text:
A power supply for a thermokeratoplasty system. The power supply can be connected to an electrode and a return element that are both coupled to a cornea. The power supply can perform a test routine to determine whether the cornea is too "wet" or too "dry".
1. An electrical power supply for a thermokeratoplasty tip that can provide an indication of an electrical characteristic of a cornea, comprising:
an electrode pin;
a return pin; and,
a circuit that can provide a current to said electrode pin and the cornea, and an indication of the electrical characteristic of the cornea in response to the current flowing through the cornea and said electrode and return pins, said circuit varies an amplitude of said current in accordance with the electrical characteristic.
2. The power supply of
3. The power supply of
4. The power supply of
5. The power supply of
6. The power supply of
7. The power supply of
8. A method for testing an electrical contact between a thermokeratoplasty electrode, a cornea and a return element, comprising:
transmitting a current through the electrode, the cornea and the return element;
comparing an electrical characteristic of the cornea to a threshold value; and,
generating an indicator output signal if the electrical characteristic is equal to or is greater than an absolute value of the threshold value.
9. The method of
10. The method of
11. The method of
12. The method of
13. An electrical power supply for a thermokeratoplasty tip that can provide an indication of an electrical characteristic of a cornea, comprising:
an electrode pin;
a return pin; and,
a circuit that can provide a current to said electrode pin and the cornea, and an indication of the electrical characteristic of the cornea in response to the current flowing through the cornea and said electrode and return pins, said circuit provides a series of radio frequency test pulses to said electrode pin.
14. The power supply of
15. The power supply of
16. The power supply of
17. The power supply of
18. The power supply of
19. An electrical power supply for a thermokeratoplasty tip that can provide an indication of an electrical characteristic of a cornea, comprising:
an electrode pin;
a return pin; and,
a circuit that can provide a current to said electrode pin and the cornea, and an indication of the electrical characteristic of the cornea in response to the current flowing through the cornea and said electrode and return pins, said circuit provides a wet indicator output signal if the electrical characteristic is equal to or less than a lower threshold value and provides a dry indicator output signal if the electrical characteristic is equal to or greater than an upper threshold value.
20. The power supply of
21. The power supply of
22. The power supply of
23. An electrical power supply for a thermokeratoplasty tip that can provide an indication of an electrical characteristic of a cornea, comprising:
an electrode pin;
a return pin; and,
a circuit that can provide a current to said electrode pin and the cornea, and an indication of the electrical characteristic of the cornea in response to the current flowing through the cornea and said electrode and return pins said circuit provides a series of operating radio frequency pulses if the electrical characteristic is greater than a lower threshold and less than an upper threshold.
24. The power supply of
25. The power supply of
This application is a continuation of application Ser. No. 09/539,270, filed on Mar. 30, 2000 now U.S. Pat. No. 6,673,069, and a continuation-in-part of application Ser. No. 09/759,684, filed on Jan. 10, 2001, pending, which is a continuation of application Ser. No. 09/239,060, filed on Jan. 26, 1999, abandoned, which is a continuation of application Ser. No. 08/957,911, filed on Oct. 27, 1997, U.S. Pat. No. 6,213,997, which is a continuation-in-part application Ser. No. 08/287,657, filed on Aug. 9, 1994, U.S. Pat. No. 5,749,871, which is a continuation-in-part of application Ser. No. 08/171,225, filed on Dec. 20, 1993, abandoned, which is a continuation-in-part of application Ser. No. 08/111,296, filed on Aug. 23, 1993, now abandoned.
1. Field of the Invention
The present invention relates to a thermokeratoplasty probe that is placed into direct contact with the outer surface of the cornea.
2. Prior Art
Techniques for correcting vision have included reshaping the cornea of the eye. For example, myopic conditions can be corrected by cutting a number of small incisions in the corneal membrane. The incisions allow the corneal membrane to relax and increase the radius of the cornea. The incisions are typically created with either a laser or a precision knife. The procedure for creating incisions to correct myopic defects is commonly referred to as radial keratotomy and is well known in the art.
Present radial keratotomy techniques generally make incisions that penetrate approximately 95% of the cornea. Penetrating the cornea to such a depth increases the risk of puncturing the Descemets membrane and the endothelium layer, and creating permanent damage to the eye. Additionally, light entering the cornea at the incision sight is refracted by the incision scar and produces a glaring effect in the visual field. The glare effect of the scar produces impaired night vision for the patient. It would be desirable to have a procedure for correcting myopia that does not require a 95% penetration of the cornea.
The techniques of radial keratotomy are only effective in correcting myopia. Radial keratotomy cannot be used to correct an eye condition such as hyperopia. Additionally, keratotomy has limited use in reducing or correcting an astigmatism. The cornea of a patient with hyperopia is relatively flat (large spherical radius). A flat cornea creates a lens system which does not correctly focus the viewed image onto the retina of the eye. Hyperopia can be corrected by reshaping the eye to decrease the spherical radius of the cornea. It has been found that hyperopia can be corrected by heating and denaturing local regions of the cornea. The denatured tissue contracts and changes the shape of the cornea and corrects the optical characteristics of the eye. The procedure of heating the corneal membrane to correct a patient's vision is commonly referred to as thermokeratoplasty.
U.S. Pat. No. 4,461,294 issued to Baron; U.S. Pat. No. 4,976,709 issued to Sand and PCT Publication WO 90/12618, all disclose thermokeratoplasty techniques which utilize a laser to heat the cornea. The energy of the laser generates localized heat within the corneal stroma through photonic absorption. The heated areas of the stroma then shrink to change the shape of the eye.
Although effective in reshaping the eye, the laser based systems of the Baron, Sand and PCT references are relatively expensive to produce, have a non-uniform thermal conduction profile, are not self limiting, are susceptible to providing too much heat to the eye, may induce astigmatism and produce excessive adjacent tissue damage, and require long term stabilization of the eye. Expensive laser systems increase the cost of the procedure and are economically impractical to gain widespread market acceptance and use. Additionally, laser thermokeratoplastic techniques non-uniformly shrink the stroma without shrinking the Bowmans layer. Shrinking the stroma without a corresponding shrinkage of the Bowmans layer, creates a mechanical strain in the cornea. The mechanical strain may produce an undesirable reshaping of the cornea and probable regression of the visual acuity correction as the corneal lesion heals. Laser techniques may also perforate Bowmans layer and leave a leucoma within the visual field of the eye.
U.S. Pat. Nos. 4,326,529 and 4,381,007 issued to Doss et al, disclose electrodes that are used to heat large areas of the cornea to correct for myopia. The electrode is located within a housing that spaces the tip of the electrode from the surface of the eye. An isotropic saline solution is irrigated through the electrode and aspirated through a channel formed between the outer surface of the electrode and the inner surface of the sleeve. The saline solution provides an electrically conductive medium between the electrode and the corneal membrane. The current from the electrode heats the outer layers of the cornea. Heating the outer eye tissue causes the cornea to shrink into a new radial shape. The saline solution also functions as a coolant which cools the outer epithelium layer.
The saline solution of the Doss device spreads the current of the electrode over a relatively large area of the cornea. Consequently, thermokeratoplasty techniques using the Doss device are limited to reshaped corneas with relatively large and undesirable denatured areas within the visual axis of the eye. The electrode device of the Doss system is also relatively complex and cumbersome to use.
"A Technique for the Selective Heating of Corneal Stroma" Doss et al., Contact & Intraoccular Lens Medical Jrl., Vol. 6, No. 1, pp. 13–17, January–March, 1980, discusses a procedure wherein the circulating saline electrode (CSE) of the Doss patent was used to heat a pig cornea. The electrode provided 30 volts r.m.s. of power for 4 seconds. The results showed that the stroma was heated to 70� C. and the Bowman's membrane was heated 45� C., a temperature below the 50–55� C. required to shrink the cornea without regression.
"The Need For Prompt Prospective Investigation" McDonnell, Refractive & Corneal Surgery, Vol. 5, January/February, 1989 discusses the merits of corneal reshaping by thermokeratoplasty techniques. The article discusses a procedure wherein a stromal collagen was heated by radio frequency waves to correct for a keratoconus condition. As the article reports, the patient had an initial profound flattening of the eye followed by significant regression within weeks of the procedure.
"Regression of Effect Following Radial Thermokeratoplasty in Humans" Feldman et al., Refractive and Corneal Surgery, Vol. 5, September/October, 1989, discusses another thermokeratoplasty technique for correcting hyperopia. Feldman inserted a probe into four different locations of the cornea. The probe was heated to 600� C. and was inserted into the cornea for 0.3 seconds. Like the procedure discussed in the McDonnell article, the Feldman technique initially reduced hyperopia, but the patients had a significant regression within 9 months of the procedure. To date, there have been no published findings of a thermokeratoplasty technique that will predictably reshape and correct the vision of a cornea without a significant regression of the corneal correction.
It would therefore be desirable to provide a thermokeratoplasty technique which can predictably reshape and correct the vision of an eye without a significant regression of the visual acuity correction.
It would be desirable to know the electrical contact between an electrode and the cornea before conducting an electro-thermokeratoplasty procedure. A cornea that is too dry may create a high electrical impedance that produces a relatively large amount of localized heating in the tissue. A cornea that is too wet may dissipate the current so that the corneal tissue is not sufficiently denatured. It would be desirable to provide a power supply and technique that can test the condition of the eye to determine if there is an acceptable electrical path.
The present invention includes a power supply for a thermokeratoplasty system. The power supply can be connected to an electrode and a return element that are both coupled to a cornea. The power supply can perform a test routine to determine whether the cornea is too "wet" or too "dry".
Referring to the drawings more particularly by reference numbers,
The power supply 14 provides a predetermined amount of energy, through a controlled application of power for a predetermined time duration. The power supply 14 may have manual controls that allow the user to select treatment parameters such as the power and time duration. The power supply 14 can also be constructed to provide an automated operation. The supply 14 may have monitors and feedback systems for measuring tissue impedance, tissue temperature and other parameters, and adjust the output power of the supply to accomplish the desired results. The unit may also have a display that indicates the number of remaining uses available for the probe 12.
In the preferred embodiment, the power supply provides a constant current source and voltage limiting to prevent arcing. To protect the patient from overvoltage or overpower, the power unit 14 may have an upper voltage limit and/or upper power limit which terminates power to the probe when the output voltage or power of the unit exceeds a predetermined value. The power unit 14 may also contain monitor and alarm circuits which monitor the resistance or impedance of the load and provide an alarm when the resistance/impedance value exceeds and/or falls below predefined limits. The alarm may provide either an audio and/or visual indication to the user that the resistance/impedance value has exceeded the outer predefined limits. Additionally, the unit may contain a ground fault indicator, and/or a tissue temperature monitor. The front panel of the power unit typically contains meters and displays that provide an indication of the power, frequency, etc., of the power delivered to the probe.
The power unit 14 may deliver a power output in a frequency range of 5 KHz–50 MHz. In the preferred embodiment, power is provided to the probe at a frequency in the range of 500 KHz. The unit 14 is designed so that the power supplied to the probe 12 does not exceed 1.2 watts (W). The time duration of each application of power to a particular corneal location is typically between 0.1–1.0 seconds. The unit 14 is preferably set to deliver approximately 0.75 W of power for 0.75 seconds.
The system has a switch which controls the application of power to the probe 12. The power unit 14 also contains a timer circuit which allows power to be supplied to the probe 12 for a precise predetermined time interval. The timer may be a Dose timer or other similar conventional circuitry which terminates power to the probe after a predetermined time interval. The unit may also allow the user to apply power until the switch is released. As one embodiment, the power supply may be a unit sold by Birtcher Medical Co. under the trademark HYFRECATOR PLUS, Model 7-797 which is modified to have voltage, waveform, time durations and power limits to comply with the above cited specifications.
The power unit 14 may have a control member 26 to allow the user to select between a "uni-polar" or a "bi-polar" operation. The power supply 14 may be constructed to provide a single range of numerical settings, whereupon the appropriate output power, time duration and repetition rate are determined by the hardware and software of the unit. The front panel of the power unit may also have control members (not shown) that allow the surgeon to vary the power, frequency, timer interval, etc. of the unit. The return electrode (not shown) for a uni-polar probe may be coupled to the power unit through a connector located on the unit. The return electrode is preferably a cylindrical bar that is held by the patient, or an eye fixation electrode.
It has been found that at higher diopters, effective results can be obtained by providing two different applications at the same location. Listed below in Table I are the power settings (peak power) and time duration settings for different diopter corrections (−d), wherein the locations (Loc) are the number of denatured areas in the cornea and dots/Loc is the number of power applications per location.
Using the parameters listed in Table I, the procedure of the present invention was performed on 36 different patients suffering from some degree of hyperopia. A pattern of 8–16 denatured areas were created in the non-vision area of the eye. Patients who needed higher diopter corrections were treated with high applications of power.
The design of the power source and the high electrical resistance of the denatured area provides a self limit on the amount of penetration and area of denaturing of the cornea. Once denatured, the cornea provides a high impedance to any subsequent application of power so that a relatively low amount of current flows through the denatured area. It has been found that the present procedure has a self limited denatured profile of approximately no greater than 75% of the depth of the stroma. This prevents the surgeon from denaturing the eye down to the Descemets membrane and endothelium layer of the cornea.
Both electrodes 30 and 32 extend from the hand piece 16 which contains a pair of internal insulated conductors 34 that are contact with the proximal end of the electrodes. The first electrode 30 has a tip 36 which extends from a first spring member 38 that is cantilevered from the hand piece 16. The electrode 30 is preferably constructed from a phosphor-bronze or stainless steel, wire or tube, that is 0.2–1.5 mm in diameter. The spring portion 38 of the first electrode 30 is preferably 50 millimeters (mm) long. In one embodiment, the tip 36 has an included angle of between 15–60�, 30� nominal, and a nose radius of approximately 50 microns. A majority of the electrode 30 is covered with an insulating material to prevent arcing, and to protect non-target tissue, the user and the patient. The relatively light spring force of the probe provides a sufficient electrode pressure without penetrating the cornea.
The second electrode 32 includes a disk portion 40 which extends from a second spring member 42 that is also cantilevered from the hand piece 16. The disk portion 40 is spaced a predetermined distance from first electrode 30 and has an aperture 44 that is concentric with the tip 36. In the preferred embodiment, the disk portion 40 has an outer diameter of 5.5 mm and an aperture diameter of 3.0 mm. The disk 40 further has a concave bottom surface 46 that generally conforms to the shape of the cornea or sclera.
In one embodiment, the bottom surface 46 has a spherical radius of approximately 12.75 mm and a griping surface to assist in the fixation of the eye. The second electrode 32 provides a return path for the current from the first electrode 30. To insure proper grounding of the cornea, the surface area of the disk 40 is typically 20–500 times larger than the contact area of the tip 36. In the preferred embodiment, the second spring member 42 is constructed to have a spring constant that is less than one-half the stiffness of the first spring member 38, so that the second electrode 32 will have a greater deflection per unit force than the first electrode 30. As shown in
For surgeons who prefer "two handed" procedures, the probe could be constructed as two pieces, one piece being the first electrode, and the other piece being the second electrode which also stabilizes the eye against corneal movement. Although the probe has been described and shown denaturing a cornea, it is to be understood that the probes and methods of the present invention can be used to denature other tissues to correct for wrinkles, incontinence, etc. For example, the probe could be used to shrink a sphincter to correct for incontinence. The technique would be basically the same with small closely spaced dots forming a tightening line, belt or cylinder.
The exact diameter of the pattern may vary from patient to patient, it being understood that the denatured spots should preferably be formed in the non-visionary portion 52 of the eye. Although a circular pattern is shown, it is to be understood that the denatured areas may be located in any location and in any pattern. In addition to correcting for hyperopia, the present invention may be used to correct astigmatic conditions. For correcting astigmatic conditions, the denatured areas are typically created at the end of the astigmatic flat axis. The present invention may also be used to correct radial keratotomy procedures that have overcorrected for a myopic condition.
The probe and power settings have been found to create denatured areas that do not reach the Descemets membrane. It has been found that denatured areas of the Bowmans layer in the field of vision may disturb the patients field of vision, particularly at night. The present invention leaves a scar that is almost imperceptible by slit lamp examination 6 months after the procedure. It has been found that the denatured areas generated by the present invention do not produce the star effect caused by the refraction of light through the slits created in a corrective procedure such as radial keratotomy.
