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US 3859899 A Abstract A motor vehicle passenger compartment ventilating system exhausts warm interior air, through a window region or sub-window region door-mounted sideview mirror housing and over the mirror for de-icing or clearing the mirror of deposited precipitation.
Claims available in Description (OCR text may contain errors) United States Patent 1 1 Mills [54] INTERIOR VENTILATION SYSTEM WITH SIDE VIEW MIRROR DE-ICING [76] Inventor: John Edward Mills, 15142 Drake Rd., Strongsville, Ohio 44136 [22] Filed: Feb. 14, 1974 21 Appl. No.: 442,676 [52] I U.S. Cl. 98/2, 350/302 [51] Int. Cl B60h l/24 [58] Field of Search 98/91, 92, 2.00, 2.04, [56] References Cited UNITED STATES PATENTS 925,329 6/1909 Goodrich 98/91 Jan. 14, 1975 2,252,161 8/1941 Borba 350/302 2,523,923 9/1950 Rodert 98/2.08 2,569,576 10/1951 Ramml 350/302 Primary ExaminerMeyer Perlin Attorney, Agent, or Firm-P. D. Golrick [57] ABSTRACT A motor vehicle passenger compartment ventilating system exhausts warm interior air, through a window region or sub-window region door-mounted sideview mirror housing and over the mirror for de-icing or clearing the mirror of deposited precipitation. 18 Claims, 8 Drawing Figures PATENTEI] JAN 1 4|975 sum 3 or 5 INTERIOR VENTILATION SYSTEM WITH SIDE VIEW MIRROR DE-ICING Herein the terminology slip stream or slip stream air" signifies the relative flow of air over the surface of 5 the vehicle due to the forward traveling motion of the car in normal operation, or the flowing air itself; interior air signifies air in or moving from the passenger space of the vehicle, and sideview mirror signifies an outside rearview mirror mounted laterally of the vehicle at a position viewable by the driver, especially one mounted on a vehicle door. For simplicity of description and discussion herein the process of or the achieved result of clearing material from a sideview mirror will here be termed de-icing with corresponding use of the verb de-ice; though in fact the material in question may be frost, frozen rain, melting and refrozen snow, or adherent rain water droplets or the like, and whether the material is initially accumulated or is being continually swept away as deposited to prevent accumulation. ,Sideview mirrors on automotive vehicles often are rendered useless or are greatly impaired in rearview display function by adherent dirt and especially precipitation, such as snow, frost, sleet, freezing rain, ice, either accumulated during open air parking or deposited and perhaps accumulating during travel, thereby causing an unsafe vision condition for the driver, often at a time when weather conditions are otherwise rendering driving hazardous to some degree, a matter often exacerbated as well by the usually relatively small reflecting area of such mirrors. Consequently there have been numerous proposals for improvements in outside mirror accessories intended to cure or at least minimize these problems. Thus, for example, the mirror element has been rotatably mounted and means provided to cause a rotation expected to clear rain, melting snow, or loosely adherent dirt by centrifugal forces. By similar drivings a wobble mirror has been slowly driven to change the effective sight direction of the mirror and thereby in effect scan a larger visual reflected field. Other prior proposals heat the mirror to prevent or remove ice, using direct electrical resistance heating of the mirror element, for example, by a resistance heated plate abutting a housing-enclosed or back face of the mirror element, or by passing current through a front face reflecting, deposited metal coating. Also slip stream air has been passed over a heated resistance either before deflection across the external mirror surface or in passing through the housing to encounter the internal side or back of the mirror as it passes to housing exhaust points. Similarly, a heated gaseous medium deriving heat from the waste heat of the internal combustion engine has been used for a like purpose. Thus a portion of the exhaust gas from the engine has been diverted through an appropriately sealed hollow mirror housing, therein passing across the back of the mirror element and thereafter exhausted in appropriate and safe manner. In some circumstances even the warming of the mirror has been conducive to more rapid runoff of rain. By another proposal, air from a compressed air storage tank, under discharge valve control, is passed through a heat exchanger arrangement at the engine exhaust manifold, and thence through a tube forming in effect a heat exchange element loop in the housing behind the mirror, finally to exhaust as a mirror surface sweeping jet. Simple air deflectors have likewise been mounted adjacent to the mirror to direct'slip stream air across the external mirror face, for multiple "purposes of preventing impingement and build up on the mirror surface of air-borne dirt in eddies aft of the mirror housing, further of sweeping rain drops, adherent melting snow, or sleet from the mirror surface. These and other prior proposals have various disad vantages, such as limited effectiveness for the principal goal of keeping the mirror surface suitably clear, especially under more critical conditions, though having an apparent simplicity; while others entail undue complex ity of structure, with attendant cost and greater likelihood of malfunction. Thus, mirror accessories heated electrically, whether the resistor element be a front reflecting mirror coating itself, a resistance heated backing plate or a resistance heater element disposed in the path of an air stream impinging upon or surrounding the mirror, all require wiring to the vehicle electrical system; embody elements of comparatively high cost; and, of course, are subject to the common and typical electrical failures. On the other hand, rotationally driven mirror ele ments, whether driven directly or indirectly by slip stream air, by cable from the engine drive system or an electrical motor in the vehicle interior, or by a small motor within the mirror housing, all obviously first require an appropriate mirror supporting shaft and bearing mounting; structure both subject to damage and needing servicing at least in lubrication; and secondly entail additional structure for producing or coupling the driving torque itself. These characteristics represent added cost for the components themselves, for their installation and maintenance, and at times objectional increase in the size of the sideview mirror unit. On the other hand, mirror cleaning or de-icing systems utilizing hot wash water or hot compressed air, though avoiding certain difficulties or undesirable aspects of electrical wiring, running into the mirror accessory unit mounting, yet require at least fluid conduits from the fluid supply point usually in or above the engine, again presenting added costs of installation and maintenance and exposure to conduit damage, especially with the mirror unit mounted on the doors at either side of the driver. The present invention, by a distinctly different approach incorporates a sideview mirror, mounted on some part of the overall door structure, especially convenient on the drivers side, into the passenger compartment ventilating system as an exhaust conduit for at least a part of the interior air normally leaving the vehicle passenger space, the heat of which serves to clear the mirror. The hollow housing, at its base region mounted to the door structure, provides an air inlet to a hollow housing space behind the mirror plate element, through which vented heated interior air may flow, passing around and heating the mirror, to exhaust through housing vents appropriately disposed; particularly in the bezel surrounding or framing the mirror, or between the mirror element edge and a surrounding portion of the housing, and through other housing vents more remote from the mirror. Thus even a normally desired ventilation exhaust air flow from the heated interior is used to heat the mirror element for clearing, cleaning, de-icin-g or other like functions promoted by heat or a scavenging air sweep. The mirror glass retainer itself in the overall housing structure may be timed to increase heat transfer from the flowing air to the structure more immediately associated with the mirror. Moreover the mirror housing itself is preferably so shaped, and the vent regions thereofso aimed that a part of the exhausted air will itself be directed from the mirror housing at the exterior surface of the adjacent window of the door upon which the mirror is mounted, a feature of special value in keeping this window area free of adhering precipitation, especially snow, sleet and ice, and thereby markedly improving the vision for the driver under adverse and inclement weather conditions. The invention may be embodied, for example, in a mirror accessory having a base or pedestal mounted more or less conventionally on or just below the external window sill region of a front seat door, to communicate through an aperture in the underlying supporting metal panel with the door interior hollow and thereby with a vent aperture in the interior door panel; the latter being covered by an air vent or grille, adjustable as desired, for its exhaust air flow, so that the air passes in effect through the door into and through the mirror housing to achieve the desired result. By another embodiment of the invention, a new and rather distinct form of mirror housing and mounting is used in which an elongated projecting hollow mirror housing has its door based end secured in and occupying the now usual forward or front lower corner apex of the glassed window space; and the inner end of the housing either itself serves as, or is provided with, an interior vent grille or escutcheon face plate. This, as a permanent immovable structure provides both the ventilation vent at the interior of the passenger space; and, v as well, in a manner acceptable from design and appearance considerations, shortens the forward reach of the door window glass area, resulting therefore in glass cost savings. Where a directional mirror control is used, the finger lever or manual control thereof may be optionally located either as now rather common, on the interior of the door panel, or on the mounted inner end of the mirror housing, facilitating installation, and simplicity of structure. Both such general types of mirror arrangement have the common feature that the mirror housing serves as a channel for the interior air ventilation system exhaust, thereby to utilize heat otherwise wasted with the air vented to the exterior, and also to afford communication with the readily available volume of warm air for the desired function as needed. Further, by the very form and disposition of the mirror accessory unit, with exhaust outlets surrounding the mirror itself and perhaps also at other rearwardly facing mirror-adjacent portions of the unit housing, there is developed an aspirating effect due to the low pressure area arising behind the mirror housing structure, in consequence of the passage of the slip stream during the forward travel of the automobile; Thus, especially in the