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The present invention relates to medical devices; in particular, the present invention provides devices and methods for sensing thickness of cardiac tissue and the like so that medical procedures may be efficiently performed through and/or upon a discrete location having suitable tissue thickness. The invention includes an elongated resilient dilator apparatus having an ultrasound transceiver coupled thereto. When the ultrasound transceiver is disposed proximate a region of relatively thin tissue, such as a latent Fossa Ovalis valve, a clinician receives a signal. The clinician may then proceed with enhanced confidence to pierce the relatively thin tissue. Thus, in the case of a transseptal procedure, the clinician gains access to the left atrial chamber from the right atrial chamber.
1. An elongated medical apparatus for tranvenously locating a relatively thin, mechanically pierceable region of tissue, comprising:
a resilient elongated body unit having a proximal end and a distal end wherein at least one orientation marker is coupled to a portion of the body unit said resilient elongated body unit adapted for transvenous deployment to a portion of endocardium;
a non-imaging volume thickness sensor coupled to a portion of the distal end and providing signals related to a thickness dimension of an adjacent region of endocardial tissue without first piercing said endocardial tissue; and
a means for conveying the signals to a clinician.
2. A medical apparatus according to
3. A medical apparatus according to
4. A medical apparatus according to
5. A medical apparatus according to
6. A medical apparatus according to
7. A medical apparatus according to
8. A method of fabricating an elongated medical apparatus for transvenously locating a relatively thin, mechanically pierceable region of tissue, comprising:
coupling a thickness sensor to a distal end portion of an electrified elongated resilient member, wherein said thickness sensor provides an output signal without piercing a portion of tissue and is not adapted for providing a signal encoding a visual image of an adjacent region of tissue;
electrically coupling the thickness sensor to an electrical conductor disposed within the electrified !elongated resilient member, wherein said electrical conductor is the only electrical conductor disposed within said electrified elongated resilient members and
forming at least one compressible loop disposed in a distal portion, and substantially orthogonal to a major longitudinal axis, of said electrified elongated resilient member.
9. A methods according to
10. A method according to
sharpening a portion of the distal end of the electrified elongated resilient member disposed adjacent the sensor.
11. A method according to
12. A method according to
coupling a switching for selectively providing electrical communication between the at least one electrode or the thickness sensor and a remote tissue monitoring device.
13. A method according to
14. A method according to
15. A method of using an elongated medical apparatus to transvenously locate and subsequently pierce a region of tissue having a reduced thickness dimension, such as a latent Fossa Ovalis valve, comprising:
interrogating a region of septal tissue with an ultrasound transceiver disposed near a distal end of a tissue dilator apparatus, wherein said ultrasound transceiver is not adapted for providing a signal encoding a visual image of the adjacent region of tissue;
providing an aural, a tactile or a simple visual signal to a clinician, wherein said signal relates to a thickness dimension of the region of septal tissue; and
advancing the distal end of the tissue dilator apparatus when the signal indicates a region of reduced thickness of said septal tissue so that said distal end pierces said region of reduced thickness.
16. A method according to
switching an electrical contact between said ultrasound transceiver and the at least one electrode and a remote tissue monitoring apparatus so that said clinician can either receive the signal or receive an electrical communication from the at least one electrode.
The present invention relates to medical devices; in particular, the present invention provides devices and methods for sensing thickness of cardiac tissue and the like so that medical procedures may be efficiently performed through and/or upon a discrete location having suitable tissue thickness.
The present invention relates to dilation and/or ablation catheters for treatment of cardiac arrhythmia, for example atrial fibrillation. More particularly, it relates to a catheter configured for transseptal access to the left atrium so that a mapping and/or ablation catheter can be advanced into the left atrium. As is known in the art, an ablation catheter is used to electrically isolate a vessel, such as a pulmonary vein, from a chamber, such as the left atrium with a continuous lesion pattern and a method for forming such a lesion pattern.
The heart includes a number of pathways that are responsible for the propagation of signals necessary to produce continuous, synchronized contractions. Each contraction cycle begins in the right atrium where a sinoatral node initiates an electrical impulse. This impulse then spreads across the right atrium to the left atrium, stimulating the atria to contract. The chain reaction continues from the atria to the ventricles by passing through a pathway known as the atrioventricular (AV) node or junction, which acts as an electrical gateway to the ventricles. The AV junction delivers the signal to the ventricles while also slowing it, so the atria can relax before the ventricles contract.
Disturbances in the heart's electrical system may lead to various rhythmic problems that can cause the heart to beat irregularly, too fast or too slow. Irregular heart beats, or arrhythmia, are caused by physiological or pathological disturbances in the discharge of electrical impulses from the sinoatrial node, in the transmission of the signal through the heart tissue, or spontaneous, unexpected electrical signals generated within the heart. One type of arrhythmia is tachycardia, which is an abnormal rapidity of heart action. There are several different forms of atrial tachycardia, including atrial fibrillation and atrial flutter. With atrial fibrillation, instead of a single beat, numerous electrical impulses are generated by depolarizing tissue at one or more locations in the atria (or possibly other locations). These unexpected electrical impulses produce irregular, often rapid depolarizations in the atrial muscles. These impulses can conduct to the ventricles causing potentially lethal ventricular arrhythmias. Patients experiencing atrial fibrillation may suffer from fatigue, activity intolerance, dizziness and even strokes.
The precise cause of atrial fibrillation, and in particular the depolarizing tissue causing "extra" electrical signals, is currently unknown. As to the location of the depolarizing tissue, it is generally agreed that the undesired electrical impulses often originate in the left atrial region of the heart. Recent studies have expanded upon this general understanding, suggesting that nearly 90% of these "focal triggers" or electrical impulses are generated in one (or more) of the four pulmonary veins (PV) extending from the left atrium.
It has been postulated that this tissue may spontaneously depolarize, resulting in an unexpected electrical impulse(s) propagating into the left atrium and along the various electrical pathways of the heart. In this regard, as the heart develops from an embryotic stage, left atrium tissue may grow or extend a short distance into one or more of the PVs. In addition, during gestation an intra-atrial valve (i.e., the Fossa Ovalis valve) remains open and closes, or is rendered latent, following birth. The latent valve provides a relatively thin tissue location through which a catheter may advance for access to the left atrium. Unfortunately, the latent valve is difficult to locate using traditional means such as fluoroscopy.
A variety of different atrial fibrillation treatment techniques are available, including drugs, surgery, implants, and catheter ablation. While drugs may be the treatment of choice for some patients, drugs typically only mask the symptoms and do not cure the underlying cause. Implantable devices, on the other hand, usually correct an arrhythmia only after it occurs. Surgical and catheter-based treatments, in contrast, will actually cure the problem by ablating the abnormal tissue or accessory pathway responsible for the atrial fibrillation thereby disrupting ionic conduction pathways of the abnormal tissue. The catheter-based treatments rely on the application of various destructive energy sources to the target tissue, including direct current electrical energy, radio frequency (RF) electrical energy, laser energy, and the like. The energy source, such as an ablating electrode, is normally disposed along a distal portion of a catheter.
Most ablation catheter techniques employed to treat atrial fibrillation focus upon locating the ablating electrode, or a series of ablating electrodes, along extended target sections of the left atrium wall. Because the atrium wall, and thus the targeted site(s), is relatively tortuous, the resulting catheter design includes multiple curves, bends, extensions, etc. In response to recent studies indicating that the unexpected electrical impulses are generated within a PV, efforts have been made to ablate tissue within the PV itself. Obviously, the prior catheter designs incorporating convoluted, multiple bends are not conducive to placement within a PV. Instead, a conventional "straight ended" ablation catheter has been employed. While this technique of tissue ablation directly within a PV has been performed with relatively high success, other concerns may arise.
More particularly, due to the relatively small thickness of atrial tissue formed within a PV, it is likely that ablation of this tissue may in fact cause the PV to shrink or constrict. Because PV's have a relatively small diameter, a stenosis may result. Even further, other vital bodily structures are directly adjacent each PV. These structures may be undesirably damaged when ablating within a PV.
In light of the above, an alternative technique has been patented by Medtronic, Inc. whereby a continuous ablation lesion pattern is formed in the left atrium wall about the ostium associated with the PV in question. In other words, the PV is electrically isolated from the left atrium by forming an ablation lesion pattern that surrounds the PV ostium. As a result, any undesired electrical impulse generated within the PV could not propagate into the left atrium, thereby eliminating unexpected atria contraction. One exemplary patent related to the foregoing is U.S. Pat. No. 6,325,797 the contents of which are hereby incorporated by reference herein.
Unfortunately, while PV isolation via a continuous ablation lesion pattern about the PV ostium appears highly viable, no acceptable ablation catheter configuration exists. Most atrial fibrillation ablation catheters have linear distal ends, designed for manipulation in a sliding fashion along the atrial wall. That is to say, the distal, electrode-carrying end of the catheter is typically slid along (or parallel to) the atrial wall. With this generally accepted configuration in mind, it may be possible to shape the distal, electrode-carrying end into a small ring sized in accordance with the PV ostium. For example, U.S. Pat. No. 5,617,854 discloses one such possibility. More particularly, the described ablation catheter includes a substantially ring-shaped portion sized to contact the ostium of the coronary sinus. Pursuant to conventional designs, the ring extends linearly from the catheter body. In theory, the ringshaped portion may be placed about a PV ostium. However, proper positioning would be extremely difficult and time consuming. More particularly, it would be virtually impossible to locate and then align the ring about a PV ostium when sliding the catheter along the atrium wall. The ring must be directed toward the ostium in a radial direction (relative to a central axis of the ostium). Even if the electrophysiologist were able to direct the ring to the ostium, the periodic blood flow through the PV would likely force the ring away from the atrium wall, as the catheter body would not provide any support.
A related concern entails mapping of a PV prior to ablation. In cases of atrial fibrillation, it is necessary to identify the origination point of the undesired electrical impulses prior to ablation. Thus, it must first be determined if the electrical impulse originates within one or more PVs. Once the depolarizing tissue has been identified, necessary ablation steps can be taken. Mapping is normally accomplished by placing one or more mapping electrodes into contact with the tissue in question. In order to map tissue within a PV, therefore, a relatively straight catheter section maintaining two or more mapping electrodes must be extended axially within the PV. Ablation catheters configured to slide along the atrial wall cannot include a separate, distal extension for placement within the PV. Instead, an entirely separate mapping catheter must be provided and then removed for subsequent replacement with the ablation catheter. Obviously, these additional steps greatly increase the overall time required to complete the procedure.
Electrical isolation of a pulmonary vein via an ablation lesion pattern surrounding the pulmonary vein ostium presents a potentially revolutionary technique for treatment of atrial fibrillation. However, the unique anatomical characteristics of a pulmonary vein and left atrium render currently available ablation catheters minimally useful. Therefore, a substantial need exists for an ablation catheter designed for rapid and accurate identification of the latent Fossa Ovalis valve so that a suitable catheter may be advanced therethrough.
The present invention provides an improved apparatus for performing a septal puncture procedure and methods for fabricating and using same. In one form of the invention, a remotely deployable thickness sensing probe couples to a distal end of an elongated cardiac tissue dilator or cardiac tissue ablation apparatus and provides a signal related to relative tissue thickness adjacent the probe. The dilator or ablation apparatus is preferably resilient to axial compression and torque. To efficiently fabricate such apparatus low cost, non-imaging thickness sensing probes are preferred. Such probes may be electrically wired or may provide signals wirelessly to remote (i.e., external) medical monitoring equipment. The thickness sensing probe may comprise acoustic-type sensor probes (e.g., so-called ultrasound-, ultrasonic-types). Such probes transmit and receive (i.e., transceive) signals that penetrate a local region of tissue. The signals relate to the volume of tissue proximate the probe. The signals may be used to confirm location of a relatively thin portion of tissue suitable for temporarily being pierced during a medical procedure such as a cardiac procedure requiring transseptal access. While a unitary transceiver is desirable, separate transmitting and receiving units may be used.
