![]() ![]() Plus, it can rip DVD on Windows 10/11 to MP4, HEVC, AVC, AVI, MPEG, WMV, FLV, WMA, MP3, mobile phones, iPad, Samsung, Xbox, PSP, etc. ![]() It can rip homemade and encrypted DVDs, regardless of their type, including movie DVDs, workout DVDs, music DVDs, game DVDs, educational DVDs, software installation DVDs, etc. How to Rip a Protected DVD on Windows 10 or 11 ComputerĬisdem Video Converter is definitely an expert in the field of DVD ripping. If your DVD is copy-protected, you will receive an error message stating that the disk is encrypted. Play DVD: Use VLC Media Player to play individual VOB files instead of the entire DVD folder, as VLC can't unlock the encryption of a single VOB.īurn DVD: Create an ISO file from DVD with ImgBurn. There are three methods to determine whether a DVD is copy-protected.Ĭheck what the DVD looks like: It says "Copy Protected" or something similar. How do you tell if a DVD is copy-protected? Among them, DVD DRM and Region Code are the most widely used. The technologies include CSS, Macrovision, ARccOS, Safedisc, DVD Region Code/RCE, UOP, Disney Fake, RipGuard and ACP, and more. Film production companies like Warner Bros, Disney, Paramount Pictures, DreamWorks, etc., or copyright holders would like to apply encryption techniques to DVDs. The purpose of DVD copy protection is to prevent DVD content from unauthorized copying and distribution. What does it mean when a DVD is copy-protected? Effortlessly download videos from YouTube and other 1000+ websites.Also allows conversion between multimedia formats.Edit videos on DVD by trimming, cropping, adding effects/subtitles, etc.Batch rip DVD titles or merge them to rip one DVD title.Rip DVD with audio sound and subtitles kept.Decrypt DVD protected by DRM, region code, CSS, multi-angle, RCE, etc.Rip DVD disc, DVD folder, ISO, and copy-protected DVD.Help to rip DVD to computer, USB, SD card, hard drive, iTunes, etc.Rip DVD to video, audio, and in-built device preset, totally 300+ outputs.Cisdem Video Converter The Best App to Rip DVD on Windows 10/11 ![]()
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![]() ![]() “I’ve learned first and foremost how many people want to promote a healthier campus. Problem-Solving Skills Training (PSST), the treatment approach we consider in this chapter, is designed to teach aggressive youngsters to use their heads. If you have questions or would like to be notified of future trainings, please contact the training instructors Alex Kim or Andy Tew learned a great deal about strategies to navigate conversations I would generally be uncomfortable with.” – Lorraine Thomas, senior Our addictions training calendar, and bespoke training service features options for virtual and face-to-face course delivery. Trainings are held each semester and over interterm and are open to all students. Objectives To evaluate the feasibility and efficacy of a handheld personal digital assistant (PDA)-based supplement for maternal Problem-Solving Skills Training (PSST) and to explore Spanish-speaking mothers’ experiences with it. There is no on-going commitment after the training, though there may be additional training and volunteer opportunities. We ask students to make a commitment to participate in all 3 sessions. PSST is an interactive training involving group discussion and role playing to provide hands-on practice to build skills and confidence in addressing difficult situations. How to connect students to appropriate resources.How to respond to emotional/mental health concerns.Listening, support and communication skills. ![]() Over the decades, PSST has established a reputation for its client-centered service and integration and compliance solutions that save time, money and resources for K-12 districts and businesses in. Peer Support Skills Training (PSST) is designed to equip students with the skills and information they need to be able to respond effectively when their friends are in struggling. PSST was founded in 1990 with a vision for improving efficiencies for K-12 and business administrators with integration and compliance solutions. When students experience emotional and mental health difficulties, they are most likely to turn to their friends first. These results demonstrate that PSST is an effective cognitive-behavioral based intervention to decrease disruptive behavior for children in the school setting.Spring 2020 training: 2:00pm-4:30pm on Friday February 21, February 28, and March 6 Significant decreases in problem behavior were found in both teacher-report measures and time out room referrals for the active treatment group over time. The study at hand examines the use and effectiveness of PSST in a school context comparing a delayed waitlist control group to a treatment group through a teacher-report measure of behavior and frequency of time out room referrals. Following