text:
Talking to Your Doctor About Scoliosis
- Main Page
- Risk Factors
- Symptoms
- Diagnosis
- Treatment
- Screening
- Reducing Your Risk
- Talking to Your Doctor
- Living With Scoliosis
- Resource Guide
- Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
- Write out your questions ahead of time, so you don't forget them.
- Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
- Don't be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.
- Does my child have any spinal curvature?
- If so, what degree is the curvature?
- Is there any way to tell whether the scoliosis has resulted in any other complications?
- Is the cause of my child's scoliosis unknown, or might it be due to some other medical condition?
- What is the chance that my child might develop scoliosis?
- Should my other children be screened for scoliosis?
- Is there any new information about ways to decrease the risk of developing scoliosis?
- Can my child be monitored instead of wearing a brace?
- How frequently will monitoring occur?
- Will a brace be necessary?
- If a brace is necessary, how long will it have to be worn each day?
- How many years will a brace be required?
- Might surgery be necessary?
- How will we know if surgery is necessary?
- Are there any activities my child cannot participate in?
- Is there any new information about any kinds of exercise or other lifestyle changes that might be beneficial?
- Could my child's scoliosis lead to any kind of disability?
- How likely is it that my child's degree of scoliosis will progress?
- Is there anything I can do to slow or halt the progression of my child's scoliosis?
Altaf F, Gibson A, et al. Adolescent idiopathic scoliosis. BMJ. 2013;346:f2508.
Idiopathic scoliosis in children and adolescents. American Academy of Orthopedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00353. Updated March 2010. Accessed November 20, 2013.
Questions and answers about scoliosis in children and adolescents. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Scoliosis/default.asp. Updated July 2013. Accessed November 20, 2013.
Scoliosis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated October 29, 2013. Accessed November 20, 2013.
Tips for talking to your doctor. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/healthcare-management/working-with-your-doctor/tips-for-talking-to-your-doctor.html. Updated November 2010. Accessed November 21, 2013.
Revision Information
- Reviewer: Michael Woods, MD
- Review Date: 12/2014 -
- Update Date: 12/20/2014 -
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
Copyright © EBSCO Publishing
All rights reserved.
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text: I started shooting when I was about 8 years old....under great supervision. I was taught safety, care, and respect. I teach my children the same thing and have taken them hunting with me for years. I also carry a handgun quite often and would not hesitate using it if some nut job pulled a gun out and terrorized people. The whole gun debate thing gets very messy because both sides make many good points. I consider myself middle of the road and reasonable on the entire topic. It is unfortunate that a middle of the road couldn't be met on this topic with our lawmakers and lobbyists.

subset: commoncrawl


text:
Jennifer Lopez Could Be Dealing With Two Messy Divorces
Star magazine has Jennifer Lopez on the cover with the headline, "The Big Lie: Divorce Deal Blows Up." According to the tabloid, there's going to be a court showdown that includes cheating and a sex […]
Jennifer Lopez Remains An 'Eternal Optimist About Love' Despite Split From Marc Anthony
After breaking the news of their seemingly out of nowhere end to their seven-year marriage, Jennifer Lopez has finally opened up and set the record straight about her split from husband Marc Anthony. [photogallerylink id=43222 […]
See The Guy That Stole Jennifer Lopez Away From Marc Anthony!
In case you missed it….. over the weekend, Jennifer Lopez and Marc Anthony ended their marriage after 7 years! Now rumors of a new post-marriage romance for Jennifer Lopez are already emerging. [photogallerylink id=47718 align=left] […]
Video: Did Maria Shriver Post This Video Hinting She Was Separating From Arnold?
Arnold Schwarzenegger and Maria Shriver have announced that they are separating after 25 years of marriage! Check out the video that Maria posted on her website on March 28th. Was this a cry for help?
Entertainment Report: Kelsey Grammer's Divorce Could Get Messy
Kelsey Grammer is begging the judge to let him get a quickie divorce in order for him to marry the woman he was having an affair with. This is the same woman who was pregnant […]
Entertainment Report: Randy & Evi Quaid Speak
In a new, exclusive interview on Good Morning America, the quacky Quaids told their story of how they think a group of bankers, lawyers and executives are out to ruin there lives and kill them.
POLL: Did The McCourt Divorce Ruin The Dodgers Season?
The Dodgers are stinking up the joint as the season comes to an end. They started off strong but as news of the nasty divorce developed their season began to crumble! So we ask….. […]
Foregone Conclusion: Tiger Woods And Wife Finalize Divorce
What many assumed last November when Elin Nordegren smashed in Tiger Woods' car windows finally came to pass officially yesterday, when the former Swedish model and world's top golfer finalized their divorce in Florida.


text:
Regulation Q - Prohibition Against The Payment of Interest on Demand Deposits
Regulation Q, originally promulgated 8/29/1933, will be removed and reserved as of 7/21/2011, nearly 78 years later.
[Click HERE for table of recent Federal Register documents affecting this regulation.]
Sec. 217.1 - Authority, purpose, and scope.
Sec. 217.2 - Definitions.
Sec. 217.3 - Interest on demand deposits.
Sec. 217.101 - Premiums on deposits.


text:
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text:
GOLDEN, Colo. — A bit of a gold rush happening right here in Colorado, following the devastating storm that hit the state two weeks ago.
"This storm of the century is having a very positive effect on panning for gold here in northern Colorado," said J.J. Long, president of Gold Prospectors of Colorado. "All the water has broken loose rock and dirt and banks of creeks and rivers from Bear Creek to the Poudre River."
All that shaking of river banks is good for gold miners who like to pan for the precious metal.
At the Gold N Detectors shop on Washington in Golden, you can get outfitted for some panning for under $50. A pan, screen, and shovel is really about all you need to get started.
But if you want to get expert tips, the Prospectors Club is the way to go. They take trips to streams, have lessons on how to spot gold in black sand, and help get you on your way to becoming, well just maybe, a very wealthy person.
"There's gold in them thar hill and in this here creek, and we're gonna find it," said Mack Plauk of Montgomery, Alabama. Plauk is spending spare time panning around the metro area.
