text:
Apparatus and methods are provided for use in sealing a vascular puncture site. The invention comprises an introducer sheath with an integrated closure component. The closure component includes a fastener and an advanceable, deformable clip having a delivery configuration in which opposing sides do not contact one another, and a deployed configuration, in which the fastener causes opposing sides of the deformable clip to close towards one another. The clip is advanced along the sheath until it pierces opposing sides of a vessel wall at a puncture site. The clip is then deformed with the fastener to draw opposing sides of the puncture together, and the sheath is withdrawn to seal the wound. The clip and fastener preferably are bioabsorbable.
1. Apparatus for sealing a puncture in a vessel wall comprising:
an introducer sheath having proximal and distal regions and an exterior surface;
a housing slidably disposed on the exterior surface of the introducer sheath, the housing including a lumen; and
a closure component comprising a clip and a fastener,
the clip having a delivery configuration, in which the clip is slidably accepted within the lumen, and a deployed configuration, wherein the fastener causes opposing sides of the clip to become directed inwards towards one another, to engage and close the puncture.
2. The apparatus of
3. The apparatus of
4. The apparatus of
5. The apparatus of
6. The apparatus of
7. The apparatus of
8. The apparatus of
9. The apparatus of
10. The apparatus of
11. The apparatus of
12. The apparatus of
13. The apparatus of
14. The apparatus of
15. A method of sealing a puncture in a vessel wall, the method comprising:
providing apparatus comprising an introducer sheath having proximal and distal regions and a lumen extending therebetween, a housing slidably and coaxially disposed on the proximal region of the introducer sheath, and a closure component comprising a deformable clip and a fastener;
inserting the distal region of the introducer sheath through a patient's skin into a vessel via the puncture;
performing an interventional or diagnostic procedure by advancing a device through the lumen of the introducer sheath;
advancing the clip and housing through the skin until the clip pierces the vessel wall on opposing sides of the puncture;
deforming the clip with the fastener; and
withdrawing the introducer sheath and housing to seal the puncture.
16. The method of
17. The method of
18. The method of
19. The method of
20. The method of
This application is a continuation-in-part of U.S. patent application Ser. No. 09/478,179 filed Jan. 5, 2000, now U.S. Pat. No. 6,197,042.
The present invention relates to apparatus and methods for sealing an iatrogenic puncture in a vessel formed in conjunction with a diagnostic or therapeutic treatment. More particularly, the present invention provides apparatus comprising an introducer sheath including a puncture site closure device comprising a bioabsorbable clip.
Catheterization and interventional procedures, such as angioplasty and stenting, generally are performed by inserting a hollow needle through a patient's skin and muscle tissue into the vascular system. A guide wire then is passed through the needle lumen into the patient's blood vessel. The needle is removed and an introducer sheath is advanced over the guide wire into the vessel. A catheter typically is passed through the lumen of the introducer sheath and advanced over the guide wire into position for a medical procedure. The introducer sheath therefore facilitates insertion of various devices into the vessel while minimizing trauma to the vessel wall and minimizing blood loss during a procedure.
Upon completion of the medical procedure, the catheter and introducer sheath are removed, leaving a puncture site in the vessel. Commonly, external pressure is applied until clotting and wound sealing occurs. However, this procedure is time consuming and expensive, requiring as much as an hour of a physician's or nurse's time, is uncomfortable for the patient, and requires that the patient be immobilized in the operating room, cathlab, or holding area. Furthermore, a risk of hematoma exists from bleeding prior to hemostasis.
Various apparatus have been developed for percutaneously sealing a vascular puncture by occluding or suturing the puncture site. For example, U.S. Pat. Nos. 5,192,302 and 5,222,974 to Kensey et al. describe the use of a biodegradable plug delivered through the introducer sheath into the puncture site. When deployed, the plug seals the vessel and provides hemostasis. Such devices have been slow to gain acceptance in the medical community, however, due to difficulties encountered in positioning the plug within the vessel.
Another previously known technique comprises percutaneously suturing the puncture site with specialized apparatus. Such apparatus is described, for example, in U.S. Pat. No. 5,304,184 to Hathaway et al. While percutaneous suturing devices may be effective, a significant degree of skill may be required on the part of the practitioner. Because such devices are mechanically complex, they tend to be relatively expensive to manufacture.
Surgical staples and resilient clips for external skin wound closure are well known in the art, Examples include U.S. Pat. No. 5,026,390 to Brown and U.S. Pat. No. 5,683,405 to Yacoubian et al, which both describe resiliently deformable closure devices suitable for manual external application.
To reduce the cost and complexity of percutaneous puncture closure devices, such devices employing resilient or deformable clips have been developed. U.S. Pat. No. 5,478,354 to Tovey et al. describes the use of resilient clips in conjunction with a trocar to close abdominal puncture wounds. U.S. Pat. No. 5,810,846 to Virnich et al. describes a specialized apparatus for closing a vascular puncture site with a plastically deformable clip. The apparatus preferably is advanced over a guide wire through a cannula to the surface of the puncture site, where the staple-like clips are delivered to close the wound.
U.S. Pat. No. 5,782,861 to Cragg et al. describes specialized apparatus for closing a puncture site with a detachable clip. The apparatus comprises a hollow shaft having a distal end formed with one or more opposed pairs of resilient grasping prongs and that is advanced over a guide wire through a coaxial hollow tube to a position at the distal end of the tube just proximal of the puncture. The grasping prongs are extended beyond the distal end of the tube to grasp the vessel on opposing sides of the puncture. The shaft then is partially retracted, causing the prongs to contract within the tube, thereby sealing the puncture site.
The percutaneous puncture closure devices described in the foregoing patents have the drawback that a separate device must be deployed through the introducer sheath to close the puncture site, thus prolonging the procedure. Moreover, these devices generally require relatively complex apparatus and involve time consuming manipulation to achieve hemostasis.
In view of the foregoing, it would be desirable to provide apparatus and methods suitable for vascular puncture closure that overcome the disadvantages of previously known devices.
It also would be desirable to provide apparatus and methods that quickly and effectively achieve hemostasis.
