text:
A method for treating at least one of a plurality of disorders characterized at least in part by vagal activity includes positioning an electrode at a body organ innervated by the vagus. An electrical signal is applied to the electrode to modulate vagal activity. The electrical signal is applied at a frequency in excess of 3,000 Hz for the signal to create a neural conduction block to the vagus with the neural conduction block selected to at least partially block nerve impulses on the vagus.
1. A method for treating obesity of a patient, said method comprising:
accessing at least one vagal nerve selected from an anterior vagus nerve and a posterior vagus nerve at a location below a vagal innervation of a heart of the obese patient;
positioning an electrode on said vagal nerve with said electrode being one of a bi-polar pair of electrodes;
implanting a pulse generator within said obese patient and with said pulse generator electrically connected to said pair of electrodes;
operating said pulse generator to generate an electrical signal treatment applied to said pair of electrodes, with said electrical signal treatment comprising:
a) an electrical signal having a frequency selected for said signal to create a neural conduction block on said vagal nerve at said location, and with said neural conduction block selected to at least partially block nerve impulses on said vagal nerve at said location, wherein said signal is at least 500 Hz;
b) said electrical signal is non-ablative and selected for a function of said vagal nerve affected by said electrical signal to at least partially recover following discontinuation of application of said electrical signal to said vagal nerve; and
c) said electrical signal having a plurality of on-times separated by a plurality of off-times, said signal applied during said on-times and not applied during said off-times, without afferent stimulation on a proximal side of said location during said on-times, and wherein the duration of the off-times is selected to allow at least partial recovery of activity of said vagal nerve, and wherein the on and off times are selected to reduce a likelihood of enteric accommodation;
wherein the application of said electrical signal treatment alleviates or decreases said obese patient's symptoms of obesity.
2. A method according to
3. A method according to
4. A method according to
5. A method according to
6. A method according to
7. A method according to
8. A method according to
The present application is a continuation-in-part application of U.S. patent application Ser. No. 10/881,045 filed Jun. 30, 2004 entitled "High Frequency Obesity Treatment" which is a continuation-in-part application of U.S. patent applications Ser. No. 10/674,324, now abandoned; Ser. No. 10/674,330, now U.S. Pat. No. 7,489,969; and Ser. No. 10/675,818, now abandoned, all filed in the name of the present inventors on Sep. 29, 2003 and entitled "Nerve Stimulation And Conduction Block Therapy", "Vagal Down-Regulation Obesity Treatment" and "Enteric Rhythm Management", respectively, and U.S. patent applications Ser. No. 10/752,940, now U. S. Pat. No. 7,444,183, and Ser. No. 10/752,944, now U.S. Pat. No. 7,176,750, all filed in the name of the present inventors on Jan. 6, 2004 and respectively entitled "Intraluminal Electrode Apparatus and Method" and "Electrode Band Apparatus and Method"; which patent applications are each continuations-in-part of U.S. patent application Ser. No. 10/358,093 filed Feb. 3, 2003, now abandoned (all of the foregoing collectively referred to herein as the "parent applications"); which parent applications are incorporated herein by reference.
1. Field of the Invention
This invention pertains to treatments of disorders associated, at least in part, with neural activity. These may include, without limitation, gastrointestinal, pancreo-biliary, cardio-respiratory and central nervous system disorders (including neurological and psychiatric, psychological and panic disorders). More particularly, this invention pertains to treatment of such disorders through management of neural impulse stimulation and blocking.
2. Description of the Prior Art
As disclosed in the parent applications and their related international patent applications Ser. Nos. PCT/US2004/002847; PCT/US2004/002841 and PCT/US2004/002849 (all incorporated herein by reference), a wide variety of disorders can be treated by blocking neural impulses on the vagus nerves. The blocking can be used as a therapy by itself or used in combination with traditional electrical nerve stimulation. The disorders to be treated include, without limitation, functional gastrointestinal disorders (FGIDs) (such as functional dyspepsia (dysmotility-like) and irritable bowel syndrome (IBS)), gastroparesis, gastroesophageal reflux disease (GERD), inflammation, discomfort and other disorders. Also, the blocking therapy has described application to central nervous system treatments.
Treatments of gastrointestinal diseases through nerve stimulation have been suggested. For example, U.S. Pat. No. 6,238,423 to Bardy dated May 29, 2001 describes a constipation treatment involving electrical stimulation of the muscles or related nerves of the gut. U.S. Pat. No. 6,571,127 to Ben-Haim et al. dated May 27, 2003 describes increasing motility by applying an electrical field to the GI tract. U.S. Pat. No. 5,540,730 to Terry, Jr. et al., dated Jul. 30, 1996 describes a motility treatment involving vagal stimulation to alter GI contractions in response to a sense condition indicative of need for treatment. U.S. Pat. No. 6,610,713 to Tracey dated Aug. 26, 2003 describes inhibiting release of a proinflammatory cytokine by treating a cell with a cholinergic agonist by stimulating efferent vagus nerve activity to inhibit the inflammatory cytokine cascade.
The present invention is an improvement upon a neural blocking therapy as described in the parent applications. Suggestions have been made to block nerves in very specific ways. For example, U.S. Pat. No. 5,188,104 to Wemicke et al. dated Feb. 23, 1993 describes an attempt to inhibit a subset of nerve fibers in the vagus. Specifically, the patent suggests selectively blocking C-fibers of the vagus at a 40 Hz signal. The maximum frequency discussed in this patent is a 150 Hz frequency. To avoid undesired effects of vagal stimulation on organs not targeted by the stimulation, U.S. Pat. No. 6,684,105 to Cohen et al. dated Jan. 27, 2004 describes the use of collision blocks to suppress antidromic effects of stimulation signals. Both of these blocking techniques have significant drawbacks. Subselection of fibers is very difficult in practice. Collision blocking results in a signal being propagated in both afferent and efferent directions. The parent applications teach application of full cross-section neural block to inhibit action potentials across all nerve fibers at a blocked site and thereby blocking both afferent and efferent signals.
The present invention is an improvement upon a neural blocking to avoid antidromic influences during stimulation or to otherwise down-regulate nerve activity. Cryogenic nerve blocking of the vagus is described in Dapoigny et al., "Vagal influence on colonic motor activity in conscious nonhuman primates", Am. J. Physiol., 262: G231-G236 (1992). Electrically induced nerve blocking is described in Van Den Honert, et al., "Generation of Unidirectionally Propagated Action Potentials in a Peripheral Nerve by Brief Stimuli", Science, Vol. 206, pp. 1311-1312. An electrical nerve block is described in Solomonow, et al., "Control of Muscle Contractile Force through Indirect High-Frequency Stimulation", Am. J. of Physical Medicine, Vol. 62, No. 2, pp. 71-82 (1983) and Petrofsky, et al., "Impact of Recruitment Order on Electrode Design for Neural Prosthetics of Skeletal Muscle", Am. J. of Physical Medicine, Vol. 60, No. 5, pp. 243-253 (1981). A neural prosthesis with an electrical nerve block is also described in U.S. patent application Publication No. US2002/0055779A1 to Andrews published May 9, 2002. A cryogenic vagal block and resulting effect on gastric emptying are described in Paterson Calif., et al., "Determinants of Occurrence and Volume of Transpyloric Flow During Gastric Emptying of Liquids in Dogs: Importance of Vagal Input", Dig Dis Sci, (2000);45:1509-1516.
Constant nerve blocking (through constant blocking signal application) can be undesirable. Such a treatment can have high power requirements. Furthermore, a complete down-regulation of a nerve can be undesirable since the nerve's desirable functions are also interrupted. It would be desirable to more fully control the degree of down-regulation of a nerve to achieve a desired therapy while minimizing undesired effects of complete or constant down-regulation.
A method is disclosed for treating at least one of a plurality of disorders of a patient where the disorders are characterized at least in part by vagal activity innervating at least one of a plurality of alimentary tract organs of the patient at an innervation site. The method includes positioning an electrode at a body organ of the patient where the organ is innervated by at least a vagal trunk or branch and with said electrode positioned at the vagal trunk or branch. An electrical signal is applied to the electrode to modulate vagal activity by an amount selected to treat the disorder. The electrical signal is applied at a frequency in excess of 5,000 Hz for the signal to create a neural conduction block to the trunk or branch at a blocking site with the neural conduction block selected to at least partially block nerve impulses on the trunk at the blocking site.
With reference now to the various drawing figures in which identical elements are numbered identically throughout, a description of the preferred embodiment of the present invention will now be described.
Description of Prior Applications
The parent applications and the afore-mentioned related international applications (all incorporated herein by reference) teach various aspects of stimulating and blocking electrodes for either up-regulating or down-regulating the vagus nerve and combinations of these electrodes for a wide variety of therapies. To facilitate an understanding of the present invention, selected portions of those applications are described in this section.
1. Description of Vagal Innervation of the Alimentary Tract
The biochemistry of the contents of the intestines I is influenced by the pancreas P and gall bladder PG which discharge into the duodenum. This discharge is illustrated by dotted arrow A.
The vagus nerve VN transmits signals to the stomach S, pylorus PV, pancreas and gall bladder PG directly. Originating in the brain, there is a common vagus nerve VN in the region of the diaphragm (not shown). In the region of the diaphragm, the vagus VN separates into anterior and posterior components with both acting to innervate the GI tract. In
The vagus nerve VN contains both afferent and efferent components sending signals to and away from, respectively, its innervated organs.
