text: Listen to Guy Kawasaki share practical advice for those looking to get into digital publishing. Guy has had tremendous success as Apple former chief evangelist and as a best-selling author. He now talks about how digital content creators need to balance the three stages of a successful project — writing or creating, publishing the digital…Read More


text:
By Jim GaramoneAmerican Forces Press Service
WASHINGTON, Jan. 13, 2000 Volksmarching clubs at West Point, N.Y., and Colorado Springs, Colo., sponsored year-round walks voted among the nation's best last year by members of the American Volksporting Association.
The 70,000-member association is the sport's U.S. sanctioning body. Both the Volksport Club of West Point and the Falcon Wanderers in Colorado Springs have large numbers of service members on their rolls.
The West Point volksmarch takes participants all over the U.S. Military Academy campus. The Colorado Springs volksmarch focuses on the Garden of the Gods park.
Volksmarching was brought to America largely by service members who received their first taste of the sport in Germany. Participants earn medals, pins, patches, steins or other souvenirs for completing noncompetitive walks over measured courses. There are two types of volksmarch in the United States.
The first is based on the European model and scheduled typically over one weekend. The second is the year-round or seasonal volksmarch. On these, local clubs measure their course, usually 10 kilometers, and designate a starting point. Walkers can do these walks any time during the year.
Association members voted the year-round volksmarch at Mackinac Island, Mich., as the nation's best last year. The march takes walkers past the historic sights of the island, located between the two peninsulas that make up Michigan.
The Top 10 Year-Round Events in 1999 were:
1. Mackinac Island, Mich.
2. Midtown Manhattan
3. Central Park, New York City
4. Fumee Lake, Mich.
5. Georgetown, Washington, D.C.
6. Kennebunk, Maine
7. Iron Mountain, Mich.
8. The National Mall, Washington, D.C.
9. West Point, N.Y.
10. Garden of the Gods, Colorado Springs, Colo.
To find the starting points for these walks, visit the American Volksporting Association Web site at www.ava.org. for links to local clubs and a listing of scheduled volksmarches.

subset: commoncrawl


text:
Japanese Mars Probe Back on Track
Scientists have re-established communication with the Nozomi spacecraft
by Elesa Janke
Scientists at the Institute of Space and Astronautical Science (ISAS) in Japan are bringing their first interplanetary mission, Nozomi, back to life. On April 21, 2002, the spacecraft was bombarded by extremely energetic solar particles from a coronal mass ejection, which pounded the craft for over six hours and caused a temporary shutdown. But engineers are now confident that the mission will soon be back on track.
Originally known as "Planet-B," Nozomi was renamed after launch to the Japanese word for "hope." It is en route to Mars, where it will study the planet's atmosphere and ionosphere. Carrying 14 instruments from five nations, including NASA's Neutral Mass Spectrometer, the mission will bring scientists valuable information about the interaction between the atmosphere and the solar wind. The spacecraft will also send pictures back to Earth of the Red Planet's surface.
After months of hunting down the source of the problem, ISAS scientists discovered that the coronal mass ejection caused one of the electrical power converters to "latch up," knocking out the main power and freezing the onboard propellant. They have since restored communication with the spacecraft and will maneuver its attitude (orientation) when the craft re-approaches Earth later this month, allowing the propellant to unfreeze.
Launched in July 1998, the craft was originally scheduled to arrive at the Red Planet in 1999. But due to a course-correction maneuver that used more fuel than planned, Nozomi did not have enough acceleration to propel it into its planned route. It is now scheduled for a December 2003 arrival, when it will begin to fly around Mars in an oval-shaped orbit that will range from 96 to 27,000 miles from the planet's surface.


text:
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text:
Creative Nail Design Solar Oil
219 reviews
79% would repurchase
Package Quality: 3.9
Price: $$$
Package Quality: 3.9
Price: $$$
INGREDIENTSPrunus Amygdalus Dulcis (Sweet Almond) Oil, Simmondsia Chinensis (Jojoba) Seed Oil, Oryza Sativa (Rice) Bran Oil, Fragrance (Parfum), Tocopheryl Acetate.
on 5/11/2014 9:00:00 PM
Age: 25-29
Skin: Normal, Fair, Cool
Hair: Brunette, Wavy, Fine
Eyes: Hazel
Absolutely love this product. I do my own gel manicures and this finishes it just like in the nail salons. It's never been greasy or oily. Absorbs fast but still moisturizes my cuticles better than any other oil.
The Butter London representative at ULTA had me try their brand and I was NOT impressed. She claimed it was better than CNDs because it's made with coconut oil instead of almond oil -- her story was that the CND solar oil went bad in her car because it has a lower boiling point. So maybe don't leave it in your car during hot summer days? Hasn't been a problem for me.
I've bought this product as a gift too. Will probably buy more just so I have a backup. It's my go to cuticle oil!(:
For my purse though, I really like The Body Shop's 'Almond Nail and Cuticle Oil'. It's got a turn-click dispensing stick, so you don't have to worry about it getting all over. AND it makes my nails/cuticles feel wonderful! One of my colleagues suggested I try it (we nurses really beat up our hands!) and I make sure to ALWAYS have it in my work bag.
on 3/30/2014 6:56:00 PM
Age: 30-35
Skin: Oily, Tan, Not Sure
Hair: Black, Other, Other
Eyes: Brown
so far I've used this 2-3 times a week. It does seem to moisturize my cuticles fairly enough. also it does dry a little faster than some of the other cheaper oils I've used. smells mainly of almond.
on 1/25/2014 1:53:00 AM
Age: 25-29
Skin: Combination, Medium, Not Sure
Hair: Brown, Curly, Medium
Eyes: Brown
This stuff has saved my nails! I try to aim for applying it 2x/day but only end up remembering 1x/day to every other day average. This stuff drys nail polish fast too like the expensive opi accelerating drops or sprays but I get a teeny bottle of this for $2! Just add a drop at base of nails by cuticle and let it run along the side about 5min after painting your nails. I also have noticed that I never get hangnails anymore so its even got long term benefits. My nails used to peel back at the tips, crack at the sides and my cuticle would look ragged. I religiously use thick oil based lotions so this one has all of those oils that all the other brands are bragging about as their main ingredients but I've been researching it and some don't work with out the others since their too small to actually penetrate the nail plate and this product has all of them in one! They deserve to brag about it but don't since its been around for so long. I cant live without it and it works no matter how irregularly I use it. Results were seen after maybe about a week of using it. I dont have to clip cuticle ever again either. It definately helps with all the trauma of all the chemicals in nail polish remover etc from affecting your nails. My whole familys nails are thin i guess its genetics and this stuff beats it!
on 1/2/2014 10:17:00 PM
Age: 30-35
Skin: Very Oily, Fair-Medium, Warm
Hair: Brunette, Wavy, Fine
Eyes: Green
this smells so good that i had to taste it. not bad.
on 12/15/2013 12:56:00 PM
Age: 44-55
Skin: Oily, Other, Not Sure
Hair: Brown, Other, Other
Eyes: Brown
When I first got gel nails done, the woman suggested I get Solar oil and use it religiously. I have problems with overgrown and dry cuticles also-solar oil has taken all of that away. I use this everyday, several times a day. This stuff really works. I find it cost effective to go online and buy the big 2 oz size. Go out and get this!
on 11/26/2013 9:53:00 PM
Age: 25-29
Skin: Combination, Fair, Cool
Hair: Red, Straight, Fine
Eyes: Blue
I love this product. It keeps my cuticles moisturized and smooth. It smells amazing and the smell actually makes me want to use it more.
Yes, I do think it is a little overpriced and that there is nothing really 'special' to it - it is just a few different oils mixed together and I could probably whip it up myself at home. Would I want the hassle of mixing it up at home? No way.
on 10/26/2013 2:45:00 PM
Age: 44-55
Skin: Combination, Fair, Neutral
Hair: Brunette, Straight, Medium
Eyes: Hazel
I got my first manicure in 1990, and that stylist put Solar Oil on my nails to dry my polish quicker. I had never heard of it before and was amazed at how well it worked, so I bought a bottle. I have never been without it in 23 years. I have recently started applying it nightly as a cuticle conditioning oil, but I have always used it as a nail polish dryer every time I paint my nails. Love the smell, consistency, and especially the way it dries my polish in minutes. Will continue to purchase oner and over.
on 9/20/2013 6:25:00 PM
Age: 19-24
Skin: Combination, Fair, Neutral
Hair: Brunette, Straight, Fine
Eyes: Green
Definitely a HG product for me! I love cuticle oils and have many different brands, scents, etc. And this one is by far my favorite!! It sinks in fast, very moisturizing, and smells great! The price is in the middle for me. Supply stores have it for a reasonable price, while it's kinda pricey at Ulta. Bottom line- great product and definitely repurchasing!
on 8/5/2013 9:35:00 AM
Age: 30-35
Skin: Acne-prone, Fair, Warm
Hair: Blond, Other, Other
Eyes: Blue
Another HG from CND!
I purchased this 5 years ago, and didn't get the hype.
Fast forward to this year - dried out nails that with a painful vertical split past the quick, they broke off and had no bend in them. Eraser sorted my cuticles, but nails were still as above. The usuals weren't working - avoplex, Flexitol, L'occitane, LF and I returned to this in desperation. Luckily it's worked. I felt it absorb right from the 1st application. The vertical split has healed for the first time in 2 years and I've only had 1 broken nail in the 6 weeks I've been using. So this and eraser are now staples and my nails have been transformed from splitting, breaking with bleeding sore cuticles to actually quite nice. I use it 2x daily, and eraser 3x daily, with L'occitane shea hand cream 2x daily. It's such a relief not to have to hide my hands from people anymore.
Update Nov '13. Have found out I'm anaemic, so if your dryness is due to anaemia it may help. With continued use, this has also removed deep vertical ridges in my thumb nail that I've had for around 3 years.
on 7/17/2013 4:33:00 PM
Age: 19-24
Skin: Sensitive, Fair-Medium, Cool
Hair: Brunette, Kinky, Coarse
Eyes: Green
There are no words to explain my love for this product. I am a cuticle care freak and this is my holy grail. I have repurchased countless times. I have one in my bag, one at home, one at my boyfriends, one at my parents house, and several back ups in my drawer.
The smell is phenomenal and this is the most moisturising cuticle treatment that I have found.
It dries quickly and it not greasy. It dried nail polish too!
I will always love this and continue to buy it. No product will ever take its place.
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text:
288 Choral Literature II (0.50)
This course is a study of the larger forms of choral music from the Baroque to the present. Students study scores and recordings and discuss representative style features and characteristics, interpretation, and conducting problems. Prerequisite: MUSIC 214, MUSIC 241, and MUSIC 242 and junior standing. Offered spring semester 2015-16 and alternate years.


