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Gaerne Balance Oiled and Balance Pro Tech Boots Review
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Joined: Dec 2009
Location: El Paso, Republic of Texas
Oddometer: 852
I have the brown oiled boots and I love them.
I would use them to commute in, wear them around all day (they almost look like romeos at first glance when your jeans are over them), Then I would go ride some logging roads afterwards. There comfortable to ride in along with walking in. There definitly waterproof and they help keep your feet warm when you go for a ride in the snow or freezing rain.
Your not going to get the same protection as a motocross boot but I dont plan on trying to clear some triples on my 950 adventure.
I like actually haveing tread on the bottom of the boot. I hate getting stuck and needing to muscle the bike around in mud and not haveing any grip. So thats a definit plus.
Id recommend them to any adventure rider anyday.
-Chrome don't getcha home, but carbon fiber sure is fancy
2005 KTM 950 Adventure - back from the dead, Was totaled.
2005 Yamaha YZ250F - low compression, because race bike
1989 Yamaha TW200 - clapped out from a tweaker
1978 Batavus 48 - back from the dead. Parked since 83'
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An implantable medical device in which an electrogram is recorded and analyzed in order to detect changes indicative of cardiac ischemia. Cardiac ischemia may be detected by recording an electrogram from a sensing channel of the device and comparing the recorded electrogram with a reference electrogram. If cardiac ischemia is detected, a cardiac drug such as a thrombolytic agent is delivered.
1. An implantable cardiac device, comprising:
a sensing channel for sensing cardiac activity;
a pacing channel for delivering pacing pulses;
circuitry for recording an electrogram from the sensing channel of an evoked response to a pace and for detecting a change in the recorded electrogram indicative of cardiac ischemia by comparing the recorded electrogram with a reference electrogram;
a drug delivery apparatus for delivering a quantity of a cardiac drug; and,
circuitry for actuating the drug delivery apparatus upon detection of cardiac ischemia.
2. The device of
3. The device of
4. The device of
5. The device of
6. The device of
7. The device of
8. The device of
9. The device of
10. The device of
11. A method for operating a cardiac device implanted in a patient, comprising:
sensing intrinsic cardiac activity;
recording an electrogram from the sensed cardiac activity in order to detect a change indicative of cardiac isehemia;
delivering a quantity of a cardiac drug to the patient upon detection of cardiac ischemia; and,
wherein a change in the recorded electrogram indicative of cardiac ischemia is detected by comparing the recorded electrogram with a reference electrogram and looking for an increased current of injury in the recorded electrogram.
12. The method of
13. The method of
14. The method of
15. The method of
16. The method of
17. The method of
18. The method of
analyzing the spectrum of intervals between heartbeats and computing an LF/HF ratio; and,
delivering a cardiac drug only when an ischemic condition is detected from the recorded electrogram and the LF/HF ratio exceeds a specified threshold value.
19. The method of
measuring the patient's respiratory rate; and,
delivering a cardiac drug only when an ischemic condition is detected from the recorded electrogram and the respiratory rate is above a specified threshold value
20. The method of
measuring the patient's activity level; and,
delivering a cardiac drug only when an ischemic condition is detected from the recorded electrogram and the measured activity level is below a specified threshold value.
21. An implantable cardiac device, comprising:
means for sensing intrinsic cardiac activity;
means for recording an electrogram from the sensed cardiac activity in order to detect a change indicative of cardiac ischemia;
means for delivering a quantity of a cardiac drug to the patient upon detection of cardiac ischemia; and,
means for detecting a change in the recorded electrogram indicative of cardiac ischemia by comparing the recorded electrogram with a reference electrogram representative of cardiac ischemia.
22. The device of
23. The device of
24. The device of
25. The device of
26. The device of
27. The device of
28. The device of
means for analyzing the spectrum of intervals between heartbeats and computing an LF/HF ratio; and,
means for delivering a cardiac drug only when an ischemic condition is detected from the recorded electrogram and the LF/HF ratio exceeds a specified threshold value.
29. The device of
means for measuring the patient's respiratory rate; and,
means for delivering a cardiac drug only when an ischemic condition is detected from the recorded electrogram and the respiratory rate is above a specified threshold value
30. The device of
means for measuring the patient's activity level; and,
means for delivering a cardiac drug only when an ischemic condition is detected from the recorded electrogram and the measured activity level is below a specified threshold value.
[0001] This application is related to U.S. application Ser. No. 09/962,852, filed on Sep. 25, 2001, the specification of which is herein incorporated by reference.
[0002] This invention pertains to implantable devices for detecting and treating cardiac disorders.
[0003] A major cause of cardiac death is acute coronary occlusion causing myocardial ischemia which results in a myocardial infarction or precipitates a lethal arrhythmia. Most patients currently treated for ventricular arrhythmias with an implantable cardioverter-defibrillator (ICD) have concurrent coronary artery disease, making them highly susceptible to ischemic events that may result in death. Although presently available ICDs can be beneficial during an acute ischemic episode by terminating any resulting arrhythmias with electrical stimulation, they do nothing to directly treat the occlusion. Present medical treatments are successful in managing acute coronary occlusion by dissolving the thrombus with chemical agents and preventing its reformation. Such treatments are generally performed only in an emergency-room setting, however, and in certain circumstances, only immediate relief from the ischemia can save the patient's life.
[0004] The present invention relates to an implantable cardiac device with the capability of detecting ischemic events and delivering cardiac drug therapy in response thereto. Such a device may be configured to also operate as a cardiac pacemaker and/or ICD. In order to detect ischemic events, the sensing channels of the device record an electrogram that is analyzed to detect changes indicative of cardiac ischemia. Upon detection of an ischemic event, the device is configured to automatically deliver a cardiac drug such as a thrombolytic agent. The recorded and analyzed electrogram may cardiac drug such as a thrombolytic agent. The recorded and analyzed electrogram may represent either intrinsic cardiac activity or an evoked response to a pace where the device is also configured to deliver cardiac pacing. In the latter case, the electrogram is recorded from an evoked response sensing channel that senses the depolarization of the myocardium brought about by the delivery of a pacing stimulus, where the evoked response sensing channel may be the sensing/pacing channel used for delivering the stimulus or another sensing channel, such as one dedicated for that purpose.
[0005] In order to detect an ischemic change, the electrogram is compared with a reference electrogram to ascertain if a morphological marker of ischemia is present, such as increased current of injury. The comparison may involve, for example, cross-correlating the recorded and reference electrograms or comparing ST segment amplitudes, slopes, or integrations with reference values. Any of these means also allows the degree of ischemia to be quantified to determine if drug therapy is warranted.
[0006]FIG. 1A is a block diagram of an exemplary cardiac device with drug delivery capability.
[0007]FIG. 1B is a block diagram of components for analyzing the frequency spectrum of intervals between heartbeats.
[0008]FIG. 2 illustrates ischemic changes in a recorded electrogram.
[0009]FIG. 3 shows an exemplary drug delivery drug delivery apparatus utilizing an intravenous catheter.
[0010] FIGS. 4A-B show an exemplary drug delivery apparatus utilizing patch electrodes.