In addition to influence from the vagus nerve VN, the GI and alimentary tracts are greatly influenced by the enteric nervous system ENS. The enteric nervous system ENS is an interconnected network of nerves, receptors and actuators throughout the GI tract and pancreas and gall bladder PG. There are many millions of nerve endings of the enteric nervous system ENS in the tissues of the GI organs. For ease of illustration, the enteric nervous system ENS is illustrated as a line enveloping the organs innervated by the enteric nervous system ENS
The vagus nerve VN innervates, at least in part, the enteric nervous system ENS (schematically illustrated by vagal trunk VN3 which represents many vagus-ENS innervation throughout the cut). Also, receptors in the intestines I connect to the enteric nervous system ENS. Arrow B in the figures illustrates the influence of duodenal contents on the enteric nervous system ENS as a feedback to the secretion function of the pancreas, liver and gall bladder. Specifically, receptors in the intestine I respond the biochemistry of the intestine contents (which are chemically modulated by the pancreao-biliary output of Arrow A). This biochemistry includes pH and osmolality.
In the figures, vagal trunks VN1, VN2, VN4 and VN6 illustrate schematically the direct vagal innervation of the GI organs of the LES, stomach S, pylorus PV and intestines I. Trunk VN3 illustrates direct communication between the vagus VN and the ENS. Trunk VN5 illustrates direct vagal innervation of the pancreas and gall bladder. Enteric nerves ENS1-ENS4 represent the multitude of enteric nerves in the stomach S, pylorus PV, pancreas and gall bladder PG and intestines I.
While communicating with the vagus nerve VN, the enteric nervous system ENS can act independently of the vagus and the central nervous system. For example, in patients with a severed vagus nerve (vagotomy—an historical procedure for treating ulcers), the enteric nervous system can operate the gut. Most enteric nerve cells are not directly innervated by the vagus. Gershon, "The Second Brain", Harper Collins Publishers, Inc, New York, N.Y. p. 19 (1998)
2. Implantable Pacing Circuit
A representative pacing circuit 100 is schematically shown in
While a fully implantable controller 102 is one possible embodiment, it is not necessary. For example, the electrodes 118, 120 can be implanted connected to a receiving antenna placed near the body surface. The control circuits (i.e., the elements 124, 110, 112 and 108) can be housed in an external pack worn by the patient with a transmitting antenna held in place on the skin over the area of the implanted receiving antenna. Such a design is forward-compatible in that the implanted electrodes can be later substituted with the implantable controller 102 at a later surgery if desired.
Although not shown in
3. Neural Blocking Therapy
The block may be intermittent or continuous. The preferred nerve conduction block is an electronic block created by a signal at the vagus by an electrode PBE controlled by the implantable controller (such as controller 102 or an external controller). The nerve conduction block can be any reversible block. For example, ultrasound, cryogenics (either chemically or electronically induced) or drug blocks can be used. An electronic cryogenic block may be a Peltier solid-state device which cools in response to a current and may be electrically controlled to regulate cooling. Drug blocks may include a pump-controlled subcutaneous drug delivery.
With such an electrode conduction block, the block parameters (signal type and timing) can be altered by a controller and can be coordinated with the pacing signals to block only during pacing. A representative blocking signal is a 500 Hz signal with other parameters (e.g., timing and current) matched to be the same as the pacing signal. While an alternating current blocking signal is described, a direct current (e.g., −70 mV DC) could be used.
The foregoing specific examples of blocking signals are representative only. Other examples and ranges of blocking signals are described in the afore-mentioned literature. For example, the nerve conduction block is preferably within the parameters disclosed in Solomonow, et al., "Control of Muscle Contractile Force through Indirect High-Frequency Stimulation", Am. J. of Physical Medicine, Vol. 62, No. 2, pp. 71-82 (1983). Particularly, the nerve conduction block is applied with electrical signal selected to block the entire cross-section of the nerve (e.g., both afferent, efferent, myelinated and nomnyelinated fibers) at the site of applying the blocking signal (as opposed to selected sub-groups of nerve fibers or just efferent and not afferent or visa versa) and, more preferably, has a frequency selected to exceed the 200 Hz threshold frequency described in Solomonow et al. Further, more preferred parameters are a frequency of 500 Hz (with other parameters, as non-limiting examples, being amplitude of 4 mA, pulse width of 0.5 msec, and duty cycle of 5 minutes on and 10 minutes off). As will be more fully described, the present invention gives a physician great latitude in selected pacing and blocking parameters for individual patients.
Applicant has determined a most preferred blocking signal has a frequency of 3,000 Hz to 5,000 Hz or greater applied by two or more bi-polar electrodes. Such a signal has a preferred pulse width of 100 micro-seconds (associated with a frequency of 5,000 Hz. It is believed this frequency and pulse width best avoid neural recovery from blocking and avoid repolarization of the nerve by avoiding periods of no signal in the pulse cycle. A short "off" time in the pulse cycle (e.g., between cycles or within a cycle) could be acceptable as long as it is short enough to avoid nerve repolarization. The waveform may be a square or sinusoidal waveform or other shape. The higher frequencies of 5,000 Hz or more have been found, in porcine studies, to result in more consistent neural conduction block. Kilgore, et al., "Nerve Conduction Block Utilizing High-Frequency Alternating Current", Medical & Biological Engineering & Computing, Vol. 24, pp. 394-406 (2004). Preferrably the signal is bi-polar, bi-phasic delivered to two or more electrodes on a nerve.
Applicants have determined a signal amplitude of 0.5 to 8 mA is adequate for blocking. Other amplitudes may suffice.
While a duty cycle can be of predetermined time periods, it is presently preferred the duty cycle be less fixed to reduce the likelihood of patient accommodation. While the periods of on and off can be random, they can be set at any non-fixed sequence (for example, 5 minutes "on" followed by 10 minutes "off" as a first cycle with a following cycle being a different set of time—such as 10 minutes on and 2 minutes off—with a non-repeating duty cycle continuing over a 24-hour period). Other signal attributes can be varied to reduce the likelihood of accommodation by the nerve or an organ. These include altering the power, waveform or pulse width.
In certain patients, the vagus nerve activity may contribute to undesired effects such pancreatitis progression or obesity contributing factors. Use of a blocking electrode alone in the vagus permits down-regulating the vagus nerve VN, the enteric nervous system ENS and pancreo-biliary output. The block down-regulates both afferent and efferent signal transmission.
The use of blocking as an independent therapy permits treatment for pancreatitis and obesity by down regulating vagal activity and pancreatic output including pancreatic exocrine secretion. Also, the blocking may be used as a separate treatment for reducing discomfort and pain associated with gastrointestinal disorders or other vagally mediated pain (i.e., somatic pain sensations transmitted along any nerve fibers with pain sensation modulated by vagal afferent fibers). A nerve stimulation to treat pain is described in U.S. patent application publication No. US2003/0144709 to Zabara et al., published Jul. 31, 2003.
4. Application to Obesity
Obesity is treatable with vagal block. Recent literature describes potential obesity treatments relative to gut hormone fragment peptide YY3-36. See, e.g., Batterham, et al., "Inhibition of Food Intake in Obese Subjects by Peptide YY3-36", New England J. Med., pp. 941-948 (Sep. 4, 2003) and Korner et al., "To Eat or Not to Eat—How the Gut Talks to the Brain", New England J. Med., pp. 926-928 (Sep. 4, 2003). The peptide YY3-36 (PPY) has the effect of inhibiting gut motility through the phenomena of the ileal brake. Vagal afferents create a sensation of satiety.
The present invention can electrically simulate the effects of PPY by using the vagal block to down-regulate afferent vagal activity to create a desired sensation of satiety. Since the down-regulation does not require continuous blocking signals, the beneficial efferent signals are permitted.
Also, vagal block restricts fundal accommodation, reduces pancreatic exocrine secretion (thereby reducing caloric absorption) and beneficially effects both satiety and satiation.
5. Apparatus for Applying Vagal Block
a. Background
With reference to
The esophagus E passes through the diaphragm D at an opening or hiatus H. In the region where the esophagus E passes through the diaphragm D, trunks of the vagal nerve (illustrated as the anterior vagus nerve AVN and posterior vagus nerve PVN) are disposed on opposite sides of the esophagus E. It will be appreciated that the precise location of the anterior and posterior vagus nerves AVN, PVN relative to one another and to the esophagus E are subject to a wide degree of variation within a patient population. However, for most patients, the anterior and posterior vagus nerves AVN, PVN are in close proximity to the esophagus E at the hiatus H where the esophagus E passes through the diaphragm D.
The anterior and posterior vagus nerves AVN, PVN divide into a plurality of trunks that innervate the stomach directly and via the enteric nervous system and may include portions of the nerves which may proceed to other organs such as the pancreas, gallbladder and intestines. Commonly, the anterior and posterior vagus nerves AVN, PVN are still in close proximity to the esophagus E and stomach (and not yet extensively branched out) at the region of the junction of the esophagus E and stomach S.
In the region of the hiatus H, there is a transition from esophageal tissue to gastric tissue. This region is referred to as the Z-line (labeled "Z" in the Figures). Above the Z-line, the tissue of the esophagus is thin and fragile. Below the Z-line, the tissue of the esophagus E and stomach S are substantially thickened and more vascular. Within a patient population, the Z-line is in the general region of the lower esophageal sphincter. This location may be slightly above, slightly below or at the location of the hiatus H.
b. Implanted Band Electrode
i. Description of Device
With reference to
The band 200 may be formed of polyester or the like or any other suitable material which may be sutured in place or otherwise fastened in place surrounding the esophagus E or gastric cardia. Preferably, the band 200 is placed at the junction of the esophagus E and stomach S such that the band may overly both the esophagus E and stomach S at the cardiac notch CN.
The band 200 may have a plurality of electrodes which, in the embodiment of
