text:
1 CFR 18.12 - Preamble requirements.
(a) Each agency submitting a proposed or final rule document for publication shall prepare a preamble which will inform the reader, who is not an expert in the subject area, of the basis and purpose for the rule or proposal.
(Name of issuing agency)
(Notice of Intent), (Advance Notice of Proposed Rulemaking), (Proposed Rule), (Final Rule), (Other).
(Brief statements, in simple language, of: (i) the action being taken; (ii) the circumstances which created the need for the action; and (iii) the intended effect of the action.)
(Comments must be received on or before: _____.) (Proposed effective date: _____.) (Effective date: _____.) (Hearing: _____.) (Other: _____.)
(Any relevant addresses.)
(For Executive departments and agencies, the name and telephone number of a person in the agency to contact for additional information about the document [Presidential Memorandum, 41 FR 42764, September 28, 1976].)
(See paragraph (c) of this section.)
[41 FR 56624, Dec. 29, 1976, as amended at 54 FR 9681, Mar. 7, 1989]
Title 1 published on 2012-01-01
no entries appear in the Federal Register after this date.
Title 1 published on 2012-01-01
The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 1 CFR 18 after this date.


text:
A body implantable medical device (IMD) includes a first shell and a second shell whose outer surfaces are biocompatible. The IMD further includes a battery enclosure defined by all or a portion of the first shell of the IMD housing and a cover. The cover of the battery enclosure is disposed between the inner surfaces of the first and second shells, has a greater rigidity than the first shell, and includes an improved feedthrough assembly for an electrochemical cell, such as a flat liquid electrolyte battery, provided in the battery enclosure. Electronic circuitry, supported on a flexible wiring substrate, is provided between the inner surface of the second shell and the cover of the battery enclosure. A hermetic seal is provided between the cover of the battery enclosure and all or a portion of the first shell.
1. A feedthrough assembly for a thin flat liquid electrolyte battery, comprising:
a feedthrough tube being disposed within an inner diameter of a ferrule and being bonded to and electrically isolated from the ferrule by a sealing glass;
an insulator cylinder;
an insulator tube having a first end disposed within the insulator cylinder; and
a first end of a feedthrough pin being disposed within the insulator tube and the feedthrough tube and being electrically coupled to the feedthrough tube; wherein,
the sealing glass is formed about the feedthrough tube within the ferrule;
the insulator cylinder is in stacked relation to the sealing glass and bonded to the sealing glass within the ferrule; and
the first end of the insulator tube is disposed in substantial alignment with the feedthrough tube.
2. The feedthrough assembly of
3. The feedthrough assembly of
4. The feedthrough assembly of
the insulator cylinder is constructed from Alumina;
the insulator tube is constructed from Polyolefin; and
the sealing glass is constructed from CABAL-12 glass, 9013 glass, or Ta-23 glass.
5. The feedthrough assembly of
6. The feedthrough assembly of
7. The feedthrough assembly of
This application is a divisional of application Ser. No. 09/687,446, filed Oct. 13, 2000, now allowed now U.S. Pat. No. 6,498,951.
The present invention relates generally to batteries for use with an implantable medical device (IMD). More particularly, the present invention pertains to an integral housing of an implantable medical device for containing a formable flat battery.
As implantable medical device (IMD) technology advances in an attempt to address a myriad of life sustaining/enhancing needs, issues such as IMD battery longevity, IMD size and shape, IMD mass, and patient comfort remain key considerations in the IMD design process. Much attention is typically placed on the power source of an implantable medical device during the IMD design process. It is appreciated that battery size and capacity, for example, significantly impact the physical configuration of the IMD and the duration of service time within the patient before battery replacement is required.
A conventional approach to providing power within an implantable medical device involves the use of a self-contained battery, not unlike a common battery which is commercially available to the consumer. Such a self-contained battery includes active electrochemical cell components housed in a battery can. Battery housing connectors or contacts are provided for establishing electrical connections to circuitry disposed within in the implantable medical device.
It is well appreciated in the IMD manufacturing industry that the battery component of an IMD requires the allocation of an appreciable percentage of usable space within the IMD. It can be appreciated that reducing the size of the battery is a desirable design objective. However, reducing IMD battery size results in a corresponding reduction in battery capacity, which necessarily places limits on the ability to make significant battery size reductions using conventional IMD battery design principles.
Moreover, the can of a conventional IMD battery is often of a configuration that creates "dead space" within the implantable medical device (e.g., a can having a substantially square or rectangular shape). Although a thoughtful design approach can help to reduce the amount of such dead space, an appreciable volume of space within the IMD typically remains unusable when employing a conventional IMD battery. Also, the metal battery can that contains the active battery components must be of a thickness sufficient to protect against battery leakage. The thickness of the battery can must also be taken into consideration when allocating space within the IMD to house a battery source of a conventional design.
There is a need in the implantable medical device manufacturing community for an IMD battery implementation which provides for an overall reduction in IMD size without a corresponding reduction in battery capacity. There exists a further need for an IMD battery implementation that provides enhanced flexibility in terms of shape, size, and other form factor properties. The present invention fulfills these and other needs.
In accordance with the invention, an improved feedthrough assembly for a flat liquid electrolyte battery contained within a housing assembly of an IMD is provided. The feedthrough assembly includes a feedthrough pin in which a first end of the feedthrough pin is disposed within an insulator tube and a feedthrough tube, and the first end of the feedthrough pin is electrically coupled to the feedthrough tube, which is disposed within an inner diameter of a ferrule. The feedthrough tube is bonded to and electrically isolated from the ferrule by a sealing glass. The sealing glass is formed about the feedthrough tube within the ferrule and an insulator cylinder is in stacked relation to the sealing glass and bonded to the sealing glass within the ferrule. A first end of the insulator tube is disposed within an insulator cylinder such that the first end of the insulator tube is in substantial alignment with the feedthrough tube. Furthermore, a second end of the feedthrough pin is electrically coupled to an anode assembly, which is also pressed around a second end of the insulator tube. The first end of the feedthrough pin, being joined to the anode assembly at its second end, is inserted into the feedthrough tube, which is disposed within the ferrule, being bonded to and electrically isolated from the ferrule, and then welded to the feedthrough tube.
While the invention is amenable to various modifications and alternative forms, specifics thereof have been shown by way of example in the drawings and will be described in detail hereinbelow. It is to be understood, however, that the intention is not to limit the invention to the particular embodiments described. On the contrary, the invention is intended to cover all modifications, equivalents, and alternatives falling within the scope of the invention as defined by the appended claims.
In the following description of the illustrated embodiments, references are made to the accompanying drawings which form a part hereof, and in which is shown by way of illustration, various embodiments in which the invention may be practiced. It is to be understood that other embodiments may be utilized, and structural and functional changes may be made without departing from the scope of the present invention.
In the case where the IMD 21 shown in
The implantable medical device 21 may also be a pacemaker/cardioverter/defibrillator (PCD), one embodiment of which is further described hereinbelow. The present invention may be practiced in conjunction with PCDs, such as those disclosed in U.S. Pat. No. 5,545,186 to Olson et al., U.S. Pat. No. 5,354,316 to Keimel, U.S. Pat. No. 5,314,430 to Bardy, U.S. Pat. No. 5,131,388 to Pless, or U.S. Pat. No. 4,821,723 to Baker et al., all hereby incorporated herein by reference in their respective entireties.
Alternatively, IMD 21 may be an implantable nerve stimulator or muscle stimulator, such as those disclosed in U.S. Pat. No. 5,199,428 to Obel et al., U.S. Pat. No. 5,207,218 to Carpentier et al., or U.S. Pat. No. 5,330,507 to Schwartz, or an implantable monitoring device, such as that disclosed in U.S. Pat. No. 5,331,966 issued to Bennet et al., all of which are hereby incorporated herein by reference in their respective entireties. The present invention is believed to find wide application in any form of implantable electrical device which utilizes a battery for providing power to various electrical and electronic components of the implantable medical device.
The IMD shield section 18 is shown to include a recessed region 15 for accommodating a number of implantable medical device feedthroughs. The IMD feedthroughs represent hermetically-sealed connector assemblies which provide for electrical connectivity between a pacing or sensing lead, for example, and IMD electronics disposed within the protective housing 18, 19 of IMD 21.
Battery section 19 includes a corresponding recessed region 32 for accommodating the IMD feedthroughs. Battery section 19 further includes at least one battery feedthrough 30 and a fillport 28. Battery section 19 incorporates a thin, flat liquid electrolyte battery provided within a hermetically-sealed battery-housing 26.
In accordance with the principles of the present invention, and as shown in
A significant advantage realized through employment of an implantable medical device 21 which incorporates a shallow-drawn case 26 of the present invention concerns the manner in which naturally occurring swelling of the flat liquid electrolyte battery is managed within the battery housing 26. More particularly, employment of a shallow-drawn case 26 and thoughtful layout of internal IMD components provides for swelling of the flat liquid electrolyte battery which is biased in a direction away from the electronics. Moreover, an enhanced degree of shape flexibility or formability is achievable, thus permitting the battery to fit the contour of the IMD housing.
The term shallow-drawn case is intended to represent a housing or case in which the draw direction of the case is the smallest of the three overall dimensions. The shape of the largest face, which is best seen in
According to the present invention, the case 26 may include complex curved portions, such as scalloped portions, in addition to or to the exclusion of straight sections. For example, the case 26 may be formed to have a shape considered non-standard within the implantable medical device industry.