inclement weather conditions usually giving rise to the more objectionable accumulation on the mirror, when particularly the usual car inte- I rior heater will be heating the interior, the warm interior air will be continually drawn out in at least a small amount requisite for keeping the mirror clear, even though the vehicle does not have a positive pressure type ventilation and heating system. On the other hand, when a driver finds his outside parked car with an accumulation of frost, ice, snow or the like on the mirror, in short order before starting to drive, he can clear the mirror by waiting briefly for engine warm-up and standard heater operation to warm the car interior, and therewith the positive pressure ventilation clears the mirror; at least then by manipulation of the usual heater and air ventilation controls, he can achieve the positive pressure within the passenger space, to cause warmed air to vent through the aforedescribed mirror systems. Also when as previously described, the mirror system is so designed and aimed, that the exhausting air is directed towards the adjacent window, the latter will in like fashion after a little delay be de-iced or cleared. The general object of the present invention is then to provide a comparatively simple yet improved system and method for de-icing a sideview mirror of an automotive vehicle. I Another object of the present invention is to provide an arrangement whereby a sideview mirror is incorporated into passenger compartment ventilating system, or more specifically the exhaust of such system, thereby to make use of the heat of interior air exhausting from that compartment for mirror element de-icing purposes. Another object of the present invention is to provide a convenient and simply mounted sideview mirror unit which may serve as part of the passenger vehicle ventilating exhaust means and thereby utilize interior-aircarried heat otherwise lost. Another object is to provide a sideview mirror arrangement serving as a portion of the exhaust system for the passenger space of the vehicle which may in particular cases serve also'to keep an adjacent area of the door window clear for mirror observation and other driver vision purposes. Another object is to provide a side view mirror unit of the type described which is adapted, upon striking an object when the vehicle is in forward motion, to yield rearwardly and fold back toward the vehicle, reducing the impact and the outward projection of the unit. A further object is to provide a unit with a yieldable housing also adapted to return to normally projecting disposition after folding back, if not seriously damaged by the impact. A still further object of a particular disclosed embodiment of the invention is to provide a side view mirror, serving as a part of the passenger vehicle space ventilation exhaust means, which is mountable in a forward lower apical portion of modern front door window structures and shapes; and which in addition to serving its own specific function, enables use of smaller glass blank for the window area. Other objects and advantages of the invention will appear from the following description and the drawings wherein: FIG. 1 shows one form of side view mirror adapted for mounting in what is normally part of the window area of current designs and certain adjacent door structure; FIG. 2 is a fragmentary detail of the housing inboard end; FIG. 3 is an exterior view; FIG. 4 is a view similar to FIG. 1, but limited to a unit as such with a mounting region modification; FIG. 5 shows in horizontal section a modification of the window mounted unit; FIG. 6 is a view similar to FIG. 1, but showing an embodiment of the invention in a more conventional type of side view mirror form and mounting arrangement; FIG. 7 is a fragmentary section taken at 7-7 in FIG. FIG. 8 is a fragmentary section taken at 88 in FIG. 6. With respect to the two distinct and particular embodiments of the invention and passenger space of the vehicle (whether the same be a passenger vehicle as such, or the drivers cab in a truck or other commercial vehicle), though only the particular mounting and form of mirror units and their assembly to and association with the doors at the drivers seat or front seat of the vehicle are dealt with, it is to be understood, of course, that the vehicle is provided with a heater to warm the air of the passenger space, which heater may be any of a variety of standard or non-standard forms; and further that the space is completely enclosed or encloseable, when the doors and windows are shut, with of course there being the usually available ancillary ventilating ducts and controls as well. Such environmental structures and accommodations being now conventional and universally known, they require here no further description. For one aspect of use or performance of the invention, it is observed that, in the majority of current passenger type vehicles, so also in cab spaces of commer' cial vehicles, the heating and ventilating system generally affords such controls as introduce external air into the vehicle through the air heating system, so that a slight positive air pressure is present in the vehicle passenger space relative to free external atmosphere even when the vehicle is stationary; so that generally under such setting or conditions air is leaking to some degree in a normally expected fashion at various parts or joints of the vehicle passenger compartment structure; eg, around the door opening seals and window seals and the like, which though effective to prevent objectionable inward' leakage drafts or inward diffusion of dangerous engine exhaust gas, yet are not, of course, hermetically sealed or closed. In FIGS. 1 and 2, the door-mounted side view mirror unit designated A as a whole, comprises a hollow housing H laterally projecting from the vehicle body, and of a somewhat box-like form mounting at an appropriate mirror view opening in its rear i.e., trailing, vertical side, a mirror plate or element M supported and held in known fashion by appropriate back plate, or clips, grips or seals around its periphery, or in an interior mounting pan;" at 14, the continuous periphery of the back edges of top, bottom and side walls or a framing bezel-like edging of the housing surrounding and defining the view opening; a mounting base 15 with associated structure providing, as a ventilation outlet point amp window framing edge 18 slopes or curves forwardly and downwardly to meet the top edge 19 of the window sill or door belt region adjacent the glassreceiving horizontal slot of the hollow lower door portion 22. For purposes of this invention, a short vertical strut 21, in conjunction with the belt 19 and the sloping edge element 18, forms a small triangular frame providing an opening at which is located the inner lateral end or base of the mirror housing. This strut 21, at its rear vertical edge channel-shaped and provided with a conventional channel-shaped seal, forms a guide and seat for the front vertical edge of the window blank or sheet G. For this particular type of window framing door structure, the unit housing may have an open framelike inboard end 15a necked down" to form at least vertical and forward sloping shoulders 25, 26, respe'ctively engaging outer surfaces of the described small .triangular frame of the door; and the reduced portion, abutting and extending inwardly of these framing parts 19, 21 is rigidly secured thereto as by screws and also by screws into the door sill, with appropriate sealing. The housing may be further anchored by an escutcheon type decorative apertured vent grille and anchor plate 28, in overlapping engagement with inner margins of these same framing portions, and in turn secured by screws threaded into boss formations 29 within the housing end. Moreover, the channel-shaped element 21 may itself be an integral part of the housing base. Vertically pivoted, louver-like elements 30 may be and preferably are used in the base anchor plate 28, for ventilation exhaust air flow control, with linkage operator at 30a. The mirror element M is supported for a limited universal adjustable tilting within the housing by a known swivel type support and Bowden cable actuator system operated by a mirror control lever 31, preferably mounted in the escutcheon grille plate but optionally locatable at 31a on the inside panel of the door. Though here the mirror element M is shiftable within the housing for vision direction setting, and a gap between the mirror edge and the surrounding margin of the opening is the principal air discharge area; the mirror can be fixedin the housing, and the housing be tiltable through a hollow ball-and-socket connection to a hollow pedestal-like base providing an air passageway; in which case, if desired, bezel slots or perforations, as air discharge openings, can be used in place of the gap and so direct air in jets across the mirror surface. Other variations will-be latter discussed. In all cases the exhaust air in flowing to the housing principal discharge region warms the mirror element for deicing. The grille openings at 16 not only may serve for ventilation ancillary discharge of air in addition to the previously described bezel apertures or the air flow gap about the mirror, but also may be internally shaped to direct some air toward, and thus to clear off, the adjacent window glass area V in the mirror vision path of the user (see FIG. 3); a purpose promoted also in some degree by the shaping of the ancillary discharge openings for aiming discharge and by the disposition of the housing directing main air discharge at the window. Where a frameless door-glass or hard-top" body style is the vehicle environment of use, that is, where the construction of the door itself does not provide framing for the top or forward edge of the window glass, but the latter is rather seated directly to body seals, carried on the adjacent door framing body parts, the base and mounting structure for the mirror unit housing will (see FIG. 4) be rigidly screw-secured to the door panel by appropriate flanging 43a on its bottom region; will include the window glass guiding channel 21 as a integral part thereof; and will then have its sloped forward edge making contact with the door seal. In FIG. 5, the modification shown in horizontal section for a left side mirror unit configuration presents a structure for the housing which is especially advantageous from the view point of safety, as it can pivot or fold back upon its base, should it strike say a pedestrian or other object outside the forwardly moving vehicle, thereby to minimize bodily injury, or to avoid or minimize damage upon hitting an external object. Here a principal outrigger portion H of the housing, with its entire back or trailing side and also its inner end open, is pivoted at its back inside corner to the housing base portion B by a vertical pivot pin 40, but is held in the normal swept back" projecting disposition by bias means such as the helical tension springs 41. A right hand unit will have the mirror-image configuration; with, however, the later described mirror actuator cables fed through the door post to a control lever fitting