text:
A system and method of developing better-designed medical devices, particularly cardiovascular stents and endovascular grafts. The system comprises a geometry generator, a mesh generator, a stress/strain/deformation analyzer, and a visualization tool. In one embodiment, the geometry generator receives three-dimensional volumetric data of an anatomical feature and generates a geometric model. The mesh generator then receives such geometric model of an anatomical feature or an in vitro model and a geometric model of a candidate medical device. In another embodiment, the mesh generator only receives a geometric model of the candidate medical device. Using the geometric model(s) received, the mesh generator creates or generates a mesh or a finite element model. The stress/strain/deformation analyzer then receives the mesh, and the material models and loads of that mesh. Using analysis, preferably non-linear analysis, the stress/strain/deformation analyzer determines the predicted stresses, strains, and deformations on the candidate medical device. Such stresses, strains, and deformations may optionally be simulated visually using a visualization tool.
1. A computer system including at least one processor and memory for analyzing medical devices comprising:
a geometry generator that receives three-dimensional volumetric data of at least one anatomical feature(s) and generates a geometric model of said anatomical feature(s);
a mesh generator that receives said geometric model of said anatomical feature(s) and a geometric model of a medical device, and generates a finite element model representing both of said geometric model of said anatomical feature(s) and said geometric model of said medical device; and
a stress/strain/deformation analyzer that receives said finite element model, material properties of said anatomical feature(s) and said medical device, load data on said anatomical feature(s) and/or said medical device and simulates an interaction between said anatomical feature(s) and said medical device over at least one dynamic expansion and contraction cycle of the anatomical feature(s) to determine predicted stresses, strains, and deformations of said medical device due to the interaction of the medical device with the anatomical feature(s).
2. The system of
3. The system of
4. The system of
5. The system of
6. The system of
7. The system of
8. The system of
9. The system of
W=a 10(I 1−3)+a 01(I 2−3)+a 20(I 1−3)2 +a 11(I 1−3)(I 2−3)+a 02(I 2−3)2 +a 30(I 1−3)+a 21(I 1−3)2(I 2−3)+a 12(I 1−3)(I 2+3)2 +a 03(I 2−3)3+�K(I 3−1)2
with K=2(a 10 +a 01)/(1−2v) where
aij are material parameters;
v is Poisson's ratio;
K is the bulk modulus given as a function of Poisson's ratio; and
I1, I2, and I3 are first, second, and third invariants of a right Cauchy-Green strain tensor, respectively.
10. The system of
11. The system of
12. A computer implemented method for analyzing a medical device comprising:
acquiring three-dimensional volumetric data of at least one anatomical feature of a patient;
generating a geometric model of said anatomical feature(s);
receiving data representing a geometric model of a candidate medical device design;
receiving said geometric model of said anatomical feature(s);
generating a finite element model representing both said geometric model of said anatomical feature(s) and said geometric model of said candidate medical device design with a mesh generator;
receiving material properties of said anatomical feature(s) and said candidate medical device design;
receiving load data imposed on said candidate medical device design and said anatomical feature(s); and
simulating an interaction between said anatomical feature(s) and said candidate medical device design over at least one dynamic expansion and contraction cycle of the anatomical feature(s) with a stress/strain/deformation analyzer to determine predicted stresses, strains, and deformation of said candidate medical device design by said load data.
13. The method of
14. The method of
15. The method of
16. The method of
17. The method of
18. The method of
19. The method of
20. The method of
W=a 10(I 1−3)+a 01(I 2−3)+a 20(I 1−3)2 +a 11(I 1−3)(I 2−3)+a 02(I 2−3)2 +a 30(I 1−3)+a 21(I 1−3)2(I 2−3)+a 12(I 1−3)(I 2+3)2 +a 03(I 2−3)3+�K(I 3−1)2
with K=2(a 10 +a 01)/(1−2v) where
aij are material parameters;
v is Poisson's ratio;
K is the bulk modulus given as a function of Poisson's ratio; and
I1, I2, and I3 are first, second, and third invariants of a right Cauchy-Green strain tensor, respectively.
21. The method of
22. The method of
23. The method of
This patent application is a continuation and claims the benefit of U.S. patent application Ser. No. 09/679,725, filed Oct. 4, 2000 now U.S. Pat. No. 7,840,393, naming Robert G. Whirley and Michael V. Chobotov as inventors, entitled VIRTUAL PROTOTYPING AND TESTING FOR MEDICAL DEVICE DEVELOPMENT, the entirety of which is incorporated by reference herein, including all text and drawings.
1. Field of the Invention
This invention relates to systems and methods of developing better-designed medical devices, specifically, intracorporeal medical devices and particularly cardiovascular stents and endovascular grafts.
2. Background and Description of Related Art
Atherosclerotic vascular disease is a significant health problem facing the world population today. Atherosclerosis results in two primary types of lesions—occlusive and aneurysmal, with the aorta being the primary site of aneurysmal disease. Occlusive disease is a process in which a vessel lumen becomes narrowed and the blood flow restricted. Occlusive disease is typically associated with plaque buildup on the vessel wall or a biological response to vessel injury. One approach to treatment of occlusive disease involves placing a stent inside the vessel to act as a structural scaffold and hold open the vessel, and also possibly to provide local drug delivery or local radiation treatment. Aneurysmal disease is a process in which a vessel dilates under the influence of hemodynamic pressure, and may ultimately lead to rupture of the vessel and severe internal bleeding. One approach to treatment of aneurysmal disease involves placing a TPEG (transluminally placed endovascular graft, or "stent graft") across the aneurysm, excluding the aneurysm from hemodynamic pressure and thereby reducing or eliminating the risk of rupture. Examples of such grafts can be found in co-pending U.S. patent application Ser. No. 09/133,978, filed Aug. 14, 1998 by Chobotov, which is hereby incorporated by reference herein in its entirety.
A TPEG is an endovascular prosthetic device that lines the interior of an artery to provide flow path integrity and structural support to the damaged or diseased blood vessel. TPEGs are sometimes called "stent grafts" because they were originally created using combinations of stents and synthetic vascular graft segments. TPEGs are delivered to a blood vessel location in a compressed state, through an incision, and are then deployed at the location of concern.
The current development process of TPEGs and medical devices generally, usually involves the reiterative and sequential steps of designing, fabricating the prototype, and testing the prototype until the required performance specifications are met. Fabrication of the prototype entails the building of the actual medical device, e.g., a TPEG. Testing can involve animal testings, human clinical trials, stress, strain, and deformation testing, and the like. Stents, TPEGs and other medical devices have suffered from long development times and from design deficiencies discovered late in the development and testing process. Thus, the development of improved medical devices could be significantly accelerated if design deficiencies could be identified earlier, before committing to lengthy laboratory testing, animal studies, and human clinical trials. A system that enables early evaluation of many aspects of device performance in vivo, and is applicable to development of stents for occlusive disease, TPEGs for aneurysmal disease, and other medical devices is highly desirable.
In designing a TPEG, several factors must be taken into account, such as the structural integrity of the TPEG, the prevention of perigraft leaks, the need for a more easily-controlled TPEG deployment to allow a more precise positioning of the TPEG, the kink resistance of the TPEG, the morphology of the arterial walls, the relatively large size and lack of TPEG flexibility in the undeployed configuration (which can create difficulties in passing the TPEG from its insertion site to its deployment site), and the like. In vivo boundary conditions and forces, particularly dynamic or static cyclic in vivo forces, and the material properties of a TPEG are also important factors. Taking these factors into consideration during virtual testing and development of a medical device generates a more accurate assessment of the maximum stresses, strains, and deformations, over time that may potentially be handled by a medical device such as a TPEG.
In designing a stent, several factors must be considered including radial force, crush resistance, flexibility (in both the compressed and the deployed configurations), fatigue life, and tissue intrusion through open stent cells. A system that allows rapid evaluation of these and other characteristics of a stent design before hardware prototypes are constructed, thereby reducing the cost and time required for development and also expanding the designer's capability to explore more exotic designs and possibly discover new and more advantageous stent designs within a given budget and timeframe is highly desirable.
Thus, systems and methods which allow accurate virtual testing of a medical device design with respect to one or more of the above noted factors, in addition to other factors not specifically enumerated, without the need for an actual prototype of the design, are needed. Such systems and methods can reduce the cost of medical device development and increase the safety and efficacy of the designs.
The invention provides a system and method for developing better-designed medical devices and particularly cardiovascular stents and endovascular grafts. The system comprises a Geometry Generator, a Mesh Generator, a Stress/Strain/Deformation Analyzer, and, optionally, a Visualization tool. The invention may obtain anatomic data from 3D volumetric data. In other embodiments, the invention utilizes an idealized anatomical feature, an in vitro model, or no anatomical feature at all.
In one embodiment, the Geometry Generator receives three-dimensional volumetric data of an anatomical feature and accordingly extracts the surface points of such data, which in turn is received by the Mesh Generator. In another embodiment, the Geometry Generator based on algorithms available in such Geometry Generator software generates an output that is directly received by the Mesh Generator. Using the output generated by the Geometry generator and the geometric model of a candidate medical device, the Mesh Generator generates a mesh or a finite element model incorporating either the anatomical feature or in vitro model and candidate medical device. In an embodiment where no anatomical feature is used, a mesh only incorporating the candidate medical device is generated. The Stress/Strain/Deformation Analyzer then receives the mesh and the material models, the loads and/or displacements placed on the anatomical feature or in vitro model, if applicable, and the candidate medical device. Using stress and strain deformation analysis, particularly non-linear analysis, the Stress/Strain/Deformation Analyzer simulates and analyzes the potential in vivo stresses, strains, and deformations or motions of the candidate medical device. Such strains, stresses, and deformations may optionally be displayed using a Visualization tool.
