text:
Hafez: God belongs only to you.
A little background here: this dude? He's the assistant football coach at the University of Nebraska-Lincoln who expresses some anti-gay sentiments, saying "Ultimately...at the end of the day it matters what God thinks most." He further says that he will continue to speak out and that "he'd consider it an 'honor' to be fired for his devout faith."
First, dogma (in any form, be it Christianity, the Yoga Sutras, Islam, Judaism, Paganism, etc.) is dangerous. It removes the need and opportunity to speak and think for yourself. We can't succumb to the siren song of dogma and all its trappings of comfort and clear right and wrong (hmm...mixed metaphor? Ah, well).
Hafez said "God belongs only to you," meaning that faith and religion are wonderful expressions of love and commitment, but you must find them for yourself, not in a book written to encase all the answers. The god you encounter in books is someone's imagining of god (i.e. a fictional character). It doesn't mean he (or she or it) doesn't exist, just that you need to find him or her or it for yourself.
Second, HOW do you know what god thinks? Last I heard, god quit talking to and smiting people thousands of years ago? But, if we're keeping track, god also "said" this:
"For six days, work is to be done, but the seventh day shall be your holy day, a Sabbath of rest to the LORD. Whoever does any work on it must be put to death." That's right. DEATH. I don't see any Starbucks/fast food/24 hour gas station employees (and everyone else works on Sundays) being put to death. It's ridiculous. You can't pick and choose. Why don't we revisit our moral stances and base them on something other than a 2,000 year old book of questionable authorship?
I mean, sheesh.


text:
Selected Policies, Guidance, and Procedures
for working with Federally Recognized Indian Tribes:
Government Performance and Results Act
Click here to link to Reclamation's Government Performance and Results Act of 1993 (GPRA) home page , which includes links to Reclamation's Strategic Performance Goals and Measures, and the Department of Interior's Strategic Plan. These documents can also be found on Reclamation's GPRA intranet site, along with other information.Note: At this time, none of Reclamation's strategic goals or measures pertain exclusive to Native Americans. Rather, all Reclamation Native American Program accomplishments are incorporated into other FY 2011-2016 performance measures, which also include accomplishments from working with non-tribal entities. Within the Department of Interior's Strategic Plan, two goals pertain exclusively to Native Americans: "Fulfill Indian Fiduciary Trust Responsibilities" and "Advance Quality Communities for Tribes and Alaska Natives," while other goals include both accomplishments from activities with tribes and non-tribal entities.
Website Contacts:
Technical problems, Janice Simmons at (202) 513-0554;
General content and 638 inquiries -- Kelly Titensor at (202) 513-0558;
NAP database -- Barbara Blackman at (202) 513-0624
Content Update: 02/08/11; General update: 8/18/11
Last updated: 8/18/11

subset: commoncrawl


text:
Lamb With Wine Sauce
|Lamb leg
|3 Pound, boned
|1 Large
|1 Large
|To Taste
|Bay leaf
|Unsalted butter
|2 Tablespoon
|4 Tablespoon
|1⁄2 Teaspoon
|Lemon juice
|1⁄2 Tablespoon (Juice Of 1/2 Lemon)
|Dry red wine
|1⁄2 Cup (8 tbs)
|Egg yolk
|1 Large
1. Rinse and bone the lamb in cold running water. Take a large size saucepan and place it the pan.
2. Slice the lamb into at least six equal pieces and trim away the fat.
3. Take a pan and add the bones in it. Pour some water and bring it to boil.
4. Cover the lid of the pan and simmer for about 2 hours.
5. Strain the stock using a cheesecloth and sieve.
6. Take a large saucepan and put all the lamb pieces. Add some stock to cover the meat.
7. Bring it to boil and strain the liquid using cheesecloth and pour again on the top of the lamb pieces.
8. Peel, slice some carrots and onions. Add them in the pan.
9. Cover the pan and simmer for about one and a half hour or just until the ingredients turn soft.
10. Add some salt, the peppercorns, and bay leaf. Cook for about 5 minutes.
11. Take a saucepan and melt some butter. Add some flour and cook for just about 2 minutes.
12. Then, add some strained lamb stock, lemon juice, the sugar, and wine.
13. Bring the sauce to a boil and keep stirring constantly. Also, simmer for about 3 minutes.
14. Allow the sauce to cool down and beat some egg yolk in it.
15. Reheat the sauce slowly, but make sure not to boil it, else the sauce will curdle.
16. Drain the lamb pieces properly and then arrange in a serving dish.
17. Take a sauceboat and pour the wine sauce. Serve it separately.


text:
You can indicate the ring size, special gift wrapping or any other request to the designer at checkout.
Ships with
DHL Express: 2 - 5 days from dispatch.
The ring is made in gold filled.
14K Gold Filled jewelry is made up of 14K Gold tubing, which is then filled with a base metal such as brass. The layer of gold bonds strongly to the brass so the gold surface so it will not wear off. The 14K Gold tubing makes up 5 percent (1/20) of the total metal weight.
. It looks very much like 14K Gold jewelry but is a lot less expensive and is also durable in the sense that it will not flake, peel, or wear off with reasonable care.
about 3mm organic diameter of the band
Please let me know if you need any other size than offered. I will make the ring in your size custom made for you. JUst let me know your size with the order.
This princess set ring is part of my HARSH PRINCESS collection. The inspiration was traditional jewelry, but in a new more rough way.
The ring is made in gold filled.
The silver stone is made of silver.l my items are shipped in a hand printed / embossed carton box.
Is this item a gift? You can mention the person's name during checkout, and I will address the manual to them, instead of you!------------------------------------------------------
All images are property of Linda Friedrich Jewelry
Ships with
DHL Express: 2 - 5 days from dispatch.


text:
Alaska Ducati Goes To Annette Island, Alaska's Only Reservation
View Single Post
Alaska Born Ducatisti
Joined: Apr 2006
Location: Anchorage, Alaska
Oddometer: 6,654
Ok, how about some slightly more scenic shots?
It was good having the van down there to get around and take whoever wanted to go with me. One day I took my mom and my niece Raven out to the south end of the island to a place called Point Davison or Point D. Awesome. Raven is the youngest daughter of my Ducati 748 riding brother, Corbin. They and my dad are all part of the Native dance group Lepquinm Gumilgit Gagoadim that had flown down from Anchorage for the festivities. It was Raven's first time to Southeast Alaska.
We also stopped at a beach on the way back into town. My mom has had both knees replaced and was very glad to be getting around. Raven came back with a bunch of beach glass.
My mom said she remembered when this was still a usable dock! She once had to board a boat from here to go to Ketchikan for the delivery of my other brother Steven. LOT'S of history in these here parts. Besides ALL aircraft having to land on the island on their way north the Coast Guard also used to have a huge base here.
We also took the relatively new boardwalk out to the renowned Sand Dollar Beach.
On our first of three visits to the beach, the wind was calm which allows the ocean water to warm up to a very enjoyable temperature. So warm that Raven, a hot weather girl from New Mexico didn't even want to get out!
Oh oh. Is that Comet bringing something this way?
ANOTHER stick?!?!
Raven, Comet, and I also took another boardwalk up Yellow Hill just outside of town. A geologist told me that Annette Island is very unique in the area for its extreme mineral diversity. There are plans to mine a high grade marble from another part of the island. Yellow hill is a mineral that is gray in color till it weathers and turns yellow.
That profile on the edge of the mountain is know as 'Washington's Nose'.
Looking north at Metlakatla. Ketchikan is about 16mi around the point.
Next, we'll hit the water. Mark H.
My Ride Reports of Alaska & The Yukon
AKDuc screwed with this post 04-18-2010 at
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text:
Originally written on Bloguin Best | Last updated 12/14/12
Rubio is a major part of the Timberwolves team, but they haven't been terrible with him out due to injury The Minnesota Timberwolves have been one of the NBA teams hardest hit by injuries early on this season, not having Ricky Rubio at all, missing half their games from Kevin Love, and even more absences due to injury present themselves as you scroll down coach Rick Adelman's roster. Surprisingly, their injury woes have not hurt them much in the standings so far, and they are to get some good news on the injury situation very soon. It appears that Rubio, Minnesota's stud young point guard, will be able to play his first game of the season this Saturday in New Orleans against the Pelicans Hornets. The Spaniard has been out of commission since gruesomely tearing both his MCL and ACL March 9 last season. The injury caused him to miss all of the Summer Olympics in London and the T-Wolves' first 19 games of the year. As of Thursday night (before they play the Mavericks late...
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text:
Applied Physiology, Nutrition, and Metabolismby Canadian Science Publishing (NRC Research Press)
Published since 1983, this monthly journal focuses on the application of physiology, nutrition, and metabolism to the study of human health, physical activity, and fitness.;
Water Practice and Technologyby IWA Publishing
Water Practice and Technology provides an invaluable source of information for water practitioners, including those active in utilities, consultants and engineers, enabling interested readers to find and access the information they are seeking.;
Water Utility Management Internationalby IWA Publishing
Water Utility Management International provides an international reference point on the strategic management issues affecting water utilities and on the leading management approaches from around the world aimed at responding to these issues.;
Water Asset Management Internationalby IWA Publishing
Water Asset Management International is an international newsletter focusing on asset management in water and wastewater utilities. The focus of the newsletter is on the strategic aspects of this developing field, providing utilities with international perspectives on infrastructure planning and maintenance as they seek to deliver cost-effective ...;
Water Researchby IWA Publishing
Editor-in-Chief: Mark van Loosdrecht Water Research publishes refereed, original research papers on all aspects of the science and technology of water quality and its management worldwide. Topics include: Treatment processes for water and wastewaters Water quality standards Studies on inland, tidal or coastal waters Limnology of lakes, ...;
Water Science & Technology: Water Supplyby IWA Publishing
Water Science and Technology: Water Supply is published as an adjunct to Water Science and Technology, in 6 issues per year, covering new developments in water supply. Papers are selected by a rigorous peer review procedure and the journal publishes the best papers on all aspects of water supply.;
Journal of Water Reuse and Desalinationby IWA Publishing
IWA Publishing launches a new journal, Journal of Water Reuse and Desalination, in 2011. Journal of Water Reuse and Desalination publishes refereed review articles, theoretical and experimental research papers, new findings and issues of unplanned and planned reuse. The journal welcomes contributions from developing and developed countries.;
Journal of Hydroinformaticsby IWA Publishing
Journal of Hydroinformatics is a peer-reviewed journal devoted to the application of information technology in the widest sense to problems of the aquatic environment. It promotes Hydroinformatics as a cross-disciplinary field of study, combining technological, human-sociological and more general environmental interests, including an ethical ...;
Journal of Water Supply: Research &Technology - AQUAby IWA Publishing
Journal of Water Supply: Research and Technology-AQUA is an official journal of the International Water Association (IWA). It publishes peer-reviewed scientific & technical, review, and practical/ operational papers dealing with research and development in water supply technology and management, including economics, training and public ...;
Water Science & Technologyby IWA Publishing
Water Science and Technology publishes peer-reviewed papers on all aspects of the science and technology of water and wastewater. Papers are selected by a rigorous peer review procedure with the aim of rapid and wide dissemination of research results, development and application of new techniques, and related managerial and policy issues. ...;


