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|Número de publicación
|Tipo de publicación
|Número de solicitud
|Fecha de publicación
|30 Ene 2003
|Fecha de presentación
|20 Sep 2002
|Fecha de prioridad
|28 Jul 1999
|También publicado como
|Número de publicación
|Ralph Kopacko, Zachary Paul, Shari Barnett
|Cesionario original
|Respironics, Inc.
|Exportar cita
|BiBTeX, EndNote, RefMan
|Citas de patentes (5), Citada por (46), Clasificaciones (9), Eventos legales (3)
|Enlaces externos: USPTO, Cesión de USPTO, Espacenet
[0001] 1. Field of the Invention
[0002] The present invention relates, in general, to respiratory masks and mask couplings and, more particularly, to respiratory masks having flexible seals adapted to receive portions of a patient's face for preventing leakage of gas supplied to the patient, forehead cushions for use with such masks, and conduit couplings having an exhaust port to exhaust CO2 laden air.
[0003] 2. Description of the Related Art
[0004] A variety of respiratory masks are known that have flexible seals and cover the nose, mouth, or both of a human user and are designed to create a continuous seal against the user's face. Because of the sealing effect that is created, gases can be provided at a positive pressure within the mask for consumption by the user. The uses for such masks range from high altitude breathing (i.e., aviation applications) to mining and fire fighting applications, to various medical diagnostic and therapeutic applications, including the treatment of obstructive sleep apnea with positive airway pressure devices.
[0005] One requisite of such respiratory masks has been that they provide an effective seal against the user's face to prevent the gas being supplied from leaking at the mask-to-face interface. Commonly, in prior mask configurations, a good mask-to-face seal has been attained in many instances only with considerable discomfort for the user. This problem is most crucial in those applications, especially medical applications, that require the user to wear such a mask continuously for an extended periods of time, such as hours or perhaps even days. In such situations, the user may not tolerate wearing the mask for long durations, and, as a result, optimum therapeutic or diagnostic objectives will not be achieved, or will be achieved with great difficulty and considerable user discomfort.
[0006] At least two types of respiratory face masks are known for the types of applications mentioned above. The most common type of mask incorporates a smooth sealing surface extending around the periphery of the mask and exhibiting a generally uniform (i.e., predetermined or fixed) seal surface contour that is intended to be effective to seal against the user's face when force is applied to the mask, with the smooth sealing surface in confronting engagement with the user's face. The sealing surface may consist of an air or fluid filled cushion, or it may simply be a molded or formed surface of a resilient seal element made of an elastomer, such as plastic or rubber.
[0007] Such masks have performed well when the fit is good between the contours of the seal surface and the corresponding contours of the user's face. However, if the seal fit is not good, there will be gaps in the seal-to-face interface, and excessive force will be required to compress the seal member to attain a satisfactory seal in those areas where gaps occur. Such excessive force is unacceptable, as it produces high pressure points elsewhere on the face of the user where the mask seal contour is forcibly deformed against the face to conform to the user's facial contours. This will produce considerable user discomfort anywhere the applied force exceeds the local perfusion pressure, which is the pressure that is sufficient to cut off surface blood flow. Ideally, contact forces should be limited between the mask and the user's face to avoid exceeding the local perfusion pressure even at points where the mask seal must deform considerably.
[0008] The problem of seal contact force exceeding desirable limits is even more pronounced when the positive pressure of the gas being supplied is relatively high or is cyclical to high levels. Because the mask seals by virtue of confronting contact between the mask seal and the user's face, the mask must be held against the face with a force sufficient to seal against leakage of the peak pressure of the supplied gas. Thus, for conventional masks, when the supply pressure is high, headstraps or other mask restraints must be tightly fastened. This produces high localized pressure on the face, not only in the zone of the mask seal but at various locations along the extent of the retention straps as well. This too will result in severe discomfort for the user after only a brief period of time. Even in the absence of excessive localized pressure points, the tight mask and headstraps often may become extremely uncomfortable and user discomfort may well cause discontinued cooperation with the regimen. Examples of respiratory masks possessing continuous cushion sealing characteristics of the type just described are provided in U.S. Pat. Nos. 2,254,854 and 2,939,458.
[0009] A second type of mask, which has been used with a measure of success, incorporates a flap seal of thin material positioned about the periphery of the mask as to provide a self-sealing action against the face of the user when positive pressure is applied within the mask. In such a mask, the flap seal typically defines a contoured sealing surface adapted for confronting and sealing engagement with the user's face. Under the influence of a flow of pressurized gas supplied to the interior of the mask, which impinges upon the surface opposite the contoured sealing surface, the sealing surface is urged into sealing contact with the user's face. With this type of sealing action, the forces that serve to hold the mask in confronting engagement on the face of the user are much lower than the strapping forces associated with the first type of mask described above. If the flap seal is capable of conforming to the contours of the user's face without forming leak paths, the mask can be used with retention straps that exert little or no net force to push the mask against the user's face. Thus, the overall sensation of constraint and confinement is dramatically reduced for the user. Such a mask, when properly adjusted, can be adapted to any positive internal mask pressure. The sealing flap will be self-sealing as long as there is no looseness in the strapping arrangement which would allow the mask to move away from the face further than the reach of the sealing flap when subjected to internal pressure.
[0010] There are two potential limitations of the above described mask type having a sealing flap characteristic. First, the sealing flap seals by laying flat against the user's face throughout its length. This action requires a close match between the contours of the face and the contours of the seal. If the match is not good, the seal will be ineffective. Second, the normal response of one applying the mask to a user's face is to push the mask harder against the user's face if the mask does not seal. With the typical flap seal-type mask, increasing contact pressure against the user's face will not help to form an effective seal if the flap seal does not initially fit well to the facial contours. It may, however, lead to patient discomfort and other problems as described above.
[0011] Some of the principal problems one encounters when trying to apply the self-sealing flap concept to the design of the respiratory mask are related to the location of relative low points and high points in the facial contours of the user relative to the shape or contour of the flap seal surface. If the seal surface does not contact the user's face at the relative lower points, then excessive gas leakage will occur, thus preventing sufficient internal gas pressure to develop to activate the sealing action of the seal flap at the low points. In the past, this problem has been solved for some applications by providing a variety of masks with differing seal flap shapes, sizes and contours. For example, for aircraft breathing masks, especially where expense is not a critical factor, wide variety of mask shapes and sizes may be provided to give the individual users an opportunity to find a mask offering good fit. In other breathing mask applications, such as a clinical use, where economic considerations may dictate a mask having the capability to accommodate a wide variety of facial sizes and contours, prior flap type seal structures have not generally been able to provide the requisite versatility.
[0012] A related problem with flap seal mask structures concerns the high points of the user's face, where the seal flap may tend to distort or collapse and fold in on itself, thus creating a channel for gas leakage, when pressure is applied in order to effect a seal at adjacent relative low points on the user's face. Even where the section thickness of the seal flap is very thin, and the material is very soft and flexible, the internal gas pressure cannot overcome such seal flap distortion to provide the desired self-sealing.
[0013] A mask of the above-characterized flap seal type is described in U.S. Pat. No. 4,907,584, the disclosure of which is incorporated herein by reference. The mask disclosed therein includes a generally annular seal comprised of a peripheral sidewall having an inturned flexible flap seal adjacent a free end thereof, with the inturned seal being configured for confronting sealing engagement with a user's face as above described. Spaced about the peripheral seal wall are plural, upstanding, flexible ribs which serve to support the peripheral wall and an inturned portion of the seal member located generally outward of the face-engaging surface portion of the seal flap. The described seal structure is intended to permit the flap seal and peripheral sidewall to distort without experiencing any mode of seal defeating deformation such as crimping, buckling, folding or other modes of collapse. In this seal structure, the structural support ribs are located and configured in a manner to provide adequate seal flap support where seal deformation is not required (i.e., at the "low" points of the contours of the user's face) and to resiliently deform in a manner to permit easy and uniform distortion of the seal flap in those areas where distortion is necessary to accommodate "high" points on the contours of the user's face.
[0014] Other respiratory masks having flexible flap facial seats are disclosed in U.S. Pat. Nos. 4,167,185 and 4,677,977. Masks comprising both continuous cushion and flexible flap sealing features are described in U.S. Pat. Nos. 2,931,356, 3,330,273, and 4,971,051.
[0015] Despite its general efficacy in affording a desired seal against the typical user's face, the construction of the inturned flexible flap is such that the contours of certain users' faces may preclude reliable sealing by masks of this type. In this regard, the seal flap includes an opening having an enlarged lower portion to accommodate lower regions of the user's nose (and possibly the user's mouth) and an upwardly extending narrow slot portion adapted to receive the bridge of the nose. The slot bifurcates the flap into a pair of opposed flap portions adapted to lie against opposite sides of the user's nose during use. The front portion of the nose is left uncovered.
