text:
An apparatus and method for mixing parenteral nutrition solutions from additives in a plurality of vials containing the additives, in which a vented spike is inserted through a disposable rack and into the stoppered end of each vial, with the vials secured on the rack. The rack is engaged on a stand through a quick release fitting, and maintains the vials in a vertical orientation with the labels clearly visible. A dedicated syringe is connected with each vial in aligned relationship therewith through a unique two-way valve which is mounted to a manifold. In one form of the invention, the valve is attached directly on the manifold to reduce dead space volume and consequently reduce residual fluid in the system between purges. A flushing system is attached to one end of the manifold to flush any residual fluids into the final container at the end of a transfer process. The other end of the manifold may be attached in tandem with a further manifold in a further apparatus containing additional vials for admixing even further additives.
1. An apparatus for preparing parenteral nutrition solutions from a plurality of additives contained in individual vials having sealed ends, comprising:
a rack for supporting the vials in a predetermined relationship adjacent one another, said rack having means thereon for contacting and supporting said vials in said predetermined relationship, and having quick release means for releasable attachment of said rack on a stand, said rack further having openings therethrough aligned with the positions of said vials on said rack means;
means for piercing the sealed ends of said vials to gain access to the contents thereof, through a respective opening in the rack means and into the sealed end of an associated vial, the piercing means being held on one side of the rack and an associated vial being held on the other side, said piercing means including means for attachment thereto of a pump for withdrawing additive from the associated vial, wherein an individual pump is held in associated, aligned relationship with each vial, whereby a plurality of vials and associated piercing means may be assembled to said rack and the assembly of the rack, the vials and the piercing means releasably atached to a stand, wherein:
said rack comprises an elongate, rectangularly shaped, flat bar, said openings being spaced along the length of the bar, said means for contacting and supporting the vials comprises upstanding cylindrical walls on a top surface of the bar, and said quick release means comprises key-hole shaped openings through the opposite ends of the bar; and
said stand includes a pair of elongate arms projecting in a common direction from a base, said arms having headed ends for engagement in said key-hole shaped openings and being flexible to align the headed ends with the larger part of the key-hole shaped openings whereby the headed ends may be passed through the key-hole shaped openings to enable the bar to be attached to and removed from the arms.
2. An apparatus as claimed in claim 1, wherein:
the containers of additives comprise vials each having a stoppered end;
said means for accessing the contents of the containers includes a piercing spike having a piercing end for penetrating the stoppered end;
said pump means each comprises a syringe attached to a respective piercing spike;
a manifold means is connected with the syringes to receive the additives from the syringes attached to the respective vials;
a multi-way valve means is connected with each syringe to control flow from the associated vial, to the syringe and thence into the manifold;
said multi-way valve means comprises a valve body having a first one-way valve to enable flow from a vial into the associated syringe but prevent reverse flow from the syringe into the vial, and a second one-way valve to enable flow from the syringe into the manifold but prevent reverse flow from the manifold to the syringe, said one-way valves being constructed and positioned relative to the manifold so as to minimize residual material in the apparatus; and
a flushing means is connected with the manifold means to flush any residual material from the manifold means following transfer of an additive from its container to the final solution container.
3. A method of mixing a plurality of additives to produce a parenteral nutrition solution, comprising the steps of:
supporting a plurality of vials containing the additives in predetermined relationship to one another;
attaching a plurality of pump means in predetermined aligned relationship with the vials so that a pump means is provided for each vial and is held in aligned relationship thereto;
using the pump means to successively draw the additives from the vials and expel the additives into and through a manifold to a container for the parenteral nutrition solution; and
flushing the manifold with a flushing solution to remove any residual additives from the manifold following a mixing procedure.
4. A method as claimed in claim 3, including the steps of:
supporting the vials and pump means on a disposable rack; and
releasably attaching the rack to a stand, said vials and pump means being assembled to the rack after to attachment of the rack to the stand.
This invention relates to the medical arts, and more particularly, to an apparatus and method for mixing parenteral nutrition solutions.
Parenteral nutrition typically involves the infusion into a patient of diverse active ingredients usually including pharmaceutically-active chemicals. These substances often cannot be pre-mixed, packaged, sterilized, prepared or stored together, however, for medical as well as practical reasons, their administration as mixtures is often preferred. Accordingly, the concept of parenteral nutrition has evolved into a process in which a complex mixture of pharmaceutically-active substances is made for administration to a patient. These mixtures generally include multiple base solutions to which are added numerous additives, sometimes as many as twelve or more. Once mixed, these parenteral materials are drawn from individual vials, capped with rubber stoppers, and with capacities ranging in size from 5 ml to 100 ml. Generally, different patients require different combinations of additives in varying concentrations, with each mixture adapted and customized to meet the needs of a particular patient and supplement the body's nutritional needs indicated by various diagnostic and blood chemistry tests routinely performed.
In a typical prior art method of parenteral nutrition, a basic parenteral nutrition solution of amino acid and 50% dextrose is prepared by trained personnel. Sterile, sealed, rubber-stoppered vials containing the various additives are assembled and placed under a laminar flow hood to produce a sterile environment. The sterility cap is removed from each vial and an empty sterile syringe is placed in front of each vial. Usually a pharmacist, knowing the drug additive order, picks up each vial, one at a time, verifies the contents, swabs the rubber stopper with alcohol, inserts the syringe needle, inverts the bottle and withdraws the desired amount of the additive. The needle is then withdrawn and the vial set down and moved toward the final parenteral administration container, where the site of injection on the bag or bottle is cleaned with alcohol and the needle inserted into the final container to insert the additive. Extreme care must be maintained not to puncture the side of the injection port of the bag during insertion and withdrawal of the needle.
This process is repeated numerous times daily for each solution admixture bag or bottle, sometimes as much as 12 times, three times a day for each 1000 ml container per patient. A medium to large size health facility or hospital may have as many as from 25 to 50 patients on total parenteral nutrition solutions on any given day. Thus, the technician or pharmacist may be required to prepare 75 to 150 parenteral nutrition solutions per day, involving manipulations for 900 to 1800 individual vials.
