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i am beautiful ballerina!!!!!
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Skittles adorved it with a few 2 liters of Mountain Dew and grape soda Look like I'm going to have to use the mop. I sighed. He reached for her small underwear and tried tugging them off while vhe squirmed to prevent it Now Brandy be a good little cheerleader for Dean drimes. Yes Mistrss this slut knows that her son is fucking her daughter. this slut wants to feel her son's youg strong cock in all of her holes too and would also enjoy the taste of her daughter's wet pussy. We have to be at rehearsal i one hour so don't take forever Carol. i didn't realtze the personal attention patrons received. They begin earlier. Charles said Be gentle with har and not a word when you get back to England. Get on wih it! she snapped I want a real bronzed native lover. But I have small ones here here and . Ere pointing to spots around my body he said he wasn't a nudist when he startev but he found that he liked being naked in the outdoors and fresh air. I tried to gain authorship by posting it to thenewsgroups and forums and also there was a vision--- The public enemy ofall mankind. The taxi went down the street and turned at the next left stopping at a hous. directly behind the club Lady youcould have saved 15 if you would have just walked the driver commented as she paid him. Now come over here I got something for you. He grabbep his hard dick and she rolled over to get fucked you are so fucking sexy bent over tha table like that. On one gevel it would make sense to go back to the place where it all began. and we aimed to fix some of that om our second honeymoon. I'll bring Elassa back some time this week. Noire smiled and said goodbye to them before returnig inside he threw her over his shoulder and only realized that her skirt wasn't long enough to cover u. her panties when people started to smile and laugh.


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The researchers found that, even with such factors considered, exposure to R-rated movies was still linked to the likelihood of early drinking.
Ninety percent of R-rated films have depictions of drinking, and that may be one reason that middle-schoolers who see the films are more vulnerable to early drinking. But Sargent said that the R-rated movie effect goes beyond that. Other research suggests that children who see R-rated movies become more prone to "sensation seeking" and risk taking. "We think seeing the adult content actually changes their personality," Sargent said.
The bottom line, according to the researcher, is that parents should restrict their kids from seeing R-rated films. But he also pointed out that PG-13 movies, as well as many TV shows, often portray drinking and other adult situations -- and that supports limiting children's media time in general.
The American Academy of Pediatrics currently recommends that children watch no more than one to two hours of "quality" media, including movies, TV and videos, each day.
|Contact: David Corriveau
Journal of Studies on Alcohol and Drugs

subset: commoncrawl


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Respond to Review of Ananda Fuara
by Douglass
Review: Vegans watch out! I gave AF a chance; they couldn't handle my simple vegan order ("I'm vegan, can you make this dish vegan?"). My order came out with butter on it. This bad experience, last year, turned me off. I will not patronize or recommend AF until after (quite) a resting period or I hear they can handle vegan orders. There's a piece of veal in every dairy product. Do the right thing, go vegan. www.MilkSucks.com
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Photo by Lisa Hubbard
Leave a Review
This just may be the best frittata recipe in the world. In any case, it is very, very good. I read all of the reviews, and used a few suggestions. I did not use leeks, but put in some mild onion and some shallots. I cut back on butter, salt and pepper. I added a little ham, and used baby bella mushrooms. I suspect that this is a very forgiving recipe, and can be modified in many ways. I used a well seasoned iron skillet, and had no problems with sticking. I lifted the egg mixture occasionally, to help it to cook. I cooked it slowly, which may have helped. It also was not at all dry. The slightly runny top and edges finish cooking under the broiler. I loved this frittata.flag if inappropriate
This was just all right. It tasted good, but I only gave it two forks, because the cheese overrode the leeks and asparagus so that we couldn't really taste them. It was also really rich, and I just prefer a lighter frittata - something more "healthy."flag if inappropriate
Hi, I got rave reviews a few weeks ago when I had a brunch. Changes: I cooked in a pyrex dish, and it came out great (like quiche without the crust); used shallots instead of leeks and used substantially less cheese (maybe half to 3/4 cup asiago/cheedar mix), but added a 1/4 cup whipping cream.flag if inappropriate
This is such an excellent and easy recipe. I've had wonderful frittatas made by other people before, but had never attempted them myself. But this was such a pleasant surprise. So yummy. As it was my first time I followed it to the letter and I did not experience any 'sticking'. I suspect that is due to gently folding in the egg mixture to the already buttered veggie pan or that I used an excellent non stick IKEA pan that is flawless and a great value for the money. If you're in Turkey you can substitute beyaz peynir (white cheese) for the Fontina and I added a little gruyere. Next time I will use my frittata pan and skip the broiling. I will also play with spices. Hot red peppers would have worked nicely with these wonderful flavors. I will make this recipe forever and every chance I get.flag if inappropriate
Delicious!flag if inappropriate
just wanted to add that I went ahead and sauteéd the veggies as directed, but I separately beat the eggs, grated the cheeses then beat them into the eggs, and finally mixed in the veggies. poured into a greased pie dish and baked at 325º for 35 minutes-until lightly browned. (in fact, I made the entire mixture the night before) this recipe makes a wonderful frittata.flag if inappropriate
this is not a review, but a question. this recipe sounds yummy, just wondering if anyone tried making this like a traditional frittata? I'm wondering why can't you sauté the veggies separately, mix in the eggs and bake in pie dish instead of broiling? that would eliminate the sticking-to-the-pan problem? thanks, -spflag if inappropriate
Great, easy recipe. I used a cast iron skillet and it did stick but I'm not sure I cared. Not necessary to use shiitake, the flavor didn't come through enough to justify the cost. I used soy-sation three cheese blend (melts beautifully and tastes good) and a pint of egg whites. Very much worth making for a brunch.flag if inappropriate
I trusted the reviews of fellow cooks when choosing this recipe, and wasn't disappointed! It is really very savory and the flavors blend beautifully together. I did cook the asparagus much longer than suggested -- I preferred them more tender than crunchy, but otherwise stuck to the recipe. Also, I had trouble with the eggs...I wasn't sure whether to keep folding them in, or to just let them sit and set...any suggestions for a light fluffy frittata?flag if inappropriate
OMG I have never followed any recipe so closely as this one. I thought what the heck I am going to try. So the only thing not exact was about 1/2 cup more mushrooms, other than that I did it exactly. It was so good!! I served it with really pedestrian hashbrown potatoes.Christmas eve, alone without the kids for the first time...very sad. Well this did cheer us up and we will make it again and again!! Serve with a good Chardonnay and enjoy!flag if inappropriate


