text:
|Publication number
|Publication type
|Application number
|Publication date
|Dec 12, 1995
|Filing date
|Apr 4, 1994
|Priority date
|Apr 4, 1994
|Fee status
|Also published as
|Publication number
|William G. Meathrel, Mohammad Saleem, Shirley A. Binks
|Original Assignee
|Graphic Controls Corporation
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (40), Non-Patent Citations (8), Referenced by (106), Classifications (12), Legal Events (6)
|External Links: USPTO, USPTO Assignment, Espacenet
The present invention relates to fetal monitoring probes and more particularly, to a non-invasive fetal probe which adheres biomedical sensors to the skin of a fetus during labor and delivery.
During labor and delivery, the well-being of the fetus must be carefully monitored. The procedure of monitoring the fetus allows the clinician to assess the health of the fetus, detect fetal stress, and provide appropriate treatment. Both internal (or direct) and external devices and methods are used to monitor and record such fetal parameters as heart rate, blood gas composition and pH levels during labor and delivery.
A. External Methods--Fetal Heart Rate
Several forms of external methods can be used for monitoring fetal heart rate. For example, one external method includes the use of ultrasound. An ultrasound transducer produces ultrasound waves which are directed at the fetus through the mother's abdomen. The ultrasound waves are reflected off moving fetal heart valves and the returning, reflected waves are received by the ultrasound transducer. Analysis of the returning waves and the duration between transmission and reception provide information concerning the fetal heart rate.
Another external method includes the use of a phonotransducer. This method involves placing a microphone, able to detect sound waves generated by the fetal heart, on the mother's abdomen. The phonotransducer then amplifies the sounds and translates them into an electric signal which can be monitored.
Abdominal wall electrocardiography is a third type of external fetal heart rate monitoring. This method detects fetal heart rate signals through ECG electrodes placed on the mother's abdomen. Electrical signals from both the fetal and maternal hearts are detected by the ECG electrodes. The maternal signal is filtered out and the remaining fetal heart rate signals trigger a monitor to count fetal heart beats. Proper placement of the abdominal electrodes is critical in this method; absent proper placement, electrical noise from electromyographic maternal abdominal wall muscle activity may prevent a clear signal.
All of the external methods of measuring fetal heart rate have an important advantage: they are noninvasive. Consequently, these methods largely avoid adverse effects on the mother or the fetus. The quality of the fetal heart rate recording using external monitoring methods is not as good, however, as that achieved by direct methods. This is a major limitation on external monitoring methods. As a general rule, it is necessary to restrict the mother's movements during external monitoring methods to reduce extraneous signals and interferences to obtain accurate tracings. Motion artifact is so common with external techniques that it is virtually impossible to obtain readable tracings unless logic data processing is used. Valuable information about fetal heart rate variability may be lost through such processing.
B. Direct Methods--Fetal Heart Rate
In direct fetal heart rate monitoring, an electrode is attached directly to the fetal presenting part. Typically, the electrode is a spiral wire or hook which penetrates (is inserted directly into) the fetal epidermis and holds the fetal probe in position. The primary advantage of a direct monitoring system of this kind is that the electrode detects the fetal cardiac electrical signal without interference which occurs when detecting the signal through another medium such as the mother's abdomen. The fetal cardiac electrical signal is a precise signal, allowing for accurate assessment of the fetal heart rate and any variations in that rate. Further, during direct fetal heart rate monitoring maternal movement is less restricted during the monitoring without compromising the tracing.
The limitation on this direct fetal heart rate monitoring method is that it is an invasive technique, exposing the mother and the fetus to the potential of injury, infection, or both. Injury may take the form of trauma (such as hemorrhage at the attachment site) to the skin, face, eyes, or other parts of the fetus. In addition, invasive attachment can threaten the life of the fetus by exposing the fetus to maternal body fluids containing infectious components. Venereal diseases and viruses such as acquired immune deficiency (AIDS) and hepatitis B can be transferred directly to the fetus. Moreover, the sharp wire or hook exposes the patient (mother) and clinician to potential injury.
C. Non-Invasive Direct Methods
Various techniques have been described attempting to obtain the benefits of direct fetal monitoring while avoiding the risks attendant invasive penetration of the fetal epidermis. Fetal blood gas analysis has been used to assess fetal health during labor. Blood gas analysis is typically done in a clinical laboratory on blood drawn from the fetus during labor (clearly an invasive technique). Alternatively, Okane et al., "Non-invasive continuous fetal transcutaneous pO2 and pCO2 monitoring during labor," Journal Perinatal Medicine, 17(6), 399 (1989), describe non-invasive continuous fetal transcutaneous pO2 and PCO2 monitoring during labor. Okane et al. used a commercially available device, the Micro Gas 7640 probe, available from Kontron Incorporated of Everett, Massachusetts. This probe is fixed to the fetal head using a suction ring connected to a vacuum pump which maintain a negative pressure of 200-300 mm Hg. The sensor is large and requires cervical dilation of 4 cm or more before insertion is possible. The large size of the sensor and the need to apply continuous suction, through an attached vacuum line, are deterrents to the use of the sensor.
Glue fixation of a transcutaneous pCO2 electrode for fetal monitoring has been described by S. Schmidt, "Glue fixation of the tcPco2 electrode for fetal monitoring," Journal Perinatal Medicine, 15(4), 377(1987). Glue fixation to a fetus is difficult to achieve. It requires sufficient dilation and careful preparation of the attachment site. The electrode often becomes detached during use and may need to be reapplied. In addition, trauma to the skin during removal of a sensor attached by glue is possible. Similarly, pressure-sensitive adhesives such as those used for self-adhesive bandages are hydrophobic and will not adhere to wet surfaces such as fetal skin.
Another non-invasive technique for detecting fetal ECG during labor is described by N. Randall et al., "Detection of the fetal ECG during labour by an intrauterine probe," Journal Biomedicine, (10), 159 (England 1988), and in U.S. Pat. No. 5,025,787 issued to Sutherland et al. The article and patent describe an intrauterine pressure catheter equipped with stainless steel tips which form a multi-point electrode. The intrauterine probe is inserted through the vagina into the uterine cavity. The sensor is held in contact with (but does not adhere to) the fetus by the pressure between the uterus and the fetus. The electronic signal from the sensors is processed to obtain a fetal ECG. The presence of amniotic fluid attenuates the signal from the sensors. The article points out the difficulties in obtaining accurate results due to problems with positioning the electrode tips accurately. Moreover, a degree of electrode isolation is required for optimum detection of fetal signals.
International Patent Publication Number WO 92/04864 (which claims priority of U.K. Patent Applications Number 90-20983 and Number 90-25758 by Van der Merwe) describes a fetal probe with a rigid suction cap approximately 1.5 to 2 cm in diameter. The probe incorporates a fetal heart rate sensor. A negative pressure is created in the rigid cap, by the action of a detachable piston pump, to hold the probe on the fetal skin. The pump is detached after a valve in the cap is closed. The rigid construction of the suction cap and the loss of negative pressure between the fetal skin and suction cap allow the probe to be easily detached during use.
U.S. Pat. No. 5,184,619 describes an intrauterine pressure and fetal heart rate sensor which is inserted between a fetus and the internal uterine wall following rupture of the membranes. The tubular device uses ECG electrodes as well as a pressure transducer to detect fetal heart rate and intrauterine pressure, respectively. Fetal heart rate is detected through the amniotic fluid.
To overcome the shortcomings of the external devices; the invasive, direct devices; and the non-invasive, direct devices used to measure fetal parameters during labor and delivery, a new fetal probe is provided. An object of the present invention is to attach the fetal probe securely to the fetus in a non-invasive manner. It is still another object of the present invention to assure attachment without risk of injury to the fetus, mother, or attending personnel. An additional object is to provide a probe able to transmit a clear, unattenuated signal representative of the fetal parameter being monitored.
To achieve these and other objects, and in view of its purposes, the present invention provides a non-invasive fetal probe which adheres biomedical sensors to the skin of a fetus during labor. The invention includes a conductive assembly, made from a hydrogel formulation, which is formed into a suction cup shape and then polymerized. It is the combination of both the suction cup shape, which initially holds the probe to the fetus, and the hydrogel material, which allows for increased adhesion in the wet environment of the mother's womb. This enables the non-invasive probe to be securely attached to the fetus during labor and delivery.
The use of the hydrogel material provides several advantages over the prior art. First, because hydrogels have memory retention properties, the probe can be used with a smaller diameter guide tube (the cup can be collapsed before insertion). As a result, the fetal probe can be attached to the presenting part of the fetus earlier in labor; insertion of the smaller diameter delivery tube facilitates insertion of the probe.
Another advantage of the use of a hydrogel suction cup to adhere the fetal probe is that, in addition to having good dry adhesive properties, certain hydrogel formulations impart enhanced wet adhesive properties to the fetal probe. The use of diisopropanolamine provides these unexpected and unique wet tack properties.
The adhesive properties achieved by the probe of the present invention avoid the attachment problems of the prior art. For example, the invasive technique of attaching an electrode having a sharp hook or wire directly to the fetal epidermis, with its concomitant risks of injuring the fetus and spreading diseases and viruses, is avoided. The accurate readings afforded by the present invention also improve the quality of the results obtained relative to such prior art as external monitoring techniques and other techniques which, although non-invasive, do not securely and releasably attach a probe to the fetus.
Thus, two important aspects of the present invention are the chemical formulation of the hydrogel material used and the configuration of suction cups made from the hydrogel material itself. An additional aspect is the use of the suction cup made of the hydrogel material in combination with the delivery system--which allows for earlier application of the probe during labor due to the memory retentive properties of the cup which allow it to be used with the smaller diameter delivery tube.
It is to be understood that both the foregoing general description and the following detailed description are exemplary, but are not restrictive, of the invention.