By way of further example, case 26 may be designed to follow the contour of a D-shaped battery or, alternatively, may be configured to have a largely prismatic shape with one corner radiused more generously than others. Employment of a thin flat cell in conjunction with thoughtful electronics packaging provides for complex battery and IMD housing shapes. In general, providing an IMD housing which is more rounded increases patient comfort and diminishes the risks of lead damage, tissue erosion, and infection by eliminating sharp device corners. A formable battery and formable flexible wiring substrate implemented in accordance with the principles of the present invention advantageously provides for optimization of the available IMD housing space, as the battery and wiring substrate may be formed to closely track the contour of the IMD housing.
According to this embodiment of battery housing 26, the cover 22 extends down into the shield half of the implantable medical device to provide more clearance for the implantable medical device components. A clearance area 32 is stamped into the cover 22 to allow clearance for the implantable medical device feedthroughs.
An important aspect of the implantable medical device 21 depicted in
In the embodiments depicted in
An implantable medical device which employs a dual purpose cover 22 of the type depicted in
For example, it has been found that an implantable medical device constructed in accordance with the principles of the present invention may provide for an increase of 10% to 13% in battery capacity over a conventional implantable medical device of equivalent size. In addition to increased battery capacity, battery mass may be reduced by roughly 50% in comparison to a conventional IMD battery of equivalent capacity.
Such capacity gains and mass reductions are achieved by eliminating an appreciable portion of the battery housing (e.g., battery case portion that would otherwise be situated adjacent an IMD shield), and by using freed-up space in the IMD shield half that would otherwise be occupied by parts such as an insulator cup, which can be wholly eliminated. This freed-up "dead space" volume may now be used for active battery components. As such, increased IMD service life may be realized without increases in device volume. Alternatively, the freed-up dead space can be allocated for additional leads, additional electronics or the implantable medical device size could be reduced.
A number of additional advantages may be realized through employment of a shallow-drawn IMD housing of the present invention. One important advantage, as discussed above, concerns the ability to bias cell swelling to one direction, such as by making the battery housing cover 22 thicker, constructing the cover 22 using a material of higher modulus relative to the case 34, or the combination of using a thicker, higher modulus cover material relative to the case material.
The ability to produce IMD batteries or cells 33 which are very thin, such as less than 0.135 inches, is also realizable. It is noted that the limit for a conventional deep-drawn IMD battery housing is approaching 0.240 inches. In contrast to a conventional housing implementation, a shallow-drawn IMD housing of the present invention provides for a battery form factor of significantly reduced size (e.g., nearly one-half that of a conventional battery housing). Further, a battery housing of the present invention can be made to fit the contour of the IMD can as desired, which represents a level of formability not achievable using conventional battery implementations.
Employment of a shallow-drawn IMD housing according to the present invention also provides for easier implantable medical device assembly. For example, straight-down assembly techniques may be employed, which significantly reduces the risk of damaging components upon insertion of same into the housing. Moreover, a straight-down assembly process may be easily adapted to automation, thereby enhancing the efficiently and cost of assembling implantable medical devices.
Another advantage concerns enhanced feedthrough orientation flexibility. The feedthrough assembly for establishing connectivity with the cell 33 may be made normal to either the cover 22 or the case 34. The bulk of the feedthrough assembly 30 (e.g., ferrule/glass interface) may be either inside or outside of the battery housing 26. The feedthrough assembly 30 can also protrude from a shelf formed within the case 34. Orienting the feedthrough pin of the assembly 30 to be perpendicular to the cover 22 when the battery 33 is packaged provides for easy attachment of the feedthrough pin to the opposing electronics module, preferably provided on a flexible wiring substrate. Other advantages include reduced implantable medical device housing costs (e.g., fewer draws and anneals), simplified cover configuration, ease of fabrication, and handling. Such a housing is also easier to clean, thus reducing the chance of metal particles being introduced into the cell 33.
With continued reference to
According to one embodiment, the anode assembly 27 includes a lithium anode, and the cathode pellet 23 includes a hybrid cathode chemistry described by an Li/CSVO/CFx chemistry. The liquid electrolyte has a chemistry described by 1M LiBFy in GBL/DME. The hybrid cathode chemistry according to this embodiment offers several advantages over other available medium rate chemistries. The shallow-drawn IMD battery 33 has roughly one-half the Li/I2 battery mass as compared to a conventional deep-drawn IMD battery of equivalent capacity. Moreover, the shallow-drawn IMD battery 33 exhibits energy densities which are comparable to conventional Li/I2 IMD batteries at low rates, and are significantly higher at increased discharge rates. A hybrid cathode chemistry of the present invention typically exhibits an increase in energy density of about 15% as compared to a conventional Li/CSV0 chemistry. Further, such a hybrid cathode chemistry provides for a relatively low degree of cell swelling.
It is desirable that the flat cell 33 leverage existing fabrication technologies from high rate and medium rate mechanical platforms. A high cathode fabrication technology, for example, may be used to fabricate the cathode 23. One large, flat cathode 23 may be fabricated using either an expanded metal screen or a perforated, etched screen as a cathode current collector.
The cathode current collector may be fabricated with tabs to facilitate attachment of the cathode to the cover 22. The cathode is preferably welded to the cover 22 to maximize the distance between the anode 27 and the case-cover weld joint. Since a polyolefin film laminate is preferably used as an electrode separator, maximizing the distance from the heat affected zone is an important design consideration. The anode 27 is preferably double-bagged in a polyolefin film laminate to provide two layers of protection between electrodes and between the anode and the case.
The anode 27 uses an etched current collector. A nickel anode current collector may also be used to improve anode processing by eliminating anode brushing during pressing. Medium rate assembly technology may be used to fabricate the anode 27.
The case 34 and cover 22, according to this embodiment, are fabricated from surgical Grade I titanium. Since the battery enclosure is subjected to body fluid, surgical Grade I titanium is preferred. Grade I titanium is also preferred for stamped part fabrication. The case 34 may have a nominal material thickness between 0.012 and 0.015 inches. The cover 22 may have a nominal material thickness of 0.030 inches.
The feedthrough assembly 30 includes a ferrule which is constructed from Grade III titanium. Grade III titanium is preferred for machine part fabrication. The fillport seal may be implemented using a variety of known approaches. The feedthrough glass may be constructed from CABAL-12 or other polymer. The feedthrough pin 34 may be fabricated from titanium or niobium with glass. Alternatively, a nickel pin with polymer feedthrough may be employed. Titanium or niobium pins with tubes may also be employed as an alternative. It is understood that the feedthrough assembly 30 may be positioned at different locations on the cover 22 and may be configured to accommodate differently-shaped electrodes. The feedthrough assembly 30, however, should be located so as not to impinge on the region 32 dedicated for IMD lead feedthroughs.
The cell separator and absorbent layers may include polyolefin film laminate. The insulators may be propylene or propylene with alumina. The cathode pellet 23 may include a cathode having an embedded cathode current collector which leverages high rate cathode manufacturing processes. The cathode current collector may have tabs which are welded to the cover 22. The anode assembly 27 may be fabricated using a medium rate process with a current collector pressed onto the back of the anode. The anode current collector may be welded to the feedthrough pin 35 of the feedthrough assembly 30. The separator may be established using a standard heating/sealing process or an ultrasonic sealing process.
With particular reference to
With reference to
As best seen in
The insulator tube 56 is "glassed" with a sealing glass, such as a CABAL-12 glass member 52. The insulating disk 54 and insulator tube 56 are press fit into the ferrule 50 to form a compression seal. This arrangement provides the necessary electrical and physical insulation between the feedthrough pin 58 and regions of opposite polarity. During assembly, the anode of the battery 33 is typically fabricated with the feedthrough 30 in place. When the battery 33 is assembled, the feedthrough 30 is welded into the cover 22 so as to secure the anode to cover assembly.
Due to the size of the cover 22, glassing the feedthrough 30 using conventional methods may not be efficient. It may, therefore, be desirable that the feedthrough 30 be glassed in the ferrule 50 as a discrete part and then welded into the cover 22. The feedthrough 30 may be assembled to include an MP-35N ferrule 50 and TA-23 glass. It is noted that the insulating disk 54 and insulator tube 56 arrangement provides for electrical insulation and protection against lithium ball formation. An ETFE coating may be applied to the feedthrough 32 to ensure protection from the lithium ball formation.
An insulator tube 56, such as one constructed from polyolefin, is slipped over the feedthrough pin 58, and one end of the insulator tube 56 is embedded in the feedthrough pin 58 when lithium is pressed to the anode current collector 25. The feedthrough 30 shown in
The feedthrough pin 58 in the anode is bent and the insulative tube assembly is slid up inside the insulator cylinder 55 and seated against the bottom of the feedthrough cylinder to complete insulation of the feedthrough assembly 30. The feedthrough pin 58 may be later welded to the end of the tube 57 to complete the battery assembly process. The feedthrough assembly 30 is also welded to the cover 22 of the battery housing. The feedthrough pin 58 is inserted into the tube 57 and the connection is made by a weld at the tube 57 and pin 58 joint location. This provides for "line of sight" isolation of the feedthrough pin 58 and the feedthrough ferrule 50 to prevent lithium ball shorting. It also provides an easy method for attaching the anode to the feedthrough assembly 30.