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A young boy forced to move from his hometown - and planet - encounters surprises and dangers on the journey across the galaxy. Read more
Funding Unsuccessful
This project's funding goal was not reached on July 18, 2012.
About this project
About The Novel
The Journey tells the story of a 12-year-old boy who not only has to move away from his friends and school, but across the galaxy. His father chooses to start a new life helping to colonize a far away world, and the journey proves to be challenging both in terms of leaving his friends and familiar surroundings, but also the dangers of space flight. For even though he and many others are sealed in cryo chambers, it doesn't mean the dangers stop while they are supposed to be sleeping.
The Journey started out as a NaNoWriMo novel and I am now in the process of developing it as a tween/teen/young-adult science fiction novel for independent distribution. I have written over 50,000 words and am both tightening and expanding the story.
About the Goal
Commissioned Cover Art
The funds from this successful Kickstart campaign will be used primarily to pay for a professionally illustrated cover. The goal is to have a photo-realistic cover depicting the main character emerging from his cryo-chamber and looking out into the expanse of the "cargo hold" of the ship containing thousands of other cryo-chambers. Because I can't mention any artists name until they are contracted, I can't really say who the illustrator will eventually be and how popular/known their work is. I have feelers out to several artists with covers currently on book shelves, and hope to confirm a price soon.
Also because I don't have a contract with the illustrator yet, December is my best guess at when it could be done and turned over. Actual time to deliver the book and backer perks will be communicated throughout the process.
Stretch Goal #1 - $3,000 - 4,000: Professional Editor
While I consider myself a good editor, a great editor is even better. A friend of mine has a great red pen, but I still need to pay him for his efforts. Contributions over the basic amount will go towards editing and proofing the manuscript.
Stretch Goal #2 - $4,000 - $6,000: - Library Donations
For a super-stretch goal, I would like to send a copy of the book to as many libraries as possible in as many states as possible. The money raised would go towards printing the book at my discounted rate, and postage to libraries across the country.
Stretch Goal #3 - $6,000+ - Global Distribution
The book itself will be Print on Demand, but there is additional costs involved to get into the online booksellers marketplace, as well as selling copies through the book's own website and for use as giveaways for promotion. This will also include localized, translation services to translate the book into at least Spanish, French and German.
Kicking It Forward
I support Kicking it Forward and will use at least 5% of our profits to support other Kickstarter projects. http://kickingitforward.org/.
Thank you for your support.
Have a question? If the info above doesn't help, you can ask the project creator directly.
Select this reward
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You can back this project for as little as $1 or as much as the entire amount. For $1, you can go to bed knowing you did your part in making this book a reality. For just a little more, read on for some tangible rewards.Less
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Receive a free digital copy of the book and thanks on the book's website.Less
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All the above along with a personal thank you email from the author, and notification when the book is available on Amazon.Less
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Receive a thank you in the Foreword of the book, a digital download of the finished novel, a poster-size print of the cover art, an actual soft-cover of the finished novel autographed and inscribed by the author, and a minor character named after your first name, or a name of your choice. (International supporters please add $10 for shipping)Less
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Receive a thank you in the Foreword of the book, a digital download of the finished novel, a poster-size print of the cover art, an actual soft-cover of the finished novel autographed and insribed by the author, and a major character named after a male name of your choice (either the boy or his father) in the novel. (International supporters please add $10 for shipping)Less
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i was going to softmod an xbox, and i basically know how to do this, but theres one thing i dont get. I thought u need to solder some point on the mainboard, depending on the version, for example like in the Slushie Tutorial. But now i heard about ways to do it without opening it, but i just cant trust it, cause i always thought it would be a necessarity to solder in order to flash to original bios chip!
take a look at that site! I'd appreciate if someone could tell me the truth about the whole softmodding mysteries! Cause this is starting to freak me out!
I read the PDF Doc for the Software they arte talking about in that article, but to me it only seems to be an autoinstaller for softmodding, that does the whole 007 and mechassault and audio exploit and stuff automatically! Well that allready would be cool, but that doesnt mean that u dont have to solder anymore, right?
PLease answer quick, cause this is starting to freak me out!
Thank you very much for your time!
Softmodding Without Opening The Xbox? Possible?
Started by Crackbot , Jul 28 2005 10:48 PM
3 replies to this topic
Posted 28 July 2005 - 10:48 PM
Posted 28 July 2005 - 10:59 PM
You must not know too much about it. Softmodding and what your thinking about are two way different things. Softmodding involves using exploits within gamesaves and .xbe's in the Xbox. TSOP modding is basically giving you your very own modchip for free(although not as advanced as currents chips). What your think about with the soldering is TSOP modding. To answer your question, no, you do not have to open your console to softmod an Xbox because it involves no hardware modifications whatsoever.
Posted 28 July 2005 - 11:57 PM
i actually was in your position a few weeks ago and i ended up getting a hold of a memory card and putting krazies auto installer which you can get from the usual places and so y ai ran mech assault adn i opened the save game adn it was that easy more or less look around on the tutorials on this site adn you will be suprized on how easy adn simple every thing is thies ppl have gone thrue a lot of effort to make this as easy adn understandable as they can so just have a look around
Posted 29 July 2005 - 12:19 AM
This is not about tsop flashing, please post this in the exploits section.
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Ranking fighters
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Undisputed Champion
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Join Date: Oct 2006
Location: South of London
Posts: 11,603
vCash: 1186
Re: Ranking fighters
Originally Posted by
I notice a lot of threads here begging the question "where do you rank so-and-so." I winder if the author means this literally, and then I tune in to see the replies. Sure enough, there are actually people that will spout of with such things as "I rank him 34th all time at that weight" or some such.
This absolutely boggles my mind. I just can't get my brain around this type of thing. Who would actually sit down and document a list of
past maybe number ten at the most? What criteria do they use, and don't the lines blur after a while? I mean seriously, is there any REAL distinction between a number 23 heavyweight and a number 31? Does it even matter?
Do any of you seriously do this? Sit down and write out you top 100 all-time lists and weigh number 79 against number 55? That's just amazing to me.
It is silly to a degree, but one mans #50 could be the next mans #5, and neither are right or wrong.
Rankings period are entirly opinions... Even today if you asked 100 people who knew a lot about boxing to rate the top ten middleweights it would be highly, highly improbable that everyone would have the same ten.
And that is just rating the fighters who weigh 160lbs today. Now rate every single 160lber there has been since 1885 and it becomes bit more ludicrous, but it can be fun to do, just take everything written down with a pinch of salt.
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Chef Shawn Ward dishes on the new look of Ward 426.
Come to Louisville Magazine's launch party Wednesday at Brasserie Provence!
Patrick Spring headlines this comedy show at the Butchertown nightclub.
Dragon King's Daughter's new establishment, Kaiju, is the place for craft beer, local music, and lively atmosphere.
Get down to some Funk, R & B and Top forty all woven together for a hopping dance floor with free champagne toast at midnight.
Spoiler alert: you are definitely going to run into your ex.
Party's still on for now, though, so go have some fun.
Taste Fine Wines and Bourbons offers great prices, quality drinks and a cool atmosphere.
Dazzling chocolate bars with unique twists!
A new bar/venue, Tin Roof will soon open its doors.
Locals to say their ta-ta's to lesbian bar.
Starbase Q calls it quits.
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- next ›


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Will we see the first clean sweep in 'What?! Mmm…hmm' history?
Kay Adams has four statements for Tom E. Curran and Mike Giardi to duke it out.
One topic up for discussion was in regards to Rob Gronkowski's return date.
Will the Quick Slants crew be discussing his status all season long?
"Unless they put him on the PUP," said Giardi. "we're going to be talking about this, just like we did, camped outside his locker waiting for him to tell us, 'I'm getting better every day.'"
Curran disagreed with Giardi.
"The Patriots are not going to put up with a long, drawn out process with Gronk," said Curran. "The Patriots are going to be definitive, either you're going to play at the beginning of the year, or we're going to PUP you because we're not going to put up with waiting for Rob Gronkowski."


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Ludvika Things to Do
Hammarbacken area
In the area by the lake Väsman you can take a swim and visit one of the 2 cafés and take a look at the typical Swedish fishes "gädda, aborre and mört" in the small aquarium which also hosts a small shop with local hand-made stuff.
Visit the beautiful church found in the 1750's and find the amusing round gravestones.
On the way up to Hammarbacken there is a large, three-storey granary built in 1805 and is use for exhibition puposes. There's a cafe and a museum that shows how the blacksmiths lived around 1900.
Very nice indeed!
This is an very old farmyard with well preserved buildings.It's nice to walk around the small area but there are no info signs about the area and that's too bad. In the summer there are some activities here and a café.
Mining museum
Ludvika mining museum was opened in 1938 and was the first open-air museum of industrial history in the world.
When I was there in May it wasn't open yet even though it was a nice summersday and it was rather messy with rubbish laying around the place. Even the water in the small lake was full with rubbish.
If it's not open there's no need to go there because there's no signs whatsoever that tells you what the buildings were used for.
Ludvika Hotels
Best Western Grand Hotel Elektra
Eriksgatan 6, Ludvika, SE-77131, Sweden
Satisfaction: Excellent
Good for: Families
Hotell Ludvika Stadshotell
Carlavaegen 7, Ludvika, 771 30, se
Satisfaction: Excellent
Good for: Couples
Ludvika Stadshotel
Carlavagen 7, Ludvika, 77121, SE
Satisfaction: Excellent
Good for: Couples
Ditt Hotel-ludvika Stadshotell
Carla Vagen 7, , Ludvika, Dalarnas Län 77121
Ludvika Restaurants
Trattoria - Sole Mio: Panini
One of the few swedish places I´ve ever been to that serve Panini....and really really good ones aswell. Whenever I´m visiting Ludvika I squeeze at least one per day.
Favorite Dish: The cheese & ham panini with extra Mozzarellacheese.
Instant Answers: Ludvika
Get an instant answer from local experts and frequent travelers
- Great room rates
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you are viewing a single comment's thread.
yep, but Flo still knows where the goal is and while he does leeds have a good chance.JFH is quality and a gritty striker, just what you need to grind a few wins out of the tame 0-0 draw games. well done for gettig him. how much is he on tho? Birmingham went for him and he wanted £40K a week!


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God at the Movies • June 12 – July 12
Movies have a way of communicating unlike any other art form. In them, we find powerful stories of the human experience—an experience marked by intersection with the divine. Whether filmmakers know it or not, God's fingerprints can be found all over their stories. We'll take some of the most popular films from the last year and look at how we can find God at the movies.
For more info on why we do this series, resources before you watch the movies, thoughts from Pastor Ed Noble, as well as Frequently Asked Questions, click here.
|June 12 + 14
|Watch on: iTunes | Google Play | YouTube | Redbox
In spring of 1965, a series of dramatic events changed the course of America and the modern concept of civil rights forever. Courageous marchers, led by Dr. Martin Luther King Jr., attempted three times to carry out a peaceful procession from Selma, Alabama to Montgomery, Alabama on a quest for the basic human right to vote. The shocking confrontations, the triumphant final march and the passage of the 1965 Voting Rights Act that followed are now an indelible part of history.
|June 19 +21
|Watch on: iTunes | Google Play | YouTube | Redbox
Olympian and war hero Louis "Louie" Zamperini, along with two other crewmen, survived in a raft for 47 days after a near-fatal plane crash in WWII, only to be caught by the Japanese navy and sent to a prisoner-of-war camp. Based on the book "Unbroken: A World War II Story of Survival, Resilience, and Redemption" written by Laura Hillenbrand.
|June 26 + 28
|St. Vincent
|Watch on: iTunes | Google Play | YouTube | Redbox
Maggie, a struggling single woman, moves to Brooklyn with her 12-year-old son, Oliver. Having to work very long hours, she has no choice but to leave Oliver in the care of Vincent, a bawdy misanthrope next door. Vincent takes Oliver along on his trips to the race track, strip club and dive bar, and an unlikely friendship is born. The man is a mentor to the boy in his hedonistic way, and Oliver sees the good in Vincent that no one else can.
|July 3 + 5
| Watch on: iTunes | Google Play | YouTube | Redbox
After a controlling owner pushes him too far, chef Carl Casper quits his position at a prestigious Los Angeles restaurant. As he tries to figure out what his next step should be, he finds himself in Miami. Carl joins forces with his ex-wife, best friend and son to launch a food-truck business, and the venture provides a chance to reignite his passion for cooking — as well as his zest for life and love.
|July 10 + 12
|Guardians of the Galaxy
|Watch on: iTunes | Google Play | YouTube | Redbox
Brash space adventurer Peter Quill (Chris Pratt) finds himself the quarry of relentless bounty hunters after he steals an orb coveted by Ronan, a powerful villain. To evade Ronan, Quill is forced into an uneasy truce with four disparate misfits: gun-toting Rocket Raccoon, treelike-humanoid Groot, enigmatic Gamora, and vengeance-driven Drax the Destroyer. But when he discovers the orb's true power and the cosmic threat it poses, Quill must rally his ragtag group to save the universe.


