text:
A therapeutic pad system (200) is disclosed for the treatment of edema, wherein the pressure applied to the user by the pad encourages the proximal flow of lymph. A fluid is provided to one or more bladder-type pads (220) in the pad through an inlet port (218) at a distal end of the pad, and is expelled from the bladder through an outlet port (220) at the proximal end of the bladder, thereby producing a pressure gradient across the pad. The system includes a flexible and compressible liner (250) filled with a number of small foam pieces (258) that is adapted to be wrapped about the therapeutic pad, and a relatively rugged, outer binder (270) that is securable about the liner (250). An advantage of the present system is that it may be applied in a number of different modes and combinations providing many treatment options.
1. A therapeutic pad system comprising:
a bladder defining a flow space for a fluid, the bladder having a distal portion with an inlet port into the flow space, and a proximal portion with an outlet port from the flow space such that during use a pressure gradient is produced across the bladder from a relatively high distal pressure to a relatively low proximal pressure;
a pump disposed in a fluid circuit with the bladder, the pump operable to circulate a fluid through the bladder, providing the fluid through the distal inlet port and receiving the fluid from the proximal outlet port;
a separable flexible liner adapted to wrap about the bladder, the liner having a plurality of compressible channels; and
a separable binder adapted to wrap about the flexible liner, the binder having a plurality of elastic straps;
wherein the bladder, separable liner, and separable binder may be used in different combinations to provide different treatment modalities.
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This application is a continuation-in-part of prior application Ser. No. 10/643,056, filed Aug. 18, 2003, priority from the filing date of which is hereby claimed under 35 U.S.C. � 120, and which prior application claims the benefit of Provisional Application No. 60/438,191, filed Jan. 6, 2003, the benefit of which is hereby claimed under 35 U.S.C. � 119, and which applications are incorporated herein by reference.
This invention relates to therapeutic compression systems and, in particular, to compression systems for the treatment of edema.
The lymphatic system includes lymph vessels, lymph nodes, and lymphoid tissues. Lymphatic fluid, or lymph, is collected from the interstitial spaces and is composed of fluids, organic and inorganic materials, and proteins too large for the venous system. In contrast to the closed-loop blood circulatory system, the lymphatic system works generally on a one-way flow principal. The lymph is first collected at the lymph capillaries that, in turn, drain into larger vessels. The movement of the collected lymph is generally from the more distal portions of the body inwardly toward the various lymph nodes and lymphoid tissues. The motive force for the lymph flow is generally associated with contractions of the adjacent muscles and walls of the larger vessels. Foreign matter and bacteria are filtered at various lymph nodes, after which the fluid enters into the venous system, primarily through the thoracic duct. Approximately one to two liters of lymph fluid drain through this duct every day in a healthy individual.
Edema is defined as the accumulation of excess fluid in a body fluid compartment, which is generally apparent as swelling of the affected area. This fluid accumulation can occur in the cells (cellular edema), in intercellular spaces within tissues (interstitial edema), or in potential spaces or cavities within the body. Edema can be caused by a variety of factors, including conditions that affect osmotic pressure, such as hypotonic fluid overload, which allows the movement of water into the intracellular space, or hypoproteinemia, which decreases the concentration of proteins and permits the passage of fluid out of the blood vessels into the tissue spaces. Edema also commonly results from surgery, injury, and other trauma or stress to the body. Vigorous exercise, for example, engaging in competitive sports, can produce stressors in the body, and particularly, in the joints, which result in edema or localized swelling.
Other causes of edema include poor lymphatic drainage (lymphedema); conditions that cause increased capillary pressure, such as excessive retention of salt and water; heart failure; and conditions that increase capillary permeability, such as inflammation. The swelling associated with edema can, in turn, cause pain and impede wound healing. If left untreated, fibrosis (a hardening of the tissue) may further complicate the drainage process.
Causes of lymphedema include aplasia (lack of development) or hypoplasia (underdevelopment) of the lymphatic system; inflammatory diseases, such as bacterial infections; malignancies, where the lymphatics or lymph nodes can be blocked by tumor cells; surgical removal of various lymph nodes; radiation therapy; local trauma to a limb; and blockage of lymphatics by various parasites. Various system diseases can cause lymphedema, including myxedema, renal disease (such as nephrosis or nephritis), and collagen diseases.
The lymphatic system is a primary system in the body for removal of the excess fluids that produce the edema or swelling. A healthy lymphatic system is therefore necessary for preventing and reducing edema. As noted above, the body's muscle systems motivate or assist in the motivation of lymph through the body toward the lymph nodes. It is known that externally applied compressive forces—for example, as produced with a compressive wrap or bandage—can also assist the lymphatic system in reducing and/or preventing edema. Such compressive therapies are often combined with the local application of ice or other cooling systems, which have also been found to prevent or reduce swelling. Alternatively, in some situations, heating of the affected area may be beneficial to the treatment of edema.
Treatment modalities known in the art include compression sleeves or stockings, pneumatic compression devices, and manual lymph drainage apparatus. U.S. Pat. No. 5,904,145; No. 5,906,206; No. 5,916,183; No. 5,918,602; No. 6,196,231; No. 6,254,554; and No. 6,338,723 disclose various designs for compressive sleeves and wraps for the treatment of lymphedema. The devices generally include a plurality of straps used to tighten the sleeve about the limb of the patient. In U.S. Pat. No. 5,904,145 and No. 6,196,231 (issued to Reid), a partially air-inflated pneumatic bladder is used to adjust the pressure applied by the straps. One of the straps is released and the partially inflated air bladder is inserted underneath the released strap adjacent to the patient's limb. The released strap is then closed and tightened to cause a predetermined increase of pressure to be achieved within the bladder. The strap is then released, the bladder is removed, and the strap is tightened to the same position that existed prior to the bladder being removed. These steps are then sequentially repeated with the remaining straps. In U.S. Pat. No. 6,338,723 (issued to Carpenter et. al.), indicia are used to adjust the compression applied by the straps. The stretch of the elastic material causes increased separation of the indicia. A system measures the separation of the indicia and converts it to compression, based upon the circumference of the body part. These systems are cumbersome to apply. A further disadvantage is the application of a static pressure to the limb.
U.S. Pat. No. 5,025,781 and No. 6,315,745 disclose air inflatable/deflatable compression devices. In U.S. Pat. No. 5,025,781 (issued to Ferrari), the compression device is used with a source of cyclical fluid pressure to provide alternating inflation and deflation cycles. The garment disclosed in U.S. Pat. No. 6,315,745 is formed through the patterned sealing of the layers of the garment at select locations to form air pockets that can selectively apply points of pressure to the affected area. In U.S. Pat. No. 5,976,099 (issued to Kellogg), there is disclosed a static reaction system containing a multiplicity of particles that is pressed against the affected area.