The feedthrough embodiment illustrated in
In such an embodiment, the anode is pressed with a feedthrough pin 58 welded to the anode, rather than a complete feedthrough assembly 30. This configuration eliminates potential damage to the feedthrough 30 during the anode pressing process. Since the feedthrough 30 is welded to the cover 22, the feedthrough pin 58 can be welded to the tube 57 during the same welding process. The cost of welding the feedthrough pin 58 to the feedthrough tube 57 should be negligible.
A third feedthrough embodiment may include a polymer feedthrough using a nickel feedthrough pin. It is noted, however, that nickel cannot be used with CABAL-12 glass due to a severe thermal expansion mismatch therebetween. A molded part incorporating an insulative tube can be fabricated which effectively protects the feedthrough pin.
It is noted that an alumina or other ceramic insulator 55 used at the bottom of the feedthrough assembly serves as both a chemical and electrical insulator. It is further noted that a plastic insulator cannot be used in cases in which welding of feedthrough assembly components is required, since the heat generated during the welding process could cause a plastic insulator to melt, thereby destroying the insulator and its insulating properties.
The feedthrough pin 58 may be constructed from Nb, Ti, Mo, or Ta. The sealing glass 52 may be 9013 glass, CABAL-12, or Ta-23 glass. The ferrule 50 may be constructed from MP-35N, 304L stainless steel, titanium 6-4, or some other suitable ferrule material for organic electrolyte lithium batteries.
Turning now to
Importantly, and as discussed previously, a flat electrochemical cell disposed in IMD 21 according to the present invention may advantageously be shaped to follow a simple or complex contour of the IMD housing. As such, complex curves, including scalloped and other high-radius curved portions, may be advantageously accommodated.
Moreover, and as will be described hereinbelow, all or some of the electronics disposed in IMD 21 are preferably supported on a flexible substrate, such as a flexible tape or flexible wiring board, which, like the battery components, may be shaped to maximize the space allocated in an IMD housing having complex curved portions. An electronics and battery packaging methodology according to the principles of the present invention provides for enhanced flexibility when designing the size and shape of an implantable medical device to achieve a wide variety of IMD design objectives.
As best seen in
Turning now to
As can be readily seen in
Additionally, flexible substrate connections to the terminal block 83, battery, capacitors, and other interfacing electronics can be integrated as part of the flexible circuit, thus eliminating the need for a separate interconnect methodology. The connections to those interfaces can be made by soldering, welding, conductive epoxy attachment or any other suitable attachment methodology. The terminations may either be flat, include a hole which registers over a conductive pin or include a groove that slides against a conductive pin. It will be appreciated that other attachment approaches may also be employed.
The flexible substrate 70 advantageously provides for a lower dielectric constant at a higher dielectric breakdown voltage in comparison to traditional printed wiring boards. In addition, the flexible substrate 70 allows for implantable medical devices to be thinner, yet retain the same number of layers as compared to IMDs employing printed wiring boards. Further, flexible substrate 70 offers a higher thermal stability than printed wiring boards.
In one embodiment, flexible substrate 70 is employed in conjunction with the flat battery shown in
The antenna of an implantable medical device of the present invention may be advantageously enlarged so as to circle the perimeter of the IMD. This allows for a greater range of sensitivity to facilitate IMD telemetry. According to one approach, the antenna may be implemented integrally with the flexible substrate 70, either as a routed antenna or as a coil 701 laminated into the flexible substrate 70.
Flexible substrate 70 includes a cathode connector 74 which connects to the battery cathode via battery feedthrough 30. Flexible substrate 70 further includes an anode connector 76 which is electrically connected to the anode of the battery. Flexible substrate 70 further includes an interconnect 80 which connects with a terminal block 83 of the implantable medical device.
As shown, interconnect 80 represents a continuation of flexible circuit 72 with necessary conductors terminating at appropriate locations for establishing connections to corresponding connectors of the terminal block 83. For example, interconnect 80 includes one or more feedthrough connection locations 72 for establishing electrical connectivity with a corresponding feedthrough connector provided on the IMD shield portion of the IMD housing. Flexible substrate 70 further includes a protection circuit 82 which provides for high current/high voltage protection as between the battery and electronic circuitry of the implantable medical device.
By way of example, the feedthrough connectors 61 may include gold-plated bellows-type contact springs, which are particularly useful in applications where tolerance build-up, vibration, and thermal expansion may become a problem. The contact springs of the feedthrough connector 61 may be manufactured from electro-deposited nickel and gold plated to enhance conductivity. End cups of the connectors may be designed to fit over standard sized pins or into recesses, such that connections to other components may be established without the necessity of soldering. Due to a very low spring rate, force requirements of approximately 0.04 ounces per 0.001 inches of travel are readily achievable. The spring contacts further provide for a minimum of self-inductance with extremely low DC resistance and a minimum of insertion loss.
The contacts 61 may have diameters ranging from 0.037 inches OD (outer diameter) to 0.125 inches OD. The contacts may have either a convex conical or concave conical tip. The contacts may be used individually or in pairs. The unique pairing of a contact with a convex conical tip with a contact having a concave conical receptacle tip allows electrical contacts to be self-aligning as a connection is established. Suitable spring-type contacts 61 are manufactured by Servometer Corporation, Cedar Grove, N.J.
As discussed previously, an advantage of using a flexible substrate 70 according to the present invention concerns the ability to achieve higher interconnect densities by eliminating staggered vias otherwise required in conventional printed wiring board implementations.
As was discussed previously, the implantable medical device 21 as shown in the figures may be representative of any of a number of different implantable electronic devices. In certain IMD applications, the polarity of the IMD housing may be an issue. It is believed that a desired IMD housing polarity may be achieved by employing known electronic design principles.
Pacemaker 111 is electrically coupled to the patient's heart 116 by lead 114. Lead 114, which may include one or two conductors, is coupled to a node 152 in the circuitry of pacemaker 111 through input capacitor 150. In the presently disclosed embodiment, an activity sensor 162 provides a sensor output to a processing/amplifying activity circuit 136 of input/output circuit 132. Input/output circuit 132 also contains circuits for interfacing with heart 116, antenna 156, and circuits 144 for application of stimulating pulses to heart 116 to moderate its rate under control of software-implemented algorithms in microcomputer unit 118.
Microcomputer unit 118 comprises on-board circuit 125 which includes microprocessor 120, system clock 122, and on-board RAM 124 and ROM 126. In this illustrative embodiment, off-board circuit 128 comprises a RAM/ROM unit. On-board circuit 125 and off-board circuit 128 are each coupled by a data communication bus 130 to digital controller/timer circuit 134.
In one embodiment, the pacemaker 111 is programmable by means of an external programming unit (not shown). One such programmer suitable for the purposes of the present invention is the commercially available Medtronic Model 9790 programmer. The programmer is a microprocessor-based device which provides a series of encoded signals to pacemaker 111 by means of a programming head which transmits radio frequency (RF) encoded signals to pacemaker 111 according to a telemetry system such as that described in U.S. Pat. No. 5,312,453 to Shelton et al. and U.S. Pat. No. 5,127,404 issued to Wyborny et al., the disclosures of which are hereby incorporated by reference herein in their respective entireties.
Antenna 156 is connected to input/output circuit 132 to permit uplink/downlink telemetry through RF transmitter and receiver unit 154. Unit 154 may correspond to the telemetry and program logic disclosed in U.S. Pat. No. 4,556,063 issued to Thompson et al., hereby incorporated by reference herein in its entirety, or to that disclosed in the above-referenced Wyborny et al. patent.
Voltage reference (VREF) and bias circuit 160 generates a stable voltage reference and bias current for the analog circuits of input/output circuit 132. Analog-to-digital converter (ADC) and multiplexer unit 158 digitizes analog signals and voltages to provide "real-time" telemetry intracardiac signals and battery end-of-life (EOL) replacement functions.
Operating commands for controlling the timing of pacemaker 111 are coupled by data bus 130 to digital controller/timer circuit 134, where digital timers and counters establish the overall escape interval of the pacemaker as well as various refractory, blanking, and other timing windows for controlling the operation of the peripheral components disposed within input/output circuit 132. Digital controller/timer circuit 134 is preferably coupled to sensing circuitry 138, including sense amplifier 142, peak sense and threshold measurement unit 141, and comparator/threshold detector 140.
Sense amplifier 142 amplifies sensed electrocardiac signals and provides an amplified signal to peak sense and threshold measurement circuitry 141. Circuitry 141, in turn, provides an indication of peak sensed voltages and measured sense amplifier threshold voltages on path 143 to digital controller/timer circuit 134. An amplified sense amplifier signal is then provided to comparator/threshold detector 140. Sense amplifier 142 may correspond to that disclosed in U.S. Pat. No. 4,379,459 to Stein, which is hereby incorporated by reference herein in its entirety.
Circuit 134 is further preferably coupled to electrogram (EGM) amplifier 146 for receiving amplified and processed signals sensed by an electrode disposed on lead 114. The electrogram signal provided by EGM amplifier 146 is employed when the implanted device is being interrogated by an external programmer (not shown) to transmit, by uplink telemetry according to the present invention, a representation of an analog electrogram of the patient's electrical heart activity. Such functionality is, for example, shown in previously referenced U.S. Pat. No. 4,556,063.
