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TORONTO, Nov. 27, 2013 /PRNewswire/ -- ClearCanvas, Inc, a leading developer, manufacturer and supplier of innovative imaging informatics infrastructure solutions, with a mission to make medical imaging available to all, announced today the breakthrough informatics solutions it will highlight at the 99th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA) at McCormick Place, Chicago from December 1st through 5th.
"This year is particularly exciting for ClearCanvas with the introduction of two truly differentiating solutions that power an organization's informatics infrastructure. Both solutions are designed to increase access to patient images, optimize efficiencies, and ultimately improve patient outcomes," said Clinton Chau, ClearCanvas's Founder and Chief Executive Officer. "RSNA gives us the chance to demonstrate what we have been working on and show the healthcare community the passion, dedication and commitment of ClearCanvas to provide the informatics infrastructure required to power medical imaging innovation around the globe both today and tomorrow."
Developed from the most powerful platform in imaging informatics, ClearCanvas is debuting two new innovative solutions as additions to its robust commercial portfolio.
|SOURCE ClearCanvas, Inc.
Copyright©2012 PR Newswire.
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The Blog
Words Have Consequences
What Obama's Cairo speech has wrought.
12:00 AM, Jun 16, 2009 • By SETH CROPSEY
Muammar Qaddafi, who had become gratifyingly less belligerent since the Reagan administration's 1986 airstrikes, subsequent economic sanctions, and the U.S. invasion of Iraq, came out of his box during a visit to Italy on June 11. "What's the difference," he asked in an address to Italian legislators, "between the U.S. airstrikes on our homes and bin Laden's actions?"
The difference is that the U.S. airstrikes of the 1980s were aimed primarily at military and government targets after Libyan planes fired missiles at U.S. carrier-based aircraft in international waters. The U.S. strike was also intended to punish Libya's complicity in the bombing of a discotheque in West Berlin frequented by off-duty American military personnel. Bin-Laden's attack on the World Trade Center was aimed at, and succeeded in, killing thousands of innocents as a means of expressing general hatred for the West and the U.S. in particular.
Qaddafi's equation of U.S. military responses to provocations of his own making--which followed Washington's extensive public and private warnings about American insistence on maintaining freedom of navigation in international waters--with bin Laden's surprise attack against civilians was offered up less than a week after President Obama's Cairo speech.
In this speech Obama called the 9/11 attacks "an enormous trauma to our country . . . that led us to act contrary to our ideals." Specifically, Guantanamo. The president reduced the evil of destroying several thousand innocents to a psychological episode that produced aberrant American behavior. Other parts of the same speech are equally unbalanced. "Israel must live up to its obligations" to allow Palestinians to lead decent lives. However, no such "obligation" exists for Palestinians to recognize Israel's right to exist.
No one should be surprised that Qaddafi's remarks followed Obama's so quickly. If the American president sees his international role as a great exhorter with a lot of explaining to do, why shouldn't the leaders of other countries, especially those who share serious misgivings about the role of the United States in the world join the chorus? If the "fight against negative stereotypes," as Obama put it, is what really stiffens the sinews and summons up the blood of the U.S. president, call in the speechwriters, act the role of the victim convincingly, and consider the attractive possibility that words may matter more than deeds in dealing with the United States--at least for a while.
For now this may be a largely moot issue in our relations with Libya. Oil prices haven't increased enough for Qaddafi to become a real troublemaker again, notwithstanding Obama's apologia and self-description as an arbiter between two value systems that may be regrettably locked in a stereotypically-induced misunderstanding.
But in other places around the world the transformation of U.S. foreign policy into moralistic exhortations anchored in efforts to judge national interest from a stereotype-free, neutral vantage point could have more immediate and serious consequences: the Korean Peninsula, for example.
On June 4, the day before Obama's speech in Cairo, Seoul reported that a North Korean patrol boat had violated its territorial waters off South Korea's western sea border. The same area was the site of naval clashes between the two states in 1999 and 2002, on the opposite side of the Korean Peninsula from where North Korea captured the intelligence ship, USS Pueblo in 1968.
Pueblo's mission was to monitor Soviet ships transiting the Tsushima Straits and collect signal and electronic intelligence from North Korea. She had departed Sasebo, Japan the second week of 1968 and was spotted and eventually forced by a North Korean sub chaser and three torpedo boats and aircraft into North Korean waters on 23 January 1968. Fired on and boarded, one U.S. sailor was killed in the action that preceded Pueblo's capture and detention in Wonsan. Her crew was taken to POW camps, starved and tortured before being released 11 months later. The incident sparked a feckless debate within the United States over how to respond. The ship today remains on the U.S. Navy's list of active-duty commissioned ships and sits in the harbor of Pyongyang, a reminder of a little power's ability to tweak a big one.

subset: commoncrawl


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Memphis Grizzlies v Boston Celtics
Members of the Boston Celtics including Rajon Rondo, Kevin Garnett,... Nieuwsfoto'sBasketbal,Basketbal - NBA Pro,Boston,Boston Celtics,Courtney Lee,Horizontaal,Huddle,Jared Sullinger,Kevin Garnett,Massachusetts,Memphis Grizzlies,Mensen,Paul Pierce,Rajon Rondo,Sport,Sportwedstrijd,TD Garden,Ten voeten uit,Verenigde StatenPhotographer Jared WickerhamCollection: Getty Images Sport 2013 Getty ImagesBOSTON, MA - JANUARY 2: Members of the Boston Celtics including Rajon Rondo #9, Kevin Garnett #5, Paul Pierce #34, Jared Sullinger #7, and Courtney Lee #11 huddle during the game against the Memphis Grizzlies on January 2, 2013 at TD Garden in Boston, Massachusetts. NOTE TO USER: User expressly acknowledges and agrees that, by downloading and or using this photograph, User is consenting to the terms and conditions of the Getty Images License Agreement. (Photo by Jared Wickerham/Getty Images)