The first electrodes 62 extend through apertures 72 in the rings 66 and 68. The electrodes 62 can move relative to the cage 64 in the directions indicated by the arrows. The probe 60 has a plurality springs 74 located between the rings and seated on washers 76 mounted to the electrodes 62. The springs 74 bias the electrodes 62 into the positions shown in
In operation, the probe 60 is pressed onto the cornea so that the electrodes 62 move relative to the cage 64. The spring constant of the springs 74 is relatively low so that there is a minimal counterforce on the tissue. A current is supplied to the electrodes 62 through wires 78 attached thereto. The probe 60 is preferably used as a uni-polar device, wherein the current flows through the tissue and into a return electrode attached to or held by the patient. Alternatively, the probe 60 may be bi-polar wherein one or more of the electrodes 62 would provide power and the other electrodes may provide a ground return path. The probe 60 may be configured so that the diameter of the electrode placement is adjustable. The electrode placement can vary incrementally between 5.5, 6.0, 6.5, 7.0, 7.5, 8.0, and 8.5 millimeters.
Approximately 30 minutes before the application of the electrode, the patient is given a mild tranquilizer such as 5 mg of valium, and the surgeon administers drops, such as the drops marketed under the trademark "Madryacil", to dilate the pupil and freeze accommodation, in block 106. Immediately before the procedure, 2 drops of a topical cocaine commonly known as "Proparacaine" is administered to the eyes in block 108. In block 110 an in line microscope light is directed to the cornea for marking purposes. Then the lighting may be directed in a lateral direction across the cornea. Laterally lighting the eye has been found to provide good visualization without irritating or photobleaching the retina.
In procedural block 112, the surgeon marks 8 or 16 spots on the cornea, wherein the pattern has a preferred diameter of approximately 7 mm. The surgeon sets the power and duration setting of the power unit to the proper setting. In block 114, the surgeon then places the tip at one of the spot markings and depresses the foot switch of the system, so that power is supplied to the probe and transferred into the cornea. This process is repeated at all of the spot markings. The epithelium of the denatured areas are then removed with a spatula in block 116. If a diopter correction of −2.5–3.5 d, or −4.0–6.0 d is required the tip is again placed in contact with the spots and power is applied to the cornea to generate a deeper thermal profile in the stroma. The procedure is then checked with an autorefractor.
The eyes are covered with a patch or dark glasses, and the patient is given medication, in block 118. The patient preferably takes an antibiotic such as a drug marketed under the trademark "Tobrex" every 2 hours for 48 hours, and then 3 times a day for 5 days. The patient also preferably takes an oral analgesic, such as a drug marketed under the trademark "Dolac", 10 mg every 8 hours for 48 hours and a drug marketed under the trademark "Globaset" every 8 hours for 48 hours. If the patient has been overcorrected, the procedure can be reversed by waiting 3–4 days after the procedure and then administering to the eyes 1 drop of a steroid such as cortisone, 3 times a day for 1–2 weeks.
The denatured pattern shown in
As shown in
As shown in
The tip 230 shown in
The probe 250 shown in
In the preferred embodiment, the fuses 302 are connected to drivers 304 that are coupled to a plurality of serial to parallel shift registers 306. The clock pin (CLK) pins and input pin D of the first shift register are connected to the unit 14. The unit 14 initially provides an input to the first shift register and then shifts the input through the registers 306 by providing a series of pulses on the clock pin CLK. An active output of a register 306 will enable the corresponding driver 304 and select the corresponding fuse 302. The unit 14 may clock the input through the shift registers 306 in accordance with an algorithm contained in hardware or software of the unit, wherein each clock signal corresponds to the end of a procedure. By way of example, a clock signal may be generated, and a fuse blown, upon the occurrence of four shots that have a power greater than 0.16 W and a duration greater than 0.25 seconds.
The circuit 300 may have a separate sample unit 308 that is coupled to the unit 14 and the fuses 302. The sample unit 308 may have an optical coupler 310 which isolates the unit 14 from power surges, etc. or may be any voltage or current threshold/comparator circuitry known in the art. The sample unit 308 may have a relay 312 that closes a switch when the fuses 302 are to be sampled. The sample circuit 308 samples the fuses 302 to determine how many fuses 302 are not blown. The number of remaining fuses 302, which correlate to the amount of procedures that can be performed with that particular probe, may be provided by a display on the unit 14. By way of example, after sampling the fuses, the unit 14 may display the number 6 providing an indication that 6 more procedures can be performed with the probe. A 0 on the display may provide an indication that the probe must be replaced.
To sample the fuses 302, the unit 14 sets relay 312 to "sample" and clocks an input through the registers 306. If the fuse 302 is not blown when the corresponding driver 304 is enabled by the output of the register, the optical coupler 310 will be enabled. If the fuse 302 is blown the optical coupler 310 will not be enabled. The process of enabling a driver 304 and monitoring the output of optical coupler 310 is repeated for each fuse 302. The unit 14 counts the number of viable fuse links remaining to determine the remaining useful lives of the probe.
As shown in
As shown in
The power supply provides a current to the cornea through the tip 362. The current denatures the stroma to correct the shape of the cornea. Because the tip 362 is inserted into the stroma it has been found that a power no greater than 0.2 watts for a time duration no greater than 1.0 seconds will adequately denature the corneal tissue to provide optical correction of the eye. The frequency of the power is typically between 1–20 KHz and preferably 4 KHz. Inserting the tip 362 into the cornea provides improved repeatability over probes placed into contact with the surface of the cornea, by reducing the variances in the electrical characteristics of the epithelium and the outer surface of the cornea.
In the preferred embodiment, the spring beam 352 is 0.90 inches long with a diameter of 0.05 inches. The tip support may be 0.25 inches long. The tip 362 may have an embedded layer of dielectric material 370 that prevents current from flowing through the epithelium. The tip 362 may be constructed from a 302 stainless steel wire that is subjected to a centerless grinding process. The grounded wire can then be exposed to a chemical milling process to create a sharp point.
The electrode pin 408 and the return pin 410 may be connected to a current to voltage converter 412. The converter 412 provides an analog output voltage to an analog to digital A/D converter 414. The analog output voltage of the voltage converter 412 is a function of a voltage drop between the electrode pin 408 and the return pin 410. The output voltage is also provided to a pulse counter 416.
The A/D converter 414 and pulse counter 416 may be connected to a controller 418. The A/D converter 414 may provide the controller 418 with a binary bit string that represents a value of the voltage from the converter 412. The A/D converter 414 may include a sample and hold circuit so that the converter 414 output corresponds to the peak voltage provided by the converter 412. The pulse counter 416 may provide a feedback signal to the controller 418 to provide an indication that energy was delivered to the cornea 404.
The controller 418 may be connected to a radio frequency (RF) pulse generator 420 and an output switch 422. The pulse generator 420 may be an L-C circuit that produces a damped RF waveform in response to an impulse from the controller 418. The controller 418 may generate a series of impulses that produce a series of damped waveforms that are provided to the cornea 404. By way of example, each impulse may be a five volt, one nanosecond pulse provided to the pulse generator 420. The controller 418 may perform an automatic gain control function to increase or decrease the amplitude of the impulse provided to the pulse generator 420 as a function of the feedback signal. For example, the controller 418 may decrease the amplitude for a dry cornea and increase the amplitude for a wet cornea.
The output switch 422 may be switched between an on state and an off state. In the off state the output provides a safety feature, wherein power is not supplied to the cornea 404.
The controller 418 may be connected to a DC power supply 424 and a display 426. The display 426 may include a pair of indicator lights designated "wet" and "dry". The controller 412 may also be connected to a power adjustment circuit 428, a time adjustment circuit 430 and a switch 432. The switch 432 may be a footswitch or a handswitch that can be manipulated by the surgeon to initiate a routine of the controller 418. The adjustment circuits 428 and 430 allow the surgeon to vary the level and time duration of energy provided to the electrode 402, respectively.
The controller 418 may perform a software routine in accordance with an algorithm shown in
The amount of pulses provided during the test routine is typically a fraction of the pulses provided during normal operation. For example, if the power supply normally provides 4800 pulses per 0.6 seconds to denature the cornea, the supply 400 may provide 100 pulses during the test routine. The lower amount of total energy allows the power supply to test the electrical contact without providing enough energy to significantly effect the cornea.
The RF pulses return to the voltage converter 412 through the return element 406 and return pin 410. A value that is a function of the voltage at the return pin 410 is provided to the controller 418 through the voltage 412 and A/D 414 converters in step 504.
The controller 418 may differentiate the voltage value provided by the A/D converter 414 to obtain the time rate of change of the voltage and corresponding resistance in step 506. The differentiated voltage may be used because the tissue will undergo a slight change in resistance in response to the energy provided by the power supply. Although a differentiated voltage is described, it is to be understood that the controller 418 can utilize some other voltage characteristic such as an undifferentiated voltage amplitude. The controller 418 may then compare the actual differentiated voltage value with an upper threshold.
If the differentiated voltage value is equal to or greater than the upper threshold the controller 420 may generate a dry indicator output signal to activate the dry indicator. In step 510, the activated dry indicator provides an indication that the cornea is too dry. The controller 418 can also switch the switch 422 to the off state.
If the actual value is below the upper value the controller 418 can compare the actual value to a lower threshold in step 512. If the actual value is less than or equal to the lower threshold then the controller may generate a wet indicator output signal that activates the wet indicator and turn off the switch 422 in step 514. If the actual differentiated value is not less than the threshold range, the test routine will terminate and the controller 418 may continue to allow pulses to be provided to the cornea in step 516. The pulses are provided for a time period that will denature the cornea.
It may be desirable to prevent the tip from rotating relative to the handle to prevent any tearing of the cornea.
The probe body 558 may include an outer groove 564 that is adapted to receive a detent ball 566. The ball 566 may be biased into the groove 564 by a spring 568. The ball 566 may be located within a sleeve portion 570 of the arm 552. The probe body 558 may extend through an inner channel 572 of the sleeve 570.
The probe 554 can be replaced by pulling the probe body 558 out of the inner channel 572. The inner groove 564 may have a tapered surface such that the detent ball 566 is pushed out of the groove 564 when the handle 558 is pulled out of the sleeve 570. A new probe 554 can be inserted into the channel 572. The probe body 558 may have a stop 574 that limits the insertion depth of the probe 554.
The pin 608′ may have a corresponding groove 626 that can receive the threaded electrode 612′. This embodiment provides a probe that has a dielectric outer sleeve 616′ with an internal contact thread that provides an electrical path between the electrode tip and the male pin 608′. The dielectric outer sleeve 616′ provides a protective element for the probe.
While certain exemplary embodiments have been described and shown in the accompanying drawings, it is to be understood that such embodiments are merely illustrative of and not restrictive on the broad invention, and that this invention not be limited to the specific constructions and arrangements shown and described, since various other modifications may occur to those ordinarily skilled in the art.
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Where can Comrie really end up?
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Lanny MacDonald*
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Marc Savard doesn't belong in the same sentence - just look at what Savard was obtained for and what Comrie may go for.
Hilarious! Wanna take a look at their stats and say that with a straight face? Wanna listen to the pissing and moaning coming from the fans and what a terrible defensive player Comrie is, and say that with a straight face? Outside of age, the only place that Comrie has an advantage over Savard is in the goal scoring department, but Savard is better in the setup department. Oh, and of course Comrie does have an edge in the hold-out department, two-to-one.
Okay, if Savard is indeed, not worthy of being in the same sentence as Comrie (.69 versus .67 ppg aveage for the two players mind you) why are the Oilers not willing to cough up the dough to sign the diminutive superstar??? If Savard is worth $2 million a season, then Comrie is definitely worth the $3.5 to 4.5 he's asking, right? I think its time for some people here to do some soul searching and realize just where Mike Comrie's value is, and just what a potential return there is waiting out there.
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Veterinarians at the Conley & Koontz Equine Hospital may be thinking about having the water tested, as the rare birthing of twin foals has happened again. Wednesday around 10 p.m., a mare named "Hooker," owned by the Herbster family of Middlebury, delivered a colt and a filly.
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Boyle's debut is best selling album in the world
Susan Boyle's debut album has been named the world's best-selling record of 2009. I Dreamed A Dream, which hit stores in November 2009, landed the title of Britain's top-selling release last year, while the Scottish singer came second to Taylor Swift's Fearless in America's 2009 run-down. But new figures released by the International Federation of […] [Read More]
Bret Michaels may be ready to rock within weeks
AP Bret Michaels is best known as the lead singer of glam rock band Poison. Rocker Bret Michaels could stage yet another comeback sooner than expected after he suffered a brain hemorrhage last week. Doctors say it is possible that Michaels, the outspoken 47-year-old former Poison frontman currently competing on "The Celebrity Apprentice," could be […] [Read More]
Lennon's handwritten Beatles lyrics expected to fetch $700,000 at auction
John Lennon's handwritten lyrics for the Beatles song "A Day in the Life" are expected to sell for as much as $700,000 when they go under the hammer in New York in June 2010. The lyrics appear on a double-sided sheet of paper, which includes corrections and amendments made in red ink. "A Day in […] [Read More]
Whitford: 'Aerosmith wouldn't have worked without Tyler'
Aerosmith star Brad Whitford is relieved frontman Steven Tyler decided to rejoin the group – because plans to continue with a different singer wouldn't "have worked". Tyler stunned his bandmates in 2009 when he decided to take a two-year hiatus and walked away from the group. The musicians immediately embarked on a mission to find […] [Read More]
Graphic new M.I.A. video banned by YouTube
M.I.A.'s hard-to-watch new video has been banned by YouTube.com due to its graphic violence and scenes featuring the killing of young boys. Romain Gavras' Born Free video premiered on M.I.A.'s official website on April 26, but the hitmaker has revealed the promo will not be posted on YouTube. In a Twitter.com post, M.I.A. initially suggested […] [Read More]
Rihanna nurses bruised knee, ego after stage fall
R&B star Rihanna is nursing a bruised ego and knee after taking a tumble onstage in France on Wednesday night. The Umbrella hitmaker was performing at Le Dome in Marseille when she slipped while walking across the stage in high heels and fell to the floor. Fans gasped but the singer brushed off the mishap […] [Read More]
Whitney Houston duets with young girl in Ireland (w/video)
Whitney Houston made one young fan's dream come true during a concert in Ireland earlier April 20, inviting the little girl onstage to perform a duet. The I Have Nothing hitmaker staged a string of shows on her 'Nothing But Love' tour at the O2 Arena in Dublin – and the singer gave an extra-special […] [Read More]
Vedder channels Lennon with birthday tune to O'Brien (w/video)
Pearl Jam star Eddie Vedder helped U.S. TV funnyman Conan O'Brien celebrate his 47th birthday in style on Monday night (19Apr10) when he adapted a John Lennon song for the comic onstage in Seattle, Washington. The rocker was a surprise guest at O'Brien's Legally Prohibited From Being Funny On Television tour in the city and […] [Read More]
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The Latest
For Egypt's Muslim Brotherhood, a Return to the Underground
In the aftermath of the toppling of President Mohamed Morsi, the Islamist party appears to be retreating into its historical narrative as an underground movement.
Who's Who In Egypt's Widening Political Divide?
The growing political unrest in Egypt has begun to split families over what's best for the future of the nation, reports Charles M. Sennott from Cairo.
Tensions Rise Between Muslim Brotherhood & Egyptian Military
FRONTLINE's cameras were there when deadly clashes killed seven and wounded more than 260 last night.
Egypt Divided: U.S. Government Emerges as a Common Foe
The two sides may be bitterly divided, but they seem to agree on at least one thing: that the United States is at fault for the mess in which Egypt finds itself.
"The Brothers"
As Egyptians revolt again, revisit FRONTLINE's February 2011 exploration of the Muslim Brotherhood and its profound influence on Egyptian society.
Egypt's Fractured Revolution Two Years On
Two years after the fall of Mubarak, Charles M. Sennott returns to Egypt to find some of the revolution's biggest leaders bitterly divided, and reflecting on some of the mistakes made along the way.
"The Lonely Battle of Wael Ghonim"
Inside The Egyptian Military's Brutal Hold on Power
As with so many things in life, you need to follow the money…
Why Is America Reaching Out to Egypt's Muslim Brotherhood?
As the final results of Egypt's parliamentary elections come in this week, the country's Islamists are walking away the biggest winners.
Islamists: The Biggest Winners in Egypt's Elections
Liberal parties and youth activists may have sparked Egypt's revolution, but the country's Islamists seem to be walking away the biggest winners in the first parliamentary elections since the fall of Hosni Mubarak last February. But what do we – and don't we – know about Egypt's Islamists?
Key Egyptian Revolutionary Advising "Occupy Wall Street"
Since the "Occupy Wall Street" protests in New York and its offshoots first broke out, protesters have invited comparisons to … Continue reading
Sennott Discusses Egyptian Revolution's "Second Wave"
"What you see in Egypt now is fatigue, but not a loss of hope," Charles M. Sennott told the PBS … Continue reading
Egypt's Unfinished Revolution
Six months later, GlobalPost's Charles M. Sennott revisits the leaders of Tahrir Square. Video portraits by Tim Grucza and Chris … Continue reading


