text:
Patient Sat Scores: Teach to the Test
Well it's that season again when contracts come up for renewal. Administrators are working hard to glean data from patient satisfaction reports and emergency physicians are working just as hard to dismiss them as worthless. It's amazing how quickly we come to be at each other's throats. When did we get to the point where we were no longer on the same team? When did we get to the point when it was one against the other? The Romans had a great phrase that the medical community would be wise to embrace: "Non mihi, non tibi, sed nobis." Not me, not you, but us.
It is amazing the extreme positions which people take with regard to patient satisfaction surveys. Let me just begin by saying that I think they tend to be weak science representing small amounts of data. They neglect to ask certain key questions and they tend to lump or split doctors from the group. Having said that, do I think they're important? In short, when your job depends on it, it becomes important. The hospital administration, who is in many ways our ultimate boss, believes in these surveys and will use them at will. So the smart doctor will pay attention and take them seriously, learning how to interact with the nursing staff such that the patient care is seamless.
When it comes down to it, you might as well "teach to the test." Take advantage of the fact that the questions are known in advance. Words and phrases can be used in your patient interactions which directly reflect the questions which are going to be asked on the survey. It's going to be a part of the program, so use the program to your advantage. Virtually all of the surveys try to ascertain whether the physician cared about the patient as a person. They try to find out whether or not the doctor was solicitous of the patient's pain. They seek to find out if the doctor put the program together for discharge. Is there anything wrong with these things? I think these are important factors. It seems as though we have fallen into a defensive posture, where anything that comes out of the patient surveys has to be wrong and cannot relate to the actual quality of care which the patient has been given. To read some of the columns, it would seem that to get a great Press Ganey score you would need to be an inferior doctor intellectually. Nothing could be further from the truth. In my 34 years of emergency medicine experience, there have been very few physicians who have been fired for lack of medical knowledge. This isn't rocket science. The two most important elements in an emergency physician are a dedication to getting the work done and the ability to make the patient feel that they've been cared for. The physicians who complain that the patient satisfaction surveys unfairly discriminate against them better put this into some kind of perspective. It is not a badge of honor or a sign of brilliance to have bad patient satisfaction scores. The best physicians I've worked with, from a scientific standpoint, also had great patient sat scores. They were able to marry the two together.
To be fair, satisfaction surveys judge physicians – and nurses -- by a set of criteria which were never taught in medical or nursing school. In the health care professions, getting the right answer was always the way to go. In the actual practice of medicine, it is much more important to find an answer which is able to accommodate the needs of the patient sitting in front of us. This does not mean that we should do things which are inappropriate. We should not give out medications which are unnecessary and we shouldn't do testing that isn't scientifically needed. But we ought to take the time to explain to people why we are doing certain things. And if this is communicated with empathy, it will almost always be a success. For instance, it is inappropriate for the physician to ever mention that the expense of a test or medication is the reason we aren't getting it. Everybody believes in cost savings…on somebody else. Nobody believes in cost savings on them or their loved ones. The best phrase to use to help you take complete control of the doctor-patient situation is merely to say, "This is what I would do with my own family member." That will do more to reassure a patient than all the studies, all the graphs, all the protestations which we use to try and discourage unnecessary care.
Many intelligent emergency physicians protest that administrations rely too heavily on patient satisfaction scores. This is indeed a major problem, one that needs to be addressed. What we need is to come together and ask for the quid pro quo. If emergency physicians are always to ask about the pain, then administration needs to do whatever it can to get patients upstairs quickly. If EPs are going to be careful to protect a patient's privacy and treat them decently, then the hospital needs to do whatever it can to get them into a bed, registered and ready for care in a expeditious manner. If EPs are going to put together the discharge package in such a way that the patient can understand it, then the hospital must provide specialists who are going to take care of cases in a timely manner. This is a joint undertaking. I realize that frustration levels are often high in emergency departments, but the great emergency doctor is able to separate out his anger and frustration at the system and is able to care gently for the patient who presents in front of him.
Most people know the attitude of the doctor or nurse taking care of them. It's not your words, it's your attitude. The patient immediately senses if you are working in their best interest or not. Let's stop the name calling. Let's stop the war. Let's start using patient sat surveys for what they're really good for: looking at both the system and physician interpersonal actions. They are both represented in the patient satisfaction numbers. Emergency physicians need to not be so defensive that we cannot learn from these studies. By the same token, the hospital has to understand that it is equally complicit in patient satisfaction by the very systems it sets up and puts into action.
Greg Henry, MD, is the founder and CEO of Medical Practice Risk Assessment, Inc. Dr. Henry is a past president of ACEP and directed an ED for 21 years.
# 2009-02-12 21:27
No one doubts that useful information can be gained in patient satisfaction surveys, The problem is that their main use is not in a collaborative effort to solve issues, but as a bludgeon to command and control.
Healthcare is the only business in America with two bosses, each with a different motivation and incentive. Administrators are focused on the finances and told they are bad if the hospital is not making money. Doctors, who are focused on their patients, control the utilization of resources and are told they are bad if they miss any diagnosis.
In the economically difficult times m edicine has experienced for at least the past 10 years , administrators have increasingly pursued a command and control style in hoping to meet their objectives. But this is a flawed strategy because it ignores the other boss. Because hospital boards hire the administrator, they are inclined to side with their choice when decisions that inevitably pit finances against good patient care compete. And as the balance between administrations and doctors has tipped over the past 10 years, finances usually win out. Doctors have, in many cases, abdicated their institutional responsibilitie s. We have all let this get horribly out of whack without realizing the consequences.
There must be a healthy tension between these groups, operating in balance, and appreciating the essential role each plays for the other in their institutions. Healthcare institutions must foster the attitude and create the beaurocracy that bring these bosses to the table as collaborators, each with a necessary perspective toward achieving the real goal of healthcare, which is the caring for health
The enlightened board, administrator and medical staff will realize that this balance is essential and necessary if the institution hopes to make good decisions on the behalf of its patients.
Maybe then, these surveys can be used for their intended purpose.
# Dr. Henry missed the boat — 2009-02-19 14:35
I think Dr. Greg Henry missed the boat on patient satisfaction scores. After 14 years of practice in emergency medicine, I find that patients are coming in with high demands and expectations. Many times I find myself jeorpardizing my practice if I tried to meet these demands and expectations. For example, I had patients with chronic pain who felt that they should be coming in to emergency room for shots of dilaudid pr prescriptions for percocets twice a week, and sometimes more frequently. Or, a 26 year-old woman who threatened to contact the media and her lawyer because she tried on two consecutive days to get admitted for heroin addiction. (There was no indication for admission and the detox physician refused to admit her both times.) Or, a 50 year-old man who demanded a MRI of his back for "chronic back pain" because his family physician was not working fast enough to get it scheduled so he came to the ER to get it done.
Patients are using emergency rooms today for their primary care needs on a regular basis. I sent many patients home "dissatisfied" because I failed to meet those needs, and not because of my care or treatment.
Lastly, emergency physicians are not doing enough to deter patients from using our emergency services irresponsibly. Because of our failure, we are creating huge problems with overcrowding of emergency rooms across the country.
If you want to do patient satisfaction surveys, at least you can do is to screen the patients you survey, or take surveys of patients with true emergencies who get admitted. If we want to continue to "satisfy" patients and run emergency rooms as clinics, then I suggest that we all go back to residency for training in family practice or internal medicine.
# Press-Ganey has trumped truth-telling — 2009-02-19 14:37
"Give me truths, for I am weary of the surfaces, and die of inanition."
I have been an avid reader of your magazine since its inception. Topics are timely and relevant to those of us "in the trenches" of our nations' emergency departments. Having seen extensive changes in our field over the past three decades the battles we are fighting now seem to me the most relevant. Dr. Henry's insights have always proven to be thoughtful and timely and I always enjoy reading his columns and editorials. I have respected his comments over the years and respectfully thank him for his years of service to our profession.
However, our profession is currently engaged in its most far-reaching political struggle to date. Press-Ganey is the standard-bearer of the cultural assault on medicine. Who decides what quality care is? Press-Ganey is an assault on the ability of physician's to tell the truth to their patients. Our society is currently reaping the consequnces of years of relativism. My truth is as important as your truths. The individual has been empowered to make decisions without regard to consequences. The expectation of personal responsiblity is nonexistent. If absolutes do not exist then everyone is allowed to state his or her truths regarding worldviews, ethics, behaviors, and now medicine.
I practice in a high-volume(85K patients/yr) trauma center. All of us who work in these settings have become adept at identifying and managing acutely ill or injured patients. As all of us know, however, that the majority of these patients have no need of the interventions modern medicine has to offer. These patients suffer from self-limiting illness, chronic illness, or psychic imbalances. Ten years ago I could sit with these patients and (hopefully with empathy) tell them that no testing or interventions would be needed.
Now these patients come armed with unreasonable expectatons as to the content of their emergency department "experience". Many of us have the opinions of these patient/custome r interactions directly tied to our paycheck. The patient has been empowered to determine the quality of the care they receive. Having received one too many "the doctor did nothing for me" complaint letters, I have now joined the ranks of those looking for diseases that are unlikely to be present. Press-Ganey has trumped truth-telling.
Who can argue with Dr. Henry's statements that patients want to feel cared for and taken seriously, or that we can improve our interactions with patients? Yes, our attitudes, both spoken and unspoken, speak volumes and can set the tone for the ER visit.. However, our Press-Ganey world has introduced an era of inauthentic patient-physici an interactions. The majority of ER testing that is currently performed has little or no impact on patient outcomes and subjects our patients to inappropriate risks.
The expectations of pharmacotherapy likewise has damaged the relationship we have with our patients. Let's be honest. Most painful conditions are self-limited and can easily be managed with rest and Advil. In fact most conditions we treat could be managed with OTC medications. Most of our injured patients leave with a Rx for a narcotic so that they will be happy with their visit. We as a profession are directly contributing to significant narcotic abuse in our culture. The larger issue relates to the development of a part of the culture that is unable to deal with the minor inconveniences that occur in life without some form of anaesthesia. Does everyone really need to leave the ER with a prescriptiuon?
I half-jokingly used to tell my colleagues that the best medical training I received was my time as a waiter at a busy steakhouse in Indianapolis. Now when I say this I am no longer joking. Yes, I still manage the chaos of my busy ER with fluency and expertise. Sick patients receive timely and professional care. But now I am more bogged down with the excess testing and cajoling that is required by the modern patient. The non-acute patient takes up a large part of my time and the department's limited space.
I have accepted Press-Ganey as a fact of modern ER life, but I have done so reluctantly. I had anticipated that the eloquent, politically-act ive members in our profession would fight the battle to limit the relevance of Press-Ganey in the arena of healthcare. They have not. To the great impoverishment of our profession and our culture we have entered into an age of "diagnostic relativism" and we wil be the poorer for it. This should give us pause.
# Residency- trained and board-cerified EMD (and proud of it) — 2009-02-21 11:31
I've been practicing emergency medicine for 17 years and would like to know why Press-Ganey isn't shoved down the throats of every specialty as much as it is ours. I would also like to know why our jobs in the E.D. are totally dependent on it, especially when we work with others who see half of the patients that other E.D. docs see and in some cases are downright dangerous, yet their jobs are intact because their patients are "happy". I do find that docs with consistently higher Press-Ganey scores order more unnecessary tests and prescribe more unneeded antibiotics and narcotics than others whose scores aren't as high. We in emergency medicine are held to a higher standard than any other specialty which gives them the excuse to do little or nothing for their patients. Are their patients giving them high scores and are their jobs on the line? Of course not, because they are not held to a standard as high as ours. How many times have we seen patients in the E.D. who have been evaluated by their doctors over the phone or who have been told by them to just "go to the emergency room" for things such as chronic problems and out-patient testing? We must ask ourselves how many times can we order the same normal tests over and over again for the same chronic problem in the E.D. before it becomes abnormal. Is this acceptable, cost-effective, common-sense medicine that will help cut down the waste and abuse in a system that costs 2.3 TRILLION dollars a year and is breking the back of our faltering economy? How long can the system coninue to practice this way and where will the money come from and who will pay for it? The answer is that we all are paying and so are the future generations that are yet to be born. Why is it up to the E.D. to solve all the world's problems?
# ED Medical Director — 2009-03-18 04:36
While I respect the opinions of other writers, I have to say, "way to go Greg." There is no correlation between test ordering and over use of analgesics to patient satisfaction. Patients want what we all do: to be kept informed, be respected, and be treated with dignity. Dr Marchiado is right, CAT scans and opiates are not a substitute for connecting with our patients. Those who falter under this notion risk driving up costs and will not find success in patient satisfaction.
Press Ganey is an imperfect tool and it high scores are not equivalent to quality. However, we as emergency physicians can not effectively argue against treating patients with dignity and respect, keeping them informed, and practicing golden-rule interpersonal skills. That is what patient satisfaction is about.
I think we are better off find ways for our teams to succeed than to fight the liabilities of the measurement tool.
Add comment
Recently on Twitter


