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Rock Climbing Photos : Comments
Comments by kachoong (681)
Only one of my favorite climbs in the World! The piton was fine when I clipped it in 96 and fell off at the lip. It's positioned perfectly so you swing past the arete. These days I'd also back it up though (where he has is the best spot). The ball I'd say helps chopper and planes 'see' the lines. The horizontal break is a great spot for gear, but it increases rope drag severely when negotiating the upper headwall. Great action shot billy!
....now only a 'n00b' like yourself, who relies on pictures like that, would make a stupid comment about something he hasn't even tried.... if you knew what you were talking about, unlike all of your arrogant anchor and safety comments, you would know a reverso used like this creates more friction....
....you know what, lightandfast? Give us more insight into your extensive knowledge about climbing, ESPECIALLY safety tips, like posting your own pictures, and I may think about backing down from the belief that you're an arrogant, bumblie tool with only negative things to say.... oh and by the way, those cams are BOMBER.... we rapped off them!! I would have repeatedly, ALL DAY LONG....
It's not complicated at all. Phil can set this whole thing up and pull it all down in around half an hour. It just looks a little 'busy' with all the gear he has on him. He has a grigri to descend with. Ascenders to climb the abseil rope and a prussik from his harness to the pulley rope. That's all.
Looks like great gear and an awesome climb. I like the shot, because it captures the clip, which can sometimes be a struggle. There isn't enough pics of climbers clipping gear. It's something every leader does and should be photographed more. I think some people would have a problem with these type of photos because they can make the climbing look awkward.
Music: Nah, he's using an ATC. Jay: Thanks mate. It's one fine route! James: what's wrong with the belayer? He's watching, holding the brake, is directly below the first piece (slightly to the side) AND wearing a helmet! Kid: You can't see it but I've placed a multi-directional first piece and a second below my feet. Dave: Your request will be soon granted ;-)
Other shots on the same climb here, here and here
(jamaica) It's actually not a tail.... It's clearer from this photo and this one too, that two of us had to tie in half way in order for our whole group of five to have a go at it. We used two ropes....
This problem is the 13-14 foot right arete of the boulder in this picture.
I don't see what the problem is. It's a good shot... well composed.... a little flat with lighting but you get that in the canyon. Just because the climber's on top-rope doesn't mean the shot sucks. Heck, climbers spend half their time with the rope above them anyway. For a top-rope pic, this is actually a really good one!
I like it. This type of shot isn't seen much here and it's nice to see something different, as sidepull stated. It could do with some adjustment; less of the foreground (perhaps 40% of the frame), so that the climber and spotter can be seen and have more emphasis, but keep the background blurred. Also maybe some more lighting on the foreground, even with a reflective surface to kick some sunlight back onto the rock texture.


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Stephanie Tilton is the principal consultant of Ten Ton Marketing. Stephanie has been immersed in the world of marketing for over 20 years, in roles as diverse as competitive analyst, marketing communications, and product marketing. Harnessing her unique blend...
Why Sales and Marketing Alignment Is Key for B2B Companies
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subset: commoncrawl


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Criminal Justice
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With crime rates continuing to rise, you'll be on right side of the law with a BBA in Criminal Justice. The BBA in Criminal Justice specialization is designed to help you develop a real life understanding of the foundations of our criminal justice system. Through NCU's unique one-to-one mentoring approach, you will explore history, ethics, legal aspects of criminal justice and practical application skills. Your final assignment is a research project demonstrating your ability to investigate a workplace problem and recommend a plan for preventative action.
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The Bachelor of Business Administration degree requires 120 semester credit hours*.
*A minimum of 60 semester transfer credits or a conferred Associate's degree are required.
Grade Point Average of "C", 2.0, or higher.
Official transcripts from a regionally or nationally accredited institution on file for all transfer credit hours accepted by the University.
Official documents on file for basis of admission: high school transcript or GED.
All financial obligations to the University paid in full.
The University may accept a maximum of 90 semester credit hours in transfer toward the bachelor's degree for coursework completed at an accredited or approved college or university with a grade of "C" or better.
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General Education - 39 credit hours
Required Foundational Courses - 33 credit hours
Specialization Electives - 18 credit hours
Open Electives – 27 credit hours*
Required Business Capstone Course - 3 credit hours
Total - 120 credit hours
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See below for specialization courses specific to this program. To learn more, fill out the request information form below or view the course catalog.
Course Code
Course Description
Introduction to Criminal Justice
Laws regulate the actions of all people residing in the nation as well as the actions of governmental bodies and organizations. The legislature writes the laws. The executive branch enforces laws. The judiciary branch adjudicates guilt or innocence. The criminal justice system then provides the structure for carrying out this process. This undergraduate level course provides students the opportunity to examine the American criminal justice structure and the functions and processes that impact communities and society.
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In this undergraduate course, students will examine the nature and extent of criminal behavior and correctional systems, corrections and penology, and criminal rehabilitation institutions. This course will not only examine prison systems, but jail operations and management as well. Other topics include community corrections, work release and home detention, pre-trial and bail services, probation, parole, and pardons and reprieves. Particular attention will be given to theories and typologies.
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Introduction to Criminal Law
This introductory course analyzes the fundamental principles and doctrines that underline criminal law in general rather than rules for a specific state. The student will become acquainted with constitutional and case law precedents and elements of criminal liability for various crimes including acts against persons and property. Criminal law's application to vice crimes and terrorism are also addressed.
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This course will examine law enforcement management and supervisors and their interrelationships with members of their organizations and the community at large. Particular attention will be paid to the best known methods and practices of police leadership and management.
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This introductory course is designed to expose students to emerging issues in the field of private security. A growing industry with employees now numbering in the millions, private security firms work hand in hand with public law enforcement strengthening the overall security posture of firms, schools, private homes etc. Beginning with a discussion addressing the differences between public and private police, classes will later analyze security needs of future business and private establishments in detail. Potential threats emanate from tapped phones, bugged offices, stolen papers, covert recording, undercover employees, phony repair people, fax intercepts and the list goes on. The substance of the course will include practical theoretical elements affecting the private/corporate security field. The threat of industrial espionage is not only a domestic threat; it is often a foreign threat as well. The course will garner a better understanding of corporate security, its principles, legal authority and its effect on society in general.
At Northcentral University, we pride ourselves in being completely transparent when it comes to tuition and fees. We have adopted an all-inclusive tuition model that gives you the cost of your Bachelor of Business Administration Degree Completion tuition and fees in one flat program rate*. The only additional cost above your BBA program rate is books. Learn more about the NCU's BBA costs below:
- Per credit cost: $432
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Total program costs reflected are calculated based on standard degree program credits exclusive of the program's potential evaluation track. The actual cost of program is determined on the program and track student enters, transfer credits if any and other unique student factors. For more information: please contact Admissions or refer to the catalog.
If there's one thing we've learned about our students, it's that they are motivated and ambitious—but they are also busy! At Northcentral University, we've designed our education experience to work with you, not against you, so you can achieve your academic goals without sacrificing the quality, flexibility and support you need to be successful.
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Cyber Fear by Osmar-ShotgunWatch
©2012-2016 Osmar-Shotgun
I create this robot but don't think that I can reach to draw him again hahahahaha
Awesome! Necron?
Wow badass looking!
roubado como sempre...
Esses seus robos são muito doidos em seu Osmar.
looks like it could be a new and powerful terminator to me,well detailed really cool looking
It's really good but I have one question, how does it stand up?
