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7,078 total
I'm in a part-time MBA program, and am out of the office for 2 days every 3 weeks. My employer agreed to not count the days out of the office as vacation or PTO, especially because I am doing extra work in the program to help the company (e.g. a P...
An employer cannot change the amount of an employee's pay retroactively. This isn't quite the same thing as retroactively changing the pay rate, but it is a retroactive change in compensation so it may be covered under the same laws. It is also likely a breach of contract. If the agreement (contract) was oral, it will be difficult to prove unless your boss and HR back you up. If you have written evidence of the agreement, such as e-mail communications, you might take copies of these to HR and ask for assistance. You can ask your boss the same thing, and you could ask the office administrator.
Keep in mind that some employers retaliate. If you haven't had this job very long or if your job is at risk, you may want to think carefully about how to approach this. Certainly you want to show respect for the employer's authority and administrators authority at all times, don't criticize anyone or blame anyone, and leave the administrator a face-saving way out. Perhaps you can talk to the admin (or?) and say "I'm sorry no one let you know in advance that this was already approved as non-vacation time. Here are copies of the discussion we had about this," or words to that effect.
Good luck!See question
I work for a courier company that hired me as an independent contract driver. This company services a pharmacy which is where i do the work. Under the contract i signed with courier company it specifies that i can hire a 3rd party to do the work, ...
As others have mentioned, much of what you describe would make you an employee under the law as opposed to an employer. Note that an employer cannot "make" someone an independent contractor or employee; that is a legal determination. Even if an employee and employer sign an agreement that says someone is an employee (or an independent contractor), it doesn't matter. This is completely a legal decision, not a personnel decision.
The general rule is that a person is an independent contractor if the employer has the right to control or direct the RESULTS of the work but not HOW the work is done or even WHAT work is done.
Many employers misclassify workers as independent contractors and pay them as "1099 employees" when in fact they should be classified and paid as regular W-2 employees. Employers receive a substantial benefit from doing this, but there is NO benefit to the workers. If a worker is wrongly classified as an independent contractor instead of an employee, that worker will not be eligible for many benefits of employment or eligibility will be reduced. Areas affected include the right to:
– be paid for all hours worked or controlled by the employer;
– the legal minimum wage;
– overtime pay;
– rest and meal breaks;
– workers' compensation insurance;
– Social Security contributions;
– unemployment benefits;
– state disability benefits;
– employer benefits such as vacation, sick leave, pension, medical insurance, etc.
Also, in some states, including California, employers are subject to a penalty if they misclassify employees as independent contractors (see below).
There are different ways to determine if a worker is an employee or independent contractor. Employers must comply with all relevant laws.
FEDERAL TAX LAW: The Internal Revenue Service (IRS) looks at three areas to determine a worker's status:
Behavioral Control – This area considers instructions and training. If the employer has the right to direct or control the work, even if it does not exercise that right, the worker is an employee. These instructions might include when to do the work, or how and where to do it; what equipment or tools to use; who the worker can hire or not hire to help get the work done; what supplies and services to buy, and/or where to buy them. If the employer trains the worker in required methods of doing the work or the procedures to get the work done, this is evidence the employer wants things done its way, which indicates the worker is an employee and not an independent contractor. Therefore, if the employer gives the worker detailed or extensive instructions on how to get the job done, the worker is probably an employee and not an independent contractor.
Financial Control – This area considers who has the right to direct and control the business, not just the work. The more of a financial or promotional investment the worker has made in the work, the more likely the worker is an independent contractor. However, there is no requirement for an investment in order to meet the definition of independent contractor. If the worker incurs expenses in performing the work but is not completely reimbursed, the worker is more likely to be an independent contractor rather than an employee, especially if these expenses are high. If the worker has the chance to make a profit or loss on the work, the worker is probably in business for himself or herself and therefore an independent contractor.
Relationship of the Parties – If the worker does not receive benefits such as medical coverage, vacation, or pension, the worker may be an employee or an independent contractor. However, if the worker receives benefits, the worker is probably an employee.
(continued in Comment below)
See question
Would I qualify for unemployment benefits if I was discharged for off duty misconduct? Former employer doesn't have proof of anything, they only heard from others. I never even did what they said I did. So should I apply for unemployment benefits?...
Generally, a person claiming unemployment benefits (a "claimant") is eligible for benefits if ALL of the following is true: he or she is (1) unemployed due to no fault of his or her own; (2) physically able to work; (3) actively seeking work; (4) ready to accept work immediately; (5) has received enough wages during the base period to establish a claim; and (6) meets eligibility requirements each week benefits are claimed. An overview of these requirements can be found on the web site of the California Employment Development Department (EDD) http://www.edd.ca.gov/Unemployment/Eligibility.htm.
There is a legal presumption (similar to an assumption) that a claimant is entitled to benefits unless the claimant was either fired FOR MISCONDUCT or quit without cause. "Misconduct" generally means taking intentional acts against the interest of the employer. Some examples are tardiness or absences without reason, insubordination, showing up drunk, initiating a fight, etc. "Unsatisfactory performance" is NOT misconduct unless the claimant intentionally did a bad job. If the claimant did his or her best but the employer wasn't satisfied, the claimant is still eligible for benefits. The burden is on the employer to show that the claimant intentionally did a bad job. For more information on misconduct, see http://www.edd.ca.gov/uibdg/Misconduct_-_Table_of_Contents.htm.
The California Employment Development Department (EDD) administers California's unemployment insurance program and evaluates claims for benefits. Often, EDD telephones the claimant and the employer and interviews both. EDD compares their statements and makes a decision based on information received. By the limited nature of the initial process, EDD sometimes makes errors. For this reason, there is an appeal process.
The Notice of Determination stating your claim was denied for misconduct includes information about the appeal. You MUST file your appeal within 30 days of the date stated in that letter. Do not miss the deadline. In the appeal, make a brief statement saying why you believe the denial was incorrect. Save your detailed argument and evidence for the hearing. For example: I did not engage in misconduct toward my employer and was falsely accused.
In a few weeks, you will receive notice of an appeals hearing with the date, time and location. At the hearing, be prepared with as much evidence as possible. You should also know the law the administrative law judge will consider. You can get a lot of helpful information on the EDD website.
Home page
Eligibility requirements
Summaries of the law (Benefit Determination Guide)
Precedent Decisions (law the administrative law judges rely on)
Frequently asked questions
Filing a claim for unemployment benefits
You can be represented by anyone at the hearing. If your appeal will be difficult or you are uncomfortable speaking, you may wish to retain an attorney to help you prepare or to represent you. For training, expect the attorney to need approximately three hours. For hearing representation, expect the attorney to need three to seven hours to prepare, depending on the complexity of the case, witnesses, documents and other evidence, and allow two hours for the hearing itself. Unemployment hearings usually last one hour or less, but you must arrive early to look at the file and there is a possibility you will have to wait for the previous case to finish.
(continued in Comment below)See question
I was fired on 7/22 due to a misconduct. A coworker was aggressively tailgating me for approx 5 miles after work. I was in my personal vehicle and not wearing my uniform. I gave him chances to go around me, but he wanted to harass me by tailgating...
California law requires employers to pay employees according to a pre-determined schedule. FOR EMPLOYEES WHOSE EMPLOYMENT IS ENDING, Labor Code sections 201, 202 and 203 require the following:
1. If the employer ends the employment relationship, the employer must pay everything owed to the employee at the time of termination, including all accumulated wages, overtime, vacation and PTO. (Labor Code section 201)
2. However, for seasonal employees working in curing, canning, or drying perishable fruit, fish or vegetables, the employer has 72 hours to make full payment.
3. If the employee ends the employment relationship without notice, the employer has 72 hours to pay the employees in full, including all accumulated wages, overtime, vacation and PTO. (Labor Code section 202). The final wage payment must be made at the place of termination.
If the employee quits without giving 72 hours notice AND does not request that final wages be mailed to a particular address, then these payment must be made at the office of the employer within the county where the work was performed.
If an employee previously authorized direct deposit, that authorization is immediately terminated when an employee quits or is discharged, and the employer must make the final wage payment as above UNLESS the employee voluntarily authorized the direct deposit AND the employer makes the payment on time, as described above.
If the employer does not pay as required, there is a penalty against the employer and in favor of the employee: the employee's pay continues as if the employee were still working, every day until the employer pays in full, up to a maximum of 30 days. The employee is entitled to interest at 10 per cent per annum on the unpaid amount. Also, if the employee must go to court to get his or her pay, then the employee is awarded reasonable attorney's fees and costs of suit. (Labor Code section 203).
The Division of Labor Standards Enforcement (DLSE) is a sub-agency within the California Department of Industrial Relations. http://www.dir.ca.gov/dlse/. Some people refer to the DLSE as the Labor Commissioner. The DLSE enforces California's wage and hour laws, including those pertaining to overtime, rest and meal breaks, and more. The link for information on filing a wage claim is here: http://www.dir.ca.gov/dlse/howtofilewageclaim.htm.See question
Could a superviser tell me 1 more and i will report you and remember. The last driver is no longer working with us anymore
It is hard to understand your question. If you worked directly for a sub-contractor and the general contractor is giving you orders you are required to follow, you may actually be working for both the sub-contractor and the general contractor. If you are being told you must wear a uniform, that is usually legal but if the uniform is not clothing you could wear outside of work (for example, if it has an employer insignia on it), then the employer is probably required to pay for the uniform and pay for its cleaning and maintenance. Yes, an employer can warn an employee that improper conduct is not acceptable and can tell the employee that a former employee is no longer employed because the former employee engaged in the same improper conduct.See question
My former employer hasn't paid me my final paycheck yet and they are tribal. So, does that mean I can't file a complaint with DLSE due to the whole sovereignty thing? Do I have to just keep twiddling my thumbs and do nothing or can I do something?...
