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Spread a Little Joy with these FREE Printables. Perfect for anyday and beyond. A great way to make someone know they are special.
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lemon squeezy: Free Download: Thank You Cards
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Design cards too!!
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DIY - Thank You Card in 2 Colorways via lemon squeezy - Free PDF Printable Visit our website at www.firethorne.org! #paper #stationary #notes #design
lemon squeezy: free thank you cards
Chevron Customized Printable Monogram
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such a easy free custom printable chevron monogram
Customized Chevron Monogram (Free Printable) from For Chic Sake {SC}
Free customized chevron printable. Just type in your initials and print off this fabulous print! Chevron Customized Printable Monogram
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Vintage-style alphabet #printable.
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Vintage ABC cards - free printable
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Vintage ABC printables. Super cute for the kid's room.
Paul Thurlby: Printable Vintage ABC cards
Alphabet book by Paul Thurlby
Oooh. Vintage-y ABC cards. PRINTABLE! i have a slight obsession with alphabet cards...
vintage label freebies DIY
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vintage tin can label freebies DIY
Vintage printable for covering tin cans -- good idea
vintage freebies DIY Labels for tin cans
Free printables: Vintage labels for covering tin cans.
Here's a page with a variety of printable rulers.
Student, Case
Printable paper rulers. Students often tell me that they don't have a ruler at home.
Cutest FREE Printable Lunch bag tags!
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Great for sack lunches and party favors!
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To-do list
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Printable To Do list courtesy of @JennyBHarris @Allsorts
Sweet Susan Branch printable.
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FREE PRINTABLE Easter tag 2014 :: Shabby Art Boutique
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The Cottage Market: A Year of FREE Digital Download Collages with New Ones in todays post! 50 of them!
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This website offers 830 paper templates for download. It has anything from regular lined paper to Yahtzee score sheet to music paper.
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Free printable paper templates. This website offers 830 paper templates for download. It has anything from regular lined paper to yahtzee score sheet to music paper.
Line paper template for book swap. It has anything from regular lined paper to yahtzee score sheet to music paper.
Printables: music sheets, lined paper
Lined paper printables. This website offers 830 paper templates for download. It has anything from regular lined paper to yahtzee score sheet to music paper.
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Handmade crafters label branding kit by Cathe Holden | Worldlabel Blog
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label templates
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Free Printable - Thanksgiving Guessing Game
Cute Thanksgiving dinner idea
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'thankful' printable, and tons of other holiday ideas
fill out 25 of these as a family and use them to make our '25 days till christmas' paper countdown chain
Thanksgiving dinner table guessing game
Thanksgiving game!
Sentiment Stamps ~ for use with circle punches
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Ideas for card sentiments
Stampin' Up! Card by Anglea M at North Shore Stamper: Stampin' Royalty Challenge
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Birthday Sentiments ~ with circle punches
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free prints!
Freebie of the month club: Dresses Printables
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happy cards + envelopes {free printable}
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That's Happy: mother's day cards + envelopes ~ Printable Stationary
That's Happy: mother's day cards + envelopes - free printable stationery set, too cute !
Free Cards + Envelopes.
My Cup of Tea
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"My Cup of Tea" gift tags ~ combination of French sheet music & a pretty teacup overflowing with purple pansies :) free printable
tea cup tags
Queen of Blossoms | Lovely tags and stationary
Yellow Rose, Hanging Tags, Free Graphics, Vintage Music, Sheet Music, Vintage Rose, Gifts Tags, Free Printable, Paper Crafts
Vintage-themed collage tag set, with pink and yellow roses, French ephemera and sheet music, free printable
free graphics source list and some pretty tags
Queen of Blossoms ~ free printable gift tags with roses combined with French music and vintage style ephemera DIY paper crafts
Queen of Blossoms Vintage Music Tags
Queen of Blossoms ~ free printable gift tags with roses combined with French music and ephemera. These would make beautiful hang tags for my handmade earrings.
Printable "garden' tags.
Cottages Gardens, Free Printable Tags, Gardens Tags, Gift Tags, Gardens Labels, Vintage Printable, Garden Gifts, Gifts Tags, Gardens Gifts
Free printable Tag
In the Garden Label
"In the Garden" gift tag ~ free printable
Cottage garden
Sweet Violets Stationery "I smelt the violets in her hand and asked, half in words, half in signs, a question which meant Is love the sweetness of flowers?" ~ Helen Keller ~
Lavender Frames, Lavender Flowers, Lavender Lilacs, Lilacs N Lavender, Free Printable, Lavender Printable, Ephemera Violets, Sweet Violets, Violets Stationery
violet stationary <3 Free Printable Stationary
Sweet Violets Stationery | Lilac Lavender- Printable
pretty lavender flowers with music
Vintage Easter Bunny & Chicks "I think of the garden after the rain; And hope to my heart comes singing, At morn the cherry-blooms will be white, And the Easter bells be ringing!" ~ Edna Dean Proctor ~


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In today's changing healthcare landscape, meeting "triple aim" goals requires a focus on new business models, new technologies, and embracing change.
The ManaCloud™ Platform is our App Platform for Healthcare, offering a secure, HIPAA-compliant solution that supports the new needs of innovative healthcare applications.
Request Sandbox and API Access Now:
Mana Health Sponsors Johns Hopkins University's First-Ever Medical Hackathon, MedHacks, Oct. 2-4.
"We are excited to work with the students of Johns Hopkins University as they seek to innovate and address some of healthcare's major challenges", said Chris Bradley, co-founder and CEO of Mana Health.
ManaPortal - MU-2 Certified Patient Portal
Our award-winning patient portal was designed to inspire patients to get to know their data. Powered by our ManaCloud Platform, it integrates clinical data from EMRs while making it easy for patients to add their own data from apps and devices. Plus, we're MU-2 Certified and mobile ready. Yes, you really can have a product that you are excited to promote to your patients, while meeting your needs for a secure and certified technology solution.

subset: commoncrawl


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While posters of the Lamborghini Countach decorated the walls of many boys' walls in the 1980s, the Diablo filled that spot for young men in the early 1990s thanks to its extreme styling. In its latest video, Jay Leno's Garage welcomes a beautiful, white 1991 Diablo into his garage for a look back on what is now a classic supercar.
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7Leno stretches Lamborghini Diablo's legs for latest Garage installment
- Chris Bruce
- May 6, 2014
- 7
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Tech News & Commentary
Someone should call PETA to complain about the bloody fight between bulls and bears in Netflix (NFLX) stock.
Investors are wagering billions betting on the success or demise of the streaming video company. Bulls say Netflix is leading a revolution in over-the-top television and has momentum on its side. Bears say the company is wildly overvalued and is due for a fall. Lately, the bulls have been goring the bears.
On Monday, Netflix shares rose on positive comments by noted value investor Whitney Tilson. Tilson told Yahoo Finance that Netflix is still relatively cheap.
View Enlarged Image
He bought the stock in the fall when it bottomed out and has seen shares quadruple in value.
"I've been trimming it all the way up for sure," he told Yahoo Finance. "It's definitely a volatile stock. It's hard to value. But when I pitched it seven months ago, I said it's trading at 100 bucks a sub in a world of thousand-dollar subs, if you look at cellphone companies and cable companies on a per-subscriber basis. Now it's quadrupled and it's trading at 400 bucks a sub in a world of thousand-dollar subs."
Tilson said Netflix has great opportunities for international expansion and has created barriers to entry with its content portfolio.
"It's growing like gangbusters," he said. "But I think Netflix could be this decade's Amazon." Like Amazon.com (AMZN), Netflix is plowing profits into growing its business.
Netflix shares were up more than 4%, near 227, in the stock market today. The stock is at its highest level since September 2011. The stock bottomed at 52.81 in August. This year, Netflix is up 145%.
Meanwhile, some bears at the Seeking Alpha site continue to scream that Netflix is a bubble waiting to pop. One writer on the site Monday posted an article called "This Is Why Netflix Will Go Bankrupt." The anonymous author, going by the handle Buffett Junior, pointed to Netflix's "absurd valuation," negative free cash flow, its rising content costs and off-balance-sheet obligations as red flags.
Related links to this week's market segment: Inside the 50: Edwards Lifesciences Leads, AMN Healthcare Lags IBD 50 IBD Stock Analysis: Watch List: Chipotle Tests Resistance In Base IBD Stock Analysis: Storage Wars: Can Extra Space Storage Buck Downturn? Stock ...
Defensive industry groups have clustered near the top of IBD's industry group table, which is based on six-month price performance. Among the top dozen groups in Friday's paper, one-third were defensive in nature. Nonalcoholic-beverages, meat-products, auto-parts and tobacco groups are all highly ...
Facebook's (NASDAQ:FB) revenue growth in 2016 is seen decelerating compared to 2015 estimates, but it is No. 1 on Goldman Sachs' list of the 100 largest S&P 500 stocks ranked by growth, excluding financials and utilities. The social networking leader is expected to see 35% sales growth next ...
At the Luxury Technology Show in Hollywood this week, companies showed off gadgets and gear to make living the sweet life even sweeter. For Your Phone Those phone-charger cords are such a hassle. Pond offers wireless charging pods ($49-$179) for the high-end market that come in U.S.-sourced maple ...
Beyond Bar-B-Que and blues, Austin, Texas, has evolved into a distinctive tech center whose persona manifests as an idiosyncratic cousin to its counterparts in Silicon Valley, New York and Boston. "I think the way Austin is set up is just unique," said the aptly named Gene Austin, CEO of social ...
Investor's Business Daily provides exclusive stock lists, investing data, stock market research, education and the latest financial and business news to help investors make more money in the stock market. All of IBD's products and features are based on the CAN SLIM® Investing System developed by IBD's Founder William J. O'Neil, who identified the seven common characteristics that winning stocks display before making huge price gains. Each letter of CAN SLIM represents one of those traits.


