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The increase of IT in modern-day healthcare is irresistible. The growth of telemedicine (meaning literally the practice of medicine at a distance) is transforming the provision of medical advice. The potential benefits of telemedicine are huge, but so are the potential problems, in particular those of patient confidentiality, the need for valid consent and the absence of personal contact between doctor and patient.
The nature of these potential problems was illustrated in June this year. The Privy Council heard an appeal by a general practitioner against a finding of serious professional misconduct made by the General Medical Council's (GMC) Professional Conduct Committee (PCC), following a complaint relating to medical advice provided through a website. The advice in question had been given by email, without the benefit of a face-to-face consultation with the patient or any discussions with the patient's regular GP. The advice was based upon information provided by the patient's wife on an online checklist. The PCC was particularly critical of the fact that the online GP had asserted that the treatment and management regime recommended by the patient's regular GP was incorrect.
Although the Privy Council deleted two of the conditions imposed on the GP's registration by the PCC, it upheld the finding of professional misconduct on the basis that the relationship between the patient and his regular GP had been undermined, contrary to good medical practice. The court did not pass comment on the rights and wrongs of the advice given, or, perhaps more significantly, on the way in which it had been given.
The case reflects the issues facing healthcare providers and patients arising from the growing use of communication technology. With the availability of web server software, practically anyone can now set up a website and publish any kind of data that is accessible to all.
Within the NHS, the highly successful NHS Direct and NHS Direct Online programmes are the most high-profile, but by no means the only, examples of the changes taking place. Other Government-led initiatives include the much-heralded implementation of a national broadband network by 2005, the proposal to introduce video equipment in ambulances and the increasing use of video and telelinks to hospital specialists. A growing number of NHS trusts are looking at ways of using telemedicine to provide new services and improve existing ones.
In the private sector it is a similar story. The explosion of interest in telemedicine has led to an exponential growth in the number of research and development projects being undertaken in the UK and
Europe. The private telemedicine industry is expanding rapidly and there are now several telemedicine websites.
In the course of such growth, it is not surprising that questions will be asked about the adequacy of the existing legal framework and safeguards for appropriate standards of medical practice in a profession where face-to-face consultations remain the gold standard. There are no formal guidelines that encompass all of the various types of 'e-consulting', but guidance is available from several sources.
The GMC guidance
In assessing whether telemedicine practitioners are providing an acceptable standard of care, the GMC has continued to rely on the guidelines for conventional medicine as set out in its booklet 'Good Medical Practice'. The GMC's guidelines are not law, but in practical terms are very important to practitioners as the GMC regulates a doctor's registration, and therefore their livelihood.
The PCC consistently emphasises the importance of an appropriate assessment. Practitioners should exercise extreme caution before making a diagnosis and before prescribing a course of treatment to patients that they have not examined. The PCC has relied on the following provision from its definition of good clinical practice in disciplining telemedicine practitioners in the past: "An adequate assessment of the patient's conditions, based on the history and symptoms and, if necessary, an appropriate examination."
The GMC has also stressed the importance of adequate follow-up care. In November 1998 it published specific guidelines regarding telephone and e-consultations, in which it cautioned that consultations and prescriptions by phone or email are particularly ill-advised when: the patient is not previously known to the doctor; no examination takes place; and where there is little or no provision for appropriate monitoring of the patient or follow-up care.
The British Medical Association guidance
In February 2001, the British Medical Association (BMA) produced a consultation paper that considered the various options currently available to patients and clinicians and provided guidance to GPs. While these guidelines are not law, they are nevertheless a useful code of good practice for doctors to follow in a number of types of e-consultation.
The BMA considers that telephone consultations, when correctly conducted, can be considered a safe and acceptable practice; that there are few benefits to be gained from live online consulting; and that time-delayed email exchanges are not safe for consultation because of difficulties with authentication, security, consent and confidentiality issues.
The BMA also advised that particular caution should be taken over prescribing drugs electronically or over the internet. Such prescriptions ideally should be limited to repeat prescriptions.
Websites – the law
Unsurprisingly, the law is evolving as it endeavours to keep pace with the changes. Difficulty arises from the fact that practically anyone can access advice given over the internet from anywhere in the world. It is not clear, as a matter of law, whether the internet publisher would be held liable in their own country or the country in which their advice was downloaded in the event of a claim.
A decision made by the Australian Supreme Court on 10 December 2002 raised concerns. It ruled that those publishing material on the internet could potentially face legal liability wherever that material was received. In addition to highlighting the impracticality of internet publishers potentially having to be aware of the provisions of every legal system in the world, the decision also raises questions about the validity of practitioners' private indemnity cover. Such cover usually excludes claims arising in the US and Canada, and sometimes all claims outside the UK. The Australian court's decision has no binding authority here, but as a Commonwealth case it may be seen as persuasive.
In light of the uncertain legal position, effective self-regulation is vital if published information is to be safe and reliable. Practitioners, therefore, receive encouragement to comply with various principles recommended by organisations such as the Health on the Net Foundation Code of Conduct (HONcode). This is a voluntary organisation established specifically for medical and health websites, which addresses one of the internet's main healthcare issues – the reliability and credibility of information. Members adhere to certain principles, including agreed standards on the following issues:
• Authority – confirmation that medical advice is given only by medically-trained personnel, unless otherwise stated.
• Confidentiality – an assurance to visitors to the site that individuals' confidentiality will be respected.
• Attribution – information to be supported by clear references to source data.
• Justifiability – claims relating to the benefits or performance of specific advice or products to be supported by objective evidence.
• Transparency of authorship – authors' contact addresses to be made available.
• Honesty in advertising and editorial policy – if advertising is a source of funding, it will be clearly stated.
It is important to note that, while compliance with HONcode demonstrates that the practitioner has addressed relevant issues, it is not protective. A practitioner will not be immune from investigation by the PCC simply by reason of being HONcode-compliant.
There can be little doubt that telemedicine is here to stay and that it will become increasingly central to the provision of healthcare in years to come. While this represents a great opportunity for patients and practitioners alike, it is essential that, in the rush to embrace the new technology, healthcare providers do not lose sight of the safeguards required to protect their patients and themselves in a rapidly changing world.
Will Marshall is an assistant solicitor in the health law department at Reynolds Porter Chamberlain


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Monday, August 26, 2013
Spring Goals
I always admire people sitting on the front/back deck chillin, whiling away the warm evenings.
As non alcoholic people I joked to my husband 'do we need to start drinking?'
'cause those people are usually nursing a drink or two.... ha ha ha.
I want my evenings to look like that! {sans the alcohol lol and with people to talk to of course!}
perhaps this is why my evenings don't look like that because what would I do sitting on the deck alone? {ha. Maybe relax and do nothing? what a shock to the system!}
The last couple of years I've been thinking about this dilemma and those people deck chillin.
I've tried several times to just sit outside and enjoy the warm evenings.
I find it kinda hard {I really do think I suffer from Attention Deficit}
Usually I've got stuff to do {clean up, dinner, dishes, put kids to bed, clean up, go on computer etc} Mind wanders, mosquito's bother, I get bored and come inside....
I read a comment the other day about a person who decided to let their {older} kids choose their own bedtime. {yikes!} but said she now chose to read in bed, do what she wanted and let them be too. And ultimately yes they did stay up a bit later but its worked out pretty good and the kids worked out their own rhythm and have learnt when to go to bed.
As a parent with growing kids this intrigued me.
I'm finding it harder to be the parent I thought I would be
I joke that I used to get more done as a parent with babies/toddlers than I do now
{would never have believed you at the sleep deprived time! what?! it gets harder?!}
I'm finding it hard to do all the things we want to do but perhaps its because I'm still hanging on to 'young child routine'
We like to come home from school {occasionally means walking or biking and stopping at park}
Homework and afternoon tea
1/2 -1 hour on computer
Dinner at 5:30
Wash dishes
Bath, books
Bed blessed bed! Yes the older kids don't go to sleep and they read for hours {and hours!}but I get anxious thinking about any other routine. We don't even do extra curricular stuff cause we are too busy eating and getting ready to go to bed. I have friends and neighbours who eat dinner like at 8pm. I'm exhausted by then and definitely not thinking about dinner! Not to mention I'm hungry early too
I want kids playing outside, I want nighttime games, I want sunset viewing, I want picnic dinners, I want chatting to neighbours and friends, I want sitting on the deck, I want outings to enjoy all this city has to offer, I want night time strolls, I want swimming in the dark, I want outdoor movie nights, I want.. I want...