Various embodiments of the invention can be used to provide a variety of useful functions and capabilities to those who design, manufacture and use medical devices. Specifically, embodiments of the invention may be used to model anatomical features or anatomical environments dynamically. As a result, a computer generated model of a medical device, or the like, may be virtually placed or deployed within the anatomical model to measure the response of the device to the environment. The dynamics of the computer generated model of the anatomical features or environment can be accelerated dramatically such that large numbers of normal biological cycle, such as a heartbeat, can be imposed upon the computer generated medical device model in a relatively short period of time.
This gives medical device designers the ability to virtually test a proposed design in a short period of time relative to the time it would take for a similar number of dynamic biological cycles in vivo. Thus, the iterative process of device design and testing of designs is accelerated and improvements in medical device technology can be achieved at a quicker rate. Further, embodiments of the invention can be used to vary and test material properties of medical device components over a broad range in a short period of time using the non-linear modeling capabilities of the embodiments. This capability can be used to select materials having optimal properties for producing the safest and most efficacious designs within a given set of design parameters.
Another benefit of embodiments of the invention is directed to varying material and configuration properties of models of anatomical features such that a simulation of testing of a given device could be performed in a large number of patients, as might be carried out in a large scale clinical trial. If the statistical variation of tissue parameters of a given anatomical feature is known for a given patient population, a medical device model could be tested in anatomical models which vary over such a given range. In this way, a large scale clinical trial could be modeled with embodiments of the invention, at least as to certain performance parameters, without the need for large numbers of actual patients being subjected to clinical testing. The data generated from such a clinical trial modeling exercise could be used to produce or refine the design of a medical device such that it performs optimally over a broad range of anatomical environments. The design could be refined using such data to improve robustness and adaptability of the medical device design.
Also, it is possible to use embodiments of the invention to identify failure modes of given medical device designs when such designs are subjected to dynamic mechanical and chemical forces. By identifying the cause of failure in a design, the "weak link" in the design can be pinpointed and necessary corrections to materials or configuration made in order to obviate the problem. It is also possible to test theories of failure experienced during in vivo clinical testing using embodiments of the invention. In other words, if an in vivo clinical failure of a medical device should occur, there may be one or more theories postulated as to the cause of the failure, particularly in a situation where multiple components of a device have failed and it is not clear from the clinical data which failure occurred first, or if an initial failure of one component of the device precipitated subsequent failure of other components of the device. The dynamic modeling capabilities of embodiments of the invention can allow rapid testing of multiple theories as to the timing and causation of complex failure modes and quickly determine which of the postulated theories is correct.
In addition, the dynamic, non-linear analysis modeling capabilities of embodiments of the invention allow a physician, who is responsible for use or implementation of a medical device, to more accurately choose a proper size or type of medical device based on a specific patient's anatomy. Such is the case when a specific patient's anatomy or anatomical feature is substantially duplicated by a computer model of an embodiment of the invention generated from 3-D volumetric image data, or the like. A large number of sizes or types of virtual medical devices can then be placed and tested within the patient's specific anatomical feature to determine optimum safety and efficacy of the design choice.
The following detailed description illustrates an embodiment of the invention by way of example, not by way of limitation of the principles of the invention. Various embodiments of the invention will be described by way of illustration with reference to various software tools, but it should be understood that other software tools that have a comparable capabilities of the mentioned tools may be used and other medical device aside from TPEGs may also be developed using this invention. In addition, although the invention is discussed in the context of prosthesis and specifically endovascular grafts, this is in no way meant to limit the scope of the invention.
Systems and methods of embodiments of the invention are suitable for the development and testing of medical devices including those for therapeutic, diagnostic, monitoring and the like purposes. In general, any device that interacts inside a patient's body may be better developed and tested with the systems and methods of embodiments of the present invention.
Embodiments of the present invention are also well suited for development and testing of intracorporeal devices or prosthesis that generally have an acute interaction with anatomical features of a patent. A list of such devices, which is in no way exhaustive, could include endovascular grafts, stents, pacemakers, artificial joints, artificial tendons, heart valves, artificial limbs, orthopedic hardware, surgical equipment such as sutures, staples, etc., and the like.
Embodiments of the present inventions are particularly well suited for the development and testing of devices for use in the vascular system or other bodily systems that have stresses, strains, and deformations which are dynamic, or quasi-static, and cyclic in nature, e.g., the rhythmic pulsing of the arterial system resulting from variations in blood pressure from the patent's beating heart and the resulting cyclic dynamic or quasi-static stresses, strains, and deformations these variations impart on the patient's arteries and medical devices disposed therein or thereon.
Embodiments of the present invention are also suitable for development and testing of interventional medical devices, which have only transient or temporary contact with the anatomical features of a patient. Illustrative examples of such devices can include catheters, balloons, atherectomy devices, guidewires, and the like.
In addition, although the embodiment of
The output of the Mesh Generator 130 is then received by the Stress/Strain/Deformation Analyzer 160. The Stress/Strain/Deformation Analyzer 160 also receives Materials Model data 170 and Load data 150 as input, which may also be outputs of the Mesh Generator 130. The output of the Stress/Strain/Deformation Analyzer 160 comprises the medical device performance data for evaluation, which may then be received by the Visualization tool 180 as input. The Visualization tool 180 in turn displays, through animation or visual representations, the predicted stresses, strains, and deformations on the candidate prosthesis "virtually in vivo."
In an embodiment of the invention, the Geometry Generator 120 is a custom-developed software tool or the MIMICS software from Materialise NV (with offices in Ann Arbor, Mich., USA); the Mesh Generator 130 is TRUEGRID� of XYZ Scientific Applications, Inc. (Livermore, Calif., USA); the Stress/Strain/Deformation Analyzer 160 is a modified version of NIKE3D or DYNA3D available from Lawrence Livermore National Laboratory (LLNL); and the Visualization tool 180 is the GRIZ visualization software, also developed by LLNL.
The unique combination of tools, data, and processing techniques as described herein in conjunction with the preferred embodiment provides a more accurate in vitro representation of anticipated in vivo forces exerted on medical devices and thereby reduces cost and time in the fabrication and testing of prototypes.
The various systems or components 120, 130, 160, 180, inputs (e.g., via files), and outputs (e.g., via files) of the present invention may be contained in one or in a plurality of computers. Thus, the Geometry Generator may be contained in one computer, while the Stress/Strain/Deformation Analyzer and the Visualization tool are run and contained in a separate computer. Furthermore, the inputs need not directly be received by the receiving system, e.g., through a network transmission. The outputs for example, of the Geometry Generator may be stored in a floppy disk and read by a Mesh Generator via that floppy disk.
Certain researchers and scientists in the biological sciences have at their disposal a wealth of voxel data A voxel is the unit of CT or MRI reconstructions, represented as a pixel in the display of the CT scan or MRI. Well-established methods to extract triangular surface representations (hereinafter referred to "surface points") from these voxel data using criteria such as variation in density are available. An embodiment of the Geometry Generator 120 first extracts the surface points, at step 220, from the CT scan or the MRI image data (e.g., segmentation, contour based, or 3D approach). A CAD software is then used to generate the Geometric Model 230 of the anatomy scanned using the extracted surface points. The extraction of surface points can be implemented by writing a software program that implements the techniques stated above or by available software programs. An example of a software program that generates surface points based on CT scan or MRI data is PREVIEW from Medical Media Systems.
The output of the Geometry Generator 120 is in the form of an Anatomy Model 240, which contains the geometric model of the anatomy scanned. The Anatomy Model 240 and the Medical Device Model 140 (containing the geometric model of the candidate medical device) are then received by the Mesh Generator 130 as input (usually as CAD files). The anatomy model may be a portion or an element of the anatomy scanned. Similarly, the medical device model may be a portion or of an element of the candidate medical device. This is useful for analyzing the interaction between a portion of a candidate device, such as a proximal stent in a TPEG, and a certain anatomical feature, such as tissue. The Mesh Generator 130 then generates a finite element model incorporating both the anatomy model, whether idealized or actual, and the medical device model as represented by box 250.
In one embodiment, the geometric models of the anatomy and the medical device are created using CAD software. Generally, the geometric models are stored in the Initial Graphics Exchange Specification (IGES) format that is an industry-standard graphic file format for CAD systems. Because of its wide-use, many FEA software tools read and utilize the IGES format. In another embodiment, the geometric models are created directly in the Mesh Generator.
The Mesh Generator 130 in accordance with an embodiment of the invention is TRUEGRID�. TRUEGRID is a 3-D finite modeling and analysis tool that generates meshes or finite element models. It is a software that tessellates a geometric model into hexahedron brick elements and quadrilateral shell elements, creating a mesh or a grid. A FEA mesh generating tool, such as TRUEGRID, uses the anatomy model 240 and medical device model 140 created by a CAD software to generate a mesh. In another embodiment of a Geometry Generator 120 (not shown in the figures), the Geometry Generator is a software tool that interfaces between scanner data, such as CT, MRI, and technical scanner data, and Rapid Prototyping, CAD, or Finite Element analysis data. Such software tools typically generate surface points from such scanner data, which are then converted into STL (stereolithography), slice files, and/or IGES files, which may then be read by the Mesh Generator 130 as input. An example of such a Geometry Generator 120 is the "Materialise Interactive Medical Image Control System" (MIMICS) available from Materialise, referred to above. The output of the MIMICS program, for example, may be directly read and processed by the Mesh Generator 130. Thus, steps 220 and 230, illustrated in
DYNA3D is a general-purpose, explicit, three dimensional, finite element program for analyzing and simulating the large deformation dynamic response of inelastic solids and structures. DYNA3D and NIKE3D implement a number of material models, for example, including elastic, orthotropic elastic, and kinematics/isotropic plasticity. NIKE3D is a general-purpose nonlinear implicit, three-dimensional, finite element program for analyzing and simulating the finite strain and static and dynamic response of inelastic solids, shells, and beams.
