text:
|Numéro de publication
|Type de publication
|Numéro de demande
|Date de publication
|26 mars 1991
|Date de dépôt
|12 déc. 1989
|Date de priorité
|3 mai 1988
|État de paiement des frais
|Numéro de publication
|Roger W. Phillips, Kraig R. Willison
|Cessionnaire d'origine
|Flex Products, Inc.
|Exporter la citation
|BiBTeX, EndNote, RefMan
|Citations de brevets (2), Référencé par (60), Classifications (22), Événements juridiques (6)
|Liens externes: USPTO, Cession USPTO, Espacenet
This is a continuation of application Ser. No. 189,620 filed May 3, 1988 now abandoned.
This invention relates to a pre-imaged high resolution transfer foil, article and method and more particularly to such a pre-imaged high resolution hot stamp transfer foil, article and method which can be utilized with flexible and rigid substrates, as well as transparent and opaque substrates.
Heretofore-hot stamp transfer foils have been provided in conjunction with hot stamp machines to stamp images on to various substrates such as paper, plastic film and even rigid substrates. Typically the image is formed by utilizing a metal die into which the desired image has been cut. This die is placed in the hot stamping machine and is used to press the image into hot stamp foil utilizing a combination of heat and pressure. Typically a heat activated adhesive is placed on the back side of the foil which upon the application of heat becomes tacky in regions of the heated image and adheres to the paper or plastic substrate. The resolution and image which is formed in this manner is on the order of 0.1 mm at best. This is due to the fact that heat introduced during the process spreads out radially through the adhesive and the substrate. If the hot stamping foil carrier substrate is thicker than approximately 48 gauge, the image which is created has edges which are ragged, i.e., the edges are fringed because the radially spreading heat spreads further than the thicker substrate. This phenomenon also occurs if the hardcoat (the release layer) and the adhesive are thick. Thus it is desirable that the substrate as, for example, PET (polyethyleneterephthalate) the adhesive and the hardcoat must be at an optimum thickness. If the PET is too thin it will tear in the hot stamping machine and not survive the vacuum metalizing step. If it is too thick, then the above-described fringing results. If the hardcoat is too thin then the hot stamp foil will not release properly or will not give the transfer image enough scratch and mar protection. If the adhesive is too thin, it will not adhere to the substrate upon which the hot stamping image is being placed. If it is desired to vacuum deposit multilayer optical coatings where the coating itself is quite thick, the PET must be at least 142 gauge and preferably 200 gauge in thickness. This thickness is required so that the heat load arising from the heat of condensation and from the radiant heat from the evaporating source does not deform the web on which the stamping is being made. Depositing materials such as dielectrics, for example, metal oxides, fluorides, sulfides and the like are particularly prone to wrinkling the web. At the thickness of 142 gauge for PET substantial fringing results in the hot stamped transferred image. This fringe when lightly brushed causes the hot stamped image to flake at the edges of the image. At high production speeds this flaking results in the hot stamping machine becoming contaminated with debris. Furthermore, the image is also subject to flaking phenomenon and is unsightly and unacceptable. There is therefore a need for a new and improved hot stamp transfer foil article and method for making the same.
In general, it is an object of the present invention to provide a pre-imaged high resolution hot stamp transfer foil, article and method.
Another object of the invention is to provide a foil, article and method of the above character in which the image formed is of graphic quality.
Another object of the invention is to provide a foil, article and method of the above character in which the edges of the transferred image are encapsulated to provide an image which is environmentally resistant.
Another object of the invention is to provide a foil, article and method of the above character in which additional levels of security can be provided.
Another object of the invention is to provide a foil, article and method of the above character in which an optically variable device is utilized.
Additional objects and features of the invention will appear from the following description in which the preferred embodiment is set forth in detail in conjunction with the accompanying drawings.
FIG. 1 is a plan view of an article in the form of an employee badge which incorporates the present invention.
FIGS. 2, 3, 4, 5 and 6 are cross-sectional views showing the various steps in the method used for making the foil and an article of the present invention.
In general, the pre-imaged high resolution transfer foil consists of a carrier having a surface, a releasable hardcoat-disposed on the surface of the carrier, a vacuum coating disposed on the hardcoat and an image formed in the vacuum coating.
In general the article of the present invention is comprised of a substrate having a surface. An adhesive is disposed on the surface. A vacuum coating is carried by and is secured to the adhesive. An image is formed in the vacuum coating and a protective coat is provided on the vacuum coating. If desired, an overprint can be provided on the protective coat.
In general in the method a carrier film is provided. A releasable hardcoat is deposited on the carrier film, a vacuum coating is then deposited on the releasable hardcoat. A photo-resist is deposited on the vacuum coating and the photo-resist is exposed to an image. The photo-resist is thereafter developed to provide a foil carrying an image. A substrate serving as a carrier film is then provided and an adhesive is provided on the image side of the foil or on the substrate. Heat and pressure is then utilized to transfer the image on the foil to the substrate with the adhesive being disposed between the image and the substrate. After the transfer has been made, the carrier film is removed.
More in particular, the pre-imaged high resolution transfer foil, article and method may now be described in conjunction with FIGS. 1-6. In FIG. 1, there is shown an employee badge or article 11 incorporating the present invention. The employee badge utilizes a substrate 12 formed of a suitable relatively rigid material such as a clear thick polycarbonate. The card as shown is rectangular in form and is provided with a front surface 13 on which there appears conventional printing 14, a stripe 16 indicating the security classification of the employee, a date 17 indicating the date of hire of the employee, a logo 18 of the employer and a patterned optical variable device photograph 21 of the employee made in accordance with the present invention as hereinafter described. The employee badge 11 also is provided with a slot 22 which can be utilized for a strap secured to suitable fastening means such as a clip (not shown) to facilitate wearing of the badge by the employee.
In producing the image or photograph 21 which is shown on the badge 11 the method which is shown in FIGS. 2-6 is utilized.
In accordance with the present invention as shown in FIG. 2, a carrier film 26 formed of a suitable material is provided. The carrier can be of a relatively flexible plastic material as, for example, PET (polyethyleneterephthalate) of a suitable gauge ranging from approximately 40 gauge to 200 gauge. The carrier 26 is provided with a surface 27 upon which there is deposited a release hardcoat layer 28. The release hardcoat 28 can be of any suitable material such as an organic wax, an acrylic type coating having wax components or a silicone type release material, all well known to those skilled in the art. It is merely necessary that the hardcoat layer have integrity during a vacuum coating process hereinafter described and have the capability in connection with a hot stamping process or a transfer roll-on process so that the carrier can be released from the device it carries.
After the release hardcoat layer 28 has been deposited, a layer 29 is deposited which can be characterized as the optical coating which is to receive the image. Typically this optical coating can be in the form of a single metal layer or in the form of a multilayer optical coating. By way of example, the optical coating can be in the form of an optically variable device such as disclosed in co-pending application U.S. Pat. No. 4,705,356. A layer 31 of photoresist is then deposited over the layer 29. The photo-resist can be of a conventional type, and can be either a negative or positive photo-resist. The photo-resist 31 is then exposed to the image to be incorporated into the coating 29. The image is carried by the negative 32. In order to provide improved resolution and to replicate the grey shades in the negative, a dot screen 33 can be utilized if desired. The photo-resist is exposed through the image 32 and the dot screen 33 utilizing ultraviolet light provided by an ultraviolet light source 34. If desired, the dot screen 33 can be utilized for placing hidden messages or other covert features into the design in the coating 29.
After the photo-resist has been exposed, it can be developed by an appropriate developer depending on whether a positive or negative photo-resist is utilized. After the photo-resist is developed to remove certain portions of the photo-resist so that the image is provided in the photo-resist to expose the optical coating 29 therebelow. The assembly which is shown in FIG. 2 is subjected to an etching step by a suitable etchant which can etch the optical coating 29. Typically this can be an acid or alkaline etch or FeCL3 (ferric chloride) in the case of copper etching.
The portion of the optical coating exposed through the photo-resist is then etched away so that the image is carried into the optical coating. After the etching operation has been completed, the remaining photo-resist can be removed in a stripping operation by a suitable photo-resist stripper to provide the assembly shown in FIG. 3 which can be identified as a foil that carries the desired image in the optical coating which is secured to the carrier 26 by the release coat 28.
Let it be assumed that it is now desired to deposit the image carried by the foil 36 into a substrate 38 of interest which is provided with a surface 39 on which it is desired to deposit the image. A coat or layer of adhesive 41 is then placed on the surface 39 of the substrate 38 or alternatively, the adhesive layer 41 can be placed over the optical coating 29 carrying the image. In the drawing the adhesive is shown being deposited on the surface 39. After the adhesive layer 41 has been applied, the carrier carrying the image can then be brought into contact with the substrate 38. Typically this is accomplished by utilizing heat and pressure utilizing a flat die stamp in a reciprocating hot stamping machine or in a roll on transfer process using heated pressure rollers. The time and pressures required for such a step are well known to those skilled in the art. As soon as this transfer has been effected, the carrier 26 can be stripped away so that there remains the article 42 which is comprised of the substrate 38, the adhesive 41 which secures the optical coating 29 to the substrate covered by the release coat 28.
