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Mike Ross is the liberal Democrat nominee for governor of Arkansas, attempting to make himself out to be a moderate in a close campaign against Republican nominee and former Congressman Asa Hutchinson. In this campaign advertisement, Ross says, "and voted against ObamaCare." That campaign spot, ironically titled "Truth," features Mike Ross not telling the truth. He says he voted against ObamaCare, but that's only partially true. Like his fellow politician, 2004 Presidential nominee John Kerry who voted for the $87 billion before he voted against it, Mike Ross did the same thing.
While Mike Ross did in fact vote against final passage of ObamaCare (H.R. 4872) in Congress representing the fourth district of Arkansas, he was one of a few key votes who could have killed ObamaCare and instead negotiated to keep it alive and allow it to pass. Mike Ross did vote for ObamaCare before he voted against it. He voted in committee to pass ObamaCare and send it to the full house for final vote. The Democrat leadership needed his vote in committee, but knowing he needed to be seen voting against it, they negotiated with him to vote for ObamaCare in committee while letting him vote against it in the full house where they had a majority of the Congress without Mike Ross's vote. So, they allow him to play politician and tell voters he voted against it when he voted for in committee first.
Mike Ross is and has been an ObamaCare champion. In July 2009, Mike Ross told Steven T. Dennis of Roll Call, "One of the biggest reasons I ran for Congress was because I wanted to reform health care."
"Moderate Democrats, led by Arkansas' Rep. Mike Ross, reached a deal Wednesday with congressional leaders and White House officials to let consideration of the stalled health-care bill resume, a move that ensures no final votes will occur until this fall," Jane Fullerton wrote in the Arkansas Democrat-Gazette on July 30, 2009, who also reported that same day, "Under the agreement, Ross and three other holdout Blue Dogs agreed to vote to pass the bill out of committee and thereby provide enough support for it to emerge."
As Mike Ross started his campaign for governor last year, telling voters he voted against ObamaCare in Congress, the truth came out. Jason Tolbert, writing for Arkansas News on April 17, 2013, reported, "...it is still a valid point that Ross and his Blue Dog colleagues cast votes that allowed the to move out of committee," in a story titled "Mike Ross: For and against health care reform." In the same article, Tolbert quoted Mike Ross as saying, "It was 10 days of very intense negotiation. I was not trying to kill health care reform. If I was, I would not have been in negotiations for 10 days," while also defending his vote to save ObamaCare in committee by saying, "We protected small businesses...Eighty-six percent of small businesses in America today will no longer be subject to any type of employer mandate to provide health insurance coverage, but at the same time those small business owners, as well as their employees, will have access to affordable health care."
So there is it, simply put, Mike Ross voted in favor of saving ObamaCare before he voted against it. The key voted was his vote to save it in committee, where it could have died, and not his voted against it in final consideration when the leadership had the votes to pass it without Mike Ross's vote on the floor of Congress.
Mike Ross is an old school politician that thinks he can get elected by telling the voters what they want to hear. He's neither the first nor last politician to take advantage of voting in Congress to cast contradictory votes on a major issue so he can tell the special interests groups he had their backs on the issue while telling the voters back home that he voted against it. In reality, he saved ObamaCare while telling voters in Arkansas he voted against it. This is exactly the kind of behavior by politicians that makes voters more cynical.
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Baits and lures from brands like Berkley, Rapala, and Northland Fishing Tackle are available at unbeatable prices. From lures, crankbaits, spinners, and jigs to worms, jerkbaits, and creatures, get the attention you want with lures, hard baits or soft baits from Gander Mountain.
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Delta Air Lines has promoted Wayne Gilbert "Gil" West to chief operating officer, replacing Stephen Gorman who will retire.
West will oversee all of the Atlanta-based carrier's flight and airport operations; Delta TechOps; in-flight service; corporate safety, security and compliance; supply chain management; Delta Connection; Delta Private Jets; and Delta Global Services.
The promotion is effective 1 March, the same day that Gorman retires. Gorman has been chief operating officer of Delta since 2007.
"Under Gil's leadership since joining Delta in 2008, ACS [airport customer service] and TechOps have achieved double-digit percentage improvements in key operational performance metrics," says Richard Anderson, chief executive of Delta, in a memo to employees. "Gil's keen business acumen and drive for continuous improvement will ensure Delta sustains and builds on its operational momentum during 2014, despite a challenging start to the year, and into the future."
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Musicians...want James Kottak, the drummer of the Scorpions, to play or sing on your album? For a limited time only James is accepting submissions to record on on a first come first serve basis. It's simple, contact genius engineer Kevin Hahn. He will explain the technical details, rates, and answer any questions you may have. Kevin Hahn firstname.lastname@example.com Rock & Roll Forever! www.jameskottak.com James Kottak


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Quinnipiac Women's
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Seniors Kristina Del Mistro (East Williston, N.Y.) and Furtuna Velaj (Stamford, Conn.) of the Quinnipiac women's soccer team were chosen to play in the 2011 Division I New England Women's Intercollegiate Soccer Association (NEWISA) Senior Bowl tentatively scheduled to take place on Dec. 4 at Merrimack College in North Andover, Mass. at 11 a.m. Del Mistro and Velaj represent the Bobcats alongside 21 Division I collegiate women's soccer players in New England.
Del Mistro and Velaj have both had successful careers in the past four years at Quinnipiac. Both players appeared in each of the Bobcats' 16 games during the 2011-12 season. As a senior, Del Mistro ranked third on the team in points (7) while tallying three goals and an assist. In addition, Velaj led the team in points (14) and goals (6), while also collecting two assists this past year.
"Kristina has been one of the most skillful players in the NEC in her four years at Quinnipiac and her selection to the Senior Bowl is an acknowledgement by the coaches in the region of her undoubted ability," said head coach Dave Clarke. "She had an excellent season and to play in the Senior Bowl is a good way for her to end her college career."
"Furtuna has had a career that the majority of players can only dream about," said Clarke. "Her selection to the Senior Bowl is a recognition of four years of being one of the best players in the region and puts the exclamation point on her Quinnipiac career."
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Kelly Matthews, Northeastern
Julia Bouchelle, Boston College
Jillian Cipriano, Central Conn
Melanie Baskind, Harvard
Kristina Del Mistro, Quinnipiac
Emma Mulla, Yale
Stephanie Wirth, Boston College
Mary Beth Lesbirel, Brown
Brittany Jackson, Central Conn
Mary Beth Hamilton, Hartford
Julie Morrissey, UMASS
Veronica Napoli, Northeastern
Furtuna Velaj, Quinnipiac
Samantha Kee, Sacred Heart
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Second Baptist Church presents 'A Celebration of Christ' Sunday
CORPUS CHRISTI - A CELEBRATION OF CHRIST: A Celebration of Christ with music and testimonies will be from 4:30 to 7:30 p.m. Sunday at Second Baptist Church, 6701 S. Staples St. Music presented by Jeff Lynn, pastor of Yorktown Baptist church, Ladies Quartet from Calallen Baptist Church and Becca Redus from Second Baptist Church. Guest speakers include C.E. Richardson from Calvary, First Baptist, the Rev. Chris DeLuna and Derrick E. Reeves Sr. Meal will be catered by Irma Elizondo. Cost: $8/adults and ages 13 and older; $4/ages 12 and younger. Cost at the door: $10/adults; $5/ages 12 and younger. Information: ccbaptistassociation.org.
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2 of 2 people found the following review helpful:
By Kurt from USA on 2008-06-23 22:53:35Things I liked:Only trap that I know of that can stop BB's and Pellets. The double curtain flaps and the steel backing are great. Great value for the ability to stop and trap pellets and BB's. Just Can't shoot pointed pellets. I have seen many traps that only stop pellets, and they cost well over the asking price for this awsum trap.
Things I would have changed:I would like it if Crosman would throw in 5-10 extra cardboard target holders. Once you blast away the thick cardboard front, you need to cut out a new one from cardboard boxes around your house. The plastic tabs that hold the cardboard facing are hard to push in even when making a pre punture hole. Most of all the frame around the front of the trap should NOT be Plastic. If you misplace a shot or two and shatter the frame that holds the double stops , they will no longer stay in thier proper place/position. The frame should be made of thin steel.