"I know there's new gold here because of the flood, that might be the only good thing about this terrible flood," he said.
For more information, visit: www.goldprospectorsofcolorado.


text:
This hotel had very courteous staff and was very conveniently located right next to the mall! I...
See full review
This hotel had very courteous staff and was very conveniently located right next to the mall! I...
The food was great. I had the best tomato soup I think I've ever eaten. The room was spacious and...
See full review
The food was great. I had the best tomato soup I think I've ever eaten. The room was spacious and...
Fitting for its central location, the décor in the Hilton Garden Inn/Saket hotel is streamlined and contemporary. Look for the distinctive red modern art on the wall in the hotel lobby and the minimalist décor in the hotel guestrooms. Rooms feature scenic views of the nearby South Delhi shopping district and subdued colors to provide a relaxing atmosphere. In-room amenities include work desks, hair-dryers, hand-held showers, free wireless Internet service (some fees may apply), feather pillows, 32-inch LCD televisions, cable television channels, and separate seating areas. Hilton Garden Inn New Delhi/Saket guests who want to see some of the city's famous historic sites can arrange for tours through the concierge service in the hotel lobby.
Close proximity to South Delhi shopping and nightlife with concierge service
Outdoor pool, fitness center, and in-room exercise equipment
Free high-speed wireless Internet service (some fees may apply) in guestrooms
Lado Sarai Golf Club (1.2 mi/1.9 km)
Garden of Five Senses (1.6 mi/2.6 km)
Qutub Minar (2 mi/3.2 km)
Ansal Plaza (2.4 mi/3.9 km)
Iskcon Temple (2.9 mi/4.7 km)
Lotus Temple (3.1 mi/5 km)
Jawaharlal Nehru University (3.3 mi/5.3 km)
Sarojini Nagar Market (3.5 mi/5.6 km)
Check-in: 12:00 p.m.
Checkout: 12:00 p.m
This is not a comprehensive list of fees. Any amounts listed above may not include taxes and are subject to change.
Extra charges may apply for children. Incidental charges, such as room service, are not included in the quoted rate.
The amenities and/or facilities may not be located at the hotel, but within a reasonable distance, and additional charges may apply for use.
Customers who viewed Hilton Garden Inn New Delhi/Saket hotel also booked these hotels.
Overall score
would recommend to a friend.
Reviewer score
Would recommend
Great location
This hotel had very courteous staff and was very conveniently located right next to the mall! I loved it!
Business trip
The food was great. I had the best tomato soup I think I've ever eaten. The room was spacious and quiet and comfortable. Service as always in India is fantastic. Really good. The only reason I did not give it 5 stars is because its not a 5 star
hotel, but its great value. Also its located inside of a shopping mall which is nice. I was there during Diwali so everything was closed.
This hotel is located in South Delhi. The shopping is on the property if you need shopping. I did not do anything in the area so I don't know it.
Location, location, location - and MORE!
The Hilton Garden Inn is a very comfortable hotel, connected to a great shopping mall (actually, two malls -DLF Place and Citywalk). The combination of this location and the high standards of cleanliness and service at the hotel made this one of
my best hotel stays EVER.
The room itself was very nice, and the hight speed internet was fast and reliable. The bed was quite firm, but comfortable. (I guess there is a way to adjust this, but I was fine with it as it was.) Good selection of pillows, too, whether your taste is for a nice supportive foam style or one that you can "smoosh". The bathroom was beautiful, and the shower #no tub# had great water pressure and plenty of hot water.
At the time of my stay, dining in Delhi was quite affordable, and this was reflected in the Hilton's India Grill - a 24/7 restaurant with a great selection, or room service. I was actually surprised at the value, as hotel restaurants tend to be kind of pricey.
You can exit the hotel on the 2nd level #where the India Grill is# and go into DLF Place mall. In addition to a good selection of stores, you'll also find TGI Friday's, The Hard Rock Cafe, and several other restaurants that all were clean and offered good food. If you exit DLF place and take about a 50 foot walk outside, you can then enter the Citywalk mall, which is perhaps twice the size of DLF Place. More great stores and dining there. Homesick Americans looking for a bit of comfort will find Starbucks and.....KRISPY KREME! #Opening December 2013# There are several other local restaurants there, including B Bar, a very trendy spot with great decor and perhaps the best Thai red curry prawns I have ever had.
Also in the vicinity, Pizza Hut, KFC, Pollo Tropical and Curry Wok. No troule finding a place to eat, no matter what you're looking for!
On the third level of the hotel there is a fitness room and an outdoor pool.
The service at the Hilton Garden Inn was wonderful. All the staff were kind and attentive, always asking how my stay was and asking if they could do anything more for me.
All in all, staying here was one of the best travel choices I've made! My last trip to Delhi, I stayed at a more luxurious hotel - but far preferred my stay here at the Hilton. I highly recommend it!
Although it's a little pricey, but the location really makes it worthwhile to stay. There are two malls right next to the hotel that are modern and have all the trendy stores. Hotel car can be expensive, but there are cabs out there if you are
adventurous, so overall, I was glad to stay there.
hilton garden inn, delhi
Hotel is still not well known to taxi drivers, useful to have a map at the airport
shopping mall with dining right next to hotel
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text:
Workers in the health and social care sectors should complete the Safeguarding Adults – Social Care course. Please click here for our accredited Safeguarding Adults course.
This e-learning course looks at the issues relating to safeguarding adults including notable drivers that have helped shape the UK's approach towards safeguarding adults. It is aimed at anyone who comes into contact with vulnerable adults during the course of their work.
This course includes scenarios to help you to think about what you would do in a given situation.
On completion of this module learners will be able to:
Please note this module was reviewed and updated May 2010.
The content of this course has been independently certified as conforming to universally accepted Continuous Professional Development (CPD) guidelines.
On completion of this course you will be able to download a Virtual College certificate.
Approximately 2 hours. The length of time taken depends entirely on how quickly you can study and absorb the material. You can proceed as quickly or slowly as you like.
This module is aimed at anyone who comes into contact with vulnerable adults.
There are no specific entry requirements for this course.