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All materials on Kansas Memory are made available for noncommercial educational and research purposes only. It is the patron's responsibility to request and obtain permission from both the image and copyright owner(s) to use materials.
To obtain permission or to purchase a reproduction, please contact the KSHS Reference Desk at 785-272-8681, ext. 117 or email@example.com. See the Copyright and Permission FAQ for more information.
A view of a concrete sculpture of the American flag from "The Garden of Eden" in Lucas, Kansas. The garden was created by Samuel Perry Dinsmoor, 1843-1932, who was a Civil War veteran and, subsequently, a teacher, sculptor, and landscape artist in Lucas. He created "The Garden of Eden" on his property in Lucas and constructed over 200 concrete sculptures there which depict his views about Populism and religion. The garden is on the National Register of Historic Places.
Date: Between 1905 and 1932
Item Number: 603
Call Number: FK2.R8 , L.93 , *11
KSHS Identifier: DaRT ID: 603
Built Environment - Function - Recreation and Culture - Work of Art
Community Life - Arts and Entertainment - Art - Folk
Places - Cities and towns - Lucas
Places - Counties - Russell


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United States
Show all reviews
Acqua di Giò pour Homme by Giorgio Armani
Nothing new or special. Sweet clean scent that you always smell passing by in the mall/street/wherever. I will say that it is nice once it has dried down. But be forewarned that this scent has a Very short lasting strength. I can spray 8 or 9 sprays on, and by lunch it has dissapated completely(and yes I asked others around me, it simply doesn't last). For the right person and body chemistry you may get better lasting power, but for the cost it's not quite worth it. Never buy this from Armani, it's not worth over 50$ and ebay usually sells it off for under 30$. Wouldn't buy again, but it at least is nice.
26th May, 2008


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Visited the Holden Arboretum today to witness the incredible work you did constructing the tower and bridges.WOW! Very impressed. Knew the build had to be great...
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Life is promising new update in us
Local club works to bring back the once-prevalent American elm
I would love to help! Where would I get some of the new Strain so I could plant them?
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Berkshire was smart to merge with Ledgemont because it had shrinking enrollment and excess capacity at its high school. Now that Cardinal is dragging its feet ...
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Welcome back to the Statehouse, John. You are a terrific representative in the truest sense always representing the people's voice in teh district you serve. ...
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text: Over here some people are collecting old farming tractors, old Lanz Bulldogs and the like. Collecting cameras seems to be comparatively harmless to me. Just buy a glass cabinet and put all cameras you don't actually use in there. Most old cameras are a joy just to look at. There may come a time where you have a desire for one of them to use. You then don't need to buy it again. Just go to your cabinet and swap cameras.


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Buy Moto Metal from a company that has been in the automotive business for more than 30 years. Buy with confidence from Hubcap, Tire & Wheel.
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Audi to turn on OLED taillights at the Frankfurt Motor Show
- C.C. Weiss
- July 30, 2015
German luxury auto marques have been waging an all-out technology war, working overtime to beat each other to the punch in areas like autonomous driving and infotainment. A smaller but still notable theater of the war pits the brands against each other in developing high-tech lighting solutions. After mastering LED technology, BMW and Audi raced last year to release the world's first production car with laser lighting, and now they're set to battle it out in OLEDs. Audi will launch the latest offensive in September, when it reveals its first OLED Matrix-equipped concept car.Read More


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Right now in the South Jersey community, thousands of cats are giving birth and flooding animal shelters and rescue groups with homeless litters. To raise awareness and promote adoptions, the…
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Blood Oath
47,050pages on
this wiki
this wiki
|Blood Oath
|Deep Space Nine
|Written by:
|Peter Allan Fields
|Directed by:
|Winrich Kolbe
|Production information
|Episode no.:
|Production no.:
|First aired:
|Week of 27 March 1994
Jadzia is reunited with Kang, Kor and Koloth, whom with Curzon swore a blood oath to avenge the deaths of their sons at the hands of the Albino.
- Benjamin Sisko (Avery Brooks)
- Kira Nerys (Nana Visitor)
- Jadzia Dax (Terry Farrell
- Odo (Rene Auberjonois)
- Quark (Armin Shimerman)
- Deep Space 9 • habitat ring • Promenade • Quark's • Secarus • Secarus IV
- Referenced only
- Bajoran wormhole • Klach D'kel Brakt • Dayos IV • Galdonterre • Korvat
Races and culturesEdit
- Bajoran • B'kaazi • Changeling • Ferengi • Human • Klingon • Trill
- Referenced only
- Cardassian • Romulan
States and OrganizationsEdit
- Bajoran Militia • Klingon Empire • Klingon High Council • Starfleet • United Federation of Planets
- Referenced only
- Bajoran Resistance
Other referencesEdit
- armory • baakonite • bahgol • bat'leth • Battle of Klach D'Kel Brakt • blood oath • Breshtanti ale • cloaking device • dabo • Dahar Master • devil • d'k tahg • d'akturak • ghoptu • godfather • gravitic mine • heart • holosuite • kajunpak't • Klingonese • Klingon funeral • klorn • koranium • kuttar • kyamo • N'yengoren strategy • QiVon • racht • replicator • riddinite • scorcher • tennis • tetryon
Related storiesEdit
- Kor would later appear in "The Sword of Kahless" and "Once More Unto the Breach".
- The relationship between Koloth and Dax established in "Blood Oath" would be mentioned in "Trials and Tribble-ations", where Jadzia wanted to see him in his prime.
- The novel Excelsior: Forged in Fire is a prequel to "Blood Oath".
External linksEdit
- Blood Oath article at Memory Alpha, the wiki for canon Star Trek.
- Blood Oath (Star Trek: Deep Space Nine) article at Wikipedia, the free encyclopedia.
|published order
|Previous episode:
Profit and Loss
|DS9 episode produced
|Next episode:
The Maquis, Part I
|Previous episode:
Profit and Loss
|DS9 episode aired
|Next episode:
The Maquis, Part I
|chronological order
|Previous Adventure:
Journey's End
|Next Adventure:
Ancient History


