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Kings Go Forth, The Outsiders Are Back (Luaka Bop)
'Kings Go Forth are a Milwaukee retro-soul band with similarities to The Dap-Kings', but boasting a much more explosive, brash production style, with plenty of punchy Santana-like percussion, horn stabs and crisp drumming à la The Meters' Joseph 'Zigaboo' Modeliste.
Songs such as 'One Day' and 'Fight With Love' employ the classic gospel double-vocal combination of a shouter matched with a falsetto crooner, producing a blend with the emotional extremity and slickness of the Isleys on 'Paradise Lost', while the smooth falsetto sounds perfectly at home on the scudding groove of '1000 Songs'. Even legendary remix pioneer Tom Moulton rates them, hanging 'Don't Take My Shadow' on an itchy guitar figure, in a mix which recalls his Salsoul supremacy.'


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Best on the web?
- Details
- Published on Wednesday, 30 November -0001 00:19
- Written by NoName
TIANJIN, China 27 May 2015 - On this day, the entire mahjong community suffered the loss of one of it's beloved and cherished seminal figures when the Professor Sheng Qi passed away. He was a great scholar and writer who was instrumental in establishing the official rules for the Chinese Mahjong Competition Rules in 1998, and continued his contributions supervising the Pai Wan Sai competition every year since 2000. He was loved by many, and will be missed.
We have 1719 guests and no members online
Global Mahjong Tournaments are four-hour-long events, held every Saturday
April was another milestone month in software improvement at Mahjong Time, with multiple new updates and enhancements now part of the ever-expanding game platform.
Guild competitions were very heated in April - the best Mahjong players from around the world led their guilds to the top of the leaderboards, shown below!
This month Mahjong Time released its brand new Auto Pass system
Global Mahjong Tournaments are four-hour-long events, held every Saturday
4th Portugal Open Mahjong Championship, Póvoa de Varzim, Portugal
Sat May 30 @10:00AM - Sun May 31 @ 6:00PM - MCR
Four Seasons Mah Jongg Tournament, Piscataway, New Jersey
Fri Jun 05 @10:00AM - Sun Jun 07 @ 6:00PM - National Mah-Jongg League
16° Mahjongata del Contado, Tuscan-Romagnolo, Italy
Sun Jun 07 @10:00AM - Sun Jun 07 @ 9:00PM - MCR
ONLYLYON Part 2, Lyon (France)
Sat Jun 13 @12:00AM - Sun Jun 14 @11:59PM - MCR
1st North American Riichi Open, Montréal (CAN)
Sat Jun 13 @10:00AM - Sun Jun 14 @ 6:00PM - Riichi
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subset: commoncrawl


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Christmas in the Kitchen 2014
It was a record setting year for Christmas in the Kitchen, $8,216 donated to Annie Malone's Childrens Home + gifts for the children
Thank you to all who shared in this event….and, if you've never been able to join us here is a taste:
Happy Holidays
From all of us
With Warmest Wishes for your Holidays!
Your continued patronage was/is the greatest gift you could give to us this Holiday season (and throughout the year).
We realize we cannot be all things to all people (there are too many flavors of tea!) and when you return again and again, and tell your friends about us, it means the world to us.
Thank you.
May you receive all you need and hope for in your lives over the next weeks
and in the New Year.
With the Spirit of Tea,
Kateri, Galen, Hannah, Joseph, Mallory, and Wintaye
10 More shopping days…
and we still have lots of tea and accessories, and more for you.
and extra shopping hours on Monday and Thursday evenings, plus 9am-5pm on Sunday 12/21
Happy Thanksgiving
Enjoy!! We are Thankful for all of YOU!
As we enter our 6th Holiday shopping season and our 2nd with a retail location, I am most Thankful for all of you who make the choice to purchase your tea from me, at Markets and events, our shop and on-line.
It has not been an easy time to start and maintain a business. When I started in 2009 the "mall stores" were pretty much the only option for looseleaf tea drinkers, and if you wanted "organic" – forget it. Now, there are lots of on-line options and more and more stores are carrying a wider variety of teas.
We strive to continue bringing you high quality at affordable prices.
Your continued support has allowed me to create a nearly full-time position for Galen, and supplement incomes for several other employees.
When you enjoy our tea, please feel our gratitude with every sip!
Kateri Meyer
Galen, Hannah, Joseph, Mallory, and Wintaye
Check the calendar for scheduled events and extra shopping hours for the next few weeks.
Remember, you can order on-line from us too.
We are looking forward to serving tea at the 1st Annual World's Fare Heritage Festival and Games Sept 12-14, 2014
In commemoration to the 1904 World's Fair and Expo, and iced tea becoming popularized that summer, in addition to our own Iced Tea Blend, we will be serving a "flight" of teas from around the world.
The event organizers are also looking for more volunteers to assist in the event. Click the link if you want to aid in the success of this inaugural event celebrating St. Louis history & the arts.
Updated Shop Hours
Our current shop hours are Tues 10am-6pm, Wed Noon-6pm, Fri 10am-5pm, and Sat 9am-5pm
Special events, special hours can be found our Calendar/Events Page, and info on the various Markets we attend is HERE.
Occasionally we may be open a little later, or on an "Off" day if working on a project – You are Always welcome, whenever we are there.
It is the height of Market Season. We enjoy Sharing Good Tea with all of you!
If I offer you $3 for a $2 bill will you take it?
That is the idea behind our "Purchasing Power Program" cards. Your advance purchase gives BOTH of us purchasing power. You get more for your money each time you visit, and in turn, we get much needed capital to stock the shop.
Purchase this card for $20
YOU Get $30-$40 of purchasing power for only $20
Card has a total of 10 stars or symbols (cost to you = $2 per star/symbol)
Each time you shop with us one star or symbol will get "punched" and you will receive at least $3 off your purchase that day
$3 value for each STAR
Special symbols (bus, bicycle, cat, snowflake) are each worth $5 if you qualify as follows:
Bus – Did you ride the bus today? show us your bus pass or bus ticket for that day
Bicycle – Is your bike outside?
Cat – Are you wearing a Tenth Life button, tee shirt, or hoodie?
Snowflake – Is it raining or snowing when you come in to shop?
Present the card to us wherever we are selling (Markets OR events)
Or you can leave the card on file in our shop, and the value will only be redeemed there.
Chai Ice cream
(by Galen McGreehan)
Shop Finally OPEN!
FINALLY. I guess it always takes about 2 months longer and at least 25% more $ than you expect it to.
to these!
AND – We've got a great staff to assist you wherever we are!
Now we can get back to stocking teas and accessories, and coming up with more ways to help you Share Good Times with Good Tea.
Shop Status – Take 3
Sinks are delivered, plumber scheduled for next week. Extra electric has been installed to handle busy brewing needs. We still need a wall separating food prep from walkway to bathroom, and I have to finish painting the floor.
Have hired some extra staff, and wonder of wonders, they can all get together at the same time for a tea sampling and orientation!
Our target OPEN date right now is Tuesday 5/14…..Taste of Maplewood is Sat 5/18, and we really want to be open for you then – as a respite from crowds and heat or chill with a refreshing cup of tea.
Maplewood Chamber of Commerce has scheduled our ribbon cutting for Tues 5/21 at 5:15 pm – Please join us for that!
Meanwhile – the "tea shop that travels" will be at opening day of Tower Grove Farmers Market on Sat 5/4 from 8:00 am-2:00 pm with some new brewing options, and perhaps a new flavor of tea to refresh you!
Looking forward to Sharing Good Tea with our friends – both old and new!


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Each year we re-invest a significant amount of our income in presenting our work through live performances and through our innovative learning and community programme, Outward Sound.
We can only continue our work by securing financial support from our Friends, Patrons and sponsors. By making a donation or supporting the Academy you will make a real difference, helping us continue to perform and to create great musical experiences for a new generation of audiences.
In return we can guarantee a real and lasting relationship with one of the world's greatest chamber orchestras.