What others should know:This is a fantastic trap. It can and will stop BB's and Pellets even from high velocity pistols and rifles. Just know that you will need to cut out and replace the cardboard target holder/ trap face. Try very hard not to hit and shatter the frame that holds the traps. I did, but I stuffed old pants& shirts where the curtains were supposed to hang and it works great because I still have the steel back to keep the rounds in the trap.
0 of 0 people found the following review helpful:
By edward j from USA on 2015-05-09 12:39:38Things I liked:that it is a pellet trap
Things I would have changed:better plastic better kevlar thicker steel backing
What others should know:do not shoot anything into this pellet trap maybe airsoft bb's
|By ahkell from USA on 2014-11-14
CheckoutSubtotal (USD):
does not include shipping and tax


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Step 3: Cut in half
Step 4: Twisting
Twist 2 at a time then once all wires are paired up do it again with another one until you don't have any more loose wire left.
Step 5: Add the V
Redo step 2 except not as long and as much twist them as usual and then twist around tree and have it stick outwards.
Do that again but wrap around v spot so it looks more realistic (look at pictures)


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a) Understanding interfacial phenomena is the key to controlling the microstructure of solids and fluids and for ensuring stability. Current projects examine:
Velocity contour of a fluid inside a rectangular micro-channel (cross section 100 µm). Data obtained by micro PIV in order to study deviations from what would be expected in large channels.
b) In particulate processing, the application of Discrete Element Method (DEM) and Birmingham's unique Positron Emission Particle Tracking (PEPT) equipment are key techniques for providing fundamental scientific insight into particulate behaviour. Projects and achievements include:
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Denton, TX (SportsNetwork.com) - Led by 13 points by Vertrail Vaughns, the North Texas Mean Green edged the East Carolina Pirates, 53-51, in a Conference USA tilt at The Super Pit.
For the Mean Green (12-13, 3-8 C-USA), Chris Jones added nine points and Colin Voss scored eight and pulled down seven rebounds.
Caleb White finished with a game-high 17 points and seven rebounds for the Pirates (13-13, 2-9), while Prince Williams scored 15 and Michael Zangari grabbed 11 rebounds.
North Texas shot just 39.3 percent from the field in the first, including 2- of-9 from 3-point range. ECU connected on 47.8 percent and 3-of-9 from beyond the arc, but its was the Mean Green that went into the break holding the slimmest of leads, 28-27.
After the intermission, the Mean Green shot 40 percent from the field but excelled with their defense, holding the Pirates to just 31 percent shooting from the field. Trailing by seven in the final minutes, Williams drained two 3-pointers, the second with 49 seconds to play, to cut the North Texas lead to just 52-51. After a Mean Green turnover, Williams had chances to tie or give his team the lead in the final seconds, but had a jumper blocked and came up short on a 3-pointer, as North Texas held on for the win.
The teams combined to shoot just 14 free-throw attempts in the game. The Mean Green had the edge on the glass, outrebounding the Pirates, 39-28. North Texas had the advantage in bench points, 26-18.
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Our weekly look at the Ravens' matchup from a fantasy football perspective. Next up, the Miami Dolphins...
The receivers
Torrey Smith - After three straight solid games, Smith busted loose with five receptions for 166 yards and a touchdown in Baltimore's loss to the Bills. For a player considered a deep threat only entering the season, the ex-Terp has been remarkably consistent so far this season with at least 85 receiving yards in each game. Led by corner Brent Grimes, Miami allows the seventh fewest fantasy points to wide receivers, but Smith has produced even as defenses know he's the one to watch. Start him, start him, start him at least as a high-end WR2
Marlon Brown - It's quite possible we've seen the best of the undrafted rookie this season. Brown scored his third touchdown in three games in Week 4, but also developed a hamstring injury, making his status questionable. Then there is the expected return of Jacoby Jones from a knee injury. Brown remains the starter, but Jones will dance away with some of his snaps and targets. Seeing as the Ravens offense isn't clicking, the Dolphins pass defense is stingy, Jones is returning and Brown could be limited, pass on starting him or Jones for that matter. Oh, don't waive Brown (or pickup Jones) unless roster issues require such a move. Touchdowns are touchdowns, but right now that's about all he's generating.
Dallas Clark/Ed Dickson - From Rotoworld's Evan Silva: " The Dolphins are allowing the most fantasy points in the league to tight ends, but Ravens TEs are awfully hard to trust. 34-year-old Clark is a half-decade removed from his prime and hasn't cleared 50 yards since Week 1. Purely in terms of pass catching, Dickson has been the worst tight end in football through four games." What he said.
The runners
Ray Rice - Come up with any excuse, but none justify the Ravens giving their lead back only five carries last week against the Bills 30th ranked run defense - or against any defense. Now comes the annual tradition of the coaching staff saying there will be a commitment to feeding Rice. Expect exactly that this week against Miami's suspect run defense and because it's the right thing to do. Start Rice in all formats and most of all don't panic. We've been through this before.
Bernard Pierce - The power back strained his calf in week 4, but should play this week. However, with Rice back and the Ravens needing to get their star involved, Pierce shouldn't play for fantasy owners unless, well, unless there isn't a choice. The frequent Flex option remains a must hold for all Rice owners and those in virtually any format.
The passer
Joe Flacco - Yeesh, that was bad. After his brutal five-interception performance against the Bills, Flacco enters Week 5 ranked 26th among fantasy quarterbacks. Factor in Miami's aggressive pass rush and there is simply no reason to play him in leagues that don't require two quarterbacks. Considering the Ravens face formidable pass defenses in three of the next four weeks, Flacco won't be viable for a while. For those holding him as a bye week option, start scanning elsewhere for help in case this doesn't turn around ASAP.
The defense and the kicker
The Dolphins are allowing 8.5 points per game to opposing fantasy defenses, 12th most overall. Baltimore's unit hasn't been dominate overall, but it has scored at least eight points in each of the last three games, As for Justin Tucker, he's made five straight kicks after missing two in Week 2. Kickers are averaging 7.7 points against the Dolphins this season, making the Ravens version a viable option.
On the other side...
Miami's passing game with second-year quarterback Ryan Tannehill is much improved, but that's more of an NFL angle. Tannehill's fantasy numbers are middle of the pack-esque and he's unlikely to produce significant stats this week against Baltimore. Ex-Steeler Mike Wallace remains largely a decoy in the Dolphins' attack. His downfield ability makes him a constant threat, but he remains a risky all-or-nothing player as evidenced by his three games with less than 25 receiving yards.
In addition to CSNwashington duties covering the Wizards, Hoyas and the college basketball scene, Ben writes about and ranks fantasy football players for FFToolbox.com, rated the most accurate site for the 2012 season.


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The Chaplaincy is here for the benefit of all, students and staff, those of all faiths and none.
It's an open space for those with a faith who want to celebrate it as well as for those with their doubts who want to question it. For those who are just looking and those who need somewhere neutral to hang out. It is for those who are experiencing difficulties and maybe don't know where to start to get help. It is confidential, non judgmental and compassionate.
The Chaplain. Reverend John Dane
John was formerly a curate in the parish of Deddington in Oxfordshire and comes to the University with an enormous amount of experience relevant for the chaplain's role. Previous to his role in Deddington John was a consultant to a British medical company. Prior to this he lived and worked in the United States for 15 years, mainly in the field of Drug and Alcohol rehabilitation. In this role he travelled in the US, Russia and Europe developing treatment programmes for a range of occupations including Doctors, Police Officers, Airline Pilots and the Clergy. He was also involved in providing treatment to the entertainment industry, specifically to those in the pop music and movie fields.
On the church front he was Director of Youth Ministry – providing pastoral care for youth and children at St Francis in the Foothills Methodist Church, Tucson, Arizona, a church heavily committed to working with refugees and other marginalised groups.
Contact him at firstname.lastname@example.com or 01243 816041
There are regular services on both campuses. You can find them on the Chapel Services document at the right of this page.
Prayer meditation and personal reflection
There are rooms available on both campuses for prayer or quiet meditation.
Prayer mats are available in both Quiet Rooms
Bishop Otter Campus
The Chapel at Bishop Otter Campus is available for prayer and personal reflection from 8am to 9am and 5pm to 6pm each week day. In addition there is a quiet room in the left hand corner of the chapel which is available at all times. You will need a code to access the room which I will happily email you.