[0016] U.S. Pat. No. 4,167,185 teaches a flexible flap type mask seal which incorporates reinforcement webs or struts in the nasal flap portions of the seal to force the flap portions against the bridge of the user's nose during use. This arrangement, however, exerts localized pressure on the user's face which, in turn, results in increased user discomfort.
[0017] U.S. Pat. No. 4,655,213 describes a nasal mask that substantially surrounds the user's nose and provides a continuous cushion type perimetrical seal therearound. Such perimeter seals are required because the mask seal bodies are over-sized to accommodate, but not contact, the user's nose. The seals provided by these masks are thus conceptually similar to and suffer from essentially the same drawbacks as the continuous cushion type mask seals discussed at the outset.
[0018] In order to improve the sealing effects and comfort of the above-described masks, flexible resilient mask flap seals have been developed which may be adapted for attachment to a respiratory mask body or may be removably placeable over the facial seal of an existing respiratory mask. A respiratory mask facial seal of this type is described in U.S. Pat. No. 5,540,223, the disclosure of which is incorporated by reference herein. Further seals of this type are shown in Soft Series Literature from Respironics, Inc. of Pittsburgh, Pa.
[0019] It is also known to provide the above-described type masks with forehead spacer or cushioning elements. The above-referenced U.S. Pat. No. 4,907,584 further describes a forehead spacer element for limiting deformation of the mask seal when in engagement with a user's face. In the featured embodiment, the spacer comprises a foam rubber spacer block attached to a pressure sensitive adhesive strip which can be applied to the mask.
[0020] Other forehead spacer/cushion elements are shown in U.S. Pat. Nos. 5,243,971, 5,517,986, 5,570,689, and International Publication No. WO 98/04310. However, a disadvantage exists with known forehead spacer/cushion elements in that multiple forehead pad sizes, mechanically complicated or cumbersome adjustment mechanisms, or both are currently required to accommodate various patient physical profiles.
[0021] An advantage exists, therefore, for a respiratory mask that affords an effective yet comfortable seal for all users, not withstanding the size or shape of a particular user's face and that does not require multiple forehead pad sizes or mechanical forehead pad adjustment mechanisms.
[0022] Respiratory masks usually require an exhaust vent or port for purging the system of CO2 laden air, especially masks intended for use in a single-limb ventilation circuit. A known respiratory mask incorporates ports in the body of the mask. However, several drawbacks have been found to be associated with ports in the body of the mask. For example, air exiting the mask ports may create noise near the user's face, blow on the patient causing discomfort, or blow on the patient's bed partner.
[0023] To address these disadvantages, Respironics, Inc. has developed and manufactured a swivel conduit under the name Whisper Swivel® Exhalation Port. This two-piece conduit provides a swivel connection between the mask elbow and the delivery conduit and also includes downwardly directed exhaust slits for directing the CO2 laden exhaust away from the patient.
[0024] However, an advantage exists for an exhaust device which provides the ability to rotate, reduces noise and that disposes the exhalation port or ports closer to the mask volume than is currently possible using the Whisper Swivel device.
[0025] The present invention provides an improved respiratory mask that reliably and comfortably seals facial contours. According to the presently preferred embodiment, the respiratory mask of the present invention includes a thin sealing area. This thin section permits the mask to more easily adapt to the contour of the human face and seal at low pressures with minimal facial pressure.
[0026] According to another aspect of the present invention, the respiratory mask is provided with a gel forehead cushion/spacer element. As the gel material is more compliant than the foam material used in known forehead cushion. The gel forehead pad is able to accommodate a wider range of physical profiles with increased comfort, and does so without the need to provide for adjustment of the forehead cushion to suit each particular patient.
[0027] In yet a further aspect of the present invention, the respiratory mask is provided with a respiratory tubing elbow coupling providing the ability to rotate 360 degrees about the faceplate of the respiratory mask and having an integrated tapered exhaust port and a polycarbonate leak ring for exhausting exhaled gases from the respiratory mask. The positioning of the exhaust ports closer to the respiratory mask body provides a more efficient exhausting of gases, and the design of the exhaust ports reduces the noise level created by the flow of air through typical fixed orifice.
[0028] These and other advantages, objects, features and characteristics of the present invention, as well as the methods of operation and functions of the related elements of structure and the combination of parts and economies of manufacture, will become more apparent upon consideration of the following description and the appended claims with reference to the accompanying drawings, all of which form a part of this specification, wherein like reference numerals designate corresponding parts in the various figures. It is to be expressly understood, however, that the drawings are for the purpose of illustration and description only and are not intended as a definition of the limits of the invention.
[0029]FIGS. 1A and 1B are front and rear perspective views, respectively, of a first embodiment of a respiratory mask according to the principles of the present invention;
[0030]FIG. 2 is a rear perspective view of a second embodiment of a respiratory mask according to the principles of the present invention;
[0031]FIG. 3 is a side view of the respiratory mask of FIGS. 1A and 1B;
[0032]FIG. 4 is a rear view of the respiratory mask of FIGS. 1A and 1B;
[0033]FIG. 5 is a cross-sectional view of the respiratory mask taken along line 5-5 of FIG. 4;
[0034]FIG. 6 is a cross-sectional view of the respiratory mask taken along line 6-6 of FIG. 4;
[0035]FIG. 7 is a cross-sectional detail view of a mask seal taken along line 7-7 of FIG. 4;
[0036]FIG. 8 is a cross-sectional detail view of a single arc section taken along line 8-8 of FIG. 3;
[0037]FIGS. 9A and 9B are perspective view of a respiratory mask and a side view of a forehead pad, respectively, according to a third embodiment of the present invention.
[0038] There is generally indicated at 10 in FIGS. 1A, 1B and 3-6 a respiratory mask constructed according to one preferred embodiment of the present invention. Respiratory mask 10 includes a shell or body portion 12, which is preferably, but not necessarily, a general rigid, formed structural shell having an open side 14 that defines an annular flange portion 16 to which a flexible, resilient, unitary seal member 18 is affixed by the provision of a retainer ring 19.
[0039] Shell 12 also defines an opening 20 or other suitable means for connecting mask 10 to a supply of gas for administration to a patient on another side of the shell opposite open side 14. The mask shown is a nasal or half mask. It is to be understood, however, that the invention contemplates a full face mask covering both the nasal and oral openings of the patient. Shell 12 further includes two outwardly projecting strap retaining tabs 22 and an upwardly projecting strap retaining tab 23, each having suitable elongated apertures 24 that receive and retain suitable conventional head straps (not shown) for retaining the mask 10 with respect to the face of a patient.
[0040] Seal 18 includes a solid flexible peripheral wall portion 26, as shown in FIG. 6, having an annular base or inner end 28 that is fixedly and sealingly retained with respect to flange 16 and an outer end 33. Peripheral wall portion 26 has a first thickness between inner end 28 and outer end 33. Adjacent outer end 33 of peripheral wall portion 26 is a generally annular inturned surface 32 spaced from the mask shell 12 for confronting engagement with a patient's face. Annular surface 32 projects inwardly of peripheral wall portion 26 from a first juncture, which corresponds to outer end 33 of peripheral wall portion 26. In addition, annular surface 32 is generally triangular in shape having an upper apex angle 32A and two lower angles 32B. Annular surface 32 is provided with a first sealing portion 31 and a thin sealing portion 35, as perhaps best shown in FIG. 7.
[0041] First sealing portion 31 begins at the first juncture, i.e., outer end 33 of peripheral wall portion 26, and extends inwardly. First sealing portion 31 has a second thickness that is substantially the same as the first thickness of peripheral wall portion 26. Thin sealing portion 35 begins interiorly of the juncture between peripheral wall portion 26 and first sealing portion 31 of annular surface 32 and extends to an inner edge 36 defining an opening 38. More specifically, thin sealing portion 35 begins at a second juncture 37 located interiorly of the first juncture that generally corresponds to the termination point of first sealing portion 31. Thin sealing portion 35 extends from second junction 37 to inner edge 36 defining opening 38. Thin sealing portion 35 has a third thickness that is significantly less than the second thickness of first sealing portion 31. In addition, thin sealing portion 35 lies substantially in a single plane and includes a lower boundary substantially near two lower angles 32B and an upper boundary substantially near upper apex angle 32A.