A therapeutic pad and system for treatment of edema are disclosed wherein the therapeutic pad is secured about a portion of the user for applying a pressure that decreases generally from a relatively high pressure at the distal end to a relatively low pressure at the proximal end. The therapeutic pad includes a bladder defining a flow space for a fluid, an inlet port to the bladder disposed at the distal end of the bladder, an outlet port disposed at the proximal end of the bladder, and securement for securing the therapeutic pad about a portion of the anatomy of a user. The therapeutic pad system includes a pump that provides a fluid under pressure to the inlet port and receives the fluid from the outlet port, such that the fluid flows through the pad from the distal end toward the proximal end, thereby producing a pressure gradient between the distal end of the bladder and the proximal end of the bladder. This pressure gradient encourages the desired proximal flow of lymph in the user. A therapeutic pad system is disclosed utilizing such a distal-to-proximal fluid flow bladder and fluid circulating system in combination with a pump disposed in a fluid circuit with the bladder, the pump operable to circulate the fluid through the bladder, a flexible liner adapted to wrap about the bladder, the liner having a plurality of channels that are substantially filled with foam pieces, and a binder adapted to wrap about the flexible liner, the binder having a plurality of elastic straps
In an embodiment of the present invention, the therapeutic pad is used in combination with a flexible and compressible liner that is adapted to be wrapped about the therapeutic pad, and a relatively rugged outer binder that is adapted to be wrapped about the liner, and secured about the portion of the user to be treated.
In an embodiment of the invention, the pump provides a periodic pressure pulse to the fluid such that the pressure pulse moves generally proximally through the therapeutic pad. The duration of the pressure pulse may be, for example, approximately equal to the transit time of the pressure pulse through the therapeutic pad.
In an embodiment of the invention, a control system controls the fluid flow rate through the therapeutic pad. The control system may also control the periodicity of the pressure pulses and/or the temperature of the fluid.
In an embodiment of the invention, the therapeutic pad includes a plurality of bladders, each bladder having a distal inlet port and a proximal outlet port, such that a more complicated pressure profile may be applied to the user. The plurality of bladders may form a unitary pad or may be separately securable to the user. For example, the bladders may be separately engageable, and may be pressurized simultaneously, in series, or independently.
In various exemplary embodiments of the invention, the therapeutic pad is adapted to be secured about a portion of the user—for example, a leg, knee, or shoulder of the user.
The foregoing aspects and many of the attendant advantages of this invention will become more readily appreciated as the same become better understood by reference to the following detailed description, when taken in conjunction with the accompanying drawings, wherein:
Referring now to the figures, wherein like numbers indicate like elements, specific embodiments of the present invention are described in sufficient detail to allow a person of skill in the art to practice the invention.
An inlet port 76 to the bladder 74 is provided at a distal end of the bladder 74, and an outlet port 78 is provided at the proximal end of the bladder 74. Throughout this document, the terms "proximal" and "distal" refer in general to the portion of the referenced element that is directed toward the "proximal" or "distal" portion, respectively, of the user when the system is in use, and wherein the lymph is understood to generally flow from a relatively distal portion of the user's anatomy to a relatively proximal portion. In other words, the therapeutic pads disclosed herein are intended to be applied to the user such that the direction from the distal end of the pad to the proximal end of the pad is generally in the direction of the lymph flow in the user.
The bladder 74 receives a fluid through the inlet port 76. The fluid flows proximally through the bladder 74 and exits through the outlet port 78. A pump 58 provides a pressure or motive force for circulating the fluid through the bladder 74. In this exemplary embodiment, a thermal modulator such as a heat exchanger 68 is provided to cool or heat the circulating fluid, whereby the therapeutic pad 70 can apply a thermal therapy simultaneously with a pressure therapy, as discussed below. A control 62 communicates with the pump 58 and optionally with the heat exchanger 68 to control the timing, duration, flow rate, applied force, and temperature of the circulating fluid. A power supply 52—for example, a battery system, external power source, or the like—provides power to the pump 58, control 62, and heat exchanger 68. The power supply 52, pump 58, control 62, and heat exchanger 68 may be conveniently provided in a single, portable console 55 (shown schematically in
It will be appreciated that the bulk fluid flow through the bladder 74 is generally one way—that is, from the inlet port 76 at the distal end of the bladder 74 to the outlet port 78 at the proximal end of the bladder 74. When the therapeutic pad 70 is properly secured about a portion of the user, pumping fluid through the bladder will produce a hydraulic pressure in the bladder 74, thereby increasing the pressure that is applied by the therapeutic pad 70 to the user. It will be appreciated by a person of skill in the art that the hydraulic pressure will exhibit a pressure gradient across the bladder 74 from a relatively high pressure, PH (see
It is contemplated by the present invention that the pump 58 may be controlled to pump the fluid continuously through the bladder 74 at a relatively constant pressure head.
It is also contemplated that the pump 58 may provide a time-varying driving pressure to the fluid—for example, to provide a periodic pressure ramp or pulse through the pad 70.
Pump 108 is operatively connected to a motor 106. The pump 108 has inlet and outlet ports (not shown) that may be substantially identical. The inlet port of pump 108 may be connected by means of a short section of PVC or similar tubing to a connector elbow of the reservoir 120 outlet. In a similar manner, the outlet port of pump 108 is connected using a short section of PVC or similar tubing to a connector elbow. By way of example, the tubing used has an internal diameter of 3/16 inch.
In the exemplary embodiment, the pump is a 24-Volt DC pump, model number UGP-2010P, manufactured by B & D Pumps. This pump is generally capable of providing up to 16 gallons per hour of fluid flow at an applied voltage of 12-volt DC. The power source for the motor may be a battery or 12-volt power supply. The power supply may be connected to any conventional household outlet, and is provided with the appropriate transformer.
During the portion of the cycle 114′ in which solenoid valve 114 is open and solenoid valve 116 is closed, the pump communicates with the bypass circuit through reservoir 120. The backward flow of fluid from therapeutic pad 300 is prevented by check valve 124. Therefore, the fluid in the therapeutic pad will be propelled forward by the inertia in the fluid supplied by the pressure gradient established during the flow cycle through the therapeutic pad. In this embodiment of the present invention, therefore, the closed time of solenoid valve 116 (equivalent to the open time of solenoid valve 114) may be selected to be approximately equal to the time for the majority of fluid to flush through the therapeutic pad 300.
The heat exchanger 118 regulates the temperature of the inlet fluid to the therapeutic pad 300. The temperature of the circulating fluid can be regulated to produce either a cooling or heating effect upon the limb being treated, or can approximate ambient temperature, whereby the fluid will produce neither a significant cooling nor heating effect upon the limb. Local hyperthermia has been shown to have a beneficial effect on edema (see Liu et. al., Lymphology 26(1):28-37, March 1993). In this study, the influence of microwave and hot water immersion hyperthermia on edema and edematous skin of the leg was studied in twelve patients. Whereas heating was associated with a reduction in girth and volume of the leg, lymph flow was found to be unchanged. Histologically, the edematous skin after heat treatment showed near resolution of perivascular cellular infiltration, disappearance of "lymph lakes" and dilatation of blood capillaries. It was concluded that the subsidence of local inflammation in the edematous limb with alteration in the extracellular protein matrix after regional heating accounted for the reduction in peripheral edema.
It has been recognized that there is an advantage to the patient's limb remaining cool while wearing a compressive sleeve on the limb. It is well known, however, that a large temperature differential between the fluid in the therapeutic pad and the normal body temperature may lead to patient discomfort, and can decrease thermal coupling by causing constriction of blood vessels in the treated limb. For example, the temperature of the circulating fluid for cooling may vary between 32 and 70� F.—the preferred temperature range is between approximately 50 to 70� F.