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Content from our sponsor Please note: The Wall Street Journal News Department was not involved in the creation of the content below.
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Findings from a study of eDiscovery practices in government reveal a confluence of factors continues to undermine stakeholder confidence in federal eDiscovery systems and processes. By taking steps to foster more effective intra-agency communication, federal CIOs may be able to mitigate some chronic eDiscovery challenges.
By 2020, ongoing technological, societal, and economic trends will have fundamentally reshaped the way governments provide services. An in-depth study by Deloitte Consulting LLP's Federal Practice offers a preview of myriad possibilities awaiting the public sector and the citizenry it serves.
Despite their much-discussed potential, bitcoin and other virtual currencies face security, price volatility, and other challenges that could ultimately prevent widespread adoption. In the second article in a two-part series, fellows from Deloitte Consulting LLP's GovLab program discuss the future viability of these hotly debated technologies.
According to a steady stream of breathless news stories, bitcoin is either a magical, transformative innovation or yet another overhyped Internet gimmick destined to fail. In the first article in a two-part series, fellows from Deloitte Consulting LLP's GovLab program examine the turbulent past and promising future of one of today's most hotly debated technologies.
Bureaucracy, insufficient authority, and lack of budget visibility, among other factors, have resulted in federal CIO turnover rates that are notably higher than those in the private sector. A former CIO of the U.S. Department of Justice discusses strategies to empower federal IT leaders and close the CIO revolving door.
For some, Agile is a welcome alternative to the rigidity of traditional Waterfall methods of software development. For others, it is an unstructured, loosey-goosey recipe for project disaster. Which is it? Deloitte specialists weigh in, dispelling the myths surrounding this hotly debated IT topic.
Findings from a recent Deloitte e-discovery benchmarking study suggest that questions about the quality of discoverable agency data are leading federal lawyers, paralegals, and others to lose confidence in their organizations' abilities to effectively manage e-discovery efforts. Federal IT leaders can deploy several strategies to help increase end-user trust and enhance approaches for managing electronically stored information.
Though most agree that the commercial drones soon to populate America's skies represent an exciting technological leap, nagging suspicions and misconceptions about unmanned aerial vehicles (UAVs) persist. Speaking recently at the SXSW conference in Austin, Texas, two Deloitte specialists in this field waded into the drone debate by debunking several myths about the effect UAVs could have on safety, privacy, and commerce.
CIO Journal has the focus of a trade journal with the global resources and
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CIO Journal has the focus of a trade journal with the global resources and
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07.20.12 Piazzola sul Brenta, Italy
Anfiteatro Camerini Villa Contarini
Ben Harper Setlist 2012-07-20 - Anfiteatro Camerini - Piazzola sul Brenta, Italy
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Submitted by vanloon on Sat, 2012-07-21 10:02.
I'm so sad today 'cause, after 2 concerts, I can't see Ben 'till next year (I hope).
Yesterday was a beautiful day for me. Fantastic emotions.
I'm dreaming to be still there. My hands are still trembling.
Thank you Ben, Jason, Jesse, Jordan, Justin, Melissa and all. Thank you so much.
I'm waiting for you next year.
- Login to comment/review