When do we get to start doing all these things?
But who is going to be cooking dinner and doing the dishes?
Maybe the trick is to rest in the early afternoon/straight after school and get it cranking again in the early evening? Maybe the trick is just to just sit on the deck chillin and ignore everything?
Is it time to give up the evening 'me' time?
{time that has been steadily shrinking anyway in the last few years due to kids NOT GOING TO SLEEP - unlike when they were little and were asleep super early and I would get so much done}
Or should I just realise that these imaginary awesome evenings are never going to happen, or will happen once all the kids are teens or have moved out?
Will I achieve 'DECK TIME' this Spring/ Summer?
Wait and see, shall we?
Posted by This Girl loves to Talk at 8:57 PM 2 comments
Sunday, August 25, 2013
FHE Lesson {Scriptures}
Opening Song: Seek the Lord Early #108
Opening Prayer:
Beforehand make letters to spell 'Scriptures' on go on top of some treats
(eg brownies, marshmallows, cupcakes, sandwiches - anything you can stick a toothpick in)
Scramble the letters so children can not tell what it spells.
Ask them to figure out what the lesson is about. They might need some clues:
We use these to help us, words of the prophets, life of Jesus, we can read them etc.
Just as we had to sort the letters to understand what it says, so to the scriptures can help us sort our lives. When we read and study things begin to make sense to us.
Scriptures can be tricky for many children.
Start with a quick perusal of a set of scriptures
Check out the tabs, ribbons, bookmarks, pictures section
Ask questions like find the Book of Mormon, New Testament, Old Testament etc.
Use the title page to find the first book in... or to find unusual named books
Choose a word to look up in the topical guide (you could even do scripture)
Do this Scripture Cards Activity from the August 2013 Friend Magazine pg 25
Print out the squares that say
When I feel happy:
When I feel afraid:
When I feel lonely:
When I need courage:
Each card has matching scriptures for these times. Depending on attention maybe just cover one from each. Have children place these cards in a place for when needed.
Explain that the scriptures are here to help us. They contain many answers for those that seek them. You can read the scriptures every day and find something new to help you. The scriptures are for happy times and for hard times.
Closing Song: Book of Mormon Stories #108
Closing Prayer:
Eat your Scripture flag treat
Posted by This Girl loves to Talk at 8:10 PM 0 comments
Labels: Family Home Evening Lessons
Sunday, August 18, 2013
FHE Lesson {Testimony}
This lesson is part of a series on Preparing for Baptism
Opening Prayer:
Opening Song: Search Ponder and Pray # 109
Article of Faith: #1
We teach children how to bear testimony at all ages but it is a focus of ours around the time of baptism. Before one is baptised its is helpful to have and understand their testimony.
I purchased this fun book at Time out for women and we are basing a FHE lesson around it.
However you probably don't need the book to do something similar such as found here in the
October 2008 Friend magazine
Basically print out 5 pictures to be attached to a glove (or a hand print out)
Heavenly Father, Jesus Christ, Joseph Smith, Temple(or chapel) and Pres Monson.
Attach each picture to a finger as you share the following:
My Testimony
:: I know that God is our Heavenly Father and He loves us.
:: I know that His Son, Jesus Christ, is our Saviour and Redeemer.
:: I know that Joseph Smith is a prophet of God. He restored the gospel of Jesus Christ to the earth and translated the Book of Mormon by the power of God.
:: I know that The Church of Jesus Christ of Latter-day Saints is the Lord's Church on the earth today.
:: I know that this Church is led by a living prophet who receives revelation.
{It's always good practice to stand up, speak clear and look up}
Have everyone write down/draw their testimony in their journal decorate with fun pens, stickers etc
Remember to say we don't have to say these things by rote (or copy the same each time) but use these points to start us off onto what we know is true, what is in our hearts, and share experiences that stem from knowing these truths.
5 Testimony Fingers Printable
Closing Song: The Church of Jesus Christ #77
Closing Prayer:
Posted by This Girl loves to Talk at 8:35 PM 0 comments
Labels: Family Home Evening Lessons
Saturday, August 17, 2013
Life According to the Iphone
Posted by This Girl loves to Talk at 7:14 PM 1 comments
Thursday, August 15, 2013
Clover Daisy Chains
It must be that time of year again. This year is going ever so fast!
But there is clover everywhere around.
Maybe I've spent enough years teaching the girls to make daisy chains or sit amongst the clover but this time they've done it all on their own.
At a party a few weeks ago apparently my daughter sat down and taught others how to do it.
Last week the eldest headed to the park and I joined them later with the youngers and while I was talking to another mum they headed to the far end of the park.
I came along later and found them like this.
Do you ever feel too busy, the kids watch too much tv, computer etc? Noone wants to leave the house or listen or its just all too much? {especially when you long for some other nostalgic life?}
Well I feel like that plenty and even though it was only 30 mins out in the clover patch it made me so happy. I want a simple, happy childhood for them.
It also makes me happy when they do things self guided.
Maybe one day when I'm gone {or they're grown}
they'll remember that we used to sit in the clover each spring and make daisy chains.
PS Reminds me of the wonderful lightbulb moment I had last year making these and 2011
Posted by This Girl loves to Talk at 2:13 PM 0 comments
Wednesday, August 14, 2013
OCTONAUTS Party
I buy up Tshirts at Target on sale for $3-4. I happened to have an orange one in the stash so we knew that had to be the birthday shirt. To match in with Octonauts colours I chose some blue fabric from my stash. To make our number birthday shirts - print out a number on paper, use it to cut out fabric and felt. Sew onto Tshirt. Easy!
There are so many awesome Octonauts cakes out there. Gup Cakes, cakes shaped like barnacles or Kwazii, The Octopod {how?!} etc. I knew these were ALL above my Cake -Making abilities and I had limited time to prep for this party. So I opted for a very easy sponge cake with cream in the middle covered in blue icing. I crushed some plain biscuits {cookies}to look like sand and stuck on some gummi lolly turtles and star fish. A set of all the Octonauts characters was a birthday present, but I said no playing with them till after they come off the cake lol. With a few strategic placed characters I think we pulled off a pretty good octonauts cake for a person with not much cake making ability!
Even though it was pretty simple and pretty crazy party she loved all the elements and was one happy girl and that is all that matters I suppose.
Posted by This Girl loves to Talk at 6:28 PM 5 comments
Monday, August 12, 2013
Four Years
Remember this post: {folder renamed} about having a folder named baby where in I stored my ultrasound pictures and pregnancy photoshoot before said baby had a name?
Well you know what? I never renamed that folder! It still says Baby!
So in honour of her fourth birthday I will finally change that folder name!
This little gal has been soooo excited for her birthday.
About 8 weeks ago we started preparing for her sisters birthday and pretty much every day since she mentioned something about 'her birthday'. {when is it, theme which changed daily, all the places/parks we were going to fly around and visit on her birthday, presents to buy, decorations, cakes etc. The list goes on and on and was discussed daily!}
The minute her eyes flutter open each morning she asks
"how old I am?"
You know just to check incase her birthday appeared during the night.
So on her actual birthday she jumped {out of my bed where she seems to end up most early mornings} and sped into the loungeroom where I had been up early preparing birthday celebrations with the biggest smile on her face and dove into my arms. It was finally here!
Birthdays are celebrated early morning here and she'd put in the order for pancakes and syrup.
Our birthday traditions of a birthday letter, a candle ring with number of candles = age {and gee the thing needs a clean!} a number shirt and a birthday crown and a couple of presents. Usually some balloons around and bunting hanging up too all ready for when they awake in the morning and have the breakfast of their choosing with a candle in it.
