text:
|Publication number
|Publication type
|Application number
|Publication date
|Apr 13, 2010
|Priority date
|Jul 17, 2001
|Fee status
|Also published as
|Publication number
|Eugene M. Breznock, Jay A. Lenker
|Original Assignee
|Breznock Eugene M, Lenker Jay A
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (20), Referenced by (9), Classifications (11), Legal Events (1)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a divisional application of U.S. application Ser. No. 10/694,510, filed on Oct. 27, 2003, now U.S. Pat. No. 7,326,197 which is a continuation of U.S. application Ser. No. 09/908,316, filed on Jul. 17, 2001, now U.S. Pat. No. 6,638,253.
The field of this invention is general surgery, thoracic surgery, trauma and critical care.
Chest drainage tubes are used following thoracic surgery, chest trauma or to treat certain medical conditions. The purpose of a chest tube is to remove buildup of excessive body fluids, contaminants or air from the thoracic cavity. The presence of an opening into the chest or thorax, created with or without a cannula will cause pneumothorax (collapsed lung). Negative pressure in the chest cavity is created by the chest muscles and diaphragm in order to cause lung expansion and resulting inspiration of a breath. Therefore, a hole in the chest will equalize pressure and prevent critical lung function, i.e. lung insufflation. Any cannula placed into a patient's chest cavity for drainage must be sealed to prevent pneumothorax from occurring.
Current chest drainage cannulae, also called chest tubes, drainage catheters or drainage cannulae, are flexible polymer tubes, placed into the chest cavity and extending outside the patient.
Chest drainage tubes are placed using a surgically invasive procedure. Generally, if a surgical incision into the chest has not been made, the chest tube is usually placed with the aid of an internal trocar that stiffens the chest tube and allows for easier chest wall penetration during placement. The procedure begins with a skin incision large enough to accommodate the diameter of the selected chest tube. Chest tubes are typically 8 mm to 10 mm diameter. The internal trocar, having a sharp point, is placed inside the chest tube. The pointed end of the trocar chest tube combination is pressed through the skin incision and plunged into the thoracic cavity through the muscle, fascia and fat layers of the patient, through the rib space and into the pleural cavity. The trocar is removed and the chest tube is clamped to prevent pneumothorax.
When drainage is required, the clamp is opened and fluid, air and contaminants are removed from the thoracic cavity. The fluid, air and contaminants typically are removed, forcefully, by use of external vacuum or pumping systems. The clamp is closed once drainage is completed to avoid reflux of fluid and air back into the chest cavity and possible generation of pneumothorax or influx of contaminants (i.e. infectious agents).
Placement of current chest drainage tubes is an invasive surgical procedure. With any invasive surgical procedure, there exists a risk of iatrogenic trauma to the patient. Significant training is required to safely perform these procedures and this training may not have been completed by emergency personnel who are the first line of treatment for many patients experiencing trauma.
Improved valving mechanisms would increase functionality of chest drainage tubes and overcome issues that occur with clamp application and removal. There are also fewer steps required of the medical practitioner in chest drainage when a tube with an internal valving mechanism is employed. There may also be a problem with a chest tube being pushed too far into the patient, resulting in kinking, compromised drainage and potential iatrogenic damage to internal organs.
This invention relates to a catheter, tube or cannula for draining fluid, air and contaminants from the chest and a method of placement.
The cannula of the present invention includes an internal, semi-automatic valving mechanism, which allows for fewer steps and minimizes the chance of leaving the chest tube open to atmosphere when drainage is completed. The cannula of the present invention also comprises an external movable fixation device to prevent inadvertently pushing the cannula too far into the patient. The minimally invasive placement method of the present invention is beneficial in not only the emergency setting but also in the hospital setting by reducing the chance of iatrogenic injury to the patient.
The cannula is a polymeric tube, preferably with a metal spiral winding to prevent kinking or collapse, which is fenestrated at or near the distal tip at a plurality of sites. The cannula includes an interior valve or seal, located inside the drainage lumen of the cannula, operably able to prevent reflux or efflux of fluid, air and contaminants to or from the chest. The cannula includes an intracorporeal fixation device, located internal to the patient, to prevent outward dislodgement of the chest tube from the chest. The cannula also includes an extracorporeal fixation device, located external to the patient to prevent inward movement of the chest tube.
In one embodiment, application of a vacuum at the proximal end of the cannula causes the internal valve to open thus allowing free flow of fluid, air and contaminants from the chest through the cannula and into the drainage system. The drainage system is typically a vacuum powered, water sealed suction device and collection reservoir. Removal of the vacuum causes exposure of the valve to atmospheric pressure and subsequent closure of the valve, thus reflux of fluid, air and contaminants into the chest is prevented.
Alternatively, the valve could be operated by application of positive pressure (above atmospheric) for closure of the valve and application of negative or zero pressure to open the valve. External feedback systems utilizing pressure sensors or other devices are used to ensure patient safety with the positive pressure valve closure embodiment.