I love the system of learning because It encourages one to study on his or her own, its self learning and is very easy to understand.VO 05/01/2014
I found the format very helpful and the way its set out gave me good easy reading and understanding.MF 09/01/2014
The easy access, pictures and simple examples used to explain the different modules is unique.RA 10/01/2014
It was easy to follow and understand and allowed me to work through it at my own pace. It was good at filling gaps in my knowledge and taught me in an engaging way.RV 14/02/2014
The content of the course was set at a good level for me. There were some aspects of safeguarding that I wasn't aware and I found the course informative.LC 27/02/2014
This was the one module on E-learning that I felt taught me something interesting and important, that I could take the knowledge of elswhere. It didn't state the obvious or give unnecessary facts and figures that were impossible to remember.MJ 11/03/2014
Easy to understand and gives the option of going back to check facts.LB 07/04/2014
Practice questions are very useful, additional guidance notes along the way are also good.KR 28/05/2014
The module was very good and informative on the aspects of safeguarding vulnerable adults the various legislation oultlined in the module and also I found the information about my role and responsibilities very good and this will help me to improve in safeguarding. AM 01/06/2014
I found the additional information in the section dealing with Mental Capacity and the ability to refer to the legal framework really helpful - not only because of work but also family situations.JW 05/06/2014
Very informative and illustrates the importance of safeguarding extremely well.JA 27/06/2014
The system is very easy to use, great deal of information and I liked where it gave examples of how an abuser would react and not just what you would see on someone who is being abused.JS 03/09/2014
The multiple questions at the end of each module was very helpful, it was easier for me to obtain the information I had just learned. Also, part of the information being read out to you was also helpful, as sometimes it is easier to hear as well as read information LP 04/12/2014
I found it very useful. It helped to refresh my knowledge of what i have already learnt on previous courses. CS 22/01/2015
Excellent informative and relevant. Thought provoking and instructive. It will definitely 'sharpen up' my practice which I had erroneously perceived as one which did not bring me into contact with vulnerable adults. I liked the way the modules flowed at a pace which made the learning accessible and the way it was possible to pause, reflect and digest new material. I did this module over a couple of days and that definitely enhanced the learning experience. It was essential to have the mcqs to focus how effective the learning had been and the graphics and case histories were very clearly presentedJS 02/03/2015
Good to have the speech aspect. Good use of pictures and examples to help you think about your own prejudices and how things can be perceived.AG 21/03/2015
It allowed you to go at your own pace to ensure you had time to take in the information.CH 16/04/2015
Reading the text may help individuals with dyslexia or could then make this training suitable for certain service users so that they have the similar knowledge to the staff supporting them.JN 22/04/2015
This is a general guide to how the system works; if you want a more detailed guide to how our purchasing and learning works please visit the Four Easy Steps page which should tell you all you need to know.
Alternatively, if you have a specific question or concern why not contact us directly ?
This is an online course, all the training will be taken through your browser window. There will be no face-to-face sessions with instructors nor will you receive any training material through the post. If you wish you may print out any page of the training material and may also print the notes you took during the training.
You can also revisit the training material at any time, even after you have completed the course.
The material for this course has been broken down into several smaller lessons, each lesson dealing with a specific area of the overall subject.
The lesson consists of a series of pages in which an instructor will talk you through the lesson material at a pace that suits you. Pages may also include supporting pictures, graphs, animation or extra sounds to help with the learning where appropriate. Some lessons will include challenges/quizzes to help you keep in touch and interested in the material.
Lessons can be taken in any order and each lesson may be PAUSED and RESUMED at any stage. When all lessons in the course have been completed our system will realise and automatically record that you have successfully completed the course
The course is self-paced so you decide how fast or slow the training goes. You can complete the course in stages revisiting the training at any time.
£30.00 + VAT (£36.00 inc. VAT)
Discounts are available for multiple users (10 or more) for more information please contact firstname.lastname@example.com or telephone us on 01943 885089.


text:
Perhaps a little bit NSFW, but hilarious none the less.
Perhaps a little bit NSFW, but hilarious none the less.
That was fantastic...and I think I'll leave it at that.
If you jiggle your monitor, does that make a jiggly gif?
If you always put limits on everything you do, physical or anything else, it will spread into your work and into your life. There are no limits. There are only plateaus, and you must not stay there, you must go beyond them. ~ Bruce Lee
cant wait to consume 900 pages of warren g harding's sexts in a little over 48 hours.
thinking about breaking it down for everyone in a blog post.
of course, this also fits nicely into my theory that warren was offed by his wife and their quack physician, dr sawyer-ludwig (whom of course marion named a park after)
Californian by birth, Marionaire by the Grace of President Warren G. Harding.
I would greatly enjoy a blog post about this subject.....
And when we win the game, we'll buy a keg of boooooooooze!! And we'll drink to old Ohio 'till we wobble in our shoes.
YES - this definitely needs a, er, pardon the pun, blow-by-blow review from the site's resident Hardingophile. And yes, this completely supports your assertion that Mrs. G. Harding had him whacked. Er, again, pardon the pun.
I love John Oliver and I loved this part of the show the other night...
Warren G. Harding was one smooth talker.
And when we win the game, we'll buy a keg of boooooooooze!! And we'll drink to old Ohio 'till we wobble in our shoes.
The 29th president of the United States and proud son of Ohio has just given me the strangest erection.
So, the G man found time to write, eh? Slow times at the White House, I guess. Wifey G not into the Jerry.
"Don't fear criticism. The stands are full of critics. They play no ball. They fight no fights. They make no mistakes because they attempt nothing. Down on the field are the doers, they make mistakes because they attempt many things."


text:
The present disclosure includes a pulse oximeter attachment having an accessible memory. In one embodiment, the pulse oximeter attachment stores calibration data, such as, for example, calibration data associated with a type of a sensor, a calibration curve, or the like. The calibration data is used to calculate physiological parameters of pulsing blood.
1. A pulse oximeter attachment comprising:
a first path adapted to communicate an LED drive current from a first stand alone instrument;
a second path adapted to communicate a waveform, from a second stand alone instrument, responsive to said LED drive current to said first stand alone instrument; and
a memory device storing information; at least a portion of said information stored in said memory device representative of calibration information; said portion of said information readable from said memory device so as to enable said first stand alone instrument to calculate and display an accurate oxygen saturation value based on information obtained using the second stand alone instrument.
