text:
|Publication number
|Publication type
|Application number
|PCT number
|Publication date
|Jun 24, 2008
|Filing date
|Oct 21, 2002
|Priority date
|Oct 22, 2001
|Fee status
|Also published as
|Publication number
|Hans Trinkaus, Karl-Heinz Kuefer
|Original Assignee
|Fraunhofer-Gesellschaft Zur Foerderung Der Angewandten Forschung E.V.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (10), Non-Patent Citations (11), Referenced by (27), Classifications (13), Legal Events (3)
|External Links: USPTO, USPTO Assignment, Espacenet
This invention relates to the technical field defined above, and alternatively a radiation dose distribution on targets and risk areas or a treatment plan optimization in a large quantity of suitable problem solutions. In addition to the technical field defined above, this invention can also be used for selecting an "problem solution" consisting of multiple characteristic values from a plurality of possible problem solutions.
In conformational radiation techniques, a three-dimensional dose distribution is the goal to maximize the effect in a tumor and minimize the probability of adverse effects. The history of radiation therapy shows that greater treatment success results from introducing improved dose distributions. In the area of the torso and to some extent in the area of the head and neck, however, there are a number of target volumes which cannot get be irradiated with a high dose that conforms to the target volume because of their irregular concave shape and their direct proximity to high risk organs, even using modern techniques currently available in the clinical field such as 3D treatment planning and the use of multileaf collimators in front of a radiation head (see Bortfeld, "Dose conformation in tumor therapy with external ionizing radiation," dissertation, University of Heidelberg (1995) and Brahme, "Treatment Optimization Using Physical and Radiobiological Objective Functions," Radiation Therapy Physics, ed. Smith, Springer, Berlin 1995).
Due to the development of inverse therapy planning with open fields and intensity-modulated radiation therapy (IMRT), the situation has changed fundamentally in recent times. Inverse planning yields optimized dose distribution in the patient to a certain extent. In conventional therapy, field weights, wedge filter geometries and incident beam directions are determined but in IMRT intensity-modulated fields are determined. Theoretical planning comparisons and preliminary clinical experience have shown that greatly improved dose distributions can be achieved in the sense of conformation radiation therapy by using these new methods, especially in serious cases.
Inverse therapy planning uses a weighting function which assigns a single score as a quality measure to each radiation plan (see Bortfeld, Stein, Preiser, "Clinically Relevant Intensity Modulation Optimization Using Physical Criteria," Proceedings of the XII th ICCR, Salt Lake City 1997, eds. Leavitt and Starkschall, pp. 1-4 and Preiser, Bortfeld, Hartwig, Schlegel, Stein, "A New Program for Inverse Radiotherapy Planning," pp. 425-428, loc. cit.). A radiation plan in its full complexity is characterized here by a single number. A planning system then selects a radiation plan having the best score out of many plans.
In general, however, many risk structures with different relevance for the quality of life of the patient must be taken into account in such planning. Furthermore, the goal of administration of a high and homogeneously distributed dose in the target volume is in contradiction with maximum protection of risk structures. These different goals, some of them contradictory, are taken into account by defining weighting functions for each organ (i.e., for target volumes and risk structures) scaled with weighting factors and then added up. The result is the above-mentioned (single) score for the entire radiation plan.
In practice, a significant problem with this type of inverse planning is in defining the weighting factors for the relevant structures. These factors cannot be interpreted clinically, i.e., a clinical evaluation and/or arrangement of organs cannot easily be converted to a comparably arranged list of weighting factors. Therefore, the weighting is determined by trial and error, which should actually be avoided through the use of inverse planning.
This means that even in inverse planning, certain optimization steps in general are performed with different weighting factors until arriving at an acceptable plan. This is extremely time-consuming and is partially responsible for the relatively low clinical acceptance of inverse planning so far. One example from experience with inverse planning at the DKFZ in Heidelberg illustrates this state of affairs. A summary of planning times for the last 50 IMRT patients treated revealed that inverse planning took 2 to 3 hours per patient, with three to 15 plans being determined for each patient. In other words, the weighting factors were readjusted two to 14 times, with the computations being performed again and evaluated each time until arriving at a satisfactory result. However, as experience is gained in this field, group problem solutions with which adequate results can be achieved, including weighting factors and other parameters, will no doubt be found for certain standard cases. In complex cases and new cases, however, the time-consuming trial-and-error method described here will be unavoidable.
Another problem with inverse planning in its current form is the statistical nature of the planning results. The optimum solution for a fixed preselected set of weighting factors does not provide any information regarding whether, for example, an increase in dose in the target volume would be possible if higher doses were allowed in certain risk organs.
These two problems—the great amount of time consumed and the statistical nature of the problem solutions—have resulted in the "ideal plan" frequently not being found for a patient even using inverse planning methods. The main cause of these problems is the multiple criteria in the statement of problem—taking into account, i.e., considering dose distributions in target volumes and risk structures but this is transformed into a problem with a single criterion by introducing artificial weighting. This arbitrary restriction of the view to a single number also gives a physician a chance to perform dynamic changes in planning after the optimization run.
Ideally after conclusion of the optimization process, independent partial weighting functions, each belonging to the respective target volume or risk organ, should be considered and modified simultaneously in order to be able to determine a radiation plan that is optimum for the patient and to do so by a process that is both dynamic and interactive and in particular is also rapid and simple.
A preferred reference value for the evaluation of radiation effects is the biologically effective equivalent uniform dose (EUD) which is described with the help of an organ-dependent convex combination of the maximum achieved dose in the entity in question and the corresponding mean dose (max and mean model), see Thieke, Bortfeld, Kuefer, "Characterization of Dose Distributions through the Max. and Mean Dose Concept," submitted to Acta Oncologica (2001).
Computation of optimum dose distributions thus constitutes a multicriterial task, whereby radiation doses in different mutually independent structures (target volumes and risk volumes) are considered. The additional requirements for a high radiation in the target and the lowest possible doses in the surrounding risk organs are inherently contradictory. Therefore, the goals should be considered separately from the optimization process and the inverse radiation planning problem with a given radiation geometry should be formulated as a multicriterial optimization task. For each relevant tissue entity—whether target volume or risk organ—mutually independent goals are defined.
Thanks to EUD modeling and also with the help of the max. and mean model, the planning problem for radiation therapy can be represented in a mathematical classification as a multicriterial linear optimization problem whose target functions seek to simultaneously minimize the biologically active EUDs in the risk areas and under irradiation of the target volume.
It can be seen from the description of the state of the art that a therapy planning, i.e., a specification of radiation doses in the treatment of unwanted tissue requires an enormously complex and time-sensitive procedure with a multitude of optimization steps, different direction factors until finding a suitable plan which can still be evaluated can be evaluated differently in its optimum selection in subjective evaluation by different people treated with said plan. Each treatment time consists of a plurality of irradiations from different directions and with different doses and even with a different intensity distribution during a radiation section. Treatment is repeated after an interval of time so that the concept of therapy includes not only a single treatment but also a recurring treatment at greater intervals of time. For any treatment or therapy, controlled variables or control commands are necessary in the sense of adjustment parameters for the radiation head, the instrument and many peripheral instruments so that the (preset) therapy can take place in an automated fashion within a short period of time.
The specification of these characteristic parameters for structural objects or technical instruments should be placed in the forefront for the following solution to this problem. A solution to a problem in the case of a radiation device should be understood to include not only an overall therapy but also individual time segments of an overall therapy based on intensities and directions and composed technically of a plurality of controlled variables or commands which are based on the radiation device as a representative of operative devices in order to obtain the radiation doses in the target volume corresponding to the solution thereby found (as the target or tumor) with the desired high dose and in the risk volume (such as endangered organs in proximity to the tumor) with the lowest possible dose when subsequently implementing the therapy.
The same thing is also true of measurable or describable technical properties of a structural object included by a solution as multidimensional (multiple) descriptions.
This problem is solved with this invention according to Claims 1, 16 and 17 as well as 18 and 19 and/or 20 and also according to Claims 42 or 41.
It is assumed here that relevant (mathematically "efficient") problem solutions to the problem are calculated in advance or are predetermined and can be computed by using a known strategy and separated from the actual application. The use of high performance computers makes it possible to solve a multicriterial problem and to discover suitable settings of the radiation head, for example, and suitable intensity distributions for each of the predetermined incident beam directions in order to as a result arrive at the dose values representing the highest possible radiation dose for the target volume as the target and the lowest possible radiation dose for the one or more risk volumes in proximity to the target or in the path of the radiation to the target, each depending on the organ, even lower doses being preferred.
Technical properties of a technical object such as services, lifetime, height and weight can also be improved jointly in a "multicriterial" process.
The plurality of possible problem solutions to the problem can be stored and is represented as characteristic values for the tissue volumes (target and risk) to be taken into account in the computation through their respective effects in the sense of dose values for example. These individual doses are not combined in a scalar, not even with individual weighting factors but instead remain as a vector in the sense that each problem solution has multiple characteristic values for the individual tissue volumes.
These problem solutions presuppose that these dose values are within the organ-dependent acceptance ranges. Thus a plurality of possible problem solutions are available, one being selected on the basis of the fact that at least a plurality of the stored problem solutions, preferably all of them, delimit or form a planning zone within which an "optimum solution" (compromise solution) can be discovered by a visually simple and reproducible method.
Accompanying information may be provided with a problem solution that has been found and may change with a change within the planning area and may be represented in addition to the planning area, yielding the respective visualizations of isodoses (by layers in transverse sections) or dose-volume ratios that characterize which amount of the volume of an organ or target receives which radiation intensity in Grays (gy). These two forms of representation are customary and can make the problem solution, which consists of multiple radiation doses for risk organs and targets, found on the basis of the planning zone, visually discernible in their effect.
