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Patent application title: Injection of fibrin sealant including an anesthetic in spinal applications
Kevin Pauza (Tyler, TX, US)
Brian D. Burkinshaw (Pflugerville, TX, US)
Brian D. Burkinshaw (Pflugerville, TX, US)
Steven I. Whitlock (Austin, TX, US)
Steven I. Whitlock (Austin, TX, US)
Mark I. Richards (Leander, TX, US)
James B. Rogan (Austin, TX, US)
James B. Rogan (Austin, TX, US)
IPC8 Class: AA61M532FI
USPC Class:
Class name: Material introduced or removed through conduit, holder, or implantable reservoir inserted in body body inserted tubular conduit structure (e.g., needles, cannulas, nozzles, trocars, catheters, etc.) body piercing condit (e.g., needle, etc.)
Publication date: 2010-06-03
Patent application number: 20100137816
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A method of treating a disc that is leaking nucleus pulposus through at
least one defect in the annulus fibrosus. The method includes injecting a
fibrin sealant into the disc to reduce at least a portion of the at least
one defect, wherein the fibrin sealant injected into the disc comprises
an anesthetic, fibrinogen and an activating compound, wherein at least a
portion of the fibrin forms after injection, with the proviso that a
corticosteroid is absent from the fibrin sealant injected into the disc.
1-69. (canceled)
70. A kit, comprising: an anesthetic, fibrinogen, thrombin, optionally at least one additive, a spinal needle, an introducer needle, wherein spinal needle is sized such that it does not extend past the tip of an introducer needle during use, wherein the kit excludes corticosteroid and wherein the kit excludes a device to provide thermal energy to a disc.
71. The kit of claim 70, wherein the anesthetic is a local anesthetic and wherein the local anesthetic is lidocaine, sarapin or bupivicaine.
72. The kit of claim 70, further comprising calcium chloride.
73. The kit of claim 70, wherein the additive is included and is selected from the group consisting of antibiotics; antiproliferative, cytotoxic, and antitumor drugs; analgesic; antiangiogen; antivirals; cytokines; colony stimulating factors; proteins; chemoattractants; EDTA; histamine; antihistamine; erythropoietin; antifungals; antiparasitic agents; non-corticosteroid anti-inflammatory agents; anticoagulants; oncology agents; cardiovascular drugs; glycoproteins; fibronectin; peptides; interferons; cartilage inducing factors; protease inhibitors; vasoconstrictors, vasodilators, demineralized bone or bone morphogenetic proteins; hormones; lipids; carbohydrates; proteoglycans; antiangiogenins; antigens; DBM; hyaluronic acid and salts and derivatives thereof; polysaccharides; cellulose compounds and derivatives thereof; antibodies; gene therapy reagents; genetically altered cells, stem cells and/or other cells; cell growth factors; type II collagen; collagen hydrolyzate; elastin; sulfated glycosaminoglycan (sGAG), glucosamine sulfate; pH modifiers; methylsulfonylmethane (MSM); osteogenic compounds; osteoconductive compounds; plasminogen; nucleotides; oligonucleotides; polynucleotides; polymers; osteogenic protein 1 (OP-1); LMP-1 (Lim Mineralization Protein-1); cartilage; oxygen-containing components;enzymes; melatonin; vitamins; and nutrients.
74. The kit of claim 70, wherein the fibrinogen and thrombin are in a freeze-dried state.
75-79. (canceled)
80. The kit of claim 70, further comprising calcium chloride.
81. The kit of claim 70, further comprising a dual barrel syringe.
[0001]This application claims priority to U.S. provisional application
Ser. No. 60/623,600, filed Oct. 29, 2004, incorporated herein by
[0002]The present invention relates generally to the use of fibrin sealant whereby the sealant is delivered such as by injection to the spinal area, and wherein the sealant includes fibrinogen, thrombin and an anesthetic.
[0003]Fibrin sealants, and glues, are well known and are used extensively in various clinical settings. Such sealants are indicated as adjuncts to hemostasis in surgeries when control of bleeding by conventional surgical techniques, including suture, ligature, and cautery is ineffective or impractical. In these cases, the sealant was applied topically.
[0004]Recently, fibrin sealant that included a corticosteroid was used to treat disc problems such as fissures in the annulus fibrosus. In this regard, U.S. Pat. No. 6,468,527 discloses that the composition was injected into a disc (an intra-discal injection) to treat disc problems.
[0005]In the practice of the present invention, fibrin sealant is injected into the spinal area of a human being. The sealant comprises fibrinogen and an activating compound such as thrombin, which form fibrin when mixed. The sealant also includes an anesthetic such as a local anesthetic. It has been found that this composition provides surprisingly superior results relative to fibrin sealant compositions containing a corticosteroid. Calcium ions, such as supplied from calcium chloride, may be included in the fibrin sealant. The fibrinogen and/or thrombin may be derived from a freeze-dried component that is reconstituted with a solution containing one or more additives, such as various biological and non-biological agents. However, in one embodiment, corticosteroids are excluded from the fibrin sealant.
[0006]In one broad respect, this invention is a method of treating a disc that is leaking nucleus pulposus through at least one defect in the annulus fibrosus, comprising: injecting a fibrin sealant into the disc to reduce at least a portion of the at least one defect, wherein the fibrin sealant injected into the disc comprises fibrinogen, an anesthetic, and an activating compound such as thrombin, wherein at least a portion of the fibrin forms after injection. Optionally, the fibrinogen, the activating compound or both has been reconstituted with a solution containing the anesthetic. In one embodiment, a corticosteroid is absent from the fibrin sealant injected into the disc. This treatment serves to reduce the amount of material from the nucleus fibrosus that leaks through the defect(s) in the annulus fibrosus. The defect can be a tear of the annulus fibrosus, a fissure in the annulus fibrosus, and the like. Advantageously, injection of the fibrin sealant can also serve to restore normal disc height and hydrostatic pressure, a key component. It should be understood that normal physiologic hydrostatic pressure can vary from person to person, and that the treatment may produce near-normal hydrostatic pressure. As used herein, normal physiologic pressure encompasses this range of pressures. In one embodiment, neither the nucleus pulposus nor the annulus fibrosus has been heated in the body to stiffen the disc either prior to or concurrent with the injection, such as discussed in for example U.S. Pat. No. 6,095,149. In one embodiment, in the practice of this invention the nucleus pulposus has not been removed by surgery, such as in the case of a total or partial discectomy or by nucleoplasty for a herniated disc.
[0007]In another broad respect, this invention is a method of treating a human back, comprising injecting a fibrin sealant into a disc to seal at least one defect of an annulus fibrosus, wherein the fibrin sealant comprises an anesthetic, fibrinogen and an activating compound such as thrombin, wherein the fibrinogen and thrombin forms at least a portion of the fibrin after injection, and wherein the fibrin sealant does not include a corticosteroid.
[0008]In another broad respect, this invention is a method of treating a human back, comprising providing a mixture of an anesthetic, fibrinogen and thrombin within a human disc to treat at least one defect of an annulus fibrosus, and wherein a corticosteroid is absent from the mixture. The mixture may be provided into the disc by injection or otherwise.
[0009]This invention also includes a kit including components used to inject the fibrin sealant. The kit may comprise an anesthetic, fibrinogen, such as freeze-dried fibrinogen, thrombin such as freeze-dried thrombin, optionally at least one additive, and a needle for injecting the sealant such as a spinal needle including for example a curved spinal needle. A spinal canula may alternatively be used. The kit excludes corticosteroid. The kit may exclude a device to provide thermal energy to a disc. The kit can optionally include contrast agent and additional additives. A single, dual or multi-barrel syringe, or other fibrin sealant delivery device, may be included in the kit. The fibrin sealant can be delivered using a convention single lumen needle, or through a bitumen or multilumen needle. If a bilumen needle is used, each component can be delivered through a separate lumen. In one embodiment, a bilumen needle or multilumen needle can be used that allows contact of the fibrinogen component and the thrombin component at the tip of the needle. Alternatively, sequential addition of the fibrinogen component followed by injection of the thrombin or other enzyme component can be used, and these injections can occur in the same needle, multiple needles, or in a bilumen or multilumen needle.
