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See The 2014 Cheyenne Frontier Days Concerts for Free
Cheyenne Frontier Days is the biggest, baddest, and best rodeo/concert event in the world. For nine days the best rodeo athletes and some of the biggest names in country music come together to give fans the best show of the summer. Would you like to go to the concerts for free? Well here is your chance!
Get Your 2014 Fireworks Festival 3D Glasses
July 4th is almost upon us, and you know what that means. The 2014 Fireworks Festival! Your fireworks viewing experience would not be complete without your 3D fireworks glasses. Find out here where to get your free pair!
Submit Your Lemonade Day Photos For Our Online Gallery [PHOTOS]
Lemonade Day is Casper was a roaring success! Lemonade stands were spread out across Casper as far as they eye could see. We want to see your photos! Submit your photos to be included in our online gallery!
Top 5 Parks For A Summer Picnic in Casper [VIDEO]
Awww summertime. That time of the year is upon us where we no longer are oppressed to spend the majority of our time indoors and we love to spend as much time outside as possible. There is so much to do in Casper in the summertime. Picnics are enjoyed by many in Casper parks, but which ones are the best? Here are my top 5 picks for a summer picnic in Casper.
2014 Casper Parade Route
The Central Wyoming Fair and Rodeo Parade will be July 8, 2014 at 10:00 am in downtown Casper. Bring your chairs, sunscreen, and get there early to get a prime spot.
Lemonade Day is This Saturday June 21st In Casper [PHOTOS]
Be on the lookout for lemonade stands all over Casper this weekend. Lemonade Day Casper is this Saturday, June 21st. Be sure to stop a by a stand a buy a refreshing glass of lemonade this weekend!
'Overprotective Dad' Photo Contest Winner
Let's face it – there's nothing more important to fathers with daughters than looking out for "Daddy's little girl". Especially when that little girl isn't so little anymore. Congratulations to Derek Smith, winner of the 'Overprotective Dad' Photo Contest!
Show Off Your Singing Skills At 'The Voice Of Casper'
"The Voice of Casper" debuts at the Central Wyoming Fair & Rodeo with vocalists from across Wyoming invited to compete in a vocal competition show. Celebrity coaches Trisha Berry, T-Roy, DJ Nyke and Lydia Defranchi. Enter your video submission now for your chance to be a star!
Help Support Injured Casper Plumber's Road To Recovery
Casper plumber Justin Daniels received severe burns to his face, chest, and arms in an accident while working at Meadow Winds Assisted Living Community Center on June 6th. Justin is currently in Greeley, CO receiving care for his injuries. The family has a "GoFundMe" account set up to help with expenses until Justin is able to return home.
2014 Scoop The Poop Mascot Contest Winner
Meet Koda, the winner of the 2014 Scoop The Poop Mascot Contest! Koda is the official 2014 spokesdog for the City's "Scoop The Poop" campaign! This lucky canine will be plastered around town on billboards, plus receive a photo shoot, a 20×24 canvas mounted print from Beartooth Photography, and a $100 gift card from Tails of the City! Congrats Koda!
'Overprotective Dad' Photo Contest Voting Open
Let's face it – there's nothing more important to fathers with daughters than looking out for "Daddy's little girl". Especially when that little girl isn't so little anymore. We asked you to send in your photos and you answered. Voting is now open in our first ever "Overprotective Dad" photo contest! Vote for your favorite photo now!
Skydiving For The First Time [VIDEO]
Of all things I have done in my life, skydiving was the greatest and most exhilarating experience I have ever had.


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Originally written on The Victory Formation | Last updated 3/29/13
Coaches like to shake things up when they arrive on campus, and they are always looking for a new way to attract recruits. Take Bobby Petrino at Western Kentucky. The Hilltoppers new head ball coach is looking to entice potential WKU football players with a new helmet that is quite shiny. Petrino tweeted it out, because that's where recruits spend a ton of time BLING BLING! Kids like these. Uniforms have become as much of the recruiting pitch as anything else. I am personally not a fan of these type of helmets, but I'm also sitting on my couch eating highly processed foods and not making a university any money. So there's that. H/T Dr Saturday
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Why Lauren Conrad is more powerful than anyone probably ever thought
Date: June 10, 2015 | Posted By: AudreyI don't know much about Lauren Conrad. Just that she was on MTV's The Hills (or Laguna Beach? Or The OC? Or all three?) and that she now has some lifestyle blog (because who doesn't?) that covers "primping, dining, decorating, crafting, reading and fashion." Ms. Conrad is on my radar these days, however, because she Continue reading
Harriet Tubman on the new $20 bill?
Date: May 19, 2015 | Posted By: KatieWhat would the United States be like if we had Harriet Tubman on our $20 bills? Depicted on current and former US dollar banknotes are George Washington, Thomas Jefferson, Abraham Lincoln, Alexander Hamilton, Andrew Jackson, Ulysses S. Grant, Benjamin Franklin, William McKinley, and Grover Cleveland. Yes, they are all men. And yes, all white men. Continue reading
Why I won't be getting naked for the body image cause
Date: February 27, 2015 | Posted By: GretchenThere is an amazing amount of work going on right now to promote positive body image. The Militant Baker, The Body Is Not An Apology, Beauty Redefined, and About-Face have all come up with pretty awesome campaigns inspiring women to love their bodies just the way they are. The goal is to show a variety Continue reading
Plus Size Princess blog inspires body positivity
Date: January 30, 2015 | Posted By: KristaAlthough social media breeds negativity and outrageous haters, it also brings wonderful sites like Plus Size Princess to our attention. I found this website through a YouTube video about dating as a plus size female. Despite the fact that I am not plus size, I love to watch these videos to gain confidence. Reading About-Face's Continue reading
Show some anger, Emma Watson!
Date: November 21, 2014 | Posted By: SiriIs anyone else fed up with having to be nice and sweet to be accepted as a feminist? Anyone else tired of wrapping their feminist message in smiles and politeness? Well I am, and Emma Watson's speech at the special event for the United Nation's HeForShe campaign just confirmed my frustration. WHY OH WHY is it so Continue reading
Bring it on, Madam President!
Date: July 2, 2014 | Posted By: SashaIs the United States ready for a female president? I don't like that we're asking that question — I don't like that we think we need to wonder. Because when we ask, "Are we ready?" we know that the answer might be "No." We remind ourselves that having a female president would be anomalous, and Continue reading
The revolution is now (and the warriors are naked)
Date: May 27, 2014 | Posted By: AudreyFinally it seems like we're at a tipping point regarding the unrelenting (and totally bogus) pressure placed upon new moms (make that all women, actually) by the incessant chronicling of just how fast celebrities manage to drop their baby weight and somehow look even better than they did before having kids. First, Ashlee Wells Jackson, Continue reading
I'm not bossy. I'm the boss.
Date: April 23, 2014 | Posted By: AllieBan Bossy. These two words designate a campaign designed to encourage girls to lead without being labeled as bossy. (Or, more commonly, the other B word. But that's a campaign for another time.) You've probably seen the Lifetime PSA by now, as part of the #BanBossy campaign spearheaded by Facebook COO Sheryl Sandberg. The video Continue reading
This statement is bound to shock you for no good reason
Date: April 1, 2014 | Posted By: Sara O"Women aren't funny." Consistently repeated and supported by journalists, comedians, and researchers, this statement is an old standby whenever someone wants to shock an audience and spark heated conversation. Though it is constantly refuted — by funny women, progressives, and common sense — this easily defeated opinion refuses to die. At lunch recently, I was seated near Continue reading
Stereotypes in three dimensions
Date: March 13, 2014 | Posted By: SashaYou may have already read about my outrage at "the pink aisle" – otherwise known as the preponderance of stereotype-based toys for girls – and I was recently disappointed to learn that LEGO has sunk to new lows in the ranks of the pink. In 2012, LEGO met with SPARK, an organization that works with girls and women Continue reading


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We've seen plenty of human-powered vehicles — from velomobile bikes to helicopters, and even hovercrafts — but the latest contraption to come down the pipeline is perhaps the strangest one yet: the treadmill bike. Designed by Bicycle Forest, the bike offers a a creative alternative to both traditional biking and running on a treadmill in the gym.
4 Comments
April 6, 2010 at 11:42 am
WOW what a ridiculous idea. They have taken the totally impact-free act of running and added a machine that requires energy and resources to produce yet it does not improve the efficiency or usefullness as a mode of transport when compared to walking or running.
This can not be considered smart or green design by any stretch of the imagination.
April 5, 2010 at 5:21 pm
Wow! This is so much better than the last time we saw it… 4 years ago.
April 5, 2010 at 5:02 pm
I love the Bicycle Forest! I once saw their Couchbike out on the street and it made my day.
April 5, 2010 at 4:16 pm
If only I could run out side…..
April the first people, THE FIRST. At least try and be on time.