text:
A polyaxial screw assembly includes an internal load dampening mechanism for sharing and dampening loads between at least one screw member and at least one rod member interconnected by the assembly. A method of interconnecting the orthopedic screw with the rod by dampening with a body member interconnecting the screw to the rod.
1. A polyaxial screw assembly comprising internal load dampening means for sharing and dampening loads between at least one screw member and at least one rod member interconnected by said assembly.
2. The assembly as set forth in
3. The assembly as set forth in
4. The assembly as set forth in
5. The assembly as set forth in
6. The assembly as set forth in
7. The assembly as set forth in
8. The assembly as set forth in
9. The assembly as set forth in
10. The assembly as set forth in
11. The assembly as set forth in
12. The assembly as set forth in
13. The assembly as set forth in
14. The assembly as set forth in
15. The assembly as set forth in
16. The assembly as set forth in
17. A polyaxial screw assembly comprising screw rotation control means for controlling the force required to rotate a screw along an axis perpendicular to an axis defined by a length of a body member retaining said screw.
18. The assembly as set forth in
19. The assembly as set forth in
20. The assembly as set forth in
21. The assembly as set forth in
22. The assembly as set forth in
23. The assembly as set forth in
24. A polyaxial screw assembly comprising a body member including an inner surface;
seat means for seating a head of a screw therein and including an outer surface seated within said inner surface of said body member and locking means for locking said screw head within said body member; and a gap between said inner and outer surfaces allowing motion of the screw relative to said body member when said screw is locked within said body member.
25. The assembly as set forth in
26. The assembly as set forth in
27. The assembly as set forth in
28. A polyaxial screw assembly comprising:
a body member for interconnecting a screw member to at least one rod member, said body member including slidable rod retaining means for retaining a rod member therein while allowing sliding movement of said body member relative to said rod.
29. The assembly as set forth in
30. The assembly as set forth in
31. The assembly as set forth in
32. The assembly as set forth in
33. The assembly as set forth in
34. The assembly as set forth in
35. The assembly as set forth in
36. An orthopedic device comprising:
a body member for interconnecting at least one rod and a screw, said body portion including at least one bearing holder for returning a rod gripping bearing therein; and
rod bearing rotator body means having a first unloaded condition allowing rotation of the bearing relative to said holder and a loaded condition for preventing relative rotation between said holder and the bearing.
37. A device as set forth in
38. A device as set forth in
39. An orthopedic device comprising:
a bearing member including a substantially tubular body portion having an inner surface for retaining a portion of a rod therein and an outer surface including engagement means for engaging an inner surface of a bearing holder which interconnects a rod to a screw and prevents relative rotation therebetween.
40. A device as set forth in
41. A polyaxial screw assembly comprising:
rod stop means for being fixedly mounted on a rod and engaging otherwise slidable body members, which interconnects a screw to a rod, to prevent further sliding movement of the body member along the rod beyond the rod stop means.
42. An assembly as set forth in
43. An assembly as set forth in
44. An assembly as set forth in
45. An assembly as set forth in
46. An orthopedic device including a biasable screw head seat.
47. An orthopedic device comprising screw self centering means for self centering a screw relative to a body member retaining the screw when the body member is unengaged from a rod member.
48. A method of interconnecting an orthopedic screw with a rod by load dampening with a body member interconnecting the screw to the rod.
49. The method as set forth in
50. The method as set forth in
51. The method as set forth in
52. A method of interconnecting an orthopedic screw to a rod by screwing a screw into a bias able screw head seat.
53. A method of stabilizing a spine for non-fusion by interconnecting screws with rods and allowing relative movement between the screws and rods.
54. A method as set forth in
55. A method as set forth in
rotating the rods relative to the body member and then locking the rods from further rotation.
56. A method as set forth in
57. A method as set forth in
58. A method as set forth in
59. A method as set forth in
60. A method of stabilizing a spine by encapsulating a locking mechanism of a screw within a body member and suspending all surfaces of locking mechanism of the screw from an internal recess of the body member.
61. A method as set forth in
62. A method as set forth in
63. A method of straightening a curve of a spine of a patient by:
sharing loads between interconnected vertebrae;
correcting curvature between the interconnected vertebrae while not requiring fusion of vertebrae; and
growing the interconnection of the vertebrae coincidental with the patient's growth.
64. A method as set forth in
65. A method as set forth in
66. A method as set forth in
67. A method as set forth in
68. A method as set forth in
69. A method as set forth in
70. A method as set forth in
71. A method as set forth in
inserting a curved rod into a bearing while aligning the curve on a coronal plane of the vertebrae;
rotating the rod and bearing in a body member, interconnected to the vertebrae by a screw, until the curve is aligned with a sagital plane; and
locking the rod from further rotation when the rotation of the bearing within the body member reaches 90� of rotation relative to the body member.
72. A method as set forth in
73. A method as set forth in
74. A method as set forth in
75. A method as set forth in
76. A method of preventing spinal compression by interconnecting at least two vertebrae with body members directly connected to the vertebrae and interconnected by at least one rod member;
selectively allowing sliding movement of the body members on the rod; and
limiting the proximity of the body members to each other along the rod.
77. A method as set forth in
78. A method as set forth in
79. An orthopedic device comprising a rod member including at least two flat surfaces opposing each other.
80. An orthopedic device as set forth in
81. An orthopedic device as set forth in
82. An orthopedic device as set forth in
83. An orthopedic device comprising: a body member including load sharing means for sharing loads placed on a spine to which said device is attached and a screw member for interconnecting said body member to the spine, said screw member including a non-round head portion seated within said load sharing means and in sliding engagement therewith.
84. The orthopedic device as set forth in
85. An implant assembly comprising: a body portion; spinal connection means for connecting said body portion to a spine; and rod connecting means for connecting said body portion to a rod, said rod connecting means including rotatable locking positions to allow locking of a rod curve at angles relative to a spinal curve without additional instruments.
86. An implant assembly comprising:
a first rod including an inner wall defining a passageway therein;
a second rod disposed within said passageway for telescoping movement relative to said first rod;
retaining means for retaining said second rod in at least one telescoped interconnection position relative to said first rod; and
range of motion means for allowing for and limiting a range of relative motion between said first and second rods while maintaining a consistent total interconnected length of said first and second rods.
87. The implant assembly of
88. The implant assembly of
89. The implant assembly of
90. The implant assembly of
91. The implant assembly of
92. The implant assembly of
93. The implant assembly of
94. The implant assembly of
95. The implant assembly of
96. The implant assembly of
97. The implant assembly of
98. The implant assembly of
99. The implant assembly of
100. The implant assembly of
101. The implant assembly of
102. The implant assembly of
103. An implant assembly of
104. The implant assembly of
105. The implant assembly of
106. An implant assembly comprising a plurality of rods interconnected at rod joints, at least some of said rod joints including range of motion means for allowing for and limiting a range of motion between two interconnected rods.
107. An implant assembly comprising a plurality of rods interconnected at rod joints, at least some of said rods being selectively rotatable relative to an adjacent rod along a longitudinal axis of said plurality of rods.
This application claims the benefit of priority to U.S. Provisional Patent Application Ser. No. 61/095,485, filed Sep. 9, 2008, which is incorporated herein by reference.
1. Technical Field
The present invention relates to orthopedic devices and, more specifically, to spinal stabilization systems which can particularly be used in the therapeutic correction of scoliosis. The present invention generally relates to polyaxial screw technology and, more specifically, load sharing and its application in polyaxial screw technology for the spine. In a preferred embodiment, the technology can be applied to the treatment and correction of scoliosis.
More specifically, polyaxial screw technology has been in existence for a number of years. While the technology has advanced, the focus of key advances have been on providing smaller and stronger means for fixing a screw that fixes a body member and rod assembly to vertebrae, with each screw assembly having the basic structure of a body with pivot means around the screw head and a rod slot. If the rod to be disposed in the rod slot is not centered relative to the screw head, the body can pivot over to adjust for the misalignment. Examples of such systems are abundant in the art.
2. Background Art
Once the polyaxial screw is connected to the rod, the assembly is locked such that the screw angulation is fixed relative to the body portion. For example, U.S. Pat. No. 6,740,086 to Richelsoph, issued May 25, 2004, shows one such system.
In a more uncommon approach, U.S. Pat. No. 4,805,602 to Puno, et al., issued Feb. 21, 1989 discloses micromotion between a round screw head and a seat of a body member such that the screw is allowed to rotate in the seat. More specifically, the assembly includes a rod and plurality of vertebral anchors that are positioned on the spine on either side of the spinous process spanning the portion of the spine to be immobilized. The rod is secured to the vertebral laminae by the vertebral anchors. The anchor includes a transpedicular screw member which is secured to a vertebrae. A rod support or body member includes a cup which captures the screw and optionally permits micromotion between the rod support and the screw. This type of approach leads to other issues, as the surgical correction to the spine cannot be effectively controlled and issues of the head rotating in the socket producing failure of the system. Therefore, this type of approach is not common. Of course, the locking strength of the spherical head of the screw in the body portion varies from design to design, as well as a locking mechanism.
A more specific issue related to polyaxial screw technology is the application of load sharing, which has various advantages, including reduction of adjacent segment degeneration and improved fusion quality. The term "load sharing" in spine relates to the ability of a spinal stabilization device to share loads otherwise placed solely upon the spine. Conventional methods of spinal fixation utilize a relatively rigid spinal fixation device to support an injured spinal segment or segments being surgically corrected. Such fixation limits movement of the injured segment. These conventional spinal fixation devices connect and couple rods or plates to fixing screws such that the injured spinal segment is supported and held in a relatively rigid and fixed position by the rods or plates. The connection units, such as the rods and plates, are used during fusion, whereby bone graft s inserted into the space and the implants act as internal braces to stabilize the spine during the bone healing and fusion process. The connection units also reduce pain and further injury to the patient by substantially restraining the movement of the spinal column. However, because the connection interferes with normal movement of the spinal column, negative effects, such ad degradation of other healthy segments or pseudoarthrosis can occur causing further complications and issues associated with the spinal column. More specifically, and in the case of large diameter rods, high rigidity of the rods and/or plates used in conventional fixation devices, the patient's fixed joints are not allowed to move after the surgical operation. Consequently, such spinal fixation devices cause decreased mobility of the patient and increased stress on the remainder of the spinal column joints adjacent to the operated area. Such excessively rigid spinal fixation can result in what is termed "stress shielding", whereby the bone graft used for fusion does not receive sufficient loading to allow for solid fusion. By altering this approach and allowing load sharing in the spine, we now have a reduction of adjacent segment degeneration and improved fusion quality.
An early approach for load sharing was a basic system change from a larger diameter rod to a smaller diameter rod. Newer techniques use more flexible rods or complex mechanisms placed as connectors between rod segments.
For example, U.S. Pat. No. 6,241,730 to Alby, issued Jun. 5, 2001, oses a complex link with moveable parts. More specifically, the Alby patent loses an intervertebral link device including at least one damper element constituted by a cage and a pin designed to be connected to bone anchor elements. The pin is engaged in a housing of the cage and is fitted with two elastically deformable members operating in opposition to an applied traction force or compression force. The damper element is a pin that is mounted inside the cage by a joint allowing multi-directional relative pivoting between the pin and the cage, at least about the axis contained in a plane perpendicular to the pin and angular abutment between the cage and the pin enables the multi-directional relative pivoting to be limited in amplitude to a predetermined value of about 4�.
U.S. Pat. No. 7,326,210 to Jahng, et al., issued Feb. 5, 2008, loses a flexible rod constructed from two different materials. More specifically, the flexible connection unit disclosed for use in a spinal fixation device includes a longitudinal member having first and second ends and at least one spacer located between the first neck and second ends wherein the spacer includes a first portion made from a first material and a second portion made from a second material and at least one flexible member located in a longitudinal axial channel of the spacer wherein the first and second ends substantially limit motion of the spacer in the longitudinal axial direction with respect to the flexible member.
Both of the above techniques have drawbacks due to the complexity, size, strength, or inability to integrate into effective spinal stabilization systems. Their use is substantially directed to fusion techniques. Stabilization of the spine for non-fusion is a totally different matter raising totally different issues. Flexion of the spine creates very high loads on the screw-bone interface and often causes loosening of the screws from the vertebrae. Common complications are for the screw to be pulled loose or screw failure, thereby totally destabilizing the fixation device.
The present invention provides a much simpler device from an engineering point of view yet effective in both fixation during fusion and non-fusion techniques. This allows for many options in the treatment of the spine with the same basic system. In addition, the present invention can be utilized for stabilization and reduction during the treatment of scoliosis.
Scoliosis is the medical term for curvature of the spine. Scoliosis occurs in approximately 2% of women and less than �% of men. It usually starts in the early adolescence and may gradually progress as rapid growth occurs. However, scoliosis can occur at any age from juvenile to adult. Persons with a curve of 10� or less are often thought to have just an asymmetry of the spine, but in children who end up with significant curves, a 10� curve can progress to a 50� curve and a significant deformity if there is enough growing time remaining. Persons with curves measuring under 30� entering adulthood are considered having a mild curve while those over 60� are considered severe. Treatment is recommended, depending on the severity and the age of the person. It would be advantageous to be able to correct the severity before it progresses while the spine is still growing, and various techniques along with various devices, such as the one covered by U.S. Pat. No. 6,554,831 by Rivard et al. have been develop, but these devices and techniques are not well developed and have complications. Adapting a rigid prior art system to the treatment of early onset scoliosis would result in degenerative growth of the spine due to the fixed nature of prior art systems or repetitive surgeries.
There are generally three options to the treatment of scoliosis. The first option is doing nothing. This may be a reasonable decision depending on the age of the patient and the predicted outcome. If the person is a teen or pre-teen and the prediction is that this curve will worsen, then doing nothing may not be appropriate. As the curve progresses, torso deformities occur. In the more severe curves, internal organs are compressed. Without surgery, such patients risk organ damage or failure. On the other hand, if the person has reached maturity, then if the curve is mild, below 40�, it may not increase any more. A second option is to wear a brace. Bracing has been shown to be a somewhat effective method of controlling the curve progression, but it does not cure scoliosis. From a practical aspect though, this treatment is reserved for children and adolescents in whom the prediction of a rapid increase in the curve needs to be thwarted. However, a brace worn even 23 hours per day and worn properly does not guarantee that the curve will not continue to increase.
The third option of treatment is surgery. For those persons who already have a significant curve with a significant deformity, surgery can reduce the curve and significantly reduce the deformity.
The usual scoliosis curve is a thoracic curve. In these curves, the general procedure is a posterior spinal fusion. The fusion is a procedure wherein the individual vertebrae are fused to the one above and below. Typically, ten or more segments are included.
It should also be noted that scoliosis a three-dimensional problem, with the curvature of the spine occurring not only in the coronal plane, but usually in angles relative to the coronal plane. One of the aims of surgery is to try to restore the normal contour of the back from both the front view and the side view to restore normal fuction, balance, and cosmetics.
