text:
|Numéro de publication
|Type de publication
|Numéro de demande
|Date de publication
|14 nov. 2000
|Date de dépôt
|2 sept. 1997
|Date de priorité
|9 oct. 1991
|État de paiement des frais
|Autre référence de publication
|Numéro de publication
|Erik Andersen, Ernst Peter Strecker
|Cessionnaire d'origine
|Boston Scientific Corporation
|Exporter la citation
|BiBTeX, EndNote, RefMan
|Citations de brevets (37), Citations hors brevets (21), Référencé par (142), Classifications (22), Événements juridiques (5)
|Liens externes: USPTO, Cession USPTO, Espacenet
This application is a continuation of application Ser. No. 08/528,061, filed Sep. 14, 1995, now U.S. Pat. No. 5,662,713, which is a continuation of application Ser. No. 07/960,584, filed Oct. 13, 1992, now abandoned, which is a continuation-in-part of application Ser. No. 07/773,847, filed Oct. 9, 1991, now U.S. Pat. No. 5,234,457.
This invention relates to endoprosthetic stents that are placed within body lumens that exhibit physiologic motion such as peristaltic motion.
Medical stents are tubular endoprostheses placed within the body to perform a function such as maintaining open a body lumen, for example, a passageway occluded by a tumor. Typically, the stent is delivered inside the body by a catheter that supports the stent in a compacted form as it is transported to the desired site. Upon reaching the site, the stent is expanded so that it engages the walls of the lumen. The expansion mechanism may involve forcing the stent to expand radially outward, for example, by inflation of a balloon carried by the catheter, to inelastically deform the stent and fix it at a predetermined expanded position in contact with the lumen wall. The expansion balloon can then be deflated and the catheter removed.
In another technique, the stent is formed of a highly elastic material that will self-expand after being compacted. During introduction into the body, the stent is restrained in the compacted condition. When the stent has been delivered to the desired site for implantation, the restraint is removed, allowing the stent to self-expand by its own internal elastic restoring force.
Strictures of the esophagus often produce obstructive dysphagia resulting in debilitating malnutrition. To date, the theoretical advantages of placing a plastic stent to restore the patient's ability to swallow have been offset by technical difficulty of placement, morbidity and mortality associated with the procedure, and poor long-term prosthesis performance. In particular, previous stents have transmitted the force and deformation of peristaltic waves inappropriately, for instance causing the stent to creep toward the stomach, perforate the esophagus, or rupture the aorta.
In a first aspect, the invention features a method for providing reinforcement to the lumen of a peristaltic organ. The stent is formed by knitting a filament into interknit loops, the pattern of the loops selected such that from a relaxed state each row of loops may shift axially relative to and independently of the rows on either side. The local lengthening and shortening allowed by the shifting allows the stent to accommodate the peristalsis of the organ without migrating within the organ.
Preferred embodiments of the stent feature the following. The lumen treated is the esophagus. The elongation factor ε by which the stent can locally lengthen by shifting is related to the angle Θ at which the lumen can incline inward by the relationship: ε=1.0/cos Θ. The stent is knitted of metal wire to be self-expandable such that the stent expands outward against the body lumen wall by an elastic restoring force of the wire. The stent is knitted from nitinol wire having a diameter of about 0.15 mm. The stent, in its free state, has a point of constricted cross-section. The constriction may have a valve.
A stent according to the invention offers the following advantages. The stent exerts a constant, gentle radial force on the wall of the lumen that maintains lumen patency and actively resists compression, as by a tumor. The inherent flexibility of the knitted stent adapts to peristalsis, transmitting the peristaltic wave to the lumen, but without changing overall length or creeping. This reduces complications and promotes long-term stability, patency, and patient comfort. The force exerted by the stent against the lumen is sufficient to compress the capillaries of the organ so that growth into the lumen is retarded. The stent can be delivered via a low-profile delivery system which is smaller than a standard endoscope. The small diameter of the delivery system simplifies implantation by eliminating the need for pre-dilating the stricture, and allows placement even in patients with tortuous esophageal anatomy or strictures prone to perforation by plastic stents.
In a second aspect, the invention features a stent for providing reinforcement to a selected region of a selected body lumen. The stent comprises two resilient cylindrical mesh layers and a semi-permeable compliant membrane sandwiched between.
Preferred embodiments of the invention feature the following. The two mesh layers may be knit of a flexible filament, and the knit may be configured so that the stent can adapt to peristalsis of the body lumen. The membrane is composed of expanded polytetrafluoroethylene.
The invention or preferred embodiments thereof may feature the following advantages. The semi-permeable membrane prevents cell ingrowth of the stent. The force exerted by the stent against the lumen is sufficient to compress the capillaries of the organ so that growth into the lumen is retarded.
In a third aspect, the invention features a method of manufacturing a delivery system for a resilient tubular device so that the tubular device can be inserted into the body in a substantially reduced diameter. The method uses a confining block having a bore and a slot leading into the bore. The tubular device is pinched and inserted into the bore and the slot. Two mandrels are inserted into the bore, one inside the tubular device and one outside. The mandrels are revolved about each other to roll the tubular device on itself until the tubular device is entirely rolled and confined at the reduced diameter within the bore. The tubular device is removed from the bore while being restrained in the reduced diameter.
Preferred embodiments of the method of manufacture feature the following. The removing step may be accomplished by pushing the tubular device from the end of the bore and restraining the tubular device as it emerges. The restraining my be by means of wrapping a wire around the tubular device. The slot may be tangent to the bore of the confining block. The tubular device may be a stent knit of an elastic filament. One of the mandrels may be part of the delivery system that will be used to deliver the stent.
The inventive method of manufacturing the stent features the following advantages. Certain prior methods required several operators to simultaneously hold and constrain the resiliency of the stent and hurt the fingers of the operators. The method of the invention requires only one operator and is comfortable to execute. The stent delivery systems produced by the method are more uniform than those manufactured by previous methods, both in distribution of stresses within a single stent and in variation between stents, thus avoiding deformation of the stent during manufacture and allowing the physician to place the stent more precisely in the patient. A stent delivery system manufactured according to the method has a small profile, and thus minimizes trauma to the patient during implantation.
Other advantages and features of the invention will become apparent from the following description of a preferred embodiment, and from the claims.
FIGS. 1 and 1c are perspective views of a stent according to the invention.
FIG. 1a is an end elevation view of the stent.
FIGS. 1b, 1d-1h, 4a, and 6 are detail views of the knitted loops of a knitted stent.
FIGS. 2, 2a, 3, and 3a-3e are sectional views of a body, showing effects and operation of a stent in the esophagus.
FIG. 4 is a sectional view of a peristaltic organ.
FIGS. 5, 5a, and 5b are schematic representations of alternate embodiments of the stent.
FIG. 5c is a partially broken-away view of an alternate embodiment.
FIGS. 6a, 7, 7a, 7c-7j, 7l, 7m, and 7p-s are perspective views of tools and a time sequence of steps in a process for manufacturing a delivery system for the stent.
FIG. 6b is a perspective view of a stent knit of interlocking pre-formed sinusoidal rings.
FIGS. 7b, 7k, 7n, and 7o are cross-sectional views taken during the process of manufacturing the delivery system.
FIG. 7t is a sectional view of the delivery system.
FIG. 7u is a perspective view of the delivery system, cut away.
FIGS. 8 and 8a-8e are a time sequence of sectional views of an esophagus showing delivery of a stent.
FIGS. 9, 9a, and 9b are a time sequence of cutaway views of an alternate delivery method.
Referring to FIGS. 1 and 1a, a stent 100 according to a preferred embodiment is formed of a knit cylinder with length L and diameter D. The knitting forms a series of loosely-interlocked knitted loops (e.g., as indicated by adjacent loops 132 and 134 in FIG. 1b) that may slide with respect to each other. This sliding or shifting allows the stent to adapt to the movement of the organ without moving axially in the organ. The adaptation is accomplished with mere bending of the stent filament.