[0010]In another broad respect, this invention is a process for manufacturing a kit, comprising: providing a fibrinogen component, a thrombin component, an anesthetic component, and a spinal needle or a polymeric catheter or both, wherein the kit excludes corticosteroid and wherein the kit excludes a device to provide thermal energy to a disc.
[0011]Advantageously, the method and kit of this invention facilitate extended pain relief for patients with leaky disc syndrome, wherein for example nucleus pulposus leaks out of the disc through defects (e.g. tears or fissures) in the annulus fibrosus. Surprisingly, it has been found that the use of fibrin without corticosteroid provides unexpectedly superior results to injections of fibrin sealant that includes a corticosteroid. The present invention provides unexpectedly superior results to the method set forth in U.S. Pat. No. 6,468,527, which discloses the injection of fibrin sealant containing a corticosteroid. Unexpectedly, fibrin sealant that includes an anesthetic supplies even more superior results. In particular, the fibrin sealant containing an anesthetic provides both immediate and extended pain relief superior to either fibrin sealant with corticosteroid or fibrin sealant that excludes corticosteroid.
[0012]FIG. 1 is a cross-sectional view of a vertebral body at the disk space exhibiting annular fissures which may be treated according to one embodiment of the present invention.
[0013]FIG. 2 is a schematic representation of the trans-foraminal space into which the improved sealant may be injected according to one embodiment of the present invention.
[0014]FIGS. 3 and 4 show graphs of the VAS scores from example 3.
[0015]The fibrin sealant of the present invention comprises an anesthetic, a fibrinogen component and an activating compounds such as thrombin that converts fibrinogen to fibrin. The sealant optionally contains one or more other additives. Optionally, the fibrinogen, the thrombin, or both is reconstituted with a solution containing at least one of the additives, wherein the additive is other than a corticosteroid. The fibrin sealant is injected into, for example, the disc to seal fissures and tears in the annulus fibrosus. Defects in the annulus fibrosus are commonly diagnosed, currently, using MRI scans and discograms. This can treat both discogenic low back pain and radiculopathy leg pain when injected into the lumbar intervertebral disc.
[0016]The fibrinogen used in the practice of this invention includes any fibrinogen that will form fibrin in a human body. Fibrinogen is frequently available in freeze-dried form, and must be reconstituted prior to use. If the thrombin is reconstituted using a solution with an additive, the fibrinogen can also be frozen or fresh, autologous (from the patient to be treated), human including pooled human fibrinogen, recombinant, and bovine or other non-human source such as fish (e.g., salmon and sea trout). The fibrinogen is used in an amount suitable for the given treatment, patient, and so on. Freeze-dried fibrinogen is reconstituted using a solution, typically containing aprotinin and calcium chloride. As discussed herein, either the fibrinogen or thrombin or both is reconstituted with a solution that includes at least one additive. For example, the freeze-dried fibrinogen can be reconstituted using, for example, saline with an anesthetic or an additive, a saline solution containing aprotinin and an anesthetic or an additive, a saline solution containing anesthetic, optionally an additive, and calcium ions (Ca+2) such as may be supplied from calcium chloride, or a solution containing combinations of anesthetic and/or additives.
[0017]Thrombin is typically the enzyme used which serves to change fibrinogen to fibrin. However, other enzymes can be used such as those derived from snake venom (e.g., batroxobin), or spider venom as is known in the art. As used herein, "activating compound" refers to a compound that causes fibrinogen to form fibrin, and this term includes thrombin, batroxobin, and so on. Thrombin is available commercially, typically in its freeze-dried form. Freeze-dried thrombin must be reconstituted prior to use. The thrombin can also be frozen or fresh. Thrombin can be autologous, from a human or pooled human supply, bovine, fish (such as salmon) or other non-human fibrinogen-cleaving enzyme source such as various arachnids and other venomous species. The thrombin or enzyme is used in any amount which facilitates changing the fibrinogen to fibrin, as is known to one of skill in the art. The thrombin can be reconstituted using saline, optionally containing an anesthetic and/or one or more additives or a saline solution containing an anesthetic and/or an additive, and calcium ions.
[0018]In the practice of this invention, the fibrin sealant includes an anesthetic such as a local anesthetic. Representative examples of such local anesthetics include but are not limited to lidocaine HCL (often sold in concentrations of 1.5% or 4%), SARAPIN anesthetic (a sterile aqueous solution of soluble salts and bases from Sarraceniaceae (Pitcher Plant), and bupivacaine HCL (also known as marcaine, which is often sold in concentrations of 0.5% and 0.75%). The chemical name for lidocaine is alpha-diethylaminoaceto-2,6-xylidide, and the IUPAC name is 2-(diethylamino)-N-(2,6-dimethylphenyl)acetamide. The chemical name for bupivicaine is 1-butyl-N-(2,6-dimethylphenyl)-2-piperidinecarboxamide, sometimes referred to as 1-butyl-2',6'-pipecoloxylidide monohydrochloride, having registry number 14252-80-3. Alternatively, procaine (2-diethylaminoethyl 4-aminobenzoate hydrochloride) or other local anesthetic can be employed. Among the local anesthetics, bupivacaine is preferred. In one embodiment, a solution containing about 0.1 to about 10 percent by weight of anesthetic is used. In another embodiment, a about 0.5 to about 5 percent solution is used. The amounts of the solution can vary widely, such as from about 0.1 mL to about 5 mL of the anesthetic solution. More typically, the amount of the anesthetic solution is in the range from about 0.5 to about 2 mL. In general, the amount of anesthetic used is effective to alleviate pain when the sealant is injected or otherwise introduced into the disc. In one embodiment, the anesthetic is water-soluble. In one embodiment, the anesthetic does not contain water-insoluble particles. Combinations of anesthetics can be used. The anesthetic can be injected with the fibrinogen and thrombin, or alternatively one or more of these components can be injected separately, either before or after the fibrin sealant has been injected. The anesthetic can be used in the solutions used to reconstitute the fibrinogen and thrombin (e.g., a solution containing a local anesthetic is used to reconstitute the fibrinogen and a solution containing type II collagen is used to reconstitute the thrombin). Alternatively, the fibrinogen or the thrombin is reconstituted and then the anesthetic is added to the reconstituted fibrinogen or thrombin. Alternatively, the anesthetic can be injected separately, either before or after the fibrin sealant has been injected.
[0019]As used herein, the term "additives" means antibiotics; antiproliferative, cytotoxic, and antitumor drugs including chemotherapeutic drugs; analgesic; antiangiogen; antibody; antivirals; cytokines; colony stimulating factors; proteins; chemoattractants; EDTA; histamine; antihistamine; erythropoietin; antifungals; antiparasitic agents; non-corticosteroid anti-inflammatory agents; anticoagulants; analgesics; oncology agents; cardiovascular drugs; vitamins and other nutritional supplements; hormones; glycoproteins; fibronectin; peptides including polypeptides and proteins; interferons; cartilage inducing factors; protease inhibitors; vasoconstrictors, vasodilators, demineralized bone or bone morphogenetic proteins; hormones; lipids; carbohydrates; proteoglycans such as aggrecan (chondrotin sulfate and deratin sulfate), versican, decorin, and biglycan; antiangiogenins; antigens; DBM; hyaluronic acid and salts and derivatives thereof; polysaccharides; cellulose compounds such as methyl cellulose, carboxymethyl cellulose, and hydroxy-propylmethyl cellulose and derivatives thereof; antibodies; gene therapy reagents; genetically altered cells, stem cells including mesenchymal stem cells with transforming growth factor, and/or other cells; cell growth factors to promote rehabilitation of damaged tissue and/or growth of new, healthy tissue such as BMP7 and BMP2; type I and II collagen; collagen hydrolyzate; elastin; sulfated glycosaminoglycan (sGAG), glucosamine sulfate; pH modifiers; methylsulfonylmethane (MSM); osteogenic compounds; osteoconductive compounds; plasminogen; nucleotides; oligonucleotides; polynucleotides; polymers; osteogenic protein 1 (OP-1 including recombinant OP-1); LMP-1 (Lim Mineralization Protein-1); cartilage including autologous cartilage; oxygen-containing components; enzymes such as, for example, peroxidase; which mediate the release of oxygen from such components; melatonin; vitamins; and nutrients such as, for example, glucose or other sugars. However, it is foreseeable that any of these additives may be added to the fibrin sealant separately or in combination. One or more of these additives can be optionally injected with the fibrinogen and thrombin, or alternatively one or more of these components can be injected separately, either before or after the fibrin sealant has been injected. Combinations of these additives can be employed and different additives can be used in the solutions used to reconstitute the fibrinogen and thrombin (e.g., a solution containing a first additive is used to reconstitute the fibrinogen and a solution containing type II collagen is used to reconstitute the thrombin). In addition, one or more other additives can be added to reconstituted solutions of either thrombin or fibrinogen. Likewise, one or more of these additives can be injected with the fibrinogen and activating compound, or alternatively one or more of these additives can be injected separately, either before or after the fibrin sealant has been injected. In one embodiment, the additive is water-soluble. In one embodiment, the additive does not contain water-insoluble particles.
