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Posted: Apr 21, 2015
Review by William
I borrowed this from a friend for a recent trip and I loved it. It held my money, passport, room key card, etc. The coin compartment is convenient. I will definitely be purchasing my own for future trips.
Posted: Nov 2, 2014
Review by Anita
I used this passport holder/wallet on a recent trip to New York City. It worked beautifully; enough space for all my cards and passport. Everything slid in nicely, no having to tug or fight to get cards in or out. I had peace of mind knowing that my cards and passport were RFID protected.
Posted: Aug 1, 2014
Review by Pamela
I loved this passport wallet so much, I have given it away many times as presents. It is the most practical gift ever- holds your passport, credit cards, etc. in a convenient wallet that is light-weight and functional.
The strap holds everything in securely.
I also print my boarding pass and put in in the wallet as well.
Don't miss out on this product- no negatives at all.
Posted: Mar 17, 2014
Review by Sandra
Enough space for your most important cards and money/miscellaneous items. I like that there's a hidden zippered pocket for currency and pocket within it. I like the visible passport sleeve as well. The wallet seems like it can fit into almost any size handbag, so that there's no worries transferring from one bag to another.
Posted: Oct 19, 2013
Review by Jane
Been using this for a while now and love it. Room for credit cards. Bills lie flat in the bill area. Coin compartment is convenient. If folds nicely to not take up room and the elastic keeps it closed. I get compliments on it often. All this and safety too! Great product!
Posted: Apr 28, 2013
Review by Jocelyne
La première raison de mon achat était la protection RFID, mais depuis que je l'utilise, c'est le format, l'organisation, la rapidité d'accès qui en font un excellent choix.


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Wilson HOPE Pink Racquetballs
Product Information:
Support the Breast Cancer Research foundation while playing with Wilson's® #1 Selling Racquetball - The HOPE® Pink Racquetballs. The vibrant color of the HOPE® balls provide increased visibility on the court. Wilson® proudly donates $250,000 annually to the Breast Cancer Research Foundation®, dedicated to preventing breast cancer and finding a cure in our lifetime by funding clinical and translational research worldwide.
- Includes 3 racquetballs per can
- Wilson's® #1 Selling Racquetball
- Vibrant pink color offers greater visibility on the court
- Wilson® proudly donates $250,000 annually to the Breast Cancer Research Foundation®, dedicated to preventing breast cancer and finding a cure in our lifetime by funding clinical and translational research worldwide. For more information about BCRF, visit bcrfcure.org. Purchase of this product does not affect the amount of the donation.
- Model: WRT917300
- Wilson
Country of Origin: TaiwanWeb ID: 18665996
Customer Reviews:
Rated 4.4 out of 5 by 26 reviewers.
Rated 5 out of 5 by Cowgirl_831 Great They awesome and will last a long time. I also loved the color! July 29, 2014
Rated 5 out of 5 by jackpac Good Ball for Competitive Play This ball has a better bounce than the blue or green balls, and is more consistent in bounce than the red ball. Plus, it supports Breast Cancer Research. July 2, 2014
Rated 5 out of 5 by Rob Excellent Very good hold up well A lot easier to see at highway speeds makes it easier to head all-around very happy with them will definitely buy more and encourage people to buy May 28, 2014
Rated 5 out of 5 by norme best racquetballs The Wilson Hope balls play truer longer than any other ball. My racquetball group uses nothing else. May 28, 2014
Rated 1 out of 5 by Dexter Excellent Product Many of the more experienced Racquetball players are choosing Wilson Balls due to the rubber. While all Racquetballs Bounce the same, Penn Brand Racket Balls do not feel the same when striking the ball. The Wilson Ball any color has a consistent fell and less stressful to arm and shoulder joints. March 26, 2014
Rated 5 out of 5 by jball Best racquetball for me The pink ball is easy to see and has a lively bounce. Not as bouncy as the red, and not dead like the purple. Stays livelier longer than the blue or green. August 29, 2013
Rated 5 out of 5 by Jim Great Racquetball Considering all factors on the court, this is the best racquetball on the market - great visibility and long lasting use. It maintains a lively bounce even with extended use and rarely breaks. August 17, 2013
Rated 5 out of 5 by sophie4us Great product. This is a very good product. It performs well and is a good value. August 15, 2013
Rated 5 out of 5 by rballin great balls, flat upon opening from dicks shelf I love these pink Wilson's for their visibility on the back glass. They seemed flat upon opening, though, the one time I bought them here. Wondering how long they spent on the shelves August 4, 2013
Rated 5 out of 5 by Stoney Pink Rocks These racquetballs play great and last forever! As a bonus part of the purchase price goes to breast cancer awareness. July 30, 2013

subset: commoncrawl


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The University of Oxford (informally Oxford University, or simply Oxford) is a university in Oxford, United Kingdom. It is the second oldest surviving university in the world and the oldest in the English-speaking world. Oxford is a member of the Russell Group of research-led British universities, the Coimbra Group, the G5, the League of European Research Universities, and the International Alliance of Research Universities. It is also a core member of the Europaeum and forms part of the 'Golden Triangle' of British universities (Excerpt from Wikipedia article: University of Oxford)
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The Portole Project: Supporting E-learning
Tracey Stanley, Mina Sotiriou and Matthew Dovey provide an overview of a project to produce tools to discover information resources and deploy them within a university VLE.
January 2004, issue38, feature article


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Sep 16 2011
Choose to Love
Here is the formal introduction for today's guest writer:Anthony Sweat grew up in West Valley City, Utah and served his mission in South America to the Bolivia, La Paz mission. Upon his return he met his wife, Cindy Bohman, and the two were married in the Logan, Utah Temple in May of 1997. They are the parents of six children: Lauren-12, Reagan-10, Jane-8, Eli-6, Vivian-2, and a newborn son, Calivn. He is the co-author of the best-selling Deseret Book publications Why?: Powerful Answers and Practical Reasons for Living LDS Standards and HOW? Essential Skills for Living the Gospel. Anthony is also the author of the book I'm Not Perfect. Can I Still go to Heaven? Brother Sweat has a PhD in Education from Utah State University, and is a full-time religious educator for the Church Educational System. He is also a speaker at Especially For Youth and BYU Education Week conferences. He is currently the seminary principal at West High Seminary in Salt Lake City, Utah. Brother Sweat's other interests include playing sports, painting, writing, and above all spending time with his wife and family.
And here is my introduction of him:Tony and I taught seminary together- and this man has the gift to teach. When I found out that he had published books with Deseret Book, I thought to myself, "Good! The world needs him." He has some books there that all of you really need to consider as adding to your personal library. His books "Why" and "How" may first appear to be directed to youth (they look like text books – super clever!), but they are just as helpful to adults – specifically parents, leaders and grandparents who are looking for good ways to explain to their children "why" we live certain Gospel principles and "how" they can do it.
He and his co-author have a website… check it out and send your kiddos there: http://www.ldswhy.com/
Choose to Love
Anthony R. Sweat
"Husband and wife have a solemn responsibility to love and care for each other and for their children."
One of the most ridiculous notions about love that is prevalent in the world todaycomes from the phrase, "We fell in love." Think about that: "We fell in love," as though it were some accidental thing that just happened when cupid randomly shot his arrow or love potion #9 wafted over us, and we had no choice in the twitterpated matter. Not only is this false idea ridiculous, but it is also dangerous to the stability of our family relationships and the divine mandate we have to love and care for our spouse and children. If we buy into the notion that love is an emotion that happens to us outside of our agency, then we also unconsciously fall into the deception that falling out of love with someone is also out of our control. As Elder Lynn G. Robbins of the Seventy taught, ""Falling out of love is a cunning myth . . . Too many believe that love is a condition, a feeling that involves 100 percent of the heart, something that happens to you. They disassociate love from the mind and, therefore, from agency." ("Agency and Anger," Ensign, May 1998, 80) .
Luckily, the Savior taught us the true definition of love,and helped us see that love is not an uncontrollable emotion, but a verb which is perfectly within our power. Jesus taught, "Greater love hath no man than this, that a man lay down his life for his friends" (St. John 15:13). In other words, love is sacrifice. "True love is," in the words of President Gordon B. Hinckley, "is not so much a matter of romance as it is a matter of anxious concern for the well being of one's companion (Ensign, June 1971, p.71). When my wife and I began dating, I knew instantly that I should marry this wonderful girl when I asked her what she—in her 20-year-old wisdom—thought the definition of love was (I know, I know, how on earth could a 21-year-old returned missionary get on the topic of discussing "love" with a beautiful girl?). Without even missing a beat, she said: "Love is sacrifice," as though it were as plain and common of a truth as the earth being round. If we understand that true love is service and sacrifice, then we begin to understand how we can use our agency to choose to love and care for our spouse and/or children. If we notice the feelings of love for our spouse/children diminishing at all, then we can quickly change that by choosing to selflessly serve them. The flower of love is grown in the soil of sacrifice.
Sometimes we mistakenly thinkthat the love we have for others is depended upon how they act, and that in order to love them they must act loveable. That is not true. Our Father in Heaven has an infinite love for each of us as his children, many times in spite of our actions. The Apostle Paul taught us, "I am persuaded, that neither death, nor life, nor angels, nor principalities, nor powers, nor things present, nor things to come, Nor height, nor depth, nor any other creature, shall be able to separate us from the love of God" (Romans 8:38-39). While we cannot control whether others choose to love us, we are in perfect control of being able to choose to love those in our family, in spite of their imperfections.
To close I relate what the famous author Stephen R. Covey saidto a man who claimed he just didn't have the same feelings for his wife that he used to. Mr. Covey said to this man, "Love her. . . . Love is a verb. The feeling of love is the fruit of love. So love your wife. You did it once, you can do it again. . . . It's your choice" ("Why Character Counts," Reader's Digest, Jan. 1999, 135.). I testify that through the divine gift of agency, and through selfless service, we can indeed fulfill the divine mandate to care for our spouse and children, and choose to love them.
