text:
|N˙mero de publicaciÛn
|Tipo de publicaciÛn
|N˙mero de solicitud
|Fecha de publicaciÛn
|12 May 2005
|Fecha de presentaciÛn
|3 Mar 2004
|Fecha de prioridad
|7 Nov 2003
|TambiÈn publicado como
|N˙mero de publicaciÛn
|Lilip Lau, Matthew Fishler, Craig Mar
|Cesionario original
|Lilip Lau, Fishler Matthew G., Craig Mar
|Exportar cita
|BiBTeX, EndNote, RefMan
|Citas de patentes (99), Citada por (10), Clasificaciones (10), Eventos legales (5)
|Enlaces externos: USPTO, CesiÛn de USPTO, Espacenet
The present invention relates to a device for treating heart failure. More specifically, the invention relates to a cardiac harness configured to be fit around at least a portion of a patient's heart. The cardiac harness includes electrodes attached to a power source for use in defibrillation or pacing.
Congestive heart failure ("CHF") is characterized by the failure of the heart to pump blood at sufficient flow rates to meet the metabolic demand of tissues, especially the demand for oxygen. One characteristic of CHF is remodeling of at least portions of a patient's heart. Remodeling involves physical change to the size, shape and thickness of the heart wall. For example, a damaged left ventricle may have some localized thinning and stretching of a portion of the myocardium. The thinned portion of the myocardium often is functionally impaired, and other portions of the myocardium attempt to compensate. As a result, the other portions of the myocardium may expand so that the stroke volume of the ventricle is maintained notwithstanding the impaired zone of the myocardium. Such expansion may cause the left ventricle to assume a somewhat spherical shape.
Cardiac remodeling often subjects the heart wall to increased wall tension or stress, which further impairs the heart's functional performance. Often, the heart wall will dilate further in order to compensate for the impairment caused by such increased stress. Thus, a cycle can result, in which dilation leads to further dilation and greater functional impairment.
Historically, congestive heart failure has been managed with a variety of drugs. Devices have also been used to improve cardiac output. For example, left ventricular assist pumps help the heart to pump blood. Multi-chamber pacing has also been employed to optimally synchronize the beating of the heart chambers to improve cardiac output. Various skeletal muscles, such as the latissimus dorsi, have been used to assist ventricular pumping. Researchers and cardiac surgeons have also experimented with prosthetic "girdles" disposed around the heart. One such design is a prosthetic "sock" or "jacket" that is wrapped around the heart.
Patients suffering from congestive heart failure often are at risk to additional cardiac failures, including cardiac arrhythmias. When such arrhythmias occur, the heart must be shocked to return it to a normal cycle, typically by using a defibrillator. Implantable cardioverter/defibrillators (ICD's) are well known in the art and typically have a lead from the ICD connected to an electrode implanted in the right ventricle. Such electrodes are capable of delivering a defibrillating electrical-shock from the ICD to the heart.
Other prior art devices have placed the electrodes on the epicardium at various locations, including on or near the epicardial surface of the right and left heart. These devices also are capable of distributing an electrical current from an implantable cardioverter/defibrillator for purposes of treating ventricular defibrillation or hemodynamically stable or unstable ventricular tachyarrhythmias.
Patients suffering from congestive heart failure may also suffer from cardiac failures, including bradycardia and tachycardia. Such disorders typically are treated by both pacemakers and implantable cardioverter/defibrillators. The pacemaker is a device that paces the heart with timed pacing pulses for use in the treatment of bradycardia, where the ventricular rate is too slow, or to treat cardiac rhythms that are too fast, i.e., anti-tachycardia pacing. As used herein, the term "pacemaker" is any cardiac rhythm management device with a pacing functionality, regardless of any other functions it may perform such as the delivery cardioversion or defibrillation shocks to terminate atrial or ventricular fibrillation. Particular forms and uses for pacing/sensing can be found in U.S. Pat. No. 6,574,506 (Kramer et al.) and U.S. Pat. No. 6,223,079 (Bakels et al.); and U.S. Publication No. 2003/0130702 (Kramer et al.) and U.S. Publication No. 2003/0195575 (Kramer et al.), the entire contents of which are incorporated herein by reference thereto.
The present invention solves the problems associated with prior art devices relating to a harness for treating congestive heart failure and placement of electrodes for use in defibrillation, or for use in pacing.
In accordance with the present invention, a cardiac harness is configured to fit at least a portion of a patient's heart and is associated with one or more electrodes capable of providing defibrillation or pacing functions. In one embodiment, rows or strands of undulations are interconnected and associated with coils or defibrillation and/or pacing/sensing leads. In another embodiment, the cardiac harness includes a number of panels separated by coils or electrodes, wherein the panels have rows or strands of undulations interconnected together so that the panels can flex and can expand and retract circumferentially. The panels of the cardiac harness are coated with a dielectric coating to electrically insulate the panels from an electrical shock delivered through the electrodes. Further, the electrodes are at least partially coated with a dielectric material to insulate the electrodes from the cardiac harness. In one embodiment, the strands or rows of undulations are formed from Nitinol and are coated with a dielectric material such as silicone rubber. In this embodiment, the electrodes are at least partially coated with the same dielectric material of silicone rubber. The electrode portion of the leads are not covered by the dielectric material so that as the electrical shock is delivered by the electrodes to the epicardial surface of the heart, the coated panels and the portion of the electrodes that are coated are insulated by the silicone rubber. In other words, the heart received an electrical shock only where the bare metal of the electrodes are in contact with or are adjacent to the epicardial surface of the heart. The dielectric coating also serves to attach the panels to the electrodes.
In another embodiment, the electrodes have a first surface and a second surface, the first surface being in contact with the outer surface of the heart, such as the epicardium, and the second surface faces away from the heart. Both the first surface and the second surface do not have a dielectric coating so that an electrical charge can be delivered to the outer surface of the heart for defibrillating or for pacing. In this embodiment, at least a portion of the electrodes are coated with a dielectric coating, such as silicone rubber, Parylene™ or polyurethane. The dielectric coating serves to insulate the bare metal portions of the electrode from the cardiac harness, and also to provide attachment means for attaching the electrodes to the panels of the cardiac harness.
The number of electrodes and the number of panels forming the cardiac harness is a matter of choice. For example, in one embodiment the cardiac harness can include two panels separated by two electrodes. The electrodes, would be positioned 180∞ apart, or in some other orientation so that the electrodes could be positioned to provide a optimum electrical shock to the epicardial surface of the heart, preferably adjacent the right ventricle or the left ventricle. In another embodiment, the electrodes can be positioned 180∞ apart so that the electrical shock carries through the myocardium adjacent the right ventricle thereby providing an optimal electrical shock for defibrillation or periodic shocks for pacing. In another embodiment, three leads are associated with the cardiac harness so that there are three panels separated by the three electrodes.
In yet another embodiment, four panels on the cardiac harness are separated by four electrodes. In this embodiment, two electrodes are positioned adjacent the left ventricle on or near the epicardial surface of the heart while the other two electrodes are positioned adjacent the right ventricle on or near the epicardial surface of the heart. As an electrical shock is delivered, it passes through the myocardium between the two sets of electrodes to shock the entire ventricles.
In another embodiment, there are more than four panels and more than four electrodes forming the cardiac harness. Placement of the electrodes and the panels is a matter of choice. Further, one or more electrodes may be deactivated.
In another embodiment, the cardiac harness includes multiple electrodes separating multiple panels. The embodiment also includes one or more pacing/sensing electrodes (multi-site) for use in sensing heart functions, and delivering pacing stimuli for resynchronization, including biventricular pacing and left ventricle pacing or right ventricular pacing.
In each of the embodiments, an electrical shock for defibrillation, or an electrical pacing stimuli for synchronization or pacing is delivered by a pulse generator, which can include an implantable cardioverter/defibrillator (ICD), a cardiac resynchronization therapy defibrillator (CRT-D), and/or a pacemaker. Further, in each of the foregoing embodiments, the cardiac harness can be coupled with multiple pacing/sensing electrodes to provide multi-site pacing to control cardiac function. By incorporating multi-site pacing into the cardiac harness, the system can be used to treat contractile dysfunction while concurrently treating bradycardia and tachycardia. This will improve pumping function by altering heart chamber contraction sequences while maintaining pumping rate and rhythm. In one embodiment, the cardiac harness incorporates pacing/sensing electrodes positioned on the epicardial surface of the heart adjacent to the left and right ventricle for pacing both the left and right ventricles.
In another embodiment, the cardiac harness includes multiple electrodes separating multiple panels. In this embodiment, at least some of the electrodes are positioned on or near (proximate) the epicardial surface of the heart for providing an electrical shock for defibrillation, and other of the electrodes are positioned on the epicardial surface of the heart to provide pacing stimuli useful in synchronizing the left and right ventricles, cardiac resynchronization therapy, and biventricular pacing or left ventricular pacing or right ventricular pacing.
In another embodiment, the cardiac harness includes multiple electrodes separating multiple panels. At least some of the electrodes provide an electrical shock for defibrillation, and one of the electrodes, a single site electrode, is used for pacing and sensing a single ventricle. For example, the single site electrode is used for left ventricular pacing or right ventricular pacing. The single site electrode also can be positioned near the septum in order to provide bi-ventricular pacing.
In yet another embodiment, the cardiac harness includes one or more electrodes associated with the cardiac harness for providing a pacing/sensing function. In this embodiment, a single site electrode is positioned on the epicardial surface of the heart adjacent the left ventricle for left ventricular pacing. Alternatively, a single site electrode is positioned on the surface of the heart adjacent the right ventricle to provide right ventricular pacing. Alternatively, more than one pacing/sensing electrode is positioned on the epicardial surface of the heart to treat synchrony of both ventricles, including bi-ventricular pacing.
In another embodiment, the cardiac harness includes coils that separate multiple panels. The coils have a high degree of flexibility, yet are capable of providing column strength so that the cardiac harness can be delivered by minimally invasive access.