The stent maintains its axial working length L when locally radially compressed, by locally lengthening or shortening due to shifting of the rows of loops relative to each other. FIG. 1c shows a region 130 of the stent not under radial compression where adjacent loops 132 and 134 are in an overlapping, relaxed configuration, and the heads of the loops are separated by a short distance s. In the case of an esophagus, a large piece of food distends the esophagus. At the first instant of the expansion, the wall may be deflected by an angle Θ, but the diameter of the organ will not have changed appreciably. In such a region, 140 in FIG. 1c, the local length of the wall elongates by a factor 1/cosΘ. The rows of loops of the stent shift axially with elastic deformation of the wire of the loops so that the separation of the heads increases to a loop length l1, as shown in FIG. 1e. In the region of maximum expansion 150, the length of each portion of the esophagus returns to its rest length, but the diameter is extended. The knit loops of the stent can widen, as shown in FIG. 1f, to accommodate this extension. Returning again to considering any peristaltic organ, the organ contracts (c of FIG. 1c) to compress a region. In a region 160 where the wall is at an angle of deflection Θ but the diameter is essentially equal to the rest diameter, the length of the wall of the organ will elongate by a factor 1/cosΘ, and the loops will again pass through a state where their width is essentially the same as the rest width, but, by relative shifting of the rows of loops axially, they are extended to length l1, the state shown in FIG. 1e. In a region of maximum compression 170, the wall of the organ is at its rest length, but the circumference is much reduced. In this region, the loops of the stent deform into the configuration of FIG. 1g, where the length of the loops is s but the width is compressed. Finally, as the peristalsis relaxes, the wall of the organ returns to its rest length and rest circumference, region 190 of FIG. 1c, and the loops of the stent return to the overlapped rest configuration of FIG. 1d.
In the case of organs that can constrict almost closed, as the lumen compresses radially the circumference shortens, and thus part of the length of the filament that contributes to the circumference of the stent in its rest state is freed to contribute to length, and thus the loops can lengthen to length l2, as shown in FIG. 1h.
The lengthening from s to l2 all occurs without significant elongation of the filament of the stent itself, only by elastic bending deformation and sliding of the rows of loops against one other. The ratio of the maximum local length to the relaxed local length, l2 /s, is determined by the configuration of the loops and the elastic limit of the material of the filament.
Referring again to FIG. 1c, the local lengthening in regions of radial extension, compression or slope does not substantially affect the loops in nearby regions that are not exposed to the radial compression, which are in turn free to elongate, contract or widen in response to the movements of their own local portions of the organ. Thus, the stent maintains its overall working length L even when locally extended or compressed. When the radial compression is released, the elasticity of the filament causes the stent to expand back to its original rest diameter D without change of the overall length, since adjacent loops in the region of compression slide back to the relaxed overlapped state, separated by distance s. Because the stent maintains point-for-point contact with the organ, averaged over a local area about the size of one loop, the stent maintains its placement in the organ, and does not migrate with the peristalsis.
A further property of the stent is that the state characterized by all adjacent loops being separated by distance s is the stable equilibrium between the elastic restoring forces of the wire and the compressive force of the esophagus. Thus, the stent automatically adjusts to overall length L regardless of the initial configuration of the loops and length of the stent. For example, if the loops are in extended positions as in FIG. 1e or 1h, then upon compression the loops adjacent the compressed region draw axially inward to the relaxed configuration in FIG. 1b, thus drawing the proximal end (120 of FIG. 1) and distal end 122 inward. When the compression releases, the loops in the region of the compression also shorten, since the ends 120 and 122 of the stent have been drawn inward and adjacent loops slide inward to adjust for the reduced overall length. Once the stent has settled into this equilibrium state, the overall length and position within the lumen are stable.
These features are enabled in the preferred stents of the invention by a sliding motion of adjacent filament loops, which in turn is enabled by the method of knitting that reduces overlap of the loops, as shown, and the elasticity of the filament and the shape of the loops. The sliding motion allows local axial lengthening or shortening of the stent substantially independently of other remotely located portions of the stent. The elasticity of the stent filament allows the stent and lumen to return to their desired patency when the compacting force is removed, without inelastic deformation. The loops are configured so that the stent assumes its desired diameter and overall length as the elastic restoring forces seek their minimum stress, the relaxed state of FIG. 1b. This minimization occurs when adjacent loops touch at their widest points, as for instance point 136 between loops 132 and 134.
These features are particularly useful in body passages in which physiologic function includes motion of the lumen walls, such as peristaltic motion of the esophagus. For example, referring to FIG. 2, an esophagus 200 is occluded by a tumor 202. In FIG. 2a, after insertion of the stent 100, the lumen's patency is restored. Once implanted in the esophagus, the stent is held in a rest diameter that is slightly compressed by the esophagus from its free diameter when outside the body. It is the elastic restoring force of the stent resisting this compression that holds the stent in place.
A stent for an organ like the esophagus, according to the invention, not only holds the lumen open but allows the organ to maintain its physiologic motion. Further, the stent adapts to this motion without itself being subject to the peristaltic force--it does not creep toward the stomach with each esophageal contraction, nor does the overall length change. The operation of the elastic knitted stent is illustrated in FIGS. 3 and 3a-3e. A food particle 310 is urged through the lumen 320 by a peristaltic wave 322 that propagates down the esophagus 200. The wave is induced by circumferential contraction of the muscular tissue surrounding the lumen, a consequence of which is radial inward extension of the wall. Before the wave reaches the stented portion, the stent lies between points T and B, with length L between. As the wave reaches point T and the portion of the esophagus reinforced by the stent 100, the stent complies with the radial contraction, as shown in FIGS. 3a-3e. As shown in FIG. 3e, after passage of the peristaltic wave the stent has not migrated from points T and B, and maintains its overall length L. The adjustment and restoration feature allows the stent to maintain its position in the lumen, without migrating axially as might occur with a unitary structure in which stresses in one portion are substantially transmitted to other portions.
Referring to FIGS. 4 and 4a, the configuration of the knit loops of the stent may be determined based on the degree of radial motion and consequent axial lengthening imposed by the peristaltic motion. Generally, the loop length of the stent in its extended position l can be expressed as:
l=εs (1)
where s is the axial length of the portion of the body lumen over which two adjacent loops of the stent extend, and ε is the factor by which the stent must elongate in response to local lengthening of the body lumen wall. It will be seen that the maximum local lengthening will occur over the portion of the wall that lies at the largest angle Θ from the at-rest position. In a worst-case limit, the entire peristaltic wave can be approximated as having a wall at angle Θ, thus distending a portion of the lumen that has rest length a to a triangular wave with hypotenuse b. Thus,
b/a=1/cos Θ (2)
This ratio, b/a, is the elongation factor by which the loops must lengthen from their relaxed length s to their extended length l to accommodate the lengthening of the lumen wall at the incline of the peristaltic wave. Thus,
b/a=1/cos Θ=l/s=ε (3)
For the stent as a whole to maintain point-for-point contact with the wall of the lumen and thus for the stent as a whole to remain stationary along the axis of the lumen, the heads of the loops are allowed to slide locally in the region of peristaltic compression by a distance (l-s)/2.
It will be noted that the stent will accommodate the elongation of the lumen wall if it is capable of local elongation ε equal to 1/cosΘ, independent of the amount of deflection c, even in the extreme case where the organ is capable of constricting completely shut--deflection c in FIG. 4a being equal to the radius D/2 of the lumen.
The amount of force exerted by the stent against the lumen wall is chosen to exceed the blood pressure within the capillaries of a typical tumor, and thereby prevent the tumor from further growth into the lumen of the esophagus. The exerted force is determined by the coefficient of elasticity of the filament, by the configuration of the loops and density of the knit (loops per unit of axial length), and by the diameters of the lumen and the stent. For instance, a stent design would exert more force against the lumen wall by choosing a stiffer material for the filament, by knitting the stent with more, smaller loops per unit of length (decreasing s, and reconfiguring the loops to maintain the ratio l/s), or by knitting the stent to a larger rest diameter D. The radial force exerted is bounded at the point where the loops reach the relaxed configuration of FIG. 1b and the stent's diameter reaches diameter D--the forces sum to zero at the contact points 136, and the force exerted on the lumen itself falls to zero. Thus, the diameter D of the stent must be slightly larger than the diameter of the lumen if the stent is to retain its place in the lumen.