[0020]For solutions containing an incompletely water-soluble additive(s), an anti-caking agent such as, for example, polysorbate, may be added to facilitate suspension of this component. Glycol may be inappropriate for use as an anti-caking agent in the instant invention.
[0021]It should be appreciated that fibrin formation begins immediately on contact of the fibrinogen and thrombin, such as in the Y-connector of a dual syringe. The term "injecting" of fibrin sealant as used herein thus encompasses any injection of components that form fibrin in the disc, including circumstances where a portion of the components react to form fibrin due to mixing prior to contact with or actual introduction into the disc. It is also within the scope of this invention to sequentially inject the components of the fibrin sealant into the disc, such as by injecting the thrombin component followed by the fibrinogen component, or by injecting the fibrinogen component followed by the thrombin component. Likewise, the fibrinogen component and the thrombin components can be each intermittently injected into the disc.
[0022]It should also be appreciated that the point, or points, of injection (e.g., at the tip of a spinal needle) can be within the annulus fibrosus or in the nucleus pulposus. If the injection occurs in the nucleus pulposus, the injected components may form a patch at the interface between the nucleus pulposus and the annulus fibrosus, or, more commonly, the components flow into the defect(s) (e.g., fissures) of the annulus fibrosus and potentially "overflowing" into the interdiscal space. In practice, over-pressurizing the disc by injecting the components into the disc should be avoided.
[0023]The anesthetic, fibrinogen and activating compound are injected in amounts effective to seal a given defect of the disc, as is apparent to one of skill in the art. The amount of activating compound such as thrombin can be varied to reduce or lengthen the time to complete fibrin formation. In general, the higher level of thrombin per unit amount of fibrinogen, the faster fibrin formation occurs. If slower fibrin formation is desired, then less thrombin is used per unit fibrinogen. The use of calcium ions (such as from calcium chloride) in one or both of the component solutions will affect the strength of the fibrin so formed, with increasing amount of calcium ions increasing the strength of the fibrin clot. Generally, for a composition comprising fibrinogen that is an aqueous solution, it is believed that from about 3 mL to about 5 mL of such composition is sufficient to be an effective fibrin sealant. However, depending on the use of the composition, the dosage can range from about 0.05 mL to about 40 mL.
[0024]Fibrin sealants mimic the final stage of the natural clotting mechanism. Typically, such sealants entail the mixing of a fibrinogen component with an activating enzyme such as thrombin. Thrombin is an enzyme that exists in blood plasma which causes the clotting of blood by converting fibrinogen into fibrin. In normal practice, the components of the fibrin sealant are reconstituted separately, from a freeze-dried state, prior to use. However, use of samples prepared from a frozen state or a fresh state is also acceptable. To increase biocompatibility of the sealant with host tissue, various components may be supplied endogenously from host body fluids. Combining the reconstituted components produces a viscous solution that quickly sets into an elastic coagulum. A method of preparing a conventional fibrin sealant is described by J. Rousou, et al. in Journal of Thoracic and Cardiovascular Surgery, vol. 97, no. 2, pp 194-203, February 1989. Cryoprecipitate derived from source plasma is washed, dissolved in buffer solution, filtered and freeze-dried. The freeze-dried fibrinogen is reconstituted in a fibrinolysis inhibitor solution containing, for example 3000 KIU/ml of aprotinin (a polyvalent protease inhibitor which prevents premature degradation of the formed fibrin), and an additive. The solution is stirred and heated to a temperature of about 37° C. Each solution (the thrombin and fibrinogen solutions) is drawn up in a syringe and mounted on a Y-connector to which a needle is attached for delivery of the combined solution. (See, e.g. the Duploject® device, from ImmunoAG, Vienna, Austria). Thus, mixing of the components only occurs during the delivery process which facilitates clot formation at the desired site of application only. The components should be injected sufficiently quickly to avoid the passage becoming blocked due to fibrin formation in the needle and/or Y-connector.
[0025]In one embodiment, the mixing of the fibrin sealant components at least partially occurs in the Y-connector and in the needle mounted on a Y-connector, with the balance of the clotting occurring in the disc. This method of preparation facilitates the formation of a fibrin clot at the desired site in the disc during delivery, or immediately thereafter. Calcium chloride may be included in the fibrin sealant to be injected to modify the composition of the so-formed fibrin and resulting strength of the clot.
[0026]In one embodiment, about 75-105 mg/mL of freeze-dried fibrinogen is reconstituted according to conventional methods, and about 45-55 mg/mL thrombin component is reconstituted separately from a freeze-dried state according to the methods and compositions of the present invention. Freeze-dried fibrinogen and freeze-dried thrombin are available in kit-form from such manufacturers as Baxter under names such as TISEEL®. These two fibrin sealant components can be prepared for example in about 2 mL samples each to yield approximately 4 mL of total sealant (reconstituted fibrinogen plus reconstituted thrombin plus anesthetic). Alternatively, about 5 mL of total sealant is used such as where 2 mL samples each of reconstituted fibrinogen and reconstituted thrombin are employed, also with 1 mL of anesthetic to yield approximately 5 mL of total sealant (reconstituted fibrinogen plus reconstituted thrombin plus anesthetic).
[0027]While several methods and compositions may be used for preparing the freeze-dried thrombin for use in the invented fibrin sealant, one method is providing about 45-55 mg/mL of freeze-dried thrombin and mixing it with a reconstituting solution. The reconstituting solution for use in reconstituting either the thrombin or fibrinogen, or for both components, may further comprise about 0.1-100 milligrams of another component described herein (e.g., local anesthetic or another additive) and/or calcium chloride. The calcium chloride concentration can be, for example, 1-100 millimoles/mL, and in one embodiment 4-40 millimoles/mL. If employed, the calcium chloride concentration should be sufficient to further the polymerization reaction that forms a durable fibrin sealant clot. A preservative-free reconstituting solution may be desirable, but is not required.
[0028]A contrast agent may be used in conjunction with the injection of the fibrin sealant. The contrast agent may be injected prior to injection of the fibrin sealant. Alternatively, the contrast agent is included in the fibrinogen component or thrombin component that is injected into the disc. Contrast agents and their use are well known to one of skill in the art.
[0029]Alternative amounts and concentrations of fibrinogen and thrombin may be used to form the desired fibrin sealant clot in the body. For example, as discussed above, varying the fibrinogen and/or thrombin amount/concentration may be done to vary the viscosity and the "setting time" of the combined fibrinogen and thrombin components. Likewise, varying fibrinogen may change the density of the combined components, which may be important for controlling flow through a long conduit such as a catheter into the body. Varying thrombin may vary the polymerization time of the components, which may be important for controlling the time at which the clot forms for ensuring the components set-up at the proper site and time in the body rather than setting-up prematurely.