In addition to the foregoing, the signals provided according to the present invention may also be used to determine how much ablation energy (e.g., radio frequency, laser, etc.) or where a surgical ablation apparatus should be applied to a surface, such an endocardial surface.
In practice, an apparatus according to the present invention is used to interrogate a tissue surface and provide signals relating to the thickness of a local region of the tissue. This information is then conveyed to a clinician. The information can be displayed on a monitor or other remote device, can be conveyed as an acoustic signal (e.g., varying pitch, tone or volume based on a sensed thickness parameter of tissue), and/or can be conveyed as a tactile response, and the like. A variety of tissue thicknesses may be interrogated; however, for the transseptal tissue of interest, a range of about 0.1 mm to approximately 10 mm is preferred. The magnitude and frequency of acoustic energy delivered the transducer should of course be designed as appropriate for a given tissue region.
With respect to axial compression and torque ranges for the elongated portion of the apparatus, a design similar to those current tissue dilators having a Brockenbrough needle coupled thereto is generally suitable for use in conjunction with the present invention. A marking or identification unit is preferably disposed on or near the distal end portion of the apparatus so that the orientation and location of the end portion may be viewed (e.g., using a fluoroscope and the like).
The region of tissue preferably comprises a latent Fossa Ovalis valve of a patient for a transseptal procedure. In such a procedure, a clinician advances the distal end of a catheter to the right atrium, and then probes for an appropriate region of reduced thickness to pierce to gain access to the left atrium. Since most humans have such a latent valve structure left over from gestation, this is a preferred route for accessing the left atrium so that left atrial chamber and the pulmonary valves therein may be accessed so that a variety of therapies may be applied thereto.
FIG. 1 is a side-elevational view of a catheter assembly in accordance with the present invention.
FIGS. 2A-2B illustrates use of the catheter assembly of FIG. 1 within a heart.
FIG. 3 is a side view of a portion of an alternative catheter assembly in accordance with the present invention.
FIG. 4A is a perspective view of a portion of an alternative catheter assembly in accordance with the present invention.
FIG. 4B illustrates placement of the catheter assembly of FIG. 4A within the left atrium of a heart.
FIG. 5 is a perspective view of one embodiment of a portion of a catheter constructed according to the present invention.
FIG. 6 is an elevational side view in cross section depicting an exemplary ultrasound transducer that may be used in conjunction with the present invention.
One preferred embodiment of a catheter assembly 20 in accordance with the present invention is shown in FIG. 1. The catheter assembly 20 is comprised of a catheter body 22, a handle 24 and electrodes 26. As described in greater detail below, the catheter body 22 extends from the handle 24, and the electrodes 26 arc disposed along a portion of the catheter body 22. While various configurations of the distal portion of the catheter body 22 are depicted herein, a linear, curvilinear or complex distal portion may be employed according to the present invention. Furthermore, while not depicted in the drawings the distal portion may be manipulated (e.g., using interior pull-wires, shape memory alloys, and the like) to form advantageous configurations for a given medical procedure. In addition, the catheter body 22 may include a lumen for fluid delivery at or near the distal end. As is known in the art, such fluid delivery may include isotonic saline solution to form so-called virtual electrode regions, marker dye or other material that is advantageously dispensed in, on or near a cardiac tissue location.
The catheter body 22 is defined by a proximal portion 28, an intermediate portion 30 and a distal portion 32, and includes a central lumen (not shown). Although not specifically shown, the catheter body may be configured for over-the-wire or rapid exchange applications. In one preferred embodiment, the proximal portion 28, the intermediate 30 and the distal portion 32 are integrally formed from a biocompatible material having requisite strength and flexibility for deployment within a heart. Appropriate materials are well known in the art and include polyamide.
The intermediate portion 30 extends from the proximal portion 28. The proximal portion 28 and the intermediate portion 30 are preferably flexible, so as to facilitate desired articulation during use. In general terms, however, the intermediate portion 30 defines a longitudinal axis L1. It should be recognized that in one position, the longitudinal axis L1 extends linearly through the intermediate portion 30 and the proximal portion 28. Upon deployment, it may be that the proximal portion 28 and/or the intermediate portion 30 is forced to a curved or curvilinear orientation. With this in mind, the longitudinal axis L1 is more specifically defined as a center of the intermediate portion 30 adjacent a point of intersection between the distal portion 32 and the intermediate portion 30.
The distal portion 32 extends from the intermediate portion 30 and forms a loop 34. In one preferred embodiment, the loop 34 is circular, formed in a plane transverse to the longitudinal axis L1. To this end, the distal portion 32 preferably includes a lateral segment 36. The lateral segment 36 extends in a generally lateral fashion from the intermediate portion 30. The loop 34 extends from the lateral segment 36 in an arcuate fashion, turning or revolving about a central loop axis. While the loop 34 is shown in FIG. 1 as forming a single revolution about the central loop axis, the loop 34 may instead include a plurality of revolutions to define a spiral or coil. In the one preferred embodiment depicted in FIG. 1, the central loop axis is aligned with the longitudinal axis L1. Alternatively, however, the lateral segment 36 may be eliminated such that the loop 34 extends directly from the intermediate portion 30. Even further, the lateral segment 36 may be configured such that the central loop axis is offset from the longitudinal axis L1. Regardless of the exact construction, however, the central loop axis is preferably substantially parallel to the longitudinal axis L1.
Regardless of the exact shape, the loop 34 preferably defines an enclosed area greater than a size of an ostium (not shown) associated with a particular vessel to be isolated, as described in greater detail below. In one preferred embodiment, the catheter assembly 20 is configured to electrically isolate a pulmonary vein from the left atrium. With this one preferred application, where the loop 34 is circular, the loop 34 has a diameter in the range of approximately 10-20 mm, more preferably 15 mm, although other sizes, either greater or smaller, are acceptable.
The loop 34 may be formed in a variety of ways, such as by incorporating a preformed section of super elastic, shape memory material, such as Nitinol, with a loop configuration. To facilitate guiding of the distal portion 32 into a heart (not shown), the catheter assembly 20 may include a stylet (not shown) internally disposed within the catheter body 22. In an extended position, the stylet would extend through the distal portion 32, so as to render the loop 34 straight. Upon retraction of the stylet, the distal portion 32 would form the loop 34. Alternatively, the catheter assembly 20 may include a sheath (not shown) slidably receiving the catheter body 22. Prior to deployment, the distal portion 32 would be retracted within the sheath, rendering the loop 34 straight. Upon deployment from the sheath, the distal portion 32 would form the loop 34. Other similar approaches for providing the loop 34 are similarly acceptable.
The handle 24 is preferably sized to be grasped by a user and includes an electrical connector 44. The electrical connector provides electrical connections to the electrodes 26 carried by the distal portion 32. To this end, wire(s) (not shown) may extend within the central lumen (not shown) from the distal portion 32 to the handle 24.
The electrodes 26 are preferably of a type known in the art and are preferably a series of separate band electrodes spaced along the loop 34. Instead of, or in addition to, separate band electrodes, the electrodes 26 may include one or more spiral or coil electrodes, or one or more counter-electrodes. Additionally, the electrodes 26 are preferably non-thrombogenic, non-coagulum or char forming. The electrodes 26 may be cooled by a separate source (not shown), such as a saline source. The electrodes 26 may be electrically isolated from one another, or some or all of the electrodes 26 may be electrically connected to one another. Preferably, however, at least one electrode 26 is provided. The electrodes 26 are preferably shaped and positioned such that during an ablation procedure, a continuous, closed therapeutically-effective lesion pattern is created. Preferably, the length of each of the electrodes 26 is about 4-12 mm, more preferably about 7 mm. The spacing between each of the electrodes 26 is preferably about 1-3 mm, and more preferably about 2 mm. Finally, to effectuate a continuous, closed lesion pattern, preferably one of the electrodes 26 is disposed at the proximal end 40 of the loop 34, and a tissue thickness sensing probe unit 41 is disposed at the distal end 42. The probe unit 41 preferably comprises a low cost ultrasound transducer capable of reliably measuring tissue thickness of about 0.1 mm and approximately 10 mm. The probe unit 41 preferably does not include ultrasound imaging circuitry and is coupled to remote tissue monitoring circuitry (not shown) such an RF energy generator and/or mapping system. Such a system preferably provides a visual, tactile or aural indication when the probe unit 41 is disposed adjacent a relatively thin region of cardiac tissue. The cardiac tissue is preferably a latent Fossa Ovalis valve. As previously described, it is not necessary that the loop segment 38 be formed such that the proximal end 40 and the distal end 42 are integral or that the distal end forms part of the radius of the loop segment 38. Indeed, the distal end 42 and the probe unit 41 are preferably more or less parallel to longitudinal axis L1 (as depicted in FIG. 4A and FIG. 5). With this in mind, the spacing or gap between the electrode 26 at the proximal 40 and the electrode 26 at the distal end 42 is preferably less than about 5 mm.
A The probe unit 41 may comprise any commercially available transceiver capable of providing at least a rudimentary signal related to tissue thickness proximate the probe unit 41. Some representative ultrasonic probe units 41 such as those patented previously in the U.S. include those disclosed in the following patents: U.S. Pat. No. 6,246,158 issued to Ladabaum; U.S. Pat. No. 6,024,703 issued to Zanelli et al.; U.S. Pat. No. 5,803,083 issued to Buck et al.; U.S. Pat. No. 5,385,148 issued to Lesh et al.; and U.S. Pat. No. 5,220,924 issued to Franzin. The contents of the foregoing patents are hereby incorporated by reference as if fully set forth herein.
FIGS. 2A and 2B illustrate use of the catheter assembly 20 shown in FIG. 1 within a heart 50. As a point of reference, the heart 50 includes a right atrium (RA), a left atrium (LA), a right ventricle (RV) and a left ventricle (LV). An inferior vena cava (IVC) and a superior vena cava (SVC) lead into the RA. The RA is separated from the LA by an interarterial septum 51 (shown in cross section in FIG. 3) typically having a latent Fossa Ovalis valve formed therethrough (generally indicated by arrow 61). This latent valve 61 provides an appropriate site to introduce a medical instrument such as a mapping and/or ablation catheter to provide diagnosis and therapy to portions of the LA, respectively. Finally, four pulmonary veins PV extend from the left atrium LA. Each of the pulmonary veins PV forms an ostium PVO in the left atrium LA wall. As previously described, during formation of the heart 50, it is possible that tissue of the left atrium LA may grow upwardly into one or more of the pulmonary veins PV. This left atrium LA tissue may spontaneously depolarize, resulting in atrial fibrillation. Notably, the heart 50 may be formed such that a separate ostium PVO is not formed for each individual pulmonary vein PV. In other words, a single pulmonary vein ostium PVO may be formed for two pulmonary veins PV. For example, a single pulmonary vein ostium PVO may be formed for both the left inferior pulmonary vein PV and the left superior pulmonary vein PV, with the two pulmonary veins PV bifurcating from the single ostium PVO.
As shown in FIG. 2A, electrical isolation of a pulmonary vein PV begins by directing the distal portion 32 of the catheter body 22 through the inferior vena cava IVC, into the right atrium RA through a puncture in the interarterial septum preferably located at the site of a latent Fossa Ovalis valve (as suggested in FIG. 3) and into the left atrium LA. In practice, a clinician advances the catheter body 22 into the RA and then switches on (or begins monitoring) the probe unit 41 and begins interrogating the tissue of the septal wall. When the probe unit 41 indicates that a tissue region or tissue location of reduced thickness is proximate the probe unit 41, an aural, tactile and/or visual signal alerts the clinician to stop interrogating. The clinician may optionally confirm (or reconfirm) that the probe unit 41 (and catheter body 22) are in fact aligned or oriented appropriately prior to piercing the septal wall. The optional step may involve fluoroscopy with or without dispensing marker material in or near the region of reduced thickness identified by the probe unit 41. In one embodiment of the present invention, a single electrical conductor switcheably couples a remote tissue monitoring system to either the electrodes 26 or the probe unit 41.
