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An ophthalmic device and system for measuring and controlling relative pressure of fluid inside an ocular globe includes a surgical instrument which is adapted to penetrate the ocular globe. A fluid pressure transducer is mounted on the instrument so that, when the instrument penetrates the ocular globe, the transducer is located adjacent to an opening that communicates with the interior of the globe so that it can react to pressure changes in the fluid therein and generate signals in response to pressure changes in the fluid. The signal is transmitted external of the instrument to a pump or other fluid transfer device which is operatively connected to the transducer for first receiving signals and then supplying or removing fluid from the ocular globe in response to the signals according to a predetermined set of instructions. The pump is connected to a closed loop in which fluid is continuously circulated. Fluctuations in intraocular pressure cause the pump to speed up or slow down and then supply fluid to or remove fluid from the ocular globe through a conduit connected to the closed loop.
1. An apparatus for measuring and automatically controlling intraocular pressure during ophthalmic procedures, comprising:
(a) a first needle means suitable for penetrating the ocular globe, and including a first opening for communicating with the interior of the ocular globe;
(b) a pressure sensor/transducer mounted on the first needle means outside and immediately adjacent to the ocular globe so as to communicate with the first opening for generating appropriate signals in reference to changes in intraocular pressure;
(c) a second needle means suitable for penetrating the ocular globe, and including an opening for communicating with the interior of the ocular globe;
(d) fluid transfer means for delivering fluid at varying rates in response to signals from the pressure sensor/transducer;
(e) conduit means for transporting fluid between the fluid transfer means the the opening of the second needle means;
(f) means for automatically varying and controlling the rate of fluid delivered by the fluid transfer means at a preselected level in response to signals from the pressure sensor/transducer.
2. The device of claim 1, wherein the pressure sensor/transducer means includes a flexible diaphragm and a pressure transducer in physical contact with the diaphragm for generating electrical signals in response to movement of the diaphragm caused by pressure differences in the intraocular fluid.
3. The device of claim 1, wherein the apparatus includes a chamber, an elongated needle portion with the opening therein projecting from the chamber, the pressure sensor/transducer means mounted in the chamber opposite to the opening in the elongated needle portion.
4. The device of claim 1, wherein the pressure sensor/transducer means includes a cantilevered piezo-resistive element and a pressure sensitive means in contact with each other.
5. The device of claim 1, wherein the fluid transfer means includes means for circulating fluid through the ocular globe at a predetermined rate and means for increasing or decreasing the flow rate for increasing or decreasing intraocular fluid pressure in response to changes in intraocular pressure.
6. The device in claim 1, wherein the fluid transfer means includes means for maintaining a predetermined static fluid pressure in the ocular globe, and means for supplying or removing intraocular pressure.
7. The device of claim 6, wherein the fluid transfer means further includes a conduit loop and a pump for continuously circulating fluid in the conduit loop, the conduit means connecting the conduit loop with the opening in the instrument, means for receiving the signals and changing the speed of the pump in response to predetermined changes in intraocular pressure.
1. Field of Invention
The present invention relates to ophthalmic microsurgical instruments and, more particularly, to such surgical instrumentation which continuously monitors and controls internal ocular globe fluid pressure during ophthalmic surgical procedures and the like.
2. General Background
A large number of microsurgical procedures inside the eye are performed through "closed systems" which maintain the integrity and internal pressure of the ocular globe while microsurgical instruments are used to penetrate the eye through one or more small incisions (see FIG. 1). Exemplary functions performed by these instruments are:
Fragmentation--the cutting and separation of ocular tissue, such as the lens in cataract surgery or fibrous and membrane-like growths inside the vitreous (e.g., vitrectomy, membranectomy);
Emulsification--the mechanical digestion of tissue (usually the lens) by means of ultrasound in order to facilitate its removal through small incisions;
Irrigation (infusion)--the introduction of a saline solution into the operating field by means of gravity or positive pressure; and
Aspiration (suction)--the removal of fluid and/or entrained tissue fragments by means of vacuum.
The surgeon combines irrigation and aspiration to transport tissue fragments away from the operating field. He or she also uses these functions to maintain intraocular pressure during the surgical procedure. Control of pressure in irrigation and aspiration is extremely important. If the aspiration suction is too strong (due to excessive vacuum) it may damage endothelial cells during anterior chamber surgery or may cause retinal detachment in vitrectomy procedures. Too high an irrigation pressure or excessive variations in the pressure or flow rate of the irrigation fluid may traumatize ocular tissue.
With traditional instrumentation the level of irrigation flow and range of aspiration vacuum are adjusted by a surgical assistant in response to the surgeon's instruction. Available systems afford the surgeon direct control of these variables, usually by means of fingertip or footpedal switches, and provide visual or audio indications of aspiration pressure (vacuum) and irrigation flow. See, for example, U.S. Pat. No. 4,168,707 entitled "Control Apparatus for Microsurgical Instruments."
Generally, such pressure sensors are located in a remote instrument console located a distance of 1-2 meters from the operating site and connected to it through thin, flexible plastic tubing containing a saline solution. Such remote monitoring of pressure has the potential of introducing significant errors in pressure measurements due to the compliance of the tubing and the inertia and viscosity of the fluid column interposed between the surgical site and pressure sensor location. Such errors become more pronounced when air bubbles and tissue fragments enter the flexible conduit which transmits fluid between the operative site and instrument console.
Since a surgeon must depend primarily on visual observation and feel of the surgical site to guide him in controlling the level of suction and irrigation flow rate, knowledge of the accurate pressure or vacuum forces exerted on the tissue at the operating site would enhance greatly the ease and safety of the procedure. Furthermore, accurate control of intraocular pressure both during intraocular surgery and at the time of final wound closure would help minimize postoperative overpressure and associated dangers to the patient.
While there are many devices which are associated with ophthalmic surgical procedures, none is known which accurately monitors internal ocular pressure during surgery. For example, Russian patent 733,670 teaches the use of a strain gauge in the cutting tip of an ophthalmic surgical instrument and a variable audible signal is generated in response to tissue pressure encountered by the instrument when cutting, but internal pressure is not measured.
U.S. Pat. No. 3,945,375 is directed to an ophthalmic surgical instrument for removing tissue and includes a rotating fluted cutter housed in a probe adapted to be inserted into a portion of the body from which tissue is to be removed. The instrument can supply irrigation fluid through the probe to the area being operated upon and evacuate the material through the probe after being engaged by the cutter, but does not monitor internal pressure.
U.S. Pat. No. 4,117,843 teaches a system which controls the infusion of fluid to a closed operating field such as an eye at a selected predetermined pressure in addition to being able to sever material in the field and for evacuating the severed material in a suspension or emulsion of the infusion fluid. However, internal pressure is not measured.
U.S. Pat. No. 4,168,707 relates to an electronic control for microsurgical instruments which is adapted for use in intraocular surgery. Commands received from a surgeon's foot control unit control the various aspiration functions normally performed manually by a surgical assistant. A typical control system used to perform the infusion and aspiration functions required during intraocular survey is described in detail.