positioned on the dash, adjacent the drivers position. The baseB, fabricated preferably as a die casting as is the principal housing part H, integrally includes a bottom part 43 conformed to the shape of the underlying door belt or sill region and thereto secured by screws; a hollow stubby external extension E of more or less quadrilateral fore-and-aft vertical cross section carrying the housing shape in to terminate in a triangular formation completing the normal outline of the window space at the plane of the glass; this formation along its back margin including the vertical channel 21a for a guide and seal structure for the window glass forward edge, and a sloped or curved front margin or edge strip 44 to engage in the window seal in the usual sloping window framing edge element 18 of the door. The extension back wall 45 running out from channel 21a carries vertically spaced apertured inward lugs, as 45a, for the pivot pin 40 endwise engaging the housing top and bottom walls; and a wall lip 45b projecting slightly into the housing back opening defines the inner vertical margin of the mirror view opening. The outer margins of the extension bottom wall 46, front wall 47 and top wall are inwardly offset, as shown at 460 and more clearly at 47a, to result in a somewhat rabbet-like end shape, accepting thereover a continuous, preferably cemented-on seal 48 of U-shaped cross section whereby these extension wall ends are sealed to the respective interior marginal portions of the open inner end of housing part H received slightly telescoped thereover. Base B also is shaped as, or to accommodate, a frame which supports a louver structure 28a in its air passage opening provided by the extension E, and as well, in the left hand unit shown, mounts the mirror tilt control lever fitting 50 presenting control lever 31 to the user of the vehicle. On the housing front wall 52, cast apertured lugs preferably merging into adjacent top and bottom wall portions, and respective inward lugs on the inset top and bottom base extension wall margins, provide attachment points for the hook ends of upper and lower housing bias springs, as shown at 53 and 46b for the lower spring 41. To support the mirror within the housing, generally conventional limited universal tilt mounting and actuation control are used. Thus, a bracket plate 55 is bolted to a cast housing boss or pad formation 56 and is rearwardly supported by spaced integral vertical ribs 57-, 57a running from the bottom housing wall 58 part way up the front wall 52; and a drawn sheet metal pan 60, with edges curled to embrace the mirror periphery, in a rearwardly offset portion 60a, has a nearly semispherical recess or socket 60b swivelingly seated on the correspondingly rounded end of a bracket pivot post 55a. For tilt actuation and control three Bowden cables, side-cables 61, 62 and bottom cable 63, are operatively connected between the control fitting 50 and the mirror mount; the opposite ends of the sheaths 61s, 62s, 63s being anchored in side and bottom sockets respectively of the bracket plate 55 and of the control fitting casing, with the opposite ends of the respective cable wires 61w, 62w and 63w being extended beyond the sockets to attachment points on mirror pan 60 and on an internal plate on control lever 31. The attachment points are similarly oriented at locations equi-spaced about the pivots of the pan and lever plate; the mirror being held seated by wire tensioning action of a prestressed helical compression spring acting on the lever plate within the casing 50. The three cables, individually represented in greater part by dot-dash lines, are enclosed in a common flexible tubular protective casing. This type of mirror mount and actuation can, of course, be used for the FIGS. 1-4 forms of the invention. Within the opening of base B, at about the plane of glass blank G, there is secured a sub-assembly 28a comprising a frame 65 spanned by spaced vertical posts 65a defining therebetween air inlet spaces controlled by louver elements 30 swingable about vertical pivot axes or shafts out into the base extension; a back socket 65b being formed on frame 65 for reception and securement therein of the fitting 50 with its lever 31 projecting through the frame for operator access. An appropriate louver or vent control linkage of conventional form is provided between the several elements 30 and a control push button 67. Since the mirror glass itself conducts heat rather poorly, to increase the heat transfer from flowing vented air to the mirror region, various mirrorassociated metal formations may be used, which (whether the mirror element itself be tiltable or not in the housing) may take the form of a shallow pan-like mirror glass retainer of stamped metal or the like, covering much of the mirror back and embracing its edges, while serving then for engagement by other mounting elements secured to or in the housing, as in the mounting described for FIG. 5. The inward base of such retainer or pan may bear fins to achieve an increased heat transfer to the general body of the pan, which then, by its side area of contact with the mirror element back and margins, effects a more rapid and thorough warming of the glass. FIGS. 6, 7 and 8 show a mirror assembly designated Z as a whole) of somewhat more conventional form in its mounting by a pedestal-like base P to an external ledge or outwardly bowing portion of the principal hollow door region, into which the passenger compartment air is immediately discharged to pass thence through the mirror unit. The hollow pedestal base P at 71 is screw attached with appropriate sealing 72 in conventional manner to the door structure D overa hole 73 through the door panel metal. Through the pedestal P can have an appropriate hollow ball-and-socket connection to the housing portion I-Ia for manual setting or adjustment of mirror aim position, and to preserve communication (at varioushousing orientations) to the hollow mirror housing from the base, hence the interior of the door, here the mirror has a tiltable support within the housing. Thus the pedestal P and housing portion I-Ia relatively immovable, though for convenience in manufacture being separate components. Here again the mirror element M is appropriately set or held in a conventional stamped sheet metal pan 74 in the outwardly offset central back region of which a socket 74a captively receives and, to hold aim setting, frictionally engages a ball element 77 screwed into a support bar or post 79 bolted at 80 to an integral interior housing boss 81. Again air entering the base passes about the mirror, and out the gap formed between the mirror edge and the housing wall margins; and if desired through supplementary discharge slots or openings 85 in a venting grille-like arrangement at the rearward or trailing face or wall of the pedestal. The housing Ha, at a bottom wall region to the windowward side of the central mirror support, is affixed to the hollow pedestal shank end by a pair of screws, such as 87, passed therethrough outboard of diagonal corners of a roughly square bottom wall air passage hole 88, into internal cast bosses 89 within the shank end. On the interior of the hollow door section 22 to cover a vent aperture 91 in the door interior panel, there is mounted (see FIG. 8) an appropriately styled interior vent opening fitting 90 which may take various forms, but includes preferably a vent flow area control device such as a sliding slotted plate 92 which in the decorative external grille portion 93 is styled to the cars interior requirements, and has slots 93a adjustably covered by slotted plate 92 as shifted by knob 94. Where it is desired to use a door-panel-mounted side view mirror unit, which is operable from the interior by a tilt actuating lever, the general arrangement of FIGS. 68 is used with appropriate mirror support in the housing and with the control cable lead through the pedestal and door structure to the conventional lever actuator fitting on the inside of the door. The setting and use of the mirror for normal view purposes are of course, carried out in the well known manner for similar hand or lever mirror aim adjustments; and the safety function of the pivoted housing mounting should be immediately obvious, as permitting a backward deflection to the fragmentarily dash-dot outlined position in FIG. resulting in a yielding blow on any object or person struck, and thereafter a spring biased return to normal and sealed position. Likewise are obvious from thepreliminary discussion and the detailed description, the use and function of the controlled ventilation by setting of the exhaust air flow controlling vents for desired ventilation induced by the aspirating effect of the slipstream passing the units and/or the positive internal pressure produced in 6 the passenger space by ventilator blower or heater operation; and so also the mirror de-icing and cleaning effect resulting from the exhausting of the warm interior air through the mirror housing and about the mirror. Further the advantageous saving in glass cost for windows equipped with units such as those of FIGS. 1, 4 and 5 is readily apparent. 5 What is claimed is: 1. In an automotive vehicle having a body providing an enclosed space as a passenger compartment and a side view mirror mounted on that body exterior at a position viewable by the driver of the vehicle through a compartment window, the combination including: a said passenger compartment; a side view mirror unit comprising a mirror element, mirror mounting means including a hollow housing having a mirror view opening in a trailing side or wall of the housing, mirror supporting means supporting the mirror in the housing proximate to said opening, a hollow base mounting the housing on the said body ex- I terior for conducting, to the housing, compartment interior air introduced thereto at the place of attachment on the body, said housing providing air discharge area at the margin of said opening and around the periphery of said mirror element, whereby interior air introduced into said housing in passing to said air discharge warms said mirror element for deicing and like purposes; and an interior air exhaust controlling passageway from said compartment space to the locus of attachment of the mirror base, whereby said passageway and mirror unit form a ventilating system exhaust for the compartment space. 2. The combination described in claim 1", wherein said exhaust air controlling passageway includes an exhaust grille unit on an interior surface of the passanger 4O compartment structure, said grille unit including exhaust air openings therethrough and means selectably setting the effective flow area of said air openings to control ventilating exhaust of compartment interior air to said mirror unit. 3. The combination described in claim 1, wherein said side view mirror unit is mounted on a door of the vehicle. 4. The combination described in claim 3, wherein the housing of said mirror unit has an open inboard end, the said place of attachment is a region defined in at the forward part of a door window opening between a forward edge of the door, the horizontal window sill, and an upright channel from the sill affording a guide for the forward edge of the window glass. 