this training, several additional modifications were made to the therapy manuals, including the creation of a brochure for parents which illustrated the steps of the problem solving process using vignettes of families of children with chronic pain. Registration for these workshops and follow up support is limited to. A two-day training workshop was held to train three therapists in PSST. One such cognitive-behavioral therapy that is effective for decreasing disruptive behaviors in children is Problem Solving Skills Training (PSST) (Kazdin, 2017), however there is no published evaluation of PSST in a school setting. Welcome to the Bright IDEAS Problem-Solving Skills Training (PSST) application page. of the vulnerable population through temporary employment and training. Meta-analyses have shown several evidence-based treatments for disruptive behavior with cognitive-behavioral therapy being an effective approach (Eyeberg, Nelson, & Boggs, 2008 McCart & Sheidow, 2016). and Social Sector Transformation Project (PSST) : restructuring (Ingls). The presence of these disruptive behaviors take a negative toll on the environment including the education setting, criminal justice system, public health services, and families (Tolan and Leventhal, 2013 Cuffel, 1997). Disruptive behaviors in children are a class of behaviors that involve problems with impulse control, regulating emotions, compliance, aggression, and respecting the rights of others or societal norms (American Psychiatric Association, 2013 Nelson, 1996). ![]() ![]() Like other Netgear modems, it has a one-year warranty. The CM600 is a little on the tall side, but it's got a funky futuristic look. (There's a firmware update that resolves this issue, though ISPs roll out such updates on their own schedule.) Because of that, you can expect reliable performance from the Netgear CM600 without the lags reported by users with Puma-6-powered modems. ![]() Netgear's modem doesn't use the Intel Puma 6 chipset that's been blamed for latency issues with some other high-speed modems, such as the Arris Surfboard SB6190. Netgear's CM600 is the best cable modem for those higher speeds, though you'll pay a little bit more than you would for the CM500. If your plan promises download speeds that top 300 Mbps, you'll want a cable modem that can take advantage of that greater performance. While most homes opt for internet plans that promise speeds of around 100 to 300 Mbps, some people prefer higher-speed service. At 7.3 inches, the CM500 is a little taller than the SB6183, and we ound its indicator lights difficult to see, although at night, you may appreciate the lack of a light show. Netgear's 16 x 4 modem enjoys wide compatibility with internet-service providers, and its design makes setup a breeze. However, Netgear only offers a one-year warranty, compared with two years for those rival modems. Opt for Netgear's CM500, and you'll get a modem that's just as capable as the Motorola MB7420 or the Arris SB6183. There's actually very little performance difference among the best cable modems in our testing, so it's seemingly slight distinctions that separate these devices. (If you've got a high-speed plan, look for a faster modem.) The Netgear CM500 works with the biggest cable providers and supports speeds of up to 300 Mbps, which should be enough for the vast majority of Internet users out there. Anytime you can find a new CM500 for around $50, that's a good buy. The Netgear CM500 remains one of the best cable modems available, and you can usually find it for a $5 to $10 less than the Motorola MB7420 most of the time. That means better protection for your investment, as the best cable modems tend to last for several years. But the edge goes to Motorola because it offers a two-year warranty to Netgear's one-year of coverage. ![]() There's not much separating the Motorola MB7420 from the Netgear CM500 as both performed dependably when we tested each modem. We also found the modem easy to set up with a coaxial connector sticking out of the modem's backside at a comfortable distance from its lone ethernet port. The blue and green lights on the MB7420 are bright enough to read at a distance without turning a dark room into a laser light show at night. Its gray color should blend in well with other networking equipment. At least, the MB7420 looks stylish, with rounded corners and vented sides. The MB7420 isn't as tall as the Netgear CM500, our previous pick for the best cable modem - and still a good choice as you'll see below - though some people may prefer the more compact size of the Arris Surfboard modems. With the MB7420 at home, Phil has enjoyed steady connectivity, and that's with multiple people stuck inside, all trying to hit the internet at once. If you can find the MB7420 for $60 or less, it's hard to track down a better value.