[0030]When acquired in freeze-dried form, the thrombin and fibrinogen need to be reconstituted for use. The thrombin reconstituting solution (e.g., a saline based solution), optionally containing anesthetic and/or one or more additives, can be prepared in a single vial prior to mixing with the freeze-dried thrombin. This component of the fibrin sealant may then be provided to users in a reconstituted state, or in two uncombined vials containing freeze-dried thrombin and a premixed reconstitution solution. Mixing of the contents of the two vials may be performed at any point up to, and including, the time at which the fibrin sealant (or its components) is injected into the patient. Reconstitution of the fibrinogen solution can be accomplished according to conventional methods. For example, the fibrinogen component may be reconstituted in an aprotinin saline solution which optionally contains other components such as, for example, a local anesthetic. If desired, the thrombin or the fibrinogen or both can be reconstituted using a saline solution that contains one or more additives. All solutions are brought to a temperature of about 37° C. Preferably, the thrombin is combined with the fibrinogen solution using the dual-syringe injection procedure described herein to form a single sealant composition which is injected into a patient. The instant invention provides a vehicle for the delivery of the sealant that conveys the sealant to the precise area of the back, seals any annular fissures, and holds the fibrin in place via the elastic coagulum. In addition, the biodegradable nature of the formed fibrin clot minimizes or eliminates the need for invasive surgical removal following the effective period of use. Therefore, an advantage of the sealant and method of application is the ability to provide a minimally invasive means of accomplishing localized, prolonged sealing of defects (e.g., fissures) in the annulus fibrosus, and if an additive is in the sealant, time-released additive delivery. Likewise, the anesthetic provides rapid, temporary pain relieve with long term pain relief arising from the effect of the fibrin sealant.
[0031]The fibrin sealant may be injected into the disc or other body area using procedures well known to one skilled in the art. Typically, an introducer needle is inserted into the intra-discal space with the tip being positioned close to the defect in the annulus fibrosus. A finer gauge needle (made of, e.g., stainless steel and capable of puncturing the annulus fibrosus) is then inserted into the introducer needle. The fibrin sealant is injected through the finer gauge needle. Alternatively, a catheter made from a synthetic polymer can be used. With either a finer gauge needle or a catheter made of synthetic polymer, the needle or catheter can be advanced through the introducer needle and into the nucleus pulposus. Alternatively, the needle or catheter can be advanced up to the tip of the introducer needle, but not far as to go beyond the tip of the introducer needle. This can have the advantage of precisely positioning the point of injection, particularly since a polymeric catheter could bend in the nucleus propulsus thereby become mis-positioned. Likewise by positioning the introducer needle at the desired point of injection as an initial matter, the fibrin sealant can be injected quickly to expedite the procedure, which is a benefit to the patient. In general, the fibrin sealant of this invention is injected into the disc, the epidural space, the zygaphysical (2-joint) joint, the vertebral canal, and/or thecal sac. With respect to an injection of fibrin sealant into a disc, an intra-discal injection serves to create a fibrin matrix which seals the disc from leaking material from the nucleus into the area outside the disc. For example, the fibrin sealant can be delivered by fluoroscopic transforaminal lumber epidural or intra-discal injection, such as described in U.S. Pat. No. 6,468,527. For the treatment of back injuries such as these, the fibrin sealant is injected into the nucleus pulposus, shown in FIG. 1, to fill any fissures or voids of the annulus fibrosus, to seal the bone end plates to the disc, increase pressure of the disc, and to increase the height of the disc space. In general, the fibrin sealant is injected at a location near the defect in the annulus fibrosus. Typically the fibrin sealant will flow into the fissures in the annulus fibrosus, and some fibrin sealant may thus flow out of the intra-discal space. The injection may also serve to coat areas adjacent to the disc, directly on the nerve roots and surrounding areas which serve to protect those areas from the effects of the leaking nucleus material. Sealing the fissures and bone end plates halts the leakage of harmful chemicals into the disc environment and prevents the initiation of foreign-body reactions towards the damaged disc by the immune system. Increasing the disc space relieves pressure on the nerve root. That is, as a result of the injection, an increase of the disc height occurs, which increases the spacing between lamina, and which in turn relieves pressure on the nerve roots on the lamina. For this application, supplementation of the fibrin sealant with growth factors may promote rehabilitation of the damaged tissues or the gradual replacement of the fibrin sealant with healthy tissue.
[0032]Use of the improved fibrin sealant composition may be better understood by reference to the following examples. These examples are representative and should not be construed to limit the scope of this invention or claims hereof. Unless otherwise indicated (example 3), corticosteroid is absent from the fibrin sealant being used in these examples and the procedures were conducted in the absence of a heating step of the nucleus fibrosus and annulus fibrosus and in the absence of a partial or total discectomy.
Example 1
Fluoroscopic Transforaminal Epidural Injection
[0033]With a patient in the prone position on the imaging table, a fluoroscope is positioned and adjusted to locate the intervertebral foramen of the affected nerve root. A curved 22 ga.×3.5'' needle is introduced after anesthetizing the skin and deep tissue. The needle is advanced under direct fluoroscopic vision to a position in the anterior epidural space. Positioning of the needle is verified by a lateral fluoroscopic view and by injecting contrast medium through the needle. Such positioning may or may not require further adjustment. If adjusted, location of the needle is once again verified. Advancement of the needle into the correct region may stimulate pain in a manner consistent with the initial complaint. Therefore, needle placement may also be verified by the patient's pain recognition. The epidural space is anesthetized with injectable anesthetic. The fibrin sealant of fibrinogen and thrombin (prior to clotting) is then introduced through the needle with continuous gentle pressure until the volumes of the dual syringe system are sufficiently depleted. The thrombin or fibrinogen or both has been reconstituted with a solution containing at least one additive. The fibrin sealant then coats the nerve root and annulus and the needle is withdrawn. Patient observation and vital signs monitoring is performed for about 20-30 minutes following the procedure.
[0034]For this procedure, a sufficient volume of the fibrin sealant is injected to effectively hydro-dissect the area around the targeted nerve root. It is believed that due to the avascular nature of the epidural space, the absorption/degradation period is typically longer than that observed for open applications in regions with greater vascularity and exposure to room air at the time of application.
[0035]The ability of the fibrin sealant to seal annular fissures related to disc herniation offers a therapeutic benefit to patients. Chemical radiculitis, or inflammation of the nerve root, is known to be quite painful in some instances. It is believed that use of the fibrin sealant in the above described manner not only coats the nerve root, but also seals annular fissures surrounding the herniated disk. (See FIG. 1). As a result of the hydro-dissection of the area around the affected nerve root, the sealant also seals annular fissures from outside the annulus.
Example 2
Fluoroscopic Guided Intra-Discal Injection
[0036]After sterile preparation, an introducer needle is advanced in oblique projection to a superior articular process. A curved spinal needle is advanced through the introducer needle into the disc. Both anterior-posterior and lateral fluoroscopic projections are used to confirm proper needle placement. If the needle placement needs to be adjusted, placement is again confirmed fluoroscopically. A contrast agent is injected to confirm needle placement. In patients with chemical radiculitis, the contrast agent can be observed to be leaking through the annular fissures and/or intra-discal pathology can be identified. Once the needle is properly positioned in the intra-discal space, the fibrin sealant (or its components) is injected. The thrombin or fibrinogen or both has been reconstituted with a solution containing at least one additive. The fibrin sealant is observed to force the contrast agent from the intra-discal space as it seals the annual fissures. Alternatively, the contrast agent is injected with the sealant. Alternatively, no contrast agent is used. The procedure seals the defects/fissures of the annulus fibrosus and stops the chemical leakage and facilitates regeneration within the disc.
Example 3
Comparison of Injection of Fibrin Sealant to Injection of Fibrin Sealant Containing a Corticosteriod
[0037]Twenty patients were split into two 10-patient groups. All of the patients suffered from pain due to disc degeneration caused by defects (fissures) in the annulus fibrosus. All of the patients had previously failed at least 6 months of traditional conservative therapy. Using the procedure in example 2, the first group of patients was intra-discally injected with fibrin sealant containing fibrinogen and thrombin. Using the procedure in example 2, the second group of patients was instra-discally injected with fibrin sealant containing fibrinogen, thrombin, and betamethasone (a corticosteroid). The corticosteroid was in the thrombin component. Each patient rated back and leg pain on a scale of 0 to 10, before and at predefined intervals following surgery. The results (VAS scores) are shown in FIGS. 3 and 4. As can be seen, the patients that were injected with fibrin sealant alone (without betamethasone) experienced superior pain relief to those patients that were injected with fibrin sealant containing betamethasone. It had been anticipated that the patients receiving injections that included betamethasone would experience superior results due to the action of the betamethasone to reduce inflammation. However, the opposite was observed. Indeed, the patients injected with fibrin sealant only experienced significantly improved pain relief, not only after one week from surgery, but especially 12 weeks after surgery. These results were surprising and unexpected.