text:
York's Fiscal Crisis, Then and Now
Tuesday, February 18, 6:30-8:30 p.m.
co-sponsored by
Baruch College School of Public Affairs
CANCELLED due to snow
Possible reschedule FALL
This forum will examine the Fiscal Crises of the 1970s and
today. The forum will be in three parts. Fiscal Crisis THEN
will feature comments from scholars who have studied the 1970s
event, including STEVE LONDON, Professor of Political Science,
Brooklyn College, and JOSH FREEMAN, Professor of History,
CUNY Graduate Center. We will also screen short excerpts from
several of the interviews taped with leading 1970s participants
by JACK BIGEL, himself a major player in those events. In
part two, Fiscal Crisis NOW, we will examine the causes of
and proposed solutions to our current situation. This will
take the form of a conversation between JAMES PARROTT, of
the Fiscal Policy Institute, and E.J. McMAHON, of The Manhattan
Institute, with each making a 10-15 minute presentation, and
then engaging in free form discussion. Finally, MIKE WALLACE
will offer a comparative look at both fiscal crises, and we
have invited some members of city government to join this
part of the evening.
History of the NAACP in New York
Thursday, March 6, 6:30-8:30 p.m.
CANCELLED due to snow
This forum will examine the history of the NAACP. After our
program, KENNETH JANKEN will sign copies of his new biography,
White: The Biography of Walter White, Mr. NAACP (The
New Press).
Civil War in New YorkFrom Print to Pixels
Wednesday, March 26, 6-8 p.m. Martin E. Segal Theatre
co-sponsored with The Center for Media and Learning
New York during the Civil War was the hub of the northern
war effort and also a city at war with itself. Defined and
divided by wealth and poverty, privilege and sacrifice, patriotism
and dissent, and abolitionism and racism, it was a social
and political powder keg that finally exploded in the draft
riots of July 1863. Novelist Kevin Baker, historian Jeanie
Attie, and media producer Andrea Ades Vasquez will discuss
and demonstrate the ways the story of New York during the
Civil War years has been told and interpreted in recent fiction,
scholarship, and new media.
KEVIN BAKER, author, Paradise Alley; JEANIE ATTIE,
Associate Professor of History, Long Island University; author,
Patriotic Toil: Northern Women and the American Civil War;
ANDREA ADES VASQUEZ, Project Director, The Lost Museum, American
Social History Project/Center for Media and Learning; JOSHUA
BROWN (Moderator), Executive Director, American Social History
Project/Center for Media and Learning.
POLITICS AND COMMUNITY STRATEGY IN THE FDR ERA, by Durahn
Taylor, Pace University
LEFT AND THE COLD WAR, 1950-1965, by Rebeccah
E. Welch, New York University
by Beverly Watkins, Columbia University
City by Tom Kessner
Thursday, May 22 6:30-8:30 p.m. Martin E. Segal Theatre
Historian TOM KESSNER will discuss his new book: Capital
City: New York City and the Men Behind America's Rise to Economic
Dominance, 1860-1900 (Simon and Schuster). Capital
City investigates the central role played by New York
City and its investors in transforming the American economy
in the years following the Civil War. It describes how Gotham's
speculative class led by Jay Gould, Cornelius Vanderbilt,
Andrew Carnegie, John D. Rockefeller and J.P. Morgan helped
develop the new corporate economy that catapulted the United
States to international economic dominance by the end of the
nineteenth century. Book signing to follow.
Rights in Post-War NYC: Book Talk and Signing by Martha Biondi
Wednesday, June 11, 6:30 p.m. | Rooms 9206/9207
story of the civil rights movement typically begins with the
Montgomery bus boycott of 1955 and culminates with the 1965
voting rights struggle in Selma. But as Martha Biondi shows
in To Stand and Fight: The Struggle for Civil Rights
in Postwar New York City (Harvard University Press),
a grassroots struggle for racial equality in the urban North
began a full ten years before the rise of the movement in
the South. This story is an essential first chapter, not only
to the southern movement that followed, but to the riots that
erupted in northern and western cities just as the civil rights
movement was achieving major victories. To Stand and Fight
demonstrates how black New Yorkers launched the modern civil
rights struggle and left a rich legacy.
is Assistant Professor of African-American Studies and History
at Northwestern University.
View past 2002 forums
Like us on Facebook!
Donate Now!
Help support the Gotham Center.
Mailing List
Sign up for the Gotham Center's mailing list so we can keep you informed about upcoming events.
Gotham History Festival 2001
Read all about it.
Gotham Center in the News
© Gotham Center for New York City History. All Rights Reserved.
The Gotham Center for New York City History
The Graduate Center, The City University of New York, Room 6103
365 Fifth Avenue, New York, NY 10016-4309
Telephone: 212-817-8460
E-mail: email@example.com


text: Comments on: Michelle Obama Worried Liberals Too Stupid, Too Dependent To Vote? http://www.thelandofthefree.net/conservativeopinion/2012/10/27/michelle-obama-worried-liberals-too-stupid-too-dependent-to-vote/ The Land of the Free presents articles and news about the world and the United States from a conservative, libertarian and classical liberal point of view. Wed, 06 Mar 2013 00:51:05 +0000 hourly 1 http://wordpress.org/?v=3.6 quick loans nevada


text:
Home ›
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Susquehanna University Bulletin ›
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Ensembles ›
MUSC:066 Collaborative Piano.
MUSC:066 Collaborative Piano.
Designed to instruct pianists in the essential aspects of performing chamber music and accompaniments. Prerequisite: Instructor's permission. May be repeated. 1 SH.
Catalog Links


text: This course examines the making of economic societies and specifically the evolution of the African (Third World) economies from pre-capitalist traditional societies through the colonial period to the present status of economic dependency. The class will strive to make students conscious of the interaction between Africa and the developed world, and the implications of these interactions, in historical perspective. Offered Fall or Spring as demand warrants.