[0042] Preferably, seal member 18 further includes a thin bridge portion 40 for confronting engagement with the bridge of a user's nose where a common pressure point occurs in existing masks. Thin bridge portion 40 extends substantially perpendicularly from the upper boundary of the sealing portion 18 to form an upper extension of thin sealing portion 35. Thin sealing portion 35 and the thin bridge 40 are of a uniform thickness of approximately 0.02 inches. A transition area 42, as best shown in FIG. 7, of gradually increased thickness is disposed between thin sealing area 35 and the thicker first sealing portion 31 of the annular surface 32. Transition area 42 also corresponds to second junction 37. For thin bridge portion 40, the transition area 42 extends between peripheral wall portion 26 and thin bridge portion 40.
[0043] In the illustrated exemplary embodiment, outer end 33 of peripheral wall portion 26 and annular surface 32 are contoured to accommodate the side of the patient's nose and upper lip. However, for a full face mask, annular surface 32 would additionally be contoured to accommodate the user's cheek and chin structure, and contiguous intervening zones. In either case, variation in user facial structure, especially in the area of the bridge of the nose, and in the chin-to-cheek proportions, makes seal flexibility necessary to accommodate the many different facial contours likely to be encountered. Alternatively, thin sealing portion 35 may also be provided in the lower portion of mask 10 between two lower angles 32B.
[0044] Also shown in Figs. 1B, 2 and 6, seal member 18 is preferably provided with a plurality of upstanding flexible members or ribs 34, which are spaced circumferentially about and integral with the interior periphery of peripheral wall portion 26. Ribs 34 project radially inwardly of wall portion 26 and their length extends intermediate inner end 28 and outer end 33. Ribs 34 resiliently support the peripheral wall portion 26 and the annular surface 32 against excessive deformation.
[0045] A further aspect of the presently preferred embodiment of the present invention pertains to the provision of a spacer element or forehead cushion 56, which is, but not necessarily, removably or fixably attached to upwardly projecting strap retaining tab 23. It should be understood that when mask 10 is donned by a patient, retaining tab 23 overlies the patient's forehead. With reference to FIG. 1B, there is shown a forehead cushion 56 in the form of a generally oval body.
[0046]FIGS. 1, 1B and 3-6 illustrate the preferred embodiment in which the forehead cushion 56 is attached to a removable base plate 58 having at least one elongated aperture 60 and preferably two elongated apertures 60. Retaining straps (not shown) pass through both elongated apertures 60, 24 of the removable base plate 58 and the upwardly projecting strap retaining tab 23 to securely, yet removably attach forehead cushion 56 to strap retaining tab 23.
[0047] Forehead cushion 56 is formed of a resilient gel substance i.e., a urethane gel, such as a viscoelastic polyurethane polymer, possessing resilience or recoil characteristics corresponding substantially to those of human fat tissue. More specifically, forehead cushion 56 preferably has a resiliency as defined by durometer measured on the Shore 00 scale, which is used to gauge the resiliency of very soft resilient materials, of about 10 or softer and, most preferably, about 0. Such resiliency corresponds substantially to that of human fat tissue, which also exhibits a durometer reading of 0 on a Shore 00 scale. While virtually indistinguishable from human fat tissue when measured on the Shore 00 scale, the gel substance of forehead cushion 56 preferably exhibits a resiliency or durometer on the Shore 000 scale, which is a scale used to measure extremely soft resilient materials, of from about 20 to 45. By comparison, human fat tissue registers a durometer of about 10 on the Shore 000 scale. A suitable gel substance is disclosed, for example, in U.S. Pat. Nos. 5,647,357 and 5,884,624. Although the gel substance is described in these patents with respect to the seal portion of a respiratory mask, the present invention contemplates using the same substance for forehead cushion 56.
[0048] In one embodiment of the present invention, forehead cushion 56 is covered by a protective covering. The covering increases the durability of the forehead cushion while also permitting easy cleaning of the cushion. The covering must satisfy several physical criteria. It must, inter alia: (1) resist tearing and puncturing, (2) tightly conform to the forehead cushion without changing or deforming the contours thereof, (3) be chemically compatible with the cushion, (4) be biocompatible and non-irritating to a user's skin, and (5) be sufficiently thin and supple such that its presence has a negligible impact on the resultant durometer of forehead cushion 56. In this regard, an exemplary embodiment of the present invention contemplates that the covering comprise a thin (approximately 2 to 10 mils thick) flexible plastic film. Urethane has been found to be preferable for this particular purpose as such material meets not only the objectives of the present invention but is also comparatively inexpensive and easy to apply to the surface of forehead cushion 56.
[0049] The covering may be applied to forehead cushion 56 by any suitable process. For instance, liquid urethane may be applied by spraying or dipping and then permitted to cure. Preferably, however, the urethane is prefabricated by vacuum forming so as to produce a skin of controllable and uniform thickness that is subsequently vacuum formed to the forehead cushion using conventional techniques.
[0050] As yet another alternative embodiment, the present invention contemplates that forehead cushion 56 be defined by substances of increasingly softer durometers in a direction toward the surface of the cushion that contacts the patient, such that the softest materials, comprising the previously discussed gel substance and possessing the resiliency characteristics described hereinabove, constitute the face-contacting portion of the forehead cushion 56.
[0051] In further embodiment of the present invention, as shown in FIG. 6, forehead cushion 56 includes a first portion 57 defined by the gel substance discussed above and a second portion 61 defined by a selectively formable substance so that the general shape of forehead cushion 56 can be customized to enable the forehead cushion to conform comfortably on the surface of the patient.
[0052] The selectively formable substance in second portion 61 of forehead cushion 56 is capable of being placed in a malleable state so that it molds from a first pattern into a second pattern. The formable substance is also capable of being placed in a fixed state so that it retains the second pattern after being so molded. Dashed line 59 in FIG. 6 represents the interface between first portion 57 and second portion 61 when second portion 61 is in its original, first pattern, i.e., prior to being molded to match the contours of the patient.
[0053] In an exemplary embodiment of the present invention, the formable substance in second portion 61 of forehead cushion 56 is heat activated so that it transitions from the fixed state to the malleable state upon being heated to a certain level. It also transitions from the malleable state to the fixed state upon being cooled to certain level. In one embodiment of the present invention, the formable substance defining second portion 61 is a combination of the above-described gel substance and a stiffening agent, such as ethyl vinyl acetate. Although a range of mixture ratios are possible to achieve a variety of stiffnesses for second portion 61, in a preferred embodiment of the present invention, the second portion is a uniform mixture of approximately 60% gel substance and 40% stiffening agent.
[0054] This embodiment of the present invention provides a customizable forehead cushion 56 for contacting the respiratory mask in a comfortable fashion. More specifically, by providing a formable substance as second portion 61 of forehead cushion 56, the forehead cushion can be macro-customized to match the general contours of the forehead of the patient, such as the bone structure underlying the portions of the patient's face over which strap retaining tab 23 is to be placed. In addition, first portion 57 of forehead cushion 56, being a gel substance as described above, provides the beneficial effects of micro-customization in that the gel readily conforms to the external features of the patient's face and without being patterned to match the specific features of the user. Instead, the consistency of the gel allows the first portion to fill in the gaps on the surface of the user once the forehead cushion is applied to the user. Thus, a single forehead cushion 56 provides the benefits of micro-customization and macro-customization.
[0055] Furthermore, the formable substance in second portion 61 can be reshaped, as needed, merely by causing the formable substance to transition again to the malleable state, which, in the above embodiment, is accomplished by reheating the second portion. Thus, forehead cushion 56 can be re-customized if, for example, the patient is unsatisfied with a previous attempt to customize the forehead cushion. Still further, because the gel substance of first portion 57 provides the beneficial effects of micro-customization and because the second portion can be customized to match the general contours of a patient, a commonly configured forehead cushion 56 having first and second portions 57 and 61 can be adapted for use with a wide variety of patients, thereby maximizing the efficiency of the manufacturing process. This feature also makes it possible to minimize the number of different off-the-shelf variations in the forehead cushion in order to provide a comfortable forehead pad suitable for each patient from a group of patients having a wide range of different physical characteristics. In addition, no special mechanisms for adjusting the forehead pad are need in order to allow a commonly configured mask to be used with a wide variety of patients.
[0056] In the embodiment of forehead cushion 56 illustrated in FIG. 6, first portion 57 and second portion 61 are generally integral with one another with the junction between the two portions being defined by a interface 59. It is to be understood, however, that the interface between first portion 57 and second portion 61 need not be as shown. On the contrary, the interface between first portion 57 and second portion 61 can vary in three dimensions depending on the desired structural characteristics of the forehead cushion.