FEA Stress/Strain/Deformation Analyzers, such as DYNA3D and NIKE3D, are capable of analyzing and simulating sliding interfaces, body force loads due to base acceleration, body force loads due to spinning (geometry-dependent), concentrated nodal loads, pressure boundary conditions (geometry-dependent), and displacement boundary conditions.
The Materials Model 170 is the numerical representation of the material characteristics of the medical device, the anatomy, and/or the in vitro model being analyzed. Loads include pressures, displacement, forces, and deformations. Using the mesh 250, the Materials Model 170, and the Load 150, the Stress/Strain/Deformation Analyzer 160 then analyzes and simulates the non-linear stress, strain, and deformation over time such as on a medical device (e.g., a TPEG and the arterial wall). The Stress/Strain/Deformation Analyzer in accordance with an embodiment of the present invention utilizes non-linear analysis (e.g., using non-linear formulas) or linear analysis to simulate and to analyze the non-linear static or dynamic behavior in the structure.
Once the Stress/Strain/Deformation Analyzer 160 has analyzed the stresses, strains, and deformations on the medical device, the Visualization module 180 (in
Generally, the numerical output of the Stress/Strain/Deformation Analyzer 160 may also be analyzed to determine the stresses, strains, deformations on the medical device without using the Visualization tool 180. Using the Visualization tool 180, however, facilitates such determination because the stresses, strains, and deformations are shown via a graphical and visual display. A virtual prototyping or simulation of a medical device design, rather than plain numerical output data, is thus produced.
In an embodiment, the Visualization tool 180 is provided by the above-referenced GRIZ software application. GRIZ is an interactive software for visualizing FEA results on three-dimensional unstructured grids, and calculates and displays derived variables from FEA software tools such as DYNA3D, NIKE3D, and TOPAZ3D (also developed by LLNL). GRIZ provides display control of the mesh materials on an individual basis, allowing the user to concentrate on the analysis and visually focus on important subsets of the mesh, and provides the ability to animate the representation over time.
GRIZ uses the Silicon Graphic Inc. (SGI) Graphics Library (GL) or Open GL for rendering and the "Motif widget" toolkit for its user interface. In order to compile and run GRIZ, both of these libraries are required. GRIZ can be used on SGI workstations as well as on SUN and other workstations using commercial GL emulation software.
Considering the visual result on the screen display 190, a user may then compare the candidate medical device as designed against selected performance requirements. If the selected design meets the performance requirements, then a prototype of the selected medical device design may be built and tested. In addition, the visual result on the screen display 190 can be used by a physician to aid in the selection of various versions (e.g., sizes) of a given medical device design. For example, prior to a procedure for placement of a TPEG in a patient's aorta, the physician may first virtually test the performance of various TPEG designs or various versions of a single TPEG design prior to the procedure. To accomplish this, the physician would obtain volumetric data from the patient's aorta by any of the various methods discussed above and input that data into an embodiment of a system 105 (in
If the version of the TPEG which was virtually tested by the system 105 falls short of the clinical requirements of the patient, another version may be tested and so on until an appropriate design is identified. The physician may then begin the actual procedure on the patient with the appropriate TPEG design version. The system 105 may be configured to display the performance of a given TPEG design version with regard to long term structural integrity, prevention of perigraft leaks or sealing function, the general sizing of the TPEG with respect to the patient's aorta and the like. With regard to testing of the long term durability or structural integrity of the TPEG or other medical device design, the system 105 has great utility. Specifically, system 105 has the ability, assuming the use of sufficiently powerful CPUs, to recreate large numbers of cyclic expansions and contractions in a short period of time. For example, as discussed above, the vascular system of a patient is constantly expanding and contracting as a result of dynamic or static pressure gradients within the vasculature from the patient's beating heart. These expansions and contractions can put stresses, strains, and deformations on intracorporeal medical devices, such as TPEG, which over time can lead to failure of the device. System 105 would give the physician the ability to quickly test a chosen TPEG design in a virtual model of the patient's expanding and contracting aorta for an amount of cycles that would equal or exceed the amount of cycles that would be expected in the patient's lifetime to determine the long term safety and efficacy of the design choice. Of course, a similar time compressed analysis could be used for any other type of medical device in any other part of a patient's body. Accordingly, if the invention is used as a preprocedure tool, physicians may analyze the use of various TPEG embodiments and select those that meet their performance requirements thereby allowing the physicians to select the best medical devices, such as the best TPEGs for treating their patients with aneurysm.
Because of the computing resources needed by FEA software tools, they are generally run on Silicon Graphics or other UNIX computer systems. The Mesh Generator, Stress/Strain/Deformation Analyzer, and the visualization of the stresses, strains, and deformations on the candidate TPEG have been run on a Silicon Graphics (R12000) machine with 640 MB of memory.
Modifications to DYNA3D or NIKE3D
In one embodiment, NIKE3D and DYN/A3D were used and modified to implement the features of the present invention (TPEG design was analyzed). In determining the required material model, an exemplary material model (herein called TPEG material model (W)) was used to accommodate a strain energy density of the form:
The TPEG material model (W), discussed above, was derived from a doctoral thesis, which discusses the stress in abdominal aortic aneurysm. (See Madhavan Lakshmiraghavan, Mechanical Wall Stress in Abdominal Aortic Aneurysm: Towards Development of a Clinical Tool to Predict Aneurysm Rupture (1998) (unpublished Ph.D. dissertation, University of Pittsburgh which is hereby incorporated herein in its entirety).
Other articles discussing a hyperelastic material, linear elastic, and non-linear elastic models of the aortic walls may also be used to derive a material model as exemplified above and other applications of the virtual prototyping system 105 (in
Modifications to NIKE3D
NIKE3D has an existing material model, number 15, which is a three-dimensional continuum hyperelastic material that uses a strain energy density function of the form:
Using the material model 15 as the framework, the material model 15 is modified to implement the TPEG Material Model "W" listed above. This entails ensuring that variables are accordingly updated or modified in the source code to capture the information required by the TPEG Material Model. Material model 15 was chosen from the NIKE3D models because it involves the least amount of code modification to implement the features of the present invention.
Implementation of the TPEG Material Model in NIKE3D
To implement the features in accordance with the present invention, two NIKE3D subroutines, weval.f and printm.f, were modified.
The following modifications were made to NIKE3D subroutine weval.f:
The NIKE3D subroutine printm.f was modified to print out all nine a material parameters to the material description in the high-speed printout file.
Invocation of the Modified NIKE3D TPEG Material Model
The TPEG material model (W) (i.e., the modified NIKE3D Material Model 15) is invoked in NIKE3D using the input data format shown in Table I. Poisson's ratio is kept as the third parameter to maintain compatibility with models using the original NIKE3D hyperelastic model. The documentation for NIKE3D, and the TRUEGRID Mesh Generator, provides an input format list for Material Model 15 similar to Table I given below, with A, B, and ν all defined on card 3 (it should be understood that the "card" represents lines of input data). The original NIKE3D code, however, reads A from columns 1-10 card 3, B from columns 1-10 of card 4, and ν from columns 1-10 of card 5. This format was changed to comply with the NIKE3D manual and the format in Table I in the modified weval.f and printm.f subroutines.
The format column specifies the expected data type. For example, a format of "I" means that an integer is expected ("I5" means integer with 5 positions), "E" means a real numeric value, and "A" means character data type.
Modifications to DYNA3D
DYNA3D has an existing material model number 27, which is a three-dimensional continuum hyperelastic material that uses a strain energy density function of the form
The material model 27 may be modified to implement the TPEG Material Model (W)). This also entails ensuring that variables are accordingly updated or modified in the source code to capture the information for the TPEG material model (W).
Implementation of the TPEG Material Model in DYNA3D
To implement the features in accordance with the present invention, two DYNA3D subroutines, f3dm27.f and printm.f, were modified. The "C(I3 −2−1)" term was left in the modified material model since without it, the explicit time integrator becomes unstable very easily. This term only significantly changes the result when the material undergoes significant change in volume. If ν≈0.5, the material behaves in a nearly incompressible matter, in this case D is much larger than C, and the inclusion of C has little to no effect on the final result.
The following modifications were made to DYNA3D subroutine f3dm27.f:
The DYNA3D subroutine printm.f was modified to correctly output the hyperelastic material constants to the resulting high-speed printout file.
Invocation of the Modified DYNA3D Material Model (TPEG Material Model)
The TPEG material model (i.e., the modified DYNA3D material model 27) is invoked in DYNA3D using the input data format shown in Table II. Poisson's ratio is kept as the third parameter to maintain compatibility with models using the original DYNA3D hyperelastic model.
Reading the doctoral thesis mentioned above, the appropriate values of input parameters may accordingly be provided as input to the Stress/Strain/Deformation Analyzer (see Madhavan Lakshmiraghavan, Mechanical Wall Stress in Abdominal Aortic Aneurysm: Towards Development of a Clinical Tool to Predict Aneurysm Rupture (1998) (unpublished Ph.D. dissertation, University of Pittsburgh).
TRUEGRID Command File
TRUEGRID, in its basic form, is not only a Mesh Generator, but is also a format generator. It outputs data in a certain format, which are then read by NIKE3D and/or DYNA3D. The invention utilizes both TRUEGRID's capability as a Mesh Generator and an output generator to create an output file (e.g., Tables I and II discussed above), containing the appropriate values that would be read by NIKE3D and DYNA3D, respectively. The outputs created by TRUEGRID may be created by other means, e.g., by other Mesh Generator software or proprietary software.
