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A gastro-laryngeal mask features softly compliant construction of the distal half of the mask, wherein the mask is of generally elliptical configuration, with an inflatable peripheral cuff to seal and support the mask around the laryngeal inlet. A back cushion is inflatable to engage the back wall of the pharynx and thus to forwardly load the peripheral-cuff seal to the laryngeal inlet. An evacuation tube for external removal of a possible gastric discharge completes an evacuation or discharge passage contained within the mask and opening through the distal end of the peripheral cuff. Special provision is made for assuring integrity of the discharge passage within the flexible distal half of the mask, i.e., assuring against collapse of the distal-end half of the softly compliant evacuation tube in the distal region of the mask, such that inflation of the mask does not compromise viability of the evacuation tube by compressing softly compliant material of the evacuation tube during periods of mask inflation. The special provision also favors such collapse of the mask when deflated as to provide a leading flexible edge for piloting a safe and correct advancing insertional advance of the deflated mask in the patient's throat, in avoidance of epiglottis interference and to the point of locating engagement in the upper sphincter of the oesophagus.
1. A laryngeal mask construction for concurrent airway service to a patient's laryngeal inlet and for removal of gastric-discharge products from the oesophagus, said construction comprising:
an inflatable ring in the form of a generally elliptical annulus having an outer periphery configured for continuously sealed adaptation to the laryngeal inlet, said ring extending longitudinally between proximal and distal ends and having an inflation port connection at its proximal end, said ring being a moulded product of relatively thin and softly pliant elastomeric material, said ring including within the inner periphery of said annulus an apertured panel or membrane establishing separation between a pharyngeal-chamber side and a laryngeal-chamber side, said ring further integrally including at its distal end a distally open tubular conduit for operative engagement and communication with the oesophageal inlet, said tubular conduit extending from its distally open end and in the proximal direction adjacent said panel and on the pharyngeal side of said panel;
a domed backing-plate member of relatively stiff elastomeric material and having a concave side which terminates in a generally elliptical footing in a geometric plane and in sealed engagement with said panel at the inner periphery of said annulus, said backing-plate member having an airway-tube connecting formation on a proximally directional axis that is at an acute angle with said geometric plane, said backing-plate member providing stability to the inner periphery of said annulus and directional stability for said tubular conduit;
an airway tube connected to said connecting formation; and
a gastric-discharge tube connected to said tubular conduit.
2. The mask construction of claim 1, in which said airway tube and said gastric-discharge tube are bonded to each other in side-by-side relation.
3. The mask construction of claim 1, in which said tubular conduit extends proximally to approximately 50 percent of the longitudinal extent of said inflatable ring.
4. The mask construction of claim 1, in which said tubular conduit extends proximally to at least 50 percent of the longitudinal extent of said inflatable ring.
5. The mask construction of claim 1, in which said backing-plate member is formed for directionally guiding relation to said tubular conduit, to determine a straight proximal direction of said tubular conduit for substantially the distal half of the longitudinal extent of said mask.
6. The mask construction of claim 5, in which said backing-plate member is further formed for tubular-conduit guidance on generally a helical arc to a location of gastric-discharge tube entry to said mask alongside said airway tube.
7. The mask construction of claim 1, further including an inflatable back cushion comprising a panel of softly compliant elastomeric material bonded peripherally to the pharyngeal-chamber side of said annulus and extending over said tubular conduit.
8. The mask construction of claim 7, in which said back-cushion panel is peripherally bonded to said tubular conduit.
9. The mask construction of claim 8, in which said back-cushion bond to said tubular conduit extends for substantially the distal half of the longitudinal extent of said inflatable ring.
10. The mask construction of claim 8, in which (a) a first arcuate circumferential fraction of said tubular conduit is connected to said backing-plate member, (b) the bond of said back cushion to said tubular conduit is angularly spaced from and generally opposite the connection of said tubular conduit to said backing-plate member, the bond to said back cushion being over a second arcuate circumferential fraction of said tubular conduit, (c) the arcuate circumferential extent by which said angular tubular-member connections are made to said backing-plate member and to said back cushion being reinforced with circumferentially arcuate stiffener formations.
11. The mask construction of claim 10, in which said stiffener formations are arcuate ribs in axially spaced array.
12. The mask construction of claim 11, in which said ribs project radially outward of said tubular conduit.
13. A laryngeal mask construction for concurrent airway service to a patient's laryngeal inlet and for removal of gastric-discharge products from the oesophagus, said construction comprising:
an inflatable/deflatable ring in the form of a generally elliptical annulus having an outer periphery configured for continuously sealed adaptation to the laryngeal inlet, said ring being a moulded product of relatively thin and softly pliant elastomeric material, said ring integrally including at its distal end a distally open tubular conduit through a distal opening in said ring, said distally open tubular conduit being for operative engagement and communication with the oesophageal inlet;
a backing-plate member of relatively stiff elastomeric material having a concave front side which is adapted to face the laryngeal inlet and which terminates in an elliptical footing in a geometric plane and in peripherally sealed engagement with the inner periphery of said inflatable/deflatable ring, said backing-plate member having an airway-tube connecting formation on a proximally directional axis that is at an acute angle with said geometric plane, said backing-plate member having a lumen for airway-tube communication with the laryngeal inlet, and said backing-plate member providing stability to the inner periphery of said annulus and proximally directed directional stability for said tubular conduit;
an airway tube connected to said connecting formation; and
a gastric-discharge tube connected to said tubular conduit.
This application is a continuation of original application, Ser. No. 08/609,521, filed Mar. 1, 1996, now abandoned.
This invention relates to a laryngeal-mask airway (LMA) device, which is an artificial airway device designed to facilitate lung ventilation in an unconscious patient by forming a low-pressure seal around the laryngeal inlet. An inflatable-ring seal surrounds an appropriately shaped mask which fits into the lower pharynx and is attached to a tube which emerges from the mouth, as for connection to medical gas-supply tubing.
More particularly, the invention relates to a variety of laryngeal masks, known as gastro-laryngeal masks (GLM), wherein. provision is made for airway assurance to the patient who is at. risk from vomiting or regurgitation of stomach contents while unconscious. U.S. Pat. No. 5,241,956 deals with this problem by providing an evacuation tube which is open through the center of the inflatable seal of the laryngeal mask, thus utilizing the distal end of the inflatable ring as an inflatable-cuff formation which establishes peripherally sealed engagement to the upper sphinctral region of the oesophagus and centrally supports the distal end of the evacuation tube. In addition, said U.S. Pat. No. 5,241,956 discloses a further inflatable cuff carried by the laryngeal mask and by the evacuation tube, for referencing inflation against the back wall of the pharynx, thus making it possible to establish the laryngeal-inlet seal with reduced inflation pressure, as compared with prior structures not having such an additional inflatable cuff.
U.S. Pat. No. 5,305,743 discloses moulding techniques for manufacture of a variety of laryngeal masks, including a gastro-laryngeal mask, wherein an inflatable back cushion provides such referencing inflation against the back wall of the pharynx as to widely distribute the back-wall reference, over substantially the full area of the laryngeal mask. Such a back-cushion construction has been found to be mechanically simple and highly effective, and U.S. Pat. No. 5,355,879 discloses such a back cushion for each of several representative laryngeal-mask constructions.
In practice, although a gastro-laryngeal-mask as described in said U.S. Pat. No. 5,355,879 works well, it has the disadvantage that the gastric evacuation channel needs to be sufficiently stiff to prevent its collapse under the influence of the increased pressure within the back-cushion cuff, when it is inflated in the pharynx. A suitably stiff tube is readily provided, but the whole device is then more difficult to insert into the patient's throat, since insertion involves flexing the device around the angle at the back of the tongue. Provision of a pre-curved airway tube facilitates passage around the back of the tongue, but the advancing distal tip end of the device is then more likely to collide with the glottis (or entrance to the larynx), and indeed it may block the larynx by so doing, with consequent danger to the patient.
It is an object of the invention to provide an improved gastro-laryngeal mask.
A specific object is to meet the above object with a construction that specifically avoids problems or difficulties with constructions of said U.S. patents.
Another specific object is to provide for ready compression and flexure of a gastric passage within a back-cushioned or cuffed gastro-laryngeal mask, when the mask is in deflated condition for insertion into the patient's throat.
Furthermore, for the deflated condition of the mask, i.e., in readiness for insertion into the patient's throat, it is an object to enable formation of a flattened flexible leading distal-end edge to self-adapt to and resiliently ride the outer limit of curvature of the patient's airway, throughout the insertional course of the deflated mask and into its locating engagement with the hypopharynx.
It is a further specific object, in conjunction with the foregoing specific objects, to provide for assurance of full patency of the gastric passage within the mask, when the mask has been inflated.
These objects are realized in the present invention by utilizing two structural mechanisms, both of which are operative when the device is inflated; one of these mechanisms prevents lateral compression of the wall of the gastric tube, while the other of these mechanisms prevents antero-posterior compression of the wall of the gastric tube; the result is to assure a substantially circular section within relatively soft portions of the evacuation passage, as long as the device is inflated and in installed position.
In a preferred embodiment of the invention, an artificial airway device to facilitate a patient's lung ventilation comprises an airway tube, an evacuation tube, and a laryngeal mask at one end of both tubes. The mask is of generally elliptical configuration and comprises a body or backplate of relatively stiffly compliant nature, and an inflatable annular cuff or ring of relatively softly compliant nature is connected to and surrounds the body or backplate. When inflated, the annular cuff adapts to and seals around the laryngeal inlet, and an inflatable cushion on the exterior of the inflated annulus bears against the back wall of the pharynx, to thereby forwardly load the inflated annulus into sealed relation with the laryngeal inlet, with the backplate dividing the mask between a laryngeal-chamber side and a pharyngeal-chamber side. The relatively stiff backplate is formed for connection to the airway tube for exclusive communication to the larynx through an opening in the backplate; and the backplate is also configured to guide and support a relatively soft flexible evacuation tube within the pharyngeal-chamber side, from a distally open end for reception of gastric products, to a proximal end for connection to an externally discharging evacuation tube.
It is a feature of the invention that along an aligning path for the flexible evacuation tube within the pharyngeal-chamber side of the mask, a first significant angular fraction of the periphery of the flexible tube is bonded to a stabilizing portion of the backplate, and that a second angular fraction of the periphery of the flexible tube is continuously bonded to the inner surface of the flexible back cushion, such that generally opposite unbonded further angular regions exist between the bonded regions. These unbonded further regions are provided with external stiffening ribs at a succession of axial intervals, to reinforce the unbonded regions against lateral compression when the back cushion and the inflatable ring are under inflation pressure. In this way, inflation of the annular laryngeal-inlet sealing ring and of the flexible back cushion will assure a maximally open evacuation passage within the mask in inflated condition, essentially without antero-posterior or lateral compression of the passage. And it is further assured that upon deflation of the mask, evacuation-passage compression will be essentially in the sense of achieving a squeezing and somewhat flattening deformation of the discharge passage against the formed back-plate area of evacuation-passage support; such flattening is maximal at the oesophageal end of the discharge passage, so that, when correctly deflated, the device forms a wedge shape for correct insertion.
The invention will be illustratively described in detail for a presently preferred embodiment, and for certain other embodiments, all in conjunction with the accompanying drawings, in which:
FIG. 1 is a simplified view, generally in side elevation, for the presently preferred embodiment of an artificial airway device, having at its distal end a laryngeal mask with a gastric-drainage feature of the invention, the same being shown in position for use in a patient;
FIG. 2 is a fragmentary plan view, to an enlarged scale showing the back or pharynx-facing side of the mask of FIG. 1;
FIG. 3 is a plan view to the scale of FIG. 2, showing a softly compliant moulded inflatable component of the mask, as seen from the aspect of FIG. 2;
FIG. 4 is a plan view to the scale of FIG. 2, showing a relatively stiffly compliant rigidising or reinforcing back-plate component of the mask, as seen from the aspect of FIG. 2;
FIG. 5 is a longitudinal section of the softly compliant component of FIG. 3, to the scale of FIGS. 2 to 4 and taken generally in the vertical plane 5--5 of substantial symmetry, but prior to an inside-out deformation step, to create the appearance of FIG. 3;
FIG. 5A is a section, taken at 5A--5A in FIG. 5;
FIG. 6 is another view in longitudinal section, to the scale of FIGS. 2 to 5 and in the vertical plane 5--5 of FIG. 3, showing the relatively stiff component of FIG. 4 in assembled relation to the softly compliant component of FIG. 3;
FIG. 7 is an end view, being a proximally directed view, of the distal end of the rigidising component of FIG. 4;
FIG. 8 is a simplified cross-sectional view of the inflated mask of FIG. 2, taken at 8--8 in FIG. 2;
FIG. 9 is a simplified cross-sectional view of the deflated mask of FIG. 2, taken at 8--8 in FIG. 2;
FIG. 10 is a view similar to FIG. 2, to show a first modification;
FIG. 11 is a view similar to FIG. 4, to show the back-plate component in the modification of FIG. 10;
FIG. 12 is a sectional view, taken at 12--12 in FIG. 11; and
FIG. 13 is a plan view to the scale of FIG. 2 to illustrate an intermediate product which is a modification of that shown in FIGS. 5 and 6.
Referring first to the preferred embodiment of FIGS. 1 to 9, the invention is shown in application to an airway system comprising a laryngeal-mask unit 10 and its airway tube 11, installed through the mouth 12 of a patient. The mask unit 10 may be generally as described in any of the above-identified U.S. patents and therefore need not now be described in detail. It suffices to say that mask unit 10 comprises a relatively stiff body or backing-plate member, generally indicated at 13, and an apertured relatively thin body-membrane portion or panel 13' having an aperture or lumen 14 through which the airway tube 11 can establish a free externally accessible ventilation passage, via the patient's mouth 12 and throat 15, and past the epiglottis 16 to the larynx 17. The body member 13 of mask 10 may be described as generally dome-shaped, with its concave side terminating in a generally elliptical footing, and facing the laryngeal inlet; and its convex side faces the backwall of the pharynx. Body 13 is suitably of an elastomer such as silicone rubber and relatively stiff; and body member 13 is surrounded by an inflatable ring 18 which is generally elliptical and which is circumferentially united to body member 13 in essentially a single plane. The inflatable ring 18 may also be of silicone rubber, although preferably relatively soft and flexible compared to body member 13. An externally accessible tube 19 is the means of supplying air to the inflatable ring 18 and of extracting air from (and therefore collapsing) ring 18 for purposes of insertion in or removal from the patient; check-valve means 21 in tube 19 will be understood to hold a given inflation or to hold a given deflation of ring 18.
In the installed position of FIG. 1, the projecting but blunted distal end 27 of ring 18 is shaped to conform with the base of the hypopharynx where it has established limited entry into the upper sphinctral region of the oesophagus 24. The back side of body member 13 is covered by a thin flexible panel 25 (FIG. 2) which is peripherally bonded to the inflatable ring 18 (FIG. 1) and in sealed engagement at peripheral line 25' around the entrance of tubes 11 and 23 to the mask structure to define an inflatable back cushion which assures referencing to the back wall of the pharynx and thus is able to load the mask unit forward for enhanced effectiveness of inflated-ring sealing engagement to the laryngeal inlet. The inflated ring, thus-engaged to the laryngeal inlet, orients the distal-end of the airway tube 11 at an acute angle to the general plane of ring 18 and in substantial alignment with the axis of the laryngeal inlet, for direct airway communication only with the larynx 17.
The laryngeal-mask unit 10 is of the GLM variety in which an evacuation tube 23 (FIG. 2) serves for extraction and external removal of gastric-discharge products from the oesophagus. Tube 23 follows the general course of the airway tube 11, with sealed entry alongside airway tube 11, beneath the back-cushion panel 25, and with passage through the interior of ring 18, near the distal end of the mask; in FIG. 3, the distally open end of the evacuation tube 23 is defined by a re-entrant tubular conduit formation 26 integrally formed with the relatively soft material of ring 18. As explained in U.S. Pat. No. 5,241,956, inflation-air supply to the back cushion may be the same (19) as for ring 18, or separate inflating means (not shown) may be provided for these separate inflatable means.
More specifically, for the particular construction shown, the relatively softly compliant flexible components may be integrally formed in a single moulding operation, in which the moulded intermediate product is an inside-out version of what will become the finished more flexible part of the finished mask unit 10. The moulded intermediate product may thus have the appearance shown in FIG. 5, following the technique described in U.S. Pat. No. 5,305,743, to which reference is made for detailed description. It suffices here to identify the inflation-air inlet formation 28, directed inwardly on a central axis 29 which also includes the outwardly directed distal-end formation of the evacuation tube 26; the central axis 29 may also be understood as identifying the equator plane (perpendicular to the drawing of FIG. 5) which applies to the inflatable annular ring 18, after evacuation tube 26 has been swung upward (counterclockwise), in the sense suggested by arrow 30, and generally for 180° of rotation about an axis 31, which (axis 31) is normal to the plane of the drawing of FIG. 5. This 180° rotation tucks tube 26 into the flanged relatively large edge 32 of the open skirt of the moulded intermediate product of FIG. 5 and makes it a simple matter to turn the remainder of the skirt inside-out, thus defining ring 18, with the edge flange 32 seated on a ledge 33 of the upper dome-shaped feature (body-membrane portion or liner 13') of the moulded intermediate product.
In the preferred form shown, the mask body member 13 (FIGS. 4 and 7) is a separately moulded component of relatively stiff nature as compared to the moulded intermediate product of FIG. 5. Stiffness vs. softness will be understood to be relative terms and not necessarily to imply that these components are formed from different materials.
In FIG. 4, the body component 13 is seen to comprise an apertured panel which is essentially a moulded dome or bowl 34 having a concave inner surface which conforms to the convex moulded contour of the dome shape 35 of the relatively soft (i.e., thin-walled) component of FIG. 5, these components being shown in FIG. 6 in assembled relation. Relative stiffness (thickness) in the bowl or dome 34 of FIG. 4 is generally in the range 2 to 5 mm, with gradually reducing thickness for greater flexibility in approach to the lower or distal end. The bowl or dome 34 has a peripheral edge which terminates in a single plane, for adhesively bonded seating to the ledge 33 of the relatively soft component of FIG. 5, after making the inside-out inversion.
The stiffness of body member 13 is greatest in the region of proximal-end seating to ledge 33, above which an inlet-air formation 36 is oriented on an axis 37 which is not only inclined at an acute angle α to the plane of seating to ledge 33., but is also laterally offset from the central longitudinal plane of symmetry of the mask, denoted 5--5 in FIG. 3. Relative stiffness of body member 13 is also enhanced (i) by the fact that its distal half features a slot 38 of width less than the diameter of the re-entrant distal-end tube 26, (ii) by the fact that the re-entrant tube 26 is adhesively retained in cradled support by and between confronting edges of slot 38, and (iii) by the fact that the distal end of evacuation tube 23 is preferably preformed (as seen in FIG. 2) with a quarter-turn helical advance to track the course of slot 38 in the upper or proximal half of body member 13. The evacuation tube 23 is preferably relatively stiff, e.g., stiffness (thickness) in the order of magnitude of the material at the upper (proximal) half of body member 13, and is seen in FIG. 2 to have telescoping fit to the proximally directed upper end of re-entrant tube 26; this is an adhesively sealed fit.
Stated in other words and in explanation of the distal and proximal halves of the body member 13 and the relation of these halves to the relatively thin material and distal-half extent of re-entrant tubular conduit 26, said tubular conduit may be said to extend proximally to approximately 50 percent of the longitudinal extent of the inflatable ring 18; alternatively, said tubular conduit 26 may be said to extend proximally to at least substantially 50 percent of the longitudinal extent of the inflatable ring 18, consistent with the drawings of FIGS. 2, 3, and 6. Furthermore, as seen in FIG. 4, the distal half of backing-plate member 13 is essentially straight, thus determining a straight proximal direction of tubular conduit 26 for substantially the distal half of the longitudinal extent of the mask.
As also seen in FIG. 2, the back-cushion panel 25 covers a substantial part of the posterior surface of the mask, being peripherally sealed around the generally elliptical course of inflatable ring 18, and also being centrally adhered to the re-entrant tube 26 for substantially the entire length of tube 26, as suggested by cross-hatching 39. Finally, to assure integrity of the inflatable ring 18, the re-entrant tube 26 is adhesively sealed to the adjacent edges of tube-26 local passage through ring 18 at the distal location designated 40 in FIG. 3; for purposes of avoiding undue complexity in the drawings, this adhesively sealed region is not shown but will be understood to be along the line of tube-26 intercept with locally adjacent walls of inflatable ring 18. In FIG. 5, this intercept line is accounted for by a local cut-out 40' at the distal end of the skirt of the intermediate product of FIG. 5.
The simplified sectional diagram of FIG. 8 illustrates the functional cooperation of described component parts and features of the described gastro-laryngeal mask construction, in inflated condition, to account for diametrically opposite section cuts through right and left halves of the inflatable ring 18, spaced by sealed fit of body member 13 to the inner profile of ring 18. The back-cushion panel 25, being centrally adhered at 39 to the upper central region of re-entrant tube 26, provides a lifting force which is in the direction to hold open the evacuation tube and, therefore, not to collapse tube 26 when the back cushion is inflated; without this force, in opposition to a retaining force attributable to adhesive connection to body member 13 (along edges of slot 38), there would be no tendency to hold a softly compliant tube 26 against collapse, in that the cushion panel would outwardly expand itself to a bowed shape 25' suggested by phantom outline in FIGS. 6 and 8.
Preferably, the effective arcuate extent of adhesive connection 39 is in the range 45° to 90° about the central axis of tube 26, as seen in FIG. 8. Preferably also, the adhesive connection of tube 26 along the straight edges of the distal half of slot 38 accounts for a corresponding range of support of tube 26 against collapse in the circumstance of back-cushion inflation. In other words, inflation of the ring 18 and back cushion 25 will assure developed vertical forces to hold the evacuation passage of re-entrant tube 26 in substantially open condition, but the transversely opposed arcuate regions (each of approximately 90° arcuate extent) between these adhesively connected regions are vulnerable to compressionally inward bowing, thus reducing the sectional area of tube 26 while the mask is inflated. The invention resolves this vulnerability by providing axially spaced stiffening ribs or ridges 42 as integral formations of the re-entrant tube 26, in the initially moulded intermediate product of FIG. 5. As shown, there are three mutually opposed pairs of ridges 42, at axial spacings which are in the order of the unstressed bore diameter of tube 26. For the indicated silicone-rubber material of the product of FIG. 5, the incremental local thickness at ridges 42 is suitably twice or three times the otherwise uniformly thin moulded product of FIG. 5, as seen in FIG. 5A.
In FIG. 8, a section taken near the location of tube 26 connection to the more stiffly compliant evacuation tube 23, the inflated condition of the GLM mask of the invention is seen to have an overall "height" dimension H1, meaning front-to-back (i.e., laryngeal inlet-to-pharynx back wall). When the mask is deflated, this dimension H1 is seen to be reduced by approximately 50 percent, as shown at H2 in FIG. 9 for the deflated condition of the same mask. When deflated, as has been pointed out in U.S. Pat. No. 5,297,547, the ring 18 collapses into flattened double walls (marked 18') which are upwardly dished; and although deflation does little to compress tube 26 other than at the region 39' of adhesion to the back-cushion panel 25, the overall deflated extent H2 is essentially unchanged from the dimension H2 which applies for collapse of ring 18. On the other hand, at the distal end of the mask, the collapse of ring 18 is operative upon the formed distal-end opening 43 of tube 26 to somewhat flatten the opening 43, into a generally shovel-shaped distal lip feature which merges smoothly into the adjacent upwardly dished double-wall. shape 18' shown in the longitudinal mid-section of FIG. 9.
It will be appreciated that the GLM device described thus far has an airway tube 11 that is of larger diameter than the evacuation tube 23; in this circumstance, the airway tube 11 is large enough to accommodate guided insertion of an endotracheal tube. The tubes 11, 23 enter the described laryngeal mask 10 in side-by-side relation and are preferably adhesively secured to each other in this side-by-side relation, and along their full longitudinal extent, in order to provide a measure of torsional resistance against twisting, thereby aiding a medically qualified person in quickly and correctly installing a fully deflated-GLM in a patient, with assurance that, upon inflation of ring 18 and the back-cushion panel 25, an exclusive and sealed airway connection will be established to the laryngeal inlet, via lumen 14 and from the airway tube 11; concurrently, a similarly exclusive evacuation connection is established to the upper sphinctral region of the oesophagus, via the distal-end opening 43 of tube 26, through the evacuation tube 23, and to suitable waste-collection means (not shown) external to the patient.
More specifically as to insertion of the fully deflated GLM device in a patient, it will be understood that a range of GLM sizes is available from which to select a sufficiently correct size for the patient. Deflation is accomplished via external means (not shown) and via check-valve means 21 to hold the deflated condition wherein the dome shape of body member 13 rises from within the dished peripheral lip 18' of the collapsed ring 18. A skilled operator is quickly able to develop the desired appearance of the GLM in its deflated state; but for a uniformly correct deflated shaping, it is recommended to use a forming tool as described in U.S. Pat. No. 5,711,293.
When correctly shaped and in its deflated condition, and at the distal end of the GLM, the opening 43 will have been flattened, and this distal end merges with the peripheral lip 18' of the collapsed ring 18. Noting that the entire distal half of the mask is of relatively soft material, stiffened only by indicated adhesive connection, the distal end projects distally and at its upwardly flared merge with lip 18', for low acute-angle incidence to the posterior arcuate profile of the patient's throat passage. That being the case, a medical technician need only make sure that upon inserting the mask via the patient's mouth and throat, the flattened distal end rides the outer (posterior) arcuate contour of the patient's airway, in that the softly flexible nature of the distally projecting and somewhat flattened distal end will be flexibly self-adapting to local irregularities (if any) in the course of passage into the pharynx; final insertional location is noted by an increase in encountered resistance, upon distal-end engagement of the GLM with the upper sphinctral region of the oesophagus. At this juncture, inflation air supplied via line 19 and retained by check-valve means 21 establishes (i) the described seal of ring 18 to the laryngeal inlet, (ii) back cushion (panel 25) contact with the back wall of the pharynx, and (iii) full opening of the evacuation tube 26 for maximum accommodation of a possible gastric discharge from the oesophagus.
Beyond what has been described, FIG. 10 illustrates at phantom outline 26' that the flexible length of the re-entrant tube 26 may be of even greater length than the approximately half-mask length shown by the solid lines of FIG. 5. In that event, arcuate stiffener ridges as described at 42 will be preferred, as long as lateral support is needed to prevent side-wall collapse of the extended tube 26', in the inflated condition of the mask, i.e., including inflation of back-cushion panel 25.
FIGS. 10 to 12 illustrate another GLM embodiment wherein an airway tube 50 and an evacuation tube 51 are of equal size, adhered (as suggested at 52) to each other in side-by-side relation for torsionally resistant and symmetrically positioned entry into corresponding side-by-side ports 53, 54 of the dome like moulded backing plate 55 or body member of FIGS. 11 and 12. The backing plate 55 may be similar to plate 13 of FIG. 4, except that in FIG. 11 the somewhat helically arcuate conduit path from the inserted distal end of evacuation tube 51 to the point 56 of softly compliant re-entrant tube (26) connection is provided by an integral passage formation 57 of the backing plate 55. At point 56 in FIG. 11, the formation 57 is seen to be in the central vertical plane 58 of symmetry of the bowl of backing plate 55 and in alignment for accepted proximal-end insertional accommodation of a re-entrant tube 26 of thin-walled material to which backing plate 55 is to be assembled, with edges of the straight slot 38' supporting tube 26 in the manner already described. Also integrally formed with backing plate 55 is an inlet-connection counterbore for coupled connection of airway tube 50 to the laryngeally exposed side of the mask. Features in FIG. 10, such as the back-cushion panel 25, the inflatable ring 18, and the adhesively bonded connection 39 of panel 25 to tube 26 are all as previously described.
It will be understood that the inside-out technique described in connection with FIGS. 5 and 6 for initially moulding and then inverting the skirt of the moulded product, is but one illustration of a way to create the mask and its inflatable ring, in which case the flexible drainage conduit does not get inverted. That being the case, the reinforcement ribs 42 are initially formed portions of the outer surface of the moulded product. On the other hand, another technique for forming the mask with its inflatable ring, involves moulding the mask bowl integrally with an elliptically configured product as shown in FIG. 13, wherein completion of inflatable-ring (18) integrity requires only an adhesively bonded completion of the ring peripherally around the inner substantially elliptical profile, where backing-plate (13) connection is also adhesively secured. In that case, the drainage tube 26 is integrally-moulded with the non-invertible ring (18), so that an inversion of tube 26 is necessary, to have it project re-entrantly, in the proximal direction, and the moulded product which is to become inflatable ring 18 must be cut away as at 40, to permit inverted tube 26 to "pass through" the inflatable ring, in order to develop a relationship which is suggested by FIG. 5. Of course, if tube 26 is to be inverted, the reinforcement ribs 42 are preferably integrally formed as radially inward rib reinforcements or discontinuities in the moulded bore of tube 26. Inversion of tube 26 places these rib reinforcements on the outer surface of tube 26, so that the bore of tube 26 is inherently smooth.
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text:
Unhappy in the US?
Hi everyone,
I have been living in the USA for exactly a year now. I moved here from Germany to get married to my husband. I was never a real USA-fanatic but neither was I very reluctant to go move to the US. Now I find myself being very, very unhappy and feeling more home-sickness than anything else. My husband is treating me very well and we are in a good financial position, both have good jobs etc., but I cannot see myself staying here for the rest of my life. I have problems finding friends here because of some of the people's attitudes (i know i know you can find this all over the world), I miss my home and my family and friends so much that the only time I am happy is when I think about Germany.
I expected it to be hard at first and I want to make it work for my husband and myself but I am so unhappy that if I had the choice right now I would totally move back to Germany (with my hubby of course).
My question is whether any of you guys have the same problem or whether its really just the first year or whatever and things change? Does anyone have a tip what I could do to feel more home or get more open-minded or something like that?
Hope to find someone who knows what the heck Im talking about
Thanks in advance
I myself had always been very unhappy in Germany, and feel totally happy here. Homesickness, in 15 years, I've only experienced it the few times I had to go to Germany for a week and wanted to come back to Oregon.
But - I have a friend in Ohio, she is very home sick. Her husband has lived with her in Germany for a long time, and now wanted to come back home, and they have 2 boys who are doing so much better here in school. She goes back and forth, and is probably going to ruin the family both financially, and otherwise. If she goes on like this, her husband might just give up on her.
What I mean is, you'll have to decide what your priorities are.
Do you want to stay here with your husband, then you will have to look towards the future, and not back to Germany, and try to make it right.
Maybe some therapy could help with better adapting to your new life.
Or go back, if your husband will go with you - good for you, if not, you will need to make a choice about your happiness. Is it your family that makes you happy or a country.
Ge�ndert von Gast17468 (19.07.2009 um 06:13 Uhr)
Hello Happytree,
can you afford trips back home? That should help.
I used to feel the way you do, but over time it has changed. Particularly since time hasn't stood still in Germany either. So many things have changed, that now I feel a bit lost during my trips.
Give yourself some more time
Sabine, this is the English only section...no German, please
Poor girl...
..but what do you want us to say?
You have to make a decision.
Maybe the thought that you can go home anytime you want might help you.
And be honest with yourself - is the reason really being homesick or do you have problems in you marriage?
You said, your husband treats you really well - how can it be that you love Germany more than him then?
At the very beginning I felt like this too. I wasn't really homesick, I just had problems getting along with people. Everyone was always so fiendly to me in the US, but after a while I realized that people are nice but not necessarily warm-hearted. That was difficult for me and sometime still is. I had tons of friends in Austria, that was never a problem for me. I'm really outgoing, happy, and I am young, but when I came here I encountered a lot of problems. I didn't understand why I never had problems finding friends in Austria, and why I met so many people in the US and I could never imagine having them as my best friends?! Maybe this sounds weird but this is just the way I feel.
What helps me a lot is VONAGE! I pay 5 Dollars a month extra and I can call my family in Austria as often, as much and as long as I want. I basically know everything about them, which makes it easier to be so far away...
This is actually the only advise I can give you. You will always miss your family and friends, but calling them as often as possible helps a lot!
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subset: commoncrawl