The spine has normal curves when looking from the side but it should appear straight when looking from the front. Kyphosis is generally a curvature of the upper spine, which when seen from the side the spine is bent forward. Lordosis is a curve that has its convexity anteriorly and concavity posteriorly. People with scoliosis develop additional curves to either side and the vertebrae of the spine twist on each other like a corkscrew.
The present invention addresses various issues encountered in the prior art. Generally, angulation of a polyaxial screw is a means of compensating for a rod that is offset relative to a screw that is inserted into the pedicile, as used above. However, angulation is not the key issue. Rather, the offset is the key issue. With regard to the issue of the rigidity of prior art systems, the present invention allows for locking of a polyaxial screw rigidly at a desired angulation but the present invention also provides load sharing. Hence, the two aspects of the design are not mutually exclusive as in the prior art. Accordingly, combining angulation of the polyaxial screw with additional offset capability allows an increase in the amount of angulation over the prior art. Likewise, combining load sharing of external components into an internal mechanism within the polyaxial screw while still utilizing standard rods eliminates complex external mechanisms or materials subject to failure. Thus, the present invention provides a polyaxial screw that can moderate loads relative to the direction of the load exerted by the force on the rod from adjacent levels.
In accordance with the present invention, there is provided a polyaxial screw assembly including internal load dampening means for sharing and dampening loads between at least one screw member and at least one rod member interconnected by the assembly.
The present invention further provides a method of interconnecting an orthopedic screw with a rod by load dampening with a body member interconnecting the screw to the rod.
Other advantages of the present invention are readily appreciated as the same becomes better understood by reference to the following detailed description when considered in connection with the accompanying drawings wherein:
A polyaxial screw assembly made in accordance with the present invention is generally shown at 10 in the Figures. Primed numbers indicate like structure amongst the several embodiments. Each of the assemblies 10 shown can include an internal load dampening mechanism for sharing and dampening loads between at least one screw member and at least one rod member interconnected by the assembly 10. The term "load dampening mechanism" means that the assembly within a body member thereof described below, includes an absorptive mechanism for dampening loads transmitted between the articulating vertebrae, through the screw member, into the body member, along a rod, and passing to another body member. As explained below in greater detail, this allows for articulation of vertebrae interconnected by the present invention while loads transmitted through the system are dampened. This internal load dampening is accomplished through a compact efficient assembly and is effective to prevent deleterious stresses placed on the system, and especially the screw members. It also allows, in a fusion, for dampening of otherwise unnatural stresses imposed on the non-fused segments by the rigidity of the fused sections. This internal dampening ability, in combination with the ability of the present invention to articulate in a novel manner and, the body members to allow sliding along interconnected rod members results in a sophisticated system for allowing growth of the system concomitant with vertebrae growth. The present invention is well suited for the treatment of spinal deformities, such as scoliosis. The ability of the system to grow with the growth of the vertebrae makes the present invention particularly well suited for the treatment of prepubescent patients whose spines will grow yet require early onset therapeutic manipulation by the system.
Referring more specifically to the drawings, and in particular at
Generally referring to the components of the assembly 10, the screw member 14 includes a threaded body portion 18 and a head portion 20. As best shown in
The body member 12, as best shown in
The body member 12 can be divided into two subportions, a first subportion for retaining the head 20 of the screw 14 therein and a second portion for retaining the rod member 16 therein. The first portion for retaining the head portion 20 of the screw member 14 therein includes a recessed portion or surface 26 between a first lip 28 and second lip 30 which extend both radially inwardly into the opening 22. A third radially inwardly extending lip 32 defines a pocket 34 therebetween. The function of these recesses or pockets will be explained below.
The rod retaining portion of the body member 12 includes a pair of arms 36, 38, as best shown in
The head 20 of the screw member 14 can be locked within the lower portion of the body member 12 by various means well known in the art. For purposes of illustration, the present invention includes a locking mechanism, the components of which are shown in exploded view in
As used above, the arms 36, 38 form a U-shaped recess or pocket 40 for receiving a rod member 16 therein, as shown in various views, for example,
The structure of the body member 12 relative to the locking member 58 can be modified, such as the body member 12 including an inwardly radially projecting rib, which would mate with a recess formed in the locking member 58. Likewise, other locking member configurations can be contemplated and executed in accordance with the present invention. For example,
For example,
A significant aspect of the present invention is internal load dampening means which share and dampen loads between at least one screw member 14 and at least one rod member 16 interconnected by said assembly 10. More specifically, the body member 16 includes the screw seat 26, which seats a screw head 20 therein. The load dampening mechanism includes at least a portion of the screw head seat, the screw head seat being defined as the walls containing the screw head seated within the body member 12. In the specific embodiment shown in the Figures, and presently specifically referring to
Alternative configurations of the load dampening mechanism can be contemplated, such as wherein various walls 26 of the body member are flexible thereby also dampening loads transmitted from a rod member 16 to a screw member 14 or vice versa. For example, the entire wall of the body member 12 can form a cup around the head 20 of the screw member 16 and locking mechanism thereof to provide load dampening in all directions about the screw head 20. Alternatively, the entire locking mechanism can be a load absorbing material so as to be able to dampen loads placed on the screw head 20 or the body member 12 which are transmitted therebetween. The dampening member would be a lining entirely covering a surface of the screw head 20 within the screw head seat.
The rod member 16 can be made from various materials, such as titanium alloys, cobalt chrome, and stainless steels. These materials can also be coated for additional strength and/or lubricity.
Consistent with the alternative embodiments discussed above, the body member could be made from a load absorbing material or the seat portion of the body member can be made from a load dampening material, such as metals and plastics well known in the art. Likewise, the body portion 12 can be made from a dual durometer material wherein the screw head seat can be made from a more absorptive load dampening material and the rod retainer portion can be made from a more inflexible material. Such methods of making dual durometer parts are well known in the art.
The screw head 20 seated with the body member 12 but not locked experiences a self-centering effect due to the biasing of the load dampening ring 98. Thus, the present invention further provides a self-centering mechanism for self-centering a screw in the body member in an unlocked condition.
In one embodiment, if the external surface of the locking mechanism comprising rings 48, 50 and 52, shown in
What is key to greater adaptability of the present invention to various final configurations and needs for reduction is not the rotation of the screw member 14 relative the body member 12, but rather the overall motion parallel to the loads exerted on the rod 16. By allowing controlled motion as used above, the loads to the pedicle and spine can be moderated in multiple directions. This is done with standard spine rods and without the need for PEEK rods, or a complex motion mechanisms of the prior art. Such an approach has advantages.
For example, it is well understood that a level that is fused alters the spine loads exerted on the levels above and below the fusion. By allowing the loads at the unaffected levels to be moderated and reduced, the healthy or relatively healthy disks are much better preserved. Hence, problems of the prior art wherein fusion results in eventual degradation of adjacent disks is minimized or avoided.
In addition, if motion in all planes is required for a perpendicular load sharing and dynamic system, then the load sharing damper mechanism of the present invention can encapsulate the locking mechanism 52, as used above. In this manner, all surfaces of the internal locking mechanism are suspended away from the internal recess 26 of the body member 12. Thus, motion is allowed in all directions, but the amount of motion based on the distance or gap between the internal locking mechanism 48, 50, 52 and the internal body wall 26.
The present invention allows the above-discussed sliding mechanism to be locked in place by direct pressure or mechanical engagement with the rod locking mechanism used above. While this does not allow for load sharing and dampening as there is direct locking force from the rod to the screw head, it does provide a benefit, especially in cervical spine applications. By allowing the screw 14 to slide, the amount of screw angulation increases (screw angulation being defined as the angle between the long axis of the screw member 14 and the axis 24 of the body member 12.) For example, as the screw 14 slides to the right, a larger gap between the lower edge of the body member 12 and the screw 14 on the left side occurs. The screw can now rotate further to the left without hitting the lower edge 102 of the body member 12 as shown in
In cervical spine manipulations, a high angulation screw is often required. The load sharing damper of the present invention allows some increased angulation already by the present approach and it is possible to adjust this combination of load sharing damping with increased screw angulation according to requirements.
If all of the benefits of the above-described system are considered, then it can be seen that there are benefits to using such a polyaxial screw assembly 10 with a pediatric scoliosis system. In such a system, the spine elements are generally present and intact, but the curve of the spine requires means to straighten it. Fusion of the spine is normally the treatment of choice as used above in detail, and pedicle screw fixation with rigid rods to hold the spine straight during the fusion process is the preferred treatment. However, it would be far better to utilize the present invention that shares the load with the spine, allows for correction, and does not require fusion, but is allowed to grow with the patient. A completely rigid screw, as is common in the current art, would not be effective in accomplishing this goal. The rods are contoured to match what the spine curve should be and the screws are rigidly fixed to the pedicles and rods. If a rigid screw were to slide along the rod, it would have infinite difficulty in moving along the curves. In addition, the change of the curvature would create extremely high loads on the pedicle, risking not only fracture, but abnormal changes in the desired curvature. This is because as the spine grows, the screw would be pushed into a different location on the rod that may have a different curvature. However, utilizing the present invention, the load is moderated and the assembly can be moved relative to the rod to maintain relative alignment without being rigidly fixed to the rod.
To accomplish the above goal in a scoliosis manipulation or other manipulation where there would be spinal growth during treatment, the amount of motion is controlled by the gap between the body member 12 and the internal locking mechanism 48, 50, 52 and the load sharing damper material properties. The more gap, the more potential motion. It is therefore possible to make the body member 12 larger or larger only in one direction, such as oval or rectangular, such that the screw member 14 can move greater distances in one direction, such as along the rod.
Secondly, if there is no rod locking mechanism, but a sliding mechanism, the height of the assembly is significantly reduced and the system will literally grow with the spine. An example of such a mechanism is shown in
By way of background, there are two basic forms of scoliosis reduction. Derotation involves creating the correct curvature for the spine in one plane and then rotating it 90� such that the curve forces the spine back into a normal shape. The rod is used as a cam for this purpose. The second method is a cantilever approach, wherein the rod is not rotated, but the rod is formed with the correct curvature and the screw brought to the rod or vice versa at each level that is secured to the rod. As a system in the earlier figures can easily accomplish the cantilever approach, the following approach is a unique method for derotation.
As best shown in
For scoliosis reduction via derotation, the curved rod 16′ is inserted into the bearing 106′ such that the curve is aligned on the coronal plane, as shown in
An alternative approach to the above is a spacer tube (not shown) which is effectively a length of tubing that simply slides along the rod 16′. The tube is placed between the screw bodies thus maintaining space therebetween. This allows both screws 14 to effectively slide along the rod 16′ without any stops, but the distance between the screws is always held apart at least a minimum amount no matter where the screw or screws slide.
The use of multiple positions for teeth engagement allows for locking during derotation at various points. Thus, if the spinal curve is reduced to an acceptable level at partial rotation of the bearing, it is not necessary to rotate further. In addition, in a minimally invasive approach, it is ideal to do the curve reduction incrementally and without the need for locking the rod to the assembly and having to unlock it to make adjustments. The use of multiple position self locking allows for the implant system to hold position without extra surgical steps. In addition, the relative position of the bearing can be relayed by an instrument to the surgeon, such that the surgeon knows by degrees the amount of derotation that has been done without having to see the implants under the skin and muscle. This is very important for a minimally invasive approach.
As materials become higher strength, they often become more notch sensitive or subject to crack propagation from a stress riser. In stainless steel, which is less sensitive to this, a collet can be used that grabs features on the rod, such as indentations. As the body members 12 are advanced on the rod 16, the collet grabs another indentation. Ideally, with higher strength materials, it is not desirable to create indentations, but rather utilize smooth rods and still be able to index the rod in the direction of growth. Thus, the present invention provides means for grabbing the rod securely only in one direction while allowing the device to release the rod during the expansion process and relock after the expansion is completed.
In the preferred embodiment shown in
In view of the above, the present invention provides a uniform loading system. Normal fixation in a single level screw fusion constructs involves using at least two rods, one on either side of the spine, and two screws per rod. As the screws are fixed rigidly to the rod and the pedicle, there is not adjustment if one screw incurs a higher stress than another. Curvature of the rods, anatomical alignment, variation of screw depth from side to side, and the addition of other components, such as cross links, all contribute to variations in stress. The higher the variation in stress, the more likely the highest stressed screw or component will fail. By allowing screws to load share and distribute the stresses in accordance with the present invention, this issue becomes greatly reduced and the loads to the assembly and spine are distributed more evenly.
A further embodiment of the present invention is shown in
In operation, at least three screws would first be disposed across vertebral junctions. The middle screw would be the reference point for the attachment of the body members 12 and eventually the rods. Adjustment would be made first of the middle screw and then above and below the rod segment. Derotation would result in straightening of the spine. Sliding of the body members along the rods would allow for growth of the spine. The various locking means above would allow for one unidirectional rotation of the rods relative to the body members.
A further embodiment of a rod assembly made in accordance with the present invention is shown in
The embodiment shown in
Generally, the embodiment provides an implant assembly generally shown at 190 including a first rod 192 as shown in
The rods 192 and 194 are interconnected by a retaining mechanism which retains the second rod 194 in at least one telescoped interconnected position relative to the first rod 192. Specifically, the neck portion 200 includes an annular recess 202 therein. The inner wall 196 of the rod member 192 also includes an annular recess 204 therein. The retaining mechanism includes a flexible snap ring 206, as shown in
As best shown in
The assembly shown in
In a multiple rod assembly, various of the rods could include the tabs and recesses 211, 213 to prevent rotation at different junctions of the assembly while other portions could include the interconnection shown in
The retaining ball and socket mechanism shown in
As best shown in
The invention has been described in an illustrative manner, and it is to be understood that the terminology, which has been used is intended to be in the nature of words of description rather than of limitation.
Obviously, many modifications and variations of the present invention are possible in light of the above teachings. It is, therefore, to be understood that within the scope of the appended claims, the invention can be practiced otherwise than as specifically described.
Patent Citations
Referenced by
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- PSILUVU commented on the question "My Dad Is Overreacting. Why doesn't he want me to date?"
- PSILUVU commented on the story "In Hot Water Over A Coffee Order"
- Docsmith commented on the question "My wife says that what I did was "disrespectful". Is she right?"
- Pixiestix voted for GoWithYourGut (side 1) on the story "My Man Or Yours?"


