text:
Heineken Cup Pool 5: Montpellier v Treviso preview
Last Updated: 17/01/14 3:25pm
Action from Round 1 of the Heineken Cup.
Treviso travel to Montpellier for their final Pool 5 fixture still looking for their first point of the Heineken Cup.
The Italians are without New Zealander Mat Berquist, meaning James Ambrosini starts at fly-half alongside Tobias Botes, who comes in for Edoardo Gori at scrum-half.
Valerio Bernabo captains the side from lock in the absence of Antonio Pavanello.
Montpellier are also already out of quarter-final contention after four defeats from five.
But they are looking for a morale-boosting performance before they head back into Top 14 action against Bordeaux-Begles.
Rene Ranger, Francois Trinh-Duc, Jim Hamilton and Nicolas Mas all return to the starting XV.
Montpellier: 15 Floch, 14 Ranger, 13 Tuitavke, 12 Combezou, 11 Dupont, 10 Trinh-Duc (capt), 9 Escande; 1 Nariashvili, 2 Bianchin, 3 Mas, 4 Hamilton, 5 Demarco, 6 Bias, 7 Gorgodze, 8 Beattie
Replacements: 16 Geli, 17 Bustos, 18 Fa'anunu, 19 Quercy, 20 Privat, 21 Perraux, 22 Berard, 23 Audrin
Treviso: 15 McLean, 14 Nitoglia, 13 Campagnaro, 12 Pratichetti, 11 Esposito, 10 Ambrosini, 9 Botes; 1 De Marchi, 2 Sbaraglini, 3 Rouyet, 4 Fuser, 5 Bernabo (capt), 6 Loamanu, 7 Derbyshire, 8 Filippucci
Replacements: 16 Ceccato, 17 Rizzo, 18 Cittadini, 19 Pavanello, 20 Minto, 21 Zanni, 22 Semenzato, 23 Di Bernardo
Heineken Cup Week Six 2013/14
Luck of the Irish
Stuart Barnes believes that the Irish provinces could all challenge Clermont for Heineken Cup glory.
O'Shea - Scarlets a delight
Harlequins boss Conor O'Shea praised both teams after his side defeated Scarlets 22-20 in tough conditions on Sunday.
Poor discipline costs Scarlets
Scarlets head coach Simon Easterby suggests poor discipline cost his side a place in the Amlin Cup quarter-finals.
- Botica boots Quins to victory
- Backing Clermont
- Davies pleased at Amlin chance
- Tough draw for English sides
- Clermont book date with Tigers
- Home tie delights Penney
- Gloucester win in Perpignan
- Home comforts for Munster
- Muller hails prolific Pienaar
- Townsend takes positives
- Montpellier crush Treviso
- Pienaar stars in Ulster win
- Warburton nearing return
- Wilkinson singing in the rain
- Exeter claim Cardiff scalp
- Toulon hold their nerve


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Letter to HHS on HIPAA's Impact on Sharing Mental Health Records for Background Checks
February 14, 2013
Excerpt: One matter that has been brought to the committee's attention is the applicability of the Health Insurance Portability and Accountability Act (HIPAA) and the HIPAA Privacy Rule on the ability of state and local governments to share mental health records with the National Instant Criminal Background Check System (NICS).
To read the letter, click here.
Letter Type:

subset: commoncrawl


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Comment: thank goodness because (Score 1, Troll) 291 291
2) One less revenue stream for government
3) More freedom for emitters of CO2
4) Happier plants since they need CO2
Comment: My modern stove doesn't make smoke (Score 4, Insightful) 1143 1143
Comment: Good (Score 1) 241 241
Comment: Let the free market decide (Score 3, Insightful) 1080 1080
My father and I used to work on cars together all year round including the winter. The trouble light we used had an incandescent 100W bulb. We used it for light AND heat! Anytime our hands got cold after gripping a freezing wrench, we would just place them around the light bulb and warm them up quickly. Now, the government is stepping in and telling me that they're smarter than me and that I need to use a CFL or LED bulb instead, which doesn't output nearly as much heat. So instead of having 1 power cord to deal under a freezing car, I am going to have to have 2; one for a light, and another for a heat source. LAME.
I know someone who replaced bulbs on a airport runways. The heat from incandescent bulbs is advantageous in street lights and runways in cold climate because the heat melts the snow which would obscure the light emitted from the bulb!
I am tired of the government pretending to be smarter than the invisible hand of the free market. Rand Paul talked about this. Search for: light bulbs rand paul congress.
Comment: Allow us to encrypt our radio transmissions (Score 1) 242 242
Comment: Re:Monetary Reform needed. Bankers = Fraudsters (Score 1) 633 633
Comment: Re:Monetary Reform needed. Bankers = Fraudsters (Score 1) 633 633
Comment: Re:Monetary Reform needed. Bankers = Fraudsters (Score 1) 633 633
Comment: Re:Monetary Reform needed. Bankers = Fraudsters (Score 2) 633 633
The amount of money circulating is thus a constant.
False. Constants don't change -- that is why they are called constants. Bank A loans out 0.9*deposit_X, which then gets deposited into Bank B. Bank B then loans out 0.9*0.9*deposit_X. Rinse and repeat say 100 times. Money_created_from_thin_air = 0.9 + (0.9^2) +
The ideal currency is one whose purchasing power remains constant over time. That could easily be done using a feedback control loop, such as a PID controller. Whenever there is inflation, the government could tax. Whenever there is deflation, the government could print debt free money. Either way, the government gets money, but under this system it can get some of the money without needing to tax it away from citizens. There is no need for a middle man (Federal Reserve Bank) to take its cut and give it to its private shareholders.
since the amount of money in the economy is set by an agency whose authority derives from Congress
You mean "derived", not "derives". The Fed was created by a very few members of Congress who were paid off by private bankers back in 1913. Desribe it however you want, but control of the Fed by the public is way too indirect. Period.
Yeah, it pretty much *is* a coincidence. Those actually familiar with history know that the Government has been borrowing (and repaying) money since the days of the Revolutionary War.
If you are implying that the Government has always been borrowing money since the days of the Revolutionary War, you are wrong. Lincoln's greenbacks issued during the Civil War were debt free currency. Coins created at the US mint even today are also debt free currency.
I'll get on that as soon as I finish the The Protocols of the Elders of Zion.
I've never heard of that book. Did you read it?
Comment: Re:Monetary Reform needed. Bankers = Fraudsters (Score 1) 633 633
Comment: Re:Monetary Reform needed. Bankers = Fraudsters (Score 2) 633 633
Comment: Monetary Reform needed. Bankers = Fraudsters (Score 3) 633 633
The hand that giveth is above the hand that receiveth. Private banks are above the governments who borrow money from them. Bankers are the masters of deception and fraud. The only things they create are debt and inflation through fractional reserve lending (fraud). Both of those are bad. They create all kinds of problems (such as the "business cycle"), and force people to participate in speculative investing or else watch their savings get inflated away.
Fractional reserve lending was pioneered by Nathan Rothschild and stemmed from greed -- he wanted to lend out more gold than he actually had! Anytime a bank expands the money supply by loaning out more money than they actually have, they are stealing from you who have saved. I understand the need to expand the money supply in order to prevent deflation. However, the government, not a private central bank, should be the one to do that. If the government created money, then they could spend that money rather than having to tax it away from the citizens.
It is no coincidence that the IRS was created shortly after the Federal Reserve Bank was created. How else would the government get money to pay interest on the money it borrowed? If you are in debt, you are a slave to your creditors. In 1913, "our" government allowed itself to become enslaved by the private Fed. The power to issue currency should reside with a government who is accountable to the public. The government exists to serve We The People. We The People should never allow ourselves to becomes slaves to our government (via entitlements, welfare, government healthcare, etc) who is a slave to the central bankers. Woodrow Wilson, and the few members of Congress who were actually present in the capital building 2 days before Christmas in 1913, made the terrible decision to give the power to issue currency to a privately held central bank (that doesn't even need to pay taxes!). The Fed is not really accountable to the public. Yes, the Fed board members are appointed by the President, but that very important decision should not be left up to a single man who may be too easily corrupted.
Governments do not need to borrow money from a bank. They can create money debt free! They are supposed to be doing that according to the US constitution:
"Congress shall have the power to coin money and regulate the value thereof." Since the value of money is determined by the quantity, Congress should be controlling the quantity of money, not banks!
Read up on Bill Still's ideas for monetary reform in his book "No More National Debt". If you don't want to read, then watch these films:
The American Dream
Money as Debt
The Money Masters
The Secret of Oz
Inside Job


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May differ from actual colors pictured above wearing a little. Please see the product pictures below color. Also, if you have any concern, please feel free to contact.
Height 165 cm ダークキャメル use: check the code
Wool t! lump material in cheer ( cheer ) tuba wide hat. Suffer, I feel classical actress, this season the trend retro Lady a is perfect for the finishing of the code. Casually became the color as fabric Ribbon that boast accent. Plump three-dimensional and large Ribbon is cute! (* only dark brown body and almost same color is)
And used throughout and thick fine felt fabric, is an elegant atmosphere.
* Here is the Rakuten international shipping
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Pronunciation: motivano
Added on: 2012-02-29 Listened: 11 timesin: verbo motivare
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How to make the transition to PowerPoint 2010 from PowerPoint 2003.
Explains the key differences between PowerPoint 2007 and PowerPoint 2003, and the benefits of upgrading.
