text:
|Publication number
|Publication type
|Application number
|Publication date
|28 Apr 1998
|Filing date
|7 Jun 1996
|Priority date
|2 Jun 1995
|Fee status
|Also published as
|Publication number
|Igor Strukel, William Banko
|Original Assignee
|Surgical Design Corporation
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (42), Referenced by (52), Classifications (17), Legal Events (9)
|External Links: USPTO, USPTO Assignment, Espacenet
This is a division of application Ser. No. 08/458,409, filed Jun. 2, 1995, now pending.
1. Field of the Invention
The present invention relates to an apparatus for surgically removing a cataractous lens from a human eye. More specifically, the present invention relates to an improved flexible phacoemulsification sleeve with a built in reinforcing member, a phacoemulsification sleeve with a barrier connected to the tip to direct infusion from a single or multiple infusion hole while permitting minimal or no occlusion, a tip for a phacoemulsification handpiece with different configuration of barriers and baffles to increase cutting and a side opening to amplify fluid flow to the tip, a phacoemulsification handpiece with a valve to regulate the rate of evacuation, a phacoemulsification handpiece with a variable aperture aspiration line, a sleeve that includes a built-in reservoir, a stepped inside ultrasonic needle to direct ultrasonic waves to enhance emulsification and aspiration, and a sleeve that is compressible and rotatably connected to the handpiece in a fluid tight manner.
2. Discussion of the Related Art
The human eye contains a lens which focuses on the retina, the sensory membrane that lines the eye and receives the image formed by the lens. Through trauma, age, disease, mutation, or naturally occurring processes, the natural crystalline lens may become opaque or cloudy and thus cease to clearly transmit and focus light. This clouding of the lens is known as a cataract.
In the last few decades, techniques have been developed to surgically remove the cataract lens and replace it with an artificial or intraocular lens. This cataract lens extraction process may be performed by a number of medically recognized techniques. One of the more well known and widely used techniques is phacoemulsification.
The phacoemulsification procedure involves placing two concentric tubes through a corneal incision of approximately three millimeters. This incision is made in the region of the limbus where a colored portion of the eye meets a white portion of the eye. The incision can also be made in the cornea. The inner tube, known as a needle, is ultrasonically vibrated such that its vibrating tip member operates to emulsify the hard nuclear material of the cataract lens.
In this type of surgery, the vibrating inner tube also functions as an aspirator so that the emulsified cataract lens material may be aspirated out of the eye. The outer tube, known as a sleeve, functions as an irrigator allowing for inflow of saline fluid into the eye. The saline fluid serves several purposes. First, the presence of the saline fluid prevents the cornea from collapsing as the lens material is emulsified and aspirated. Second, the saline aids in the aspiration of the cataract lens material out of the eye. The concentric tubes of a handpiece of the system are attached to an external power source, fluid source, and vacuum source, which provide for controlled ultrasonic vibration, irrigation, and suction.
The importance of infusing a fluid into the eye during cataract surgery cannot be understated. The fluid infusion serves to maintain the eye in an inflated, pressurized condition during cataract removal. However, there are several factors that increase the difficulty with which the eye structure can be maintained and supported in an inflated, pressurized condition during cataract surgery.
One of the prevalent causes of diminished inflation of the eye during cataract surgery is leakage of fluid from the eye. This leakage normally occurs between the edges of the incision and the exterior surface of the infusion sleeve. This leakage can have significant deleterious consequences to the success of the surgery being performed.
One of the adverse consequences of fluid leakage is that there is a tendency for the eye to deflate during the operation. This deflation causes certain tissues within the eye to collapse on each other or on the surgical instrument that extends into the eye. The tissues most likely to be damaged from the consequences of such fluid loss are the cornea, the iris, and the lens capsule, which surround the cataract. One method of counteracting this fluid leakage is to increase the amount of fluid flow in order to maintain proper inflation of the eye. However, this approach is not a satisfactory solution to the problem of fluid leakage from the eye because the greater the infusion of fluid into the eye, the more the flow becomes rapid and even turbulent. This can cause damage to the cornea, especially to the fragile cells that line the inside of the cornea.
The fragile cells that line the inside of the cornea are known as corneal endothelium and cannot be regenerated by the eye. Once these cells are damaged or destroyed, they cannot be repaired or replaced by human regeneration. Also, damage to the corneal endothelium can cause permanent damage to the cornea, resulting in corneal clouding and decreased vision, all of which may require a corneal transplant. It should be noted that the most common cause of corneal clouding and corneal transplantation in the United States today are complications from eye surgery for cataract removal and intraocular lens insertion.
As a result, the phacoemulsification procedure would be significantly improved if corneal damage as a result of fluid flow leakage during intraocular surgery could be reduced or eliminated.
Most infusion sleeves used for phacoemulsification or intraocular surgery are made of silicone or silicone-type material. However, the use of silicone sleeves presents significant problems with respect to fluid leakage between the incision edge in the eye and the exterior surface of the silicone infusion sleeve. This is due to the fact that the incision in the eye must be larger than the silicone infusion sleeve, since the silicone infusion sleeve is made from a soft, compressible material and cannot be used safely when inserted through an incision in the eye where there is a minimal amount of clearance between the incision and the exterior of the silicone infusion sleeve.
When there is a minimal amount of clearance between the exterior of the silicone infusion sleeve and the incision in the eye, the incision tends to compress the non-rigid silicone sleeve against the vibrating tip, resulting in a relative rubbing movement between the silicone sleeve and the vibrating tip. This rubbing movement generates undesirable heat as the needle in the tip is vibrated at relatively high frequencies. The heat thus generated is extremely undesirable and can result in thermal burns and shrinkage of ocular tissue surrounding the silicone infusion sleeve.
The burning and shrinkage of ocular tissue is a serious problem that has sight threatening implications. The rubbing of the infusion sleeve against the vibrating needle also constricts the path for fluid flow into the eye, thus impeding efforts to keep the eye pressurized and inflated.
In an attempt to reduce the infusion fluid leakage and the deleterious effects that can be caused by the undesirable friction, some infusion sleeves have been constructed from rigid non-compressible materials. Generally, these materials have consisted of teflon or metallic-based compositions. These rigid non-compressible infusion sleeves have been somewhat successful in solving the constriction problems in the fluid flow path between the distal end of the infusion sleeve and the vibrating tip. In addition, these sleeves have also reduced the heat generation and thermal burns associated with silicone-type sleeves.
While rigid, non-compressible sleeves are capable of being inserted through smaller incisions that reduce leakage through the clearance between the rigid, non-compressible sleeve and the incision, there is still a significant amount of leakage. The primary cause of this remaining leakage is that the cross section of the rigid, non-compressible sleeve does not match the shape or contour of the eye incision. As a result, there are fairly substantial gaps between the rigid, non-compressible sleeve exterior surface and the eye incision. This is due to the fact that the collagen fiber structure of the cornea resists deformation and does not readily assume the shape of the infusion sleeve.
Other attempts to reduce the infusion fluid leakage and associated side effects, such as the one disclosed in U.S. Pat. No. 5,084,009 to Mackool, include using a double sleeve system with the inner sleeve being made from a rigid material such as teflon and the outer sleeve being made from a flexible material such as silicone. However, there are still many problems with this type of approach. For example, a double sleeve system requires a stepped titanium needle. The needle 106 is not illustrated as being stepped in the '009 patent, however, only the most distal end of the needle is illustrated. In practice, this double sleeve arrangement requires a stepped titanium needle. Additionally, this arrangement requires more parts (i.e., teflon sleeve inside and a silicone outside sleeve). The teflon sleeve must be cut along its entire axial length to be placed around the posterior part of the needle, because the needle contains a threaded posterior part and a stepped anterior part. Since both the thread and step are larger than the diameter of the sleeve, the only way to get the teflon sleeve on the needle is to cut the sleeve along its entire length.
Additionally, with respect to the phacoemulsification sleeve, prior art devices use two infusion ports in order to improve fluid flow. However, the use of two ports or holes tends to cause turbulence in the eye. Thus, there is a need for improved flow sleeves that reduce or completely eliminate turbulence in the eye and direct infusion away from the aspiration hole.
As to the handpiece used in phacoemulsification procedures, it should be recalled that the inner tube is used for aspiration, while the outer tube is used for irrigation. During surgery, it is often desirous to change the rate of aspiration. However, if the rate of evacuation or aspiration is too high, undesirable intra-ocular surges may occur. Thus, there exists a need for a phacoemulsification handpiece, where the aspiration can be reliably and accurately controlled.
Regarding the tip or needle that performs the actual cutting away of the nuclear material as it is ultrasonically vibrated, different designs have been proposed in order to increase cutting. However, these designs suffer from emitting ultrasonic energy in the eye and not emulsifying efficiently.
It is therefore an object of the present invention to provide a phacoemulsification sleeve that significantly reduces infusion fluid leakage by providing a silicone sleeve with a built-in reinforcing member. It is also an object of the present invention to provide a phacoemulsification sleeve with barriers or vanes or steps that direct infusion fluid flow away from the aspiration hole and minimize turbulence in the eye.
It is yet a further object of the present invention to provide a phacoemulsification handpiece having a valve which will close when the rate of evacuation is too high, in order to prevent intraocular surges. A still further object of the present invention is to provide a phacoemulsification handpiece with a variable capacity reservoir in the infusion line to vary the amount of infusion flow to account for surges in the aspiration line tubing. The surges in the aspiration line would decrease the intraocular pressure.
It is a further object of the present invention to provide a phacoemulsification needle with a single aspiration hole on one side to amplify the flow coming to the tip. It is a further object to provide a needle with different configuration of barriers, baffles, steps in order to increase cutting and suction effect within the needle.
Additional objects and advantages of the invention will be set forth in the description which follows, and in part will be obvious to those skilled in the art from the description itself, and further will be appreciated by those practicing the invention and using the resulting phacoemulsification device.
The above and still further objects, features and advantages of the present invention will become apparent upon consideration of the following detailed description of a specific embodiment thereof, especially when taken in conjunction with the accompanying drawings wherein like reference numerals in the various figures are utilized to designate like components, and wherein:
FIGS. 1A and 1B are cross-sectional and front views, respectively, of the of the silicone phacoemulsification sleeve with a built-in reinforcing member;
FIGS. 2A and 2B are cross-sectional and front views respectively of the silicone sleeve inserted through an incision in the cornea;
FIGS. 3A-G are a top and side views of a phacoemulsification sleeve with a single infusion hole with internal or external steps to direct infusion;
FIG. 4 is a side view of a phacoemulsification handpiece or an irrigation-aspiration handpiece having a valve to constrict the aspiration line;
FIG. 5 is a schematical side view of a phacoemulsification handpiece with a variable aperture aspiration line;
FIGS. 6A-F are side and front views showing various shaped needles;
FIGS. 7A-B are side views of a phacoemulsification needle with a hole on one side and a single infusion hole in the sleeve;
FIGS. 8A-D, 9A-D, 10A-D, 11A-D, 12A-D show different shapes of the emulsification end of the needle;
FIGS. 13A-B, 14A-B, 15A-B; 16A-B, 17A-B show different sizes and shapes of aspiration holes;
FIGS. 18A-B, 19A-B, 20A-B show concave, convex and angled surfaces which are designed to direct ultrasonic waves;
FIGS. 21A-B, 22A-B, 23A-B, 24A-B, 25A-B, 26A-B and 27A-B show multiple aspiration holes;
FIG. 28 is a side view of handpiece assembly including a silicone membrane which acts as a reservoir chamber for infusion fluid;
FIG. 29 is a side view of the handpiece assembly of FIG. 28 with the silicone membrane being shown collapsed during an aspiration surge;
FIG. 30 is a side view of a phacoemulsification needle showing one of the different configurations of barriers and baffles;
FIG. 31 is a front view of a phacoemulsification needle employing one of the different configurations of barriers and baffles;
FIG. 32 is a front view of a phacoemulsification needle employing one of the different configurations of barriers and baffles;
FIGS. 33A-B, 34A-B, 35A-B, 36A-B, 37A-B and 38-42 show various shape barriers which can be placed on the inside or outside of the needle
FIGS. 43 and 44 show a top and side view of a needle having a single aspiration hole and specially designed internal and external surfaces to enhance the emulsification and the aspiration effect;
FIG. 45 shows a barrier similar to the embodiment illustrated in FIGS. 33A-B but with the barriers set further back within the needle;
FIGS. 46 and 47 illustrate various barrier shapes and steps disposed within the needle to enhance the emulsification and aspiration;
FIG. 48 illustrates a stepped needle which enhances emulsification and the aspiration effect;
FIGS. 49 and 50 are sectional views of additional embodiments of needle tip;
FIG. 51 is a side view of a compressible sleeve according to the present invention; and
FIG. 52 is a anterior view of the compressible sleeve inserted into an incision in the cornea.
The phacoemulsification sleeve 10 of the present invention is a silicone sleeve with a built-in reinforcing member. The sleeve can be used in an ultrasonic handpiece similar to the one disclosed in Applicant's commonly owned U.S. Pat. No. 5,242,385 to Strukel, the disclosure of which is hereby incorporated by reference. The sleeve is essentially a silicone sleeve of approximately 0.005 inches thickness with an overall dimension of approximately 1.0 inch, as shown in FIG. 1. In a preferred embodiment of the present invention, interwoven in the silicone walls of the sleeve are strands of teflon or metallic-based material 12 to provide a rigid frame for the silicone walls. In an alternative embodiment, the teflon or metallic material is in the form of a spiral or single strand that are embedded in the silicone walls of the sleeve. Alternatively, the sleeve could be impregnated with strands of fiber glass or kevlar which will also act as a reinforcing member. Of course, the sleeve could be reinforced with any number of different devices so long as the reinforcing member has a higher durometer (i.e., is harder) than the silicone.
The resulting sleeve has the advantages of both a rigid sleeve and a compressible sleeve, without suffering from the deleterious effects that plague each individual approach. By having a relatively compressible outer layer, the sleeve of the present invention is able to be deformed slightly in order to match the shape or contour of the eye incision 14, in the cornea 15, as illustrated in FIGS. 2A-2B. However, because the present sleeve has a built-in rigid frame, it is not deformable to the extent that a completely compressible silicone sleeve would be deformed. This reduction in deformation avoids the prior art disadvantages such as rubbing between the silicone sleeve and the vibrating tip that results in heat generation and thermal burns, as well as constriction of the fluid flow path into the eye.
During phacoemulsification the ultrasonic needle radiates ultrasonic energy from its tip into the eye and pushes fluid and lens material away from the tip. The flow through the aspiration port brings the material to the tip. The ideal effect is to efficiently bring the cataract to the tip, completely emulsify the cataract and aspirate the emulsified cataract through the ultrasonic needle. To enhance the emulsification, surfaces can be added to the inside or outside of the ultrasonic needle which will direct ultrasonic waves in the desired direction.
Ultrasonic needles are currently manufactured of titanium and have a generally circular cross-section as illustrated in FIGS. 6A and 6B. The needles 16 are used for phacoemulsification and for cutting and removing tissue during surgery. Other cross sectional shapes such as a triangle, as illustrated in FIGS. 6C and 6D, or polygonal shapes, such as a hexagon, as illustrated in FIGS. 6E and 6F can be used to improve the cutting and emulsification properties of the needle. In addition, the use of non-circular cross-sectional needle shapes will provide a flat surface which may be a more practical surface to work with to weld or machine other surfaces to the needle. These additional surfaces would then vibrate with the needle. The surfaces, which will generate ultrasonic energy, can be arranged so that the ultrasonic energy is directed in the preferred areas.
Conventionally, ultrasonic needles have been manufactured having circular openings at the distal end. This opening is known as the aspiration hole 18. The aspiration opening within the needle is simply made by drilling a throughbore in the titanium shaft. An alternative method of forming the needle 16 would be to not drill the hole completely through the needle but to leave the distal end of the needle closed. In other words, a blind bore would be drilled into the needle. An aspiration hole 18 would then be provided on the side of the needle 16. An advantage of providing the aspiration hole 18 in the side of the needle is that the distal axial end of the needle can then be made, by machining, to any desired shape, such as a flat surface or a slanted wedge shape, as illustrated in FIGS. 7A and 7B. Numerous other end configurations are illustrated in FIGS. 8A-27B. A further advantage of placing the aspiration hole 18 in the side of the needle 16 is that the hole 18 can be placed anywhere along the needle surface and can be sized and/or shaped depending on the needs of the user. A further advantage is that with the closed tip, additional ultrasonic energy will be emitted from the closed tip surface which will aid in emulsifying tissue. The specific shape of the tip, including the angle, concavity, convexity, etc. can be designed to selectively focus ultrasonic energy. Additionally, surface area can be designed to emit either a large or small amount of ultrasonic energy. Generally, the larger the surface area, the larger the amount of ultrasonic energy which will be generated. In certain portions of the tip it is important to emit less ultrasonic energy to reduce the likelihood of breakage to the posterior capsule.
The ultrasonic waves radiate from the metallic surfaces. Accordingly, the surface of the tip could be modified so that it will intensely focus the ultrasonic energy to emulsify tissue. However, if the surface is designed to focus low ultrasonic energy, that surface can be used to selectively clean tissue without the emulsification of tissue taking place. Additionally, if the ultrasonic energy is finely focused, that energy can be used to cut the tissue. Accordingly, the surfaces of the tip can be designed to be tissue specific in its ability to focus ultrasonic energy. Various embodiments of ultrasonic needles 16 are illustrated in FIGS. 7A-27B. Each of these needle embodiments have hole of various sizes and shapes and various needle surfaces to vary the amount of focusing of the ultrasonic energy and the amount of aspiration through the aspiration hole 18.
As discussed above, conventional ultrasonic needles have only one aspiration port 18 which is disposed at the axial distal end of the needle. Applicants have discovered that the addition of a second aspiration port, disposed near the main aspiration port or even as part of the main aspiration port can provide numerous advantages in the use of the needle 16. FIGS. 24A and B illustrate an embodiment where the second aspiration port 18' can be disposed as being a part of the main aspiration port 18. For example, during certain uses of the needle you will want to build a vacuum in order to hold tissue at the tip. This is especially true during certain types of cataract surgery, where it is desirous to occlude the tip during either the "divide and conquer" or the "phaco chop" techniques of cataract surgery. During these techniques, it is often desirable to hold the nucleus on the phaconeedle tip. Obviously, it will be necessary to cover both aspiration holes to build a vacuum. However, during the emulsifying of tissue in the primary port, it is often advantageous to have a secondary aspiration port available to assist in the further aspiration of the emulsified tissue.
Referring to FIGS. 3A-36 a sleeve 10 having an infusion port 17 is illustrated. Sleeve 10 is illustrated as having baffles 19 disposed on either the interior or exterior surface adjacent to the infusion port 17 to assist in directing the flow of infusion fluid. As illustrated in FIG. 3A, the baffle 19 can be disposed on the outer portion of the sleeve 10 in an area disposed between infusion port 17 and the distal end of the sleeve 10. In FIG. 3A the baffle directs an infusion fluid away from the aspiration port. However, if desirable, the baffle 19 can be placed on the opposite side of the infusion port 17, as illustrated in FIG. 3B to direct the infusion fluid in the forward direction towards the distal end of the sleeve 10.
As illustrated in FIG. 3E, the baffle 19 can be disposed within the interior of the sleeve 10 between the infusion port 17 and the distal end of the sleeve. Alternatively, as illustrated in FIG. 3F, the baffle 19 can be disposed on the proximal side of the infusion port 17. Additionally, as illustrated in FIG. 3G, a baffle 19 can be disposed on both the exterior and interior surface of sleeve 10. As illustrated in FIG. 3G, the baffles are located on the distal side of infusion port 17. However, just as has been illustrated in FIGS. 3B, 3D and 3F, baffles 19 could be disposed on proximal side of the infusion port 17.
Referring now to FIGS. 4 and 5, a phacoemulsification handpiece 11 according to the present invention is shown. The handpiece 11 has a valve 20 in the aspiration line. The function of the valve is to constrict the flexible tubing of the aspiration line to create resistance in the aspiration line. Also, the valve may be used to change the flow characteristics at the needle tip. The valve may be controlled either at the phacoemulsification machine control panel or directly at the handpiece. It should be pointed out that the valve control can be simply an on/off valve or a valve that allows for analog-type control whereby the valve can be adjusted to any precise level between completely on and completely off. In the preferred embodiment of the present invention, the valve is located at the anterior portion of the handpiece.
The handpiece of FIG. 4 has a valve 20 which is preferably controlled so that it can be adjusted to any precise level between completely on and completely off. The valve can be positioned at position C in FIG. 4 which is within the handpiece, or at position B immediately behind the handpiece or at position A, which is adjacent to the housing for the aspiration pump. The valve is controlled by a control console which receives signals from a pressure transducer (not shown) which detects the fluid pressure within the aspiration conduit. Upon the detection of the varying pressure within the aspiration line, the control console automatically actuates the valve to variably increase or decrease the cross-sectional area of the aspiration conduit to ensure substantially constant pressure within the conduit.