The invention is best understood from the following detailed description when read in connection with the accompanying drawing, in which:
FIG. 1 is a cross section of a non-invasive fetal probe constructed in accordance with the present invention;
FIG. 2 is a cross section of the fetal probe shown in FIG. 1 attached to a fetus;
FIG. 3 is a cross section of the fetal probe of the present invention having a fetal sensor embedded in the hydrogel of the body of the fetal probe;
FIG. 4 is a graph of tack force (g) versus drying time (minutes) illustrating the effect of drying the hydrogel composition of Example 3, Table 1, on adhesion;
FIG. 5 is a cross section of the non-invasive fetal probe of FIGS. 1 or 3 disposed inside a guide tube in a collapsed state;
FIG. 6 is a cross section of the non-invasive fetal probe of FIGS. 1 or 3 in its normal expanded state outside of the guide tube and following expulsion from the guide tube;
FIG. 7 is a cross section of an additional embodiment of a non-invasive fetal probe having a shell coated with hydrogel;
FIG. 8A is a cross section of the wall of the shell shown in FIG. 7, illustrating a straight inner wall surface;
FIG. 8B is a cross section of the wall of the shell shown in FIG. 7, illustrating a ridge;
FIG. 8C is a cross section of the wall of the shell shown in FIG. 7, illustrating a ledge; and
FIG. 9 shows an exemplary embodiment of the maternal sensor incorporated into the fetal probe of FIGS. 1, 3, or 7.
Referring now to the drawing, wherein like reference numerals refer to like elements throughout, FIGS. 1, 2, and 3 illustrate a non-invasive fetal probe 10 constructed in accordance with the present invention. It is emphasized that, according to common practice, the various elements of the drawing are not to scale. On the contrary, the width, length, and thickness of the various elements are arbitrarily expanded or reduced for clarity.
Fetal probe 10 is inserted through the birth canal and is attached to the presenting part (typically the head) of the fetus 100. Because it is "non-invasive," fetal probe 10 does not penetrate the fetal skin. Once attached, fetal probe 10 can continuously sense, depending upon the sensors incorporated in fetal probe 10, such fetal parameters as heart rate, blood gas composition, temperature, and pH levels during labor and delivery. Other types of sensors and test equipment or combinations of sensors and test equipment could be incorporated into fetal probe 10.
Fetal probe 10 has a fetal sensor 12 with an attached fetal sensor connector 14. A maternal sensor 16 and attached maternal sensor connector 18 may also be provided. Fetal sensor 12 and maternal sensor 16 are electrodes, and fetal connector 14 and maternal connector 18 are electric leads, when fetal probe 10 is a fetal heart rate probe. In that case, an insulating barrier 20 maintains electrical separation between fetal sensor 12 and maternal sensor 16. Maternal sensor 16 can be positioned on the top surface of probe 10 or may extend down the sides of probe 10, so long as maternal sensor 16 does not contact the fetus to which probe 10 is adhered. A body 30 provides the base to which fetal sensor 12 and maternal sensor 14 are attached and secures fetal probe 10 to fetus 100.
As shown in FIG. 1, fetal sensor 12 may be positioned on the surface of body 30. Alternatively, as shown in FIG. 3, fetal sensor 12 may be embedded in body 30. In either case, fetal sensor connector 14 and maternal sensor connector 18 connect fetal sensor 12 and maternal sensor 16, respectively, to an external monitor 80.
Suction cups are commonly used to attach items to flat surfaces. The attachment is achieved by creating a negative pressure between the flat surface and the inner, concave surface of the suction cup. The bond between the flat surface and the concave surface of the suction cup depends both upon the composition, shape, and area of the suction cup and upon the characteristics of the flat surface such as smoothness and porosity. The bond fails when the negative pressure between the two surfaces is increased to atmospheric pressure. That occurs when air leaks under the edges of the suction cup or diffuses through the suction cup into the small gap formed between the flat surface and the concave surface of the suction cup.
Strong, durable bonds between suction cups and smooth, rigid, flat surfaces such as glass can be formed by the creation of strong Van der Waals' forces due to the close proximity of the two surfaces. Moreover, suction cups adhere better to wet surfaces because the water reduces surface texture and, therefore, increases Van der Waals' interactions. On fetal skin, however, which is pliable, textured, and curved, conventional suction cups will not adhere for sufficient time to be useful for fetal monitoring applications. They fall off almost immediately when applied to fetal skin.
Fetal probe 10 of the present invention solves that problem in two ways. First, the material or composition of body 30 of fetal probe 10 is designed to provide adhesion between body 30 and fetus 100. Second, the configuration of body 30 is a suction cup designed to facilitate adhesion between suction cup 30 and fetus 100. The initial attachment of fetal probe 10 to the wet surface of fetus 100 uses the vacuum created by the suction cup configuration of body 30. Thereafter, the material used to form body 30 absorbs the moisture of the wet environment, creating strong surface adhesive properties between body 30 and the skin of fetus 100.
A. Composition of Body
Polymeric hydrogels can be soft and flexible materials. Hydrogels exhibit shape memory and will return to their original shape even after deformation. Hydrogels also have the important characteristics of biocompatibility, hydrophilicity (the ability to absorb water), and may have adhesive properties, and electrical conductivity --they mimic characteristics of living tissue.
Various compositions can be used to make a hydrogel suitable for body 30. Example compositions (by percentage) are listed in Table 1. Example 3 shows a preferred embodiment for substantially hairless fetal skin. Example 5 is a preferred embodiment for fetal skin with a significant amount of hair. Example 1, which does not contain diisopropanolamine, would not be satisfactory for an in-vivo fetus.
TABLE 1______________________________________Component Ex. 1 Ex. 2 Ex. 3 Ex. 4 Ex. 5______________________________________Water 15.16 24.82 38.96 10.7 37.56Acrylic Acid 25.84 19.13 28.97 21.7 15.97Darocur 1173 0.47 0.35 0.35 0.33 0.35Polyethylene Glycol 0.13 0.10 0.10 0.17 0.15(400) DiacrylateGlycerine 53.04 46.80 -- 27.8 --Colloid 121 -- -- -- 14.9 --Diisopropanolamine -- 7.80 28.12 13.8 28.12Sodium Chloride -- 1.00 -- -- --Potassium Chloride 5.40 -- 3.50 1.0 3.5027% Aqueous -- -- -- 9.6 --Sodium HydroxideVinyl Pyrrolidone -- -- -- -- 13.00______________________________________
Each of the polymers formed in the hydrogel compositions in Table 1 can be a homopolymer of acrylic acid, copolymer of acrylic acid and acrylic acid salts, copolymers of acrylic acid and esters derived from alcoholamines, copolymers of acrylic acid and vinyl pyrrolidone, copolymers of acrylic acid and acrylates, and polymers obtained from any of the above monomer combinations. In the case of a fetus with significant amounts of hair, a formulation made with 13 percent of vinyl pyrrolidone is the preferred embodiment (Example 5). Darocur 1173 (2-hydroxy-2-methyl-l-phenyl-propane-1-one) is a photoinitiator available from Ciba Geigy. Polyethylene glycol (400) diacrylate is a crosslinking agent available under the trade name Sartomer� 344, available from the Sartomer Company of West Chester, Pa. Glycerine is a humectant and plasticizer which provides flexibility and dry tack properties. Colloid 121 a polyacrylic acid solution available from Rhone-Poulenc in Marietta, Ga. enhances wet tack, viscosity, and formability properties. Diisopropanolamine, a humectant and plasticizer, helps to neutralize the acid and gives the hydrogel good wet adhesive properties. Sodium hydroxide is added to control pH. Sodium chloride and potassium chloride are electrolytes which increase conductivity.
The preferred hydrogel composition contains an alcoholamine such as diisopropanolamine. Hydrogel compositions have been prepared, however, including other secondary and tertiary alcoholamines such as triethanolamine and diethanolamine. These compositions also have good wet adhesive properties.
U.S. Pat. No. 4,921,904 (Sparapany et al.) describes super-absorbant hydrogels which include a polyamine. Diisopropylamine is mentioned. Diisopropylamine is not the same chemical, however, as diisopropanolamine. Polyamines have a single functional atom, the nitrogen atom, whereas alcoholamines have at least two functional sites--a nitrogen atom and a hydroxyl group.
U.S. Pat. Nos. 5,124,076 and 5,183,599 issued to Smuckler teach a hydrogel adhesive composition for medical electrodes which polymerizes rapidly, preferably in less than ten seconds. Specifically, the hydrogel composition contains a mixture of an N-vinyl lactam and an acrylate monomer. The hydrogel compositions of the present invention use a single monomer, acrylic acid, or a copolymer of acrylic acid and vinyl pyrrolidone, and the polymerization time (although rapid) is of little importance.
During labor, the intrapartum fetus is exposed to amniotic fluid, vaginal fluids, and, in some cases, fetal excretions. In this wet environment, an adhesive with good wet tack properties is required. (The tack is the characteristic of the adhesive to stick to a surface.) The hydrogels produced by curing the compositions listed as Examples 2-5 in Table 1 exhibit the unique property of having both a dry and a wet tack. The alcoholamine (and, specifically, diisopropanolamine) used in the compositions provides this property.
Many adhesives, for example pressure sensitive adhesives which are used with adhesive tapes, exhibit good adhesive properties to dry surfaces. These adhesive tapes, however, typically do not adhere well to wet surfaces. U.S. Pat. No. 5,139,023 issued to Stanley et al. describes a blood glucose sensor which uses a hydrogel (hydroxypropyl cellulose, gelatin, and carbopol) to adhere the device to mucosal membranes. Such materials are unlikely to have sufficient adhesive properties to hold a device such as fetal probe 10 to a wet surface such as fetus 100.
The hydrogel compositions of the present invention also have shape memory. The shape memory characteristic enables body 30 to return to the desired concave suction-cup shape after deformation. The great flexibility of the hydrogel also allows body 30 to form a strong suction when pressed against the epidermis of fetus 100.
The attachment force which holds fetal probe 10 in place on fetus 100 must be sufficient to hold fetal probe 10 in place during labor. An attachment time of ten hours or more may be required. Further, fetal probe 10 must adhere even if fetus 100 has hair 102.
It has been found that drying the hydrogel, Example 3, Table 1 to remove some of the water from the polymer matrix can increase the tack of the hydrogel on hairy skin. FIG. 4 shows the effect of drying time on adhesion. Moreover, hydrogels prepared using vinyl pyrrolidone provide added adhesion to hairy tissue. Increased adhesion to hairy tissue has been found by replacing approximately half of the acrylic acid monomer with vinyl pyrrolidone (see Example 5 of Table 1).
Because body 30 may be used as a conductive pathway of electrical signals between fetus 100 and fetal sensor 12, body 30 must be electrically conductive as well as adhesive. The hydrogel compositions used to form body 30 meet that requirement. The hydrogel compositions of Table 1 have a 10 Hz impedence less than or equal to 2000 ohms to an impressed current of 100 microamperes. Thus, the physical and electrical properties of the hydrogel compositions can be controlled to provide a flexible, conductive, adhesive interface between fetus 100 and fetal sensor 12.