text:
You won't be able to dismiss this by usual means (escape or click button), but you can close it programatically based on user choices or actions.
"This was delivered quickly with the highest quality paper! The design was fantastic and was exactly what we wanted. This simple yet classy save the date is sure to impress our guest."
"We ordered our save the dates and received them in less than a week. Looked great. Everyone loved them. We will definitely order everything else from them."
"I was happy the way the cards looked and felt. They were a lot thicker and more glossy than I was expecting. Everybody who got one keeps telling me how cute they are. I love that I was able to personalize it with our picture, names, dates, and location. The little saying on the back of the card is what sold me, though!"
"I "abused" this card for a birth announcement rather than a save the date announcement, mostly because wedding paper divas is one of the few sites that allows the addition of international characters. As always, they came thru, provided me with a proof in less than 24 hours and it was perfect. Great quality, even better service."
"This is my first purchase from WPD and I'm incredibly happy! First of all, this site is far more affordable than most wedding invitation sites and they give you such a broad range for customization. These save the dates are gorgeous, the size is perfect too, not too large. Thank you! I'll be purchasing the rest of my wedding suite with you."

subset: commoncrawl


text:
South Carolina continues to find themselves in the mix for the nation's best recruit in 2014 as defensive lineman Da'Shawn Hand released a new top five on Monday.
Hand currently lists South Carolina, Florida, Virginia Tech, Michigan and Alabama as his top five schools currently in the running for his commitment.
New top five Alabama,Florida,Michigan,South Carolina,VaTech— Da'shawn Hand (@TheHand54) February 4, 2013
Hand had previously listed North Carolina among his top five schools but a few recent coaching changes caused North Carolina to be moved out and replaced by Florida. The moves that caused this were Brad Lawing departed South Carolina for Florida and the Gamecocks hiring former UNC defensive line coach Deke Adams to replace Lawing.
There was a good connection brewing between Lawing and Hand while Lawing was with the Gamecocks. The no-nonsense approach to his recruitment by Lawing certainly had a hand in the Gamecocks landing in Hand's initial top five. Lucky for South Carolina, Deke Adams was also doing a great job recruiting Hand for North Carolina.
So far, South Carolina has a major selling point to Da'Shawn Hand and his name is Jadeveon Clowney. Look at how the Gamecocks' star defensive end has blossomed at South Carolina in his two short years here in Columbia. This past season, Clowney became an even bigger commodity and was being tossed around as a player who would be the number one draft pick in this year's NFL draft as a sophomore.
Hand's abilities in high school right now are nearly unrivaled across the country. Hand has an incredible burst and quickness off the edge as a pass-rusher. He has a great frame already and can provide plenty of power going up against big offensive lineman.
The 6-foot-5, 247-pound junior from Woodbridge, Virginia has over 30 offers among the nation's best schools across the country. There is currently no timetable for his decision and plans to make multiple visits to his top five schools before deciding on his new home.
A strong 2013 season by the Gamecocks with Jadeveon Clowney in the headlines could certainly help South Carolina's chances in landing Da'Shawn Hand.