Heat exchanger 118 may be any standard fluid loop heat exchanger. By way of example, cooling can be accomplished by immersing heat exchange coils containing the circulating fluid into a mixture of ice and water (not shown). This approach is inexpensive and has the added advantage of portability. Any other suitable cooling system may alternatively be used. For example, the coolant system can utilize a vapor-compression refrigeration system, thermoelectric cooling, or heat pipe technology. In a conventional refrigeration system, the main working parts are the evaporator, condenser, and compressor. Thermoelectric cooling, also called the "Peltier Effect," is a solid-state method of heat transfer through dissimilar semiconductor materials. Heat pipes passively transfer heat from the heat source to a heat sink where the heat is dissipated.
Alternatively, if heat therapy is to be utilized, the circulating fluid may be heated. Heating a fluid may be accomplished, for example, using any of several types of electric heaters. Some heaters physically lend themselves to direct immersion in the fluid, while others are better suited for heating a pipe or vessel containing the fluid.
In the disclosed embodiment of
A control panel 112 (see
The circulating fluid enters therapeutic pad 300 through inlet port 318 and exits through outlet port 320 disposed generally opposite the inlet port 318, whereby the flow through the pad 300 is on average one way through the pad. The inlet and outlet ports may be fabricated from any suitable material—for example, plastic tubing or metal fittings. The inlet port 318 is positioned in the distal aspect of the limb being treated and the outlet port 320 is positioned proximally on the limb.
Therapeutic pad 300 is preferably fabricated of two superposed sheets of a flexible, waterproof material, such as polyurethane, rubber, or a synthetic form of rubber. The sheets may also be fabricated from a fabric coated with an elastomer, such as polyurethane-coated nylon. The sheets are joined together at the edges by suitable means, such as RF welding, heat welding, or otherwise bonded as desired. Spaced-apart heat-sealed lines 312 and spot bonds or welds 308 are also formed during the heat sealing process. The spot welds typically range in diameter from ⅛ inch to � inch, with the spacing between spot welds typically varying between � inch to � inch. The spot welds may be uniformly or randomly distributed throughout the therapeutic pad. The therapeutic pad 300, as shown in
The therapeutic pad 300 includes a bladder defining three distinct sections—an inlet manifold 302, a center section 304, and an outlet manifold 306. The inlet manifold 302 is in fluid communication with the inlet port 318 and center section 304. The outlet manifold 306 is in fluid communication with the center section 304 and the outlet port 320.
Heat seal lines 314 in inlet manifold 302 are oriented to direct the circulating fluid from inlet port 318 toward each of the spaces 310 in the center section 304 of therapeutic pad 300 formed by the heat seal lines 312. Heat seal lines 316 in outlet manifold 306 are oriented to direct the circulating fluid from each of the spaces 310 in the center section 304 of therapeutic pad 300 toward outlet port 320. It will be appreciated that although the seal lines 312 are shown as individually continuous lines, intermittent seal lines 312 are also contemplated by the present invention, and may provide in advantages such as greater flexibility, and more even transverse pressure distribution. Similarly the seal lines may be wider than shown, and/or may be of more complex shape, to produce the desired flow pattern.
The seal lines 312 and spot bonds or welds 308 form the spaces 310 that direct the circulating fluid from inlet manifold 302 to outlet manifold 306 along generally parallel paths. The seal lines 312 are shown with ripples to reduce eddy currents adjacent to the lines. Spot welds 308 are distributed generally throughout the therapeutic pad 300. Without the spot welds 308, the sections between adjacent heat lines 312 will undesirably balloon out in response to the fluid pressure since the inner and outer layers of the bladder are fabricated from flexible materials. The regions between the spot welds 308 will also balloon out in response to fluid pressure, creating a plurality of projections against the skin. It will be apparent to persons of skill in the art that the resulting projections or protuberances in the bladder that define flow paths for the circulating fluid produce localized high- and low-density regions, producing a pattern of relatively high and low pressures applied to the body part that the therapeutic pad 300 is applied to, which is believed to produce or promote localized interstitial flow paths to promote fluid movement and thereby reduce swelling.
The outer wrap 406 may be fabricated from any suitable material, preferably an elastic woven fabric. Furthermore, in some applications, it may be advantageous that the outer wrap 406 be anisotropic, i.e., having a greater elongation axially than radially. In contrast to compression sleeves used in the treatment of edema, the present invention does not rely solely on radial compression from the outer wrap 406 to reduce the degree of edema. Rather, the present invention provides a directional pressure gradient that may be time-varying, to promote a distal-to-proximal lymph flow, combined with a high-low pressure distribution to stimulate the movement of biological fluids. When placed on a limb, the ability of the outer wrap 406 to elongate in an axial direction provides improved form and fit when the limb is moved while the therapeutic pad is in place, particularly when the therapeutic pad spans a joint, such as the knee or elbow.
The outer wrap 406 may be fashioned to secure the therapeutic pad about the desired portion of the user's anatomy. It will be appreciated that the properties of the outer wrap 406 may be selected by using fabrics having the desired properties.
The seal lines 312 are shown to be generally parallel to each other in
It should be appreciated that by locating the inlet and outlet ports 318, 320 generally at opposite ends of the pad 300, the substantially unidirectional flow in the pad 300 may be directed to flow along the user's natural lymphatic pathways, as discussed below, thereby generating a desired pressure profile that directs flow generally toward the lymphatic nodes.
As shown in
The circulating fluid enters the therapeutic pad 700 through inlet ports 704 and 722. The circulating fluid is introduced through two inlet ports 704 and 722 and two manifolds 706 and 724 to provide more uniform distribution of the circulating fluid over the palmar and dorsal aspects of the arm and shoulder. The inlet ports 704 and 722 may be fluidly interconnected with a Y-connector (not shown) which, in turn, communicates with the fluid circuit shown in
It is known in human physiology that the radial and ulnar lymph trunks of the forearm largely join to form the medial lymph trunks of the upper arm, which primarily drain into the axillary nodes. Some of the radial lymph trunks join the lateral trunks of the upper arm, which drain into the supra- and sub-clavicular nodes. The heat seal lines 718, 736 of the disclosed embodiment are generally arranged to be uniformly spaced and parallel to one another in the upper arm. The fluid flow over the medial aspect of the upper arm is directed toward the axilla. The fluid flow over the anterior and lateral aspects of the upper arm is directed toward the sub-clavicular and supra-clavicular regions, corresponding to the pattern of lymph flow. Posteriorly, the fluid flow is largely directed toward the axilla, again corresponding to the pattern of lymph flow.
Spot welds 716, 734 are provided throughout the therapeutic pad. As discussed above, the heat seal lines 718, 736 and spot welds 716, 734 operate to distributed the circulating fluid from inlet ports 704 and 722 through manifolds 706 and 724 relatively uniformly through the upper arm sections 708 and 726, and through anterior shoulder flap 710 and posterior shoulder flap 728. The fluid exits the therapeutic pad through outlet manifolds 712, 730 and outlet ports 714 and 732, and circulate, for example, through the fluid circuit shown in
The therapeutic pad 800 is designed to direct the flow of circulating fluid toward the inguinal nodes. The outlet port 820 is off center, since the flow of circulating fluid is directed toward the medial aspect of the affected thigh. The therapeutic pad 800, shown in
The inlet manifold 902 includes seal lines 924 that generally disperse or distribute flow entering the pad 900 through the inlet port 928. In the distal center section 904 and the proximal center section 908, the seal lines 914, 922 are positioned to generally direct the flow parallel to the flow paths of lymph fluid in the portion of the user's calf and thigh that is covered or wrapped by the pad 900. In the distal segment of the lower limb, lymph flows in a relatively parallel path from the distal. Lymph from the medial and lateral aspects of the calf converges over the anterior calf and also flows from the distal to proximal calf. Seal lines 926 in the outlet manifold 910 direct the flow generally toward the outlet port 930. Spot welds or attachments 912 in the bladder 920 further define the flow paths in the bladder.