In another embodiment, the internal valve is placed at the proximal end of the cannula. This valve is fabricated from a soft polymeric compound or foam with a central hole that is normally closed. Application of a mechanical force through the center of the valve, with a hollow obturator, for example, opens the valve and allows flow through the hollow obturator. Removal of the hollow obturator causes closure of the valve and prevention of reflux back into the thoracic cavity.
In yet another embodiment, the valve is a duckbill valve that passively prevents reflux back into the thoracic cavity while allowing drainage from the chest cavity under application of appropriate pressure drop across the valve. Such pressure drop can occur from an increase of intrapleural pressure caused by buildup of fluids or by application of a vacuum to the outlet side of the valve.
In all embodiments, the valve systems are, preferably, integral to the cannula and unable to be separated from the cannula when, for example, the patient rolls over and stresses the connection.
The drainage cannula of the present invention includes an intracorporeal fixation or retaining device that prevents the cannula from being removed inadvertently from the patient. This intracorporeal device is, for example, an elastomeric or inelastic (i.e. angioplasty-type) balloon affixed to the exterior surface of the cannula. The balloon is passed inside the chest cavity and is inflated with sterile liquids or air to prevent withdrawal through the hole or wound in the chest wall. Inflation typically occurs using a balloon inflation lumen in the cannula, inflation ports between the lumen and the balloon, and an inflation device external to the cannula.
Additionally, the drainage cannula of the present invention includes an extracorporeal fixation device that may comprise one or more clips that are affixed to the exterior of the cannula in a movable fashion. These clips are, preferably, located proximally to the internal fixation device or balloon. They may be moved against the chest wall and frictionally engaged to the cannula shaft to prevent the cannula from being forced too far into the patient. Such extracorporeal fixation devices could be retrofitted to existing chest tubes to improve the functionality of existing chest tubes.
A means for placement or insertion of the chest drainage tube into the thoracic cavity can be described as follows. The chest drainage tube of the current invention is placed in a minimally invasive procedure. Placement is accomplished by first performing a surgical skin nick and then placing a hypodermic needle into the pleural space of the patient at the site of the skin nick. A J-tip guidewire is placed through the hypodermic needle and the hypodermic needle is removed. A percutaneous access device or trocar is placed into the central lumen of the chest tube and over the guidewire and routed into the pleural space.
In a further embodiment, the cannula is steerable by the following means. This is accomplished by use of a malleable, bendable trocar that can be shaped prior to insertion into the patient. In another embodiment, steerability is obtainable by heat setting the cannula with a curved shape. Axially moving a rigid straight trocar into the bent portion of the cannula from the proximal end causes the curved shape to straighten out. This controllable bending is useful for negotiating tight turns in the patient. In another embodiment, steerability may be obtained using actuators on the surface or within the interior of the cannula to force bending of the cannula. These actuators are typically electrically powered. An actuator comprises electrical leads, a power source, a compressible substrate, and shape memory materials such as nitinol. Such actuators may be distributed along the length of the cannula. The actuators may be placed so as to oppose each other. Opposing actuators are activated one at a time and not simultaneously.
The combination of minimally invasive placement and reduced steps to operate the chest drainage tube will benefit patients and medical practitioners by reducing errors, minimizing trauma, increasing ease of use, and improving patient outcomes.
Referring to
The distal end of the multi-lumen tubing 22 comprises the plurality of drainage holes 20. The drainage holes 20 connect the exterior of the catheter 10 with the drainage lumen 32. The holes 20 are of sufficient size and quantity to allow for passage of fluid, thrombus and debris that might need to be removed from the chest cavity. The plurality of drainage holes 20 and the drainage lumen 32 may further be coated with an anti-thrombogenic coating of material such as, but not limited to, heparin.
The valve or seal 14 is preferably located in the drainage lumen 32 of the catheter 10, between the manifold 12 and the drainage holes 20. Alternatively, the valve or seal 14 may be mounted proximal to the manifold 12 or inside the manifold 12. If the optional valve housing 15 is used, the housing 15 encircles the catheter 10 and is open to the drainage lumen 32. The valve 14 sets inside the housing 15. The intracorporeal fixation balloon 18 is located on the outside surface of the multi-lumen tubing 22, between the manifold 12 and the drainage holes 20, approximately 2 cm to 40 cm from the most proximal drainage hole. More preferably, the intracorporeal fixation device or balloon 18 is located between 5 cm and 20 cm from the most distal drainage hole. The balloon 18 is located over a balloon inflation port that allows communication between the balloon 18 and the inflation lumen 36. The extracorporeal fixation device 16 is slidably located on the outside of the multi-lumen tubing 22, between the manifold 12 and the intracorporeal fixation balloon 18.
When the catheter 10 is in use, the manifold 12 connects to a drainage system through the drainage adapter 24. The drainage adapter 24 is typically larger in diameter than the balloon inflation fitting 28 or valve-enabling fitting 26. The drainage adapter 24 is capable of being connected to the gravity-fed, pump-driven or vacuum-fed drainage system and is most typically a ⅜ inch to � inch diameter hose barb. Standard drainage systems generally comprise a connector, a length of tubing and a reservoir. Optionally, a vacuum pump may be connected to the reservoir.