Output pulse generator 144 provides pacing stimuli to the patient's heart 116 through coupling capacitor 148 in response to a pacing trigger signal provided by digital controller/timer circuit 134. For example, each time the escape interval times out, an externally transmitted pacing command is received, or such commands are received in response to other stored commands as is well known in pacing art. Output amplifier 144, for example, may correspond generally to the output amplifier disclosed in U.S. Pat. No. 4,476,868 to Thompson, also incorporated by reference herein in its entirety.
The PCD device 270 is provided with six electrodes 201, 202, 204, 206, 208, and 210. For example, electrodes 201 and 202 may be a pair of closely-spaced electrodes located in the ventricle. Electrode 204 may correspond to a remote, indifferent electrode located on the housing of the implantable PCD 270. Electrodes 206, 208, and 210 may correspond to large surface area defibrillation electrodes located on device leads or to epicardial electrodes.
Electrodes 201 and 202 are connected to detector circuit 209 which includes band pass filtered amplifier 211, auto-threshold circuit 212, which provides an adjustable sensing threshold, and comparator 213. A signal is generated by the comparator 213 whenever the signal sensed between electrodes 201 and 202 exceeds the sensing threshold defined by auto-threshold circuit 212. Further, the gain of amplifier 211 is adjusted by pacer timing and control circuitry 214. The sense signal, for example, is used to set the timing windows and to align successive waveshape data for morphology detection purposes. For example, the sense event signal may be routed through the pacer/timer control circuit 214 on data bus 215 to processor 224 and may act as an interrupt for processor 224 such that a particular routine of operations is commenced by processor 224.
Switch matrix 216 is used to select available electrodes under the control of processor 224 via data/address bus 215, such that the selection includes two electrodes employed as a far field electrode pair in conjunction with a tachycardia/fibrillation discrimination function. Far field EGM signals from the selected electrodes are passed through band pass amplifier 217 and into multiplexer 218, where they are converted to multi-bit digital data signals by A/D converter 219 for storage in random access memory 226 under the control of direct memory address circuitry 228.
The processor 224 may perform various morphology detection functions. For example, such detection functions may be indicative of tachycardia or fibrillation, or various other functions may be performed as set out in numerous references including any of the references incorporated herein by reference and others with regard to implantable PCDs.
The remainder of the device 270 of
In the event that a tachyarrhythmia is detected, and an anti-tachyarrhythmia pacing therapy is desired, appropriate timing intervals for controlling generation of pacing therapies are loaded from processor 224 into pacer timing and control circuitry 214. Similarly, in the event that generation of a cardioversion or defibrillation pulse is required, processor 224 employs the timing and control circuitry 214 to control timing of such cardioversion and defibrillation pulses.
In response to detection of fibrillation or a tachycardia requiring a cardioversion pulse, processor 224 activates cardioversion/defibrillation control circuitry 229, which initiates charging of the high voltage capacitors 231-234 via charging circuit 235 under the control of high voltage charging line 236. Thereafter, delivery and timing of the defibrillation or cardioversion pulse is controlled by pacer timing/control circuitry 214. One embodiment of an appropriate system for delivering and synchronizing cardioversion and defibrillation pulses, and controlling the timing functions related thereto, is disclosed in greater detail in U.S. Pat. No. 5,188,105 to Keimel, which is incorporated herein by reference in its entirety.
Other circuitry for controlling the timing and generation of cardioversion and defibrillation pulses is disclosed in U.S. Pat. No. 4,384,585 to Zipes, U.S. Pat. No. 4,949,719 to Pless et al., and in U.S. Pat. No. 4,374,817 to Engle et al., all of which are incorporated herein by reference in their respective entireties. Further, known circuitry for controlling the timing and generation of anti-tachycardia pacing pulses is described in U.S. Pat. No. 4,577,633 to Berkovitz et al., U.S. Pat. No. 4,880,005 to Pless et al., U.S. Pat. No. 4,726,380 to Vollmann et al., and U.S. Pat. No. 4,587,970 to Holley et al., all of which are incorporated herein by reference in their respective entireties.
It is understood that this diagram is an illustration of an exemplary type of device in which the invention may find application, and is not intended to limit the scope of the present invention. Other implantable medical devices, such as those described previously, having functional organizations wherein the present invention may be useful, may also be modified to incorporate an integral IMD battery housing for containing a flat liquid electrolyte battery and flexible wiring substrate in accordance with the present invention. For example, the present invention is also believed to be useful in conjunction with implantable pacemakers/cardioverters/defibrillators as disclosed in U.S. Pat. No. 4,548,209 to Wielders, et al.; U.S. Pat. No. 4,693,253 to Adams et al.; U.S. Pat. No. 4,830,006 to Haluska et al.; and U.S. Pat. No. 4,949,730 to Pless et al.; all of which are incorporated herein by reference in their respective entireties.
The foregoing description of the various embodiments of the invention has been presented for the purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise form disclosed. Many modifications and variations are possible in light of the above teaching. It is intended that the scope of the invention be limited not by this detailed description, but rather by the claims appended hereto.
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Photo: Bodyboarders shred treacherous waves at Shark Island
Photo: Bodyboarders shred treacherous waves at Shark Island
Tue, Jul 24, 2012 at 10:46 AM
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Photo: Matt King/Getty Images
Shark Island Challenge
Ewan Donnachie of Australia competes on July 24 in the finals for this year's Shark Island Challenge just off the coast of Cronulla near Sydney, Australia.
Touted as the world's ultimate bodyboarding championship, the challenge features dangerous, barreling waves caused by a sharp and treacherous reef break.
* * *
Also on MNN:
Want to see more great photos? Check out our Big Snapshot archive


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Simple, sleek, and sophisticated, the Bulletor Watch features a sleek black analog dial and date display with a color-matched, oversized crown protector and Eviga logo on the face. A Japanese quartz movement and water resistance up to 3 atm ensure you're getting the best in tech specs and style.
Band: Black rubber. Band width: 22 mm near case and at buckle. Case thickness: 14 mm. Case width: 50 mm at crown. Battery included. Water resistant to 3 ATM. Length: Up to 8.25". Movement: Japanese quartz.
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Lost Angelic Chronicles of Frane: Dragons Odyssey
Know Something We Don't?
You can submit new cheat codes for this game using our Cheat Submission Form.
Have We Been Fooled?
If you see a non-working or fake code in the list above, let us know by using our Problem Submission Form.


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My discography of albums and singles I've recorded drums and percussion on over the last 20 years are below.
They include 47 top 20 albums.
42 reached the top 10. My discography also includes 20 top 10 singles.
To date, I've recorded 17 number 1 albums and 10 number 1 singles which have featured on various pop and rock charts around the world.
A Spotify playlist of some tracks I've played on.


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Join Date: Apr 2009
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Part hippie-chick, part type-A career woman, all mama. Enjoying life as a wife to my partner of 11 years, and a mama to our smarty-pants toddler, Cadence.
wife of 8 years to DH , mama to DD (2006) & DS (2011) (Dec. 2012) due Nov. 2013
me, my man, and our boys (1/08 and 3/11)
Homebirth Midwife
After 4 m/c, our is here!
Fiction writer by training, writer/editor of anything anyone will hire me for by trade. Me + D=my girls E (4/2011) and little N, 1/2014.
Mommy to three girls DD 6, DD 3.5,DD 8/2011 & new babe 3/2013, 2 's 1/2008 and 8/2010
Shannon~mother to 7 #8 due @Sept 8th.
Jill, wife to J, mama to O (10/03), MK (7/05), (7/09), A (5/4/10), and ***4***8***12***16***20***24***28***32***36*****
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"I use this product for Real Estate, to market my properties. I like it because it looks professional, its easy to customize and it is small enough to pass out to people with relevant information on the inside."
"I love these cards they are exactly what I was looking for and the process was easy with wonderful customer service and prompt processing and shipping!"
"This product was amazing when it arrived! Exceeded all expectations. My only complaint is that I wish I would have chosen GLOSS when I made the order! Aside from that, this was as expected! I purchased it so people could use it as a "picture" for their wallet with multiple images captured from my son's birthday party."
"I designed a business card using photos of my work. The online design process is relatively easy, although the view varies from device to device (my iPad had better images than my laptop). The option to see a proof and update the product is very helpful, and the person providing prrofs was very responsive. I also like the option of up to three updates (I'd missed an error in my email address, it was easily fixed)."
"I had a lot of fun designing this card. I was able to use one of my own favorite photos as a backdrop, and then play with various fonts and font sizes to come up with a look that pleased me. Because I am retired, I didn't need but a few lines of basic information. Tiny Prints allowed me to preview the results, and edit them over and over. Before my order went to print, I was given the opportunity to proofread the card one final time. The cards came nicely packaged, and the first thing that I thought was how substantial the card was. I am very pleased."