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A Community MealPosted on 05 / 30 / 2014
"Folkekøkkenet" (Community kitchen) in Ungdomshuset is a great place to come and eat a solid dinner very cheap and in alternative surroundings.
The food variates a lot since most of the food is donations and the treasures from dumpster diving. But the volonteer-kitchen crew always dish up with something interesting.
However a lot of people comes by, so to avoid long lines - be there a while before.
OR participate in the free hatha yoga classes in the house from 5-7pm, before hitting in the plates.


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Women's Brooks® PR LD 4:48 :: Run fast and run alone in the awesomely light PR LD. Welded overlays provide a light support structure on an extremely airy mesh upper and asymmetric construction wraps the foot and keeps it on platform. When 1600 meters or more stands between you and glory, lace up the PR LDs for seriously speedy performance.
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Poet of Sound and Image KiNo presents a film in episodes: Live!
Documentary of life and collaborations in New Vague City.
This film is dedicated to my friend Ira Cohen who passed away recently; leaving behind a materialised account of the akashic records in his poems, photographs, films and inspiring conversations with the individuals whom were graced by his friendship.
With highlights from the KiNo Exhibition - Invasion from Within.
Featuring footage of the performances with musical legends Malcolm Cecil (Pioneer of electronic music) and Andy Rourke (The Smiths).
Ira Cohen film
The Invasion of Thunderbolt Pagoda
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Tour de Troit 2015
- Sports & Fitness
- 2200 Michigan Ave Detroit 48216, US
Michigan Values Veterans: Hiring Veterans How-To Conference
Michigan Values Veterans
Thursday, September 12, 2013 from 7:00 AM to 4:00 PM (EDT)
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Registration opens at 7 a.m.
Conference begins at 8 a.m.
Lunch will be provided
Join millions of people on Eventbrite.
In order to purchase these tickets in installments, you'll need an Eventbrite account. Log in or sign up for a free account to continue.


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Fractures I. Fractures a. Must always examine the joint as well as the neurologic/vascular function above and below the fracture b. 6 P's of compartment syndrome i. Pulselessness, Pallor, Paresthesias, Pain, c. Treatment i. 1st step is to stabilize the fracture 1. Done by immobilization (splints) ii. 2nd step is to reduce the fracture 1. If displaced iii. 3rd step maintain reduction 1. Splint, cast, surgery d. Reduction i. Maintain reduction restores acceptable anatomical position ii. Must allow for normal range of motion iii. Must preserve vascular and neurologic status of area iv. Avoid complications v. Make patient pain-free long term II. Fractures of the proximal humerus a. Common in elderly i. Fracture of surgical neck or greater tuberosity ii. Most fractures are acceptable without surgery 1. Can accept 6-8mm of displacement b. Treat with immobilization i. Sling and swath ii. If unstable fracture use cooptation splint iii. 6 weeks immobilization for adults 1. Some exceptions III. Fractures of the Collarbone a. Common in sports b. Must be concerned with vascular status and pneumothorax c. There will be a lot of pain with cosmetic deformity d. Must be careful with proximal 1/3 fractures e. 1/3 overlap is considered acceptable f. Treatment i. Sling and swath ii. Pain medications IV. Mid-Shaft Humerus Fractures a. Very difficult to maintain in reduction due to rotation of shaft b. Must assess vascular/neurologic function above and below the fracture site c. Commonly caused by high velocity trauma d. Treatment i. Immobilization with cooptation splint ii. Can be immobilized with an intramedullary rod 1. Screws lock the rod V. Elbow Fractures (Olecranon Fractures) a. Fracture of the proximal ulna b. 3mm is the maximum number for the gap in articular surface that can be allowed c. Treatment i. Patient will respond well to splint (posterior part of arm) 1. Splint should be reviewed in first week to 10 days a. Further evaluation for casting or maintaining splint ii. If the gap is more than 3mm the elbow may require surgery VI. Radial head Fracture a. Very common b. Can be a subtle finding on x-ray i. A good physical exam will detect pain in antecubital fossa ii. Supination will be painful c. Tend to be a very stable fracture d. Treatment i. Sling for 2 weeks ii. Start early range of motion to decrease stiffness and maintain ROM VII. Coracoid Process Fracture a. Mostly a non-displaced fracture b. Must stress the elbow if x-ray shows displaced fracture to observe humeral displacement i. This will assess the stability ii. If the elbow is not displaced do not stress elbow iii. Unstable will have to be operated on VIII. Radius and Ulna Mid-shaft Fracture (Both Bone Forearm Fracture, BBFA) a. Often transverse fractures with blunt trauma b. Oblique is associated with non-blunt trauma c. Carrying angle of arm is important i. Valgus angle at elbow normally d. Large incidence of compartment syndrome i. Must assess neurovascular function e. Treatment i. Splinting ii. Must assess on weekly intervals in the beginning to observe for compartment syndrome IX. Colles Fracture a. Distal radius fracture b. Usually due to slip and fall with hands planted c. Displaces dorsally ( if it does not displace dorsally it is not a Colles fracture) d. Common in elderly e. Generally a stable fracture f. Treatment i. If in good position fragment may be left alone ii. Some require reduction X. Smith Fracture a. Distal radius fracture that displaces volarlly b. Slip and fall with a bent-back hand c. Generally not a stable fracture d. Treatment i. Almost always require an ORIF (70-75%) XI. Distal Radius Fracture a. Fracture of the distal radius with no displacement XII. Golleazzis Fracture a. Fracture of the ulna with a radial dislocation at the wrist b. Can get ulna and radius fracture occasionally XIII. Monteggia Fracture a. Fracture of the ulna causes a dislocation of the radial head towards the elbow b. Often missed due to radiology oversight i. See ulnar fracture but miss radial dislocation c. Must get elbow x-ray to rule out dislocation XIV. Scaphoid Fracture (Carpo navicular Fracture) a. Occurs with slip and fall on a dorsiflexed wrist b. Scaphoid is the most common carpal bone fractured i. Other carpal bones can fracture c. Many times in younger people d. Scaphoid has very poor blood supply i. Can result in non-union even if treatment is correct e. Will present with pain in the anatomical snuff box f. 30% of the time does not show up on x-ray (navicular view) i. Must go on patients symptoms and exam ii. Splint the patient and have them return to repeat x-rays g. MRI is the alternative film for study h. Treatment i. Splinting- thumb spica ii. Surgery if non-union XV. Metacarpal Fracture a. Most common fracture in metacarpals is boxer's fracture i. Associated with punches b. Most concerned about the rotation of a metacarpal fracture c. Treatment i. If reduced will require operation ii. Must maintain metacarpophalangeal joints 1. Put patient in splint with flexion to prevent shortening iii. Must put on an ulnar gutter 1. Immobilize the joint lateral to the fracture XVI. Phalangeal Fracture a. Most phalangeal fractures will be okay in the position they are in b. Must be concerned with rotation of the phalanges XVII. Lateral Epicondylitis (tennis elbow) a. Pain (burning sensation) that runs down forearm into fingers b. Tender to direct palpation of the lateral epicondyle c. Pain on dorsiflexion of the wrist against resistance i. Some patients will have pain on supination d. Treatment i. Anti-inflammatory or NSAIDS (conservative) ii. Injection of steroid and lidocaine iii. May require a long time to heal XVIII. Medial Epicondylitis (Golfer's elbow) a. Pain on volar flexion and pronation b. Treatment i. NSAIDS or anti-inflammatory iii. Rarely requires surgery ii. Injection of steroid and lidocaine XIX. Carpal Tunnel Syndrome a. Compression of the median nerve b. Paresthesias in the first 3 fingers and half of the 4th finger palm side c. Phalen's test and Tinel's sign i. May be negative tests in DM and hypothyroidism d. EMG/NCV must be performed e. Treatment i. Splinting in dorsiflexion ii. B6 1000mg per day may help iii. Can be injected with steroid and lidocaine iv. Surgery is a carpal tunnel release 1. The longer the patient has carpal tunnel syndrome the worse they will be post-operatively XX. Dequervain's Tenosynovitis a. Abductor tendon of the thumb b. Common in new mothers c. Ask the patient to fold fingers around the thumb i. Finklestein test- positive test is pain in the thumb d. Treatment i. NSAIDS ii. Thumb abduction splint- wear during the day if possible iii. Injection into the first dorsal compartment 1. Don't stress the joint for 1 week after due to weakened tendon iv. Surgical treatment XXI. Game-Keeper's Thumb a. Refers to the ringing of necks f chickens for killing b. Now seen mainly in skiing, driving, and break-dancing c. Treatment i. Splinting- most of the time this is enough ii. Hand surgeon (surgery)- For continuation of pain
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It's been a busy past few months for EA's Edmonton, Alberta-based studio BioWare. The role-playing game factory has released critically acclaimed installments in its preferred genre--dark fantasy Dragon Age: Origins and sci-fi space opera Mass Effect 2. Beyond that, the studio has supported both releases with substantial helpings of downloadable content. To wit, Dragon Age: Origins - Awakening hit March 16, a week before Mass Effect 2's Firewalker pack.
As a sign that things aren't likely to be slowing down any time soon at the development house, BioWare today launched a mysterious countdown timer. The countdown timer appears on Mass Effect's, Dragon Age's, and BioWare's company-wide Web sites and is set to expire on Monday, March 29 at 9 a.m. PDT.
So what does the countdown timer pertain to? One topic that seems like it can be ruled out is Star Wars: The Old Republic. Developed and published in conjunction with LucasArts, The Old Republic's Web site does not boast the same ticking clock that BioWare's other Web sites prominently display.
However, considering the cross-game promotion, the timer could point to BioWare's as-yet-unannounced "new next gen game." First spotted on a developer's resume in June 2009, the game is expected to be an all-new intellectual property from the Canadian studio. No other information on the project has been made available.
One other possibility is that BioWare could be gearing up to officially announce Dragon Age 2. In February, EA confirmed that the fantasy RPG would receive a new installment during its January-March 2011 quarter. Upon Awakening's release last week, BioWare included a cryptic flyer with the expansion's retail release indicating that Dragon Age 2 will dawn February 1, 2011.