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Weirdest Film Ever?
a few weeks ago, I stumbled across the trailer for a film called House (Hausu). For some reason I feel compelled to see this film, even though I know it will result in nothing more than utter confusion.
But confusion can be good too, right? Most of David Lynch's output seems to fall into this category.
So, I was wondering if anyone eles had any recommendations for films that weren't good, weren't bad but were just way out there?
Rubber - A film about a tyre (yes, a tyre) that is possessed & kills people.:eek:
A woman's vagina has a tooth in it and everytime someone goes to rape or have sex with her, it kills
Gozu - is terrifyingly weird but it really is a sweet film about love.
I have already shared my list in a similar recent thread: Strangest film ever.
I noticed you mentioned Hausu - so, how was it? worth the £16 I'll have to pay to watch it?
might have to get me a copy though.
Anything directed by Peter Greenaway
The Cell.
For example: there is a scene where a character plays piano and she loses her fingers. It's a nod at a time when there was a trend for children to practise piano every Saturday morning. Hence, this childhood joke: "My fingers disappeared last Saturday." E.g. they practised so hard that their fingers went numb. There are many other similar references.
In folk mythology, for instance, a mirror is a gateway to another you. There is an idea that each person has three selves: public you, private you and inner you. The mirror apparently can reveal the inner you. The water represents purity and the afterlife, so when a ghost's long hair in the water of your bath, it's contaminated, e.g. you can't die with grace (it's against Shinto belief to bury a dirty body). The length of a ghost's hair is a measurement of strength or anger as there is a folk belief that hair keeps growing after a wronged woman dies. Longer the ghost's hair, more difficult to kill the ghost. The list just goes on. Ringu or Ringu 2 has a better spin on all this, but I digress.
Most sly digs and references are lost in translation, though, but they aren't important, anyway. There are three main layers: visual, characters and sly digs through dialogue, and they have nothing to do with each other. The director is more into making each fear come alive by any means, however bizarre. :D It's basically a nonsensical campy film.
You're better off renting it because imo, it's ideal for a one-time viewing only.
Anything by David Lynch. Discussion over.
I'd contribute but discussion is over?
Tree of Life
A film with too much riddles. Arty crap that wants you see things that arent there. Other people claiming they are soo clever that they get it.
Hausu is definitely up there, but I think it's weird in all the right kind of ways. It's a lot of fun to watch even though I don't think i'd have the energy to watch it often.
I thought Tideland was a weird one.
A Snake of June was unusual too but interesting.
The Gingerdead Man
Nowhere (1997) - Gregg Araki
You can watch this free online at archive.org as it's in the Public Domain.
Anyone seen Sextette a musical with Timothy Dalton and Mae West, in I think her last role. Not only is it weird, its just wrong.
Motorama (1991) is a great but totally bizarre film which was directed by Barry Shils. A 10 year old boy steals a car and goes on a road trip across a dystopian version of America, while being pursued by the doctor from Star Trek Voyager and - at one point - arm wrestling Meatloaf in a pub. It's also got Jack Nance from Twin Peaks and Eraserhead in it. If you haven't seen it, you should definitely try to get hold of it!
Pokemon the first movie. Very strange. Mew too.
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I posted last week about my miserable mornings with my dd age 9. Well for a few weeks now she has been telling me her medicine is making her sleepy. I have been noticing a huge downturn from what I saw the first semester of school. She has been forgetting things, not turning things in, grades are starting to slip, miserable mornings and now complaints of her medicine making her sleepy. Does this mean we need to up dosage? I can't stand the thought of putting more medicine into her. She is at 20mg of Vyvanse now- she started taking it in August. Can the body adjust that quickly? I'm terrified of causing major heart problems, we have no history of that but its a huge fear of mine.
Vyvanse Making My Child Sleepy??
Comments (10)
I find it really odd that a stimulant would make her sleepy unless she is having problems going to sleep at night.
We feel like Luke needs 30 mg, but when we gave him 30 mg in November, it took him 3 hrs to fall asleep. So we went back down to 20. But this week we went back to 30 thinking his body would be more used to the med. And it is. At least he falls asleep in an hour which is normal for him. So yes, they adjust to it. But I am still not sure how a stimulant is making her sleepy? All you can do is discuss it with her dr.
I agree with PP, I would talk with her doctor. It seems very odd that a stimulant would make her sleepy. Have you been tracking her sleep. For awhile, I would put my DS to bed at 8:30 and realized he wasn't going to sleep till after 10.
Dawn~SAHM to 3 Little Monkeys Dylan(7), Logan(4) and Alex
Tourette's Syndrome? Follow Me
I would wonder if she is getting enough sleep like pp's... is she ok until she takes it then says she is sleepy? or sleepy before hand?...
When was she diagnosed? maybe its not the right med for her..
When My 9 year old takes his, he is on 30mg of vyvanse if he is sleepy before hand it perks him up some..it doesn't make him sleepy...
I would talk to your dr about the concerns you have with the heart...
Mom 2 Bryan 21 & Andrew 11
My son is also on Vyvanse. I dont think it would make her sleepy...unless she cannot fall asleep at night because of the new meds and is therefore still tired in the AM's because of lack of sleep. My son is hard to wake up in the mornings, but he has never been a morning person. If anything, the meds wake him up a bit. If she is still forgetting things...maybe the dosage has never been right for her. But, I will say that the meds have helped DS in those categories, but it has always been a struggle for him to remember his coat, his water bottle regardless of the meds. What has improved is his ability to do his work at school, his handwriting, and his fidgeting. I think his does needs to be increased as well because of after 2 years at 20 mg I can barely read his writing again. It was beautiful the first 1.5 years on Vyvanse.
Up until Christmas break we were thinking the Vyvanse was truly a miracle drug. She easily made A's (lowest A was 97 in Social Studies), remembered everything, handwriting was the best in the class, desk was neat, AR goals met, she cared about how things were and looked and on top of everything she was having zero side effects. Sleep was the same, appetite was the same, she was growing, moods were good.
Now- struggling with work, forgetting everything, not wanting to get up and making mornings just beyond hard, not hardly eating, complaining of sleepiness and moods are horrible!!
JMO but it means that it's January. Every year, at this time, both my kids go through 2-3 months of being complete scatter brains. I just had to take YDD's math homework to the school today. Yesterday it was her reading packet. ODD's grades are down. Since we have never touched meds, and since YDD doesn't even have ADHD, I think it's the shortage of sunshine that does it.
As for making her sleepy - Ritalin, when my older brother took it, made him sleepy. So much that the school actually let him take a nap every day in school.
Karen, DanceMom to Alyssa(5/00) & Julia(11/01)
* ADHD without meds ** Parents of TEENS with ADHD *
BCPAC - Parents of kids in the performing arts!
Probably just my idiosyncratic reaction, though, as I really seem to crave sleep no matter what med I am on. But that one really highlighted it for me.
Karen- Glad to hear that other kids are struggling right now too. (Not that I want your children to struggle!) I got three emails from the teacher since winter break ended. ugh!
My daughter is just 7 this week and on her first school year on vyvanse. At 20mg dosage she is a lot easier to deal with....at school that is. Mornings are horrible for her. She is so difficult to wake and ask anything of her. By the time shes home, its the same scenario but worse because her older brother is in the mix now, who's also adhd and on same dosage of vyvanse. Evenings were so long and drawn out until pediatrician recommended melatonin (which is a miracle worker in my house). I wished I had heard of it a few years ago. She sleeps like a log once she is asleep and for a good 12 hours if I let her. Ii recently had a parent teacher over the phone and shes let me know that at school she is still very distracted and has moments of aggression when anything competitive comes into play. Shes concerned her attention spam is stopping her from keeping up with the rest of the class so im going to discuss her dosage with the pediatrician and cross my fingers for next report card.


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And she's still got it. Read More
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See who won and who went home empty handed at the BET Awards. Read More


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Bangs Synthetic Hairpiece by hairdo - $24.65
|Overall Rating
I ordered Buttered Toast. The color matched pretty close but the texture was horrible. Women if you ever had a Barbie Doll and tried to cut its hair and make it have bangs that's what it looked like. The hair made my scalp itch.
Looked like a dead animal pelt on my head!
|Overall Rating
The bangs look like real hair. And the shade ginger brown matched my hair color perfectly :)
|Overall Rating
Jessica Simpson bangs
They are a perfect color match and look terrific from the front/side. I have one wish and that is if they could be styled so that there are a few of the strands that go back over the end of the piece. There is no way to cover the back end of it and I don't have a lot of hair to tease up to try to hide it.
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Absolutely love
I have purchased the entire line of these clip in extensions and wear them individually or use 2 or 3 together. They stay in well, allow you to blend in your own hair and can be curled, flat ironed or hair dryer styled on low settings to match your own hair even better. After an illness all of my hair fell out and is still growing back, but very slowly, so this line of products allows me to add length and is not as hot as wearing a full wig, especially in summer. No one realizes it isn't real and i get lots of compliments....would definitely recommend.
Color, option to use heated styling aides, clips stay in.
I wish they had a wiglet for the very top of my head. The crown of my hair is coming back much slower than the rest and just a little piece would be great for really hot days or for just a quick run up to the store when I don't have time to mess with it
|Overall Rating
Perfect for chemo hat
This is the best "peekaboo" hair with a cap for me. Lost my hair in chemo, and I purchased this because the sides are longer than any other bangs. I removed the combs and stitched the piece to a hairband, and my hairpiece is secure under a chemo or baseball cap with long sides to casually tuck under the hat and frame my face below ears. Washes and styles easily, looks natural, and during my weekly treatments the nurses and other patients tell me I look wonderful. I showed them my hairpiece and they nearly fell on the floor, they thought it was my own hair.
Realistic and you are getting a full face frame, not just bangs, to wear with a chemo cap!
Purchased R25 and my bangs are monochromatic, would prefer a pretty blend.
|Overall Rating
Bought Wrong Color- Still Is Great!
Sadly, i bought a way lighter color then I should have. I tried to dye them, and the dye didn't stick. Overall, it's great if you buy the color thats right for you, i recommend to go darker, because it did look darker online then in my hands.
Great Feel, Looks Real, Feels Great On
Wasn't Right Color
|Overall Rating
fits great
i wondered about 3 little clips but they hold super well. I don't even know it is there. no one and i mean no one has figured out that it isn't my hair. it matches perfectly and with my bangs thinning i needed the boost.
easy to put in
|Overall Rating
Have to have
I have used this piece for a long time, I'm getting another. It may be surprising but it is versatile. I can use it as bangs or turn it around as a filler to go over a 3/4 wig line to cover it up and it adds volume to my own hair that can't quite cover up the line to blend my hair with the 3/4 wig. (I got R4, midnight brown)
wispy and natural to blend easy.
|Overall Rating
Looks fake
I bought this hairpiece hoping to hide my thinning areas. Having purchased a ponytail piece from the Jessica Simpson line (I love it), this seemed like a good solution. The piece looks very fake, however, and I can't imagine how anyone can make this look real unless they have very thick hair or wore a headband/scarf to hide the edge nearest the crown. The fringe looks so fake too. Huge disappointment and I can't return it because I tried it on/missed the 10-day return period because I was out of town.
Good clips
Looks very fake
|Overall Rating
Good for Look'in Good
My hair, which was long, thick and beautiful, fell out due to a thyroid condition. Specially around the sides of the face and bangs. I still wear my hair long, and pin it behind my ears. Thyroid medication is slow to regain hair loss, but will come back. Searching wigs online found this site, The colors they show are perfect match to my own. Quick shipping, priority mail. So they arrived and I immediately put them on according to directions (easy)., 3 steps. I think they took 10 years off my appearance. I am ordering another, I am that delighted. The bangs blend in, can't tell where you clip them on, and go with great with my hair style.
Easy to apply
my hair is dark brown, what color should i order?
Can I get this in real human hair
are there other shades
dies it actually clip into place
Can the piece be washed?