Remember to visit the other blogs hosting this celebration!They have great things going on each day! Montserrat from Chocolate on My Cranium, Jocelyn from We Talk of Christ, and Jaime from Welcome to the Madness. Be sure to visit each blog every day!
And here are today's Giveaways! We are doubling up so you have twice the chance to win!Tony Sweat is guest blogging at The Red Headed Hostess today and he is giving away one of his CDs, The Devil Made Me Do It (and five other lies that Satan tries to trap us with)! Anthony Sweat has a PhD in education from Utah State University. He is a full-time religious educator for the LDS Church, and also a speaker at Especially For Youth and Education Week conferences. Please be sure to go and read his post today!
ANDTemple Prints from Plum Street Prints Our Temple Prints are a wonderful way to display the temple in your home in a personalized and modern way. Whether you'd like to remember your wedding/sealing day or display the temple in your child's room, or even give a gift to someone on their wedding day, these prints can be customized to your style. We currently have 20 temples available and are adding more each week. Visit Plum Street Prints today!
34 Responses to "Choose to Love"
Another great post! I am SO loving this Celebration of Family. Love is a verb, and it isn't always easy. Thanks so much for sharing.
(When I started reading Anthony's bil, I thought to myself-wow he is younger than he looks! He got married in 1997-that is forever ago…My brain must not be awake yet…that is the year I got married too. Hopefully I am younger than I look, but I don't think so…)
# Christi Williams on 16 Sep 2011 at 12:08 pm
"love is sacrifice" Making the relationship and loving our spouse should our highest priority. Thank you
I have and LOVE both of those books – Why? and How?
I also love this post! IT's true! Love is a choice. ♥
# Joni on 16 Sep 2011 at 1:35 pm
Celebration of the Family is so awesome. Love is Sacrifice. So true.
Thanks so much for this post. Just *yesterday*, my 14-year-old and I were talking about love being a choice. It will be awesome to get to show her this.
# Shauna on 16 Sep 2011 at 1:46 pm
Incredible post…and so very very true.
# Amy Bateman on 16 Sep 2011 at 1:57 pm
Great post. Thank you!
Just bought WHY? and have LOVED reading through it. What a wonderful resorce! HOW? is on my wish list for this year!
I love this post. It really is true that Love doesn't just happen. We need to work at it. You don't just fall into love and hope it stays forever. What a wonderful reminder.
I looked at the bio and thought the same thing Carrie did…WOW he is young. Then I remembered I got married in 1997 and I have a 12 yo too! Oh boy, maybe getting old is a bad thing….
This is great. I never really thought of some of the things he stated but they are true. Thanks.
This is so true! Love is a choice, and a verb. Thank you for your post.
# Becky L. on 16 Sep 2011 at 3:34 pm
I choose to love! What a great post! I just put the books How and Why on the Christmas list for my teens.
# Danica on 16 Sep 2011 at 3:38 pm
This is such a great post! It's an answer to prayer right now. Just the words I needed. I think my husband and I will read it together
# Lisa C on 16 Sep 2011 at 3:54 pm
I am loving the daily inspiration!
# Chocolate on my Cranium on 16 Sep 2011 at 4:00 pm
My husband and I were sealed and married in the temple by Pres. Hinckley. He repeated that same counsel to us! We must always put the other before ourselves and serve, serve, serve. If we start to feel love waning it is because we are starting to focus on ourselves (selfishness) instead of on our spouse (unselfishness).
Great thoughts!
What a great post, we've just been talking about service within our family to show our love. I love "the flower of love is grown in the soil of sacrifice"! I think that's going on the refrigerator.
I totally agree!
# Stacy S. on 16 Sep 2011 at 4:48 pm
My husband and I are trying to teach our children that love and marriage involve work. Never thought about the work being service but it makes perfect sense!
# Kristin on 16 Sep 2011 at 5:44 pm
There are so many people I know who could benefit from reading this! My husband and I talk about this all the time– you don't just fall out of love if you truly loved someone in the first place. Just like everything else– it is a choice! That's why marriage can be work sometimes Thank you so much!
I attended Bro. Sweats classes during Education Week… he was AWESOME and REAL!! I am a better seminary teacher because of him!! Thank you!!
I am hooked, I love this website. So many ideas and lesson helps and delicious recipes!
Great great post!
# Laura@ Living a Big Story on 16 Sep 2011 at 7:44 pm
There's a theme with some blogs I've been reading today … and with my kids going through an emotional stage right now, I'm just so grateful for the reminder.
# Laura McMullin on 16 Sep 2011 at 8:32 pm
Thank you so much for this. I am printing this off and will be using for FHE this coming week. I can't wait to go pick up the books too. Thank you
I want to bookmark this post and read it again and again. Thanks so much for sharing!
# Jeni Atkinson on 16 Sep 2011 at 10:03 pm
Fantastic thoughts to keep me thinking all day!
# Heather Lynne on 16 Sep 2011 at 11:17 pm
Thanks for being a part of this celebration!
# Tessa (Nelson) Rosales on 17 Sep 2011 at 12:33 am
I love Bro. Sweat's insight! This is so great, it's just what I needed Thanks for sharing this Shannon!
# Connie holladay on 17 Sep 2011 at 12:55 am
Ths was a great post. I really enjoyed it.
# marielle on 17 Sep 2011 at 4:54 am
Wish he would have been my seminary teacher.
It's been a rough, emotional day. This post made me smile, encouraged me, and reminded me that there is still much good and many good people in the world. Thank you:)
# Kristin on 17 Sep 2011 at 1:09 pm
I appreciate the reminder that "Love is sacrifice". And not only is love a verb, but it is an action verb! Thanks for such a great post!!
# Terressa T. on 17 Sep 2011 at 8:19 pm
Thank you for the reminder on what love is!
I LOVED this article. It is so well put and such a good reminder to serve those you love!!!! Thank you so much. I will have to check out those books.
Thank you so much for this! Just thinking if you'll have printable copy of this? I'll insert this to my personal journal!


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The Reformation Study Bible (2015) notes are now available on Bible Gateway! Click to learn more.
grape-town, one of the cities in the mountains of Judah, from which Joshua expelled the Anakim (Josh. 11:21; 15:50). It still retains its ancient name. It lies among the hills, 10 miles south-south-west of Hebron.


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U.S. Senate Confirms IRI President Ambassador Mark Green to MCC Board
Washington, DC – Ambassador Mark Green, president of IRI was confirmed by the United States Senate to serve a second term on the Board of Directors of the Millennium Challenge Corporation (MCC). Green was first appointed to the board in 2010.
"I am honored to be confirmed to serve once again on the MCC board and proud of the work the organization is doing around the world," said Ambassador Green. "Through the work of MCC, the United States not only gives aid to those countries in need, but gives it to those countries committed to democratic governance and economic freedom."
Prior to joining IRI, Green served as president and chief executive officer of the Initiative for Global Development. Green also served as U.S. ambassador to Tanzania from mid-2007 to early 2009 and served four terms in the U.S. House of Representatives representing Wisconsin's 8th District. During his time in Congress, Green helped craft key policy initiatives including the Millennium Challenge Act and President George W. Bush's AIDS program. Green has also served as senior director at the U.S. Global Leadership Coalition.
Green serves on the Center for Strategic and International Studies Executive Council on Development and co-chairs the Consensus for Development Reform. Alongside many other activities, Green is a board member of WorldTeach and serves on the Former Members of Congress Association Diplomatic Advisory Council. He is a member of the Council on Foreign Relations.
Green holds an Honorary Doctor of Science degree from Georgetown University's School of Nursing and Health Studies, a juris doctor from the University of Wisconsin Law School and a bachelor's degree from the University of Wisconsin–Eau Claire.
MCC is a United States government corporation based on the principle that aid is most effective when it reinforces good governance, economic freedom and investments in people. MCC's mission is to reduce global poverty through the promotion of sustainable economic growth.
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This press release is licensed under a Creative Commons Attribution 3.0 Unported License. Read full copyright information here.


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These looks are timeless.
10 Awesomely Unsexy Halloween Costumes You Need in Your Life Immediately- Page 1
For a flirty daytime look, reach for the Laura Mercier Corner Faux Eyelashes, $18. They give you an instant cat eye and will look natural over sangria and omelets.
Get noticed on the dance floor with a set of rhinestone embellished faux lashes. The yellow stones on these Napoleon Perdis "Luxe Firecracker" Full Faux Eyelashes, $45, will light up brown eyes.


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This week on Cum Fiesta we hot a PYT by the name of Zoey Wayne. Seeking out a big cock for her pleasure, she made her way to the Fiesta. At the door, Zoey was asked for the password, and she pulled out her big delicious tits. They were un-fucking-believable. Tony had to ask if they were real because they were so big and perfect. Zoey blew our minds when she replied that they were. We'd seen a lot of nice titties on the Fiesta, but Zoey's were exceptional. She also had a ripe booty to go along with them and a bag of tricks for the sex. Zoey showed of her cock sucking skills, as she looked up at the camera with her pretty blue eyes and slobbed on Tony's knob until he was rock hard. He was so ready for that pussy, he wasted no time getting in her. Tony jumped on it and went balls deep. He stroked that hot teen pussy from all angles, and Zoey loved it. She came hard as hell several times. When Tony got to have his turn, he pulled out and busted all over that cute face and those hot tits.
This week on Cum Fiesta we had a smoking hot babe by the name of Sam Summers. This sexy gal had been let down by most of the guys she'd come across and was looking for a skilled sex partner. When she heard about Jmac and the Fiesta, she knew she had to go. Just by taking a look at the pics in this post, you can tell she is a super sexy babe that had Jmac sprung from the first moment. When she flashed her tits at the door, we were really impressed.