text: Our family got together at Christmas time (12-27-2014) we rented 4 rooms from this hotel. when arriving, we noticed 15 mattresses at the dumpsters. upon enquiring at the front desk, we were told of "No Problems" with the rooms or bugs. well, besides all of us getting bitten thru the night, yes, we have pictures, lots of pictures. the bugs... More


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50 year old man | Las Vegas, NV, USA | Seeking women 28-45
The Right Stuff.
My friends say I'm laidback, easygoing, a smart young lad. I enjoy laughing and a good joke. I'm not into the club scene but enjoy hanging out at a sports bar talking with friends. I'm looking for a relationship with a woman that has a great sense of humor, sexy, fun, easy to talk too. I'm looking for a woman that knows how to balance her professional and personal life. Someone that will have a great time whether we go out or stay at home watching a movie.
Camping , Coffee and conversation , Business networking , Dining out , Fishing/Hunting , Gardening/Landscaping , Hobbies and crafts , Movies/Videos , Museums and art , Music and concerts , Exploring new areas , Performing arts , Playing sports , Travel/Sightseeing , Video games , Watching sports , Wine tasting
Auto racing / Motorcross, Baseball, Basketball, Billiards / Pool, Bowling, Cycling, Football, Golf, Hockey, Martial arts, Running, Soccer, Tennis / Racquet sports, VolleyBall, Walking / Hiking, Weights / Machines
I exercise 3-4 times per week.
Don't display my sign
I like Birds, Cats, Dogs, Exotic Pets, Fish, Horses, Other
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text:
Could I get a business credit card if I didn't have any business income but had personal income?
Tons of cards if you are willing to PG it and your personal credit is good. Basically nobody if you aren't willing to PG.
PG? Personal Guarantee?
xgac12x wrote:
PG? Personal Guarantee?
Yes. Basically like you are applying for credit. Doesn't really matter the situation with business as you are responsible for payment as well as company. But I assume it isn't a corporation so really wouldn't make a difference anyway.
A credit card with your business name on it gives your business credibility. A business credit card looks more professional than personal one. Own a business credit card to build credit. For abusiness loan , you can apply with your business credit card to get lower rateof interest.
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text: I'm not exactly sure what possessed me to think that I'd be able to provide a blog post during my last week at site. I don't think any of my capacities – emotional, mental, physical – were prepared to commit precious time to a computer screen during my last few days, so I apologize this post is later than planned. 1,098 more words


text:
Without music, dancing would be awkward, road trips would be silent and feeling the beat would consist of giving yourself a hiding. Make sure you've got the music with you with today's Groupon: pay R399 for an iLuv Portable Speaker Case for Tablets, including delivery. Choose from the following:
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- Works with any tablet or phone that has a 3.5mm auxiliary jack
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- Product packaging may indicate that the device is intended for use with Samsung GALAXY or Apple iPad. Please note the GALAXY unit will still work 100% with an Apple iPad and vice versa. They will also work with tablets other than those of iPad and GALAXY.


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On March 31, 2014, two young men suddenly appeared in a dark alley in Pittsburgh. Their subsequent encounter with my partner, Allen, changed our lives forever. It turns out Pittsburgh is a pretty good place to have a massive heart attack. But for these two strangers, Allen would undoubtedly have died that night.
We hear it far too often: A young athlete collapses and dies, their youth and athleticism proving to be a cruel camouflage for a time bomb ticking within their seemingly-invincible body. Sadder still is the realization that thousands of more youngsters meet similar fates without warranting headlines.