text:
Watch for Hummingbirds NOW
|Courtesy Missouri Department of Conservation
|Here they come!
The big time to see them or course is July, when the young'uns start buzzing around, and also August, when many are heading back southward.
But right now, a good many of them are passing through on their way to northern states, and some will end up sticking around and starting families.
By the way, if you're going to put out a feeder, the state of Missouri warns against red dye in the sugary liquid, as it apparently harms the birds.
Sponsor Content


text:
IU Health La Porte Hospital
Classic Concert
- Danielle Belen, Violin - Sphinx Competition Winner, Soloist
- Sunday, March 17, 2013
- 2:00 pm Concert
- Elston Performing Arts Center, Michigan City
The orchestra will celebrate youth, diversity and triumph. This concert will feature the 15th Annual Sphinx Competition winner in a solo performance along with highlighting the talents of symphony musicians with a performance of Stravinsky's chamber orchestra work Dumbarton Oaks. The orchestra will celebrate the inaugural season with an encore performance of Tchaikovsky's Symphony No. 5.
LACKEY Overture of the Season
STRAVINSKY Dumbarton Oaks
VIVALDI Summer (Four Season)
PIAZZOLLA Verano Porteno (Summer-Four Seasons) Danielle Belen, Violin
TCHAIKOVSKY Symphony No. 5
Funding for this concert is also from: Michigan City Enrichment Corporation & the Paul's Foundation
If you cannot attend the Sunday Concert, you can enjoy the entire performance on Saturday
Portage Township Live Performance - Saturday, March 16th - 7:00 pm
Portage High School, 6450 U.S. Hwy 6, Portage IN 46368 Click here for More Information
Danielle Belen, Violin
Sphinx Competition Winner, Soloist
Winner of the 2008 Sphinx Competition and Naxos recording artist, Danielle Belen has soloed with symphonies across the U.S. including the Pittsburgh, Atlanta, Nashville and San Francisco Symphonies, the Boston Pops, and the Florida and Cleveland Orchestras. Zachary Lewis from the Cleveland Plain Dealer wrote "Violinist Danielle Belen... captivated every ear with an assured, impassioned performance of Ravel's "Tzigane," knocking off the daunting showpiece as if it were a trifle." She has recently enjoyed working with conductors such as Franz Welser-Mostt, Robert Spano, Keith Lockhart, Yehuda Gilad and Carl St. Clair.
A graduate of the USC Thornton School of Music and the Colburn Conservatory in Los Angeles, Ms. Belen is now on faculty at the Colburn School. With a growing violin studio of her own, and also teaching assistant to renowned pedagogue Robert Lipsett, she loves to work with young aspiring talent. She enjoys teaching master classes and leading community engagements across the country in conjunction with her professional performance appearances. Ms. Belen was recently appointed as Concertmaster of the New West Symphony and has also appeared as soloist with the orchestra. She is the founder and Artistic Director of Center Stage Strings, a summer camp and performance festival for gifted young musicians in Three Rivers, California. The camp attracts students and seasoned artists from around the world, including cellist Lynn Harrell, who will perform as part of the 2012 Festival.
Ms. Belen plays on a 1709 Allessandro Gagliano violin from the Mandell Collection of Southern California. For more information on Ms. Belen visit: www.belenviolin.com
Daneille Belen - Solo Recital/Master Class
Monday, March 18 - 12:00 p.m., LSF Building, Room 144, Purdue North Central, Westville Campus.
Also on Sunday, March 17 enjoy another musical festivity:
Classical Gas with Rich Ridenour & Steve Brook
La Porte Civic Auditorium Sunday, March 17 - 6:00 pm
Tickets & information: La Porte Community Concert Series


text:
Mesut Ozil has warned his Arsenal team-mates they still have plenty of room for improvement despite a fine start to the season.
Borussia Dortmund coach Jurgen Klopp has been banned for two matches by UEFA following his outburst during their 2-1 defeat to Napoli in the Champions League last month.
Tottenham are planning to move again for Thomas Ince in January and are increasingly confident that an offer of £4million will be enough to sign him from Blackpool.
Captain Nemanja Vidic says Manchester United players must remember "you shouldn't enjoy yourself too much in football".
Lewis Holtby believes his understanding with Jermain Defoe will flourish if they start for Tottenham against Anzhi Makhachkala.
England coach Gary Neville publicly criticised Manchester City goalkeeper Joe Hart's performance against Bayern Munich on Wednesday.
Manchester City defender Micah Richards admitted Bayern Munich were excellent at the Etihad but insisted the Blues are better than they showed in the 3-1 defeat.
Manchester United defender Chris Smalling says a point away at Shakhtar was important after the West Brom defeat but the Reds must get a result at Sunderland.
David Moyes has praised his players' defending after United earned a hard-fought 1-1 draw against Shakhtar Donetsk on Wednesday.
Liverpool midfielder Lucas Leiva has been recalled to the Brazil squad for their upcoming friendlies against South Korea and Zambia.
Victor Moses is loving his season-long loan spell with Liverpool.
Everton have unveiled the new official crest chosen from a shortlist of three by a public vote of Blues fans.
Everton have been linked with young goalkeeper Kjetil Haug, 15, of Norwegian side Sarpsborg.
Alan Pardew says he is prepared to ring the changes in his team for Newcastle's trip to Cardiff.
Pardew wants players to produce the complete performance.
John O'Shea insists 'moral victories' are of no use to Sunderland as Sunderland struggle to climb off the foot of the table.
Kevin Ball insists his transition from Sunderland youth coach to caretaker manager is neither 'massive' nor 'illogical'.
Sunderland's caretaker manager Kevin Ball will be given more duties even if he does not become head coach on a permanent basis.
Alan Shearer has told Newcastle fans they had better get used to erratic performances such as the dismal first-half at Everton.
Vurnon Anita believes Newcastle will be heading to Cardiff this weekend intent on showing fans the 'real' United.
Alex McLeish should be the next boss of Sunderland, says former Black Cats favourite Alex Rae.
John O'Shea insists positives in defeat count for nothing and the Sunderland defender has targeted a first win against Manchester United.
Birmingham City supremo Carson Yeung is 'personally' involved in preliminary talks to sell the club, acting chairman Peter Pannu has revealed.
West Brom will discuss the prospect of signing Morgan Amalfitano on a permanent basis - but Steve Clarke insists there is no rush on the club's part to conclude the deal.
Christian Benteke is expected to get a World Cup call-up today but the chances of him playing are slim with Villa also urging Belgium not to risk the injured striker.
Lee Clark says it's not just Jesse Lingard's goals that have made a difference to Birmingham City, but also his work rate and attitude, which is typical of players from Manchester United.
Wolves keeper Wayne Hennessey has been recalled to the Wales squad for the forthcoming World Cup qualifiers against FYR Macedonia and Belgium.
Bakary Sako pulled out of training today as Wolves and Nottingham Forest were locked in negotiations over his future.
West Brom boss Steve Clarke has claimed Albion are "in the driving seat" over the signing of loan star Morgan Amalfitano.
Former Stoke boss Tony Pulis is now being linked to a move to Sheffield Wednesday.
Tottenham Hotspur boss Andre-Villas Boas has hailed Andros Townsend's decision to apologise for diving against Chelsea.
Borussia Dortmund coach Jurgen Klopp will be absent from the touchline for the Champions League trip to Arsenal after UEFA extended his ban on Thursday.
Harry Redknapp has washed his hands of Loic Remy and Adel Taarabt by admitting he wants neither back at QPR.
Ashley Williams has been named in the Wales squad for the World Cup qualifiers with Macedonia and Belgium.
Swansea City manager Michael Laudrup wants Williams rested from the games as he battles to overcome an ankle injury.
Norwich goalkeeping coach and former Barnsley stopper Dave Watson advised highly-rated keeper Jack Butland to join his old club in a bid to get regular first team action after a frustrating move to Stoke.
Claus Lundekvam has hailed Dejan Lovren and José Fonte as the best centre-back combination Saints have had since he was paired with Michael Svensson.
Hull's medical team have defended the timing of Robbie Brady's hernia surgery and say he could not play through the pain for any longer.
Brian McDermott admitted he had little expectation of forcing a deal to bring Luciano Becchio back to Elland Road.
Ross McCormack says he is ready to "step up" and provide a solution to Leeds United's goalscoring problems after helping to inspire a morale-lifting win over Bournemouth.
Burnley boss Sean Dyche says getting the basics right and a winning mentality have been key factors in the club's rise to the top of the Championship table.
Burnley manager Sean Dyche and defender Jason Shackell have been nominated for the Championship manager of the month and player of the month respectively.
Blackburn captain Scott Dann will discover whether the injury he sustained in the win over Watford will rule him out of this weekend's trip to Wigan.
Sheffield United hope to sign defender Simon Lappin on a month's loan from Cardiff in time for tomorrow night's clash with Crawley.
Beram Kayal has warned Ajax that Celtic can still deliver a knockout punch to their Euro rivals without bad Bhoy skipper Scott Brown.
Celtic skipper Brown admits he regrets his 'mistake' which saw him red carded in Tuesday's 1-0 loss to Barcelona in the Champions League.
Charles Green has been showing off his new French home where he hopes to pursue his passion for horses following his £1m pay-off from Rangers.
Celtic skipper Scott Brown has accepted responsibility for his game-changing red card against Barcelona.
Scotland manager Gordon Strachan has criticised the culture of South American players in the wake of a red card given to Brown.
Gordon Strachan has warned Jordan Rhodes that he will need to keep learning if he wants to become a regular starter for Scotland, who are not yet good enough to accommodate a player who thrives on crosses.