Posted by This Girl loves to Talk at 12:47 PM 1 comments
Labels: Celebrations, Traditions
Sunday, August 11, 2013
FHE Lesson {Families and Moroni and Title of Liberty}
Opening Song: Stand for the Right #159
Opening Prayer:
Article of Faith: #11
This lesson inspired by Friend Magazine July 2013 page 40
Show picture 312 from the Gospel Art picture kit of Captain Moroni
:: Use a big piece of paper to make a banner that represents your family.
Children can draw things that make your family unique and describe your family
{how many people, where you live, school, temple, church, scriptures, extended family, favourite foods, talents, things you like to do, faith in Jesus, favourite things - flowers, weather etc}
:: Families with older children could sit and write out a family mission statement.
{Or revisit it if you already have one} Ours {below} is now 10 years old!!
You could print it out nice and laminate it and display in a central area {ours is on top the piano}
Follow Christ * Humbly Pray * Actively Listen * Seek Knowledge
Seek Wisdom * Accept Responsibility
Posted by This Girl loves to Talk at 2:33 PM 0 comments
Labels: Family Home Evening Lessons
Wednesday, August 7, 2013
Time Out for Women and Sydney!
Time Out For Women
Time out for women was back after two years and initially I wasn't going to attend due to The Mr's work travel schedule, time, effort, money, being a nervous traveller {when alone}, not knowing my own way around Sydney etc.
Then last month I convinced my lovely friend to drag me around Sydney again.
{Isn't she wonderful!}
And I'm glad I did! I had a wonderful weekend.
I am truly blessed that a bunch of strangers {to me} let us use their car to pick me up from airport, another to host me at their house and cook me delicious food and sit up all night chatting to us {seriously I stayed with the best family in all of Sydney!} another set to drive us to Homebush for the TOFW conference, another to drive and take us out to dinner and our hosts to take us back to the airport at the end of it all. Truly Blessed - as all this made it possible for me to attend.
LDS women are the BEST!
The thing I love best about TOFW is just having all those church ladies in one room. Such a buzz to be with 2300 ladies of the same faith! Everyone so happy and kind. I was able to {briefly} catch up with about 30 women I haven't seen in a long time. I even met a few people I only know online. It was so much fun to meet them. Just the feeling from the group is almost worth it alone to make sure you attend.
A few people who could not attend have asked for an overview of the talks from Time Out for Women. So here goes ~ hopefully you can make sense of my rambling notes.
Hillary Weeks
If you like Hillary's music its almost like attending a concert of hers.
She sung around 10 songs all up I think.
So if you like her ticket price worth it on that alone probably.
The conference was based on Isaiah 55:9
For as the heavens are higher than the earth,
so are my ways higher than your ways,
and my thoughts than your thoughts
Virginia H Pearce started off by stating that:
All we have to offer eachother is our stories.
This really touched me and made me want to continue blogging even when I think it is a waste of time. And as someone who loves to talk... well.... All we have to offer is our stories! YAY!
We hear what we are listening for.
Sheri Dew recounted a story about going to watch her neice play in an orchestra of 270 people. Her neice plays Obo so they were particularly straining to hear the Obo. Noone else there may have heard the Obo alone but she did because she was looking to listen for it.
Listen. Hear what is for you. Do More, Do Less, Stop. Whatever it is find your message.
Virginia H Pearce
We all want choices but if we have too many we can stall, walk away or make a choice and end up with dissatisfaction since we could have had anything but ended up with 'this'.
Limit your choices to 3, Lower your expectations {nothing will ever turn out perfect!}
1. Chose to believe you have a choice {even in hard circumstances thrusted upon us}
2. Choose to surrender
3. We can Choose to Show up.
Surrender to God without resentment and resistance. SHOW UP for our Families, our Callings. There are no dead people here. We ALL still have something to give. When Sister Marjorie Hinckley was ageing she was sad that she felt she no longer could contribute in anyway. Her daughter said 'your presence in a room is enough mother'. She shared a story about a lady with Alziehmers and a blind lady assisting each other. One had the sight, one had the ability to make sure they got home.
We all have deficiets. If we all show up for one another this makes up the difference.
She shared a story about Pres Eyerings Dad who was in extreme pain showing up to pull weeds at a church farm and having to crawl along in the dirt as his legs didn't work. After he was finished someone said 'oh no you didn't pull those weeds did you? Those have been sprayed and will die in a week anyway!' His Son was shocked that he just laughed and wasn't upset.
He just said 'I wasn't here for the weeds Son'
Showing up for the Saviour - so nothing is ever a loss.
She ended with a slide show of a compilation of all the words spoken by the Savior to us from the scriptures. It was very moving and I think I will try and do likewise and make a compilation of all statements made by a loving Father in Heaven and a Loving Christ. To have all those statements in one place, to show how much he loves us, was beautiful.
Hillary Weeks
shared a new song which will be in her coming soon new album called 'I found me'.
It was very good. She asked us to make a mantra to share with ourselves.
I am.... { I am refined, caring, dynamic person ... enter your saying here}
Brad Wilcox
The Atonement is a vicarious gift. The Atonement means we survive mortality but any growth is really up to us. A gift is valued if it is used. We will see who values baptism, the atonement etc.
Seek His power not Willpower.
Perfection is a long term journey. Covenants are part of the process. They are like petrol that keeps us going in our journey. He used an example of a lovely girl who said that she knew what the Atonement was but that she hoped she will never have to use it {by trying really hard to be perfect} He said that is like saying I'm going on a cross country trip but I'm not going to buy any petrol on the way.
Instead of just Come Unto Christ ~ BeCOME like Christ
We don't always pray because we are worthy{perfect} we pray because we need it
We serve missions, go to temple not because we made it {perfect} but because we need it
We don't take Christs name ~ he gives it.
It creates us.
Week after Week, Weakness after Weakness we are using the Atonement.
Abandon sin to get comfortable with God ~ however many
Abandon God to get comfortable with Sin
Without endurance to the end it would all be about the here and now.
We are saved by Grace and Transformed by Grace.
No If Only. If only I had a saviour. Because of the Atonement we won't face mortality alone or have the 'whens' or 'ifs' destroy us.
Heaven is not a prize for perfect people but a home for anyone who uses and values the Atonement.
Laurel Christensen
She spoke about different fears. Asked us to think of a fear we have and keep it in mind.
Fear of disappointment
Fear of failure
Fear of success {This! really spoke to me! Aha!}
Life is not meant to be lived in our comfort zone.
Formula for life/everything is
desire, believe, experiment, receive
When we stop praying for things needed so we don't have to suffer disappointment when we don't get it, then there is no desire and this is a tragedy. The tragedy no longer lays in not getting what you wanted. The tragedy is not wanting it anymore.
Wanting to know God's will can become wanting God to make all your decisions for you.
Sometimes we use God's will as a cop out {ie if God wanted it to happen for me it would have. If God loved me he would help me out, If God wants me to have a man/job/life he would have given it to me}
We need to MOVE, MAKE CHOICES and ACT LIKE GOD
He will not command us in all things
There is alot of room in Gods will. He will make room for OUR WILL to be HIS WILL.
God loves our agency more than he loves our happiness {which must be very sad for him}
There is peace on the other side of brave.
What will the Lord have me do to live HIGHER?
Sheri Dew
She had the sister missionaries come up on stage and they and the whole crowd sang a new arrangement of Janice Kapp Perry's 'As sisters in zion" called The Sisters of Zion
The sisters of Zion are called to God's labor,
We willingly serve Him with spirit and might.
We go to the nations with truth everlasting,
We teach of the Savior, our Lord Jesus Christ.
We thank thee, O God, for a prophet to guide us,
We trust in his words and our purpose is clear.
The angels of heaven are walking beside us,
We'll share our glad message with all who will hear.
We go forth enlisted with Helaman's Army
In numbers much greater than ever before.
With power and spirit we'll faithfully witness
The heavens have spoken and truth is restored!
IT was very moving to have 2300 women all singing this song.
Sheri recounted a couple different stories about her travels and life as a strong LDS woman.
What Mormon women know. While following Pres Hinckley around reporters always wanted to know about the poor downtrodden repressed Mormon women. Pres Hinckley quipped
'We get out of their way that's what!"
She said no organization in the world has so many women be able to teach, preach, lead, direct, reach out, serve.
We are powerful women.