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Home -> Law Blog Directory -> Class Action Blogs -> Class Action Defense Blog
(866) 635-2689 for Personal Injury or (866) 635-9402 for Criminal Defense
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Class Action: Class Action Defense Blog
Class Action Defense Cases–Negrete v. Allianz Life: Ninth Circuit Reverses District Court Order Enjoining Class Action Defendant From Settling Class Actions Pending In Other State And Federal Courts
By Michael J. Hassen
All Writs Act did not Permit District Court to Issue Injunction Prohibiting Class Action Defendant from Negotiating Settlements of Class Actions Pending in Other Federal Courts, and Anti-Injunction Act Barred District Court from Issuing Injunction Prohibiting Class Action Defendant from Negotiating Settlements of Class Actions Pending in State Court Ninth Circuit Holds
Plaintiff filed a class action complaint against Allianz Life Insurance Company of North America alleging inter alia violations of RICO (Racketeer Influenced and Corrupt Organizations Act) and breach of fiduciary duty arising out of defendant's sale of fixed deferred annuities which, the class action alleged, was "'an unsuitable financial product' because the maturity date exceeded his life expectancy and restricted his access to principal without surrender charges." Negrete v. Allianz Life Ins. Co. of North Am., ___ F.3d ___, 2008 WL 1868993, *1 (9th Cir. April 29, 2008). The district court certified the litigation as a nationwide class action with respect to the RICO claims, and as a state-wide class action with respect to certain other claims, id. This class action was but one of several class actions filed against Allianz regarding the sales of annuities, including: Iorio v. Asset Marketing Inc., No. 05-CV-00633 (S.D.Cal.), filed in March 2005, in the United States District Court for the Southern District of California, and certified as a state-wide class action (covering a class that "partially overlaps the Negrete class") in July 2006; Mooney v. Allianz Life Ins. Co. of North Am., No. 06-CV-00545, filed February 9, 2006, in the United States District Court for the District of Minnesota, and certified as a nationwide class action (covering a class that, according to defense attorneys, includes annuity transactions that "overlap those in Negrete"); and Castello v. Allianz Life Ins. Co. of North Am., Civ. No. MC03-20405, filed December 22, 2003, in a Minnesota state court and certified as a nationwide class action. Id. (The nationwide class action certification order in Negrete expressly excludes members of the nationwide class action certified in Castello, id., at *1 n.3.) In addition to these class actions, the Minnesota Attorney General filed State of Minnesota v. Allianz Life Ins. Co. of North Am., Civ. No. 07-581, on January 7, 2007, in a Minnesota state court ("the AG Action"), seeking "relief under Minnesota law on behalf of Minnesota residents who purchased Allianz's fixed deferred annuity products" (covering a class that, according to defense attorneys, also may partially overlap the class certified in Negrete). Id., at *2. The district court entered an order "that effectively prevents [Allianz] from proceeding with any settlement negotiations on similar class action claims raised in any federal or state court without first obtaining permission from Negrete's Co-Lead Counsel, and from finalizing a settlement in any other court 'that resolves, in whole or in part, the claims brought in [the Negrete] action,' without first obtaining the district court's approval." Id., at *1. The Ninth Circuit reversed.
The district court order arose as follows. Allianz entered into settlement discussions with the parties in Mooney, Castello, and the AG Action. Negrete, at *2. Plaintiffs' lawyers in Negrete learned of these negotiations from a third party and requested that defense attorneys assure them that the settlement negotiations would not cover any of the claims addressed in or class members covered by the Negrete action; defense attorneys refused to provide such assurances so Negrete filed an ex parte application seeking an order that would prohibit Allianz from "settling, attempting to settle, negotiating, compromising, or releasing any claims, causes of action, or damages relating to any Allianz deferred annuity purchased by any Class Member in the Negrete/Healey matter during the relevant Class Period, in any other forum, including but not limited to, the Mooney matter, without the express approval of this Court and participation of Court appointed Co-Lead Counsel in the Negrete/Healey matter." Id. While the district court order, issued without a hearing, "nominally" denied the application as "not authorized by the All Writs Act," the court nonetheless ordered, "Any discussions of a settlement that would affect any claims brought in this litigation, other than claims of an individual plaintiff or class member, must be conducted or authorized by plaintiffs' Co-Lead Counsel. Any proposed settlement that resolves, in whole or in part, the claims brought in this action shall first be subject to review and approval by the Court in this litigation." Id. Defense attorneys appealed that order, id., at *3.
Full post as published by Class Action Defense Blog on May 06, 2008 (boomark / email).
New Ninth Circuit class action decision: Negrete v. Allianz Life Insurance Co.
In Negrete v. Allianz Life Insurance Co., ___ F.3d ___ (9th Cir. Apr. 29, 2008), the Ninth Circuit invalidated a district court order that would have prohibited the defendant from settling similar class actions pending in other jurisdictions without the...
So Little Time, So Much To Blog! (Negrete v. Allianz)
Ordinarily, a federal trial court cannot order that some other lawsuit in state court be stopped.When federal courts preliminarily approve class action settlements, however, they often enjoin prosecution of competing cases that could interfere with the settlement...
Ninth Circuit Opinion on Anti-Injunction Act
The Ninth Circuit issued an opinion last week on the All Writs Act exception to the Anti-Injunction Act. In Negrete v. Allianz Life Insurance Co. of North America, 2008 WL 1868993, the district court certified a nationwide RICO class a...
Labor Code Class Actions Consistently Outnumber All Other Categories Combined
The Class Action Defense Blog published by Michael J. Hassen has made a regular weekly feature of tracking the new filings of class actions in state and federal courts in California...
USERRA - Not Always in Federal Court.
USERRA cases are relatively rare still (probably not for long) so unusual to see two cases from different circuits on consecutive days. Both are on procedural grounds and in both cases, notwithstanding that USERRA would seem to be the quintessential federal question case, plaintiffs lost out on a federal court hearingThe 6th Circuit today joined the 5th Circuit (see post here) in holding that USERRA claims are subject to arbitration agreements...
How is the Class Action Fairness Act working
The Washington Legal Foundation announces a new paper by Brian Anderson and Mel Schwing: "Two leading class action defense attorneys utilize a federal court judge?s recent rejection of a settlement as a case study of how CAFA can deter defendants? ability to 'buy peace' through settlements" in cases where the claim is so meritless that it is only worth a small amount of money for the defendant to settle:While CAFA surely benefited class action defendants more than plaintiffs by transferring more cases to federal courts that offer more fairness and predictability in the adjudication of class actions, it is not a ?free-pass? for targets of class action lawsuits...
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text: Foreclosure activity continues slow decline By: Graziella Steele July 22, 2014 Foreclosures and delinquencies continue their slow improvement in the Charlotte metro region, according to property information and analytics provider CoreLogic. For the month of May, foreclosures affected 1.10 percent of all mortgage loans, a decrease of 1.06 percentage points compared with the same time last year, when the rate was 2.16 percent. Overall foreclosure activity in the ... Subscribe Login Email Address: Password: Already a paid subscriber but not registered for online access yet? For instructions on how to get premium web access, click here.Forgot your password? Share this:EmailPrintFacebookLinkedInTwitterGoogle +1Like this:Like Loading... CoreLogic foreclosures May 2014 1:15 pm Tue, July 22, 2014 Mecklenburg Times: News for Mecklenburg, Union and Iredell counties Graziella Steele


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House address:
8225 Knotting Wood Way
Chattanooga TN, 37421
Directions to the house:
From I-75 N take Exit 3A (TN-320 E / E Brainerd Rd) and turn right onto E Brainerd Rd.
In 2.5 miles turn right onto Givens Rd and the subdivision will be on your right in .3 miles.
Follow signs to the lot.


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yellowbootsgirl's Blog
primum nomen
Ever wonder what name we would pick for ourselves if our parents had waited to ask us? What would you have picked? Why would you have picked it? I wonder what parents would call their children while they waited til the child was old enough to decide and how many children would end up called Dora, or Barney?
When picking the name of my table quiz team I panic, I don't want to be in charge of making such a final decision and then watching them write it up on the board and knowing, that name is my fault, responsibility, choice. Even then the panic is strong and the nerves sit in. Although no one really cares and they are all probably sitting their panicking quietly too, waiting for society to scream at us.. WHAT HAVE YOU DONE?! It never comes, thankfully. Yet, ever table quiz, sports team, fifa/ playstation /X Box game that I miraculously end up playing I feel the stress of naming it, overwhelming.
So, the reason I have chosen this odd subject to write about is, how do we decide on our childrens' names? I have already renamed this blog 4 times. How do I know the one I like the most? Does the blog look like this name? Does it suit it? Does it suit the context? How do I know the context of a baby? Should I have typed something into our heavenly google to aid me? Or do I go with a gut instinct?
Is there a time in your life that you loved? Or a place? Even having somewhere or something like this, is calling you baby girl Pampalona okay? Or calling your little boy Abs because you once loved 5ive really the best choice?
If this is the case and this is the method of eliminating names in the race for my childs' primum nomen. Then my poor child is going to be called after my favourite dessert-Spotted Dick.
Family huh
Where do we begin when we think of family? Mine is a rather normal one. We eat and sleep and work and when I was small my parents indulged my games and tucked me in at night. They told me to sleep tight and don't let the bed bugs bite.
But Families become strange things. Its an odd habitat that we are forced to grow up in. Its a jungle for the smaller ones who can easily be eaten, or often in my rather large family, can be forgotten. However, its meant to get easier as we get older, at least that is the ideal notion, the abstract concept, it is, in reality, what we all hope is going to happen. What happens is something somewhat different.
Now, people say odd things that get you thinking such as, "you take after your mum" "you have your grandaddys nose!" "you like your father when he was a wee one".. What people don't say is that you absentmindedly happen to take on their weird patterns and somehow want to believe that it is hereditary.
Take tonight. I'm sitting here not doing an assignment, trying hard not to focus on the fact that that guy I like still has not facebooked me. My little brother is just in, and for once Dad doesn't have anything to say about it, this could be down to the fact that hes already in bed and fast asleep. My tiniest little brother, who I am so very protective of is fast asleep after playing his little heart out at some tournament and my poor ever worrying mum has just sat down "to do some work"... I dont know about all of you, but its after 1 in the morning and my family is most definitely an odd one. So Im blaming genes and chromosomes for my inability to get my work done on time and the knowledge that since I am so ridiculously lazy, Il force myself to stay up all night to get an assignment done-then blame my family for it. But not before I blog about it..