She definitely had one of the best racks EVER in fiesta history. And once she came in and saw Jmac's cock, she was really happy she had come through. A big dick and a deep stroking was exactly what she was looking for. Next thing Sam did was slip off her pants and give us a look at that ass. It was exceptional. Her amateur booty was big, round and juicy. Jmac dove in and went balls deep into that pussy. He gave Sam everything he had, and she loved the stroking. Sam came several times, but Jmac just once and across her pretty face. It was HOT!
Click Here and See Catch More HOT Amateur Pussy & Porn Pics on Cum Fiesta for Just $1
All the way from a little town in Idaho, Keegan made her way down to the big university to get away from the boredom. So far from home, Keegan let it all hang out. When she heard about the Cumfiesta from a roommate, she had to go check it out. After getting the location, Keegan dressed up in a super sexy pink miniskirt that was skin tight. She knocked the door and showed her perky tits for entrance. Keegan then gave a seductive striptease that blew our man's mind. He was dying to get into that pussy. He rubbed that teen pussy, and Keegan gave his cock a through sucking. Then she took that dick deep for an amazing ride and even squirted for the first time, she was so horny. After her pussy stroked good, and cumming, Keegan got the official Fiesta cumshot all over her pretty face.
See Fine Amateur Teens Giving BJ's & Having Sex on Cum Fiesta for Only $1
Missy Lynn was a smoking hot and totally freaky blond teen in search of big dicks. And she got exactly what she was looking for at the Cum Fiesta. Missy was just bored to death from the average size pricks she'd been messing with and needed a full fledged, trouser python. Lucky for her, a friend told her where she could find the Fiesta. Missy came up and knocked the door.
We were blown away by how cute she was and how hot her body was. She showed off her teen tits and came right in. In no time, she had a massive cock in front of her face, and she went to town on it. Missy sucked away on that dick and took it into her pussy. She was so wet and horny, you could hear her pussy sloshing. Missy came multiple times and even got treated to a mega dose of cum, as she got her face blasted. It was awesome!
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Not uncommon, Angel Cassidy was a girl that needed big cocks to be satisfied. Let down be her recent luck in the dick department, she was seeking a massive rod to take her frustrations out on. Lucky for her, a friend had told her about the Cum Fiesta. Hesitant, Angel arrived at the door with her doubts. When she knocked, and Jmac answered, he asked her to show him the password. Angel pulled out her hot tits, and Jmac let her right in. He was very impressed by Angel's good looks and smoking hot body. That ass and pussy were perfect. Then it was Angel's turn. Once she grabbed Jamc's cock, she never let go. Angel stuffed it in her mouth and jammed it into her pussy, as she rode him like a wild stallion. She got exactly what she wanted, and so did Jmac when he came all over that pretty face of hers.
Check Out A TON of Hot Amateur Teen Porn Pics & Videos on Cum Fiesta for Only $1
In search of bigger cock, Cadence Lux found herself at the footsteps of the Cumfiesta. After some second guessing, she knocked the door and flashed her tits to get inside. Jmac was the one that answered and was immediately taken back by how hot Cadence was and how nice her tits were. She went ahead and came inside. Once everyone broke the ice, Cadence reached out and grabbed Jmac's dick print through his pants. He undressed her, and Cadence showed off those incredible teen tits and ass. In no time flat, Cadence had Jmac's cock straddled between her sweet lips. She gave him an awesome blow job and got him good and hard, so he could stoke her right. Well, that is exactly what Jmac did. He went wild on that teen pussy and made Cadence cum multiple times. Then he finished up by busting his cum load all over her pretty face. It was awesome!
Click Here to Watch ALL the Sexy Amateur Teen Porn Pics & Videos You WANT on Cum Fiesta for Just $1
This week we've got a blond bombshell named Courtney Shea for you. She was stacked and had D sized tits. When she knocked the door, and JMac opened, he took one look at her tits and knew it was going to be a great fiesta. Without hesitation, Courtney pulled out her succulent boobs and was given instant access. JMac was so excited to jump in. Courtney was a girl that was all about the sex, so it didn't take them long to start the licking and sucking. Jmac spread her wide and tagged that pussy from every imaginable angle. No doubt, Courtney was loving it. This is one Cum Fiesta episode you won't forget about anytime soon.


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Shopping (243 community guides)
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Taste costly vinegars, deer ham, Alpine cheeses and good wine. And hunt for bargains on Saturdays at the flea market.... read more »
High street basics? Or something utterly unique? Whatever you're after, Brighton's eclectic shopping streets can deliver. I'll point you in the right direction.... read more »
Although fashion in Seville tends to run towards the conservative, you can find many high-end designer clothing shops and, of course, shoes, shoes and more shoes... read more »
If money is no object – or you just want to press your nose up against the windows of designer heaven, Milan is the place to be. But where should you start looking?... read more »
If you're after a special memento of your visit to Budapest, then what about an antique print, a tablecloth embroidered with traditional rural motifs or a fine piece of Herend porcelain?... read more »
Local crafts and handmade wares can be found in all corners of Cape Town. Here's where to buy the best and where you'll get good value... read more »
A tour of Oxford shops that avoids chain stores... read more »
Lisbon is a delight for hunters of high quality local goods and produce... read more »
Lisbon will surprise you with its quirky boutiques and innate effervescent style... read more »
Shopping should be fun, and Hong Kong's markets and themed shopping streets are exactly that... read more »
With their practical, democratic eye for detail the Danes (OK, with help from their Scandinavian cousins) have conquered the applied arts, not least among them furniture and interior goods design... read more »
In its own quiet way, Copenhagen is turning heads in the global fashion industry ... read more »
Enjoy some boutique hopping in NYC's beautiful residential surroundings ... read more »
Independent retailers still thrive in Bath and the city is home to everything from trendy clothes and homeware shops to food markets and vinyl toy shops. Here's my guide to the best of the bunch...... read more »
Singapore may be perceived as squeaky clean and well regulated but that just adds to its delights as a modern and efficient business centre... read more »
Cape Town's foodie scene has grown at a remarkable rate over the past few years. You can see it in the quality of the eateries that have popped up and in the plethora of food stores and markets... read more »
Milan may be one of the world's fashion capitals but there are ways to make your euros stretch that little bit further.... read more »
Brighton's favourite shopping streets are lively, individual and fun to explore on foot. As a bonus, they're also stuffed with great little places to eat and drink. So go on, treat yourself.... read more »
Make the most of an excellent public transport network to see the sights of the shining jewel of Canada's West Coast... read more »
A girls' weekend of fine dining, vintage clothes shops and culture in Newcastle upon Tyne proves that there's more to The Toon than Viz magazine and half-dressed revellers partying in The Bigg Market... read more »
Showing 221-240 of 243 results


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on wordpress themes, could be added free plugins, noted obviusly and with the download link or plugin page… or is against rules?
I saw this in those premium theme site. They are offering a link within the instruction page. So, there is no often. But, do you think if a theme which required users to download dozen of plugins can considered as premium theme?
Just my 2 cent.
don´t know, really, i mean, "premium".. tomorroy the name will be "golden templates" and so on….
i agree with you on the "amount" of extra things to include, you know, the less, the more easy to the buyier.. but always you need a plugin to do something, it´s imposible not use one or more…. or dozens!!! jeje.
by the way, nice works kailoon, like your clean style
I only ever use plugins now if I really need to and when I do I make it an option so if you user wants that functionality they can, but I'll put it on an options page so its up to them, I must admit with Kailoon, when someone buys a premium theme it should be premium, the user shouldn't have to then set up a whole load of plugins just to use the template. As for whether it is against the rules, I doubt it will be but you'll have to check with staff about this, most plugins are released under terms that allow the use in most things, the plugin should be an extra to a theme.
Not saying that we do not use any plugins. But better do not include into the theme. Because I consider it as a add on to a site/blog. So, I only prepare what is included in my design
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Woodlands Checkpoint breach: Driver charged in Singapore with rash act and vandalism
Published on Mar 10, 2014 10:26 AM
SINGAPORE - A Mercedes-Benz driver, who allegedly breached a security barrier at Woodlands Checkpoint meant to stop unauthorised vehicles from entering Singapore, was charged in court on Monday.
Tan Chu Seng, 64, is accused of committing a rash act by driving the Mercedes-Benz recklessly on Saturday, causing injury to police officer Safie Mahrom. The Singapore permanent resident from Malaysia also faces a single charge of vandalism after he allegedly drove into the cat-claw security barrier, damaging it.
Both offences took place at Woodlands, one of the busiest land immigration checkpoints in the world. The court on Monday granted the prosecution's request for the accused to be remanded at Jurong Police Division for a week for further investigations.
Tan had asked for a shorter remand of four days, saying he suffers from hypertension, urine acid and diabetes, but his request was rejected by the court. Instead, the district judges instructed him to inform police investigators about his condition.