Bognor Regis Campus
The Quiet Room at Bognor Regis Campus is also available for prayer, meditation and personal reflection. Prayer mats are available. The room is located next to the SU office near the MII bar and cafeteria. (You will need a code to access the room which I will happily email you).
Looking for local Church, place of prayer. worships or meetings for other faiths and beliefs?
The Chaplain knows many of the local ministers, churches and faith leaders. He always welcomes the opportunity to talk to you about your needs and where you would feel most comfortable.


text:
The 2010 Bouldering World Cup womens finals highlight reel from Vail Colorado.
Final Results:
1. GRAFTIAUX, Chloé
2. Stöhr, Anna
3. Wurm, Juliane
4. Puccio, Alex
5. Johnson, Alex
6. Ansade, Maud
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text: I went to a private party tonight at Disneyland, I was invited by a friend of mine. The party went from 4 pm to 1 am and all of disneyland was ours, or at least it belonged to the company he works for. It was around 930 and we were in tomorrowland waiting for the train to come around, they had only 1 running tonight. So we're sitting there and my mother asks the conductor a question, it was answered and the conversation picked up a little, the conductor was talking to my little niece and nephew, throwing suggestions out there and what attractions to ride, she was proud of my niece for being able to ride snow white and not get scared. Shes been with the company for a little over 6 years, normally a Thunder Mountain CM but because of its refurb shes being cross trained across the park. Anyways, I didnt really talk too much, I just let the conversation find its way and I was more of a listener just taking stuff in so to speak. But I did notice(and very quickly) that this cast member was just so full of life and every question asked it was like she was excited it got asked, she was just a good person and its CMs like her who want people to keep coming back. She was sent to disney world for a few weeks and the way that she spoke of it, it was like the greatst thing she had ever done. She never half answered anything, when asked about her job it was nothing but great things... These are the CMs I enjoy running into when I visit, I wanted to leave a compliment at city hall but it had a line, I definitly wanted to get it out there though what my experience was like. I would post her name but am unsure of what the rules are on this website reguarding that


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Box 3.1
Four Domains of Information Technology in Health Care
Motivated by a presentation from Intermountain Healthcare's Marc Probst, the committee found it useful to categorize health care information technology (IT) into four domains:
Automation. Automation is the use of IT to perform tasks that can be repeated with little modification—examples include bar code medication administration, generation of laboratory results, and issuing invoices for payment.
Connectivity. Connectivity begins with physical infrastructure—ensuring base-level electronic connections between various physical facilities so that data can be transmitted electronically. Examples might include high-speed fiber lines and routing capabilities throughout a physical plant, wide-area networks, and the deployment of wireless infrastructure. Connectivity includes interfaces that map data from one system into another. At the highest level, connectivity involves connecting people to systems and to each other.
Decision support. Decision support (DS) involves the use of IT-based applications to provide information at a high conceptual level to clinicians to facilitate or improve decisions made about care. For example, DS can include simple rule-based alerts such as reminders to physicians about possible drug interactions when medication orders are entered. DS can also involve the presentation of information to care providers in ways that make it easier for them to know how to direct their attention—a "dashboard" indicating patient status across an entire ward or for a physician's 50 sickest patients would be an example of DS for presentation. Finally, DS can also refer to statistical and heuristic decision support reflecting an intelligent synthesis of information about the patient, information from the care setting, and biomedical knowledge—for example, a DS system might recommend a particular antibiotic based on the patient's condition and a database of the recent sensitivity of microorganisms to different antibiotics in their hospital.
Data-mining capabilities. Data-mining capabilities use knowledge discovery techniques to analyze various similar or dissimilar datasets to recognize known or unknown relationships. Data mining converts raw data signals into clinical variables and models to provide a rich source for new approaches to evidence-based medicine and personalized care. Examples range from identification of a marker for breast cancer therapeutic response from microarray data, through mining the text literature for little-known drug-drug interactions, to mining multimedia electronic health records to identify a patient's condition from a text note or a change in heart size from a sequence of images, and extracting ideas or relationships from a recent publication in a leading journal and pushing the information to the physicians who are treating patients who may benefit from those findings. Data mining provides many of the inputs needed for decision support.
The National Academies of Sciences, Engineering, and Medicine 500 Fifth St. N.W. | Washington, D.C. 20001
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"3 Crossing the Health Care IT Chasm."
Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions.
Washington, DC: The National Academies Press, 2009.
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President Barack Obamas victory positions him to claim a mandate for pushing a proposal through Congress that would let tax cuts expire for top earners and avert $1.2 trillion in automatic spending reductions.
Obama now must decide how to contend with opposition from congressional Republicans who demand a tax-cut extension for all income levels.
Obama defeated Republican Mitt Romney to win a second term that will begin with the same balance of power in Congress: Democrats controlling the Senate and Republicans holding the majority in the House. Republicans were counting on either a Romney victory or a Senate takeover to improve their negotiating posture.
Emboldened by the election results, Obama will offer a brand-new plan of his own, Steve Bell, senior director of the Economic Policy Project at the Bipartisan Policy Center, said in an interview.
Bell said one option the Obama administration is considering is pushing anew for a balanced plan to cut as much as $100 billion in spending as a deficit-reduction down payment while letting the George W. Bush-era tax cuts expire for top earners.
Congressional aides have previously said that lawmakers in both parties are discussing fallback plans for $60 billion to $100 billion in deficit reduction.
Senate Finance Chairman Max Baucus, a Montana Democrat, said this week that he expected Obama to call on Congress soon after the election to pass a deficit-reduction plan that includes revenue increases and spending cuts.
Balanced Approach
Theres a mandate for a balanced approach, and that means its got to be a combination of revenue and cuts, former Representative Tom Perriello, a Virginia Democrat, said in an interview. He said he would like to see Obama put a very bold plan out there.
Unless Congress acts, automatic spending cuts, known as sequestration, will begin in January and the Bush tax cuts will expire Dec. 31. Obama and congressional Democrats want to let the tax cuts expire for top earners, while Republicans advocate extending them for all income levels. The spending reductions and tax increases, amounting to $607 billion in 2013, are known as the fiscal cliff.
To help bring Republicans to the table, Obama also may propose minor changes to entitlement programs, such as a temporary change in the formula used to calculate annual benefit adjustments, Bell said.
Obama will certainly be very proactive, he said.
Senate Control
A big question is the degree to which Republicans will back off from their opposition to tax increases.
For two years, our majority in the House has been the primary line of defense for the American people against a government that spends too much, taxes too much and borrows too much when left unchecked, House Speaker John Boehner said yesterday at an election event in Washington. With this vote, the American people have also made clear that there is no mandate for raising tax rates.
Boehner indicated before the election that the House may be willing to pass short-term legislation to make time for broader talks on reducing the deficit and averting automatic spending cuts over the next decade.
The American people re-elected the president, and re- elected our majority in the House, Boehner of Ohio said in a statement. If there is a mandate, it is a mandate for both parties to find common ground and take steps together to help our economy grow and create jobs, which is critical to solving our debt.
Step Forward
Eric Ueland, chief of staff to former Senator Bill Frist when the Tennessee Republican was majority leader, said Obama has a responsibility to step forward quickly and express his specific interest in what he wants to see happen in December and then let Congress react to that.
Ueland said Obamas victory increases pressure on him to reach across the aisle.
While hell have the ability to argue that he received an endorsement of his positions, he also has the responsibility of working with the Republicans in the House and Senate, Ueland said.
Some congressional Republicans, especially in the Senate, have said they may be willing to consider eliminating some tax breaks to help pay for eliminating automatic cuts to defense programs.
Political Center
To the extent that Obama wants to move to the political center, which is where the work gets done in a divided government, well be there to meet him halfway, Senate Minority Leader Mitch McConnell, a Kentucky Republican, said in a statement. That begins by proposing a way for both parties to work together in avoiding the fiscal cliff without harming a weak and fragile economy.
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A method of conditioning a diaphragm of a patient is provided. The method can include the steps of implanting an electrode adjacent a target site in the diaphragm of the patient and operating the electrode to deliver a sufficient amount of electrical stimulation to the target site in the diaphragm of the patient to cause the diaphragm to contract.