A circular cutout 932 is preferably provided in the middle of the center section 906 of the therapeutic pad to expose part of the patella. Oppositely-disposed tapered slits 918 and 934 are provided on both sides of cut-out 932 to allow the pad to remain in proximate contact to the skin as the knee joint is moved from flexion to extension, and vice versa. The taper helps to direct the circulating fluid toward the inner aspect of the pad as it flows from the calf toward the patella, and then distributing the fluid along the various flow paths over that portion of the therapeutic pad covering the thigh.
Thus far, single pads have been disclosed for the treatment of edema affecting a specific area of the body. It is also contemplated that two or more pads may be placed in series, such that the pads can be activated in any desired sequence, simultaneously, continuously, and/or in overlapping sequence. For example, the pad located most proximally may be activated first to cause proximal clearing of edema, which, in turn, will facilitate clearing of edema by the more distally placed pads. The pressure pulse period may be different in the various pads, for example the pressure pulse period in the distal pad may be half the period of the proximal pad.
A pair of pads 300, 300′ is shown in two generally separate but overlapping fluid circuits. The present invention may include more than two pads. The two fluid circuits share a heat exchanger 118′, power supply 102′, and control system 110′. The remaining components are generally the same as the corresponding elements shown in
The control system 110′ controls the valves 114, 114′, 116, 116′, and motors 106, 106′ to achieve the desired flow pattern through the pads 300, 300′. Although not indicated in
For example,
It will be readily appreciated, and is contemplated by the present invention, that the multiple pads 300, 300′, and 300″ may be constructed either as physically separate pads as shown schematically in
Although the therapeutic pads disclosed above, utilizing a directional fluid flow through a bladder, are described in a substantially stand-alone system, it has been found that the efficacy of such therapeutic pads may be augmented in a system that includes in combination, a therapeutic pad as taught above, a resilient and compressible liner, and a compressive outer binder, as in the exemplary embodiment described below.
It will be appreciated that the benefits of the directional fluid flow through the bladder-type pad 220, i.e., the generally distal-to-proximal pressure profile, is retained in this system 200. As shown schematically in
The liner 250 includes a soft and flexible outer layer 252 defining a soft container. The outer layer may be made from cotton or from a suitably comfortable natural or manmade material. The outer layer 252 is filled with a number of irregularly shaped, resilient foam pieces or chips 258. A number of seams 254—for example, the generally parallel, longitudinal seams 254 shown in FIG. 15—forms a plurality of elongate channels 256 in the liner 250. The channels 256, being filled with the resilient foam pieces 258, are compressible. Therefore, when the liner 250 is affixed tightly about a user's foot, the liner 250 will apply a relatively gentle, secondary pressure profile on the user. Although the preferred liner 250 has been described, it is also contemplated that an alternative flexible liner construction may be used, including, for example, a liner comprising a sealed outer layer and containing a compressible material such as a gas or compressible gel.
The liner 250 includes a clasping mechanism—such as hook-and-loop type fasteners 260—such that the liner 250 may be secured about the foot and ankle of a user (not shown). Although it is preferred to have a clasping mechanism 260, it will be readily apparent that the liner 250 may alternatively rely on the binder 270 for securement about the user.
The liner 250, filled with the plurality of foam pieces 258, provides a comfortable and resilient wrap that adapts to and accommodates the complicated anatomical geometry of the human foot and ankle. The pressure applied by the liner 250 and augmented by the binder 270 is diffused somewhat by the therapeutic pad 220 interposed between the user and the liner 250.
The body portion 271 of the binder may be made from a flexible, sewable material, such as a relatively thick nylon panel, composite panel, or the like. The fastening material 274 and straps may conveniently be attached to the body portion 271 by stitching, or any other suitable attachment method as are well known in the art. In the preferred embodiment, an elastic web 278 is attached at a middle edge of the body portion, generally holding the body portion in an L-shaped configuration.
Referring now to
It will be appreciated that although this embodiment is described with reference to a foot and ankle wrap, the liner may be constructed to be applied about other portions of the anatomy. For example, the therapeutic pads for the shoulder, thigh, or knee of a user may be incorporated into a system including a liner and binder adapted for the particular needs of the corresponding pad. It is contemplated that the fluid and thermal system such as that contained in the console 55 (
Another benefit of the present invention is the flexibility provided by this system 200. It should be readily apparent that the system may be alternatively applied to the user in a number of different modalities to accommodate the particular needs and preferences of the user. It is contemplated, for example, that the user may beneficially wrap the liner 250 and binder 270 about the user's foot and ankle without the therapeutic pad 220—for example, when the user is moving around and does not want to be attached to the fluid console 55 and related components. The liner 250 and binder 270 will provide support and enhance lymphatic circulation, albeit without the benefits of the directional flow pad 220. It is also contemplated that in some instances it may be desirable to reverse the relative positions of the liner 250 and the therapeutic pad 220, so that the relatively soft liner 250 is adjacent to the user's foot, and the pad 220 is disposed about the liner 250. This may be desirable, for example, to provide a more diffuse thermal treatment from the therapeutic pad 220, that is, if the therapeutic pad is providing a heat treatment, the heat may be diffused by the liner 250 before being applied to the user. Similarly, it may be beneficial to apply only the therapeutic pad 220 with the binder 270 to the user, without the liner 250. This modality may be desirable, for example, where it is beneficial to apply a more direct pressure to the user's ankle, without the softening attributes of the liner 250.
It is contemplated that the system 200 may be adapted to incorporate the variations on the therapeutic pad taught previously, including, for example, the use of heat seal lines and spot welds to direct the flow of the fluid through the bladder, the use of a pulsed fluid flow, and/or the use of multiple bladders. The system 200 disclosed herein, therefore, provides a very flexible treatment system.
While the preferred embodiment of the invention has been illustrated and described, it will be appreciated that various changes can be made therein without departing from the spirit and scope of the invention.
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Company to Maintain and Enhance the Biometrics Automated Toolset - Army System
SAN DIEGO and MCLEAN, Va., Oct. 23 /PRNewswire-FirstCall/ -- Science Applications International Corporation (NYSE: SAI) today announced it has been awarded a task order by the U.S. Army Program Executive Office - Enterprise Information Systems (PEO-EIS) to provide engineering support to help maintain and enhance the Biometrics Automated Toolset - Army (BAT-A) system. The task order has a one-year base period of performance, three one-year options and a total contract value of more than $37 million if all options are exercised. Work will be performed primarily in Sierra Vista, Ariz., and Kingstowne, Va. The task order was awarded under the Information Technology Enterprise Solutions -- 2 Services (ITES-2S) contract.