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text: We're sorry, Sunset Sweatshirt is no longer available Why not try one of these instead? Dark Is The Night Slouch Sweater by Bonbi Forest £28$56.12€39.58$44.45 65% Off Organic Cotton Cable Top by LIV - Organic & Sustainable Living £21$42.09€29.69$33.33 Big Bear Jumper by Don't Feed the Bears £30$60.12€42.41$47.62 'R And P Vintage Vinyl' Sweatshirt by Rael & Pappie £29$58.12€41$46.04 Sunset Sweatshirt by Mudd & Water £23.60$47.30€33.36$37.46 This item is no longer available £6.95$13.92€9.82$11.03 delivery to United States - Receive this item 5-10 working days from dispatch International delivery available colourcolour (required)Port - size 12 OnlyIndigo Stripe - size 8 Onlycolour (required)Port - size 12 OnlyIndigo Stripe - size 8 Onlycolour (required)Port - size 12 OnlyIndigo Stripe - size 8 Onlycolour (required)Port - size 12 OnlyIndigo Stripe - size 8 Only sizesize (required)UK8UK12size (required)UK8UK12size (required)UK8UK12size (required)UK8UK12 we're sorry we're sorry, This item is no longer available buy a gift voucher related categories fashion > women's fashion > jumpers & cardigans > jumpers fashion > cosy casuals fashion > our picks: winter clothing by Mudd & Water Location: London, GB read seller's profile see seller's complete range more items from this seller Old Pine Cardigan £24.15$48.40€34.14$38.34 Lucky Leggings £11$22.04€15.55$17.46 Babel Sweater £22.75$45.59€32.16$36.11 Redchurch Sweater £26.25$52.61€37.11$41.67 view all you may also like PRODUCT DETAILS CUSTOMER REVIEWS DELIVERY RETURNS eco-friendly ask seller a question Organic cotton fleece sweatshirt Stunning soft organic cotton fleece sweatshirt with a funnel cowl neck and lovely contrasting trim detail. Contrast embroided Mudd and Water logo on front double pocket and text to back. Another essential piece for day & weekend wear. Detail: Machine washable @ 30° Double front pocket Full length sleeves Deep rib elastane cuffs Length finishes at low hip Garment washed for softness available in Indigo stripe, Marina stripe, Navy and Port made from: 95% Organic cotton fleece 5% elastane dimensions: Body length 67cm product code: 270954 1 customer review Wed 01 Jan 2014 Great! read about our product rating system ratings guide trusted independent customer feedbackforum excellent bad good poor This product is dispatched to you by Mudd & Water. MAINLAND UK order now and receive this item on or before price Free Delivery Thursday 28 May FREEFREEFREEFREE Express Next Day Wednesday 27 May £4.95$9.92€6.99$7.85 NON-MAINLAND UK estimated delivery price Highlands & Islands of Scotland 2-5 working daysfrom dispatch £1.75$3.50€2.47$2.77 Northern Ireland 2-5 working daysfrom dispatch £1.75$3.50€2.47$2.77 Other UK Islands 2-5 working daysfrom dispatch £3.95$7.91€5.58$6.27 INTERNATIONAL DELIVERY estimated delivery price Western Europe 2-5 working daysfrom dispatch £5.00$10.02€7.06$7.93 Rest of Europe 5-10 working daysfrom dispatch £5.00$10.02€7.06$7.93 USA & Canada 5-10 working daysfrom dispatch £6.95$13.92€9.82$11.03 Far East & Australasia 5-10 working daysfrom dispatch £7.25$14.53€10.25$11.51 Rest of the world 5-14 working daysfrom dispatch £7.25$14.53€10.25$11.51 You have 28 days, from receipt of cancellable goods, to notify the seller if you wish to cancel your order or exchange an item. Please note: goods that are personalised, bespoke or made-to-order to your specific requirements, perishable products and personal items sold with a hygiene seal (cosmetics, underwear) in instances where the seal is broken are non-refundable, unless faulty. Read more about our returns policy.Should you choose to return or exchange your order you will need to deliver the item(s) to the UK, where this seller is based. Mudd & Water's return policy


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from Jack Bogle, Burt Malkiel, Cliff Asness ...and John West. Remember, I ..... Messrs. Bogle, Malkiel, and Asness , unsurprising given the deep respect I held and continue ..... pick them). Was it new or, as Cliff Asness (2006) suggested, just a cleverly repackaged form of value
arbiter of justice, the marketplace of investors, can deliver its verdict. Late note: Earlier this week, AQR's Cliff Asness addressed the topic that I discussed in my last column ( "The Attack on Shareholder Value" ). His comments are worth
Robert Haugen found that stocks with lower volatility produced higher returns than the rest of the market. Clifford Asness and Andrea Frazzini of AQR Capital Management and Heje Pedersen of New York University discovered the same holds true of high quality companies, those with above average
AQR founder and managing principal Cliff Asness , Franklin Templeton executive vice ..... and his portrayal in the press. Asness : Splitting the Middle on Market ..... in the Efficient-Market Debate Asness : Why I'm a Cynic of Active Stock
Conference. Joining me today is AQR's Cliff Asness . Cliff, thanks for joining us. Cliff Asness : Thank you. Burns: Now, recently the ..... person who you are going to bring up for me. Asness : Lars Hansen. Burns: Lars Hansen. Why
research. Joining me today is AQR's Cliff Asness . Cliff, we had you at the Morningstar ..... world where everybody indexes? Cliff Asness : First, this is one of the great ..... you collect the cash flows. Asness : So we are obviously talking about
rest. In a study published last year, Cliff Asness and Andrea Frazzini of hedge fund AQR Capital Management and Lasse Heje Pederson, a finance ..... balance sheets. (I am a believe in Cliff Asness and his mometum focus but one has to
put momentum skeptics in their place. It is not shy in doing so. In many instances, state the authors (Clifford Asness , Andrea Frazzini, and Ronen Israel of AQR Capital Management and Tobias Moskowitz of Chicago Booth), their decision to use the term "confusion and debate" about the momentum
was a student of Gene Fama's, Cliff Asness , who documented the strategy ..... any other school, beginning with Asness and extending in recent years to ..... salt. The Good New Days Either Cliff Asness was being uncharacteristically
Middle Ground Earlier this month, Cliff Asness and John Liew published" The Great Divide ..... are very difficult to exploit. The Asness and Liew article neatly summarizes ..... large amounts. This behavior, as Asness and Liew point out, amounts to a


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Athletics top BoSox for 9th win in row
OAKLAND, Calif. (AP)
As best as he can, Bob Melvin keeps his mind from wandering to what the upstart Oakland Athletics might accomplish by season's end if they keep going like this. Josh Reddick insists it goes for him, too.
TAKE ME OUTBaseball diamonds are a girl's best friend. Check out MLB's FOXiest fans and tweet us your photo.
That's OK, everybody else is doing plenty of scoreboard watching for the A's as this overachieving club tries to get back to the postseason for the first time in six years.
In one impressive 10-day stretch, Oakland (76-57) is suddenly in a tie with the New York Yankees for the second-best record in the American League behind the two-time reigning AL champion Texas Rangers (79-54).
''It's crazy,'' pitcher Brett Anderson said. ''Who would have predicted that Sept. (2) that we'd be tied with the Yankees for the same record? Everything's working right now: offense, defense, pitching. When that's happening, special things are going to happen.''
Seth Smith hit a two-run homer, Stephen Drew hit a solo shot for his first clout since joining Oakland and the A's beat the Boston Red Sox 6-2 on Sunday for their season-best ninth straight win.
Anderson (3-0) won his third straight start since returning from a 14-month absence to recover from Tommy John surgery. Having him back is a big boost for the AL wild-card leading A's down the stretch after they lost Bartolo Colon to a 50-game suspension Aug. 22.
Reddick added a sacrifice fly and Yoenis Cespedes drove in a run with a groundout for the A's. They have the club's longest winning run since 10 in a row from June 8-18, 2006, in the last year they reached the playoffs.
Oakland has 29 games left, including seven against Texas and all but six contests with Seattle coming against opponents with winning records.
MLB STANDINGSWho's clinched? Who's still in the playoff picture? Check all the divisional races.
''We're not looking too far ahead,'' Reddick said. ''I don't think we're going to worry about who we're tied with right now. All that matters is when that last game of the year comes along, where we're at at that point.''
The A's won their eighth in a row against the Red Sox to match their longest winning streak in the rivalry since the Philadelphia A's did so May 2-28, 1932. The 8-1 record against Boston also set an Oakland single-season mark, topping the previous 9-3 by the 1971 and `88 teams and an 18-3 mark by the 1928 squad.
Daisuke Matsuzaka (1-4) had another rough day in the right-hander's second straight short start at the Oakland Coliseum. On July 2, Dice-K allowed five runs in one-plus inning while dealing with a stiff neck. This time, he was tagged for a season-high six runs and seven hits in 3 2/3 innings. He struck out four and walked four in his second-shortest outing after that previous start here.
''We don't have the firepower to keep climbing out of big holes early,'' Red Sox skipper Bobby Valentine said. ''It's a tough way to make a living.''
Drew, acquired from the Arizona Diamondbacks on Aug. 20, also hit an RBI single in the third and an eighth-inning double for his first three-hit game for Oakland. Coco Crisp walked twice, scored two runs and stole his 31st base.
The A's outscored the Red Sox 33-5 in the series and hit nine home runs — five of those in Friday night's 20-2 rout, two Saturday and two more Sunday. That after hitting four in the series finale at Cleveland on Thursday. Oakland has outscored opponents 72-22 during the winning streak.
Anderson allowed one run on five hits in six innings, struck out four and walked one in another impressive day since returning from his injury — even if he raised his ERA from 0.64 to 0.90.
POWER RANKINGSSee if your favorite team is pointed in the right direction this week.
Anderson, who improved to 5-2 in eight career starts against the Red Sox, was given an extra day because the schedule worked out to do so and Melvin wants to be especially cautious with the left-hander after all the time he missed.
He faced two over the minimum through five innings and was done after running into trouble in the sixth, when he got a big save from his defense.
After Dustin Pedroia reached on an infield single in the sixth inning that was stopped from going for extra bases by diving third baseman Josh Donaldson, Cody Ross hit an RBI single. Scott Podsednik tried to score from second but left fielder Cespedes grabbed Ross' one-hopper and fired home to catcher Derek Norris to save a second run.
Mauro Gomez hit a sacrifice fly in the ninth for the Red Sox. Boston dropped its sixth straight and remained winless on this West Coast swing, which finishes with a three-game series at Seattle beginning Monday.
''It's unacceptable,'' Ross said.