Do we know what we know? We have access to the most remarkable privileges on earth.
Often as a leader she prayed 'Lord just tell me what to do' Alas he always wants us to come forward and present. The language of revelation is in the scriptures. Proper study opens the conduit to heaven.
Each woman has an impact on about 1000 people in their lives.
Collectively all of us at TOFW can impact 2 million people.
And there is my report from Time out for Women. I hope it makes sense to those who weren't able to attend and I hope you can feel of the spirit that it was imparted with. Notes rarely do just service.
Thank goodness for wonderful friends! Without her I wouldn't have gone!
It was such a full weekend 3 days of late nights that I promptly went to sleep at 7pm Sunday night.
Posted by This Girl loves to Talk at 8:20 PM 5 comments
Monday, August 5, 2013
FHE Lesson {Baptismal Gifts}
This is part of the Preparing for Baptism group of lessons
Opening Song: When I am Baptised #103
Opening Prayer: Child
Article of Faith: #4
Have prepared 5 little boxes or gift bags to look like presents
{or wrap up a box of food/brick - whatever you got}
You can attach a sign with the name of the gift to it, or you could print the name of the gift out and insert inside the present to find the answer when the children unwrap the 'gift'
On the day you are baptised you receive these special gifts of love from Heavenly Father
:: You become an official member of The Church of Jesus Christ of Latter-day Saints
:: Jesus Christ makes you completely clean
:: Later when you do something wrong you can repent and be completely clean again
:: You promise to keep the commandments and that will keep you safe and happy
:: You receive the gift of the Holy Ghost to guide and comfort you.
Talk about each 'present' individually, ask any questions children have.
If time permits go into more details about how you become clean, how taking the sacrament each week is part of it, go over the commandments, how we can invite the Holy Ghost to be our constant companion etc.
Comment how lucky we are to have these gifts JUST for us. God cares about us so much he sent us the Gift of Baptism and The Holy Ghost. We are blessed to have these gifts in our life so we can return to him in the next life. Our gift to God is to try and be the best person we can be.
Get children to think about what could be their 'gift' back to God.
Perhaps you can write them down or draw them and put them into a gift box
{ie be nicer to siblings, behave better, pray daily, help mum around the house etc}
Closing Song: The Holy Ghost #105
Closing Prayer: Child
Pre- Wrap up a treat and say I have a gift for you for listening so well in FHE
{perhaps if you need a little bribery for attention, announce this part at the beginning :}
Inspiration for this lesson came from The Friend Magazine June 2013 page 22
Posted by This Girl loves to Talk at 1:46 PM 0 comments


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Antonio Brown introduces Dancing with the Stars partner to Pittsburgh
Fans gather at Heinz Field to cheer on AB & Sharna Burgess as they prepare to compete for Mirror Ball Trophy
Steelers fans and Dancing with the Stars fans gathered at Heinz Field for a meet and greet with Antonio Brown and professional dancer Sharna Burgess.
Lovers of the show chanted "Here We Go" in true Pittsburgh fashion as Antonio Brown and Sharna Burgess made their way to the stage.
Antonio Brown thanked fans for supporting his journey on Dancing with the Stars and let it be known that "Business is booming!"
Antonio Brown snapped pictures of the crowd for his Instagram and Snapchat accounts.
Fans had the opportunity to snag autographs, pictures and selfies with Steelers wide receiver Antonio Brown and professional dancer Sharna Burgess.
Antonio Brown asked fans to "come close" for a snapchat selfie video!
Watch Antonio Brown and his dancing partner Sharna Burgess compete for the Mirror Ball Trophy on the new season of Dancing with the Stars premeiring at 8 p.m. on March 21.
Antonio Brown and Sharna Burgess


text:
Texas Badlands, 1886: Fresh out of medical school, John McCutcheon finds his stagecoach under attack by brutal outlaws. With the help of a feisty acquaintance Lily Anthony, he manages to fend off the assault. Lily is attracted to the charming cowboy-doctor, with his chiseled good looks and teasing ways, then heartbroken to learn he's engaged to be married.
Once settled in Rio Wells, Texas, John tries to ignore the fact that his cousin has taken a shine to Lily. When a bounty hunter shows up looking for a priceless jewel that Lily has found stashed away in her aunt's belongings, Lily fears her dreams of owning her own shop - and of finding true love - are about to go up in flames...or, could that just be the glow of a beautiful...Texas Twilight?
©2011 Caroline Fyffe (P)2014 Caroline Fyffe
"I laughed. I cried. I didn't want Texas Twilight to end." (Theresa Ragan, New York Times and USA Today best-selling author)
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"Maggis review "
Would read it 1000000 times more. Awesome book! 😄 Tomorrow is my late husbands birthday and it has really helped. Thank you so much! ☺ maybe there are some good Christian men out there.
"John Jake McCutcheon's story."
I really enjoyed listening to this story. The narrator used different voices for each character and it made it easier to tell who was speaking. John Jake McCutcheon has just graduated from medical school and is on his way to begin his career in Rio Wells, Texas, near his Uncle Winston McCutcheon's ranch. John's stage is attacked by Comancheros and he was cut on his face, making a dramatic beginning. When John meets his cousin Dustin there is a tenseness and you know there will be trouble between them. For those that look forward to each book, following the McCutcheon family, you will thoroughly enjoy this story. John's sister, Charity makes an unexpected visit and Brandon follows her, adding to the drama.
"Loved Caroline Fyffe's Texas Twilight!"
I enjoyed the print book so much I was interested in listening to the audio version. I found this form to be delightfully entertaining, especially when my eyes are too tired to read any longer. I really thought Brant Bolton did an excellent job with all the characters especially the men. Although his version of Tante Harriett, Lily's edlerly aunt was delightful!
I was an avid Max Brand reader years ago and this book reminds me of his style very much.
Dr. John McCutcheon.
Definately had me on edge, but overall really brought out warm feelings, and a few tears.
I love Fyffe's easy descriptive style and wait for each new release. She knows how to create characters that brandish true grit and deep heart. Her books are uplifting, entertaining and have values that leave you believing in life and love! Thank you Ms. Caroline Fyffe!
"love this series"
I am listening to the series in order and so far I love the first two I've listened to!
"Beautifully written and intricately woven"
This is, so far, my favorite of the McCutcheon Family Series. I fell in love with John and Lilly and all the supporting characters. Was especially happy to see Charity and Brandon's story unfold at the same time.
"Good clean listen!!"
Clean listen! Good storyline and a romance that gives you a good feeling at the end. The narrator did a good job distinguishing the different voices and accents.
"great story"
I am really enjoying this series. looking forward to the next one. Thanks Carolyn Fyffe!
I am REALLY LOVING THIS SERIES!! I CAN'T WAIT TO SEE WHO'S SORRY IS NEXT!! :-) THE NARRATOR GRANT DID AN AMAZING JOB! CAROLINE FYFFE IS QUICKLY BECOMING ONE OF MY NEW FAVORITE AUTHORS!! OK SO HERE IT IS,
Would I recommend this Book to anyone?? YES I DEFINITELY WOULD!!
Is it worth a credit?? ABSOLUTELY!!
Will I be getting the next book in the series??
"One adventure after another; all exciting....."
There is never a dull day in Rio Wells, Texas. Lily is traveling with her Aunt Harriet on the same stagecoach as John McCutcheon (of the Montana McCutcheon Family). In this book there are stage robbers, town leaders of questionable character, hard working citizens and young lovers. John graduated from Medical School and comes to town to assume duties while learning the old Doctor hadn't retired at all. I loved the patience John has with those injured and sick as well as the old Aunt that needs his care. The author has a great talent in weaving the rich with the poor people along with the less fortunate with handicaps. I loved Tucker as well as the little white kitten. In the end, I had to bring out the Kleenex and wipe a tear.
The main character of John along with the heartbroken Dustin were both my favorites. The author managed to weave the storyline with both men and I felt sorry for Dustin. It definitely was meant for John to win the girl but I felt sad for Dustin.
John was the strong performance. The voice was firm, knowledgeable and Doctor-like. Even when injured, John's character was "the man in charge" sort.....