The release hardcoat 28 can be left in place to protect the image. If desired, an additional protective overcoat 46 can be provided. Also printing 47 of a conventional type can then be printed on the overcoat 46.
It has been found that in accordance with the present invention by pre-imaging the hot stamp foil 36 the thickness of the carrier can be increased as well as the thickness of the adhesive and the hardcoat without adversely affecting the quality of the hot stamp image. In fact, the transferred image is of a much higher quality than can be obtained with conventional hot stamping processes. In addition, there are no fringes formed in the image and the image is of graphic quality. Thus it can be seen that the present invention can be readily adapted for use on numerous commercial hot stamp products which are presently on the market such as greeting cards, paperback book covers, decals and consumer items, packaging and the like, none of which at the present time have graphic quality images or pictures thereon.
By utilizing the present invention it has been found that in addition to obtaining a graphic quality image that the image is also encapsulated along the edges by the bonding of the adhesive to the hardcoat outside of the image area which makes the transferred image more environmentally resistant.
When an optical variable coating is utilized for the coating 29, it is possible to use the hot stamp image as a security device. The transferred image not only shifts from one color to another in reflected light as the viewing angle is changed but it also has a shift from a positive to a negative image in going from reflected to transmitted light. In addition, by providing the optically variable thin film coating with a magnetic layer as described in co-pending application Ser. No. 189,779, filed May 3, 1988, a still further security feature can be incorporated into the single image device which greatly enhances the anticounterfeiting capabilities of the device. The device also can incorporate printing. If the printing is of a small size so that it only could be seen under a microscope, another level of security could be provided to provide a total of five security features, three overt and two covert, the photograph, color shift with viewing angle, positive to negative image reversal, magnet, property, and microscopic printing encoded into photograph.
The present invention relates itself to many types of products as hereinbefore described. For example, the invention lends itself to plastic identification cards of the type shown in FIG. 1 and in which an OVD photograph of the person can be incorporated into the card. An optical variable device incorporating the present invention having the high resolution graphics could be used as a seal of authenticity on documents, or for example, on currency. By way of example, the optical variable device could be in the form of a photograph of the president, founder or ruler of the country for that currency. Other security documents such as passports could utilize such optically variable device photographs.
Although the present invention has been described in conjunction with hot stamp foils, it should be appreciated that the method taught herein can be used to apply images directly to optical coatings which are coated directly onto the plastic film. In those situations where the optical coating is deposited directly onto a clear carrier film only the photo-resist coating steps (coating, exposure to UV light and developing) are necessary. If a colored carrier film is used, additional interesting effects can be generated. For example, the color of the carrier film can be adjusted to match one of the colors of the optical variable device so that at a certain angle as, for example, normal viewing, the optically variable device would not be obviously visible as it would blend into the background. At a different viewing angle, however, it would stand out against the background.
In connection with the above it should be appreciated that the substrate of interest 38 can be transparent or opaque. It can be flexible or rigid. Thus six security features can be built into a single device. The color shifter in reflected light, the shift from a positive in reflected light to a negative image in transmitted light, the photograph itself, magnetic qualities with a magnetic layer, microprint images within the OVD and overprinting for the device.
Also it should be appreciated that the present invention can be used by preimaging a hot stamp foil comprised of a thin layer of aluminum deposited on a thin layer, i.e., 48 gauge PET. The 48 gauge material is capable of withstanding the heat when the aluminum is deposited n a vacuum chamber. This construction could be utilized in the embodiment of the invention shown in FIG. 3. The image would be formed only in the aluminum layer and the release hardcoat would be dyed with a solid color. This construction provides a non-shifting colored image on the substrate or carrier.
It is apparent from the foregoing that there has been provided a pre-imaged high resolution transfer of foil, article and method which lends itself to many applications, particularly those where anticounterfeiting is important.
|Brevet cité
|Date de dépôt
|Date de publication
|9 sept. 1985
|13 janv. 1987
|Interlock Sicherheitssysteme
|Information carrier in the form of a card
|7 févr. 1986
|1 mars 1988
|American Bank Note Company
|Process for providing holograms on documents or the like
|Brevet citant
|Date de dépôt
|Date de publication
|5 sept. 1990
|19 nov. 1991
|Polaroid Corporation
|Process for incorporating hologram into laminar structure with photograph
|28 janv. 1991
|25 févr. 1992
|Transilwrap Company, Inc.
|Multi-sheet laminated identification card with tamper resistant, ultrasonic weldments
|20 aoűt 1993
|17 oct. 1995
|Gao Gesellschaft Fuer Automation Und Organisation Mbh
|Multilayer data carrier and a method for producing it
|3 févr. 1992
|28 mai 1996
|Moore Business Forms, Inc.
|Intelligent foil transfer
|11 sept. 1997
|23 févr. 1999
|E-Systems, Inc.
|Identification document with enhanced level of security
|31 mai 1996
|6 avr. 1999
|Raytheon Company
|Identification document and personalization and assembly process
|4 mai 2001
|5 mars 2002
|Strata-Tac, Inc.
|Apparatus and method for improved patch for business forms with integrated cards
|17 nov. 2000
|20 mai 2003
|Flex Products, Inc.
|Color-shifting pigments and foils with luminescent coatings
|17 nov. 2000
|3 juin 2003
|Flex Products, Inc.
|Luminescent pigments and foils with color-shifting properties
|31 juil. 2001
|17 févr. 2004
|Flex Products, Inc.
|Diffractive pigment flakes and compositions
|10 déc. 2002
|15 juin 2004
|Flex Products, Inc.
|Diffractive pigment flakes and compositions
|23 déc. 2002
|6 juil. 2004
|Flex Products, Inc.
|Methods for producing imaged coated articles by using magnetic pigments
|8 juil. 1999
|13 juil. 2004
|Flex Products, Inc.
|Diffractive surfaces with color shifting backgrounds
|7 févr. 2003
|16 nov. 2004
|Flex Products, Inc.
|Multi-layered magnetic pigments and foils
|8 aoűt 2003
|4 janv. 2005
|Flex Products, Inc.
|Multi-layered magnetic pigments and foils
|5 avr. 2002
|11 janv. 2005
|Flex Products, Inc.
|Chromatic diffractive pigments and foils
|28 mai 2004
|8 nov. 2005
|Perrin Manufacturing Company
|License plate frame
|18 sept. 2003
|17 janv. 2006
|Jds Uniphase Corporation
|Patterned reflective optical structures
|17 oct. 2003
|28 févr. 2006
|Jds Uniphase Corporation
|Security articles having diffractive surfaces and color shifting backgrounds
|12 nov. 2003
|18 avr. 2006
|Jds Uniphase Corporation
|Security articles having diffractive surfaces and color shifting backgrounds
|13 févr. 2003
|30 janv. 2007
|Jds Uniphase Corporation
|Robust multilayer magnetic pigments and foils
|31 janv. 2005
|29 mai 2007
|Jds Uniphase Corporation
|Optically variable security devices
|11 juil. 2007
|23 juin 2009
|Jds Uniphase Corporation
|Non-toxic flakes for authentication of pharmaceutical articles
|2 aoűt 2006
|1 déc. 2009
|Jds Uniphase Corporation
|Alignable diffractive pigment flakes and method and apparatus for alignment and images formed therefrom
|14 juin 2006
|8 déc. 2009
|Jds Uniphase Corporation
|Covert security coating
|4 oct. 2005
|12 janv. 2010
|Jds Uniphase Corporation
|Provision of frames or borders around opaque flakes for covert security applications
|15 nov. 2005
|23 févr. 2010
|Jds Uniphase Corporation
|Patterned structures with optically variable effects
|1 mai 2006
|9 mars 2010
|Jds Uniphase Corporation
|Two-step method of coating an article for security printing by application of electric or magnetic field
|12 déc. 2006
|1 juin 2010
|Jds Uniphase Corporation
|Security device with metameric features using diffractive pigment flakes
|12 nov. 2003
|13 juil. 2010
|Jds Uniphase Corporation
|Methods for forming security articles having diffractive surfaces and color shifting backgrounds
|25 janv. 2011
|Jds Uniphase Corporation
|Patterned optical structures with enhanced security feature
|1 oct. 2007
|1 févr. 2011
|Jds Uniphase Corporation
|Patterned optical structures with enhanced security feature
|15 janv. 2007
|3 mai 2011
|Jds Uniphase Corporation
|Apparatus for orienting magnetic flakes
|30 oct. 2007
|27 sept. 2011
|Jds Uniphase Corporation
|Printed magnetic ink overt security image
|27 juin 2007
|21 févr. 2012
|Alberto Argoitia
|Stamping a coating of cured field aligned special effect flakes and image formed thereby
|5 mars 2007
|24 avr. 2012
|Phillips Roger W
|Security devices incorporating optically variable adhesive
|4 avr. 2006
|1 janv. 2013
|Jds Uniphase Corporation
|Dynamic appearance-changing optical devices (DACOD) printed in a shaped magnetic field including printable fresnel structures
|28 oct. 2011
|25 févr. 2014
|Jds Uniphase Corporation
|Taggent flakes for covert security applications having a selected shape
|26 sept. 2012
|20 mai 2014
|Jds Uniphase Corporation
|Apparatus for orienting magnetic flakes
|9 janv. 2014
|7 avr. 2015
|Jds Uniphase Corporation
|Taggent flakes for covert security applications having a selected shape
|6 oct. 2009
|12 mai 2015
|Jds Uniphase Corporation
|Method and apparatus for orienting magnetic flakes
|9 janv. 2013
|11 aoűt 2015
|Jds Uniphase Corporation
|Article with curved patterns formed of aligned pigment flakes
|17 oct. 2003
|29 avr. 2004
|Bonkowski Richard L.