text:
The disclosure herein discloses a levered set of barbs, tangs or jaws for engaging a shoulder of a port from a body fluid device. The port of the body fluid device can have a shoulder or a series of barbs and a shoulder. Interiorly of the connector is a resilient interior member. The interior member is sloped interiorly to match the end region of the port. It receives the end of the port in displaced relationship in a manner whereby the interior member provides a seat that deforms against the end of the port as well as deforming outwardly to provide an angularly sloped member and a resilient seat in combination with each other for an expanded seated seal.
1. A connector for interconnecting a body fluid device having a connection port with a collar comprising:
a connection member comprising a resilient plastic body having at least one pivotally supported member with a portion for digital displacement by one's fingers and a jaw for engaging the collar of said port and connection means for securing said body to a tube;
an interior member partially within the body of said connection member adapted to have one end placed within a tube and the other end within said connection member, said interior member having a seating portion which is angularly matched to the angular end of said port and formed of resilient material which is adapted to deform when the end of said port engages the matching surface;
the body of said connection member terminating distally from said jaws in an interiorly extending flange and said interior member having at least one shoulder which is secured against the interior flange of said connection member; and,
said jaw is formed with an opposite jaw member to comprise a pair of jaws, and the ends of said jaws have tangs for engaging the collar of said inlet connection port.
2. The connector as claimed in claim 1 further comprising:
means for bonding the tube to said interior member while allowing the shoulder of said interior member to rotate radially against the flange of said connection member.
3. A body fluid interconnect for connecting a tubular member to a port of a body fluid handling device wherein the port of the body fluid handling device has at least one collar in upstanding relationship surrounding said port and a reduced peripheral surface at the end with a sloping portion thereof wherein the interconnect comprises:
a first body member having at least one lever connected thereto in pivotal relationship and a depending hook at the end thereof which can engage the collar of said port;
an interior member seated within said first member having a connection means between said first member and said interior member wherein said interior member extends from said first member and is adapted to receive a tube thereover;
and said interior member having a resilient seat which is angularly matched to the angular end of said port and which is adapted to deform when the end of said port engages the matching surface.
4. The interconnect as claimed in claim 3 wherein:
said interior member has a shoulder and said first member has an interiorly turned flange which engages said shoulder to form the connection means and said shoulder can rotate against said interior flange and thereby allow said first member to radially change with respect to said interior member for various radial orientations.
5. The interconnect as claimed in claim 4 further comprising:
said interior member having said seat formed of a resilient material which is allowed to deform against the interior of said first member to within the range of ten percent of expansion.
6. The interconnect as claimed in claim 5 further comprising:
a plurality of said levers having a digital portion at one end that can be depressed and a connecting member at the other end in the form of a depending tang which extends downwardly to engage the shoulder of said collar on said port.
7. The interconnect as claimed in claim 6 wherein:
said depending tangs have a leading sloping surface to override the collar until said tangs are engaged.
8. The interconnect as claimed in claim 7 wherein:
said levers are mounted on webbed extensions extending from the exterior of said first member.
9. The combination of an interconnect for a tubular member for connection to a port of a device for handling bodily fluids wherein said combination comprises:
a bodily fluid handling device with a port having a passage therethrough terminating in a reduced end wherein said port has a sloping surface in adjacent relationship sloping inwardly toward the end of said port, and a collar surrounding said port having an upstanding shoulder;
an interconnect member having an outer body of a tubular configuration which is adapted to extend over the end of said port;
a pivotal member mounted on said outer body having a first end with an inturned tang for engaging the collar of said port and a digital member at the other end for impressing said member downwardly to allow said barb to move over said collar; and,
an interior member within said outer member having a resilient seat adapted for receiving the end of said port interiorly thereof and a portion extending beyond said first member adapted for receiving a tube connected thereto; and wherein,
said interior member is sufficiently resilient to allow for a depression of the end of said port into said resilient seat, and further having a sloping surface adjacent to where the end of said port is seated that matches the sloping surface adjacent the end of said port.
10. The combination as claimed in claim 9 wherein:
said tangs have a surface on the leading edge which is angled to allow said tangs to slide over said collar.
11. The combination as claimed in claim 9 wherein:
said tangs which are mounted on said pivotal members are pivotally connected to an expansion formed of the same material as said outer member.
12. The combination as claimed in claim 11 wherein:
said tangs and pivotal members as well as said expansion and outer member are all formed of a unitized plastic material and said mounting point for said pivotal members forms a living hinge for causing said pivotal members to flex thereon.
13. The combination as claimed in claim 9 wherein:
said interconnect member has an interior flange and said interior member has a shoulder which engages said interior flange for rotational movement thereagainst.
14. The combination as claimed in claim 12 wherein:
said sloped surface at the end of said port is a portion of a barbed connection which is adapted for receipt of a flexible plastic tube thereover.
15. An interconnect for use with a barbed connector port having at least one sloping barb terminating in a reduced circumferential portion of a port for transport of body fluids to a body fluid handling device wherein said interconnect comprises:
a first body member of a circumferential size capable of being received over said barbed port;
at least one pivotal member attached to the first body member on an expansion having one end for digital displacement and the other end formed with a hook;
an interior member within said first member having a resilient seating surface adapted for receipt of the end of the barb of said port at one end interiorly of said first member and having a tubular member extending therefrom for receipt of a tube thereover;
said sloping surface of said port barb is matched with an angle of said seating surface of said interior member for receipt thereof for providing an angular surface engagement with said barb in combination with the resilient seating at the end of said barb member;
said pivotal member is of a plurality forming a pair of jaws with said hooks for engaging a flange of said port; and wherein,
said seat of said interior member is formed of resilient material which is deformed upon the end of said port being engaged thereagainst.
16. The interconnect as claimed in claim 15 wherein:
said first member has an interiorly inturned flange and said interior member has a shoulder for engaging said interiorly inturned flange; and wherein,
the interface is such wherein the interior member can turn radially with its shoulder against the interior portion of said flange for relative placement in different radial locations on said port.
17. The interconnect as claimed in claim 16 wherein:
said expansion for mounting said pivotal member comprises a plastic continuous material flowing from said pivotal member to said first member providing a living hinge.
18. The interconnect as claimed in claim 17 further comprising:
a plastic tubular member bonded to said interior member over an extension thereof.
19. The interconnect as claimed in claim 18 wherein:
the hooks of said interconnect have an angled surface adapted for displacement against the leading edge of the collar of said port; and,
said hook has a surface adapted for retention against the collar of the flange of said port.
The field of this invention pertains to surgical apparatus. More particularly, it lies within the field of surgical apparatus for use in fluid transmission to and from a body. Such transmission can be performed utilizing tubes connected to oxygenators, reservoirs, blood filters, cardioplegia devices, as well as other pre, post, and operative decvices for the patient.
This invention is an improved body fluid interconnect device. It incorporates features for enhancing a quick disconnect and interconnect.
Such interconnect devices can connect filters to remove clots and extraneous material from the blood so that the blood can be returned to the patient. It also applies to oxygenators, which are well known in the prior art for oxygenating blood in a continuous cycle. Such oxygenators provide the function of the lungs during open heart surgery, so that the blood can be utilized by the body.
The interconnects are also used with cardiotomy reservoirs of the prior art which have also been known to have filtration systems as an option or in some cases eliminated. Cardiotomy reservoirs are currently an important and helpful adjunct to all apparatus during open-heart surgery.
An innovation of recent note has been the re-introduction of systems for providing autotransfusion which incorporates pleural drainage. Autotransfusion is the transfusion of the blood lost by a patient back to the patient. Autotransfusion also requires interconnects for transmission of body fluid.
A substantial example of usage of body fluid interconnects is within open-heart surgical procedures. Such open-heart surgical usage usually relies upon the withdrawal and introduction of fluids from a patient's chest cavity. The withdrawal of fluids is to not only drain the chest cavity of any blood loss, but also other fluids which are drained out of a patient's chest post operatively. The units to be interconnected comprise oxygenators, cardiotomy reservoirs, blood filters, cardioplegia devices and various canula for drainage and introduction of body fluids.
There is a significant drawback in converting such devices from intraoperative use to post operative use. The removal of tubing from barbed connectors, by design, is difficult at best. Ordinarily, the tubing is left on the connectors when the device is discarded in the operating room.
When a device is not discarded, certain tubing will have to be removed from certain barbed connectors. This removal typically requires cutting of the tubing at the connector, thereby increasing the risk of violating the sealing feature of the barbs, and/or personal injury. This is also difficult to accomplish while maintaining aseptic technique.
The significance of having quick interconnects and disconnects for body fluid is therefore appreciated by those skilled in the art.
This invention provides an interconnect inventively over the prior art. This avoids the problem of when PVC or other plastic tubing flows into the grooves and over the lands of a barbed fitting.
In order to accomplish this, a pair of tangs, barbs, jaws or grips engage the upright surfaces which are associated with prior art ports. The tangs or jaws are connected to levers which can be depressed to open up the jaws and spread the tangs.
The tangs serve to lock the interconnect to the flange of a barbed port to provide a seal. The seal is provided in part by a resilient inner sealing portion of the interconnect.
The resilient portion is formed in the interconnect by a deformable plastic seat. The deformable plastic seat receives the end of the barbed fitting of the port. This in turn seals the interconnect.
The seat is sufficiently resilient to allow a sloping shoulder of the barb to expand it and provide a frictional seal in cooperation with the seat and end of the barb. Thus, an improved quick connection and interconnection can be established with a barbed or other like connector.
All the foregoing features are different from the known prior art, including U.S. Pat. No. 4,009,720, dated Mar. 1, 1977, which although incorporating levered barbs differs in its sealing function.
In summation, this invention comprises an interconnect for bodily fluid which incorporates a seat to receive the end of a barbed or like connection or port.
The interconnect can be used with a barbed connection as is found in many surgical devices that are connected with plastic tubing such as tubing made of polyvinyl chloride (PVC). The interconnect has an inner sleeve or interior seat portion that is connected to a portion tube. The inner sleeve has a shoulder that receives a circular flange of the main body of the interconnect.
The main body incorporates molded jaws or tangs connected to levers that cause them to expand or contract. The ends of the jaws or tangs incorporate interior gripping surfaces that overlie an upright shoulder portion or flange of a barbed or other like connector. The reduced end of the barbed or other like connector engages and is impressed into the seat of the inner sleeve. Additionally, the sloping surface of the barbed connector expands the inner seat to provide a frictional seal in cooperation with the end that is seated in the inner sleeve.
The net result is a tight seal established by depression into a resilient seat of the sleeve and expansion of the sleeve by a sloping shoulder of the connector.
The invention will be more clearly understood by reference to the description below taken in conjunction with the accompanying drawings wherein:
FIG. 1 shows a perspective view of the quick interconnect clamp and tube assembly of this invention for transmission of bodily fluids.
FIG. 2 shows a sectional view of a tube of the prior art without the interconnect on the barbed fitting portion of a barbed connector port.
FIG. 3 shows a mid-line sectional view of the interconnect as seen in FIG. 1 when connected to a barbed connector such as that shown in FIG. 2.
FIG. 4 is a mid-line sectional view of the interconnect prior to the end of the port engaging the resilient seat of the interconnect.
FIG. 5 is a detailed sectional view of the sealing and seating elements prior to the seal being made.
FIG. 6 is a detailed sectional view after the seat and sealing has been made.
The body fluid interconnect which has been described hereinbefore effectuates a tightened fluid interconnect in the manner specifically as will be set forth hereinafter. This avoids the utilization of a barbed connector or port having to be disconnected from a piece of plastic tubing that is shrunk thereover. It can also be utilized of course with alternative embodiments having generally the same type of shoulder and surfaces which a barbed connector would have.
The invention enhances the connection and disconnection of lines, such as line 220 shown in FIGS. 2, 3 and 4. Line 220 is a PVC line but can be any other suitable elastomer or plastic. This connection and interconnect specifically is utilized with such body fluid devices as hereinbefore set forth. The invention is connected to a port such as port 38 that has a barbed portion extending therefrom. This exemplary port 38 is shown with the barbs as well as the shoulder portion that is known with regard to such ports and connectors 38.
In FIGS. 2, 3 and 4, an exemplary port such as port 38 is shown. Port 38 has a barbed connector 210 which has been shown with an inlet or outlet opening 212 and barbs 214 and 216.
Generally in the prior art as seen in FIG. 2, when barbs 214 and 216 engage the soft PVC tubing 220, the tube cannot be removed thereover. This is because of the fact that the PVC tubing shown as tube 220 flows by plastic deformation or creep into the respective low points 213 and 215 of the barbs and cannot be withdrawn over the shoulders in adjacent relationship thereto. By not being able to be withdrawn over the shoulders of the barbs, an inappropriate removal of the tubes 220 is required.
The showing of FIG. 2 consists fundamentally of a prior art showing the way barbs engage tubing 220. This has been most unsatisfactory. The inventor hereof has invented a quick disconnect interconnect whereby the invention enhances disconnection and interconnection of body fluid devices, including the conversion of a cardiotomy to a pleural drainage/autotransfusion unit after a surgical procedure. This latter usage is set forth in a companion application signed by the same inventor hereof on the same date of this application.
It should also be recognized that FIG. 2 shows that tubing 220 can be used alternately with the quick disconnect assembly 240 of FIG. 1. This is of significant importance as it allows the user to choose between the quick disconnect interconnect of this invention and the standard soft PVC tubing without sacrificing convenience. Thus, the tubing 220 is interchangeable as to its usage between the prior art and this invention. This avoids the use of new sizes of tubing and allows the interchangeability and accommodation of the prior art elements of tube 220 and port or connector 38.
The quick disconnect interconnect of this invention or fitting as shown in FIGS. 1 and 3 through 6 provide a plastic spring loaded tang member 240. The spring loaded tang member 240 is adapted for seating over the polycarbonate barbs 214 and 216 and for connection to an angular collar or flange 242 having a sloping surface 246. The angular collar 242 has a space 244 interfacing it with the polycarbonate tube 38.
The flange or collar 242 has a sloping surface 246 and a generally flat shoulder surface 248 which is a surface generally normal to the axis of tube 38. The shoulder surface 248 can be of any character, texture or angle so long as it engages the tangs, hooks or barbs of the device as set forth hereinafter, namely that of tanged device 240. In other words, surface 248 can slope toward the tube 48 or backwardly, so long as it engages the tangs of member 240. It can also be formed from any other suitable configuration, such as a spline or flange to receive the tangs of member 240, so long as it is a shoulder, ridge, spline or flange which the interconnect member 240 can engage as set forth hereinafter.
Looking at quick disconnect interconnect 240, it can be seen that it is formed of a resilient plastic outer tubular member 250. The outer tubular member 250 has an opening 252 therethrough. The opening 252 is such wherein it can receive the outer dimensions of the barbs 214 and 216 of port or connector 38. The tubular portion 250 extends to a surface 254 surrounding the opening 252. Adjacent the opening 252 are two respective shoulders, expansions or flanges 260 and 262. The shoulders or expansions 260 and 262 extend upwardly to support PG,12 resilient levers 266 and 268. The resilient levers 266 and 268 are connected to the shoulders 260 and 262 respectively by means of thin or reduced webs 270 and 272 that allow them to pivot in a flexible manner thereon.
The webs 270 and 272 can be of any suitable configuration to allow for the levers 266 and 268 to pivot thereon. They can also be of any suitable living hinge material or flexible mechanically linked hinge or pintal and hinge plate supports. Levers 266 and 268 comprise hand or digital operating portions 276 and 278. The hand or finger portions 276 and 278 allow for a depression or squeezing thereof, thereby opening and articulating jaws 280 and 282. Jaws 280 and 282 terminate in barbs, tangs, hooks or angular portions 290 and 292. The barbs 290 and 292 have surfaces adjacent the interior of the jaws which engage the shoulder or upright or normal surface 248. The criteria should be that the barbs 290 and 292 are matched to provide a catch or securement on shoulder 248.
In order to release the lever members 266 and 268 and their barbs 290 and 292 from engagement, it is merely necessary to depress or squeeze together the handle or digital portions 276 and 278. This allows the member 240 to be withdrawn over the shoulders and surface 248.
Any suitable tang or hook arrangement 290 or 292 can be utilized as well as any other barbs or engaging means. The requirement is that the entirety should be capable of being removed through a simple opening or squeezing of jaws adjacent to a receiving surface, such as surface 248.
In order to connect the member 240 to the PVC tube 220, an interconnecting stepped sleeve or interior seat portion 310 is shown. The stepped sleeve or interior portion 310 has a shoulder 312 which extends outwardly against an interior flange or shoulder 315 of member 240. The stepped sleeve member 310 is bonded to the tube 220 by a solvent bond. The sleever member 310 is only bonded at the tube 220 and is allowed to rotate freely in the space 252 of the member 240. The stepped shoulder 312 rotates against the interior surface of flange 315. This allows for radial orientation of the member 240 on the port 38 in a facile manner.
The stepped shoulder insert 310 is of a resilient material and allows the narrowed end 316 of the barbed fitting to engage and depress the resilient material of the stepped shoulder insert or interior portion 310 as shown at 316 and 318. This is formed against a seat 319 that depresses inwardly when the edge 316 is impressed thereagainst.
The foregoing sealing function of the stepped insert 310 allows for the functionality of the device so that a seal can be maintained. Prior art seals of this type and interconnects have not maintained the seal with a barbed connector and a radially rotational member. Stepped member 310 is such wherein it engages the reduced thickness of the barbed member at the barbed end 316 and 318 by being depressed 31, into the resilient media. Thus, it is believed that this sealing function and the flexible opening of the jaws allow for a dual tightened fixation that can be readily removed and at the same time maintain a seal between the port 38 and the tube 220.
The seat 319 is further enhanced by way of a sloping or angular surface 321 that receives the angular outer surface of barb 214 thereagainst. The elongated surface of barb 214 against the sloping interior 321 causes it to expand. There is approximately up to a 5% expansion of angular seating surface 321 by the barb surface 214 thereagainst. This effectively causes a sealing along surfaces 214 and 321 as well as the resilient depression engagement at 316 and 318 circumferentially around the resilient interior shoulder member 310. In effect, the position and insertion of the sloping surface of barb 214 against the interior surface 321 causes a tightened expansion. As previously stated this expansion can be in the nature of approximately 5% and up to 10% so that a tightened elongated surface to surface seal is performed as well as an engagement of the circumferential reduced end area 316 against the shoulder 319.
The interior angular surface 321 can be provided in any manner, as well as the shoulder 319 so long as it engages the barbed surface and the reduced end. Also, the barbed surface can be substituted so that the outer surface of the barb 214 can be of any angular configuration so long as it engages the surface 321. It is not necessary that a barb of the design and angle be utilized but other sloping surfaces can be utilized. Also, in some cases it is not necessary that the barbed surface 214 and interior surface 321 be used for mutual engagement of each other.
Summarily stated, the invention relies upon the levered barbs or tangs engaging a shoulder of a connector or port that is to be connected. Interiorly of the connector or interconnect is a resilient surface in which a sloping shoulder of the port can be engaged, whether it can be in adjacent relationship or not to a reduced end portion which engages a resilient seat within the connector.
Based upon the foregoing advances of the art as specified herein, it is believed that this invention should be entitled to broad consideration and substantial breadth and scope applied to the following claims.
Citas de patentes
Citada por
Eventos legales
Imagen original