A more general consideration of this invention yields a much broader range of application than that of radiation therapy. This invention can prepare other planning functions with the planning zone described here and a polygon movable therein, (having been entered) as a navigation body, such as designing other technical instruments or technical objects such as engines for automobiles or for aviation designs in which the technical properties of these objects must often fulfill divergent criteria. For the engine of an automobile or another motor vehicle, the displacement, power, rotational speed and consumption may be technical parameters, but in addition, economic parameters such as image or benefit may also be taken into account. These parameters are multicriterial on the whole and have divergent development directions. For example, fuel consumption does not necessarily decrease when displacement is increased. When high costs are reduced, one cannot expect a large power range. When the stated object is an aircraft, for example, parameters such as lightweight construction, material strength, thickness of the material used in the wall area and load capabilities constitute the technical side, whereas cost, safety and lifetime are other criteria which tend to be more economically oriented but definitely have an influence on technical parameters as well. A greater expenditure for materials has a positive influence in the direction of lifetime and in the direction of safety but has a negative influence with regard to cost. Construction time can also be of influence, so that an object whose technical properties can be represented on the axis sections in the planning zone by representative values can be planned better. Additional applications are suggested in the planning of such objects as a sewage treatment facility or a refuse incineration plant where such technical criteria as space, throughput and pollution burden can be used as suitable properties (in the sense of technical parameters) whereas site determination, shipping distance and cost are economic factors but they can also have an influence on the technical factors, i.e., the technical factors alone do not determine the design and form of such a large-scale installation. This would even allow for planning of such difficult systems as the construction of a soccer stadium, where not only the site location but also other technical implementation criteria such as traffic connections, cost sharing and nature conservation regions (flora/fauna habitat regions) are taken into account in the planning or decision-making. This object can also be described by technical properties which are assigned individual axes as part of the planning zone and a line body which encloses this planning zone allows a modification of the individual technical properties for discovering one optimized solution from a multitude of problem solutions that are available.
Such technical objects which are themselves work objects, i.e., not only design objects, but also operative devices and equipment such as robots, lathes or automated assembly systems can also be described with regard to their technical properties so that optimized planning of such equipment is feasible and comprehensible. A great variety of problem solutions are therefore no longer damned to incomprehensibility but instead may form a basis for navigation on the part of the user who is then able to navigate easily among the various possible problem solutions and in doing so can easily discover the optimum values for his or her given concept horizon. From the selection thus made, the technical parameters can be taken over directly and used as the basis for further design (object design or construction of the design object) or used as the basis for further construction of operating equipment. In a special case, use of preparation of specifications which arise from the planning preparation described here is also possible.
This invention avoids the problem requiring new calculations that are widely separated in time and it is assumed that a number of advance calculations are already available, but the multitude of possible problem solutions does not overload the person performing the work and determining the result but instead presents the results to him in a plausible and visual form so that he apparently has only to compare a very small quantity of data. By varying an input navigation line body or a navigation polygon for the case when the planning zone is formed as a polygonal surface, it allows an evaluation of a polygonal form whose corner values are formed by the technical properties or by dose values for the risk areas and the targets. This polygon does not depart from the planning area and when one of the corner values is altered, the entire polygon changes within the planning area.
This is based on the fact that only one problem solution is depicted cohesively but no more than one problem solution is imparted visually to the observer in a stationary display. All the problem solutions are available for access in the database but they are not displayed as problem solutions. They are merely displayed to the observer due to the fact that on the whole the planning area represents the combination of all problem solutions that would be possible hypothetically, but the environment of the planning zone cannot be selected. The environment may be a polygonal body inside the inner edge of the planning zone plus a remaining area outside of the outer edge of the planning zone. This is possible in both 2D and 3D.
A change on one of the axes, e.g., a change on the weight axis or on the risk axis, toward a higher value, which is actually desired, changes the problem solution displayed in therapy planning so that the other dose value for the risk organs also change. In most cases it is such that not all wishes for the maximum dose for the target and minimum dose for the risk organs can be met at the same time and an optimum should be sought, but this is a highly subjective matter. Reducing radiation doses on very sensitive risk organs, for example (bone marrow or organs of sight) may result in other risk organs receiving higher radiation doses and the target also receiving a higher radiation dose—which is actually desirable. Other risk organs may be less sensitive, e.g., the lungs, so that a higher radiation dose does not do as much damage there as it would to more sensitive organs.
The user is completely free to make subjective choices; a visual change in the line body input allows qualification of the problem solution displayed as more or less suitable at a glance.
It should be emphasized that multiple problem solutions cannot be linked together in the display but instead only one solution is selected on the basis of the cohesive navigation line body as a polygonal structure that has been entered and whose points of intersection with the axes represent the characteristic values of the radiation dose of the vector described above or the score vector or radiation dose vector of a problem solution.
The same thing is also true of the technical properties of other equipment or technical objects (entities influenced by design).
A change to displaying another problem solution can preferably take place in a fluid manner following a transition state in which the one problem solution is faded into the other solution within the planning zone (Claim 8). The quality of a change can be evaluated here by the change in the navigation body input, which as such preferably does not have any jumps.
Each of the several axes forms a radiation dose scale for a tissue volume, for example, such as the target volume and the at least one risk volume, preferably two or more risk volumes. These axes are applied in a visual form to a display device such as a display screen and are referred to below as the risk axes and the target axis. No two axes coincide and all axes arranged side-by-side form an angle greater than zero between them. Adjacent axes do not run parallel in order to be able to span at least one area (2D consideration).
Characteristic values are shown on each axis and the total number of problem solutions stored defines a particular axis section on each axis. This axis section is an acceptable interval which has an upper end and a lower end predetermined by the problem solutions and their characteristic values of radiation doses based on the particular risk axis or target axis affected.
The acceptance intervals define the planning zone when their particular upper limits and lower limits are interconnected. To illustrate the planning zone with respect to the environment, this is depicted differently from the environment.
This offers the user of the planning tool as a system or method or visual representation (Claims 17, 18, 43, 44) the possibility of discovering within the planning zone a navigation polygon or the line body described above which is most suitable for him personally for a subsequent therapy or an entity that is influenced by design. An enormous volume of possible problem solutions is thus easily made available, with an even greater number of technical parameters behind them for the settings of the technical equipment, in particular radiation therapy equipment being investigated in the sense of a property distribution or a dose distribution in the organs and risk areas whereby the actual therapy is not yet taking place but instead is merely being planned, said planning being (far) before the actual treatment takes place and thus it does not take place directly concurrently with this therapy (Claim 10).
Certain characteristic values on the risk axes and the target axis can be defined or fixed in order to be able to be concerned mainly with the change in the remaining characteristic values on the other axes (Claim 12). To simplify this change and for a visual representation of the restriction on the problem solutions that are now possible, a (two-dimensional) section of the planning zone can be considered separately. This is done by separating it visually so that it is shown as lighter than the remaining planning zone, for example, or in a different color. All the problem solutions which have an inferior characteristic value as the dose which is on the axis on which the characteristic value has been fixed are then locked out (Claim 12).
This also results in reductions or eliminations in the remaining planning zone in which the locked out problem solutions extend due to the connection of the points on the risk axes and on the target axis.
Multiple axes may be fixed with the respective characteristic dose values so that multiple sections can also be selected from the total planning zone.
The individual sections selected out of further planning (and the planning zone) may also be added again (Claim 13).
In the case of a (planar) polygon, this blockage is to be equated with a fixation of the crown point and all characteristic values between the crown point and the exterior edge line, i.e., the bordering polygon on the outside are blocked.
The problem solutions stored in the database may preferably be pareto-optimal problem solutions. It is time-consuming and pointless to depict all possible problem solutions. However, it is appropriate to calculate a suitable representative system from the quantity of (mathematically) efficient problem solutions. In practical implementation, such a representative system usually consists of 100 to 200 or more problem solutions which are stored in the data base and can be made available visually. A rapid selection from the multitude of proposals in the database is possible despite its extent and can be set up for a patient individually or planned for him in advance to take into account in accordance with the course of his or her disease and the personal subjective perception on the part of the operator making the decision.
The same thing is also true of planning the technical properties of a design object.
The pareto-optimality is based on the assumption that the multicriterial optimization problem is to be solved in such a way that the target function for radiation therapy seeks to minimize a predetermined (biologically active) EUD (equivalent uniform dose) in the risk areas and at the same time to minimize underirradiation of the target volume (the target), whereby not all the predetermined values (the upper limit values as desired values for the target and the lower limit values as desired values for the risk area) can be met at the same time, but approximately optimized problem solutions can be found in an overall view in the case of pareto-optimality.
A plurality of these problem solutions then advantageously form the content of the database described above which is individualized via the planning to only one problem solution which is to be applied subsequently.
