text:
|Publication number
|Publication type
|Application number
|Publication date
|Aug 16, 2011
|Filing date
|Jul 21, 2005
|Priority date
|Jun 30, 1994
|Fee status
|Also published as
|Publication number
|James Barry
|Original Assignee
|Boston Scientific Scimed, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (37), Classifications (16), Legal Events (3)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation of application Ser. No. 10/012,133, filed Oct. 22, 2001, now U.S. Pat. No. 7,090,655 now allowed, which is a continuation of application Ser. No. 09/385,604, filed Aug. 30, 1999, now U.S. Pat. No. 6,344,028, which is a continuation of application Ser. No. 09/121,561, filed Jul. 23, 1998, now U.S. Pat. No. 5,954,693, which is a divisional of application Ser. No. 08/867,292, filed Jun. 2, 1997, now U.S. Pat. No. 5,857,998, which is a continuation-in-part of application Ser. No. 08/507,844, filed Jul. 27, 1995, now U.S. Pat. No. 5,685,847, which is a continuation of application Ser. No. 08/268,999 filed Jun. 30, 1994, now U.S. Pat. No. 5,439,446, each application being incorporated by reference herein of their entirety.
The present invention generally relates to stents positionable within the body of a patient and more particularly relates to a stent for delivering a therapeutic agent therefrom and a method and system for delivery of a therapeutic agent to replenish the stent.
Physicians often use medical guidewires and catheters in combination. Medical guidewires are devices navigable through narrow passages in the body such as vessels, tubes, ducts, passages and the like, hereinafter collectively referred to as vessels. A physician controls the position and travel of a distal end of the guidewire by manipulating a steering mechanism at a proximal end outside the body. In other applications the physician guides the catheter through a laparoscope or endoscope. Medical catheters generally comprise hollow, flexible tubes that convey fluids, such as contrast, embolic, or pharmacological agents, to or from a vessel within a body.
Typically in transluminal procedures, a physician inserts and directs a medical guidewire through a vessel in a patient's body. The physician monitors the travel of the guidewire by fluoroscope or other known device. Once positioned proximate the desired area, a steering mechanism is removed from the guidewire and a medical catheter is inserted into the vessel along the guidewire. Other procedures are also well known for directing catheters or similar devices into larger vessels of the body such as the esophagus.
Often these catheters include specialized attachments for providing different treatment modalities. For example, the following references disclose catheters with attachments for administering a therapeutic agent and performing balloon therapy:
(1989) Wolinsky
(1989) Sagae et al.
(1993) Wang
(1993) Lennox et al.
U.S. Pat. No. 4,824,436 to Wolinsky discloses a multi-lumen catheter having opposed ring balloons positionable on opposite sides of a plaque formation in a blood vessel. Inflation of the ring balloons define an isolated volume in the vessel about the plaque. Heparin is then injected into the volume between the ring to assist the body in repairing the plaque deposit. This patent also discloses a central balloon which can be employed to rupture the plaque prior to inflation of the ring balloon.
U.S. Pat. No. 4,832,688 to Sagae et al. discloses a multi-lumen catheter having an occlusion balloon positionable distally of a tear in a vessel wall. Inflating the balloon occludes the vessel and isolates at the tear. A therapeutic agent, such as heparin or thrombin, injected from the catheter into the volume reduces the risk of thrombosis or restenosis. The balloon is then deflated and moved adjacent the rupture and reinflated to repair the ruptured wall by coagulation of blood thereat.
U.S. Pat. No. 5,254,089 discloses a balloon catheter having an array of conduits disposed within the outer wall of the balloon. The conduits include apertures in the other wall for delivery of medications through the wall of the balloon into the body of a patient. This type of balloon is often referred to as a channeled balloon.
U.S. application Ser. No. 08/105,737 to Lennox et al. discloses catheters having spaced balloons for treating aneurysms. The inflated balloons define an isolated volume about the aneurysm. A port connects a vacuum source to evacuate the volume and draw the aneurysmal wall toward its ordinary position. Inflating a third balloon with a heated fluid to contact the aneurysmal wall effects the repair.
Therapeutic agent and balloon delivery systems must meet certain criteria. That is, the cross-sectional dimension of the catheter must be minimized to enable transit through the vessel while also having sufficient dimension to enable fluid flow to selectively inflate and deflate the balloon, guidewires to pass therein, and therapeutic agents to flow therethrough for delivery along the catheter. Catheters must also have sufficient internal rigidity to prevent collapse of the lumens while having sufficient flexibility for passage along vessels.
The following references disclose stent delivery systems:
(1987) McGreevy et al.
(1990) Strecker
(1990) Savin et al.
(1991) Stack et al.
(1992) Ryan et al.
(1992) Lau et al.
(1993) Anderson
(1993) Lau et al.
Stent delivery systems, as disclosed by the Lau et al. and Ryan et al. patents, often include a catheter supporting a compacted stent for transport in a vessel and an expansible device for expanding the stent radially to implant the stent in the vessel wall. After removal of the catheter, the expanded stent keeps the vessels from closing.
The McGreevy et al. patent discloses a stent formed of biologically compatible material, such as a frozen blood plasma or the like. According to McGreevy et al., a stent of this type carried by a catheter may be inserted into opposed ends of a ruptured vessel to support the separated vessel walls while the ends are bonded together. Once deployed, the heat from the bonding operation and the body eventually melt the stent and clear the vessel.
The Strecker patent describes a stent and delivery system. The stent is knitted from metal or plastic filaments and has a tubular structure. The delivery system includes a balloon catheter and a coaxial sheath. The catheter supports and carries the compacted stent to a site within the body. The sheath covers the stent preventing premature deployment and facilitating transit of the stent through passages in the body. Exposure of the stent by moving the sheath axially with respect to the catheter and expansion of a balloon urges the stent into contact with the walls of the vessel. Deflation of the balloon frees it from the stent and enables withdrawal from the vessel of the delivery system.
In the Savin et al. patent a stent delivery system includes a catheter having an expansible distal portion, a stent carried thereon in a contracted position for expansion thereby and sleeves that overlie the end portions of the stent. The sleeves protect the vessel and the stent during transit without substantially inhibiting deployment of the stent.
The Stack et al. patent discloses a stent delivery system comprising a catheter for delivering a compressed stent on a balloon or mechanical extension to the locus of a stenotic lesion. The balloon or mechanical extension proximates the distal end and expands the stent. Deflation of the balloon or retraction of the mechanical extension permits withdrawal of the distal end of the catheter through the stent. The stent comprises bioabsorbable porous material that reduces the likelihood of embolization and promotes tissue ingrowth in order to encapsulate the stent.
In accordance with the Anderson patent, a stent delivery system includes a dissolvable material that impregnates a self-expanding stent in a compacted form. In one embodiment, the removal of a sheath exposes the stent to body heat and liquids so that the material dissolves and the stent expands into a deployed position.
Stent delivery systems used in such procedures generally include catheters with selectively expansible devices to deliver and expand a contracted "stent" or restraints that can be removed to allow a self-expanding stent to assure an enlarged or expanded configuration. Stents are known and have a variety of forms and applications. For example, stents serve as prostheses and graft carriers in percutaneous angioplasty. Stents used as an endoprothesis and graft carriers to which the present invention relates usually comprise radially expansible tubular structures for implant into the tissue surrounding "vessels" to maintain their patency. As is known, such stents are utilized in body canals, blood vessels, ducts and other body passages, and the term "vessel" is meant to include all such passages.
Like the previously described therapeutic agent and balloon therapy systems, stent delivery systems must conform to several important criteria. First, it is important to minimize the transverse dimension of the delivery system, so the stent must be capable of compaction against a delivery device, such as a catheter. Second, the delivery system must facilitate the deployment of the stent once located in a vessel. Third, the stent delivery system must easily disengage from the stent after the stent is deployed. Fourth, the procedure for removing the delivery system from the body must be straightforward. Fifth, the delivery system must operate reliably.
It has been found that the administration of therapeutic agents with a stent can reduce the risks of thrombosis or stenosis associated with stents. Stents administered along with seed cells, such as endothelial cells derived from adipose tissue, can accelerate the reformation of an afflicted area. Likewise, tears or other vessel damage associated with balloon angioplasty can be reduced by a deployed stent used in combination with a therapeutic agent.
When both therapeutic agent and stent therapies are required, a physician generally (1) steers a guidewire to the treatment locus, (2) guides a catheter over the guidewire, (3) operates the catheter to provide the first stage of treatment, (4) inserts an exchange guidewire to the guidewire, (5) withdraws the catheter, (6) guides a second catheter over the guidewire, and (7) operates the second catheter to provide the second stage of treatment. After this, the physician withdraws the guidewire, if not previously removed, and the catheter from the body of the patient.
U.S. Pat. No. 5,439,446 discloses a stent delivery system that incorporates a drug delivery system in the catheter. This device permits the surgeon to use one catheter to deliver both the stent and the therapeutic agent at a selected site in the patient's body.
Other references disclose the use of stents that release therapeutic agents associated with a deployed stent over time For example, U.S. Pat. No. 5,234,457 discloses stents impregnated with a gelatin that enables the release of the stent. It is suggested that the gelatin could entrain a therapeutic agent that dispenses as the gelatin dissolves.
These references thus provide the ability to deliver stents and therapeutic agents to an afflicted site within a patient's body and even enables the dispersion of the therapeutic agent from the stent over time. However, if an additional therapeutic agent is needed at the site, another catheter must be inserted to deliver the therapeutic agent or by generally introducing the additional therapeutic agent to the vessel such as by injection in the case of a blood vessel or by bathing the esophagus, for example.
In some cases, where a slow release of the therapeutic agent is desired, the therapeutic agent may be entrained in a gelatin or other hydrophilic or hydrophobic polymers on a stent. Once the therapeutic agent was delivered, replenishment required one of two procedures. In one, a new stent was inserted to be adjacent the old stent. Sometimes this reduced the effectiveness of the therapeutic agent, particularly when the area of treatment was displaced from the second stent. An alternative that overcame that problem was substituting a new stent for the old stent. It is true that percutaneous transluminal procedures and other procedures involving the insertion of stents into the body have improved in recent years. Likewise, the reduction in the size of the instruments inserted into the patient reduces the risk of damage. However, it is still a fact that each insertion and extraction risks further damage to afflicted areas and damage to otherwise unaffected areas through which the instruments pass and can add to patient trauma. Moreover, insertion and withdrawal of additional instruments in sequence increases the time of the physician, staff, and medical facility, and the cost of multiple instruments. Thus, reducing the number of instruments and the overall size of the instruments necessarily inserted and withdrawn from a patient, the steps required by the processes, and the overall size of each of the instruments is generally preferred.
Thus, the above-described references generally disclose various forms of stents and delivery systems for treatments or therapies using a catheter in percutaneous transluminal procedures and other internal procedures. Some combined with stent delivery systems, which may include a balloon for deploying the stent, while others combine balloon therapy and therapeutic agent delivery systems. Still some of the references disclose a stent delivery system combined with a therapeutic delivery system or a stent that actually enables the slow release of a therapeutic agent carried by the stent. However, none of these references disclose a stent that enable both the release of a therapeutic agent therefrom and the charging or recharging of the stent with a therapeutic agent once positioned within the body to permit delivery of a therapeutic agent to replenish a stent. None provides a structure for improving the efficiency of percutaneous transluminal procedures and other internal procedures by providing a stent for dispensing a therapeutic agent that can receive additional therapeutic agents in vivo and a therapeutic agent delivery system for replenishing the therapeutic agent dispensed from the stent. None disclose a delivery system and method capable of replenishing a therapeutic agent after it has been depleted from an original supply.
Therefore, it is an object of this invention to provide a method and apparatus for stent and therapeutic agent treatments by a stent with a replenishable reservoir of a therapeutic agent.
It is another object of this invention to provide a method and apparatus for charging and recharging with a therapeutic agent a therapeutic agent delivery stent positioned within a patient whereby the stent can continue to dispense a therapeutic agent.
It is another object of this invention to provide a therapeutic agent delivery system adapted for replenishing a therapeutic agent reservoir of a deployed stent.
Yet another object of this invention is to provide a method and apparatus which enables delivery of a therapeutic agent to an afflicted portion of a vessel in a patient after depletion of an initial volume of therapeutic agent carried by the stent.
It is a further object of this invention to provide a method and apparatus for delivering a stent and therapeutic agent to a vessel which is relatively simple and inexpensive to produce and use.
In accordance with one aspect of this invention, a stent assembly for deployment within a patient's body includes a frame that defines a stent assembly form. The frame supports a therapeutic agent reservoir characterized by allowing the therapeutic agent to seep from the reservoir. A port connected to the reservoir allows the introduction of the therapeutic agent into the reservoir subsequent to the deployment of the stent assembly in the patient's body.
In accordance with another aspect of this invention, a stent assembly for deployment within a patient's body includes a frame that defines the shape of the stent assembly. A reservoir carried by the frame delivers the therapeutic agent from the stent assembly. A delivery system connects to the reservoir means to enable the addition of the therapeutic agent to the reservoir means in vitro.
The appended claims particularly point out and distinctly claim the subject matter of this invention. The various objects, advantages and novel features of this invention will be more fully apparent from a reading of the following detailed description in conjunction with the accompanying drawings in which like reference numerals refer to like parts, and in which:
For ease of understanding the invention, the vessel 20 will be described in terms of a blood vessel. Blood 26 flows in a direction represented by arrow 27 within the vessel 20. If left untreated, the flap 23′ can grow in size and occlude the vessel due to coagulation of blood thereat. Such flaps may also result in ruptures of the vessel. Other abnormalities in vessels of the type to which the present invention is applicable include aneurysms, ruptures, stenosis, and the like. Additionally, the stent according to this invention can be used as a site delivery vehicle that over time dispenses a therapeutic agent proximate a desired location such as a tumor, other abnormality or other site selected for the delivery of such agent.
The stent 36, as depicted in
In accordance with this invention, a membrane 41 overlies at least a portion of the frame 40A, or preferably, as shown in
Referring again to
The therapeutic agent 42 preferably includes an active agent, such as a drug or endothelial cells. Examples of the drugs which would be appropriate active agents include antithrombins such as heparin and derivatives thereof; antiplatelet agents such as PPACK, iloprost, integrelin, and chimeric antibodies such as c7E3; genetic therapies including antisense oligonucleotides and various gene constructs; antipoliferatives such as angiopeptin; chemotherapeutic agents such as paolitaxel; antioxidants such as probucol; vasorelaxants such as nitroglycerin and papaverine or ones with multiple effects such as nitric oxide; and the like. The active agent would preferably have an affinity for the afflicted tissue, the stent 35, or both, or the active agent could be encapsulated or attached to albumin, cells, fibrin and other matrix proteins, platelets, various natural and synthetic polymers, liposomes, red blood cells or the like having such an affinity if desired. In such case, the active agent, whether directly or due to its encapsulation, would attach on or near the irregular wall portion 23.
If the membrane 41 is formed of a hydrophilic material, and certain therapeutic agents are introduced into the isolated volume 51, the hydrophilic material initially absorbs a portion of the therapeutic agent. When the bounds on the isolated volume are thereafter removed and the therapeutic agent in the blood disperses, the hydrophilic membrane will release the absorbed therapeutic agent over time. With such a device it will be further evident that replenishment can be accomplished by relocating a balloon such as shown in
Moreover, encapsulating the active agent in a dissolving material, such as albumin or various polymers which would effect a continuing release of the active agent, proximate the irregular wall portion 23 during the patency of the encapsulating agent. Examples of such polymers would include pluronics gels, citric acid cycle polymers, such as polylactic acid, polyglycolic acid and derivatives thereof, polyanhydrides, polyphosphazenes, polysaccarides, such as alginic acid, chitin and derivatives thereof, collagen and derivatives thereof, and glycosaminoglycans, such as hyaluronic acid and derivatives thereof. In other modalities in which endoscopic procedures are involved, such a catheter as incorporates this invention can be inserted through a working channel in the ordinary manner and directed to a desired location.
Use of the present invention to treat irregularities in vessel walls generally comprises several stages of treatment. The steps usually include percutaneously inserting the guidewire 31 into a patient's vessel, guiding the guidewire to a position proximate the irregularity in the vessel 20, and inserting the guidewire lumen 37 of the catheter 30 over the guidewire 31 to enable the catheter to be directed to the irregularity, as represented in
Notwithstanding the modality used to locate the catheter, once located within a patient, the inflation of the balloon 35 to contact the wall 22 substantially occludes the vessel 20 and inhibits blood flow therethrough, as depicted in
Deflation of the balloon 35, as depicted in
Referring to
Referring to
This embodiment has been described in terms of a four-lumen catheter, although it will be appreciated that various modifications can be made. For example, the balloons 35 and 137 can be inflated from a common source through a common lumen when independent inflation is not needed. Those skilled in the art will recognize that this embodiment can also be employed as a common angioplastic catheter for treating, for example, stenotic irregularities by dilation of the vessel proximate the stenosis.
Specifically, the balloon 137 enables the dilation of vessels to dilate a stenotic vessel in a known manner, as well as other therapies involving either or both balloon and therapeutic agent therapies. However, in situations in which an irregularity of the type adapted for treatment by stent therapy, such as a flap, rupture or other irregularity results from the balloon therapy or is detected during such therapy, in which such irregularity is detected during the balloon therapy, the present invention enables stent and therapeutic agent therapy without exchanging catheters or other delay. In such case, the catheter would be repositioned so as to enable the stent to be deployed at the irregular wall portion and the steps previously described would occur. Thus, this embodiment with a separate inflation balloon 137 permits a physician to provide balloon therapies, while also providing stent and therapeutic agent therapy as needed.
As depicted in
Referring to
This heat thermally coagulates the weakened aneurysmal wall 223. Specifically, thermal coagulation has the chronic effect of forming fibrous scar tissue in the weakened aneurysmal wall 223. This shrinks and thickens the aneurysmal wall 223 to reduce its compliance and arrest progression of the aneurysm formation which is further strengthened by the deployed stent 35. Preferably, a temperature sensor 255 connected through the conductors 251 to the rf heating source 252 provides a feedback control signal to accurately regulate the temperature of the liquid 234.
Upon completion of the treatment with the rf heating source 252 deenergized, the vacuum source 231 turned off, and the balloons 137 and 235 deflated, the delivery system 228 assumes the compact configuration depicted in
Stating that those skilled in the art will now appreciate that both with and without the rf heating, the embodiment of
The specific apparatus 228 in
As depicted in
Continuing to refer to
Those skilled in the art will appreciate that, as discussed with respect to the embodiment of
The means for expanding and deploying the stent the invention can include the stent itself. For example, certain stents react to heat or other conditions by expanding and deploying. Other stents expand and deploy upon release of a stent from removable sleeves. The apparatus shown in connection with the various figures is adapted for deploying such self-expanding stents. A removable sheath is disposed over the stent to protect the vessel and permit selective deployment of the stent. Employing such self-expanding stents˜eliminates the requirement for balloon expansion. However, the balloon still functions to occlude the vessel. Alternatively, as shown in
In summary, a delivery system according to each of the embodiments of this invention, comprises a catheter having means for deploying an expandable stent and delivering a therapeutic agent for contacting the stent. Moreover, the operating techniques are analogous to standard medical procedures with respect to positioning the catheters in blood vessels, inflating the balloons, deploying the stents, and injecting therapeutic agents so the use of this apparatus is readily mastered. However, the apparatus eliminates the need for repetitive insertion of apparatus for different treatment modalities and reduces the risk of additional trauma to the patient. The invention also improves the treatment of patients by allowing combined modalities of treatment relatively concurrently, as well as successively. The invention also increases the efficiency of doctors, staff, and medical facilities. Moreover, by using bioabsorbable stents no foreign objects, such as clips or tubes, remain permanently in the patient after treatment. The invention also provides delivery systems sized for the treatment of irregularities in both large and relatively small vessels.
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|U.S. Classification
|International Classification
|Cooperative Classification
|European Classification
|Mar 27, 2015
|Maintenance fee reminder mailed
|Aug 16, 2015
|Lapse for failure to pay maintenance fees
|Oct 6, 2015
|Expired due to failure to pay maintenance fee
Effective date: 20150816