text:
Release Date:
July 25, 2000
Rating: R - Adult Language, Adult Situations, Profanity, Questionable for Children, Violence
When sweet Northern college kid Bill (Ralph Macchio) and his buddy Stan (Mitchell Whitfield) are picked up and thrown into the slammer in a hick Southern town, at first it looks like no big deal. Then they are informed that they are accused of murder. Penniless and without a single friend in the area, Bill decides to call his goofy cousin Vinny (Joe Pesci), who has somehow recently become a lawyer. Full of family feeling and bravado, Vinny, who has never tried a criminal case in his short life as a lawyer, rides south to defend his trusting relative. He's an expert motormouth and street-level logician from the wilder reaches of metropolitan New York, complete with a thick accent and the attitude to go with it. Otherwise, he's much less well qualified than your average public defender. When he arrives on the scene with his equally brassy girlfriend Lisa (Marisa Tomei), Bill is fairly sure he's going to be sentenced to death. His buddy Stan is even less confident of his legal representative, if that's possible, and the first thing Vinny has to do is to regain the consent of his clients to represent them. The local judge doesn't seem any too sympathetic to Vinny's verbal shenanigans either, and even the most optimistic supporter of the boys would begin to have doubts at this point -- and Vinny's no exception. With the insistent moral encouragement of his girlfriend, Vinny somehow accomplishes the impossible and wins grudging (if very irritated) respect from all concerned, for once studying as if his life depended on it. ~ Clarke Fountain, Rovi
- Genre: Comedy
- Category Courtroom Comedy, Comedy of Manners
- Theme: Fish Out of Water, Culture Clash, Bumbling Cops, Miscarriage of Justice
- Run Time: 02 hr
- Language: French , English
- Subtitle Language: English , Spanish
- Picture Format: widescreen
- Lead Actor: Joe Pesci , Ralph Macchio , Fred Gwynne , Mitchell Whitfield , Marisa Tomei
- Supporting Actor: Raynor Scheine , Bruce McGill , Lou Walker , Pauline Meyers , Aubrey J. Osteen , Ken Jones , Bill Coates , Bob Penny , Austin Pendleton , Lane Smith , Maury Chaykin , Jill Jane Clements , Jeff Lewis , Muriel Moore , Suzi Bass , Michael Simpson , James Rebhorn , Thomas Merdis , Ron Leggett , Michael Genevie , Michael Burgess , Larry Shuler , Chris Ellis , J. Don Ferguson
- Director: Jonathan Lynn
- Academy Awards (1)
- Academy Awards , Best Supporting Actress , 1992 , Marisa Tomei
other Info.
- Online Item #: 11537323
- Store Item Number (DPCI): 058-14-0185
- Made in the USA or Imported