1-2 of 2 Blogs
Previous Postsprimum nomen, posted January 13th, 2013
Family huh, posted January 3rd, 2013
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Click on a thumbnail to go to Google Books.
Dark Desire (The Carpathians (Dark) Series, Book 2) (edition 2006)
by Christine Feehan
Work details
Dark Desire by Christine Feehan
No current Talk conversations about this book.
***Originally read August 6, 2009***
3 Stars - I heart Shea! She is such a strong character.
***Reread April 20, 2011 - April 27, 2011***
3 Stars -
Ok, here's the deal with this book: it was better than the first one and after you get over the world building and all the Carpathian's customs, you begin to see how things fall into place. That said, I was a little uncomfortable with the way Jacques treated Shea and how sometime their relationship blurred the lines of mind control. Despite that, things got into a good rhythm and there's also the problem with Jacques' memory condition after his imprisoment and how he sees things differently. Shea was a great addition to the Carpathian family and she brang a softness and some fun to the plot. Jacques was able to relax with her and I totally cherished their fun and cute moments together, seeing that Carpathians have this uncanny ability to be kind of dark and heavy sometimes. I really liked this book!
***Originally read August 6, 2009***
3 Stars - I heart Shea! She is such a strong character.
***Reread April 20, 2011 - April 27, 2011***
3 Stars -
This was meh.
Not as good as Dark Prince. I like Jacques a lot, and I liked him before in Dark Prince. However, I find Shea a little annoying...insipid really.
I love the romance between them, the way they need each other and help each other. Some of it was a bit repetitive of Dark Prince though, mimicking Raven and Mikhail's story.
Overall, I found it okay. I just find it a little annoying that someone as supposedly intelligent as Shea, can see love and feel love for someone like Jacques and refuse to accept it. I know it's the whole will she/won't she dilemma of whether she will ever give in, but really, she's a lifemate, she doesn't have much choice.
References to this work on external resources.
Wikipedia in English
Amazon.com Product Description (ISBN 0843956534, Mass Market Paperback)Seven years ago, Dr Shea O'Halloran experienced an unexpected and horrendous pain unlike anything she had ever known. It felt as if she were being tortured. Eventually the pain disappeared, but Shea never forgot. She has since devoted her life to trying to understand the cause of the rare genetic blood disorder that is slowly killing her. The answers to some of Shea's questions start to reveal themselves when she is approached by two men, who accuse her of being a vampire. Shea runs for her life and - following a feeling she can't explain - her desperate wanderings lead her to Romania. The ancient one known as Jacques Dubrinsky can explain. Seven years ago, Jacques was captured, tortured and buried alive by several humans and a Carpathian betrayer. The years of extreme pain and lack of sustenance that followed have nearly driven Jacques insane. He has been using what is left of his powers to psychically draw Shea to the region. But is Shea to be his healer or his prey?
(retrieved from Amazon Mon, 30 Sep 2013 13:52:28 -0400)
The stranger silently summoned her from across the continents, across the seas. He whispered of eternal torment, of endless hunger...of dark, dangerous desires. And somehow American surgeon Shea O'Halloran could feel his anguish, sense his haunting aloneness, and she ached to heal him, to heal herself.… (more)
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The Five Points of Pagan CalvinismThe Fluidity and/or Subjectivity of Ultimate Spiritual Reality The Pagan Elect Transcendence Irresistible Enlightenment Exclusive PluralismThe Fluidity and/or Subjectivity of Ultimate Spiritual RealityThere is a mystical Oneness of All Things which permeates all of nature. No thing is ever separate from the One. Separateness is an illusion and an error. We perceive separateness by being unaware of or unwilling to recognize the logical … [Read more...]
The Five Points of Pagan Calvinism
September 15, 2012 by Leave a Comment


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Jermichael Finley has been writing his ticket out of Green Bay for the past two seasons, and it looks like the Packers are finally prepared to part ways with him.
The Milwaukee Journal Sentinel reported late Saturday that the Packers are prepared to release Finley after the season if they are not able to trade him first. Finley signed a two-year, $14 million extension in February. He has a $3.5 million roster bonus coming in March, so he is likely to be cut by then.
The Journal Sentinel says financial, competitive, and behavioral reasons play a role in the decision. Translation: Had Finley been playing like the sixth-best tight end in football — which is where his salary ranks him — then they might be willing to bring him back. And if he were playing well and proving to be an invaluable member of the team, they might overlook the criticism he and his agent have had for Aaron Rodgers.
Because Finley has underachieved despite the vast potential the team believed he had, they are prepared to get rid of him. He'll no doubt be scooped up by another team at a lesser pay rate. Who knows? Maybe he'll blossom elsewhere.
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United States Department of Agriculture
Agricultural Research Service
Zeeshan Ahmed is a PhD student in Agronomy at the University of Agriculture, Faisalabad, Pakistan. Zeeshan has been conducting research in Pakistan on Camelina sativa as a potential oilseed crop for water limited environments. His research in Pakistan is primarily focused on developing Camelina sativa as an oilseed crop for edible uses. He is visiting the NGPRL for six months to collaborate with Dr. David Archer on oilseed production, simulation modeling, and economic analysis.
Dr. Md Abdul Momin, (Momin for short) joined the NDSU Department of Agricultural and Biosystems Engineering in November as a Research Specialist in the "Affected Wood Utilization 2" project funded by the North Dakota Forest Service. He is conducting research, developing educational materials, and helping arrange technical workshops. Dr. Momin was previously an Associate Professor in the Department of Farm Power and Machinery at Bangladesh Agricultural University (BAU). He received his doctorate in Bio-Sensing Engineering at the Graduate School of Agriculture at Kyoto University in Japan. Dr. Momin brings expertise in farm machinery and image-processing of horticultural products.
Krystal Leidholm has joined the "Renewal of the Standing Rock Sioux Reservation: Land, Cattle, Beef, and People" project. She is a native of Washburn, ND and an NDSU graduate. She was previously employed at the North Dakota Department of Parks and Recreation.


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Andrew Martin Milton Chair - Ivory Fabric
The sophisticated Andrew Martin Milton Chair with classic shape and design makes the perfect lounge chair for your home.
Shown upholstered in Westbourne ivory fabric - a smart and soft chenille ottoman fabric which looks great anywhere.
Arm height - 50cm
(Please note cushion and accessories not included).
|Seat Height
|75 cm
|91 cm
|94 cm
|46 cm
Stock availability is shown above.
If in stock and ordered before 3pm, this product is delivered in the UK using DPD Next Day complete with tracking codes and text / email updates with the option to change deliveries to work for you.
If no stock is showing then we've already got it on back order or it's in our suppliers warehouse and is on a 6 week lead time to you for UK deliveries, but can on occasion be delivered quicker. International deliveries are also carried with DPD and once dispatched, take an additional 3-5 Day.
This is a special order product, and is made to order.See our full delivery & returns policy for more details.


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Where the 'Princesses' of Long Island shop
Bravo's latest reality TV show "Princesses: Long Island" features the privileged lives of six women from affluent areas who live at home with their parents while attempting to find true love and progress their careers. Amanda Bertoncini, Chanel Omari, Ashlee White, Erica Gimbel, Casey Cohen and Joey Lauren are different in many ways, but they all share a love for shopping. Heres a look at 13 of their favorite stores to shop at on Long Island. -- Compiled by Meghan Giannotta
Good buys for foodies Drink and dine on the water in NYC Great grilling recipes for Father's Day Peek into Long Island's most lavish homes Every NYC flea market you need to visit this summer Puppies from North Shore Animal League Pets take over Coney Island for a day Governors Ball, 95 other NYC weekend picks Block Island: What to see, where to stay 15 new theme park rides, attractions in 2015 J. Crew, Kohl's, more sales this weekend Your pet photos: Adorable dogs, cats and more


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Hot Seat: Scott Suckow
Remember, the voters passed Proposition 63 to expand services. They knew we had failed for decades to provide adequate mental health care. Proposition 1E breaks the promise voters made.
Please suggest a specific alternative program you would cut to achieve the estimated $230 million a year in savings that Proposition 1E would produce.
The so-called "savings" from Proposition 1E are an illusion. By cutting mental health care we will see all the additional, higher costs that result from untreated mental illness: unemployment, hospitalization, homelessness and criminal justice costs.
There are few areas where it is so clear: Cut mental health care and pay more. The voters had this right in 2004, and we think they'll get it right again by voting No on Proposition 1E.


