text:
Forgot Password? | Not a User? Sign up
Your browser does not support iframes.
Being cited late last month for alleged illegal use of a blue light apparently isn't the only problem facing an Anderson County constable.
Charles Imel, 40, of 2124 Indian Trail was elected constable in 2006 in the county's 2nd District, which is where Indian Trail is located. But earlier this year Imel used his Indian Trail address when he filed for election in the county's 1st District, according to copies of election filing documents obtained by The Anderson News through an open records request.
Anderson County Schools will be closed for the second consecutive day on Tuesday, Feb. 16.
Anderson and surrounding counties remain under a winter storm warning until 7 p.m. Monday.
Check back here for updated information as it becomes available.
Never mind that the songs BCB performs were originally written several decades before its members were born.
Never mind that some of the songs were reworked and parodied in feature films several years before group members could even cry, let alone croon.
The three boys of BCB — Benjamin Pinkston, Evan Cornett and Benjamin Black, all sixth-graders at the Christian Academy of Lawrenceburg — belt out the tunes of Motown and the hits from the Sister Act films like they are their own.
A front-page story in last week's Anderson News, "I'm a Preacher," chronicled the return of Corinth Christian Church minister Gene Koons to the pulpit after suffering both a heart attack and stroke just before Thanksgiving.
After the story had gone to press, but before it hit the newsstands, The Anderson News received word that Koons had suffered a setback and had been taken to the Frankfort Regional Medical Center.
Anderson County Schools will be closed today, Feb. 15, according to a One Call Now announcement from school officials.
Anderson and surrounding counties are under a winter storm warning until 7 this evening, and according to the National Weather Service, several inches of snow are expected.
Check back here for more information as it becomes available.
Anderson County Schools will be closed again on Thursday, Feb. 11, making the third straight day of an unscheduled vacation. Check back for more weather-related information as it becomes available.
The following people were indicted recently by the Anderson County Grand Jury, according to documents available at the Anderson Circuit Clerk's office.
Derek N. Hartley, 26, of 1016 Anderson City Road, was indicted on two counts of first-degree criminal abuse on January 19 by the Anderson County Grand Jury.
The following people were indicted February 2 by the Anderson County Grand Jury.
Anderson County Schools will be closed Wednesday, Feb. 10, school officials announced Tuesday evening.
Schools were also closed Tuesday after a winter storm swept through and blanketed the area with several inches of snow.
Very cold temperatures, burst of snow showers and wind gusts up to 35 mph are expected overnight, according to the National Weather Service.
Judge Linda Armstrong heard the following cases during Anderson District Court proceedings Nov. 2.
Daniel J. Catlett, arraignment, three counts of third-degree unlawful transaction with a minor -- pleaded guilty, sentencing Nov. 5.
Michael S. Cummins, arraignment, third-degree possession of a controlled substance (drug unspecified), possession of marijuana, failure to surrender a revoked operator's license -- pleaded not guilty, pretrial conference Nov. 5.
For more than 25 years, Gene Koons told people they need to be ready.
Since Nov. 20, Koons has been living and breathing ready at a level he never envisioned when he uttered those words while preaching to his congregation at Corinth Christian Church.
"Oh, yeah. Big time," he said, using one of his favorite phrases.
Already legally blind, Koons suffered a major heart attack at his home on that fateful Friday. The next day he suffered a stroke that has, for the time being at least, cost him the use of his left arm and leg.
Copyright © 2015
The Anderson News is your source for local news, sports, events, and information in Lawrenceburg, KY and the surrounding area.


text:
Venturan arrested in assault with a deadly weapon
A Ventura man was arrested Wednesday after his ex-girlfriend told police he had threatened her with a knife the night before, putting the weapon to her throat, authorities said.
Police said the woman also said the 19-year-old had gone to her current boyfriend's house and threatened him through a closed door with a knife.
Police said the teen was angry over a lovers' triangle.
Police said they arrested Colton Braga near Pacific View mall, where he was taken into custody without incident. Police said they found a knife they suspect was used in the incident.
Braga was arrested on suspicion of assault with a deadly weapon, police said.
Police said no one was injured in the incident.
Police said Braga was taken to the Ventura County jail, where he was being held Wednesday night. There was no information on whether bail had been set for him.
Subscribe to the Ventura County Star
Need Help? Call us at 1-877-710-6182.
Monday-Friday: 6am-3pm / Saturday: 6:30am-10:30am / Sunday: 7am-11am

subset: commoncrawl


text:
Recent comments
Forum topic: NaCl games
Hi guys
I've noticed there were many debates raised recently regarding game inclusion/exclusion policy, so I think I can bring my 5 cents.
First of all, I would like to remind anyone few things:
- This is not the first time such discussions appear.
- Each time most people agreed that LGDB has no 100% strict inclusion/exclusion policy.
- By examining those games already included in LGDB, other Linux gaming related websites, blogs, etc. it seems to be practically impossible to create such policy, which would allow to easily determine what needs to be included and what not (and make people happy at the same time).
- Hence, currently games are included according to some "general" guidelines, with exceptions being made for particular games.
- The ideas behind submission guidelines can be described as: do not flood the database with unrelated, poor quality games that has nothing to do with Linux (99% Flash & browser games); support Linux friendly developers; popularise Linux as a platform (make exceptions for good quality games, even if they are not really native); give people stuff they want to see here; popularise FOSS games and technologies. In other words, support Linux (hence, some "political" decisions can be made).
- If I remember correctly, we've also agreed to avoid where possible exclusion of those games that were added to DB (relatively) long time ago.
Regarding NaCl games - I'm not really fan of these (this is subjective opinion), but if they are already here, then we can go with this. Just keep the quality to be decent.
Forum topic: Not sure if I agree with this submission
They are completely different games! Unlike, say, PySolFC, it would just be unfair to say that these are single units, as they don't show up as one game on the desktop. Beyond the obvious fact that they are developed and played as individual games as well. Either way, I'm sure we can agree that they are not components of one game.
Also, they don't have to get updated at the same time; in fact, many of them don't as you would be aware if you follow KDE development. In the upcoming release (4.12), only KNetWalk received updates.
There is a core KDE games library but that's like saying that any game that uses SDL should be listed as a single game.
I'd suggest dividing these into several games. It's a chore, but remember, we are building the best database of Linux games in the world. =p
Forum topic: NaCl games
These are really browser games. NaCl is meant for browsers to run native code, not for operating systems (like Linux) to run them directly. So one might call them Chrome platform games, not Linux games.
They are exclusively available in the Chrome web store and cannot be played in other browsers. I don't see any other browsers adopting NaCl either since Firefox went with OdinMonkey.
It is also worth noting that none of those games are available native on any GNU/Linux platform.
Forum topic: DOS game
ScummVM is a VM. Basically an emulator. If WINE is to be considered an emulator, a VM should certainly be considered an emulator... I don't think ScummVM-compatible games should be listed here either to be honest with you.
Forum topic: DOS game
yeah but it works with ScummVM which includes a replacement engine/reimplemation, so I guess we can keep it
Forum topic: Not sure if I agree with this submission
hm, they get all updated at the same time, they all have nearly the same requirements and almost all are too simple to include seperatly - did I forgot something?
Forum topic: Triplicate
There is now a little box that checks for duplicate titles when submitting a new game. hope that helps. ;)
Forum topic: Flash
Nothing it's a great engine for games and you can include flash games as long they have a downloadable client - Which the reason why I will unpublish SH - Online in the near future


text:
School Group Rules:
- All children must be supervised at all times. (Unattended children will be kept for extra farm labor...)
- Please do not chase the chickens.
- We are big on hand washing! Hand sanitizing/washing stations are located throughout the farm.
- An adult must accompany student groups in the maze. (This doesn't guarantee the group won't get lost, but at least there will be someone to blame for navigational errors.)
- You are required to have a fun, safe and memorable experience. Kids are required to leave the farm wishing they could come back!
Hints and Tips:
- The pumpkin patch and maze can be muddy. Have the kids wear old shoes.
- Some groups have kids bring pillowcases or plastic bags to carry their pumpkins in. We will help you load the bus with pumpkins if desired.
- We can accommodate wheelchairs and other special needs. Just let us know how we can provide any accommodations needed.
- Let us know if any children are allergic to hay or others allergens they might encounter on the farm.
- Pumpkins keep very well in a cool environment (like a basement or garage), so if you schedule a field trip for late September or early October, the pumpkins should be fine by Halloween.
- Cell phones often don't work well at the farm. You can use our phone line if needed--(608) 592-3481.
- Do not use rely on your GPS or internet map program without first checking our Map and Directions page.
- Bring your cameras—our farm is one big photo op!
- You are welcome to use our picnic area—just let us know so we can accommodate all groups who would like to eat lunch or a snack here.
- Our concession stand is closed during the week. If you would like the concession stand open for your students, please let us know in advance. We have cold drinks, popcorn, chips, and candy bars.
- For maze field trips, please allow at least two hours at the farm (longer for groups of over 50.) We can shorten the maze experience if needed, but some groups do get lost and need extra time to find their way out. We do a few "rescues" every year, but that still takes time. You can bring walkie-talkies for each group to make it easier for the adults who are supervising. (We do have some walkie-talkies available to lend you.)
- For pumpkin patch field trips, allow a minimum of 1.5 hours at the farm, if possible. There are enough activities to keep a group busy for several hours. The pumpkin patch ride and pumpkin-picking takes about 30-45 minutes, and the rest of the time you are free to explore and play at the farm.
- We can accommodate large groups (up to 500 at one time.) Please call for more information.
- We can customize almost any aspect of your farm visit. Please let us know if you have requests or ideas for your groups. We want to personalize your visit to make sure you have a great experience.
You may also call us at 608-622-7407. We are always happy to help you schedule your group, answer any questions you may have, or to help you design a field trip that meets your needs.