I have ombre colored hair and the ends of my hair are the same shade as "buttered toast." However the roots of my hair and a few inches out is a medium warm brown. I have these clip in bangs in "chestnut" (from when my hair was darker) and when I tried it on now it was way too dark.
Is there a color shade that would work for me?
I know this has been asked but will they make these in red tones?
Because the bangs are synthetic if the color is a little off can I take them to my hairdresser and have her adjust the color??? I have clip-on hair extensions but they are made of real hair and my hairdresser was able to adjust the color.
Genevieve
how far back on the crown of the head does the hair piece go? I have areas I need to cover on the top of my head back to the crown. If this isn't the correct hairpiece, could you please recommend what would work in my situation?

Can the bangs be trimmed or will they fall apart if I try?
If I get the Hairpiece and the color is too light or too dark for my hair, can I exchange it?
Please,please make this for red hair!!!!!! All shades of red. You show all other colors but reds. I would appreciate it if you would look into this. Thanks so much.
What's the difference in color between SS25 and R25?
my hair is colored redkin n7 with a touch of 8 to cover gray what color do u suggest and can these be colored


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I tend to be a fairly argumentative person most of the time... but yeah, okay. You're right, baby sloth friend. Your giraffe is most definitely better than my giraffe.
Thank you for visiting us this week sea lions, it has been quite the ex-squee-rience! You all are welcome to swim by again anytime.
-Sally Squeeps
Despite their sharp claws and fierce bite, wolf cubs look so squeedorable and cuddly!
-Sally Squeeps


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Simon Pegg hasn't read Roberto Orci's earlier draft for the next Star Trek film. Plus, he shares his thoughts on Star Trek Into Darkness.
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Simon Pegg and Doug Jung have taken over scripting duties for Justin Lin's 2016 Star Trek movie...
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Justin Lin takes over from JJ Abrams on the Star Trek franchise, as Paramount confirms a summer 2016 release for the next film.
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Roberto Orci won't be directing the next Star Trek film. But Jonathan Frakes has been in touch with JJ Abrams about taking on the job.
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Man killed in Brattleboro crashAugust 06,2013Man killed in
Brattleboro crash
BRATTLEBORO Police say a 51-year-old Wilmington man has died of injuries suffered in a weekend crash in the Vermont town of Brattleboro that followed a police chase.
Brattleboro police say Robert Avallone was airlifted to the Dartmouth Hitchcock Medical Center following the Saturday morning crash on Route 9.
Another occupant of the car, 38-year-old Jennifer Flagg, also of Wilmington, was airlifted to the Albany Medical Center where she is reported to be in stable condition.
Police say the car Avallone and Flagg were in refused to stop for police early Saturday. Police broke off the pursuit because of the speed the vehicle reached.
It was later discovered the car had crashed.
Police are continuing to investigate the circumstances of the crash.MORE IN This Just In
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Unify Cloud Storage and Sync Services
key review info
- Application: CloudFuze 1.2.2
- Reviewed on:
application features
- One login for multiple accounts
- (5 more, see all...)
One of the advantages of storing your data online is easy access to it from any device connected to the Internet. On the downside, many users may require more free space than what is offered through registration by default.
One solution to increase the free space for keeping your files online is to subscribe to more than one cloud service; but the hurdle to jump next would be managing all the accounts or separating the data between them.
CloudFuze has been created to solve this particular problem and it allows you to easily handle multiple accounts for cloud storage and synchronization services.
It supports most of the popular choices when it comes to syncing data, as solutions such as Microsoft's SkyDrive missing on the list. Instead, it includes Dropbox, Google Drive, Box and SugarSync; there is also the possibility to add an FTP account.
Even if access to all supported services is free of charge, CloudFuze does come with a price tag of $4.99 / €3.77 per month or you can opt for yearly purchase, which is $49.99 / €37.81.
Most average users prefer the free part of the cloud storage and for a business this would mean increasing the costs; and depending on the service and the selected plan CloudFuze could represent at least 50% more.
You can also test the application for a period of 30 days, absolutely free of charge and with all functionality enabled. Using it requires an account, which can be set up in less than a minute, at no financial cost.
Installing CloudFuze is basically a matter of clicking through the standard screens.
The design of the interface is neat and simple, with a clear focus on the content available in the cloud accounts. Information is listed in columns; the first one allows you to select the storage account, the second displays the folders available while the third shows the actual files in the selected folder. You can add as many accounts as you want from the supported services.
At the top of the main application screen, the developer added options for viewing files by their type. As such, you can choose to view only documents, music files, images or videos.
Contrary to our expectations, these presets work only for the selected folder and help you filter all other items except for the specific category. In the case of music files, we noticed that not all audio formats are displayed; in our case, OGG and FLAC files would be left out, while MP3, M4A, AAC and WAV would be shown.
Custom categories can be created and you can assign any files to them; but you cannot assign items to the preset groups.
One of the advantages of using CloudFuze is that you do not have to install the sync clients on the system. It connects to the online account and all transfers happen through a single application. Furthermore, you only need to log into CloudFuze to access all storage locations.
You can easily upload data to a specific account or download it locally; both actions are carried out by simply dragging and dropping the item to the desired location.
During our evaluation, we had to repeat the drag and drop action in order to see the download job carried out. This happened because the item needs to be properly selected before it can be transferred.
If you think CloudFuze is flexible enough to let you transfer data between two different account, this feature is not yet available in the application.
Still on the downside, the transfer job happens almost invisibly, with no control over or details about it. Information like time estimation for completing the task, speed of the transfer or progress of the job would be pretty helpful.
The only bite of info available is that synchronization is currently in progress (check the icon in the lower right hand corner of the application window).
File operations supported include launching the item locally with the default program, deleting it from the remote location, sharing it publicly (available for all supported services except for Dropbox and FTP) and enabling selective sync.
As far as the latter action is concerned, checking an item for selective sync prevents synchronization of all the other files. Thus only the document that has been modified will be uploaded, which shortens the sync time.
The configuration panel of the application is extremely simple. It offers the possibility to remove accounts, make proxy settings or edit categories. The wishlist of a more advanced user would include at least the option to clear the cache since all the files opened are saved on the system drive and in time they might pile up to large size, chipping away the free space.
The Good
You get to manage multiple cloud storage accounts with a single application, without having to install any of the clients for the services.
File transfer (upload/download) is carried out by dragging and dropping the file to the desired location. Selective sync allows synchronization of particular files only. Search results are displayed as you type the query.
The Bad
The price may be quite the deterrent for the average user and even for businesses. The lack of options is also an important factor, as are the minor glitches we encountered during the tests.
The Truth
CloudFuze is clearly at an early beginning and there is plenty of room for improvement. It is not ready for the masses but it definitely has the potential to grow in popularity as soon as it becomes more flexible and refined.


