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The invention provides an implantable trial neurostimulator. The implantable trial neurostimulator may be equipped with limited, short-term battery resources. The limited battery resources are designed to last for a finite period of time, thereby preventing a patient or physician from prolonging the trial neurostimulation period. For example, the implantable trial neurostimulator may be designed to stop functioning after a number of days or weeks, upon exhaustion of the battery resources. Alternatively, the implantable trial neurostimulator may be disabled upon expiration of a timer. The trial neurostimulator may be temporarily implanted in a subdural pocket in which the chronic stimulator is ultimately implanted. In this manner, the trial neurostimulator can be coupled to a chronic lead and avoid any percutaneous connections, reducing the risk of infection and affording greater convenience and comfort to patients.
1. An implantable trial neurostimulator comprising:
a neurostimulation therapy delivery circuit; and
a battery to deliver power to the circuit, wherein the battery is selected such that the battery is exhausted within a predetermined trial period of time, thereby disabling the circuit.
2. The neurostimulator of
3. The neurostimulator of
4. The neurostimulator of
5. The neurostimulator of
6. The neurostimulator of
7. The neurostimulator of
8. The neurostimulator of
9. An implantable trial neurostimulator comprising:
a neurostimulation therapy delivery circuit; and
a processor to control the circuit, wherein the processor automatically disables the circuit upon expiration of a trial period of time.
10. The neurostimulator of
11. The neurostimulator of
12. The neurostimulator of
13. The neurostimulator of
14. The neurostimulator of
15. The neurostimulator of
16. An implantable trial neurostimulator system comprising:
an implantable neurostimulator including a neurostimulation therapy delivery circuit, and a transcutaneous receiver coil; and
an external power supply including a transcutaneous transmitter coil to deliver power to the circuit via the transcutaneous receiver coil, wherein the power supply automatically terminates the delivery of power by the transcutaneous transmitter coil upon expiration of a trial period of time.
17. The neurostimulator system of
18. The neurostimulator system of
19. The neurostimulator system of
20. The neurostimulator system of
21. A method comprising:
implanting a neurostimulation lead in a patient;
implanting a trial neurostimulator in the patient;
coupling the trial neurostimulator to the lead; and
removing the trial neurostimulator from the patient upon expiration of a trial period of time.
22. The method of
23. The method of
24. The method of
25. The method of
26. The method of
27. The method of
28. The method of
29. The method of
30. The method of
31. The method of
32. The method of
33. The method of
34. The method of
35. An implantable trial neurostimulator comprising:
means for delivering neurostimulation therapy to a patient; and
means for automatically disabling the delivery of neurostimulation therapy upon expiration of a trial period of time.
36. The neurostimulator of
37. The neurostimulator of
38. The neurostimulator of
39. The neurostimulator of
40. The neurostimulator of
41. The neurostimulator of
42. The neurostimulator of
43. The neurostimulator of
44. The neurostimulator of
45. The neurostimulator of
46. The neurostimulator of
47. The neurostimulator of
48. The neurostimulator of
49. The neurostimulator of
[0001] The invention relates generally to neurostimulation and, more particularly, to trial neurostimulation to evaluate efficacy and patient acceptance of neurostimulation.
[0002] A variety of pelvic floor disorders such as urinary control disorders, fecal control disorders, interstitial cystitis, sexual dysfunction, and pelvic pain are influenced by the sacral nerves. In particular, the organs involved in various bodily functions receive much of their control via the second, third, and fourth sacral nerves, commonly referred to as S2, S3, and S4, respectively. The sacrum, in general, is a large, triangular bone situated at the lower part of the vertebral column, and at the upper and back part of the pelvic cavity. The spinal canal runs throughout the sacrum. The sacral nerves pass through the sacrum via the anterior and posterior sacral foramina. These organs are also innervated via other nerves, such as the pudendal nerve.
[0003] Electrical stimulation of the sacral nerves, pudendal nerves, and other nerves of the pelvic floor has been found to offer relief for many pelvic floor disorders. For example, medical leads having discrete electrodes are implanted on and near the sacral nerves. An implantable pulse generator drives the electrodes with an electrical signal to stimulate the sacral nerves, and thereby restore or control bodily functions affected by pelvic floor disorders. Several techniques of electrical stimulation may be used, including stimulation of nerve bundles within the sacrum.
[0004] Chronic implantation of a pulse generator and lead for sacral nerve stimulation is typically preceded by a trial period. The trial period ordinarily has a prescribed maximum duration, but sometimes is exceeded by the patient or the physician. During the trial period, a clinician evaluates the efficacy of sacral nerve stimulation in alleviating the patient's disorder to determine whether the patient is a good candidate for chronic implantation.
[0005] The trial period ordinarily involves implantation of a temporary or chronic lead, and percutaneous connection of the lead to an external trial stimulator. Often, connection of the lead to the trial stimulator involves extensive subcutaneous tunneling of the lead to a percutaneous exit site. In addition, the percutaneous connection presents a significant risk of infection. Indeed, to reduce infection risk, the lead is ordinarily tunneled away from the site selected for chronic implant, requiring added time and effort by the surgeon.
[0006] U.S. Published Patent Application No. 20020147485 to Mamo et al. describes minimally invasive implantation of a sacral stimulation lead for percutaneous connection to a trial stimulator or subcutaneous connection to a chronic implantable stimulator. U.S. Published Patent Application No. 20020055761 to Mann et al. describes subcutaneous tunneling of a lead to a percutaneous exit site for connection to a trial stimulator. U.S. Pat. No. 6,360,750 to Gerber et al. describes the connection of an implanted sacral nerve lead to a test stimulator for use in screening a patient for implantation of a chronic stimulator. Table 1 below lists documents that disclose trial neurostimulation systems.
[0007] All documents listed in Table 1 above are hereby incorporated by reference herein in their respective entireties. As those of ordinary skill in the art will appreciate readily upon reading the Summary of the Invention, Detailed Description of the Preferred Embodiments and Claims set forth below, many of the devices and methods disclosed in the patents of Table 1 may be modified advantageously by using the techniques of the present invention.
[0008] The present invention is directed to an implantable trial neurostimulation device. The invention has certain objects. That is, various embodiments of the present invention provide solutions to one or more problems existing in the prior art with respect to the trial neurostimulation for evaluation of efficacy and patient acceptance of neurostimulation.
[0009] Such problems include, for example, the time and effort involved in implantation, tunneling and percutaneous connection of nerve leads to external trial stimulators. In addition, the problems include the risk of infection posed by the percutaneous interconnection. Another problem concerns the inconvenience and discomfort presented by a percutaneous connection, and the need to carry an external trial stimulator during the course of the patient's daily routine during a trial neurostimulation period. A further problem pertains to the ability of the patient or physician to prolong the trial neurostimulation period for an extended period of time.
[0010] Various embodiments of the present invention have the object of solving at least one of the foregoing problems. For example, it is an object of the present invention to reduce the amount of time and effort required for connection of a nerve lead and a trial stimulator. It is a further object of the invention to reduce infection risks during the trial neurostimulation period. Another object is to eliminate the need for the patient to carry an external trial stimulator during the trial neurostimulation period. An additional object is to more effectively control the maximum duration of the trial neurostimulation period.
[0011] Various embodiments of the invention may possess one or more features capable of fulfilling the above objects. In general, the invention provides an implantable trial neurostimulator. The neurostimulator may include one or more leads positioned to stimulate sacral nerves, pudendal nerves, perineal nerves, or other areas of the nervous system. In accordance with the invention, the implantable trial neurostimulator is equipped with limited battery resources. The limited battery resources are designed to last for a finite period of time, thereby preventing a patient or physician from prolonging the trial neurostimulation period. For example, the implantable trial neurostimulator may be designed to stop functioning after a number of days, weeks, or months, either upon exhaustion of the battery resources or expiration of a timer. The limited battery resources may be realized by a small, commercially available battery that affords opportunities for reduction in the size of the implantable trial neurostimulator relative to the size of an implantable chronic neurostimulator. The trial neurostimulator may be temporarily implanted in a subdural pocket in which the chronic stimulator is ultimately implanted.
[0012] In comparison to known implementations of trial neurostimulators, various embodiments of the present invention may provide one or more of advantages. For example, the trial neurostimulator is implanted and need not be carried by the patient, offering convenience and comfort. As a further advantage, implantation of the trial neurostimulator in the chronic implant site reduces the amount of lead tunneling that must be performed by the surgeon, as the chronic implant site typically will be disposed relatively close to the nerve stimulation site. Also, the implantable trial neurostimulator eliminates the need for a percutaneous connection, and thereby reduces the risk of infection to the patient during the trial period. As another advantage, the limited battery resources provided in the implantable trial neurostimulator are designed to last for a finite period of time, thereby preventing a patient or physician from prolonging the trial neurostimulation period. Further, the absence of a percutaneous connection makes the trial neurostimulator easier to tolerate, and presents a reduced infection risk, permitting trial periods to run for extended period of times.
[0013] The above summary of the present invention is not intended to describe each embodiment or every embodiment of the present invention or each and every feature of the invention. Advantages and attainments, together with a more complete understanding of the invention, will become apparent and appreciated by referring to the following detailed description and claims taken in conjunction with the accompanying drawings.
[0014] The details of one or more embodiments of the invention are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the invention will be apparent from the description and drawings, and from the claims.