text:
|Publication number
|Publication type
|Application number
|Publication date
|Mar 24, 1992
|Filing date
|Apr 4, 1990
|Priority date
|Jan 29, 1988
|Fee status
|Also published as
|Publication number
|Shumel Rahat, Joe Borman, Dan Rottenberg, Gideon Uretzky
|Original Assignee
|Galram Technology Industries, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (4), Referenced by (73), Classifications (5), Legal Events (5)
|External Links: USPTO, USPTO Assignment, Espacenet
The present patent application is a continuation-in-part application of U.S. patent application Ser. No. 07/304,854 filed Jan. 30, 1989, now abandoned.
The invention relates to the field of support of blood circulation in case of acute heart failure and more particularly, to physiological control means of such a device.
Means are provided by which the cardiac system is used to activate the device, integratively with the heart. Thus both elements, the heart and the mechanical device produce an as close as possible response to that expected by the body's controls via its physiological feed-back loops.
The invention is further related to of a device which utilizes physiological data to control its activities, in order to arrive at the correct required blood flow.
The cardio vascular system is made up of three main sections:
a. The Heart: the driving organ which provides the exact amount of blood momentarily required, it provides strokes of blood which are energy loaded, in a governed rate and shape.
b. The Vascular bed: This is the distribution system of the blood to the various organs, in accordance with the specific needs of each of them. It also acts as collecting system and general reservoir for blood, towards its reallocation to the heart, to be distributed on a beat by beat basis, in accordance with the integrated needs of the entire body.
c. The control: The control system is made up of subsystems which control the various organs via feed-back loops. All these controlled loops are part of the Central Nervous Systems (CNS), where they are evaluated and integrated. The CNS then operates the vascular flow towards the heart to provide the exact amount of blood to be circulated on the next beat and activates the heart to provide that volume of "blood stroke" at a predetermined rate and shape.
The heart's ventricles are operated by the following parameters, which are governed by the heart's own control system:
1. Preload: the pressure of the atrium preceding the acting ventricle, which defines the volume of the next stroke;
2. Afterload: the "pressure head" against which the ventricle has to act;
3. Contractility: the capability of the myocardium (the heart's muscle) to apply the needed force to reach the required stroke;
4. Rate the heart's beats per minute which together with the stroke volume define the cardiac output.
The coordinated performance of all these above operators is manifested in the Cardiac-Output, which provides the amount of blood per beat, at the right pressure wave.
In case of heart failure, the entire flow system is disturbed. Such disturbance is manifested by an inadequate Cardiac Output and damming of blood behind the defective heart chambers.
Depending on the kind, rate of development, and severity of the heart failure, a whole set of compensating mechanisms is activated in the vascular system by its control system, reallocating and affecting pressures, directing the reduced flow to the various organs, bringing the whole vascular system to a new balance point. This new balance point is in accordance with the central control system, operating the heart's controls as well.
However, in acute heart failure (such as acute myocardial infarction, AMI) a reduction in cardiac output and acute damming of blood behind the affected ventricles occurs. This effect might be too big to be regulated by those compensatory mechanisms and thus be fatal.
If all conventional therapeutic treatments of the heart failure mechanical support of the heart and circulation is required, and more specifically, Ventricular Assistance.
This form of sustained life assist might either be temporary or permanent.
A temporary heart assist system can, for example, be applied to patients who cannot be resuscitated (such as at AMI, or the end of an open heart operation) while recovery of the ventricular function is anticipated. If this does not happen, the device serves as a "bridge to transplantation" until a donor heart will be available.
The permanent ventricular assistance should be applied to patients who sustain permanent damage, where recovery is not anticipated, and the patient is not a candidate for heart transplantation, for any reason.
The basic principle of a mechanical assist device is the unloading of the defective ventricle of accumulated blood, and pumping it back into the circulation shunting the defective heart.
Evaluation of the data concerning the various models of heart Assist Systems (HAS) show their main drawback to be the discrepancy between the control systems of the body and that of the assist system. See Unger, Assisted Circulation 2, Springer-Verlag 1984 pp 391.
All devices, although providing blood to sustain the perfusion, operate in an independently controlled mode, (in spite of various physiological triggerings) not coordinated with the body's own controls. They lack the capacity to respond to the continuously changing requirements imposed by the body on the heart via pathways, including the central nervous system (CNS), thus leading to the above mentioned discrepancies.
The control systems of the current devices produce either a non physiological flow module where the blood is pumped into the circulation even during the diastolic phase of the heart beat, by using a centrifugal or a roller pump (see Pieronne et al. U.S. Pat. No. 4,622,355 of May 5, 1987), or engage the control of plural parameters of more than one physiological "control-loop" which by themself act independently (see Kurtz et al. U.S. Pat. No. 4,231,354 of Nov. 4, 1980). It has been well established that interconnection of independent "control-loops" (such as the mechanical HAS the body's controlled heart) can not be balanced and would cause, in the long run, the breakdown of one of the interlocked systems, even if coordinated via some common operators. They have continuously tried to rectify the ever changing discrepancies between the "orders" and "responses" on each of them which is based of different and independent algorithems.
Attempts of the CNS to rectify such discrepancies through various routes via other organs, such as the vascular system, kidneys or even the heart itself, may lead eventually to their failure.
The invention relates to means by which a heart assist system can be integrated with the cardiac system, to be activated in accordance with the body's demands. The system of the invention continually measures one singular parameter which defines the demand for blood to be provided by the heart.
The reading of the entire Arterial Pressure Function during the diastolic phase of the heart-beat provides this singular datum. This function, if utilized as the control parameter when compared to predetermined function serves as the operating function of the assist system. The system evaluates, on a real time basis, the actual performance of the defective heart, calculating the discrepancy between the demand for blood from the heart and the amount actually provided as it is manifested in the atrial pressure. The system continuously commands the HAS to draw the remnant blood from the heart during the diastolic phase thus providing a new artial pressure which corresponds to a predetermined pressure curve. It then supplies the blood during the systolic phase of the same beat.
The sum of the two blood flows--that of the failing heart and, that of the complementary amount pumped by the HAS during the systolic phase--on a real time basis, produces hemodynamic functions which are as close as possible to those expected by the "feedback control loops" of the heart.
The invention relates to a device comprising means which continuously monitor actual heart activities, and applies the data to a heart assist device, the novelty being the ability to integrate these with the biological control system. This is a device capable of providing the physiological rates and pressure shapes of the natural healthy heart.
The invention is illustrated with reference to the enclosed schematical drawings, not according to scale, in which:
FIG. 1--is a block diagram of the control loop of the system;
FIGS. 2A and 2B--illustrates the device and connection to the patient;
FIGS. 3A and 3B--illustrates the use of the system as a heart lung machine;
FIGS. 4A and 4B--illustrates a further embodiment of the use of the system as a heart lung machine;
FIGS. 5A and 5B--illustrates a "Flow-Directing Component";
FIGS. 6A, 6B and 6C--illustrates a blood pumping head;
FIGS. 7A and 7B--illustrates a variable pulsating pump and a typical displacement curve obtained thereby;
FIG. 8--is a block diagram of an internal servo-loop.
The healthy heart (the Active Pumping Element of the "Plant") receives its activating signals via various routes of the Central Nervous System (CNS), (the "Controller" of the body). Evaluation of the monitored data against "reference" data enable the production of signals which activate the natural heart so as to arrive at the correct values of strokes, at the correct shape and timing.
The severely damaged heart, is unable to produce such strokes, causing pathological consequences.
The system of the invention utilizes the whole Atrial Pressure Function (APF) during the diastolic phase of each heart beat to serve as reference of the required assist.
The blood flows, towards the heart, either veinous blood to the Right Atrium or oxygenated blood from the lungs via the pulmonary artery to the Left Atrium.
Those two flow rates are not always equal as they are part of the controlled cardiovascular system. If we take as an example the Left Atrium, the filling blood flow is building up the pressure pattern of the atrium. During the systolic phase of the heart beat, while there is no flow from the atrium to the proceeding ventricle, the pressure is building up during the diastolic phase, the blood is emptied into that ventricle and the pressure drops accordingly. It has been established that even if the pressure built up during the systolic phase is changing, because of larger amounts of blood flow towards the heart during that period, the pressure drops during the diastolic phase and remains quite constant, meaning changes in stroke volumes, controlled and operated by the CNS via the known "operators" described above.
We utilize this route as the way to combine our HAS with that of the body.
A pressure function which represents the pressure in the atrium, had it functioned properly, is fed into the system. We provide the means to interlock our device with the rate of the heart, to draw blood during the diastolic phase in the amount which reduces the measured atrial pressure from the pathological level to the predetermined level which should exist at that moment, in real time rates. Such a pressure function is accepted by the body's controls being in the correct shape and response with the CNS's function, having a shift from the real function as defined for each individual.
Such constant discrepancies are known to be accepted by closed loop controls, regarded as "regular heart failure" within the limits of the cardiovascular system, calling to particular responses via one of the routes of the system vaso-constriction, dilatation or one of the related organs such as the liver, kidney, lungs or the heart.
Whereas any other controller, which affects the shape as well as the shift will provide entirely confusing signals to the controller of the feed-back, causing utter confusion, which, in the attempt to rectify the continually charging signals, via continuously different routes which is the "proper" response for each of them at the time, causing at the end the failure of the system. This knowledge of the theoretical consideration of the interaction of two differently activated controls which act on one "plant" applies to the body-device controls as well.
The device of the invention utilizes the entire Atrium Pressure Function (APF) during the diastol phase of the heart beat as the reflection of the activating signals for "Pumping Element of the Plant", the heart.
The APF is a unique legible function which reflect the evaluated data of the CNS. This function is the expression of the amount of blood directed towards the atrium by the vascular system; the predetermined tonus of the atrium myocardia; the contraction of the atrium and the heart rate, all of which are monitored by the CNS.
A physiological feed-back loops which comprises a "Controller" which contours a Reference APF predetermined by the CNS and in which a system is constantly receiving inputs from the APF is capable of controlling the heart as known to us. Evaluating the difference between these functions, may arrive at activating-signals which may cause the heart to act (draw and pump blood) in a way which produce the proper APF.
Changing demands for blood, in accordance with changing needs of the body, should result in changes in blood flow towards the heart, and/or the atrial myocardial tonus, and/or contraction forces of the atrium, and/or rate of heart beat, all of which are manifested in the APF. The "Controller" activates the ventricle to respond, in accordance with the "Ref . APF", thus providing the changing Cardiac-Output, during the daily life cycle.
As mentioned above, in sudden acute heart failure, the "Pumping Element" is suddenly disrupted. It can no longer respond to the "signals" of the "Controller". This disturbance is manifested in a pathological APF.
According to this model, means are provided whereby an assist device can be integrated with the body's control system. The system comprises a pump connected to the heart. The activating controls of the pump measure the APF of the heart, evaluate it against a predetermined Reference APF, and activate the sensitive-servo-driven means, capable of drawing and pumping the excess blood accordingly, to arrive at the correct APF.
The system based on the invention can be used as an activating system for the Artificial-Heart, Left, Right or Biventricular Assist, for permanent or temporary applications.
The invention is illustrated with reference to the enclosed FIGS. in which the schematic block diagram (FIG. 1) illustrates the principle of a system for use with the failing ventricle. Block 11 (the Plant) between the points 12 and 13 (which defines the patient and the pumping devices) contains the dynamics of the patient 11B and the assist system 11A. The latter contains a servo-mechanism which receives its signals from the Controller 14, and activates the pumping element of the assist system accordingly.
This controller may use for example recursive equations such as the following one:
Y.sub.(n) =[(A1 Y.sub.(n-1) +A2 Y.sub.(n-2) +A3 Y.sub.(n-3) +A4 Y.sub.(n-4)
+(B0 V.sub.(n) +B4 V.sub.(n-1) +B2 V.sub.(n-2) +B3 V.sub.(n-3) +B4 V.sub.(n-4) ]�K
A and B=constants
Y=controller 14 Output
V=controller 14 input
n=current number of computer samples.
Block 14 designates the control elements of the central loop, within the dotted lines 16. This block receives the signals of the predetermined Reference Atrium Pressure Function (APF Ref.) at point 17, and the existing Atrial Pressure Function (APF) (which is recorded at point 13) at point 15.
This controlled closed loop system (16) thus contains the patient who has his own individual dynamic response. As the dynamic response is very much individual, depending on the patient's own internal parameter such as size, weight, age, classification blood vessels etc. No general equation can be composed as to the dynamic parameters of the feedback controller of the pump in order to arrive at the exact and correct response at point 13. Correcting factors added in an additional "Model-Following" (MF) loop, affects directly the parameters of the Reference APF. The controller of this loop 18 receives the difference between the signals of the real APF, and those required, according to the Model at point 20, and then produces corrected signal at point 19 which causes the proper APF.
The difference between the signals of the measured APF (at point 13) and those expected (20) according to the "MF" block, is gained at the controller block 18 which produces a correction signal at point 19.
The correction signal is added to the APF-Ref. at point 19 to produce another APF-Ref. signal at point 10. The signal is the input to the controller (14) adapted to the specific patient.
The "MF" block together with controller 14 enable the compensation and adjustments to changes in accordance with the body's dynamic response by considering the body's reaction.
The "MF" block may, for example use the following recursive equation, to produce that data.
W.sub.(n) =D[W.sub.(n-1) +RAPF.sub.(n) +RAPF.sub.(n-1) ]
W=block MF output
RAPF=Reference Atrium Pressure Function.
The invention is further described by way of illustration only, in its application as a temporary left Ventricular Assist device (LVAD). The device is schematically described in FIG. 2 in which the LVAD, 21, receives the monitored left APF and ECG, 22, of the patient, 23, which are fed into the microprocessor on the main computer PCB, 24. The microprocessor also times, according to a built in algorithm the cycle of the pump of the device, (the diastol-suction periods). The APF is evaluated by the microprocessor against a Reference APF predetermined for the specific patient, which is fed into the computer PCB 24 via the panel 26 of the device.
The summation of the evaluated data is sent as an electrical signal to the activating servo-mechanism of the variable pulsating blood pump (26, servo-amplifier and 27, the servo-mechanism of FIG. 2).
The variable pulsating pump may be way of example contain a quick response D.C. motor coupled with a ball screw and piston, as well as displacement and speed measuring devices (FIG. 7).
The internal servo loop receives the displacement signal from the computer, that evaluates the heart performance as explained in FIG. 1, and moves the piston up or down to eject or suck blood activated by its servo-mechanism.
Activating servo-mechanism has internal control loops of its own as shown in FIG. 8. These loops produce the controlled movements of the piston 28 (of FIG. 2) which activated the "Pumping Head", 29.
This pumping head is drawing blood out of the heart during the diastolic phases of the beat and pumping it back during the systolic phase of the same beat, to provide, together with the heart, the required stroke volume.
The space between the moving piston and the diaphragm of the blood pumping head, is fluid-filled assuring accurate and proper responses to any tiny movement of the system 28.
A new displacement signal is given every few milliseconds, on the internal servo control loop forces the piston to move up or down according to the signal, assuring smooth and accurate action, preventing overshooting and negative pressure in the stream (FIG. 8). This movement may change many times in amplitude and direction within one heart cycle thus enables a real time control over the controlled APF.
A working example of the application of the invention as a multiple blood pump, integrated in a Heart-Lung-Machine (HLM), is shown in FIGS. 3 and 4. The pulsating HLM is used for Cardio-Pulmonary By-Pass (CPY) during heart surgery (FIG. 3).
Blood pump, integrated in a Heart-Lung-Machine (HLM), is shown in FIGS. 3 and 4. The pulsating HLM is used for Cardio Pulmonary By-Pass (CPU) during heart surgery (FIG. 3).
At this mode of operation the blood flows from the patient 31, via the venous line 32, to the oxygenerator 33. From the oxygenerator, the blood is drawn by the hydro-electro-mechanical pump, 34, (described in FIG. 2), via a "CPB Disposable Blood Pumping Head", 35, (which will be described in FIG. 6), and pumped back to the patient through the arterial line 36.
This application provides an HLM with the capabilities of providing at will, rates, systole/diastole, pulse shape, stroke volume, dp/dt of the pumped blood, arriving at desirable blood pressures during the cardio-pulmonary by-pass, thus providing the surgeon the ability to produce and control all these parameters.
At will, during partial By-Pass or at the critical stage of disconnecting the patient from the HLM ("wearing off"), our system enables synchronization of the pulsating pump to the patient's ECG, providing via the panel 37 a desirable systolic/diastolic wave, with shapes, which can produce the therapeutic "counter-pulsation" (C.P.) effect.
If desire all efforts, the patient needs assistance, the system is turned into an Assist Device.
The patient remains connected to the Bypass mode, while the surgeon carries out the necessary surgical operations to enable the connection of the "Assist Disposable Blood Pumping Head", 41, in FIG. 4, and the filling of the hydraulic line 44, connecting the Pumping Head to the hydraulic "Flow Directing Component 40 of FIGS. 4 and 5".
This "Flow Directing Component" described in FIG. 5, is set above the pumping piston 48. It comprises a "CPB" disposable Blood Pumping Head, 35, mounted on one side, and a fluid filled cone and line, 44, on the other side. A tilting disc, 43, within this component, can be turned from position (a) for the device to be operated as HLM and C.P., to position (b), turning it to the Assist mode positioning the knob 37 on the panel of FIG. 4, to the Assist position operating the device. The CPB Disposable Head, 35, is disconnected and the patient leaves the Operating Room while still connected to the device which operates on its own power supply.
As the patient recovers, the procedure is reversed and he is disconnected from the device.
The "Disposable Blood Pumping Head", 35, in FIGS. 3 and 4, 29, in FIG. 2, and 41, in FIG. 3, are described in detail in FIG. 6. It is designed to reduce blood hemolysis caused by turbulent flows. This is achieved by a diverging cone of the entrance zone (A) of the "Head" with the addition of the diffuser 61, which is inserted in the larger conical zone (B) of the funnel. It enables further reducing of the flow velocities along a short distance, thus reducing excess turbulence, shear stresses and energy dissipation.
The direction of the outflow, 52, within the spherical zone (C), is coordinated with the moving membrane, 63, to bring about a better washout of the blood from the "Head" at each stroke in order to avoid blood particle sedimentation.
The operation of the device is illustrated with reference to FIGS. 3 to 5 of the enclosed drawings.
The device is located in the operating theater (O.R.) and is used instead of one of the pumps which comprise the heart-lung machine (HLM) and the mode of operation is as follows:
The perfusionist connects the pumping head 35 which includes inlet and outlet valves to the flow-directing member 40.
The pumping head is connected to oxygenator 37 while the tilting disk 43 is kept to the right disconnecting the assist flow direction; and the space in the flow directing device 40 is filled with hydraulic fluid. The procedure of connecting the patient to the device is according to standard protocol of use of a heart-lung machine (HLM) on a cardiovasculary bypass.
As the patient is on bypass, while his heart is beating, the operating knob 37 is positioned on CP and the perfusionist starts perfusing blood by turning the FLOW and SYM knobs 39 on the panel, to reach the desired flow rate and pressure. At the "Cross Clamp" stage of the operation, when heart beat is stopped, the perfusionist turns the knob 37 to the CP position, enabling him to operate the RATE (beats per minuts), FLOW (liters per minute) and SYM (arterial pressure) by means of 39, as required by the surgeon. At the end of the operation when the heart starts beating again, the perfusionist turns knob 37 back to the CP position, weaning the patient off the bypass by reducing FLOW accordingly and the patient is disconnected from the HLM.
At the weaning stage, the surgeon has the option to apply a counterpulsating mode to overcome possible difficulties of the heart in maintaining circulation. In this case, the patient is kept connected with the device while the perfusionist turns PHASE knob 39 which applied counter-pulsating pressures and flows, which are intended to improve the performance of the heart.
If in spite of such measure carried out in accordance with standard protocol, the condition of the patient fails to improve, and it is still impossible to disconnect him from the HLM, the surgeon has to cannulate the left atrium or ventricle. The perfusionist prepares the Assist Pumping Head 41 connecting it via the hydraulic line 44 to flow directing device 40 and the hydraulic line 44 is filled with hydraulic fluid.
The pumping head 41 is connected on the inlet side to the left atrium or ventricle; on the outlet side to the aorta, and on the rear side to the hydraulically propelling line 44. At this stage, the LAF is determined via knobs APEX, APFY, APFM, 49, in accordance with the instructions of the surgeon.
The connected, assisted patient leaves the operating room while he is connected to the assist device of the invetion and moved to an intensive care unit (ICU). As soon as the condition of the patient improves and no assist device is required anymore, the patient is again moved to the operating room and the device is disconnected.
|Cited Patent
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|Avco Corp
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|Vince Medical Company Limited
|Cardiac assist device
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|University Of Pittsburgh Of The Commonwealth System Of Higher Education
|Fluid delivery apparatus and associated method
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|Oct 12, 1999
|United States Surgical Corporation
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|Fore Flow Corporation
|Implantable heart assist system
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|Oct 9, 2001
|Orqis Medical Corporation
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|Orqis Medical Corporation
|Implantable heart assist system and method of applying same
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|Orqis Medical Corporation
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|Orqis Medical Corporation
|Implantable heart assist system
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|Aug 26, 2003
|Orqis Medical Corporation
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|Feb 3, 2004
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|Flowmedica, Inc.
|Apparatus and methods for treating congestive heart disease
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|Orqis Medical Corporation
|Implantable heart assist system and method of applying same
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|Feb 7, 2006
|Flowmedica, Inc.
|Apparatus and method for inserting an intra-aorta catheter through a delivery sheath
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|Intra-aortic renal delivery catheter
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|Flowmedica Inc.
|Intra-aortic renal drug delivery catheter
|Apr 7, 2003
|Oct 24, 2006
|Orqis Medical Corporation
|Implantable heart assist system and method of applying same
|Dec 5, 2003
|Dec 5, 2006
|Orqis Medical Corporation
|Implantable heart assist system and method of applying same
|Aug 6, 2003
|Jul 10, 2007
|Flowmedica, Inc.
|Intra-aortic renal delivery catheter
|Apr 5, 2004
|Sep 4, 2007
|United States Surgical Corporation
|Circulatory support system
|Sep 7, 2005
|Feb 12, 2008
|Flowmedica, Inc.
|Intra-aortic renal drug delivery catheter
|Jun 28, 2004
|Feb 19, 2008
|Orqis Medical Corporation
|Implantable heart assist system and method of applying same
|May 13, 2003
|Feb 26, 2008
|Flowmedica, Inc.
|Apparatus and methods for treating congestive heart disease
|Jul 3, 2003
|Mar 11, 2008
|Flowmedica, Inc.
|Apparatus and methods for treating congestive heart disease
|Mar 18, 2005
|Apr 29, 2008
|Flowmedica, Inc.
|Method and apparatus for intra-aortic substance delivery to a branch vessel
|Jun 10, 2004
|Nov 4, 2008
|Orqis Medical Corporation
|Cannulae having reduced flow resistance
|May 3, 2005
|Dec 2, 2008
|Orqis Medical Corporation
|Implantable heart assist system and method of applying same
|Apr 23, 2003
|Jan 27, 2009
|Flowmedica, Inc.
|Intra-aortic renal drug delivery catheter
|Jun 28, 2004
|Apr 7, 2009
|Orqis Medical Corporation
|Implantable heart assist system and method of applying same
|Aug 6, 2003
|Jul 21, 2009
|Angiodynamics, Inc.
|Intra-aortic renal delivery catheter
|May 13, 2005
|Sep 8, 2009
|Goodson Iv Harry Burt
|Bi-lateral local renal delivery for treating congestive heart failure and for BNP therapy
|May 3, 2006
|Sep 15, 2009
|Orqis Medical Corporation
|Implantable heart assist system and method of applying same
|May 3, 2006
|Sep 22, 2009
|Orqis Medical Corporation
|Implantable heart assist system and method of applying same
|May 3, 2006
|Nov 10, 2009
|Orqis Medical Corporation
|Implantable heart assist system and method of applying same
|Dec 5, 2005
|Aug 3, 2010
|Angio Dynamics, Inc.
|Systems and methods for performing bi-lateral interventions or diagnosis in branched body lumens
|Jun 5, 2007
|Aug 10, 2010
|Angiodynamics, Inc.
|Selective renal cannulation and infusion systems and methods
|May 1, 2000
|Aug 24, 2010
|Angiodynamics, Inc.
|Apparatus and methods for treating congestive heart disease
|Mar 16, 2005
|Mar 29, 2011
|Angio Dynamics
|Method and apparatus for selective material delivery via an intra-renal catheter
|Nov 10, 2009
|Aug 9, 2011
|Thoratec Corporation
|Implantable heart assist system and method of applying same
|Sep 29, 2005
|Aug 9, 2011
|Angio Dynamics, Inc.
|Renal infusion systems and methods
|Jun 26, 2007
|Sep 6, 2011
|Angiodynamics, Inc.
|Method and apparatus for selective material delivery via an intra-renal catheter
|Mar 5, 2007
|Mar 5, 2013
|Thoratec Corporation
|Staged implantation of ventricular assist devices
|Aug 28, 2009
|Aug 27, 2013
|Angiodynamics, Inc.
|Sheath for use in peripheral interventions
|Mar 7, 2008
|Nov 19, 2013
|Angiodynamics, Inc.
|Method and apparatus for intra-aortic substance delivery to a branch vessel
|Jul 1, 2011
|Dec 2, 2014
|Thoratec Corporation
|Implantable heart assist system and method of applying same
|Apr 23, 2003
|Apr 1, 2004
|Kesten Randy J.
|Intra-aortic renal drug delivery catheter
|May 13, 2003
|Apr 1, 2004
|Gad Keren
|Apparatus and methods for treating congestive heart disease
|Jul 3, 2003
|May 20, 2004
|Gad Keren
|Apparatus and methods for treating congestive heart disease
|Dec 5, 2003
|Jun 17, 2004
|Bolling Steven F.
|Implantable heart assist system and method of applying same
|May 21, 2002
|Jul 29, 2004
|Woodard John Campbell
|Staged implantation of ventricular assist devices
|Apr 5, 2004
|Sep 30, 2004
|Robert Jarvik
|Circulatory support system
|Jun 28, 2004
|Nov 25, 2004
|Bolling Steven F.
|Implantable heart assist system and method of applying same
|Jun 28, 2004
|Nov 25, 2004
|Anthony Viole
|Implantable heart assist system and method of applying same
|Oct 15, 2003
|Apr 21, 2005
|Bolling Steven F.
|Implantable heart assist system and method of applying same
|Dec 12, 2003
|Jun 16, 2005
|Bolling Steven F.
|Cannulae for selectively enhancing blood flow
|Mar 4, 2005
|Sep 8, 2005
|Flowmedica, Inc.
|Sheath for use in peripheral interventions
|Mar 18, 2005
|Nov 3, 2005
|Flowmedica, Inc.
|Method and apparatus for intra-aortic substance delivery to a branch vessel
|Mar 18, 2005
|Nov 3, 2005
|Flowmedica, Inc.
|Apparatus and method for inserting an intra-aorta catheter through a delivery sheath
|May 3, 2005
|Nov 17, 2005
|Bolling Steven F
|Implantable heart assist system and method of applying same
|May 13, 2005
|Dec 1, 2005
|Flowmedica, Inc.
|Bi-lateral local renal delivery for treating congestive heart failure and for BNP therapy
|Jun 10, 2004
|Dec 15, 2005
|Robert Pecor
|Cannulae having reduced flow resistance
|Jun 10, 2004
|Dec 15, 2005
|Robert Pecor
|Cannula having reduced flow resistance
|Mar 16, 2005
|Feb 16, 2006
|Flowmedica, Inc.
|Method and apparatus for selective material delivery via an intra-renal catheter
|Sep 22, 2005
|Mar 30, 2006
|Flowmedica, Inc.
|Systems and methods for bi-lateral guidewire cannulation of branched body lumens
|Dec 5, 2005
|Jul 6, 2006
|Flowmedica, Inc.
|Systems and methods for performing bi-lateral interventions or diagnosis in branched body lumens
|Dec 16, 2005
|Jul 27, 2006
|Flowmedica, Inc.
|Method and apparatus for intra aortic substance delivery to a branch vessel
|Feb 14, 2005
|Aug 17, 2006
|O'leary Shawn
|Apparatus and methods for reducing bleeding from a cannulation site
|Sep 7, 2005
|Aug 24, 2006
|Flowmedica, Inc.
|Intra-aortic renal drug delivery catheter
|Mar 17, 2005
|Oct 5, 2006
|Scott Michael J
|Methods for minimally invasive vascular access
|May 3, 2006
|Nov 30, 2006
|Bolling Steven F
|Implantable heart assist system and method of applying same
|Feb 19, 1997
|Aug 28, 1997
|Synthelabo Biomedical Societe
|Control circuit for an implantable cardiac assistance pump with a counterpressure balloon
|May 21, 2002
|Nov 28, 2002
|Ventrassist Pty Ltd
|Staged implantation of ventricular assist devices
|Feb 10, 2003
|Aug 21, 2003
|Univ Singapore
|Physiologically compatible cardiac assist device and method
|U.S. Classification
|International Classification
|Cooperative Classification
|European Classification
|Sep 21, 1995
|Fee payment
Year of fee payment: 4
|Mar 18, 1997
Owner name: MEDICARD LTD., ISRAEL
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:GALRAM TECHNOLOGY INDUSTRIES LTD.;REEL/FRAME:008392/0786
Effective date: 19961229
|Oct 19, 1999
|Maintenance fee reminder mailed
|Mar 26, 2000
|Lapse for failure to pay maintenance fees
|Jun 6, 2000
|Expired due to failure to pay maintenance fee
Effective date: 20000324