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text:
A safety, over-the-needle midline catheter, designed generally for insertion distal to the antecubital crease to be threaded proximally to a site just distal to the axilla. An accompanying safety apparatus is employed which permits only proximal displacement of an associated needle cannula into a safety housing. The catheter has an internal lumen of constant diameter and a proximally disposed taper which in conjunction with the constant internal diameter, provides a wall thickness which effectively resists kinking and associated closure of said lumen which might result from bending of an elbow when a portion of the catheter is disposed at the cubital crease. A butterfly is disclosed which has a collet having a superiorly disposed slit and lips associated with the slit which are sufficiently thin and supple to permit the catheter to be separated from the collet (and butterfly) while wings of the butterfly are disposed upon skin of a patient. Apparatus and methods are disclosed for assisting threading the catheter through difficult anatomical pathways.
1. Safety midline catheter apparatus comprising:
a catheter specifically intended for midline catheter applications, said catheter having a length, circumscribed about a hollow lumen of substantially constant internal diameter such that an increase in outside diameter of a portion of said catheter results in a consequential increase in catheter wall thickness, comprising a distal section, a medial section, and two proximal sections;
said distal section having a predetermined outer diameter sized for over-the-needle skin insertion and being made of sufficiently rigid material for over-the-needle venipuncture;
said medial section, proximally disposed relative to said distal section, also having the predetermined outer diameter and being made of a material which is pliable but which has sufficient stiffness to facilitate threading of the distal section of the catheter inserted at a venipuncture site and threaded to a predetermined target site;
said two proximal sections comprising a tapered section and a most proximal section which has an essentially constant diameter which is larger than the outer diameter of the distal and medial sections, said tapered section being disposed immediately proximally relative to said medial section and being tapered from the outer diameter of the medial section to an outer diameter which is the larger outer diameter of said most proximal section, whereby tapering of said tapered section, in conjunction with the internal diameter of the hollow lumen, provides a wall thickness which effectively resists kinking and associated closure of said lumen which might be associated with bending of the catheter such as may occur due bending of an elbow by a patient into which the catheter is inserted;
a hollow needle cannula disposed within said lumen and having a sharpened distal end which is exposed for catheter insertion;
an elongated wire affixed, at a distal end, to a proximal end of said needle cannula and, at a proximal end, to a fixture whereby the needle is proximally displaced after catheter insertion; and
a safety needle enclosure apparatus into which the needle is displaced and secured, said safety enclosure apparatus comprising means for securely, but releasibly affixing said wire in place, for proximally displacing said hollow needle and for effectively resisting distal displacement of said elongated wire thereby assuring the needle and associated sharpened tip can only be displaced proximally.
2. Safety midline catheter apparatus according to
3. Safety midline catheter apparatus according to
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18. Safety midline catheter apparatus according to
19. Safety midline catheter apparatus according to
20. Safety midline catheter apparatus according to
21. Safety midline catheter apparatus according to
22. Safety midline catheter apparatus according to
23. A midline catheter comprising:
a catheter specifically intended for midline catheter applications, said catheter having a length, circumscribed about a hollow lumen of substantially constant internal diameter such that an increase in outside diameter of a portion of said catheter results in a consequential increase in catheter wall thickness, comprising a distal section, a medial section, and two proximal sections;
said distal section having a predetermined outer diameter sized for over-the-needle venipuncture and being made of sufficiently rigid material for over-the-needle venipuncture;
said medial section, proximally disposed relative to said distal section, also having the predetermined outer diameter and being made of a material which is pliable but which has sufficient stiffness to facilitate threading of the distal section of the catheter from a point of insertion at site near the antecubital crease and threaded to a predetermined target site;
said two proximal sections comprising a tapered section and a most proximal section having an essentially constant outer diameter which is larger than the outer diameter of the distal and medial sections, said tapered section being disposed immediately proximally relative to said medial section and being tapered from the outer diameter of the medial section to an outer diameter which is the larger outer diameter of said most proximal section, whereby tapering of said tapered section, in conjunction with the internal diameter of the hollow lumen, provides a wall thickness which effectively resists kinking and associated closure of said lumen which might be associated with bending of an elbow by a patient into which the catheter is inserted;
an associated butterfly member by which the catheter is gripped for purposes of inserting both needle and catheter and otherwise for maintaining position control of the catheter during use, the butterfly being displaceable along the catheter, having a slit collet disposed about the catheter and being formed of material which is sufficiently flexible to permit opening of the slit in the collet to permit disengagement of the catheter from the collet of the butterfly while the butterfly is resident upon a skin surface of a patient.
This patent application claims priority to U.S. Provisional Patent application, titled OVER-THE-NEEDLE MIDLINE CATHETER WITH RETAINING MEANS, Ser. No. 60/432,136, filed in the U.S. Patent and Trademark Office on Dec. 10, 2002 by Michael W. Howlett and James V. Mercer (Attorney's docket number 15791.1), the entire contents of this disclosure being hereby incorporated by reference herein.
This invention relates generally to vascular access and more particularly to midline catheters which are generally inserted distal to the antecubital crease and threaded proximally to a site just distal to the axilla.
According to Medical Data International, one hundred and seventy million peripheral intravenous catheters (PIV) are expected to be sold in the United States in 2002. PIV catheters range up to three inches (7.5 centimeters) in length and typically remain in place or "dwell" from a few hours to four days according to U.S. Centers for Disease Control (CDC) recommendations. For longer therapies, PIVs are serially replaced or an extended use (extended dwell) IV catheter is inserted. The most popular extended dwell IV catheter is the peripherally inserted central catheter (PICC) that is typically sixteen to twenty four inches (forty to sixty centimeters) in length. The end or tip or the catheter is generally positioned in the superior vena cava, one to three centimeters above the right atrium of the heart. PICC insertions require a highly skilled nurse or physician for insertion as they may employ a variety of special components including a complicated, large-gauge, peel-away introducer and/or fine-gauge wires that are inserted into the vein. Local anesthesia with Lidocaine� is almost always required prior to insertion to make the procedure tolerable. In pediatrics, IV conscious sedation is frequently utilized, making the procedure less traumatic for children and their families.
Multiple complications can arise from the placement of a PICC line ranging from simple bruising to significant tissue damage, In all cases, a post-procedural chest X-Ray is used to indicate whether or not the catheter is appropriately positioned in the superior vena cava. Sometimes, the catheter tip is found to reside either in the jugular vein, in the right atrium of the heart, or malpositioned elsewhere. In the event of improper catheter tip placement, the PICC must be manipulated into proper position, removed or pulled back into a sub-optimal, non-central position. Repositioning of a PICC line can be both difficult and costly, as it often requires the use of a Fluoroscope for X-Ray imaging guidance. Failure to reposition a poorly placed catheter tip can result in complications such as abnormal heart rhythms, vessel damage, or, rarely, a perforation of the superior vena cava or other central vessels. Due to both the invasive nature of a PICC and the risks involved, a physician must provide a written order for this procedure to be performed. Many physicians are hesitant to order a PICC line for these same reasons.
In between the PIV and PICC is a mid-length (midline) catheter which is approximately eight inches (twenty centimeters) long and designed for a moderate extended dwell period of between six and thirty days. Medical Data International estimated that about three hundred and forty thousand midline catheters would be sold in the United States in 2002. It is likely that half again as many midlines are inserted each year by cutting or trimming PICCs to the midline length.
All currently known contemporary commercial midline catheters are introduced through a needle, through an introducer or over a wire. Needle diameter sizes used for midline catheter introduction are relatively large, generally ranging from 22 to 16 gauge. Introducers may have "peel-away" features for facilely disengaging such introducers following catheter introduction. In some cases, a stylet may be used in catheter placement.
In the 1990's, a midline catheter, named the Landmark manufactured by Menlo Care, Inc., was made of an elastomeric hydrogel which expanded one or two gauge sizes after insertion due to water and body fluid absorption. This catheter is no longer commercially available as it was pulled from the market following suspected adverse patient reactions to the elastomeric hydrogel.
A catheter having general vascular application is disclosed in U.S. Pat. No. 5,885,251 issued Mar. 23, 1999 to Ronald B. Luther (Luther). Luther teaches a vascular/venous access device having an insertion needle cannula disposed through the wall of a catheter and outward from the central bore of the catheter to act as an over the needle introducer. Once the catheter is introduced into a patient's vascular system, the needle is withdrawn through the wall. As well, a gripper which is used to selectively hold the catheter cannula and facilitate needle and catheter insertion is taught by Luther. The gripper has a pair of wings and a centrally disposed collet which is sized to slide along a catheter, but to seize the catheter when the wings are upwardly bent. Further, the collet is split forming a gap extending along the length of the collet. The gripper is made from a resilient polymer which permits the upward bending and removal of the gripper from the catheter by bending the wings away from the gap, thereby expanding the gap to free the gripper from the catheter. There is no needle safety procedure which affords protection from a contaminated needle removed from a catheter found in Luther.
U.S. Pat. No. 4,840,613 issued Jun. 20, 1989 to Daniel J. Balbierz (Balbierz) discloses a catheter assembly including a cannula with an over-the-needle insertion, a slitted sheath which affords a protective sterile field proximal from a gripped insertion member and an insertion needle which is retracted by a wire. U.S. Pat. No. 5,195,974 issued Mar. 23, 1993 to Dwayne E. Hardy (Hardy) discloses a safety wire needle extractor construction which retracts a longitudinal piercing member (needle) into entrapment in a receiving tube. The needle is trapped in the tube by pulling a wire through a proximal orifice which is smaller in diameter than the needle and the wire and needle through a distal orifice which is formed to reduce likelihood of any further distal displacement of the needle.
Midline catheters may be inserted through the cephalic, basilic or median cubital veins, although most technicians consider the basilic vein to be optimal. Some technicians prefer that the point of insertion be just above the antecubital space to minimize mechanical (kinking) problems associated with arm bending at the elbow. However, inserting and servicing a catheter at such an insertion point is considered to be less desirable than just below the antecubital space.
Of course, sterile technique is essential and a sterile field must be maintained during catheter placement. In some cases, fluoroscopic imaging is required to place a catheter due to physiological vasculature abnormalities.
As midline catheters are intended for extended use (e.g. up to 30 days), phlebitis is a concern. Catheter parameters, such as catheter diameter and biological inertness, pliancy, and suppleness of catheter material are considerations which affect midline catheter design relative to phlebitis considerations.
This novel invention provides an innovative safety midline catheter which permits over-the-needle catheter insertion, and, therefore, use of standardized insertion techniques currently employed for insertion of other catheters (e.g. PIV catheters). Designed to be able to be inserted below the antecubital crease, the catheter of the present invention is mildly tapered and thickened proximally (near the catheter hub), to compensate for bending of an elbow which would otherwise challenge patency of the catheter, while retaining a lumen of constant size throughout its length. This novel midline catheter has a tip, of sufficiently high durometer to facilitate over-the-needle insertion, proximally affixed to a body of lesser durometer to provide necessary flaccidity and pliability of the major portion of the catheter for use in a medium dwell period catheter. The mild taper not only provides protection against kinking, but also improves closure at the site of catheter insertion, thus reducing bleeding from the insertion site.
The catheter is preferably an extruded synthetic resinous material which is selectively filled with a radiopaque substance such that a linear window along the length of the catheter is provided for blood flash visualization. A series of readily visible surface marks are also distributed along the catheter at regular intervals for facile determination of inserted catheter length.
A displaceable butterfly is disposed to be displaced along the length of the catheter generally to facilitate catheter insertion, although the butterfly may also be selectively used to anchor a partially inserted catheter. The butterfly has a normally superiorly disposed collet through which the catheter is threaded and which permits displacement of the butterfly relative to the catheter. A pair of wings disposed along each side of the collet have raised ridges which securely grasp the collet (and catheter disposed therein) when folded together. The collet has a superiorly disposed medial slit along its length which forms a pair of lips which are sufficiently flaccid to be opened by outwardly directed pressure from inside the collet. Thus, the catheter may be extricated from the collet by upwardly lifting a proximal portion of the catheter through the lips, leaving the butterfly free for disposal. Also, the lips are facilely parted to permit distal progress of the tapered portion of the catheter into and through the collet.
A hollow medical needle having a sharpened distal tip is exposed from within the distal end of the catheter. Proximally, the needle is securely affixed to a flexible wire which is threaded through the catheter lumen and used to extract the needle from the catheter. The wire is used to withdraw the needle into a safety housing upon venipuncture, but prior to complete catheter insertion into a vessel of a living being. As any distal movement of the needle relative to the catheter may yield an unsafe condition (e.g. catheter perforation) once the needle tip is withdrawn into the lumen of the catheter, wire movement is restricted to displacement away from venipuncture site (i.e. proximal displacement) relative to the long axis of the catheter. On a proximal end, the wire is affixed to a cap which is releasibly affixed to the safety housing to assure controlled extraction of the needle.
Accordingly, it is a primary object to provide a safety needle midline catheter system which may be effectively inserted and retained below the antecubital crease for midline catheter use.
It is another primary object to provide an over-the-needle midline catheter which, when inserted below the antecubital crease in the arm of a patient, retains patency when an associated elbow of the patient is bent to close the crease.
It is a fundamental object to provide for needle retraction into a safety housing following venipuncture.
It is another fundamental object to provide a needle retraction mechanism which assures all needle displacement relative to the catheter is restricted to a proximal direction.
It is an object to provide a secure, but facilely releasible lock which assures no displacement of the needle until the lock is manually unfastened preparatory to retracting the needle.