[0015]FIG. 1 is a diagram illustrating implantation of a nerve stimulation lead.
[0016]FIG. 2 is a diagram illustrating an implantable trial neurostimulation system for evaluation of nerve stimulation.
[0017]FIG. 3 is a block diagram illustrating various components of an implantable trial neurostimulation device.
[0018]FIG. 4 is a block diagram illustrating various components of another implantable trial neurostimulation device.
[0019]FIG. 5 is a block diagram illustrating various components of a patient programmer for use with the implantable trial neurostimulation system of FIG. 2.
[0020]FIG. 6 is a block diagram illustrating various components of another patient programmer for use with the implantable trial neurostimulation system of FIG. 2.
[0021]FIG. 7 is a diagram of an implantable trial neurostimulation device with a small battery as a power source.
[0022]FIG. 8 is a diagram of an implantable trial neurostimulation device with a transcutaneous receiver coil interface for power delivery.
[0023]FIG. 9 is a flow diagram illustrating implantation and use of an implantable trial neurostimulator system.
[0024]FIG. 1 is a diagram illustrating implantation of a nerve stimulation lead 10 for use in a trial neurostimulation period to evaluate efficacy and patient acceptance of sacral nerve stimulation. In the example of FIG. 1, lead 10 is inserted into body 12 of a patient, and implanted into one of dorsal foramen 14 of sacrum 16. However, lead 10 alternatively may be positioned to stimulate pudendal nerves, perineal nerves, or other areas of the nervous system. As further alternatives, lead 10 may be positioned for temporary spinal cord stimulation for the treatment of pain, or for gastric stimulation for the treatment of gastric mobility disorders and obesity. Sacral nerve stimulation will be described herein for purposes of illustration.
[0025] Lead 10 may be implanted via a needle stylet for minimal invasiveness. Positioning of lead 10 may be aided by imaging techniques, such as fluoroscopy. The effect of different electrodes carried by lead 10 on sacral nerves 18 may be tested with a test stimulator before selecting a final lead depth. Lead 10 can be implanted for a variety a purposes such as to treat pelvic floor disorders. In some embodiments, a plurality of stimulation leads may be provided. As will be described, lead 10 is coupled to an implantable trial neurostimulator either directly or via a lead extension. In either case, there is no need for a percutaneous connection between lead 10 and the trial neurostimulator.
[0026]FIG. 2 is a diagram illustrating an implantable trial neurostimulation system 21 for evaluation of sacral nerve stimulation via lead 10. Trial neurostimulation system 21 alternatively may be used as a cost-effective means to evaluate neurostimulation for new indications, or indications that require only short term, temporary neurostimulation, e.g., post-operative retention or post-operative pain.
[0027] Trial neurostimulation system 21 delivers neurostimulation to the sacral nerves or other regions of the nervous system known to treat pelvic floor disorders urinary control disorders, fecal control disorders, interstitial cystitis, sexual dysfunction, and pelvic pain. As shown in FIG. 2, system 21 includes lead 10 and an implantable trial neurostimulator 24.
[0028] Trial neurostimulator 24 includes an implantable pulse generator, and delivers neurostimulation therapy to patient 12 in the form of electrical pulses generated by the implantable pulse generator. In the example of FIG. 2, trial neurostimulator 24 is implanted in the upper left buttock of patient 12, but may be implanted at other locations.
[0029] A proximal end of stimulation lead 10 is coupled to a connector block 26 associated with trial neurostimulator 24. In the example of FIG. 2, lead 10 is coupled to connector block 26 via a lead extension 28 and connector 30. Trial neurostimulator 24 can be implanted within the same subdural pocket 31 that serves as the implant site for a chronic neurostimulator following the trial period.
[0030] The implant site for trial neurostimulator 24 may serve to avoid the excessive subcutaneous tunneling otherwise required for percutaneous connection to an external trial neurostimulator. In addition, implantable neurostimulator 24 eliminates the need for any percutaneous connection, reducing the risk of infection and affording greater convenience and comfort to the patient. Further, the absence of a percutaneous connection makes the trial neurostimulator easier to tolerate, and presents a reduced infection risk, permitting trial periods to run for extended period of times. Accordingly, the trial period may run for days, weeks or even months, in view of heightened patient tolerance. As examples, the trial period may be less than one month or, in some cases, less than six months.
[0031] Notably, as shown in FIG. 2, trial neurostimulator 24 may be significantly smaller than the chronic neurostimulator, indicated by reference numeral 32. In particular, in view of its limited use in the trial period, trial neurostimulator 24 can be equipped with a much smaller and lower capacity battery than chronic neurostimulator 32. In addition, the limited usage of trial neurostimulator 24 may permit the use of less expensive batteries, including commercial available coin cell batteries and the like.
[0032] Lead 10 carries one or more stimulation electrodes to permit delivery of electrical stimulation to sacral nerves. For example, implantable trial neurostimulation system 21 may stimulate organs involved in urinary, fecal or sexual function via C-fibers or sacral nerves at the second, third, and fourth sacral nerve positions, commonly referred to as S2, S3, and S4, respectively. Also, in some embodiments, lead 10 may carry one or more sense electrodes to permit trial neurostimulation device 24 to sense electrical signals within sacrum 16.
[0033] Accordingly, lead 10 includes an outer lead body that contains one or more conductors to electrically couple the electrodes to terminals within connector block 26. In some embodiments, trial neurostimulator 24 may be coupled to two or more leads deployed at different positions relative to the spinal cord or sacral nerves.
[0034] As further shown in FIG. 2, implantable trial neurostimulation system 21 also may include a clinician programmer 34 and a patient programmer 36. Clinician programmer 34 may be a handheld computing device that permits a clinician to program neurostimulation therapy for patient 12, e.g., using input keys and a display. For example, using clinician programmer 34, the clinician may specify neurostimulation parameters for use in delivery of neurostimulation therapy.
[0035] Clinician programmer 34 supports radio frequency telemetry with trial neurostimulator 24 to download neurostimulation parameters and, optionally, upload operational or physiological data stored by trial neurostimulator. In this manner, the clinician may periodically interrogate trial neurostimulator 24 to evaluate efficacy and, if necessary, modifies the stimulation parameters.
[0036] Like clinician programmer 34, patient programmer 36 may be a handheld computing device. Patient programmer 36 may also include a display and input keys to allow patient 12 to interact with patient programmer 36 and implantable trial neurostimulator 24. In this manner, patient programmer 36 provides patient 12 with an interface for control of neurostimulation therapy by neurostimulator 24.
[0037] For example, patient 12 may use patient programmer 36 to start, stop or adjust neurostimulation therapy during the trial period. In particular, patient programmer 36 may permit patient 12 to adjust stimulation parameters such as duration, amplitude, pulse width and pulse rate, within an adjustment range specified by the clinician via clinician programmer 34.
[0038] Trial neurostimulator 24, clinician programmer 34 and patient programmer 36 may communicate via wireless communication, as shown in FIG. 1. Clinician programmer 34 and patient programmer 36 may, for example, communicate via wireless communication with trial neurostimulator 12 using RF telemetry techniques known in the art. Clinician programmer 34 and patient programmer 36 also may communicate with each other using any of a variety of local wireless communication techniques, such as RF communication according to the 802.11 or Bluetooth specification sets, or other standard or proprietary telemetry protocols.
[0039]FIG. 3 is a block diagram illustrating various components of an implantable trial neurostimulator 24 a. As shown in FIG. 2, device 12 delivers neurostimulation therapy via electrodes 37A, 37B, 37C, 37D of lead 10 (collectively "electrodes 37"). Electrodes 37 may be ring electrodes. The configuration, type and number of electrodes 37 illustrated in FIG. 2 are merely exemplary. Electrodes 37 are electrically coupled to a therapy delivery circuit 36 via lead 14.
[0040] Therapy delivery circuit 36 may, for example, include an implantable pulse generator coupled to a power supply 38 that generates stimulation energy from power delivered by a short-term battery 40. The implantable pulse generator within therapy delivery circuit 36 delivers electrical pulses to patient 12 via at least some of electrodes 37 under the control of a processor 42. In general, therapy delivery circuit 36 may deliver neurostimulation pulses with an amplitude in the range of approximately 1 to 10 volts, at a frequency in the range of approximately 5 to 150 Hz, for a duration of approximately 1 to 5 minutes, or continuously in some cases.
[0041] Processor 42 controls the implantable pulse generator within therapy delivery circuit 36 to deliver neurostimulation therapy according to selected stimulation parameters. Specifically, processor 42 controls therapy delivery circuit 36 to deliver electrical pulses with selected amplitudes, pulse widths, and rates specified by the programs. In addition, processor 42 also controls therapy delivery circuit 36 to deliver the neurostimulation pulses via selected subsets of electrodes 37 with selected polarities.
[0042] Processor 42 may control therapy delivery circuit 36 to deliver each pulse according to a different program, thereby interleaving programs to simultaneously treat different symptoms or provide a combined therapeutic effect. For example, in addition to treatment of urinary incontinence, trial neurostimulator 24A may be configured to deliver neurostimulation therapy to treat pain. Processor 42 may include a microprocessor, a controller, a DSP, an ASIC, an FPGA, discrete logic circuitry, or the like.