5. The combination as described in claim4, wherein the said base is secured tothe door within said region and projects from said housing through said region to provide said passageway and conduit. 6. The combination described in claim 5, wherein said housing is pivotally secured to said base to swing from a normal position rearwardly from said base back in toward thecar body upon encountering an external object or person, and is springbiased to said exhaust air controlling passageway includes an exhaust grille unit on an interior surface of the passenger compartment structure, said grille unit including exhaust air openings therethrough and means selectably setting the effective flow area of said air openings to control ventilating exhaust of compartment interior air to said mirror unit; and said housing of the mirror unit, between its open inboard end and the mirror view opening, has a grille-like series of slots through the trailing wall, forming an exterior ventilation discharge ancillary to the said air discharge area. 8. The combination described in claim 7, wherein said mirror supporting means affords a limited universal adjustability of the plane of the mirror element within the housing for mirror aim setting, and includes a setting cable mechanism including plural Bowden cable means running through said housing and base to operating lever means accessible in said compartment. 9. The combination as described in claim 8, with said operating lever means mounted in said exhaust grille unit to project into the passenger compartment. 10. The combination as described in claim 8, with said operating lever means mounted on a door sup porting said unit to project into the passenger compartment. 11. The combination described in claim 3, wherein the margin of the mirror view opening of said housing is spaced from the said mirror element, and the mirror element is so supported in the housing to afford air flow space from behind the element, around the edges thereof and past the margin of said view opening. 12. The combination described in claim 1, wherein said mirror supporting means holds the mirror element in fixed relation to said mirror view opening of the housing, said base comprises a hollow pedestal with one end secured to the vehicle body and the other end having a hollow swivel or ball-and-socket connection with the housing to afford a manually adjustable mirror settingfor the mirror unit and air communication from the base into the housing. 13. The combination described in claim 12, wherein said pedestal has, through a trailing wall portion thereof, a grille-like series of slots to its hollow interior, forming an exterior ventilation discharge ancillary to the said air discharge area in the housing. 14. The combination described in claim 12, wherein said side view mirror unit is mounted on a door of the vehicle. 15. The combination described in claim 14, wherein the margin of the mirror view opening of said housing is spaced from the said mirror element, and the mirror element is so supported in the housing to afford air flow space from behind the element around the edges thereof past the margin of said view opening. 16. The combination described in claim 14, wherein said passageway is constituted of a hollow,window-mechanism-housing lower part of said door provided with a first opening through an inside panel of the door and a second opening, in an outside panel, into the said hollow pedestal, and disposed over the said first opening, an exhaust grille unit on an interior surface of the passenger compartment structure, said grille unit including exhaust air openings therethrough and means selectably setting the effective flow area of said air openings to controlventilating exhaust of compartment interior air to said mirror unit. 17. The combination as described in claim 4, wherein the said base has an open portion filling said region and an outward extension therefrom; said housing has an open inboard lateral end slightly telescoped over the extension end and pivoted thereto by a vertical pivot in the back side of the extension; bias spring means, normally holding said housing telescoped on said extension end, permit the housing to swing back on said pivot upon impact. 18. The combination of claim 17, including a seal element sealing the front, top and bottom walls of the housing to said extension. Patent Citations
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Decisions Under Certainty: The Time Value of Money (Decisiones Bajo Certeza: El Valor Del Dinero En El Tiempo)Ignacio Velez-ParejaGrupo Consultor CAV Capital Advisory & Valuation October 20, 2004 Abstract: This is a course material from the book Managerial Decision Making Under Risk and Uncertainty. The book is originally in Spanish and is untitled as Decisiones empresariales bajo riesgo e incertidumbre. The level of the book is basic. We use very few mathematics and it is expected to be used by managers. In this second chapter we deal with the Basic concept in Finance: the time value of Money. A dollar today is worth more than a dollar tomorrow. This concept allows us to find equivalent amounts of Money in different period of time. This will enable us to compare different cash flow profiles. In the last part f the chapter we study the Net Present Value NPV and the Internal Rate of Return, IRR. We use intensively the spreadsheet. Note: Downloadable document is in Spanish Number of Pages in PDF File: 29 Keywords: Time value of money, interest, discount process, annuities, real interest rate, discount rate, Net Present Value, NPV, Internal Rate of Return, IRR JEL Classification: G31 Date posted: May 16, 2007 ; Last revised: March 12, 2013Suggested CitationContact Information
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List: | General Discussion | « Previous MessageNext Message » | |
From: | Daniel Kasak | Date: | June 9 2005 12:04am |
Subject: | Re: microsoft sequel server | ||
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Kirk wrote: >Is anyone familiar with how to dump a database from Microsoft sequel server >to mysql? I know nothing about Microsoft products and am looking for a >utility or similar to do the conversion. Maybe Microsoft has something >built in? Although I doubt it. > > There are tools around - some are linked from the MySQL web site. I avoid these. It's a much better idea to do the migration yourself. Any mistakes with using the wrong field types can lead to data loss, and I've noticed a lot of migration tools using 'interesting' choices of field types. Get your documentation for both servers out, study your table definitions, and then set up your destination tables in MySQL. You can then use a front-end like MS Access to link tables from the source & destination databases, and use Access' "append" queries to move the data. Alternatively, you can use SQL Server's data transformations to connect to remote ODBC data sources and insert the data that way. Which ever way you do it, watch for errors and do some testing of the data to compare source and destination tables, eg do count queries on each table, do sum queries on numeric fields, and of course test your application linked to the new MySQL database *before* doing the actual migration. When everything appears to looks OK, truncate all the MySQL tables, backup the SQL Server database, and do the actual migration. -- Daniel Kasak IT Developer NUS Consulting Group Level 5, 77 Pacific Highway North Sydney, NSW, Australia 2060 T: (+61) 2 9922-7676 / F: (+61) 2 9922 7989 email: dkasak@stripped website: http://www.nusconsulting.com.au
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• microsoft sequel server | Kirk | 9 Jun |
• Re: microsoft sequel server | Daniel Kasak | 9 Jun |
• Re: microsoft sequel server | Dan Rossi | 9 Jun |
• RE: microsoft sequel server | DChristensen | 9 Jun |
• Re: microsoft sequel server | Martijn Tonies | 9 Jun |


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Laura Bush, Jenna Bush to Meet Book-Lovers at National Book Festival; Young Readers' Toolkit Available.
Co-Authors Laura Bush and Her Daughter, Jenna Bush, Will Present at the National Book Festival on the National Mall Sept. 27WASHINGTON, Sept. 8 /PRNewswire/ -- First Lady Laura Bush and her daughter, Jenna Bush, co-authors of the book "Read All About It!" will join the authors and special guests presenting at the 2008 National Book Festival (http://www.loc.gov/bookfest/), organized and sponsored by the Library of Congress and Mrs. Bush. The festival will be held from 10 a.m. to 5:30 p.m. on Saturday, Sept. 27, rain or shine, on the National Mall in Washington, D.C., between 3rd and 7th streets. The festival is free and open to the public.
Today the Library also is launching its National Book Festival Young Readers' Online Toolkit, which will bring the festival into libraries, schools and homes from coast to coast. The toolkit offers information about National Book Festival authors who write for children and teens, and offers podcasts of their readings along with teaching tools and activities for children. With the toolkit, teachers, parents and kids can put together their own book festivals.
The online toolkit features a Hosting Guide which provides an overview of the site and ideas for holding local book festivals; an Author Details section including biographies and a "scoop" area that tells the stories behind their stories; and the 2008 National Book Festival Poster.
Among more than 70 authors and illustrators participating in the National Book Festival this year are Tiki Barber, Marc Brown, Warren Brown, Kimberly Dozier, Arthur Frommer and Pauline Frommer, Philippa Gregory, Steven Kellogg, Brad Meltzer, Salman Rushdie, Bob Schieffer, Daniel Schorr, Alexander McCall Smith, Paul Theroux and Dionne Warwick. Jon Scieszka, a children's book author recently named the National Ambassador for Young People's Literature by the Librarian of Congress, will be among the authors presenting in the Teens & Children's Pavilion.
Festival authors, illustrators and poets will discuss their work in pavilions dedicated to Children, Teens & Children, Fiction & Mystery, History & Biography, Home & Family and Poetry. PBS characters and NBA/WNBA players will appear at the festival, including NBA Legend and Hall of Famer Bob Lanier and players Chris Duhon and Ivory Latta. Each year, players participate in the festival by reading their favorite children's books aloud with the help of students from local area schools as part of "NBA Cares."
The Pavilion of the States, sponsored by the Institute of Museum and Library Services, will highlight reading, literacy and library promotion activities in all 50 states, the District of Columbia and several American trusts and territories.
The Library of Congress Pavilion will feature a variety of family-centered activities illustrating the depth and breadth of the Library's extraordinary collections available online. It will also offer a sampling of interactive activities available through the recently launched Library of Congress Experience and promote the joy of reading through its "lifelong literacy" campaign.