Ĭapable of supporting speeds available to a majority of home internet plans, the MB7420 is ideal for internet plans that top out at 300 Mbps. In fact, managing editor at Tom's Guide Philip Michaels has been using the MB7420 for nearly two years without a single complaint. The Motorola MB7420 is the best cable modem for most homes. Learn more about how internet speed can be affected by which cable modem you use in my article, Does a Modem Affect Internet Speed?. So we recommend getting a DOCSIS 3.1 modem. The downside to getting a modem with DOCSIS 3.0 is that it's not fully supported by Xfinity, even though it may still work. DOCSIS 3.0 is good enough for slower connections, but DOCSIS 3.1 is ideal for future-proofing performance. The different versions of DOCSIS mainly determine the speed of your Internet connection coming from the coax cable. DOCSIS 3.1 is the current standard, and DOCSIS 4.0 will be available in the future. There are multiple versions of DOCSIS available. ![]() ![]() Coax cables are the cables often used for cable TV. DOCSIS makes it possible for a cable modem to connect to the Internet by using the coax cable in your wall. DOCSIS (Data Over Cable Service Interface Specification) is the international data transfer standard for existing cable television systems (CATV). ![]() ![]() ![]() Edvard Munch, The Scream, 1893: This is another landscape reference that occurs with Friedrich's Wanderer Above the Sea of Fog. Munch could identify with Friedrich's representative landscapes and in this work a clear reference is seen to Friedrich's Man and Woman Contemplating the Moon. Among his admirers was Symbolist painter Edvard Munch whose work has been explicitly related to Friedrich's. His poise is one of a confident man, he leans on his cane, and a relaxed hand rests in his pocket.Įdvard Munch, The Lonely Ones, 1899: Friedrich influenced only a few artists that followed him. In line with Friedrich's other works, and the overall Romantic ideal, it seems fitting to believe that this wanderer stands in awe of the spooky nature before him. Tone elicited: As the viewer cannot see the figure's face, the tone is questionable. The rock the mysterious figure stands on remains mostly in silhouette form, though some detail is visible at the top near the figures' feet. Use of light: The light seems to be coming up from beneath the rock, somehow illuminating the fog. He paints the figure in a dark green coat - typical German attire. He mixes blues and pinks across the sky with the mountain and rock in the distance echoing these colors. Color palette: For this composition Friedrich uses a slightly brighter palette than usual. By separating the figure and the viewer, the latter focuses more on the beauty of the surroundings rather than the man's role in nature. This makes the figure something of a mystery to the viewer - they are unsure what he is thinking or his reaction to the landscape that they too are taking in. Use of technique: Once again Friedrich employs the Ruckenfugen technique in which he paints the figure with his back towards the viewer. The upright position of the canvas models the uprightness of the figure in the painting. Composition: Friedrich chose to paint this landscape vertically instead of the much seen horizontal orientation. His use of color and lighting is also notable. He depicts the mountains, the trees, and the heavy mist above the sea.įriedrich executes a unique composition and employs his famous technique in Wanderer Above the Sea of Fog. He was always greatly inspired by German landscape and deeply moved of the beauty he found in his homeland. Though Friedrich painted this scene in his studio, he sketched it at the place of inspiration, Elbsandsteingebirge, in Saxony and Bohemia. As this man was most likely killed in 1813 or 1814, this painting may also serve as a patriotic tribute. ![]() He wears the green uniform of the volunteer rangers, those called into service against Napoleon by King Friedrich Wilhelm III of Prussia. ![]() Friedrich Gotthard von Brincken, of the Saxon infantry. ![]() Though some believe this to be a self-portrait tradition recounts that the figure in Wanderer Above the Sea of Fog is a particular person, a high-ranking forestry officer, Col. By placing his back toward the viewer he is not shutting them out - rather he enables them to see the world through his own eyes, to share and convey his personal experience. He wonders in that moment about the unforeseen future. The figure stands in contemplation and self reflection, mesmerized by the haze of the sea fog as if it were a religious and spiritual experience. The young figure standing in contemplation has the same fiery red hair as the artist. Some believe Wanderer Above the Sea of Fog to be a self portrait of Friedrich. ![]() ![]() You can also find our outlets in Dhaka, Chattagram, Khulna, Gazipur, and Rangpur to get