Each of the compositions listed in Table 1 may be polymerized by various means, such as ultraviolet light, heat, electron beam, redox reagents, and the like. Exposure to ultraviolet radiation is the preferred way to initiate polymerization. The hydrogel composition may be used "as is," in its form following polymerization, or the composition may be cast as a coating and then dried to provide a flexible, non-tacky, thermoplastic film.
Alternatively, the composition may be polymerized directly into a non-tacky, flexible sheet. This dry coating, flexible sheet can then be formed into the desired shape (such as a suction cup). The dry coating can be "wetted" to regain its dry and wet adhesive properties. Using the polymer as a non-tacky, dry coating on fetal probe 10 can allow for easy insertion of fetal probe 10 through the birth canal. Once in place, fluids around the fetus will reactivate the adhesive properties of the hydrogel and hold fetal probe 10 in place.
The applications for a hydrogel having good wet and dry adhesive properties are broader than a noninvasive fetal probe 10. Applications such as wound dressings and closures, transdermal drug delivery systems, ostomy adhesives, medical tapes, various medical electrodes, and the like could benefit from a hydrogel adhesive with wet and dry adhesive properties.
B. Configuration of Body
The hydrogel compositions of the present invention can be molded or formed to provide almost any desired size and shape. Body 30 can be formed by dispensing the hydrogel composition into a mold of the desired shape then polymerizing the monomers in the mold. Alternatively, suction cup-shaped probes can be prepared by spin casting, similar to the procedure used to prepare soft contact lenses.
The size and shape of body 30 formed by the hydrogel composition of the present invention affects the adhesion between body 30 and fetus 100. A suction cup shape for body 30 having a concave surface 32 contacting fetus 100 is preferred to enhance adhesion. Table 2 compares various shapes and diameters possible for body 30 and provides the 90-degree peel (the force required to peel body 30 from a flat, stainless steel plate) for each particular shape and diameter. A Shimpo Digital Force Gauge Model DF-5.0R (supplied by Shimpo America corporation of Lincolnwood, Ill. 60659) was used to make the measurements contained in Table 2.
TABLE 2______________________________________Shape Diameter (mm) 90� Peel Force (g)______________________________________Concave U 15 400Concave V 15 450Concave V 20 710Concave V 50 >1075Flat 20 360Convex 30 720______________________________________
Table 2 indicates that a shallow, V-shaped cup is more difficult to remove than a deeper, U-shaped cup. This additional adhesive power is beneficial toward maintaining contact during labor. Larger surfaces also have higher 90-degree peel strengths. Finally, cups with a concave shape require more force to remove them than flat and convex-shaped cups of similar size.
It is desirable for a fetal probe 10 to have a small enough diameter for ease of application early in labor. For example, a V-shaped, concave cup with a diameter of 15 to 20 mm, or which can be collapsed into a dispenser or guide tube of this diameter or less, is preferred. Such a size permits application of fetal probe 10 when cervical dilation is 1 cm or less. Fetal probe 10 need not be collapsed for insertion, as it can be placed inside a delivery tube or applied with other delivery means in an uncollapsed state.
To assure both applicability of fetal probe 10 early in labor and maximum adhesive strength (larger surfaces provide more strength), the shape-retention property of hydrogel proves useful. FIG. 5 shows an exemplary embodiment of fetal probe 10 disposed inside a guide tube 60. Guide tube 60 may have a diameter of 20 mm while body 30 of fetal probe 10 has a diameter of 40 mm. Accordingly, fetal probe 10 is collapsed within guide tube 60. It will be understood that the sizes for both fetal probe 10 and guide tube 60 (or other delivery means) can be made smaller or larger, depending upon the application as will be understood by those skilled in the art.
Drive tube 70, which has a smaller diameter than guide tube 60, may be used to push fetal probe 10 out of guide tube 60. Once removed from guide tube 60, body 30 of fetal probe 10 regains--through the shape retention properties of the hydrogel used to form body 30--its initial, uncollapsed shape. FIG. 6 shows fetal probe 10 following ejection from guide tube 60.
In FIG. 6, it can be seen that fetal probe 10 has regained its desired, initial shape and is ready for attachment to the fetal skin. Thus, the deformation of fetal probe 10 while disposed inside guide tube 60 does not affect the shape at the time of attachment to fetus 100. Other methods of placing fetal probe 10 into contact with fetus 100 will be understood by those skilled in the art.
Body 30 may be formed entirely of hydrogel. Alternatively, body 30 may be formed of another material and only concave surface 32 of body 30 coated with a hydrogel composition of the present invention. Fetal probe 10 having body 30 so constructed shows satisfactory adhesive properties to fetus 100.
FIG. 7 depicts a thermoplastic shell 34 coated with hydrogel to form body 30. Shell 34 can be formed by a number of processes understood by those skilled in the art, including molding. Suitable dimensions for shell 34 are a total height of about 6.2 mm and a diameter of about 15 mm.
Various thermoplastic resins are suitable for forming shell 34. Example materials include Pellethane™ (a polytetramethylene glycol ether resin available from Dow Chemical Company, such as Pellethane 2363), Pebax™ (a polyether block amide resin available from Atochem, Inc., such as Pebax 2533) PVCs, polyurethanes and polyethylenes. Each of these materials offer different combinations of characteristics important to the manufacture and operation of fetal probe 10. Some of these characteristics are ease of molding, strength, adhesion to hydrogel, hardness water absorption, biocompatibility, price, and signal isolation.
By using shell 34, the hydrogel of body 30 may be isolated from external fluids. FIGS. 8A, 8B, and 8C show three variations in the configuration of wall 50 of shell 34. FIG. 8A shows a "straight" inner surface 36, without deviations or additions, entirely parallel to the outer surface 48 of wall 50 of shell 34. FIG. 8B shows a ridge 38, which is a straight, vertical segment near the perimeter of wall 50 of shell 34. Ridge 38 has a top edge 40 and a lower edge 42. Top edge 40 is defined by ridge 38 meeting inner wall 36. Lower edge 42 is defined by bottom, horizontal surface 44 of wall 50 meeting ridge 38.
FIG. 8C shows a ledge 52, which is an extension of the wall 50 in a plane which is approximately at a 30-degree angle to outer wall 48 of shell 34. The angle of ledge 52 could be adjusted (at, for example, angles between 15 and 60 degrees) to achieve a desired holding strength. Ledge 52 has a side surface 54 and a top surface 56.
Ridge 38 of FIG. 8B and ledge 52 of FIG. 8C help to isolate the hydrogel of body 30 from external fluids by forming a seal between the hydrogel and external fluids. A fetal probe 10 constructed with ridge 38 remained attached to a simulated test "baby" for more than 32 hours while immersed in an isotonic saline solution. Ledge 52 is advantageous because it allows the hydrogel to be extended closer to the edge of shell 34.
Initial attachment of fetal probe 10 to fetus 100 uses both the vacuum effect (negative pressure) created by the suction cup shape of body 30 of fetal probe 10 and the adhesive properties of the hydrogel adhering to the wet surface of fetus 100 in the uterus. Because hydrogels have shape-retention properties, body 30 retains its suction-cup shape. As the hydrogel absorbs fluid, strong surface adhesive properties are created between the hydrogel and the fetal skin. Air will not seep under the edges of body 30, which would reduce the negative pressure under body 30, because the hydrogel adheres to fetus 100. Thus, suction cup body 30 made of the hydrogel of the present invention exhibits strong adhesive force throughout the duration of labor.
Body 30 of fetal probe 10 has a combined adhesive force generated by the adhesive properties of the hydrogel interface and the concave, suction-cup shape of the interface. Individually the adhesive force generated by the hydrogel and that generated by the geometry of the interface may be insufficient to secure attachment throughout labor. Although the combined attachment force is sufficient to hold fetal probe 10 in place during labor, it also allows detachment without injury to sensitive fetal tissue. The detachment force of fetal probe 10 from fetal tissue is in the range of 200 g to 2000 g and preferably in the range of 300 g to 1000 g.
C. Fetal Heart Rate Probe
One specific application of fetal probe 10 will be described to better illustrate the advantages of fetal probe 10. Fetal probe 10 may be used to monitor fetal heart rate without penetration of the fetal epidermis. At least four criteria affect the quality of the fetal heart rate signal monitored: (1) symmetry between the fetal and maternal (reference) electrodes, (2) maximum separation between the fetal and reference sensors, (3) maximum surface contact area to minimize impedance, and (4) stabilized connections. Application of fetal probe 10 to monitor fetal heart rate meets these criteria well.
In this application, fetal sensor 12 detects the electrical fetal heart rate signal transcutaneously. To do so, fetal sensor 12 must maintain contact with fetus 100, either directly (FIG. 1) or through the conductive hydrogel of body 30 (FIG. 3). When in direct contact with fetus 100, fetal sensor 12 may be covered with a conductive medium, such as a conductive gel, to lower impedance at the skin-sensor interface. Fetal sensor 12 must provide a sufficiently large surface area and be electrically conductive to sense the electrical fetal heart rate signal. In addition, fetal sensor 12 must be inert to chemical reaction with hydrogel and biological fluids and tissues.
A suitable material for construction of fetal sensor 12 in this application is the silver-silver chloride sensors commonly used in ECG monitoring electrodes. Fetal sensor 12 could also be formed from multi-strand stainless steel wire, such as a Teflon� coated steel wire sold by Cooner Wire in Chatsworth Calif. In one embodiment, six individual strands of 40-gauge wire were spread over concave surface 32 of body 30 to form fetal sensor 12. Such wire is very fine and light weight; therefore, it adds little mass to fetal probe 10. Alternative insulating jacket materials for the wire, other than Teflon�, could also be used.
Multi-strand carbon fiber wire is a suitable replacement for stainless steel in forming fetal sensor 2. Carbon wires are light weight and flexible. Moreover, they provide good electrical signals and do not react with hydrogel components or saline solutions. Suitable carbon wire can be obtained from Minne. Wire and Cable Company in St. Paul Minn.
In this application, fetal connector 14 is a lead wire suitable for conducting the electrical signals from fetal sensor 12 to a monitoring-signal processing unit. Fetal connector 14 passes through body 30 and maternal sensor 16 and is ultimately connected (perhaps through other wires and electrical connections) to a fetal heart rate monitor (monitor 80 shown in FIGS. 1 and 3). The environment in which fetal probe 10 is used, namely inside the uterus, requires insulation of the lead wire. The connection between fetal connector 14 and fetal sensor 12 is embedded in the conductive, adhesive hydrogel of body 30.