It further would be desirable to provide vascular puncture closure apparatus and methods that do not require the introduction of additional apparatus at the completion of the catheterization procedure to achieve closure.
It still further would be desirable to provide apparatus and methods wherein all foreign materials left in a patient's body are bioabsorbable.
It would be desirable to provide vascular puncture closure apparatus and methods that are safe, lower cost, and easy to use.
In view of the foregoing, it is an object of the present invention to provide vascular puncture closure apparatus and methods that overcome disadvantages of previously known devices.
It also is an object of this invention to provide apparatus and methods suitable for vascular puncture closure that quickly and effectively achieve hemostasis.
It is a further object of the present invention to provide apparatus and methods for vascular puncture closure that do not require the introduction of additional apparatus at the completion of the catheterization procedure to achieve closure.
It is still further an object of the present invention to provide apparatus and methods wherein all foreign materials left in a patient's body are bioabsorbable.
It is yet another object of the present invention to provide vascular puncture closure apparatus and methods that are safe, lower cost, and easy to use.
These and other objects of the present invention are accomplished by providing a vascular introducer sheath having an integrated wound closure component. The closure component consists of a bioabsorbable and deformable clip with a bioabsorbable fastener and is disposed on and advanceable over the exterior of the introducer sheath in an expanded delivery configuration until opposite sides of the clip pierce a vessel on opposite sides of a puncture site. The clip is then mechanically deformed with the fastener into a deployed configuration, thereby drawing opposite sides of the puncture together and closing the wound. Means also are provided for confirming when the bioabsorbable clip has engaged the vessel wall to indicate to the surgeon that the clip may be deployed and the introducer sheath may be withdrawn.
In a preferred embodiment, the bioabsorbable clip resembles an inverted "Y" with pointed ends that puncture the vessel to be closed. The fastener comprises a bioabsorbable locking collar that may be advanced down the length of the clip to bring the pointed ends together.
In a second embodiment, the bioabsorbable clip comprises a hoop with pointed legs extending therefrom. The hoop has two points of reduced thickness spaced 180 degrees apart on the circumference of the hoop. The fastener comprises a bioabsorbable conical wedge that is pushed down into the hoop to force opposing sides of the hoop towards one another and bring the pointed legs together.
Advantageously, the wound closure component of the present invention is inexpensively integrated into a standard-size introducer sheath, thereby eliminating the need for a separate closure device at the conclusion of a catheterization procedure. The present invention provides quick, safe, effective, and easy-to-use apparatus for achieving vascular closure that overcome drawbacks of previously known devices. Methods of using the apparatus of the present invention also are provided.
The above and other objects and advantages of the present invention will be apparent upon consideration of the following detailed description, taken in conjunction with the accompanying drawings, in which like reference characters refer to like parts throughout, and in which:
FIG. 1 is a side view of an integrated vascular device constructed in accordance with the present invention;
FIGS. 2A-2C are, respectively, a cross-sectional view of a closure component of the vascular device of FIG. 1, an exploded side view of proximal slots of the closure component, and an exploded side view of distal slots;
FIGS. 3A-3C are, respectively, views of a bioabsorbable clip and fastener of the present invention shown in top view in a delivery configuration, in side view in the delivery configuration, and in side view in a deployed configuration;
FIGS. 4A and 4B are isometric views of an alternative embodiment of the bioabsorbable surgical clip and fastener, constructed in accordance with the present invention and shown, respectively, in a delivery configuration and in a deployed configuration; and
FIGS. 5A-5B through 8A-8B are side-sectional views of the closure component of FIG. 2A in use at a vascular puncture site, with corresponding side views of the proximal and distal slots of FIGS. 2B and 2C, illustrating a method of sealing the puncture site with the present invention.
The integrated vascular introducer sheath with closure component of the present invention overcomes disadvantages associated with previously known methods and apparatus for sealing a vascular puncture by providing a quick, simple, safe, lower cost, effective, and easy-to-use solution to wound closure. Apparatus constructed in accordance with the present invention provide vascular introduction and wound closure in a single device, eliminating the time and manipulation required to insert a separate closure device at the completion of a procedure.
Referring to FIG. 1, a first embodiment of apparatus of the present invention is described. Vascular device 10 comprises introducer sheath 12 coupled to hub 14, clip housing 16 and clip actuator 18. A closure component 20, as described in detail hereinbelow, is disposed in clip housing 16.
Introducer sheath 12 comprises a material typically used for vascular introducer sheaths, such as polyethylene or nylon, and includes central lumen 13 through which other interventional devices may be introduced into the vasculature, for example, to perform a diagnostic or interventional procedure such as angiography, angioplasty, or stenting.
Hub 14 is mounted to the proximal end of introducer sheath 12 and includes side port 22, actuator lumens 24, closure lumens 26, backbleed lumens 28, backbleed tubes 30, and device port 32. Device port 32 communicates with central lumen 13 of introducer sheath 12, and has self-sealing elastomeric membrane 33 disposed across it. Self-sealing membrane 33, which may comprise, e.g., latex or a biocompatible synthetic rubber, permits interventional devices to be introduced through device port 32, while preventing blood loss through central lumen 13. Side port 22 of hub 14 is also in communication with central lumen 13, and is connected to hemostatic port 34 via biocompatible tubing 36.
Clip housing 16 includes two lumens, as described hereinbelow, that each hold a bioabsorbable, deformable clip. In accordance with the principles of the present invention, clip housing 16 is slidably disposed on the exterior of introducer sheath 12 and is movable from a stowed position, adjacent hub 14, to a distal clip deployment position, where the bioabsorbable clip is urged into engagement with tissue surrounding a vascular puncture. Clip housing 16 prevents the clips from snagging on tissue during advancement of clip housing 16.
Clip actuator 18 comprises plunger 38 and rods 40, which are configured to slidably pass through actuator lumens 24 of hub 14. Plunger 38 further includes openings 39. The distal ends of rods 40 are mounted in clip housing 16, so that movement of plunger 38 causes corresponding proximal or distal movement of clip housing 16. As described in detail hereinafter, when plunger 38 is moved to its proximal-most position, clip housing 16 is disposed adjacent to hub 14 and provides adequate clearance for interventional devices to be inserted through device port 32 and central lumen 13 into the patient's vasculature. When moved to its distal-most position, plunger 38 causes rods 40 to urge clip housing 16 distally.