All embodiments of the cardiac harness, including those with electrodes, are configured for delivery and implantation on the heart using minimally invasive approaches involving cardiac access through, for example, subxiphoid, subcostal, or intercostal incisions, and through the skin by percutaneous delivery using a catheter.
This invention relates to a method and apparatus for treating heart failure. It is anticipated that remodeling of a diseased heart can be resisted or even reversed by alleviating the wall stresses in such a heart. The present invention discloses embodiments and methods for supporting the cardiac wall and for providing defibrillation and/or pacing functions using the same system. Additional embodiments and aspects are also discussed in Applicants' co-pending application entitled "Multi-Panel Cardiac Harness" U.S. Ser. No. 60/458,991 filed Mar. 28, 2003, the entirety of which is hereby expressly incorporated by reference.
Prior Art Devices
The term "cardiac harness" as used herein is a broad term that refers to a device fit onto a patient's heart to apply a compressive force on the heart during at least a portion of the cardiac cycle.
The cardiac harness illustrated in
In the harness illustrated in
With further reference to
In the harness shown in
The undulating spring elements exert a force in resistance to expansion of the heart. Collectively, the force exerted by the spring elements tends toward compressing the heart, thus alleviating wall stresses in the heart as the heart expands. Accordingly, the harness helps to decrease the workload of the heart, enabling the heart to more effectively pump blood through the patient's body and enabling the heart an opportunity to heal itself. It should be understood that several arrangements and configurations of spring members can be used to create a mildly compressive force on the heart to reduce wall stresses. For example, spring members can be disposed over only a portion of the circumference of the heart or the spring members can cover a substantial portion of the heart.
As the heart expands and contracts during diastole and systole, the contractile cells of the myocardium expand and contract. In a diseased heart, the myocardium may expand such that the cells are distressed and lose at least some contractility. Distressed cells are less able to deal with the stresses of expansion and contraction. As such, the effectiveness of heart pumping decreases. Each series of spring hinges of the above cardiac harness embodiments is configured so that as the heart expands during diastole the spring hinges correspondingly will expand, thus storing expansion forces as bending energy in the spring. As such, the stress load on the myocardium is partially relieved by the harness. This reduction in stress helps the myocardium cells to remain healthy and/or regain health. As the heart contracts during systole, the disclosed prior art cardiac harnesses apply a moderate compressive force as the hinge or spring elements release the bending energy developed during expansion allowing the cardiac harness to follow the heart as it contracts and to apply contractile force as well.
Other structural configurations for cardiac harnesses exist, however, but all have drawbacks and do not function optimally to treat CHF and other related diseases or failures. The present invention cardiac harness provides a novel approach to treat CHF and provides electrodes associated with the harness to deliver an electrical shock for defibrillation or a pacing stimulus for resynchronization, or for biventricular pacing/sensing.
The Present Invention Embodiments
The present invention is directed to a cardiac harness system for treating the heart. The cardiac harness system of the present invention couples a cardiac harness for treating the heart coupled with a cardiac rhythm management device. More particularly, the cardiac harness includes rows or undulating strands of spring elements that provide a compressive force on the heart during diastole and systole in order to relieve wall stress pressure on the heart. Associated with the cardiac harness is a cardiac rhythm management device for treating any number of irregularities in heart beat due to, among other reasons, congestive heart failure. Thus, the cardiac rhythm management device associated with the cardiac harness can include one or more of the following: an implantable cardioverter/defibrillator with associated leads and electrodes; a cardiac pacemaker including leads and electrodes used for sensing cardiac function and providing pacing stimuli to treat synchrony of both vessels; and a combined implantable cardioverter/defibrillator and pacemaker, with associated leads and electrodes to provide a defibrillation shock and/or pacing/sensing functions.
The cardiac harness system includes various configurations of panels connected together to at least partially surround the heart and assist the heart during diastole and systole. The cardiac harness system also includes one or more leads having electrodes associated with the cardiac harness and a source of electrical energy supplied to the electrodes for delivering a defibrillating shock or pacing stimuli.
In one embodiment of the invention, as shown in a flattened configuration in
The undulating strands 22 provide a compressive force on the epicardial surface of the heart thereby relieving wall stress. In particular, the spring elements 23 expand and contract circumferentially as the heart expands and contracts during the diastolic and systolic functions. As the heart expands, the spring elements expand and resist expansion as they continue to open and store expansion forces. During systole, as the heart 10 contracts, the spring elements will contract circumferentially by releasing the stored bending forces thereby assisting in both the diastolic and systolic function.
As just discussed, bending stresses are absorbed by the spring elements 23 during diastole and are stored in the elements as bending energy. During systole, when the heart pumps, the heart muscles contract and the heart becomes smaller. Simultaneously, bending energy stored within the spring elements 23 is at least partially released, thereby providing an assist to the heart during systole. In a preferred embodiment, the compressive force exerted on the heart by the spring elements of the harness comprises about 10% to 15% of the mechanical work done as the heart contracts during systole. Although the harness is not intended to replace ventricular pumping, the harness does substantially assist the heart during systole.
The undulating strands 22 can have varying numbers of spring element 23 depending upon the amplitude and pitch of the spring elements. For example, by varying the amplitude of the pitch of the spring elements, the number of undulations per panel will vary as well. It may be desired to increase the amount of compressive force the cardiac harness 20 imparts on the epicardial surface of the heart, therefore the present invention provides for panels that have spring elements with lower amplitudes and a shorter pitch, thereby increasing the expansion force imparted by the spring element. In other words, all other factors being constant, a spring element having a relatively lower amplitude will be more rigid and resist opening, thereby storing more bending forces during diastole. Further, if the pitch is smaller, there will be more spring elements per unit of length along the undulating strand, thereby increasing the overall bending force stored during diastole, and released during systole. Other factors that will affect the compressive force imparted by the cardiac harness onto the epicardial surface of the heart include the shape of the spring elements, the diameter and shape of the wire forming the undulating strands, and the material comprising the strands.
As shown in
It is preferred that the undulating strands 22 be continuous as shown in
Associated with the cardiac harness of the present invention is a cardiac rhythm management device as previously disclosed. Thus, associated with the cardiac harness as shown in
Diseased hearts often have several maladies. One malady that is not uncommon is irregularity in heartbeat caused by irregularities in the electrical stimulation system of the heart. For example, damage from a cardiac infarction can interrupt the electrical signal of the heart. In some instances, implantable devices, such as pacemakers, help to regulate cardiac rhythm and stimulate heart pumping. A problem with the heart's electrical system can sometimes cause the heart to fibrillate. During fibrillation, the heart does not beat normally, and sometimes does not pump adequately. A cardiac defibrillator can be used to restore the heart to normal beating. An external defibrillator typically includes a pair of electrode paddles applied to the patient's chest. The defibrillator generates an electric field between electrodes. An electric current passes through the patient's heart and stimulates the heart's electrical system to help restore the heart to regular pumping.
Sometimes a patient's heart begins fibrillating during heart surgery or other open-chest surgeries. In such instances, a special type of defibrillating device is used. An open-chest defibrillator includes special electrode paddles that are configured to be applied to the heart on opposite sides of the heart. A strong electric field is created between the paddles, and an electric current passes through the heart to defibrillate the heart and restore the heart to regular pumping.
In some patients that are especially vulnerable to fibrillation, an implantable heart defibrillation device may be used. Typically, an implantable heart defibrillation device includes an implantable cardioverter defibrillator (ICD) or a cardiac resynchronization therapy device (CRT-D) which usually has only one electrode positioned in the right ventricle, and the return electrode is the defibrillator housing itself, typically implanted in the pectoral region. Alternatively, an implantable device includes two or more electrodes mounted directly on, in or adjacent the heart wall. If the patient's heart begins fibrillating, these electrodes will generate an electric field therebetween in a manner similar to the other defibrillators discussed above.
Testing has indicated that when defibrillating electrodes are applied external to a heart that is surrounded by a device made of electrically conductive material, at least some of the electrical current disbursed by the electrodes is conducted around the heart by the conductive material, rather than through the heart. Thus, the efficacy of defibrillation is reduced. Accordingly, the present invention includes several cardiac harness embodiments that enable defibrillation of the heart and other embodiments disclose means for defibrillating, resynchronization, left ventricular pacing, right ventricular pacing, and biventricular pacing/sensing.
In further keeping with the invention, the cardiac harness 20 includes a pair of leads 31 having conductive electrode portions 32 that are spaced apart and which separate panels 21. As shown in
Still referring to
As will be described in more detail, the electrodes 32 have a conductive discharge first surface 38 that is intended to be proximate to or in direct contact with the epicardial surface of the heart, and a conductive discharge second surface 39 that is opposite to the first surface and faces away from the heart surface. As used herein, the term "proximate" is intended to mean that the electrode is positioned near or in direct contact with the outer surface of the heart, such as the epicardial surface of the heart. The first surface and second surface typically will not be covered with the dielectric material 37 so that the bare metal conductive coil can transmit the electrical current from the power source (pulse generator), such as an implantable cardioverter/defibrillator (ICD or CRT-D) 36, to the epicardial surface of the heart. In an alternative embodiment, either the first or the second surface may be covered with dielectric material in order to preferentially direct the current through only one surface. Further details of the construction and use of the leads 31 and electrodes 33 of the present invention, in conjunction with the cardiac harness, will be described more fully herein.