There are also various patents which deal with strain gauges that are used to measure blood pressure. See, for example, U.S. Pat. Nos. 2,959,056; 3,550,583; 3,946,724; and 4,274,423. Blood pressure transducers implantable in arteries or veins are described in U.S. Pat. Nos. 3,724,274 and 3,748,623. U.S. Pat. No. 4,274,423 teaches a catheter for use in determining pressures within blood vessels and the heart. And U.S. Pat. No. 4,175,566 is directed to a fluid velocity flow probe.
U.S. Pat. No. 3,776,238 relates to an instrument with two tubes that are mounted co-axially within one another with an opening adjacent the end of the outer tube. Cutting of the vitreous and fibrous bands in the eye caused by hemorrhaging is performed by a chopping action of the sharp end of the inner tube against the inner surface of the end of the outer tube and the bands are removed by suction through the inner tube. The removed vitreous is continuously replaced by a saline solution introduced into the eye through the instrument.
None of these prior art devices provides an ophthalmic microsurgical instrument which can safely and accurately monitor or control internal fluid pressure during ophthalmic surgery.
The subject invention is directed to a device and system for measuring and controlling fluid pressure within the ocular globe during opthalmic surgery.
The apparatus of the present invention senses the intraocular pressure exerted on the tip of the microsurgical instrument or local suction forces on tissue removed through aspiration. An electric signal generated in response to relative pressure changes can be used to regulate automatically aspiration vacuum level or irrigation flow rate within acceptable ranges for providing an extra measure of safety to those surgical procedures.
The instrument includes a needle-like instrument with a pressure transducer mounted so that, when the instrument penetrates the ocular globe, the transducer lies either immediately outside the globe or inside the globe, where it can communicate directly with the fluid therein. The transducer is capable of measuring either the pressure of ocular fluid surrounding the instrument relative to ambient atmospheric pressure or local suction forces in the instrument opening exerted on diseased tissue as the tissue is aspirated.
The ocular instrument utilizes a miniature pressure sensor located adjacent to a thin, flexible diaphragm. The diaphragm can be constructed from natural rubber or other suitable elastomer and serves as a barrier between the fluid, the pressure of which is to be measured, and some appropriate reference environment. The diaphragm is connected to the transducer and operates to transmit forces to the transducer as a result of pressure differences between these two environments causing the diaphragm to move.
The transducer is a suitable, miniaturized pressure transducer with appropriate sensitivity and stability. An electric signal is generated by the transducer, which is transmitted to an instrument console where it is amplified and displayed. The signal can be used to activate known feedback control circuits to operate a valve for regulating or limiting suction vacuum or irrigation fluid flow through the same or another instrument.
One system in which the instrument can be used includes a closed loop through which a pump continuously circulates a saline solution compatible with intraocular fluid. When the transducer detects pressure fluctuations in the eye outside a predetermined range, the signals generated by the transducer, which are received by a microprocessor controller, cause the pump to speed up or slow down for changing the fluid pressure in the closed loop and causing fluid to be supplied to or removed from the eye through a conduit that is connected to the closed loop.
Accordingly, it is an object of this invention to provide an ophthalmic surgical instrument which accurately and safely measures the pressure exerted by ocular fluids or tissues at the site of microsurgical activity.
Another object of the invention is to provide an accurate pressure valve signal to feedback control circuits which automatically regulate and/or limit suction vacuum or regulate the flow and pressure of the irrigation fluid responsive to sensed intraocular pressure.
The instrument which is the subject of the present invention provides a number of controls during anterior chamber or cataract surgery such as, for example: (1) control of anterior chamber depth (space between cornea and iris); (2) better regulation of bleeding by precise pressure tamponade; (3) accurate measurement of intraocular pressure through a second site during wound closure; (4) better control of suture tension during wound closure to avoid astigmatism; and (5) better approximation of physiologic intraocular pressure after wound closure.
Controls afforded by the invention during vitreous surgery include: (1) measurement and control of aspiration forces applied to diseased tissue at the instant of excision and limitation of these forces to avoid retinal detachment; (2) regulation of vitreous pressure from a second site in order to control bleeding during surgery; and (3) better approximation of physiologic intraocular pressure after wound closure.
For a better understanding of the nature and objects of the present invention, reference should be had to the following detailed description, taken in conjunction with the accompanying drawings, in which:
FIG. 1 is a schematic section view illustrating a "closed system" surgical procedure in the eye;
FIG. 2 is a sectional view of the tip of a microsurgical instrument for performing vitreous surgery which is known in the prior art;
FIG. 3 is a sectional view of one embodiment of the invention where a pressure transducer is mounted to provide communication between the interior of the ocular globe and an internal conduit of an instrument of the type shown in FIG. 2;
FIG. 4 is another embodiment of the invention in which the transducer communicates directly with the interior of the ocular globe;
FIG. 5 is a sectional view looking along lines 5--5 of FIG. 3;
FIG. 6 is a sectional view looking along lines 6--6 of FIG. 4;
FIG. 7 is a sectional view of another instrument similar to those of FIGS. 3-6, in which the transducer is located outside the eye but adjacent to an opening that communicates with interior of the eye when the instrument penetrates it; and
FIG. 8 is a schematic view of an embodiment of the control system which includes the instrument shown in FIG. 9.
FIG. 1 illustrates an ocular globe or eye 12 which includes a lens 13, cornea 14, anterior chamber 15, iris 16, ciliary body 17, vitreous body 18, optic nerve 20, retina 21, sclera 22 and choroid 23. An instrument 25, the tip of which is shown in greater detail in FIG. 2, is a surgical needle 0.4 to 1.0 mm in outside diameter formed of stainless steel which is attached to a handpiece (not shown) for manipulation by the surgeon. The handpiece can be connected through flexible plastic tubing (not shown) to both a saline solution reservoir for irrigation (not shown) and a pumping system for aspiration (not shown). The details of elements not shown are known to those with ordinary skill in the art and need not be described in detail in order to practice the invention.
The instrument 25 is a known irrigation/aspiration/cutting tip and is shown in FIG. 1 as being inserted in the vitreous 18. Suction is used to aspirate diseased tissue 30 into a side opening 31 of the instrument 25. As shown best in FIG. 2, the tissue is cut by a curved microguillotine blade 32 which is actuated by the surgeon and slidable in the instrument 25. A saline solution or the like is discharged through outlets 33, 34, and infuses the operation site. The infusion, in combination with controlled suction through the opening 31, helps to draw the tissue fragments 30 into the instrument 25 for removal after they are cut by the blade 32. Arrows 36 in FIG. 2 illustrate both the discharge of saline solution and suction action mentioned above.
The conventional instrument shown in FIGS. 1 and 2, however, has no provisions for accurately measuring the local suction force used to draw the diseased tissue 30 into the instrument 25 prior to cutting. Since the tissue removed by the vitrectomy procedures is usually located in the immediate vicinity of the retina 21, the danger of inadvertent damage to the retina 21 or other healthy tissue by excessive suction force during vitrectomy is considerable.