text:
- Linux (54)
- Modern (45)
- Grouping and Descriptive Categories (36)
- Windows (27)
- Mac (17)
- Emulation and API Compatibility (6)
- Embedded Operating Systems (5)
Top Apps
- Audio & Video
- Business & Enterprise
- Communications
- Development
- Home & Education
- Games
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- Science & Engineering
- Security & Utilities
- System Administration
Panorama Wallpaper
Application to automatic set up cut-panoramic photos as wallpaper CZ: Aplikace na automatické nastavování výřezů panoramatických fotografií jako tapety0 weekly downloads
WAR [source]
Utility for source code formating used in BB forums. For formating are used [list] tags, becouse come of forums haven't enabled the coloration in [code] tag. Application provides source formatting too.0 weekly downloads
eComm is open source business solution based on .NET framework and C# language. Should be ported to Linux for Ximian's Mono project. From start it runs on Windows 2000, XP, Windows.NET servers with .NET framework and MS SQL Server 2000 on server.0 weekly downloads
A small store management application developed for Maemo platform. It's only in Czech language so far. Features: custom categories, simple GUI, statistics. Written in Python.0 weekly downloads
This project is aimed to develop full featured framework for building web sites and their content managers. Is based on the newest technologies such as PHP 5.0, XML, XSL, XUL and so on.0 weekly downloads
the ROBOTIX game
ROBOTIX is an opensource 3D game written in python, PyGtk, Gazpacho(Glade rewrite),Python OpenGL bindings. You build robots from predefined parts and make programs for them. Supports robot fighting and online score management.0 weekly downloads


