schedule and the date of its filing.
Amount Previously Paid: 80,051.60 Filing Party: Papyrus Acquisition Corp., Smith & Nephew
Consolidated, Inc. and Smith & Nephew plc
Form or Registration No: Schedule TO
Date Filed: March 20, 2019
Check the box if the filing relates solely to preliminary communications made before the commencement of a tender offer.
Check the appropriate boxes below to designate any transactions to which the statement relates:
third-party tender offer subject to Rule 14d-1.
issuer tender offer subject to Rule 13e-4.
going-private transaction subject to Rule 13e-3.
amendment to Schedule 13D under Rule 13d-2.
Check the following box if the filing is a final amendment reporting the results of the tender offer: ý
If applicable, check the appropriate box(es) below to designate the appropriate rule provision(s) relied upon:
Rule 13e-4(i) (Cross-Border Issuer Tender Offer)
Rule 14d-1(d) (Cross-Border Third-Party Tender Offer)
This Amendment No. 4 (this "Amendment") amends and supplements the Tender Offer Statement on Schedule TO relating to the tender offer by Papyrus Acquisition Corp., a Maryland corporation ("Purchaser") and a direct wholly owned subsidiary of Smith & Nephew Consolidated, Inc., a Delaware corporation ("Parent"), an indirect wholly owned subsidiary of Smith & Nephew plc, a public limited company formed under the laws of England and Wales ("Smith & Nephew"), for all outstanding shares of common stock, par value $0.001 per share (the "Shares"), of Osiris Therapeutics, Inc. ("Osiris"), at a price per Share of $19.00 in cash, net to the holder of any applicable withholding taxes and without interest (the "Offer Price"), upon the terms and subject to the conditions set forth in the Offer to Purchase, dated March 20, 2019 (the "Offer to Purchase"), a copy of which is attached as Exhibit (a)(1)(A), and in the related letter of transmittal (the "Letter of Transmittal", a copy of which is attached as Exhibit (a)(1)(B), and which, together with the Offer to Purchase and other related materials, as each may be amended or supplemented from time to time, constitutes the "Offer"). The original Schedule TO was filed by Purchaser, Parent and Smith & Nephew with the Securities and Exchange Commission on March 20, 2019 (together with any subsequent amendments and supplements thereto, including this Amendment, the "Schedule TO").
This Amendment relates to the expiration of the Offer as scheduled at 12:01a.m., Eastern time, on April 17, 2019. All the information set forth in the Offer to Purchase, including Schedule I thereto, is incorporated by reference herein in response to Items 1 through 9 and Item 11 of this Schedule TO, and is supplemented by the information specifically provided in this Amendment.
Capitalized terms used but not defined in this Amendment shall have the meanings assigned to such terms in the Schedule TO.
Items 1 through 9 and Item 11.
The Offer to Purchase and Items 1 through 9 and Item 11 of the Schedule TO, to the extent such Items incorporate by reference the information contained in the Offer to Purchase, are hereby amended and supplemented as set forth below:
"The Offer and withdrawal rights expired as scheduled at 12:01a.m., Eastern time, on April 17, 2019. The Depositary has indicated that, as of the Expiration Time, a total of 21,079,693 Shares (excluding a total of 416,982 Shares with respect to which notices of guaranteed delivery were delivered but which Shares were not yet delivered) have been validly tendered and not validly withdrawn pursuant to the Offer, representing approximately 61% of the outstanding Shares as of the Expiration Time. The number of Shares validly tendered and not properly withdrawn pursuant to the Offer satisfies the Minimum Tender Condition. All conditions to the Offer having been satisfied or waived, Purchaser has accepted for payment and will promptly pay for all such Shares in accordance with the Offer.
As a result of its acceptance of the Shares tendered in the Offer, Purchaser acquired a sufficient number of Shares to complete the Merger without a vote of the stockholders of Osiris in accordance with Section 3-106.1 of the Maryland General Corporation Law. Accordingly, on April 17, 2019, Parent and Purchaser will effect the Merger in accordance with Section 3-106.1 of the Maryland General Corporation Law. Pursuant to the Merger Agreement, at the Effective Time of the Merger, each issued and outstanding Share (other than (a) Shares directly owned by any of Osiris' subsidiaries and (b) Shares directly owned by Purchaser immediately prior to the Effective Time) will be converted into the right to receive consideration equal to the Offer Price. Each Share directly owned by any of Osiris' subsidiaries or by Purchaser will be automatically canceled and cease to exist, and no consideration will be delivered in such exchange. Following the Merger, all Shares will be delisted from NASDAQ. In addition, Parent intends to terminate the registration of the Shares under the Exchange Act after consummation of the Merger as soon as the requirements for termination of registration are met."