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Scores Rising in the Capital; District's Charter Schools Show Significant Test Gains
Byline: Mark Lerner, SPECIAL TO THE WASHINGTON TIMES
Preliminary data compiled by the D.C. Office of the State Superintendent of Education show that the test scores of students in D.C. public-charter middle and high schools increased significantly in the last academic year. Student proficiency in math increased 9 percent, and reading proficiency rose 7 percent. This compares to increases in math proficiency of 4 percent and reading proficiency of 2 percent in the city-run middle and high schools.
Overall, math proficiency among secondary-school students in the District's public charter schools is 57 percent (compared with 40 percent in the noncharter public schools) and for reading 53 percent (41 percent in the city-run schools).
At the elementary school level, the charter schools' gains were more modest than those of the city-run public schools, overseen by Chancellor Michelle A. Rhee, who was appointed two years ago by Mayor Adrian M. Fenty.
Students at city-run public schools increased their reading proficiency 4 points and their math proficiency 8 points to reach 49 percent in both. Charter elementary schools' reading proficiency increased 1 percent in math and one-half of a percent in reading to reach 42 percent in math and 43 percent in reading. This reverses last year's results when charter elementary schools were slightly ahead of the city-run schools in student proficiency.
Charter advocates highlighted the strong increases in proficiency at the secondary level.
The significant gains of D.C. public-charter middle and high school students indicates that the longer children stay in public charter schools, the better they do, said Robert Cane, executive director of Friends of Choice in Urban Schools. This result underscored findings from a recent Stanford University study, Mr. Cane said.
Addressing the charter elementary school results, charter advocates pointed out the somewhat different demographics of the District's public charter schools compared to their city-run counterparts.
Charters are concentrated in underserved District communities, and the vast majority are located in high-poverty neighborhoods, said Mr. Cane. Many city-run elementary schools are in the District's high-income Ward 3, but no charters are located there.
The D.C. Public Charter School Board, the charters' regulatory body, was impressed with the improvement in secondary school test scores. …


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This project engages students in the science and engineering processes used by NASA Astrobiologists as they explore our Solar System and try to answer the compelling question, "Are we Alone?" Students will identify science mission goals and select... (View More) an astrobiologically significant target of interest: Mars, Europa, Enceladus or Titan. Students will then design their mission to this target in search of their chosen biosignature(s). Students will encounter the same considerations and challenges facing NASA scientists and engineers as they search for life in our Solar System. Students will need to balance the return of their science data with engineering limitations such as power, mass and budget. Risk factors play a role and will add to the excitement in this interactive science and engineering activity. Astrobiobound! will help students see how science and systems engineering are integrated to achieve a focused scientific goal. Includes an alignment document for NGSS and Common Core State Standards. (View Less)
This is an activity about observation. Learners will first observe a first quarter Moon and as a group, predict which phase the Moon will be in during the next observation. After this, learners will continue to chart the progress of the lunar cycle... (View More) of phases throughout the following weeks to better understand the sequence. This is Activity A-2 of Universe at Your Fingertips 2.0: A Collection of Activities and Resources for Teaching Astronomy DVD-ROM, which is available for purchase. (View Less)
Learners will first observe a first quarter Moon and as a group, predict which phase the Moon will be in during the next observation. They then continue to chart the progress of the lunar cycle of phases throughout the following weeks to better... (View More) understand the sequence. This is Actividad 1.2 as part of El Universo a Sus Pies, a Spanish-language curriculum, available for purchase. (View Less)


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Pegasus Hostel
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1141 Poplar Springs Church Rd, Shelby
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Many risk factors for breast cancer are well studied and documented. Thus, scientists are sure by now that early first menstrual period, late onset of menopause and a family history of breast cancer are associated with an increased breast cancer risk.
However, neither an individual woman nor medicine can influence whether family members develop breast cancer or at what age menopause starts - these are risk factors on which we have no influence. Scientists of the German Cancer Research Center in the team of Associate Professor (PD) Dr. Karen Steindorf and Professor Dr. Jenny Chang-Claude, jointly with Professor Dr. Dieter Flesch-Janys of Hamburg Eppendorf University Hospitals, have been searching for risk factors which can be influenced by changes in lifestyle and behavior.
"58,000 women in Germany are diagnosed with breast cancer each year," says Jenny Chang-Claude."Therefore, a key question is whether there are behavioral changes that might help to lower the disease risk. Our study aims to determine the percentage of cases where these avoidable risk factors are responsible."
The researchers focused on aspects such as taking hormones for relief of menopausal symptoms (hormone replacement therapy), physical activity, overweight and alcohol consumption. All these lifestyle factors have been identified in prior studies as possible risk factors for the development of breast cancer.
In their current MARIE study, which is supported by Deutsche Krebshilfe (German Cancer Aid), the epidemiologists studied 6,386 female controls along with 3,074 patients who had been diagnosed with breast cancer after the onset of menopause. On the basis of these data, the scientists calculated the percentage of cancer cases that is attributable to a particular risk factor (or a particular combination of several risk factors).
Of the modifiable lifestyle factors, it is primarily hormone replacement therapy and a lack of physical activity whi
|Contact: Dr. Sibylle Kohlstaedt
Helmholtz Association of German Research Centres


text: Home Redwood Montessori School offers a dynamic and engaging preschool and Kindergarten program designed to cultivate a lifelong love for learning. We provide a high-quality early education program rooted in the principles of Dr. Maria Montessori in a mixed age environment. We are licensed to serve 36 children between the ages of 24 months through Kindergarten. Our mixed-age classroom provides benefits to children of all ages. Younger children look up to the older children as their role models, and the older children gain a sense of leadership, confidence, and high self-esteem from being the "teachers".