The general applicability of the technical concept of the planning tool described above is illustrated by the independent claims (Claims 40, 41), which can also be regarded as a planning diagram (displayed on a display screen) or as a method of displaying such a diagram. Likewise as in the possible therapeutic uses of the results found here, it is not the planning itself that is the object of the claim but instead making possible such planning by providing a suitable tool with which this planning can be implemented.
Exemplary embodiments illustrate and supplement the invention.
The application contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.
The planning for a therapy which is selected here as an example and is not directly related to the planning but instead proceeds at a different time and place is illustrated in the survey diagram in
Once a problem solution has been found in the database—with the problem solution being a compilation of a plurality of controlled variables of a radiation therapy device, for example—it is transmitted via the control line 1 a to another interface 2 as part of the control system 5, where it can be stored temporarily. It can then be relayed digitally to another control and monitoring device 10 of the radiation therapy device via control lines 6. It can also be transmitted via another data line 7 to a supporting device 9, which can be lifted or rotated. The supporting device 9 for supporting a patient can be rotated at an angle β (beta) and can be moved in height h and in the longitudinal direction z. The radiation therapy device consists of a fixed system part 10 and a second part 11 which is pivotable about the axis 100 and carries a radiation head 12 which is directed at a patient who is hypothetically on the supporting table 9. With the movements described here, the radiation head can be adjusted in several directions α, to which end corresponding controlled variables are relayed to it. A radiation dose of the radiation head 12 is explained with the multileaf collimator according to
If all the characteristic values for one treatment session have been transmitted and set in the instrument, the treatment can begin but that is not the object of the present patent.
The problem solutions stored in the database are pareto-optimal problem solutions in this example, which constitute a diminution of an optimum solution in order to be able to find any problem solutions at all that are acceptable given the contradictory goals in a multi-criteria system.
A pareto-optimal solution is a compromise between under-irradiation and over-irradiation, taking into account whether it is a risk organ or the target organ. In the former case, maximum values must not be exceeded and in the latter case the values should not go below the minimum values and at best maximum predetermined setpoint values should be obtained without causing a burden on the risk organs that goes beyond the limits established.
Three risk organs are assumed below with a target volume T as illustrated in a transverse section in
To do so,
The effect of a head 12 modulated in its radiation intensity with any desired radiation such as photons, electrons, heavy ions or protons is illustrated by the schematic diagrams in
A computer system 20 according to
The starting points for the advance calculation of problem solutions with "score vectors" in the sense of radiation dose for the individual organs and risk areas are calculations of pareto-optimal problem solutions by the computer system 20 with specification of at least the following values:
For example a previously known treatment plan for a certain patient having a tumor that has already been diagnosed may be used as the starting problem solutions E of the dimension p at the beginning of the calculation of the pareto-optimal problem solutions in computer unit 20. An empirical problem solution may also be used as the starting point, as can a standard problem solution. Starting with this, taking into account the boundary condition D1 of the dimension n and the physiological parameters through computer tomography CT of the dimension m, the pareto-optimal problem solutions are calculated, these problem solutions having been fed into the database 1 via the data line 21 and the unit 22 over the data line 23 after completing the advance calculations, leading to the visual display that is described below.
Although any number of target volumes may be used, the description will be based on a target volume T as the target. Although the operation will also function with (just) one risk volume h3 in addition to the target volume T, this example will be illustrated on the basis of three risk volumes in the sense of three organs h1, h2 and h3. Another way of saying this is that at least two volumes are to be irradiated, one of them receiving a much higher radiation dose than the other. If there are multiple risk organs, then multiple risk volumes are to be exposed to a low radiation burden and one target volume is to be exposed to a considerably higher radiation burden.
Examples include approximately 33 Gray (gy) for a lung, slightly higher for tissue without an organ structure, and for organs at greater risk such as the spinal cord at 25 gy or less than 10 gy for optic nerves. These limit values enter the computation by computer 20 through the parameters D1; the computer performs computations with volume elements (voxel) and determines the total burden on an organ or the target on the basis of the burden for the individual volume elements, which can be compared with a calculation over finite (spatial) elements.
This does not show controlled variables but instead depicts a "problem solution" of a radiation therapy plan which itself includes a plurality of said controlled variables and control commands, as already mentioned above for the radiation therapy device. This information which is stored in database 1 is not depicted but instead the score vector is depicted in the sense that characteristic values of radiation doses for a target volume T and for at least one risk volume, in this case three risk volumes h1, h2, h3, are used to define the planning zone. The planning zone 40 graphically outlines the plurality of technical controlled variables that stand behind each problem solution and does so with the characteristic values which correspond to the radiation doses, said problem solution consisting in the example presented here of four radiation doses 50, 51, 52 and 53 which are assigned to the three risk organs h2, h1, h3 and to the target T for this solution.
In the case presented here, a linear connection of the four characteristic values described yields a two-dimensional polygon NP, which forms as a navigation line body a quadrilateral within which the planning zone which is depicted here as an area and is bordered on the inside and outside by interior and exterior polygons Pi and Pa respectively. The navigation polygon NP=P1 is inside this region. This region may also be three-dimensional and it need not necessarily have a polygonal structure but in the case described here this structure is advantageous with regard to its easy traceability, with a complex multitude of problem solutions standing behind it.
In the example described here, the navigation polygon NP is defined by the four points 50 through 53. Each point is located on one of the axes 30, 31, 32, 33, with the risk axis 30 pertaining to the target T being between doses of approximately 72 gy to 80 gy. The two risk axes extend over lower radiation doses between 25 gy and 28 gy for h3 and 33 to 37 gy for h2 and h1 each. The axes shown here are such that no two axis are identical and adjacent axes, e.g., 32 and 31 or axes 30 and 33 do not coincide, so that the planning zone 40 can span the distance between the interior polygon Pi and the exterior polygon Pa.
Within this navigation zone, the characteristic value 50 for the target on the axis 30 to the characteristic value 52 for the risk organ h2 are connected by a straight line as the distance 62. The connection to the other points 51 and 53 is accomplished accordingly, each being connected to the adjacent axis and the characteristic quantity given there for the radiation dose of the solution being depicted at the time. Thus as an example the connecting distance 63 between the radiation doses 52 and 51 is represented on the two risk axes h2 and h1. The other connecting distances are derived from the relationship and are not labeled separately.
Only section is shown for the radiation axes each of which contains a scale; this section includes at least the section in which characteristic values for radiation doses from the stored problem solutions of database 1 are located. All the problem solutions taken together or at least a significant portion of the available problem solutions generated previously by a computer 20 according to
It should be pointed out here that this external line need not constitute a solution but instead is composed of points which originate from different problem solutions. A solution is merely represented by the fact that an internal navigation polygon NP, represented here as P1 for one solution, is depicted visually. The visual representation is accomplished with a discernible contrast in comparison with the color or the gray value of the navigation zone which is in turn shown that it is differentiated in color or in terms of the gray value or otherwise perceptibly differentiated from the exterior space which is not in question or the interior space which is also not in question.
The two regions of the visual display which are considered together as the surrounding area are characterized as 45 and 45 a in
It can be seen here that the respective interval a30, a31 has been formed no the axes 30 and 31 respectively from characteristic values of problem solutions which are available in database 1. The same thing is also true accordingly for the axes 32 and 33 and the intervals a32, a33. These intervals or sections of the axes 30 to 31 which are referred to as acceptance intervals form the specifications for the navigation zone 40 which is plotted as an area and is depicted as being gray in comparison with the environment 45, 45 a.
The navigation polygon NP here is shown as a polygon within the zone and is emphasized in comparison with it. Only one solution is depicted here which can be referred to as the starting solution; starting from this solution a user can make a change in the solution depicted within the context of the following
To do so here one should start with the characteristic values 53 a shown according to
To rephrase technically, this solution means that a radiation dose of 75 gy has been allocated to the target for the case of selection of this solution, while the risk organs will receive the radiation doses indicated by them accordingly. An upper limit value of 30 m on the target axis would be desirable corresponding to 76 gy and a lower (internal) limit value on the other risk axes, although these cannot both be achieved together in one solution according to the pareto-optimal problem solutions for the stored quantity of available problem solutions described previously. The desired radiation value of 80 gy on the target axis has also been eliminated because this could not be retained within the problem solutions calculated in advance without violating the other boundary conditions of the risk axes.
The upper and lower limit values 30 m and 30 n are target axis 30 should also be explained where corresponding upper and lower limit values can also be found on the risk axes 31, 32 and 33. With these limit values, the acceptance interval is limited on each axis so that all characteristic values of radiation doses come to life within or at least on the edge line of the planning zone 40. From the starting illustration of
All the available and possible problem solutions are present in database 1 and were stored there in advance. They are selected out individually in the course of the following
However, before describing the way to leave
These different radiation doses on the transverse plane may be characterized with colors, whereby deviations in the lower direction can be obtained in the case of risk area R and deviations in the upper direction can be obtained in the case of target T with the same colors. Therefore the particular target direction is depicted with the same color while the other deviations are depicted with another color but can also be characterized with the same color. Reference is made to the color display of
The assignments of 0 to 80% with regard to the risk areas h1, h2 and h3 are characterized with the same color as the target above 120% on the accompanying
The planning session and the planning tool work in the direction of reducing the dose of h3 and increasing the dose of T in the case of the improvement on FIG. 6 so that for example the corner point 53 a can be shifted by the user so it is discernible and sensitive on the image representation that with the help of a control tool such as a mouse or a pad 4, this spot can be picked up and shifted in any direction desired so that for example it comes to rest at 53 b at a radiation value of 25.5 gy with the planning zone 40 unchanged and also with no change in the scaling of the axes 30 to 33.