Presentations by young poets and artists will be a new feature in the Teens & Children Pavilion. Each of the K-12 students presenting will be a winner in the River of Words environmental poetry and art contest sponsored by the Library's Center for the Book.
A presentation by four of the more than 100 authors and illustrators who contributed to the volume "Our White House: Looking In, Looking Out," sponsored by the National Children's Book and Literacy Alliance, will be featured in the Teens & Children Pavilion. Those writers are Mary Brigid Barrett, Steven Kellogg, Katherine Paterson and Jon Scieszka. (The book, with an introduction written by David McCullough, is published by Candlewick Press, 2008.)
Downloadable podcasts of interviews with popular participating authors will be placed on the Library's Web site (http://www.loc.gov/bookfest/). In addition, The Washington Post will make online discussions with National Book Festival authors available on its Web site, washingtonpost.com, from Sept. 15 through Sept. 26. These will begin with CBS newsman and author Bob Schieffer on Monday, Sept. 15 at 2 p.m. EDT; noted travel writers Arthur and Pauline Frommer, on Tuesday, Sept. 16 at 10 a.m. EDT; and fiction/nonfiction writer Alexander McCall Smith, on Friday, Sept. 19 at 11 a.m. EDT.
The artist for this year's festival is beloved children's author and illustrator Jan Brett, whose poster of animals and birds on the National Mall will be available at the festival. Brett, who has written and/or illustrated more than 30 books and has more than 33 million books in print, will be among the authors and illustrators speaking in the Children's Pavilion.
The 2008 National Book Festival is made possible with generous support from Distinguished Benefactor Target; Charter Sponsors AT&T and The Washington Post; Patrons the Institute of Museum and Library Services, the James Madison Council and the National Endowment for the Arts; and Contributors Barnes & Noble, the Kalima Foundation, the Library of Congress Federal Credit Union, Marshall and Dee Ann Payne, NBA/WNBA, PBS, Penguin Group (USA), Scholastic Inc. and US Airways.
The Junior League of Washington will again provide hundreds of volunteers, joining Library of Congress volunteers, in assisting those attending the National Book Festival.
The latest list of participating authors, illustrators and poets in each presentation pavilion follows.
CHILDREN Tiki Barber Jan Brett Marc Brown & Judy Sierra David A. Carter Doreen Cronin & Betsy Lewin Kadir Nelson & Doreen Rappaport David Shannon Dionne Warwick TEENS & CHILDREN Mary Brigid Barrett, Steven Kellogg & Katherine Paterson Joseph Bruchac Sharon M. Draper Neil Gaiman Andrea Davis Pinkney Matthew Reinhart & Robert Sabuda River of Words with Pamela Michael, David Gewanter, and young contest winners Jon Scieszka Charles R. Smith, Jr. R. L. Stine Judith Viorst FICTION & MYSTERY Louis Bayard Geraldine Brooks Sandra Brown Marisa de Los Santos Philippa Gregory Andrew Klavan James McBride Brad Meltzer Richard Price Francine Prose Peter Robinson Salman Rushdie Alexander McCall Smith HISTORY & BIOGRAPHY Rick Atkinson Michael Dobbs Kimberly Dozier Tony Horwitz Kay Bailey Hutchison Immaculee Ilibagiza Walter Isaacson David Maraniss Cokie Roberts Bob Schieffer Daniel Schorr Paul Theroux Gordon S. Wood HOME & FAMILY Warren Brown Marcus Buckingham Eleanor Clift George Duran Arthur Frommer & Pauline Frommer Julie Morgenstern Mike Richman Nancy Schulman & Ellen Birnbaum Cathy Scott Michelle Singletary POETS Eavan Boland Dan Chiasson Elsa Cross Michael S. Harper Michael Lind Molly Peacock Stanley Plumly J. Allyn Rosser Kay Ryan (Poet Laureate Consultant in Poetry, Library of Congress) Poetry Out Loud SPECIAL GUESTS Chris Duhon Bob Lanier Ivory Latta
CONTACT: Jennifer Gavin of Library of Congress, +1-202-707-1940, firstname.lastname@example.com
Web site: http://www.loc.gov/bookfest
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02-02-2014, 12:20 AM | #1 (permalink) |
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Join Date: Aug 2013
Posts: 36
My (off) white Shepherd
How do you keep your white shepherds to white? Which soap works the best? How often to groom? Any supplements help?
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02-02-2014, 08:30 AM | #2 (permalink) |
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Location: NC
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When we had our white Shepherd, we didn't do anything special. I think we used a cheapo human shampoo. When she would start looking gray, she got a bath but that was not often. No supplements.
Dagr "Dag" 11/07/2013- |
02-02-2014, 10:07 AM | #3 (permalink) |
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Their fur naturally repels dirt once it is dry so you can just brush them. Same skin and coat care as for other German Shepherds. Mine grooms herself like a cat!
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02-02-2014, 10:35 AM | #4 (permalink) |
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I did forget to mention she got brushed daily.
Dagr "Dag" 11/07/2013- |
02-02-2014, 01:55 PM | #5 (permalink) |
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I use horse shampoos on my dogs. I have blue shampoo that takes stains out of white. It rinses well and afterwards. I'll spray show sheen on them and it makes them slick / soft and shiny. Also helps with brushing out tangles on my LH shepherd.
Hondo Von Dopplet L Bauernhof "Hondo"- GSD Lilie's Tug McGraw "Tug" - Golden Retriever Maggie - Mini Dachshund (Rescue) Lonestar Pivo - Texas Blue Lacy Ashe - Barn Cat Katie / APHA |
02-03-2014, 01:27 AM | #6 (permalink) |
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If you are looking to make the color look a little brighter, you can use a mix of baking soda and peroxide mixed with the regular shampoo. I only do this one or twice a year if he is "stained" from rolling in red clay or something else that normal shampoo doesn't clean.
Other than that, a good Whitening shampoo is all you'll need.
RIP Sebastian, Baby, Cheyenne, Baxter. Gone but never forgotten. Finnian The Irish Lad WGSD: SAR Abeni the Little Warrior: Pomeranian rescue. "Res nos operor ut alius algo" "Go mairidís beo" |
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Anna Eleanor Roosevelt (/ˈɛlɨnɔr ˈroʊzəvɛlt/; October 11, 1884 — November 7, 1962) was the longest-serving First Lady of the United States, holding the post from 1933 to 1945 during her husband President Franklin D. Roosevelt's four terms in office. President Harry S. Truman later called her the "First Lady of the World" in tribute to her human rights achievements.
A member of the Roosevelt and Livingston families, Eleanor had an unhappy childhood, suffering the deaths of both parents and one of her brothers at a young age. At 15, she attended Allenwood Academy in London, and was deeply influenced by feminist headmistress Marie Souvestre. Returning to the US, she married her cousin Franklin Delano Roosevelt in 1905. The Roosevelts' marriage was complicated from the beginning by Franklin's controlling mother, Sara and after discovering Franklin's affair with Lucy Mercer in 1918, Eleanor resolved to seek fulfillment in a public life of her own. She persuaded Franklin to stay in politics following his partial paralysis from polio, and began to give speeches and campaign in his place. After Franklin's election as Governor of New York, Eleanor regularly made public appearances on his behalf. She had also shaped the role of First Lady during her tenure and beyond.
The United States of America (USA), commonly referred to as the United States (US), America, or simply the States, is a federal republic consisting of 50 states, 16 territories, and a federal district. The 48 contiguous states and the federal district of Washington, D.C., are in central North America between Canada and Mexico. The state of Alaska is the northwestern part of North America and the state of Hawaii is an archipelago in the mid-Pacific. The country also has five populated and nine unpopulated territories in the Pacific and the Caribbean. At 3.79 million square miles (9.83 million km2) in total and with around 316 million people, the United States is the fourth-largest country by total area and third largest by population. It is one of the world's most ethnically diverse and multicultural nations, the product of large-scale immigration from many countries. The geography and climate of the United States is also extremely diverse, and it is home to a wide variety of wildlife.
Paleo-indians migrated from Asia to what is now the US mainland around 15,000 years ago, with European colonization beginning in the 16th century. The United States emerged from 13 British colonies located along the Atlantic seaboard. Disputes between Great Britain and these colonies led to the American Revolution. On July 4, 1776, delegates from the 13 colonies unanimously issued the Declaration of Independence. The ensuing war ended in 1783 with the recognition of independence of the United States from the Kingdom of Great Britain, and was the first successful war of independence against a European colonial empire. The current Constitution was adopted on September 17, 1787. The first 10 amendments, collectively named the Bill of Rights, were ratified in 1791 and guarantee many fundamental civil rights and freedoms.