Referring again to FIGS. 1, 1a and 1b, a particular embodiment for use as an esophageal stent is knitted of nitinol wire of about 0.15 millimeters in diameter to have a diameter D of about 18 mm, though diameters of 14 mm to 25 mm may be useful. The proximal end 120 is flared to 20 mm, to secure fixation to the esophageal wall. Stents manufactured in overall lengths varying from 5 to 15 cm allow selection of a stent tailored to the patient's needs. The relaxed loop length s is about 0.80-0.85 mm, and the maximum loop length l attained without significantly distorting the loops is about 1.05-1.15 mm. This elongation factor of about 1.4 is close to √2, allowing for a maximum angle Θ of about 45°. The peak-to-peak height p of the loops is about 2.2 mm when the loops are in their rest state.
Examples of filament materials include shape memory metals, for example, nitinol, tantalum steel, stainless steel or other elastic metals, or plastics such as polyester, polypropylene, or carbon fiber. The filament may be selected to have a sufficiently high elastic limit to allow the delivery system to rely entirely on this elasticity, rather than, for example, the balloon 820 of FIG. 8e to expand the stent. The filament may be formed of a two-component metal wire system that exhibits desirable physical properties such as enhanced radiopacity along with desirable mechanical properties, such as extreme elasticity. A full discussion of composite medical wires will be found in U.S. application Ser. No. 07/861,253, "Medical Wire" by Kevin R. Heath, incorporated herein by reference. The stent may be knit of two or more filaments.
As shown in FIG. 4a, the stent is knitted of a single filament. This view shows only the front half of the stent. The loops that appear in this view as independent rows in fact are a single spiral-wrapped sequence, much as a common screw has only one ridge from head to tip. In alternate embodiments of the stent, multiple filaments or other knits could be used, so long as the knit structure allows a single row to elongate without forcing the two adjacent rows to shift. The last loop of the wire is cut 440. To prevent the stent from unravelling, the last three loops (two shown, 450 and 452) of the stent are coated in urethane, as shown in FIG. 4b. The coating also covers the sharp ends of the filament.
It will be realized that the stent is applicable to malignant or benign obstructions of many other organs. Stents to treat biliary duct obstructions, for instance when treating liver sclerosis or bleeding, would be about 8 to 10 mm in diameter and 4 to 8 cm in length. Stents for the ureter would be about 6 to 10 mm in diameter and about 2 to 10 cm in length. Urethral stents would be about 10 to 20 mm in diameter and about 2 to 6 cm in length. Stents for the prostatic urethra would be about 10 to 20 mm in diameter and about 2 to 6 cm in length. Colonic stents would be about 10 to 20 mm in diameter and about 4 to 10 cm in length. Stents for hemodialysis shunts would be about 6 to 8 mm in diameter and about 2 to 6 cm in length. Stents for the porta canal would be about 8 to 14 mm in diameter and 4 to 8 cm in length. Stents for the trachea and bronchi would be about 8 mm to 25 mm in diameter and 1 to 8 cm in length. Stents for gastric outlet obstructions would be about 8 to 20 mm in diameter and 1 to 25 cm in length. Peristaltic stents may also be configured for aortic aneurysms or dissections (preferably weaving the filament material with a covering such as dacron), and treatment of superior vena cava syndrome and venous restrictions. The invention is also useful in lumens in which compression is caused by some outside force, for example in blood vessels compressed by muscular contraction, movement of an extremity, or pressure exerted by an object external to the body.
FIGS. 5, 5a, and 5b represent alternate forms for stents. (Showing the knit loops in these projections would obscure the shape; these figures represent only shapes of the stents.) The stent could be shaped to include, in its free and rest states, a narrowing at a point in its length. This narrowing would accommodate the stent to the anatomy of a natural sphincteric structure, for instance the pylorus or the cardia. A stent so narrowed would enable the organ to close, for instance to prevent reflux. The narrowing could be shaped at one of the ends, for instance for use in the rectum at the anus or in the common duct for a Papilla of Vater.
The narrowing could be shaped conically, as in FIG. 5 for use in sphincter organs. FIG. 5a shows a stent incorporating a flattening, with the circumference in the area of the flattening reduced so that the width remains constant. The latter embodiment could be used in an occlusion with two lips such as the vocal cords. In either case, it may be desireable to form the loops in the region of the constriction so that their free state is similar to one of the compressed configurations, e.g. FIG. 1g, so that the constriction is capable of opening to the rest diameter D.
As shown in FIG. 5b, the margins of the narrowing could incorporate a valve to ensure complete closure of the stented organ, as for instance the reinforced lips 520. This valve could be opened and closed either by the muscles normally surrounding the point of constriction or by a manually-operated control extended to outside the body. This would allow the use of the stent, for instance, across the aortic valve or as a replacement for the urinary sphincter. It may be desireable to reinforce the point of the constriction, e.g., with a stiff wire, especially in conjunction with the flattened constriction of FIG. 5a. It may also be desireable to provide a valved stent with a watertight membrane, similar in form to that discussed below and shown in FIG. 5c.
The stent can be made to exert varying force along its length, for instance by varying the gauge of the wire or the density of the knit. In the narrowed stents discussed above, it may be desireable to make the stent particularly flexible in the region of the narrowing.
Some tumors are so invasive that the stent is quickly ingrown by the tumor. As shown in FIG. 5c, the stent may be manufactured with an elastic semi-permeable membrane 530 of porosity less than 50 microns and of very low modulus of elasticity, sandwiched between two knit layers. The membrane may advantageously be of expanded polytetrafluoroethylene (teflon) or latex. The inner layer 532 is essentially identical to the single-layer stent, providing most of the elastic force against the lumen. The outer knit layer 534, which acts to retain the membrane, is typically constructed of thinner wire, for instance 0.07 mm diameter, or a less-resilient material such as polypropylene or polyethylene. The outer knit layer is slightly shorter in length than the inner layer.
The stent is knit on a conventional knitting machine, very similar to that used to knit stockings. During the knitting process, the wire is deformed past its elastic limit. Referring to FIG. 6, on some knitting machines, or for stents of some diameters, it may be convenient to produce a knit with the "up loops" 610 of a different shape than the "down loops" 612. In some applications, for instance the aorta, it is important that the loops be uniform so that the stent exerts uniform pressure along the lumen wall. During the knitting process, the wire will be under tension, and thus the loops will be in a tight configuration, similar to FIG. 1e, or possibly to FIG. 1f or 1h depending on the geometry and setup parameters of the knitting machine itself.
The knitting machine produces a long "rope" of knit loops. The rope is cut into lengths somewhat longer than the final length of the stent. The extra length allows for the shortening of the stent that will occur as the loops are shortened from the elongated state in which they emerge from the knitting machine to the rest state of FIG. 1b, and allows for some trimming. As shown in FIG. 6a, after knitting, the stent is mounted on a mandrel 620 for annealing, to relieve the strains induced by the plastic deformation of knitting and to produce greater elasticity in the wire. The mandrel is in the free shape of the stent, 18 mm in diameter with a flare 622 to 20 mm at one end. To achieve the constricted embodiments of FIGS. 5 and 5a, the mandrel would have a constriction formed in it, and an external restraint would be applied to the stent so that the annealed shape would be as shown in those figures. As the stent is loaded onto the mandrel, the operator shortens the overall length so that the loops assume the relaxed, shortened state of FIG. 1b. The stent is annealed at approximately 450° C. for about 15 minutes.
After annealing, the stent is cut to its final length, and the three loops at each end of the stent each receive a drop of urethane (450 of FIG. 4a or FIG. 6) to prevent unravelling.
Alternately, the stent may be knit of interlocking pre-formed sinusoidal rings, two of which 630, 632 are shown in FIG. 6b.