This corresponds to a direction to another solution to be displayed although it need not necessarily have a corner point at the point 53 b as shifted by the user. The planning tool, i.e., the hardware or software standing behind it in the control unit 5 allows a point for this which is closest to the point to which the user has shifted the point 53 a on the axis 33. To this end, sorting according to the h3 value and selection of the most proximate point are suggested for a database. On the basis of the predetermined direction, this corresponds to a narrowing of the beginning of a new navigation polygon which is to be formed and is depicted here as already having been formed as p2 in
The other points 50 b, 52 b and 51 b are determined according to a search structure so that all these three other points are as close as possible to the previously valid radiation values on the same axes, namely in this case the values 50 a, 52 a and 51 a in
It is also possible to modify one of the other characteristic values 50 a, 52 a and 51 a from
With regard to the change in sequence in the side-by-side displays of the isodoses and the dose/volume histogram, a corresponding display like that in
It is then also desirable based on
The transition from
A steady or continuous change in one polygon to the next polygon functions so that the user is able to visually experience or observe how a polygon P2 changes on the whole starting from a "distorted" point 53 b to point 53. The two lines starting from point 53 begin from the old polygon P2 starting at point 53 and changing over to the lines of the new polygon, which is equivalent to a type of blurring effect or a steady transition effect which should take place so long that it is also visually perceptible. In a transition phase, the first stationary display of
All the visual lines of the polygon P2 within the planning zone 40 are cross-faded from the left into all the lines of the polygon P3. The time of this cross-fading is a transition phase in which not only one solution from the database but instead two sections of two problem solutions are displayed from the database simultaneously but not completely and instead portions are being changed continuously.
A distortion of point 53 b in the other direction (toward 53 a) causes the blurring effect to begin in reverse at point 52 b (from the right).
The technical function of the cross-fade ensures easier graphic comprehensibility by the user and gives the feeling of direction and quality of change without having to switch back to the previous old point again each time in order to detect the difference by a back-and-forth movement of points 53 and 53 b.
A further improvement should not be desirable from
This blocking is achieved by clicking on the section 33 a, which is assigned to the axis 33. According to the diagram in
Clicking on the sensitive area of the image 33 a blocks values that are inferior to those already optimized with the setting 53 as the characteristic value for a respective radiation dose. This yields a change in the planning zone 40 because now this excludes all problem solutions which have dose values on the scale 33 that are between the point 53 and the maximum possible point of the upper end of the acceptance interval a33 of
This is shown more clearly in
This therefore yields a reduced planning zone 42 which comes to lie within a new outer outline Pa′ as shown on a larger scale in
It is self-evident that the blocked region 41 can also be activated when the locking function is activated again by clicking on the section 33 a of the image in
For the following description, a further improvement on the T axis 30 derived therefrom in
The control values for a radiation therapy plan corresponding to these settings, i.e., the solution thus found can be used subsequently for therapeutic purposes after being transmitted over the control lines 6, 7 into the therapy device, corresponding to a selection of controlled variables for the setting of the radiation head at the different instrument angles α1 and thus also corresponding to a predetermined intensity distribution as shown schematically in
It is possible to move forward or backward within the log data file by using the recorder button in section 70 of the screen display. In this way new starting points for new optimization searches can be selected, corresponding to a solution discovered previously, stored temporarily before wanting to perform further optimization in a direction which was assumed at that time to be reliable, which would then not lead to any reasonable result. It is helpful here to return to the previously stored starting point as the NP.
In addition to the one log data file described here, a sequential log data file may also be carried along automatically, tracking each development step of the NP in the planning zone and recording the results so that by forward and backward switching and beginning and end switching areas in the function section 70, it is possible to achieve a control. This facilitates retrieval of problem solutions seen previously.
Although first a point of emphasis on the section depicted in
A physical therapy setup is also stored in the background and may if necessary be included in a physical planning window under "information."
Although the display according to
On the basis of the representation as volume, the third dimension is also depicted in this graph. The isodose representation is one of a plurality of possible two-dimensional cuts. A strictly two-dimensional representation in the planning zone 40 is the starting point for the two auxiliary representations described above.
|Cited Patent
|Filing date
|Publication date
|Jun 18, 1993
|May 23, 1995
|Wisconsin Alumino Research Foundation
|Method for radiation therapy planning
|Feb 2, 1994
|Jun 18, 1996
|Swerdloff; Stuart
|Method and apparatus for radiation therapy
|Mar 21, 1996
|Feb 11, 1997
|Llacer; Jorge
|Method for optimization of radiation therapy planning
|Jun 28, 1996
|Sep 2, 1997
|Systems Medical Systems, Inc.
|Optimization of an intensity modulated field
|Jul 9, 1999
|Apr 24, 2001
|Mitsubishi Denki Kabushiki Kaisha
|Irradiation dose calculation unit, irradiation dose calculation method and recording medium
|May 18, 2000
|Jan 28, 2003
|Computerized Medical Systems, Inc.
|Radiation therapy and real time imaging of a patient treatment region
|Aug 6, 1999
|May 6, 2003
|Wisconsin Alumni Research Foundation
|Method for preparing a radiation therapy plan
|May 13, 2004
|Apr 11, 2006
|Jorge Llacer
|Method for assisted beam selection in radiation therapy planning
|May 16, 2003
|Feb 12, 2004
|Barbara Ann Karmanos Cancer Institute
|Method and apparatus for combined diagnostic and therapeutic ultrasound system incorporating noninvasive thermometry, ablation control and automation
|May 13, 2004
|Nov 17, 2005
|Jorge Llacer
|Method for assisted beam selection in radiation therapy planning
|Arellano, A. R., et al., "Clinically oriented inverse planning implementation" Proceedings of the 22<SUP>nd </SUP>Annual International Conference of the IEEE Engineering In Medicine and Biology Society (Cat. No. 00CH37143), Proceedings of the 22<SUP>nd </SUP>Annual International Conference of the Engineering in Medicine and Biology Society, Chic, vol. 3, pp. 2071-2074 (2000).
|Censor, Y: "Mathematical aspects of radiation therapy treatment planning: continuous inversion versus full discretization and optimization versus feasibility", Computational Radiology and Imaging: Therapy and Diagnostics, Bd. 110, pp. 1-12 (1999).
|Ehrgott et al. "Radiation therapy planning by multicriteria optimisation".
|Hamacher et al. "Inverse radiation therapy planning-a multiple objective optimisation approach", Technical Report (ITWM), pp. 10-14, Dec. 1999.
|Hamacher, H. W., "Inverse radiation therapy planning-a multiple objective optimization approach", Technical Report (ITWM), pp. 1-14 (Dec. 1999).
|K. Preiser et al., "A New Program For Inverse Radiotherapy Planning", XIIth ICCR May 27-30, 1997, Salt Lake City Utah USA, pp. 425-428.
|K. Preiser et al., "A New Program for Inverse Radiotherapy Planning", Xllth ICCR May 27-30, 1997, Salt Lake City, Utah U.S.A., pp. 425-428.
|Küfer, K. H., "A multicriteria optimization approach for inverse radiotherapy planning", Operations Research Proceedings, pp. 3-7 (Sep. 2000).
|Qiuwen, Wu et al., "IMRT optimization based on the generalized equivalent uniform dose (EUD)", Proceeding sof the 22<SUP>nd </SUP>Annual International Conference of the IEEE Engineering in Medicine and Biology Society (Cat. No. 00CH37143), Proceedings of the 22<SUP>nd </SUP>Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Chic, vol. 1, pp. 710-713 (2000).
|Thomas Bortfeld et al., "Clinically Relevant Intensity Modulation Optimization Using Physic Criteria", XIIth ICCR May 27-30, 1997, Salt Lake City Utah, USA, pp. 1-4.
|Thomas Bortfeld et al., "Clinically Relevant Intensity Modulation Optimization Using Physic Criteria", Xllth ICCR May 27-30, 1997, Salt Lake City, Utah, U.S.A., pp. 1-4.
|Citing Patent
|Filing date
|Publication date
|Feb 29, 2008
|Sep 22, 2009
|Accuray Incorporated
|Method for automatic anatomy-specific treatment planning protocols based on historical integration of previously accepted plans
|Jul 21, 2006
|Oct 27, 2009
|Tomo Therapy Incorporated
|System and method of generating contour structures using a dose volume histogram
|Feb 16, 2010
|Sun Microsystems, Inc.
|Using interval techniques to solve a parametric multi-objective optimization problem
|Jul 21, 2006
|Aug 10, 2010
|Tomotherapy Incorporated
|Method and system for evaluating quality assurance criteria in delivery of a treatment plan
|Feb 24, 2006
|Jun 7, 2011
|Cadman Patrick F
|Method and apparatus for modulating a radiation beam
|Jul 17, 2012
|Tomotherapy Incorporated
|Method for adapting fractionation of a radiation therapy dose
|Jul 21, 2006
|Jul 24, 2012
|Tomotherapy Incorporated
|System and method of detecting a breathing phase of a patient receiving radiation therapy
|Jul 31, 2012
|Tomotherapy Incorporated
|System and method of treating a patient with radiation therapy
|Nov 20, 2012
|The Board Of Trustees Of The Leland Stanford Junior University
|Radiation therapy inverse treatment planning using a regularization of sparse segments
|Jan 29, 2013
|Tomotherapy Incorporated
|System and method of calculating dose uncertainty
|Mar 19, 2013
|Tomotherapy Incorporated
|Non-voxel-based broad-beam (NVBB) algorithm for intensity modulated radiation therapy dose calculation and plan optimization
|Mar 6, 2003
|Mar 26, 2013
|Tomotherapy Incorporated
|Method for modification of radiotherapy treatment delivery
|Aug 10, 2010
|May 14, 2013
|Tomotherapy Incorporated
|Method and system for evaluating quality assurance criteria in delivery of a treatment plan
|Mar 31, 2010
|Jul 29, 2014
|Matthew R. Witten
|System and method for radiation therapy treatment planning using a memetic optimization algorithm
|Jan 11, 2013
|Dec 16, 2014
|Tomotherapy Incorporated
|System and method of calculating dose uncertainty
|Jul 21, 2006
|Aug 23, 2007
|Kapatoes Jeffrey M
|System and method of generating contour structures using a dose volume histogram
|Jul 5, 2006
|Jan 10, 2008
|Ruetsch Gregory R
|Using interval techniques to solve a parametric multi-objective optimization problem
|Feb 29, 2008
|Jun 26, 2008
|Saracen Michael J
|Method for automatic anatomy-specific treatment planning protocols based on historical integration of previously accepted plans
|Jan 29, 2008
|Apr 2, 2009
|Siemens Medical Solutions Usa, Inc.
|Irradiation system and method
|Apr 14, 2011
|Lei Zhu
|Radiation therapy inverse treatment planning using a regularization of sparse segments
|Oct 29, 2010
|May 26, 2011
|Weiguo Lu
|Non-voxel-based broad-beam (nvbb) algorithm for intensity modulated radiation therapy dose calculation and plan optimization
|Nov 27, 2010
|Aug 2, 2012
|Fraunhofer-Gesellschaft zur Förderung der angewandten Forschung e.V.
|Anpassen einer Dosisverteilungs-Einstellung für ein technisches Gerät der Tumortherapie
|Jun 7, 2011
|Apr 10, 2013
|The University of Manitoba
|Multi-objective radiation therapy optimization method
|Jun 7, 2011
|Dec 15, 2011
|The University Of Manitoba
|Multi-objective radiation therapy optimization method
|Jun 7, 2011
|Feb 2, 2012
|The University Of Manitoba
|Multi-objective radiation therapy optimization method
|Nov 23, 2011
|May 31, 2012
|Fraunhofer-Gesellschaft Zur Foerderung Der Angewandten Forschung E.V.
|Customization of a dose distribution setting for a technical appliance for tumour therapy
|Dec 20, 2012
|Jun 27, 2013
|Fraunhofer-Gesellschaft Zur Foerderung Der Angewandten Forschung E.V.
|Navigable presentation of a variety of solutions for therapy plans
|U.S. Classification
|250/363.02, 378/153, 378/65, 600/427
|International Classification
|Cooperative Classification
|European Classification
|Nov 22, 2004
Owner name: FRAUNHOFER-GESELLSCHAFT ZUR FOERDERUNG DER ANGEWAN
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:TRINKAUS, HANS;KUEFER, KARL-HEINZ;REEL/FRAME:016230/0637;SIGNING DATES FROM 20040421 TO 20040426
|Dec 15, 2011
|Fee payment
Year of fee payment: 4
|Dec 17, 2015
|Fee payment
Year of fee payment: 8