[0043] Trial neurostimulator 24A also includes a memory 30. In some embodiments, memory 46 stores multiple sets of stimulation parameters that are available to be selected by patient 12 for delivery of neurostimulation therapy. For example, memory 30 may store stimulation parameters transmitted by clinician programmer 21. Memory 30 also stores program instructions that, when executed by processor 28, cause device 12 to deliver neurostimulation therapy.
[0044] Memory 30 may include any volatile, non-volatile, magnetic, optical, or electrical media, such as a RAM, ROM, CD-ROM, hard disk, removable magnetic disk, memory cards or sticks, NVRAM, EEPROM, flash memory, and the like. Accordingly, the invention also contemplates computer-readable media storing instructions to cause processor 42 to provide the functionality described herein.
[0045] A telemetry circuit 44 supports wireless communication between device 12, clinician programmer 34, and patient programmer 36. In addition, in some embodiments, trial neurostimulator 24A may optionally include a timer 48. Timer 48 may serve to time the duration of the trial period. For example, upon initiation of the trial period, timer 48 starts running to track the elapsed time in the trial period relative to a maximum trial period time. In some embodiments, when timer 48 expires, processor 42 responds by disabling therapy delivery circuit 36. In other words, processor 42 stops the trial period by stopping delivery of neurostimulation therapy to patient 12 by trial neurostimulator 24A.
[0046] In this manner, implantable trial neurostimulator 24A can be configured to prevent patient 12 or a physician from prolonging the trial period beyond a prescribed period of time. Rather, implantable trial neurostimulator 24A has a finite period of operation, determined by a maximum trial period that may be specified at the factory or in a programmable manner by a physician. Timer 48 may be implemented in hardware using a real-time clock, in software by processor 42, or a combination thereof. Accordingly, timer 48 is illustrated as a separate component in FIG. 3 merely for exemplary purposes.
[0047] As an alternative to the use of timer 48, short-term battery 40 of implantable trial neurostimulator 24A may be selected based on the amount of battery resources available from the battery relative to the desired length of the trial period. In other words, short-term battery 40 may be selected with the explicit intention that it will only last for a short period of time commensurate with the trial period.
[0048] Short-term battery 40 is selected such that the battery is exhausted below a usable level within a predetermined trial period of time. If the desired trial period in one week, for example, short-term battery 40 is selected to last only approximately one week before power is exhausted, given a known range of rate of power consumption by implantable trial neurostimulator 24A.
[0049] When short-term battery 40 is exhausted, trial neurostimulator 24 stops functioning, and the trial period is therefore over. Accordingly, differently sized batteries can be selected for different desired trial periods. The use of a short-term battery 40 serves an objective that is essentially the opposite of batteries ordinarily used in implantable neurostimulators, i.e., the short-term battery ensures short life span for trial neurostimulator 24A rather than neurostimulator longevity.
[0050] As examples of short-term batteries, trial neurostimulator 24A may incorporate a variety of commercially available batteries such as lithium, NiCad, Nickel-metal-hydride or other batteries ordinarily used in watches, cameras and the like. In some embodiments, short-term battery 40 may take the form of a coin cell battery that reduces the size and profile of trial neurostimulator 24A relative to typical chronic neurostimulators. Short-term battery 40 may be selected to deliver power in the range of approximately 30 to 200 milliamp-hours (mAh). Again, the precise power range will depend on the desired length of the trial period in view of known power consumption requirements of trial neurostimulator 24A.
[0051]FIG. 4 is a block diagram illustrating various components of another implantable trial neurostimuiator 24B. Trial neurostimulator 24B conforms substantially to trial neurostimulator 24A, but incorporates a transcutaneous receiver coil 50 instead of a battery 40. Transcutaneous receiver coil 50 is implanted with trial neurostimulator 24B and transduces electromagnetic energy receive from an external coil into power for power supply 38. In this embodiment, trial neurostimulator 24B does not rely on limited battery resources to control the duration of the trial period. Instead, trial neurostimulator 24B receives power via transcutaneous receiver coil 50 and controls the duration of the trial period in response to timer 48.
[0052]FIG. 5 is a block diagram illustrating various components of a patient programmer 36A for use with the implantable trial neurostimulation system 21 of FIG. 2. As shown in FIG. 5, patient programmer 36A includes a processor 52, a user interface 54, and a telemetry circuit 56 for communication with telemetry circuit 44 of either of trial neurostimulators 24A, 24B. Patient programmer 36A also includes memory 58 to store parameters, settings and instructions, and optionally a timer 60. Timer 60 may be implemented in hardware or software, and may operate as a programmable feature of processor 52.
[0053] Patient programmer 36A responds to user input entered via user interface 54 to adjust stimulation parameters, settings, and the like. In addition, patient programmer 36A may interrogate trial neurostimulator 24 to obtain parameters, settings, and other operational data. For example, patient programmer 36A may be used to initially program trial neurostimulator 24 for the trial period, and to upload parameters, settings, and other operational data from trial neurostimulator 24 upon expiration of the trial period. During the course of the trial period, trial neurostimulator 24 may store a variety of information concerning adjustments made by the user, usage profiles and the like.
[0054] Notably, patient programmer 36A is physically decoupled from trial neurostimulator 24 in the sense that the trial neurostimulator is implanted and the patient programmer is external to patient 12. In addition, in some embodiments, patient programmer 36A may be the same patient programmer used with the chronic neurostimulator that is implanted following the trial period. Accordingly, patient programmer 36A may upload applicable parameters, settings, and operational information from trial neurostimulator 24 at the end of the trial period, and then download that information directly to the chronic neurostimulator, providing significant convenience to the physician.
[0055] Patient programmer 36A may operate with a rechargeable or replaceable battery (not shown). In the example of FIG. 5, it is assumed that trial neurostimulator 24 includes its own battery. In other embodiments, as described herein, patient programmer 36A may deliver power to trial neurostimulator 24 transcutaneously. In addition, rather than download operational parameters and settings to trial neurostimulator 24 for substantially independent operation by the neurostimulator, patient programmer 36A may dynamically control the operation of the trial neurostimulator by continuous communication with the trial neurostimulator via telemetry circuit 44.
[0056] In addition, in some embodiments, patient programmer 36A, rather than trial neurostimulator 24, may control the end of the trial period. For example, processor 52 may be responsive to expiration of a period of time, as indicated by timer 60. In this case, processor 52 transmits a signal to implanted trial neurostimulator 24 instructing the neurostimulator to cease operation. In some embodiments, it may be possible to pay a fee to reactivate trial neurostimulator 24 for a limited period of time. To avoid prolonged use, however, it is generally desirable to disable neurostimulator 24 after a finite period of time.
[0057] Alternatively, processor 52 may terminate communication with trial neurostimulator 24, in which case the trial neurostimulator terminates operation. Accordingly, termination of the trial period may be initiated within trial neurostimulator 24 or within patient programmer 36A, and may be accomplished in a variety of ways.
[0058]FIG. 6 is a block diagram illustrating various components of another patient programmer 36B for use with the implantable trial neurostimulation system 21 of FIG. 2. Patient programmer 36B conforms substantially to patient programmer 36A of FIG. 5. However, patient programmer 36B further includes a transcutaneous transmitter coil 62 to deliver electromagnetic energy to transcutaneous receiver coil 50 of trial neurostimulator 24B for transformation into operating power.
[0059] Accordingly, patient programmer 36B is worn by the patient. Patient programmer 36B, or at least transcutaneous transmitter coil 62, is positioned adjacent trial neurostimulator 24 to provide effective electromagnetic coupling between the transcutaneous transmitter coil and transcutaneous receiver coil 50. In the example of FIG. 6, termination of the trial period can be made by simply terminating the supply of power from transcutaneous transmitter coil 62 and transcutaneous receiver coil 50.
[0060]FIG. 7 is a diagram of an implantable trial neurostimulator 24A with a small, short-term battery 40 as a power source. In the example of FIG. 7, battery 40 is depicted as a coin cell battery, although other batter configurations may be used. In general, battery 40 may be small, inexpensive, and have a substantially reduced power capacity and longevity relative to batteries used in chronic neurostimulators.
[0061]FIG. 7 also depicts patient programmer 36A. As shown in FIG. 7, patient programmer 24A may include buttons 66, 68 to increase and decrease stimulation settings, respectively. In addition, patient programmer 36A includes a display 64, and navigational buttons 70 to permit navigation and selection of control options presented via the display. Buttons 66, 68, 70 and display 64 form part of user interface 54. In some case, display 64 may present information advising patient 12 that expiration of the trial period is approaching.
[0062]FIG. 8 is a diagram of an implantable trial neurostimulator 24B with a transcutaneous receiver coil 50 for power delivery. In particular, trial neurostimulator 36B includes a transcutaneous receiver coil 50, which either resides within or extends from a housing associated with the trial neurostimulator. Transcutaneous receiver coil 50 receives electromagnetic energy from transcutaneous transmitter coil 62, which may be integrated with patient programmer 36B or extend from a cable 72, as shown in FIG. 8. With the exception of transcutaneous transmitter coil 62, patient programmer 36B may otherwise conform to patient programmer 36A of FIG. 7.
[0063]FIG. 9 is a flow diagram illustrating implantation and use of an implantable trial neurostimulator system 21 in accordance with the invention. As shown in FIG. 9, a sacral stimulation lead 10 is first implanted (74), e.g., as shown in FIG. 1. Lead 10 may be chronic or temporary. With trial neurostimulator 24 implanted in the chronic implant site, however, it may be desirable to use the chronic lead and thereby avoid the need to withdraw a temporary lead and replace it with the chronic lead.