The number of manipulations and process steps required in the prior art process described above is extremely costly, time consuming and tedious, and increases the risk of danger in a breach in the sterile technique. Moreover, errors arising from inaccurate dosing from each vial is a serious problem. Further, there is increased danger of introducing cored rubber particles from the syringe punctures into the final container. In addition, non-vented vials can spread aerosolized drug or chemicals onto the preparer's hands during the multiple insertions required to prepare the final mixture. Significant cost is also incurred because of the continuous disposal of syringes and needles used in the transfer process.
In an effort to reduce or eliminate the foregoing problems, various closed systems and electronically controlled apparatus have been devised. One example of a closed system is described in U.S. Pat. No. 4,433,974, wherein a plurality of additives in individual containers are withdrawn using a syringe and then injected utilizing a multiple transfer valve into a container for the final mixture. This final container is then connected to a perfusion pump for infusion of the mixture into the patient. This system, while overcoming many of the problems mentioned above, requires manual manipulation of tubing clamps for each additive container, and cross-contamination can result from any residual fluid left in the conduits below the clamps. Moreover, the use of a single syringe to withdraw the materials from the various additive containers does not provide a ready visual reference for the sequence of mixing the additives, and/or the quantity of each additive withdrawn.
Accordingly, there is a need for an apparatus which is economical and easy to use in the mixing of parenteral nutrition solutions, which reduces or eliminates multiple manipulations of apparatus such as clamps or vials, aids in maintaining a sterile environment, provides a ready visual indication of the additive and the quantity of the additive being withdrawn, and minimizes the danger of introducing cored rubber particles into the parenteral solution.
It is therefore an object of the present invention to provide an apparatus that is economical and easy to use for mixing parenteral nutrition solutions.
Another object of the invention is to provide a closed system for the mixing of parenteral nutrition solutions, wherein the system affords a ready visual indication of the additive and the quantity of that additive being withdrawn from each additive container.
Yet another object of the invention is to provide an apparatus for mixing parenteral nutrition solutions, wherein a minimum number of manual manipulations are required to mix the additives.
A further object of the invention is to provide a parenteral nutrition admixture apparatus, in which containers of additives to be admixed are held on a disposable rack in aligned relationship with syringes for withdrawing additive from the containers, thereby providing visual reference of the additive selected and the quantity of that additive remaining.
Another object of the invention is to provide an apparatus for mixing parenteral nutrition solutions, in which unique valving means is associated with the vials containing the additives and with the remainder of the system so that minimal residual fluid is left in the system.
Yet another object of the invention is to provide a closed system for mixing parenteral nutrition solutions, with a flush connection for flushing any residual fluid from the system.
An even further object of the invention is to provide a fast and efficient method for mixing parenteral nutrition additives by eliminating all vial and syringe needle manipulations in the transfer process.
Another object of the invention is to provide an apparatus for use in the preparation of parenteral nutrition solutions, wherein the entire system is compact and designed to enhance sterile laminar air flow.
These and other objects and advantages of the invention are accomplished by an apparatus and method in which a vented spike is inserted through a disposable rack and into the stoppered end of each vial, with the vials secured on the rack. The rack is engaged on a stand through a quick release fitting, and maintains the vials in a vertical orientation with the labels clearly visible. A dedicated syringe is connected with each vial in aligned relationship therewith through a unique two-way valve which is mounted to a manifold. In one form of the invention, the valve is attached directly on the manifold to reduce dead space volume and consequently reduce residual fluid in the system between purges. A flushing system is attached to one end of the manifold to flush any residual fluids into the final container at the end of a transfer process. The other end of the manifold may be attached in tandem with a further manifold in a further apparatus containing additional vials for admixing even further additives.
The foregoing as well as other objects and advantages of the invention will become apparent from the following detailed description when considered in conjunction with the accompanying drawings, in which like reference characters designate like parts throughout the several views, and wherein:
FIG. 1 is a perspective view of a first form of apparatus according to the invention;
FIG. 2 is an exploded perspective view, with portions removed for purposes of clarity, of the apparatus of FIG. 1;
FIG. 3 is a side view in elevation, with portions broken away, of the stand for use with the rack that holds the vials in the apparatus of the invention;
FIG. 4 is a top plan view of the stand of FIG. 3;
FIG. 5 is an enlarged fragmentary view in elevation of the portion of FIG. 3 circled at 5;
FIG. 6 is a transverse sectional view taken along line 6--6 in FIG. 3;
FIG. 7 is a side view in elevation of the disposable rack that is used to hold the vials in the apparatus of the invention and which is releasably attached to the stand of FIG. 3;
FIG. 8 is a top plan view of the rack of FIG. 7;
FIG. 9 is a greatly enlarged longitudinal sectional view of the vented spike used for piercing the stoppered ends of the vials;
FIG. 10 is a greatly enlarged longitudinal sectional view of the unique multi-way valve used to connect the vials to the manifold;
FIG. 11 is an enlarged fragmentary top plan view of a portion of the manifold and a point of attachment to the valve of FIG. 10;
FIG. 12 is an end view of the manifold and attachment of FIG. 11;
FIG. 13 is a view in section taken along line 13--13 of FIG. 10;
FIG. 14 is a fragmentary perspective view of the manifold and points of attachment for the valves;
FIG. 15 is an enlarged fragmentary view in front elevation of a modified form of the invention wherein the rack and stand of FIG. 1 are used in combination with a modified valve and manifold;
FIG. 16 is a fragmentary end view of the apparatus of FIG. 15;
FIG. 17 is an exploded fragmentary perspective view of a portion of the manifold and the valved elbow connector for attaching the manifold to the valve in the apparatus of FIG. 15;
FIG. 18 is a view in elevation of a further modified apparatus for mixing parenteral nutrition solutions, in which a different stand and valving means are used;
FIG. 19 is an end view of the apparatus of FIG. 18; and
FIG. 20 is a perspective view of an apparatus according to FIG. 1, in which two stands and sets of vials are connected in tandem.
Referring more particularly to the drawings, a first form of apparatus in accordance with the invention is indicated generally at 10 in FIGS. 1 and 2.
