text:
|Publication number
|Publication type
|Application number
|Publication date
|Apr 9, 2002
|Filing date
|Jul 31, 2000
|Priority date
|Nov 18, 1998
|Fee status
|Also published as
|Publication number
|Clifton A. Alferness, James Edward Shapland
|Original Assignee
|Acorn Cardiovascular, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (47), Non-Patent Citations (8), Referenced by (75), Classifications (11), Legal Events (7)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation of application Ser. No. 09/195,770, filed Nov. 18, 1998, now U.S. Pat. No. 6,169,922, which application(s) are incorporated herein by reference.
1. Field of the Invention
The present invention pertains to a method for treating heart disease. More particularly, the present invention is directed to a method for treating congestive heart disease and related valvular dysfunction and to provide defibrillating treatments.
2. Description of the Prior Art
Congestive heart disease is a progressive and debilitating illness. The disease is characterized by a progressive enlargement of the heart.
As the heart enlarges, the heart is performing an increasing amount of work in order to pump blood each heart beat. In time, the heart becomes so enlarged the heart cannot adequately supply blood. An afflicted patient is fatigued, unable to perform even simple exerting tasks and experiences pain and discomfort. Further, as the heart enlarges, the internal heart valves cannot adequately close. This impairs the function of the valves and further reduces the heart's ability to supply blood.
Causes of congestive heart disease are not fully known. In certain instances, congestive heart disease may result from viral infections. In such cases, the heart may enlarge to such an extent that the adverse consequences of heart enlargement continue after the viral infection has passed and the disease continues its progressively debilitating course.
Patients suffering from congestive heart disease are commonly grouped into four classes (i.e., Classes I, II, III and IV). In the early stages (e.g., Classes I and II), drug therapy is the commonly prescribed treatment. Drug therapy treats the symptoms of the disease and may slow the progression of the disease. Importantly, there is no cure for congestive heart disease. Even with drug therapy, the disease will progress. Further, the drugs may have adverse side effects.
Presently, the only permanent treatment for congestive heart disease is heart transplant. To qualify, a patient must be in the later stage of the disease (e.g., Classes III and IV with Class IV patients given priority for transplant). Such patients are extremely sick individuals. Class III patients have marked physical activity limitations and Class IV patients are symptomatic even at rest.
Due to the absence of effective intermediate treatment between drug therapy and heart transplant, Class III and IV patients will have suffered terribly before qualifying for heart transplant. Further, after such suffering, the available treatment is unsatisfactory. Heart transplant procedures are very risky, extremely invasive and expensive and only shortly extend a patient's life. For example, prior to transplant, a Class IV patient may have a life expectancy of 6 months to one-year. Heart transplant may improve the expectancy to about five years.
Unfortunately, not enough hearts are available for transplant to meet the needs of congestive heart disease patients. In the United States, in excess of 35,000 transplant candidates compete for only about 2,000 transplants per year. A transplant waiting list is about 8-12 months long on average and frequently a patient may have to wait about 1-2 years for a donor heart. While the availability of donor hearts has historically increased, the rate of increase is slowing dramatically. Even if the risks and expense of heart transplant could be tolerated, this treatment option is becoming increasingly unavailable. Further, many patients do not qualify for heart transplant for failure to meet any one of a number of qualifying criteria.
Congestive heart failure has an enormous societal impact. In the United States alone, about five million people suffer from the disease (Classes I through IV combined). Alarmingly, congestive heart failure is one of the most rapidly accelerating diseases (about 400,000 new patients in the United States each year). Economic costs of the disease have been estimated at $38 billion annually.
Not surprising, substantial effort has been made to find alternative treatments for congestive heart disease. Recently, a new surgical procedure has been developed. Referred to as the Batista procedure, the surgical technique includes dissecting and removing portions of the heart in order to reduce heart volume. This is a radical new and experimental procedure subject to substantial controversy. Furthermore, the procedure is highly invasive, risky and expensive and commonly includes other expensive procedures (such as a concurrent heart valve replacement). Also, the treatment is limited to Class IV patients and, accordingly, provides no hope to patients facing ineffective drug treatment prior to Class IV. Finally, if the procedure fails, emergency heart transplant is the only available option.
Clearly, there is a need for alternative treatments applicable to both early and later stages of the disease to either stop the progressive nature of the disease or more drastically slow the progressive nature of congestive heart disease. Unfortunately, currently developed options are experimental, costly and problematic.
Cardiomyoplasty is a recently developed treatment for earlier stage congestive heart disease (e.g., as early as Class III dilated cardiomyopathy). In this procedure, the latissimus dorsi muscle (taken from the patient's shoulder) is wrapped around the heart and chronically paced synchronously with ventricular systole. Pacing of the muscle results in muscle contraction to assist the contraction of the heart during systole.
Even though cardiomyoplasty has demonstrated symptomatic improvement, studies suggest the procedure only minimally improves cardiac performance. The procedure is highly invasive requiring harvesting a patient's muscle and an open chest approach (i.e., sternotomy) to access the heart. Furthermore, the procedure is expensive—especially those using a paced muscle. Such procedures require costly pacemakers. The cardiomyoplasty procedure is complicated. For example, it is difficult to adequately wrap the muscle around the heart with a satisfactory fit. Also, if adequate blood flow is not maintained to the wrapped muscle, the muscle may necrose. The muscle may stretch after wrapping reducing its constraining benefits and is generally not susceptible to post-operative adjustment. Finally, the muscle may fibrose and adhere to the heart causing undesirable constraint on the contraction of the heart during systole.
While cardiomyoplasty has resulted in symptomatic improvement, the nature of the improvement is not understood. For example, one study has suggested the benefits of cardiomyoplasty are derived less from active systolic assist than from remodeling, perhaps because of an external elastic constraint. The study suggests an elastic constraint (i.e., a non-stimulated muscle wrap or an artificial elastic sock placed around the heart) could provide similar benefits. Kass et al., Reverse Remodeling From Cardiomyoplasty In Human Heart Failure: External Constraint Versus Active Assist, 91 Circulation 2314-2318 (1995). Similarly, cardiac binding is described in Oh et al., The Effects of Prosthetic Cardiac Binding and Adynamic Cardiomyoplasty in a Model of Dilated Cardiomyopathy, 116 J. Thorac. Cardiovasc. Surg. 148-153 (1998), Vaynblat et al., Cardiac Binding in Experimental Heart Failure, 64 Ann. Thorac. Surg. 81-85 (1997) and Capouya et al., Girdling Effect of Nonstimulated Cardiomyoplasty on Left Ventricular Function, 56 Ann. Thorac. Surg. 867-871 (1993).
In addition to cardiomyoplasty, mechanical assist devices have been developed as intermediate procedures for treating congestive heart disease. Such devices include left ventricular assist devices ("LVAD") and total artificial hearts ("TAH"). An LVAD includes a mechanical pump for urging blood flow from the left ventricle into the aorta Such surgeries are expensive. The devices are at risk of mechanical failure and frequently require external power supplies. TAH devices are used as temporary measures while a patient awaits a donor heart for transplant.
Commonly assigned U.S. Pat. No. 5,702,343 to Alferness dated Dec. 30, 1997 teaches a jacket to constrain cardiac expansion during diastole. Also, PCT International Publication No. WO 98/29401 published Jul. 9, 1998 teaches a cardiac constraint in the form of surfaces on opposite sides of the heart with the surfaces joined together by a cable through the heart or by an external constraint. U.S. Pat. No. 5,800,528 dated Sep. 1, 1998 teaches a passive girdle to surround a heart.
Patients suffering from congestive heart failure are frequently vulnerable to additional cardiac risks. For example, cardiac arrhythmias can arise. Defibrillation is a method to terminate fibrillation. As disclosed in commonly assigned and copending U.S. patent application Ser. No. 09/114,757 filed Jul. 13, 1998, a cardiac constraint device is preferably electrically permeable to permit application of an externally sourced defibrillating waveform. The prior art includes implantable defibrillators. An example of such an implantatable defibrillation is shown in European Patent Application No. 88301663.6 published Aug. 31, 1988 as Publication No. 0 280 564 A2. One object of the present invention to provide a cardiac constraint device which can also perform defibrillating functions.
According to a preferred embodiment of the present invention, a device is disclosed for treating cardiac disease of a heart. The device includes a jacket of flexible material defining a volume between an open upper end and a lower end of the jacket. The jacket is dimensioned for an apex of the heart to be inserted into the volume through the open upper end and for the jacket to be slipped over the heart. The jacket has a longitudinal dimension between the upper and lower ends sufficient for the jacket to constrain the lower portion of the heart between a valvular annulus and ventricular lower extremities. The jacket is adapted to be secured to the heart with the jacket having portions disposed on opposite sides of the heart between the valvular annulus and the ventricular lower extremities. The jacket is adjustable to snugly conform to an external geometry of the heart and to constrain circumferential expansion of the heart during diastole and permit substantially unimpeded contraction of the heart during systole. In one embodiment, a first and a second grid electrode is carried on the jacket. The grids are disposed to be in overlying relation to opposite sides of the heart when the jacket is secured to the heart. The first and second grids are connectable to a source of a defibrillating waveform.
FIG. 1 is a schematic cross-sectional view of a normal, healthy human heart shown during systole;
FIG. 1A is the view of FIG. 1 showing the heart during diastole;
FIG. 1B is a view of a left ventricle of a healthy heart as viewed from a septum and showing a mitral valve;
FIG. 2 is a schematic cross-sectional view of a diseased human heart shown during systole;
FIG. 2A is the view of FIG. 2 showing the heart during diastole;
FIG. 2B is the view of FIG. 1B showing a diseased heart;
FIG. 3 is a perspective view of a cardiac constraint device to be used according to the method of the present invention;
FIG. 3A is a side elevation view of a diseased heart in diastole with the device of FIG. 3 in place;
FIG. 4 is a perspective view of an alternative cardiac constraint device to be used according to the method of the present invention;
FIG. 4A is a side elevation view of a diseased heart in diastole with the device of FIG. 4 in place;
FIG. 5 is a cross-sectional view of the device of FIG. 3 overlying a myocardium and with the material of the device gathered for a snug fit;
FIG. 6 is an enlarged view of a knit construction of the device of the present invention in a rest state;
FIG. 7 is a schematic view of the material of FIG. 6;
FIG. 8 is a view of the device of FIG. 3 secured to a heart and modified according to the teachings of the present invention; and
FIG. 9 is a view of the open cell material of the jacket of FIG. 8 and showing interwoven defibrillating conductors of an electrode grid.
To facilitate a better understanding of the present invention, description will first be made of a cardiac constraint device such as is more fully described in commonly assigned and copending U.S. patent application Ser. No. 09/114,757 filed Jul. 13, 1998. In the drawings, similar elements are labeled similarly throughout.
With initial reference to FIGS. 1 and 1A, a normal, healthy human heart H′ is schematically shown in cross-section and will now be described in order to facilitate an understanding of the present invention. In FIG. 1, the heart H′ is shown during systole (i.e., high left ventricular pressure). In FIG. 1A, the heart H′ is shown during diastole (i.e., low left ventricular pressure).
The heart H′ is a muscle having an outer wall or myocardium MYO′ and an internal wall or septum S′. The myocardium MYO′ and septum S′ define four internal heart chambers including a right atrium RA′, a left atrium LA′, a right ventricle RV′ and a left ventricle LV′. The heart H′ has a length measured along a longitudinal axis BB′-AA′ from an upper end or base B′ to a lower end or apex A′.
The right and left atria RA′, LA′ reside in an upper portion UP′ of the heart H′ adjacent the base B′. The right and left ventricles RV′, LV′ reside in a lower portion LP′ of the heart H′ adjacent the apex A′. The ventricles RV′, LV′ terminate at ventricular lower extremities LE′ adjacent the apex A′ and spaced therefrom by the thickness of the myocardium MYO′.
Due to the compound curves of the upper and lower portions UP′, LP′, the upper and lower portions UP′, LP′ meet at a circumferential groove commonly referred to as the A-V groove AVG′. Extending away from the upper portion UP′ are a plurality of major blood vessels communicating with the chambers RA′, RV′, LA′, LV′. For ease of illustration, only the superior vena cava SVC′, inferior vena cava IVC′ and a left pulmonary vein LPV′ are shown as being representative.
The heart H′ contains valves to regulate blood flow between the chambers RA′, RV′, LA′, LV′ and between the chambers and the major vessels (e.g., the superior vena cava SVC′, inferior vena cava IVC′ and a left pulmonary vein LPV′). For ease of illustration, not all of such valves are shown. Instead, only the tricuspid valve TV′ between the right atrium RA′ and right ventricle RV′ and the mitral valve MV′ between the left atrium LA′ and left ventricle LV′ are shown as being representative.
The valves are secured, in part, to the myocardium MYO′ in a region of the lower portion LP′ adjacent the A-V groove AVG′ and referred to as the valvular annulus VA′. The valves TV′ and MV′ open and close through the beating cycle of the heart H.
FIGS. 1 and 1A show a normal, healthy heart H′ during systole and diastole, respectively. During systole (FIG. 1), the myocardium MYO′ is contracting and the heart assumes a shape including a generally conical lower portion LP′. During diastole (FIG. 1A), the heart H′ is expanding and the conical shape of the lower portion LP′ bulges radially outwardly (relative to axis AA′-BB′).
The motion of the heart H′ and the variation in the shape of the heart H′ during contraction and expansion is complex. The amount of motion varies considerably throughout the heart H′. The motion includes a component which is parallel to the axis AA′-BB′ (conveniently referred to as longitudinal expansion or contraction). The motion also includes a component perpendicular to the axis AA′-BB′ (conveniently referred to as circumferential expansion or contraction).
