text:
A catheter is provided with steering capability at its distal end by a tubular guiding member which protrudes from an opening at the distal end of the catheter and either changes shape or rotates about its longitudinal axis upon pressurization from the proximal end. In one means of actuation, the tubular member has one or more ports close to its distal end, which form laterally directed jets when the tubular member is pressurized within by fluid, the reaction force of the jets bending the tubular member in the desired direction or causing it to rotate. In another means of actuation, the tubular member either curves upon pressurization from an otherwise straight configuration upon pressurization, or straightens from an otherwise curved configuration. The tubular member can expand upon pressurization to seize the interior of the catheter body, rending both elements movable as a unit. Once the catheter is fully positioned, the tubular member can be withdrawn and replaced by functional devices or guidewires.
1. A combination catheter body and guiding member, said combination comprising:
a catheter body with distal and proximal ends and a catheter body lumen open at both said distal and proximal ends;
a tubular member having distal and proximal ends and a longitudinal axis and sized to be received in said catheter body lumen, said tubular member having at least one tubular member lumen and a distal segment formed of elastic material inflatable from a relaxed condition in which said tubular member fits loosely in said catheter body lumen to an inflated condition in which said tubular member seizes said catheter body, said tubular member being closed at said distal end and having at least one port within approximately 1 cm of said distal end, said at least one port shaped and arranged to eject a stream of fluid in a direction transverse to said longitudinal axis upon pressurization of said tubular member.
2. A combination in accordance with claim 1 in which said at least one port is shaped and arranged to eject a stream of fluid in a direction of from about 60° to about 120° relative to said longitudinal axis.
3. A combination in accordance with claim 1 in which said at least one port is shaped and arranged to eject a stream of fluid in a direction of about 90° relative to said longitudinal axis.
4. A combination in accordance with claim 1 in which said at least one port has an axis intersecting said longitudinal axis.
5. A combination in accordance with claim 1 in which said at least one port has an axis which does not intersect said longitudinal axis.
6. A combination in accordance with claim 1 comprising only one such port.
7. A combination in accordance with claim 1 in which said tubular member comprises two or more such tubular member lumens and such ports are equal in number to said tubular member lumens, one port communicating with each tubular member lumen.
8. A combination in accordance with claim 1 in which said tubular member comprises exactly two such tubular member lumens and exactly two such ports, one port communicating with each tubular member lumen.
9. A combination in accordance with claim 1 in which said tubular member when in said relaxed condition exceeds said catheter body in length by at least about 1.0 cm.
10. A combination in accordance with claim 1 in which said tubular member when in said relaxed condition exceeds said catheter body in length by from about 1.5 cm to about 10.0 cm.
11. A combination in accordance with claim 1 further comprising a source of pressurized fluid supplying said at least one tubular member lumen.
12. A combination in accordance with claim 11 further comprising control means for varying the pressure of said pressurized fluid supplied to said at least one tubular member.
13. A combination in accordance with claim 1 in which said tubular member comprises two or more such tubular member lumens, a plurality of ports equal in number to said tubular member lumens, one port communicating with each tubular member lumen, a source of pressurized fluid supplying said tubular member lumens, and control means for individually controlling fluid pressure supply from said source of pressurized fluid to each of said tubular member lumens.
This invention lies in the field of medical catheters and relates to means for advancing catheters through elongated and often branched or convoluted bodily passages.
Catheters are widely used in medical procedures, providing access to internal bodily passages and cavities for both diagnostic and therapeutic purposes without surgery. Catheter use has enabled physicians to perform sophisticated non-surgical procedures in such diverse regions of the body such as the heart and coronary arteries, the brain, and the genito-urinary tract. Catheters offer significant benefits in these procedures by lowering the cost of the procedure and reducing risks.
A critical step in catheter procedures is the insertion of the catheter into the body and the placement of the catheter tip at the appropriate location. Precise placement of the catheter tip is often critical to the function to be performed by the catheter, since the function must often be performed at a highly localized region of internal tissue without affecting adjacent areas. Placement is particularly difficult when the bodily passage is very small in diameter as well as long and tortuous, and when the interior wall of the passage is delicate and susceptible to puncture.
There are numerous examples where catheter tip placement can be critical to the success of the procedure. The removal of plaque from arteries in cardiovascular surgery is one example. Accurate steering is important in this procedure in reaching or sub-selection of the affected arteries and the location of the plaque or thrombi. In obstetrics and gynecology, directional control is important when catheters are used for the selective removal of excessive tissue and cyst growth in dilatation and curettage procedures. The same is true for the use of catheters used to deliver site-specific treatments for ovarian cancer. Directional control is also important in catheter-based urology procedures, such as the selective removal of malignant prostate tissue and the treatment of urinary tract blockages and infections. Improved biopsy methods use catheters to reduce the incidence of trauma in healthy tissue. Directional control is particularly important in neurosurgery involving the use of catheters to remove intracranial hematomas and similar procedures. Due to the high degree of tortuosity of the vasculature, sub-selection of the affected artery is difficult, requiring a long time and a high degree of dexterity by the clinician. Other procedures and applications where steering capability is important will be readily apparent to the experienced medical practitioner.
Steering mechanisms have been devised for directing the distal tip of the catheter in a desired direction by remote control from the proximal end. One such mechanism includes a series of wires running the length of the catheter body on either side of its central axis and terminating in shims or thin strips at the distal end of the catheter. The operator steers the catheter by applying tension to one shim relative to the other, thereby causing the distal end to curve in the direction of the wire to which tension has been applied. This mechanism has disadvantages, however. The wires and the mechanism at the proximal end for selectively applying tension are unwieldy and susceptible to breakage. Furthermore, the wires offer limited directional choice without twisting the entire catheter to achieve angular adjustments relative to the catheter axis.
Guidewires are widely used to assist in the placement of catheters in locations which are difficult to reach. A guidewire is typically of very narrow diameter to fit within the lumen of a catheter. This permits the operator to slide the catheter over the guidewire once the guidewire has been properly positioned. It also permits the operator to remove one catheter and replace it with another without removing the guidewire, thereby avoiding the cumbersome procedure of independently relocating the catheter tip to the region of interest. The steering of a guidewire is generally accomplished by incorporating a slight curve into the guidewire construction at its distal tip, the tip being resilient in construction to resume the curvature when relaxed. This enables the operator to direct the guidewire tip laterally into branches of the vessel. To do this, however, the operator must rotate the guidewire from the proximal end so that the curve points in the desired direction.
A further steering method described in the literature involves the use of laterally directed jets of fluid at the distal tip of the catheter, where the reaction force from the jets causes the tip to bend. A disclosure of jets of this type is found in Boretos, U.S. Pat. No. 4,403,985, issued Sep. 13, 1983. The reaction force principle is also used to advance a catheter into the bodily passage by directing the jets at an acute angle relative to the catheter axis. By simultaneously actuating two or more jets positioned at intervals around the circumference of the catheter tip, the net reaction force will be directed along the catheter axis in the distal direction. Disclosures of catheters utilizing this effect are found in Papantonakos, U.S. Pat. Nos. 4,717,381, issued Jan. 5, 1988, and U.S. Pat. No. 4,769,006, issued Sep. 6, 1988, and Schubert, U.S. Pat. No. 4,475,902, issued Oct. 9, 1984. One difficulty with these systems is that they require several independent lumens extending the length of the catheter and independent ports at the catheter's distal tip, limiting the space available at the tip for functional (therapeutic or diagnostic) elements.
These and other disadvantages of the prior art are addressed by the present invention.
The present invention resides in a steering guide for a catheter, which replaces the guidewire and provides directional steering at the distal tip upon command from the proximal end, and yet is removable from the catheter once steering of the catheter is no longer required. The steering guide is a hollow tubular member which upon pressurization from the proximal end either curves at its distal end from an otherwise straight configuration, straightens from an otherwise curved configuration, rotates around the longitudinal axis of the tubular member, or simultaneously rotates and either curves or straightens. The tubular member is of sufficiently small diameter that it fits loosely within a lumen in the catheter body, permitting an easy withdrawal of the tube, at least when the tube is not pressurized. For embodiments in which pressurization causes a change in the shape of the distal end, this is due to either a reaction force from one or more jets formed at one or more ports near the distal end or to a distortion in shape due to the pressurization alone. For embodiments in which pressurization causes the distal end to rotate, the rotation is the result of a reaction force from a jet.