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TCEQ plan is a corruption of legislative order
David Sikes' outdoors column
CORPUS CHRISTI - The conservation community is reeling with outrage and disbelief over the unreasonable rejection of reasonable recommendations aimed at balancing the needs of man and nature with rational protections for river flow.
Environmental flows strategies for the Guadalupe, San Antonio, Mission and Aransas rivers that feed Copano, Aransas and San Antonio bays, along with the Colorado and Lavaca rivers that feed Matagorda and Lavaca bays, were mandated by the Texas Legislature as part of a larger charge involving river flow standards for every major stream and bay system in the state.
Most of you understand the importance of instream flows and freshwater inflow to our bays and estuaries, though there remains many misconceptions and misguided opinions about the difference between wasted water and sound policies that promote conservation.
Freshwater is the lifeblood of our bays, providing necessary nutrients and maintaining livable salinity levels. In turn, healthy rivers and bays are the economic engines of riverside and coastal communities, not to mention a recreational respite for locals and visitors.
Of course, rivers and reservoirs also provide water for many other necessary human uses, ranging from simple drinking water and agriculture to industrial applications. Part of the problem is that too many of these users were allowed to purchase water rights long before environmental flows were part of the equation or considered necessary for healthy rivers and estuaries.
If all the Guadalupe River water allocated to users was actually removed from the river it would run dry. In fact, the Guadalupe is over-allocated in the same way that airlines over book flights.
But among all the confusion and debate over environmental flows there is a single, undisputed and simple fact. We know rivers are intended to flow into the sea.
And also we know the Texas Legislature intended to strike a balance in this policy debate by assembling a group of interested and informed citizen volunteers with scientists to examine every possibility for an equitable solution in the face of man's growing thirst for water. These stakeholder committees were made up of representatives from river authorities, river and coastal communities, industry, agriculture, conservation groups, recreational anglers, commercial fishermen, regional water planners and groundwater conservation districts.
The Colorado/Lavaca committee reached a unanimous compromise, while the Guadalupe/San Antonio committee endorsed its recommendations by a super majority of 21-3. Each committee offered its recommendations to the Texas Commission on Environmental Quality. The commission is charged with weighing the information and then adopting a sensible water plan.
Here is where the debate explodes.
After crafting a list of recommendations through at least 18 months of grueling deliberations the TCEQ took the document, whittled it down and spit out its own inadequate scheme, rejecting many key components of the stakeholder plan.
I say spit because metaphorically that's what the TCEQ did in the face of volunteers who displayed goodwill and faith in believing the reasonable compromise they had reached almost unanimously would be given more than a condescending glance.
"I can only surmise that they looked at making as much water available as possible for pumping out of rivers, without really assessing the impacts of those withdrawals on the health of rivers and bays," said stakeholder committee member Diane Wassenich, executive director of the San Marcos River Foundation.
Noted conservationist David Langford, former executive vice president of the Texas Wildlife Association, was on the ground floor when the Texas Legislature designed the stakeholder process for consensus-based regional solutions for environmental flows for each river and bay system. He served on the Environmental Flows Advisory Committee which made recommendations for Senate Bill 3, the latest water bill to end all water bills.
Langford believes what the TCEQ is attempting to do is a corruption of SB 3.
"The question we should be asking is whether Texas is an agency-driven state or a citizen or legislative driven state," Langford said. "This is a unilateral decision by TCEQ, showing a "they know best" attitude. It's not politics, it's arrogance and condescending toward local input."
The TCEQ in effect told us not to worry, it's going to rain and we'll get our water. Rejecting key parts of the committee's recommendations will foster greater suspicion of the process, undermine its legitimacy and discourage well-meaning citizens from participating in government, Langford said.
"They basically said 'We turned down your recommendation because you did your job of balancing the needs of man and nature,'" he said. "Nobody thought they would disparage the process to this extent. Sure, it's up to them to enforce the water rules, but its not up to the TCEQ to ignore the process mandated by the legislature. This bruise will stay purple for a while."
Hopefully TCEQ's arrogance will not subdue what should be a spirited public comment process. And hopefully the ultimate plan will come closer to what the stakeholders envisioned.
The most egregious deviation from the recommendations involves the amount of river water that would be allowed to flow into San Antonio Bay.
Jennifer Ellis, with the National Wildlife Federation who served on the Guadalupe/San Antonio bay/basin stakeholder committee, said the TCEQ's plan does not include adequate protections of river flow fluctuations. The TCEQ rules particularly fall short of protecting the Guadalupe River basin, failing to recognize the benefits of allowing a percentage of water to remain in the river after rainfall increases its flow, even though they have protected this benefit in other rivers, Ellis said.
And rather than protecting higher-flow pulses that provide critical flushing, not to mention nourishment for the bays, the TCEQ plan would allow for new diversion channels, dams and reservoirs to remove and capture these large pulses, thereby dramatically limiting the natural ecological benefits they provide.
The TCEQ also rejected a committee recommendation to dedicate or set aside 10 percent of the water issued in new permits for the preservation and health of rivers and bays. This 10 percent rule could be satisfied by returning wastewater to the bay or by other imaginative means.
Then the agency removed even more bay protections by proposing a 10 percent reduction in the frequency of inflows for San Antonio Bay below what the committee recommended. In all, the TCEQ staff removed some of the most critical protections recommended by the Guadalupe River/San Antonio Bay committee.
Tell them this is unacceptable.
David Sikes' Outdoors columns run on Thursday and Sunday. Contact David at 361-886-3616 or firstname.lastname@example.com.
Voice your position
May 14 is the deadline for public comment on the TCEQ's proposed plans for the Guadalupe, San Antonio, Mission and Aransas rivers that feed Copano, Aransas and San Antonio bays, along with the Colorado and Lavaca rivers that feed Matagorda and Lavaca bays.
Submit comments to email@example.com or www.tceq.texas.gov/permitting/water_rights/eflows/rulemaking. Tell the commission whether its proposal provides sufficient river and bay protections. Or simply recommend they adopt the protections submitted by the stakeholder committees.
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by Libby Anne cross posted from her blog Love, Joy, FeminismCreated To Be His Help Meet, pp. 180—182So, Debi gets mail. Or rather, Michael does, but whatever, it made into Debi's book. Dear Mr. Pearl,I am a busy mother whose children go to a Christian school. I am realizing that without another close female in my life who could share house duties, it is harder on me than it should be. Do you by any chance have a husband? Because believe it or not, they can help out with things like housework and childcare. I know, right? It's crazy! … [Read more...]
CTBHHM: Praying Women and "Spiritual Masturbation"
Keeping the "Unity of the Body" Without Being a Martyr: You Have the Right to Protect Yourself
by Suzanne Titkemeyer cross posted from her blog Seeking The LightHow emotionally triggering has the last week or so been? So triggering that last night I had to post this on my Facebook wall: "Dear Former Fellow Church Members From Raccoon Ford Christian Fellowship - If you are not currently on my friends list and someone I actually still have a positive relationship with please do not send me a friends request. If you behaved hatefully towards me when I left the church I really have no desire to be 'friends' now. I've moved on." … [Read more...]
Quoting Quiverfull: Christians Versus "The Sodomites"
by Jeramy Anderson from Persevero News - Sodomy: A Cycle of Collapse(Editor's note: While Jeramy doesn't define exactly what he considers a 'sodomite' it seems like he might be talking about the LBGT community, but he could be speaking about any group that doesn't necessarily subscribe to his worldview.) A good comparison would be that of a Homeschool family. Not all are Christian, but many of them are believers. It only makes sense, for the very reason parents Homeschool is because they do not want their children to be engulfed by a false worldview. Furthermore, as they align themselves with Scripture, they rejoice in children, desire to be good stewards by saving instead of wasting … [Read more...]
Sexuality and Shame, Part 1: Sexpectations
by Kaleesha Williams cross posted from her blog The Lost (and Found) Mind of Kaleesha WilliamsPlease welcome our newest member of the SASBN Kaleesha Williams! She's written a great series on sexuality we'll be posting! Welcome aboard Kaleesh! "Shame, boatloads of shame Day after day, more of the same Blame, please lift it off Please take it off, please make it stop" -The Avett Brothers … [Read more...]
Duggars are Not Crazy
by Lana Hope cross posted from her blog Wide Open GroundAfter I heard that Jessa Duggar is now courting, I've struggled to find words. In a way, I'm happy for her. In a way, I'm always sad to see my peers trapped in patriarchy. But in the midst of those emotions, I don't have anything to say to Jessa. This is her life, not a cartoon on TV. I do, however, have something to say to all her harsh critics – all the critics who mock her family, … [Read more...]
Quoting Quiverfull: Mental Illness is Self Focus?
by John Piper from desiring God - 10 Resolutions for Mental Health That night Dr. Kilby had a pastoral heart and a poet's eye. He pled with us to stop seeking mental health in the mirror of self-analysis, but instead to drink in the remedies of God in nature. He was not naïve. He knew of sin. He knew of the necessity of redemption in Christ. But he would have said that Christ purchased new eyes for us as well as new hearts. His plea was that we stop being unamazed by the strange glory of ordinary things. He ended that lecture in 1976 with a list of resolutions. As a tribute to my teacher and a blessing to your soul, I offer them for your joy. … [Read more...]
Saturday News Links – August 24, 2013
Christian family fed up with the immorality of the US gets a sailboat, inadequate supplies, packs up the children and tries to cross the Pacific Ocean to an island. It goes about like you think it would - http://www.npr.org/blogs/thetwo-way/2013/08/11/211072485/family-rescued-in-pacific-after-sailing-where-god-led-us … [Read more...]
Fun is Not in the Bible, You Say?
by Cindy Foster cross posted from her blog Baptist Taliban and BeyondI borrowed this from a facebook status today. It reminded me of a particular notion The Preacher was 'inspired' with and later emphasized in a sermon. … [Read more...]
CTBHHM: What is a "help meet"? (in the KJV)
by Libby AnneCreated To Be His Help Meet, p. 24Debi finishes this her first chapter with a memo on the background of the word "help meet." I sort of feel like this should have come earlier, given that most people I've mentioned the book to find the term odd. The word help meet appears … [Read more...]