|Security articles having diffractive surfaces and color shifting backgrounds
|12 nov. 2003
|20 mai 2004
|Bonkowski Richard L.
|Methods for forming security articles having diffractive surfaces and color shifting backgrounds
|10 nov. 2003
|27 mai 2004
|Phillips Roger W.
|Optically variable security devices
|12 nov. 2003
|3 juin 2004
|Bonkowski Richard L.
|Security articles having diffractive surfaces and color shifting backgrounds
|18 sept. 2003
|24 mars 2005
|Phillips Roger W.
|Patterned reflective optical structures
|31 janv. 2005
|16 juin 2005
|Flex Products, Inc.
|Optically variable security devices
|5 mars 2004
|8 sept. 2005
|Unifoil Corporation
|Metallization process and product produced thereby
|28 mai 2004
|1 déc. 2005
|Patrick Perrin
|License plate frame
|9 aoűt 2005
|19 janv. 2006
|Perrin Manufacturing Company
|License plate frame
|4 oct. 2005
|16 févr. 2006
|Jds Uniphase Corporation
|Provision of frames or borders around opaque flakes for covert security applications
|15 nov. 2005
|13 avr. 2006
|Jds Uniphase Corporation
|Patterned structures with optically variable effects
|1 mai 2006
|31 aoűt 2006
|Jds Uniphase Corporation
|Two-step method of coating an article for security printing
|4 avr. 2006
|7 sept. 2006
|Jds Uniphase Corporation
|Dynamic appearance-changing optical devices (dacod) printed in a shaped magnetic field including printable fresnel structures
|2 aoűt 2006
|23 nov. 2006
|Jds Uniphase Corporation
|Alignable Diffractive Pigment Flakes And Method And Apparatus For Alignment And Images Formed Therefrom
|14 juin 2006
|21 déc. 2006
|Jds Uniphase Corporation, Delaware
|Covert Security Coating
|27 juin 2001
|18 avr. 2002
|Flex Products Inc
|Titanium-containing interference pigments and foils with color shifting properties
|29 juil. 2001
|23 mai 2002
|Flex Products Inc
|Luminescent pigments and foils with color-shifting properties
|16 janv. 2002
|3 janv. 2003
|Flex Products Inc
|Multi-layered magnetic pigments and foils
|Classification aux États-Unis
|283/72, 283/904, 283/75, 283/77, 283/85
|Classification internationale
|Classification coopérative
|Classification européenne
|22 sept. 1994
|Fee payment
Year of fee payment: 4
|21 sept. 1998
|Fee payment
Year of fee payment: 8
|25 sept. 2002
|Fee payment
Year of fee payment: 12
|9 oct. 2002
|Maintenance fee reminder mailed
|16 mai 2005
|17 mai 2005


text:
Can Little-Known Heroes Be Hollywood Hits?
By LAURA M. HOLSON
Published: July 26, 2004
SAN DIEGO, July 24 - The actor Keanu Reeves could not have turned in a more important performance than his first appearance at Comic-Con International on Friday, the nation's largest comic convention, where scenes from his next movie, "Constantine," made their debut.
When the lights went down in Hall H of the San Diego Convention Center, the digital video cameras popped up to film an 18-minute preview of the supernatural thriller based on the "Hellblazer" graphic novels, nearly ensuring that footage would be online soon. When the lights came up, frenzied fans rushed to the stage to ask questions and take photographs, which will also most likely end up on fan Web sites.
It was the kind of enthusiastic welcome that Warner Brothers, the studio releasing the movie next year, could have only hoped for, worth countless dollars in free publicity and sure to generate positive early buzz. Still, even Mr. Reeves, no stranger to pop culture hysteria, seemed more than a little dazed by it all.
"What is going on?" he asked in disbelief as the 6,500 fans who showed up to see him cheered wildly after an enthusiastic female fan gave him a hug and a book as a present for his birthday in September.
Hollywood, these days, is flush with movies based on comic books, graphic novels - stories narrated in sequential panels - and original science-fiction and horror fare, making Comic-Con a vital promotional tool in movie marketing campaigns. Comic book lovers eager for the latest gossip obsess over cast changes and plot details, posting convention news about their favorite movies online. A star turn by a celebrity or screenwriter can turn negative publicity to good. Indeed, an eager reception at Comic-Con, which was expected to draw more than 75,000 fans this year, can be more valuable than a red carpet appearance at a movie's premiere or a trip to the "The Tonight Show."
So much so, no less than 18 Hollywood blockbuster hopefuls - even those not derived from comic books - were promoted this weekend at Comic-Con, a sizable increase from years past. Twentieth Century Fox showed scenes from its franchise, "Alien vs. Predator," and introduced the cast to its coming comic book adaptation, "Fantastic Four." New Line Cinema presented a first look at "Blade: Trinity," the third movie in its "Blade" series. And Paramount Pictures, which has a lot riding on its coming original science-fiction thriller, "Sky Captain and the World of Tomorrow," handed out limited edition T-shirts and posters designed by the director Kerry Conran.
Even the Walt Disney Company , which has rarely had such a strong presence at the convention, was promoting its television shows and comic books, as well as showing a scene from "The Incredibles," an original movie from Pixar Animation Studios about a superhero family, which will be released in November.
Such exposure is even more important now, as many of the most well-known comic book characters have been exploited and Hollywood is tapping lesser-known stories.
"This is the linchpin to the marketing of these movies," said Robert Friedman, chief operating officer of Paramount Pictures who first attended Comic-Con in the 1970's to promote "Superman" for Warner Brothers. "It is important and critical for movies of this nature, and the people who star in them, to be embraced by this crowd."
Just ask Frank Miller and Robert Robriguez. "Who and who?" joked Mr. Miller, who commands a nearly mythic status among comic book fans as the creator, writer and illustrator of the "Sin City" series of graphic novels about a man named Marv, who thrives in a seamy underworld. Mr. Miller resisted Hollywood's overtures to turn "Sin City" into a movie for more than a decade. But he relented when he met Mr. Rodriguez, a comic book fan and the director of "Once Upon a Time in Mexico," a joyfully violent saga about a soulful killer with a penchant for his guitar, as well as the highly popular "Spy Kids" franchise.
Mr. Rodriguez wanted to turn three books, "Sin City," "The Big Fat Kill" and "That Yellow Bastard" into a movie for Disney's Dimension Films. Mr. Miller said he agreed after the director tracked him down in New York and showed him a test screening, which he thought captured the spirit of his books.
The two were on hand Saturday to show six minutes of "Sin City," which they co-directed and will be released next March. They showed the footage at Comic-Con not only because many of Mr. Miller's fans were there ("It was the perfect place to tell the story and this is an audience who appreciates it," Mr. Rodriguez said), but the two are looking for the kind of grass-roots online excitement that will keep eager moviegoers talking for months.
"We want them chattering away," Mr. Miller said. "We want to send shock waves. As word gets out, it is especially huge because everyone is here." But as important, Mr. Miller said, he and Mr. Rodriguez wanted to reassure fans, many who have been disappointed with Hollywood adaptations, that they have stayed true the spirit of the illustrated books.

subset: commoncrawl


text:
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text:
I have been writing the Racial and Gender Report Card since the 1980s. The report released today by The Institute for Diversity and Ethics in Sport at the University of Central Florida marks the first time that every sport covered has received a grade of at least a B-minus for race.
It shows that professional and college sport is making real progress, while still leaving room for improvement, especially in certain categories. In the early years of the Report Card, the NBA was the only league to receive a B or better.