Placement of the band 200 as described ensures that at least a subset of the electrodes 202, 203 will be in overlying relation to the anterior and posterior vagus nerves AVN, PVN. As a result, energizing the electrodes 202, 203 will result in stimulation of the anterior and posterior vagus nerves AVN, PVN and/or their branches.
In therapeutic applications, the upper array 202 of electrodes may be connected to a blocking electrical signal source (with a blocking frequency and other parameters as previously described) and the lower array 203 of electrodes may be connected to a stimulation electrical signal source as previously described. Of course, only a single array of electrodes could be used with all electrodes connected to either a blocking or a stimulating signal.
In a preferred embodiment for treating obesity, only upper band 200 is used with both of electrodes 202, 203 being bi-polar pairs (i.e., alternating anode and cathode electrodes) for applying a blocking signal as will be described.
The electrical connection of the electrodes 202, 203 to a controller is not shown but may be as previously described by having a leads connecting the electrodes directly to an implantable controller. Alternatively, and as previously described, electrodes may be connected to an implanted antenna for receiving a signal to energize the electrodes.
The use of an array of electrodes permits the collar 200 to be placed without the need for great accuracy at the time of placement. In the event it is desirable that electrodes not directly overlying a vagus nerve be deactivated, the electrodes could, through operation of a controller, be individually energized to detect a physiological response. The absence of a physiological response (other than possible muscular action of the stomach and esophagus) would indicate the absence of an overlying relation to a vagus nerve. The presence of a physiological response would indicate overlying relation of the tested electrode to a vagus nerve.
By identifying which electrodes create a physiologic response, the remaining electrodes (i.e., those not having a physiological response) could be permanently deactivated. An example of a physiological response would be a cardiovascular response which may be attributed to a signal of about 2-80 hertz and up to 50 milliamps and as more fully described in U.S. Pat. No. 6,532,388 to Hill et al dated Mar. 11, 2003. As a result, a selected one of the AVN or PVN could be energized.
It will be appreciated the foregoing description of identifying electrodes to be deactivated is a non-limiting embodiment. For example, all electrodes could be energized. The therapies as previously described could be employed by using blocking electrodes or stimulation electrodes or both in order to block or energize (or both) the vagus nerve.
In addition to the benefits of nerve pacing, the band 200 can also be used to restrict and potentially lengthen the esophagus thereby reducing possibilities for reflux as more fully described in commonly assigned and co-pending U.S. patent application Ser. No. 10/600,080 filed Jun. 20, 2003 and entitled "Gastro-Esophageal Reflux Disease" (GERD) Treatment Method and Apparatus".
An alternative placement of the band is to place the band at the cardia-esophagus junction or at the top of the cardia over-lying a fat pad which surrounds a patient's cardia. Such a placement is used in placing restrictive bands such as the Lap-Band or the Swedish Band of Obtech Medical, AG. So placed, the band 200 covers both anterior and posterior vagal trunks. In most patients, this placement will result in the band 200 not covering the hepatic branch of the vagus. However, the hepatic branch is believed to have little impact on gastric or pancreatic function.
ii. Application to Obesity and Satiety
The embodiment of
In the embodiment of
The prior art suggests stimulating the vagas with a stimulating signal for treating obesity or eating disorders. See, e.g., U.S. Pat. No. 5,188,104 to Wernicke et al., dated Feb. 23, 1993; U.S. Pat. No. 5,263,480 to Wernicke et al., dated Nov. 23, 1993; U.S. Pat. No. 6,587,719 to Barrett et al., dated Jul. 1, 2003 and U.S. Pat. No. 6,609,025 to Barrett et al., dated Aug. 19, 2003. These patents all describe stimulating, non-blocking signals (e.g., stimulating to a level slightly below a so-called "retching threshold" as described in the '025 patent). As such, all fail to note the problem associated with obesity and eating discords that is not addressed by stimulating the vagus but, rather, by blocking stimulation on the vagus.
The blocking at cardiac notch CN reduces fundal accommodation and creates satiety sensations. Such a physiologic response is suggested by vagotomy data in which truncal vagotomy patients have experienced weight loss and increased satiety. See, e.g., Kral, "Vagotomy as a Treatment for Morbid Obesity", Surg. Clinics of N. Amer., Vol. 59, No. 6, pp. 1131-1138 (1979) , Gortz, et al., "Truncal Vagotomy Reduces Food and Liquid Intake in Man", Physiology & Behavior, Vol. 48, pp. 779-781 (1990), Smith, et al., "Truncal Vagotomy in Hypothalamic Obesity", The Lancet, pp. 1330-1331 (1983) and Kral, "Vagotomy for Treatment of Severe Obesity", The Lancet, pp. 307-308 (1978).
The optional lower band 200′ is placed lower on the stomach (e.g., close to the pylorus). The lower electrode array 203′ of the lower band 200′ is energized with a stimulation signal to modulate intestinal motility in the event motility is otherwise impaired by the upper band blocking.
The upper array 202′ of the lower band 200′ is energized with a blocking signal so that the stimulation signal at electrodes 203′ does not interfere with the blocking effect of electrodes 203 of upper band 200. In this obesity treatment, the electrodes of the bands 200, 200′ can be placed on constricting bands (such as the well-known Lap-Band� system of Inamed Inc., Santa Barbara, Calif. USA, and used in obesity treatment or the previously mentioned and similarly used Swedish band). More preferably, the bands 200, 200′ are not constricting thereby minimizing erosion risks otherwise associated with highly constricting bands. However, the neural blocking technology of the present invention can be incorporated into such constricting bands or used in conjunction other obesity surgeries or therapies. Specifically, the scientific literature indicates a vagotomy in combination with other obesity procedure (e.g., antrectomy, gastroplasty and biliopancreatic bypass) improves weight loss procedures. Tzu-Ming, et al., "Long-Term Results of Duodenectomy with Highly Selective Vagotomy in the Treatment of complicated Duodenal Ulcers", Amer. J. of Surg., Vol. 181, pp. 372-376 (2001), Kral, et al., "Gastroplasty for Obesity: Long-Term Weight Loss Improved by Vagotomy", World J. Surg., Vol. 17, pp. 75-79 (1993), and Biron, et al., "Clinical Experience with Biliopancreatic Bypass and Gastrectomy or Selective Vagotomy for Morbid Obesity", Canadian J. of Surg., Vol. 29, No. 6, pp. 408-410 (1986).
Vagal neural blocking simulates a vagotomy but, unlike a vagotomy, is reversible and controllable. Therefore, while obesity is particularly described as a preferred treatment, the vagal neural block of the present invention can be used as a less drastic procedure for treatments previously performed with a vagotomy. Without limitation, these include obesity, ulcers or chronic pain or discomfort (alone or in combination with conjunctive procedures).
Further, bulimia has been identified as a disease amenable to treatment by decreasing afferent vagal activity via pharmacological vagal inhibitors delivered systemically. Faris, et al., "Effect of Decreasing Afferent Vagal Activity with Ondansetron on Symptoms of Bulimia Nervosa: a Randomized, Double-Blind Trial", The Lancet, pp. 792-797 (2000). Therefore, bulimia and other diseases treatable with vagal blocker drugs can be treated with the targeted and site-specific vagal neural block of the present invention.
c. Acute Treatment Device
i. Device Description
The nasogastric tube 300 is multi-lumen tube which includes distal openings 302 to which suction can be applied to remove gastric contents through the tube 300. A compliant balloon 304 surrounds the gastric tube. Proximal to the balloon 304 is an opening 309 in communication with a lumen (not shown) to which a suction can be applied to remove saliva through the opening 309.
The balloon 304 has a plurality of electrodes which may include an upper array 306 of electrodes and a lower array 307 of stimulation electrodes. The electrodes of the upper array 306 may be connected to a blocking signal source via conductors 306 a (
As in the embodiment of
It will be noted in this embodiment that the electrodes are disposed abutting the mucosal surface of the esophageal and stomach lining and are not in direct contact with the vagus nerves AVN, PVN. Instead, the electrodes are spaced from the vagus nerves AVN, PVN by the thickness of the stomach and lower esophageal wall thickness.
Transmucosal electrical stimulation of nerves is well known. Such stimulation is disclosed in U.S. Pat. No. 6,532,388 to Hill et al dated Mar. 11, 2003 (describing transmucosal stimulation of nerves across a trachea using a balloon with electrodes in the trachea to modulate cardiac activity). Also, the phenomena of transmucosal electrical stimulation of nerves is described in Accarino, et al, "Symptomatic Responses To Stimulation Of Sensory Pathways In The Jejunum", Am. J. Physiol., Vol. 263, pp. G673-G677 (1992) (describing afferent pathways inducing perception selectively activated by transmucosal electrical nerve stimulation without disruption of intrinsic myoelectrical rhythm); Coffin, et al, "Somatic Stimulation Reduces Perception Of Gut Distention In Humans", Gastroenterology, Vol. 107, pp. 1636-1642 (1994); Accarino, et al, "Selective Dysfunction Of Mechano Sensitive Intestinal Afferents In Irritable Bowel Syndrome", Gastroenterology, Vol. 108, pp. 636-643 (1994), Accarino, et al "Modification Of Small Bowel Mechanosensitivity By Intestinal Fat", GUT, Vol. 48, pp. 690-695 (2001); Accarino, et al, "Gut Perception In Humans Is Modulated By Interacting Gut Stimuli", Am. J. Physiol. Gastrointestinal Liver Physiol., Vol. 282, pp. G220-G225 (2002) and Accarino, et al, "Attention And Distraction Colon Affects On Gut Perception", Gastroenterology, Vol. 113, pp. 415-442 (1997).
Alternative embodiments of the transmucosal stimulation device of
In all of the foregoing, a balloon is expanded to urge the electrodes against the mucosal tissue. While this is a presently preferred embodiment, any mechanism for urging the electrodes against the mucosal tissue may be used. In each of
A still further embodiment is shown in
The TapScope (which comes in various sizes—e.g., 5, 10 or 18 French) is used positioned high in the esophagus with the electrodes placed near the heart. The TapScope is stimulated to cause pacing of the heart. Such pacing is using to perform cardiac stress testing patients. It is particularly useful in patients who are not ambulatory or who cannot tolerate more traditional stress testing (such as dobutamine stress testing. A discussion of such use of the TapScope can be found in Lee, et al., "Nonexercise Stress Transthoracic Echocardiography: Transesophageal Atrial Pacing Versus Dobutamine Stress", J. Amer College of Cardiology, Vol. 33, No. 2 pp. 506-511 (1999).