The stent itself is packaged into a delivery catheter as shown in FIGS. 7 and 7a-7u. The center of the delivery catheter is a carrier tube 700, shown in FIG. 7. The carrier is a flexible tube of Pebax, a polyether/polyamide-12 resin from Atochimie with desireable flexibility/rigidity characteristics, 2.5 mm in diameter and approximately 80 cm long. The carrier has several radiopaque O-rings 704,706 mounted along the most-distal 20 cm. The preferred radiopaque material is tantalum.
The preferred process of mounting the stent on the carrier tube 700 uses several tools: a confining block, two mandrels, and a pusher. The confining block 710, shown in FIGS. 7a-c, is cylindrical, somewhat longer than the stent itself at about 20 cm, and formed of a rigid plastic with low friction characteristics, preferably delrin or nylon. The block has a drilled bore 712 of 8 mm diameter, with a 1 mm-wide slot 714 cut from the top of the outside of the block and meeting the inner bore 712 at a tangent. The slot and bore may have a guideway 718 formed, to make the following steps easier. The block may also have flats 716 milled in the bottom so that the block may be mounted in a vise. A first mandrel 720, shown in FIG. 7d, is a simple rod approximately 30 cm long and about 3 mm in diameter. A second mandrel 722, shown in FIG. 7e, has a shaft of about 3 mm diameter and length longer than the confining block, two handles 724, each about 10 mm in diameter, with center bores that friction fit on the ends of the mandrel shaft, and slots 726 of width to accommodate the carrier tube. Both mandrels have rounded ends so that they will not catch on the loops of the stent. A third tool is a pusher 728, shown in FIG. 7f, with a shaft 729 of slightly less than 8 mm diameter and a bore 730 somewhat larger than the outer diameter of the carrier 700. The bore may either be the full length of the pusher, or as shown in FIG. 7f, may have a breech hole 732. A fourth tool, which will be seen in FIG. 7q, is a soft copper wire with a silicone sheath 760 (silastic) over it. The sheathed wire is about 50 cm long, and the sheath is about 1-2 mm in diameter.
Referring to FIG. 7g, the confining block 710 is securely mounted, as in a vise 750. An operator squeezes a stent 100 flat and works it into the slot 714 preferably starting at a corner 752, and bottoms it in the bore 712. Referring to FIG. 7h, the stent is positioned in the confining block so that the proximal end 120 of the stent extends from the end of the confining block. The first mandrel 720 is inserted into the distal end of the carrier 700, and then the mandrel and carrier tube are passed through the center of the stent. The operator slides the stent to the center of the confining block, as shown in FIG. 7i. Referring to FIG. 7j, the stent is slid back so that the flared proximal end again extends from the end of the confining block. One handle of the second mandrel is removed, and the shaft 722 of the second mandrel inserted through the bore of the confining block but outside the stent. Referring to FIG. 7k, the first mandrel 720 lies inside the carrier tube 700, which in turn lies inside the stent 100. The lower portion of the stent and the second mandrel 722 lie inside the bore 712 of the confining block. Referring to FIG. 7l, the stent is slid back to the center of the confining block. The several slides forward and back equalize the distribution of the knit loops evenly over the length of the stent. The second handle of the second mandrel is affixed to the shaft of the second mandrel, and the slots 726 of the handles engaged with the carrier tube 700 and/or first mandrel 720. The operator can center the O-rings 704,706 within the stent so that the carrier will be axially positioned roughly correctly within the stent. Referring to FIG. 7m, the operator twists the handles, revolving the two mandrels about each other and winding the stent about the two mandrels. FIG. 7n shows the configuration of the stent and the two mandrels after about half a revolution. The operator continues winding until the stent is completely rolled on itself in the bore of the confining block. The operator removes a handle from the second mandrel and removes the second mandrel from the confining block. The stent is held in the wound conformation by the confining block, as shown in FIG. 7o.
Referring to FIG. 7p, the operator threads the pusher 728 over the proximal end of the carrier, with the shaft 729 distal. The pusher will be used to slowly push the stent out of the bore of the confining block.
Referring to FIG. 7q, using the pusher the stent is pushed out of the confining block by about 1 cm. The operator makes any final adjustments required to center the radiopaque O-rings within the stent. The operator wraps several turns of the copper wire and silicone sheath 760 around the exposed distal end 122 of the stent, with about a 1 mm gap between turns, and lays the bight of the sheathed wire into the slot of the confining block. Referring to FIG. 7r, the operator gradually feeds the stent out of the confining block using the pusher, and wraps the sheathed wire around the stent to keep it confined to a diameter of about 8 mm. The operator maintains a roughly uniform 1 mm spacing between wraps.
After the stent is fully bound in the copper wire 760, the pusher is removed back over the proximal end of the carrier tube and the carrier tube is pulled out of the bore of the confining block, the stent and silastic/copper wrap is dipped in U.S.P. grade dissolving gelatin, and the gelatin is allowed to set. The copper wire can then be unwrapped; the silicone sheath acts as a release surface so that the gelatin peels off the wire and remains set on the stent in a 1 mm-wide "threaded" strip, 770 in FIG. 7s, confining the stent.
Referring to FIGS. 7t and 7u, the stent delivery system catheter 799 is completed by affixing a nose piece 772 onto the distal end of the carrier 700, and surrounding the entire assembly in a cylindrical sheath 774. Both the carrier and sheath are essentially rigid in the axial direction, so that they can be used to push or pull the catheter to position it, and so that handles 782 and 784 can be squeezed together to retract the sheath from over the stent. Also shown in FIG. 7t are the radiopaque markers 704,706 and in FIG. 7u graduation markings 778 on the sheath, both of which will be used during implantation to guide positioning. The inner pair of the markers indicate the length the stent will assume at its 18 mm fully-expanded diameter, and the outer pair indicate the length of the stent when compressed to 8 mm diameter. A guidewire 778 will be threaded through the center bore 776 of the carrier during implantation.
The process of implanting the stent is illustrated in FIGS. 8 and 8a-8e. Referring to FIG. 8, using an endoscope 810, the proximal margin 812 of a stricture 814 is identified. The guidewire 778 is advanced across and beyond the stricture. In FIG. 8a, an 8 cm-long balloon 820 is advanced over the guidewire and inflated to 12 mm diameter, dilating the stricture to 12 mm. After examining the stricture endoscopically and fluoroscopically, a gelatin-encased stent 4-6 cm longer than the stricture is chosen. The delivery system 799 is passed over the guidewire and advanced until the distal inner radiopaque marker 704 is 2-3 cm below the distal margin 832 of the stricture.
Referring to FIG. 8c, The outer sheath is retracted by squeezing together handles 782 and 784 (see FIG. 7u), and the stent begins to deploy. The gelatin will immediately begin to dissolve, allowing the stent to expand under its own elastic restoring force. The material of the stent filament, nitinol, is chosen so that even the fairly severe deformation required to compact the stent into the delivery system does not exceed the elastic limit. Referring to FIG. 8d, after the proximal 120 and distal ends 122 of the stent have expanded and firmly attached to the esophageal wall, the catheter 799 can be removed. Referring to FIG. 8e, depending on the patient, a 12mm-diameter balloon 820 may be inflated within the stent to ensure that the occlusion is opened to the desired patency, to affix the stent firmly to the esophageal wall, and to ensure adequate esophageal lumen size for endoscopic examination. Peristaltic contractions of the esophagus will allow the stent to "settle" into its most-relaxed configuration.
Referring to FIG. 9, in another delivery system, the stent 100 is formed of an elastic filament material that is selected so compaction produces internal restoring forces that allow the stent to return to its rest diameter after the compacting restraint is removed. The stent may be compressed onto a catheter 900 that includes a sleeve 902; the sleeve holds the stent in a relatively compacted state. The compaction is typically achieved by rolling the stent upon itself using two mandrels, as in FIGS. 7g-7o. In other cases, the stent may be positioned coaxially over the catheter. The catheter is positioned within the lumen at the region of the tumor 202. In FIG. 9a, the sleeve is removed from about the stent, for example, by withdrawing axially in the direction of arrow 910, thus allowing the stent 100 to radially expand by release of its internal restoring force. As shown in FIG. 9b, the axial force exerted by the stent is sufficient to dilate the lumen 200 by pushing the tumor growth 202 outward, or in some cases to compress the occlusion against the lumen wall. The catheter can then be removed.
Other embodiments are within the following claims.
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|Fee payment
Year of fee payment: 4
|17 avr. 2008
|Fee payment
Year of fee payment: 8
|25 juin 2012
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|14 nov. 2012
|Lapse for failure to pay maintenance fees
|1 janv. 2013
|Expired due to failure to pay maintenance fee
Effective date: 20121114