[0057] Although FIG. 6 illustrates a relatively distinct separation between first portion 57 and second portion 61, it is to be understood, however, that there need not be such a distinct separation of these portions. On the contrary, forehead cushion 56 can be constructed and arranged so that the mixture ratio of gel to stiffening agent gradually changes. For example, in one embodiment of the present invention, the mixture ratio of gel to stiffening agent gradually increases in the direction toward the surface of the forehead cushion 56 that contacts the patient, which is substantially 100% gel substance, with no specifically defined transition from second portion 61 to first portion 57. The present invention also contemplates that the mixture ratio can vary in three dimensions. Also, the rate of change in the mixture ratio from one portion to another in forehead cushion 56 need not be constant, i.e., linear. Instead, the rate of change in mixture ratios can vary depending on the desired characteristics for forehead cushion 56. Furthermore, the physical location of the areas of changing mixture ratios in the seal can vary depending on the needs of the user. Also, the present invention contemplates that there may be multiple layers of first portion 57 or second portion 61 or both defining forehead cushion 56.
[0058] In an alternative embodiment of a respiratory mask 100 according to the principles of the present invention, as illustrated in FIG. 2, a gel cushion 560, which is otherwise the same as gel cushion 56 discussed above, is fixedly attached directly to strap retaining tab 23 of mask 100 without the use of base plate 58. Although gel cushion 56 and 560 are illustrated as being generally oval shaped, it is to be understood that the present invention contemplates other suitable shapes, such as trapezoidal or rectangular, for the gel cushion. Strap retaining tab 23 is preferably trapezoidal in shape with elongated apertures 24 at slight angles to provide a comfortable yet secure retaining strap arrangement.
[0059] Yet another alternative embodiment of the present invention, a respiratory mask 600 and forehead cushion 602 according to the principles of the present invention is illustrated in FIGS. 9A and 9B. Forehead cushion 602 is that a gel cushion that is otherwise the same as gel cushion 56 discussed above except that it is removeably attached to strap retaining tab 604 of mask 600 without the use of base plate 58. In the illustrated exemplary embodiment, removeable coupling of the forehead cushion to the strap retaining tab is accomplished via a snap-fit engagement of the forehead cushion to the strap retaining tab. More specifically, a pair of snap-fit slots 606 are provided in strap retaining tab 604 that receive protrusions 608 that extend from one side of a snap-fit plate 610. Gel substance 612 is fixed to the other side of snap-fit plate 610, for example, by adhesive attachment. Of course, the present invention contemplates that the snap-fit slots and protrusions can be provided in any manner on the strap retaining tab 604 and snap-fit plate 610.
[0060] It is to be understood that the present invention contemplates using other mechanisms to releaseably secure the gel forehead pad to the strap retaining tab. For example, a hook and loop attachment mechanism, such as VELCRO®, or a tongue and groove attachment mechanism can be used to releaseably secure the forehead pad to the strap retaining tab.
[0061] Yet a further aspect of the presently preferred embodiment involves an elbow coupling 62 rotatably attached at a first end portion 64 to opening 20 in shell 12 for coupling mask 10 to a supply circuit operatively connected to the supply of gas e.g., a blower or other suitable means for providing a flow of pressurized breathing gas. The rotatable swivel attachment of the first end portion 64 of the elbow coupling 62 provides the supply circuit with the ability to rotate 360° about the mask 10. In the illustrated embodiment, first end portion 64 of coupling 62 extends from mask shell 12 along a first axis 65 generally perpendicular to a first plane 67 defined by the side of respiratory mask shell 12 opposite open side 14. First plane 67 generally corresponds to the plane in which opening 20 lies.
[0062] In addition, the elbow coupling 62 includes integral exhaust ports defined in first end portion 64 for purging exhaled gas from the respiratory mask system. First end portion 64 preferably includes a slot 66 with side walls 68 and at least one, and preferably two, openings 70 located 120° left and right from the vertical centerline of elbow coupling 62. At least one, and preferably two, arc sections 72 a and 72 b are positioned within slot 66 on first end portion 64. An exemplary embodiment of an arc section 72 a, 72 b is shown in FIG. 8. As shown in this figure, each arc section includes a tapered through hole 74 overlying one of the two openings 70. Tapered through hole 74 is larger on the inside diameter and smaller on the outside diameter to provide a quiet passage of gas through the holes.
[0063] Arc sections 72 a and 72 b are preferably formed of a nonelastomeric polycarbonate material, but may be formed of any suitable material including elastomeric materials. Arc sections 72 a and 72 b have lower ends 73 having a cut out portion 76 such that arc sections 72 a and 72 b matingly join about the circumference of first end portion 64 of coupling 62. Arc sections 72 a and 72 b are preferably glued into slot 64 in elbow coupling 62.
[0064] Opening 70 and through hole 74 together define an exhaust port that is disposed near shell 12 to minimize dead space in the respiratory circuit. In addition, the exhaust port defined by opening 70 and through hole 74 are configured and arranged to exhaust gas from the first end portion of the coupling in a second plane 75 that is generally parallel to first plane 67. By directing exhaust gases in this manner, the present invention prevents that exhaust gas from disturbing the patient or the patient's bed partner. Arc sections 72 a and 72 b make it possible to easily manufacture tapered exhaust ports in the coupling while providing opening 70 and through hole 74 in the locations shown maximized comfort associated with the exhausting of gas from the respiratory mask system.
[0065] Coupling 62 includes an elbow portion 78 operatively coupled to first end portion 64. Elbow portion 78 includes a second axis coaxially aligned with the first axis 65 and a second axis 80 generally parallel to first plane 67 and second plane 75 so that coupling 62 defines a 90° bend in the patient circuit. It is to be understood, however, that the elbow portion of coupling 62 can be defined over a range of angles other than the 90° angle shown in the figures.
[0066] Although the invention has been described in detail for the purpose of illustration based on what is currently considered to be the most practical and preferred embodiments, it is to be understood that such detail is solely for that purpose and that the invention is not limited to the disclosed embodiments, but on the contrary, is intended to cover modifications and equivalent arrangements that are within the spirit an scope of the appended claims.
|Patente citada
|Fecha de presentación
|Fecha de publicación
|4 May 1936
|28 Mar 1939
|American Box Board Co
|Título no disponible
|Título no disponible
|Título no disponible
|Título no disponible
|Patente citante
|Fecha de presentación
|Fecha de publicación
|4 Oct 2002
|1 Mar 2005
|Resmed Limited
|Forehead support for facial mask
|13 May 2005
|2 Feb 2010
|Map Medizin-Technologie Gmbh
|Breathing mask arrangement and a forehead support device for same
|25 Mar 2005
|23 Feb 2010
|Ric Investments, Llc
|Headgear assembly for a respiratory support system
|17 Dic 2007
|27 Jul 2010
|Resmed Limited
|Mask with integral cushion and forehead piece
|25 Jul 2006
|17 Ago 2010
|Map Medizintechnologie Gmbh
|Breathing mask for feeding a breathing gas to a mask user and discharge device for discharging breathing gas
|17 Jun 2005
|9 Nov 2010
|Nellcor Puritan Bennett Llc
|Ball joint for providing flexibility to a gas delivery pathway
|17 Jun 2005
|14 Dic 2010
|Nellcor Puritan Bennett Llc
|Gas exhaust system for a gas delivery mask
|17 Jun 2005
|8 Mar 2011
|Nellcor Puritan Bennett Llc
|Gas delivery mask with flexible bellows
|25 Abr 2006
|28 Jun 2011
|Map Medizin-Technologie Gmbh
|Application device for breathing mask arrangement
|16 Oct 2008
|12 Jul 2011
|Nellcor Puritan Bennett Llc
|Adjustable gas delivery mask having a flexible gasket
|28 Nov 2007
|9 Ago 2011
|Map Medizin-Technologie Gmbh
|Breathing mask arrangement as well as an application device and a forehead support device for same
|3 Ago 2009
|31 Ene 2012
|Nellcor Puritan Bennett Llc
|System and method for securing a gas delivery mask onto a subject's head
|13 Jul 2006
|8 May 2012
|Ric Investments, Llc
|Forehead pad and forehead support assembly
|23 Sep 2009
|29 May 2012
|Resmed Limited
|Forehead support for facial mask
|30 Jun 2010
|3 Jul 2012
|Resmed Limited
|Mask with integral cushion and forehead piece
|9 Jul 2010
|12 Feb 2013
|Resmed R&D Germany Gmbh
|Breathing mask for feeding a breathing gas to a mask user and discharge device for discharging breathing gas
|27 Ago 2009
|26 Mar 2013
|Resmed R&D Germany Gmbh
|Breathing mask arrangement and a forehead support device for same
|7 Jun 2007
|9 Jul 2013
|Fisher & Paykel Healthcare Limited
|Breathing assistance apparatus
|20 May 2011
|9 Jul 2013
|Resmed R&D Germany Gmbh
|Breathing mask arrangement as well as an application device and a forehead support device for same
|13 Nov 2008
|11 Feb 2014
|Intersurgical Ag
|Anti-asphyxiation valves
|4 Ago 2010
|29 Abr 2014
|Darren Rubin
|Universal medical gas delivery system
|28 Ene 2013
|10 Jun 2014
|Resmed R&D Germany Gmbh
|Breathing mask for feeding a breathing gas to a mask user and discharge device for discharging breathing gas
|19 Jun 2012
|5 Ago 2014
|Resmed Limited
|Mask with integral cushion and forehead piece
|3 Jun 2005
|19 Ago 2014
|Resmed Limited
|Cushion for a patient interface
|31 Oct 2007
|7 Oct 2014
|Resmed R&D Germany Gmbh
|Method for manufacturing hollow structure for breathing mask
|3 Sep 2009
|28 Oct 2014
|Resmed Limited
|Foam-based interfacing structure method and apparatus
|8 May 2008
|4 Nov 2014
|Resmed Limited
|Mask assembly
|17 May 2011
|4 Nov 2014
|Resmed R&D Germany Gmbh
|Application device for a breathing mask arrangement
|27 May 2011
|2 Dic 2014
|Home Health Medical Equipment, Inc.