[0011] As noted above, chemical agents are available today that can successfully treat cardiac ischemia due to coronary occlusion by dissolving the thrombus or blood clot. Such agents include tissue plasminogen activators (tPA), streptokinase, and similar drugs. Agents are also available that do not directly dissolve existing blood clots but act to prevent further clotting. These agents include low and high molecular weight heparin and anti-platelet drugs such as aspirin and similar drugs. Other drugs may also be administered to treat the effects of the ischemia such as anti-arrhythmic agents, beta-blockers, nitrates, and angiogenic agents. Because time is often of the essence in treating cardiac ischemic episodes, it would be beneficial for an implantable device to have the capability of automatically delivering cardiac drugs that would either resolve the situation or stabilize the patient enough so that further medical treatment could be obtained. Administration of cardiac drugs is not without risk, however, especially thrombolytic agents or drugs that otherwise inhibit hemostasis. Nevertheless, certain selected patients could benefit from automatic drug administration if a condition warranting such administration could be detected with sufficient specificity. The present invention relates to an implantable medical device that is configurable to automatically deliver one or more cardiac drugs upon detection of cardiac ischemia. The methods for detection of such ischemia detailed below also allow the detection to be quantified so that the extent of ischemia can be ascertained. The device may then be programmed by a clinician to deliver drugs only when ischemia of a specified degree is present.
[0012] 1. Exemplary Hardware Platform
[0013] Cardiac rhythm management devices such as pacemakers and ICDs are typically implanted subcutaneously in a patient's chest and have leads threaded intravenously into the heart to connect the device to electrodes used for sensing, pacing, or delivery of defibrillation shocks. A programmable electronic controller causes the pacing pulses to be output in response to lapsed time intervals and sensed electrical activity (i.e., intrinsic heart beats not as a result of a pacing pulse) or defibrillation shocks to be delivered when an arrhythmia is detected. The present invention may be incorporated into a pacemaker or ICD or a dedicated device that is similarly implanted which is equipped with cardiac leads for sensing cardiac activity in order to detect ischemia. For illustrative purposes, however, a block diagram of an implantable device with dual-chamber pacing (i.e., the atria and ventricles) and cardioversion/defibrillation capability is shown in FIG. 1A. The controller of the device is made up of a microprocessor 10 communicating with a memory 12, where the memory 12 may comprise a ROM (read-only memory) for program storage and a RAM (random-access memory) for data storage. The controller could be implemented by other types of logic circuitry (e.g., discrete components or programmable logic arrays) using a state machine type of design, but a microprocessor-based system is preferable. As used herein, the terms "circuitry" or "programmed controller" should be taken to encompass either custom circuitry (i.e., dedicated hardware) or processor-executable instructions contained in a memory along with associated circuit elements.
[0014] The device has an atrial sensing/pacing channel comprising ring electrode 43 a, tip electrode 43 b, sense amplifier 41, pulse generator 42, and an atrial channel interface 40 which communicates bidirectionally with a port of microprocessor 10. The device also has a ventricular sensing/pacing channel that includes ring electrodes 33 a, tip electrodes 33 b, sense amplifier 31, pulse generator 32, and a ventricular channel interface 30. For each channel, the electrodes are connected to the pacemaker by a lead and used for both sensing and pacing. The channel interfaces may include analog-to-digital converters for digitizing sensing signal inputs from the sensing amplifiers, registers that can be written to for adjusting the gain and threshold values of the sensing amplifiers, and registers for controlling the output of pacing pulses and/or changing the pacing pulse amplitude. A MOS switching network 70 controlled by the microprocessor is used to switch the electrodes from the input of a sense amplifier to the output of a pulse generator. A minute ventilation sensor 77 and an accelerometer 78 are provided in order to sense the patient's minute ventilation and body activity, respectively. The device may use the sensed minute ventilation and/or the accelerometer signal to adjust the rate at which the pacing pulses are delivered to the heart in the absence of a faster intrinsic rhythm, sometimes called rate-adaptive pacing. A shock pulse generator 50 with shock leads 50 a and 50 b for delivering cardioversion/defibrillation shocks is also interfaced to the controller.
[0015] The device also has an ischemia detection sensing channel that comprises an ischemia detection channel interface 20 and a sense amplifier 21 that has its differential inputs connected to a unipolar electrode 23 and to the device housing or can 60 through the switching network 70. The ischemia detection channel may be used to record an electrogram in order to detect ischemia as described below, where the electrogram may represent either intrinsic cardiac activity or an evoked response to a pacing pulse. When configured to sense evoked responses, the channel can also be used to verify that a pacing pulse has achieved capture of the heart and caused a contraction.
[0016] The microprocessor 10 controls the overall operation of the device in accordance with programmed instructions stored in memory. The sensing circuitry of the device generates atrial and ventricular sense signals when electrogram signals sensed by the electrodes exceed a specified threshold. The controller then interprets sense signals from the sensing channels and controls the delivery of paces in accordance with a programmed pacing mode. The sense signals from any of the sensing channels of the device can also be digitized and recorded by the controller to constitute an electrogram that can be analyzed to determine if ischemia is present, as well as either transmitted via a telemetry link 80 to an external programmer or stored for later transmission. A drug delivery interface 330 enables the controller to actuate a drug delivery apparatus in order to deliver a cardiac drug to the patient when an ischemic event is detected, where the drug may be delivered in various ways as described below.
[0017] 2. Detection of Ischemia
[0018] In order to detect whether the patient is experiencing cardiac ischemia, the controller is programmed to analyze the recorded electrogram of an evoked response to a pace or of an intrinsic contraction and look for morphological and temporal markers of a "current of injury." When the blood supply to a region of the myocardium is compromised, the supply of oxygen and other nutrients can become inadequate for enabling the metabolic processes of the cardiac muscle cells to maintain their normal polarized state. An ischemic region of the heart therefore becomes abnormally depolarized during at least part of the cardiac cycle and causes a current to flow between the ischemic region and the normally polarized regions of the heart, referred to as a current of injury. A current of injury may be produced by an infarcted region that becomes continuously depolarized or by an ischemic region that remains abnormally depolarized during all or part of the cardiac cycle. A current of injury results in an abnormal change in morphology and timing of the electrical potentials measured by either a surface electrocardiogram or an intracardiac electrogram. In the normal heart there is a period during the cardiac cycle, at the start of the contraction phase, when the cells in the ventricle are essentially isopotential. Electrocardiographically this segment occurs between the end of the QRS complex and the T wave and is referred to as the ST segment. The spatio-temporal dispersion of repolarization starts the relaxation phase of the heart and results in the T-wave on the electrocardiogram. In ischemic tissue, the individual cellular potentials are blunted resulting in a spatial and temporal dispersion of membrane potential during periods when the normal heart is isopotential. This results in the current of injury which is reflected on the electrocardiogram as a positive or negative shift, depending on the location of the ischemic or infarcted region. Traditionally, however, it is the ST segment that is regarded as shifted when an abnormal current of injury is detected by an electrogram or electrocardiogram. A current of injury produced by an ischemic region that does not last for the entire cardiac cycle may only shift part of the ST segment, resulting in an abnormal slope of the segment.