In the embodiment illustrated in FIG. 5, a valve 21 is disposed within the handpiece 11. This valve 21 is preferably of the type that is an on/off valve, as discussed above. Upon the detection of a pressure surge, the control console immediately sends a signal to close valve 21. Simultaneously, valve 23 is opened to release relatively high pressure fluid from a sterile fluid container into the aspiration conduit. Thereafter, the bottom valve 21 is opened, the full effect of the surge is erased and then valve 23 is closed once again. The system is then ready to detect and control the next surge within the aspiration line.
The advantages of an on/off valve, such as valve 21, include that when a piece of cataract occludes the phaco tip, vacuum will build up in the aspiration line. When that occluded piece is emulsified, there still will be a vacuum in the aspiration line and a surge will be created thus reducing the intraocular pressure. When a pressure transducer in the aspiration line detects a rapid change in vacuum, the valve in the handpiece can be instantaneously closed and a release of sterile fluid in the aspiration line can occur to remove the vacuum and the handpiece valve can then reopen. This valve, by closing instantaneously and opening immediately after fluid is released into the aspiration line, will prevent surges of intraocular pressure.
Referring now to FIGS. 28 and 29, a handpiece assembly 11 that includes a collapsible silicone membrane 22 is illustrated. The silicone membrane 22 is disposed radially outside of the needle 16 and defines an annular reservoir chamber 24 disposed between the silicone membrane 22 and needle 16. The reservoir is in fluid communication with the infusion fluid as it passes through the handpiece assembly and out through the infusion sleeve port near the needle tip. The silicone membrane is made from a soft elastic material so that the membrane 22 can collapse during an aspiration surge during use of the ultrasonic handpiece. Typically, when an aspiration surge occurs the relatively large amount of fluid within reservoir 24 is of a sufficient volume so that this fluid can be immediately withdrawn from the reservoir and introduced into the intraocular area, which results in an immediate compensation for the fluid lost from the surge. As is well known, a drop in intraocular pressure can cause considerable problems such as collapse of the intraocular tissue onto the vibrating phaco needle. Accordingly, the reservoir 24 is designed to provide additional infusion fluid in the intraocular area as soon as an aspiration surge occurs. The reservior is located immediately adjacent to the needle tip to mimimize the time it takes to replace the intraocular fluid. The surge will cause a decrease of intraocular pressure and will therefore provide a suction effect to withdraw the fluid contained within reservoir 24. This suction effect causes the membrane 22 to collapse, as illustrated in FIG. 29. An air vent 26 is provided radially outside of the silicone membrane 22 to permit membrane 22 to collapse freely.
Referring now to FIGS. 30-42, a series of barriers are illustrated, which are attached to the walls of the ultrasonic needle 16. The barriers permit limited or no occlusion at the tip of the needle to enhance emulsification of tissue. As discussed above, occlusion of the tip can create a surge of fluid flow upon break up of the tissue causing the occlusion. This surge in fluid flow can cause a collapse of the intraocular pressure within the eye which is a condition that should be avoided. In addition, the barriers also provide an additional ultrasonic cutting surface to enhance the cutting and emulsification ability of the tip. The barriers are structural members, such as bars, baffles, wedges, etc. which are attached to the walls of the needle 16.. A barrier 28 is illustrated in FIG. 30. Other embodiments of barriers including a single bar 30 disposed in the center of the needle or double bars 32, 34 disposed about the center of the needle are illustrated in FIGS. 31 and 32, respectively. The bars 30, 32, 34 prevent nuclear tissue from penetrating into the tip beyond a predetermined amount. Other embodiments of barriers are illustrated in FIGS. 33A-42. For example, in FIGS. 33A. and B, an annular ramp shaped barrier 36 is disposed within the tip 16. A wedge shaped plate barrier 38 which does not extend fully across the inside of the tip is illustrated in FIGS. 34A and B. A pair of spaced apart bars 40, 42 are illustrated in FIGS. 36A and B. A barrier 44, 46, illustrated in FIGS. 35A and B, is disposed on the outer surface of needle 16. These barriers 44, 46 do not assist in preventing an occlusion, but they do provide an additional surface from which ultrasonic energy can be generated. Other barrier embodiments are illustrated in cross-section in FIGS. 38 and 42. Clearly, almost any type of geometric shape can be used to assist in permitting a limited occlusion of the tip and to aid in emulsifying tissue.
Referring now to FIGS. 37A and B, barrier 42 is illustrated for use in a modified tip 16'. Tip 16' has a wedge shaped distal end surface 48 which provides a large metallic surface area for ultrasonically cutting tissue. The ultrasonic energy from surface 48 is directed in an opposite direction with respect to the aspiration port 18. A tip similar to the one illustrated in FIGS. 37A and B is illustrated in FIGS. 43 and 44. The angled surface 50 disposed inside of the needle 16' can be used to focus energy towards the aspiration port 18, but within the needle 16', to aid in the emulsification of tissue. Other surfaces within that needle including surface 52 and a stepped shoulder surface 54 assist in the suction of the nuclear tissue after it has been emulsified. Surface 52 also is disposed within the line of ultrasonic energy that has been generated from surface 50 to effectively prevent this energy from causing damage to the surrounding tissue. Surface 52 is preferably a spherical surface, and can simply be formed by drilling a blind bore into the shaft 16'. Surface 52 would be the distal portion of the blind bore. Exterior surface 53 is a blunt surface which emits ultrasonic energy at a sufficient energy level to be able to split the cataract. However, the energy generated by surface 53 dissipates quickly so as to minimize the risk of damaging to the posterior capsule.
FIG. 45 illustrates a needle that includes a ramp shaped annular barrier 56 whose ramp shaped surface 58 is directed towards the needle tip to focus ultrasonic energy across the aspiration port 18. The stepped rear shoulder surface 60 of the ramp 56 is used to assist in the suction of the nuclear tissue after it has been emulsified. In most uses it is desirous to contain the ultrasonic energy within the needle to minimize the ultrasonic radiation which can cause damage to the intraocular tissue. In the embodiment illustrated in FIG. 45, ultrasonic energy generated by ramp surface 58 is prevented from exiting the needle by the needle's interior surface.
The present inventors have found the use of steps, angles, and barriers within the ultrasonic needle useful to focus ultrasonic energy across the aspiration port to aid in emulsifying nuclear tissue and to aid in pushing emulsified material in the direction of the aspiration flow.
FIGS. 46-50 illustrate various embodiments of needle tips which achieve these results. FIG. 46 illustrates a tapered needle 16 that has an internal annular shaped ramp 62 similar to ramp 56 illustrated in FIG. 45. In addition, the front tapered end surface 64 of the needle 16 also radiates ultrasonic energy within the internal area of the tip to assist in the emulsification of nuclear tissue.
FIG. 47 illustrates an annular shaped ramp surface 66 that has a forwardly directed ramp surface 68, a reduced diameter passageway 70, and a stepped shoulder surface 72. Ramp surface 68 emits ultrasonic energy to aid in the emulsification of tissue, whereas shoulder surface 72 emits ultrasonic energy to assist in the suction of the emulsified tissue.
FIG. 48 illustrates a needle tip 16 that has the tip end 71 off-center (i.e., not concentric) with respect to the main portion of the tip 16. An internal ramp surface 74 emits ultrasonic energy adjacent to the aspiration port 18 to assist in the emulsification of nuclear tissue. A stepped shoulder surface 76 assists in the suction of that emulsified tissue by generating ultrasonic waves in the direction of flow. Additionally, an external ramped surface 73 emits ultrasonic energy to aid in the cutting and emulsifying of nuclear tissue.
FIG. 49 illustrates a needle tip 16 that has a wedged shape front tip surface 78. Surface 78 emits ultrasonic energy outside and forward of the tip end to assist in the cutting of nuclear tissue. In addition, a shoulder surface 80 disposed adjacent to the aspiration port 18 assists in pushing the material into the interior of the needle tip 16. Internal surfaces 82, 83 also emit ultrasonic radiation energy to assist in the emulsification of nuclear tissue.
FIG. 50 illustrates an embodiment similar to that illustrated in FIG. 49 in that a front wedged shape surface 84 and ramp surfaces 86, 87 are utilized in a similar manner to surfaces 78, 82 and 83 in the embodiment illustrated in FIG. 49.
Referring now to FIGS. 51 and 52. A compressible sleeve 88 is illustrated. Sleeve 88 includes an accordion section 90 to permit the sleeve 88, once it is connected to the handpiece 11 (not shown in FIGS. 51 and 53) at area A, to move axially with respect to the handpiece. Sleeve 88 is connected to the handpiece by a fluid tight connection, which permits the handpiece 11 to rotate freely with respect to the sleeve 88. When the tip end of the needle 16 is inserted into the incision 14 of the cornea, the forward end 92 of the sleeve 88 extends through the corneal surface 16, such that forward end 92 substantially matches to the incision 14 in the cornea. Due to the accordion design and to the rotational coupling, the handpiece and needle can be manipulated to a limited extent in the axial direction and rotated freely about the longitudinal axis while the sleeve 88 will remain stationary with respect to the cornea . Thus, this forward portion 92 of the sleeve acts similar to a plug to completely seal the incision in the cornea. In addition, the infusion port at the distal end of the sleeve 92 is located near the cornea and away from the aspiration hole 18 of the needle. Thus, there is considerably less turbulence within the eye which provides for better aspiration of emulsified tissue. In other words, if the infusion port is located too close to the aspiration port, the fluid will naturally follow a path of least resistance and short circuit directly from the infusion port to the aspiration port, which clearly reduces the amount of tissue that can be removed from the eye or at the very least reduces the amount of time it takes to remove the desired amount of tissue from the eye.
Having described the presently preferred exemplary embodiment of a new and improved phacoemulsification handpiece, sleeve, and tip, in accordance with the present invention, it is believed that other modifications, variations and changes will be suggested to those skilled in the art in view of the teachings set forth herein. It is, therefore, to be understood that all such variations, modifications, and changes are believed to fall within the scope of the present invention as defined by the appended claims.
|Cited Patent
|Filing date
|Publication date
|16 Sep 1968
|15 Sep 1970
|Surgical Design Corp
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|Surgical Design Corporation
|Rotatable surgical instrument
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|Multi-purpose phacoemulsification needle
|27 Apr 2004
|23 Dec 2004
|Sartor Joe Don
|Suction coagulator with dissecting probe
|8 Jan 2004
|14 Jul 2005
|Mackool Richard J.
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|5 Oct 2006
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|24 Jan 2008
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|Takayuki Akahoshi
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|International Classification
|Cooperative Classification
|European Classification
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|Fee payment
Year of fee payment: 4
|12 Nov 2001
|Surcharge for late payment
|20 Nov 2001
|Maintenance fee reminder mailed
|16 Nov 2005
|Maintenance fee reminder mailed
|25 Nov 2005
|Fee payment
Year of fee payment: 8
|25 Nov 2005
|Surcharge for late payment
Year of fee payment: 7
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Effective date: 20100428