Importantly, the dielectric material 37 used to attach the electrodes 32 to the undulating strands 22 insulates the undulating strands from any electrical current discharged through the conductive metal coils 33 of the electrodes. Further, the dielectric material in this embodiment is flexible so that the electrodes can serve as a seam or hinge to fold the cardiac harness 20 into a lower profile for minimally invasive delivery. Thus, as will be described in more detail (see
In further keeping with the invention, cross sectional views of the leads 31 and the electrode portion 32 are shown in
Referring to
While it is preferred that the cardiac harness 20 be comprised of undulating strands 22 made from a solid wire member, such as a superelastic or shape memory material such as Nitinol, and be insulated from the electrodes 32, it is possible to use some or all of the undulating strands to deliver the electrical shock to the epicardial surface of the heart. For example, as shown in
In contrast to the current conducting undulating strands of
An important aspect of the invention is to provide a cardiac harness 20 that can be implanted minimally invasively and be attached to the epicardial surface of the heart, without requiring sutures, clips, screws, glue or other attachment means. Importantly, the undulating strands 22 may provide relatively high frictional engagement with the epicardial surface, depending on the cross-sectional shape of the strands. For example, in the embodiment disclosed in
In another embodiment as shown in
Still referring to
While the
At present, commercially available implantable cardioverter/defibrillators (ICD's) are capable of delivering approximately thirty to forty joules in order to defibrillate the heart. With respect to the present invention, it is preferred that the electrodes 22 of the cardiac harness 20 of the present invention deliver defibrillating shocks having less than thirty to forty joules. The commercially available ICD's can be modified to provide lower power levels to suit the present invention cardiac harness system with electrodes delivering less than thirty to forty joules of power. As a general rule, one objective of the electrode configuration is to create a uniform current density distribution throughout the myocardium. Therefore, in addition to the number of electrodes used, their size, shape, and relative positions will also all have an impact on the induced current density distribution. Thus, while one to four electrodes are preferred embodiments of the invention, five to eight electrodes also are envisioned.
In keeping with the present invention, the cardiac harness and the associated cardiac rhythm management device can be used not only for providing a defibrillating shock, but also can be used as a pacing/sensing device for treating the synchrony of both ventricles, for resynchronization, for biventricular pacing and for left ventricular pacing or right ventricular pacing. As shown in
In another embodiment of the invention, as shown in
Referring to the embodiments shown in
The cardiac harness embodiments 60 shown in
In an alternative embodiment, similar to the embodiment shown in
Referring to
It is to be understood that several embodiments of cardiac harnesses can be constructed and that such embodiments may have varying configurations, sizes, flexibilities, etc. Such cardiac harnesses can be constructed from many suitable materials including various metals, fabrics, plastics and braided filaments. Suitable materials also include superelastic materials and materials that exhibit shape memory properties. For example, a preferred embodiment cardiac harness is constructed of Nitinol. Shape memory dielectric materials can also be employed. Such shape memory dielectric materials can include shape memory polyurethanes or other dielectric materials such as those containing oligo(e-caprolactone) dimethacrylate and/or poly(e-caprolactone), which are available from mnemoScience.
In keeping with the invention, as shown in
Again referring to
In another embodiment of the invention, shown in
The cardiac harness of the present invention, having either electrodes or coils, can be formed using injection molding techniques as shown in
In further keeping with the invention, as shown in
In keeping with the invention, as shown in
In further keeping with the invention of
In an alternative embodiment, as shown in
The cardiac rhythm management devices associated with the present invention are implantable devices that provide electrical stimulation to selected chambers of the heart in order to treat disorders of cardiac rhythm and can include pacemakers and implantable cardioverter/defibrillators and/or cardiac resynchronization therapy devices (CRT-D). A pacemaker is a cardiac rhythm management device which paces the heart with timed pacing pulses. As previously described, common conditions for which pacemakers are used is in the treatment of bradycardia (ventricular rate is too slow) and tachycardia (cardiac rhythms are too fast). As used herein, a pacemaker is any cardiac rhythm management device with a pacing functionality, regardless of any other functions it may perform such as the delivery of cardioversion or defibrillation shocks to terminate atrial or ventricular fibrillation. An important feature of the present invention is to provide a cardiac harness having the capability of providing a pacing function in order to treat the synchrony of both ventricles. To accomplish the objective, a pacemaker with associated leads and electrodes are associated with and incorporated into the cardiac harness of the present invention. The pacing/sensing electrodes, alone or in combination with defibrillating electrodes, provide treatment to synchronize the ventricles and improve cardiac function.
In keeping with the invention, a pacemaker and a pacing/sensing electrode are incorporated into the design of the cardiac harness. As shown in
In one of the preferred embodiments, multi-site pacing (as previously shown in
In another embodiment, shown in
The defibrillating electrode 130 as disclosed herein, can be used with commercially available pacing/sensing electrodes and leads. For example, Oscor (Model HT 52PB) endocardial/passive fixation leads can be integrated with the defibrillator electrode 130 by molding the leads into the fibrillator electrode using the same molds previously disclosed herein.
The foregoing disclosed invention incorporating cardiac rhythm management devices into the cardiac harness combines several treatment modalities that are particularly beneficial to patients suffering from congestive heart failure. The cardiac harness provides a compressive force on the heart thereby relieving wall stress, and improving cardiac function. The defibrillating and pacing/sensing electrodes associated with the cardiac harness, along with ICD's and pacemakers, provide numerous treatment options to correct for any number of maladies associated with congestive heart failure. In addition to the defibrillation function previously described, the cardiac rhythm devices can provide electrical pacing stimulation to one or more of the heart chambers to improve the coordination of atrial and/or ventricular contractions, which is referred to as resynchronization therapy. Cardiac resynchronization therapy is pacing stimulation applied to one or more heart chambers, typically the ventricles, in a manner that restores or maintains synchronized bilateral contractions of the atria and/or ventricles thereby improving pumping efficiency. Resynchronization pacing may involve pacing both ventricles in accordance with a synchronized pacing mode. For example, pacing at more than one site (multi-site pacing) at various sites on the epicardial surface of the heart to desynchronize the contraction sequence of a ventricle (or ventricles) may be therapeutic in patients with hypertrophic obstructive cardiomyopathy, where creating asynchronous contractions with multi-site pacing reduces the abnormal hyper-contractile function of the ventricle. Further, resynchronization therapy may be implemented by adding synchronized pacing to the bradycardia pacing mode where paces are delivered to one or more synchronized pacing sites in a defined time relation to one or more sensing and pacing events. An example of synchronized chamber-only pacing is left ventricle only synchronized pacing where the rate in synchronized chambers are the right and left ventricles respectively. Left-ventricle-only pacing may be advantageous where the conduction velocities within the ventricles are such that pacing only the left ventricle results in a more coordinated contraction by the ventricles than by conventional right ventricle pacing or by ventricular pacing. Further, synchronized pacing may be applied to multiple sites of a single chamber, such as the left ventricle, the right ventricle, or both ventricles. The pacemakers associated with the present invention are typically implanted subcutaneously on a patient's chest and have leads threaded to the pacing/electrodes as previously described in order to connect the pacemaker to the electrodes for sensing and pacing. The pacemakers sense intrinsic cardiac electrical activity through the electrodes disposed on the surface of the heart. Pacemakers are well known in the art and any commercially available pacemaker or combination defibrillator/pacemaker can be used in accordance with the present invention.
The cardiac harness and the associated cardiac rhythm management device system of the present invention can be designed to provide left ventricular pacing. In left heart pacing, there is an initial detection of a spontaneous signal, and upon sensing the mechanical contraction of the right and left ventricles. In a heart with normal right heart function, the right mechanical atrio-ventricular delay is monitored to provide the timing between the initial sensing of right atrial activation (known as the P-wave) and right ventricular mechanical contraction. The left heart is controlled to provide pacing which results in left ventricular mechanical contraction in a desired time relation to the right mechanical contraction, e.g., either simultaneous or just preceding the right mechanical contraction. Cardiac output is monitored by impedence measurements and left ventricular pacing is timed to maximize cardiac output. The proper positioning of the pacing/sensing electrodes disclosed herein provides the necessary sensing functions and the resulting pacing therapy associated with left ventricular pacing.
An important feature of the present invention is the minimally invasive delivery of the cardiac harness and the cardiac rhythm management device system which will be described immediately below.
Delivery of the cardiac harness 20,60, and 100 and associated electrodes and leads can be accomplished through conventional cardio-thoracic surgical techniques such as through a median sternotomy. In such a procedure, an incision is made in the pericardial sac and the cardiac harness can be advanced over the apex of the heart and along the epicardial surface of the heart simply by pushing it on by hand. The intact pericardium is over the harness and helps to hold it in place. The previously described grip pads and the compressive force of the cardiac harness on the heart provide sufficient attachment means of the cardiac harness to the epicardial surface so that sutures, clips or staples are unnecessary. Other procedures to gain access to the epicardial surface of the heart include making a slit in the pericardium and leaving it open, making a slit and later closing it, or making a small incision in the pericardium.
Preferably, however, the cardiac harness and associated electrodes and leads may be delivered through minimally invasive surgical access to the thoracic cavity, as illustrated in
The delivery device 140 also includes a dilator tube 150 that has a distal end 151 and a proximal end 152. The cardiac harness 20,60,100 is collapsed to a low profile configuration and inserted into the distal end of the dilator tube, as shown in
As shown in
As shown in
As more clearly shown in
In the embodiments shown in
As shown in the embodiments of
In the embodiments shown in
Importantly, during delivery of the cardiac harness 20,60,100, the harness itself, the electrodes 32,120,130, as well as leads 31 and 132 have sufficient column strength in order for the physician to push from the proximal end of the harness to advance it distally through the dilator tube 150. While the entire cardiac harness assembly is flexible, there is sufficient column strength, especially in the electrodes, to easily slide the cardiac harness over the epicardial surface of the heart in the manner described.
In an alternative embodiment, if the cardiac harness 20,60,100 includes coils 72, as opposed to the electrodes and leads, the harness can be delivered in the same manner as previously described with respect to
In another embodiment, delivery of the cardiac harness 20,60,100 can be by mechanical means as opposed to the hand delivery previously described. As shown in
As with the previous embodiment, suitable materials for the delivery system 140,180 can include the class of polymers typically used and approved for biocompatible use within the body. Preferably, the tubing associated with delivery systems 140 and 180 are rigid, however, they can be formed of a more flexible material. Further, the delivery systems 140,180 can be curved rather than straight, or can have a flexible joint in order to more appropriately maneuver the cardiac harness 20,60,100 over the epicardial surface of the heart during delivery. Further, the tubing associated with delivery systems 140,180 can be coated with a lubricious material to facilitate relative movement between the tubes. Lubricious materials commonly known in the art such as Teflon™ can be used to enhance slidable movement between the tubes.