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|Publication number
|Publication type
|Application number
|Publication date
|Oct 2, 2008
|Filing date
|Mar 30, 2007
|Priority date
|Mar 30, 2007
|Publication number
|Elvir Causevic, Randall J. Krohn
|Original Assignee
|Everest Biomedical Instruments Co.
|Export Citation
|BiBTeX, EndNote, RefMan
|Referenced by (50), Classifications (13), Legal Events (2)
|External Links: USPTO, USPTO Assignment, Espacenet
Not Applicable.
Not Applicable.
The present invention relates generally to a system and apparatus for monitoring levels of anesthesia and sedation in a human or animal patient, and in particular, to an improved monitoring apparatus and system which is self-contained and portable, and which includes an interface in which an input signal is processed by common mode circuitry to reduce signal noise and interference.
In the medical field of anesthesiology, patients must be carefully and continuously monitored to achieve an appropriate balance between delivery of too much or too little of an anesthetic or sedative. Delivery of an inadequate amount of an anesthetic results in a patient being aware of what is happening during a procedure and possible later recall of the procedure, while excessive amounts of the anesthetic or sedative create the risk of damage to the patient's central nervous system from ischemia due to inadequate perfusion. In recent years, the critical importance of depth-of-anesthesia or sedation monitoring has been highlighted by highly publicized incidents of patients' recall of, or sensation awareness during surgery, and incidents of serious injury or death resulting from delivery of excessive amounts of anesthetic. Most anesthesia-related malpractice lawsuits are premised on inadequate monitoring.
The current standards for basic anesthetic monitoring, as specified by the American Society of Anesthesiologists state that "[b]ecause of the rapid changes in patient status during anesthesia, qualified anesthesia personnel shall be continuously present to monitor the patient and provide anesthesia care . . . . During all anesthetics, the patient's oxygenation, ventilation, circulation and temperature shall be continually evaluated." There is an emerging field of devices that assist the anesthesiologist in monitoring anesthesia, conscious sedation, and deep sedation. This is currently served by passively monitored electroencephalography (EEG) signals.
Similarly, qualified anesthesia personnel are employed to monitor a patient's heart rate and heart condition through electrocardiogram (ECG) signals, and to monitor a patient's oxygenation through pulse-oximetry readings.
More specifically, known cerebral hemodynamic monitoring techniques include cerebral pulse oximetry and infrared spectroscopy, which measure cerebral oxygen saturation. Transcranial Doppler sonography is a noninvasive technique providing real-time, continuous measurements of blood flow velocity and other hemodynamic parameters such as direction of blood flow and pulsatility in major intracranial vessels. These continuous measurements are utilized as indicators of the status of collateral cerebral circulation, and provide early indications of any disruption of cerebral perfusion which could result in cases of brain ischemia or death.
Electrophysiological monitoring techniques include the use of the electroencephalogram (EEG), such as is described in U.S. Pat. No. 5,287,859 to John, U.S. Pat. No. 6,052,619 to John, and U.S. Pat. No. 6,385,486 to John et al. The degree of randomness of the cortical EEG signal is correlated with the level of awareness of the patient, and is used as an indicator of approaching alertness in a patient. Also, changes in the frequency spectrum, amplitude and phase, statistical properties, coherence, and changes in other measures of the EEG are also used as indicators of changes in the awareness level of the patient. Further, mathematical processing such as wavelet transformation, singular value decomposition (SVD), principal and independent component analyses (PCA/ICA), and other mathematical tools also detect changes in the EEG features that are not detectable using standard techniques, and can provide additional information for accurate gauging of the patient awareness state.
Another known monitoring technique is based on monitoring specific evoked potentials in a selected sensory pathway, such as the auditory pathway. Such a technique is typically employed when certain neural structures in specific sensory pathways are known or believed to be at risk of damage. A sensory stimulus is introduced, and the resulting neural activity generates a wave pattern that is analyzed. The technique relies on adequate discrimination of waveforms using parameters such as peak latency and peak amplitude. Real time changes of the parameters provide a basis for calculating the speed of electrical conduction at the sensory pathway from the peripheral receptor to the sensory cortex. However, evoked signals are intermixed with random EEG activity. To adequately discriminate evoked potentials from random activity, techniques are employed including linear averaging, wavelet processing, statistical analysis and other nonlinear techniques.
The complex auditory evoked potential (AEP) is produced upon presentation of an auditory stimulus or series of stimuli, such as a click or a tone burst, or a complex waveform embedding decoding information for use in later signal processing. The stimuli could be presented to the ear monaurally, with or without masking noise in the contra-lateral ear, or they could be presented binaurally using the same waveform in both ears or different stimulus waveforms to obtain the best signal detection. The AEP consist of early, middle, and late components.
In the early or short latency component of the AEP, the auditory brainstem response (ABR) occurs within 15 ms after occurrence of an auditory stimulus and is widely used for clinical evaluation of hearing in infants and other individuals who are unable to effectively communicate as to whether a sound was perceived. In individuals with normal hearing, the ABR generates a characteristic waveform. Auditory testing using the ABR typically involves a visual or statistical comparison of a tested individual's waveform to a normal template waveform. Like other evoked potentials, the ABR is recorded from surface electrodes placed on the patient's scalp. However, the electrodes also record background noise comprised of unwanted bio-potentials resulting from other neural activity, muscle activity, and nonphysiological sources in the environment. The ABR is typically only minimally affected by anesthesia or sedation.
The middle component of the AEP, the auditory mid-latency response (AMLR), also referred to as the middle latency auditory evoked potential (MLAEP) occurs 15 ms-100 ms after occurrence of the auditory stimulus, and is believed to reflect primary, non-cognitive cortical processing of auditory stimuli. Lately, the AMLR or MLAEP has been of particular interest as a measure of the depth of anesthesia.
It is known that the AMLR consists of positive and negative waves that are sensitive to sedatives and anesthetics. In general, increasing the level of sedation or anesthetic increases the latency of these waves, and simultaneously decreases the amplitude. For monitoring purposes, changes in the AMLR waves are quantified as latency to peak, amplitude, and rate of change, and are sometimes combined in a single index.
Alternatively, it is known that a 40 Hz auditory signal can induce an enhanced "steady-state" AEP signal. Conventional signal averaging over a period of time is required to extract the AMLR signal from background EEG signals, but adequate signals usually may be obtainable in about 30-40 seconds. The existence of an intact AMLR is believed to be a highly specific indicator of the awakened state of a patient, and gradual changes in the depth of sedation or anesthesia appear to be reflected by corresponding gradual changes in the AMLR. The AMLR is known to be very susceptible to signal noise.
Another component of the complex AEP, the auditory late response (ALR) is believed to be especially sensitive to the level of sedation or anesthesia applied to a patient, and exhibits a distinct flattening of the waveform at a relatively light level of sedation or anesthesia, among other features. Furthermore, a waveform known as the P300 appears in response to random non-matching stimulus, and is useful for anesthesia monitoring.
The AEPs are characterized as a "weak" bio-signals and present a significant technical problem in analyzing and using the AEP, especially when speed and accuracy are critical. Signal processing techniques using linear averaging, filtering, or conventional denoising are known. However, these techniques remain especially limited in ability to process weak biosignals rapidly and, in some cases, accurately.
The measurement of weak biosignals on the scalp presents a signal acquisition challenge, as the signal of interest is generally much smaller than the environmental electrical noise. This noise is dominated by mains 50/60 Hz signals that are capacitively coupled to the patient and to the equipment through building infrastructure, power cords, and even other patient-connected equipment. The main signal noise is generally present as a common-mode signal on the patient, and can be considered to be equal in magnitude at the 3 sensing electrodes typically utilized to acquire biosignals such as EEG or AEP.
Ideally what is needed is a brain activity monitoring technique which is sufficiently sensitive to provide a near instantaneous indicator of small functional changes in a patient's brain. This permits immediate corrective measures to be taken in ample time before patient recall or awareness, or tissue damage occurs. However, known anesthetic monitoring techniques, including those that focus on measures of cerebral perfusion or electrophysiologic function in the brain, are limited in terms of sensitivity and speed, and thus the ability to anticipate and allow timely response to significant functional changes. Against this background, a need exists for improved methods and systems for monitoring the brain function and depth of sedation or anesthesia in a patient.
To monitor brain function and depth of sedation or anesthesia, test equipment must be capable of accurately measuring low voltage electrical signals in the sub-microvolt range has a wide range. Low voltage electrical signals in the sub-microvolt range can be extremely difficult to detect, as often the signal noise levels and interference present can mask the desired signals. Handheld test equipment, in which numerous electrical circuits are packaged in close proximity, is particularly susceptible to such signal noise and interference. Accordingly, it would be advantageous to provide a handheld measurement and testing device which is configured to filter incoming low voltage electrical signals using common mode cancellation techniques and circuits to reduce signal noise and interference, to reduced measurement time
Briefly stated, the present invention provides an apparatus and a system which incorporates a measurement of at least one input representative of a human (or animal) patient's condition, into a self contained, portable, battery powered unit that a practitioner can move between different surgical venues including a hospital's main operating room, outpatient surgery centers, special procedure units, and medical practitioners' offices. Low voltage signals acquired by the device through electrodes disposed on a patient are processed by common mode circuitry to reduce signal noise and interference. The filtered signals are utilized together with additional selected patient parameters, which may include signals acquired through electroencephalography (EEG), pulse-oximetry monitoring, AEP, breath gas (CO2) monitoring, and ECG monitoring to provide a quantitative measure related to a patient's level of consciousness (LOC). These measures provide information that a practitioner can use, in conjunction with other clinical indicators, to titrate the dose of commonly used anesthetics or sedatives throughout a surgical procedure. The clinical endpoints are patient safety, active management of the level of a patient's consciousness, and the controlled return of the patient to consciousness. These measures can be used individually or combined in a single level of consciousness index to assess overall patient state with respect to anesthesia and sedation administration.
The foregoing features, and advantages of the invention as well as presently preferred embodiments thereof will become more apparent from the reading of the following description in connection with the accompanying drawings.
In the accompanying drawings which form part of the specification:
Corresponding reference numerals indicate corresponding parts throughout the several figures of the drawings. It will be understood that the drawings are for illustrating the concepts of the invention and are not to scale.