text:
Posted at: 11/18/2012 11:44 AM
Updated at: 11/18/2012 5:28 PM
By: Shaun Griswold, KOB.com; Whitney Jones, KOB.com
Interstate 25 is back open after crews cleaned the remains of a semi truck fire near Bernalillo. Southbound lanes were closed for six hours.
All southbound lanes at mile marker 241 were closed Sunday.
Drivers told us Sunday afternoon that traffic is backed up all the way to La Bajada.
The vehicle fire was reported around 10:30 a.m. Sunday.
Drivers should still expect delays as traffic gets moving again.


text:
beyond the battlefield
beyond the battlefield
Results: 1 - 1 of 1
Magazines / #Reaction
Lexi prom video gets you tweeting. Patriotism or public relations?
It startles us sometimes to see what gets you going. Today it's Lexi Thompson, the amazing 17-year-old LPGA player who posted a video on her Facebook page asking for a military man between 18 and...
Friday, 4/27/2012 at 5:58PM
Results: 1 - 1 of 1


text:
For season 9 one of the future episodes will include Miley Cyrus playing a prank on boy friend Liam Hemsworth. The episode will involve Liam?s car, the police and?two naked people who get into Liam?s car. Meanwhile boy wonder Justin Bieber pulled a prank on singer Taylor Swift which involved a wedding and ?wow, a fire.
The Exclusive Insight And Behind The Curtain Gossip Of The Biggest & Hottest Celebrities Of Hollywood. Catch up-to-the-minute news on your favorite celebrities, from fashion disasters to malfunctions , break-ups to hot new couples and a lot more straight from the paparazzi.


text:
The College of Communication, Information, and Media Diversity Interest Group is proud to present "Communication + Culture: Dialoguing Difference," a student symposium showcasing student work that addresses culture, diversity, and difference.
Students can
submit their work related to culture and diversity issues. Applications are due
by February 7. The symposium provides a wonderful opportunity for students to
share their work with others, and many colleagues from across campus often
attend to identify good candidates for their graduate programs.
Copyright © 2015 Ball State University 2000 W. University Ave. Muncie, IN 47306
800-382-8540 and 765-289-1241


text:
Majority pay for benefit of minority
People avoid downtown mostly because of the parking problem and the homeless problem. The Sky Sox used to play at Memorial Park years ago then moved out east. There are 40,000 registered Sky Sox fans out of more than 500,000 citizens. Why do we all have to pay for the benefit of the few who will be using the new stadium?


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A Diet during Pregnancy can Help you Both
Eating the right diet during pregnancy should be among your top priorities. This is because now you are carrying a baby inside of you and you must ensure that your baby receives an ample amount of vitamins and nutrients. Eating the wrong diet during pregnancy can impact your baby's growth and overall health. In order for you to find the right diet, it is necessary that you plan ahead of time on which foods should and should not be eaten. If you are having trouble finding the right foods to eat InShapeMommy will help you determine a healthy regimen of foods. There are plenty of tips and videos on this site that can help you eat well, which will ultimately help you in achieving the right diet during pregnancy.
A Doctor is a Must if you Plan to Diet During Pregnancy
First of all, you need to seek advice from your doctor. It is best to refer to a gynecology doctor because he or she has a wide knowledge regarding pregnancy and knows which type of diet during pregnancy that you should consume. Additionally, when you seek help from a medical expert, you don't have to worry about the possibility of making the wrong choice of food. This will allow you to have peace of mind which is vital for the benefit of your baby's growth.
To Diet During Pregnancy you should Expect to Eat Fruits and Vegetables
The best diet during pregnancy should be foods containing all kinds of nutrients, including various fruits and vegetables. Eating unhealthy snacks while pregnant can be a detriment to you and your child. Examples of unhealthy snacks are chips, candies, cookies or anything else loaded with sugar. Refraining from chemically processed foods is also a very good idea. It's easier said than done as we are fully aware of the temptations that come along with being pregnant, but it's important for you to fight those junk food urges. It's also important to cut down on your intake of salt because pregnant women have the tendency to experience high blood pressure and diabetes. A combination of all types of healthy food should be included in your diet during pregnancy.
Keep in mind that you need to maintain a good level of hydration throughout the entire period of pregnancy. Therefore, make sure you include at least eight glasses of water into your diet during pregnancy.