Franklin Delano Roosevelt (/ˈroʊzəvɛlt/ ROH-zə-velt or /ˈroʊzəvəlt/ ROH-zə-vəlt; January 30, 1882 — April 12, 1945), commonly known by his initials, FDR, 32nd President of the United States (1933–1945), served for 12 years and four terms until his death in 1945, the only president ever to do so, and a central figure in world events during the mid-20th century, leading the United States during a time of worldwide economic depression and total war. A dominant leader of the Democratic Party and the only American president elected to more than two terms, he built a New Deal Coalition that realigned American politics after 1932, as his domestic policies defined American liberalism for the middle third of the 20th century.
With the bouncy popular song "Happy Days Are Here Again" as his campaign theme, FDR defeated incumbent Republican Herbert Hoover in November 1932, at the depth of the Great Depression. Energized by his personal victory over polio, FDR's persistent optimism and activism contributed to a renewal of the national spirit. Assisted by key aide Harry Hopkins, he worked closely with British Prime Minister Winston Churchill and Soviet leader Joseph Stalin in leading the Allies against Nazi Germany and Japan in World War II. The war ended the depression and restored prosperity.
In the Americas, the Delano family, includes notables such as U.S. presidents Franklin Delano Roosevelt and Calvin Coolidge, U.S. president and Union Army general Ulysses S. Grant, author Laura Ingalls Wilder, and astronaut Alan B. Shepard. Its progenitor was Philippe de Lannoy (1602–1681) The Pilgrim of Flemish descent arrived at Plymouth, Massachusetts, in the early 1620s. His descendants also include Frederic Adrian Delano, Robert Redfield, and Paul Delano. Delano family forebears include the Pilgrim who chartered the Mayflower, seven of its passengers and three signers of the Mayflower Compact.
Aplastic anemia is a disease in which the bone marrow, and the blood stem cells that reside there, are damaged. This causes a deficiency of all three blood cell types (pancytopenia): red blood cells (anemia), white blood cells (leukopenia), and platelets (thrombocytopenia). Aplastic refers to inability of the stem cells to generate the mature blood cells.
It occurs most commonly in the teens and twenties, and also among the elderly. It can be caused by exposure to chemicals, drugs, radiation, infection, immune disease, and heredity; in about half the cases, the cause is unknown.
Human migration is movement by humans from one place to another, sometimes over long distances or in large groups. Historically this movement was nomadic, often causing significant conflict with the indigenous population and their displacement or cultural assimilation. Only a few nomadic people have retained this form of lifestyle in modern times. Migration has continued under the form of both voluntary migration within one's region, country, or beyond and involuntary migration (which includes the slave trade, trafficking in human beings and ethnic cleansing). People who migrate into a territory are called immigrants, while at the departure point they are called emigrants. Small populations migrating to develop a territory considered void of settlement depending on historical setting, circumstances and perspective are referred to as settlers or colonists, while populations displaced by immigration and colonization are called refugees. The rest of this article will cover migration in the sense of a "change of residence", rather than the temporary migrations of travel, tourism, pilgrimages, or the commute.
Anna Roosevelt Cowles (January 18, 1855 – August 25, 1931) was the older sister of United States President Theodore Roosevelt and the aunt of Eleanor Roosevelt. Her childhood nickname was Bamie, a derivative of bambina, but as an adult, her family began calling her "Bye" because of her tremendous on-the-go energy - (Hi Bamie, bye Bamie). Throughout the life of her brother, Theodore, she remained a constant source of emotional support and practical advice. On the child-bed death of her brother Theodore's young wife Alice, Bamie took custody of the child, assuming parental responsibility for TR's first daughter, Alice Lee Roosevelt.
The term crime does not, in modern times, have any simple and universally accepted definition, but one definition is that a crime, also called an offence or a criminal offence, is an act harmful not only to some individual, but also to the community or the state (a public wrong). Such acts are forbidden and punishable by law.
Science of drugs including their origin, composition, pharmacokinetics, pharmacodynamics, therapeutic use, and toxicology.
Pharmacology (from Greek φάρμακον, pharmakon, "poison" in classic Greek; "drug" in modern Greek; and -λογία, -logia "study of", "knowledge of") is the branch of medicine and biology concerned with the study of drug action, where a drug can be broadly defined as any man-made, natural, or endogenous (within the body) molecule which exerts a biochemical and/or physiological effect on the cell, tissue, organ, or organism. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function. If substances have medicinal properties, they are considered pharmaceuticals.
In journalism, a human interest story is a feature story that discusses a person or people in an emotional way. It presents people and their problems, concerns, or achievements in a way that brings about interest, sympathy or motivation in the reader or viewer.
Human interest stories may be "the story behind the story" about an event, organization, or otherwise faceless historical happening, such as about the life of an individual soldier during wartime, an interview with a survivor of a natural disaster, a random act of kindness or profile of someone known for a career achievement.
Heart failure (HF), often called congestive heart failure (CHF) or congestive cardiac failure (CCF), occurs when the heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition is diagnosed by patient physical examination and confirmed with echocardiography. Blood tests help to determine the cause. Treatment depends on severity and cause of heart failure. In a chronic patient already in a stable situation, treatment commonly consists of lifestyle measures such as smoking cessation, light exercise, dietary changes, and medications. Sometimes, depending on etiology, it is treated with implanted devices (pacemakers or ventricular assist devices) and occasionally a heart transplant is required.
Common causes of heart failure include myocardial infarction and other forms of ischemic heart disease, hypertension, valvular heart disease, and cardiomyopathy. The term heart failure is sometimes incorrectly used for other cardiac-related illnesses, such as myocardial infarction (heart attack) or cardiac arrest, which can cause heart failure but are not equivalent to heart failure.
Miliary tuberculosis (also known as "disseminated tuberculosis", "tuberculosis cutis acuta generalisata", and "Tuberculosis cutis disseminata") is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions (1–5 mm). Its name comes from a distinctive pattern seen on a chest X-ray of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term "miliary" tuberculosis. Miliary TB may infect any number of organs, including the lungs, liver, and spleen. It is a complication of 1–3% of all TB cases.
Bronx, Kings, New York, Queens, Richmond
New York is the most populous city in the United States and the center of the New York Metropolitan Area, one of the most populous urban agglomerations in the world. The city is referred to as New York City or the City of New York to distinguish it from the State of New York, of which it is a part. A global power city, New York exerts a significant impact upon commerce, finance, media, art, fashion, research, technology, education, and entertainment. The home of the United Nations Headquarters, New York is an important center for international diplomacy and has been described as the cultural capital of the world.
How Jean Stapleton And Eleanor Roosevelt Saved An Evening At The Theater
Eleanor Roosevelt Biography
Eleanor Roosevelt Ranks First Among First Ladies
Eleanor Roosevelt's cause of death and end of life issues examined during clinicopathological conference
Political Gurus Weigh In on How History Will Judge Hillary Clinton


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Connected Books
See More Connected BooksIf you like this, Harlequin recommends
- The Surprise Triplets
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Josh Lorenz is the last man Diane Bittner wants for a neighbor--he's the holdout juror responsible for letting her husband's killer walk. But she finds herself outvoted when their preteen daughters conspire to bring their divided parents together.
Josh has always followed his conscience and hopes Diane can forgive him for doing what he believed was right. But he realizes he wants a lot more from the attractive single mother. With the help of their kids and their close-knit community, he and Diane have to decide what really matters. Reliving the mistakes of the past? Or planning their future--together?


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Limited data guide radiotherapy choices for patients with brain metastases. This survey aimed to identify patient, physician, and practice setting variables associated with reported preferences for different treatment techniques.
277 members of the American Society for Radiation Oncology (6% of surveyed physicians) completed a survey regarding treatment preferences for 21 hypothetical patients with brain metastases. Treatment choices included combinations of whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and surgery. Vignettes varied histology, extracranial disease status, Karnofsky Performance Status (KPS), presence of neurologic deficits, lesion size and number. Multivariate generalized estimating equation regression models were used to estimate odds ratios.
For a hypothetical patient with 3 lesions or 8 lesions, 21% and 91% of physicians, respectively, chose WBRT alone, compared with 1% selecting WBRT alone for a patient with 1 lesion. 51% chose WBRT alone for a patient with active extracranial disease or KPS=50%. 40% chose SRS alone for an 80 year-old patient with 1 lesion, compared to 29% for a 55 year-old patient. Multivariate modeling detailed factors associated with SRS use, including availability of SRS within one's practice (OR 2.22, 95% CI 1.46-3.37).
Poor prognostic factors, such as advanced age, poor performance status, or active extracranial disease, correspond with an increase in physicians' reported preference for using WBRT. When controlling for clinical factors, equipment access was independently associated with choice of SRS. The large variability in preferences suggests that more information about the relative harms and benefits of these options is needed to guide decision-making.