Teaches basics such as formatting slides, adding charts and tables, graphics, special effects, printing, and templates.
"Your training goes way more in-depth than most classes at my school, and you can pause and rewind it if you don't follow it the first time." —Jared L.
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text:
Microprocessor Design/Instruction Set Architectures
The instruction set or the instruction set architecture (ISA) is the set of basic instructions that a processor understands. The instruction set is a portion of what makes up an architecture.
Historically, the first two philosophies to instruction sets were: reduced (RISC) and complex (CISC). The merits and argued performance gains by each philosophy are and have been thoroughly debated.
Complex Instruction Set Computer (CISC) is rooted in the history of computing. Originally there were no compilers and programs had to be coded by hand one instruction at a time. To ease programming more and more instructions were added. Many of these instructions are complicated combination instructions such as loops. In general, more complicated or specialized instructions are inefficient in hardware, and in a typically CISC architecture the best performance can be obtained by using only the most simple instructions from the ISA.
The most well known/commoditized CISC ISAs are the Motorola 68k and Intel x86 architectures.
Reduced Instruction Set Computer (RISC) was realized in the late 1970s by IBM. Researchers discovered that most programs did not take advantage of all the various address modes that could be used with the instructions. By reducing the number of address modes and breaking down multi-cycle instructions into multiple single-cycle instructions several advantages were realized:
- compilers were easier to write (easier to optimize)
- performance is increased for programs that did simple operations
- the clock rate can be increased since the minimum cycle time was determined by the longest running instruction
The most well known/commoditized RISC ISAs are the PowerPC, ARM, MIPS and SPARC architectures.
We will discuss VLIW Processors in a later section.
Vector processors[edit]
We will discuss Vector Processors in a later section.
Computational RAM[edit]
Memory Arrangement[edit]
Instructions are typically arranged sequentially in memory. Each instruction occupies 1 or more computer words. The Program Counter (PC) is a register inside the microprocessor that contains the address of the current instruction.[1] During the fetch cycle, the instruction from the address indicated by the program counter is read from memory into the instruction register (IR), and the program counter is incremented by n, where n is the word length of the machine (in bytes).
In addition to fetches of the executable instructions, many (but not all) instructions also fetch data values from memory ("load") into a data register, or write data values from a data register to memory ("store"). The address of the particular memory word accessed in such a load or store instruction is called the "effective address". In the simplest instruction sets, the effective address always contained in some address register. Other instruction sets have more complex "effective address" calculations — we will discuss such "addressing modes" later.
Common Instructions[edit]
Move, Load, Store[edit]
Move instructions cause data from one register to be moved or copied to another register. Load instructions put data from an external source, such as memory, into a register. Store instructions move data from a register to an external destination.
Instructions that move (or copy) data from one place to another are the #1 most-frequently-used instructions in most programs.[2]
Branch and Jump[edit]
Branching and Jumping is the ability to load the PC register with a new address that is not the next sequential address. In general, a "jump" or "call" occurs unconditionally, and a "branch" occurs on a given condition. In this book we will generally refer to both as being branches, with a "jump" being an unconditional branch.
A "call" instruction is a branch instruction with the additional effect of storing the current address in a specific location, e.g. pushing it on the stack, to allow for easy return to continue execution. A "call" instruction is generally matches with a "return" instruction which retrieves the stored address and resumes execution where it left off.
An "interrupt" instruction is a call to a preset location, generally one encoded somehow in the instruction itself. This is often used to reach commonly-used resources such as the operating system. Generally, a routine entered via an interrupt instruction is left via an interrupt return instruction, which, similarly to the return instruction, retrieves the stored address and resumes execution.
In many programs, "call" is the second-most-frequently used instruction (after "move").[2]
Arithmetic Instructions[edit]
The Arithmetic Logic Unit (ALU) is used to perform arithmetic and logical instructions. The capability of the ALU typically is greater with more advanced central processors, but RISC machines' ALUs are deliberately kept simple and so have only some of these functions. An ALU will, at minimum, perform addition, subtraction, NOT, AND, OR, and XOR, and usually also single-bit rotates and shifts. Many CISC machine ALUs can also perform multi-bit rotates and shifts (with a barrel shifter) and integer multiplication and division. While many modern CPUs can also do floating point mathematical operations, these are usually handled by the FPU, a different part of the machine. We describe the ALU in more detail in the ALU design chapter.
Input / Output[edit]
Input instructions fetch data from a specified input port, while output instructions send data to a specified output port. There is very little distinction between input/output space and memory space, the microprocessor presents an address and then either accepts data from, or sends data to, the data bus, but the sort of operations available in the input/output space are typically more limited than those available in memory space.
NOP, short for "no operation" is an instruction that produces no result and causes no side effects. NOPs are useful for timing and preventing hazards.
Instruction Length[edit]
There are several different ways people balance the various advantages and disadvantages of various instruction lengths.
Fixed-length instructions are less complicated for a CPU to handle than variable-width instructions for several reasons, and are therefore somewhat easier to optimize for speed. Such reasons include: CPUs with variable-length instructions have to check whether each instruction straddles a cache line or virtual memory page boundary; CPUs with fixed-length instructions can skip all that. [3]
There simply are not enough bits in a 16 bit instruction to accommodate 32 general-purpose registers, and also do "Ra = Rb (op) Rc" -- i.e., independently select 2 source and 1 destination register out of a general purpose register bank of 32 registers, and also independently select one of several ALU operations.
And so people who design instruction sets must make one or more of the following compromises:
- sacrifice code density and use longer fixed-width instructions, typically 32 bit, such as the MIPS and DLX and ARM.
- sacrifice fixed-width instructions, requiring a more complicated decoder to handle both short 16 bit instructions and longer 3-operand instructions, such as ARM Thumb
- sacrifice 3-operands, using no more than 2 operands in all instructions for everything, such as the Atmel AVR. 3-operand instructions allow better reuse of data[3]; without 3-operand instructions, programs occasionally require extra copy instructions when both variable input operands to some ALU operation need to be preserved for some later instruction(s).
- sacrifice registers, so only 16 or 8 programmer-visible registers.
- sacrifice the concept of general purpose register -- perhaps only 16 or 8 "data registers" are visible to 3-operand ALU instructions, as in the 68000, or the destination is restricted to one or two "accumulators", but other registers (such as "address registers") are visible to other instructions.
Further reading[edit]
- ↑ Practically all modern CPUs maintain the illusion of a program counter sequentially walking through code one instruction at a time. However, a few complex modern CPUs internally execute several instructions simultaneously (superscalar), or execute instructions out-of-order, or even speculatively pre-execute instructions down the "wrong" path, then back up and take the right path. When designing and testing such internal structures, the concept of "the" PC is a bit fuzzy. Some processor architectures, for instance the CDP1802, do not have a single Program Counter; instead, one of the general purpose registers is used as a program counter, and which register that is can be changed under program control.
- ↑ a b Peter Kankowski. "x86 Machine Code Statistics"
- ↑ a b The evolution of RISC technology at IBM by John Cocke – IBM Journal of R&D, Volume 44, Numbers 1/2, p.48 (2000)


text:
1. Position a rack in the middle of the oven. Preheat oven to 375 F (190 C). Line 2 large baking sheets with parchment paper.
2. In a large bowl, add in the canola oil, brown sugar and granulated sugar. Whisk with a hand mixer.
3. Beat in the omega – 3 egg and pure vanilla until the mixture thickens slightly and is sort of smooth.
4. In another bowl, add in the steel cut oats, rolled oats and oat bran. Into the same bowl stir in whole wheat flour, cinnamon and baking soda. Whisk all the ingredients with a fork.
5. Add in the dates to the mixture and mix with hands.
6. Stir in the oat mixture to the sugar mixture, and beat with hand mixer.
7. Mix all the ingredients with hands. When the dough is mixed, scoop out 1 tbsp. dough, roll it between your palms, and place the ball on one of the prepared baking sheets. Repeat with the remaining dough, spacing out the balls about 1 inch apart.
8. When you have finished scooping out the balls of dough, lightly press down with palm to flatten them.
9. Bake until lightly browned for 14 minutes. Let the cookies cool on the baking sheet for 5 minutes, then remove the cookies and let them cool completely on wire racks.
10. Serve Triple Oat Cookies with milk and enjoy!


text:
Results 1 to 13 of 16
Thread: Is this crazy?
August 7th, 2014 #1Registered User
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Is this crazy?
So, right now I am currently in college. I have about two to three years left, but I need to have a portfolio done sometime by 2016. There are many problems with my current art education. For one, I do not have the money to go to an art school and am basically stuck at my local university taking their art program. The problem, however, is that the classes aren't specialized and there is no digital art program, which means I have to go use another resource alongside my studies. A second issue with my current education is that it's not challenging enough. Yeah there's a class focusing on Anatomy, but that's only Drawing II. They have up to a drawing IV here, but you only get instruction in Drawing I and II. Drawing III and IV is mostly you coming up with your own assignments. The fundamentals, such as how cloth behaves, how light and shadows behave, color theory, perspective (I've got one and two down, and am just now beginning to understand 3 point a little more) to name some examples, are glossed over.
I have improved a bit, but mostly because I have used outside resources. What I thought about doing is using my refund check, plus taking out a little bit of loans for art supplies, perhaps an art tablet, a computer and some stuff for an art studio, such as lights and an easel, plus some living expenses and these art courses listed below.