text:
Apparatus and methods are provided for creating and regulating a gastric stoma by intraluminally reducing or partitioning a local cross-sectional area of the stomach, thereby inducing weight loss in obese patients. Various embodiments of stomas in accordance with the present invention are provided, as well as various regulation mechanisms for controlling or adjusting the size of the stoma.
1. A flow restriction apparatus for placement within a hollow body organ, comprising:
a plurality of anchors slidingly inter-connected via a drawstring,
wherein the plurality of anchors is adapted to adhere to an interior tissue wall within a hollow body organ, and
wherein each of the plurality of anchors is further adapted to draw towards an adjacent anchor upon tensioning of the partition such that the hollow body organ is restricted.
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. A flow restriction system for distributing a force applied to a stoma within a hollow body organ, comprising:
a biocompatible mesh adapted to be formed about a stoma formed from tissue within the hollow body organ, the mesh being further adapted to distribute a force from the tissue surrounding the stoma over the mesh; and
a plurality of tissue anchors for adhering the mesh to the tissue surrounding the stoma.
15. The system of
16. The system of
17. The system of
18. The system of
19. The system of
20. The system of
21. The system of
22. The system of
23. A method of restricting flow through a stoma within a hollow body organ, comprising:
advancing a biocompatible mesh endoluminally into the hollow body organ;
forming the mesh onto tissue surrounding a stoma formed from tissue within the hollow body organ; and
securing the mesh onto the tissue.
24. The method of
25. The method of
26. The method of
27. The method of
28. The method of
29. The method of
30. The method of
31. The method of
This application claims the benefits of priority to U.S. provisional patent application Ser. No. 60/545,403, filed Feb. 17, 2004, and is a continuation-in-part of U.S. patent application Ser. No. 10/288,619, filed Nov. 4, 2002, which is a continuation-in-part of U.S. patent application Ser. No. 09/746,579, filed Dec. 20, 2000, and a continuation-in-part of co-pending, commonly assigned U.S. patent application Ser. No. 10/188,509, filed Jul. 3, 2002, which is a continuation-in-part of U.S. patent application Ser. No. 09/898,726, filed Jul. 3, 2001, which is a continuation-in-part of U.S. patent application Ser. No. 09/602,436, filed Jun. 23, 2000, which claims benefit from U.S. provisional patent application Ser. No. 60/141,077, filed Jun. 25, 1999, the entireties of which are incorporated herein by reference.
Field of the Invention
The present invention relates to apparatus and methods for creating and regulating a stoma within a patient's gastrointestinal ("GI") lumen. More particularly, the present invention relates to apparatus and methods for creating and regulating a gastric stoma by intraluminally reducing or partitioning a local cross-sectional area of the stomach, thereby inducing weight loss in obese patients.
Extreme or morbid obesity is a serious medical condition pervasive in the United States and other countries. Its complications include hypertension, diabetes, coronary artery disease, stroke, congestive heart failure, multiple orthopedic problems and pulmonary insufficiency with markedly decreased life expectancy.
Several surgical techniques have been developed to treat morbid obesity, e.g., bypassing an absorptive surface of the small intestine, or reducing the stomach size. These procedures are difficult to perform in morbidly obese patients and present numerous life-threatening post-operative complications.
U.S. Pat. Nos. 4,416,267 and 4,485,805 to Garren et al. and Foster, Jr., respectively, propose disposal of an inflated bag within a patient's stomach to decrease the effective volume of the stomach that is available to store food. Accordingly, the patient is satiated without having to consume a large amount of food. A common problem with these inflated bags is that, since the bags float freely within the patient's stomach, the bags may migrate to and block a patient's pyloric opening, the portal leading from the stomach to the duodenum, thereby restricting passage of food to the remainder of the gastro-intestinal tract.
Apparatus and methods also are known in which an adjustable elongated gastric band is disposed around the outside of a patient's stomach near the esophagus to form a collar that, when tightened, squeezes the stomach into an hourglass shape, thereby providing a stoma that limits the amount of food that a patient comfortably may consume. An example of an adjustable gastric band is the LAP-BAND� made by INAMED Health of Santa Barbara, Calif.
Numerous disadvantages are associated with using the adjustable gastric band. First, the band may be dislodged if the patient grossly overeats, thereby requiring additional invasive surgery to either reposition or remove the band. Similarly, overeating may cause the band to injure the stomach wall if the stomach over-expands. The laparoscopic disposal of the gastric band around the stomach requires a complex procedure, requires considerable skill on the part of the clinician, and is not free of dangerous complications. To dispose the gastric band around a patient's stomach, a clinician must perform a surgical procedure to gain access to the patient's stomach from outside the stomach. This is typically performed using the narrow field of vision provided by a conventional laparoscope, and presents a risk that the clinician inadvertently may perforate the stomach, damage major organs and vessels disposed in the vicinity of the stomach, such as the liver, kidneys, and the abdominal aorta, damage the vagus nerve and/or cause numerous other complications associated with surgery.
In view of the foregoing, it would be desirable to provide apparatus and methods for creating and regulating a gastric stoma via intraluminal reduction of a local cross-sectional area of the stomach.
Apparatus and methods for creating and regulating a gastric stoma may be provided for intraluminally reducing or partitioning a local cross-sectional area of the stomach. The gastric stoma described may also reduce the risk of damaging surrounding organs, vessels, and nerves when compared to conventional devices and methods. The localized reduction or partition redefines the gastrointestinal ("GI") lumen into first and second portions. The reduced volume of the first portion, as compared to the native volume of the GI lumen, constrains an amount of food that a patient consumes by providing a feeling of satiety after only a small amount of food has been consumed. Furthermore, the reduced cross-sectional area of the GI lumen reduces a rate at which food passes through the GI lumen. This increases a residence time of the food within the first portion of the GI lumen, thereby enhancing the feeling of satiety.
In a preferred embodiment, apparatus of the present invention includes a stoma that may be endoscopically implanted within a patient. In an even more preferred embodiment, a cross-sectional area of the stomal lumen(s) may be adjusted non- or minimally invasively to regulate food passage through the stoma. For example, the stoma may be endoscopically adjusted within the patient intra- or post-operatively. The stoma may also be configured to dynamically adjust itself in response to pressure sensed from ingested food proximal to the apparatus. Implantable stomas in accordance with the present invention optionally may be used in conjunction with complementary gastric reductive or constrictive apparatus and methods, per se known.
The implantable stoma may comprise one or more anchoring elements configured to intraluminally secure the stoma to a wall of the GI lumen to prevent dislodgement or migration of the apparatus. Alternatively, the stoma may be disposed submucosally to achieve anchoring. Contrivance may be provided for adjusting/regulating a cross-sectional area of the stomal lumen, for example, a drawstring; an inflatable member; a resilient element, such as a ring, mesh, braid, stent, or stent graft; a fluid reservoir; bulking agents; an iris; radiofrequency elements; etc. Adjustment of the stoma may, for example, be performed endoscopically, e.g. via an endoscopically retrievable tube or via an endoscopically accessible port; through actuation, e.g. remote actuation via an external control unit, of implanted elements coupled to the adjustment contrivance; via a subcutaneously implanted port; dynamically in response to the pressure of food in the GI lumen; etc. Also provided are delivery catheters for delivering and deploying the stoma without injuring surrounding organs and vessels.
Methods of using the apparatus of the present invention also are provided.
Further features of the present invention, its nature and various advantages will be more apparent from the accompanying drawings and the following detailed description of the preferred embodiments, in which:
The present invention relates to apparatus and methods for creating and regulating a stoma within a patient's gastrointestinal ("GI") lumen. More particularly, the present invention relates to apparatus and methods for creating and regulating a gastric stoma by intraluminally reducing or partitioning a local cross-sectional area of the stomach, thereby defining first and second portions of the lumen and inducing weight loss in obese patients. The reduced volume of the first portion, as compared to the native volume of the GI lumen, constrains an amount of food a patient consumes by providing a feeling of satiety after only a small amount of food is consumed. Furthermore, the reduced or partitioned cross-sectional area of the GI lumen reduces a rate at which food passes through the GI lumen. This increases residence time of the food within the first portion of the GI lumen, thereby enhancing the feeling of satiety. It will be obvious to one of skill in the art that, while the following written description illustratively describes use of the apparatus and methods of the present invention to partition or reduce a patient's stomach, the present invention may be implanted anywhere in the gastro-intestinal tract, e.g., esophagus, and within a variety of body lumens requiring restriction of flow of materials therethrough.
Referring to
Each anchor 12 incorporates substrate 18 having multiplicity of barbs 20 and at least one fixture point 15, e.g., an eyelet, through which drawstring 14 may be threaded. Preferably, substrate 18 is made of a flexible material to permit the anchor to conform to the surface of the lumen wall. Each barb 20 has sharpened distal end 24 that enables the barb to penetrate into the lumen wall, and to resist disengagement therefrom when tensile forces applied to drawstring 14 are transmitted to anchor 12. Distal ends 24 of barbs 20 may have a harpoon configuration (24 a in
Referring now to
Alternatively, to enable cross-sectional area A defined by drawstring 14, and thus the localized reduction or partition in the cross-sectional area of the GI lumen, to be adjusted, fastener 16 may comprise adjustable clip 34 having housing 36 and engagement piece 38 translatably disposed within housing 36. Housing 36 includes first bore 38, which is disposed orthogonal to the direction of translation of engagement piece 38, and has a cross-sectional area that accommodates unrestricted movement of drawstring 14 therethrough. Likewise, engagement piece 38 also incorporates second bore 40 disposed parallel to first bore 38, and having a cross-sectional area that will accommodate unrestricted movement of drawstring 14 therethrough. Also included within clip 34 is spring 42 that is disposed between housing 36 and engagement piece 38 to bias engagement piece 38 so that first and second bores 38 and 40 are misaligned absent an external force to counter the force of spring 42. When the first and second bores are misaligned, drawstring 14 is constrained from freely translating therethrough. When an external force is applied to counter the outward biasing force of spring 42, engagement piece 38 translates within housing 36 until engagement piece 38 contacts ledge 44. At this point, first and second bores 38 and 40 are aligned, and drawstring 14 may move freely therethrough to adjust the tension applied to drawstring 14. Advantageously, this permits the reduction in the cross-sectional area of the GI lumen to be adjusted, thereby providing control over the rate that food passes through the GI lumen.
Referring now to
Preferably, drawstring 14 is pre-threaded through fixture points 15 prior to adherence of anchors 12 to inflatable member 56. Drawstring 14 also preferably has sufficient length to span lumen 48 proximal to inflatable member 56 so that a clinician can grasp the ends of drawstring 14 (not shown) to facilitate delivery of apparatus 10 in a manner described in greater detail hereinbelow. Furthermore, fastener 16 preferably is engaged to drawstring 14 prior to advancement of delivery catheter 52 into lumen 48 to facilitate delivery of apparatus 10. It will be apparent to one of ordinary skill in the art that, while distal ends 24 of barbs 20 are sufficiently sharp to penetrate the lumen wall of the GI lumen, the distal ends also preferably are sufficiently dull to avoid puncture of inflatable member 56.
Referring now to
To tighten drawstring 14, and thereby cause a localized reduction in the cross-sectional area of stomach S, catheter 58, having end effector 60, is provided for disposal within stomach S through guide catheter 46. End effector 60 comprises a mallet/anvil assembly that can grasp fastener 16 by manipulating an actuator (not shown) disposed on a proximal end of catheter 58. After end effector 60 is engaged to fastener 16, concurrent application of a distal force to catheter 58 and a proximal force to the ends of drawstring 14 distally urges fastener 16 along drawstring 14. Continual advancement of fastener 16 tightens drawstring 14, drawing each anchor 12 closer to adjacent anchors. Since anchors 12 are engaged to lumen wall W, this causes a localized reduction in the cross-sectional area of stomach S and forms stoma 11, as shown in
Once sufficient tension has been applied to drawstring 14 to obtain a lumen through stoma 11 of desired cross-sectional area, end effector 60 may be disengaged from fastener 16 and proximally retracted from guide catheter 46. To reduce drawstring 14 to an appropriate length within stomach S, catheter 62 having end effector 64 comprising a pair of scissors is advanced through guide catheter 46. Once drawstring 14 has been cut, guide catheter 46 is removed from the patient along with catheter 62, endoscope 50 and the severed portion of drawstring 14 that is disposed through guide catheter 46.
Of course, it will be evident that anchors 12 may be delivered to stomach S without drawstring 14 having been pre-threaded through fixture points 15 prior to adhesion of the anchors to inflatable member 56. In such a case, after anchors 12 have been engaged to lumen wall W, a catheter having an appropriate end effector may be inserted through guide catheter 46 to thread drawstring 14 through fixture points 15.
In operation, anchor 12 is placed against an inner surface of lumen wall W. Pinchers 68 are actuated to grasp anchor 12 and lumen wall W so that they fold into the space between pinchers 68. Pressure applied by pinchers 68 penetrates barbs 20 into lumen wall W, thereby engaging anchor 12 thereto.
Referring now to
Alternative embodiments of anchors 76 are provided in
Referring now to
Delivery catheter 120 further comprises inner catheter 132 slidably disposed within central lumen 134 of outer catheter 122. Inner catheter 132 has inner distal end 136 and inner lumen 138, within which plurality of anchors 104 are disposed for delivery to lumen wall W. As discussed hereinabove, drawstring 14 preferably is pre-threaded through fixture points 107 of anchors 104, and fastener 16 preferably is engaged to drawstring 14 prior to disposal of anchors 104 within inner lumen 138 to facilitate delivery of anchors 104. Also disposed within inner lumen 138 proximal to anchors 104 and fastener 16 is push rod 140.
In operation, delivery catheter 120 is advanced through one of the lumens of guide catheter 46 to stomach S. Under the visual guidance of endoscope 50, delivery catheter 120 is maneuvered to dispose end effector 126 adjacent lumen wall W. Wires 128 then are actuated to open pinchers 141 of end effector 126 to grasp the lumen wall therebetween, forming a fold of lumen wall W that defines pocket P distal thereto and that closely approximates outer distal end 124 of outer catheter 122. Thereafter, push rod 140 is distally advanced to urge one anchor 104 through inner distal end 136 into central lumen 134 of outer catheter 122. To determine when one anchor has been ejected from inner catheter 132, indicia (not shown) on a proximal end of delivery catheter 120 may be provided. After one anchor 104 is disposed within central lumen 134 between inner and outer distal ends 136 and 124, inner catheter 132 is advanced distally to urge anchor 104 through outer distal end 124 and into lumen wall W. Further distal advancement of inner catheter 132 relative to outer catheter 122 causes anchor 104 to penetrate through lumen wall W and into pocket P as shown in
Referring now to
To deliver distal portions 146 of anchors 142 through lumen wall W, anchors 142 are disposed in their reduced delivery profile within catheter 148 (see
Referring now to
Rather than endoscopically manipulating fastener 16 to adjust the tension in drawstring 14 and thus adjust the localized reduction in the cross-sectional area of the GI lumen, remote adjustment of drawstring 14 may be provided. As depicted in
In use, a clinician inputs commands into external control unit 170, which generates a wireless signal responsive thereto. The wireless signal is transmitted by the transmitting antenna within external control unit 170, and received by the receiving antenna within internal control unit 168, which then energizes motor 164 to turn reel 166. If the command input by the clinician calls for a reduction in cross-sectional area A, motor 164 will actuate reel 166 to wind an appropriate length of drawstring 14 therearound. Conversely, if the command input by the clinician calls for an increase in cross-sectional area A, motor 164 will actuate reel 166 to unwind an appropriate length of drawstring 14 therefrom. In this manner, the localized reduction in the cross-sectional area of stomach S defined by drawstring 14 may be remotely adjusted.
Referring now to
In contrast to drawstring 14 and the elongated gastric band described in the "Background of the Invention", the partition of the present embodiment creates a localized reduction in the GI lumen without substantially altering the native shape of the lumen, or, when used in conjunction with a VBG procedure (see
To inflate balloon 172 and thereby adjust or regulate cross-sectional area A of stoma 174, inflation medium may be endoscopically injected through re-sealable port 184, which is disposed on proximal surface 180 of balloon 172. Re-sealable port 184 is covered by a septum preferably made of silicone, so that the septum will not leak even after repeated punctures. Optionally, re-sealable port 184 may further comprise an endoscopically retrievable tube (not shown) for accessing port 184.