The following detailed description illustrates the invention by way of example and not by way of limitation. The description enables one skilled in the art to make and use the invention, and describes several embodiments, adaptations, variations, alternatives, and uses of the invention, including what is presently believed to be the best mode of carrying out the invention.
The following definitions are used throughout this specification for describing Sedation and Anesthesia according to the American Society of Anesthesiologists (Standards, Guidelines and Statements, 2004):
"Minimal Sedation" (Anxiolysis) is a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected;
"Moderate Sedation/Analgesia" (Conscious Sedation) is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained;
"Deep Sedation/Analgesia" is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained; and
"General Anesthesia" is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.
Because sedation is a continuum, it is not always possible to predict how an individual patient will respond. Hence, practitioners intending to produce a given level of sedation should be able to rescue patients whose level of sedation becomes deeper than initially intended. Individuals administering Moderate Sedation/Analgesia (Conscious Sedation) should be able to rescue patients who enter a state of Deep Sedation/Analgesia, while those administering Deep Sedation/Analgesia should be able to rescue patients who enter a state of general anesthesia.
A condition known as burst suppression sometimes occurs during the administration of anesthesia and sedation. It is characterized by a specific EEG waveform containing bursts of EEG activity followed by suppression of EEG activity in subsequent time periods. This condition is indicative of a patient's awareness level, generally corresponding to deeper states of anesthesia.
The anesthesia and sedation monitoring system of the present invention, indicated generally 10 in the drawings, provides a level of consciousness (LOC) index of a patient P to a practitioner administering anesthetic agents to the patient during a surgical procedure. The LOC index indicates, such as on a scale of 0-99, the level of the patient's brain activity, so to guide the administration of the agents. Optional secondary functions provide a measure of the level of oxygenation in the patient's system via a pulse oximetry patient interface which consists of a finger or forehead sensor and associated cable, and a measure of the patient's breath gases such as CO2 via a cannula drawing breath gases to a capnometer. The LOC index may integrally incorporate information from any of the above specified measures, or the individual measurements may be presented as stand-alone indices. Preferably, the monitoring system 10 is a highly portable instrument, which is pole or bench mounted, and which preferably provides a display having a good distance visibility for the various clinical indices.
An embodiment of anesthesia and sedation monitoring system 10, and as shown in
The unit 12 has a display 14 which includes a color display, preferably with touch sensitivity, and a control section 16 comprising a keypad having buttons or keys 18 by which a user can use the display. Unit 12 also contains analog and digital hardware with appropriate internal couplings to other functional blocks in order to implement the desired functionality of the anesthesia and sedation monitoring system 10.
A sensor suite 20 includes various sensors one or more of which are connected to unit 12 at any one time to provide patient information to medical personnel. Four such sensors are shown in
An embodiment of system 10 is constructed of unit 12, a Patient Interface Cable 201, and electrode array 26. The Patient interface cable (PIC) 201 is primarily constructed with an amplifier printed circuit assembly 35, an electrode connector 203, and a shielded cable and second connector 202.
The amplifier printed circuit assembly 35 is primarily constructed with an Instrumentation Amplifier (IA) 142, gain and filter circuit 144, and common-mode cancellation circuit 220. The signal path from 144 provides the input to the Analog to Digital Converter (ADC) 146. This signal path may take the form of a single-ended or differential analog interface.
The circuits contained within the PIC 201 are configured to provide for filtering of sub-microvolt signals acquired from a patient to reduce signal noise and interferences. In one embodiment the PIC 201 as shown generally in
Signals from the electrodes 34 are initially filtered for radio-frequency interference with filter 250, and then amplified at an amplifier 142 before being routed to a second-stage capacitive-coupled operational amplifier 144 having a high gain setting. The routing of the initially filtered and amplified signals may be done directly, or through an optional switching network, wherein an individual signal is automatically selected and passed to the amplifier 144. A common mode cancellation amplifier 220 is included in the PIC 201 to further reduce signal noise levels. The resulting amplified signal is then routed through a shielded cable and second connector 202 to the ADC 146.
Turning to
Electrical signals received through the electrode connector 203, shown in
Signals from the radio-frequency interference filter circuit 250 are then passed to an instrumentation amplifier 142, shown in
The circuits of the common mode cancellation amplifier 220 are configured to filter and invert a common-mode signal CMS that is amplified from the electrodes 34 by the instrumentation amplifier 142. Initially, the common-mode signal CMS is filtered by a high-pass filter having a corner at approximately 7.5 Hz, and which consists of a capacitor C1 and resistor R21. This filter blocks any DC component that might be present on the signal 215, and assures that the eventual output of the CMCA is referenced to circuit ground GND_IA. After passing through the high-pass filter, the signal is provided to a unity gain buffer U22B. Additionally, this high-pass filter serves to prevent DC mismatches between patient electrodes 34 from being amplified and saturating amplifiers 142 and 144. The unity gain buffer U22B isolates the instrumentation amplifier 142 from an amplifier U22A associated with a low-pass filter network, preventing noise from the operation of the common-mode cancellation amplifier circuits 220 from disturbing the operation of the instrumentation amplifier 142. The low-pass filter network, consisting of resistor R12, and capacitor C37, provides a corner of approximately 105 Hz.
The circuits of the common-mode cancellation amplifier 220 are configured to attenuate the common-mode signal CMS that might otherwise appear in the resulting signal which is digitized by the ADC 146, and have a specific frequency response designed to operate on signals within a specified frequency band. The circuits are configured such that the effective output impedance of a reference signal REF supplied back to the patient reference electrode via the connector 203 is very low, with patient auxiliary current limiting provided within the feedback loop of the inverting amplifier U22A by resistor R5. This low effective output impedance further serves to improve common-mode cancellation of noise that would otherwise be impressed upon the electrical signal due to differences in alternating current potential between the patient and the monitoring device. These potential differences occur because the patient, the device, and other patient connected equipment each have varying degrees of capacitive coupling to alternating current mains and earth ground.
As the common-mode cancellation signal is referenced to circuit ground GND_IA, the electrical potential difference between the patient and circuit ground_IA is minimal. Simultaneously, the amplifier and the patient are still allowed to float together to an arbitrary voltage defined by capacitive coupling in the environment. This common-mode cancellation implementation does not cause the power supply rails to modulate with respect to the common-mode voltage; they have a constant offset from circuit ground GND_IA.
Turning to
The PIC 201 may additionally embody an impedance check circuit 210, shown in
Requisite signals for the operation of the PIC 201 including power and ground GND_IA signals, the impedance check signals Z+, Z−, and the resulting amplified electrical signals (applied to the ADC 146) are preferably routed through a shielded cable and second connector 202, which in turn connects to the unit 12.
The PIC 201 may additionally embody an electrode tracking system to be used to verify that the connected electrode is an authentic OEM product, and to automatically detect the specific type or functionality of the electrode system being used (i.e. adult vs. pediatric, with or without ECG feature, with or without AEP feature, etc).
Alternately, patient interface cable (PIC) 201 may embody all the requisite amplification, filtering and ADC conversion, such that the signals out of the patient interface cable (PIC) are fully digitized. This alternative embodiment may incorporate an analog-to-digital converter 146 within the patient interface cable (PIC) 210 to transmit a digitized version of the amplified EEG signal to Finite Impulse Response (FIR) filter and decimate processing unit 148 through the shielded cable and second connector 202.
It will be understood that the specific electrical components shown and described above in connection with
For example, the resistance value of resistor R64 (shown in
Once the received electrical signals are passed through the PIC 201, they are passed to the processing system 42. The processor system 42, see
During operation of the system 10, data from the respective sensors in sensor suite 20 is first collected in a sample buffer 48 until the buffer is filled, at which time an interrupt signal is generated to stop further data collection until the accumulated data is processed. Alternately, the collected data may be continually streamed for processing at the processor system 42. During processing, the digital signal processor (DSP) 42 moves the data from the sample buffer 48 to a working buffer 50. The digital signal processor (DSP) may employ a window function, a data saturation function, and other time-domain integrity checks. If the received data is acceptable, an LOC calculation is performed to generate the LOC index value. Preferably, the LOC algorithm includes a Fast-Fourier Transform (FFT) and various filter functions. Alternately, the LOC algorithm includes additional mathematical tools, linear and non-linear, such as wavelet processing, SVD, PCA/ICA, etc. As is shown in
Preferably, in one embodiment of the present invention, data collection functions are handled by a SNAP module 60 connected to unit 12, and which contributes to patient safety electrical isolation per IEC 60601-1-1 and 60601-2-26 requirements. A proprietary communication bus 62 is utilized to transfer data between SNAP module 60 and the OMAP processor system 42. As shown in
The primary function of the SNAP module 60 is to implement the LOC algorithm. This algorithm processes the acquired EEG waveforms and provides an indication of the patient's LOC. Other information may be incorporated into the LOC, such as the AEP, EKG, CO2, etc. The calculation to provide this information is data driven. A control CPU 46 initializes the digital signal processor (DSP) using an Application Program Interface (API) function and then uses another API function to commence data collection. In an alternate embodiment the LOC algorithm may be implemented directly on the digital signal processor (DSP) of the processor system 42.
The SNAP module 60 may additionally embody an electrode tracking system to be used to verify that the connected electrode is authentic, and to automatically detect the type of electrode system used (i.e. adult vs. pediatric, with or without ECG feature, with or without AEP feature, etc).
Patient data records, when optionally recorded, may be stored on external FLASH memory cards 44 using a Compact Flash (CF) card format. Anesthesia and sedation monitoring system 10 will operate with or without a CF card 44 inserted; however, no patient record storage will be available if a CF card or other storage media is not provided. This includes storage of raw EEG/AEP data.
The primary user interface to system 10 is touch interface 14. The touch interface is used to initiate tests, manage record storage and retrieval, and control and respond to alarms. An audible alarm is incorporated in the Printed Circuit Board (PCB) for keypad 16. The secondary user interface to the device is keypad 16. A "standby" state of the device is changed by pressing a standby power button (not shown). Other buttons (also not shown) are used to perform specific functions as defined in the software specification for system 10.
A display 14 provides the main feedback to a user regarding the current operating state of device 12 and the LOC of the patient. A Graphical User Interface (GUI) 68, see