BAT-A devices collect fingerprints, iris scans, facial photos and biographical information of persons of interest and store information in a searchable data base, facilitating the use of biometrics for intelligence exploitation. The system provides Government forces with the ability to identify, track and exploit individuals encountered in the Global War on Terror. Through this task order, the SAIC-led team will help ensure continued, reliable technical support to BAT-A systems, peripherals and networks.
"SAIC has been the lead BAT-A engineering contractor since 2003, and we look forward to contributing to the growing biometrics support our fighting men and women are receiving throughout the world," said John Thomas, SAIC senior vice president and business unit general manager.
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As of Thursday, February 21, 2013
© Copyright 2015 Clayton News Daily
JONESBORO — Clayton County school finance officials were recognized recently for meeting national financial reporting standards.
Clayton County Public Schools was recently awarded the Certificate of Excellence in Financial Reporting from the Association of School Business Officials International for the fifth consecutive year.
Lonita Collier is the district's director of Business Services. She said the district underwent an extensive review by certified public accountants and practicing school business officials to be eligible.
"We're elated to be awarded this great recognition again," said Collier. "We hope that this will give the taxpayers an understanding that we are being financially responsible with their money."
The recognition came to the district Feb. 13 despite the revolving door of chief financial officers during the past few years of school board dysfunction and scrutiny from the Southern Association of Colleges and Schools.
Lonita has been with business services for the past five years and has assisted four different chief financial officers in that time. They included Theresa McDugal, Roger Reese, Denise Stevens and Chief Financial Officer Ken Thompson.
"I reported to them all," said Collier. "We've had a lot of changes in our leadership but our support staff — we've been kind of stable. The leadership changes but the work pretty much stays the same."
The school finance support staff is about 20 people who serve across departments. She said it has had to account for declining local revenues in shrinking budgets since 2007.
Collier said the general funds budget was $335 million this year, down $4 million from last year. The staff had to figure a way to make up for it.
She pointed to the district's new grant writer, Lonnie Smith, who has been with the school district for nearly two years. His position was created under the direction of former Superintendent Dr. Edmond Heatley to help fill gaps in school funding.
Smith has earned the district more than $2 million in grant awards to date.
Collier said that Smith applied for 154 grants during the 2011-12 school year and was awarded 62 of them, totaling $1.4 million. So far this year, the district has been approved for 27 grants worth a combined $724,000.
The grants allow the district to reallocate budgeted funds to its reserve balance, which could be used in the future to offset budget shortfalls.
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- BOE to vote on final FY14 budget ( June 22, 2013 )
- Institute names Clayton among Georgia's neediest, cash-strapped districts ( September 24, 2013 )
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- Proposed BOE budget dips $11 million into savings ( April 2, 2013 )


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The Magazine
Primate Primer
Uneasy lies the head of the Anglican Communion.
Aug 2, 2010, Vol. 15, No. 43 • By MARK TOOLEY
To paraphrase Pascal, the God of philosophers and scholars is not necessarily the God of Abraham, Isaac, and Jacob. Williams once told the BBC at Christmastime that much of the traditional nativity story is untrue. (He was referring to the snowy mangers and talking animals of popular lore.) But the media—not unreasonably, though inaccurately—assumed he was questioning traditional Christians' beliefs about the virgin birth, singing angels, and wise men. When the Church of England voted to divest from Caterpillar Inc. for doing business with Israel, Williams heartily endorsed the gesture, not anticipating any controversy. Within only a few days he and the Church had to backtrack, facing criticism not only from British Jews but much of the media and Williams's predecessor, Archbishop George Carey. His implied endorsement of certain aspects of sharia law in Britain excited even greater condemnation, though Williams insisted he was only defending Muslims' freedom to submit voluntarily to Islamic-guided contracts. He was, at least momentarily, the least popular man in Britain, he later moaned.
Political statements from Williams, who was appointed by Tony Blair, usually seem conventionally left-wing: He is sharply critical of globalization and free markets, very concerned about global warming, and outspokenly opposed to the Iraq war. He wants nuclear disarmament, though he is unsure how to get there and largely ignores his own theological warnings against utopianism. During the 1980s he protested at American military bases in Britain.
And yet, despite Williams's outspokenness on a wide range of political and theological issues, he is not naturally comfortable with public disputations. Even his admiring biographer admits to Williams's discomfort with the public eye on his "sometimes tortuous prose, his well-meaning but not always astute pronouncements on economic policy or sharia law, and even of the (absurd as well as false) rumor that he had attended orgies as a student in Oxford during the 1970s." Shortt notes that detractors see Williams's account of core doctrine "lost in a fog of equivocation" and Shortt grants that some of Williams's work is "under-edited and unduly mystifying."
Shortt insists that Williams's enormous intellect more than compensates for these failures to communicate with brevity, contrasting him with his supposedly less brainy predecessor George Carey, whose "contribution to intellectual debate was trifling." But is an archbishop of Canterbury's vocation chiefly to foster debate, or to lead his flock? Shortt indirectly admits that Williams may be out of place in his public role: As a student he was academically "faultless" but "shy" and "loved seclusion." He considered monasticism, and even Roman Catholicism, but ultimately pursued ordination in the Church of England. He thrived as a teacher, but as a pastor and bishop he was not always comfortable making hard decisions.
Despite Williams's introversion, he is a magnetic man and has always attracted followers. One admirer from his academic days recalls him as "scintillating," emitting an "aura," and exuding a "great white light." A female fan, early in his academic career, committed suicide, apparently distraught that her admiration was not reciprocated. A male admirer likens his presence to an "arena of prayer." A colleague fondly remembers that Williams was a "holy man" who was "sometimes a little in the clouds" and would cite "Gilbert and Sullivan" when preaching to a congregation likely to be unaware of late Victorian comic operas. Another colleague has warned, "Don't worry about his radicalism. Watch for his romanticism." Shortt himself thinks Williams may be more "tenderhearted" than a good judge of character. One liberal editorial cheered Williams's appointment to Canterbury: "He is a prophet and theologian. He is not a 'safe' man. If Tony Blair decides to hitch his wagon to the American star and back an attack on Saddam Hussein, Rowan Williams is unlikely to be found cheering him on." Another commentator noted that Williams's appointment had "squashed the ambitions of an evangelical lobby which reflects the prejudices of the developing world, not cosmopolitan London."
After his accession, Williams tried to mollify critics concerned about his liberalism. "I have always been committed to the Church's traditional teaching on sex before marriage," he insisted, not entirely accurately. For better or worse, Williams is sometimes guilty of "carefully judged unclarity." Shortt describes his "flair for seeing both sides of an argument" and Williams himself has been frustrated by the way his public comments are often received, likening it to speaking to the hard of hearing, admitting that his attempts are sometimes "stumbling" and "clotted" because the "subject matter isn't wrestled to the ground very easily."
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Results 1 to 6 of 6
Thread: Head plus body or just head.
January 27th, 2009 #1
Head plus body or just head.
Hallo. Sorry if this is 10001 thread about learning but i could not find answer to my question. I study human head at the moment. Nothing more. Sometimes it is so boring to draw just head but i could reach good level faster if i could fraw one subject at a time. I though that when i become better at drawing heads then will move to body anatomy. But maybe this is wrong way. I mean maybe i should draw everything at once? How do you draw?
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I think you need to focus on the entire body, not just the head. By learning how to draw the body(shoulders and below), it will also help you draw the head. It's like trying to learn how to ride a bike, with just the front wheel. You learn how to ride a bike by getting on the entire bike and trying to move forward. Learn the entire figure, not just the head. You will not only save yourself time, but it will also probably become less boring.