The embodiment of the invention illustrated in FIGS. 3 and 5 solves this problem by enabling the suction force to be monitored constantly. An instrument similar to the one in FIGS. 1 and 2 has been modified to measure pressure differences between the external and internal forces of its cutting/aspiration tip. The modified instrument is referred to generally by reference numeral 60 and includes an outer elongated housing 61 which surrounds an inner concentric guillotine 70 which carries a cutting blade 62 that cooperates with an opening 66 for surgically removing tissue fragments as described above. An inner bore or channel 63 operates to convey fluids and/or tissue. Only the tip of such an instrument is shown in FIG. 3 and additional features such as the discharge outlets 33, 34, shown in FIG. 2 were omitted to simplify the description.
A pressure transducer 65 is mounted in a chamber 65a located near aspiration inlet 66, the chamber 65a being bounded by two parallel diaphragms 67, 68, formed of silicon rubber inserts that are about 1 mm in diameter. The diaphragms 67, 68, are connected to the instrument 60 by means of an epoxy resin. The transducer 65 is preferably mounted at the outer end 61(a) of the tip of the housing 61.
Pressure transducer 65 is a piezo-electric or photo-electric device known to the art which is capable of measuring intraocular pressure with the required sensitivity (�1 mm. Hg), stability and linearity. Other types of transducers, such as sensors operating in conjunction with fiber-optic light guides which transmit signals in the form of variations in light intensity caused by pressure differences moving a reflective surface, can also be used in conjunction with the invention without substantially altering the size, shape or function of the instrument. An electrical signal generated by the transducer 65 is carried through wire leads 71 to a monitor/console which is known in the art and contains a suitable power supply as well as the necessary electrical circuits for conditioning, amplifying and displaying the pressure measurement.
The piezoelectric elements 65(b) are attached to a cantilever beam and a rigid base 65c, which is anchored to the wall of the instrument. Wire leads 71, which carry electrical signals from the transducer 65, are connected to the exterior surface of the instrument 60 so as to avoid interference with the action of the guillotine cutter 70. The leads 71 are bonded to the instrument 60 so that they are part of its smooth outer surface.
The vitrectomy suction instrument 60 significantly enhances safety through sensitivity to suction force and consequently intraocular pressure during surgery. As the surgeon aspirates strands of diseased tissue into the opening 66, the local pressure difference measured between diaphragms 67, 68, by the transducer 65 results in a relative pressure reading that reflects the forces exerted on the tissue strands as they enter the aspiration inlet 66. These forces fluctuate continuously because of differences in the viscoelastic properties of the manipulated tissue and the viscosity of the surrounding vitreous. The force level at any given time can fall in a range that departs considerably from the average force and the pressure in the vacuum line can be adjusted to accommodate these fluctuating force levels.
By using the transducer 65, a signal can be generated to activate momentarily a vacuum relief valve in a known way (not shown) when the local pressure exceeds preset levels to adjust the suction when the force level falls outside the permissible range. Thus, the instrument 60 operates to reduce considerably the danger of damage to healthy tissue by preventing excessive instantaneous peaks in local suction forces.
Referring to FIGS. 4 and 6, another embodiment of the invention is illustrated, this one being directed to a surgical instrument which can measure intraocular pressure while performing an irrigation or aspiration procedure. The instrument is generally designated by reference numeral 40 and is an elongated body 41 formed of surgical grade stainless steel with an outside diameter of approximately 1 mm. The body 41 is divided through substantially its entire length into two parallel channels 42, 43, that are separated by an internal wall 49. Channel 43 is an irrigation/aspiration channel which is connected through a handpiece (not shown) to either a vacuum system (not shown) or a saline supply reservoir. The channel 43 has an outlet 44 located near the apex 45 of the tip of the instrument 40.
A transducer 50 is mounted in the portion of the channel 42 adjacent to the tip of the instrument 40, the channel 42 being vented to the atmosphere at a suitable site away from the operating field. The transducer 50 is of the type described above for the embodiment of FIGS. 3 and 5 and is connected to the instrument 40 through a base 55a. At the tip of the instrument 40, the transducer channel 42 terminates at a window 46 which is located adjacent to the outlet 44. The window 46 is approximately 1 mm in diameter and is fitted with a diaphragm 47 formed of silicon rubber. The diaphragm 47 is connected to the window 46 by means of epoxy resin. Wire leads designated by reference numeral 52 carry electrical signals generated by the transducer 50 to suitable instrumentation (such as that described below) for translating the signals into useful information for monitoring and regulating intraocular pressure.
The intraocular pressure probe 40 is suitable for the measurement and control of intraocular pressure during closed system procedures in the anterior chamber 15 as well as in the vitreous chamber 18. The instrument 40 can be inserted at a site separate from the operating incision and remain in place throughout the entire procedure, providing to the surgeon an independent source of determining and/or controlling intraocular pressure for providing information used in tamponade, suture tension controls and final approximation of physiologic pressure at the end of wound closure.
One disadvantage of placing the transducer in the portion of the probe that penetrates the eye, as done in instruments 40 and 60 (see FIGS. 4 and 3, respectively), is that this configuration requires the probe to have a larger diameter than would otherwise be necessary. This problem can be eliminated without significantly affecting the accuracy or speed of the device by relocating both the pressure sensitive diaphragm and the transducer outside the eye but in a position where a significant signal can be generated in response to changes in intraocular pressure.
FIG. 7 illustrates one such alternative embodiment of the invention. The instrument, generally designated by reference numeral 95, includes an elongated needle section 96 with an opening 97, which can be inserted into the ocular globe. The opposite end of the needle section 96 opens into a chamber 98 that is designed to remain outside the ocular globe. A transducer 99 is mounted in the chamber 98 opposite the opening 97. Although the transducer 99 is not located inside the ocular globe, its position adjacent to the opening into the globe supplies a pressure reading nearly as accurate as one obtained through internal placement.
The transducer 99 can be of the type described above for the embodiments illustrated in FIGS. 3-6, or a fused silicon type such as Entran Model No. EPIL-F080-55 manufactured by Entran Devices, Inc., Fairfield, N.J., which is separated from the chamber 98 by a diaphragm 100 formed of paralyne or the like. Wire leads 102 carry electrical signals generated by the transducer 99 to external instrumentation that is described in detail below. The chamber 98 is equipped with an input opening 103 that can be connected to a flexible plastic tubing 104 for supplying fluid in appropriate amounts to the ocular globe.
The instruments shown in FIGS. 3-5 and 7 can be incorporated into any number of systems for controlling pressure within the ocular globe 12. For example, the signal generated by the transducer can be used to control the suction level through the same probe on which the transducer is located (FIGS. 1 and 2) or a second probe when the surgical procedure requires fluid to be circulated through the eye. For other surgical procedures, pressure in the eye can be maintained within a predetermined range through a single probe.