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A ureter prosthesis fabricated from copolyurethane materials which are non-reactive in the urinary environment and adapted for fixation within a patient to avoid adverse migration. This ureter prosthesis can be adapted for intermediate location along a ureter or can be constructed with one-way valve means appropriate for implantation into the bladder lumen without a resulting vesico-ureteral reflux. The ureter prosthesis includes an elongate duct having a lumen whose interior surface is ultrasmooth based on microscopic inspection. An exterior cuff with terminal and intermediate sewing projections is formed around a portion of the elongate duct to enable its fixation by suturing to appropriate muscular tissue. The utility and success of this ureter prosthesis has been confirmed in multiple testing of dogs which have survived more than a year with the prosthetic ureter in place.
1. A distal ureter prosthesis comprising:
a. a substantially straight, flexible, elongate duct formed of block copolymers and having a lumen with an inner diameter approximately ranging from a normal human ureter diameter to as much as four times this size as seen in some diseased conditions, and an interior surface of said block copolymer which is ultrasmooth based on microscopic inspection;
b. one-way valve means coupled at one end of said duct for permitting outflow of fluid therefrom, while preventing backflow from fluids exterior to the duct;
c. terminal sewing projections formed around the ends of the duct except for exposed terminal segments of the duct which project beyond the terminal sewing projections; and
d. at least one sewing projection integrally attached to said duct at an intermediate location between the terminal sewing projections and including a site for suturing to provide means for secure fixation of the prosthesis within the patient.
2. A prosthesis as defined in claim 1, wherein the duct comprises multiple thin layers of the block copolymer integrally connected to form a single wall structure for the duct.
3. A prosthesis as defined in claim 1, wherein said sewing projections comprise multiple layers of foam-like material coupled together to form a circumscribing wall around the duct.
4. A prosthesis as defined in claim 3, wherein total void space within the foam-like material is within the approximate range of 40% to 80%.
5. A prosthesis as defined in claim 3, wherein void space in the foam-like material is made up of many small void spaces having diameter sizes within the approximate range of 10 to 200 microns.
6. A prosthesis as defined in claim 5, wherein said small void spaces have diameters within the approximate range of 80 to 120 microns.
7. A prosthesis as defined in claim 1, wherein the sewing projections material is formed from block copolymers selected from the group consisting of copolyurethanes, copolyether-urethanes and copolyether-urethaneureas.
8. A prosthesis as defined in claim 1, wherein said terminal and intermediate sewing projections comprise a plurality of annular rings circumscribing the elongate duct and having a radius substantially greater than remaining portions of the prosthesis.
9. A prosthesis as defined in claim 8, wherein said sewing projections are formed as part of a continuous and integral exterior cuff comprised of foam-like material.
10. A prosthesis as defined in claim 9, wherein said sewing projections are positioned along the exterior cuff at separation distances of approximately 1 to 3 cm.
11. A prosthesis as defined in claim 1, wherein said one-way valve comprises a bicuspid valve which opens for single directional flow when fluid pressure within said duct exceeds 2 mm Hg, and withstands reverse flow from without the duct in fluid pressures greater than approximately 8 mm Hg.
12. A prosthesis as defined in claim 1, wherein the inner diameter of the duct lumen tapers from a larger diameter at the valved end of the duct to a smaller diameter at the opposing duct end.
13. An intermediate ureter prosthesis comprising:
a. a substantially straight, flexible, elongate duct having a lumen with an inner diameter approximately ranging from a normal human diameter to as much as four times the size as seen in some diseased conditions, and an interior surface which is ultra-smooth based on microscopic inspection thereof;
b. terminal sewing projections formed around the ends of the duct except for exposed terminal segments of the duct which project beyond the terminal sewing projections; and
c. at least one sewing projection attached to said duct at an intermediate location between the terminal sewing projections and including a site for suturing to provide means for secure fixation of the prosthesis within the patient.
14. A prosthesis as defined in claim 1 or 13, wherein said duct is comprised of a material including block copolymers selected from the group consisting of copolyurethanes, copolyether-urethanes and copolyether-urethane-ureas.
15. A prosthesis as defined in claim 1 or 13, wherein the interior face of the duct has surface characteristics and properties which are substantially identical to surface characteristics developed by forming said material on a highly polished surface of glass or metal.
16. A prosthesis as defined in claim 13, wherein said sewing projections comprise multiple layers of foam-like material coupled together to form a circumscribing wall around the duct.
17. A prosthesis as defined in claim 13, wherein the sewing projection material is formed from block copolymers selected from the group consisting of copolyurethanes, copolyether-urethanes and copolyether-urethane-ureas.
18. A prosthesis as defined in claim 13, wherein said sewing projections comprise a plurality of annular rings circumscribing the elongate duct and having a radius substantially greater than remaining portions of the prosthesis.
1. Field of the Invention
This invention relates to prosthesis devices for replacement of segments of the ureter. More particularly, it relates to a distal ureter prosthesis which is adapted to feed directly into the bladder.
2. Prior Art
The ureter is a fibromuscular tube which conveys urine from the kidney to the bladder. It begins with the pelvis of the kidney, a funnel-like dilatation and empties into the base of the bladder. A normal length for an adult ureter is approximately 16 to 18 inches.
Numerous conditions may arise which can cause the need for replacement of all or part of the ureter. Pelvic and primary carcinoma represent major causes for uretheral blockage or failure. In addition, radiation injuries, trauma and iatrogenic injuries can develop conditions requiring replacement of the ureter.
Many attempts have been made to develop a uretheral graft useful for replacing a non-terminal segment of the ureter. Experimentally in animals, segments of ureter have been replaced by abdominal wall fascia, Fallopian tubes, polyvinyl chloride, vitalium, freeze-dried arteries and veins, tantalum, polyethylene, TEFLON, and silicone rubber. The polyethylene and silicone rubber tubes have proved to be moderately successful when used to replace segments of the dog ureter.
A much more difficult challenge arises with the replacement of a distal ureter segment which empties into the bladder. Previous attempts to develop a distal ureter with a one-way valve mechanism to prevent vesico-ureteral reflux have been prepared from TEFLON, silicone rubber and stainless steel. None of these devices, however, have met with success. Common problems which have apparently led to graft failure have included migration of the implant, leakage, stenosis at the prosthesis-uretheral or prosthesis-bladder junction and incrustation with resultant hydronephrosis. Also, a general poor tolerance of the graft material has contributed to prosthesis failure in many of these cases.
It is therefore an object of the present invention to provide a ureteral prosthesis which can be successfully implanted in a human patient.
It is a further object of the present invention to provide a distal ureter prosthesis which has an acceptable life expectancy for human application.
A still further object of the present invention is to provide a ureteral prosthesis device which is not subject to failure due to incrustation or migration.
It is yet another object of this invention to provide a ureteral prosthesis device which has sufficient mechanical compliance with human tissue to prevent adverse reaction of attached tissue due to poor tolerance.
These and other objects of the present invention are realized by a novel ureter prosthesis and process of fabrication. The ureter prosthesis comprises a flexible elongate duct whose lumen has an inner diameter ranging between a normal human diameter up to as much as four times this normal human diameter size. The interior surface of the duct is ultrasmooth based on a microscopic inspection thereof. An exterior cuff is formed around a portion of the elongate duct, leaving terminal segments at each end exposed to facilitate attachment within the patient. This exterior cuff is formed of a foam-like material which has at least 40% void space therein to provide a proper density for suturing to a substantially fixed location within the patient. The ultrasmooth surface of the duct interior provides primary prevention of incrustation. The exterior cuff with its foam-like composition facilitates suturing and secure fixation of the graft not only to the ureter and bladder, but also to the psoas and retroperitoneal fascia. These features, in combination with the favorable surface characteristics and mechanical properties of the block copolymers disclosed herein provide for an operable ureter prosthesis which has proved effective in extensive animal testing.
The ureter prosthesis is adapted for distal use by coupling a one-way valve at one end of the duct to permit outflow of urine therefrom. The one-way valve prevents backflow or vesico-ureteral flux of urine. The one-way valve found most useful is a bicuspid valve which can be well adapted for the fluid pressures experienced in this segment of the urinary tract. The ureter is prepared by first selecting a tubular mandrel having a highly polished surface and an outer diameter corresponding to a desired inner diameter for the prosthesis. One end of the mandrel is configured to conform to a cavity shape which is acceptable to form the body of the valve previously referenced. The next step in this process involves applying a fluid layer of block copolymer to the mandrel. The block copolymers found particularly suitable as ureter replacement materials include copolyurethanes, copolyether-urethanes and copolyether-urethane-ureas. With the mandrel suitably coated, the copolymer layer is solidified to fix its shape in conformance with the mandrel surface. Mold blocks are then secured around terminal segments at each end of the coated mandrel to form boundaries for the formation of an exterior cuff. These blocks have an opening centrally disposed therein and corresponding to an approximate diameter of the coated mandrel to facilitate mounting the mandrel within the respective mold blocks. The cuff is formed by permanently affixing a material whose final state develops a foam-like composition over the coated mandrel between the mold blocks. Cuff thickness is selected to ensure that suturing therethrough will not intercept any of the interior material such as the duct or its lumen. Once the cuff is formed and appropriately configured to facilitate suturing to fascia within the patient, the mold blocks are removed and the mandrel is withdrawn. In addition to using the stated block copolymers as duct material, the same copolymer can be appropriately fabricated to develop the foam-like end product structure. This may be accomplished by admixing powdered inorganic salt to a solution of approximately 12 to 17% (w) block copolymer, or may utilize a fluid transfer method for establishing a 40% void throughout the cuff material.
Other aspects and features of the process and prosthesis material are outlined in greater detail hereinafter. These features, along with other objects and features of the invention will be apparent to those skilled in the art based on the following detailed description, taken in combination with the figures described and provided herein.
FIG. 1 is a side view of a partially cut away prosthesis graft constructed in accordance with the subject invention.
FIG. 2 is a side view of a mandrel used in connection with fabrication of the subject ureter prosthesis.
FIG. 3 shows a perspective view of a partially cut-away coated mandrel with attached mold blocks.
FIG. 4 depicts a coated mandrel with attached cuff material.
FIG. 5 is a cross-section of the device shown in FIG. 4, taken along the line 5--5, including a partially exploded view of the cuff material.
FIG. 6 shows a method for emplacement of the distal ureter graft.
FIG. 7 is a cross section of FIG. 4 taken along lines 7--7.
Referring now to the drawings:
A distal ureter prosthesis constructed in accordance with the subject invention is illustrated in FIG. 1. The ureter comprises a substantially straight flexible, elongate duct 10 which is shown to be tubular in shape to conform to the tubular configuration of the ureter. The lumen 11 of the duct is constructed such that its inner diameter ranges from a normal ureter diameter to as much as four times the size of a normal ureter diameter as occurs in some diseased conditions. It will be apparent to those skilled in the art that the diameter size for the prosthesis device must be conformed to the ureter size of the patient which is to be treated. Furthermore, the inner diameter of the lumen may be uniform along the length of the duct 10, or it may taper from a larger diameter at a valved end 12 of the duct to a smaller diameter at the opposing duct end 13 which is secured at an open segment of the ureter of a patient. This attachment configuration with a human ureter is disclosed in FIG. 6 and discussed in greater detail hereinafter. The benefit of this tapered diameter is to prevent resistance to fluid flow as urine enters the prosthesis lumen, and continues passage therethrough to the bladder.
FIG. 5 shows a cross-section of a typical ureter prosthesis and discloses the structure of the duct 20 more clearly. As can be noted therein, the duct traverses the full length of the prosthesis beginning at an opening at one end of the lumen 21 and traversing to the valved end 22. A significant requirement of the invention is that the interior surface 16 of the duct have an ultrasmooth finish to impede incrustation within the lumen 21 of the prosthesis. As used herein, the term "ultrasmooth" refers to a material surface which appears very smooth even under microscopic examination. In other words, many surfaces which appear smooth to the unaided eye would appear very rough or textured under microscopic examination. An essential requirement of the ureter prosthesis disclosed herein is that this inner duct surface 16 must be constructed such that its surface is smooth even under microscopic examination.