The TapScope can be modified to lengthen the catheter to position electrodes near or below the diaphragm to apply a blocking signal instead of a stimulating signal. The TapScope can also be modified to provide a hollow center to permit concurrent use of the TapScope as a gastric or jejunal tube. Further, the device can be modified to place an inflatable balloon on the catheter to reside in the stomach. The inflated balloon acts as a stop to prevent withdrawing the catheter prematurely and insure accurate positioning of the electrodes near or below the diaphragm.
ii. Application to Acute Pancreatitis
When energized with a blocking frequency, the embodiment of
A recent study reported that the average total hospital cost to obtain a survivor of severe, acute pancreatitis is nearly $130,000 with an average length of hospital stay of 40 days. Soran, et al., "Outcome and quality of life of patients with acute pancreatitis requiring intensive care", J. Surg. Res., 91(1), pp. 89-94 (2000). Further complicating the management of these patients is the uncertainty surrounding the prognosis because the course of the disease is unpredictable at initial presentation. Chatzicostas, et al., "Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II and II scoring systems in predicting acute pancreatitis outcome", J. Clinical Gastroenterology, 36(3), pp. 253-260 (2003). If patients could be successfully treated during the initial phases of the disease, with a higher survival rate, there is a high probability of returning to a productive life. Soran, et al., supra.
Pancreatitis may be associated with a number of etiologies including chronic alcoholism or gallstones (e.g., gallstones lodged in the pancreatic or common duct). When acute pancreatitis becomes severe, treatment options are severely limited. Morbidity and mortality rates for pancreatitis are sobering. Baron, et al., "Acute Necrotizing Pancreatitis", New England J. of Medicine, Vol. 340, No. 18, pp. 1412-1417 (1999) and Steer et al., "Chronic Pancreatitis", New England J. of Medicine, pp. 1482-1490 (1995).
Down-regulating vagal activity can be used to treat pancreatitis. A recently reported finding in experimental pancreatitis demonstrated that the vagus nerves are strongly implicated in the pathophysiology of pancreatitis. Yoshinaga, et al., "Cholecystokinin Acts as an Essential Factor in the Exacerbation of Pancreatic Bile Duct Ligation-Induced Rat Pancreatitis Model Under Non-Fasting Condition", Japanese J. Pharmacol, Vol. 84, pp. 44-50 (2000). Pharmacologic means of decreasing pancreatic secretion have been attempted with limited success because of the dose-limiting side effects encountered with the drugs, their lack of specificity or their lack of availability. In fact, one recent trial of a specific blocker of parasympathetic (vagus nerves) control of secretion demonstrated a shortened recovery period in patients with acute pancreatitis while trials with other pancreatic down-regulating drugs that are less specific or potent have proven to be disappointing. Zapater, et al., "Do Muscarinic Receptors Play a Role in Acute Pancreatitis?", Clin. Drug Invest., 20(6), pp. 401-408(2000); Norton, et al., "Optimizing Outcomes in Acute Pancreatitis", Drugs, 61(11), pp. 1581-1591 (2001). Atropine is a drug that blocks parasympathetic nerve endings. It is known to be desirable to use atropine in acute pancreatitis patients to down-regulate pancreatic activity. Unfortunately, for most such patients, this drug cannot be used due to its many side effects.
Acute pancreatitis patients may be placed on intravenous feeding with the device 300 left in place for a chronic length of time (e.g., several days or weeks). At least the electrodes of the lower array 307 may be energized with a blocking signal for the treatment of acute pancreatitis. The invention permits down-regulation of pancreatic output through vagal blocking without the need for undesirable surgery for direct vagal access.
In addition to utility for treating pancreatitis, the present invention may be used to avoid pancreatitis in patients having an increased likelihood of developing the disease. For example, patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and/or related procedures are known to having a higher likelihood of developing pancreatitis. Such patients may be treated with the present invention with a blocking signal to down-regulate pancreatic output and reduce the likelihood of developing pancreatitis.
Many physicians treating patients with pancreatitis use a nasogastric tube as part of the treatment. As a result, the present invention is illustrated as being incorporated on a nasogastric tube. However, a significant body of physicians adheres to a belief that pancreatitis patients benefit from a feeding involving placing nourishment directly into the jejunum portion of the small intestine via a naso-jejunal tube. While the present invention is illustrated in an embodiment of placement of the balloon and electrodes on a naso-gastric tube, the invention can also be placed on a nasojejunal tube or a nasogastricjejunal tube.
Improvements to Control Nerve Down-Regulation
While simulating a vagotomy through a nerve block as described above is beneficial, a complete and continuous block can have adverse consequences in some patients. The vagus nerve serves a wide variety of functions. For example, vagal activity contributes to pyloric relaxation (thereby promoting gastric emptying) as well as intestinal motility. Also, a vagotomized patient may experience a loss of the benefits of a vagotomy over time. For example, over time, the enteric nervous system may compensate for a vagotomy. Therefore, in patients who have experienced weight loss from vagotomy, some patients may experience a relapse of weight gain over time as the enteric nervous system compensates for the loss of vagal activity. As a result, a complete and permanent simulation of a vagotomy at times may be undesirable.
Animal studies performed by applicants reveal nerve and organ function recovery after cessation of a vagal blocking signal. In such studies pancreatic exocrine secretion is collected and measured in juvenile pigs. The collection of such secretions as a measure of vagal activity is described in Holst, et al., "Nervous control of pancreatic exocrine secretion in pigs", Acta Physiol. Scand. 105: 33-51 (1979) (in which an up-regulating stimulation of the vagus was studied).
Electrodes applied to both anterior and posterior vagal trunks are energized with a blocking signal. The signal is applied for a limited time (e.g., 5 minutes). In response to vagal blocking, pancreatic exocrine secretion drops significantly (e.g., by up to about 90% from baseline). After cessation of blocking, the level of pancreatic exocrine secretion gradually increases toward baseline. The speed of vagal activity recovery varies from subject to subject. However, 20 minutes is a reasonable example of the time needed to recover to baseline. After recovery, application of a blocking signal again down-regulates vagal activity which can then recover after cessation of the signal. Renewed application of the signal can be applied before full recovery. For example, after a limited time period (e.g., 10 minutes) blocking can be renewed resulting in average vagal activity not exceeding a level significantly reduced when compared to baseline.
Recognition of recovery of vagal activity (and recognition of the significant variability between subjects) permits a treatment therapy and apparatus with enhanced control and enhanced treatment options.
As shown in
The flexibility to vary average vagal activity gives an attending physician great latitude in treating a patient. For example, in treating obesity, the blocking signal can be applied with a short "no blocking" time to reduce weight as rapidly as possible. If the patient experiences discomfort due to dysmotility, the duration of the "no blocking" period can be increased to improve patient comfort. Also, the reduction of enzyme production can result in decreased fat absorption with consequential increase of fat in feces. The blocking and no blocking duration can be adjusted to achieve tolerable stool (e.g., avoiding excessive fatty diarrhea).
The control afforded by the present invention can be used to prevent the enteric nervous system's assumption of control since vagal activity is not completely interrupted as in the case of a surgical and permanent vagotomy. Further, pancreatic production of digestive enzymes (such as the fat digesting enzyme lipase) is not eliminated but is controllably reduced.
While patient weight loss and comfort may be adequate as feedback for determining the proper parameters for duration of blocking and no blocking, more objective tests can be developed. For example, the duration of blocking and no blocking can be adjusted to achieve desired levels of enzyme production and nutrient digestion. In one example of drug therapy for obesity, orlistat blocks the action of lipase. Lipase is a fat-digesting enzyme. As a consequence of this reduction in lipase, the fat content of feces increases. It is generally regarded as desirable to modulate drug intake so that fecal fat does not exceed 30% of ingested fat. Similarly, the blocking and no blocking durations can be modulated to achieve the same result. Such testing can be measured and applied on a per patient basis or performed on a statistical sampling of patients and applied to the general population of patients.
As shown above, the present invention uniquely uses a recovery of the vagus nerve to control a degree of down-regulation of vagal activity. This gives a physician enhanced abilities to control a patient's therapy for maximum therapeutic effectiveness with minimum patient discomfort.
While a duty cycle can be of predetermined time periods, it is presently preferred the duty cycle be less fixed to reduce the likelihood of patient accommodation. While the periods of on and off can be random, they can be set at any non-fixed sequence (for example, 5 minutes "on" followed by 10 minutes "off" as a first cycle with a following cycle being a different set of time—such as 10 minutes on and 2 minutes off—with a non-repeating duty cycle continuing over a 24-hour period). Other signal attributes can be varied to reduce the likelihood of accommodation by the nerve or an organ. These include altering the power, waveform or pulse width.
Options For Bipolar Electrode Placement
In any of
In addition to the above, other configurations are possible. For example, the electrodes can be helical electrodes placed on the nerve.
While any of the foregoing electrodes could be flat metal pads (e.g., platinum), the electrodes can be configured for various purposes.
With the foregoing detailed description of the present invention, it has been shown how the objects of the invention have been attained in a preferred manner. Modifications and equivalents of disclosed concepts such as those which might readily occur to one skilled in the art, are intended to be included in the scope of the claims which are appended hereto.
Patent Citations
Non-Patent Citations
Referenced by
Legal Events
Original Image