I would do like a few head/skull/portrait studies. Then I would do anatomy studies of the rest of the body. Then once I got the basic construction down, I would move on to specific body parts, etc.
I'm just starting out too, so we're in the same boat. Good luck.
Don't forget to learn perspective and value..Do these things while studing anatomy also...
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January 27th, 2009 #4
Thanks for advise people. I appreciate that8)
January 27th, 2009 #5
Do whatever you like, there's no right way how to do it ..if you only want to draws heads 8 hours each day for 2 months and if you are able to do this and even enjoy it - do it.
I think that evenly and versatile growing is better thought, I always have the feeling that working on different subjects gives me more inspiration and that I don't get stuck in my same old ways.. it just feels more round.. you also don't start bodybuilding by just training your right arm.
You could do the whole anatomy thing with a weekly focus on one subject ("this week I try to learn all face muscles, but I also do caricatures, pose studies and I try to draw with charcoal").
Last edited by Kiera; January 27th, 2009 at 06:14 PM.I just took a break to post this.
But sometimes I also draw stuff
January 28th, 2009 #6
Thanks Kiera. This is good idea to focuse on some body part every week but also study all anatomy. Good point.


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Let those among us without sin be the first to condemn
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|32 posts found
So I figured someone had to do it and yeah it did peak my interest about the debate that TOR's launch/headstart would completely derail Rift. I am guessing right about now is going to be peak time for most MMO's like WoW/Rift/Aion/WAR/EQ2, so this is the best time to get a snip it.
I figured this might be a interesting topic.
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Originally posted by Puremallace
Apprentice Member
Joined: 7/24/03
I don't think we will see much of a hit. The servers seem to have stabilized of late. According to rfift status Rift got a bump in population the week of Ember ISle release but it then went down back to where it was prior to Ember Isle.We don't have a single player in my guild leaving for swtor and I nly know one who will even be playing it and that is only part time as a second game.
I am not cocerned about Rifts population. The game is doing amazingly well. The retention rate with 55 servers 10 months after release is pretty amazing. Rift could still lose half its population and still be quite successful. IMO there are to many people playing Rift. My server always seems crowded. I often wish there were a lot less people.
I think ToR is drawing from a different audience than the most of the players who are stillplaying Rift. Plus almost all the players in Rift are pretty happy with Rift.
But I am curious to see the Rift Status numbers the next 4-5 weeks.
Originally posted by Zippy
58 NA servers down to 27 with 6 more ready to go is amazing retention?
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Joined: 6/11/08
I think with my heart and move with my head.-Kongos
I think Rift's population has stabilized to "people who want to play Rift". A lot like Warhammer's and AoC's population has stabilized to people who want to play those games. The people who want to play something else have already stopped playing. It just so happens that Rift's stable population is a good bit higher than the competition (so far).
I can not remember winning or losing a single debate on the internet.
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Originally posted by teakbois
99 serevrs down to 55 10 months afetr release is pretty amazing retention. Look at recent releases they all lost 2/3 of their intial sales in 6 months. Keeping over 50% is pretty amazing. Not to mention 55 servers is a huge amount. EQ2 when it peaked after recovering from its bad launch only had 16 total servers. Rift may end up going down to 30 servers or even 15 but even if that happens its a very successful release.
Compare that to AoC dropping down from 49 total servers to 18 serevrs 6 months after release. Then down to its present number of 4, 2 years after release. No Idea how many Warhammer has but I am sure its not many. Aion dropped to 4 NA servers 2 years after release. Rift is doing quite well now 10 months after release.
Right now Rift is the number two western P2P MMO by a long shot and the most successful western mmo since WoW's release. That will likely change with SWTOR and GW2.I am sure SWTOR and GW2 will sell a lot more boxes. Hard to compare GW as its not a P2P game but I am sure SWTOR will lose a lot mroe people but they will have a big advanatage as they will be able to replace those people with new people because of the name brand of Bioware and all the SW fans. Rift only had 10k total forum signups 2 months prior to release. So to sell over a million boxes the at release and to have 99 servers at release is pretty amazing. Still having 55 servers is also amazing.
But whats most important about Rift unlike these other failed games is Trion believes in the game enough to keep investing in new content. If they believed the game did not have a healthy long term future I doubt they would be putting the money they are into new content. Insteaed they would likely be nickel and diming us to death on new content to rake in as much as they could befroe going away. But they are doing the exact opposite and investing in the games long term future. Eq2's regrwoth I hink is something that made an impression upon Hartsman. if you keep building the game people will keep coming.
I would not be worrued about the population but rather I am excited by Rift's population. I would only begin to worry if Trion sopped putting money inot the game in the form of new content. If they did that then I might be agree with some of the doomsayers. But as long as they keep providing support to the game with new content then Rift looks nothing like failed games like AoC, Vanguard, and Warhammer.
hmmz about hour till what most consider prime time and even more people allowed into TOR. Server status for Rift looks identical to what I have posted above. What I am looking for is a point where it stabalizes in that EQ2 fashion or how Aion settled at a small number of 4.
That stabalization point because in the genre of themeparks TOR is about the biggest hit I think Rift will be taking for awhile. I know patch 1.7 is probably about to go into testing and I get the feeling it will have a world event leading up to the Maelforge raid. I am almost willing to put money on the fact that raid will open up the same day TOR 30 subs are coming due.
It will be very interesting to see where it is in a month. My best guess is WoW is taking just a brutal hit right now thanks to TOR. Hell I know Aion took such a bad hit EU is about to go F2P. I know more then a few guilds in Aion NA that were guaranteed dropping it for TOR, so expect NA to follow very soon.
Originally posted by Puremallace
And as of right now on a friday night there are 12 low pop servers instead of the usual 6. They may still make it to medium by the time, but it is well into primetime for 2/3 of the population. Definitely a noticeable slowdown but not an omg 50% left slowdown
Originally posted by Zippy
EvE is very possibly ahead right now, they are 350k+.
Most successful since WoW short term but I think LOTRO had 250k after year 1 and 275k after year 2, Rift isnt a guarantee to beat that
Friday night, heart of primetime....11 of 27 servers low pop. Im actually surprised, I didnt think it would make that big of a difference.
Im betting Puremallace wont be taking a screenie and posting it though lol
Originally posted by teakbois
No i was watching it as much as everyone else. I also looked at this
Honestly this was expected or if anything not expected. Massively hyped game just launched I expected as much, especially with the curiosity it has with the story content. Alot of my guild has said they will check it out and play it along side Rift for atleast a month.
There are about 5 more low pop servers then what that image above shows. NOWWWWWW does this mean unsubs straight out just using the free x-fer system? That is the tricky part you can pick up and move in a flash.
My big thing is one month from now what will the TOR servers and reviews look like and how will that really affect Rift? I still predict WoW taking a much much heavier hit then Rift.
THE HUGEEEE thing here is it is not just outright killing RIft. Aion EU right away went f2p bam and some people were calling that
Originally posted by Puremallace
First, I commend you for acknowledging it
Second, the wow server status seems roughly the same. its the same PvP servers that have been low pop for months now. All the PvE servers are still medium or better and there are still plenty of high pop servers
third, trying to say the servers went to low on a weekend because of transfers off is pretty silly. Everyone magically said 'todays the day im transferring?' far fetched, to say the least.