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Odd Jobs
Essays and Criticism
(If any tax is payable it will be calculated and shown at checkout.)
moreTo complement his work as a fiction writer, John Updike accepted any number of odd jobs—book reviews and introductions, speeches and tributes, a "few paragraphs" on baseball or beauty or Borges—and saw each as "an opportunity to learn something, or to extract from within some unsuspected wisdom." In this, his largest collection of assorted prose, he brings generosity and insight to the works and lives of William Dean Howells, George Bernard Shaw, Philip Roth, Muriel Spark, and dozens more. Novels from outposts of postmodernism like Turkey, Albania, Israel, and Nigeria are reviewed, as are biographies of Cleopatra and Dorothy Parker. The more than a hundred considerations of books are flanked, on one side, by short stories, a playlet, and personal essays, and, on the other, by essays on his own oeuvre. Updike's odd jobs would be any other writer's chief work. less
Random House Publishing Group; December 2012
1024 pages; ISBN 9780679645856
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Title: Odd Jobs
Author: John Updike
1024 pages; ISBN 9780679645856
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Title: Odd Jobs
Author: John Updike
Buy, download and read Odd Jobs (eBook) by John Updike today!
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The Hammer of Witches 2009 US$ 28.00 669 pages
Middle Egyptian Literature 2014 US$ 26.00 460 pages
The Fran Lebowitz Reader 2011 US$ 11.99 352 pages
If You Want to Write 2010 US$ 9.99
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The latest news from Edinburgh's Festivals, plus articles and features to help you get more out of the Festival City.
Tattoo heads back down under in 2016
The Royal Edinburgh Military Tattoo has announced plans to perform in Australia and New Zealand in February 2016.
Thundering Hooves 2.0 - a ten year strategy for the festival city
Thundering Hooves 2.0, a major strategy document to strengthen Edinburgh's position as the world's leading festival city, has been launched.
Edinburgh Art Festival announces 'Improbable City' commissions
Edinburgh Art Festival has unveiled its 2015 commissions programme under the title 'The Improbable City'
'Iona' will close Film Festival 2015
Edinburgh International Film Festival has announced this year's closing film - Scott Graham's enthralling drama, 'Iona'...
Imaginate Festival opens soon!
The Imaginate Festival opens next week, with 7 days of performing arts fun and entertainment for young people of all ages.
Robert Carlyle's black comedy to open Film Festival
The opening film of the 2015 Edinburgh International Film Festival will be Robert Carlyle's 'The Legend of Barney Thomson'
Jazz and Blues Festival reveals all!
Edinburgh Jazz & Blues Festival has launched a bumper programme for July 2015
Mela/Tattoo to hold open auditions for Bollywood spectacular
Edinburgh Mela and Royal Edinburgh Military Tattoo are after local dance enthusiasts to star in their 2015 Bollywood dance extravaganza
Film Festival 2015 to screen classic made-for-TV movies
Edinburgh International Film Festival will screen classic American TV movies as part of its 2015 programme
Jazz Festival reveals 40 more acts for summer
Edinburgh Jazz and Blues Festival has announced details of a further forty acts in their bumper 2015 programme.
On a Budget
Booking a bargain at the festivals is easy if you know how - here are some of our top tips for all 12 of Edinburgh's festivals...
Science Festival 2015 launches The Ideas Factory
Edinburgh International Science Festival has launched its full 2015 programme, transforming into The Ideas Factory...
- Follow us on Twitter Follow @edfests on Twitter


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'The Atlantic' Says 'Last Week Tonight' Is "Making a Difference in the Real World"
"This is the magic of John Oliver. It's been only 14 episodes so far (the show is slated for 19 this season) but the Last Week Tonight team has found a way to take a seemingly complicated issue, remove the talking points and cultural baggage surrounding it, break it into understandable parts—and then slowly rebuild it. It's an ingenious formula that's making a difference in the real world."
– Last Week Tonight with John Oliver is showered with more well-deserved praise in a new Atlantic piece called "How John Oliver Beats Apathy."


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Inside Insights
Bird diapers, helmet parachutes and tricycle lawnmowers: 10 strange and unusual patents
Over the years, the intellectual property group at WHGC has come across some very strange and unusual patents while conducting research, so we thought it might be fun to share with you those we found most interesting.
Navigating the middle stages of the EDRM: Data processing and searching/culling
The key for corporate legal departments is to utilize technology to get the results needed, while at the same time checking the results to ensure they are accurate and in the best interest of the case team.
A peek at the past to predict the uncertain future of software patent eligibility
While it is unwise to expect that there will be a Diehr-type shift back toward defining what is patent eligible (as happened after Flook and Bergy) as a response to Alice, it is equally unwise to expect the pendulum to stop swinging back-and-forth.
Avoiding personal liability amidst heightened AML enforcement
BSA/AML compliance officers have an opportunity and an incentive to redouble the involvement of senior management in every aspect of the institution's compliance regime.
8 arbitration surprises awaiting the uninitiated
This article provides a glimpse into the unique world of international arbitration and identifies some of the features that may be surprising to those more accustomed to U.S. litigation.
Has patent reform really hurt the patent trolls?
The debate continues whether more reform is needed, but further developments will occur, both in Congress and the courts and inside counsel need to stay alert.
Tips for new GCs: Managing law department information
As a new GC, you need to understand if your organization has a records management schedule and if the electronic content is being actively managed in an enterprise content management system.
Insurance for business litigation risks: Managing multiple policies
The scope of coverage for business tort claims varies widely from policy to policy and may overlap in multiple policies. As such, policyholders should undertake a careful analysis to identify all policies potentially triggered by a business tort claim in order to give timely notice.
Avoiding joint employment liability: The control factor
The key to avoiding liability is distinguishing between direct control (indicative of a true employment relationship) and quality control (indicative of a legitimate subcontracting arrangement).
A private conversation with a data privacy first responder
Jeff Scarpitti speaks with Theodore Kobus III, co-leader of the Privacy and Data Security Practice at Baker Hostetler, on the current state of cybersecurity regulations, emerging issues in the field and more.


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Subscribe now to vCloud® Air Special Offers.
Access VMware's NEW self-service pay-as-you-go public cloud, Virtual Private Cloud OnDemand, and get $300 in service credit for your first 90 days!
vCloud Air helps you transform IT in a radical way. Built on the trusted foundation of vSphere, it lets you consume IT without constructing IT so you can scale as you grow, by extending your current data center to the cloud with ease.
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Protect your application and data with VMware vCloud® Air™ Disaster Recovery, a recovery-as-a-service offering that supports capabilities for VMware vSphere® virtual environments. Simple to deploy and easy to scale, this cloud-based solution offers flexibility with minimal investment.
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If you are a new customer purchasing a vCloud Air subscription greater than one (1) month during the promotion period, you will receive the first month at no charge. In addition, you have the right to cancel your service within the first 30 days, with no penalty.


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It is an irony that the removal of superior court judges is in complete sync with the caste and regional politics.
Strangely judges who are under oath to be impartial in dispensation and act above caste find it easier to invoke the plea of caste or region that they belong to overawe the gravity of the allegations such as misconduct, corruption or amassing of wealth from unknown sources.
No fault can be found with the old adage that money is above caste, creed, faith, region, sex and legal and constitutional obligations. In a way it's secular in the real sense of the term.
When a woman high court judge faced the prosecution for taking bribe, she cried foul saying she was discriminated against for she is a woman.
Earlier in 90s when a Supreme Court judge V Ramaswami faced the inquiry under the Judges Inquiry Act, a step before impeachment by parliament, his sympathisers vehemently argued that he had been singled out because he belonged to the southern part of the country.
The north -south divide overtook the findings of the inquiry committee that had held him guilty of 'proven misconduct'.
However, a section of politicians who were more concerned with the fast-approaching polls in Tamil Nadu and its neighbouring states helped him out.
The Congress walked out at the crucial moment when the House was to pass the motion of removal by two-thirds of MPs present and voting. He escaped.
After being 'removed' unceremoniously, a judge is stripped of the right to call him or her a retired or a former judge.
That capitalisation on provincial sentiments had paid the dividends to Ramaswami. Now, Justice P D Dinakaran is following the footprints left behind by Ramaswami.
In his resignation letter to the president, Dinakaran says that he is being targeted as "he belongs to a lower caste'', and that he has a sneaking suspicion that his misfortune was because of his "birth in the socially oppressed and underprivileged section of the society''.
According to Dinakaran "integrity of members of these communities who attain high office is always baselessly questioned through innuendo, sneering and spreading of false rumours while the privileged are treated by the vested interests as embodiment of all virtues''.
He shouldn't forget that the first 'dalit' chief justice of India K G Balakrishnan had recommended his elevation to the apex court despite massive protests from within the member of collegium.


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Christopher and Rebecca Deskins would like to announce the birth of their son, Cole Christopher Deskins.
Cole was born March 4, 2014 at 2:41 p.m. at CAMC Women's and Children's Hospital in Charleston. He weighed 6 pounds, 13 ounces and was 21 inches long.
Cole is the grandson of James and Kathy Burns and Carl and Teresa Deskins, all of Pecks Mill. He is the nephew of Adam and Natasha Burns and has three special cousins, Parker, Kenleigh and Bennett Burns.
Cole is the great-grandson of Rainelle Browning, the late Frank Browning, William Burns Sr., the late Dicie Burns, the late Fred and Betty Ferrell, and the late E.N. "Slim" and Virgie Deskins.


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The Plaintiffs in Mack v. HH Gregg, Inc. sued the Defendants for breach of contract over the alleged failed installation of dryers.