The elongate duct should be flexible to permit an elastic response of the prosthesis to movement of muscular tissue to which the implant is attached. In addition, this helps prevent failure of the device due to mechanical mismatch of the prosthesis material with the body tissue to which it must conform or be compatible. Polymeric materials are particularly well suited for this application in view of their common elastic character and compatibility with body tissues. The most preferred class of polymers has been found to be a group of block copolymers represented by copolyurethanes, copolyether- urethanes, and copolyurethane-ureas. The use of these materials and their method of fabrication is discussed in greater detail hereinafter.
Circumscribing the duct 10 is an exterior cuff 16 which is formed around a central portion of the elongate duct. The purpose of the cuff is to provide an exterior material to the duct which facilitates suturing or other attachment of the prosthesis to the ureter and other tissue to which the device is attached. Although composition of the cuff material may vary, the material selected must include a foam-like character which has a sufficiently low density to permit easy suturing therethrough. The foam-like character of the illustrated prosthesis device is obtained by establishing a large number of small void spaces 14 (FIG. 1) and 49 (FIG. 5) throughout the cuff material. These void spaces may be measured in terms of density or in terms of total void space; however, the primary functional requirement is that of establishing sufficient strength in the cuff material to retain a suture therein, and sufficient low density to permit passage of a needle without unnecessary strain.
As a general guideline, the cuff material should have at least 40% void space made up of a generally uniform dispersion of small void cavities whose dimensions range from diameters of 10 microns to as much as 200 microns in size. Where the cavity sizes are smaller than 10 microns, the material becomes difficult to suture. At the other extreme of cavity sizes in excess of 200 microns, the material lacks strength to hold a suture, which tends to tear away from the cuff and from its fixed location within the patient. A preferred range which balances the cuff material properties between these opposing extremes is developed where the majority of void spaces or cavities have diameters within the range of 80 to 120 microns, and where the total void space over a uniform dispersion of voids within the material is at least 40%.
To further facilitate ease in securing the prosthesis device within the patient, the exterior cuff is configured with sewing projections 17, 17', 51, 51", which project outward from the duct to provide sufficient material for receiving a suture without risk of intercepting the duct or lumen thereof. As shown in the figures, these sewing projections are located along the length of the ureter prosthesis. Each sewing projection includes two opposing faces 18 and 19, 20 and 21 (FIG. 1) which operate as suture entry and exit sites. Practically speaking, the opposing faces may be opposite sides of a hump where the sewing projection is located intermediate of the two end sewing projections of the cuff. These sewing projections 17' at the cuff ends have one face 18 which is substantially flat, while the other face 19 tapers down to the normal cuff diameter.
The difference between the respective terminal and intermediate locations for the sewing projections 17" and 17 reflects their sutured location within the patient. As seen in FIG. 6 the blocked ends 17' of the cuff facilitate suturing the prosthesis in line between the ureter and the bladder. The distal face 18 of the cuff is sutured directly against the bladder, with the valved end of the duct 12 projecting into the bladder interior. The sewing projections 17 and 17' therefore provide large segments of cuff material which can be used to anchor sutures 30 without great concern for inadvertently intercepting the duct.
The prevention of such inadvertent interception of the duct lumen is extremely significant. If a suture were to pierce even a small point of the lumen surface, the ultrasmooth character thereof would be interrupted. The consequence of this perturbation over the ultrasmooth surface would be incrustation build-up beginning at that point and possibly continuing to occulude the urine flow path with consequent failure of the prosthesis device.
The radial thickness of these suturing projections 17 and 17' should be sufficiently great to allow the suture to penetrate sufficiently deep below the cuff surface to prevent tearing of the sutures through the cuff material. Such tearing could be prompted by sudden muscular exertion by the patient or even by the constant peristaltic action of the ureter or attached muscle. The consequence of torn sutures is a susceptibility of the implant to migration, kinking or other dislocation. If the ureter prosthesis is not securely attached in a fixed location, the peristaltic action of the attached healthy ureter will tend to drive the prosthesis device into the bladder wall causing kinking of the duct or serious damage to the bladder fascia. The sewing projections of the cuff permit secure fixation of the prosthesis device against the psoas as shown in FIG. 6, as well as provide good suturing locations to tie the terminal sections 12 and 13 of the duct to the ureter and bladder wall respectively.
Numerous configurations can be conceived which would be suitable for use as sewing projections as contemplated by the present invention. The specific structure illustrated in the drawings depicts these sewing projections as a plurality of annular rings 17 and 17' or 51 and 51' whose extreme radius r1 is substantially greater in length than the shorter radius r2 which represents the radial distance to the most thin segment of cuff material intermediate between any two respective sewing projections (see FIG. 5).
It will be apparent to those skilled in the art that such sewing projections 17 and 17' could be structured of separate material from the cuff itself, such as rings or tabs which are integrally attached to the cuff. However, as is disclosed in the attached drawings, the preferred embodiment provides a continuous and integral exterior cuff which includes the sewing projections 17 and 17' as part of a single foam-like material.
The distance a between the annular sewing rings 26 (FIG. 5) may vary depending upon the number of suturing locations required along the length of the device. Experimental research with animals has shown that the placement of sewing projections or sewing rings 26 every 1 to 3 centimeters along the length of the cuff. The exact separation distance a will be a function of the size of the ureter prosthesis, as well as its projected location within the patient. Likewise, the length of the ureter prosthesis will depend upon the needs of the patient; however, typical lengths have ranged from 8 to 24 centimeters.
In addition to the duct 10 and circumscribing cuff 16 shown in FIG. 1, the embodiment therein includes a distal valve 27 which is formed in a bicuspid configuration. This biscuspid valve 27 is representative of a general one-way valve means which is coupled at the distal end of the duct to permit outflow of fluid, while preventing backflow or reflux from fluids exterior to the duct. Such a valve is essential when the prosthesis is a distal ureter prosthesis which feeds directly into the bladder as shown in FIG. 6. Without such a one-way valve, vesico-ureteral reflux would occur through the open duct end.
A significant advantage of the present invention arises with the fact that this bicuspid valve 27 can be directly formed as part of the duct body. Using the methods of this invention, it has been discovered that the block copolymers disclosed herein can develop a bicuspid valve which opens for single directional flow when fluid pressure within the duct exceeds 2 millimeters of mercury, and withstands reverse flow without the duct in fluid pressures greater than approximately 8 millimeters of mercury. This valve 27 operates similar to a normal bicuspid valve in which the opposing valve flaps 28 and 29 respond with an open or closed condition based on the fluid pressure previously mentioned. It is to be understood that other valve configurations could be implemented which meet the requirements of one-way flow at the distal end of the ureter prosthesis.
In addition to a distal ureter prosthesis device, the subject invention includes an intermediate ureter prosthesis which is substantially identical with the distal ureter device, except for the absence of a valved end. Such a device is represented in FIGS. 4 and 7 as that portion of the prosthesis viewed along the line 7--7. In both the distal ureter prosthesis and the intermediate prosthesis, the terminal segments of 12 and 13 and 22 and 23 respectively, are not covered with cuff material but are left exposed for location either within the human ureter or through the bladder wall.
The implantation of this prosthesis segment would be accomplished by suturing healthy end pieces of ureter at each opposing end of the prosthesis device. Such implacement would be represented by a ureter prosthesis as shown in FIG. 6, except that rather than having the prosthesis project into the bladder, it would be coupled to the natural ureter duct which empties into the bladder void.
The characteristic features of the ureter prosthesis of the present invention can be developed by a process of manufacture which is outlined herein as part of the invention. Generally speaking, this process involves the following steps:
1. A mandrel is selected having a geometric configuration which conforms to the projected interior configuration of the prosthesis. If a intermediate ureter prosthesis is to be prepared, the end structure of the mandrel is not critical. This is because both ends of the formed prosthesis can be cut to expose the lumen of the duct formed. If, however, a distal ureter is to be formed, then one end of the mandrel should be configured to conform to a cavity shape to form the valve means required for a distal ureter prosthesis. FIG. 2 illustrates such a mandrel 30 for use in the present invention. The shape of the mandrel is tubular to match the tubular shape of a typical ureter. The mandrel diameter will serve to fix the inner diameter of the prosthesis duct in view of the formation of the duct end of the surface 31. One end of the mandrel 32 tapers from diametrically opposing sides to form two faces 33 and 34 which join at a single tapered edge 35 to form a flattened configuration which operates as a mandrel body for forming two opposing flaps which operate as a bicuspid valve.
As indicated previously, a very significant aspect of the present invention is to provide an ultrasmooth surface at the lumen interior. Therefore, the surface of the mandrel 31 must likewise be ultrasmooth based on microscopic inspection. It has been found that highly polished metals such as aluminum and stainless steel or also glass mandrels provide the desired surface to enable formation of the ultrasmooth prosthesis surface. Virtually any metal capable of being highly polished would be satisfactory, provided no adverse reaction occurs with the polymer coating.
2. A fluid layer of polymer material is then applied to the surface of the mandrel to form the duct portion of the prosthesis device. The polymers which appear to be the most effective in providing good surface characteristics compatible with blood and body tissues is a class of urethane block copolymers represented by copolyurethanes, copolyether-urethane, copolyetherurethane-ureas. The copolymer must be applied as a fluid layer to insure that the interior surface formed is ultrasmooth in character. This does not necessarily mean that the copolymer must be fluid prior to application. It simply requires the copolymer layer to be in a fluid state prior to solidification. For example, the mandrel may be wrapped with copolymer film which is then subjected to an energy source to liquify this film around the mandrel.
Another method for application is to develop a solution of copolymer and dip the mandrel into this solution to provide a smooth, even coat. Such a solution can be prepared utilizing approximately 10 to 15% (w) block copolymer in a suitable solvent. Such solvents include N,N-dimethyl formamide, N,N-dimethyl acetamide and dimethyl sulfoxide. A 15% (w) solution provides an appropriately thin coat of polymer to form the first layer of the duct body. A preferred range of viscocity for the block copolymer falls generally within a range of 0.5 to 1.0 inherent viscocity (η inh) in N,N-dimethyl formamide at 30 degrees Centigrade. It will be apparent to those skilled in the art that other methods could be utilized to apply the block copolymer in a manner to insure that an ultrasmooth surface was developed in conformance with the highly polished surface of the mandrel.
3. The thin copolymer layer is then solidified to fix its shape in conformance with the mandrel surface. One method of solidifying the copolymer is to apply heat to enable it to dry and harden. Where the block copolymers of the suggested urethane class are used, a process of drying the material at approximately 70 degrees centigrade for 15 to 45 minutes will develop an appropriate surface structure to ensure compatibility with blood and tissue of the human body as well as preserve an ultrasmooth surface at the interior of the duct.
4. The previous steps of applying polymer material and solidifying the polymer to a thin layer fixed in shape to the mandrel surface may be repeated to develop sufficient thickness and mechanical compliance for the prosthesis duct. Generally, three to four coats are preferable; however, the actual number of coats will vary depending upon the desired thickness and strength. Although additional layers have been set forth as a specific step in this process of manufacture, it is to be understood that their use would be optional and that certain circumstances may permit the use of a single coating of polymer material to realize the benefits of this invention.