The command file (contained in
The line numbers at the start of each line are only added to facilitate reference to particular lines in the command file and are not part of the command file. Text after the "c" are ignored by TRUEGRID (comments). To take advantage of the capabilities of TRUEGRID, the command file contains various parameters that help developers customize their simulation and/or Stress/Strain/Deformation analysis. Mesh generating tools, such as TRUEGRID, in the non-interactive mode, generally require that command files or similar files be created to enable them to generate finite element models. In the interactive mode, a finite element model may be created by a medical device designer (e.g., TPEG designer) using the options available in the interactive mode of TRUEGRID.
Referring to
TRUEGRID can also act like an interpreter. It reads the information contained in the command file, and interprets and processes the lines accordingly. For example, the text after the word "para" or "parameter" are parameters read by TRUEGRID. These terms indicate the value or the formula that should be used by TRUEGRID. For example, line 21 denotes that the parameter inike contains the initial value 1.
Line 46 in
Line 138 in
Embodiments of the invention can simulate various phases of TPEG use. For example, it calculates the stresses, strains, and deformations on the TPEG when it is compressed then decompressed for deployment, when the TPEG is compressed into the catheter for deployment, when the TPEG expands, and the like.
Referring to line 432, in
The files listed in
To start, a TPEG designer first determines, in box 905A, the performance requirements desired, such as to secure an optimal structural integrity of the TPEG, to avoid potential health risks such as ruptures and endoleaks, or to have a smaller TPEG packaging. 3D volumetric data of the anatomy desired, for example, in this case a blood vessel, is then acquired at box 910A, using CT or MRI scanners. Alternatively, if 3D volumetric data are already available, such acquisition may be skipped and such 3D volumetric data be obtained from the archive.
It should be noted here that the "anatomy" desired, which defines the embodiment in which a medical device is to be tested, is not necessarily limited to a patient's body. For example, embodiments of the present invention could be used to obtain test results for medical device performance in a wide variety of in vitro tests, some of which may be necessary or desirable for Food and Drug Administration (FDA) approval of the medical device in question. Various forms of in vitro failure mode testing such on tensile pull testing and the like could be performed by an embodiment of the invention and allow the tester to easily vary test parameters, device design, and test frequency to quickly obtain the desired test results. In addition, volumetric anatomical data for animals could be used to simulate animal testing that is necessary or desirable for FDA approval of a medical device. This may be of particular importance for a medical device design, which seeks to establish equivalence with an existing approved product which has been previously tested in animal studies.
The geometry generator (120 in
Next, a candidate TPEG model or design, which is obtained typically from a model created using a CAD software, is selected or modeled by the TPEG designer (step 925A). The Mesh Generator (130 in
If the candidate TPEG does not meet the performance requirements, a "no." outcome at decision box 955A, the TPEG designer chooses another TPEG design or model at step 980A, and repeats the steps as shown by the arrow to box 925A. If it, however, meets the target performance requirements, a "yes" outcome at decision box 955A, a prototype is then fabricated based on the candidate TPEG model and design at step 960A. The fabricated prototype is then subjected to testing, e.g., animal testing or clinical testing, at step 965A. If the fabricated prototype meets the target performance requirements, the candidate TPEG model thus is a final design and may be used to produce other TPEGs.
If the fabricated prototype, however, does not meet the performance requirements, a "no" outcome at decision box 970A, the TPEG designer modifies the TPEG design or selects a new TPEG design, and repeats the steps as shown with the arrow to box 925A. If necessary, the process is repeated several times until the performance requirements and the final design is obtained. A benefit of the invention is to reduce the number of "no" outcome at decision box 970A compared to a development process which uses only hardware prototypes for design verification.
As discussed above, a proposed TPEG model may be evaluated against a number of anatomical features to determine the suitable range of conditions of an applicable TPEG model (e.g., size). Similarly, a set of anatomical features may be evaluated against a number of TPEG models to determine the type of suitable TPEG model for such set of anatomical feature. Furthermore, an analysis of the stresses, strains, and deformations may be conducted on the medical device without interaction to certain anatomical features.
Visual display of the simulation is not necessary because a reading of the numerical representation of the stresses, strains, and deformation on the TPEG may guide a TPEG designer whether the performance requirements are met. However, visual display is often desirable because a visual representation of the stresses and strains, for example, red hot spots on the visual TPEG model can be easier to understand than mere numerical representations.
In another embodiment not shown, only the medical device model is analyzed absent the anatomical feature or in vitro model. The operations shown in
To start, a physician first determines, in box 1105, the surgical or interventional procedure objectives, typically, to ensure robust sealing and structural integrity of the TPEG in vivo for a particular patient. The physician then obtains 3D volumetric data of the potential site of the TPEG, e.g., the abdominal aorta, at step 1110. The Geometry Generator (120 in
Next, a candidate TPEG, which is obtained typically from a model created using a CAD software, is selected by the physician (step 1125). (TPEG models may be created in advance and stored in a library in the system. At this point, the physician is determining which available TPEG design is best suited for that patient or individual). The Mesh Generator (130 in
If the candidate TPEG does not meet the procedural objectives, a "no" outcome at decision box 1155, a physician may decide to change the TPEG to be used in the procedure at step 1180 and repeat the process as shown by the arrow to box 1125. Based on the physician's judgment, if the candidate TPEG does meet the procedural objectives, a "yes" outcome at decision box 655, the physician then may decide whether to proceed with the planned TPEG implant procedure or not, at step 1160.
The CPU 1302 operates under control of programming steps that are temporarily stored in the memory 1306 of the computer 1300. When the programming steps are executed, the pertinent system component performs its functions. Thus, the programming steps implement the functionality of the system components illustrated in the figures. The programming steps can be received from the DASD 1304, through the program product 1316, or through the network connection 1318. The storage drive 1304 can receive a program product, read programming steps recorded thereon, and transfer the programming steps into the memory 1306 for execution by the CPU 1302. As noted above, the program product storage device can comprise any one of multiple removable media having recorded computer-readable instructions, including magnetic floppy disks, CD-ROM, and DVD storage discs. Other suitable program product storage devices can include magnetic tape and semiconductor memory chips. In this way, the processing steps necessary for operation in accordance with the invention can be embodied on a program product.
Alternatively, the program steps can be received into the operating memory 1306 over the network 1318. In the network method, the computer receives data including program steps into the memory 1306 through the network interface 1308 after network communication has been established over the network connection 1318. The program steps are then executed by the CPU 1302 to implement the processing of the present invention.
Although the present invention is implemented on UNIX workstations, typical personal computers could likely be adopted to perform these functions in the future.
It should be understood that all of the computers of the systems embodying the various systems illustrated in
Those skilled in the art will recognize that variations in the steps, as well as the order of execution, may be done and still make the various embodiments of the invention operate. Furthermore, one skilled in the art will realize that although the examples described herein generally refer to TPEGs, other medical devices may be designed in accordance with the present invention.
In addition, although the modules of the system 105 (
Embodiments of the present invention have been described above so that an understanding of the present invention can be conveyed. There are, however, many alternative software programs available or able to be written that would embody the functions of the present invention, and thus, may be used accordingly. The present invention should therefore not be seen as limited to the particular embodiments described herein, but rather, it should be understood that the present invention has wide applicability with respect to medical device design generally. All modifications, variations, or equivalent arrangements and implementations that are within the scope of the attached claims should therefore be considered within the scope of the invention.
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i love the shrimps with garlic here. can eat one plate alone, that is normaly for 2 persons... decorations nothing special but portuguese food and wines are great!
Average location. average decor but very friendly service.
Food is quie pricey and disappointing (at least the scamoi which are frozen!).
Small restaurant but great atmosphere and excellent food.
We had typical Portuguese dishes and it was excellent.
Wines from Portugal are also available!
Menu offers many options
Staff welcomes you and tries to bring you the best service.
Parking nearby is also a plus.
An excellent experience!
This is a typical Portuguese fish restaurant, serving very generous portions of fresh food. Prices are not cheap, but not exaggerated either for the quality you get. The target audience seems to be the local Portuguese community, offering extra assurance that you did not walk into a tourist trap. But, don't expect an upscale atmosphere. This is a nice family...
We were there several times I really love the Cataplana Royale the Lobster and the Bacalhau One of the best place to eat fish in Luxembourg not fancy maybe but excellent food
Nothing is left of the old amazing baccalau a la bras and gambas atlantique of my first dinners in Luxembourg (2006-2009)...too sad!
We thoroughly enjoyed our saturday evening at this restaurant that was recommended to us by several portuguese coworkers.
The restaurant in itself is quite sobre so don't expect anything special.
I had the bacalao a bras and was well impressed by the quality of the food served.
The service was simply as it should be! Impeccable!
Will return soon.
Very good and varied food, inexpensive wines backed up by excellent service, you will not be dissappointed, nor will your wallet.
We love to go to this place! I admitt it's optically nothing special (it's of course clean and quite new), but the staff is very friendly and the owner (cook) also comes out every time and asks if everything was fine.
The restaurent is as the name suggests specialised in fish which they defenitively know to prepare very well.
Don't know what to say exactly, the place has nothing special, is far from being among the top Portuguese places in Luxembourg, but it's alright, with nothing negative to raise either. The food could be improved. Definitely average.
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Hoodie Allen - Hey Now
Artist: Hoodie Allen
Producer: Something Silent
Album: Unreleased
Avg Rating: 3.5 ( 11 votes )
After finding some #1-level success from his album, All American, New York City emcee Hoodie Allen is back with the release of his new record, Hey Now. Produced by Something Silent, Hey Now is built on an electronically influenced beat that will be sure to be played at every party in the country soon. On the mic the indie emcee shows why he has the nation buzzing with his skills, sticking with the typical narrative of a hip-hop drinking song while adding his own unique Hoodie Allen twist. Hey Now isn't attached to a particular project just yet, but fans can keep an eye out for Hoodie and his tour partner G-Eazy to hit a city near them on their joint The Excellent Adventure Tour.