Pedroia extended his hitting streak to 13 games with a first-inning single.
''We're not playing good baseball by any means,'' Pedroia said. ''We're really not doing anything well.''
NOTES: Oakland lost at Fenway Park on April 30, then won the next eight meetings with the Red Sox this year. ... Dice-K threw 97 pitches during his short outing. ... Red Sox CF Jacoby Ellsbury got a scheduled day off. ... Oakland RHP reliever Andrew Carignan, who had Tommy John elbow ligament replacement surgery June 19, said he will begin throwing with a sock Oct. 7 as part of his rehab, then likely a regular program in November. He plans to spend the offseason in Arizona instead of his home state of Connecticut. ... Boston recalled INF Ivan DeJesus Jr., another player from the Dodgers trade, from Triple-A Pawtucket. ... The A's raised $53,600 for breast cancer education and research through their annual breast cancer awareness day. ... Lefty Tommy Milone (11-9) pitches Monday for the A's against Angels LHP C.J. Wilson (10-9). ... Drew had a three-hit game vs. Pittsburgh on Aug. 7 while with the D-backs.
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text:
Platinum Collection by SF Designs
Tufted Cocktail Ottoman
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- linen talc
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This item is final sale and non-returnable.
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Description: Tufted Cocktail Ottoman:
- Handmade linen upholstered cocktail ottoman
- Sturdy wooden frame
- Features handcrafted diamond tufting and spindle legs
- Functions as a footrest, seat or tabletop
- Easy assembly required
Measurements: 35½" W x 35" D x 18" H
Care: Spot clean
Due to its handmade nature, variations in size and color can be expected and are an intentional and desirable aspect of this product.
Material: Linen, wood
Care: Spot clean
Brand: Platinum Collection by SF Designs
Origin: United States


text:
A system for transferring data into and out of medical devices wherein a personal data manager (PDM) is used in a web-based network is disclosed. The PDM co-operates with a programmer to enhance remote monitoring of implanted medical devices on a chronic basis to deliver clinical therapy in real time. The PDM is handheldable and mobile and expands the reach of the programmer by storing and forwarding data from the programmer to web-based network constituting a medical environment. The PDM is also implemented to store and forward information to PCs and similar peripheral equipment. In a specialized application, the PDM is configured to exchange data with the unregulated operational/functional segments of the IMD.
1. A method for remotely conducting interactive patient diagnostics for a patient having one or more implantable medical devices (IMDs), monitoring the patient, and delivering therapy to the patient, all of which is carried out over a bi-directional communication system establishing a communications network link and comprising a remote web-based expert data center, a programmer for the IMDs, and a hand-held personal data monitor (PDM) operating as an interface to the programmer, the method comprising the steps of:
connecting the programmer to the remote data center for data communication via the data communications network link;
connecting the PDM to the programmer and transferring data into and out of the programmer with the PDM; and
uplinking data from the IMD to the programmer.
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This application is a divisional of application Ser. No. 09/460,580, filed Dec. 14, 1999 U.S. Pat. No. 6,418,346.
The present invention relates to medical device systems. Specifically, the invention pertains to a remote bi-directional communications with one or more programmers and medical units, or related controls that are associated with implantable medical devices (IMDs). More specifically, the invention relates to a handheld or external, independent device implemented in an integrated system and method of bi-directional telecommunications between a web-based expert data center and a programmer, utilizing various types of network platforms and architecture, to implement in the IMDs, chronic monitoring, therapeutic and diagnostic procedures and data exchange remotely.
A technology-based health care system that fully integrates the technical and social aspects of patient care and therapy should be able to flawlessly connect the client with care providers irrespective of separation distance or location of the participants. While clinicians will continue to treat patients in accordance with accepted modern medical practice, developments in communications technology are making it ever more possible to provide a seamless system of remote patient diagnostics, care and medical services in a time and place independent manner.
Prior art methods of clinical services are generally limited in operations. For example, if a physician needs to review the performance parameters of an implantable device in a patient, it is likely that the patient has to go to the clinic. Further, if the medical conditions of a patient with an implantable device warrant a continuous monitoring or adjustment of the device, the patient would have to stay in a hospital indefinitely. Specifically, patient conditions which require chronic monitoring of the IMD present serious economic problems in the management of therapy and diagnosis on a continuous basis. Under the exemplary scenario, as the segment of the population with implanted medical devices increases, many more hospitals/clinics including service personnel will be needed to provide in-hospital service for the patients, thus escalating the cost of healthcare. Additionally the patients will be unduly restricted and inconvenienced by the need to either stay in the hospital or make very frequent visits to a clinic.
Yet another condition of the prior art practice requires that a patient visit a clinic center for occasional retrieval of data from the implanted device to assess the operations of the device and gather patient history for both clinical and research purposes. Such data is acquired by having the patient in a hospital/clinic to down load the stored data from the implantable medical device. Depending on the frequency of data collection this procedure may pose serious difficulty and inconvenience for patients who live in rural areas or have limited mobility. Similarly, in the event a need arises to upgrade the software of an implantable medical device, the patient will be required to come into the clinic or hospital to have the upgrade installed. Further, in medical practice it is an industry-wide standard to keep an accurate record of past and temporaneous procedures relating to an IMD uplink with, for example, a programmer. It is required that the report contain the identification of all the medical devices involved in any interactive procedure. Specifically, all peripheral and major devices that are used in down linking to the IMD need to be reported. Currently, such procedures are manually reported and require an operator or a medical person to diligently enter data during each procedure. One of the limitations of the problems with the reporting procedures is the fact that it is error prone and requires rechecking of the data to verify accuracy.
A further limitation of the prior art relates to the management of multiple medical devices in a single patient. Advances in modern patient therapy and treatment have made it possible to implant a number of devices in a patient. For example, IMDs such as a defibrillator or a pacer, a neural implant, a drug pump, a separate physiologic monitor and various other IMDs may be implanted in a single patient. To successfully manage the operations and assess the performance of each device in a patient with multi-implants requires a continuous update and monitoring of the devices. Further, it may be preferred to have an operable communication between the various implants to provide a coordinated clinical therapy to the patient. Thus, there is a need to monitor the IMDs including the programmer on a regular, if not a continuous, basis to ensure optimal patient care. In the absence of other alternatives, this imposes a great burden on the patient if a hospital or clinic is the only center where the necessary upgrade, follow up, evaluation and adjustment of the IMDs could be made. Further, even if feasible, the situation would require the establishment of multiple service areas or clinic centers to support the burgeoning number of multi-implant patients world-wide.
Accordingly it is vital to have a programmer and a personal data monitor (PDM) units that would connect to a remote expert data center, a remote web-based data center or a remote data center, all these terms being alternate equivalents as used herein, to provide access to the expert system and import the expertise to a local environment. Further, it is a significant advantage to have a PDM which communicates with the unregulated non-clinical sections of the IMD in addition to being communicable with the programmer and to also serve as a cost-effective mobile, handheld data transfer unit. Furthermore, it is very desirable to have a PDM system which communicates with the diagnostic section of the IMD to routinely perform diagnosis-related data exchange with the IMD. More specifically, it is highly desirable to have a PDM unit that is interactive with various peripheral communications and computer devices to promote remote delivery of patient therapy and clinical care at reasonable cost and speed.
The proliferation of patients with multi-implant medical devices worldwide has made it imperative to provide remote services to the IMDs and timely clinical care to the patient. Frequent use of programmers to communicate with the IMDs and provide various remote services, consistent with co-pending applications titled "System and Method for Transferring Information Relating to an Implantable Medical Device to a Remote Location," filed on Jul. 21, 1999, Ser. No. 09/358,081; "Apparatus and Method for Remote Troubleshooting, Maintenance and Upgrade of Implantable Device Systems," filed on Oct. 26, 1999, Ser. No. 09/426,741, now U.S. Pat. No. 6,442,433; "Tactile Feedback for Indicating Validity of Communication Link with an Implantable Medical Device," filed Oct. 29, 1999, Ser. No. 09/430,708, now U.S. Pat. No. 6,644,321; "Apparatus and Method for Automated Invoicing of Medical Device Systems" filed Oct. 29, 1999, Ser. No. 09/430,208, now U.S. Pat. No. 6,385,593; "Apparatus and Method for Remote Self-Identification of Components in Medical Device Systems," filed Oct. 29, 1999, Ser. No. 09/429,958, abandoned in favor of application filed Dec. 7, 2001, Ser. No. 10/010,406, now U.S. Pat. No. 6,754,538: "Apparatus and Method to Automate Remote Software Updates of Medical Device Systems," filed Oct. 29, 1999, Ser. No. 09/429,960, now U.S. Pat. No. 6,363,282: "Method and Apparatus to Secure Data Transfer From Medical Device Systems," filed Nov. 2, 1999, Ser. No. 09/431,881; "Implantable Medical Device Programming Apparatus Having An Auxiliary Component Storage Compartment, " filed Nov. 4, 1999, Ser. No. 09/433,477, now U.S. Pat. No. 6,411,851; and "Remote Delivery Of Software-Based Training For Implantable Medical Device Systems," filed Nov. 10, 1999, Ser. No. 09/437,615, now U.S. Pat. No. 6,386,882, which are all incorporated by reference herein in their entirety, has become an important aspect of patient care. Thus, In light of the referenced disclosures, use of a PDM system as an interface mobile unit between an IMD and an expert data center is a significant advance over the prior art.
The prior art provides various types of remote sensing and communications with an implanted medical device. One such system is, for example, disclosed in Funke, U.S. Pat. No. 4,987,897 issued Jan. 29, 1991. This patent discloses a system that is at least partially implanted into a living body with a minimum of two implanted devices interconnected by a communication transmission channel. The invention further discloses wireless communications between an external medical device/programmer and the implanted devices.
