text:
|Publication number
|Publication type
|Application number
|Publication date
|Oct 20, 2009
|Filing date
|Apr 18, 2006
|Priority date
|May 1, 2000
|Fee status
|Also published as
|Publication number
|Steven J. Tallarida, Steven W. Ek
|Original Assignee
|Arthrosurface Incorporated
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (106), Non-Patent Citations (99), Referenced by (23), Classifications (123), Legal Events (3)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation of U.S. patent application Ser. No. 10/360,228, filed Feb. 6, 2003, now U.S. Pat. No. 7,029,479, which is a divisional of U.S. patent application Ser. No. 09/846,657, now U.S. Pat. No. 6,520,964, filed May 1, 2001, which claims benefit of U.S. provisional application Ser. No. 60/201,049, filed May 1, 2000.
This invention relates to devices and methods for the repair of defects that occur in articular cartilage on the surface of bones, particularly the knee.
Articular cartilage, found at the ends of articulating bone in the body, is typically composed of hyaline cartilage, which has many unique properties that allow it to function effectively as a smooth and lubricious load-bearing surface. However, when injured, hyaline cartilage cells are not typically replaced by new hyaline cartilage cells. Healing is dependent upon the occurrence of bleeding from the underlying bone and formation of scar or reparative cartilage called fibrocartilage. While similar, fibrocartilage does not possess the same unique aspects of native hyaline cartilage and tends to be far less durable.
Hyaline cartilage problems, particularly in knee and hip joints, are generally caused by disease such as occurs with rheumatoid arthritis or wear and tear (osteoarthritis), or secondary to an injury, either acute (sudden), or recurrent and chronic (ongoing). Such cartilage disease or deterioration can compromise the articular surface causing pain and further deterioration of joint function. As a result, various methods have been developed to treat and repair damaged or destroyed articular cartilage.
For smaller defects, traditional options for this type of problem include non-operative therapies (e.g., oral medication or medication by injection into the joint), or performing a surgical procedure called abrasion arthroplasty or abrasion chondralplasty. The principle behind this procedure is to attempt to stimulate natural healing. At the defect site, the bone surface is abraded, removing approximately 1 mm. or less using a high-speed rotary burr or shaving device. This creates an exposed subchondral bone bed that will bleed and will initiate a fibrocartilage healing response. Although this procedure has been widely used over the past two decades and can provide good short term results, (1-3 years), the resulting fibrocartilage surface is seldom able to support long-term weight bearing, particularly in high-activity patients, and is prone to wear.
Another procedure, referred to as the "microfracture" technique, incorporates similar concepts of creating exposed subchondral bone. During the procedure, the cartilage layer of the chondral defect is removed. Several pathways or "microfractures" are created to the subchondral bleeding bone bed by impacting a metal pick or surgical awl at a minimum number of locations within the lesion. By establishing bleeding in the lesion and by creating a pathway to the subchondral bone, a fibrocartilage healing response is initiated, forming a replacement surface. Results for this technique are generally similar to abrasion chondralplasty.
Another known option to treat damaged articular cartilage is a cartilage transplant, referred to as a Mosaicplasty or osteoarticular transfer system (OATS) technique. This involves using a series of dowel cutting instruments to harvest a plug of articular cartilage and subchondral bone from a donor site, which can then be implanted into a core made into the defect site. By repeating this process, transferring a series of plugs, and by placing them in close proximity to one another, in mosaic-like fashion, a new grafted hyaline cartilage surface can be established. The result is a hyaline-like surface interposed with a fibrocartilage healing response between each graft.
This procedure is technically difficult, as all grafts must be taken with the axis of the harvesting coring drill being kept perpendicular to the articular surface at the point of harvest. Also, all graft placement sites must be drilled with the axis of a similar coring tool being kept perpendicular to the articular surface at the point of implantation. Further, all grafts must be placed so that the articular surface portion of these cartilage and bone plugs is delivered to the implantation site and seated at the same level as the surrounding articular surface. If these plugs are not properly placed in relation to the surrounding articular surface, the procedure can have a very detrimental effect on the mating articular surface. If the plugs are placed too far below the level of the surrounding articular surface, no benefit from the procedure will be gained. Further, based on the requirement of perpendicularity on all harvesting and placement sites, the procedure requires many access and approach angles that typically require an open field surgical procedure. Finally, this procedure requires a lengthy post-operative non-weight bearing course.
Transplantation of previously harvested hyaline cartilage cells from the same patient has been utilized in recent years. After the cartilage is removed or harvested, it is cultured in the lab to obtain an increase in the number of cells. These cells are later injected back into the focal defect site and retained by sewing a patch of periosteal tissue over the top of the defect to contain the cells while they heal and mature. The disadvantages of this procedure are its enormous expense, technical complexity, and the need for an open knee surgery. Further, this technique is still considered somewhat experimental and long-term results are unknown. Some early studies have concluded that this approach offers no significant improvement in outcomes over traditional abrasion and microfracture techniques.
U.S. Pat. No. 5,782,835 to Hart et al. discloses an apparatus and method for repair of articular cartilage including a bone plug removal tool, and a bone plug emplacement tool. The method of repairing defective articular cartilage includes the steps of removing the defective cartilage and forming a hole of sufficient depth at the site. A bone plug comprising intact bone and cartilage adhering thereto is removed from a bone lacking defective cartilage is placed in the hole at the site of the damage.
U.S. Pat. No. 5,413,608 to Keller discloses a knee joint endoprosthesis for replacing the articular surfaces of the tibia comprising a bearing part which is anchored on the bone having an upper bearing surface and a rotatable plateau secured on the bearing surface and forming a part of the articular surface to be replaced. A journal rises from the bearing surface and cooperates with a bore in the plateau to provide lateral support.
U.S. Pat. No. 5,632,745 to Schwartz describes a method of surgically implanting into a site a bio-absorbable cartilage repair assembly. The assembly includes a bio-absorbable polygonal T-shaped delivery unit having radial ribs to be mounted in the removed area and a porous bio-absorbable insert supported by and in the delivery unit. The method comprises the steps of preparing the site to receive the assembly by removing a portion of the damaged cartilage and preparing the site to receive the assembly by drilling and countersinking the bone. The assembly is inserted and seated using an impactor in the drilled and countersunk hole in the bone until the assembly is flush with the surrounding articular surface.
U.S. Pat. No. 5,683,466 to Vitale illustrates an articular joint surface replacement system having two opposing components. Each component has a tapered head piece for covering the end of a bone and for acting as an articular surface, an integrally formed screw stem of sufficient length to extend into the bone and inwardly angled bone grips on the underside of the head piece to allow fixation to the bone by compression fit. The partially spherical convex shaped exterior of the first component complements the partially spherical concave shaped exterior of the second component.
U.S. Pat. No. 5,702,401 to Shaffer discloses an intra-articular measuring device including a hollow handle defining a first passageway and a hollow tube having a second passageway extending from the handle, the hollow tube carrying a projection at its distal end for seating on a fixed site and a probe disposed at the distal end of the hollow tube which may be directed to a second site, to enable measurement of the distance between the first and second sites.
U.S. Pat. No. 5,771,310 to Vannah describes a method of mapping the three-dimensional topography of the surface of an object by generating digital data points at a plurality of sample points on said surface, each digital data point including a property value and a position value corresponding to a particular point representing the properties of the surface of the object. A 3-D transducer probe (e.g., a digitizer) is moved on or over the surface along a random path, and the sample points are digitized to generate a real-time topography or map on a computer screen of selected properties of the object, including without limitation, surface elevation, indentation stiffness, elevation of sub-surface layers and temperature.