The instruments described above can be used in a system of the type shown in FIG. 8 where a pressure level within a predetermined range is maintained and controlled more accurately than in any other known system. This is accomplished through the use of a closed loop through which saline solution is continuously circulated. The loop is connected to the eye so that reaction to a change in pressure detected by the transducer, which speeds up or slows down the circulation, causing fluid to be supplied to or withdrawn from the eye, is virtually instantaneous.
Referring to FIG. 8, an instrument I of the type shown in FIGS. 3-6 or 7 penetrates the ocular globe 12 and is connected to a fluid conduit 104. A flow loop 110 is connected to the conduit 104 through a flow splitter connection 109. When the system is operating, a peristaltic pump 107 continuously circulates saline solution through the loop 110 in the direction of arrows 111. A reservoir of solution 108 is connected to the loop 110 for supplying addition solution when needed. A pressure relief value 112 can be provided at the splitter connection 109, but it is not considered necessary for successful operation of the circuit.
If the instrument 100 detects a pressure change in the ocular globe 12, a signal is transmitted through a line 102 to a monitor/console 105 of a type known in the art, which contains a suitable power supply as well as the necessary electrical circuits for conditioning, amplifying and displaying the pressure measurements. The signal is in turn transmitted to a microprocessor controller 106 of a type known in the art, which is operatively connected to the pump 107.
The microprocessor controller is programmed to allow the pump 107 to circulate fluid through the loop 110 at a predetermined flow rate when signals received from the transducer indicate that the pressure of intraocular fluid is within a preset range. This flow rate will operate to maintain a predetermined pressure level within the ocular globe. However, if a pressure drop is detected by the instrument I, the resulting signal to the microprocessor controller operates to speed up the pump a predetermined amount for infusing additional saline solution into the eye.
Conversely, if a pressure increase is detected, the pump speed is reduced. The use of a flow splitter in relatively close proximity to the instrument 100 (for example, by resting it on the forehead of the patient) and the continuously circulating saline solution in the loop 110 provide for a much more rapid response to pressure changes in the eye than if a long fluid column were used or if a pump had to be activated in response to each pressure change.
Another embodiment of the invention is shown in FIGS. 9 and 10, where a compliance chamber 120 is connected to the fluid conduit 104, either downstream from the splitter connection 109 (FIG. (9) or at the splitter connection 109 (FIG. 10). The compliance chamber 120 operates to accommodate sudden changes in pressure in the ocular globe 12 caused by surgical manipulations such as pressing on the globe, pulling on the ocular muscles or tightening of stitches where pressure is raised or starting or enlarging an incision where pressure is lowered. Such pressure fluctuations tend to be very rapid, on the order of 10-2 -10-1 per second. The normal response time of the system shown in FIG. 8 is not fast enough to react to many such pressure fluctuations because of inertial and frictional forces in the equipment and associated flow lines.
In order to provide a quicker response time to these sudden fluctuations, the compliance chamber 120 is included in the flow line leading to the eye, in close proximity to eye. Preferably, the compliance chamber 120 is located from 6-10 cm. from the tip of needle section 96a.
The compliance chamber 120 is formed as a small, spherical chamber that is 4-8 cm. in diameter with highly elastic walls. The compliance chamber 120 can be completely filled with the fluid F flowing through the flow lines 102, 104 (FIG. 10). However, the reaction time to intraocular pressure changes can be increased by initially filling the chamber 120 with air or other gas G, as shown in FIG. 9, for more rapidly accommodating pressure changes because of the greater compressibility of the gas G.
As shown in FIG. 9, the compliance chamber 120 can be formed as part of or connected to the conduit 104, downstream from the splitter connection 109. In such case, the conduit 104 can be formed separately from the conduit 102, with individual needle sections 96, 96a, respectively, connected to the flow line 104 and instrument I as described above. Alternatively, as shown in FIG. 10, the compliance chamber 120 can be connected to the loop 110 at the flow splitter connection 109.
The inventions embodied in the instruments and systems described above are useful in constantly monitoring and controlling both intraocular fluid pressure and suction forces during ophthalmic surgery. By allowing the surgeon the benefit of this type of equipment much of the guesswork of maintaining optimum intraocular pressure during surgery is removed, resulting in safer and more accurate surgical procedures. Moreover, the control systems can automatically regulate intraocular pressure according to a predetermined set of commands more rapidly and accurately than possible before.
Although different embodiments of the invention may vary in detail they are still intended to be within the scope of the inventive concept described above. The details described in the foregoing preferred embodiments are intended to be illustrative and not limiting in any sense.
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Swiss banks enter US tax-evasion programme
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The Boston Bruins have had some recent issues with Marchand but they still don't plan to trade the struggling forward. The Bruins depend on Marchand and this isn't the first time they have had to announce the fact that they were not trading him.
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Articles for January 2012
Our articles for January 2012 are shown below.
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Cambridge partners with Lilly in Open Innovation Drug Discovery Platform
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Why is Gran Torino rated R?
Official MPAA Rating: Gran Torino is rated R for for language throughout, and some violence.
The film's script contains a continuous stream of strong sexual expletives (some used in a sexual context) and derogatory racial slurs along with profanities, scatological slang, crude sexual language and terms of Christian Deity. Various gangs threaten individuals. A young man is burned on the face with a cigarette. A female character is raped and beaten (though the crime takes place off screen, her bruised and bloody body is seen). Other characters are pummeled, shot at and threatened (some blood is depicted). One man is shot repeatedly in the chest. A page from a pornographic magazine is briefly shown (no nudity and limited details are seen). Some scenes of crude sexual innuendo are portrayed along with frequent depictions of drinking, smoking and other tobacco use (including a teen smoking). The horrors of war are also briefly discussed.


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Outdoor kitchen counter structural design questions
1 Attachment(s)
Im planning a counter area adjacent to my pizza oven. If you can picture a rectangular area, with the pizza oven entrance on the back side, the counter is to the left and 128 long and 36 deep. Ive built a 3-sided concrete block structure (back + 2 sides) using 4 layers of 8x8x16 block on a concrete pad. The fifth layer is 4x8x16 blocks which are flush to the exterior, exposing 4 of the top surface of the fourth layer. I plan to use that extra four inches to extend the counter space. I also plan a 4 over hang in front, so the overall counter space is 120 x 36. Ill probably tile for the top and stucco or rock on the front.
You can see the pad layout in the Picture 1.
Im new to steel framing but it seems the best choice to build the walls of the structure. I plan to put synthetic decking on the floor and screw the steel framing through the deck boards and into the concrete. The deck boards will look nice and keep the steel framing out of any (unlikely) water that would collect in it. It should look nice too.
One of my questions is about the orientation of the steel studs. After much thinking, it seems easiest to secure a 36 steel track (32 of block + 4 overhang) horizontally on the left and right sides flush with the top of the fourth course with the open sides facing each other, which would all me to put (128-8) 120 studs horizontally in the track. Ill have to cut the studs and cross-frame the area for the sink.
On top of this horizontal wall Ill add 1/2 pressure treated plywood + thinset + 1/4 hardibacker + thinset + tile (and grout).