It is an object to provide a window which extends along the catheter whereby a blood flash signaling entry into a blood vessel may be seen.
It is an object to provide a liquid flow barrier proximal to the catheter such that blood flow is restricted to catheter pathways which are distal to the safety housing into which the needle is retracted.
It is an object to provide a liquid flow barrier which permits venting air from the catheter to permit proximal blood flow within the catheter.
It is an object to provide an elongated radiopaque strip along the wall of the catheter which permits fluoroscopic tracking of a pathway of an inserted catheter.
It is an object to provide circumferential marks about the catheter spaced at predetermined intervals for the purpose of determining distance a catheter is inserted.
It is an important object to provide an associated butterfly member by which the catheter is gripped for purposes of inserting both needle and catheter and otherwise for maintaining position control of the catheter during use, the butterfly being displaceable along the catheter, having a slit collet disposed about the catheter and being formed of material which is sufficiently flexible to permit opening of the slit in the collet to permit disengagement of the catheter from the collet of the butterfly while the butterfly is resident upon a skin surface of a patient.
It is another important object to provide a catheter which has a distal over-the-needle, nose section which has a first outside diameter and which has sufficient rigidity for over-the-needle insertion.
It is also another important object to provide a catheter of which there is a portion which is proximal to the distal nose section, which is more supple than the nose section, but which has sufficient rigidity for threading the nose section to a target site just distal from the axilla and which has a first outer diameter which is the same outer diameter of the nose section.
It is yet another important object to provide a catheter which is proximally tapered, from the first outer diameter to a second larger outer diameter.
It is an object to provide the taper at a site along the catheter such that the smaller diameter potion of an inserted catheter is displaced beyond the antecubital crease and the taper and larger diameter portion are ordinarily disposed in the region of the antecubital crease.
It is a significant object to provide a catheter having a substantially constant internal lumen along the length of the catheter such that the tapered region and the region of the second diameter has an increased wall thickness which effectively resists kinking and other closure of the catheter lumen to retain patency thereof.
It is an object to provide a tapered catheter which has a thickened wall at the venipuncture site which effectively increases resistance to antiseptic (e.g. alcohol) degradation and gently plugs the insertion site to reduce bleeding.
It is an object to provide secondary methods and apparatus which aid threading a catheter into a desired, predetermined site.
It is an object to provide a distal nose section of a catheter which is bulged to mildly dilate tissue at the insertion site to reduce friction thereat.
These and other objects and features of the present invention will be apparent from the detailed description taken with reference to accompanying drawings.
In this description, the term proximal is used to indicate the segment of a device or a part of a device which is normally closest to a technician using the device. The term distal refers to the other end. Reference is now made to the embodiments illustrated in
A safety midline catheter system 10 made according to the instant invention is seen in FIG. 1. System 10 generally includes a midline catheter 20, an insertion needle cannula 30 having a sharpened tip 32, a butterfly 40 used for gripping catheter 20 and cannula 30 during catheter insertion and a needle safety housing 50. Note that catheter 20 resides about cannula 30 for the purpose of over-the-needle insertion. Also seen in
Needle cannula 30 is better seen in FIG. 2. Tip 32 is clearly seen to extend distally from catheter 20. Note that catheter 20 is "necked down" about cannula 30 a its most distal end 100 to facilitate entry at a penetration site. Needle cannula 30 has an elongated body 110 which has sufficient length to be securely gripped by pressure imposed via butterfly 40. At a proximal end 112 of cannula 30, body 110 is securely affixed to a thin wire 120 which is employed to retract needle cannula 30 after catheter 20 is satisfactorily disposed in a vessel. On a proximal end 122, wire 120 is firmly affixed to a cap 130. Cap 130 is designed to be a handle which facilitates displacement of wire 120.
As is well known in over-the-needle catheter art, it is not advisable, and, in fact, may be considered poor medical practice, to attempt to refeed a needle cannula distally once needle retraction has been initiated. For this reason, system 10 does not permit distal displacement of cannula 30 relative to catheter 20. As seen in
Vessel 180 is closed at a distal end 192 by three pads, numbered 194, 195 and 196, except for holes, 194′, 195′ and 196′, which elastically close about, but permit passage of wire 120. Similarly, on a proximal end 198, vessel 180 has a small hole 198′ which is sized to permit passage of wire 120, but too small to pass needle cannula 30.
Proximally affixed to vessel 180 is another hollow elongated, but angled vessel 200 which defines an angular pathway 202 for wire 120 as wire 120 is pulled through hole 198′ by proximal displacement of cap 130. Also, distal to cap 130, vessel 200 has a partially closed structure 204 which has a medially disposed slot 206 which restricts transverse motion of wire 120 when displaced distally. Note that slot 206 becomes a hole when vessel 200 is fully assembled.
Reference is now made to
This method of restricting distal travel of wire 120 is also usefully applied when needle cannula 30 is finally displaced proximally into vessel 180. Note that as wire 120 and attached needle cannula 30 are displaced proximally, both are wiped in combination by pads 194, 195 and 196. Also, in combination, pads 194, 195 and 196 are sufficiently elastic and pliable to close any fluid pathway afforded by a combination of holes 194′, 195′ and 196′ as either wire 120 or needle cannula 30 is displaced therein or when needle cannula 30 has been completely pulled therethrough. A more detailed disclosure concerning pads 194, 195 and 196 is provided hereafter.
Finally, proximal displacement of needle cannula 30 is limited by a diameter of hole 198′ which is sized to permit facile transport of wire 120, but which is smaller than the axial diameter of needle cannula 30. It is important to note that, due to impediment to distal displacement of wire 120 afforded by interaction of hole 198′ and angulation of pathway 202 in vessel 200, no additional impediment to restrict further distal travel of needle cannula 30 need be provided. Once needle cannula 30 is disposed in vessel 180 as seen in
As distal displacement of needle cannula 30 is fully impeded, it is important that any inadvertent proximal displacement of needle cannula 30 be avoided. As seen in
Cap 130 is seen displaced from vessel 200 in FIG. 3. Also, as seen in
Catheter 20 with needle cannula 30, wire 120 and safety housing 50 removed is seen in FIG. 6. Catheter 20 may be envisioned as having three distinctive sections, a distal tip section 240, an elongated section 250 of constant diameter contiguous with distal tip, a tapered section 260 wherein the outer diameter of catheter 20 is enlarged from the outer diameter of elongated section 250 to a constant enlarged outer diameter of a section 270. Individual magnified examples of each of these sections are seen in
As seen in
A design may be varied in many ways within the scope of the present invention, however, it is presently preferred that material selected for manufacture of catheter 20 be Carbothane�, currently available from Thermedics Polymer Products. Carbothane� is an aliphatic, polycarbonate base TPU that is available over a wide range of durometers, colors and radioipacificers. It has excellent oxidative stability and long-term biostability and is immune to alcohol degradation. Carbothane� products may be formed by extrusion and may be variably extruded and insert molded. Details of materials which may be selectively used in catheter 20 are provided hereafter.
As well, it is preferred that catheter 20 have two different visual characteristics distributed along its length. A major portion of the catheter should be relatively clear and translucent, permitting blood flash to be readily seen along the full length of catheter 20; however, it is also preferred that catheter 20 be "fluoroscopically trackable" and therefor should have a line of radio-opaque material distributed linearly along the length thereof.
Proximal to portion 274 is an elongated portion 276 of constant diameter, which is seen by example in section 250 in FIG. 8. Portion 276, having a constant internal and outside diameter, is disposed between portion 274 and a tapered portion 278 seen as a part of tapered section 260 in FIG. 9. Tapered portion 260 increases the outside diameter of catheter 20 proximally until it reaches a constant outside diameter as seen in section 270 in FIG. 10. As seen in FIGS. 7 and 8-10, catheter 20 also has readily visible equally spaced markings, generally numbered 279, (preferably one centimeter apart) as indicators for determining catheter 20 insertion distance. Further, as seen in
Other appurtenances, which may be affixed to catheter 20, are catheter stabilization component 60 and a snap closure, catheter occluding clamp 70, as seen in FIG. 6. Component 60 is like catheter tie down components which are commonly use for long term stabilization of catheters. Note that distal lip 62 of component 60 (see
Catheter 20 may be fabricated as follows. Distal portion 272 may be formed by insert molding of two Carbothane� materials, PC-3555D and PC-3555D-B20. Both PC-3555D and PC-3555D-B20 have a shore hardness of 60 D. PC-3555D is clear while PC-3555D-B20 has a barium content of 20% for radio-opacity and an added green dye for color. PC-3555D-B20 is molded with PC-3555D to provide a radiopaque strip approximately one millimeter wide along the length of portion 272. As an example, distal portion 272 may be two centimeters in length.
The rest of catheter is preferably formed by controlled extrusion of two other Carbothane� materials, PC3585A and PC3585A-B20, both of which have a shore hardness of 84A. PC3585A-B20 has a barium content of 20% for radio-opacity and has an added green dye. PC3585A-B20 is extruded simultaneously with PC3585A to form a mostly clear catheter 20 having an elongated radiopaque line of about one millimeter in width along the length thereof.
As seen in
As examples, lumen 150 may range from 0.028 (0.070 centimeters) to 0.035 inches (0.090 centimeters or the size of 20 Gauge per the Stubbs Needle Gauge System) in diameter. External diameter of portion 276 may be about 0.044 inches (0.112 centimeters or the size of 19 Gauge per the Stubbs Needle Gauge System). Tapered portion 278 increases outside diameter of section 270 to 0.049 inches (0.124 centimeters or the size of 18 Gauge of the Stubbs Needle Gauge System). Catheter 20 may be 20 to 22 centimeters in length. For a catheter 20 having a length of 22 centimeters, portion 272 may be two centimeters in length. Portion 276, including portion 274, may be 14 centimeters in length. Portion 278 may be one centimeter in length, and section 270 may be five centimeters in length. Taper of portion 278 is preferably linear.
Also as examples, needle cannula 30 may be a 20 to 21 gauge needle made from stainless steel and teflon treated and should be sufficiently long to be securely engaged by gripping via butterfly 40 when being used in catheter insertion. Nominally, cannula 30 may be two and a half centimeters in length. Sharpened tip 32 may have a bevel which is well known in the art of making needles for over-the-needle catheter insertion. Wire 120 may be 27 gauge stainless steel and made to extend from attachment to needle cannula 30 to cap 130.
Reference is now made to
As seen in
Inferiorly, each wing 300 and 300′ has a series of bumps, generally numbered 322, on a contiguous underside 324. See FIG. 12. The bumps provide a surface for gripping butterfly 40 and therefore catheter 20 and needle cannula 30 via pressure placed upon wings 300 and 300′. Relative geometry between wings 300 and 300′, ribs 320 and 320′, collet 310, catheter 20 and needle cannula 30 is seen in frontal perspective in FIG. 13. Note thinning of superiorly disposed lips 330 and 330′ of collet 310 at slit 314. This thinning provides an important feature and operational element for catheter system 10 and is treated more fully hereafter.
As butterfly 40 may be freely displaced along catheter 20, it is important that articulated wings 300 and 300′ distort that portion of catheter 20 which is resident in collet 310 of butterfly 40 to assure catheter 20 is effectively secured thereat by butterfly 40. Such a case may be seen in FIG. 14. In this case, catheter 20 is seen in cross section with needle cannula 30 removed therefrom. Wing 300′ has been articulated relative to wing 300 to distort catheter 20 for the purpose of holding catheter 20 in place. In this instance, underside 324′ of wing 300 is disposed against skin of a patient and a bandage 340 is disposed about butterfly 40 to securely hold butterfly 40 and therefore catheter 20 in place.
Reference is now made to magnified examples of butterfly 40 and catheter 20 found in
Reference is now made to
Assembly of midline catheter system 10 is straight forward. Attention is drawn to
As seen in
Vessel 200 is preferably made in two parts and assembled as a clam shell. One part 390 is seen, superiorly disposed, in
Steps in system 10 assembly may be accomplished as follows: (See
1. Affix clamp 70 and component 60 to catheter 20.
2. Affix butterfly 40 to catheter 20.
3. Thread a proximal end of wire 120 with needle cannula attached through distal end 100 of catheter 20.
4. Sandwich pads 194, 195 and 196 into pocket 372 of fitting 170.
5. Thread wire 120 to luer fitting 160 and through a medial thru hole 408 of fitting 170 and through pads 194, 195 and 196.
6. Affix fitting 170 to fitting 160.
6. Thread wire 120 through along path 140 through vessel 180 and through hole 198′.
7. Securely affix vessel 180 to fitting 170.
8. Lay wire 120 along pathway 202 and through slot 206 with wire 120 extending proximally outside vessel part 392.
9. Affix part 390 to part 392 to form vessel 200 and a hole about slot 206.
10. Securely affix vessel 200 to vessel 180.
11. Thread wire 120 through hole 228 of cap 130.
12. Affix cap 130 to vessel 200.
13. Securely affix wire 120 to cap 130 in hole 228 with adhesives 230.
14. Remove excess length of wire 120.
In some vessel pathways, threading of a catheter may be more difficult than others due to anatomical anomalies. To dispose distal end 100 of catheter 20 at a desired site may require use of a stylet. Such a stylet 410 is seen being displaced through a catheter 20 in
Stylet attachment module 420 is better seen in cross section in FIG. 18. As seen in
When needed and provided, module 420 is affixed to luer fitting 160 by standard methods used in connecting catheter lines already attached to a patient and stylet 410 is threaded through catheter 20 until end 430 is distally disposed as seen in
In addition to a stylet, such as wire 410 and end 430, catheter insertion may be facilitated by providing a leading, distal portion, such as bulging portion 272′ seen in FIG. 19. By providing such a bulging portion 272′, in a distal tip section 240′ of a midline catheter, it is possible to dilate contacted portions of a vessel and thereby more easily displace more pliant portions (reverse taper) of a catheter during catheter insertion.
Properly disposed, a needle cannula, such as cannula 30, may be employed to increase rigidity at distal end 100, as seen in FIG. 20. Note, in
It may be desirable to provide a needle cannula which is more pliant than a solid metal cannula like cannula 30. For this reason, a cannula/spring combination 450, as seen in
To use needle cannula 30, with safety to increase rigidity just proximal from end 100 of needle cannula 30, sharpened needle point 32 must be retracted and retained within insert 440. As distal displacement of wire 120 (and therefore needle cannula 30) is inhibited by geometry of vessel 200 relative to hole 198′ (or by other methods and apparatus which impedes proximal displacement of wire 120, which is consistent with the present invention, see, for example, FIGS. 3 and 4), sharpened needle point 32 may be simply retracted a predetermined distance into insert 440.
Such may be accomplished by affixing a mass to wire 120 as seen in
As seen in
Latch 470 is facilely assembled into vessel 200 at the time part 390 is affixed to part 392. Spring 492 is fitted about guide pin 490 and guide pin 490 is inserted into slot 474. Similarly, pin 476 is inserted into slot 472.
Note in one state, as seen in
The invention may be embodied in other specific forms without departing from the spirit or essential characteristics thereof. The present embodiment is therefore to be considered in all respects as illustrative and not restrictive, the scope of the invention being indicated by the appended claims rather than by the foregoing description, and all changes which come within the meaning and range of equivalency of the claims are therefore intended to be embraced therein.
Patent Citations
Referenced by
Legal Events
Original Image