text:
Today's Photo Journal - February 5, 2014
Jamie Paynter of Emmaus uses a resistance band in the total body conditioning class. Fitness instructor Catherine Roseberry of Hereford held the class at the Allentown YMCA & YWCA Wednesday afternoon. The class is a step class with muscle conditioning and stretch and is held twice a week on Monday and Wednesdays at 5 p.m. EMILY ROBSON / THE MORNING CALL


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The child who is being evaluated for attention deficit hyperactivity
disorder (ADHD) may be evaluated for other disorders associated with the
condition, such as learning or behavior disorders. The child may be asked
questions (verbal tests) or may be given written tests to evaluate his or her
intellectual abilities.
The most common tests for intellectual abilities in children are:
Last Revised:
April 12, 2010
Healthwise Staff
Medical Review:
John Pope, MD - Pediatrics & Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics
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The staff and Doctors are very good at what they do and take the time to explain the in's and out ' s about your health issues. I definitely would recommend this office to anyone I know who may need a spine and pain specialist
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Dr. Gordon and his assistant April are THE Best....Professional, Helpful, Attentive and do all that is possible to provide relief from pain. I would highly recommend Dr. Gordon to anyone seeking pain relief or a referral for surgery.
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Dr. Gordon and his assistant April are professional and helpful in every way. I recommend everyone I know with back issues to Dr. Gordon. Dr. Gordon is a great listener, wants to know your level of pain since your last treatment and if it helped, discusses the treatment he recommends during your visit and offers his recommendations going forward. Dr. Gordon is THE Best!
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Excellent care !!! Dr. Gordon is truly an asset to this practice. He explains procedures very well and takes the time to listen and understand the problems and concerns of the patient.
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It took a while to finally get to a treatment that worked for me, but that was mostly because I wanted to try conservative measures first. I felt the procedures I had were explained fairly well, but I wasn't prepared for the extremely lengthy recovery time and didn't know until I was on the table for a procedure that I couldn't have the entire thing done at once and had to schedule a second appointment while I wasn't really thinking clearly. I have always gotten appointments quickly and the staff have been very friendly, but I think they're lacking a bit in clearly communicating with patients what they should expect, not just in terms of preparing for a procedure, but more detailed info on what to expect from a recovery. Dr. Gordon and his PA are quick to recommend procedures, and I wasn't always convinced those procedures were the correct course of action.
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I began seeing Dr. Gordon Jan 2009 after I had a horrible experience with another PM Dr. Dr, Gordon's practice Capital Spine & Pain Management Centers are very strict & by the book when it comes to medications which makes me more comfortable. I suffer from extreme/chronic back pain & have had 4 back surgeries in the past 5.5 yrs. Dr. Gordon has found a combination of 3 medications that allow me to function with a pain level of about a 3 out of 10. He is very thorough in his exams, and is always looking at different ways to improve my quality of life.
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The Issue: Schools of Islam in our changing world
by Noel Debien with Muslim panel
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In this episode, Sundaynights looks into Islam in some of its distinctive parts through the personal experiences of some Australian Muslims.
While Muslims report that Islam is one and unified, there are nevertheless nuances and distinctive movements among Muslims. Sunni and Shia is one such distinction, and many others can be made. Sunnis and Shias say they agree on all the fundamentals of Islamic belief. But as the Arab Spring unfolds, distinguishing the real motives in rapidly changing political scenes is not easy.
The Iraq-Iran war has sometimes incorrectly been portrayed as a Sunni-Shia dispute- as if the war was about theology rather than national interests. Sectarian violence has been reported along these lines also. For example, the Alawi in Syria are identified as a Shia minority among a Sunni majority- again as if the political violence in Syria is about theological disputes instead of about the re-ordering of political power. Distinguishing ethnic and political interests from religious demographics can be difficult at the best of times, and so tonight we take a brief look at some of the religious nuances of Islam.
In summary:
Sunni Islam is the largest group in Islam. The name Sunni comes from the "Sunnah" - the actions of Muhammad that are recorded in hadiths - often rendered the "usual practice". Their religious laws and precepts are developed from the text of the Quran, the hadiths, juristic reasoning and consensus. There are several major traditions of Islamic law for Sunnis- including schools such as the Hanafi, the Zahiri, the Shafi'i, Maliki and Hanbali. Sunnis are the majority in most parts of the Muslim world.
Shia Islam is the second largest group in Islam. "Shia" means "followers of Ali", the cousin and son-in-law of the prophet Muhammad. They believe that God chooses the leader who safeguards Islam. Shias regard Ali as the proper successor to Muhammad, and the first imam ( a term which among the Shia has special leadership significance). Shias also teach that Muhammad's family and certain of his descendants have special spiritual and political authority over the community. Shias divide into two main sub-groups, "twelvers" who count 12 Imams; and "Seveners" who count only seven. Shias will also make "visitation" to holy sites other than Mecca - shrines of holy leaders for example. Shias are the majority group in Iran, Iraq, Azerbaijan and Bahrain, and there are significant minorities of them in Lebanon Turkey, Pakistan,and many other places. The Alawi (in Syria), and the Alevi are sub-groups of Shia Islam.
Sufism is a mystical-ascetic practice of Islam (found among both Sunni and Shia). It is a practical spirituality, and focusses on the experiential aspects of religion. It emphases intuitive and emotional faculties. It is often referred to as being "of the heart".
Mehmet Ozkam : Sufi practitioner
Kuranda Seyit : ED of FAIR Australia (Sunni)
Tasnim Saeid: Law and Social inquiry student at UTS executive committee member of the Federation of Muslim Students and Youth, (Sunni)
Sheikh Zaid: Shi'ite teacher and Imam
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Hex takes a look at the revelations and highlights of the video game event of the year: E3 2015.