Referring now also to FIGS. 2, closure component 20 of vascular device 10 is described in greater detail. Clip housing 16 comprises lumen 42 that slidably receives introducer sheath 12, rod bores 41 (see FIG. 1) in which rods 40 are mounted, clip lumens 44 in which bioabsorbable clips 46 are housed and advanced to a puncture site, pin holes 48 for rigidly receiving distal pins 50, and backbleed indicator ports (not shown, out of the plane of the cross-section of FIG. 2A) that are coupled to backbleed tubes 30 via blood lumens 31.
Closure component 20 further comprises caps 52 with pin holes (not shown, out of the plane of the cross-section of FIG. 2A) configured to receive proximal pins 54, clip holders 56 attached to bioabsorbable clips 46, and locking collar drivers 58 configured to advance fasteners 60. Locking collar drivers 58 are slidably received within lumens 39 of plunger 38, closure lumens 26 of hub 14, and clip lumens 44 of clip housing 16. Drivers 58 further comprise lumens 59 and square clip bores 47, in which clip holders 56 and clips 46, respectively, are slidably received. Bores 47 are of square cross section.
As illustrated in FIG. 2B, locking collar drivers 58 comprise proximal driver slots 62 that communicate with lumens 59, while clip holders 56 comprise proximal holder slots 64. Proximal pins 54, mounted in caps 52, pass through and are slidably received within slots 62 and 64. As seen in FIG. 2C, locking collar drivers 58 further comprise distal driver slots 66 that communicate with lumens 59, while clip holders 56 further comprise distal holder slots 68. Distal pins 50, mounted in clip housing 16, pass through and are slidably received within slots 66 and 68.
As discussed hereinabove, backbleed indicator ports (not shown) are coupled to backbleed tubes 30 via blood lumens 31 that extend through clip housing 16. Backbleed tubes 30 are slidably disposed through backbleed lumens 28 of hub 14. When the distal end of clip housing 16 is advanced distally against a vessel wall at a vascular puncture, blood enters the backbleed indicator ports and exits through tubes 30, providing visual confirmation to an operator that the distal end of clip housing 16 is positioned adjacent to the vessel wall. Backbleed tubes 30 thus enable the operator to determine when clip housing 16 has been sufficiently advanced to permit clip deployment, while reducing the risk that the clip is either deployed short of the puncture site or extended into the vessel.
In conjunction with clip deployment, a bioglue or tissue sealant may be delivered through hemostatic port 34, biocompatible tubing 36, side port 22 and central lumen 13 of introducer sheath 12 to the vascular puncture to further help seal the vessel after deployment of clips 46. Alternatively, the bioglue or tissue sealant may be delivered through device port 32 or through the backbleed path described above.
With reference now to FIGS. 3A-3C, bioabsorbable clip 46 and fastener 60 are described in greater detail. FIG. 3A shows clip 46 in the delivery configuration. Clip 46 comprises curved legs 70 and proximal end 72. Legs 70 distally terminate at spikes 74 with optional engagement means 76, and proximally terminate at narrowed region 78. Engagement means 76 may comprise, for example, barbs or hooks. As seen in FIG. 2A, proximal end 72 attaches to clip holder 56 by, for example, adhesive, and is slidably received by square clip bore 47 of locking collar driver 58. As with bore 47, clip 46 is of substantially square cross section.
Fastener 60 comprises bioabsorbable locking collar 80, which is slidably received on the exterior of clip 46. As seen in FIG. 3B, locking collar 80 may be distally advanced down the exterior of clip 46 to deform the clip to its deployed configuration, wherein curved legs 70 and spikes 74 are drawn together. Clip 46 may then be separated from clip holder 56 by rotating proximal end 72 with respect to legs 70, causing the clip to snap into two pieces at narrowed region 78, for the reasons described hereinafter. Clip 46 and locking collar 80 preferably are fabricated from bioabsorbable materials, such as polyglycolic acid.
Referring to FIGS. 4, an alternative embodiment of the closure component of the present invention is described. Closure component 90 comprises bioabsorbable clip 92 and fastener 94. Clip 92 comprises proximal hoop 96 with narrowed regions 98, and legs 100 terminating in spikes 102. Fastener 94 comprises bioabsorbable wedge 104. Wedge 104 has a diameter substantially equal to the diameter of hoop 96 at its distal end, the diameter tapering to a maximum diameter at the proximal end of wedge 104. Clip 92 therefore may be deformed from the delivery configuration of FIG. 4A to the deployed configuration of FIG. 4B, wherein legs 100 and spikes 102 are drawn together, by advancing wedge 104 into hoop 96 to deform clip 92 at narrowed regions 98. Lumen 106 extends through hoop 98 of clip 92, while lumen 108 extends through wedge 96. Clip 92 and wedge 96 therefore are configured for delivery over the exterior of an introducer sheath. The clip and wedge preferably are fabricated from bioabsorbable materials.
With reference to FIGS. 5A-5B through 8A-8B, in conjunction with FIGS. 1-3, methods of using vascular device 10 are described. Introducer sheath 12 is advanced through skin, fat, and muscle tissue into vessel V, through vascular puncture P, which is formed in accordance with well-known techniques. Vascular device 10 is used in the same manner as a standard introducer sheath, with instruments being advanced into the vessel via lumen 13. Specifically, with plunger 28 and rods 40 in the proximal-most, fully retracted position, an interventional procedure then is performed by introducing one or more interventional devices, e.g. angioplasty balloons, stent delivery systems, atherectomy devices, etc., through device port 32 and lumen 13 of introducer sheath 12 in accordance with well-known techniques. Side port 22 may be used to infuse fluids, e.g., contrast agents or medications, into the vessel through introducer sheath 12 during the interventional procedure.
Upon completion of the procedure, vascular device 10 advantageously may be used to close vascular puncture P. At this point, clip actuator 18, clip housing 16, and closure component 20 with clips 46, are disposed in the proximal-most position adjacent to hub 14.