The tubular member passes through a lumen running the length of the catheter body. The lumen may be the same lumen used for passage of a guidewire in over-the-wire catheters of the prior art or a lumen which has been specifically designed for the steering guide of this invention. In either case, the lumen is open at both the proximal and distal ends of the catheter so that the tubular member can be inserted at and withdrawn from the proximal end and can protrude from the distal end. In preferred embodiments, the tubular member is formed at least in part by a material of construction which is soft and elastic relative to the catheter body. In these embodiments, pressurization will cause the tubular member to expand and seize the internal wall of the catheter body lumen. In this condition, the tubular member and the catheter move as one. Deflation of the tubular member causes it to resume its relatively narrow cross section so that it fits loosely within the lumen and can be moved independently of the catheter, permitting it to be advanced into and withdrawn from the catheter. The relatively soft, elastic portion of the tubular member may be only a segment of the tubular member at its distal end, or it may constitute the full length of the tubular member.
For embodiments of the invention utilizing the reaction force of a jet, the tubular member is closed at its distal end except for one or more ports positioned a short distance from the distal end. These ports are shaped to emit jets of the pressurized fluid from the interior of the tubular member outward in lateral directions, and depending on the shape of a particular port, the reaction force can either be in a direction which intersects the axis of the tubular member or is offset from the axis. When the direction intersects the axis, the reaction force will cause the tip of the tubular member to bend or curve to one side. When the direction is offset, the jets will exert a tangential reaction force, causing rotation of the tubular member unless the rotational force is balanced by a second tangential jet.
For embodiments which do not utilize reaction forces, the tubular member is completely closed at its distal end and responds to the pressurization by a distortion in shape. Elastic tubular members which are preshaped to have a curved tip when relaxed (not pressurized) will distort to lose the curvature and straighten when pressurized. Similarly, elastic tubular members whose tips are straight when relaxed are constructed in such a manner that they distort by curving to one side when pressurized.
In each of these embodiments, the distal end of the tubular member protrudes a short distance from the distal opening of the catheter. Upon pressurization, the tubular member may lengthen elastically to protrude further.
In each of the embodiments as well, the tubular member can contain a single lumen or two or more lumens, all extending the full length of the tubular member from its proximal to its distal end. In embodiments in which jets are emitted, a single lumen may open at a single port to form a single jet. Alternatively, the single lumen may have two or more ports near the distal end to provide an added steering effect from the sum of the reaction forces generated at each port. This is useful when it is desirable to avoid high pressures at the jets. Still further, the tubular member can have two or more lumens, each leading to its own lateral port near the distal end, the ports distributed around the circumference of the tubular member. An independent supply of fluid to each lumen will actuate the jets independently. In further variations when multiple ports are present, the configurations of the ports can differ from one port to the next to point the jets at different angles to serve different purposes, thereby by affording the clinician a choice, for example, between axial rotation of the tubular member and non-rotational bending of the tip. Multiple lumens may also play a role in bending the tip for tubular members which do not form jets, and in selecting the direction in which the tip will bend.
A more detailed explanation of these embodiments, as well as additional features and advantages of the invention, are offered in the description which follows.
FIG. 1 is a perspective view of the distal end of a catheter and tubular guiding member representing one embodiment of the present invention.
FIG. 2 is a view identical to that of FIG. 1 with the tubular guide member moderately pressurized.
FIG. 3 is a further view identical to that of FIG. 1 with the tubular guide member pressurized to a higher degree than in FIG. 2.
FIG. 4 is a cross section of a tubular member representing one embodiment of the invention, at a location intersecting the location of the jet.
FIG. 5 is a cross section of a tubular member representing a second embodiment of the invention, at the same location.
FIG. 6 is a cross section of a tubular member representing a third embodiment of the invention, at the same location.
FIG. 7 is a cross section of a tubular member representing a fourth embodiment of the invention, at the same location.
FIG. 8 is a perspective view of the distal end of a catheter and tubular guiding member representing an embodiment of the invention which does not employ jets.
FIG. 9 is a view identical to that of FIG. 8 with the tubular guide member pressurized.
FIG. 10 is a perspective view of the distal end of a catheter and tubular guide member representing a second embodiment of the invention which does not employ jets.
FIG. 11 is a view indentical to that of FIG. 10 with the tubular guide member pressurized.
FIG. 12 is a cross section of a tubular member which can be substituted for that shown in FIGS. 10 and 11.
FIG. 13 is a cross section of the tubular member of FIG. 12 with one of two lumens inflated.
FIG. 14 cross section of the tubular member of FIG. 12 with the other lumen inflated.
FIG. 15 is a cross section of a catheter body and tubular member containing a styler.
FIG. 16 is a diagram depicting the components of a single-jet catheter steering system representing one embodiment of the invention.
FIG. 17 is a diagram depicting the components of a dual-jet catheter steering system representing a further embodiment of the invention.
While the invention is broad in scope and has numerous features each of which is variable to some degree, the invention is best understood by a detailed description of certain specific examples such as those shown in the attached drawings. Throughout this specification and the appended claims, the terms "proximal"and "distal" are used in the same manner as they are by medical professionals who regularly perform catheter procedures, "proximal" denoting the end of the catheter or similar device closest to the physician when the device is in place inside the patient's body, and "distal" denoting the end furthest from the physician and furthest inside the patient's body.
FIGS. 1 through 7 show various embodiments of the invention involving jets and their reaction forces.
FIGS. 1, 2 and 3 show the distal segment of a catheter body 11 with a tubular member 12 placed inside the catheter body. The tubular member 12 resides in a longitudinal lumen 13 in the catheter body. In the view shown in FIG. 1, the tubular member 12 is not under tension, but instead in a relaxed state, and the fit between the tubular member and the catheter body is loose enough to permit longitudinal motion of one relative to the other.
The catheter body 11 shown in FIGS. 1, 2 and 3 is a simple cylinder with a single central lumen 13. In typical implementations of this invention, the catheter body may contain one or more additional lumens, and one or more functional elements, such as diagnostic elements, imaging elements or ablative or other therapeutic elements, at the distal end. Alternatively, functional elements may be inserted in the same lumen as the tubular element after the catheter body has been fully positioned and the tubular element has been withdrawn. For convenience, these figures show only a rudimentary structure.
The distal end 14 of the tubular member protrudes beyond the distal end 15 of the catheter body by a short distance to permit bending. In preferred embodiments, this distance is about 1.0 cm or greater, more preferably about 1.5 cm to about 10.0 cm, and most preferably about 2.0 cm to about 9.0 cm. The distal end 14 of the tubular member is closed, but an opening or port 16 leading from the interior of the tubular member opens to one side of the tubular member, the port being positioned a short distance from the distal end of the tubular member. This distance may vary, but in most cases will be about 1 cm or less, and preferably about 0.5 cm or less.
Pressurization of the tubular member with a fluid in its interior causes the tubular member to assume the configurations shown in FIGS. 2 and 3. The tubular member is formed of an elastic material which readily bends under the influence of external forces and resumes its original relaxed configuration when those forces are no longer present. The port 16 in the side wall of the tubular member ejects the pressurizing fluid as a jet 21 in the direction of the arrow 22. The reaction force from the jet causes the tip of the tubular member to bend as shown in FIGS. 2 and 3.
In the absence of other external forces, the reaction force will be balanced by the resiliency of the tubular member, i.e. , its tendency to return to its relaxed state. The resiliency force increases with the degree of bend, and the tubular member bends toward an equilibrium position in which the reaction force from the jet and the resiliency force from the tubular member material are equal. The degree of bend shown in FIG. 2 is the result of a moderate pressure in the tubular member. A greater pressure produces a stronger jet 23 and thus a greater reaction force and greater degree of bend, as shown in FIG. 3.
Internal pressure in the tubular member 12 also causes the tubular member to expand and fill the catheter body lumen 13, seizing the interior wall of the lumen. When the catheter body 11 is advanced forward (in the proximal direction) in this condition, it pushes the distal tip 14 of the tubular member forward. In this manner, the tubular member is advanced into branched or tightly curved passages, with its distal tip at an appropriate angle for advancement in the desired direction.
Cross sections of various different types of tubular members designed to form jets and corresponding reaction forces are shown in FIGS. 4, 5, 6 and 7. These cross sections are perpendicular to the longitudinal axis of the tubular member and intersect the ports at which the jets are formed.
The tubular member 12 of FIG. 4 has a single port 16, the port itself having an axis which lies radially relative to the tubular member. The direction of the jet emerging from the port is shown by the arrow 22, and the resulting reaction force intersects the axis 17 of the tubular member, causing a simple bending movement of the tubular member tip. To bend the tip in another direction, the tubular member must be rotated about its longitudinal axis by a torsional force exerted manually at the proximal end. If the tubular member is sufficiently expanded to seize the catheter body, both the tubular member and catheter body will be rotated as a unit.