[0019] As aforesaid, an electrogram of an evoked response to a pace can be recorded and used to detect cardiac ischemia in accordance with the invention. An evoked response is the wave of depolarization that results from a pacing pulse and, since it evidences that the paced chamber has responded appropriately and contracted, it can also be used to verify that the pace has achieved capture of the heart. Sensing channels in a pacemaker that provide senses for controlling pacing are commonly rendered refractory (i.e., insensitive) for a specified time period immediately following a pace in order to prevent the pacemaker from mistaking a pacing pulse or afterpotential for an intrinsic beat. This is done by the pacemaker controller ignoring sensed events during the refractory intervals, which are defined for both atrial and ventricular sensing channels and with respect to both atrial and ventricular pacing events. Furthermore, a separate period that overlaps the early part of a refractory interval is also defined, called a blanking interval during which the sense amplifiers are blocked from receiving input in order to prevent their saturation during a pacing pulse. If the same sensing channel is used for both sensing intrinsic activity to control pacing and for sensing an evoked response, a period for sensing an evoked response should preferably be defined that supercedes any normal refractory period of the sensing channel.
[0020] An ischemia detection-sensing channel for recording an electrogram can be a sensing channel used for other purposes or can be a sensing channel dedicated to sensing electrograms for ischemia detection. In order to detect ischemic changes in an electrogram, it is preferable to record the electrogram with a unipolar electrode that "sees" a larger volume of the myocardium as a wave of electrical activity spreads than a bipolar electrode. In the embodiment illustrated in FIG. 1A, the atrial and ventricular sensing pacing channels utilize bipolar electrodes, and a dedicated ischemia detection sensing channel is provided with a unipolar electrode. Alternate embodiments may employ unipolar electrodes in the atrial and/or sensing/pacing channels, in which case unipolar sensing of an electrogram for ischemia detection may be performed with those channels instead of a dedicated channel.
[0021] A change in an electrogram indicative of ischemia is detected by recording the electrogram and comparing it with a reference electrogram, which may either be a complete recorded electrogram or particular reference values representative of an electrogram. Because certain patients may exhibit a current of injury in a reference electrogram as a the result of a subclinical ischemic condition (e.g., coronary artery disease) or as the result of an inherited or aqurired disease(e.g., Bruggada Syndrome), the controller is programmed to detect ischemia by looking for an increased current of injury in the recorded electrogram as compared with the reference electrogram, where the latter may or may not exhibit a current of injury. FIG. 2 shows examples of evoked response data for two cases labeled A and B, where A is the baseline reference and B is during an acute ischemic episode. A surface electrocardiogram labeled ECG, a pacing timing diagram labeled PTD, and an electrogram labeled ER are illustrated for each case. The ST segment of the electrogram for case B is seen to have a different amplitude and slope as compared with the amplitude and slope of the ST segment of the electrogram for case A. One way to look for an increased current of injury in the recorded electrogram is to compare the ST segment amplitude and/or slope with the amplitude and slope of a reference electrogram. Various digital signal processing techniques may be employed for the analysis, such as using first and second derivatives to identify the start and end of an ST segment. Other ways of looking for a current injury may involve, for example, cross-correlating the recorded and reference electrograms to ascertain their degree of similarity. The electrogram could be implicitly recorded in that case by passing the electrogram signal through a matched filter that cross-correlates the signal with a reference electrogram. The ST segment could also be integrated, with the result of the integration compared with a reference value to determine if an increased current of injury is present.
[0022] If a change in a recorded electrogram indicative of ischemia is detected, the device controller may be programmed to deliver a thrombolytic agent or other cardiac drug by writing a command to the drug delivery interface. Because of the risks attendant with administering cardiac drugs in an uncontrolled setting, the drug should only be delivered when the ischemia is severe enough to warrant it. The methods for detecting ischemia in a recorded electrogram discussed above are advantageous in this regard because the degree of ischemia can be quantified as, for example, the extent of correlation between the recorded and reference electrograms, measured amplitude or slope of an ST segment, or result of integrating the ST segment. The quantitative measure of ischemia necessary before the device delivers a drug dose can then be adjusted by a clinician until the drug delivery criteria has the desired specificity and sensitivity.
[0023] A detected ischemic change may also be logged as a clinically significant event in the device's memory. The event log and/or the recorded electrogram exhibiting the ischemia may then be later downloaded to a clinician for analysis via an external programmer. The clinician is then able to use this information in making subsequent treatment decisions.
[0024] 3. Additional Criteria for Drug Delivery
[0025] As aforesaid, delivery of certain cardiac drugs can present risks to the patient. It is therefore desirable for the criteria used in detecting ischemic events that initiate therapy to be as specific as possible in order to minimize the possibility of a false-positive detection causing unwarranted drug delivery. As noted above, the present invention allows the degree of ischemia detected from an electrogram to be quantified so that the ischemia detection criterion can be adjusted to the desired specificity and sensitivity. Another way of increasing the specificity of event detection for drug delivery is to use additional criteria based on other measurable physiological variables which correlate either with cardiac ischemia or with the need for drug delivery during such events such as heart rate variability, minute ventilation, and activity level. Drug delivery can then be initiated if ischemic changes are detected in the electrogram and if one or more of the additional criteria are also met.
[0026] Cardiac ischemia causes metabolic stress that the body responds to with increased activity of the sympathetic nervous system. Among the indicia of such increased sympathetic activity is the frequency spectrum of heart rate variability. Heart rate variability refers to the variability of the time intervals between successive heart beats during a sinus rhythm and is primarily due to the interaction between the sympathetic and parasympathetic arms of the autonomic nervous system. Spectral analysis of heart rate variability involves decomposing a signal representing successive beat-to-beat intervals into separate components representing the amplitude of the signal at different oscillation frequencies. It has been found that the amount of signal power in a low frequency (LF) band ranging from 0.04 to 0.15 Hz is influenced by the levels of activity of both the sympathetic and parasympathetic nervous systems, while the amount of signal power in a high frequency band (HF) ranging from 0.15 to 0.40 Hz is primarily a function of parasympathetic activity. The ratio of the signal powers, designated as the LF/HF ratio, is thus a good indicator of the state of autonomic balance, with a high LF/HF ratio indicating increased sympathetic activity. Additional specificity for initiating drug delivery may thus be provided by monitoring the LF/HF ratio and initiating drug therapy only if it exceeds a specified threshold value. The predetermined threshold value may be fixed or may be determined by the device based upon previous measurements. For example, the LF/HF threshold may be set to 50% of the maximum computed LF/HF ratio value during the previous day.
[0027] A cardiac rhythm management device can be programmed to determine the LF/HF ratio by analyzing data received from its ventricular sensing channels. The intervals between successive ventricular senses, referred to as RR intervals, can be measured and collected for a period of time or a specified number of beats. In order to derive a signal representing heart rate variability during a sinus rhythm, ectopic ventricular beats (i.e., premature ventricular contractions or PVCs) can be detected by monitoring whether a P wave precedes each R wave, with the RR intervals before and after the PVC changed to an interpolated or otherwise filtered value. The resulting series of RR interval values is then stored as a discrete signal. The signal can be used directly as indexed by heartbeat such that each value of the signal represents an RR interval for a particular heartbeat. Preferably, however, the signal is resampled at a specified sampling frequency in order to equalize the time intervals between signal values and thus convert the signal into a discrete time signal, where the sampling frequency is selected to meet the Nyquist criterion with respect to the frequencies of interest. In any case, the RR interval signal can then be analyzed to determine its energies in the high and low frequency bands as described above. Spectral analysis of an RR interval signal can be performed directly in the frequency domain using discrete Fourier transform or autoregression techniques. Frequency domain analysis is computationally intensive, however, and may not be practical in an implantable device. A time-domain technique for determining the high and low frequency components of the signal is therefore preferably used. FIG. 1B illustrates the functional components of an exemplary system for doing this that can be implemented as code executed by the controller and/or dedicated hardware components. The RR interval signal obtained as described above is input to both a low band digital filter 201 and a high band digital filter 202. The low band filter 201 is a bandpass filter with a passband corresponding to the LF band (e.g., 0.04 to 0.15 Hz), while the high band filter 202 is a bandpass filter with a passband corresponding to the HF band (e.g., 0.15 to 0.40 Hz). The outputs of filters 201 and 202 are then input to power detectors 203 and 204, respectively, in order to derive signals proportional to the power of the RR interval signal in each of the LF and HF bands. Power detection may be performed, for example, by squaring the amplitude of the signal and integrating over a specified average time. The output of power detector 203 is thus a signal P1 that represents the power of the RR interval signal in the LF band, and the output of power detector 204 is a signal P2 representing the power in the HF band. The signals P1 and P2 are next input to a divider 205 that computes the quantity S1/S2 which equals the LF/HF ratio. The LF/HF ratio is then input to a moving average filter 206 that computes an average value for the ratio over a specified period (e.g., 5 minutes). An updated LF/HF ratio may be computed in this manner on a beat-to-beat basis.