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This invention is related to a novel passive medical device that can be used in surgery to stabilize tissue for anastomosis or other surgical work. More particularly, the tissue stabilization device and surgical arm stabilizes cardiac tissue which enables coronary artery bypass grafting surgeries to proceed while the heart is beating, or during other surgical procedures that require holding or retraction of tissue and arresting blood flow. A surgical arm comprising: (a) a first hollow link; (b) a second hollow link; (c) a hollow universal joint connecting an end of the first link with an end of the second link; (d) a support mount for the first link, the universal joint and the second link; and (e) a hollow tissue stabilizer connected to an end of a hollow link opposite to the hollow link that is proximate the support mount.
1. A surgical arm comprising:
(a) a first hollow link;
(b) a second hollow link;
(c) a hollow universal joint connecting an end of the first Link with an end of the second link;
(d) a support mount for the first link, the universal joint and the second link; and
(d) a hollow tissue stabilizer connected to an end of a hollow link opposite to the hollow link that is proximate the support mount said hollow tissue stabilizer being constructed in the form of a hollow "C" with a cross-section wherein the top and two side walls of the cross-section are solid and the bottom side of the cross-section is open and unobstructed throughout its length, the internal radius of the "C" being within a range of about 7 to 14 nm, and an inner wall height of the "C" being within a range of between 4 and 8 mm.
2. A surgical arm as claimed in claim 1 including a third hollow link, and a second hollow universal joint, located between the first hollow link, first hollow universal joint and second hollow link, to form three links in series, connected by hollow universal joints between the respective links.
3. A surgical arm as claimed in claim 1 wherein the support mount is a clamp which can be detachably affixed to a stable body.
4. A surgical arm as claimed in claim 1 wherein an end of the first hollow link, remote from the first hollow universal joint is connected to the support mount by a hollow universal joint.
5. A surgical arm as claimed in claim 1 wherein an end of the second hollow link, remote from the hollow universal joint, is connected to the tissue stabilizer by a universal joint.
6. A surgical arm as claimed in claim 1 wherein the hollow universal joint is biased to hold a position when the first hollow link is moved relative to the second hollow link.
7. A surgical arm as claimed in claim 1 wherein the hollow universal joint comprises a first ball and a second ball connected together by a sleeve.
8. A surgical arm as claimed in claim 7 wherein one part of the first and second balls is constructed of metal and a second part of the first and second balls is constructed of a resilient material.
9. A surgical arm as claimed in claim 7 wherein the first ball and the second ball are biased by a metal spring.
10. A surgical arm as claimed in claim 8 wherein the first ball and the second ball are biased by a spacer.
11. A surgical arm as claimed in claim 7 wherein the first ball and the second ball which are housed in a tubular sleeve, each internal end of the tubular sleeve having a conical taper of an angle between 1 and 5 degrees which first and second ball exert a force on the interior of the tubular sleeve when air pressure is applied to the interior of the tubular sleeve.
12. A surgical arm as claimed in claim 1 wherein the hollow "C"-shaped tissue stabilizer has openings therein which permit the tissue stabilizer to affix to tissue when a vacuum is applied to the interior of the "C"-shaped hollow tissue stabilizer.
13. A surgical arm as claimed in claim 1 including a suction machine which draws a vacuum on the interior of the surgical arm and tissue stabilizer.
14. A surgical arm as claimed in claim 7 including a groove in the sleeve and an O-ring in the groove.
15. A surgical arm as claimed in claim 1 wherein the first hollow link, the second hollow link and the hollow universal joint are pressurized and the hollow tissue stabilizer has a vacuum drawn on it.
16. A tissue stabilizer for releasable vacuum attachment to living tissue, said tissue stabilizer being constructed in the form of a hollow "C" with a cross-section wherein the top and two side walls of the cross-section are solid and the bottom side of the cross-section is open and unobstructed throughout its length, the internal radius of the "C" being within a range of about 7 to 14 mm, and an inner wall height of the "C" being within a range of between 4 and 8 mm.
17. A tissue stabilizer as claimed in claim 16 wherein the tissue stabilizer is adapted to be releasably vacuum attached to a living human hart.
18. A tissue stabilizer as claimed in claim 17 wherein the vacuum pressure is controlled by a computer.
This application claims the benefit of U.S. Provisional Application Ser. No. 60/085,523, filed May 5, 1998, and U.S. Provisional Application Ser. No. 60/089,014 filed Jun. 12, 1998.
This invention is related to a novel passive medical device that can be used in surgery to stabilize tissue for anastomosis or other surgical work.
More particularly, the tissue stabilization device and surgical arm stabilizes cardiac tissue which enables coronary artery bypass grafting surgeries to proceed while the heart is beating, or during other surgical procedures that require holding or retraction of tissue and arresting blood flow.
Coronary artery bypass grafting surgeries are very challenging procedures that require suturing of tiny vessels (with diameters as small as 1.5 mm) on the surface of the heart. Presently the common practice is to stop the heart while such suturing takes place and bypass the natural blood oxygenation process through the lungs with an artificial cardiopulmonary bypass machine.
Because the disadvantages of cardio-pulmonary bypass are numerous and have been well documented in the literature (Kirkland, 1993; The Committee on Trauma, 1996), several approaches have been proposed to perform coronary artery bypass grafting surgery without stopping the heart. All such approaches require the stabilization of the cardiac tissue surrounding the coronary bypass site without significant bleeding to allow the above-mentioned delicate suturing to take place. Several approaches have been proposed to accomplish a stable operating field.
In one common approach, tissue surrounding the coronary is sutured to a fixed support, allowing the grafting surgery to proceed. The fixation suturing is time consuming and relies on significant tissue stretching to achieve a reasonably stable surgical field. Significant tissue motion is still present, implying that the quality of the grafts is not as high as it could be.
In another common approach, cardiac tissue stabilizers that press down on the coronary artery bypass site have been proposed. CTS (Cremer et al., 1997; Boonstra et al., 1997) and Guidant (Guidant Corporation, 1997) Corporations make devices that rely on a horseshoe shaped mechanism to push down the region of the coronary artery requiring bypass, trapping the heart tissue at this location. The CTS horseshoe (Cremer et al., 1997; Boonstra et al., 1997) is attached to a vertical rod which is screw-tightened to a slide which is screwmounted to a custom made chest retractor. This gives it three degrees of freedom. The Guidant device's horseshoe is fixated to the chest retractor through a flexible cable clamp mechanism screw also tightened to the retractor. The push-down mechanisms developed have to press on the heart with sufficient force to still be in contact with the cardiac tissue when the heart is fully contracted.
Another approach proposed in Borst et al., 1996, consists of using discrete suction cups around the coronary bypass site to fixate tissue with respect to the retractor or an adjustable surgical stand. In one of the embodiments of this approach, several sets of discrete suction cups are held on rods mounted on cable clamps, resembling an "Octopus" latching on tissue surrounding the surgical sight. In turn, the cable clamps are screw-fastened to an adjustable surgical stand or fastened to a support attached to the operating table. The art taught in Borst, 1996, has led to a product marketed by Medtronic called the "Octopus" device (Medtronic, 1997).
U.S. Pat. No. 5,727,569, Benetti et al., Mar. 17, 1998, discloses devices and techniques which use a negative (suction) pressure or vacuum, applied through a surgical instrument, to fix the position of a portion of the surface of a beating heart so that a surgical procedure can be more easily performed. The devices apply a negative pressure at several points on the outer surface of the heart such that a portion of the heart is fixed in place by the suction imposed through the surgical instrument. Because the instrument fixes the position of the tissue, and because the instruments remain at a constant distance from the particular portion of the heart where the surgery is being performed, the device may also serve as a support or platform so that other surgical instruments or devices can be advantageously used at the site. In certain perferred embodiments, the devices described herein have structures to facilitate the use of additional surgical instruments such that the placement of negative pressure device permits the surgeon to advantageously manipulate the other instruments during surgery. The negative pressure is preferably imposed through a plurality of ports which may be disposed in a substantially planar surface of the instrument which contacts the cardiac tissue.
WO 98/37814, Takahashi, published Sep. 3, 1998, discloses an improved device to hold an anastomotic site of coronary artery for the bypass surgery; to provide said device wherein the coronary artery bypass operation can be quickly and accurately performed on the beating heart by firmly and atraumatically holding said anastomotic site motionless and bloodless. That is to say, the characteristic feature of the present invention is in that the coronary artery can be stably held motionless without need to forcedly compress the heart surface. This is accomplished with a circular flexible suction device which surrounds the target artery, and whose center is open to expose the anastomotic site. The device is suctioned to the heart surface by drawing off the air in the flexible circular channel, creating negative pressure.
U.S. Pat. No. 5,749,892, Vierra, May 12, 1998, discloses a system and method for performing less invasive surgical procedures within a body cavity. In a preferred embodiment, the invention provides a system and method for isolating a surgical site such as an anastomosis between an internal mammary artery and a coronary artery in a thoracoscopic coronary artery bypass grafting procedure. The system comprises a foot pivotally coupled to the distal end of a shaft by a linkage. The foot has first and second engaging portions with contact surfaces for engaging a tissue surface. The engaging portions are movable between an open position, where the contact surfaces are separated by a gap, and a collapsed position, where the foot is configured for delivery through the percutaneous penetration. An actuator, at the proximal end of the shaft, can be rotated to pivot the foot about a transverse axis to that the contact surfaces are oriented generally parallel to the surgical site to apply pressure to the tissue structure on both side of the surgical site.