One of the limitations of the system disclosed in the Funke patent includes the lack of communication between the implanted devices, including the programmer, with a remote clinical station. If, for example, any assessment, monitoring or maintenance is required to be performed on the IMD the patient will have to go to the remote clinic station or the programmer device needs to be brought to the patient's location. More significantly, the operational worthiness and integrity of the programmer cannot be evaluated remotely thus making it unreliable over time as it interacts with the IMD.
Yet another example of sensing and communications system with a plurality of interactive implantable devices is disclosed by Stranberg in U.S. Pat. No. 4,886,064, issued Dec. 12, 1989. In this disclosure, body activity sensors, such as temperature, motion, respiration and/or blood oxygen sensors, are positioned in a patient's body outside a pacer capsule. The sensors wirelessly transmit body activity signals, which are processed by circuitry in the heart pacer. The heart pacing functions are influenced by the processed signals. The signal transmission is a two-way network and allows the sensors to receive control signals for altering the sensor characteristics.
One of the many limitations of Stranberg is the fact that although there is corporeal two-way communications between the implantable medical devices, and the functional response of the heart pacer is processed in the pacer after collecting input from the other sensors, the processor is not remotely programmable. Specifically, the system does not lend itself to web-based communications to enable remote troubleshooting, maintenance and upgrade from outside the patient's body because the processor/programmer is internally located in the patient forming an integral part of the heart pacer.
Yet another prior art reference provides a multi-module medication delivery system as disclosed by Fischell in U.S. Pat. No. 4,494,950 issued Jan. 22, 1985. The disclosure relates to a system consisting a multiplicity of separate modules that collectively perform a useful biomedical purpose. The modules communicate with each other without the use of interconnecting wires. All the modules may be installed intracorporeal or mounted extracorporeal to the patient. In the alternate, some modules may be intracorporeal with others being extracorporeal. Signals are sent from one module to the other by electromagnetic waves. Physiologic sensor measurements sent from a first module cause a second module to perform some function in a closed loop manner. One extracorporeal module can provide electrical power to an intracorporeal module to operate a data transfer unit for transferring data to the external module.
The Fischell disclosure provides modular communication and cooperation between various medication delivery systems. However, the disclosure does not provide an external programmer with remote sensing, remote data management and maintenance of the modules. Further, the system does neither teach nor disclose an external PDM for telemetrically interacting with the IMDs and the programmer.
An additional example of prior art practice includes a packet-based telemedicine system for communicating information between central monitoring stations and a remote patient monitoring station disclosed in Peifer, WO 99/14882 published Mar. 25, 1999. The disclosure relates to a packet-based telemedicine system for communicating video, voice and medical data between a central monitoring station and a patient that is remotely located with respect to the central monitoring station. The patient monitoring station obtains digital video, voice and medical measurement data from a patient and encapsulates the data in packets and sends the packets over a network to the central monitoring station. Since the information is encapsulated in packets, the information can be sent over multiple types or combination of network architectures, including a community access television (CATV) network, the public switched telephone network (PSTN), the integrated services digital network (ISDN), the Internet, a local area network (LAN), a wide area network (WAN), over a wireless communications network, or over asynchronous transfer mode (ATM) network. A separate transmission code is not required for each different type of transmission media.
One of the advantages of the Pfeifer invention is that it enables data of various forms to be formatted in a single packet irrespective of the origin or medium of transmission. However, the data transfer system lacks the capability to remotely debug the performance parameters of the medical interface device or the programmer. Further, Pfeifer does not disclose a method or structure by which the devices at the patient monitoring station may be remotely updated, maintained and tuned to enhance performance or correct errors and defects. Specifically, the Pfeifer invention does not disclose a programmer and a PDM co-operatively engaged to manage the regulated and unregulated functions of IMDs to provide efficient and chronic monitoring for real-time delivery of therapy and diagnosis.
Another example of a telemetry system for implantable medical devices is disclosed in Duffin et al, U.S. Pat. No. 5,752,976, issued May 19, 1998, incorporated by reference herein in its entirety. Generally, the Duffin et al disclosure relates to a system and method for communicating with a medical device implanted in an ambulatory patient and for locating the patient in order to selectively monitor device function from a remote medical support network. The communications link between the medical support network and the patient communications control device may comprise a world wide satellite network, a cellular telephone network or other personal communications system.
Although the Duffin et al disclosure provides significant advances over the prior art, it does not teach a communications scheme in which a programmer and a PDM unit interact with IMDs to remotely debug, maintain, upgrade or modify the functional elements of IMDs. Specifically, the Duffin et al disclosure is limited to notifying remote medical support personnel or an operator about impending problems with an IMD and also enables constant monitoring of the patient's position worldwide using the GPS system. However, Duffin et al does not teach the remote monitoring and chronic management of the IMD to dispense therapy and diagnosis as required.
In a related art, Thompson discloses a patient tracking system in a co-pending application entitled "World-wide Patient Location and Data Telemetry System For Implantable Medical Devices", Ser. No. 09/045,272, filed on Mar. 20, 1998 which is incorporated by reference herein in its entirety. The disclosure provides additional features for patient tracking in a mobile environment worldwide via the GPS system. However, the remote programming concepts advanced by the present invention are not within the purview of the Thompson disclosure because there is no teaching of a web-based environment in which a programmer and a PDM unit operate as interactive units of the web-based data, management, therapy and diagnosis system.
Yet in another related art, Ferek-Petric discloses a system for communication with a medical device in a co-pending application, Ser. No. 09/348,506 which is incorporated by reference herein in its entirety. The disclosure relates to a system that enables remote communications with a medical device, such as a programmer. Particularly, the system enables remote communications to inform device experts about programmer status and problems. The experts will then provide guidance and support remotely to service personnel or operators located at the programmer. The system may include a medical device adapted to be implanted into a patient; a server PC communicating with the medical device; the server PC having means for receiving data transmitted across a dispersed data communication pathway, such as the Internet; and a client PC having means for receiving data transmitted across a dispersed communications pathway from the SPC. In certain configurations the server PC may have means for transmitting data across a dispersed data communication pathway (Internet) along a first channel and a second channel; and the client PC may have means for receiving data across a dispersed communication pathway from the server PC along a first channel and a second channel.
One of the significant teachings of Ferek Petric's disclosure, in the context of the present invention, includes the implementation of communication systems, associated with IMDs that are compatible with the Internet. Specifically the disclosure advances the art of remote communications between a medical device, such as a programmer and a PDM unit and experts located at a remote location preferably using the Internet or equivalent network. Primarily, among the many objectives of the invention the communications scheme is structured to alert remote experts to existing or impending problems with the IMDs and/or the programming device so that prudent action, such as early maintenance or other remedial steps, may be timely exercised. Further, because of the early warning or advance knowledge of the problem, the remote expert would be well informed to provide remote advice or guidance to service personnel or operators at the programmer.
While Ferek's invention advances the art in communications systems relating to interacting with a programmer via a communication medium such as the Internet, the system does neither propose nor suggest a programmer and a PDM unit performing specialized tasks remotely to enhance patient therapy and clinical care.
Another disclosure relating to ambulatory patient health monitoring techniques utilizing interactive visual communications is disclosed by Daniel et al in U.S. Pat. No. 5,441,047, issued Aug. 15, 1995. The invention relates to a system in which the patient is monitored by a health care worker at a certain station, while the patient is at a remote location. The patient's condition is monitored in the home using various monitoring devices. The health care worker is placed into interactive visual communication with the patient.
Yet another prior art provides a monitoring method and a monitoring equipment in U.S. Pat. No. 5,840,020 by Pekka et al issued on Nov. 24, 1998. The patent relates to a monitoring equipment including means for receiving a measurement result indicating the patients blood glucose level, and for storing it in memory. In order to improve and facilitate the treatment of the patient, the monitoring equipment further includes means for receiving data concerning the patient's diet, medication and physical strain and for storing it in the memory. A series of calculations are refined to provide predictive values.
Further, another prior art provides a method for monitoring the health of a patient as disclosed in U.S. Pat. No. 5,772,586 issued to Pekka et al on Jun. 30, 1998. The disclosure relates to a method for monitoring the health of a patient by utilizing measurements. In order to improve the contact between the patient and the person treating him, the results of the measurements are supplied via a communications device utilizing a wireless data transmission link to a data processing system available to the person monitoring the patient's health. The patient's health is monitored by means of the data stored in the data processing system.
Yet a further example of a prior art is provided in U.S. Pat. No. 5,701,904 by Simmons et al issued on Dec. 30, 1997 relating to telemedicine instrumentation pack. The invention includes a portable medical diagnostic apparatus for data gathering . A video camera generates signals based on images taken from the visual instruments. Other electronics circuitry generates signals based on output of the audio instrument and data-gathering instruments. The signals are transmitted to a remote site for analysis by medical personnel.
Yet another example of a prior art is provided in U.S. Pat. No. 5,311,449 by Adams relating to sterilization hand-held programmer or interrogator. The patent discloses a unit that communicates with an IMD to function fully as a data programmer and as an interrogator. Interrogated data can be linked directly to the surgeon via a modem. One of the limitations of the Adam patent is the fact that the hand-held unit is a programmer with limited functions. In sharp contrast the present invention relates, inter alia, to a specialized co-operative structure and scheme between a programmer and a PDM unit to share and perform specialized functions to provide a highly mobile and adaptable system for management of IMDs. Significantly, the present invention provides a web-based bi-directional communications system as a data manager to enable delivery of a comprehensive therapy and diagnosis in real time.