Alternatively, inflation medium, e.g., air, water or contrast fluid, may be introduced through inflation port 186, which is coupled through tube 188 in fluid communication with balloon 172. Tube 188 preferably comprises a fluid impermeable, substantially non-extensible material, i.e., one having very low compliance, so that the tube does not "absorb" volumes of inflation medium that are intended to be infused into or withdrawn from the balloon. Inflation port 186 incorporates body 190 defining chamber 192, re-sealable septum 194 disposed distal to chamber 192, and stop 196 disposed within chamber 192. Septum 194 preferably is made of silicone, so that the septum will not leak even after repeated punctures by needle 198 of source 200 of inflation medium. Stop 196 prevents needle 198 from puncturing body 190 of inflation port 186 during insertion thereof. Inflation port 186 preferably is encapsulated with silicone and includes a plurality of suture holes for anchoring body 190 to subcutaneous fascia F with septum 194 facing outward in vivo. A puncture may be made through lumen wall W in a manner similar to a percutaneous endoscopic gastrotomy to permit delivery of inflation port 186 to subcutaneous fascia F and disposal of tube 188 across the lumen wall.
Source 200 of inflation medium preferably comprises needle 198, body 202 containing inflation medium, and plunger 204 which may be actuated to inject (or withdraw) inflation medium into (or from) inflation port 186 through needle 198. Needle 198 preferably is non-coring, i.e., the needle will not bore a piece out of septum 194 when inserted into inflation port 186. Source 200 also may comprise optional pressure gauge or transducer 206 to measure and display the pressure in inflation port 186.
In the embodiment of
For example, as shown in
Alternatively, as described in
Coupled in fluid communication with balloon 208 via substantially non-extensible tube 218 is inflation port 220. In addition to having compliant body 222 defining chamber 224, septum 226 preferably made of silicone, and stop 228 to prevent a needle of a source of inflation medium from penetrating body 222, inflation port 220 further incorporates unidirectional inflow valve 230 and unidirectional outflow valve 232, both of which preferably are disposed within chamber 224. Inflow valve 230 permits inflation medium to flow from tube 218 into chamber 224 at a rate slower than the rate that outflow valve 232 permits inflation medium to flow in the reverse direction. Illustratively, this effect may be achieved by restricting the opening of inflow valve 230, as compared with the opening of outflow valve 232.
This permits the present invention to dynamically adjust the diameter of stoma 212 responsive to the pressure of food in the GI lumen proximal to proximal surface 210 of balloon 208 in the following manner: In operation, stoma 212 preferably is completely closed or has a small cross-sectional area A in its equilibrium state, i.e., the state in which food is absent. When food enters the GI lumen proximal to balloon 208 and contacts proximal surface 210, the pressure within the balloon exceeds the pressure within chamber 224. The resultant pressure gradient drives inflation medium from balloon 208 to inflation port 220 through restricted inflow valve 230, thereby increasing cross-sectional area A of stoma 212 by partially deflating balloon 208. Inclined proximal surface 210 and increase in the cross-sectional area of stoma 212 facilitates disposal of accumulated food through stoma 212 into a distal portion of the GI lumen. Preferably, to enhance the feeling of satiety and thereby decrease the amount of food consumed, the rate that cross-sectional area A increases is slower than the rate of food consumption.
After all the accumulated food has emptied into the distal portion of the GI lumen, the resulting removal of pressure from proximal surface 210 of balloon 208 causes a shift in the pressure gradient, in which the pressure in inflation port 220 becomes greater than that in balloon 208. This pressure gradient drives inflation medium from inflation port 220 back into balloon 208 to re-inflate the balloon, causing stoma 212 to resume its equilibrium cross-sectional area. Since outflow valve 232 has a bigger opening than that of inflow valve 230, flow of inflation medium back into balloon 208 occurs at a faster rate than flow of inflation medium into inflation port 220. A reservoir similar to that described hereinbelow with respect to
Pursuant to another aspect of the present invention, stoma 174 defined by balloon 172 may be remotely adjusted. As described in
Similar to internal control unit 168 of
Alternatively, cross-sectional area A of stoma 174 may be adjusted through direct mechanical reduction of the circumference of stoma 174. One example is described in
Referring now to
To return band 262 to its non-contracted state, and thereby enlarge cross-sectional area A of stoma 174, a counteracting energizable band (not shown) that is structurally coupled to band 262 may be provided. More specifically, the counteracting band, which is also made of a shape memory material and electrically coupled to internal control unit 270, may be configured to expand from the second diameter to the first diameter when the counteracting band is energized. When the counteracting band expands into the larger diameter, band 262 expands therewith.
Rather than directly energizing band 262, an inductor may be used to heat the band and thereby cause it to contract in diameter.
As previously discussed, illustrative hardware suitable for use with the apparatus and methods of the present invention to remotely adjust cross-sectional area A of stoma 174 are described in U.S. Pat. No. 6,210,347 to Forsell. Additional telemetric apparatus and methods also are well known in the art.
It will be apparent to one of ordinary skill that the remote adjustment mechanisms described hereinabove also may be applied to adjustment of stoma 212 of
The diameter of stoma 174 of balloon 172 may be determined through numerous techniques. One technique relies on provision of a correlation between the diameter of the stoma and the pressure within either the balloon or the inflation port, if present. An exemplary relationship is shown in graph 276 of
Alternatively, as described in
In operation, after internal control unit 282 receives a command wirelessly transmitted by the external control unit, the internal control unit instructs first crystals 278 a to generate and transmit ultrasound signals to second crystals 278 b of adjacent ultrasound transducers. Upon receipt of the signals by the second crystals, the time-of-flight of each transmitted signal is determined, and the linear distances between adjacent transducers are calculated. Geometric triangulation of the calculated distances is used to compute the diameter of the stoma.
Described in
Referring now to
Pursuant to another aspect of the present invention, partition 13 is designed to create a seal with lumen wall W of the GI lumen to prevent food from shunting past the stoma defined by the partition. For example, as shown in
Referring now to
Pouch P preferably is formed endoscopically, as described, for example, in Applicant's co-pending U.S. patent application Ser. No. 10/735,030, filed Dec. 12, 2003, which is incorporated herein by reference in its entirety. Bulking agent stoma 320 is formed at the outlet of pouch P, for example, via catheter 322 having needle 324. Needle 324 injects bulking agent B into the submucosal space of lumen wall W. Optionally, saline or some other space filling fluid may be injected into the interstitial space of lumen wall W prior to injection of bulking agent B, in order to expand the interstitial space for more uniform delivery of the bulking agent.
Injection of bulking agent B forms stoma 320 having lumen L of reduced cross-sectional area, as compared to the cross-sectional area of pouch P. Bulking agent B preferably is injected around the circumference of pouch P to form stoma 320 with a substantially cylindrical profile. Bulking agent B may comprise, for example, a biologic material such as collagen or synthetic material such as polyethylene glycol (PEG). Additional alternative materials will be apparent. Lumen L of stoma 320 preferably has a diameter less than about 1.5 cm, and even more preferably has a diameter less than or equal to about 1 cm.
Regulation of stoma 320 may be achieved by reinserting catheter 322 through a patient's esophagus into pouch P. Needle 324 then may be reinserted within stoma 320 to withdraw or add additional bulking agent B, as needed. Advantageously, the ability to withdraw bulking agent B post-delivery makes formation of stoma 320 reversible. Furthermore, bulking agent B optionally may be fabricated from bioresorbable materials in order to form a temporary stoma 320.
With reference to
In a preferred embodiment, sewing ring 352 is fabricated from a resilient material that provides dynamic adjustment/regulation of stoma 350. When the patient eats an excessive amount of food, a pressure gradient across stoma 350 resiliently expands lumen L of sewing ring 352 to allow passage of the food. Once the pressure gradient has decreased, stress applied to the sewing ring decreases, and stoma 350 resiliently returns to the specified diameter. Stoma 350 preferably is designed such that stoma 350 restricts food passage and expands only when necessary to prevent injury to the patient or perforation of pouch P.
Referring to
With reference to
Iris diaphragm valve 404 is similar to iris diaphragm valves well known in the art, for example, those used to adjust the aperture of a camera lens. Cams 410 of support structure 408 advance overlapping elements 406 into lumen L of stoma 400 upon counterclockwise rotation of support structure 408 relative to the overlapping elements, thereby reducing a cross-sectional area of stoma lumen L. Conversely, relative clockwise rotation of the support structure retracts the overlapping elements from lumen L, thereby increasing the size of the stoma. As will be apparent, the relative counterclockwise/clockwise, advancement/retraction relationship of elements 406 and support structure 408 may be reversed.
When implanted within a patient's stomach, regulation of iris stoma 400 via advancement and/or retraction of elements 406 yields an adjustable mechanical constriction for selectively controlling food passage through stoma 400. Such regulation may be achieved using any of the mechanisms described previously, including, but not limited to, wireless actuation of a motor, injection of a pressurized fluid, use of specialized endoscopic tools, etc. Additional tools will be apparent to those of skill in the art.
With reference now to
Ring 412 preferably comprises element 414, illustratively friction locking lip 415, through which additional smaller rings, e.g. ring 416, may be coupled to ring 412 to reduce the size of stoma 410. Conversely, removing one or more such smaller rings from ring 412 may increase the size of stoma 410. When multiple smaller rings 416 are used to regulate stoma 410, the rings may be nested within one another and interconnected via elements 414 disposed on each nested ring. Advantageously, adjustment of stoma 410 may be achieved after implantation of initial ring 412. Such adjustment or regulation, as well as such initial implantation, preferably is achieved endoscopically.
Referring now to
With reference to
Element 436 comprises sharpened distal tip 438, as well as lumen 440 within which band 432 may be disposed. Element 436 preferably further comprises sensor 442, which may comprise a light-emitting diode or a fiber optic that may be visualized from within the stomach to guide the procedure while the needle element is disposed exterior to the stomach. Alternative sensors, such as ultrasonic or magnetic sensors, will be apparent.
In use, catheter 434 may be advanced through a patient's throat into pouch P and/or stomach S, as in
Referring to
With reference now to
Stoma 452 may be regulated via system 454 and programmer 480. Encoder 476 and/or controller 470 transmit data regarding stoma 452 to programmer 480 via antenna 474. Programmer 480 receives the data via antenna 482. A medical practitioner then reviews the data and determines appropriate adjustment or regulation parameters for stoma 452, e.g. an increase or reduction in the size of the stoma. The practitioner programs the regulation parameters into programmer 480, which transmits the parameters back to system 454. Transmission of data between controller 470 and programmer 480, and vice versa, may be conducted at a radio bandwidth, via ultrasound, etc.
Controller 470 actuates motor 468 to turn screw 466, thereby advancing or retracting nut 464 to shorten or lengthen, respectively, the portion of drawstring 462 forming stoma 452. This serves to alter the size of stoma 452 as specified by the regulation parameters. After the specified regulation has been achieved, controller 470 stops motor 468. Optional encoder 476 provides feedback to controller 470 that ensures proper regulation has been achieved. If a discrepancy is noted between the parameters input by the medical practitioner and the actual regulation achieved, controller 470 may re-actuate motor 468, as needed, in a control loop feedback cycle.
Power for system 454 is provided by battery 472. Battery 472 preferably comprises adequate energy capacity to facilitate repeated adjustment of stoma 452, for example, at least 50 adjustments, and even more preferably at least 100 adjustments. Additionally or alternatively, battery 472 may be rechargeable. For example, battery 472 may comprise an inductive coil (not shown) for wirelessly recharging the battery. Rechargeable embodiments of battery 472 allow substantially limitless adjustment of stoma 452. Battery 472 preferably comprises a Lithium Ion ("Li-Ion") battery; additional embodiments, such as Nickel Cadmium ("Ni-Cad"), will be apparent.
With reference to
In use, controller 494 communicates with programmer 480 to exchange data regarding stoma 452 and regulation thereof. When programmer 480 instructs controller 494 to increase the size of lumen L through stoma 452, the controller initiates opening of pressure valves V3 and V2 to vent fluid (air, saline, CO2, etc.) from inflatable bladder 490 into the patient's stomach, thereby at least partially deflating the bladder and increasing the size of lumen L. When sufficient fluid has been vented from the bladder to achieve the regulation parameters input by the medical practitioner, valves V3 and V2 are closed to maintain stoma 452 at the preferred dimensions. Valve V3 serves as a secondary safety valve to ensure proper pressurization is maintained within bladder 490.
When it is desirable to decrease the size of lumen L, controller 494 initiates opening of pressure valves V3 and V1 to allow pressurized fluid within cartridge 496 to flow into, and inflate, bladder 490. After adequate inflation of the bladder, the pressure valves are closed to maintain the inflation. Pressure gauge 498, disposed on the bladder side of valve V3, may be used to confirm adequate regulation of stoma 452. If proper pressurization is not achieved, pressure gauge 498 may feed this information back to controller 494, such that the controller may fine-tune the adjustment via operation of the pressure valves.
Referring now to
With reference to
Inner cylinder 516 comprises valve 524 for fluid communication between the inner and outer cylinders. The valve comprises gate 526 that swings open when inner cylinder 516 is slidingly advanced within outer cylinder 518, due to the pressure differential established between the sealed inner and other cylinders. The open gate allows fluid F to freely flow between the two cylinders, thereby providing only a mild damping effect. Conversely, the gate swings shut when the inner cylinder is slidingly retracted from the outer cylinder. Hole 528 in gate 526 allows fluid F to flow more slowly between the two cylinders when the gate is shut, thereby damping such relative motion.
In this manner, regulation mechanism 514 provides for dynamic self-adjustment of stoma 510. Spring 522 biases drawstring 512 to form a small stoma 510. When a significant pressure differential adequate to overcome the spring constant of spring 522 and the viscosity of fluid F is applied across stoma 510, for example, due to ingestion of a substantial quantity of food, inner cylinder 516 is retracted from outer cylinder 518, which expands stoma 510 to relieve the pressure gradient across the stoma and allow food to pass. Closed gate 526 hinders passage of fluid F from the inner cylinder to the outer cylinder, which yields slow expansion of stoma 510.
Conversely, after the pressure differential across the stoma has been reduced, inner cylinder 516 is again advanced within outer cylinder 518 due to tension stored in stretched spring 522. Gate 526 swings open during such relative motion to facilitate easy passage of fluid F from the outer cylinder to the inner cylinder, which yields more rapid contraction of stoma 510. Thus, stoma 510 is dynamically regulated in a manner allowing for slow expansion and rapid reduction. By reducing the rate of expansion relative to reduction, it is expected that enhanced weight loss may be achieved. However, it should be understood that a more linear elastic dynamic regulation mechanism alternatively may be provided.
Referring now to
With reference to
Referring now to
Strips 600 comprise trailing edges 601 a and 601 b, respectively, that are not attached to pouch P. As seen in
With reference to
Referring to
As seen in
While preferred illustrative embodiments of the invention are described above, it will be apparent to one skilled in the art that various changes and modifications may be made therein without departing from the invention. For example, while some embodiments of the present invention have been described as useful for reducing an entire cross-section of the stomach and others have been described as useful for reducing a VBG pouch, it should be understood that all embodiments may be used in either application—as well as further alternative applications—by altering the size of the embodiment. Furthermore, while regulation mechanisms for adjusting embodiments of the present invention have been described in conjunction with specific embodiments, it should be understood that such regulation elements may be modified for use with alternative embodiments of the present invention. Furtherstill, additional embodiments of the present invention, as well as additional regulation mechanisms—be they non-adjustable, dynamically adjustable or actively adjustable—for use with embodiments of the present invention, will be apparent to those of skill in the art in view of this disclosure and are included in the present invention. The appended claims are intended to cover all such changes and modifications that fall within the true spirit and scope of the invention.
Referenced by
Legal Events
Original Image