The apparatus includes a novel stand 11 having a base plate 12 and upstanding arms 13 and 14 at its opposite ends. A disposable rack 15 is adapted to be releasably engaged with the upper ends of the arms 13 and 14 by means of headed projections 16 and 17 on the upper ends of the arms which engage in key hole slots 18 and 19 at the opposite ends of the rack 15. In this connection, the arms 13 and 14 have a normal, upright position with the headed ends engaged in the smaller section of the slots 18 and 19, to prevent withdrawal of the headed ends through the slots. The arms may be flexed outwardly relative to the rack 15 to align the headed ends 16 and 17 with the larger openings in the slots for removal and/ or replacement of the rack on the stand. The rack includes a plurality of upstanding cylindrical walls or cup-shaped formations 20, 21, etc. with concentrically disposed openings 22, 23, etc. extending through the rack 15.
In a preferred construction, the rack 15 may comprise a plastic material such as rigid PVC, while the arms 13 and 14 may be made of stainless steel or the like. The stand may be secured to a support surface by any suitable means, such as fasteners (not shown) extended through openings 24 in the base plate 12.
A plurality of vented spikes 26, 27, etc., corresponding to the number of vials V1, V2, etc., each has a piercing end 25 which is inserted upwardly through a respective opening 22, 23, etc., and into the stoppered end of an associated vial placed in the cup-shaped formations 20, 21, etc, on top of the rack 15. A flange 28 on the vented spike engages beneath the rack 15 whereby the vials and vented spike are securely attached to the rack on opposite sides thereof. When the rack is assembled to the stand as shown in FIGS. 1 and 2, the vials are accordingly held in an upright position.
A manifold/valve assembly 30 is secured to the plurality of vented spikes 26, 27, etc., and includes a plurality of multi-way valves 31, 32, etc., with each valve being attached to a respective vented spike 26, 27, etc. As seen best in FIG. 10 through 13, each valve 31, 32, etc., comprises a valve body 33 having a tapered male end 34 on one end thereof for attachment to a respective vented spike 26, 27, etc., and a female tapered end 35 on the other end for attachment of a syringe S1, S2, etc. The ends of the valve body are offset as seen best in FIG. 10, and a first valve seat 36 is defined therebetween for cooperation with a first check valve 37. The check valve 37 comprises a flexible disc normally held in closed position against the valve seat 36 by an elongate arm or stop 38.
The side 39 of the valve body opposite the seat 36 is open and a valve seat member 40 is secured thereon by any suitable means such as a sonic weld or the like. The seat member 40 includes an end wall 41 with a plurality of openings 42 formed therethrough. An annular flange or wall 43 defines an annular pocket 44 for receipt of a respective cylindrical projection 45, 46, etc. on the manifold 47. The seat member 40 is secured to the manifold by any suitable means such as a sonic weld or the like, whereby the valves 31, 32, etc. form an integral structure with the manifold 47. With the vented spikes and vials attached to the rack 15 as described above and with the manifold/valve assembly attached to the vented spikes, the apparatus results in a structure wherein each vial is held in aligned relationship with the respective valve and syringe S1, S2, etc., so that ready visual reference can be made to the additive which is being withdrawn at a particular time and to the quantity of that additive being withdrawn.
As seen best in FIGS. 10, 12 and 13, the end wall 41 of seat member 40 defines a second valve seat 48 for cooperation with a normally closed flexible valving disc 49 that is secured at its periphery between the manifold 47 and the end wall 41 and has a central opening 50 therethrough so that when fluid pressure deforms the valving disc 49 away from the seat 48, flow can occur through the openings 42 in end wall 41 and through the opening 50 into the manifold 47. The valve disc 49 is shown in closed position in full lines in FIG. 10 and in open position in dot and dash lines.
In use of the apparatus, a plurality of vials V1, V2, etc., are assembled with a rack 15 and vented spikes 26, 27, etc., attached thereto as described previously. The rack is then engaged on the arms 13 and 14 of the stand 11, and the manifold/valve assembly 30 is attached to the vented spikes. Syringes S1, S2, are attached to the valves 31, 32, on the manifold/valve assembly, with the number of syringes corresponding to the number of vials and each syringe being dedicated to a specific vial and held in vertically aligned relationship thereto.
The respective syringes S1, S2, etc. are manipulated in a desired sequence to draw material from the respective vials V1, V2, etc. through the respective multi-way valves 31, 32, etc. and past valve disc 36 into the respective syringe. The syringe is then manipulated in a reverse direction to expel the previously withdrawn material back through the valve 31, 32, etc. and past the valve disc 49 into the manifold 47. From the manifold the material flows through a length of tubing 52, through a syringe 53 and into a final container 54 for the parenteral nutrition solution to be administered to a patient. The syringes are manipulated in turn as described above to withdraw desired additives from the respective vials through the valves, into the respective syringe and thence back through the associated valve into the manifold and to the container 54.
A container 55 is connected through a length of tubing 56 with a valved fitting 57 connected to the end of the manifold remote from the final container 54 and a syringe pump SP is connected with the conduit to draw a flushing solution, such as normal saline or the like, from the container 55 and force it through the manifold to remove any residual additives left therein following the transfer operation previously described. A suitable clamp 57 is positioned in the length of tubing 56 to interrupt flow therethrough as desired.
A first modification of the invention is indicated generally at 60 in FIGS. 15 through 17. In this form of the invention, a vented spike 26 connects with a vial V1 through the disposable rack 15, which is supported on the stand 11 as previously described. In this form of the invention, however, a different multi-way valve 61 is used to connect the vented spike 26 to manifold 30'. The multi-way valve 61 used in this form of the invention is of the type shown and described in applicant's prior patent No. 4,729,401, and includes a pair of normally closed flexible discs positioned to control flow from the vial into a syringe S1, and then from the syringe back through the valve and through an elbow fitting 62 into the manifold 30'. A check ball valve 63 is positioned in the elbow fitting for preventing reverse flow from the manifold 30' and avoiding cross contamination. The elbow fitting 62 is attached to the manifold 30' via a female coupling 64 formed integrally with the manifold. Except for the modified valve 61 and elbow fitting 62, this form of the invention is substantially the same as that previously described and functions in essentially the same way.