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I am not an art aficionado so something that happened to me more than 10 years ago is even more surprising. I was at The Louvre for a brief visit. I did not know the layout of the museum nor where any art items were stored or displayed. I came upon The Winged Victory of Samothrace from the upper staircase and was stunned at what I saw. I had seen images of this statue my whole life and knew really nothing about it. The surprise of seeing it in The Louvre as I did has made a lasting impression which I shall not forget. I'm so happy to read of the restoration and now quite anxious to get back to see it again. I applaud the care, determination, and historicism displayed by all individuals that had anything to do with making The Winged Victory even better to view and imagine. Thank you so much.
Speakeasy is a blog covering media, entertainment, celebrity and the arts. The publication is produced by Barbara Chai and Jonathan Welsh with contributions from the Wall Street Journal staff and others. Write to us at email@example.com or follow us on Twitter at @WSJSpeakeasy or individually @barbarachai.
Content engaging our readers now, with additional prominence accorded if the story is rapidly gaining attention. Our WSJ algorithm comprises 30% page views, 20% Facebook, 20% Twitter, 20% email shares and 10% comments.


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X-COM: Apocalypse
Cheat Codes
In order to use any of the cheats listed below, first activate Cheat Mode. To do this, go into the main interface and hold alt and type
ufo cheat
The message bar should confirm that cheat mode has been enabled. Then you can enter one of the following codes for the desired effect.
Effect Code Apocalypse (Terror) Mission Alt + T Display Number of Aliens in Buildings Alt + N Flip Dimensions Alt + 0, 1, 2, 3, 4, 5, 6, or 7 Force Base Mission Alt + B Force Overspawn Alt + S Force UFOs to crash Alt + C Gain $100,000 Alt + M Gain One More of All Equipment Alt + [Keypad Plus] Gain One of Each Vehicle Type Alt + X Show People Tube Connections Alt + Z Test Alien Dimension Alt + G Toggle Allow All Manufacture Alt + Q Toggle Allow All Research Alt + R Toggle Auto-Save Alt + A Toggle Build Base Facilities Alt + F Toggle Dimension Map Alt + D Toggle Instant Project Finish Alt + P Toggle View All UFOpaedia Alt + V
Contributed By: Evil Penguin and th3l3fty.
Cheat Mode
In the main interface, hold alt and type "tac cheat". The message bar should confirm that cheat mode has been enabled. Then you can enter one of the following codes for the desired effect.
Effect Code Decrease music intensity Alt + G Exit Cheat Mode Alt + [Esc] Increase music intensity Alt + F Kill hostile units Alt + K Toggle hidden terrain Alt + H Toggle hidden units Alt + V Toggle invincibility Alt + I Toggle training Alt + T Toggle weightlessness Alt + W View FMV sequences Alt + U
Contributed By: th3l3fty.
Know Something We Don't?
You can submit new cheat codes for this game using our Cheat Submission Form.
Have We Been Fooled?
If you see a non-working or fake code in the list above, let us know by using our Problem Submission Form.