Underneath, I will build the steel walls whose heights are flush with the framing from the top. Im not sure I need a wall on the back side (or left or right sides) if I secure the horizontal stud into the concrete block with Tapcons (screwed into concrete block). The front wall will be flush with the block minus 1/4 for the hardibacker.
As far as access to the area under the counter, Id love to use stainless access doors but its too expensive - $425+ for a 48x19 double door and Id want two. That leaves crafting some weatherproof doors. What wood and natural-looking finishes can I use that stands up to the heat and humidity of the South? The doors will face North so theyll never see sunlight thats a plus and a minus. I also need to figure out how to mount hinges with steel studs? Do I need to add some wood somewhere?
Questions I'd especially like help with:
1. Is it reasonable to build the counter support as a horizontal wall secured to the concrete block?
2. Do I need to build a stud wall on the back wall to support the countertop framing (the horizontal wall) or are the tapcons sufficient?
3. How do I mount door hinges into steel studs? How does that change if I put stucco or rock on the surface?
Re: Outdoor kitchen counter structural design questions
2 Attachment(s)
Time for a progress report. It's still raining and cold so I'm inside instead of outside.
I've resolved that the cylinder block walls will provide support for 3 of the 4 sides. I'll need to make sure the front wall is substantial as it will carry the load on the fourth side.
Points 1 and 2 are moot now. I've already started the framing as I described. I did add a double horizontal studs in the front (111" long). So there's a track in the back mounted against the block and another in the front - backed against the horizontal stud. (that's on the left side of the first picture.) Next I'll put in short (28") studs connecting the front track to the back.
The overall width is 128" which includes 4" on each side small for the 1/2 width (4") block walls ends. The Countertop is 120" wide and the front storage opening is 111"
I'll build the front wall eventually. I'll used the concrete block as the support for now.
I'm planning three cabinet areas. Each will have double doors - material to be decided. Has anyone tried using decking board (Trex or cheaper equivalent) to make doors?
If the double doors are each 32" wide (16x2) that leaves about 6" between areas/cabinet doors.
At this point I don't know what will be stored under the counter other than some dishes, outdoor supplies and cast iron for cooking in the pizza oven. In any case I want it to be dry.
I have a double basin kitchen sink from remodeling the kitchen, but at 33" wide that would take up too much counter space.
For the counter, I figure 24" open space to left of the sink + sink (18-24") + open counter space (72") for making pizzas and placing the cooked ones. That adds up to 114-120"
Re: Outdoor kitchen counter structural design questions
Steel framing questions are a little out of my league:confused:
However, I have seen inserts over sinks when they were not in use to maximize space. Some were were desinged to match the counter top while others were were cutting boards. The trick to this is mounting the sink underneath the counter top.
A sink of this size would be better covered with a split insert. Maybe one side an insert to match the counter and the other side a cutting board.
Just throwing that out there if you want to salvage the sink that you have:)
Re: Outdoor kitchen counter structural design questions
Thanks for the input. I can see how that can work. The new kitchen is an undermount, unfortunately the old one that I'm trying to recycle is not.
Thinking about it for a few minutes now, the other problem is that the counter top will consist of plywood, hardibacker and tile (unless I win the lottery).
So those layers would be visible at the edge of the sink cutout.
Re: Outdoor kitchen counter structural design questions
I'm still working on the WFO, but I am thinking about the rest of the outdoor kitchen. I am planning on doing a concrete counter (landing) for the oven and hope to gain some experience to be used on the kitchen countertops.
Will be watching your build, trying to get ideas from everyone.
Re: Outdoor kitchen counter structural design questions
I hope it works out.
Just for future reference, those steel studs are not designed to work in bending (as in a beam - your application). They are designed to be used only in compression, as in a wall.
A better material for your application would be angle iron. Check your shed or local land fill for an old bed frame.
Another option for your application is to cast a 1 1/2 inch or 2 inch reinforced concrete counter top. This will easily span your opening without any beam or support on the leading edge. This can then be either tiled or ground/polished.
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Perfect for Thanksgiving, these warm hors d'oeuvres can be assembled a day ahead and chilled, then baked before serving.
Leave a Review
I've made this a few times and although I thought they were good, I also found something lacking in the consistency of the stuffing. It was too much like oozing cream cheese with chunks of sausage in it. So, I decided to make the following changes: 1) Once the sausage was cooked, I minced it on a cutting board. 2) I decreased the amount of cream cheese by 1/4. 3) I increased the parmesan (I actually used italian blend shredded cheese) by 1/4. 4) I added 1/3 cup (or so) of bread crumbs. Overall, I thought it was much better and so did my test audience. I had read that some people thought the taste was one dimensional and these changes helped.flag if inappropriate
I have made this dish for several work functions as well as family get togethers. Everyone raves about how spicy and creamy it is. I'm consistantly asked to bring in more each time there is something going on!flag if inappropriate
Made these for a Christmas Party. Everyone loved them and wanted the recipe. I deviated from the reipe by adding some red pepper flakes (1/2 tsp) for a little zip.flag if inappropriate
Personally I thought it was a little heavy on the creamy cheesy-ness. Use hot italian sausage and fresh chopped or minced garlic for some pop.flag if inappropriate
We made these last Thanksgiving and they disappeared in minutes. We used chicken sausage and followed everthing else by the book. Deeeeelish. We'll have to double the recipe for Thanksgiving this year.flag if inappropriate
super easy and requested at every holiday function.stffing freezes as wellflag if inappropriate
This is a crowd pleaser, I get so many comments...see my more extensive comments on my cooking blog, at http://tbculinarysciences.blogspot.com/2009/05/sausage-stuffed-fungi.html!flag if inappropriate
After reading some of the reviews, I felt I had to chime in. I have been making these since finding the recipe a few years back on this site. These are fantastic - if you follow the recipe. Do not attempt to "lighten" or substitute - they will not be the same. As for those who have commented that the recipe is missing something...it must be the type of sausage you're using. You need to use traditional hot Italian sausage - pork - not turkey or chicken. I live in WNY and our area produces outstanding Italian sausage. Perhaps that's the problem with some of the reviewers? Hope this helps.flag if inappropriate
Thought this good, and great for a cocktail app because they're easy to eat and serve. Next time I would probably cut down on the cream cheese, which I though detracted from the sausage and mushroom flavors without adding anything great.flag if inappropriate
Very good but very very heavy. I would add creme fraiche next time to lighten the dish up.flag if inappropriate


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Press release from CNW Group
Mandalay Resources Corporation Ships First Commercial Silver-Gold Concentrate from its Cerro Bayo Mine, Chile
Monday, February 14, 2011