text:
When and who first got you into Paddleboarding? I first started paddling when I was in Junior Lifeguards and Alfred Laws was my instructor. He set an example for me, as he was a great ocean athlete and a great surfer. At age 16 I did my first Catalina channel crossing on borrowed boards with a couple of friends. Who ... Read More »
Home » Tag Archives: Joe Bark
Tag Archives: Joe Bark
2010 Hennessey's International
Sept 25, 2010 Hennessey's International Championships, San Diego, CA Race Results Read More »


text:
Monthly supplement
Food for thought
A word from the Editor-in-Chief Hosny Guindy
Time for forgiveness?
Mona Anis revels in a 1960s memoir vividly chronicling the underground life of Egypt's angry young writers
A sun which leaves no shadows
Mokhtarat (Selections), Ghaleb Halasa, Al-Ahram (Kitab fi Garida), February 1999
Mothering the populace
The Pure and the Powerful, Studies in Contemporary Muslim Society, Nadia Abu Zahra, London: Garnet Publishing,1997. pp.308
Lights, camera, chit-chat
Cairo: From Edge to Edge, essay by Sonallah Ibrahim and photographs by Jean Pierre Ribière, Cairo: AUC Press, 1998. pp21+ 70 photographs
The art of conversation
Tawfiq El-Hakim Yatathakar (Tawfiq El-Hakim Reminisces), ed Gamal El-Ghitani. Cairo: Supreme Council of Culture, 1998. pp183
Not quite another country
Alnesaeyat, Malak Hefny Nassef. Cairo: The Women and Memory Forum publications, 1998. pp246
Journey of a giraffe
Zarafa, Michael Allin, London: Headline Book Publishing, 1998. pp215
Village life from within
Denys Johnson-Davies offers insight into Mohamed El-Bisatie's work, and translates an extract from his new novel, appearing this Saturday in the Al-Hilal series
And the Train Comes
Short Reviews:
*Al-Kotob: Wughaat Nazar (Books: Viewpoints)
*Soheir El-Qalamawi, Nabila Ibrahim
*Sifr Amal Donqol (The Book of Amal Donqol), ed Abla El-Reweini
*Mithl Saif Lan Yatakarar Kathiran: Mahkiyat (Like a Summer that will Not Often Repeat Itself: Anecdotes)
*Al-Sayida allati wa'l-Rajul alathi lam... (The Lady who and the Manwho did not ...), Sabri Moussa
*Buka'iya illa Hafiz Al-Shirazi (Elegy to Hafiz Al-Shirazi), Abdel-Wahab Al-Bayati
*Deen Al-Harafeesh fi Misr Al-Mahrousa (The Religion of the Harafeesh in Egypt the Protected), Ali Fahmi
*Al-Ibna Faten (Daughter Faten), Naim Sabri
*Siwa Door: Poems 1993-1997, Tom Lamont
*Tujar Al-Tawabil fi Misr fi'l-Asr Al-Mamluki ah (Spice Merchants in Egypt in the Mameluke Period), Mohamed Abdel-Ghani El-Ashqar
*Ragul Tayeb Yukalim Nafsah (A kind man who talks to himself), Girgis Shukri
*Nizwa: A quarterly literary Journal
*Al-Tifl Al-Manbuz (Testaments Betrayed), Milan Kundera
*Arba' Masrahiyat 'Iraqiya (Four Iraqi Plays)
Illustrations courtesy of International Commitee of the Red Cross
"Folk drawings and tales", Cairo, 1996
The art of conversation
During his childhood Tawfiq El-Hakim moved with his country magistrate father from one small Delta town to another. One such town was Dessouk, the hometown of the great Sufi Sheikh Ibrahim El-Dessouki, whose moulid was a great event. For the celebration the town would be decked out like a bride. The Gouqa (troupe) of Sheikh Salama Hegazi made it a point to participate in the moulid and to perform their famous operetta Shuhadaa Al-Gharam (Martyrs of Love).
As a child El-Hakim had the opportunity to witness the splendid sight of the Hegazi troupe, followed by children running behind them as they paraded through Dessouk in splendid, colourful costumes, their wigs topped with old-fashioned headdresses and all of them brandishing swords and daggers. Because Sheikh Salama Hegazi's was such a famous theatrical troupe, many dignitaries, including El-Hakim's father, attended the play, bringing their children along. And it was after watching Shuhadaa Al-Gharam that Tawfiq El-Hakim's destiny -- indeed -- the destiny of Arab theatre, was sealed. El-Hakim would become a renowned writer, with over 60 books to his name including novels, literary criticism, works on religion and philosophy. But his most single impressive contribution to Arab culture lies in his pioneering of Arab theatre, which he transformed from an impoverished form of entertainment without purpose or vision into a more serious, intellectually and emotionally challenging art form.
There would have been no real Arab theatre to speak of had it not been for Tawfiq El-Hakim. Indeed, Egypt's recent celebrations of the centenary of El-Hakim's birth last year, which included a five-day conference titled Tawfiq El-Hakim: An Ever Renewed Presence, were no less celebrations of the centenary of the birth of Arab theatre.
The conference comprised 24 sessions and numerous round table discussions, with tens of critics and scholars from Egypt, the Arab world, Europe and the Americas participating.
Its convening, last November, coincided with the publication of Gamal El-Ghitani's Tawfiq El-Hakim Yatathakar (Tawfiq El-Hakim Reminisces), an honest transcription of a number of taped conversations which took place in 1978 between El-Hakim and El-Ghitani. The book also includes a chapter from a never to be completed novel begun by El-Hakim in 1944 and eventually dedicated to El-Ghitani when the conversations were first published.
But to return to Tawfiq El-Hakim the child and Salama Hegazi's troupe. El-Hakim says: "I will never forget that night. The curtain rose revealing the entire troupe with their bright costumes, men and women standing in rows, singing the opening song, only to disperse soon afterwards in order for the acting to begin. In those days I could not of course understand much of the play's detail. All that interested me and charmed my mind were the duels, and the first thing I did the next day was to break the broomstick and turn it into a sword, challenging a servant that we had at the time to a duel. This servant used to go to a café at night where a folk singer with a rababa told the story of Abu-Zeid El-Hilali and Diab Ibn-Ghanim..."
When Tawfiq El-Hakim's mother fell ill and was confined to her bed, she read folk epics such as Hamza Al-Bahlawan and Sief Ibn Thi Yazin. No sooner would she finish reading a part of these cycles than she would start recounting what she had read to her children. According to El-Hakim "she was good at telling us these stories, at trying to convey every single detail. My grandmother and I would be all ears listening to her, and sometimes my father joined us after he finished examining his cases, as if it was an infection that reached him too. When the episode she was telling left the protagonists in a suspenseful situation and we were eager to know how it would end, my mother would say, 'Wait till I've read the next part', and leave us on the edge of our seats, living intensely with these heroes and waiting till we could return to them. She did not just tell the stories but added her own commentary in order to bring the characters closer to us, saying for example that this or that character resembled such and such a kind or evil person in our own circle, so that I was able to picture the protagonists' faces..."
From such childhood scenes began the path that would make of El-Hakim a seminal influence on Egyptian theatre. But after describing his mother El-Hakim moves to his father. A graduate of the Faculty of Law, with nothing to his name other than a monthly salary, El-Hakim's father was an ardent nationalist, committed in resisting the British occupation. El-Hakim records the note written by his father on the day of his birth: "A telegraph from my brother-in-law, which I had copied, arrived: 'You have been given a boy, Congratulations'. I was sitting in the meeting room speaking with the judge Ali Bey Galal about various things. It was 12.30pm. Another letter arrived asking me to give the boy a name. I replied, saying that I leave the matter of naming the boy to my wife. I then went to Alexandria and visited my wife. She was in good health and informed me that the boy was named Hussein Tewfik El-Hakim."
El-Hakim's mother would later tell her story of his birth. How he came into the world silently, without crying or screaming or wailing the way newborns do. How, terrified, it occurred to her that he may have been born dead. How, when she asked the nurse why he was not making any sounds, they all turned to where he was lying and found him, finger in mouth, contemplating the lantern hanging above him with curiosity.
El-Hakim was not a studious schoolboy. He had to repeat several years at primary and preparatory schools, partly because his father moved so often between the small Delta towns and Alexandria, and also because he was an avid reader. His weakness in maths would lead to El-Hakim's being sent to live in Cairo, in the traditional quarter of Sayeda Zeinab, with a teacher uncle who might help El-Hakim through his final school years.
Once in the capital, El-Hakim steeped himself in the world of theatre, attending plays performed by theatrical troupes like Salama Hegazi's and George Abyad's. Eventually El-Hakim moved from being a spectator to an author and actor. It was with the greatest of difficulty that El-Hakim managed to complete his BA in Law. And it was during this period that he met Sayed Darwish, though their friendship did not last long.
Then came the 1919 Revolution, which resulted in El-Hakim's first play, Al-Deif Al-Thaqil (The Heavy Guest). In the immediate wake of the 1919 Revolution he wrote, too, Awdit Al-Roh (Return of Spirit), based on his experiences in Cairo. The events of the novel unfold in Sayeda Zeinab, and the major characters of the novel are based on people he knew.
A new phase of El-Hakim's life began when, after graduating from the Faculty of Law, he went to Paris to complete his studies. He lived there for four years without setting foot in Egypt, afraid of facing his father who, naturally, would ask him about his studies. But instead of studying law, El-Hakim spent his time in Paris going to plays, listening to music and reading.
When he returned to Egypt, El-Hakim practiced law like his father but continued to hone his literary craft. His production was prolific -- including the play Sheherezade, published under the semi-psuedonym Hussein El-Hakim, together with Awdit Al-Roh, Yawmiyat Naib fil Aryaf, Ahl Al-Kahf and Asfour min Al-Sharq. And it was in Tawfiq El-Hakim's hands that Arab theatre was to emerge from the realm of farcical entertainment to respectable art form.
Reviewed by Mahmoud El-Wardani