Having described a healthy heart H′ during systole (FIG. 1) and diastole (FIG. 1A), comparison can now be made with a heart deformed by congestive heart disease. Such a heart H is shown in systole in FIG. 2 and in diastole in FIG. 2A. All elements of diseased heart H are labeled identically with similar elements of healthy heart H′ except only for the omission of the apostrophe in order to distinguish diseased heart H from healthy heart H′.
Comparing FIGS. 1 and 2 (showing hearts H′ and H during systole), the lower portion LP of the diseased heart H has lost the tapered conical shape of the lower portion LP′ of the healthy heart H′. Instead, the lower portion LP of the diseased heart H bulges outwardly between the apex A and the A-V groove AVG. So deformed, the diseased heart H during systole (FIG. 2) resembles the healthy heart H′ during diastole (FIG. 1A). During diastole (FIG. 2A), the deformation is even more extreme.
As a diseased heart H enlarges from the representation of FIGS. 1 and 1A to that of FIGS. 2 and 2A, the heart H becomes a progressively inefficient pump. Therefore, the heart H requires more energy to pump the same amount of blood. Continued progression of the disease results in the heart H being unable to supply adequate blood to the patient's body and the patient becomes symptomatic of cardiac insufficiency.
For ease of illustration, the progression of congestive heart disease has been illustrated and described with reference to a progressive enlargement of the lower portion LP of the heart H. While such enlargement of the lower portion LP is most common and troublesome, enlargement of the upper portion UP may also occur.
In addition to cardiac insufficiency, the enlargement of the heart H can lead to valvular disorders. As the circumference of the valvular annulus VA increases, the leaflets of the valves TV and MV may spread apart. After a certain amount of enlargement, the spreading may be so severe the leaflets cannot completely close. Incomplete closure results in valvular regurgitation contributing to an additional degradation in cardiac performance. While circumferential enlargement of the valvular annulus VA may contribute to valvular dysfunction as described, the separation of the valve leaflets is most commonly attributed to deformation of the geometry of the heart H.
Having described the characteristics and problems of congestive heart disease, a treatment method and apparatus are described in commonly assigned and copending U.S. patent application Ser. No. 09/114,757 filed Jul. 13, 1998 now U.S. Pat. No. 6,085,754. In general, a jacket is configured to surround the myocardium MYO. While the method of the present invention will be described with reference to a jacket as described in commonly assigned and copending U.S. patent application Ser. No. 09/114,757 filed Jul. 13, 1998, now U.S. Pat. No. 6,085,754 it will be appreciated the present invention is applicable to any cardiac constraint device including those shown in U.S. Pat. No. 5,800,528 and PCT International Publication No. WO 98/29401.
With reference now to FIGS. 3, 3A, 4 and 4A, the cardiac constraint device is shown as a jacket 10, 10′ of flexible, biologically compatible material. The jacket 10 is an enclosed knit material having upper and lower ends 12, 12′, 14, 14′. The jacket 10, 10′ defines an internal volume 16, 16′ which is completely enclosed but for the open ends 12, 12′ and 14′. In the embodiment of FIG. 3, lower end 14 is closed. In the embodiment of FIG. 4, lower end 14′ is open. In both embodiments, upper ends 12, 12′ are open. Throughout this description, the embodiment of FIG. 3 will be discussed. Elements in common between the embodiments of FIGS. 3 and 4 are numbered identically with the addition of an apostrophe to distinguish the second embodiment and such elements need not be separately discussed.
The jacket 10 is dimensioned with respect to a heart H to be treated. Specifically, the jacket 10 is sized for the heart H to be constrained within the volume 16. The jacket 10 can be slipped around the heart H. The jacket 10 has a length L between the upper and lower ends 12, 14 sufficient for the jacket 10 to constrain the lower portion LP. The upper end 12 of the jacket 10 extends at least to the valvular annulus VA and further extends to the lower portion LP to constrain at least the lower ventricular extremities LE.
When the parietal pericardium is opened, the lower portion LP is free of obstructions for applying the jacket 10 over the apex A. If, however, the parietal pericardium is intact, the diaphragmatic attachment to the parietal pericardium inhibits application of the jacket over the apex A of the heart. In this situation, the jacket can be opened along a line extending from the upper end 12′ to the lower end 14′ of jacket 10′. The jacket can then be applied around the pericardial surface of the heart and the opposing edges of the opened line secured together after placed on the heart. Systems for securing the opposing edges are disclosed in, for example, U.S. Pat. No. 5,702,343, the entire disclosure of which is incorporated herein by reference. The lower end 14′ can then be secured to the diaphragm or associated tissues using, for example, sutures, staples, etc.
In the embodiment of FIGS. 3 and 3A, the lower end 14 is closed and the length L is sized for the apex A of the heart H to be received within the lower end 14 when the upper end 12 is placed at the A-V groove AVG. In the embodiment of FIGS. 4 and 4A, the lower end 14′ is open and the length L′ is sized for the apex A of the heart H to protrude beyond the lower end 14′ when the upper end 12′ is placed at the A-V groove AVG. The length L′ is sized so that the lower end 14′ extends beyond the lower ventricular extremities LE such that in both of jackets 10, 10′, the myocardium MYO surrounding the ventricles RV, LV is in direct opposition to material of the jacket 10, 10′. Such placement is desirable for the jacket 10, 10′ to present a constraint against enlargement of the ventricular walls of the heart H.
After the jacket 10 is positioned on the heart H as described above, the jacket 10 is secured to the heart. Preferably, the jacket 10 is secured to the heart H through sutures. The jacket 10 is sutured to the heart H at suture locations S circumferentially spaced along the upper end 12. While a surgeon may elect to add additional suture locations to prevent shifting of the jacket 10 after placement, the number of such locations S is preferably limited so that the jacket 10 does not restrict contraction of the heart H during systole.
To permit the jacket 10 to be easily placed on the heart H, the volume and shape of the jacket 10 are larger than the lower portion LP during diastole. So sized, the jacket 10 may be easily slipped around the heart H. Once placed, the jacket's volume and shape are adjusted for the jacket 10 to snugly conform to the external geometry of the heart H during diastole. Such sizing is easily accomplished due to the knit construction of the jacket 10. For example, excess material of the jacket 10 can be gathered and sutured S″ (FIG. 5) to reduce the volume of the jacket 10 and conform the jacket 10 to the shape of the heart H during diastole. Such shape represents a maximum adjusted volume. The jacket 10 constrains enlargement of the heart H beyond the maximum adjusted volume while preventing restricted contraction of the heart H during systole. As an alternative to gathering of FIG. 5, the jacket 10 can be provided with other arrangements for adjusting volume. For example, as disclosed in U.S. Pat. No. 5,702,343, the jacket can be provided with a slot. The edges of the slot can be drawn together to reduce the volume of the jacket.
The jacket 10 is adjusted to a snug fit on the heart H during diastole. Care is taken to avoid tightening the jacket 10 too much such that cardiac function is impaired. During diastole, the left ventricle LV fills with blood. If the jacket 10 is too tight, the left ventricle LV cannot adequately expand and left ventricular pressure will rise. During the fitting of the jacket 10, the surgeon can monitor left ventricular pressure. For example, a well-known technique for monitoring so-called pulmonary wedge pressure uses a catheter placed in the pulmonary artery. The wedge pressure provides an indication of filling pressure in the left atrium LA and left ventricle LV. While minor increases in pressure (e.g., 2-3 mm Hg) can be tolerated, the jacket 10 is snugly fit on the heart H but not so tight as to cause a significant increase in left ventricular pressure during diastole.
As mentioned, the jacket 10 is constructed from a knit, biocompatible material. One embodiment of the knit 18 is illustrated in FIG. 6. Preferably, the knit is a so-called "Atlas knit" well known in the fabric industry. The Atlas knit is described in Paling, Warp Knitting Technology, p. 111, Columbine Press (Publishers) Ltd., Buxton, Great Britain (1970).
The Atlas knit is a knit of fibers 20 having directional expansion properties. More specifically, the knit 18, although formed of generally inelastic fibers 20, permits a construction of a flexible fabric at least slightly expandable beyond a rest state. FIG. 6 illustrates the knit 18 in a rest state. The fibers 20 of the fabric 18 are woven into two sets of fiber strands 21 a, 21 b having longitudinal axes Xa and Xb. The strands 21 a, 21 b are interwoven to form the fabric 18 with strands 21 a generally parallel and spaced-apart and with strands 21 b generally parallel and spaced-apart.
For ease of illustration, fabric 18 is schematically shown in FIG. 7 with the axis of the strands 21 a, 21 b only being shown. The strands 21 a, 21 b are interwoven with the axes Xa and Xb defining a diamond-shaped open cell 23 having diagonal axes Am. In a preferred embodiment, the axes Am are 5 mm in length when the fabric 18 is at rest and not stretched. The fabric 18 can stretch in response to a force. For any given force, the fabric 18 stretches most when the force is applied parallel to the diagonal axes Am. The fabric 18 stretches least when the force is applied parallel to the strand axes Xa and Xb. The jacket 10 is constructed for the material of the knit to be directionally aligned for a diagonal axis Am to be parallel to the heart's longitudinal axis AA-BB
While the jacket 10 is expandable due to the above-described knit pattern, the fibers 20 of the knit 18 are preferably non-expandable. While all materials expand to at least a small amount, the fibers 20 are preferably formed of a material with a low modulus of elasticity. In response to the low pressures in the heart H during diastole, the fibers 20 are non-elastic. In a preferred embodiment, the fibers are 70 Denier polyester. While polyester is presently preferred, other suitable materials include polytetrafluoroethylene (PTFE), expanded PTFE (ePTFE) or polypropylene.
The knit material has numerous advantages. Such a material is flexible to permit unrestricted movement of the heart H (other than the desired constraint on circumferential expansion). The material is open defining a plurality of interstitial spaces for fluid permeability as well as minimizing the amount of surface area of direct contact between the heart H and the material of the jacket 10 (thereby minimizing areas of irritation or abrasion) to minimize fibrosis and scar tissue.
The open areas of the knit construction also allows for electrical conductivity between the heart and surrounding tissue for passage of electrical current to and from the heart. For example, although the knit material is an electrical insulator, the open knit construction is sufficiently electrically permeable to permit the use of trans-chest defibrillation of the heart. Also, the open, flexible construction permits passage of electrical elements (e.g., pacer leads) through the jacket. Additionally, the open construction permits other procedures, e.g., coronary bypass, to be performed without removal of the jacket.
A large open area for cells 23 is desirable to minimize the amount of surface area of the heart H in contact with the material of the jacket 10 (thereby reducing fibrosis). However, if the cell area 23 is too large, localized aneurysm can form. Also, a strand 21 a, 21 b can overly a coronary vessel with sufficient force to partially block the vessel. A smaller cell size increases the number of strands thereby decreasing the restricting force per strand. Preferably, a maximum cell area is no greater than about 6.45 cm2 (about 2.54 cm by 2.54 cm) and, more preferably, is about 0.25 cm2 (about 0.5 cm by 0.5 cm). The maximum cell area is the area of a cell 23 after the material of the jacket 10 is fully stretched and adjusted to the maximum adjusted volume on the heart H as previously described.
The fabric 18 is preferably tear and run resistant. In the event of a material defect or inadvertent tear, such a defect or tear is restricted from propagation by reason of the knit construction.
The jacket 10 constrains further undesirable circumferential enlargement of the heart while not impeding other motion of the heart H. With the benefits of the present teachings, numerous modifications are possible. For example, the jacket 10 need not be directly applied to the epicardium (i.e., outer surface of the myocardium) but could be placed over the parietal pericardium. Further, an anti-fibrosis lining (such as a PTFE coating on the fibers of the knit) could be placed between the heart H and the jacket 10. Alternatively, the fibers 20 can be coated with PTFE.
The jacket 10 can be used in early stages of congestive heart disease. For patients facing heart enlargement due to viral infection, the jacket 10 permits constraint of the heart H for a sufficient time to permit the viral infection to pass. In addition to preventing further heart enlargement, the jacket 10 treats valvular disorders by constraining circumferential enlargement of the valvular annulus and deformation of the ventricular walls.
FIG. 8 illustrates the device of FIG. 3 modified according to the present invention. In FIG. 8, an open cell jacket 10 of knit construction as previously described is placed on a heart H. The jacket 10 carries first and second electrode grids 100, 100 a of electrode conductors 101, 101 a. The conductors 101, 101 a are bundled in insulated carriers 104, 104 a. The carriers 104, 104 a convey the conductors 101, 101 a to an implantable source 106 of a defibrillating waveform.
FIG. 9 illustrates how the first grid 100 is incorporated into the material 18 of the jacket 10. Since second grid 100 a is similarly incorporated, it is not separately shown and described in detail.
As previously described, the material 18 is a knit defining crisscrossing fiber strands 21 a, 21 b. The strands 21 a, 21 b define a grid of open cells 23. Uninsulated, electrically conductive electrode conductors 101 are interwoven through the cells 23. Examples of such electrode conductors 101 include titanium wire and platinum-coated stainless steel. Such electrode conductors 101 may be braided, multi-strand wires.
In one undulating pattern, the electrode conductors 101 are woven into alternating ones of the strands 21 a, 21 b. For example, an electrode conductor 101 may be woven into strand 21 b for a distance equal to the length of two cells 23. Then, the electrode conductor 101 is woven into strand 21 a for a distance equal to the length of two cells 23. This creates a zigzag pattern repeated along the length of the electrode conductor 101. For ease of illustration, FIG. 9 shows strands 21 a, 21 b as monofilament strands with conductors 101 positioned alongside the strands 21 a, 21 b. In fact, strands 21 a, 21 b are preferably multifilament as illustrated in FIG. 6 and the conductors 101 are interwoven into the multifilaments to securely position the conductors 101 on the jacket 10 and to maintain spacing between adjacent conductors 101.