|CPAP mask frame
|6 Dic 2004
|1 Sep 2015
|Fisher & Paykel Healthcare Limited
|Breathing assistance apparatus
|21 Jun 2013
|29 Sep 2015
|Resmed R&D Germany Gmbh
|Breathing mask arrangement as well as an application device and a forehead support device for same
|14 Mar 2002
|11 Mar 2004
|Bernd Lang
|Breathing mask arrangement and a forehead support device for same
|4 Nov 2003
|27 May 2004
|Resmed Limited
|Forehead support for facial mask
|9 Abr 2004
|13 Ene 2005
|Resmed Limited
|Mask with integral cushion and forehead piece
|25 Mar 2005
|28 Sep 2006
|Ric Investments, Llc.
|Headgear assembly for a respiratory support system
|17 Jun 2005
|21 Dic 2006
|Brian Woodard
|Gas exhaust system for a gas delivery mask
|17 Jun 2005
|21 Dic 2006
|Geiselhart Edward M
|Gas delivery mask with flexible bellows
|17 Jun 2005
|21 Dic 2006
|Brian Woodard
|Ball joint for providing flexibility to a gas delivery pathway
|17 Jun 2005
|21 Dic 2006
|Brian Woodard
|System and method for securing a gas delivery mask onto a subject's head
|17 Jun 2005
|21 Dic 2006
|Ed Geiselhart
|Adjustable gas delivery mask having a flexible gasket
|6 Dic 2004
|21 Feb 2008
|Mcauley Alastair Edwin
|Breathing Assistance Apparatus
|31 Oct 2007
|29 Abr 2010
|Map Medizin-Technologie Gmbh
|Hollow structure and method/tool for manufacturing same
|29 Ene 2009
|30 Dic 2010
|Peter Forsell
|Device, system and method for treating obesity
|8 Dic 2011
|Home Health Medical Equipment, Inc. d/b/a AG Industries
|Cpap mask frame
|24 Dic 2007
|6 Nov 2008
|Röderich, Hans J.
|7 Jun 2007
|21 Dic 2007
|Fisher & Paykel Healthcare Ltd
|Breathing assistance apparatus
|Clasificación de EE.UU.
|128/206.24, 128/205.25
|Clasificación internacional
|Clasificación cooperativa
|Clasificación europea
|7 Nov 2005
Owner name: RIC INVESTMENTS, INC.,DELAWARE
Free format text: DIVIDEND FROM SUBSIDIARY TO PARENT;ASSIGNOR:RESPIRONICS, INC.;REEL/FRAME:016741/0570
Effective date: 20020627
|8 Nov 2005
Owner name: RIC INVESTMENTS, LLC.,DELAWARE
Free format text: CHANGE OF NAME;ASSIGNOR:RIC INVESTMENTS, INC.;REEL/FRAME:016747/0177
Effective date: 20040317
|14 Mar 2013
|Fee payment
Year of fee payment: 4


text:
M. Golf
The Commodore men's golf team finished the first round of the Nike Collegiate Invitational in 12th place on the team leader board after...Read More «
M. Cross Country
Jake Van Geffen was one of numerous Commodores to PR on Friday at the Notre Dame Invitational.Read More «
M. Golf
The sixth-ranked Commodore men's golf team, fresh off of a team victory at the DICK's Collegiate Challenge Cup last weekend at The Golf...Read More «
W. Soccer
Vanderbilt tied LSU 1-1 on Friday night on the road in Baton Rouge, La. Sophomore goalkeeper Christiana Ogunsami made stopped all six of the Tigers...Read More «
W. Cross Country
Seven VU women set new PRs and Van Geffen shines for the VU men during impressive showing at Notre Dame.Read More «
M. Basketball
The 2015-16 edition of the Vanderbilt Commodores hit the floor for the first time on Friday afternoon in their first practice of the season. ...Read More «

subset: commoncrawl


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Piedmont Traditional
Posted by dfuller on Jul 17, 2015 in Listings, Piedmont | 0 comments
Sunny entertainer's dream, steps to Dracena Park! Family oriented layout. Spacious kitchen, sunny enclosed breakfast patio, Cozy family room with fireplace. Exceptional master bed/bath, fireplace, peek a boo views of the city. Exercise room, cedar sauna 1,500+ sqft attic. Plus spaces. Close to schools!
Piedmont Cottage
Posted by dfuller on Jan 21, 2015 in Piedmont | 0 comments
Updated 3 Bdrms, 2 Baths light-filled Craftsman on quiet street with bonus space off of garden, ideal for home office or storage. Level garden with deck. Near public transportation, the Rose Garden, top-rated Piedmont schools, College Avenue and Piedmont Avenue shops and restaurants.
Piedmont Craftsman
Posted by dfuller on Jan 21, 2015 in Listings, Piedmont | 0 comments
Light-filled 1920's Craftsman. 1st time on market in 40-years! 4 spacious BR/2 baths on one level, spacious living room. Eat-in-kitchen levels out to huge yard. Close proximity to Dracena Park., Piedmont Ave.; Top rated K-12 schools.
Piedmont Colonial
Posted by dfuller on Jan 29, 2014 in Piedmont | 0 comments
The gracious American Colonial house at 312 Sheridan Avenue in Piedmont is on the market for the first time in over 55 years. It was built in 1920 for Henry L. Chase and his young family. Chase was a commercial property and investment manager and chose this generous pie-shaped lot for his own home. Designed as a family home, the rooms are large, the ceilings are high, and many windows bring in lots of light. With five bedrooms and a flexible floor plan, there is plenty of room to play, study and/or work.
Retaining many of the original details, this classic house has recently been renovated throughout with a new kitchen and bathrooms, new exterior and interior paint, refinished hardwood floors and new landscaping. The unusual Dutch front door is capped with a curved pediment and flanked by square, paneled columns. Angled bay windows bring in light to the generous living and dining rooms. French doors on each side of the classic fireplace lead from the living room to the brick terrace with new wood benches. The dining room opens directly to the spacious kitchen with its 8-burner Viking stove and pot filler faucet, Viking refrigerator, marble counters and generous pantry space. The house has many of the original chandeliers. Beyond the kitchen, there is a family room with built-in bookcases, guest room and full bathroom, laundry room (once a breakfast room with corner cabinet) and interior access to the garage. A rear entrance opens directly from the driveway to the kitchen.
Buying A Property Specifically for Vacation Rental – A How To
Posted by dfuller on Nov 2, 2013 in Alameda, Albany, Berkeley, Blog Entries, Emeryville, Oakland, Piedmont | 0 comments
John Wheatley has a great article on how he went about purchasing a property specifically to rent out via AirBnB. If you are not familiar with AirBnb, go and check it out. My wife and I have used it many times when visiting other cities. Basically the owner is renting the property out on a several day to week long basis. This sort of arrangement allows for much higher rents than monthly leasing. Another similar site to AirBnB is VRBO (Vacation Rentals By Owner).
Here is John's article, chock full of tips and tricks.
Ain't it the truth!
Posted by dfuller on Jun 12, 2013 in Berkeley, Emeryville, Oakland, Piedmont | 0 comments


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Marci Varley recently visited a RARUDO project to empower AIDS widows in Uganda. She wrote:
I arrived in Tororo town the night before my visit to Rayland Rural Development Organization (RARUDO) and was warmly welcomed by Mr. Joseph Onyango, the Executive Director and Founder of RARUDO. We sat together for about an hour so that he could tell me more about the organization which is non-denominational and non-partisan and hopes to "help the community (his hometown of Tororo) to stand on its own." Joseph founded RARUDO in 1997 because he "wanted to form a group of people to help, support and educate all of those in need." He truly wants to give all of those in need a chance to dream of a future, something many people in the developing world never do. Currently, RARUDO supports 240 children and 60 women; and, since 2007, has incorporated a local group of disabled and elderly people into the group (25 women and 15 men).