A number of surgical arms have been developed in the past for holding, positioning and supporting patient limbs during operation (Auchinleck et al., 1992; McEwen et al., 1993; McEwen et al., 1993).
U.S. Pat. No. 4,616,632, Wigoda, Oct. 14, 1986, discloses a set of retractors which are coupled by releasable locks to rods on the side of an operating table. A foot pedal is provided to release the locks and allow the retractors to be repositioned easily and with one hand by the doctor while performing the surgery. The foot pedal may utilize hydraulic fluid to lock or release the movement of the retractors. The joint holding the retractors is also rendered free to rotate to properly position the retractors, when the foot pedal is depressed.
U.S. Pat. No. 4,863,133, Bonnell, Sep. 5, 1989, discloses an instrument-supporting, articulated device with a distal end capable of supporting an instrument in the region of a surgical operating site. The device has at least one joint that supports a movable distal support element relative to a proximal support, the joint being associated with a mode selector. The joint has structure capable, upon selection of a first mode of operation by the selector, of enabling relatively free motion of the joint for achieving a desired positon of the instrument and the joint has structure capable, upon selection of a second mode of operation by the selector, to set the position of the instrument in space with lightly loaded restraint. The lightly loaded restraint is of a value that, while the second mode continues to be selected, the user may adjust the position of the instrument by application of a light force to the instrument and upon release of such light force by the user, the instrument will remain in the newly adjusted position.
U.S. Pat. No. 5,201,325, McEwen et al., Apr. 13, 1993, discloses an apparatus useful in surgery for holding retractors and other surgical instrumentation in a number of different positions required by a surgeon for the performance of a surgical procedure, including advanced sensing and regulation of retraction pressures and position; and incorporating a force amplification method to drive a locking mechanism in the supporting structure that utilizes a constrained, substantially incompressible, flexible solid material to yield a mechanism that is suitable for clinical use.
The surgical arms designed for holding, positioning and supporting patient limbs during operation must handle very significant loads. For this purpose, these devices are endowed with pneumatic brakes that include mechanical force multiplication that makes their design and constructions quite complicated and expensive. Similar approaches used in the design of above pneumatic limb positioning and holding devices have been used in the design of a passive pneumatic camera holder, the Endex arm (Andronic Devices, 1994). The Endex arm uses a number of internally pressurized links and single axis pneumatic brakes to lock in position a camera holder at the site required by a laparoscopic surgeon. Computer Motion's AESOP (Automated Endoscopic System for Optimal Positioning) 3000 (Sackier, 1996) is an FDA-approved voice controlled active arm used for maneuvering and positioning an endoscopic camera for laparoscopy.
Another "general purpose" surgical holding arm that has been developed for holding endoscopic and orthopaedic tools is the "automatic, medical holding device" research arm described in Erbse et al., 1997. It is a passive arm with several links connected through ball joints at their ends. The ball joints are locked in place with piezoelectric actuators used as jams.
A novel system for the stabilization of cardiac tissue during off-pump (while the heart is still beating) coronary artery bypass grafting procedures is presented. This system brings together in a novel fashion a novel tissue holder that attaches to the heart and a novel surgical arm that immobilizes the tissue holder with respect to the patient's retractor or another reference frame. The tissue holder is a "C"-shaped hollow channel with a vacuum inlet. When the open section of the tissue holder is placed on a tissue and the vacuum is activated, the tissue is sucked within the channel resulting in holding forces. The tissue holder attaches to the distal end of a support arm. The proximal end of the support arm attaches to the patient's retractor, bed or other platform. The arm consists of several links attached to each other by ball joints that are locked in place by pneumatic pressure. It features a lightweight, quick to activate/deactivate, highly dextrous, unobtrusive design, with gas supplied to the links through piping interior to the arm.
The invention is directed to a surgical arm comprising: (a) a first hollow link; (b) a second hollow link; (c) a hollow universal joint connecting an end of the first link with an end of the second link; (d) a support mount for the first link, the universal joint and the second link; and (e) a hollow tissue stabilizer connected to an end of a hollow link opposite to the hollow link that is proximate the support mount.
The surgical arm can include a third hollow link, and a second hollow universal joint, located between the first hollow link, first hollow universal joint and second hollow link, to form three links in series, connected by hollow universal joints between the respective links.
The support mount can be a clamp which can be detachably affixed to a stable body. An end of the first hollow link, remote from the first hollow universal joint can be connected to the support mount by a hollow universal joint.
An end of the second hollow link, remote from the hollow universal joint, can be connected to the tissue stabilizer by a universal joint. The hollow universal joint can be biased to hold a position when the first hollow link is moved relative to the second hollow link.
The hollow universal joint can comprise a pair of joint balls connected together by a sleeve. The joint can include a groove and an O-ring in the groove to improve the seal. One part of the joint ball can be constructed of metal and the second part of the ball can constructed of a resilient material. The first ball and the second ball can be biased by a metal spring or by a spacer.
The universal joint can comprise a first ball and a second ball which can be housed in a tubular sleeve, which first and second balls can exert a force on the tubular channel when air pressure is applied to the interior of the tubular connector.
The tissue stabilizer can be constructed in the form of a hollow "C". The hollow "C"-shaped tissue stabilizer can have openings therein which can permit the tissue stabilizer to affix to tissue when a vacuum is applied to the interior of the "C"-shaped hollow tissue stabilizer. The surgical arm can include a suction machine which can draw a vacuum on the interior of the surgical arm and tissue stabilizer.
In drawings which illustrate specific embodiments of the invention, but which should not be construed as restricting the spirit or scope of the invention in any way:
FIG. 1 illustrates a schematic end partial section view of the cardiac tissue stabilizer and surgical arm positioned on the heart of a patient.
FIGS. 2a and 2 b illustrate respectively elevation and plan views of the cardiac tissue stabilizer.
FIG. 3 illustrates an isometric view of the cardiac tissue stabilizer positioned on a heart.
FIG. 4 illustrates an end section view of the cardiac tissue stabilizer with vacuum channel installed on tissue.
FIGS. 5a and 5 b illustrate respectively a detailed perspective view of the cardiac tissue stabilizer with vacuum channel and suction hole, and a section view of the vacuum channel.
FIGS. 6a and 6 b illustrate respectively alternative embodiments of the tissue stabilizer with vacuum channel.
FIG. 7 illustrates an end section view of the cardiac tissue stabilizer vacuum channel installed on tissue, the vacuum channel having rounded bottom edges.
FIGS. 8a and 8 b illustrate end section views of two alternative embodiments of the cardiac tissue stabilizer vacuum channel installed on tissue.
FIGS. 9a, 9 b and 9 c illustrate respectively an elevation view and detail views of the assembled surgical arm and tissue stabilizer, arm mount and joint construction.
FIG. 10 illustrates a schematic section view of a hollow universal joint construction with two balls and a tube.
FIG. 11 illustrates a perspective view of one embodiment of the universal surgical arm and the C-shaped cardiac tissue stabilizer.
FIG. 12 illustrates a schematic section view of an embodiment of a universal joint construction with two balls, a tube and a helical spring.
FIG. 13 illustrates a schematic section view of an embodiment of universal joint construction with two balls, and an outer tube and an inner tube.
FIG. 14 illustrates a detailed section view of a further embodiment of joint construction which has enhanced holding force.
Detailed Description of the Invention in Relation to the Drawings
FIG. 1 illustrates a schematic end partial section view of the cardiac tissue stabilizer and surgical arm positioned on the heart of a patient. The cardiac tissue stabilizer according to the invention comprises two parts, as shown in FIG. 1: a tissue holder 1, attached to a surgical arm 2. The tissue holder 1 at the distal end of the surgical arm 2 attaches to the heart 49 inside the rib cage 48 and creates a stable suturing area 4. The proximal end of the surgical arm 2 attaches to the patient's chest retractor 19 or to a surgical stand affixed to the operating table 46 or on the operating room floor (not shown). FIG. 1 also illustrates the operating table 46, a side rail 29, a clamp 47, an airflow suction tube 10, airflow channel 26, and air pressure tube 32.
FIGS. 2a and 2 b illustrate respectively elevation and plan views of the cardiac tissue stabilizer. FIG. 3 illustrates an isometric view of the cardiac tissue stabilizer positioned on a heart. FIG. 4 illustrates an end section view of the cardiac tissue stabilizer with vacuum channel installed on tissue. FIGS. 2, 3 and 4 illustrate an embodiment of a C-shaped tissue holder 1 that uses vacuum suction to attach to the heart. The hollowed-out device illustrated in detail in FIGS. 2a and 2 b consists of a vacuum channel 30, 31, 33 placed on the heart, a support member 7, and a vacuum port 6, as shown in FIG. 3. When vacuum is applied through tube 10, the heart tissue 14 is pulled inside the ring 30 as shown in the cross-section shown in FIG. 4 (tissue inhaled within the vacuum channel 15). A continuous vacuum volume is formed within the vacuum channel that is bounded by the heart tissue 14 on the underside of the C-section device and by the walls 30 of the device, namely the cylindrical section wall 30, the inner cylindrical section wall 31, the vacuum channel end walls 37 and the flat circular arc wall 33.
