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Effectiveness of D-Cycloserine as an Aid to Enhance Learning for Individuals With OCD Receiving Behavior Therapy
- Full Text View
- Tabular View
- Study Results
- Disclaimer
- How to Read a Study Record
This study will assess the effectiveness of Seromycin (D-cycloserine) in enhancing the positive effects of behavior therapy for people with Obsessive-Compulsive Disorder (OCD).
Obsessive-Compulsive Disorder
Drug: seromycin
Behavioral: Behavior Therapy
Phase 3
|Study Type:
|Study Design:
|Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:
|A Randomized, Double-Blind, Placebo-Controlled Medication Trial With D-Cycloserine for Individuals With OCD Currently Receiving Behavior Therapy
- Yale-Brown Obsessive Compulsive Scale (YBOCS) [ Time Frame: Post-treatment (week 5) ] [ Designated as safety issue: No ]A clinician-rated measure of obsessive-compulsive disorder severity. Each item is scored on a 0 to 4 range. Total scores are obtained by summing items 1-10 and thus range from 0 to 40 with higher scores indicating greater symptom severity. Results posted below are from the post-treatment evaluation (after 10 treatment sessions).
- Clinical Global Impressions Scale (CGI) [ Time Frame: Post-treatment (week 5) ] [ Designated as safety issue: No ]
- Beck Depression Inventory (BDI) [ Time Frame: Post-treatment (week 5) ] [ Designated as safety issue: No ]
- Beck Anxiety Inventory (BAI) [ Time Frame: Post-treatment (week 5) ] [ Designated as safety issue: No ]
- Obsessional Beliefs Questionnaire (OBQ) [ Time Frame: Post-treatment (week 5) ] [ Designated as safety issue: No ]
- Short-Form Health Survey (SF-36) [ Time Frame: Post-treatment (week 5) ] [ Designated as safety issue: No ]
- Disability Inventory [ Time Frame: Post-treatment (week 5) ] [ Designated as safety issue: No ]
|Study Start Date:
|November 2003
|Primary Completion Date:
|January 2008 (Final data collection date for primary outcome measure)
|Assigned Interventions
|Active Comparator: Seromycin
Drug: seromycin
100mg tablet administered 1 hour prior to each therapy session
Other Name: D-CycloserineBehavioral: Behavior Therapy
10 weekly hour-long behavior therapy sessions
|Placebo Comparator: Placebo
Behavioral: Behavior Therapy
10 weekly hour-long behavior therapy sessions
Detailed Description:
We hope to enroll 50 subjects in a double-blind, placebo-controlled study of D-cycloserine augmentation of behavior therapy for Obsessive-Compulsive Disorder. All subjects will undergo a pre-treatment assessment, and then be randomly assigned to receive Seromycin (100 mg) or placebo one-hour before each of 10 therapy sessions. Subjects will then come in for a treatment planning session and the behavior therapy sessions delivered twice weekly for 5 weeks. Comprehensive assessments of obsessive-compulsive symptoms, mood state, and cognitions will be given at baseline, after 5 treatment sessions, after 10 sessions and 1 month and 6 months post-treatment.
|Ages Eligible for Study:
|18 Years and older
|Genders Eligible for Study:
|Accepts Healthy Volunteers:
Inclusion Criteria:
- Structured Clinical Interview for DSM-IV (SCID) diagnosis of Obsessive Compulsive Disorder
- Score of greater than 16 on the Yale-Brown Obsessive Compulsive Scale
- Negative urinary beta-Human Chorionic Gonadotropin (hCG) test
Exclusion Criteria:
- Currently taking or have taken an unstable dose of psychotropic medications within 2 months prior to enrollment
- Currently taking medications that may interfere with the study medication
- History of seizure disorder or other serious medical illnesses (e.g., cardiovascular, liver, kidney, respiratory, endocrine, neurologic, or blood-related disease)
- Current diagnosis of tuberculosis
- Other psychiatric diagnoses (e.g., alcohol dependence, bipolar disorder, psychosis, organic mental disorder, or development disorder) that are of greater concern than the obsessive-compulsive disorder diagnosis
- Currently taking medications that may lower seizure threshold (e.g., including clozapine, pethidine, and the following antibiotics in high dosage: penicillins, cephalosporins, amphotericin, and imipenem)
- Poses a serious suicidal or homicidal threat
- Currently undergoing psychotherapy
- Failure to benefit from ten or more sessions of previous Exposure and Response Prevention (ERP) treatment
- Pregnant or breastfeeding
Please refer to this study by its ClinicalTrials.gov identifier: NCT00182000
|Principal Investigator:
|Sabine Wilhelm, Ph.D.
|Massachusetts General Hospital
No publications provided
|Responsible Party:
|Sabine Wilhelm, Director, Massachusetts General Hospital
|ClinicalTrials.gov Identifier:
|NCT00182000 History of Changes
|Other Study ID Numbers:
|Study First Received:
|September 13, 2005
|Results First Received:
|May 1, 2012
|Last Updated:
|July 10, 2012
|Health Authority:
|United States: Federal Government
Keywords provided by Massachusetts General Hospital:
Additional relevant MeSH terms:
Compulsive Personality Disorder
Obsessive-Compulsive Disorder
Anxiety Disorders
Mental Disorders
Personality Disorders
Anti-Bacterial Agents
Anti-Infective Agents
Anti-Infective Agents, Urinary
Antibiotics, Antitubercular
Antitubercular Agents
Molecular Mechanisms of Pharmacological Action
Pharmacologic Actions
Renal Agents
Therapeutic Uses
ClinicalTrials.gov processed this record on October 09, 2015