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Yes. It is when the temperatures go up.a lot. Penguins could get killed because of global warming. The ice would melt and the water would dry out.....
, 11,
It can affect the animals and plants by having less food and the animal s have to adapt to it
, 6,
This website is so cool. I wish other people could learn more about pollution. And how pollution is harmful to animals that live in the area polluting gas. I wish people would stop littering on our beautiful nation. You know it's not like the earth cleans itself or something.!. I wish people wouldn't litter because animals could be in danger.
, 9,
we have to save the earth because we only have one .You can save the earth by recycle or take care of animals,are many other forms you only have to think on that.
Thank for your attention
, 10,
Guatemala City
recyle it's imporant cause you can save the earth everyday.BE A EARTH SAVER
, 8,
i dont know much bout global warming but i know alot about animals and the heat is affecting them highly some are even dying because they cant do the thing they are used to doing
, 14,
I think we should have Earth Day every day. I think the earth desearves it. I mean we have been living on the earth for many many decades. I love the earth. It is very important to me.
, 10,
Green Bay
Well, the earth is one of mother nature ahd created. I bet that mother nature is griving right about now. The world is getting closer and closer to it being global warming. You may think- Oh I am the only one pulluting the earth, so there will be no global warming but there will infact be some what of a global warming. Every one polluets. The world needs to wake up and smell the polluted air and step up!
Alexie keenan Jansen
, 11,
GreenBay Wisconsin-sullivan School
The planet will be a better place with our help eco club. save our planet.
, 10,
I would like to save the invirement and keep it very very tidy it is the best that we keep it tidy and it will be a lot beter place to live and more peopel will live on planet earth it will be the best planet in the world i would like it that way
, 8,
10 >>