your desired product without having any kind of second thoughts about the product. You can order online and get the product delivered to you either through a home delivery service, if you are located in Dhaka City, or get it couriered to your desired destination anywhere in Bangladesh. After cuneiform was replaced by alphabetic writing sometime after the first century A.D., the hundreds of thousands of clay tablets and other inscribed. Star Tech is bringing the top of line, XP Pen Graphics Tablets at affordable pricing. The gorilla glass display allows for better resistance from scratches and from breaking. Each of these tablets can be carried easily and effortlessly. There are tablets with screens, without screens, wired, wireless, multiple hotkeys, and many other perks to help you have a better experience on your work and also be able to work on the go. tableta y portátil, mejor que tablet y notebook Tableta es una alternativa en español al anglicismo tablet, y la voz portátil puede sustituir a los vocablos notebook o laptop. There is a huge range of XP-Pen graphics tablets available with many different specifications and features. The company also specializes in graphics tablets, pen display monitors, light pads, stylus pens, and digital graphical products. iScribe has a solution that is affordable, effective, and simple to install. The digitalization of healthcare was intended to improve medical information systems, and yet the surge of EHR mandates in the past decade has only served to shift the burden of data onto doctors. XP-Pen also has a holding on the subsidiaries of Hanvon Ugee Group, China. iScribe is on a mission to make medicine about care, not clicks. ![]() In the United States, XP-Pen Technology Co was founded in 2015 and opened its office in Shenzhen, China. 3 years later an office was established in Taiwan. The company also specializes in graphics tablets, pen display monitors, light pads, stylus pens, and digital graphical products. The XP-PEN is a graphics tablet research and development brand that was founded in 2005 in Japan. Included With: Special pen using standard refill with Extra Refill and Removal Extractor, USB Cable, Digital Writing Pad, and User Manual.Buy the Top Quality XP-Pen Graphics Tablet at the best Price in Bangladesh Complimentary Product for Smart Classrooms, Online Teaching, Learning, Online Meeting Notes, corporate trainersĥ. USB Connectivity, works On Not Just Paper, Even Notebooks (up to 200 Pages), The Files Can Be Saved Played Back. Annotate on PDF /PPT files Create your own AV contents output as MP4 files Saved files can be recalled Edited and Played back, Play Back as per sequence with 3-speed OptionsĤ. Free Online Assistance is available for Demo and Installation guidance post-purchase, contact the below-mentioned details in the manufacturer contact field.ģ. ![]() When the iScribe software has not been accessed for a specific length of time. ![]() Chalk And Talk Experience Write Naturally Retrieve Digitally, Screen Share Of Live Notes /writings Through Any Video Conferencing Platforms, Save File, Multiple Pages As One File, Export To Pdf. 200-day supply, take 1/2 tablet in the morning, with no refills. In OneNote, each page has a title, and the title appears on the page tab on. Digital Graphic Writing Pad for Online Teaching Size: A4 Paper Holder Size, Active Area (210mm X 291.5mm), Colour Black, Plug & Play, USB Interface - Comfortable for both left- and right-hand users. Around 2000, I began writing electronic prescriptions using iScribe for Palm. ![]() ![]() Action may, however, be taken against players who fraudulently report. Click 'Report User' and tell us what sort of problem you're having.False reports of another player is a violation of the Terms of Service and actions will not be taken against the player reported. Click on their name to open the user's Profile.5. Search for the Origin ID of the user you want to report.4. We encourage an open, free and collaborative environment and offer a vast and resourceful file database, a wiki thats packed with structured information and tutorials, access to the most intelligent. ![]() Due to our Privacy Policy, EA will be unable to disclose the results of this investigation, or any actions taken against the reported account. Xbox: Find their name in the recent players list > File Complaint > Cheating > Submit.PSN: : a player on Origin:1. UnKnoWnCheaTs is the oldest game cheating forum in existence, leading the game cheating community for over 20 years. If you want to report someone or already have, EA will investigate this report and take action in accordance with our Terms of Service. Comments 53 4 Upgrades The following items become available when you earn the indicated amount of Experience Points. The trainer for Battlefield Bad Company 2 is a literal toy box for shooter fans. Gold: Knife kill a player ranked 46 to 50. It doesn’t exactly take Modern Warfare 2’s throne, but the great online play is back and with a beefed up single player it comes close. Read the full article on reporting users here: Battlefield Bad Company 2 is every bit as fun as its predecessor, perhaps even a bit more. Click 'Report User' and tell us what sort of problem you're having.