text:
HARRAH, Wash. (AP) -- Authorities say a 26-year-old man was left in critical condition after being shot several times with a rifle Friday afternoon in Harrah, Wash.
The Yakima Herald-Republic reports that Roberto Ocampo Ursino was rushed to Yakima Regional Medical and Cardiac Center after being repeatedly shot.
The Yakima Sheriff's office says it's unclear what happened. When deputies arrived, three of Ursino's relatives were at the scene. They told deputies that one of them had accidently shot Ursino.
Sgt. Mike Russell says deputies detained an 18-year-old man they believed was the shooter, but what exactly happened is still sketchy.

subset: commoncrawl


text:
Description: Killing Pinoccio
Image was hearted from killingpinoccio.tumblr.com
Other images from this site
loading life was first to heart it
3 people have hearted this image
This image is in 1 collection
You might like these too
Now available in your language!Use in your language! Go back to English
Other images from this site
You might like these too
Sign in with Facebook or Twitter to start your gallery.
Sign in with Facebook Sign in with TwitterDon't have Twitter or Facebook? Skip this step!


text:
Can i get my case customised?
Want to have a case with my own personality and with my name at the from where the apple sign would be able to shine through it. Is this possible?
- Asked by Orson W
- Flag as inappropriate (Can i get my case customised?)
1 Answer from the Community
No, the only way you can "customize" the case is by purchasing a case in a color that matches your personality. I "customized" mine by buying a clear one and putting bumper stickers on it from different places I've traveled to.
- Answered by Kristina L from Laurel
- Flag as inappropriate Answer 1
Related Questions
Can I get a customised Mac Air
- Asked by Philip C
- 09-Jan-2014
- Flag as inappropriate (Can I get a customised Mac Air)
- Asked about: Mac
Answer now (Can I get a customised Mac Air)
No answers yet
How much does this case weigh?
- Asked by Deborah H from Greensboro
- 04-Nov-2013
- Flag as inappropriate (How much does this case weigh?)
- Asked about: MICHAEL Michael Kors Clutch Bag for…
Does the clear case get discolored with use?
- Asked by Sonya B from Campsie
- 11-Nov-2012
- Flag as inappropriate (Does the clear case get discolored with use?)
- Asked about: Speck GemShell Case for iPhone 4S


text:
- Avengers
- Batman
- Superman
- Star Wars
- Wonder Woman
- Captain America
- Spider-Man
- Daredevil
- Green Lantern
- Flash
- Deadpool
- Iron Man
- Teenage Mutant Ninja Turtles
- Guardians Of The Galaxy
- X-Men
- Thor
- Transformers
- Incredible Hulk
- Man Of Steel
- Nightwing
- Wolverine
- Batgirl
- Dc Heroes And Justice League
- Supergirl
- Punisher
- Joker
- Robin
- Star Trek
- Game Of Thrones
- Venom
- Big Bang Theory
- Aquaman
- Fantastic 4
- Shazam
- Green Arrow
- Walking Dead
- Catwoman
- Harley Quinn
- Doctor Who
- Ghost Rider
- DC Comics Merchandise
- Supervillains
- Marvel Heroes And Avengers
Superman Symbol Queen Blanket
Building your own fortress of solitude? Pillows, more pillows and a Superman Symbol Queen Blanket; that's how Superman did it. Trust me. This blanket is 100% warm, soft and plushy polyester, measuring approximately 79 inches by 95 inches. You'll probably recognize the symbol on this toasty "blankey." Yep, it's the totally super classic Superman Shield on the also classic blue.
More Details:
- - Rating: 4.9 out of 5 based on 7 reviews.
- - Licensor: Dc
- - Call Us: 866-787-4376
- - Need Help?
Extremely comfy and big enough for me and my girl, definately recommend this to anybody and everybody
I thought this was going to be a comforter. i was surprised when i got it was iffy about it being warm. To my surprise first night i used it was super warm. Wish they had more then just superman.
I thought this was going to be a comforter. i was surprised when i got it was iffy about it being warm. To my surprise first night i used it was super warm. Wish they had more then just superman.
I think the blanket was priced well for the quality.
This blanket is awesome! It is super warm and super soft. Great to cuddle under too!!
Definitely worth the money! As the weather is starting to turn over here, me and the Mrs have been snuggled up in them! And they work really as furniture throws as well! even on a three seater!
super quality


text:
Media houses are increasingly moving towards integrated newsrooms, with journalists reporting across platforms, languages, themes, in real time. But this may not be smooth and uncontested
It has been in the offing for a while, but the idea of 'integrated newsrooms' is picking momentum in an unprecedented manner.
Major networks are in the middle of a major overhaul. Newspapers and channels, belonging to the same network, have been brought together in common office spaces for greater 'synergy'. There has been a spurt in investment in online platforms, with the 'web-first' philosophy – whereby reporters are first told to file a story for the net, before sending a longer one for the print edition or TV – gaining traction across the industry. And the lines between being a TV, print, digital reporter or photographer is blurring rapidly, with journalists expected to perform a range of responsibilities, and possess skills across mediums, languages, beats, and platforms.
Two factors are driving the change.
The first, all industry veterans admit, is 'cost-cutting' at a time when media houses are feeling the pressure in an ultra-competitive environment, a sluggish economy, and with many networks facing severe financial crises. The second is technological, and recognition that people are already shifting to consuming news online. The fact that the future is digital is now a truism. This has resulted in pressure to streamline operations to deliver news 'as it happens', across platforms.
Akash Banerjee, author of Tales from Shining and Sinking India, a book on the news television business, explains the various ways in which the concept of an 'integrated newsroom' is taking shape.
He gives the example of the Living Media group, which owns India Today and TV Today network, and where he worked in the past. "Across platforms, different news categories, and languages, reporters first feed in the news to a wire service. This is manned by an assignment desk, which flashes the news on an internal wire. Any of the group's media platforms can then run with it. It is called technological synergies of resources."
Then, there is 'physical proximity' where reporters, editors, desk and production hands share a common office space, enabling greater interaction and exchange of information. A common OB van, with skeletal staff, goes out for an assignment instead of multiple vans for each platform of the same media house.
"The greatest impact on journalists, of course, is they have to be multi-faceted. You do a piece-to-camera in English and Hindi, write for the group's publications, tweet in real-time, post short video-blogs, and may even need to do your own camera-work," says Mr Banerjee.
New pressures
All of this has meant new pressures on editors and reporters.
Smita Sharma, the associate foreign editor and anchor with IBN7 channel, is among the most productive TV journalists in the business. In the past few months, besides her regular reporting and anchoring duties in Delhi, she has reported on elections in Karnataka, protests in Bangladesh, elections in Pakistan, natural disaster in Uttarakhand. And she has often done so for both the Hindi and English channels of Network 18, besides live web-blogging for Firstpost.com, their digital platform.
She has no doubts that journalists will have to 'reinvent' themselves to stay relevant, or otherwise face the real prospect of losing jobs.
When asked whether it takes a toll, she said, "It offers us an opportunity to work across mediums, but is physically and mentally taxing. Besides, one has to be in step with new age media to check news that is breaking." She adds that this does result in erosion in the quality of the work. "My video quality will obviously not be as good as that of a professional cameraperson."
Mr Banerjee adds such wide-ranging responsibilities leave the reporter with little time to specialise. "If you are joining the TV news profession now, where is the space to cultivate expertise and sources? One is expected to track the big story of the day and deliver on an hourly basis preferably."
R Sukumar, editor of Mint, which was an early pioneer in the concept of integrated newsrooms, has written that besides traditional skills, such newsrooms make new demands of editors. "The first one is the ability to understand what kind of story works online – and online, what story works with a video and which one doesn't need one – and what works in print."
The second, he noted, was having the 'sensory bandwidth' to deal with all that was happening around and information coming in from 24/7 news channels, Twitter live-feeds, and 'respond selectively'. The third was 'considerable physical and mental stamina'. And the fourth, Mr Sukumar pointed out, is an understanding of the digital medium, "not so much in terms of technology…but what it can do for content and readers."
Structural challenges
A senior media practitioner, familiar with this transition underway, spoke to The Hindu on the condition of anonymity. While acknowledging that cost-cutting and technological considerations were key drivers, he felt that India's media owners were acting hastily. "They are worried about the crisis a lot before the crisis has actually hit us. Foreign consultants have made extraordinary amounts of money spouting wisdom about integrated newsrooms. This needs to be more carefully thought-out."
The haste, he argued, had resulted in major problems. "Forcing and threatening print and TV reporters – who were hired with different job descriptions, ensconced in particular ways in an organisation – to suddenly do multiple jobs, beyond their skills, is not working." So a TV reporter used to writing a script does not necessarily know how to structure print copy, and this had to be substantially re-edited. Or a print person did a raw job of a piece-to-camera for TV news. Desk editors in some major media houses which have experimented with the trend confirmed this pattern, and called it 'messy'.
The other issue, the senior media source suggested, was the absence of product differentiation. "The idea is that a magazine, a newspaper, channels of one media house will all have distinct elements, and capture their own market share. If a consumer is getting the same information, from the same set of people, across the platforms, why should he pay for all products?"
He added that this was not to suggest that integrated newsrooms should not happen at all, but it needed to be started with a clean slate. "People should be hired with the job description they are meant to perform. There should be adequate training and retraining of staff."
Most importantly, he said, journalists need to be 'incentivised' rather than 'threatened'; otherwise there will be an exodus. "Encourage and enable them to build skills, don't tell them they would become dinosaurs."
But in the ruthless and competitive media world, that is not how the message is being relayed. It is blunter – synergise or perish.
Keywords: media houses, integrated newsrooms, TV journalism, media groups


text:
Topic: Off-topic / did i lose my edge?
You must meme your way to the meme fountain and meme the secret meme to open up the meme cavern. You will then meme on down to the meme shrine and meme to the meme gods. Only then can you retrieve your edginess and euphoria.


text:
Overstuffed but charming bookstore. Owner is incredibly well informed on all things Alaska, is excited to share her knowledge and is a pleasure to talk to.
I was determined to visit Observatory Books after having seen the owner, Dee, on the BBC dvd "Alaska: Inside Passage." She is just as intelligent and engaging in person and her store is wonderful.
Dee has forgotten more than most of us will never know. If you are a history buff, DO NOT miss the opportunity to rummage through old books and maps while listening to musings of Dee Logenbaugh. I don't know which I enjoyed more, the bookstore or its owner.
It does have a few books but be well prepared to spend lot$ on anything worth owning. A couple books I was interested in weren't for sale, apparently reference material. It would be way down "my must visit while in Juneau" list.
This is a wonderful store to find Older books about Alaska, and the owner is very well informed on all things Alaska, including politics, and local character.
Your standard overstuffed, funky book store with a good section of Alaska specific books. A place to spend a while and search for that special find. Lots of little cubbies and rooms to explore on a rainy day.
Register now for free — and start getting automatic notification of new reviews, responding to traveler feedback, adding new photos to your listing and much more.


text:
Graphic Designer
Seeking Graphic Design Intern (unpaid) for charitable foundation, located in the Bathurst & Sheppard area. Looking preferably for a recent or current university/college graduate to start immediately. The internship will last for approximately 6 weeks and can be done from home if preferred.
-Preferably a recent or current university/college graduate to start immediately
-Background in graphic design
-Previous experience with Wordpress is favourable
-Candidate relies on their experience and knowledge to plan and accomplish goals. Ideal candidates will have the desire and ability to absorb new skills and technologies and an enthusiasm for putting them to use.
-Candidate possesses good interpersonal and communication skills to help educate others about using the site
What you will gain:
-Technical hands on experience
-Travel Expenses Compensated
-Written References provided upon completion
-Opportunity for future consulting work afterwards
*Please send your resume & contact information via e-mail. Thanks!