text:
Saturday, April 14, 2007 @ 23:19
It's been ages hasn't it? Thought so. Partly it's because I've been busy being creative. That happens when you buy a Mac. Things just work, so you have time to get stuff done.
The other thing is we have a Wii now. I make no apologies, this is the greatest invention of all time EVER. I defy anyone to disagree. I've never known anything entertain the girlfriend for so long. Rayman Raving Rabbids is just amazing entertainment.
Love it.
A Pint of Beer For Sound Control
Monday, January 29, 2007 @ 23:29
Just thought I should briefly tip my hat to the guys from Sound Control in Southampton.
The girlfriend and I have had nothing but grief from an SE Electronics microphone recently purchased from said store, and after two botched replacements (both of which I believe were attributable to the manufacturer) we finally lost faith in the product and pleaded with Sound Control to replace it with something from another company.
They very graciously agreed, offering a nice Rode NT2000 as a replacement. This has turned out be a solid mic, and thus far there have been no problems to report.
Consider me a lifelong fan.
iTunes and Podcasts
Tuesday, January 23, 2007 @ 20:21
What on Earth have Apple done to the iTunes homepage today?
How do I get to the podcasting section now that they've removed the flippin' link to it?
NB: The change only appears to be affecting the European stores at the moment. I can still use the United States store without issue, but talk about making life more difficult for your users.
iPhone : A Question of Icons
Wednesday, January 10, 2007 @ 23:04
There's almost nothing I can add to the thousands and thousands of comments already floating around the Web regarding Apple's newly announced iPhone.
I will say I approve on every level, except that according to Carphone Warehouse, I have to wait until December before I can have one. Also, that it makes the current range of iPod's immediately look clunky by comparison.
The one question I do have, that I've not found answered anywhere else is…what is with the missing menu icons? Take another look at iPhone's main menu, the one with the Camera, Photos and Weather buttons on it. The layout looks lopsided, it's not balanced like every other screen on the device.
I'm just guessing here, but either the menu had a few things stripped right before the announcement or that space is intentionally left blank in order that it can be filled closer to the release date. Given the effort that appears to have gone into every other facet of the design this can't have been an oversight.
Final point – we really have entered the Star Trek era now haven't we? James T. Kirk eat your heart out.
Having No Luck At All
Wednesday, December 27, 2006 @ 22:51
So, that's the second gadget I've purchased this month, to fail within the first 24 hours of use. They really don't make them like they used to.
Today the Carlsberg Draught Master was sent packing after it turned a 5kg keg of lager into 8 pints of foam. A great party trick I assure you, unfortunately not the result I was looking for.
A quick call to the helpful customer services people (who interestingly, each received one of these things to try out for free) confirmed it wasn't supposed to sound like a Boeing 747 during take off and thus should be returned forthwith.
Never mind, a new one is on it's way.
Wednesday, December 27, 2006 @ 0:57
The Carlsberg Draught Master arrived as expected, but I've just discovered I have to wait 24 hours for the liquid to chill in the fridge!
Anyhow, couple of points:
- It is huge, you'll need a really big worktop to put this thing on.
- It is noisy, like 'you can forget putting it in your living room kind of noisy'.
- The Carlsberg stickers come with the keg of alcohol not the actual pouring device. I'm assuming then that this isn't limited to just one brand and that one day I'll be able to have a variety of brands 'on tap'.
Sunday, December 24, 2006 @ 21:28
I'm wondering, if maybe, when Apple spent all that time converting their application codebase to run on x86 architecture they might have skipped a few steps just to meet the deadlines? Y'know, we've all done it, time is tight, "can we miss a few things when no-one's looking?", that sort of thing.
The only reason I suggest this is because iMovie, the video editing package that ships with OS X, is a bit rubbish. By rubbish I mean it's the only piece of software I have on my Mac that crashes. And the only piece of software that can grind my machine to a halt (when only trying to render the most basic of transitions).
I get the impression that someone, somewhere should have implemented a bunch of more efficient code routines to help the application perform to expectations, but between you and me, I think they forgot.
Considering Apple is the kind of company that can bundle an application as wonderful as GarageBand with their operating system. iMovie sucks.
While I'm bashing iMovie, can I bring up just one more gripe? How is it that Apple figured users would want to cross-fade audio and so gave them x2 music tracks to play with, but figured just one solitary video track would be plenty? It's a video editing package for goodness sake!
I know there has to be some distinction between iMovie and the next step on the ladder, Final Cut Express but Express can handle 99 video tracks, adding just one more to iMovie is hardly bringing it into Express' territory is it? It would make the application infinitely more useful out of the box. Usable even.