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Dressing Room Shots: Anna Sui for Target
Okay, so ASui for Tar-jay has a few downs; it's also got a whole lotta ups. I'm referring specifically to the Dresses category, which boasts an abundance of awesomeness unparalleled in any designer collabs collection to date.
Of the four dresses I tried on, I genuinely liked three, was borderline-obsessed with two, and ended up purchasing one. Here's how it played out in the dressing room.
On the hanger, the Silk Patterned Dress – a carbon copy of a Sui RTW look from a few years back – had me at hello. Alas, a crisscross bodice and a puffed sleeve don't work so well when paired with real, live boobs. I felt like a slutty shepardess or something. An A or B cup could totally rock this dress but if you're a C like me or bigger, no dice.
The Blue Print Floral Jacquard Dress was the first thing that made me say Yay. A wide elastic belt gives it serious shape, and the conservative neckline is nicely balanced by its shorter-than-average length.
The uber-versatile Silk Jumper and the perfect-for-partying Metallic Jacquard Dress were my faves of the bunch. I briefly considered buying both, but then thought better of it – while Sui's collection for Target achieves her characteristic vintage aesthetic for less, it still fails to meet my standards of Cheap. Then again, few things do.
Based on the fact that Sui's prints are all over this line, I'm going to give it a rating of only slightly overpriced/possibly worth paying for.
Ultimately, versatility won the day and I decided on the black Silk Jumper.
Did I enjoy ponying up $59.99 for something from Target? Fuck no. But I've already worn the thing twice. So there ya go.