Hoodie Allen DownloadsR&B/PopClub
Written by Dillon White on Jul 30, 2012
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Brain Tumor Center - Lafayette, LA
Lafayette Oncologist Doctors for Brain Tumor
Type of Physician: Oncologist
What is a Oncologist?
A subspecialty certification by the Board of Internal Medicine; the oncologist specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. These subspecialists decide on and administer chemotherapy as well as consult with surgeons and radiotherapists on other treatment for cancer.
Specialty: Oncology (Medical)
Common Name: Cancer Doctor
Oncologist Doctors in Lafayette *
Louisiana Hmtlgy Onclgy Assocs
Louisiana Hmtlgy Onclgy Assocs
Louisiana Hmtlgy Onclgy Assocs
Louisiana Hmtlgy Onclgy Assocs
Louisiana Hmtlgy Onclgy Assocs
Louisiana Hmtlgy Onclgy Assocs
Urgent Care Of Baton Rouge
Bayou Oncology Specialists
Lafayette, Louisiana
Brain Tumor
Brain tumor facts*
*Brain tumor facts Medically Edited by: Charles P. Davis, MD, PhD
Other Related Brain Tumor Articles
Emergency Contact for Lafayette
Nearby Lafayette Hospitals *
Community Specialty Hospital
Lafayette General Medical Ctr
University Medical Center
Kindred Hospital Lafayette
UMC Psychiatric Acute Center
Heart Hospital Of Lafayette
Our Lady Of Lourdes Reg Med Ctr
Regional Med Ctr Of Acadiana
Vermilion Hospital
Women And Children's Hospital
LTAC Of Louisianna
St Martin Hospital
Acadia-St Landry Hospital
St Landry Extended Care Hosp
Abbeville General Hospital
American Legion Hospital
Dauterive Hospital
Iberia Medical Center
Abrom Kaplan Memorial Hospital
Opelousas General Health System
Acadian Medical Center
*Provider Directory Terms of Use:
The WebMD 'Provider Directory' is provided by WebMD for use by the general public as a quick reference of information about Providers. The Provider Directory is not intended as a tool for verifying the credentials, qualifications, or abilities of any Provider contained therein. Inclusion in the Provider Directory does not imply recommendation or endorsement nor does omission in the Provider Directory imply WebMD disapproval.


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- UNDP around the world
Many of UNDP's relationships with countries and territories on the ground exceed 60 years. Find details on our successes and ongoing work. Visit UNDP's global website.
- Afghanistan
- Albania
- Algeria
- Angola
- Argentina
- Armenia
- Azerbaijan
- Bahrain
- Bangladesh
- Barbados
- Belarus
- Belize
- Benin
- Bhutan
- Bolivia
- Bosnia and Herzegovina
- Botswana
- Brazil
- Burkina Faso
- Burundi
- Cambodia
- Cameroon
- Cape Verde
- Central African Republic
- Chad
- Chile
- China
- Colombia
- Comoros
- Congo (Dem. Republic of)
- Congo (Republic of)
- Costa Rica
- Côte d'Ivoire
- Croatia
- Cuba
- Cyprus
- Democratic People's Republic of Korea
- Denmark (Rep. Office)
- Djibouti
- Dominican Republic
- E.U. (Rep. Office)
- Ecuador
- Egypt
- El Salvador
- Equatorial Guinea
- Eritrea
- Ethiopia
- Fiji
- Finland (Rep. Office)
- Gabon
- Gambia
- Geneva (Rep. Office)
- Georgia
- Ghana
- Guatemala
- Guinea
- Guinea-Bissau
- Guyana
- Haiti
- Honduras
- India
- Indonesia
- Iran
- Iraq (Republic of)
- Jamaica
- Jordan
- Kazakhstan
- Kenya
- Kosovo (as per UNSCR 1244)
- Kuwait
- Kyrgyzstan
- Lao PDR
- Lebanon
- Lesotho
- Liberia
- Libya
- Madagascar
- Malawi
- Malaysia
- Maldives
- Mali
- Mauritania
- Mauritius & Seychelles
- Mexico
- Moldova
- Mongolia
- Montenegro
- Morocco
- Mozambique
- Myanmar
- Namibia
- Nepal
- Nicaragua
- Niger
- Nigeria
- Norway (Rep. Office)
- Pakistan
- Panama
- Papua New Guinea
- Paraguay
- Peru
- Philippines
- Programme of Assistance to the Palestinian People
- Russian Federation
- Rwanda
- Samoa (Multi-country Office)
- São Tomé and Principe
- Saudi Arabia
- Senegal
- Serbia
- Sierra Leone
- Somalia
- South Africa
- South Sudan
- Sri Lanka
- Sudan
- Suriname
- Swaziland
- Sweden (Rep. Office)
- Syria
- Tajikistan
- Tanzania
- Thailand
- The former Yugoslav Republic of Macedonia
- Timor-Leste
- Togo
- Tokyo (Rep. Office)
- Trinidad and Tobago
- Tunisia
- Turkey
- Turkmenistan
- Uganda
- Ukraine
- United Arab Emirates
Regional PresenceMuch of UNDP's work is administered through 5 regional bureaus.
- Operations
- Research & Publications
- News Centre
News Center
Showing 301 - 320 of 378
27 Nov 2007
Statement delivered by UNDP Country Director, Ms. Anne-Isabelle Degryse-Blateau, at the launch of the Global Human Development Report 2007
08 Nov 2007
Electricity lights up village, UNDP Associate Administrator Ad Melkert inaugurates micro hydro project
The UN Under Secretary General and UNDP Associate Administrator Mr. Ad Melkert visited Nepal from 6-8 November. Mr. Melkert jointly with the Member of the National Planning Commission, Mr. Rama Kanta Gauro inaugurated the 42 kilo watt micro hydro project in Bhimgithe Village Development Committee of Baglung district - supported by UNDP Rural Energy Development Programme.
11 Oct 2007
Government officials receive training on MDGs Needs Assessment
A 9-days training on the MDGs Needs Assessment was conducted by the National Planning Commission with technical support from the UNDP MDG Initiative, other UN regional offices and the UN Country Team in Nepal.
24 Sep 2007
Government of Nepal and UNDP sign US$ 1.9 million Rural Energy Project
The Government of Nepal and UNDP signed a 12.5 crores (US$ 1.9 million) rural energy project (phase III) for a period of three years (2007-2010). Both UNDP and World Bank are continuing their support in this phase III-Rural Energy Development Programme. While UNDP is contributing US$ 1.9 million for the project, the World Bank parallel funding of US$ 3.8 million for the project goes to the communities through Alternative Energy Promotion Centre' the executing agency for the project.
08 Sep 2007
Statement delivered by UNDP Resident Representative, Matthew Kahane during the inaugural ceremony of the Conference on Justice System and the Constitution
04 Sep 2007
UNDP's support to current natural disaster
Incessant rainfall since 10 July 2007 has triggered floods and landslides in Nepal. In July, UNDP provided financial support to make the UNMIN helicopters available for rescuing and transporting relief materials.
04 Sep 2007
UNDP support to UNMIN: second phase registration and verification in two places completed
The second phase registration and verification of Maoists combatants of divisions I and II, encamped in two main and six satellite cantonments in Ilam and Sindhuli has been completed.
24 Aug 2007
UNDP to facilitate electoral observation in Nepal
As a fundamental step in the peace process of Nepal, the Election Commission is preparing to conduct elections on the 22nd of November 2007 to elect a Constituent Assembly that will draft the new Constitution of Nepal. The Election Commission is expecting large numbers of domestic observers and about 500 international electoral observers to be deployed in the coming months throughout Nepal.
31 Jul 2007
Response from UN agencies to flood and landslide victims:UNDP extends support to fly rescue teams Response from UN agencies to flood and landslide victims: UNDP extends its support to fly rescue teams to the site
The United Nations System in Nepal has responded rapidly to the national crisis caused by flooding across Nepal, and the request of the Government of Nepal for assistance. UNMIN has responded to the Government request to make its helicopters available, and with financial support from UNDP has flown rescue teams including members of the Nepal Army, police, Red Cross, government officials and UN agencies for evacuation, relief and assessment operations.
13 Jul 2007
Statement delivered by Mr. Rahama Mohammed UNDP Resident Representative (Acting) on the occasion of the launch of the Global Millennium Development Goals Report 2007 and South Asia Millennium Development Goals Report
05 Jul 2007
Government of Nepal and UNDP sign US$ 3.8 million mini hydro project
The Government of Nepal (GoN) and the United Nations Development Programme (UNDP) today signed a US$ 3.85 million Khimti Neighbourhood Development (KiND) Project to be implemented in Dolakha and Ramechhap districts. The project will be funded by the Government of Norway, Himal Power Limited (a private power producer company) and UNDP (US$ 200,000) for the period of 2007 to 2010. The Alternative Energy Promotion Centre (AEPC) will be the implementing partner.
20 Jun 2007
Statement delivered by Ghulam M. Isaczai, UNDP Deputy Resident Representative for Programme on the workshop-`Long Term Project Based Financing' organized by Nepalese Young Entrepreneurs' Forum
01 May 2007
Statement delivered by UN Resident and Humanitarian Coordinator Mr. Matthew Kahane, on the occasion of Award Ceremony to the Honourable justices of the Supreme Court and Senior Advocates
04 Apr 2007
Speech by Mr. Matthew Kahane, Resident and Humanitarian Coordinator of the UN System In Nepal on the occasion of The International Day For Mine Awareness And Assistance In Mine Action
30 Mar 2007
UNDP signs US$ 4.9 million contract with the Global Fund
The United Nations Development Programme (UNDP) signed US$ 4.9 million "phase two" agreement with the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) as the second principle recipient (PR 2). The National Centre for AIDS and STIs Control (NCASC) signed US$ 2.3 million Individual Agreement with GFATM as first principle recipient (PR1).