Alternatively, the introduction of the distal portion 32 of the catheter body 22 into the right atrium RA is also suggested by passage of the distal portion 32 into the right atrium RA through the superior vena cava SVC. The loop 34 is positioned slightly spaced from the ostium PVO associated with the pulmonary vein PV to be treated. More particularly, the loop 34 is positioned such that the central loop axis is approximately aligned with a center of the pulmonary vein ostium PVO. The catheter body 22 is then advanced distally such that the loop 34 contacts the left atrium LA wall about the pulmonary vein ostium PVO in question, as shown in FIG. 2B. In other words, the catheter body 22 is advanced in a direction parallel with the central loop axis such that the loop 34 contacts the left atrium LA wall, surrounding the pulmonary vein ostium PVO. Importantly, because the central loop axis is parallel to the longitudinal axis L1, the catheter body 22 longitudinally supports advancement of the loop 34. In other words, the longitudinal axis L1 is effectively aligned with the pulmonary vein ostium PVO such that blood flow from the pulmonary vein PV acts along the longitudinal axis L1. Thus, the catheter body 22 limits deflection of the loop 34 otherwise caused by blood flow from the pulmonary vein PV.
The electrodes 26 (shown in FIG. 1) are then energized to a sufficient level to ablate the contacted tissue, for example with an RF source. In one preferred embodiment, the electrodes 26 ablate the left atrium LA tissue for 30-120 seconds at a temperature in the range of approximately 60-70 degree C. As a result, a continuous, closed lesion pattern is formed around the pulmonary vein ostium PVO. Pursuant to the above described catheter assembly 20 configuration, the lesion pattern is formed in a plane substantially perpendicular to the longitudinal axis L1. Notably, while the lesion pattern is shown as being only slightly larger than the pulmonary vein ostium PVO, the loop 34 (FIG. 1) may be sized to produce an even larger ablation lesion pattern. To this end, where a single pulmonary vein ostium PVO is formed for two pulmonary veins PV, the resulting pulmonary vein ostium PVO may be elongated. As shown in FIG. 2B, then, the loop 34 (FIG. 1) is configured to form a continuous, closed lesion pattern about the elongated-shaped pulmonary vein ostium PVO.
The continuous, closed lesion pattern electrically isolates the pulmonary vein PV from the left atrium LA. Any undesired electrical impulses generated in the pulmonary vein are effectively "stopped" at the lesion pattern, and will not propagate into the left atrium LA.
An alternative embodiment of a catheter assembly 80 is shown in FIG. 4A. The catheter assembly 80 includes a catheter body 82, an electrode 84, a locating device 86 and a tissue thickness sensing probe unit 41. For ease of illustration, only a portion of the catheter assembly 80 is shown, and catheter assembly 80 may further include a handle similar to the handle 24 associated with the catheter assembly 20 (FIG. 1) previously described. Also, the electrode 84 and the probe unit 41 are electrically coupled to a remote tissue monitoring system as previously described and, in general, as known in the art.
Catheter body 82 is defined by a proximal portion (not shown), an intermediate portion 88 and a distal portion 90. The intermediate portion 88 extends from the proximal portion and is defined by a proximal segment 92 and a distal segment 94. In a preferred embodiment, the distal segment 94 is preferably more flexible than the proximal segment 92. With this configuration, the distal segment 94 can more easily deflect relative to the proximal segment 92, thereby facilitating desired positioning of the distal portion 90 during deployment. In this regard, an internal pull wire (not shown) may be provided to effectuate desired deflection of the distal segment 94. Even further, an anchor 96 is preferably included for facilitating a more radical displacement of the distal portion 90 relative to the intermediate portion 88.
As with previous embodiments, the intermediate portion 88 defines a longitudinal axis L3. Once again, where the intermediate portion 88 is axially aligned with the proximal portion (not shown), the longitudinal axis L3 is linear along the intermediate portion 88 and the proximal portion. However, because the intermediate portion 88 is preferably bendable relative to the proximal portion, and further because the distal segment 94 may bend relative to the proximal segment 92, the longitudinal axis L3 is more succinctly defined by the intermediate portion 88 at the point of intersection between the intermediate portion 88 and the distal portion 90.
Similar to the catheter assembly 20 (FIG. 1) previously described, the distal portion 90 preferably forms a loop 98. The loop 98 may include one or more loop segments (one is shown in FIG. 4A), with each loop segment revolving around a central loop axis C3. The loop 98 is formed substantially transverse to the longitudinal axis L3, with the central loop axis C3 preferably aligned with the longitudinal axis L3. Alternatively, the central loop axis C3 may be slightly offset from the longitudinal axis L3. Regardless, the central loop axis C3 is preferably parallel with the longitudinal axis L3.
The electrode 84 is shown in FIG. 4 as being a continuous coil electrode. Alternatively, a plurality of spaced, band electrodes or counter-electrodes may be used.
Finally, the locating device 86 includes a tip portion 104 configured to extend distal the loop 98. In one preferred embodiment, the locating device 86 is integrally formed with the catheter body 82, extending from the distal portion 90. Alternatively, the locating device 86 may be a separate body. Regardless, the tip portion 104 extends distal the distal portion 90, and is generally aligned with the central loop axis C3 defined by the loop 98. The tip portion 104 preferably has a diameter less than a diameter of a pulmonary vein, and a length in the range of approximately 1-15 mm. Further, as shown in FIG. 4A, the tip 104 may include a series of mapping electrodes 102 and a probe unit 41. The mapping electrodes 102 are electrically connected to an external recording system (not shown) for providing information indicative of tissue polarization and the probe unit 41 is electrically connected to circuitry which provides an indication of relative tissue depth proximate the probe unit 41, as previously described herein. A common electrical conductor may be used to couple the electrodes 102 and the probe unit 41 that is separately addressable (e.g., employs an electronic switch, different multiplex circuitry, and/or other addressing techniques known in the art). Preferably, the
As shown in FIG. 4B, during use, the catheter assembly 80 is directed into the left atrium LA as previously described. The locating device 86, and in particular the tip 100, is then used to locate the pulmonary vein ostium PVO. Once located, the tip 100 is inserted into the pulmonary vein PV, effectively centering the loop 98 around the pulmonary vein ostium PVO. Where the tip 100 includes the mapping electrodes 102, a mapping procedure can be performed, whereby information indicative of tissue activity nearby the mapping electrodes 102 is provided. During this mapping procedure, a determination can be made as to whether the particular pulmonary vein PV is generating undesired electrical impulses. Where it is determined that, in fact, tissue in the pulmonary vein PV is spontaneously depolarizing, the electrode 84 is energized to form the continuous, closed lesion pattern about the pulmonary vein ostium PVO as previously described.
Yet another alternative embodiment of a catheter assembly 110 in accordance with the present invention is shown in FIG. 5. The catheter assembly 110 is highly similar to the catheter assembly 80 (FIG. 4A) and includes a catheter body 112, electrodes 114 and a locating device 116. The catheter body 112 includes a proximal portion (not shown) an intermediate portion 88 defining a longitudinal axis L4 and a distal portion 120. The distal portion 120 extends from the intermediate portion 118 and forms a loop 122 substantially transverse to the longitudinal axis L4. In this regard, the loop 122 revolves about a central loop axis C4. In one preferred embodiment, the central loop axis C4 is aligned with the longitudinal axis L4. Alternatively, the central loop axis C4 is offset from, but substantially parallel with, the longitudinal axis L4. The electrodes 114 (shown as spaced band electrodes) are disposed along the loop 122 for forming a continues, closed lesion pattern.
The locating device 116 includes a tip 124 that extends distal the loop 122. In one preferred embodiment, the locating device 116 is integrally formed with the catheter body 112 and includes mapping electrodes 126 connected to an external recording device (not shown). Alternatively, the locating device 116 may be a separate body. As shown in FIG. 5, the tip 124 forms a descending diameter coil, generally aligned with the central loop axis C4. By providing a coil configuration for the tip 124, the tip 124 facilitates a more positive centering of the loop 122 about a pulmonary vein ostium PVO (FIG. 4B). In one preferred embodiment, the tip 124 defines a maximum diameter approximating a diameter of a pulmonary vein. When inserted within a pulmonary vein, then, the tip 124 effectively lodges along the pulmonary vein wall. This, in turn, positions the loop 122 in a more central fashion about the associated ostium. Further, by providing the mapping electrodes 126, the locating device 116 additionally serves as a mapping device for evaluating a particular pulmonary vein.
A preferred sensor structure forming a part of the probe unit 41 is depicted in FIG. 6. This particular structure is provided by Sensant Corporation of San Jose, Calif. Fundamentally, these sensor devices are capacitive structures. A DC bias voltage is applied across the top and bottom electrodes establishing an electric field that creates tension in the suspended membrane. An AC signal voltage applied across the membrane varies this tension and causes it to vibrate, emitting ultrasonic waves. Conversely, during reception of ultrasound echoes, an acoustic wave impinges on the top membrane causing it to move. The changing distance between the top and bottom plates of the capacitor produce variations in capacitance that result in an output voltage signal. For air or gas applications, the sensor operates in a resonant mode to maximize its sensitivity. However, in immersion or water applications, the sensors are extremely broadband for optimal pulse-echo signal quality and broadband frequency response. The sensor utilized for use in the probe unit 41 may produce a wireless signal indicative of a region of tissue having reduced thickness.
Although the present invention has been described with reference to preferred embodiments, workers skilled in the art will recognize that changes may be made in form and detail without departing from the spirit and scope of the invention. For example, the preferred embodiment has described electrical isolation of a pulmonary vein from the left atrium for treatment of atrial fibrillation. Alternatively, the method and apparatus of the present invention may be utilized in the treatment of other cardiac arrhythmias, such as isolating the coronary sinus from the left atrium or isolating the outflow tract (or pulmonary valve) from the right ventricle. Further, a number of the described embodiments have included a catheter body forming a single loop. Alternatively, a multi-plane coil or spiral may be formed. The coil or spiral may increase or decrease in diameter as it extends distally, or may have a uniform diameter. Additionally, while the loop has been described as preferably being circular, a variety of other substantially closed shapes, including square, triangular, octagonal, etc. are equally acceptable. Also, several of the described embodiments have included a locating device for centering the loop about a pulmonary vein ostium and for mapping a pulmonary vein. In this regard, the locating device may be configured to serve only as a centering device or only as a mapping device, or both. Finally, other features may be incorporated into the catheter assembly. For example, to expedite deployment, the catheter assembly may be configured to slidably receive a guide wire used to position the catheter assembly within the left atrium. Even further, the catheter assembly may include a rapid exchange feature for quick placement over and removal from the guide wire.
Patent Citations
Referenced by
Legal Events
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LEXINGTON - During Tuesday's scheduled meeting at the KHSAA Office, the Board of Control awarded the girls' basketball state tournament to the Bank of Kentucky Center and Northern Kentucky University for 2016 and 2017, while extending the stay of the Worth/KHSAA Softball State Tournament at Jack C. Fisher Park in Owensboro for four more years (2015-18). In addition, the Board approved a final draft of the football alignment for the 2015-18 seasons which can be found at this link: http://goo.gl/rZfNWC.
"It speaks volumes to the growth and progress of female athletics in this state that we received two very strong proposals for both championships, where in the past there might not have been much interest. It bodes very well for the future of female athletics in Kentucky," said KHSAA Commissioner Julian Tackett. "In terms of the girls' basketball championship, the Board was of the opinion that moving the championship to a new site might help grow the event and offer further exposure to the sport and its participants. Moving the tournament is in no way an indictment of Bowling Green, WKU or Houchens Industries. They have been great partners of the KHSAA and will continue to be in the future."
Bowling Green and Western Kentucky University's E.A. Diddle Arena have been home to the Girls' Sweet 16 since 2001, with Houchens Industries serving as title sponsor since the 2003 tournament. WKU is scheduled to host the event in 2015 before it transitions to the Bank of Kentucky Center. Following the two-year period, the Board will evaluate the event's success compared to past tournaments and determine a direction for the future. Bowling Green remains the host city for the Leachman Buick-GMC-Cadillac/KHSAA State Golf Championships (through 2020), and the Board has approved an agreement for WKU to host the Russell Athletic/KHSAA Commonwealth Gridiron Bowl Football Championship through 2018.
Owensboro's Jack C. Fisher Park has been the host site for the KHSAA Softball State Tournament since 2008, and will hold the event for 11-consecutive years when Tuesday's extension expires following the 2018 tournament.