Clip actuator 18 then is advanced by urging plunger 38 in the distal direction, thus causing rods 40 to slide through actuator lumens 24 of hub 14 and advance clip housing 16. Distal pins 50, mounted in housing 16, abut distal slots 66 and 68 of drivers 58 and holders 56, respectively. Thus, distal advancement of clip housing 16 also distally advances closure component 20. Continued distal advancement of plunger 38 causes the distal end of clip housing 16 to abut against the exterior of the vessel, so that the back bleed indicator ports (not shown) of clip housing 16 directly communicate with the puncture wound. The presence of pressure in the vessel higher than atmospheric pressure causes blood to pass through the indicator ports, through blood lumens 31, and exit through the proximal ends of tubes 30, thus confirming that clip housing 16 is positioned at the puncture site and should not be advanced further.
FIG. 5B illustrates closure component 20 via sectional views through clip housing 16 along planes parallel to introducer sheath 12. FIG. 5A shows the locations of proximal pins 54 within proximal slots 62 and 64, and the locations of distal pins 50 within distal slots 66 and 68, corresponding to the relative longitudinal positions of clip holders 56 and locking collar drivers 58 depicted in FIG. 5B. Pin locations are shown via side views of clip holders 56 and locking collar drivers 58 at the relevant locations.
As seen in FIGS. 5A and SB, with clip housing 16 positioned at puncture site P, proximal pins 54, mounted in caps 52, are positioned at the extreme right of proximal driver slots 62 and of the circumferential portions of proximal holder slots 64. Distal pins 50 are located at the distal end of distal driver slots 66 and of the longitudinal portions of distal holder slots 68.
In FIGS. 6A and 6B, with clip housing 16 held immobile, force is applied to caps 52 to distally advance clips 46 with respect to housing 16. Specifically, proximal pins 54 abut and apply force against proximal slots 62 and 64, which advances drivers 58 and clip holders 56, as well as attached clips 46 and locking collars 80. Distal pins 50 move freely within distal slots 66 and the longitudinal portions of distal slots 68. Distal advancement of clips 46 continues until pins 50 abut against the proximal end of the longitudinal portions of distal holder slots 68 of clip holders 56. Drivers 58 likewise are restrained by their connection to clip holders 56 via proximal pins 54. The tissue-engaging members, spikes 74 and engagement means 76, of clips 46 contact and pierce the wall of vessel V on opposite sides of the puncture site P.
As seen in FIGS. 7A and 7B, once the spikes have pierced the vessel wall, locking collar drivers 58 are advanced distally while clip housing 16 and clip holders 56 remain stationary, thereby distally advancing locking collars 80 down the exteriors of clips 46 to draw legs 70 and spikes 74 together to close puncture P. Engagement means 76 serve to retain the clips within the vessel wall during healing.
To achieve this advancement of drivers 58 with respect to clip holders 56, caps 52 are rotated clockwise, as viewed from above, until proximal pins 54 abut against the extreme left of proximal slots 62 and 64, thereby aligning the pins with the longitudinal portions of proximal holder slots 64. Then, force is once again applied to caps 52 to advance drivers 58 and deform clips 46 to their deployed configurations. Specifically, proximal pins 54 abut and apply force to proximal driver slots 62, thereby distally advancing drivers 58. Pins 54 move freely within the longitudinal portions of proximal holder slots 64 until they abut against the distal ends of slots 64. Likewise, distal driver slots 66 move freely until distal pins 50 abut the proximal ends of slots 66. In FIG. 7A, when proximal pins 54 abut slots 64 and distal pins 50 abut slots 66, locking collars 80 have been driven down the exteriors of clips 46, thereby deforming the clips to draw legs 70 together and close the puncture site.
In FIGS. 8A and 8B, with clips 46 deformed to seal puncture P, clip holders 56 are detached from clips 46 by snapping the clips free at narrowed regions 78. At this point, or prior to detachment, a suitable biocompatible bioglue or tissue sealant optionally may be injected into the puncture tract, as discussed hereinabove, through device port 32 or side port 22, to aid in sealing vascular puncture P. Alternatively, the bioglue or tissue sealant may be delivered through the backbleed path described above. Vascular device 10 then is withdrawn from the vessel wall, completing the procedure.
Clips 46 are detached from clip holders 56 by rotating caps 52 counterclockwise, as viewed from above. Proximal pins 54 of caps 52 move freely within proximal driver slots 62, but abut against the distal end of the longitudinal portions of proximal holder slots 64 and cause clip holders 56 to rotate with respect to collar drivers 58. Distal pins 50 of clip housing 16 move freely within the circumferential portions of distal holder slots 68 during rotation of clip holders 56. Meanwhile, drivers 58 are restrained from rotation by distal pins 50, which abut against distal driver slots 66. Bioabsorbable clips 46 do not rotate because the square cross section of square clip bores 47 of drivers 58 matches the substantially square cross section of clips 46; thus, since drivers 58 are restrained from rotation, so are clips 46. Non-square cross sections for clips 46 and bores 47, capable of performing the restraining function, will be apparent to those of skill in the art and fall within the scope of the present invention.
Since clips 46 are restrained while clip holders 56 rotate, and since proximal ends 72 of clips 46 are attached to clip holders 56, counterclockwise rotation of caps 52 causes clips 46 to snap at their weakest points: narrowed regions 78. Vascular device 10 may then be removed from the patient to complete the procedure.
Although preferred illustrative embodiments of the present invention are described above, it will be evident to one skilled in the art that various changes and modifications may be made without departing from the invention. For example, with minor modifications, vascular device 10 may be configured to carry closure component 90 of FIGS. 4, or any of a variety of alternative bioabsorbable and deformable clips. Proximal pins 54 may be formed integrally with caps 52, and distal pins 50 may be formed integrally with clip housing 16. Any number of clips 46 may be used to close the vascular puncture. It is intended in the appended claims to cover all such changes and modifications that fall within the true spirit and scope of the invention.