text:
By Jay Steiger
Eighteen months ago, Jeff Bergeleen was just another soccer dad. Proud of his children but content to cheer from the sidelines. Then a local league official informed the parents from his daughter's team that there was no coach, and if someone did not step forward, the team would have to disband.
Bergeleen had experience playing the sport and, with some trepidation, told the league he would coach. He soon discovered that he enjoyed the experience and returned as a coach for the following season.
Now his team has achieved a rare feat for La Mesa — winning a tournament in highly-competitive Orange County to advance to the Western States Playoffs, held in late March in Carson City, Nevada.
Coach Bergeleen's team is a group of 8- and 9-year-old girls who call themselves the Iron Maidens. They play for La Mesa American Youth Soccer Organization (AYSO). AYSO is the largest national youth soccer program and recently celebrated its 50th anniversary.
La Mesa AYSO has been teaching soccer for 40 years. The top teams from ages 8 to 13 in each region compete in an east county area playoff in December, with the winners advancing to a sectional tournament in Orange County in February.
While La Mesa AYSO regularly sends teams to sectionals, the competition there is extremely high, and it has been 20 years since a La Mesa Team has advanced to the Western States Championship.
Coach Bergeleen said that advancing to the championship is "mind blowing" and he is in a bit of amazed shock as to how well the team has done and how far they have gone in regular season and tournament play. He doesn't feel that his coaching was anything particularly unique. He knows these are young girls and works to balance teaching basic skills with keeping things enjoyable.
On the first day of practice he told the parents and players he wanted to, "Put the fun back in fundamentals." Team building was also a key component, with the players having group events, including trips to watch the SDSU Women's Soccer Team.
Bergeleen noted that although he appreciates the thanks he receives from parents, he is personally grateful to the players on the team for showing so much team spirit and sportsmanship. He said his two top scoring forwards were both sick during the sectional tournament and still scored a combined 14 goals. Bergeleen also recognized his assistant coach, Scott Schultz, for his work in support of the team.
La Mesa AYSO Commissioner, Nicole A Ciokiewicz, said she is incredibly proud of the team and their success.
"From the start of the season, they hit the ground running and it is impressive to see how far they have come and how much further they will go," she said.
Ciokiewicz believes that the AYSO organization is like a family and that if it takes a village to raise a child, AYSO is a wonderful village. ASYO has six core philosophies: Balanced Teams, Player Development, Everyone Plays, Positive Coaching, Open Registration and Good Sportsmanship, which are unique within the world of youth sports.
La Mesa AYSO is currently running a Spring Select program and will start registration for the fall season in April. They have a Facebook page and their website is lamesaayso.org.
The Iron Maidens are hard at work practicing regularly and the parents are also hard at work fundraising for the trip to Carson City. The team was recently featured on Fox 5 San Diego and they have set up a donation page at bit.ly/2l2SaaG.
Coach Bergeleen noted he always tries to keep things in perspective and tells his team to play hard, but no matter what result they achieve in the Western States Championship, they are already winners because they work together and play as a team rather than individuals.
—Jay Steiger is a parent, school, community, and youth sports volunteer. He serves as the public relations chairperson for the La Mesa AYSO Board.