įalse reports of another player is a violation of the Terms of Service and actions will not be taken against the player reported. Weapon: XM8 Prototype - 3,020 Experience Points. Gadget: Ammo Box - 1,180 Experience Points. Click on their name to open the user's Profile.ĥ. The following items become available when you earn the indicated amount of Experience Points. Search for the Origin ID of the user you want to report.Ĥ. Battlefield: Bad Company 2 Cheat Codes, Trainers, Patch Updates, Demos, Downloads, Cheats Trainer, Tweaks & Game Patch Fixes are featured on this page. ![]() Xbox: Find their name in the recent players list > File Complaint > Cheating > Submit.ģ. Due to our Privacy Policy, EA will be unable to disclose the results of this investigation, or any actions taken against the reported account. ![]() ![]() ![]() ![]() Let's not pretend otherwise: this seems to be what used to be known as an 'unofficial DVD release', a 'bootleg' - and looks like it has been compiled from a Japanese TV broadcast concert, complete with fixed Japanese text. For the moment we'll ignore the fact that she has totally ignored her country of birth by continually snubbing the UK - only ever appearing here on TV to promote her latest CD compilation or some miracle jungle juice. We should therefore be grateful for this release. Given the number of concerts Olivia has given around the world, predominantly in the USA and Asia, there is precious little available of her live performances in DVD format. To learn more about how and for what purposes Amazon uses personal information (such as Amazon Store order history), please visit our Privacy Notice. You can change your choices at any time by visiting Cookie Preferences, as described in the Cookie Notice. ![]() Click ‘Continue without accepting’ or ‘Customise Cookies’ to decline these cookies, make more detailed choices or learn more. Third parties use cookies for the purposes of displaying and measuring personalised advertisements, generating audience insights, and developing and improving products. This includes using first- and third-party cookies which store or access standard device information such as a unique identifier. If you agree, we will also use cookies to complement your shopping experience across Amazon stores as described in our Cookie Notice. We also use these cookies to understand how customers use our services (for example, by measuring site visits) so we can make improvements. We use cookies and similar tools that are necessary to enable you to make purchases, to enhance your shopping experiences, and to provide our services, as detailed in our Cookie Notice. ![]() ![]() ![]() The first thing you’ll need to do is choose the screen recording software you’ll use. How to choose your desktop screen recorder This could leave you needing extra tools and software just to edit and share your videos. The problem with many built-in screen recorders that come as standard on your computer (and some third-party ones) is that they limit you to just recording. ![]() Not all software offer this level of functionality, but these ‘extra’ tools can have a big impact on the screen recordings you create. You can use free apps like QuickTime (on Mac) or Xbox App (Windows), but if you’re comparing different screen recording tools, make sure you get a screen recorder with sound recording and video editing options built-in. We’ll also discuss the difference between using built-in screen recording tools and third-party software such as Camtasia and Snagit.īy the end of this article, you’ll know exactly how to start a screen recording on your laptop, PC or Mac.ĭownload one of our free screen recorder trials (on Windows or Mac) to quickly and easily record your computer screen.ĭownload now! Should I use a free screen recorder? In this article, we’ll look at how to record your screen with audio so that your viewers can hear what you’re saying and see what you’re doing. So if you’re asking yourself: “How can I record my screen?” Don’t worry. If the key purpose of your videos is knowledge sharing, you’ll want to make sure that the software you use can also record sound, as giving your viewers audio instructions will make it easier for you to convey information and for them to digest it. These factors will also influence your decision when finding the best screen recording software. Regardless of who you are or what you do, there’s a good chance you’ll need to capture different types of screen recordings depending on your audience, the purpose of your video, and even the length of it.