text:
A beleaguered and embattled Australian Test team has allowed the Ashes to slip through its fingers after squaring the series. Thus, the present English side became the first team from Old Blighty to retain the Ashes Down Under since Mike Gatting's heroes in 1986-97. Now Australia have the chance to pre-empt the tourists from grabbing another monstrous record and that is an outright series win on Aussie soil.
While England's winning combination remains unchanged for the series' finale at Sydney, Australia will be sporting a new look side for the new year. A broken finger has denied Ricky Ponting the privilege to close out the series with the mantle of skipper falling on a capable, but currently struggling Michael Clarke.
A cool and collected debutant Usman Khawaja will be standing in for Ponting at the crucial No. 3 spot which after a poor run of scores, badly needs a reversal of fortune. Meanwhile, off-spinner Michael Beer, who was brought into the side after the second Test, but didn't get a shot at a game since then, will be making a high-profile Test debut on Mon, Jan 2.
As was the case with the WACA at Perth, Australia have history on their side in Sydney. They have pulled off a record 14 victories from 16 Tests at the SCG. But the Boxing Day test was their fifth Test loss in their last 7 encounters. Will Sydney signal a rennaisance for the slumping side? After all, no one realistically gave the hosts a chance of drawing level earlier in he series until they turned out one dramatic performance at Perth.
Will Mitchell Johnson regain some of the magic who was able to sprinkle during that clash? Peter Siddle seemed to have partially returned to his wicket-taking ways at Melbourne. Now he will have to carry that tendency into Sydney. Meanwhile, Michael Hussey, who has been Australia's most successful batsman in the series, will have to justify that distinction, while the poorer performers like opener Philip Hughes and middle-order batsman Michael Clarke, will have to fire.
While England's batting looks to be in devastating form (with the sole exception of Paul Collingwood), it's mainly their bowlers who can turn the fortune of a match. Paceman Tim Bresnan, who returned fantastic figures of 6/75 from 34.4 overs at Melbourne, undoubtedly stands out as a key man for England. The rest of bowling unit looks dynamite as well with James Anderson, Graeme Swann and Chris Tremlett re-proving their potency.
England go into Sydney as undeniable favourites to wrap up the series, but can Australia pull off something extraordinary. History sits in the waiting room.