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This item is currently
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HN-KAEP008 Kaepa
Kaepa Womens Ace Volleyball Shoe - Blue/SilverItem # HN-KAEP008
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- Lightweight shoe with flexible upper and microfiber backing
- Gum rubber and traction tread designed sole for better grip
- Duratoe, high-abrasion toecap resists toe abrasion
- Low-cut ankle and anti-microbial Agion lining
- Attractive blue and silver shoe in a variety of women's sizes
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Kaepa Womens Ace Volleyball Shoe - Blue/Silver
Play like a pro with the high-performance Kaepa Womens Ace Volleyball Shoe - Blue/Silver. This shoe utilizes a Dynamic Stability Control System that centers the heel for enhanced game play and superior cushioning. The midfoot support alone provides the torsional rigidity you need to keep your ankles perfectly stable, which greatly reduces your chance of injury. Add all of those features with the Secure Fit System and Dura-to technology and you have professional quality volleyball shoe! The Kaepa Womens


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"I dare say Mrs D. will be in Yellow": Reconstructing an Art Exhibit Attended by Novelist Jane Austen
"Even if Jane Austen had not attended this public exhibit, it would still be well worth reconstructing. ...The British Institution's show was a star-studded 'first' of great magnitude for the art community and a turning point in the history of modern exhibit practices." Among the canvases in the retrospective gallery, portraits of 18th-century politicians, actors, authors and aristocrats offer examples of just how someone such as Jane Austen, who did not personally circulate among the social elite, was nonetheless immersed in Georgian England's vibrant culture. more »
Culture Watch Book Reviews: The Bookman's Tale and Rebels at the Bar; The Fascinating, Forgotten Stories of America's First Women Lawyers
Reviewer Julia Sneden writes: The Bookman's Tale involves a blazing romance, a marriage followed by tragedy, a rare book mystery, and even a murder. If you like books, history, and mysteries involving old books, this is the story for you. Being reminded of the brave, intelligent, controversial women who broke through many barriers a good hundred years before the 1950's has been a fascinating experience and I have read Rebels at the Bar with profound gratitude. more »
Review: Kristin Nord Takes a Walkabout at Yale's Edwardian Opulence Exhibit
Ah, the Edwardians – with their sumptuous clothes and candelight dinners, their bone china, their silks, their gleaming silver. Merchant and Ivory and the BBC have made fortunes selling fanciful pastiches of this era to the viewing pubic, all the while touching lightly on a less seemly back story. more »
Edwardian Opulence at Yale: 'As If a Viennese Hussar Had Suddenly Burst Into an English Vicarage'
This is the first major international exhibition in more than a generation to survey visual and decorative arts in Britain during the reign of King Edward VII (1901–1910). The exhibition immerses visitors in the sumptuousness of British art and society immediately before World War I, while encouraging them to consider the multifaceted character of the era that fostered such material lavishness. more »


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Deluxe solid hardwood table, featuring a 0.75" bull-nose edge, easy to clean with a natural finish. Sturdy 1.75" square legs. Three rung Ladderback chairs are made of solid hardwood construction for durability and curved back legs to help reduce tipping. Easy to assemble.
Additional Documents
Weights & Dimensions
|Shape: Circle
|Top Surface: Solid Wood
|Color: Natural Wood
|Country of Manufacture: Viet Nam
About the ManufacturerECR4Kids is a company committed to developing and distributing only the highest quality products, all the while, ensuring that these products represent the maximum value in the marketplace. With so many "me-too" products in the market, the company's focus and commitment is to bring you added value in features, functionality, performance and service.
Combining their responsibility to the community and their desire to be environmentally conscious, they have a program to reduce (or better yet, re-use) what they would normally dispose of... Early Childhood Resources has eliminated almost all of their cardboard waste by implementing commercial cardboard shredding equipment in its facilities to convert cardboard destined for the landfill into some of the best packing material available.
Competition typically demands lower costs and with it, labor intense jobs are being exported faster and faster every year. Early Childhood Resources, being committed to "Maximum Value," balances the demands from the marketplace with the practicality and social values of finding ways to maximize the capabilities of those in our community with developmental disabilities, and want to work! The program provides a stimulating and developmentally enriching environment. These individuals gain valuable social and work skills while earning competitive wages, and creating "Maximum Value" in their products.
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We want you to love it. If you don't, you may return your purchase within 30 days of delivery. All you need to do is visit our Self-Service Return Center for instructions. Return credits are issued within 24 hours once the item is received and inspected. Please note that shipping charges are non-refundable. The cost of return shipping will be deducted from your refund. 30-Day Return Policy
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so cute!! Deirdre from West Simsbury, CT on 12/02/2014 – Verified Buyer– Top 1000 Reviewer
perfect furniture for a dramatic play area. Fits two nicely but four can be accommodated with out it being too crowded
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A dual subspecialty certification by the Board of Internal Medicine. Practitioners have expertise in blood diseases and cancer. The Hematologist/Oncologist treats diseases of the blood and blood-forming organs (spleen, lymph nodes, bone marrow, and thymus) as well as neoplastic diseases arising in any organ system.View More
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4461 Coit Rd Ste 100
Frisco, TX 75035
7777 Forest Ln Ste C850
Dallas, TX 75230
3410 Worth St Ste 300
Dallas, TX 75246


text: http://www.ubuntugeek.com – {lang: 'en-GB'} DayFolder for Ubuntu. Here's what it does: Takes the files from your desktop and moves them to a directory named with the day's date in your specified "DayFolder" directory. Do this from the application indicator in the panel of the desktop. Change the directory your daily DayFolder is created. Choose between a daily, weekly, or monthly folder to help organize the way you want. Set specific destinations for single file types (for example, you can have all your .png files be moved to your Pictures folder). (...)Read the rest of Da (HowTos)


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Commentary: If super high-resolution screens are arguably unnecessary for your 65-inch TV, they're just about useless for your 5.5-inch phone.
Startup Nextbit launches its first smartphone as a Kickstarter project. Early commitments will nab the device, named "Robin," for $299.
Nextbit makes the bold claim that its smartphone will actually get better over time thanks to software tweaks. It plans to sell it for $300 to $400.
The Magnepan MMG and Pioneer Elite SP-EBS73-LR are two very different sounding speakers, so which one is best for you?
Beginning Friday, crowdfunding sites like Kickstarter and Indiegogo can give the public the chance to be startup owners, not just donors.
The island of Myst may soon come to life as a streaming series, hopefully with all of the original game's intrigue and beauty intact.
Dolby has brought its multichannel movie technology to Lenovo mobile devices. But how do you go from 51 theatre-shaking speakers to two earbuds? We tried it out.
A screen-used prop phaser from the original "Star Trek" series is up for sale and it's expected to fetch a price that is out of this world.
This magnetic speakerphone for your fridge includes an e-ink messaging display, radio, and a hefty one month battery life.
The 2014 Land Rover LR4 is the last of the chunky, square Land Rover left in North America. Let's see if it can still mix stylish elegance with off-road pedigree.