1. A method of treating a neurodegenerative disorder of a patient affecting the patient's diaphragm, the method comprising the steps of:
identifying the patient as having a neurodegenerative disorder;
delivering electrical stimulation to a target site in the diaphragm through an electrode implanted in the diaphragm to contract the diaphragm; and
synchronizing the delivering step with a breath or breathing attempt made by the patient to condition the diaphragm.
2. The method of
3. The method of
identifying the target site in the diaphragm of the patient prior to the implanting step.
4. The method of
5. The method of
6. The method of
7. The method of
8. The method of
9. The method of
10. The method of
delivering breathing gas to the patient from a ventilator to assist breathing by the patient at specified gas delivery intervals.
11. The method of
synchronizing delivery of the breathing gas to the patient by the ventilator with delivery of the electrical stimulation of the target site in the diaphragm of the patient by the electrode.
12. The method of
13. The method of
14. The method of
The present application claims priority to U.S. Provisional Patent Application No. 60/481,124 filed on Jul. 23, 2003, which is herein incorporated by reference in its entirety.
A patient may need respiratory assistance as a result of disease and injuries of various kinds. The need can be direct, especially when the injury or illness afflicts the patient's respiratory system. The need can also be indirect, e.g. during anaesthesia and some intensive care. The respiratory assistance can encompass everything from facilitating spontaneous breathing to total control of breathing. Typically, a mechanical ventilator is employed to provide the breathing assistance.
One potential problem occurring in long-term controlled respiration is that the patient's own respiratory musculature becomes weakened. In many instances, the patient then loses the ability to breathe spontaneously after the true need for assisted respiration has been eliminated. Weaning the patient off the ventilator then takes longer. This causes a cost increase to the society in the form of longer treatment duration times and, more important, increases the discomfort and risk of secondary disease for the patient.
Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig's Disease or Motor Neuron Disease) is a progressive neurodegenerative disease of unknown cause. Approximately 1.4 individuals per 100,000 develop ALS annually and the peak incidence is between the ages of 55 and 75. The exact etiology of ALS is unknown although many potential causes have been proposed including exposure to neurotoxic agents, genetic or autoimmune disease, deficiencies of nerve growth factors, and viral infection. The typical clinical presentation is that of an individual with gradually progressive asymmetric weakness associated with hyperreflexia, muscle atrophy and fasciculations. Typically patients have difficulty with walking, balance, picking up objects, and eventually any limb muscle movement. The diagnosis of ALS is made on the basis of the history, a physical examination revealing upper and lower motor neuron signs, and electromyography demonstrating signs of disseminated active denervation and true reinnervation.
One effect of progressive neuromuscular weakness in patients with ALS is the effect on respiration. Although ALS has no direct effect on the lung, it has devastating effects on mechanical function of the respiratory system. ALS affects all of the major respiratory muscle groups: upper airway muscles, expiratory muscles, and inspiratory muscles. Therefore, all patients with ALS are at significant risk for respiratory complications. Progressive inspiratory muscle weakness in ALS inevitably leads to carbon dioxide retention, inability to clear secretions and hypercarbic respiratory failure, the major cause of death in ALS. At some point, ALS involves the respiratory muscles so severely that bulbar paresis is combined with severe expiratory and inspiratory muscle weakness and invasive ventilation becomes the only option for survival.
It will be appreciated that illustrated boundaries of elements (e.g. boxes, groups of boxes, or other shapes) in the figures represent one example of the boundaries. One of ordinary skill in the art will appreciate that one element may be designed as multiple elements or that multiple elements may be designed as one element. An element shown as an internal component of another element may be implemented as an external component and vice versa.
The following includes definitions of selected terms used throughout the disclosure. The definitions include examples of various embodiments and/or forms of components that fall within the scope of a term and that may be used for implementation. Of course, the examples are not intended to be limiting and other embodiments may be implemented. Both singular and plural forms of all terms fall within each meaning:
"Patient," as used herein, includes but is not limited to any living creature, i.e. human or animal.
"Signal", as used herein, includes but is not limited to one or more electrical signals, AC or DC, analog or digital signals, one or more computer or processor instructions, or other means that can be received, transmitted, and/or detected.
"Software", as used herein, includes but is not limited to one or more computer readable and/or executable instructions that cause a computer or other electronic device to perform functions, actions, and/or behave in a desired manner. The instructions may be embodied in various forms such as objects, routines, algorithms, modules or programs including separate applications or code from dynamically linked libraries. Software may also be implemented in various forms such as a stand-alone program, a function call, a servlet, an applet, instructions stored in a memory, part of an operating system or other type of executable instructions. It will be appreciated by one of ordinary skill in the art that the form of software may be dependent on, for example, requirements of a desired application, the environment it runs on, and/or the desires of a designer/programmer or the like. It will also be appreciated that computer-readable and/or executable instructions can be located in one logic and/or distributed between two or more communicating, co-operating, and/or parallel processing logics and thus can be loaded and/or executed in serial, parallel, massively parallel and other manners.
A system and method is provided for electrically stimulating the diaphragm of a patient to condition the diaphragm of the patient. As used herein, the term "condition" can mean maintaining the strength of, strengthening, building the fatigue resistance of the diaphragm of the patient, or changing other contractile properties of the diaphragm muscle fibers. Although not wishing to be bound by theory, electrical stimulation can also have one or more of the following effects that are intended to be included in the meaning of the term "condition": 1) eliciting muscle fiber type conversion (from fast twitch, rapidly fatiguing, type I fibers to slow twitch, slowly fatiguing type II fibers); 2) increasing muscle mass (through reversal of disuse atrophy); 3) changing the contractile properties of the muscle by stimulating through the muscle's range of motion (thereby reducing any shortening of fibers and/or spasticity), and 4) even potentially having an effect of collateral sprouting of adjacent nerve fibers to innervate muscle that has lost its innervation through damage to the phrenic nerve or lower motor neuron.
To condition the diaphragm of the patient, a sufficient amount of electrical stimulation can be continuously or periodically applied to one or more sites in the diaphragm to achieve at least one of the effects described above.
Illustrated in
In one embodiment, the electrical signal generator 110 can be configured to generate pulses and/or signals that may take the form of sinusoidal, stepped, trapezoidal waveforms or other relatively continuous signals. The electric signal generator 110 can include one or more channels that can independently control the amplitude, frequency, timing and pulse width of the corresponding electrodes connected thereto.
In one embodiment, the electrical signal generator 110 can be an external signal generator that is electrically connected to or in electrical communication with the electrodes 120. One example of a suitable electrical signal generator is the NeuRx RA/4 stimulator that is manufactured by Synapse Biomedical, Inc. of Oberlin, Ohio. The NeuRx RA/4 stimulator is a four-channel device with independent parameter programmability. It will be appreciated that since the NeuRx RA/4 stimulator has four channels, it has the capability to independently control up to four electrodes. In an alternative embodiment, the electrical signal generator 110 can be an implantable signal generator. One suitable example of a fully implanted signal generator is the "ITREL II" electrical signal generator available from Medtronic, Inc. of Minneapolis, Minn. One example of a partially implanted radio-frequency signal generator system is the "XTREL" system also available from Medtronic, Inc.
As stated above, the system 100 can include electrodes 120 implanted in the diaphragm of the patient to provide electrical stimulation to the diaphragm. Although
Illustrated in
One example of a suitable intramuscular electrode is the Peterson intramuscular electrode (P/N 21-0002) manufactured by Synapse Biomedical, Inc. of Oberlin, Ohio, which is the electrode illustrated in
In one embodiment, the electrodes 120 can be implanted into target sites in the diaphragm of the patient. For example, the electrodes 120 can be implanted into or adjacent the phrenic nerve motor points of the diaphragm (i.e., where the phrenic nerve enters the diaphragm) of the patient. The phrenic nerve motor points of the diaphragm are locations in the diaphragm that provide the greatest muscle fiber recruitment in response to an applied stimulation.