That is very necron.
I see what you mean, something that awesome can usually only be drawn once and be equally awesome
Reminds me of them evil Necrons from Warhammer 40k
wow very cool
love the weapons design
love the weapons design


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The demand of the people in their "barangay" seems very favorable to her, and so she decided to increase her production by acquiring some bakery equipment. This was the time she needed money to finance the bakery and decided to join Paglaum Multi-Purpose Cooperative in 2006. She has requested a loan amounting to PHP 20,000. The purpose of the loan is to buy additional sacks of flour and sandwich-slicer equipment in order to increase the volume of production. Paglaum MPC has also helped her to save a part of her income for future use, aside from its other benefits like insurance and dividends. With God's help and hard work, her business is going so well that she was able to send her son to college and purchased some baking equipment.
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Additional Information
About Paglaum Multi-Purpose CooperativePaglaum Multi-Purpose Cooperative (PMPC) was founded in 1992 by the beneficiaries, parents and staff of the Paglaum Community Development Foundation to address economic and livelihood activities for sustainability. The organization operates in the northwestern provinces of Mindanao and Visayas.
In the local vernacular, "paglaum" means "hope." The initial foundation is dedicated to child development through a holistic approach. The goal is to build self-reliance and expand opportunity so the poorest of the poor can help themselves.
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|Publication number
|Publication type
|Application number
|Publication date
|Apr 26, 2005
|Filing date
|Mar 25, 2002
|Priority date
|Mar 25, 2002
|Fee status
|Publication number
|Richard Lu
|Original Assignee
|Pacesetter, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (18), Referenced by (73), Classifications (6), Legal Events (3)
|External Links: USPTO, USPTO Assignment, Espacenet
This application relates to copending U.S. patent application Ser. No. 09/952,728, filed Sep. 13, 2001, titled "Implantable Stimulation Device and Method for detecting Capture of a Heart Using Cross-Chamber Conducted Depolarization"; to copending U.S. patent application Ser. No. 09/847,703, filed May 1, 2001, titled "Method and Apparatus for Biventricular Stimulation and Capture Monitoring," which, in turn, claims the priority of Provisional Patent Application Ser. No. 60/204,277, filed May 15, 2000; and to copending U.S. patent application Ser. No. 09/952,902, filed Sep. 12, 2001, titled "Implantable Cardiac Stimulation System and Method for Measuring Atrioventricular Conduction and Adjusting Atrioventricular Hysteresis," which applications are assigned to the same assignee as the present application, and which are incorporated herein by reference.
The present invention relates in general to capture verification in a cardiac stimulation device. More specifically, the present invention relates to a method for performing an inter-chamber conduction search and conduction time measurement.
In the normal human heart, the sinus node, generally located near the junction of the superior vena cava and the right atrium, constitutes the primary natural pacemaker initiating rhythmic electrical excitation of the heart chambers. The cardiac impulse arising from the sinus node is transmitted to the two atrial chambers, causing a depolarization known as a P-wave and the resulting atrial chamber contractions. The excitation pulse is further transmitted to and through the ventricles via the atrioventricular (A-V) node and a ventricular conduction system causing a depolarization known as an R-wave and the resulting ventricular chamber contractions.
Disruption of this natural pacemaking and conduction system as a result of aging or disease can be successfully treated by artificial cardiac pacing using implantable cardiac pacing devices, including pacemakers and implantable defibrillators, which deliver rhythmic electrical pulses or anti-arrhythmia therapies to the heart at a desired energy and rate. One or more heart chambers may be electrically paced depending on the location and severity of the conduction disorder.
Modern pacemakers and implantable defibrillators possess numerous operating parameters, such as pacing pulse energy, pacing rate, sensing threshold, pacing mode, etc., that must be programmed by the clinician to satisfy individual patient need. In practice, this programming process can be time consuming and complicated. A common goal of pacemaker manufacturers, therefore, is to fully automate pacemaker function in order to minimize the complexity of programming operations and to maximize the safety and effectiveness of the cardiac pacing device.
One function of the pacemaker is to deliver a pacing pulse of sufficient energy to depolarize the cardiac tissue causing a contraction, a condition commonly known as "capture." Automating this function continues to be a strong focus of development efforts by pacemaker manufacturers. One approach to ensure capture is to deliver a fixed high-energy pacing pulse. While this approach, used in early pacemakers, is straightforward, it quickly depletes battery charge and can result in patient discomfort due to extraneous stimulation of surrounding skeletal muscle tissue.
Therefore, the aim commonly strived for in the pacemaker industry is to deliver pacing pulses at or slightly higher than the capture "threshold." Threshold is defined as the lowest stimulation pulse energy at which capture occurs. By stimulating the heart chambers at or just above threshold, comfortable and effective cardiac stimulation is provided without unnecessary depletion of battery charge. Capture threshold, however, is extremely variable from patient-to-patient due to variations in electrode systems used, electrode positioning, physiological and anatomical variations of the heart itself, and so on. Therefore, at the time of device implant, the threshold is determined by a clinician who observes an ECG recording while pulse energy is decreased, either by decrementing the pulse amplitude or the pulse width, until a loss of capture occurs.
Typically, the pulse width is fixed and the pulse amplitude is decremented. The stimulation pulse energy is then programmed to a setting equal to (or as a function of) the lowest pulse energy at which capture still occurred (threshold) plus some safety margin to allow for small fluctuations in threshold. Selection of this safety margin, however, can be arbitrary. Too low of a safety margin may result in loss of capture, an undesirable result for the patient. Too high of a safety margin will lead to premature battery depletion and potential patient discomfort.
Furthermore, the threshold will vary over time within a patient as, for example, fibrotic encapsulation of the electrode occurs during the first few weeks after surgery. Fluctuations may even occur over the course of a day or with changes in medical therapy or disease state. Hence, techniques for monitoring the cardiac activity following delivery of a pacing pulse have been incorporated in modern pacemakers in order to verify that capture has indeed occurred. If a loss of capture is detected by such "capture-verification" algorithms, a threshold test is performed by the cardiac stimulation device in order to re-determine the threshold and automatically adjust the stimulation pulse energy. This approach, called "automatic capture", improves the patient's comfort, reduces the necessity of unscheduled visits to the medical practitioner, and greatly increases the pacemaker's battery life by conserving the energy used to generate stimulation pulses.
The most widely implemented technique for determining whether capture has occurred is monitoring the intracardiac electrogram (EGM) received on the implanted cardiac electrodes. Heart activity is monitored by the pacemaker by keeping track of the stimulation pulses delivered to the heart and examining the EGM signals that are manifest concurrent with depolarization or contraction of muscle tissue (myocardial tissue) of the heart. Through sampling and signal processing algorithms, the presence of an "evoked response" following a stimulation pulse is determined. The "evoked response" is the depolarization of the heart tissue in response to a stimulation pulse, in contrast to the "intrinsic response" which is the depolarization of the heart tissue in response to the heart's natural pacemaking function.
When capture occurs, the evoked response of a P-wave or a R-wave indicates contraction of the cardiac tissue in the atria or ventricles, respectively, in response to the applied stimulation pulse. For example, using such an evoked response technique, if a stimulation pulse is applied to the ventricle (hereinafter referred to as a Vpulse), a response which is sensed by ventricular sensing circuits of the pacemaker following the application of the Vpulse and meets the capture detection criteria, is presumed to be an evoked response that evidences capture of the ventricles.