1. Raybould's Virtual art academy
2. Digital tutors
3. Drawing tutorials online
4. Vilppu's stuff
5. Five Pencil Method
6. Sycra
Now I plan to do these on my own spare time to help give me a push since school really isn't doing anything for me really. I know it seems like a lot, but I've had a look at these sites, and may offer lessons in things not really taught or emphasized at school. The first one I figure I can practice the methods I learn from there when it comes time to do assignments for classes. I'm at a point where I'm at a dead end. I know what I need to improve on, but I just need some really challenging lessons on it. I've also thought about cutting back on art classes for a semester to a year, pick some really easy general eds, and focus on the art basics. So far, I've got perspective down a bit, but not to an advanced level, I need to really work on my shading skills because it's been the biggest thorn in my side. I know how to pick out the form in things and I get proportions fairly accurate. But I'm really not learning anything at college, and no one seems to know what i'm talking about when I mention something about perspective of the human figure. My adviser, another art teacher, said it wasn't important to know how to draw from memory and that you can always use a reference photo while one of my art teachers said that you do not need to know human anatomy to be a good artist. I'll have to disagree with both.
And one more thing; I want to be an illustrator and graphic novelist but I also want to try my hand at the fine arts too. I also looked into Industrial Design, but you need calculus for that degree, and the only math I'm good at is Geometry.
Sorry I ranted on a bit, but I want to see if anyone else was in this situation. and I already did try to Google up an answer for this, but I must have a specific answer. Thanks if you skimmed or read :3
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Hide this ad by registering as a memberAugust 8th, 2014 #2
Why don't you try the Start! program here and then move one to the Level Up! Scroll down for the reviews
Currently doing the Level Up course, so my SB is going to be lonely
August 8th, 2014 #3
More and more lately I've been hearing artists advise that instead of going to art school you're better off educating yourself at home.
I can't speak for how good those resources you listed are (although I've heard Vilppu is great), but I would suggest listing the fundamentals and making a curriculum of your own, something solid you can follow.
But I've never done this myself so I would take my advice with a grain of salt.
I'd also second Black Spot's advice, Level Up looks quite good and it's much cheaper than art school.
August 9th, 2014 #4
Even when you do go to a school with a decent program it is more about what you do outside of class then in it. Artists must always be driven to out perform themselves and whatever weaknesses they may have. If you feel you have a weakness that isn't being addressed in school then lter some of your assignments to push you in that direction. Artists for a large part are self motivated so one important thing to learn through art school is to be a self motivated student. Learn to utilize classes and lessons in a way that works for you. In the end your grades aren't as important as what you learn, and being a self starter is one of the best thing you can learn. Plus, think of all the money you will save.
ANDREWS WEBSITE I am available for work
REIGN OF THE GODS strategic fantasy warfare board game
August 11th, 2014 #5
I am in a bit of a similar situation to OP myself. I am teaching myself art. But this thread isn't about me so I will respond. I have looked at a lot of sites online and my experiences are as follows:
Digital Tutors - this is an advanced 3D art site, specializing in Autodesk products. I was subscribed to this and I am into 3D software. I had mixed outcomes. Its "basics" tutorials are good. But if you don't use Maya or 3D Studio Max it's probably not worth the cost.
CG Cookie - now this is a good site. It covers the absolute basics. If you have never done art in your life this is the site. Want to know how to set up a wacom? This is the site! Then there are more advanced tutorials on blender and unity. There is even a section on traditional physical sculpting if that's your bag. The style of tutorial tends to be informal and if you are a member you can download the tutorials and keep them! That is unique!
Lynda - a brilliant site. A bit of everything. Art. Programming. Business skills.
VTC.com - when I was doing my Dip of Graphics Design I was given full access to this site. So I know it well. Has a lot of microsoft tech tutorials on it and linux ones. Dwayne Ferguson offers good 3D and art tutorials. VTC is a bit "old school" in that it uses a lot of text tutorials rather than total videos. But it's worth a look. IMHO I think that Lynda is a shade better.
Gnomon - I don't know much about this. But it has actual online classes. I've never done one.
That is not intended to be a total list! There are a lot more sites for self-learning than this! If I were the OP I would go with Lynda and CGcookie. But it depends what kind of art you are doing and how advanced you have got to.
August 11th, 2014 #6
I would suggest Riven Phoenix for you human anatomy learning. It is reaaaal good!
August 11th, 2014 #7
August 11th, 2014 #8
August 11th, 2014 #9
There are certainly worse courses available online, but also much better ones. I don't think there's anything else that needs to be said about that.
August 12th, 2014 #10
What if I said that perhaps, just perhaps, the figure drawing the Riven teaches is ideal for getting your feet wet in terms of learning semi near accurate human proportions, and the basic components of the human body really fast. I am just 19 video into a near 250 video series and have already learnt a considerable deal. For now these videos are forcing me to work because they are really simple to follow and digest. Unlike when learning from a book source, I find it hard to procrastinate when learning through his videos. Yes I've seen his work, and they leave much to be desired when compared to the better works that I've seen.
But let me say this, I do not know whether or not you've seen the way he teaches and what he teaches, but I would say his method is akin to skimming through a 100 mediocre medical books about 100 different ailments as opposed to reading a single master class book about one particular medical ailment in the same time period. The 100 books allow for a mediocre comprehension of the 100 ailments, but this abundance allows you to swiftly put two and two together and improve at a faster pace. And at your discretion, you can always refine you work based on the better artists out there. Plus the guy makes learning anatomy fun
All that said, if his fundamental anatomical explanation is wrong, something I do not have the skill to pass judgement on yet, then all I've said thus far is void. Anyway, this is just my opinion.
August 12th, 2014 #11
August 14th, 2014 #12
I don't know what to say, cause I did buy the darn course..
I was enthralled with the near 100 hour content for the cheap price. Compared to Vilppu and co., admittedly, his work is bad. And it goes without saying, you do have considerably more experience both as an artist and as a member of these forums. That said, Riven Phoenix has been, thus far, thorough with teaching the various anatomies, so at least I have gained knowledge about the components of the human body.
I am assuming that you have not purchased the course so I believe it is wee bit bad on your part to pass judgement on the entirety of the content, here is why. Yeah it is art where great work naturally distinguishes itself from mediocre and easily from bad work, but you have to also consider that there maybe other merits from the content.
Take for example perspective tutorials where the visual work is never ever the goal. Rather the artist always wants to teach you a thing or two about perspective. They usually recognize that they are not great artists, but that does not stop them from teaching what they know. So it is fundamental perspective that they set out to instil in your brain. There work might lack creativity but for all we know that man could be a great perspective master and you have much to gain from them.
Good artists, good teachers do not always make and likewise good teachers, good artists do not always make. I disagree with Kev Ferrara on this based on past experiences in a field unrelated to art. You must consider that this maybe similar to that. While this man's work may not be visually pleasing I did learn a lot about anatomical components and workings.
Perhaps the way he is selling his product is what is leading to the confusion. He does after all call it the: "The Famous Figure Drawing Course." If he had instead called it: "Basic Fundamental Components and Workings of the Human Body" then this issue might have been more agreeable between me and you.
I am never one to knock any ones hustle. And you can tell Riven Phoenix has put a lot of hustle into making this 100 hour content. So I thank him for that.
Finally to conclude, I must say that I appreciate your input because, after all, you are doing it out of your free time to help up and comings to reach their goals faster. So thanks man.
Last edited by NesanJanan; August 14th, 2014 at 10:58 AM. Reason: Added a point
August 14th, 2014 #13
You must understand that I don't critizise the course/ his work because it isn't up to some arbitrary standard for art teachers that I have set myself and enforce as the ultimate judge.
It is simply that from the point of view of the consumer, the other courses available all come from teachers who're not only more skilled (as is evident from their own personal work), but also are reportedly good teachers (I own Vilppus videos and have seen all of the free content Stan offers). There's really no rational reason to go with the Pheonix course then, unless one assumes that the more content (in quantity), the better. Personally, I don't think the equation is that easy. I'd take one hour "with" Vilppu over 20 with any less competent teacher any time.
I'm sure the course benefited you, and I certainly didn't want to make you feel buyers remorse or something like that. I was merely offering options that I'm sure are better choices (at least from where I'm standing).
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text:
A computer assisted, minimally invasive method and apparatus for surgically removing abnormal tissue from a patient, for example, from a breast, are disclosed. The method involves imaging of the breast to locate the abnormal tissue, and determining a volume encapsulating the abnormal tissue and including a margin of healthy tissue. Based on the volume, a sequence of movements of a surgical instrument for tissue removal device is planned, so as to predictably excise the desired volume of tissue.
1. A computer-assisted method of removing abnormal tissue from a region of interest by way of a reduced number of incisions, said method comprising:
generating a three-dimensional (3-D) map of said region of interest comprising abnormal tissue;
determining a tissue volume, based on said 3-D map, said tissue volume including the abnormal tissue and an adjacent margin of healthy tissue;
determining, based on said tissue volume, at a computing device a surgical plan including at least one incision point and a series of associated excision points associated with said at least one incision point; and
controlling movement of a surgical instrument used to excise tissue, to sequentially move to each of said at least one incision point and to each of its associated excision points and excise tissue, resulting in removal of said tissue volume;
wherein at least one of said at least one incision point is associated with two or more excision points.