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Companion forum thread to:Backpacking versus Thru-hiking
Not having done a thru hike...yet, I have over the years backpacked with a minimalist attitude. The last two years have me at a 5-7lb base weight for all of my trips. Luckily I see food as simply something that fills what is empty and can eat darn near anything. THis article gives me some confidence in what I am doing, so I can complete a thru hike. There are always those nagging doubts. Even though i have done 100 milers in four days etc, the biggest for me is if I have the mental toughness to go day after day. Will I get homesick or will I grow to see the trail as my home. These for me are much bigger than the gear and technique issues. Listening to trail lore is a good tip. I have read many journals and try to imagine myself in their shoes. One day soon we will see.
Edited by mtnrat on 09/20/2011 17:52:13 MDT.
Weekend backpacking can be a tough when a weekend warrior must return to work in time to close the Figby account but there's the mental aspect of 'the deadline', so UL has relevance for those who need to be back for glorious Monday morning (ugh). Maybe load the same pack/gear with gourmet food for weekends then UL rations for weeklong trips? My idea though the most I've been out backpacking is a week. Maybe 2 weeks is next before tackling 1 month or more. My issue that it doesn't sit well is paying mortgage/rent while out for a month or 2, ... unless it's too hot at home.
Edited by hknewman on 09/21/2011 16:21:14 MDT.
Great articel. It took me several years to learn what he said. I still do the weekend trip, but I find I would rather do a three week trip. I do not start to have fun until about day 10. I hope thease longer trips have given me that knowalage I need to do the Thru-Hike in 2014 when I retire.
Was this article written for the BPL audience? I ask because so much of the methodology described seems to be what we ULrs have been doing as standard operating procedures.
Edited by kthompson on 09/20/2011 22:15:57 MDT.
Yeah, what Ken said.
+1 on the audience aspect, but I think these kind of articles are excellent, and should be "put out there" for those who need to read and hear it.
Some people that are new to backpacking and are non-ULers do bring a change of clothes for everyday since they're only out for 2-3 days. I saw people at trail camp near mount whitney with CHAIRS. I thought everyone used their bear can as a seat/dinnertable. Almost everyone we passed had brand new gear and kept the packaging the stuff came in (i.e. rei pad in the rei information sack).I cringe to even admit this but when I was a dayhiker I kind of just hid my tp from my number ones in leaves. HORRID I know. Now that I "leave no trace behind" and I see all the tp from dayhikers and noob backpackers I get livid. I didn't start backpacking in places where the wilderness permit hander-outer gave you a 15 minute how to camp in the wilderness lecture so when I get the lecture and know everyone else got that same lecture and they choose not to abide is when I get mad.Anywaay I think there is a huge difference from people who backpack a couple days in a row once a year and people who do it all the time and get into so much they read and post in forums. Articles like this show people different and better ways to hike.
Are you sure the opinions expressed in this article are really always valid?Why can't thru-hikers take a different pace if their style is not necessarily go-go-go!?It's not like a thru-hike must be 6 months long or a certain number of miles to be considered so. We're not all in such a rush to log miles or finish a huge trail.I'd strongly argue that one can thru-hike at the pace that one sets for oneself. If you want a day in camp during a rainstorm, just set a schedule beforehand which allows it.I understand the whole "do the entirety of the Appalachian Trail before winter" mentality, but that does not a thru-hike make.
Edited by dasbin on 09/21/2011 03:24:31 MDT.
I like this kind of article. Did it tell me anything new? ... no, other than the tale of the $20 AT thru-hike. But I'm glad to see articles like this as part of the BPL publishing mix.Was this article written for the BPL audience? I ask because so much of the methodology described seems to be what we ULrs have been doing as standard operating procedures.True ... but preaching only to the choir does not grow the choir. Consider Doug Prosser's ultralight at Philmont articles ... I've shown them to countless scouters, didn't help some, few became ultralighters but many made very significant pack weight reductions (40%-50%).It's not like a thru-hike must be 6 months long or a certain number of miles to be considered so.Also true. But note that Francis opens with the info "About one in five prospective Appalachian Trail thru-hikers quit within the first week!" ... that would apply to any trail long enough to qualify as a "thru-hike" and closes with "a whopping 50 percent quit within the first six weeks of a thru-hike". ... not all of those are quitting in week 5 or 6, again could be applied to shorter long hikes.
Edited by jcolten on 09/21/2011 05:24:02 MDT.
While I also agree that much of the article simply describes a standard BPL'ers normal operating procedure, it would find a good home on a page dedicated to people who are very new to BPL and the concepts that make up our general philosophy toward backpacking. Sort of a free run-down of the BPL philosophy/FAQ page complete with articles such as this.
What I find interesting is that many thru-hikers do not backpack if they are NOT thru-hiking (or participate in the outdoors at all).Part of the reason I live where I do is that I need the outdoors part of my daily life, not just a trip every couple of years or so.I loved my long trips (and I can't wait to get back out there again in about 2 yrs, but that's another story) but need the after work climbs, the long day hike, the hut trip or the long weekend backpack as well.To only do something outdoors once every couple of years or so is not something I can wrap my brain around.So, oddly enough, many thru-hikers do not backpack all that much comparatively speaking in the grand scheme of things. :)FWIW, I've take the UL philosophy and applied it to my weekend trips. I might take some creature comforts depending on the trip (wine comes to mind. ;) ), but overall my gear does not change all that much, if at all in the case of solo trips, from the thru-hikes I've done.
>Part of the reason I live where I do is that I need the outdoors part of my daily life, not just a trip every couple of years or so.Same here bro. Not everyone can constantly take 1, 2, 3 weeks away from work and family. Sometimes I think the "career outdoorspeople" start to forget that.>I've take the UL philosophy and applied it to my weekend trips. I might take some creature comforts depending on the tripAgain, same here. I did a quick little overnighter last weekend in which I only hiked in 6 miles (gasp!). I enjoyed the misty sunset, sleeping under a 5.5'x8' tarp, a glorious sunrise, and a leisurely stroll back out. My sin: carrying a SnowPeak canister stove instead of a 0.00438 ounce alcohol stove.I hope everyone can forgive me.
Jennifer, you bring up a good point. This is another difference I noticed while thru-hiking. At least the year I hiked the PCT, I noticed very strict LNT principles such as carrying out TP, drinking the water used to clean a pot (and of course never draining food water on the ground), and never building a fire.Paul, you are also right about thru-hikers not backpacking. I admit, I do much less backpacking now that I have completed long trails. It isn't the same. And I only day hike for exercise. I think thru-hiking ruined backpacking for me.And James, you are right too. No one can take that kind of time off consistently. I had to quit a high-paying career to become a career backpacker. And now I work in retail during the months I am not thru-hiking. It isn't something that people can just do. They have to create it, and that takes way more sacrifice than most people are willing to make.
Edited by melissaspencer on 09/21/2011 10:44:30 MDT.
Friends that know my passion for hiking often ask if I want to thru hike some day. I say "No" without any hesitation. Yet, I could live in the woods.The unappealing part of a thru hike is having to follow a course and a time table. Must get to Katahdin before winter sets in.That sounds just like my everyday work life - phooey!I want to just wander aimlessly in nature with no particular place to go and no particular time to get there. Well, since I'm older now, I probably will get my wish soon enough as Alzheimer's set in. :-(
I was intrigued by the potential difference between thru-hiking and backpacking according to the article until I realised that for me it's the same thing :)If anything, a thru-hike demands the mental strengh that usually comes with a determination to make it. Most of the hikers that left their thru-hikes that I saw were doing technically fine but couldn't handle it anymore.And I know this is probably a very personal thing but for me backpacking and thru-hiking recall esentially the same feelings. Once I have to spend one night outside, it takes me to a certain level of consciousness that's way beyond the day-hike experience. Some of my most memorable thru-hikes were two day hikes :) Anyway, the mind adapts. If I'm out for a week my mind adapts to that and will feel like done when the week expires. It's worked the same for me when I've been out for several months in a row.
I think thru-hikes are a very different beastie than a shorter multi-day trip. It would be interesting to do thorough interviews of thru-hikers to see what their motivation was. I wonder how many start out because they are at some transition point in their life. Spending some time out alone may find some answers to what they are really about (or really need), with some 40 days and 40 nights biblical leanings and no guarantee that you will like the person you find out there. I imagine that some of the early drop-outs have never spent a light alone in the woods or found that backpacking is a lot of work. To paraphrase the old quip about combat, backpacking can be hours of drudgery punctuated by moments of awesomeness. My real take is that it is punctuated by many small delights walking through a forest garden spiced with an occasional mind-blowing view--- but not without the work. It is easy to buy a load of gear and put your feet on the trail with no experience whatsoever. 2500 feet of switchbacks is a very sobering reality! Losing hard-won elevation gains over and over again makes the legend of Sisyphus real. I could see the adventure losing it's gloss after a few weeks of endless footsteps, roller coaster elevations, sweat, sore muscles, blisters, bugs, dirt, monotonous meals, heat, cold, wet, hard ground, stormy nights, varmints stealing your food and just plain exhaustion. And I can imagine that it can also be empowering and teach volumes on self-reliance and attaining goals. That which doesn't kill you makes you stronger--- indeed!
I was an outdoors person before I was a thru-hiker. Just love being out there.My thru-hikes tended to reflect that feel as I spent a lot of time by myself, enjoyed the social interaction but did not necessarily seek it out, same thing with the ongoing linear community, etc.I love looking at maps, making my own route and having my own experience. When I do a long hike again, I just may make my own route off the beaten path or no path at all. I, of course, reserve the right to go back on my own words. ;)An example of hiking my own hike:Seven Days Solo in the San JuansThe long trails (even the CDT) are too linear at times. Nature of the beast. So, guess my weekend (or more) backpacks are about being outside much like my thru-hikes. I do love the journey and being out for weeks or months at a time admittedly.Don't get me wrong I LOVED my thru-hikes. The AT was responsible for me moving out to Colorado and everything else that followed in my outdoor 'career'. But, if all I did was hike the long trails, I'd miss out on the canyons of Utah off the Hayduke, never explore the Sangres, not see the sun set over the distant Rockies while at the Pawnee Buttes, being immersed in winter while gliding along on skis deep in the backcountry, feel what it is like to rope up and attain the summit of the mountain or climb the glacier.I treasure those experiences too much. And doing just thru-hikes would not me experience all that.Everything involves a sacrifice. Darn if I know the balance!Anyway, works for me. If there was a best way for everyone, it would be a freakin' boring world! :)
Paul, great post. :)
Edited by spelt on 09/21/2011 13:28:14 MDT.
One aspect that was touched on that I found to be most critical was attitude, and specifically whether people enjoyed the lifestyle of thruhiking. For people who bought into the lifestyle everything else was secondary. When I did the PCT two people stood out - one hiker with a 60lb+ pack (solar charger, Marine Corps knife etc) who just trucked along without a complaint and ground out the miles, and another who graduated from college in FL with a bunch of mail-order REI equipment and who had never spent the night in a tent before that first night at Lake Morena. Neither finished, but both made it to OR and were just stopped by early winter snow.What kept them (and me) going was that they loved doing it. I did view thru-hiking as a job - I worked 6 days a week, and each work day I'd get up at 6am, have breakfast, pack up 'the house' and go to work for 10-12 hours. On the seventh day I'd do chores (laundry, grocery shopping etc) and then start the work week again. The key thing is that I liked my 'job' and looked forward to going back to it each week. Thru-hiking is a profession in a way and thru-hikers become professional hikers for 5 months or so. If you like the job you'll probably finish and if you don't like the job you'll quit and find another one.
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The Orioles claimed Todd Redmond off of waivers from the Reds, Darren Wolfson of 1500 ESPN reports (on Twitter). The Reds designated Redmond for assignment one week ago to create roster space for Manny Parra.
Redmond made his MLB debut in 2012, starting one game at the big league level. The 27-year-old spent most of the season at Triple-A, where he posted a 3.63 ERA with 8.2 K/9 and 2.4 BB/9 in 148 2/3 innings. The Reds acquired him from the Braves for Paul Janish last July.
Read more at http://www.mlbtraderumors.com/2013/02/o ... 6TCgVyF.99
http://www.mlbtraderumors.com/2013/02/o ... qus_thread
The Orioles announced that they designated outfielder Trayvon Robinson for assignment. The move creates roster space for right-hander Todd Redmond, who was claimed off of waivers from the Reds.
The Orioles acquired Robinson from Seattle for Robert Andino this past November. Robinson appeared in 46 games for the Mariners in 2012, posting a .221/.294/.324 batting line in 164 plate appearances as a left fielder. The 25-year-old was initially acquired by the Mariners in the three-team trade with the Red Sox and Dodgers that sent Erik Bedard to Boston.
Read more at http://www.mlbtraderumors.com/2013/02/o ... hy0Bqj6.99
http://www.mlbtraderumors.com/2013/02/o ... nment.html


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I don't truly understand suicide. I've had the challenge of being around four suicide attempts in my Navy career. All were unsuccessful, thankfully. In one, one of my best buddies in language school, despondent over low grades, went to a motel with a bottle of Jack and a rusty knife. And the hotel staff found him in the morning, bloody and alive. It was strange, me and another of our friends were doing well at the same language. And our buddy (who attempted suicide) would not let us help him with his studies. We were happy to see him alive and able to get the help he needed. He left the Navy and returned to a job he was effective at. We were compassionate with him, but somewhat puzzled about it. (I know that may sound unfeeling, but it is the truth.)
Sadly, another Sailor (possibly) committed suicide today, Commander Job Price, of Naval Special Warfare Group Four:
A senior member of the U.S. Navy's elite SEAL unit has died in Afghanistan, the Defense Department said on Sunday, and media reports said the death was a possible suicide.
Commander Job Price, 42, of Pottstown, Pennsylvania, died on Saturday of a non-combat related injury in central Afghanistan's Uruzgan Province, the Pentagon said in a statement.
"This incident is currently under investigation," it said.
Price was assigned to a Naval Special Warfare unit in Virginia Beach, Virginia, the statement said.
NBC News and CNN quoted unnamed military officials as saying that the death was being looked at as a possible suicide.
Lieutenant David Lloyd, a spokesman for Naval Special Warfare Group Two, which comprises the four SEAL teams on the U.S. East Coast, declined to comment on the cause of death, saying it was under investigation.
I wish the Commander's family and teammates well during this trying time. RIP, Sir.