Item 12. Exhibits.
Regulation M-A Item 1016
(a)(1)(A) Offer to Purchase*
(a)(1)(B)
Letter of Transmittal.*
(a)(1)(C)
Notice of Guaranteed Delivery.*
(a)(1)(D)
Letter to Brokers, Dealers, Commercial Banks, Trust Companies and Other Nominees.*
(a)(1)(E)
Letter to Clients for Use by Brokers, Dealers, Commercial Banks, Trust Companies and Other Nominees.*
(a)(1)(F)
Summary Advertisement as published in The New York Times on March 20, 2019.*
(a)(1)(G)
Press Release, dated March 12, 2019 (incorporated by reference to Exhibit 99.1 to the Schedule TO-C filed by Smith & Nephew plc with the U.S. Securities and Exchange Commission on March 12, 2019).*
(a)(1)(H)
Investor Presentation, dated March 12, 2019, issued by Smith & Nephew plc (incorporated by reference to Exhibit 99.2 to the Schedule TO-C filed by Smith & Nephew plc with the U.S. Securities and Exchange Commission on March 12, 2019).*
Smith & Nephew plc's $1 billion existing revolving credit facility, dated June 15, 2018, between Smith & Nephew plc, as borrower, the guarantors from time to time party thereto, the lenders set forth on Schedule 1 thereto, HSBC Bank PLC as Facility Agent and various financial institutions as lead arrangers (incorporated by reference to Exhibit 4(a)(v) to the Annual Report for the year ended December 31, 2018 on Form 20-F, filed by Smith & Nephew plc with the U.S. Securities and Exchange Commission on March 4, 2019).*
(d)(1)
Agreement and Plan of Merger, dated as of March 12, 2019, by and among Smith & Nephew plc, Smith & Nephew Consolidated, Inc., Papyrus Acquisition Corp. and Osiris Therapeutics, Inc. (incorporated by reference to Exhibit 2.1 to the Current Report on Form 8-K filed by Osiris Therapeutics, Inc. with the U.S. Securities and Exchange Commission on March 12, 2019).*
Confidentiality Agreement, effective as of July 12, 2018, by and among Smith & Nephew, Inc. and Osiris Therapeutics, Inc.*
Tender and Support Agreement, dated March 12, 2019, between Smith & Nephew Consolidated, Inc., Papyrus Acquisition Corp. and Peter Friedli.*
Previously filed.
After due inquiry and to the best of their knowledge and belief, each of the undersigned certifies that the information set forth in this statement is true, complete and correct.
/s/ SUSAN M. SWABEY
Name: Susan M. Swabey
Title: Company Secretary
Name: Michael Zagger
Title: Vice President
Title: President
Dated: April 17, 2019
(a)(1)(A) Offer to Purchase, dated March 20, 2019.*


By now you've surely read about MotoCzysz's new eDD and it's "suitcase" chassis design. Recently Asphalt & Rubber got a chance to take a peak into the Portland, Oregon based company's service bay and take a closer look at the 2009 E1pc D1g1tal Superbike, with a specific interest in its quick-release swappable batteries and unique chassis design. We'll be covering these innovations in a two-part series, starting today with a never before seen look at the MotoCzysz battery packs. More and photos from Peter Lombardi Kustom Photography after the jump.
As the only bike to arrive at the Isle of Man with swappable battery packs, the MotoCzysz E1pc was the only bike at the TTXGP that seemed capable of the presumed switch to a two-lap race in 2010, which would allow for racers to pit and exchange spent batteries for fresh ones. While the design certainly would have proved a benefit had the organizers of TTXGP had their way, the real purpose of the E1pc's quick-release batteries was to aid in on-track research and development.
Needing a way to get a full day's worth of testing out of his electric motorcycle when at the race track, Michael Czysz and his team incorporated a system to quickly change out battery packs; thus allowing for there to be fresh packs waiting on the charger, ready to be swapped out while the E1pc was taking laps. Of course, the more time the bike was out testing, the more data that could be gathered and learned from.