5. With the mandrel coated to a desired thickness of polymer materials, mold blocks are secured around terminal segments at each end thereof. FIG. 3 shows a coated mandrel 40 with attached mold blocks 41 and 42. The polymer coating 43 has been uniformly solidified over the highly polished surface 44 of the mandrel. The mold blocks 41 and 42 are positioned toward the end of the mandrel to block off an intermediate segment L to facilitate formation of a cuff around the coated mandrel body. These mold blocks 41 and 42 may be constructed of any suitable material (i.e. teflon) and should have openings 45 and 46 roughly corresponding to the outer diameter of the coated mandrel 40 so that the blocks can be somewhat tightly mounted thereon. The mold blocks shown in FIG. 3 are half blocks having a cylindrical indent to form the respective openings 45 and 46. Each half block is then brought from opposing sides of the mandrel to form a single cylindrical opening around the mandrel body. Screws or other fastening means 47 and 48 are used to secure the blocks to a closed configuration around the mandrel. It is to be understood that the term "mold blocks" is to be broadly contrued to mean any type of blocking means which operates to section off an intermediate portion of the quoted mandrel so that the cuff to be formed thereon is somewhat squared-off at its ends. It should be apparent, therefore, that the illustrated blocks 41 and 42 are one of many ways to accomplish this end result.
6. A cuff is then formed around the intermediate length L of the prosthesis device as illustrated in FIG. 4. This cuff is formed by permanently affixing a material whose final state develops a foam-like compositon. This foam-like composition has already been described and defined, and may be developed by numerous methods. One process which has been notably successful involves the preparation of a solution of approximately 12 to 17% (w) of the block copolymers previously referenced, followed by the admixture of sufficient powdered inorganic salts to develop at least a 40% void space within the material when it has reached its final state. As mentioned earlier, the void size should be in the range of 10 to 200 microns, and preferably in the specific range of 80 to 120 microns to properly balance strength versus suturing ease in the material. This solution is then applied to the surface 50 of the coated mandrel between the respective mold blocks 41 and 42.
The configuration of the layered material over this coated mandrel may be illustrated in FIG. 5, elements 51 and 51' which are denominated herein as intermediate sewing rings 51 and terminal sewing rings 51'. In view of the previous discussion of the function of these sewing rings, it will be apparent that other forms could be developed including another structure suitable for attachment to appropriate location within the patient. Furthermore, it will be apparent that the full length L between the mold blocks does not necessarily require the cuff coating, provided sufficient sewing projections are included to enable the device to be securely fixed in place.
With respect to the inorganic salts added to the copolymer solution, NaCl and NaHCO3 are very effective for this process. In view of the requirement to have void sizes within certain ranges, the majority of salt grains should be within the range of 10 to 200 microns, and preferably between 80 and 120 microns in size. Furthermore, the total amount of salt added to the copolymer should be sufficient to develop at least a 40% void space within the cuff material as stated. Preferably, the total void space within the structure in its final product state will fall between 50 to 70%. An alternative measure of the appropriate amount of salt for the admixture of copolymer and salt powder is to provide for a ratio of salt to copolymer of 2.5:1, plus or minus 20%. In either case, the final state product is a material whose strength and suturability is appropriately balanced.
Where the cuff material is formed from the copolymer mixtures outlined previously, it may be necessary to apply additional layers of the salt copolymer admixture. The number of layers will depend upon the desired cuff thickness and type of cuff configuration selected. Each application of additional layers should be followed by an appropriate solidification step such as drying, etc.
With the cuff appropriately formed the device is allowed to stand in dionized water to accomplish the removal of salt grains and develop the final foam-like structure desired. This structure results by virtue of the fact that the salt grains are dissolved in the water solution and are thereby free to migrate out of the cuff material, leaving a somewhat uniform dispersion of void spaces corresponding to the original location of the salt grains.
A second method of realizing the foam-like structure desired for the final state of the cuff material is disclosed in U.S. Pat. No. 4,173,689. This process involves preparation of a copolyurethane composition having a molecular weight range approximately corresponding to an inherent viscosity of 0.4 to 1.0 as measured in a solution of 0.5% concentration in N,N-dimethyl formafide at 30 degrees centigrade. This copolyurethane composition is dissolved in a suitable solvent to produce a dipping solution having 5 to 12% by weight polymer concentration. This relates to a relative viscosity between the range of 100 to 1,000 at a dipping temperature of between 10 degrees centigrade to 60 degrees centigrade.
This solution is applied over at least a portion of the coated mandrel and at the exposed block faces most adjacent to the cuff location. The coated mandrel is then immersed into a precipitating solution which comprises a fluid which is miscible in the referenced solvent but operable as a precipitating non-solvent with respect to the copolyurethane composition. The coating is fixed in a stable physical structure by means of a balanced rate of exchange between the solvent and non-solvent molecules which prevents any substantial shrinkage of the coating which would otherwise destroy the void spaces fixed therein. The specific methods and procedures for such a process are thoroughly outlined in the referenced patent and are not further explicated herein.
It is to be understood that other methods of developing a foam-like material for the cuff are contemplated by the present application. In addition to the salt removal and fluid transfer methods described herein, such other methods such as foam blowing processes may be utilized to provide the desired uniform dispersion of small voids throughout the cuff material.
With the cuff formed around the intermediate section of the duct, the respective mold blocks 41 and 42 can be removed. Although not necessary, it is desirable to provide a final overall coat of block copolymer as a final protective layer over both the exterior cuff and duct. This may be accomplished by dipping this final product into a solution of 7-12% (w) of the block copolymer, followed by a subsequent drying step to solidify this final coating. The mandrel is then extracted from the prosthesis, preferably through a nonvalved end. The ends should be appropriately squared off by trimming and the final prosthesis degassed by conventional techniques. If the prosthesis formed is a distal ureter having a valved end, the valve flaps will probably require trimming along their common edge 52 as shown in FIG. 4. This can be most easily performed with the mandrel in place to provide for a clean cut to permit separation of the opposing flaps 53 and 54 in response to fluid pressures from within the duct.
A ureter prosthesis for distal use was fabricated by multiple solution casting of a 15% (w) solution of block copolyurethane in N,N-dimethyl formamide on a highly polished stainless steel mandrel having a shape similar to that shown in FIG. 2. The desired duct wall thickness obtained was approximately 6 to 10 mills. The coated mandrel was dried at 70 degrees centigrade for 15 minutes. Subsequent layers (ranging from 4 to 8 in total number) were cast by a similar procedure, each followed by a 15 minute drying period. TEFLON mold blocks were clamped over the coated mandrel toward each end, to leave exposed terminal segments of the coated material.
A second casting solution of similar concentration of approximately 15% (w) solids containing 2.5 parts of powdered sodium chloride per one part of polymer was layered onto the coated mandrel. Each layer was dried under similar conditions to the drying step previously applied to layers of the coated mandrel. Here again, multiple coatings of the second casting solution were applied to develop a desired thickness of the cuff and to provide annular sewing rings as shown in FIG. 4. To insure proper size for void spaces within the cuff material, a majority of the sodium chloride grains had diameters ranging between 80 to 120 microns.
After the cuff material was layered as illustrated in FIG. 4, the prosthesis was then soaked in dionized water for up to 48 hours to remove the excess sodium chloride. The prosthesis was then dried and a final coating of block copolyurethane solution having 10% solids was coated over the entire device. This coating was then dried by heating the prosthesis for 45 minutes at 70 degrees centigrade. The implant was then degassed under vacuum to remove any excess solvent.
Ureter prostheses having internal diameters of 2.0 millimeters and lengths of approximately 9 centimeters were fabricated in accordance with the procedure outlined in the previous example. Each prosthesis was stored in saline in a glass tube and was steam sterilized in this tube. 17 mongrel dogs weighing between 20 to 25 kilograms were anesthetized with Nembutal (20 mg./kg.) and intubated to maintain an airway. A mid-line abdominal incision was made, the right kidney and ureter were identified, and the distal one half or more of the ureter was excised. The free end of the ureter was sutured to the proximal end of the prosthesis with six-0 PROLENE in a continuous or running suture to form a watertight anastomosis. The short stent or exposed terminal section of the coated duct of the prosthesis facilitated this proximal anastomosis. The bladder was then opened anteriorily and a sub-mucosal tunnel was created in the right posterolateral bladder wall. The distal or valved end of the prosthesis was placed in this sub-mucosal tunnel, with the one-way valve projecting into the bladder lumen.
The sewing ring at the base of the one-way valve was fixed to the bladder mucosa and underlying muscularis with interrupted sutures of DEXON. A "psoashitch" was performed to fix the posterolateral aspect of the bladder to the psoas facia and muscle (see FIG. 6).
After free flow of urine through the prosthesis and the one-way valve had been demonstrated, the bladder was closed with absorbable suture material. The abdominal wall was then closed. The animal was allowed to eat and drink as tolerated postoperatively. No antibiotics were used. Intravenous pyelography (IVP) was performed at regular intervals after the insertion of the uretheral prosthesis. At intervals, the animals were sacrificed and histologic examination and electron microscopy studies were made of the kidney, ureter, prosthesis and bladder.
Technical errors in surgery procedures in one animal led to its intraoperative sacrifice. An IVP was performed on each of the remaining 16 dogs at one month, three months, six months and one year postoperative intervals. At one month all 16 dogs were alive. Ten of these had normal intravenous plyograms without signs of hydronephrosis. Such a remarkable evidence of success was more than expected and highly gratifying, particularly where previous methods had always resulted in a more serious state of hydronephrosis. Four dogs exhibited minimal hydronephrosis with no delay in the appearance of contrast in the ureter. The remaining 2 dogs developed moderate hydronephrosis with delayed appearance of contrast in the ureter.
During the interval from 1 to 3 months, 2 dogs were inadvertently removed from the vivarium. Both of these dogs had shown normal IVP's at the one month interval. Of the remaining 14 dogs, 11 were still normal at the 3 month IVP. Of the 3 remaining dogs, one had an unchanged condition from the moderate hydronephrosis previously detected. Another of these dogs had shown some improvement from its previous IVP and the remaining dog developed moderate hydronephrosis from its previous normal state. One of these dogs died from an anesthesia complication after the 3 month IVP; however, its autopsy revealed no problems with the ureter implant.
During the remaining months of the test period, selected animals were sacrificed to determine the extent of possible migration of the prosthesis, as well as microscopic analysis of the affected organs and prosthesis device. Virtually all of these results confirmed the utility of the implant constructed in accordance with this invention. At this time, 5 dogs remain alive with functional uretheral prostheses even after one year following implantation. The primary remaining problem is the prevention of pyelonephritis or anastomatic disruption caused by infection. Since such infections are capable of control by antibotics, the subject copolyurethane ureter prostheses should function very well for extended periods of time.
Although preferred forms of this invention have been disclosed herein, it is to be understood that this disclosure is by way of example only and that numerous variations are possible without necessitating a departure from the scope of the invention claimed herein.
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Severe Duty Report - May 2011
Freightliner Sever Duty Line Ready to be Upfit for your Toughest Challenge
Freightliner has introduced a new family of work trucks, named the Severe Duty (SD) line. Designed specifically for vocational markets, the new Freightliner SD series consists of the 108SD and 114SD as well as a Coronado® SD for extreme heavy-hauls and off-road applications.
Freightliner iPad App Transforms Customer Experience
Next time you visit a Freightliner truck dealer, the walk-around process might include an iPad instead of a notepad. The iPad isn't standard issue on the truck, but the new tool is a complete resource of technical and operational information that encompasses the entire Freightliner Trucks product line.
Product Spotlight: Detroit's DD13® Engine
At a time when everybody in the industry is keeping an eye on the bottom line, the Detroit DD13® is a 12.8 liter engine whose fuel efficient design makes the most of every gallon.
Spotlight On: Knapheide Manufacturing
Against all odds, The Knapheide Manufacturing Company in Quincy, Illinois, is a thriving business 163 years after H. Heinrich Knapheide founded the Henry Knapheide Wagon Company in 1848. Today, The Knapheide Manufacturing Company is the largest U.S. producer of service and utility truck bodies.