text:
Now Playing
Connect with Us
Most Active Stories
Current State and Current Sports
Podcasts & RSS Feeds
|All Content
|View all podcasts & RSS feeds
Hot Views
9:06 am
Mon April 28, 2014
Breaking Barriers - Pioneers of Television
By editor
Tue. Apr. 29 - 8pm - 23.1 WKAR-HD | The story of people of color on U.S. television. Included: the mid-1960s breakthroughs of African-Americans Diahann Carroll and Bill Cosby; and such Latino landmarks as Desi Arnaz and Edward James Olmos.
This episode traces the story of people of color on American television, including the mid-1960s breakthroughs of African Americans Diahann Carroll ("Julia") and Bill Cosby ("I Spy"). Latino landmarks range from "I Love Lucy" with Desi Arnaz to "Miami Vice" with Edward James Olmos. Also featured are Asian-Americans like George Takei ("Star Trek"), who details his youth spent in a Japanese internment camp.
View the Preview


text:
Milani Brow Fix Brow Kit
147 reviews
90% would repurchase
Package Quality: 3.9
Price: $$
Package Quality: 3.9
Price: $$
Not tested on animals
on 3/9/2012 5:23:00 PM
Age: 25-29
Skin: Oily, Fair, Not Sure
Hair: Red, Other, Other
Eyes: Green
My brows are kind of an unusual color and I've had a lot of trouble in the past finding shades that I could use to fill them in. I've been using soft brown from MAC and that worked pretty well, but I saw this in the DS and decided it was worth a try. I got the medium kit and I'm very pleased with it! I even like the highlighter shade that comes in the compact, its very pretty and not chalky at all! I mostly use the second shade, I don't really use the bottom one because its much too dark. I picked this up without reading reviews first which is not something I do very often, I'm happy I did! I believe there's 3 different compacts to choose from so even if you have very light or dark brows they should have one that will work for you!
on 3/9/2012 4:47:00 PM
Age: 18 & Under
Skin: Normal, Fair, Neutral
Hair: Blond, Straight, Fine
Eyes: Blue
I got this in the medium color. The quality of the powder itself is fine but The color is way too reddish. I may be a strawberry blonde but it doesn't mean I want my eyebrows to look like carrots!
on 2/25/2012 11:26:00 AM
Age: 25-29
Skin: Acne-prone, Fair-Medium, Warm
Hair: Blond, Wavy, Medium
Eyes: Blue
I've been sort of obsessed with the perfect brow over the years. Brows and foundation are sort of my poisons. Anyway, being naturaly light blonde I'm fairly lucky to have ANY eyebrows to work with. My mother who dies her hair blonde has invisible sparse brows and has the urge to kill her own child when she sees mine. I'm trying to teach her that it's mostly an illusion! This is my magic little trick. Being so obsessed with the perfect brows for as long as I've been, I've been around the brow product block so to speak and I am still so excited and happy to pull this gem out of my drawer everyday. It's amazingly creamy but not overly or obnoxiously so, so it fills the brows in very quickly with even color. I chose light and I usualy dip my angled brush in to the light and darker shades both and it provides the perfect color for my light/ light medium brown eyebrows without looking unatural. I LOVE LOVE LOVE that the color isn't too warm or too cool, as most brow products tend to run. I scoff at my maybeline powder, pencil and revlon pencil now. My mac in fling and lingering, however, tend to scoff at me. They seem to knowingly mock me, sitting untouched, with their hefty price tags. This baby was 6 dollars! The highlight color I actualy quite liked as well which surprised even me! It's a beautiful light sheen without being too frosty and it's not very opaque so it let's your skin tone shine underneath. I've used all of the tools in here in a pinch and while they are not great by any means they are still very usable and appreciated! Love this perfect, handy, cheap little kit and the makeup horder in me wants to rush out and buy a backup even though I don't see myself using it all up anytime soon. But at such a great price for such a great staple product, I may do just that!
on 2/24/2012 9:30:00 PM
Age: 18 & Under
Skin: Combination, Fair-Medium, Warm
Hair: Brunette, Wavy, Coarse
Eyes: Green
I didn't start even coloring in my eyebrows until recently. My mom had this on her dresser one night and I just decided to use it. Needless to say, I don't walk out of the house without having my eyebrows in 'shape'. I have this in medium. I love the powder and I love the slant brush.
on 2/11/2012 4:02:00 PM
Age: 25-29
Skin: Combination, Fair, Cool
Hair: Blond, Straight, Medium
Eyes: Blue
This is my go-to brow product. The two colours work together nicely to fill my brows in naturally. I don't use the tweezers or the sponge tip applicator but the little brush is useful. This is a great product for the price!
on 2/10/2012 5:57:00 PM
Age: 30-35
Skin: Combination, Fair, Warm
Hair: Red, Straight, Fine
Eyes: Brown
I love this product- it is my HG for my brows. It comes with a highlighter, two brow colors, 2 applicators and very small tweezers. I don't use the tweezers but I love everything else in the kit. It fills in my brows without making them look fake. I mix a swipe of each color (dark & light) and then swipe over it with an eyebrow brush. Will continue using this product because it works great and is a great price.
on 2/7/2012 10:37:00 PM
Age: 25-29
Skin: Normal, Fair-Medium, Warm
Hair: Brown, Wavy, Medium
Eyes: Blue
This Is My HG brow kit! I love that it has the highlight included in a color that matches my skintone! i use the middle shade to fill in my brows and its a perfect match! i can apply this in the morning and I have to take it off at night since it has GREAT staying power! i used to use a Lancome eyebrow pencil and once I found this i never went back!
on 1/18/2012 11:03:00 PM
Age: 19-24
Skin: Combination, Tan, Not Sure
Hair: Brunette, Other, Other
Eyes: Brown
THIS IS THE ONLY EYEBROW PRODUCT USE! i have tried so many different products from pencils to creams to loose powders, and this by far is the best. not only is the price right on point, but the product is as well! ive been using this for about 2 years, and i swear by it. it wont smudge when it rains or if you happen to touch your brows throught the day. they come in nice matte pressed powder form, and a little definitly goes a long way. i love this product!
on 1/16/2012 1:52:00 PM
Age: 19-24
Skin: Combination, Fair, Cool
Hair: Brunette, Wavy, Medium
Eyes: Brown
I don't know if I am using this the wrong way or if I am just too used to my eyebrow pencil but it didn't work for me. I bought it because I have sparse eyebrows hair, actually the only way of making it look like an eyebrow is letting them grow and comb then. But anyway, the first time I put this on it didn't look natural at all so I considered that maybe I apply to much, which was the case. Lately I've been trying it over and over but it just doesn't look as good as my Too Faced Brow pencil. However if you are capable with eyebrow powders this is very affordable.
on 12/28/2011 11:50:00 PM
Age: 30-35
Skin: Combination, Medium, Warm
Hair: Blond, Wavy, Medium
Eyes: Brown
This is great all around kit, especially for the price! A little goes a long way... and I also find that I get better results when using a primer on my eyes. The powder gives good definition, fills in brows nicely but with a soft look (doesn't end up looking like you used a sharpie marker!) I really love the highlight shade too. I would definitely purchase again and recommend this to anyone looking for great quality and reasonable prices!
Popular Brows Products
Video Reviews & Tutorials
Favorite Product Review by Cathies Ensemble


text:
There are currently no items in your cart.
"Port o'brien *%3A*": 3 items found
The Phillips Collection of Traditional American Fiddle Tunes Vol 1
Composed by Stacy Phillips. For Fiddle. Perfect binding, Solos. All Styles. Multiple Levels. Book. 268 pages. Published by Mel Bay Publications, Inc (MB.94711)
Usually leaves our warehouse: Within 24 hours
(The Life, Times, and Music of an Irish Harper). Composed by Turlough O'carolan. For Harp. Classical History, Style & Culture. Music Sales America. Irish, Folk, Celtic. Softcover. 378 pages. Music Sales #OMB144. Published by Music Sales (HL.14006203)
Usually leaves our warehouse: Within 3 to 5 business days
Irish Session Tunes - The Red Book
(100 Irish Dance Tunes and Airs). Edited by Matt Cranitch. For Fiddle. Music Sales America. Irish, Folk, Celtic. 48 pages. Ossian Publications #OMB142. Published by Ossian Publications (HL.14016245)
Usually leaves our warehouse: Within 3 to 5 business days


text:
Bodie, the Sacramento police dog shot during a police chase last month, is recovering from jaw surgery.
Police spokeswoman Michele Gigante said the three-hour surgery Tuesday afternoon at VCA Sacramento Veterinary Referral Center went well.
Surgeons installed a metal cleat in the German shepherd's jaw.
Bone marrow also was taken from Bodie's shoulder and packed into the broken jaw to aid in bone regeneration, Gigante said.
The dog is expected to be hospitalized for at least another day.
Bodie was shot twice through his left jaw and once in his paw. His medical bills have been offset by numerous donations, which totaled $20,000 as of May 26.


text:
Select Language
My Bag0
My Favorites0
Established in 2003, CITIZENS OF HUMANITY has charmed the fashion world with a rigorous commitment to cutting edge denim styling, supreme comfort and fit without compromise. CITIZENS OF HUMANITY designs, markets and produces over one million pairs of jeans annually in their own off site laundries. Each piece of CITIZENS OF HUMANITY is unique and handcrafted to perfection.
If an item you would like to purchase is out of stock, you can place a Special Order Inquiry. REVOLVE will then check the availability and obtain an approximate arrival date for the item, if available. Typically, it takes up to 3-4 weeks to verify this information.
Placing a Special Order Inquiry is absolutely free and there is no obligation to follow through with a purchase.
Sort by body type:
Love these shorts! I've gotten many compliments on them... they're great dressed up with heels or dressed down with flip flops... very sexy and really compliment the butt. My boyfriend loves the way I look in them and all my friends constantly want to borrow them.
Very pretty one! No wonder Linsey Lohan and Mariah Carey wear them so often in public~ This pair fit my Havaianas flip-flops but shows extremely long and straight legs when high heels go with.... Love it! BTW I do have TR's Jess short but compare with this one.. just somehow not so pretty.. the same comfortable though....
For a better shopping experience on REVOLVE
please upgrade your internet browser


text:
Mon-Fri: 7am-1am EST / Sat-Sun: 7am-11pm EST
ApplianceWhirlpool Refrigerator
Level of DifficultyReally easy
Time to do repairLess than 15 mins
Age of Appliance5 - 10 years
11 out of 17 people found this instruction helpful
I noticed that everytime I plug the refrigerator cord into to the wall outlet it would trip the shock prevention safety switch on the wall outlet. I came to the conclusion that something was blocking the electrical current to flow to the compressor. I figured if I changed the the part attached to the compressor then the electricity would be able to make a complete circuit to the compressor. so I got the part # from the old part and I researched it through your company. You had the part in stock. I ordered it and it was at my door the next day. It worked extremely well. I proudly can say I did it myself and most importantly I don't need a new refrigerator and I save a lot of money. thanks I will definitely use your company in the future. Ray
Help other customers find the most helpful instructions.
Were these instructions helpful?
Part Number: PS993073
All brand logos are trademarks of their respective owners.
The PartSelect logo is a Registered Trademark of Atlantic Laundry Centres, Ltd.
Copyright © 1999-2015 , Eldis Group Partnership. All rights reserved.