Illustrated in
In one embodiment, an electrode 120 can be implanted into or adjacent the phrenic nerve motor points of each hemidiaphragm and an additional electrode can be implanted in each hemidiaphragm for one or more of the following reasons: 1) to backup the primary electrode (i.e., the electrode implanted adjacent the phrenic nerve motor point); 2) to be positioned near the primary electrode to gain higher output if the phrenic nerve motor point is imprecisely located; or 3) to be positioned near the primary electrode to allow for surgical error in placement near the phrenic nerve motor point. Alternatively, if the phrenic nerve motor point is on the central tendon, one or more electrodes can be positioned near branches of the phrenic nerve.
In one embodiment, the system 100 can include an indifferent electrode 140. The indifferent electrode 140 can be similar to the intramuscular electrodes 120 shown and described above, except that it has a shorter de-insulated tip and does not have a barb at one end. In one embodiment, the indifferent electrode can be used as a common anode that can provide a return for the electrical charge from the electrodes 120. One suitable example of an indifferent electrode is PN 21-0004 manufactured by Synapse Biomedical, Inc. It will be appreciated that other indifferent electrodes can take the form of other shapes, sizes, and configurations, and can be made of other materials suitable for implantation into a patient or placed on the skin surface.
In one embodiment, the indifferent electrode 140 can be implanted in the subcutaneous tissue adjacent the diaphragm of the patient. Alternatively, the indifferent electrode 140 can be implanted in other areas such as integral to an implanted pulse generator or placed on the skin surface.
In one embodiment, the electric signal generator 110 can supply the electrodes 120 with an electrical signal that serves as electrical stimulation. For example, the electrical signal can be a capacitively coupled, charge balanced, biphasic, constant current waveform with adjustable parameters as shown below in Table I. It will be appreciated that the electrical signal can take the form of other waveforms for electrical stimulation such as monophasic or rectangular biphasic.
In one embodiment, the electrical stimulation can be delivered to the diaphragm of the patient continuously or periodically. For example, the electrical stimulation can be delivered to the diaphragm of the patient at specified intervals per day (e.g. 5-6 sessions per day) for a certain period of time per interval (e.g. 5 minutes per session totaling about 25-30 minutes per day). Obviously, the electrical stimulation can be delivered at different intervals depending on the needs of a particular patient.
In one embodiment, the electrodes 120 can be implanted into the diaphragm of the patient using a laproscopic procedure. One suitable device that can be used to implant the electrodes 120 into the patient's diaphragm is the electrode delivery instrument shown and described in U.S. Pat. No. 5,797,923, which is herein incorporated by reference in its entirety. In another embodiment, the electrodes 120 can be implanted into the diaphragm of the patient using an open surgical technique and placement with a hypodermic needle.
To locate the phrenic nerve motor points in each hemidiaphragm of the patient, a mapping procedure can be performed on the patient. In one mapping procedure, a test electrode and mapping software can be used to map the response of stimulus in each hemidiaphragm. The electrode includes a metal ring surrounded by tubing. The tubing extends from the metal ring a surgery-room vacuum port. The tubing is also connected to a pressure transducer for measurement of intra-abdominal pressure during the mapping procedure. To begin the procedure, the electrode is placed into contact with the diaphragm muscle tissue and held against the muscle tissue with suction. When the electrode is introduced into the peritoneal space, the tubing and metal ring are enclosed within a cannula. When a desired test site has been identified, a standard laparoscopic dissector is used to position and temporarily hold the electrode against the muscle tissue until the suction has been turned on. Electrical stimulation (e.g., stimulus amplitude of 20 mA and pulse duration of 100 μs) is delivered through the electrode resulting in diaphragm contraction. The magnitude of the evoked muscle response and visual confirmation of the contraction are recorded and noted, respectively. Also, the resultant change in pressure of the abdominal cavity is recorded. The suction can then be turned off, the electrode moved to a new test site, and the process can be repeated. With this information, the diaphragm of the patient is methodically mapped on a grid pattern (e.g., overlayed on the laparoscopic monitor).
The magnitude of the evoked muscle response and the resultant change in pressure of the abdominal cavity can then be used to identify the optimal electrode implant site of each hemidiaphragm. The optimal site, which is typically referred to as a phrenic nerve motor point of the hemidiaphragm, is chosen as the site that elicits a diffuse contraction and the greatest magnitude of pressure change. Although one mapping procedure has been described in detail above, it will be appreciated that other mapping procedures can be used to identify the phrenic nerve motor points in the diaphragm of the patient. For example, another suitable mapping procedure and device is shown and described in U.S. Patent Application entitled "Minimally Invasive Surgical Stimulation Tool" filed on the same date herewith, which is herein incorporated by reference in its entirety.
Illustrated in
In one embodiment, the system 400 can further include a flow sensor 420 provided along the ventilation breathing circuit (i.e., between the mechanical ventilator 410 and the upper airway of the patient). The flow sensor 420 can be used to sense inspiratory or expiratory air flow in the ventilator circuit.
In one embodiment, the system 400 can include a stimulation apparatus 430 that can include an electrical signal generator 110 (similar to the one described above) and a breathing sensor and control circuit 440 that is in electrical communication with the electrical signal generator 110 and the flow sensor 420. The breathing sensor and control circuit 440 can be configured to detect certain breathing attributes of the patient (e.g., the inspiration phase of a breath, the duration of the inspiration phase, the exhalation phase of a breath, the duration of the exhalation phase, tidal volume, and/or flow rate), convert these attributes to signals, and communicate these signals to the electrical signal generator 110.
Optionally, the system 400 can include a pressure gauge (not shown) and gas meter (not shown). These can be provided along the ventilator breathing circuit to measure the pressure and gas-related parameters of the patient's breathing, respectively. Also, a physiological measurement unit can be connected to the patient to measure certain physiological parameters such as blood pressure, blood values, body temperature, etc.
In one embodiment, electrical stimulation of the diaphragm can be synchronized with attempts at breathing or breathing made by the patient (e.g., on the patient's own or by the mechanical ventilator). For example, electrical stimulation can be triggered following the inspiration phase of the breath (i.e., during exhalation) to maximize the contraction during the period when the diaphragm is at its longest length. This could be beneficial to a patient with injuries to or blockages in her/his nerve conduction system between the respiratory center and the respiratory musculature. It will be appreciated that electrical stimulation of the diaphragm of the patient may not be synchronized with attempts at breathing or breathing made by the patient and, thus, can be applied during any portion of a breath.
By applying electrical stimulation to the diaphragm periodically or at specified intervals, weakening of the diaphragm can be reduced. When the condition of the patient improves and he/she makes sporadic attempts to breathe naturally, adaptation to these attempts can be made in combination with intensified muscle stimulation. This can increase exercise of the diaphragm and prepare the patient for the time when the patient starts taking over an increasing part of the breathing.
One possible advantage of periodically delivering electrical stimulation to the patient's diaphragm to condition the diaphragm of the patient while the patient is using a mechanical ventilator is that the dependence of the patient on the mechanical ventilator can end sooner. For example, electrical stimulation of the diaphragm while the patient is breathing using a mechanical ventilator can help wean the patient off the mechanical ventilator by reversing the disuse atrophy of the diaphragm, thereby providing fatigue resistance and strength. Initially, patients may only be able to tolerate electrical stimulation of the diaphragm for a short period of time due to rapid muscle fatigue and low diaphragm strength resulting in low tidal volumes. Over a period of weeks, the diaphragm can build endurance and strength and patients may be able to tolerate electrical stimulation of the diaphragm for longer durations until they are able to achieve full-time electrical stimulation. This can mean that the duration of hospital treatment can be greatly reduced. Moreover, it may be possible to reduce costs and treat more patients at hospitals when treatment durations are reduced.
Illustrated in
As shown in
To the extent that the term "includes" or "including" is used in the specification or the claims, it is intended to be inclusive in a manner similar to the term "comprising" as that term is interpreted when employed as a transitional word in a claim. Furthermore, to the extent that the term "or" is employed (e.g., A or B) it is intended to mean "A or B or both". When the applicants intend to indicate "only A or B but not both" then the term "only A or B but not both" will be employed. Thus, use of the term "or" herein is the inclusive, and not the exclusive use. See, Bryan A. Garner, A Dictionary of Modern Legal Usage 624 (2d. Ed. 1995). Also, to the extent that the terms "in" or "into" are used in the specification or the claims, it is intended to additionally mean "on" or "onto." Furthermore, to the extent the term "connect" is used in the specification or claims, it is intended to mean not only "directly connected to," but also "indirectly connected to" such as connected through another component or components.