text:
PASJ Major with Theater Concentration
Theater Emphasis courses in the PASJ major builds the foundation necessary to create theater in our changing world, by providing students with technical training, room for personal exploration and artistic expression, and the social and historical context in which theater is made. San Francisco provides a unique laboratory in which our students engage the world. The goal of the major is to develop artists who are not only technically competent and versatile, but who have also explored the conceptual, compositional and creative processes underlying theater as an artistic form.
Theater Minor
Ideal for students who have a passion for theater, the minor allows students to specialize in either performance or technical theater/design.
Contact Info
Performing Arts Department
Mon-Fri, 8:30a.m. - 5p.m.

subset: commoncrawl


text:
Because I Ain't Attached to This Shit: An art and garage sale for Yuri Arajs
Moving to a new residence can be exhausting. Art curator and mentor Yuri Arajs moved from Minnesota to British Columbia in 2008 and is still dealing with the pangs of not having enough boxes. He left many of his belongings behind, and now, two years later, he's decided to have a garage sale rather than trying to haul the rest of his unique collection to his new abode.
Curator and art hound that he is, Arajs's garage is overflowing with pieces that he didn't have room to pack. So this is not just any garage sale, but an exhibit--a temporary installation even. It even has its own title: Because I Aint Attached to This Shit: An Interventionist Art and Garage Sale for Yuri Arajs by Amy Rice.
Local artist Amy Rice--one of Arajs's discoveries--is taking over the details of the garage sale, and alludes that this event may be a little painful for Arajs. "If you tell [Arajs] how much (how little) you paid for stuff I will be in big trouble," says Rice. "So prices are a secret in the deal. Okay?"
Even more enticing: "This is not the left-over stuff from the garage sale Yuri had when he moved," Rice explains. "This is art and artifacts Yuri planned to keep." Suddenly being asked to help clean out a garage over the weekend doesn't seem like such a chore.
The garage sale will be located at 650 Pierce Street Northeast in Minneapolis this Saturday from 8 a.m. to 4 p.m. and Sunday from 10 a.m. to 2 p.m. Enter through alley.
Hand crocheted pillows, 1967; photo of Dorothy Hammerstein
Art by Dorothy Hammerstein, widow of Oscar Hammerstein
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- TanzaniaFoodFunding via Tujijenge Tanzania Ltd
Saranga GroupTanzaniaFoodFunding via Tujijenge Tanzania Ltd
Kibo GroupTanzaniaFoodFunding via Tujijenge Tanzania Ltd
Busara 1B Group
This is her third loan request from Kiva's partner, Tujijenge Tanzania. She used the previous two loans to buy business chairs, tables, and food-making ingredients, like baking flour and meat. By doing so, she became able to receive more customers than before. She will use her share of this new loan to buy meat for making soup, baking flour for making chapati, and charcoal for cooking. She dreams that her business will grow, up to the hotel level. Pendo does not posses a higher-level education, but she is able to manage well her business, despite big challenges. She believes that, through Tujijenge loan services, she will be able to grow and meet her business targets. Pendo uses her business profit to meet her life expenses.
She will share this loan with her loan group, "Busara 1B." The group is comprised of six members. The members of the group will hold each other accountable for paying back the loan.
Additional Information
About Tujijenge TanzaniaThis loan is administered by Tujijenge Tanzania, which was founded in 2006. It has operations in Dar es Salaam, the coastal region, and the Lake Victoria region. The organization aims to reach out to micro entrepreneurs and provide them with financial and social intermediation services because capital is one of the major barriers to development and success for micro-enterprise initiatives in Tanzania.
For more information on Tujijenge Tanzania, please visit its partner page, or join its lending team.
This is a Group Loan
In a group loan, each member of the group receives an individual loan but is part of a larger group of individuals. The group is there to provide support to the members and to provide a system of peer pressure, but groups may or may not be formally bound by a group guarantee. In cases where there is a group guarantee, members of the group are responsible for paying back the loans of their fellow group members in the case of delinquency or default.
Kiva's Field Partners typically feature one borrower from a group. The loan description, sector, and other attributes for a group loan profile are determined by the featured borrower's loan. The other members of the group are not required to use their loans for the same purpose.
About Tanzania
24View loans »
Success!! The loan was 100% repaid
- Repayment Term
- 6 months (Additional Information)
- Repayment Schedule
- Monthly
- Pre-Disbursed:
- Jan 31, 2014
- Listed
- Feb 24, 2014
- Currency Exchange Loss:
- Possible
- Ended:
- Aug 17, 2014


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I have installed openSUSE (12.2) on a PC that has Win8 installed.
At the beginning there were problems and it didn't start, after some "fixes" Linux started but when going in the
grub2-efi Windows 8 entry I get this error:
error: can't find command 'drivermap'
error: invalid EFI file path
First of all, I have checked and in my
/boot/EFI/ there's no Windows
.efi file, just the openSUSE one.
I have tried the command:
grub2-efi-probe --target=fs_uuid /boot/efi/EFI/Microsoft/Boot/bootmgfw.efi
and I got:
grub2-efi-probe: error: failed to get canonical path of /boot/efi/EFI/Microsoft/Boot/bootmgfw.efi."
I tried also to modify
/boot/grub2-efi/grub.cfg, adding:
menuentry "Windows 8 UEFI" {
insmod part_gpt
insmod fat
insmod search_fs_uuid
insmod chain
set root='(hd0,gpt4)'
search --fs-uuid --no-floppy --set=root 4f84-ee2e
chainloader (${root})/efi/Microsoft/Boot/bootmgfw.efi
as suggested in some websites..
I also tried:
menuentry "Microsoft Windows Vista/7/8 x86_64 UEFI-GPT" {
insmod part_gpt
insmod fat
insmod search_fs_uuid
insmod chain
search --fs-uuid --set=root $hints_string $uuid
chainloader /EFI/Microsoft/Boot/bootmgfw.efi
but no luck.
My guess is that the Win EFI file has been deleted and I need that to make Win start? Am I right?
In this case, where can I find it? Is it possible to solve this problem without reinstalling Windows (I've got no DVD)?
sudo ls -l $(find /boot/efi -iname "*.efi")
root's password:
-rwxrwxr-x 1 root root 665600 Jan 8 2013 /boot/efi/EFI/opensuse/grub.efi
-rwxrwxr-x 1 root root 120832 Mar 11 2013 /boot/efi/EFI/opensuse/grubx64.efi


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Creedence Clearwater Revisited With Special Guests Robert Randolph & The Family Band
Our Price
$39.50 - $49.50*
Full Price
$49.50 - $69.50
Formed by Doug "Cosmo" Clifford and Stu Cook, two of the founding members of Creedence Clearwater Revival, Creedence Clearwater Revisited plays classic hits such as "Fortunate Son," "Bad Moon Rising," "Proud Mary," "Have You Ever Seen the Rain" and many more. The two are joined by lead singer/rhythm guitar player John Tristao (formerly of the band People), lead guitarist Kurt Griffey (who's toured with members of the Eagles, Foreigner and more) and multi-instrumentalist Steve Gunner. What started as a plan to perform at private parties has turned into almost 20 years of touring to enthusiastic crowds. The band even released an album, Recollection, in 2008 featuring their version of CCR songs. Fans of CCR and classic rock will love hearing the band's hits live with the same energy they had back in the day. Joining Creedence Clearwater Revisited is Robert Randolph & The Family Band, who have an upbeat, soul/funk/gospel sound. Randolph was also named one of the 100 Greatest Guitarists of All Time by Rolling Stone.
* Additional fees apply. No coupon or promo codes necessary to enjoy the displayed discount price.
All offers for Creedence Clearwater Revisited have expired.
The last date listed for Creedence Clearwater Revisited was Sunday August 3, 2014 / 7:30pm.
Currently at Mountain Winery
The Cult Live in Concert at Mountain Winery
- Full Price:
- $51.00
- Our Price:
- $23.50
Led by the charismatic Ian Astbury, The Cult is one of the most influential and controversial rock… More
Venue Details
$5 off parking if there are at least 3 in your car.star this tip starred
Parking is cash only and exit is a madhouse. Parking so you don't have to back out will save your sanity. It's the one thing they could do betterstar this tip starred
Reviews & Ratings
Creedence Clearwater Revisited
Featured review from alla
view more less of this review
More Information
About the Ticket Supplier: AEG Live - Mountain Winery
The Mountain Winery in Saratoga, California is dedicated to preserving the Mountain Winery's history and restoring the property to its magnificent glory for the enjoyment of all.