In addition to Mr. Pedersen's accurate advice, t may ake a difference if you worked directly for a tribe or for a contractor of a tribe; if you worked on or off a reservation; if you worked for a commercial business owned by a tribe and open to non-tribal customers, or if you worked for an entity that only services tribe members; and other considerations. You can try Googling the name of the tribe and the word "compact" or the phrase "employment law" to see if the info is easily available. However, be prepared for difficulty finding what you are looking for.
Good luck!See question
I am a federal employee in CA, three years ago I was a victim of retaliatory action by my supervisor since I file a whistleblowing case. I went through long process by filing with MSPB and I got the final order on my side, the MSPB ordered a cor...
It is rare when I disagree with Mr. Pedersen, who is an extremely good attorney. Here, however, it does not sound like the MSPB has jurisdiction (power to act) over the retaliation you describe – though I do not understand everything you wrote. (For example, what do you mean by "I didn't file to have it."?)
The law in this situation is ridiculously complicated, . The MSPB has jurisdiction over claims that an agency retaliated against an employee because the employee filed a prior claim with the MSPB. But for the MSPB to have jurisdiction, the retaliation must be in the form of an adverse action that the MSPB would otherwise have jurisdiction over anyway. In other words, it must be a removal, suspension of more than 14 days, or a demotion.
The retaliation you describe does not appear to fit into any of the three categories MSPB can address. So, oddly enough, you have to go to a different agency, the Office of Special Counsel (OSC). https://osc.gov/ If OSC feels it is appropriate, then OSC can take the case to the MSPB. You will have to show the MSPB it can win the case, which will require proof that (1) you engaged in an activity protected by the statute; (2) you were subsequently treated adversely; (3) agency officials knew or had constructive knowledge that you engaged in protected activity; (4) there was a causal connection between the protected activity and the personnel action (that is, the protected activity caused the adverse action); and (5) the protected activity was a significant factor in the agency taking the action.
You may also file with the agency's EEO office within 45 days for the actions that you say are "very clear religious, nationality, and gender discrimination." The process for pursuing a discrimination complaint against the federal government is complicated and counter-intuitive. Because of its special characteristics, I have written a guide to help federal employees navigate the system. If you decide to pursue these claims, I suggest you first read my guide to the EEO complaint process for federal government employees and how to find the right attorney: http://www.thespencerlawfirm.com/pdf/tslf-federal-ee-discrim.pdf.
I wish you the very best in pursuing your claim.See question
My company is still undergoing major growth changes and the scheduling team has my lunch/meal break set to be at 10:30. My start time is 5AM. When asked about the issue, was told there was nothing they could do and to advise my team supervisor (wh...
The law regarding meal breaks and rest breaks in California is that most employees are entitled to one meal period of at least 30 minutes if they work 5 hours or more in one day (unless they are exempt from overtime). However, the employee and the employer can mutually agree to waive the meal period if the employee works no more than 6 hours in one day. Employees who work more than 6 hours in one day may not waive their meal breaks. The 30-minute meal break must be a full 30 minutes -- not 29 minutes -- and must be COMPLETELY free from duty. These 30 minutes must be "net." They cannot include time spent walking to a time clock; the 30 minutes must be actual break time. The meal period should be given in the middle of the work day but the time is not precise and it subject to the work needs of the employer. The meal period is unpaid.
Employees are entitled to a second meal period of at least 30 minutes if they work more than 10 hours in one day. If the total hours worked is 12 hours or less, then the employee and employer can mutually agree to waive the second meal period but ONLY if the first meal period was not waived.
Employees are entitled to one 10-minute rest period for every 4-hour period of work performed, or major fraction of the hour. If an employee works 3-1/2 hours per day, there is no rest period requirement. The rest period must be 10 full minutes -- not 9 -- and must be completely free from duty in most cases. These 10 minutes must be "net." The rest periods should be given in the middle of each 4-hour block of time but the time is not precise and it subject to the work needs of the employer. The rest periods are paid.
Example A: The employee works an 8 hour shift from 8:00 a.m. to 4:30 p.m. There should be one 10-minute rest break at approximately 10:00 a.m. The meal break should be from approximately 12:00 p.m. to 12:30 p.m. There should be a second 10-minute rest break at approximately 2:30 p.m.
Example B: The employee works a 5 hour shift from 12:00 p.m. to 5:00 p.m. There should be one 10-minute rest break at approximately 2:30 p.m.
Example C: The employee works a 6 hour shift from 12:00 p.m. to 6:00 p.m. The employee and employer have agreed to waive the meal break. There should be one 10-minute rest break at approximately 3:00 p.m.
Example D: The employee works a 6 hour shift from 12:00 p.m. to 6:00 p.m. The employee and employer have NOT agreed to waive the meal break. There should be one 30-minute meal break from approximately 2:45 p.m. to 3:15 p.m.
The employer must make these breaks available to employees and cannot interfere with the employees' freedom to take the breaks or discourage employees from taking breaks. However, the employer does not have to make sure employees actually take the breaks.
If the employer has actually PREVENTED or INTERFERED WITH the employees' ability to take breaks, the employer may have to pay a penalty of one additional hour's pay for every day in which a meal break is not allowed, and one additional hour's pay for every day in which one or both rest breaks are not allowed.
There are some industries, such as the motion picture industry, that must follow different rules. You should always check with an attorney if you want to be certain about your rights.
The Division of Labor Standards Enforcement (DLSE) is a sub-agency within the California Department of Industrial Relations. http://www.dir.ca.gov/dlse/. Some people refer to the DLSE as the Labor Commissioner. The DLSE enforces California's wage and hour laws, including those pertaining to overtime, rest and meal breaks, and more. The link for information on filing a wage claim is here: http://www.dir.ca.gov/dlse/howtofilewageclaim.htm. The DLSE's page on meal periods is here: http://www.dir.ca.gov/dlse/FAQ_MealPeriods.htm.See question
I.send an email to the owner complaining the way he was talking to me After that i faced displinary action and retaliation.
How was the owner talking to you? Was he making comments about your race, national origin, language skills, age (40 yrs. and older), disability, or what? Was he telling you to work for improper pay or under unsafe conditions? It makes a difference. If the owner was just being a rude jerk, then there is no legal remedy. But if the employer said bad things about your membership in a protected group, such as those I mentioned above, or if the owner was giving you an illegal instruction and you protested, you may have a remedy.
It may help you to know that generally, employees and job applicants have very few employment rights, and employers have a lot of leeway in how they choose to run their businesses. In general, an employer can be unfair, obnoxious or bad at management. And an employer can make decisions based on faulty or inaccurate information. An employer has no obligation to warn an employee that he or she is not performing as the employer wants. It's not a level playing field. An employer hires employees to provide work for its benefit, not for the benefit of the employees. Don't expect the employer to take care of its employees; it doesn't have to and it rarely does.
There are some limitations on what an employer can do, mostly in the areas of public policy (such as discrimination law or whistle blowing), contract law, union-employer labor relations, and constitutional due process for government employees. Please see my guide to at-will employment in California which should help you understand employment rights: http://www.thespencerlawfirm.com/pdf/tslf-at-will-california.pdf. After you take a look at the guide, you may be able to identify actions or behavior that fits one of the categories that allows for legal action. If so, an experienced plaintiffs employment attorney may be helpful.
Employment rights come from the state and federal legislatures. One of the best things people can do to improve their employment rights is vote for candidates with a good record on pro-employee, anti-corporate legislation. Another way to protect employment rights is to form or affiliate with a union, or participate in a union already in place.
I hope there is a good resolution to this situation.See question
Some time in Nov or Dec 2015, I was working and experienced what seemed like a charlie horse in my leg. I immediately went to the aid facility located on the property just to be told to stretch and drink plenty of fluids and take advil or tylenol....
I doubt your employer can put all the responsibility for this on you to deny you workers' compensation benefits. I'm not a workers' compensation attorney but do know the law is quite broadly applied. Particularly, if your employer provided the care facility for its employees' use, the employer may have institutional knowledge of your injury and cannot wriggle out of liability.
I suggest two things. Re-post your question in the California workers' compensation forum here on Avvo, and also get yourself a workers' compensation attorney. You can find a workers' compensation attorney on the California Applicant Attorneys Association (CAAA) web site: https://www.caaa.org. CAAA is the strongest California bar association for attorneys who represent injured workers. On the home page, click on the picture of the wheelchair above the words "Injured Workers." On the next page, click on the link to "Attorney Search" on the left side. Enter your city or any other information and click "Search."