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- Northern New York Newspapers
- Watertown
- Ogdensburg
- Massena-Potsdam
- Lowville
- Carthage
- Malone
- NNY Business
- NNY Living
- NNY Ads
Meet Emica Katherine Arquette, the regions first baby of 2013.
Emica was born safe and sound at 1:25 a.m. Tuesday at Massena Memorial Hospital to proud parents Amanda N. Vedder and Aaron J. Arquette. She weighs 6 pounds, 14.4 ounces and is 18.5 inches long.
Ms. Vedder spent the last few hours of 2012 in the hospital when she went into induced labor at about 7 p.m.
Emica is the Massena couples second child. Their first, Brayden Arquette, is 2 years old.
The couple spent the last several months preparing for the arrival of their first daughter.
Its new. Its exciting, Mr. Arquette said.
They found Emicas name, a combination of Erica and Emma, on the Internet.
Ms. Vedder cradled Emica in her arms in the hospital maternity ward Tuesday afternoon.
She was tiny compared to what my son was, she said.
Ms. Vedder and her baby will stay at the hospital until Thursday before returning home.
Massena merchants greeted the first baby of the year with gift baskets filled with $500 worth of stuffed animals, gift cards, a blanket and more.
Brayden Arquette has not yet met his new sister. A local flu virus has officials taking extra precautions, so Brayden and Emica will not be able to see each other for another day or two. The 2-year-old is excited to say hello to the familys new member, according to Ms. Vedder.
He understands, but he hasnt gotten to meet her, she said. He keeps saying Theres a baby in the belly. Theres a baby at home. Well have to tell him the baby isnt in the belly anymore.
Emicas grandparents are Verna and Robert Vedder on her mothers side and David Arquette and Debbie Thompson on her fathers side.
In Lewis County, Taylen Drew Mallette was born at 5:39 a.m. at Lewis County General Hospital to parents Alyssa N. and Andrew S. Mallette. The baby is 9 pounds, 7 ounces and 21 inches long.
Jefferson County greeted Luann Keslyn Tulensru at 8:21 a.m. at Samaritan Medical Center. Her parents are Lucy and Pastian W. Tulensru of Fort Drum. Luann is 9 pounds, 11 ounces and 22 inches long.
Thousands of readers like you have made Northern New York Newspapers the number one ranked website* for local news and sports coverage in the north country.
You can continue on to this article in a few seconds, or you can visit one of our websites:


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The financial commitment that comes with purchasing a new bag every season can be, well, off-putting to put it lightly, especially for style-minded ladies with a wardrobe budget! Happily, we found the perfect solution to our inevitable handbag woes: the removable embellished strap. We can't take all the credit, though; Karl Lagerfeld showed us this brilliant accessory idea at his Paris-Bombay Pre-Fall 12 collection for Chanel, and we've been infatuated with the textured strap ever since. With metal-embroidered detailing, the strap instantly upgrades your tried-and-true carrier, giving it a cool and modern look that will take you stylishly through fall. Accordingly, we are truly excited to show you just how easy it is to craft your very own Chanel-inspired bag strap in this month's Do It Yourself project!
The Inspiration
The Flap Boy Bag with Hand-Embroidered Strap ($6900, 310.278.5505) was just one of the many decadent accessories featured in the Chanel Paris-Bombay Pre-Fall 12 show, but for obvious reasons it has remained our favorite piece from the collection. Melding the storied brand's classic quilted design with the punk rock spirit of the metal embellishments, the bag manages to be both very chic and utterly cool-definitely a season must-have!
All this lusting after one bag got us thinking about the ways in which we could make our own, so we called up Erica Domesek of P.S. I Made This to help guide us through the process. We're happy to report that with Domesek's easy-to-find ingredients and step-by-step instructions, you can create a covetable Chanel-inspired bag and still have enough money left over to snag all of your fall clothing essentials, making it a win-win!--Jessica Baker
-Flap Bag with Removable Straps ($39)
-Rock Steady Guitar Strap ($6)
-Collins Unique Stitch Fabric Glue ($6)
-9x9mm Studs (from $5)
-20mm Flat Back Rhinestones (from $8)
-Pearl Beads ($12/yard) (Per Domesek, feel free to pick whatever style you like.)
-Tweezers ($1)
-2 Carabiners
1. Lay the guitar strap flat on a large surface.
2. Randomly place the various studs, rhinestones, and pearl trim so that they cover the entire strap.
3. Once you are happy with the placement, use tweezers to secure the stud accents, then glue the rhinestones and pearl trim in place. Wait an hour or until completely dry.
4. Once the strap is completely dry, use carabiners to secure the guitar strap to your bag.


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In a technological age, a student's ability to continue his or her education after high school is becoming more important. As Anthony Carnevale, of the Educational Testing Service, notes in Crossing the Great Divide, "Jobs today require more education. In 1959, 20% of workers needed some college; in 2000, 56% do" (Educational Testing Service, 2000). In response to this dramatic change and other developments, communities and states across the country are looking for ways to improve student achievement, access to and success in higher education. To do this, local communities and states are trying to create a "seamless system of education" in which all levels of education preschool through college educate as one system instead of several. These efforts most commonly are named K-16, P-16 or P-20 systems.
The movement toward a P-16 model is driven by a current lack of coherence and alignment from preschool through college. Examples of this vacuum can be found at every level of education. According to the Education Commission of the States' report ABCs of Investing in Student Performance, children who attend a quality preschool program experience higher rates of graduation and enrollment in postsecondary institutions (1996). Yet there is little coordinated effort to link preschool instruction to elementary school instruction. At the elementary and middle school levels, the U.S. Department of Education's Mathematics Equals Opportunity reported that "students who take rigorous mathematics and science courses are much more likely to go to college than those who do not" (1997). Despite this information, college-preparation programs often begin as late as 9th grade.
In A Babel of Standards, Michael Kirst notes that high school students must decipher the maze of admissions-related tests and decisions. In the southeastern United States, for example, there are as many as 75 placement tests and more than 125 combinations of these exams (National Crosstalk, 2000). Finally, at the postsecondary level, colleges and universities increasingly are placing recent high school graduates in remedial math, language and science courses. The Condition of Education 2000 by the National Center for Education Statistics shows that students who take any remedial reading courses are less likely to earn a two- or four-year degree than those who take other combinations of remedial courses. The trend toward remedial coursework in postsecondary education is not only expensive for individual states, but also disturbing in light of new state standards and assessments.
Ultimately, the goal of P-16 reform is to create, as Harold Hodgkinson wrote in All One System, "a single system of education underlying all of the segments" (Institute for Educational Leadership, 1999). As the Consortium for Policy Research in Education said, the time has come to end the long history in American education of segments acting "independently and at cross-purposes from one another" (June 2000).
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Long-Term Care Insurance Rate Guide
Authored By: Texas Department of Insurance
Long-term care refers to the type of personal care services you need if you become unable to care for yourself because of a loss of functional capacity or cognitive impairment. Long-term care is different from traditional medical care that attempts to permanently cure or control illnesses. Long-term care helps seniors, people with disabilities, and people with injuries or illnesses perform normal daily activities, but it may not improve or correct their medical problems. Care may be provided at home or in a hospice, adult day care center, nursing home, or assisted living facility.


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Tech.Book'n'Tips SHOVEL . Many Years
George Greer wrote:Morning Chris...
Try clicking this:
http://www.kickstandforum.com/pdf/HD%20 ... 0-1947.pdf
George Greer wrote:Chris,
I am at work as I write this. So I will make it quick.
I did find one /www.kickstandforum.com
Go down to Tech.. Harleys...
Is this the one you mentioned?
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By Mario Di CaroCommander American Legion Price Post #3 Price
Compliments to the editor and employees of the Sun Advocate, for the annual publication of the photos honoring our local veterans. Richard Shaw, the editor and publisher, has been very supportive of Veterans and their issues.
Also, I would like to let the staff and students of the Pinnacle Canyon Academy know how much we appreciate them for attending our special Veterans Day ceremonies at the Peace Garden, on Nov. 11.
I believe there were over 500 students present, all of us veterans were humbled by their support. The staff should be congratulated on the effort it took to get the students to the Peace Garden, and to the students for being so well behaved and attentive during our ceremony. Your students taught us a lesson, and it was "We were not forgotten."
After the ceremony was over, I noticed some of the students and staff members were thanking some veterans for their sacrifices and tears were forming in the veterans eyes, mine included.