While the present invention has been illustrated by the description of embodiments thereof, and while the embodiments have been described in considerable detail, it is not the intention of the applicants to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications will readily appear to those skilled in the art. Therefore, the invention, in its broader aspects, is not limited to the specific details, the representative apparatus, and illustrative examples shown and described. Accordingly, departures may be made from such details without departing from the spirit or scope of the applicant's general inventive concept.
Patent Citations
Non-Patent Citations
Referenced by
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text:
Unemployment Rates
Numbers show promise for area job seekers
In Fairfax County, companies have announced they've recently created or will create hundreds of new jobs.
Report finds labor struggles in Virginia despite favorable unemployment rate
Virginia's unemployment rate remained at 6.8 percent in October.
Arlington has lowest unemployment rate in the area
Arlington has the lowest unemployment rate in the D.C. area.
Thanks, Feds: DC area has lowest unemployment in the country
Area has the lowest unemployment rate of any metro area in the country, according to a report released earlier today by the Bureau of Labor Statistics.
In the scientific and technical services industry, the jobs are aplenty, but the recruits are hard to find
Despite higher-than-usual unemployment rates in the Washington region, defense and government contractors trying to fill highly technical scientific and analytic jobs still face an uphill battle.
Experts see a bumpy road to recovery for region's economy
Sara Kline, associate economist, Moody's Analytics.
Unemployment goes up in Md., down in D.C., Va.
The latest unemployment numbers are in and despite government hiring, unemployment is worse in worse in part of the region.
Putting Washington teens back to work
The fact that one in four teens in the labor force nationwide is unemployed is disturbing.
Washington job growth third-best in nation
Washington is one of 35 metropolitan areas deemed to have a rebounding economy by the U.S. Bureau of Labor Statistics.
Imperfect Arlington: What unemployment rate?Comment
Looks like the county hasn't managed to completely eradicate unemployment yet.
Fairfax unemployment rate falls below 5 percent
Fairfax County's unemployment rate ticked below 5 percent in August, part of a general, if not totally uniform, decline in joblessness across the region.
D.C.-area unemployment lowest in the nation
Two metropolitan regions in the Washington area posted the lowest unemployment rates among large metros in the nation in August.
How the census worked as stimulus
Washington D.C. engages in a direct-employment program every ten years.
D.C. August unemployment figure drops, but not into double digits
The unemployment rate in the District dropped back to 9.9 percent in August, mostly due to the end of the Summer Youth Employment Program.
Republican Governors Association attacks O'Malley, doesn't have all their facts straightComment
The Republican Governors Association's new ad, titled "Backwards", is airing in the Washington market and amounts to a full frontal attack on Democratic Governor Martin O'Malley. The ad argues the governor's policies have caused an economic catastrophe in the Old Line State.
Fairfax County businesses shine on top 500 list
The D.C. area continues to do better with employment than most of the country and one local county is promoting that heavily.
U.S. unemployment nears that of D.C.
The nation's unemployment rate rose in August, bringing it closer in line with the jobless rate in the nation's capital.
Fairfax jobless picture brightens slightly
Fairfax County's unemployment rate slid downward a tick from June to July.
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COLLEGE PARK, Md.
ONE-HOUR SHOW TO AIR LIVE ON CSN PLUS AT 7:30 PM, ENCORE ON COMCAST SPORTSNET AT 9 PM FOLLOWING LIVE COVERAGE OF TERPS MENS SOCCER AT DUKEBethesda, Md. (Oct.
COLLEGE PARK, Md.
There is no point in pretending otherwise: from program defections to the loss of several key graduating players, the CAA men's basketball league is not entering the upcoming season with the s
Attention College Park Police Department: If past is prologue, you could have a bonfire situation on your hands come Thursday. Not for a game result, but a recruiting announcement.


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Class Notes
Get behind the most interesting education stories, research and trends with the Express-News education reporters.
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Summer reading
There's a big debate over "summer learning loss" — whether kids backslide during the summer or whether it's a healthy break. For more, check out this story. But research does show that those likeliest to struggle are low-income kids. One of the easiest ways to keep a child's mind engaged in the summer is through […] [Read More]
More than you want to know
In an era of standardized testing, there's no shortage of data about schools. But one of the most helpful sites is Just4Kids.org. It's user friendly. It has lots of useful comparative information. And most importantly (and unlike many other sites on the Internet) it relies on relatively recent data. Of course, as useful as any […] [Read More]
And the winner is…
San Antonio trustees plan to announce the next superintendent to lead the city's largest urban district at a meeting Tuesday night. Last week, they visited the school districts of the two finalists: Superintendent Robert Duron at Socorro Independent School District in suburban El Paso and Superintendent Sylvester Perez at San Marcos Consolidated Independent School District. […] [Read More]
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Hang tight!
Recipe by ErinInVegas
"This is a staple of Thai cooking. Adjust the spices to your own tastes for a really great use for leftover rice!! I get the basil from a local Asian market. It has a different flavor than that of regular basil and makes all the difference in this recipe. It is fast and fairly easy to make, but requires constant stirring."
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3 tablespoons
oyster sauce
2 tablespoons
fish sauce
1 teaspoon
white sugar
1/2 cup
peanut oil for frying
4 cups
cooked jasmine rice, chilled
6 large cloves
garlic clove, crushed
serrano peppers, crushed
1 pound
boneless, skinless chicken breast, cut into thin strips
red pepper, seeded and thinly sliced
onion, thinly sliced
2 cups
sweet Thai basil
cucumber, sliced
1/2 cup
cilantro sprigs
I am a connoisseur of Thai Basil Chicken dishes, and this recipe is my favorite with a few modifications.
I added 2 tblsp soy sauce to the oil/pepper/garlic after frying a bit. You should also add the fish/oyster sauce at this point before adding the other ingredients or it won't absorb evenly into the food - you'll probably get some bites that taste fishy. I also halved the oyster and fish sauce since the smell was...well..terrifying. With that amount it added perfectly to the flavor but wasn't a noticeable/dominant taste at all (no one would know it is in there). It's important to use fresh garlic. I also prefer to chop the chicken after slicing (or use ground chicken) so it absorbs more of the flavor.
The hardest thing about this recipe is finding the Thai basil (different from Italian), I found it in an Asian market. You can substitute stir fry or wide rice noodles for the rice if you prefer. If you use wide rice noodles, it's best to chop them up a bit so they absorb the flavor.
Wonderful recipe - I'm so excited I found it! This will be a weekly recipe in my house!
Rice was too wet for my liking. Perhaps too much oil.
130 Ratings
Yummy! I'm a vegetarian who doesn't eat fish products--so I substituted fish sauce for soy sauce, and substituted oyster sauce for a mushroom stir-fry sauce I bought at an asian market. Instead of chicken, I added some delicious fried tofu.
Great recipe!
This is a great recipe. Here are my recommended changes: 1) Use 4 to 8 Thai "bird's eye" chili peppers instead of serranos. 2) Add the bell pepper when the chicken and onion are nearly done cooking so it won't overcook. 3) You can change the flavor of this dish a lot depending on when you add the fish/oyster sauce. Add it before the chicken and it will lose most of its characteristic Thai flavor. Add it a couple minutes after the chicken and you will keep some of the fishy Thai flavor. Or, add it with the rice as instructed here and you retain a lot of the fishy flavor!
I did what one reviewer suggested and added the fish sauce and oyster sauce in the oil for a bit before adding the chicken. This is an old trick my mom uses to take the strong fish smell out of the fish sauce. I also had to add two extra cups of rice since it was quite wet. I'll have to try seafood or beef next time. Excellent dish!
This recipe had very genuine thai flavor. Instead of sugar I substituted a bit of honey and only used a drizzle of oil to cut back on the fat. I also used brown rice and added a few handfuls of sugar snap peas to increase the serving size without increasing the calories by much. Excellent recipe and I can't wait to share it with all of my friends
As is, this recipes is just so-so. With a few modifications, it can be great! I use soy sauce instead of oyster sauce and I add a few extra tablespoons of it - but that's just a personal choice. What makes a HUGE difference is using real Thai chilis instead of serrano peppers. I personally use five chilis, but I like it REALLY hot so normal people may want to use 2 or 3. I also cut the oil in half, added 1/4 tsp of salt, and added sliced shitake mushrooms. Awesome!