Prosthetics for total knee replacement (TKR), whereby the entire knee joint or a single compartment of the knee joint is replaced can be a common eventuality for the patient with a large focal defect. Although these patients are also managed with anti-inflammatory medications, eventual erosion of the remaining articular cartilage results in effusion, pain, and loss of mobility and/or activity for the patient. Problems encountered after implanting such prostheses are usually caused by the eventual loosening of the prosthetic due to osteolysis, wear, or deterioration of the cements used to attach the device to the host bones. Further, some prostheses used are actually much larger than the degenerated tissue that needs to be replaced, so that extensive portions of healthy bone are typically removed to accommodate the prostheses. Patients who undergo TKR often face a long and difficult rehabilitation period, and the life span of the TKR is accepted to be approximately 20 years. Accordingly, efforts are made to forgo the TKR procedure for as long as possible.
Accordingly, there is a need for an improved joint surface replacement system that would be effective in restoring a smooth and continuous articulating surface and that would also be as durable as the former hyaline cartilage surface, within the context of a minimally invasive procedure that allows for a nearly immediate return to activity, restoration of lifestyle, and pain relief.
The present invention provides tools and methods for mapping and measuring the articular surface of a joint (or of any bony surface) and for fabricating a prosthetic device based on this recorded data.
In one method consistent with the invention, once the defect of the chondral surface has been identified, a guide pin is inserted arthroscopically. A fixation screw having a tapered distal tip and an aggressive distal end thread form is then driven into the subchondral bone in relation to a reference axis that is approximately central to the defect. The fixation device also serves to define a tangent point to the surrounding articular surface. The screw is driven by a socket type driver that engages a hex-shaped proximal extension. A further cylindrical proximal extension of the screw (or other mating feature, e.g., a recess in the screw) that eventually serves as a fixation element for the surface prosthetic is at this time concealed with a cover (or other mating feature corresponding to the mating feature of the screw, e.g., a plug for mating with a screw having a recess as its mating feature) having a radiused proximal end. One or more milled slots run the length of the uniform diameter portion of the screw.
Under arthroscopic view, the screw depth is adjusted so that the radiused cover surface is positioned tangent to the radius that defines the existing articular surface. At this time, the guide pin is removed and the knee is articulated. The depth positioning of the radiused cover establishes an origin or reference point for all future measuring, cutting, and prosthetic machining operations. Arthroscopic examination is carried out to confirm positioning.
A measuring tool is inserted on the reference axis. A central element of the measuring tool is a static post that establishes the axial location of origin. By rotating the outer arm or outrigger of the measuring tool relative to the static post while also maintaining contact with the articular surface, an axial displacement or Z dimension can be established relative to the origin for any point along the known radial sweep of the outrigger to determine the final geometry of the prosthetic surface which fits within the defect. These Z dimensions can be recorded in real time with conventional dial gauge indicators, or with digital recording devices, or by using marking techniques. Although numerous points may be taken, ideally a minimum number of points are taken to accurately define the target articular surface.
Locating surfaces or features created on the screw, (or alternatively, on the radius cover, as described in alternative embodiments herein), correlate to some surface or feature on the measuring tool and allow the measurement of the rotational position of the points about the axis with respect to the locating surfaces. Data recorded during the mapping procedure can then be entered into parametric engineering design software or similar algorithm to define a three dimensional surface matched to the bearing surface geometry to be implanted and reproduce the anatomic contours mapped.
An alternative measuring device for obtaining the articular surface dimension includes an outer marking element and an inner recording element. The marking element includes a sharp indenting mechanism which when pressed by the surgeon creates a depression or mark in the relatively soft surface of the recording element, which deforms at these marked points so that they can be utilized as patient data. The recording element also includes a surface that corresponds to the surface of the proximal extension of the fixation screw. During the mapping procedure, data points are established of the rotational position of the mapped articular surface relative to the screw. These data points are translated to the implant geometry so that the accurate rotational location of the implant relative to the screw is maintained.
In order to secure the implant to the fixation screw, a precision taper (or other component of a mating feature) is machined into a protrusion (or other component of a mating feature) on the back of the device. The implant may be constructed of cobalt chromium, or other materials. The implant may also include a slight outward taper or protrusion along the diametrical surface to enhance load bearing or load transfer properties of the implant to surrounding bone. Additionally, a series of radial cuts may create surfaces that increase resistance of the implant to rotational forces. These features may be located around the outer diameter of the implant.
In another aspect, the invention includes a compass instrument for measurement and surface preparation of the implant target site subsequent sizing of the implant. This compass instrument is configured so that it can be delivered to the site arthroscopically, and when coupled to the axis defined by the guide pin it can be used for measuring and cutting operations.
In another embodiment, the compass instrument consists of a handle, a cannulated shaft that extends through the handle, and a cannulated distal offset arm configured to serve as a linearly adjustable mounting tool for a series of cutting blades, boring blades, or measuring probes.
With the guide pin advanced through the instrument shaft, when fitted with a blade, a fixed length from the rotational or reference axis to the cutting blade's cutting surface is established. This defines the radius that is effected as the instrument is rotated around the guide pin, and corresponds to the overall diameter of the implant. This sharp cutting blade is used to circumscribe and cleanly cut the surrounding articular cartilage.
In another aspect, the invention features a bone cutting or scoring instrument whereby the bone-cutting instrument is positioned on the guide pin reference axis and is used to prepare the target site to match in configuration and dimension the contacting surface of the implant. The matching fit between the bone surfaces of the prepared target site and the bone contacting surfaces of the implant can advantageously ensure long term clinical results with the implant, as poor quality of fit between bone surfaces and bone contacting surfaces of traditional orthopedic prosthetic devices has been noted to contribute to early clinical failures.
Following fabrication of the implant, a second surgical procedure is performed. The radiused cover is removed exposing a precision taper (or, alternatively, the cover may be removed during the first procedure). A pin with a distally mounted element is placed through the central lumen of the fixation screw so that the distally mounted element is secured into the screw. This element carries one or more suture strands that now trail from the fixation screw. The sutures are then threaded through the implant and a knot or bead may be created proximal to the implant. By continuing to manipulate and tension the suture strands, the implant can be brought coaxial to the fixation screw. Once coaxial, the implant is aligned via engagement of the keyed elements and driven into place with a plastic driving rod and mallet. Finally, through the guide aperture on the surface of the implant, bone cement may be injected to enhance the contact surface between the implant and the subchondral bone.
In another aspect, the invention further features a driver whereby the implant is connected to the driver via a holder and a tether element, such as a suture or wire. The implant and the driver are then inserted arthroscopically. Tension is then applied to the tether element so that the implant is drawn back and seated on the driver. The implant can then be controllably delivered to the prepared target site. The seat portion of the driver may comprise a material that may be impacted to seat the implant without damaging the implant surface.
As an overview,
As illustrated in
One or more milled slots 13 run the length of the uniform diameter portion of the screw 10. Slots 13 ensure that as healing or tissue in-growth begins, migrational or rotational movement of the screw is inhibited. The screw 10 is configured to be driven by a female or socket type driver 2 as shown in
Alternatively, as shown in