The Wilds of Texas
Each book I read or listen to from this author, has a character you want to hug, give your attention and get to know better. It is usually a person who has had to struggle in life and this story was no different. I want to get to know Tucker and see him enjoy success.
"another great story and great narration"
I have only listened to this story not read it , but it is a very nice story plenty of action no swearing or crude sex scenes just beautiful well written stories anyone would enjoy these books,
I loved Lily and her Aunty had a special relationship .
I have listened to narrator before and love his voice ,he does the best job on these stories and voices
I just got right into the story and enjoyed the journey with Lily and Aunty.
do yourself a favour and listen to all Caroline Fyffe books you will love them as much as i do,
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Night of the Living Dead Volume 03
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Night of the Living Dead Volume 03 Product Description
The most terrifying night in American history was only the beginning! The year is 1969, and though the risen dead had ravaged the eastern seaboard a year earlier, two thousand miles of distance bring comfort to a handful of young and carefree "weekend warriors." Eager to leave their tensions behind, they head out into the Californian dunes for three days of hot sun, dune buggies, and skimpy bikinis. But the pristine white sands will soon run red, as a secret even more gut-wrenching than flesh-eating ghouls coes to light! Collecting the entire "Death Valley" story arc by horror comic legend Mike Wolfer, with an added bonus story set in the Louisiana bayou, where the psychological threat of the coming undead hordes pits survivor against survivor!
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Search by Date Search by Category Search with Google
Fatal error: Call to undefined function popular_posts() in /home/philsa/public_html/wp-content/themes/WpNewspaper/sidebar.php on line 42
"No law shall be passed abridging the freedom of speech, of expression, or of the press... (Sec. 4, 1987 Philippine Constitution)"
ZAMBOANGA CITY/19 August 2016 by Vic Larato—The city government is expected to operate on a P3.13 billion budget next year with a projected income of P2.83 billion based on the proposed Local Development Investment Program (LDIP).
The 2017 annual budget marks an 11% increase compared with the current year's budget of P2.82 billion.
A comparative review of the city's annual budgets in the previous years showed that when Mayor Beng Climaco assumed office in 2013 the budget then was 2.19 billion.
The following year (2014), the …August 19 2016 / Comments Off on City gov't eyes P3.13B annual budget for 2017 / Read More »
ZAMBOANGA CITY/19 August 2016 by Sheila Covarrubias—Mayor Beng Climaco expressed agreement to the proposal of President Rodrigo Duterte to launch …August 19 2016 / Comments Off on Climaco favors lifestyle check on gov't officials / Read More »
ZAMBOANGA CITY/14 July 2016 by Frencie Carreon–The Medical Symposium and Expo 2016 organized by West Metro Medical Center this morning …July 14 2016 / Comments Off on West Metro Medical Expo kicks off / Read More »
MANILA, 10 December 2015—As the year ends, the Armed Forces of the Philippines (AFP) is set to receive 77 units …December 10 2015 / Comments Off on US grants 114 armed personnel carriers to AFP; 77 now in Subic Bay / Read More »
In 1992, the Philippine Government made a commitment to uphold the goal of Universal Salt Iodization because of the alarming rate of Iodine Deficiency Disorder throughout the country. The Department of Health invited …Jul 6, 2016 / Read More »
MANILA, 10 December 2015—As the year ends, the Armed Forces of the Philippines (AFP) is set to receive 77 units from among 114 of M113A2 Armed Personnel Carriers (APC) from the US Government, following …Dec 10, 2015 / Read More »
MANILA,03 December 2015—From last season's splash of colours to a binary, monochromatic ensemble, Filipino designer and National Ambassador for Peace Arnold Galang showcased his Spring Summer (SS) 2016 Peace Collection, despite the dark …Dec 3, 2015 / Read More »
"..We need to be flexible in dealing with human lives, in dealing with humanity." Thus said Col. Jose Johriel Cenabre, then commander of the Joint Task Force Sulu and 2nd Philippine Marine Brigade, …Mar 6, 2014 / Read More »


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2009 Pascal Jolivet Sancerre Les Caillots
Retail: $36.99
$28.98per bottle
Product Description:
"This white has the vintage's rapier acidity, but it's embedded in a creamy, porcelainlike texture that carries verbena, lemon curd, white peach and gooseberry notes through the long, stylish, stone-tinged finish. Drink now through 2013. 150 cases imported."


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A christmas carol : the graphic novel by Charles Dickens
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Sun and moon, ice and snow by Jessica Day George
A Poppy is to Remember by Heather; Lightburn Patterson, Ron
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TheraBreath, PerioTherapy, Healthy Gums Oral Rinse, Alcohol Free, 16.9 fl oz (500 ml)
TheraBreath, PerioTherapy, Healthy Gums Oral Rinse, Alcohol Free, 16.9 fl oz (500 ml)
- You earn loyalty credit for every order you place at iHerb!
- Loyalty credit is equal to 5% of the value of your order, excluding shipping charges.
- Your loyalty credit will be applied towards your next order as soon as your current order has shipped.
- Your loyalty credits are valid for up to 60 days from the date of your last purchase.
Expiration Date:?Jan 2020Expiration Date
The length of time for the expiration date or "best used before" date depends on the type of product, as well as the brand.
Perishable items (such as flax oils or certain probiotics) generally have shorter expiration dates. Although our warehouse is fully air-conditioned, these more fragile items are put in cold storage (freezer or refrigeration unit) for maximum freshness.
Our receiving department does its best to verify and then enter the correct expiration dates for all incoming products. However, discrepancies do occur from time to time. This being said, the exceptionally high turnover at iHerb ensures that our inventory is among the freshest in the industry.
Shipping Weight:?1.48 lbsSwitch to Metric units
- Product Code: THB-05010
- UPC Code: 697029050101
- Package Quantity: 16.9 fl oz (500 ml)
7.9 x 2.7 x 2.7 in, 1.25 lbsSwitch to Metric units
|Combo Discount:
|- $4.00
- Anti Gingivitis Formula
- Dentist Recommended Solution to Help Bleeding Gums & Receding Gums
- Safe for Diabetics
- Pure Natural Ingredients
- Committed to a Greener Planet
- Approved for Diabetics
- Certified KSA Kosher
Dr. Harold Katz created TheraBreath PerioTherapy to stop periodontal problems such as irritated or bleeding gums at their source. This clinical strength formula is designed to be tough on gum problems yet gentle on sensitive gum tissue.
Suggested Use
Shake well before each use.
To Open: Pull up to remove dosage cup before unscrewing bottle cap.
For Daily Use: Fill dosage cup to mark. Rinse mouth for 1 minute with one cup-full. Gargle with another cup-full for 30 seconds to clean your throat- a major source of bacteria.
For Best Results: Use as part of a twice daily regimen with TheraBreath or PerioTherapy Toothpaste.
Other Ingredients
Purified water (aqua), peri02 (proprietary stabilized oxychlor compounds), Peg-40 hydrogenated castor oil, sodium bicarbonate, zinc gluconate (zincrx), citric acid, flavor, melaleuca alternifolia (tea tree) leaf oil, sodium benzoate.
Keep out of the reach of children. If spilled on fabrics, wash out immediately. This product was sealed with protective packaging at the laboratory. If seal is missing, do not use. Statements regarding PerioTherapy have not been evaluated by the Food and Drug Administration (FDA). These products are not intended to diagnose, prevent, treat or cure any disease. Please consult a qualified healthcare professional for medical advice.
The product is not tested on animals
It actually works, I mean really works.
Verified Purchase
It actually works, I mean really works.
I've been using this and the basic formula for over a year now and it makes my moth feel very clean. Breath is better, tonsil stones under control and it reduces the severity and duration of colds and swollen tonsils for me. I can't make any claims for the specific perio therapy application but for the extra money I felt this formula was worth a try over the standard one.
helped my gums
Posted by 5288288903896151977 on May 24, 2017 | Verified Purchase
I use their toothpaste together with this rinse, it really helped my gums which were bleeding and inflamed.