The manifold 12 also connects to an inflation system through the balloon inflation adapter 28. The balloon inflation adapter 28 is typically a female luer fitting but may be any fluid-tight fitting suitable for use with an inflation syringe or the like. The standard balloon inflation system comprises a syringe, a volume of balloon inflation fluid such as sterile saline, air or radiopaque media, and a valve or stopcock. Additionally, the balloon inflation system could comprise a device, such as a jackscrew, to advance or withdraw a plunger on the syringe using mechanical advantage.
Additionally, the manifold 12 connects to a valve enabling system through the valve-enabling adapter 26. The valve-enabling adapter 26 is, preferably, a female luer lock adapter, but could be another type of fluid-tight connection such as a threaded swage-lock, or the like.
Additional methods and means for chest tube placement and bending are shown in
Referring to
In another embodiment, the intracorporeal fixation device 18 is an expandable region of cylindrical material with longitudinal slits or slots, a distal ring and a proximal ring. The rings and interconnecting slotted cylinder are disposed coaxially and concentrically around the cannula 10 shaft. The distal ring is connected to a control rod routed through the intracorporeal fixation lumen 36 to a control handle on the proximal end of the cannula 10. When the cannula 10 is in place, the control rod is pulled, causing the distal ring of the intracorporeal fixation device 18 to pull along the cannula 10 shaft, toward the proximal ring. This causes the slit cylinder to collapse in length and the cylinder material between slits expands in diameter, forming a starburst pattern. A locking mechanism at the proximal end of the cannula 10 keeps the control rod from moving once the intracorporeal fixation device 18 is opened in the desired position. This system functions like a moly-bolt or drywall anchor to keep the cannula 10 from being removed from the chest inadvertently. The control rod may be unlocked and the distal ring advanced distally to contract the anchor around the cannula 10 so the cannula 10 may be removed from the patient. Optionally, holes or openings in the cannula 10 that connect with the drainage lumen 32 may be disposed underneath the slots or slits of the intracorporeal fixation device 18 thus providing additional chest drainage ports when the intracorporeal fixation device 18 is in the open position.
In addition to enabling the intracorporeal fixation device 18, the extracorporeal fixation device 16 is also enabled once the catheter 10 is in place in the patient's chest. The extracorporeal fixation device 16 is located outside the chest and is disabled to allow the fixation device 16 to slide over the exterior of the catheter 10, into place, against or close to the patient's skin. The extracorporeal fixation device 16 is enabled and forcibly stops sliding, preventing the chest drainage tube 10 from inadvertently being pushed farther into the patient's chest.
In a preferred embodiment, the extracorporeal fixation device 16 is a lockable clip device. When the lock is open, the extracorporeal fixation device 16 slides over the catheter 10. When the desired location on the catheter 10 is reached, the lock is closed and the extracorporeal fixation device 16 engages the catheter 10 with enough force to make dislodgement of the fixation device 16 relative to the cannula or catheter 10 difficult, but with insufficient force to crimp or restrict the catheter 10 or the lumens 32,34,36. The clip 16 is considerably larger than the diameter of the catheter 10 and the incision in the chest and, preferably has atraumatic rounded edges where it contacts the patient. At least one lateral dimension of the external fixation device or clip 16 is generally between 0.25 and 2 inches. More preferably, the external fixation device or clip 16 is between 0.5 and 1.0 inches in lateral dimension.
In another embodiment, the extracorporeal fixation device 16 is an inflatable balloon. The extracorporeal fixation balloon 16 may be inflated from the balloon inflation lumen 36 used to inflate the intracorporeal inflation balloon 18. Alternatively, the extracorporeal inflation balloon 16 may be inflated from an additional balloon inflation lumen.
In yet another embodiment, the extracorporeal fixation device 16 is an opposably engaged spring clip, which encircles the catheter 10. When the spring is compressed, the clip 16 is slid to the desired location on the catheter 10. When the pressure on the spring is released, the clip 16 is locked into place on the catheter 10. A similar type of spring clip is used to secure a drawstring on a sleeping bag. A further embodiment of the extracorporeal fixation device 16 is a rocking clip that slides when it is tilted relative to the lateral axis of the cannula 10 and locks when it is in the plane perpendicular to the axis of the cannula 10.
In another embodiment, the extracorporeal fixation device 16 comprises a penetrable polymeric tab to allow suture passage and attachment of the extracorporeal fixation device 16 to the patient's skin with suture. The distal side of the extracorporeal fixation device 16 may comprise an adhesive layer to facilitate not only fixation but provide a contamination barrier at the entry site. The extracorporeal fixation device 16 optionally comprises a hole located somewhere on its structure, through which suture may be passed to facilitate attachment to the patient's skin.
In yet another embodiment, the extracorporeal fixation device 16 slides over a plurality of bumps or detents on the cannula 10 exterior surface. These bumps or detents serve to prevent axial motion of the extracorporeal fixation device except under substantial selective manual force. The extracorporeal fixation device 16 may additionally have a ratcheting mechanism that allows for axial motion toward the patient but prevents motion in the reverse direction away from the patient.
The extracorporeal fixation device is useful to retain not only drainage tubes but also any type of catheter in place in the patient.