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HP Pavillion dv9398ea laptop
3.5 stars
Powerful, great screen, comfortable to use
Not the most powerful machine for the price
HP is currently the world's favourite notebook manufacturer, overtaking Dell and everyone else in sales.
It's business notebooks make up the majority of such sales but the Pavilion line, which is aimed at home buyers, has now been overhauled.
The HP Pavillion dv9398ea is billed as a media centre, so it ideal for use as a family machine for those looking to best the most from their PC.
This is an impressive looking machine built around a 17-inch Super-TFT display that sadly lacks punch, as the native resolution is 1440 x 900 pixel (WXGA+), which is fine for daily tasks but not so good for high-detailed image editing or gaming. More importantly, it means you won't be able to take full advantage of the integrated HD-DVD drive, which needs a resolution of 1920 x 1200 pixels (WUXGA) to play movies in true high-definition. There is a HDMI port for sending High-Def content to an external monitor, so this may not be too limiting.
Graphics use NVIDIA's GeForce Go 7600, which is coming to the end of its shelf-life but is still a great mid-level GPU for most mainstream games and we got above average frame rates when running S.T.A.L.K.E.R. Sound is also fairly impressive, due to the inclusion of Altec Lansing speakers. There are a range of touch-sensitive buttons to make it easy to control your movies and music.
Weighing in at 3.7kg, this is a heavy notebook but it isn't as heavy as we were expecting. We managed to get a couple of hours of battery life from the large battery pack but this machine isn't really intended for mobile use – that is unless you class moving it about the house as mobile.
The large screen means there is room for a decent keyboard as well as a numeric number pad. The build quality of the keys, like the laptop itself, is high and we found it had a comfortable typing action.
When it comes to power, this laptop isn't exactly lacking. It comes with an Intel 1.83GHz Core 2 Duo T5600 and 2GB of memory, which helps programs really fly. The 240GB of storage is made up of two 120GB drives and we've been informed this will soon be upgraded to 320GB at the same price, so it's worth checking before you buy. It has full connectivity, as you'd expect, including 802.11g Wi-Fi and Gigabit Ethernet, so if you network this machine up you'll find it can connect at the best possible speeds. Overall, we were impressed with the day-to-day handling of this machine.
In this age when where it's possible to get three HP laptops for the price of the dv9398ea, the question has to be "is it worth the asking price?"
It's a great notebook but ultimately, we feel that it falls short and there are any number of media machines that cost less and offer a little more cutting-edge technology, which is a shame, as we enjoyed using the Pavilion dv9398ea.
Apple's 21.5-inch iMac with a 4K display might finally launch next week
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- Apple OS X El Capitan now out: Here's how to get the free update and more
- Apple OS X El Capitan almost ready for download: 10 new features to try
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- Microsoft Lumia 950 and Lumia 950 XL confirmed: What's the story?
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-Find top-rated Service Providers
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Baby Equipment Rental Services in Renton, WA
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$400 for a Moving Truck and a Two-Person...All American Spirit MovingMember Price$400 $400VIEW
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4. Angie's List is there to resolve any issues.


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Diego Alberto Milito (born 12 June 1979) is an Argentine footballer who plays as a striker for Argentine side Racing Club and also formerly played for the Argentine national team. A prolific and consistent centre-forward, Milito has averaged just over a goal every two appearances over the course of his 10-year professional career. He was pivotal in Inter's 2009–10 treble-winning season, contributing two goals in the 2010 UEFA Champions League Final.Wikipedia
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For the latest edition of Lil Wayne's weekly #WeezyWednesday series he delivers the 2nd official trailer for his upcoming tour with Drake entitled Drake Vs. Lil Wayne. The tour kicks off August 8th in New York and hits Pittsburgh August 17th.
More in Trailers
Rihanna Releases Extended Version "Trailer For "Bitch Better Have My Money" Music Video
Rihanna will be premiering the video for her smash single "Bitch Better Have My Money" this coming Thursday on Vevo, today...June 29, 2015
Azealia Banks "Wallace" [VIDEO]
Today Harlem sexiness Azealia Banks released a dope interactive visual for "Wallace", off her current album Broke With Expensive Taste, out...March 11, 2015
Straight Outta Compton [Trailer]
Watch the official red band trailer.February 9, 2015
Kathleen Hanna Stars In Short Film 'Myrna The Monster'
A short film by director and screenwriter Ian Samuels with loving production by MTV Other, Myrna The Monster has been accepted...January 26, 2015
Watch the Official Movie Trailer For "Entourage" In Theaters Summer 2015
Finally we get a trailer!December 23, 2014
Nicki Minaj & James Franco 'SNL' Promo
Sagittarian beauty Nicki Minaj is set return to Saturday Night Live this weekend as the musical guest along-side Comedian James Franco....December 5, 2014
French Montana & Jeremih "Set It Off" Tour + Trailer: Jeremih "Don't Tell 'Em" (Remix) f. French Montana & Ty Dolla $ign
French Montana & Jeremih are currently on the road for their "Set It Off" tour, which hits New Orleans tonight. Pushing...November 28, 2014
J. Cole Releases Trailer For His Upcoming 3rd Album '2014 Forest Hills Drive' Out 12|9|14
Last night Roc Nation emcee J. Cole took to YouTube to deliver a trailer for his 3rd album 2014 Forest Hills...November 17, 2014
Azealia Banks "Chasing Time" [Trailer]
Azealia Banks surprises everyone once again with the official trailer for her new single "Chasing Time." Cop Azealia Banks debut album...November 8, 2014


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Bench coach Mark Parent has been fired by the White Sox.
Rarely will the Bears need more impact from their tight ends than Sunday against the Seattle Seahawks.
PHILADELPHIA – Joe Maddon remembered exactly where he was when he first heard about the 9/11 attacks, almost 3,000 miles away from the Twin Towers at his house in Long Beach, California.
INDIANAPOLIS – Given the current state of affairs in multiple corners of the NFL, what didn't happen on Wednesday may be on par news-wise with what did happen between the Bears and Indianapolis Co
SOUTH BEND, Ind. — On a crowded wide receiver depth chart, Notre Dame redshirt sophomore Torii Hunter Jr. appears to have carved out an important niche during his first healthy preseason camp.


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Son Of Argyle Family Reeling After Crash
ARGYLE (CBSDFW.COM/AP) – The son of a North Texas woman is grappling with the deaths of his mother, stepfather and two half-siblings when a pickup truck slammed head-on into their vacation van in New Mexico.
The Friday night crash in northwestern New Mexico killed 48-year-old LeAnn Miller, 47-year-old Michael Miller and their children, 12-year-old Zoey and 7-year-old Miles. The pickup truck driver suffered non-life-threatening injuries.
Cory Dixon says he was at the family's Argyle home when he talked with his mother by phone for about 10 minutes shortly after 8 p.m. Friday. Eight minutes later, the rest of the family was dead. Dixon, who's 24, told the Denton Record-Chronicle that he was thankful that he talked with his mother one last time before she died.
A prayer vigil will be held for the family at the Argyle United Methodist Church Sunday evening from 5 p.m. to 6 p.m.
(© Copyright 2014 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten or redistributed.)
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Wanting to the biggest Virtual Pet forum on then net? Feel free to sign up today.Sign Up to VPL
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Quality Inn
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- Continental Breakfast
- Swimming pool
- Free High-Speed Internet
- Fitness/Health center
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Visa update
... proof of ID, insurance for truck and then we should be able to order plates and get it all sorted....however as Darren doesn't have his green card yet or any official documents to show he is a permanent resident they told us we could not do this (we had both our names put on the title at the dealer as it made more sense for other reasons....not knowing it would cause us trouble now!!) She said to go back to dealer and ask him to take Darrens name off title and then do it all ...
Almost ready!!
... pool and seeing Grandma.
Today we started to get packages delivered so it's like Christmas here! We also received our National Parks annual pass too so we can now get into any National Park for free for a year....very excited! This also means that if anyone comes to visit we can take you to any of them free too so you better start booking flights!!
That's about it for now.....oh one more ...
I'll keep it pretty short this time...the last few days have been spent playing tennis, running, swimming, visiting grandma and slowly gathering camping/outdoors items.
Biggest news is that today we bought a.....HAMMOCK!!! Is it sad how excited we were about this?? We decided that instead of buying a tent, if we are able to sleep outside at any of the national ...
Walks and Driving Tests
... off multiple walls before sinking it. We didn't have much luck until Darren did it!!! He bounced it off a wall high up and it went in!! He went CRAZY!!!! Obviously I said it was an OK shot but I bet he couldn't do it again....this time I videoed it and you can see the result! Crazy Darren cracks me up!!
Ok so back to these last few days...Sunday:
We started to properly look around at camping bits and comparing prices etc...It was a big day ...
Say howdy to BIG RED!!!
... social security number and some proof of address. Then I could do the theory and then book my practical....we are undecided if its a real benefit getting it now or if we will both wait until we know which state we will be long term and then doing it there.
Ok I think I've gone on enough and I know some is boring but I figure some of you might be interested in the differences...if not....SORRY!!!