text:
Your Rating:
Hold the CTRL or Command key to select multiple releases
20 total votes
#30 lowest rated PS strategy game (#681 on PS, #16093 overall)
72.73% of 11 total votes
#39 easiest PS strategy game (#734 on PS, #20404 overall)
4 total votes
43% of 21 total votes
In order to save your ratings you must have a GameFAQs account. Please log in or register to continue.
If you're stuck in Bomberman Wars, ask your fellow GameFAQs members for help.
To ask or answer questions, please log in or register for free.
0 Users
12 Users

subset: commoncrawl


text:
Turkey Apple Salad
Total Time
Prep 10 mins
Cook 0 mins
Although the recipe calls for canned turkey, this is a great recipe to use up your leftover Thanksgiving turkey.
Ingredients Nutrition
- 2 (5 ounce) cansswansons white turkey
- 1 1⁄2 cups sliced apples
- 1 cup sliced celery
- 4 tablespoons raisins
- 2⁄3 cup Italian dressing
- 2 tablespoons brown sugar
- Stir turkey, apple, celery and raisins together.
- Mix Italian dressing and brown sugar; pour over turkey mixture.
Most Helpful
Pretty good. I subsituted dried cranberries (craisins) for the raisins - just a personal taste. We ate this as is and also put it in a pita wrap. Great use of chicken or turkey leftovers. Just what I was looking for tonight. An easy no cook meal! Thanks.


text:
laird popkinShared publicly -
3D printing in PLA with the Replicator is a dream. I'm printing a large object that I had a lot of trouble with in ABS with curling/splitting, and it's coming out PERFECTLY in PLA. So far I've replaced some broken light switches, printed a Hilbert Cube, a few tanks, chess pieces I designed years ago, and a Quad Rotor Copter (with some friends). Life is good!
Add a comment...


text:
This highly detailed, brightly colored yard spinner will proclaim your fascination with bright red cabooses for all to see. Made from weather and UV resistant Solarmax® fabric and comes complete with ground stake and durable fiberglass poles, 29" x 20.5" diameter. by Premier Kites
Connect with us: Follow us on Twitter Become a Fan on Facebook Watch videos on YouTube


text:
Lakes Region planners hear what warmer temps doing to Experimental Forest
MEREDITH — "The climate is changing and we can read the signature of change in our own backyard," said Lindsey Rustad, an ecologist with the United States Forest Service who studies the effects of rising temperatures on the northern forest at the Hubbard Brook Experimental Forest in Woodstock.
As the keynote speaker at the annual meeting of the Lakes Region Planning Commission on Monday night, Rustad tackled what she called the "the conundrum of climate" , or "what we know, don't know and need to know" from both a global and local perspective. She began by tracking the rising levels of carbon dioxide in the atmosphere since 1800, which after reaching unprecedented levels have continued to rise at a quickening pace. As the concentration of carbon dioxide and increased, temperatures have climbed. "Ten of the hottest years on record occurred in the last 15 years," Rustad said, "and the hottest year ever was 2104."
Rustad recalled that the changing climate began to catch the attention of scientists in the late 1950s and 30 years later the International Panel on Climate Change (IPCC) was convened. The first report of the IPCC, issued in 1990, she described as "wishy-washy" but its fourth report found that "warming of the climate system is unequivocal" and "very likely" is the result of man-made greenhouse gas emissions. The most recent report of the IPCC concluded that "human influence has been the dominant cause of observed warming since 1950" and warned that longer the reduction of greenhouse gas emissions is delayed, the greater the costs will be. "The language of the IPCC has changed dramatically," Rustad remarked.
Warming temperatures, Rustad said, have hastened the melting of sea ice leading to rising sea levels. At the same time, the warming world has been marked by changing patterns of precipitation levels as well as altered the patterns of precipitation and greater frequency of what she called "extreme events," like heavy precipitation, severe droughts and heat waves.
Rustad said that the changing climate has left its marks at the Hubbard Brook Experimental Forest. Established in 1956 , the 8,000 wooded acres riven by Hubbard Brook was originally a venue for studying the impact of acid rain, but since 1996 has been a center for measuring the effects of climate change on the northern forest. She said that since 1955 the average annual temperature in the forest has risen 2.9 degrees Fahrenheit, more than the global average. She noted that temperatures have risen relatively more at the higher latitudes. Precipitation has increased 12 percent, with more rainfall than snowfall. Both the amount of snowfall and days of snow cover have dropped 25 percent.
Rustad explained that because of the diminished snow cover, the soil freezes to greater depths in the winter, which impairs the capacity of the roots of trees and shrubs to absorb nutrients, chiefly nitrates and phosphorus, stunting the growth of their root systems. Instead, elevated levels of nitrates and phosphorus leach into ground and surface water. At Hubbard Brook, Rustad said, the ice storm of 1998 was simulated by spraying trees with a fire hose amid freezing temperatures. The experiment confirmed that when the capacity of trees to absorb nutrients is impaired, elevated levels of nitrates and phosphorus are found in nearby surface water after the icing event.
Rustad herself is interested in extreme events, which she defined as precipitation of two inches or more. She said that as the climate has changed wet and dry periods, which once alternated, have begun to coincide with greater frequency. "We have drier soils in a wetter world," she remarked. Likewise, warmer temperatures prompts trees to leaf and flowers to blossom earlier in the spring while a late spring frost, which counts as an extreme event, may destroy a significant share of the forest canopy opened by the early warming.
Asked what aspect of climate change should most concern municipal Planning Departments in New Hampshire, without hesitation Rustad replied "heavy precipitation".
Although Rustad acknowledged some have questioned the findings and ignored the warnings of the scientific community, she said that more and more people, especially those whose livelihoods and life styles are affected, understand from experience that the climate is changing. "People are beginning to care," she said.
- Category: Local News
- Hits: 621