Good luck!See question


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"For most of the hundred-plus years of manned flight, aircraft have been used in combat and tens of thousands have been lost. When a military aircraft goes down there has always been the desire, but not always the means, to rescue the survivors. George Galdorisi and Tom Phillips have provided a comprehensive, and well-written history of the development of combat rescue up to the present, including dramatic accounts of rescues, among them many never before revealed. Leave No Man Behind is a story of heroism which should appeal to a broad spectrum of readers; historians, serving military, and those who love a good aviation story."
—Norman Polmar, author of Aircraft Carriers: A History of Carrier Aviation and Its Impact on World Events
The Register-Pajaronian
"George Galdorisi and Thomas Phillips provide an account of combat search and rescue (CSAR) from World War I to the conflict in Iraq. This is the story of the unheralded men and women who fly the dangerous missions to retrieve downed airmen and soldiers stranded behind enemy lines. Chronicling nearly 100 years of CSAR history, the authors include stories of previously classified missions and several Medal-of-Honor winning operations in an extensive look at this little known facet of military operations. The books also addresses the ongoing debate of whether the tendency to cut CSAR at the end of a conflict is wise. Without an existing infrastructure, it takes far too long to get these units operational again when the need arises."
"Combat search and rescue -- the ability to save downed pilots -- becomes more important each time the United States uses aircraft in combat. As enemy defenses improve, it also becomes more difficult, and the technology involved becomes more complex. Yet this story has never really been told before. Leave No Man Behind shows how attempts to rescue pilots began as early as World War I, and how modern systems have worked, both in theory and in difficult practice. It offers a unique combination of operational experience and technical description."
—Dr. Norman Friedman, author of The Naval Institute Guide to World Naval Weapons
"Leave No Man Behind is a solid piece of history. Starting with the birth of military aviation itself, it tells the story, almost 100 years in length, of the efforts that have been put forth to develop and use rescue forces to recover downed aviators. Focusing primarily on well-documented vignettes from conflicts as recent as Iraqi Freedom, it is the story of sacrifice, valor, and heroic airmen who go forth so that, 'others may live.' Well written, well told, well done!"
—Darrel Whitcomb, author of The Rescue of Bat 21, Combat Search and Rescue in Desert Storm, and Call Sign - DUSTOFF
"An important and comprehensive work on that most American of military imperatives—going in harm's way to get one of our own."
—Dick Couch, author of The Sheriff of Ramadi and Chosen Soldier

subset: commoncrawl


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Watch Next
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A woman who slept with two cousins has appeared on The Jeremy Kyle Show to determine who the father of her 10 week old baby daughter is.
Cody and Chris are currently dating and already have a child together, but Cody also slept with Chris' cousin Ivan while still with Chris.
Cody was convinced Chris was the dad and his name even appears on the birth certificate, but she recently had doubts about who the father is - it is boyfriend Chris or his cousin Ivan?
"She couldn't pin-point the date she slept with him and slept with Ivan," Jeremy Kyle says.
"If that was a bloke he would be called every name under the son.
"Do you think that behaviour is acceptable?" he then asks before Cody storms off stage.
"Do you love both of them?" Kyle asks.
"I don't want to be with either of them. I just want to know for my daughter's sake while she's still young," Cody says.
"Chris' name is on the birth certificate because we were 100% sure at that point."
"Who would you prefer to be the father?"
"I don't know," she says, "Because I'm not judging any of them."
"If Chris is the father of your daughter do you think the two of you could get back together? the host presses.
"I think your head is messed up and you don't know what you want," Chris adds.
Jeremy Kyle then reads out the results of the DNA test and the child ISN'T Chris' - it's Ivan's.
"It's a mess, isn't it?" a shocked Kyle blurts out.
A devastated Chris then bursts into tears and storms off, while Cody goes after him and tells him she's sorry.
"Graham will work with both of you," Kyle says, "Continue to be a good dad."
"It was all three of you but the most important thing is those two children."


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Hotfrog Ireland provides information regarding Connacht Tribune in Galway. Connacht Tribune is located at 15 Market St, Galway Galway and provides fishing services. Contact them on (091) 536 222 or by visiting them on their website http://www.galwaynews.ie.
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When you join Ladies' Circle (LC) you normally attend a meeting of a local Circle in your town/village. There you will make friends with members of that Circle. Eventually you will attend an Area meeting and meet Circlers in that Area and after that you will attend the country's Annual General Meeting (AGM) and meet many more Circlers. Following this you may opt to attend the LCI AGM and then meet lots of Circlers from all over the world. As you can see friendship may be experienced, locally, nationally and internationally. It is a remarkable experience sharing a bond with ladies from different parts of the globe, different cultures, different up bringing and yet, sharing one common goal and language true friendship.
Every Circler endevours to make a difference to those less fortunate than them by supporting community projects and raising funds for the needy, locally and nationally. Globally Circlers also support an International Service Project which runs for two years. Sometimes it is only when we see, feel and touch that we can truly appreciate the need however if you are inquisitive it is easy to learn about needs of others and as they say 'The Sky is the Limit'! The good feeling Circlers experience when they help others is something indescribable – it is all about service.


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Lost Sounds
Blacks and the Birth of the Recording Industry, 1890-1919
By (author) Tim Brooks
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Lost Sounds by Tim Brooks
Book DescriptionBiographies of the first African-American recording stars, and how they succeeded against tremendous odds.
Buy Lost Sounds book by Tim Brooks from Australia's Online Bookstore, Boomerang Books.
Book DetailsISBN: 9780252073076
(6466mm x 4531mm x 1171mm)
Pages: 656
Imprint: University of Illinois Press
Publisher: University of Illinois Press
Publish Date: 8-Jul-2005
Country of Publication: United States
Other Editions...
Books By Author Tim Brooks
Cricket on the Continent, Paperback (October 2016)
Cricket on the Continent is the inside story of how the sport was developed in mainland Europe, the challenges it faces in a continent obsessed with football and a colourful journey through one of the sport's frontiers in the company of its cricketers and custodians. It also asks what the future holds for cricket in continental Europe.
British Propaganda to France, 1940-1944, Hardback (March 2007)» View all books by Tim Brooks
This book examines the important issue of British propaganda to France during the Second World War and aims to show the value of the propaganda campaign to the British war effort.
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Author Biography - Tim Brooks
Tim Brooks is Executive Vice President of Research at Lifetime Television. He is coauthor of The Complete Directory to Prime Time Network and Cable TV Shows and The Columbia Master Book Discography, and the author of Little Wonder Records: A History and Discography. He is past president of the Association for Recorded Sound Collections and the winner of its Lifetime Achievement Award. Dick Spottswood is a freelance author, broadcaster, and record producer. He is the author of the seven volume reference work, Ethnic Music on Records.
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Current guidelines recommend prophylactic use of granulocyte-colony stimulating factors (G-CSF) when febrile neutropenia (FN) risk is greater than 20%. Advanced age is a risk factor for FN; however, little is known about the impact of other factors on the incidence of FN in an older population.
We analyzed SEER-Medicare data (1994–2005) to develop and validate a prediction model for hospitalization with fever, infection, or neutropenia occurring after chemotherapy initiation for patients with breast, colorectal, prostate, and lung cancer.
In multivariate analysis (N=58,053) independent predictors of FN included advanced stage at diagnosis [stage 2 (OR 1.29; 95% CI: 1.09–1.53), stage 3 (1.38; 95% CI: 1.19–1.60), and stage 4 (1.57; 95% CI: 1.35–1.83)], number of associated comorbid conditions [one condition (1.13; 95% CI: 1.02–1.28), two conditions (1.39; 95% CI: 1.22–1.57), and three or more conditions (1.81; 95% CI: 1.61–2.04)], receipt of myelosuppressive chemotherapy (1.11; 95% CI: 0.94–1.32), and receipt of chemotherapy within 1 month of diagnosis [1 to 3 months (0.70; 95% CI: 0.62–0.80) and greater than 3 months (0.63; 95% CI: 0.55–0.73)].
We created a prediction model for febrile neutropenia with first cycle of chemotherapy in a large population of elderly patients with common malignancies.
Febrile neutropenia (FN) is a major dose-limiting toxicity of systemic chemotherapy, associated with delays in treatment, hospitalization, higher costs [1, 2], and mortality ranging from 4% to 21% [1, 3]. Prophylactic administration of granulocyte-colony stimulating factor (G-CSF) decreases the risk of febrile neutropenia and infection [4, 5]. Given the significant costs associated with G-CSF, it is neither practical nor clinically appropriate to administer this agent to all patients receiving chemotherapy. Rates of FN vary substantially with different chemotherapy regimens and many commonly used regimens have a negligible risk of FN [6–8]. American Society of Clinical Oncology (ASCO) guidelines recommend G-CSF prophylaxis when the risk of FN is approximately 20% or higher [6]. These guidelines also recommend primary prophylaxis be considered in patients at increased risk due to advanced age (>65), poor performance status, pre-existing neutropenia, extensive prior chemotherapy, irradiation to a significant amount of bone marrow, a history of recurrent FN, and comorbid conditions that increase the risk of mortality with a serious infection. Despite these recommendations, limited data exist on the increase in risk associated with each of these conditions. In addition, little is known about how these risk factors may interact in the elderly who are already vulnerable [8].