The tubular member shown in FIG. 5 has a port 27 which is arranged with its axis tangential relative to the tubular member lumen 28, still perpendicular to but not intersecting the axis 17 of the tubular member. The emerging jet 29 is tangential as well, and the reaction force on the tubular member causes rotation of the tubular member around its longitudinal axis 17, in the direction shown by the arrow 30. Rotation can occur simultaneously with bending, since the reaction force of the jet 29 is still transverse to the longitudinal axis 17 of the tubular member. Rotation can be suppressed, however, by stabilizing the catheter body at its proximal end. Since the catheter body is seized by the tubular member under these conditions, the tubular member will likewise be prevented from rotation. The portion of the tubular member protruding from the distal end of the catheter body will then bend to one side, as its only response to the reaction force. Alternatively, the response to the reaction force can be restricted to rotation, for example by pressurizing the tubular member when the distal tip is positioned in a non-branched segment of the vasculature or other bodily passage.
The tubular members shown in FIGS. 6 and 7 differ from those of the two preceding figures by having two lumens instead of a single lumen. In FIG. 6, the two lumens 34, 35 are of equal cross section, separated by a dividing wall 36. Each lumen has a separate port 37, 38, radially oriented, forming jets in the directions indicated by the arrows 39, 40. Selective pressurization of any one lumen will produce a reaction force oposite to the direction of the jet emerging from that lumen, and the tubular member can be made to bend in either of two opposing directions.
In FIG. 7, the two lumens 44, 45 are identical to those of FIG. 6, but the ports 46, 47 are tangential. When the lumens are pressurized individually, the resulting jets produce reaction forces which cause rotation in the directions of the arrows 48, 49, respectively. The direction of rotation can thus be selected by pressurizing the appropriate lumen. When the two lumens are pressurized simultaneously and equally, the tubular member tip will bend without rotating, as a reaction force to the additive effect of the two jets, the rotating forces canceling each other. The configuration of FIG. 7 can thus be used for rotation of the tubular member in either direction or for bending of the tubular member without rotation.
The ports shown in FIGS. 4, 5, 6 and 7 are all shaped to form jets emerging in a direction perpendicular to the longitudinal axis 17 of the tubular member, whether or not the jet directions intersect the axis. Alternatively, the ports can be shaped to form jets at an angle other than perpendicular relative to the tubular member axis, provided that the jet vectors have a component perpendicular to the axis. Angles may for example range from about 60° to about 120° relative to the axis. Jets which are angled backward, i.e., in the proximal direction, can serve the added function of providing forward thrust to the tubular member in addition to steering the tubular member to one side. When two or more rearly directed ports are symmetrically distributed around the tubular member circumference, each port supplied by a separated lumen, steering may be accomplished by actuating one port to the exclusion of the others, and advancement without steering may be accomplished by actuating all ports simultaneously. With the tubular member sufficiently inflated to seize the catheter body, advancement of the catheter body is achieved as well.
FIGS. 8 through 14 show various embodiments of the invention involving shape changes achieved at the distal tip of the tubular member without reaction forces.
FIGS. 8 and 9 show the distal end of a catheter body 51 with a lumen 52 and a tubular member 53 passing through and protruding from the lumen, the tubular member having no distal ports. FIG. 8 shows the tubular member 53 in its relaxed, deflated condition, the tubular member loosely fitting inside the catheter body lumen 52 and having a shape memory causing its distal tip to curve as shown. FIG. 9 shows the tubular member 53 in its inflated condition, in which the tubular member has not only expanded to seize the internal wall of the catheter body lumen but has also straightened upon being made rigid by the internal pressure.
FIGS. 10 and 11 show an embodiment which is the converse of that shown in FIGS. 8 and 9. The catheter body 51 is the same, but the tubular member 56 has no curvature when relaxed (FIG. 10), assuming its curvature only when inflated (FIG. 11).
The imposition of curvature by inflation can be achieved in a variety of ways. In the embodiment shown in FIGS. 10 and 11, one side 58 of the tubular member near the distal tip is formed of a stiffer, less expandable material than the remainder of the tubular member. Thus, when the interior of the tubular member is pressurized, the side opposing the side of low expandability will exhibit a greater expansion, resulting in the curvature shown. The formation of the stiffer, less expandable region is achievable by conventional means, for example by causing a localized higher degree of crosslinking, or by bonding a relatively non-expandable material to the region.
An alternative method of causing the curvature upon pressurization is shown in FIGS. 12 through 14, which show the tubular member in cross section. Here the tubular member 61 has two lumens 62, 63, one on either side of the longitudinal axis 64 of the tubular member, similar to the tubular members of FIGS. 4 through 7 except without ports. Pressurization of one lumen 62 exclusive of the other 63 as shown in FIG. 13 causes the tubular member to curve to the side opposite the side of the pressurized lumen. Curvature in the opposite direction is achieved by selectively pressurizing the other lumen 63, as shown in FIG. 14. In either case, only the portion of the tubular member which protrudes from the distal end of the catheter body will curve, the catheter body itself preventing the remainder of the tubular member from curving. The degree of curvature in the protruding segment can be varied by varying either the inflation pressure, the length of the tubular member protruding from the catheter, or both. The clinician can thus select the direction of curvature as well as the degree.
For each of the embodiments in FIGS. 1 through 14, additional control of both the tubular member and the catheter body can be achieved by the inclusion of a stylet inside the tubular member. FIG. 15 shows such a stylet in a cross section of the catheter body 11 and tubular member 12. The stylet is formed of a relatively rigid material such as stainless steel, but of progressively narrowing diameter in the distal direction to provide gradually increasing flexibility. The styler can be moved longitudinally relative to both the tubular member 12 and the catheter body 11 to add stiffness to the combined parts at the location where needed.
A complete system for catheter steering embodying the present invention is shown in FIG. 16. The catheter body 11 is shown, with the protruding distal tip 71 of the tubular member. The system shown in this figure is a jet-actuated system, using a tubular member with a single distal jet 72 to cause the tubular member to bend. Appropriate tubular members for this system are those shown in FIGS. 4 and 5. The remainder of the steering system in this embodiment consists of a fluid reservoir 73 serving as a source of fluid for the jet, and a variable speed pump 74 to feed fluid from the reservoir to the tubular member at a selected pressure depending on the angle of bend sought. The same system can be used to control the tubular member of FIGS. 10 and 11.
The system shown in FIG. 17 is a two-jet system, the two jets 81, 82 directed in opposite directions. An appropriate tubular member for this system is the one shown in FIG. 6, and analogously in FIGS. 12 through 14 for a tubular member without jets. The two lumens (not visible in FIG. 17) of the tubular member (corresponding to lumens 34 and 35 of FIG. 6, 44 and 45 of FIG. 7, and 62, 63 of FIGS. 12 through 14) are individually supplied by separate supply lines 83, 84, each one fed by a separate variable speed pump 85, 86, both of which draw fluid from a common reservoir 87. Valves with variable openings, single-lever valves with lever mobility in orthogonal directions rather than two individual valves, or any other conventional flow control or pressure control device may be substituted for the variable speed pumps.
Conventional components and materials may be used in the practice of this invention. The catheter body may be formed of any material conventionally used for catheters. Examples are stainless steel, polyethylene, polyvinyl chloride, polycarbonate, polyethylene terephthalate, and various polyimides. The tubular member will be of an elastic material. Examples of suitable materials are the known elastomers, including polyisoprene, polyisobutylene, polybutadiene, polychloroprene, poly(ethylene-co-propylene), poly(ethylene-co-propylene-co-diene), poly(styrene-co-butadiene), poly(isobutylene-co-isoprene), poly(styrene-co-isoprene), poly(butadiene-co-acrylonitrile), polydimethylsiloxane, silicone rubbers, polyesterurethanes and polyetherurethanes. For the pressurization fluid, physiologically compatible fluids may be used, such as water or saline.
The steering mechanism of this invention may be used in a variety of ways, depending on the needs of the particular procedure and the configuration of the passageway into which the catheter is sought to be inserted. Pressurization of the tubular member can for example be alternated with advancement of the catheter body, or both may be done simultaneously. Monitoring of the position of the catheter body can be achieved by conventional methods such as the incorporation of a radiopaque marker at or near the distal end of the catheter body, combined with fluoroscopy or other appropriate detection means. Once the catheter body is fully positioned and the tubular member is no longer needed, the tubular member can be deflated and withdrawn from the catheter body without disturbing the catheter body. Instruments can then be inserted through the catheter body, using the same lumen previously used for the tubular member.
The foregoing is offered primarily for purposes of illustration. It will be readily apparent to those skilled in the art that the components of the system, their materials of construction, their dimensions, and their configuration, arrangement and operation can be further modified or substituted in various ways without departing from the spirit and scope of the invention.
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Submitted by kdeweese on March 23, 2011 - 5:19pm
This just in!
In a press release today from Random House Children's Books, it was announced that the final book of the wildly-popular Christopher Paolini "Inheritance" series will be released in November 2011! Wahoo!!
Book 4: Inheritance
This exciting news comes more than three years after the release of the previous book. Author Christopher Paolini (only 17 years old when he wrote the first book) is quoted as saying: "The burning questions asked by fans around the world will finally be answered in this last installment. All will be revealed!"
Click here for a link to the Random House publisher's description of the new book.
I'm looking forward to it! Are you?