text:
August 4, 2015
JASPER, Texas (AP) - A Jasper couple is accused of binding a
four-year-old boy with duct tape at a day care and dangling him
over a trash bin -- to punish him.
Child endangerment charges have been filed against 48-year-old
George Block and his wife, 47-year-old Julia Block. She's manager
of the Young Years Day Care Center in Jasper.
Each could get up to two years in state jail if convicted.
Both are free on $5,000 bond. Each declined comment.
An affidavit says George Block bound the boy's wrists and feet
on March 3rd with duct tape before dangling him over a trash bin at
the center.
Court papers say Julia Block approved her husband's actions as
discipline for the boy "after a day of very disruptive behavior."
The boy told investigators what allegedly happened to him.
Jasper police say they don't believe race played a role in the
alleged incident.
The Blocks are white. The child is black.
Information from: The Beaumont Enterprise,
(Copyright 2008 by The Associated Press. All Rights Reserved.)
To comment, the following rules must be followed:
Comments may be monitored for inappropriate content, but the station is under no legal obligation to do so.
If you believe a comment violates the above rules, please use the Flagging Tool to alert a Moderator.
Flagging does not guarantee removal.
Multiple violations may result in account suspension.
Decisions to suspend or unsuspend accounts are made by Station Moderators.
Questions may be sent to firstname.lastname@example.com. Please provide detailed information.
Click Here to access the online Public Inspection File
Viewers with disabilities can get assistance accessing this station's FCC Public Inspection File by contacting the station with the information listed below. Questions or concerns relating to the accessibility of the FCC's online public file system should be directed to the FCC at 888-225-5322, 888-835-5322 (TTY), or firstname.lastname@example.com.