Also, while many of the components described herein are cannulated, having guide apertures, through holes, and/or central lumina along their length, for disposing such components about a guide rod for proper location of the components with respect to the articular surface, it should be recognized that a suture 313 or other flexible element, or other guide feature may be used in place of a guide rod, or a guide rod or wire may be eliminated altogether from one or more steps consistent with the invention described herein. As shown in
As shown in
In order to secure the implant 40 to the fixation screw 10, precision taper 44 is machined into or onto a protrusion 45 on the top surface 42 of the implant. The precision taper 44 is configured to engage the cylindrical proximal extension 14 of the screw 10, once the hex-shaped cover 30 has been removed therefrom. Taper 44 may be mated with extension 14 so that a friction fit is provided between these surfaces. The assembled fixation device is shown in
As shown in
By way of example,
A drill mechanism 306, as illustrated in
For surface preparation and accurate measurement of the implant site and the subsequent sizing of the implant, instrument 120 is provided. The compass instrument 120 may be configured to serve as a mounting tool for a number of functional blades or tips and when located about the axis 20A, via guide rod 20, may be used for measuring and cutting operations. In the embodiment shown in
Referring to
As illustrated in
In an alternative embodiment, as shown in
Turning now to
Turning to
For example, as shown in
Locating surfaces or features created on the radius cover 30, or along some length of the fixation screw 10, hex-shaped drive surface of the screw 14 or on the cylindrical proximal extension (or recess) of the screw 14, correlate to some surface or feature on the measuring tool 70 and allow the measurement of the rotational position of the four measured points 81 a, 81 b, 82 and 82 b, about the reference axis 20A with respect to said locating surfaces. This data becomes important in configuring the implant 40 with respect to the fixation screw 10 so that the proper orientation of said measured points to fabricated geometry is maintained. Of course, such measuring tool can be configured to measure any number of points at any interval desired.
While the measurements are illustrated in
Other embodiments of measuring and recording tools are possible. One such embodiment of a measuring and recording tool 210′ is shown in
As shown in
As shown in
Referring now to
Datum curves 86 and 87, representing the medial-lateral ("ML") and anterior-posterior ("AP") curves, are constructed by connecting the end points of the line elements 81 a and 81 b, and 82 a and 82 b and the point of origin 80, which is common to both curves. These two datum curves 86 and 87 can be used to construct the articular or bottom surface 41 of the prosthetic implant 40. By sweeping datum curve 87 along a path defined by datum curve 86, a three dimensional surface is now defined.
By constructing this series of geometric relationships in a known parametric engineering model, patient-specific geometry can be input as values and the model algorithm can be run to reproduce the anatomic contours mapped in the patients within only a few moments. As a process, this generic model is the starting point for all patient treatments. Sterile pins, screws, and measuring devices that are all non-patient-specific may be stocked in the hospital and ready to use whenever an appropriate defect is diagnosed. Patient-specific data may be transmitted from the surgeon to the fabricating facility via an interface to the Internet or other network. Data input into the interface may be read directly into the generic parametric model to produce a viewable and even mappable patient-specific parametric model within moments. Confirmation by the surgeon could initiate a work order for the production of the patient specific device. Existing technology allows the parametric model to generate toolpaths and programming, e.g., to a CAD/CAM system comprising appropriate hardware and/or software coupled to appropriate data-driven tools, to fabricate the implant.
Defining two additional datum curves 88 and 89, at offset distances from datum curves 86 and 87, is performed to define the top or non-bearing surface 42 of the implant 40. This top surface 42 should be closely matched to the bearing surface geometry to be implanted without having to remove an excessive quantity of bone from the chondral surface.
Referring to
For example, as shown in
As shown in
However, if a greater depth of implant is needed as a result of the defect appearance the offset curves 88 and 89 (as shown in
With reference now to
maxval= D6
if maxval < D11
maxval = D11
if maxval < D14
maxval = D14
D684 = maxval + .045
In the foregoing exemplary algorithm, a first data point D6 is initially assigned as the maximum value (maxval). If . . . then type statements are used to compare other data points (D11 and D14) to maxval. If other data points are greater than maxval, the algorithm reassigns maxval to the new larger data point. LLMT represents the height of the lower limit plane along the z-axis, and ULMT represents the height of the upper limit plane along the z-axis. D684 is a dimension that controls the ULMT plane, which is established in the model as the upper surface of the implant. ULMT is positioned as maxval plus an additional arbitrary and/or fixed material offset (0.045 in this case).
Referring to
In an alternative embodiment, as shown in
As shown in
Additional data can be taken at the time of the initial procedure, e.g., for fabricating a non-circular implant. Additional data curves can also be defined by measuring the offsets from the reference axis 20A and determining diameters at these offsets. The final implant geometry, although measured using circular techniques, need not be circular.
Referring to
Turning to
If necessary, the arthroscopic wound 200 is expanded slightly in either a vertical or horizontal direction, so that the implant 40 may be passed through. A polymeric sleeve (not shown) positioned over the implant may prove helpful in passing the implant through the incision. As shown in
As shown in
Referring to
Finally, as shown in
Alternatively, guide aperture 46 in the implant 40 may be altogether eliminated by using an alternative implant delivery system, as shown in
As shown in
Further composite implant embodiments are illustrated in
Other materials from which an implant consistent with the invention may be constructed, in whole or in part, include ceramic, e.g. aluminum oxide or zirconium oxide; metal and metal alloys, e.g. Co—Cr—W—Ni, Co—Cr—M, CoCr alloys, CoCr Molybdenum alloys, Cr—Ni—Mn alloys, powder metal alloys, 316L stainless steel, Ti 6Δ1-4V ELI; polymers, e.g., polyurethane, polyethylene (wear resistant and cross-linked), thermoplastic elastomers; biomaterials, e.g. polycaprolactone; and diffusion hardened materials, e.g. Ti-13-13, Zirconium and Niobium. Coatings used may include, e.g., porous coating systems on bone-contacting surfaces, hydrophilic coatings on load-bearing surfaces, hydroxyapatite coatings on bone-contacting surfaces, and tri-calcium phosphate on bone-contacting surfaces. Additionally, components of the invention may be molded or cast, hand-fabricated, or machined.
Alternatively, measurement methods may be utilized whereby radius measurements are taken with respect to an axis AA corresponding to an axis about the point of origin in the implant to be used (as shown in
It is noted that, although the invention is herein described as utilizing a single reference axis, multiple reference axes may be used for measuring, mapping, or cutting a single defect or an articular surface having multiple defects, as well as for fabricating a single implant, or multiple implants for a single articular surface, consistent with the invention. In other embodiments, methods for mapping the defect and/or articular surface other than those described hereinabove are possible, e.g., MRI or CT scanning.
It is further noted that, although the invention is described herein as utilizing the specific geometry of a patient's articular surface to fabricate an implant for that patient, it is contemplated that data from a plurality of patients may be analyzed statistically and utilized in fabricating and/or manufacturing (e.g. in large quantities) one or more universal, generic, or standard supply item type implants for medical practitioners to use in a procedure consistent with the invention. For such implants, as well as for patient-specific implants as described herein, pre- or post-implantation trimming may be required to correct for minor variations that may occur as between the implant and the subchondral bone (or other articular surface).
It should be understood that, although the various tools described hereinabove, e.g., for measuring, cutting, and seating, are described as separate devices, a single handle, shaft and/or instrument may be configured to serve as a universal mounting tool for a series of devices for performing various functions consistent with the invention.
Those skilled in the art will recognize that the present invention is subject to other modifications and/or alterations, all of which are deemed within the scope of the present invention, as defined in the hereinafter appended claims.
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|U.S. Classification
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|International Classification
|Cooperative Classification
|European Classification
|Apr 21, 2009
Owner name: ARTHROSURFACE INCORPORATED, MASSACHUSETTS
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:TALLARIDA, STEVEN J.;EK, STEVEN W.;REEL/FRAME:022574/0488
Effective date: 20030225
|Jan 12, 2010
|Certificate of correction
|Apr 22, 2013
|Fee payment
Year of fee payment: 4