The NBA still sets the standard this year with the only A among men's sports, but major league baseball and the NFL are closing the gap with B-plusses in the new Report Card.
In MLB, Ozzie Guillen, a Latino manager, and Ken Williams, an African-American general manager, led the Chicago White Sox to the 2005 World Series title. And this season, Omar Minaya, a Latino GM, and Willie Randolph, an African-American manager, took the New York Mets to Game 7 of the National League Championship Series.
For the first time in its history, the NFL is playing with as many as seven African-American head coaches. As of this week, Lovie Smith's Chicago Bears have the best record in the NFC at 12-2 and Tony Dungy's Indianapolis Colts are tied with the Ravens for the second-best record (behind San Diego) in the AFC at 11-3.
The NBA currently has 12 African-American head coaches. Unlike in the other sports, we've reached a point in the NBA that we almost don't notice when a black head coach is either hired or fired. Commissioner David Stern has set the highest bar in sports regarding opportunities for the best candidates to fill positions, irrespective of race.
How do race and gender affect sports? Are we playing fair on and off the field when it comes to race and gender?
There are readers who regularly respond to my columns with suggestions that I am too worried about opportunities for African-Americans and Latinos, and that I am biased against whites. After my column last week on college sports, I was bombarded with angry e-mails and phone calls.
Here is one message I received from a reader: "What nonsense! If you did one of your 'studies' on the NBA, you would find blacks make up 95% of the players. Would you then whine about diversity? No -- you would not even do such a study, let alone whine about the outcome. You people are idiots!"
For the record, African-Americans make up 73 percent of the players in the NBA.
Many of the responses I get could wonder why I don't argue for more opportunities for white players, and include statements such as, "I can't tell my son he can be an athlete in college or the pros."
Another common response involves the belief that African-Americans are superior athletes (brawn skills) while whites are smarter and better leaders (brain skills), such as this recent e-mail: "So, if the overrepresentation of blacks as players is based on merit, can't it be possible that other races are better at administration/management/coaching duties and these account for their overrepresentation? Clearly these jobs require a different skill set than those required to play basketball. Having an advanced skill in one area does not mean that same individual will have an advanced skill in another unrelated area. You can't have it both ways. Your study smacks of racism."
I get such responses whenever I write about an unequal playing field. Some readers misunderstand my intent. I support a process that will get the best candidates into the interview room so that the best person will be hired for the job, irrespective of race. That goes for players, coaches and front office/athletic department personnel.
Roger Goodell inherited a far different NFL than did Paul Tagliabue, who became commissioner in 1989 when the NFL had no African-American head coaches or GMs. Now, the NFL has a league-wide policy that urges all its teams to interview at least one person of color for any front office vacancy.
For the third time, the WNBA, now 10 seasons old, gets A's across the board for race, gender and as a combined grade. It received the same sweep of A's in the 2001 and 2004 Racial and Gender Report Cards. No other professional sports league has achieved that even once. Donna Orender has continued the progressive leadership of Val Ackerman, the WNBA's first president.
NCAA president Dr. Myles Brand has often argued for more opportunities for people of color and women. Nonetheless, college sports received a B-minus for race and a B for gender hiring practices, and that B-minus is the lowest grade overall for race. College sports received an F in the area of hiring college football coaches, because only 5 percent of Division IA head coaches are African-American, while 45 percent of the players are African-American. College sports set a new record for people of color as men's basketball head coaches (25 percent in Division IA), but also received F's for university presidents, athletic directors, women's basketball coaches and conference commissioners.
One of the most striking finds in this Racial and Gender Report Card, which I co-authored this year with Danielle Kushner, Jenny Brenden and Stacy Martin, is that there has been little progress for gender. The WNBA maintained it's A; but the NFL did not improve, the NBA dropped from a B to a B-minus and MLB slipped from a C to a D-plus. College sports declined from a B-plus to a B.
Still, the improvements I've noted, along with the fact that some individual categories hit record highs in most of the leagues and colleges, show that goals for diversity can be reached with concerted work.
I believe that commissioners Stern, Tagliabue (now Goodell) and Selig, and presidents Orender and Brand regularly work to improve hiring practices for people of color and women in front offices/athletic departments and in the coaching and managerial ranks. However, the results at the team levels still clearly show that their power is limited in this area. League and NCAA leaders set an important tone, but don't have the authority to affect real change at the team or college level.
The NBA has made progress year by year. It took dramatic actions by Selig and Tagliabue (the Rooney Rule) to mandate diverse pools of candidates for the top jobs in MLB and the NFL. After Major League Soccer received an F for gender in 2003, it addressed the problem on a league-wide basis. The NCAA and college sports have no such mechanism in place. As of the publication of this most recent Racial and Gender Report Card, discussions are ongoing about adopting something similar to a Rooney Rule for colleges. The Black Coaches Association is also contemplating legal actions against colleges using Title VII regulations.
It is far from a perfect world in college and pro sports regarding opportunities for women and people of color to be real leaders in sport. But I am convinced we have the right people in place to continue to move us ahead and make meaningful change.
Richard E. Lapchick is the Chair of the DeVos Sport Business Management Graduate Program in the College of Business Administration at the University of Central Florida (http://www.bus.ucf.edu/sport/). He is President of the National Consortium for Academics and Sports. The author of 12 books, Lapchick also directs UCF's Institute for Diversity and Ethics in Sport. He has joined ESPN.com as a regular commentator on issues of diversity in sport.


text:
I have picked my finally two names and just am not sure which one i like more.. I need some help please.. My favorite name is Jaidyn Marie McMullin my second favorite is Marley Jo McMullin. What do you think.
Finally two and can't decide
I prefer Marley Jo. I really don't care for the name Jaidyn at al.
Alexandra & Catherine's Mom
Jayden, and all its respellings, is the second most popular boys' name (http://www.namenerds.com/uucn/2007xy.html). It doesn't matter how its spelled; she will still be the Girl Jayden in her class sitting next to the two boy Jaydens.
I don't care for either name, but I would pick Marley McMullin. Marley may be trendy and cutsie, but at least its a girls' name.
Honey Bee married to Bumble Bee (Apr 2013)
Expecting Baby Bee (October 2015)
I have to concur with the PP about Jaidyn/Jayden/Jaden/etc. It's not feminine to me, at all.
What about: Jada, Jana, Jayla, Jolie, Josie, Jocelyn
As for Marley, not a fan. Sorry. It's Bob's last name and the name of a rather famous dog right now. It seems perpetually cutesy to me.
What about: Marla, Maggie, Millie, Haley, Allison (Allie), Lily...or the millions of other --ley last names right now.
xoxo Amanda
So, you think it's cute to misspell your child's name? It's not. You're welcome.
Definitely Marley over Jaidyn, but I prefer Marla or Marlena nn Marley.
Boy 07/07, Girl 12/10, Boy 03/05/13 VBA2C!!!!
**Melissa** momma to :
(2/24/04) Drama Llama ~ Hadley Veronica
(5/12/08) SuperMan~ Sawyer Christopher
Jaidyn definatly!
Brooke(24)married Brian(27),on August 16th 2008.
Miscarried October 2008. 3year old son, 18month old son, due with baby girl 6/12
I strongly prefer Marley.
Jaime, mom to Norah (6.06)�and Lucy (4.08) and Henry (3.11).


text:
Posted November 17, 2012 on AP on Fox
Zach Randolph had 20 points and 15 rebounds, Marc Gasol added 24 points and the Memphis Grizzlies handed the New York Knicks their first loss of the season with a 105-95 victory on Friday night. Rudy Gay scored 17 points and blocked four shots, and Mike Conley added 16 points and eight assists as Memphis won its seventh straight. The Grizzlies own the NBA's best record for the first time in franchise history at 7-1. Carmelo Anthony scored 20 points for New York, which was trying to start 7-0 for the first time since the 1993-94 team that reached the NBA Finals. Raymond Felton scored 18 points and handed out five assists. Rasheed Wallace scored 13 points, shooting 6 of 10. The Knicks shot 51 percent for the game, but Memphis had 12 offensive rebounds, leading to a 22-12 advantage in second-chance points. Memphis led by as many as 21 in the third quarter and still held a 19-point lead in the early stages of the final period. The Knicks answered with a 12-3 rally and appeared pois...