Example 4
Fibrin Sealant Including Local Anesthetic
[0038]Using the procedure of example 2, patients were intra-discally injected with fibrin sealant containing fibrinogen, thrombin, and a local anesthetic (bupivacaine HCL). The local anesthetic solution (approximately 1 mL) was mixed into a calcium chloride solution used to reconstitute the fibrinogen. The total amount of fibrin sealant injected was thus 5 mL. It was found, surprisingly, that the fibrin sealant including a local anesthetic provided superior results to either fibrin sealant containing a corticosteroid or the fibrin sealant of example 3.
Example 4
Fibrin Sealant with a Local Anesthetic
[0039]A patient was treated with fibrin sealant containing a local anesthetic. The local anesthetic was used to reconstitute the thrombin. The patient suffered from pain due to disc degeneration caused by defects (fissures) in the annulus fibrosus. Using the procedure in example 2, the patient was intra-discally injected with fibrin sealant containing fibrinogen, thrombin, and a local anesthetic (3 cc of 0.75% bupivacaine). Local anesthetic was used reconstitute the thrombin. A total of 5 cc of fibrinogen, thrombin, and local anesthetic was injected. The patient rated back and leg pain on a scale of 0 to 10, before and at predefined intervals following surgery. The results were as follows for back pain: pre-treatment, 4; 1 week after treatment, 4, 3 weeks after treatment, 1; and after 6 weeks, 1. Leg pain was zero both at pre-treatment and after treatment. Owing to the dramatic decrease in pain after 6 weeks, these results were surprising and unexpected.
[0040]It is envisioned that the present invention may be used to address various conditions through use of the fibrin sealant in a manner similar to that described in the examples above. Discussion of this invention referenced particular means, materials and embodiments elaborating limited application of the claimed invention. The invention is not limited to these particulars and applies to all equivalents. Although this invention has been described above with reference to particular means, materials and embodiments, it is to be understood that the invention is not limited to these disclosed particulars, but extends instead to all equivalents within the scope of the following claims.
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Circle of Dust
– Past –
Circle of Dust, the 90s industrial / electronic-rock project created by Klayton, marked the beginning of the musical career of the man who later went on to create Celldweller. Now after 20 years, Circle of Dust is back.
– Present –
Celldweller creates a fusion of digital and organic textures: intricately designed soundscapes constructed from Drum & Bass, Electro and Modular Synths, woven together with aggressive Rock, Metal and Orchestral elements.
– Future –
Red has scoured the depths of the ancient wasteland he calls home for something lost and buried, something revolutionary. What he unearthed was the New Retro sound of a forgotten era. He formed Scandroid to bring that sound into his world.
Artist / Musician
Klayton is a multi-instrumentalist and vocalist, skillfully playing everything from guitars, bass, drums and keys to operating a massive collection of modular synthesizers. Klayton's sound is further characterized by his intricate production in editing, programming and mixing. Klayton's music has garnered prominent charting and response from fans from around the globe.
Composer / Producer
Known for his world-class production quality across a wide range of styles, Klayton's music has garnered hundreds of Film/TV/Video Game placements and hundreds of millions of online music/video streams.
Klayton is also known for his powerful & unique remixes, for artists like Pendulum, Motionless In White, BT, I See Stars, Asking Alexandria, Jes and Criss Angel.
Performer / Entreprenuer
Klayton has toured the globe with performances ranging from USA & Canada to Brazil, the UK, Germany, Russia and Japan and more. When not creating music, Klayton exercises an entrepreneurial spirit, owning and operating the independent record label FiXT, the production music label Subterra Records, a sci-fi clothing line Outland Industries, and a pro audio hardware/software company Refractor Audio.

subset: commoncrawl


text:
Recipe by: RUTHWARD
Based on a 2,000 calorie diet
Sort stores by
May we suggest
Ready In
See how easy it is to make this hearty, salad-bar-style salad.
A crisp, colorful salad that brings a little heat with Thai and jalapeno chiles.
An easy corn salad with roasted red peppers and a creamy dressing.
Cook 5-star weekday dinners every time.
This recipe was really good! I had never had celery root before but my husband requested it so I found this recipe, one of the few on here for celery root. I forgot to put the pecans in at fir...


text:
Hello guys,
I have a product page, where i wants to display custom fields in tabular format. I inserted below code in single.php to get my custom fields for the same.
echo '
';
$mykey_values = get_post_custom_values('my_key');
foreach ( $mykey_values as $key => $value ) {
echo '
';
echo "$key 	 $value
	";
echo '
';
echo '
';
The result was good but not great as the meta key was displaying 0 , 1, 2 etc. like array. check the link for reference.
Now i just want a code which will change this values (0,1) to my custom field's meta key, which i will entered.
plz guys help me.


text:
United States gross domestic product increased 1.2 percent in second quarter 2016, according to the "advance" estimate from the Department of Commerce, following a revised increase of just 0.8 percent in the first quarter.
Rates from Shanghai to Northwest Europe, which hold a 20 percent weight on the overall index, skyrocketed 57.8 percent since last week, from $713 per TEU to $1,125 per TEU.
The Dubai-based port terminal operator signed a 30-year lease with Port Saint John on the East Coast of Canada to operate its West Side Container Terminal, DP World and port officials said in a joint statement Thursday.
Registration takes less than 1 minute.
Captain John Loftus, who was fired in 2013 after working for Horizon Line for 20 years, has been awarded $655,000 in back wages, $225,000 in punitive damages, $10,000 for emotional distress, and more than $200,000 in legal costs.
Some logistics providers remain skeptical about how well it will work for ports to weigh containers and transmit the data to carriers on behalf of shippers.
The parcel carrier and logistics provider's DHL Freight division has expanded its rail transport offerings to and from Asia and North Africa via its hub at Duisburg to include direct links and consolidation services.


text:
LAKELAND, Fla. — Valentine's Day can mean huge sales for supermarket fresh departments. Floral sales are second only to Mother's Day, and in-store bakeries see Valentine's Day as excellent for cake sales. At Publix Super Markets, Lakeland, Fla., Valentine's Day is the second biggest sales day for cupcakes, with Halloween being the biggest, Shannon Patten, Publix spokesperson, told SN. Patten said, too, that Valentine's Day falling on a weekday is usually a boon ...
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My hobbies are photography especially nature and macro. Walking the countryside and coastal walks. i do the odd bit of fishing but havent been for about 3 years. i think alot about exercise but never get round to doing it although i do once a week help train my boys football team and play football with friends at work once a month.
Have been told i give a good massage as well
Also, love computers and a bit of a computer whizz/geek.
I love cooking and shopping (Not food) and dont mind cooking at all for that special person.
I love all sports and am trting to be more active to get fit and trim again.
My friends say i have this ability to make people laugh and can get on wirh anyone.
I have 4 children that mean everything.
and i look better in person than my pictures lol
My phone
My camera
My bed
My car


text:
A subspecialty certification by the Board of Internal Medicine. Practitioners treat disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. Endocrinology also deals with disorders such as diabetes, metabolic and nutritional disorders, pituitary diseases, and menstrual and sexual problems.View More
1-3 of 3
285 E Main St Ste 105
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1275 Summer St Ste A1
Stamford, CT 06905
292 Long Ridge Rd Ste 206
Stamford, CT 06902


text:
I'm running 3.7-beta2 on a few test sites and I'm receiving an email everytime there's an update. I love the update feature, but is there a way to disable these email notifications?