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For the upcoming China International Animation, Cartoon and Game Fair, which runs July 12-16 in Shanghai, Bandai Namco is erecting a RX-78-2 Gundam China Special statue that will be nearly 20-feet tall and feature exterior coloring design by Beijing Yankai Cultural Development Co., which creates the Chinese Mobile Suit Gundam UC comic series.
A 1/100 scale model of the statue (above) is also planned. Priced at 420 yuan (US$66), the limited edition statue is available from Bandai's official shop on China's Taobao e-commerce site. Pre-orders start July 12.
全高約6メートルのガンダム立像が中国に登場 [Gigazine]


text:
The Alinco DJ-X11T wideband receiver covers 50 kHz to 1299.995 MHz (less cellular) in AM, FM wide, FM narrow, SSB and CW modes. The illuminated LCD display supports two lines. In addition to frequency information, it will also show the operating mode, memory channel, battery strength, signal strength and a number of other user-selected operating parameters. The keypad is backlit. Six types of memory banks are supported. The DJ-X11T even supports dual frequency simultaneous reception giving you the ability to concurrently listen with the main band and sub band (with some frequency limitations). Please note that sub band coverage is 118-174 MHz and 336-470 MHz. The F tuning function allows you to automatically tune very strong, nearby signals. The built in MW ferrite bar antennas provides good AM band reception
The DJ-X11T features 1200 memory channels and three scan speeds are available. The supplied SMA antenna is removable.
Other features include: APO Auto Power Off, Attenuator, BS Battery Save function, Beep On/Off, ext DC input jack (5.4-6VDC) and battery-low icon. This radio's firmware may be updated over the web (with optional cable and software). One year limited manufacturer's warranty.
This radio comes with the EBP-174 3.7V 1800 mAh lithium ion battery, EDH-36 cell holder, AC adapter, SMA flexible antenna, belt clip and hand strap. 2.4 x 4.17 x 1.5 inches 8.3 oz.
Manufacturer's Website Product Website Additional Product Info