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text:
|N·mero de publicaci¾n
|Tipo de publicaci¾n
|N·mero de solicitud
|Fecha de publicaci¾n
|2 Sep 2004
|Fecha de presentaci¾n
|13 Nov 2003
|Fecha de prioridad
|21 May 1999
|Tambiķn publicado como
|N·mero de publicaci¾n
|Jeffrey Stahmann, Andrew Kramer
|Cesionario original
|Stahmann Jeffrey E., Kramer Andrew P.
|Exportar cita
|BiBTeX, EndNote, RefMan
|Citas de patentes (99), Citada por (17), Clasificaciones (15), Eventos legales (3)
|Enlaces externos: USPTO, Cesi¾n de USPTO, Espacenet
[0001] This application is a continuation-in-part of the following co-pending, commonly assigned patent applications: U.S. patent application Ser. No. 09/748,796 filed on Dec. 26, 2000, and U.S. patent application Ser. No. 09/316,515 filed on May 21, 1999, the specifications of which are herein incorporated by reference in their entirety. This application also incorporates by reference in its entirety U.S. patent application Ser. No. 09/316,588 which issued as U.S. Pat. No. 6,285,907.
[0002] This invention pertains to cardiac pacemakers and methods for operating such devices. In particular, the invention relates to methods for cardiac pacing during an atrial tachyarrhythmia.
[0003] Congestive heart failure (CHF) is a clinical syndrome in which an abnormality of cardiac function causes cardiac output to fall below a level adequate to meet the metabolic demand of peripheral tissues. CHF can be due to a variety of etiologies with that due to ischemic heart disease being the most common. Some form of cardiac pacing can often benefit CHF patients. For example, sinus node dysfunction resulting in bradycardia can contribute to heart failure which can be corrected with conventional bradycardia pacing. Also, some CHF patients suffer from some degree of AV block such that their cardiac output is improved by synchronizing atrial and ventricular contractions with dual-chamber pacing using a programmed AV delay time (i.e., atrial triggered ventricular pacing or AV sequential pacing).
[0004] A common sequela of CHF is dilation of the heart chambers (especially the left ventricle) as end-diastolic volume is increased in the body's attempt to increase stroke volume. The ventricles can then become stretched and less contractile which actually worsens the heart failure. Stretching of the ventricular wall can also cause slowed conduction of depolarization impulses through the ventricle. If conduction velocity is slowed in the left ventricle more than the right, for example, the contraction of the two ventricles during ventricular systole becomes uncoordinated which lessens pumping efficiency. Some CHF patients also suffer from conduction defects of the specialized conduction system of the heart (a.k.a. bundle branch blocks) so that a depolarization impulse from the AV node reaches one ventricle before the other. In both of these situations, cardiac output can be increased by improving the synchronization of right and left ventricular contractions. Cardiac pacemakers have therefore been developed which provide pacing to both ventricles. (See, e.g., U.S. Pat. No. 4,928,688, issued to Mower and hereby incorporated by reference.)
[0005] Due to stretching of the atrial walls caused by the cardiac dilation described above, CHF patients are predisposed to occurrence of atrial tachyarrhythmias. Atrial tachyarrhythmias are cardiac rhythms characterized by atrial contractions occurring at a rapid rate, either due to an ectopic excitatory focus or abnormal excitation by normal pacemaker tissue. Atrial tachyarrhythmias can be classified according to increasing rate into entities that include atrial tachycardia, atrial flutter, and atrial fibrillation. Due to the refractory period of the AV node, some degree of AV block is usually always present so that the ventricular rate is less than the atrial rate if the AV conduction pathway is otherwise intact. In atrial fibrillation, the atria depolarize in a chaotic fashion with no effective pumping action, and the ventricles beat both rapidly and irregularly due to conduction of excitatory impulses from the fibrillating atria through the AV node. In atrial tachyarrhythmias, and especially atrial fibrillation, the atria no longer act as effective primer pumps for the ventricles which decreases stroke volume, referred to as a loss of atrio-ventricular synchrony. Also, when the ventricles contract at irregular intervals, the contraction can occur prematurely before diastolic filling is complete and decrease the stroke volume for that contraction. An episode of atrial tachyarrhythmia can thus depress cardiac output and cause such symptoms as dyspnea, fatigue, vertigo, and angina. This is especially problematic in CHF patients who are already hemodynamically compromised.
[0006] The present invention relates to a method and system for altering the pacing mode of a pacemaker in order to maintain hemodynamic stability during an atrial tachyarrhythmia such as atrial fibrillation. The invention may be especially beneficial to pacemaker patients with CHF whose hemodynamics are adversely affected by episodes of atrial fibrillation.
[0007] In accordance with the invention, the pacing mode of a pacemaker is switched from a normal pacing mode to an atrial fibrillation pacing mode in response to detection of an atrial tachyarrhythmia. The atrial fibrillation pacing mode is adapted for pacing in the presence of an irregular intrinsic ventricular rhythm. Depending upon the individual patient and the normal pacing mode, the atrial fibrillation mode may include initiation or modification of ventricular resynchronization therapy, initiation of ventricular rate regularization pacing, and/or changes to rate-adaptive parameters.
[0008] In one embodiment, the atrial fibrillation mode includes ventricular resynchronization, wherein pacing stimulation is applied to both ventricles or to one ventricle in a manner that improves the coordination of ventricular contractions. Such pacing is beneficial in patients with interventricular or intraventricular conduction defects, and switching to a resynchronization mode during an episode of atrial tachyarrhythmia improves cardiac output in those patients. If the normal pacing mode already includes resynchronization therapy, it may be beneficial to modify the resynchronization in the atrial fibrillation mode by, for example, adjusting a biventricular offset value or initiating biventricular triggered pacing.
[0009] In another embodiment, the atrial fibrillation mode includes ventricular rate regularization where a ventricular escape interval is dynamically adjusted in accordance with a measured intrinsic ventricular rate. By adjusting the ventricular escape interval to more nearly match the intrinsic ventricular rate, more paces are delivered and less variability in the overall ventricular rhythm is allowed. With a more regular ventricular rate, cardiac output is improved during an atrial tachyarrhythmia. Ventricular rate regularization may also enhance the effectiveness of ventricular resynchronization pacing in the presence of an atrial tachyarrhythmia by increasing the number of paces delivered.
[0010]FIG. 1 is a system diagram of a microprocessor-based pacemaker.
[0011]FIGS. 2A and 2B show an exemplary filter implementation of a ventricular rate regularization system.
[0012]FIG. 3 is a block diagram illustrating exemplary atrial fibrillation pacing modes.
[0013] The most common condition for which pacemakers are used is in the treatment of bradycardia, where the ventricular rate is too slow. Atrio-ventricular conduction defects (i.e., AV block) that are fixed or intermittent and sick sinus syndrome represent the most common causes of bradycardia for which permanent pacing may be indicated. If functioning properly, a pacemaker makes up for the heart's inability to pace itself at an appropriate rhythm in order to meet metabolic demand by enforcing a minimum heart rate. As described below, bradycardia pacing modes define which chambers are paced and the manner in which the paces are delivered. Pacing therapy can also be used in the treatment of congestive heart failure (CHF). Some CHF patients suffer from some degree of AV block or are chronotropically deficient such that their cardiac output can be improved with conventional bradycardia pacing. It has also been shown, however, that some CHF patients suffer from intraventricular and/or interventricular conduction defects such that their cardiac outputs can be increased by improving the synchronization of right and left ventricular contractions with electrical stimulation, referred to herein as ventricular resynchronization therapy.
[0014] A pacemaker patient with some degree of CHF who experiences an episode of atrial fibrillation will suffer some diminishing of cardiac output from the resulting irregular ventricular rhythm and/or loss of atrio-ventricular synchrony. Thus, even if a patient were adequately treated during normal circumstances with only a bradycardia pacing mode, the same patient may benefit from resynchronization therapy to restore hemodynamic stability during the atrial fibrillation episode. Furthermore, patients treated with resynchronization therapy in addition to a bradycardia pacing mode may benefit from a modification to the pacing mode including changes to the mode of resynchronization. The present invention relates to a method for operating a pacemaker in which a normal pacing mode is switched to an atrial fibrillation pacing mode upon detection of an atrial tachyarrhythmia such as atrial fibrillation that counteracts the adverse effects of atrial fibrillation.
[0015] 1. Hardware Platform
[0016] Cardiac pacemakers are cardiac rhythm management devices that provide electrical stimulation in the form of pacing pulses to selected chambers of the heart. (As the term is used herein, a pacemaker is any cardiac rhythm management device that performs cardiac pacing, including implantable cardioverter/defibrillators having a pacing functionality.) Cardiac rhythm management devices are typically implanted subcutaneously in a patient's chest and have leads threaded intravenously into the heart to connect the device to electrodes used for sensing and pacing, the electrodes being disposed in proximity to selected chambers of the heart. Pacemakers typically have a programmable electronic controller that causes the pacing pulses to be output in response to lapsed time intervals and sensed electrical activity (i.e., intrinsic heart beats not as a result of a pacing pulse). A depolarization wave associated with an intrinsic contraction of the atria or ventricles that is detected by the pacemaker is referred to as an atrial sense (P wave) or ventricular sense (R wave), respectively. In order to cause such a contraction in the absence of an intrinsic beat, a pacing pulse with energy above a certain pacing threshold is delivered to the chamber.