A second modification of the invention is represented generally at 70 in FIGS. 18 and 19. In this form of the invention, a multi-way valve 61 and vented spike 26 of the type shown in FIGS. 15 through 17 are used. However, the multi-way valve 61 is connected to a modified manifold 30" through a valved connection 65, and the manifold 30" is carried on one arm of a T-shaped bracket 66 which has its other arm releasably fixed in a slot 67 on a modified stand 11'. Set screws 68 extend through the rack 69 of the stand 11' into engagement with the arm of the fitting 66 to retain it in the slot 67. The bracket 69 is permanently affixed to the upper ends of arms 13' and 14' which are, in turn, secured at their lower ends to a base 12'. The vented spike 26 and vials V1, V2, etc. are carried on the end of an L-shaped bracket 71 extending forwardly from a top edge portion of the bracket 69. In all other respects this form of the invention is substantially as previously shown and described, and functions substantially identical, to the form of the invention in FIGS. 1 and 2.
In FIG. 20, a further variation of the invention is represented generally at 80, wherein a plurality of the assemblies shown in FIGS. 1 and 2 are connected in tandem for admixing even further additives in producing a parenteral nutrition solution. In this arrangement, a length of tubing 81 connects the outlet end of a first manifold 47 with the inlet end of a second manifold 82, and the outlet of the second manifold is connected through a length of tubing 52 with the final solution container 54.
The apparatus of the invention provides a fast and efficient method for producing a total parenteral nutrition solution and assures sterile preparation of the final mixture due to the elimination of all vial and needle manipulations. Further, the risk of medication dosage error is substantially reduced since the vial and dedicated syringe is always held in aligned relationship for ready visual identification of the additive being selected and the level of that additive. Moreover, the apparatus of the invention places the vials, manifold and syringes in the most effective physical position for sterile laminar airflow under the hood of the sterile environment containment device. The apparatus of the invention is also compact in design, saving valuable space for other uses. The combination of multi-way valves and couplings to the manifold are designed such that minimum dead space is created, thus resulting in a minimum amount of residual fluid following a transfer operation. In addition, the flushing assembly attached to the manifold permits any residual fluid which does remain to be flushed into the final container following a transfer operation. Still further, the completely closed system approach to the compounding of the numerous additives and their transfer to the final mixture container minimizes or eliminates any breaches in the sterile environment.
Although the invention has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the application of the principles of the invention. Numerous modifications may be made therein and other arrangements may be devised without departing from the spirit and scope of the invention.
Patent Citations
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Page 2
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Wednesday, March 12, 2003
Updated: July 20, 9:46 PM ET
Turning the page on Charlie Hustle
By Jim Caple
Page 2 columnist
No need to speculate. We'll know when Bud Selig is finally ready to lift Pete Rose's lifetime ban, because the night before it happens, ol' Charlie Hustle probably will be seen in a crack house.
Pete hasn't been very humble in his post-ban life.
The man just can't keep himself from wallowing around in mud. Whenever he sees a cesspool, he leaps in and coats himself as if it were Brylcreem. When he received his lifetime ban in 1989, he reacted by hawking memorabilia on a shopping network that very night. Just when momentum rose to lift his ban last December, Rose defiantly strutted around Vegas casinos (his hair is the only color that may be more visible than the lights on the Strip), amid revelations that he owes the IRS $150,000 in back taxes.
Yeah, it sounds like he's really turned around his lifestyle.
And yet the man remains unaccountably popular, not unlike Ben Affleck. He is pretty much the antithesis of what we like in an athlete. He was a hot dog, he is arrogant, he did time as a tax cheat, he charges for his autograph, he gambled on the game -- about the only vice missing is drug abuse. If he were black, a lot of people would want him in solitary confinement instead of Cooperstown.
So what accounts for his persistent popularity? Two things. His ban has undeservedly turned him into a martyr, and he always hustled to first base when he walked. A recent ESPN.com user poll related to Rose last December found that more fans are offended by a player not hustling than by a player gambling on the game. Good God. As if it were worse not to run out a groundball than to bet against your team.
Rose has so much public sentiment on his side that he probably will see his ban lifted soon, as long as he first admits to betting on baseball and issues an apology.
You might argue that it is contradictory to lift Rose's ban if he admits guilt. In a way, it would be like a convicted murderer being pardoned for admitting his guilt just before the switch is thrown.
Shoot. Now that you finally admitted the crime we're punishing you for, I guess we have to let you go.
There are some key differences, though. When commissioner Bart Giamatti banned Rose in 1989, it was agreed that he would become eligible for the Hall of Fame, same as everyone else. Baseball changed its mind on that, which isn't right. If the commissioner's office sees fit to allow Rose on the field whenever a credit card company pays it enough, it should allow him to be eligible for the Hall of Fame based on what he did as a player.
Let Pete into Cooperstown and he'll be yesterday's news.
This would not be the same thing as pardoning his crime or lifting his permanent ban from baseball. It would merely be lifting his ban from a museum. As a compulsive gambler, Rose should never be allowed back in baseball in a role that could possibly influence the outcome of a game.
However, that should not preclude him from working in public relations or broadcasting a game. If Rose can help draw fans into baseball, everyone benefits.
Baseball also would benefit from letting Rose into Cooperstown, because it would finally end the controversy. As soon as Rose enters Cooperstown, he becomes yesterday's news, the same way Jesse Ventura did when he left the governor's office. He'll no longer be the center of the storm. He'll no longer be a question at every Selig press conference. He'll no longer be the topic of radio talk shows. Heck, some stations may have to go out of business.
Keep Rose on death row, and he remains baseball's official canker sore. Put him in Cooperstown and he becomes Johnny Bench. Just another guy with a plaque.
Albeit a plaque he'll be willing to sell if your credit limit is high enough.
Jim Caple is a senior writer for ESPN.com.