text:
Customer Reviews
4 Item(s)
- Finicky Chula Review by Hilda
My finicky Yorkie-Poo, Chula, kind of liked this food. I usually make a combination of boiled chicken, cooked steak, kibble, and some other treats. I added this to the mixture, and it looks like she ate most of it. Tonight I forgot to add it, but I will try again to see how she does.
(Posted on 4/29/14)
- Dogs love this stuff Review by Susan
Great product AND when you open it, it doesn't smell horrible like some products made with less than human ingredients might. Agree some product is lost after it's opened (hard to get it ALL out), but I just swish some water in the package (when it nears the end) and grab up all the little pieces and put on top of dry food.
(Posted on 10/22/13)
- Best Dog food on the market !!!!!!!! Review by Mary
I have 5 Chihuahuas - 1 has liver problems, another has a heart murmur, and another has kidney problems because she's getting old, plus I have one that has brain damage & has seizures. The last one, she just loves food and is getting too fat. They have all perked up since changing to this dog food. They are crazy over it and the dog with the liver problems isn't as listless as he use to be. Keep up the good work Three Dog. I would recommend this to everyone as well as the one with broccoli in it, too.
(Posted on 10/17/13)
- Mmmmmmmm Review by Noah and scout
I found this at a local pet shop, a little disappointed I paid .45 more. But the goldens loved it so much, the package needed to be cut open so they get every bite. I like the bag, but you do loose product if you don't cut it open. It's a yummy treat, they will enjoy this a few times a month. I might order online over the local store.
(Posted on 11/10/12)
4 Item(s)


text:
About our company
Little Daisy Wholesale sells crafting supplies for your children boutique needs. We offer all the big sellers as well as unique items that will increase your profits and bring in buyers. We hope to provide items that save you time! We carry only high quality products.
We have several years experience in the boutique world and know the kind of things you want! Little Daisy Wholesale was created to give another option to our fellow crafters in hopes to provide great customer service. We plan to stay stocked, ship quick and make you happy. We will be adding new items regularly so check back often. We would love to hear your item requests!


text:
Linguistik-Klassifikation: Spracherwerb / Language acquisition
Document Type
- Working Paper (5)
- Part of a Book (1)
- Spracherwerb (3)
- Griechisch (2)
- Kindersprache (2)
- Modalität <Linguistik> (2)
- Aspekt (1)
- Deklination (1)
- Einführung (1)
- Grammatik (1)
- Griechisch (1)
- Morphologie (1)
- The acquisition of Greek case, number, and gender: a usage based approach (2007)
- Children […] growing up with highly inflected languages such as Modern Greek will frequently hear different grammatical forms of a given lexeme used in different grammatical and semantic-pragmatic contexts. In spite of the fact that the Greek noun is not as highly inflected as the verb, acquisition of nominal inflection of this inflecting-fusional language is quite complex, comprising the three categories of case, number, and gender. As is usual in this type of language, the formation of case-number forms obeys different patterns that apply to largely arbitrary classes of nominal lexemes partially based on gender. Further, frequency of the occurrence of the three gender classes and case-number forms of nouns greatly differs in spoken Greek, regarding both the types and tokens. […] [A] child learning an inflecting-fusional language like Greek must construct different inflectional patterns depending not only on parts of speech but also on subclasses within a given part of speech, such as gender classes of nouns and inflectional classes within or (exceptionally) across genders. It is therefore to be expected that the early development of case and number distinctions will apply to specific nouns and subclasses of nouns rather than the totality of Greek nouns. The two main theoretical approaches of morphological development that will be discussed in the present paper are the usage-based approach and the pre- and protomorphology approach.
- The modality constituent : a neglected area in the study of first language acquisition (1978)
- Studies of syntax in first language acquisition have so far concentrated on the propositional side of the sentence, i.e. on the occurrence and interplay of semantic roles like agent, benefactive, objective, etc. and their syntactic expression. The modality constituent, however, has received little attention in the study of child language. This may be due in part to the impetus more recent research in this field has received from studies of the acquisition of English, a language with poor verb morphology as compared to synthetic languages. The research to be presented in this paper is concerned with an early stage of the acquisition of Modern Greek as a first language, a language with a particularly rich verb morphology. Since modality, aspect, and tense are obligatorily marked on the main verb in Mod. Greek, this language offers an excellent opportunity for studying the development of these fundamental categories of verbal grammar at an earlier stage than in more analytic languages. [...] As this paper is concerned with the semantic categories of verbal grammar mentioned above as weIl as with their formal expression, only utterances containing a verb will be considered. For reasons of space we shall further limit ourselves to those utterances containing a main verb. Such utterances divide into two classes, modal and non-modal. [...] In spite of Calbert's claim (Calbert 1975) that there are no strictly non-modal expressions, affirmative and negative statements as well as questions not containing a modal verb will be considered as non-modal. As will be shown below, modal and non-modal expressions are formally differentiated at the stage of language acquisition studied.
- The development of modality in language acquisition (1983)
- Defined as a general inner-linguistic function, modality pervades language and there can thus be no strictly nonmodal predicative expressions. We shall, however, in what follows, keep to grammatical tradition and exclude declarative and interrogative sentences in the indicative mood from consideration. Although a thorough study of the development of modal negation should prove most rewarding, we must renounce such an attempt out of space limits. […] [W]e shall be concerned with the formal linguistic devices employed by the child for expressing modality in various languages and the functions these serve, i.e. how they are used. Only by the conjoint study of form and function can one hope to arrive at a fair understanding of how the modalizing function develops in the ontogenesis of language.
- The acquisition of Greek (1995)
- On the Early Development of Aspect in Greek and Russian Child Language, a Comparative Analysis (2003)
- The category of aspect is grammaticized in both Greek and Russian opposing perfective and imperfective verb forms in all inflectional categories except the nonpast ('present'). Despite these similarities there are important differences in the way the aspectual systems function in the two languages. While in Greek nearly all verbs oppose a perfective to a given imperfective grammatical form, Russian aspect is more strongly lexicalized with pairs of imperfective and perfective lexemes not only differing aspectually, but also as far as their lexical meanings are concerned. This is especially true of perfective verbs formed by prefixes as compared to their imperfective bases. Thus, in pairs of prefixed and unprefixed dynamic verbs, the derived prefixed (perfective) member has a telic meaning while its unprefixed (imperfective) counterpart is atelic (e.g. sjest' (PFV) 'to eat up' vs. jest' (IPF) 'to eat'). Such derived perfective verbs may in turn be "secondarily" imperfectivized by suffixation furnishing the only "true" perfective/imperfective pairs of verbs (e.g. sjest' (PFV) 'to eat up' vs. sjedat' (IPF) 'to eat up' (iterative)). "Secondary" imperfectives do not occur in our child data. In this pilot study, we will analyze the tense-aspect-mood forms of the 20 most frequent verbs with equivalent meanings occurring in the longitudinal audiotaped data of a Greek and a Russian boy between 2;1 and 2;3 (their entire lexical inventories comprise approx. 100 verbs each). We adopt a constructivist perspective on the development of aspect in Greek and Russian child language and will show that in spite of a broad inventory of imperfective and perfective verb forms to be found in the speech of both children aspect has not yet developed into a generalized grammatical category, but is strongly dependent on aktionsart (stative/dynamic, telic/atelic) in both languages. While this results in a strong preference for perfective verb forms of telic verbs and of imperfective forms of atelic ones in the speech of the Greek boy, the Russian child tends to use the unmarked members.


text:
Available in shapes other than rectangle.
Made in USA.
BRAND: Karastan
COLLECTION: English Manor (2120)
STYLE: Stratford
COLOR: Ivory (00505)
MADE IN: United States
CONSTRUCTION: Machine-Made
MATERIAL: 100% Wool
THICKNESS: 1⁄2" (approx.)
WARRANTY: 20 year - manufacturer
Inspired by the timeworn comfort of an English country house, the classic patterns in our English Manor collection offer relaxed elegance for everyday living. The pure New Zealand worsted wool yarns have been specifically dyed to create when woven, a random stria reminiscent of the aged colors found in antique manor house rugs. English Manor rugs are woven with a cotton foundation for strength and suppleness, and undergo...
Rugs Direct recommends you avoid using your vacuum's beater bar on any area rug. For complete information on area rug care and cleaning, please click here.
Rugs Direct in-home delivery is available for selected rugs in this collection.
Standard curb-side delivery of oversized rugs is free on most purchases from Rugs Direct.
However, special "white glove" delivery is available for selected rugs in this collection at additional cost. If you select this option, we will make an appointment to deliver your purchase at a time convenient for you and place the rug in...