Mandalay Resources Corporation Ships First Commercial Silver-Gold Concentrate from its Cerro Bayo Mine, Chile07:30 EST Monday, February 14, 2011TORONTO, Feb. 14 /CNW/ - Mandalay Resources Corporation ("Mandalay" or the "Company") (TSX: MND, MND.WT) is pleased to announce that it has commenced commercial production at its wholly owned Cerro Bayo silver-gold mine in Patagonia, Chile, on February 11, 2011, with the shipment of its first concentrate. The commencement of commercial production is an important milestone for the Company, which acquired the mine on care and maintenance from Coeur d'Alene Mines on August 10, 2010; began underground mining on September 16, 2010; and began processing ore through the restarted mill on January 10, 2011. The first concentrate shipment, to a smelter in Japan, consists of 327 tonnes of concentrate containing approximately 215 ounces of payable gold and 68,000 ounces of payable silver. The Company is ramping up production at Cerro Bayo to a planned steady state of production by the 4th quarter of 2011 of 1,500 to 2,000 ounces of payable gold and 250,000 to 300,000 ounces of payable silver per month.Qualified Person: Mark Sander, Chief Operating Officer of Mandalay Resources and a member of the Australasian Institute of Mining and Metallurgy, is a Qualified Person as defined by NI 43-101 and has reviewed and approved the technical and scientific information pertaining to the Cerro Bayo mine contained in this release.About Mandalay Resources Corporation: Mandalay Resources is a Canadian-based natural resource company with producing assets in Australia and exploration projects in Chile. The Company is focused on executing a roll-up strategy, creating critical mass by aggregating advanced or in-production gold, copper, silver and antimony projects in Australia and the Americas to generate near-term cash flow and shareholder value.Forward-Looking Statements: This news release contains "forward-looking statements" within the meaning of applicable securities laws. Readers are cautioned not to place undue reliance on forward-looking statements. Actual results and developments may differ materially from those contemplated by these statements depending on, among other things, changes in commodity prices and general market and economic conditions. The factors identified above are not intended to represent a complete list of the factors that could affect Mandalay. In addition, there can be no assurance that any inferred resources that are discovered as a result of additional drilling will ever be upgraded to proven or probable reserves. Although Mandalay has attempted to identify important factors that could cause actual actions, events or results to differ materially from those described in forward-looking statements, there may be other factors that cause actions, events or results not to be as anticipated, estimated or intended. There can be no assurance that forward-looking statements will prove to be accurate, as actual results and future events could differ materially from those anticipated in such statements. Accordingly, readers should not place undue reliance on forward-looking statements.For further information: For Further Information: Bradford Mills Chief Executive OfficerGreg DiTomaso Investor Relations Contact: 647.260.1566 Email: email@example.com Company website: www.mandalayresources.com


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3 bed, 2.00 full bath. Great single family home! Features an open floor plan with vaulted ceilings, eat in kitchen, & staiMore info


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Originally written on NFL Trade Rumors | Last updated 12/26/12
MINNEAPOLIS - 2009: Leslie Frazier of the Minnesota Vikings poses for his 2009 NFL headshot at photo day in Minneapolis, Minnesota. (Photo by NFL Photos)
Jeff Zulgad of ESPN 1500 Twin Cities writes that it's likely "only a matter of time" before the Minnesota Vikings offer head coach Leslie Frazier a contract extension. Zulgad adds that while it's almost certain that Frazier will have an offer to consider, a deal probably won't be finalized until after the season. Frazier's first full season with the Vikings was pretty disappointing in terms of their overall record (3-13), but he was starting a rookie quarterback and there were some holes on their roster that needed to be addressed. Clearly, this year's Vikings team is much improved and has added some solid young talent to their roster. Minnesota's success is ultimately tied to Christian Ponder, but they're currently a single game away from making the playoffs. A win in Week 17 would be very big for Frazier and a Vikings team that was picked to finish last in the NFC North by almost everyone. The post Vikings Prepared To Offer Leslie Frazier A Contract Extension? appeared first on NFL Trade Rumors.
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MobiCritique: @FloridaDBPR Hi, the "License Type" drop-down-menu does not work on iphone (see pic, there are no choices). TY. http://twitpic.com/2o5787
From the "Profile" drop-down list you can find one format that meets your requirement. The former is the input format and the latter is the output format. 5a1f8dd0ecformat.jpg Fantastic news: You can download any video from now on!
In the Network name textbox, input iPhone as the name of the network. 8. Select a security type from the dropdown. (If you select WEP, you will need to enter a security key in the unghosted textbox) 9. If you want to use this network more than ... 2)Lets now configure the iPhone. 1. Press the main Application button. 2. Select Settings, then select Wi-Fi from the menu, let your iPhone scan for a network and the network iPhone will pop-up. 3. Connect to the network iPhone
OtterBox Commuter iPhone Case. /images/apl5-iph3g-20-c5otr.4.jpg ... Defender Series Case and trims it down to a lightweight slender case. The OtterBox Commuter? Series for iPhone . ... I went caseless when I first got my iPhone 4, which worked fine until one day, when I dropped the phone onto the asphalt while getting out of my car. Suffice it to say, the iPhone's glass CAN shatter if you drop it in just the right (wrong) way, and I now understand the value of having a
iPod Touch 4($229 for 8GB; $299 for 32GB; $399 for 64GB), 40 hours of music, a Retina display (the same kind as the iPhone 4) is included. The distinctive new feature of iPod Touch 4 is two cameras: one on the front for use with FaceTime( a feature .... Open Profile drop-down list and choose MP3 as the output format. Then set output path below it. Step 4. Click Convert button to start the FLAC to MP3 conversion. Home Stereo and Portable/Handheld Devices Supporting FLAC
Click Add File button to add AVCHD files(batch conversion supported), click Profile drop-down list to set output format, and save files by clicking Browse... button. Step 3.(Optional)personalize AVCHD files .... There have also been rumors that the price of the iPhone 4G will be lower than previous models - this could be bad news for the iPad. You do have the choice to save money and go for the non-3G option -the lack of tethering support with the iPhone could deter
Click Profile drop-down list to set output format and select output folder for WMV video. Step 4. Customize WMV video. Customize your WMV video by clicking Trim, Crop, Effect. Step 5. Convert Click Convert button to finish the WMV to .... There have also been rumors that the price of the iPhone 4G will be lower than previous models - this could be bad news for the iPad. You do have the choice to save money and go for the non-3G option -the lack of tethering support with
That's to say, with Mac MPEG to iPad Converter, you can not only convert MPG to iPad, MPEG-1 to iPad, MPEG-2 to iPad on Mac, and import MPG/MPEG-1/MPEG-2 video to iPad, iPod, iPhone 3G/3GS/4G...but also can convert other popular video/audio ... In the drop down list of Profile, select MP4, H.264 as output format and choose an output folder to save videos. Step 4: Edit MPG/MPEG Videos (optional) Freely edit MPG/MPEG-1/MPEG-2 videos by clicking Trim(set the video duration),
Plus it feels more open as a platform, and I love the drop down menus. Is symbian really going to run as smoothly on the HD? If so, the hardware is outstanding. Plus will the HD have gaming abilities? Thanks again
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1798/97 10C 16 Stars on Reverse XF40 NGC. JR-1, R.3....