Once the catheter 10 is placed in the patient's chest, the valve 14, which is normally closed, prevents pneumothorax from occurring. The normally closed valve 14 seals the drainage lumen 32. When the medical personnel require chest drainage, the valve 14 is enabled or opened to allow fluid, air and contaminants to drain from the chest drainage tube 10.
In one embodiment, the valve-enabling lumen 34 is connected through the valve-enabling adapter 26 to a vacuum system. The typical vacuum system is operated by an electrical vacuum pump and regulator to maintain a low level vacuum of 1 to 100 mm Hg. Preferably, the vacuum is maintained at a level of 1 to 20 mm Hg. When the vacuum system is activated, a vacuum is drawn through the valve-enabling lumen 34 and the valve 14 opens. Stopping the vacuum system causes the valve 14 to close and seal the drainage lumen 32.
The preferred vacuum activated valve embodiment 14 is one or more balloons mounted within the drainage lumen 32 of the cannula 10. More preferably, the balloons 14 are exposed to the drainage lumen 32 but reside within the optional valve housing 15 that is larger than the diameter of the drainage lumen 32. The collapsed balloons 14 reside within the housing 15 and do not impinge on the drainage lumen 32 where they could impede passage of the trocar 40 or 54. The balloons 14 are maintained in their collapsed state and out of the drainage lumen 32 by application of a vacuum through the valve-enabling adapter 26 and the valve-enabling lumen 34. An optional stopcock on the valve-enabling adapter 26 is closed to maintain the vacuum until it is desired to close the drainage lumen seal 14. The valve housing 15 is fabricated, preferably, from transparent materials in order to allow for visualization of valve function and verification of drainage lumen patency. The balloons 14 are made with open cell foam. Such open cell foams are typically made from polyurethane materials and the spaces between the cells in the foam interconnect. The skin or surface of the balloon 14 is a fluid impermeable, elastomeric material such as latex, polyurethane, silastic, silicone elastomer and the like.
Means for closing or opening the valve affixed to the chest tube include the following. The balloons 14 are inflated, thus closing the bidirectional valve 14, by resilient expansion of the foam after fluid is allowed to flow back into the collapsed balloons. This may be done by removal of the vacuum or by opening the stopcock. When the bidirectional valve 14 is closed, drainage through the drainage lumen 32 stops and the chest opening is sealed. The bidirectional valve 14 is opened by application of a vacuum to the valve enabling lumen 34. The vacuum system can be operably connected to the same vacuum system used for drainage of the thorax. In this way, the bidirectional valve 14 automatically opens when drainage is activated.
Other valve embodiments 14 include balloons that are normally deflated and open. These valves 14 require that positive pressure be applied to inflate the balloons and occlude the drainage lumen 32. Removal of the pressure or application of a vacuum causes the balloons to deflate and the valve 14 to open. Such valves 14 do not require the use of open cell foam cores but may require external devices to monitor drainage lumen parameters and ensure patient safety.
In another embodiment, the valve or seal 14 is made from a soft rubber or polymer. A central hole, slit or cross in the valve 14 allows for generation of potential space in this normally closed structure. In this embodiment, insertion of a hollow obturator through the valve-enabling adapter 26 and the central hole, slit or cross opens the valve 14, permitting fluid, air and contaminants to pass through the hollow obturator.
In yet another embodiment, the valve or seal 14 is a duckbill or one-way valve permitting fluid, air and contaminants to flow from the chest but not permitting introduction of air into the chest. When the trocar 40 or 54 is advanced into the cannula 10, the valve leaflets are moved into the open position to permit passage. This operation may be performed manually or automatically when trocar 40 or 54 insertion is required. The duckbill valve is typically fabricated from soft polymer materials such as silicone rubber, polyvinyl chloride, polyurethane and the like. The duckbill valve is preferably coated with materials such as heparin or silicone that prevent thrombosis and prevent unwanted permanent sealing of the valve leaflets.
In another embodiment, the slots 60 are located in the wall 38 of the multi-lumen tubing 22 and connect the exterior of the catheter 10 with the drainage lumen 32, replacing the drainage holes 20. As the control rod 72 is retracted proximally, the slits or slots 60 expand radially and increase their opening size, thus providing drainage.
In a further embodiment of the means to selectively bend the chest tube, the cannula 10 of the present invention comprises at least one flexible control rod 72 extending from the distal tip of the cannula 10 to the proximal end of said cannula 10. The control rods 72 are slideably disposed within one of the lumens of the multi-lumen tubing 22. The control rods 72 are disposed off-center and terminate at or near the proximal end of the cannula 10 with a handle. The control rods 72 are fabricated from wire, polymer fiber or other flexible material. The cannula 10 further comprises an area of increased flexibility proximal to the distal attachment point of the control rod 72 to the cannula 10.
By withdrawing the control rod or rods 72 proximally, the cannula tip may be made to bend in a controlled direction in the area of increased flexibility. Such selective steerability is useful in advancing the cannula 10 through tortuous anatomy.