In this study, we sought to create a clinical prediction model for the risk of FN in the first cycle of chemotherapy in the elderly. At a time when efforts are being made to provide more aggressive chemotherapy for older individuals, it is important to further identify those patients at highest risk of complications related to neutropenia.
We used the SEER-Medicare database, which has been previously well-described [9]. The catchment areas (six metropolitan areas and five states) of the SEER population, not including the 2,000 expansion areas (Kentucky, Louisiana, New Jersey, and California), covers about 14% of the total US population. The SEER population is comparable to the US elderly population with respect to age, sex, and socioeconomic measures (education and poverty level). However, cancer mortality rates are slightly lower in the SEER-Medicare cohort as compared with the total US population [9].
The SEER registry has been found to capture almost all (97%) incident cancer cases based on comparisons with detailed reviews of hospital, pathology, and radiation oncology records [10, 11]. Medicare administrative data includes information on demographics, Medicare enrollment, and outpatient and inpatient claims. This includes part A coverage for inpatient care, skilled nursing facilities, home health and hospice. Part B Medicare covers outpatient care, to which 95% of Medicare beneficiaries subscribe. About 97% of all US adults age 65 years and older have Medicare as their primary insurer [9]. The combination of SEER and Medicare data together has been shown to be highly complete in determining which treatments a patient has received [12, 13].
The observation period for study inclusion was defined as 1 year before cancer diagnosis (in order to capture comorbid conditions) until 1 month after initial chemotherapy administration. We excluded those who did not receive chemotherapy within 11 months after cancer diagnosis. The Committee for the Protection of Human Subjects at the University of California Los Angeles approved this study.
We included subjects with breast, lung, prostate, and colorectal cancer, diagnosed from (1994–2005), who received chemotherapy within 11 months of their diagnosis. We excluded those with in situ carcinoma or unknown cancer stage, those eligible for Medicare coverage due to disability or end-stage renal disease, and individuals for whom Medicare claims data would not fully capture the health care services they received: (1) not enrolled in both Medicare parts A or B for ≥1 month during study period, (2) enrolled in Medicare health maintenance organization (HMO). Patients for whom the chemotherapy agents could not be identified—patients with a chemotherapy administration code but no claims for individual drugs or those receiving inpatient treatment only—were also excluded.
To allow sufficient follow-up, we excluded those who died within 28 days of initial chemotherapy administration unless they were hospitalized for FN prior to death. Finally, subjects who received G-CSF within 7 days of chemotherapy administration were excluded since this would alter their baseline risk of FN. Prophylactic antibiotic use to prevent FN use could not be evaluated within the dataset.
Cancer stage was evaluated as a potential risk factor for FN using AJCC stage reported in SEER (stage I, II, III, and IV) for breast, lung, and colon cancer. After 1993, within the SEER dataset, prostate cancer was classified simply as 1 for local/regional disease and 4 for advanced disease. We examined patient demographic data from the Patient Entitlement and Diagnosis Summary File (PEDSF), including age (5 year intervals: 65–69, 70–74, 75–79, 80–84, 85 years and older), sex, and race/ethnicity (white, black, Latino, Asian, other).
Receipt of chemotherapy, as previously described [14], was identified by ICD-9 codes and J codes. The following chemotherapy agents were classified as myelosuppressive based upon a significant association with FN (p<0.05 for Chi square): carboplatin, cisplatin, cladribine, etoposide, floxuridine, irinotecan, paclitaxel, pentostatin, streptozocin, vinblastine, vincristine, and vinorelbine.
Time between chemotherapy treatments (chemotherapy interval) was estimated using the time between the first four claims and coded as 1 (0–7 days), 2 (8-14), 3 (15–21), or 4 weeks (22–42). Subjects with variation in the length of chemotherapy intervals were classified by the initial interval. Subjects who had only one treatment were coded as "no interval." Time from diagnosis to initial administration of chemotherapy was classified as less than 1 month, 1–3 months, and greater than 3 months.
Since burden of illness has been shown to affect both cancer treatment [15, 16] and mortality [17], we included unweighted count of comorbid conditions in our model using conditions contained in the Charlson Comorbidity Index [18–20]. We considered a condition present if one inpatient or two outpatient claims at least 1 month apart included diagnostic codes in the 12 months prior to cancer diagnosis [19, 21]. Because individual conditions may be independent predictors of neutropenic events [1, 22], we also tested the association of FN with the individual conditions comprising the comorbidity index: myocardial infarction, congestive heart failure, peripheral vascular disease, other cardiovascular disease, dementia, chronic pulmonary disease, rheumatologic disease, peptic ulcer disease, liver disease, diabetes, paralysis, renal disease, and acquired immunodeficiency syndrome.
The outcome was limited to the first cycle of chemotherapy as more than 50% of episode of FN occur at this time and decisions to use prophylactic growth factor should be made before initiation of treatment [23, 24]. Also, chemotherapy regimens are often modified if complications occur after the first cycle of treatment. To ensure we examined FN associated with the first cycle only and not subsequent cycles, we limited the occurrence of FN to within 28 days of the first chemotherapy administration. Medicare claims do not have a specific code for FN, so we defined our outcome variable as any of the following admission diagnoses; neutropenia (ICD-9 288.0), fever of unknown origin (ICD-9 780.6), or various infectious complications (Appendix A). We also performed sensitivity analyses using hospitalization with neutropenia (288.0) alone as a narrower definition of FN.
We first randomly split the sample into a "training set" and a "validation set" with two thirds of the sample included in the training set and one third of the sample included in the validation set. We examined the bivariate relationship of demographic and clinical characteristics with febrile neutropenia using χ2 for categorical variables and t tests for continuous variables. We used logistic regression to estimate the association of the predictor variables with febrile neutropenia. We used both forward and backward stepwise selection methods to identify the best predictors for the final model with p=0.10 for inclusion in the model. All two-way interaction terms were also tested in the model.
We then created a prediction model using the beta coefficients from the logistic regression. To simplify the model, we multiplied the regression coefficients by a common multiplying factor (10) and rounded to the nearest integer [25]. The points assigned to each predictor ranged from −13 to 6.
Performance of the risk-stratification system in the training and validation set was quantified and compared using the receiver operating characteristic analysis [26]. The predictive accuracy of the model to identify patients at high risk of developing FN was estimated using the C-statistic, which ranges from 0.5, indicating a model that performs no better than chance alone, to 1.0, indicating perfect prediction [27]. We also calculated positive and negative predictive values for the ability of the model to evaluate a risk of FN greater than 10%.
The final sample included 86,693 subjects, from an initial SEER-Medicare sample of 1,717,478 patients with breast, lung, prostate, and colorectal cancer. Subjects were excluded because they were not diagnosed between 1994–2005 (N=490,106), were Medicare-eligible due to disability or end-stage renal disease (N=97,590), were enrolled in managed care, not eligible for Medicare A and B, or disenrolled from Medicare for 1 or more months (N=390,302), did not receive chemotherapy within 11 months of diagnosis (N=320,689), were missing specific chemotherapy agents (N=313,333) received G-CSF within 7 days of chemotherapy (N=1,269), had in situ cancer or unknown stage at time of diagnosis (N=5,198), or had unknown date of diagnosis (N=11,347). We also excluded 681 men with breast cancer.
Patient characteristics are presented in Table 1. Chemotherapy regimens varied greatly between cancer types. Lung cancer was more commonly associated with comorbid conditions. The outcome variable (FN) also varied significantly between cancer sub-types with the most episodes of FN in the first cycle in subjects with lung cancer (10.2%). The initial total sample was divided randomly into the training sample (N=58,053) and validation sample (N=28,910). There were no significant differences in patient, disease, or treatment characteristics between the two samples.
In bivariate analysis across all tumor types using the training dataset, younger age, female sex and white race were the only demographic characteristics correlated with the outcome (Table 2). Patients with lung and colon cancer diagnosis had an increased risk of FN while patients with prostate cancer diagnosis had markedly decreased risk of FN as compared with a breast cancer diagnosis. An increasing number of comorbid conditions were also associated with and increasing risk of FN. Being diagnosed with stage II or greater cancer was associated with increased risk of FN. In addition, having a shorter time from diagnosis to initiation of chemotherapy and use of any myelosuppressive chemotherapy agent were associated with FN.
In multivariate analysis, the independent predictors of FN were cancer type, cancer stage (stage 2 or greater), an increasing number of comorbid conditions, and less than 1 month from time of diagnosis to initiation of chemotherapy (Table 3). Predictor variables and overall performance of the models were similar when looking at the more restrictive definition of FN (ICD-9 diagnosis of neutropenia only) and the less restrictive definition (ICD-9 diagnosis of neutropenia, infection, or fever; data not shown). The C-statistic for was 0.75 for both the training and validation datasets. We tested all 2-way interaction terms, a few of which were statistically significant, but had almost no effect on the predictive value of the model. Thus, we chose to exclude the interaction terms from the model for the sake of simplicity and ease of calculating a FN risk score.
The point values for the clinical prediction model were created from the multivariate model of the training dataset (Table 3). Correlation between the predicted probability from the multivariate model and the prediction model score was high (0.93). For each patient, individual risk score values were summed to create a total risk score. Maximum possible score was 19, and highest reached within the sample was 19.