Accordingly, it would be advantageous to provide a system in which a programmer and a PDM could uplink to a remote expert data center to import enabling software for monitoring, therapy and diagnosis. Yet another desirable advantage would be to provide a system to implement the use of remote expert systems to manage the operations of IMDs on a real-time basis. A further desirable advantage would be to provide a communications scheme that is compatible with various communications media, to promote a fast uplink of a programmer and a PDM to remote expert systems and specialized data resources. Yet another desirable advantage would be to provide a high speed communications scheme to enable the transmission of high fidelity sound, video and data to advance and implement efficient remote data management of a clinical/therapy system via a programmer and a PDM thereby enhancing patient clinical care. Yet a further desirable advantage would be to simplify the components and cost of a programmer by integrating it with a PDM to thereby enable web-based data management where the PDM is implemented as a data messenger. As discussed herein below, the present invention provides these and other desirable advantages.
The present invention generally relates to a communications scheme in which a remote web-based expert data center interacts with a patient having one or more implantable medical devices (IMDs) via associated external medical devices, preferably a programmer and a PDM, located in close proximity to the IMDs. Some of the most significant advantages of the invention include the use of various communications media between the remote web-based expert data center and the programmer to remotely exchange clinically significant information and ultimately effect real-time parametric and operational changes as needed.
In the context of the present invention, one of the many aspects of the invention includes a real-time access of a programmer to a remote web-based expert data center, via a communication network, which includes the Internet. The operative structure of the invention includes the remote web-based expert data center, in which an expert system is maintained, having a bi-directional real-time data, sound and video communications with the programmer via a broad range of communication link systems. The programmer is in turn in telemetric communications with the IMDs such that the IMDs may uplink to the programmer or the programmer may down link to the IMDs, as needed. Further, a PDM is used to uplink data from the programmer to the web-based expert data center. Specifically, the PDM could be used as a highly flexible platform that is readily configurable to transfer data from both the programmer and the IMDs. More specifically, the PDM is implemented to effect a highly adaptable feature to the programmer, IMD and web-based expert system.
Yet another context of the invention includes a communications scheme that provides a highly integrated and efficient method and structure of clinical information management in which various networks such as Community access Television, Local area Network (LAN), a wide area network (WAN), Integrated Services Digital Network (ISDN), the Public Switched telephone Network (PSTN), the Internet, a wireless network, an asynchronous transfer mode (ATM) network, a laser wave network, satellite, mobile and other similar networks are implemented to transfer voice, data and video between the remote data center and a programmer. In the preferred embodiment, wireless communications systems, a modem and laser wave systems are illustrated as examples only and should be viewed without limiting the invention to these types of communications alone. Further, in the interest of simplicity, the applicants refer to the various communications system, in relevant parts, as a communication(s) system. However, it should be noted that the communication(s) system, in the context of this invention, are interchangeable and may relate to various schemes of cable, fiber optics, microwave, radio, laser and similar communications or any practical combinations thereof.
Some of the distinguishing features of the present invention include the use of a robust web-based expert data center to manage and tune the operational and functional parameters of an IMD or IMDs via a programmer and a PDM in real-time. The present invention focuses on the remote real-time monitoring and management of the programmer generally and the IMDs particularly. Specifically, a programmer and a PDM co-operate to provide a flexible and scalable data exchange system via the Internet or equivalent communications media. One of the many advantages of the present invention is the ability to chronically monitor IMDs on a proactive basis to promote the patient's well being.
Yet one of the other distinguishing features of the invention includes the use of a highly flexible and adaptable communications scheme to promote continuous and real-time communications between a remote expert data center, a programmer and a PDM associated with a plurality of IMDs. The IMDs are structured to share information intracorporeally and may interact with the programmer, as a unit. Specifically, the IMDs either jointly or severally can be interrogated to implement or extract clinical information as required. In other words, all of the IMDs may be accessed via one IMD or, in the alternate, each one of the IMDs may be accessed individually. The information collected in this manner may be transferred to the programmer by up linking the IMDs or via the PDM as needed.
The invention provides significant compatibility and scalability to other web-based applications such as telemedicine and emerging web-based technologies such as tele-immersion. For example, the system may be adapted to applications in which a PDM unit may be used to uplink the patient to a remote data center for non-critical information exchange between the IMDs and the remote expert data center. In these and other web-based similar applications the data collected, in the manner and substance of the present invention, may be used as a preliminary screening to identify the problem and evaluate the need for an interactive data exchange to determine further intervention.
More significantly the present enables high mobility and transferability of data between the IMDs and the programmer and, as well, between an expert data center using a PDM unit that is scalable and adaptable. Further, the PDM unit provides a cost advantage by providing a mobile, hand-heldable platform having high flexibility and scalability for software and hardware changes and upgrade. Particularly, the PDM is a cost-effective extension of the programmer and operates as a data messenger between the programmer, the data center and the IMDs.
The present invention will be appreciated as the same becomes better understood by reference to the following detailed description of the preferred embodiment of the invention when considered in connection with the accompanying drawings, in which like numbered reference numbers designate like parts throughout the figures thereof, and wherein:
Programming commands or data are transmitted from programmer 20 to IMDs 10, 10′ and 10″ via external RF telemetry antenna 24. Telemetry antenna 24 may be an RF head or equivalent. Antenna 24 may be located on programmer 20 externally on the case or housing. Telemetry antenna 24 is generally telescoping and may be adjustable on the case of programmer 20. Both programmer 20 and PDM unit 20′ may be placed a few feet away from patient 12 and would still be within range to wirelessly communicate with telemetry antennas 28, 32 and 38.
The uplink to remote web-based expert data center 62, hereinafter referred to as, interchangeably, "data center 62", "expert data center 62" or "web-based data center 62" without limitations, is accomplished through programmer 20 or PDM unit 20′. Accordingly programmer 20 and PDM unit 20′ function as an interface between IMDs 10, 10′ and 10″ and data center 62. One of the many distinguishing elements of the present invention includes the use of various scalable, reliable and high-speed wireless communication systems to bi-directionally transmit high fidelity digital/analog data between programmer 20 and data center 62.
There are a variety of wireless mediums through which data communications could be established between programmer 20 or PDM unit 20′ and data center 62. The communications link between Programmer 20 or PDM unit 20′ and data center 62 could be modem 60, which is connected to programmer 20 on one side at line 63 and data center 62 at line 64 on the other side. In this case, data is transferred from data center 62 to programmer 20 via modem 60. Alternate data transmission systems include, without limitations, stationary microwave and/or RF antennas 48 being wirelessly connected to programmer 20 via tunable frequency wave delineated by line 50. Antenna 48 is in communications with data center 62 via wireless link 65. Similarly, PDM unit 20′, mobile vehicle 52 and satellite 56 are in communications with data center 62 via wireless link 65. Further, mobile system 52 and satellite 56 are in wireless communications with programmer 20 or PDM unit 20′ via tunable frequency waves 54 and 58, respectively.
In the preferred embodiment a Telnet system is used to wirelessly access data center 62. Telnet emulates a client/server model and requires that the client run a dedicated software to access data center 62. The Telnet scheme envisioned for use with the present invention includes various operating systems including UNIX, Macintosh, and all versions of Windows.
Functionally, an operator at programmer 20 or an operator at data center 62 would initiate remote contact. Programmer 20 is down linkable to IMDs via link antennas 28, 32 and 38 to enable data reception and transmission. For example, an operator or a clinician at data center 62 may downlink to programmer 20 to perform a routine or a scheduled evaluation of programmer 20. In this case the wireless communication is made via wireless link 65. If a downlink is required from programmer 20 to IMD 10 for example, the downlink is effected using telemetry antenna 22. In the alternate, if an uplink is initiated from patient 12 to programmer 20 the uplink is executed via wireless link 26. As discussed herein below, each antenna from the IMDs can be used to uplink all or one of the IMDs to programmer 20. For example, IMD 10″ which relates to neural implant 30 can be implemented to up-link, via wireless antenna 34 or wireless antenna 34′, any one, two or more IMDs to programmer 20. Preferably bluetooth chips, adopted to function within the body to outside the body and also adopted to provide low current drain or an equivalent chip, are embedded in order to provide wireless and seamless connections 42, 44 and 46 between IMDs 10, 10′ and 10″. The communication scheme is designed to be broadband compatible and capable of simultaneously supporting multiple information sets and architecture, transmitting at relatively high speed, to provide data, sound and video services on demand.
Programming commands or data are transmitted between IMD 10, RF telemetry antenna 28, for example, and an external RF telemetry antenna 24 associated with programmer 20. In this case, it is not necessary that the external RF telemetry antenna 24 be contained in a programmer RF head so that it can be located close to the patient's skin overlying IMD10. Instead, the external RF telemetry antenna 24 can be located on the case of programmer 20. It should be noted that programmer 20 can be located some distance away from patient 12 and is locally placed proximate to the IMDs such that the communication between IMDs 10, 10′ and 10″ and programmer 20 is telemetric. For example, programmer 20 and external RF telemetry antenna 24 may be on a stand a few meters or so away from patient 12. Moreover, patient 12 may be active and could be exercising on a treadmill or the like during an uplink telemetry interrogation of real-time ECG or other physiologic parameters. Programmer 20 may also be designed to universally program existing IMDs that employ RF telemetry antennas of the prior art and therefore also have a conventional programmer RF head and associated software for selective use therewith.
In an uplink communication between IMD 10 and programmer 20, for example, telemetry transmission 22 is activated to operate as a transmitter and external RF telemetry antenna 24 operates as a telemetry receiver. In this manner data and information may be transmitted from IMD 10 to programmer 20. In the alternate, IMD 10 RF telemetry antenna 26 operates as a telemetry receiver antenna to downlink data and information from programmer 20. Both RF telemetry antennas 22 and 26 are coupled to a transceiver comprising a transmitter and a receiver.