Patent Citations
Non-Patent Citations
Referenced by
Legal Events
Original Image


text:
That would be my first response as a homeowner. Only a sales person could say that with a straight face; because this is a buyer's market, the likes of which have never been seen. Banks are trying to dump their foreclosures. Short sales abound. And foreign buyers are coming into South Florida with cash driving prices down even more. Why would I want to sell now?
While all of the negatives are there to be seen, if we look carefully, there is a significant financial windfall available to a very large group of homeowners with equity in their favor.
DataQuick statistics report of average sold properties between 1999 and 2009 indicates that the general Weston area (33326) accumulated 48% in equity value for 1999 buyers who still own the same home. The "real-ity" of real estate is that most people do not understand how to use equity in their property when the market turns down because it last turned down like this more than 53 years ago.
The difference between that downturn and this is twofold. First, foreign nationals make up a significant number of south Florida buyers today because of a weak dollar. That wasn't the case 53 years ago. Second, we have an aging population of baby boomers today and they were the babies about to be born in that market 53 years ago.
Equity profit in a down market is all about shifting equity for value. That is, not buying a "bigger" house, but buying a better lifestyle for the same amount of money created by one's current equity. If you are in the normal mode of life event house issues (growing family, better school choices, a loss, divorce or marriage), then, as a seller, you are at a market disadvantage in a down market. But, if you are a home owner with a decade or more of equity and little or no 2nd mortgage hits on your equity, then selling now is an opportunity. Buying now with the intent of growing your equity over the next 10 years can be even more profitably than it was in the last 10 years in the house you are in. Here is why.
Suppose the home you purchased 10 years ago was a 3BD/2.5 bath property and that you paid $170,000 then. Today, in your zip code of 33326, your 3/2.5 is now selling at $192,000 (avg median sold). So, you have an equity value of $22,000, even after the 30% drop caused by the market fall in your area. If you want to profit from a sale then you simply begin looking for a property to buy with your equity value in those areas where the down market has reduced value greater than your 30% loss. Sales profit and your government stimulus ($6,500 - $8,000) in an area that has taken more a drop and meets your new needs for social, work and health amenities becomes a new value for you in a down market. If you have made certain value added improvements in your current home, (kitchen, bath, HVAC, Roof), that improve your equity your purchasing power will be further enhanced when you sell.
In today's market the equity in a home is significant. So too, are lifestyle changes. Lifestyle changes – turning homeowners from family-raising parents to baby boomers with children who are on their own. Equity and the freedom of aging may be the perfect opportunity to take advantage of the current market to sell the large family roost and make a quality of life smaller home purchase for its amenities and security. Before making any investment strategy decision be sure to consult with a qualified professional accountant and/or attorney.

subset: commoncrawl


text:
Real Estate Adviser,
I recently spent significant monies remodeling my house (kitchen,
bathrooms, wood flooring, patio, etc.). The contractor said he'd
get all the necessary city permits. After completion, I began to
suspect he didn't do so because there were no city inspections.
I've since attempted to contact him with no success. I did have
an independent electrician and plumber inspect the house and they
said everything seemed fine. What impact does this have on my ability
to eventually sell the house? I don't want to obtain the permits
now and have the city take down everything.
-- Jack Dupp
Based on the inspections you had, it sounds as if you had decent-quality
work done without the requisite permits, which is far better than
shoddy work done sans permits. But, at best, you are still in an
uncomfortable position.
For edification sake, most municipalities require
permits for any kind of repair, improvement, construction, modification
or demolition work on a house. Separate plumbing, electrical and
mechanical permits are also required, as a rule.
In your case, the first course of action should be
to determine if any permits were actually granted for your address,
which you can accomplish by calling your city's building department.
It's unlikely that your request will raise any red flags, in part
because this information is public record, and people handling these
requests are generally in the business of information dissemination,
not field enforcement, and they are very busy.
If your "no-permit" suspicions are confirmed, you're
not alone. Some municipal building officials estimate that up to
half of the minor home remodeling work around town is performed
without the mandated permits, often by do-it-yourselfers. Sometimes
a city's permit process is so lengthy or red-tape laden that even
licensed contractors take shortcuts.
But this is increasingly problematic for homeowners
such as you for a number of reasons. In many states, a home seller
must divulge repairs or additions to potential buyers and disclose
whether they were performed with a permit. If they weren't permitted,
the buyers may demand that the seller get the work permitted and
inspected by the city before the transaction can be completed, or
at least demand a healthy discount for the problem they are inheriting.
Enforcement and fines for non-permitted work varies
greatly from area to area, but penalties can be between three and
10 times the cost of the permit. Worse, the city can demand portions
of the repair work be undone to make sure underlying components
were constructed safely. Another potential problem: Some insurance
companies will not pay a claim if a fire originates in, or another
problem stems from, an illegally constructed area.
Some homeowners in your situation will hire another contractor to get such existing work permitted, but this can cause city inspectors to suspect something below-board has occurred if they see the work is not freshly done.
Most times, particularly in cases such as yours, where
a contractor apparently deceived you, cities will go a little easier
on the homeowner while casting a suspicious eye on the contractor
if he surfaces in other local jobs -- something I discovered during
my days of covering real estate and construction for a large metro
Safety -- not just revenue -- is generally the chief concern of most code-enforcement and building departments. For the sake of your peace of mind, you might have to "come clean" here. I am sorry an unethical contractor caused you such concerns.
Good luck.
To ask a question of the Real Estate Adviser, go
to the "Ask the Experts
page," and select "buying, selling a home" as the


text:
Production History
World Premiere!
The Blue Houseby José Cruz González
Directed by Tom Arvetis
SHOW DESCRIPTIONAcclaimed playwright and Childsplay (AZ) Associate Artist José Cruz González premiered a thrilling new work on our Adventure Stage. Co-commissioned by Adventure Stage Chicago and the Chicago Childrens Humanities Festival, The Blue House is the story of thirteen-year-old Maricela, who lives in a vibrant Chicago neighborhood with a rich and sad history. Haunting dreams of strangers from another time lead Maricela to an abandoned lot where the mysterious Blue House once stood. Told in English and Spanish, this World Premiere work set during the 1919 Race Riots and present day celebrates the power of courage, love and forgiveness.