The cannula 10 of the present invention is useful during or after many thoracic surgeries and will benefit many patients in the emergency setting. The system is easier to place in the patient than standard chest drainage tubes and may be placed by personnel with less training than physicians (e.g. paramedics). The system is less likely to be misused than standard chest drainage tubes.
The cannula 10 of the present invention may be used for abdominal drainage, thoracic drainage, peritoneal dialysis and other procedures. The invention is not limited solely to thoracic procedures but to general mammalian body cavity drainage and/or catheterization.
The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is therefore indicated by the appended claims rather than the foregoing description. All changes that come within the meaning and range of equivalency of the claims are to be embraced within their scope.
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|U.S. Classification
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|International Classification
|Cooperative Classification
|European Classification


text:
The world changed with the advent of the Internet. All of a sudden, information and content became instantly accessible, just at the click of a mouse. It seems like everyone is talking about content marketing these days as if it's some kind of newfangled industry tactic. But in 1999, Seth Godin was already writing about the importance of a content-centered marketing strategy, and it's still true: content remains king.
DOMO reports that Internet users produce over 347 blog posts and send over 200 million emails every minute of the day. With all of this noise, how can brands increase visibility of, and engagement with their content? Brand new research indicates that content length plays a key role in how much content ultimately resonates with customers.
But before we talk about better practices, we need to keep a few things in mind: not all content engagement is the same. We have to first break down content into two categories: inbound and outbound. Inbound content is used for SEM conversions, whereas outbound content is used in email campaigns. This simple classification makes a huge difference in the mindset of the consumer and the size of your content.
Inbound Content: Why Longer Is Better
For inbound content, you have a person searching for help. They are finding your content while doing research for a topic. They are searching out an answer, and you popped up in the middle of the search. During this scenario, the consumer actively wants to engage. This means they have dedicated time to learn, which dictates a longer form of your content in order to answer all of their questions.
When someone finds your content from an inbound search, and you ask or her to fill out a form to gain access to your content, you are in a negotiation with the person. You ask for an email address, with the promise of delivering valuable content in return. For you to win the negotiation and the email lead, you have to provide content that seems to be worth the email address. This is why longer-form content usually works in this context. The longer and more helpful your content seems to be, the more value it appears to have to the consumer, and the more likely you are to drive an action.
Shorter-Form Content As an Outbound Strategy
For outbound content, the consumer's perception of your brand and your content is very different. You are being disruptive to the person's day by sending her an email and proposing to offer some value that she didn't seek out. People will still engage with large documents via outbound channels; however, many people just want content to be quick and easily digestible when it's coming to them through an outbound platform. For example, a quick personal development piece would fall into this category.
What the Numbers Say
Before you decide whether that piece of content needs to be a detailed e-book or a brief two-pager, consider the numbers. I recently conducted a survey of 300+ B2B buyers that yielded two important statistics:
- 66 percent of B2B buyers are looking for short-form content either daily, weekly, or monthly.
- 70 percent of B2B buyers say they prefer content to be under five pages long.
So should all content be under five pages? No, it shouldn't. Instead of thinking that your content should forever stay below the five-page mark, these numbers point to the fact that data consumers want their content to be targeted and appropriately detailed or brief according to their needs. Disruptive content needs to be easy to download and absorb in a short window of time, while content found through search can be longer and more comprehensive.
A five-page e-book might not be as attractive on a PPC conversion as a 20-page e-book, but the shorter content might perform better in a nurturing campaign. So when creating content, always factor in where the content will ultimately live as you plan the piece's scope and length. Keep your content targeted to its purpose – and keep the length tailored to that goal – and your engagement rates will increase as your bounce rates go down.
Image on home page via Shutterstock.
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About فضايح فننات العرب
فضايح فننات العرب Two of the most familiar are a fluttery, white Southern matron, Amanda {Mary Steenburgen}, who unwittingly condescends to her black maid, and an overweight black mama, Nadine {Davenia McFadden}, with a dirty mind. فضايح مني ذكي ``We already have one, but we have two televisions in our house and we`d like to have another box so we can watch TV in the other room,`` she said. فضايح الهام شاهين She said she was well aware that the conversion clock is ticking down.
The children of Sapphire, the fraternal twins Prince Daisy and Princess Violetta, are the main characters. While operating on a mythic level �Honeydripper� also wants to create the same kind of top-to-bottom social microcosm found in many of Mr.Clark, a blues hotshot from Austin, Tex., with several albums to his credit, is proto-Chuck Berry, though not as distinctive.It didn`t take long for the track ``Don`t Mess With My Man,`` featuring Brian and Brandon Casey of Jagged Edge, to enter the Top 10 of music charts across the nation. فضايح فننات العرب The face is blacked out and other areas are obscured.The children of Sapphire, the fraternal twins Prince Daisy and Princess Violetta, are the main characters. فضايح الهام شاهين David Carradine Death Scene Photo - David Carradine death scene photo has been leaked by the Thai Rath and is said to be very graphic.Earlier today the Carradines have learned that the forensics experts believe that the �Kung Fu� actor did not commit suicide.The family has hired specialists to work with the Thai investigators so they can determine the cause of death of the actor.David�s love ones are hoping that the FBI will investigate the mysterious death.Prior to the start of the 2004 NFL season, the Bears fired Jauron and hired Lovie Smith, who declared Grossman the team`s starting quarterback. فضايح سكس The single has also been nominated for a Grammy award.