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The NBCCEDP Conceptual Framework
Definition and Purpose of the NBCCEDP Conceptual Framework
Program Management
Management and evaluation are represented by a sphere that symbolizes their all-encompassing nature. The placement of management on top represents how all other parts of the program fall under this leadership. Managing these components requires a "systems approach"—understanding the bigger picture of how and why the program components interrelate to achieve optimal results.
Screening and Diagnostic Services
Screening and Diagnostic Services is represented as the core of the program. Providing these services to underserved women is the intent of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). All other program components are related to and support the delivery of screening and diagnostic services to those most in need.
Data Management
Data Management is represented as a circle surrounding Screening and Diagnostic Services, indicating its focus on this component. Collection and analysis of surveillance data, especially the results of the screening and diagnostic services, should be used to inform and evaluate each of the other program components.
Quality Assurance/Quality Improvement
Quality Assurance/Quality Improvement is represented as an inner circle to show its direct connection to screening and diagnostic services. It works in concert with the data management and evaluation components to monitor, assess, and improve program outcomes. Quality Assurance is on top, representing the Program Management responsibility of assuring quality care. Quality Improvement is at the bottom, showing its proximity to evaluation.
Partnerships are represented as an extension to show that partnerships expand the reach, capacity, and resources of the NBCCEDP. Partnerships influence all components and partners play a key role in advancing the broader goals of the NBCCEDP—enhanced access and quality for all women.
Professional Development
Professional Development is one of two structural links that directly tie partnership to delivery of screening and diagnostic services. Professional Development enhances service delivery.
Recruitment is one of two structural links that directly tie partners to delivery of screening and diagnostic services. Recruitment creates demand from and provides a link to services for women most in need. Recruitment includes educating women about the importance of screening, explaining the services available, and removing their barriers to obtaining these services.
Management and evaluation are represented by a sphere that symbolizes their all-encompassing nature. Evaluation is placed at the bottom to show it is the foundation of successful operation of all components, individually and together.
Contact Us:
- Centers for Disease Control and Prevention
Division of Cancer Prevention and Control
c/o CDC Warehouse
3719 N Peachtree Rd
Building 100 MS F-76
Chamblee GA 30341
- Contact CDC-INFO