subset: commoncrawl


text:
(Phaseolus vulgaris) Heirloom first introduced in 1897 by Peter Henderson & Co. Long, slender, slightly curved green beans 12-15cm long with shiny,
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(Phaseolus nanus) Butter Bean. Vigorous, heavy producer, bright yellow, straight, flat pods to 18cm, black seed when mature. Stringless at all stag
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(Phaseolus coccineus) Perennial - Scarlet Runner type also known as 'Seven Year Bean'. Vigorous vine with scarlet coloured flowers; produces numerou
(Phaseolus nanus) Prolific cropping; flat pods 18-20cm. Popular garden variety. Stringless when picked early.
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Memory optimization software works by removing old and unneeded data and improving the area that is free, thus ensuring there is no conflict of memory allocation space.
A computer's memory is similar to the human brain's memory in that it is used to store, preserve and recall data when needed. However, computer memory can gradually become cluttered by old and unused files, clusters and image pieces taking up vital parts of the RAM (random access memory). This is a gradual process that happens over time, gradually slowing down processes and applications on your computer. Before long, regular crashes are experienced as programs reach for a specific part of the RAM, only to find it is already occupied by old and unnecessary data.
MemAgent is a highly acclaimed memory optimization software that, once installed, works in the background to clean up memory and get rid of unnecessary files. It also promises to noticeably improve your computer's speed while greatly reducing the likelihood of crashes and freezes. John Bishop, Director of MemAgent, says that memory issues are a cause of huge irritation and stress for many people. "Most of the time they don't even realize that cluttered memory is the fundamental problem behind their computer's repeated failures," Bishop says, "MemAgent is a simple way to get your computer working again like it is supposed to."
MemAgent has very few minimum requirements before it can be installed on your computer. You need to have Windows 95/98/ME/NT/2000 or XP, Pentium 90MHz, and 4MB RAM. It is a very small application – in order not to take up more of your RAM! – and has been designed to work very efficiently.
Technophobes will be comforted to learn that MemAgent is extremely simple to use. Once downloaded, it can be set up on your computer in 5 to 10 minutes. All you are required to do is follow the simple steps. When installed, MemAgent chugs away quietly in the background - greatly reducing the time you spend having awkward technical conversations with the computer repair shop!
Just some of the extra features in the newly released MemAgent Elite version include a windows defragmenter, an ability to scan and optimize internet connection settings, faster processing, and speeded up system start and shut down time. The only downside to MemAgent is that it can't promise to wipe out crashes altogether. But then again, this does vary from computer to computer, so it could well be a long-term fix for you.
Overall, MemAgent is a well put together program and good value for money. The amount of time it saves you in the first few weeks alone will be well worth the price!
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text:
A Reintroduction-Hi, My Name is Michelle and I'm a PF Blogger
For the past couple of months or so a lot has been going on behind the scenes. I've started a new project, I've created some closed Facebook groups, and I've gotten very clear about the direction I would like things (like…my life..) to move towards. But, in the midst of all of that planning, working, and strategizing I realized that there were a few important things that I needed to do first.
I continue to love personal finance and all of its intricacies and imagine that I will continue to blog about/podcast/and speak about the topic of financial empowerment for the near future. But, in all of my business maneuverings I realized that I was needing to get back to the basics and focus on what this blog is all about.
I needed to reconnect with The Shop My Closet Project, its mission, and the goals that I set as part of this project. I've changed and how I view what I share via The Shop My Closet Project has changed in some subtle ways that people who have know me know that I've spent a lot of time and energy working on so that I can move forward with integrity. But, first, I think it's important to reintroduce myself to my long-time readers and supporters and new visitors to my page.
My Name is Michelle…
And, I'm a personal finance blogger.
It's funny when you introduce yourself in that way to new people. Yes, I write about my feelings concerning my money, my mistakes, and my lessons learned. I geek out on debt repayment, side hustles, and when people win their battle with personal finance.
Since 2012 I've written about my money. I was an obsessive reader of personal finance blogs and randomly stumbled on a conference called FinCon that was in its second year and being held in Denver two weeks after I discovered it. I had to go! It was only $100 and scrounged that money up so that I could meet people who geeked on talking about personal finance just like I did. And even though I am a serious extrovert-I held back that weekend because it was so much to take in. I wasn't the only one struggling with money. There were people out there who had experienced similar hard times and had taken control of their money.
There were also amazing people who had no financial issues but loved to share their knowledge and passion about personal finance with others. I had no idea what becoming a part of the FinCon Community would do for me.
You have to understand that at the time I started blogging about money I was:
- Depressed
- Overwhelmed
- Over weight (still am a little bit!)
- Deeply in Debt
- Frightened
- Worried
- And, lonely
I was coming off of years of supporting both myself and my mother who had lost her job and was unable to find another one even though she had worked hard all her life. Like most people, I was ill-equipped to handle this financial tsunami that threatened to drown me. At the time that I found myself helping out my mom I was in the process of trying to finish graduate school and was working at Startbucks to supplement my income.
I would graduate with no job (we were in a down turn) and earning an average of $9 an hour including tips. I will forever be grateful to Starbucks and even though I'm a HUGE supporter of local business, Starbucks continues to be a chain that I support because…they hired me when no one else would.
I understand what it's like to:
- Have bill collectors call
- To have no savings
- To have credit card debt accrue because you use your cards for groceries.
- To have to completely re-educate yourself about money
- To kill bad financial habits
- And, to have people talk down to you about what you've done to survive.
As a result of these experiences you won't be judged by me as you work to change your money story. I won't shame you when you make epic mistakes, I won't tell you what "I would have done" patronize you, or kick you when you're down.
You won't get talked down to and told how you shouldn't have done what you've done….with your money. Because ultimately you have to manage your mistakes. You're an adult and most of us are doing the best we can with information and resources we have. And, most of us learn our money lessons through trial, error, and a splash of pain.
My Personal Finances
Could be better and could be worse. I became self-employed at the of 2014 and have experienced a totally different financial education that includes:
- Managing inconsistent cash flow
- Self-employment taxes
- Saving for retirement as a self-employed person
- And dealing with debt as a self-employed person
I've made mistakes and I've rocked several decisions. I've learned a lot about personal finance since 2012 and the biggest lesson that I've learned is the following:
Personal finance is a complicated mix of mindset, knowledge, actions, and strategy.
Without the right mindset it will be hard to use the knowledge that you gain, apply focused action, and devise strategies that will get you ahead.
My Mindset
I've experienced a profound mindset shift in the past 5 years and I want to quickly walk you through it.
- 2012-I begin blogging "for real" I'm was so overwhelmed and couldn't see a light at the end of the tunnel. I wanted to leave my job, but how could I? I had so much debt. How would I live, eat, and pay my bills? I hated what I was doing and felt profoundly stuck.
- 2013-I decided to do a year long No Shopping Challenge because why not? I end up saving $4000 by not shopping for clothes and begin to discover the real difference between wants vs. needs. It also shocks me how much my spending was a result of boredom, loneliness, and habit. I begin to work on lowering several line items in my budget. I begin to imagine working for myself. Didn't have a clear idea of how I would do it, but it seemed like a cool idea.
- 2014-I finish my No Shopping Challenge and then proceeded to work even harder on slashing my budget. I manage to cut $13,500 from my overall budget and have a light bulb moment. I was working like a dog for a lot of sh$t I didn't need. I decide that this was the year that I would take a leap of faith and leave my job. My D.O.N.E. moment was on December 16, 2014. I fly out of Denver the day after I quit and then made my way to Sydney, Australia for a 2 month break.
- 2015-I began working for myself and work a business model completely ill-suited for my personality BUT STILL MAKE MONEY. Huh? I didn't like what I was doing but I loved how my life was coming together.
- 2016-I change my business model from business to business to business to consumer and create The D.O.N.E. Society a community for people working their 9-5 but can't leave yet. I also reconnect with my mission to grow The Shop My Closet Project's community and help create empowered people who are slashing their budget without lowering their quality of life through strategic and well-thought out money moves.
It is now June 2016 and I cannot believe how much time has passed by. There have been a lot of mistakes made along the way…but, I'm still standing.
In the end, I've discovered that mindset has been where I struggled most. Developing an abundance mindset, believing that I can be debt free, noticing moments of self-sabotage and demanding what I'm worth as I negotiate business deals has been an eye opener.
My SMCP Goals
- I want to help people believe that they can earn more via entrepreneurship or through sheer belief. I want to help people go from $9 an hour to salaried if they DON'T want to be an entrepreneur.
- I want to help people see that around 80% of the time they are making financial choices…with the jobs that they choose, the fields that they are in, the cars that they buy, the people that they marry (harsh, but true) the homes they purchase, and societal norms that they follow.
- To help people cut at least 25% from their budget without feeling like they are suffering. No FOMO (fear of missing out) in case you believe in YOLO.
- Get people thinking about, looking for, and finding side hustles that pay a heck of a lot more than minimum wage. Examples include: freelance writing, creating products, starting a blog (long-term), brand ambassador work, etc.
- Get people to maximize their time and money.
- Help people live their best lives in the moment that they are in now as they work towards future goals.
My Name is Michelle…
And I'm a personal finance blogger who is still on my money journey. And, that's ok. I finally see the light at the end of the tunnel. I will continue working hard so that one day I can share my "I'm debt free post."
Until then, here is a little more about me.
- I am from Colorado and love Colorado like Texans love Texas. I even blog about Colorado! If you're visiting this year-check it out! www.coloradoluvhub.info
- I am an adult learning how to drive for the first time. I purchased a car as a self-employed person-cash. I will share that story someday. It was a bit of a mess, but things worked out. Just think…cash flow. I plan on taking my driving test this month-watch out Colorado!
- Some of my best side hustles: helping people learn how to use cell phones $22 an hour, giving people a food product $22, was in an R Kelly video filmed at Red Rocks $100, getting people to sign up for a giveaway $35 an hour, and freelance writing around $250, and blogging depends on the month.
- I read A LOT. Like, A LOT. I'm reading at least 3-5 books at a time.
- I am getting back into dancing and have auditioned for the Denver Broncos Cheerleading Squad and the Denver Nuggets Dance Squad. Did well, didn't get it. Now I'm obsessed with Yanis Marshall's heels choreographer. Not for the faint of heart. You can check it out on Youtube.
- I've learned French and Spanish. I can still read French but can't speak it right now. I'm still studying Spanish.
- Travel is bae. Seriously. I like traveling by myself or with specific friends or my mom. I don't care as long as I'm traveling.
Do I Like Working for Myself?
I don't miss, chit chatting around the water cooler, commutes, serving the wrong people (who I loved..but, they already had enough resources), or the field that I was in even though I'm still passionate about it.
Are there things that I hate?
Cash flow is my biggest pet peeve and I've spent a lot of time working on how to manage it. I strongly believe that people working for themselves should always have at least 1 product is completely theirs. And, yes, I'm working on it.
Join TSMCP's Closed Facebook Group!
Need inspiration, support, money saving resources, and a judgement free zone? Click the following link to join our closed Facebook group today! Also, check out my free Summer Savings guide that will get you on track to saving 25% of your budget. Now, let's be clear, judgement free doesn't mean anything goes. It just means that if you make a bonehead mistake you're an adult who understands that there are consequences.
Hang out with me this month on Periscope. You'll find me at: @ShopMyCloset12 I plan on scoping every day in the month of June on all topics related to money, saving you money, and mindset related issues.
More from my site
Latest posts by Michelle (see all)
- Why Earning More is An Act of Radical Self-Care - 13 November, 2017
- 25 Cool Gifts For Christmas When You Have No Clue - 8 November, 2017
- Figuring Out My Conference ROI-FinCon17 Was it Worth It? - 6 November, 2017
20 thoughts on "A Reintroduction-Hi, My Name is Michelle and I'm a PF Blogger"
I like read your posts also when you talk about mistakes because in my personal opinion they helped you to became woman you are now and I'm sure you'll achieve all your goals…
That was lovely to read, sounds like you went on a great journey over the past 6 years of blogging! I look forward to reading more.
Awesome post. I love how you broke down your mindsets from the previous years. I with you on being at a different place mentally when starting out a blog. It's amazing how things can change in a relatively short time.
Every blogger changes over time as long as they're keeping their 'voice', so the various shifts and such are to be expected and even embraced. Good luck.
Great post! Just like Jason I love reading about the mindset shifts. I can't believe I've been following you for this long. Time is legit FLYING by. I always appreciate how authentic your blog is. Weight loss and cash flow… two of my biggest problems, too! Joined the group!
"Harsh but true" – ha, this is great! I have been thinking a lot lately about the choices I have made and how they shape where I am today. And our choice in partner is so crucial to our financial wellbeing.
It's good to see you back in the groove!
Loved this Michelle! It's interesting how much we can alter our mindset – and a good thing! I was experiencing the same things as you when I started blogging. Awesome that you tried out for a cheerleading squad – sounds like so much fun!
Can't wait to see you at Fincon 🙂
Nice to meet you again, ha! Sometimes it's nice to get back to your roots and remember why you started a project in the first place.
I've been a bit absent from the blogging scene, and checking back in with some of my favorites. I can't believe you are so close to getting your license – way to go! Bummer about not making the cheerleading squad, but… there is always next year. That would be a fun hustle to add in!
I love your posts. Very insightful. You're working so hard to get to where you want to be. Not always so, these days. Driving in SoCal, mainly LA is ridiculous (so I feel you) I basically have to make a deal with myself to not yell at the guy who just cut me off (and I'm nice, I let people in LOL) And Thank You hun, I just used your coupon for ThredUp. TOO AWESOME Lots of love to ya