subset: commoncrawl


text:
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text:
|Honors & Awards
|Office of Naval Research, Young Investigator Program (ONR YIP), 2002-Present
|National Science Foundation, Faculty Early Career Program (NSF CAREER), 2001-Present
|Packard Foundation, Fellowships in Science and Engineering, 1999-2004
|NIH Director's Pioneer Award, 2006
|Ph.D., Computation & Neural Systems, California Institute of Technology, 1997
|MSE, Electrical & Computer Engineering, Johns Hopkins University, 1989
|BSE, Electrical & Computer Engineering, Johns Hopkins University, 1989
Research Interests
Boahen's research interests include mixed-mode multichip VLSI models of biological sensory and perceptual systems, their epigenetic development, and asynchronous digital communication for reconfigurable connectivity.
Representative Publications
|J H Wittig Jr. and K Boahen, "Silicon Neurons that Phase-Lock, IEEE International Symposium on Circuits and Systems, May 2006.
|K M Hynna and K Boahen, "Neuronal Ion-Channel Dynamics in Silicon", IEEE International Symposium on Circuits and Systems, May 2006.
|B Wen and K Boahen, "A 360-Channel Speech Preprocessor that Emulates the Cochlear Amplifier", IEEE International Solid-State Circuits Conference, February 2006.
|J V Arthur and K Boahen, "Learning in Silicon: Timing is Everything", Advances in Neural Information Processing Systems 17, B Sholkopf and Y Weiss Eds., MIT Press, 2006.
|K Boahen, "Neuromorphic Microchips", Scientific American, vol 292, no 5, pp 56-63, May 2005.
|T Y W Choi, P Merolla, J Arthur, K Boahen and B E Shi, "Neuromorphic Implementation of Orientation Hypercolumns", IEEE Transactions on Circuits and Systems I. vol 52, no 6, pp 1049-1060, June 2005.
|K A Zaghloul, K Boahen and J B Demb, "Contrast Adaptation in Subthreshold and Spike Responses of Mammalian Y-Type Retinal Ganglion Cells", Journal of Neuroscience, vol 25, no 4, pp 860-868, January 2005.
|P Merolla and K Boahen, "A Recurrent Model of Orientation Maps with Simple and Complex Cells", Advances in Neural Information Processing Systems 16, S Thrun, L Saul, and B Sholkopf Eds., MIT Press, pp 995-1002, 2004.
|K Boahen, "A Burst-Mode Word-Serial Address-Event Link", IEEE Transactions on Circuits and Systems I, vol 51, no 7, pp 1269-1300, July 2004.
|K A Zaghloul and K Boahen, "Optic Nerve Signals in a Neuromorphic Chip", IEEE Transactions on Biomedical Engineering, vol 51 no 4, pp 657-675, April 2004.
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|K A Boahen, "Point-to-Point Connectivity Between Neuromorphic Chips using Address-Events", IEEE Transactions on Circuits & Systems II, vol 47 no 5, pp 416-434, May 2000.
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I never played the original Darkness, mainly because the whole Italian mobster fantasy put me off, since it's been done to death in other media. After looking up some of the important story bits in the first game, (Jenny's death and the ending), I became interested, and decided to check this out.
I'm a few hours in and I'm finding it quite enjoyable. The shooting feels really fucking good, and the overall pacing reminds me a lot of the F.E.A.R. series, with its breakneck pace and all of the different gameplay options. I'm playing mainly for the story, because I want to see where this takes Jackie, and if there is another, hidden, resolution with Jenny, but I find myself enamored with the combat. It's not especially unique, but it's responsive, fun and bloody.
How is everybody else enjoying this so far?