[0064] Upon creation of a subdural pocket (76), the trial neurostimulator is placed in the subdural pocket for implantation (78). The chronic lead is subcutaneously tunneled through the body of patient 12 to the subdural pocket (80). As shown in FIG. 2, for example, the lead may extend from sacrum 16 to a subdural pocket 31 in the upper left buttock area of patient 12.
[0065] When lead 10 is tunneled to subdural pocket 31, the lead is connected to trial neurostimulator 24 either directly or via a lead extension and connector. Before connecting lead 10 to trial neurostimulator 24, and tunneling the lead, a test stimulator may be connected to the lead to deliver neurostimulation for assistance in determining lead placement, lead depth and electrode selection.
[0066] Once the subdural pocket 31 is sealed, the trial neurostimulator 24 is activated for use in the trial period (82). Patient 12 thereafter goes about his daily routine, and may control trial neurostimulator 24 via patient programmer 36. When the trial is complete (84), e.g., as evidenced by expiration of a timer within trial neurostimulator 24 or patient programmer 36, or exhaustion of battery resources within the trial neurostimulator, the trial neurostimulator ceases operation.
[0067] Patient programmer 36, or physician programmer 34, then may upload from trial neurostimulator 24 a set of neurostimulator parameters, settings, operational information or the like either pre-programmed or accumulated during the course of the trial period (86). The information can be uploaded to patient programmer 36 either pre- or post-explant of trial neurostimulator 24.
[0068] If the results of the trial period are favorable, the physician replaces trial neurostimulator 24 with a chronic neurostimulator (88). In particular, the chronic neurostimulator may be placed in the same subdural pocket previously occupied by trial neurostimulator 24. In addition, the chronic neurostimulator can be connected to the proximal end of the chronic lead already residing within the subdural pocket.
[0069] Before or following implantation of the chronic neurostimulator, patient programmer 36 or physician programmer 34 downloads at least some of the parameters, settings, and other operational information uploaded from trial neurostimulator 24 (90). In this manner, patient programmer 36 or physician programmer 34 can be used to quickly and conveniently program the chronic neurostimulator based on the results of the trial period. This feature can greatly simplify programming of the chronic neurostimulator following the trial period.
[0070] The preceding specific embodiments are illustrative of the practice of the invention. It is to be understood, therefore, that other expedients known to those skilled in the art or disclosed herein may be employed without departing from the invention or the scope of the claims. For example, the present invention further includes within its scope methods of making and using systems for neurostimulation, as described herein.
[0071] In the claims, means-plus-function clauses are intended to cover the structures described herein as performing the recited function and not only structural equivalents but also equivalent structures. Thus, although a nail and a screw may not be structural equivalents in that a nail employs a cylindrical surface to secure wooden parts together, whereas a screw employs a helical surface, in the environment of fastening wooden parts a nail and a screw are equivalent structures.
[0072] Many embodiments of the invention have been described. Various modifications may be made without departing from the scope of the claims. These and other embodiments are within the scope of the following claims.
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* Bankruptcy Call for a free consultation
* Social Security Disability
* Debt Settlement
* Civil Litigation Defense
* Tax Law and Return Preparation
* Wills and Trusts
We are a client-centered law firm committed to helping individuals find relief to financial difficulties through bankruptcy, debt settlement, civil litigation defense, Social Security Disability representation, and Tax. We also help protect your assets with Wills and Trusts. We work diligently to meet your needs. Our goal is to treat each client how we want to be treated.
We offer reasonable bankruptcy fees starting at $1000 and flexible payment options to suit your needs. Our sliding scale fees are based on your income and household size. Additionally, we offer harship fees of $750 for those living on a fixed income (ex. Social Security, Disability, Retirement, etc.)
Fees for other services range from $250 and up depending on the service. We are always flexible and willing to work with you and your budget.
Initial consultations free.
Esha N. August 6, 2014
Jeff H. March 26, 2014
"La Juan was professional, available when I needed to speak to her, and gave me a great price for the bankruptcy action."
Alexandria W. March 25, 2014
"Thank you so much! LaJuan was a great attorney, very helpful, and understanding of my financial issues. I would definetly reccomend using her! Thank you again! "
Thomas T. December 23, 2013
LaJuan, was great to work with. She quickly answered all of the myraid questions I had during this stressful process. My BK was discharged and everything went off without a hitch. She's great and I wouldn't hesitate to work with her again or recommend her to my friends should they ever need her services
Hope E. November 25, 2013
"LaJuan and her staff were both professional and understanding of my needs. She made sure to stay in constant contact with me and kept me informed each step of the way. I have already recommended family and friends to her, and will continue to."
Aaron K. July 13, 2013
I'm glad that I went with La Juan for my bankruptcy, whenever I had a question she would answer them herself instead of referring me to a lackey. With that being said I hope I never have to use her services again, but if I do, she will be the first one I call.
Jennifer J. September 12, 2012
I was referred to La Juan Wood's practice and it made all the difference in the world. I was being sued and needed help fast. Ms Wood's was professional and explained the process to set me at ease. She did everything she promised and the outcome was in my favor. Her price was very reasonable and I was more than happy to pay it to have this issue go away. I highly recommend La Juan Woods for your legal needs!!!
Martha H. September 11, 2012
The Law Office of LaJuan E. Wood was the best thing that could happen to me when I was dealing with a stressful situation (Bankruptcy). They were compassionate, and understanding to my needs. In addition, anytime I had questions they were quick to answer with knowledge and, in a nonjudgmental matter. I will highly recommend anyone who is going through a hard situation such as Bankruptcy to go to the offices of LaJuan E. Wood.
Irene Aug 27, 2012
The experience that I had with Attorney Wood was a bankruptcy. The services that were rendered were exceptional and thorough. Going through a bankruptcy was not easy, and I was very frightened doing something that I had never done before. Attorney Wood made the process smooth, and her professionalism really put my mind at ease, alleviating the stressful situation. The length of the entire process was much faster than I ever imagined. I met with her in March, and we were at the federal court house in June. I was impressed!! Attorney Wood is very kind and took the time to answer all of my many questions without hesitation. There is nothing I can say that could improve her service. Attorney Wood is an expert on bankruptcy, and was there for me. She earned my respect during the entire process. I would recommend her to anyone going through a financial crises. Her price is very fair especially for the work and preciseness of a bankruptcy situation. I was very pleased and happy with her work and I wish her all the best in her career. Thanks again and again because I am less stressed, I can sleep at night, and I am finally debt free all because of the wisdom and guidance of Attorney Wood!!
Elza Jan 10, 2012
If you prefer an attorney who will guide you through your Chapter 7 (or Chapter 13) bankrupty with the utmost respect, honesty, professionalism, and courtesy, I would highly recommend the Law Offices of LaJuan E. Wood. Ms. Wood enthusiastically accepted my case when other "well-known" Sacramento bankruptcy attorneys wouldn't. Ms. Wood provided exceptional guidance and assistance throughout my (sometimes) stressful bankruptcy process. Ms. Wood was always positive and assured me that "everything was going to be okay." She consistently returned my phone calls and answered all my questions (and believe me, I had alot of them). My Chapter 7 bankrupty was sucessfully discharged in December 2011. My heart-felt thanks go to Ms. Wood. She definitely changed my opinion about attorneys. So...if you're in need of an attorney, look no further and don't call anyone else in Sacramento...except the Law Offices of LaJuan E. Wood.


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Marina Del Mar Resort and Marina - Key Largo
527 Caribbean Drive - Key Largo1-877-662-6988
Book a room at this family-friendly Key Largo hotel and you won't be disappointed! Marina Del Mar Resort and Marina is on the waterfront, offers free breakfast, an outdoor pool and a restaurant with garden views.
This hotel has its own restaurant serving breakfast, lunch and dinner where you will find a selection of items to try. If you want low-key dining options, you will be pleased to find barbecue grills and a picnic area. If you are visiting United States of America for business or on vacation, make sure to take some time to relax as you will find a spa tub and a fitness center on offer.
The lobby is home to complimentary newspapers, a TV and a safe. Reception is open during limited hours only. Guests can make use of the free Wi-Fi. Planning a meeting? This hotel has 3 meeting rooms, as well as a business center. Other amenities include gift shops/newsstands, ATM/banking, an elevator (lift), laundry facilities and a computer station.
Very difficult to find, but the area is so beautiful. Helpful staff, nice rooms an...Venere Guest, France
These reviews have been left by customers who actually stayed at this hotel
Check Availability at Marina Del Mar Resort and Marina
Breakfast at Marina Del Mar Resort and Marina
A free continental breakfast is available between 7 AM and 9:30 AM.
Facilities at Marina Del Mar Resort and Marina
- Business Center
- Meeting Room
- Lift/elevator
- Gift shop
- Pets accepted
- Entire property is non-smoking
- Laundry room
- Gym
- Tennis court
- Outdoor swimming pool
- Multilingual staff
- Newspapers
- Front desk - safety deposit box
- Restaurant/Dining
- Barbecue
- Internet/Email services
- TV Lounge
- Hydromassage Jacuzzi
- Free parking
Know before you go
- Children 17 years old and younger stay free when occupying the parent or guardian's room, using existing bedding.