As shown in FIGS. 2a, 2 b and 3, the vacuum suction for holding the tissue is delivered through the vacuum delivery hose port barb 6. This barb 6 is part of a support member 7 that connects the tissue holder 1 to the surgical arm 2. The support member 7 jogs to accommodate vacuum delivery hose barb 6 and is placed at hose barb angle 8 to the plane of application of tissue holder 1. This is done to allow easier application for the surgeons with less interference with the interior of the thoracic cavity.
The tissue holder 1, as seen particularly in FIGS. 2b and 3, is shaped as an open "C", rather than a closed "O"-ring to allow its removal following anastomosis of arterial grafts to the coronary artery 9 in surgical site 4. (An end-to-side anastomosis is shown in FIG. 3.) Once the grafting artery 35 is sutured to the coronary artery 9, the vacuum inside the C-shaped holder 1 can be switched off and the ring can be pulled free from the suture site in the direction of the support member 7. The sutured artery can pass through the gap 5.
In surgical application, as shown in FIG. 3, the tissue holder 1 is placed over a coronary artery 9. Vacuum pressure delivered by vacuum line 10 through hose barb 6 to vacuum port 34 (see FIG. 2b) creates a continuous vacuum surface 3 that pulls the heart tissue into vacuum volume 11 holding the tissue holder 1 to the heart and creating a flat unmoving surface 4 that the surgeon may suture to unimpeded by the beating of the heart. In addition, coronary artery 9 is inhaled at application points 12 and 13 (see FIG. 3) to temporarily cut off blood flow between application points 12 and 13, thus preventing blood from reducing vision in suturing site 4. In cross-section, this arrangement appears as in FIG. 4, where the inhaled cardiac tissue 15 is inhaled by the vacuum force in the C-shaped cross-section. Due to the compliance of cardiac tissue 14, 15 as it is pulled into vacuum volume 11, the heart tissue creates an effective compliant seal that is difficult to break.
It should be noted that, if necessary, there can be a manual or computer adjustment of vacuum pressure to allow the correct amount of tissue to be sucked into the ring 30. For example, the surgeon may be able to switch the vacuum on, but also adjust the vacuum level by proportionally turning a knob or pressing a pedal connected to the vacuum control. This allows the minimum vacuum level necessary for tissue stabilization to be used and could protect the cardiac tissue.
Experimentation with a number of vacuum holding devices (Gilhuly, 1998) has enabled the inventors to make the following observations (referring to FIG. 2):
(1) Vacuum holders with very small aspect ratio between the vertical walls height "h" and the horizontal wall cross-section "c" perform poorly as the heart tissue itself blocks the vacuum channel and reduces the holding force significantly.
(2) Vacuum holders that allow the heart tissue to be "inhaled" within their vacuum channel perform better, as the "inhaled" tissue creates an effective vacuum seal.
In order for the surgeon to work with the tissue stabilizer 1, the stabilized space 4 inside the "C" shape must be wide enough for suturing in and the height of the wall must not interfere with the surgeon's manipulation. An inner radius "r" of roughly 7 to 14 mm is preferred for the stabilized tissue area 4. A ratio of inner radius "r" to height "h" in the range of 5:3 has been found to work well in limiting the vacuum channel profile, thereby allowing the surgeon approximately 60 degrees of approach and suggesting an inner wall vacuum channel height "h" ranging between 4 and 8 mm.
Variations of the above vacuum tissue holder are possible within the spirit of the above described embodiment and the invention. An alternative design consisting of a vacuum channel 36 (with two vacuum channel ends 37), ported to a vacuum supply hose 38 and held by a rigid attachment, as shown in FIGS. 5a and 5 b. The vacuum supply port and the rigid attachment, support post 39, can be one and the same part. Within the scope of the invention, there are many possible designs for the vacuum channel 36, as well as for the vacuum channel cross-section 409 also shown in section view in FIG. 5b.
FIGS. 6a and 6 b respectively show the design of a rectangular vacuum channel 50 and a spiral vacuum channel 51. In a further variation, the bottom edges of the vacuum channel cross-section can be curved outwardly as shown in FIG. 7, so as to make the heart tissue sealing surface area 41 larger. In further variants of the device, as shown in FIGS. 8a and 8 b, the inner wall 31 of the tissue holder (vacuum channel) would be made shorter in height than the outer wall 30, thereby giving it the appearance of a stadium (FIG. 8a). The lower height inner wall 31 would provide reduced interference with the surgeons' work, thereby allowing them an approach to the surgical site 4 at a reduced angle.
Variations on this, including one with a small square vacuum channel added to and above the vacuum volume 11 adjacent to the outer wall 30 to approximate the stadium shape, as shown in FIG. 8b, are also possible.
To hold the tissue holder 1 fixated to the heart and form a rigid link between it and the patient or another reference frame, a multiple position surgical arm 2 is used. FIGS. 9a, 9 b, 9 c, 10 and 11 illustrate an embodiment of a surgical arm 2 that uses pressurized air to removably lock the tissue holder 1 to the patient retractor (see FIG. 1) or another reference frame.
In one embodiment as illustrated in FIGS. 9a, 9 b, 9 c, 10 and 11, 20 the surgical arm 2 consists of three hollow tubular links 16 having ball joints 21 at each of their adjacent ends. Each ball joint 21, as seen in FIG. 9c, has a ball 25 that can rotate inside and translate a small amount along the principal axis of a cylindrical sleeve 22. Each cylindrical sleeve 22 has a spherical end section matching the ball joint ball 25 to close radius tolerance. The amount of translation inside the cylindrical sleeve 22 is limited by a middle link segment 23 (see FIG. 10) that connects the sleeves 22 together and also acts as a spacer. The links 16 are connected to each other by connecting rods 17 that join adjacent ball joint balls 25. As seen in FIG. 9a, the first or proximal ball joint ball 27 of the surgical arm 2 is connected to the patient's retractor 19 or other reference by a base connector 18. The last or distal ball joint ball 28 of the surgical arm 2 is attached to the tissue holder 1 via the support member 7, as explained previously in relation to FIGS. 1, 2, 3 and 4.
As seen in the detail of FIGS. 9a, 9 b, 9 c and 10, each of the connecting rods 17 and the base connector 18, as well as the ball joint balls 25, 27, have therein hollowed-out gas delivery channels 42 that allow gas to flow from a pressurized gas delivery nozzle 20 in the base connector 18 to each and every link. The distal ball joint ball 28 does not have a channel in it.
When the surgical arm 2 is not pressurized, each ball joint 21 allows three-degree-of-freedom angular motion of its connecting rod 17, base connector or distal support member through a limited pitch and roll and unlimited yaw angle, thereby giving the arm illustrated in FIGS. 9a and 11 eighteen degrees of freedom.
When the surgical arm 2 is pressurized through the gas delivery nozzle 20 by opening valves, air flows through the channel 26 (see FIG. 1) through pressure tube 1 the interior of the base connector 18, the proximal ball joint 27, the links 16 and the delivery channels 42 in the connecting rods 17 and through the ball joint balls 25. The pressurized gas then pushes each of the ball joint balls 25 against their matching spherical outer sleeve shells 22, with a force proportional to the gas pressure and the cross-sectional area of ball-outer-shell contact (this is close to the cylindrical cross-section 22). Friction forces developed between the ball joint balls 25 and the outer shells 22 lock the arm in its required configuration.
For a given tissue holder position and orientation (and implicit tissue holder support member 7 position and orientation), the arm redundancy allows the arm 2 to be locked in multiple (virtually an infinite number) configurations, some of which may be out of the surgeons' way and therefore advantageous. The connecting rods 17 may be angled at right angles as shown in FIGS. 9a and 9 c, or at other angles or otherwise curved between the ball joint balls 25 in order to increase the dexterous reach of the arm 2 inside the thoracic cavity. Such bending removes some of the motion constraints imposed by the outer sleeve shells 22 which hold the ball joints 21 inside the links 16.
It will be understood that more or fewer links 16 interconnected by connecting rods 17 can be used in different implementations depending on the application and the surgeon's preference.
The links 16 and the connecting rods 17 can be made of stainless steel or any other high strength autoclavable material of accepted use in an operating room, with sealing materials such as urethane rubber or neoprene used to produce seals between the ball joint balls 25 and the links 16. The sleeves 22 and the middle link segments 23 are hermetically sealed, so once the ball joint balls 25 are pushed against the sleeves 22, pressurized air is trapped inside the surgical arm 2.