The parties agreed the Defendants would produce a "summary of its dryer installation invoices that would include the state of the sale, date of purchase, amount paid for delivery and installation, and the make and model of dryer purchased."
The Defendants in turned produced an 11,757 page "locked" PDF summary for the Plaintiffs.
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Found 1 Item Tagged "pentimento"
Each of these works is the product of a religious tradition that synthesized and adapted new beliefs and art forms to e...
Hiroshige's One Hundred Famous Views of Edo
Hiroshige's 118 woodblock landscape and genre scenes of mid-nineteenth-century Tokyo, is one of the greatest achievements of Japanese art.
On View: Comb with Human Image
This narrow comb originally had long teeth, and it was probably worn as a hair ornament. The long beard on the face resembles that on the ca...
200 Eastern Parkway
Brooklyn, New York 11238-6052
Eastern Parkway/Brooklyn Museum
Wednesday: 11 a.m.–6 p.m.
Thursday: 11 a.m.–10 p.m.
Friday–Sunday: 11 a.m.–6 p.m.


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Pronunciation: Aramis
Added on: 2011-08-10 Listened: 2.1K timesin: name, first name, aftershave, Musketeer
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DMV to Internet-less New Yorkers: Get in Line
By Jared Chausow
By Katie Toth
By Elizabeth Flock
City Hid Facts From Feds About Rikers
By Albert Samaha
Flood Wall Street Gets Pepper Sprayed and Arrested
By Anna Merlan
By Jon Campbell
Report Sheds Light on Anti-Muslim Bias
By Jon Campbell
Rikers Island Lawsuits Over Diabetic Care
By Albert Samaha
Trio has declared June "Flops!" month, featuring this enticing original documentary about Michael Cimino's Heaven's Gate. The notoriously overbudget film effectively put United Artists out of business. This doc holds Cimino largely responsible for killing off the auteurist strain of '70s American film but also redeems him as a perfectionist artiste who sacrificed success for that vision thing.
Tuesdays at 9 on Bravo
Just like Rocco DiSpirito, Jonathan Antina celebrity hairdresser opening a new Beverly Hills salonis charismatic and talented, and has put his career at stake to star in his own reality show. Antin flirts with women (including a job applicant, whom he dates instead of hiring), which is presumably supposed to evoke memories of Warren Beatty's hedonistic character in Shampoo. But in the episodes I've seen, Antin's mostly obsessing over contractors and profit margins. Watching someone panic over his business may be entertaining, but it sure ain't sexy.
June 13, 6 to 11 p.m., on Sci Fi Channel
Timothy Hutton stars in this engaging five-part thriller (which will run in its entirety on June 13) about a physics professor who receives mysterious documents that suggest he will die in five days. The show takes a few too many notes from 24 and the noir classic D.O.A., but at least it has a sense of humor, slipping Blue Öyster Cult's "Don't Fear the Reaper" into the soundtrack.
Coverage begins June 21 on ESPN
Tennis fans, prepare your couches. This year, ESPN promises 120 hours of Wimbledon coverage, anchored by veteran commentator Dick Enberg.
This Week's Other TV Reviews:
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- When is the peak of Fall color in Jo Daviess County?
- Are there any scenic motorcycle rides in Jo Daviess County?
- When is the big craft fair in Galena?
- Where can I rent a wheelchair?
- Where can I stay with my pet?
- Where can I get visitor information once I get there?
When is the peak of fall color in Jo Daviess County?
Regarding the peak of fall colors, many factors determine their intensity and timing, such as the amount of precipitation and temperatures. Generally, a hard frost precedes the peak of fall colors. While we cannot predict the precise peak, if you contact us shortly before your visit we would be happy to give you an idea of how the colors are developing.
Are there any scenic motorcycle rides in Jo Daviess County?
Jo Daviess County is a beautiful place to take a motorcycle ride. Please be aware that many of the township roads have no shoulders or guardrails and some have gravel surfaces. Here are a couple of suggested routes along hard-surfaced roads:
2. Start on Stagecoach Trail in Galena and travel east towards Apple River. Just west of Apple River, take right (south) on Scout Camp Rd. to Woodbine. Turn left (east) on Highway 20 towards Stockton. In Stockton, turn right (south) on Highway 78 to Mt. Carroll. In Mt. Carroll, turn right on Highway 64/52 (west) to Savanna. In Savanna, take Highway 84 north through Hanover. In Hanover, turn left onto Blackjack Road and follow Blackjack Road back to Highway 20 into Galena..
When is the big craft fair in Galena?
The annual Galena Country Fair is held in Grant Park on the weekend before the Columbus Day holiday. In 2014, the fair will be held Saturday-Sunday, Oct. 11-12, in 2015 it will be held on Oct. 10-11 and in 2016 it will be held on Oct. 8-9. The fair attracts more than ten thousand visitors and lodging reservations should be made well in advance. For more information, please visit www.galenacountryfair.com.
Where can I rent a wheelchair?
Hartig Drug Store located at 11002 Bartell Blvd., about two miles west of downtown Galena, has two wheelchairs for rent. There is a $100 fully-refundable deposit and a $15 per day rental fee. You can reserve a wheelchair for use during your visit by calling Hartig's at 815.777.2700.
Where can I stay with my pet?
The following lodging properties accept pets:
Best Western Designer Inn & Suites, 815-777-2577
Chestnut Mountain Resort, 800-397-1320
Country Inn & Suites by Carlson-Stockton, 815-947-6060
Eagle Ridge Resort & Spa, 800-892-2269
Grant Hills Motel, 877-421-0924
Marcotte's Family Motel, 815-858-2217
Stoney Creek Inn, 800-659-2220
Timmerman's Hotel & Resort, 815-747-3181
Aaron's Cottages & Cabins at the Goldmoor, 815-777-3925
Allen's Log Cabin Guest House, 815-777-4777
Cloran Mansion & Antonio's Cottage, 866-234-0583
Galena Log Cabin Getaway, 815-777-4200
Goldmoor Inn, 815-777-3925
LeFevre Inn & Resort, 800-619-9500
Oscar Swan Country Inn, 815-541-0653
Peaceful Pines, 815-745-2536
Tierra Linda, 815-777-1234
A+ Reservations by Dixie, 888-801-3111
The Birds Nest, 847-516-3402
Cogan's Valley Ridge, 773-866-1344
Country View Home, 815-546-5581
Eagle Ridge Resort & Spa, 800-892-2269
Galena Rentals, 773-631-5253
Rocky Waters Vineyard/Winery, Inc., 815-591-9706
Rosebud Rentals, Inc., 877-858-2601
Where can I get visitor information once I get there?
Additional area offerings and visitor information may be found at the Galena/Jo Daviess County Convention and Visitors Bureau by calling 877.464.2536. While in town, visit the CVB's Old Train Depot Visitor Information Center at 101 Bouthillier St. (corner of Park Avenue) for on-site assistance and countywide information.


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Confusion about the L-3/Alenia C-27J's price tag relative to the C-130J's sparked one of history's most memorable lines from a Congressional hearing earlier this year on military acquisition. Here's that famous exchange between Rep Neil Abercrombie and USAF acquisition head Sue Payton:
"REP. ABERCROMBIE: Ms. Payton, you are right on the edge of getting into the Blues Brothers.
MS. PAYTON: Sorry sir, I don't mean to be there. I –
REP. ABERCROMBIE: That's when — when Jake says, Bill, but you liedto us about the band. They lied to me when I was in prison about theband. You haven't kept the band together. He goes, I never lied to you.I bullshitted you a little bit, but I never lied to you."
Six months later, Abercrombie's hunch proved right on the mark. The defense appropriations conference report approved by the House last week explains that the twin-engined C-27J costs much less than a four-engined C-130J after all. Here's the language:
"The report(H. Rept. 110-652) accompanying the House bill noted that, at the time of thereport, the Air Force was reporting a unit cost for JCA of $60.7 million, andwas reporting a unit cost for C-130J aircraft of $56.7 million.
Afterfurther discussion with the Air Force acquisition officials and clarificationof terminology, we believe that a fairer, apples-to-apples comparison of suchcosts would raise the comparable average procurement unit cost for a C-130J to $84.2million, in terms of fiscal year 2007 dollars."


text:
You'll Get Through This: Hope and Help for Your Turbulent Times
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Product Description
Sometimes the challenges of life threaten to overwhelm us. We wonder how we'll carry on after the day the bottom dropped out. For you, it may have been the day of a financial crisis, a bad diagnosis, an accident, or you were served divorce papers by your spouse. Whatever it was, you knew your life was going to change dramatically, and it didn't seem like it was for the better.
In You'll Get Through This: Hope and Help for Your Turbulent Times, Max Lucado encourages readers through sharing the Biblical story of Joseph. Stripped of his identity, thrown into a pit and sold as a slave, his was a story of defeat and challenges, but as time passed God worked through his circumstances to bring redemption and reconciliation. And although it may seem hard to believe, you will get through this too.
The story of Joseph's life didn't end in the pit and neither does yours.
Product Information
|Format: Hardcover
Number of Pages: 240
Vendor: Thomas Nelson
Publication Date: 2013
|Dimensions: 9.50 X 6.50 X 1.0 (inches)
Availability: In Stock
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Publisher's Description
Youll get through this.
It wont be painless.
It wont be quick.