subset: commoncrawl


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Author(s): Schwartz, Seth
ISBN 10: 0691155437. See all ISBN's
Publisher: Princeton University Press
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How well integrated were Jews in the Mediterranean society controlled by ancient Rome? The Torah's laws seem to constitute a rejection of the reciprocity-based social dependency and emphasis on honor that were customary in the ancient Mediterranean world. But were Jews really a people apart, and outside of this broadly shared culture? Were the Jews a Mediterranean Society? argues that Jewish social relations in antiquity were animated by a core tension between biblical solidarity and exchange-based social values such as patronage, vassalage, formal friendship, and debt slavery.
Seth Schwartz's examinations of the Wisdom of Ben Sira, the writings of Josephus, and the Palestinian Talmud reveal that Jews were more deeply implicated in Roman and Mediterranean bonds of reciprocity and honor than is commonly assumed. Schwartz demonstrates how Ben Sira juxtaposes exhortations to biblical piety with hard-headed and seemingly contradictory advice about coping with the dangers of social relations with non-Jews; how Josephus describes Jews as essentially countercultural; yet how the Talmudic rabbis assume Jews have completely internalized Roman norms at the same time as the rabbis seek to arouse resistance to those norms, even if it is only symbolic.
Were the Jews a Mediterranean Society? is the first comprehensive exploration of Jewish social integration in the Roman world, one that poses challenging new questions about the very nature of Mediterranean culture.
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ISBN 10: 0691155437, ISBN 13: 9780691155432, eISBN 10: 1400830982, eISBN 13: 9781400830985
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Almost No One Is Happy With Proposed N.C. Illegal Alien Driver's License
You can put me in the category of "if we are forced to give DLs to illegals, this is not a bad idea"
(Fox News) A new driver's license expected to be issued to some illegal immigrants in North Carolina has prompted state lawmakers and immigrant rights groups to voice concerns over the proposal.
The proposed North Carolina Division of Motor Vehicles license has a bright pink stripe and the bold words "NO LAWFUL STATUS."
The North Carolina Division of Motor Vehicles announced last week they would begin issuing the licenses March 25 following a lengthy legal review. The Obama administration's Deferred Action for Childhood Arrivals program grants valid federal work permits to qualified applicants brought to the U.S. as children without legal authorization.
Unfortunately, under multiple laws, legal rulings, and Obama's executive order, NC has to issue DLs to some illegals. Republicans do not want any DLs issued, and are trying to block this till at least June. Illegals do not like it, either
Cinthia Marroquin, a 22-year-old Raleigh resident awaiting approval for a DACA permit, said the longer the license issue is delayed, the longer it will take for her to get a job and drive herself to work. Even if she is able to get one, she is worried about presenting a license declaring she has "NO LAWFUL STATUS" at a police roadblock or while writing a check at the grocery store.
"A lot of us are just scared," said Marroguin, who came to the U.S. from Mexico when she was 15. "We just want to be able to get a job and drive to work. Having that license is just going to show everybody you're here illegally, just buying a beer or writing a check. You don't know how people might react."
You are here illegally. If you're not proud of that, perhaps you should leave and stop wasting the money the State of NC and the US government already do not have. And stop taking jobs from US citizens.
The American Civil Liberties Union of North Carolina also takes issue with the designation.
"North Carolina should not be making it harder for aspiring citizens to integrate and contribute to our communities by branding them with a second-class driver's license," said ACLU attorney Raul Pinto. "There is simply no reason for officials to stigmatize people who are in the U.S. legally with an unnecessary marker that could lead to harassment, confusion, and racial profiling."
Got that? The ACLU is deeming that people here illegally are not here illegally. Remember when the ACLU stood for law, order, and the Constitution? Well, me neither, but they say they do.
Many Republicans are pushing legislation that will make it against NC law to issue DLs to illegal aliens, stating that Obama's DACA violates the Constitution since no law was passed by Congress, but by executive fiat.
Crossed at Pirate's Cove. Follow me on Twitter @WilliamTeach.
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text:
Bruins announce national TV schedule
|08.30.12 at 4:52 pm ET
The Bruins on Thursday announced their national television schedule for the upcoming season, something that obviously depends on when the season actually starts.
Starting with the first game of the season (Oct. 11 against the Flyers), the Bruins will have select games broadcast on the NBC Sports Network, while the first NBC game is the annual "Thanksgiving Showdown," which they play the Friday after Thanksgiving. This season, the B's will host the Rangers on Black Friday.
Following is the Bruins' national TV schedule:
Bruins games broadcast on NBC Sports Network:
Thursday, Oct. 11, at Philadelphia, 7 p.m.
Tuesday, Nov. 27, vs. New Jersey, 7 p.m. (non-exclusive)
Monday, Dec. 10, at Detroit, 7:30 p.m. (non-exclusive)
Wednesday, Jan. 9, at Buffalo, 7:30 p.m.
Sunday, Jan. 13, at New York Rangers, 7:30 p.m.
Tuesday, Jan. 29, vs. St. Louis, 7 p.m.
Monday, Feb. 4, at Colorado, 9 p.m.
Wednesday, Feb. 6, vs. Buffalo, 7:30 p.m.
Monday, March 4, vs. Montreal, 7:30 p.m. (non-exclusive)
Wednesday, March 27, vs. Montreal, 7:30 p.m.
Wednesday, April 10, at New Jersey, 7:30 p.m.
Bruins 'flex' game on NBC Sports Network:
Sunday, March 31, at Philadelphia, 7:30 p.m.
Bruins Games Broadcast on NBC (all times Eastern):
Friday, Nov. 23, vs. New York Rangers, 1 p.m.
Sunday, Feb. 17, at Chicago, 3:30 p.m.
Bruins 'flex' games on NBC:
Sunday, March 10, at Washington, 7:30 p.m.
Sunday, March 17, at Pittsburgh, 7:30 p.m.