Delivery and implantation of an ICD, CRT-D, pacemaker, leads, and any other device associated with the cardiac rhythm management devices can be performed by means well known in the art. Preferably, the ICD/CRT-D/pacemaker, are delivered through the same minimally invasive access site as the cardiac harness, electrodes, and leads. The leads are then connected to the ICD/CRT-D/pacemaker in a known manner. In one embodiment of the invention, the ICD or CRT-D or pacemaker (or combination device) is implanted in a known manner in the abdominal area and then the leads are connected. Since the leads extend from the apical ends of the electrodes (on the cardiac harness) the leads are well positioned to attach to the power source in the abdominal area.
It may be desired to reduce the likelihood of the development of fibrotic tissue over the cardiac harness so that the elastic properties of the harness are not compromised. Also, as fibrotic tissue forms over the cardiac harness and electrodes over time, it may become necessary to increase the power of the pacing stimuli. As fibrotic tissue increases, the right and left ventricular thresholds may increase, commonly referred to as "exit block." When exit block is detected, the pacing therapy may have to be adjusted. Certain drugs such as steriods, have been found to inhibit cell growth leading to scar tissue or fibrotic tissue growth. Examples of therapeutic drugs or pharmacologic compounds that may be loaded onto the cardiac harness or into a polymeric coating on the harness, on a polymeric sleeve, on individual undulating strands on the harness, or infused through the lumens in the electrodes and delivered to the epicardial surface of the heart include steroids, taxol, aspirin, prostaglandins, and the like. Various therapeutic agents such as antithrombogenic or antiproliferative drugs are used to further control scar tissue formation. Examples of therapeutic agents or drugs that are suitable for use in accordance with the present invention include 17-beta estradiol, sirolimus, everolimus, actinomycin D (ActD), taxol, paclitaxel, or derivatives and analogs thereof. Examples of agents include other antiproliferative substances as well as antineoplastic, antiinflammatory, antiplatelet, anticoagulant, antifibrin, antithrombin, antimitotic, antibiotic, and antioxidant substances. Examples of antineoplastics include taxol (paclitaxel and docetaxel). Further examples of therapeutic drugs or agents include antiplatelets, anticoagulants, antifibrins, antiinflammatories, antithrombins, and antiproliferatives. Examples of antiplatelets, anticoagulants, antifibrins, and antithrombins include, but are not limited to, sodium heparin, low molecular weight heparin, hirudin, argatroban, forskolin, vapiprost, prostacyclin and prostacyclin analogs, dextran, D-phe-pro-arg-chloromethylketone (synthetic antithrombin), dipyridamole, glycoprotein IIb/IIIa platelet membrane receptor antagonist, recombinant hirudin, thrombin inhibitor (available from Biogen located in Cambridge, Mass.), and 7E-3BÆ (an antiplatelet drug from Centocor located in Malvern, Pa.). Examples of antimitotic agents include methotrexate, azathioprine, vincristine, vinblastine, fluorouracil, adriamycin, and mutamycin. Examples of cytostatic or antiproliferative agents include angiopeptin (a somatostatin analog from Ibsen located in the United Kingdom), angiotensin converting enzyme inhibitors such as CaptoprilÆ (available from Squibb located in New York, N.Y.), CilazaprilÆ (available from Hoffman-LaRoche located in Basel, Switzerland), or LisinoprilÆ (available from Merck located in Whitehouse Station, N.J.); calcium channel blockers (such as Nifedipine), colchicine, fibroblast growth factor (FGF) antagonists, fish oil (omega 3-fatty acid), histamine antagonists, LovastatinÆ (an inhibitor of HMG-CoA reductase, a cholesterol lowering drug from Merck), methotrexate, monoclonal antibodies (such as PDGF receptors), nitroprusside, phosphodiesterase inhibitors, prostaglandin inhibitor (available from GlaxoSmithKline located in United Kingdom), Seramin (a PDGF antagonist), serotonin blockers, steroids, thioprotease inhibitors, triazolopyrimidine (a PDGF antagonist), and nitric oxide. Other therapeutic drugs or agents which may be appropriate include alpha-interferon, genetically engineered epithelial cells, and dexamethasone.
Although the present invention has been described in terms of certain preferred embodiments, other embodiments that are apparent to those of ordinary skill in the art are also within the scope of the invention. Accordingly, the scope of the invention is intended to be defined only by reference to the appended claims. While the dimensions, types of materials and coatings described herein are intended to define the parameters of the invention, they are by no means limiting and are exemplary embodiments.
|Patente citada
|Fecha de presentaciÛn
|Fecha de publicaciÛn
|1 Ago 1956
|11 Mar 1958
|Vineberg Heart Foundation
|Cardiac resuscitation device
|5 Sep 1967
|26 May 1970
|Andre Sausse
|Prosthesis for cardiac assistance
|20 Dic 1968
|28 Jun 1971
|Schiff Peter Paul
|Mechanical ventricular assistance assembly
|1 Jul 1974
|29 Jun 1976
|Hancock Laboratories Incorporated
|Preparing natural tissue for implantation so as to provide improved flexibility
|22 May 1975
|15 Mar 1977
|Philip Nicholas Sawyer
|Packaged prosthetic device
|12 Nov 1976
|3 Ene 1978
|Philip Nicholas Sawyer
|Surgical method of using a sterile packaged prosthesis
|5 Sep 1978
|11 Mar 1980
|Manfred Asrican
|Cardiac assist device
|29 Jun 1979
|14 Abr 1981
|Iker Aranguren Duo
|Process for installing mitral valves in their anatomical space by attaching cords to an artificial stent
|24 Dic 1980
|8 Feb 1983
|Vijil Rosales Cesar A
|Apparatus and method for surgical correction of ptotic breasts
|16 Feb 1982
|31 Ene 1984
|Ellman Barry R
|Surgical bag for splenorrhaphy
|6 Abr 1984
|23 Abr 1985
|Angicor Limited
|Storage unit
|21 May 1986
|19 May 1987
|Raychem Corporation
|Medical devices incorporating sim alloy elements
|10 Ago 1987
|14 Jun 1988
|Osteonics Corp.
|Package with tray for securing and presenting a sterile prosthetic implant element
|27 Feb 1987
|18 Abr 1989
|Intermedics Inc.
|Biphasic waveforms for defibrillation
|27 Feb 1987
|9 May 1989
|Intermedics Inc.
|Implantable defibrillation electrodes
|16 Sep 1987
|30 May 1989
|Evans Phillip H
|Venting apparatus and method for cardiovascular pumping application
|14 Mar 1988
|13 Jun 1989
|Pioneering Technologies, Inc.
|Heart valve and xenograft washing system
|29 Sep 1986
|20 Jun 1989
|Johnson & Johnson Patient Care, Inc.
|Heparin-containing adhesion prevention barrier and process
|15 Feb 1988
|26 Jun 1990
|Kulik Yaroslav P
|Prosthetic pericardium
|18 Jun 1990
|11 Feb 1992
|Boaz Avitall
|Myocardial iontophoresis
|14 May 1990
|24 Mar 1992
|Vascor, Inc.
|Biocompatible ventricular assist and arrhythmia control device including cardiac compression pad and compression assembly
|2 Nov 1990
|21 Abr 1992
|Angelase, Inc.
|19 Nov 1990
|9 Jun 1992
|Anstadt George L
|Heart massage apparatus
|28 May 1991
|16 Feb 1993
|Albert Einstein College Of Medicine Of Yeshiva University
|Hemostasis apparatus and method
|9 Abr 1991
|2 Mar 1993
|Raychem Corporation
|Medical devices incorporating SIM alloy elements
|12 Dic 1991
|9 Mar 1993
|Daskalakis Michael K
|Synthetic intraventricular implants and method of inserting
|26 Abr 1991
|30 Mar 1993
|Advanced Coronary Technology, Inc.
|Removable heat-recoverable tissue supporting device
|17 Ago 1992
|18 Ene 1994
|Ethicon, Inc.
|Drawstring surgical pouch and method of use for preventing ovarian adhesions
|10 Oct 1991
|1 Mar 1994
|Earl K. Sipes
|Method and apparatus for hernia repair
|28 Jul 1992
|24 Ene 1995
|Vascor, Inc.
|Biocompatible ventricular assist and arrhythmia control device including cardiac compression band-stay-pad assembly
|27 Ago 1993
|31 Ene 1995
|Rose Health Care Systems
|Diagnostic and treatment method for cardiac rupture and apparatus for performing the same
|5 Nov 1993
|31 Ene 1995
|Sulzer Medizinaltechnik Ag
|Container for the packaging of a hollow endoprosthesis
|17 Jun 1993
|31 Ene 1995
|Wilk; Peter J.
|Intrapericardial assist device and associated method
|22 Jul 1993
|11 Abr 1995
|United States Surgical Corporation
|Resilient arm mesh deployer
|17 Ago 1994
|19 Mar 1996
|Mures Cardiovascular Research, Inc.
|Cardiac valve
|12 Abr 1994
|16 Abr 1996
|Ventritex, Inc.
|Cardiac insulation for defibrillation
|31 May 1994
|23 Abr 1996
|Dunlop; Richard W.
|Method and apparatus for the creation of tricuspid regurgitation
|1 Oct 1993
|11 Jun 1996
|Advanced Surgical, Inc.
|Self-deploying isolation bag
|10 Ago 1994
|14 Ene 1997
|Segmed, Inc.
|Apparatus and method for reducing and stabilizing the circumference of a vascular structure
|7 Jun 1995
|14 Ene 1997
|C. R. Bard, Inc.
|Method for limiting the incidence of postoperative adhesions
|2 Oct 1992
|28 Ene 1997
|Raychem Corporation
|Medical devices incorporating SIM alloy elements
|5 Dic 1994
|18 Feb 1997
|Jarvik; Robert
|Two-stage cardiomyoplasty
|27 Ene 1995
|4 Mar 1997
|The Regents Of The University Of California
|Soft tissue augmentation apparatus
|13 Jun 1995
|3 Feb 1998
|Abiomed R&D, Inc.