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- IDEALS Home
- →
- Browse by Subject
Browse by Subject "Cytokines"
Now showing items 1-2 of 2
(2011-05-25)Previous research suggests that mild traumatic brain injury (mTBI) results in significant cognitive and behavioral learning deficit, as well as long-term depressive like behavior in mice. mTBI has been identified as ...
application/pdfPDF (800kB)
Induction of epithelial to mesenchymal transition in mesothelial cells by secreted factors from uterine epithelial cells (2012-05-22)Establishment of the disease endometriosis requires the attachment and invasion of endometrial fragments into the peritoneal lining of the peritoneal cavity. For proper attachment and invasion to occur, the endometrial ...
application/pdfPDF (34MB)
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I have been crafting from early age In Norway where we learned sewing, kniitting, embroidery etc. In school. I also do a lot of quilting. I am also an artist using watercolor and oil. I love it all.
Showing 1 - 2 of 2 saved projects
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Craftsy Apps for iOS and Android. Read more »


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A Loss of Heart
One of the most precious things than any individual can experience is a healthy sense of who they are in relation to the rest of the world. Yet, in all my clinical work, I have rarely seen any phenomena affect an individual's sense of worth like pornography. It strikes at the very heart of the one who has been caught in its bonds, and removes from them any sense of purpose and direction. It is hard to put into words how it changes one's perspective of themselves, however there is an emotional basis for this change.
Guilt, Shame, and the Erosion of Self
Guilt and shame are common emotional responses in men and women who view pornography. They play a key role in facilitating a thought process that leads to an erosion of the self. Here are a few examples of thoughts which facilitate an ongoing negative self- perception:
- I am weak and such a failure.
- God is disappointed in me and can no longer work through me.
- My friends are so much stronger than I am.
- I'll never be free of using pornography.
When an individual who uses pornography dwells on such thoughts, they are sure to feel bad emotionally and view themselves in a negative light. These negative self-perceptions, along with feelings of guilt and shame, additionally contribute to patterns of isolation.
For many, the thought of approaching another individual is utterly fear provoking. They fear losing reputability in the eyes of others. They struggle with the thought of having to admit to some degree of personal failure, and they harbor uncertainty as to how another person may respond to their disclosure. I know from my own previous battle with pornography use just how powerful the fear associated with being open with a trusted friend can be.
Stopping the Negative Cycle
Personally, seeking the support of others was a crucial step in overcoming my use of pornography. Whether I had fully succeeded or failed, I always had others who could help keep me moving forward and provide encouragement. Furthermore, taking the first step of actually telling someone about my struggle was the starting point in ultimately overcoming my usage.
As a clinician, I can confidently say that those I have treated who have chosen to be open with a trusted professional, friend, pastor, or colleague about their use have ultimately identified doing so as a primary step in their recovery. My point is that a strength and freedom come from breaking the secrecy and being open with another individual about one's use. In the end, those who do so facilitate the change process in their lives, because they are no longer caught in the pattern of hiding.
Reclaiming the Self
Having support from others and avoiding usage of pornography over an increasing period of time allows you to avoid the guilt, shame, and negative self-perceptions. It also help reinforce the following:
- You are not a failure.
- You are strong.
- You can break free from using pornography.
- God can use you in spite of your past.
- Your friends and others may need you to help them end their own struggle with pornography.
However, breaking free requires more than simply reaching out for support. You must immediately challenge every thought that tempts you to return to previous patterns. In the beginning, you may have to do this constantly. Yet, this process becomes easier over time as your mind becomes used to focusing on other things besides pornography. Ultimately, the goal is to remain free of further use.
Here's what Scripture has to say about this:
"For though we walk in the flesh, we do not war according to the flesh; for the weapons of our warfare are not of the flesh, but mighty before God to the casting down of strongholds), casting down imaginations, and every high thing that is exalted against the knowledge of God, and bringing every thought into captivity to the obedience of Christ…"
2 Corinthians 10:5, ASV
This verse clearly shows that you and I are engaged in a daily spiritual battle, and that the battle ground is largely centered in our minds. Reclaiming your identity and healing from an addiction to pornography require that you infuse into your mind "whatsoever things are true, whatsoever things are honorable, whatsoever things are just, whatsoever things are pure, whatsoever things are lovely, whatsoever things are of good report; if there be any virtue, and if there be any praise, think on these things (Philippians 4:8, ASV)."
Seeking Help Through Christian Counseling
For those of you reading this article who are struggling to overcome your use of pornography, working with a Christian counselor can be an important means of helping you effectively address those usage patterns. Here at Seattle Christian Counseling, you can process the emotional, relational, spiritual, and psychological impact pornography has had on your life, and learn how to bring healing to those specific areas. As a practitioner who focuses on providing treatment for individuals, couples, and families who have been impacted by pornography use, I would be glad to either schedule a consultation with you, or to coordinate with you by email if you have any specific questions related to the issue of pornography. You can reach me by going to seattlechristiancounseling.com
"Wait a Minute," courtesy of Md saad and allb (CC BY 2.0) Flickr CreativeCommons; " . . . Born from a Noble Soul," courtesy of Varvara, (CC BY 2.0) Flickr CreativeCommons
Author Info
Eric Gomez, MS, LMFT, MHP
Licensed Marriage and Family Therapist
Contact Eric directly:
(206) 701-9126 | firstname.lastname@example.com
Read More about Eric's Services
Individual, Marriage, and Family Counselor


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How to delete your Facebook account? – How to close your Facebook profile?
Instructions to delete your Facebook Account / Delete Facebook Account:
Here we go, a direct link to start the Facebook account deletion process.
Click through and follow the instructions or bookmark this page for future reference.
The Facebook Account Deletion Process
Your account will be deactivated for two weeks. After this period it will be permanently deleted. Do not login to your account during this time, it will cancel the deletion request.
Deleting Facebook Data
Please login first and foremost in your Facebook account. Once you are logged in, you simply click on the link below.
Direct link to delete Your Facebook Account:
In theory, deleting your account will immediately delete all Facebook data. In reality, things are more complicated.
Facebook is a complex piece of software engineered to deliver social data quickly. Instant data removal is not the priority.
So, leverage all your options before account deletion,
Lock down all privacy settings.
Revoke app permissions and linked accounts e.g. Google and Yahoo!
Delete all messages, photos, tags, status updates if possible.
Contact friends about tags, photos that you would like deleted.
If this is daunting, concentrate on the more sensitive content.
Leaving Social Data Behind
As hard as you try, some personally identifiable information may remain. This could be something as simple as your name on a message to someone else.
You have little control over this or what others choose to share about you in future. The most you can realistically do is ask your friends to respect your privacy.
Any data that you have shared with Facebook apps and advertisers is with them permanently.
Just avoid Facebook at all costs for the next two weeks. Do not login to the website, via your desktop browser, mobile device or through any third-party app that you may have logged in with Facebook but forgot to log out of. Your account will be permanently deleted after the given amount of time.
About Facebook:
Facebook is an online social networking service headquartered in Menlo Park, California. Its name comes from a colloquialism for the directory given to students at some American universities. Facebook was founded on February 4, 2004, by Mark Zuckerberg with his college roommates and fellow Harvard University students Eduardo Saverin, Andrew McCollum, Dustin Moskovitz and Chris Hughes. The founders had initially limited the website's membership to Harvard students, but later expanded it to colleges in the Boston area, the Ivy League, and Stanford University. It gradually added support for students at various other universities and later to their high-school students. Facebook now allows anyone who claims to be at least 13 years old worldwide to become a registered user of the website, although proof is not required.
After registering to use the site, users may create a personal profile, add other users as friends, exchange messages, post status updates and photos, and receive notifications when others update their profiles. Additionally, users may join common-interest user groups, organized by workplace, school or college, or other characteristics, and categorize their friends into lists such as People From Work or Close Friends.
More Facebook services:
Deactivate Facebook Account
Delete Facebook Pages
Delete Facebook Groups
Delete Whatsapp Account
Delete Instagram Account
Delete Account
Caption: Screenshot Facebook.com