text:
ODT Online
ODT /directory
Paradise Trust chairman Tom Pryde (third from left) updates
the community on the trust's next steps at an ashes picnic
held at the site of Paradise Homestead on Saturday.
With him are (from left) trustee Paul Ferris, Marijke Miller
whose family formerly owned the property, property managers
Daman and Mandy Groshinski and Mandy's sister Chrissy.
The historic homestead - the main source of income for the
trust - was destroyed by fire last month.
Trustees are now focused on fundraising to help meet expenses
until a new building can be constructed.
A name, residential address, and (preferably residential) telephone number is required from readers who comment on ODT Online. These details will not be visible to site visitors.
Post a note
Submit your news & photos - Login or
Opinion? Have your say - Login or Register
Submit your
event or notice
Add a photo
Bookmark ODT
Make ODT my
Otago Daily Times print and digital edition, The
Star - Dunedin, The News - Central Otago, The
Ensign - Gore, Southland Express -
Invercargill, Southern Rural Life - Otago and
Southland, The Courier - Timaru, Courier Country - Canterbury and
West Coast, Queenstown Times - Queenstown, Mountain Scene -
Queenstown, The Oamaru Mail - Oamaru, The
Greymouth Star - Greymouth, Hokitika Guardian - Hokitika,
West Coast Messenger - West Coast, The Ashburton Courier -
Ashburton, The News - North Canterbury, Extra! schools
publication, Property
Times South Canterbury


text:
Perimenopause can bring with it a number of uncomfortable signs and symptoms, which can affect one's daily and nightly quality of life. During her life, a woman goes through four phases in relation to menopause:
Premenopause. These are the years after a woman has begun menstruation and before her periods stop. During these years, she is fertile, able to have children and lactate.
Perimenopause. This is the stage that leads up to menopause. In preparation of menopause, the hormones estrogen, progesterone and testosterone are in a state of flux, which can cause uncomfortable and unpleasant symptoms such as night sweats, insomnia and fatigue.
Menopause. This is the moment in which the menstrual cycle stops and a woman is no longer fertile. This point is usually considered to be 12 months after a woman has her last period.
Postmenopause. Postmenopause is the time after menopause when a woman is no longer menstruating and is no longer fertile.
How to Manage Insomnia during Perimenopause
Perimenopause can cause uncomfortable nights and days of tiredness and irritation due to dramatic fluctuations in hormones. Perimenopause symptoms may include numerous side effects that can upset healthy sleep patterns, such as night sweats, sleep disturbances, fatigue and insomnia. Find below interesting information that can help to reduce the impact of insomnia during perimenopause:
Layer Your bed Sheets
Night sweats can be a particularly bothersome symptom of perimenopause; these spells wake you up from your slumber in an uncomfortable cold sweat. Layering the sheets on your bed can help you handle these late night troubles, as it makes it easier to adjust your body temperature throughout the night.
Take a Break
When suffering from insomnia, take a break from staring at the ceiling and trying to sleep, and divert your attention for a moment. Do not check your work emails or surf the internet, but read a book, have a glass of water or a mug of warm milk. These activities will help soothe you. You will return to bed more mentally relaxed and your body will be more ready for a good night's sleep.
Drink Water
Keep your nightstand stocked with a glass of cold water. When you are disturbed by night sweats at late hours, a glass of water will keep your body hydrated. It will also soothe you through the stress that insomnia can bring, keeping you cool, hydrated and calm.
Meditation can also be an extremely effective relaxation technique for women going through perimenopause. If you are suffering from night sweats, unable to rest completely and drift back to sleep, go to a cool, quiet place; then, take the following steps: sit up straight, focus on your breathing and repeat calming affirmations. Do so until you feel completely calm and ready to fall asleep.
Click on the following link to read more about treatments for perimenopause.
Other Related Articles:
Perimenopause: Accepting The Inevitable
Peri-Menopause Signs And Symptoms


text:
Unwind, pause, replay: How recorded leactures are changing academia
February 24, 2016
Some pros and cons of recorded lectures and their affect on student grades and attendance.
Read the entire article from Macleans.
Interested in free and customizable textbooks for your classroom? Check out this initiative from BCCampus.
Frightened of your classroom technology? Work it out ahead of time with our completely interactive simulator activity, complete with walkthrough tutorials for common tasks.
Grande Prairie Regional College offers all kinds of exciting courses and complete programs through eCampus Alberta. Click here to find out more!
Copyright is a rapidly changing field, and educators are required to comply with these evolving standards in our classrooms. Have you taken the course yet?
Some pros and cons of recorded lectures and their affect on student grades and attendance.
Read the entire article from Macleans.
"A new study shows that students who see themselves as consumers are more likely to underperform academically."
Read the entire article at Goldsmiths.
Using the psychology of anticipation with social media to promote learning in your classroom
Read the entire article at informED.
Personalized videos cut down on direct student conferencing in large classes.
Read the entire article at Faculty Focus.


text:
Visited for business as my office is a 5 minute walk; And when you dont have a car lots of needed things are around. Like a big mall with lots of restaurants. When you do have a car everything interesting is only 15 min away, like Venice beach, Marina Del Rey, Beverly hills, etc.
The hotel staff is very friendly, accurate and sharp; The rooms clean, pretty big and have all you need; Breakfast is good, all fresh and of good quality.
So yes when you need to stay in a convinent hotel, this is a good one.
- Official Description (provided by the hotel):
- This brand new hotel features 260 spacious guestrooms and suites in addition to over 10,000 square feet of flexible indoor-outdoor event space and a full catering department. 3.5 miles north of LAX. ... more less
- Reservation Options:
- TripAdvisor is proud to partner with Booking.com, Marriott, Expedia, Hotels.com, Priceline, Hotwire, Odigeo and Travelocity so you can book your Courtyard Los Angeles Westside reservations with confidence. We help millions of travelers each month to find the perfect hotel for both vacation and business trips, always with the best discounts and special offers.
- Also Known As:
- Courtyard By Marriott Los Angeles Westside Hotel Culver City
- Courtyard Culver City
- Courtyard Hotel Culver City
- Culver City Courtyard
- Culver City Marriott


text:
Be polite; be courteous; and have a plan to kill everyone you meet.
That's one of my favorite sayings of all time. Most people do seem shocked when they hear it though. I guess they just don't understand.
This is a discussion on "Have a plan to kill everyone you meet"--from Fox News: MERGED within the Law Enforcement, Military & Homeland Security Discussion forums, part of the Related Topics category; Originally Posted by arniejen Media Idiot I recognize that my title is an oxymoron. Actually, it's not an oxymoron, it's simply repetitive. You're right, however ...
A man fires a rifle for many years, and he goes to war. And afterward he turns the rifle in at the armory, and he believes he's finished with the rifle. But no matter what else he might do with his hands - love a woman, build a house, change his son's diaper - his hands remember the rifle.
Be polite; be courteous; and have a plan to kill everyone you meet.
That's one of my favorite sayings of all time. Most people do seem shocked when they hear it though. I guess they just don't understand.
When you've got 'em by the balls, their hearts & minds will follow. Semper Fi.
I guess the journalist has a plan to hug everybody?
He should start with the fellow in the thickest vest in the room.
Lord knows we need more dead journalists.
Having a plan to kill everyone you meet is the way most of us are naturally wired. I know I am. I don't want to kill anyone but if the solid waste strikes the bladed, oscillating air movement device, I want to be as ready as I can be. So I plan.
,=====o00o _
l_--- \___l---[]lllllll[]
(o)_)-o- (o)_)--o-)_)
...To me, not having a plan is planning to fail...
Right on Mike
Magazine <> clip - know the difference
martyr is a fancy name for crappy fighter
You have never lived until you have almost died. For those that have fought for it, life has a special flavor the protected will never know
I do, just in case.
Les Baer 45
Sig Man
N.R.A. Patron Life Member
Be polite, be professional but have a plan to kill everyone you meet. As has been said, you do not know who might be planning to kill you. I wonder what this guy would think of this: "Its not my job to die for my country, my job is to make the other poor b**tard die for his"
goawayfarm, just read this post this morning. thanks for the quote by
Frank Lloyd wright "Im all in favor of keeping dangerous weapons out
of the hands of fools. lets start with typewriters" that was great.
thanks for the laugh.
(SHERIFF BUFORD T. JUSTICE) "what the hell is
the world coming too"
FOXNews.com - Iraq Journal: A Plan to Kill Everyone - International News | News of the World | Middle East News | Europe News
I guess journalist (even from FOX) just don't get it!
Its not about guns...Its about Freedom!
Assistant Instructor @ http://www.green-ops.com/ Located in the Washington D.C. Metropolitan Area "Why should your training be any less special?"
Well, I get it, but maybe I've just been brainwashed.Yup, pretty much.Welcome to counterinsurgency.
Fortes Fortuna Juvat
Former, USMC 0311, OIF/OEF vet
NRA Pistol/Rifle/Shotgun/Reloading Instructor, RSO, Ohio CHL Instructor
"Be Polite, Be Professional, Be Prepared to kill Everyone you meet."
They will blow themselves up while smiling and shaking your hand.
Colt 1911 New Agent, CTLaser
You do not work for them, they work for you.
Senators http://senate.gov/general/contact_in...nators_cfm.cfm
Congressmen http://www.house.gov/house/MemberWWW_by_State.shtml
When I was stationed in Viet Nam with the 1st Tactical Fighter Wing at Ben Hoa the sign over the gate said "Wait Hell, I want To Kill something"
Seemed reasonable to me
Gun control is hitting what you aim at
Why not have that plan? They have already planned to kill everyone of us!
"Don't hit a man if you can possibly avoid it; but if you do hit him, put him to sleep." - Theodore Roosevelt
I woulda looked at him and said if your so bullet proof why even wear a vest,everybody knows reporters never get killed in war zones.I always liked the line where the sergeant hands a guy an M16 and the journalist says I'm a non combatant and the sergeant replies everybodys a combatant today
"Outside of the killings, Washington has one of the lowest crime rates in the country,"
--Mayor Marion Barry, Washington , DC .