subset: commoncrawl


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Select Local Merchants
Ace HardwareRead MoreWith summer spreading like a bag of spilled gravy, now is the ideal time to stock up on cookware and housewares for outdoor entertaining and to get home-care projects underway. Pick up a Stanley six-piece screwdriver set for $6.99, a VPT rip hammer for $9.49, and a whole bunch of screws, anchors, and bolts (prices vary), and you'll be ready to finally mount every buffalo nickel and steel penny in your coin collection. Illuminate the newfound d?cor with a 12-pack of Ace light bulbs ($21.48), the better to see by as you make use of a Purdy four-piece premium paint-tray kit ($19.99). If you need to match paint to a favorite coverlet or choose a hue that complements a pleather recliner, each store offers a paint-matching service free of charge. Get keys made for $2.29 a pop.117 W Commonwealth AveFullerton, CA US
Habitat for Humanity of Greater Los AngelesRead MoreSince becoming established in 1990, Habitat for Humanity of Greater Los Angeles' workforce has constructed or renovated more than 350 homes for low-income families throughout 112 cities and unincorporated areas of Los Angeles County. The organization relies largely on volunteer labor and donations of building materials, home decor, furniture, and appliances, which are used in building projects or sold at the ReStore. These sales not only help raise funds for building projects, but have also helped save more than five million pounds of reusable materials from ending up in local landfills.17700 S Figueroa St.Gardena, CA US
Frazee PaintRead MoreA Southwest-based company for more than a century, Frazee Paint and its team of manufacturers are well acquainted with the unique climactic conditions of the region. Always pulling from the latest technology, their technicians design each of their paint and coating products to withstand dry heat, sparse rainfall, and showers of chewing tobacco from passing cowboys. Their quality paints, wall-coverings, wood-care products, and painter's tools stock the shelves of more than 125 retail locations throughout California, Arizona, and Nevada, as well as international dealers in Mexico, China, and Guam.1404 S Los Angeles StLos Angeles, CA US
Liz's Antique HardwareRead MoreLiz's Antique Hardware offers a plethora of salvaged vintage door, window and furniture hardware along with lighting and accessories dating from1860 to 1970, though a large selection of contemporary hardware is also available. The left side of the store is dedicated to contemporary designs, while the large right side is stacked practically from floor to ceiling with milk crates full of carefully curated and organized hardware. Liz's is the perfect place for anyone sourcing replacement parts for fixtures and hardware for an antique or period restoration, though it's fun enough to simply trawl through the bins, looking for inspiration. The staff is knowledgeable and helpful in finding exactly you need, but be prepared to spend some time looking for what you want regardless; there's a lot to discover.453 S La Brea AveLos Angeles, CA US
Tritch Hardware Co.Read MoreThis old-fashioned Eagle Rock hardware store offers personalized service from the Tritch family, who has been in the hardware business since the mid-1800s. At their Colorado Boulevard outpost, the carpets are worn and patched with tape in places, but Merritt Tritch still runs the place, even though he's in his 80s. Sons Glen and Jeff are there as well, guiding customers down aisles to find the perfect household need or construction item for sale. Low-slung and shabby in spots, Tritch Hardware Company oozes neighborhood charm, and is actually located inside the first commercial structure ever built in Eagle Rock, back in 1907. Affiliated with True Value Hardware stores, regular customers can put their items on a paper account and be billed later.1620 Colorado BlvdLos Angeles, CA US
Rockler Woodworking And HardwearRead MoreFamily patriarch Nordy Rockler opened the doors of his first store in 1954 to supply his fellow craftsmen with knowledge, friendly advice, and a large selection of tools for at-home woodworking projects. Now, the chain of retail outlets brims with more than 20,000 tools and specialized woodworking equipment. Next to a steely rainbow of hinges, casters, and screws, a supply of lumber and exotic hardwoods provides planks for building tree houses or just leaving around as a warning to uncooperative trees. The tenor buzz of power tools operated by newly knowledgeable guests drifts from educational sessions on operating equipment and woodworking.20725 Hawthorne BlvdTorrance, CA US