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Kendriya Vidyalaya Sangathan, with its headquarter based in New Delhi, is an autonomous body fully financed by Govt. of India and under the Ministry of H.R.D. It was established in 1962 on the recommendation of II CPC with a view to cater to the educational needs of the children of transferable Central Govt. employees including Defense and Para-Military personnel,by providing a common syllabus. Accordingly in 1963 Kendriya Vidyalaya Sangathan and Kendriya Vidyalayas aboard-one in Kathmandu (Nepal) and another in MOSCOW (Russia). It has 18 Regional Offices at Bajaj Nagar, Jaipur.KVS has set pace in education & maintained excellent standard of education with the help of learned, dedicated, conscientious, loyal and sincere teacher.
It provides the best extra curricular and co-curricular activities to the students for their harmonious development. It has all three disciplines-Humanities, Commerce and Science.It has co-educational. Vidyalayas following acommon syllabus & bilingual medium of instructions Its Vidyalayas,It has co-educational Vidyalayas following a common syllabus& bilingual medium of instructions. Its Vidyalayas,are setting a model exampleof National integration, affiliated to the CBSE, NewDelhi. KVSnitiates i& promotes experimentation& innovations in education in collaboration withother bodies like CBSE, NCERT etc. it has appropriate teacher-pupil ratio so as to impart better quality of education. It has provision for waiving off tuition fee for girls, SC/ST.students and KVS wards Kendriya Vidyalaya No.1, Bikaner, K.V. No.1, Bikaner is one of theoldest institutions in this organization. It was established in1964 when the Military school, Ganga Risa la was taken over by the then Central school organization.Originally started in barracks, it can, now boast of its own buildingwhich has grown withtimeAt present it caters to various educational needs of 1817 students as on 1/7/15. It is situated on National Highway No.11 Opposite. Dungar College, the biggest Post Graduate multi-faculty college of the city.


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Shows how to turn a daytime summer scene into a nighttime winter scene using Photoshop and After Effects, with illustrator David Mattingly's production-proven matte painting techniques.
"Loving the pace of training, the clarity, and the flexibility to learn anytime at your own pace. The range of courses is great." —Nick C.
more from our members »


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As spoiled child-turned-murderous villain Dandy Mott on "American Horror Story: Freak Show," Finn Wittrock gave a whole new meaning to bloodbath.
The 30-year-old actor joined the ranks of the FX anthology horror series in its fourth season as the rich, friendless sociopath who becomes the protege to deranged, toothy Twisty the Clown. Dandy, very quickly, embarks on a murder spree -- with his mother...Read more
The eventual best picture Oscar winner played or premiered at the Toronto International Film Festival from 2007 to 2013. Then last year, "Birdman" bypassed the Canadian event in favor of a closing slot at the New York Film Festival. Fox Searchlight figured that after earlier high-profile dates at the Venice and Telluride festivals, it was better to slot the New York-centric "Birdman" in the city where...Read more
We take pride in the accuracy of our predictions here at the Gold Standard, so when something goes awry, rather than resort to finger-pointing and name-calling, we like to take a deep look at ourselves and say, "How did we miss that?"
Having had a little time to mull over the Emmy nominations, let's look at a few of our more high-profile picks and what may have caused the voters to look a different...Read more
Tony Hale spoke to The Times on Thursday morning about his Emmy nomination for his portrayal of poor Gary Walsh, the sycophantic, abuse-tolerant, Selina-pleasing aide in HBO's comedy "Veep." The series collected nine Emmy nominations overall including one for best comedy series.
How are you feeling?
It's been a great day. My wife and I, we have our screaming session when it's announced. My poor daughter,...Read more
It's good to be back on top. Just ask Alex Gansa, who on Thursday was celebrating "Homeland's" Emmy nomination for drama series -- a year after the Showtime spy thriller was shut out of the same category.
"Now I can be completely honest and tell you how devastating it was," he said of last season's snub. "It was really hard."
In hindsight, though, the slight may have been a blessing in disguise....Read more


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GMC to Host Farmers Gathering
On Tuesday, November 27, Green Mountain College hosts the third annual Farmers Gathering. This years theme is Healthy Food and Healthy Communities: Forging the Farm to Cafeteria Link. The event kicks off in Withey Hall at 4 p.m. with a workshop on starting farm-to-cafeteria programs led by Abbie Nelson of VT FEED. At 6 p.m., the Rutland Area Farm and Food Link (RAFFL) presents a dinner featuring Local Exposure Calendar Stew along with cheeses, breads and apple treats. Vern Grubinger of the University of Vermont Extension Service gives a keynote address at 7 p.m. entitled Forging the Farm-to-Cafeteria Link. Vermont Secretary of Agriculture, Roger Allbee, will also be attending the event. All events are free and open to the public. The farmers gathering is co-sponsored by RAFFL and the GMC Family Farm Forum Series.
Rugby Team Ends Season in Top Four
The GMC mens rugby team had their most successful season ever, competing in the semifinals held in Rhode Island and securing a top four place in the 15-team division. Field Captain Joe Machowski led a strong squad that included veterans Alex Ervin, Lucas Richardson, Richie Love and John Gaeddert. The team also had the support of some fresh talent. Rookies Chris Wetzel and Matt Dopp came out hard for this season, as did many other new players.
Singer-Songwriter to Perform
Meg Allison, a singer/songwriter with a gift for storytelling, performs at Green Mountain College on Wednesday, November 28. Her concert begins at 9 p.m. in the Gorge; free refreshments will be provided. The event is sponsored by the College Programming Board.
Holiday Concert on this Saturday
The Green Mountain College Choirs, Folk Ensemble and Festival Brass Ensemble present their annual holiday concert on Saturday, December 1, at 7:30 p.m. in Ackley Hall. Prof. James Cassarino directs the concert entitled A Folk Christmas. This years seasonal music will be based on the folk traditions of early America and the British Isles. Audience participation will be encouraged, and a festive reception will follow the concert.
Jazz Bands to Perform at GMC
The Green Mountain College and Castleton College jazz bands host a concert on Monday, December 3, at 7 p.m. in the Gorge. These ensembles will join forces to perform music for small combo and big band. The concert is free and open to the public.
"Major Barbara" Performances Set for Ackley Theatre
The Green Mountain College Department of Visual and Performing Arts presents Major Barbara, a play written by George Bernard Shaw, on December 6, 7 and 8 at 7:30 p.m. Tickets are free for GMC students, faculty and staff with IDs, and $5 for the public.
Major Barbara is set in the early 20th century and is considered one of Shaws most entertaining, provocative and controversial works. The play portrays the conflict between Barbara, a Salvation Army major, and her wealthy, charismatic father, Andrew Undershaft, who is a "bloodstained" weapons manufacturer. The clash proves to be a test of Barbara's faith as her aristocratic family, Salvation Army comrades and even her love interest all fall under Undershaft's spell.
The role of Andrew Undershaft is played by David Alastair Lewis, a professional actor. Alison Thatcher stars as Major Barbara; Cameron Steinmetz plays her fiancé, Adolphus Cusins. GMCs production is directed by Prof. Paula Mann.
Spaghetti Dinner to Help Families in Need
The Poultney United Methodist Church will be hosting a spaghetti dinner on Saturday, December 1, from 5 to 7 p.m. Credo Christe members will be helping to serve. It is a free-will donation. All proceeds benefit local families in need to make sure they can afford to heat their homes and feed and clothe their families this winter.