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Tricia, married to DH. 2MC's & 4 yrs ttc...finally mom to Andrew6/06 and Benjamin 10/09. Adopted bro & sis 2002. My 2 fav. words: Spay and Neuter! I'm an Ultimate Viewer, 2010!
Ummmm, I would have to confidently say "No".
Each Mom makes milk catered perfectly to her babes needs (milk differs in composition throughout breastfeeding from newborn to toddler/older nurslings).
To classify us a creating skim...2%...1%...etc...sorry but thats
Also, I am moving this out to the general forum, as per the Breastfeeding Challenges guidelines.
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but i think the mom was joking maybe? i would say no to the question though.
mama to 7 amazing children married to my main man for 24 years and finally home FULL time
I saw that comment though, and was like "huh?" until I started talking with some friends of mine. Maybe she just meant sort of in comparison with other moms, hers seems less creamy.
Katrina - Mama to Gabriel 11/20/2009 and Norah 10/11/2011 and Theo03/11/2013- married to Wayne -
I think milk may vary from person to person; My milk is more on the "skim" side, where as a friend of mine's is very thick and creamy. Her LO is 3 months younger than mine but weighs within a pound or so of mine. Both boys are lean though, chubby thighs, but lots of muscle tone.
I saw that comment though, and was like "huh?" until I started talking with some friends of mine. Maybe she just meant sort of in comparison with other moms, hers seems less creamy.
I think that breastmilk composition flunctuates so regularly (part of what makes it great!) that it's difficult to make blanket comparisons.
Oh, and my daughter is 11 mo now, and until we nightweaned (necessary evil- I'm pregnant again and my supply is nearly gone), she was definitely still nursing that much at night. At that age some babies truly still need it, but some just like to comfort nurse- if you're bedsharing, as Dr. Jay Gordon says, it's like sleeping next to your favorite restaraunt that happens to be open 24-7.
Please don't feel, OP, like your breastmilk is somehow less adequate than other people's, just because LO wakes up frequently. I think you'll find plenty of mamas on here who would say a night similiar to what you're describing is "normal" for them.
Hope the TV mum in the original post was in fact joking (although I wish she hadn't made this joke on what I assume is national television). Otherwise, I feel incredibly sorry for her being allowed to believe this about her milk.
I don't think she was joking, I think she was truely concerned since she is dealing with a micro-premmie.
She qualified her statement of having "skim" milk with the statement that she always had SKINNY breastfed babies. I'm guessing someone has said something to her in the past about how skinny her babies are compared to someone elses. I don't think she did a lot of pumping prior to this last baby and unless you pump multiple times during the day, you really don't get to see the amount of foremilk/hindmilk, much less how it will change throughout the day. If I remember the episode correctly, the doctor wasn't worried at all about it.
I don't think she was joking, I think she was truely concerned since she is dealing with a micro-premmie.
I have always thought that it was genetics that was playing a major role in how big my babies are, but after I heard that comment I started to think that maybe this is also why my 9 month old is getting up so much. Now that I think about it more, that's probably not the case. I think that more than anything, my children have the "don't sleep long" gene!
Tricia, married to DH. 2MC's & 4 yrs ttc...finally mom to Andrew6/06 and Benjamin 10/09. Adopted bro & sis 2002. My 2 fav. words: Spay and Neuter! I'm an Ultimate Viewer, 2010!
It is possible to have skim milk. Very rare, but possible. The thing is, if you're breast feeding your baby successfully and they are gaining weight (at all! Even a little) or are even just maintaining their weight, then your breast milk has fat in it.
I produced breast milk for my oldest and youngest with absolute 0% fat. My oldest was losing weight so fast within the first week of life we had him tested for just about everything. When the tests came back normal we were relieved and scared at the same time cuz he was still losing weight.
My pediatrician then told me to stop breast feeding directly and to start pumping. After tests, we found it wasn't baby but my milk. Absolutely no fat at all. No calories = weight loss. We switched to formula at that point and he gained weight at an average 2 oz./day for the first week.
If you have skim milk. Your baby will be suffering from it at a very early stage. And you'll know beyond any doubt that something is wrong. So yes, it is possible, but very, very rare!
Where your baby has been breast feeding successfully for so long and obviously thriving, even if they aren't chubby or at the bottom of the average weight for their age, your breast milk is still the very best thing for baby.
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A fire ignites a trailer home in Washington County -- killing an elderly man who was sound asleep.
It happened just after 3 a.m. inside a private RV Park located on FM 1948 and LBJ near Lake Somerville.
"I knew he was an older guy," said neighbor Keith England.
Neighbors say he kept to himself.
"I said what's your name…and he couldn't tell me his name," England
Keith England says he grew concerned Monday afternoon after not hearing or seeing his quiet neighbor many residents who live on LBJ Drive near Lake Somerville, call: "Pappy." England says he grew even more concerned after walking over to his house to check on him.
"The heater I smelled, it was bad and he couldn't get up out of bed and there was trash all around his bed," England lamented.
The next morning around 3:30…
"I didn't know there was a fire," said England.
That is until he stepped outside.
"I looked outside and all I saw was the whirling lights; and gosh, the fire, paramedics, police cars," said England
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As soon as the firefighters arrived on scene they say the 20 foot trailer was fully engulfed and had collapsed and the elderly victim was trapped inside.
"It took about 30 minutes to get it knocked down," said Mantey. "We even had to get Prairie Hill to bring in water."
While a space heater is in question -- Tuesday afternoon the State Fire Marshal began his investigation to find what exactly caused the trailer to ignite.
England says he feels guilty for not checking on his lonely neighbor much sooner.
"I don't even know the guy, I walked over there and I saw him," lamented England.
The cause remains under investigation.
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The anonymous blogger discovered the secret society's internal e-mails and gleefully published the most amusing material: members deliberating over which ties to wear (Brooks Brothers, of course) and another insider venting about the "extremely left-wing tilt" of the Georgetown University campus tour.
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Publisher's Description
Miri Brayden teeters on a razor's edge between placating and enraging her brother, whom she depends upon for support. Yet if his anger is unleashed, so is his madness. Miri must keep his descent into lunacy a secret, or he'll be committed to an asylumand she'll be sent to the poorhouse.
Ethan Goodwin has been on the run all of his lifefrom family, from the law ... from God. After a heart-changing encounter with the gritty Reverend John Newton, Ethan would like nothing more than to become a man of integrityan impossible feat for an opium addict charged with murder.
When Ethan shows up on Miri's doorstep, her balancing act falls to pieces. Both Ethan and Miri are caught in a web of lies and deceitfallacies that land Ethan in prison and Miri in the asylum with her brother. Only the truth will set them free.
Author Bio
Michelle Griep has been writing since she first discovered blank wall space and crayons. She resides in the frozen tundra of Minnesota where she teaches history and writing classes for a local high school co-op.
Product Reviews
ShannahAge: 25-34Gender: female4 Stars Out Of 5I loved it!September 17, 2013ShannahAge: 25-34Gender: femaleQuality: 4Value: 4Meets Expectations: 4I loved this book. As it states in the description, Miriall (Miri) Brayden walks a fine line between keeping the peace and her sanity. The author does a very good job of showing us the roiling emotions in Miri's life and you can't help but feel for her circumstances. You are afraid when she is; you are angry when she is; you are happy when she is. Ethan's character is charming in a roguish way. He is enough of a gentleman to hint at his past upbringing, but his appearance and mannerisms speak of a life on the streets. The only complaint I have about Ethan is his "change" was a bit rushed. I felt like I needed more of his background to understand that he could just believe so quickly after the life he had been living.
This book is what some might consider "preachy." However, I think that fits the setting. Ethan comes to know God from a Reverend. I would expect a Reverend to preach the gospel and speak a lot about it. Miri lives in a rectory with a Bishop and her brother, a former minister of God. I would also expect to hear a lot about God from their characters. I didn't think it was over-done as some novels tend to be, though, so I was ok with it.
Overall, Michelle does a great job of conveying her message: to trust in God, no matter what. Her characters are written in a way that the reader can relate to. The descriptions of the asylum and the people in it makes the reader both disgusted for the place they live in and sympathetic with their plight.
Deborha MitchellRedding, CAAge: 45-54Gender: female5 Stars Out Of 5Great Book!!!July 4, 2013Deborha MitchellRedding, CAAge: 45-54Gender: femaleQuality: 5Value: 5Meets Expectations: 5A Heart Deceived by Michelle Griep
After reading Michelle's previous book Undercurrent, I was expecting nothing less than a great read. Well, I was not disappointed. Michelle has definitely stepped it up a bit with this new release. A bit on the darker side, but so intriguing and well written. There is so much going on in A Heart Deceived, you may ask "Will I get lost?" The answer is no! Michelle does an excellent job bringing all the different aspects together and making a perfectly harmonious story_..Murder, addictions, insanity, uncertainty, heartbreak_..add to that, forgiveness, love, compassion and heroism. You will also get a close up look at what went on inside Asylums in those days_.so sad.
Best of all, Michelle brings the power of God into her story in a way that will give you goosebumps. I truly think the story ended too soon. I would love to see a sequel to this book. I highly recommend this book to anyone looking for a story that stirs the soul and makes your heart pound.
I received a copy of this book from NetGalley, but was under no obligation to give a positive review.
MarbieThe NetherlandsAge: 35-44Gender: female5 Stars Out Of 5July 3, 2013MarbieThe NetherlandsAge: 35-44Gender: femaleA new-to-me-author, this was my first introduction with Michelle Griep's writing. This woman really can write! Usually I'm not so much into books with a sort of 'dark' setting and that's why I looked at this book for at least three times and every time decided not to request it for review, but then I did it anyway—and boy, am I glad I did!
The author has a unique way with words that drew me into the story right away—on the first page I sat next to Miri in church and reluctantly had to let my new friend go on the last.
The descriptions are so rich and full, I could almost feel, hear, smell, and touch them. The emotions splattered from the pages—fear, despair, unfairness, hope, love, romance!
Extremely well written, excellent research, and a brilliant plot!!
*Thanks to the publisher for providing me with a review copy through NetGalley.*
Melissa4 Stars Out Of 5Packs a Deep Spiritual PunchJuly 1, 2013MelissaQuality: 4Value: 4Meets Expectations: 5I have been following Michelle's blog for over a year and love her personality. I also interviewed her early on in my blogging life.
So when I picked up Michelle's newest release I think I was expecting something a bit light-hearted since her tone on her blog is fun and quirky but her book was very far from that. In fact her book packed a deep spiritual punch and I loved it.
The first half of the book sets up all the page-flipping intensity of the second half. Once I reached the 50% mark on my Kindle I couldn't stop reading. I found myself reading almost until 1:00 am because I had to see what would happen next.
I could relate to Miri Brayden as she was verbal bashed by her brother. I know the feeling of cowering in a corner and feeling utterly defenseless and knowing your words will only make things worse.
I also understand the character of Ethan, as someone with a dark past and not fully ready to accept God's grace but desperately wanting it.
Oh, and I can't forget to mention Michelle's clever use of last names in the book. See if you notice how well they fit the characters they are attached to.
There were so many times in this book that I wanted to shout out, "Yes, this is what Jesus did for us." I love how Michelle shows this (but I can't tell you how, you'll just have to read it).
If you enjoy historical romances with a deeper, and at times haunting, feel to it than this is a book you will want to devour. Way to go Michell, you knocked this out of the park :)
A copy of this book was given to me by the publishers through Netgalley.com in exchange for an honest review.
Josie4 Stars Out Of 5Reminds me of Liz Curtis HiggsJune 1, 2013JosieQuality: 4Value: 5Meets Expectations: 5This is a very good book. It reminds a lot of Liz Curtis Higgs. The author plants you into the time period very well especially with her use of dialogue.
THe characters are very real and you find yourself routing for Ethan and Mirri as they struggle through various trails and tribulation. Both Ethan and Mirri have dark secrets that they are trying to cover up, and it is those secrets that threaten their burgeoning love.
Good book. Readers are definitely getting a bargin with the price.
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Located in: Minneapolis, Minnesota
Submitted: May 13, 2013
Tell us a little about yourself. I hear voices. Loud. Incessant. And very real. Which basically gives me two options: choke back massive amounts of Prozac or write fiction. I chose the latter.
What was your motivation behind this project? To gain a deeper understanding of the insidiousness of deception and root it out of not only my own life, but to encourage others to do the same.
What do you hope folks will gain from this project? The realization that sometimes a lie need only be spoken once for it to be believed as truth. We should examine the "truths" we believe in light of Scripture.
How were you personally impacted by working on this project? In my research, I was appalled at the harsh treatment of early nineteenth century mental health patients--practices committed oftentimes on those who were known to be perfectly sane, in the name of following orders. It made me question what 'orders' I follow and why.
Who are your influences, sources of inspiration or favorite authors / artists? Favorite authors: Travis Thrasher, John Steinbeck, Lisa Mangum, Charlotte Bronte, Jill Williamson, Jessica Dotta, Tim Downs
Anything else you'd like readers / listeners to know: Life is a vapor--seek God now before it's too late.
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New research shows Android's smartphone market share rise 29% in a year.
Google's Android operating system last year grabbed a 37.4 per cent market share of UK smartphone sales placing it comfortably ahead of both the Blackberry RIM and Apple iOS platforms, new reports have shown.
The technology giant's strategy of licensing Android across handsets produced by numerous mobile manufacturers has paid dividends with 73.8 per cent of Android's new customers having previously owned a non-smartphone.
Similarly, 74.9 per cent of new iPhone buyers were revealed by Kantar Worldpanel ComTech's sales survey not to have purchased a smartphone prior to their Apple handset adoption.
In the 12 weeks ending 20 March 2011, Android not only dominated in Blighty but also in France and the USA with Blackberry's traditional stronghold in North America collapsing from 32.5 per cent to just 12.9 per cent.
Interestingly despite having been described as a 'burning platform' by Nokia's new CEO, Stephen Elop, Symbian remains the number one smartphone platform in Germany with a 30.5 per cent market share. However, this figure is down from 47.3 per cent one year ago.
Dominic Sunnebo, Consumer Insight Director for Global, Kantar Worldpanel ComTech commented: "If you have any interest in technology, the phenomenon that is Android is unlikely to have passed you by. Our market share figures reveal that far from playing catch up, Android is now dominating the sector in many key territories."
Are you an Android, iOS of BlackBerry OS smartphone touter? Let us know which platform you have adopted and why via the T3 Twitter and Facebook feeds.