Preferably, anesthesia and sedation monitoring system 10 of the present invention is battery operated using an internal battery pack 72 which includes, for example, one or more Lithium ion batteries. Current to charge the battery is supplied by a UL recognized medical-grade power supply 76. A battery management module 74 of OMAP processor 42 monitors the charge/discharge cycles of the batteries. Battery charge monitoring does not utilize any software; rather, charge current to battery 70 is provided by power supply 76 through an appropriate charging connection 78. A dedicated non-rechargeable battery (not shown) provides power to a real-time-clock (also not shown) in unit 10 when the device is not operating, thus maintaining the correct time when the unit is in its "standby" mode.
The anesthesia and sedation monitoring system 10 incorporates various electrical isolation barriers in the internal design. In the preferred embodiment, unit 12 includes a 4 mm creepage gap in the printed circuit board (PCB) components installed in the unit, and employs opto-isolators 79 where components are required to bridge the gap between PCBs of a front end SNAP module 81 and a SNAP data module 83 for data transfer between the modules. An isolated power source 80 includes a DC-DC converter and provides 1 kVDC isolation and 5 VDC to the isolated portions of SNAP module 60 as shown in
The operating system (OS) for the anesthesia and sedation monitoring system 10 invention is preferably an embedded version of a Linux� operating system or any other commercially available or custom operating system, so to provide the necessary elements for a multi-threaded application suitable for the purposes of the invention. The OS enables programming through readily available tools such as a Qt GUI Library 82, see
A SNAP module driver 85 performs the interfacing required for the OMAP Processor platform to work with the SNAP module hardware. The driver relays commands and data through a defined interface to affect control and communication for the module.
A battery monitor driver 84 interacts with a battery monitor circuit to monitor the charge status of battery pack 72. The battery monitor circuit uses a 1-wire or HDQ serial port to affect communications. Processor system 42 also has an integrated 1-wire or built in HDQ communications controller and an associated driver 86. Driver 86 performs all required setup and interpretation of the bit stream from the communication controller, and reports the data through a structure defined by a main program for unit 12.
Alarm driver 88 controls supply of power to an acoustic transducer 90 on a PCB for keypad 16 in response to a command from the main program. The driver manages the port and controls hardware I/O for the transducer. A touch screen driver 92, CF card driver 94, and a USB driver 96 regulate power and data flows to these components.
A main application code module 100 for system 10 is shown in
GUI 68 uses a Qt development system from Trolltech. A single path 102 interfaces the GUI with Qt library 82. A path 104 allows the GUI to manage touch screen and a path 106 allows the GUI to manage a LCD frame buffer for display 14. Both paths allow bi-directional communications through Qt library 82. The GUI communicates with main application code module 100 through a bi-directional GUI message queue 108.
Next, main application code module 100 interfaces with a LOC module 120 through a bi-directional LOC message queue 122, a LOC library module 124, and a communications path 126 between modules 120 and 124, to implement the command structure and the data structure.
The battery management function periodically generates requests for battery charge status through the battery monitor circuit. Returned data is used to drive a graphical battery gauge (not shown) on the GUI.
The pulse oximetry function includes a serial port driver 110 which handles communications with a pulse oximetry module 112 (see
During operation, system 10 is configured to provide audible alarms, using an alarm system 114 (see
To facilitate the storage of patient information, system 10 preferably generates a database record for each procedure performed on each patient, when the patient database option is enabled through an optional memory card. The procedure database preferably contains basic patient information (in compliance with local healthcare facility policies regarding HIPPA). This information may include a patient ID, patient name, gender, birth date, weight, height, allergies, and associated notes. Additional information stored in the database may include clinician information (identifying anesthesiologists, surgeons, and other attending staff, an index trend (including AEP), SpO2 tred, heart rate, and end-tidal CO/CO2 concentrations.
In addition to the procedure database, a second, optional comprehensive database contains processed, but undecimated measurement data streams including: continuous EEG waveform samples; SpO2 Pleth waveform (when available); ECG waveform (when available); and CO/CO2 waveforms (when available)
In the preferred embodiment the above data streams can be temporarily stored in a circular buffer in the memory of the processor system 42. The number of procedures that may be stored in system 10 depends upon the durations of procedures, and the size of available memory storage; and, may be flexible. Preferably, an external PC viewing program is available for printing information, and to allow practitioners to log their procedures into the system for documentation purposes.
In addition to the databases, system 10 may also be configured to store all input keystrokes and operational states in compliance with HIPPA guidelines, for purposes of problem operating issues reported by users
To facilitate storage and exchange of data, a device communication interface is provided in the system of the present invention. Preferably, this interface includes at least one CF 44 memory expansion port through which data is transferred to either an external device or an external memory, or the interface allows updating of application software running on the system. Those skilled in the art will recognize that other device communication interfaces may be provided, including, but not limited to, MIB (IEEE 1073 Medical Information Bus) compliant interfaces, USB, IRDA, Ethernet (TCP/IP), RS-232, Bluetooth or other wireless link, or other removable storage interface (Memory Stick, etc.)
To acquire bioelectric signal data from a patient, system 10 employs a single-use non-sterile electrode array. The array preferably comprises the three electrodes 34 which form one differential EEG channel with a reference. The electrodes 34 are physically connected to each other as part of EEG sensor 26, but are electrically isolated and terminated with a standard 5-pin positive latch connector designed to mate with patient interface cable 41. The patient's skin could be prepared by wiping it with an alcohol pad, for example. As is conventional, electrodes 34 are constructed with conductive gels specifically designed for use with EEG electrodes. As previously described, the array is part of a headband 30 worn by the patient for the duration of a procedure.
During use, the electrodes 34 are preferably placed on the forehead of the patient. The preferred practice is for one input electrode (+) or (−) to be placed on the centerline of the forehead, the other input electrode to be placed above the temple, and the middle to be placed over the eye. The electrodes may be placed on either side of the forehead.
Part or all of the integrated sensor suite 20 may be embedded in headband 30. The preferred embodiment of the sensor suite 20 and headband 30 could be made disposable or reusable depending upon manufacturing cost, device reuse requirements, and cleaning requirements. An alternative permutation would have portions of the sensor suite 20 disposable with other portions of sensor suite 20 being reusable, with headband 30 being reusable. The integrated sensor suite may be battery operated or supplied with power by the anesthesia system.
Integrated sensor suite may additionally embody an electrode tracking system to communicate to the anesthesia system that the connected electrode is authentic, and to automatically inform the anesthesia system of the type of electrode system that is being connected (e.g. adult vs. pediatric, with or without ECG feature, with or without AEP feature, etc).
The present invention is implemented, in part, by computer-implemented processes and apparatus for performing those processes. The present invention can also be embodied, in part, in the form of computer program code containing instructions embodied in tangible media, such as floppy diskettes, CD-ROMs, hard drives, or other computer readable storage media. In this regard, when computer program code is loaded into, and executed by, an electronic device such as a computer, micro-processor or logic circuit, the device becomes an apparatus for practicing the invention.
Referring to
The mid-range frequency component of the signal from FIR 148 is directed to both a FIR filter and decimate unit 152 and a sample and storage module 154. Data in module 154 is processed using a FFT and High Frequency (HF) protocol as indicated at 156. The result of this processing is directed to a SNAP index 164.
If an artifact is detected in the filter and decimate processing unit 148, a quick restart algorithm is used to refill the sample and storage module 154. In the preferred embodiment the sample and hold module contains 10s of contiguous samples in 10 1s buffers. To reduce the lag required to refill these buffers after an artifact event, a quick restart algorithm fills the buffers with manipulated copies of the 1s buffer of data acquired after the artifact event. The buffers are numbered sequentially 0-9 with buffer 0 corresponding to the buffer to be filled with data from the current acquisition and buffer 9 corresponding to data acquired 9 seconds previous. The quick start algorithm fills buffer 0 and the other even-numbered buffers with the currently acquired data, whereas the odd-numbered buffers are filled with a time-reversed versions of the buffer. This alternating pattern of forward-reversed data provides 10s of data while eliminating jump discontinuities across buffers. By eliminating the jump discontinuities, we reduce the resulting spurious high frequency components which would be present in the frequency domain analysis that follows in module 158. Those skilled in the art will recognize that the specific parameters of the quick restart algorithm can be adjusted to optimize performance, and that a different combination of buffers could be used to accomplish the same task.
The output from FIR 152 is a low-range (e.g., 204.8 Hz) component of the signal and is supplied to display 14 through switch 150. The output from FIR 152 is also directed to a sample and storage module 158. Data in module 158 is processed using a FFT and Low Frequency (LF) protocol as indicated at 160. The result of this processing is directed to SNAP index 164 through a burst suppression module 162. Burst suppression module detects the presence of the burst suppression patient condition in the EEG and incorporates that information into the index. Alternately, burst suppression module informs the user, via a GUI, that the patient has entered burst suppression state, and may indicate to the user the parameters of the burst suppression waveform—such ratio of burst to suppression, % burst, etc.
In one embodiment the above SNAP index could be further augmented by including information from ECG, AEP, CO/CO_2 and SpO2 sensors in the index calculation.
Finally, the present invention can be embodied, in part, in the form of computer program code, for example, whether stored in a storage medium, loaded into and/or executed by a computer, or transmitted over some transmission medium such as electrical wiring or cabling, through fiber optics, or via electromagnetic radiation. When computer program code is loaded into and executed by a computer in this way, the computer becomes an apparatus for practicing the invention. When implemented in a general-purpose microprocessor, the computer program code segments configure the microprocessor to create specific logic circuits. This includes an embodiment that performs all the specified functions in a stand-alone module, OEM module, without user interface, which could be operatively coupled to any standard multiparameter patient monitor (Philips, GE, Siemens, etc).
In view of the above, it will be seen that the several objects of the invention are achieved and other advantageous results are obtained. As various changes could be made in the above constructions without departing from the scope of the invention, it is intended that all matter contained in the above description or shown in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.
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|U.S. Classification
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Owner name: EVEREST BIOMEDICAL INSTRUMENTS COMPANY, MISSOURI
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:CAUSEVIC, ELVIR, MR.;KROHN, RANDALL J., MR.;REEL/FRAME:019096/0384;SIGNING DATES FROM 20070329 TO 20070330
|Feb 13, 2014
Owner name: STRYKER CORPORATION, MICHIGAN
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:EVEREST BIOMEDICAL INSTRUMENTS COMPANY;REEL/FRAME:032213/0454
Effective date: 20111028