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Other Works ConsultedChang MW, Orlow SJ (2008). Neonates and infants
section of Neonatal, pediatric, and adolescent dermatology. In K Wolff et al.,
eds., Fitzpatrick's Dermatology in General Medicine, 7th
ed., vol. 1, pp. 935–941. New York: McGraw-Hill.Grichnik JM, et al. (2008). Congenital nevomelanocytic
nevi section of Benign neoplasias and hyperplasias of melanocytes. In K Wolff
et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 1, pp. 1099–1103. New York:
McGraw-Hill.Horii KA, Sharma V (2010). Birthmarks section of Pediatric Dermatology. In JC Hall, ed., Sauer's Manual of Skin Diseases, 10th ed., pp. 425–427. Philadelphia: Lippincott Williams and Wilkins.Huikeshoven M, et al. (2007). Redarkening of port-wine
stains 10 years after pulsed-dye-laser treatment. New England Journal of Medicine, 356(12): 1235–1240.Miller JH (2010). Hemangiomas. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 289–291. Philadelphia: Mosby Elsevier.Miller T, Frieden IJ (2008). Vascular tumors. In K
Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol,. 1, pp. 1164–1172. New York:
McGraw-Hill.Morelli JG (2007). Diseases of the neonate. In RM
Kliegman et al., eds., Nelson Textbook of Pediatrics,
18th ed., pp. 2661–2664. Philadelphia: Saunders Elsevier.Swee TT, et al. (2010). Low-dose propranolol for infantile haemangioma. Journal of Plastic, Reconstructive and Aesthetic Surgery. Published online July 9, 2010 (doi:10.1016/j.bjps.2010.06.010).
Last Revised:
March 21, 2011
Healthwise Staff
Medical Review:
Sarah Marshall, MD - Family Medicine & Adam Husney, MD - Family Medicine & Alexander H. Murray, MD, FRCPC - Dermatology
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As of yet, there is no established pharmacological treatment for primary motor stereotypies, however behavioral therapy (habit reversal) has been shown to be helpful. There has been little research in normally developing (nonautistic) children. Dr. Harvey Singer, director of the pediatric neurology division at Johns Hopkins, is currently conducting several studies with the goal of one day developing an effective treatment.
Behavior therapy
Behavior therapy, administered by a psychologist, consisting of a combination of awareness training and competing response training has been an effective treatment for primary motor stereotypies. Children are taught to recognize the presence of their repetitive behaviors.
For more information: Contact Tina Kline at 410-955-1960 or firstname.lastname@example.com
Drug therapy
To date, drugs have not proven to be an effective treatment for primary motor stereotypies and are rarely prescribed. There have been no formal studies on drug treatments in normally developing children. Studies of drug treatments for stereotypies in autistic and developmentally disabled children have been inconsistent. Future studies designed to investigate newer potential medications are planned and are being developed.
Current brain imaging in affected individuals and neurochemical measurements in animal models seek to better understand the alterations underlying the movement abnormalities in the brain. The hope is that this research will one day lead to clinical trials for new and effective drug treatments.


text: So Saturday Night Live last weekend. Tina Fey was great. Michael Phelps clearly has a bright future as an actor. And our man Lil Wayne delivered the biggest laughs of the night by performingwhat was undoubtedly the worst/best/worst-again guitar solo in known human history. At the end of his otherwise enjoyable performance of "Lollipop", standing on the very same stage where GE Smith used to shred face every Saturday night, Weezy whipped out his axe and launched into a guitar solo that can only be described as what a brain-damaged blind person might look like playing Guitar Hero, on Easy level, while blacked out on booze and pills. This is to the long storied history of Guitar Solos what Ashlee Simpson was to singing.


text:
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text: The Soft Pouch- Digital versions offer a unique protective carrying system that's ideal for the photographer on the go. The easy-access design enables the photographer to quickly access the camera. The compact, tailored fit offers great protection without the bulk of a large camera bag. It's sure to become a necessity for all digital users!


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Today is my ex's birthday. Things ended quite badly. Should I call/email good wishes for his day?
We haven't spoken in about 10 months. I have had a difficult time getting over him, but, I'm almost there completely. I don't want him to construe... Show More
Most Helpful Opinion
I think its ok to contact him on his birthday or other different occasions. In no way does this make you have to restart a friendship that isn't wanted. it takes two people to communicate, thus, wish him his happy birthday with no expectations of a response from him, and in the occasion that he does respond (ex. pick up the phone / answer the message). take control of the interaction and stand tall. If he sees this as a restart that you don't want, simply don't answer his calls / messages and you should be fine.
What Guys Said 4
If you want to close the book.then end all ties.the fact that you are wanting to do this.to praise him if you will.by letting him know you are grateful? If he was so great you would still be together.cut ties.time heals all
Thank you. I agree. Its just that I'm the type of person that doesn't like to leave loose ends if you will. And it seems such a shame to let things go into history so negatively.
What Girls Said 8
But you did leave things in a negative terrible way months ago. You know what happened and it was no doubt for a good reason that you guys ended things. When it's over, it's over. Time to move on.
If you start this, then you will either hate him because he's not grateful for your call or you will end up communicating with him, thinking he's changed. He hasn't and you haven't. There is nothing so great about him that warrants a call after 10 months other than you wanting to have contact.
Stop being week and grow some girl! It's time for you to move on because he no doubt has. Every ending does not need to be kind and loving. Some endings just need to be endings. You got your closure 10 months ago. Leave it alone, you will only be hurting yourself.
Girl, the best is just to leave him alone. Don't even call him, regardless even tho it's his bday. You've got good intentions, but surely enough he may thing the same, and think that you're still strung up on him. So it's better for YOU that you don't even bother. Especially since you don't want ties with him. Plus you had a hard time getting over him, sometimes talking to him would bring back feelings, even though you may think that you're ok. Get out there, keep yourself productive, think about it this way, has he called you to say happy birthday or happy holidays? if no, drop it and move on. concentrate on yourself, and be with family and friends that are important and loves you. Good Luck, It sucks, but we all go through it at least one heart break in our lifetime.
If you really want nothing to do with him, then don't call him. You can't be friends with a guy until you are completely over him.and even then it's hard sometimes. And you said that he probably wouldn't contact you on your birthday. Why jump through hoops for someone that wouldn't do the same for you?
hey I know its been a while since you posted this question but I'm just curious. I'm sorta in the same situation. I was talking to this guy and I ended it with him in February. we have not had any contact at all and his bday is approaching. I'm debating if I should text him or not. so I want to know did you contact your ex? what was the ending result and how did he respond?
No I did not. I let the date go by. I figured if we are meant to speak to one another again we would and not to force the issue. Then, we ended up running into each other a couple of months ago just for a brief minute. So then we spoke by phone to try to clear things up and put unresolved issues to rest. It was helpful in that it allowed me to do just that but also it was helpful because it made me realize that he's still the same jerk I knew that he was. People don't change. Don't call.
Have an opinion?