text:
I'm trying to store the data that is in a stringstream into a vector. I can succesfully do so but it ignores the spaces in the string. How do I make it so the spaces are also pushed into the vector?
Code stub:
#include <iostream>
#include <sstream>
#include <vector>
using namespace std;
int main()
stringstream s;
string line = "HELLO HELLO\0";
stringstream stream(line);
unsigned char temp;
vector<unsigned char> vec;
while(stream >> temp)
for (int i = 0; i < vec.size(); i++)
cout << vec[i];
cout << endl;
return 0;


text:
My wife and I stopped in for breakfast. The food was really good, nothing fancy, just down home breakfast that's good, tasty and filling. We will be back here next time we are in Shelton.
We stayed at the Shelton Inn for 2 nights next to Blondies and ate Breakfast there both mornings. The food was great and we readily enjoyed the home town hospitality. Shelton Inn gave us a 10% discount coupon at the front desk.
Service was slow and the food average. People who came in after we had ordered our meal were served ahead of us. We had to request coffee refills.
Who cares what we think... The locals love this place and don't mind if we stop in. Ask the waitress what she thinks and she will give you an honest answer...home fries are better than hash browns. Good food.
Very good place to eat wonderful breakfast and great hamburgers too my favorite is the dagwood burger. Fast and friendly service
The waitress did a good job and the food was good and fresh. Very convenient if you stay at the Shelton Inn next door.
I've tried them 3 times every time the food was mediocre, cold, under cooked. When brought to their attention. ..not much response. I've finally gotten my friends to stop going there.
I really like Blondie's; they serve really good and fresh food. The waitresses could be a little nicer.
By the looks of the outside of this place you might think "yikes or maybe even yuck". but let me tell you, don't judge a book by it's cover. This seat your self restaurant had nice friend waitstaff and it was clean inside. The breakfast was the best breakfast diner i have ever eaten at. You can tell the that...
Blondies is a very good restaurant for American food. I've never gotten a bad meal there and the breakfasts are especially good. Very welcoming atmosphere and people tend to linger over their coffee.
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text:
NEW YORK (AP) — The most dangerous parts of a flight are takeoff and landing. Rarely do incidents happen when a plane is cruising seven miles above the earth.
Why Malaysia Airlines jet might have disappeared
So the disappearance of a Malaysia Airlines jet well into its flight Saturday morning over the South China Sea has led aviation experts to assume that whatever happened was quick and left the pilots no time to place a distress call.
It could take investigators months, if not years, to determine what happened to the Boeing 777 flying from Malaysia's largest city of Kuala Lumpur to Beijing.
"At this early stage, we're focusing on the facts that we don't know," said Todd Curtis, a former safety engineer with Boeing who worked on its 777 wide-body jets and is now director of the Airsafe.com Foundation.
Military radar indicates that the missing Boeing 777 jet may have turned back before vanishing, Malaysia's air force chief said Sunday as authorities were investigating up to four passengers with suspicious identifications. The revelations add to the mystery surrounding the final minutes of the flight. Air force chief Rodzali Daud didn't say which direction the plane veered when it apparently went off course, or how long it flew in that direction, Some of the information it had was also corroborated by civilian radar, he said.
If the information about the U-turn is accurate, that lessens the probability that the plane suffered a catastrophic explosion but raises further questions about why the pilots didn't signal for help. If there was a minor mechanical failure — or even something more serious like the shutdown of both of the plane's engines — the pilots likely would have had time to radio for help. The lack of a call "suggests something very sudden and very violent happened," said William Waldock, who teaches accident investigation at Embry-Riddle Aeronautical University in Prescott, Ariz.
It's possible that there was either an abrupt breakup of the plane or something that led it into a quick, steep dive. Some experts even suggested an act of terrorism or a pilot purposely crashing the jet.
"Either you had a catastrophic event that tore the airplane apart, or you had a criminal act," said Scott Hamilton, managing director of aviation consultancy Leeham Co. "It was so quick and they didn't radio."
No matter how unlikely a scenario, it's too early to rule out any possibilities, experts warn. The best clues will come with the recovery of the flight data and voice recorders and an examination of the wreckage. U.S. investigators from the FBI, the National Transportation Safety Board and the Federal Aviation Administration and experts from Boeing were heading to Asia to assist in the investigation.
A massive international sea search has so far turned up no confirmed trace of the jet, though Vietnamese authorities said late Sunday that a low-flying plane had spotted a rectangular object in waters about 90 kilometers (56 miles) south of Tho Chu island, in the same area where oil slicks were spotted Saturday. The state-run Thanh Nien newspaper said, citing the deputy chief of staff of Vietnam's army that searchers had spotted what appeared to be one of the plane's doors.
Airplane crashes typically occur during takeoff and the climb away from an airport, or while coming in for a landing, as in last year's fatal crash of an Asiana Airlines jet in San Francisco. Just 9 percent of fatal accidents happen when a plane is at cruising altitude, according to a statistical summary of commercial jet airplane accidents done by Boeing.
Capt. John M. Cox, who spent 25 years flying for US Airways and is now CEO of Safety Operating Systems, said that whatever happened to the Malaysia Airlines jet, it occurred quickly. The problem had to be big enough, he said, to stop the plane's transponder from broadcasting its location, although the transponder can be purposely shut off from the cockpit.
One of the first indicators of what happened will be the size of the debris field. If it is large and spread out over tens of miles, then the plane likely broke apart at a high elevation. That could signal a bomb or a massive airframe failure. If it is a smaller field, the plane probably fell from 35,000 feet intact, breaking up upon contact with the water.
"We know the airplane is down. Beyond that, we don't know a whole lot," Cox said.
The Boeing 777 has one of the best safety records in aviation history. It first carried passengers in June 1995 and went 18 years without a fatal accident. That streak came to an end with the July 2013 Asiana crash. Three of the 307 people aboard that flight died. Saturday's Malaysia Airlines flight carrying 239 passengers and crew would only be the second fatal incident for the aircraft type.
Continue reading this story on the...