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The British economy has experienced the most rapid growth in the G7 over the last few months. It increased at an annual rate of more than 3 percent in the last quarter -- even as the U.S. economy barely grew, continental Europe remained in the doldrums and Japan struggled to maintain momentum in the face of a major new valued added tax increase.
The Great Debate UK
from Nicholas Wapshott:
The EU-U.S. love-hate relationship
The elaborate gavotte between the American and European economies continues.
While the Federal Reserve has begun to wind down its controversial quantitative easing (QE) program, the European Central Bank (ECB) the federal reserve of the eurozone, has announced it is considering a QE program of its own.
from Nicholas Wapshott:
No, austerity did not work
There have been a lot of sighs of relief in Europe lately, where countries like Britain and Spain, long in recession, have finally started to grow. Not by much, nor for long. But such is the political imperative to suggest that all the misery of fiscally tight economic policies was worth the pain that there are tentative claims the worst is now over and, ipso facto, austerity worked.
from Breakingviews:
UK's big build dreams still dogged by past binge
By Ian Campbell
The author is a Reuters Breakingviews columnist. The opinions expressed are his own.
from Nicholas Wapshott:
Austerity is a moral issue
Security worker opens the door of a government job center as people wait to enter in Marbella, Spain, December 2, 2011. REUTERS/Jon Nazca
from Nicholas Wapshott:
Not in the spirit of Hayek
It has been a bad couple of weeks for conservative social scientists. First a doctoral student ran the numbers on the study by Harvard's Carmen Reinhart and Kenneth Rogoff that underpins austerity and deep public spending cuts as a cure for the Great Recession and found it full of errors. Then a policy analyst, Jason Richwine, who angered Senate Republicans trying to pass immigration reform with a one-sided estimate of the cost of making undocumented workers citizens, was obliged to clear his desk at the Heritage Foundation when it became known his Harvard dissertation suggested Hispanics had lower intelligence than "the white native population."
from Anatole Kaletsky:
If Europe wants Thatcherism, it must abandon austerity
Among all the obituaries and encomiums about Margaret Thatcher, very few have drawn the lesson from her legacy that is most relevant for the world today. Lady Thatcher is remembered as the quintessential conviction politician. But judged by her actions rather than her rhetoric, she was actually much more compromising and pragmatic than the politicians who now dominate Europe. And it was Thatcher's tactical flexibility, as much as her deep convictions, that accounted for her successes in the economic field.
from Anatole Kaletsky:
Even Britain has now abandoned austerity
The Age of Austerity is over. This is not a prediction, but a simple statement of fact. No serious policymaker anywhere in the world is trying to reduce deficits or debt any longer, and all major central banks are happy to finance more government borrowing with printed money. After Japan's election of Prime Minister Shinzo Abe and the undeclared budgetary ceasefire in Washington that followed President Obama's victory last year, there were just two significant hold-outs against this trend: Britain and the euro-zone. Now, the fiscal "Austerians" and "sado-monetarists" in both these economies have surrendered, albeit for very different reasons.
from Reihan Salam:
Does Britain's austerity hold lessons for the United States?
The dog's breakfast of a deal that "resolved" the fiscal cliff fell far short of expectations. In the hours after it passed, deficit hawks at the Committee for a Responsible Federal Budget and the tag team of former Senator Alan Simpson and former Clinton White House chief of Staff Erskine Bowles all expressed disappointment in a bargain that was anything but grand. Senate Republicans gritted their teeth to accept a small increase in taxes on America's highest-earning households while Senate Democrats made permanent the bulk of the Bush-era tax cuts. A number of tax provisions that hark back to the 2009 fiscal stimulus law were extended, as were unemployment benefits, thus delivering a modest income boost to a large number of low-income households. But the Social Security payroll tax cut, a Republican-backed replacement for the more narrowly targeted Making Work Pay tax credit that was part of the stimulus law, which benefited a wide range of affluent households as well as families of more modest means, was allowed to lapse. Long-term spending levels, meanwhile, were left largely untouched, which is why rebellious House Republicans came close to scuttling the delicately constructed compromise.
from Lawrence Summers:
Why the UK must reverse its economic course
It is the mark of science and perhaps rational thought more generally to operate with a falsifiable understanding of how the world operates. And so it is fair to ask of the economists a fundamental question: What could happen going forward that would cause you to substantially revise your views of how the economy operates and to acknowledge that the model you had been using was substantially flawed? As a vigorous advocate of fiscal expansion as an appropriate response to a major economic slump in an economy with zero or near-zero interest rates, I have for the last several years suggested that if the British economy – with its major attempts at fiscal consolidation – were to enjoy a rapid recovery, it would force me to substantially revise my views about fiscal policy and the workings of the macroeconomy more generally.


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- ESPN's Jackson wins Pro Football Hall's broadcasting award Associated Press - 10 minutes ago
CANTON, Ohio (AP) — ESPN broadcaster Tom Jackson has won the Pete Rozelle Radio-Television Award. More »ESPN's Jackson wins Pro Football Hall's broadcasting award
CANTON, Ohio (AP) — ESPN broadcaster Tom Jackson has won the Pete Rozelle Radio-Television Award.
- Harry Shearer back at 'The Simpsons' after contract dispute Associated Press - 13 minutes ago
- Whoopi Goldberg Defends Bill Cosby Amid New Revelations, Raven-Symone Reserves Judgment: "He Has Not Been Proven a Rapist" Us Weekly - 24 minutes ago
- Paula Deen's Latest Controversy: Brownface Access Hollywood - 29 minutes ago
- Kelly Rowland Joins 'Empire' for Season 2 The Wrap - 32 minutes ago
- CBS Corporation to Raise $800 Million for Stock Repurchase Plan The Wrap - 39 minutes ago
- Bill Cosby Accusers Call Deposition "A Game-Changer" The Hollywood Reporter - 44 minutes ago
Barbara Bowman and Joan Tarshis spoke to CNN's Don Lemon about the comedian's admission, in an unsealed court document, that he obtained drugs to give to women for sex.
- 'X-Files' Adds 'Flight of the Conchords' Star Rhys Darby to Cast The Wrap - 44 minutes ago
- TV Ratings: 'Bachelorette' Wins Another Monday The Hollywood Reporter - 45 minutes ago
The night's reality series hold steady after the holiday weekend.
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Remember Me
In addition beginning Tuesday, September 22, 2009, NPR Music will host an Exclusive First Listen of I and Love and You on their website, www.npr.org/firstlisten, where fans will be able to get a sneak peak of the new album a week prior to release. NPR Music's distinctive Exclusive First Listen series recently showcased new music from such innovators as Wilco, Moby, Bjork and Neko Case.
The story of The Avett Brothers has been told by word of mouth until now. Come witness what thousands have been loyally following and speaking about for years...
7/09 Norfolk, VA Harrison Opera House
7/10 Richmond, VA The National
7/11 Roanoke, VA Roanoke Performing Arts Theatre
7/12 Louisville, KY The Riverfront Belvedere
7/16 Saint Augustine, FL St. Augustine Amphitheatre
7/17 Lake Buena Vista, FL House of Blues
7/18 Tampa, FL The Cuban Club
7/19 Fort Lauderdale, FL Parker Playhouse
7/24 North Myrtle Beach, SC House of Blues
7/25 North Myrtle Beach, SC House of Blues
7/30 Buffalo, NY Lafayette Square
7/31 Syracuse, NY The Westcott
8/01 Newport, RI Fort Adams State Park (Newport Folk Festival)
8/02 Northampton, MA Calvin Theater
8/04 Dewey Beach, DE Bottle & Cork
8/08 Charlotte, NC Bojangles Coliseum
8/14 Ozark, AR Mulberry Mountain (Festival)
8/15 Kansas City, MO The Crossroads
8/16 Omaha, NE Sokol Auditorium/Underground
8/19 Telluride, CO Sunset Plaza @ Mountain Village
8/20 Steamboat Springs, CO Summer Concert Series (Howelson Hills Amp)
8/21 Boulder, CO Boulder Theater
8/22 Denver, CO Ogden Theatre
8/25 Salt Lake City, UT Red Butte Garden
8/26 Boise, ID Knitting Factory Concert House
8/28 Seattle, WA Paramount Theatre
8/29 Jacksonville, OR Britt Festival
8/30 San Francisco, CA Outside Lands Music Festival
9/01 Arcata, CA HSU Van Duzer Theater
9/03 Reno, NV Grand Sierra Theater
9/04 Camp Mather, CA Strawberry Music Festival
9/05 Los Angeles, CA Orpheum Theatre
9/17 North Charleston, SC North Charleston P.A.C.
9/18 Augusta, GA Westobou Festival/Riverwalk
9/19 Tallahassee, FL The Moon
9/20 Tuscaloosa, AL Bama Theatre
9/22 Oxford, MS The Lyric Oxford
9/24 Memphis, TN Minglewood Hall
9/25 Little Rock, AR Robinson Center Music Hall
9/26 Tulsa, OK Cain's Ballroom
9/27 Dallas, TX Granada Theater
9/29 Baton Rouge, LA Baton Rouge River Center Theatre
10/1 New Orleans, LA House of Blues
10/2 Austin, TX Austin City Limits
10/3 Midwest City, OK Rose State PAC
10/5 Murray, KY Lovett Auditorium Center
10/15 Baltimore, MD Rams Head Live
10/16 Philadelphia, PA Electric Factory
10/17 New York, NY Terminal 5
10/18 Boston, MA House of Blues
10/20 Iowa City, IA The Englert Theatre
10/21 Madison, WI Barrymore Theatre
10/22 Urbana, IL Canopy Club
10/29 Huntington, WV Keith Albee Theatre
10/30 Louisville, KY Louisville Palace
10/31 Nashville, TN Ryman Auditorium
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We have over 200 sales a week, starting at 12pm ET Monday-Saturday and 9pm ET on Wednesday and Sunday. Most sales last just 36 hours.
Standout styles with a globally inspired look and feel
Some of our favorite styles, for a steal
Texture and culture meet in these inspired designs


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Mönckeberg's sclerosis – is the artery the only target of calcification?
Department of Internal Medicine, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
BMC Cardiovascular Disorders 2005, 5:34 doi:10.1186/1471-2261-5-34Published: 12 December 2005
Since its first description, Mönckeberg's sclerosis has only been related to arterial media calcification, being listed among the primary diseases of the vessels.
Case presentation
We report here a clinically and histologically confirmed case of Mönckeberg's sclerosis in which the patient presented with massive areas of soft tissue calcifications in the pharynx and larynx. Polysomnographic parameters showed severe obstructive apnea refractory to nasal continuous positive airway pressure. Clinical and laboratory findings excluded concomitant endocrine or rheumatological diseases.
Our data provide a new insight about Mönckeberg's sclerosis, i.e., the fact that the etiopathogenic process involved in the phenomenon of calcification may not be restricted only to the arteries, but may occur in the entire organism. Further studies of the etiopathogenesis of this disease are needed.