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21. An apparatus for tissue removal comprising:
a robotic imaging arm for holding and moving an imaging probe;
a robotic surgical arm for holding and moving a surgical instrument suitable for tissue removal;
a computing device for controlling movements of said robotic imaging arm, said imaging probe, said robotic surgical arm and said surgical instrument, said computing device operable to
generate a three-dimensional (3-D) map of a region of interest in a patient, said region of interest comprising abnormal tissue;
determine a tissue volume, based on said map, said tissue volume including the abnormal tissue and an adjacent margin of healthy tissue;
determine a set of coordinates including an incision point and a series of at least two excision points associated with said incision point to move a tissue removal device to said incision point and from said incision point to said series of excision points and excise tissue to remove said volume, resulting in removal of the abnormal tissue using a reduced number of incision points.
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29. A computer readable medium storing processor executable instructions which, when executed by a processor of a control system of a surgical apparatus comprising a robotic imaging arm for holding and moving an imaging probe; and a robotic surgical arm for holding and moving a surgical instrument, adapt said control system to:
generate a three-dimensional (3-D) map of the tissue comprising abnormal tissue;
determine a tissue volume in a patient, based on said map, said tissue volume including abnormal tissue and an adjacent margin of healthy tissue;
determine one or more incision points and a series of excision points associated with said incision points, based on said tissue volume to move a surgical instrument sequentially to said incision point and said series of excision points and excise tissue to remove said volume, resulting in removal of the abnormal tissue;
wherein at least one of said incision points is associated with two or more excision points.
30. A computer-assisted method of removing abnormal tissue from a region of interest by way of a reduced number of incisions, said method comprising:
generating a three-dimensional (3-D) map of said region of interest comprising abnormal tissue;
determining a tissue volume, based on said 3-D map, said tissue volume including the abnormal tissue and an adjacent margin of healthy tissue;
determining, based on said tissue volume, at a computing device at least one incision point and a series of associated excision points associated with said at least one incision point;
controlling movement of a surgical instrument used to excise tissue, to sequentially move to each of said at least one incision point and to each of its associated excision points and excising tissue, resulting in removal of said tissue volume;
wherein at least some of said series of excision points are at the same axial position along an axis through one of said at least one incision point, and said determining comprises accounting for the collapse of tissue into a void created by said excising.
The present invention relates generally surgical apparatus and methods, and more particularly to an apparatus and method for removing abnormal tissue. The apparatus and methods are particularly well suited for removing abnormal breast tissue.
In most countries, breast cancer is the second most prevalent cancer to afflict women. Currently, abnormal breast tissue is detected by various methods, such as physical breast examination, mammography, ultrasound and other breast imaging methods.
In order to determine whether such abnormalities are benign or malignant, examination of the histopathology of the abnormal tissue is required. Therefore, a sample of the abnormal tissue is taken by biopsy and is analysed by microscopic evaluation.
At present, there are biopsy techniques that can be performed through a small incision in the affected breast, and which are therefore considered to be minimally invasive. Typically, a radiologist or surgeon removes a sample of breast tissue and sends it to a pathological laboratory for microscopic examination. Minimally invasive techniques for breast biopsy include fine needle aspiration (FNA), core needle biopsy, large core surgical (ABBI) and vacuum-assisted biopsy (Mammotome or MIBB).
Minimally invasive biopsies may use computer-generated images to locate breast abnormalities, including the use of x-ray and ultrasound generated images. By accurately pinpointing and mapping the area to be biopsied, a small sample can easily be taken from the abnormal tissue.
The existing biopsy methods are limited to one or at most a few sample removals, and are not designed, nor are intended, to perform surgical excision of the abnormality. In some cases the biopsy method is limited to the removal of just enough cells or fluid sufficient for pathological testing.
If the abnormality is confirmed to be cancerous, typically the abnormal tissue, as well as a surrounding margin of healthy tissue, is removed. Surgical methods typically involve either a lumpectomy, which involves removal of the abnormality and surrounding tissue while leaving the majority of the breast tissue intact, or a mastectomy, which involves removal of all or a large portion of the breast tissue. Surgical removal may be done in combination with other treatments, such as chemotherapy or radiation treatment.
The advent of screening mammography has led to a paradigm shift in the presentation of breast cancers, with a higher proportion of tumours diagnosed at an impalpable stage. These lesions are smaller in size, and breast conservation treatment would be appropriate for these cancers. Breast conservation therapy involves the removal of the cancer, together with a margin of surrounding normal tissue, followed by a secondary treatment as necessary.
Surgical methods typically require stitches to close the excision and can leave a scar, which may complicate the interpretation of follow up breast examinations; increase the chance of bleeding, and infection; and cause problems with wound healing. As well, there are mortality risks associated with the use of anaesthesia.
Clearly then, there is a need for minimally invasive surgical methods for effective removal of abnormal tissue from a breast.
A computer assisted, minimally invasive method of surgically removing abnormal tissue from a patient, for example, from a breast, is provided. The method involves imaging of the breast to locate the abnormal tissue, and determining a volume encapsulating the abnormal tissue and including a margin of healthy tissue. Based on the volume, a sequence of movements of surgical instrument is planned, so as to excise the desired volume of tissue.
In one embodiment, an automated device, combining an imaging probe attached to a robotic imaging arm and a tissue removal device attached to a robotic surgical arm, controlled by a central control system, suitable for surgically removing abnormal tissue from a breast, is provided. The control system may drive the movements of both the imaging arm and the surgical arm, and receives and processes the image data so as to determine the sequence of movements necessary to excise the volume of tissue desired.
Methods exemplary of the invention use the apparatus to provide an assisted or automated surgical method for removing abnormal tissue, such as a tumour, from a breast, and which limit the volume of tissue removed and the size of the incision or incisions made, so as to reduce scarring and deformation of the remaining tissue. The method is particularly suitable for small breast tumours and abnormalities that are localized and intact (e.g. carcinomas in situ). It can be performed using a local anaesthetic on an outpatient basis, eliminating the cost and risk associated with current lumpectomy and mastectomy procedures.
In accordance with an aspect of the present invention, there is provided a computer-assisted method of removing abnormal tissue from a region of interest. The method includes generating a three-dimensional (3-D) map of the region of interest including abnormal tissue, and determining a tissue volume, based on the 3-D map. The tissue volume includes the abnormal tissue and an adjacent margin of healthy tissue. The method further includes determining, based on the volume, a set of coordinates locating at least one incision point and a series of excision points associated with the incision point, and controlling movement of a surgical instrument used to excise tissue, to sequentially move to the incision point and the series of excision points and excise tissue, resulting in removal of the tissue volume.
In accordance with another aspect of the invention, there is provided an apparatus for tissue removal, including a robotic imagining arm for holding and moving an imaging probe, and a robotic surgical arm for holding and moving a surgical instrument suitable for tissue removal. A computing device controls movements of the robotic imaging arm, the imaging probe, the robotic surgical arm, and the surgical instrument. The computing device is operable to generate a three-dimensional (3-D) map of the tissue including abnormal tissue; to determine a tissue volume, based on the map, the tissue volume including the abnormal tissue and an adjacent margin of healthy tissue; and to determine a set of coordinates, including an incision point and a series of excision points associated with the incision point to move a tissue removal device to the incision point and the series of excision points and excise tissue to remove the volume, resulting in removal of the abnormal tissue.
In accordance with yet another aspect of the invention, there is provided a computer-readable medium storing processor-executable instructions which, when executed by a processor of a control system of a surgical apparatus including a robotic imaging arm for holding and moving an imaging probe and a robotic surgical arm for holding and moving a surgical instrument, adapt the control system to generate a three-dimensional (3-D) map of the tissue including abnormal tissue, and to determine a tissue volume, based on the map, the tissue volume including the abnormal tissue and an adjacent margin of healthy tissue. The control system is also adapted to determine a set of coordinates, including an incision point and a series of excision points associated with the incision point, based on the tissue volume to move a surgical instrument sequentially to the incision point and the series of excision points and excise tissue to remove the volume, resulting in removal of the abnormal tissue.
Other aspects and features of the present invention will become apparent to those of ordinary skill in the art upon review of the following description of specific embodiments of the invention in conjunction with the accompanying figures.
In the figures, which illustrate, by way of example only, embodiments of the present invention,
In this context, the term "abnormal tissue" refers to tissue, which may be benign or malignant, and includes cysts, lumps, microcalcifications, spiculated masses, and asymmetric densities, and which may be palpable or non-palpable. Other abnormal tissue may be part of localized tumors, including carcinoma—in situ, such as Fibroadenomas, Phyllodes tumours, which are benign breast tumors in the glandular and stroma (connective), Fat necrosis (a benign condition where fatty breast tissue swells or becomes tender) as well as malignant breast tumours such as Lobular Carcinoma in situ (LCIS), Ductal Carcinoma in situ (DCIS), preferably at Stage-0 and I.
As illustrated, apparatus 10 includes a robotic imaging arm 12 for holding and moving an imaging probe 14; and a robotic surgical arm 16 for holding and moving a minimally invasive surgical instrument 18.
Arms 12 and 16 are interconnected with computing device 20 acting as a control system for computerized control and movement of these arms 12, 16. Imaging output of imaging probe 14 is similarly provided to computing device 20.
A simplified preferred hardware architecture of an example computing device 20 is schematically illustrated in
Software components stored within memory 24 are further illustrated in
Robotic imaging arm 12 is further schematically illustrated in
Exemplary robotic imaging arm 12 thus has five degrees of freedom. Preferably, the imaging probe 14, in combination with robotic imaging arm 12, may sample any position in 3-D space in proximity to the patient, allowing the region of the breast tissue comprising abnormal tissue may be completely scanned.