text:
Gertrude Hansen
October 28, 2014
On June 14, 1911, Gertrude was born in Two Rivers, Wisconsin, a small town on the shore of Lake Michigan. After her mother died in the 1918 flu epidemic, she and her father moved in with her grandparents.
She married Robert in 1939 and they celebrated 51 years together before his death. They lived in San Francisco, and their daughter Karen was born there.
Robert L. Elledge
October 28, 2014
Robert L. Elledge, age 85, of Issaquah, died Oct. 17, 2014 from a fall.
Survivors are his wife Janet, his sister Sharon, and many nieces and nephews.
Jerrold Lee Butcher
October 28, 2014
Jerry passed away after a long illness with his family by his side on Oct. 22, 2014.
Leighton Bernard Evans
October 21, 2014
"Bernie" passed of natural causes Oct. 3, 2014.
He was born in Victoria, B.C., on Nov. 30, 1924. He was the "son of a sailor" with his father a salvage ship captain, but Bernie found his passion in the sky. In World War II, he trained as a fighter pilot and flew one of the world's first fighter jets, the "Vampire," for the Canadian Air Force.
Karl F. Besecker
October 21, 2014
Karl F. Besecker, formerly of Issaquah, father to Joshua, passed Sept. 23, 2014, in Shoreline.
A celebration of his life will be at 1 p.m. Friday, Oct. 24, at Snoqualmie Ridge Golf Club in Snoqualmie.
Constance Leahy
October 21, 2014
Constance L. Dunham Leahy, age 86, of Burlington, a former longtime Issaquah resident, passed away in Bellingham at a care facility Tuesday, Oct. 14, 2014.
Arrangements are pending with Sig's Funeral & Cremation Services in Bellingham, 360-656-5459.
Donald Richard Semon
October 14, 2014
Lt. Col. Donald Richard Semon, USMC, Retired, died Sept. 25, 2014.
A Celebration of Life service will be held at Issaquah Christian Church at 10 a.m. Friday, Oct. 17, 2014, with a Shelter Service to be held at Tahoma National Cemetery in Kent at 2:15 p.m. after the Celebration of Life service.
Knute 'Fred' Melsom
October 14, 2014
Knute "Fred" Melsom, of Issaquah, well-known Resource & Aerial Mapping photo pilot of the Pacific Northwest, died on Sept. 14, 2014, at age 80.
He is survived by wife Sylvia, daughter Julie (Jon), and grandchildren Caitlin and Haley.
Ioan Elenes
October 14, 2014
Ioan Elenes, age 89, passed away on Oct. 7, 2014.
He is survived by his wife Teodora, son Ovidiu (Carmen) Elenes and granddaughter Cassandra.
David Kiwas
October 7, 2014
My beloved husband David passed after long illness Sept. 24, 2014, in my arms, his best friend Thomas by his side.
David was born Nov. 26, 1954, in Los Angeles. His sister Charlotte, his brother Sam, sister-in-law Pauline and my whole family are grieving for him.
After high school, he moved to Phoenix, Arizona, to attend DeVry University to become an electronic technician. He moved back to L.A. after graduation and worked for Hughes Aircraft on helicopter defense.