Despite a raison d'être far removed from the proposed two laps of the Mountain Course, MotoCzysz's swappable battery design carries over with it practical applications into track and short circuit racing, especially with the refinements found in the new eDD suitcase chassis. While the first generation battery packs take only the turn of a safety screw and a jostling of the hand to be released from the E1pc's frame, "they weren't fully integrated" as Czysz explained to us. However, the next iteration of MotoCzysz's battery design inserts into the frame with a mere push of a finger, and extracts with the pull of a lever. Total swap-out time, just a few seconds compared to the original minute and a half or so.
Another counter-intuitive advancement with the 2010 E1pc is the fact the bike sports more batteries by volume and more power by density, but remains 200mm narrower than the 2009 race bike. Helping achieve this feat is the eDD's new chevron shaped battery packs, which allow for a more compact design element, and push the batteries closer to the front wheel, thus allowing for a longer swingarm design, while maintaining appropriate clearances with the front wheel and forks. The new LiPo battery cells take on a double entendre, and slim down what Czysz calls a "fat" bike when viewed from the rear. With the chevron packs in place, the 2010 E1pc is slim like a 500cc GP racer, and more narrow than the MotoCzysz C1…despite the fact the 2010 E1pc frame is actually wider than its predecessor's.
Grabbing hold of one of the old battery packs, one is surprised at the weight found in these elements of the E1pc. Judging from just my grip, I'd place a single pack at roughly 15lbs or more. Multiple this by 10, add in the cells found under the tail section, and it's easy to see where the bulk of these motorcycles reside, and where the biggest improvements can come from for future advancement. Check out the photos below of the 2009 MotoCzysz E1pc, courtesy of Peter Lombardi Kustom Photography.


Bill Matson, Life Member of Swimming New Zealand and Swimming Wellington, FINA Vice-President.
Bill had been involved in swimming administration for more than four decades, rising to become a FINA Bureau member in 1996, re-elected in 2000 and elected Vice President of FINA in 2005. He was a Past President and Life Member of Swimming New Zealand and also of the Wellington Swimming Association. He was President of Oceania Swimming Association from its inception in 1991 until 2008. He was a former board member on the New Zealand Olympic Committee.
In 2010 he was honoured by Her Majesty Queen Elizabeth II when she appointed him an Officer of the New Zealand Order of Merit for his services to swimming.


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text:
Emailhao.yan@asu.edu
1 Short survey
50 - 100 out of 208 results
Controlled nucleation and growth of DNA tile arrays within prescribed DNA origami frames and their dynamics
Li, W., Yang, Y., Jiang, S., Yan, H. & Liu, Y., Mar 12 2014, In : Journal of the American Chemical Society. 136, 10, p. 3724-3727 4 p.
Oligonucleotide Array Sequence Analysis
Nucleation
DNA-cholesterol barges as programmable membrane-exploring agents
Johnson-Buck, A., Jiang, S., Yan, H. & Walter, N. G., Jun 24 2014, In : ACS Nano. 8, 6, p. 5641-5649 9 p.
Fluorescence quenching of quantum dots by gold nanoparticles: A potential long range spectroscopic ruler
Samanta, A., Zhou, Y., Zou, S., Yan, H. & Liu, Y., Sep 10 2014, In : Nano Letters. 14, 9, p. 5052-5057 6 p.
Semiconductor quantum dots
Guest editorial: Nucleic acid nanotechnology
Seeman, N. C., Mao, C. & Yan, H., Jun 17 2014, In : Accounts of Chemical Research. 47, 6, p. 1643-1644 2 p.
Hierarchical assembly of plasmonic nanostructures using virus capsid scaffolds on DNA origami templates
Wang, D., Capehart, S. L., Pal, S., Liu, M., Zhang, L., Schuck, P. J., Liu, Y., Yan, H., Francis, M. B. & De Yoreo, J. J., 2014, In : ACS Nano. 8, 8, p. 7896-7904 9 p.
Capsid
Kinetics of DNA tile dimerization
Jiang, S., Yan, H. & Liu, Y., Jun 24 2014, In : ACS Nano. 8, 6, p. 5826-5832 7 p.