|Extra cardiac ventricular assist device
|20 Feb 1996
|17 Mar 1998
|Cardiothoracic Systems, Inc.
|Surgical devices for imposing a negative pressure to fix the position of cardiac tissue during surgery
|21 May 1996
|12 May 1998
|Duke University
|Direct mechanical bi-ventricular cardiac assist device
|23 Jun 1997
|2 Feb 1999
|E.P. Technologies Inc.
|Atrial appendage stasis reduction procedure and devices
|28 Mar 1995
|2 Mar 1999
|Gore Enterprise Holdings, Inc.
|Self-expandable helical intravascular stent and stent-graft
|7 Jun 1995
|18 May 1999
|Medtronic, Inc.
|Device or apparatus for manipulating matter
|8 Ene 1998
|8 Jun 1999
|Cardiassist Incorporated
|Ventricular assist device and method
|3 Oct 1996
|18 Ene 2000
|Medtronic, Inc.
|Method and apparatus for temporarily immobilizing a local area tissue
|1 May 1998
|15 Feb 2000
|Correstore Inc
|Anterior segment ventricular restoration apparatus and method
|29 Jul 1998
|4 Abr 2000
|Myocor, Inc.
|Heart wall tension reduction apparatus and method
|2 Ene 1997
|18 Abr 2000
|Myocor, Inc.
|Heart wall tension reduction apparatus
|4 Ene 1999
|9 May 2000
|Myocor, Inc.
|Heart wall tension reduction apparatus
|8 Dic 1996
|6 Jun 2000
|Hearten Medical, Inc.
|Device for the treatment of infarcted tissue and method of treating infarcted tissue
|14 Ene 1999
|13 Jun 2000
|Brennan; Edward F.
|Apparatus and methods for treating congestive heart failure
|29 Jul 1998
|20 Jun 2000
|Myocor, Inc.
|Stress reduction apparatus and method
|23 Sep 1997
|20 Jun 2000
|Acorn Cardiovascular, Inc.
|Cardiac reinforcement device
|7 May 1996
|27 Jun 2000
|Heartport, Inc.
|Method for thoracoscopic intracardiac procedures including septal defect
|18 Nov 1998
|2 Ene 2001
|Acorn Cardiovascular, Inc.
|Defibrillating cardiac jacket with interwoven electrode grids
|21 Sep 1999
|16 Ene 2001
|Acorn Cardiovascular, Inc.
|Cardiac constraint with tension indicator
|21 Sep 1999
|30 Ene 2001
|Acorn Cardiovascular, Inc.
|Device for heart measurement
|21 Sep 1998
|6 Feb 2001
|Myocor, Inc.
|External stress reduction device and method
|5 Mar 1998
|20 Feb 2001
|The University Of Cincinnati
|Device and method for restructuring the heart chamber geometry
|21 Sep 1999
|27 Feb 2001
|Acorn Cardiovascular, Inc.
|Cardiac constraint with draw string tensioning
|10 Mar 1998
|10 Abr 2001
|University Of Cincinnati
|Article and method for coupling muscle to a prosthetic device
|4 Ene 2000
|17 Abr 2001
|Focal, Inc.
|Compliant tissue sealants
|30 Sep 1998
|24 Abr 2001
|The University Of Cincinnati
|Device and method for restructuring heart chamber geometry
|13 Feb 1998
|1 May 2001
|Abiomed, Inc.
|Passive girdle for heart ventricle for therapeutic aid to patients having ventricular dilatation
|18 Nov 1998
|15 May 2001
|Acorn Cardiovascular, Inc.
|Cardiac constraint with prior venus occlusion methods
|7 Dic 2000
|5 Mar 2002
|Focal, Inc.
|Compliant tissue sealants
|8 Oct 1999
|26 Mar 2002
|Swaminathan Jayaraman
|Modification of properties and geometry of heart tissue to influence heart function
|2 Jul 1998
|21 May 2002
|Origin Medsystems, Inc.
|System to permit offpump beating heart coronary bypass surgery
|14 Nov 2000
|11 Jun 2002
|Myocor, Inc.
|External stress reduction device and method
|27 Abr 2001
|11 Jun 2002
|Myocor, Inc.
|Stress reduction apparatus and method
|21 Oct 1999
|18 Jun 2002
|Myocor, Inc.
|Methods and devices for improving cardiac function in hearts
|21 Jul 1997
|11 Feb 2003
|Gore Enterprise Holdings, Inc.
|Exterior supported self-expanding stent-graft
|8 Nov 2000
|6 Ene 2004
|Acorn Cardiovascular, Inc.
|Adjustment clamp
|11 Jun 2002
|27 Ene 2004
|Acorn Cardiovascular, Inc.
|Tension indicator for cardiac support device and method therefore
|23 Oct 2002
|27 Ene 2004
|Acorn Cardiovascular, Inc.
|Cardiac disease treatment and device
|6 Ene 2003
|2 Mar 2004
|Revivant Corporation
|Minimally invasive direct cardiac massage device and method
|28 Ene 2004
|19 Abr 2005
|Acorn Cardiovascular, Inc.
|Delivery of cardiac constraint jacket
|3 Nov 2000
|3 May 2005
|Converge Medical, Inc.
|Heart support to prevent ventricular remodeling
|13 Feb 2003
|17 May 2005
|Acorn Cardiovascular, Inc.
|Cardiac reinforcement device
|20 Sep 2002
|24 May 2005
|Acorn Cardiovascular, Inc.
|Cardiac disease treatment and device
|7 May 2001
|17 Ene 2002
|Melvin David Boyd
|Heart wall actuation device for the natural heart
|17 May 2001
|24 Ene 2002
|Reese James W.
|Lead free liner composition for shaped charges
|13 Abr 2001
|21 Feb 2002
|Melvin David B.
|Device and method for restructuring heart chamber geometry
|10 Sep 2001
|7 Mar 2002
|Lilip Lau
|Expandable cardiac harness for treating congestive heart failure
|10 Sep 2001
|18 Abr 2002
|Lilip Lau
|Expandable cardiac harness for treating congestive heart failure
|14 Sep 2001
|2 May 2002
|Lilip Lau
|Expandable cardiac harness for treating congestive heart failure
|23 Ene 2002
|6 Jun 2002
|Myocor, Inc.
|Heart wall tension reduction apparatus
|22 Dic 2000
|27 Jun 2002
|Acorn Cardiovascular, Inc.
|Cardiac disease treatment and device
|25 Sep 2001
|27 Mar 2003
|Gifford Hanson S.
|Ventricular infarct assist device and methods for using it
|25 Sep 2001
|27 Mar 2003
|French Ronald G.
|Passive ventricular support devices and methods of using them
|25 Sep 2001
|27 Mar 2003
|French Ronald G.
|Pericardium reinforcing devices and methods of using them
|16 Sep 2003
|17 Mar 2005
|Acorn Cardiovascular, Inc.
|Apparatus and method for applying cardiac support device
|8 Nov 2004
|21 Abr 2005
|Acorn Cardiovascular, Inc.
|Cardiac support device
|Patente citante
|Fecha de presentaciÛn
|Fecha de publicaciÛn
|7 Nov 2003
|26 Dic 2006
|Paracor Medical, Inc.
|Cardiac harness for treating congestive heart failure and for defibrillating and/or pacing/sensing
|2 Dic 2004
|16 Ene 2007
|Paracor Medical, Inc.
|Cardiac harness for treating congestive heart failure and for defibrillating and/or pacing/sensing
|12 Feb 2004
|29 May 2007
|Paracor Medical, Inc
|Cardiac harness for treating congestive heart failure and for defibrillating and/or pacing/sensing
|6 Sep 2006
|21 Dic 2010
|Pacesetter, Inc.
|Implantable cardiac patch for measuring physiologic information
|31 Ene 2007
|5 Abr 2011
|Pacesetter, Inc.
|Passive fixation for epicardial lead
|23 Ene 2007
|24 May 2011
|Pacesetter, Inc.
|Epicardial lead
|28 Feb 2011
|7 Abr 2015
|Pacesetter, Inc.
|Passive fixation for epicardial lead
|7 Nov 2003
|12 May 2005
|Lilip Lau
|Cardiac harness for treating congestive heart failure and for defibrillating and/or pacing/sensing
|12 Feb 2004
|12 May 2005
|Lilip Lau
|Cardiac harness for treating congestive heart failure and for defibrillating and/or pacing/sensing
|2 Dic 2004
|2 Jun 2005
|Lilip Lau
|Cardiac harness for treating congestive heart failure and for defibrillating and/or pacing/sensing
|ClasificaciÛn de EE.UU.
|ClasificaciÛn internacional
|ClasificaciÛn cooperativa
|ClasificaciÛn europea
|17 Abr 2007
|Certificate of correction
|14 Jun 2010
|Fee payment
Year of fee payment: 4
|25 Jul 2014
|Maintenance fee reminder mailed
|12 Dic 2014
|Lapse for failure to pay maintenance fees
|3 Feb 2015
|Expired due to failure to pay maintenance fee
Effective date: 20141212


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Utah joined a growing list of states removing barriers for youth hunters recently, as Gov. Jon Huntsman signed House Bill 328 into law.
The Utah Senate passed legislation that removes the minimum age for hunting upland game, small game and turkeys in the state. HB 328 passed by a margin of 20-7, and under the bill, hunters must be accompanied by an adult mentor at all times.
"This is a huge victory for mentored hunters in Utah," said Jon Leonard, National Wild Turkey Federation Utah state chapter president. "We are pleased young hunters will now have the opportunity to hunt with a mentor and without worry of a minimum age requirement."
Leonard represented the NWTF on the Wildlife and Habitat Legislative Coalition in Utah. The coalition is made up of representatives from sportsmen's groups, and was instrumental in getting the legislation passed through the committee.