subset: commoncrawl


text:
Welcome to the wonderful world of Katy Sue Designs' manufacturers and designers of imaginative craft and cake decorating products. The Katy Sue product range is equally as popular and useable with cake decorating as general crafts and papercrafts; our award winning silicone molds are known worldwide for their creative designs, stunning detail and superior quality.
Back in 1993 my Mum (Doreen Thompson) and I (Susan Balfour - me!) began a kitchen table business called Katy Sue Dolls, making miniature porcelain dolls for collectors. The business grew and eventually we had collectors in 28 countries. After almost 12 years and wanting a new challenge we took a side step and turned our creative talents to the papercraft market.
So in 2004 we set up Katy Sue Designs Ltd (visit the Katy Sue Designs Facebook page) as a manufacturer and designer of innovative craft products. In 2006, we introduced the world famous Flower Soft® brand (visit the Flower Soft Facebook page) into the papercraft market and today our diverse craft range regularly appears on shopping TV channels in the UK, USA and Germany and our products are sold around the world.
Now we are side stepping again! And launching a range of food safe molds this September into the cake decorating market. This is so exciting as it has allowed us to return to our roots in sculpting and mould making (through the amazing skills of Graeme Pippet our super talented sculptor). We have 20 years of experience in the creative industries and are bursting with imaginative ideas to bring to the world of cakes so please enjoy your visit with us and check in often as we will be adding lots and lots of different products over the next few months.
The main design, manufacturing and distribution facility is in South Shields, UK. We also have our own Sales and Distribution centre in Champlain, New York, USA.
© 2017 Katy Sue Designs All Rights Reserved Katy Sue Designs USA INC. C/O Kool Tak, 22 Dubois Road, Champlain, NY. 12919. US


text:
Two Announcements of Important Upcoming Events
Joint NEHAWU, DENOSA, HOSPERSA Press Alert: Trade unions respon to crisis at Chris Hani Baragwanath Hospital
"Our Church has AIDS" - Event to be lead by Archbishop Ndungane on 23 November in Stellenbosch
Joint NEHAWU, DENOSA and HOSPERSA Press Alert
Invitation to Media Conference:
Trade Unions Respond to Crisis at Chris Hani Baragwanath Hospital
DATE: Wednesday 12th November
Time: 10:00 am
Venue: Chris Hani Baragwanath Hospital, Old
Potchefstroom Rd, Soweto (Exact venue within hospital to
be confirmed)
The trade unions organised at Chris Hani Baragwanath hospital invite you to a press conference where we will:
Announce our response to the current crisis at the above institution and other tertiary hospitals
Present our research into the causes of the crisis and propose solutions
Present the transformation project in the Surgical Department of Chris Hani Baragwanath hospital, which is based on the trade union proposals and is being jointly implemented by management and unions
Call on government to support the transformation of Chris Hani Baragwanath
For further details please contact:
Patrick Craven
Shopsteward editor
and acting COSATU spokesperson
011 339 4911
082 821 7456
Upcoming Event Organised by Fikelela AIDS Project (a project of the Anglican Church)
Our church has AIDS
Service to be held on Sunday Nov 23 at 3 pm at the DF Malan Hall at
Stellenbosch University.
The service will be led by Archbishop Njongonkulu
Guest Speaker : Rev Diana Nkesiga. She is an Anglican priest from Uganda. She is currently the chaplain to the University of Port
Elizabeth and was one of the first Anglican clergy in South Africa to get involved in HIV/AIDS ministry.
For details contact Rev Rachel Mash on 021 465 1557