2011 September Long Beach Signature US Coin Auction #1159
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Long Beach Convention Center
100 S. Pine Avenue
Long Beach, CA 90802
XF 1798/97 Dime, 16 Star Reverse, JR-11798/97 10C 16 Stars on Reverse XF40 NGC. JR-1, R.3. The large 7 underlying the much-smaller 8 overdigit attributes the obverse, with the 16 Star reverse and eagle's claw over the last A confirming the die pairing. Glimmers of luster remain despite 20 points of wear over surfaces that show intermingled silver-gray, jade, and saffron hues. A few old scrapes appear under a loupe, although we single out a small dig just below the bust that may be of Mint origin.(Registry values: P6) (NGC ID# 236F, PCGS# 4468)
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Wolf Spiders Play Leaf-Vibrating Songs to Attract Mates
Wolf spiders are deaf—they don't have the right structures for hearing. However, they are very good at sensing other kinds of vibrations, and they use this ability to communicate. One species of wolf spider plays songs on dead leaves to attract mates.


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Career Center
ATTENTION EMPLOYERS: We will have a database system migration which will require us to hold any jobs/internships sent to us between June 15 and July 1. Any postings that we receive during that two-week time period will not be posted until after July 1.
** For an Update of Events in the Career Center, please see Career Connections or the Campus Calendar.**
The Wall Street Exchange Summer Program (WSE) is a career development program designed to augment and coincide with the summer internship work experience of select qualified rising college seniors working as summer interns in the New York metropolitan area. The program consists of a series of events hosted by top firms and companies for professional and personal development. The WSE IS NOT AN INTERNSHIP OPPORTUNITY AND DOES NOT PROVIDE INTERNSHIPS FOR STUDENTS.
Insider referrals are the fastest way to get into companies. Showcase yourself with a collegefeed profile and they will connect you directly to hiring managers and founders at 500+ great companies in their fast growing network.
Interview Stream is a virtual interviewing system that allows Muhlenberg students to digitally record an unlimited amount of practice interviews before seeking employment. The system also provides video clips on interviewing with tips from experts.
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A good floor plan starts with defining usable spaces with the help of walls, and being able to modify those walls as needed as your project evolves. In this course, Ed Cotey shows you how to design a space with interior walls, doors, and windows in Autodesk Revit. Design issues such as wall alignment, trimming and extending walls, and splitting walls to make openings and new wall types are also covered. You'll also learn to incorporate some aesthetic elements such as trim and crown molding and apply them to walls.
There may be times when the standard rectangular wall you normally have in a design just is not going to do it. You may want to create a wall that is, let's stay, stepped in appearance, or even stacked. Revit allows you to change a rectangular wall by altering its profile. Also, you can take two basic walls, and stack one on top of the other. And, you can even embed one wall into another wall. So you have some design options to play with, other than just plain old ordinary walls.
Let's take a look at how to create what is called a wall profile. I'm going to zoom in to this profile here. And it just looks like a plain ordinary wall. If you look at it though, it's actually a generic eight inch glass block wall. And we're going to click on it. And when you click on it, under Modify Walls, you'll notice that under Mode, there's what's called Edit Profile. So, when we pick Edit Profile, what we're able to do is setup actually, a change in this wall's shape.
And we're going to do that in Elevation View. And you get this dialogue box. It's asking you what elevation you want to look at. We're going to pick south, and then press Open. And, we'll kind of zoom in a litle bit closer. These magenta lines represent the actual wall. And I'm going to come up here to the draw tool and pick lines. And I'm just going to arbitrarily just kind of draw a step. Something maybe like this, and hit Modify. I'll take the Trim tool, and I kind of trim this up.
So we have something that looks like this now. And, in fact, I can even add in an opening, if I want to. I'll just come in and put something like this, in here. And we'll just kind of connect that up. Now any profile that you make has to be closed. You can not have lines that overlap or anything. And once you're done, hit Okay for finishing it. And you'll notice that it's now kind of editable with the graphic squares here that you have.
Let's take a look at it quickly in 3D. And there's your wall. So, you've got a totally different kind of wall based on that. Let's put this back into floor plan view. We're going to go to level one, and we're going to shift over here to stacked wall. Now, vertically stacked walls can be used for interior applications. They're just not for exterior use. Basically, it's just taking two walls, and stacking one on top of the other. What you need to do is pick out your materials that you want and specify any heights.
So you can do this with any number of different wall types. Now, you have to start off with one particular wall type. And that is basically the stacked wall. Now, if we click on here, and you look at it, it's a specific category of wall for Revit. It has to say Stacked Wall. So, in this case what we're going to do, since we already have a stacked wall here, we're going to go ahead and click on it, and then hit Edit Type.
Now when you hit Edit Type, the preview is kind of important because we're not looking down at it. We're looking at it as a section view. You can always change your views by coming down here in it, depending on what kind of wall you're working on. But we're currently working on this type. Now what we're going to do is, we're going to duplicate it. And we're just going to call it stacked wall, glass, and drywall. And then press Okay.
Then come over to structure, where it says value, hit Edit. Now, in this case, we have two categories. We have the top which is actually, I got a brick material that's on here. And then on the bottom, if you notice, we have a CMU bottom. So, what we need to do is change the materials. So, I'm going to come in here, and in the drop down list you'll find a set of materials that already exists. So I'm going to find generic eight inch glass block and click on that.
And then the bottom of this, I'm going to change this as well to a material that works for us here, which is generic eight inch drywall. And I want to change the height of the drywall. Right now it's only three feet. I'm going to add six inches to it, and we'll put in six inches. And we'll hit Okay, and Okay again. And this wall has now changed. If we look at it, you'll notice here that you've got two wall types.
To check that out you can come down here to the visual display and, we'll change this basically to more realistic. And you'll see that both these walls that we've done so far are now glass, and you've got drywall here. Let's go back to floor plans, level one. And in this case we're going to embed a glass wall inside this generic eight inch drywall wall. So, to do that we follow basically these steps. Okay. Number one, is you go to the Architecture tab and pick up basically the wall type that you want. So we're looking for eight inch glass blocks. So we're going to pick that.
We're going to set the top constraint to be up to level two. And we're going to make sure that the location line is on wall center line. And then, we're going to come in here, and I can pick a point, and drag it over to another point. And you're going to get this warning, that comes in. Just take the warning and click it off. And pretty much completed here as far as what our wall is. We just have to modify it a little bit. Click Modify.
And go down to the Project Browser. Find Elevations and go to Self. And let's swing over and take a look at it. And you;ll notice here that our glass wall is embedded here. I'm going to go ahead and just kind of change it's shape a little bit. And there you have it. And I'll just come in and take a look at it in 3D. And there it is. You can change a standard rectangular wall type into something that's more exciting than just a plain ordinary wall.
You can do this by changing its profile. You can modify heights, you can create openings, and make these old walls look a lot different. Stacking two walls on top of one another gives you some other design options. And, you can create other types as well with this default stacked wall, by using other kinds of materials and changing the heights. And finally, you can embed one wall into another one. And give it a totally different appearance, even though it's one wall, showing two walls inside.