"When you restrict the age at which a young person can enter the woods, you interfere with the family tradition of hunting and conservation," said Jon Leonard, National Wild Turkey Federation Utah state chapter president. "This law gives families another opportunity to strengthen their ties, while at the same time removing barriers for youth hunting."
The WHLC relied heavily on statistics from the Youth Hunting Report, which was written by Silvertip Productions, the U.S. Sportsmen's Alliance and Southwick Associates Inc.
The report shows youth hunters are the safest hunters in the woods when accompanied by an adult. Of the 31 states that have no minimum age restrictions, the incident rates are .0483 per 1,000 hunters. The remaining states where the government sets minimum hunting age requirements had an incident rate nearly 10 percent higher at .0534 incidents per 1,000 hunters.
The findings of the report were peer reviewed for statistical validity by the Triad Research Group. The NWTF has led the charge in promoting youth hunting opportunities and has teamed up with USSA and National Shooting Sports Foundation to remove youth hunting barriers across the nation.
The research compelled the NWTF, USSA and NSSF to launch Families Afield, a program designed to work with hunters and elected officials about the negative impact of high age restrictions.
"Youth hunters are the future of conservation and the hunting tradition," said Rob Keck, CEO of the NWTF. "If we don't get these young people involved in hunting and conservation at an early age, our hunting traditions could suffer. By hooking them on hunting at an early age, we ensure the future of hunting and conservation remains strong."
While the Youth Hunting Report showed mentored hunters are safe hunters, it also showed hunter retention in Utah is on the decline. It also clearly shows regulations that limit youth participation have a negative impact on a state's ability to attract future hunters.
According to the Youth Hunting Report, Utah currently has 384,000 youth 6 to 15 years old, and a hunter retention rate of only 0.59, which means for every 100 hunters who leave hunting, only 59 take their place. Meanwhile, Mississippi has a comparable number of youth in the same age range - 438,000 to be exact - and a hunter retention rate of 1.01. Mississippi also has no minimum hunting age.
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Friday, April 16, 2010
You KNOW how much I love Joel Dewberry ...
... so imagine how excited I was to hear from Laurie Dewberry, Joel's wife, in response to my blogiversary post! I guess Laurie caught wind of all of the gushing I do around these parts about Joel's fabrics.
And here's the best part ... Laurie has graciously offered to provide a full fat quarter pack of one of Modern Meadow's three different colorways. Modern Meadow is Joel's newest fabric line, and it is FABULOUS. Check it out.
By the way, BIG THANKS to everyone who has so generously offered giveaway prizes for my big giveaway. If you emailed me but haven't heard back from me yet, you will soon! I am currently compiling the list of giveaways and will be posting it here soon.
Can't wait that long? Head on over to the Dewberrys' blog, where they are currently hosting a giveaway of their own. You'll also see some sneak peeks into Joel's latest book, "Sewn Spaces", due to come out this spring. Can't WAIT for that one!!
Thanks again, Joel & Laurie!
12 comments:
Thanks for sharing this John! I immediately went over and left a comment for that great giveaway. That and a rather long story about how much I love Joel's woodgrain fabric, haha. The book looks awesome too!ReplyDelete
The Cool Stream Modern Meadow is to die for! A very generous offer for you.ReplyDelete
Oh wow, this is so awesome John! I didn't even know that Joel Dewberry had a blog - can't wait to see his new book and all the prizes you'll be revealing!ReplyDelete
That is way cool. and double cool of you to have a give away, just make sure a guy quilter from Kansas wins something would ya???ReplyDelete
Modern Meadow is beautiful!ReplyDelete
shannoncarman at yahoo dot com
That's one of my current favorite lines--just beautiful! Thanks for sharing the blog info.ReplyDelete
We KNOW how much you love Joel Dewberry! I do too. Please enter me in your giveaway for ANY FQ bundle of Modern Meadow. It is so very nice of the Dewberrys and you to offer this giveaway. I didn't know they had a blog, so appreciate the information. mlwright29 (at) hotmail (dot) comReplyDelete
Oh yea...I get to be the first commenter on the MBS tutorials...wonderful pillows and such a fun idea to work with Julie.ReplyDelete
nice! modern meadow is a great line!ReplyDelete
Oh John congrats on your two years of blogging. Your tut for wonky log was my first on line quilt and I enjoyed it so thank you for that tooReplyDelete
By the way, please enter me for your give away. ThanksReplyDelete


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Anatomic problems of the lower GI tract are structural defects. Anatomic problems that develop before birth are known as congenital abnormalities. Other anatomic problems may occur any time after birth—from infancy into adulthood.
The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food. Organs that make up the GI tract are the mouth, esophagus, stomach, small intestine, large intestine—which includes the appendix, cecum, colon, and rectum—and anus. The intestines are sometimes called the bowel. The last part of the GI tract—called the lower GI tract—consists of the large intestine and anus.
The large intestine is about 5 feet long in adults and absorbs water and any remaining nutrients from partially digested food passed from the small intestine. The large intestine then changes waste from liquid to a solid matter called stool. Stool passes from the colon to the rectum. The rectum is 6 to 8 inches long in adults and is located between the last part of the colon—called the sigmoid colon—and the anus. The rectum stores stool prior to a bowel movement. During a bowel movement, the muscles of the rectal wall contract to move stool from the rectum to the anus, a 1-inch-long opening through which stool leaves the body.
The lower GI tract
Anatomic problems of the lower GI tract may involve parts of organs being in the wrong place, shaped abnormally, or incorrectly connected to other organs. Anatomic problems that affect the large intestine or anus include
About 4 weeks into gestation—the 9-month period from conception to birth—the intestines of the developing baby, or fetus, consist of a thin, straight tube that connects the stomach and the rectum. Over the next 2 weeks, the rapidly developing intestines outgrow the baby's abdomen and move into the umbilical cord, which connects the baby to the mother. During gestational weeks 10 to 12, the baby's abdomen has grown large enough to hold the intestines, which return to the abdomen, rotating counterclockwise to their final position. The intestines are held in place by tissue called mesentery.
Malrotation is when the intestines do not rotate completely or correctly during gestation. Malrotation can cause serious medical problems in some infants and children, while others may never develop problems. Surgeons estimate that problems with malrotation occur in a small percentage of cases and are usually diagnosed in the first month of life. Boys are more likely than girls to be diagnosed with malrotation during infancy, but problems identified later in childhood are equally likely in boys and girls. Malrotation rarely occurs in adults.
Malrotation can prevent the cecum—the beginning of the large intestine—from moving to its normal position in the lower right area of the abdomen. If this happens, bands of mesentery can block the small intestine, creating an intestinal obstruction—also called bowel obstruction—a life-threatening event and a medical emergency. Malrotation may also leave the mesentery only narrowly attached to the back of the abdomen. This incomplete attachment may result in the intestine twisting—a serious condition called volvulus—see "What is volvulus?"
Infants who have serious problems resulting from malrotation experience pain that can be severe, and they often vomit bile—a greenish-yellow fluid. Other symptoms may include
Older children with problems from malrotation may have the above symptoms as well as nausea, abdominal pain, diarrhea, or an abnormal growth rate, as compared with their peers.
Infants or children with any of the above symptoms should be evaluated immediately by a health care provider.
Doctors use x rays of the abdomen and imaging studies to diagnose intestinal problems related to malrotation.
The above tests are all performed at a hospital or outpatient center by an x-ray technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging.
Surgery is almost always required to correct problems resulting from malrotation. A surgeon performs the procedure in a hospital and the child is given general anesthesia. With early diagnosis and treatment, surgery is usually successful and may involve
Volvulus occurs when the intestine twists around itself and the mesentery that supports it, creating an obstruction. The area of intestine above the obstruction continues to function and fills with food, fluid, and gas. The mesentery may become so tightly twisted that blood flow to the affected part of the intestine is cut off. This situation can lead to death of the blood-starved tissue and tearing of the intestinal wall—a life-threatening event and a medical emergency.
Volvulus can be caused by malrotation or by other medical conditions such as
Sigmoid volvulus—twisting of the sigmoid colon—accounts for the majority of cases, with cecal volvulus—twisting of the cecum and ascending colon—occurring less frequently.
Anatomic problems that increase a person's risk of developing sigmoid volvulus include
Sigmoid volvulus that occurs after infancy is more commonly seen in people who
Sigmoid volvulus symptoms can be severe and occur suddenly. Symptoms may include
People with any of these symptoms should be evaluated immediately by a health care provider.
Other symptoms may develop more slowly but worsen with time, such as constipation, inability to pass gas, and abdominal swelling. People with these symptoms should also contact a health care provider.
Prompt diagnosis and appropriate treatment of sigmoid volvulus generally lead to a successful outcome. Doctors use x rays, upper or lower GI series, CT scans, and flexible sigmoidoscopy—another common diagnostic test—to help diagnose sigmoid volvulus.
If volvulus is found, the doctor may use the sigmoidoscope to untwist the colon. However, if the colon is twisted tightly or if the blood flow has been cut off, immediate surgery will be needed. Surgery involves restoring the blood supply, if possible, to the affected part of the sigmoid colon. Sometimes the affected part of the colon must be removed and the healthy ends reattached, a procedure called an intestinal resection. Resection prevents volvulus from recurring; untwisting the volvulus with the sigmoidoscope may not prevent recurrence.
Cecal volvulus is twisting of the cecum and ascending colon. Normally, the cecum and ascending colon are fixed to the abdominal wall. If improperly attached, they can move and become twisted.
More commonly seen in people ages 30 to 60, cecal volvulus may be caused by abdominal adhesions, severe coughing, or pregnancy. People with cecal volvulus often have intermittent chronic symptoms—those that come and go over a longer period of time—including
People with any of the above symptoms should be evaluated immediately by a health care provider.