text:
EnochF began exploring Wookieepedia to look for ideas and iron out inconsistencies while designing RPG adventures set in the Old Republic Era and got hooked. Here are some articles featuring my contributions. Enjoy my stilted writing style, replete with unnecessary adverbs like 'somewhat' and 'apparently' and 'mostly.'
Hey, kids, laugh along with Enochf at Enochf's Happy Caption Page!
Notes for further work
Satire on fanwankery
Articles createdEdit
|Biographical information
|Birth date
|Physical description
|Hair color
|Eye color
|General information
Articles with substantive editsEdit
|Other Information
- 2-1C medical droid
- Addath Gadan
- ADK-25-MED medical droid
- Agr
- Apelben Werl
- aquanna
- Aquar
- Augara Jowil
- Battle Scythe
- Blue Sector
- Boiling Sea
- Bongo Advanced Behemoth
- Bongo Behemoth
- Caamas
- carbon
- Chagrian
- Champala
- Champion
- Chandrila
- Chine Gabbard
- Coromon headhunter
- Coromon Islands
- Coronet City
- Crevasse City
- datapad
- death stick
- Dnalvec
- Dracmus
- Draethos (species)
- Dunsenn
- Ebrihim
- Eriaduan rat
- Fambaa sonic cannon
- Flitknot speeder
- Floating Rock Gardens of Ryloth
- Giat Nor
- Gilflyn
- Hollowtown
- Hortel Ossilege
- HummBike
- Jade's Fire
- Jander Graffe
- Jurec Tre
- Kar Yang
- Karia Ver Seryan
- Kas air cruiser
- Kas tank
- Kettrifee Air Mover
- killball
- Killer RoboLeia-2000
- Kilmaulsi
- Kleyvits
- Kligson
- kouhun
- lerraa
- Liberator (Wookiees)
- life-bearer
- Lintu
- List of references to Star Wars in movies (deleted)
- List of references to Star Wars in television (deleted)
- lylek
- MED-47 medical droid
- Mon Calamari blink code
- Muunilinst
- N-1L Light Starfighter
- N-1T Advanced Starfighter
- Naboo Royal Lifter
- Neimoidian transport
- nova crystal
- Nubia
- Nuknog
- Otoh Gunga
- Otoh Jahai
- OX9 labor droid
- Pesktda
- PKN-49 worker droid
- Rebel combat speeder
- Recon-PK series droid
- Reytha
- Royal air cruiser
- Royal cannon
- Royal crusader
- Royal med droid
- Royal trade ship
- Ryloth
- Sacorrian Triad
- Salculd
- Sando HoverFreighter
- Sarcophagus
- schinga shikou
- Selonian language
- shock cannon
- Showolter
- shyarn
- spaceport
- speeder bike
- Steadfast (tank)
- Sullustan
- Sump
- swift
- Symponik Nabooalla
- Tendra Risant Calrissian
- Thrag
- Udopal speeder
- vaapad
- Watchkeeper
- X-34 landspeeder
QOTD workEdit
I spend way too much time hanging out at the Quote of the Day forum. I've been unofficially managing it for... what, five years now; I tweaked the archive to include a separate calendar page; and for ease of use, I split the nomination page into two sections, in-universe and the rest. (For newcomers, it used to all be one file, and if you think it loads slow now, you should've seen it before.)
For what it's worth, my QOTD nominations so far that have been on the main page are:
The non-bolded ones are almost all from the movies and were probably inevitable anyway. The bold ones took a little bit of searching, and I figure there's a good chance nobody else would have nominated them otherwise, so it's more of an achievement. It's challenging to find cool stuff nobody else would have suggested, from the computer games, novels, comics and cartoons, or from online interviews. But check out the archive, and you'll see so many quotes from the movie trilogies that aren't there yet!
Hmm. Here's a work in progress: a quick table of QOTD sources and pointers for likely sources, and a similar character guide.