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Proficiency Grading Information
Please click here for more information related to Proficiency Grading as related to report cards. Thank you!
8th Grade Parents -- Connect With CHS
Smarter Balanced Test Results
6th Grade Outdoor School
Outdoor School is an opportunity for 6th grade students to gain valuable real life/hands-on lessons about science, soil, water, ecosystems and much more. They also get the chance to interact with students throughout the metropolitan area.
Welcome 2015-16 from Principal Westphal
Dear Hosford Students & Families:
Hope you are having a restful and exciting summer. Hard to believe that the new school year is just around the corner! I am humbled and excited to join the Hosford community as principal this year, and can't wait to get to know you all in the year to come.
I started my career in education in New York City, where I taught Language Arts to middle school students in 7th and 8th grades. One of my classes was a special education inclusion class where I worked with a case manager to support students with special education needs, as well as other students who were currently working below grade level.
When I moved to Oregon, I taught Language Arts at all high school grades, including dual credit college classes to seniors, and freshman seminars for incoming 9th grade students. As an administrator, I've worked at Portland Evening Scholars (PPS' credit recovery program) and at Grant High School in NE Portland. Because I'm deeply familiar with the demands and opportunities of high school, but also come from a middle school background, I'm especially excited to have the chance to return to middle school to help our Hosford students be well-equipped to succeed in high school and beyond.
This year, we're focusing on a new motto derived from our school mission statement: "Courage * College * Community".
Hosford students are at an important juncture in their lives: they've graduated from elementary school, and are learning to be young adults of character who live the values of their families and community under their own power. It's our job both to help them continue this character journey, and to be ready to enter high school with the academic skills and motivation to thrive.
Courage = the inner strength required to stand up for what's right, to set goals and stick with them, and to develop your own sense of self in spite of outside pressure. In the context of Hosford, this relates to all areas of our school. Courage means speaking up for a classmate when you hear someone say something mean, instead of being a bystander. It means living your family's values consistently. It means taking academic risks, knowing that practice makes you smarter. It means developing the personal grit to persevere, even when it's hard. "Courage" can be summarized in these phrases:
Be yourself. Stand up for each other. Live your values. Stick with it.
College = working to be ready for academic and career success after high school. This year, Hosford is pioneering the AVID (Advancement Via Individual Determination) program, which is designed to help all students develop the academic skills and habits they will need to be successful in high school and higher education. We know that there are many different paths our students may take after high school; what's important is that every student enters high school equipped to be successful in a college-level track, so that they have the full array of options available to them upon graduation. Our "College" focus can be summarized like this:
Work hard. Get smarter through practice. Try new things.
Make each step build toward tomorrow.
Community = making each other central to our thinking. Hosford has the benefit of being a richly diverse community, with many racial, cultural, and linguistic backgrounds represented in our school. Community means that we make decisions based on the good of all, work to help each other succeed, consistently act in a way that honors our family and community values, and recognize that our own personal growth is a path toward giving back to the community that made us. This piece of our motto can be summarized like this:
Is it kind, is it right? Do your family proud. Rise up together. Give back.
Our "Courage * College * Community" motto will be focusing our work together this year, as we support each of our students to develop holistically into young people of purpose.
I can't wait to meet you in late August. On a personal note, my husband Elvyss and I welcomed a new addition into our family July 16, our first child, Diego. I am taking some time away this summer to get to know him, but will be back with you for the start of school. Enjoy the rest of your summer, stay cool, and see you then!
Kristyn Westphal, Principal -- firstname.lastname@example.com
Welcome Assistant Principal Rui Neves!
Dear Hosford Family:
As you know from recent communication, Hosford's Assistant Principal for the last two years, Vanessa Martinez, recently accepted the principalship of Beach K-8. Congratulations to Vanessa, and many thanks for her service to Hosford. We're excited for her, and wish her all the best in her new role.
This note is to follow up with you on our next steps for the admin team, and to let you know that I am very pleased to be able to welcome Rui Neves as Hosford's new Assistant Principal. Rui has been an educator for over twenty years, including roles spanning kindergarten through graduate school.
Rui was born in Pico, Azores, Portugal, and immigrated to the U.S. as a pre-teen. After earning his B.A. from U.C. Berkeley, his teaching credential at St. Mary's College, and a masters in Education Leadership from Cal State Sacramento, he began teaching in Richmond Unified School District. He has taught kindergarten, second, fifth, and sixth grades, as well as high school Language Arts and Social Studies. As a native Portuguese speaker, as well as a speaker of Spanish, he values multilingualism, and has experience teaching students who are learning English.
Rui values relationships with students and families, and believes in fostering academic success for all students through data and a continuous focus on developing strong shared instructional practices. During his time in Oregon, he has served as an ESL and Social Studies teacher at Aloha High School, as a Teacher on Special Assignment for Beaverton School District, and as the Assistant Principal at Woodlawn School in PPS. He and his wife, Annie, and two daughters, Sofia, and Julia, enjoy travel, cooking, kayaking, reading, and soccer.
We're very pleased to welcome him to Hosford, and he is looking forward to meeting you in the month to come.
Kristyn Westphal
Upcoming Events On The Hosford Calendar
1 Extended advisory schedule- Mind Up
1 Monthly Burgerville fundraiser 5-8pm
3-9 Muli school visit
9 State In-service for Teachers- No school for students
13 Pizzacato Dough for Dollars- 60th & Division st.
14 Late Opening - First Bell 11:10 No breakfast served
14 Student Council election
14 Site Council mtg 4pm
21 Student/Teacher/Parent Conferences- no school
9-12pm, 1-4pm, 5-8pm
22 Student/Teacher/Parent Conferences- no school
9-12pm, 1-4pm, 5-8pm
22 AVID Family Night 6-7pm
23 No school
25-30 Outdoor School (1st group)
28 PTSA General Mtg
29 End of 1st quarter
29 School dance- CRR fundraiser
30 Teacher Grading/Planning Day- No school for students
2-6 Outdoor school (2nd group)
1 School picture deliver/pick up
2 CHS Foundation Welcome to 8th grade Parents
5 Monthly Burgerville fundraiser 5-8pm
6 1st qtr. PBIS reward- no referral
6 1st qtr. Perfect attendance reward
11 Veteran's Day Holiday- No school
12 Picture re-takes
13 TAG field trip- OMSI
18 Site Council mtg 4pm
16 Spirit Week Assembly- PM
16-20 Spirit Week
19 Extended advisory schedule- Spirit Week
25 Student Recognition Assembly*
26-27 Thanksgiving Holiday
30 School Re-opens
HMS State Report Card 2013-14
Please click on the following link to review Hosford's 2013-14 state report card:


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Potomac Suites Rosslyn
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July Monthly Thoughts and Final Trip Thoughts
... way better than I thought. Lauca National Park in Chile was amazing, definitely worth the effort to get there off the normal Andean track for backpackers.
Places that didn't live up to expectations: Brazil wasn't our favorite place. The World Cup was amazing, obviously, but the country didn't grab us. Mediocre food and bad weather didn't help. Bali, too, seems a bit overrated, the beaches weren't astounding or anything. As ...
Absolutely Expected! Completely Unexpected!
... br>
Leslie, Joe's very sharp and smart wife came in shortly and
was the best person evvvver to ask what I could do for the evening? She had an
air of confidence and sophistication that just could not be ignored. The pair
had diligently laid out brochures of all kinds for their guests to be able to
plan exactly what they wanted. I figured where to go and how to get there
easily for the next day and then asked her what could I do on my first night ...
Colonial Williamsburg
After leaving Washington very hungover and very early we had a long journey to Williamsburg to which Josh luckily woke up for. We then got a cab straight to our motel which was stupidly close and recuperated in there for a while escaping the mid day heat and enjoying Mark Walburg films, pizza and American adverts. After mustering the energy to get up Alex and I went to explore (josh was still feeling to weak). As we were walking to the center ...
"Miss! We found where Washington peed!!"
... than Ms. Allen. I was simply giddy... Someone said "Miss! You are like a kid in a candy store!" ummmm... I am a kid in a candy store... Some of the highlights were bacon taffy, toilet bowl sour stuff, and ten pound gummy bears. We ate at a restaurant called King Street Blues. It was lush. 80%25 of our kids had chicken tenders. Mia, Fergus, Sarah and Melina had a veggie pasta, and some others branched out and had grilled chicken. I had red beans and rice. ...
3 Americanos & a Chicken Meal
... our train so of course, we found a caffe and Blaine was happy with his 3rd Americano. :-) The first train we popped on had no more seats so we were dragging our bags through it for awhile bumping into everyone :-) jumped off at the Zurich intercity station and went to find the #9 platform to Chur... Whew! Up and down stairs with these bags has been hard! Stay tuned for St Moritz!
Other places to stay in Arlington
Sheraton Pentagon City Hotel900 S Orme St, Arlington | 3 star hotelfrom $98
- Great, just don't count on the shuttle
- Great Hotel, Great Location
- Good deal, great service, nice views
The Westin Arlington Gateway801 North Glebe Road, Arlington | 4 star hotelfrom $117
- Best hotel ever!!
- Good but not great
- Decent!
Holiday Inn Rosslyn @ Key Bridge1900 North Fort Myer Drive, Arlington | 3 star hotelfrom $108
- Great Hotel-Great Service!
- Good Value, Great Location
- Washington DC with indoor pool for $135
Crowne Plaza Washington National Airport1480 Crystal Drive, Arlington | 3 star hotelfrom $104
The Ritz-Carlton Pentagon City1250 South Hayes Street, Arlington | 5 star hotelfrom $174
- A big, confused, mobbed, surely this is not a Ritz, Ritz
- A BIG rip-off!!!
- Wonderful
Hyatt Regency Crystal City2799 Jefferson Davis Highway, Arlington | 4 star hotelfrom $91
- Hyatt is rude
- This Hyatt was great
- Not That Bad.... Good Stay
Holiday Inn National Airport / Crystal City2650 Jefferson Davis Highway, Arlington | 3 star hotelfrom $99
Hyatt Arlington1325 Wilson Boulevard, Arlington | 4 star hotelfrom $113
- Nice hotel and good price
- Worked well for our family vacation
- Probably not again
DoubleTree by Hilton - Washington DC - Crystal City300 Army Navy Drive, Arlington | 3 star hotelfrom $110
- Super service at the Doubletree
- Terrific hotel for sightseeing with kids!!!
- It was Okay
Marriott Crystal Gateway1700 Jefferson Davis Highway, Arlington | 4 star hotelfrom $121
- Beautiful and Comfortable
- A pleasant stay.
- Very good service
Hilton Crystal City at Washington Reagan National Airport2399 Jefferson Davis Highway, Arlington | 3 star hotelfrom $98
- 1st Hilton stay & not impressed (2nd floor)
- Great Hilton Property!
- Why bad reviews?!.....
Virginian Suites Arlington1500 Arlington Blvd, Arlington | 3 star hotelfrom $110
- Those little things can ruin your stay
- Pleasant Stay
- Great Stay - Wonderful Value
Key Bridge Marriott1401 Lee Hwy., Arlington | 4 star hotelfrom $122
- Solid/Comfortable Hotel
- Home away from home....
- Exactly what you expect at a Marriott
Radisson Hotel Reagan National Airport2020 Jefferson Davis Highway, Arlington | 3 star hotelfrom $84
- Quelle surprise!
- Great hotel, but bring your own food!
- Never a radisson again
Crystal City Marriott at Reagan National Airport1999 Jefferson Davis Hwy, Arlington | 4 star hotelfrom $123
- Nice Hotel, Great location
- Monuments
- Surprisingly very comfortable
Embassy Suites Hotel Crystal City-National Airport1300 Jefferson Davis Hwy, Arlington | 3 star hotelfrom $155
- Embassy ...everything you need
- Nice!
- We were impressed with the Embassy Suites
Residence Inn Arlington Pentagon City550 Army Navy Drive, Arlington | 3 star hotelfrom $122
- Exellent all-round Hotel
- Great location to see DC
- Very pleasant stay
Holiday Inn Arlington At Ballston4610 N. Fairfax Dr., Arlington | 3 star hotelfrom $96
The Westin Crystal City1800 Jefferson Davis Highway, Arlington | 4 star hotelfrom $144
Courtyard Arlington Crystal City/Reagan National Airport2899 Jefferson Davis Highway, Arlington | 3 star hotelfrom $104
BEST WESTERN Pentagon Hotel - Reagan Airport2480 South Glebe Road, Arlington | 2 star hotelfrom $85
- So So Hotel
- Worst Hotel in DC
- Not Fancy but Fine
Hilton Arlington950 North Stafford Street, Arlington | 3 star hotelfrom $112
- Wow - what a change
- OK, but an inconsistent choice
- Below expectations
Clarion Collection Hotel Arlington Court Suites1200 N Courthouse Rd, Arlington | 3 star hotelfrom $133
Hilton Garden Inn Arlington Courthouse Plaza1333 North Courthouse Road, Arlington | 3 star hotelfrom $107
- More than I ever expected
- What a Beautiful Hotel!!!!
- Ideal choice for my needs
BEST WESTERN Rosslyn/Iwo Jima1501 Arlington Boulevard, Arlington | 3 star hotelfrom $98
- Great staff
- Good Value and Super Convenient
- The Worst
Le Meridien Arlington1121 N 19th Street, Arlington | 4 star hotelfrom $130
- A First-Rate Hotel in Rosslyn, VA.
- Cool and hip hotel to enjoy while working!
- Sleek, Luxurious--but With a Few Big Problems


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Questions You Must Ask About Your Online Relationships
Questions You Must Ask About Your Online Relationships
Questions You Must Ask About Your Online Relationships
If you had no doubts before, surely after the Manti Te'o fiasco you are taking a hard look at your online relationships. Let me say that I'm no online prude. I have clients I work with who I've never met offline. I've had virtual assistants I've never even spoken with on the phone. I've done online dating and talked to high school boyfriends online. I've taken virtual classes and have colleagues I've "met" in those classes who I've never met in person. All of that is fine. I do try to recognize these relationships for what they are, and accept their limitations. I'm suggesting you try to do the same.
Let's do a little Q & A.
• Q. Should I be concerned that he doesn't want to meet me offline?
A. Yes! You should absolutely be concerned if he only wants to talk online. Not wanting a real face-to-face says he definitely has something to hide. It could be the same thing that explains why he's never available in the evening or on the weekend. Someone who doesn't want to meet you is not a boyfriend, friend or any other type of intimate. They're just someone you talk to online.
• Q. Why am I always the one initiating contact?
A. Great question. Why are you always the one waiting for the magic "ping" signaling contact from this person? You're waiting because you've stopped living your life and you're living for a person you hardly know. I know, when you contact him he's quick to respond and flirt. It's still a sign that he might not be that into you. In fact, it's a sign that he's likely not that into you. Set a timeframe during which the relationship has to progress. If it doesn't, it's time to move on.
More Juicy Content From YourTango:
Article contributed by
As I ran one day it came to me, in the way that running and yoga bring insights, that there are striking similarities between the experiences of running and yoga. Neither is solely about benefits like relaxation, stress reduction or weight management, because the gains are so much bigger. Most forms of exercise and meditation enable us to practice... READ MORE
It's been almost six months since my mother died and she's still everywhere. It's difficult to distil the wisdom of 91 years, but the rules of life I learned from her are my constant companions.This is just a sampling.1. It Never Hurts To MatchWhether partnering a purse and shoes, blouse and skirt, or clothing and jewelry, avoiding clashing colors... READ MORE
You've probably had one of those knots in your back like the one I have right now. You stress out over something, lean over your computer too much, go to yoga, slip on your mat and, a day later, agony.You can hardly lift your arm over your head without excruciating pain. This must be much like the samskara, or energy knot, my yoga instructor has... READ MORE


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Faruq Rasid
- January 11, 2011
( 31)
NOTE: Only support default Android calendar for now. Does not full support Moto Calendar YET!
DONATE VERSION ONLY HAS 1 EXTRA FEATURE: Select which Calendar to use
Inspired by Clockr, Calendr is a minimalistic agenda widget for your home screen.
How minimalistic? It show's only the upcoming event, within 1 week from today and only display the needed information (default, but user definable).
Calendr is also very light on your battery - it only updates once a day, or every time your calendar changes!
Bug Report and Feature Request @ http://ruqqq.uservoice.com
SEO: Calendr, Calendr+, Calendr Plus, clockr, Donate, donate, Calendar, Minimal, minimal
No compatible! Please list the devices this works with, instead of just taking our money and letting us find it out ourselves!
No ics. Hunk of useless bytes on my phone. I want to use this. I want to love it. Maybe someday, when the author catches it up to the present!
ICS incompatibility Doesn't work with ICS. Despite being out for 5 months now. Please fix!!!!!
lacking... would be 5 star, but will only show either all day events, or those that aren't all day; but not both. Otherwise, great app!!
. Great widget, used it on my HTC Desire. But I can only rate it three stars as it is not compatible with HTC One X. Please fix it :-)
Bad No more updates? I get device not supported.
What's New
Other than Calendr Free changes, Calendr+ has the feature to select which calendar to display from


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- 18 & over
- 2 Beverage Minimum Per Person
- Non-Refundable & Non-Transferable
Purchase Tickets
Homo Comicus with Kate Clinton
Wednesday, May 07, 2014 8:30 PM
Gotham Comedy Club, New York, NY
Share with your friends:
Show Details
- Ticket Price: $0.00
- Door Time: 7:45 PM
- Show Type: Comedy
18 & over
2 Beverage Minimum Per Person
Non-Refundable & Non-Transferable
Out comedy legend the great KATE CLINTON headlines a hilarious night of LGBT comedy with a gaggle of fabulous female comics, hosted by POPPY CHAMPLIN (from Comics Unleashed with Byron Allen, Comedy Central and Showtime Pride), with CLAUDIA COGAN (from NBC's "Last Comic Standing" and HereTV's "Hot Gay Comics"), SCOUT DURWOOD (from The Mindy Project and Howard Stern) and NY KAZ (from Women's Week P-Town and the Fresh Fruit Festival). There is a pre-show Networking and Socializing Mixer open to all from 7:30pm-8:30pm in the main showroom sponsored by LYNX Lounge / Out Professionals
Tweet Feed
- RT @realmikeyoung: NYC @GothamComedy Wed Night. 8PM. Looking forward to a cool stage and some new material and a shot of something downsta… 10 h
- RT @FlexAforeal: Hey New York I'll be hosting @AXSTV @GothamComedy October 8th 10pm hope to see you there!! pic.twitter.com/i9LdAFGuLG 13 h
- Rain Shmain! Come check out @ErikGriffin from @ComedyCentral's @WorkaholicsCC 2nite thru Sunday! Tix goo.gl/g0uIAG Oct 02
- thank you @EllenCleghorne! twitter.com/EllenCleghorne… Oct 02
- RT @LaughForSight: We are so excited to announce that @ArtieQuitter will be performing at this years @LaughForSight @GothamComedy 11/16/15 Oct 01