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This quaint totally furnished garden cottage, one bedroom apt. is private with it's own key, private entrance, and courtyard in the downstairs of our historic brick English tutor home in Laurelhurst, a beautiful old Portland community! Read our outstanding reviews!
This quaint 1 bedroom furnished apt. is located downstairs in our historic brick English tutor home. It has a separate key, private entrance, and courtyard. The space is well-lit with two windows and has a back door to a beautiful garden and patio in the backyard as well as a side door to the courtyard. The location is Laurelhurst - one of Portland's oldest and most beautiful planned communities on a quiet, tree lined street within 10 minutes of the city and 15 min. from the airport. Major shopping, wonderful restaurants and one of Portland's most beautiful parks are all within walking distance. This ideal location is only two blocks from a major bus line and 5 blocks from the MAX train. It is also within walking distance of favorite east side shopping and dining areas, including Hawthorne, Belmont and 28th street.
When you enter this mid-century decorated apartment you will immediately feel at home! You will find a comfortable queen sized bed, overstuffed chair and desk with the latest mesh technology wireless internet, flat screen TV with cable, Blu-ray CD player, a collection of movies in the bedroom. The newly tiled bathroom has a tub and shower and, although there is not a separate "living room", the kitchen and pantry is fully furnished with everything you may need to make your own meals if you choose (i.e. microwave, gas stove, refrigerator, blender, coffee maker, dishes, pots/pans, spices, condiments, etc.). Other amenities include a private courtyard, washer/dryer in the apt., and easy walking distance to bus, train, restaurants and shopping.
More information on our historic home can be found on Oregon Encyclopedia website. Search for "Brick House Beautiful". Our home has also been in "Better Home and Gardens" magazine and has been twice on the cover of "Old House Journal".
If we are home when you arrive, we will be happy to give you a tour of our home and offer you a cup of tea or a glass of wine while you have complete access to our English gardens, courtyard and barbecue during your stay. We think you will be pleased if you choose to stay in the "Quaint English Garden Apartment " located in our beautiful historic home!
Guests have their own entrance and after booking, we will send them lock box info!
We like to entertain and will sometimes have friends over for a barbeque, dinner party or even a small party. Guests are always welcome to join us. However, guests do have their own private courtyard with privacy, a place to eat outside and enjoy the lovely pots of flowers.
Check in is 3:00 unless you have made other arrangements with hosts.
Check out is at 11:00 so we will have time to clean the apt. for new guests.
No smoking or pets please.
Leave apt. as found including dishes washed and put away.
Upon departure please put used sheets, pillowcases and towels in laundry basket.
Outside quiet time before 8:00 am and after 10:00 pm.
No maid service is provided.
Please park along curb in front of our house.
We always try to greet our guests personally and give them a tour of the home and surroundings. Upon request, we are happy to provide our guests with suggestions for exciting places to visit, dine and/or play! We love meeting new friends!
We live in a historic home in Laurelhurst, in Portland. Sue is a retired principal and Bob retired from the big aerospace company in Seattle (Boeing). Sue has a passion for decorating and gardening (is very creative and good at both), Bob is into art and also enjoys and appreciates creating and living in a tasteful environment. We both enjoy entertaining, hosting frequent social gatherings in our home in our English garden or just having friends over for a "glass" of wine. We also have a house on the Oregon Coast that we love and enjoy sharing with family and friends and that is also available for short term rental. We stay constantly busy with our "projects" spending time with the grandchildren, try to fit some time in for a little golf and getting away for a few days from time to time.
As hosts and your staying in our Portland apartment, we would be happy to invite our guests for a tour of our historic home, sit with us and enjoy a glass of wine in front of the inglenook fireplace or on the patio in the garden. If our guests prefer to left alone we are sensitive to that as well. Our goal is to provide a welcoming, comfortable, and tasteful environment for our guests, and possibly develop new friendships.
If you are staying in our beach house, you will have total privacy. We will not be there to greet you. We provide you with a code to the lock box and you are have the home to yourself. If you need something you can call us and we will do what we need to address your needs.
As guests we appreciate friendly hosts, but we do appreciate a host sensitivity to our privacy. We also appreciate hosts that provide recommendations and insight into places to visit and things to do.
As to a life motto we both think that, Live, Love, Laugh and Learn is how we approach life.


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Sudden Impact | 1983
Dirty Harry's at it again, this time a serail killers trail leads all the way to Santa Cruz, but Harry's packing his favorite Magnum.
Jump to
Pacific Title & Art Studio
Someone is leaving a trail of dead dirtbags all over San Francisco, and the powers-that-be have no choice but to call on take-no-prisoners SFPD inspector 'Dirty' Harry Callahan to shine up his .44 Magnum and track the killer down. With Sondra Locke and Pat Hingle.