text:
Karim Abdel Aziz wants a piece of the Ramadan drama pie
Ramadan 2014 won't know what hit 'em if Karim Abdel Aziz has anything to do with it. The Egyptian actor is getting started now to ensure that next year's holy month marathon has his new drama with director Amro Arafa as the main event.
Karim received crazy success in the past, according to Laha Magazine. Karim's TV drama "Al Huroob" (Running Away) was one of the most successful of that Ramadan season, but this year his only claim to fame was a part in a major ad campaign.
The man who loves to share all on social media is keeping the deets of next year's drama hush hush, but sounds like we can expect something big!
The celeb has also been hard at work on the film "Al Feel Al Azraq" (The Blue Elephant), based on the novel with the same title by author Ahmad Murad. The film starring Khaled Al Sawi and Nelly Karim is soon to be screened.
Do you expect his drama next year will be worth the hype coming a year in advance? Please share by commenting below!


text:
By Ulf Laessing
KHARTOUM, July 26 (Reuters) - Sudan said on Tuesday it was ready to negotiate an end to fighting in its main oil state of South Kordofan but accused armed groups there of trying to prolong the violence by teaming up with rebels in neighbouring Darfur.
Tens of thousands of civilians have fled since clashes flared in June between Sudan's army and fighters, many of them from South Kordofan's ethnic Nuba group.
The United Nations has said Sudan has caused "huge suffering" among civilians by bombing the remote territory, a charge rejected by the army.
"The war is not the will of the people of South Kordofan ... The doors for dialogue and peace are wide open," state governor Ahmed Haroun told reporters in Khartoum.
Sudan has accused the fighters of launching a rebellion inside South Kordofan to try and control the region, and team up with rebels in other areas to challenge the national government.
Activists and some aid workers have accused the Khartoum government of starting the fighting to stamp its authority on the key oil-producing state after the secession of country's south earlier this month. Khartoum has denied the charges.
Southerners voted to declare independence in a referendum that was promised in a 2005 peace deal that ended decades of civil war with the Khartoum government.
South Kordofan, which borders the new country of South Sudan, is home to large groups who fought alongside the south during that civil war and are now seeking greater autonomy inside what remains of Sudan.
Analysts say fighting could spread to other Sudanese states that border the south, chief among them Blue Nile and Darfur, the scene of a separate eight-year insurgency.
Haroun said the South Kordofan fighters were spurred on by Abdelaziz el-Helu, a senior official from the northern branch of South Sudan's governing Sudan People's Liberation Movement (SPLM).
He accused Helu, the SPLM's candidate in the South Kordofan's governorship election in May, of coordinating attacks with Darfur rebels.
"As he exploited the sons of the area to serve South Sudan's goals during the past years, Abdelaziz is now attempting to exploit sons of the area to serve the Darfur rebel movements," he said.
Helu pulled out of the governorship vote and regional government after accusing Khartoum of rigging the elections, charges denied by the north. He was not immediately available for comment on Tuesday.
Haroun is wanted by the International Criminal Court to face charges of masterminding war crimes when he was a government minister during the early stages of the Darfur conflict, which surged in 2003.
Last week, Darfur's most powerful rebel group, the Justice and Equality Movement (JEM) said it had attacked a government position in South Kordofan alongside local fighters. The northern army denied the report.
Events in South Kordofan are hard to verify independently. Aid and U.N. agencies complain they have limited or no access to many areas.
Haroun said authorities were cooperating with aid agencies, adding that life in the state capital Kadugli and other areas had returned to normality.
South Sudan's army has said it no longer has linked with its former fighters in South Kordofan. (Reporting by Ulf Laessing; Editing by Andrew Heavens)


text:
The leadership of Vanderbilt University Medical Center has hired a senior finance executive from the Duke University Health System to be its associate vice chancellor of finance.
In her new role, Cecelia B. Moore will oversee all financial and control activities at VUMC, including the Vanderbilt University hospitals and clinics, the School of Medicine and the School of Nursing. Moore had been vice president of finance and COO for the Patient Revenue Management Organization at Duke University Health System. She fills the spot vacated earlier this year by Warren Beck.


text:
Eating Out
Befriending Chefs/Restaurant Staff
Sooooo the new place I'm moving into is literally 2 doors down from Alinea and has a clear view into the restaurant's kitchen (they have big windows on the side). I couldn't be more excited about this and am wondering if/how I could potentially strike up a relationship with some of the chefs there. It's juvenile, I know, but I am such a fan of their "work" and would love to get to know them over the next few years! What would you do? Considering a "I LOVE ALINEA!" sign for the side of my new place (kidding, kidding). Ideas? :)
Talk is closed, but that doesn't mean the conversations have to stop!
Check out this post for a more thorough explanation, and jump onto our Facebook page or our Twitter feed to keep the conversations going!


text:
To embed, copy and paste the code into your website or blog:
TORONTO, January 22, 2014 – In response to the long-awaited regulations pertaining to the Canadian government's anti-spam legislation, Bill C-28, Bennett Jones LLP has created a one-of-a-kind informational site designed to help businesses and individuals plan a comprehensive compliance See more +
TORONTO, January 22, 2014 – In response to the long-awaited regulations pertaining to the Canadian government's anti-spam legislation, Bill C-28, Bennett Jones LLP has created a one-of-a-kind informational site designed to help businesses and individuals plan a comprehensive compliance strategy.
According to the Government of Canada website the intent of the new law is to deter the most damaging and deceptive forms of spam from occurring in Canada. Covering far more than unsolicited emails, the legislation, which will come into effect on July 1, 2014, also goes after all forms of spyware, malware and phishing.
The Bennett Jones Anti-Spam Learning Centre opens with a "what you need to know" infographic primer video that covers everything from simple definitions, to what is covered under the Act, to some tips that may help ensure compliance.
This user-friendly site informs the viewer of the need to act while taking away the mystery surrounding this piece of legislation. The Anti-spam Basics section gives the user background information to orient them before they move to the more in-depth sections covering what a business needs to do to prepare.
"This was the obvious response to the question of how best to help our clients conform to this new law", says Martin Kratz, a Partner and Head of the Bennett Jones Intellectual Property practice group. "With maximum penalties in the millions it is not something to be taken lightly," he adds.
With so many grey areas and vague implications within the legislation, this new site hopes to bring clarity to what can seem a daunting task. The word "consent" and what that entails will pique most viewers' interest. On a number of occasions the site reminds users that consent can be "expressly given or implied". It is the latter form of consent that may have businesses resting a little easier.
"If a customer has already requested to be on a mailing list, a business may potentially infer consent moving forward", said Lisa Abe-Oldenburg, a Partner with Bennett Jones' Information Technology practice group. "The grey areas still remain as to what will constitute a commercial electronic message and how broad is the definition for implied consent."
Considered the harshest legislation of its type within the G-8, it is still to be discovered to what extent the government will prosecute offenders. The intent of the law is to protect businesses, so it will be interesting to see if the government prosecutes to the letter of the law or its stated intent.
Please visit our Anti-Spam Learning Centre at http://bennettjones.com/CASL/ for more information.
About Bennett Jones
Bennett Jones is one of Canada's premier business law firms and home to more than 380 lawyers and business advisors across eight offices. With exceptional experience in complex cross-border and international transactions, Bennett Jones is well equipped to advise foreign businesses and investors with Canadian ventures, and to connect Canadian businesses and investors with opportunities around the world.
See less -
See more
Bennett Jones Spring 2014 Economic Outlook
Why choose Bennett Jones for your Canadian Cross-Border Income Trust (CBIT)?
What are the tax benefits of a Canadian Cross-Border Income Trust (CBIT)?
Why choose Canada for a Cross-Border Income Trust (CBIT)?
What is a Canadian Cross-Border Income Trust (CBIT)?
DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.
© Bennett Jones LLP
Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up to create your digest using LinkedIn*
Back to Top
Copyright ©