In this application, maternal sensor 16 must provide a sufficiently large surface area and be electrically conductive to sense the electrical maternal heart rate signal and other muscular or electrical activity. In addition, maternal sensor 16 must be inert to chemical reaction with biological fluids and tissues. Multi-strand stainless steel or carbon fiber wires, described above for use as fetal sensor 12, can also be used for maternal sensor 16. Alternatively, maternal sensor 16 may be an electrically conducting material such as a metal foil (e.g., silver, aluminum, or stainless steel) or metallized film (e.g., aluminum metallized polyester) which covers the upper surface of insulating barrier 20. Other electrically conductive, non-metallic films and coatings such as conductive carbon and conductive graphite may also be used.
Maternal sensor 16 may be a band, washer, wire loop, or plate which fits on top of body 30 over insulating barrier 20. In an exemplary embodiment, as shown in FIG. 9, stainless steel band 90 can be approximately 3.5 to 4.0 mm wide (preferably 3.7 mm) and 5.0 to 5.5 mm in diameter (preferably 5.4 mm). Maternal connector 18 is a lead wire connected to maternal sensor 16 for communicating received electrical signals.
The maternal heart rate detected by maternal sensor 16 is used as a reference signal so that any maternal heart rate and other muscular or electrical signals which pass through the fetus and are detected by fetal sensor 12 can be subtracted out to provide an accurate fetal heart rate measurement. Generally, the reference component of the signal detected by fetal heart rate sensor 12 is a minor component when compared to the fetal heart rate signal. The fetal heart rate can then be isolated from the combined fetal and reference signals detected by fetal sensor 12. This is accomplished by isolating the fetal R-waves from the other signals.
Non-invasive fetal probe 10 has two leads 14, 18--similar to conventional fetal scalp electrodes--for fetal sensor 12 and maternal reference sensor 16. Both the fetal and maternal leads 14 and 18 could be replaced by a non-wired connecting system, such as a radio transmission system, to communicate information from fetal sensor 12 and maternal sensor 16 to monitoring equipment 80. A radio system would require supporting hardware as is understood by those skilled in the art.
Referring back to FIGS. 1 and 2, insulating barrier 20 serves to maintain electrical insulation between fetal sensor 12 and maternal sensor 16. Pebax a polyether block amide, is one type of insulating barrier which can serve this purpose. Other similar materials having sufficiently high dielectric properties also would suffice. Insulating barrier 20 should be flexible so as not to impede the flexibility of body 30. Ridge 38 or ledge 52 provided on wall 50 of shell 34 increases the separation of the fetal and maternal signals, which allows monitor 80 to more easily isolate the fetal heart rate signal, and helps to assure electrical isolation between fetal sensor 12 and the external fluid.
When fetal probe 10 is initially applied to fetus 100, the hydrogel of body 30 absorbs moisture and increases in tackiness. Moreover, the hydrogel swells and forces ridge 38 or ledge 52 against fetus 100--enhancing the adhesive seal between fetal probe 10 and fetus 100. Should the hydrogel absorb too much moisture and swell to the extent that it extends under shell 34, however, the seal between fetal probe 10 and fetus 100 may be adversely affected. In addition, the electric isolation between fetal sensor 12 and the external fluid would be jeopardized. Ridge 38 or ledge 52 helps to isolate the hydrogel from external fluids, thereby preventing the hydrogel from absorbing too much moisture and risking such adverse consequences.
FIGS. 1 and 3 illustrate fetal probe 10 connected to a signal processing and display unit 80. Signal processing and display unit 80 is used, in this application, to monitor the fetal heart rate detected by fetal probe 10. Signal processing display unit 80 contains the digital signal processing equipment and control instructions necessary to discriminate the fetal heart rate signal from the other extraneous signals. Signal processing display unit 80 may also carry out, in other applications for fetal probe 10, blood gas analysis, oximetry measurements, and other functions.
Although illustrated and described herein with reference to certain specific embodiments, the present invention is nevertheless not intended to be limited to the details shown. Rather, various modifications may be made in the details within the scope and range of equivalents of the claims and without departing from the spirit of the invention. For example, although the fetal probe 10 of the present invention has been described in detail for attachment of non-invasive fetal heart rate sensors, fetal probe 10 could also be used for other sensors such as blood gas analyzers and oximetry sensors. If so, fetal connector 14 and maternal connector 18 may constitute fiber optics rather than lead wires.
|Cited Patent
|Filing date
|Publication date
|Dec 13, 1971
|Aug 7, 1973
|Hewlett Packard Gmbh
|Double spiral electrode for intra-cavity attachment
|Dec 4, 1972
|Aug 6, 1974
|E Hon
|Bipolar electrode structure for monitoring fetal heartbeat and the like
|Oct 3, 1977
|Apr 17, 1979
|Hewlett-Packard Company
|Electrode assembly for sensing heart activity
|Apr 24, 1978
|Dec 25, 1979
|Hewlett-Packard Company
|Electrode assembly for sensing heart activity
|Jun 19, 1979
|Nov 10, 1981
|Mario Zilianti
|Bipolar electrodes for fetal heart-rate recording during labor
|Apr 14, 1980
|Nov 24, 1981
|American Home Products Corporation
|Rotating mechanism for introducing a fetal electrode
|Mar 9, 1979
|Jan 5, 1982
|National Research Development Corporation
|Electroencephalograph monitoring
|Jun 13, 1980
|Mar 23, 1982
|American Home Products Corporation
|Fetal electrode
|Dec 11, 1981
|Mar 20, 1984
|American Home Products Corporation
|Apparatus for monitoring fetal heartbeat and the like
|Sep 14, 1981
|May 7, 1985
|Nitto Electric Industrial Co., Ltd.
|Electrode pad
|Dec 22, 1983
|Mar 25, 1986
|Rocket Of London Limited
|Medical instrument
|Aug 1, 1985
|Jul 29, 1986
|Nitto Electric Industrial Co., Ltd.
|Biomedical electrode
|Feb 24, 1986
|Apr 21, 1987
|International Biomedics, Inc.
|Spiral probe for simultaneous electrical and chemical monitoring of a fetus
|Jun 30, 1986
|Nov 17, 1987
|Nepera Inc.
|Conductive adhesive medical electrode assemblies
|Aug 21, 1985
|Mar 15, 1988
|Kingston Technologies Limited Partnership
|Intraocular lens
|Dec 19, 1988
|May 1, 1990
|Nalco Chemical Company
|Superabsorbent polymers
|May 12, 1989
|Jun 19, 1990
|American Home Products Corporation
|Fetal electrode product
|Oct 28, 1988
|Jul 3, 1990
|Nellcor Incorporated
|Perinatal pulse oximetry sensor
|Mar 30, 1989
|Feb 5, 1991
|Preston Keusch
|Highly conductive non-stringy adhesive hydrophilic gels and medical electrode assemblies manufactured therefrom
|Jul 3, 1989
|Mar 26, 1991
|Medtronic, Inc.
|Process for making biomedical devices utilizing thermoplastic hydrophilic gels
|Feb 26, 1990
|Jun 25, 1991
|The Imperial College Of Science, Technology & Medicine
|Intrauterine probe
|Jan 19, 1990
|Jun 23, 1992
|Contour Electrodes, Inc.
|Rapid, curing, electrically conductive adhesive
|Jun 2, 1989
|Aug 18, 1992
|Theratech Inc.
|Apparatus and method for noninvasive blood glucose monitoring
|Mar 26, 1990
|Sep 1, 1992
|Nepera, Inc.
|Non-stringy adhesive hydrophilic gels
|Jun 18, 1991
|Feb 2, 1993
|Smuckler Jack H
|Rapid curing, electrically conductive adhesive
|Oct 2, 1987
|Feb 9, 1993
|Peritronics Medical, Inc.
|Intrauterine pressure and fetal heart rate sensor
|Feb 8, 1991
|Oct 19, 1993
|Showa Denko K.K.
|External application base or auxiliary agent and external application composition for human being or animal containing the same
|Apr 19, 1991
|Sep 13, 1994
|Egnell Ameda Limited
|Non-invasive medical probe provided with suction cup
|Feb 6, 1975
|Oct 5, 1976
|Corometrics Medical Systems, Inc.
|Bipolar electrode structure for monitoring fetal heartbeat and the like
|Dec 21, 1977
|Jun 23, 1981
|John B. Murphy
|Electrode assembly for sensing heart activity
|Oct 22, 1971
|Apr 26, 1973
|Siemens Ag
|Selbsthaftende elektrode fuer die ekgdiagnostik
|Title not available
|Oct 25, 1993
|Feb 10, 1994
|Arbo Robotron Medizin Technolo
|Biomedizinische Elektrode
|Jul 7, 1983
|Jan 25, 1984
|Kontron Incorporated
|Fetal electrode apparatus
|Oct 11, 1984
|Apr 17, 1985
|J�rgen Prof. Dr. Morgenstern
|Physiological sensor
|Jun 1, 1987
|Dec 9, 1987
|Rocket of London Limited
|Instrument for monitoring foetal heart rate
|Title not available
|Nov 7, 1990
|Jun 13, 1991
|Jason Otto Gardosi
|Fetal probe
|Apr 19, 1991
|Oct 31, 1991
|Egnell Ameda Limited
|Non-invasive medical probe provided with suction cup
|Sep 26, 1991
|Apr 2, 1992
|Merwe Marius V D
|Monitoring device
|Hofmeyr, A nonpenetrating fetal scalp electrode, British Journal of Obstetrics and Gynaecology, vol. 100, pp. 649 652 (Jul. 1993).
|Hofmeyr, A nonpenetrating fetal scalp electrode, British Journal of Obstetrics and Gynaecology, vol. 100, pp. 649-652 (Jul. 1993).
|N. J. Randall et al., Detection of the fetal ECG during labour by an intrauterine probe, 27th Annual Meeting of Biological Eng. Society, Oxford, UK, 2 4 Sep. 1987.
|N. J. Randall et al., Detection of the fetal ECG during labour by an intrauterine probe, 27th Annual Meeting of Biological Eng. Society, Oxford, UK, 2-4 Sep. 1987.