Imaging probe 14 may be any device that can scan a patient or a region of a patient's body and produce a 2-D image of the scanned region. For example, the imaging probe 14 may be an ultrasound probe or, an x-ray device as used in conventional mammography devices. Such imaging probes are known to a skilled person. In a preferred embodiment, the imaging device may include a linear or sector ultrasonic sensor, as available commercially.
Imaging probe 14 is in communication with computing device 20, and sends the scanned image information for processing by 2-D imaging component 44 at computing device 20. In the depicted embodiment, imaging probe 14 scans images in the plane of orientation of probe 14.
Apparatus 10 further include robotic surgical arm 16 and tissue removal instrument 18, more particularly illustrated in
Surgical instrument 18 may be a device suitable for excising a region of tissue from a patient's body, in an automated, minimally invasive manner. For example, the device may be adapted to create an incision in the skin of a patient, and then, by inserting a blade, needle or other cutter into the incision, may be capable of excising a tissue portion. Such devices may include biopsy devices, including a minimally invasive device, for example, as commercially available core needle device or a vacuum assisted biopsy device. The latter is illustrated in the preferred embodiment.
The surgical instrument 18 may be any biopsy device, as would be understood by a skilled person. Example devices are disclosed in U.S. Pat. Nos. 6,213,957, 5,595,185 and 6,019,733, the contents of which are herein incorporated by reference.
A core needle biopsy device includes a hollow needle that can be inserted through the skin to the abnormal tissue. Typically, the barrel of the needle is fitted with a cutting mechanism that may excise a tissue sample. A vacuum assisted biopsy device includes a hollow probe that uses a vacuum to gently draw tissue into a tissue-receiving chamber. A cutting mechanism is used to excise a tissue sample.
The exemplified surgical instrument 18 may have a motor driven cutting mechanism that can be moved longitudinally within the hollow probe.
In the exemplified embodiment, surgical instrument 18 is a vacuum assisted biopsy device, having a hollow needle and an aperture in the sidewall of the needle. Excised tissue may thus be collected using suction.
Further, in the depicted embodiment, robotic surgical arm 16, depicted in
A further rotational joint 69 connects arm portion 60 c at its end to shaft 68. A linear actuator 72 further connects surgical instrument 18 to arm portion 60 c. Finally, surgical instrument 18 includes a further rotational joint 74 allowing rotation about the axis of the surgical instrument 18 and allowing for the positioning of the aperture in a desired position to access the tissue that is to be excised and then removed through the aperture by the application of a vacuum and the actuation of a cutting device located within the bore of the needle, under control of computing device 20.
Exemplified robotic surgical arm 16 thus has seven degrees of freedom, so as to allow it to access any point in 3-D space adjacent to the region of tissue scanned by imaging probe 12. Preferably, the surgical instrument 18 can be translated and rotated about its longitudinal axis, providing an additional two degrees of freedom, and allowing surgical instrument 18 to access and excise tissue from any point in the scanned region of the patient's body, preferable from within a region of the patient's breast.
As should now be apparent, arm portions 50 a, 50 b and 60 a, 60 b lie in a plane. This facilitated counterbalancing of arms 12 and 16. As well, torques required for actuators of joints 54 a, 54 b and 64 a, 64 b is reduced.
As will become apparent, apparatus 10 uses a common Cartesian co-ordinate system to define locations of the end of each arm 12 and 16, imaging probe 14 and the tip of tissue removal instrument 18.
Translation of joint positions to Cartesian co-ordinates may best be appreciated with reference to
So, matrix expressions for the link vectors for the manipulator are,
Link position vectors in the stationary reference frame with their origin at the joint 54 a are designated as Pi for the ith link.
The position of the shaft 58 of arm 12 is the output of the direct kinematic analysis or, input of the inverse kinematics, expressed as:
This can also be expressed in polar co-ordinates P and θ. The square of magnitude of positive vector p=p2 is,
Joint positions for a desired location (x,y) of shaft 58, may similarly be calculated noting that,
Thus, each solution from cos θ2 represents two values for θ2 characterized by equal magnitude and opposite signs represented as the dotted lines. Since arms 12, 16 have the same geometry these two solutions (inward arm and outward arm with respect to the origin) may be used independently for each arm. As a default the inward arm solution is used for surgical arm 12 and the outward arm solution is for imaging arm 12 (as represented by the dotted line of
Now, for calculating tan θ1:
Thus, these equations may be used to compute the image position reference in XY plane in case of imaging arm 12 and later fed to the surgical arm 16 for positioning. Arm position in Z-direction is a direct calculation of the vertical joint variable for joint 56 (or 66).
The wrist unit for both arms 12 and 16 provide a spherical workspace for the end-effectors. To simplify the kinematic model, each wrist is decoupled to generate pitch, yaw and linear axes.
The kinematic diagram of the wrists of imaging arm 12 and surgical arm 16 are shown in
During initialization actuators 56, 66 and 72 are fully retracted. For both arms, the wrist is aligned horizontally and through T3 and aligned with arm through T4 and set to 0�. The needle aperture window is aligned and T5 is set to 0�.
Exemplary holding cup 80 is a cup or other shape designed to tightly compress the breast tissue. The holding device is preferably constructed of a rigid or semi-rigid material, for example, stainless steel mesh 82 that can be penetrated by a surgical needle or probe. As will be apparent, the finer the mesh 82, or the more penetrable the material generally, the less likely it is that the holding cup 80 will interfere with the sampling of 3-D space by tissue removal instrument 18. At the same time, the material should be strong enough to secure the breast from movement during the tissue removal process.
Holding cup 80 may be lined with a membrane (not shown) to protect the skin of the patient, for example, with a latex membrane. Conveniently, the latex membrane holds the breast in position with a comfortable tightness to reduce unpredictable mobility of tissue during excision. Further, latex is transparent to ultrasound and typically does not deteriorate the image for the purpose of surgical guidance. Skin along with the membrane is pierced with the needle while making initial incision.
Holding cup 80 may be attached to the patient, for example, with straps 84 a and 84 b. In the embodiment depicted in
Alternatively, a breast may be held by another holding device such as a pair of parallel compression plates, as for example typically used in mammography. This alternative embodiment allows for x-ray based scanning of the breast. The plates are used to compress the breast so as to make the abnormalities visible under x-ray imaging. Apparatus 10 may easily be used with such a holding and imaging device, however, the excision may be restricted to planes lying between the compression plates. Intermittent x-ray imaging, similar to that used in stereotactic breast biopsy is suggested for this method.
In operation, a patient 100 is placed on an operating platform as illustrated in
Apparatus 10 under software control performs steps S1000 depicted in
In step S1002, computing device 20 under imaging control arm control component 40 (
As noted, location of the surgical arm 16 and all the relative measurement of the position and orientation of imaging probe 14 and surgical instrument 18 are measured with respect to a common reference.
In step S1004, the two-dimensional (2-D) images are received at computing device 20 from the imaging probe 14, and processed by 2-D imaging component 44.
Once 2-D scanning data is acquired, computing device 20 under control of 3-D mapping component 46 calculates a 3-dimensional map of the scanned breast in step S1006. Specifically, computing device 20 compiles the 2-D images received and processed by 2-D imaging component 44 so as to generate a 3-D volume of the affected region. For example, the 3-D volume may be determined by stereotactic methods. Alternatively, the 3-D image may be determined by taking multiple 2-D images in parallel planes, with a given distance between the planes, as for example illustrate in
Once a 3-D map has been calculated, computing device 20 under control of surgical co-ordinate calculation component 48 calculates incision and excision coordinates required for the surgical instrument 18 to perform an incision followed by a series of excisions so as to excise the abnormal tissue. That is, computing device 20 under control of surgical co-ordinate calculation component 48, based on the 3-D, locates the abnormal tissue within the 3-D image in step S1008 and calculates the size and orientation of the volume of tissue to be excised shape of the tissue to determine the excision coordinates in step S1010.
Various image-processing algorithms may be used in step S1008 to accurately detect the edge of the breast tumour in the ultrasonic images captured in step S1004 and mapped in step S1006. Example algorithms include known watershed segmentation, non-rayleigh statistics, neural networks, texture analysis and the like.
In any event, the edges of the breast tumour are used to assess a volume of tissue to be excised. As there is typically limited control over the shape and size of the excised tissue sample due to limited size of cutter, the tissue is not exactly removed within the tumour boundary. As such, in the disclosed embodiment, a volume of interest having a regular geometric shape that encapsulates the entire tumour is assessed in step S1010. In the disclosed embodiment, a cylindrical excision region is illustrated. Conveniently, a cylindrical shape suits a rotating needle of surgical instrument 18. However, other regular geometric shapes such as a rectangular prism or other shapes befitting and encapsulating a given tumour dimension may also be used.
The dimensions and co-ordinates of the volume of interest are derived from the 3-D image map in step S1004. As well, a 2-D reference image may be assessed. That is, the 2-D cross-section of the tumour having the largest dimension may be considered as the reference image. Four extreme points on the visible tumour on the reference image identify the boundary of the tumour.
For use during surgery, a series of additional 2-D images with a known internal spacing along the full maximum length may optionally be taken along the plane normal to the reference image (cross-section plane perpendicular to reference image plane) plane.
Similarly, four extreme points representing the boundary of the tumour on these images may be used to find or verify the maximum dimension of the tumour. This may provide the third dimension (depth) for volume estimation.
Tumour location is calculated from the Cartesian co-ordinates of the tumour, based on the position of the imaging probe as the 2-D images are acquired. The cylinder is identified by its diameter, length and axial orientation.