text:
The Obama administration will soon reveal how it plans to save the region's iconic fish.
Oregonians are throwing out less garbage while increasing recycling habits.
A new "catch share" program is adopted by the West Coast groundfish fleet.
Surface mines in Columbia County see rock removal fall 24 percent.
A legislative mandate requires a 2 percent biodiesel blend with Oregon's standard diesel.


text:
Unleash the potential of Final Cut Studio with the help of other applications in Apple's video and audio editing suite.
Teaches everything to get up and running in this upcoming release and plenty of new features to tease returning users for the more full courses to come.
Demonstrates the strengths and weaknesses of five different keying tools.
How to create movement using Final Cut Pro 6 and Motion 3.
A comprehensive explanation of HD, how to work with its many forms, and how to use the most common formats and codecs.
"Keep up the good work—it's helping so many of us stay up to speed on all the many topics involved in building creative websites." —Sandra M.
more from our members »


text:
Fletcher quits GOP, turns independent
The U-T poll also showed a majority of San Diego voters aren't familiar with Fletcher. He has raised nearly $1 million and is expected to soon launch an aggressive advertising campaign to introduce himself to city voters.
Fletcher announced his decision by releasing a YouTube video about 6:20 a.m. Wednesday and later held a news conference in front of the USS Midway Museum. In the video, Fletcher said he has been told by fellow Republicans that he isn't good at playing the game in Sacramento.
"I fought in a war. I put it all on the line for my country," he said. "I didn't go through all that to come back home, run for office and play games. I did it to solve problems, to make people's lives better, to build coalitions, to deliver results. And that's why today I'm leaving partisan politics. … I'm embracing an independence to focus solely on solutions."
Fletcher sported a small cut above his left eye from a spill while surfing earlier in the morning.
"I want to dispel one notion, I did make this decision before I hit my head," he joked. "It was made with a clear mind and clear purpose."
The mayoral primary is June 5. If no one wins a majority, the top two finishers compete in a November runoff.
Staff writer Pat Flynn contributed to this report.


text:
Caution Recommended For Kids Returning To Sports After Concussion
According to a new report in Pediatrics, a doctor should clear kids who suffer concussions before they begin playing sports again.
The American Academy of Pediatrics' Council on Sports Medicine and Fitness recommends the physical and mental recovery period that is necessary for young athletes after a head injury.
A separate study estimates that about 100,000 kids between the ages 8 and 19 go to the emergency room with concussions. Dr. Lisa Bakhos from Brown University's Warren Alpert Medical School in Providence, Rhode Island led the survey.
The study found that more kids are being treated for concussions that occurred during organized sports. However, that "leaves the question of all of the other concussions that may be occurring where the kids are not reporting it and the parents are not taking them to the emergency room," Dr. Tamara Valovich McLeod, the sports medicine chair at the Arizona School of Health Sciences, who was not involved in the research, told Reuters Health.
The Council wrote that the brains of kids and adolescents might be more susceptible to the effects of a concussion than older athletes.
They recommend a gradual increase in activity after a concussion.
According to the recommendations, athletes, parents, and coaches should be aware of concussion symptoms, as well as the harms of not properly treating head injuries.
Sport-related concussions often occur after a blow to the head or neck.
The Council says that the symptoms include headache, nausea, sensitivity to light and noise, or depression and anxiety.
"We're relying on an athlete reporting symptoms," Dr. Mark Halstead, director of the Sports Concussion Program at Washington University in St. Louis and one of the report's authors, told Reuters Health. "There's obvious (concussions) where a kid gets knocked out." But, for "the majority, the kid … may not realize they've had one."
According to Council recommendations, coaches and trainers should first rule out the possibility of a spine injury and then test the athlete's mental functioning by asking questions like "What team did you play last week?"
The council says that if a concussion is confirmed, then kids need to rest physically and mentally.
Bakhos and her colleagues found in their emergency room study that the rate of concussions was highest in kids who played football and ice hockey. They found that twice as many kids visited the emergency room for concussions suffered during organized sports in 2007 than in 1997.
Most concussions that took place off the field occurred while bike riding, skiing, and playing on the playground.
Experts say that the rise in emergency room visits for concussion may reflect a mixture of good and bad news.
Much of the increase comes from parents and coaches getting better at recognizing and reporting concussions.
"Concussions have always been, 'oh, you've just been dinged' … they've been kind of ignored," Halstead told Reuters Health. "The awareness is out there a lot more."
On the Net:


text:
Common Conditions
Find & Review Drugs
Popular Topics
Encouragement on the journey to hope and healing
By Howard Chang
Published Jul 30, 2012
A big congratulations to Howard Chang! Last week, Healthline named The Itch to Beat Psoriasis one of the best psoriasis blogs of 2012. Keep up the good work!
– The Everyday Health editors
You must be logged in to post a comment.
Sign up for the free Healthy Skin newsletter!
Sign up for more FREE Everyday Health newsletters.
A system error was encountered. Please try again later.
Follow us on your favorite social network!
Howard Chang has lived with severe psoriasis for more than 35 years since childhood. He is a volunteer for the National Psoriasis Foundation. Howard works as a Christian spiritual advisor and is a married...read more
E-Mail Address:
Forgot your password?
Log in
Not a member? Register now!


text: One-Direction By September 1, 2013 12:58 PM Share on Facebook Share on Twitter Category: Share on Facebook Share on Twitter More Leave a comment Send to a friend! Print this page Pin it! Reddit This! Share on Tumblr! Best of 101.9 Blake FM Delta's Awesome Pizza Party for Passengers on Delayed Flights Makes Flying a Joy Man Cuts Fruit Salad (Very) Fast and (Very) Furious Marine Reunited With Dog He Rescued in Afghanistan The 10 Sexiest Country Songs Recommended For You Around the Web


text:
Mya Bliss
Mya Bliss. Another shorty who's got an open invite to the YAKWII spot. She's says that she stands at 5'2″ with 32F-24-34 measurements. Damn…Mizz Mya Bliss is SERIOUS!!
More Mya Bliss after the jump! Some of the pics are NSFW, so that's a good thing! one.
One Response to "Mya Bliss"
So sexy.