|Okane et al., Non invasive continuous fetal transcutaneous pO 2 amd pCO 2 monitoring during labor. J. Perinat. Med 17 (1989) pp. 399 410.
|Okane et al., Non-invasive continuous fetal transcutaneous pO2 amd pCO2 monitoring during labor. J. Perinat. Med 17 (1989) pp. 399-410.
|Schmidt, Glue fixation of the tePco 2 for fetal monitoring, J. Perinat. Med. 15 (1987), pp. 377 382.
|Schmidt, Glue fixation of the tePco2 for fetal monitoring, J. Perinat. Med. 15 (1987), pp. 377-382.
|Citing Patent
|Filing date
|Publication date
|Jun 7, 1995
|Sep 9, 1997
|Graphic Controls Corporation
|Hydrogel adhesive for attaching medical device to patient
|Apr 9, 1996
|Mar 17, 1998
|Lectec Corporation
|Dual purpose ultrasonic biomedical couplant pad and electrode
|Oct 31, 1996
|Nov 10, 1998
|Graphic Controls Corporation
|Non-invasive fetal probe having improved mechanical and electrical properties
|Aug 27, 1998
|Feb 15, 2000
|T.A.O. Medical Technologies Ltd.
|Method of and system for estimating placenta and fetus well being using system identification techniques
|Oct 3, 1997
|May 23, 2000
|Brain Functions Laboratory, Inc.
|Jan 15, 1998
|Jun 27, 2000
|Lumend, Inc.
|Method and apparatus for the guided bypass of coronary occlusions
|Jan 16, 1998
|Dec 5, 2000
|Lumend, Inc.
|Catheter apparatus for treating arterial occlusions
|Jan 15, 1998
|Jun 5, 2001
|Lumend, Inc.
|Catheter apparatus for guided transvascular treatment of arterial occlusions
|Jan 13, 2000
|Jul 24, 2001
|Lumend, Inc.
|Catheter apparatus for treating arterial occlusions
|Jul 7, 1999
|Sep 4, 2001
|Masimo Corporation
|Fetal pulse oximetry sensor
|Nov 26, 1999
|Jan 22, 2002
|T.A.O. Medical Technologies Ltd.
|Method and system for system identification of physiological systems
|Jul 24, 2001
|Sep 30, 2003
|Kimberly-Clark Worldwide, Inc.
|Methods of making humidity activated materials having shape-memory
|Jul 24, 2001
|Dec 16, 2003
|Kimberly-Clark Worldwide, Inc.
|Disposable products having humidity activated materials with shape-memory
|Feb 14, 2000
|Oct 5, 2004
|Ballard Medical Products, Inc.
|Inherently antimicrobial quaternary amine hydrogel wound dressings
|Jul 24, 2001
|Aug 23, 2005
|Kimberly-Clark Worldwide Inc.
|Methods of making disposable products having humidity activated materials with shape-memory
|Nov 17, 2000
|May 9, 2006
|Spectrx, Inc.
|Tissue interface device
|Jun 15, 2004
|Apr 28, 2009
|Kci Licensing, Inc.
|System for combined transcutaneous blood gas monitoring and negative pressure wound treatment
|Jan 28, 2009
|Feb 9, 2010
|Nellcor Puritan Bennett Llc
|Device and method for reducing crosstalk
|Sep 29, 2006
|Mar 16, 2010
|Nellcor Puritan Bennett Llc
|Method and apparatus for detecting misapplied sensors
|Sep 13, 2007
|Sep 14, 2010
|Nellcor Puritan Bennett Llc
|Device and method for reducing crosstalk
|Sep 28, 2006
|Feb 15, 2011
|Nellcor Puritan Bennett Llc
|System and method for mitigating interference in pulse oximetry
|Jan 17, 2007
|Jul 19, 2011
|Kci Licensing Inc.
|System and method for applying reduced pressure to cell culture
|Sep 30, 2005
|Nov 22, 2011
|Nellcor Puritan Bennett Llc
|Sensor for tissue gas detection and technique for using the same
|Sep 29, 2005
|Jan 10, 2012
|Nellcor Puritan Bennett Llc
|Method and system for determining when to reposition a physiological sensor
|Dec 18, 2008
|Jan 10, 2012
|Nellcor Puritan Bennett Llc
|Hydrogel thin film for use as a biosensor
|Dec 29, 2008
|Jun 12, 2012
|Nellcor Puritan Bennett Llc
|Flex circuit snap track for a biometric sensor
|Sep 30, 2005
|Jul 31, 2012
|Nellcor Puritan Bennett Llc
|Mucosal sensor for the assessment of tissue and blood constituents and technique for using the same
|Mar 14, 2011
|Oct 16, 2012
|Nippon Contact Lens Inc.
|Contact lens and its manufacturing method
|Jun 30, 2009
|Nov 13, 2012
|Nellcor Puritan Bennett Llc
|Reflectance and/or transmissive pulse oximeter
|Apr 30, 2010
|Nov 27, 2012
|Nellcor Puritan Bennett Llc
|Air movement energy harvesting with wireless sensors
|May 26, 2009
|Jan 8, 2013
|Covidien Lp
|Folding medical sensor and technique for using the same
|Dec 24, 2008
|Feb 5, 2013
|Covidien Lp
|LED drive circuit for pulse oximetry and method for using same
|Nov 25, 2008
|Mar 5, 2013
|C. R. Bard, Inc.
|Integrated system for intravascular placement of a catheter
|Apr 21, 2009
|Mar 5, 2013
|Bard Access Systems, Inc.
|Method of locating the tip of a central venous catheter
|Jul 17, 2009
|Mar 5, 2013
|Covidien Lp
|System and method for memory switching for multiple configuration medical sensor
|Aug 10, 2009
|Apr 9, 2013
|Covidien Lp
|Digital switching in multi-site sensor
|Sep 30, 2008
|Apr 16, 2013
|Covidien Lp
|Medical sensor and technique for using the same
|Aug 19, 2009
|Apr 23, 2013
|Covidien Lp
|Nanofiber adhesives used in medical devices
|Mar 31, 2010
|Apr 23, 2013
|Covidien Lp
|Thermoelectric energy harvesting with wireless sensors
|Jul 7, 2006
|Apr 30, 2013
|Covidien Lp
|Stacked adhesive optical sensor
|Oct 7, 2009
|May 7, 2013
|Bard Access Systems, Inc.
|Percutaneous magnetic gastrostomy
|Dec 24, 2008
|May 14, 2013
|Covidien Lp
|System and method for estimating physiological parameters by deconvolving artifacts
|Dec 24, 2008
|May 28, 2013
|Covidien LLP
|System and method for attaching a sensor to a patient's skin
|Mar 16, 2009
|May 28, 2013
|Covidien Lp
|Medical monitoring device with flexible circuitry
|Feb 11, 2009
|Jul 2, 2013
|C. R. Bard, Inc.
|Systems and methods for positioning a catheter
|Feb 28, 2010
|Jul 9, 2013
|Covidien Lp
|Motion compensation in a sensor
|Mar 7, 2007
|Jul 9, 2013
|Covidien Lp
|Non-adhesive oximeter sensor for sensitive skin
|Jun 30, 2009
|Aug 13, 2013
|Covidien Lp
|System and method for providing sensor quality assurance
|May 15, 2009
|Aug 13, 2013
|Covidien Lp
|Method and apparatus for detecting and analyzing variations in a physiologic parameter
|Sep 9, 2010
|Aug 20, 2013
|Bard Access Systems, Inc.
|Method of locating the tip of a central venous catheter
|Mar 31, 2010
|Oct 8, 2013
|Covidien Lp
|Biodegradable fibers for sensing
|May 20, 2009
|Jan 21, 2014
|Covidien Lp
|Method and system for self regulation of sensor component contact pressure
|Feb 4, 2011
|Feb 25, 2014
|Covidien Lp
|System and method for mitigating interference in pulse oximetry
|Jan 9, 2013
|Jul 8, 2014
|Bard Access Systems, Inc.
|Method of locating the tip of a central venous catheter
|Mar 2, 2010
|Jul 15, 2014
|C. R. Bard, Inc.
|System for placement of a catheter including a signal-generating stylet
|Aug 23, 2006
|Jul 22, 2014
|C. R. Bard, Inc.
|Stylet apparatuses and methods of manufacture
|Nov 5, 2010
|Aug 5, 2014
|Spotlight Technology Partners Llc
|Fragmented hydrogels
|Oct 27, 2011
|Aug 12, 2014
|C. R. Bard, Inc.
|Bioimpedance-assisted placement of a medical device
|Sep 10, 2009
|Sep 30, 2014
|C. R. Bard, Inc.
|Apparatus and display methods relating to intravascular placement of a catheter
|Aug 16, 2013
|Oct 14, 2014
|Bard Access Systems, Inc.
|Method of locating the tip of a central venous catheter
|Feb 28, 2010
|Oct 28, 2014
|Covidien Lp
|Ambient electromagnetic energy harvesting with wireless sensors
|Apr 8, 2013
|Mar 3, 2015
|C. R. Bard, Inc.
|Systems and methods for positioning a catheter
|Jun 30, 2009
|Apr 21, 2015
|Covidien Lp
|System and method for linking patient data to a patient and providing sensor quality assurance
|Feb 22, 2010
|Jul 14, 2015
|Covidien Lp
|Motion energy harvesting with wireless sensors
|Feb 2, 2011
|Sep 8, 2015
|Bard Access Systems, Inc.
|Apparatus and method for catheter navigation and tip location
|Dec 29, 2008
|Sep 15, 2015
|Mark Evans
|Identifying the level of fetal risk during labor
|Apr 15, 2009
|Dec 1, 2015
|Kci Licensing, Inc.
|System for combined transcutaneous blood gas monitoring and negative pressure wound treatment
|Nov 7, 2012
|Dec 15, 2015
|C. R. Bard, Inc.
|Ruggedized ultrasound hydrogel insert
|May 5, 2014
|Feb 23, 2016
|Bard Access Systems, Inc.
|Method of locating the tip of a central venous catheter
|Jul 23, 2014
|Mar 22, 2016
|Spotlight Technology Partners Llc
|Hydrogel compositions
|Jun 14, 2010
|May 17, 2016
|Bard Access Systems, Inc.
|Adaptor for endovascular electrocardiography
|Oct 3, 2014
|May 24, 2016
|Bard Acess Systems, Inc.
|Method of locating the tip of a central venous catheter
|Jul 31, 2014
|Aug 16, 2016
|C. R. Bard, Inc.