[0028] Another useful physiological variable that correlates with cardiac ischemia is the respiratory rate. Patients suffering a heart attack subjectively experience shortness of breath and attempt to compensate by increasing their respiratory rate. The sensor normally used for measuring minute ventilation can also be used to measure respiratory rate, with drug delivery then being initiated only if the measured respiratory rate is above a specified threshold value.
[0029] Another variable that may be useful in determining if drug therapy for treating cardiac ischemia is warranted is the patient's activity level as measured by an accelerometer. Cardiac ischemia may occur while the patient is either active or at rest. Exertional angina, for example, occurs when a patient experiences cardiac pain from cardiac ischemia due to an increased exertion level. If the angina is stable, meaning that the pain disappears when the patient's exertion level returns to a resting value, the situation is not ordinarily considered emergent. It therefore may not be desirable for an implantable device to automatically deliver a drug upon detection of cardiac ischemia in such a situation. Accordingly, the device may be programmed to deliver drug therapy only when cardiac ischemia is detected from the electrogram and a resting activity level is detected by the accelerometer as indicated by the measured activity level being below a specified threshold value.
[0030] 4. Delivery of Cardiac Drugs
[0031] Once the controller 10 detects an ischemic change in an electrogram warranting administration of a cardiac drug, a command is issued to the drug delivery interface 330. The drug delivery interface then actuates the drug delivery apparatus incorporated into the device, examples of which are illustrated in FIGS. 3 and 4A-B. In FIG. 3, a cardiac rhythm management device is depicted which includes a metallic housing 100 and a header portion 110. Leads 120 used for sensing and/or pacing enter the header 110 and then pass into the interior of the housing via feedthrough assemblies that maintain the hermetic sealing of the housing. A pump 340 and a drug reservoir 350 located within the header 110 communicate with a catheter 360. The drug delivery interface 330 within the housing communicates with the pump 340 by control wires that pass into the header through a feedthrough. Upon actuation by the drug delivery interface 330, the pump 340 pumps a quantity of drug from a reservoir 350 into the lumen of a catheter 360. By locating the pump and drug reservoir in the header, an external port 370 can be provided through which a quantity of drug can be injected in order to replenish the reservoir.
[0032] The catheter 360 may be passed into patient intravenously along with the sensing/pacing leads so that the pumped quantity of drug egresses out the distal end of the catheter and into the patient's bloodstream. The distal end of the catheter may also be disposed at a cardiac location. In modifications to this embodiment, the catheter may incorporate lead wires and electrodes for facilitating the drug delivery such as by iontophoresis, electroporation, electrorepulsion, or electro-osmosis. The current to the electrodes in that case is then actuated by the drug delivery interface in coordination with operation of the pump.
[0033]FIGS. 4A and 4B show an alternative embodiment where the distal end of the catheter 360 is attached to a patch electrode 400 for iontophoretic drug delivery. The patch electrode may, for example, be disposed at a subcutaneous location on the patient's chest or abdomen. The patch electrode 400 has a drug reservoir 410 into which a quantity of drug is pumped by the pump 340 during a drug delivery operation. A separate lead 440 with a patch electrode 450 is also provided so that a voltage can be impressed across the patch electrodes 400 and 450 during drug delivery. The impressed voltage then causes migration of charged drug molecules from the reservoir and into the body tissues. In an alternative embodiment, the patch electrodes 400 and 450 are mounted on the device housing 100. External drug delivery means may also be used by the device for drug delivery in response to ischemia. Examples of external drug delivery apparatus are disclosed in U.S. Pat. No. 6,361,522, assigned to the assignee of the present application and hereby incorporated by reference.
[0034] Finally, the device may be programmed to deliver drugs upon detection of conditions other than ischemia, which may be beneficial for certain patients. For example, an anti-platelet drug or heparin may be administered by the device when atrial fibrillation is detected.
[0035] Although the invention has been described in conjunction with the foregoing specific embodiment, many alternatives, variations, and modifications will be apparent to those of ordinary skill in the art. Such alternatives, variations, and modifications are intended to fall within the scope of the following appended claims.
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At CIA, Petraeus takes up top spy post
But Petraeus has insisted he will be serving the president and the policymakers, providing information, but not shaping policy.
And the White House and Petraeus both have taken steps to make peace.
Obama has promised Petraeus regular, weekly access in a capital where face time with the president equals influence.
Petraeus agreed to hire Obama White House veteran, and longtime CIA employee Rodney Snyder to be his chief of staff. Snyder has spent the past few years at the NSC, as a senior official on intelligence and counterterrorism issues.
Another encouraging sign is an employee who is staying put, at least for now. That's the current chief of the CIA's Counterterrorism Center, who is an undercover operative, and the de facto chief of the agency's drone war against al-Qaida. He had initially made moves to depart because of past personality clashes with Petraeus when they both served in leadership roles in Iraq.
Petraeus has vowed to reach out to such experienced staffers, recruiting them as he said he knew they would try to recruit him.
One crossover skill that agency staff welcome is Petraeus' and wife Holly's reputation for taking care of troops he commands- a crucial skill in a secret world where you can't tell your neighbor what you do, why you travel so much, or perhaps, how you got wounded overseas.
A Petraeus trait that CIA staff is less excited about: his penchant for taking his staff on 10-mile morning runs.
AP National Security Writer Anne Gearan and Associated Press writer Julie Pace contributed to this report.
Kimberly Dozier can be followed via Twitter on (at)kimberlydozier.
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New York Yankess starting pitcher CC Sabathia is selling his 4,100 square foot home in Fairfield, California, and it looks amazing.
The 33-year-old star is selling the three-bedroom house for $1.5 million. The house itself is beautiful, but the man cave and the swimming pool will blow you away. If the house looks familiar, that's because it was actually featured on an episode of Cribs back in 2007.


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Addi - Addi Circular
Wonderful needles
I own several pairs of Addi circular needles and they are wonderful. The points work perfectly with all of the yarns that I have used and the length of the actual needle is sufficient that my hands do not get tired knitting.No comments on this review yet.