[0017]FIG. 1 shows a system diagram of a microprocessor-based pacemaker physically configured with sensing and pacing channels for the atrium and both ventricles. The controller 10 of the pacemaker is a microprocessor which communicates with a memory 12 via a bidirectional data bus. The memory 12 typically comprises a ROM (read-only memory) for program storage and a RAM (random-access memory) for data storage. The pacemaker has atrial sensing and pacing channels comprising electrode 34, lead 33, sensing amplifier 31, pulse generator 32, and an atrial channel interface 30 which communicates bidirectionally with a port of microprocessor 10. The device also has ventricular sensing and pacing channels for both ventricles comprising electrodes 24 a-b, leads 23 a-b, sensing amplifiers 21 a-b, pulse generators 22 a-b, and ventricular channel interfaces 20 a-b where "a" designates one ventricular channel and "b" designates the other. For each channel, the same lead and electrode are used for both sensing and pacing. The channel interfaces 20 a-b and 30 include analog-to-digital converters for digitizing sensing signal inputs from the sensing amplifiers and registers which can be written to by the microprocessor in order to output pacing pulses, change the pacing pulse amplitude, and adjust the gain and threshold values for the sensing amplifiers. An exertion level sensor 330 (e.g., an accelerometer or a minute ventilation sensor) enables the controller to adapt the pacing rate in accordance with changes in the patient's physical activity. A telemetry interface 40 is also provided for communicating with an external programmer. A pacemaker incorporating the present invention may possess all of the components in FIG. 1 and be programmable so as to operate in a number of different modes, or it may have only those components necessary to operate in a particular mode.
[0018] The controller 10 controls the overall operation of the device in accordance with programmed instructions stored in memory. The controller 10 controls the delivery of paces via the pacing channels in accordance with a pacing mode, interprets sense signals from the sensing channels, and implements timers for defining escape intervals and sensory refractory periods. The controller also detects the presence of arrhythmias such as atrial fibrillation by measuring the time interval between senses and implements the mode switching function as described herein. It should be appreciated that these functions could also be performed by custom logic circuitry either in addition to or instead of a programmed microprocessor.
[0019] 2. Bradycardia Pacing Modes
[0020] Bradycardia pacing modes are generally designated by a letter code of three positions where each letter in the code refers to a specific function of the pacemaker. The first letter refers to which heart chambers are paced and which may be an A (for atrium), a V (for ventricle), D (for both chambers), or O (for none). The second letter refers to which chambers are sensed by the pacemaker's sensing channels and uses the same letter designations as used for pacing. The third letter refers to the pacemaker's response to a sensed P wave from the atrium or an R wave from the ventricle and may be an I (for inhibited), T (for triggered), D (for dual in which both triggering and inhibition are used), and O (for no response). Modem pacemakers are typically programmable so that they can operate in any mode which the physical configuration of the device will allow. Additional sensing of physiological data allows some pacemakers to change the rate at which they pace the heart in accordance with some parameter correlated to metabolic demand. Such pacemakers are called rate-adaptive pacemakers and are designated by a fourth letter added to the three-letter code, R.
[0021] Pacemakers can enforce a minimum heart rate either asynchronously or synchronously. In asynchronous pacing, the heart is paced at a fixed rate irrespective of intrinsic cardiac activity. There is thus a risk with asynchronous pacing that a pacing pulse will be delivered coincident with an intrinsic beat. Most pacemakers for treating bradycardia today are therefore programmed to operate synchronously in a so-called demand mode where sensed cardiac events occurring within a defined interval either trigger or inhibit a pacing pulse. Inhibited demand pacing modes utilize escape intervals to control pacing in accordance with sensed intrinsic activity. In an inhibited demand mode, a pacing pulse is delivered to a heart chamber during a cardiac cycle only after expiration of a defined escape interval during which no intrinsic beat by the chamber is detected. If an intrinsic beat occurs during this interval, the heart is thus allowed to "escape" from pacing by the pacemaker. Such an escape interval can be defined for each paced chamber. For example, a ventricular escape interval can be defined between ventricular events so as to be restarted with each ventricular sense or pace. The inverse of this escape interval is the minimum rate at which the pacemaker will allow the ventricles to beat, sometimes referred to as the lower rate limit (LRL).
[0022] In atrial tracking pacemakers (i.e., VDD or DDD mode), another ventricular escape interval is defined between atrial and ventricular events, referred to as the atrioventricular interval (AVI). The atrio-ventricular interval is triggered by an atrial sense or pace and stopped by a ventricular sense or pace. A ventricular pace is delivered upon expiration of the atrio-ventricular interval if no ventricular sense occurs before. Atrial-triggered ventricular pacing attempts to maintain the atrio-ventricular synchrony occurring with physiological beats whereby atrial contractions augment diastolic filling of the ventricles. If a patient has a physiologically normal atrial rhythm, atrial-triggered pacing also allows the ventricular pacing rate to be responsive to the metabolic needs of the bodv. Atrial tracking modes are contraindicated when there is chronic refractory atrial tachyarrhythmia such as atrial fibrillation or atrial flutter.
[0023] A pacemaker can also be configured to pace the atria on an inhibited demand basis. An atrial escape interval is then defined as the maximum time interval in which an atrial sense must be detected after a ventricular sense or pace before an atrial pace will be delivered. When atrial inhibited demand pacing is combined with atrialtriggered ventricular demand pacing (i.e., DDD mode), the lower rate interval is then the sum of the atrial escape interval and the atrio-ventricular interval.
[0024] Rate-adaptive pacemakers modulate the ventricular and/or atrial escape intervals base upon measurements corresponding to physical activity. Such pacemakers are applicable to situations in which atrial tracking modes cannot be use. In a rate-adaptive pacemaker operating in a ventricular pacing mode, the LRL is adjusted in accordance with exertion level measurements such as from an accelerometer or minute ventilation sensor in order for the heart rate to more nearly match metabolic demand. The adjusted LRL is then termed the sensor-indicated rate.
[0025] 3. Ventricular Resynchronization Therapy
[0026] In a ventricular resynchronization pacing mode, pacing stimulation is applied to one or both ventricles in a manner that improves the coordination of ventricular contractions and thereby improves ventricular pumping efficiency. In delivering such therapy, for example, it may be useful to pace only one ventricle on an inhibited demand basis in accordance with sense signals received from the opposite ventricle, pace one ventricle in a triggered mode in which an intrinsic beat in one ventricle triggers a pace in the opposite ventricle, pace both ventricles on an inhibited demand basis in accordance with sense signals received from only one ventricle, or pace both ventricles in a combination of triggered and inhibited demand modes. In the examples of resynchronization therapy that follow, the ventricular pacing modes are based upon intrinsic activity in the right ventricle. It should be appreciated, however, that equivalent embodiments could be applied to pacing modes based upon left ventricular intrinsic activity.
[0027] One implementation of resynchronization therapy is biventricular (BV) pacing. In BV pacing, a left ventricular pace is delivered either simultaneously or in a timed relation with a right ventricle pace as specified by a biventricular offset interval. The offset interval may be zero in order to pace both ventricles simultaneously, positive in order to pace the left ventricle after the right, or negative if the left ventricle is paced before the right. In many cases, pumping efficiency of the heart will be increased by simultaneous pacing of the ventricles with an offset of zero. However, it may be desirable in certain patients to pace one ventricle before the other in order to compensate for different conduction velocities in the two ventricles, and this may be accomplished by specifying a particular biventricular offset interval. The ventricles may be paced on an inhibited demand basis where the ventricular escape interval is restarted with either a ventricular pace or a right ventricular sense. The pacing mode may also include atrial tracking. In that case, a pair of ventricular paces are delivered after expiration of the AVI escape interval or expiration of the LRL escape interval, with ventricular pacing inhibited by a right ventricular sense that restarts the LRL escape interval or stops the AVI escape interval. Since the ventricular escape interval in this mode is reset or stopped by senses only from the right ventricle, a left ventricular protection period may be provided that starts with the occurrence of a left ventricular sense and lasts for a specified time. A left ventricular pace is then not permitted upon expiration of the escape interval if it would occur within the protection period.
[0028] A variation of biventricular pacing is to pace only the left ventricle (LV-only pacing). LV-only pacing may be advantageous where the conduction velocities within the ventricles are such that pacing only the left ventricle results in a more coordinated contraction by the ventricles than with conventional right ventricular pacing or biventricular pacing. LV-only pacing may be implemented in inhibited demand modes with or without atrial tracking, similar to biventricular pacing. A left ventricular pace is then delivered upon expiration of the AVI escape interval or expiration of the LRL escape interval, with left ventricular pacing inhibited by a right ventricular sense that restarts the LRL escape interval or stops the AVI escape interval. As with BV pacing, a left ventricular pace may be inhibited if a left ventricular sense occurs within a protective period prior to expiration of the ventricular escape interval. Since an inhibited left ventricular pace in this mode could result in a cardiac cycle with no pacing, the mode may be further modified such that a right ventricular safety pace is delivered if the left ventricular pace is inhibited and no right ventricular sense has occurred.