But God will use this mess for good.
Dont be foolish or naïve.
But dont despair either.
With Gods help, youll get through this.
You fear you won't make it through. We all do. We fear that the depression will never lift, the yelling will never stop, the pain will never leave. In the pits, surrounded by steep walls and aching reminders, we wonder: Will this gray sky ever brighten? This load ever lighten?
In You'll Get Through This, pastor and New York Times best-selling author, Max Lucado offers sweet assurance. "Deliverance is to the Bible what jazz music is to Mardi Gras: bold, brassy, and everywhere." Max reminds readers God doesn't promise that getting through trials will be quick or painless. It wasn't for Joseph--tossed in a pit by his brothers, sold into slavery, wrongfully imprisoned, forgotten and dismissed--but his Old Testament story is in the Bible for this reason: to teach us to trust God to trump evil.
With the compassion of a pastor, the heart of a storyteller, and the joy of one who has seen what God can do, Max explores the story of Joseph and the truth of Genesis 50:20. What Satan intends for evil, God redeems for good.
Author Bio
More than 120 million readers have been inspired by the words of Max Lucado. He lives with his wife, Denalyn, and their mischievous mutt, Andy, in San Antonio, Texas, where he serves the people of Oak Hills Church.
Product Reviews
Janet5 Stars Out Of 5you'll get through thisApril 28, 2015JanetQuality: 5Value: 5Meets Expectations: 5This review was written for You'll Get Through This: Hope and Help for Your Turbulent Times.i am still reading this book and i love it of course i haven't read a book by Max Lucado yet that i din't like .
i haven't found any product you sell that i don't like nor regret buying
By His Word Ministries5 Stars Out Of 5This is AWESOME!!April 21, 2015By His Word MinistriesQuality: 5Value: 5Meets Expectations: 5This review was written for You'll Get Through This: Hope and Help for Your Turbulent Times.This book is just what I needed to read. Even when you know you will the author has a special way of confirming that for you in this book. The example of Joseph is so on target of the things that could happen to us is not that bad at all and we will get through all things through Christ who strengthens us!!
roseNew York, NYAge: 55-65Gender: female5 Stars Out Of 5Terrific!March 2, 2015roseNew York, NYAge: 55-65Gender: femalePractical, inspiring book that will help you face life! I've used it to teach our adult Sunday School class and the folks have benefited tremendously.
blust5 Stars Out Of 5you'll get through thisOctober 3, 2014blustQuality: 5Value: 5Meets Expectations: 5I purchased this book for my aunt. She recently lost her husband. I thought this book would help. It is an excellent book on issues that happen to us in life. The book was as described and arrived in a timely manner. Thank you.
Angie5 Stars Out Of 5Amazing!October 3, 2014AngieQuality: 5Value: 4Meets Expectations: 5I am at the very end of this book and will read it again. The writing with scripture references is unbelievable. Max Lucado is a wonderful writer. I will definitely recommend this book to others I know that are going through turbulent times
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Guss Tuno
Edit Page Last Edit: 3 years 3 months ago
Guss Tuno is a male Mon Calamari, who becomes a Companion of a Smuggler class. He is not a Romance option.
At A Glance
- Accompanies: Smugglers
- Species: Mon Calamari
- Distinguishing Features: Bulging eyes
- Areas of Expertise: Healer
- Likes: Mocking Force users, profit from those who can afford it, a good scam
- Dislikes: Killing innocents, risking your neck for nothing
- Primary Stat: Cunning
- Secondary Stat: Endurance
- Primary Weapon: Blaster Pistol
- Secondary Weapon: Scattergun
- Crew Skills Bonus: +10 Archaeology,+2 Critical Treasure Hunting
- Favorite Gifts: Underworld, luxury, technology
BackgroundLanguss "Guss" Tuno was male Mon Calamari smuggler during the Cold War. A failed Jedi Padawan who abandoned his training, the enthusiastically greedy Guss Tuno prefered the Underworld lifestyle's potential for material riches. In a perfect Galaxy, Guss would spend his retirement lounging in a heated swimming pool surrounded by exotic beauties while consuming a steady diet of fresh fish and expensive cocktails.
Although he often speaks before he thinks, Guss had talked his way out of certain death many times. He often uses his minimal knowledge of Jedi--and the Lightsaber he stole from his old master--to fool gullible criminals into leaving him alone. When that failed, Guss revealed he's a much better shot than anyone would believe.
What Links Here
Smuggler | Class Companions | Smuggler Companions | Companion Gift Guide | Smuggler Companion Gifts Guide | Romance
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New York Family Assessment Response (FAR) Quarterly Vol. 2, No. 1 Pups Pave the Way for FAR Marcia Young, Administrator, family members in the home were, Child and Family Services, to use a technical term, "freaking Monroe County Department of out." The workers, armed with their Human Services recently acquired skills in family engagement, went head-on into the Monroe County received a report home to find out what all the fuss was from an outlying town. The family about. One family member managed had numerous previous reports, to communicate that the family dog and had not exactly welcomed the was having a litter of puppies at that previous workers in the home. The very moment. The grandmother was new report included concerns of chasing the dog around in an attempt inadequate guardianship regarding to have her deliver the puppies in marijuana use in the home. After one place instead of all over the several failed attempts to contact the house, and was finding it to be quite a family, two workers took the 32-mile challenge. journey out to the country to meet with the family and tell them about As it happens, the assigned Governor David A. Paterson the options for response, including caseworker had previous experience FAR. delivering puppies (she formerly Commissioner Gladys Carrión, Esq. questioned whether it was a good Upon arrival, the workers found that idea to put this experience on the children were in school and the her resume) and she shared this information with the family. As soon as the grandmother heard this, she knew it was divine intervention and motioned for the worker to get in there and help her out. This newly trained FAR worker rolled up her sleeves and guided grandma through the delivery process. At some point during the process (there must have been a lull in the conversation), the worker was able to explain FAR, and grandma, elbow-deep in puppies, said she would like to participate in this process. An appointment was scheduled for the workers to return when the whole family would be there. The workers called back later to check on the puppies. The report is that the new mother and puppies are doing well. The caseworkers are a big hit with the family, the children are safe and the case remains open. Yes indeed, engagement was achieved. 1 www.AmericanHumane.org New York FAR Quarterly Vol. 2, No. 1 Raising the FLAG spring, 2009, that some were having difficulty completing the FAST (it had As with most functional assessment instruments, the FLAG is not Michelle Rafael, Senior Policy Analyst 41 assessment areas with separate designed as a checklist to be read to Joanne Ruppel, M.A., Research Scientist assessments for each parent and the parents or children, but as a way III, FAR Program Evaluator each child in the family). Another for workers to consistently record option was sought. A committee at the outcomes of a comprehensive As our program name, Family OCFS, with significant county input, assessment process that includes Assessment Response, indicates and adapted and shortened the FAST to discussions with family members our enabling legislation requires, an better meet the collective needs of and other sources of information assessment of each family is vital to users. The tool is designed to record as appropriate. FAR workers may comprehensively addressing family family strengths and needs on 23 provide family members with a copy needs, identifying family strengths to questions in four general areas (The of the FLAG instrument and use it as support those needs and responding Family Together, Caregivers' Status, a conversation starter, reference or in a way that meets those needs. Children's Status and Caregiver discussion guide. They may also use Advocacy Status). other approaches and tools they find When we began pre-implementation helpful in conducting comprehensive planning with Round 1 counties, Like the FAST, there are four detailed assessments tailored to each family. If we reviewed several assessment answer options for each question, workers do not share the FLAG with instruments used by other states which range from a clear strength to families, they can use the FLAG items (Hawaii, Minnesota, North Carolina) a need for immediate or intensive as a reminder to themselves to assess and even other countries (Ireland, service action. In some critical areas, all key areas listed. As each family is New Zealand). The Round 1 counties such as mental health or substance unique, there may be other strengths worked together to determine the abuse, the answer choices now or needs that the worker and family best fit for them and they even held explicitly address the family's current discuss, but an assessment of the a rare face-to-face meeting to review use of services, which the FAST did areas on the FLAG instrument is and discuss available tools. An almost not do. The tool became different considered the minimum that needs unanimous decision was reached enough from the original to merit its to be done for each family on the FAR to use the Family Advocacy and own name: Family-Led Assessment track. Support Tool (FAST), an adaptation Guide (FLAG), a name that captures of a series of outcome management the engagement spirit — a hallmark tools collectively known as the Child of our FAR approach. and Adolescent Needs and Strengths Assessment, originally developed by John S. Lyons, Ph.D., for the child Q: Is OCFS writing guidelines for FAR mental health population and later documentation in Connections? expanded with additional sections for A: Great question! When the case review was being the child welfare and juvenile justice completed in December, we all realized that some populations. guidelines for what to include in the record would In the spirit of learning and evolving be very helpful. FAR supervisor Faith Aprilante as we go, OCFS allowed a tryout from Orange County is chairing such an effort to use period of approximately six months the expertise of many current FAR supervisors to create once counties began FAR practice. a helpful document. Stay tuned for the results, due out Even after Tompkins County modified the FAST language to be more family- before the next newsletter. friendly, it became evident by late If you have a question you'd like addressed, please send it to email@example.com. 2 www.AmericanHumane.org New York FAR Quarterly Vol. 2, No. 1 Creating a Favorable Buzz About Our Work With Families Kerron Norman, Director of Child familiar with some of the dimensions reached out to the press to cover Welfare, Westchester County Department of this response. This familiarity also the schools' success story. The press of Social Services created a favorable buzz about our in turn reached out to WCDSS and new way of engaging families. some of the partners for our input, How did the