įor example, a how-to video (often referred to as a screencast) demonstrating a brand-new product will probably need to be longer and more polished than a simple video showing a colleague how to take screenshots on their computer. However, knowing how to screen record on a laptop or PC with sound will make your videos even more impactful. Whether you’re a software developer that needs to create a how-to video, you need to record your screen for a presentation, or simply want to make a helpful YouTube video, being able to capture a screen recording is essential in today’s world. ![]() ![]() ![]() Tell your healthcare provider if you have any of the following:Įxcessive bleeding, or bleeding longer than 2 days after the procedureįoul-smelling fluid drains from your vagina Your healthcare provider will tell you when to return for more treatment or care. You may go back to your normal diet unless your healthcare provider tells you otherwise. This might be no strenuous activity or heavy lifting. You may also have other limits on your activity. Take only advised medicines.ĭon’t douche, use tampons, or have sex for 2 to 3 days after an endometrial biopsy, or as advised by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Take a pain reliever as advised by your healthcare provider. It's normal to have some mild cramping and spotting or vaginal bleeding for a few days after the procedure. You may want to wear a sanitary pad for bleeding. If you had any type of sedative, you will need someone to drive you home. What happens after an endometrial biopsy?Īfter the procedure, you may rest for a few minutes before going home. They will send the tissue to a lab for study. Your provider will remove the catheter and speculum. The amount of and place where the tissue is removed depends on the reason for the endometrial biopsy. The provider will then gently turn and move the tip of the catheter in and out to collect small pieces of endometrial tissue. The provider will withdraw the inner tube, creating suction at the end of the catheter. The catheter has a smaller tube inside it. Your provider will put a thin tube (catheter) through the cervical opening into the uterus. This is done to find the length of the uterus and place for biopsy. Your provider may put a thin, rod-like tool called a uterine sound through the cervical opening. You may feel some cramping when it is used. Your provider may use a type of forceps to hold the cervix steady for the biopsy. Or they may use a numbing spray on your cervix. Your provider may numb the area using a small needle to inject medicine. Your provider may clean your cervix with an antiseptic solution. It's used to spread the walls of the vagina apart to view the cervix. Your healthcare provider will put a tool called a speculum into your vagina. You will lie on an exam table, with your feet and legs supported as for a pelvic exam. You will empty your bladder before the procedure. You will undress fully or from the waist down. Generally, an endometrial biopsy follows this process: Procedures may vary based on your condition and your healthcare provider’s practices. Or it may be one as part of your stay in a hospital. What happens during an endometrial biopsy?Īn endometrial biopsy may be done in a healthcare provider's office. You may want to bring a sanitary napkin to wear home after the procedure.īased on your condition, your healthcare provider may call for other preparation. If your provider gives you medicine to relax (sedative) before the procedure, you will need someone to drive you home afterward. You may need to schedule the procedure for a certain time of your cycle. Your healthcare provider may ask you to keep a record of your menstrual cycles. You may be told to stop these medicines before the procedure. Also tell your provider if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. Tell your healthcare provider if you have a history of bleeding disorders. Tell your healthcare provider of all prescription and over-the-counter medicines, vitamins, and herbal supplements that you are taking. Tell your healthcare provider if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthesia. Your healthcare provider may want to do a pregnancy test to be sure. Tell your healthcare provider if you are pregnant or think you could be. ![]() But your healthcare provider may advise you to take a pain reliever 30 minutes before the procedure. Generally, you won’t need to do any preparation before the procedure. Read the form carefully and ask questions if something isn't clear. You will be asked to sign a consent form that gives your permission to do the procedure. Your healthcare provider will explain the procedure and you can ask questions. How do I get ready for an endometrial biopsy? ![]() ![]() ![]() Since the