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For most of us, a sore or scrape is nothing more than a minor, short-lived nuisance. But for people with diabetes, cuts and wounds can easily get infected and turn into a bigger health problem.
The mystery of blood sugar and wound healing
When diabetes is not kept in check, it can slow the healing of scratches and scrapes. This happens because of:
- Dry skin and other skin problems. High blood sugar levels cause your body to lose fluid. This can lead to dry, itchy, cracked skin. Germs can enter through the cracks and give you an infection.
- Higher risk for and problems fighting infections. People with diabetes are more likely than those without the disease to get bacterial, fungal and yeast infections. This is because diabetes weakens your immune system, so small skin breaks can turn into infected, open sores (ulcers). And high blood sugar levels harm the blood vessels throughout the body. Poor blood flow makes it difficult for blood to get to your hands and feet to fight off infections.
- Loss of feeling. Nerve damage can make you lose feeling in your feet. If you step on something sharp, you can get hurt and not know it. Nerve damage can also harm the joints and alter the shape of the foot. This change can make walking hard, and calluses and ulcers can form over new pressure points.
What to do when you spot a sore
Call your doctor right away when you see any skin breaks, calluses, ulcers, redness or a cut that isn't healing. Always follow your doctor's orders for treating a wound at home. Your doctor may suggest these steps for wound care:
- Wash your hands well with soap and water before caring for the wound.
- Clean out the wound with the solution your doctor suggests. To do this, apply the solution to gauze and use circular motions to cleanse the area. Clean the skin 1 inch beyond the wound on each side. Then dry the wound with a new piece of gauze.
- Apply all medicines your doctor recommends to the wound.
- Cover the wound with a sterile, clean dressing.
- Keep the wound covered with a bandage for as long as your doctor says to do so. Uncovering a wound to "air it out" has been shown to be harmful to healing. Wounds heal faster and better when they are kept covered and moist.
- Replace the dressing each day or as often as directed. Never reuse a bandage.
- Follow all other care instructions from your doctor, such as:
- Keeping pressure off the affected area. This is called "off-loading." You may need to use crutches, a wheelchair or special foot gear if you have a wound on the bottom of your foot.
- Taking medications as prescribed. Your doctor may prescribe antibiotics to treat an infection.
- Keep your blood sugar in check. High blood sugar levels can slow wound healing. Work with your doctor to get your blood sugar under control to reduce the risk of further complications.
Note that sometimes a hospital stay or surgery are needed to treat severe ulcers.
Contact your doctor if you think your wound is worsening.
How to avoid wounds
- Keep a close watch of your feet. Check your feet everyday and ask your doctor to look at them at each checkup. Let your doctor know when you notice any redness, calluses or skin injuries. Never try to remove a callus or corn on your own. Always get help from your doctor.
- Ask your doctor about special shoes. Special shoes can help people with diabetes avoid pressure points and prevent wounds.
- Prevent dry skin. Only bathe in warm water. Hot water dries out the skin. Use a skin moisturizer on your feet after you bathe and dry off. Do not put lotion in between your toes.
- Follow your diabetes care plan as directed by your doctor. Keeping your blood sugar in a healthy range cuts your risk for all diabetes complications, including infections.
- Get your feet evaluated. Follow your doctor's recommendations about periodic, comprehensive foot evaluations.
- Don't smoke. Smoking can make it more likely that foot wounds will lead to major complications
- Get immunized. Be sure you are up to date on your tetanus immunizations.
Created on 04/28/2011
Updated on 01/20/2012
- American Diabetes Association. Living with diabetes: Foot care.
- National Diabetes Information Clearinghouse. Prevent diabetes problems: keep your feet and skin healthy.
- Visiting Nurse Service of New York. Patient teaching guide: wound care handbook.
- California Podiatric Medical Association. What is a diabetic foot ulcer?