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The Virtue of Responsibility
God help me to honour my commitments to my family, school and community. Help me to be dependable and reliable and to be accountable for all the things I say and do.
Read More...
Aussi X-Movement
The Aussi X-Movement will be working with students in all of the grades during the week of May 16th. The aim of this program is to provide in-school physical activities and mindfulness that builds life skills and helps to create a positive school climat
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Grade 7 Confirmation
Congratulations to the grade 7 students who received the Sacrament of Confirmation on May 3rd and 4th.
Read More...
Comic Art Tour Presentation
Grade 2-6 will participate in a presentation about Comic Art during the morning of May10th.
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Kindergarten First Impressions
Kindergarten First Impresssions will take place on May 11. Welcome to all our future Holy Jubilee students and parents.
Read More...
French Plays
The French teachers have been working with the primary students on short plays. Each grade will be sharing their productions during the following weeks: Grade 2- The week of May 2nd, Grade 3- The week of May 9 and Grade 1- The week of May 30th. Parent
Read More...
Copyright: The contents of all materials on this site are the property of YCDSB and/or its employees. Distribution or commercial use without permission is strictly prohibited.
External Links: This website contains links to information created from outside organizations. The York Catholic District School Board is not responsible for the content of these pages and does not control the accuracy, reliability, or appropriateness of this information.


text:
Navico, provider of recreational and coastal commercial marine electronics, announced the appointment of Mark McCully as its new Global Chief Marketing Officer. McCully will direct all high-level brand identity and marketing activities for the B&G, Eagle, Lowrance, Northstar and Simrad brands throughout the world, with a targeted goal of expanding the company's brand presence and positioning.
Bringing more than 25 years of marine and consumer electronics marketing experience and over 15 years of senior marketing executive experience to the position, McCully joins Navico after spending five years operating a strategic marketing and tactical execution consulting firm, Intellectual Marketing Capital. His marketing record also includes seven years as Vice President of Global Consumer Marketing for Philips Consumer Electronics as well as holding senior marketing positions with The Coca-Cola Company, Hayes Computer Products and Lippi/Morris International/BK&T, working on P&G brands. McCully has a Bachelor of Science degree in marketing and Minor in Advertising from The Pennsylvania State University. He is an active member of the American Marketing Association, Direct Marketing Association, and Public Relations Society.
Maritime Today
The Maritime Industry's original and most viewed E-News Service
Four themes at this year's Danish Maritime Days will highlight some of the most important challenges and opportunities which the global maritime industry is facing, organizers said.
CMA CGM, the world's third-largest container shipping firm, is to go ahead with its planned acquisition of Singapore's Neptune Orient Lines (NOL) after receiving regulatory clearance from China,
Baltic Exchange privately owned by 380 shareholders.
The Singapore Exchange (SGX) is in exclusive talks to buy London's Baltic Exchange, which has been at the


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My wife and I will be visiting relatives in North Miami in early July after which we'd like to spend a few days relaxing on the west coast. Can you recommend a good location for (a) sunbathing on the beach, (b) swimming/snorkeling in the Gulf, and (c) perhaps fishing off some pier? We're looking for something between Marco and St.`Petersburg. Thank you.
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Try the island of Captiva. It's gorgeous. The Tween Waters Hotel & Marina has all three things you're looking for. Situated on a narrow part of the island, it faces both the Gulf and the Intercoastal waterway. They have cottages or regular rooms. Get a cottage, they're adorable. They also have boat rentals and fishing galore. also, if your taste is more upscale, check out the south Seas Plantation. Expensive, exclusive, and they occupy the whole north end of the island.
Joan - Treasure Island, FL
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Woman drinker, 24, suffers severe burns after flaming Sambuca cocktail 'explodes in her face'
- Young drinker suffered severe burns to her cheeks, forehead and chest
- She was given morphine at the scene and rushed to a specialist burns unit
- 'Freak accident' happened in Lola's cocktail bar in Manchester
A young woman suffered severe burns after a flaming Sambuca cocktail 'exploded' in her face in a bar in the early hours of the morning.
Eyewitnesses said the 24-year-old's 'face caught fire' in the 'freak accident' in Lola's cocktail lounge in Manchester city centre which actively promote their fiery drinks.
She sustained burns to her cheeks, forehead and chest and was rushed to Wythenshawe Hospital's burns unit after being treated with morphine.
Flaming Sambuca: The young woman, 24, suffered severe burns when the drink 'exploded' in her face in Lola's cocktail bar, Manchester. This picture is taken from the bar's promotional material
Probe: The bar, in Manchester's Northern Quarter, have launched a review of health and safety policy following the 'freak accident'
Drinkers around the world have been accidentally set on fire by flaming cocktails in bars.
The 24-year-old woman in Manchester is still in hospital recovering today after being set alight by sambuca.