text:
Ask a Librarian
Branches & Hours
Find Books
Manage Your Account
Library Card Registration
Commuter Services
Ride On Schedules
Traffic Cameras
Traffic Incidents
Trip Planning
Blue Bin Requests
Bulk Trash Collections
RainScapes Rewards
Holiday Schedule
Scrap Metal Collections
Transfer Station
Activity Registration
Aquatics Programs
Athletic Fields
County Parks
Facility Locations
Sports Programs
Board of Appeals
Board of Investment Trustees
Community Engagement Cluster
Community Use of Public Facilities
Consumer Protection
Correction & Rehabilitation
County Attorney's Office
County Council
County Executive's Office
Economic Development
Emergency Mgmt & Homeland Security
Environmental Protection
Ethics Commission
Fire and Rescue Service
General Services
Health & Human Services
Housing and Community Affairs
Human Resources
Human Rights
Inspector General
Intergovernmental Relations
Legislative Oversight Office
Liquor Control
Management and Budget Office
Merit System Protection Board
Permitting Services
Public Information Office
Public Libraries
Sheriff's Office
State's Attorney's Office
Technology Services
Zoning & Administrative Hearings
More ...
For Immediate Release: 7/23/2014
|Montgomery County Recognized for Performance Management Focus
The International City/County Management Association (ICMA) is pleased to announce that Montgomery County, Maryland, is being recognized for its performance management efforts with a Certificate of Excellence from the ICMA Center for Performance Analytics™.
• Reporting of performance data to the public through budgets, newsletters, and/or information provided to elected officials
Now in its 100th year, ICMA, the International City/County Management Association, advances professional local government worldwide. Its mission is to create excellence in local governance by developing and advancing professional management of local government. ICMA provides member support; publications; data and information; peer and results-oriented assistance; and training and professional development to nearly 9,000 city, town, and county experts and other individuals and organizations throughout the world. The management decisions made by ICMA's members affect millions of individuals living in thousands of communities, from small villages and towns to large metropolitan areas.
About the Center for Performance Analytics
ICMA's Center for Performance Analytics is dedicated to helping local governments use performance information to better the lives of the people they serve. The Center encourages the use and public reporting of performance information in a positive, continuous-learning environment in order to foster organizational cultures that deliver results that matter. For more information on the center's comparative data analysis services, please visit icma.org/performanceinsights.
# # #
Contact: Gerald Young; Senior Management Associate
|Release ID: 14-295
Return to News Releases


text:
In this course we will start with:
We will then cover:
Finally we will:
MetaboLights consists of two distinct layers: a repository, enabling the metabolomics community to share findings, data and protocols for any form of metabolomics study, and a reference layer of curated knowledge about metabolites (forthcoming).
The Reference Layer is still under development. Once finished this will be a comprehensive knowledge base, organised around a metabolite-centric view, and will include elements such as reference spectra of various types, biological reference data, protocols and cross-references to other resources. There will be comprehensive manually curated data, including:
Publication references and protocols will also be available. This will enable experimentalists to get a comprehensive Metabolomic view on known metabolites.
This session will usually be offered as one of a number of short introductions to EBI Services that can be booked separately.Course TimeTable
Please note that if you are not eligible for a University of Cambridge Raven account you will need to book by completing the form available from the appropriate Booking System Page.
Please only book for our courses if you are seriously intending to attend. Without your co-operation, we cannot sustain the provision of widely available, inexpensive/free, high quality training.
We ask for 5 working days notice of cancellation, time to alert the next person on the waiting list.
None of our current courses requires you to bring your own computer. However, if you want to bring a laptop and have it online we can arrange access via the University Lapwing wireless service.
All our courses are a part of the Training Programme of the Graduate School of Life Sciences.
A full list of Bioinformatics courses offered by the School of Biological Sciences and currently open for booking can be found here.
A number of other excellent programmes of Bioinformatics courses are offered by various Institutions. These include:
In the UK.
In the rest of Europe.
The course will be conducted in:
The Bioinformatics Training Suite, The Craik-Marshall Building,
University of Cambridge Downing Site,
Tennis Court Road, Cambridge, Cambridgeshire CB2 3EB
Some helpful information on how to get here can be found in the Genetics Department's web pages.
The Craik-Marshall Building has wheelchair access, but only to the ground floor. There is currently no way to easily access our training room, on the first floor, in a wheelchair. There are currently no toilets suitable for wheelchair users. If a way could be found to get a wheelchair into our training room, we have two workstations on height adjustable desks and extra space, suitable for wheelchair users. Most of the other workstations should be accesible to wheelchair users also.
Our training room is equipped with an Audio Induction Loop.
We are happy to customise workstations to meet the individual needs of visually impared people as far as is possible. Please contact us before atending one of courses so you can advise us of your requirements
If you wish to discuss any difficulties you might perceive in reaching/using our training room, or you have any other queries or particular requirements, please ask.
Number of times this page has been accessed is: 598Wednesday, 29 July 2015 01:25:44 Europe/London, 1438129544 seconds since time began


text:
Gear Review
Great for my wife and I. We have bought the MSR deep dish plates (size small goes around the smaller pot inside the big one) and the MSR mugs. Between the inside of the mugs and the space between them, this pot set holds everything we need. The larger pot is great for bringing water to a quick boil, and the smaller, non-stick pot is great for cooking the meal of the day.
View More Details on MSR Quick 2 Pot Set


text:
Electricity suppliers
It is a condition of license that all electricity providers who supply small retail customers in New South Wales are members of EWON. You can make a complaint to EWON about any of our members.
Important information:
- Choosing a retailer: In NSW you can buy your electricity from the Standard Electricity Retailer for your area, or take up negotiated contract with a licensed retailer. Note that a retailer doesn't have to offer you a contract or they may not retail in your area.
- Standard Electricity Retailers: If you don't enter into a negotiated contract your electricity will be supplied by one of the Standard Electricity Retailers under a regulated tariff. To find the standard retailer for your area visit www.ipart.nsw.gov.au
- Electricity distributors: Distributors are responsible for reading your meter and maintaining network assets. There are three distributors in NSW with designated network areas: Ausgrid, Endeavour Energy and Essential Energy.
The Independent Pricing and Regulatory Tribunal (IPART) oversees the licensing, pricing and compliance of electricity suppliers in NSW.
Links to electricity retailers
= Electricity retailer = Gas retailer
Links to electricity distributors
= Electricity distributor = Water distributor/retailer
|Service provided in NSW
|Ausgrid (formerly EnergyAustralia Network)
|Endeavour Energy (formerly Integral Energy Network)
|Essential Energy (formerly Country Energy Network)
|NSW electricity transmission
Do you have a dispute with a Gas, Water or Electricity supplier?
Freecall1800 246 545
Related Content
Share this page


text:
Cambridge Elementary School is at 2000 Cambridge Drive in Cocoa.
- Filed Under
A kindergartner was removed from Cambridge Elementary School after he kicked and scratched an assistant principal on Wednesday afternoon.
"He was a 6-year old boy, he was out of control," said Barbara Matthews, spokesperson for Cocoa Police Department.
Staff at the school brought the boy to the front office, in the process he hurt one administrator. The police were called to document the issue, the school did not press charges and the administrator did not need medical attention, ...