concept of fractals has often been applied in many scientific studies to evaluate complex phenomena and objects including lung morphology, this review is aimed at summarizing the fractal properties in nature and to describe the potential of the fractal concept for quantifying the complexity of airway disease, emphysema, and vascular abnormalities in COPD. Nonetheless, these simple quantifications of lung structure do not capture the complexity of the size and spatial distributions of the pathological features in COPD lungs. Indeed, the area and volume of emphysematous regions, the wall and lumen cross-sectional area (CSA) of airways, and the volume of smaller vessels have been measured and utilized as indexes of emphysema severity, airway remodeling, and reduced vascularity and shown to be associated with various outcomes of COPD ( Grydeland et al., 2010 Haruna et al., 2010 Matsuoka et al., 2010 Han et al., 2011). CT is accessible and less invasive and allows for a 3D separate evaluation of airway disease, emphysema, and vascular abnormality for the whole lungs ( Lynch and Al-Qaisi, 2013 Labaki et al., 2017). Alternatively, CT is commonly used to estimate the pathology of the lungs and extrapulmonary abnormalities. Even when histological samples are obtained from a biopsy specimen, these samples are usually small or affected by other diseases, such as malignancy, and cannot represent the heterogeneous structural changes in whole lungs. Histology is a gold standard for the morphological analysis of COPD lungs, but histology is too invasive to perform in live patients. A combination of these airway, lung parenchyma, and vessel lesions underlies the structural heterogeneity, which not only influences lung function but can be a driving factor for the disease progression in patients with COPD ( Mondoñedo et al., 2019). Furthermore, morphological alteration of vessels is also a pathological feature, and pulmonary hypertension is a common comorbidity in patients with COPD ( Matsuoka et al., 2010 Coste et al., 2019). For example, COPD patients with similar airflow limitation may have substantial near homogeneously-distributed emphysema without airway disease, moderate upper-dominant heterogeneously-distributed emphysema with moderate airway disease, or little emphysema with severe airway disease ( Schroeder et al., 2013 Lynch et al., 2015). Additionally, the heterogeneous spatial distribution of these two pathological changes in each patient complicates understanding of the structural basis of the disease. ![]() Emphysema and airway disease are two main pathological changes that contribute to airflow limitation, but their relative contributions to the disease differ among patients. Airflow limitation measured by spirometry is a key physiological feature and gold standard to diagnose COPD. Therefore, the power-law and fractal analysis of the parenchyma and airways, especially when combined with computer simulations, could lead to a better understanding of the structural alterations during the progression of COPD and help identify subjects at a high risk of severe COPD.Ĭhronic obstructive pulmonary disease (COPD) is a major respiratory disease that imposes a high social health burden worldwide ( Adeloye et al., 2015). ![]() Simulations are also useful to understand the mechanism of disease progression. The FD of the airway tree shape and the D of the size distribution of airway branches have been proposed indexes of structural assessment and clinical predictions. Although D is not the same as FD of emphysematous clusters, it is a useful index to characterize the spatial pattern of disease progression and predict clinical outcomes in patients with COPD. Power-laws can also manifest in other statistical descriptors of structure such as the size distribution of emphysema clusters characterized by the power-law exponent D. This fractal property is governed by power-law functions characterized by the fractal dimension (FD). An object forms a fractal if it exhibits the property of self-similarity at different length scales of evaluations. Since the concept of fractals has been successfully applied to evaluate complexity of the lung, this review is aimed at describing the fractal properties of airway disease, emphysema, and vascular abnormalities in COPD. ![]() While simple measurements of areas and volumes of emphysema and airway structure are common, these methods do not capture the structural complexity of the COPD lung. 2Department of Biomedical Engineering, Boston University, Boston, MA, United StatesĬhest CT is often used for localizing and quantitating pathologies associated with chronic obstructive pulmonary disease (COPD).1Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.Naoya Tanabe 1 * † Susumu Sato 1 † Béla Suki 2 Toyohiro Hirai 1 ![]() |
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