The case comes after a Russian man suffered severe burns in May after a barman set fire to his head while trying to pour a glass of flaming absinthe into his mouth. Alexey Ponamarev, 28, was rushed to hospital with burns to his face after the incident in a bar in Novosibirsk, south-west Siberia.
Four years ago British tourist Stuart Feltham (pictured) was turned into a human fireball when his genitals were apparently set alight by a woman in Malia, Greece.
Marina Fanouraki, 26, claimed that the holidaymaker, 20, had sexually assaulted her.
In 2010, bartender Albert Trummer was arrested in Manhattan, USA, by undercover fire marshalls after setting liquors alight in a bar trick.
The management at the 'Miami-style cocktail lounge' said they are reviewing health and safety procedures following the incident in the early hours of Sunday.
Flaming Sambuca shots are made by pouring the spirit into a glass over two of three coffee beans. They are set alight and the alcohol burns with a pale blue flame
The flames should then be extinguished and drinkers inhale the fumes from the glass before downing it.
The idea of the
drink is that by setting it alight, the coffee flavour infuses into the Sambuca.
A spokeswoman for the North West Ambulance Service NHS Trust confirmed it received a report of a woman with her 'face on fire' at 1.54am on Sunday. Paramedics were at the scene in under five minutes.
An ambulance service spokesman said: 'A female suffered significant facial burns.'
Reports from eyewitnesses on social media suggested the woman was at the bar with a friend when her hair caught fire.
A spokesman for Greater Manchester Police said they were investigating the incident. However, it is thought to have been an accident.
The woman remains in hospital today.
In promotional material, Lola's bar have written that they offer cocktail-making classes where you can 'get a chance to make your own cocktails and learn about the history of each... even play with fire!'
A spokesman for Lola's said: 'Following the recent event in our venue resulting in injury to one of our customers, we sincerely offer our sympathies for her injuries sustained.
'We have been trading for many years and have never had another incident such as this and we have revisited our health and safety procedures once again to prevent this type of freak accident from happening again.'
Accident: The girl was injured in Lola's cocktail bar in the Northern Quarter, Manchester, in the early hours of Sunday
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Go for a retro-inspired look with these olive-green suede booties featuring a mid-calf silhouette and stitch detailing. Finished with an exposed side zipper and a faux wood stacked heel. Rock them with your favorite throwback outfits for a street chic look. By Seychelles.
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Create a sexy and chic look with black mini dress designed with an oversized fit, long gathered sleeves, and a polka dot print white. Complete with soft pleating at the back and pintuck pleating at the shoulders, this flowy dress is finished button closures at the V-cut neckline. For a variety of looks, the self-tie sash at the neckline can be worn open or tied into a totally cute bow! Unlined, opaque. By Knot Sisters.
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Perfect for a daytime party or a mimosa brunch with the girls, this gold-toned chiffon crop top features an abstract floral print in a vibrant magenta hue and is accented with gold-toned crochet trim along the hems and arms. Complete with a hint of sheen, this sexy crop top can be styled as a set for a flirty bohemian look. Hidden side zipper. Semi-sheer. By For Love & Lemons.
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SPX/Gardner Denver11 Dec 2012
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Does your company already have an FN licence? Email us now
SPX leads race for Gardner Denver
SPX is understood to have emerged as the front-runner in the auction of industrial-pumps maker Gardner Denver, with the two companies entering into one-on-one talks this week with the goal of hammering out a deal.
Several private equity firms that had put in all-cash offers in the range of low- to mid-$70s per share for Gardner Denver last week have been told to wait on the sidelines as the two companies negotiate, it has emerged. SPX has offered several dollars more per share, likely through a mix of cash and stock, to combine with Gardner Denver, sources said. Both companies have nearly identical market capitalisations of around $3.4bn, necessitating the exchange of stock for a merger.
Gardner Denver said in October it would explore options such as a sale or merger, following pressure from activist investor ValueAct Capital Master Fund, which owns more than 5% of the shares.
Article Tags
Other press digests in this section
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When M&A music stops, these banks won't have chairs
Some boutique bank stocks are positioned better than others for a downturn in M&A, so investors should take note
From The Wall Street Journal


text:
|Name: _________________________
|Period: ___________________
This quiz consists of 5 multiple choice and 5 short answer questions through Prologue and Chapters 1-4.
Multiple Choice Questions
1. How old is Ronnie in the beginning of the story?
(a) 14.
(b) 15.
(c) 17.
(d) 16.
2. What in literature refers to the author's providing of some background information to the audience about the plot, characters' histories, setting, and theme?
(a) Argumentation.
(b) Exposition.
(c) Rising Action.
(d) Rhetoric.
3. Where does Ronnie's father live?
(a) South Carolina.
(b) North Carolina.
(c) Florida.
(d) New Mexico.
4. What is Steve making for the church that was damaged in a fire the previous spring in the novel?
(a) An entrance door.
(b) An apse.
(c) A sign.
(d) A stained glass window.
5. Where does Ronnie live with her mother?
(a) New York.
(b) New Hampshire.
(c) Connecticut.
(d) Massachusetts.