Great product
Posted by Reviewer1648054 on Apr 06, 2017 | Verified Purchase
Love this product. Again, does not taste great but do see great results with regular use - it really does get rid of gingivitis and sensitive teeth / gums, and no bleeding!
clear results
Posted by 4823434136327899477 on Apr 03, 2017 | Verified Purchase
you can notice clear results; especially the gum and less plaque; easy in use;
Perio theraphy
Posted by 4733627855989729498 on Jan 30, 2017 | Verified Purchase
I've been using Therabreath product for the past 6 years and I am fully satisfied with these products. Perio theraphy is recently introduced and seems good for gum disease.
Posted by 5378025509522517499 on Jan 18, 2017 | Verified Purchase
I use this product in combination with the PerioTherapy Healthy Gums Toothpaste and I absolutely LOVE it!!! After years of gum issues it looks like these products will help me get rid off (most) of my gum problems!


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| Clip Of Chief Justice John Roberts Remarks This clip, title, and description were not created by C-SPAN.
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July 5, 2013 Roberts' Summer Read Chief Justice John Roberts on his summer reading.
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Dandelion1982.com is a 1 year old domain, situated in Korea, Republic of. The domain is linked to the IP address 220.127.116.11.
It was registered by Hou Wenjing , who can be reached at . The site is owned by Wenjing Hou. Registration details show that it was registered on 08 Jan 2016 through xin net technology corporation and will expire on 08 Jan 2017.
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text:
|Publication number
|Publication type
|Application number
|Publication date
|May 20, 2003
|Filing date
|Feb 16, 2000
|Priority date
|Feb 16, 1999
|Fee status
|Also published as
|Publication number
|Xiao Yu Wu, Frank Yam
|Original Assignee
|Xiao Yu Wu
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (3), Non-Patent Citations (15), Referenced by (43), Classifications (29), Legal Events (4)
|External Links: USPTO, USPTO Assignment, Espacenet
This application claims benefit of provisional application 60/120,064 filed Feb. 16, 1999.
The present invention relates to a polymeric system, and more particularly to a system which releases drugs in response to environmental stimuli or separates solutes.
The human body has its own homeostatic mechanisms to regulate a variety of physiologic parameters within a certain range. These parameters include temperature, pH and salt content. In instances of disease, however, these parameters may be affected due to various mechanisms. It is essential that the body maintain homeostasis for proper conditions for enzyme reactions and metabolism to be carried.
In infection, the interactions between polymorphonuclear cells and bacteria may result in the production of pyrogens. These pyrogens may disrupt the thermo-regulatory system located in the hypothalamus of the mid-ventricle in the brain resulting in an elevation of the temperature threshold and the normal body temperature. (1) Also, in localized inflammation, the immune system of the body responds with an increase in vasodilation and release of many inflammatory mediators. Histamine, for example, results in an increase in vasodilation and consequently, the permeability of capillaries increases (2) with resulting edema. Sites of inflammation also manifest with an increase in temperature. Products of reactions resulting from inflammation are usually acidic. Therefore, the pH of the local area is reduced.(3)
In tumors, research has demonstrated that the intracellular region is of a lower pH than the extracellular region.(4) Hyperthermia has also been studied as an adjunct in cancer chemotherapy. It was found that tumor cells were more sensitized to chemotherapeutic agents when heat was applied locally to the tumor site.(5)
Regulated drug delivery, or more appropriately called, stimuli-responsive drug delivery, is a concept in which a drug or drugs is/are delivered at an appropriate rate in response to stimuli. As aforementioned, disease states may cause a change in some parameters of the body and this can be used as a stimuli or a "trigger" for the onset and offset of the delivery of drugs. Certain polymers exhibit property changes in response to variations in temperature, and pH. A number of these polymers have been investigated extensively and some success in drug delivery with them has been achieved. For example, polymers loaded with glucose oxidase have been used for regulated delivery of insulin according to the amount of glucose in the body. The glucose reacts with glucose oxidase producing an acid which induce the swelling of the polymer thus increasing the release of insulin.(6) Thermosensitive polymers such as poly(N-isopropylacrylamide) (PNIPAm) have also been used for regulated drug delivery. Such polymers experience a dramatic change in hydration when the temperature is increased or decreased through the phase transition temperature (Ttr). At T<Ttr, the polymers swell and release more drug; at T>Ttr, the polymers collapse resulting in a decrease in release rate due to the formation of dense skin following a pulsatile release at the initial stage.(7) However, in light of this, type of delivery system suffers from negative thermosensitivity, i.e., which is in the opposite direction of the slow of therapeutic agents associated with hyperthermia. In addition the system has the disadvantages of slow response and low mechanical strength.
To overcome these problems, several new designs of thermosensitive delivery systems have been developed.(8-13) These include a hydrogel-valve cylindrical device (14) and various membrane systems. Positive thermoresponse (i.e., higher release rate at higher temperature) has been obtained and mechanical strength has been improved in these systems. However, their application is limited by the methods of fabrication. For example, one is a cylindrical device with a hard plastic shell in which a drug solution is enclosed. The release of the drug solution is controlled by a piece of hydrogel which changes volume with temperature. Unfortunately, the volume change of the hydrogel is rather slow because of its size. Moreover, the device, with a rigid shape, requires surgery for introduction and removal from the body.
Existing membrane systems that exhibit positive thermosensitivity are prepared by chemical reactions such as cross-linking, grafting or radical polymerization.(8-13) Therefore, purification is required after the fabrication of the membrane. More importantly, and a clear disadvantage of such systems is that the reaction conditions are hazardous for therapeutic agents, especially those biological products such as proteins and peptides.
The human body is known to exhibit certain circadian rhythms according to different times of day. It has been found that for some anti-cancer agents, their toxicity can be minimized if the drug is administered at a certain time of the biological clock. Tumor cells are found to multiply at different rates during different time of the day. They are also known to follow a circadian rhythm. Clinical trials have demonstrated that therapeutic agents administered according to circadian rhythms are more effective and less toxic than the standard schedule of therapy.(15) Therefore, pulsatile delivery of drugs may be advantageous over the constant delivery.
With the development of recombinant DNA technology in the production of proteins and peptides, more and more new protein and peptide drugs are synthesized. In biotechnological processes such as fermentation, a number of peptides may be produced in one batch. These processes require further purification of the products.(16) Therefore, it is necessary to design a membrane that can separate a series of compounds of various molecular weights.
In vivo instability especially enzymatic degradation, hinders application of proteins and polypeptides as therapeutic agents. As such it is desirable to have a delivery system that can allow therapeutic agents to diffuse out while preventing the enzymes from entering.
This invention involves the development of a composite polymeric system containing stimuli-responsive particles and at least one other polymer. As used herein, the term "particles" includes nano- or microspheres, or any other particles having dimensions within the range from nanometeres to millimeteres. The system and particles can be of any shape. This new system can be made to be biocompatable and can be biodegradable. The system can change pore size quickly in response to external stimuli such as pH, temperature, ionic strength, multivalent ions, and other chemicals, i.e., it is stimuli-responsive and consequently it can provide stimuli-responsive drug release. Further, pore size of the system can be tailored for release and/or separation of solutes of different sizes. It can also protect protein and polypeptide drugs from enzymatic degradation.
Broadly stated, the present invention relates to a composite polymer system comprising stimuli-responsive particles, preferrably nano- or microspheres, and at least one other polymer. The "at least one other polymer" is referred to herein as a second polymer. Second polymer can be one or more other polymers, i.e., one, two three or more "second polymers". The invention provides a polymeric system which strengthens the mechanical strength of a responsive component using at least one other polymer, i.e., second polymer which acts as a matrix and to increase the response rate of the system. A responsive component such as PNIPAm/MAA nanoparticles act as responsive nanovalves which can form channels in response to changes in external stimuli like temperature and pH. This invention can potentially be applied to other systems comprising a swellable hydrogel and nonswellable hydrophobic polymer.
Accordingly, the present invention provides a composition for a composite polymer system comprising a stimuli-responsive polymer, preferrably swellable, and at least one second polymer, preferrably non-swellable and hydrophobic.
According to a preferred embodiment the stimuli-responsive polymer is selected from the group consisting of R-acrylamide, R1-acrylate, R2-acrylic acid, and polyethylene glycol where R, R1, and R2 may each be H or alkyl.