Dimerization
Lattice-free prediction of three-dimensional structure of programmed DNA assemblies
Pan, K., Kim, D. N., Zhang, F., Adendorff, M. R., Yan, H. & Bathe, M., 2014, In : Nature Communications. 5, 5578.
Low temperature assembly of functional 3D DNA-PNA-protein complexes
Flory, J. D., Simmons, C. R., Lin, S., Johnson, T., Andreoni, A., Zook, J., Ghirlanda, G., Liu, Y., Yan, H. & Fromme, P., Jun 11 2014, In : Journal of the American Chemical Society. 136, 23, p. 8283-8295 13 p.
Peptide Nucleic Acids
Azurin
182 Citations (Scopus)
Multi-enzyme complexes on DNA scaffolds capable of substrate channelling with an artificial swinging arm
Fu, J., Yang, Y. R., Johnson-Buck, A., Liu, M., Liu, Y., Walter, N. G., Woodbury, N. W. & Yan, H., 2014, In : Nature Nanotechnology. 9, 7, p. 531-536 6 p.
Reengineering the optical absorption cross-section of photosynthetic reaction centers
Dutta, P. K., Lin, S., Loskutov, A., Levenberg, S., Jun, D., Saer, R., Beatty, J. T., Liu, Y., Yan, H. & Woodbury, N. W., Mar 26 2014, In : Journal of the American Chemical Society. 136, 12, p. 4599-4604 6 p.
Photosynthetic Reaction Center Complex Proteins
Reengineering
Single-particle tracking and modulation of cell entry pathways of a tetrahedral DNA nanostructure in live cells
Liang, L., Li, J., Li, Q., Huang, Q., Shi, J., Yan, H. & Fan, C., Jul 21 2014, In : Angewandte Chemie - International Edition. 53, 30, p. 7745-7750 6 p.
Cell Tracking
Structural DNA nanotechnology: State of the art and future perspective
Zhang, F., Nangreave, J., Liu, Y. & Yan, H., Aug 13 2014, In : Journal of the American Chemical Society. 136, 32, p. 11198-11211 14 p.
Nanorobotics
A DNA tweezer-actuated enzyme nanoreactor
Liu, M., Fu, J., Hejesen, C., Yang, Y., Woodbury, N. W., Gothelf, K., Liu, Y. & Yan, H., 2013, In : Nature Communications. 4, 2127.
Nanoreactors
A perspective on functionalizing colloidal quantum dots with DNA
Samanta, A., Deng, Z., Liu, Y. & Yan, H., Dec 2013, In : Nano Research. 6, 12, p. 853-870 18 p.
Nanocrystals
Semiconductor materials
Complex archimedean tiling self-assembled from DNA nanostructures
Zhang, F., Liu, Y. & Yan, H., May 22 2013, In : Journal of the American Chemical Society. 135, 20, p. 7458-7461 4 p.
Nucleotide Motifs
DNA functionalization of colloidal II-VI semiconductor nanowires for multiplex nanoheterostructures
Deng, Z., Pal, S., Samanta, A., Yan, H. & Liu, Y., May 2013, In : Chemical Science. 4, 5, p. 2234-2240 7 p.
Single-Stranded DNA
Nanowires
DNA gridiron nanostructures based on four-arm junctions
Han, D., Pal, S., Yang, Y., Jiang, S., Nangreave, J., Liu, Y. & Yan, H., Mar 22 2013, In : Science. 339, 6126, p. 1412-1415 4 p.
DNA origami templated self-assembly of discrete length single wall carbon nanotubes
Zhao, Z., Liu, Y. & Yan, H., Jan 28 2013, In : Organic and Biomolecular Chemistry. 11, 4, p. 596-598 3 p.
Functionalized DNA nanostructures for nanomedicine
Liu, X., Liu, Y. & Yan, H., Aug 2013, In : Israel Journal of Chemistry. 53, 8, p. 555-566 12 p.
Medical nanotechnology
Mapping the thermal behavior of DNA origami nanostructures
Wei, X., Nangreave, J., Jiang, S., Yan, H. & Liu, Y., Apr 24 2013, In : Journal of the American Chemical Society. 135, 16, p. 6165-6176 12 p.
Energy Transfer
Multifactorial modulation of binding and dissociation kinetics on Two-dimensional DNA nanostructures
Johnson-Buck, A., Nangreave, J., Jiang, S., Yan, H. & Walter, N. G., Jun 12 2013, In : Nano Letters. 13, 6, p. 2754-2759 6 p.