Short Answer Questions
1. In Chapter 1, Ronnie has not spoken to her father in how long?
2. What is the main character of a literary narrative, around whom the events of the narrative's plot revolve?
3. What sports game does Ronnie watch while at the beach in Chapter 3?
4. What is taking place at the beach when Ronnie arrives in Chapter 3?
5. In what month is Ronnie's birthday?
This section contains 180 words
(approx. 1 page at 300 words per page)


text:
Marc Jacobs Enlists BFF Sofia Coppola For Fragrance Campaign, AGAIN
There are some celeb friendships that seem fleeting — not naming anyone in particular — and there are others that are the real deal, long-standing bonds just like the one between you and your bosom buddy. Marc Jacobs and Sofia Coppola fall into the latter category. And, the latest news from the designer confirms it. As reported by Grazia Daily, Coppola will star as the face of Jacobs' next Daisy fragrance campaign for TV.
The not exactly new, but still pretty awesome news is just the latest example of the pals' collaborative work and ongoing support — Jacobs cast Coppola in his first ever fragrance campaign, and Coppola wore Jacobs to the Oscars…and won. While there are no other details available yet about the release of this new campaign, we'll keep an eye out for when the friendship-created campaign officially airs. ( Grazia Daily )
Photo: Via Grazia Daily.
- Beauty |
- Fragrance |
- Perfume |
- Marc Jacobs | Marc Jacobs Sofia Coppola Fragrance Campaign
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house700 sqftThis gated unique private ocean view property was custom built in 2001and features two stand... More
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house1650 sqftThis property is only available for 6 or 7 weeks approximately June 15, 2016 thru August 6,... More
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house1467 sqftVACATION RENTAL: PRICE RANGE REFLECTS WEEKLY WINTER and MONTHLY SUMMER RATES 2016 2016 Dates NOT... More
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house2650 sqftExclusively offered for the dates between July 1 through August 15, 2016 only. Welcome to your... More
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Summary for Encinitas, CA
Median rental price for rentals in Encinitas, CA for May was $3,600, an increase of 6% compared to the same period last year.
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This is a tutorial on how to make a Christmas ornament out of paper called a Polish star. They look a lot like sea urchins.Music by Jason Shaw ... Jason Shaw@ ... I used ... inch circles to make the segmen
by CellularMango
by Game Guy DIY
by Meg Newberg
by Better Homes and Gardens
by OneVeryHappyBird
by sachinsfanrajkumar
by CrystalStarGems


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Photo ID amendment:
Minnesotans will vote Nov. 6 on an amendment to the state Constitution that would require voters to present a valid photo identification. To pass, the amendment must receive the votes of a majority of those who cast ballots in the election.
The question:
"Shall the Minnesota Constitution be amended to require all voters to present valid photo identification to vote and to require the state to provide free identification to eligible voters, effective July 1, 2013?"
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God, I Love puffy nipples! Gorgeous! very beautiful girl. Love every part of her heavenly body. Wow, what an absolutely amazing breast. She has the most perfect tits I have ever seen. I would love to see more of her… gambar pecah dara gambar cipap johar vedio wanita rawat pagina seks lucah rahimah dirogol bidin berzina dengan mertua foto bulu ketiak fhasa sanda Posted by nafsuin,20 May 2016 - 20:42. Kumpulan HOT Awek Tetek Besar Cun Terlampau - bogel gadis , awek tudung bogel, sex lucah related: gambar, iceFilms.info - Globolister - Discover Over 100,000 HQ DivX TV & Movies! All DVD Quality! 99.99% Active Links! The Fastest Streams! Updated Daily! No Cams! And we love you too :) … Continue reading
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Moms & Babies8 Hearty Dishes Your Kids Will Love
From roast tomato soup to baked eggs to shrimp and grits, Brooklyn Supper bloggers (and real life couple!) Brian Campbell and Elizabeth Stark share their yummy, easy-to-make recipes
Updated: Tuesday Jan 29, 2013 | 06:00 AM EST By: Shanelle Rein-Olowokere
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Bring a buddy.4.54 / 5.00 10,477 Views
Yugi and Kaiba have a duel to the death!4.46 / 5.00 39,358 Views
Vampire Pixel in the Neon City
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and i thought salad fingers was a bit deranged.....
I don't understand...
I don't get it... made no sense and had no purpose. What's the point of ripping on it if it doesn't nake sense and is nothing like the original thing? And whats with the music?
4 for the music its funny :). and -2 for going on forever
alas, it has gone crappy
I's a ggod thing i saw the next two befor i watched this one, this one made me sad. it had no point other than two show that his fingers are bananas and he can walk, but i gotta give you credit for the music, it was the only thing that kept me from turning it off after like 10 seconds. it was bad, very very bad, i'd kick you in the shin but i probably wouldn't kick past your ancle, lousy tall people and their high shins
oh dear... -___-;;
To the person who commented before me, this is supposed to be a "parody"... That's a big difference than just merely copying something. However, this wasn't a very good parody. I'd hate to rag on something that's about four years old, but still... I couldn't even watch the whole thing. It was just really... boring -__- Nonetheless, I'm giving this a "2" since the animation was pretty good. The content though.. eh.. that left something to be desired.