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Free SmoothFox's Amethyst Square 12x12 by Donna Mason-Svara
Welcome! You are browsing as a guestWould you like to see 159 projects made from this pattern and much more? join Ravelry now What am I missing?
© SmoothFox
© Jewel
© Laurie
© Laurie using cotton
Free SmoothFox's Amethyst Square 12x12
This pattern is available as a free Ravelry download
If you enjoy testing crochet patterns, follow the link to my blog.
This would be a wonderful square for any CAL out there. If you know a group using 12x12 squares - please let them know this is available.
Happy Crocheting!
For more information, see: http://smoothfoxlover.blogspot.com/2010/07/smoothfox...


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We are a major producer and marketer of over 90 commodities. Our diversified operations comprise over 150 mining and metallurgical sites, oil production assets and agricultural facilities. Our industrial and marketing activities are supported by a global network of more than 90 offices located in over 50 countries. We employ around 181,000 people, including contractors.
Our company is structured into three distinct business segments:
Metals and minerals
Includes copper, zinc/lead, nickel, ferroalloys, alumina/aluminium and iron ore production and marketing activities. We have interests in both controlled and non-controlled industrial assets that include mining, smelting, refining and warehousing operations.
Energy products
Covering coal and oil industrial and marketing activities, our Energy products businesses include controlled and non-controlled coal mining and oil production operations and investments in strategic handling, storage and freight equipment and facilities.
Agricultural products
Focuses on grains, oils/oilseeds, cotton and sugar. Our Agricultural products group is supported by both controlled and non-controlled storage, handling and processing facilities in strategic locations.


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The Ten Best Thanksgiving Parties in St. Louis
Thanksgiving is upon us! Between the bouts of turkey-feastification, Drunksgiving alcohol consumption and familial re-unification, you may find yourself looking for something to do over the extendo-weekend. Look no further; we have what you need! Below is a list of the ten best Thanksgiving time shows from Wednesday night to Sunday. You'll notice that most of these shows fall on either Wednesday or Saturday, which makes sense: The former is the biggest bar night of the year and the latter is, well, a Saturday. Remember to drive safe this weekend; drunks and cops alike will be out in high numbers, offering potential personal peril of varying varieties. Check out all of our picks below!
Ha Ha Tonka - Friday @ Off Broadway
The Stag Nite All Stars (covering the Last Waltz)
8:00 p.m. November 21
@ Off Broadway - Free
Accept no substitutes. Too many years running to count, and it's free for the first time ever. If you want to see people covering the Last Waltz in St. Louis on Wednesday, I can't imagine why you'd go anywhere else. (KM)
Messy Jiverson
8:00 p.m. November 21
@ 2720 Cherokee - $10
Messy Jiverson is back! The jam legend went down before its time, but after fertile explorations, solo and in other bands, the gang's back together, though who knows for how long. Do not miss. (KM)
10:00 p.m. November 21
w/ Modern Man
@ Lemmons - $5
Cape Girardeau's ((Thorlock)) returns to Lemmon's to lay waste to the place with riff after pummeling riff. Local hardcore punk stalwarts Modern Man open the show and are also not to be missed. (DH)
9:00 p.m. November 21
w/ The Conformists, Corrigan Brothers, Yowie
@ The Heavy Anchor - $5
Assuredly the noisiest option for celebrating turkey day in the Lou this year. Climb out of that box and watch musical boundaries fade away. (DH)
Dubb Nubb
8:30 p.m. November 21
w/ Tim Gebauer, Adam Balbo, Curtain Co.
@ Foam - $5
Everyone playing this show should be famous. And a few of them just might end up there, though they'd blush at the suggestion. Let's just call it the finest folk bill we've seen of late and call it a day. (KM)
Location Info
Wildey Theatre
254 N. Main St., Edwardsville, IL
Category: Film
2720 Cherokee Performing Arts Center
2720 Cherokee St, St. Louis, MO
Category: General
Blank Space
2847 Cherokee St., St. Louis, MO
Category: General
Lemmons - CLOSED
5800 Gravois Ave., St. Louis, MO
Category: Music
The Heavy Anchor
5226 Gravois Ave., St. Louis, MO
Category: Music
6691 Delmar Blvd., University City, MO
Category: Music
Sponsor Content