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text: Are listed below the special regulations and technical rules for Synchronized Skating discipline. Discipline Single & Pair Skating & Ice Dance Synchronized Skating Speed Skating Short Track Speed Skating DocumentList Download Calendar of Events ISU Communications Special Regulations and Technical Rules Introduction Synchronized Skating Forms DocumentCategories From To Current filters match 1 documents. Synchronized Skating 2014 30 Sep 2014


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Mitra, NJ; Gupta, MR; (2002) Two-stage color palettization for error diffusion. In: Rogowitz, BE and Pappas, TN, (eds.) HUMAN VISION AND ELECTRONIC IMAGING VII. (pp. 207 - 217). SPIE-INT SOC OPTICAL ENGINEERING
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Image-adaptive color palettization chooses a decreased number of colors to represent an image. Palettization is one way to decrease storage and memory requirements for low-end displays. Palettization is generally approached as a clustering problem, where one attempts to find the k palette colors that minimize the average distortion for all the colors in an image. This would be the optimal approach if the image was to be displayed with each pixel quantized to the closest palette color. However, to improve the image quality the palettization may be followed by error diffusion. In this work, we propose a two-stage palettization where the first stage finds some m << k clusters, and the second stage chooses palette points that cover the spread of each of the 1 clusters. After error diffusion, this method leads to better image quality at less computational cost and with faster display speed than full k-means palettization.
|Proceedings paper
|Two-stage color palettization for error diffusion
|Conference on Human Vision and Electronic Imaging VII
|2002-01-21 - 2002-01-24
|color palettization, color clustering, multi-level halftoning
|UCL classification:
|UCL > School of BEAMS > Faculty of Engineering Science > Computer Science
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text:
Wilcock, TR; Gibson, R; Grant, DN; Gration, DA; (2010) Performance-based seismic design of an offshore platform in the Caspian Sea. In: SECED Young Engineers Conference. : London, UK.
Full text not available from this repository.
|Proceedings paper
|Performance-based seismic design of an offshore platform in the Caspian Sea
|Additional information:
|keywords: Arup, By me, LS-DYNA, Structures
|UCL classification:
|UCL > School of BEAMS > Faculty of Engineering Science > Civil, Environmental and Geomatic Engineering
Archive Staff Only: edit this record


text:
Posts filtered on Category
How about a Christmas Day game at the AT&T Center?
The NBA is considering adding a couple of extra games on Christmas Day, boosting the league to five games on the holiday. The New York Times reports that the league plans five games on the holiday. The first game will be at 11 a.m. CT, following by tip-offs at 1:30 p..m., 4 p.m, 7 p.m. […] [Read More]
Spurs can be begin contact with free agents this morning
It will be humming as usual on Spurs Lane in northwest San Antonio for a change Wednesday morning. For the first time since July 1, NBA players will be welcomed back to team training facilities. Voluntary workouts and physicals will begin Thursday. And team officials can begin talking to potential free agents at 8 a.m. […] [Read More]
Bodog pegs Spurs tied for third in 2011-12 wins
The internet gambling website Bodog.com is expecting big things from the Spurs this season. In a proposition bet for the 2011-12 season, Bodog has ranked the Spurs tied for third in expected number of victories among NBA teams. Bodog has set the "over/under" on Spurs victories at 46 ½ in the upcoming 66-game season. Win […] [Read More]
KD starts courtship of Shane Battier
Kevin Durant realizes that Oklahoma City needs some improvement to be able to challenge NBA elite teams like Miami and Dallas in the playoffs. And with all due respect for Thunder general manager Sam Presti, Durant isn't leaving anything to chance as he attempts to improve Oklahoma City's roster. It's why Durant has already begun tweeting […] [Read More]
How would NBA settle a draft lottery with no 2011-12 games?
We always like to answer any and all questions that Spurs Nation poses to us. Here's one that took a couple of days of research, but hopefully we will answer to our reader's satisfaction. Dear Spurs Nation: Even though I'm in Austin, I visit the Spurs Nation site daily. If the entire upcoming season […] [Read More]
Happy Thanksgiving from Spurs Nation!
This is the day for all of us to reflect on all that we have to be thankful for. I hope everybody will have the opportunity to spend time with friends and family to celebrate the true meaning of the holiday. And while you're enjoying some more stuffing or an extra piece of pie, let's pause […] [Read More]
TP determined to win more titles
There's been concern among some in Spurs Nation about how dedicated that Tony Parker really is to his NBA career. Parker is 29 and become one of the most notable athletic pitchmen in Europe after his 10-season career. He's got a cartoon and radio shows and advertises everything from fast food to watches overseas. But […] [Read More]
DeShawn Stevenson: Mavs 'don't get the respect'
If Spurs Nation is searching for solace in the extended NBA lockout, it can be found by looking north. As the lockout approaches its sixth month, the NBA champion Dallas Mavericks still haven't been able to truly celebrate their title by raising a banner at the American Airlines Center. That thought about their arch rivals may be […] [Read More]
Duncan's new shoe set for Black Friday offering
Want another reason to set a mental note for another present to think about buying on Black Friday? Forget about snuggies for your mother-in-law or that new HD television set at Best Buy that you'll have to stay up all night to acquire. Tim Duncan's new black Foamposite Max shoes will be released on Friday. […] [Read More]
Blog brother ranks Pop No. 2 among all active coaches
Gregg Popovich's coaching excellence is sometimes overlooked by some in Spurs Nation as a primary reason for the team's sustained success. Sure, it's helped that the Spurs picked up David Robinson and Tim Duncan in the NBA lottery. But Popovich's abilities to adapt over the years — most notably last season with an offensive-heavy team […] [Read More]
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text:
9 Bedrooms | 6 Baths | Pool | Garden
Cotswold Hills, England
From £4,040 per week
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Hardwick House, Cotswold Hills, England
Hardwick House provides an ideal luxury family base for an extended visit to the Cotswolds. Situated in five acres of private parkland protected by electronic security gates it is a home-from-home to enjoy at your leisure. Take a swim in the heated pool situated in the historic walled garden, play a frame of snooker in the games room or just relax in the magnificent drawing room while you plan your excursion for the day. Hardwick House is located just to the north of Tewkesbury, England's largest intact medieval town and just a few miles from Cheltenham, Centre for the Cotswolds. Take in a play at Stratford (Shakespeare's birthplace), take a dip in the spa waters at Bath's restored Roman Baths, visit the World-famous University city of Oxford or just tour the myriad of beautiful Cotswold villages – all less than a one hour drive away. To the west are the wonderful Welsh mountains – keen walkers should take a hike up to the top of Brecon Beacon – again less than an hour's drive away. A week is simply not enough time to get the most out of what the Cotswolds have to offer!
The house itself was built in the 1860s to the very highest Victorian standards with 28-inch Cotswold stone walls and beautiful styling details. The Main House has been lovingly restored with original fireplaces, flocked wallpaper and chandeliers while the rooms retain their original generous proportions. The Cellar Apartment restoration was completed in early 2010 and combines period features with modern decoration, marble en-suite bathrooms, a separate living room and kitchen. The House and Cellar Apartment are available on a self catering basis and can be rented together or separately depending on the size of your party. Please contact us to discuss your own particular requirements – we pride ourselves on our flexibility.