text:
Our online store offers an easy way for Parker families to purchase Parker School Uniforms, PE Uniforms, as well as textbooks and readers for the upcoming year.
Recent Campus Scenes
To expand the slideshow, hover your mouse over the slideshow and click the "Full Player" button in the top right.
See More Parker Photos
See Our YouTube Video Gallery
Get the Latest NewsSign up to receive a Parker e-newsletter.
© 2014 Francis Parker School | A JK-12 preparatory school committed to sustaining a diverse, family-oriented educational community.
Home | Contact Us | Privacy Policy


text:
March 18, 2005
ALBUQUERQUE, N.M. - The New Mexico softball team held on despite a seventh inning rally by Liberty to win its only game of day one in the Fairfield Inn Lobo Softball Classic. The Lobos beat the Flames, 4-2, improving to 6-15 overall. Liberty, who lost game one of the tournament to New Mexico State earlier in the day, 7-5, fell to 8-10 overall.
The Flames got on the board in the first inning as Shannon McKain doubled to right center with two outs, driving in Beth Hensley from second base.
The Lobos fired back in the bottom of the inning to take a 2-1 lead. Sophomore Ryanne Hodgins led off the inning with a single to left. Two outs later, junior Cassie Chavez doubled to left, bringing home Hodgins. Junior Kristina Schmallen, who is fully recovered from her injury that prohibited her from playing in the field, singled to left center, allowing Chavez to score.
One inning later, sophomore Becky Dover led off by reaching second base on an error by the left fielder. Again with two outs, the Lobos came up big as Hodgins singled to the shortstop and hussled down the line to beat out the throw while Dover scooted home.
New Mexico continued to put a run up on the board for the third straight inning. Chavez scored with two outs in the third off of a single to left center by senior Ashley Shartzer.
Trailing 4-1, Liberty's Jessica Moore sent the ball to the wall in right center for a RBI triple that scored Gertie Jeffries in the fifth. Two innings later, the rally caps were on and Liberty found itself with the bases loaded and one out. Hensley grounded the ball hard to freshman shortstop Christina Rios, who threw home to sophomore cather Liz Young, who tagged out pinch runner Rachel Love at the plate. Still with the bases loaded, Claire Fridey could not convert, hitting a grounder to Schmallen at second, who tossed the ball over to Shartzer for the final out at first.
Junior Katie Gregg improved to 4-1 on the season with her five-hit complete game, allowing just two walks and two strikeouts. Terra Lowe took the loss for the Flames, throwing six innings for eight hits, two earned runs, two walks and six strikeouts.
New Mexico out-hit Liberty 8-5 with Hodgins having a perfect 4-for-4 day at the plate. Hodgins also had a RBI and run scored. Chavez was 2-for-3 with one RBI and two runs scored. Five different Flames each had one hit.
Besides New Mexico State's 7-5 win over Liberty to open play in the tournament, Texas Tech earned an eight-inning 1-0 win over the Aggies in the only other game played today at Lobo Field.
The tournament picks up tomorrow morning at 10 a.m. with Texas Tech and Liberty squaring off, followed by a rematch of the Texas Tech-New Mexico State game at approximately 2 p.m. The Lobos will play the final game of the day against New Mexico State at approx. 2 p.m.


text:
*For our first reader spotlight, welcome Lindsay!*
Who is your beauty inspiration?
Penelope Cruz
What is your favorite beauty product?
alima pure minerals blush in candy
If you were stranded on an island, what two makeup products would be a must-have?
sunblock and lip gloss
Any tips or tricks in your beauty routine? Any tips that your mom/grandmother passed down?
- Don't wash your hair everyday, (thank you dry shampoo)
- moisturize your neck when you are doing your face.
- Wash your face immediately after working out.
- Sleep with your hair in a scrunchie not an elastic, so you don't break your hair.
Favorite makeup brand
everyday minerals


text:
Brightcove chairman and CEO, Jeremy Allaire, blogged about the need to re-conceptualise the TV as an application platform, meaning we should think of TV screens and monitors as "the final frontier in Internet-based software applications, not as devices to watch and consume video content."
At the same time, there is a growing consumer trend toward multi-tasking while watching TV. A U.S. survey of more than 2,000 web-enabled smartphone users conducted by Razorfish and Yahoo! found that 80% of respondents were mobile multitasking while watching TV.
Jeremy's vision and the shifting trend toward multi-tasking signals an important opportunity for media publishers to capitalise on - dual screen viewing experiences. These experiences enable viewers to stream programmes to their TV while enjoying relevant content from the same publisher via a mobile app. For publishers, this is a fantastic opportunity to introduce rich content apps that simultaneously control content, data and information presented on the TV while displaying synchronised content on their mobile device, delivering a more engaging, contextual viewing experience for viewers.
Leading the way in this evolution is Apple through its AirPlay technology and Apple TV platform. Apple announced last July that the company sold 1.3 million Apple TV devices last quarter, an increase of 170% over the same quarter last year. Also of interest, Microsoft sold 1.1 million Xbox 360s worldwide during the same time period.
At Brightcove, we are focused on helping publishers take advantage of new opportunities like dual screen experiences. Last year we introduced a new App Cloud Dual Screen Solution for Apple TV to open the door to a new kind of content experience for the connected consumer that blends the rich contextual information that fans crave with HD television viewing.
You can learn more about the power of dual screen experiences, as well as our solution, in this Bright Ideas video. In this video Brightcove CMO Jeff Whatcott is joined by Brightcove CEO, Jeremy Allaire, who shares his thoughts on this growing trend, and walks through a cool demonstration of dual screen apps in action.
Content on this page is provided and controlled by Brightcove.