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2015 Title Sponsors
Willamette Valley Music & May Trucking Company
2015 Business Sponsors
Uptown Music
Huggins Insurance
Collier Law
Deems, Inc.
Many, Many Thanks to all our Trophy Sponsors & Program Sponsors!
This event couldn't take place without you!!!!
2015 marks our 34th Annual Event – Please Join us!
Date: October 3, 2015
Location: Sprague High School Stadium, Salem OR
Information on PCI Sponsorship
2015 PCI Sponsorship Payment Form
Up-to-date Event Information
(Updates will be found here when schedules, parking info and maps come out)
Spectator Information
Spectator tickets: $15 adult all-day general admission. Discounts for Senior and Student.
Free parking shuttle from overflow lots (1/4 mile away)
Show Host Information
Event Coordinator: Anne Nelson email@example.com
Sponsorship Coordinator: Amy Nasset firstname.lastname@example.com
Hosts: Sprague High Band and Colorguard Boosters and Sprague High School
Attending Band Information
Registration opens on June 15th via the NWAPA web page
Entry fee: $325 per band
PCI is home of the Full Band Retreat – your students will LOVE it
PCI provides indoor facilities for every band – just in case the weather is an issue.
Two rounds of competition (Prelims and Finals) for all bands.
Adjudicators are NWAPA-selected, locally and nationally recognized.
Exhibition (non-competitive) bands are welcome!
Stadium surface is Field Turf.
Traveling a long distance to PCI? Local accommodations can be arranged.
Contact firstname.lastname@example.com if you have any questions.


text:
Call Now! 800-498-1750
|Shipping & Delivery
|We ship flooring and related materials throughout the United States and Canada. In some cases we will also get involved with exporting into other countries, upon request. We offer the most competitive freight rates currently available.
Special Low Shipping Rates!
We have worked out special arrangements with our freight carriers and suppliers to bring you the lowest shipping rates possible! These low rates are based on the products you purchase and where you are located. To find out the shipping fee for the product you want, simply get a quote using our FloorCart™ Shopping System. This offer is valid for delivery anywhere in the contiguous 48 United States and does not apply to Alaska, Hawaii, or any other areas that might require special shipping requirements. Note: All prices and shipping rates are subject to change without notice. With some products from time to time we may offer FREE SHIPPING promotions. This will usually be indicated on the product details page for those products. Unless otherwise stated, there is a $1,200.00 minimum purchase for those products to qualify for the FREE SHIPPING promotion. The quote or order will not reflect FREE SHIPPING on those products unless that minimum is met. If you have any questions, feel free to contact us at 800-498-1750.
Delivery Time
Once your order is submitted, we need 1 to 3 business days to properly process the order through our vendors and partners. After the order is processed, it's then picked up by one of our freight carriers. Standard time in transit is 7 to 10 business days (not including weekends or holidays) after the order ships. We usually tell customers to estimate one and a half to two weeks total however we do not guarantee any dates or times. In route shipping time can vary due to time or year and many other factors. In some cases guaranteed shipping is available as an added service and additional fee. This estimated time applies to the contiguous 48 United States. Delivery time will be longer to Alaska, Hawaii, Canada, and anywhere outside the Continental United States. If part of the order or the entire order is not in stock, we will notify you and advise you of your options.
How We Deliver Your Order
We use some of the largest and most well-respected carriers in the industry. All they handle is this type of freight, which is referred to as "LTL" - Less Than Truckload quantities. These companies' rate of claims or damaged material is less than 1%. We use these companies to get you the absolute lowest freight rate on your order. These companies do have certain terms that you need to be aware of. The following are some of these terms and conditions. You can choose to have your order delivered to your home, a business, or you can pick it up at a designated freight terminal in your area. Usually, the charge for having the order sent to a business or delivered to a freight terminal is slightly less than to a home. If you choose this option, we will notify you as to the terminal location AFTER you make a purchase. You must have someone at the delivery location to help unload the order. Deliveries are "curb side". The driver's will not bring the material into your home. If you are handicapped or have no way of assisting the driver, please call our office and we will explain the extra fee to have the material unloaded. The freight carrier will usually contact you prior to the delivery. We will send you an e-mail listing the terminal phone number and a tracking number. If you have not heard from the freight carrier by the time you have received this e-mail, we suggest that you contact them to confirm the delivery date and time. The freight company will usually give you the date of delivery, and a time window which should be a two to six hour time span. Whoever is accepting the delivery must inspect it and sign for the order according to the Delivery Checklist we send you. We make it simple for you to work within these terms. We provide you with the tracking number and a terminal telephone number in order for you to track your order and schedule a delivery day and time that will be convenient for you. In most cases, the trucking company can narrow the delivery time down to a two- to six-hour window. You need to make sure that the order is inspected when delivered. We provide you with a detailed inspection checklist to follow. If you are not going to be the one accepting the order, you have to make sure that the person signing the order is capable of doing so. You cannot sign the paperwork and let the driver leave until the order has been thoroughly inspected. If there is any damaged material, it must be noted on the paperwork and retained in order for us to issue replacement material to you and for us to be properly reimbursed by the trucking company. We are referring to damage by the trucking company, not manufacturer defects. If there is any damaged material, we will reship your replacement for this material, as long as it was noted in the paperwork. And again anything you are requesting to be replaced cannot be used and be retained until we have filed a claim for the replacement cost.
General Notes
All flooring and tile sold by the carton is shipped via common carrier (trucking lines). We cannot send any flooring via UPS. For that reason with certain exceptions most all of the products we sell require a minimum $500. purchase. The exceptions would be certain items we sell by the piece such as mosaic sheet tile, etc. If you have any other questions or concerns, please reach us on our Flooring Hotline and we will be more than happy to talk with you.


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cute mare adoptables by ivyhazeWatch
©2013-2016 ivyhaze
these are auctions.
you may offer points & cash.
you may offer points & cash.
minimum increase is 100 points.
autobuy for #2 is 2500 points.
(the high prices are to encourage bidding!)
#1 was traded with ~ULTIMAREOne
highest bid for bat pony: n/a
OMGGGG! I love these!
I was wondering of you took points? I know this ended a while ago, but do you take them?
I want the one on the left
can i have one??
Is the bat pony still open? I'd bid 500 on her
sure! sounds great. just send the points and she's yours <3
Aw...too bad the batpony isn't still open...I would've given $5 for her >n<
I bid 200 on the bat if she's open c:
she's all yours, dear! just send the points <3
I'll send them right away, but turns out I have only 193 points lol. Is that ok ??
sorry for the late reply, but that will work just fine!
Hello again. Well, something came up, and I do not that amount. :/
Only 98, and I doubt you want that. If you do, I'd be happy to send them all, but again, if it's not what she's worth, then I guess she isn't mine. ;-;
Agh! Some thing came up. Is. 193 ok?
20 points for the bat :3
Is the bat pony still open?
can i have the wan with normal wings please please! please!! please!!! i do good caring!!!!
Is the bat one still open for auction
aw their so cute! XD
i've bid 600 incase you didn't know uvu
i bid 200 for #2 uwu
the highest bid is now $27!
on 2 I bid 100 points


text:
Your Source for Fat Burners
|Fat Burner Pills Home Page • Best Fat Burner • MoreNiche • Affiliates • Contact Us
Copyright © FatBurners (tm) All Rights Reserved. The copyright in the content of this website is the exclusive property of FatBurners (tm).
In accessing our Website, you agree that you may only download the content for your own personal non-commercial use.
This website should be considered an advertorial feature.