The parameters for the cylindrical tumour volume calculation are
The parameters for the volume of interest, which includes the margin amount, are
Alternatively, a simplified approach to generate a boundary may be based on a surgeon's selection of four extreme points (2 points in each dimension) on the region of interest covering the suspected tumour on each image. Volumetric information may be generated by linearly scanning the ultrasound transducer across the affected surface in a given direction as shown.
Imaging probe 14 may be moved manually to the suspected region and scanned manually by moving the imaging arm (all joints are back drivable to manually move and can be locked at any configuration using mechanical and servo lock) to obtain the image showing best possible view of the tumour or suspicious mass. The best possible view corresponds to show the maximum spreading of the tumour horizontally and vertically with respect to the image plane. After selection of points on the reference image the transducer is rotated by 90� to show the cross-sectional view of the suspected area or tumour. The transducer is moved linearly along the scan axis with small increment (typically 2 mm) to acquire images showing the cross sectional views of the tumour. Similar to the reference image, four points are selected on each image showing the tumour.
Each selected point carries x and y values which correspond to the absolute location on the tumour as they are converted from the screen coordinate which is in number of pixel to corresponding millimeter on their respective image. The difference between the minimum x and maximum x out of all selected points with respect to the screen represents length of spread of the tumour along Zi-axis. Similarly, the difference between minimum y and maximum y out of all selected points represents the length of spread of the tumour along Yi-axis. Extreme points on the images may be marked through input provided by surgeon to computing device 20, through for example keyboard 38.
Out of these two values, the maximum and minimum dimensions may be taken as the length and diameter of cylinder respectively and the cylinder volume may be calculated. The margin amount is specified by the surgeon and added accordingly to the dimensions of the cylinder to calculate the total excision volume.
Subsequently, the number of cuts required for complete excision of the tumour is calculated based upon a given cutter window size in step S1012. In the disclosed embodiment, the incision is made along an axis that is parallel to the axis of the cylinder defining the volume of interest.
Specifically, based on the abnormal tissue volume, surgical coordinate calculation component 48 can then calculate the coordinates required for the incision and excisions to be performed by surgical instrument 18 in step S1012.
As noted, a margin of healthy tissue is included in the calculations in step S1010, so as to increase the probability of capturing most of the abnormal tissue, including tissue at the periphery of the abnormality, which may be abnormal but may not appear so based on the scanned image. For example, a 1 cm perimeter of apparently healthy tissue may be included in the calculation.
In step S1012, computing device 20 under control of coordinate surgical co-ordinate calculation component 48 calculates the coordinates for one or more incision to be made by tissue removal instrument 18, and the coordinates for a series of excisions to be made from that incision point where the cutting device of the tissue removal device is inserted in the breast tissue. That is, the calculated excision volume includes a central axis.
In most cases, only a single incision is required for surgery, however, multiple possible incision coordinates may be calculated in step S1012 and presented to a surgeon for a decision, as a mechanically feasible and optimum incision may not always be clinically optimum due to some clinical complications, for instance, very close to chest wall, lymph nodes, etc. Also, some larger tumour lumps (e.g. larger than stage 2 and spread) may also require multiple incisions
In any event, the approach axis of surgical instrument 18 is calculated in step S1012. In one embodiment, the central axis of the cylinder is used as the approach axis. Similarly, if rectangular prism is used, its central axis could be used as the approach axis. Accordingly, the intersection of this central axis and the surface of the breast is used as the point of incision.
Thus, the cutting needle of the surgical instrument 18 is placed at the center of the tumour and the tissue is progressively removed from all around in a symmetrical manner.
As well, the number and orientation of excisions that are to be made are calculated. The calculation is performed based in part on the capacity of a surgical device that is to be used to remove the tissue and based in part on the placement of the abnormal tissue with respect to the breast. Specifically, each excision is assumed to excise tissue along a length Lx. Lx may be assessed empirically and depends on the length of the opening of the excision device and the strength of the vacuum.
Moreover, each excision is assumed to excise tissue within a region parallel to the incision axis and within a defined distance of the axis. Thus, excisions at four angular positions, at 90� spacings, and corresponding to a single axial position allows excision in a generally cyclindrical volume having length Lx. This is illustrated in
As tissue is assumed to collapse into the void created by the excision, additional excisions at the same location, allows excision of a cylinder of larger diameter of length Lx. The number of rotations of the blade of surgical instrument 18 is thus calculated in dependence on the diameter of the diameter of the cylinder to be excised. Each rotation of the blade is thus assumed to excise an additional annulus about the central axis, as illustrated in
However, as the effect of gravity and compression may be less on the sides of volume to be excised, this method may not be accurate if the tumour size is too large (e.g. larger than 2 cm as the largest dimension with a 4 cm diameter including the margin tissue on both sides). As such, multiple parallel incision axes may be calculated for any particular cylinder.
The surgical co-ordinate calculating component 48 thus provides set of Cartesian coordinates (x, y, z) representing an incision co-ordinates I1 for the end of the robotic surgical arm 16, holding surgical instrument 18 to be positioned in 3-D space outside the breast at the appropriate position and angle for incision.
As noted, the center line of the cylinder determined in step S1012 used to encapsulate the tumour is used as the incision axis. The incision is effected by orienting the axis of surgical instrument 18 to align with incision axis in XIZI plane (by adjusting yaw and pitch (T4, T5) through joints 68, 69 and 74—vis
The corresponding values for each of joints 68, 69 and 74 and actuator 66 of surgical arm 16 are thus calculated based on the projection of the incision axis on the excision arm co-ordinate frame.
The cutting point of the tissue removal device 22 is inserted through cup 82 and through the patient's skin to the site of the abnormal tissue. Preferably, the incision or incisions are minimally invasive so as to minimize scarring, preferably between 1 and 10 mm, more preferably between 1 and 5 mm in length.
Next, the surgical instrument 18 is moved to the initial excision position E1 I1(d2, θ) in step S1014, by adjusting joints 66 and 74 and cutting device is actuated to excise a volume of tissue. In the depicted embodiment, the cylinder of interest is excised at beginning at its deepest extreme from the point of incision. Step S1016 is repeated for all excision co-ordinates associated with incision co-ordinate I1, as a result of step S1018. Specifically, for each radial position d2, the needle of surgical instrument 18 is rotated to the various angular positions. At each angular position, extractions of tissue are made by applying suction transmit through the window of surgical instrument 18. Next, the radial position (d2) of surgical instrument 18 is adjusted, based on the size of its cutting window. After all excisions at incision point I1, are made, steps S1014 may be repeated for any additional incisions (e.g. additional incision axes), as assessed in step S1020.
During surgery, on-line guidance may be provided by apparatus 10. Pre-calculated coordinates may be replicated by the apparatus 10 on the display of computing device 20 and the reference 2-D image along the cylinder axis shows the needle and the target region and collapse of the tissue (along the axes of the cylinder) may be updated as the surgery progresses, in step S1017.
Thereafter, the area of interest may optionally be rescanned as determined in step S1022, by repeating steps S1004 and onward to assess additional incision and excision co-ordinates. Optionally, a surgeon's input (provided, by example, by way of an input device such as a keyboard 38 or, a light pen, or, mouse) may be sought in step S1022 to control re-scanning. This repetition of steps S1004 and onward after completion of excisions associated with each incision allows a surgeon to monitor the position of the abnormal tissue during the surgery. This is particularly useful if the abnormal tissue mass collapses or deforms during the surgery as the result of removal of a partial volume of the abnormal tissue, and helps to ensure that subsequent incisions properly target the abnormal tissue.
Alternatively, instead of positioning the blade of the surgical instrument 18 at the centre of the volume of interest, the suction window may be placed along another axis, such as a parallel axis at the lower boundary of the total tumour as shown in
As should now be appreciated, in the disclosed embodiment scanning and excision are performed by apparatus 10 in a mostly automated manner. However, apparatus 10 may be used in conjunction with input of a surgeon. For example, a surgeon can manually verify that incision is in the proper location, and can guide or assistant in the guidance of imaging probe 14 and surgical instrument 18. To this end, joints and actuators of the imaging arm 12 and surgical arm 16 may be manually manipulated, in addition to be being actuated by computing device 20. Of course, changes in position resulting from manual manipulation are sensed by computing device 20 for reference purpose or to be used further in computation of desired excision coordinates. Positions of surgical instrument 18 and imaging probe 14 may be presented in real time on the display of computing device 20. Similarly, incision and excision co-ordinates may be presented on this display.
As well, although the disclosed device and techniques are particularly well suited in breast surgery, they may easily be used in removing other lesions, in other regions of interest. For example, the device and techniques, appropriately modified, might be used in the removal of testicular lesions, or other lesions.
As can be understood by one skilled in the art, many modifications to the exemplary embodiments described herein are possible. The invention, rather, is intended to encompass all such modification within its scope, as defined by the claims.
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- Medication prescription for various diseases.
- The best choice for pocket drug dictionary and drug book for nurses with facts, doses and overdose information.
- Missed dose details describing the impacts of a missed dose and necessary measures.
App Features:-
- Search feature to lookup the offline drug index.
- Drug classifications computations and calculations.
- Very friendly and beautiful interface.
- Drugs Encyclopedia with complete information regarding their use and abuse, side effects and pill identification.