The electrode conductors 101 extend in a direction parallel to the longitudinal axis of the heart. Opposing electrode conductors 101 are evenly spaced along their length.
The grids 100, 100 a are positioned on the jacket 10 to overly opposite sides of the heart H after placement of the jacket 10 over the heart. Preferably, the grids 100, 100 a overly the right and left lateral ventricular epicardium, respectively. As a result, a maximum amount of cardiac mass is located within the direct current path of a defibrillating shock.
As the jacket 10 is adjusted during placement, the cell size may very. Due to the jacket construction as described, the cell size around a circumference of the heart remains uniform. Therefore, during adjustment of the jacket, a uniform spacing between electrode conductors 101, 101 a is retained.
With the construction as described, a defibrillating shock can readily be applied to a patient's heart treated with a cardiac constraint device. Further, the jacket 10 retains its electrical permeable quality permitting additional defibrillation applied external to the body. In defibrillators, the electrode conductors also act to receive signals from the heart. Since the electrode conductors are in close proximity to the heart, these electrode conductors permit easy detection of cardiac signals by the implantable defibrillator 106 facilitating analysis of electrical activity of the heart.
From the foregoing detailed description, the invention has been described in a preferred embodiment. Modifications and equivalents of the disclosed concepts are intended to be included within the scope of the appended claims. For example, the fibers 21 a, 21 b of the jacket material 18 may be selectively metalized with such fibers serving as the electrode conductors. Also, while the invention is shown overlying the ventricles, the jacket may overly the atria with grids over the atria to defibrillate the atria.
|Cited Patent
|Filing date
|Publication date
|Dec 20, 1968
|Jun 28, 1971
|Schiff Peter Paul
|Mechanical ventricular assistance assembly
|Jun 2, 1975
|Oct 5, 1976
|American Hospital Supply Corporation
|Heart support for coronary artery surgery
|Sep 17, 1976
|Sep 20, 1977
|Goetz Robert H
|Heart massage apparatus
|May 13, 1982
|Sep 13, 1983
|Wilkinson Lawrence H
|Gastric pouch
|Feb 16, 1982
|Jan 31, 1984
|Ellman Barry R
|Surgical bag for splenorrhaphy
|Apr 30, 1984
|Dec 23, 1986
|Adrian Kantrowitz
|Dynamic aortic patch for thoracic or abdominal implantation
|Jul 1, 1985
|Sep 1, 1987
|Snyders Robert V
|Ventricular assist device
|Feb 27, 1987
|Apr 18, 1989
|Intermedics Inc.
|Biphasic waveforms for defibrillation
|Feb 27, 1987
|May 9, 1989
|Intermedics Inc.
|Implantable defibrillation electrodes
|Oct 13, 1987
|Nov 7, 1989
|Ethicon, Inc.
|Perihepatic prosthesis
|Feb 15, 1988
|Jun 26, 1990
|Kulik Yaroslav P
|Prosthetic pericardium
|May 9, 1989
|Sep 18, 1990
|Astra Tech Ab
|Heart assist jacket and method of using it
|Sep 22, 1989
|Nov 27, 1990
|Pioneering Technologies, Inc.
|Cardiac sling for circumflex coronary artery surgery
|Oct 11, 1988
|Dec 11, 1990
|Kwan Gett Clifford S
|Artificial pericardium
|Apr 27, 1989
|Oct 15, 1991
|The Research Foundation Of State University Of New York
|Method and apparatus for hemostasis and compartmentalization of a bleeding internal bodily organ
|Jun 18, 1990
|Feb 11, 1992
|Boaz Avitall
|Myocardial iontophoresis
|Jul 16, 1990
|Jul 21, 1992
|Grooters Ronald K
|External cardiac assist device
|Aug 15, 1991
|Sep 29, 1992
|Cox James L
|Cooling net for cardiac or transplant surgery
|May 28, 1991
|Feb 16, 1993
|Albert Einstein College Of Medicine Of Yeshiva University
|Hemostasis apparatus and method
|Dec 12, 1991
|Mar 9, 1993
|Daskalakis Michael K
|Synthetic intraventricular implants and method of inserting
|Aug 17, 1992
|Oct 26, 1993
|Snyders Robert V
|Cardiac assist envelope for endoscopic application
|Oct 10, 1991
|Mar 1, 1994
|Earl K. Sipes
|Method and apparatus for hernia repair
|Feb 5, 1993
|Oct 18, 1994
|C. R. Bard, Inc.
|Implantable mesh prosthesis and method for repairing muscle or tissue wall defects
|Jul 28, 1992
|Jan 24, 1995
|Vascor, Inc.
|Biocompatible ventricular assist and arrhythmia control device including cardiac compression band-stay-pad assembly
|Aug 27, 1993
|Jan 31, 1995
|Rose Health Care Systems
|Diagnostic and treatment method for cardiac rupture and apparatus for performing the same
|Nov 9, 1990
|Jul 4, 1995
|Mcgill University
|Cardiac assist method and apparatus
|Apr 12, 1994
|Apr 16, 1996
|Ventritex, Inc.
|Cardiac insulation for defibrillation
|Oct 1, 1993
|Jun 11, 1996
|Advanced Surgical, Inc.
|Self-deploying isolation bag
|Dec 5, 1994
|Feb 18, 1997
|Jarvik; Robert
|Two-stage cardiomyoplasty
|Jun 7, 1995
|Jul 15, 1997
|W. L. Gore & Associates, Inc.
|Method of making a left ventricular assist device
|Oct 2, 1996
|Dec 30, 1997
|Acorn Medical, Inc.
|Cardiac reinforcement device
|Jun 13, 1995
|Feb 3, 1998
|Abiomed R&D, Inc.
|Extra cardiac ventricular assist device
|Jul 9, 1996
|Sep 1, 1998
|Wilk; Peter J.
|Intrapericardial assist device and associated method
|Dec 29, 1995
|Sep 1, 1998
|Abiomed R & D, Inc.
|Passive girdle for heart ventricle for therapeutic aid to patients having ventricular dilatation
|Sep 20, 1996
|Oct 20, 1998
|The Uab Research Foundation
|Line electrode oriented relative to fiber direction
|Jan 14, 1999
|Jun 13, 2000
|Brennan; Edward F.
|Apparatus and methods for treating congestive heart failure
|Jul 29, 1998
|Jun 20, 2000
|Myocor, Inc.
|Stress reduction apparatus and method
|Sep 23, 1997
|Jun 20, 2000
|Acorn Cardiovascular, Inc.
|Cardiac reinforcement device
|Jul 13, 1998
|Jul 11, 2000
|Acorn Cardiovascular, Inc.
|Cardiac disease treatment method
|Nov 3, 1995
|Feb 1, 1996
|Hohmann Claas Dr Med
|Feb 26, 1988
|Aug 31, 1988
|Intermedics, Inc.
|Implantable defribrillation electrodes
|Feb 15, 1988
|Feb 22, 1989
|Blagoveschensky Gosudarstvenny Meditsinsky Institut
|Artificial pericardium
|Title not available
|Title not available
|Title not available
|Dec 31, 1997
|Jul 9, 1998
|Myocor, Inc.
|Heart wall tension reduction apparatus and method
|Jun 16, 1998
|Dec 30, 1998
|Hans Haindl
|Bag for at least partially enveloping a heart
|Capouya, et al., "Girdling Effect of Nonstimulated Cardiomayoplasty on Left Ventricular Function," The Society of Thoracic Surgeons, 56:867-871 (1993).
|Cohn, "The Management of Chronic Heart Failure", The New Eng. J. of Med., 335 (7): 490-498 (Aug. 15, 1996).
|Kass et al., "Reverse Remodeling From Cardiomyoplasty in Human Heart Failure, External Constraint Versus Active Assist", Circulation 91 (9): 2314-2318 (May 1, 1995).
|Levin et al., "Reversal of Chronic Ventricular Dilation in Patients With End-Stage Cardiomyopathy by Prolonged Mechanical Unloading", Circulation 91 (11): 2717-2720 (Jun. 1, 1995).
|Oh et al., "The Effects of Prosthetic Cardiac Binding and Adynamic Cardiomyoplasty in a Model of Dilated Cardiomyopathy," J. Thorac. Cardiovasc. Surg., 116:148-153 (1998).
|Revista Espanola de Cardiologia, vol. 51, No. 7 (Abstract in English)(Jul. 1998).
|Vaynblat, M. et al., "Cardiac Binding in Experimental Heart Failure," Abstract in Supplement to Circulation 92(8):1810 (Oct. 15, 1995).
|Vaynblat, M. et al., "Cardiac Binding in Experimental Heart Failure," Ann. Thorac. Surg., 64:81-85 (1997).
|Citing Patent
|Filing date
|Publication date
|Aug 8, 2000
|Mar 9, 2004
|Paracor Surgical, Inc.
|Expandable cardiac harness for treating congestive heart failure
|Oct 6, 2000
|Apr 20, 2004
|Myocor, Inc.
|Methods and devices for improving mitral valve function
|Jan 9, 2002
|Jul 20, 2004
|Myocor, Inc.
|Devices and methods for heart valve treatment
|Sep 20, 2002
|May 24, 2005
|Acorn Cardiovascular, Inc.
|Cardiac disease treatment and device
|Mar 5, 2004
|Feb 14, 2006
|Acorn Cardiovascular, Inc.
|Cardiac support device with anti-fibrosis lining
|Mar 5, 2004
|Apr 4, 2006
|Acorn Cardiovascular, Inc.
|Cardiac support with controlled ventricular pressure
|Mar 26, 2004
|Apr 11, 2006
|Acorn Cardiovascular, Inc.
|Metallic cardiac support device
|Mar 26, 2004
|Dec 26, 2006
|Acorn Cardiovascular, Inc.
|Cardiac support disease with anti-fibrosis coating
|Jul 15, 2003
|Mar 11, 2008
|Thomas David Starkey
|Device and method to limit filling of the heart
|Mar 8, 2004
|Jun 3, 2008
|Mardil, Inc.
|Method and apparatus for external heart stabilization
|Jun 12, 2006
|Aug 18, 2009
|Acorn Cardiovascular, Inc.
|Cardiac support device with anti-fibrosis coating
|Mar 26, 2004
|Aug 25, 2009
|Acorn Cardiovasculas, Inc.
|Cardiac support device with differential expansion
|May 31, 2005
|Nov 24, 2009
|Ethicon, Inc.
|Method and device for deployment of a sub-pericardial sack
|Mar 17, 2006
|Dec 29, 2009
|Pacesetter, Inc.
|Cardiac constraint/therapeutic stimulation device
|Jan 10, 2006
|Jan 26, 2010
|Acorn Cardiovascular, Inc.
|Cardiac support with metallic structure
|Jul 17, 2006
|Jan 26, 2010
|Acorn Cardiovascular, Inc.
|Cardiac support device delivery tool with release mechanism
|Jul 7, 2005
|Feb 23, 2010
|Edwards Lifesciences Llc
|Devices and methods for heart valve treatment
|Jul 1, 2005
|Mar 16, 2010
|Edwards Lifesciences Llc
|Devices and methods for heart valve treatment
|Feb 17, 2004
|Apr 13, 2010
|Edwards Lifesciences Llc
|Heart wall tension reduction apparatus and method
|Jul 9, 2002
|May 25, 2010
|Edwards Lifesciences Llc
|Transventricular implant tools and devices
|Apr 14, 2006
|Aug 3, 2010
|Edwards Lifesciences Llc
|Methods and devices for improving mitral valve function
|Apr 23, 2002
|Feb 8, 2011
|Edwards Lifesciences Llc
|Heart wall tension reduction apparatus and method
|Jan 30, 2007
|May 10, 2011
|Mardil, Inc.
|Cardiac disease treatment and device
|Oct 13, 2009
|Jun 14, 2011
|Ethicon, Inc.
|Method and device for deployment of a sub-pericardial sack
|Jun 5, 2008
|Jul 19, 2011
|Edwards Lifesciences Llc
|Transventricular implant tools and devices
|Jan 25, 2010
|Dec 6, 2011
|Edwards Lifesciences Llc
|Devices and methods for heart valve treatment
|Sep 5, 2007
|Jan 10, 2012
|Mardil, Inc.
|Heart band with fillable chambers to modify heart valve function
|May 16, 2008
|Jan 10, 2012
|Mardil, Inc.
|Method for external stabilization of the base of the heart
|Dec 11, 2008
|Jan 24, 2012
|Mardil, Inc.
|Low friction delivery tool for a cardiac support device
|Dec 12, 2006
|Mar 6, 2012
|Mardil, Inc.
|Method and apparatus for external stabilization of the heart
|Jul 1, 2005
|Jul 24, 2012
|Edwards Lifesciences, Llc
|Valve to myocardium tension members device and method
|Mar 2, 2010
|Aug 21, 2012
|Mardil, Inc.
|Pericardium management method for intra-pericardial surgical procedures
|Jul 8, 2010
|Sep 18, 2012
|Edwards Lifesciences, Llc
|Heart wall tension reduction apparatus and method
|Sep 11, 2012
|Jun 11, 2013
|Edwards Lifesciences, Llc
|Heart wall tension reduction apparatus and method
|Dec 2, 2011
|Aug 13, 2013
|Edwards Lifesciences, Llc
|Devices and methods for heart valve treatment
|Jun 5, 2008
|Nov 12, 2013
|Edwards Lifesciences, Llc
|External cardiac stress reduction method
|Jun 15, 2012
|Dec 31, 2013
|Mardil, Inc.
|Cardiac support device delivery tool with release mechanism
|Feb 6, 2012
|May 6, 2014
|Mardil, Inc.
|Method and apparatus for external stabilization of the heart
|Apr 15, 2011
|Apr 14, 2015
|Mardil, Inc.
|Cardiac disease treatment and device
|Jul 7, 2009
|Dec 1, 2015
|Edwards Lifesciences, Llc
|Methods and devices for improving mitral valve function
|Mar 17, 2014
|Mar 22, 2016
|Mardil, Inc.
|Method and apparatus for external stabilization of the heart
|Oct 14, 2013
|Jun 21, 2016
|Mardil, Inc.
|Cardiac treatment system and method
|Oct 14, 2013
|Aug 23, 2016
|Mardil, Inc.
|Cardiac treatment system
|Oct 14, 2013
|Aug 23, 2016
|Mardil, Inc.
|Cardiac treatment system and method
|Sep 20, 2002
|Feb 6, 2003
|Acorn Cardiovascular, Inc.
|Cardiac disease treatment and device
|Aug 15, 2002
|Mar 6, 2003
|Schweich Cyril J.
|Heart wall tension reduction devices and methods
|Oct 24, 2002
|Mar 13, 2003
|Myocor, Inc.
|Splint assembly for improving cardiac function in hearts, and method for implanting the splint assembly
|Mar 26, 2004
|Sep 16, 2004
|Acorn Cardiovascular, Inc.
|Cardiac disease treatment and device
|Mar 26, 2004
|Sep 16, 2004
|Acorn Cardiovascular, Inc.
|Cardiac disease treatment and device
|Mar 26, 2004
|Sep 16, 2004
|Acorn Cardiovascular, Inc.
|Cardiac disease treatment and device
|Jun 15, 2004
|Dec 2, 2004
|Myocor, Inc.
|Devices and methods for heart valve treatment
|Mar 8, 2004
|Dec 30, 2004
|Mardil, Inc.
|Method and apparatus for external heart stabilization
|Jul 27, 2004
|Mar 24, 2005
|Myocor, Inc.
|External stress reduction device and method
|Jan 10, 2006
|May 25, 2006
|Acorn Cardiovascular, Inc.
|Cardiac support with metallic structure
|Feb 18, 2005
|Aug 24, 2006
|Acorn Cardiovascular, Inc.
|Transmyocardial delivery of cardiac wall tension relief
|Jun 12, 2006
|Oct 19, 2006
|Acorn Cardiovascular, Inc.
|Cardiac support device with anti-fibrosis coating
|May 31, 2005
|Nov 30, 2006
|Ethicon, Inc.
|Method and device for deployment of a sub-pericardial sack
|Jul 6, 2005
|Dec 21, 2006
|Josy Cohen
|Multi-site pacemaker with slaved eletrodes network
|Aug 31, 2006
|Jan 4, 2007
|Acorn Cardiovascular, Inc.
|Cardiac support device with differential compliance
|Oct 6, 2006
|Mar 8, 2007
|Myocor, Inc.
|Endovascular splinting devices and methods
|Nov 3, 2005
|May 3, 2007
|Lilip Lau
|Apparatus and method of delivering biomaterial to the heart
|Mar 3, 2006
|Sep 6, 2007
|Acorn Cardiovascular, Inc.
|Self-adjusting attachment structure for a cardiac support device
|May 19, 2006
|Nov 22, 2007
|Acorn Cardiovascular, Inc.
|Pericardium management tool for intra-pericardial surgical procedures
|May 19, 2006
|Nov 22, 2007
|Acorn Cardiovascular, Inc.
|Pericardium management method for intra-pericardial surgical procedures
|Jun 29, 2006
|Jan 3, 2008
|Acorn Cardiovascular, Inc.
|Low friction delivery tool for a cardiac support device
|Jul 17, 2006
|Feb 7, 2008
|Acorn Cardiovascular, Inc.
|Cardiac support device delivery tool with release mechanism
|Jan 30, 2007
|Feb 7, 2008
|Acorn Cardiovascular, Inc.
|Cardiac disease treatment and device
|Oct 11, 2006
|Apr 17, 2008
|Cardiac Pacemakers, Inc.
|Method and apparatus for passive left atrial support
|Jun 29, 2006
|Apr 24, 2008
|Acorn Cardiovascular, Inc.
|Cardiac support device with low friction delivery structures
|Sep 5, 2007
|Mar 5, 2009
|Leinsing Karl R
|Heart band with fillable chambers to modify heart valve function
|Dec 11, 2008
|May 21, 2009
|Acorn Cardiovascular, Inc.
|Low friction delivery tool for a cardiac support device
|Oct 13, 2009
|Feb 11, 2010
|Ethicon, Inc.
|Method and device for deployment of a sub-pericardial sack
|Mar 2, 2010
|Jun 17, 2010
|Acorn Cardiovascular, Inc.
|Pericardium management method for intra-pericardial surgical procedures
|Mar 15, 2011
|Jul 7, 2011
|Mardil, Inc.
|Self-adjusting attachment structure for a cardiac support device
|Oct 14, 2013
|Nov 18, 2014
|Mardil, Inc.
|Heart treatment device
|U.S. Classification
|607/5, 600/16, 600/37
|International Classification
|Cooperative Classification
|European Classification
|Feb 11, 2003
|Certificate of correction
|Sep 27, 2005
|Fee payment
Year of fee payment: 4
|Sep 22, 2009
|Fee payment
Year of fee payment: 8
|Jul 6, 2011
Owner name: ACORN CARDIOVASCULAR, INC., MINNESOTA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:ALFERNESS, CLIFTON A.;SHAPLAND, JAMES EDWARD;SIGNING DATES FROM 19990121 TO 19990122;REEL/FRAME:026549/0100
|Jul 7, 2011
Owner name: MARDIL, INC., MINNESOTA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:ACORN CARDIOVASCULAR, INC.;REEL/FRAME:026558/0507
Effective date: 20101210
|Jul 19, 2011
Owner name: MARDIL, INC., MINNESOTA
Effective date: 20101210
Free format text: CORRECTIVE ASSIGNMENT TO CORRECT THE ASSIGNMENT DOCUMENT A COPY OF WHICH WAS INCOMPLETE WHEN SUBMITTED PREVIOUSLY RECORDED ON REEL 026558 FRAME 0507. ASSIGNOR(S) HEREBY CONFIRMS THE COMPLETENESS OF THE ATTACHED ASSIGNMENT DOCUMENT;ASSIGNOR:ACORN CARDIOVASCULAR, INC.;REEL/FRAME:026616/0655
|Sep 26, 2013
|Fee payment
Year of fee payment: 12