28 Mar 2007
Government, UNDP launch Millennium Development Goals ' District Progress Reports
The Government of Nepal and the United Nations Development Programme (UNDP) today jointly launched the Millennium Development Goals Progress Report for 5 districts of Nepal'Chitwan, Kanchanpur, Morang, Bhaktapur and Banke. Also, the report entitled 'Voices of the People on Development,' jointly produced by the Government of Nepal, UNDP and UNICEF was launched on the same occasion.
28 Mar 2007
Statement delivered by Mr. Matthew Kahane, UNDP Resident Representative on the occasion of the launch of 'Millennium Development Goals: District Progress Reports' and `Voices of the People on Development'
15 Mar 2007
Government of Nepal and UNDP sign US$4 million project for conservation and sustainable use of Wetlands
The Government of Nepal and the United Nations Development Programme (UNDP) today signed a US$ 4 million project entitled 'Conservation and Sustainable Use of Wetlands in Nepal' to be implemented in the Koshi Tappu Wildlife Reserve in Sunsari and its buffer zone districts and the Ghodaghodi Lake Complex of Kailali district.
06 Mar 2007
UNDP kicks off series of 'inclusive constitution-building' seminars
UNDP kicks off series of 'inclusive constitution-building' seminars Building a truly national constitution will require national engagement beyond participating in elections to the assembly. This is the key message that emerged from a conference hosted by UNDP in Kathmandu on March 3 and 4. The weekend conference brought together a broad spectrum of people from a diverse range of Nepal's political, professional, caste and ethnic groups.
08 Feb 2007
UNDP supports the peace process in Nepal
UNDP supports the peace process in Nepal Registration of weapons and combatants. Marking a new phase in the peace process, the United Nations has begun registering and storing weapons of Maoists, former combatants in Nepal, currently encamped in seven main cantonments and 21 satellite cantonments around the country.
Contact UNDP in NepalUNDP, UN House
P.O. Box 107
Kathmandu, Nepal Phone: 977-1-5523200
Email: email@example.com Fax: 977-1-5523991, 5523986
- "Basic first aid skills are skills for life," said Timor Leste's Community Volunteer and First Aid Training Manager Mariano de Jesus Pereira. "They can be used at home as well as in the work place." Starting May, Timor Leste police and civilian staff begin first aid trainings on a monthly basis ensuring they'll be super prepared for any emergency. UNDP Timor-Leste 56 minutes ago
- Libyan youth groups advocate for their voice in Constitution building supported by UN Development Programme in Libya, 3 hours ago
- "See more posts on"Facebook


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Sen. Jim Tracy (R) @jimtracy
Politwoops no longer follows this account."The reports of Secretary Kerry saying that Israel is becoming an apartheid state are not only factually wrong,... http://t.co/PKw5mwdZBF
An archive of the public statements deleted by U.S. politicians. Explore the tweets they would prefer you couldn't see.
To meet the Twitter API Terms of Service, all deleted tweets shown here since June 22, 2012 have been reviewed and approved by the Sunlight Foundation.


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By chandoo on March 15, 2011
Dutch model Lara Stone did a photo shoot with photographers Inez van Lamsweerde & Vinoodh Matadin for the fashion magazine Vogue China for the month of March 2011.
Dutch model Lara Stone is the colorful lady on the cover page of fashion magazine Vogue China for the month of December 2010. Photographed by ...
Dutch model Lara Stone photographed by by Mark Seliger for the cover shoot of the fashion magazine Vogue Russia for the month of July 2011.
Dutch model Lara Stone is the cover star of the fashion magazine Vogue Japan for the November 2011 issue. Lara Stone shines in front of ...
Dutch model Lara Stone, photographed by Mario Sorrenti in very colorful spring collection of Gucci, featured on the pages of fashion magazine Vogue France for ...
Dutch model Lara Stone done the cover page and and editorial Gloria of the fashion magazine Vogue France for the month of September 2009. She ...
Posted in Vogue | Tagged china, Dutch, Lara Stone, march, model | 1 Response
Woooow….the best Dutch fashion model and two great Dutch photographers!
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Fashion blogger that joined the BagBliss team February 2008 and TheFashionRow June 2010.
When I first saw the Maison Martin Margiela Défilé Clutch, as it is pictured on Shopbop.com, I thought the style looked vaguely familiar. I had to think for ...On October 9, 2014 / By BrS
Edie Parker is relatively new to the handbag scene. And, until just recently, I had not paid too much attention to this designer. Before launching her own handbag ...On October 6, 2014 / By BrS
Alexander McQueen is no stranger to unicorns. Sure, the brand is more well-known for its skulls and Union Jack-inspired designs. But you do see a unicorn here and ...On October 1, 2014 / By BrS
Olympia Le-Tan is famous for her embroidered book clutches. The details seen on these clutches are absolutely breathtaking. There is no doubt I have admired them many times ...On September 30, 2014 / By BrS
Mmmmm, I need to get myself some fringe for this Fall. Yep, I love fringe and tassels almost as much as I love studs. And you know how ...On September 23, 2014 / By BrS
The buyer's picks collection at Net-A-Porter, known as FINDS, has already brought us some wonderfully unique and intriguing pieces since its inception earlier this year. If you are ...On September 22, 2014 / By BrS
I saw pictures from the Rebecca Minkoff Spring 2015 Runway and all I can say is "WOW". Everything was so gorgeous! I loved the clothing, the shoes, and ...On September 19, 2014 / By BrS
How about a little throwback from the 1990s? When I was a kid, those Hypercolor t-shirts were all the rage. If you don't know what I am talking ...On September 17, 2014 / By BrS
According to Shopbop, the Rebecca Minkoff Ascher Bag offers a unique blend of surrealist flair and punk personality. I spent some time thinking about it and I don't ...On September 16, 2014 / By BrS
I stumbled upon an interesting trend today, if you can call it a trend. Has anyone else noticed a trickle of music themed handbags out there? They have ...On September 15, 2014 / By BrS
There is a recurring trend that never fails to make an appearance each and every fall season. In fact, I am sort of in favor of not calling ...On September 11, 2014 / By BrS
Some people don't know this about me, but I love snakes. Okay, I love a lot of animals. But there is something special about snakes. They have this ...On September 9, 2014 / By BrS
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Education & Teaching Success Story
Culture: The Human Mirror
This week I visited Professor Vine who teaches the course Culture: The Human Mirror. When I asked him about his strategies as a Professor, I was once again shocked by the answer. He told me cutting edge technology didn't play a big role in his classroom, he actually preferred older methods. This is why Prof. Vine uses the overhead projector to teach most of his classes. He believes it is better than PowerPoint and it is easier for him to use. Although he uses the overhead projector quite often, Prof. Vine says he uses "a mix of various teaching strategies". He therefore also uses videos, but most importantly conversations and questioning strategies are the ones that take up a big part of the class time. When I asked about his class size he told me that even though there were 40students, the class still managed to have engaging conversations where all the students participated.
After talking about his class we started discussing the general education here at American University and how he thought his class reached its goals. First of all, he defined three specific ways on how he tried to incorporate the goals. First, he includes contemporary issues in all his classes so that the students are aware of current events and the world they live in. Second, he makes his classes writing intensive which helps the students practice their writing and develop skills that help them express their ideas clearer through paper. Finally, he engages the students as active learners making them involved in class though their opinions, comments and beliefs. Prof. Vine further tries to convey an introduction to anthropological ways of thinking so that students gain a different perspective on daily events. He encourages his students to look at issues and topics through perspectives of race, gender, poverty etc.
Overall, Prof. Vine believes that general education works to create more informed human beings that can solve problems through many different angles. However, he thinks all students should have a liberal arts education where the program doesn't require students to take certain courses but rather it encourages them to have exposure to a field outside of their own.


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Ultraman Fighting Evolution Rebirth Agul vs EX Red King - Download MP3 music or MP4 video:
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A tutorial to getting the S rank for the Gaia Vs Agul stage, hope it helps!!
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Monday, Jul 09, 2012
SINGAPORE – About 60 personnel from the ASEAN navies will be participating in the inaugural ASEAN Maritime Security Information-Sharing Exercise (AMSISX) to be held from July 8 to 10.
This marks the first time that ASEAN navies are coming together for an exercise to enhance maritime information sharing.
The inaugural exercise, which is to be conducted from the Changi Command and Control Centre as well as various naval operations centres in the region, is to be co-hosted by the Republic of Singapore Navy (RSN) and the Indonesian Navy (TNI AL).
The exercise will see participants, based in Singapore and their respective countries' operations centres, linked up through the ASEAN Information-Sharing Portal (AIP).
Launched during the opening ceremony, the AIP provides a common platform for all ASEAN navies to share maritime security related information in the region and enhance information-sharing procedures among the ASEAN countries.
The exercise will see participants sharing information to tackle various maritime security scenarios such as piracy, sea robbery and maritime terrorism.
The development of the AIP, which involved the ASEAN navies, was led by the RSN and the TNI AL.
The participation of the ASEAN navies in the exercise reflects their strong commitment to multilateral cooperation and the promotion of regional maritime security, the Ministry of Defence (Mindef) said.
Chief of Navy Rear-Admiral (RADM) Ng Chee Peng and Chief of Naval Staff of the Indonesian Navy Admiral (ADM) Soeparno officiated at the opening ceremony of the exercise at the Changi Command and Control Centre earlier this afternoon, with navy chiefs from Brunei, Malaysia and Thailand in attendance.
Later today, Head Naval Operations RADM Jackson Chia and Assistant to Chief of Naval Staff for Operations RADM Didit Herdiawan will be signing an arrangement between the RSN and the TNI AL.
The arrangement will lay the foundation between the RSN and the TNI AL in the area of submarine rescue support and cooperation.