text:
|Publication number
|Publication type
|Application number
|Publication date
|Sep 2, 2010
|Filing date
|Sep 1, 2009
|Priority date
|Mar 30, 2001
|Also published as
|Publication number
|James Browning
|Original Assignee
|Mpathy Medical Devices Limited
|Export Citation
|BiBTeX, EndNote, RefMan
|Referenced by (34), Classifications (8), Legal Events (3)
|External Links: USPTO, USPTO Assignment, Espacenet
The present invention relates to the treatment of a hernia such as a uterovaginal prolapse and, in particular, to a surgical implant for use in such treatment and to a related surgical procedure and device.
A hernia is basically a defect resulting in the protrusion of part of an organ through the wall of a bodily cavity within which it is normally contained. For example, a fairly common and well known type of hernia is a defect in the lower abdominal wall resulting in a sac which may contain a portion of the intestine protruding through the abdominal wall. This is referred to as an inguinal hernia. Similarly, a defect in the abdominal wall after surgery is referred to as an incisional hernia. Another type of hernia is a defect in the pelvic floor or other supporting structures resulting in a portion of the uterus, bladder, bowel or other surrounding tissue protruding through, e.g., the vaginal wall. This is usually referred to as uterovaginal prolapse.
A common way of treating hernias is to repair the defect by sutures, whether or not the hernial sac is also sutured or repaired, in order that the protruding organ is contained in its normal position. As the defect generally comprises a weakening and attenuation leading to parting of tissues in a fascial wall, it is usually necessary to apply tension to the sutures in order to close the parted tissues. Thus, the fascial wall is generally pinched or tensioned around the area of the defect in order to close the parted tissues.
This treatment is generally effective, but does have some inherent problems. In particular, the pinching or tensioning of tissue around the defect can lead to discomfort and/or recurrence of the hernia. Additionally, in the case of uterovaginal prolapse, such pinching or tensioning of the vaginal wall almost inevitably results in anatomical distortion (such as narrowing of the vaginal cavity) with consequential pain and quality of life implications for the patient and relatively high recurrence and/or complication rates.
In order to address these problems, in the case of inguinal hernia repair, it has been suggested to make use of a surgical implant to overlay or close the weakened and parted tissues without the need to pinch or tension the surrounding tissue of the fascia. Such surgical implants generally comprise meshes and are now widely used in inguinal hernia repair. Meshes may be applied subcutaneously (i.e. under the skin), internally or externally of the abdominal wall and may be either absorbable or non-absorbable depending on the nature and severity of the particular defect being treated. Meshes may be applied in combination with sutures to hold the mesh in place or, alternatively, with sutures that close the parted tissues as in a "non-mesh" technique. Meshes are usually applied in open surgical procedures, although they may sometimes be applied in laparoscopic surgical procedures.
A typical mesh for an inguinal hernia repair comprises woven or knitted polypropylene such as Marlex� or Prolene�. Such meshes have a number of desirable properties that make them effective for use in hernia repair. For example, they are made of materials that are suitably inert so as to be less likely to cause adverse reactions when implanted in the body. Furthermore, they are mechanically strong, cheap, easily sterilisable and easy to work with.
However, conventional meshes have a number of inherent problems. For example, fistula or sinus (i.e. abnormal passages between internal organs or between an internal organ and the body surface) can develop as a result of a mesh being implanted and left inside the body. More generally, the placement of a foreign body subcutaneously can also lead to inflammation or infection. Similarly, edge extrusion (i.e. the erosion of body tissue around the edge of the mesh) can occur. Nevertheless, overall, the use of meshes is generally considered to be beneficial in the treatment of incisional and inguinal hernias.
It has also been suggested to use meshes in the treatment of uterovaginal prolapse. Meshes that have been proposed for use in the repair of uterovaginal prolapse are similar to those that are used for the repair of inguinal hernia and such like. However, there is concern that the above mentioned problems with the use of meshes are greater when a mesh is placed in the vaginal wall as this tissue is generally thin only just below the surface and therefore more prone to adverse reactions. Furthermore, the placement of a foreign body close to the rectum and urinary tract may increase the risk of infection, inflammation, erosion, fistula or translocation. Thus, it is a relatively widespread view that the use of meshes in the treatment of vaginal prolapse is less desirable than in the treatment of other hernias.
Nevertheless, as the use of meshes to treat uterovaginal prolapse can avoid anatomical distortion and the above mentioned problems related to this, the Applicant considers there are significant benefits in the use of meshes in the treatment of uterovaginal prolapse should it be possible to mitigate the problems associated with mesh treatment.
The applicant has recognised that there are a number of specific features of conventional meshes that exacerbate the problems of fistula, sinus, edge extrusion, infection etc., particularly when these meshes are implanted in the vaginal wall. The Applicant has therefore realised that it is possible to provide a surgical implant that has the benefits of mesh treatment, i.e. the avoidance of anatomical distortion and its related problems, and also minimises the above mentioned problems.
One specific problem with conventional meshes that the Applicant has recognised is that they have jagged or rough edges. The rough edges arise as conventional meshes are generally formed from sheets of multiple woven or intersecting fibres or strands. When the meshes are cut to size in manufacture or prior to fitting, the stray ends of the fibres or strands are left extending from the edge of the mesh, particularly where the edge is curved. In other words, the perimeter of the mesh comprises the spaced ends of the fibres or strands and is not smooth. It is thought that the jagged rough nature of the edges of the implant increases the likelihood of extrusion of the edge of the mesh in situ.
Conventional meshes are generally unnecessarily strong and substantial for use in the vaginal wall and of significant mass. This results in an unnecessary excess of foreign body material in the vaginal wall, increasing the risks associated with the placement of foreign bodies inside the human body, such as the risk of infection. Likewise, the bulk of such meshes can undesirably result in discomfort for the patient as the mesh can often be felt when in position. This is of particular concern when a mesh is placed in sensitive vaginal tissues or near to bowel or bladder.
A further disadvantage of the meshes presently used to treat hernias relates to pore size. The pore size of meshes in use is unphysiological and does not encourage acceptance of the implant in the body.
It is a aim of the present invention to overcome problems associated with existing meshes used to treat hernias.
According to the present invention there is provided a surgical implant suitable for treatment of hernias, the implant comprising a mesh having a residual maximum mass density of 50 g/m2.
Preferably the maximum mass density is less than 30 g/m2. More preferably the maximum mass density is less than 25 g/m2.
By minimising mass density of a mesh for use in treating hernias the advantages of using a mesh are still apparent whereas the disadvantages are lessened in that jagged and rough edges are minimised as is the risk of infection. The residual mass density is the mass density of the mesh after implantation.
Preferably the surgical implant mesh comprises strands and includes major spaces and pores.
The strands of the mesh may be formed by at least two filaments, the major spaces formed between the strands providing the surgical implant with the necessary strength, the filaments arranged such that pores are formed in the strands of the mesh.
Alternatively the strands may be foamed by monofilaments which form loops which give rise to the pores.
Preferably strands are spaced by wider distance than the fibres or filaments of conventional meshes used in hernia repair.
Preferably the strands are spaced apart to form major spaces of between 1 to 10 mm.
More preferably the strands are spaced apart to form major spaces of between 2 to 8 mm.
The use of mesh having strands spaced between 1 to 10 mm apart has the advantage of reducing the foreign body mass that is implanted in the human body. Only sufficient tensile strength to securely support the defect and tissue being repaired is provided by the mesh.
It is desirable that the mesh of the present invention has a mass of between one tenth ( 1/10th) and one hundredth ( 1/100th) that of a conventional, e.g. Prolene�, mesh of the same surface area. The mesh of the invention therefore avoids the unnecessary bulk of conventional meshes.
More specifically it is preferred that the mass density is less than 50 g/m2, more preferably less than 30 g/m and most preferably less than 20 g/m2.
It is also preferred that the strands of the mesh of the present invention are narrower than those of meshes of the prior art.
Preferably the strands have a diameter of less than 600 μm.
In one embodiment the strands are arranged to form a diamond net mesh.
In an alternative embodiment the strands are arranged to form a hexagonal net mesh.
The strands and filaments are preferably warp knit.
In an alternative embodiment the strands are arranged to form a net mesh with suitable tensile strength and elasticity.
Preferably the strands are arranged to form a net mesh which has isotropic or near isotropic tensile strength and elasticity.
Preferably the filaments have a diameter of between 0.02 to 0.15 mm.
More preferably the filament of the mesh is of a diameter 0.08 to 0.1 mm.
This likewise has the advantage of reducing the overall bulk of the implant, and hence the amount of material retained in the human body.
Particular meshes which are embodiments of the present invention include warp knit diamond or hexagon net diamond net meshes. Four particular embodiments are set out below.
In two particular embodiments wherein the filaments are formed from polypropylene having a diameter of 0.07-0.08 mm wherein the strands are spaced to form spaces of either 2 mm or 5 mm.
Alternatively, filaments are formed from polyester having a diameter of 0.09 mm wherein the strands are spaced to form spaces of 5 mm.
Alternatively, filaments are formed from polyester having a diameter of 0.05-0.07 mm wherein the strands are spaced to form spaces of 2 mm.
As the surgical implant is comprised of narrow members arranged to be spaced by relatively wide gaps, major spaces, tissue may be slow to grow into the mesh. It is desirable for the mesh to have means for promoting tissue ingrowth. More specifically, it is desirable to provide pores in the strands of the mesh to aid tissue ingrowth and to which tissue may more easily adhere.
Preferably two filaments are interwoven/knitted to produce strands of the mesh comprising pores.
Alternatively at least three filaments are interwoven/knitted to produce strands of the mesh comprising pores.
For manufacturing reasons it is preferred that two filaments are used to form the pores in the strands of the mesh which aid tissue ingrowth, however if the one filament could be suitably knotted or twisted to form pores of suitable dimensions it is clear that this could be used to similar effect to form the strands of the mesh.
Preferably the pores in the strands are of between 50 to 200 μm in diameter.
More preferably the pores are of between 50 to 75 μm in diameter.
This is important in enabling efficient fibroblast throughgrowth and ordered collagen laydown in order to provide optimal integration into the body. This is discussed in detail in copending Patent Application No PCT/GB01/04554.
Rings or loops of material comprising pores of between 50 to 200 μm may be adhered to or formed on the strands of the mesh to provide pores.
As mentioned above, reducing the mass of the mesh has distinct advantages in relation to the suitability of the mesh for implantation in the body, i.e. the reduction of foreign body mass and improving the comfort of the patient. However, the handling characteristics of such a mesh, e.g. the ease with which a surgeon can manipulate and place the surgical implant in its desired location in the body, can be poor in some circumstances. More specifically, a mesh having narrow members or strands that are widely spaced will inevitably be somewhat flimsy and lacking in rigidity compared to conventional meshes.
Ideally the implant should be formed from materials or uses technologies which provide the implant with Dual Phase Technology™, such that it has suitable surgical handling characteristics and is also of minimal mass and suited for implantation in the body. The implant may be formed from a range of materials to provide it with Dual Phase Technology™.
The term Dual Phase Technology™ refers to a means to provide temporary substance to the mesh. Depending on the type of Dual Phase Technology™ employed the benefits imported, in addition to allowing minimal residual mesh mass may include assisting the mesh to be handled and cut, minimising the effect of rough edges, assisting placing the mesh in position and providing tackiness to assist in holding the mesh in position on implantation, thus minimising or negating the need for any additional fixation by suturing or adhesion.
In a preferred embodiment of the invention having improved handling characteristics, the implant therefore has an absorbable coating.
Preferably this coating encapsulates the mesh of the surgical implant.
Alternatively this coating is applied to at least one face of the mesh.
The coating, covering or layer of absorbable material stiffens and adds bulk to the mesh such that it is easier to handle.
As the coating, covering or layer is absorbable, it is absorbed by the body after implantation and does not contribute to the foreign body mass retained in the body. Thus, the advantages of a surgical implant having minimal mass are retained.
Preferably the coating, covering a layer absorbs within 48 hours following implantation.
The coating, covering or layer may comprise any suitable soluble and biocompatible material.
Suitable hydrogel materials can be obtained from First Water in the UK. A typical hydrogel being developed for use in this application is known as FIRST PHASE™ or PHASE 1™.
The absorbable material may be a soluble hydrogel such as gelatin,
Alternatively the absorbable material is a starch or cellulose based hydrogel.
In a further alternative the absorbable material is an alginate.
In a further alternative the absorbable material may contain hyaluronic acid.
The coating, covering or layer may have any thickness or bulk that provides the surgical implant with suitable handling characteristics.
Preferably, the coating is a sheet with a thickness greater than that of the mesh.
Suitable handling characteristics may also be provided to the mesh by a range of other methods. The surgical implant may comprise a mesh and a backing strip the backing strip releasably attachable to the mesh.
The backing strip may be formed from a range of materials including plastics.
The surgical implant may be releasably attachable to the backing strip by adhesive.
The releasable attachment of a backing strip to the mesh provides a more substantial and less flexible surgical implant that is more easily handled by a surgeon. Following suitable placement of the surgical implant the backing strip can be removed from the surgical implant, the surgical implant being retained in the body and the backing material being removed by the surgeon. The surgical implant can therefore benefit from reduced mass while still providing characteristics required for surgical handling.
In a further alternative the strands of the mesh of the surgical implant are comprised of bicomponent microfibres.
Preferably the bicomponent microfibres comprise a core material and surface material.
The composite or biocomponent fibres preferably comprise a nonabsorbable or long lasting absorbable core and a shorter lasting absorbable surface material.
Whereas any licensed materials may be used, suitable materials presently available include polypropylene for the core and polylactic acid or polyglycolic acid for the surface materials.
Alternatively the bicomponent microfibres comprise an material which is rapidly absorbed by the body and a material which is not absorbed for a suitable longer period of time.
Preferably the surface material is capable of being absorbed by the body in a period of less than 48 hours.
Preferably the core material is capable of remaining in the body for a period of time sufficient to enable tissue ingrowth.
The surface material of the bicomponent microfibres or a portion of the composite polymers present during the insertion and placement of the surgical implant provides the surgical implant with characteristics required for surgical handling.
Following a period of insertion in the body, the surface material of the bicomponent microfibre is absorbed by the body leaving behind the reduced foreign mass of the core material of the strands of the mesh.
It is preferred that the surface material of the bicomponent microfibre is absorbed by the body within a number of hours such that only a core portion is left in the body for an extended length of time. Typically materials presently available which could be used to form the microfibres are absorbed by the body over a period of days or weeks.
The filaments of the mesh comprise a plastics or synthetic material.
Preferably the filaments of the mesh comprise of polypropylene or polyester.
Alternatively the filaments of the mesh comprise an absorbable material.
It can be appreciated that filaments which comprise in part of absorbable material would allow better surgical handling, but would enable the implant to also have minimal mass following implantation in the body.
Preferably the surgical implant comprises material that has memory.
Preferably the surgical implant has memory which urges the surgical implant to adopts a flat conformation.
Preferably the implant has a generally curved perimeter, i.e. to have few or no corners or apexes, as sharp corners increase the likelihood of edge erosion and infection. The specific shape will, however, vary according to the use to which the implant is to be put.
Due to the variety of sizes of such defects, and of the various fascia that may need repair by the implant, the implant may have any suitable size,
Preferably the surgical implant is of width between 1 cm to 10 cm and of length between 1 cm to 10 cm.
It may be desirable to provide a variety of implants having different sizes in order that a surgeon can select an implant of suitable size to treat a particular patient. This allows implants to be completely formed before delivery, ensuring, for example, that the smooth edge is properly formed under the control of the manufacturer. The surgeon would have a variety of differently sized (and/or shaped) implants to hand and select the appropriate implant to use after assessment of the patient.
Typically an anterior uterovaginal prolapse is ellipse shaped or a truncated ellipse whereas a posterior prolapse is circular or ovoid in shape.
Accordingly the implant shape may be any one of elliptical or tuncated ellipse, round, circular, oval, ovoid or some similar shape to be used depending on the hernia or polapse to be treated.
Different shapes are suitable for repairing different defects in fascial tissue and thus by providing a surgical implant which can be cut to a range of shapes a wide range of defects in fascial tissue can be treated.
Preferably the mesh can be cut to any desired size. The cutting may be carried out by a surgeon or nurse under sterile conditions such that the surgeon need not have many differently sized implants to hand, but can simply cut a mesh to the desired size of the implant after assessment of the patient. In other words, the implant may be supplied in a large size and be capable of being cut to a smaller size, as desired.
In this regard, whilst the surgical implant of the invention is particularly useful for the repair of uterovaginal prolapse, it may be used in a variety of surgical procedures including the repair of hernias.
Preferably the surgical implant is suitable for use in the treatment of hernias including incisional and inguinal hernias and/or for the treatment of uterovaginal prolapse.
More broadly, the Applicant has therefore recognised that the implant can have any shape that conforms with an anatomical surface of the human or animal body that may be subject to a defect to be repaired by the implant.
As discussed a disadvantage of the meshes used in hernia repair is that they have jagged or rough edges. Due to the wide spacing between strands of the mesh described above and the small diameter of the filaments, the edge problems are mitigated to an extent by the present invention.
To further reduce edge problems it would be preferable if a mesh had a circumferential member which extends, in use, along at least part of the perimeter of the implant to provide a substantially smooth edge.
In other words, the mesh has at least one circumferential member (i.e. fibre, strand or such like) that extends around at least part of its circumference.
Preferably at least part of the perimeter of the implant is defined by the circumferential member,
Alternatively at least part of the perimeter of the implant is defined by more than one circumferential member, at the edge of the mesh.
The edge of the mesh, and hence the perimeter of the implant, can therefore be generally smooth and this has significant advantages over conventional surgical meshes. Specifically, the Applicant has recognised that an implant having a smooth edge is less likely to cause edge extrusion or erosion.
Any amount of the perimeter of the implant may be defined by the circumferential member(s).
However, in order to maximise the benefits of the implant of the invention, it is preferable that at least 50% of the perimeter of the implant is defined by the circumferential member(s).
More preferably at least 80% of the perimeter of the implant is defined by the circumferential member(s).
Most preferably 100% of the perimeter of the implant is defined by the circumferential member(s).
The majority or the whole of the perimeter of the mesh being smooth minimises the risk of a rough edge causing edge erosion or infection.
The circumferential member(s) may be arranged in one of a variety of ways to provide the smooth edge or perimeter.
Preferably the circumferential members are arranged such that they each follow the edge of a desired shape of the surgical implant, the perimeter of the implant formed from as few members as possible.
This simplifies the construction of the mesh, which is desirable not only for manufacture, but also because simpler structures are less likely to have defects which might be problematic after implantation.
Preferably the perimeter of the mesh is defined, in use, by one circumferential member.
Preferably the mesh has a plurality of circumferential members arranged at different radial locations.
In order to provide an implant of given dimensions, the periphery of the mesh outward of the desired circumferential member is cut away such that one or more selected circumferential members form the perimeter of the implant as desired.
More preferably, the circumferential members are arranged concentrically.
A concentric arrangement of a plurality of circumferential members conveniently allows maintenance of the shape of the implant for different sizes of implant and provides the mesh with an even structure.
The remainder of the structure of the mesh may take a variety of forms.
The circumferential members can be arranged to join with one another in order to form an integral mesh.
Alternatively the mesh may additionally comprise transverse members which extend across the circumferential members joining the circumferential members.
The transverse members may extend radially from a central point to the perimeter of the implant.
Alternatively, the transverse members may extend toward the perimeter of the implant.
Preferably the transverse members are arranged to provide substantially even structural strength and rigidity to the implant.
It may be desirable to secure the mesh in place once it has been suitably located in the patient.
Preferably the mesh can be sutured to strong lateral tissue.
Alternatively, the mesh may be glued in place using a biocompatible glue.
This is advantageous, as it is fairly quick to apply glue to the area around the surgical implant.
Preferably the mesh comprises at least one capsule containing biocompatible glue for securing the implant in place.
Preferably 4 capsules containing glue are provided around the perimeter of the surgical implant.
Preferably the capsules comprise hollow thin walled spheres of around 3 to 5 mm diameter including gelatin.
Preferably the glue is a cyanoacrylate glue.
Conventionally, open procedures have been preferred for the treatment of hernias with meshes, as relatively broad access is required to the site of the defect to suitably implant and secure a mesh by sutures or such like.
However, it is desirable to treat hernias, as when carrying out any surgery, with as little trauma to the patient as possible. Thus, the use of minimally invasive techniques has been suggested for the treatment of hernias. However, such surgical techniques have not been considered to be useful in the treatment of uterovaginal prolapse with a mesh, as it has not been considered practical to position a mesh subcutaneously in the vaginal wall due to the difficulty in gaining direct access to this area.
According to another aspect of the present invention, there is provided a minimally invasive method of treating uterovaginal prolapse, the method comprising the steps;
Thus, a mesh or the surgical implant such as that according to the invention can be inserted through a small incision (e.g. around 1 cm to 2 cm in length) at or in the region of the periphery or opening of the vaginal cavity. An incision in this position is easier for a surgeon to access than an incision deeper in the vaginal cavity, yet the Applicant has realised that it is also convenient to treat vaginal prolapse by implanting a mesh in a surgical procedure carried out entirely through such an incision.
Preferably, the incision is at the anterior or posterior extremity of the prolapse sac of the vaginal cavity.
This is desirable as prolapse most often occurs in the anterior or posterior vaginal wall, so positioning the incision in such a location allows the most convenient access to these parts of the vaginal wall.
The provision of suitable handling characteristics for the mesh is particularly advantageous when the mesh is intended to be used in a conventional open surgical procedure, as the surgeon needs to handle the implant directly in order to place it in its desired location.
However, the suitable placement particularly in the treatment of uterovaginal prolapse, by minimally invasive techniques require the mesh to be as flexible as possible and therefore to have no absorbable coating or encasement.
A flexible, less bulky mesh may be more easily handled by tools that may be used to carry out the procedure.
Tools that may be used to carry out this procedure have a number of specific needs that need to be met that are not presently met by conventional minimally invasive surgical tools.
These specific needs can best be understood by considering the steps of the surgical procedure of the invention in turn.
The incision is made in the vaginal wall at the opening of the vaginal cavity. This can be carried out using a conventional implement such as a scalpel. It is preferable that the incision is as small as possible as this reduces trauma to the patient.
A cut is then made in the vaginal wall over the defect causing the prolapse or hernia. For example, scissors or another specialised cutting tool can be inserted through the incision and manipulated to provide a cut over the defect. The cut is below the surface of the skin and may provide a space between an upper (or outer) layer and a lower (or inner) layer of the vaginal wall, or between the skin and the vaginal wall, in the region of the defect, into which cavity the mesh can be inserted.
Next, the mesh is placed in the space defined by the cut. It is preferred that the mesh of the invention is supplied rolled up in order that it can be inserted through a small incision and unfurled in situ, i.e. in its intended position. Thus, it may be possible for the surgeon to insert the mesh through the incision by hand. However, this is likely to result in the incision needing to be large enough for the surgeon to insert a finger to manipulate the mesh in the space. This may cause unnecessary trauma to the patient and can be difficult for a surgeon to carry out.
According to another aspect of the present invention, there is provided a surgical tool for delivering a mesh subcutaneously through an incision, the tool being adapted to radially confine the mesh during delivery and being operable to release the mesh in its intended position.
Such a tool for placement of a mesh or the surgical implant of the present invention can insert and position the mesh or surgical implant in a convenient and controlled manner through a small incision. Furthermore, the incision through which the mesh is inserted need only be as large as the diameter of the tool, or the tool when carrying the mesh, which can be significantly smaller than where a surgeon's finger must be able to fit through the incision.
Preferably the tool comprises a housing and unfurling means the housing and unfurling means insertable through an incision in the patient, the housing and unfurling means adapted to accommodate a rolled up mesh and separable to release the mesh the unfurling means capable of unfurling the rolled up mesh without any significant movement around the area of the incision
Preferably, the tool comprises two or more parts, the parts movable such that in a first position they house the mesh or surgical implant and, in a second position the mesh or surgical implant is released. More preferably the tool comprises two semi-circular channels, an inner channel having an external diameter suitable for fitting inside an outer channel.
The channels may be rotatable about a common axis such that in a first position the open faces of the channels face one another to form a closed housing and in a second position the inner channel sits inside the other channel to release the mesh.
Alternative the tool comprises a shaft and releasable securing means, the shaft adapted such that the mesh can be rolled around the shaft and releasable securing means to secure the rolled mesh in place.
In use, the tool is inserted through the incision with the mesh rolled around the outside of the shaft. Once the tool has been inserted, the mesh is released by turning the shaft to unroll the mesh at the same time as moving the shaft across the space in which the mesh is being placed.
A needle may be used to secure the free, outer end of the mesh whilst it is unfurled. The needle may be inserted through the vaginal wall to pin the mesh in place. Similarly, where the mesh is released from within a housing, needles may be used to ease the mesh out of the open housing.
In an alternate embodiment, the tool comprises two or more arms, each of which is releasably attached at one end to an edge of the surgical implant. The arms may be movable from a first position in which they radially confine the mesh to a second position to unfurl the mesh in its intended position.
In one example, the arms are pivotally interconnected such that they can be manipulated to move the ends of the arms from the first position to the second position.
In another example the arms may be arranged to extend radially outward from a housing to move from the first position to the second position. The extendable arms may comprise wires arranged to be extendable and retractable from and into the housing by operation at an end of the housing.
In another example, the arms may be resilient or sprung elements that can be released from the first position and move into the second position to which they are biased, i.e. to unfurl the mesh.
As can be appreciated, all of the above, embodiments of the tool are able to unfurl the mesh without any significant movement around area of the incision. For example, the pivot can be arranged to coincide with the incision, the tool rolled around an arc centred at the incision or the arms operated or housing opened forward of the incision. Thus, the incision can be small as no lateral movement is required at the area of the incision.
Embodiments of the present invention will now be described, by way of example only, with reference to the accompanying drawings, in which:
Referring to
Whilst the organ 3 that may protrude through the defect 2 is usually still contained by some other membrane 4, the hernia, prolapse or such like is inevitably painful and liable to infection or other complications. An effective and desirable treatment is therefore to close the defect 2 and contain the organ 3 in its normal position.
Referring to
Referring to
Referring to
Area A is the lower one third of the anterior vaginal wall 12 (i.e. the one third nearest the entrance to the vaginal cavity) adjacent the bladder 13 and urethra 14. Prolapse in this area is referred to as anterior or, more specifically, urethracoele prolapse. Area B is the upper two thirds of the anterior vaginal wall 12. Prolapse in this area is referred to as anterior or, more specifically; cystocoele prolapse. The central area of the vaginal wall 12 in which the cervix 10 is located is adjacent the uterus 15 and prolapse in this area is referred to as central, uterine or vault prolapse. Area C is the upper one third of the posterior vaginal wall 12. This area of the vaginal wall 12 is adjacent the small bowel 16 and prolapse in this area is referred to as posterior or entreocoele prolapse. Finally, area D is the lower two thirds of the posterior vaginal wall and is adjacent the rectum 17. Prolapse in this area is generally referred to as posterior or rectocoele prolapse.
Conventionally, any of the above types of hernia have been treated by providing sutures in the area of the prolapse. For example, the extent of the defect causing the prolapse is first identified by the surgeon. Lateral sutures, i.e. sutures from one side to the other of the vaginal wall 12 as seen in
A surgical implant for use in the repair of vaginal prolapse in accordance with an embodiment of the present invention comprises a mesh 20. The mesh is comprised of strands 22. The strands being less than 600 μm and approximately 150 to 600 μm in diameter. The strands are arranged such that they form a regular network and are spaced apart from each other such that for a diamond net a space of between 2 mm to 5 mm exists between the points where the strands of the mesh interact with each other (a). In a hexagonal net arrangement the space is between 2 mm to 5 mm between opposite diagonal points where the strands of the mesh interact (b).
It is preferable to space the strands as far as part as possible to allow blood to pass through the implant and reduce the mass of the implant, while providing the mesh with sufficient tensile strength and elasticity to be effective. It can therefore be appreciated that considerable variability in the maximum spacing between the strands can be achieved depending of the material from with the strands are comprised and the net pattern in which the strands are arranged.
In the embodiment shown in
For example a hexagonal net pattern may be used as shown in
Ideally in order to reduce the overall mass of the implant the strands 22 should have as narrow a diameter as possible while still providing the mesh 20 with suitable tensile strength and elasticity.
The strands 22 of the mesh 20 are comprised of at least two filaments 26 arranged to interact such that pores 28 are formed between the filaments 26.
The pores 28 formed between the filaments 26 are around 50 to 200 μm, such a spacing allowing fibroblast through growth to occur. This fibroblast through growth secures the implant 20 in place within the body. Additionally and importantly the suitably sized pores allow the implant 20 to act as a scaffold to encourage the lay down of new tissue. The lay down of new tissue promotes the healing of the hernia.
The filaments 26 may be formed from any biocompatible material. In this embodiment the filaments 26 are formed from polyester, wherein each polyester filament 26 is around 0.09 mm in diameter.
In the embodiment shown the filaments 26 of the strands 24 are knitted together using warp knit to reduce the possibility of fraying of the filaments 26 and strands 24.
Alternative suitable materials of which the filaments may be formed include polypropylene.
Suitable materials from which the mesh can be made: provide sufficient tensile strength to support a fascial wall during repair of a defect in the fascial wall causing a hernia; are sufficiently inert to avoid foreign body reactions when retained in the human body for long periods of time; can be easily sterilised to prevent the introduction of infection when the mesh is implanted in the human body; and have suitably easy handling characteristics for placement in the desired location in the body.
The fine warp knit of the filaments 26 provides a surgical implant which is flexible in handing, which can be easily cut into different shapes and dimensions. As the strands 24 are formed using warp knit the possibility of fraying of the edge of the surgical implant 20 following production or cutting of the surgical implant 20 is reduced.
Other methods of reducing fraying of the filaments 24, not arranged to form the strands using warp knit, following cutting or production of the implant are heat treatment, laser treatment or the like to seal the edges of the surgical implant.
The mesh 20 may be supplied in any shape or size and cut to the appropriate dimensions as required by the surgeon.
It can be appreciated that cutting of the mesh will produce an unfinished edge 30. Due to the sparse nature of the strands that form the mesh and their narrow diameter this unfinished edge does not suffer from the same problems as edges of meshes of the prior art.
In other words the edge produced is not rough and jagged such that it increases the likelihood of extrusion of the edge of the mesh in situ or the chance of infection.
As discussed an advantage of the mesh of the present invention is that it allows the production of a mesh suitable for use in hernia repair which allows substantially less foreign material to be left into the body.
However, the mesh being flexible and insubstantial is less suitable for allowing easy handling of the mesh directly by a surgeon. Referring to
The absorbable coating 32 comprises a layer of absorbable material having a thickness greater than that of the strands 22 of the mesh 20. For example, the thickness of the layer of absorbable material may be around 1 to 2 mm. The strands 22 of the mesh 20 may be entirely embedded in the absorbable coating 32 such that the outer surface of the mesh 20 is covered entirely of the absorbable coating 32.
In effect the entire surgical implant is encased in the absorbable coating as shown in
Thus, the surgical implant has no gaps or holes on its surface. This has the advantage of reducing the likelihood of bacteria becoming lodged on the strands 22 of the mesh 20 before implantation of the mesh 20. Furthermore, the absorbable coating 32 makes the mesh 20 more substantial and less flexible such that it is more easily handled by a surgeon. This is particularly useful when it is desired to place the mesh in a desired location in a conventional, open surgical procedure.
In an alternative embodiment shown in
It can also be envisaged that the surgical implant is provided with improved surgical handling qualities by a range of other methods. Such methods including, the releasable attachment of the mesh 20 to a backing strip 40. This embodiment is shown in
The backing strip may be formed from plastics material and is adhered to the surgical implant using releasable adhesive.
In a similar fashion to the absorbable coating the backing strip 40 causes the mesh 20 to be more substantial and less flexible such that it is more easily handled by a surgeon. Following the suitable placement of the mesh 20 the backing strip 40 can be removed from the mesh 20, the mesh 20 being retained in the body and the backing material 40 being removed by the surgeon. Application of the backing strip 40 to the mesh 20 means the mesh 20 benefits from reduced mass but that the mesh 20 and backing strip 40 together give characteristics required for surgical handling.
In a further embodiment the filaments of the mesh may be comprised from bicomponent microfibres 50 or composite polymers 60. These technologies provide the implant with dual phase technology.
As shown in
Suitable bicomponent microfibres 50 include a polypropelene non absorable portion and a polylactic acid absorbable portion.
The surface material 54 is present during the surgical procedure when the mesh 20 is being inserted and located in the patient, and provides the mesh with characteristics desirable for surgical handling. Following a period of insertion in the body, typically a few hours, the surface material 54 is absorbed into the body leaving only the core material 52 of the filaments 26 in the body. The core material of the filament having reduced foreign mass in comparison to meshes of the prior art or the mesh 20 when it also includes the surface material 54.
As shown in
Referring to 9 a, a further embodiment of the mesh may comprise strands as discussed and more specifically, perimeter strands. Typically the mesh is circular or the like in shape and thus this perimeter strand can be generally referred to as a circumferential strand 70.
In the example shown in
As shown in
An outer circumferential strand 70 extending around the perimeter of the mesh 20, and further circumferential strands 72 and 74 are arranged inwardly of the outer circumferential strand forming a perimeter spaced by a distance (a). The distance a between adjacent circumferential members 70, 72 and 74, can vary and in this example is 20 mm.
Transverse strands 76 extend from the centre of the oval mesh 20 to points on the perimeter of the mesh 78. In this example, four transverse strands 76 are provided across the diameter of the mesh 20, dividing the mesh 18 into eight angularly equal portions.
The mesh 20 of this embodiment may be formed from materials as previously described. Depending on the material chosen the mesh may be woven, knitted or extruded as one piece, or individual or groups of strands can be extruded separately and joined to one another.
Such a construction as described above provides a mesh 20 with sufficient tensile strength to repair defects causing vaginal prolapse whilst having minimal bulk. Similarly, such a construction provides a suitably flexible yet resilient mesh for handling using the surgical tools described below. Referring to
These meshes have a similar structure to that described with reference to
In addition to the pores provided by the combination of filaments 26 which form the strands 22, pores can be provided by rings of polypropylene positioned at the intersection of the circumferential and transverse members.
Alternatively the pores may be formed by the spacing of the transverse members, such that pores of a size 50-200 μm suitable for enabling tissue ingrowth exist between the transverse members.
To secure the mesh to a suitable location in the body a number of methods can be used. The tackiness of the absorbable coating may hold the mesh suitably until it is secured by tissue ingrowth.
Alternatively the surgical implant can have capsules 100 (not shown) of biocompatible glue for securing the mesh 20 in place. In this example, six capsules 100 comprising spheres having a diameter of 4 mm and made from a rapidly absorbable material are provided around the perimeter of the mesh 20. On placement in the body, the capsules 100 dissolve and release a biocompatible glue contained within to secure the mesh 20 in place.
Referring to
Referring to
Referring to
Referring to
In use, the wires 236 are attached to the mesh 20 and retracted by pulling them back through the housing 30 such that the mesh 20 is radially confined close to the housing 232. Once the tool 230 has been inserted into the intended position, the wires 236 are pushed into the housing 232 and consequently out through the holes 234 to urge the mesh 20 away from the housing 232. Thus, the mesh 20 can be unfurled in its desired location in the body.
Referring once again to
The meshes described above are, in this example, supplied in a single size. After examination of the patient and estimation of the desired dimensions of the preferred mesh, the surgeon cuts the mesh to the preferred size.
Where the mesh comprises a circumferential member 70 the cut made in the mesh is through the transverse members 76 just outward of the circumferential member 70 corresponding most closely with the preferred size of mesh. Thus, regardless of the size to which the mesh is to be cut, a circumferential member 70 defines the perimeter of the mesh, and the perimeter of the mesh is substantially smooth. This desirably reduces the likelihood of infection or edge erosion once the mesh is inserted in the body.
The surgeon then attaches the mesh to or inserts the mesh with one of the insertion tools described herein. For example, the mesh is rolled up and placed within the insertion tool 200 illustrated in
An incision 9 is then made in the vaginal wall 12 at the forward most portion of the vaginal wall 12 adjacent the opening of the vaginal cavity. A cutting implement (not illustrated), such as scissors or a specialised cutting tool, is/are then inserted through the incision 9 into the area A, i.e. the lower portion of the anterior vaginal wall 12. Using the cutting implement, a cut is made in the area A parallel with the surface of the vaginal wall 12. In other words, a space is opened up in the vaginal wall 12 over the area of the defect in the vaginal wall 12. The cutting implement is then withdrawn and the mesh 20 is inserted in the space defined by the cut.
Where the insertion tool 200 illustrated in
Where the insertion tool 210 illustrated in
Where the insertion tool 220 illustrated in
Finally, where the insertion tool 250 illustrated in
Once the mesh 20 is in place, the incision may be closed.
However, it can be desirable to secure the 20 in place, rather than rely on the mesh 20 remaining in its desired location of its own accord. In one example, sutures are therefore be placed either laproscopically through the incision 9 or directly through the vaginal wall 12 to hold the mesh 20 in place. In another example, glue capsules provided on the mesh 20 dissolve to secure the mesh 20 to the tissue surrounding the space defined by the cut, or such capsules may be punctured by needles inserted directly through the vaginal wall 12.
The surgical implant described herein is advantageous over the meshes of the prior art in several ways.
In particular the mesh, of the present invention includes smoother edges, the polyester material of the present invention being softer than polypropylene. Further, the filaments of the present invention are narrower in diameter enabling them to be more pliable than the strands of the meshes of the prior art. This causes the edge or edges of the mesh of the present invention to have fewer jagged edges and thus be smoother that the edges of meshes or the prior art.
In addition encasement of the mesh in an absorbable coating further protects the tissue both during placement and for a period of time after placement of the surgical implant.
Dual Phase Technology™ such as encasement in an absorbable coating or as otherwise discussed herein provides the implant with good handling characteristics, further it enables the implant to be more easily cut. As described above an absorbable coating may protect the tissues around where the implant is to be located both during placement and for a period of time following placement of the implant in the tissue.
Dual Phase Technology™ may also provide the implant with memory. This memory may allow the implant to be more easily placed flat on the tissue. Further the dual phase technology such as an absorbable coating may provide the implant with mild adhesive properties or tackiness which would aid both the locating and securing of the implant in the tissue.
The surgical implant described herein thus allows tension free repair of hernias, particular vaginal prolopse, with minimum pain. This allows the procedure to be performed under local anaesthetic in an out patient or office setting.
Whilst the above embodiments of the invention have been described with reference to vaginal prolapse, the mesh and surgical tools may equally be used to repair any bodily hernia. Furthermore, whilst the above procedure has been described in relation to a urethrocoele prolapse, prolapse in other parts of the vaginal wall 12 can be treated through incisions elsewhere in the vaginal wall, or other bodily hernias through suitable incisions in the appropriate tissue.
|Citing Patent
|Filing date
|Publication date
|Jul 16, 2010
|Aug 30, 2011
|Coloplast A/S
|Apparatus and method for treating female urinary incontinence
|Apr 4, 2011
|Nov 1, 2011
|Coloplast A/S
|Surgical system for supporting pelvic anatomy
|Jun 14, 2011
|Feb 21, 2012
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|Method for supporting pelvic anatomy
|Jun 21, 2011
|Feb 21, 2012
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|Method for implanting an adjustable surgical implant for treating urinary incontinence
|Jun 21, 2011
|Feb 28, 2012
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|Jun 14, 2011
|Mar 6, 2012
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|Aug 26, 2009
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|Pelvic implant systems and methods with expandable anchors
|Jun 12, 2011
|Nov 18, 2014
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|Jun 1, 2011
|Dec 16, 2014
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|System and method for treating urinary incontinence
|Dec 15, 2011
|Dec 30, 2014
|Coloplast A/S
|Method and device for treating urinary incontinence
|Jun 1, 2011
|Dec 30, 2014
|Coloplast A/S
|Surgical implant with anchor introducer channel
|Jun 14, 2011
|Jan 13, 2015
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|Incontinence implant with soft tissue anchors and length not allowing abdominal wall penetration
|Jan 13, 2012
|Apr 14, 2015
|Coloplast A/S
|Self-anchoring sling and introducer system
|Apr 20, 2012
|Jun 23, 2015
|Coloplast A/S
|Tissue supported implantable device
|Jan 10, 2014
|Jul 28, 2015
|Coloplast A/S
|Pelvic implant with suspending system
|Aug 14, 2013
|Jul 28, 2015
|Coloplast A/S
|Urinary incontinence treatment and devices
|Sep 3, 2014
|Aug 25, 2015
|Coloplast A/S
|Apparatus and method for treating urinary incontinence
|U.S. Classification
|International Classification
|Cooperative Classification
|European Classification
|Oct 9, 2009
Owner name: MPATHY MEDICAL DEVICES LIMITED, UNITED KINGDOM
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:BROWNING, JAMES;REEL/FRAME:023353/0457
Effective date: 20040331
|Dec 20, 2010
Owner name: COLOPLAST A/S, DENMARK
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:MPATHY MEDICAL DEVICES LIMITED;REEL/FRAME:025521/0648
Effective date: 20101217
|May 20, 2015
|Fee payment
Year of fee payment: 4