text:
Alice Slater
Alice Slater is New York director of the Nuclear Age Peace Foundation and serves on the Coordinating Committee of Abolition 2000.
Articles by this author
Friday, September 25, 2015 - 1:00pm
Let Us Again Be Inspired to Ban Nuclear Weapons
The stirring condemnation of nuclear weapons by Pope Francis today at the United Nations and his call for their prohibition and complete elimination in compliance with promises made in the Non-Proliferation Treaty (NPT), signed by the U.S. in 1970, 45 years ago, should give new momentum to the...
Read more
Monday, December 15, 2014 - 7:00am
Time to Ban the Bomb
Global Momentum is building for a treaty to ban nuclear weapons. While the world has banned chemical and biological weapons, there is no explicit legal prohibition of nuclear weapons, although the International Court of Justice ruled unanimously that there is an obligation to bring to a conclusion...
Read more
Tuesday, September 2, 2014 - 6:45am
With Nukes on All Sides, We Demand a Peaceful Settlement in Ukraine
It is ironic that at this moment in history when so many people and nations around the world are acknowledging the 100 th anniversary of our planet's hapless stumble into World War I, great powers and their allies are once again provoking new dangers where governments appear to be sleepwalking...
Read more
Monday, March 24, 2014 - 3:50pm
Time for a 21st Century US Foreign Policy
With 16,000 of the world's 17,000 nuclear bombs in the US and Russia, the US should certainly not be fanning the fires for a new cold war after the distressing events in Crimea and the Ukraine.
Read more
Sunday, January 19, 2014 - 12:22pm
US Going Backward on Efforts to Ban Weapons in Space
"The most important lesson one can acquire about US foreign policy is the understanding that our leaders do not mean well. They do not have any noble goals of democracy and freedom and all that jazz. They aim to dominate the world by any means necessary. And as long as an American believes that the intentions are noble and honorable, it's very difficult to penetrate that wall. That wall surrounds the thinking and blocks any attempt to make them realize the harm being done by US foreign policy."
Read more
Monday, August 26, 2013 - 6:54am
Time for a Missile Ban Treaty
This July, only one day after the US celebrated another anniversary of its Declaration of Independence from tyranny, it was reported that once more, a test of US anti-missile defenses against incoming long-range ballistic missiles, launched from Vandenberg Air Force Base in California had failed again.
Read more
Tuesday, August 28, 2012 - 10:32am
Iran Call for Nuclear Abolition by 2025 is Unreported by New York Times
The Non-Aligned Movement (NAM), formed in 1961 during the Cold War, is a group of 120 states and 17 observer states not formally aligned with or against any major power bloc. The NAM held its opening 2012 session yesterday under the new chairmanship of Iran, which succeeded Egypt as the Chair.
Read more
Tuesday, June 19, 2012 - 6:44am
The Folly of Mindless Science
In 2000, I traveled to India, invited to speak at the organizing meeting of the Indian Coalition for Nuclear and Disarmament and Peace. About 600 organizations, including some 80 from Pakistan gathered in New Delhi to strategize for nuclear disarmament. India had quietly acquired the bomb and performed one nuclear test at Pokhran in 1974 but it was in 1998 that all hell broke out, with India exploding five underground tests, swiftly followed by six in Pakistan.
Read more
Tuesday, January 10, 2012 - 2:55pm
Tone Deaf US Foreign Policy Announcements Create New Provocations in Asia
On UN Day, at a panel on Nuclear Disarmament, Secretary General Ban-ki Moon spoke about his 2008 five point proposal for nuclear disarmament, including the requirement for negotiations to ban the bomb. It was dismaying when the next speaker, a retired US Air Force General, Michal Mosley, breezily assured the audience and his fellow panelists that it certainly was now possible to rid the world of nuclear weapons, since atomic bomb technology is thoroughly out of date.
Read more
Friday, September 2, 2011 - 8:11am
Time to Disband NATO: A Rogue Alliance
When the Cold War ended, many believed there would be a peace dividend, nuclear disarmament, and dismantling of the war machine with industrial conversion to peaceful technology. Instead, we've witnessed the aggressive expansion of NATO, to include the former Soviet Republics, right up to the Russian border, which should be a wake-up call to many living in the American Empire. Many people still labor under the apparently false impression that the US is exemplary in holding up the rule of law, the sanctity of the United Nations, and human rights.
Read more