2. The pulse oximeter attachment according to
3. The pulse oximeter system according to
4. The pulse oximeter attachment of
5. A method of acquiring calibration information for a first stand alone instrument, the method comprising:
providing an LED drive path;
providing a detector drive path;
providing a memory interface;
receiving a drive current on said LED drive path from a first stand alone instrument;
determining an indication of oxygen saturation on said first stand alone instrument;
uploading at least a portion of stored information representative of calibration information;
utilizing at least said portion of said information to relate a waveform to oxygen saturation;
transmitting, from a second stand alone instrument, said waveform on said detector drive path in response to said drive current and said indication of oxygen saturation; and
displaying visual information indicative of said oxygen saturation on said first stand alone instrument.
6. The method according to
7. A pulse oximeter system comprising:
a first path communicating a sensor drive signal from a host instrument including a processor configured to determine a physiological measurement;
a second path [adapted to communicate] communicating information responsive to said sensor drive signal to said host instrument from a monitoring instrument capable of calculating information indicative of an oxygen saturation value, said monitoring instrument being different from said host instrument;
a memory device storing data; wherein said data stored in said memory device is representative of a relationship between data indicative of said information and experimental data and adapted to be read from said memory device by said monitoring instrument for use when calculating said information indicative of an oxygen saturation value.
8. The pulse oximeter attachment according to
9. The pulse oximeter attachment according to
10. A method of uploading calibration data associated with a pulse oximetry system, the method comprising:
communicating an LED drive current configured to drive a pulse oximetry sensor from a first instrument including a processor configured to determine a physiological measurement;
receiving a waveform responsive to said LED drive current at the first instrument;
determining a first oxygen saturation value from said waveform at a second instrument; and
uploading at least a portion of information representative of calibration information associated with a pulse oximetry system from a cable connecting the first and second instruments;
using said portion of said information in order to cause said first instrument to display a substantially similar oxygen saturation value to said first oxygen saturation value.
11. The method according to
12. A pulse oximeter comprising:
an output configured to communicate an LED drive signal to a sensor;
an input configured to receive a detector signal from the sensor in response to said LED drive signal;
an interface configured to access at least a portion of information representative of calibration information from an attached memory;
a first processor responsive to said detector signal and said at least said portion of said information to determine an oxygen saturation value; and
a host instrument generating said LED drive signal, including a second processor configured to determine an oxygen saturation measurement based upon information from said first processor, the host instrument including an oxygen saturation display, said oxygen saturation display responsive to said second processor.
This application is a continuation of U.S. patent application Ser. No. 10/153,263, filed May 21, 2002, entitled "System And Method For Altering A Display Mode Based On A Gravity-Responsive Sensor," which is a continuation of U.S. patent application Ser. No. 09/516,110, filed Mar. 1, 2000 now U.S. Pat. No. 6,584,336, entitled "Universal/Upgrading Pulse Oximeter," now allowed, which is a continuation of U.S. patent application Ser. No. 09/491,175, filed Jan. 25, 2000, entitled "Universal/Upgrading Pulse Oximeter," now abandoned, and application Ser. No. 09/491,175 claims the benefit of U.S. Provisional Application No. 60/161,565, filed Oct. 26, 1999, entitled "Improved Universal/Upgrading Pulse Oximeter, and Application Ser. No. 60/117,097, filed Jan. 25, 1999, entitled "Universal/Upgrading Pulse Oximeter." Each of the foregoing applications is incorporated by reference herein.
Oximetry is the measurement of the oxygen level status of blood. Early detection of low blood oxygen level is critical in the medical field, for example in critical care and surgical applications, because an insufficient supply of oxygen can result in brain damage and death in a matter of minutes. Pulse oximetry is a widely accepted noninvasive procedure for measuring the oxygen saturation level of arterial blood, an indicator of oxygen supply. A pulse oximetry system consists of a sensor applied to a patient, a pulse oximeter, and a patient cable connecting the sensor and the pulse oximeter.
The pulse oximeter may be a standalone device or may be incorporated as a module or built-in portion of a multiparameter patient monitoring system, which also provides measurements such as blood pressure, respiratory rate and EKG. A pulse oximeter typically provides a numerical readout of the patient's oxygen saturation, a numerical readout of pulse rate, and an audible indicator or "beep" that occurs in response to each pulse. In addition, the pulse oximeter may display the patient's plethysmograph, which provides a visual display of the patient's pulse contour and pulse rate.
The pulse oximeter 100 determines oxygen saturation (SpO2) by computing the differential absorption by arterial blood of the two wavelengths emitted by the sensor 110. The pulse oximeter 100 contains a sensor interface 120, an SpO2 processor 130, an instrument manager 140, a display 150, an audible indicator (tone generator) 160 and a keypad 170. The sensor interface 120 provides LED drive current 122 that alternately activates the sensor red and IR LED emitters 112. The sensor interface 120 also has input circuitry for amplification and filtering of the signal 124 generated by the photodiode detector 114, which corresponds to the red and infrared light energy attenuated from transmission through the patient tissue site. The SpO2 processor 130 calculates a ratio of detected red and infrared intensities, and an arterial oxygen saturation value is empirically determined based on that ratio. The instrument manager 140 provides hardware and software interfaces for managing the display 150, audible indicator 160 and keypad 170. The display 150 shows the computed oxygen status, as described above. The audible indicator 160 provides the pulse beep as well as alarms indicating desaturation events. The keypad 170 provides a user interface for such things as alarm thresholds, alarm enablement, and display options.
Computation of SpO2 relies on the differential light absorption of oxygenated hemoglobin, HbO2, and deoxygenated hemoglobin, Hb, to determine their respective concentrations in the arterial blood. Specifically, pulse oximetry measurements are made at red and IR wavelengths chosen such that deoxygenated hemoglobin absorbs more red light than oxygenated hemoglobin, and, conversely, oxygenated hemoglobin absorbs more infrared light than deoxygenated hemoglobin, for example 660 nm (red) and 905 nm (IR).