Well get a better view next weekend when the riftstatus.net numbers encompass the full early access time and start including the actual launch. i agree it wont kill Rift, but I didnt even expect it to affect it as much as it has.
Originally posted by Zippy
It is from 99 to 47, but who is counting.
However, I do not believe Trion managed to keep around 50% of its players. Judging from the agressive advertising by Trion in which they give away the game for free nowadays and are offering 30 days free playtime to people who cancelled their account, and observing the high throughput off players from launch till now on the servers I played, my educated guess is that Rift kept around 10% of its players or less.
It takes one to know one.
Originally posted by Astraeis
10% of its players or less.
Nah wayyy more then this. If you look at Aion or WAR, then yes that number applies more. My guess is the 40-50% number definitely applies. Have you seen what Blizzard has been doing lately? Rift is not the only mmo taking a hit.
Originally posted by Puremallace
Its a pretty safe bet that Rift has lost a higher % of its subs this year than WoW. WoW is seven years old and coming off of a very poorly received expansion.
You are right though that MMO activity has been down across the board. But Rift is probably down quite a bit more than the average, and with all the promotions its run it shouldnt be
Originally posted by Puremallace
It might be that the amount of players now playing as compared to when Rift started is 30-50%. I would agree to that. But the amount of players that started to play Rift and have stopped by now is way more than 80%, if not more than 90%.
It takes one to know one.
Originally posted by Astraeis
Say what you want about Rift, but this thread is proving Rift was and is a tripple A mmo. I would prefer for every server to be packed, but the mmo world is not like it used to be. People want quality and quick content for free and will insist on hopping from one mmo to the next.
Originally posted by Puremallace
There is no denying that Rift was being presented as a triple-A game and even next-gen. But it is the lack of depth that makes the game a fleeting experience. People do not leave because the game has so much to offer. Personally I am not hopping to any other game. But there will be alot of people with the hope another mmorpg might bring them what the current game does not deliver.
It takes one to know one.
Advanced Member
Joined: 10/05/03
Gaming should be about fun, not gender equality.
I use XFire to gauge population changes and from what I can see there Rift was in sharp decline before SW:TOR was released and probably it will get even worse.
Let's face it, besides the flexible class system, this game has no lasting appeal.
Apprentice Member
Joined: 6/13/10
It's all been said many times before......the game brings little to hold gamers......some twists on pve (but a LOT thats far too familiar).....weak crafting.....RVR that is just awful(and they bragged about their Mythic employees who knew the ins and outs of DAOC ). Development decisions makers ...not all but many....still don't understand their target market.The gamers level of experience..their likes.....the need for a strong reason why a player will STAY with your game.
SWTOR's development decision makers ...so far...are showing the same lack of understanding...bring to games not enoung compelling and fresh ideas...and could have similar results.


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Save your energy in other ways before sex. Skip heavy chores that day, if you can. "When it's date night, put off your grocery shopping and other errands until the next day," says Darlene Lee, NP, a nurse practitioner and practice manager at the University of California Rheumatology Clinic in San Francisco.
Plan your medicine doses. If your pain medication takes an hour to work, take it an hour before you have sex, says Ruffing. Just be aware that some drugs, like opioid painkillers, can slow things down.
Warm up. Take a warm bath before sex to relax and ease your aches, Ruffing says.
Don't get hung up on how sex used to be. Having RA has probably changed a lot about your life. It's probably going to change your sex life, too. That doesn't mean it has to make your sex life worse. If some of your standard moves don't work now, try new positions. Think beyond intercourse. You may need to adapt, but you don't need to give in. Use these changes as a chance to find new pleasures, says Lee.
Go easy on yourself. "People with RA tend to be their harshest critics," says Lee. "Be forgiving instead." If you're planning to have sex tonight, remember: It's not an audition. Just feeling close and connected can be good for you and your partner.
With or without RA, sex can be clumsy and silly sometimes. That's OK.
If a new technique doesn't work, try not to get self-conscious or embarrassed. Laugh it off and try another. Sex isn't supposed to be solemn. It's supposed to be fun.


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Al Montoya the cheater and womanizer
Posted February 26, 2013
Al Montoya the guy that all hockey fans think is great and wonder cheats on his wife with woman in different states. And when he comes back to his home town he has many woman I'm which he cheats on his wife with. The fancy article written about him that you can find in magazines and the Internet, they are a bunch of bull. Yes he is Cuban but what he leaves out is that he isn't 100% Cuban. His mother is 100% Cuban but his father is Colombian. Which he never admits he's Colombian because he's ashamed he Colombian and ashamed of his father'
1 Comment:
and he aint alone..
take a number???
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College Open Textbooks Community
Driving Awareness, Adoptions, and Affordability
Jacky, I am really looking forward to working with you on this project. It
will be like old times! Since I am new to this field I also look forward to
learning new things. What little I know about what you are doing has
me excited to learn more. Thanks .........Judy
Thanks Jacky for the warm welcome. I am excited to be a part of this group. I am excited to expand the visibility of Open Education. I think it is desperately needed. Thank again.
Hi Jacky, thanks for your comment. It's good to meet people who know Joel & Justin; they are great to work with! I will check out the blog post functionality you suggested. Thanks!
Thanks for giving me the rundown about collegeopentextbooks.com :) I feel like I had a mini orientation and I understand how things work a lot better. I uploaded my avatar, and I look forward to participating in this wonderful and inspirational movement!!
Thanks !!!
Thanks for this information.
Dear Jacky,
I am excited about all the possibilities that Open Textbooks present.
Of course I am new to the field and I want to meet others and see what they are doing. Thanks for your welcome and I am looking forward to some great projects.
Barbara J
Hi, Jacky - just playing "hi."
p.s. great new picture!
Thank you for this information.
Enjoy a glorious year,
Hi Jacky! Thank you for talking about our bookloan program, that is really exciting! We're working on improving and expanding, I'll send you updates once in a while if that would be useful.
Last year Nicole Allen helped us in promoting open-textbooks and the information you share has helped me so much in teaching faculty about open-textbooks. Since we met, I've become obsessed with open-textbooks :) and promoting them is a fun role our program is incorporating into every semester.
Cheers and I hope you have a very fulfilling 2011 :)
© 2015 Created by Jacky Hood. Powered by


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Bill Moyers Journal | Climate Security, Workplace Safety | PBS
Duration: 51:34 (Full Program)
Program: Bill Moyers Journal #1212
Broadcast Date: Jun. 27, 2008
Senator Barbara Boxer on the Climate Security Bill. EXPOSE and THE JOURNAL go inside America's poultry industry to show the reality of working conditions and to investigate how official statistics showing a drop in workplace injuries may have been the result of deceptive reporting. A Bill Moyers essay on big oil.Tags:
BILL MOYERS JOURNAL | Workplace... (#1212)
Injury rates reported at America's poultry plants have dropped dramatically in recent years, and so have workplace... 00:34
Bill Moyers Journal | America's... (#1339)
Full Program: Assessing Obama's first year in office. And, confronting America's energy crisis. Faced with the increasing global... 53:20
BILL MOYERS JOURNAL | Obama and...