On-chip isotachophoresis separation of functional DNA origami capture nanoarrays from cell lysate
Mei, Q., Johnson, R. H., Wei, X., Su, F., Liu, Y., Kelbauskas, L., Lindsay, S., Meldrum, D. R. & Yan, H., Oct 2013, In : Nano Research. 6, 10, p. 712-719 8 p.
Structural integrity
PNA-peptide assembly in a 3D DNA nanocage at room temperature
Flory, J. D., Shinde, S., Lin, S., Liu, Y., Yan, H., Ghirlanda, G. & Fromme, P., May 8 2013, In : Journal of the American Chemical Society. 135, 18, p. 6985-6993 9 p.
Quantum efficiency modification of organic fluorophores using gold nanoparticles on DNA origami scaffolds
Pal, S., Dutta, P., Wang, H., Deng, Z., Zou, S., Yan, H. & Liu, Y., Jun 20 2013, In : Journal of Physical Chemistry C. 117, 24, p. 12735-12744 10 p.
Quantum efficiency
Self-assembly of DNA rings from scaffold-free DNA tiles
Yang, Y., Zhao, Z., Zhang, F., Nangreave, J., Liu, Y. & Yan, H., Apr 10 2013, In : Nano Letters. 13, 4, p. 1862-1866 5 p.
Super-resolution fingerprinting detects chemical reactions and idiosyncrasies of single DNA pegboards
Johnson-Buck, A., Nangreave, J., Kim, D. N., Bathe, M., Yan, H. & Walter, N. G., Feb 13 2013, In : Nano Letters. 13, 2, p. 728-733 6 p.
Three-input majority logic gate and multiple input logic circuit based on DNA strand displacement
Li, W., Yang, Y., Yan, H. & Liu, Y., Jun 12 2013, In : Nano Letters. 13, 6, p. 2980-2988 9 p.
Majority logic
logic circuits
Logic gates
Tip induced fluorescence quenching for nanometer optical and topographical resolution
Schulz, O., Zhao, Z., Ward, A., Koenig, M., Koberling, F., Liu, Y., Enderlein, J., Yan, H. & Ros, R., 2013, In : Optical Nanoscopy. 2, 1, p. 1-8 8 p.
Unidirectional scaffold-strand arrangement in DNA origami
Han, D., Jiang, S., Samanta, A., Liu, Y. & Yan, H., Aug 19 2013, In : Angewandte Chemie - International Edition. 52, 34, p. 9031-9034 4 p.
A DNA nanostructure platform for directed assembly of synthetic vaccines
Liu, X., Xu, Y., Yu, T., Clifford, C., Liu, Y., Yan, H. & Chang, Y., Aug 8 2012, In : Nano Letters. 12, 8, p. 4254-4259 6 p.
Synthetic Vaccines
Charge transport within a Three-dimensional DNA nanostructure framework
Lu, N., Pei, H., Ge, Z., Simmons, C. R., Yan, H. & Fan, C., Aug 15 2012, In : Journal of the American Chemical Society. 134, 32, p. 13148-13151 4 p.
Charge transfer
Molecular electronics
Controlled drug release by a nanorobot
Fu, J. & Yan, H., May 2012, In : Nature Biotechnology. 30, 5, p. 407-408 2 p.
Nanorobots
Drug Carriers
DNA origami as a carrier for circumvention of drug resistance
Jiang, Q., Song, C., Nangreave, J., Liu, X., Lin, L., Qiu, D., Wang, Z. G., Zou, G., Liang, X., Yan, H. & Ding, B., Aug 15 2012, In : Journal of the American Chemical Society. 134, 32, p. 13396-13403 8 p.
Doxorubicin
DNA origami with double-stranded DNA as a unified scaffold
Yang, Y., Han, D., Nangreave, J., Liu, Y. & Yan, H., Sep 25 2012, In : ACS Nano. 6, 9, p. 8209-8215 7 p.
Effect of DNA hairpin loops on the twist of planar DNA origami tiles
Li, Z., Wang, L., Yan, H. & Liu, Y., Jan 31 2012, In : Langmuir. 28, 4, p. 1959-1965 7 p.