text:
Doctor insights on:
Pimple Like Bums On Throat
Got a antibiotic shot for strep throat 4 years ago the shot left somewhat of a lump on my left buttocks now 4 days ago that lump turn into a pimple can't seat run walk right and it huts badly!help!
Abscess: You need to see your doctor. Sounds like you may have developed an abscess. It may get better with a course of antibiotic. If not, surgery may be needed to drain the pus. ...Read moreSee 1 more doctor answer
Pharynx (Definition)
It is the connection between the mouth and the throat. The 3 parts are the oropharynx, nasopharynx, and hypo-pharynx. The pharynx leads into the ...Read more
I have a pimple on my throat exterior?
Pimple: Hard to tell from your description. Do you have a pimple on your neck? ...Read moreSee 1 more doctor answer
I recently suffered from what I thought was a cold, but now have raised pimple-like bumps on my throat area causing pain. should I be worried?
Depends: Depends. Is it progressive? Trouble swallowing, chewing or breathing? If minimal symptoms, wait. If persistent or progressive, see your MD. ...Read more
I see small pimple type bump in right side of throat, it sometimes pain sometimes doesn't, its long term since so many months. What is that?
Bump in throat: It could be something caught in your tonsil. You can it checked out by a board certified otolaryngologist. ...Read more
I have something like a pimple in my throat which keeps becoming bigger and then becomes smaller. I have a tonsilectomy 5 months ago. I have no pain?
Call physician: Your physician will have to see lesion to know what it is and how to treat it. ...Read more
What does it mean if I have white pimples in back of throat?
White pimples: Hello, the white pimples n the back of your throat sound like tonsilliths. These are food particles that get stuck in the tonsil tissues. They harden and make your tonsils look like they are infected. Under these tonsil pimples is a cavity or crevice that may be inflamed and infected. Gargle with water after every meal. This helps to clear these white pimples. Also see your doctor. ...Read more
I have these white zit looking pimple things on my throat there very tiny and my throat is dry should I worry? What could it be ?
May be infection: White things on the throat sound like there could be a throat infection, especially if one has a sore throat and some swollen lymph node glands in the neck. A primary care doctor can evaluate to see what the problem is, and prescribe antibiotics if there is a strep throat infection. ...Read more
I had a tonsillectomy 2 weeks ago, and am still experiencing pain on 1 side of my throat and have developed these white pimple things. What are they?
Have your throat: rechecked by your surgeon or primary care doctor. It may be perfectly normal and part of the healing process, but we can't tell that for sure on this platform. ...Read more
Is there such a thing as throat pimples. If so can they actually pop and have white stuff that smells like an actually pimple or cyst.
Food particles stuck: This is usually food particles that got stuck in small crypts of tonsils or pharynx and bacteria accumulate to cause the smell but not infected. No treatment needed. Mouth wash gargle can help. ...Read more
I feel like there is something in my throat like a hair or hard dried phlegm i can see a small pimple like skin hanging out just behind my uvula, help?
Have it examined: See your family doctor or an ENT specialist and have the throat examined. ...Read more
Pimples (Definition)
Pimples are a kind of acne, and are a condition where oil gets trapped in a pore of the skin resulting in small area of ...Read more
- Talk to a doctor live online for free
- Pimple like bums on shin
- Pimple like bums on skull
- Pimple like bums on eyelid
- Ask a doctor a question free online
- Pimple like bums on tonsils
- Pimple-like bumps on the armpit
- Talk to a dermatologist online


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There is a great choice of ships offering all inclusive cruises 2017 from Southampton, from 5* club cruises to 6* luxury liners. Azamara's upgrade to more inclusive cruising offers a great way to enjoy a wonderful 5* cruise, but in a less formal setting offering inclusive drinks, meals and shore excursion AzAmazing Evening.
If 6* luxury is more appealing to you Regent Seven Seas offer the ultimate in all inclusive cruises from Southampton in 2017. Their incredible ships boast the finest cuisine at sea, a fabulous choice of inclusive beverages and great shore excursions all included in the cruise fare. Once you arrive onboard your every wish is taken care of.
Silversea Cruises and Seabourn also offer fantastic all inclusive options, if looking for a luxury experience at sea.
There are great benefits of cruising from Southampton wonderful European destinations. the main benefits are not having to deal with the hassle of flying or the restrictive luggage allowance some airlines put in place. You can arrive in a relaxed fashion having packed for every occasion.
(Club Oceanview)
Azamara Journey
Line: Azamara Cruises
Ship Rating:
Cruise Only
Ports of Call: Southampton, Guernsey (St Peter Port), Bordeaux, St. Jean de luz, Pasajes, Bilbao (Getxo), Spain, Porto...
Azamara Journey
Azamara Cruises
£5,579 pp
Regent Seven Seas Explorer
Line: Regent Seven Seas
Fly Cruise
Ports of Call: Southampton, North Sea - Cruising, Newcastle, Edinburgh, Coast of Scotland - Cruising, Belfast, N.Ireland...
Regent Seven Seas Explorer
Regent Seven Seas
Silver Whisper
Line: Silversea Cruises
Ports of Call: Southampton, Fowey, Cornwall, Cobh, Ireland, Dublin, Ireland, Belfast, N.Ireland, Reykjavik, Iceland...
Silver Whisper
Silversea Cruises
Silver Muse
Ports of Call: Southampton, Falmouth, Cornwall, Waterford, Cobh, Ireland, Galway City, St. John's, Newfoundland, St.-Pierre & Miquelon...
Silver Muse
Silversea Cruises
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DENSO Develops an Information Service To Operate Smartphones Using the Car Navigation Display
― Helping ensure the safe use of smartphone applications while driving ―
KARIYA (Japan) ― The Smartphone has changed the way we do things. Not only is it a phone, but it's an information source that constantly keeps us connected. To help drivers safely stay connected while driving, DENSO has developed ARPEGGiO, a smartphone-based, information system that uses the onboard navigation screen to display and operate smartphone applications.
DENSO's ARPEGGiO will be released in Japan next year and the company plans to have the service used worldwide in the future.
"In the last few years the number of smartphone users has rapidly increased," said Hiroyuki Wakabayashi, executive director of DENSO's Information and Safety Systems Business Group. "DENSO used its more than 20 years of car navigation technical expertise and know-how to develop a service that is intended to help users safely enjoy the convenience of smartphones while driving."
To use DENSO's new system, it requires an ARPEGGiO-enabled car navigation system and users will then need to download the respective DENSO ARPEGGiO app to their smartphone. Once complete, the smartphone and car navigation system will automatically communicate with each other through a Bluetooth® connection and display a list of smartphone applications, available through ARPEGGiO, onto the car navigation display.
For safety reasons, the direct use of smartphones while driving is prohibited by many traffic regulations around the world. ARPEGGiO is not just a system that displays the smartphone operation screen on the navigation display. The system modifies the look of the original smartphone application and formats it in a way that's easier to view on the car navigation screen. In addition, to ensure safety, the system is designed to restrict the driver's operation of certain applications while driving.
At present, the preceding application services planned for the Japanese market include:
- Searching for locations and setting destinations
- Playing music stored on smartphones and streaming Internet radio
- Track vehicle fuel efficiency
- Registering the vehicle's current location on social networking services (SNS), such as mixi (a Japan based Facebook application)
Content providers will update information and supply these services through the user's smartphone, enabling them to obtain the latest information without updating their car navigation systems. Also, it's important to note, DENSO can add additional applications to meet user wants and needs.
The middleware of ARPEGGiO is light and easy to install on a variety of operating systems (OS), allowing ARPEGGiO to be built into any type of car navigation system.
DENSO Corporation, headquartered in Kariya, Aichi prefecture, Japan, is a leading global automotive supplier of advanced technology, systems and components in the areas of thermal, powertrain control, electric, electronics and information and safety. Its customers include all the world's major carmakers. Worldwide, the company has more than 200 subsidiaries and affiliates in 35 countries and regions (including Japan) and employs approximately 120,000 people. Consolidated global sales for the fiscal year ending March 31, 2011, totaled US$37.7 billion. Last fiscal year, DENSO spent 9.3 percent of its global consolidated sales on research and development. DENSO common stock is traded on the Tokyo and Nagoya stock exchanges. For more information, go to www.globaldenso.com, or visit our media website at www.densomediacenter.com.
How ARPEGGiO works
1. Users download the ARPEGGiO application from their selected application store (online application marketplace) to their smartphones.
2. Users bring their smartphone into their car and start the ARPEGGiO application. The car navigation system and smartphone then automatically communicate with each other wirelessly via Bluetooth®.
3. The car navigation system accesses servers that provide ARPEGGiO services via the smartphone to download applications that can be used on ARPEGGiO-enabled navigation systems.
Concept of selecting applications usable on ARPEGGiO
Applications are selected from four categories based on the results of surveys regarding what functions users wish to use while driving.
|Location search
Accessing latest information from external content providers for possible driving destinations, which can be set as destinations for route guidance
Playing songs and music that users often enjoy on their smartphones
Incorporating check-in functions through SNS sites that have a large number of members
|Environmental functions andnews
• Using a system of membership-based, environmental information registration/archival websites to easily keep track of the user's vehicle fuel efficiency to raise their environmental and energy conservation awareness
• Obtaining timely information


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Stores »
Cute school girl dress!
I think this would make a darling bridesmaid dress, or a great bridal getaway outfit!
We are a community of shoppers sharing our best finds from across the web.
© 2017 ThisNext, Inc. ThisNext is a member of BUZZMEDIA Entertainment, a division of BUZZMEDIA.