text: Mitzi - Who Will Love You Now by future classic published on 2012/10/22 01:38:12 +0000 Having blown audiences away with their debut EP All I Heard, MITZI are back with their latest single, 'Who Will Love You Now'. Mixed by Ash Workman (Metronomy, Klaxons, Summer Camp), this track showcases MITZI's unique brand of garage disco, NYC indie and the light heartedness of Australian pop. Who Will Love You Now is available worldwide on iTunes now! www.facebook.com/mitziband www.facebook.com/futureclassic www.futureclassic.com.au


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China Motor Denies Report on South Africa Factory Investment
June 22 (Bloomberg) -- China Motor Corp. has no plans to build a factory in South Africa, company spokeswoman Anny Fu said by telephone today.
The Johannesburg-based Business Day newspaper reported June 21 that China Motor plans to build a $1 billion factory near Harrismith in South Africa.
To contact the editor responsible for this story: Chua Kong Ho at firstname.lastname@example.com


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Tech Helproom
It's free to register, to post a question or to start / join a discussion
MS Office 2000 Publisher table gridlines not printing
Likes # 0
Posted August 19, 2011 at 3:40PM
Can someone please remind me how to get gridlines in a Publisher table to print? I'm using MS Office 2000 Professional. Thanks in anticipation!
Likes # 0
Posted August 19, 2011 at 4:53PM
It's years since I worked with Publisher 2000. But I don't think that you are referring to gridlines but infact what the cell boundaries of the table to print. You should be able to right click and find this.
Likes # 0
Posted August 19, 2011 at 5:13PM
Thanks Woolwell.....right clicking is not helping but I decided to make the table in Word! Thanks anyway...I'm sure I used to be able to do it.
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Posted August 19, 2011 at 5:22PM
The right click should have given an option to format the table and then the table boundaries. But this is from memory.
Likes # 0
Posted August 19, 2011 at 10:36PM
Sorry I never got back to you. Just found how to do it. The right click didn't let me in to formatting but I just remembered what I did years ago! I highlighted the frames I needed > Format > Borders shading > then ticked the box that gave the option to print a grid (highlighting all lines.) Worked great! Thanks again for your assistance .....I'm afraid my Office copy is old but it is well used and usually gets the job done! Thanks
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Canada oil pipeline into US gets extension support
"The rewards of additional pipelines for all of Canada are too great to ignore," said report co-author Michal Moore. "Pipelines must be a national priority."
TransCanada Corp. is looking to relieve the bottleneck at Cushing, Oklahoma, a massive storage hub that has become a major choke point.
The report said producers stand to gain US$10 for every barrel they produce if they can get their oil past Cushing to the Gulf Coast, where it would displace imported crude like Mexico's Maya.
"It seems to me that the right role of government is to make it clear that this resource is a world product and should be allowed to get access to world markets and, where possible, they can seek out the help to do that."
The Associated Press


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Pavtube releases DVD and Blu-ray conversion software
05/12, 8:00pm
Convert DVD and Blu-ray movies
Pavtube Studio has added to its line of video conversion software with the release of iMedia Converter for Mac. The program works as an audio and video conversion tool capable of ripping DVD and Blu-ray movies. The conversion process is claimed to maintain all aspects of a movie including commentary, menus, titles and ads. When working with high-definition videos, users can compress or recode the data into other formats without losing HD resolution. Support is also included for recorded TiVo shows and animated GIF images.


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Leon Fontaine can also be seen on his very popular teaching show. Pastoring one of Canada's largest multi-site churches, Springs Church, you'll love his teaching series'.


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Cindy Street said her husband died on Wednesday at St. Rose Dominican Hospital in Las Vegas. She had taken him to the emergency room on Friday after he had trouble breathing.
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'Lincoln,' 'Les Miz,' 'Argo' earn producers honors
LOS ANGELES – The Civil War saga "Lincoln," the musical "Les Miserables" and the Osama bin Laden thriller "Zero Dark Thirty" were among the nominees announced Wednesday for the top honor from the Producers Guild of America.
Other best-picture contenders are the Iran hostage-crisis thriller "Argo"; the low-budget critical favorite "Beasts of the Southern Wild"; the slave-turned-bounty-hunter saga "Django Unchained"; the shipwreck story "Life of Pi"; the first-love tale "Moonrise Kingdom"; the lost-souls romance "Silver Linings Playbook"; and the James Bond adventure "Skyfall."
Walt Disney dominated the guild's animation category with three of the five nominees: "Brave," "Frankenweenie" and "Wreck-It Ralph." The other nominees are Focus Features' "ParaNorman" and Paramount's "Rise of the Guardians."
Along with honors from other Hollywood professional groups such as actors, directors and writers guilds, the producer prizes help sort out contenders for the Academy Awards. Those nominations come out Jan. 10.
The guild, an association of Hollywood producers, hands out its 24th annual prizes Jan. 26. The big winner often goes on to claim the best-picture honor at the Oscars, which follow on Feb. 24.
Previously announced nominees by the Producers Guild for best documentary are "A People Uncounted," "The Gatekeepers," "The Island President," "The Other Dream Team" and "Searching for Sugar Man."
Other nominees:
— TV drama series: "Breaking Bad," "Downton Abbey," "Game of Thrones," "Homeland," "Mad Men."
— TV comedy series: "30 Rock," "The Big Bang Theory," "Curb Your Enthusiasm," "Louie," "Modern Family."
— Long-form television: "American Horror Story," "The Dust Bowl," "Game Change," "Hatfields & McCoys," "Sherlock."
— Non-fiction television: "American Masters," "Anthony Bourdain: No Reservations," "Deadliest Catch," "Inside the Actors Studio," "Shark Tank."
— Live entertainment and talk television: "The Colbert Report," "Jimmy Kimmel Live," "Late Night with Jimmy Fallon," "Real Time with Bill Maher," "Saturday Night Live."
— Competition television: "The Amazing Race," "Dancing with the Stars," "Project Runway," "Top Chef," "The Voice."
— Sports program: "24/7," "Catching Hell," "The Fight with Jim Lampley," "On Freddie Roach," "Real Sports with Bryant Gumbel."
— Children's program: "Good Luck Charlie," "iCarly," "Phineas and Ferb," "Sesame Street," "The Weight of the Nation for Kids: The Great Cafeteria Takeover."
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VIDEO: Sneak Peek - Tonight's KROLL SHOW, WORKAHOLICS on Comedy Central
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Tonight on COMEDY CENTRAL, "Workaholics" is back with an all-new episode, and 'Kroll Show' has its premiere. Get a sneak peek below!
On tonight's "WORKAHOLICS", when "Workaholics" premieres an all-new episode at 10:00 p.m. ET/PT, the guys are determined to be the funniest ones at an office roast.
Following "Workaholics," the series premiere of "Kroll Show," titled "San Diego Diet," debuts at 10:30 p.m. ET/PT Liz B. (Jenny Slate) and Liz G. (Kroll) are two very different young publicists trying to have it all on "Publizity" also tonight on "San Diego Diet," Ref Jeff tries to lock down plans and on "Wheels Ontario" students shun the new kid.
"The Daily Show with Jon Stewart" welcomes Jessica Chastain promoting her Golden Globe-winning and Oscar-nominated performance in "Zero Dark Thirty" tonight at 11:00 p.m. ET/PT
"The Colbert Report" welcomes Tom Brokaw, journalist and correspondent for NBC News who discusses some of the media's hottest topics, tonight at 11:30 p.m. ET/PT.
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- Telemundo to Present FUTBOL ESTELAR: LEON VS SANTOS, Today
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By Brian Deakyne
RUMSON — If there were a word to describe Rumson-Fair Haven's September record, it would be variety.
In jumping out to a 4-0 record, the Bulldogs have won in all different types of assortments. They've had overtime wins, blowouts, and last Friday against Red Bank, they added an ugly, yet efficient win to their transcript.
Rumson was able to fight off a feisty Red Bank (0-3) team, but a 41-yard field goal from junior kicker Jake D'Amelio in the second quarter and a one-yard touchdown run from senior quarterback Danny Roberto helped the Bulldogs pull out the 9-3 win.
"We knew we were going to get [Red Bank's] best effort, we made a lot of mistakes, offensively," Rumson-Fair Haven head coach Shane Fallon said. "In the first half, we didn't get in a rhythm offensively, they did a good job mixing up some of their defenses."
Roberto wasn't as sharp as he normally has been, but it hardly mattered. After allowing a long drive in the first quarter that ended with a fumble recovery on their own 11-yard line, the Bulldogs defense hunkered down and didn't allow the Bucs to get into any type of offensive pattern.
After Rumson's, 13-10, come-from-behind overtime win against Shore Regional on opening night, it pulled off back-to-back upset wins over St. John Vianney and Holmdel, proving, when needed, it can contend as one of the most explosive teams in the Shore Conference.
The win, since it was non-divisional, still keeps the Bulldogs in a first-place tie in the A-Central with Red Bank Catholic, which beat Raritan 49-14 last week.
Roberto completed 8 of19 passes for 78 yards and tossed an interception. Senior running back Travis Clark carried the ball 18 times for 65 yards and sophomore running back Charlie Volker had 14 rushes for 33 yards.
The Bulldogs will have a bye this week before hosting Raritan at home and try to remain unbeaten overall and within the division.
"We've got to get healthy, we've got a lot of kids banged up," Fallon said. "We're real happy to be 4-0, we certainly are. It's a good confidence booster; we're growing as a team. We're good, but we're not great yet.
"We're making some mistakes, we've got a lot of kids in the lineup for the first time, but we'll get there."
Rumson will host Raritan (0-4) on Oct. 12 at 7 p.m. The Rockets have allowed at least 41 points in every game they have played this season.
Red Bank Looking For First Win Saturday
The wins haven't been there in 2012, but the progress has.