Check in 2PM
Check out 11AM
Children Welcome
No Pets
No Smoking Inside
200 Security Deposit
50% due to book
50% (balance) due 60 days prior
Travelers Insurance RecommendedFinal Cleaning Included
Price List
|Low/Mid Season
|October – March
|Excluding Christmas & New Years
|High/Peak Season
|April – September
|Christmas & New Years
**All starting rates are low season rates. Rates are now quoted based on occupancy and use. Please call or inquire for individual group rates.**
Quick Links
Property Highlights
9 Bedrooms
6 Bathrooms
Sleeps 18 Adults
Non-Smoking Rooms
Cable / Satellite TV
Coffee / Tea Maker
Internet Connection (wireless)
En suite
Private Bathroom
five acres of private parkland to explore
unlimited use of heated outdoor swimming pool
Freeview TV in every guest suite and a snooker/games room
luxury toiletries
the option of a locally-sourced English cooked breakfast
generous, secure off-road parking
local country pub within two minutes' walk
a warm welcome from your host family


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Gazzaniga, Michael S. : Dartmouth College
Michael Gazzaniga (Ph.D., California Institute of Technology) has held positions at the University of California, Santa Barbara; New York University; the State University of New York, Stony Brook; Cornell University Medical College; and the University of California, Davis. Currently, he is the David T. McLaughlin Distinguished Professor at Dartmouth College. Professor Gazzaniga founded and presides over the Cognitive Neuroscience Institute and is the editor-in-chief of the Journal of Cognitive Neuroscience. His research focuses on split-brain patients.
Ivry, Richard B. : University of California, Berkeley
Richard Ivry (Ph.D., University of Oregon) has held positions at the University of California, Santa Barbara, and now at the University of California, Berkeley. His research includes sensorimotor control, perception, and attention. He has received numerous awards, including a Sloan Fellowship in Neuroscience and the Troland Award from the National Academy of Sciences.
Mangun, George R. : Duke University
George Mangun (Ph.D., University of California, San Diego) has taught at Dartmouth Medical School and is now at Duke University. His research focuses on the cognitive neuroscience of perception and attention. Professor Mangun has received numerous honors for his research, helped found the Cognitive Neuroscience Society, and is currently an editor of the Journal of Cognitive Neuroscience.
1 A Brief History of Cognitive Neuroscience
2 The Cellular and Molecular Basis of Cognition
3 Gross and Functional Anatomy of Cognition New!
4 The Methods of Cognitive Neuroscience
5 Perception and Encoding
6 Higher Perceptual Functions
7 Selective and Attention Orienting
8 Learning and Memory
9 Language and the Brain
10 Cerebral Lateralization and Specialization
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12 Executive Functions and Frontal Lobes
13 Emotional Mechanisms New!
14 Evolutionary Perspectives
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16 The Problem of Consciousness
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Colston, Stills, Toon's Fantasy Reaction
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The New Orleans Saints ' passing attack was firing on all cylinders in Week 15's 31-15 Monday night victory against the Chicago Bears ... Read More »
5 Saints Who Must Add Offensive Production
by Zane Brown
In light of the recent injuries that have hobbled some of their most prominent offensive weapons, a number of New Orleans Saints players must step up and increase their offensive production... Read More »
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'12 Rooks Who'll Break out in '13
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All-Time Wisconsin Dream Team Revisited
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text:
A method is disclosed for communication between a vehicle travelling along a route and a stationary system. The vehicle is equipped with a communication unit to communicate messages to the stationary system. The method includes dividing the route into a plurality of partial sections, defining for each partial section a required information flow from the vehicle, and adapting the communication to this definition. The method makes it possible to command the communication unit to communicate with correctly adjusted accuracy. This also improves the possibility of effectively utilizing the traffic information in local units, for instance for displays and traffic signals.
1. A method for communication between a vehicle travelling along a route and a stationary system, the vehicle including a communication unit to communicate messages to the stationary system, the method comprising:
dividing the route into a plurality of partial sections;
defining for each partial section a required information flow from the vehicle;
creating a set of parameters for each partial section, the set of parameters define at least one of when messages are sent and the contents of the messages,
receiving the set of parameters for each partial section at the vehicle communication unit, and
adapting the communication based on said parameters, the adapting includes shifting between a time-controlled communication and a distance-controlled communication.
2. A method as claimed in
communicating, by the stationary system, the set of parameters for each partial section to the vehicle.
3. A method as claimed in
associating each partial section with one of a plurality of predetermined classes, which each define an adaptation of the information flow; and
determining which class each partial section is associated with, and adapting the communication for each partial section according to this class.
4. A method as claimed in
5. A method as claimed in
6. A method as claimed in
7. A method as claimed in
8. A method as claimed in
9. A method as claimed in
associating each partial section with one of a plurality of predetermined classes, which each define an adaptation of the information flow; and
determining which class each partial section is associated with, and adapting the communication for each partial section according to this class.
10. A method as claimed in
11. A method as claimed in
12. A method as claimed in
13. A method as claimed in
14. A method as claimed in
15. A method as claimed in
The present invention relates to a method in communication between a vehicle travelling along a route and a stationary system, the vehicle being equipped with a communication unit which communicates messages to the stationary system.
As an alternative to information systems based on polling of vehicles in a fleet of vehicles (such as buses in a public transport system), AB TRYGGIT has recently developed a system where each vehicle on its own initiates communication with a central unit and, thus, notifies the system of position, speed etc. The system which is disclosed in the Publication WO01/76105 is based on radio communication, where all vehicles transmit messages on the same radio frequency. The need for frequency bands thus is extremely limited, and by frequently transmitting messages from every vehicle, collisions, if any, between messages do not constitute a problem.
In a system of this kind, where update of the information of the system is initiated from the vehicle, it is a matter of vital importance how often such communication is transmitted. If messages are transmitted too infrequently, there is a risk that the system is not sufficiently updated, and moreover the system will be more vulnerable to any message losses.
On the other hand, frequent communications from all vehicles tend to flood the system with radio messages. Although a system according to WO01/76105 is adapted to handle such information excess, it may still put an unnecessary load on the system.
The object of the present invention is to obviate the above problems and provide a system for traffic information which is updated with sufficient accuracy.
According to the invention, this object is achieved by a method of the type stated by way of introduction, further comprising dividing the route into a plurality of partial sections, defining for each partial section an adaption of the communication, and adapting the communication to this definition.
"Stationary system" can relate to, for instance, stationary radio receivers connected to one or more central units, for collecting information from a plurality of vehicles. However, it may also relate to local units provided with radio receivers which are adapted to receive information from vehicles in the absolute vicinity. Such local units can be suitable to assist in controlling traffic lights and to allow display of information at stops.
The method makes it possible to command the communication unit always to communicate with correctly adjusted accuracy. This also improves the possibility of effectively utilising the traffic information in local units, for instance for displays and traffic signals.
The option of collecting, along certain sections, more frequent information can also be used, for instance, to make a statistical analysis of this section.
In one embodiment, the method comprises creating a set of parameters which define when messages should be sent and/or which contents the messages should have, and making said set available to the communication unit, so that the communication unit is capable of adapting the communication.
A definition of a set of parameters that is made available to the communication method is a simple way to accomplish the invention.
The method may further comprise associating each partial section with one of a plurality of predetermined classes, and determining which class the current partial section is associated with, and adapting the communication according to this class.
This method can be combined with the definition of a set of parameters, but it may also constitute an alternative where the division into differently classified partial sections replaces the parameters.
An important type of adaptation that may be of interest is shifting between time-controlled communication and distance-controlled communication. While time control (for instance a message is transmitted at least every 10th second) may be convenient for sections at a greater distance from planned stops and crossings, distance control (for instance a message is sent at least every 10th meter) may be convenient when a vehicle approaches a stop or crossing.