Westchester County which resulted in a second article. Department of Social Services get Roughly six months subsequent We later collaborated with the Vera favorable press on family assessment to launching the FAR model, we Institute of Justice, which produced a response? Timing combined with decided to celebrate the successes comprehensive document that speaks strategy. of the families we'd worked with. well of Yonkers' dedication and We were inspired by three things: response to truancy. Since early 2007, WCDSS Child an 18.6 percent improvement in Welfare Services has participated in a school attendance over a two-year In short, good news and good will are multidisciplinary Truancy Reduction period since the start of the Yonkers worth announcing. Task Force. This collaboration started Truancy Reduction Taskforce; a desire from a shared concern about the high to support the Graham Windham rate of truancy in Yonkers. It involves foster care agency's Graham Youth the Yonkers Board of Education, the Development Program, which trains probation and police departments, youths for careers in the catering the district attorney's office, Student industry and other fields; and the Advocacy and other community Governor's proclamation that 2009 service providers. In alignment was the Year of the Caseworker. with this focus, Yonkers piloted an educational neglect unit in the As we planned our celebration, we child protective services program to began to recognize that we were respond to the majority of truancy- in a good place to announce to the related allegations. The following year, Westchester County community when OCFS initiated the FAR model, this "feel good, done good" news we saw it as a natural progression for story about our child welfare work. our work with educational neglect We consulted with the county's cases. first deputy commissioner and the communications director about We announced our plans to the task our celebration plans and received force and answered their questions. a favorable response to releasing We educated our partners on Social the story to the press. The press and Services Law 427-a, which addresses the community responded quite the legality of a differential response, positively. and referenced the OCFS website for additional review. Extremely helpful The school district also received to us was that several years ago, a favorable community response WCDSS piloted a differential response to FAR and the truancy reduction approach, so the partners were strategies. The school superintendent Helpful Resources From the American Humane Association: • A Social Worker's Tool Kit for Working with Immigrant Families, which includes A Child Welfare Flow Chart and Immigration Status and Relief Options: Download a copy at www.americanhumane.org/migrationtoolkits • Guidelines for Family Group Decision Making in Child Welfare: Download a copy at www.fgdm.org • The Quality Improvement Center on Differential Response in Child Protective Services: www.differentialresponseqic.org 3 www.AmericanHumane.org New York FAR Quarterly Vol. 2, No. 1 FAR Quality Assurance Case Review Gail Haulenbeek, OCFS, and other states are doing for quality ◦ Case activity consistent with Faith Aprilante, Orange County FAR assurance but nothing met our FAR model is documented in Project Coordinator and Case Supervisor needs. As a group, the Round 1 progress notes counties and OCFS decided that the ◦ Appropriate use of informal What is "typical" FAR practice? development of quality assurance services and family support How do supervisors, managers, tools was needed and that it would be network administrators and OCFS know what beneficial to everyone to get a better FAR practice looks like with families? ◦ Case closings or openings for understanding of what we could learn How do we know if FAR case practices formal preventive services that about FAR case practice by a review of and services are providing for are within county-targeted casework records. children's safety and building families' time frames and appropriate capacities to care for their children? To get started on the development of to case circumstances a first-generation quality assurance These questions have been raised • Practice fidelity process and tool set, OCFS invited the by FAR counties and OCFS during FAR counties to have a representative ◦ How well/clearly are conference calls and at the FAR participate in a conference call to caseworkers explaining the symposium. As FAR has grown from develop the requirements for a review two options? an idea into a significant portion tool and process. The group agreed of some districts' child protection ◦ How well are caseworkers that the following dimensions of response systems, we have all begun explaining the issues of FAR practice needed to be examined to expand our focus from startup to concern and engaging through a case review: continuous quality improvement. all family members in a Now that we know what FAR is and • Model fidelity discussion of their views have developed our implementation of those issues and other knowledge and skill set, the time ◦ Case track assignment in line concerns of the family? has come for us to ask ourselves, "so with county criteria how are we doing?" The future of ◦ First contact: timely call, ◦ How thoroughly are workers FAR in New York will be determined appointment setup versus exploring/eliciting each in part by what we learn now about unannounced visit family's strengths and the quality and effectiveness of FAR potential solutions to ◦ Safety: accurate and timely identified issues? practices, so knowing as much as we initial and ongoing assessment can about how FAR is being practiced ◦ Are strengths-based and is very important to all of us. ◦ Re-reporting when danger is solution-focused techniques identified and/or family not being used? The Needs and Requirements cooperating with FAR after FAR track was chosen ◦ Is there sufficiency/ We agreed that we need a quality adequacy of engagement and ◦ Assessments of safety and information gathering on areas assurance process for FAR. Our family strengths and needs of family functioning that tools for assessing the provision (FLAG or other approved impact child safety and well of traditional CPS investigation assessment tool) are consistent being? and assessment clearly would with case circumstances and not meet the need. OCFS asked ◦ Are families being supported documented American Humane to identify what to make decisions regarding what actions, supports or services might be needed? ◦ Do the services or solutions fit the family's needs and reduce the likelihood that maltreatment will occur? ◦ Is the level of casework contacts and efforts commensurate with family strengths and needs? (Continued on page 5) Training Participants, Livingston and Yates Process & Practice Training, April 6-7, 2010 4 www.AmericanHumane.org New York FAR Quarterly Vol. 2, No. 1 (Continued from page 4) regarding answers to all of the review The report was shared with the questions. counties early in February. Individual ◦ What is the quality of decision debriefing conference calls were set making on closing the case The Review up so that each county could discuss or opening it for preventive its findings with OCFS and American services, including a warm During the week of Dec. 7, 2009, three Humane. The findings were mixed; handoff? 3-person review teams met at OCFS some strengths and a number of to review 94 cases, with roughly equal practice soft spots were identified. ◦ What is the quality of numbers of cases from each of the six Like everything else related to FAR, it supervision in guiding staff Round 1 counties. Reviewers included was a great learning experience. We members' work with families, Faith Aprilante from Orange County, expect that the review will launch a in coaching their engagement Steve Grome from Onondaga County lot of discussion, self-assessment and and interviewing skills and Gina Newlin from Tompkins more work to develop useful tools for with families and in setting County; Lara Bruce, Debra Gilmore the counties and OCFS to assess and expectations for the quality of and Lauren Morley from American promote quality FAR practice. the FAR process? Humane; and Margaret Coombs, Based on this agreement, OCFS Sonoma Pelton and Karen Sessions, staff developed a draft case review professional development program tool and process in consultation associates from the regional offices. with American Humane and the Each case was reviewed by all three Round 1 counties. It was important review team members and one to everyone that all the perspectives review consensus was reached. The of those of us involved in FAR be process was challenging, as at this represented in the review. In order to point in the evolution of FAR in New do that, a process was developed in York, no specific standards for case which a 3-person team, comprising documentation had been developed; a representative from American thus, documentation varied widely. Humane, an OCFS Regional Office American Humane developed a staff person involved in FAR report on the findings and worked implementation and a county FAR with the reviewers to be sure that the supervisor or worker, would review findings were accurately represented. case records and come to consensus tive: rilan te shares her perspec coordinator Faith Ap FAR implementation t to each case by e perspectives brough a very inter esting experience. Th scussion about FAR practices Participating in this case review was r quite thoughtful di ict reviewers made fo s. Many of the large themes gleaned OCFS and local distr American Humane, nt do cumentation method d not find surprising es through our curre reviewed, which I di and how that translat t among each of the districts the documentation of the from this expe rience were consisten dantly clear throug h this process is that g. What became abun documentation to be ture in order for the but did find reassurin ilies needs more struc ality assurance, I aking with our FAR fam ue to the nature of qu great efforts we are m flecti on of our practice. Tr ate our practice as we ll clear and accurate re ourselves and evalu useful and present a lpin g us "check in" with collaborate in was quite useful in he stricts have agreed to feel that this review w, many of the FAR di e guidelines will help what reso nated from the revie It is hoped that thes as our needs. Using documentin g within a FAR case. d at the same time wo rk to idelines to follow in their case records an developing gu arly demonstrated in that their work is cle our FAR staff ensure actice. ross the state improve casework pr l work being done ac such great, cre ative and thoughtfu view is that there is is innovative work! What I saw in this re ocess only adds to th to evaluate our pr and that continuing Write for Us! The American Humane Association provides this newsletter to New York Contact us with your ideas so we can counties currently implementing get them into our schedule. We'll feature Family Assessment Response. one story per issue. Please reply to Lara Bruce at firstname.lastname@example.com. 5 www.AmericanHumane.org
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Cate, Krysyna, and Stephanie.... thank you, thank you, thank you!!
I'm pleased with my site, and it was pretty easy to put together. Perhaps it's a generational thing, mine invariably cost more than what you'll be able to pull together, but it saved me a lot of time and frustration, I think, as I have never bothered to learn any HTML, of CSS, or even Photoshop!
Good luck with your projects, and let us know when you have them online... I'd love to see it!