Those with higher risk scores had a higher predicted and observed risk of FN in the first 28 days (Table 4). Among those with a score of 0 or less, the predicted risk of FN in the first 28 days was 1.6%, and the observed risk was 1.6% in the validation dataset. In contrast, those with a risk score of 13 or higher had a predicted risk of 15.0% and an observed risk of 15.5% in the validation dataset. Similar results were found in the training dataset.
A cutoff of 10 points (score≥10) on the FN risk score was associated with a predicted FN risk of greater than 10%. Using this cutoff, the sensitivity of the model was 24% and specificity of 93%. The positive predictive value was 12% and negative predictive value 97%.
In this study, we created and internally validated a clinical prediction model for development of FN in the first cycle of chemotherapy among elderly patients with four common malignancies. With increasingly aggressive efforts to treat malignancies within this population, the model has the potential to help clinicians identify those patients at greatest risk of FN prior to initiation of myelosuppressive chemotherapy. Efforts were made to maintain the simplicity of the model by keeping myelosuppressive chemotherapy as a dichotomous variable and using a total number of comorbid conditions, to assure that it could be easily used with information readily available within the clinic setting. Ultimately, the model provided moderate predictive power to identify patients at higher risk of developing FN.
To our knowledge, a clinical prediction model of this nature has not previously been published. Given the difficulty in identifying a high-risk patient population, past studies have attempted to find predictors of FN and have identified patient specific factors as well as therapy and disease-related effects. Similar to previous studies, we found that increased risk of FN was associated with more advanced stage at diagnosis and comorbid conditions [24, 28]. Previous studies have found that persons older than 65 years have a higher risk of FN than those who are younger [24, 29]. Although we expected that the risk might increase with increasing age in the elderly, we did not find an association between age and FN among a sample of persons older than 65 years. Although the reason for this finding is not clear from our analysis, it may reflect the use of lower doses or less aggressive chemotherapy regimens for older persons. Alternatively, the risk of FN may be greater for those 65 years and older compared with those under age 65 years, but FN risk may not vary substantially among those older than 65 years.
A recent national cohort of prospectively enrolled patients undergoing chemotherapy found that neutropenic complications, defined as an absolute neutrophil count less than 500 or infection, were associated with anthracycline chemotherapy regimens, pre-treatment cytopenia, prior chemotherapy, low performance status, elevated blood urea nitrogen, and elevated alkaline phosphatase [30, 31]. We found a number of other agents in addition to anthracycline drugs associated with FN, which suggests that the elderly may have a different risk of FN with these agents than younger patients. However, a recent publication which summarized available clinical data noted a greater than 10% incidence of febrile neutropenia for numerous non-anthracycline based chemotherapeutic regimens [6]. We suspect that our extensive database also allowed us to identify other agents not normally captured in smaller studies. Our study lacked some of the clinical detail included in the prospective cohort; however, it is based upon a population-based sample and thus is less subject to selection bias that may result when practices and patients have to agree to participate.
Cancer type was also associated with FN in our multivariate analysis and was included in the prediction model. Numerous past studies that have evaluated risk factors for FN have focused on a single cancer type such as NHL and breast cancer [22]. Patients with hematologic malignancies have been demonstrated to have an increased risk of FN [6, 22]. The prospective study previously outlined did include a variety of solid tumor diagnosis, but they were not noted to be associated with FN in published results [31]. We suspect that the influence of cancer type on episodes of FN is related to both individual patient factors, such as overall health and performance status not captured with our comorbid illness score, as well as difference in treatment regimens that were not captured by our chemotherapy variables.
While the chemotherapy interval was not associated with FN, receiving chemotherapy within 1 month (as compared with 1–3 months or >3 months) of diagnosis was associated with a higher risk of FN. To our knowledge, timing of chemotherapy initiation has not been examined in past studies as a risk factor for development of FN. Although we do not have any supporting evidence, we suspect that timing of chemotherapy initiation may be a reflection of disease severity (i.e., more rapid therapy for more aggressive disease) or a proxy for patient-related factors that influence the choice or intensity of chemotherapy regimens.
It is important to note that the current study only identified episodes of FN in the first 28 days in order to approximate the first cycle of chemotherapy. We limited our prediction model to the first cycle because clinicians often make changes to the chemotherapy dose based upon patients' experience in the first cycle, and our dataset would not capture these changes. In addition, the decision to use G-CSF should ideally occur at the start of the first cycle since that is when half or more of the FN episodes occur and therefore should be based upon the data available to the clinician at that time [23, 24].
Given that approximately 50% of episodes of FN occur after initial chemotherapy cycle [30], we chose FN risk of 10% in the study as cutoff for our clinical prediction rule. This cutoff is based on the assumption that those with risk greater than 10% after initial cycle are similar to the population with cumulative risk greater than 20% across all cycles of chemotherapy. If the prediction rule is utilized across all four malignancies, any patient with a prediction score of 10 or greater would have 10% or greater predicted risk of developing FN with the initial chemotherapy cycle and should be considered for prophylactic growth factor administration.
This study has a number of limitations common to analysis of administrative datasets [32]. We identified chemotherapy through Medicare claims which do not accurately capture dose, which may be especially important in an elderly population where physicians may be more apt to reduce dose to avoid toxicity. Claims also lack clinical data, such as neutrophil count or functional status, which have been shown to be predictive of FN.
Because no specific ICD-9 codes exist for FN, we defined FN as a hospitalization for fever, infection, or neutropenia immediately following use of chemotherapy. Chen-Hardee used SEER-Medicare data and chart reviews to study FN in patients with non-Hodgkin's lymphoma [33]. With chart review data as the comparison, they found the ICD-9 code for neutropenia (288.0) from the Medicare data had 80% sensitivity for FN. Our definition of FN is likely more sensitive, but may misclassify others who have infections without neutropenia. However, the definition of FN did not appear to bias our estimates of the risk of FN, as the results were similar when the definition of FN was varied in a sensitivity analysis.
Despite these limitations, the current study provides important information and a potentially useful tool for clinicians treating elderly patients with chemotherapy. The clinical prediction model can easily be used with available data prior to initiation of chemotherapy. Ongoing efforts should be made with prospective cohorts with more detailed clinical data to improve the accuracy of prediction model. Specifically, laboratory data, performance status, and more detailed information on chemotherapy dosing will likely be valuable components to a final model. Before our model is used in clinical practice, our current prediction model should be tested in other cohorts to examine its performance and clarify its overall utility. Ultimately, implementation of an accurate prediction model into clinical practice would help further define the role of G-CSF on an individual patient basis and improve the appropriate use of growth factors to prevent FN after chemotherapy use.
This projected was funded by Amgen, Inc. Mitchell Wong has received consulting compensation from Amgen. Jennifer Malin was an employee of Amgen at initiation of project and also continues to receive consulting compensation from the company.
Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.
ICD-9 codes used to define outcome variable. Final analysis included any admission with any of the following ICD-9 codes as reason for admission.
Acknowledgement of research support
This study was funded by a grant from Amgen, Inc.
Results of this study have been presented in part at the 2007 Annual Meeting of the American Society of Clinical Oncology.
Jennifer Malin was an employee of supporting company (Amgen, INC) at time of initiation of study.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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One person is in serious condition after a stabbing at a house near Dufferin and Davenport.
The incident took place just before midnight at a residence on Chandos Avenue.
Two were transported to a trauma center, one with stab wounds in the lower body.
Police did not have details on how the incident went down, but it's believed to have been started by a domestic dispute.
13 Division officers are responding to a call for possibly armed male on Chandos Av ^sm
— Toronto Police OPS (@TPSOperations) December 13, 2015


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Arts, Culture, & History
Highlighting the important contributions that everyday voices and images make to artistic practice, cultural preservation, and efforts to document local history.
Case Studies
Charleston, SC has a rich history and oral storytelling heritage, and the Charleston County Public Library (CCPL) is one of the hosting partners of the annual Charleston Tells Storytelling Festival each spring. In 2014, CCPL decided to add a digital component to the storytelling festival. After contacting StoryCenter, CCPL applied for, and was awarded, a Library Services and Technology Act grant from the Institute of Library and Museum Services administered by the South Carolina State Library.
Colorado Public Television is focused on curbing the dropout rate among Gay, Lesbian, Bisexual, Transgender and Questioning (GLBTQ) students, which is nearly three times the national average. The youth media engagement project aimed to re-engage kids in school through the multi-media effort "Drop in Denver," community conversation, and guidance to eight at-risk youth who created a series of compelling video stories on personal experiences with school.
When the Wild Center opened its doors in 2006, it was already one of the most unique science centers in the United States, situated in the heart of the largest natural park in the United States. The relationship to the local and regional community was always one of active engagement, and nowhere was that more true than with the decision to provide a maple sugaring education and production facility right at the museum. The Community Maple Project brought scientists and experts, commercial producers, and do-it-yourself enthusiasts together to help the community re-claim the tradition of maple sugaring. The Wild Center chose to celebrate the many years of this work by gathering people together to make digital stories to be shared with the larger community.