However, for several reasons it can be difficult to detect a true evoked response. First, because the evoked response may be obscured by a pacing pulse and therefore difficult to detect and identify. Second, the evoked response may be difficult to distinguish from an intrinsic response since an intrinsic response may occur approximately the same time as an evoked response is expected to occur. Third, the signal sensed by the pacemaker's sensing circuitry immediately following the application of a stimulation pulse may not be a QRS complex but noise, either electrical noise caused, for example, by electromagnetic interference, myopotential noise caused by skeletal muscle contraction, or "cross-talk," defined as signals associated with stimulation pulses or intrinsic events occurring in other heart chambers.
Another signal that interferes with the detection of an evoked response, and potentially the most difficult for which to compensate because it is usually present in varying degrees, is lead polarization. A lead-tissue interface is where an electrode of the pacemaker lead contacts the cardiac tissue. Lead polarization is commonly caused by electrochemical reactions that occur at the lead-tissue interface due to application of an electrical stimulation pulse, such as an atrial pacing pulse, at the interface.
If the evoked response is sensed through the same electrodes through which the stimulation pulses are delivered, the resulting polarization signal, also referred to herein as an "afterpotential," formed at the electrode can corrupt the evoked response that is sensed by the sensing circuits. This undesirable situation occurs often because the polarization signal can be three or more orders of magnitude greater than the evoked response. Furthermore, the lead polarization signal is not easily characterized; it is a complex function of the lead materials, lead geometry, tissue impedance, stimulation energy and other variables, many of which are continually changing over time.
In each of the above cases, the result may be a false positive detection of an evoked response. Such an error leads to a false capture indication, which in turn leads to missed heartbeats, a highly undesirable and potentially life-threatening situation. Another problem results from a failure by the pacemaker to detect an evoked response that has actually occurred. In that case, a loss of capture is indicated when capture is in fact present, which also constitutes an undesirable situation that could cause the pacemaker to unnecessarily invoke the threshold testing function in a chamber of the heart, and to inappropriately deliver backup pulses.
Automatic threshold testing is only invoked by the pacemaker when loss of atrial or ventricular capture is detected, or a predetermined duration has expired. An exemplary conventional threshold test procedure is performed as follows. When loss of capture is detected, the pacemaker increases the stimulation pulse output level to a relatively high predetermined testing level at which capture is certain to occur, and thereafter decrements the output level until capture is lost. The stimulation energy is then set to a level slightly above the lowest output level at which capture was attained. Thus, capture verification is of utmost importance in proper determination of the pacing threshold.
It would thus be desirable to provide an implantable, multi-chamber cardiac stimulating device in which an inter-chamber conduction search, conduction time measurement, and reliable capture verification are performed. It would also be desirable to provide a system and method for capture verification that avoids the adverse effects of polarization and noise. It would further be desirable to enable the device to perform capture verification without requiring dedicated circuitry and/or special sensors.
The present invention addresses these needs by providing an implantable cardiac stimulation device capable of verifying capture in a stimulated atrial chamber by detecting a conducted depolarization in the opposing chamber that has not been stimulated, during an atrial capture detection window. As used herein, conducted depolarization includes a depolarization of the opposing chamber in response to the atrial stimulation, or an evoked response signal that has propagated along an inter-atrial path (i.e., atrium to atrium) to the opposing atrial chamber, in response to the atrial stimulation. In a preferred embodiment, a test is performed to confirm inter-atrial conduction, prior to detecting the conducted depolarization.
Thus, if stimulation is delivered in a right atrial chamber, capture of the right atrium is verified by detecting a conducted depolarization in the left atrium. Likewise, if stimulation is delivered in the left atrium, capture is verified by detecting a conducted depolarization in the right atrium. The present invention is therefore intended for use in patients with intact inter-atrial conduction. Patients may have other conduction disorders, such as atrioventricular block, that do not prevent the use of the present invention.
The foregoing and other features of the present invention are realized by an implantable cardiac stimulation device equipped with cardiac data acquisition capabilities. A preferred embodiment of the stimulation device includes a control system for controlling the operation of the device; a set of leads for receiving cardiac signals and for delivering atrial and ventricular stimulation pulses; a set of sensing circuits comprised of sense amplifiers for sensing and amplifying the cardiac signals; and pulse generators for generating atrial and ventricular stimulation pulses. In addition, the stimulation device includes memory for storing operational parameters for the control system, and for storing data such as depolarization threshold data. The device also includes a telemetry circuit for communicating with an external programmer.
The present invention further presents a method for setting an atrial capture detection window during which a depolarization signal may be detected. The method for setting an atrial capture detection window starts by verifying that inter-atrial conduction is intact, and then measures the inter-atrial conduction time. The measured inter-atrial conduction time may then be used for setting the atrial capture detection window.
This atrial capture detection window is applied to the intracardiac electrogram signal received from sensing electrodes positioned in or near the atrium opposite to the atrium being stimulated. Alternatively, a depolarization signal template may be generated and stored in memory such that a sensed signal from the atrium opposite the stimulated atrium may be compared to the depolarization signal template to determine if capture has occurred in the stimulated chamber.
By sensing the intracardiac electrogram signal in the chamber opposite the stimulated chamber, the negative effects of lead polarization on the electrogram signal sensed in the stimulated cardiac chamber are avoided. Thus the present invention improves cardiac stimulation device performance by providing a method for reliably verifying capture without additional hardware or complex software.
Further features and advantages of the present invention may be more readily understood by reference to the following description taken in conjunction with the accompanying drawings, in which:
The following description is of a best mode presently contemplated for practicing the invention. This description is not to be taken in a limiting sense but is made merely for the purpose of describing the general principles of the invention. The scope of the invention should be ascertained with reference to the issued claims. In the description of the invention that follows, like numerals or reference designators will be used to refer to like parts or elements throughout.
As indicated earlier, the present invention relates to a cardiac stimulation device capable of performing reliable capture verification by detecting a conducted depolarization in an atrial chamber, opposite the atrial chamber being stimulated. The methods of the present invention may be implemented in numerous cardiac stimulation devices possessing at least one stimulation and sensing electrode in a right atrial chamber and one stimulation and sensing electrode in the opposing left atrial chamber, or vice versa. A preferred embodiment of an implantable cardiac stimulation device will be described in conjunction with
To sense left atrial and ventricular cardiac signals and to provide left-chamber stimulation therapy, the stimulation device 10 is coupled to a "coronary sinus" lead 24 designed for placement in the "coronary sinus region" via the coronary sinus os so as to place a distal electrode adjacent to the left ventricle and additional electrode(s) adjacent to the left atrium. As used herein, the phrase "coronary sinus region" refers to the vasculature of the left ventricle, including any portion of the coronary sinus, great cardiac vein, left marginal vein, left posterior ventricular vein, middle cardiac vein, and/or small cardiac vein or any other cardiac vein accessible by the coronary sinus.
Accordingly, the coronary sinus lead 24 is designed to receive atrial and ventricular cardiac signals and to deliver: left ventricular pacing therapy using at least a left ventricular tip electrode 26, left atrial pacing therapy using at least a left atrial ring electrode 27, and shocking therapy using at least a left atrial coil electrode 28. In an alternative embodiment, the coronary sinus lead 24 may also include a left ventricular ring electrode 25.