Pill Identifier by Health5C
Powered by : Pillbox (U.S. National Library of Medicine)
HHS has been rapidly advancing a major new Open Government flagship project called the Community Health Data Initiative (CHDI). The Initiative embodies the philosophy of "open data" and data sharing.The core principle is that the government can help trigger enormous public good by implementing the idea of "government as platform". Supplying greater amounts of high quality, free government data to the public and actively marketing the availability of this data – which can then be turned into useful insights, applications, products, and services by a growing "ecosystem" of private and public sector innovators from across the country, working with engaged consumers, providers, civic leaders, employers, researchers, and others.
This is ongoing activity and Pillbox will continue to add new images to its database.
Disclaimer: The information given by Pill Identifier is not intended as medical advice or prescription. The information is only to help the user in identifying the medicines based on physical properties. Health5C does not endorse any of the medications listed in the application. Health5C is not responsible for any of the data entered by the user. The data entered by the user is at own risk.
By Health5C Wellness Solutions (P) Ltd. <http://www.health5c.com>
iPharmacy Pill ID & Drug Info
Join 3,000,000+ healthcare professionals and consumers users who are using iPharmacy ® to manage your medication, access dosage, side effect and warnings and etc for FDA approved medications.
<<<< Powered by GoodRx to find the lowest meds:
Easily compare prices at local and mail order pharmacies to find the lowest price.
--- Over 1 million prices for more than 6,000 drugs at every major US pharmacy chain and many local stores
--- Prices from all major US pharmacy chains and online pharmacies Information on manufacturer discount cards (free coupons provided by pharmaceutical manufacturers that can save you $500 or more)
-- Incredible saving: might be less than your copay!
-- One click refill to main pharmacy chains: CVS, RiteAid, Walgreens, Costco, WalMart and more!
<< User testimonials <<<
"iPharmacy is a one-stop shopping for medicine information and savings." A Patient
"This application has helped me with identifying many pills and has given me GREAT information on the 12 medications I take!" A Diabetes Patient
" I use iPharmacy to make sure all my medicines play nicely with each other and to know when is the best time to take them. " A Traumatic Brain Injury Survivor
**An excellent medical dictionary for both consumers and health professionals**
** Built-in 12,000 high quality pill and package images**
** Controlled substances which are susceptible to addiction and abuse are labelled by US Department of Justice schedules. Best for law enforcement officers.
# Identify medication of interest by brand name, generic name (ingredient), color/shape/imprint and bar code!
# "Best iPhone App for Prescription Reference" in the O'Reilly book titled "Best iPhone Apps", (2nd edition) 2010. (http://bit.ly/BestRxRef)
# 2000 Controlled Substances by DEA Scheduling
# Identify more than 10000 drug by imprint, color and shape!
# Find out customer ratings / comments of your prescription.
# Most commented medication includes XANAX, OXYCONTIN, ZOLOFT, PERCOCET, LISINOPRIL, ADDERALL, GABAPENTIN, ATIVAN, VICODIN and more.
Maintaining a proper medication schedule requires discipline, and a helping hand from the iPharmacy app.
Medical compliance is one of the biggest boosts you can give to your health.
The iPharmacy app enables you to set reminders for multiple medications.
o Exclusively FDA-approved drug information such as:
o Indications & Usage
o Dosage & administration
o Contraindications
o Warnings and precautions
o Adverse reactions
o Drug interactions
o Overdosage
Plus more features coming soon!
Please visit our website or email firstname.lastname@example.com for further information.
The iPharmacy application and its owners are not affiliated with FDA. All information presented by the application is for educational purpose solely. Nothing on the application should be taken to constitute professional advice or a formal recommendation. We exclude all representations and warranties relating to the content and use of these applications.
1mg (formerly HealthKartPlus)
- Side effects: Know about a medicine's impact on pregnancy, lactation and its effect on your body if you consume alcohol. 100,000+ Medicines listed!
- Substitutes: Medicines with the same composition can be made by different manufacturers. Some may be 90% cheaper than what you're prescribed.
- Information: Know about typical ailments a medicine is prescribed for and understand its action on your body.
- Ordering: Order Allopathic medicines, Homeopathic pills, Cancer and other Speciality drugs - through the app with a few clicks. Earn upto 15% discounts. Available only in Delhi, Faridabad, Ghaziabad, Noida.
- Diagnostic Tests: Book blood tests, thyroid tests through the app, and save around 30%
Awards & Recognition:
- Rated one of the best "Made in India" apps by Apple in 2014.
- Recognized by the Government of India - Ministry of Health and Family Welfare as a m-health initiative that consumers can use
- Ranked Top App in Medical Category in India - Android & iOS
- Frost & Sullivan Award for "Innovative Healthcare Service Delivery Model of the Year"
- VC Circle Award for the "Most promising Healthcare startup"
- Winner of m-Billionth award for m-health in South Asia
Press Coverage:
The Indian Express: http://archive.indianexpress.com/news/drugs-on-the-net/1147273/
The Economic Times: http://articles.economictimes.indiatimes.com/2014-10-30/news/55595277_1_wellness-market-nutrition-market-healthkart
Business Standard: http://www.business-standard.com/article/pti-stories/healthkart-bets-big-on-health-nutrition-mkt-in-india-114103000884_1.html
The Business Line: http://www.thehindubusinessline.com/features/smartbuy/generic-drugs-search-app-gets-2-lakh-downloads-in-2-weeks/article5670496.ece
MediaNama: http://www.medianama.com/2012/09/223-healthkart-launches-generic-drug-search-engine-healthkartplus/
NextBigWhat: http://www.nextbigwhat.com/healthkart-confirms-series-b-funding-297/
Your Story: http://yourstory.com/2014/11/healthkart-plus/
TechInAsia: https://www.techinasia.com/india-healthkart-sells-medicines-drugs-online/
Permissions Explained:
- Identity: To help the login/sign up process become smoother.
- Photos/Media/Files: To store and retrieve your uploaded prescriptions.
- Camera/Microphone: To allow you to take a photo of your prescriptions to send us.
Drug Guide
The Medscape app is the highest rated, fastest growing free mobile app for healthcare professionals with over 4 million registered users.
The Medscape app for Android™ is available for free.
All features are available for free. (Log in required only for the first time using the app. New users can register for a free account.)
Most popular features available in our app:
- Medical News:
Read the latest news available across 30+ specialties, covering FDA announcements, thought leader perspectives, conference news, important journal articles, plus physician business news and tips.
- Drug Information and Tools:
Look up adult and pediatric drug dosing information in seconds, check drug interactions, access medical calculators, and get health plan formulary information to support you with patient care.
- Disease & Condition Information:
Prep for patients by reviewing clinical presentation, workup, and treatment information for 4,400+ diseases and conditions. Authored and reviewed by expert physicians.
- Medical Calculators
Access 129 medical calculators covering formulas, scales, and classifications directly through the calculator feature. Plus, 600+ drugs in our drug reference have integrated dosing calculators.
- Drug Formulary Information
Find out whether a drug is covered under a particular health plan and easily compare tier status for drugs in the same class to consider an alternative for your patient. Choose from our complete list of 1,800 plans across all 50 states.
- Continuing Medical Education Courses:
Complete accredited CME/CE courses for professional development and to fulfill licensure requirements. Courses available in 1,000+ topics across 30+ specialties.
- Offline Access:
Drug, condition, and procedure reference, plus drug interaction checker can be accessed without an internet connection when you select the option to download our clinical reference database.
For more information, visit medscape.com/mobileapp
Please remember, we aren't able to respond to you based on comments. If you have any suggestions to improve our app or are having issues using our app, please contact us through our online help center at help.medscape.com.
Supported Device and OS Information:
Supported Devices: Google Nexus S, Samsung Galaxy S II, Samsung Galaxy S III, Google Nexus 7, Samsung Galaxy Note II, Samsung Galaxy Nexus, Motorola Droid Razr, Samsung Galaxy Note, HTC Evo 4G, HTC Incredible
Supported OS: 2.3, 4.0, 4.1, 4.2, 4.3, 4.4
NOTE: Users with 'rooted' devices and ad-blocker software installed may experience connectivity errors while using Medscape.
Please disable ad-blocker software before attempting to download Medscape's offline Clinical Reference.
Drug dictionary - FREE
App Highlights:
- Completely offline and free to download.
- Full list of drug name (including generic and trade name) and uses.
- Detailed drug guide including the drug terms, brands and generics.
- Medication prescription for various diseases.
- The best free drug dictionary for nurses/doctors with facts, doses and overdose information.
- Great details describing the impacts of a missed dose and necessary measures.
App Features:
- Auto complete search feature to lookup the drugs.
- Drug classifications computations and calculations.
- Very friendly and beautiful interface which can be customized.
- Drugs with complete information regarding their use and abuse, side effects and pill identification.
- Bookmark feature that give you fast access to your favorite ones.
- History of looked up drug list.
Drug Index & Guide
DrugIndex delivers frequently updated, comprehensive, practical information on over 30,000+ brand name and 2000+ generic drugs. This powerful app contains everything you need to provide better care to your patients including information on dosing and administration, safety, interactions and patient teaching.
It provides all the information required to protect themselves and their patients when administering drugs. This application delivers evidence base need to safely administer these drugs along with important patient monitoring instructions specific to each drug.
• Prescription & safety information of 2,000+ drugs and 30000 brands
• Drug / Brand Search Features
• Bookmark useful drugs / brand drugs to a personalized 'saved' list for easy access
• Special features of drugs, detailed information, safety details, available brands for each drugs etc.