text:
Beautiful Yorkie Babies
Photo by Judy Wilbur Craig, at Taylor Made Yorkies
SANGERVILLE - Ever think about growing mushrooms in your backyard or on your farm? This all-day workshop will cover the basics of growing shiitake mushrooms on hardwood logs for beginners and experienced growers, from tree selection to harvest on May 9th 10:00 am to 4:30 pm at Marr Pond Farm in Sangerville.
The day will begin with an information-sharing session, including a walk through the woodlot and discussions on log selection, a log yard tour, inoculation techniques, fruiting cycles, and more.
Following a potluck lunch attendees will have the opportunity to gain hands-on experience in log inoculation. Skills we will practice include: drilling, plugging, waxing, log yard stacking, and placement techniques. All tools needed will be provided, and we may have some extras on-hand for purchase.
This workshop will provide you with the theoretical and hands-on knowledge to start your own home or commercial mushroom yard. The workshop is $30 and includes two inoculated logs to bring home.
Marr Pond Farm is an off-grid homestead and small-scale mushroom farm in it's second year of production. We look forward to meeting new people in the community, and educating farmers and gardeners alike about mushroom cultivation. In addition to teaching you new skills, this workshop will provide much appreciated support for us as a recently established farm.
In the interest of providing individualized attention and instruction this workshop has a limited number of spaces. Please RSVP by May 2nd.
To register or for more information and directions email Ryan at firstname.lastname@example.com
DEXTER - Frightened of that lamp that keeps flickering on and off? Wondering how safe that electrical cord is that your kitten has been teething on? "Wiring for Dummies" is for you.
On Saturday April 25th, 10 to noon, DDATT will be hosting a wiring workshop for simple electrical repairs to household appliances.
The focus will be repairing and replacing electrical cords and plugs. Participants are encouraged to bring small appliances such as lamps, toasters, irons, and clocks with frayed cords, loose plugs, etc., as well as pliers and wire cutters, if owned.
The event takes place at the Abbott Memorial Library Meeting Room, 1 Church St. Dexter.
For more information contact 924-7292.
DEXTER - On May 2,2015 Adoption's Plus and The Pet Motel are sponsoring a rabies clinic at the Pet Motel on Route 7 in Corinna Maine.The clinic will run from 12:00 until 1:00.
Dogs are 15.00 and cats are 25.00, nails are seven, there will also be micro chips offered at 35.00 which is a good source of identification for your pet.
Part of the proceeds will go to help the stray animals at the Pet Motel get vet care and altered to help reduce unwanted animals and reduce animal cruelty. Adoption's Plus is a small non-profit organization created in 2005 to help the stray animals in the community and we believe in the no kill policy.
The Dexter Veterinary Clinic will be doing the vaccinations and micro chips. For more in formation please call 924-7513.
NEW GLOUCESTER - The intricate carvings of a 19th century stone carver will be the focus of the Spring Program of the Maine Old Cemetery Association in New Gloucester, May 16, at the First Congregational-Christian Church. The church is located at 19 Gloucester Hill Road.
Bartlett Adams (1726 to 1828) arrived in Maine from Massachusetts in 1800 to establish a stonecutting workshop, that was in business from 1800 to 1828. He made marble hearthstones, mantelpieces and door jams, but the most lasting, and visible, impact of his work is still seen today in the early cemeteries of southern Maine.
The Maine Old Cemetery Association is comprised of nearly 700 paying members and more than 1,100 Facebook "friends", all focused on preserving and researching the old cemeteries of Maine. The organization was founded in 1968 by the late Hilda Fife.
Ron Romano, the region's Bartlett Adams expert, will be the featured speaker for the spring program, with a focus on his research of Adams' stones. The program also features a discussion of and visits to New Gloucester cemeteries, presented by Thomas and E. Philip Blake, president of the New Gloucester Cemetery Association and the curator of New Gloucester Historical Society, respectfully. Thomas is also the acting sexton of the local cemeteries since 1998 and E. Philip is the author of Images of America's "New Gloucester" (2009).
Registration for the program is $3 at the door, and is open to all. Membership in MOCA can be paid at the program or online at www.moca-me.org Annual membership is $7 or $30 for five years, and $150 for lifetime membership. Membership includes a quarterly newsletter with updates on cemetery-related projects and goals, as well as communication with researchers.
MOCA programs always include exhibits and displays of cemetery-related projects. Anyone involved with cemetery research or preservation projects is invited to create a display of their work to share with the membership.
A MOCA business meeting is planned before lunch with President Clyde Berry presiding. All are welcome to attend to learn more of the work of the MOCA membership. The afternoon will feature a trip to New Gloucester Lower Cemetery, one of their oldest, lead by the Blakes. The door prize drawing will be held during the tour, and winners must be present to win.
Lunch by reservation will be provided by the Congregational Church Meal Committee at a cost of $7 paid at the door. Reservations can be made until Thursday, May 7, online at www.moca-me.org or by email to Debi Curry at firstname.lastname@example.com or by phone to Jessica Couture at (207) 877-7675.
The week following the spring program a "Cleaning and Leaning Workshop" will be held in Waterboro, sponsored by the Waterboro Cemetery Committee and MOCA. The workshop includes MOCA's program of Cemetery DOs and DON'Ts. A $20 donation is requested for registration including a pizza lunch. More information is available from Angela M. McCoy of the cemetery committee at (207) 651-1059 or email@example.com and also at www.facebook.com/WaterboroCemeteries.
MOCA members and interested parties are also invited to participate in the 2015 Association of Gravestone Studies Conference, June 23 to 28 at Westfield State University in Westfield, MA, that will include a bus tour of cemeteries in Southern Berkshire County, a noted marble region. More information is available at https://gravestonestudies.org/conference/register. Another "Cleaning and Leaning Workshop" is planned in Rockport Aug. 29. More details will be available on the MOCA website.
MOCA's Legislative Liaison is currently following and seeking support for three bills aimed at cemetery maintenance and protection, LDs 378, 1071, 862 and 953. To learn more go to www.legislature.maine.gov/bills/
PENQUIS - Event set for 10 a.m.-1 p.m. April 25 at Avalon Acres Orchard & Farm.
University of Maine Cooperative Extension in Skowhegan will offer a free apple tree pruning and grafting field day from 10 a.m. to 1 p.m. Saturday, April 25, at Avalon Acres Orchard & Farm, 234 Dexter Road, Saint Albans.
Avalon Acres owner Mark Sheriff will present information about general planting and management practices for apple trees and demonstrate pruning and grafting in the orchard. Home orchardists and those planning to plant apple trees this spring are welcome to attend, according to a news release from the extension.
Preregistration is requested, but not required. Attendees should wear footwear appropriate for walking on uneven terrain. For more information, to register, or to request a disability accommodation, call Pete Bastien at 474-9622 or 800-287-1945 (toll-free in Maine)..
GARLAND - Do you need to clean out your home, attic, or barn? Are you in search of used treasures? Come on over to Garland Grange Hall Saturday, May 9 from 9 am to 4pm.
In addition to lots of great stuff for sale, there will also be some excellent Grange food for sale including lunch items, baked goods and more.
SELL YOUR OWN STUFF: For your opportunity to sell your unwanted/unused stuff, call Jackie at 564-0029. You can reserve your own table for only $10.00, but the rule is carry in, carry out. OR, WE WILL SELL IT FOR YOU: Donations are accepted and pick up is available within 10 miles of Garland. Call Jackie at 564-0029 to arrange for pick up of your unwanted/unused stuff. No furniture, please. All donations become property of Garland Grange. Garland Grange Hall is located on the Oliver Hill Road in Garland.
Note: this is NOT the safest possible route to take, but it is a good service and much better than never running a virus check.
To check your computer, go to housecall.antivirus.com
Many people think that if they have a virus program on their system they are safe, BUT you are only as safe as your latest update. Yes, you do have to update your virus program frequently. (I do it every day!)
Download a FREE virus program that works well at www.free.avg.com
The Daily ME is on-line only, non-profit newspaper and a one-woman operation with the help of contributing writers and photographers. If you would like to contribute to The Daily Me, we welcome press releases, contributing editor's young and old. Send your Upcoming local events, news, Town reports, club news, school news or other items that you have in mind. If you have pictures you would like to share with friends and relatives far and near, please contact The Daily Me. We encourage feedback and suggestions from our readers. I hope that The Daily ME gives you information that keeps you in touch with home!
Copyright 1997-15 The Daily ME, All Rights Reserved * Owned & Operated by Judy Craig Consulting * Updated:
Powered by Maine Hosting Solutions


text:
FMLY Fest assembles dozens of musicians for DIY weekend
By Emily Eveland
Hollow Boys embrace the dark on third album
By Sarah Stanley-Ayre
10 Thousand Sounds 2014: Behind the bands
By CP Staff
Black Market Brass delivers hip-shaking funk rhythms
By Zach McCormick
For the Love brings hip-hop festivities to Lowertown
By Jack Spencer
Kitty Cat Klub hosts Tourniquet Noise series
By Sarah Stanley-Ayre
Max Gremillion steps into the spotlight
By Rob van Alstyne
The world of Howler's sophomore album
By Zach McCormick
In fact, X/O is less about capturing youth than not growing up. The lovely first single, "Waltz #2 (X/O)," sees him estranged from a recently married love object. "She shows no emotion at all," he sings with pain, offering what sounds more like a presumption than an observation. Fading in and out of love and loss, our little soldier collapses: "Just leave me alone/In the place where I make no mistakes/In the place where I have what it takes," he rails with childlike anger. But X/O is so pretty, honest, and, in its pop bliss, so free of mistakes, we're willing to allow him all him that and more. We may even wanna crawl in with him: goo goo.
Sponsor Content


text:
Can anyone help me fill in the missing people (of the ancestry tree below)?
My (Liguori and Lizzi) family are all from Troia, Foggia, Italy.
Added birth dates and passing dates would also be great!
Robert Liguori
Postby gliesian66 » 23 Jul 2013, 00:16
Postby Jean Galata » 25 Jul 2013, 04:58
Postby gliesian66 » 05 Nov 2013, 01:46
Users browsing this forum: Baidu [Spider], Bing [Bot], Google [Bot], MSNbot Media and 9 guests


text:
Saturday's NFL playoffs pits Tom Brady's Patriots against the Colts and the Seahawks against the Saints. Over on the other side of the world, will Serena serve herself into history — again? NPR's Scott Simon talks with Howard Bryant of ESPN.com and ESPN the Magazine, about the sports stories of the week and sports to come.
Source: NPR
Leave a Comment
Email addresses are required but never displayed.


text:
The missing person identified as 70-year-old Margo Johnson has been located. Please see the press release from Metropolitan Police Department below.
Know before you go! Check out our Wait Times and Webcams.
Organ donation saves lives. If not already participating, sign up here.
Give us feedback! Engage with your government and help the DMV improve the quality of our services.


text:
A gentleman named Jacek Kolodziejczyk has fired a salutary salvo to Ferrari's XX track-programme with his take on how a harder, faster, ventier and totally unobtainable F12 would look like.
And it looks like that evil-eyed hunk of carbon fibre, above. But of course, it's not made of carbon fibre, because it doesn't exist, because it's definitely not real*. But it looks every inch a new pin-up track monster from Ferrari.
Gallery: Ferrari F12XX render and the 599XX
Because Maranello has only just released the new F12 Berlinetta - which you can read about here - this take on how a future XX model is utter conjecture. And thus, a good time to remind you what happened to the old 599 when it was fed through the track-mill.
The V12 was boosted to 700bhp after stripping weight from components and using carbon fibre where possible. Ferrari also spent hours playing in the wind tunnel: the 599XX can increase downforce and cut drag depending on cornering conditions thanks to a porous material in the diffuser and two fans in the boot channelling air flow from under the car.
As such, the 599XX can generate 280kg of downforce at 200km/h and 630kg at 300km/h. That's like having four fully-grown male cheetahs sitting on top at 124mph, or a large adult polar bear at 186mph slumbering on the roof. A bear!
Have a look through the gallery at Jacek's work, and let us know what you think below. In particular, the F12XX rendered in black makes us believe it is displeased with our lack of faith...
*Seriously, it's not real.


text:
A second experiment, in which subjects were free to browse same-sex or opposite-sex photos, provided an additional measure of implicit sexual attraction.
Through a series of questionnaires, participants also reported on the type of parenting they experienced growing up, from authoritarian to democratic. Students were asked to agree or disagree with statements like: "I felt controlled and pressured in certain ways," and "I felt free to be who I am." For gauging the level of homophobia in a household, subjects responded to items like: "It would be upsetting for my mom to find out she was alone with a lesbian" or "My dad avoids gay men whenever possible."
Finally, the researcher measured participants' level of homophobia both overt, as expressed in questionnaires on social policy and beliefs, and implicit, as revealed in word-completion tasks. In the latter, students wrote down the first three words that came to mind, for example for the prompt "k i _ _". The study tracked the increase in the amount of aggressive words elicited after subliminally priming subjects with the word "gay" for 35 milliseconds.
Across all the studies, participants with supportive and accepting parents were more in touch with their implicit sexual orientation, while participants from authoritarian homes revealed the most discrepancy between explicit and implicit attraction.
"In a predominately heterosexual society, 'know thyself' can be a challenge for many gay individuals. But in controlling and homophobic homes, embracing a minority sexual orientation can be terrifying," explains Weinstein. These individuals risk losing the love and approval of their parents if they admit to same sex attractions, so many people deny or repress that part of themselves, she said.
In addition, participants who reported themselves to be more heterosexual than their performance
|Contact: Susan Hagen
University of Rochester