The stimulation device 10 is also shown in electrical communication with the patient's heart 12 by way of an implantable right ventricular lead 30 having, in this embodiment, a right ventricular tip electrode 32, a right ventricular ring electrode 34, a right ventricular (RV) coil electrode 36, and an SVC coil electrode 38. Typically, the right ventricular lead 30 is transvenously inserted into the heart 12 so as to place the right ventricular tip electrode 32 in the right ventricular apex so that the RV coil electrode 36 will be positioned in the right ventricle and the SVC coil electrode 38 will be positioned in the superior vena cava. Accordingly, the right ventricular lead 30 is capable of receiving cardiac signals, and delivering stimulation in the form of pacing and shock therapy to the right ventricle.
The stimulation device 10 includes a housing 40 which is often referred to as "can", "case" or "case electrode", and which may be programmably selected to act as the return electrode for all "unipolar" modes. The housing 40 may further be used as a return electrode alone or in combination with one or more of the coil electrodes 28, 36, or 38, for shocking purposes. The stimulation device 10 further includes a connector having a plurality of terminals, 42, 44, 46, 48, 52, 54, 56, and 58 (shown schematically and, for convenience, the names of the electrodes to which they are connected are shown next to the terminals). As such, to achieve right atrial sensing and pacing, the connector includes at least a right atrial tip terminal 42 adapted for connection to the atrial (AR) tip electrode 22. The connector may also include a right atrial ring terminal (AR RING) 43 for connection to the atrial ring electrode 23, and a left ventricular ring (VL RING) 45 for connection to the left ventricular ring electrode 25.
To achieve left chamber sensing, pacing and/or shocking, the connector includes at least a left ventricular (VL) tip terminal 44, a left atrial (AL) ring terminal 46, and a left atrial (AL)shocking terminal (coil) 48, which are adapted for connection to the left ventricular tip electrode 26, the left atrial tip electrode 27, and the left atrial coil electrode 28, respectively.
To support right chamber sensing, pacing and/or shocking, the connector further includes a right ventricular (VR) tip terminal 52, a right ventricular (VR) ring terminal 54, a right ventricular (RV) shocking terminal (coil) 56, and an SVC shocking terminal (coil) 58, which are adapted for connection to the right ventricular tip electrode 32, right ventricular ring electrode 34, the RV coil electrode 36, and the SVC coil electrode 38, respectively.
At the core of the stimulation device 10 is a programmable microcontroller 60 that controls the various modes of stimulation therapy. The microcontroller 60 typically includes a microprocessor, or equivalent control circuitry, designed specifically for controlling the delivery of stimulation therapy, and may further include RAM or ROM memory, logic and timing circuitry, state machine circuitry, and I/O circuitry. Typically, the microcontroller 60 includes the ability to process or monitor input signals (data) as controlled by a program code stored in a designated block of memory. Any suitable microcontroller 60 may be used that carries out the functions described herein.
As shown in
The microcontroller 60 further includes timing control circuitry 79 which is used to control the timing of such stimulation pulses (e.g. pacing rate, atrio-ventricular (AV) delay, atrial interconduction (A—A) delay, or ventricular interconduction (V—V) delay, etc.), as well as to keep track of the timing of refractory periods, PVARP intervals, noise detection windows, evoked response windows, alert intervals, marker channel timing, etc.
The switch 74 includes a plurality of switches for connecting the desired electrodes to the appropriate I/O circuits, thereby providing complete electrode programmability. Accordingly, the switch bank 74, in response to a control signal 80 from the microcontroller 60, determines the polarity of the stimulation pulses (e.g. unipolar, bipolar, cross-chamber, etc.) by selectively closing the appropriate combination of switches.
Atrial sensing circuits 82 and ventricular sensing circuits 84 may also be selectively coupled to the right atrial lead 20, coronary sinus lead 24, and the right ventricular lead 30, through the switch bank 74, for detecting the presence of cardiac activity in each of the four chambers of the heart. Accordingly, the atrial and ventricular sensing circuits 82 and 84 may include dedicated sense amplifiers, multiplexed amplifiers, or shared amplifiers. The switch bank 74 determines the "sensing polarity" of the cardiac signal by selectively closing the appropriate switches. In this way, the clinician may program the sensing polarity independent of the stimulation polarity.
In accordance with the present invention, sensing during the capture verification methods to be described herein will be performed in the opposing atrial chamber. Thus, switch bank 74 will selectively close the appropriate switches such that during an atrial capture detection window, sensing electrodes positioned in the atrial chamber opposite that being stimulated are connected to the appropriate atrial sensing circuits 82.
Each of the atrial sensing circuit 82 or the ventricular sensing circuit 84 preferably employs one or more low power, precision amplifiers with programmable gain and/or automatic gain control, bandpass filtering, and a threshold detection circuit, to selectively sense the cardiac signal of interest. The automatic gain control enables the stimulation device 10 to deal effectively with the difficult problem of sensing the low amplitude signal characteristics of atrial or ventricular fibrillation.
The outputs of the atrial and ventricular sensing circuits 82 and 84 are connected to the microcontroller 60 for triggering or inhibiting the atrial and ventricular pulse generators 70 and 72, respectively, in a demand fashion, in response to the absence or presence of cardiac activity, respectively, in the appropriate chambers of the heart. The atrial and ventricular sensing circuits 82 and 84, in turn, receive control signals over signal lines 86 and 88 from the microcontroller 60, for controlling the gain, threshold, polarization charge removal circuitry, and the timing of any blocking circuitry coupled to the inputs of the atrial and ventricular sensing circuits 82 and 84. In accordance with the present invention, timing signals associated with the onset and duration of an atrial capture detection window may be received over signal lines 86 and 88.
For arrhythmia detection, the stimulation device 10 utilizes the atrial and ventricular sensing circuits 82 and 84 to sense cardiac signals, for determining whether a rhythm is physiologic or pathologic. As used herein "sensing" is reserved for the noting of an electrical signal, and "detection" is the processing of these sensed signals and noting the presence of an arrhythmia. The timing intervals between sensed events (e.g. P-waves, R-waves, and depolarization signals associated with fibrillation which are sometimes referred to as "F-waves" or "Fib-waves") are then classified by the microcontroller 60 by comparing them to a predefined rate zone limit (e.g. bradycardia, normal, low rate VT, high rate VT, and fibrillation rate zones) and various other characteristics (e.g. sudden onset, stability, physiologic sensors, and morphology, etc.) in order to determine the type of remedial therapy that is needed (e.g. bradycardia pacing, anti-tachycardia pacing, cardioversion shocks or defibrillation shocks, collectively referred to as "tiered therapy").
Cardiac signals are also applied to the inputs of an analog-to-digital (A/D) data acquisition system 90. The data acquisition system 90 is configured to acquire intracardiac electrogram signals, convert the raw analog data into digital signals, and store the digital signals for later processing and/or telemetric transmission to an external device 102. The data acquisition system 90 is coupled to the right atrial lead 20, the coronary sinus lead 24, and the right ventricular lead 30 through the switch bank 74 to sample cardiac signals across any pair of desired electrodes.
The data acquisition system 90 may be coupled to the microcontroller 60 or another detection circuitry, for detecting an evoked response from the heart 12 in response to an applied stimulus, thereby aiding in the detection of "capture" as will be described in detail in conjunction with FIG. 3. Capture detection may involve differentiation, integration, or other morphological analyses of the sampled signals, or a sensed signal above a predetermined sensing threshold. Morphology detector 64 of microcontroller 60 may be used for comparing a sensed signal with morphological characteristics of a depolarization signal. For a more detailed description of the implementation of capture detection circuitry and algorithms refer, for example, to U.S. Pat. No. 5,350,410 to Kleks et al.