text:
STAR WARS: EPISODE VII - Fun Fake Leaked Footage
One of our readers sent in this entertaining fan-made video footage from the "set" of Star Wars: Episode VII. The video was created by Frank Wunderlich, and he is having a little fun with Star Wars fans. He basically turned the Frankfurt (Germany) airport, named FraPort, into StarPort. There are a ton of Imperial ships and vehicles for you to enjoy in a real world setting. Here's the note that came along with the video:
Looks like the Story of Star Wars plays on Earth too in the next Episode. I took these pictures on my Flight back from the States to Germany at the Frankfurt Airport. Seems like the biggest german airport plays a key role as an imperial starport in the new episode -- there have just been imperial forces at the scene. Maybe the Rebelboys hide in Berlin... :-D
Joey Paur — Co-Founder / Editor of GeekTyrant.com, and if you haven't noticed I write… a lot. Movies are my passion and I live and breathe all things geek. This site is part of my life's work, it's a part of me. I love what I do, and I enjoy sharing everything I can with you when it comes to movies and geekery. In my spare time I travel to the netherworlds to battle demons. @JoeyPaur | email@example.com
Featured Posts on GeekTyrant
TV The Karate Kid, Cobra Kai, Ralph Macchio, William Zabka, Will Smith, YouTube Red Joey Paur Comment
TV The Karate Kid, Cobra Kai, Ralph Macchio, William Zabka, Will Smith, YouTube Red Joey Paur Comment