subset: commoncrawl


text:
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- Anatomic, Foreign Body, Structural Disorders
- Torsion testis/Spermatic cord
- Synonyms
- Spermatic Cord Torsion, Spermatic Cord Torsions, TESTICLE TORSION, Testicular torsion, Testicular Torsions, Testis torsion, Torsion of spermatic cord, Torsion of spermatic cord (disorder), Torsion of testicle, TORSION OF TESTICULAR CORD, Torsion of Testis, Torsion of testis (disorder), Torsion of testis unspecified, Torsion of testis unspecified (disorder), Torsion Spermatic Cord, torsion testes, Torsion Testicular, TORSION TESTIS, Torsions Spermatic Cord, Torsions Testicular
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text:
Full Paper
Development of Improved PPARβ/δ Inhibitors
Version of Record online: 24 OCT 2011
DOI: 10.1002/cmdc.201100408
Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim
Volume 7, Issue 1, pages 159–170, January 2, 2012
Additional Information
How to Cite
Toth, P. M., Naruhn, S., Pape, V. F. S., Dörr, S. M. A., Klebe, G., Müller, R. and Diederich, W. E. (2012), Development of Improved PPARβ/δ Inhibitors. ChemMedChem, 7: 159–170. doi: 10.1002/cmdc.201100408
Publication History
- Issue online: 27 DEC 2011
- Version of Record online: 24 OCT 2011
- Manuscript Received: 25 AUG 2011
Funded by
- Deutsche Forschungsgemeinschaft. Grant Number: SFBTR17/A3
- LOEWE-Schwerpunkt "Tumor and Inflammation" of the state of Hesse (Germany)
- inhibitors;
- nuclear receptors;
- PPARβ/δ;
- structure–activity relationships
GSK0660 (1) is the first peroxisome proliferator-activated receptor (PPAR) β/δ-selective inhibitory ligand described in the literature. Based on its structure, we designed and synthesized a series of modified compounds to establish preliminary structure–activity relationships. Most beneficial for increased binding affinity towards the PPARβ/δ ligand binding domain was the replacement of the 4′-aminophenyl substituent by medium-length n-alkyl chains, such as n-butyl or iso-pentyl. These compounds show activity down to the one-digit nanomolar range, thus possessing up to a tenfold higher binding affinity compared with GSK0660. Additionally, the subtype-specific inhibition of PPARβ/δ was confirmed in a cell-based assay making these compounds invaluable tools for the further exploration of the functions of PPARβ/δ.


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For some reason I can't add new content. I can edit old content but when I cut and paste new content the "word count" at the botton just says "0" (even though there are 750 words on the page)and when I hit "publish" nothing publishes. HELP!
(Man I wish they had a phone so I could call customer service.)


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He is charging me $900 for labor, $850 in parts and $500 to take the more to a machine shop for additional machine work. This seems like too much money. Just a few months ago, he did the top part of the motor, so now, he is just doing the bottom part of the motor. Please help
by mgb1977 in Port Charlotte, FL on July 16, 2011


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Vote below for this week's Project of the Week.
The winning filmmaker will receive a digital distribution consultation from SnagFilms and will become a candidate for Project of the Month. That winner will be awarded with a creative consultation from the fine folks at the Tribeca Film Institute!
The four projects up for the prize: "Cinéma, de notre temps: James Benning and Richard Linklater," "Finders Keepers," "Councilwoman Castillo" and "Above All Else."
Voting will end on Monday May 27, at 11AM Eastern.
Note: Votes are confirmed by email. After voting, please look for an email from Poll Daddy and confirm your vote. Indiewire nor PollDaddy use your email address after the confirmation, but if you do want to sign up for our newsletter, why DON'T you mosey on over here and do so!


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My DH and I are going to DL July 10 - 14th. Will anyone be down there around the same time? This is my 5th trip to DL & Me & DH's 2nd trip. We just can't get enough of Disney (well me I guess).
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Snow boots
About us
Founded in 2006 with the mission to make high quality footwear, Burnetie is a shoe company that promises you comfortable, stylish and lightweight shoes that fit your lifestyle. We support your footwear choices with un-compromised quality and value. We believe in making a product that benefits our customers, our employees, and the world community by striving for a zero waste manufacturing process. Our shoes and our programs help you to b-Comfortable | b-Yourself | b-Green | b-Burnetie
At Burnetie, we uphold a strong commitment to b-Green. Our factories have award winning corporate responsibility programs. We are focusing our efforts on reducing and re-using rubber waste in a way that is both innovative and groundbreaking. As a result, our outsoles are made from 30% to 50% de-vulcanized rubber. We also consider packaging a big part of the solution to our b-Green effort. We continue to improve and to find new and unique programs that reduce packaging.
Burnetie: Unbelievably comfortable and fabulous shoes, providing value with a strong commitment to the environment in every step of the way.
b-Comfortable | b-Yourself | b-Green| b-Burnetie


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Product Details
Style: WK0016
Kamik knows men need waterproof apres ski boots to protect their feet from wet, cold weather in the winter but still want to look like they gave more thought to style than the guy next door who pulled plastic grocery bags over his shoes to shovel the driveway. That's why they designed the Fernie Winter Boots with waterproof suede and nylon uppers and a flexible rubber shell outsole to repel moisture, then packed super thin insulation inside to give you warmth without the bulk. The front zipper adds extra style and makes slipping into these boots as easy as your neighbor's plastic bags.
- Waterproof suede and nylon uppers are seam sealed to keep water from entering boots
- Waterproof and flexible rubber shell means no friction blisters caused by wet feet
- 200B Thinsulate™ ultra insulation delivers warmth without bulk
- Moisture wicking lining keeps feet dry
- Front zipper for easy on and off
- Padded collar and gusset tongue for extra comfort
- Grippy SNOWGRIP outsole boosts traction on slippery surfaces
- Height: 8.5 Inches
- Weight Per Pair: 3.87 pounds
Questions and Answers
ASK A QUESTION Got questions about this product? Ask them here. Got questions about anything else? Please see our FAQ.
1 Answers | Answer Question
Question by CHOPPER on 1/20/2011 - 1:28 am
"These do run pretty true to size. However, if you are a 1/2 size then I would size up."
Answer by Ashley (Peter Glenn Staff) on 2/4/2011 - 1:29 pm
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Government innovation is not an oxymoron. The challenge and opportunity for making this transformation is for public service managers and staff alike to develop a common understanding and practice of what innovation looks like and thereby overcome the natural skepticism that asks "is innovation possible in a risk averse environment?". BridgePoint Effect has extensive expertise in making innovation achievable in government organizations. We can help you learn how make innovation structural, language-based, actionable and measurable and in the process we can help you reach new levels of performance.
John Abbott
Miguel Angel Ruiz
Peter Drucker
Brian Greene
Bridges, 2001 p.1
James Allen


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A fast-moving storm spread snow across the U.S. Northeast on Tuesday, tying up air traffic and boosting spot energy prices as electricity demand surged.
New York may receive 2 to 4 inches before the storm ends late today, the National Weather Service said. Boston may get 8 inches, said Alan Dunham, a weather service meteorologist in Taunton, Massachusetts.
As of early afternoon in New York (about 10 a.m. Pacific time), 184 flights at Newark Liberty International Airport in New Jersey and 84 at New York's LaGuardia had been canceled, according to FlightAware, a Houston-based airline tracking service. Newark in particular was being affected by ice and snow.