text:
GMDC and RetailNet Group have partnered on a new partnership tool called the GMDC/RNG Insights Portal.
Inter Parfums has announced that its majority owned Paris-based subsidiary, Interparfums SA, has closed on its previously announced acquisition of Rochas brand from Procter & Gamble.
The Food and Drug Administration Friday announced that it had approved Rapamune (sirolimus), distributed by Pfizer's Wyeth Pharmaceuticals, as a treatment for the rare lung disease lymphangioleiomyomatosis (LAM).
Industrial auctioneer Ritchie Bros. has announced that Rexall CFO Sharon Driscoll will be joining the company as CFO, effective July 6.
Type-2 diabetes patients do better when a pharmacist is a part of their care team.
Recognizing that onsite health facilities can be an integral component of a successful health care program, employers are seeking to expand their use of such centers in the coming years, according to new research by global professional services company Towers Watson.
Fruth Pharmacy has unveiled new technology to make prescription label reading easier for the visually impaired by partnering with AccessaMed to bring a special prescription label into all 26 Fruth Pharmacy locations.
HDMA panel to explore how data may better define the front-end opportunities for independents.
Some online pharmacy sites will soon be able to point visitors to their .pharmacy domain names.
Mack Elevation Forum introduced a new serial digital commentary to help fine tune the process of developing innovation strategy on Thursday.
Retailers are increasingly elevating their game and looking to better connect with consumers via personalization and Canada's Shoppers Drug Mart is no exception.
In a new survey of approximately 2,700 American customers, the Canadian International Pharmacy Association found continued demand for safely ordering prescription medications online from licensed Canadian pharmacies.
A new anti-itch device using a static charge to alleviate a bug bite hit the market Wednesday.
J&J tests the "avalanche theory" of healthcare costs, finding that health starts declining at an accelerating rate after age 45.
Coty's N.Y.C. New York Color has announced the launch of a "Developed with New York Makeup Artists" initiative, a program that supports the brand's mission to deliver innovative, budget-friendly go-to-beauty essentials that have been developed with the expertise of trendy, young New York City-based fashion makeup artists.
The 21st Century Cures legislation would foster drug development.
The Food and Drug Administration has approved Boehringer Ingelheim, Inc.'s Stiolto Respimat (tiotropium bromide and olodaterol), a once-daily inhaler meant to treat obstructed airflow in patients, the company announced Tuesday.
Specialized manufacturers are gearing up for a robust trade out of generic biosimilar approvals, Kalorama reported last week.
New-to-the-block sports nutrition company Glukos lands a major U.S. soccer player's endorsement heading into the FIFA Women's World Cup.
Kroger has raised almost $12 million in the past five years to support the USO.
DSN senior editor Antoinette Alexander examines niche opportunities in the natural product, device, oil and depilatory categories , including the latest trends, in this multi-page report.
Drug Store News, in partnership with higi, a consumer health engagement company, is hosting the first-ever Fit Pharmacist Challenge, a series of fitness-tracking competitions that will reward winning pharmacists and pharmacy technicians for logging the most miles.
Did you know that makeup residue, oil and dead skin can collect on makeup brushes and impact your skin's health?
Beauty giant L'Oréal USA has teamed up with 3-D bioprinting company Organovo Holdings to develop 3-D printed skin tissue for product evaluation and other areas of advanced research.
DSN senior editor MIchael Johnsen examines niche opportunities in the intimacy health, gummy vitamin, pet health and cough-cold prevention categories, including the latest trends, in this multi-page report.


text:
Oxford, Mississippi's Andrew Bryant has proved to be a prolific songwriter, releasing his sixth solo album earlier this year This Is The Life, an album that has firmly entrenched itself in OpenEars Music's Top 5 of the year (no matter what comes out the rest of the year). 382 more words
Tags » Eddie's Attic
Sam Burchfield with special guest Great Peacock at Eddie's Attic
Review By: Mike Gerry
Photos By: Jamie Platus
On this Tuesday evening, one of our favorite bands in the world, Nashville's Great Peacock, came to town to play 504 more words
Eddie's Attic Presents: Leon Bridges
Review and Photos by: Jamie Platus
Last night I had the honor and privilege of seeing a man by the name of Leon Bridges . He played at one of… 367 more words
Eddie's Attic
Friday night, we went to a concert at Eddie's Attic! I had never been to this venue before, but I have always heard great things about it. 123 more words
prologue: 6 weeks
Sunday, February 22 to Saturday, February 28: it has been a pretty typical week, a favorite moment however, being Megan and Kevin finding out we're pregnant. 237 more words
Concert photos: David Bromberg plays Eddie's Attic
For more than four decades, multi-instrumentalist David Bromberg has spread his combination of quirky lyrics and folk-bluegrass-blues-rock music on more than a dozen albums.
On Sunday, the mainstay also known for working with Willie Nelson, Jerry Garcia and Bob Dylan played at Eddie's Attic and photographer Chuck Holloway was there to capture his performance. 18 more words
Jim White vs. the Packway Handle Band headed to Eddie's Attic
Call it a collaboration or a collision. "Take It Like a Man," the new album released under the group name Jim White vs. 791 more words


text:
Despite a friendly staff and best efforts at interior, the experience was tainted by long waiting times and tv blasting in the livingroom/bar. The place is basically a house turned into a restaurant and it lacked professionalism. Only could pay cash or m-pesa.
If you own or manage Sabrina's Ethiopian Restaurant, register now for free tools to enhance your listing, attract new reviews, and respond to reviewers.


text:
Custom Firmware 6.39 ME-9.6 and 6.60 ME-1.5 (FAT & Slim)
Neur0n is back with a couple of minor updates here for his Custom Firmware 6.39 ME-9.6 and 6.60 ME 1.5. Both changelogs are the same . Whats new? We now have a new CPU clock 199/99. And a big fix when saving the VSHMenu config. Neur0n also optimized the patching process.
Remember that the Light versions are for you guys that can't flash full firmware. For example you have a PSP Go or PSP-3000.
Non llights version are for you PSP-1000 and PSP-2000 (non TA88v3+ guys)
CFW 6.39 ME-9.6 / CFW 6.60 ME 1.5 changelog:
- Added CPU clock to 199/99.
– Fixed a bug in save config When VSHMenù.
– Optimizing the patch.
Test installation made
from 4.01M33 -> OK
On 5.00m33 -> OK
From 5.50GEN-D3 -> OK (edit version.txt)
From 5.50Prometheus -> OK (edit version.txt)
From 6.20TN-D -> OK
From 6.37ME -> Error
From 6.38ME -> OK
From 6.39ME -> OK
From 6.20PRO-B4 -> Error
From 6.35PRO-B4 -> Error
From 6.20PRO-B5 -> OK
From 6.35PRO-B5 -> OK
From 6.39PRO-B6 -> OK .: Installation :.
Source: Neur0ns twitter
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