Check-in: between 3 PM and 10 PM.
Check-out: before 11 AM.
Please contact the property ahead of time if you are planning to arrive after 10 PM.
PolicyExtra-person charges may apply and vary depending on hotel policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
City tax and/or any other fees charged by the hotel
The following fees and deposits are charged by the property at time of service, check-in, or check-out.
- Pet fee: USD 50 per pet, per stay
- Rollaway bed fee: USD 20 per day
The above list may not be comprehensive. Fees and deposits may not include tax and are subject to change.
Marina Del Mar Resort and Marina is also known as
Marina Del Mar Resort And Marina Key Largo
Marina Del Mar Resort And Marina Key Largo Hotel
Marina Del Mar Resort And Marina Key Largo Hotel Key Largo
Marina Del Mar Resort and Marina reviews
- August 2012
- Venere Guest
- Family with older children
- France
Very difficult to find, but the area is so beautiful. Helpful staff, nice rooms and very good breakfast. Lovely pool too.
- May 2012
- Venere Guest
- Couple
- France
very nice location along the marina canal. Not enough tables and seats for breakfast.
- August 2013
- Venere Guest
- Family with older children
- Netherlands
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- April 2014
- Venere Guest
- Not Specified
- Italy
- July 2014
- Venere Guest
- Family with older children
- France
- April 2014
- Venere Guest
- Family with young children
- Germany
- June 2013
- Venere Guest
- Family with older children
- Germany
Marina Del Mar Resort and Marina reviews by TripAdvisor
Room Details
Marina Del Mar Resort and Marina offers 76 guest rooms for your family-friendly holiday. Guests can unwind at the end of a long day and enjoy 32-inch TVs with cable channels. Business travelers will have access to phones during their Key Largo visit.
Partially open bathrooms are outfitted with shower/tub combinations and complimentary toiletries. Refrigerators, irons/ironing boards, coffee/tea makers and hair dryers are supplied in each room to facilitate basic travel needs. Rooms also include air conditioning and ceiling fans.
Accommodation Services
- Telephone
- Air conditioning
- Mini fridge
- Extra beds
- Coffee and tea maker
- Baby cots/cribs available
- Hairdryer in each room
- In-room ironing facilities
- Cable TV
- Fan
Distances from Marina Del Mar Resort and MarinaDolphins Plus - 1.3 km / 0.8 mi
John Pennekamp Coral Reef State Park - 3.2 km / 2 mi
Dolphins Plus Bayside - 3.2 km / 2 mi
Bluefin Rock Harbor Marina - 3.4 km / 2.1 mi
MarineLab Undersea Laboratory - 5.7 km / 3.5 mi
Florida Keys Wild Bird Rehabilitation Center - 9.7 km / 6.1 mi
Florida Keys Wild Bird Center - 9.7 km / 6.1 mi
Harry Harris Park - 9.9 km / 6.1 mi
Christ of the Deep - 10.6 km / 6.6 mi
Founders Park - 20.1 km / 12.5 mi
Windley Key Fossil Reef Geological State Park - 22.9 km / 14.2 mi
Theater of the Sea on Islamorada - 23.4 km / 14.5 mi
History of Diving Museum - 26 km / 16.2 mi
Hurricane Monument - 28.7 km / 17.8 mi
Bud n' Mary's Dive Center - 31.3 km / 19.4 mi
The preferred airport for Marina Del Mar Resort and Marina is Miami, FL (MIA-Miami Intl.) - 79.4 km / 49.4 mi.
Distances are calculated in a straight line from the property's location to the point of interest or airport and may not reflect actual travel distance.
Distances are displayed to the nearest 0.1 km and mile.
Transportation services Marina Del Mar Resort and Marina
- Free parking
We have the accommodation you need, all over the world
- • Sheraton Laval Hotel - Montreal, Canada
- • Playacartaya Spa Hotel - Cartaya, Spain
- • Capsis Hotel Thessaloniki - Thessaloniki, Greece
- • Resort Moon Palace - Cancun, Mexico
- • Hellerup Parkhotel - Copenhagen, Denmark
- • Hotel Douro Inn - Tabuaço, Portugal
- • Comfort Inn Bellingham - Bellingham, USA
- • Svanfolk B&B - Aalborg, Denmark
- • Roslyn Apartments - Dunedin, New Zealand
- • Shibuya Excel Hotel Tokyu - Tokyo, Japan
- • Hotel King - Rome, Italy
- • Vasilias Nikoklis Inn - Paphos, Cyprus
- • Moorgarth Guest House - York, United Kingdom
- • Hotel Romanico Palace - Rome, Italy
- • Porto Perissa Hotel - Megalohori, Greece
- • Ebene Hotels, Mauritius
- • Nagercoil Hotels, India
- • Hanau Hotels, Germany
- • Nilgiri Hills Hotels, India
- • Bad Nauheim Hotels, Germany
- • Raunheim Hotels, Germany
- • Sulzbach Hotels, Germany
- • Eltville am Rhein Hotels, Germany
- • Royal Chitwan National Park Hotels, Nepal
- • Moncalvo Hotels, Italy
- • Wörgl Hotels, Austria
- • Ischgl Hotels, Austria
- • Küssnacht am Rigi Hotels, Switzerland
- • Kals am Großglockner Hotels, Austria
- • Prägraten am Großvenediger Hotels, Austria


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Details on Bourbon & Tunns, Palms Bistro's next incarnation
Bourbon & Tunns Tavern, the new concept for the site of Palms Bistro in the Third Ward, opens next week with an expanded bar and food with a focus on Midwestern ingredients.
The last night for the current format at the restaurant, 221 N. Broadway, is Saturday. It will close for a few days after that for the changeover. »Read Full Blog Post(2)
Discovery World closes for the day because of snow
The snow made them do it. Discovery World, 500 N. Harbor Drive, is closing at 2 p.m. today because of the weather, according to its Facebook page. They expect to be open at 9 a.m. tomorrow. Just in case, call (414) 765-9966 or see www.discoveryworld.org »Read Full Article
Someone mashed up Nine Inch Nails and Carly Rae Jepsen...and it sounds better than it should
Trent Reznor shocked fans by announcing a new collaboration with cutesy pop singer Carly Rae Jepsen. Not really; someone just mashed up their songs. But maybe they should tour together? No, no they should not. Journal Sentinel photo by Michele Jokinen. »Read Full Blog Post
Registration open for Braise's annual morel hunt
Someday spring will come, and then it will be time for the annual morel mushroom hunt organized by chef David Swanson's Braise. But you'll have to register for it now.
Registration for the event May 11 opened Tuesday morning, and it always sells out early. It's limited to 20 people. »Read Full Blog Post
Japandroids among new Milwaukee concert announcements
Canadian rock duo Japandroids, which released one of 2012's most acclaimed albums, the succinct and aggressive "Celebration Rock," is coming to Turner Hall Ballroom, 1040 N. 4th St., on May 27.
Milwaukee Music Video: See the visual treatment for Alchemy's 'Creature of Love'
The music video for glossy synthpop band Alchemy's "Creature of Love" doesn't feature unicorns, a snuggly, six-foot-tall stuffed animal or any other cutesy creatures of love. But it does have a CGI mud monster, a sickly, paranoid dude in a hoodie and the local group rocking out at Mad Planet.
"Creature of Love" is also the name of the band's latest EP, which the band celebrated with a show at Mad Planet last month. And it has another cause for celebration: after winning a battle of the bands at Marquette Friday, Alchemy will get to open for buzz band Twenty One Pilots at Weasler Auditorium April 5. »Read Full Blog Post
On Tap Today: Northern Ireland, through photos and music
"Look Behind You!" may be a more appropriate title for a slasher movie than a performance and lecture on Northern Ireland, but tonight's presentation sounds intriguing nevertheless. The event includes candid photos taken by Bobbie Hanvey and snippets of radio interviews with some of Northern Ireland's best-known figures, with Steafan Hanvey providing further context through singing.
"Look Behind You!" begins at 7 p.m. at the UWM Hefter Conference Center. »Read Full Blog Post


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Temple Of Trax
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This page has been viewed 32 times this month, and 842 times total.
Temple Of TraxTemple Of Trax (1967) Season 1 Episode 27-13- The Herculoids Cartoon Episode Guide by Dave Koch
This page has been viewed 32 times this month, and 842 times total.
- The Herculoids Cartoon Episode Guide
- Hanna-Barbera Studios
- Cartoon Characters: Zandor, Tara, Igoo, Dorno, Zok, Gloop, Tundro.
- Originally Released in 1967.
- Season: 1
- Color
- Running Time: 9 minutes.
Cartoon Summary:
The Herculoids come upon the ruins of a lost civilization. When Zandor leaves with Zok, Tara is kidnapped and the others are attacked by gargoyle statues that have come to life. Zandor returns to help The Herculoids do battle with an ancient priest who intends to sacrifice Tara to the largest gargoyle, Trax.
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Do you have anything to add to this page? Have we made any mistakes... or do you ahve any additional information about Temple Of Trax? If so, we would love to hear from you. Please send us a quick note with your additions or corrections to this page, and we will make the corrections as soon as possible!Report Errors / Submit Additional Information
Cartoon Comments:
Do you love Temple Of Trax, or do you think it is the worst cartoon ever? Let us know what you think! Surely you have an opinion... so share what you think. Take a minute and post your own comments about this cartoon here.