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1920 Dodge Touring Sedan
Stock#938-LOUVehicle is located in Memphis, IN. 16 miles north of downtown Louisville, off I65. $22,995.001920 Dodge Touring812-294-1555Engine: 350 CID V8Body:
... $19,995
1920 Other Cunningham
1920 Cunningham car for sale...... Motor is rebuilt, new wheels and tires, to much to list it needs to be finished. NO RUST If interested call Ben 360-569-2032
... $28,000 obo


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PHOTOS: The weather is warm and so are Treasure Coast home sales for March
Subscribe to TCPalm.com and our Treasure Coast Newspapers
Ready to subscribe to TCPalm.com, The Stuart News, The St. Lucie News Tribune and The Indian River Press Journal? Choose between a Premium or Digital subscription below.
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|Numéro de publication
|Type de publication
|Numéro de demande
|Date de publication
|24 mai 2007
|Date de dépôt
|18 nov. 2005
|Date de priorité
|18 nov. 2005
|Autre référence de publication
|Numéro de publication
|John Krueger, Evan Linderman
|Cessionnaire d'origine
|Krueger John A, Linderman Evan D
|Exporter la citation
|BiBTeX, EndNote, RefMan
|Référencé par (44), Classifications (10), Événements juridiques (2)
|Liens externes: USPTO, Cession USPTO, Espacenet
The present invention relates to devices and methods for stabilizing bone structures. More particularly, it relates to devices, systems and methods for delivering a curable, stabilizing material into a bone structure.
Surgical intervention at damaged or compromised bone sites has proven highly beneficial for patients, for example patients with back pain associated with vertebral damage.
Bones of the human skeletal system include mineralized tissue that can generally be categorized into two morphological groups: "cortical" bone and "cancellous" bone. Outer walls of all bones are composed of cortical bone, which has a dense, compact bone structure characterized by a microscopic porosity. Cancellous or "trabecular" bone forms the interior structure of bones. Cancellous bone is composed of a lattice of interconnected slender rods and plates known by the term "trabeculae."
During certain bone procedures, cancellous bone is supplemented by an injection of a palliative (or curative) material employed to stabilize the trabeculae. For example, superior and inferior vertebrae in the spine can be beneficially stabilized by the injection of an appropriate, curable material (e.g., PMMA or other bone cement). In other procedures, percutaneous injection of stabilization material into vertebral compression fractures by, for example, transpedicular or parapedicular approaches, has proven beneficial in relieving pain and stabilizing damaged bone sites. Other skeletal bones (e.g., the femur) can be treated in a similar fashion. In any regard, bone in general, and cancellous bone in particular, can be strengthened and stabilized by a palliative injection of bone-compatible material.
The conventional technique for delivering the bone stabilizing material entails employment of a straight access device or cannula that bores (or otherwise cuts) through the cortical bone to gain access to the cancellous bone site. Bone stabilization material is then driven through the cannula to fill a portion of the cancellous bone at the bone site. To minimize invasiveness of the procedure, the cannula is typically a small diameter needle.
With the above in mind, because the needle cannula interacts with the cancellous bone and other soft tissue structures, an inherent risk exists that following initial insertion, the needle cannula might core or puncture other tissue and/or the bone mass being repaired (at a location apart from the insertion site). Thus, during percutaneous vertebroplasty, great care must be taken to avoid puncturing, coring, or otherwise rupturing the vertebral body. Similar post-insertion coring concerns arise in other interior bone repair procedures. Along these same lines, to minimize trauma and time required to complete the procedure, it is desirable that only a single bone site insertion be performed. Unfortunately, for many procedures, the surgical site in question cannot be fully accessed using a conventional, straight needle cannula. For example, with vertebroplasty, the confined nature of the inner vertebral body oftentimes requires two or more insertions with the straight needle cannula at different vertebral approach locations ("bipedicular" technique). It would be desirable to provide a system for delivering bone stabilizing material that can more readily adopt to the anatomical requirements of a particular delivery site, for example a system capable of promoting unipedicular vertebroplasty.
Instruments sold by Cook Medical under the OSTEO-RX ™ product line utilize a curved needle to deliver bone stabilizing material as part of vertebroplasty or similar procedure. The curved needle purportedly enhances a surgeon's ability to locate and inject the stabilizing material at a desired site. Similar to a conventional straight needle cannula, the curved needle dispenses the curable material through a single, axial opening at the distal-most tip. However, the curved needle is used in combination with an outer cannula that assists in generally establishing access to the bone site as well as facilitating percutaneous delivery of the needle to the delivery site (within bone) in a desired fashion. More particularly, the outer cannula first gains access to the bone site, followed by distal sliding of the needle through the outer cannula. Once the needle's tip extends distal a distal end of the outer cannula, the needle tip is "exposed" relative to the bone site. To avoid coring, and thus potentially damaging, tissue when inserting the needle's distal tip into the bone site, an additional wire component is required, coaxially disposed within the needle and distally extending from the distal tip. The inner wire "protects" tissue or other bodily structures from traumatically contacting the distal tip of the needle as the tip is being positioned. The coaxial wire must be removed prior to infusing the bone stabilizing material through the needle. Further, the needle can only dispense the stabilizing material through the axial opening at the distal tip of the needle, perhaps impeding a surgeon's ability to infuse all desired areas and/or requiring an additional procedural step of "backing" the needle tip away from the desired delivery site. Also, because the needle tip, and thus the axial opening, is likely at or facing the bone defect (e.g., fracture in the vertebral body) being repaired, the stabilizing material may be injected directly at the defect, giving rise to a distinct possibility that the stabilizing material will forcibly progress through and outwardly from the defect. This is clearly undesirable. The issues and concerns described above in the context of percutaneous vertebroplasty can also arise in similar surgical procedures at other bone sites.
The injection of palliative materials into damaged or compromised bone sites has proven highly beneficial for patients. However, the known access and infusion techniques necessitate multiple needle sticks and/or risk coring bone or tissue. Therefore, a need exists for an improved device and system for delivering stabilizing material to damaged or compromised bone sites.
Benefits achieved in accordance with principles of the disclosed invention include a delivery cannula providing a non-traumatic, blunt distal end that minimizes the risks of coring tissue or puncturing bone or tissue during intraosseous procedures without requiring additional components (such as separate wire). Other benefits relate to a delivery cannula defining at least one side orifice adjacent to a blunt distal end, where the orifice(s) permit a radial infusion of a curable material at a site within bone even in the case where the distal end is in contact with bone and/or tissue. Thus, a palliative bone procedure can be accomplished with reduced operating room time and with fewer approaches of surgical instruments to the bone site. For example, unipedicular vertebroplasty is readily accomplished. Further, virtually any area within the surgical site can be accessed. Also, the distal end of the delivery cannula can be placed as close as desired to a particular anatomical feature of the surgical site (e.g., a bone fracture) without fear that subsequently delivered material will forcibly progress into or through that feature.
Some aspects of the present invention relate to a delivery cannula device for delivering a curable material into bone. The device includes a delivery cannula and a hub forming a fluid port. The delivery cannula defines a proximal end, a deflectable segment, a distal end, a lumen, and at least one side orifice. The proximal end is axially open to the lumen. The deflectable segment is formed opposite the proximal end and terminates at the distal end that is otherwise axially closed. Further, the distal end has a blunt tip. The lumen extends from the proximal end and is fluidly connected to the side orifice(s). To this end, the side orifice(s) is formed adjacent to, and proximally space from, the distal end. Finally, the deflectable segment forms a curved shape in longitudinal extension and has a shape memory characteristic. With this configuration, the deflectable segment can be forced to a substantially straightened shape and will revert to the curved shape upon removal of the force. The hub is fluidly coupled to the proximal end of the delivery catheter. With this construction and during use, the distal end will not damage or core tissue when inserted into a delivery site within bone due to the blunt tip. Further, the side orifice(s) afford the ability to inject a curable material regardless of whether the distal end is lodged against bodily material, and can achieve more thorough dispensement.
Other aspects of the present invention relate to an intraosseous, curable material delivery system for delivering a curable material, such as bone cement, to a delivery site within bone. The system includes the delivery cannula and hub as described in the previous paragraph, along with a guide cannula. The delivery cannula and the guide cannula are sized such that the delivery cannula is slidable within the guide cannula. To this end, the deflectable segment is configured to deflect to a substantially straightened shape when inserted within the cannula and revert to the curved shape when extended distal the guide cannula for delivery of the curable material. In one embodiment, the guide cannula and the delivery cannula are sized to perform a vertebroplasty procedure.