On Friday morning, we headed to the office in a rural village outside Tororo town to meet with other members of the organization...both those working to help the community and members of the community being assisted by the organization. As we approached the office, a group of about 10 women danced out of the main door singing a welcome song followed by other songs of appreciation and thanks as well as songs about the scourge of HIV/AIDS, their worries and their hopes of a better future. It was such a beautifully, traditional welcome that warmed my heart and definitely started the visit off on the right foot. (The attached picture is of the women singing another song as they re-entered the office and formally welcomed me. All of these woman have received aid from RARUDO.)
Several of Joseph's colleagues spoke about their work with RARUDO and even described how the organization helped them in years past. They outlined the projects of RARUDO which include, but are never limited to: training farmers in sustainability; distributing goats for sustainability projects; trainings and support on agriculture and livestock rearing; teaching long-term HIV/AIDS survival skills (through trained HIV/AIDS counselors within the group); sensitizing/teaching communities on avoiding/living with AIDS (through trainings and drama performances); building new homes to provide healthy living environments; distributing mosquito nets; running a vocational school for women and orphans (teaching tailoring and other domestic works such as baking in their new fuel-efficient oven for income sustainability); distributing scholastic materials and fees to orphans; and generally supporting the poorest of the poor (orphans, elderly, widows, widowers and disabled).
In addition to hearing about these projects, I also heard from a few of the community members who have received assistance from the organization. One AIDS widow, named Azeresi Achieng, even performed a monologue to describe her journey since learning of her own HIV status...her feelings of fear and solitude and how she overcame those feelings with the help of RARUDO and found strength to move forward. Ms. Achieng's initial thoughts were "where did this come from? it's all over the country and all over the world; everyone, even doctors are suffering; and no one knows where it came from" and she even thought that she should kill her children so that when she is gone, they don't suffer. However, with the help of RARUDO's trained counselors, she learned that she could live a happy and healthy life with HIV and now sees how "life, in so many ways, is good." The organization has aided her in several ways including teaching her how to stay healthy and training her in tailoring, but most importantly, RARUDO provided emotional support that truly helped her to get past her initial reactions and gain the strength to survive.
As I said my goodbyes and left the office, Joseph translated the song that was being sung by the women: RARUDO is a symbol of development and hope within a community of widows, orphans, disabled and elderly people. The group works together to support and counsel each other and are partners in the development that uplifts the community. RARUDO tells youth to study and work hard, to be safe and to know about HIV. The women will not stop singing, but will always tell others about RARUDO's work and continue to do what they can to be a part of that good work.
My visit with Joseph and all of the members of RARUDO is one that I will never forget. The work they have done in the community is inspiring and as I left them I felt myself wanting to be a better person.
- - - - - -
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Executive Director


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I figured out what is wrong with the world today. There isn't enough real country music anymore. Much of the country music today isn't really country and some I really don't like. Well, all is right in Bob's universe now, thanks to a show by Nathan Farrow and his band last Friday night.
Pat and I both thoroughly enjoyed the show and it started me to wondering – why is so little country music played live in the clubs today? It's a niche that I know must still exist, but we don't see too many bands that do country or venues that promote the same. There are few good solo musicians, like Channing, Pee Wee and others, but not too many bands. That's too bad, really.
Nathan Farrow started out being darn fine in my book for a non-musical reason. He is a fireman and that is one profession I really respect and admire. At the end of this column, you will see why. (Don't skip down to read now…finish this whole column, please…no cheaters allowed!)
Nathan had his band with him Friday night, which included a drummer, lead guitarist, bass guitarist and keyboard player. Nathan also plays the guitar and provides the spectacular lead vocals. The band is doggone good and performed well together. With some Johnny Cash songs, David Allan Coe, and other "real" county tunes, the band sounded great. Somehow, they even made the venerable "Mustang Sally" sound good, which is amazing because we have heard it 104,234 times in the past weeks. I think that Federal Law 133-9-A-4 should be repealed, which makes performing Mustang Sally a requirement for almost all bands.
Note to Venues – try mixing up your line-up by throwing in some country music occasionally. From what I saw, the crowd was really into the band and we heard several comments from the audience that it was a nice departure from the usual cover band material.
Want to know more about Nathan Farrow, hear some cuts of his music and find out where he will be playing in the coming weeks? His website is at click here.
There is still time to get tickets to the Hot Pink In The City Gala to benefit the MaryEllen Locher Breast Center at Memorial Hospital. Band X from Atlanta is playing. Cocktails, a silent auction, dinner and dancing are all on the ticket for January 23 at the Chattanooga Convention Center. Call the Memorial Hospital System Foundation at 423-495-4151 for more information and tickets.
Oops…I almost forgot to tell you my fireman story. On Jan. 28, 1922, a winter storm dumped 28 inches of snow on Washington D.C. and the East Coast. Washington's largest theater, the Knickerbocker, had a packed house when the roof caved in from the weight of the snow. Unfortunately, 98 people died, but hundreds were rescued by heroic firefighters that night. My Grandfather, Chief Fred M. Edwards was among the first responders. For years he had been fighting with the District over the switch from horse-drawn fire equipment to engine driven. His company still used the horses and was the only company able to get to the scene of the disaster in quick order. He was highly decorated for his efforts that night, and went on to have a 38-year career at the fire department. In my mind, he was the greatest grandfather and greatest fireman ever to live. I think he is in good company, with Nathan Farrow. Live! In Chattanooga
Thursday, January 15
Rhythm & Brews – 6 Day Bender, with Don Arther
Buds - Channing
Friday, January 16
Charles & Myrtles - Jack Williams
Buds – The Beaters
Blues Train Café Dalton – Frankie Moates
Murphy's Ale House – The Mudville Mafia
T-Bones - Seersucker
Market Street Tavern – Bluegrass Pharaohs
Rhythm & Brews – 8OZ-Enuff
Blue Orleans Creole Rest on Amnicola – Matt Turnure Trio
Table 2 – Live Jazz by the Ben Friberg Trio
Blue Orleans Downtown – David Anthony Blues
Midtown Music Hall – Behind The Sun: Red Hot Chili Peppers Tribute
Club Fathom – Infinite Orange, Raenbow Station
Saturday, January 17
Charles & Myrtles - Stephen Foster
T-Bones – The Mudville Mafia
Blues Train Café Dalton – Buckner Brothers
Las Margaritas Hixson Pike – Priscilla & Little Rickee
Murphy's Ale House – Robert Grier with Huskey Burnette
Angelo's Cleveland – Milele Roots
Rhythm & Brews – Boom Box
Riders – Common Ground
Dalton Depot – Bud Lightning
Midtown Music Hall – 6 Deuce
Ziggy's – Tragic Flaw
Club Fathom – Alyria, The Seas Aflame, Robert Paulson, A Fall From Grace
Tuesday, January 20
Table 2 – Live Jazz by the Ben Friberg Trio
Blue Orleans Downtown – Roddy Noll Jazz Trio
Spectaters - Channing
Wednesday, January 21
Buds – Nathan Farrow and Channing
Rhythm & Brews – Benefit for Suzy Kay
Market Street Tavern – Live Jazz by the Ben Friberg Trio
To have your venue's live event listed, just email us at email@example.com
October 9, 2015
October 8, 2015
Lt. Eddy Chamberlain was given the Extra Mile Award by the Highland Park Neighborhood Association for going above and beyond his normal line of duty, during National Night Out. Officials ... (click for more)
In order to safely construct the roundabout, the west side of Standifer Gap Road, (Eastbound approach), will be closed to through traffic, and detour signs will be posted, beginning on Oct. ... (click for more)
In conjunction with Haskell Interiors design studio, Shuptrine Fine Arts Group will present a celebration of art and design featuring master watercolorist Alan Shuptrine. At an open ... (click for more)
Lt. Eddy Chamberlain was given the Extra Mile Award by the Highland Park Neighborhood Association for going above and beyond his normal line of duty, during National Night Out. Officials said, Lt. Chamberlain ensures that every neighborhood issue is addressed and any actions taken are reported back to the citizens. He has welcomed this responsibility and accountability, ... (click for more)
In order to safely construct the roundabout, the west side of Standifer Gap Road, (Eastbound approach), will be closed to through traffic, and detour signs will be posted, beginning on Oct. 17, and scheduled for completion on Dec. 31. Ooltewah Ringgold Road (SR 321) will remain open (North and Southbound thru traffic.) Motorists are reminded of the reduced ... (click for more)
Attorney Gary Patrick said Chattanooga is "the most logical place for consolidating the Volkswagen litigation because it is the only location in the country where VW vehicles are being produced." Attorney Patrick, of the local firm of Patrick, Beard, Schulman and Jacoway, said a hearing is set Dec. 3 in New Orleans on the issue. A host of lawsuits seeking class action status ... (click for more)
A young woman was stabbed to death on Hooker Road early Friday morning and a man was injured. At approximately 1:54 a.m., Chattanooga Police responded to a stabbing at the 4000 block of Hooker Road. There police located an unidentified black female, believed to be in her twenties, deceased. A second person, an unidentified black male, was transported to a local hospital ... (click for more)
A few years ago I was flying over Chattanooga on my way to Atlanta. The sun had just come up and I enjoyed picking out Signal Mountain's location, on Walden's Ridge, in the morning light. What was amazing was that I could not tell that a town existed under the tree canopy. I hope that the same can be said 10, 20, or even 50 years from now. During last ... (click for more)
On July 4th of this year, FBI agents – acting on a tip -- arrested Alexander Ciccolo, a 23-year-old with known mental problems, as he carried a duffle bag full of automatic attack weapons. Moments before, he had bought the illegal firearms from an undercover informant outside of Boston. As agents later scoured his apartment, they found bomb-making equipment including a pressure ... (click for more)


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Nanuet Housekeepers
Choose from 14 housekeepers in Nanuet, NY! Average rate: $14.75/hr. Join for free today and make sure to share this rate with friends!