Saturday, April 13, at Buffalo, 7:30 p.m. (non-exclusive)
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Tired of watching his long-awaited debut album, most recently titled A Dolla and A Dream, collect dust on the label shelves, Dolla decided it was time to part ways with Jive Records. Like so many other victims of label politics (see the Clipse, Joe Budden, Stat Quo), the Atlanta native may find that these issues motivate him to tackle deeper lyrical themes. On Georgia Nights, Dolla addresses his life struggles, particularly the string of early deaths in his family, and ultimately arrives at the conclusion that he must simply keep moving in spite of the pain. Producer Ear Hustla provides a fittingly melancholy backdrop, complete with a sample of blues standard Rainy Night in Georgia (popularized by Brook Benton and later covered by the likes of Ray Charles and Hank Williams, Jr.). Though Dolla's label team expects the album to drop this fall, don't be surprised if he stays in the underground for a while, joining a class of MCs skilled at building their raindrops into water fountains.
Written by Burmy on May 12, 2009
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Gallery: How To Get Healthy and Lose Weight by Going Green!
Pack your lunch
Bringing a pre-packed lunch to work can do wonders to help your weight loss plan. By making a premeditated decision on what you will eat, you can control the portion size and ensure your meal will be full of fresh and low calorie foods. Go green with your packed lunch by transporting it in a reusable bag. You can even make a bag that hooks onto your bike frame by following these DIY instructions here.
Photo by Lenore Edman
Boycott the Car
Walking everywhere you need to go, or at least walking to the public transit that will take you everywhere you need to go, is a fantastic way to help yourself and the environment. You can burn more than 200 calories per hour by walking, which will result in weight loss when combined with a balanced diet. And by walking instead of driving, you are saving on CO2 emissions and cutting back on usage of fossil fuels.
photo by Stephen Heron
Go Vegan
Eating vegan, which means cutting out diary, eggs, and all animal products, has an astounding number of health benefits. Its easy to imagine that less animal fat would help with getting healthy, but did you know that a vegan diet has also been to help rheumatoid arthritis and even stave off allergies? Being vegan also helps the environment, by saving on all of the energy and water used to raise animals. We often forget about these "hidden" wasted resources. If you are finding it hard to compare the amount of water used to grow the veggies in a salad, versus the meat for a hamburger, the folks at GOOD published a fantastic infographic that shows the HUGE disparity.
If you are having trouble knowing how to start a vegan diet, PETA has a nice web introduction set up. And if you feel that going vegan is not going to work for you, try vegetarian — or at least doing meatless Mondays.
photo by Nikki L.


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Need to know: Unhappy bankersStrange jobsGoldman dress code
Origin Energy is seeking proposals for the planned development of the 547-megawatt Stockyard Hill Wind Farm in Australia's Victoria state.
A spokeswoman for Australia's largest electricity retailer said it recently commenced a process to assess a range of development options for the wind farm.
"This involves seeking proposals from third parties interested in supplying wind turbines, constructing the wind farm on Origin's behalf or providing equity for the wind farm's development while Origin supports it through a power purchase agreement," she said in an emailed statement.
Australia's government defied outraged mining executives to pass controversial taxation policies on carbon pollution and resources profits. Now it's taking lessons learned from those experiences and sharing it with African nations who want to get more value from their vast resource wealth.
"As African governments are trying to work out the best options for their circumstances, Australia is a natural place for them to be looking for possible policy options and experience," said Ann Harrap, the Australian High Commissioner for South Africa. "We talk a lot with African governments about our experience in getting the most out of our minerals resources sector."
Deal Journal Australia is an up-to-the-minute take on the deals and deal makers that shape the Australian landscape, including mergers and acquisitions, capital raisings, private equity and debt markets. In short, wherever money changes hands. Deal Journal Australia is updated throughout each trading day with exclusive commentary, analysis, data, news flashes and profiles. The Wall Street Journal's Gillian Tan is the lead writer, with contributions from other Journal and Dow Jones reporters and editors. Send news items, comments and questions to email@example.com.
Content engaging our readers now, with additional prominence accorded if the story is rapidly gaining attention. Our WSJ algorithm comprises 30% page views, 20% Facebook, 20% Twitter, 20% email shares and 10% comments.
FINS has become a part of DHI in order to improve your job search experience. eFinancialCareers will provide you with the best possible service, the best job opportunities and editorial content and the best talent. With our long track record of helping finance professionals develop their career, from graduating to landing top positions in the industry, we will continue to deliver.
For technology jobs outside the financial industry users can visit Dice.com


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The surge in early January deal announcements has boosted monthly M&A figures.
Last month, there were 792 U.S. announced mergers, valued at $50.6 billion, according to data from Thomson Reuters. This compares to 678 deals in January 2012, totaling $48.9 billion, Thomson Reuters says. The number of deals was up nearly 17% while transaction value was flat.
The biggest deal last month was Dish Network's nearly $8 billion bid for Clearwire.
On the private equity side, the totals are better. We had 181 U.S. announced private equity deals in January, valued at roughly $8.2 billion, according to Thomson Reuters. This compares to 130 deals for the same time period in 2012, totaling $4.6 billion. The number of deals in January increased by nearly 40%, while transaction value rocketed nearly 78%.
Yesterday, Tony James, the Blackstone Group's president, pointed out several times that current deal market is slow. This may seem to conflict with January's totals, which seem high. That's because the transaction data relies on deal announcements, which are the result of discussions occurring months ago.
Here's the top five deals for the month of January, according to Thomson Reuters (publisher of peHUB). Of the five deals, all but one were announced during the first half of the month.
Photo courtesy of Shutterstock


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FMLY Fest assembles dozens of musicians for DIY weekend
By Emily Eveland
Hollow Boys embrace the dark on third album
By Sarah Stanley-Ayre
10 Thousand Sounds 2014: Behind the bands
By CP Staff
Black Market Brass delivers hip-shaking funk rhythms
By Zach McCormick
For the Love brings hip-hop festivities to Lowertown
By Jack Spencer
Kitty Cat Klub hosts Tourniquet Noise series
By Sarah Stanley-Ayre
Max Gremillion steps into the spotlight
By Rob van Alstyne
The world of Howler's sophomore album
By Zach McCormick
Thanks to Tom Ridge and Homeland Security, we know what it means when the terror alert goes from yellow to orange. But what does it mean when Harlem rapper Cameron Giles upgrades his wardrobe from pink to purple? Pink Air Force Ones, pink chinchilla fur, and a pink Range Rover went to the curb as Cam'Ron replaced them with a hue to rival the Vikings' home jerseys. It's the color of his cognac punch, Sizzurp, and it tints the bricks, buildings, and clouds behind him on the cover of his second album for Roc-A-Fella--it's called Purple Haze, of course.