text:
PORT CHARLOTTE - A registered sex offender has been charged with first degree murder after confessing to killing a man found in a makeshift grave beside a home in Port Charlotte.
The caretaker of a 74-year-old Port Charlotte man reported to CCSO Saturday morning that she was concerned for the well-being of the man. After speaking to an ex-boyfriend, 47-year-old Juan Reyes, the woman was led to believe the man could have been the victim of some kind of violence.
Detectives say Reyes lived at the home with the elderly man and his caretaker. The caretaker had been out of town for several days and returned home on Saturday.
Subscribe to the Naples Daily News
Need Help? Call us at 1-888-878-6842.
Monday-Friday: 6am-6pm / Saturday: 7am-3pm / Sunday: 7am-2pm


text:
Welcome back to the ever-popular and much beloved VH1 Celebrity Bikini Awards! Yes, it's that time of year again, where we pit your favorite stripped down celebs against one another to see has the most bangin' bikini bod of 2012. Happy summer, folks!
Any D-lister knows that all they gotta do to make headlines is strut their stuff beachside in as little clothing as possible. But amazingly, this same trick also works for the Hollywood elite! No matter how big their movies open, superstars in bikinis will always lead the news. And 2012 has been no different! Fresh off her unfortunate phone hacking, Scarlett Johansson forgot her troubles (and Sean Penn) under the hot tropical sun. Jessica Alba showed off her toned torso mere months after giving birth to her second daughter Haven, while Anne Hathaway showed off her Catwoman-worthy body and new haircut! Big screen badass Michelle Rodriguez hit up Cap d'Antibes, and Gabrielle Union kept it right here in the USA as she basked in the Miami heat.


text:
The swan that got away: Bishop's Palace swan takes flight
Posted: October 04, 2012|
It was a love-match following in a tradition nearly 200 years old – but fears are growing that a famous swan has taken flight and is feathering his nest elsewhere.
Visitors to the Bishop's Palace – adjacent to Wells Cathedral – are aghast that just one of the iconic swans is in residence on the moat.
Swans have been a feature of the Bishop's Palace moat in the Somerset city since the 1800s, with subsequent feathered friends learning to ring a bell at the Gatehouse whenever they want feeding.
But now in what could be the celebrity break-up of the year, the male swan appears to have got a cob on and taken flight, leaving his female companion as the lonely inhabitant of the moat.
It flies in the face of a survey released yesterday that showed 91 per cent of married couples are happy together and that marriage rates are increasing.
A spokeswoman for the Bishop's Palace was swift to say they are have not given up hope of a reconciliation.
"We can confirm that one of our swans is missing, the male one took to his wings and has taken flight," she said.
"We have just his female companion now."
It is thought that the male flew off more than a week ago – although he appears to have made one last visit to his mate, before deciding to abandon her once and for all.
Only time will tell if he is commuting from another love-nest or if his most recent visit was his swansong to his one-time mate.
"We understand he was spotted back at the weekend for a short time but disappeared again and hasn't been seen since," said the spokeswoman.
"We are hopeful that in fact he will decide the moat is an attractive place to live and return for good. But they are wild swans, they are free to come and go as they please.
"The swans we had before had only one wing each. But these ones came from a sanctuary and are wild.
"Yes we do care for them, feed them and look after them. Obviously we would like them to stay but if one wants to fly off we can't stop them. However the female is here still, so we hope her mate will return."
It is not the first time that the Bishop's Palace swans have looked to pastures new.
In the mid-90s, police in Wells found a swan near their police station and released it on to the Somerset Levels, only to later discover it was the sole "widowed" swan that had been left on the moat after the death of its mate.
The escaped swan incident was later immortalised in the film Hot Fuzz.
The pair thought to have stayed on the moat the longest were Glinty and Ricky who were resident for about 15 years. Ricky sadly died and Glinty was given a new home at a swan reserve.
The Bishop's Palace spokeswoman added that if the current feathered inhabitants have indeed broken up for good another swan will be introduced from a sanctuary to keep the female from pining.
The first to spot the possible separation of the two love-birds was Marianne Smith, a conveyancer with Chubb Bulleid Solicitors in Wells who walks past them every day.
So concerned have Marianne and her colleagues become they have been staging their own unofficial 'swan watch'.
"We've been hoping the separation isn't permanent," she said.


text:
Stephanie Hill: Silence reveals God's beauty and love for his creation
"If we had a keen vision and feeling of all ordinary human life, it would be like hearing the grass grow and the squirrel's heart beat and we should die of that roar which lies on the other side of silence. As it is, the quickest of us walk about well wadded with stupidity." -- From "Middlemarch" by George Eliot, pen name for Mary Anne Evans
Running through the park in Huntington recently, a squirrel darted across the path in front of me. Wrapped up in my own thoughts, like one wears a tightly belted wool coat while walking in a stiff winter wind, I almost tripped over the little furry creature. The squirrel seemed to notice my stuttering steps and paused, nut between its front paws, head cocked to one side, then to the other, and scampered quickly to the opposite side from which he came, and dashed up a tree.
I continued on my way, refocusing my thoughts to the self-talk gibberish that gets me through a tough run. "You can do this. Only 10 more minutes to go. Think of how proud you'll be when you finish."
Images of that squirrel, though, head cocking, paws clinging to food, kept jabbing my brain like a fork trying to poke through a tough piece of meat. What was this simple creature trying to communicate? Why had it literally crossed my path?
Driving home later, after picking up my daughter, Madelyn, from soccer practice, an old U2 CD was playing when I heard the line from the song "Breathe," "the roar that lies on the other side of silence." I asked Maddie if she heard those words, and restarted the song for her. "I don't get it," she said. Used to my quirkiness, though, Maddie added, "Do you want me to send you a text with those words in it?" I nodded "yes," and we continued on our way.
I felt certain this line was significant. Discovering that Bono had inserted an allusion to a great literary work into his lyrics was an intriguing discovery -- one I found thanks to the Internet. I have not read this book, but I will certainly add it to my "to-read" list. Reading the excerpt from Evan's book, however, further convinced me the squirrel incident had not been coincidental.
How often do we stop, really stop and just be? No TV, cell phone, computer, no music playlist pumping out tunes -- just you, utterly alone, and still. I am reminded as I write this of the few times my home has been without electricity -- especially during a nighttime thunder storm; or snowfall, when traffic outside my home on Ohio 243 halts. There is no buzz of electricity through the lines. No refrigerator, water pump, heater or air conditioner kicking on and off -- just complete, peaceful, uninterrupted silence.
Often, in the early morning hours, when I wake around 4:30 or so, I get up, coffee in hand, and just sit in my family room -- soft back lighting, no electronic devices on, and I breathe. I am reminded of the beautiful word, "Om," often chanted at the end of my yoga DVDs during meditation.
"Om," as I am to understand it, possesses quite a deep philosophical meaning. Researching its meaning and history can lead to hours of reading. I like to Christianize its meaning, however, and think of it as the Holy Spirit.
"Om," I've read, is the sound God uttered as he created the universe. It also symbolizes past, present and future lives, all interconnected.
It can further mean the Divine, to me that would be the Holy Spirit, residing within each of us. I am strongly connected to those beliefs.
First of all, how exquisite to think of the sound of rushing air as God breathed his grace into the silence of nothing, and created our beautiful and magnificent universe? How further glorious to see this same breath ushered into a baby's lungs at birth.
Take it one step further, how splendid to see this same hand of God guiding the grass to grow and the squirrel's heart to beat. All living things wrapped in the breath of God -- interconnected, interdependent, interlocked in God's loving hands.
If I sincerely believe my simple definition of "Om," then God, through the Holy Spirit, resides within each human I encounter. I believe that is why tears filled my eyes this summer watching a seemingly homeless and grossly unkempt man move down 4th Avenue from one trashcan to another, removing half-eaten food, partially filled cups as he ate and drank from each. I should add that Maddie and I watched this from the comfort of Tropical Moon. I did nothing. I sat in stunned silence. He is one of God's creatures. How did he get to this utter state of depravity?
Remembering that God created each person we encounter is an important and humbling fact to remember. It haunts me afterward when I make fun or criticize another.
Additionally, if I will keep it in my forethoughts, it grounds me from being too quick to judge. Unfortunately, it does not always stop me; and, I am brought to humility once again.
Being still, through meditation, prayer or simply breathing -- focused on the silence, so that, in the words of Emerson, "we may hear the whisper of God," is an important practice, I believe.
The silence provides us with the "keen vision" to which Evans referred, and allows us to hear, and later, as we move throughout our day, perhaps see, the "roar" of God's voice.
May today, just for a moment or two, we pause in silence so that later we may hear and see God's beauty and love, infinitely surrounds us, if only we are willing to look and listen.
Stephanie Hill is a freelance writer and a teacher at St. Joseph Catholic School in Huntington. She is also a lifelong resident of Lawrence County. She can be reached at firstname.lastname@example.com.