• Default category based news channels (RSS feeds)
• Add or remove new changes
• Ability to save and email articles, share articles on Facebook and read offline without internet connection
• Supported OS: 4.0 , 4.0.3, 4.0.4 , 4.1
NOTE: Users with 'rooted' devices and ad-blocker software installed may experience connectivity errors while using drugindex.
Emergency Medicine Guidance
Managing prescriptions is hard work. We'll make sure you always have an up to date list of your or your loved one's medications, and that you're staying on top of instructions given to you after diagnosis, treatment or discharge.
Always have a medication list with you.
Quickly create a detailed medications list, which is securely backed up and accessible from any mobile device or browser at the clinic, in an emergency, or any other time you need it.
Reminders help you stay on schedule.
Schedule when you, or a family member, is supposed to take each dose and we'll send reminders to you, your family, or anyone you choose that it's time to take medicines. Don't forget to schedule reminders for refilling prescriptions!
Organize important info in one place.
We'll also help organize the mountain of personal information you're challenged to manage in healthcare situations — from reaction journals and care calendars to medical contacts and insurance information.
• Medication Management: Keep a single list of medications, dosages, refill information, and prescribing docs in your pocket.
• Contacts: Organize important contacts — doctors, pharmacies, insurance, family, and helpers.
• Sharing: Safely share access with others in case of an emergency, or to coordinate care.
• Journal: Keep a journal to record observations and share updates.
• Calendar: Keep track of appointments and refill dates.
• To-Dos: Organize and assign tasks to others. If you need help, we'll find volunteers from within your family for you.
• Photos: Securely upload and store photos from your phone.
• Notes: Jot down everything you'd otherwise squirrel away in a desk drawer.
Your info is private and secure. We promise.
Your data is protected using the same techniques as your bank, and security firms routinely audit our systems to ensure everything is safe.
The info you store at CareZone is also available via web browsers at CareZone.com, and via other mobile devices.
Diseases Dictionary ✪ Medical
This medical disease hand book can act as a clinical advisor for self diagnosis and can also be used to look up symptoms, diseases and treatment. Medical diseases dictionary free download is like a FREE Doctor at home for common diseases and treatment codes.
Diseases dictionary FREE - Medical App Features:
- Works Offline without internet.
- Detailed description of all major medical conditions and diseases.
- Information regarding treatment of diseases for all medical conditions and symptoms along with medication information, medication interaction and drug side effects.
- Medical reference book and thesaurus covering all medical terminologies and abbreviations.
- Prescription drug info along with pill description is provided in the treatment section.
- Physicians desk reference and pharmaceuticals dictionary.
- A handy free pocket guide for nurses for use as an emergency guide.
Who can use this free disease dictionary:
Healthcare professionals, pharmaceuticals, physicians, hospital nurses, medical students, nursing professionals, pharmacy, physician assistants and for students who work in clinical practice & dispensary.
This app cannot and should not replace a pharmacist or a doctor consultation. App content is only for pocket reference & educational purposes. Consult a doctor before actual usage of any of the information in this app.
Medical Handbook
We have done our best to facilitate your search of numerous drugs and diseases. Our application offers you an extensive drug guide and a disease guide.
We do our best to monitor all novel and rare medicines and update our information on a daily basis, to make sure that we provide you with the latest data. With our medical application you will be able to choose the most effective, fast-acting and least harmful drugs.
Stay healthy and remember that your health is in your hands!
This application includes:
1. Drug Handbook
2. General Diseases - Handbook
-- Update #2
Oxford Medical Dictionary TR
' "No home should be without one" certainly applies to this splendid medical dictionary', Journal of the Institute of Health Education
This best-selling and market-leading dictionary contains over 12,000 clear and concise entries, covering all aspects of medical science. Written by a team of medical experts, the entries are accessible and jargon-free, and complemented by over 140 illustrations and diagrams. The 8th edition has been fully revised and updated to cover changes in this fast-moving field. Entries on techniques and equipment, drugs, general medical practice, health service organization, and treatment have all been reviewed, and updated where necessary.
The dictionary has also been expanded in many areas, with particular attention paid to pharmacology, obstetrics and gynaecology, paediatrics, ethics, nephrology, and psychiatry. Selling over a million copies in previous editions, this is an indispensable reference guide for students, as well as those working in the medical and allied professions. It is also an invaluable home reference guide for the general reader
featuring search autocomplete to help you find words quickly by displaying predictions similar to the terms you're typing. You also get enhanced search extras including:
• A quick search of words while you type.
• A 'fuzzy filter' for when you are not sure of the correct spelling of a word.
• A 'keyword' search for finding key words within compound words.
• A wild card search function ('*' or '?') which can replace a letter or entire parts of a word.
• Download dictionary definitions locally for offline word lookup.
including a number of features that help you further enhance your vocabulary:
• A 'Favorites' feature to create custom folders with lists of words from the extensive library, including cross-curriculum words.
• History list to help you easily review looked-up words.
• Discover more using the included special language notes.
• See words in context with example sentences.
• 'Word-of-the-day' feature with dedicated homescreen widget.
A mobile dictionary application from MobiSystems with content from Oxford University Press.
Find my Medicine
5/5 "Very useful when traveling! I found all the medicines that one could need around the world! Good job!"
5/5 "Fundamental and intuitive! Really well designed!"
Either if you are a frequent traveller or if you are going on holiday abroad for the first time, Find My Medicine is a fundamental App to put in your luggage! In a few clicks, it will enable you to find the names of your medicines in the Country you are traveling to. Travel illnesses and the little problems every traveller faces will no longer be an issue.
The App functions in a very simple and intuitive way: research your usual medicine easily by name, active principle, symptom or pharmacological category, and you will find the right equivalent in the country you are visiting. The current version covers seven countries (Italy, USA, Spain, Germany, England, France, Poland), but it is constantly being updated in order to follow you in all of your journeys.
- More than 6500 medicines.
- Each medicine comes with a card with all the details.
The current version covers 9 Countries:
- Italy
- England
- France
- Spain
- Germany
- Poland
- Canada
- India
3 research methods:
- by name
- by active principle
- by pharmacological category
WARNING: The medicines included in the app are the basic remedies for usual small traveling problems. In this version we preferred not to add antibiotics or medicines that need a prescription, because for those it is always suggested to consult your doctor.
Having any problem or suggestion? We would love to hear from you!
Don't write in the comments below because we can't answer you. Reach us at: email@example.com
Clinicians Drug Reference 2011
*** This is a fully functional trial ***
Proving that sometimes less text can deliver more information, this super-concise guide covers more than one thousand of the most commonly used medications. Organized alphabetically by generic drug name, Clinician's Pocket Drug Reference zeros-in on must-know information such as selection and administration, mechanisms of action, dosage, cautions, contraindications, and side effects.
"A big plus is the herbal section, which lists the medicines patients are most likely to try on their own, presented in the same layout as the rest of the book....For its size, this book is a valuable re¬source. It takes up very little pocket room, and it is an efficient way to recall details about familiar drugs."--Yale Journal of Biology & Medicine
**Biographical note
Leonard G. Gomella, MD, is Chair of Urology at Thomas Jefferson University Medical College in Philadelphia, PA.
Steven Haist, MD, and Aimee G. Adams, PharmD, are affiliated with the University of Kentucky School of Medicine.
featuring search autocomplete to help you find words quickly by displaying predictions similar to the terms you're typing. You also get enhanced search extras including:
• A quick search of words while you type.
• A 'fuzzy filter' for when you are not sure of the correct spelling of a word.
• A 'keyword' search for finding key words within compound words.
• A wild card search function ('*' or '?') which can replace a letter or entire parts of a word.
• Download dictionary definitions locally for offline word lookup.
including a number of features that help you further enhance your vocabulary:
• A 'Favorites' feature to create custom folders with lists of words from the extensive library, including cross-curriculum words.
• History list to help you easily review looked-up words.
• Discover more using the included special language notes.
• See words in context with example sentences.
• 'Word-of-the-day' feature with dedicated homescreen widget.


text:
Ciminelli Real Estate Corp. is a full-service commercial real estate services firm that is dedicated to delivering the highest level of expertise and service to our clients. Core areas of service include development, property/facilities management, asset management, leasing, acquisition and disposition. With a history of being both an owner and operator of a substantial commercial real estate portfolio, coupled with decades of experience in these service areas, Ciminelli brings the added benefit of an ownership viewpoint to each client we represent. Our commercial real estate services are currently provided throughout New York State, Southwest and Central Florida, Western and Eastern Pennsylvania, and Connecticut. The firm has a portfolio of more than 11 million square foot of commercial space managed or developed, and a 30-year track record of success. It has a team of more than 150 dedicated professionals and has offices in New York, Florida, Pennsylvania and Connecticut. To learn more about Ciminelli Real Estate Corp., please call (716) 631-8000 or visit http://www.ciminelli.com.
About Hammond Hanlon Camp LLC
Hammond Hanlon Camp LLC is an independent investment banking and strategic advisory firm, with an exclusive focus on the healthcare community and related organizations. The firm traces its heritage back almost 30 years through its predecessor organizations, including Shattuck Hammond Partners. The firm's principals have been lead advisors on hundreds of transactions in the healthcare industry representing billions of dollars in value. The company serves clients across the nation from offices in Atlanta, Chicago, New York and San Diego. H2C's real estate investment bankers have a long track record of success in the healthcare real estate industry and are currently acting as financial advisor on numerous transactions nationwide. Hammond Hanlon Camp
|Source: PRWeb
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