To distinguish between tissue absorption at the two wavelengths, the red and IR emitters 112 are provided drive current 122 so that only one is emitting light at a given time. For example, the emitters 112 may be cycled on and off alternately, in sequence, with each only active for a quarter cycle and with a quarter cycle separating the active times. This allows for separation of red and infrared signals and removal of ambient light levels by downstream signal processing. Because only a single detector 114 is used, it responds to both the red and infrared emitted light and generates a time-division-multiplexed ("modulated") output signal 124. This modulated signal 124 is coupled to the input of the sensor interface 120.
In addition to the differential absorption of hemoglobin derivatives, pulse oximetry relies on the pulsatile nature of arterial blood to differentiate hemoglobin absorption from absorption of other constituents in the surrounding tissues. Light absorption between systole and diastole varies due to the blood volume change from the inflow and outflow of arterial blood at a peripheral tissue site. This tissue site might also comprise skin, muscle, bone, venous blood, fat, pigment, etc., each of which absorbs light. It is assumed that the background absorption due to these surrounding tissues is invariant and can be ignored. Thus, blood oxygen saturation measurements are based upon a ratio of the time-varying or AC portion of the detected red and infrared signals with respect to the time-invariant or DC portion:
The desired SpO2 measurement is then computed from this ratio. The relationship between RD/IR and SpO2 is most accurately determined by statistical regression of experimental measurements obtained from human volunteers and calibrated measurements of oxygen saturation. In a pulse oximeter device, this empirical relationship can be stored as a "calibration curve" in a read-only memory (ROM) look-up table so that SpO2 can be directly read-out of the memory in response to input RD/IR measurements.
Pulse oximetry is the standard-of-care in various hospital and emergency treatment environments. Demand has lead to pulse oximeters and sensors produced by a variety of manufacturers. Unfortunately, there is no standard for either performance by, or compatibility between, pulse oximeters or sensors. As a result, sensors made by one manufacturer are unlikely to work with pulse oximeters made by another manufacturer. Further, while conventional pulse oximeters and sensors are incapable of taking measurements on patients with poor peripheral circulation and are partially or fully disabled by motion artifact, advanced pulse oximeters and sensors manufactured by the assignee of the present invention are functional under these conditions. This presents a dilemma to hospitals and other caregivers wishing to upgrade their patient oxygenation monitoring capabilities. They are faced with either replacing all of their conventional pulse oximeters, including multiparameter patient monitoring systems, or working with potentially incompatible sensors and inferior pulse oximeters manufactured by various vendors for the pulse oximetry equipment in use oat the installation.
Hospitals and other caregivers are also plagued by the difficulty of monitoring patients as they are transported from one setting to another. For example, a patient transported by ambulance to a hospital emergency room will likely be unmonitored during the transition from ambulance to the ER and require the removal and replacement of incompatible sensors in the ER. A similar problem is faced within a hospital as a patient is moved between surgery, ICU and recovery settings. Incompatibility and transport problems are exacerbated by the prevalence of expensive and non-portable multi-parameter patient monitoring systems having pulse oximetry modules as one measurement parameter.
The Universal/Upgrading Pulse Oximeter (UPO) according to the present invention is focused on solving these performance, incompatibility and transport problems. The UPO provides a transportable pulse oximeter that can stay with and continuously monitor the patient as they are transported from setting to setting. Further, the UPO provides a synthesized output that drives the sensor input of other pulse oximeters. This allows the UPO to function as a universal interface that matches incompatible sensors with other pulse oximeter instruments. Further, the UPO acts as an upgrade to existing pulse oximeters that are adversely affected by low tissue perfusion and motion artifact. Likewise, the UPO can drive a SpO2 sensor input of multiparameter patient monitoring systems, allowing the UPO to integrate into the associated multiparameter displays, patient record keeping systems and alarm management functions.
One aspect of the present invention is a measurement apparatus comprising a sensor, a first pulse oximeter and a waveform generator. The sensor has at least one emitter and an associated detector configured to attach to a tissue site. The detector provides an intensity signal responsive to the oxygen content of arterial blood at the tissue site. The first pulse oximeter is in communication with the detector and computes an oxygen saturation measurement based on the intensity signal. The waveform generator is in communication with the first pulse oximeter and provides a waveform based on the oxygen saturation measurement. A second pulse oximeter is in communication with the waveform generator and displays an oxygen saturation value based on the waveform. The waveform is synthesized so that the oxygen saturation value is generally equivalent to the oxygen saturation measurement.
In another aspect of the present invention, a measurement apparatus comprises a first sensor port connectable to a sensor, an upgrade port, a signal processor and a waveform generator. The upgrade port is connectable to a second sensor port of a physiological monitoring apparatus. The signal processor is configured to compute a physiological measurement based on a signal input to the first sensor port. The waveform generator produces a waveform based on the physiological measurement, and the waveform is available at the upgrade port. The waveform is adjustable so that the physiological monitoring apparatus displays a value generally equivalent to the physiological measurement when the upgrade port is attached to the second sensor port.
Yet another aspect of the present invention is a measurement method comprising the steps of sensing an intensity signal responsive to the oxygen content of arterial blood at a tissue site and computing an oxygen saturation measurement based on the intensity signal. Other steps are generating a waveform based on the oxygen saturation measurement and providing the waveform to the sensor inputs of a pulse oximeter so that the pulse oximeter displays an oxygen saturation value generally equivalent to the oxygen saturation measurement.
An additional aspect of the present invention is a measurement method comprising the steps of sensing a physiological signal, computing a physiological measurement based upon the signal, and synthesizing a waveform as a function of the physiological measurement. A further step is outputting the waveform to a sensor input of a physiological monitoring apparatus. The synthesizing step is performed so that the measurement apparatus displays a value corresponding to the physiological measurement.
A further aspect of the present invention is a measurement apparatus comprising a first pulse oximeter for making an oxygen saturation measurement and a pulse rate measurement based upon an intensity signal derived from a tissue site. Also included is a waveform generation means for creating a signal based upon the oxygen saturation measurement and the pulse rate measurement. In addition, there is a communication means for transmitting the signal to a second pulse oximeter.