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Results 1 to 1 of 1
09-02-09, 13:12 #1Registered User
- Join Date
- Nov 2003
- Location
- Revere, PA
- Posts
- 212
Project Lead - Senior J2EE Developer
This is a full time employment opportunity in NY City with a long stand client of nearly 10 years. The compensation package is competitive and includes bonus and a generous benefits package, flexible working environment, career path growth, healthy balance/quality of life, and supportive management. Apply to firstname.lastname@example.com
Must have strong BPM experience, specifically BPM.
No H1s.
Relocation assistance to successful applicants.
Project Lead Senior Java developer with the knowledge, motivation and energy to help build robust and flexible business logic Java applications.
This J2ee Lead position requires extensive experience with architecting and managing a team of developers, requiring the Lead to have extensive ORM development skills, a strong understanding of multi-layer development and the desire to work on a variety of projects using the latest technologies. This position is for someone that wants to work heavily with client groups, and focus on leading a team that develops applications to meet business needs.
The team will be developing a tool that manages content from ingesting the content through the entire workflow process, including delivering the content in multiple digital formats for different outputs (such as broadcast, broadband, mobile, etc). These applications have complex logic and are integrated with several other in-house systems. This Project Lead will lead a team of Software Engineers and will be comfortable handling new challenges involving emerging technologies and leading teams through the full SDLC.
Primary Responsibilities
Meet with business clients to help drive the analysis and design of software systems; help shape system requirements, and develop analysis-level documents that reflect the requirements.
Maintain system and design documentation, and prepare materials for project reviews.
Plan, prioritize and monitor work for team members working on multiple projects.
Plan and monitor the unit testing, implementation, and production release of a project.
Actively create, refine, and evangelize processes and technical standards for the dept
Work with client groups directly and manage contact between IT, clients, and between groups within IT
Supervise the maintenance of software systems.
Experience required:
Technical Skills:
5+ years Java J2EE with complex multi-layer applications
2-3+ years experience with Spring/Hibernate, (strong ORM expertise)
7+ years heavy backend database development, Oracle preferred -with SQL and entity relationship modeling.
Current knowledge of and experience with application servers such as Weblogic
Excellent object-oriented design & programming skills, including strong working knowledge and experience in using UML and design patterns
2+ years leading complex development projects
5-7 years strong foundation in methodologies and architecting complex large scale software systems.
Ant / Ant Maker / CVS-2yrs.
Rose (or some UML tool)-4yrs.
Overall Skills
Bachelor's Degree or advanced degree in Computer Science, Information Technology, Engineering or a related field
Strong communications and critical thinking skills.
Expertise architecting applications based on business requirements.
Experience designing the architecture and then managing the development of multi-year, multi-staff projects
Strong understanding of all aspects of corporate software development; strong client, server, database, and reporting skills.
Full understanding of systems composed of multiple related applications, from both software and business perspectives
Must be able to weigh business and technical requirements to produce project plans and estimates.
Strong time management and multitasking skills. Ability to handle changes in business requirements and set priorities across multiple projects.
Business and negotiation skills to work with clients and business analysts to determine what features the project team will deliver, given constraints of staff, time, and quality.
Strong understanding of standard software development lifecycle methodologies.
Software development ability, experience, speed, and quality.
Ability to lead complex tasks, such as partitioning an application across tiers, establishing transaction boundaries, and selecting integration technologies like message passing and directory services.
Experience in data migration between systems and work flows.


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Today I like to present the 30+ Innovative Facebook Timeline Cover photo Examples. Facebook Timeline is the hottest feature that was introduced in the current Facebook meeting. It's usually a complete service of the profile page with the fresh facility to sight your status updates in a list sorted by time.
Facebook is one of the famous and very well accepted social networking websites that is used similarly by the youths and older people. Facebook users make use of their Facebook accounts to stay in touch with each other and find the childhood friends were we miss them. In Facebook you can share photos, events and to get new friends and it help will you in business also.
Here I collect some stunning and creative FB timeline cover photo. The actual size of this covers are 850*315 pixel. See and enjoy it.


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Who We Work With:
How Can We Help You?
There's no denying it. The Medical & Healthcare industries are growing, and digital marketing is an integral part of that growth. The marketing pros at Sprout Media Lab are standing by to put your company squarely on this Healthcare Boom Bandwagon.
The point is – we've got tons of experience in web design and internet marketing working with healthcare professionals – and all this experience has taught us a thing or two about how to drive patients not only to your website but more importantly – to your office doors.
How Our Skills Stack Up:
Medical & Healthcare providers partner up with Sprout Media Lab to generate more leads and see more new patients.
Create a Winning Digital Marketing Campaign
Sprout Media Lab knows medical & healthcare marketing. The special issues you deal with every day are on our radar – things like insurance, HIPAA, payer mix – or simply making sure your flow of patients continues to build. Following is an outline of how we'll help you reach your goals and get you the results you need:


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Men Vitamins
Patient : I am a 43 year old male truck driver. I am 5"9 and aprox 300 Ilbs. I want to know a healthy vitiamin and mineral that I could take to increas my energy and what is the best brand name to take?
Doctor : There are a lot of good vitamin complex products in the market; any of those if you take it may have a beneficial effec ct in your body. According to your age, weight, gender, and physical activity, I would suggest that you try "Centrum" for men or "One a Day" for men, take it at night before to go to sleep, because it seems that the body at rest gets the most benefit out of the vitamins.
Related Q&A
Vitamin D3 Result: 25 Reference Range as per report.
Q: Hello Doctor, Good Day! Age: 3o Years, Female (Lab report from: Yenepoya Specialty Hospital, Mangalore) V...
For about 5 days now I have been experiencing an burning ...
Q: For about 5 days now I have been experiencing an burning sensation in my left ankle. At times I will feel it in both ...
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Q: Hi Guys, I have been looking for answers for the last 3 years on this problem- but have failed at every...
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I just took too much metronidazole by accident.
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Dr. James Obaji M.D.
- 247 Reviews
- Family Physician
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- Cardiologist
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- 112 Reviews
- Plastic Surgeon


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The Musketeers: Season Two
- (3 Pack, Widescreen, 3PC)
- Format: DVD
- Release Date: 4/21/2015
|your cart is empty
En garde! Prepare for more pulse-pounding thrills, more breathtaking action and more high-stakes heroism. The gallivanting royal bodyguards for King Louis XIII - Athos (Tom Burke, The Hour), Aramis (Santiago Cabrera, Heroes), Porthos (Howard Charles, & Me) and d'Artagnan (Luke Pasqualino, Skins) are back for love, honor and adventure. Together, the inseparable Musketeers employ their bravery and skill to track down a missing Musketeer; become embroiled in a full-scale riot orchestrated by a notorious criminal mastermind; and embark on a dangerous mission to Le Havre. It's all for one in the non-stop second season of The Musketeers.


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Hotel Accommodation near Morgny-la-Pommeraye
Search 54 hotels in Morgny-la-Pommeraye
Get Secret Prices on selected hotels
These prices aren't available to everyone.
Where to stay in Morgny-la-Pommeraye
France   accommodation in Morgny-la-Pommeraye - Hotels.com offers great last-minute Morgny-la-Pommeraye hotels deals and discount room rates. Our hotels in Morgny-la-Pommeraye can easily be booked online. Our fast online search facility allows you to:
- - Find and compare different hotels in Morgny-la-Pommeraye by star rating, amenities, theme, or brand
- - Choose the perfect Morgny-la-Pommeraye hotel and view room rates, hotel details, guest reviews and photos
- - Securely book your hotel room online today!
- - Receive email and text confirmations with reservation details of your online hotel booking


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Sandra Tessier
Listed by Re/Max Property Spec. Grp. Inc.
Great location for this 3 bedroom cape with 1st floor bedroom! Home has eat-in kitchen with ample cabinets and counter space, a front-to-back living room with new carpet, updated bathroom, 2-bedrooms upstairs with hardwood floors and vaulted ceilings!! 3 Season enclosed porch 14x10. New vinyl siding, newer vinyl windows, natural gas heat & new gas hot water tank, fenced yard, 1-car detached garage, full basement and public water/sewer complete the package!
Date Showings Begin:
Delayed Showing: Unknown


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Ishi The Last Yahi Trailer (1992)
01 January 1992
Documentary - Linda Hunt narrates this documentary look at Ishi, the last survivor of the Yahi Native American tribe following massacres in California in the late 1800s. This PBS film celebrates the human spirit while indicting the settlers' treatment of Native Americans. - Rayna Green, Linda Hunt
Watch the official Ishi The Last Yahi 1992 trailer in HD below or find more Ishi The Last Yahi videos on Vidimovie.