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Step 1: Design
Create a new part file using the Standard Part template
New -> Standar Part.ipt
Draw a snowman using three circles and two rectangles. Save the sketch.
Extrude the front face 0.75in
On the back side start a sketch and use project geometry to get the outline of the snowman, then use offset to get a larger shape about 0.2in larger.
Extrude this sketch in the opposite direction of the first 0.1in this will be the handle part
On the back again project geometry and make it 0.1in smaller than the inside shape
Extrude cut this shape in the direction of the first through all, this will give us a cutter 0.1in thick
Save the part and then export it as an .STL file
Step 2: Prepare for printing
generate the gcode and then create an S3G file
copy the .S3G file to your SD card formatted as FAT16, you can put this card into the Makerbot for printing


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Tangy apps, curries, seafood & desserts.
Ginger is commonly used as a spice in Indian dishes, and is also a quintessential ingredient of Chinese, Japanese and South Asian cuisines for flavouring seafood, meat and vegetarian recipes. Peel, chop or grate fresh gingerroot to kick up the flavours in curries, soups and noodles. Powdered dry gingerroot is typically used to flavour gingerbread, cookies, cakes, ginger ale, and ginger beer. This spicy root has endless uses! Try fresh ginger in a pork cashew curry (above left), ginger black bean sauce (top right), or sliced and sautéed with baby bok choy (bottom right).
Comment Guidelines
We welcome your feedback on Houseandhome.com. H&H reserves the right to remove any unsuitable personal remarks made about the bloggers, hosts, homeowners and/or guests we feature. Please keep your comments focused on decorating, design, cooking and other lifestyle topics. Adopt a tone you would be willing to use in person and do not make slanderous remarks or use denigrating language. If you see a comment that you believe violates any of the guidelines outlined above, please click "Flag as inappropriate." Thank you.


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Current Opinion in Nephrology and Hypertension, 06/01/2012
Kalantar–Zadeh K et al. – Mineral and bone disorder (MBD) following kidney transplantation is common and characterized by loss of bone volume and mineralization abnormalities, often leading to low turnover bone disease. Although there are no well established therapeutic approaches for management of MBD in renal transplant recipients, clinicians should continue individualizing therapy as needed.
© 2015 M3 USA Corporation. ALL Rights Reserved.


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The last Friday of the calendar year is tailor-made for a "slow news day" story. And today's is that Instagram, the incredibly popular photo-sharing app from Facebook, has lost a breath-taking 25 percent of its user base in just one week! Why? Because, according to AppData, which tracks usage of popular apps that connect via Facebook, "[We are] pretty sure the decline in Instagram users was due to the terms of service announcement." Before we get to that announcement, however, let's just put this simply: The story isn't true.
The announcement in question, concerning Instagram's policies with regards to advertising, so enraged users that Kevin Systrom, who developed the app and sold his company to Facebook, had backed off and rescinded the change within days. While it's certainly possible that users haven't forgiven the transgression and are leaving the service, experience and reality suggest that what's going on here is something different. That "different thing" is that a decently reputable firm, AppData, which collects information, has for some reason detected a decline in Instagram usage — from 16.4 million daily-active users before the change to 12.4 million today — and lacking any other explanation has concluded: "It must be thus!"
And everyone ran with it:
- In The New York Post, the headline reads, "Rage Against Rules" and breathless opens with " Instagram users outraged over new rules made good on their threat to dump the popular photo-sharing app."
- Stock blogging website The Motley Fool wondered "Is Facebook the Next Instagram?" suggesting the traffic drop would spread from the photo-sharing site to all of parent-company Facebook. " However, what we do know is that Internet users can be fickle. Once they leave, they don't come back. Just ask Facebook buddy Zynga. Once players begin dropping off onFarmVille, MafiaWars, or Draw Something, the trend is practically irreversible." (The fact that Zynga has 270 million monthly-active users for its Facebook apps, according to AppData, a lead of 200 million on second-place Microsoft seems to have escaped the Fool writer, but nevermind.)
- Facebook traded down 3 percent early in the day before closing nearly where it opened.
The question one has to ask is: How could a bunch of people be so non-critical of what seems so wrong on its face?
If you look at the chart that started this ruckus, what you can plainly see is that the drop in users doesn't coincide at all with the changes in Instagram's policy around December 17, but instead matches remarkably closely wth Christmas Day. That's after the policy change had already gone into the dustbin. Fortunately, not all journalists were asleep on this slow news day, however. At Business Insider, they theorized, a change in the way Instagram works might have been responsible for AppData's reported number. This is a bit arcane, but AppData only measure certain kinds of behavior that link through Facebook — logins and interactions through the Facebook site and such — but not all Instagram activity goes through Facebook. That's true for all apps, but a Dec. 21 Instagram update made it easier to use Instagram directly with some built-in features of the iPhone and, of course, a lot of people got new iPhones around Christmas.
But the explanation might be simpler still. TheNextWeb actually bothered to look at data for some other apps. And, wonder of wonder, many apps were down around Christmas. Pinterest was down 27.5 percent, dating/meet-up app Zoosk was down 31 percent, and Yahoo's Social Bar app was down a stunning 67 percent. Even Spotify, the popular music app, was down 10 percent, suggesting that people were just too darned busy with their families and such to be on their computers!
A reasonably safe bet is that the next time people care enough to look at the data — perhaps Valentine's Day? — is that Instagram will be again setting records for usage. It's been a straight-line up in terms of usage since the app launched just a few years ago. In the meantime, today's fake news was mostly dead by the time someone bothered to pick up the phone and ask Instagram what was up. Responsible types at the Los Angeles Times actually got a quote from an Instagram rep: "This data is inaccurate," an Instagram spokeswoman told The Times. "We continue to see strong and steady growth in both registered and active users of Instagram."
In other words, there is simply no there, there.


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To embed, copy and paste the code into your website or blog:
The Sarbanes–Oxley Act of 2002 (Pub.L. 107-204, 116 Stat. 745, enacted July 30, 2002), also known as the 'Public Company Accounting Reform and Investor Protection Act' (in the Senate) and 'Corporate and Auditing Accountability and Responsibility Act' (in the House) and commonly called Sarbanes–Oxley, Sarbox or SOX, is a United States federal law enacted on July 30, 2002, which set new or enhanced standards for all U.S. public company boards, management and public accounting firms. It is named after sponsors U.S. Senator Paul Sarbanes (D-MD) and U.S. Representative Michael G. Oxley (R-OH).
The bill was enacted as a reaction to a number of major corporate and accounting scandals including those affecting Enron, Tyco International, Adelphia, Peregrine Systems and WorldCom. These scandals, which cost investors billions of dollars when the share prices of affected companies collapsed, shook public confidence in the nation's securities markets.
It does not apply to privately held companies. The act contains 11 titles, or sections, ranging from additional corporate board responsibilities to criminal penalties, and requires the Securities and Exchange Commission (SEC) to implement rulings on requirements to comply with the new law. Harvey Pitt, the 26th chairman of the SEC, led the SEC in the adoption of dozens of rules to implement the Sarbanes–Oxley Act. It created a new, quasi-public agency, the Public Company Accounting Oversight Board, or PCAOB, charged with overseeing, regulating, inspecting and disciplining accounting firms in their roles as auditors of public companies. The act also covers issues such as auditor independence, corporate governance, internal control assessment, and enhanced financial disclosure.
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Select an edition for more focused local news coverage when you visit NOLA.com.
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Could not agree more on all 5 points! Esp the endless goal possibilites :) I love the challenge & I LOVE YOUR ARTICLES Rivs! Keep 'em coming!
I'm excited about this route! I'm only doing the 13.1 & didn't do it last year but compared to the route 2 years ago, I like this one much better for the 13.1! I much prefer running down St. Charles and not in and out of the neighborhoods and down Tchop :) I like the new start much better too!
What great article Molly! I deal with those comments on a weekly basis and those suggestions on how to handle them are excellent :)
How dare they not warn you about out heat and humidity... I feel your pain! I've lived here my whole life and I have yet to get used to it. I read somewhere that if you eat an icee (or super cold drink) 30 minutes before your run it will drop your body temp to where you don't overheat as fast. We'll have to try that summer 2012!
That's great that your body has adapted well to the humidity! I drink water every 2 miles when training during the fall/winter but I have to drink every mile when running during the summer, it's killer!
LOL I'm gonna find a magazine this weekend! :)
Great info Michael! I just dislike the treadmill because it's not as fun as changing scenery but I agree that it does wonders for speedwork when you're limited! Interesting to hear that it's not the cause of injuries because that is something I've heard a lot!
Just 1? I wanted 1 in every color... guess I should'ce specified! LOL!
Thx for the recommendation Ron, checking it out now!
Welcome back my friend & you're right, I run a tight ship ... so stay in line! :)
I think I'm planning a bucket list of different things, mostly running/triathlon related as opposed to a new year resolution... I want my list to carry me through till the end of the year to keep me on my toes. If I have one goal and reach it mid year, what then? That's too easy for me :)
Great article Michael with a ton of great suggestions!
I'm adding these to my workout because I have slacked on my core work the past month and a half.
Thanks Beth, I really needed this reminder!
I ran the somewhere in the low 400's but I'm hoping to be somewhere between 800-1,000 in 2012 depending on how hard the heat and humidity of the summer in NOLA hits me. I'm hoping to maintain 15-20/week through the summer and 25-30/week in the winter... we will see!
&& those bad runs really make me appreciate the good runs even more cdgnow, I feel the same way at times! :)
LOL Erica! Well I think we should do it together this year!!!
Thanks Alex! I can't wait to hear about your bucket list... make sure you post the link here so I can check it out once you've published it!
I'm excited about this! If you want to run the Louisiana Riverfront Half on 01/29 & you haven't registered yet... you can use the code Expo2012 until Jan 21st to get $10.00 off an already very affordable race!
Thanks Michael! I was afraid I was going to slow to start & hit my goal & it was really close but still a PR in my eyes :) I pushed my body hard enough to run fast but not too hard to where I was fully recovered after about 2 days, so I feel like I found the right balance for me and my body!
Slow mo would be awesome!!! LOL :) Loved the recap Rivs & I'm adding it to my list for next year!
Thanks for letting us know.... we're working on it now!