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There are approximately 1500 extant species in the Asteroidea. (Brusca and Brusca, 2003; Canada's Aquatic Environments, 2002)
Geographic Range
Mainly a marine group, asteroids are found in all the oceans. (Brusca and Brusca, 2003; Canada's Aquatic Environments, 2002)
- Biogeographic Regions
- arctic ocean
- indian ocean
- atlantic ocean
- pacific ocean
- mediterranean sea
Except for a few species which inhabit brackish waters, asteroids are benthic organisms found in marine environments. (Brusca and Brusca, 2003; Canada's Aquatic Environments, 2002; Waggoner, 1994)
- Habitat Regions
- saltwater or marine
- Aquatic Biomes
- brackish water
- Other Habitat Features
- intertidal or littoral
Physical Description
Asteroids can range from less than 2 cm to over one m in diameter, although the majority are 12 to 24 cm. Arms extend from the body from a central disk and can be short or long. A majority have 5 arms, although some can have up to 40. Calcareous ossicles make up the internal skeleton.
The water vascular system of the sea stars open up at the madreporite, a perforated opening in the central part of the animal. Internally, the madreporite leads to a stone canal, made up of skeletal deposits. The stone canal is attached to a ring canal which leads to each of the five (or more) radial canals. Tiedemann's bodies and polian vescicles are pouches on the ring canal whose function may be osmoregulation or hydraulic regulation within the water vascular system. Each radial canal ends in a terminal tube foot, which has a sensory function.
Each radial canal has a series of lateral canals that terminates at a tube foot. Each tube foot is made of an ampulla, podium, and usually a sucker.
The oral surface, under the central disc, is where the mouth is located. The hemal system parallels the water vascular system and probably distributes nutrients from the digestive tract. Hemal channels extend to the gonads.
Larvae are bilaterally symmetrical and adults are radially symmetrical. (Brusca and Brusca, 2003; Canada's Aquatic Environments, 2002)
- Other Physical Features
- ectothermic
- heterothermic
- bilateral symmetry
- radial symmetry
Asteroids are deuterostomes. Fertilized eggs develop into bilaterally symmetrical planktonic larvae, which have 3-part paired coeloms. Embryonic coelomic structures have specific fates as the bilaterally symmetrical larvae metamorphose into radially symmetric adults. Adult pheromones may attract larvae, which tend to settle near conspecific adults. Metamorphosis in some species is triggered by adult pheromones. After settling, the larvae go through a sessile stage and metamorphose. (Anonymous, 2005; Barnes, 1987; Brusca and Brusca, 2003; Canada's Aquatic Environments, 2002)
- Development - Life Cycle
- metamorphosis
Asteroids can regenerate arms and some can reproduce asexually as the central disc divides. In sexual reproduction, asteroids are mainly gonochoristic (having separate sexes), but a few are hermaphroditic. Asteroids usually have two gonads in each arm and a gonopore opening to the oral surface. Gonopores are usually at the base of each arm. Most asteroids are free spawners, releasing sperm and eggs into the water. A few hermaphroditic species brood their young. Spawning is probably nocturnal. (Brusca and Brusca, 2003; Canada's Aquatic Environments, 2002)
- Key Reproductive Features
- gonochoric/gonochoristic/dioecious (sexes separate)
- simultaneous hermaphrodite
- sexual
- asexual
- fertilization
- viviparous
- oviparous
Although there is generally no parental investment beyond fertilization, a few hermaphroditic species brood their eggs. Brooding species are usually found in environments that are harsh for the larval stage. (Brusca and Brusca, 2003; Canada's Aquatic Environments, 2002)
- Parental Investment
- provisioning
- female
- protecting
Some sea stars can live up to 35 years. (Canada's Aquatic Environments, 2002)
Asteroids move by using their water vascular system. Internal muscle contractions squeeze fluid to the tube feet, which then elongate. Cilia within the epithelium of the water vascular system moves the water. The end of the tube feet have suckers, which chemically adhere to the substrate. Another chemical bond is secreted to release the tube feet. Sea stars living on soft bottom substrates have pointed tube feet (rather than suckers) to help them move. (Brusca and Brusca, 2003; Canada's Aquatic Environments, 2002)
Communication and Perception
The non-centralized nervous system allows echinoderms to sense their environment from all sides. Sensory cells on the epidermis sense light, contact, chemicals and water currents. Higher densities of sensory cells are found in the tube feet and along feeding canal margins.
Red pigmented eye spots are found on the end of each arm. These function as photoreceptors and are clusters of pigment-cup occelli.
Adult pheromones may attract larvae, which tend to settle near conspecific adults. Metamorphosis in some species is triggered by adult pheromones. (Brusca and Brusca, 2003; Canada's Aquatic Environments, 2002)
- Communication Channels
- chemical
- Other Communication Modes
- pheromones
Food Habits
Asteroids are mainly scavengers and carnivores. In many areas where they are found they are high level predators. Asteroids feed on slow moving prey, including gastropods, bivalves, barnacles, polychaetes and other invertebrates. They feed by grasping the prey, then everting their stomach and secreting primary enzymes on the prey. The digestive juices break down the tissue of the prey, which the asteroids then suck up.
Some asteroids are suspension feeders. Plankton and organic detritus sticks to mucus on the body surface and is moved by cilia to the mouth. A few species that use their pedicellariae to capture prey may even feed on fish.
Asteroids have a complete digestive system. The mouth leads to the cardiac stomach, which is what the sea star everts to digest its prey. The cardiac stomach leads to a pyloric stomach. Digestive glands, or pyloric ceca located in each arm. Enzymes are secreted through pyloric ducts. A short intestine follows the pyloric stomach and leads to the anus. (Brusca and Brusca, 2003; Waggoner, 1994)
- Primary Diet
- piscivore
- eats non-insect arthropods
- molluscivore
- scavenger
- Foraging Behavior
- filter-feeding
Planktonic larval stages are probably the most vulnerable to predation. Calcareous ossicles probably discourage predation of the adults. Other predators include Hyperoodon ampullatus, the northern bottlenose whale. Asteroids can lose arms to predators and regenerate the arms later. (Brusca and Brusca, 2003)
- Known Predators
- northern bottlenose whales (Hyperoodon ampullatus)
Ecosystem Roles
Some asteroids, such as Acanthaster planci, have increased in population and damage coral reefs as a result of their grazing. Many asteroids are top predators and keystone species. (Brusca and Brusca, 2003; Canada's Aquatic Environments, 2002; Waggoner, 1994)
- Ecosystem Impact
- keystone species
Economic Importance for Humans: Negative
Asteroids can damage coral reefs. They can also be a problem to commercial oyster beds. (Canada's Aquatic Environments, 2002; Waggoner, 1994)
Other Comments
Since most all asteroids are marine, they are osmoconformers. There is probably some ionic regulation, but very little. Outpockets of the body wall, called papulae, function in gas exchange and waste excretion. Coelomocytes, specialized cells, accumulate waste and are then released at the distal ends of the papulae. (Brusca and Brusca, 2003; Canada's Aquatic Environments, 2002)
Renee Sherman Mulcrone (author).
- Arctic Ocean
the body of water between Europe, Asia, and North America which occurs mostly north of the Arctic circle.
- Atlantic Ocean
the body of water between Africa, Europe, the southern ocean (above 60 degrees south latitude), and the western hemisphere. It is the second largest ocean in the world after the Pacific Ocean.
- Pacific Ocean
body of water between the southern ocean (above 60 degrees south latitude), Australia, Asia, and the western hemisphere. This is the world's largest ocean, covering about 28% of the world's surface.
- asexual
reproduction that is not sexual; that is, reproduction that does not include recombining the genotypes of two parents
- bilateral symmetry
having body symmetry such that the animal can be divided in one plane into two mirror-image halves. Animals with bilateral symmetry have dorsal and ventral sides, as well as anterior and posterior ends. Synapomorphy of the Bilateria.
- brackish water
areas with salty water, usually in coastal marshes and estuaries.
- carnivore
an animal that mainly eats meat
- chemical
uses smells or other chemicals to communicate
- ectothermic
animals which must use heat acquired from the environment and behavioral adaptations to regulate body temperature
- external fertilization
fertilization takes place outside the female's body
- fertilization
union of egg and spermatozoan
- filter-feeding
a method of feeding where small food particles are filtered from the surrounding water by various mechanisms. Used mainly by aquatic invertebrates, especially plankton, but also by baleen whales.
- heterothermic
having a body temperature that fluctuates with that of the immediate environment; having no mechanism or a poorly developed mechanism for regulating internal body temperature.
- intertidal or littoral
the area of shoreline influenced mainly by the tides, between the highest and lowest reaches of the tide. An aquatic habitat.
- keystone species
a species whose presence or absence strongly affects populations of other species in that area such that the extirpation of the keystone species in an area will result in the ultimate extirpation of many more species in that area (Example: sea otter).
- metamorphosis
A large change in the shape or structure of an animal that happens as the animal grows. In insects, "incomplete metamorphosis" is when young animals are similar to adults and change gradually into the adult form, and "complete metamorphosis" is when there is a profound change between larval and adult forms. Butterflies have complete metamorphosis, grasshoppers have incomplete metamorphosis.
- molluscivore
eats mollusks, members of Phylum Mollusca
- motile
having the capacity to move from one place to another.
- native range
the area in which the animal is naturally found, the region in which it is endemic.
- nocturnal
active during the night
- oviparous
reproduction in which eggs are released by the female; development of offspring occurs outside the mother's body.
- pheromones
chemicals released into air or water that are detected by and responded to by other animals of the same species
- piscivore
an animal that mainly eats fish
- radial symmetry
a form of body symmetry in which the parts of an animal are arranged concentrically around a central oral/aboral axis and more than one imaginary plane through this axis results in halves that are mirror-images of each other. Examples are cnidarians (Phylum Cnidaria, jellyfish, anemones, and corals).
- saltwater or marine
mainly lives in oceans, seas, or other bodies of salt water.
- scavenger
an animal that mainly eats dead animals
- sexual
reproduction that includes combining the genetic contribution of two individuals, a male and a female
- tactile
uses touch to communicate
- viviparous
reproduction in which fertilization and development take place within the female body and the developing embryo derives nourishment from the female.
Anonymous, 2005. "Class Asteroidea" (On-line). Accessed January 26, 2005 at http://www.encyclopedia.com/html/section/Echinode_ClassAsteroidea.asp.
Barnes, R. 1987. Invertebrate Zoology. Orlando, Florida: Dryden Press.
Brusca, R., G. Brusca. 2003. Invertebrates. Sunderland, Massachusetts: Sinauer Associates, Inc..
Canada's Aquatic Environments, 2002. "Asteroidea" (On-line). Invertebrates. Accessed January 26, 2005 at http://www.aquatic.uoguelph.ca/inverts/diver/marine/echinodermata/astero.htm.
Waggoner, B. 1994. "Introduction to the Asteroidea" (On-line). Accessed January 26, 2005 at http://www.ucmp.berkeley.edu/echinodermata/asteroidea.html.


text:
Eduardo Coutinho (São Paulo, 1933) is an essential name in Latin American documentary film. His work is shaped by political issues but manages to avoid propaganda, as he addresses the everyday lives and subjectivities of marginal majorities with a sensibility not altered by melodrama. This retrospective, the most extensive to date, presents a body of work that ranges from the context of Cinema Novo to the analysis of fiction in contemporary film.
Eduardo Coutinho (São Paulo, 1933) is an essential name in Latin American documentary film. His work is shaped by political issues but manages to avoid propaganda, as he addresses the everyday lives and the subjectivities of marginal majorities with a sensibility not altered by melodrama. Coutinho has performed his professional activity in several fields, including law, theatre, and both print and television journalism. His first contact with film occurred when he was the editor of the magazine Visão. His work with the television staff of Globo Repórter, for decades the most popular documentary program in Brazil, enabled him, despite the censorship in place at the time, to conduct in-depth documentation on numerous topics: the drought and the harshness of agricultural work, the banditry plaguing the north-eastern part of the country, the lives of public figures, such as Colonel Teodorico Bezerra and the painter Cándido Portinari, among others.
After the success of his documentary Cabra marcado para morrer (1984), highly praised by critics all over the world (and the winner of the Grand Coral, the top prize at the Havana Film Festival as well as the Golden Toucan in Río de Janeiro), Coutinho left the staff of Globo Repórter to work in the production of video documentaries and to write scripts for series made by TV Manchete. At the same time, he made his own documentaries, creating works such as O Fio da Memória which, coinciding with the centennial of the abolition of slavery, analyses the presence of black people in Brazilian culture and history. Other films of his include Boca do Lixo, Santa Marta-duas semanas no Morro, O Jogo da Dívida and Romeiros do Padre Cícero. Starting in 1999, Coutinho returned to feature-length films in digital video (later transferred to 35 mm) and he directed films such as Santo Forte, Babilônia 2000, Edifício Master, Jogo de cena and As Cançoes.
Coutinho's cinema has been defined by Consuelo Lins from the perspective of "the ethics of cruelty" but not in the sense of maintaining or showing suffering, but rather in that of rejecting complacency in his relationship with the subjects or situations he shows throughout his filmmaking career.
Activity´s details
Museo Reina Sofía
Festival Punto de Vista, the Embassy of Brazil, Spanish-Brazilian Culture Foundation and ECAM (Film and Audiovisual School of the Community of Madrid)
Videofilmes, Brasil
35 mm copy of Cabra marcado para morrer from the Cinemateca Brasileira


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SAVANNAH, Ga. (AP) — Two dogs rescued near the edge of death more than a month ago have joined the Chatham County Sheriff's Office Operation New Hope program to give them another shot at life.
Dogs rescued in Bryan County find a home in jail
Charlie and Lola were in such bad condition when they were found on Oct. 3 along U.S. 17 in Bryan County that they had to undergo a series of medical treatments to restore their weight and health. Now they will be trained by jail inmates to hopefully transition them into normal lives.
Recently, Jeffrey Oliver and Jermaine Ladson, Chatham County jail inmates, greeted their new roommates for the first time. The dogs were active and friendly toward their new handlers.
"They help us just as much as we help them," Oliver, 56, said while petting Charlie.
In April, Operation New Hope began as a way to allow low-risk inmates to train six to eight unadoptable dogs at a time from the Humane Society for Greater Savannah, teaching them basic commands and behavior skills. At the conclusion of the four-week program the dogs are typically put up for adoption.
Sgt. Roberts Brooks said the idea came from his wife, Petra, a Liberty County Animal Control volunteer, who told him about similar programs at other sheriff's offices. Brooks said Sheriff Al St Lawrence was receptive to the idea.
"It benefits the inmates by primarily teaching them some responsibility," said Brooks.
The program is funded by the humane society at no cost to taxpayers, he said.
Guinn Friedman, director of operations for the humane society, said the inmates receive training from the humane society and do a good job working with the dogs that live with them 24 hours a day.
Continue reading this story on the...