The microcontroller 60 could also include an automatic capture detector 65 that enables capture detection by triggering the atrial pulse generator 70 to generate a stimulation pulse, starting the atrial capture detection window using the timing circuitry within the microcontroller 60, and enabling the data acquisition system 90 via control signal 92 to sample the cardiac signal that falls in the atrial capture detection window and, based on the amplitude of the sampled cardiac signal, determines if capture has occurred. The method for determining atrial capture in accordance with the present invention will be described in greater detail in conjunction with
In accordance with the present invention, a conduction search engine 61 included in microcontroller 60 executes algorithmic steps for measuring inter-atrial conduction time between the left and right atria. Measured inter-atrial conduction times are stored in the memory 94. The inter-atrial time will be subsequently used by for appropriately adjusting a capture detection window as will be fully described herein.
The microcontroller 60 is further coupled to a memory 94 by a suitable data/address bus 96, wherein the programmable operating parameters used by the microcontroller 60 are stored and modified, as required, in order to customize the operation of the stimulation device 10 to suit the needs of a particular patient. Such operating parameters define, for example, pacing pulse amplitude, pulse duration, electrode polarity, rate, sensitivity, automatic features, arrhythmia detection criteria, and the amplitude, waveshape and vector of each shocking pulse to be delivered to the patient's heart 12 within each respective tier of therapy.
Advantageously, the operating parameters of the stimulation device 10 may be non-invasively programmed into the memory 94 through a telemetry circuit 100 in telemetric communication with the external device 102, such as a programmer, transtelephonic transceiver, or a diagnostic system analyzer. The telemetry circuit 100 is activated by the microcontroller 60 by a control signal 106. The telemetry circuit 100 advantageously allows intracardiac electrograms and status information relating to the operation of the stimulation device 10 (as contained in the microcontroller 60 or memory 94) to be sent to the external device 102 through the established communication link 104.
In one embodiment, the stimulation device 10 further includes a physiologic sensor 108, commonly referred to as a "rate-responsive" sensor because it is typically used to adjust pacing stimulation rate according to the exercise state of the patient. However, the physiological sensor 108 may further be used to detect changes in cardiac output, changes in the physiological condition of the heart, or diurnal changes in activity (e.g. detecting sleep and wake states). Accordingly, the microcontroller 60 responds by adjusting the various pacing parameters (such as rate, AV Delay, V—V Delay, etc.) at which the atrial and ventricular pulse generators 70 and 72 generate stimulation pulses.
The stimulation device 10 additionally includes a power source such as a battery 110 that provides operating power to all the circuits shown in FIG. 2. For the stimulation device 10, which employs shocking therapy, the battery 110 must be capable of operating at low current drains for long periods of time, and also be capable of providing high-current pulses (for capacitor charging) when the patient requires a shock pulse. The battery 110 must preferably have a predictable discharge characteristic so that elective replacement time can be detected.
As further shown in
If it is a function of the stimulation device 10 to operate as an implantable cardioverter/defibrillator (ICD) device, it must detect the occurrence of an arrhythmia, and automatically apply an appropriate electrical shock therapy to the heart aimed at terminating the detected arrhythmia. To this end, the microcontroller 60 further controls a shocking circuit 116 by way of a control signal 118. The shocking circuit 116 generates shocking pulses of low (up to 0.5 Joules), moderate (0.5-10 Joules), or high (11 to 40 Joules) energy, as controlled by the microcontroller 60. Such shocking pulses are applied to the patient's heart through at least two shocking electrodes, and as shown in this embodiment, selected from the left atrial coil electrode 28, the RV coil electrode 36, and/or the SVC coil electrode 38 (FIG. 1). As noted above, the housing 40 may act as an active electrode in combination with the RV electrode 36, or as part of a split electrical vector using the SVC coil electrode 38 or the left atrial coil electrode 28 (i.e., using the RV electrode as common electrode).
Cardioversion shocks are generally considered to be of low to moderate energy level (so as to minimize pain felt by the patient), and/or synchronized with an R-wave and/or pertaining to the treatment of tachycardia. Defibrillation shocks are generally of moderate to high energy level (i.e., corresponding to thresholds in the range of 5-40 Joules), delivered asynchronously (since R-waves may be too disorganized), and pertaining exclusively to the treatment of fibrillation. Accordingly, the microcontroller 60 is capable of controlling the synchronous or asynchronous delivery of the shocking pulses.
At step 305 of method 300, a stimulation pulse is delivered to an atrial chamber, either right or left, of the heart. The method 300 applies to either atrial chamber, and thus method 300 will be described in one atrial chamber with capture detected in the opposite atrial chamber. For stimulation in the atrial chamber, atrial pulse generator 70 delivers a stimulation pulse according to timing control 79 of microcontroller 60.
At step 310, the intracardiac electrogram signal is sensed in the opposing atrial chamber during the atrial capture detection window. Thus, if stimulation were delivered in the right atrial chamber, sensing at step 310 is performed in the left atrial chamber. Similarly, if stimulation were delivered in the left atrial chamber, sensing at step 310 is performed in the right atrial chamber.
The intracardiac electrogram signal is received by the appropriate atrial sensing circuit 82. Alternatively or additionally, the sensed intracardiac electrogram signal is received by the A/D converter 90 where it may be sampled and digitized.
The atrial capture detection window may begin at a predefined delay (i.e., approximately 10 msec.) following the delivery of the stimulation pulse. Normally, conduction from one atrial chamber to the opposing atrial chamber occurs within approximately 10 msec to 20 msec. Preferably, the atrial capture detection window extends approximately 10 msec to 50 msec beyond the expected inter-chamber conduction time. The timing of the atrial capture detection window, its onset and duration, are predetermined. Alternatively, they can be programmable so that it may be tailored to individual patient conditions to account for variations in intra-chamber and inter-chamber conduction times.
A conducted depolarization may be detected by standard techniques used in known capture verification methods (step 307). For example, a depolarization sensing threshold may be set such that if the received signal exceeds the depolarization threshold, a conducted depolarization is verified. Other techniques may determine a slope, integral, or other characteristic of the received signal that may be compared to a predefined depolarization threshold value.
The capture verification method determines, at decision step 310, if a conducted depolarization is detected in the opposite or non-stimulated atrial chamber, within the atrial capture detection window that follows an atrial stimulation.
When capture is verified at step 315, the stimulation amplitude or pulse width is decremented at step 345, and method 300 returns to step 305 and awaits for the next stimulation pulse delivery. In this way, beat-by-beat capture verification can be performed. In alternative embodiments, the method 300 may be performed less frequently, for example after a given number of stimulation cycles, once per minute, hourly, daily, etc.
Returning to decision step 310, if a depolarization signal is not detected, loss of capture is verified at step 325, and backup stimulation is provided at step 352. If a number of consecutive losses, such as 2 losses of capture occur, the stimulation amplitude or pulse width may be increased at step 355, whereupon method 300 returns to step 305.