The Blue House was funded in part by a 2008 grant from the National Endowment of the Arts and was co-commissioned by the Children's Humanities Festival - a program of the Chicago Humanities Festival, which creates year-round opportunities for people of all ages, backgrounds and circumstances to explore and enjoy the arts and humanities. The Children's Humanities Festival celebrates children's powers of self-expression and their desire to communicate their life experiences with each other and adults.
Learning GuideOur Education Department produces a Learning Guide for all of our productions. This text is FULL of fun background information about the show, pre-show and post-show discussion questions, as well as art and language activites. While we primarily make it for our educators, we think parents should check it out as well. Click here to join the fun!
BLOGClick here to visit our Adventure Page and read all blog posts about The Blue House!
Photos by Johnny Knight.


text:
Advantages of Cell Phone Locate Applications for Businesses
Cell phone locate: In this article, you will learn how you can use new technology to protect your business and resolve problems with your employees. Have you heard the news about cell phone locate programs to track mobilephones? Not only are they useful for people who suspect their partners, or parents concerned about their children, they are also an excellent tool for employers and employee control.
Helpful Cell Phone Locate Service Examples
Many people are wary of cell phone locate technology, but many business have found the great advantages of using it.
If you are an owner or manager of a business, you may have the need to keep track of employees in remote locations or to investigate what they are doing when they use their mobilephone that the company provides them. The software to track mobilephones is sure to help with this matter.
By using cellular technology to locate, you can do the following:
- find out if there is any breach in your company, like if an employee is selling secrets or product information to other companies.
- detect whether workers are lying about their presence at a work site
- review employee mobilephone bills and have the information available at any time using the cell tracker software
- safely detect who is the best employee in your organization.
How to use cell phone locate Programs
Let's take a look to see how you can use mobilephone locator technology. Well, it's very simple. It only takes a few minutes to install the spy software on a mobilephone before handing the device to an employee. Yes, it does not take more than five minutes, but this software will provide many long-term benefits.
After installing the spy software for cellular phones, you will be privy to calls, text messages and information about the location of employees. A cell phone locate program could save your company money and protect it from threats.
Cell Phone Locate Spyware
Remember when there was an abundance of telephone booths? Probably not, but today, if you forget your mobilephone at home, you may return home to get it, and then call the person waiting for you to let them know you'll be arriving a little late.
Of course, the mobilephone is no longer just a tool to contact people. Many, like Smartphones and iPhones are like having a mini computer or a multimedia center at your disposal. They are used for social networking, reading and writing emails, and maintaining a calendar, among a load of other things. Teens keep in touch with friends and share media files, like photos, videos and music.
Many applications have been developed specifically for mobilephones, but the newest and most popular app is spy software. Check it out, if you haven't used cell phone locate technology yet, perhaps it's time to give it a go.


text:
The Amherst Survival Center was created by and for our community. As a member of that community, we hope you'll feel free to drop in and join us.
We would love to hear from you and to help answer your questions about our programs, activities, and volunteer and donation opportunities.
If you have any questions, please call or email:
- For coordination or drop off of donations of food, toiletries, diapers or toilet paper: Contact Niri Azuage, Pantry Coordinator 413-549-3968 ext 104 or by email at email@example.com.
- For donations of clothing, and housewares: Contact Tracey Levy at 413-549-3968 ext 102 or by email at firstname.lastname@example.com
- For volunteering: please visit our volunteer page. You can also contact Tracey Levy, our Volunteer Coordinator at 413-549-3968 ext 102 or by email at firstname.lastname@example.com.
- For making a financial donation: please go to our donation form here.
- For inquiries including press and special events: Please contact Mindy Domb, Executive Director at 1-413-549-3968 ext 107 or by email at email@example.com
- For all other inquiries about the Amherst Survival Center programs, events or operations: email firstname.lastname@example.com and someone will get back to you shortly.
- For inquiries concerning the Board of Directors, you can email Sarah Barr, our Board President, at email@example.com.
Visit us at:
138 Sunderland Road (across from Cowls) in North Amherst
Send us mail at:
P.O. Box 9629
North Amherst, MA 01059-9629
Call us:
Fax us:


text:
Police Foundation
Advancing Policing Through Innovation & Science
The DPD sought to implement multiple department-wide programs within five years. Programs included, increasing the education level of officers, recruiting women and members of minority groups, and decentralizing administrative and strategic decision making to better meet the needs of the community and neighborhoods.
This second volume focuses on the human resource aspect of the programs implemented by the DPD. This volume describes the surveys used to ascertain whether or not personnel attitudes and behaviors changed over time between 1973-1976 (time when DPD wanted to implement new programs). Findings suggest that personnel attitude and behavioral changes did not take place; however, educational levels of officers rose and the number of women in the department increased.
To download the full article click here.
"Failure to discuss corruption openly has permitted it to flourish. A dearth of research on the subject handicaps police administrators, elected officials, journalists and citizens anxious to address the problem of corruption."
"Failure to discuss corruption openly has permitted it to flourish. A dearth of research on the subject handicaps police administrators, elected officials, journalists and citizens anxious to address the problem of corruption."
This report does not make suggestions about how to stop corruption. Instead police administrators are encouraged to create their own programs and policies based on the information detailed in this report. Many questions were left unanswered with the hope that police organizations would conduct their own research to address the problem of corruption.
A representative from each agency came to the Police Foundation to create a common vocabulary around policing and to discuss differing views on conditions and practices in police organizations.
This study found that these six cities differed greatly on many fronts, including number of arrests for violent crimes, selection and entry requirements, and police vehicle accidents.
To download the full article click here.
Creating effective mutual aid agreements is a difficult task; it requires detailed planning and outlining participation requirements, assessing vulnerabilities inherent with such an agreement, establishing oversight, and conducting training and promoting funding for this collaborative approach.
To address these factors, the Police Foundation highlighted key efforts by regions across the nation to work in these cooperative partnerships across jurisdictions. Law enforcement agencies should consider studying these cases to understand how to partner with regional agencies effectively to address terrorism prevention, preparedness, and response.