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This Dome Is A Home (video)
Poop and Paddle (video)
Extreme DIY: Homemade 3D Printer (video)
by Neal Stephenson
The title-holder for strongest biological material goes to a small mollusk.
An excerpt from Neal Stephenson's new book, Seveneves.
An engineer and an artist are transforming pollution from coal mines into pigments used to tint paint.
An excerpt from How to Bake Pi by Eugenia Cheng.
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HIS 2450: Medieval World
- Academic OneFile
- Military and Intelligence
- InfoTrac War and Terrorism Collection
- World History Collection
- Gale Virtual Reference Library
- Diversity Studies Collection
- Religion and Philosophy Collection
- Subject - History
- Subject – Humanities
- Complete Current Scholarship Collection
Print/Electronic Journals:
Most of the commonly cited journals in history are available both in print at Madonna Library and online from various databases the library subscribes. To access full-text electronic journals, click on Journals from library home page and search by journal title, or browse titles under subject of "History & Anthropology", you will find "General History" and "Regions & Countries" with various numbers of titles. The following lists are some of the examples:
Journal of world history (Electronic | Print)
The Journal of medieval and Renaissance studies (Electronic | Print)
Journal of medieval and early modern studies (Electronic | Print)
Journal of medieval history ( Print)
Journal of the history of ideas (Electronic | Print)
Journal of the history of philosophy (Electronic | Print)
The Historian; a journal of history (Electronic | Print)
Journal of the early Republic (Electronic | Print)
The Journal of interdisciplinary history (Electronic | Print)
Social science history (Electronic | Print)
The Journal of economic history (Electronic | Print)
The New Cambridge medieval history REF D117 .C32 1995 (v.1-7)
The Encyclopedia of World History REF D21 .E578 2001
The Medieval Hero on Screen REF PN1995.9.H44 M44 2004
Encyclopedia of the Renaissance REF CB361 .E52 1999 (6v.)
Encyclopedia of the Renaissance REF D205.B47 1987
Marriage, Family, and Law in Medieval Europe HQ611 .S48 1997
Handbook of Medieval Sexuality REF HQ14 .H35 1996
Dictionary of the Middle Ages REF D114 .D5 (13v.)
Encyclopedia of the Crusades REF D115 .A6 2003
New Catholic Encyclopedia REF BX841 .N44 2003 (14v.)
The Encyclopedia of world history: ancient, medieval, and modern, chronologically arranged REF D21 .E578 1972
Great lives from history. Ancient and medieval series REF CT113 .G74 1988
Alcohol, sex, and gender in late medieval and early modern Europe HV5438 .M37 2001
We have a large collection of electronic books available from Ebrary and Gale Virtual Reference. To search for ebooks in these databases, put your topic as a key word in the search box, you will get a list of the results. The followings are some ebooks related to Medieval World:
The Encyclopedia of world history
ancient, medieval, and modern, chronologically arranged
The rise of the medieval world, 500-1300 a biographical dictionary
Ancient, medieval, and modern
Handbook of medieval studies terms, methods, trends
History teacher's handbook
Medieval Europe
A history of the medieval Church 590-1500
A history of medieval political thought, 300-1450
Medieval philosophy
Medieval education
Medieval economic thought
Internet Medieval Sourcebook
The ORB: Online Reference Book for Medieval Studies
The Labyrinth: Resources for Medieval Studies
Netserf: The Internet Connection for Medieval Resources
The Online Medieval and Classical Library
Renaissance: What Inspired this Age of Balance and Order?
Librarians' Internet Index: History
Others(Style Manual)
A Manual for Writers of Term Papers, Theses, and Dissertations
APA, MLA, AMA, Turabian, and Chicago Citation Styles (Long Island University)
Citing References: Turabian Style
Citing Sources: Assembling a List of Works Cited in Your Paper
Updated by Lijun Xue 7/10/13


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Deloitte Consulting Finds New Training Solution
The Saba program will be used to train consultants on new products and services. "Saba is pleased to have the opportunity to work with Deloitte Consulting to provide them with a learning solution designed to maximize productivity, while reducing the costs associated with training and travel," said Bobby Yazdani, Saba founder and CEO.
Saba and Deloitte Consulting have teamed previously [2] to provide training and certification solutions to clients of the Big Five firm's consultancy group.
Saba currently teams with three of the top five Fortune 500 companies, all three of the "Big 3" automakers, and several branches of the U.S. government.


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players Have skill but! bots an css are noobs even cs 1.6 aneweare even valvue bots are noobzzzzz fuking hell if we are all noobs css and cs 1.6 well ownted
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Robert Marcellus Ledbetter
Robert Marcellus Ledbetter, age 91, father, grandfather, and brother, passed away Thursday, Dec. 30, 2010, at Oaktree Plantation after an extended illness.
Born on Mar. 31, 1919, in Vina, Ala., he was a son of the late Charles A. & Peggy Weatherford Ledbetter.
Mr. Ledbetter was a lumberman, an employee of True Temper of Amory, Miss., and owned his own fabric business for many years. He was a deacon and member of First Baptist Church, Amory, Miss., over 50 years. Mr. Ledbetter enjoyed farming, gardening, carpentry work and his church.
Catherine Myers Wactor
Catherine Myers Wactor, age 86, passed away Tuesday, Jan. 4, 2011, at her residence in Meadville, Miss.
Mrs. Wactor was born Mar. 24, 1924, in Webster County to Joseph Myers and Rosie Grissom Myers. She was a homemaker and a member of Elmo Baptist Church.
Rev. Mike Dobrosky
The Rev. Mike Dobrosky, age 69, a priest of the Episcopal Diocese of Miss., and Oblate of the order of St. Benedict, passed away Sunday, Jan. 2, 2011, at his home in Clinton Miss., while under the care of Hospice Ministries.
Fr. Mike had been fighting a recurrence of gall bladder cancer. He was born in Lorain, Ohio, in 1941, to Peter and Mary (Demyan) Dobrosky. He attended and graduated from Lorain Ohio High School 1959.
David Michael "Mike" Johns
Ethel Kennedy-Price
Ethel Kennedy-Price, age 86, passed away Thursday, Dec. 30, 2010, at North Mississippi Medical Center in West Point, Miss.
Funeral services are Wednesday, Jan. 5, 2011, at New St. Peter M.B. Church in West Point, Miss., at 10 a.m. with Pastor Judias Neal officiating. Burial will follow in Mt. Zion Whites M.B. Church Cemetery in West Point, Miss.
Visitation is Tuesday, Jan. 4, 2011, at Carter's Mortuary Services Chapel from 2 – 5 p.m.
Carter's Mortuary Services is in charge of arrangements.
Russell Carl Bird
Russell Carl Bird Sr., age 70, of West Point, passed away Thursday, Dec. 30, 2010, at Waverly Care Home in West Point, Miss
He was born on July 24, 1940, to the late William H. Bird and Irma Berry Bird. Mr. Bird was a retired Receiving Clerk at Bryan Brothers Foods and Animal Control Officer for West Point. He was a member of West End Baptist Church.
Robert E. Hemphill
Robert E. Hemphill, age 88, passed away, Thursday, Dec. 30, 2010, North Mississippi Medical Center, West Point. Robert E. Hemphill was born Nov. 11, 1922, in Columbus, Miss., to the late Florence Marie Stafford and Samuel Nathan Hemphill. He was a Textile Mill Operator for Fruit of the Loom for 58 years. Mr. Hemphill was a member of Garden Baptist Church in Aliceville, Ala., where he was still an active Deacon. Robert E. Hemphill married Maggie Reed Hemphill on Oct. 11, 1941, in Fayette, Ala., she preceded him in death Mar. 27, 1995.