Brain metastases; Stereotactic radiosurgery; Whole brain radiation therapy; Treatment patterns; Physician surveyBackground
Brain metastases are the most common intracranial tumor, occurring in 20-40% of cancer patients and accounting for 20% of cancer deaths annually [1]. Median survival is 1–2 months with corticosteroids alone [2] or six months with whole brain radiation therapy (WBRT) [3,4].
A major advance in the treatment of these patients was addition of surgery to WBRT for treatment of a single metastasis, which improved local control, distant intracranial control and neurologic survival compared to either modality alone [5,6]. A retrospective study demonstrated differential survival among patients undergoing WBRT according to recursive partitioning analysis (RPA) classes [7]; further prognostic refinements have incorporated histology and number of lesions [8].
More recently, stereotactic radiosurgery (SRS) has been used alone or with WBRT in patients with up to 4 metastases. When compared with WBRT alone, the addition of SRS has improved local control, functional autonomy and survival [5,9-11]. However, WBRT can have significant toxicities, including fatigue, drowsiness and suppressed appetite, and long-term difficulties with learning, memory, concentration, and depression [12-14]. The use of SRS alone controls limited disease and delays the time until WBRT is necessary for distant intracranial progression [12,15,16].
In most clinical trials of therapies for brain metastases, patients have been selected on the basis of having few metastases, stable extracranial disease, and excellent performance status. In clinical practice, patients with brain metastases are a heterogeneous population, and decision-making requires the synthesis of multiple variables.
The objective of this survey of radiation oncologists was to identify patient factors, physician characteristics, and practice setting variables associated with physicians' preferred use of different techniques for treating brain metastases. This survey aimed to generate data that would allow physicians to: (1) compare their practice patterns to a national sample; (2) assess the influence of their practice environment on treatment choice; and (3) generate new hypotheses regarding appropriate treatment.
This project was approved by the IRB of Harvard Medical School. The survey was launched online, and physician members of the American Society for Therapeutic Radiology and Oncology (ASTRO) were emailed a recruitment letter. Eligibility criteria included respondent status as a U.S. or Canadian physician in the ASTRO database, valid email address, and current management of patients with brain metastases, as reflected by the screener question. Respondents linked directly to the survey from the email, and there was no incentive for survey participation.
Data collection
Data was de-identified and collected through the online survey tool for one month. We emailed surveys to 4357 physician members of ASTRO on September 26, 2008, and the survey was closed on October 26, 2008. 417 respondents answered at least one question, and 277 answered all demographic and clinical questions, for a response rate of 6%. Despite our low response rate, physician respondents were representative of practicing radiation oncologists when compared to respondents to the American College of Radiology's (ACR) Survey of Radiation Oncologists. Our sample was similar to the ACR survey on selected characteristics such as sex (73% male in our survey, 77% in ACR), age (62% ages 35–54 in our survey, 65% in ACR) and being in private practice (52% in our survey, 48% in ACR) [17]. However, it was not possible to assess interest in SRS or palliative care, or use of advanced technology, among those included in the ACR sample, which limits the comparison.
The survey was designed to: (1) describe radiation oncologists' patterns of treatment of patients with brain metastases; and (2) identify clinical, demographic, and practice setting factors associated with treatment patterns. To test physician practices, a series of short hypothetical clinical vignettes were developed to assess respondents' preferred treatment modalities. Vignettes have been demonstrated to be a valid study tool when compared with actual clinical practice patterns [18]. Treatment options for each vignette were identical: WBRT alone; WBRT with SRS; SRS alone; WBRT with surgery; or no treatment. We constructed 3 versions of a reference vignette: the first with 1 metastasis, the next with 3 metastases, and one with 8 metastases. Each reference vignette described a 55 year-old patient with non-small cell lung cancer, inactive extracranial disease, Karnofsky Performance Status (KPS) 80%, and asymptomatic, small brain lesion(s). For each of these 3 vignettes, we asked about 6 additional patients, modifying a single variable: melanoma histology, active extracranial disease, KPS 50%, presence of neurologic deficit, age of 80 years old, and large lesion (Figure 1).
Figure 1. Variations under assumptions of 1, 3, 8 metastases in each Reference Patient. The survey sequentially varied the characteristics of each Reference Patient to create vignettes for Patients 1–6. The effect of each variation was evaluated under assumptions of 1, 3, and 8 lesions, respective to each vignette's Reference Patient.
Other survey items assessed factors related to the patient, physician, or practice setting. These questions included physician demographics, practice environment, availability of SRS, and opinions about the nature of intracranial disease and the toxicity of its treatment. A copy of our survey is included as supplementary material (Additional file 1: Appendix 1). Data regarding non-respondents were not collected.
Additional file 1. Appendix 1. Complete physician survey.
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Statistical analysis
Effects of patient clinical characteristics on treatment choices
For the four category treatment choice responses (WBRT alone, WBRT with SRS, SRS alone, or surgery with WBRT), we used a series of multivariate binomial generalized estimating equation (GEE) models to estimate odds ratios that measured the effects of each change in patients' clinical characteristics on the odds of each of 4 treatments choices relative to the odds of the remaining 3 alternatives. Since each vignette represented a repeat measurement on a physician, we considered treatment choices as correlated observations clustered within individual physicians. We used an exchangeable correlation structure to account for the correlation of physician responses between vignettes. Graphical techniques were used to assess model adequacy. We chose to use a series of binomial models to model a multi-category response because of the lack of available statistical software to implement multi-category GEE models with exchangeable correlation structure [19].
Effects of patient & physician characteristics on odds of including SRS
We grouped treatment responses that included SRS (SRS or WBRT with SRS) and compared them with the 3 remaining alternatives as a combined reference group (WBRT, WBRT with surgery, or no treatment) in a binomial GEE model that included patient clinical, physician and practice setting characteristics as covariates. These groupings were created to allow for exploration of factors contributing to integrating advanced technology (SRS) into the treatment plan, despite the fact that each treatment approach may have different clinical indications, as explored through the above-detailed models. Working correlations and clustering were treated as in the previous models.
All parameter estimates were tested for statistical significance at the 0.05 level. SAS® software version 9.2 was used in all analyses.
Physician demographics and practice environment
The characteristics of our survey respondents are shown in Table 1. Sixty percent of respondents were in single-specialty group practices. Most practices were hospital-based, academic (38%) or private (30%). Seventy-six percent of respondents treated 10–50 patients with brain metastases per year. Forty-four percent of respondents performed SRS, while 35% had a colleague at their institution who performed SRS. Sixty-one percent of respondents had LINAC-based SRS, and 18% had no SRS equipment.
Table 1. Distribution of Physician Characteristics (N=277)
Physicians' responses to the 21 vignettes varied substantially (Table 2). Multivariable modeling revealed clinical factors influencing treatment selection (Tables 3, 4, 5; complete results in Additional file 2: Appendix 2).
Additional file 2. Appendix 2. Odds Ratios and Confidence Intervals Comparing the Odds of Treatment Choices for Different Patient Characteristics.
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Table 2. Unadjusted Response (in %) Among Radiation Oncologist (N=277)
Table 3. Odds Ratios for Choice of WBRT* alone versus SRS† Alone
Table 4. Odds Ratios for Choice of WBRT alone versus WBRT with SRS
Table 5. Odds Ratios for Choice of WBRT with SRS versus SRS alone
Whole brain radiation therapy alone
WBRT alone was selected frequently, particularly for patients with 8 metastases. For the 80 year-old patient with 3 or 8 metastases, WBRT was commonly preferred (52% and 96% vs. 21% and 91%, respectively, for the 55-year old patient, Table 2). Even for a patient with a single metastasis, 56% of respondents preferred WBRT alone if that patient had KPS 50%; 51% would choose WBRT if the patient had active extracranial disease. In adjusted analyses, all of the clinical variables (melanoma histology, KPS 50%, active extracranial disease, age of 80 years old, presence of focal neurologic deficits, and large lesion) were associated with a higher likelihood of respondents preferring WBRT alone versus either SRS alone (Table 3) or WBRT with SRS (Table 4), except for radioresistant histology.
Addition of surgery
For the reference patient with a single metastasis, 44% of respondents selected surgery with WBRT, although most respondents selected a non-operative approach that included SRS (26% WBRT with SRS; 29% SRS alone, for a total of 55% of respondents). When the reference vignette was revised to include the presence of focal neurologic deficits, the distribution of responses was similar for those with 1 lesion, with 48% of respondents preferring surgery with WBRT. When considering patients with a single, large lesion, the percent of respondents choosing surgery with WBRT increased from 44% to 63%. After adjusting for all other clinical factors, respondents were more likely to choose surgery with WBRT rather than WBRT alone for patients with large versus smaller lesions (OR=1.9, 95% CI 1.3-2.8). For 3 or 8 lesions, age 80, active extracranial disease, and KPS 50%, respondents were more likely to choose WBRT alone than surgery with WBRT (Additional file 2: Appendix 2). Melanoma histology and presence of neurologic deficits did not correlate with respondents' selections.