I'm running 3.7-beta2 on a few test sites and I'm receiving an email everytime there's an update. I love the update feature, but is there a way to disable these email notifications?
Or set them to only email if there is a problem?
+1 vote for this.
The problem with only email when there's a problem is when you have to troubleshoot a failed upgrade because a plugin or theme caused a problem.
I suspect someone will write a plugin to filter them, but really don't you want to know when your site gets updated?
With all due respect, I manage over 40 installs. So, no.
Ideally, on a production site I would never enable auto-updates. On a development site I would enable it and not want email notifications, perhaps just a message when I log in to the panel.
Option 1) Make a default WP admin email and just use it for admin alerts (i.e. firstname.lastname@example.com)
Option 2) Email Filters.
That makes me sad :( The whole point of the auto-updates is to save you the pain of minor WP updates. Remember this is MINOR only.
Do remember that in BETA yes you're getting emails twice a day. When this is live, your real sites will only get ONE email, once, when an update happens. So yeah, Greg will get 40 emails one day when 3.7.1 comes out, but that's it. And they'll all be titled "[Sitename] Background updates have finished" so you can easily filter it.
And before someone says "But what about my users who don't know HOW to filter?" I say this: Those are the people who absolutely, 100%, are the reason we do want to have these emailed. Imagine how nice it'll be when we see "I got an email that WP's Background updates have finished, and now my theme is broken!" Aha! We know what happened!
I'm OK with emails as long as it's not 40, twice a day :)
Thanks for the clarification!
Oh yeah, no, you'll only get them when an upgrade runs. The catch is with BETA testing, it's set to run twice a day cause... beta. So don't put customers on Beta! Which ... goes without saying, I hope.
In the future even that will be improved to not upgrade unless there's something to upgrade (right now it upgrades no matter what, even if you're on THAT version).
So I don't have to do anything for WordPress to automatically update? But I still have to worry about the plugins? Is there a way to be notified of plugin updates?
There should definitely be a toggle option for email notifications following automatic updates. For lots of reasons...
no this upsets me too. I don't see why there isn't a setting to turn off the notifications / auto update feature.
I manage nearly twice as many wps as greg and I also have tons more registered with clients. So you can imagine the amount of emails I'm receiving asking what they do as they've received notification of a required update.
I'm in the same boat, Craig. I take care of all technical aspects for my clients, including all necessary upgrades.
The minor automatic updates are a great new feature and will save me a lot of time and help to keep things more secure.
However, I have needed to contact all my clients to explain the notification that they MAY have received and why.
So it would certainly be useful if there was more control over this. But the feature is nonetheless very appreciated. Hopefully more settings to control this will appear in future updates.
This topic has been closed to new replies.


text:
Connecticut voters chose state's poor fiscal management
The insanity in the People's Republic of Connecticut is running rampant. The voters are getting what they voted for. They soon will be hit with more taxes. Gov. Dannel P. Malloy probably won't increase any taxes, but he most will eliminate the property-tax credit as one way to increase revenues. We had the largest tax increase in 2011, and the state's the spending didn't stop. The magic busway, the "improvements" to the rail service going to Massachusetts, the tax credits given to the "First Five" corporations creating jobs in the state, the "bribes" given to corporations not to leave the state, etc., are a waste of our tax money.
The earned income tax credit also should be eliminated if our property-tax credit is to be made to disappear. The elimination of the property-tax credit would give the state $150 million to play with, and eliminating the earned income tax credit would net $220 million.
Read more of this story and more!
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- Rep. Nardello has kept her promise to run a clean, positive campaign
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First impression on unpacking the Q702 test unit was the solid feel and clean, minimalist styling.
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For work use, Microsoft Word and Excel programs pre-installed on the device are adequate for preparing short documents.
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The season of fundraising is upon us, and this Thanksgiving week, charity work is foremost on the minds of many former and current top tennis players. To recognize those efforts on this distinctly American holiday, ESPN.com presents a sampling of homegrown tennis stars who give back.
Katrina Adams
Harlem (N.Y.) Junior Tennis and Education Program
The Harlem program, founded in 1972, serves about 150 children ages 7 to 18 from low-income inner city neighborhoods during each school year and about double that in summer camps. Adams, a commentator and former WTA player who won 21 doubles titles on the circuit, is the organization's executive director. Aside from tennis instruction for levels from beginner on up, the HJTEP offers after-school academic tutoring, SAT preparation, computer classes and guidance in areas including personal hygiene, financial management and nutrition. There is also an active parents' association. In tough economic times, Adams said the program is simply trying to maintain what it has rather than expand. Roughly one-quarter of the program's participants are awarded college tennis scholarships. James Blake is among the program's alumni.
Leslie Allen
The Leslie Allen Foundation/Win 4 Life
www.leslieallen.net or Win4Life Facebook
Allen's program, based in Charleston, S.C., is designed to introduce middle and high school students to different career paths through tennis. The students work intensively for a three-month period, shadowing professionals in business, administrative, public sector and communications jobs related to a WTA tournament in the area, as well as receiving academic support and participating in life skills seminars and recreational programs. They also interact with students at local colleges. Allen, who graduated from the University of Southern California with honors, is a former top-20 player whose WTA title in Detroit in 1981 was the first by an African-American woman since Althea Gibson in 1958. She said her goal is to restart a similar program she ran in New York until a few years ago, and to establish a summer camp with the same principles.
James Blake
Thomas Blake Sr. Memorial Research Fund (at Sloan-Kettering)
Write to email@example.com.
Blake has been holding annual offseason fundraisers and donating the proceeds to cancer research for a number of years (a total of $1.5 million thus far). In 2008, he decided to establish an earmarked fund under the auspices of Memorial Sloan-Kettering Cancer Center in honor of his father, who died of stomach cancer in 2004. The fund supports research to accelerate the development of promising treatments and techniques, especially for early diagnosis of cancer. This year's benefit for the fund will be held in New York on Dec. 1 and features an exhibition match between Blake and Andy Roddick, and a concert by Wyclef Jean. More information on the event and the fund is available on the Sloan-Kettering website. Blake, winner of 10 career ATP titles, hit a career-high No. 4 in 2006 and was a member of the U.S. Davis Cup team that won the 2007 championship.
Todd Martin
The Todd Martin Development Fund
Martin's hometown of Lansing, Mich., has always been vulnerable to economic ups and downs because of its dependence on the auto industry and other manufacturing, and the former top-10 player said the current needs to help children of low-income families is greater than ever. A chapter of the U.S. Tennis Association's National Junior Tennis and Learning Program, Martin's fund supports tennis instruction, after-school programs in academic tutoring and leadership skills for about 600 children ages 8 to 18 annually, as well as a summer program that includes field trips to sports and cultural destinations. The organization's annual fundraising event will be held in Lansing the weekend of Dec. 4-5 and features exhibition tennis with two-time Grand Slam finalist Martin, NCAA champion Devin Britton and ATP veteran Jeff Morrison.
Andy Roddick
The Andy Roddick Foundation
Roddick's foundation targets abused, neglected and disadvantaged children in two areas he calls home: central Texas and southeastern Florida. The group holds annual fundraising events in Austin, Tex., where Roddick lives (Nov. 30, sold out), and Boca Raton, Fla. (Dec. 12-13) where he went to high school. Funds are distributed to outreach and children's health care organizations with the stipulation that they go directly to children and not be used for operational expenses such as staff salaries. Roddick, an ATP top-10 player for the past eight years, dedicated Davis Cup player, 2003 U.S. Open winner and finalist in four other Grand Slam events, started his foundation at age 19 in 2001, inspired by his mentor Andre Agassi, who told Roddick he regretted starting his own charity work so late in his career.
Pam Shriver
Baltimore Community Foundation Tennis Challenge
Rather than operating her own foundation, Shriver supports two separate funds -- one with her own money, the other with proceeds from an annual tennis exhibition in her hometown of Baltimore -- under the umbrella of the Baltimore Community Foundation. Since 1992, the BCF has distributed $4 million raised or donated by Shriver to a plethora of local agencies and non-profit organizations, chiefly child-oriented, considering different requests and needs each year. Shriver, a 21-time Grand Slam doubles champion, Olympic doubles gold medalist and currently an ESPN analyst, initially directed her charitable efforts toward cystic fibrosis research before electing to try to serve a broader base. The annual BCF Tennis Challenge will be held on Dec. 9 in downtown Baltimore and will be headlined by John Isner, Melanie Oudin and the Bryan brothers.