|Bioimpedance-assisted placement of a medical device
|Aug 10, 2010
|Sep 20, 2016
|Bard Access Systems, Inc.
|Devices and methods for endovascular electrography
|May 27, 2011
|Oct 4, 2016
|C. R. Bard, Inc.
|Apparatus for use with needle insertion guidance system
|Jul 6, 2012
|Nov 15, 2016
|C. R. Bard, Inc.
|Needle length determination and calibration for insertion guidance system
|Dec 23, 2011
|Dec 20, 2016
|C. R. Bard, Inc.
|Systems and methods for guiding a medical instrument
|Jun 19, 2014
|Dec 27, 2016
|C.R. Bard, Inc.
|System for placement of a catheter including a signal-generating stylet
|Sep 22, 2011
|Jan 3, 2017
|Bard Access Systems, Inc.
|Apparatus and method for catheter navigation using endovascular energy mapping
|Sep 26, 2014
|Jan 24, 2017
|C. R. Bard, Inc.
|Apparatus and display methods relating to intravascular placement of a catheter
|May 27, 2011
|Jan 31, 2017
|C. R. Bard, Inc.
|Insertion guidance system for needles and medical components
|Sep 29, 2009
|Jan 31, 2017
|Covidien Lp
|Smart cable for coupling a medical sensor to an electronic patient monitor
|Apr 29, 2013
|Mar 7, 2017
|Covidien Lp
|Oximetry assembly
|Mar 14, 2016
|Mar 14, 2017
|Spotlight Technology Partners Llc
|Hydrogel compositions
|Apr 29, 2013
|Mar 21, 2017
|Covidien Lp
|Oximetry assembly
|Jan 7, 2011
|Mar 21, 2017
|General Electric Company
|Fetal scalp doppler device and system
|Sep 29, 2010
|May 2, 2017
|C.R. Bard, Inc.
|Stylets for use with apparatus for intravascular placement of a catheter
|Apr 17, 2009
|May 16, 2017
|C. R. Bard, Inc.
|Systems and methods for breaching a sterile field for intravascular placement of a catheter
|May 11, 2012
|Jun 20, 2017
|C. R. Bard, Inc.
|Integrated system for intravascular placement of a catheter
|Nov 5, 2010
|Jul 11, 2017
|Spotlight Technology Partners Llc
|Polysaccharide based hydrogels
|Jul 24, 2001
|Mar 27, 2003
|Topolkaraev Vasily A.
|Methods of making disposable products having humidity activated materials with shape-memory
|Sep 30, 2005
|Apr 5, 2007
|Carl Kling
|Mucosal sensor for the assessment of tissue and blood constituents and technique for using the same
|May 5, 2009
|Oct 8, 2009
|Association For Public Health Services
|Vacuum delivery extractor
|Dec 29, 2008
|Jul 1, 2010
|Mark Evans
|Identifying the level of fetal risk during labor
|Mar 31, 2009
|Sep 30, 2010
|Nellcor Puritan Bennett Llc
|System And Method For Wirelessly Powering Medical Devices
|Aug 10, 2009
|Feb 10, 2011
|Nellcor Puritan Bennett Llc
|Systems and methods for balancing power consumption and utility of wireless medical sensors
|Sep 29, 2009
|Mar 31, 2011
|Nellcor Puritan Bennett Llc
|Patient sensor intercommunication circuitry for a medical monitor
|Feb 28, 2010
|Sep 1, 2011
|Nellcor Puritan Bennett Llc
|Ambient electromagnetic energy harvesting with wireless sensors
|Feb 28, 2010
|Sep 1, 2011
|Nellcor Puritan Bennett Llc
|Motion compensation in a sensor
|Mar 14, 2011
|Sep 29, 2011
|Nippon Contact Lens Inc.
|Contact lens and its manufacturing method
|Sep 22, 2010
|Jul 5, 2012
|Casagrande Charles L
|Vacuum mounted carrier for a vehicle
|Aug 1, 2012
|Feb 11, 2014
|C. R. Bard, Inc.
|Ultrasound probe head
|Aug 1, 2012
|Mar 17, 2015
|C. R. Bard, Inc.
|Cap for an ultrasound probe
|Jan 24, 2014
|Apr 19, 2016
|C. R. Bard, Inc.
|Ultrasound probe head
|Oct 20, 1997
|May 6, 1998
|Graphic Controls Corporation
|Non-invasive fetal probe having improved mechanical and electrical properties
|Oct 2, 1997
|Apr 16, 1998
|Nellcor Puritan Bennett Incorporated
|Pulse oximeter sensor with articulating head
|U.S. Classification
|International Classification
|Cooperative Classification
|European Classification
|Apr 4, 1994
Owner name: GRAPHIC CONTROLS CORPORATION, NEW YORK
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|Oct 30, 1995
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'A new design in series of basic PSD stationery objects to let you showcase your new branding design project in realistic style.This great mockup is best for minimalistic style but is also great with other type of design. You can replace design easy with smart layers.'
Free Branding Identity PSD Mockup
'Completely layered branding identity mockup with office supplies. The PSD file's dimensions are 3500 x 2700 px.'
Branding Stationery PSD Mockup
'Here's some sketchbooks, business cards and pencils in a stationerymock up. For your needs 3 kind of woods are available and you can also change the wood color, saturation and anything else. Finally, add a realistic blur effect by using the Photoshop action included in this ZIP file.'
Photography -Branding & Identity PSD Mockup
'Here's the latest volume in our identity mock-up collection, a high quality resource great for photography related branding projects but not only. The PSD file includes smart objects and is fully editable to allow you to create the right composition for your project.'


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Pain in rib cage and tiredness: Chronic fatigue syndrome?
Patient : My friend is in his early 50's and has recently become very tired.and now is experiencing pain in his lower left rib underneath. He's not too concerned about it but I am as he has been sleeping much more and now this has come up.
Doctor : Chronic fatigue syndrome (CFS) is defined by two major criteria, chronic severe fatigue for at least six months not ca caused by a diagnosable disease or relieved with rest and at least four other specific symptoms that occur at the same time or after the development of severe fatigue. Usually is associated with Fibromyalgia and costochondritis. The cause of CFS is unknown. Chronic fatigue syndrome (CFS) is a diagnosis made by excluding many diseases that have chronic fatigue as major or frequent symptom. Unfortunately, there are no physical signs or diagnostic tests that identify CFS. The diagnosis is made by fitting the two major criteria set out by a group of CFS research experts. The first criteria states the patient must have severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis (a diagnosis by exclusion). The second criteria requires the patients have four or more of the following symptoms that either occurred at the same time or after the severe chronic fatigue. The symptoms are substantial impairment in short-term memory or concentration, sore throat, tender lymph nodes, muscle pain, multi-joint pain without swelling or redness, headaches of a new type, pattern or severity, non-refreshing sleep, and post-exertion malaise lasting more than 24 hours. Although there are no lab studies that identify CFS, lab studies do provide some supportive evidence for a diagnosis, for example: low erythrocyte sedimentation rate(ESR), elevated immunoglobulins against Coxsackie B virus, HHV-6 or chlamydia pneumoniae, decreased number of natural killer cells. I suggest to have a comprhensive evaluation for a Physician to rule out all the possible causes mentioned above.
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Monday, 22 December 2014
The books I bought in November
Happy Monday, guys! Here's a new video for you. A look at all the books I bought in November. You can watch it over here. xx
Posted by Jen Campbell at 13:56
Labels: booktube, haul, november book haul
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- select colour
it's an internet thing!
it's an internet thing!
10:41 17 January 2013
If you're thinking about your future and if you want to make sure that you'll be well-covered financially for your golden years, you should seriously consider paying into a personal pension plan while you're still employed.
Here are some tips on how you can find the best one for you:
1. Understand and identify the best type of personal pension that meets your needs. The first step is to do your research and to fully understand the types of personal pension available to you.
Doing this will help you determine where and how you want your money to be invested. You may opt for self-invested personal pension plans or go with traditional managed pension funds. Know the pros and cons to easily figure out which one is best for you.
2. Check each pension's track record. You would want to make sure that the type of pension plan that you want to invest in have stellar track record; after all, it's your money. Aside from getting information online, conduct surveys as well. Interview some people who have invested on the same pension fund to get much-needed tips.
3. Check the fees. Once you've decided on what type of personal pension you need, the next step is to check the fees, which may vary significantly from account to account. Thorough research and careful comparison is needed to ensure that you pick the best one for you.
Disclaimer: Supanet is not responsible for, and disclaims any and all liability for the content of comments written by contributors to this website


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Creating a new account is quick and easy.
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Joyce Hayes
Click here to email
Click for Full Website
805 Del Grove Avenue
Newark, DE 19713
302 2996331
Fax: 3023681189
Description of Practice
Mrs. Hayes is the volunteer Executive Director and Secretary of Delaware Elder Mediation Services, Inc. (DEMSI (www.demsi.org)) a tax-exempt public charity offering conflict resolution services to the elderly and disabled. All matters involving the elderly or disabled will be handled through DEMSI other than Court appointments. Mrs. Hayes is available for mediations pursuant to court appointments or in matters not involving the elderly or disabled.
Professional Background
Mrs. Hayes was with the management company of the Columbia Gas System for 22 years and was Associate General Counsel responsible for securities and corporate law compliance and mergers and acquisitions. Mrs. Hayes has extensive understanding of corporate finance and corporate governance and basic business principles. Since 2008, Mrs. Hayes has been concentrating her volunteer efforts in the area of elder law and elder mediation. All mediation involving the elderly or disabled other than court appointments are referred to Delaware Elder Mediation Services, Inc., a public charity that offers free mediation for individuals.
Mrs. has has over 50 hours of mediation training including basic mediation training through the Delaware Superior Court and the University of Delaware (facilitative mediation training) and advanced elder mediation training through the Montgomery County Conflict Resolution Center (transformational mediation training). She has conducted numerous mediations in guardianship matters as a volunteer for the Court of Chancery and is a volunteer mediator for Delaware Elder Mediation Services, Inc.
JD Rutgers School of Law BA University of Delaware
|Delaware Superior Court
|Mediation Training 20 hours
|Montgomery County Mediation Center/Winnie Backlund
|Elder Mediation Training (Transformational) 18.5 hours
|University of Delaware
|Basic Facilitative Mediation Training 28 hours
Mrs. Hayes uses a blend of transformative and facilitative approaches to mediation in the hopes that the parties will gain insights into how to resolve future issues while resolving the most immediate problem.