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Discovering Batman's secret identityEdit
After witnessing how judge Maria Vargas put her life in peril to recover a mysterious cassette, Batman decided to investigate. Bruce Wayne then visited the Yuca Springs Resort after he learned that Judge Vargas has visited the resort weeks before all of these strange events had taken place. Once he arrived at the spa, Bruce signed up for a stress reduction program in order to gather information. After a therapy session, in which the doctor used a special mind-reading device that he invented, Hugo Strange accidentally discovered that Wayne was Batman to his surprise. He decided not to use Batman's secret identity to blackmail him, but instead he contacted the Joker, Two-Face and the Penguin to auction a tape revealing the secret. However, Wayne made a false recording of Strange going on about how he would use the machine to con the supervillains, and then destroyed the mind-invading device. When the villains saw Strange's modified video, they were furious and kidnapped Strange, taking him to an airplane. He told them Wayne is Batman, but they didn't believe him. The Joker was about to throw him off the plane, but were foiled by Batman. Strange then tried to tell this fact to Commissioner James Gordon but the billionaire himself (which was actually Dick Grayson in disguise) showed up and that charade rendered Strange's accusation impossible. He was later delivered to the police.
Recruited by CadmusEdit
<img alt="StrangeCadmus" src="http://static1.wikia.nocookie.net/__cb20071007200130/dcanimated/images/thumb/8/8b/StrangeCadmus.jpg/180px-StrangeCadmus.jpg" width="180" height="135" class="thumbimage" data-image-name="StrangeCadmus.jpg" data-image-key="StrangeCadmus.jpg" />Hugo Strange in Project Cadmus's conference room.Added by ThailogYears later, Hugo Strange became a division head on Project Cadmus. Despite being led to believe that Bruce Wayne was not Batman, he may have discovered the truth and possibly told Amanda Waller about Batman's secret identity.
Write the second section of your page here.


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Bookends...che fatica!
Bookends...che fatica! with frame in lacquered MDF and handmade. Available in three colors.
H. 13 x W. 7 x D. 3 cm
Availability: In stock
Bookends...che fatica!
The bookends D-Italy intended to order the books, will give a touch of color, originality and some of the simpler design of the shelves. Cheerful, ironic and functional.
- Frame in lacquered MDF
- Handmade
- Available in the colors: white, black and red
- 100% italian product
- H. 13 x W. 7 x D. 3 cm
The company
Original forms and quality of materials. D-ITALY is a new Italian brand that operates in the field of furniture, in particular of furnishing accessories. The goal of D-ITALY is to suggest to the public a selection of useful and functional furnishing accessories designed specifically for our homes and our spaces. Our unique products are made in small workshops and with traditional materials like wood and metal.
In order to guarantee a high quality of its products D-ITALY entrusts implementation to artisans professionals who have decades of experience in various fields, such as carpentry, painting and metal machining.
The order will be processed by our logistics service, through the best-specialized partners in dealing with fragile product.
Shipping costs will depend on volume weight (the value is given by a conversion factor that translates volume into taxable kilograms).
To calculate shipping costs add products to the cart and specify the postcode.
The products ordered will be delivered with packaging at street level. Assembly and delivery at floor are excluded. All costs for any additional services are charged to the customer.
Please contact Customer Support for special needs on deliveries: assistenza[@]deconlinestore.com
(During the summer, or before Christmas, delivery times may be delayed because of reduced service by couriers).
Enter your destination to get a shipping estimate.
Yes No
The Customer, within 14 days of receipt the purchased goods, may exercise the right of withdrawal.
The customer must send the formal communication of withdrawal before that period expiry.
For more information on product's return and the right of withdrawal, please see our Terms and Conditions by clicking here.


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David Wall press release
Turbo Healing Puts Wall Back On Track
Fifteen weeks after breaking his left foot in a work accident David Wall was back behind the wheel of a V8 Supercar at Phillip Island today.
The Fair Dinkum Sheds racing co-driver wore a plaster cast for six weeks followed by an 'air boot' for a further six in a bid to speed his recovery in time for the 2011 V8 endurance races.
Despite saying his foot was 'probably a seven out of ten,' Wall put in a great opening performance today to finish 18th in his practice session.
Lead driver, Karl Reindler, was hindered by oil on the track in the third and final practice session of the day and the pair finished 21st overall.
Qualifying for the L&H 500 starts at 11.25am.
David Wall
Fair Dinkum Sheds Racing
"We didn't do much running in P2 because we had an issue with the steering rack not being quite centred. I did an older tyre run, which gave us some direction for P3 and it all seemed to behave as we thought it would.
"My foot is probably about a seven out of ten at the moment. By the end of the day I've had enough. I've got the broken part strapped up but the rest of it hasn't worked for 15 weeks and it's only just starting to free up. I've tried to spread the load but over a long run you feel it towards the end. Luckily it's the clutch pedal foot so the most it hurts is going out the pits."
Karl Reindler
Fair Dinkum Sheds Racing
"I don't know where we are with the car at the moment. We wanted to put on a set of greens but with the oil on the track there was no point. I jumped in the car just as the oil went down and never really got a good reading of the car. Dave seems pretty happy though and we were definitely honing in on a good set-up before then.
"The car feels like it's on a bit of a knife edge at the moment through the fast stuff. I'm not sure if it's the mechanics or the wind. It's a bit choppy out there. You go through an aero corner in fifth gear and the wind pushes you wide!"


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I have a PSP 3000 version and I am looking forward to the rumored PSP 2. I would like the PSP Go simply for the Bluetooth connectivity to listen to my podcasts/music. So what are the most important features for a possible PSP 2? It is rumored to have a touch sensitive back side, and I think this is to help facilitate the port of numerous iphone/android apps which is what the current market is driving. It is smart for Sony to adjust to the existing market. It better have two analoge sticks simply for the elimination of psp complaints on IGN websites. The HD screen probably refers to a OLED screen which has a higher resolution. Im hoping for a built in phone as I only use my bluetooth anyways. It will have 3G or 4G support for multiplayer. I only play online multiplayer for pixeljunk monsters anyways. So what is your required PSP 2 trait (It better be $250 or cheaper also) ?
Ok I've heard a lot of negative feedback about PS+ and I would half to disagree with most of it. I was the type of gamer who would buy the Playstation magazine stricktly to have the demo disk. I LOVE DEMOS!!!!!! I fkn hate my WII because it doesn't offer demos ( OK it did offer some demos in the past, not anymore). I have a psp and dont use it much, except for pixeljunk monsters online and podcasts. Now I have 4 minis demos thanks to PS+. I have not been able to download the last 2 PS+ PSP mini free games but I am thankful that I was able to try them out and not buy them (on the PS3). I love puzzles. To be honest I really got PS+ to reward Sony for the free oline and to tell Microsoft to Fk Off for charging to play for online. All those people who pay for online are suckers who dont know any better. Tell me what other platform is charging just for online. Please dont give me the WOW argument because I have a life and little time. We are just rewarding the concept of now $10 more a month once Nov. starts. No fkn thanx. FU Mikrosoft. I will once again reward Sony when my subscription of PS+ ends. Reward free internet and u will get more free online.
I have to admit that I will not buy an XBOX until they offer free online. I just dont see what Im missing from my PS3 that would be worth the price of admission. I am only wishing that Limbo would be available on the PS3 but that is their loss. I wonder how the Kinect will resonate among the hardcore gamers. I see that the lack of precision control will require a peripheral eventually and then they will be labeled as a PS3 copy. Just guessing. I wonder if there will be too much lag for regular gamers to get frustrated. I got the move and I am still waiting for a good FPS. I got RE5 but there has to be a new update so I can use the trigger button (for shooting!). So far I am impressed with the control.
I would have to say that LBP is the best game ever invented. Check out LBPCentral.com and try 5 random levels to see the creativeness out there. Can't wait for LBP2. When you consider the graphics, infinite levels, ongoing creativity and replayability factor, it deserves a 10 on any type of review.