As an example of how sealing between the ball joint balls 25 and link sleeves 22 can be achieved, a particular embodiment is shown in FIG. 10. This embodiment uses ball joint balls made out of two adjoining hemispheres—a metal one 24 and a urethane rubber one 25. Contact between the ball joint balls and the link sleeves 22 is made through the urethane rubber material only, which has increased friction against stainless steel, would be the case if the ball was made of stainless steel or other hard metal. Furthermore, grooves can be cut, ground, etched or otherwise made in outer shell 22 to increase friction with the rubber hemisphere 25. The urethane rubber hemisphere 25 needs to be made from a durable, autoclavable rubber. It needs to be hard enough to prevent it from being extruded by the air pressure, yet compliant enough that it offers good friction contact. Both urethane rubber and neoprene have been found to be good materials for this purpose. It will be obvious to those skilled in the art that alternative designs do exist to increase friction in the pressurized ball joints presented above. The ball joint ball could be made out of steel or other hard material (potentially grooved), and the shell 22 can be made with an appropriate rubber gasket—an O-ring or a hemispherical gasket.
It should be noted that the ball joint balls 25 can be pre-loaded against the ball joint sleeves 22 by internal springs 43, as shown in FIG. 12. This may allow the surgical arm 2 to hold its weight while the arm is not pressurized. Also note that another pressure level, rather than atmosphere, could be used to preload the arm brakes while it is in its limp or movable state. This pressure level could be used to adjust the arm stiffness while it is movable. Also, several levels of internal pressurization can be provided in order to control the arm stiffness.
It should also be understood that design modifications within the spirit of this invention can be made to make the arm construction simpler or cheaper. For example, FIG. 13 shows a link design that consists of only two sleeves 44 that attach to each other directly. An internal spacer 45 separates the ball joint balls 25 at the end of the links. The internal spacer 45 could be replaced, as mentioned above, with a spring (not shown).
FIG. 14 illustrates a detail section view of a joint construction that allows for substantially greater holding force to be possible at each of the arm ball-joints 21. FIG. 14 illustrates another embodiment of sealing between ball-joint balls 25 and link sleeves 44. The link design in FIG. 14 also consists of two sleeves 44 that attach to each other directly. This embodiment uses steel (or other hard material) ball-joint balls with O-ring seals 52 located in place by O-ring grooves 53 in the surgical arm link sleeves 44. When the device is not pressurized, the ball-joint balls 25 are held lightly in a socket formed by the conical taper 54 and the O-rings 52. The O-rings 52 are placed a small distance L behind the ball centers. When the surgical arm is pressurized, the O-rings 52 are pushed against the ball-joint balls 25 and the O-ring grooves 53 and seal the interior of the link. An internal spacer 45 could be used optionally to ensure that the balls 25 are never unseated from the socket and pushed past the O-ring 52. The internal spacer 45 can be spring loaded.
In order to improve the arm holding force, the link sleeves 44 can be designed to have a conical taper 54 that increases the force between the ball-joint balls 25 and the link sleeves 44 by a wedge action. For taper 54 angles between 1 degree and 5 degrees, one can expect force amplifications approximately between 60 and 10. The taper angle should be selected to be small enough for the wedge action to provide adequate hold without damaging the ball-joint ball 25 or the link sleeves 44.
Both vacuum flow and pressurized gas flow for the tissue holder 1 and surgical arm 2 are controlled through use of valves in air flow channel 26, as shown in FIG. 1. These valves 26 could be located in a box on the floor or on a nearby table, but in a preferred solution, they could be mounted unobtrusively to a rail 29 on the side of the operating room table 46 with a clamp 47. The surgeon would control the vacuum and pressure flow through the valves 26 through use of a switch (not shown). For example for ease of application, this could be done through the use of a foot pedal.
The heart stabilizer presented above functions as follows. With the surgical arm pressure OFF, and the vacuum supply line 10 to the tissue holder also OFF, the surgical arm 2 is limp and the surgeon can position the tissue holder 1 onto the desired operating site unimpeded. The vacuum into the tissue holder 1 can be switched ON when desired, thus locking the tissue holder 1 to the operating site. Then, the gas pressure in the surgical arm 2 can also be switched ON, instantly locking the surgical arm 2 in position and therefore locking the tissue holder 1 and the surgical site to the patient's retractor 19 (bed or surgical stand). Should repositioning be required, the surgical arm 2 gas supply can be switched OFF when desired for unimpeded positioning of the tissue holder 1. Said switching may be accomplished by using one or two foot pedals, one or two hand switches on or near the operating table or a combination of the two. If required, the switching of tissue holder 1 vacuum and surgical arm 2 pressure could be coupled so that a single switch or foot pedal switches vacuum and pressure ON or OFF at the same time.
Features and Advantages of the Invention
Stabilization by suturing has several disadvantages. It takes time to set up, it does damage to heart tissue and there is still significant heart motion left.
Relative to previous devices used for cardiac tissue stabilization (Cremer, 1997; Guidant, 1977; Borst, 1996), the system according to the invention provides improved stabilization, activation and deployment. The device includes a surgical arm which is useful in any task that requires a "third hand" that can be quickly positioned, locked and later released.
Unlike the systems presented in Cremer, 1997, or Guidant, 1997, the cardiac tissue holder described in this invention uses vacuum to perform tissue immobilization. The use of suction allows greater range of application, as the device of the invention is not restricted to heart locations that can only be pushed down upon. The device exerts smaller maximal forces on the heart, and therefore is less likely to cause arythmias.
Relative to the "Octopus" device (Medtronic, 1997), the vacuum suction of the device according to this invention is provided in a large continuous chamber instead of across discrete suction cups. This permits lower suction pressures to be used for the same holding forces. In addition, the inhalation of tissue in the vacuum channel of the hollow C-channel, when the vacuum is activated, temporarily closes the coronary artery underneath the channel, thereby preventing the flow of blood into the suturing field.
As in prior designs, the tissue stabilizer according to this invention is mechanically affixed by a mount to a stable platform such as the patient's retractor, the operating table or the operating room floor. Prior mechanical holding devices involve the tightening of a cable clamp (Guidant, 1997; Cremer, 1997) or securing a bulky, cumbersome, support arm in several places as involved in the Octopus device (Borst, 1996). The use of mechanical clamps requires the tightening of a cable that can snap and that takes time to properly lock in place. The use of the Octopus arm requires the sequential tightening of several locking links.
The use of other surgical stabilizer devices mentioned in the background art is also not appropriate for cardiac tissue stabilization, The pneumatic arms reported (Auchinleck et al., 1992; McEwen et al., 1993; McEwen et al., 1993; Andronic Devices, 1994) are bulky and of limited dexterity. This is due to their design for high load applications which require that the pneumatic brakes be implemented as large, single-degree-of-freedom brakes. The design of such arms does not scale down easily and it would be unrealistic to imagine a twelve or eighteen-degree-of-freedom passive stabilizer, such as provided by the subject invention, made up of as many one-degree-of-freedom joints with pneumatic brakes between the links. The AESOP system (Sackier, 1996) teaches a motorized robot with angle sensors and motors at each axis. Such a system would be expensive, obtrusive and of marginal dexterity in an application that requires the arm to enter the thoracic cavity.
Although the piezoelectric brake arm presented in Erbse et al., 1997 could be miniaturized as a holder for application with a cardiac tissue stabilizer, the use of PZT material implies high voltages, proper insulation and electrical connectors, and would be difficult to sterilize, expensive, and risky to use in surgery.
The combination of a vacuum tissue holder and a pressurized surgical arm according to the subject invention for cardiac tissue stabilization is much easier to use and much less cumbersome than any prior art cardiac tissue stabilizing device. In particular, both tissue stabilization by the vacuum tissue holder and arm fixation to a reference frame are almost instantaneous and literally involve the flick of a switch or the push of a pedal. Solutions proposed in the prior art are time consuming since they involve the tightening of a cable clamp or securing a bulky, cumbersome support arm in several places.
The surgical arm of the subject invention is unobtrusive. It has been designed after conducting careful measurements of heart forces in animals and scaling to humans (Gilhuly, 1998). It can be sized properly and designed with multi-degree-of-freedom brakes, thereby saving space and expense. It is of very small size, having a maximum diameter of less than 3.5 cm. This provides minimal interference with the surgeons manipulating their surgical instruments to suture and allows secure mounting of the arm to the patient's retractor to couple its motion to the patient. Chest retractor mounting has several advantages. The arm does not interfere with the movement or work of the surgeons, as is the case with operating table or floor mounted arms. The surgical arm according to the invention can be smaller and lighter if mounted close to the heart, and patient motion, such as caused by coughing, has a reduced potential for patient injury due to collision with or pulling on the cardiac tissue.
The surgical arm according to the invention has many degrees of freedom, thereby giving it a highly dexterous workspace and allowing the surgeon to "route" the surgical arm so as to have little interference with the surgical field, the surgeons' hands and their instruments.
To summarize, with respect to prior art cardiac stabilizer designs, the cardiac tissue stabilizer and surgical arm of the subject invention has the following novel features:
(1) application of vacuum for tissue immobilization in a single large continuous chamber, thereby leading to strong stabilizing forces at low vacuum pressures and also leading to a bloodless operating field;
(2) easy set-up and nearly instantaneous locking and release;
(3) small size and lightweight, thereby making it non-obtrusive and mountable on the patient's retractor;
(4) safety and easy sterilization; and
(5) high dexterity.