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If selected for publication, it will appear as soon as possible on Haaretz.com.
Tehran has pictures of restricted Israeli areas, says Iran MP
Earlier this month, the Israel Defense Forces shot down a drone after it flew 25 miles into Israel; Iran lawmaker says drone transmitted pictures of Israel's 'sensitive bases' before it was downed.
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Iran holds pictures of Israeli bases and other restricted areas obtained from a drone launched into Israeli airspace earlier this month, an Iranian lawmaker was quoted as saying on Monday.
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"Otis" Music Video, Live In Times Square
Talk show host Jay Miller and comedian Casey Jost took to Manhattan for a "Public Music Video" for Jay Z and Kanye West's hit "Otis." It's pretty hilarious, complete with Times Square costume characters.
Check out more articles on BuzzFeed.com!
More News About Kanye West
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Postby GinaFashioni » 01 Nov 2013, 16:32
Postby Italysearcher » 01 Nov 2013, 20:36
Postby GinaFashioni » 01 Nov 2013, 20:55
Postby dominique426 » 01 Nov 2013, 21:54
GinaFashioni wrote:Hi,
I am looking for any information about my Gt. Grandmother, Mariantonia Lanni. She came from the Cassino arae and married my Gt Grandfather, Benedetto Faascione in England in 1892. They had 2 children but sadly she became ill and so they returned to Italy where she passed away, I believe in about 1901. We think that she had brothers and sister but have been unable to find any. Can anyone help?
Gina Fashioni (Fascione)
Postby dominique426 » 01 Nov 2013, 22:06
Postby GinaFashioni » 02 Nov 2013, 01:31
Postby dominique426 » 02 Nov 2013, 02:28
GinaFashioni wrote:Hi Dominique,
I am just waiting to get a copy of their marriage certificate so that I can find out Mariantonia's father's name. But I understood that she was born in Italy. I will let you know.
Thanks for your help,
Postby GinaFashioni » 02 Nov 2013, 10:42
Postby dominique426 » 02 Nov 2013, 17:45
GinaFashioni wrote:Hi Dominique,
I HOPE that is our Mariantonia! But I can't be sure until I get the marriage certificate and check her last name. Is there any way of checking the death records there? We think she died when my Grandad was about 3 or 4 years old which would have been 1900 -1901. This is the first time we have had any luck in tracing her - so thank you SO much. Can you tell me the names of her siblings so that I can see if I can find them in any family trees on genealogy websites?
Postby dominique426 » 02 Nov 2013, 17:53
Name: Mariantonia Lanni
Date of Registration: Jan-Feb-Mar 1892
Registration District: Ormskirk
Inferred County: Lancashire
Volume Number: 8b
Page Number: 105
Records on Page:
Mariantonia Lanni
Elizabeth Louisa Broughton
Annie Bowyer Cooper
Samue Prince Heatley
Samuel Prince Heatley
Margaret Myers
William Scott
Postby GinaFashioni » 02 Nov 2013, 20:38
Postby dominique426 » 02 Nov 2013, 21:00
GinaFashioni wrote:You are amazing! I've been looking for so long! I am also going to try and find her in the Cassino records!
Thank you so much! Are you in the UK Dominique?
Postby GinaFashioni » 02 Nov 2013, 21:10
Postby dominique426 » 02 Nov 2013, 21:40
GinaFashioni wrote:No - I am nowhere near London! I am a town mouse. Southport is a sea side town not far from Liverpool. It is funny that you have Sophia Loren as your picture - my sister looks very like her and has been compared to her all her life! What is your Italian connection Dominique?
Postby GinaFashioni » 02 Nov 2013, 23:30
Users browsing this forum: Baidu [Spider], Bing [Bot], Google [Bot], Google Adsense [Bot], maggiehill, Majestic-12 [Bot] and 6 guests


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The life of a lark is never dull! Whether it's chatting amongst themselves, gathering, or even fighting the small enemies that dwell near them, the larks will always live to see another day – even if it means having to move.
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2:26 pm
Tue July 30, 2013
Does Egypt's Crisis Signal The End Of Political Islam?
By Leila Fadel
Originally published on Tue July 30, 2013 3:32 pm
We take a look at what the Muslim Brotherhood's fall from grace means for the future of religion and politics in Egypt. Was it tested, failed and now dead?


text:
I've got a google maps website in beta. I've done all the output with no styling and now want to give it a lick of paint.
So far in the clean-ish code i've used tables (some with some restrictive widths/heights), paragraphs and . Are they okay to keep or tables last century?
And presumably i want to identify what text should be headers 1, 2 etc. And then muck around with the css file afterwards.
i would love to do something like the twitter atlas here. But i don't know how the floating panes work. Presumably there is a browser neutral method?
The generated text on the website thankful is all in one slim table that is in one big string variable server-side so i can do some last minute manipulation on it if required before it gets dumped to screen.
I might as well provide the link: Planet Nomad.
It's got some nice feeds coming in - like the flickr feed, uk traffic news and reuters news service. I suppose its main selling point is the fact that users, once registered, can set up email alerts based upon a subject matter and a map location. I've used it personally to receive traffic news about my route to work every morning. Anyway, I'd appreciate any advice about the lick of paint stage and if it any dabbing web guru wants to help, well, i'd more than happy for the help.
bf3: sergeant_shaftoe


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Wow...what can you say about this issue? One of the all-time bests for Spider-Man! Excluding the Goblin and the Chameleon this story has all of Spideys best foes teaming up (or getting in line) for a fight with him. Even though it's obviously a bit faster paced than usual, each foe gets several pages, no one is offed in one page. Doc Ock gets the most screen time, since he obviously was the biggest threat of them all, and just about every Marvel-Hero safe for Daredevil has a cameo in this story.
Other thoughts: Doc Ock let's everyone pick the order, in which they fight him...and yet, the cards also have the best fighting spot for them? Either he fixed the draw (quite possible, seeing as he got the last fight), or this was a little mistake from Stan.
The little featurette at the end about Lee und Ditko clearly was meant in fun...but, as history showed, it kinda seemed to be more true than they let on.
All in all: Great all-time classic.


text:
by Incongruous CircumspectionSeven years old was a big year for me. It was at this point that Mama and Dad's relationship boiled over and broke apart. Dad left and went to live by himself, leaving my siblings and I alone with Mama. At this point in my life, the alone time with Mama wasn't too bad. She hadn't learned yet, to take her immature "lashing out," and reconcile it with her interpretation of the Bible. She was just solidly abusive and then excitingly adventurous.At one point, Dad did try to come back and give the marriage another chance. I remember being asked to dry the dishes one evening. Dad had pulled our old black and white television from its corner, to the mid … [Read more...]
Snipped! Part 4 The Freedom of Divorce
Authoritarian Parenting and Emotional Repression
by LatebloomerI have a lot of respect for my dad. He's thoughtful and generous to all of us. His constant reading makes him an interesting and well-informed conversationalist. He makes his life decisions very carefully, yet never looks down on me for making different decisions than him. Instead, he tells me all the time that he loves and misses me, and that he's proud of who I've become. I feel so lucky to have him as my dad.Unfortunately, we have not always gotten along so well. Less than ten years ago, our relationship had been almost completely destroyed thanks to the authoritarian parenting techniques of the fundamentalist Christian homeschooling culture. Authoritarian parenting … [Read more...]
Justice is No Lady: Chapter 10 My Right to Be Heard
By Tess WilloughbyNate got another partner almost immediately. He found her on a Christian dating site. Patty had money from her millionaire father and a big house paid for by the government salary of her estranged husband. Nate had told me that remarriage for me was unbiblical, but he found a loophole in Scripture and told the children that he and Patty were already married in God's eyes. God having spoken, Nate moved into Patty's house and put our marital home up for rent.Nate wrote me a letter warning that if I did not "come to terms" (give him full custody of the children), he would hold a big yard sale and sell off everything in the house that belonged to me and the kids. He had … [Read more...]
How the Doctrine of Hell Justifies Quiverfull Authoritarian Parenting
by Libby AnneFrom my experience, I would argue that hell is the worst Christian doctrine of all. I'm not even going to get into how there is no justice in punishing finite transgressions with eternal torture, or into all the other problems with the theological ins and outs of hell. Instead, I'm referring to the practical implications of the doctrine.I am a mother. I look at my beautiful young daughter, so full of life and joy and excitement and curiosity, and I feel my love for her bubbling up in my heart. If I believed that there were any possibility that this sweet little thing could end up tortured in a lake of fire for eternity, I would leave no stone unturned in d … [Read more...]
Carefully Scripted Lives – The Real Reality of the Duggar Family "Blessings"
by Libby Anne I can't say how often I've heard ordinary Americans defend Jim Bob and Michelle Duggar and their popular TLC television show, 19 Kids and Counting. "I wouldn't choose to have nineteen kids," they say, "but if they can manage it, who am I to question their choice?" "The kids look happy and healthy," they say, "look how polite and well mannered they are." I hear these comments and I just have to sigh.First of all, I want to point out that I would have concerns about the Duggars even if they were your ordinary family plus seventeen extra children. For one thing, there is no way any two parents can give nineteen children the individual attention and time they need. It's just no … [Read more...]
Snipped! – Part 2: My Little Years
by Incongruous CircumspectionI was born in Minneapolis as a boy. Mama took one look at me and exclaimed, "I thought he was going to be Rebecca!" Needless to say, I was scarred for life. In those days, getting an ultrasound to determine the sex of a baby wasn't a bygone decision and people essentially relied on the doctors and midwives to make educated guesses based on measurements, heart rates, and old wives tales.Yes, I was born in a hospital. My mother birthed all seven of us children before she entered the world of Bill Gothard (Billy Boy G.), i.e. no home births. Thus, there were no complications when she had to have an emergency C-section with my younger sister (though she … [Read more...]
But They Look So Happy!
Excerpted from Dulce De Leche:All of the recent news about the Duggar's newest baby spawned a number of online arguments. One of the most frequent comments was about how cheerful their family is, especially the children. How Michelle is a great mom who doesn't yell. It must be working for them, because the kids are well behaved and look happy. Sounds reasonable, right?I might believe it, if I didn't know what I know of Gothard/ATI and the Pearls. The Duggars are deeply enmeshed in ATI, and ATI takes allegiance very seriously. It isn't a vague Statement of Beliefs that you sign so your kids can take the courses. It is several pages of in depth info that covers what kind of music … [Read more...]
To My Shame … I think I might understand Hillary Adam's mother
Major trigger warning for all former QF moms who read here at NLQ - :(by VyckieOkay - I told myself not to watch that Judge Adams video, cuz I knew it would be triggering - but I followed the link posted by an NLQ forum member to Pandagon, read the article - and then played the video. God help me.All I could think was - what ever must Hillary's mom have been thinking? And the horrible thing about it is that I could guess what must've been going through her mind when she actively participated in the beating of her daughter.I can remember many occasions in which my ex-husbands's abuse of the children was so intolerable - I would actually jump in and take over because I knew … [Read more...]
Corpses Don't Rebel: A former follower of Michael Pearl's "To Train Up A Child" reacts to the death of Hana Williams
Trigger Warning: This article contains graphic descriptions of infant and child abuse.This piece was submitted by No Longer Quivering member, "ExPearlSwine" - who understandably wishes to share her story anonymously.The death toll from parents following Michael and Debi Pearl's teachings continues to mount. Another child is has been "biblically chastened" to death via corporal punishment, and Michael Pearl is defending his teachings in the mainstream media while promoting his new book. Gary Tuchman and Anderson Cooper both reported on the death of 13-year-old Hana Williams, whose adoptive parents Larry and Carri Williams subjected her to beatings and neglect while following the te … [Read more...]
No Greater Joy Ministries Capitalizes on Tragedy with the Release of Michael Pearl's New Book: "Training Children to Be Strong in Spirit"
by Vyckie GarrisonMichael Pearl is getting a lot of media attention lately in the wake of the controversy fueled by the discovery of his child training book, "To Train Up a Child" in the home of yet another couple accused of killing their daughter by the excessive use of punitive discipline.Pearl defended TTUAC to CNN's Anderson Cooper, and he was also interviewed on HLN last week.Writing an official statement for No Greater Joy Ministries' Facebook page, Michael Pearl vowed to redouble NGJs efforts in light of the Hana Williams tragedy.In a calculated and appallingly callous move, greedy Michael Pearl is taking "pre-orders" for his newest book, "Training Your Children To Be … [Read more...]