text:
Living Psychoanalysis
From theory to experience
By Michael Parsons
Routledge – 2014 – 264 pages
Routledge – 2014 – 264 pages
Living Psychoanalysis: From Theory to Experience represents a decade of work from one of today's leading psychoanalysts. Michael Parsons brings to life clinical psychoanalysis and its theoretical foundations, offering new developments in analytic theory and vivid examples of work in the consulting room. The book also explores connections between psychoanalysis, art and literature, showing how psychoanalytic insights can enrich our lives far beyond the clinical situation.
Living Psychoanalysis comprises four main sections:
Life and Death – asks what it means to be fully and creatively alive, and introduces the concept of avant-coup
Sexuality, Narcissism and the Oedipus complex – develops fresh ways of understanding these key concepts
How analysts listen – explores links between psychoanalytic listening and the way artists look at the world, and introduces the concept of the internal analytic setting
The Independent tradition in British psychoanalysis – considers the theoretical foundations of Independent clinical technique, and discusses from various perspectives the role of training in developing the identity of analysts and analytic therapists
With fresh theoretical concepts and a focus on specific aspects of clinical practice, Living Psychoanalysis: From Theory to Experience will be a valuable resource for analysts, therapists and professionals who wish to extend their vision of psychoanalysis. It will also be of great interest to general readers concerned to deepen their understanding of the links between culture and the mind.
"The language of the Independent tradition in British psychoanalysis, carried by Donald Winnicott, Marion Milner, Nina Coltart and many others, has always been non-dogmatic, lyrically tentative, close to the heart of the life of being an analyst. Like a deep, familiar drum the voice of Michael Parsons speaks from within that tradition. He ranges widely and deeply from clinical issues to theoretical axioms, to works of art and literature, and further afield, always remaining close to experience. Independent thinking lives on in this profound and creative work." – Christopher Bollas, psychoanalyst.
"The psychoanalyst Donald Winnicott noticed that a regular outcome of psychoanalytic treatment was an enhanced sense of being alive. And he came to think this ought to be an aim of psychoanalysis: to help analsands recover their own lost sense of vibrancy. In Living Psychoanalysis, Michael Parsons takes up this idea with nuance, sensitivity and rich clinical detail. He shows us how crucial it is for human life itself that we be able to celebrate life via our capacity for feeling alive." - Jonathan Lear, The University of Chicago.
Introduction. Part 1: Between Death and the Primal Scene.Keeping Death Alive. Why Did Orpheus Look Back? Après-Coup, Avant-Coup. Appendix: More About Memory. In Defence of the Uncanny. Part 2: Concepts on the Move. Sexuality and Perversion: Discovering What Freud Discovered. Oedipal Disidentification: Au Nom Du Fils, Au Nom De La Fille.Narcissism as Prison, Narcissism as Springboard: A Reading of Sophocles' Ajax. Part 3: The Activity of Listening. Listening Out, Listening In, Looking Out, Looking In. The Analyst's Countertransference to the Psychoanalytic Process .Raiding the Inarticulate: Internal Setting, Beyond Countertransference. Part 4: Clinical Practice Taking Shape. What Does Interpretation Put Into Words? An Independent Theory of Clinical Technique. Forming an Identity: Reflections on Psychoanalytic Training.
Michael Parsons is a Training Analyst of the British Psychoanalytical Society and a member of the French Psychoanalytic Association. With more than thirty years of experience in his field, he teaches and lectures all over the world. He is the author of The Dove that Returns, The Dove that Vanishes: Paradox and Creativity in Psychoanalysis (Routledge, 2000).
Name: Living Psychoanalysis: From theory to experience (Paperback) – Routledge
Description: By Michael Parsons. Living Psychoanalysis: From Theory to Experience represents a decade of work from one of today's leading psychoanalysts. Michael Parsons brings to life clinical psychoanalysis and its theoretical foundations, offering new developments in...
Categories: Psychoanalysis


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off the sofa(7 Posts)
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text: On my 2nd pair of Sennhieser and it appears yet again that the left side of them is losing audio. Was curious to know if the PSP (3000 to be exact) can use wireless headphones. Issues with wireless headphones? I presume it's the PSP GO that can only use bluetooth. Can the Vita? If I eventually get it (after a price drop and a color I want) I'd be curious to know how it handles music compared to the PSP.


text:
In the end, I suspect, we will all be a little too reticent for a brother-to-brother presidential transition. So maybe he's the No. 2 this time around. Romney-Bush? Allen-Bush? Either match-up would give you a tested executive powerhouse -- Mitt Romney and George Allen have served as governors, of Massachusetts and Virginia, respectively. Others will suggest McCain-Bush, teaming him up with the Arizona senator.
If Bush's only reason for not running for president in 2008 -- or any other year -- comes down to his being a Bush, that would be a shame. There's nothing in the Constitution prohibiting people who have too many family members who've been elected to the job. Nor should there be. As one Floridian recently e-mailed me, "I'm against these familial dynasties, but in the Bushes' case, they've saved the best for last, and I see no reason to punish ourselves by not electing a capable Jeb, just because his father and brother were mixed successes at best."
Scarborough flips out: Why are these GOP candidates so damned gloomy about America's prospects? | Allahpundit


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Textural ring set in 18K yellow gold and oxidized silver. Bezel set 4x6mm cabachon cushion shaped peridot.
Hinged bangle bracelet hand-fabricated from oxidized sterling silver, 18K gold and peridot. Fits up to a 7.5" circumference wrist. Signed on the inside
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- Article
- Web sites
- Contributors
External Web sites
Britannica Web sites
Articles from Britannica encyclopedias for elementary and high school students.
- Telescopium - Student Encyclopedia (Ages 11 and up)
In astronomy, Telescopium refers to a constellation of the Southern Hemisphere bounded by the constellations Ara, Pavo, Indus, Microscopium, Sagittarius, and Corona Australis. It was created and named by Nicolas Louis de Lacaille when he mapped parts of the southern skies during his stay at the Cape of Good Hope from 1751 to 1752. The constellations Lacaille delineated are Antlia, Caelum, Circinus, Fornax, Horologium, Mensa, Microscopium, Norma, Octans, Pictor, Pyxis, Reticulum, Sculptor, and Telescopium. Lacaille's catalog of southern stars, Coelum Australe Stelliferum, was published posthumously in 1763. Telescopium is shown as an aerial telescope in Johann Bode's 1801 publication Uranographia under the name of Tubus Astronomicus. The constellation was later restricted to an area east of Ara and south of the Corona Australis and Sagittarius.


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Each week The Sun's John McIntyre presents a moderately obscure but evocative word with which you may not be familiar — another brick to add to the wall of your working vocabulary. This week's word:
The word, pronounced jak-tuh-TAY-shun, comes from the Latin verb jactare, "to throw." In jactitation, your limbs are thrown about without your volition.
There is a specialized legal meaning of the word as well growing out of a sense of a boastful public declaration — to "throw out" a statement. Garner's Dictionary of Legal Usage says that it narrowly meant to make of false declaration of marriage to someone but has since taken on broader usage.
Example: She's also prone to hypnagogic jactitation, which means she twitches abruptly as she's falling asleep.


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Learn how to build rich, HTML-based websites with Adobe Muse, the web design tool.
Shows how to use InDesign to add animation and interactivity to digital documents.
"Through lynda.com, I have learned website design from scratch, enabling me to begin the journey of working from home. Thank you for everything!" —Pat H.
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text:
Press release from Business Wire
Law Offices of Howard G. Smith Announces Class Action Lawsuit Against Tile Shop Holdings, Inc.
Wednesday, November 27, 2013
Law Offices of Howard G. Smith Announces Class Action Lawsuit Against Tile Shop Holdings, Inc.21:32 EST Wednesday, November 27, 2013
BENSALEM, Pa. (Business Wire) -- Law Offices of Howard G. Smith announces that a class action lawsuit has been filed in the United States District Court for the Southern District of New York on behalf of a class (the "Class") comprising all purchasers of the securities of Tile Shop Holdings, Inc. ("Tile Shop" or the "Company") (NASDAQ:TTS) between August 22, 2012 and November 13, 2013, inclusive (the "Class Period").
Tile Shop operates as a specialty retailer of manufactured and natural stone tiles, setting and maintenance materials, and related accessories in the United States. The Complaint alleges that throughout the Class Period the defendants made false and/or misleading statements and failed to disclose material adverse facts about the Company's business, operations and financial performance.
On November 14, 2013, Gotham City Research LLC, issued a report alleging that Tile Shop had inflated its 2013 earnings by 200% as a result of an undisclosed third-party relationship with a China-based supplier, Beijing Pingxiu. The Gotham Research report further alleges that Beijing Pingxiu accounts for 20-30% of Tile Shop's cost of goods sold, that it is controlled by a relative of a Tile Shop executive, and that the Company "has used its China-based undisclosed related party and improper accounting to overstate profits."
If you are a member of the Class described above you may move the Court no later than January 14, 2014, to serve as lead plaintiff; however, you must meet certain legal requirements. To be a member of the Class you need not take any action at this time; you may retain counsel of your choice or take no action and remain an absent member of the Class. If have any questions concerning this Notice or your rights or interests with respect to these matters, please contact Howard G. Smith, Esquire, of Law Offices of Howard G. Smith, 3070 Bristol Pike, Suite 112, Bensalem, Pennsylvania 19020 by telephone at 215-638-4847, Toll-Free at 888-638-4847, or by email to firstname.lastname@example.com, or visit our website at http://www.howardsmithlaw.com.
Law Offices of Howard G. Smith
Howard G. Smith, Esquire


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