text:
VIEWS: 10 PAGES: 11 POSTED ON: 12/30/2011 Public Domain
RESPONSE TO NEEDLE STICK INJURY AND SPLASHES POLICY Document Version number: 1.0 Date Written: September 2007 Updated: Not Applicable Author: Dee May / Helen Evans Job Title: Infection Control Advisors Email Address: email@example.com Contact Number: 0208 812 7643 Date Approved by Infection Control Committee: September 2007 Next Review Date: September 2009 This policy can only be considered valid when viewed via the Wandsworth PCT website. If this document is printed into hard copy or saved to another location, you must check that the version number on your copy matches that of the one online. This Policy is valid on: 30 December 2011 Page 1 of 11 Response to Needle Stick Injury and Splashes Policy 1 Introduction 1.1 Due to the need for prompt action with an exposure to blood or blood- stained body fluids, staff should be made aware of the action to be taken at induction before there is a risk of injury, and at regular intervals thereafter to ensure that practice is up-to-date. 1.2 This policy deals with sharps / splash incidents which may result in accidental exposure to Blood Borne Viruses (BBVs). 2 Purpose Health care workers who come into contact with patients' blood or body substances may be at risk of exposure to blood borne viral infections. To prevent the likelihood of transmission this policy must be followed in the event of a sharps/splash incident. 3 Scope The policy is applicable to all healthcare workers who come into contact with patients' blood or body substances. 4 Roles and Responsibilities The Director of Provider Services has over-arching responsibility for all Infection Control issues at Wandsworth tPCT. The tPCT has an Infection Control team who are available to advise on any issues on 0208 812 7643. The Infection Control Team also provide the Infection Control Training. 5 Training Requirements The management of needle stick and splash injuries is covered at Infection Control Training. Infection Control Training is mandatory for all staff as identified in the Training Needs Analysis. Non-clinical staff are required to attend Infection Control training at Corporate Induction at commencement of employment. Clinical Staff are required to attend Infection Control Training at corporate induction at commencement of employment and thereafter for updates annually. 6 Blood-borne Viruses (BBVs) 6.1 Blood-borne viruses include Hepatitis B and C and the Human Immunodeficiency Virus (HIV). Page 2 of 11 6.2 All individuals infected with blood borne viruses may be capable of transmitting the virus to others irrespective of whether they are ill or apparently fit and healthy. Infectivity depends on a number of individual risk factors and will vary from individual to individual. Many individuals are unaware that they are infected and thus health care workers should always treat all blood and body substances as if they are infected. Body substances that have been shown to transmit BBVs include: cerebrospinal fluid peritoneal fluid pericardial fluid pleural fluid synovial fluid amniotic fluid human breast milk semen vaginal secretions saliva in association with dentistry any other body substance containing visible blood, e.g. faeces, urine, sputum unfixed tissues and organs exudate or other tissue fluid from burns or large skin lesions. 7 Prevalence 7.1 The risk to the healthcare worker for each virus is proportional to the prevalence of that infection in the population, the infectious status of the individual source patient (which may or may not be known) and the risk of a significant occupational exposure occurring during the procedures undertaken. 7.2 The risk of transmission to a healthcare worker from an infected patient following a sharps injury has been shown to be: Hepatitis B (e antigen positive) 1:3 Page 3 of 11 (if healthcare worker is non-immune) Hepatitis C 1:30 HIV 1:300 (UK Health Departments, 1998) Certain geographical areas of the world have a higher prevalence of blood-borne viruses than others. Such information is useful in certain situations e.g. when making epidemiological assessments of risk. However, on a day-to-day basis, ethnicity is not used as a determinant of risk. 8 How Can BBVs be Transmitted? By needle stick injury, contaminated sharp object, bite, scratch or other skin puncture with contaminated blood or bloodstained body fluids. Unprotected sexual intercourse with an infected person. From infected mother to baby. Either via the placenta or at the time of delivery, or through breast-feeding. Via exposure prone procedures (when infected healthcare workers can infect patients) Via sharing contaminated sharps/"works" of injecting drug abusers. Via contaminated blood or blood products (not usually a risk in the UK but may occur if receiving blood in other countries). 9 Occupational Acquisition of BBVs 9.1 A number of factors are associated with an increased risk of occupationally acquired BBV infection: Deep injury Visible blood on the device which caused the injury Injury with a needle which had been placed in a source patient's artery or vein High levels of circulating virus in the source patient – as in late stage AIDS or during sero-conversion in the early stages of infection Page 4 of 11 These factors will be taken into consideration when assessing the risk of BBV transmission following a sharps injury. Such an assessment will be undertaken by either the Occupational Health Department or other departments, such as Accident and Emergency or Minor Injuries Treatment Unit following national guidelines. Risk assessment should never be undertaken by the individual who has received the sharps injury. 9.2 The risk of HIV transmission after percutaneous exposures involving larger volumes of blood, particularly if the source patient's viral load is likely to be high, may exceed the average risk. This may occur if injury is sustained with a large hollow-bore needle when the needle contains a large volume of blood from either an artery or vein. 9.3 Risk of infection from cutaneous exposure from infected blood/or contaminated body fluids will depend on the infectivity of the material and the size of the exposed area e.g. people with large areas of psoriasis or eczema could be at higher risk of acquiring these infections if in contact with infectious material when splashed. 9.4 The highest risk of contamination from cutaneous exposure relates to splashes involving mucous membranes such as conjunctivae and mouth. Hence the requirement for staff to wear appropriate PPE when undertaking splash-inducing procedures e.g. endoscopy, or aerosol producing procedures e.g. many dental treatments 10 Sharps /Splash Incidents 10.1 There are three types of exposures in health care settings associated with significant risk. These are: percutaneous injury (from used needles, scalpel blades, lancets and other pointed instruments or equipment; bone fragments, significant bites which break the skin, etc) exposure of broken skin (abrasions, cuts, eczema, etc) to blood and/or blood stained body fluids exposure of mucous membranes, including the eyes, nose and mouth, to splashes of blood and/or blood stained body fluids 11 Responding to an Injury (Appendix 1) It is essential that a risk assessment is undertaken at the earliest possible opportunity as delay in receiving prophylaxis (if required) could affect outcome. This needs to be undertaken at the time of the injury NOT at the end of the shift. Current guidance states that HIV prophylaxis should be commenced within one hour of the incident, but can still be given after that time. Page 5 of 11 11.1 First Aid Encourage bleeding from the wound. Do not suck. Wash the area thoroughly with warm running water and soap Cover with water-proof dressing Eyes or mouth - irrigate with copious amounts of saline or water 11.2 Report ALL sharps injuries and splash incidents must be reported to the Senior Nurse or Manager on duty (dependent on place of work) as soon as possible, but do not delay seeking guidance on the need for prophylaxis if a manager cannot be contacted. An incident report must be completed by the person affected by the event as soon as possible. The completed incident report should be sent to the Risk Manager. 11.3 Record Details Try to identify the source patient. Complete the Checklist Form - Following Sharps/Splash incident (Appendix 1) to help with the risk assessment and take it to the nearest Accident and Emergency Dept. (Kingston or St. George's Hospitals) The Checklist will help to establish if the member of staff has had a significant exposure to a high risk body fluid and provides guidance on the important questions that will be asked by the assessing clinician when undertaking risk assessment. CONTACT DETAILS Wandsworth PCT staff During office hours: QMH and community staff: As soon as possible after injury, inform the Occupational Health (OH) service where you have been seen before (for QMH contact Orchard Hill): St. George's Hospital OH (020) 8725 2633 Orchard Hill OH (020) 8770 8308 Otherwise: Attend the nearest Accident and Emergency Department (either Kingston or St. George's Hospital). Identify yourself as a healthcare worker who has sustained a sharps injury requiring risk assessment Page 6 of 11 GP Practice staff During office hours: As soon as possible after injury, inform Occupational Health Tel. No. (020) 8682 3248 Out of hours: Staff should attend St. George's Hospital Accident and Emergency Department. Identify yourself as a healthcare worker who has sustained a sharps injury requiring risk assessment When attending for risk assessment, the staff member affected must take the completed Checklist to ensure that appropriate information is available to the clinician undertaking the risk assessment. The staff member may be required to have a blood sample taken and stored for further testing if necessary. You may also be required – dependent on the risk assessment – to have medication or immunisation to reduce the likelihood of sero-conversion. Any concerns due to exposure, drug treatment or employment etc. can be discussed in confidence at this time If the source is identified the clinician undertaking the risk assessment will arrange for testing of that patient's blood via their GP / clinician. If seen out of hours, the Occupational Health Department will arrange co-ordination of results and follow-up and determine whether further blood tests will be required at 3, 6 and 12 months. This will be undertaken the following working day after injury. 11.4 Forms Complete the WtPCT's Accident and Incident Report (AIR) form. See Trust web page: http://www.wandsworth-pct.nhs.uk/work/policies/default.asp?expid=29 If the exposure is from a Hepatitis B, C or HIV positive source, RIDDOR form 2508 will be completed by the Occupational Health Physician once confirmation of the test results are known. 12 Hepatitis B – Vaccination / Prophylaxis All health care workers at risk of exposure to blood/body fluids as part of their work should be offered vaccination against Hepatitis B. Page 7 of 11 12.1 Primary Course This consists of 3 injections at 0, 1 and 6 month intervals followed by a blood test to determine antibody levels. Some people may not develop antibodies even after further doses of vaccination. In addition to primary immunisation, Hepatitis B specific immunoglobulin may be required within 24 hours in the event of accidental exposure from a high risk Hepatitis B source. 12.2 Accelerated Course Accelerated Hepatitis B immunisation consists of injections at 0, 1 and 2 month intervals which may be administered to a non-immunised person in the event of accidental exposure from medium to low risk Hepatitis B source. 12.3 Routine Follow-up It is recommended that all health care staff who receive Hepatitis B vaccine should be screened by Occupational Health department every five years to ensure antibody levels remain sufficiently high to provide protection in the event of an injury. A booster dose may be given if necessary. 13 HIV – Vaccination / Prophylaxis 13.1 Although there is no protective vaccine for exposure to HIV there are certain drugs which, if taken soon after exposure, offer some protection to the exposed individual. Ideally, this should be received within 1 – 2 hours of injury but can still be administered for up to 72 hours post- injury. 14 Hepatitis C - Vaccination / Prophylaxis 14.1 There is currently no vaccine available for prevention of Hepatitis C infection. 15 Staff Support 15.1 Needle stick and splash injuries, especially those resulting in Prophylaxis can cause a great deal of worry for members of staff directly affected by the incident and it is important for managers to recognise this and support the member of staff through this period. 15.2 Occupational Health services are also available to advise and support staff following such incidents and are contactable on 0208 725 2633. Page 8 of 11 16 Blood-borne Virus-infected Healthcare Workers 16.1 Healthcare workers who are known to have a BBV are restricted from certain aspects of patient care. These restrictions are in place in order to reduce the risk of transmission of BBVs to patients from infected healthcare workers whilst carrying out certain procedures known as Exposure Prone Procedures (EPP's) 16.2 EPP's are those invasive procedures where there is a risk that injury to the worker may result in the exposure of the patient's open tissues to the blood of the worker (bleed-back). These include procedures where the worker's gloved hand may be in contact with sharp instruments, needle tips or sharp tissues (e.g. shards of bone or teeth) inside a patient's open body cavity, wound or confined anatomical space. However, other situations, such as pre-hospital trauma care and care of patients where the risk of biting is predictable (e.g. such as with a disturbed and violent patient) should be avoided by healthcare workers restricted from performing EPP's. 17 Review and Monitoring 17.1 All NHS trusts must ensure that policies are in place to identify and manage employees with blood borne viruses. 17.2 All staff are under legal and ethical duties to protect the health and safety of their patients. They also have a right to expect that their confidentiality will be respected and protected. 17.3 All risk assessments must be sent to Occupational Health. 17.4 Needlestick and splash injury incidents are analysed by the Trust's Risk Manager and Infection Control department and are monitored by the Infection Control Committee and Provider Safety Committee. Figures will be presented and any trends will be highlighted, this will enable the Trust to consider how recurrences might be prevented. The Infection Control Team Tool is undertaken on an annual basis. 17.5 The Provider Infection Control Committee will meet bi-monthly to review the effectiveness of this policy and ensure best practice. Page 9 of 11 Appendix 1 RISK ASSESSMENT FOLLOWING SHARPS/SPLASH INJURY To be completed by staff member who has sustained the sharps/splash injury and then taken to Accident & Emergency Department and / or Occupational Health. PERSONAL DETAILS Name: Date of Birth: Post: Place of Work: Telephone Number: Manager: Home: Work: Date: Time of Accident/Incident: DETAILS OF THE INJURY Brief description of the incident with blood/blood stained body fluids (please tick box if applicable) SHARPS INJURY: Needle/scalpel blade or other sharp instrument Scratch Bite Cut Bone Other CONTAMINATION: Abrasion Eczema Psoriasis Other EXPOSURE TO MUCOUS MEMBRANE Eye Other Which high risk body substance? Blood Blood stained body fluid Vaginal secretions Saliva (if visibly blood stained e.g. in association with dentistry) Used needle Other please specify …………………………………………………………… Page 10 of 11 C Source Patient History (if known, to be completed by doctor/nurse managing the staff member NOT the injured person) Name…………………….. Tel No: …………………………………… Address: …………………………………………………………………………… DOB ……………………………………………………………………………… GP / Clinician details: …………………………………………………….. Source patient infected with HIV HBV HCV Source patient on medication for one (or more) of above illnesses IV drug user (present or previous) Does client have high-risk behaviour? (ask only if appropriate and in the strictest confidence) Page 11 of 11
Pages to are hidden for
"Needle Stick Injury and Splashes Policy v1 (DOC)"Please download to view full document


text:
Geek Speak
Geek Speak is where the world of Geekdom comes alive.
Posts filtered on Category
VIDEO: Slave Leia PSA. Exactly.
Only The Big Bang Theory star Kaley Cuoco could bring such welcome perspective to wayward cosplaying women when it comes to so-called Slave Leia fatigue. Because Cuoco knows whereof she speaks. And what she speaks of are options. Colorful, glorious options. You're welcome. (Thanks, Sean!) Related: • PIC: Bikini Leia and her stunt double napping […] [Read More]
Vampire Princess Leia slays us with pulpy fun
(StarWarsShop.com) How's this for the dark side of the Force? Industrial Light & Magic designer Harrison Parker crafted the Princess Leia vampire art seen here as an exclusive invitation to ILM's 2008 Halloween party for ILM staffers and select Lucasfilm insiders. If you never got your artsy pulp mag invite, take heart you can still […] [Read More]
PICS: Help me, United States Postal Service; you're my only hope
Back in 2007 (truly "a long time ago" in Web time) the United States Postal Service was all over the 30th anniversary of "Star Wars" with commemorative stamps plus a legion of special R2-D2 mailboxes. Anywho, there's your context for these oldie but goodie Princess Leia pics. Sure hope those Death Star plans had the […] [Read More]
VIDEO: 'Galactic Empire State of Mind' gives 'Star Wars' the Jay-Z & Alicia Keys treatment
See more funny videos and funny pictures at CollegeHumor. Nothing like original trilogy "Star Wars" on the hip hop beat — especially when it's Darth Vader doing his best Jay-Z and Princess Leia working the Max Rebo nalargon like Alica Keys in this solid spoof of "Empire State of Mind." (Digg) • 'Star Wars Gangsta […] [Read More]
Rare 'Star Wars' photos take us back to that original trilogy far, far away…
(Total Film) This year being the 30th anniversary of "The Empire Strikes Back," I'm swimming in more waves of "Star Wars" nostalgia than usual. Stuff like this TotalFilm.com slideshow of 30 rare "Star Wars" photos only makes me even more wistful for those original trilogy days. Luckily, a slave Leia shot like the one pictured […] [Read More]
PIC: Salvador Dali work gets the 'Star Wars' treatment
(image link) Why, it's "The Temptation of St. Anthony" by my favorite surrealist Salvador Dali, only with AT-ATs and other eye candy from my favorite "Star Wars" trilogy. I do believe my head just exploded. (Spotted via BuzzFeed.) Got geek news, events, insights, outrage or other manna you want to share? E-mail me. My Twitter […] [Read More]
PIC: Bikini Leia and her stunt double napping in the Tatooine sunshine
(link) You're welcome. (Spotted via Digg.) My Twitter page is still speechless. For a change. Got geek news, events, insights, outrage or other manna you want to share? E-mail me. [Read More]