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Browsers are software that provide a graphical interface to information on the Web and facilitate web navigation with address bars, bookmarks, backward and forward buttons, and other tools.
Internet Explorer and Firefox are popular browers, and there are a variety of others. Choosing a browser is often a matter of personal preference combined with what type of computer and operating system you have. Regardless of your browser choice, it is always a good idea to have an up to date version.


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Flooring Services in the Highlands
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Are you looking for a carpet and rug shop in Inverness? If you are then you have come to the right place.
Our company has been established for over 10 years now and we have built up a fantastic local reputation for the quality of our products and services, so you can rest assured that we will not leave you disappointed.
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We are a family run business and, whilst we work in a very professional manner, we like to think that we haven't lost that personal touch in our customer service which makes us so appealing to our clients. Our team are all highly experienced in the flooring trade and can provide you with work of an exceptional standard.
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For commercial and domestic flooring in Inverness, choose the Gavin MacDonald.


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Friday, May 6, 2005
© Copyright 2015 Clayton News Daily
By Greg GelpiOld Man Winter has the snowman, and Anna Blodgett has the "Banana Bunch," an award-winning group of decorated bananas with pieces of black olives for eyebrows, carrots for eyes, slivers of apple peel for lips and aprons of lettuce. After winning first place in the county and first place in district, the Jackson Elementary School food services manager won first in the statewide garnishing competition of the Georgia School Nutrition Association for her food art. "It's just really simple," Blodgett, 46, says of her food turned art. "Anybody can do it, which is why I was surprised I won." Cutting fruit in half making various designs and decorating the cafeteria serving areas with stuffed animals and an inflatable cow, she says that the students at Jackson "get a kick out of" the special touches she adds to the eating experience "Kids eat with their eyes," Jane Lofton, the director of the Clayton County School Nutrition Program, says. "It's all in creating interest in students. All of that creates eye appeal." Food that looks good translates into students eating school lunch, she says. "If it looks good, you're going to try it at least." Blodgett, who has 13 years of school nutrition experience, started work in the cafeteria because of the convenient work schedule, but has since come to love her job. "It's so great to see (students') faces," she says. "They're fun to watch when they come through." School cafeterias have changed over the years, Blodgett says, recalling her days in school. "You were served one thing and you took it," she says, adding that today's school nutrition program offers options to students, as well as breakfast. Blodgett is married and has one daughter, who attended Clayton County schools before graduating. After her mother took the job in the school cafeteria, she began to ask her to cook tacos and yeast rolls similar to those she makes at school. At home, though, Blodgett says that cooking is entirely different than at school, where she cooks for 900 students. "You go home and you don't really want to cook," she says, explaining that she cooked daily for her daughter when she was younger and still cooks four or five times a week, although eating out is always a pleasure. Prior to school nutrition, Blodgett worked as a homemaker and also in daycare. When she's not in the kitchen, she's outside doing yard work, planting flowers. She also enjoys reading and arts and crafts, including cross-stitching, embroidery and sewing. Everyday People is a regular feature of the News Daily. If you know someone in the community who you think should be profiled in this feature, contact Assistant Managing Editor Bob Paslay at (770) 478-5753 ext. 257 or at email@example.com .
More like this story
- 'Rub-a-dub-dub, thanks for the grub'
Schools use nutrition labs to curb obesity, diabetes ( September 5, 2008 )
- Pointe South serves options for lunch ( March 8, 2004 )
- Locals recognized at school nutrition banquet ( October 2, 2004 )
- Locals recognized at school nutrition banquet ( October 1, 2004 )
- Where's the beef, some students were asking ( October 14, 2003 )


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Jantzen Kids Flowered Skirted Bikini (Little Kids/Big Kids)SKU: #8408911
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- Tuck a flower behind her ear and turn her into an island princess with the Flowered Skirted Bikini.
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- 90% polyester, 10% spandex.
Lining: 100% polyester.
- Hand wash cold, line dry.
- Imported.
- If you're not fully satisfied with your purchase, you are welcome to return any unworn and unwashed items with tags intact and original packaging included.


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There's nothing more Chinese than dim sum. Ching He Huang visits Great Eastern Dim Sum House to peek at the masters at work, then she heads south to source seasonal sweetness at Gizdich Fruit Farm. Back in her kitchen, she finds three junior sous chefs to lend a hand and taste her savory and sweet delights! Recipes: Prawn and Chive "Shui Jiao" (Water Dumplings), Steamed Pork and Mushroom "Siu Mai" Dumplings, Roast Pork Pastry Puffs, Iced tea/gelato/fruit Drink
Get Cooking Channel on your TV.


text: I know its always better to get a car for free if possible, but that is never the case round here. Doing a quick CL search I found quite a few cars for about $4-600. These cars do have titles. I know the value varies by weight and the rate for each yard, but what is the max you would pay to haul away a titled average size car?


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A pit bull found dead in a suitcase in a St. Petersburg canal was placed there by her owners as a burial after the pet was struck by a car, officials said Thursday.
The distraught couple told police they were not allowed to bury the dog at their apartment complex and could not afford the fee required by the SPCA to take the dog.
The blue, hard-shell suitcase was found Wednesday floating near a dock, police said. Inside the suitcase was the female pit bull, black and gray and weighing 30 to 35 pounds.
The dog, named Beloved, had trauma to its head and lower body, and police began to investigate, concerned the animal had been fatally beaten.
However, the dog's owners said Beloved got loose while being walked and ran across Fourth Street, where the pet was struck by a car, police said.
Samuel Orsini, the owner who was walking the dog, carried her back to his apartment, which he shares with Gina Glass, police said.
Police said Orsini and Glass, who are mentally disabled, were distraught after the dog's death.
Orsini and Glass said they contacted the Society for the Prevention of Cruelty to Animals but were told it would cost $55 for the organization to take the dog, police said.
The couple told police they also attempted to bury Beloved at their apartment complex, but the landlord refused.
Instead, Orsini and Glass decided to submerge the dog in a "lake," saying it was the dog's favorite spot, police said.
Glass put the dog in the suitcase, which she found in a dumpster, and partially filled it with water in the hope it would submerge Beloved.
Police said they are still investigating and waiting for the results of necropsy.