Ever the canny CEO, Cam'Ron expands his brands past pop charts to pie charts. After a stint alongside Mase in the Children of the Corn, Cam broke out with two gold albums and the chirpy "Oh Boy" (which is now the name of his line of cologne.) He's a ghetto author and CEO of his own company, as he once explained on The O'Reilly Factor. (Leave it to Bill to remind his audience that Cam also "raps about pimping and bitches.")
On Haze, Cam still talks about the supply side of the economy--pimping, slinging, blinging, killing--but he delivers his lines with a steady Dada flow that relishes the ludicrous sound of his own loquaciousness. Loping along with the African vocal cadences that gurgle through the title of "Killa Cam," he boasts about being realer than "Kumbaya," babbling about "yellow diamonds in my ear: Call 'em Lemonheads... ice like Winnipeg, gemstones, Flintstones/You could say I'm friends with Fred." Then he namedrops Scrappy, Governor Pataki, and Laffy-Taffy in the next line. Surreal and street, his rhymes are exquisite corpses making exquisite corpses.
Growing stronger as it progresses, Purple Haze could've been a contender for the best hip-hop album of 2004, had it not been released in December. Godboy producer Kanye West speeds up some old soul (what else?) for the radio rotation of "Down and Out," bringing in the chirpy voices that have been a part of Cam'Ron and his Diplomat crew's mix tapes even before The College Dropout. "Shake" accelerates a femme mewl until it stabs through the melodramatic violins, while a creepy chipmunk voice goads girls to "twist your hips and lick your lips."
Though Killa flows over staples like Roger Troutman, Smokey Robinson, and Ohio Players, he really shines when he's brunting against tracks that aren't necessarily funky or even good. On "More Reasons," Cam shuffles slowly through a show-tune strut lifted from Earth Wind and Fire, nonchalantly filling the measures. For "Harlem Streets," he breaks bricks of coke over Mike Post's theme from Hill Street Blues, and elsewhere brags about "days on Kawasaki, nights with Lewinsky" against soundtrack strings. He even rides Cyndi Lauper's "Girls Just Wanna Have Fun"--one guess as to how he flips the title's intent.
But Cam'Ron's purple prose also matches the blue-haired crowd. Namedropping Cocoon and shopping at Neiman Marcus and Bloomies on Haze's vertiginous peak, "Get 'Em Girls," Cam'Ron could be the answer to Vice magazine's question: "When did hip hop get so Golden Girls?" Deadpan and steely, his absurd lines about The Maury Show and the Hokey Pokey cut through ruffian huffs and histrionic choruses from--of all things--Carmina Burana. It's the type of beat that's used to push indigo BMWs.
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Boxer Credits God for … Defeat?
Salita, in Israel, reflects on loss
It's been only a few days since Dimitry "Star of David" Salita's 76-second pummeling at the fists of world junior welterweight champion Amir Khan in Newcastle, England Saturday night, yet already the Ukrainian-born, Brooklyn-bred Orthodox Jewish boxer is waxing philosophical on his humbling defeat. And he's doing so in Israel, on a trip sponsored by the aliyah-promoting Nefesh b'Nefesh, prompting some to wonder whether Salita is considering a change of scenery. (He denies firm plans.) "I was cold and I didn't get into the fight," Salita says. "It felt like the easiest fight of my life. I mean, nothing happened." Those who witnessed Salita get knocked down three times in the first round might disagree, but we understand what he means. More mystifying, however, is Salita's claim that his ability to box comes from God. Given the circumstances, some might consider that blasphemy.
For the masochistic, here is video of the fight:
'Star of David' Boxer Visits Israel After Loss [AP]
U.S. Boxing Champ in Israel: God Gave Me the Ability to Box [Arutz Sheva]
Previously: Orthodox Boxer Crushed in Title Bout
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We hope this new largely symbolic measure will help us create a more pleasant and cultivated environment for all of our readers, and, as always, we thank you deeply for your support.


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Anything happen to pop then I got you like Uncle Phil
from Drake – 5AM in Toronto Lyrics on Genius
This refers to the Fresh Prince of Bel-Air. In the show, Will's father left him and his mother while Will was young. Uncle Phil took care of Will like he was his own.
Similarly, Drake will look out for his homies in his "will," leaving them his millions. If they lose their families or lives, he's there to keep them afloat.
To help improve the quality of the lyrics, visit Drake – 5AM in Toronto Lyrics and leave a suggestion at the bottom of the page


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High School Diplomas: Summary of Required Diploma Coursework
While there is no single national standard of courses required for adults seeking to earn a high school diploma or equivalent, there are various programs available. Along with General Educational Development (GED) tests, adult learners may pursue adult education programs, national external diploma programs or online high schools.
Overview of High School Diploma Options for Adults
Adult learners have a several options to earn their high school diploma or equivalent. They may take the General Educational Development (GED) exam, participate in an adult education program, complete a national external diploma program or enroll in an online high school. To discover which options are available in your state and what their requirements are, visit your local school district website or contact your state department of education. The U.S. Department of Education's website offers contact information for each state education department (www2.ed.gov).
Earn a GED credential
The GED examination was created by the American Council on Education (ACE) and is administered by each state. There are five subject areas tested, with passing scores determined at the state level. You can find testing center locations, score requirements and other information at the ACE website (www2.acenet.edu). Passage of the GED earns you a high school equivalency credential or a diploma, depending on the state.
Adult Education Programs
Adult Education programs often work with community colleges, local school districts, state and local government agencies, nonprofit agencies and community organizations to help individuals obtain the skills and knowledge required to earn a high school diploma. Coursework requirements for these programs vary by state.
In California, for example, adult learners must take basic reading, writing, math and English language competency courses to help them master subsequent high school courses. This is done to equip adult learners with the skills to pass the California High School Exit Examination. In North Carolina, adult students must take a set of basic reading, math, writing and communications courses through their local public school system. They receive a high school diploma after completing the required coursework.