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Memorial follows overland route to sectional title
Tigers get three touchdown passes, but ground game is the key
VINCENNES, Ind. - Memorial High School's football team needed a change at the halftime on Friday night.
Vincennes Lincoln was running all over the visiting Tigers and led at the break, 21-20, after rushing for more than 200 yards in the first half alone.
So Memorial decided the running game would work for it too, and trampled the Alices in the second half to win 49-28.
The Tigers won their 10th sectional title overall and third under coach John Hurley by running for 209 yards after intermission, much of it coming on the same end sweep.
"We saw they were in a 4-1 (alignment), so we wanted to go outside," said senior guard Jake Durchholz.
"We put in the run and it was successful, so we just kept going with it."
It started on the first play of the second half when freshman halfback McKinley Warren started in motion and went 12 yards around left end behind Durchholz and senior running back Sam Curtis, the lead blocker.
"They had a lot of deep overage so we went with the run," said Curtis. "We saw that McKinley was running well and we just kept giving him the ball."
And it kept working.
Warren ran for 134 yards in the second half alone and finished with 152 yards and two touchdowns in 16 carries. He also added a two-point conversion on the sweep.
"They made some adjustments at the half," said Vincennes Lincoln coach Jon Heiden. "Then once they started running 'jet sweep', we just couldn't stop it.
"We had a great first half and we could've been in better shape if we didn't lose two fumbles in the first half. Then we had some penalties really hurt us on third down in the second half."
Vincennes Lincoln (5-7) had three pass interference penalties on third down in the second half and Memorial 7-5 made them pay.
Curtis got his second of three touchdowns on a 20-yard pass from Dane Hurley to open the second half and give the Tigers a brief lead, their first.
Lincoln came right back to tie the score on a 38-yard touchdown run by senior halfback Taylor George, but that would be it for the Alices.
Warren put up the next two scores on runs of 6 and 40 yards and Lincoln couldn't respond through the air.
"They adjusted and we adjusted at the half," said Hurley, who is now 3 for 4 in sectionals at Memorial, which he led to state finals appearances in 2008 and 2009. "Curtis was doing a great job on the lead block so we just kept going with it.
"The plan all along was to try and get a lead because we thought they might have trouble throwing the ball.
"Once we got the lead again, it worked out."
Curtis also had a big night on the ground with 153 yards in 18 carries. He had two TDs running and one receiving.
Junior quarterback Dane Hurley threw for 160 yards and three touchdowns in just his second game back after missing the entire regular season.
"They just a really good football team," said Heiden.
Memorial advances to host Corydon Central (10-2), which fended off Heritage Hills 13-12 on its home field on Friday night.
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South Beach,10mn walk2beach,Pool, All Sept.$910/wk
from £84 /night help Price for guests, Nights approx:
from £84 /night help Price for guests, Nights approx:
Estimated nightly price based on a weekly stay. Contact the advertiser to confirm the total cost.
Condo / 2 bedrooms / sleeps 8
Availability Your dates are available
Condo / 2 bedrooms / sleeps 8
|Key Info
Location of the apartment:
L'etoile is located on the quiet Euclid Avenue in the center of the historic district of Miami Beach. This charming, two-story building is made of four apartments a pool and parking spots available based on a first come first served basis.L'etoile is located 3 minutes away from the famous Lincoln Road Street and at an 8 minutes walking distance from the beach. L'etoile is surrounded by the most trendy restaurants and stores of Miami Beach.
About the apartment:
Unit A has two bedrooms, two baths plus an additional den with a full size bed. This tastefully decorated ground-floor apartment has 1,200 square feet of living space and will comfortably sleep up to eight people.
The living room is equipped with a sofa bed, nice furnishings and a plasma TV. Between the living room and the kitchen is the dining room with table and four chairs. The kitchen is fully equipped. The master bedroom has a king-size bed and opens up on the pool deck. The second bedroom is equipped with 2 twin size beds and a plasma TV. The den is equipped with a full bed.
Local phone calls are free. *Wifi available for $ 15 a day, fee will be waived if guests fill up a survey.*. Washer and dryer operating with coins are available in the building. The unit has a safe to store valuable effects. Daily Cleaning service is available for a small fee.
This property is a legal short rental with all city and state licenses and is managed professionally.
Our extensive property management team will assist you in case of needs. The building has 24 hour video surveillance for your protection.
The property has 3 parking spots and should be reserved upon booking. They are being allocated based on a first come first served basis. In the event that they are already taken we can provide guests with a resident parking permit that will let them park in the surrounding streets.
*Please make prior arrangements with your sales agent to obtain parking pass.*
|Sleeps up to 8, 2 bedrooms
|Car not necessary
|Nearest travel links
|Nearest airport: Miami International Airport 10 km
|Family friendly
|Great for children of all ages
|No pets allowed, No smoking at this property
Features and Facilities
|Internet access
|Shared outdoor pool (unheated)
|Air conditioning, TV, Telephone, Satellite TV, Wi-Fi available
|Iron, Hair dryer
|Clothes dryer, Microwave, Fridge, Washing machine
|2 bedrooms, 2 bathrooms of which 2 Family bathrooms
|1 Sofa beds, Double beds (2), Single beds (2)
|Linen provided, Towels provided
|Shared outdoor pool (unheated)
|Parking, Suitable for people with restricted mobility, Not suitable for wheelchair users
The Florida region
Florida is known for its warm and pleasant weather, which is why it is one of the top tourist destinations in North America and has been named "The Sunshine State". Florida has mild winters; this is the main reason why many residents of the cold Northeast and Midwest (as well as many international travelers) spend their winters or retirement here.
Miami is the youngest major city in the US. Its history is very unique and knowing this helps understand what is Miami about. The first inhabitants came to the region 10,000 years ago and erected settlements on the Bay and on the river. They named this settlement Mayami. The powerful Spanish claimed this land as theirs until 1821 when the United States decided to acquire it as another state we know now as Florida. At the same time Bahamian seamen as well as the Seminole Indian tribe, that had been pushed away from their land in other US states, also establish their home in Florida.
Miami Beach
Miami is not only sandy beaches and art deco. This cosmopolitan and modern city is full of attractions for all ages and needs. The attractions are so broad that you can get all you need, want or dream off as soon as your arrive at Miami International Airport.
Activities range from art to nightlife, sports to shopping and much more. You can find the best NBA teams and concerts at the American Airline arena, great dining and nightlife in South Beach and for the nature lovers we are minutes away form the Everglades National park, the largest subtropical wilderness in the United States.
Fairchild Tropical Botanic Garden is one of the world's best botanic gardens, with and extensive and rare collection. Your will find the most rare and intriguing species of palms, cycads, flowering trees and vines.
The new Carnival Centre for the Performing Arts is the central point of performing arts activity in South Florida and serves as a platform for the finest cultural programs.
The Duck Tour is a unique city tour, not only will you be able to see the city by wheels you will also cruise Biscayne Bay and see Miami from the bay.
Also you can take a typical walking tour by the Art Deco district where you can learn about the history and architecture of South Beach.
We hope Miami-info helps you find the attraction you are looking for and best of all how discover Miami!
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Miami Habitat (Property Manager Miami Habitat)
- 2 Years listed
Calendar last updated:03 Aug 2015
Based in United States
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What's happening this weekend
A look at some events on the calender the weekend of October 5-7
The Gruene Music and Wine Festival runs Thursday - Sunday in the Gruene Historic District. The event features Texas wine and food tastings, live music, food trucks, and a market. Click here for more information.
The annual South Texas School Expo happens this weekend. KSAT is hosting the event, along with the Children's Hospital of San Antonio. The expo offers educational opportunities from elementary school through college. It's all day Saturday at Northstar Mall. Click here for more information.
A section of Broadway will close on Sunday for the annual Siclovia. Bikers, runners, walkers, and skateboarders will take over the whole street, with fitness and family fun activities placed along the route. The route starts at Alamo Plaza and ends at Broadway and Parland. The event is from 10:00p.m. - 3:00p.m. Click here for the event website.
20,000 rubber ducks will take over the San Antonio River for the annual Lucky Duck Race. It costs $5 to enter a rubber duck in the race and proceeds benefit Haven For Hope and the Paseo Del Rio Association. That's on Sunday, starting at 3:00p.m. A concert follows the race.
And if you are looking for someone to watch the big game with, you can take advantage of Animal Care Services' "Football Friendzee" that runs through football season. Adoption fees will be reduced on Sundays from 12:00pm-4:00pm, at the shelter on Highway 151, off Old Highway 90.
Copyright 2012 by KSAT.com All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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(November 14, 2013) For the final Automax Marquee Matchup of the season we get a sequel. Lorena and Rockdale met in the bi-district round last season. A game Rockdale had a 14 point lead in.
"We just came out pretty flat to begin with. A few things weren't clicking," said Lorena quarterback Harris Coleman. "Coaches were able to get that squared away with at halftime. And we just came out with a lot more intensity, second half."
"We can't spot people two touchdowns and expect to dig out of it every friday night and we managed to do it last year but I think the main thing it wasn't a scheme of things it was intensity and effort on our part," said Lorena head coach Ray Biles. (In the) second half we changed the tempo a little bit of what we were doing and our kids played with a little more effort."
"Going into halftime we were beating Lorena, and then came out, seems like we weren't the same team in the second half," said Rockdale receiver and linebacker Austin Caffey. "So, going into this year we want to play all four quarters."
Both teams are a little different from what they were a year ago, but the returners have learned from the experience.
"We've had a tendency to relax a couple times, a little bit I think, at halftime," said Rockdale head coach Jeff Miller. "When we've had somewhat of a lead, we've had it happen a couple times to us this year. I think we've gotten better now at realizing that we've got to come out the second half with the same intensity that we came out the first half."
"I learned that no matter what the scoreboard looks like you've just got to get out there and keep playing," said Rockdale defensive back LaDontice Coats. "You don't stop until that last whistle blows."
"We've just got to be mentally focused. Physically we're there, there's nothing else," said Lorena defensive lineman Trevor Beard. "Although (as coach says) we put all the hay in the barn. We've got to be mentally prepared. We got to come out there ready to play a football game and not let it be our last one."