Similarly, PDM 20′ communicates with programmer 20 via telemetry antennas 23 and 23′. Further, in a specialized application, PDM 20′ may communicate with IMDs 10, 10′ and 10″ via telemetry antennas 26 and 26′. (See
Further referring to
In order for the physician, other caregiver or operator to communicate with the programmer 20, a keyboard or input 82 coupled to CPU 80 is optionally provided. However the primary communications mode may be through graphics display screen of the well-known "touch sensitive" type controlled by a graphics circuit. A user of programmer 20 may interact therewith through the use of a stylus, also coupled to a graphics circuit, which is used to point to various locations on screen or display 84 which display menu choices for selection by the user or an alphanumeric keyboard for entering text or numbers and other symbols. Various touch-screen assemblies are known and commercially available. Display 84 and or the keyboard comprise means for entering command signals from the operator to initiate transmissions of downlink or uplink telemetry and to initiate and control telemetry sessions once a telemetry link with data center 62 or an implanted device has been established. Display screen 84 is also used to display patient related data and menu choices and data entry fields used in entering the data in accordance with the present invention as described below. Display screen 84 also displays a variety of screens of telemetered out data or real-time data. Display screen 84 may also display uplinked event signals as they are received and thereby serve as a means for enabling the operator to timely review link-history and status.
Programmer 20 further comprises an interface module, which includes digital circuit, non-isolated analog circuit, and isolated analog circuit. The digital circuit enables the interface module to communicate with the interface controller module. As indicated hereinabove, the operation of programmer 20, in accordance with the present invention, is controlled by microprocessor 80. Programmer 20 is preferably of the type that is disclosed in U.S. Pat. No. 5,345,362 to Winkler, which is incorporated by reference herein in its entirety.
Screen 84 may also display up-linked event signals when received and thereby serves as a means for enabling the operator of programmer 20 to correlate the receipt of uplink telemetry from an implanted device. Programmer 20 is also provided with a strip chart printer or the like coupled to interface controller module so that a hard copy of a patient's ECG, EGM, marker channel of graphics displayed on the display screen can be generated.
As will be appreciated by those of ordinary skill in the art, it is often desirable to provide a means for programmer 20 to adapt its mode of operation depending upon the type or generation of implanted medical device to be programmed and to be compliant with the wireless communications system through which data and information are transmitted between programmer 20 and data center 62.
PDM 20′ is implemented as a handheld device to primarily transfer data into and out of programmer 20. In yet another embodiment, PDM 20′ is used to transfer data to and from both programmer 20 and/or IMD 10. The latter implementation requires that PDM 20′ be able to access only the unregulated non-medical environments of IMD 10.
More specifically, PDM 20′ is preferably powered via battery 114 and shall interface with programmer 20 via infrared communication port 102 and wireless network interface 104. Data transferred from programmer 20 is stored in memory 108. Barcode scanner 100 is used to read the identification of IMD 10 before implant and is intended to aid in tracking IMD and component inventories. In the preferred embodiment, before implantation, IMD 10 barcode is scanned into PDM 20′ and is stored. Thereafter, the identifying barcode is transferred to programmer 20 from PDM 20′. Serial communication port 106 is implemented to exchange data between memory 108 and other computers, servers, etc., adapted with the required hardware and software. Further, wireless network interface 104 is preferably implemented to access networks and the Internet.
Programmer 20 is in a bi-directional data communication with IMD 10 via link 116. Similarly, links 118, 136, 136′ and 136″ represent bi-directional data communications between programmer 20 and PDM 20′, data center 136 and PDM 20′, data center 62 and LAN/WAN 126, and data center 62 and peripheral device 128, respectively.
In yet another preferred embodiment, PDM 20′ may be adopted to directly interact with IMD 10 to transfer data to and from IMD 10 within the unregulated portion of the data and operations regime. In this manner unregulated aspects of IMD 10 could be programmed, modified or changed via PDM 10. Further, the unregulated data and operation of IMD 10 could be directly transferred to, for example, data center 62 by using PDM 20′ as a data messenger thus by-passing programmer 20.
Referring to
As applied herein, the medical environment includes IMD 10, programmer 20 and the remote data center 62 in which PDM 20′ is implemented. Specifically, the medical environment implies a network of medical devices integrated to provide clinical therapy and diagnosis in real time through the exchange of pertinent data. PDM 20′, of the present invention, facilitates the transfer and exchange of the data.
Referring to programmer 20 in more detail, when a physician or an operator needs to interact with programmer 20, a keyboard coupled to Processor 80 is optionally employed. However the primary communication mode may be through graphics display screen of the well-known "touch sensitive" type controlled by graphics circuit. A user of programmer 20 may interact therewith through the use of a stylus also coupled to a graphics circuit, which is used to point to various locations on screen/display to display menu choices for selection by the user or an alphanumeric keyboard for entering text or numbers and other symbols as shown in U.S. Pat. No. 5,345,362 incorporated herein in its entirety by reference. Various touch-screen assemblies are known and commercially available. The display and or the keyboard of programmer 20, preferably include means for entering command signals from the operator to initiate transmissions of downlink-telemetry from IMDs and to initiate and control telemetry sessions once a telemetry link with one or more IMDs has been established. The graphics display /screen is also used to display patient related data and menu choices and data entry fields used in entering the data in accordance with the present invention as described below. The graphics display/screen also displays a variety of screens of telemetered out data or real-time data. Programmer 20 is also provided with a strip chart printer 118 or the like coupled to interface controller module so that a hard copy of a patient's ECG, EGM, marker channel or similar graphics display can be generated. Further, Programmer 20's history relating to instrumentation and software status may be printed from printer. Similarly, once an uplink is established between programmer 20 and any one of IMDs 10, 10′ and 10″, various patient history and IMD performance data may be printed out. The IMDs contemplated by the present invention include a cardiac pacemaker, a defibrillator, a pacer-defibrillator, implantable monitor (Reveal), cardiac assist device, and similar implantable devices for cardiac rhythm and therapy. Further the IMD units contemplated by the present invention include electrical stimulators such as, but not limited to, a drug delivery system, a neural stimulator, a neural implant, a nerve or muscle stimulator or any other implant designed to provide physiologic assistance or clinical therapy.
Expert data center 62 represents a high speed computer network system which is located remotely, with respect to the IMDs, having wireless bi-directional data, voice and video communications with programmer 20 via wireless communications link 116 (See FIG. 5). Generally data center 62 is preferably located in a central location and is equipped with high-speed web-based computer networks. Preferably, the data resource center is manned 24-hours by operators and clinical personnel who are trained to provide a web-based remote service to programmer 20. Additionally, as discussed hereinabove, data resources 62 provide remote monitoring, maintenance and upgrade of programmer 20. The location of data center 62 is dependent upon the sphere of service. In accordance with the present invention, data resource 62 may be located in a corporate headquarters or manufacturing plant of the company that manufactures programmer 20. Wireless data communications link/connection 116 can be one of a variety of links or interfaces, such as a local area network (LAN), an internet connection, a telephone line connection, a satellite connection, a global positioning system (GPS) connection, a cellular connection, a laser wave generator system, any combination thereof, or equivalent data communications links.
As stated hereinabove, bi-directional wireless communications 116 acts as a direct conduit for exchange of information between data center 62 and programmer 20. Further, bi-directional wireless communications 118 provides an indirect link between data center 62 and IMDS 10, 10′ and 10″ via PDM 20′. Similarly, bi-directional communication links 136′ and 136″ represent a data, voice, and/or video communications between data center 62 and LAN/WAN 126 and peripheral device 128, respectively.
As discussed above, programmer 20 is a medical device which is coupled to IMD 10 via lead 18. IMDs 10, 10′ 10″ represent various implantable medical devices, such as cardiac pacemakers, defibrillators, pacemaker/defibrillators, and combinations thereof. Further, IMDs 10, 10′ and 10″ may represent drug delivery systems, electrical stimulators including nerve and muscle stimulators, deep brain stimulators, or heart assist devices or pumps.
Programmer 20 enables the operator to assess the performance of IMD 10 and its associated circuitry via information link 116. Specifically, procedures involving implantation of IMD 10, programming of IMD 10, and transmission of operational information feedback from IMD 10 are controlled and monitored by programmer 20. These procedural functions are checked by an operator who manages the various functions of programmer 20. Programmer 20 includes software applications for monitoring the IMDs.
In the context of the present invention, PDM 20′ is a strategic tool which is mobile and could be used as a highly adaptable platform for implementing a variety of software to manage the unregulated aspects of the IMDs. Specifically, PDM 20′ is implemented as a support platform for programmer 20 by being a specialized highly functional store-foreward data manager. PDM 20′ is handheldable and offers high mobility. Further, PDM 20′ is readily adaptable to both hardware and software changes. This feature makes the PDM 20′ an effective complementary tool for data upgrade, and means of transfer/exchange of data complementing programmer 20 and IMD 10, in a cost effective manner.
Accordingly, the present invention provides inter alia, a remote handheldable manager and data exchange unit to work with programmers worldwide. Generally, in the context of the invention, all programmers located proximate to IMDs or patients with IMDs and distributed globally are connected to an expert data center to share software upgrades and access archived data. The programmer and the PDM of the present invention function as an interface between the remotely located expert data center and the IMDs. Further, procedural functions such as monitoring the performance of the IMDs, upgrading software in the IMDs, upkeep and maintenance of the IMDS and related functions are implemented via the programmer and the PDM. The preferably telemetric and yet local interaction between the programmer, the PDM and the IMDs enable delivery of therapy and clinical care in real time. In order to facilitate the just-in-time patient care at the location of the patient, the invention provides a highly efficient data exchange/data transfer system. This scheme enables the dissemination of software and clinical data worldwide while maintaining a high standard of patient care at reduced costs.
Although specific embodiments of the invention have been set forth herein in some detail, it is understood that this has been done for the purposes of illustration only and is not to be taken as a limitation on the scope of the invention as defined in the appended claims. It is to be understood that various alterations, substitutions, and modifications may be made to the embodiment described herein without departing from the spirit and scope of the appended claims.
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