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Collaborative Activism Towards the Promotion of
Health! Education, Policy, Action
Join us in improving public health education at your school and advancing the health of your community through policy action. The Community and Public Health Action Committee is dedicated to:
- Engaging premedical and medical students to educate their schools and communities about important public health issues.
- Empowering future physicians with knowledge about social determinants of health and environmental factors.
- Encouraging chapters to develop and execute local programming to promote primary care.
Get Involved
- National Primary Care Week
National Primary Care Week (NPCW) is an annual event to highlight the importance of primary care and bring health care professionals together to discuss and learn about generalist and interdisciplinary health care, particularly its impact on and importance to underserved populations.
- Food Day
The purpose of Food Day is to reduce diet-related disease by promoting healthy foods, support sustainable farms and cut subsidies to big agribusiness, expand access to food and alleviate hunger, protect the environment and animals by reforming factory farms, and promote health by curbing junk-food marketing to kids. AMSA's goals are also to education and empowerment students to address these issues in their local communities. See how you can engage your local community.
- Public Health Scholars Program
The Public Health Scholars Program teaches AMSA members how to effectively work with their local community, as well as develop, implement and evaluate a local project. The program includes an in-person training session in community engagement for social justice, as well as program planning and evaluation. Students then start a year-long community engagement project in their local area, which could include their medical school class, academic institution, local community or even an issue-based national community.
Healthy People 2020
Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks & monitored progress over time to:
- Encourage collaborations across sectors.
- Guide individuals toward making informed health decisions.
- Measure the impact of prevention activities.
New topics introduced in 2020:
- Adolescent Health
- Blood Disorders and Blood Safety
- Dementias, including Alzheimer"s Disease
- Early and Middle Childhood
- Genomics
- Global Health
- Health-Related Quality of Life and Well-Being
- Healthcare-Associated Infections
- Lesbian, Gay, Bisexual and Transgender Health
- Older Adults
- Preparedness
- Sleep Health
- Social Determinants of Health
In the News – Stay Updated
- Pediatricians Pressured To Drop Parents Who Won't Vaccinate (NPR, 2/4/2015)
- As Docs Face Big Cuts In Medicaid Pay, Patients May Pay The Price(Kaiser Health News, 12/23/2014)
- Trends in Childhood Influenza Vaccination Coverage—U.S., 2004–2012 (Public Health Records, 10/14)
- Want A Calorie Count With That? FDA Issues New Rules For Restaurants (NPR, 11/24/2014)
- Young Athletes Risk Back Injury By Playing Too Much (NPR, 02/03/14)
- Climate change magnifies dead zone woes in world waterways and it'll get worse, study says (U.S. News, 11/10/14
- High levels of toxic molds identified in herbal medicines (Medical News Today, 10/26/14)
Career Development
- Public Health Education: Electives, internships, fellowships and other experiences for medical and premedical students in the public health field
- MD/MPH Joint Degree Program Resource Guide
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- Preventive Medicine Diversity Video: Preventive Medicine physicians not only are interesting individuals with really diverse interests but also work in diverse areas such as: public health, administration, policy, start-ups and so much more.
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Harsh Medicine: As Health Care in Jails Goes Private, 10 Days Can Be a Death Sentence


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Originally written on Pro Sports Daily | Last updated 8/31/12
All season, the Texas Rangers' bullpen has been an extreme asset for the club. The team is taking every precaution to insure that advantage exists deep into the playoffs. By adding pitchers, giving others extended rest and by being judicious with everybody's usage, the Rangers enter their series with the Cleveland Indians on Friday with just 105 relief innings since the All-Star break. It is the second-lowest figure in the majors behind the Seattle Mariners, who have used relievers for 104 1/3 innings. The Rangers' bullpen threw 251 innings in the first half, a middle-of-the pack number. The lighter load in the second half could be significant entering the playoffs. A year ago, Texas relievers pitched 198 2/3 innings in the second half. Manager Ron Washington said that was too much work, and it caught up to the bullpen during a full month's worth of playoff action. "My bullpen ran out of gas," Washington said. The fumes on which the bullpen was running last fall became pai...
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Britain seeks to strengthen ties with Australia, New Zealand
- From: News Corp Australia Network
- January 14, 2013
BRITAIN has not been paying enough attention to its "family" Australia but will this year strive to reinvigorate the old alliance it now says could jointly be a leading voice in global economics.
And in a bid to leverage old ties to boost Britain's profile in the Asia Pacific region, Foreign Secretary William Hague will this week visit Australia and New Zealand for a series of high-level talks.
Mr Hague said the British-Australian relationship was rooted in history and shared common goals but it was time it, as well as the rest of the Commonwealth, become a renewed powerhouse in the world.
On the eve of his visit to Australia, he said the ties with its former colony had never been more important as strategic and global allies.
"Our membership of the Commonwealth means that we are not just allies, we are also family," he said.
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paul of croydon park Posted at 9:49 AM January 14, 2013
watch out, their coming to borrow a quid or two.
Comment 1 of 5
margaret cutler of AU Posted at 7:39 AM January 18, 2013
I hope someone will talk to him about expat pensions , give it to him wish he was coming near to me.
Comment 2 of 5
James Aitken of Sunshine Coast Queensland Posted at 7:39 AM January 18, 2013
Watched the interview on ABC last night.The man is a typical politician side stepping questions and fence sitting when the interviewer pushed for answers. I wouldn't trust this man as far as I could throw him. What boloney to hear his comment about us being "family". Ignored by the country that became part of Europe, they now discover that Europe is in the weeds, and want to "be friends" again. I just hope Bob Carr is up to the job of ensuring we don't get dudded. While he is so concerned for the "family", maybe someone will ask him about the discrimination against 500,000 ex patriate Brit pensioners who choose to live in Australia and other Commonwealth "family" countries. Although we paid in to the State Pension fund like those who remain in UK, we never get any increase in pension, to compensate for cost of living increases, from the date it is first awarded, unlike other countries like USA or Phillipines! Makes absolutely no sense. I'd say he has no chance of getting half a million ex pats on side until this anomaly is corrected.
Comment 3 of 5
James Nelson of Leongatha Posted at 8:48 AM January 18, 2013
Mother coming home to family after her European lovers are found to be unfaithful.
Comment 4 of 5
Richard Lane of Kariong, NSW, Australia Posted at 1:37 PM January 18, 2013
As a UK expat, I think that before any new agreements are made between the UK and Australia, the UK Govt need to address the issue of UK state pensions. All that is being asked is that Commonwealth countries receive the same deal on annual indexation as the USA and European Union receive. The Australian Government end up having to subsidise UK expats, because the UK Government have robbed them of inflation upratings that those in the EU and US get. Expats in Australia will then be on an even par with expats in those countries, as the UK expats will be in receipt of the same state pension as those in the EU and USA who have contributed equally to the National Insurance Fund. It is insulting to Australians to receive second class treatment compared to the US and EU. If the UK genuinely wants to restore links with Australia, then it should negotiate.
Comment 5 of 5