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Compassionate Ministries
Nazarene Compassionate Ministries seeks to live and act compassionately in the world following Christ's own life and ministry. We seek to be incarnations of the same gospel that Christ lived and preached and to be witnesses to the same love and compassion God has for our world. In the United States and Canada, NCM works closely with Compassionate Ministry Centers (CMCs) to bring compassion and healing to communities that need the love and presence of Christ.
YIM is a summer missioning opportunity primarily for the 89% of Nazarene young adults at State Colleges & Universities. Click here to see the YIM promo video.
Follow us on Twitter: @NazareneYIM
Be inspired, equipped, challenged to approach the issues facing our world at the Compassion & Justice Conference, February 16-18 — hosted by the J.V. Morsch Center for Social Justice at Trevecca and Nazarene Compassionate Ministries USA/Canada. To visit the website, click here.
There are over 180 Nazarene Compassionate Ministry Centers in the United States and Canada. You can access our CMC database here to find one in your area. If you would like to find volunteering opportunities at CMCs or in your area, you can visit NazServe to see what volunteer opportunities are available to you.
Nazarene Compassionate Ministries USA/Canada is also involved in disaster response. When a natural disaster strikes, local Nazarene churches respond with assistance and resources for their community. For more information on Nazarene Disaster Response, visit our NDR page.
Creation Care & Discipleship
Reaching Out Through Gardening
Creation Care Taking Root
Building the Garden


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Based in Toronto we provide market research and consumer insights to companies across Canada and around the world. With over 90% of our clients coming back forMore
$5 mil. - $10 mil.in Revenue
20 - 50EmployeesContact people at this company
789 Don Mills Road Suite 614TorontoOntarioM3C 1T5Canadaview map
(416) 467-7101(416) 467-7648Fax
ProPub_Iteration_NT.411[05] SEIDXWK-23


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This item was perfect for my theme
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This product was perfect for my theme. Loved it.
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This jungle critters candle is sure to be wildly popular with your birthday party guests! The perfect complement to a jungle or safari theme, this candle features four cute jungle critters including a lion, a zebra, an elephant, and a monkey. The round base contains a clear tea light holder, and comes with a white tea light candle. Leave the candle in its gift packaging for a ready-to-give party favor, or take it out and use it as a fun accent to your jungle or safari theme!
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Coconut Candles
Beautiful and exotic, these scented coconut candles are lovely guest favors for romantic beach celebrations. Place one candle at each guest's place setting or display them in a large basket near the entrance of the banquet room. View Product
Jungle Animal Cookies
Take a walk on the wild side with these adorable (and delicious!) jungle animal cookies. Each set includes four hand-decorated jungle animal cookies: elephant, lion, zebra, and giraffe. View Product
Personalized Natural Cotton Birthday Favor Bag
These personalized natural cotton birthday favor bags are a must. Each soft bag is made of eco-friendly unbleached cotton, evoking a simple, rustic charm. View Product
Mini Cupcake Candles
When it comes to planning the perfect party, these irresistible cupcake candle favors are the proverbial and literal cherry on top! Piled high with faux frosting and a red cherry, these candle favors add calorie-free flavor to your birthday ... View Product
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When I installed Lucid I installed the operating files in a 10Gig partition with the idea that it would be easier to do a clean update. I thought the partition size would be large enough for the root. I have blindly installed all files that the update manager suggested. Now the update manager is telling me that I have less than 0.4 Gig of free space. I have remove every program that I haven't opened, games, etc., but this has had little impact on the free space in the root. Is 10 Gig large enough for the root partition or is there program which can clean programs or features that I haven't used the root?
Thanks for your anticipated assistance.


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I will just be driving my truck, and all of a sudden the gauges, radio, and lights all just kind of turn off and back on in a split second. It happens when I change gears going up hill or getting onto the gas just a little bit. What could be causing this? The truck doesn't shut off, just the gauges, radio, and lights
by Visitor in Mooresburg, TN on May 26, 2011


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Come mothers and fathers
Throughout the land
And don't criticize
What you can't understand
Your sons and your daughters
Are beyond your command
Your old road is
Rapidly agin'
Please get out of the new one
If you can't lend your hand
For the times they are a-changin'
- Bob Dylan
The times were rapidly changing when Bob Dylan authored those lyrics 50 years ago. The leaders of the civil rights movement were demanding an end to the long accepted injustice that relegated people to second-class citizenship because of the tint of their skin, risking and sometimes giving their lives for the cause.
In the 1960s the younger generation would challenge many of the precepts of their parents and grandparents - that America's wars were to be supported right or wrong, that women had to keep their place, that material acquisitions in a suburban home were the measure of success.
In June 1969, as that tumultuous decade ended, a series of violent demonstrations against police raids on gay bars in Greenwich Village, New York City - the Stonewall Riots - marked one of the first times homosexuals outwardly challenged a legal system that sanctioned their persecution.
The times, of course, are always changing, and not always for the better. The counter-culture movement of the 1960s embraced drug use, and ultimately abuse, ruining many lives. Criticism of a war led to a hurtful and misguided condemnation of those obligated to fight it by law or sense of duty. For most young people, the rejection of materialism proved fleeting and not terribly practical.
But the aspiration toward a society that treats people equally and with equal opportunity is a change that has endured. A photo published Tuesday by The Day of a routine though wonderful event long part of the culture of southeastern Connecticut - the return of a submarine after a long tour of duty - was a reminder that the times are again changing and in ways some "can't understand."
The photo, also the subject of the opening of the news story, was familiar - a sailor on bended knee surprising his beloved with a dockside proposal upon returning ashore. But there was a difference; the sailor and the object of his ardor were both men.
It was a scene once unimaginable, but then, so too was the prospect of racially integrated military units. Two years ago Congress ended the duplicitous "don't ask, don't tell" policy that allowed homosexuals to serve their nation and risk their lives, but only if they kept a major part of their identity secret.
This is the far better way.
The photo - provided by a U.S. Navy photographer - jolted some of our readers. Using the reader comments tool on theday.com, a reader, identified as "Chuck," commented on an earlier version of the story, one with no reference to the photo of the proposal. It instead carried a more traditional illustration of a baby running into a dad's arms.
"I just wish every kid from middle school through the 12 grade could see what the benefits are for bearing down in school and keeping their noses clean. You young men are the best there is. Welcome home and a job well done," he wrote.
Chuck was aghast when his comments remained as the story was updated, with the photo of a man proposing to a man.
"It went from a good story about a ship returning to homeport from deployment to another politically motivated Gay agenda story," wrote Chuck, demanding an apology from theday.com for having kept his comments up with the revised coverage.
This news organization's only agenda is to reflect a changing society, one that still welcomes home young men who are the best there is and acknowledges their job well done, but no longer demands they hide who they are.
Expect more changes, Chuck. The Navy is moving ahead with its plan to integrate enlisted women into the submarine service. Female officers are reporting for duty aboard the large, ballistic-missile submarines. By 2015 the Navy expects to assign women officers to attack submarines, the kind stationed at the Groton base.
Anticipate more welcome-home photos not seen before, reflecting change for the better.
UPDATED: Rapper arrested in T.I. concert shooting that killed 1
Aldridge, Woods deliver Fitch to ECC tournament softball title in the seventh
New London man charged with negligent homicide after fatal accident in Bozrah
Waterford nursing home honors vets with photo wall, ceremony
Hospice House project to fill an unmet need in eastern Connecticut
The countess of Monte Cristo: Sally Pavetti leaves a vital O'Neill-based legacy
Fentanyl-related overdose deaths projected to increase significantly
DOT Commissioner: I-95 widening, improvements should be on 'front burner'