Doctors use x rays, upper or lower GI series, and CT scans to diagnose cecal volvulus. Imaging shows whether the cecum is out of place and inflated with trapped air. Imaging may also show that the appendix, which is attached to the cecum, is filled with air. To treat cecal volvulus, surgeons use a procedure called cecopexy to reposition the cecum and attach it to the abdominal wall. If the cecum is seriously damaged by volvulus, the surgeon will perform intestinal resection surgery. Cecopexy and intestinal resection surgery have high rates of success and usually prevent the recurrence of cecal volvulus.
Intussusception is a condition in which one section of either the large or small intestine folds into itself, much like a collapsible telescope. The condition can cause obstruction and cut off blood flow to the affected part of the intestine—a life-threatening event and a medical emergency.
Malrotation increases the risk that an infant or young child will develop intussusception. Sometimes, a viral infection or growth in the small or large intestine—such as a polyp or tumor—can trigger intussusception, but most childhood cases have no known cause.
Intussusception, though uncommon, is the leading cause of bowel obstruction in young children in the United States. About 1,400 cases occur in the United States each year, nearly all of them in children younger than 1 year old. Intussusception is 1.5 times as likely to affect boys as girls.1
1Tate JE, Simonsen L, Viboud C, et al. Trends in intussusception hospitalization among US infants, 1993–2004: implications for monitoring the safety of the new rotavirus vaccination program. Pediatrics. 2008;121(5):e1125–e1132.
Infants or children with intussusception may have symptoms including
A range of tests may be required to diagnose intussusception. X rays of the abdomen may show an intestinal obstruction. Upper and lower GI series can locate the intussusception and show telescoping of the intestine. CT scans can also help diagnose the condition. If intussusception is not diagnosed promptly, it can cause serious damage to the affected part of the intestine.
In some cases, intussusception may be temporary and correct itself and, if no underlying problem is found, treatment is not required. When intussusception does not resolve on its own, doctors can usually correct the problem with a lower GI series, using air or barium to gently push the telescoped part of intestine into its proper position. However, intestinal resection surgery is sometimes necessary to successfully treat the condition.
A fistula is an abnormal passage, or tunnel, between two organs—called an internal fistula—or between an organ and the outside of the body—called an external fistula. In the lower GI tract, both internal and external fistulas can occur. Fistulas can develop during gestation or at any age after birth. Fistulas that develop during gestation are more common in boys than girls.
Fistulas may occur as a result of
Some people with a fistula in the lower GI tract have no symptoms; others may experience
External fistulas can be found during a physical examination. Internal fistulas can be seen during an upper or lower GI series, CT scan, or colonoscopy.
Internal and external fistulas may close on their own, although this process could take weeks or months. The doctor may prescribe antibiotics to prevent or treat infection resulting from leakage of intestinal contents. Some people may need to stop eating and receive nourishment intravenously to ensure proper healing.
If a fistula does not close on its own, a surgeon may perform intestinal resection surgery.
Imperforate anus occurs during gestation and involves abnormal development of the rectum and anus. This condition results in a blocked or missing anus, which allows little or no stool to pass from the rectum. Imperforate anus is uncommon and occurs slightly more often in boys than in girls. Types of imperforate anus include
Although most girls with imperforate anus have a less severe form of the condition, such as anal atresia, some are born with a more severe form of imperforate anus called cloaca—a common opening for the rectum, bladder, and vagina.
Imperforate anus is observed when a newborn is first examined after birth. In addition to visible indications such as an incorrectly placed anus, imperforate anus may be associated with symptoms that include abdominal swelling and the absence of bowel movements.
The severity of imperforate anus depends on where the blockage is situated—low, intermediate, or high—in relation to the set of muscles that support the rectum and other organs within the pelvic region. X rays of the abdomen and CT scans can help determine the severity of the condition. The doctor may perform other tests to look for abnormalities in the urinary tract.
Correcting imperforate anus almost always requires surgery, and the type of procedure depends on the location and severity of the defect. For example, a low imperforate anus may only require gently widening the anus. Sometimes anoplasty—a surgery to rebuild or move the anus—is needed within the first days after birth. Intermediate or high imperforate anus may require multiple surgeries done in stages. Girls with cloaca may require multiple extensive and complicated surgeries.
The outcome of surgery is measured by the child's ability to eventually control bowel movements. Most children treated for imperforate anus develop voluntary bowel movements at the usual age of toilet training. However, some children may not achieve good bowel control after surgery because the anal muscles do not develop properly. Factors affecting the outcome of surgery include
Colonic atresia is an extremely rare congenital anomaly that occurs when a section of the colon closes before birth. Symptoms appear in infants soon after birth and include vomiting, abdominal swelling, and the absence of bowel movements. Intestinal resection surgery is performed immediately after diagnosis.
Eating, diet, and nutrition have not been shown to play a role in causing or preventing anatomic problems of the lower GI tract.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducts and supports research into many kinds of digestive disorders, including anatomic problems of the lower GI tract. Researchers have found that a single gene plays an essential role in controlling normal intestinal development during gestation. Ongoing studies will demonstrate how the absence of the gene affects colon formation.
Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.
Crohn's & Colitis Foundation of America 386 Park Avenue South, 17th Floor New York, NY 10016 Phone: 1–800–932–2423 Fax: 212–779–4098 Email: firstname.lastname@example.com Internet: www.ccfa.org
Digestive Disease National Coalition507 Capitol Court NE, Suite 200 Washington, D.C. 20002Phone: 202–544–7497Fax: 202–546–7105Email: firstname.lastname@example.com: www.ddnc.org
Gastro-Intestinal Research Foundation70 East Lake Street, Suite 1015 Chicago, IL 60601 Phone: 312–332–1350 Fax: 312–332–4757 Email: email@example.com: www.girf.org
International Foundation for Functional Gastrointestinal DisordersP.O. Box 170864 Milwaukee, WI 53217–8076 Phone: 1–888–964–2001 or 414–964–1799 Fax: 414–964–7176 Email: firstname.lastname@example.com: www.iffgd.org
National Organization for Rare Disorders55 Kenosia Avenue P.O. Box 1968 Danbury, CT 06813–1968 Phone: 1–800–999–6673 or 203–744–0100 Fax: 203–798–2291 Email: email@example.com or firstname.lastname@example.com: www.rarediseases.org
The Simon Foundation for ContinenceP.O. Box 815 Wilmette, IL 60091 Phone: 1–800–23–SIMON (1–800–237–4666) or 847–864–3913 Fax: 847–864–9758 Internet: www.simonfoundation.org
United Ostomy Associations of America, Inc.P.O. Box 512 Northfield, MN 55057–0512 Phone: 1–800–826–0826 Email: firstname.lastname@example.com: www.uoaa.org
Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication was originally reviewed by Robert Beart, M.D., University of Southern California; James W. Fleshman, M.D., Washington University and Barnes-Jewish Hospital; Kevan Jacobson, M.B.B.Ch, B.C.'s (British Columbia, Canada's) Children's Hospital; Joseph Levy, M.D., Children's Hospital of New York-Presbyterian; and John H. Pemberton, M.D., Mayo Clinic.
You may also find additional information about this topic by visiting MedlinePlus at www.medlineplus.gov.
This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit www.fda.gov. Consult your health care provider for more information.
2 Information WayBethesda, MD 20892–3570Phone: 1–800–891–5389TTY: 1–866–569–1162Fax: 703–738–4929Email: firstname.lastname@example.com: www.digestive.niddk.nih.gov
The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.
This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.
NIH Publication No. 12–5120December 2011
Page last updated July 10, 2013


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By KEVIN SCANNELLSun Advocate reporter
At any hospital there is constant movement among the doctors, nurses and surgeons making sure patients are provided with care in their time of need.
But none of that may be possible if it isn't for the work behind the scenes of those who fill out the paper work, find qualified doctors and do everything else imaginable in a days work.
For Kendra Rhodes, 30, and Christine Hammer, 38, Castleview Hospital is a one very interesting place to work.
"This job has a constant chaos that comes with it," said Hammer, executive assistant at Castleview Hospital. "It's a high stress job and sometimes I might have five different projects going on at once, but I'll take it. I enjoy working here a lot."
"Multitasking is a very important part of our jobs," said Rhodes, medical staff coordinator at Castleview Hospital. "We may be answering phone calls, filing reports and have 30 people asking us to do things for them on a regular basis."
While dealing with some of the harder parts of their jobs, such as patient complaints and demanding deadlines, Rhodes looks toward each day as a challenge to be conquered.
"Everyday is a new challenge for us," Rhodes said. "The staff here is very appreciative of the work that we do and that feels really good to know."
Part of her job as a medical staff coordinator requires Rhodes to search for potential doctors who are applying for a position at Castleview. Two keys that doctors need to have when applying are to be easy going and be content with the small town atmosphere that Price and Carbon County provide, Rhodes said.
When she has days with a lot of stress, Hammer only needs to sit back in her chair, take a deep breath and look at her computer monitor. Taped to bottom of her monitor is a piece of paper with the words 'I love my job' written on it.
Hammer is known around the office as the linking pin, someone who is connected to everything happening and everyone working at the hospital.
"I take pride in my job and I try to say to myself everyday that I'm good at my job," Hammer said. "I know what's going on around here."
When they are away from the hospital, Hammer, a Price resident, spends much of her free time outdoors going boating, fishing, camping, hiking and taking care of her two children and three stepchildren along with her husband.
Rhodes, a Wellington resident, spends her free time with her husband and their three children on their 50 acre farm. She keeps busy with her children playing baseball in the spring and summer and spends time participating in breakaway roping with her five horses.
As for the future, both Hammer and Rhodes see themselves continuing to work with Castleview Hospital. But that won't prevent them from pursing other interests.
"I might look into getting my MBA maybe," Hammer said.
"I'll be here until I retire, unless I somehow win the lottery," Rhodes laughed. "But I think the odds are against me winning it."