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|Publication number
|Publication type
|Application number
|PCT number
|Publication date
|Aug 18, 1987
|Filing date
|Mar 28, 1984
|Priority date
|Mar 28, 1983
|Fee status
|Also published as
|Publication number
|Laszlo Forintos
|Original Assignee
|Laszlo Forintos
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (10), Referenced by (11), Classifications (11), Legal Events (3)
|External Links: USPTO, USPTO Assignment, Espacenet
H[HN--(CH2)10 --CO]n OH
This application is a National Phase Application corresponding to PCT/HU 84/00020 filed Mar. 28, 1984 and based, in turn, upon Hungarian application No. 1037/83 filed Mar. 28, 1983.
The invention relates to a surgical instrument which can advantageously be used especially for performing neurosurgical operations.
When performing neurosurgical operations, e.g. in cerebral surgery, there is a grave problem with respect to removal of blood, secretions, etc. from the operative field, usually by suction, and to stop bleeding of the blood-vessels, to close the arteries referred to as coagulation, because the operative field is difficult and elaborate to reach, and because several kinds of surgical instruments have to be used alternately. Some of the instruments are connected to a high frequency power source; therefore the instruments must be electrically insulated in order to prevent "arcing" which may occur when two different instruments are present simultaneously, e.g. in the skull. Such instruments include the so-called bipolar forceps used to stop bleeding of the blood-vessels (coagulation). This important group of instruments comprises about 40 to 50 units of different forms, and it depends on the organ to be operated and on the nature of the operation which kind of instrument is used. When using the bipolar forceps, the electric circuit is closed and the end of the blood-vessel being pinched between the forceps is so to say "welded" by the high frequency current. Before introduction of the bipolar forceps, the suction probe has to be removed. It is disadvantageous that separate persons are needed to handle the suction instrument and the bipolar forceps. These latter have also the disadvantage that due to mechanical overstrain and to the everyday gas sterilization, they deteriorate, are damaged quickly and require time for replacement of the unusable forceps.
Suction instruments, as used today, are constructed as thin, rigid pipes made of a special metal or metal alloy, connected to the vacuum source of the operating room and operated by temporary opening and closing the vacuum--as needed. Their up-to-date types are available--at very high prices--in the form of sets comprising several pipes bent at different--predetermined--angles. They are able to perform only one funtion i.e. suctioning. A whole series of suction tubes with different bending angles are needed, as the more flexibly the suction tube or the series of suction tubes reach that area where the fluids super-fluous blood etc. have to be sucked from, the more reduced the operative field may be. The cost factors are even less favourable in the case of disposable suction tubes destined for a single application, while their value in use is not or at least not substantially better.
The object of the invention is to provide a surgical instrument especially for performing neurosurgical operations, which can be used both for the function of suctioning and coagulating, can be bent at any optional angles, is electrically insulated and resists mechanical stresses as well as gas sterilization.
The invention is based upon the recognition that when the suction tube is made of a material which is easy to bend, significantly resists flexing, is corrosion-proof, is conductive and non-toxic, and is coated with a plastic material resisting flexing and gas sterilization over that area which contacts the operative field, except near its tip, and when this suction tube is equipped with an electric connector with the aid of which it can be connected to a high frequency power source, then both coagulating and sucking may be performed by one instrument of maximum flexibility.
The surgical instrument of the invention has a suction tube which can be connected to a vacuum source, the suction tube being provided with a finger plate having a hole communicating with the inner space thereof. The suction tube is formed as a flexible silver pipe, the portion of said suction tube in the operative field--with the exception of the pipe end functioning as a coagulating end--being provided on its outer surface with an electrically insulating, flexible plastic coating, and an electric connector enabling connection of the suction tube to the high frequency power source. Expediently, the suction tube has a plastic coating made of a synthetic thermoplastic material of the polyamide type, being advantageously a plastic coating made of polyamide-11 produced by condensation of 11-amino-undecane carboxylic acid of the formula H[HN--(CH2)10 --CO]nOH based on castor oil.
According to a further feature of the invention, the electric connector is arranged between the finger plate and a connecting piece provided on the end of the suction tube being opposite to the coagulating end, and in a cable joined to the electric connector, there is inserted a pedal enabling switching on and off the electric circuit. According to a further embodiment of the invention, the end portion of the suction tube functioning as a coagulating end, has a lesser thickness and/or a smaller diameter than the other part of the tube. The plastic coating is present on the portion between the coagulating end and the finger plate and its length is several times, advantageously about 10 to 20 times, longer than the length of the naked pipe end serving as the coagulating end. In order to enable a fine adjustment of the sucking effect, there may be formed in the finger plate two holes of different diameters communicating with the inner space of the tube.
Finally, it is advantageous when the electric connector and the electric cable joined thereto are connected together in a manner enabling their rotation in relation to each other, and when the instrument is equipped with a cleaning means consisting of a metal, e.g. a steel, filament having an outer diameter smaller than the inner diameter of the suction tube and of a handle arranged at the end thereof.
The invention will be described below with reference to the accompanying drawing which shows an advantageous embodiment of the instrument as well as a possible mode of its use. In the drawing
FIG. 1 shows the instrument in a longitudinal axial section, partly in side elevation;
FIG. 2 is a view taken in the direction of arrow A of FIG. 1;
FIG. 3 shows the instrument according to FIGS. 1 and 2 in perspective view in use, during performing an operation and shows diagrammatically the auxiliary devices needed to operate the instrument; and
FIG. 4 shows in elevation a means for cleaning the instrument according to FIG. 1.
The surgical instrument as shown in FIGS. 1 and 2, having as a whole the reference numeral 1, comprises a suction tube 2 made of silver, having a diameter of 0.5 to 1 mm and a length of about 20 cm. At one end of the suction tube 2 there is arranged a connecting piece 3 by the aid of which a hose 10 shown in broken lines in FIGS. 1 and 2 can be connected to the suction tube 2; the function of the hose 10 will be described later.
The end 5 of the suction tube 2 opposite the connecting piece 3 serves for performing coagulation. The coagulating end 5 of a length a C the value of a may be a few millimeters, preferably not greater than 1 cm. is bare, i.e. is formed by the silver pipe itself, while a portion H rearwardly of the coagulating end 5 having a length of about 10 to 20 cm is provided with a plastic coating 4. It is understood that the numeral data are only of informative character, the instrument may be constructed also of different dimensions.
The silver pipe manufactured from industrial silver by drawing, has excellent properties for performing the operations aimed at with the instrument, it can be made flexible by heat treatment, resists even frequent flexing, has a favorable electric conductivity, can be sterilized, is non-toxic, is fully corrosion-proof and, finally, plastics can excellently adhere thereto.
Also the plastic coating 4 is non-toxic, sterilizable and resists gas sterilization. It must, like the silver pipe, be flexible and resist frequent flexing, i.e. mechanical stresses. Further, it must be an electrically insulating material. All these requirements are met by synthetic thermoplastic materials of the polyamide type. The raw material used for the manufacture is castor oil comprising mainly glycerides of ricinoleic acid. The castor oil is converted with methanol into ricinoleic acid ester. Under the effect of heat treatment, the esters of the ricinoleic acid will be decomposed to enanthol and undecylenic acid methyl ester, this latter being hydrolyzable to undecylenic acid which is converted by amination into 11-amino-undecane carboxylic acid. From this polyamide-11 is formed by polycondensation, having the following formula:
H[HN--/CH2 /10 --CO]nOH.
This product is marketed in the form of granules or powder under the name RILSAN. The powdered product is then applied--by hot melting techniques--onto the outer surface of the section tube 2 of heat treated silver, over the portion of a length H as mentioned above (FIG. 1), forming thereby a minimum thickness (on the order of a few tenths of a millimeter) plastic coating 4.
As shown in FIG. 1, proceeding from the coagulation end 5 towards the connecting piece 3, there are connected to the suction pipe 2 first a finger plate 7 and then an electric connector 6. The finger plate 7 can be fixed, e.g. by welding or by soldering, to the suction tube 2, is oviform and its size corresponds to that of the thumb. In the finger plate 7 there are formed a large hole 8 and a small hole 9, both communicating with the inner space of the suction tube 2, and suction may be controlled, started, stopped and interrupted by either covering the hole or holes or allowing them to open freely.
Between the finger plate 7 and the connecting piece 3 there is fixed to the suction tube 2 the electric connector 6 made expediently also of industrial silver, through which an electric connection may be established between the suction tube 2 and the high frequency power source, by inserting a plug 20 attached to an electric cable 14 into the socket 6a (FIG. 3). In FIG. 1 the cable 14 is shown in broken lines. Conveniently, the plug 20 is an interchangeable piece ensuring that all electric instruments used in the operating room can be powered via the cable 14. Besides, the plug and the connector are connected together by a rotatable joint so that, the operating surgeon may use the instrument by turning it in any direction.