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"Twilight is the kingdom where nobody dies." - Edna St. Vincent Millay, 1937
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About hanahula:
My ThisNext manifesto: Good design. New colors. Clean solutions. A sense of humor. I look for all of these qualities in both the people and the products I choose to embrace. And I am always looking. In magazines, on the web, in stores, on other people or in their homes. I ask lots of questions when I find something I like. Where was it made ? How was it made ? Does it last ? Will it make me or someone else giggle ? Will it contribute to a good human or environmental cause ? Is is child friendly ? Will I want to read it again and again and again ? And, thanks to a very eclectic undergraduate education, my aesthetic and intellectual interests are all over the globe. I love yoga and running. High heels and Bean boots. Jeans and jewelry. Email and snail mail. The super cute (i.e. Hello Kitty !) and the super chic (i.e. Chanel). Although I am a Mac user, I still drool over some of the options available within the PC universe. Although I am a vegetarian, I appreciate the value of perfectly grilled steak. Although I am a girl, I know the difference between a five-yard penalty and a personal foul. And, since I am a mother, I always like to consider the world from a child's fresh perspective.
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All quotes tagged Annoying
(109 quotes found)
"I stand at the register and buy lotto tickets. As if that doesn't take long enough, I decide to take my time and ask the clerk about what all scratch off games they have while the line behind me gets longer and more impatient. After I waste my money on quite a few scratch offs, I stay at the counter and start scratching like as if I'm not in the way of the other customers..."
"They come right over the house, but it's not very often and it's annoying only for the several seconds that they are over the house."
"It's not annoying that people don't know. What's annoying is when people don't know but they think they know better."
"He's got just a little muscle spasm in the back of his left shoulder. It was annoying him hitting and bothering him throwing. It will be strictly day-by-day and hope optimistically for tomorrow."
"I love being married. It's so great to find that one special person you want to annoy for the rest of your life."


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GAFFNEY (AP) — A 28-year-old mother has been sentenced to 20 years in prison following a crash that killed her 8-year-old daughter.
Prosecutors said Samantha Rhinehart pleaded guilty Thursday to reckless homicide.
Investigators say Rhinehart was driving 62 mph in a 45 mph zone on Jan. 11 when she lost control of her pickup and it ran down an embankment and crashed into a tree.
Authorities say there were seven passengers in the truck and Anna Rhinehart was sitting in someone's lap in the front seat. She died from head injuries.
Samantha Rhinehart was originally charged with felony driving under the influence with a death. But prosecutors say those charges were changed when lab tests determined there was methamphetamine in her urine, but not her blood, indicating the drug didn't impair her driving.


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Newly single Ciara indirectly dishes on her break-up with Future on "I Bet."
Yeah, this is Ciara's song, but considering how rare it is for Dre to release new music, this excites us in some capacity. We'll take it. LISTEN: Ciara – "Ride (Remix)" (feat. Bei Maejor & Andre 3000)
Ciara returns with two new videos – the first, her new duet with Ludacris, which you can expect to hear on urban radio all day long. And the second….ah, the second….. Ciara takes it back to the streets, yo. Or better, a backlot with lots of dirt and shrubbery. Here, she shows us just how [cont.]
Here is the first official single from Ciara off her upcoming new album. This track features Ludacris, and is the CDQ version without the drops. LISTEN: Ciara + Ludacris – "Ride (CDQ)"
Been giving this track a few spins in the club over the last month or two. Ciara's looking very fly right here – Men At Work, eat your hearts out. – DJ Pizzo
- Raekwon Sets A Release Date For "F.I.L.A." Album
- BUSH: A Snoop Odyssey Produced By Pharrell Williams [Preview]
- Drake – "If You're Reading This It's Too Late" Surprise Album on iTunes Now
- Action Bronson "Mr. Wonderful" Cover Art and Tracklist
- Juicy J "Blue Dream & Lean 2″ Mixtape Cover Art & Release Date Revealed
- MF Grimm "MF Love Songs" Cover Art + Tracklist
- Lord Hakim – "Brass Knucklez" (feat. Vast Aire & Phizz Ed)
- IAMSU! – "Hella Good" (feat. Tyga)
- DJ Kay Slay – "I Declare War" (feat. Styles P, Sheek Louch, Vado, Raekwon, & Rell)
- Maverick Sabre – "We Don't Wanna Be" (feat. Joey Bada$$)
- Cannibal Ox – "Blade: Art of Ox" (feat. Artifacts & U-God; prod. Black Milk)
- Asher Roth – "Blow Your Head" (prod. Nottz)
- It's Time To Say Goodbye...
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- Fat Trel - "In My Bag" (feat. Wale)
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- Sole Vs. El-P: Part One - Sole
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Commented on by Atom


text: Chances are you heard about the Gmail outage that took place on Friday. But there is something else that happened aside from it. A glitch in Google search is causing David S. Peck, a Hotmail user, to receive thousands of emails from people he does not even know. During the outage, people were frantically searching "Gmail" and when they clicked on the first sublink, they were sent to a window that had Peck's email address in the "To" input box. Of course, people decided to press Send. Read more