The improvements provided by this invention can be applied to a large set of problems encountered in surgery (e.g. tool positioning, tissue retraction and immobilization) and general mechanical repair (e.g. whenever something relatively small and light would be required to be held).
As will be apparent to those skilled in the art in the light of the foregoing disclosure, many alterations and modifications are possible in the practice of this invention without departing from the spirit or scope thereof. Accordingly, the scope of the invention is to be construed in accordance with the substance defined by the following claims.
1. Kirkland, John W., et al. Cardiac Surgery: Morphology, Diagnostic Criteria, Natural History, Techniques, Results and Indications. Churchill-Livingstone Press, New York, 1993.
2. The Committee on Trauma, Division of Medical Sciences National Academy of Sciences. Mechanical Devices to Assist the Failing Heart. National Research Council, Washington, D.C., 1966.
3. Guidant Corporation, internet web page as of May, 1998, copyright 1997: http://www.guidant.com/cvs/product/.
4. Cremer, Jochen et al. "Off-Bypass Coronary Bypass Grafting via Minithoracotomy Using Mechanical Epicardial Stabilization". Annals of Thoracic Surgery, vol. 63, pp. S79-83, 1997.
5. Boonstra, Piet W., et al. "Local Immobilization of the Left Anterior Descending Artery for Minimally Invasive Coronary Bypass Grafting". Annals of Thoracic Surgery, vol. 63, pp. S76-78, 1997.
6. Borst, Cornelius, et al. "Coronary Artery Bypass Grafting without Cardio-Pulmonary Bypass and without Interruption of Native Coronary Flow Using Novel Anastomosis Site Restraining Device ('Octopus')". Journal of American College of Cardiology, vol. 27, no. 6, May 1996.
7. Medtronic Inc., internet web page as of May 1998, copyright 1997: http://www.medtronic.com/mics/.
8. Andronic Devices Inc., product literature, 1994.
9. Sackier, Jonathan M., and Wang, Yulun. "Robotically Assisted Laparoscopic Surgery: From Concept to Development". Computer Integrated Surgery, edited by R. H. Taylor, S. Lavallee, G. C. Burdea and R. Mosges, MIT Press, 1996.
10. Gilhuly, Terence. "Optical and physical heart stabilization for cardiac surgery". M.A.Sc. Thesis submitted The University of British Columbia, Vancouver, Canada, submitted confidentially Apr. 30, 1998, to appear June 1998.
11. Auchinleck et al. "Apparatus for Patient Limb Positioning". U.S. Pat. No. 5,104,103, Apr. 14, 1992.
12. McEwen et al. "Advanced Surgical Retractor". U.S. Pat. No. 5,201,325, Apr. 13, 1993.
13. McEwen et al. "Powered Surgical Retractor". U.S. Pat. No. 5,271,384, Dec. 21, 1993.
14. Computer Motion, internet web page, as of May 1998: http://www.ComputerMotion.com.
15. Erbse, St., et al. "Development of an Automatic Surgical Holding Based on Ergonomic Analysis". CVRMed-MRCAS'97: Computer Vision, Virtual Reality and Robotics in Medicine, and Medical Robotics and Computer Assisted Surgery conference proceedings, 1997.
16. Snyder, W. S. Report on the Task Group on Reference Man, International Commission on Radiological Protection #23, Pergamon Press, Oxford, U.K., 1975.
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Miklos Rozsa (1907-1995): Sinfonia concertante op.29
- Miklos Rozsa (1907-1995)
- Sinfonia concertante op.29
- Andrey Tchekmazov, Anastasia Khitruk, Dmitry Yablonsky
- CD i **;
- Künstler: Anastasia Khitruk, Andrey Tchekmazov, Russian PO, Dmitry Yablonsky
- Label: Naxos, DDD, 2007
- Bestellnummer: 5543500
- Erscheinungstermin: 3.9.2007
ProduktinfoBorn in Hungary and trained in Leipzig, Miklós Rózsa moved to America in 1940, winning a name for himself as a master of the Hollywood epic. During his summer breaks in Italy, however, Rózsa was able to devote himself to his concert works. Combining dazzling virtuosity with Hungariantinged lyricism, the Violin Concerto, written for Jascha Heifetz in just six weeks, is one of his finest works, later to be adapted for the Billy Wilder film The Private Life of Sherlock Holmes. The angular Sinfonia Concertante (a double concerto for violin and cello) was written originally alongside the score of Ben-Hur. It, too, is rich in reminders of the composer's Hungarian origins.
- Tracklisting
- Mitwirkende
- 1 Violin Concerto, Op. 24: I. Allegro non troppo ma passionato
- 2 Violin Concerto, Op. 24: II. Lento cantabile
- 3 Violin Concerto, Op. 24: Iii. Allegro Vivace
- 4 Sinfonia Concertante, Op. 29: I. Allegro non troppo
- 5 Sinfonia Concertante, Op. 29: II. Theme and Variations: Andante
- 6 Sinfonia Concertante, Op. 29: Iii. Allegro Con Brio
lieferbar innerhalb einer Woche
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|Feb 19, 2013, 05:05 PM
Apple Employees Hacked By Visiting iPhoneDevSDK
As reported by The New York Times, the software development website responsible for seeding malicious software to Mac computers at Apple, Facebook, and presumably Twitter has been revealed by a person who was involved with the investigation at Facebook.
The compromised site, iPhoneDevSDK, is an online forum designed for software developers. The site is still infected, and visiting it is not recommended.
At this time, it is unknown if the site had any involvement in the attacks, though it is likely that it was the work of third party hackers given the site's prominent standing as a dedicated community for iPhone developers.
Apple this morning announced that a small number of its employees' computers had been compromised through the Java plug-in vulnerability, an issue that has now been fixed with the Java update and malware removal tool released by Apple this afternoon.
Mac users can determine whether or not they have been affected by the security flaw by installing the Java update, which will notify a user if malware is found. Apple says that the Java update and malware removal tool will "remove the most common variants of malware."
As noted by The Next Web, iPhoneDevSDK is currently in maintenance mode.
Article Link: Apple Employees Hacked By Visiting iPhoneDevSDK
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Originally written on Patriots Life | Last updated 11/19/14
NEW ORLEANS - NOVEMBER 30: Wes Welker #83 of the New England Patriots looks on against the New Orleans Saints at Louisana Superdome on November 30, 2009 in New Orleans, Louisiana. (Photo by Scott Halleran/Getty Images)
We could be watching a depleted New England Patriots offense for Sunday's big encounter with the Indianapolis Colts.ESPN reported this after Thursday's practice.The New England Patriots were without wide receiver Wes Welker (ankle) and guards Logan Mankins (ankle/calf) and Dan Connolly (back) for the start of Thursday's practice. All three players did not practice on Wednesday.While the tackles have found their feet recently this season, the rest of the offensive line has been unsettled. Constant injuries have not helped, and with the news that Mankins and Connolly aren't practicing, it's worrying news for Tom Brady, who has been sensitive to pressure recently.However, the addition of Mitch Petrus, a guard formerly of the New York Giants, will add some depth to an ailing offensive line group. However, he has only been on the team since he signed on Monday. Again, thanks to ESPN, we know he's flexible.Petrus filled in briefly at left guard for the Giants last season, but said he's a...
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Mumbaikars can heave a sigh of relief. Public buses will be available for commuters from Thursday morning as the strike called by drivers and conductors of the Brihanmumbai Electric Supply and Transport (BEST) Undertaking has been called off, rather they will not proceed on mass leave.
After a series of meetings and a tough stand taken by the warring parties, ie the workers and the administration, the latter stepped down to bring buses back on city's roads.
It began early on Wednesday, with none of the drivers and conductors reporting to work despite the Bombay high court ordering them on Tuesday to resume duty immediately.
As the day progressed, the state government invoked five sections of the Essential Services Maintenance Act, 1968, against the staff as well as the workers' union, making the strike a non-bailable offence.
Even after this, there was no indication of any of the staffers reporting to work. In the afternoon, the HC was moved again. It's only when a meeting took place between BEST officials, representatives of BEST Workers' Union and BEST Kamgar Sena that a solution was found and the entire team went to the state secretariat to meet chief secretary JS Saharia and principal secretary of transport SK Sharma.
At 6pm, the "strike" was called off after the BEST administration withdrew the Canadian firm-made computerised duty chart. "Necessary changes will be made to the duty schedule, which will be mutually acceptable to all parties. The revised rota will come into force from June 1. Moreover, with the new bus depot at Malad becoming operational from April 7, necessary adjustment will be made in duty schedule and adequate manpower will be deputed there," said Saharia.
He claimed that the administration was trying to resolve the issue since last (Tuesday) evening and had almost succeeded in doing so. However, there were some hiccups. Attempts to resolve the issue had continued even on Wednesday, with the first round of negotiations being carried out between BEST officials and the union and then another round later in the day. Now, it has been resolved and an agreement has been signed, Saharia added.
When asked who will be held responsible for the inconvenience caused to people, Rao dished out a weak apology and said "he blamed the administration for the anger among the workers".
Saharia refused to commit on whether the losses incurred due to the strike would be recovered from the union and staff.