In FIG. 3 there is shown the mode of use of the surgical instrument 1 according to the invention. The hose 10 usually a rubber hose) adjoining the connecting piece 3 (FIG. 1) leads as shown by arrow b to a vacuum source (not shown). The electric cable 14 connected to the electric connector 6 runs to the high frequency apparatus 11 which is also connected by means of an electric cable 21 to a 220 V power source, e.g. to the electric network, as shown by arrow c. It is to be noted that the high frequency apparatus is shown per se and may be e.g. of the type ERBOTOM. As is also well known, in hospitals there is usually available a central vacuum source since it is needed also for other purposes. To a branch 22 of the electric cable 14 there is connected a pedal 15. By operating this pedal 15, the instrument 1 may optionally be connected either to the vacuum to perform suction, or to the high frequency power source to perform coagulation (i.e. stopping of the blood vessels. The high frequency apparatus 11 (power source) is also joined to an electric cable 16 at the end of which there is arranged a body electrode 12 to be fixed during operation onto the body surface of the patient 17. The operating table 13 is shown only symbolically; it is connected to ground.
The instrument 1 according to the invention is used during an operation of, e.g. a brain-tumor, as follows:
In the skull of the patient 17 there is prepared--in a mannner known per se--a hole 19 by cutting out a piece of the skull and the tumor 18 marked with dotted lines in FIG. 3 is exposed, then removed. During operation, by means of the instrument 1 the blood, secretions, etc. may be sucked from the operative field and the intersected blood vessels can be coagulated. The respective actions may be performed consecutively by means of a single instrutment without the need to remove it from the operative field. In order to perform alternately both actions, the operating surgeon has only to depress the pedal 15 and during sucking action, the control of suction and regulation of the sucking intensity may optionally be performed by temporary closing and opening the holes 8, 9 with the thumb. The small hole 9 is provided in order to enable a more fine control of the sucking effect, it is used first of all in special operations (e.g. in the case of aneurism). The access to the operative field--in the present case to the area round the tumor--is ensured by the instrument 1 since the suction tube 2 together with the coating 4 may optionally be bent even during the operation, thus, every point of the operative field may perfectly be reached during the whole process of the operation, in order to perform either suction or coagulation.
The cleaning means 23 shown in FIG. 4 is an essential accessory of the instrument according to the invention. It consists of a filament 24 of spring steel (stylet) and of a handle 25 formed on one end thereof. By drawing the filament 24 through the tube 2, the instrument 1 can be cleaned both during operation or thereafter. The length of the filament 24 preferably exceeds the entire length of the tube 2.
The advantageous effects attached to the invention are as follows:
This single instrument in itself is able to perform two functions which until now could be performed not only by two separate instruments but actually by to separate sets of instruments. A set of the known rigid suction tubes comprises, e.g. ten to twenty pipes, bent at different angles in order that different points of the operative field may be reached therewith. By contrast the instrument according to the invention may be bent at any optional angles--even during operation--thus, it may be adapted much more flexibly to the function to be performed than a whole set of rigid suction tubes comprising any number of pipes. Also the bipolar forceps used till now for coagulation are marketed in form of sets and it is obvious that the operating surgeon can better reach the blood vessels to be stopped at any point of the operative field by using the instrument according to the invention which may optionally be bent in any directions, than by using the known bipolar forceps. Handling this latter is more complicated than the use of the instrument according to the invention, because the blood vessel to be coagulated has to be squeezed by the forceps while my instrument need only to be touched to the blood vessel to be stopped; thus, when using the instrument according to the invention, coagulation takes place only on that desired small area where it is needed--this is due also to the insulating plastic coating--and meanwhile the instrument needs not to be kept away from the surroundings of the operative field being otherwise very limited. Besides, sucking and coagulating operations may be performed subsequently, alternately or, in principle, even simultaneously by means of the instrument according to the invention, and the instrument need--as mentioned already--not be removed from the operative field even when also other instruments are applied there, because the plastic coating guarantees an electric insulation; thus electric arcing may not occur between the different instruments. Both the silver and the polyamide-type plastic can be readily sterilized, easily flexed and resist well mechanical stresses, easily accommodating frequent flexing in alternate directions. Both the silver and the plastic material are non-toxic. The plastic coating may be manufactured in various colors which may involve practical advantages. Due to the advantageous properties of the instrument as set forth above, one hand of the surgion is free during operation. The rotating connection between the cable and the instrument enables the surgeon to perform various operations very easily, the instrument accommodating to the palm of the hand does not impede the fine motions and, a main activity of the staff, namely to ensure connection between the cable and the instrument--often associated with contact failures--may be omitted, so that the staff can better assist in the surgical part of the operation. Due to the flexible tube being able to bend in any directions, only a minimum area has to be opened as operative field. Yet, the visibility and accessability to the operative field is better, the operation may be performed faster and due to the significantly limited operative time, the patient has a better possibility of survival--e.g. in case of brain operations or other severe neuromuscular operations. Transfusion is needed to a reduced extent and due to the limited operative time, the utilization of the operating room can be improved. The instrument may be manufactured in several e.g. 8 to 10 sizes [different lengths and/or thicknesses and/or outer or inner diameters, etc.], according to the requirements as raised by different operations. The instrument is extraordinarily suitable for brain and spinal operations to be performed within deep, narrow holes and also for other operations being practically insolvable with the instruments as used today. Finally, the manufacturing costs of the instrument according to the invention are lower than that of the conventional instruments.
The invention is of course not restricted to the embodiment described above in details, but it may be realized in many other ways within the scope of the claims.
|Cited Patent
|Filing date
|Publication date
|Mar 19, 1973
|Jul 23, 1974
|Durden Enterprises Ltd
|Disposable electrosurgical cautery
|Mar 26, 1973
|Aug 13, 1974
|Valleylab Inc
|Combined electrocoagulator-suction instrument
|Jul 22, 1974
|Aug 17, 1976
|Durden Iii John G
|Disposable electrosurgical cautery having optional suction control feature
|Mar 27, 1978
|Jun 17, 1980
|Choy Daniel S J
|Laser tunnelling device
|Jul 26, 1979
|Dec 29, 1981
|Weber Jr Jaroy
|Electrocautery apparatus and method and means for cleaning the same
|Feb 21, 1980
|Jan 25, 1983
|Contemporary Ocu-Flo, Inc.
|Surgical fluid flow system
|Jan 13, 1982
|Aug 7, 1984
|Garito Jon C
|Universal finger/foot switch adaptor for tube-type electrosurgical instrument
|Apr 25, 1983
|Apr 23, 1985
|Richard Wolf Gmbh
|Medical coagulation device
|Title not available
|Title not available
|Citing Patent
|Filing date
|Publication date
|Mar 28, 1991
|Mar 9, 1993
|Nadiv Shapira
|Vortex smoke remover for electrosurgical devices
|Jan 23, 1996
|Apr 14, 1998
|Valleylab Inc
|Method and apparatus for a valve and irrigator
|Sep 27, 1996
|Sep 15, 1998
|Heff; Allan
|Surgical tool holding and positioning device
|Feb 21, 1997
|Sep 14, 1999
|Stephen R. DeSisto
|Self-evacuating electrocautery device
|Feb 14, 1996
|Sep 12, 2000
|Cunningham; James Steven
|Instrument for suction electrosurgery
|Jan 15, 2002
|Dec 30, 2003
|Giancarlo Luigi
|Multifunctional electrosurgical instrument
|May 29, 2003
|Jan 22, 2004
|Desisto Stephen R.
|Self-evacuating electrocautery device
|Jan 16, 1997
|Jul 24, 1997
|Valleylab Inc
|Rinsing device for surgical use
|Sep 11, 1996
|Mar 19, 1997
|Megadyne Medical Products, Inc.
|Suction coagulator bending tool
|Feb 19, 1999
|Aug 23, 2000
|Magnetic Vision GmbH
|Device for cutting and aspirating tissue
|Nov 14, 2008
|May 20, 2009
|Ewald Hensler
|Coagulation instrument
|U.S. Classification
|604/541, 604/119
|International Classification
|Cooperative Classification
|European Classification
|Mar 19, 1991
|Maintenance fee reminder mailed
|Aug 18, 1991
|Lapse for failure to pay maintenance fees
|Oct 29, 1991
|Expired due to failure to pay maintenance fee
Effective date: 19910818


text:
Is it crohn's?
I have been diagnosed with IBS. I am having constipation, week digestion, and I am unable to gain weight. I have tried everything but there is no improvement. From past few weeks, I am having pain(bearable till now) on right side between chest and waist. It becomes active especially when I am jogging/running. Also, sometimes I can see my skin getting red on that particular area. Can it be crohn's? Can crohn's cause constipation. I will surely meet a gastro but I would like you to tell me what might be the reason for my health issues.
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Doctor Answers (1) on Is it crohn's?
Venkat Raghav
Bangalore | General Physician
INR 250 for 24 hrsCHAT NOW
Hello..... Diagnostic procedure is required to confirm it as crohs even though symptoms mimic the same... Colonoscopy and biopsy is done to confirm.... Diarrhea, abdominal pain, fever, blood I'm stool all these are present in crohns disease...so get colonoscopic examination done...
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text:
How do you find a new passion?
I found my passion while taking psychology. Or should I start with psychology? I began psychology because it always seems like I am the "go to" person for everyone.
So, I might as well learn some skills in listening attentively and not just rattling off nonsensical advice that is sound for the moment, but not for duration. Anyway psychology became my passion. Then I started getting more into politics and decided that I needed to learn more about history and our justice system. Thus, criminal justice came into the mix.