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Black Hooded Vest BambooSize Guide
$ 58
Feminine draped top with hood. Made from 100% bamboo jersey - luxurious soft fabric with incredible drape.
Add a high waisted belt to create a beautiful hour glass shaped dress.
- hooded vest
- so many ways to wear it - play with it
- versatile and luxurious, comfortable and easy
- drapes to perfection
Fold it in half and slip your arms through the arm holes to create a bat wing shaped cape.
Fold asymmetrically to have different styles of draped top in one multi purpose garment.
One size fits all. Looks amazing on every body type. The ultimate outer wear piece that multitasks as an accessory. Keep experimenting to find more ways to wear it.
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From the Publisher
A new and simple learn-by-picture method that makes it easy for anyone aged twelve and up to perform all the classic sleights just as they are done by the world's greatest professional magicians. Long-time magician Bill Tarr has teamed up with Barry Ross, an illustrator famous for his instructional sports diagrams, for easy-to-follow, step-by-step instructions, so that with the help of more than 1,500 line drawings that capture each eye-fooling movement, you'll learn everything from simple sleights you can master in minutes to the great classics of magic. With ordinary objects -- a regular deck of cards, a coin from someone's pocket, a few balls of crumpled aluminum foil -- you'll soon be doing ...Card FanningSpringing the Cards from Hand-to-HandThe Lit-Cigarette TrickThe Three-Shell GameThe Cups and BallsThree-Card MonteThe Cut and Restored RopeThe Miser's Dreamplus ...Unbelievable Card TricksCoin and Cigarette Vanishesand dozens and dozens of the world's greatest sleight-of-hand effects!
Published: VintageAnchor an imprint of Random House Publishing Group on Oct 12, 1976


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$1,200.00 3 months ago
Super updated 3 bed 2 bath (Southern Maryland a)
Our spacious one and two bedroom apartments feature on site laundry facilities, window coverings, air conditioning and 24 hour maintenance service. Rent includes heat, water, sewer and trash removal. For leasing info call: (see phone number in ad) Welcome to The Evergreens at Smith Run-beautiful and spacious apartments designed for your needs -- one or two bedrooms, sunrooms, balconies, terraces o
3 months ago
San Luis Obispo, CA
$950.00 6 months ago
$950, 1br, FREE utilities, FIOS WiFi in basement apartment
Conveniently located between Washington DC and; Baltimore, there is a Howard County planned community called Columbia.At the outskirts of Columbia, you will find the affluent Clarksville village.West of Clarksville, there\\\'s a tiny rural town, landmarked by the Crossroads Pub, famed for their Maryland blue crabs, called Dayton. Yes, there\\\'s a Dayton in Maryland...At walking distance to the Tr
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****** Newly Renovated Apartment for Rent!! ***** (Hanover, PA)
A beautiful two bedroom, first floor apartment is ready to rent. Work in Maryland, rent in Hanover, PA for way lower rates!!!Amenities:*High efficiency heating system*Central AC*New microwave, new 20" stove, and refrigerator*Newly renovated kitchen*Large lawn area outside*Off Street parking for one car*Washer and dryer hookups*Comes with a dryer*Privacy shades/blinds throughout*Hardwood floors thr
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Awesome West Side 3 Bed Apartment!! Newly Remodeled!! (914 Harmony Way)
3 beds 2 baths 2,698 sqftTake a look at this large 3 bedroom, 2 bathroom apartment located on the top of Maryland Street Hill on Evansville's west side. Renting for $895 a month with a $750 deposit, this house comes with all the charm of a house built in the 1920's, but the convenience of modern amenities. The apartment features much of the original metalwork on the walls, and some of the original
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$1,100, 2br, 2 bedroom 1 bathroom private apartment in basement of dunkirk, md
private 2 bedroom basement apartment with each room having walk in closet and private entrance. private bath with jacuzzi tub and shower. House has shared Kitchen. You can have your own fridge, microwave and your own walk in closet. w/d in house that is shared. off-street parkingLarge room for rent in new house in Dunkirk Maryland. available Immediately 1100$/ month . Includes utilities ( AC/heat,
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WWE Mattel build an Interview set. Toys R Us Exclusive!
- Sold for: Start Free Trial or Sign In to see what it's worth.
- Item Category: Toys, Dolls, Games & Puzzles
- Source: eBay
- Sold Date: Sep 27, 2014
- Channel: Auction House
You are bidding on a Mattel WWE build and Interview set. This was part of the build a line by Mattel. In order to complete this, you had to buy 4 figures. This has been used for display only in a smoke and pet free home. Item is mint, other than the TV stand. The Cena sticker has a scuff by his face, but that is the way it was straight from the package. Any further questions feel free to contact me. Thanks!


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Posted on May 28, 2015 by: acid stag
Red Bull Music Academy reveal their impressive stage line-up for Splendour In The Grass
We claim no credit for any images, music and/or videos posted on this site unless otherwise noted. All audio and visual content is copyright to its respectful owners. We are also in no way responsible for, or have control of the content of any external web site links. This website was created as a promotional tool. Please support the artists and purchase their work.


text: The Stone of Deaver was a locale on the planet Crullus Prime. Located at the top of the Stairs of Gilfoyle, the Stone of Deaver was the site where famed Ferengi Milch was put to death by the native Crullers after trying to trick them into selling their entire population of females for a fruit basket. (DS9 reference: Legends of the Ferengi)


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Our Classic Halter is about to be in heavy rotation. Made of nylon spandex, this top features princess seaming to accentuate your curves. Available in a number of colors, cuz a girl needs options!
Nylon / Spandex
Model is wearing size small
Hand Wash / Hang Dry
Made In The USA