Addition of stereotactic radiosurgery
SRS was commonly preferred by respondents for patients with 3 lesions (23% SRS alone; 54% SRS with WBRT, Table 2), and it largely replaced the use of surgery for the older patient with a single lesion (25% WBRT with SRS; 40% chose SRS alone). Presence of neurological deficits and large lesion size were associated with physicians' preference for WBRT with SRS over SRS alone (Table 5). However, older age, poorer performance status and melanoma histology were associated with less frequent selection of WBRT with SRS versus SRS alone.
Use of stereotactic radiosurgery
Multivariable analysis was performed to identify which factors were independently associated with including SRS as part of treatment (SRS or WBRT with SRS) compared to all other treatment choices (WBRT, WBRT with surgery, no treatment), adjusting for all other characteristics in Table 6. Number of metastases was strongly associated with treatment preferences: after adjustment for all other factors in the model, respondents were significantly more likely to favor SRS for 3 lesions than for 1 (OR=2.22, 95% CI 1.96-2.51), and physicians were 5 times less likely to choose an approach that included SRS for a patient with 8 lesions relative to patients with 1 lesion (OR=0.19, 95% CI 0.15-0.23).
Table 6. Results of logistic regression model showing the reported use of SRS* as part of treatment for brain metastases according to multiple clinical, sociodemographic, and practice setting factors2
Across all clinical vignettes, after adjusting for all other factors, poor KPS (OR=0.38, 95% CI 0.31-0.46), active extracranial disease (OR=0.56, 95% CI 0.47-0.65), and large lesion (OR=0.58, 95% CI 0.47-0.71) remained strongly negatively associated with the choice of SRS, while melanoma histology (OR=2.84, 95% CI 2.45-3.29) and advanced age (OR=1.23, 95% CI 1.07-1.41) were positively associated with choice of SRS. Physician access was the strongest factor associated with choosing SRS as part of treatment. Respondents with SRS capability in their own practice were more likely to favor its use for hypothetical patients than those without it (OR=2.22, 95% CI 1.46-3.37). As expected, those physicians who personally used SRS were more likely to recommend it than those who did not have it or use it personally in their practice (OR=3.57, 95% CI 2.42-5.26). Patient volume and physician seniority were examined, but were not associated with SRS use.
Treatment of patients with brain metastases is heterogeneous. WBRT is a standard therapy, with the addition of surgery or SRS to WBRT, or SRS used alone, reserved for selected patients on the basis of their clinical characteristics. One potential advantage of local therapy may be avoiding the toxicity of WBRT [12-14]. However, SRS, when used alone, has several disadvantages. SRS alone has been shown to be inferior to the combination of SRS with WBRT for durable local control and distant intracranial control [15]. When studying patients initially undergoing any local therapy – surgery or SRS – more patients required salvage if treated without WBRT [20]. Long-term cognitive outcomes have been shown to be more closely correlated with intracranial progression than with treatment modality, emphasizing the significance of intracranial control over short-term side effects [21,22].
Given the limited scope of current studies and the variability in outcomes, National Comprehensive Cancer Network (NCCN) guidelines allow for a wide range of treatment options including WBRT, surgical resection, or SRS, alone or in combinations [23]. Previous reviews of treatment patterns have demonstrated stable rates of surgery since the 1980s, with an increasing use of SRS [24]. Despite clinical trials limiting eligible patients to those with limited central nervous system disease, a recent survey demonstrated that more than half of physician respondents would consider using SRS as an initial treatment for patients with 5 or more intracranial lesions [25]. The increased utilization of SRS as well as the persistent heterogeneity in practice may be due to the time of dissemination of research into clinical practice, or the time to purchase and adoption of new technologies.
With mixed evidence and a heterogeneous patient population, treatment decision-making is complex. Significantly, our study demonstrates that although clinical factors, such as number of lesions and patient age, affected treatment selection, physician practice environment had a strong, independent effect on the use of SRS.
Factors related to the patient's clinical condition affected treatment selection. There was increased use of WBRT for increasing number of lesions, which is consistent with the lack of evidence to support the use of local techniques for patients with numerous metastases. However, we observed that a substantial proportion of physicians still chose SRS as part of their approach for patients with multiple lesions, particularly for patients with 3 lesions. The increased use of SRS with 3 lesions as compared with 1 was possibly due to the use of surgery for a substantial proportion of patients with 1 lesion, and due to the use of SRS combined with WBRT in patients with 3 lesions. Interestingly, physicians overall selected WBRT for patients with 1, 3, or 8 lesions more often for patients who were frail (increased age, low KPS) and might suffer increased morbidity from WBRT. This finding was unexpected, since WBRT has been shown to cause side effects that might be difficult for frail patients with limited life expectancy to tolerate, such as increasing fatigue, worsening physical function, and deterioration of appetite [7,14,26]. Additional clinical factors may influence treatment selection, but were not addressed in this study, including tumor location and surgical accessibility; additional treatment options not evaluated include the use of SRS in combination with surgery, chemotherapy, and the role of hospice.
Practice environment and clinical expertise also influenced the use of SRS, even when controlling for clinical factors. Although practice type was not associated with the preference for SRS, the availability of SRS was significantly associated with its use, indicating that patients are more likely to receive this treatment if the physician they see practices it herself or has it available within her practice. This pattern of care could lead to under- or over-utilization of SRS: patients may have treatment guided more by a provider's practice than by the patient's clinical condition. Previous studies have demonstrated the association of physician specialization, board certification, treatment volume and time in practice with other cancer-related treatment decisions [27,28]. For example, diagnostic imaging use has increased when such imaging is performed at a self-referred facility [29]. Similarly, radiation oncologists may be prescribing complex treatment approaches more frequently when they have access to the facilities or equipment. Alternatively, this propensity for increased use of SRS with easy access may relate to physicians' familiarity with their own clinical outcomes when using new technology. Our respondents may also have rates of access to SRS that are not comparable to those available nationwide, since the ACR survey did not report on the availability of SRS equipment.
Our study has several limitations due to its reliance on physician self-report as a proxy for practice, its timing, and the limited number of respondents. Clinical scenarios were hypothetical and treatment options were limited. Although physician surveys have shown a strong correlation between vignettes and actual practice [18], further objective validation of these data would be desirable, as the vignettes used in this survey were novel. Respondents to this survey were dominantly radiation oncologists, whose treatment decisions may be greatly impacted by other members of the inter-disciplinary oncology team not represented in this survey. Rates of radiosurgery utilization more than doubled between 2000 and 2005, so continued increases in the use of radiosurgery could have occurred since the completion of this survey [30]. Additional research has been published since 2008 that may have resulted in further shifts in practice patterns.
The limited number of respondents to our survey limits the generalizability of our findings. The response rate of 6% may indicate that the practice patterns outlined in this study are specific to a subgroup of clinicians with particular interest or expertise in radiosurgery and may not be indicative of global patterns of care. Although respondents were similar to those in the ACR survey, the comparison is limited due to the nature of the variables available; key issues, such as expertise with SRS or volume of patients brain metastases, were not available in the ACR survey for comparison. However, ours is the first study to document practice patterns using vignettes in this clinical setting.
Although many patients with cancer develop brain metastases, there is little data to guide treatment decisions. Our study demonstrates the significant heterogeneity among radiation oncologists in general clinical practice even for patients with identical clinical characteristics. Certain non-clinical factors, such as access to SRS, appear to be key drivers of use of advanced technology. This finding raises the question about what additional incentives could be driving treatment selection in the absence of gold-standard evidence of the superiority of a single approach over other alternatives. Our findings from this survey also underscore the likely uncertainty or disagreement that may exist among radiation oncologists about the relative harms and benefits of different treatment approaches. This uncertainty is likely related to the lack of prospective randomized studies that compare specific single- and multi-modality approaches for the treatment of brain metastases. More research is needed that directly compares the effectiveness of these approaches for a variety of different clinical circumstances. It would also be important to investigate underlying non-clinical factors, such as physician environment, reimbursement, and technology access, which likely contribute to observed heterogeneity of care for patients with brain metastases.
WBRT: Whole brain radiation therapy; SRS: Stereotactic radiosurgery; KPS: Karnofsky performance status; RPA: Recursive partitioning analysis; ASTRO: American society for therapeutic radiation oncology; ACR: American college of radiology; GEE: Generalized estimating equation; NCCN: National comprehensive cancer network.
Competing interests
Dr. Ramakrishna has received speaker's honoraria from and prepared educational materials for Brainlab Ag, Heimstetten, Germany. The remaining authors have no conflicts of interest to disclose.
Authors' contributions
NR and MK conceived of the study, designed the survey, and completed data collection. MK, KU, SM, and AP performed statistical analysis and data interpretation. MK, SM, and AP drafted the manuscript. All authors read and approved the final manuscript.
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