[0029] Another ventricular resynchronization mode is a biventricular triggered (BT) mode where one or both ventricles are paced within a latency period following a sense from the right ventricle. In this mode, rather than inhibiting pacing upon receipt of a right ventricular sense, ventricular pacing is triggered to occur in the shortest time possible after a right ventricular sense in order produce a coordinated contraction of the ventricles. This mode of pacing may be desirable when the intraventricular conduction time of the heart is long enough that the pacemaker is able to reliably insert a pace before depolarization from the right ventricle would reach the left ventricle. The time delay between a right ventricular sense and the ensuing pace output is dictated by the response time of the hardware and is designated as the sense-to-pace latency (SPL) interval. Note that the SPL interval is a characteristic of the hardware and not a programmable timer interval. The mode may operate such that following a right ventricular sense, either the left ventricle only is paced, or both ventricles are paced. In the latter case, the right ventricle is paced even though a right ventricular sense has been received to allow for the possibility that the right ventricular sense was actually a far-field left ventricular sense in the right ventricular channel. If the right ventricular sense were actually from the right ventricle, the right ventricular pace would occur during the right ventricle's physiological refractory period and be of no consequence. With either type of BT pacing mode, pacing of the left ventricle can be inhibited by a left ventricular sense that triggers a left ventricular protective period interval. Biventricular triggered pacing can also be combined with biventricular inhibited demand pacing.
[0030] 4. Ventricular Rate Regularization
[0031] Ventricular rate regularization (VRR) is a ventricular pacing mode in wnich the LRL of the pacemaker is dynamically adjusted in accordance with a detected intrinsic ventricular rate. When a pacemaker is operating in a ventricular pacing mode (e.g., VVI), intrinsic ventricular beats occur when the instantaneous intrinsic rate rises above the LRL of the pacemaker. Otherwise, paces are delivered at a rate equal to the LRL. Thus, paces are interspersed with intrinsic beats, and the overall ventricular rhythm as a result of both paces and intrinsic beats is determined by the LRL and the mean value and variability of the intrinsic ventricular rate. VRR regularizes the overall ventricular rhythm by adjusting the LRL of the pacemaker in accordance with changes in the measured intrinsic rate.
[0032] The intrinsic ventricular rate is the rate at which intrinsic ventricular beats occur and can be defined both instantaneously and as being at some mean value with a certain variability about that mean. The instantaneous intrinsic rate can be determined by measuring an R-R interval, where an R-R interval is the time between a present ventricular sense (i.e., an R-wave or intrinsic ventricular depolarization) and the preceding ventricular sense or ventricular pace, with the instantaneous rate being the reciprocal of the measured interval. The LRL of a pacemaker is initially set to a programmed base value and defines the ventricular escape interval, which is the maximum time between ventricular beats allowed by the pacemaker and is the reciprocal of the LRL. At any particular mean intrinsic rate above the LRL, a ventricular pace is delivered only when, due to the variability in the intrinsic rate, an R-R interval would be longer than the ventricular escape interval were it allowed to occur. As the mean intrinsic ventricular rate increases above the LRL, fewer paces are delivered and more variability in the overall ventricular rhythm is allowed. The VRR pacing mode counteracts this by increasing the LRL as the intrinsic ventricular rate increases to thereby increase the frequency of paced beats and lessen the variability in the overall ventricular rate. The VRR mode then decreases the LRL toward its base value as the number of paces delivered increases due to a decrease in either the mean intrinsic ventricular rate or its variability. The LRL adjusted in this manner is also referred to herein as the VRR-indicated rate.
[0033] In one embodiment of VRR, the LRL is adjusted by measuring an R-R interval when a ventricular sense occurs and then computing an updated ventricular escape interval based upon the measured R-R interval. When a ventricular pace is delivered, on the other hand, the LRL is made to decay toward the programmed base value. FIGS. 2A and 2B show an exemplary implementation of a VRR system made up of a pair of filters 515 and 516 which may be implemented as software executed by the controller 10 and/or with discrete components. Filter 515 is employed to compute the updated ventricular escape interval when a ventricular sense occurs, and filter 516 is used when a ventricular pace is delivered.
[0034] When a ventricular sense occurs, the measured R-R interval is input to a recursive digital filter 515 whose output is the updated ventricular escape interval. The filter 515 multiplies the measured R-R interval by a filter coefficient A and then adds the result to the previous value of the output (i.e., the present ventricular escape interval) multiplied by a filter coefficient B. The operation of the filter is thus described by VEIn=A(RRn)+B(VEIn−1), where A and B are selected coefficients, RRn is the most recent R-R interval duration, and VEIn−1 is the previous value of the ventricular escape interval. A useful way to conceptualize the filter 515 is to decompose the coefficients A and B into a scaling factor a and a weighting coefficient w such that A=aĘw and B=(1−w), where w is between 0 and 1. Viewed this way, the filter is seen as computing a weighted average of the present R-R interval multiplied by the scaling factor a and the present ventricular escape interval. The filter thus causes the value of the ventricular escape interval to move toward the present R-R interval multiplied by the scaling factor at a rate determined by the weighting coefficient. This corresponds to the filter moving the pacemaker's LRL toward a fraction 1/a of the instantaneous intrinsic ventricular rate as determined by the measured R-R interval. If a ventricular sense has occurred, the current LRL is necessarily less than the measured instantaneous intrinsic ventricular rate. If it is also less than 1/a of the intrinsic rate, the LRL is increased by the filter up to a value that is 1/a of the intrinsic rate to result in more pacing and less variability in the overall ventricular rhythm.
[0035] When a ventricular pace is delivered due to expiration of the venticular escape interval without a ventricular sense, filter 516 multiplies the present ventricular escape interval by a filter coefficient C so that VEIn=C(VEIn−1). To provide stable operation, the coefficient C must be set to a value greater than 1. Filter 516 then causes the ventricular escape interval to increase in an exponential manner with each pace as successive values of the escape interval are input to the filter up to a value corresponding to the base LRL.
[0036] The updating of the ventricular escape interval may be performed in various ways including on a beat-to-beat basis, at periodic intervals, or with averages of successive R-R intervals. In a presently preferred embodiment, however, the updating is performed on a beat-to-beat basis with each ventricular sense or pace causing adjustment of the LRL by filter 515 or 516, respectively. The two filters operating together thus cause the LRL to move closer to 1/a of the measured intrinsic rate after a ventricular sense and to decay toward the base LRL value after a ventricular pace.
[0037] The coefficients a and w (or A and B) and C are selected by the user and may be made programmable so that the behavior of the system can be adjusted to produce the clinically best result in an individual patient. For example, as the scaling factor a is made greater than 1, the filter 515 causes the LRL to move toward a smaller fraction 1/a of the detected intrinsic rate which allows more intrinsic beats to occur and greater variability in the overall rhythm. As a is decreased back toward 1, the filter 515 tends to move the LRL of the pacemaker toward a larger fraction of the detected instantaneous intrinsic rate, thus increasing the amount of pacing and decreasing the amount of variability allowed in the overall ventricular rhythm. If a is made smaller than 1, the LRL is moved toward a rate higher than the intrinsic rate, further increasing the amount of pacing to point where most of the ventricular rhythm is made up of paced beats. The larger the weighting factor w, the faster the LRL is moved to the specified fraction of the intrinsic rate, making the system more responsive to increases in the variability of the intrinsic rhythm. The larger the decay coefficient C, the more rapidly will filter 516 cause the LRL to decrease toward its programmed base value when ventricular paces are delivered due to no ventricular senses being detected within the ventricular escape interval. The controller limits the updated ventricular escape interval as a result of the operations of filters 515 and 516 to minimum and maximum values in accordance with a programmed maximum pacing rate MPR and base lower rate limit LRL, respectively.
[0038] As noted, the coefficients of filters 515 and 516 can be made programmable by the user, such as by using a remote programmer. In another embodiment, the user selects a desired performance parameter (e.g., desired degree of rate regularization, desired amount of pacing, desired decay rate, etc.) from a corresponding range of possible values. The appropriate combinations of coefficients for filters 515 and 516 are then automatically selected to provide filter settings that correspond to the selected user-programmed performance parameter. The filter coefficients can also be made functions of other parameters, such as the measured R-R interval and current LRL setting, and dynamically adjusted.