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i have just moved from b2evolution to wordpress as of last night, and i was going to edit the theme, but i don't like doing that while the site is live..
i looked around on here, and found that the only ways around this are the obvious ones. i don't really want to get too much into installing and testing on a separate installation, so i had an idea..
in b2evolution, you can specify a them to use in he url like:
or something like that..
i tried this in WP, but no luck.. i suppose i could look over the code for something like this..
but i thought i would ask you guys first..
is there a way to specify the theme through the url?
this would sure take the edge off..


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Terminator Genisys
Schwarzenegger has turned into your elderly uncle, dancing like a goofball at your wedding after a couple glasses of champagne. He knows he's being silly,…
Schwarzenegger has turned into your elderly uncle, dancing like a goofball at your wedding after a couple glasses of champagne. He knows he's being silly,…
"Magic Mike XXL" is about as close to experimental as pure entertainment can get.
"The Ballad of Narayama" is a Japanese film of great beauty and elegant artifice, telling a story of startling cruelty. What a space it opens…
Patrice Leconte's "Monsieur Hire" is a tragedy about loneliness and erotomania, told about two solitary people who have nothing else in common. It involves a…
Rare interview and review excerpts with Roger Ebert are brought to animated life by Blank on Blank and others.
Video from the Cannes Film Festival on the impact of being a jury member on filmmakers and the question of whether or not this makes…
Rare interview and review excerpts with Roger Ebert are brought to animated life by Blank on Blank and others.
The July 2015 edition of The Unloved looks at Andrew Dominik's "The Assassination of Jesse James by the Coward Robert Ford."
A review of Han Gong-ju from a Far Flung Correspondent.
An FFC responds to Kyle Smith's assertion that women can't enjoy GoodFellas.
Rape scenes are lazy writing; Penelope Spheeris on "The Decline of Western Civilization"; The new online racism; Affleck and Garner at the box office; Tenth…
An essay on the underrated scores of late composer James Horner.
You never know.
Based on those unavoidable TV ads for "Jack the Giant Slayer" featuring CGI-looking giants clomping around and throwing windmills while a hipster-quipster Jack romances a generic-looking princess, I wasn't exactly dreading the screening, but I can't say I had it circled on my calendar, either.
I'm pleased to report, however, "Jack the Giant Slayer" is a rousing, original and thoroughly entertaining adventure. Director Bryan Singer, a first-rate cast and a stellar team of screenwriters, set designers and special-effects wizards have dusted off an old and (let's face it) never particularly compelling fairy tale and have given us a great-looking thrill ride in which we actually care about a number of characters.
There's even room for just the hint of empathy for the giants. It's not easy being a giant. In fact, I have a few questions about the Giant Way of Life, but we'll get to that later.
"Jack the Giant Slayer" begins with the reading of a legend in two very different homes on the same night. Young Jack, a farm boy about 8 years old, has read the story so many times, the pages on his book have nearly worn away — yet he begs his kindly, widowed father to tell him the tale just one more time.
Meanwhile, behind the walls of the castle Cloister, a princess in waiting eagerly absorbs the same story, read to her by her mother, who, like Jack's dad, isn't going to make it past the opening credits of this story.
Cut to 10 years later. Jack has grown up to become Nicholas Hoult, a handsome and almost boringly noble young man now living with his bitter old uncle after the plague took Dad.
Eleanor Tomlinson is Princess Isabelle, who of course is adventurous and romantic and incorrigible, and REALLY wishes she didn't have to marry the gross, old and obviously duplicitous Roderick (the great Stanley Tucci, hamming it up just shy of a mustache twirl).
It takes a long while — truth to be told, a few scenes past the point of perfect timing — before we get to the magic beans and the stalk that shoots to the sky and the mysterious land above Earth populated entirely by giants. But once we get there, game on.
Especially when seen in close-up, the giants are pretty awesome. They're a grotesque bunch of louts, picking their noses and passing gas and making pigs in a blanket, which are literally pigs. In blankets.
As usual, the 3-D is mostly about 2.5-D, though we do get a few battle scenes where you want to duck. But over all, the special effects are impressive. It really looks like those little men are battling those giant-ass giants, who are led by a two-headed general, with the invaluable Bill Nighy buried somewhere in there playing the general.
There's no way you can have a fair fight between giants and people, so there's a convenient device to level the playing field; a magic crown, forged from ingredients including but not limited to the heart of a long-ago vanquished giant. He who wears the crown has complete command over the giants, and it's the evil Roderick's plan to whip out the crown at just the right moment and lead the giants to a conquest of Cloister and all the kingdoms of Earth.
(You'd think Roderick would have been pleased with the deal he already had: marrying the hot young princess, commanding the kingdom and living a cushy live, but there you have it.)
"Jack the Giant Slayer" is filled with neat touches, from the casting of Ewan McGregor as Elmont, a knight in shining armor who's supposed to be the hero of the story and is indeed A hero, but not THE hero, to an epilogue that's just flat-out cool. The PG-13 violence, including a close-up of an eyeball popping out of a giant's face, means the action is a little too intense for very young children. But for everyone else, including cynical grown-up critics who didn't think they'd ever give a Fee, a Fi, a Fo or a Fum about this movie, it's a terrific adventure.
Oh, right: the giants. They live in this world between Earth and heaven, and if you're willing to overlook the scary rock formations and the isolation, it seems like a pretty sweet deal. Lush greenery, room for a giant to roam around, plenty to eat if you can curb your appetite for humans.
What I want to know is, where are the lady giants and the teenage giants and the baby giants? If there are no women, how do these guys not die off? They're not immortal, because several get killed during this movie.
It would have been kind of neat to meet the wife of a two-headed giant general, just to see what her deal is and how she spends her days. Maybe someday.
A rebuttal to Joni Edelman's piece on "Inside Out."
This message came to me from a reader named Peter Svensland. He and a fr...
What should be nominated for Emmys this year? Let us guide the way.
MTV's Scream and CBS's Zoo premiere tonight. One is worth your time. Which one?


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|Sunday May 18, 2003
Sherpas in struggle for policeman's body
Two sherpa guides were yesterday battling time and unpredictable weather in a fresh attempt to recover the body of Victorian policeman Paul Carr from Cho Oyu mountain on the border between Tibet and Nepal. more
OTHER WORLD | Full coverage here
SOCCER | Full coverage here
Arsenal retains FA Cup
Defending champion Arsenal beat Southampton 1-0 to become the first team for 21 years to win the FA Cup two seasons in a row. more
OTHER SPORT | Full coverage here
FILM | Full coverage here
Middle-aged British nudes a big hit at Cannes
The Full Monty turned a bunch of male strippers into a worldwide box office hit. Now it's time for the Calendar Girls. more
OTHER ENTERTAINMENT | Full coverage here
Dollar soars to highest in three years
The Australian dollar soared 1.8 per cent higher to close at a 40-month high of 65.31 US cents in New York on Friday night, as international money traders dumped the greenback against most world currencies. more
OTHER BUSINESS | Full coverage here
What began 25 years ago
as an efficient method of
inviting colleagues
to a work function has
evolved into the scourge
of cyberspace. Full report
OTHER TECHNOLOGY | Full coverage here
The right to die
The euthanasia debate won't go away, so do we need to address the issue of death more openly? We talk with long time euthanasia campaigner Dr Philip Nitschke about his views on the issue.
The family club
Back in haystack
The can-can can-do man
Pretty as a princess, anyway
My Melbourne
Odd Spot
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Claire M. Coutu
PAWTUCKET - Claire M. Coutu, 95, of East Avenue, Towers East, Pawtucket, died Thursday, October 25, 2012 at the Philip Hulitar Home & Hospice Center in Providence. She was the wife of the late Henry C. Coutu.
Claire was born in Pawtucket, a daughter of the late Osea and Ozeline (Boutin) Lallier. Though she worked as a textile worker and then retired from Hasbro Industries, she enjoyed being a home maker to her family the most.
Marcel G. Bergeron
CENTRAL FALLS - Marcel G. Bergeron, 94, passed peacefully October 26th. He was the husband of Isabelle (Beaudoin) Bergeron. They have been married for 63 years.
Born in Drummondville, Quebec, a son of the late Joseph and Lydia (Marier) Bergeron.
He had been employed by Gilbane Corp. as a Union Carpenter serving Local 94 for many years.