text:
I wish to implement a menu in my footer. It is a CSS list-based menu (with a javascript for IE6).
Is this how I call the menu's stylesheet in the header? If so, why doesn't the menu look right on my site?
<link rel="stylesheet" media="all" type="text/css" href="<?php bloginfo('stylesheet_directory'); ?>/skeleton_up/skeleton_up.css">
Can I paste the bits in the menu-specific stylesheet into the theme's stylesheet? How do I ensure there are no conflicts with the menu's stylesheet?


text:
GD Awarded $52 M for Maintenance Work on USS Mississippi
General Dynamics Electric Boat has been awarded a $51.7 million contract modification by the U.S. Navy to plan and perform the post-shakedown availability (PSA) on the nuclear submarine USS Mississippi (SSN-782). Electric Boat is a wholly owned subsidiary of General Dynamics (NYSE: GD).
The PSA includes maintenance, repairs, alterations and testing. It will be performed at Electric Boat's Groton shipyard. Up to 400 employees will be engaged in the work, which is scheduled for completion by December 2013.
Marine Propellers Market - Global Forecasts to 2020
Initially awarded in April 2012, the contract has a total potential value of $67 million.
In May 2012, Electric Boat delivered Mississippi to the U.S. Navy a year ahead of contract schedule and more than $60 million below target cost.
Mississippi is the ninth ship of the Virginia Class, the most advanced submarines in the world. These ships are providing the Navy with the capabilities it requires to retain its undersea dominance well into the 21st century.
Your company's press release on ASDNews and to thousands of other journalists and editors? Use our ASDWire press release distribution service.
Source : General Dynamics Corporation (NYSE: GD)
Naval Mission Systems Technology Conference
Nov 14 - 15, 2016 - Rome, Italy
EAR / OFAC Export Controls e-Seminar
Jan 1 - Dec 31, 2016 - USB Drive, Windows Computer
Additive Manufacturing for Defense and Aerospace Conference
Sep 28 - 30, 2016 - Arlington, United States


text:
News By Tag
Industry News
News By Location
Industry News
Wicker Building Supply Reduces Idling by 80 Percent with NexTraq Fleet Tracking
Full-service building supply company uses the Idle Report to cut down wasted fuel and monitor unauthorized vehicle use
Steven Melton, General Manager of Wicker Building Supply, said, "We immediately saw an 80 percent decrease in idle time using the Idle Report in the NexTraq Fleet Tracking platform." He adds that he purchased the solution, not because he didn't trust his employees, but that they probably didn't realize how much time they spent idling, wasting fuel and producing harmful emissions.
Additionally, he was able to track employees that were using company vehicles for personal business. Melton notes that's the exception with his employees rather than the rule, saying, "We didn't purchase the fleet tracking solution to come down on our employees, but rather to correct inappropriate behavior. There have been no issues since they knew it was installed."
Melton also implemented the Fleet Dispatch application so drivers can receive voice-guided, turn-by-turn directions, increasing customer service by providing accurate ETAs. With the dispatching functionality, communication between the office and his employees in the field has been simplified and improved.
Mike Scarbrough, CEO of NexTraq, said, "Our Idle Report is one of the most popular reports for our customers. The ability to track idling benefits our customers in numerous ways; the most popular benefit is a significant reduction in fuel expenses. Some of our customers report a 20 percent reduction in fuel expenses and with gas prices continuing to rise, that's a considerable amount of money saved."
For more information on the NexTraq Fleet Tracking platform and its applications - Fleet Mobile, Fleet Metrics and Fleet Dispatch - please visit http://www.nextraq.com or call us at 800.358.6178.
About Wicker Building Supply
Established in 1984, Wicker Building Supply is a family-owned and operated business that takes pride in providing superior service for its customers building supply needs. In 1998, the company diversified and established Melton's Pumping Service providing septic tank and grease trap services for customers in more rural areas. For more information, please call 601-249-2066.
# # #
Established in 2000, NexTraq provides the highest value GPS fleet and asset tracking solution in the telematics industry. The NexTraq platform is a cloud-based application that enables service and distribution businesses to optimize fleet operations while reducing operational costs and maximizing revenue. Based in Atlanta, NexTraq customers achieve ROI in as little as one month. For more information, please visit www.nextraq.com.
Account Email Address Account Phone Number Disclaimer Report Abuse


text:
Friday's Nicholls State baseball game postponed
Published: Friday, March 27, 2009 at 6:22 p.m.
Last Modified: Friday, March 27, 2009 at 6:22 p.m.
THIBODAUX -- Because of the threat of rain on Friday, the Nicholls State baseball game against Texas-Arlington has been postponed.
The teams will play a doubleheader starting at 3 p.m. Saturday at Ray E. Didier Field in Thibodaux.
Reader comments posted to this article may be published in our print edition. All rights reserved. This copyrighted material may not be re-published without permission. Links are encouraged.
Comments are currently unavailable on this article