Another aspect of the present invention is a measurement apparatus comprising a portable portion having a sensor port, a processor, a display, and a docking connector. The sensor port is configured to receive an intensity signal responsive to the oxygen content of arterial blood at a tissue site. The processor is programmed to compute an oxygen saturation value based upon the intensity signal and to output the value to the display. A docking station has a portable connector and is configured to accommodate the portable so that the docking connector mates with the portable connector. This provides electrical connectivity between the docking station and the portable. The portable has an undocked position separate from the docking station in which the portable functions as a handheld pulse oximeter. The portable also has a docked position at least partially retained within the docking station in which the combination of the portable and the docking station has at least one additional function compared with the portable in the undocked position.
A further aspect of the present invention is a measurement apparatus configured to function in both a first spatial orientation and a second spatial orientation. The apparatus comprises a sensor port configured to receive a signal responsive to a physiological state. The apparatus also has a tilt sensor providing an output responsive to gravity. In addition, there is a processor in communication with the sensor port and the tilt sensor output. The processor is programmed to compute a physiological measurement value based upon the signal and to determine whether the measurement apparatus is in the first orientation or the second orientation based upon the tilt sensor output. A display has a first mode and a second mode and is driven by the processor. The display shows the measurement value in the first mode when the apparatus is in the first orientation and shows the measurement value in the second mode when the apparatus is in the second orientation.
Another aspect of the present invention is a measurement method comprising the steps of sensing a signal responsive to a physiological state and computing physiological measurement based on the signal. Additional steps are determining the spatial orientation of a tilt sensor and displaying the physiological measurement in a mode that is based upon the determining step.
In addition to providing pulse oximetry measurements, the UPO 210 also separately generates a signal, which is received by a pulse oximeter 268 external to the UPO 210. This signal is synthesized from the saturation calculated by the UPO 210 such that the external pulse oximeter 268 calculates the equivalent saturation and pulse rate as computed by the UPO 210. The external pulse oximeter 268 receiving the UPO signal may be a patient monitoring system (MPMS) 260 incorporating a pulse oximeter module 268, a standalone pulse oximeter instrument, or any other host instrument capable of measuring SpO2. The MPMS 260 depicted in
The internal pulse oximeter 310 may be a conventional pulse oximeter or, for upgrading an external pulse oximeter 260, it may be an advanced pulse oximeter capable of low perfusion and motion artifact performance not found in conventional pulse oximeters. An advanced pulse oximeter for use as an internal pulse oximeter 310 is described in U.S. Pat. No. 5,632,272 assigned to the assignee of the present invention and incorporated herein by reference. An advanced pulse oximetry sensor for use as the sensor 110 attached to the internal pulse oximeter 310 is described in U.S. Pat. No. 5,638,818 assigned to the assignee of the present invention and incorporated herein by reference. Further, a line of advanced Masimo SET� pulse oximeter OEM boards and sensors are available from the assignee of the present invention.
The waveform generator 320 synthesizes a waveform, such as a triangular waveform having a sawtooth or symmetric triangle shape, that is output as a modulated signal 324 in response to an input drive signal 322. The drive input 322 and modulation output 324 of the waveform generator 320 are connected to the sensor port 262 of the external pulse oximeter 260. The synthesized waveform is generated in a manner such that the external pulse oximeter 260 computes and displays a saturation and a pulse rate value that is equivalent to that measured by the internal pulse oximeter 310 and sensor 110. In the present embodiment, the waveforms for pulse oximetry are chosen to indicate to the external pulse oximeter 260 a perfusion level of 5%. The external pulse oximeter 260, therefore, always receives a strong signal. In an alternative embodiment, the perfusion level of the waveforms synthesized for the external pulse oximeter can be set to indicate a perfusion level at or close to the perfusion level of the patient being monitored by the internal pulse oximeter 310. As an alternative to the generated waveform, a digital data output 326, is connected to the data port 264 of the external pulse oximeter 260. In this manner, saturation and pulse rate measurements and also samples of the unmodulated, synthesized waveform can be communicated directly to the external pulse oximeter 260 for display, bypassing the external pulse oximeter's signal processing functions. The measured plethysmograph waveform samples output from the internal pulse oximeter 310 also may be communicated through the digital data output 326 to the external pulse oximeter 260.
It will be understood from the above discussion that the synthesized waveform is not physiological data from the patient being monitored by the internal pulse oximeter 310, but is a waveform synthesized from predetermined stored waveform data to cause the external pulse oximeter 260 to calculate oxygen saturation and pulse rate equivalent to or generally equivalent (within clinical significance) to that calculated by the internal pulse oximeter 310. The actual physiological waveform from the patient received by the detector is not provided to the external pulse oximeter 260 in the present embodiment. Indeed, the waveform provided to the external pulse oximeter will usually not resemble the plethysmographic waveform of physiological data from the patient being monitored by the internal pulse oximeter 260.
The cable 230 (
The waveform shaper 420 creates a continuous pulsed waveform from the waveform segments provided by the waveform LUT 410. The waveform shaper 420 has a shape parameter input 422 and an event indicator input 424 that are buffered 470 from the parameters 318 output from the internal pulse oximeter 310 (
The event indicator input 424 specifies the occurrence of pulses in the plethysmograph waveform processed by the internal pulse oximeter 310 (
The waveform splitter 430 creates a first waveform 432 corresponding to a first waveform (such a red wavelength) expected by the external pulse oximeter 260 (
As described above, one particularly advantageous aspect of the UPO is that the operating wavelengths of the sensor 110 (
A modulator 450 responds to an LED drive input 322 to generate a modulated waveform output 324 derived from the first waveform 432 and second waveform 434. Also, a data communication interface 460 transmits as a digital data output 326 the data obtained from the sat 442, pulse rate 462 and synthesized waveform 428 inputs.