Comparing Red Bank's (0-3) 47-0 loss to Red Bank Catholic in week one and its 9-3 loss to Rumson-Fair Haven (4-0) in week four, the Bucs have made giant leaps towards getting a win.
Coming off a bye week and two weeks removed from a 34-28 double-overtime loss to Wall, Red Bank nearly upset the unbeaten Bulldogs last Friday night at Count Basie Field, but costly mistakes resulted in a loss in front of an enormous crowd.
In the loss to Rumson, the Bucs offense was strong in the first quarter, but it fell off. Their defense, however, did not.
Red Bank's defensive front was in the backfield all night, stopping Rumson quarterback Danny Roberto, who has had a strong September, from getting any type of rhythm together.
The Bucs threatened to take an early 7-0 lead in the first quarter, but, on first and goal from the Rumson six-yard line, the snap flew over the head of senior quarterback Ross Gisondi.
That would be as close as Red Bank would get all game.
"We're about opportunities and we had opportunities early in the game to put some points on the board and we take a step backwards," Red Bank head coach Nick Giglio said. "That's kind of how our season is going at times, we take two steps forward and three back."
After a blowout loss on opening day, Red Bank has lost a pair of games by less than a touchdown, leading it to believe that it is right there and is just a play or two away from being 2-1, instead of 0-3.
"Looking back at the game, its 9-3, 7 points would've been nice," Giglio said.
The Bucs only score came late in the fourth quarter against Rumson, when senior kicker Erwin Pupovic nailed a 25-yard field goal, but the Bulldogs recovered the ensuing onsides kickoff. Gisondi recovered a fumble and returned it 35 yards deep into Rumson territory to set up the field goal.
"We're a very different team in terms of physical-ness, we're getting our bodies healthy again. The guys that were young in the early season are starting to come around," Giglio said. "There's a lot of good stuff that's going to happen from here on out."
Red Bank used a number of different formations, including using two quarterbacks. Gisondi and senior quarterback Alex Fox rotated in and out of the offense, although neither was able to establish any type of scoring drives.
On Saturday, Red Bank will be home against Ocean Township (2-2) in an attempt to get its first win. A victory would give the Bucs their first win within the division as well and with time ticking on the season, every win is going to be important.
That game is at 2:30 pm.


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Fire inspectors are responsible for ensuring that facilities are compliant with applicable codes and laws, and they are often employed by emergency response service companies and government entities. Their duties revolve around inspecting fire safety plans and the systems needed to extinguish fires to ensure that they comply with local laws, and they may also issue permits and investigate origins of fires.Read More...
Those in this position help facilities determine what must be done in order to comply with regulations and laws, and it is very important to follow up with inspected companies to ensure this compliance in the long run, as well. Public speaking skills are beneficial for this position, as they may occasionally be involved in developing and administering safety education programs. Travel is often required to visit facilities and perform fire inspections, so a valid driver's license is generally required. Sometimes, fire inspectors may be sought in emergency situations to provide additional support, which may involve driving an emergency vehicle.
Aspiring fire inspectors should be familiar with all laws and regulations regarding fire prevention, and the ability to perform CPR is also important. A minimum of a high school diploma is generally required, and a college degree may also be required by some employers.
Median of all compensation (including tips, bonus, and overtime) by years of experience.
For Fire Inspectors, more experience in the field does not usually mean bigger paychecks. Salaries for the relatively untried average out to around $39K, but survey participants with five to 10 years of experience earn a significantly higher median of $48K. Fire Inspectors who work for 10 to 20 years in their occupation tend to earn about $53K. Individuals who report more than two decades of experience seem to make only slightly more than folks in the 10-to-20 year range; the more senior group sees median earnings in the comparatively modest ballpark of $55K.
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Dramatic Play
- Rebekah R. Pender
- … show all 1 hide
Creative dramatics; Fantasy play; Pretend play; Pretension play; Socio-dramatic play; Symbolic play
Dramatic play permits children to fit the reality of the world into their own interests and knowledge. Dramatic play gives the child the opportunity to release his/her emotions while feeling less threatened and exposed owing to the distance that dramatic play creates from his/her problems [1, 3].
Dramatic play includes role-playing, puppetry, and fantasy play. It does not require interaction with another. By acting out experience, he/she comes into contact with reality. It is constructive for the child to remember situations through play and to have the opportunity to repeat them and work through them. Socio-dramatic play is dramatic play with the additional component of social interaction with either a peer or teacher [1]. Creative dramatics involves spontaneous, creative play. Children frequently reenact a scene or a story....
- Center for best practices, University of Western Illinois. (2002). Dramatic play. Retrieved December 18, 2008, from http://www.wiu.edu/thecenter/art/artexpress/draplay.html.
- Dramatic Play. (n.d.). Retrieved December 18, 2008, from http://www.playtherapyonline.net/Books/Entering-the-world-of-a-child/Chapter-9-Dramatic-play.html.
- Ghaci, G, Richardson, JTE (1980) The effects of dramatic play upon cognitive structure and development. Journal of Genetic Psychology 136: pp. 77-84
- Van der Merwe, M. (2005). Dramatic play. Retrieved December 18, 2008, from http://www.playtherapyonline.net/Books/Entering-the-world-of-a-child/Chapter-9-Dramatic-play.html.
- Title
- Dramatic Play
- Reference Work Title
- Encyclopedia of Child Behavior and Development
- Pages
- pp 522-523
- Copyright
- 2011
- 10.1007/978-0-387-79061-9_893
- Print ISBN
- 978-0-387-77579-1
- Online ISBN
- 978-0-387-79061-9
- Publisher
- Springer US
- Copyright Holder
- Springer Science+Business Media, LLC
- Additional Links
- Topics
- Industry Sectors
- eBook Packages
- Editors
- Sam Goldstein Ph.D. (480)
- Jack A. Naglieri Ph.D. (481)
- Editor Affiliations
- 480. Neurology, Learning and Behavior Center
- 481. Department of Psychology MS 2C6, George Mason University
- Authors
- Author Affiliations
- 1. 11300 Expo Blvd #2218, San Antonio, TX, 78230, USA
Continue reading...
To view the rest of this content please follow the download PDF link above.


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Jenny McCarthy is reportedly "over the moon" since marrying Donnie Wahlberg.The former Playboy model walked down the aisle in a ceremony near her hometown of Chicago, Illinois, the groom's brother, actor Mark Wahlberg, confirmed last weekend.And ... Read More »
Tag Archives: Mark Wahlberg
McCarthy and Wahlberg wed
Jenny McCarthy and Donnie Wahlberg have wed.The couple became man and wife during a ceremony near her hometown of Chicago, Illinois, the groom's brother, actor Mark Wahlberg, confirmed in a tweet posted Sunday."Congratulations @DonnieWahlberg and @... Read More »
Mark Wahlberg: I was a bad beau
Mark Wahlberg was an "asshole boyfriend".The actor has a checkered past and was sentenced to two years in prison at the age of 16 after being charged with attempted murder and then pleading guilty to assault.Aged 43 he's now turned his life around, and... Read More »
Mark Wahlberg: I cry freely
Mark Wahlberg isn't afraid to cry in front of women.The Transformers: Age of Extinction star has a checkered past. By the age of 13 he was dabbling in drugs and at 16 he was sentenced to two years after being charged with attempted murder after attac... Read More »
Wahlberg: Flashy cars are the best
Mark Wahlberg wants his cars to be as flashy as possible.The actor has taken over from Shia LaBeouf in the Transformers franchise and will hit screens as Cade Yeager in latest installment Age of Extinction.Cars that change into robots are the premise o... Read More »
Wahlberg "dreading" having teenage kids
Mark Wahlberg is "dreading" the moment his daughters begin dating.The Hollywood actor is father to girls Ella, ten, and Grace, four, with wife Rhea Durham. The couple also have sons, eight-year-old Michael and Brendan, five, together.Mark has often spo... Read More »
Jack Reynor: Fassbender is my idol
Jack Reynor idolises Michael Fassbender.The two actors are starring alongside each other in upcoming Shakespearian tale Macbeth, which tells a story of ambition, power, insanity and murder.Michael takes on the title role and Jack can't help but gush ab... Read More »
Mark Wahlberg wants his kids to study
Mark Wahlberg can't force his children to study, as he didn't complete education himself.The 42-year-old actor and his wife Rhea Durham have Ella, ten, Michael, eight, Brendan, five and four-year-old Grace together. He first rose to fame in the ban... Read More »
Jared's special bond with Lupita
Jared Leto feels a bond with Lupita Nyong'o because they're both "the class of 2014".The actor has stock-piled prizes this awards season thanks to his role as transgender AIDS victim Rayon in Dallas Buyers Club. Lupita's turn in 12 Years a Slave has al... Read More »
Jack Reynor engaged
Jack Reynor is engaged to wed.The 22-year-old American born Irish actor has been in a relationship with Madeline Mulqueen for two years now.And his representative has confirmed to People magazine the Transformers: Age of Extinction star is now betrothe... Read More »


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Airedale foundation NHS trust conducts videoconferencing consultations with prisoners at Full Sutton maximum security jail, reports Gill Hitchcock
Dick Vinegar, the Patient from Hell, tracks telehealth's rollercoaster ride over the last twelve months
Applications of telehealth can speed up diagnosis, as well as improve patient treatment and longer-term outcomes, writes Ian Jackson
While we wait for the successor to the 3millionlives group, we should listen to those patients with experience of telehealth, suggests Lynn Young
KPMG report says society must move beyond hospital walls to address healthcare in the 21st century, writes Hilary Thomas
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The Patient from Hell wants to know why we can't use a co-produced, quickly updated wiki to share progress on telehealth
Dick Vinegar: The study was completed a long time ago, yet the findings haven't been published. Is it because the NHS doesn't like the conclusions?
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