Results suggested that two-officer units produced lower levels of service, were less efficient, and were less safe than comparison one-officer units. The authors concluded, "On the basis of this study, two-officer regular patrol units do not appear to be justified in San Diego. Separate comparisons of unit performance, efficiency, and officer safety under current conditions all suggest that one-officer units are at least equal to and often more advantageous than two-officer units".
Geographic areas were assigned to three treatment conditions: (1) FIs conducted as business as usual, (2) FIs conducted by patrol officers given special training to "minimize friction between the department and the public", and (3) no FI activity.
Findings suggested:
This From the Archive report explored the extent to which women were being employed as sworn officers in state and municipal departments across the United States. Published in 1981, the purpose of the study was to analyze the effects of specific personnel practices designed to support full employment of women in policing. To this end, an effort was made to place the employment status of women in policing in its full historical and sociopolitical context.
The methodology used in this report included case studies and a national survey. From these two methods, the Police Foundation was able to address employment of women in many important areas of policing: eligibility, recruitment, selection ,rank, training, promotion, and assignment.
This report concludes that the greatest challenge for women in policing in the eighties was to overcome barriers to promotion and obtain a more significant proportion of supervisory and police-making positions in police departments.
The full article is available in our electronic library.
This Research in Brief highlights the study's findings with an in-depth look at how large police departments are dealing with drug trafficking and drug-related crime. The study concluded that the new methods of policing left citizens believing that police were more effective than compared to other tactics. Furthermore, crime rates in the experimental neighborhoods decreased, particularly for violent crimes.
The full article is available at the link.
This report concludes that establishing team policing in a community
© 2014 Police Foundation
Privacy Policy


text:
Original Vintage "Set of Glass Stands" for Glass Shelf Supports !
Chrome or Nickle plated Screw Connectors between top and bottom glass halves. Some have beginnings of normal fractures, but still work fine as long as you do not over tightening them.
Measurements are 8 1/4 inches high, and the tops and bottoms are 4 7/8 inches across.
Some normal EAPG straw & mold marks , but no cracks or unsightly large chips.
Weigh an average of 1 pound 9 ounces each. Combined 3 Pounds and 2 Ounces.
Will ship a set well wrapped for safety at 4 1/2 pounds per set.
4 other shoppers have this item in their Cart or Wish List.
Original Antique Americana , U.S. Militaria , Original Photos, Period Lighting , & Fine Art Prints.


text: Volcom's Timber Lined Hoodzip is always ready for the weather ahead. This jacket offers a durable and warm addition to your layers. Done up in that layered look, appearing as a vest but in fact connected to hood and sleeves, making this an easy piece. This jacket features a drawstring hood, side entry front pockets, and a snap closure pocket at left chest. Zipper front closure with leather zipper pull. Custom Volcom hardware. Volcom Scout branding at left chest. Shell and exterior are constructed of 100% polyester while lining is constructed of 80% cotton, 20% polyester. Available in colorways as seen below. Model wears a medium.


text:
Results 1 to 5 of 5
Registered Member
- Join Date
- Apr 2006
- Posts
- 108
Posted On:
10/05/2006 3:04am
Style: Some time ago: Muay Thai--
What if? Government intervention.
This could be the stupidest thread I have started on any forum ever:
Imagine for the moment that you've ben made Grand High PoohBar of Martial Arts in the United States. It is your job to ensure that only alive, effective, realistic, martial art training is provided by dojo's, schools and gyms across the country. How would you go about it? What horrible annoying loopholes would there be that bullshido schools could slip through? How much moeny would your schemes need?
For me Martial arts would need to be roughly categorised and it's there that my scheme starts to fall apart. I can't come up with a scheme that excludes tip-tap point sparring that doesn't also exclude pretty much all submission grappling.
Enforcer of Northeast Anti-Silliness Department Inc.
- Join Date
- Jan 2006
- Location
- Long Island, NY
- Posts
- 6,901
Posted On:
10/05/2006 8:08pm
Senior Member
- Join Date
- Sep 2005
- Posts
- 3,081
Posted On:
10/05/2006 8:13pm


text:
Kepler-452b revolves around a sun much like our own.
Arrested Development Makes for Long-Lived Worms
June 23, 2014|
Starvation suspends cellular activity in C. elegans larvae and extends their lifespan.
June 23, 2014|
Starvation suspends cellular activity in C. elegans larvae and extends their lifespan.
June 11, 2014|
Genetic modification approach to control malaria-spreading mosquito populations incites conversations on the ethics of manmade extinction.
June 5, 2014|
A new plan to protect the Great Lakes from the invasive species is set in motion.
June 4, 2014|
A study documents boys with autism who were exposed to elevated levels of testosterone, cortisol, and other hormones in utero.
June 1, 2014|
As rich sources of genetic diversity, the progenitors and kin of today's food crops hold great promise for improving production in agriculture's challenging future.
May 22, 2014|
Mice in nature appear to enjoy running on wheels, helping to settle the question whether the behavior is a just a neurotic response in lab mice.
May 8, 2014|
An increasingly common algal growth, found in rivers the world over, is caused by changing environmental conditions, not accidental introductions.
May 7, 2014|
Darwin's finches use pesticide-treated cotton to line their nests and unwittingly protect themselves against parasitic fly larvae.
May 1, 2014|
Madness and Memory, Promoting the Planck Club, The Carnivore Way, and The Tale of the Dueling Neurosurgeons
May 1, 2014|
A symbiotic relationship between squid and bacteria provides an alternative explanation for bacterial sheathed flagella.


text:
Just a reminder – please consider voting for my two panel proposals at for SXSWi2009. I'd LOVE to see more non-profit/library/non-monetization type presentations at this conference!
My two panels are:
- (vote here) Experiencing Digital Community: Conversation Economy and Non-Profits
The conversation economy is all about experiencing real conversations in your organization's digital space. This panel discusses online conversations in the digital spaces of non-profits. We'll touch on: * Conversation as experience (conversation economy) * how to start conversations online * examples galore from non-profits, what works and what doesn't.
- (vote here) Non-Profit Rockstars: Using Video to Share Your Message
Video is a great way to share your organization's message, start conversations, and move people to action. How do online videos fit into your non-profit's digital space? This panel discusses ways to incorporate online, interactive video into your organization's digital space.