Mrs. Hayes charges vary depending upon the complexity of the matter with a basic per hour fee of $150. However, all mediations through Delaware Elder Mediation Services are as a volunteer.
Areas of Practice
- Adult Family
- Business
- Civil (general)
- Commercial
- Community
- Contracts
- Elder
- General
- Organizational
- Probate
- Securities
Professional Services
- Mediator
- Arbitrator
- Collaborative Professional


text:
STAR TREK: INTO DARKNESS Super Bowl Spot
Here's the Super Bowl commercial for Star Trek: Into Darkness in which Benedict Cumberbatch's villain claims he's "better at everything."Check out the spot here, and tell us your latest theories on the still unanswered questions over at our social media links below. Got a comment? There's lots of conversation on Newsarama's FACEBOOK and TWITTER!
Twitter activity Tweets by @Newsarama


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Numark HF Wireless DJ Headphones
Numark HF Wireless DJ HeadphonesDetails
Product Ref: 54997View Full Description
Full DescriptionView Full Description
Comments from customers who bought this item:
The key to the superior wireless streaming of the HF Wireless headphones is the Bluetooth® 4.0 technology with NFC pairing, meaning signal connection is always strong and clear. With a range of over 30 feet, giving freedom of movement while monitoring the musical delivery. The built-in rechargeable battery gives up to 10 hours of music playback on a single charge, so those 10:00 p.m - 04:00 a.m gigs are no problem.
The on-ear cup feature makes these headphones a pleasure to use. Featuring excellent bass response and outstanding noise isolation, a compact, collapsible design with built-in microphone and wide-range 40mm drivers. Resulting in detailed, articulate sounds and well-defined bass - essential for perfect beat matching. Dual purpose, the HF wireless headphones come with a 4ft cable with 1/8'' stereo plug, so the DJ doesn't need a second set of headphones.
''The idea of wireless headphones that give the DJ great freedom of movement during his gig is very compelling. The Numark HF Wireless really delivers, unlike many other wireless devices that seem to fall short of what they promise. Add to its great wireless performance its truly outstanding audio quality, long lasting battery and its adaptability to different situations and the HF Wireless is the ideal headphone solution for the active DJ.'' - Chris Roman Senior Product Manager for Numark.
Key Features:
- Bluetooth® 4.0 technology With NFC pairing.
- Rotating Earcup Provides Hands-free, Single Ear Monitoring.
- 32 ohm Impedance Works Well With Low-Output Devices.
- Wide-range 40mm Drivers And Built-in Microphone
- 60-20kHz Frequency Responses Provide A Significant Upgrade From Earbuds.
- 1/8'' (3.5mm) to 1/4'' (6.3mm) Adapter Included
- Leatherette Earcups Provide A Comfortable, Custom Fit
- Built In Rechargeable Battery - Up To 10 Hours Of Playback On A Single Charge
The product price includes 6 years' warranty and 180 day money back guarantee.
However, the Gear4music extended warranty scheme provides an enhanced service, and is designed to offer a higher level of protection than many 'free' warranties offered by some retailers and manufacturers.
The highlights of this enhanced warranty service are:
- Warranty is extended to 6 years from the date of delivery.
- Our Money Back guarantee is extended from 30 days to 180 days (terms apply after 30 days)
- Collection and delivery costs are included for the first 2 years
- Claim 50% cash back on the cost of the policy after 6 years if it has not been used!
- Warranty is transferable if the item is re-sold
- Loan or replacement equipment will be provided if the product isn't repaired within 30 days
- If an item can not be repaired, a similar alternative product or cash discount (as defined in this policy) will be offered
- The policy can be cancelled within 30 days, and at any time after that for a pro-rata discount
Please note that this extended warranty is currently only available on products sold within the EU or EEA, and is subject to the terms and conditions as detailed on the extended warranty certificate provided.
For customers in outlying areas of the country, the price of the Extended Warranty may be marginally higher, due to the potential for higher collection and redelivery transport costs.
This enhanced warranty is in addition to the standard Gear4music and manufacturer warranty policies, and the Gear4music terms and conditions of trade. No statement or condition of sale contained within these terms affects or restricts your statutory rights as defined under the Consumer Contracts Regulation 2014.
Once the product is delivered, you have 180 days to decide that you definitely want to keep it. If you decide it is not suitable for any reason, you can return it back to us for replacement or full refund, including standard delivery charges.
All Products are new unless stated, and include a minimum of 2 years warranty.
Some items are only eligible for money back guarantee if they are returned to us unused and sealed in the original packaging, and in the case of software, unregistered. These items include:
- Software
- CDs & DVDs
- In-ear Monitors
- Earplugs and Ear Protection
- Mouthpieces, Reeds etc… for Woodwind and Brass instruments
- Mouth / Lip Care Products
We are unable to accept returns of any custom made items designed to work together as a unique package, such as computer system built to a customer's personal specifications. Exceptions may only be possible with prior agreement of the vendor, and may be subject to a cancellation fee.
If you also purchase items that do not qualify for free delivery, some delivery charges may be applied to your order which will be shown in your shopping basket.


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If Chris Wilder's love for his boyhood club Sheffield United had not held sway, Blades' manager would be sitting in the home dugout tomorrow at The Valley.
The 49-year-old was close to becoming the new Charlton Athletic manager after leading Northampton Town to promotion from League Two.
But the chance to succeed Nigel Adkins was too big a lure for the former Blades player, and Wilder headed north to take charge at Bramall Lane.
Tomorrow, he takes United – currently on a 14-match unbeaten league run – to Charlton, who this week sacked Russell Slade and replaced him with former MK Dons boss Karl Robinson.
Wilder said he had been impressed with the size of Charlton, and their potential, but could not resist the chance offered by Blades chief Kevin McCabe.
"I spoke to them," said Wilder. "I thought the time was right to explore what was out there.
"I had an unbelievable time at Northampton, but I thought it was my right to look and that it was the right moment.
"But, to be fair, I think everybody will understand that when the call from Kevin came through, it was done. That was decision made."
Robinson becomes Roland Duchatelet's seventh managerial appointment since the Belgian businessman bought Charlton in January 2014.
The Addicks, 11th in the table, have won their last two games under caretaker manager Kevin Nugent.
Robinson will watch from the stands tomorrow, but Wilder is adamant it will not interfere with the result.
"They are up against us, the manager can't step onto the pitch," he said.
"You'd think him being at the game will possibly lift a few of the players' performances, but, like I say, he's going to be up there in the stands, not out there in the game.
"They are a dangerous team, they've got a lot of good players and are a historic club.
"It should be an entertaining game at a proper ground with three and a half thousand of our fans going down there who we don't want to disappoint.
"We want to take that challenge on.
"The players they've got, especially their attacking players, I don't think they are going to sit on the edge of their own box.
"People have seen we've got dangerous players away from home too."


text: On Sun, 2 Aug 1998, Jeff Sheinberg wrote: : It seems to me that removing bo from ftp.debian.org is a violation : of the GPL (in spirit, if not in letter), by removing acesss to : the source from those people that installed Debian via the ftp : method. : : I feel that any Debian distribution should be made available via : ftp for at least 3 years from its release date. Please feel free to donate disk space and equipment needed to fulfill the above requirement :) Remember, Debian is a volunteer effort. Also, several people have volunteered space on their mirrors, so bo is still around (as has been pointed out a few times). -- Nathan Norman MidcoNet - 410 South Phillips Avenue - Sioux Falls, SD 57104 mailto:firstname.lastname@example.com http://www.midco.net finger firstname.lastname@example.com for PGP Key: (0xA33B86E9) -- To UNSUBSCRIBE, email to firstname.lastname@example.com with a subject of "unsubscribe". Trouble? Contact email@example.com


text:
Friday, 31 December 2010
Flashback! The Ghost of Holidays Past
We're all supposed to be looking forward to 2011, but I'm going to use these last few hours of 2010 to look back even farther... to the kinds of festivities my family have every year to celebrate Christmas and the New Year. This year's been a bit different; I'm in Barcelona (which is great, don't get me wrong) and my family were in the upheaval of moving over the Christmas season. Things will be a bit different but equally fun in the future I'm sure, but here's a little look back at some of my favourite festive moments...
Christmas dinner got a bit surreal last year after my grandfather got a headlamp for a present. My uncle keeps his best straight face. It's terrible getting old.
Flaming Christmas pudding!
Me and my two fantastic sisters. Paper crowns are mandatory!
On New Years' Eve we usually play board games over endless bottles of wine and sparkling wine.
Some people are suspected of being devious.
Some people are suspected of being drunk.
Some are just confused as to what all the fuss is about.
At all festive occasions for the last several years, our family friend opens the bubbly and Shona stands with the waiting glass. We're big traditionalists. It's never going to be any other way.
Then everybody makes sure there is an exactly equal distribution of liquid between the glasses. Our friend evens them out with a spoon. Newcomers sometimes say, "Oh, never mind, I'll take the one with less." That is not the point. They must be equal. And then we all stand around making mock-pretentious comments like, "you can definitely taste the slight hint of rosehip and saskatoonberry on the palate."
Sometimes, guitars are brought and old folk songs are played...
And others sing along.
There's a constant at every party: Shona always falls asleep on the couch.
Absolutely always.
Happy New Year Everyone! It's been great getting to know you all, and I'm looking forward to "seeing" you all again in 2011!
35 comments:
- A said...
Very good post. Enjoyed a lot.
Color, class and country do not make any difference when it comes to family coming together to celebrate. I just have to replace people with my family and rest remains same....:)))))
Happy New Year to you too Emily and wish you achieve your goals that you set for 2011 if any.
- 31 December 2010 at 21:08
- Closet Fashionista said...
Hehe so much fun to look back on times past :D :D YAYYY :D
- 31 December 2010 at 21:27
- daisychain said...
Have a fabulous NYE and all the best for 2011! xxx
- 31 December 2010 at 22:06
- Tashrin said...
It was really beautiful going back down memory lane with you.
Have a wonderful New Year :)
Look forward to hearing from you
Tashrin from Toronto, Canada
- 31 December 2010 at 22:50
- sojourned in style said...
humourous. delightful. loved it. the "Some people/are....." were so great. i must say your family traditions are pretty entertaining to see. Happy New Year!!
- 1 January 2011 at 01:53
- Velvet said...