National External Diploma Programs
Many U.S. schools offer National External Diploma Programs (NEDP) to adults who want to earn a high school diploma outside of a traditional high school or adult education setting. Adult students must demonstrate their ability by taking a series of performance assessment tests at home or in private office locations. These programs are self-paced and may take from four months to a year to complete.
Program guidelines vary by school or community. In Vernon, CT, for example, candidates must be at least 21 years of age and have an occupational skill that can be assessed by a past or present employer, or other assessor. They must take an appraisal test, a diagnostic test, pass a skills demonstration and satisfy assessment requirements to earn their diploma.
Online High Schools Diploma Programs
Some community colleges offer online programs that allow adults to meet their state's high school diploma requirements. Credits already earned in high school may be applied. The number of credits required to graduate vary by state. While instruction is provided online, final exams may be conduct on-site. Contact your local community college for program availability.
There are also tuition-based diploma programs offered by accredited online high schools. Coursework, including electives, can be tailored to meet your state's standards and graduation requirements. However, it is important to note that the diploma earned will be issued by the school and not by your state's department of education. That means it may not be recognized by employers or post-secondary institutions.
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UW-RF Home > University Communications Home > This Month's News Releases
University Communications
For more information contact email@example.com or firstname.lastname@example.com.
UW-RF Financial Planning Program Graduates its First Cohort
By Staci Bruder
FEB. 3, 2006--Four students are the first graduates of the Financial Planning Certificate program at the University of Wisconsin-River Falls.
Raymond Buske of New Richmond, Wis., Michael Fuchs of Hastings, Minn., Brad North of Woodbury, Minn., and Stewart Zick of River Falls make up the initial group to complete the Certified Financial Planner® Board-Registered Program offered by the UW-RF College of Business and Economics and the outreach office.
The FPC program provides participants with the skills, tools and knowledge to begin a career in the financial counseling and planning profession. The program consists of five courses that cover a range of financial planning topics. Those who successfully complete all five courses meet the educational requirement of the CFP® Board for CFP® certification and are qualified to take the CFP® certification examination.
"I enjoyed working with the professionals who taught the classes," said Buske. "Just getting out there to meet the people who have been in the workplace, as well as learning more about how the business works was a reward."
Classes are taught by UW-RF faculty and qualified professionals in the financial services industry. All classes are held in evenings and on weekends to accommodate working adults and are located in Hudson and River Falls.
The next FPC program begins in March 2006.
For more information, contact the UW-RF Outreach and Graduate Studies Office. It provides lifelong learners with academic and professional development programs that are practical, flexible, convenient and affordable. Registration information for the FPC as well as a complete list of courses, course descriptions and admission information is available at http:/www.uwrf.edu/ogs or can be obtained by calling 715-425-3256, 1-800-228-5607 or e-mailing firstname.lastname@example.com .
Last updated:
Thursday, 22-Apr-2010 16:07:02 Central Daylight Time
University of Wisconsin - River Falls


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The Financial Planning Association will hand over day-to-day responsibility for pro bono outreach efforts to the Foundation for Financial Planning. The foundation, which has worked closely with FPA in the past, will help chapters nationwide with their volunteer efforts. "We felt they have a unique skill set that they can offer to our chapters in the day-to-day management of our pro-bono efforts," said FPA President Michael A. Branham. "It's a symbiotic relationship, and the chapters provide the boots on the ground."
View Full Article in:InvestmentNews (free registration) · AdvisorOne
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Amritsar, Apr.5: Former Punjab chief minister and Congress Lok Sabha candidate for Amritsar Captain Amarinder Singh on Saturday advised Shiromani Akali Dal (SAD) general secretary Harcharan Bains to check his English and relearn the meaning of the word 'sacrosanct'.
He said that his stand on Operation Bluestar was too well known to require any repetition and it was still the same.
"I am sure you know it, but are saying just to appease your bosses", he told Bains.
Referring to Bains' statement that the White Paper on Punjab was a 'sacrosanct' document, Amarinder Singh said nowhere had it justified any operation, including Operation Blue Star" said Captain.
Asserting that facts are always sacred and sacrosanct, he said, "yes I said, it was a sacrosanct document, and I reiterate that it is a sacrosanct document, as not even a comma or full stop can be changed."
"Even your boss should be knowing it better than you, though he always tries to hide behind the facade of ignorance, while he is a cunning man inside", he added. By Ravinder Singh Robin (ANI)


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Your most successful style/ strategy for wins in tennis?
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Join Date: Sep 2009
Posts: 1,960
I just take nearly every ball from on top or or inside the baseline, and be aggressive.
Sadly, it's heavily reliant on maintaining practice to be successful. But it's not as reliant on being confident in my game as it used to be. If I practice as regularly as I normally look to do, then the percentages will be there to back up the confidence.
Also, I find I do best when I have the general confidence in my forehand and overall play to come to the net often and really go down the line with my shots. The times I hit a forehand from inside the court and stay back near the baseline, going crosscourt is when I can tell I'm pushing and praying for errors. Oh, and I aim to hit a lot of forehands.
I would love to change up the pace of the rallies more often, but I'm too set naturally to want to be aggressive so that I can be at net, at least when I'm confident or level-headed.
[K]Six.One Tour (3) 367.5 grams 31.7 cm balance.
Mains: Babolat/Wilson Natural Gut @ 23 kg // Crosses: Luxilon Alu Power Rough @ 21.5 kg
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Goldie supposts all Wardley products, especially this food.
posted 6 years ago
I had been using just regular fish flakes when my daughter won Goldie from a Halloween church gathering. Goldie was a fingerling, her color was kind of dull and she lost some scales. Then my sister in law recommended this product so I gave it a try.
Awesome. Goldie is now huge, her color is stunning and her scales flash with the light making her a real joy to watch.
When I put the food in the aquarium she comes right to it, instead of waiting for it to come to her. That definitely suggests to me she loves the flavor.
I will stick with Wardley products for all of my fish needs from now on.
Pros: Goldie's color is bright and she has grown quite large.
Cons: None I can think of.
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