A further alternative embodiment of the present invention includes a method 500, shown in
Method 500 begins at step 510 by setting the stimulation pulse energy in one atrium to a predetermined level expected to guarantee capture. At step 520, the inter-chamber conduction window is increased for a given number of cycles (N), for example three cycles. At decision step 525 microcontroller 60 determines if depolarization signals are sensed in the opposite atrium following each stimulation pulse.
If depolarization of the opposite chamber is not sensed, the inter-atrial conduction window is again increased at step 520 after first verifying that it has not reached a maximum allowed value at decision step 530. If the maximum allowed inter-atrial conduction window is reached without sensing in the opposite atrium, a failure to detect inter-atrial conduction is noted at step 535, and the programmed values for inter-atrial conduction window and atrial stimulation pulse energy are restored. Method 500 is terminated at step 538.
Having determined that inter-atrial conduction is not intact, the automatic capture method 300 of
If sensing in the opposite chamber does occur at decision step 525, the increased inter-atrial conduction window is maintained for an additional number of cardiac cycles, for example 10 cardiac cycles, to verify that sustained inter-atrial conduction occurs at decision step 550. If method 500 determines that the inter-atrial conduction is not sustained at decision step 550, it returns to decision step 530 and proceeds as described earlier.
The inter-atrial conduction window at which sustained sensing of the conducted depolarization occurs is stored as the inter-atrial conduction time at step 555. The capture detection window that is set during the capture verification method 300 of
The method 500 described for measuring inter-atrial conduction may be applied for measuring right atrial to left atrial conduction or left atrial to right atrial conduction. Furthermore, the method 500 could be adapted to measure the conduction time between any two heart chambers (atrial or ventricular) through the appropriate adjustments of inter-chamber conduction windows.
Thus, a method and apparatus have been described for performing an inter-atrial conduction search and conduction time measurement, which allow reliable atrial capture verification during cardiac stimulation by detecting a cross atrial chamber conducted depolarization. It should however be understood that the conduction search is not limited to an inter-atrial conduction search, but can be extended to other inter-chamber conduction searches as well. As an example, a conduction search can be performed between an atrial chamber and a ventricular chamber.
The method of the present invention advantageously avoid problems associated with lead polarization by sensing cardiac activity away from the site of stimulation. The cardiac stimulation device performance is improved by allowing capture verification regimes, such as automatic capture, to be executed more reliably. While the invention has been described according to specific embodiments and applications thereof, numerous modifications could be made thereto by those skilled in the art.
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|U.S. Classification
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Owner name: PACESETTER, INC., CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:LU, RICHARD;REEL/FRAME:012761/0568
Effective date: 20020325
|Oct 27, 2008
|Fee payment
Year of fee payment: 4
|Oct 26, 2012
|Fee payment
Year of fee payment: 8


text:
Cervical Length Fluctuation
Last edited 07/25/2014
I had a rescue cerclage at 19.5, was measuring 5mm. At my follow up a week later I was at 1.9cm. Two weeks later I am at 1.4cm, and 22.4weeks along. Funneling has stayed stable...feeling helpless. I have been on modified bedrest for over 3 weeks and progesterone suppositories daily. Is it possible the length could increase? Please share your story.
Comments (5)
Posted 07/25/2014
Bump... I'm not sure, but hopefully someone else has some insight.
Lost My Beautiful Twins in 2014, Rainbow Baby Boy born in 2015, Work Full-Time, Married 10 Years
Posted 07/25/2014
I need some advice too. Ium 20 weeks, and yesterday was told my cervix measured 1.7! I have never had a shoer cervix before. Today I saw a specialist and he said my cervix measures normal. So it must be dynamic? I have ot wait til Monday top see what the plan is when I see my Dr. Im on temporary bedrest and worse- pelvic bedrest!! How long might I be on that? If my cervix imporves, can I have sex again? other than my baby's health, that is my huge concern! If you have sex like me and my husband do, you'd understand- I am freaking out. Im scared about so many things. Help?
Posted 07/27/2014
Yes ur cervical length can increase at 20weeks I measured 1.8 with funneling I was put on bedrest and had a cerclage put in and my cervix has been stable ever since it went to a 3.5 and from my last visit two weeks ago it went to 3.8 with no funneling. So don't be scared. Keep the faith and trust God . am now 36weeks
Posted 07/27/2014
ladies I been where you are. I was on bed rest for the time I hit 19 weeks all the way to delivery 38w. my cervical length was being measured weekly and each week it was getting shorter...I was given the shots at 23w and daily progesterone suppository. I also has gestational diabetes, so daily insulin shots, suppository, diet, weekly cervical checks, and bed rest. long story short my baby boy made it to 38 weeks via scheduled c section. hes a healthy 5 month old. keep praying and take bed rest serious bec it helped me.
Posted 07/28/2014
You might not be on bed rest the rest of your pregnacy, but you probably will be in pelvic rest.


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her name is yan li lin fully chinese girl... she still new... :D i know her from other vids same like this but full ver and get deleted...damn...i hope someone upload more japanese fuck chinese girl vids
she is full chinese..her name is yang li lin....i think she's still new in japan...i love her...i wish someone upload more japanese fuck chinese girl vids...
like this video
she isn't Chinese!!
She look more like mix but she did speak chinese in the video,
whats her name?
Man I LOVE that song
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President Obama Demands Defense For U.S. Homeland And Allies Against North Korea
HONOLULU, Feb. 12, 2013 /PRNewswire-USNewswire/ -- Riki Ellison, Chairman and Founder of the Missile Defense Advocacy Alliance (MDAA), www.missiledefenseadvocacy.org, comments on the North Korea's nuclear test this morning. Ellison is one of the top lay experts on missile defense in the world. Kim Jong-un has followed the success and international notoriety from his long-range ballistic missile firing on December 17th and vow against the United Nations and the United States to conduct a nuclear test in North Korea's development of a miniaturized nuclear weapon to go in their long range ballistic missiles that will have the capability to strike the U.S.Due to the immense sanctions that are placed on North Korea and these monumental successes it is abundantly clear that North Korea is getting help from outside its country and will continue to drive no matter what is placed on them by the international consensus, short of war, to get real capability to strike and hold the United States of America at threat from a nuclear long range ballistic missile attack. Defense of the United States homeland from Hawaii to New York and Alaska to Florida is absolutely critical. Urgency as well as investment, regardless of sequestration, must be put in place to make our nation 100 percent safe and secure before a pending North Korean nuclear threat is in place. Currently, our missile defense systems that are in place to defend against North Korea are not 100 percent. Work has to be done across the spectrum in the Pacific and in the United States to have complete reliability and confidence in our detection, sensors, communications, shooters, and our men and women who operate these missile defense systems. It is the responsibility of our Army, Navy, Air Force, our President, and the United States Congress to ensure that we will not fail in this critical mission of defending our citizens and homeland.
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text: A transformer connectedd to a 120V (rms) ac line is to supply 1.22*10^4V (rms) for a neaon sign. To reduce the shock hazard , a fuse is to be inserted in the primary circuit and is to blow when the rms current in the secondary circuit exceeds 8.00mA. What is the ratio of secondary to primary turns of the transformer N2/N1 ........what power must be supplied to the transformer when the rms secondary current is 8.00mA ..answer not displayed in W ......what current rating should the fuse in the primary circuit have answer Not displayed in A


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NIKON D610 and NIKKOR 28.0-300.0 mm f/3.5-5.6 at 98 mm, f/8, ISO 320, 9 exposures between 1/320 and 1/200 second in Aperture priority, ‒ ⅓ EV, Pattern metering mode. 9x1 handheld panorama stitched in Hugin 2014, projection: Trans Mercator, FOV: 93 x 17, 154.6MP. Final panorama: Blemish removal in Photoshop CS6, cro...