text:
As this week opened, the major news at all the top tech sites was, well, mini.
Amid all the buzz is Apple's much-anticipated, diminutive successor to the iPad.
The iPad Mini, of course, isn't even available yet, but techies and Apple fanatics alike nearly blew a gasket this morning when rumors of an upcoming iPad Mini event began to swirl.
Now, don't get hasty. The rumors aren't even about a supposed date for said event, but rather about a date for the first invitations to get sent out. Citing a major Apple investor as a source, Fortune reported that the press should expect invitations for October 10.
That date led 9to5 mac to speculate that an iPad Mini launch could be expected for mid-October, followed by shipping in November. Since that would be an apt time for Apple to capitalize on the Christmas shopping frenzy, we tend to lean toward that projection holding true.
But if tablet and Apple junkies got excited about mere rumors about event invitations, just imagine how they must have felt when a leaked mock-up of the new tablet showed up on Japanese Apple blog Macotakara.
The video, which shows a non-functioning iPad Mini dummy, seems to confirm all "previous design rumors," says BGR. That includes the conjecture about a 7.85" display, thinner bezel, and a thickness comparable to an iPod – most of which had already been hinted at by the discovery of third party cases for the iPad Mini.
The new tablet also appears to have speakers at the bottom rather than at the rear, which is in line with yet more rumors.
But that's not the last bit of tantalizing gossip to emerge this week. Macotakara also reported that production for the iPad Mini has, in fact, begun in Brazil. though, they say, they "don't have information if it has been produced in [a] Chinese factory, yet."
Nor do we at Pure Mobile expect this to be last we hear about the next big – or is it little – thing to happen to the iPad.