Conformations
Interenzyme substrate diffusion for an enzyme cascade organized on spatially addressable DNA nanostructures
Fu, J., Liu, M., Liu, Y., Woodbury, N. W. & Yan, H., Mar 28 2012, In : Journal of the American Chemical Society. 134, 12, p. 5516-5519 4 p.
Glucose Oxidase
Reconfigurable DNA origami to generate quasifractal patterns
Zhang, F., Nangreave, J., Liu, Y. & Yan, H., Jun 13 2012, In : Nano Letters. 12, 6, p. 3290-3295 6 p.
helices
Robust DNA-functionalized core/shell quantum dots with fluorescent emission spanning from UV-vis to near-IR and compatible with DNA-directed self-assembly
Deng, Z., Samanta, A., Nangreave, J., Yan, H. & Liu, Y., Oct 24 2012, In : Journal of the American Chemical Society. 134, 42, p. 17424-17427 4 p.
Simultaneous Atomic Force and Confocal Fluorescence Microscopy for Correlated Nanometer Topographical and Optical Resolution
Schulz, O., Zhao, Z., Ward, A., Liu, Y., Yan, H. & Ros, R., 2012, In : Microscopy and Microanalysis. 18, p. 882-883 2 p.
Confocal microscopy
Spatially-interactive biomolecular networks organized by nucleic acid nanostructures
Fu, J., Liu, M., Liu, Y. & Yan, H., Aug 21 2012, In : Accounts of Chemical Research. 45, 8, p. 1215-1226 12 p.
Steric crowding and the kinetics of DNA hybridization within a DNA nanostructure system
Pinheiro, A. V., Nangreave, J., Jiang, S., Yan, H. & Liu, Y., Jun 26 2012, In : ACS Nano. 6, 6, p. 5521-5530 10 p.
Challenges and opportunities for structural DNA nanotechnology
Pinheiro, A. V., Han, D., Shih, W. M. & Yan, H., Dec 2011, In : Nature Nanotechnology. 6, 12, p. 763-772 10 p.
DNA-directed artificial light-harvesting antenna
Dutta, P. K., Varghese, R., Nangreave, J., Lin, S., Yan, H. & Liu, Y., Aug 10 2011, In : Journal of the American Chemical Society. 133, 31, p. 11985-11993 9 p.
DNA directed self-assembly of anisotropic plasmonic nanostructures
Pal, S., Deng, Z., Wang, H., Zou, S., Liu, Y. & Yan, H., Nov 9 2011, In : Journal of the American Chemical Society. 133, 44, p. 17606-17609 4 p.
Dimers
DNA nanostructures as models for evaluating the role of enthalpy and entropy in polyvalent binding
Nangreave, J., Yan, H. & Liu, Y., Mar 30 2011, In : Journal of the American Chemical Society. 133, 12, p. 4490-4497 8 p.
Biophysical Phenomena
DNA origami: A quantum leap for self-assembly of complex structures
Tørring, T., Voigt, N. V., Nangreave, J., Yan, H. & Gothelf, K. V., Dec 2011, In : Chemical Society Reviews. 40, 12, p. 5636-5646 11 p.
DNA origami with complex curvatures in three-dimensional space
Han, D., Pal, S., Nangreave, J., Deng, Z., Liu, Y. & Yan, H., Apr 15 2011, In : Science. 332, 6027, p. 342-346 5 p.
Encapsulation of gold nanoparticles in a DNA origami cage
Zhao, Z., Jacovetty, E. L., Liu, Y. & Yan, H., Feb 25 2011, In : Angewandte Chemie - International Edition. 50, 9, p. 2041-2044 4 p.
High-quality manganese-doped zinc sulfide quantum rods with tunable dual-color and multiphoton emissions
Deng, Z., Tong, L., Flores, M., Lin, S., Cheng, J. X., Yan, H. & Liu, Y., Apr 13 2011, In : Journal of the American Chemical Society. 133, 14, p. 5389-5396 8 p.
Zinc sulfide
phosphine
Insulator-Based dielectrophoretic (iDEP) manipulation of DNA origami in a microfluidic system
Gan, L., Ding, B., Yan, H. & Ros, A., Jan 1 2011, 2011 Annual Meeting of the American Electrophoresis Society, AES 2011 - Topical Conference at the 2011 AIChE Annual Meeting. AIChE, p. 87-88 2 p.
Microfluidics