subset: commoncrawl


text:
The Action for Autism (AFA) center has been alive and well in India since 1991. Merry Barua, the director of AFA will speak on autism in Israel at ICare4Autism's International Autism Conference Autism: A Global Perspectiveon August first and second of 2012. Ms. Baura's address will illuminate awareness on how to empower parents in low resourced areas. Her organization in partnership with UCLA is a comprehensive study of the Parent Child Training Program. This project led by cultural psychologist Tamara Daley is in collaboration with research director Nidhi Singhal.
The Parent Child Training Program (PCTP) at Action For Autism is a 'model' program that addresses the critical need for parent education. How to parent an autistic child is not an intuitive process. True parental involvement is the key to successful autism programming and activities.
PCTP's training empowers parents to take charge of their children's health and education. Parental involvement on this level not only helps educate children, but it heals the emotional stresses that parents face. The PCTP training program is a ten-week country wide opportunity.
The coursework covers behavior modification and skills maintenance. Mothers learn tools and tactics for facilitating learning. Most importantly, they gain confidence through community by meeting other parents. This is the goal of ICare4Autism's conference and our institute at large. By sharing information we strengthen our skills.
Ms. Barua's organization quotes that they hope for "a society that views the interdependence of people of every ability as valuable and enriching." AFA seeks to provide equal opportunities for all. Their goals are not only research and expanding autism education in India but also independent life training and skills.
The AFA's reach goes beyond Los Angeles and India to the Europe. AFA created "Activate Yourself!" to put into action the value of all people. Due to the nature Autism, people with this disorder have difficulties in terms of self-advocating their fundamental rights. Therefore "Activate Yourself" was developed to encourage active participation of young people with ASD; empower them as active citizens, make them aware of their role in creating their own future and promote their equal rights and opportunities. The project is supported by the Youth in Action Programme of the European Union.
This kind of active work is right in line with the International Center for Global Research. We learn as much in the classroom as we do from the scientists in our lab. How to educate our autistic youth comes directly from their communication and achievements.


text:
|Joseph Smith's Seer Stones (2016)
While Joseph Smith may have been reluctant to divulge too much about the nature of the translation of the Book of Mormon beyond affirming it was accomplished "by the gift and power of God" (perhaps in part because he considered it sacred, and perhaps in part because even he couldn't fully explain the miracle), there has survived a splendid corpus of historical documentation from the eyewitnesses involved in the coming forth of the Book of Mormon, as well as from those who interviewed and interacted with said eyewitnesses. Letters, interviews, journal entries, personal histories, and other types of documentation detail the coming forth of the Book of Mormon to such a degree as perhaps no other sacred text in the world enjoys. While the historical record is lamentably patchy in some places, historians of early Mormonism nevertheless have access to a deep well of sources to draw from.
Building on recently published work on the coming forth of the Book of Mormon, the Religious Studies Center at Brigham Young University and Deseret Book have co-published a superb new volume titled simply enough Joseph Smith's Seer Stones. Written by Michael Hubbard MacKay and Nicholas J. Frederick, this new monograph is an extremely valuable contribution to not only Book of Mormon studies, but also to such subjects as Joseph Smith's involvement with "folk magic" and the religious worldview of Mormonism's first generation of converts.
The appearance of this volume is timely. In conjunction with the publication of a facsimile edition of the printer's manuscript of the Book of Mormon, just one year ago The Church of Jesus Christ of Latter-day Saints for the first time published photographs of a seer stone once in the possession of Joseph Smith and widely considered by historians to be the stone used in the translation of the Book of Mormon. Two months later the Ensign published an article on the topic of Joseph Smith as a seer, including the now-famous photo of the stone. Subsequent commentary by authorities such as Richard Bushman and even President Dieter F. Uchtdorf once again ignited interest in Joseph's seer stones.
|Joseph Smith's brown seer stone
Joseph Smith's Seer Stones can easily be read as picking up where the initial wave of last year's enthusiasm and interest left off. It dives into not only the history of Joseph Smith's seer stones themselves (where and when they were discovered, how they were used, which hands they passed through after leaving Joseph's possession, etc.) but into a wider discussion of folk magic, the supposed "magic world view" of Joseph Smith and the early Saints, the translation of the Book of Mormon, what the Book of Mormon itself has to say about seers and seer stones, and other related topics. The book is richly illustrated with original artwork from Anthony Sweat and other artists. Additionally, graphs, charts, appendixes, and an enormously helpful selected annotated bibliography of primary sources on Joseph's seer stones compliment the historical and theological analysis offered by MacKay and Frederick.
Much of the story told by MacKay and Frederick would undoubtedly already be familiar to students of early Mormonism. Those acquainted with the work of D. Michael Quinn and Mark Ashurst-McGee, for example, will be greeted by familiar topics: folk magic, money digging, seer stones, Indian lore, Book of Mormon translation, etc. However, where MacKay and Frederick stand out is both in in their thoughtful critique of once-prevailing paradigms and their careful look at the provenance of Joseph Smith's seer stones down to the present day.
For instance, chapter 2 ("Money Digging and the Second Great Awakening") of the book argues that looking at "the broader religious cultural context" of early 19th century America "helps to demonstrate why Joseph interpreted the recovery of his seer stones as fundamentally religious in nature" (p. 6). Despite the past efforts of some to demarcate "magic" from "authentic" religious experience, MacKay and Frederick (along with some others) convincingly critique "the idea that money digging was a nonreligious endeavor, while the translation of the Book of Mormon was decidedly religious in nature." They continue, "These are labels imposed by the modern perspective, and they ignore that both treasure seeking and translating were likely perceived by Joseph's early converts as supernatural events. Early believers did not necessarily struggle with the fusion of Joseph the treasure seeker and Joseph the translator" (p. 9). MacKay and Frederick thus recommend a healthy dose of historiographical humility in approaching this topic, as a sloppy polemical approach (as seen on some questionable Internet sites today) can easily make one stumble into a presentistic ditch.
Most fascinating is MacKay and Frederick's treatment of the provenance of Joseph Smith's seer stones, including the brown stone brought to the public's attention last year and a white stone possessed by Joseph beginning sometime in the early to mid-1820s. Despite "numerous gaps" in provenance, the brown stone can be relatively easily traced from Oliver Cowdery's possession in 1830 to the First Presidency's private collection in 1970, where it has resided since (pp. 66–77). The provenance of the white stone has been more difficult to ascertain, but it appears to have been handed down from prophet to prophet beginning with Brigham Young. "This stone may have remained in the hands of the Presidency for decades," write MacKay and Frederick, and "it is apparently in the possession of the First Presidency" as of today (p. 84). Unfortunately, much less is known about the white stone beyond that it was shown to members of the Quorum of the Twelve in Nauvoo and was eventually consecrated on the altar of the Manti Temple by Wilford Woodruff in 1887 (pp. 79–80).
Perhaps future research will uncover more on the provenance of Joseph Smith's white seer stone. Perhaps, assuming it is in fact in the possession of the First Presidency, the white stone will also be photographed and published along with the brown stone at some future time. It may even turn out that the white stone was used in the translation of the Book of Mormon all along, as MacKay and Frederick draw attention to some historical sources that suggest such (pp. 77–82). At this point, however, we must be content with speculation until further sources come to light. "If the Presidency's papers do not include more historical information about the white stone, they . . . face the problem of not knowing its provenance with certainty." While the brown stone appears to be a "better candidate" for being the stone used in the translation, and thus was selected for publication, some uncertainty remains, and caution should therefore be exercised (pp. 84–85).
To conclude, I think it's important to not overlook the significance of this book's mere existence. To see a book published by Deseret Book that dives right into the heart of this topic is a testament to the growing maturity of the Church's institutional historical consciousness. It is an encouraging sign that Church leaders and members are not afraid to face inquiries raised by both sympathetic and hostile questioners. It is also promising evidence that Elder M. Russell Ballard's challenge given earlier this year to "raise the bar," as it were, in producing institutionally-sanctioned works on Church history is being answered.
|Seriously, read both of these.