According to another preferred embodiment the second polymer is selected from the group consisting of polysaccharides, polysaccharide derivatives, cellulose, cellulose derivatives, polyesters; anhydrides; poly(orthoesters); and polyurethane. Most preferably a composition according to this invention is biocompatable and biodegradable. A preferred embodiment is a composite polymer system comprising poly(N-isopropylacrylamide-co-methacrylic acid) and ethylcellulose.
The invention also broadly contemplates methods for preparing composite polymeric systems of the present invention containing stimuli-responsive particles, preferrably nano- or microspheres, and at least one second polymer as follows:
(a) obtaining particles with suitable responsive properties and sizes;
(b) mixing the particles with at least one second polymer solution;
(c) casting the composite polymer system. The system can be case in any shape which is desired or appropriate depending upon the application.
Accordingly, the present invention provides a method of preparing composite polymer system, preferrably with particles that are nano or microspheres comprising: (a) preparing particles with a stimuli-responsive polymer; (b) adding and mixing at least one second polymer, preferrably non-swellable and hydrophobic, under conditions which permit dispersion of the particles in the second polymer; and (c) casting the resulting composite polymer system.
According to a preferred method the stimuli-responsive polymer is selected from the group consisting of R-acrylamide, R1-acrylate, R2-acrylic acid, and polyethylene glycol where R, R1, and R2 may each be H or alkyl.
According to a further preferred method the second polymer is selected from the group consisting of polysaccharides, polysaccharide derivatives, cellulose, cellulose derivatives, polyesters; anhydrides; poly(orthoesters); and polyurethane.
According to preferred embodiments the step of mixing is carried out by melting the polymers or mixing them in solution.
The composite polymeric systems of the present invention may also be used in any one or more of the following applications: solute separation and filtration; temperature, pH and ionic strength and biochemical ions—responsive drug delivery; diagnostic and monitoring tools; protein and peptide drug delivery; and coating and microencapsulation of solid dosage forms such as tablets, or microencapsulation of live cells.
According to further embodiments of the present invention the particles may also be used for treating inflammation, infection, diabetes, arthritis, and cancer, as well as a method for stimuli-responsive separation of solutes of different sizes in an aqueous medium.
Other features and advantages of the present invention will become apparent from the following detailed description. It should be understood, however, that the detailed description and the specific examples while indicating preferred embodiments of the invention are given by way of illustration only, since various changes and modifications within the spirit and scope of the invention will become apparent to those skilled in the art from this detailed description.
The invention will now be described in relation to the drawings in which:
FIG. 1 is a graph showing the variation of particle diameter of PNIPAm/MAA nanoparticles with temperature in DDI water and pH 4 buffer.
FIG. 2 shows SEM photographs of cross-section of the composite membrane (left) and the control (right) (ethylcellulose membrane).
FIG. 3 is a graph showing the swelling ratio of the composite membrane changing with temperature in 0.0001 M KCl.
FIG. 4 is a graph showing the effect of temperature on the relative contact angle of DDI water on the composite membrane and the control.
FIG. 5 is a graph showing the variation of permeability of acetaminophen across the composite membrane with temperature in DDI water.
FIG. 6 is a graph showing the permeability of vitamin B12 at 25 and 40� C.
FIG. 7 is a graph showing permeation profile of vitamin B12 across the composite membrane in 3.33�10−2 mM CaCl2.
FIG. 8 is a graph showing the effects of pH on the permeation of theophylline at 20 and 45� C.
FIG. 8A is a graph showing the effects of pH on the permeation of vitamin B12.
FIG. 9 is a graph showing the effect of the monovalent and divalent ions on the degree of enhancement of permeability of theophylline across the composite membrane.
Composition of the Polymeric System
The polymeric system contains stimuli-responsive nano- and/or microparticles comprising at least one compound including R-acrylamide, R1-acrylate, R2-acrylic acid, where R═H, alkyl, R1═H, alkyl, R2═H, alkyl, and at least one polymer including cellulose and derivatives, e.g., cellulose, ethylcellulose, methylcellulose, propylcellulose, methoxypropylcellulose, hydroxypropylmethylcellulose, cellulose nitrate, poly(vinyl alcohol), poly(vinyl chloride), polystyrene, polyethylene, polypropylene, poly(ethylene-co-vinyl acetate), polyesters, e.g., poly(hydroxybutyric acid), poly(hydroxyvalerianic acid-co-hydroxybutyric acid), poly(lactic acid), poly(glycolic acid), poly(lactic acid-co-glycolic acid), poly(epsilon(-caprolactones), poly(epsilon(-caprolactone-co-DL-lactic acid), polyanhydrides, e.g., poly(maleic anhydride), polyamides, albumin, gelatin, chitosan, collagen, pol(hydroxyalkyl)-L-glutamines, poly(gamma(-ethyl-L-glutaminate-co-glutamic acid), poly(L-leucine-co-L-aspartic acid), poly(proline-co-glutamic acid), poly(orthoesters), e.g., poly(alkyl 2-cyanoacrylates), polylysin, alginate, alginic acid, polyurethanes, poly(methyl methacrylate), poly(methyl methacrylate-co-methacrylic acid), poly(methacrylate-co-hydroxypropyl methacrylate).
Preparation of Composite Membranes
In a typical method, dried nano- and/or microparticles were dispersed in a solution containing at least one polymer such as ethylcellulose, poly(lactic acid), poly(lactic acid-co-glycolic acid), poly(epsilon(-caprolactones), and poly(orthoesters). The mixture was then poured into a glass ring and allowed to dry forming a membrane. Melting method can also be used for preparation of the composite membranes. In this method, the dried nano- and/or microparticles were mixed with powders of at least one polymer such as poly(ethyline-co-vinyl acetate). The powders were then melted forming a membrane upon cooled.
The polymeric system can applied for stimuli-responsive release of vaccine, for treatment of inflammation, infection, diabetes, arthritis, impotency, and cancer, as well as for separation and/or purification of solutes of different sizes in one batch. Examples of stimuli-responsive conditions are changes in temperature, pH, ionic strength, multivalent ions, and other chemicals and as appropriate under the circumstances providing higher dose of therapeutic agents. It can also be applied as diagnostic and monitoring tools, e.g., biosensors. Because of its sitimuli-responsive pore size, it can protect proteins and peptides from enzymatic degradation by preventing the enzymes from entering. Therefore, it will be useful for protein and peptide drug delivery. The system exhibits strong response to biochemical ions such as calcium ions and hence may be used for delivery of therapeutic agents in response to the stimuli of a biochemical process. Because of the ease of fabrication, the polymeric system can be applied as coating of a solid, semi-solid, or even liquid dosage forms providing stimuli-sensitive drug release. The present invention can also be used for encapsulation of live cells.
The following non-limiting examples are illustrative of the present invention:
Preparation and Characterization of P(NIPAm/MAA) Nanoparticles
Poly(N-isopropylacrylamide-co-methacrylic acid) (PNIPAm/MAA) nanoparticles were prepared by an aqueous dispersion polymerization process. N-isopropylacrylamide (NIPAm, Eastman Kodak) was recrystallized in toluene and hexane. Methacrylic acid (MAA, Aldrich) was distilled to remove the inhibitor. N,N′-methylenebisacrylamide (BIS) (99%) and potassium persulfate (KPS) were purchased from Aldrich and used as received. Sodium dodecyl sulfate (SDS) was obtained from Mallinckrodt and used as received. The two monomers were dissolved in distilled water to make a molar ratio NIPAm/MAA=1/0 to 1/9 and a total concentration of 135 mM. After the incorporation of 6.4 mol % of BIS, a small amount of SDS was then added to the reaction mixture to a concentration level of 0.4 mM. The reaction mixture was purged with nitrogen and maintained at 70� C. The polymerization was started with the addition of a small amount of concentrated KPS solution to give a total concentration of 2.1 mM. The polymerization was carried out under nitrogen blanket at 70� C. for 4 hours at 200 rpm.
Purification of the Nanoparticles
The nanoparticles were enclosed in a standard cellulose dialysis tubing with a molecular weight cutoff of 12,000 to 14,000. After the sealing both ends with enclosure, the dialysis tubing was immersed in distilled and deionized (DDI) water. The water was changed twice daily for about 3 days, or until the conductivity of the water outside the dialysis tubing was comparable to that of distilled water.