House Cleaning — Nanuet, NY
I am an excellent housekeeper and a senior caregiver. I have been doing this for more than 10 years! I am very honest, reliable, and experienced. I am very detailed with great cleaning skills. I have ...
10 yrs of exp.
Housekeeper/Organizer — Nanuet, NY
I have many years of experience maintaining a meticulous and organized home for my family of five. I've recently utilized my abilities in making housekeeping my profession and look forward to helping ...
3 yrs of exp.
Housekeeper And Organizer At Your Service — Nanuet, NY
My name is Danielle. I run my own business for pet care, childcare and also personal care. I am a great cleaner and organizer and I am a neat freak, any speck of dust or unclean service is a have not!...
10 yrs of exp.
Full-Time/Part-Time Housekeeper — Nanuet, NY
I have been a housekeeper for numerous families. I've done everything from the laundry and dishes to dusting mopping, vacuuming and cleaning ovens. I have references if needed. I am very hardworking a...
3 yrs of exp.
Nanuet, NY
Hello my name is Veronica. I have experience on Housekeeping , actually I have work a few days , but I am looking for the rest of the week, I have very good reference I'm very hones person.
10 yrs of exp.
House Cleaning Service — Nanuet, NY
Hello! I have been doing house cleaning service for 7 years, I do houses apartments, condos , offices, I do weekly, bi-weekly and monthly. I have experience and good references. I have my own car. I a...
7 yrs of exp.
Caring Babysitter/Nanny — Nanuet, NY
My name is Loveline. I'm a mother of 1 child. I love taking care of kids because it is something I enjoy doing. I love to clean and cook. My hobbies are singing, dancing, reading, playing sports and t...
5 yrs of exp.
Housekeeper — Nanuet, NY
My name is Iris I am a reliable, responsible person. I am looking for a housekeeping opportunity. I have been working for years with families. I have a lot of experience with all kind of housekeeper r...
8 yrs of exp.
Full Time Housekeeper — Nanuet, NY
Polished glass surface and windows dusted picture frames and walls hanging with a cloth change bed linen and remove the soil stuff sweep and mop the floor as need take the trash out.
3 yrs of exp.
Part-Time Housekeeper — Nanuet, NY
I am an excellent housekeeper. I have been doing this for more than 5 years! I am very honest, reliable, and experienced. I am very detailed with great cleaning skills. I have my own transportation an...
5 yrs of exp.
Join free today
Sign up now! It only takes a few minutes.
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text:
Sep 30, 2015 - Content scored high in Moz's biennial ranking of search engine ranking factors. It may have been the first time that it was included in the research, but industry experts believe we'll be seeing a lot more of it as a definitive ranking factor. Comments
May 14, 2015 - How retailers can come out on top in the changing world of search. Comments
Feb 18, 2015 - What do marketers need to consider to make sure they're optimizing their sites for the best mobile search experience possible? Comments
Oct 27, 2014 - For those who have already decided to bid on competitor terms in pay-per-click search, here are some best practices to consider. Comments
Aug 15, 2014 - A look at several of the Google AdWords extensions, ratings, and review services available, including what they do, where they come from, and how they can help your marketing efforts. Comments
Jun 25, 2014 - A study from BrightEdge suggests that brands could be losing out on traffic and conversions due to badly implemented mobile sites. Comments
Apr 16, 2014 - Technical SEO is still as relevant as ever and coding best practices are still vital to SERP success. So here is a look at the key impact areas that affect global SEO. Comments
Mar 26, 2014 - As search engines innovate, the SERPs will continue to be crowded, thus limiting the potential for a large number of text ads to display. If we are all competing for top spots on a larger scale, it is possible for CPCs to rise at a faster pace. Comments
Mar 19, 2014 - A comparison of results that each kind of search returns, as well as how to deal with semantic search changes. Comments
Mar 18, 2014 - Although there are endless touted benefits to ad extensions, here is a look why they may not be all they're cracked up to be, with 11 detailed reasons. Comments
Feb 28, 2014 - Although many think that paid and organic search clicks have been overvalued, the truth is that much of the value of search marketing - and search clicks - isn't acknowledged at all by most marketers. Comments
Feb 5, 2014 - How will SEO in 2014 be different from 2013? What do we need to do to overcome future update issues? Here are six things every SEO professional should be concerned about in 2014. Comments
Jan 31, 2014 - Put in place a process to understand how hard each form of marketing is working for you, how much it costs to ramp up that form of marketing, and how each form can change the behavior of your clients. Comments
Nov 7, 2013 - Great tactics to help gain extra exposure to your blog will help maximize its reach and overall ROI on your business. Comments
Sep 11, 2012 - Consider these ways to a more integrated approach to search that would minimize missed opportunities and redundant effort. Comments
Aug 9, 2012 - Consider these tactics to optimize your content on social media platforms. Comments
May 30, 2011 - With an increasing shift to smartphones, consider these four tips to optimise your mobile site. Comments
Mar 7, 2011 - Follow these steps to kick-start a comprehensive search integration strategy. Comments
October 21-22, 2015
November 17-19, 2015
November 25-26, 2015
April 11-13, 2016
Spring 2016
US Consumer Device Preference Report
Traditionally desktops have shown to convert better than mobile devices however, 2015 might be a tipping point for mobile conversions! Download this report to find why mobile users are more important then ever.
E-Commerce Customer Lifecycle
Have you ever wondered what factors influence online spending or why shoppers abandon their cart? This data-rich infogram offers actionable insight into creating a more seamless online shopping experience across the multiple devices consumers are using.
October 13, 2015
1pm ET/ 10am PT
November 12, 2015


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Coghlan's 9714 Zipper Pull Thermometer/Compass$3.99Keep track of the weather and where you are! General-purpose compass includes Fahrenheit and Celsius scale, plus wind-chill chart on back. Learn More
Coghlan's 7600 Folding Scissors$3.99A great travel accessory, with stainless steel blades and chrome-plated, die-cast handles. Learn More
Coghlan's 504D Camp Stove Toaster$3.49A classic design, the original camp stove toaster still performs perfectly, toasting up to four slices at a time. Durable steel construction features coated wires that won't rust and fold flat for easy packing. 9" diameter. Learn More
Coghlan's 1018 Trail Tape - Orange$3.99On Backorder Until 10/29/2015Bright-orange ribbon can be tied to trees, bushes and objects to mark favorite hiking or biking trails, campsites, fishing spots, and more. Easy to tear and tie by hand, this tape can come in handy in emergency situations as well. 150' long x 1" wide. Learn More


text:
Watch a book video for Political Justice in Budapest after World War II by Andrea Pető and Ildikó Barna.
Our 2015 Fall/Winter catalogue is available for download.
A long-awaited, highly-anticipated volume on nationalism and empire. The essays by outstanding scholars include case studies of Europe-based empires: Bourbon Spain, Napoleonic France, Italy, Great Britain, Oldenburg Denmark, Germany,Habsburg Austro-Hungary, Late-Ottoman Turkey, and Romanov Russia.
The Introduction can be downloaded free of charge from the book's webpage.
Watch an interview with Margarita Balmaceda about energy and state-building in Eastern Europe and about her book "Living the High Life in Minsk".