text:
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News Posts
Extreme Fieldwork on the Bloody Bay Wall
by AMNH on
We wanted to include a panoramic image of a magnificent coralscape in Creatures of Light: Nature's Bioluminescence, and Bloody Bay Wall [off Little Cayman Island] was the perfect place.
But capturing Ansel Adams-like vistas are impossible under water, where sections of the light spectrum—especially reds—are absorbed within a meter. We need to get in very close to our subject and use flash photography to capture the reef 's true color. We have to repeat this process hundreds of times over the wall face. Then, the small consecutive images are painstakingly stitched together to create a life-sized, true-color view.
Puppet Theater "Luna's Sea" Comes To Museum
by AMNH on
This Mother's Day weekend, travel from the shores of Africa to the deep-sea habitats of bioluminescent creatures with a live puppet theater production that makes its New York premiere.Luna's Sea tells the story of a girl named Luna on a magical journey through the world's oceans using dance, puppetry, optical illusions, and black-light theater. Luna's Sea will hold performances at the Museum on Saturday, May 12, and Sunday, May 13. The show's creator, Linda Wingerter, recently shared the history of Luna's Sea as well as some of the details about how the production's spectacular puppets are made.
As Firefly Numbers Seem to Slide, Researchers Ponder Effects on Ecosystems
by AMNH on
Firefly larvae are voracious predators, feeding on snails, slugs, and earthworms and keeping ecosystems in delicate balance. Many are stocking up on food for their whole adulthood, throughout which they will never eat. Some climb trees in pursuit of arboreal snails. Others have gills like fish that allow them to dive for aquatic snails, whose shells they then use for protection like hermit crabs. In parts of Asia, a large mollusk called an apple snail has ravaged important crops such as rice, and firefly larvae are being explored as a potential form of biocontrol to protect those nations' food supply.
Podcast: Space Chronicles with Neil deGrasse Tyson
by AMNH on
In a podcast from this March, Director of the Hayden Planetarium Neil deGrasse Tyson discusses his new book, Space Chronicles: Facing the Ultimate Frontier.With his trademark humor and sharp insights, Dr. Tyson offers an eye-opening perspective on the importance of space exploration for America's economy, security, and morale in the 21st century.
Museum President Ellen V. Futter Appears on "Digital Age"
by AMNH on
Museum President Ellen V. Futter recently spoke about the Museum's digital initiatives on the talk show "Digital Age," hosted by Jim Zirin. Watch the full interview below.