MaliVai Washington
MaliVai Washington Kids Foundation
The 1996 Wimbledon finalist has achieved one of the most ambitious goals of any recent tennis philanthropist -- making a tangible, dynamic and continuing contribution to one of the most economically depressed neighborhoods in Jacksonville, Fla. Washington's foundation, established in 1997, spearheaded the construction of a $3 million, 9,000-square-foot youth center that opened last year and features eight tennis courts, a gym, classrooms, a library and a computer center. A large, varied menu of academic, life skills and tennis programs, as well as a summer camp, are based at the center for children from first grade through high school. Parental involvement is required in the form of community service and attendance at family nights. The foundation also does community outreach and holds several fundraising events every year.
Bonnie D. Ford covers tennis and Olympic sports for ESPN.com. She can be reached at firstname.lastname@example.com.


text:
ODT Online
ODT /directory
Citing an unnamed source close to the Labour party, it said
Labour leader Ed Miliband would seek to reform Britain's EU
ties and back holding a membership referendum, but not by
2017 as Prime Minister David Cameron has pledged.
The report said Miliband was open to changing the bloc's
founding treaties and would use any treaty change as an
opportunity for a referendum. An announcement was expected in
the next two weeks, the article said.
If an election was held today polls suggest Labour would win
since they enjoy a lead of around 5 percentage points over
Cameron's Conservative party. The next national election is
still 15 months away, however.
Labour has yet to publicly state whether it wants an EU
referendum, but has been critical of a promise by Cameron, it
re-elected, to hold an in/out vote on Britain's EU membership
by the end of 2017.
If he wins the next election, Cameron has said he would try
to reform Britain's EU ties before offering such a vote.
When asked about the Times report, a Labour spokesman
declined to confirm or deny it.
"We will keep our position consistent ... We have always said
that any decision about a European referendum will be based
on the national interests," the spokesman said.
"We do not believe committing now to an in/out referendum in
2017 is in Britain's national interest."
Some opinion polls show a slim majority of Britons would vote
to leave the EU if given the chance, with many frustrated at
perceived interference from Brussels in domestic politics.
That frustration has been reflected in the growing support in
polls for the anti-EU UK Independence party (UKIP).
In an interview with Reuters earlier this month, UKIP leader
Nigel Farage said Miliband's backing for a referendum on EU
membership would be the "single most important determinant of
whether Britain leaves the European Union" because it would
dramatically increase the chances of a vote taking place.
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In This Section
AES Regions
- Eastern Region, USA/Canada
- VP: Anthony Schultz
- Central Region, USA/Canada
- VP: Jason Corey
- Western Region, USA/Canada
- VP: David W. Scheirman
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- VP: Bill Foster
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- VP: Thomas Sporer
- Southern Region, Europe
- VP: Liz Teutsch
- Latin American Region
- VP: Valeria Palomino
- International Region
- VP: Toru Kamekawa
Austrian AES Section
Piotr Majdak
Vice Chair:
Nadja Wallaszkovits
Thomas Gmeiner
Gerhard Graber
Robert Hoeldrich
Ewald Kerschbaum
Christian Kollmitzer
Alfred Kraker
Karl Peschel
Heinrich Pichler
Dietrich Schueller
Gregor Widholm
If you wish to change the listing for your section, please fill out this form.
If you are not a member of an AES Section yet, you can join this section today!
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November 26, 2015 - Modernste Messtechnik für Musikinstrumente am Institut für Wiener Klangstil
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April 30, 2014 - Collectors, Archivists and Technology: Indian Scenario!
April 10, 2014 - Can hearing-aid users benefit from enhanced pinna cues for sound localisation?
January 30, 2014 - Music reconstruction of automatons of the Renaissance
November 19, 2013 - Joint AES-AAA-Meeting
September 13, 2013 - Projects and progress on virtual auditory displays
March 3, 2013 - Orientation assistance for the blind - auralization simulation
December 4, 2012 - Piano sound design by intonation and voicing of the hammer felt


text:
Jenny Craig Center - Layton, UT
- WebMD Physician Directory of Layton Doctors
- Related Jenny Craig Articles
- Layton Emergency Contacts
- Nearby Layton Hospitals
- Find a Local Pharmacy on RxList - Layton
Layton Doctors and Specialists for Jenny Craig
Jenny Craig
What It Is
Jenny Craig isn't a Janie-come-lately to the diet field. The program began in 1983 in Australia and started U.S. operations in 1985.
The Jenny Craig method is a three-level food-mind-body plan to...
Other Related Jenny Craig Articles
Emergency Contact for Layton
- In case of Emergency, call 911
Nearby Layton Hospitals results
- 1Davis Hospital & Medical Center
1600 W Antelope Dr
Layton, Utah 84041
(801) 807-100
- 2Ogden Regional Medical Center
Layton, Utah 84405
(801) 479-211
- 3Mckay-Dee Hospital Center
4401 Harrison Blvd
Layton, Utah 84403
(801) 627-280
- 4Lakeview Hospital
630 Medical Dr
Layton, Utah 84010
(801) 292-623
- 5South Davis Community Hospital
Layton, Utah 84010
(801) 295-236
- 6Benchmark Behavioral Health
Layton, Utah 84010
(801) 299-530
- 7LDS Hospital
8th Ave & C St
Layton, Utah 84143
(801) 408-110
- 8Shriners Hospitals For Children
1275 E Fairfax Rd
Layton, Utah 84103
(801) 536-350
- 9Salt Lake Regional Medical Ctr
1050 E South Temple
Layton, Utah 84102
(801) 350-411
- 10Primary Children's Medical Ctr
100 Mario Capecchi Dr
Layton, Utah 84113
(801) 662-100
- 11University Of Utah Hospital
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My home page feed has a variety of items including a featured post and other features that I'd only like present on the home feed. When a user clicks on pagination to load older posts, I'd like to load up a new page template without all the home page bells and whistles. Is there a WP template file I'm overlooking or is this not supported?
Consider using the
Reference to is_home on the WordPress Codex


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Skip to comments.Homeschoolers React to State of the Union Education Demand
Posted on 01/25/2012 12:27:51 PM PST by scripter
click here to read article
Urgent Calls Needed to Stop Obama's Attack on Educational Freedom
Dear HSLDA Members and Friends,
"So tonight, I am proposing that every state--every state--requires that all students stay in high school until they graduate or turn 18."
--President Barack Obama, last night's State of the Union speech.
I was shocked when I heard that. Under our U.S. Constitution, education matters are left to the states. Our Founders wanted decisions about education and a host of other matters left to the states and local government so that these important decisions that affect every family could easily be influenced by the real decision makers: parents and the family.
Parents--not the federal government and certainly not the president--are the ones who should decide how children are educated and when they're ready to graduate from high school.
But last night, President Obama made it clear that he thinks the federal government should be in the business of telling states how long children should stay in school.
Since we were founded in 1983, HSLDA has fought attempts by state legislatures to increase the ages of compulsory attendance in school. We do this because parents--not education bureaucrats--are best equipped to decide how long their children should stay in school.
Now, thanks to President Obama and his willing allies in Congress, we're going to have to fight this in Congress, too. We need to make sure that the White House, and their allies in Congress hear our message loud and strong: leave education decisions to parents.
Right now, please call the White House, and your members of Congress, and give them this message:
"Last night, President Obama called for the government to mandate that all children stay in school until they graduate or turn age 18. This is not the federal government's responsibility. Leave education decisions to parents, not federal bureaucrats. Tell President Obama to withdraw his compulsory attendance mandate immediately." The White House: 202-456-1414, or send an online message: http://www.hslda.org/elink.asp?id=13517 Your U.S. representative and two U.S. senators: 202-224-3121 (Capitol Switchboard) or http://www.hslda.org/elink.asp?id=13518 to find their names and contact info.