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Sprint NBA Mobile
500,000 - 1,000,000 downloadsAdd this app to your lists
+ By NBA Digital
Sprint NBA Mobile is now NBA Game Time from Sprint. Please visit https://play.google.com/store/apps/details?id=com.nbadigital.gametimelite to download the new application. Now available for Sprint, Boost and Virgin Mobile customers.
NBA Game Time from Sprint brings you FREE unlimited live coverage of every NBA game. Sprint customers get exclusive access to live NBA games on the Sprint TV ESPN channel and free access to NBA Game Time Plus with live radio broadcasts, game video alerts and more. All FREE with an Unlimited data plan from Sprint.
Sprint customers save 20% off NBA LEAGUE PASS Mobile for the 2012-13 season.
Tags: sprint nba mobile 20112012, sprint nba mobile 20112012 apk, nba.apk, sprint nba mobile apk, nba.tv, sprint nba mobile, nba 2012, nba mobile 2012, nba mobile .apk, nba game time 20112012 apk.
********Important Update Available Now - Sprint NBA Mobile is now NBA Game Time from Sprint.
Sprint brings you exclusive access to live NBA games on the Sprint TV ESPN channel and FREE access to NBA Game Time Plus with live home and away radio, in-game video highlights, alerts and more. All FREE with an Unlimited data plan. Only from Sprint.
Note: To uninstall Sprint NBA Mobile, go to Settings>Applications or Google Play
(67 stars)
(67 stars)
Everytime I download this app & then go to open it, it tells me a new version is avaiable. I can open from the Play Store but not from the app on my phone. Another great job by Sprint. 10 months can't go by fast enough.
(67 stars)
Kinks in software and does not detect Sprint network on brand new Galaxy note
(67 stars)
Yet another app I do not care about. PLEASE take this off of Sprint and give at lease an option if weather you want this app or not. I clearly don't. Please do something about this!!!!!!
(67 stars)
By far the best most reliable sports app. Love it
(67 stars)
Keeps saying no internet connection when I'm at full wifi. Very inconsistent. Loads score for the previous day. Uninstalled.
(67 stars)


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- FIFA adds prison labor to its arsenal
- Sitting on a scoop: the story behind the V-E headlines of May 1945
- Bilderback repeats at Speedway
- US permits Arctic drilling, but questions about safety remain
- ISIS takeover of Ramadi means hard choices face the Iraqi and US governments
- State Roundup: Democrat sponsored prevailing wage amendment passes
- Facebook's Instant Articles not a threat to media
- U of I expert: Rauner's pension fix 'unconstitutional'
- State Senate approves lesser penalties for marijuana possession
- State Roundup: Natural gas vehicle tax stalls in committee
Halloween parade, costume contest at Edgebrook Oct. 29
Staff Report
Rockford's Edgebrook shopping center will host its sixth annual Festival of Fantasy Children's Halloween parade and costume contest from 12:30 to 3:30 p.m., Saturday, Oct. 29.
Since its beginning, the festival has become a popular event that makes Halloween a kids' holiday once again. This event is free to the public. The purpose of Festival of Fantasy is to give kids control over their own creative expression and a sense of creative empowerment through that expression.
Children between the ages of infant to 12 years old are eligible. Treat bags will be handed out, while supplies last. Registration will take place on the day of the event in the Edgebrook courtyard. Parents of children eligible for the parade can get in on the fun by dressing up and marching with their children.
Dancing dragons, a children's Halloween dance, prizes, entertainment, activities and awards for best costumes will be featured. Also, one grand prize of an age- and gender-appropriate Trek 20 bicycle will be awarded to the best costume of all.
Homemade costumes are preferred, but not required. Registration is from 12:30 to 1 p.m., Dragon Mania and Parade are from 1 to 1:30 p.m., and the Costume Judging & Prizes are from 1:30 to 3:30 p.m.
Edgebrook is at 1601 N. Alpine Road and can be reached at (815) 226-0212.
From the Oct. 26-Nov. 1, 2011, issue


text:
- Article
- About the Authors
- Metrics
- Comments
- Related Content
About the Authors
- Stefanie Widder, Javier Macía, Ricard Solé
- Complex Systems Lab (ICREA-UPF), Barcelona Biomedical Research Park (PRBB-GRIB), Barcelona, Spain
- Ricard Solé
- Santa Fe Institute, Santa Fe, New Mexico, United States of America
Corresponding Author
Email: firstname.lastname@example.com
Competing Interests
The authors have declared that no competing interests exist.
Author Contributions
Conceived and designed the experiments: SW JM. Performed the experiments: SW JM. Analyzed the data: SW JM. Wrote the paper: SW JM RVS.


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MIDDLEBURY — On Monday afternoon, the booths in a back room in Proctor Dining Hall at Middlebury College were filled with couples pairing off, chatting, and switching tables.
It looked like speed dating, but the couples included Shaw's Supermarket managers with local pesto makers, and small food producers with area school foodservice coordinators. The nearly 30 people gathered in the small room were participating in the Addison County Relocalization Network's second Matchmaker event.
The full text of this article is only available to online subscribers.
Are you an online subscriber? Click to login.
Click here to learn more about our online subscription options. If you have a print subscription, click to add online access for only $10/year
MIDDLEBURY — When the official panel discussion on food and sustainable agriculture wrapped up on Oct. 14 at Middlebury College, the talking in the room was still in full swing.
MIDDLEBURY — A dairy reform bill in the U.S. House of Representatives is causing some local concerns among the very people it seeks to help.
When farmers gathered in Middlebury on Monday for the annual meeting of the Addison County Farm Bureau, all eyes were on a bill that seeks to stabilize the dairy industry and milk prices.
ADDISON COUNTY — As frost rolls in over the Champlain Valley, farmers and home gardeners in the county are beginning to take stock of what has been, for many, a disappointing growing season.
"It's been very, very, very wet," said Bill Scott, president of the Addison County Farm Bureau.
In fact, as of Sept. 30, preliminary precipitation totals from the National Weather Service this year add up to 44.2 inches in Burlington, making 2011 already the fifth wettest year on record.
FERRISBURGH — It's not a glamorous industry, but these days, the services of Vermont Livestock Slaughter and Processing in Ferrisburgh are in high demand.
"Right now, we're booking into fall of 2012," said Carl Cushing, owner and a retired state meat inspector. "We turn away about as much as we do."
VERGENNES — Nobody likes to think about the worst-case scenario, but at a forum at the Vergennes American Legion last week Julie Smith urged the 10 or so farmers in attendance to do just that.
Smith, a dairy specialist at the University of Vermont Extension, is partway through a three-year USDA-funded project aiming to educate and combat potential hazards to Vermont's food production systems, specifically dairy.
WEYBRIDGE — Deep in the field at Weybridge Gardens, the green stalks and budding tassels overhead look almost like corn. But the green abundance that forms the winding paths of the Thompson Hill Road maze isn't corn this year — it's Sudan grass.
Though sisters Kris Bowdish and Audra Ouellette are still calling this year's installation a corn maze, by the time the fields dried out from this spring's flooding it was already July.
ADDISON COUNTY — As fall rolls in, it's looking like a mixed bag for area apple orchards. In a growing season that included a wet spring, extensive flooding, hailstorms and a tropical storm, orchards took a hit.
But those in the industry said it could have been worse.
"Despite some of the losses we're looking at, it's a relatively good crop," said Steve Justis, executive director of the Vermont Tree Fruit Growers Association.
ADDISON COUNTY — As Tropical Storm Irene dropped a deluge of water across Vermont on Aug. 28, the late-season crops on Gildrien Farm's River Road property in New Haven surrendered to chest-high water from the New Haven River.
Days later, the Vermont Agency of Agriculture issued the death knell for those crops left standing: Due to food safety concerns, no crops touched by floodwaters from the storm may be sold for human consumption.
MIDDLEBURY — Mary Hogan Elementary School fifth-graders hatched them, Patricia A. Hannaford Career Center agribusiness students raised them and Middlebury College students will eat them.
Without leaving the town of Middlebury, the 203 chickens of the Chick-to-Plate project have been teachers to more than 200 students — by career center Director Lynn Coale's count — and now, will be dinner to hundreds more.
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She would have turned 20 this month, but eight years ago 12-year-old Rosa Sandoval went missing. Months later her body was found.
Now investigators have released new details in the case in hopes of catching her killer.
Rosa was reported missing on May 28, 2004.
The 6th-grade student went missing from her home in the 8700 block of Seven Seas.
At the time, she was a student at Sky Harbour Elementary.
In December 2004, 7 months after her disappearance, Rosa's remains were found in the 11000 block of Kearney Road. More remains were discovered a month later.
As another anniversary date approaches, investigators area asking for your help in solving the case.
In February, investigators said they had new information in the case. Now they are releasing new details.
Those details include a photo of a blue 1983 four-door Oldsmobile found in a junk yard.
In 2005,some timeafter her body was found, someonediscovered the photo of Rosa inside the vehicle.In the photoRosawas celebrating her birthday at home.
Investigators say sometimes people are more inclined to talk after some time has passed. If you can help detectives bring Rosa's killer to justice, you are asked to call Crime Stoppers at 210 224-stop.