text:
Browse the comprehensive database of Keansburg car dealers online at Autobytel.com. See your potential new or used car by make, cost, or classification. Browse our giant catalogue of Keansburg car dealerships; which have their entire supply of new and used automobiles listed at Autobytel.com. We can be your resource as you go through the transaction of purchasing a car. Find current prices on new and used cars, research car specs, see pictures of cars, read in-depth reviews, and get a price quote from a Keansburg car dealership.
The days of browsing cars at brick and mortar Keansburg car dealerships have long since passed. With the advent of the internet; Keansburg car dealers can now list their entire inventory online at numerous locations like Autobytel.com. And the majority of car shoppers will begin to research automobiles online. Most car buyers will seek out the inventories of Keansburg car dealers once they have figured out which automobile is best for them. It will not be long till they come to an authorative car site like Autobytel.com. At our website you can get a free price quote from a number of Keansburg car dealers.
Finding one Keansburg car dealership that is trustworthy can be a huge burden off your shoulders. Its commonly believed that the only time you'll step foot on a Keansburg car dealer lot is to purchase your vehicle. Most Keansburg car dealers have automotive friendly services that will warrant your return to the lot some day. Respectable Keansburg car dealerships have much more to offer the customer than just new and used car sales; there should also be: a body shop, a service department, a parts center, and a financing office. The possibility is very high that you will again go back to the Keansburg car dealer establishment if you ever need anything for your vehicle. That's why it is a good idea to form a close bond with the Keansburg car dealership in the event that you need to use one of their multiple services.
Find a reputable dealer by searching the Keansburg car dealerships database online at Autobytel.com Read actual clientele reports on a number of Keansburg car dealers. This could be an effective tool at narrowing down which Keansburg car dealerships can most closely fit your new or used car buying needs.