text:
Macworld's July Digital Edition: which laptop has the best battery life?
In July Macworld, we compare which Apple laptop has the best battery life. Also, Apple debuts El Capitan, promising increased speed and much more. Plus: Hands-on with the new Spotify and see the three biggest reveals of WWDC 2015.
The best slides, charts, and factoids from Apple's WWDC 2015 keynote
You know how Apple always pads its presentations with awesome info slides that disappear as quickly as they appear? Here are the ones you may have missed when you looked down at your iPhone for a hot second.
Live blog: Apple's WWDC 2015 keynote, featuring iOS 9, El Capitan, Apple Music, and more
Apple's annual Worldwide Developer's Conference keynote has come and gone, but you can relive the play-by-play in our live blog.
Macworld's June Digital Edition: Apple's new 12-inch MacBook
In June, Jason Snell reviews Apple's new 12-inch MacBook. Is the single USB-C port a deal breaker? Executive Editor Susie Ochs, takes a closer look at the Apple Watch, and we give you tips to master Apple's new Photos app.
Staff Picks: Our favorite ways to use the Apple Watch
How Apple's newest gadget is making a difference in our lives so far.
Staff Picks: 8 Apple Watch apps we can't wait to use
Before the Apple Watch even shipped, updates started hitting the App Store, adding Watch interfaces to the apps we already love on the iPhone.
Macworld's May Digital Edition: hands-on with the Apple Watch
In May, it's hands-on with the Apple Watch and the new 12-inch MacBook. Executive Editor Susie Ochs raves about the Apple Watch software while former Macworld Editorial Director Jason Snell takes on the MacBook's redesigned trackpad. Plus: Time-saving tips for Office for iPad.
iPad turns 5: What Apple's tablet has meant to us
It was the last new product Steve Jobs announced. It defined a category. It hit the sweet spot between laptop and phone. And five years on, iPad is still the best tablet you can get.
We take a first look at Photos for OSX in Macworld's April Digital Edition
In the April issue, we take a first look at Photos for OS X, Apple's iPhoto replacement. Also, Apple's Tim Cook warns that sacrificing privacy "risks our way of life". Plus, how to share your location with iOS 8 (without creeping yourself out).
Live blog: Apple's March 9 special event
The Apple Watch is about to launch, and Macworld will be reporting live. Check back here Monday morning for all the play-by-play.
HomeKit is here in Macworld's March Digital Edition
In the March issue, we look at HomeKit and how Apple will win the smart home by keeping it simple. Also, how the Macbook Air could change everything (again). Plus: First look at Logic Pro X 10.1.
Why 2015 will be the year of the Apple
Apple's 2014 products don't even compare to what we expect out of Cupertino next year.
Live blog: Join Macworld for Apple's October 2014 iPad event
Follow along as Apple unveils its next round of shiny new products, including iPad Air 2 and iPad mini 3!
Articles by Macworld staffNext Page


text:
|Size (cm)
|Response size
|24.5 - 25
|Pineapple Princess pink, camel
|Body: should last more
|Brand description
|[OKA b. Okabe] is the oldest shoe brand was born in the United States in the summer of 2005
Luxury line. From celebrities attending American hotels and luxury spa design of skillfully fashion taste and rich color variation has attracted spreading popularity of Word of mouth. Own material from slipping even when wet, superior durability and shape "micro p last but realized fashionable and comfortable sandal.
Further アルエイジェンツ formula helps prevent mildew or odor effect is.
|Product description
|Wood motif is fresh and cute!
Is a vivid color contrast with feet flat pumps.
|Please note that
The size of your anxiety if you ask in-room workout wear.
(Please note that is worn on the outside and is not eligible for Exchange or return. )
If the actual product and color slightly depending on shooting locations and image.
See colors image and color of the product.
|About shipping
* This product is not compatible in the mail.
* Courier shipping nationwide uniform and 500 yen.
* Shipping terms and conditions privacy policy please check and note that we ask.
* Shipping terms and conditions click here .
This product cannot be shipped to United States from the store.
Please contact the store for further information.


text:
No young person with cancer left out
Our report, No young person with cancer left out, looks at the impact of cancer on young people's education, employment and training.
It is the third in a series of reports and follows No child with cancer left out (2012) and No teenager with cancer left out (2013). The report also builds on previous research – More than my illness (2010) and Counting the Costs of Cancer (2011).
For this report we spoke to 205 young people aged 16 to 24 about how cancer had affected them, using a survey, focus groups and face-to-face interviews.
Our findings
Our report found a cancer diagnosis and treatment can have a significant impact on young people's confidence, which can be a barrier to education, employment and training.
- Two thirds (67%) said they were worried about the impact cancer would have on their education while 74% were concerned about the impact it would have on future employment
- More than half (54%) of the young people said they were not fully confident about preparing for job interviews while 61% were concerned about how they should disclose the fact they had cancer on an application form
- 30% of young people in employment did not know what adjustments they were entitled to at work while 24% disagreed their employer had made necessary adjustments for them.
For some young people, however, having cancer and going through treatment gave them a new perspective and new focus to achieve their ambitions.
What does CLIC Sargent do to help?
We provide information and support for young people to help them regain their confidence during and after cancer. We can help arrange work experience placements, speak to education providers and provide information and practical advice on finding employment.
CLIC Sargent Social Workers and Young People's Social Workers offer emotional, practical and financial support to young people, helping them take control of their lives.
The charity also introduced Young People's Community Workers who are able to support young people within their own communities and help them build up the confidence to continue their education or get into employment.
Next steps
We will use the findings from this report to help develop our services for young people, particularly within their own communities.
We will:
- Develop specialist information for post-16 education providers and employees
- Raise awareness of the rights of young people with cancer at work, school, college or university
- Continue to campaign with governments and policy makers to ensure young people who have experienced cancer receive the support they need to access education and employment
- Help more young people access work experience opportunities and provide more CV writing and interview advice.
How you can help
Donate or raise funds for CLIC Sargent and you can help young people facing these challenges. Your money will:
- Help us provide vital support to young people in education, employment and training through their cancer journey
- Enable us to expand our services for young people
- Help us share good practice with employers and education providers.


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15 U.S. Code § 2471 - Authorization of appropriations
§ 2471.
Authorization of appropriations
There are authorized to be appropriated to carry out the purposes of this chapter, not to exceed $6,250,000 for the fiscal year ending June 30, 1976, and the subsequent transition period ending September 30, 1976; not to exceed $5,000,000 for the fiscal year ending September 30, 1977; and not to exceed $5,000,000 for the fiscal year ending September 30, 1978. Funds appropriated for any fiscal year shall remain available for obligation until expended.
(Pub. L. 94–136, title VII, § 701, Nov. 28, 1975, 89 Stat. 743.)
LII has no control over and does not endorse any external Internet site that contains links to or references LII.


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Trinity Oasis is Balaji Trinity Group's new Residential project located at Thane, Mumbai. Trinity Oasis offers 1 BHK,2 BHK Residential apartments. If you are interested in buying property in Trinity Oasis please join the Project Group and our team will help you to get the best possible rates in Trinity Oasis.
Bhayanderpada is one of the prime areas of growth on the Ghodbunder Road. Equidistant from Thane and Borivali, it offers an advantage of proximity to not only these important suburbs, but also other important residential project developing at a fast pace in this area. Trinity Oasis offer many amenities among which a swimming pool, a clubhouse, a gym and views of the creek and mountain from all flats are the highlights. Touching the main road, Trinity Oasis will also have schools and colleges. Hypercity Mall and a hospital within easy. Also, a Proposed MHADA waterpark and the planned Metro Rail Junction are sure to enhance the value of this project.
Groupmagix is a great way to get 100% genuine deals on properties in your city.
Groupmagix © 2014. All Rights Reserved


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This is a mash up of the vampire diaries and twilight .
What happens when Katherine's long lost sister from the Reniassance returns to Mystic Falls ? But there's a catch . She lost her memory last time she was there back in 1864 . What happens when she meets the Salvatores again ? Will they remember her ? Will she be able to control her thirst ? Will Kaus and Elijah find her ? Will she ever get her memory back ? What is her connection to the deep and brooding Stefan ?
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On This Day: Remembrance
Normally, I use my "On This Day" posts for a few historical tidbits, country music flashbacks, and–most importantly–humor. But today, I'm going to do things a bit different. And for a very special reason.
First of all, I wrote a regular "On This Day" post yesterday while deliberately omitting two very important events. You see, yesterday was the 18th anniversary of the Branch Davidian standoff in Waco, Texas during which, among others, 25 children died. It was also the 16th anniversary of the bombing of the federal building in Oklahoma City, during which 168 people–including 17 children–were killed. Clearly, no humor can be derived from those tragedies. Nor can it be found as we remember the twelve students and one teacher who were killed 12 years ago today in the horrific Columbine High School shootings in Littleton, Colorado. Classes were cancelled today at the school in their honor. And so I decided to combine remembrances for these three dark days in American history into one post. There's a time to be funny. This was not one of them.