Of course the message frequency can in both cases be still more adapted, with more frequent messages along critical sections. This occurs in time control by changing a fixed longest time period which is allowed to pass before the next messages are sent, and in distance control by changing a fixed longest section along which the vehicle should travel before the next messages are sent.
Moreover distance control can be more explicit by indicating fixed points along the route at which messages should be sent. This is advantageous if the need for information is associated with predetermined places, such as a crossing.
The adaptation may also comprise indicating an event which is to initiate transmission of a message. As a rule opening or closing of doors initiates transmission of a message, but it may also be appropriate, along certain sections, to let other events recorded by the information system of the vehicle trigger messages. This may involve an accidental stop, a request from a passenger that the vehicle stop at the next stop etc.
Another adaptation may involve the contents of the message. On certain sections limited information (for instance position) may be sufficient, while on other sections more extensive information may be relevant, (for instance position, speed, display of direction of travel etc).
The benefit of the invention will be illustrated with reference to a number of situations related to a public transport system.
As a rule, it is more important for the system to obtain correct and accurately updated information about the vehicle (position, speed etc) in conjunction with a stop, compared with many other parts of the route.
For example, information about the speed of the bus just before the stop can at an early stage indicate whether the bus intends to stop at the current stop or not. This information thus allows earlier update of the information about the bus than would otherwise have been possible.
The partial section preceding the stop can thus be given priority, in which case the communication unit is arranged to communicate, along this section, information about position and speed at frequent intervals, for instance every 5th meter or every two seconds.
In the same way it can be important for the system to be able to determine the status of a bus standing at the stop, for instance if its doors are open or closed. To this end, the communication unit can be arranged to include, in certain places, information whether the doors of the bus are open or closed in every message. The unit can also be arranged to initiate transmission of a message each time the doors of the bus are opened or closed. Consequently this involves a change from time- or distance-controlled transmission to event-controlled transmission.
A further example is a route in conjunction with a crossing with traffic lights. Since crossings controlled by traffic lights frequently cause a sudden change of the rhythm of the traffic (the bus may have to stop), which affects the estimate of the next time of arrival, it is important for the system to receive more information in connection with traffic lights. There is also a further advantage of adapting the behaviour of the communication unit just before a crossing, viz. in connection with intelligent traffic lights. There are prior-art systems where traffic lights are affected by information received from approaching vehicles. In such systems it is necessary somehow to initiate the communication from the vehicle, and this may take place using different types of sensors etc. The present invention presents a simple way of ensuring that the communication unit transmits messages with sufficient frequency and with sufficient contents for the traffic lights to function in a satisfactory manner.
The above described communication at frequent intervals, which thus is applied before a stop, may also be suitable before a traffic light. A slightly different composition of information may also be convenient, which may then involve a different adaptation.
However, it may also be important to obtain reports at some exact places, for instance along a certain section before a crossing, and in the middle of a crossing. The adaptation could therefore imply that a message is sent at certain points along the partial section.
Other adaptations can be convenient in sparsely populated areas. Along such sections, the stationary system typically need not receive information very often, since there will be few events changing a previous estimate of, for instance, the expected time of arrival. It may therefore be appropriate for such a partial section to be associated with a reduction of the frequency of messages, so that messages are sent more infrequently along this section, for instance every 30th second or every kilometer.
Along low-priority partial sections of this type, it may be convenient for the communication unit also to be adapted to send additional messages if certain events should occur. For instance, it may be justified to send a message if the speed of the bus falls below a predetermined value since this indicates some kind of traffic disturbance on the route.
Particularly preferred embodiments of the present invention will now be described in more detail by way of example and with reference of the accompanying drawings.
With reference to
According to the invention, the route 7 is divided into partial sections 8, which each are associated with a certain desired flow of information from the vehicle 1 to the system 2. This division is made available to the communication unit in the bus, in the same way as the unit knows which stops are included in the route. This can be achieved by preprogramming of the communication unit 3, for instance as described in WO01/76105, which is herewith incorporated by reference. Alternatively, the division can occur from the stationary system 2 and be communicated (for instance broadcasted) to the bus. However, it is essential for the invention that the communication unit 3 be aware of the current division.
In operation, the communication unit 3 is arranged, according to the adaptation as defined for the currently run partial section, to adapt the communication, i.e. the transmissions of messages. It can imply, for instance, that communication is initiated more frequently along certain partial sections, that a message is sent at predetermined places, or that each message that is sent contains more information along certain partial sections. It may also imply that a message is triggered by different events on the different sections.
The partial sections 8 of the route are in this case identical with the sections between the stops 11, 12 along the route, which also passes two crossings 13. In a file, a set of data 10 is stored (see
The communication unit 3 is provided with the file containing all relevant data sets and can thus determine whether a currently run section has a defined set of parameters, in which case adaptation of the information flow should take place.
The data set 10 in
Correspondingly, distance-controlled message frequency can instead be applied to a selected section. A parameter then represents the longest section that is allowed to pass before a new message is to be sent.
In addition to indicating such a section with more frequent transmission, the data set 10 may also contain parameters (a-d) which indicate a plurality of places along the partial section when messages are always to be sent. This type of distance-related reporting can be advantageous, for example, in connection with crossings with traffic lights.
The set 10 may further contain parameters which indicate different transmission and monitoring frequencies f1, f2 than the frequencies that are usually employed by the communication unit 3. This can be used to increase the reliability of adapted communication.
The result of the above example is that the adapted partial section between the stops 11 and 12 has two segments (section A-B and section a-d) which have a different "class" than the remaining partial section. In the example described above, the section a-d contains points which are specific for the current partial section, but if this need is disregarded, a similar adaptation could be provided by defining in advance a number of classes, and then indicating which partial sections should belong to the respective classes. In this case it may be advantageous to let the partial sections constitute only parts of sections between stops (such as section A-B in
It is to be noted that the invention does not exclude overlapping partial sections. A classification involving increased information contents does not prevent classification corresponding to increased message frequency. On occasions where both adaptations are active, messages are sent frequently and with increased information contents.
In a situation where two overlapping partial sections with adaptations which, for instance, indicate different message frequency or contents, this can be regulated in a suitable manner. For instance, it is possible to let the highest message frequency rule, or send the union of the different information contents.
In the above examples (
It should also be noted that the set of parameters that has been described relate to the adaptation of the information flow according to the invention. Thus, it cannot be excluded that the normal information flow comprises transmission of messages in addition to the parameters in the set 10. For instance, it can be advantageous to transmit messages at predetermined distances to the current stop 12 (for instance 180, 120 and 60 m). This normal information flow does not have to be affected by the set of parameters 10. Alternatively, the set of parameters 10 controls all transmission of messages. It may then be suitable to increase the set 10 with parameters corresponding to the normal occasions of transmission, for instance the above-mentioned transmissions before the current stop.
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The Final Recollections of Charles Dickens by Thomas Hauser is a mystery with a Dickensonian feel! : Mystery And Crime » Read
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Results 31 to 34 of 34
--Posted by Steve-kbi
I just read all the comments in this thread and it seems to have lost its point!...
Thanks for your interest in this thread.
Could you tell us who teaches which classes? I can't seem to find any info online about that, when I clicked on the 'Enquire' button for Ninjutsu it said my enquiry was about Kickboxing! Scrubbed that and wrote my question, then it wouldn't send unless I gave my phone number! No Thanks!