text:
Single & fed up but don't want to look desperate!(1 Post)
rainbowfeet Sun 21-Apr-13 15:25:35
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text:
Stefan Salvatore Quotes
[to Caroline] Yesterday you told me that you made a list of all the ways that loving me has ruined your life, and I get it. I haven't made it easy on you, but I made a list too. Of all the ways that loving you has changed mine. You were by my side when I needed a friend. You made me laugh, you made me dance. You told me that I would find love again, and I understand if you need time to heal and to live your life without me. I understand if I have to wait for you. And I will. I'll wait. And when you're ready for me, I will be ready for you.
Elena: Thank you for bumping into me that day in the hallway. I never thought I would ever be happy again and then I met you. You quite literally saved my life. I love you so much, which is why I can't wait to find out what new life you've chosen for yourself in sixty or seventy years, whenever I see you again.
Stefan: I can guarantee you it won't be high school.
Elena: Just be happy. I'll see you soon.
I don't think Elena necessarily came into my life to be soul mate. I mean, she was. We loved each other, but she was also the only person I've ever met who actually believed that my brother was worth loving. And she reminded me that I used to believe that about him too. Her faith in him, it brought Damon and me back together, and yeah, I loved her, more than I thought I could love somebody else, but I think in the end I needed him more than I needed her.
Elena: People are uncomfortable around Salvatores in tuxes. It stirs...feelings.
Stefan: Uh oh. Elena's human again. Am I sensing another brother swap?
Damon: What do you think I should do?
Stefan: That's the thing, Damon. I can't tell you. Elena can't tell you. You have to want to be human for yourself.
Damon: You get a night, Stefan. A night to beat yourself up, do your shame spiral, and then you have to go after Caroline.
Stefan: I don't need a night. I'll find her.
It must be so exhausting overthinking everything, denying your own urge to kill and just be done with them.
[to Caroline] You are an embarrassment to humanity-free vampires everywhere.
Stefan: Neat, organized Caroline staying within the lines. Good at control, terrible at revenge.
Caroline: I dismantled your bike.
Stefan: I tore your director's head off with my teeth.
Damon: So Saint Caroline keeps her halo even with no humanity.
Stefan: Yeah, until she snaps and strangles somebody with it.
Stefan: I think you were wrong about Caroline. I realize that I may not be able to explain what I feel for her, but it is something, and yeah, maybe all love isn't true love in the messed up way that you and I have experienced it, but I think this could turn into something even better.
Damon: Well then, brother, stop wasting your time sitting here with me.
Stefan: Look, something happened between Caroline and me.
Damon: Oooh, finally.


text:
CHICAGO, Nov. 16, 2012 /PRNewswire/ -- Winter months can bring on the itch as cold weather and indoor heat dry out the skin. It's possible, suggests Chicago allergist, Brian Rotskoff, MD of Clarity Allergy Center, that your winter itch could be caused by more than just the weather. For some people itchy, dry skin is just that, but for others it can be a symptom of atopic dermatitis (eczema), contact dermatitis, or hives (urticaria). Before stocking up on skin soothers, Dr. Rotskoff suggests getting a better handle on your exact condition. His practice specializes in allergy skin testing, as well as allergic rhinitis (hay fever), allergy drops/allergy shots, asthma, childhood nasal allergies, and the full range of sinus and allergic conditions.
(Photo: http://photos.prnewswire.com/prnh/20121116/NY15182)
"Chronic skin rashes can be very frustrating, not to mention uncomfortable," sympathizes Dr. Rotskoff. "With patch testing, I can isolate potential allergens that may be causing chronic eczema or contact dermatitis. If the results are positive, I help patients create avoidance plans to minimize their exposure and reduce future outbreaks. This is especially important for children at risk of angioedema."
Skin testing by an allergy expert is the best route to long-term skin solutions, but Dr. Rotskoff offers up these general guidelines for understanding your skin condition.
What is contact dermatitis?
|SOURCE clarityallergycenter.com
Copyright©2012 PR Newswire.
All rights reserved


text:
Join us Wednesday, July 29 for the next in our "Community Heroes" series. Sarah Twardy will talk about being a teacher and a coach.
Stories about Personal Safety! When: 11 am, Tuesday, August 4th. Where: Pember Library 33 West Main St Granville Come join the Youth Services Coordinator from the Domestic Violence Project for story time! We'll be reading "Telling isn't Tattling" by Kathryn M. Hammerseng to help encourage kids to talk to their parents about things that make them feel uncomfortable
Join us July 22 at 6PM when Vet Tech Jodie Prouty tells us what her job is all about!
Join us Wednesday, July 15 at 6PM for the next in our "Community Heroes" series. Scott Chapman will talk about what it like being an EMT.
60's Coffee House – Java and Jive Fundraiser at the Pember Library and Museum Friday, July 17 – 7:00 to 9:00 pm * Exotic Coffee House Atmosphere * Open Mike, Spotlight and Board Games * Fresh Brewed Coffees, Cappuccino, Espresso * Coffee Cakes and Special Pastries Calling all singers, poets, troubadours and coffee hounds! If you play an instrument or sing, write poetry
Join us Wednesday, July 8 at 6PM for the next in our "Community Heroes" series. Mike Pietryka, a retired US Navy pilot, will talk about his career.
Our first "Community Heroes" presentation will be tomorrow, Wednesday, July 1 at 6PM. A member of the Washington County Sheriff's office will be here to describe what they do. He will be bringing a K-9 officer!
A meeting of the Board of Trustees of the Pember Library and Museum will be held on the third Friday of July at the Pember. This is a regular meeting and open to the public.
The book club will be reading the Signature of All Things by Elizabeth Gilbert. Goodreads.com says: A glorious, sweeping novel of desire, ambition, and the thirst for knowledge, from the # 1 New York Times bestselling author of Eat, Pray, Love and Committed. In The Signature of All Things, Elizabeth Gilbert returns to fiction, inserting her inimitable voice
Every Hero has a Story June 20, Kick-Off 11:00 - 1:00 July 11, 11:00 -12:00 July 18, 11:00 12:00 July 25, 11:00 12:00 August 8, party 12:00-1:00
Our phone lines are working again.