There appears to be no limit to this president's desire for power. Car companies, banks, doctors, and now schools and the family. But this time he's gone way too far, and homeschoolers and freedom-loving Americans need to make sure that he hears our message.
Thank you for standing with us for freedom.
Michael P. Farris, JD, LLM Chairman, HSLDA
P.S. Click here http://www.hslda.org/elink.asp?id=13519 to watch the president threaten education freedom in last night's State of the Union speech.
You probably have this in email. I thought I'd post in here for a wider audience.
Here is a list of current compulsory education, by state:
Longer government skool attendance = more goonion teachers = more dues = more goonion contributions to dhimmiecrats
So glad I didn't watch - my heart probably would have given out listening to all this Big Brother Socialist crap ...
I don't see how this will work on religious grounds.
I am not fully aware of the law, but in Maryland it is required that student stay in school until 16, but the Amish who live here do not go to High School. They stop in the 6th grade and generally the older ones stay and help the others by teaching. At least some of the girls do. I believe the boys are just truant after the 6th grade.
Of course Obama has already shown that Freedom of Religion means nothing to him, he showed that when he went against the Conscience act to force Catholics out of the adoption business and forced helping in abortion on Catholic nurses.
Oh Well" More Obama made laws and regulations coming down the pike, I wonder why we have a Congress when we have a President who rules like a King.
Exactly. Just a reason to try to justify more money to "schools and education".
1. Steal the peoples' money
2. "Give" it to the local school districts until they become addicted and can't function without it.
3. Impose your indoctrination requirements on districts who "choose" to accept the peoples' money that you stole.
And get all children under the thumb of leftist indoctrination. None can be allowed to escape, that would be dangerous.
I envy you. I watched about 5 seconds with the sound off and saw Biden clapping... that was enough.
I guess Obama's answer to the dropout rate is the same as his answer to people not having health careThrow your butt in prison if you don't comply.
I guess Obama's answer to the dropout rate is the same as his answer to people not having health careThrow your butt in prison if you don't comply.
I watched no more than 10 minutes of that cr@p, and I managed to see both his zero sum economics (you rich people need to pay more taxes because the $ has to come from SOMEWHERE) and his attempt to destroy homeschooling!!!!
I hope this gets mentioned in the next debate.
As I understand, attendance is already compulsory in many states. Is the issue that the Federal Govt wants to be in charge of this; i.e., centralization of control of children, or is the issue mandatory attendance itself?
I was homeschooled, and I hope to homeschool my (someday) children.
I might have to re-ask my parents, but as I recall, you only have to show the state that you are educating your child at home and that counts as attendance.
I dislike centralizing power, but how much more complicated is forwarding that same information to the government?
Serious questions—not trolling or playing devil's advocate. I am a bit naive about the particulars of these laws.
What would be the point in forcing an unengaged kid to keep attending school?
Da teechers unions need mo' job securitah.
Cruachan! III%
What gets me is this jackass uses the excuse of "government should not interfere with private family matters" when it comes to justifying abortion.
"...I wonder why we have a Congress when we have a President who rules like a King."
If there were no House or Senate, who would go to all those cocktail parties???
This is just about Obama sucking up to the teacher's unions. Pure and simple.
The thing about homeschoolers is that they (we) are by nature... well... zealots. We'll go to the mats to defend our rights to homeschool,
and the commies need to understand just what that means.
Help me understand the controversy vis-a-vis homeschoolers. The proposal Obama iterated was that students stay in school a.) until they graduate; or b.) turn 18. So, for instance, if a homeschooled student completed the requisite coursework for HS graduation at 16 years of age (i.e. graduated), then the 18 years of age restriction becomes moot. Are not most homeschoolers educating their children up to and including HS graduation?
Baby steps with a goal of forcing all children under the tutelage of a communist indoctrination "educator" from birth to age of majority.
Money. They get paid per body, engaged or not.
The more & deeper a distant bureaucracy gets in trying to dictate educational processes, the worse public education in America gets. (See Public Schools: Issues & Reality.)
But, of course, with the influence of the NEA, many public schools are avidly pushing a pro-Obama indoctrination. That explains a lot.
William Flax
This ping list is for articles of interest to homeschoolers. I hold both the Homeschool Ping List and the Another Reason to Homeschool Ping List. Please freepmail me to let me know if you would like to be added or removed from either list, or both.
The keyword for the FREE REPUBLIC HOMESCHOOLERS FORUM is frhf.
"and had been excepted to UNC Willmington"
That's racist! What did you do when your child was denied entry? :) :) :)
Yes, I understand these communists' agenda, and their incremental erosion of our individual rights and privileges. I suppose I can see this as another "camel's nose under the tent" situation. Just trying to understand the specific implications for homeschooling if this becomes another federal mandate.
Actually, I don't.
My youngest is a sophomore in college and we're no longer members of HSLDA.
So, if you see anything from them that should be known, by all means, ping me again.
"...until they graduate...."
What's the problem?
We signed up as "lifers" when my oldest was 4...
I guess I'll be getting emails & publications for a while.
Between this and the message from HSLDA I saw on Facebook Monday regarding the "Homeschool Study" from the Dept of Education (http://www.hslda.org/docs/news/2012/201201200.asp), I am getting concerned.
I'm still curious as to how the federal gov't got the names and addresses of homeschoolers to send out this study...I'm assuming that I had never heard of it before because we previously homeschooled in Texas and Germany (on a military base) where we didn't have to report to anyone. Now we are in a state that I have to report in, but I did not give our county permission to pass along my info to the Dept of Ed.
Massachusetts now has a LAW against doing this, don't they?
The notion of compulsory education is for the most part ridiculous, and ignores the obvious fact that the only thing many students kept against their will do, is to interfere in many ways with the education of students that *do* want to be educated.
1) Teachers try to teach "to the middle" of their classes abilities. If the class has more smart, motivated children, the teacher can, at least theoretically, teach at a higher level. However, poor, unmotivated, and disruptive students can drag down a class proportionately much more than smart, motivated students can uplift it.
2) Schools need some means of culling disruptive and even criminal students. As was demonstrated by principal Joe Clark, once even an inner city school was purged of its troublemakers, it was able to thrive.
3) Students are often very aware of their own intellectual interests and shortcomings, seeing no practical advantage to graduating or even attending school beyond a particular point. While later, as adults, they change their minds and get their GED, efforts to persuade or coerce they earlier just creates a wall of resistance, and even anger from them.
Thanks for the ping. Homeschoolers were the first ones I thought of when I read this latest madness of King Barry.
Last night, the Washington Capitals vs Boston Bruins hockey game is the only thing I watched on TV.
It was an exciting game, and I became so absorbed in it that I actually forgot Obama was giving a campaign speech...
...I wasn't going to say anything...
; - )
You have to remember that public education is primarily a (union) jobs program.
I had some extended family living in a state where the compulsory age was 16. They had a son who hooked up with the wrong crowd and started getting in trouble. His dad tried to put him into a parochial school where he'd get more structure and better guidance. But the kid did not like it, and when he turned 16 he dropped out. His father was told that was the law, and there was nothing he could do about it.
Then he kept getting in trouble with the cops. The police kept bringing him back to his dad. The dad was in a Catch 22 because he was still responsible for the kid for two more years, but could not legally force him to go back to school. And legally he could not kick the kid out either.
This is a stupid and untenable legal situation. Age of majority and compulsory attendance need to be the same.
He needs two more years to DUMB DOWN the public school (or as NY City spelpt it shcool) student, so they be WONDERFUL socialists.
mandatory age 18 is just mandated indoctrination and
MOST IMPORTANT mandated teacher union employment pay off.
School till 18 means more teachers means more union dues funneled to democrats.
According to STAR testing, my home-educated kids were intellectually ready to attend college at the age of 10. There is no way in hell I would ever allow them to remain in a school just to make life easier for incompetent teachers.
"spelpt it shcool"
Sorry! But sometimes typos are funny!
By the time I was 18 I had an associates degree and was in a four year school. No diploma from anyone that the government would recognize because that's what worked for us.
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