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Six Months.
Six Months I spent living in that tent, growing accustomed to the infrequent mortar shells and RPG-7 rounds that found their way into camp. Kandahar Airfield, Afghanistan, was our staging point, my first taste of the Desert, getting my feet wet. Or bone dry, whichever you prefer. The airfield I arrived at was not, in fact, my destination, but merely a staging point for me to be shipped out with the rotational force as an augmentee for the Marines stationed in an FOB in Helmand Province.
You'll notice I said augmentee, because I am not in fact a Marine, nor am I a soldier, I am an Airman. I have been told all my career how I'm not a real "soldier", we only put on a uniform and play military, when this is the reality. Me, battle rattle, M4 Carbine, deployed in the Desert right alongside the fuckin' Marine Corps. I am a Tactical Air Control Party specialist, TACP, a USAF Augmentee for Army, Marine Corps, and SOG units used to direct the air support might of the US Air Force accurately onto target, right from the crosshairs of my prey. My prey, how ironic the terminology used by my instructors was in hindsight.
Hindsight is 20/20 they say, but looking back, I still recall my time spent as this horrible tan blur, intermittently sprinkled with the faces, the movements, the "uniforms" of the...opposition? The enemy? No, to call them an enemy implies a contest between the two forces, this was no contest, is...no contest. This is a game.
Patrols, PAR sweeps, UXO identification and removal, standard operating procedure. We continually pushed deeper through our patrol routes, Helmand Province being equal parts mountainous terrain and towns. We encountered opposition roughly 13 klicks from our FOB, small arms fire intermingled with unguided rocket fire, unremarkable marksmanship, we suppressed with a Squad Automatic Weapon, and moved in for a clean sweep of the area. My first close quarters engagement, it was overwhelmingly...plain.
The description escapes me, it was as if all emotion is stripped, you can only observe, calculate, execute, and fall back on your training and instincts to allow the engagement to evolve in your favor. The breach, the sweep, the "Clear" report, then after the reflexive synapses stop firing, the muscle memory runs its course, the cognitive functions return, and your mind begins to absorb what your eyes are telling it, what your nose is relaying it, and what your eardrums are sending it, and it recoils in shock, unsure of how to react even with months of training for every scenario feasible in a warzone. What laid before me was not feasible in a warzone, not feasible in any crevasse of a sane human mind.
The bodies piled there, no, bodies is not the correct term. The skins, the very faces, clothes, equipment, hair, and flesh of our hitherto known enemies, leaking bodily fluids, pieces of flesh, crudely and brutally vacated from the bodies of what were once Afghan males, dressed in the somewhat iconic garb of the guerilla force known as the Taliban. The...bodies? Sure, bodies, I guess, were all positioned around windows, doors, what would be vantage points for defending against my patrol just minutes ago. Despite what the post-op debriefings are supposed to tell me, I still firmly believe that we traded fire with these men, or what was left of these men, prior to finding them in this state.
Since then I have seen...I don't know, "them"? The opposition? Whatever the fuck was the perpetrator behind the remains we found on that first patrol. But I have seen the fuckers since then, I know it, the Marines I have been deployed with are some tough men, but I know they have seen it as well, they aren't nearly as dumb as portrayed in the media, those devildogs. We are all chilled to the core when we see that one face amongst the crowd of innocents roaming through the cities, the face that changes, leers at us, because they fucking know that we know. We see the body bags from decon crews that don't look quite...full enough. We hear of the Taliban prisoners cursing and crying in terror of us despite any hospitalities, screaming about how we stole the faces of their comrades, how our soldiers have done the demonic work, turning his comrades against him like puppets.
It was then we realized, whatever they are, they are manipulating us, toying with both sides. God damn it, it all makes sense now, the clean sweep of towns just to have them occupied again not even hours later? The legendary ability to disappear into a cave system? Here we were, thinking about the borderline superhuman ingenuity of our Taliban enemies, while all the while they were being absolutely decimated from within by a force that neither side understands. I have been in engagements, fired upon and hit my intended target, just to confirm a kill on a fucking fleshy blanket with a human face, looking like it was carved out with a God Damned Rusty Pumpkin Spoon!
This conflict will never fucking end!
We keep spending billions fighting an enemy that shouldn't fucking exist in this world!
We will never clear out every town, we will never establish democracy, we will never extinguish the Taliban as long as whatever the Fuck that keeps wearing their troops decides to let us go.
It is playing a fucking game with us all, with our government, our leaders, our people, the Afghanis, hell maybe the Iraqis? Who knows where their reach spreads? None of us are a reliable source anymore, we see the human yet such inhuman faces everywhere, on everyone, our families, our friends, loved ones, WHY ARE THEY FUCKING EVERYWHERE?!
I have lost all will to keep contact with anyone prior to deployment, I just don't want to see the faces anymore, I cannot stand to see those movements, those eyes, those Fucking Things in Everyone I loved.
Colonel, what do they want? You have to know, it's why I was sent to you.
Sir, you have to know what their goals are.
What the hell are they using this conflict for?
Sir...what the fuck is this war?
[20120923 \ SUBJECT: SrA W. CRISWELL \ E-4 \ POST-AEF DEPLOYMENT]
[20120923 \ REVIEWED BY: Col. M. MADIGAN \ 'O-6 \ 'MEDG\CC]
Subject is suffering from a moderately severe case of Post-traumatic stress disorder, undoubtedly induced as a result of the prolonged high-stress/high-risk operations subject had integral part of while on patrol in Helmand Province, Afghanistan. Recommend re-evaluation within a period of one month, with possible mandatory incarceration should the condition escalate further.
'The subject's movements and contacts from here forth shall be 'monitored, denoted, and any suspected relaying of the contained information to an external device shall be summarily disposed of IAW Applicable Orders, and any person(s) suspected of receiving information shall be immediately detained and debriefed of any incriminating information, and summarily displaced if necessary.
[20120924 \ END ADDENDUM \ DIGITALLY SIGNED Lt. Gen. R. MUNROE \ CONAF\CC]


text:
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Possible WWE RAW Match For Tonight, Sasha Banks Talks Bayley Match (Video), Great Khali Reactions
Former TNA Tag Team Champion Confirms GFW Departure
Jinder Mahal On How Far He's Come In A Year, Triple H Sends Title To Team (Photo), WWE Stock
Bayley On Facing Sasha Banks Tonight (Video), Kofi Kingston - WWE Battleground Stat, AJ Styles
Kevin Owens And Renee Young Get Heated, Finn Balor Ready For Payback, WWE Battleground Social Score
AJ Styles - WWE Battleground Loss Note, "Table For 3" Video For Tonight's New Episode, Kurt Angle
WWE Live Event Results From Salisbury (7/23): Roman Reigns Vs. Braun Strowman, Guest Referee, Balor
New Total Divas Cast Members Confirmed (Video), WWE Announces Total Bellas Date
WWE Battleground Results - New Champions, Punjabi Prison Surprise, Flag Match, Natalya, More
Paige Responds With Photo Over Concerns About Her Health
Another Wrestler Done With GFW
The Rock Responds To SmackDown Star, WWE 2K18 Motion Capture (Video), Fans On Funniest Stars
Former WWE Star Claims He Originally Came Up With Talking Smack
Samoa Joe On Brock Lesnar Not Liking To Plan Out A Match, His Kurt Angle Feud Helping Him For Lesnar
Randy Orton Asks Former WWE Star About One More Match, John Cena, The Hardys' WrestleMania Figures
Former WWE Referee On The Undertaker's Run, His Worst Bump And Most Surreal Moment, Jimmy Hart Story


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text:
1 jobs
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Within a radius of mi of
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11 vacancies are available in Castlebay on neuvoo.co.uk. Submit your application now and land the best job in the city.
Careers in Castlebay
Castlebay is located in the county of Scotland. Nearby cities such as Glasgow, Edinburgh, Aberdeen, Dundee, Livingston or Paisley also have several vacancies to offer.
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During the last 30 days, 6 job opportunities in Castlebay were shown on neuvoo.co.uk, 2 during the last 7 days.
neuvoo.co.uk: the largest job search engine in Castlebay
neuvoo.co.uk centralises over 669765 vacancies across the United Kingdom, 11 of which are in Castlebay.Show more...
Castlebay, Scotland
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Do you spend much time On Line using Social Media (Facebook, Twitter. eBay etc.). Are you looking to supplement your income (working from home part time based on line). If so, then...
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text:
YAN Model
Andy LynchPhotographer Male Doncaster, England, United Kingdom
My Website: andy lynch photographerMy MM URL: http://www.modelmayhem.com/andylynch
Mayhem # 1041478
About Me
I have some free shooting space for tfp/cd in june/july contact me if you want portfolio updates . Now shooting regular portfolio work for myself . also looking for models for other projects . contact me if you want TFCD .
Have you worked with Andy Lynch? Add Credits for Andy Lynch! >>
YAN Model
Ryan Phillip Brown Model
Blonde Alien Model Model
Charlotte Victoria G Model
Tiddlepops Model
Mariius - Jewellery Clothing Designer
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text:
Contact information
|+44 (0)1865 271444
My connections
- Matthew Rushworth Profile
- Rushworth lab Our lab website
- Decision and Action Laboratory (Prof. Matthew Rushworth) Research Group
Miriam Klein-Flugge
BSc Mathematics/Computer Science (2006), MSc Neuroscience (2008), PhD Neuroscience (2013)
Postdoctoral Researcher
Sir Henry Wellcome Fellow
I am a neuroscientist interested in how the human brain enables us to perform complex types of decisions, for example when desired outcomes are only obtained after delay, physical labour, or sequences of actions. I use brain imaging (fMRI, MEG) as well as causal stimulation techniques (TMS) to study these processes in the healthy human brain.
In my PhD, I was particularly interested in the mechanisms by which decision signals reach motor regions to enable implementation of the resulting actions. In my current postdoctoral fellowship, I am continuing my previous lines of research but I am also planning to study which precise aspects of these computations are impaired in disorders involving abnormal decision-making, such as depression.
Please refer to my personal website (link to the left) for more information.
Recent Publications5
Selective alteration of human value decisions with medial frontal tDCS is predicted by changes in attractor dynamics.
Hämmerer D. et al, (2016), Sci Rep, 6
Behavioral modeling of human choices reveals dissociable effects of physical effort and temporal delay on reward devaluation.
Klein-Flügge MC. et al, (2015), PLoS Comput Biol, 11
Variability of human corticospinal excitability tracks the state of action preparation.
Klein-Flügge MC. et al, (2013), J Neurosci, 33, 5564 - 5572
Segregated encoding of reward-identity and stimulus-reward associations in human orbitofrontal cortex.
Klein-Flügge MC. et al, (2013), J Neurosci, 33, 3202 - 3211
An agent independent axis for executed and modeled choice in medial prefrontal cortex.
Nicolle A. et al, (2012), Neuron, 75, 1114 - 1121


text:
When the U.S. President orders the dismantling of the deadliest nuclear weapon ever devised, a sinister terrorist group, led by a super-human Android, plan to steal it.
Frank Zagarino, Bryan Genesse, Beth Toussaint, Danny Hill, Todd Jensen, Danny Keogh
John Eyres
Action, Sci Fi
6423 Wilshire Blvd.
Los Angeles, California 90048
+1 310 388-6900 p
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If you are searching a ISP company who can provide you best Internet Connection with proper Technical Support and can meet your requirement then OneNet is the right solution for you.You will get more from your expectation.
In addition to broadband internet services, we help our clients build, connect, operate and maintain their own SOHO or office network.
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Nowadays, any establishment where people are expected to come and spend a reasonable amount time, requires a WiFi hotspot.
With or without other security arrangements, today, a video surveillance system is seen as a requirement in every business establishment.
Our customers are our top priority. No matter where in the world you are, or what you need, our service representatives are ready to help.
With our Office Network Solutions/Services we can help you design, build and maintain your IT network architecture.