text:
Hey Guys, just wondering if you can tell me what advantages your new multipress plugin will offer that Caffienated Content doesn't have; I am refering to your paid version as well as the free one. Thanks
Hey Guys, just wondering if you can tell me what advantages your new multipress plugin will offer that Caffienated Content doesn't have; I am refering to your paid version as well as the free one. Thanks
Caffienated Content site currenlty says: "We have decided to take Caffienated content off the market for the forseeable future until we have ironed out the bugs..."
So the main difference is that our plugins work :)
I can't tell you more because I never used CC and can't use it anymore...
I do appreciate your response, however it didn't really stimulate me to purchase - in fact I found it to be quite irritating. Your statement that its no longer being sold is a flat out betrayal of the truth. Anyone who visits http://www.Kansieo.com will find it still available for purchase at a modest price. And, it's still has great support.
Rather than provide some constructive insight that would validate your offer, you chose to simply say that CC doesn't work, it's not available anymore, and your product is the answer. Pretty lame for an outfit that's trying to promote a new product - leads me to wonder if we'll get the same half-baked attitude when seeking support because it has bugs...
It's interesting to note that there is an outfit that has literally copied the code, line for line, from CC and has packaged it as their own solution - that wouldn't be you guys would it? If not then please enlighten us...
I have to say that I've used Caffienated Content for several years and while its not perfect I find it suitable for most of my needs. Yes, there are some issues with it these days (that are being resolved) but it still works for the large number of individuals who already own it as well as those intersted in purchasing new.
The fact is that I'm looking for something that will offer a BETTER solution. Your lame answer doesn't really sell me on the fact that your product is going to fit the bill; in fact it leaves me wondering if I'll just throw some money away on a plugin that I already own...
If it's truly a better solution then please provide an answer that persuades us to believe it.
First off, i am sorry if my first reply came off as crass, that is not how it was intended at all. I told you i am not familiar with CC so i made a search on google. The first result was http://www.caffeinatedcontent.org/ with the big message that CC is not on sale anymore due to bugs and programming issues. Again, i don't know CC, i don't know which site is legit or not.
Secondly, the reason that I did not come on here and run down a list of features, benefits, and reasons why MultiPress is superior to CC is simply due to the fact that this is a free version. This is the precise reason that we have created a free trial offer and placed it here for anyone that is interested. Instead of simply using words, false claims, or shouting from the rooftop that our software is the best thing since sliced bread, we allow potential customers to download it for free, use it, play around with it, and test it out before deciding to purchase the paid version.
If I came on here and instantly started marching around and saying that MultiPress was better than CC, it would be far less ethically responsible, seeing as I mentioned the fact that I personally have never tried it.
Many companies, product creators, and salesmen are more than willing to directly try an answer the question, "is your product better than product X, product Y, or product Z?"
That is however a matter of personal preference and speculation. It is quite common for any software developer to feel that their new product is the best on the market.....as that is most likely always their intention when the design and creation begins. Thus, we feel that directly answering a question like that has no real value anymore, and that offering a free trial for everyone to test out themselves is the best way to answer that question without any bias or alternative motives.
Finally, I would ask that you try and refrain from using blanket statements or false accusations in your future posts or discussions. Your comments revolving around "bad support" and "stolen and repacked code" are unjustified and do not warrant any real response.
Our company has been successfully provided valued customer support and popular software for years and we have the loyal client base to prove it. We have thousands of happy, successful, and repeat customers behind us
If you are not comfortable trying out our free version of the plug-in, or are completely satisfied with Caffeinated Content, then MultiPress is obviously not the software for you.
And I can wholeheartedly understand that.
We have never had any false illusions that every webmaster or marketer out there would love our product; instead we focused on ensuring those that are interested in giving it a try can have the best possible experience possible.
We would love if you downloaded the free trial and gave it a spin for yourself and do your own judgment as in how it compares with CC. But that is a choice you will have to make based on your personal situation and needs.
Thank you for the reply. I can appreciate your comments about refraining from certain comments, however as a former and potential customer I feel entitled to an intelligent and informative response to a legitimate question. My aim was not to discredit you guys but simply to get a good answer to the question of what makes this product worthy of investing my time to try it out. I suppose the inclusion of CC as a reference point was the fly in the ointment here and for that I apologize.
I do appreciate the free trial download but given that time is the most precious comodity I own I simply can't warrant wasting it on just trying everything that comes along - I need to be compelled to do so by a valid overview of what the potential product will offer me.
My original question stemmed from the fact that a full list of features was not available (or, I wasn't smart enough to be able to locate it). I did, however, find everything I needed today when I made another visit to the multipressplugin.com site and discovered a great deal more info on the product than had previously been available there. I would have been very satisfied had you simply directed me to that info in the first reply to my question.
In fairness I must say that I'm pleased with the overview of info I found there and am now persuaded to try your product. If it does everything you say it does then it will be a better solution and I will no doubt become a long-term customer and proponent of your product.
I am sorry again that my first answer was not as clever as you expected. The issue is that people assume i just know how any other plugin or software works and i can make a comparison between our plugin and any other. That is far from truth. I usually don't care about competition or similar plugins. I don't buy it, i don't use it, i don't test it. I just try to come up with useful stuff, that i use myself and i believe other people will like as well and even willing to pay for it. If i succeed, great. If not, no big deal. I will keep trying :)
Have a nice day and prosperous work.
Difference between this and CC is that Multipress can make you get banned on adsense because some of they links are to affiliate sites and websites that are not allowed to be linked on a website with adsense code.
As well Multipress will make your website gets SEO Penalties for linking to a nonrelevant websites, as well you will get PR punishment because linking in every post to same site looks like bought links.
So be careful with using multipress, you can easy turn your website in bad neighbor.
You are probably kidding. I don't want to think that you really believe what you are saying.
"..links to affiliate sites and websites that are not allowed to be linked on a website with adsense code."
Since when you can get banned from adsense for linking to affiliate sites?! Or any other site as a matter fact (excluding porn or illegal sites)...
That is a very good joke :)).
Anyway, seriously now, first of all there are no affiliate links added in the posts, and second, the links that are added are to legit sites, mostly blogs.
Are you CC owner or just paid to make them good press?! :))
I m not making anyone anything. I just want to warn people that they could get banned. You could get greedy, you could place in your machine link to a beer website by thinking that its harmless and that way many people could lose adsense.
And what about other penalties?
Stuffing your website posts with irrelevant links that will just make your site receive penalties in search engine.
I really doubt you will make any cash by stuffing peoples websites, instead of that you could place paypal donation button and i m sure your plugin will have better rating and you will make more cash, because honestly i really don't know who will use your plugin and receive penalty if there is old WP O Matic which is free and wont make you get banned or penalized....
P.S. i m just webmaster that works daily on websites
ONE link in a post is NOT link stuffing! There is a paid version of the plugin as well for anyone that does not like ONE link in a post. Your warning is silly and not based on any facts. Don't assume what we could get or not, you have no idea about that.
Recommending wp-o-matic against multipress is at least funny and it will surely not help anyone.
Beside wp-o-matic being not updated for more then 2 years and reported with many issues like making duplicate posts, is also not even doing 15% from what our multipress can do. Wp-o-matic limited to rss only.
I started out with the free version and was relatively happy with it.
It does put ads at the end of about 75% of your posts and they are completely unrelated to anything in your posts and are often quite scammy looking. For example: Make money with blogs!
Anyway it worked fine on a new blog I was setting up. I had 2 - 4 rss rules set up and everything was working so I purchased the product.
(I had to go back and edit the ads out of all the old posts by hand but that wasn't the end of the world.)
I added more rules and installed the usual plugins and then Multipress stopped working. I have not been able to get those issues resolved.
Yesterday I was hopeful that the problems had been resolved because I was notified of an update. But when I performed the update, all it did was revert back to the free version and put ads in my new posts. It did not fix the problems.
So I want to give a few tips about the free plugin: 1) the ads are pretty jarring, 2) if you upgrade to paid you will need to edit all the ads out by hand, 3) if you upgrade to paid do NOT update the plugin because it will revert back to the free version, 4) most important - before you pay, test it out on a fully configured blog with lots of traffic and with all the rules you will ever need because once you upgrade to paid there are NO REFUNDS.
I used the free plugin too (i may be one of the first users) and then upgraded to paid. Free and paid plugins are actually same, the rules created with free plugin will even work with the paid plugin, the only difference is the links in posts.
I can't say i loved the free links in the posts (that is why i upgraded) but i don't think is anything wrong with it either. Most of the links i noticed in my posts were to some services or sites operated by the same company and none of them to any shady site.. There was no adult, gambling, etc.
I have had no problems after moving to paid.
@twoenough yea its sad that old wp o matic is still best option for grabbing rss. Its very old but it works better than any other autobloging plugin. Duplicate content can be easy fixed.
And as i say, any serious webmaster will not use your product or will pay you for removing links, but then again why would he waste money if there are plugins that dont fill your website with totally irrelevant links which bring penalty on search engines...
And No refunding of your product just makes this plugin already at 3 stars, i m pretty sure it will go more down.
You had good idea, but monetizing it, was totally wrong...
just installed wp o matic and have the duplicate content problem.
just curious how you took care of that since you mentioned it was an easy fix.
google it, type in wp-o-matic duplicate content, you will find tens blogs with coding solution and i bet cleverplugin have the plugin for it, not sure if its free.
@dadaas, should we take it that you are not a serious webmaster?! It looks like you are using our plugin instead of those aged ones you praise.
As about our refund policy, we offer a 100% free two weeks trial. That is enough time for any serious webmaster to decide if the plugin worth pay for or not. What you think is better, a 14 days refund policy like wprobot has or a fully working and free 2 weeks trial?!
@sailpilot, looks like you are out of luck. Unless you know php and can fix wp o matic yourself, you may have to pay for a plugin that will fix the other plugin bug. :)
@everybody else: that happens when you are taking advices from people that have no idea what they are talking about... Do your own due diligence and don't listen all the trolls...
I see several items on google about the duplicate problem but only one that offers a solution and that one is from 2008 and several people in comments indicate that it doesn't work for later versions. Also it appears that this solution must be run manually (unless I misunderstood the directions)
this fix is at http://bloke.org/php/wordpress-wp-o-matic-duplicate-posts-fix/
I am looking for an inline code fix for that latest version of WP that will run as items are added to the posts and deletes that immediately.
Do you know of any?
twoenough: I do know php and just a side comment I think this war of words here is not helpful to anyone. If you have a solid product people will test it and buy it, if not people will point out the problems as with any other software.
@sailpilot: you are generally right, just that sometime people don't know what they are doing and talking and what they are pointing out are not software problems but issues caused by their lack of knowledge, not reading manuals or simply because they try to push another plugin by bashing the competitors.
I see that this Multipress plugin has been removed.
My question is if it was removed because of it is never working or it was removed because of the owners are so angry and not helping?
This topic has been closed to new replies.


text:
I'm a JavaScript developer from Estonia. I have a BSc in power electronics but somehow got stranded away and landed in the wonderful world of JavaScript.
- Tallinn, Estonia
- andrisreinman.com
- Member for 6 years, 8 months
- 0 profile views
- Last seen Nov 27 '15 at 16:36
Communities (4)
Top Network Posts
- 887Convert JS object to JSON string
- 30Converting a string to a defined constant in PHP
- 21Cropping image in PHP
- 18What's wrong with this javascript? Array not defined
- 16JavaScript: How do I change the Hash in the Address Bar WITHOUT adding an entry to history?
- 13Detect file changes in node.js via watchFile
- 12javascript sort with unicode
- View more network posts →
Keeping a low profile.
This user hasn't posted... yet.
Badges (7)
Gold —
Silver 6
Bronze 1


text:
Obesity is a known risk factor for atrial fibrillation, which can trigger stroke and other dangerous problems when the top chambers of the heart, called the atria, quiver erratically -- sometimes faster than 300 times per minute.
The Mayo Clinic researchers examined data from 438 patients with a BMI of 40 or higher who were identified as good candidates for bariatric surgery, with about three-quarters of them electing to undergo the procedure.
While the incidence of atrial fibrillation was not markedly different between the surgical and nonsurgical group at the start of the study, only 6 percent of the surgical patients developed the abnormal heartbeat condition over the next seven years, compared to 16 percent of the nonsurgical patients, according to study documents.
"I think this is further evidence that maintaining a normal body weight or weight loss is important for cardiovascular health," said Gold, who is also second vice president of the Heart Rhythm Society. "It provides further impetus for clinicians to think about bariatric surgery sooner, particularly cardiologists. We can be more proactive in our treatment."
Dr. John Day, director of heart rhythm services at Intermountain Heart Institute in Murray, Utah, noted that North America has the highest prevalence of atrial fibrillation in the world, largely because of its obesity epidemic. Prior research has indicated that obesity increases the risk of atrial fibrillation by more than 50 percent, he said.
"The message here is that getting the weight off can have a powerful reversal effect on atrial fibrillation," Day said. "Atrial fibrillation is a reversible condition, it's not set in stone. This is a message of hope for so many patients suffering from it."


text:
Punch Medium Shopper Tote
Product Actions
Valextra Nero (black) soft pebbled leather Punch medium shopper tote.
Style # 503443415
- Signature black 'costa' lacquered piping
- Lined with beige smooth leather; two slip pockets and small key fob at interior
- Topstitched rolled leather top handles
- Top zip closure at flap over interior top line
- 9.75" height x 12.50" width x 5.00" depth (approximately)
- 7" handle drop, approximately
- Made in Italy
Since Valextra's inception in 1937, the Italian craftsmen have held a steadfast commitment to fulfilling our various luggage and handbag desires with their substantial collection of supremely constructed and highly functional leather goods.
Need Help? Have Questions? Contact Us.
Please call 1.888.222.7639 to speak with a Customer Service Representative.
We're here to help you:
Monday - Friday, 9 AM - 9 PM (ET)
Saturday - Sunday, 10:30 AM - 7 PM (ET)
If you prefer email, we can be reached anytime at email@example.com.
Free Shipping & Returns on all U.S. Orders. See Details.