As always,tips may be left anonymously.


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Dynamics PTS Workshops
Other Interesting Blogs
Important Links
Our Social Connects
Peter Joeckel, the President and Founder of TurnOnDynamics a Microsoft Dynamics GP (formerly Great Plains) and AX (formerly Axapta) partner primarily servicing the Texas, Oklahoma, Louisiana and Arkansas (TOLA) area, has posted a couple of interesting articles on reality check between Dynamics GP and NetSuite.
These are interesting articles which will be helpful for the partner community, hence I have decided to share it here.
NetSuite vs. Microsoft Dynamics GP - A Reality Checkhttps://community.dynamics.com/b/turnondynamics/archive/2013/01/09/netsuite-vs-microsoft-dynamics-gp-a-reality-check.aspx
NetSuite vs. Microsoft Dynamics GP - A Reality Check Part Twohttps://community.dynamics.com/b/turnondynamics/archive/2013/01/16/netsuite-vs-microsoft-dynamics-gp-a-reality-check-part-two.aspx
I hope this helps. Until next post!
Thank you sir. I appreciate the kind words...be on the lookout for the last three posts in the series.
Thanks Peter... Will surely check them out!


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Everton striker Romelu Lukaku remains grateful to West Bromwich Albion boss Steve Clarke.
Lukaku, on-loan at Everton from Chelsea, spent last season at the Hawthorns.
ŌĆ£I want to make defenders scared of me,ŌĆØ he told the Telegraph. ŌĆ£I study them all. Van Persie has the best movement. He always finds a yard of space for himself. I love RooneyŌĆÖs all-round game, a great No 10, Jermain DefoeŌĆÖs finishing and then DrogbaŌĆÖs hold-up play, which is still unmatched.
"Then there was Thierry Henry. He had complete authority on the pitch. When they saw him defenders said ŌĆśoh noŌĆÖ. Drogba had that as well, but Henry had a presence that meant the opposition defence was already killed before the game started, and yet off the pitch he was humble. I want to be the same.
ŌĆ£There was a changing point for me while I was at Chelsea. We lost in the League Cup in 2012 and I knew I would not play again all season. I was training with the reserves and I thought: ŌĆśDo you know what, next year I am going to make defenders afraid.ŌĆÖ
ŌĆ£I was already tough, but I had to have more self-confidence. I knew the only way to get that was by playing and scoring goals. ThatŌĆÖs why I went to West Brom [on loan] last season. Steve Clarke changed my life, showing me how the game works. Without him I could not have gone to the next level. That was why I had to leave Chelsea.ŌĆØ
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Feds seek to legalize marijuana industry banking
Grassley asked what the Justice Department plans to do to protect states like Iowa from marijuana being diverted from states like Colorado. Cole responded, "If it's being exported from Colorado to Iowa and we find out about it, we will prosecute."
With the door to legalization open in two states, others could follow.
The 20,000-member Marijuana Policy Project says it will support efforts to end marijuana prohibition in 10 more states by 2017.
In a harshly worded letter to Holder this week, nine former Drug Enforcement Administration chiefs predicted that "when marijuana will be fully legal to buy, diversion of the drug will explode."
Associated Press writers Kristen Wyatt and Colleen Slevin in Denver contributed to this report.
The Associated Press


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Phantom of the Opera (Karaoke CD)
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Phantom of the Opera (Karaoke CD) by Various Artists. By Andrew Lloyd Webber. 2 discs. Broadway. Karaoke CD. Published by Stage Stars Records (SI.RPT509).
Selections from the musical re-recorded in the original show key and show tempo. Two versions of each song are included (versions with and without guide vocals). Lyrics not included.


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The original meaning of Café/Coffee shops is a small informal place where coffee and light food is served. Traditionally coffee shops used to be parts of hotels only. But these days coffee shops in Pune are best known as second home to Punekars. Or in other words cafes in Pune is the heartthrob of young Puneites.
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Monday, April 20, 2015
Catching up with friends at coffee shops in Pune
The original meaning of Café/Coffee shops is a small informal place where coffee and light food is served. Traditionally coffee shops used to be parts of hotels only. But these days coffee shops in Pune are best known as second home to Punekars. Or in other words cafes in Pune is the heartthrob of young Puneites.
Wednesday, April 15, 2015
Kolkata Style Chicken Egg Roll | Bengali Chicken Kati Roll | Kolkata Street Food
I've admitted many times that I'm a big snacker! And I would even ditch a meal to enjoy extra snacks! There were days when I was a student on the streets of Kolkata, the ultimate destination of street food lovers and on my way back all those deliciousness on the pavements used to invite me and I never had any choices but accepting their invitations. Singara, Kochuri, Alur Dom, Khasta Kochuri, Chaat, Dahi Vada, Aloo Vada, chowmein and yes sometimes fuchka and churmur used to be part of them too as sourness has never been my forte. But when it comes to Egg Roll or Egg Chicken Roll and Mughlai Porota it is a complete different ball game. Oh boy! I've been a true lover of them, till date! And there is no shame in admitting that ignoring such a beauty for a long time is a crime. But it's better be late than never you know; so I'm (finally) penning down the recipe of Bengali style Egg Chicken Roll aka Kolkata Chicken Kati Roll.
Friday, April 10, 2015
Restaurant Review | MoMo Café | Courtyard by Marriott | Hinjewadi | Pune
Let me disclose in the very beginning of this review; I'm not a buffet person, not at all. I simply can't handle so many foods together and I end up with over loaded stomach. So no, buffet is not my forte though I don't hesitate to stop by whenever I grab such opportunities.
Recently I got a voucher of buffet at MoMo Café, Hinjewadi from Zomato Team and I was there on a Saturday night.
Tuesday, April 7, 2015
Satisfying Your Chaat Cravings in Pune
'Chaat'! One little yet powerful word that can make one drool even with the name only! For those poor guys, who have no idea what I'm talking about, let me explain a bit. Chaat is a unique Indian addition to the world of street food. And Maharashtra is the mother of this food. As Puneites are known for the fondness of their soul foods, Pune can be called as the capital of chaat shops.
Wednesday, April 1, 2015
Traditional Gajar ka Halwa | Vegan Indian Carrot Pudding | Eggless Carrot Halwa
A large bowlful of warm Gajar ka Halwa aka Carrot Halwa and a good thriller: it was the scene at my home for past one week whenever I got some free time in hands. Not to mention it's Vegan Carrot Halwa as you already know I'm lactose intolerant.
Recently I noticed I've penned down so many times about my feelings towards winter but I never mentioned anything about Gajar ka Halwa (only a tiny mention in Beetroot Halwa recipe) though it has a deep relationship with my winter days since childhood. So the traditional recipe of Gajar ka Halwa and little chitchats are today's pick.
Posted by Rimli at 6:23 PM 1 comment:
Labels: Dairy Free, Dessert, Eggless, Festival Special, Healthy Recipes, Holi, LakhshiPuja/Diwali, Low Calorie Recipes, North Indian Cuisine, Pudding/Halwa, Sweets/Indian Dessert, Under 90 mins, veg, Vegan
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How to: make a Romulan character.
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Archived Post
Lt. Commander
Join Date: Dec 2007
Posts: 120
# 6
Originally Posted by
HERE is T'Jahn
, my Romulan. She is a little darker than many Romulans, but she has a propensity for sun bathing and active outdoor sports like rock climbing on Vulcan. Still you can see the contrast is a little better preserved from the material to the game. I always select the Unknown Alien species as a base since you have more active control of the sliders and colors. I like your hair styles. I often get that wrong. (She was meant to look like a Romulan Marie Digby)
HERE is Subol
, my main character's "number one". He appears to be a fairly typical Romulan male. You will note that his still has the green tinge that T'Jahn has, but he is much more far like a typical Romulan. Still he is not as pale as the ones presented in your tutorial. (He was meant to look like a young Jack Palance as a Romulan)
It is so hard to make a distinctly Romulan character in the editor. I blame the lack of triangular uniforms and shoulder pads. lol
What bugs me is that many Vulcans from the TV series and movies had very Histical (Hebrew/Jewish) facial features, but they are practically impossible to mimic correctly in the game. (Lower nose lengths, high strong cheeks and thinner lips.) The poor Romulans likewise suffer in that regard, but you can easily produce the looks of these proud people with the unknown alien race...sad.
Good good post, Jaime!
Good read, thanks for sharing.
Hehe, your Romulans are a little darker than I would go, but they capture the look as best as one can in this game. I had not noticed the Histical style of Vulcans in the show. That's a pretty interesting observation. More sample pictures of your creations are always welcome, guys. I would love to see what you had done both before and after this post.


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Ronald Gorsline
Hudson Cook, LLP
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Ron Gorsline is a partner in the firm's Chattanooga, TN office. He focuses his practice primarily on consumer financial services and regulatory compliance, as well as taxation law involving tax-exempt organizations. He is a frequent guest speaker and workshop presenter to national industry groups. Mr. Gorsline is listed in The Best Lawyers in America for banking law, and is AV rated by Martindale Hubbell.