Characterization of the Volume Phase Transition of the Nanoparticles
A small sample of nanoparticles was transferred to a glass cell and then diluted to a proper concentration using an aqueous medium such as DDI water, KCl solutions, CaCl2 solutions, and buffer solutions of various pH. The cell was then placed in a sample holder at a constant temperature which was controlled by a computer. The particle size was determined with a dynamic light scattering particle sizer (NICOMP Model 370). The measurement was run for at least 3 cycles for each sample and the intensity-weighted particle diameter at 15-60� C. was recorded.
FIG. 1 illustrates the particle diameter change with temperature in distilled deionized water and pH 4 buffer (0.5 M) for PNIPAm/MAA nanoparticles with NIPAm/MAA=1/0.1. A dramatic decrease in diameter is revealed for both cases indicating the volume phase transition. However, the transition temperature (Ttr) is shifted from ˜37� C. in DDI water to ˜23� C. in pH 4 buffer. The results suggest that the polymer particles are not only temperature sensitive but also pH responsive.
Preparation of Composite Membrane
In a typical preparation, 21.30 g of nanoparticles emulsion of PNIPAm/MAA were dried in an oven at ˜55� C. 0.69 g of ethylcellulose (viscosity 100, Dow Chemical Company) was added to the dried nanoparticles, together with 24 g of absolute alcohol. The ethylcellulose clumps were broken down into smaller pieces using a spatula and the mixture was stirred and heated in a water bath at 70� C. overnight. The mixture was then taken out of the water bath and stirred inside a cold room at 4� C. for 2-3 days. The mixture was let to equilibrate at room temperature for about 1 day. The solution of ethylcellulose with dispersed PNIPAm/MAA nanoparticles were then cast in a glass ring which was covered with 6 pieces of paper towel and placed in a chamber. The relative humidity within the chamber was controlled by a drying agent, silicon gel, which was replaced by a fresh one whenever necessary. The composite membranes were then formed after ˜2 days at room temperature within the chamber.
Characterization of the Membranes
a) Determination of swelling, partition, and morphology of the membranes
The swelling ratio of the membrane was obtained by measuring the weight of dry and wet membranes which had equilibrated with the media at various temperatures. Partition coefficient of the drugs between the membrane and the media was determined by the sorption method. Membrane samples were equilibrated with the drugs for more than two days until equilibrium and the decrease in the drug concentration was measured by UV spectroscopy. Cross-sectional morphology of the membrane was examined by scanning electron microscopy using A scanning electron microscope (Hitachi S-520) was used to determine the cross-sectional morphology of freeze-dried and fractured samples of the membranes.
FIG. 2 compares the SEM photograph of cross-section of the composite membrane with that of a ethylcellulose membrane. A more porous structure and presence of the nanoparticles were revealed. The pores, originally occupied by the swollen particles, formed as the particles collapsed when they were dried prior to the measurement. Similarly, the pores were also formed at a higher temperature or lower pH when the particles deswelled. FIG. 3 shows that the swelling ratio of the composite membrane is a function of temperature and exhibits a transition at ˜35� C.
b) Measurement of contact angle
The contact angle (CA) of water on the membranes was measured using a goniometer (Model 100-00 Rame-Hart Inc.). The temperature in the sample chamber was controlled by a water bath (Haake D8). The samples were equilibrated for 5 minutes at various temperatures prior to the measurements. FIG. 4 shows that the increase in contact angle of distilled water on the composite membrane with temperature is more significant than that of control (ethylcellulose membrane). This implies the temperature-dependent surface hydrophobicity of the composite membrane.
Characterization of Stimuli-responsive Permeation of the Membranes
Permeation of solutes of various molecular sizes through the membrane was determined using a side-by-side diffusion cell. The solution in the receptor cell was pumped to a UV cell with a peristaltic pump. The amount of solute permeated was assayed by a diode array spectrophotometer (HP 8452A). The pH of the medium was adjusted either by addition of sodium hydroxide and hydrochloric acid.
a) Temperature-responsive permeation
FIG. 5 illustrates that permeability of acetaminophen across the composite membrane increases continuously with increasing temperature and experiences a drastic increase as temperature is raised from 30 to 40� C. This suggests a transition of permeability at ˜35� C. which is similar to the transition of the swelling ratio. The ratio of the permeability at 40� C. to that at 25� C. is about 2.6 times. Like acetaminophen, permeability of theophylline increased about 2.8 times. More significant change in permeability was observed for larger solutes such as vitamin B12. FIG. 6 depicts that almost negligible permeation of VB12 across the membrane into water at 25� C. compared with that at 40� C. In the presence of a bivalent salt, CaCl2, the permeation of VB12 was measurable. However, as shown in FIG. 7, its permeability at 45� C. was much higher, about 11-fold of that at 20� C. as calculated from the slopes of the curves. Macromolecules, e.g., chymotrypsin (MW 22,000), could not penetrate through the membrane at the studied temperatures.
b) pH-responsive permeation
The permeability of theophylline at various pH and two different temperatures is illustrated in FIG. 8. A peak permeability at ˜ pH 6.25 is revealed at both temperatures, especially at 45� C. This implies that an increased permeation may be expected at a site of inflammation with a combination of hyperthermia and lower pH.
c) Dependence of permeation on ionic strength and divalent ions
FIG. 9 depicts that the permeability increment of theophylline as temperature is increased from 20� C. to 45� C. is reduced with increasing ionic strength. However, in the presence divalent ions, Ca+, the permeability increment is always higher than that with monovalent ions, K+. This observation suggests that the permeation is responsive to the divalent ions.
While the present invention has been described with reference to what are presently considered to be the preferred examples, it is to be understood that the invention is not limited to the disclosed examples. To the contrary, the invention is intended to cover various modifications and equivalent arrangements included within the spirit and scope of the appended claims.
All publications, patents and patent applications are herein incorporated by reference in their entirety to the same extent as if each individual publication, patent or patent application was specifically and individually indicated to be incorporated by reference in its entirety.
Ability to
close to
No leakage of
No reaction
response to
pore size
vacuum filtration
hydrogel synthesis
by polymerization
This invention
X - means "NO"
✓ - means "YES"
P(45� C.)/P(20� C.) in
0.0001M KCl
Vitamin B12
No permeation at both
Full Citations For References Referred To In The Specification
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|International Classification
|Cooperative Classification
|European Classification
|Mar 17, 2003
Owner name: WU, XIAO YU, CANADA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:YAM, FRANK;REEL/FRAME:013874/0081
Effective date: 20030314
|Nov 17, 2006
|Fee payment
Year of fee payment: 4
|Nov 12, 2010
|Fee payment
Year of fee payment: 8
|Oct 23, 2014
|Fee payment
Year of fee payment: 12


text:
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text:
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text: With a steady stream of new Ubiq's upon us, the Japanese footwear brand follows up one of their most recent releases with a low-top brother to the previously seen Grace Mid. The younger sibling takes a flashier approach incorporating all-patent uppers but still maintaining a clean aesthetic. Available in three colors over at Chapterworld.


text:
Chapter Two
"Who are you talking to?" Evelyn's father asked.
"No one," she said quickly.
Her dad looked at her strangely for about half a second but then he shrugged and left.
Victor reappeared. "Come now," he said.
She hesitated.
"What are you waiting for?" Victor asked impatiently.
"I just don't know if I should go with you. I just met you."
"No, you met me thousands of years ago. Please, Ellenoire, come with me."
"Okay, first off my name is Evelyn, not Ellenoire. Second, what will my parents think?"
"Fine, Evelyn. I will just kill your family and then they can't think anything."
"No, please don't. What about my friends?"
"Evelyn, we can figure this all out later. Now I need you to go before it's too late."
"When will it be too late?"
"At exactly midnight I will be dragged back to Romania by the Power."
"Midnight? Romania? Power? Isn't that just a little cliche?" Evelyn asked.
"Please?" Victor's eyes were pleading.
"Fine," Evelyn gave in. "How are we gonna get there?"
Victor grinned. He gripped her hand and turned into a bat.