The handheld embodiment described in connection with
The portable 610 can be installed into the docking station 660 to expand its functionality. When installed, the portable 610 can receive power 662 from the docking station 660 if the docking station 660 is connected to external power 668. Alternately, with no external power 668 to the docking station 660, the portable 610 can supply power 662 to the docking station 660. The portable 610 communicates to the docking station with a bi-directional serial data line 664. In particular, the portable 610 provides the docking station with SpO2, pulse rate and related parameters computed from the sensor detector signal 614. When the portable 610 is installed, the docking station 660 may drive a host instrument 260 (
In one embodiment, the docking station 660 does not perform any action when the portable 610 is not docked. The user interface for the docking station 660, i.e. keypad and display, is on the portable 610. An indicator LED on the docking station 660 is lit when the portable is docked. The docking station 660 generates a detector signal output 674 to the host instrument 260 (
An interface cable 690 connects the docking station 660 to the host instrument patient cable 230 (
The management processor 720 controls the various functions of the portable 610, including asynchronous serial data communications 724 with the pulse oximeter processor 710 and synchronous serial communications 762 with the docking station 660 (
The processor 720 also controls the user interface 800 (
Advantageously, the caregiver can set (i.e. configure or program) the behavior of the portable display 740 and alarms when the docked portable 610 senses that an interface cable 690 has connected the docking station 660 to an external pulse oximeter, such as a multiparameter patient monitoring system. In one user setting, for example, the portable display 740 stops showing the SpO2 811 (
Another task of the processor 720 includes maintenance of a watchdog function. The watchdog 780 monitors processor status on the watchdog data input 782 and asserts the :P reset output 784 if a fault is detected. This resets the management processor 720, and the fault is indicated with audible and visual alarms.
The portable 610 gets its power from batteries in the power supply 730 or from power 766 supplied from the docking station 660 (
A non-volatile memory 706 is connected to the management processor 720 via a high-speed bus 722. In the present embodiment, the memory 706 is an erasable and field re-programmable device used to store boot data, manufacturing serial numbers, diagnostic failure history, adult SpO2 and pulse rate alarm limits, neonate SpO2 and pulse rate alarm limits, SpO2 and pulse rate trend data, and program data. Other types of non-volatile memory are well known. The SpO2 and pulse rate alarm limits, as well as SpO2 related algorithm parameters, may be automatically selected based on the type of sensor 110 (
The LCD display 740 employs LEDs for a backlight to increase its contrast ratio and viewing distance when in a dark environment. The intensity of the backlight is determined by the power source for the portable 610. When the portable 610 is powered by either a battery pack within its power supply 730 or a battery pack in the docking station power supply 990 (
Examples of how the display area can be used to display SpO2 811, pulse rate 813, a plethysmographic waveform 815, a visual pulse indicator 817 and soft key icons 820 in portrait and landscape mode are shown in
The keypad 750 includes soft keys 870 and fixed keys 880. The fixed keys 880 each have a fixed function. The soft keys 870 each have a function that is programmable and indicated by one of the soft key icons 820 located next to the soft keys 870. That is, a particular one of the soft key icons 820 is in proximity to a particular one of the soft keys 870 and has a text or a shape that suggests the function of that particular one of the soft keys 870. In one embodiment, the button portion of each key of the keypad 750 is constructed of florescent material so that the keys 870, 880 are readily visible in the dark.
In one embodiment, the keypad 750 has one row of four soft keys 870 and one row of three fixed keys 880. Other configurations are, of course, available, and specific arrangement is not significant. The functions of the three fixed keys 880 are power, alarm silence and light/contrast. The power function is an on/off toggle button. The alarm silence function and the light/contrast function have dual purposes depending on the duration of the key press. A momentary press of the key corresponding to the alarm silence function will disable the audible alarm for a fixed period of time. To disable the audible alarm indefinitely, the key corresponding to the alarm silence function is held down for a specified length of time. If the key corresponding to the alarm silence function is pressed while the audible alarm has been silenced, the audible alarm is reactivated. If the key corresponding to the light/contrast function is pressed momentarily, it is an on/off toggle button for the backlight. If the key corresponding to the light/contrast function is held down, the display contrast cycles through its possible values.
In this embodiment, the default functions of the four soft keys 870 are pulse beep up volume, pulse beep down volume, menu select, and display mode. These functions are indicated on the display by the up arrow, down arrow, "menu" and curved arrow soft key icons 820, respectively. The up volume and down volume functions increase or decrease the audible sound or "beep" associated with each detected pulse. The display mode function rotates the display 740 through all four orthogonal orientations, including portrait mode (
The docking station processor 910 orchestrates the activity on the docking station 660. The processor 910 provides the waveform generator 930 with parameters 932 as discussed above for
The docking station processor 910 accesses non-volatile memory 920 over a high-speed bus 922. The non-volatile memory 920 is re-programmable and contains program data for the processor 910 including instrument communication protocols, synchronization information, a boot image, manufacturing history and diagnostic failure history.
The waveform generator 930 generates a synthesized waveform that a conventional pulse oximeter can process to calculate SpO2 and pulse rate values or exception messages, as described above with respect to
The status indicators 982 are a set of LEDs on the front of the docking station 660 used to indicate various conditions including external power (AC), portable docked, portable battery charging, docking station battery charging and alarm. The serial data port 682 is used to interface with either a computer, a serial port of conventional pulse oximeters or serial printers via a standard RS-232 DB-9 connector 962. This port 682 can output trend memory, SpO2 and pulse rate and support the system protocols of various manufacturers. The analog output 688 is used to interface with analog input chart recorders via a connector 964 and can output "real-time" or trend SpO2 and pulse rate data. The nurse call output 684 from a connector 964 is activated when alarm limits are exceeded for a predetermined number of consecutive seconds. In another embodiment, data, including alarms, could be routed to any number of communications ports, and even over the Internet, to permit remote use of the upgrading pulse oximeter.
The PROM interface 940 accesses synchronization data 692 from the PROM 1010 (
As shown in
A menu option on the portable 610 (
Shown in
Another embodiment of the docking station 660 incorporates an input port that connects to a blood pressure sensor and an output port that connects to the blood pressure sensor port of a multiparameter patient monitoring system (MPMS). The docking station 660 incorporates a signal processor that computes a blood pressure measurement based upon an input from the blood pressure sensor. The docking station 660 also incorporates a waveform generator connected to the output port that produces a synthesized waveform based upon the computed measurement. The waveform generator output is adjustable so that the blood pressure value displayed on the MPMS is equivalent to the computed blood pressure measurement. Further, when the portable 610 is docked in the docking station 660 and the blood pressure sensor is connected to the input port, the portable displays a blood pressure value according to the computed blood pressure measurement. Thus, in this embodiment, the docking station 660 provides universal/upgrading capability for both blood pressure and SpO2.