text:
Breastfeeding Basics class meets one time for two hours. The class is designed to help new moms understand how to begin breastfeeding, how breast milk is produced, all topics to assist new moms in getting started the 'right way'! The goal is to provide moms and support people with information to be successful in breastfeeding their newborn.
Class should be taken when mom is past 32-38 weeks
Registration is for mom and 1 support person


text:
- Overview
- Specs
- Reviews
Fi'zi:k Ardea Versus SaddleSweet relief. The Fizik Ardea Versus, along with the entire Versus series, is a solid base saddle design with an ergonomic channel spanning the length of the saddle to reduce pressure and improve comfort without sacrificing performance. Fizik believes that comfort is achieved by optimizing the seating surface area, not cutting it totally out, which detrimentally decreases the seating surface available and essential support.
The Fizik Ardea Versus Saddle is meant to be the perfect balance for riders who have moderate flexibility. The Ardea Versus's foam padding and its flexible nylon shell provide reasonable flex with ample cushioning and support at the sit bones. The sides of the saddle are covered in a slick fabric to prevent thigh contact and eliminate chafing during your pedal stroke. A breathable Microtex cover and integrated scuff guards provide resistance against wear over time. The Manganese rails provide plenty of strength without adding undue weight. The Ardea Versus weighs in at only 264 grams.
- Breathable Microtex cover
- Nylon Carbon Reinforced shell
- Manganese rails for support
- Integrated Clip System ready for bags and lights
- Weight is 264 grams
Fi'zi:k Ardea Versus Saddle
- cover:
- Microtex
- dimensions:
- 142mm x 173mm
- rails:
- Manganese
- weight:
- 264g
- rating:
- 4


text: Do death row inmates have a right to die? Share this story email Share this story «Previous 22 of 25 Photos Next » Read the story « » Death Row Haugen Gary Haugen appears in Marion County Circuit Court, in Salem, Ore., on Wednesday, April 18, 2012. Haugen, a condemned inmate spared from the death penalty is back in court Wednesday as he challenges a reprieve granted by Gov. John Kitzhaber. (AP Photo/Statesman-Journal, Timothy J. Gonzalez)


text:
Why is Tyra Banks doing white face?!
The supermodel just unveiled a first look at an ambitious new photo shoot -- showing her being transformed into 15 other famous models like Cindy Crawford, Kate Moss, Twiggy, Brooke Shields and Kate Upton.
And the results are pretty impressive!
Sporting a mole and Crawford's signature tresses, Banks could easily be Cindy's twin in the pic above -- which the photographer swears is "raw," "un-retouched" and done without digital manipulation.
They say imitation is the highest form of flattery ... and Cindy is happy with the results.
Hey @tyrabanks I was just writing my model Monday about you for tomorrow & here you are all #fierce & amazing! #workit #loveit #tyra15— Cindy Crawford (@CindyCrawford) September 8, 2013
Udo Spreitzenbarth, who took the photos, says Tyra "takes on the notion of 'black and white' beyond the portrayed models' varying ethnicity" in the photos. Their art project, "Tyra Banks Presents: 15" opens today at Jack Studios as part of New York Fashion Week.
What do you think of the photos? Here she is as Kate Moss and Cara Delevingne below:
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