Happy new year!!
Thanks for sharing these photos, they're lovely and funny at the same time.
- 1 January 2011 at 02:01
- Amber Rose, Laughing With Broken Eyes said...
Your post had me grinning ear to ear.
"Some folks were suspected of being drunk.. Some are just confused as to what all the fuss is about!"
I just adore you! I hope that this new year is truly wonderful for you. You are one of the sweetest gals I've had the pleasure of meeting through the blogging community, and I am so grateful for that!
Wishing you well!
- 1 January 2011 at 03:03
- Emily, Resplendent Tranquility said...
Happy New Year, Emily!
Your family's holiday traditions look so delightful. I've always been a bit bummed that we never do Christmas crackers. Oh well. I plan on starting that tradition when I have a family of my own (or when I'm fully in charge of the season's festivities).
The picture of your grandpa wearing the headlamp is so great. My dad actually gave me one of those a few months ago - haha. I haven't really used it, but it's there should I ever need it ;)
- 1 January 2011 at 06:25
- Jazzy E (hivennn) said...
Awh you write so beautifully. Lovely photos too. xx
- 1 January 2011 at 09:20
- Shallow Mallow said...
Happy New Year :)
Your family celebrations sound like a lot of fun too!
- 1 January 2011 at 13:52
- Tilly said...
Hehe, they look like some fun dos... and great way to reminisce with photo round ups. Can I come next time? ;)
- 1 January 2011 at 21:04
- Kallie, Happy Honey and Lark said...
This made me laugh so hard! Your CHristmases look like such a great time! (Im the one in my house that falls asleep on the couch), and that headlamp pic is amazing. Families are the best.
ps- the seychelles boots I have are from way back from 2008, and about an inch higher than the similar style they have out now (which I'm saving for because of the lower heel height). They are beyond comfy but the height on the Romance ones is a bit lower and better for work.
- 1 January 2011 at 21:36
- veronika, tick tock vintage. said...
that picture of your grandfather is absolutely hilarious - my grandmother sort of does the same thing, but with a ridiculous beret.
- 1 January 2011 at 22:10
- Terri said...
the headlamp looks like something that would happen at our Christmas. :)
- 2 January 2011 at 00:43
- Lula said...
Haha I LOVED reading this post. I think the best part is your Grandfather with the head lamp. My father bikes to go to work, he wears one just like that. When he comes home I always think he started digging a tunnel somewhere.
- 2 January 2011 at 00:49
- Raquel said...
I loved reading this, I'm such a nosy blogger haha!
You and your sisters look so different but also so much alike at the same time, can't explain it. And the sleeping Shona pictures are so funny!
Happy New Year sweet Em, looking forward to seeing you again, lets hope it'll be soon ;)
- 2 January 2011 at 02:33
- Henar said...
what a funny post, very very cool!!
- 2 January 2011 at 02:54
- Madeline said...
This is cute! happy new year!
- 2 January 2011 at 03:11
- A Little Brighter said...
You look so very lovely and this all looks like so much fun! We are traditionalists here too and every Christmas is the same with us, but I love it! What a cute outfit too!
Ayesha x
- 2 January 2011 at 04:06
- Jenny Morris said...
such nice festivities to look back on. Happy New Year, Im so happy to have found your blog in the last few months.
- 2 January 2011 at 05:03
- Anything but Bland said...
looks like you had a great time. I am sorry to hear that about your grandma, too. Mine is so lucky, she lives at home by herself.. she is still sweet as can be to me.. so I appreciate it. Thanks for your kind comment :P
- 2 January 2011 at 05:37
- Ashley said...
this is so damn cute. and your family is a gem!!! I love the part about being a pretentious alcohol taster...I know too many of those. ha.
- 2 January 2011 at 08:41
- Lenne said...
The way your family celebrate festivities looks fabulous! I love love loved this post.
I hope you'll have an amazing 2011!! ♥
- 2 January 2011 at 16:09
- Noelle Chantal said...
Aww very cute Happy New Year photos! Looks like everyone enjoyed the night. And funny your gift that your grandfather received, the headlight so cute! :)
Wish all the best this year!
- 2 January 2011 at 16:19
- eliza said...
aw, i love your christmas photos & your family traditions...i think there's something so reassuring about some of the same things happening every year & little traditions being made! i also agree that paper hats are so essential! :)
happy new year :)
- 2 January 2011 at 20:48
- mode. said...
looks like great fun!
happy new year!
<3 mode.
- 3 January 2011 at 00:13
- sbot said...
haha, that shot of your grandpa is awesome.
<3 Stephanie
- 3 January 2011 at 01:58
- Kayraheart.fashion said...
looks like fun family time...Happy New Year
- 3 January 2011 at 06:23
- Laura said...
thanks for sharing your family traditions- your grandfather looks darling!
- 3 January 2011 at 07:05
- jess said...
aww the photos look so happy and fun! hope you have a fabulous 2011!
- 3 January 2011 at 13:53
- danniekate said...
lovely family shots, your family look so lovely :) happy 2011! xx
- 3 January 2011 at 17:42
- Erin Cathleen said...
Fun photos! Your family looks like a hoot! :)
Happy new year!
- 3 January 2011 at 18:37
- CAITLIN said...
this was a great post--i love getting a glimpse into your fun family life :) someday i'll have to do a post like this--my family also has plenty of fun doing the same exact thing year in and year out :)
- 3 January 2011 at 20:55
- Anthea said...
What an awesome post! This really warms my heart! Spending time with family is really priceless. I must admit I've been moaning about the holiday season and how full everything is, but I just realised that it's the best time to be with family and that trumps everything else. That being said, I would also like to experience the holidays in another country some day.
Embracing Style
- 4 January 2011 at 08:24
- ana said...
Happy New Year darling! These family pictures are fantastic! love the golden crowns!! Hope we read each other also in this 2011!
big hug to you!
- 7 January 2011 at 00:20


text:
Eco-Drive Ladies Sports Watches are a quality, self-powering or "eco-driven" watch, drawing energy from natural sunlight or even lamp light so that the watch battery need not be replaced over the lifetime of the watch.
Watches that recharge themselves are one of more recent innovations. The Citizen watch company, who has been around since 1924 have in fact claimed the title of world's largest watch maker, an achievement they have held since the year 1986. In the watch maker's history they have come out with many fresh innovations and advances in watch technology. The company boasts a voice recognition watch, an innovative dive watch with an electronic depth sensor and the world's thinnest LCD watch among it's achievements.
The self powering watch is one of Citizen's recent inventions, their "Eco" range covers all types of watches from sport watches to dress models, with a wide range of attractive designs to choose from. Eco-Drive women's sports watches lie within the following categories:
- Calibre 4700
- Professional Diver
- Gold-Tone
- Two-Tone
- Riva
- Silhouette
- Serano
- Aviara
There are a few common questions people ask about Citizen Eco-drive watches which we will now take the time to answer:
I am not sure if my Eco-Drive is getting sufficient light? How can I tell?
The Eco-Drive watch draws watch at all times from natural sunlight, artificial fluorescent lamp light or an incandescent lamp. In the unlikely event an Eco Drive watch is low on power, the "Low Charge Warning Mode" will activate causing the second hand to jump two seconds at a time. Don't worry, the watch will still keep the correct time when this happens.
How long will my Eco-Drive watch battery last in low-light conditions?
Depending on the particular model, a Citizen Eco-Drive watch will run from 45 days to 5 years. But this is not a concern unless your watch is placed in a location where there is no light at all available to it.
What Types of Light will Recharge My Eco-Drive Watch?
The Eco-Drive watch line is designed to use different types of both natural and artificial light sources to recharge itself. Fluorescent lamp light (within about 8 inches), an incandescent lamp (a regular light bulb no closer than 20 inches) and of course natural sunlight are all effective light sources that your Eco-Drive watch can use. The most effective of these being direct natural sunlight.
Are there Any Types of Light Sources That I Should Avoid?
Avoid using a halogen lamp. The heat generated can damage your Eco-Drive watch.
Visit our website to view more Ladies Sport Watch types. Check it out here. Sport Watches
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text:
Results 1 to 4 of 4
June 5th, 2012, 12:20 PM #1Private Offers
Why do I always get private offers that look to be the exact same as my current offer?
June 5th, 2012, 04:03 PM #2
Your question is quite broad and without knowing your specific case, I can only provide a general response. Sometimes Advertisers send private offers that look exactly like your current offer so they can potentially send you additional links/creative or even coupon codes that they normally would not provide to everyone on the regular offer.
Additionally, an Advertiser may consider becoming private and will simply let their base offer expire and only work with the Publishers in the private offer.
Thanks From:
June 5th, 2012, 05:09 PM #3
I have to be broad because it happens all the time with different merchants. Okay, so supposed it's the first option you gave. Wouldn't that mean if I accept the new offer that I would no longer get the additional links/creative for the current private offer I'm in? The problem is that I have no details to separate the 2 offers to know which one is better, since they look exactly the same.
June 6th, 2012, 10:25 AM #4
You are right, that could happen because you can't be active in two offers concurrently. At this point, I would advise you to reach out to the Advertiser if there is no clear definition.
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Washington, Feb 6: In a latest addition to Indians occupying a place of honor in Obama administration, US president Barack Obama has appointed Indian-American Pulitzer Prize-winning author Jhumpa Lahiri, along with five others, as member to the Obama's committee on the Arts and Humanities.
"I am proud that these distinguished individuals will serve in my Administration. The arts and the humanities enhance the vibrancy of our society, inspire us and strengthen our democracy. I look forward to working with them in the weeks and months ahead," Obama said.
The white House said that apart from Lahiri, Chuck Close, Fred Goldring, Sheila Johnson, Pamela Joyner and Ken Solomon have been appointed to the committee.
The noted Indian writer, has received the Pulitzer Prize, the PEN/Hemingway Award, the Addison M Metcalf Award and the New Yorker magazine's Debut of the Year for her debut collection of stories, Interpreter of Maladies.
Her most acclaimed novel 'The Namesake', was a New York Times Notable Book and was the finalist for the Los Angeles Times Book Prize.
It was also named as one of the best books of the year by USA Today and Entertainment Weekly and movie based on the book was made by Indian film maker Mira Nair.
The Frank O'Connor International Short Story Award and the Vallombrosa-Gregor von Rezzori Prize, for her latest story collection, Unaccustomed Earth is another feather in her cap.
OneIndia News