Yet other aspects of the present invention relate to a method of stabilizing a bone structure of a human patient. The method includes providing a delivery cannula as previously described. A distal tip of a guide cannula is located within the bone structure. The delivery cannula is inserted within the guide cannula. In this regard, the deflectable segment deflects to a substantially straightened shape within the guide cannula. The delivery cannula is distally advanced relative to the guide cannula such that the distal end and at least a portion of the deflectable segment of the delivery cannula projects distal the distal tip of the guide cannula. To this end, the portion of the deflectable segment distal the distal tip of the guide cannula naturally reverts to the curved shape. The distal end of the delivery cannula is positioned adjacent a desired delivery site within the bone structure. A curable material is injected into the lumen. The injected curable material is delivered to the delivery site via the side orifice(s). Once delivered, the curable material is allowed to cure so as to stabilize the bone structure. In one embodiment, the method further includes rotating the delivery cannula relative to the guide cannula so as to alter a spatial position of the side orifice(s), thus affording the ability to inject the curable material in different planes.
The accompanying drawings are included to provide a further understanding of the present invention and are incorporated in and are a part of this specification. Other embodiments of the present invention, and many of the intended advantages of the present invention, will be readily appreciated as they become better understood by reference to the following detailed description. The elements of the drawings are not necessarily to scale relative to each other. Like reference numerals designate corresponding similar parts.
The system 20, and in particular the delivery cannula device 26, is highly useful for delivering a curable material in the form of a bone cement material. The phrase "curable material" within the context of the substance that can be delivered by the system/device of the invention described herein is intended to refer to materials (e.g., composites, polymers, and the like) that have a fluid or flowable state or phase and a hardened, solid or cured state or phase. Curable materials include, but are not limited to injectable polymethylmethacrylate (PMMA) bone cement, which has a flowable state wherein it can be delivered (e.g., injected) by a cannula to a site and subsequently cures into hardened cement. Other materials, such as calcium phosphates, bone in-growth material, antibiotics, proteins, etc., could be used in place of or to augment, PMMA (but do not affect an overriding characteristic of the resultant formulation having a flowable state and a hardened, solid or cured state). This would allow the body to reabsorb the cement or improve the clinical outcome based on the type of filler implant material. With this in mind, and in one embodiment, the system 20 further includes a source (not shown) of curable material fluidly coupled to the delivery cannula device 26.
Given the above, the outer guide cannula 22 generally enables access of the delivery cannula device 26 to a bone site of interest, and thus can assume a wide variety of forms. In general terms, however, the guide cannula 22 is sized to slidably receive a portion of the delivery cannula device 26, terminating in an open, distal tip 28. The distal tip 28 can further be adapted to facilitate coring of bone tissue, such as when using the guide cannula 22 to form a delivery site within bone. To promote a desired interface between the guide cannula 22 and a portion of the delivery cannula device 26 otherwise slidably inserted within the guide cannula 22 during use (described below), in one embodiment, an inner diameter surface of the guide cannula 22 is highly smoothed to a matte or mirror finish (i.e., RMS range of 4-16). Regardless, and in some embodiments, the guide cannula 22 can further be attached, at a proximal end thereof, to a handle 30 for enhancing a surgeon's ability to manipulate the system 20. Alternatively, the handle 30 can be eliminated.
The delivery cannula device 26 is shown in greater detail in
The handle assembly 32 includes, in one embodiment, a handle 40 and a retainer 42. The handle 40 is adapted to receive the hub 34, with the retainer 42 securing the hub 34 (and thus the delivery cannula 36) to the handle 40.
The handle 40, in one embodiment, includes a first section 44 and a second section 46. The first section 44 is adapted for snap-fit assembly to the second section 46, such as by complimentary annular protrusion(s) 48 and grooves 50. Regardless, the first section 44 forms a central passage 52 extending inwardly from an exterior surface 54 thereof.
The second section 46 defines an internal aperture 56 that, upon final assembly of the handle 40, is aligned with the central passage 52. The aperture 56 can assume a variety of forms sized to receive the hub 34 in a nested manner. The nested interface between the handle 40 and the hub 34 is preferably adapted such that the hub 34 cannot rotate relative to the handle 40 upon final assembly (i.e., the hub 34/handle 40 interface resists a torque imparted on either component such that rotational movement of the handle 40 results in an identical rotation of the hug 34/delivery cannula 36 even when the delivery cannula 36 is inserted within a confined surgical site). Thus, in one embodiment, the aperture 56 and the hub 34 (as described below) have corresponding non-symmetrical or non-circular shapes in transverse cross-section. Relative to the longitudinal cross-sectional view of
The retainer 42 is configured to secure the hub 34/delivery cannula 36 to the handle 40, and forms a central opening 64 defining a proximal portion 66 and a distal portion 68. The proximal portion 66 forms the central opening 64 to have a diameter slightly greater than that of the hub 34, along with internal threads 70 sized to threadably engage the exterior threads 62 of the handle 40. The distal portion 68 forms the opening 64 to have a diameter approximating an outer diameter of the delivery cannula 36 so as to provide a more rigid connection between the handle assembly 32 and the hub 34/delivery cannula 36. Alternatively, the handle assembly 32 can assume a wide variety of other forms and in some embodiments can be eliminated entirely.
In one embodiment, the hub 34 is of a conventional fluid port design and defines a fluid passage 71 and an exterior thread 72 on a proximal end 74 thereof. In one embodiment, the thread 72 is a double start right hand Luer thread including a 5-millimeter lead, although other thread conformations and lead sizes are also acceptable. Regardless, as previously mentioned, in one embodiment, the hub 34 is configured to be rotatably "locked" relative to the handle assembly 32 upon final assembly. Thus, in one embodiment, a body of the hub 34 forms a generally cylindrical surface 76 a portion of which is flattened in an area 78, as shown in
The hub 34 is formed, in one embodiment, of a sterilizable polymeric material. By way of example, the hub 34 can be formed of a polylac 717C acrylonitrile-butadiene-styrene (ABS) copolymer, although other sterilizable polymers and/or copolymers are also acceptable.
Returning to
The proximal end 80 is axially open to the lumen 86. Conversely, the distal end 82 is axially closed to the lumen 86 (i.e., material cannot be axially expelled from the distal end 82 relative to an axis of the lumen 86). That is to say, material in the lumen 86 cannot be forced distally therefrom in an axial fashion. Further, the distal end 82 defines or includes a blunt tip 100. For example, in one embodiment, the blunt tip 100 defines a hemispherical surface, although other blunt (i.e., curved or curvilinear) shapes or contours are also acceptable. The blunt tip surface 100 is adapted to provide a non-traumatic surface suitable for accessing, contacting and probing bone or tissue while minimizing the risk of puncture and/or coring of the tissue or damage to the bone. To enhance a desired softness, the blunt tip 100 can have a differing thickness as compared to a remainder of the delivery cannula 36 such as by sintering the distal end 82 to form the blunt tip 100 (when the delivery cannula 36 is initially provided as a continuous tube). Alternatively, the blunt tip 100 can be formed apart from a remainder of the delivery cannula 36 and subsequently attached to the delivery cannula 36 to form the distal end 82 (e.g., the delivery cannula 36 can include a first tubular body formed of a hardened material along with a second, solid body formed of a softer material attached (e.g., welded) to the tubular body to form the distal end 82/blunt tip 100).
With reference to
The side orifice(s) 84 can assume a wide variety of shapes and sizes (relative to an exterior surface of the delivery cannula 36). For example, the side orifice(s) 84 can be oval, circular, curvilinear, etc. In one embodiment, and with reference to
In particular, and with additional reference to
Returning to
To facilitate delivery of a curable material (e.g., bone cement) into a confined site within bone (such as with a vertebroplasty procedure), the deflectable segment 88 can be formed to define the bend 90 at a pre-determined radius of curvature R appropriate for the procedure in question. In one embodiment, the bend 90 is J-shaped (approximating at least a 90 degree bend) and defines the radius of curvature R to be less than 1.5 inches, preferably in the range of 0.25-1.5 inches. In one preferred embodiment, the bend 90 defines the radius of curvature R to be approximately 1 inch. Alternatively, and as described in greater detail below, the radius of curvature R can be greater or lesser, depending upon the particular procedure for which the delivery cannula 36 is to be employed.
Further, to facilitate ready deflection of the deflectable segment 88 from the curved shape to a substantially straightened state (such as when the delivery cannula 36 is inserted within the outer guide cannula 22 (
In another embodiment, the pre-set curve or bend 90 is formed in an initially straight cannula by cold working the straight cannula and applying a mechanical stress. Cold working permanently locks a crystalline structure (for example, a partial martensitic crystalline structure) in a portion (i.e., the deflectable segment 88) of the cannula, while an unstressed portion remains in, for example, an austenitic structure.