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LOVERS of sticky sweet pastries rejoice: a competition has been launched to find the state's best baklava.
Yesterday at Balha's pastry shop in Brunswick the state government and the Australian Multicultural Foundation launched the Baklava Bake-Off.
Balha's claims to sell more than 6000 baklava daily in 10 different varieties. They are made of layers of filo pastry with chopped nuts and syrups.
Multicultural Affairs Minister Nick Kotsiras said both amateur and professional bakers could enter. The competition will be judged by chef Shane Delia of Maha restaurant and a panel of food experts. Winners will be announced at a final bake-off on April 21 at Federation Square.
Mr Kotsiras said: "The baklava is an iconic dish made by people from many countries and cultures including Greeks, Lebanese, Turkish and first generation Australians.
''It exemplifies the fusion of cultures that makes Victoria so inclusive and unique.
"The Baklava Bake-Off is a way to bring people together by celebrating this rich culinary tradition - in its various adaptations - passed down through the generations and enriching dinner tables all around Victoria.''
There will be cash prizes for finalists and winners. Entries close on March 15. Entry forms are at: amf.net.au


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NEW YORK (Feb. 4)
A statement of "unity and identification" with Israel was released Thursday by 51 U.S. Jewish organizations, including four publicly critical of Israel's use of beatings to quell Palestinian violence in the administered territories.
The statement was circulated by the Conference of Presidents of Major American Jewish Organizations, a coordinating body of 42 organizations.
The statement said the signators had "received assurances from the president and prime minister of Israel that the policy of restraint continues," that they "have expressed to them our concern regarding any departures in contradiction" of the policy and that they "trust that this policy will be uniformly implemented."
The statement voiced regret at the loss of life in the territories and welcomed the efforts of the United States and others "to move the peace process forward to a just and lasting peace."
It also noted that for decades the Arab world "exploited and victimized" the Palestinians by refusing "to come to the peace table to negotiate a settlement with Israel."
"The security of Israel," it continued, "is a prime concern to Jews everywhere."
The signators said, "We believe we speak for the overwhelming majority of Jews across the country and around the world in this expression of unity and identification with the embattled nation of Israel."
A spokesman for the conference said the statement was meant to "reassure the Israeli community that it hasn't been abandoned and reassure the American Jewish community that Israel has the support" of the major American Jewish organizations.
Organizations critical of the beatings policy have come under criticism themselves from Israel and U.S. Jewish organizations either supportive of the policy or uncomfortable with public condemnation of the beatings policy.
Among the 42 constituent members and nine observer groups of the conference signing the statement were the American Jewish Congress and two Reform organizations — the United of American Hebrew Congregations and the Central Conference of American Rabbis.
All three organizations had previously issued statements critical of a policy announced two weeks ago by Defense Minister Yitzhak Rabin of "might, force, beatings" to subdue Palestinian rioters.
A third Reform organization that signed the conference statement also voiced on Thursday its "alarm and distress" over the beatings.
Rabbi Charles Kroloff, president of the Association of Reform Zionists of America (ARZA), said in the statement that Israel's use of "excessive force" in maintaining order is "contrary to the moral values of the Jewish community and to the principles on which the State of Israel was founded."


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This is going to be controversial.
In an article written earlier today by Benny Morris and published by the UK's Guardian Unlimited newspaper, famous historian and civil rights activist John Hope Franklin had this to say regarding his home:
"This country is so arrogant, so self-certain," he says,
asked whether the west is now engaged with the Muslim world in a war of
civilisations. "I am not sure that is what we are confronting. [But I
am also] not sure we have done what we ought to have done to cultivate
the rest of the world. We're so powerful and so presumptuous that it
makes us unattractive, almost unbecoming. We don't treat other
countries and people right. Power without grace is a curse."
The article goes on to mention that:
Franklin is also fierce in his opposition to the war in
Iraq. "I don't see any good reason why we went in there or why we are
there now. The invasion has sullied our reputation as has our behaviour
there. We have undertaken to spread democracy when we ourselves are not
America not democratic - how so?
"Our presidents are elected by electoral colleges, not directly. And
our military is not democratic. There's no draft. Bush's children and
my children do not serve." He points out that those who do serve are
mostly from America's poorer classes, including many blacks, driven
into the professional army by economic necessity. He suggests that the
Bush administration keeps down the minimum wage to prompt the poor to
volunteer for the (relatively) well-paid armed services.
Of course, prominent Americans who grant interviews to the foreign
media, criticizing the US, is nothing new. This is, unfortunately, a
common practice on both sides of the political spectrum.
With that said, this is not your typical, "let's bash America"
piece. Granted, it is described as a "Special Report" on the United
States of America which, in actuality, is nothing more than a liberal
opinion piece. At the same time, however, who penned the interview
is just as interesting as the man being interviewed.
Both the interviewer, Benny Morris, and the interviewee, John Hope
Franklin, are prominent historians. Mr. Morris is an Israeli citizen
and Mr. Franklin an American citizen, yet the article is published in a
British newspaper. And in no way is Mr. Morris a regular contributing
editor to the paper. I counted just about five articles written by Mr.
Morris for the Guardian in the last five years.
If you delve into Mr. Morris' background, you actually find that he
is a self-proclaimed "new historian." In Israel, that is simply a way
of saying that he's one of those historians who does not believe that
the Jews claims to Israel are legitimate and tends to be a historical
So here suddenly we have some fascinating parallels between Mr. Morris and Mr. Franklin:
- Both question the legitimacy of their governments,
- Both see their governments as oppressors,
- Both are harsh critics of their governments' policies,
- And both stand firmly against the Iraq war.
In fact, it seems to me that both men express a common ideology, that of Folk Marxism:
Folk Marxism looks at political economy as a struggle
pitting the oppressors against the oppressed. Of course, for Marx, the
oppressors were the owners of capital and the oppressed were the
workers. But folk Marxism is not limited by this economic
classification scheme. All sorts of other issues are viewed through the
lens of oppressors and oppressed. Folk Marxists see Israelis as
oppressors and Palestinians as oppressed. They see white males as
oppressors and minorities and females as oppressed. They see
corporations as oppressors and individuals as oppressed. They see
America as an oppressor and other countries as oppressed.
The folk Marxist view of Iraq is that the United States is the
oppressor, and the groups fighting the United States are the oppressed.
At the extreme, Michael Moore and Ted Rall have made explicit
statements to this effect. However, even reporters in the mainstream
media who are not openly supporting the enemy take this folk Marxist
view when they refer to "the insurgency."
Clearly, that bias is showing through in this article. And not just
in this article. Read through so many other articles published by the
MSM and I think you'll see that this ideology dominates liberal
Unfortunately, too many liberals in the media try to dress up such
opinion pieces and call them "news" so as to forward this ideology.
Fortunately, the blogosphere is here to question such practices.


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Australian consumer price inflation was unexpectedly benign last quarter thanks to falls in food, electronics and drugs, sending the local dollar down slightly as it modestly added to the chance of a rate cut next month.
Key measures of underlying inflation rose 0.55 per cent on average in the fourth quarter, under forecasts of a 0.7 per cent increase. Annual underlying inflation of 2.3 per cent was also under forecasts and the previous quarter was revised lower. Inflation remains well within the Reserve Bank of Australia's (RBA) long-term target of 2 to 3 per cent.
"These numbers are coming a bit below the RBA's own forecasts, so inflation is possibly surprising them slightly to the downside. It increases the risk of a rate cut, because inflation is coming in lower than what the RBA had forecast and because it is in the bottom half of the target range and very well-behaved. We've had one more cut in the profile.
"We've been thinking that they delivered some easing in Q4 and they may wait a little bit. But this will increase speculation of a move from them sooner rather than later, given what's been fairly disappointing activity data domestically."
"I don't think it's quite weak enough to push the RBA over the line (to cut rates). Certainly it makes it easier for the RBA to cut rates and it suggests they will be revising down some of their inflation forecasts.
"There's probably a 35 to 40 per cent chance of a February rate cut so not enough to get it over the line, but certainly we think the prospects of a March rate cut are very real. "The RBA will continually have to cut rates over 2013. If the capex investment report at the end of February is softer again, then it will open the door to a March rate cut."
"We've all come in a bit on the low side so headline increase is only 0.2 so that's half of what the market is expecting. Also on the core measures – they came in quite low as well, 0.6 on the trim mean and 0.5 on the weighted median so both of those a touch under what was expected.
"When you analyse all that you're getting inflation is still quite low, so just above 2 per cent on all those measures, so nothing particularly alarming but still there's hope that the RBA is going to be cutting rates sometime soon just on those numbers."
"Inflation was slightly lower than we expected, but was within the forecast band." "But we still think they will cut in April. We think they will hold off (in February), but they will cut one more time, by 25 basis points in April, and then on hold.
"Inflation is well contained. There no rush. Since the last meeting, the global backdrop has improved. There has been a pick-up in housing, and the labour market, though soft, isn't collapsing. We don't have chaos or panic conditions, but one more cut will probably be sufficient."
"The headline outcome was a fair bit lower than the market expectation. It looks like there were some fairly big falls in just a couple of items that drove it lower. The underlying measures are still benign. If you are of the view that the RBA needs to cut rates, you'd have got a fair bit of ammunition to support that from an inflation viewpoint.
"But it looks like the RBA, from previous statements, was expecting some pretty benign numbers for the December quarter. We don't have any change in the cash rate over the next few quarters."
"Inflation through the year is about 2.3 per cent, that is a little below the Reserve Bank of Australia's target of 2.5 per cent, but we need to keep in mind that changes to the carbon tax and health rebate boosted inflation by a quarter of a percent in the last six months.
"So on balance, inflation has run at around 2 per cent rate excluding policy changes, both over the last six months and over the last year. That is low enough to keep the RBA on an easing cycle. There is an even chance they cut in February. If I had to say yes or no, at this point I would say yes. It's a finely balanced decision for February. "The data has not picked up enough to end the easing cycle given how low inflation is. Which month they cut is hard to say, but it's definitely on the table."
"We've got underlying inflation of 2-and-a-quarter per cent and headline inflation the same, so those metrics are probably a quarter of a percent lower than what the Reserve Bank (of Australia) thought three months ago.
"It does give them a bit more room to manoeuvre, the question is do they want to wait a little bit longer given they've cut rates in October and December, and just wait and see the effects of those because we've had very little domestic data.
"So I think they may not ease again just yet but certainly it will be a live discussion ... they will probably want to wait a bit longer to see if their easings are having some material effect on domestic demand."