text:
New and Familiar Faces
New and Familiar Faces
Meet new face Carmen Roberts, Business Manager, Division of Diversity, Equity and Inclusion
Meet familiar face Joanne Fenn, Assistant Professor; Collections Manager/Museum Registrar; and Adjunct Faculty Member for the School of Library and Information Science, Kent State University Museum
Carmen RobertsBusiness Manager
Kent Campus
Division of Diversity, Equity and Inclusion
New Face
Job Description:I provide business support functions for multiple departments within the Division of Diversity, Equity and Inclusion.
Worked at KSU since:March 2012
Employment Prior to Kent State University:From 2008 – 2011, I was an accountant/examiner for the Ohio Rehabilitation Services Commission located in Youngstown.
Likes Most About Kent State University:The people are extremely nice.
Attraction to Kent State University as an Employer:Kent State is a sizable institution providing a vast array of opportunities.
Resides in:Niles, Ohio
Hometown:Niles, Ohio
Education:B.S., Accounting, Westminster College; and Master of Business Administration (currently in progress), Youngstown State University
Hobbies:Coaching soccer, working out, painting, photography and film making
Joanne FennAssistant Professor; Collections Manager/Museum Registrar; and Adjunct Faculty Member for the School of Library and Information Science
Kent Campus
Kent State University Museum


text: From the yellow mosaic tables outside, to the leather chairs surrounding the indoor fireplace., Vino Bella is as cozy as it is sophisticated. The interior boasts exposed brick walls, which showcase work by local artists, and delicate lighting, both of which create Vino Bella's relaxing atmosphere. Come by and enjoy a cappuccino. Looking for something a little more upbeat? Stop by on a Friday or Saturday night for some live music. We'll give you something to tap your toes to while you sip on something from our extensive wine list, or enjoy something off of our new menu or desserts. Both comfortable and elegant, Vino Bella is Issaquah's up-and-coming premiere destination.-------------------------------------------------- Upcoming Special EventsWednesday, May 20th Comedy NightSeating begins at 7:00pm, show starts at 8:00pm. Reservations required. $15, non-refundable. Call 425-391-1424 for reservations.MC - Billy AndersonFeature - Adam NorwestHeadliner - Nathan BrannonNathan was the winner of the 2014 Seattle International Comedy Competition!Nathan takes the audience on an unexpected ride full of witty stories, clever punch lines, and amusing shadow puppets. He brings smiles and hilarious anecdotes to the stage every time he grabs the microphone. Nathan also added this sentence because he needed a higher word count. Nathan was the winner of the Seattle International Comedy Competition in 2014, was voted in Willamette Week's "Portland's Funniest 5" for 2013, and released his first comedy album, I Black Out, that same year. On top of that, he was the winner of Helium Comedy Club's "Portland's Funniest Person Comedy Competition" in 2012. Nathan has opened for national headliners such as Dave Chappelle, Damon Wayans, Maria Bamford, and has photoshopped himself into photos with many more. The back of Nathan's head was seen in NBC's new series, "Grimm". Nathan is now seeking a funnier way to end this paragraph.


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Energy in Africa
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A sustainable forest management program in Senegal puts communities in charge of local natural resources, increasing income and opportunities for electricification. Read More »
TZ-GEF Energy Dvpt and Access Expansion
Tanzania - Energy Development and Access Project : Tanzania - Energy Development and Access Project
Guinea - Electricity Sector Efficiency Improvement Project
The Project's principal objective is to support the Government of Guinea's current effort in improving the operational and commercial efficiency of its power sector... Show More +
Guinea Electricity Sector Efficiency Improvement
The Guinea Electricity Sector Efficiency Improvement Project seeks to improve the electricity sector's commercial and operational efficiency. These results will be achieved through critical investment... Show More +
Nigeria - Rural Electrification and Renewable Energy Development Project
The objectives of the Energy Access Project for Ethiopia are to: (i) establish a sustainable program for expansion of access to electricity and for improvement of the quality and adequacy of the elect... Show More +


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Six tranches de Vie
Paperback, 140 Pages
List Price: $7.82
Price: $6.26
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Six histoires qui n'ont jamais fait la "Une" de la Presse mais qui n'en demeurent pas moins extraordinaires.
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Product Details
- 9781447853077
- Copyright
- Daniel Pina (Standard Copyright License)
- Edition
- Troisième Edition
- Publisher
- Lulu.com
- Published
- October 22, 2014
- Language
- French
- Pages
- 140
- Binding
- Perfect-bound Paperback
- Interior Ink
- Black & white
- Weight
- 0.58 lbs.
- Dimensions (inches)
- 6 wide x 9 tall
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of 1,279 Diseases / Medical Conditions
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Gestational diabetes
Gestational diabetes is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy. There is some question whether the condition is natural during pregnancy. Gestational diabetes is caused when the insulin receptors do not function properly. This is likely due to pregnancy-related factors such as the presence of human placental lactogen that interferes with susceptible insulin receptors. This in turn causes in...... more on Wikipedia
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With its vineyards located at more than 1000 meters above sea level, the unique terroir of Gougenheim Winery combines the wonders of exeptional nature and the art of craftsmanship. The secret of Valle Escondido lays in its intense aromas and soft nature tannins.


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Chargers down 'Dores in JV action Monday
Oxford's junior varsity football team used a powerful running game and a strong effort on defense to post a 14-0 win over Lafayette Monday night at William L. Buford Stadium. After picking up two first downs and 25 yards on their first offensive drive of the game, the Chargers went on a 14-play, 60-yard scoring drive the second time they had the ball. (September 14, 2010, Page 6)
Yoste's six goals pace Earthquakes in win
John Owen Yoste scored six goals to lead the U-12 Earthquakes to a 7-4 win over the Sounders Monday in Oxford Park Commission youth soccer action. In the other U-12 game, the Galaxy and Tornados tied 5-5.
In two U-10 boys league games, United tied the Tornados 3-3, while the Crew pounded the Fire 7-1. In the Under 10 girls league games, United and Earthquakes tied 3-3, while the Fire topped the Galaxy 3-1. In the U-12 girls league, United blanked the Crew 1-0, while the Tornados topped the Sounders 2-0. (September 14, 2010, Page 7)
First meet a success for Lafayette teams
Lafayette's cross country teams fared well in the opening meet of the season, the Pontotoc Invitational.
The varsity girls finished second overall, while the varsity boys team was fourth. The seventh- and eighth-grade boys team both finished third.
Eleven teams competed in the varsity division, while 16 teams made up the middle school division. (September 13, 2010, Page 3B)
Rushing attack leads WVHS past Jaguars
A dominant ground attack led the Water Valley Blue Devils to an impressive 41-14 victory over the J.Z. George Jaguars Friday night at Bobby Clark Field.
Blue Devils coach Brad Embry was proud of the effort his team displayed on a special Homecoming Night. (September 13, 2010, Page 4B)
Water Valley storms J.Z. George
WATER VALLEY— The Blue Devils lopsided 41-14 victory over the J.Z. George Jaguars at Bobby Clark Field on Friday will be a Homecoming night few fans will forget.
The Wrecking Crew defense proved once again to be elite while the Blue Devils offense left many fans excited about the remainder of the season. (more…) (September 11, 2010)
McChristian helps lead NWCC Rangers to win
Two touchdowns each from Myles White and Jay Jones helped lead the No. 15 Northwest Mississippi Community College Rangers to a 41-26 win over East Central Thursday night at Bobby Franklin Field.
NWCC (2-0 overall) jumped out to a 19-6 lead in the first quarter but ended up trailing 20-19 at the half. The third quarter proved to be the difference in the game for the Rangers as they outscored East Central 15-0. (September 10, 2010, Page 7A)
Know Your Opponent
Ole Miss has won the last nine meetings, dating back to 1988.
Tulane scored the rare season opening win for its program with a 27-21 win over neighbor Southeastern Louisiana last Thursday night. With on 252 yards of total offense, the highlight of the night came in the rushing game, led by true freshman Orleans Darkwa (75 yards, 3 TD) and junior Albert Williams (67 yards). (September 10, 2010, Page 8A)
OPC's Volleys top Spinners
After splitting four tight matches, it came down to fewest games lost and in the end the Oxford Park Commission junior team tennis' Volleys defeated the Spinners.
Earning wins for the Volleys were Allie Bowen in the No. 1 singles match, and the duo of Barrett Childress and Drew Backstrom in the No. 2 doubles match. Zacarrah Nelms earned the Spinners' singles point, while Matt Read and Anne Hardy picked up the doubles point. (September 10, 2010, Page 9A)
Farese, Burns net four goals in soccer action
Emma Farese and Emily Burns each scored four goals to lead their respective teams to wins in the Under 12 Girls League Tuesday night.
Farese's Crew beat the Sounders 4-1, while the Galaxy topped the United 4-0. In two Under 10 Girls league games, the United beat the Crew 3-2, while the Sounders beat the Galaxy 3-0. In the Under 10 Boys league, United topped the Sounders 6-2, while the Tornados nipped the Earthquakes 4-3. In the Under 12 boys league, the Wizards beat the Tornados 5-2, while the Galaxy topped the Sounders 7-4. (September 8, 2010, Page 8)
LMS Splits with Charleston
The Lafayette Middle School football teams split a pair of games with Charleston Tuesday night. The Commodores and Tigers tied 0-0 in the seventh-grade game, while the older Commodores defeated the Tigers 16-6 to improve to 3-0 on the year. (more…) (September 8, 2010, Page 9)
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text:
LOS ANGELES – The first round of the 2002 NBA draft had come and gone.
Reggie Evans suddenly had little interest in the second.
He was in Pensacola, Fla., at his grandmother's house, tired of being shackled to a phone that wouldn't ring.
"I just got out of the house and started walking," Evans said Wednesday morning. "I just wanted to be by myself. I was going home. It's about a 15- or 20-minute drive, so it was a long walk.
"After a while my grandma could tell I wasn't coming back, so my uncle picked me up, about a block from my house. And then I started crying."
The second and final round also rejected Evans, who, at Iowa, led the Big 10 in scoring and rebounding.
"The type of numbers I had, the accolades I'd received, I knew I should be in the league," he said.
A bad night led to a new morning.
"And the next day I was back in the gym, working," Evans said.
Ten years later, Evans still is.
He signed a free-agent contract with Seattle, made the team at the urging of Coach Nate McMillan, and grabbed tough and easy rebounds alike.
"I didn't take any water breaks during that camp," he said. "I wasn't there to make friends either."
After the workouts, he would walk from the Super Sonics' facility to his hotel. And then, later, to a train station that led to his house.
"I didn't get a car until my contract got guaranteed in February," Evans said.
Sixteen of those 58 drafted players are still in the league. Some, such as Nikoloz Tskitshivili (the fifth pick) and Qyntel Woods (21st) made no ripples at all.