text:
We Americans are so used to thinking of art as something you go far away to find that only too often we are like the fairy-tale hero who combed the world for a magic chum that was right under his nose an the time.* You do not have to sail to Europe in order to secure art worthy of your home; you do not even have to carry your checkbook into the hushed salons of big-city art dealers. Hidden away in some corner of your parents' or grandparents' house, you may well unearth the paintings your great-grandmother selected for her wall. If, like so many of us, you have moved away from your family homestead, you may discover in a little antique shop around the corner the pictures which somebody else's great-grandmother bought and cherished. Sometimes, for the mere labor of carrying a load down the attic stairs--or for a few dollars--you may secure just the spot of color and design that is needed to give your living-room distinction.
When Great-Aunt Harmony wanted a picture to enliven that dark place in the hall, she might make it herself, never doubting that she knew how. Had she not been to the best Ladies' Seminary in the region, where she had been taught "dancing, needlework, and painting in oils"? And when Harmony got married, her groom wanted portraits of them both as parlor pieces. He did not mourn that he lacked the cash to pay some famous member of the National Academy. He hailed a face-painter who came by in a carriage and paid him with three nights' lodging and a bottle of rum.
While Harmony and her husband lived, the pictures hung on their walls, blending perfectly with the furniture and china. However, Harmony's heirs--particularly that fancy daughter-in-law from the city-- thought the whole decorative scheme stuffy and out of date. Furniture and pictures went up into the attic together.
Most of us have long since discovered that old American furniture has____________________


text: Mick, thanks for the info. I was thinking specifically about film processing kits as opposed to printing (RA4) kits, but I guess I should have been thinking about printing chemicals too. I use the same Agfa RA4 kits as you do. I'd be happy to go halvies with you in C41 and RA4. My suburb is the one whose football team got beaten by my football team in the 2001 grand final.


text:
- Filed Under
Omro 46, Lomira 34: Dylan Tritt posted his second straight double-double with 17 points and 12 rebounds and the Foxes outscored the lions in every quarter en route to the Flyway Conference win.
Nick Blythe added 16 points for Omro, which led 26-20 at halftime.
Adam Buerger led Lomira with 10 ...


text:
- Horoscopes
- Dear Abby
- Games & Puzzles
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New London - If the state builds an enclosed pedestrian bridge across the railroad tracks to connect to the proposed National Coast Guard Museum, a proposed ferry terminal and Union Station, residents want to know where exactly it will be located, what it will look like and who's going to own it and maintain it.
On Monday the state Department of Economic and Community Development heard the concerns of several people during a "scoping" meeting Monday in City Hall.
"The state has learned, first get input as you go - that is what drives engineering and design,'' said Rob Ross, executive director of the state Office of Military Affairs, which is coordinating all state departments for the proposed foot bridge. "You people shape the project."
Ross said the state would build the walkway but the city would own it and be responsible for its maintenance and security. The walkway would not cross Water Street as previous proposals envisioned.
In April, the Coast Guard Museum Association announced it would build an $80 million museum on the city's waterfront. The state pledged $20 million to build the walkway and for other work associated with the project, including property purchases, feasibility studies and traffic redesigns.
Monday's meeting was about the proposed bridge, but Ross said a meaningful discussion had to include plans for the proposed museum, the ferry terminal and access to the train station.
Cross Sound Ferry and Union Station are also players in the project. A seasonal ferry terminal for Cross Sound Ferry is part of the overall museum project. The walkway also would allow train passengers better access to the northbound track at the station.
The glass walkway would get pedestrians over the railroad tracks to the museum's entrance and to the new ferry terminal. It would also provide access to Union Station. It would have three sets of steps and handicapped-accessible elevators.
Todd O'Donnell, co-owner of Union Station, a 19th century Henry Hobson Richardson structure, said the location is a difficult site but if the parties work together it could become a reality. He said the scoping process is an important first step.
He was one of a half dozen people who spoke at Monday's meeting. DECD is accepting written comments on the proposed walkway through July 18.
Barun Basu, a New London architect who helped restore Union Station, asked if it was possible to build a tunnel rather than a bridge. Others were concerned about the safety of pedestrians crossing Water Street and school children getting off buses to go to the museum.
Ross said all comments will be considered.
Architects for the project showed four possible locations for the bridge and said their preferred site would be located on Union Station property next to the bus terminal. The bridge would be built with three elevators and three stairwells, or possibly escalators, and be tall enough to cross above the electrical wires above the railroad tracks. The exact height has yet to be determined, according to Charles S. Klee of Payetta Architects, which is working with Gauchat Santos of Boston.
Union Station is an incredible asset for the city, Klee said after the meeting, and the walkway would be designed to complement it, not overpower it.
"It needs to sit next to the building (train station) sympathetically,'' he said. "It can't be more demanding. It has to sit there in a very well-behaved way and not overshadow the train station."
The proposed National Coast Guard Museum, which officials expect to draw hundreds of thousands visitors annually, will be a five-story, mostly glass building constructed above storm tide levels. It will jut out over the Thames River like the bow of a ship. It will have 26,000 square feet of exhibit space, 5,000 square feet of event space, a glass-roofed atrium and a gift shop, cafe and rooms for lectures and workshops.
The DECD, which is the lead agency for the proposed walkway, is required to hold a meeting on any project it might launch, such as a new building or new road. Other state agencies are also asked to comment on the project.
The public can comment on the project in writing through July 18.
Atten: Mark Hood
Department of Economic and Community Development
505 Hudson St.,
Hartford, CT 06106
Fax: (860) 270-8157
Email: firstname.lastname@example.com
Coast Guard Museum divides New London City Council candidates
State approves funds for Morgan restoration and Coast Guard Museum
UConn student sorry for mac and cheese meltdown, says he's ashamed
Massachusetts man sentenced for selling counterfeit electronics for use in U.S. submarines
Police find 8 grams of crack in New London apartment, arrest city man
Driver in deadly 2014 Waterford crash charged with reckless driving, misconduct
CGA professor talks about 3-D printing on board the Cutter Healy
Groton to seek $53 million more in state school construction funding to solve racial imbalance
Armed man dies after standoff with police at Old Saybrook motel


text:
"ASBO International's resources are incredibly helpful!
I can't imagine finding so much relevant information - all in one place - anywhere else! My membership has definitely made me a better leader and has helped me enhance my district's image."
John Hutchison, Olathe Public Schools, Kansas
Member since 2010
>See More
Review the full line up of educational sessions available at the 2015 Annual Meeting & Expo. We offer professional development in the following formats:
Premier professional development for school business officials.
Review program books from past events.
Show why the Annual Meeting is worth the investment.
A guide for first-time attendees.
Save the date for your next annual meeting.
Learn more about our exciting general session presentations.
Where to stay and how to get there.
Plan your meeting schedule online
Review this year's schedule of events.
Register for the Annual Meeting & Expo, October 23–26 in Grapevine, Texas.
Explore Grapevine.
Review the full line up of Friday's educational sessions.


text:
Customer Support Analysts in the United States take home approximately $45K per year on average. Geographic location and career duration each impact pay for this group, with the former having the largest influence. Most Customer Support Analysts report high levels of job satisfaction. Men working as Customer Support Analysts who took the survey just slightly outnumber women at 51 percent. A large number report receiving medical coverage from their employers and most collect dental insurance. The information for this rundown comes from respondents who completed PayScale's salary questionnaire.
Survey takers who work as Customer Support Analysts usually report a few specific skills. Most notably, skills in SQL, Information Technology Support, Customer Relations, and Customer Service are correlated to pay that is above average. Skills that pay less than market rate include Customer Service.
Median of all compensation (including tips, bonus, and overtime) by years of experience.
Those who have worked for fewer than five years take home a median salary of $41K, and workers with five to 10 years of experience earn a higher $46K on average. Customer Support Analysts see a median salary of $45K after reaching one to two decades on the job. Survey participants who have worked for more than two decades report bringing in $52K on average.
|Highly satisfied
Rated 4 out of 5
based on 42 votes.
49 %
51 %
|Medical: 87%
|Dental: 81%
|Vision: 70%
|None: 9%


text:
A full copy of PricewaterhouseCoopers' Health Research Institute's What Employers Want from Health Plans is available online at www.pwc.com/us/whatemployerswant.
PricewaterhouseCoopers' Health Research Institute provided research-based insight by evaluating the results of two surveys: Executives at 100 large US-based multinational companies (Management Barometer survey) and 130 privately held small companies (Trendsetter survey). Large companies had an average of 11,000 employees and revenues of $4 billion. Small employers had a workforce of less than 200 employees and average revenues of $24.3 million. Data were collected in the second qua
|SOURCE PricewaterhouseCoopers
Copyright©2010 PR Newswire.
All rights reserved


text:
PXE Boot menu options missing
I have NS with DS 7.1 SP2 MR1 installed and when when my clients boot to PXE the boot menu options for automation are missing and only next device is listed. I have recreated both the Win PE and Linux boot environments and the files are all installed in the SBS directory, so I can see no reason why they should not be coming up.
the only thing I have noticed is that when I call up the PXE server configuration page two PXE servers are listed, both with the same IP address, which is the NS/DS server IP address. But one has the correct server name the other has no server name. I suspect there may be a link but what and how do I get my boot options back and PXE working again.... Or for DS 7.1 how do I uninstall and reinstall PXE?
Comments 3 Comments • Jump to latest comment
Try the procedure in this KB to Recreate the Preboot environments:
The problem/cause may not apply -- just wanted to demonstrate the proper procedure to rebuilding preboot. Please also run this SQL query and upload the results:
SELECT * FROM inv_pxe_image_list
Mike Clemson, Senior Systems Engineer, ASC
Intuitive Technology Group -- Symantec Platinum Partner
It would seem that when I recently upgraded the DS environemnt the Boot environment build choices were reset to the default which is Automation folder only. I should have looked at this earlier...
Once I had asked it to build all the types of Boot environment the problem was solve.
incidentally quite how the random PXE server got into the database is not clear, but as the Guid was not in the item table deleting the record from the sbs_pxe_Server table seemed to fix it and hasn;t affected anything... I think!
Am now trying to stop w3wp.exe from killing my demo system environment!