text:
Ralph Johns (UK) Nov 20, 2012 3:00 PM
Re: How do you use iChat when it says my password is incorrect? in response to bhbader
If this is an Apple ID ending in @mac.com, @me.com or @icloud.com and the password is over 16 characters the AIM servers (As it is a valid AIM Screen Name) cannot read the password.
This applies to all versions of iChat and Messages
If you have an iCloud issued @me.com or @icloud name then these will only work in iChat 6 or above.
Apple now have iChat 6 and the Messages app also login on to me.com which in turn allows the passwords to be seen by AIM.
As a consequence iChat 5 and earlier don't login in to me.com and then the password access is not verified. (It does not work in this an earlier versions)
11:00 PM Tuesday; November 20, 2012
Please, if posting Logs, do not post any Log info after the line "Binary Images for iChat"
iMac 2.5Ghz 5i 2011 (Mountain Lion 10.8.2)
G4/1GhzDual MDD (Leopard 10.5.8)
MacBookPro 2Gb (Snow Leopard 10.6.8)
Mac OS X (10.6.8),
Couple of iPhones and an iPad
"Limit the Logs to the Bits above Binary Images." No, Seriously


text:
- Infowars - http://www.infowars.com -
New York Senate Passes Draconian Gun Bill
Posted By kurtnimmoadmin On January 15, 2013 @ 10:02 am In Featured Stories,Old Infowars Posts Style,Tile | Comments Disabled
Kurt Nimmo
January 15, 2013
The New York Senate has passed a gun bill following governor Andrew Cuomo's attack on the Second Amendment during his state of the state address earlier this month.
The legislation now moves on to the Assembly for passage.
If enacted, owners of firearms classified as "assault weapons" by the state will be forced to register them with the police.
A firearm will be classified as an assault weapon if it has one or more cosmetic military feature, such as a pistol grip or a bayonet mount. Owners will be required to "recertify" their weapons after five years.
The bill contains a raft of additional regulations imposed on law-abiding firearms owners, including:
— Limiting magazines to seven bullets (down from the national "standard" of 10)
— Making unsafe storage of so-called assault weapons a misdemeanor
— Outlawing internet sales of assault weapons
— Requiring retailers that sell ammunition to register with the state, run background checks on purchasers, and maintain a database of all sales
— Mandating mental health therapists report their patients if they made a credible threat to use a gun illegally (the police would then confiscate the firearm)
On Monday night, Cuomo declared the Second Amendment "is a scourge on society" as Democrats said the legislation does not endanger the constitutional right to own firearms.
"This is not about taking anyone's rights away," said Bronx Democrat Sen. Jeffrey Klein. "It's about a safe society … today we are setting the mark for the rest of the county to do what's right."
Article printed from Infowars: http://www.infowars.com
URL to article: http://www.infowars.com/new-york-senate-passes-draconian-gun-bill/
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text:
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Please call our Hospitality Sales Desk at (212)-872-4942 / (212)-872-1275 or email firstname.lastname@example.com for more information, and we'll work with you to choose the right setting and customized menu for your private event.
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