This recipe was easy to make and it was very tasty. It is close to the dish I usually order at the Thai restaurants.
* Percent Daily Values are based on a 2,000 calorie diet.
Thai Spicy Basil Chicken Fried Rice
Serving Size: 1/6 of a recipe
Servings Per Recipe: 6
Amount Per Serving
Calories: 794
Calories from Fat: 199
With our 2,700+ chicken breast recipes, you'll never serve the same old chicken again.
The firm, juicy texture of zucchini make them a perfect side to toss on the grill.
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A quick chicken stir-fry with loads of crisp, colorful vegetables.
See Chef John's tasty version of spicy Thai chicken soup.
A fantastic use for leftover rice, this is one restaurant quality dish!


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Depestre, René
From Library of Congress Name Authority File
Depestre, René
Instance Of
Scheme Membership(s)
Collection Membership(s)
Exact Matching Concepts from Other Schemes
- found: His Etincelles, 1945.
- found: Info. converted from 678, 2012-10-02 (b. 1926)
- found: East Carolina Univ. Writers of the Caribbean WWW site, Mar. 30, 2004 (René Depestre, b. in Haiti in 1926; lived in Cuba as an exile from the Duvalier regime; a founder of the Casa de las Americas publishing house; best known for his poetry; later a resident of France)
- found: Danticat, E. "René Depestre" in The Caribbean writer, vol. 9, 1995: p. 87 (Depestre was born in Jacmel, Haiti on August 29, 1926)
LC Classification
Change Notes
- 1980-02-14: new
- 2014-07-10: revised
Alternate Formats


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Pritchard company in business over 50 years
PRICHARD -- Anyone who's ever had a surgical procedure has likely noticed the yellow hue on their skin at the place of an incision. That would be povidone iodine, and that would be a product that is manufactured and bottled right in Wayne County and shipped throughout the country and beyond, to Asia, Europe, the Middle East and South America.
Aplicare, which is located in Prichard, also makes sterile lubricating jellies used in catheter insertions and small bottles of hand-sanitizer, lotions, mouthwashes and shampoos that are provided for hospital patients throughout the world.
Prichard's 38,000-square-foot facility (along with a leased 30,000 warehouse in Huntington) make up up one of two major locations for Aplicare, the other being in Meriden, Conn., also the site of its sales and marketing business offices.
Aplicare's history in West Virginia goes back to 1956, when Don McDaniel established Redi Products in Huntington. That company was acquired by General Medical Corp. in 1971, and it was the mid-1970s when it started manufacturing povidone iodine. It moved in 1981 to its current facility in what is now the A. Michael Perry Industrial Park in Prichard.
In 1995, it sold to McBar Medical Products and a year later McBar Medical merged with Aplicare and in 1999 Aplicare took control, leaving the company with its current name.
Last year, it was acquired by the Clorox Company, a move that has brought a number of pleasant surprises, said Paul Carico, general manager at Aplicare's Prichard plant.
Clorox does more than just surface cleaning solutions, he pointed out. It also owns Hidden Valley Ranch, Burt's Bees, Glad bags, Kingsford Charcoal and more. It has a wealth of resources that Aplicare can now access in terms of global sourcing and buying power, research and development and more.
"We have a bunch of new resources now to help us move forward," Carico said, adding that since being purchased by Clorox, Aplicare has invested $300,000 in capital improvements.
"I can't say enough about the Clorox Company," Carico said. "It's a big company, and we were expecting big company politics."
But in the maybe 50 visits from management, they've found Clorox officials to be cordial, understanding, willing to listen and easy to work with, Carico said. "It's a people-friendly organization," he said.
It's taken a lot of work to get the systems in place as Clorox prefers to operate, but in the meantime, Aplicare has been educating Clorox, for which this is a first endeavor into health care products.
"We're educating them while they're educating us," Carico said.
"I believe our future is brighter now than it has ever been," Carico said. Clorox already has innovative product ideas in the pipeline, but is in the midst of learning the ropes as it pertains to FDA regulations, he said. Aplicare is helping with that.
Registered with the Food and Drug Administration for manufacturing, processing, packing and holding of drugs and medical devices, Aplicare has much experience in working in compliance with strict health care regulations. In that sense, the company has been able to help Clorox learn some things while it learns a tremendous amount from it about improving systems, Carico said.
Along with changes undergone in the past 18 months, Aplicare has seen increases in volume and is poised for even more growth.
Just this summer, Aplicare was honored with a Governor's Commendation for International Market Entry Award, for increasing its exports to 12 new countries in 2012 -- Afghanistan, Canada, China, India, Israel, Italy, Malaysia, Mexico, Panama, Saudi Arabia, Turkey and the United Kingdom. Carico credits international sales manager Jim Durkin, based in Connecticut, for the boost.
He's been hard at work pursuing international sales, which is fairly involved as it pertains to making sure the products meet with federal health guidelines in various countries.
But he's succeeding, and "We're seeing improved volumes because of that," Carico said.
Aplicare's Prichard plant has 45 full-time employees working on a three-shift schedule five days a week. Annual sales dollars out of the Prichard facility are somewhere around $18 million, Carico said.
"Our biggest asset is our people, bar none," he said. "We've been in business over 50 years for a reason."
It's their willingness to take personal ownership and responsibility for their work, their attention to detail, and willingness to work together toward a common goal.
Also due much credit for the success of the company is the previous general manager, Rick Hicks, who retired last year, and his leadership that inspired employees to do all those things, Carico said.
Plant engineer Bill Harris, who has customized machinery for Aplicare's specific needs, has been a key player as well, Carico said.
"I'd put his plant engineering capabilities against anyone in the world," Carico said. "He's built our production equipment in-house and tailored it to our needs. Because of that, we're able to be more efficient. It's truly amazing what he's done."
He's been there more than 30 years, and 32 percent of the total employees have been there more than 20 years, Carico said.
Two of them are Veronica Murphy (28 years) and Sandy Hay (27 years). Both said they work there for the people.
"It's like a family -- we have a lot of history together, all of us," said Murphy, a packer in the plant. "In our business, we're all close. We all learned it together."
And they take pride in knowing that the products they make help people every day prevent illness.
"I'm one of them -- I have Graves' disease, an auto-immune disease," she said. "I'm not going to send something out that I wouldn't want used on my own children."


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(12 Days of Holiday Sweets) Day FIve: Gluten-Free Cut-Out Cookies
December 07, 2011
This time of year leaves me feeling a little like the Cookie Monster: "Me want cookies!" And I don't want just any cookie, I want cut-out cookies. I love cookie cutters. I might love them too much. My 200-plus cookie cutter collection even boasts an armadillo-shaped cookie cutter.
When I want to make use of my excessive cookie cutter collection I turn again and again to my recipe for basic cut-out cookies. As written, it makes delicate vanilla-scented cookies that strike a nice balance between sweet and buttery. But like most, I like to play with my food. This recipe welcomes change! If you crave a more robust flavor, swap brown rice flour and brown sugar for the white rice flour and granulated sugar. Or you can add some lemon zest and oil instead of vanilla extract.
This recipe first appeared on SeriousEats.com as part of my Gluten-Free Tuesday column. But I love it so much that I wanted to share it during the 12 Days of Holiday Sweets. Enjoy!
Dry Ingredients
1 1/4 cups white rice flour
1/2 cup cornstarch
1/4 cup sweet rice flour
1 teaspoon baking powder
1/4 teaspoon salt
1/4 teaspoon xanthan gum
Wet Ingredients
2/3 cup butter, softened
3/4 cup granulated sugar
1 large egg
1 teaspoon vanilla extract
2-3 teaspoons water, if needed


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About a month ago, I installed DriveHarmony from DataCore and created a protected disk. Today, I am updating you with the results of my unprotected disk testing and giving you a short summary of the DriveHarmony product. Read on for details!