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News > Top 10 Cheapest Beachfront Homes On Oahu December 2013
Overall, beach properties on Oahu held up fairly well since the residential real estate bubble burst in the United States in 2008, but that's not to say there aren't a few great deals out there. So, if you're looking to own a piece of beachfront paradise, here's your holiday wish list... the top 10 cheapest beachfront homes for sale on Oahu.
54-065 Kamehameha Highway, Hauula, HI 96717
Opportunity Knocks! This is the lowest priced beachfront property on Oahu! This cute one bedroom, one bath beach cottage is awaiting creativity and a little TLC to bring back its shine. It's a perfect weekend or get-a-way home in beautiful Hau'ula with space available to launch a small boat on-site. The property is located on a white sand beach and adjacent to Beach Park. Property listed by Arquette Properties, Inc.
53-859 Kamehameha Highway, Hauula, HI 96717
This is a completely remodeled beachfront three bedroom, three-bath bungalow located in the scenic seaside town of Hauula. A large covered lanai fronts the entire oceanfront width of home to enjoy stunning views of the turquoise Pacific, and glorious sunrises and moonrises. Property listed by List Sotheby's Int'l Realty.
91-633F Pohakupuna Road, Ewa Beach, HI 96706
Very rare oceanfront property in Ewa Beach with 13,000 SQ FT of R-5 zoned land. One house already sits on property and the land may have development potential. Use your imagination to create more living space or another unit. Private location off the main road. Property listed by Locations LLC, Diamond Head.
53-797 Kamehameha Highway, Hauula, HI 96717
This unique property is two separate oceanfront cottages at the water's edge comprised of a studio and a one bedroom. This well maintained property is virtually impossible to duplicate. Live/vacation in one and rent the other. Owner can help finance with considerable down. Property listed by Topic Realty Inc.
84-179 Makau Street, Waianae, HI 96792
VIEWS x 3. This gorgeous 2-story, custom-built, oceanfront luxury house includes a legal Ohana suite downstairs. Entertain in the open gourmet kitchen overlooking the landscaped yard and ocean. Flowing floor plan, hardwood and marble floors, spacious master suite with ocean view, and lanai on one side of living room make this a beautiful Oceanside retreat. Property listed by Nedra Chung Realty, LLC.
68-615 Farrington Highway8A/B, Waialua, HI 96791
Historical kama'aina villa in the North Shore country, this beautiful gated gem is located on approx. six lush garden acres in beautiful Mokuleia. This is Ideal resort living: steps away from turtles on the beach, tennis courts, and a salt-water pool. Famous polo fields and horse boarding across the street, close to Mokuleia Surf Beach Park and near parachuting, skydiving, parasailing, a must see for outdoor lovers! Property listed by Caron B Realty.
55-071 Naupaka Street, Laie, HI 96762
Spectacular two bedroom and two-bath oceanfront home (flood zone "X", not flood via FEMA map) with three decks overlooking the ocean in a regular lot, not a flag lot. New spa nicely located between decks. Enjoy the sounds and views of being oceanfront. Property also has attached storage room, which can be used as a third bedroom. Lots of potential! Property listed by Creative Properties Realty, Inc.
45-003 Bayside Place, Kaneohe, HI 96744
Single level 4 bedroom 3 bathroom, waterfront home on beautiful Kaneohe Bay. Custom interior and exterior stone work, tropical landscaping throughtout property and 74 feet of water frontage! Currently used as two separate livings spaces, but easy to combine. Great for boat owners and water enthusiasts. Easy water access to yatch club, coconut island, sandbar, reef diving, surfing, fishing and sailing!
55-557 Kamehameha Highway, Laie, HI 96762
BEACHFRONT… Enjoy the spectacular views of Temple Beach from living areas, kitchen and both upstairs bedrooms. Relax in your beachfront home enjoying the ocean views from the huge open lanai, take a walk on the sandy beach or swim in the warm turquoise ocean. Furnished and ready to move in with an outdoor shower too. Property listed by Century 21 Lewis Real Estate.
Rare sandy beachfront feels like private beach in Makaha! This gorgeous home is completely remodeled with flexible layout (in-law suite), stone floors, modern kitchen and contemporary bathrooms. Miles of ocean views from all rooms and a giant second story deck. Lovely landscaping, secure electric gate, and high stone walls, this is a great income property, weekend getaway for your large family/friends, or the perfect piece of paradise to call your own. Property listed by Kfg Properties, Inc.
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Main Menu
Shadow Lawn Stage is the professional Equity theater of Monmouth University, whose goal is to present the best of past and present plays and musicals for the Jersey Shore. As a professional theater on a university campus—Actors' Equity Association is the official union for stage actors in the United States—Shadow Lawn gives students a unique opportunity to work side-by-side with Equity actors, learn the details of professional production (both backstage and onstage), and earn points toward Equity membership.
All Shadow Lawn Stage productions take place in the beautifully renovated Lauren K. Woods Theatre.
Buy Tickets Online
Wednesdays through Saturdays, July 8 - July 25 at 8 p.m. with matinees on Fridays at 3 p.m. | Lauren K. Woods Theatre
A frustrated adolescent magically becomes an adult, discovering life is not simply child's play.
The classic 1987 motion picture fantasy bursts onto the stage in the unforgettable theatrical experience, Big The Musical. Featuring a witty, moving, and insightful book by John Weidman (Assassins, Pacific Overtures, Road Show) and a dazzling, energetic, heartfelt, contemporary score by David Shire and Richard Maltby, Jr. (Baby, Closer Than Ever, Starting Here, Starting Now) Big is a perfect show for audiences of all ages!
Josh Baskin is sick of being an awkward kid. At a carnival, he makes a wish to the Zoltar machine to become "big". To his shock, his wish is granted. After an understandably awkward beginning, Josh is forced to do "adult" things like getting a job and a girlfriend. In the end he discovers there's much more to being an adult than he's bargained for, and learns we must all grow up at our own pace, in our own time.
Big, The Musical Is presented through special arrangement with Music Theatre International (MTI).
All authorized performance materials are also supplied by MTI.
421 West 54th Street, New York, NY 10019
Phone: 212-541-4684 | Fax: 212-397-4684


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From F-Con Software: DescriptionJoin the world's first contact networkMYWI is the worlds first contact details search engine where individuals , Government departments and companies can build complete contact profiles online.Phone NumbersEmail addressesWeb addressesApp download linksLocation mapsSocial network profilesInstant Messaging ID'sEvery entity is issued a unique Web Identity number which allows users to locate the profile page of that entity. Individuals have a 7 digit number, government departments have a 4 digit number and companies have a 5 digit number.Premium and memorable Wi numbers are available as an upgrade service.Content rating: Low Maturity
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Juvederm Q&A
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text:
- Published: New York : Amy Einhorn Books/G.P. Putnam's Sons, 2010.
- Year Published: 2010
- Description: 326 p.
- Language: English
- Format: Book
ISBN/Standard Number
- 9780399156199
- 0399156194
- Postmasters -- Fiction.
- World War, 1939-1945 -- Fiction. -- Massachusetts -- Franklin
- World War, 1939-1945 -- Fiction. -- Radio broadcasting and the war
- London (England) -- Fiction. -- History -- Bombardment, 1940-1941
- Historical fiction.
- FICTION / Literary
- FICTION / Historical
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- World War II Historical Fiction for Adults
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The postmistress
by Blake, Sarah, 1960-
There are currently 2 available
Where To Find It
Call number: Fiction
Available Copies: Downtown 2nd Floor
Additional Details
In London covering the Blitz with Edward R. Murrow, Frankie Bard meets a Cape Cod doctor in a shelter and promises that she'll deliver a letter for him when she finally returns to the United States. Filled with stunning parallels to today's world, "The Postmistress" is a sweeping novel about the loss of innocence of two extraordinary women--and of two countries torn apart by war.
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There are many dilemmas to talk about and question in this beautifully written novel.
Book discussion groups will talk about it for weeks.
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