Again, this is my passion to make me a better mother for my children to look up to. I cannot demand a higher education from them , if I cam pursuing the same goal. My life is my passion and my passions guide my life.
In Response to
Tuesday, February 2, 2016
How do you find a new passion?
☆☆Happy Blogging☆☆Drop By Anytime 😉


text:
Womens Knit Summer Dresses
Double-V-Neck Knit Dress
Customer Rating:0.0/5
A feminine style with a curved waist seam, pretty dolman sleeves, and a dramatic double V-neck with inverted pleats. This versatile piece can stay simple with sandals or go all out with wedges and a statement necklace. * Classic fit * V-neckline * Short dolman sleeves * Knee length * Viscose/elastane * Poly-lined skirt * Imported
Price: $88.00
Tulip-Hem Knit Dress
Customer Rating:0.0/5
You'll capture the energy of spring's first bloom in this graceful dress. We crafted it in slubbed linen/modal jersey knit, and added a dramatic overlap in front to sweep around back. * Relaxed fit; cinched waist * Banded boat-neckline * Cuffed cap dolman sleeves * Belt loops; 2-layer removable belt * Tulip hem * Knee length * Slubbed linen/modal jersey knit * Imported
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Petal-Hem Knit Dress
Customer Rating:0.0/5
Inspired by origami with interesting folds and pleats, our knit dress gives the look of a wrap without effort. * V-neckline * Sleeveless; bra-friendly * Faux-wrap front with ruching detail on one side * Petal hem * Above-knee length * Viscose/elastane * Imported
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Gathered Wrap Dress
Customer Rating:0.0/5
Our unfussy pull-on features a faux-wrap front, dramatic drape, and flattering gathers. And, just between us, it's crafted in a secretly slimming jersey with a dash of easy-fit spandex. * Classic fit * V-neck surplice bodice * Cap sleeves * Faux wrap with decorative side tie * Knee length * Lightweight cotton/rayon/spandex jersey knit * Imported
Price: $98.00
Mixed-Fabric Tank Dress
Customer Rating:0.0/5
Every bit of this tank dress is a wow, from its flirty cocoon shape and flattering drape to the contrasting sheen of mixed-fabric knit body with woven trim. * Relaxed fit * Scoop neckline * Sleeveless * Tulip hem * Knee length * Viscose/Tencel®/elastane * Imported
Price: $98.00
Everyday Ponte Knit Dress
Three reasons we love this simple sleeveless dress: a modern fit (that looks great on every body); an easy silhouette (to layer with a denim jacket or wear solo later); and a flattering ponte fabric (to give a knit a little structure). Dressing — done. * Sleeveless * Scoop neckline * Darts at the bust * Front pockets * Above-knee length * Cotton/spandex * Imported
Price: Was $98.00
Now $48.00 - $98.00
Juliet Knit Dress
Everyone needs a graceful go-to dress in her closet — and we made sure this one is feminine without being fussy. The surplice bodice wraps smoothly across the front, and the skirt floats gracefully for a very flattering silhouette. * Extended cap sleeves * Knee length * Cotton/rayon/spandex; lined skirt * Imported
Price: Was $98.00 Now $48.00
Sophia Cap-Sleeve Knit Dress
One of our best-selling silhouettes has a fit-and-flare style that skims the bodice, then gathers just below the waist, ready to twirl through days and dinners with a decidedly retro-inspired charm. * Scoop neck * Cap sleeves * Above-knee length * Cotton/rayon/spandex; lined skirt * Imported
Price: $98.00
Starlet Knit Dress
Luscious jersey knit and our own artistic prints beg the question, where did you find that? Surplice neckline dips softly in front. * Empire waist* Front pockets* Above-knee length* Viscose/elastane; lined bodice* Imported
Price: $78.00
Pointelle Overlay Knit Dress
As uncomplicated as your favorite tee, this knit dress takes casual to beautiful places. Crafted in breezy pointelle stripes, it features a cinched waist for a blouson-effect bodice and a two-tiered skirt with a crossover hem in front for some sassy swing. * Relaxed fit, with cinched waist * Scoop neckline * Dolman cap sleeves * Drawcord at waist * 2-tiered skirt with crossover petal hem in front *...
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Lightweight French Terry Dress
Add some swing with this sporty, stay-comfy-all-day French terry dress. Featuring an A-line silhouette, a low waist, curved seams, and a high-low hem. * A-line * Scoop neckline * Sleeveless; sports bra--friendly * Slight racerback * High-low hem * Above-knee length in front; slightly longer in back * Viscose/poly/elastane French terry * Imported
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Riviera Embroidered Lace Dress
Lace, unlaced — our relaxed and super-easy silhouette gives lace a life beyond the party-dress trope. From its pull-on styling to its tonal lining, this dress has an Indie spirit. And the lining stops short of the scalloped hem for a peek of sheerness just where you'd want it. * Front and back scoop neckline * Bust and back darts * Waistline has a bit of elastic for give * Knee length, with s...
Price: Was $148.00 Now $48.00
Essential Shift Dress
We're drawn to a shift that knows how to shift gears — from season to season, daytime to date night. Our minimalist version has a straight silhouette and a series of seams at the waist, front to back, that define the body beautifully. The fabrication ups the elegance factor (crêpe = drape). * Sleeveless * Knee length * Poly/viscose/spandex crêpe * Imported
Price: Was $138.00 Now $38.00
Hooded Knit Cover-Up
Our après-swim cover-up features a sea of stylish details, including a hood, a kangaroo pocket, and dramatic side vents. Wear the long sleeves up or down. Decked in sporty stripes with good sun coverage. In extra-cozy French terry. * Relaxed fit * Split neckline * Long sleeves (unrolled) or 3/4 sleeves (rolled); button cuff with tab closure * Hood with tasseled drawcord * Kangaroo pocket * Hig...
Price: $138.00
Eileen Fisher Organic Cotton Ballet-Neck Dress
MADE BY EILEEN FISHER FOR GARNET HILL The basic knit dress in soft certified organic cotton with a little Lycra® to maintain its flattering A-line shape. With its graceful ballet neck and cap sleeves, it's a versatile style that can be dressed up or down. * By Eileen Fisher * Knee length * Certified organic cotton with Lycra® * USA
Price: $138.00
Eileen Fisher Viscose Jersey High-Low Dress
BY EILEEN FISHER FOR GARNET HILL With its score of flattering details, like a surplice neckline, cap sleeves, and high-low hem, this polished dress is crafted in your favorite Eileen Fisher jersey that's body-skimming with a touch of perfect-fit stretch. * By Eileen Fisher * Classic fit * Surplice neckline * Cap sleeves * High-low asymmetrical hem * Below-knee length at front; midi length in back *...
Price: $188.00
Eileen Fisher Viscose Jersey Crewneck Tank Dress
Through the seasons and over the years, this versatile dress is a gorgeous go-to for all occasions. Crafted in Eileen Fisher's body-skimming jersey-knit viscose and spandex, it's lovely on its own, over leggings, or peeking out from underneath a wrap or cardigan. * By Eileen Fisher for Garnet Hill * Classic fit * Crew neckline * Sleeveless; bra-friendly * Knee length * Viscose/spandex jersey knit *...
Price: $158.00


text: 3.6/10 (1,181 votes) Behemoth (2011)Scientists discover a giant creature under the Earth that is wrapped around the entire planet. When the creature wakes all grumpy, it causes worldwide destruction. Directed by: W.D. HoganYear: 2011 | Duration: 90 minGenre: Horror, Sci-FiStarring: Cindy Busby, Ed Quinn, Jessica Parker Kennedy, Pascale HuttonCountry: Canada, USALanguage: English N/A


text:
Thursday, August 21, 2014
Review: Magic Exists
Magic Kingdom follows Cory as he travels to the Magic Kingdom to rescue his sister, Claire, and niece from, well, Claire. After being abandoned by her husband in Tomorrowland, Claire sets out to make a new home right in the Magic Kingdom. As insanity ensues, we meet a cast of characters including old and new flames for both siblings, zany tourists, and Mickey himself! No, not the mouse but the personification of the mouse's corporation. Conley's script is nothing short of smart, clever, and beyond engaging. The theatricality of the world is quite brilliant. The story is told simply. Sure some of the circumstances are a bit out there but that's what makes Conley loveable. And if you're enthusiasts of the source location, there are some fun inside jokes for you. Despite the D word never being uttered, the Happiest Place on Earth is present through reference and projections. The one tiny question that begs to be asked is what if another actor played Cory. Would the story still be told properly? Sure, this is a personal story and Conley is a wonderful nonchalant comedian, but with such a beautiful script, any sense of indulgence would deter from its intent.
Director Craig Baldwin does a fabulous job using the space to it's fullest and keeping the action lively and entertaining. Baldwin's brilliance in simplicity easily told the story, nailing the range of emotions lifted from Conley's script. Miriam Nilofa Crowe's lights were colorful, evoking the happy endorphins Magic Kingdom naturally spreads.
Magic Kingdom is nothing short but amusing and a beautiful script. The entire teams does a fantastic job telling Conley's story. The burning question for the future is does this play live on without Cory as Cory. But without a doubt, this another incredible script from a brilliant mind.
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