As a refresher, I installed WHS2011RC on a VMWare Server installation on my HP HPE390t desktop. Here is the test system summary again:
- VMWare Server version 2.0.2;
- Host machine is a HP HPE390t running Windows 7 Ultimate 64 bit, two cores from my i7-980X and 4GB of memory allocated to the VM;
- One 400GB IDE drive harvested from my old 2001 era Gateway desktop, loaded into a ThermalTake Silver River DUO Enclosure using USB 2.0; and,
- One 500GB Seagate drive that was originally in my HP EX475 MSS, loaded into a RocketFish USB 3.0 3.5" SATA Hard Drive Enclosure.
My installation process was as follows:
- Add the external enclosures to the HPE390t;
- Allocate these USB drives to the host machine in VMWare Server;
- Allocate these drives as new virtual drives in the virtual machine that is running WHS2011 RC;
- Install DriveHarmony;
- Create an unprotected drive.
Since I added the drives to the VMWare Server instance when I performed my protected drive tests, I'll just document the process of adding the USB drives to an unprotected pool in this article. See my last post on DriveHarmony for details on how to add the drives to the VM.
Click on Create Unprotected Drive.
Next, click on drive(s) to add. Click on Create Drive.
36 hours later, the format had not completed so I killed the job. DataCore advised me that USB 2 drives are too slow for acceptable performance of DriveHarmony and advised ensuring that external drives are connected either via ESATA or USB 3. Once that drive format would have completed, I would have had an unprotected pool created from the available space on both drives.
This concludes my testing of DataCore's DriveHarmony.


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While I was first learning torch-fired enameling, I did a lot of experiments--propane vs MAPP gas, sifting on vs dunking in enamel powders, opaque vs transparent, copper vs silver vs iron underneath--and even brass, which apparently couldn't be done. I'm so glad I found that it can be done, because transparent enamel on brass makes a pretty opalescent look that I love.
After all that experimenting, I've ended up with a whole bunch of random pieces--enameled bead caps, organic enameled shapes, lots of enameled flowers and domed pieces for stacking (because that seems to be my favorite thing to do!), and wayyy too many melted things. (Tip: Most of the jewelry supplies you buy in craft stores, such as stamped metal components, metal charms and blanks, bezels, etc., are not suitable for torch-fired enameling--they'll melt almost immediately. If it clings to a magnet, you can probably enamel it, but my brass pieces don't cling to a magnet and they work fine.)
While I enjoy cutting out and shaping my own pieces to enamel and playing with color combos, I found myself wanting to explore more of this technique that I love so much. There are many ways to add interest and alter enameled jewelry designs, beyond just different colors. (Note that these are additions that go on pieces that already have a base layer of enamel.)
1. Stencils: I tried using stencils with enameling right from the start. I took some pieces of firm plastic recycled from to-go container lids and used various craft hole punches to make designs in them. I kept it simple at first, making a stencil with lots of small dots, one with lots of larger dots, and stencils with just one of each size so I could have better control over placement.
Here's the basic how-to: Enamel my shapes as usual, and with the cooled piece already on the wire mesh or trivet, place the stencils and sift enamel powders over them. Then remove the stencil carefully and refire, taking care to warm the already-enameled piece gently to avoid cracking the existing enamel. As you can see here, the larger-dot stencil made fun polka dot pieces, and I used the single larger-dot stencil to play around with making eyes and a nose on a bear face, just to see if I could. In her new video Basic Jewelry Enameling, Pauline Warg uses a feathery fern leaf, copper screen, metal mesh, punched papers, and other items as a stencil. There are really no limits on this one, but you should heat carefully so as to not lose the stenciled details.
2. Glass beads, (3) millefiori slices, and (4) glass threads are precise, easy, mess-proof ways to add concentrated spots of color and patterns to enameled pieces. Just place them where you want them (on pieces that already have an enameled base) and refire. Remember that enamels are simply pulverized glass, so adding glass in forms that are less pulverized (lumps, beads, discs, threads, etc.) is fun to try.
5. Enamel pens are the ultimate in versatility and creativity for enameled pieces. They come in a variety of colors and you can use them to draw or write anything your heart desires onto a cooled, base-enameled piece. Then just refire.
6. Liquid enamels are much the same as enamel pens, but you mix your own with water and paint them on as opposed to drawing with the convenient pens. Either way, it's simply "painting" with enamels in a liquid form, and it's how I made the white polka dots on blue in this test piece. The liquid/binder burns off leaving your enameled designs.
7. Stamps and ink: I love finding all kinds of ways to use rubber stamps from my "other" crafty life in jewelry making. You can use rubber stamps and Staz-On ink to stamp patterns and designs on base-enameled pieces. Press the stamped design into enamel powder, tap off the excess, and refire from underneath. You're just using the ink sort of like Klyr-Fire to hold the enamel in place during firing.
8. Decals: I first experienced decals in a torch-fired enameling class with the wonderful Barbara Lewis in Tucson last year. You can buy ceramic decals and simply soak them following manufacturer's instructions until the backing comes off, then place them on your base-enameled pieces. Dab off excess water, place the piece in a trivet on mesh on a tripod, sift on a good layer of clear enamel, and refire from underneath.
9. Metal wire, (10) metal foil, and (11) metal ink: We spend a lot of time adding color to metal--here's a way to add metal back to your colorful enameled pieces. You can easily add texture and dimension to enameled pieces by adding wire shapes, whether in cloisonné style (like Pauline's designs on the right) or simply adding a pre-enameled or bare wire spiral or other shape onto a base enameled piece and enameling over it (transparent or clear would be best, but a thin layer of opaque could work too).
Pieces of pure metal foil (silver, gold, or copper) can be adhered to metal or base-enameled pieces using Staz-On, Klyr-Fire, non-aerosol hairspray, or liquid enamels, allowed to dry, and be fired; if you choose, you can then cover them with a layer of transparent or clear enamel before firing again. (Metal foils must be fired with nothing over them first, to bond them to the metal or enamel underneath. Otherwise the pure metal foil can ball or crinkle up just like pure metals can and all but disappear.) Metal foils add a bright metallic splash to your designs. You can also draw metal designs onto enameled pieces using real metal "ink" pens. Cool Tools has a gold one in their new enameling offerings that I can't wait to try.
12. Drawing, scratching, scrolling (like sgraffito): This is possibly the simplest and most complicated one of all. It's simple because you don't need anything--just the mandrel, soldering pick, or some other steel tool that you're probably already using, though there is such a thing as a scrolling tool made for this--but complicated because you have to work in hot enamels to achieve it. Working with two or more colors, you can add lump or powder enamels or glass beads to a base-enameled piece and heat; while it's still in a liquid state, move the flame and "draw" in the molten enamel, pulling one color into another, making swirls, or scratching designs through several layers, even down to the metal again. Please be careful if you try this and keep it simple--the open flame and molten enamel complicate things enough. Check your morning latte foam for design inspiration--it's the same technique of dragging one color into the other.
13. Negative space: This is a design element that I'm really drawn to but I often forget about. Mary Hettmansperger and Barbara Lewis, two enamel jewelry designers I've enjoyed learning from, turned me onto cutting out organic shapes, punching holes in them, then enameling. If you keep the holes clear of enamel, you end up with an interesting surface that you can leave as-is or embellish with other elements like beads, wire, etc.
If you'd like to learn more about torch-fired enameling, we just released a new video tutorial, Basic Jewelry Enameling: Torch Fired Tutorial with Pauline Warg, that is packed with fun and info. In her video, Pauline shares:
Order or instantly download Basic Jewelry Enameling: Torch Fired Tutorial with Pauline Warg. It's over two hours of oh-so-much fun!
Pauline Warg is a metalsmith with 38 years of experience. She earned a Journeyman Metalsmithing Certificate after completing a three-year apprenticeship to Master Goldsmith Philip Morton and holds a BFA from the University of Southern Maine. Pauline authored Making Metal Beads and contributed to Jewelry Design Challenge. Currently Pauline owns and operates WARG Enamel and Tool Center in Scarborough, Maine. Visit www.wargetc.com.
Re: rubber stamps: Why use a dark ink? I use embossing pads (essentially a light glue in a pad). I sift the enamel on and then give the piece a solid rap to knock off the excess.
Hi lillian13,
StazOn inks come in most any color, so it doesn't have to be dark. Please let me know if I've overlooked the part about using dark ink in the blog; I don't see it.
Thanks for writing and for being part of JMD!
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