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Happy Easter!
For many of years we have delivered Easter Egg Hunts, contests, new events, items or quests to celebrate Easter and the anniversary of the game, however, I have not prepared any of this for you this year. After careful consideration and circumstances beyond my control, I, along with several members of the community have made the decision to leave the game alone and desist in our attempts to nurture the brand of Terraworld any further.
It has come to our realization that the gem that used to be considered Terraworld did not hold its allure based on the merits of the game itself, as many similar games derived from FSO were available through out the lifespan of the game to this day. It was, in fact, the community that made this game what it was and only through the endeavors, hard work, and volunteered effort of various members of the community throughout history, that was this game ever remotely successful.
The fact is, the community no longer has the ability to drive this game forward due to limitations and inadequacies of its platform and the ineptitude and lack of foresight from its owner to allow the game to move forward. Without any type of leadership or willingness to let the community take the reigns, this game has, most unfortunately and unnecessarily, died. No one plays, there is no support, and there is no active community; its finished all but in name and my recent attempts to revive the certain components of the game have failed.
The Announcement
For those of you who celebrate Easter, it is known that today is a celebration of Rebirth and Resurrection. If you don't celebrate Easter, you can still understand the implications of the concept. For many months I have been focused on the resurrection of this game from it's current state, working up to something that would be deliverable to the community on this day, to commemorate 15 years of Terraworld and to reignite the spark and hope in the community and those of you who have been involved and wished to see the game prosper to previous levels and beyond.
As I alluded to previously, it seems out of my hands to do so and any attempts without the right means are surely doomed to fail - and so I have come to the right conclusion that it is not the game that needs resurrection, but the community, its interests, and ideals. It is my intent to preserve what is left of the Terraworld Community, promote it's growth, and nurture your expectations in a progressive direction and bring to you a game, a world, and a community that can flourish and grow on a modern platform shared by both mobile and PC gamers, without the pitfalls and limitations that inevitably sunk Terraworld Online to unrecoverable depths.
The true announcement is that this endeavor is already in large part under way, and while those of us working on it here at Dimensionscape LLC had hoped to bring you a playable experience by this day, we have many other released commercial projects requiring much of our attention.
The good news, is that the team is nearly ready to release our latest title, code named, "Daedalus One", which is the spearhead of our effort to deliver a MMO inspired by FSO and subsequently Terraworld by association to FSO.
Please Join us and the rest of the active Terraworld Community on Discord at Terraworld Discord Chat Server for more information and the very latest updates in regards to Daedalus One. We look forward to seeing you all.


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With the help of computer software and 3D printing, a company called 3DPhotoworks is hoping to open-up a whole new world of painting and photography to blind people.
Their process involves scanning 2D paintings and converting them into digital data. Using computer software, digital conversion specialists "manually" include information that can account for the sense of depth in the images. This information is then given to a 3D printer, which creates a 3D print of the painting, complete with contours and texture. This printing process allows up to 4.5 centimeters (1.75 inches) of relief depth.
So far, the technique has been used to produce three-dimensional versions of some of the fine-art world's most lionized masterpieces, such as da Vinci's "Mona Lisa," Emanuel Leutze's "Washington Crossing the Delaware" and Van Gogh's "Dr. Gachet." However, this is just the beginning – they also want to move into the realm of photography as well.


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Toilet Paper Roll Craft – Minions!!!
Another Pinterest project come to life! These made me so happy
I love these toilet paper roll crafts — I think I might just be addicted! Click through the link to find more progress shots
I cut everything out the night before so that it would be easy for Rand to tape everything together the next day
We definitely got a good amount of play in with these


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B&B Description
Cottages with wood interior, very nicely equipped. All confort and the bedrooms on the first floor. groups are welcome up to 40 persons and a community room is on the place;
Holiday Rental Description:
Rental of 5 comfortable gites ( from 2 to 8 persons ) with bedroom(s) on the 1st floor.All gites have a fully equipped kitchen(corner), electrical heating, extra sofa-beds in the living-room, own Show more descriptionbathroom with shower and toilet. The gites are in a restored farmhouse with a large garden and swimming pool. Groups are welcome. English spoken.Les Messauts lies directly at the bank of the canal lateral, a canal with many bridges and locks that runs from the Mediterranean sea ( canal du midi ) to near Bordeaux ( canal latéral ).in an area famous of its vineyards, chateaux, medieval towns, historic monuments, museums and beautiful gardens. A region of music and dance festivals, markets and brocantes.An area for people who love peace with plenty of possibilities in the locality to play golf, cycle, go horse riding or walking, fishing, canoeing and swimming.One must ofcourse visit one of its many vineyard to taste and buy wine.Some of the famous wine regions nearby: the Graves, Sauternais, Saint-Emilion, Pomerol, Entre Deux Mers, Première Côtes de Bordeaux, Côtes de Bergerac, Monbazillac.
Prices:Prices may vary depending on the season. Please check with the owner.
|Daily Price
|Weekly Price
|Room (2 pers.)
|70 -
|265 - 565
|Room (3 pers.)
|90 -
|265 - 565
|135 - 205
|335 - 735
|195 - 265
|455 - 995


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GC Initial MC/:LF/:TI Shade Guide, Basic Set
GC Initial MC/LF/TI Shade Guide Basic Set is used with GC Initial MC ceramic for metal alloy frameworks, GC Initial LF ceramic for low fusing techniques, and GC Initial TI ceramic for titanium frameworks.
PRODUCT OPTIONS: GC Initial MC/:LF/:TI Shade Guide, Basic Set
GC Initial MC/LF/TI Shade Guide, Basic Set - GC Initial MC/LF/TI Shade Guide, Basic Set
Sku# 877020
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Food & Sustainability at School
Too many elementary and secondary students do not understand the extent to which food from the industrialized food system harms our health, poisons the environment, and accelerates global warming. We will develop tools and resources to encourage and help teachers tackle these concerns.
In addition, we will continue to improve and spread the word about the previous phase of this project, which dealt with interdisciplinary teaching on global warming and greenhouse gas [GHG] emissions. (Except for the free School GHG Calculator, this information is now available online at teach-climate.net.)
Throughout the project our focus is on student-centered, inquiry-based learning. For the food module, we are considering an assessment of school food for the hands-on element, but that has not yet been finalized.
This internship involves a combination research and writing, some of which can be done off-site once someone is familiar with the project and its goals. (We use our online Sustainability Commons for collaboration and sharing content, coupled with frequent email communication on work in progress and regular meetings to meet with teachers, review progress, and brainstorm ideas. Activities will include some or all of the following:
- Prepare an updated version of materials from phase 1 (climate & GHG) by adding information to help teachers link to curriculum standards that they are required to follow; post online and create PDF
- Identify reliable resources and help create new resources that teachers can use to integrate topics related to food, health, climate and sustainability in their classes; help prepare a guide for teachers similar to that done for climate & GHG emissions [see teach-climate.net];
- Assist with development of tools for a hands-on project related to food at school;
- Identify or develop ways for teachers at all ages to encourage observation, analysis, and solving problems, including ways designed for younger children;
This internship is still in development, and will be available (in slightly different forms) for spring, summer, and fall 2017. For more information, email internship coordinator Peter Crownfield.


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When the NHL lockout comes to its official end, few players will be discussed more than Roberto Luongo. That's mainly due to the fact that few players face a more uncertain future than the embattled Vancouver Canucks goaltender.
Luongo lost his starting gig between the Vancouver pipes to the younger Cory Schneider. By all accounts, Schneider will now become the starter for the Canucks. Which has left Luongo's future with the club entirely up in the air, as he faces a few different scenarios.
We've heard a ton about a potential trade of Luongo. If the Canucks, and Luongo, have their way, he will likely be traded before a new season begins. The two most obvious takers are the Toronto Maple Leafs and Florida Panthers.
The Leafs are in dire need of a veteran goaltender, and a player of Lu's caliber would be a tremendous addition, even if the team in front of them does need a ton of work. Despite initial rumors that Luongo did not want the pressure of playing in that type of market, he has since said otherwise.
There is also the Panthers, who the Canucks had originally acquired Luongo from. He still resides in Florida, and would probably be more than happy to take his talents back to South Beach. But it's unknown whether or not the Cats would be willing to surrender the prospects that Vancouver might want.
Should the Canucks fail to find a match in a Luongo trade, which seems unlikely, things may get tricky. At this point, it's almost impossible to see him returning to Vancouver, even though he has said he's open to it. If not, would the Canucks use one of their two buyouts on him?
That is actually unlikely. Even if the Canucks were hellbent on getting rid of Luongo, there are candidates more worthy of a buyout, and they don't carry the value that he does.
It's still likely that Luongo is going to be traded. Heading to Toronto or to South Beach is a more likely occurrence than virtually any other scenario. But until we actually see where he is headed, we are left to wonder what will become of old Bobby Lu heading into the 2013 season.


text: Wondering if anyone has found out if there are housing units for the Droid X. Was wanting to make mine completely white. Don't know if that is possible. Used to have a blackberry and did it with my blackberry but was wondering if you can with a Droid X. If you know of any reliable websites or places to go please let me know! Thanks!! Logan


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Age: 35
Lives: Tiverton, Devon
Plays: Right-handed
Peter started playing deaf tennis aged 17 after a national coach saw him competing against hearing players at a British Tour event in Taunton and persuaded him to attend a Deaf tennis training camp. Peter has since gone on to represent Great Britain in numerous international Deaf tennis events including the Dresse Cup, Deaflympics, European Championships and World Championships. Peter has continued to compete in numerous LTA sanctioned events and has also built a successful career as a tennis coach in both the UK and USA. Peter enjoys watching a variety of sports, especially tennis and football, and is also a keen sky diver.
Major achievements:
- Twelve-time Men's Singles National Champion
- Fifteen-time Men's Doubles National Champion
- Four-time Mixed doubles National Champion
- 2005 Deaflympics Men's Singles 4th Place
- 2003 Dresse Cup* Men's Team Silver Medallist
*Dresse Cup is the equivalent of the Davis Cup for Deaf tennis.