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Update HistoryVersion 1.9- Sep 22nd, 2014
- Updated : Compatible with Wordpress 4.0 - Updated : Revslider 4.6 - Fixed : Toggle Menu issue on Iphone
Version 1.8- July 1st, 2014
- Fixed : Fix Editor in Wordpress 3.9+Version 1.7- Aprial 1st, 2014
- Added : New Revolution Slider 4.3.3 - Added : New content demo files - Updated : New Search Page - Fixed : Search pagination problem - Fixed : Related Post Label in single post - Fixed : Pricing title of pricing tableVersion 1.6 – November 20th, 2013
- Added : Feature Box , Feature Circle , People Profile display 2 columns when have only 2 entry - Added : Option to upload scroll logo (for only scroll header) - Added : Custom Javascript and CSS - Fixed : Accordion height issue - Fixed : Scrolling menu in iOS - Fixed : column shortcodes can add shortcodes - Fixed : fix pricing unit position and pricing buttons - Fixed : white header option of scroll header
Version 1.5 – November 5th, 2013
- Updated : Working fully with wordpress 3.7.1 - Updated : New demo files - Added : Full background options for any page builder widgets!*Update Notice: The page builde have big changes so it will break some widgets. You should make backup data of widgets then redone the broken page and it will working fine.
Version 1.4 – October 11th, 2013
- Added : Pricing Tables Shortcodes
Version 1.3 – August 29th, 2013
- Update : Working Fully with Wordpress 3.6 - Added : Option White header for dark logo - Fixed : Auto relayout for portfolio page - Fixed : Text Tab of Content Editor Popup
Version 1.2 – July 24th, 2013
- Added : Option to resize the Nav Header Smaller when Scroll - Fixed : Page Heading in some Page Template
Version 1.1 – July 20th, 2013
Note : Updating will effect to the page use content box widget. Just need to re-done this page again.
- Updated : Add author bio to top page of Author Page - Added : Author Bio on Single Blog page - Added : Related articles to Single Blog Page - Added : Option to add Opacity to Nav Header - Added : Color Background Option for Content Block in Page Builder - Added : Option for Single Project Full Width - Added : White under White background Option for Widgets in Page Builder - Added : Option to display On/Off Sidebar on Mobile - Added : Option to display no Heading on Page - Added : Option Feature Name align for Feature Box in Page Builder - Fixed : Image Slides button BUGS of Post/Portfolio on Mobile
June 22th, 2013
- Added : Color Bars page
interesting to see this theme work smooth in mobile? just click "REMOVE FRAME" in the top bar.
The Hypertext is an awesome Flat Portfolio wordpress theme which brings many useful and most popular functions with Flat Design which is popular right now. It's ideal for any corporate agency, creative studio or for personal portfolio.
It's very flexible and powered by our Wope Framework which has advanced theme options to make your site very flexible and fully customizable. You can build dozens custom pages with our Page Builder which has many useful and popular options. You can build the page easily, and yes update is simple as how it was built.
The Hypertext also brings Revolution Slider Plugin (15$ Value) which is fully intergated. You can use Revolution Slider easily in all pages. We used Isotope (25$ Value) for our sortable portfolio.
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|Drowning Victim Identified by Caldwell SO
|Written by Steve Frank
|Wednesday, 04 September 2013 14:27
The Caldwell Sheriff's Office had identified the man who drowned Labor Day in the waters of Wilson's Creek. Investigators say it was Elder Ortiz Velasquez, who would have been 23 today. Velasquez reportedly drowned in Wilson's Creek near Brown Mountain Beach
Resort late Monday afternoon, the 911 call coming in at 4:52 p.m., but he had been missing for about 45 minutes by then, according to Capt. Larry Price of Collettsville Fire and Rescue. Search crews were at the scene within 10 minutes, but it was much too late for the Guatemalan man. Caldwell officials say he was at the waterway with some friends. The body was found at around 7 p.m., and it took a number of rescuers to lift the body up a steep incline. It was the third fatality in the area since July.
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Click here to read all of this product's reviews


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By Andy Sweet
If you're in the market for a back-to-school laptop, a portable PC, or just a basic computer that won't break your budget, there's a chance you've heard the word "netbook." No, it's not a fishing manual for old-time sailors, it's a type of PC that's catching on—and for good reason.
I've been using an ordinary, middle-of-the-road netbook for the last year and love it. Read on and I'll give you the inside scoop on netbooks—what they are, why there's so much buzz about them, and what's in the fine print.
Basically, netbooks are just small laptops with a couple of differences that we'll get into in a bit. Their small size makes them highly portable, so they're perfect when you're on the go. You can bring a netbook along when you wouldn't consider lugging a heavier, bulkier laptop. For example, when I'm flying, my netbook sits on the tray table, while other passengers struggle with their larger, heavier laptops.
If you find yourself using your PC mainly for checking and writing e‑mail and browsing the web, rather than crunching numbers, then a netbook could be a great match for you. I often have mine nearby when watching TV, so I can look up a show's website for more information, or find out what other movies an actor or actress has been in.
First, a netbook is still a full-fledged PC with a real keyboard. You can only do so much on a phone, no matter how smart it is. Typing on my phone is usually limited to "LOL," but I've typed stories, notes, proposals, and yes, even this column on a netbook—in my backyard, no less. And because netbooks are PCs, you can still do the routine PC tasks you're used to doing—installing programs made for Windows, printing files, attaching devices, connecting to networks, and more.
The main thing that makes a netbook a netbook is its compact size—they're portable and light. My netbook weighs only about 3 pounds, and at about the same size of a hard-cover book, it fits in my bike messenger bag with plenty of room to spare without weighing me down. It just feels smaller, and it's not even one of the smaller models. Some netbooks are even small and light enough to fit comfortably inside a purse.
Netbooks take advantage of power-sipping CPUs that give them very good battery life, which makes them even more portable. I get several hours of use without having to worry about the next charge, needing to camp out near an electrical outlet, or lugging a power cord along.
And let's not forget one of the most compelling reasons to get a netbook—price. Netbooks aren't intended to be (or advertized as) the screaming sports cars of the computing world, because they don't have the fastest hardware. But that's what makes them affordable, and I find my netbook more than adequate for the tasks I do every day—casual web surfing, checking e‑mail, and writing. A netbooks is a great choice as a portable, primary PC, and makes a smart, inexpensive second PC as well (which is how I use mine).
Now, like many things in life, there are a couple of tradeoffs to consider. Netbooks are light, portable, and easy to use; that's a given. But just remember that powerful laptops still have their place, so you might need to give up a couple of luxuries when using a netbook.
Some things to keep in mind:
No DVD drive. One of the things that make netbooks so small is the lack of an internal DVD drive. If you get most of your programs and data from the Internet, or watch movies online, this won't be as much of an issue. If you need to play DVDs, you can always get an external DVD drive. If all you want to do is access files stored on a DVD, maybe some old pictures you've archived, you can always use a desktop PC or a laptop and copy your files to a USB flash drive, Secure Digital (SD) card, or other removable storage device. (SD cards are used in many digital cameras, and many netbooks have SD slots.)
Smaller screen. The resolution of my 10-inch screen (1024 x 600) is fine for reading. But, you might need to do some extra scrolling when looking at large pictures, big maps, or websites designed for larger screens. Also, you probably won't find a top-of-the-line video card under the hood either, so adjust your expectations when playing games or watching movies. (It's fine, just not great.)
Smaller keyboard. Some people just won't be comfortable with a small keyboard. My netbook's keyboard is 90% of a full-sized keyboard, and for me, that's the sweet spot. I can type easily with no more typos than usual. But, unless you've got small hands or are buying one for a child, I'd stick with that 90% size or close to it. The best way to know is to try one in person—computer, electronics, and office supply stores are a good place to start. (I've even seen entry-level models at larger toy stores!)
Moderate performance. Those efficient CPUs that give netbooks long battery life naturally are a little slower than what you might find in other PCs. So you probably won't be using your netbook for intense 3D gaming, Hollywood video editing, or DNA genome sequencing. But for everyday use, I've had no complaints, even when I've had several different programs open at the same time.
Limited disk space in some models. Some netbooks use solid-state drives (SSDs) rather than hard disks—sort of like using a built-in USB flash drive as a hard disk. But they're often fairly small (maybe 16 GB), so they can fill up pretty fast with music and pictures. The netbook I bought in 2008 has an 80 GB hard disk. Today, that's considered small. Many netbooks now have 160 GB or larger hard disks. If you do buy a netbook with a SSD and find yourself running low on disk space, you can use a large-capacity SD card to make more space.
Because you have less space to work with on a netbook screen, here are some easy tweaks you can make to help use that space more efficiently:
Use small taskbar buttons.
Windows 7 made the taskbar buttons larger and more visible than in earlier versions of Windows, but you can toggle the size to make them smaller. For more information, see Change how buttons appear on the taskbar.
Auto-hide the taskbar. This one might take some getting used to, but every little bit of space helps. When you set the taskbar to auto-hide, it's only visible when you move your cursor over where your taskbar lives. Then the taskbar pops back up so you can open programs, use Jump Lists, and get to files. When you're finished, the taskbar minimizes out of the way. For more information, see Show or hide the taskbar.
Use small icons on the desktop. This will help save space for gadgets or shortcuts if you like to keep them on your desktop. For more information, see Show, hide, or resize desktop icons.
Hide optional menu bars. The menu bars on your web browser can take up a good chunk of your window. You might find you can live without some of them (and you can always add them back later). If your program has a large menu bar, check the program's Help to see if the menu bar can be minimized.
Netbooks have a lot to offer, and so do their bigger siblings the laptops. Each has its place—it's really a question of the right tool for the job. If a phone is too small for what you need to do, but you don't want the weight and price of a traditional laptop, a netbook might be just right. To learn more about what to look for in a netbook, see Finding a netbook that's right for you.
For more information about netbooks and Windows 7, check out Installing Windows 7 on a netbook and Upgrading Windows 7 on a netbook using Windows Anytime Upgrade.
About the author
Andy Sweet is a writer on the Windows team at Microsoft. Most recently, he developed user interface text for several Windows 7 features. Previously, he helped create instructor-led training for Windows IT professionals and was a science and technology editor for Encarta Encyclopedia.
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