text:
We provide you with the most current jobs in Nigeria 2016. Find latest careers and employment opportunities available across various sectors in Nigeria. Also discover opportunities of Scholarships in Nigeria 2016. Welcome to Nigeria's most popular jobsite
Work as a freelance writer from Nigeria
Are you looking for job in Nigeria? With ThePensters you may work as a freelance writer even from Nigeria and make good money!
Wednesday, 2 January 2013
The Institute of Credit Administration (ICA) was established as a non-profit organization in 1992 and got its legal status as a body limited by guarantee under the law of Nigeria in year 2002. ICA was created in order to foster development of credit management in Nigeria and Africa, and to ensure that standards are set based on best practices in professional and ethical conducts, as well as provision of services geared toward enhancing skills and capacity building of those involved in credit functions.
The following vacancies exist in our Institute
JOB TYPE: Full Time
JOB FIELD: Finance
Applicant must be a graduate with good experience on the job; be able to present a good credit report and capable of interpreting audited account/financial statement of companies through application of ratios. Only a credit analyst who is able to write well and speak well in business and financial English should apply.
JOB TYPE: Full Time
JOB FIELD: Sales/Marketing
Applicant must be a graduate, very smart, lively with strong knack for marketing success and excellent knowledge of Lagos city.
An applicant who does not have the drive to succeed in today's marketing should not apply.
Please send CV to: firstname.lastname@example.com
DUE DATE: 9th January, 2013.
Subscribe to: Post Comments (Atom)


text:
Hi there,
I was just skimming through todays paper the Courier Mail and came across the editorial section.
There is an article written there which looks like I will have to type in because I can't find it online.
Share Road Responsibly
I drive a bus about 200 to 250km around Brisbane five or six days a week.
I always make sure that I give cyclists a wide berth.
Occasionally I receive a wave of thanks from a cyclist, but not very often.
However, the overtaking on the left, riding the wrong way in one-way streets, ignoring red lights, often with the legally required helmet hanging on the handlebar, does stretch the friendship with drivers.
Drivers don't hate cyclists, but they do resent their almost total disregard of the road rules, while reminding drivers of the cyclists' rights.
Published with this is the authors full name as well as their email address, which is a bit unusual.
Now I agree with the genearl gist of their statement except for the 'overtaking on the left' which is perfectly legal to do if you are a cyclist provided the vehicle you are overtaking is not turning left. Since the author left contact details, is it worth contacting them to point out their own lack of knowledge of the road rules pertaining to cyclists, especially since I agree with everything else he has said?


text:
Super Flop on Opening Night
Defending Champion Giants Stuck in Preseason Mode as They Lose to Cowboys
EAST RUTHERFORD, N.J.—The Giants' regular season, the defense of the Super Bowl they so improbably won last February, officially began just after 8:40 p.m. on Wednesday. The NFL had made sure America knew this. The 82,287 fans who started arriving at MetLife Arena in midafternoon knew this.
But the Giants, for at least half the evening, played like it was just the fifth game of the preseason. As the Cowboys beat the Giants, 24-17, the home team's shortcomings left them unrecognizable from the team that beat the Patriots in Indianapolis.
To coach Tom Coughlin, training camp will never be long enough—especially now that two-a-day practices are gone and the players have more days off. There will always be more his team could have worked on. Wednesday made that plainly apparent.
"Take a bite out of humble pie, that is what it is," Coughlin said. "It brings you back down to earth."
The pass rush, so often praised for its suffocating work last season, made little impact as the Giants allowed quarterback Tony Romo to complete 22 of his 29 passes for 307 yards and three touchdowns. Their efforts stopping the run weren't much better as DeMarco Murray picked up 131 yards on the ground. And the offensive line was allowed the Cowboys through to sack Eli Manning three times.
Yet the Giants had reason to be confident opening their campaign against the Cowboys. Their two victories against Dallas in November and January went down as mile markers of their championship season. But they showed none of that when they twice had chances to take control of the game in the first half.
A nine-play drive that made the Giants' offense look exactly as they had hoped—there were catches by Victor Cruz, Hakeem Nicks and Martellus Bennett, short gains by Ahmad Bradshaw and rookie David Wilson—ended abruptly when Wilson coughed up the ball on the Cowboys' 27-yard line. The explosive promise he showed in the preseason had eclipsed Wilson's biggest problem in college: his seven fumbles in 2011. Wilson didn't return to the game until the last minute of the half.
Their second opportunity came courtesy of their defense. Early in the second quarter, linebacker Michael Boley stepped in front of Kevin Ogletree to intercept a pass from Romo and return it 51 yards to within a sneeze of the end zone. A penalty brought the Giants even closer. But they squandered the next three plays and settled for a field goal to make it 3-0.
The Giants never took the lead again. Twice in the space of five minutes either side of halftime, Romo found Ogletree for touchdowns. The second, in particular, badly exposed the Giants' secondary as Ogletree flew past Corey Webster for a 40-yard gain.
Ahmad Bradshaw's 10-yard touchdown run in the third quarter pulled the Giants within four, but the Cowboys restored a 10-point cushion by hitting a field goal on their next drive. Only an excellent play by cornerback Michael Coe, who later hobbled off with a hamstring injury, denied Dallas more points.
Romo finally settled the game with a 38-yard touchdown pass on first-and-30 to Miles Austin. Austin leapt over Justin Tryon and Antrel Rolle and easily eluded both of them to stroll into the end zone.
Martellus Bennett's touchdown catch with 2:36 left in the game threatened to give Manning a chance to lead another fourth-quarter comeback—he had eight last season—but the Cowboys never gave the ball back.
"We gave ourselves a chance there at the end of the game," Coughlin said. "We just took too long to score."


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State officials are cracking down on commercial drives who drive drowsy. The goal of these inspections is to make sure commercial drivers are logging their time on and off the road.
It's called Roadcheck 2011. Josie West knows firsthand the tragedies that can happen when a person drives drowsy.
"We want them to think twice before they get behind the wheel, you know it's now summertime, and people are traveling, so if you see a rest stop, pull over. Think twice."
West's 8-year-old niece Ronshay Dugans died in an accident involving a restless driver. Marchuan Andrews was driving the cement truck that crashed into Ronshay's school bus.
The Florida Department of Transportation says driver fatigue is a common factor in many commerical truck and bus crashes.
Robert Rooney has been driving semi trucks for six years. Rooney says, "It doesn't take very long to wreck one of those, one slight drift off the road it's in the woods or you could kill someone going across traffic."
FDOT requires drivers to log their sleeping hours. If a log indicates a driver didn't get eight hours of sleep before their shift, the driver will have to fork over up to a hundred dollars in fines.
They'll also have to hand over their keys for up to ten hours. On Monday, officers expect to release the number of citations they issued in the three day sting.


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OLYMPIA, Wash. (AP) — An Olympia police officer has been wounded while helping serve a search warrant at a suspected drug house near Lacey.
KOMO reports the officer is part of a SWAT team.
Thurston County sheriff's Lt. Greg Elwin says when officers went into the home Monday morning, a man inside fired a shot that struck the Olympia officer in the arm.
He's being treated at St. Peter's Hospital in Olympia and is expected to be OK.
Elwin says the shooting suspect is in custody.
Information from: KOMO-TV, http://www.komotv.com/


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The Drama Machine - Papercraft figure by ViluVectorWatch
©2013-2016 ViluVector
I made The Drama Machine from Total Drama World Tour/Revenge of the Island/All-Stars. Hope you like it
Is it just me, or could they have waited a bit longer to reveal to the contestants that Alejandro was inside the robot? I mean, I'm fine with the way they did it, but imagine what they could've done with it...
that's true it would have been better cuz the robot could of helped the vultures win more
True, I agree with you! it was to quick...
Hey its great are you going to share the template!!?
It would be awesome if you put a paper Alejandro inside the robot.
Well, my brother made Alejandro. But he made him with cardboard, he's in other style. Btw, he doesn't enter in the robot :/
I looked at some of your art and it's really, really good!
Awesome papercraft!


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Apple mission statement: To the best of my knowledge Apple has never published a "mission statement," but I enjoyed this quote from Tim Cook of Apple regarding Apple's business philosophy, which is essentially an Apple mission statement:
There is an extraordinary breadth and depth and tenure among the Apple executive team, and these executives lead over 35,000 employees that I would call "all wicked smart." And that's in all areas of the company, from engineering to marketing to operations and sales and all the rest. And the values of our company are extremely well entrenched.
We believe that we're on the face of the Earth to make great products, and that's not changing. We're constantly focusing on innovating. We believe in the simple, not the complex. We believe that we need to own and control the primary technologies behind the products we make, and participate only in markets where we can make a significant contribution.
We believe in saying no to thousands of projects so that we can really focus on the few that are truly important and meaningful to us. We believe in deep collaboration and cross-pollination of our groups, which allow us to innovate in a way that others cannot.
And frankly, we don't settle for anything less than excellence in every group in the company, and we have the self-honesty to admit when we're wrong and the courage to change. And I think, regardless of who is in what job, those values are so embedded in this company that Apple will do extremely well.
Breaking down Apple's mission statement (business philosophy) and this quote from Tim Cook, these lines really stand out for me:
Thats sounds an awful lot like a corporate mission statement to me, and a very interesting one at that. If that's the Apple mission statement, I like it.
Here's a nice article about Tim Cook, should you happen to be interested in learning more about him.
Not really a "mission statement", more a list of company values. Nice post and breakdown though. Thanks for sharing!