Energy and State-Building in Ukraine, Belarus and Lithuania: Between Domestic Oligarchs and Russian Power
a lecture by
Margarita M. Balmaceda
Supernatural phenomena and causalities played an important role in medieval society. Religious practice was relying upon a set of cult images and the sacral status of these depictions of divine or supernatural persons became the object of heated debates and provoked iconoclastic reactions.
The miraculous intervention of saints or other divine agents, the wondrous realities beyond understanding, or the manifestations of magic attributed to diabolic forces, were contained by a variety of discourses, described and discussed in religion, philosophy, chronicles, literature and fiction, and also in a large number of pictures and material objects. The nine essays in this collection discusses how supernatural phenomena – especially angels and devils – found visual manifestation in Latin and Eastern Christianity as well as Judaism in the late medieval, early renaissance period.
List of Illustrations Preface
Norbert Schnitzler, The Beam of Grace and the Ocular Paradigm. Some
Remarks on the Relation between Late Medieval Theology and Art
Gerhard Jaritz, Visual Images of the Supernatural in the Late Middle Ages, or,
How to Make the Entities Recognizable that Are not Part
of Our Natural World
Alexander E. Makhov, … In diversas figuras nequitiae:
The Devil's Image from the Viewpoint of Rhetoric Helmut Hundsbichler, Devils in Visual Proximity
Béla Zsolt Szakács, Supernatural Figures Incognito
Maria Crăciun, Guardians or Avengers? Depictions of Angels in Transylvanian
Altarpieces from the Late Medieval Period Zsófia Buda, Heavenly Envoys: Angels in Jewish Art
György E. Szőnyi, The Reincarnations of Enoch
from the Middle Ages to the Renaissance Anna Maria Gruia, Images to Influence the Supernatural:
Apotropaic Representations on Medieval Stove Tiles List of Contributors Index
216 pages, 90 illustrations
cloth $40.00 / €35.00 / £30.00


text:
Credits & Info
- Uploaded
- Nov 19, 2009 | 5:44 PM EST
- Weekly Users' Choice November 24, 2009
- Review Crew Pick November 24, 2009
- Daily Feature November 20, 2009
If you liked this, check these out!
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Author Comments
Rated 5 / 5 stars
the first time to see stanford and deimos also the first time they were protogonists this is the first stanford and deimos episode
Rated 5 / 5 stars
wait... in this series... all guys that smoke cigarets die...
litterally... this ep. is in which ep did one of them die... btw.. best series ever
Rated 5 / 5 stars
gotta love madness
ok when sanford was putting the bandanna on his head....deimos shot a shotgun right next to his ear
ouch much.........
Rated 4.5 / 5 stars
the first aparition on sanford and deimos... loves this animation.
Rated 5 / 5 stars
great dLc


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text:
By JUSTIN KENDALL
Ladies of Kansas City, wanna bang? Kansas City Chiefs quarterback Tyler Thigpen wants to go on a date with you right after the 24-year-old South Carolinian finishes banging this skeleton. KC Magazine will auction Thigpen off December 5 at the Uptown for Big Brothers and Big Sisters. It'll be a double date with 38 the Spot cue-card reader Holly Starr. You'll get tickets to see Thigpen be abused by the San Diego Chargers and then take a limo ride to 810 Zone. I didn't realize he was into S&M on top of skeleton play. Deadspin wonders who's bringing the skeleton.
Speaking of skeletons, Bill Snyder has returned to Manhattan to coach the Kansas State Wildcats after three years of Ron "Grimace" Prince stomping the sidelines. Arrowhead Addict is overjoyed about the return of the windbreaker-wearing Monty Burns lookalike (thank you, JoCoSOB). Life in SoJoCo
wants to pee on the parade and remind you that Snyder's last two
seasons in the "Little Apple" were losing. For only the second time ever, I agree with JoCoSOB. "The hiring of Snyder ensures that the Purple Towel waving hillbillies to the West will remain losing." Especially in Arrowhead next year.
KC Currents' Sylvia Maria Gross goes in-depth on the Kansas City Star's layoffs and interviews former Star fixtures Lee Judge and Kit Wagar. In the second part, Gross talks with the Star's Publishing Prince of Darkness, Mark Zieman. Note: Laying people off makes Zieman :(
The Seattle Post-Intelligencer's
Dan Raley totally wants to make out with the Sprint Center and its
"charcoal-colored seating," "upscale feel" and "cool electronic
imagery." I guess that makes the score, Kansas City 1, Seattle
Salut, C.W. Gusewelle! State of the Line has figured out a way to get through the 217-year-old Star
columnist's insufferably verbose dispatches. A drinking game! You guys
nailed the "wonderment at the glory of nature" bit but I gotta say I'm
a little disappointed. Where's the references to Paris, Mickey the Cat or C-Dub's unparalleled bird watching abilities?
Departing Columbia Daily Tribune political reporter Jason Rosenbaum remembers the life and times of Gobbles, the turkey pardoned by Gov. Matt Blunt. Gobbles star shined bright and then faded into obscurity and obesity. Gobbles, the fat Elvis of turkeys.
Showing 1-3 of 3


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In many areas, localized releases of industrial chemicals, pesticides, petroleumadditives such as MTBE. and fuel components such as benzene and hydrazine. have impaired groundwater quality. These groundwater 'plumes' are commonplace, and in many cases impact public water supplies or impedes the redevelopment of potentially valuable land.
Model RMT - Trailer Mounted Groundwater Remediation Systemsby Ozone Solutions, Inc. based in Hull, IOWA (USA)
This trailer used a large manifold with 7 solenoid valves controlling 11 and 12 wells each. 82 wells were controlled with this system. The ozone generators are water cooled TG-450 Ozone Generators.
AMS - Injection Toolingby Art's Manufacturing and Supply, Inc. (AMS Inc.) based in American Falls, IDAHO (USA)
The injection of remediation compounds or remedial solutions has rapidly become a widely accepted approach for addressing contaminated sites. AMS injection tooling may be used with a wide variety of remedial injection compounds, as well as standard bentonite based grout mixes. The tooling may also be adapted to any injection pump system. Include ...
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Secondly, Retro-Coat is a recently introduced vapor intrusion technology from REGENESIS' Land Science Technologies Division, whose widely used Geo-Seal composite vapor barrier system received the Environmental Business Journal (EBJ) Remediation Technology Award in 2008. Retro-Coat is a new chemical-resistant coating specifically engineered ...
AMS - Portable Grout Stationby Art's Manufacturing and Supply, Inc. (AMS Inc.) based in American Falls, IDAHO (USA)
This portable grout station provides a continuous flow of grout for completion of drilling and direct push applications. The grout station's hydraulic piston pump attaches easily to quick connects on AMS' auxiliary hydraulic hook-up kit. A lever controls the supply of liquid grout, which is delivered through a tube, ID of DP tooling, or tremie ...
CAP 18 ME - Anaerobic Bioremediation Productby Carus Corporation based in Peru, ILLINOIS (USA)
CAP 18 ME® anaerobic bioremediation product has been specifically manufactured for environmental applications such as anaerobic remediation of soils and associated groundwater.


text:
I'm new here (I think...I was a member of the Ford Fiesta Owners Club before but my log in/email address isn't recognised anywhere...!!!).
I did have a Ford Fiesta Flame mk 6, but I now have a Ford Fiesta Ghia 1.6 Mk6 (Facelift).
Started by Kate87, Oct 19 2010 06:52 PM
2 replies to this topic
Posted 19 October 2010 - 06:52 PM
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Posted 19 October 2010 - 07:01 PM
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Our October 5 meeting at Metrotown is close to the Mid Autumn Festival (Zhongqiujie) day (3/10). Let's celebrate this important Chinese event by having our meeting at a restaurant near Metrotown. The Fortune House Seafood Restaurant is in the US section of the Metrotown website map. This is very close to the entrance from the Skytrain. See the map on their
website. Attendees can use the mall directories to help locate the restaurant, and there is free parking in the underground mall parkade. No 'Maybe' RSVP allowed as we need to make a firm commitment to the restaurant. See you there! Ci zhi.
We have reached the limit of twenty participants in the October 5th meeting. (18 + 2 guests). Anybody who now wants to come will go on a waiting list. If somebody changes her/his RSVP, the first person on the wait list joins. IF YOU SAY YOU ARE COMING, IT IS IMPORTANT THAT YOU DO COME, UNLESS, OF COURSE, CIRCUMSTANCES CLEARLY PREVENT YOU FROM ATTENDING.
0 · October 3, 2009
I decided to start Reno Motorcycle Riders Group because I wanted to be part of a group of people who enjoyed my passion... I was excited and nervous. Our group has grown by leaps and bounds. I never thought it would be this big.
— Henry, started Reno Motorcycle Riders
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