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Tuesday, January 8, 2013
Local Hardware Companies Out In Force At CES
Who says that Southern California's high tech industry is all about Hollywood and e-commerce? The region's large stable of high tech hardware companies are out in force this week at CES, with San Diego-based Qualcomm leading the charge and the keynote; Irvine-based Broadcom announced a new chip aimed at UltraHD TV Home gateways, MoCA 2.0 and Gigabit DOCSIS products, and more; Irvine-based Vizio announced new HDTVs, smartphones, tablets, and Windows 8 PCs; and Viewsonic, based in Walnut, showed off its new high resolution touch displays. The companies are just some of the many high tech manufacturers announcing or showing off their products in Las Vegas this week.
Among the most visible companies was Qualcomm, which announced a new line of Snapdragon processors, the Snapdragon 600 and 800, aimed at smartphones, tablets, and smart televisions today in the show's keynote from CEO Paul Jacobs. Jacobs shared the stage with Microsoft's Steve Ballmer, band Maroon 5, and even a video connection with Bishop Desmond Tutu.
Broadcom announced digital and web television, home gateway technology, 5G WiFi ecosystem expansion, and automotive Ethernet products, with what it calls a game changer of a chip aimed at HDTV market.
ViewSonic has debuted a new, Android-powered "smart display" which is aimed at both consumers and the enterprise, along with new touch-screen digital displays.
Get More SocalTech Data
Try our two week free trial to find new tech customers, find high tech startups and jobs, find venture funding, and more!Learn More


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After a three month hiatus, The Hills girls are back, and along with them, my weekly food quiz! Last night's season premiere was filled with drama. Lauren hosted a barbecue and Heidi's sister annoyed Spencer, but the most climatic part was the showdown between Lo and Audrina.
Did you watch? Take our quiz and find out up if you picked up on all the foodie details.
Photos courtesy of MTV
The Hills Food Quiz: "We'll Never Be Friends"
Who is Lauren planning a birthday barbecue for?


text: A sophisticated tented safari camp in Samburu National Reserve, Larsens Camp lies along the north-east border of the Uaso Nyiro River, perfectly placed for watching animals visiting the watering hole. Beautifully furnished tents, with a touch of colonial elegance and exciting wildlife excursions allow you to experience the heart of Africa in style. Wake at sunrise to the sounds of birdsong and monkey chatter. Step into the warming suns rays on your terrace and watch birds and wildlife on the river. The feeling here is that of total serenity and calm introspection. Enjoy a champagne breakfast alongside the river, or set out early on a game drive, with a picnic basket and see giraffes, lions, elephants and Grevys zebra. Return to the camp to dine under the shade of fig trees, around the campfire or on the tree deck. The Larsens Camp is a Small Luxury Hotels of the World property.


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This page is a printable version of: http://www.enfieldccg.nhs.uk/about-us/ccg-board-meetings.htm
Date: 19 August 2017
Enfield Clinical Commissioning Group (CCG) is made up of 48 GP member practices who report to a Governing Body, whose role is to oversee the work of the CCG and ensure that decisions about changes to local health services are debated openly and fairly.
Our Governing Body meets every other month and we welcome members of the public to attend our meetings. Click on the dates below to find out more information and to download the meeting papers.


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Songs to get busy to: The playlist
In case you missed it, we recently posted our guide to the best songs for getting it on. (It's pegged to Valentine's Day, but trust us, they're good all year long.) But while reading about the tunes is a sexy experience of a certain type, hearing them, of course, is even sexier. So, with the help of imeem, we've created a playlist of all 15 selections and embedded it below. You're welcome.


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opening now. can come when you see bun!
alright ready whenever~
kk will move in/out erik once daddie's done with her villagers!
Yup! Let me know if you're available tonight
whew ended quickly but you're welcome! enjoy
sorry reopened!
gates are open
okay opening gates now
yea lemme know if you're still around!
kk bun is open
Share your friend codes, gamer tags, and network IDs.
Junior Member


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- Trending Now: More Trending:
- Svengali syzygy hegemon repugnant white nationalist, white supremacist
Definition of couth
: sophisticated, polished Although they disagreed with the speaker, they were couth enough to listen to him respectfully.
Examples of couth in a Sentence
he's remarkably couth for someone who grew up in a small town with limited cultural opportunities
Origin and Etymology of couth
back-formation from uncouth
First Known Use: 1896See Words from the same year
Definition of couth
: polish, refinement I expected kindness and gentility … but there is such a thing as too much couth. — S. J. Perelman
Examples of couth in a Sentence
their future son-in-law's lack of couth was of some concern to this patrician couple
Origin and Etymology of couth
see 1couth
First Known Use: 1947See Words from the same year
Learn More about couth
See words that rhyme with couth Thesaurus: All synonyms and antonyms for couth
Seen and Heard
What made you want to look up couth? Please tell us where you read or heard it (including the quote, if possible).


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Robert Pattinson thinks he is a gentleman because he never tells a girl to change for him.
When it comes to treating girl properly, Robert Pattinson thinks he is a gentleman. Providing an evidence to that, he says, "I don't tell [a girl] how she has to be for me. I don't want her to change herself for me."
Talking about girls of his dream, Pattinson reveals he likes "talented girls." He admits, "If she's really talented, I don't really care about the other things." Also he frankly claims that he "would rather go out with girls than with guys", while jokingly adding, "but if I tried to hit on every girl around me, then I would lose those friendships."
In line with girls, Pattinson confesses he believes in love at first sight, about which he gushes, "It's absolutely possible that you can meet someone on the street and suddenly fall in love with that person. That often happens to me."
Considered as a hunk and ladies' man, Robert Pattinson has been romantically linked to a number of actresses, including Camilla Belle and his "Twilight" co-star Kristen Stewart. Despite the mounting dating speculation, he has insisted he is dating no one.
As for the girl of his dream, he previously admitted he is looking for "the worst - mental, strong women." He was quoted as stating, "The stuff I find attractive in women, I always regret finding attractive. I always like a kind of madness in a woman, and when they are really, really strong", adding, "But I like it when they hate me right from the beginning."


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Holmes City homebodies
Not much has changed for Lola and Dave Anderson over the years. And they wouldn't want it any other way.
Residents of Holmes City, Dave and Lola live only about a mile from where they each grew up.
Lola's grandparents, who came from Sweden, homesteaded one mile south of Holmes City in the late 1800s. Her father was born on that farm, and so was Lola in 1941. When Lola married her childhood sweetheart, Dave, in 1961, her name didn't even change. Her maiden name was Anderson.
Dave's grandparents were also Holmes City residents. His dad was born by Pocket Lake and his mother was also born in Holmes City Township. Dave was born on a farm about a quarter mile south of where he and Lola now live - and have their entire married lives.
The Holmes City connections for the Andersons are endless. Lola and Dave are both 100 percent Swedish. They were born about a mile apart. And Lola's mother was born one-half mile from where Dave's mother was born.
"Our families were friends," Lola said. "We have always known each other."
"We played together as children," added Dave, a quiet man of few words, as his wife explained their history.
Lola went to school in Holmes City through 6th grade and in 7th grade went to Central Junior High in Alexandria.
"We were the first class that got to go to Alex in 7th grade," she said, adding that hers was also the first class to graduate from the new Jefferson High School in 1959.
Two years older than his wife, Dave went to Pocket Lake Country School and in 9th grade attended Central High School. He graduated in 1957.
The bright lights and hustle and bustle of a big city didn't entice either one of the Andersons. While he was still in high school, Dave rented a farm that neighbored his parents'. Always sure that he wanted to be a farmer, Dave stayed put after high school and worked on both farms.
Lola didn't have any desire to leave either. She stayed in Holmes City and worked at the co-op, and then worked for awhile in Brandon.
"Then we got married," she said matter-of-factly, trying to remember if she and Dave dated in high school.
"I guess so," she surmised. "It was so long ago. It will soon be 50 years. It was nothing big and fabulous."
After their marriage the two Holmes City natives bought the farm that Dave was renting. Later, they bought Dave's parents' farm, and property on Lake Rachel, which is across the road. Today, the couple owns 270 acres in Holmes City Township.
Although much has stayed the same for the Andersons, there have been a few changes. They had a son and a daughter and are now the proud grandparents of two.
And in 2003, the couple moved into a new home they built on their farm - further cementing their desire to stay put in the community they have always called home.
"After you built the whole place, it's home," Dave said, referring not only to the new house, but the land, family and friends they have acquired.
"Why go someplace where there are thousands of people and traffic?" Lola questioned. "It's so peaceful and pretty here. Where else would a person want to live?"
And with a quiet nod, Dave agreed as he pondered, "Why go anywhere else? We know this is home."
Editor's note: The Andersons will join with other area residents to celebrate Holmes City's Sesquicentennial on Saturday, June 21. For more information on the celebration, refer to the printed version of the Friday, June 13 edition of the Echo Press.


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Roasted Asparagus
Roasted Asparagus
Part of Ep. 1802 Ep. 1802 - Asparagus, Grass and Daffodils
Yield: Serves 4-6.
Credit: Recipe courtesy of Jack Kaestner, executive chef of the Oconomowoc Lake Club
1 lb. asparagus, bottom ends snapped off
8 oz. Shitake mushrooms, stems removed
or 4 oz Morels in 1/3-inch slices
2 Tbsp. olive oil or clarified butter
8 cups mixed greens
2 cups cooked wild rice (optional)
Parmesan cheese
Salt and fresh ground pepper to taste
Zest of one lemon
3 Tbsp. lemon juice
1 tsp. fresh sage, tarragon or chervil
1/4 cup extra-virgin olive oil
Salt and fresh ground pepper to taste
Place asparagus and mushrooms in bowl and sprinkle with salt, pepper and oil. Spread in single layer on baking sheet and place in oven. Roast asparagus and mushrooms in 400 or 450° oven for 4-8 minutes depending on thickness. Edges will soften and darken a bit. Let cool. Toss greens with a little salt, pepper and dressing to taste. Sprinkle with cooked wild rice for a more substantial salad. I think wild rice and asparagus make a great combination. Top with asparagus, mushrooms and cheese. Enjoy!
Funding for The Wisconsin Gardener is provided, in part, by The Wisconsin Master Gardener Association.


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Pastilles Poncelet Art Print by Jules Cheret
£5.99 In stock
This lithographic art print is based on a drawing entitled Pastilles Poncelet by Jules Cheret. Active from around 1850 onwards, the artist is noted for art nouveau works. Themes: grey, cabaret dance, vintage, deco, nouveau, woman, rain, coat, umbrella, hat, advert, storm.