A partial panorama of the beautiful Pantiles in Tunbridge Wells. I was shooting East to include much of the Pantiles area including - Mottrams Kitchen Shop (great to visit!), the Duke of York Pub which I believe also owns the Ragged Trousers Pub opposite (one of my favourites) and of course, the pretty Tourist Informa...
Vista panorámica de Barcelona realizada desde el mirador de Sarriá. Panoramic view of Barcelona made from the viewpoint of Sarria. Blog: chus1967.blogspot.com /
Our rooftop is currently having its railings replaced, so I had to sneak up last night to catch this dreamy panoramic sunset. I used my 105mm telephoto lens and shot a total of 42 overlapping images to make up this panorama photograph. Consequently, you can zoom in quite close and gain the benefit of this ultra sharp ...
Vista panorámica del barrio Barcelonés de El Carmel (en el centro de la imagen) realizada desde el mirador de Horta. Panoramic Barcelona neighborhood of El Carmel (center of image) made from the viewpoint of Horta. Blog: chus1967.blogspot.com /
This is a 2x5 panoramic shot of Victoria's Inner Harbour, spanning from the Undersea Gardens on the left, to the Fairmont Empress Hotel on the right. You can see the Johnson Street bridge in the centre background. This set of 10 exposures was taken with my Nikon D600 and 50mm lens. I dropped exposure compensation...
This is a 3x6 panoramic shot of Victoria's Inner Harbour, spanning from the Fairmont Empress Hotel on the left, to the Undersea Gardens on the right. You can see the BC Legislature Buildings in in the centre background, and the lower causeway. I did a panorama of this location before, but from the other direction. This...
Castle Cachtice, residence Elisabeth Bathory (1560-1614). The castle is near the village Cachtice. It is beautiful place to see. The village is situated 100 km North from Bratislava, the capital of Slovakia. 360 panoramas also on www.panoramas.ic.cz
I've been planning a shoot from this vantage point for quite some time, and lucked out today when I found a presumably legitimate access to this otherwise out of bounds location. Victoria's Johnson Street blue bridge shown here is about to be replaced with a more modern structure. I'm glad I get a chance to capture ...


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Key things you need to know aboutDr. Hochron:
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Conditions Dr. Hochron Treats
- Acute Pharyngitis
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Patients' risk of dying during a hospital stay for heart bypass surgery could be 87.4% lower, on average, at a hospital rated 5 stars compared to a hospital rated 1 star for that procedure. Choosing the right hospital is critical to your health. View Slideshow
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Likelihood of recommending Dr. Hochron to family and friends is 4.4 out of 5 5 1 14
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text:
Mt. Redoubt Steaming by MSimpsonPhotosWatch
©2011-2016 MSimpsonPhotos
Mt. Redoubt was steaming and I went out at sunset to check it out. So glad I did! The volcano's tip is a bit obscured, but I still like it.
amazing. Such stunning colors.
Lot's of beautiful layers!
Wow, this is an interesting picture. The sunset and clouds are gorgeous, and the rest is intriguing. It gets hard to tell what I'm looking at around the middle, but that doesn't necessarily make it bad. It's definitely unusual and cool to look at.
Yea, I wish it was a bit more perfect as far as the mountain goes, but I just loved the sunset I couldn't help it
Great Shot
Very nice. I love it.
omg! so beautiful!!! i love it!!
Instant fav
This is stunning.
this shot true....?
Oh wow, that is somethin!
What a gorgeous skyscape, Michelle! Love the incredible colors...
[pretty shot of it
Wow, those colors are so beautiful! Great pick. ^^
Wow! Stunning shot.


text:
In the photo at lower left,
The overall winner was John Van Sternberger with a time of 18.02 minutes. The top female runner was Joan Wall of Winder, who finished in 22.12 minutes. The race had 199 runners with more than $5,000 raised.
The money helps the club offer its annual $1,500 scholarship, along with other community service projects.
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text:
Victorian Penshell glass
Victorian Penshell Glass
Tortoise Shell finish Victorian Penshell glass
The shape of the Ibiza Collection was inspired by the points and curves of the island coastline. Combining these elements with traditional Spanish lighting design and Kalco's Victorian Penshell Natural Bowl Glass shade makes for a unique addition to any space. Color: Orange Wire Length: 0.5-Inch Hang Weight: 12 lbs Backplate Canopy Width: 6-Inch Backplate Canopy Height: 1-Inch Some Assembly Required Bulb is not included


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Any suggestions for a place to stay in Strasbourg or Colmar in May?
We are going to be driving through Strasbourg and Colmar on the way to Luzerne. Any suggestions for a place to stay in Strasbourg, Colmar or Luzerne.
We are going to be driving through Strasbourg and Colmar on the way to Luzerne. Any suggestions for a place to stay in Strasbourg, Colmar or Luzerne.
Connie, you don't say what your price range is but if you're in the €100-150 range, we stayed in 2002 at the Hostellerie le Maréchal in Colmar and found it extremely comfortable. We also did the half-board and dinner was excellent. We're looking forward to our stay this May at Hôtel Saint Martin also in Colmar. Maybe we'll run into each other!
I stayed at http://www.rapp-hotel.com/en/ on my last trip to Colmar and would absolutely recommend it. It's in a great location, the room was very comfortable, they served a nice breakfast and the food in the restaurant was fantastic. They also have a swimming pool on the lower floor. You didn't say what your budget is, but I thought the rates were quite reasonable.
try this thread for suggestions for Colmar
We stayed in Hotel Cathedral in Strasbourg and liked it -- our window opened onto the view of the facade of the magnificent Colmar Cathedral. They had parking available for a modest price in a subterranean lot a few blocks away.
Hi Connie. We stayed at the Best Western Grand Hotel Bristol in Colmar at 7 Place de la Gare, right across the street from the train station. We had a car and although they had paid parking, our timing was such that we were able to park for free on the street right outside of the hotel because we were there on Sunday and Monday (May 1st holiday). It was a comfortable, nice hotel, and a short walk to the center of town. Very convenient after we returned our car and had a morning train to catch on our way to Italy.
In 2012 we stayed at the Hotel le Colmar, which is easily walkable from the train station. The rooms aren't huge, but we had a room on the 3rd or 4th floor, looking out on the place and the canal: a great view. We loved it. No elevator, but that didn't bother us. We're returning to Strasbourg in a couple a weeks and have a reservation there again.
Hotel le Colmar: 1 rue du Maire Kuss Tél: +33 (0) 388 321 689.
Room with shower & toilet: €54. Breakfast €7.
I stayed at the Le Rapp in Colmar a few weeks ago that someone mentioned above. Location is great, the front desk person was friendly and spoke excellent English, but I was not overly impressed with the place (and it wasn't cheap). It wasn't bad, but my room seemed a bit faded (though it was clean). The hallway had an awful musty smell though my room smelled fine. I wouldn't stay there again if going back to Colmar, most likely.


text:
Our mission is to provide quality basic health and preventive services to the students of Augusta University.
Through these services we aim to assist each student in maintaining their maximum physical and emotional health, so that every student will realize to their fullest the educational opportunities afforded by Augusta University.