So if you have some info you could share that would be great.
Are you Stephen Dixon?
Consumer advocacy is something completely different.King without a crown
Stephen Dixon is the owner of Holistic Fitness Sport MA in Wimbledon.
Stephen Dixon �?? 4th degree black belt / Director of Training.
"I have spent time training in seal lung and wing chun kung fu, sport kickboxing, unlicensed boxing, armed forces control and restraint, unarmed combat, armed combat military and civilian, aikido, Pilipino stick fighting, various weapons, boxing, and most recently MMA.
Master instructor (Great Britain Martial Arts Association).
Senior tournament official WAKO/WPKA/WKA/WKO/UMA.
Edit: The .net site is a 404, there's some info here:
Last edited by Resonance10; 2/20/2013 11:01am at . Reason: being a dumbass..
- Join Date
- Dec 2014
- Location
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Posted On:
12/16/2014 9:45am
Style: MMA--
I can echo everything related in this post, with the exception of receiving emails from Eric. Whilst Eric had good enthusiasm, he was clearly lacking from any real credentials as a head instructor for MMA(or sports combat as it is known there) in comparision to other gyms I have trained out of(I work all over the UK so I try out as many gyms as I can). The moment I walked in, it was Steve Dixon who had just finished teaching his kickboxing class and was doing the hard sell of signing up to direct debit, insurance etc, even though I clearly stated I'd only be able to come for two weeks due to work commitments. With that he turned away mouthing something under his breath. I was tempted to walk out there and then but thought I may as well give it a chance as I was there. At the start of the class Eric left to go leafleting and left the class with one of the students to do the warm up. At this point I liked it as the guy(I forget his name, but he was a former Thai boxing champion, who said he had been there about a month or so) had us do a pretty good warm up, and then showed us how to throw leg kicks, which we drilled for a good ten minutes or so. I felt despite the very basic and limited surroundings his level of teaching was pretty good. After this Eric arrived back and that's when my opinion took a nose dive. He would show us a judo throw, without teaching me how to break fall(which fortunately for me I knew already, but surely that should be one of the first things to teach when you have a perceived newbie) and it would be drilled for no more than a minute. Then same again with the next technique, and again. This continued for half hour. We then moved on to some sparring. But rather than observe, Eric was sparring with one of the other lads and not watching what was going on etc. Luckily for me I was put with the Muay Thai lad, who was, at least to me, a much better teacher than the instructor himself. He was very controlled and made things very clear to me. Seriously the guy is wasted in that gym.
Then at the end of the class Eric would proceed to do the hard sell, just as Mr Dixon had done 90 mins or so earlier, almost word for word, which would lead me to believe that it's Mr Dixon who is pushing the instructors to do this. I expect it is the same with the other classes they do.
Now while the price of membership is quite competitive with other gyms, the teaching was well below par when compared to other gyms I've tried up and down the country. No other club has ever tried to get me to fill in a direct debit form before I have even given the class a try.
IMHO I'd say give this place a miss unless you want an extremely basic level of martial arts. There are a couple of other gyms in the surrounding area such as in Richmond, Croydon etc, where it may cost a few more quid a month, but the level of instruction is on a whole nother level.
Personally, this was not the place for me. Just my opinion, but one it seems I'm not alone in


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950 Adventure /S '03-'05
950 Adventure /S '03-'05
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Quick and Easy Hummus
Yield: about 2 cups
A really well-made hummus with tahini is a thing of beauty, with complex, balanced flavor. It's likely familiar as a dip for vegetables, but try adding it to burgers, noodle salads, deviled eggs or salad dressing.
- 1 clove garlic Add to list
- 1/4 cup tahini Add to list
- 1/4 cup fresh lemon juice Add to list
- 2 cups cooked or canned garbanzo beans, drained and rinsed (see note) Add to list
- 1/2 cup water Add to list
- 1/4 teaspoon ground cumin, or to taste Add to list
- 1/4 teaspoon cayenne, or to taste Add to list
- Salt, to taste Add to list
- Extra virgin olive oil Add to list
These ingredients are:
Vegetarian Vegan Corn-free Dairy-free Egg-free Gluten-free Peanut-free Soy-free Tree nut-free Wheat-free
In a food processor or blender combine garlic, tahini and lemon juice; process for 1 minute. Add garbanzo beans and process until smooth. Add water, a little at a time, to achieve desired consistency.
Add cumin, cayenne and salt and process. Taste and adjust seasonings. Transfer to a serving bowl, smooth top and drizzle with olive oil.
Canned beans are fine in this recipe, but we suggest cooking a pot of Pedrosillano cafe garbanzo beans to try the difference. Available in our bulk department, this variety of bean has a creamy texture and nutty flavor that is perfect in hummus.
For additional flavor, reserve the garbanzo cooking liquid and use it as a replacement for the 1/4 cup water in this recipe.


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The Milwaukee Journal-Sentinel says "don't be surprised to see the Packers use a bevy of tight ends in more specified roles this season," hinting at a possible committee approach.
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Coach Mike Pettine referred to TE Rob Housler as "the ideal 'F.'"
The Florida Times Union projects Marqise Lee as the Jags' No. 3 wideout entering camp, behind Allen Hurns.
Todd Gurley (ACL surgery) will soon meet with Dr. James Andrews for a recheck of his surgically repaired knee.
Sources tell Bleacher Report's Jason Cole that contract-year QB Russell Wilson is looking to become the highest-paid player in the NFL.
A decision on Tom Brady's appeal is not expected until mid- or late-July.
A league source tells Profootballtalk.com that Tom Brady "simply reiterated his denial" regarding involvement in or knowledge of deflating footballs during Tuesday's appeal with commissioner Roger Goodell, and "the answers were regarded by some in the room as not entirely credible."
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ESPN New York's Rich Cimini projects Bilal Powell as the Jets' No. 2 running back to begin training camp.
Tevin Coleman will enter training camp behind Devonta Freeman on the depth chart.
The Tampa Tribune says Doug Martin had his "best offseason in three years."


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Rachel (Myers) Geiger, 84, of Norwalk, died Sunday, Dec. 9, 2007, in Gaymont Nursing Center in Norwalk.
She was born Feb. 15, 1923, in Norwalk and was a member of St. Alphonsus Catholic Church. She enjoyed wintering in Naples, Fla., golfing and knitting.
She is survived by her sons, John Geiger of Germantown, Md., and William (Paulette) Geiger of Milan; daughter, Carol (Tom) Sorenson of Norwalk; six grandchildren,; nine great-grandchildren; and many nieces and nephews.
She was preceded in death by her husband, Arthur J. Geiger, in 1988; parents, Earl Mox Myers and Margaret (Ott) Myers; brothers, Paul, Robert and Carlton; and a sister, Pauline.
Friends may call from 10:30 a.m. Wednesday until Mass of Christian Burial at 11:30 a.m. in St. Alphonsus Catholic Church, 1360 Settlement Road, Peru Township. The Rev. Kenneth Lill, pastor of the church, will officiate. Burial will follow in the parish cemetery.
Memorial contributions, if desired, may be sent to Gaymont Nursing Center Activities Fund, 66 Norwood Ave., Norwalk, OH 44857.
Arrangements are by Evans Funeral Home, 314 E. Main St., Norwalk.
Condolences may be sent to norwalkfuneral.com.


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