text:
I was wandering the internet looking for hard-hitting gossip and porn news last night (well, all right - I was looking for gay porn, but don't tell anyone!) when I came across some interesting claims.
You are probably already aware of Nextdoor Studios. Yes, those fine folks who bring us sites featuring gay and bisexual jocks like Nextdoor Buddies, Cody Cummings, Nextdoor Male and Austin Wilde, to name a few. I was reading and watching and I ran across their "About Us" page, and I realized I had never been there, so I clicked and started reading.
Their first few claims were about what you'd expect - in business since 2002, number of websites (12), number of DVD's produced. Then we got to the next one - number of scenes produced per year, which is 250. Think of it. 250 scenes all ending in cumloads. And most of them have 2 guys or even 3, so let's average that at 500 loads of jizz. That means that Nextdoor Studios is responsible for almost 10 moneyshots per WEEK. But wait - there's more!
They said they've filmed 1,000 scenes total, and 3,500 inches of cock. But wait a minute... that averages out to only 3 and a half inches per guy. That can't be right! I've seen Tommy D's cock, and it's a lot longer than 3 1/2 inches. Luckily they mention that they've filmed 500 guys, which means 7 inches per jock - that's better! But my favorite claim was that they've used over 4,000 condoms. Four THOUSAND condoms. Think of all those rubber-covered cocks pushing their way into thousands of holes!
Staggering, isn't it?


text:
Owning a Cricut Personal Electronic Cutter manufactured by Provo Craft gives you the ability to cut almost any letter or shape from paper, fabric and more. The machine requires that you use branded cartridges, however, and building a substantial collection of cartridges can be expensive. One cost-saving measure is to share cartridges with your crafty friends. You can always lend cartridges to one another, but here is another way to share your cartridges if you're all in one place. If you have a Cricut Gypsy, you can link all of your cartridges with the device, bring it with you to craft events and share your whole Cricut library with your friends.
Things You'll Need
- Cricut Gypsy
Purchase a Cricut Gypsy. The Gypsy, which retails for around $200 as of 2011, is a portable device that allows you to design with any Cricut cartridge and cut on any machine without having the actual cartridge with you. The Gypsy comes with the capability to design with all available Cricut cartridges, but will only cut images from cartridges that are linked to the device.
Link your cartridges to the Gypsy. Attach the Cricut Link Cable to the machine and place a cartridge in the dock. Click on the Menu or Cricut App button on the touch screen and then click on "Link Cartridge" to add your cartridge information to the device.
Bring the Gypsy with you when you attend a scrapbooking event or go to a friend's home to craft. You'll need the device as well as the USB cord to connect it to a Cricut machine.
Design the image you want to cut on the Gypsy screen. Attach the device to the Cricut machine and press "Cut" to cut your images.
Tips & Warnings
- Cricut cartridges can only be added to one Gypsy at a time. If you add a cartridge to your device, you cannot add it to a friend's.
Related Searches
You May Also Like
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The Cricut die cutting machine is commonly used for scrapbooking. This machine uses specialized dies to cut letters, shapes, and figures out...
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text:
- This event has passed.
Earth Day Clean-up
April 22 @ 10:00 am
Event Navigation
Help us in our attempt to keep Oakwoods clean and beautiful by tidying up the park. A free lunch for participants will be served afterward. Please preregister, (734) 782-3956.
Time: 10 a.m.
Cost: Free
Location: Oakwoods Nature Center – Map Me
- Phone: (734) 782-3956
- E-Mail: firstname.lastname@example.com


text:
Unfortunately Northcity4 will no longer be offering any jewellery making courses. After four and a half years of operating as a studio and school, the Northcity4 board has made the difficult decision to wind up our education program with the final classes finishing at the end of 2016 and the last workshop running over the Easter weekend 2017.
The success of the school has been a great source of inspiration and pride to us, however, 2017 sees us turning our attention towards our immediate contemporary jewellery community and creating time for our own professional practices.
Please contact us if you would like information on where else you can study jewellery making in Melbourne.


text:
Remember Me
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National Sales Manager @ Merck
Premium Subscribers & members of my network may view my contact information.
Employment at Merck:
From Mar 2008 to Present
Employment at Abbott Laboratories:
From Jan 2006 to Jun 2007
Commercial Manager North-West Africa, Malta:Responsible to reorganize Abbott's presence and re-launch the company's products in this emerging market: 29 countries. Previous structure relying on promotional agents and local distributors. Responsible to coordinate the activities of 8 Product Managers and 44 Sales Reps based in 6 core countries. Headquarter in Madrid. Responsible in West Africa to enforce the Abbott Laboratories HIV aid program. Achievements:10 Launches in different countries45% Sales Growth 2006 Vs 2005.Developed Strategic Plan for the creation of local affiliates (North Africa).Succesfully monitored exports of Kaletra ®, Abbott's HIV product donated to affected Developing countries in French Speaking West Africa.
From Dec 2002 to Jan 2006
2002-2006. Business Unit Manager Immunology, Spain: Creation of the Immunology Business UnitResponsible for Marketing and Sales Teams.Humira Pre-Marketing & Launch. Abbott Labs most important product and launch. Achievements:Sales March-November 2004: 15.6 MM €. 2005: 36,1 MM €.2004: Humira is awarded the EDIMSA "Product of the Year 2004".2004: Best Hospital product launch. AIMFA Awards.Sales 2006: 56 MM €. Humira Anti TNF market leader in rheumatology.2006: Spain elected best affiliate. "Humira Cup".
From Jan 2001 to Dec 2002
• 2001-2002: Marketing Manager Immunology, Spain: Developed the Strategic 5 year plan of the Humira launch.
Peer Assessment:?
Social Influence:?
national sales manager
none add specialties
yacine belkaid
© 2006-16 Viable Ventures, LLC. All rights reserved.


text:
Top 3 trends Americans wish would just die - [READ]
According to Vanity Fair and 60 Minutes, the majority of Americans want the following to take a long jump off a short pier:
64% low-rise jeans (WHO STILL WEARS THESE?!?!?!)
8% fake glasses (as someone who actually needs glasses to see, I agree)
5% Uggs (NEVER! I need them to take out my dogs ands such!)
**the hotdog parts of this poll were harem pants & clogs, etc**
Want to add anything?
And in honor of low-rise jeans peacing out, let's watch the QUEEN of low-rise jeans! Those abs.)


text:
Best Free Car Demon Theme
I recently started working with the Car Demon plugin.
I think the plugin in Absolutely Fantastic.
One of the best plugins I have ever seen.
However, I am having some second thoughts regarding the theme compatibility.
Essentially my question is;
What is the Best Free Theme to use with the Car Demon Plugin?
What theme is the most compatible with the Car Demon plugin?
I understand that Car Demon has Custom themes they make specifically for their plugin but they cost $80 USD – $100 USD and I just don't have the money. ( https://www.cardemons.com/product-category/themes/ )
I would appreciate ANY feedback what so ever regard this topic! =]
Thanks in advance,
– Tim
- The topic 'Best Free Car Demon Theme' is closed to new replies.


text:
Decision makers
Support the Northern Rockies Ecosystem Protection Act!
The U.S. House of Representatives Natural Resources Committee's Subcommittee on National Parks, Forests and Public Lands is now considering the Northern Rockies Ecosystem Protection Act (NREPA), a bipartisan-supported proposal to protect some of the most biologically-important remaining lands in the country.
As your constituent, I ask you to support the Northern Rockies Ecosystem Protection Act (NREPA). NREPA protects some of America's most beautiful and ecologically important lands while saving taxpayer money and creating jobs. To preserve the biological integrity of the Northern Rockies ecosystem, NREPA designates as wilderness nearly 7 million acres in Montana, 9.5 million acres in Idaho, 5 million acres in Wyoming, 750,000 acres in eastern Oregon, and 500,000 acres in eastern Washington. Included in this total are over 3 million acres of backcountry wilderness in Yellowstone, Glacier and Grand Teton National Parks.
Northern Rockies wildlands provide key habitat for many species, provide clean air and water, and offer myriad recreational opportunities. By officially designating these remaining roadless areas as wilderness, NREPA provides the strongest protection that the federal government can confer on public wildlands and dependent species.
Please consider supporting this landmark legislation to ensure that future generations will also be able to experience these pristine lands as we know them today.
Thank you,
[Your name]
Center for Native Ecosystems started this petition with a single signature, and now has 139 supporters. Start a petition today to change something you care about.
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