He also regularly advises loan companies, financial institutions and banks regarding open-end and closed-end credit, prepaid cards, electronic payments (ACH transactions) under NACHA - The Electronic Payments Association, federal consumer protection and privacy law and regulations, including the Federal Arbitration Act, Federal Equal Credit Opportunity Act (Regulation B), Electronic Fund Transfer Act (Regulation E), Truth-in-Lending Act (Regulation M and Z), Gramm-Leach-Bliley Act (Regulation P), Fair Credit Reporting Act, Fair and Accurate Credit Transactions Act (Regulation V), Fair Debt Collection Practices Act, the Bank Secrecy Act, USA Patriot Act and Servicemembers Civil Relief Act; Electronic Signatures in Global and National Commerce Act, and the Dodd-Frank Act.
Mr. Gorsline co-authored the BNA Tax Management Portfolio's "Estates, Gifts and Trusts, Tax Issues of Educational Organizations" and "When Is a Cheque not a Cheque?" that was published in the Journal of Payments Strategy & Systems.
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For many of us, including my colleague Judith Woods, the idea of churning out yet another Christmas dinner, plus any number of ancillary meals, brings out our inner Eeyore. It's the shopping as much as the cooking that wears us down. I know. Pushing the trolley around the supermarket an hour before it closed one Christmas Eve (oh yes, I've been there) the ready-stuffed, self-basting turkey crown plus carton of gloopy gravy looked astonishingly appealing. Who cared what they tasted like. At least it would be easy.
Happily, help for exhausted Christmas cooks is at hand. Make a phone call or click online, and within a couple of minutes you can arrange for the ingredients of an entire Christmas dinner, from the sprouts to the plum pudding, to be delivered in one fell swoop two to four days before Christmas.
No 11th-hour trolley dash, no miserable jostling for a place on online delivery services, no worrying about what you have forgotten. Someone else has done the donkey (sorry, Eeyore) work.
The idea of "Christmas dinner in a box" took off about three years ago, with smart Gloucestershire-based farm shop Daylesford one of the first. Since then more companies have got on board. But a bit of research pays off as the deals vary. Some have simply done the shopping for you, which for determined cooks will be as much help as they want. Other companies go the top-notch ready-meal route, providing everything including the turkey cooked and ready to reheat. Some have even cut the crosses in the bases of the brussels sprouts.
A happy medium is Hellofresh, a company that spends most of the year delivering fresh ingredients for easy supper dishes to cook at home. Ingredients are pre-weighed, cutting down preparation time, and there are idiot-proof recipe cards to follow. It's an idea that first took off in Sweden in 2007, and there are now Hellofreshes in America and Germany.
The ingredients are fresh (they won't have peeled the potatoes for you) so you still feel you've had a hand in cooking it. Sourcing is impeccable, with prawns for the prawn cocktail from Royal Warrant-holding James Knight, and turkey from award-winning producer Copas. The recipes are provided. And everything, and I mean everything, is in the box. They've even remembered the crackers. As long as you have salt, pepper and olive oil, you really shouldn't need to go to the shops at all.
The traditional upmarket retailers are doing their own versions of Christmas dinner in a box, including chic Chiswick deli Melrose and Morgan and rustic veg-box scheme Riverford Organics. And this year Forman and Field, the mail-order arm of Britain's oldest established smoked salmon producer H Forman and Sons, has taken up the challenge for the first time with a "Full Works" Christmas dinner box.
When I visited the slick new factory in east London (the old one was flattened to make way for the running track in the Olympic Stadium) Lance Forman, great grandson of founder Harry Forman, showed me the exquisite, gently smoky salmon being hand sliced by the team of white-coated workers. And the chefs next door, preparing the vegetables and stuffings in the restaurant-style kitchen, were the antithesis to the production lines of mass-produced ready meals. Formans, Lance assured me, can – and will – adapt the box to individual needs. Not that it is generally necessary. People like to have the decisions made for them. Sometimes, he says, "you can have too much choice".
Supermarkets have been slower on the uptake, with just Marks & Spencer in on the act. It has been running the scheme for a couple of years, and this year offers a Festive Feast at £100 for six. I confidently predict that by next year, all the big supermarkets will join suit.
What about expense? I put through a Christmas dinner shopping list on Tesco's website, opting for its Finest range where possible, but keeping to a slimline list of a turkey, vegetables, sausage meat for stuffing, pigs in blankets, cranberry sauce, Christmas pud and cream (I couldn't find brandy butter) and it came to a few pence short of £85 for six to eight people – cheaper than any of the "box deals" I looked at. And I could have slashed this by half by opting for economy versions of all the products.
Read Paul Rankin's advice on how to cook turkey
But add in the various goodies in the other boxes, and the difference would be much less. It's also worth bearing in mind that the turkeys are super-luxury, costing up to £80, or even more. Some of the deals seem a positive bargain, given the quality. It's enough to make me feel quite Tiggerish.
Festive food-bearers
Forman and Field
020 3601 5464; formanandfield.com
The Full Works
Serves: 8
Price including delivery: £169.95
Cost per person: £21.24
Last order date: December 13
Best for: Smoked salmon, and the fact it saves nearly £30 on the price of buying the items separately. The box includes London cure smoked Scottish salmon (400g), Seldom Seen Farm free-range bronze turkey (4.5-5.5kg) with stuffing, chipolatas, streaky bacon and chestnuts; dauphinoise potatoes, brussels sprouts with bacon and chestnuts; Christmas pudding and brandy butter; a bottle of Chapel Down Vintage Reserve English sparkling wine and Champagne truffles.
0800 083 1233; daylesfordorganic.com
Christmas Lunch
Serves: 8-10 (4-6)
Price including delivery: £158 (£100)
Cost per person: £15.80-£19.75
Last order date: December 14
Best for: Swanky organic raw ingredients at a bargain price. Daylesford isn't known for competitive prices but this is surprisingly good value (although there's no brandy butter or crackers for the cheese). It includes a bronze turkey (6kg); ham (1.5kg), chipolatas, stuffing, cranberry sauce (200g); Daylesford Cheddar, Christmas pudding (900g).
Hello Fresh
020 3510 6076; hellofresh.co.uk
Christmas Box
Serves: 8-10 (4-6)
Price including delivery: £255 (£155)
Cost per person: £25.50-£38.75
Last order date: midnight December 16 (delivery December 21)
Best for: time-short cooks as it includes ready measured raw ingredients. It's steep for four people but for a crowd this becomes a bargain; inside are the ingredients and recipes for a prawn cocktail starter, garlic and herb brussels sprouts with toasted pine nuts, roasted maris piper potatoes and pigs in blankets. Plus free range turkey from Copas, Christmas pudding and brandy butter, handmade mince pies, cheeses, crackers, a Prestat chocolate bauble and mince pie flavoured popcorn.
Laverstoke Park
0800 334 5505; laverstokepark.co.uk
Ultimate Christmas Day
Serves: 6-8
Price including delivery: £159.00
Cost per person: £19.88-£26.50
Last order date: December 14
Best for: Christmas pudding haters and fans of Laverstoke's fine quality organic ingredients. Former racing driver Jody Scheckter has turned his skills to tending the soil at Laverstoke Park Farm in Hampshire, where he rears organic buffalo as well as cattle, pigs and sheep on special mixed herb pastures. It doesn't come cheap, but this is Formula One stuff, and includes Norfolk black turkey (3.5-4.5kg), 1kg ham, bacon, pigs in blankets, cranberry sauce, carrots, two tubs of buffalo milk ice cream and Christmas pudding or sticky toffee pudding.
Melrose and Morgan
020 7485 1600; melroseandmorgan.com
Christmas in a Box
Serves: You specify the number
Cost per person: £60 (plus delivery charge)
Last order date: December 17
Best for: Super luxe at an eye-watering price. Smart Chiswick delicatessen Melrose and Morgan have produced a sumptuous box of pre-prepared food including chicken liver and white port parfait, onion marmalade and mini sourdough toasts, Goodman's bronze turkey, pork chestnut and marsala stuffing balls, potatoes roasted in duck fat with thyme, spiced red cabbage, bacon-wrapped chipolatas, cranberry, orange and port sauce, bread sauce, Christmas pudding, brandy custard, cheeses including truffled Tunworth, Montgomery Cheddar and Stichelton, oat cakes, dark chocolate Florentines, prosecco, white and red wine plus a dessert wine. Phew.
01803 762059; riverford.co.uk
Christmas Hamper with Meat
Serves: 6 "generously"
Price including delivery: £135
Cost per person: £22.50
Last order date: December 18
Best for: Fabulous mince pies and heaps of organic leftovers. There is no brandy butter, but given the extras it's a fair price. The all-organic contents include medium slow-grown turkey, chipolatas and smoked streaky bacon, cranberry sauce, a medium vegbox, clementines, 12 mince pies, Christmas pudding, oatcakes and award-winning Stilton.
Marks & Spencer
Festive Feast
Serves: 6
Price: £100
Cost per person: £16.67
Last order date: 3pm December 15
Delivery: collect in-store
Best for: Price, but it doesn't include a whole bird and there is no delivery. And you'll have to buy your own Christmas pudding if you want a traditional meal. Includes: turkey crown, fresh gravy, cranberry sauce, bread sauce, passion fruit mousse with raspberry coulis, cheese and chutney.


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|[si-contact-form form='1']
|Our office has permanently moved from Los Angeles to Sacramento, California. We still however welcome clients from LA areas as we consult and work on cases by communicating through emails and phone calls. Emailing us scanned documents related to your case and mailing a certain original documents actually make this work very smoothly.