Bill Moyers talks with two environmental activists who are disappointed in Obama's progress on climate change. Also,... 17:16
Bill Moyers Journal | Swing State... (#1220)
Full Program: Analysis of the Democratic Convention. Earl and Merle Black on swing states. 52:24
BILL MOYERS JOURNAL | Jim... (#1353)
Bill Moyers interviews populist Jim Hightower about the history and legacy of people's movements and discusses how... 24:28
Bill Moyers | The Journal:... (#1353)
Full Program: Citizen action in Iowa, Jim Hightower on Populism and writer Barry Lopez. 01:23:08
BILL MOYERS JOURNAL | William K.... (#1352)
As President Obama makes the case for strong financial reform, Bill Moyers sits down with veteran regulator William K.... 26:27
BILL MOYERS JOURNAL | Bill... (#1352)
A Bill Moyers essay on the Deepening the American Dream project. 03:35
As Big Telecom tightens its grip over broadband, is your access to the Web at risk? Bill Moyers talks with FCC... 23:29
Bill Moyers | The Journal: Our... (#1352)
Full Program: FCC commissioner Michael Copps on 'net neutrality', William K. Black on Wall Street. 53:39
BILL MOYERS JOURNAL | James... (#1351)
How did Big Finance grow so powerful that its hijinks nearly brought down the global economy and what hope is there... 24:48
BILL MOYERS JOURNAL | James... (#1351)
How did Big Finance grow so powerful that its hijinks nearly brought down the global economy and what hope is there... 29:28
BILL MOYERS JOURNAL | Preview:... (#1352)
SPECIAL WEB PREVIEW: The Internet has transformed business, politics, and culture but will a corporate agenda kill... 04:26
Bill Moyers | The Journal:... (#1351)
Full Program: Simon Johnson and James Kwak on Wall Street and Washington. 53:48
BILL MOYERS JOURNAL | Andrew... (#1350)
Full Program: Historian, international relations expert and former US Army Colonel Andrew J. Bacevich returns to the JOURNAL to... 35:08
BILL MOYERS JOURNAL | Wendell...
Full Program: Bill Moyers speaks with former insurance executive turned public health advocate Wendell Potter, who argues that all... 26:43
Bill Moyers | The Journal: Louise... (#1350)
Full Program: Louise Erdrich discusses her life and work. Historian Andrew Bacevich on Afghanistan. 53:50
Bill Moyers | The Journal:... (#1349)
Full Program: Bill Moyers discusses inequality with attorneys Bryan Stevenson and Michelle Alexander. 53:28
Bill Moyers | The Journal: Sara... (#1317)
Full Program: "Change, growth, and new learning" — there's a cultural shift in America, says Sara Lawrence-Lightfoot. Bill Moyers... 49:19
- Watch more video from this program
Post Date: June 27, 2008


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Jax is 17m actual, 15 adjusted. And I am going to scream if his pedi and the EI team we assess with do not figure out what learning curve he needs to be on. He is caught up to actual age on things like gross motor skills. He is perfectly at adjusted age on fine motor. And he is behind adjusted on cognitive, and especially his speech. He says 2 words (mama, and kitty, and honestly they aren't even really the words for it, but sounds that he makes repeatedly that I know what he is talking about, EI and pedi both said they count though). His pedi wants him to be saying 5-7 and EI wants him to be saying 3-5, clearly.
BUT, EI won't step in because he isn't behind ENOUGH. Pedi says EI needs to get on this because he is supposed to be caught up fully by 2yo. He isn't catching up. He scored much the same as he did when we did his first assessment when he was around 6 months old. Far enough behind it's obvious he needs help, but not quite far enough he can get it.
I'm frusterated. I want him to do better. But he's a happy, healthy kid, so I can't complain much. I just feel that the longer we take to address these issues, the harder it will be for him to catch up.
Advice? Tricks you learned to help develop cognitive skills and especially speech?


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Rock Hard Rally Gear. KTM LC4 and LC8 rally bash plates. (Australia)
View Single Post
Me like bikes!
Joined: Jul 2008
Location: NH, USA
Oddometer: 1,158
Tool box detail on a KTM 640 Adventure bash plate
I thought I'd post some photos of this great bash plate's functional toolboxes since there wasn't much out there on the thread with that kind of detail and it was something I was interested in before I bought one.
The two toolboxes are very roomy and easily fit a nice selection of tools and gear keeping the weight down low. I didn't even try to streamline or otherwise reduce and fine tune the tools I had been carrying in a Wolfman Enduro CarryAll front bag on another bike. I just put the tools right into the two bash plate tool boxes. In addition to what's in the bash plate boxes I have a small tail bag on the bike which has a spare inner tube, some tire irons, and a couple other odds and ends.
Right tool box packed
Right tool box contents
Tool roll, spare spark plug, and first aid kit
Left tool box packed
Left tool box contents
Factory tool kit and tire repair kit (CO2 cartridges, patches, compound, etc.)
Fall ride on a 1935 motorsickle
View Public Profile
Find More Posts by MeRide


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Environmental Studies
End of Semester Poster Celebration
Date: 5:00pm PST December 7, 2011 Location: Smith Hall
Smith Hall
Come see what students have been up to this semester as they showcase their work in an all-out poster session.
Share this story onDownload ical event
Environmental Studies
- The Program
- Faculty and Staff
- Learning Outcomes
- Special Initiatives
- Environmental Affairs Symposium
- The ENVS Community
- Evan Williams Tree Walk
- News
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- ENVS Calendar
Contact Us
Environmental Studies is located in room 343A of John R. Howard Hall on the Undergraduate Campus.
email firstname.lastname@example.com
voice 503-768-7790 fax 503-768-7379
Director Jim Proctor
Environmental StudiesLewis & Clark0615 S.W. Palatine Hill RoadMSC 62PortlandOR97219


text:
One of the most prolific and active contemporary artists of Manila today, Yason Banal has been exhibiting continuously and constantly while experimenting in different genres. He pauses to chat with Planting Rice in between exhibiting and teaching experimental cinema at the local University.
Welcome to Planting Rice
Written in 2003, this article is one of Pat Hoffie's texts from her Santiago Bose archive. A seminal essay, this introduces Santiago Bose's inherited background and moves on to his resurrection of the past as his unique way of reviving Philippine culture, his initiatives and overall cultural resistance.
Lena Cobangbang speaks about her association to her oeuvre as 'failed science projects' in this interview by Adeline Ooi for the exhibition "Velvet Landing" at Mo_space.
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In this Q&A made in 2012, Don Salubayba talks about project-oriented work, artist-residencies including collaborative experience with international artists and art communities.
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In this podcast (originally aired in November 2010), Leeza Ahmady talks with Patrick Flores, one of the most active curators working in Southeast Asia today, just after completion of his four-month research grant from the Asian Cultural Council to study the modern-to-contemporary shift in American Museums. Courtesy of the Program from Dialogues in Asian Contemporary Art, hosted and produced by Leeza Ahmady, Independent Curator and director of Asian Contemporary Art Week in New York City.
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Jeff Collins Ministries filed as a Domestic Nonprofit Corporation in the State of Texas on Friday, July 21, 1995. This corporation is no longer active according to documents filed with Texas Secretary of State and is listed as Involuntarily dissolved.
Milicent's past corporate interests include the Director of Jeff Collins Ministries .
Key roles for Milicent Collins
Jeff Collins Ministries
Director , Vice-President