[0039] The VRR system in this embodiment uses the programmed base LRL of the pacemaker as the lower limit to which the LRL is permitted to decay when no ventricular senses are detected. The base LRL can be changed periodically by the user with an external programmer, and rate-adaptive pacemakers have the capability of dynamically adjusting the LRL in order to adapt to exercise. If a rate-adaptive pacemaker is operated in a VRR mode, the sensor-indicated rate can simply be regarded by the pacemaker as the base LRL. The lower limit for the VRR-indicated rate is then the sensor-indicated rate rather than the programmed base LRL.
[0040] 5. Pacing Mode Switching During Atrial Fibrillation
[0041]FIG. 3 is a block diagram illustrating examples of an atrial fibrillation pacing mode that is switched to upon detection of an atrial tachyarrhythmia. An atrial tachyarrhythmia, such as atrial fibrillation, is detected at block 300 while the pacemaker is operating in its normal mode. Atrial triggered ventricular pacing is contraindicated during an atrial tachyarrhythmia because atrial rate tracking would result in ventricular pacing that is too rapid. If the normal mode incorporates atrial tracking and/or atrial pacing, therefore, the atrial fibrillation mode includes a reversion to a non-atrial triggered ventricular pacing mode (i.e., VVx mode) as shown at block 301. The atrial fibrillation mode may also include one or more other pacing modes, each of which will be discussed in turn.
[0042] The atrial fibrillation mode may include initiation of ventricular rate regularization as shown at block 302. If AV conduction is intact in a patient, atrial fibrillation results in a very rapid and intrinsic ventricular rhythm, and regularizing the ventricular rate improves cardiac output directly through its effect on diastolic filling. Ventricular rate regularization may be applied in this instance with parameter settings such that the ventricles are driven at a rate near the intrinsic rate. The intrinsic ventricular rhythm that occurs during an episode of atrial fibrillation is a result of the chaotically occurring depolarizations occurring in the atria being passed through the AV node to the ventricles. The intrinsic ventricular rate is thus governed by the cycle length of the atrial fibrillation and the refractory period of the AV node. If a ventricular pacing pulse is delivered before the next intrinsic beat occurs, the ventricular depolarization is conducted retrogradely to the AV node causing late depolarization of the AV node during the ventricular beat. The refractory period of the AV node is also delayed, which delays the time before an atrial depolarization can be conducted through the node to result in an intrinsic beat. The effect of the pace is thus to lengthen the time until the next intrinsic beat. Ventricular rate regularization at a pacing rate near the intrinsic ventricular rate is thus especially effective at regularizing the ventricular rate during atrial fibrillation.
[0043] Ventricular resynchronization therapy may also be initiated as part of the atrial fibrillation mode. In pacemaker patients having some degree of interventricular or intraventricular conduction delays, a ventricular resynchronization pacing mode can improve cardiac output by improving the coordination of ventricular contractions. Although cardiac output may be adequate in some of these patients during normal circumstances even without ventricular resynchronization pacing, an episode of atrial fibrillation with loss of atrio-ventricular synchrony and irregular diastolic filling may cause the conduction deficits to become clinically evident. Switching the pacemaker to a ventricular resynchronization pacing mode may then be helpful in maintaining cardiac output when atrial fibrillation is detected.
[0044] Resynchronization pacing as incorporated into the atrial fibrillation mode may be delivered in a number of different pacing modes. One such resynchronization pacing mode is biventricular pacing with or without an offset interval. This mode can be combined with the reverted to VVI bradycardia pacing mode to result in biventricular pacing on an inhibited demand basis as depicted at block 304. Other alternatives for the atrial fibrillation mode are biventricular-triggered and LV-only pacing modes as shown by blocks 306 and 303, respectively. Biventricular-triggered resynchronization pacing may be particularly useful when the intrinsic ventricular rate is irregular as it allows reliable delivery of resynchronization pulses based upon the irregular rate. It may also be advantageous to combine resynchronization pacing with ventricular rate regulation as the ventricular rate regulation can be set to increase the amount of pacing and, therefore, the amount of resynchronization. If ventricular resynchronization is part of the normal pacing mode, the atrial fibrillation mode may then include particular modification of resynchronization pacing parameters such as adjustments to the biventricular offset interval designated by block 305, or switching to an alternative resynchronization pacing mode or switching to additional or alternate pacing sites.
[0045] The diminished cardiac output that occurs during atrial fibrillation can also be partially counteracted by making the pacing rate responsive to measured exertion levels. Accordingly, the atrial fibrillation mode may also include switching from nonrate adaptive to rate-adaptive pacing as shown at block 308, and/or modification of rate-adaptive parameters as shown at block 307. In the latter case, for example, the rate-response curve that maps a given exertion level to a particular pacing rate may be adjusted to make the pacemaker more responsive, and/or the base lower rate limit corresponding to a resting exertion level could be increased.
[0046] Although the invention has been described in conjunction with the foregoing specific embodiment, many alternatives, variations, and modifications will be apparent to those of ordinary skill in the art. Such alternatives, variations, and modifications are intended to fall within the scope of the following appended claims.
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|Clasificaci¾n de EE.UU.
|Clasificaci¾n internacional
|Clasificaci¾n cooperativa
|Clasificaci¾n europea
|19 Abr 2004
Owner name: CARDIAC PACEMAKERS, INC., MINNESOTA
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|30 Sep 2010
|Fee payment
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text:
Readers beware. The BDS folks extend the notion of "colonial occupation" to the Negev ("Naqab" to them), advocate the boycotting of all Israeli produce wherever grown, decry Israeli exporting firms that invite Palestinian producers to share their facilities, and preach cultural boycott of Israelis as such. If this won't destroy Israel, it's not for their lack of trying.
Second rocket fired from Gaza explodes inside Strip (Haaretz)


text:
Detroit Lions fans this morning... https://t.co/0mvUTnRjQy
This pilot was caring dad of 8...RIP Michael Johnston https://t.co/EQ6YQyKubw
Teens and well, a whole helluva lot of adults... great read! https://t.co/9KWOCJUhxk
After extensive research and of course my experience as a child / teenager We decided to have the? https://t.co/zxf7eettoX
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text:
Ghost Whisperer
The Collector
- Episode Description
Melinda meets a man who has the same abilities to see and talk to the dead. Melinda later learns that he has a different plan for the dead. A ghost enlists Professor Payne to help Melinda.
- Cast & Crew
Camryn Manheim
David Conrad
Jennifer Love Hewitt
Jay Mohr
Melissa Jo Peltier
- Fan Reviews (8)
WOW another ghost whisperer in Grandview!!
i loved this episode i just make me wanna see the nexts ones soo badly!
Why I watch the show!
She's not alone!!!
I was nevous the whole episode!
- Trivia & Quotes
Quotes (9)
Melinda: I can't believe you followed me, what are you, 12? Payne: It was in the name of Science, plus my lecture let out at 5. Melinda: Do you have any idea what this makes me look like? Payne: Tell me about it, I was running like a girl holding this camera. I fell down, that guy grabbed me and I almost...thank god he did not break this camera because that is not cheap and I am.
Professor Payne: Melinda, listen to yourself, you sound just like all those little frightened people that have doubted you your whole life! Melinda: Uh, you were one of those not too long ago. Payne: I'm a scientist! It's my job to doubt you!
Professor Payne: Are we going to find this ghost guy or are we going to write bumper stickers?
Melinda (about Gabriel): Why is he collecting souls? Why does he want them to stay earthbound? Kate Payne: It's not just him. It's happening all over, they're planning something. Melinda: Who is? Kate Payne: Everyone on this side. Melinda: What do they want? Kate Payne: They want to make the dead stronger than the living. They want to take over.
Melinda (about Gabriel): I have to talk to him because maybe I can help him. Professor Payne: No. No, I forbid it, no you cannot. This is not a stray dog Melinda; this guy is trouble, okay?
Notes (2)
International Air Dates:
Denmark: May 17, 2007 on Kanal 4
Australia: Thursday, Nov 29, 2007 on Network 7
Belgium: December 2, 2008 on 2BE
Finland: January 3, 2009 on Nelonen
Turkey: January 28, 2008 on CNBC-e
Featured music:
Barenaked by Jennifer Love Hewitt (played when Delia asks Melinda about ghosts at funerals)
All Good Things (Come to an End) by Nelly Furtado (played when Gabriel is over at Melinda and Jim's house for dinner)
The High Low - by Penfifteen Club
Trivia (2)
When Melinda walks into "Same As It Never Was" and is talking to Delia, the song "Barenaked" by Jennifer Love Hewitt is playing in the background. Jennifer recorded this Top 40 hit in 2002.
Reggie ("Demon Child" and "The Vanishing"), Amy Fields aka the Flight Attendant (Season 1 Finale), Bleeding Man ("Love Still Won't Die"), Jared ("The Curse of the Ninth"), Randy Cooper ("The Cradle Will Rock") and Kelly Payne ("Speed Demon") all make a reappearance after joining the dark side as part of Gabriel's collection of earthbound spirits.
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