text:
VIDEO: Downies take first game of 2012
Last updated at 00:11, Saturday, 07 April 2012
Downies took the first game of 2012 mass football game series.
The ball was hailed at about 10pm. See our replay below for what happened.
First published at 21:24, Thursday, 05 April 2012
Published by http://www.timesandstar.co.uk
Have your say
well.that 12 month flew in.a cant make it this fridays.ave got tonsilitis and bad knees and me elbow. come on downies.
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Youth Hostels South Korea - HEY Guest House is one of the cheapest places to stay but you can enjoy the maximum comfort at an incredibly low price with tax and a meal included...
Youth Hostels Taiwan - Taiwan is about the friendliest, safest, most wonderful place on Earth. The people are wonderful too!...
Youth Hostels China - This art-deco style building was constructed in the 1920s. It is now a warm home for the backpackers...
Youth Hostels China - Searching for a great place to stay in Shanghai? Look no further! This is Shanghai City Central Youth Hostel located at the intersection of Wuning Lu and Zhongshan Bei Lu just three stops from
Youth Hostels Japan - Now many people recognize that Nishinari in Osaka City is the area where you can find many cheap hotels.
Youth Hostels China - Ah Shan Hostel is located at Mong Kok which is the centre of delicious food, entertainment and shopping.
Youth Hostels China - Welcome to our budget hostel. We established our services in 1980. We have just completed renovation...
Youth Hostels Sri Lanka - Situated on the beautiful sandy beach of south coast 101 km from Colombo, 18km from Galle...
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Find a hostel in Asia and save money on discount lodging. Hosteling in Asia offers a different travel experience than staying at traditional accommodations. Youth hostels allow you to meet new people and learn from other international and worldly travelers. Most hostels are conveniently located in the center of the action close to public transportation, including buses and rails. Staying at a hostel in Asia is a great option whether you are backpacking or traveling on a budget . Browse our hostels and plan your Asia vacation today!
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Marijuana Blog
Seattle wants to ban Hash and Concentrates
Category: News | Posted on Tue, May, 21st 2013 by THCFinder
Washington's proposed marijuana rules weren't even 24-hours old when critics began finding things not to like. The 46-pages of draft regulations released Thursday cover everything from where marijuana can be grown to the criminal backgrounds of license applicants. But it's the section on marijuana concentrates that's getting some negative buzz.
Let's start with the criminal background part of this. Under the proposed rules, anyone who wants a piece of the legal marijuana business would have to submit to a background check - even the financial backers of a marijuana start-up. A felony conviction in the last 10 years would likely disqualify someone. But a couple of misdemeanor pot convictions would not count against an applicant. Brian Smith, spokesman for the Liquor Control Board, says that rule was written with black market operators in mind.
"They want to get into the recreational marijuana market. They want to be legit. The board wants them to get out the black market and to come into the recreational market and be legitimate and so that's the thinking that the board had," Smith said.
License applicants would be scored based on their criminal background. Where marijuana can be grown has been a topic of much discussion. The board proposes to limit grows to secure indoor buildings or greenhouses; no emerald waves of marijuana plants out in the open. But it's another limitation in the proposed rules having to do with a very specific marijuana product that getting a lot of attention. It's a ban on hash and other forms of concentrated THC extracted from marijuana plants – unless it's infused into a product.
"I believe that the products that we're producing have received a bad rap because of the nickname BHO, Butane-extracted hash oil," said Jim Andersen with a company called XTracted.
Andersen says Butane is often used to extract the THC, but if done right, it leaves no chemical trace. He plans to fight the ban on raw marijuana extracts.
Smith said the Liquor Control Board was inclined to allow concentrates, but got some legal advice to the contrary.
"The law says the usable marijuana is the buds or the flowers of a marijuana plant, and an extract doesn't meet that criteria of being the bud," he said.
Read more: http://www.kplu.org
Alien OG Bubba (AOGB)
Category: Nugs | Posted on Mon, May, 20th 2013 by THCFinder
Blurry Line on Pot-DUI Cases
Category: News | Posted on Mon, May, 20th 2013 by THCFinder
As some states relax laws on pot possession, lawmakers are struggling to create rules for how police officers should identify motorists who are driving under the influence of marijuana.
The problem: Identifying pot impairment isn't as clear-cut as testing for alcohol. There is no broad agreement over what blood level of THC—marijuana's psychoactive ingredient—impairs driving. Breathalyzers can't detect marijuana levels, and only a small percentage of police officers are trained to authoritatively identify pot-DUI cases.
When voters in Washington state legalized recreational pot use last fall, they decreed that drivers with five nanograms or more of THC per milliliter of blood—a level that some studies suggest is associated with increased accident risk—are under the influence. In Colorado, which also last year legalized pot possession, lawmakers passed a bill earlier this month that sets the same limit, but gives drivers a chance to prove that they weren't impaired. In Montana, where medical marijuana is legal, the governor signed similar legislation last month.
But the correlation between THC levels and impairment isn't scientifically straightforward, said R. Andrew Sewell, an assistant professor of psychiatry at Yale School of Medicine. He said the compound leaves the blood quickly and that regular pot smokers who have built up a tolerance and maintain higher levels may not be impaired at the new legal limits. Setting these limits "is going to cause a lot of impaired drivers to be missed and it's going to cause a lot of innocent people to get arrested," he said.
Read more: http://online.wsj.com
Get HIGH grades
Category: Fun | Posted on Mon, May, 20th 2013 by THCFinder
Study Finds Marijuana Helps Control Blood Sugar, Waistlines
Category: Culture | Posted on Mon, May, 20th 2013 by THCFinder
(VOA) – Marijuana has been used for centuries to relieve pain, improve mood and increase appetite. A new study finds that the herb also has a positive effect on blood sugar levels, suggesting it could be helpful in diabetes control.
Researchers analyzed data collected from more than 4,600 patients who completed a drug-use questionnaire and provided blood samples. Nearly half had never used marijuana, about 2,000 others had used it in the past and the rest were current users.
Participants who reported using marijuana in the previous month had the lowest levels of fasting insulin and the highest levels of the so-called 'good' cholesterol – indicators of a lower risk for both diabetes and heart disease.
The study also found the marijuana users tended to have smaller waistlines. Large waist circumference, typically associated with obesity, is linked to diabetes risk.
Read more: http://insidecostarica.com
Lavender Nugs
Category: Nugs | Posted on Mon, May, 20th 2013 by THCFinder
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text:
25 years of experience
25 years of experience
808 W Fox Hunt Trce
Thiensville, WI 53092 Phone number & directions
Thiensville, WI 53092 Phone number & directions
License & Identifications
A medical license is required for a doctor to practice medicine in a particular state. Requirements vary by state but most require, at a minimum, post-graduate training in the doctor's specific specialty. An NPI number is a national identifier unique to an individual health care provider and is managed by the Center for Medicare & Medicaid Services (CMS).
Learn more about Dr. Eyal Tzeel:
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Specialties & Research
Dr. Eyal Tzeel, MD is board certified in Pediatrics.
Education & Awards
Dr. Tzeel graduated from University of Michigan Medical School, Ann Arbor.
Dr. Tzeel has 1 hospital affiliations:
- Childrens Hospital of Wisconsin
Home > Find a Pediatrician > WI > Dr. Eyal Tzeel, MD
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- Additional Information
- Dr. Eyal Albert Tzeel MD is a male Pediatrician, has 25 years of experience and practices in Pediatrics.
- Where does Dr. Eyal A. Tzeel practice?
- Dr. Eyal Tzeel has 1 office location.
- Dr. Eyal Tzeel practices Pediatrics near Thiensville, WI.