In addition to Nitinol, other materials exhibiting this shape memory behavior can be employed, including superelastic or pseudoelastic copper alloys, such as alloys of copper, aluminum, and nickel, and alloys of copper, aluminum, and zinc, and alloys of copper and zinc. Regardless, the deflectable segment 88 is formed to be resilient and to naturally assume the desired radius of curvature R. In this manner, after the delivery cannula 36, and in particular the deflectable segment 88, is flexed to a substantially straightened shape (not shown), upon a subsequent relaxation, the deflectable segment 88 "remembers" the pre-set curved shape and reversibly relaxes/returns to the bend 90, as described in detail below.
The above material selection in combination with delivery of curable liquid through one or more, relatively large side orifice(s) (otherwise positioned proximal of the distal end 82) and the blunt tip 100 has surprisingly been found to allow the delivery cannula 36 to be smaller and thinner than conventional bone cement delivery needles (i.e., having an outer diameter of approximately 0.125 inch, yet still provide sufficient structural integrity to perform all desired procedures entailing delivery of curable material to, or removal of material from, a site within bone. More particularly, and as best shown in
An additional feature of the delivery cannula 36 in accordance with one embodiment is best shown in the plan view of
With reference to
Following attachment of the hub 34 to the delivery cannula 36, the hub 34 is mounted within the handle assembly 32 as previously described. For example, the hub 34 is nested within the aperture 56 of the handle 40, and the retainer 42 is coaxially disposed over the hub 34/delivery cannula 36 and secured (e.g., threadably engaged) to the handle 40. To this end, and in one embodiment, the hub 34 is oriented relative to delivery cannula 36 such that the flattened area 78 of the hub 34 "faces" a spatial direction of the bend 90. The previously described configuration of the handle assembly 32 thus dictates that upon assembly of the hub 34 to the handle 40, the bend 90 will also extend in a known spatial direction relative to the handle 40. Alternatively, a spatial direction of the bend 90 relative to the handle 40 can be visually determined following mounting of the hub 34 thereto. Regardless, in one embodiment and as best shown in
Although the delivery cannula device 26 has been described as including the delivery cannula 36 otherwise forming one side orifice 84, a variety of other configurations are also acceptable. For example, two, circumferentially aligned side orifices can be provided. Further,
A distal-most side orifice 130 a is offset the distance D1 from the distal end 116. Once again, the distance D1 is, in one embodiment, in the range of 0.05-0.5 inch, preferably in the range of 0.1-0.25 inch. A longitudinal spacing between the remaining side orifices 130 proximal the distal-most side orifice 130 a can vary. Preferably, however, the second side orifice 130 b defines a smaller sized opening as compared to the distal-most side orifice 130 a, and the third side orifice 130 c is smaller than the second side orifice 130 b. This reduction in side orifice size proximal the distal end 126 promotes consistent distribution of curable material otherwise being forced through the delivery cannula 122.
While three of the side orifices 130 are shown, other configurations are also acceptable. For example, multiple side orifices (i.e., more than three side orifices) can be formed longitudinally along the length of the delivery cannula 122, and in addition, the side orifices 130 can include more than one longitudinally aligned series of side orifices. In an exemplary embodiment, the side orifices 130 that are visible in
As a point of reference, the pre-set curve 134 is curved away from a central axis C of the delivery cannula 122 such that the curvature of the pre-set curve 134 is less than the radius of curvature R of the pre-set curve 90 (
Regardless of an exact configuration, the assembled delivery cannula device (such as the delivery cannula device 26 of
The curable material source 152 includes, in one embodiment, a canister 160 containing a curable material as previously described, and tubing 164 extending from the canister 160 to the handle assembly 30 of the delivery cannula device 26. In this regard, the tubing 164 terminates at a fitting 166 configured to removably attach to the hub 34. In particular, the fitting 166 is configured to fit within the passage 52 of the handle 40 and removably couple to the hub 34. In one embodiment, the fitting 166 threads onto a Luer thread defined by the hub 34. In another embodiment, the fitting 166 snap-fits over the hub 34. Alternatively, a wide variety of other attachment configurations are also available.
The controller 154 can assume any form known in the art and is coupled to the curable material source 152. In an exemplary embodiment, the controller 154 controls a mass flow and a mass flow rate (i.e., a fluid delivery rate) of curable material from the canister 160 to the delivery cannula device 26. The controller 154 can include a variety of actuators (e.g., switch(es), foot pedal(s), etc.) affording a user the ability to remotely control liquid flow into the delivery cannula 36. Alternatively, manual control can be employed such that the controller 154 can be eliminated.
During a palliative bone procedure, with the delivery cannula 36 partially retracted within, or entirely removed from, the outer guide cannula 22, the outer guide cannula 22 is located at a desired delivery site within bone. For example, in a vertebroplasty procedure the outer guide cannula 22 is introduced into a vertebra 180, preferably at a pedicle 182. In this regard, the vertebra 180 includes a vertebral body 184 defining a vertebral wall 186 surrounding bodily material (e.g., cancellous bone, blood, marrow, and other soft tissue) 188. The pedicle 182 extends from the vertebral body 184 and surrounds a vertebral foramen 190. In particular, the pedicle 182 is attached posteriorly to the vertebral body 184 and together they comprise the vertebrae 180 and form the walls of the vertebral foramen 190. As a point of reference, the intraosseous system 150 is suitable for accessing a variety of bone sites. Thus, while a vertebra 180 is illustrated, it is to be understood that other bone sites can be accessed by the system 150 (i.e., femur, long bones, ribs, sacrum, etc.).
The outer guide cannula 22 forms an access path to a delivery site 192 (or forms the delivery site 192) through the pedicle 182 into the bodily material 188. Thus, as illustrated, the outer guide cannula 22 has been driven through the pedicle 182 via a transpedicular approach. The transpedicular approach locates the outer guide cannula 22 between the mammillary process and the accessory process of the pedicle 182. In this manner, the outer guide cannula 22 provides access to the delivery site 192 at the open, distal tip 28. With other procedures, the outer guide cannula 22 can similarly perform a coring-like operation, forming an enlarged opening within bone.
Once the outer guide cannula 22 has formed, or is otherwise positioned within bone at, the desired delivery site 192, the delivery cannula 36 is slidably inserted/distally advanced within the outer guide cannula 22. As illustrated generally in
The delivery cannula device 26, and in particular the delivery cannula 36, is then distally advanced within the guide cannula 22 as shown in
In connection with distal advancement of the delivery cannula 36, the blunt tip 100 of the distal end 82 is hemispherically shaped (or other non-sharpened or blunt shape) and thus atraumatic relative to contacted tissue/bone. In this manner, the blunt tip 100 can contact and/or probe the vertebral wall 186 with a minimum of risk in puncturing or coring the vertebral body 184. Thus, the blunt tip 100 offers an advantage over the conventional, sharp-edged bone cement delivery needles, and does not require a separate wire to prevent coring as is otherwise necessary with available curved needles.
The side orifice 84 is offset from the distal end 82 and is, therefore, available to deliver curable material into, and remove bodily material from, the delivery site 192. In particular, the side orifice 84 can eject curable material radially from, and aspirate bodily material into, the delivery cannula 36, even when the distal end 82 is pressed against a surface, such as an interior wall of the vertebral body 184.
With the above in mind, in one embodiment, the fluid source 152 is then operated (e.g., via the controller 154) to deliver a curable material (not shown) to the delivery cannula 36 via the hub 34. Curable material entering the delivery cannula 36 is forced through the lumen 86 (
Importantly, by injecting the curable material radially from a side of the delivery cannula 36 rather than axially from the distal most end (as will otherwise occur with conventional delivery needles), the system 150 (
As shown in
In one embodiment, and returning to
In more general terms, during the palliative bone procedure, a clinician operating the intraosseous system 150 extends a portion of the pre-set curve 90 into the delivery site 192 otherwise defined within bone. In one embodiment, a subsequent rotation of the delivery cannula 36 rotates a spatial position of the side orifice 84 relative to the delivery site 192, thus accessing multiple planes of the delivery site 192 with only one "stick" of the outer guide cannula 22. Thus, by a combination of retracting the delivery cannula 36 within the outer guide cannula 22, distally advancing the delivery cannula 36 relative to the outer guide cannula 22, and by rotating the delivery cannula 36, multiple planes and multiple regions of the bone site of interest can be accessed by the delivery cannula 36 with a single approach of the outer guide cannula 22. Thus, for example, a unipedicular vertebroplasty can be accomplished with the system 150.
Although specific embodiments have been illustrated and described herein, it will be appreciated by those of ordinary skill in the art that a variety of alternate and/or equivalent implementations may be substituted for the specific embodiments shown and described without departing from the scope of the present invention. This application is intended to cover any adaptations or variations of the specific embodiments discussed herein. Therefore, it is intended that this invention be limited only by the claims and the equivalents thereof. For example, while specific reference has been made to vertebroplasty procedures, the devices, systems, and methods in accordance with principles of the present invention are equally applicable to delivering curable material within multiple other bones of a patient.
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Owner name: CAREFUSION 2200, INC.,CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:KRUEGER, JOHN A.;LINDERMAN, EVAN D.;REEL/FRAME:023423/0563
Effective date: 20091023
|16 oct. 2013
|Fee payment
Year of fee payment: 4