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Caneel Bay Resort
|#1 in Best U.S. Virgin Islands Hotels
|Hotel Class 4.5-star
|Critic Rating Good
Guest Rating
TripAdvior Traveler Rating
Based on 40 reviews
U.S. News Review
Caneel Bay Resort appeals to travelers seeking an isolated enclave where they can disconnect from the outside world. With no in-room Internet access or TVs to steer you away from total relaxation, you can enjoy the resort's tranquil setting within the Virgin Islands National Park on St. John's northeastern edge, surrounded by 170 acres of palm trees and pristine beaches. In fact, previous visitors highlight the resort's tranquility as its greatest asset. As soon as you arrive, you're greeted with a complimentary bottle of island rum before being shown to your room, adorned with Caribbean stone, plush robes and lavish Lady Primrose bath products. Caneel Bay's grounds boast a variety of activities to choose from, including tennis, yoga and sunset cruises. To cap off your relaxing day, treat your taste buds to the zesty cuisine served at the resort's five dining establishments. Members of the Leaders Club can earn complimentary nights by staying at this Leading Hotels of the World property.How we rank hotels
Awards Received
- AAA/CAA Four Diamond Lodgings 2015
- Concierge.com Editor's Pick
- Condé Nast Readers' Choice List 2014
- Fodor's Choice
- Frommer's Exceptional
- Lonely Planet Recommended
Editor's note: Hotel information is updated periodically. If this is your property and you notice any inaccuracies, please let us know. If you are interested in obtaining a badge to display on your website or in other media, please contact us.
Similar Hotels Nearby
The Ritz-Carlton, St. Thomas
5.6 miles away
- Hotel Class5.0-star
Marriott's Frenchman's Cove
10.4 miles away
- Hotel Class4.0-star
The Westin St. John Resort & Villas
2.4 miles away
- Hotel Class4.0-star
Frenchman's Reef & Morning Star Marriott Beach Resort
10.4 miles away
- Hotel Class4.0-star


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Genoese Sponge
|2 Ounce (50 Grams)
|Caster sugar
|4 Ounce (125 Grams)
|Plain flour
|4 Ounce, sifted (125 Grams)
|Double cream
|1⁄4 Pint (150 Milliliter, For Finishing)
|2 Tablespoon (For Finishing)
|Icing sugar
|2 Tablespoon (For Sprinkling)
Line and grease a 23 cm (9 inch) moule a manque tin.
Warm the butter gently until just soft; take care that it does not become oily.
Whisk the eggs and sugar in a mixing bowl over a saucepan of hot water until the mixture is thick enough to leave a trail.
Remove from the heat and whisk until cool.
You do not need to put the bowl over hot water if you are using an electric beater.
Fold in the flour.
When it is almost incorporated, fold in the butter as rapidly as possible, being careful not to knock out the air.
Turn immediately into the prepared tin and bake in a preheated oven, 190°C (375°F), Gas Mark 5, for 30-35 minutes or until the cake springs back when lightly pressed.
Leave in the tin for 1 minute then turn on to a wire rack to cool.
Whip the cream until stiff then whisk in the lemon curd.
Split the cake in half and sandwich together with the lemon cream.
Sprinkle with icing sugar.


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Picture: Gary Busey, Hope Dworaczyk Stars of 'The Celebrity Apprentice' celebrate the season premiere with cast party at Surrender Nightclub at Encore Resort and Casino...
Actor Gary Busey has Oscar winner Marlee Matlin to thank for solving his hearing problems - she realised he was partially deaf when he started shouting at her during an introduction on hit U.S. TV show Celebrity Apprentice.
The deaf star could tell there was something wrong with Busey when they first met and it didn't take her long to realise what it was.
She explains, "My interpreter kept signing that someone kept yelling, 'What? What?'... It took me five seconds to realise he must be partially deaf. I've seen it too many times not to figure it out just like that."
Busey, who is famous for his eccentric behaviour and his mumbling, was happy to let Matlin's hearing experts check out his ears.
He says, "(The doctor) told me I was only using 40 per cent of my ear canals. He fit me with a hearing aid I can actually plug into my iPod. Things are much better now."


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Silky Underwear i love the feeling of womens silky panties. i have worn them full time for over 20 years. they feel wonderful on my erect penis, and find women think they are very sexy. a woman's sl;ip feels... [more]
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I Have Been Taking Enemas Since I Was 12 Years Old On My Own. I Purchased My Own Bag When I Was 15. My Mother Gave Them To Me When I Was Very Young And I Found Them Very Painful At First. Then I Began To Enjoy The Feeling Of The Nopzzle Slipping In as time went by i gave myself many enemas and accumulated a lot of equipment of every variety. i had a woman enema partner for three years and learned a lot about the pleasures a woman can have whil… [more]
I Believe In The Healing Power Of The EnemaMy Need For Enemas i am older and have a constipation problem, which combined with rectal bleeding, scares me. i take regular enemas to keep my colon clean (as well as for personasl enjoyment) if i don;t have time t… [more]
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Is This Really A Marriage? if you live in a sexless marriage you are not married in the biblical sense. the physical part of a marriage is just as important as the mental side. whose fault is this? do you desire a relati… [more]


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Clinical Oral Implants Research, 05/02/2012
For a minimal deviation during the surgery with a stereolithographic guide, it is very important to use the drill in a centric position, parallel to the cylinder. The use of longer drill keys and sleeves are critical for optimal accuracy.
© 2015 M3 USA Corporation. ALL Rights Reserved.


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A CASED TIFFANY & CO. JAPANESE PATTERN SILVER AND SILVER DESSERT SERVICE . Tiffany & Co., New York, New York, ... (Total: 16 Items)
2013 June 14 Silver Signature Auction - Dallas #5127
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Heritage Auctions - Design District Annex
1518 Slocum Street
Dallas, TX
Tiffany & Co., New York, New York, circa 1871
Marks: TIFFANY & CO., STERLING, M, PAT. 1871
10-3/4 inches long (27.3 cm) (slice)
21.4 ounces
From a Private West Coast Collection
The dessert service with gilt bowls and matte and satin finish in the Japanese pattern, comprising:
1 ice cream slice,
1 serving shovel,
1 sugar sifter,
12 ice cream spoons.
16 Total, including case
Condition Report*:With some loss of gilding.
Tiffany & Co.:Tiffany & Co. remains the largest luxury-item retailer in the world, offering sterling silver, jewelry, crystal, china, stationery, leather goods, and fragrances. In 1837, Charles L. Tiffany and John B. Young opened "Tiffany & Young" in New York City as a "fancy goods emporium" which sold stationery, European decorative objects, Chinese pottery and umbrellas, desks, and silver. Major silver manufacturers, such as Grosjean & Woodward, William Gale, Gorham, and John C. Moore, supplied the flatware and hollowware selections, and by the mid-1850s, "Tiffany, Young & Ellis" (renamed in 1841 with the addition of partner J.L. Ellis) had become the leading silver retailer in New York. In 1852, the company began utilizing the English sterling silver standard, which was later adopted by the U.S. government as the American standard. In 1853, Tiffany bought out his partners to build the jewelry arm of the firm, at which point "Tiffany & Co." was officially born. With the outbreak of the Civil War, Tiffany & Co., or "Tiffany," became an arsenal for the North, producing swords, flags, uniforms, and surgical instruments, and supplying rifles and ammunition from Europe. By the end of the 1860s, the firm was creating its own silver designs – bowls, pitchers, tea services, and other tableware -- for which it received major recognition, including an award for excellence in silverware at the 1867 Paris Exposition Universelle and the gold medal for jewelry and the silver prize for silverware at this Exposition in 1878. Wealthy U.S. families, such as the Astors, Vanderbilts, Morgans, and Posts, purchased silver and diamonds from Tiffany, and, beyond this hefty endorsement, the company broadened its sales through a mail order catalog, the "Blue Book," first published in 1845. When Charles L. Tiffany died in 1902, his son, Louis Comfort Tiffany, became the firm's first official Design Director. Tiffany solidified its position as both a team-playing American company and an international tastemaker during the twentieth century. With the onset of WW I and WW II, the firm again turned its attention to the war effort by manufacturing airplane parts and surgical instruments. 1940 saw the opening of Tiffany's new and now legendary store on 5th Avenue, structured like a grand ballroom with special lighting to offset the silver and jewelry. During the post-War decades, Tiffany's president Walter Hoving brilliantly increased sales by reaching out to a broader customer base: he hired famous designers to create products for the store -- for example, silver jewelry by Frank Gehry, Elsa Peretti, Paloma Picasso, and Jean Schlumberger and stationery by Andy Warhol – and he opened Tiffany stores internationally. Today, Tiffany operates in twenty-two countries and nets sales of over $3.6 billion.
*Heritage Auctions strives to provide as much information as possible but encourages in-person inspection by bidders. Statements regarding the condition of objects are only for general guidance and should not be relied upon as complete statements of fact, and do not constitute a representation, warranty or assumption of liability by Heritage. Please note that we do not de-frame lots estimated at $1,000 or less and may not be able to provide additional details for lots valued under $500. All lots are sold "AS IS" under the Terms & Conditions of Auction.
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The Perfect Pizza Crust — Fix My Dishby Heather Ramsdell in Community, How-to, January 18th, 2012
Twice a month, we're giving readers a chance to ask Food Network Kitchens' advice about an issue they're having with a dish. They can't reformulate a recipe for you, but they're happy to help improve it.
Question: "How do I get my pizza crust to have that slightly chewy texture and hollow bubbles to obtain that authentic pizzeria-style crust?" — Stephanie.