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The Pound declined against the Dollar yesterday, snapping a three day rally, and UK two-year gilts rose for the first time in three days, as investors sought the security of government debt on concerns that the crisis in the world's banking industry has further to run. The yield spread between two and 10-year securities widened to the most in a month, after the U.S commercial lender CIT Group Inc said that it probably won't receive a federal bailout, fueling speculation that it will file for bankruptcy.
The UK currency maintained a generally steady tone in London as it remained resilient, but was unable to make any strong headway, encountering strong resistance around 1.1650 versus the Euro and $1.6400 against the U.S Dollar. The International Monetary Fund warned that the UK government may need to take further action to stabilise the financial sector, which undermined confidence to some extent.
The IMF also reported that the Prime Minister Gordon Brown risks putting pressure on the Pound unless he produces a "credible plan" to curb Britain's budget deficit. In its annual assessment, the IMF said in a statement that "the success of the current policy packages hinges on the trust of the public in the solvency of the government."
The Fund predicts that UK debt may double to almost 100% of UK gross domestic product in the next five years, a level that Standard & Poor's said in May was incompatible with Britain's top AAA credit rating. Brown faces the an election within the next year and has resisted talking about spending cuts, saying that the economy needs a boost form government funds.
Concerns over the UK debt position has undermined confidence in financial markets, as stocks plunged over night and weakened the Pound, with an element of risk aversion saturating the the market. The Pound may face a sterner test over the coming weeks if there is a sharp deterioration in international sentiment and renewed pressure on the banking sector.
The Pound edged back below $1.64 as investors became cautious with no economic releases to guide direction. Henrik Gullberg, a currency strategist at Deutsche Bank AG, said that the Pound's 13% rally against the Dollar this year is "overdone" and it may decline towards its "near-term fair value" of $1.55 in the coming months. "The Pound is overvalued, this doesn't mean that I'm bearish the Pound, but it has moved out of line with everything else around it this year."
A gauge of technical analysis indicates that the Pound will struggle to break the resistance at $1.6450 and a decline below $1.60 will trigger further downward moves towards the $1.54 level. However, in the short-term the UK currency is being supported by the resilience in risk appetite and UK stock advanced for a fourth day yesterday, as earnings at JP Morgan Chase & Co boosted banking shares.
Lloyds Banking Group Plc led a measure of bank shares to a one-month high, after JP Morgan posted a 36% increase in second quarter profit. The benchmark FTSE 100 Index added 0.4% on the day and is heading for the best weekly performance since March. The FTSE 100 has rallied 5.7% since July 10th, after companies including Goldman Sachs Group Inc reported earnings that beat 'analysts' estimates.
The Euro dipped to lows near $1.4050 in European trading on Thursday, but the Dollar was unable to make any further headway and retained a generally weaker tone through the course of the day. There were no major Euro-zone economic developments to guide markets, while rising European equity markets have eased structural fears for the time being.
U.S economic data was mixed and did not have a decisive impact on the market, with the Dollar unable to benefit from a slightly more cautious tone. The number of Americans filing claims for jobless benefits fell last week to the lowest level since January. Initial claims dropped by 47,000 to 522,000, which was slightly lower than forecasts.
There was a high degree of distortion in the unemployment figures from the auto sector, as seasonal layoffs were lower than usual due in part to the number of job cuts already announced. Elsewhere, the Philadelphia Fed manufacturing index weakened to -7.5 for July, from -2.2 the previous month, as optimism over future business conditions deteriorated despite the orders component rising to a 10-month high.
Data Released 17th July
EU 10:00 Foreign Trade Balance (May)
U.S 13:30 Housing Starts (June)
– Permits
U.S 18:00 NAHB Housing Index (July)
written by Adam Solomon
Related posts:
- The Pound rallied against the Euro yesterday amid concerns that the U.S government's plan to buy $700 billion in bad debt with fail to bolster growth
- The Pound declines against the Dollar on concerns that banking losses will increase
- The Pound suffers against the majors as we bounce off the significant resistance level at 1.4675 against the Euro
- The Pound rose against both the Euro and the Dollar yesterday as BoE policy maker Bean warns of persistant inflationary concerns
- The Euro's looking strong ahead of the ECB interest rate announcement


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Gear Review
CWX Performance Tights - watch your calves size.
These are just a great example of technology for high end gear! The compression is great and you can feel great support for your muscles on short and long runs.
I do have to say I had some issues with my calves. I am 5'2" and 120 lbs, with slim/average thighs but big calves. I got the size small, the support to my knees and thighs is great, but I still feel my calves too tight after a while using them. I dont think the M will work for me, so I decided to keep them.
View More Details on CW-X 3/4 Length Stabilyx Tight - Women's


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Find a Lawyer Ask a Lawyer IndyBar Events IndyBar Review Small Firm Resources Job Bank FAQs Indybar News
- July 24, 2015Thank you for "Stocking the Schools"!
- July 22, 2015Go Green and Be Seen!
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Irish Beef Stew
Get this recipe on the next page >>
What makes this an Irish beef stew is the use of Guinness Stout. This is now my favourite way of making beef stew because the beer not just adds flavour, it also tenderises the beef, as I noticed that they get more tender within a shorter time of stewing (I used a cheap but decent cut of "chunk tender" cut for the stew), as compared to cooking without beer.
Similar Recipe: Oven-Baked Beef Stew
The tomatoes balance and complement the bitterness of the Stout, and also gives the stew an attractive, rustic reddish hue. I love beef stew, not just because it is so delicious – but it is also super easy to cook and feed hungry people for an entire day with often with leftovers for the next day. This is a perfect laze-at-home weekend recipe. My kitchen is filled with a fantastic beef stew aroma as this stew was bubbling away in the oven.
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My method of baking beef stew was taught by my friend Joyce. Instead of simmering over the stove top, the oven is used to bake the stew which is to me, the only method I used to cook such stews as I need not worry about watching the stove.


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Posted at: 03/17/2013 10:39 PM
By: Jenna Lohse
A Rochester woman who has been battling cancer for almost 5 years says her strength stems from her son and her desire to watch him cross each milestone in life.
Even though they're more than 300 miles apart, Carla Hicks and her son Jordan remain close at heart.
"I don't see her as just like a mom, I see her as a best friend," said Jordan Hicks.
Jordan is a senior at Loyola University Chicago and just finished his last year on the basketball court. While it's hard being away from his mom during her battle with cancer, Jordan says he's doing it for her.
"It helps to know that this is what she wants me to do and this is where I need to be," said Jordan.
Carla's battle with cancer has lasted nearly 5 years, spreading to her lungs, brain and spine.
"I tried to give it my all, but it just wasn't winnable," said Carla Hicks.
But she's holding on for Jordan.
"Even though he's 22, you know a mom worries about her child," said Carla.
Having close friends and family to watch over Jordan is what Carla clings to.
"I know he's going to be in good hands," said Carla.
The turnout for Carla's benefit Sunday night proves support is all around her.
"It's really cool tonight to be able to see all these people coming out for such a wonderful person," said Shaun Lang, a close family friend who coached Jordan in high school.
"Just knowing that we have so many people that love her and are thinking about her and caring for her, it just means the world to me," said Jordan.
Jordan's milestones are documented in pictures throughout Carla's house and she is hoping to add at least one more to the collection.
"My next goal is reaching graduation, if I have anything to say about it I'll be here," said Carla.
"That's what it is for me, it's him. You know, I'm excited to get to heaven," said Carla.
The money raised at the benefit tonight will go towards Carla's medical expenses.


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Latest Obsession: Kenzoki Perfumed Beneficial Waters Relaxing Lotus Shh Review
You have to be very careful when shoppin' Kenzo's line of fragrance. Alot of the line is hardcore and very in your face when it comes to fragrance. My sister absolutely adores the line and anything they release is put on her auto buy list. For myself, I'm a little more wary when I purchase from them since florals don't always agree with me.
I recently tried a few of the new Kenzoki Perfumed Beneficial Waters one of which is my absolute latest obsession!
Check it!


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These tomato beds are all raised 8-10". Untreated wood, which after avg 4-5 years, are needing replacement due to partial rot and termite food ! First year use of plastic "red mulch"......goal to significantly reduce weeds.....and is working like a champ in that regard ! Also, may be increasing strength/production of plants due to red color fake out.....i.e., perhaps making plants think ahead of time that the red reflecion is ripening tomatoes. Have attempted interviewing plants to ask if in fact we have conned them with plastic.....but to date they have stayed quiet, refusing to answer. Average plant gets partial sun, i.e., 5-6 hours....so we're happy with WHATEVER production we get....cannot compare to other gardeners who get 10-12 hours.
June 30,2008 6pm
Aug 9,2008 7am
Sunday, August 10, 2008
Veggie Beds
Labels: Heirloom Tomatoes
3 comments:
Wow, how big is your vegetable garden?ReplyDelete
OMG, that is 20 times what I planted (2 in a SWC). You are going to have hundreds of pounds of tomatoes. Yum! I see some serious preserving in your future...ReplyDelete
Love the red mulch. I went white not knowing red was best I just knew black (garbage bags) was bad.
Seeing your yard I would have never guessed you had that much growing space! Amazing!
We have a average backyard. My husband claimed 1/3 of it for his vegetables. And yes I would love to have more room for my beds but I love him more than gardening.ReplyDelete
The front of our home is modestly landscaped...but the backyard is our fun place!
Thanks for your visit and comment.
Glad to answer questions when I visit you...
Making life easier is a good thing.
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The Olympians
The young Olympians competing in the London 2012 Summer Olympics (July 27-Aug. 12) can teach us a few lessons.
Frankly, I'm amazed and challenged by the dedication and physical stamina of these youthful athletes. If you've been watching, you've heard testimonies of their journeys. Many persevered against all odds. Some tell of previous Olympians who have [...]