Likewise, the docking station 660 can function as an universal/upgrading instrument for other vital sign measurements, such as respiratory rate, EKG or EEG. For this embodiment, the docking station 660 incorporates related sensor connectors and associated sensor signal processors and upgrade connectors to an MPMS or standalone instrument. In this manner, a variety of vital sign measurements can be incorporated into the docking station 660, either individually or in combination, with or without SpO2 as a measurement parameter, and with or without the portable 610. In yet another embodiment, the docking station 660 can be configured as a simple SpO2 upgrade box, incorporating a SpO2 processor and patient cable connector for a SpO2 sensor that functions with or without the portable 610.
Unlike a conventional standalone pulse oximeter, the standalone configuration shown in
The Ethernet controller module 1410 can be embedded with web server firmware, such as the Hewlett-Packard (HP) BFOOT-10501. The module 1410 has both a 10 Base-T Ethernet interface for connection to the Ethernet 1460 and a serial interface, such as RS-232 or USB, for connection to the docking station 660. The module firmware incorporates HTTP and TCP/IP protocols for standard communications over the World Wide Web. The firmware also incorporates a micro web server that allows custom web pages to be served to remote clients over the Internet, for example. Custom C++ programming allows expanded capabilities such as data reduction, event detection and dynamic web page configuration.
As shown in
The UPO may have other configurations besides the handheld unit described in connection with
Further, although a universal/upgrading apparatus and method have been mainly described in terms of a pulse oximetry measurement embodiment, the present invention is equally applicable to other physiological measurement parameters such as blood pressure, respiration rate, EEG and ECG, to name a few. In addition, a universal/upgrading instrument having a single physiological measurement parameter or a multiple measurement parameter capability and configured as a handheld, standalone, portable, docking station, module, plug-in, circuit card, to name a few, is also within the scope of the present invention.
The UPO has been disclosed in detail in connection with various embodiments of the present invention. These embodiments are disclosed by way of examples only and are not to limit the scope of the present invention, which is defined by the claims that follow. One of ordinary skill in the art will appreciate many variations and modifications within the scope of this invention.
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ISC '10 Reflections: NVIDIA Makes Its Mark on the Top 500
Last week NVIDIA was in Hamburg, Germany for the International Supercomputing Conference to talk to Europe's high performance computing (HPC) community about GPU Computing. If you've never been to Hamburg, goâ?¦..it's a beautiful city with a great scene.
The biggest news of the show was the announcement of the June 2010 list of the global Top500 supercomputers. And the major news from the June 2010 list is a new supercomputer, equipped with Tesla 20-series GPUs, entered the chart at number 2! The system is called 'Nebulae' and is built by Dawning China and deployed in the Shenzhen Supercomputing Center.
If you were wearing an NVIDIA shirt at this show, everyone wanted to stop and talk to you about this system. It scored a whopping 1.27 petaflops in the LINPACK benchmark to get the number 2 slot, but what is even more impressive is that they did this using just 2.55 megawatts! Compared to the number 1 supercomputer, which uses 7 megawatts to deliver 1.75 petaflops, Dawning achieved DOUBLE the performance per watt by using Tesla 20-Series GPUs, making it one of the most power efficient systems on the list.
The Nebulae system has 13,920 processors ' 4640 GPUs plus 9280 CPUs. However, despite there being twice as many CPUs in the system, Tesla GPUs are doing the majority of the processing -- more than 80%! In a press release at ISC, Intel claimed they were playing 'the vital role' in the new Nebulae system and forgot to even mention that GPUs were used at all. Oops. In reality, this system illustrates a trend occurring in supercomputing where Tesla GPUs based on our Fermi architecture are being used increasingly to power the world's top scientific computing systems.
Nebulae isn't the only supercomputer on the list; the Institute of Process Engineering (IPE) at the Chinese Academy of Sciences (CAS) also deployed a Tesla 20-series GPU-based supercomputer, called Mole 8.5. This is a smaller system but they still ranked in the Top 20, coming in at number 19. The Tesla business is just 3 yrs old this month, so securing two Top 20 supercomputers, including #2, is a great achievement and we congratulate Dawning and CAS-IPE for their hard work and commitment to making this happen.
Earlier that day, 65 professors, researchers and scientists from universities and supercomputing centers from around the world gathered at an NVIDIA-hosted breakfast briefing to hear from leading lights in the HPC world.
Prof. Wei Ge from the CAS-IPE showed more than a dozen examples of important science bring run on Tesla GPUs and Prof. Erik Lindahl talked about advances in the molecular dynamics application, GROMACS as well as his thoughts on how the HPC community will scale to the millions, even billions of computing cores that will be available in the years to come. Finally, Prof. Thomas Schultess, two time winner of the Gordon Bell award for peak performance, Director of the Swiss National Supercomputing Center and Chair of the Computational Physics group at ETH Zurich spoke about extreme scale simulations and the acceleration provided by GPUs. Presentations from the event are now available to download.
One of the other highlights of the show was GPUDirect, a new technology from NVIDIA that enables the GPU to communicate with other devices like Infiniband switches, hard drives, frame grabbers, etc with reduced involvement of the CPU, thereby reducing communication overhead. Our lead development partner Mellanox had the system on show and were discussing how this new technology enables them to accelerate system communication by as much as 30%!
QLogic, another company bringing this technology to market, also announced their intent to support this new standard. It was a hot topic at the show for sure, and judging by the amount of questions we got from customers, channel partners and press, we believe it will become a mainstay for large scale GPU clusters deploying Infiniband.
Overall, ISC has been an exciting show, lots of Tesla on the show floor, many talks about GPUs and a huge milestone for the Tesla business with the Top500 announcement. We're looking forward to SC'10 in New Orleans where we expect to have more groundbreaking news for you from the Tesla business.
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