Voting ends at 11:59 pm central time on Friday, August 29, so don't dawdle! Thanks!


text:
Browse Archives By:Date Alphabetical
Oct 01 2014
I Love You, Snip
I'm working on a longer post for tomorrow morning that will detail my experiences in the press box of our small town stadium, where I've been assuming the role of coach's wife and shooting game film for both my boys' football teams. Let's just say it's [...]
Keep Reading
Jul 16 2014
Charlie in Slow Motion
Oh, Charlie. Ohhhh, Charlie. So night before last, I'm on my walk/run/walk with the dogs and I decide to shoot a video of Charlie in all his Alpha Dog glory, barking at the horses in a feeble attempt to get them to respond at all, which they never do, because if you were a horse, [...]
Keep Reading
Jul 09 2014
My Precious
On my walk/run/walk last night, I stopped and visited with the ranch horses a bit. L.B. came right over to me, of course, because…well, he's My Precious. Just look at those eyes. He's peering straight into my soul with those things. [...]
Keep Reading
Mar 27 2014
Ode to L.B.
My favorite part of driving from the Lodge after a day of shooting (we're making new shows for the next couple of weeks)—well, besides getting to relax and nestle into the sofa with Marlboro Man, the kids, and Charlie (it's a very full sofa)—is driving across the [...]
Keep Reading
Mar 17 2014
The Happy Golden Hour
Throughout the history of this website—and did you know I'm in my eighth year of blogging? Lord help my love handles—I have posted many photos of the mustangs across the pond. "Across the pond." Har har har. Like clockwork, they make their [...]
Keep Reading
Feb 07 2014
The Daily Special
Marlboro Man took my camera with him when he went feeding a few days ago. I love it when he takes my camera. I like seeing the photos he takes, because there's always a landscape shot or two. This is a creek Marlboro Man has always loved. [...]
Keep Reading
Jul 22 2013
Every Evening
Every single evening, just before the sun starts to go down, the mustangs make their way all the way across the pasture east of our house and get themselves a big ol' drink. They only come once a day… And I'm always glad to see [...]
Keep Reading
May 23 2013
Surefooted: A Visual Definition
I'm taking the visual dictionary approach today. This is hard for me. You know how I like to talk. But I'll look at it as a spiritual discipline. The Word of the Day: Surefooted. Here's what it means. EXAMPLE A [...]
Keep Reading
Mar 07 2013
Sorting Pairs in the Cold
We didn't leave until about 7:30 yesterday morning. But it was so cold, it might as well have been 3:00 a.m. I totally didn't wear the right socks. My boy opened the gate so his mama wouldn't have to. And I was very, very [...]
Keep Reading
Mar 06 2013
How to Warm Up Your Face
This morning we left the house at 7:30 and spent three hours sitting stationary on horseback while Marlboro Man and his brother Tim sorted off pairs. I'll write a post about our morning in a little bit, just after all of my bodily systems defrost. You see, it was cold this morning. I [...]
Keep Reading
Oct 17 2012
Miss Mustang 2012
It's that time of year, ladies and gentlemen: It's the Miss Mustang Beauty Pageant of 2012! The beautiful contestants have been preparing like mad, trimming their hooves on native sandstone, soaking in natural ponds, and honing their talents so that they can enter the competition [...]
Keep Reading
Oct 15 2012
You Scratch My Back, I'll Scratch Yours
I was out among the mustangs last night. Sort of like being out among the English. Except with wild horses. Hello, beautiful girl. Anyway, I must have arrived right at the Scratching Hour, because a few minutes after I got there, the mustangs [...]
Keep Reading
Aug 08 2012
Kids and Their Harses
This is my oldest child with Pepper. Sometimes it's difficult to get a kid and a horse in focus at the same time. It's a depth-of-field thing. But that's another story for another section of my website. There. Much better! This is my younger [...]
Keep Reading
May 30 2012
Cowboy Multiple Choice
Who's riding the horse in the foreground of this photo? a) Charlie b) Pioneer Woman c) Ronald McDonald d) Marlboro Man What is this cowboy's name? a) Harvey Wallbanger b) Tom Collins c) Jack Daniels d) Josh What is Marlboro Man doing in [...]
Keep Reading
May 21 2012
The Wild Horses
Post by Marlboro Man. Photos by Marlboro Man's wife, also known as P-Dub. (You can call her P-Widdy-Dub-Diddy-Diddy-Dub-Dub for short.) We have three types of animals we run on our main ranch: cow/calf, yearlings and wild horses. We contract with the U.S. government to take [...]
Keep Reading
May 10 2012
A Bright Golden Haze on the Meadow
Oh, what a beautiful morning… Oh, what a beautiful day! I've got a beautiful feeling… That calf is going to stay. (Photos snapped by Marlboro Man from atop his trusty steed.) And finally, from my then three-year-old boy [...]
Keep Reading
Dec 09 2011
Cowboys in the Mist
Marlboro Man had to sort some cattle a couple of weeks ago. It was a damp, dark, desperately cold morning. The dogs and the cats were smart enough to stay inside. Man, do they have a nice life. And it was oh, so foggy. Unusually foggy. Eerie foggy. [...]
Keep Reading
Dec 05 2011
My girls are still growing. I can't get them to stop. My older daughter is headed toward six feet tall and my younger daughter is just about to pass me. I still can't fit into their jeans. This is unfair. But I still like cheese and chocolate…so I won't be holding [...]
Keep Reading
Nov 14 2011
Things I Learned at the Rodeo
We had such a great time at the rodeo. We did not do very well at the rodeo. But that's okay, because we still enjoyed the rodeo. Rodeo, rodeo, rodeo, rodeo, rodeo, rodeo, rodeo. Here are some things I learned about rodeos at this year's rodeo. 1. Every [...]
Keep Reading
Oct 20 2011
Buddy is our family's oldest horse. He's been here longer than I have. I met him when I did not have jowls. Buddy lives happily among our other horses, Snip, LB, Jack, Peso, Cutter, Bronco, and Red. But there's one thing about Buddy that's different [...]
Keep Reading