The Augusta University Student Health Clinic fall 2015 and spring 2016 hours are Monday and Wednesday, 8:00am-5:00pm, Tuesday and Thursday, 8:00am-6:00pm and Friday, 8:00am-4:30pm.
The Student Health Clinic summer hours are Monday-Thursday 8:00am-5:00pm and Friday 8:00am-4:30pm.
If you have a medical emergency, please call 911 or go to the nearest emergency room. If you are very sick and need medical care during the times the clinic is closed please call the AU Health Family Medicine Clinic at 706-721-4588 to schedule an appointment. Please let them know you are a Augusta University student. You can also go to the nearest Urgent Care facility of your choosing. Please be sure to take your insurance information to your visit. You will be responsible for any charges, co-pays or deductible amounts from your visit to Family Medicine or the Urgent Care facility.
Please call our office to schedule an appointment. We have same day appointments for acute illness or injury, 706-721-3448.
Students must present valid student identification prior to being seen at student health.
No appointment is required for TB skin testing, immunizations, and laboratory testing. PPDs are placed everyday except Thursday.
Construction on Laney Walker Blvd over the next 6-8 months will impact student access to student health. Please click the link below for the latest updates.
Construction Detour Information Map (please click here)


text:
Spring look around the Pac-10
Updated: April 12, 2006, 12:05 PM ETBy Ted Miller | Special to ESPN.com
Arizona Wildcats
After a successful appeal, Arizona won back one of the four scholarships it originally lost because of falling short on new NCAA academic standards. Based on its scrimmage last weekend, that spot should go to an offensive player. Other than a 78-yard touchdown pass from quarterback Willie Tuitama to Syndric Steptoe, the Wildcats defense dominated, controlling the line of scrimmage and shutting down a sloppy offense that fumbled twice and couldn't seem to remember the snap ...
Read full story
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One mother learned her baby had two heads just moments before giving birth via Cesarean section in northern Brazil Mon.
Just your source tells me not to bother..
yeah you were right.. More my thing I guesss. All so unclear now,, Nuclear will be what that house and senete will need. to come to an agreement but the one on the floor seems viable as a bandaid so to speak. I hate when governing bodies waste so much red tape when it could just be holding up a shower curtain.Lol. But this seems like a step in the right direction. pinky
Love too.. It seeems we are Agreeable...
you'd think doctor woulda picked up on this well be that....
jesus christ, in this day and age.... that would freaking kill me inside going thru that
Odds are the poor baby will die ): deforms dont usually live long when it comes to two heads. Thats my guess anyway, im better with animals then people.
Ah i see. Ok.
Two heads are better than one?
It will give a whole new meaning to the term "Talking to yourself."
They'll always go on double dates, but the foreplay is gonna get confusing. They'll always have someone to talk to. I'm sure they can get a hat company to sponsor their college education. I wonder if they'll be telepathic. If they have sex, will both have an ******? When they go to school will they get two lockers?
Very sad for the child and the parents

Lets hope they dont make a freak show for the child and exploit for money
Its something in the water!
Out where? better not be
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Condos for rent in Irving's Crest
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Jil Sander
Railton Cropped Jacket
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Silk blend tech fabric three-quarter sleeve zip front cropped jacket with tie neck closure, diagonal front flap pockets, and inside drawstring waist adjustment. Partially lined. Available in Black. Made in Italy. Polyester/silk/tech radzimir. Dry clean. Style # 503145976
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Kenseth, Stewart racing at Madison International today
Gazette Staff
June 29, 2010
The race also will include an ASA Midwest Tour Super Late Model event. More than 40 of the top drivers in the Midwest will compete on the half-mile oval, including current series point leader Chris Wimmer, Steve Carlson and Kelly Bires.
Practice begins at noon and will continue until 3:30. Qualifying is scheduled to begin at 4 p.m., with the first race scheduled for 7 p.m.
The All Star Challenge 100 is expected to begin at approximately 8 p.m .
A Trackside Charities concert and autograph session is scheduled for 5:15 p.m.
Spectator pit passes are $50 (14 years and older), while general admission adult tickets are $25. Students ages 7-17 are $10, and kids 6 and under are free.
The rain date is Wednesday.


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bizarre video, poor quality but these two girls are really good together. I would like to see more, blondies tits looked juicy !


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Washington Capitals center Nicklas Backstrom should have been celebrating his 25th birthday in Dallas playing the Stars, instead the NHL lockout forced him to spend his special day playing hockey in Russia for Dynamo Moscow of the Kontinental Hockey League against Severstal Cherepovets. Not quite the Las Vegas of Western Russia, but still a day the 25-year-old won't soon forget.
Backstrom celebrated his birthday in grand fashion with a goal and three assists in Dynamo's 5-3 comeback win over Severstal. Opposing goalie Vasily Koshechkin probably won't forget the game anytime soon either after his team blew a 3-0 in the defeat in suffering its tenth regulation loss of the year.
Dynamo fell behind 3-0 early, but used four goals is a span of ten minutes in the second period to pull themselves back from the dead. Late in the period Backstrom and fellow Capitals' star, Alexander Ovechkin, took the game over. The birthday boy carried the puck into the attacking end, leaping over an incoming hip check from a Severstal defender to find Ovechkin for the eventual game-winning goal; it was Ovi's second of the game.
Backstrom put the game on ice late in the third period by banging home nifty pass to secure the win and keep Dynamo Moscow at the top of the KHL standings. Dynamo picked up its 16th win of the season and pulled three points (61 pts.) ahead of second place Lokomotiv (58 pts.).
Backstrom has been on fire over since making the jump from the locked out NHL to the KHL. Since November 14, Backstrom has scored six goals, including a hat trick. He has 15 points (7g 8a) overall in 10 games.
The NHL lockout is now into its third month and another round of games cancellations that include the wildly popular Winter Classic and All-Star game, it looks like Backstrom and the other NHL'ers playing overseas still have plenty of time to pad their stats. Lucky us.
Follow me on Twitter! @StevePalumboNHL
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text:
Two things usually happen when a familiar technology innovation is modified and launched as something new these days. First, there's a big roll-out party/press event.
Two things usually happen when a familiar technology innovation is modified and launched as something new these days. First, there's a big roll-out party/press event. Second, there's an even bigger lawsuit filed by a competitor that claims it's been copied. So on day one of Amazon's big debut of its Android-based "Appstore," Apple just crossed off the second item on the list with a fatty lawsuit over Amazon's use of that very term.
Obviously, Apple was unimpressed by the subtle change.
Into the fray comes Microsoft, which has long fought Apple's previous attempts to trademark the term App Store.
Microsoft, however, has somewhat conceded the "App" fight for now, using the term "Windows Marketplace for Mobile" to describe its application store--a name that seems right in line with Microsoft's habit of using excruciatingly long and clunky names for its products and services.
Other companies have avoided the App Store moniker as well. Google uses "Android Market" and "Chrome Web Store." Blackberry uses "App World" and Nokia uses "Ovi Store"--whatever an "Ovi" is.
Amazon's use of Appstore seems to be the most daring venture into Apple's nomenclature territory, and it's no surprise Apple is suing, given that trademark lawsuits are one of the principal products produced by major technology companies these days.
Deciding whether the word "App" is now common enough to keep it from being copyrighted will be haggled over in courts for months, possibly years to follow.
In the meantime, folks can get Angry Birds for free on the Appstore, which is more than can be said for the App Store.
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