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SALT LAKE CITY — A bill has been introduced in the Utah State Legislature that would essentially decriminalize polygamy in the state, following a federal judge's ruling that had the same effect.
HB 58, sponsored by Rep. Jerry Anderson, R-Price, would strike the cohabitation portion of Utah's bigamy statute, a line that has been used to prosecute polygamists in the past.
In an interview with FOX 13 News, Anderson said his bill would help address issues in polygamous communities by allowing people to feel free to come forward.
"To relieve our attorney general and all of our law enforcement, I think this is a step in the right direction," he said. "Besides being in line with the First Amendment religious liberty."
Anderson's bill comes after a federal judge ruled last month that part of Utah's bigamy statute is unconstitutional. U.S. District Court Judge Clark Waddoups ruled in favor of reality TV polygamist Kody Brown and his wives, who sued Utah over its ban on plural marriage on religious freedom and privacy grounds.
"I think it's a good bill to get in line with the reality of what's going on," Anderson said of Waddoups' ruling.
The Utah Attorney General's Office said Wednesday it was aware of Anderson's bigamy bill, but had no comment on it. Attorney General Sean Reyes told FOX 13 in an interview last month he intended to appeal the polygamy ruling, but his office said it was still deciding whether to formally appeal.
Polygamist Joe Darger, who lives in Utah with his three wives, said he was happy to see such a bill introduced in the legislature.
"The intent of what he's trying to accomplish, I absolutely am behind," he told FOX 13 News. "We should not legislate morality."
During last year's legislative session, Darger and his wives lobbied lawmakers for a similar bill. Judge Waddoups' ruling, Darger believes, gave it a boost. Looking over the bill's language, Darger said he would like to see the language dealing with "purporting to marry" clarified further.
"If I called my wives mistresses, it was OK," he said. "But if I called them wives, then I was somehow a criminal? That made me a polygamist criminal."
Anti-polygamy activists expressed concerns about the bill.
"We haven't addressed the problems within polygamy," Kristyn Decker of the Sound Choices Coalition told FOX 13 News. "The harms to women and children, the harms to society."


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Below is the poem entitled Sugarcoat which was written by poet
Aguire. Please feel free to comment on this poem. However, please remember, PoetrySoup is a place of encouragement and growth.
Read Poems by
Jeremy Aguire
Dip the truth in sugar. Now it's safe to eat.
Point the twisted finger. Don't admit defeat.
Carve your name in stone, just to tell your sons.
A caper bent on error, and twisted by the gloves.
Mark my mind with paint, what a wild taste.
Echo promises before the big erase.
Leave a jar on every step, you've promised and you've broken.
You're not one for the people, an elitist for the tokens.


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I am Isabella and I have Celiac sometimes it can be very stressful seeing people eat food in front of me that I can not eat but I think Celiac is special
250 Granite Street, Braintree, MA 02184
I have eaten here a few times and leave so full. The food here is delicious and they have many gluten free options.
410 Main St, Everett, MA 02149
I have eaten there several times the GF pizza there is amazing. I love how they very careful to not put any wheat on my pizza!!