text:
|Publication number
|Publication type
|Application number
|Publication date
|Oct 5, 1993
|Filing date
|Feb 21, 1992
|Priority date
|Feb 21, 1992
|Fee status
|Also published as
|Publication number
|Randall W. Fincke, Michael L. Lopin
|Original Assignee
|Zmd Corporation
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (2), Non-Patent Citations (2), Referenced by (48), Classifications (7), Legal Events (7)
|External Links: USPTO, USPTO Assignment, Espacenet
This invention relates to transcutaneous pacemakers and defibrillators.
Emergency techniques for cardiac therapy are essential for successfully treating life threatening cardiac conditions. The most common of such conditions is ventricular fibrillation, in which the electrical pulse generators in the cardiac muscle fibrillate asynchronously, causing chaotic muscle contraction. The other common cardiac threat is loss of pacing, in which the pacing stimulus nerves of the cardiac muscle fail to initiate contraction of the muscle.
Ventricular fibrillation is treated with a high energy electrical pulse, called a defibrillation pulse, which is transcutaneously delivered to the heart to resynchronize the heart's pulse generators. Loss of pacing is treated using a transcutaneous pace maker to deliver pacing current pulses to the heart and thereby maintain cardiac contractions.
Frequently a patient in cardiac distress experiences both the conditions of fibrillation and loss of pacing. In order to most efficiently treat this situation, both defibrillation and external pacing equipment are typically combined in a single portable instrument for emergency personnel convenience. Such an instrument includes a pair of transcutaneous pacing electrodes and corresponding pacing circuitry, as well as a pair of defibrillation electrodes and corresponding defibrillation circuitry. In addition, the instrument may include a specialized multifunction electrode pair which can deliver both pacing and defibrillation pulses when used with appropriate connections to the pacing and defibrillation circuitry.
Typically, a hardware relay scheme isolates operation of the pacing circuitry from the defibrillation circuitry to thereby isolate the circuitry outputs. When separate pairs of pacing and defibrillation electrodes are used with the circuitry, the relay scheme decouples the two circuits. Conversely, when the multifunction electrode pair is used, the relay scheme couples the circuits to a common output so that the pacing stimuli and defibrillation pulses may be delivered to a single electrode pair. Such relays, being required to withstand the defibrillation pulse, are quite bulky and rather expensive, and must be isolated from any surrounding transformers that could trigger their activation.
Defibrillation electrodes are usually mounted one each on a hand-held paddle which includes a pressure-activated switch for initiating the defibrillation discharge of energy to a patient. Because this energy is high enough to be lethal if delivered at the wrong time or to the wrong location, the paddle switches are both connected in series with the discharge circuitry. If one switch is unintentionally activated alone, no discharge will result; only the simultaneous activation of both switches will initiate a discharge. However, if one switch is held closed (activated) as a result of a hardware malfunction, activation of the other switch would result in unintentional defibrillation discharge. Without the ability to monitor the open and closed state of the switches an operator has no way of verifying the integrity of the switches, and therefore the integrity of the discharge circuit. Moreover, the discharge control circuitry is unable to internally detect a switch malfunction and prevent a corresponding discharge malfunction.
The electrical current generated by the defibrillation discharge circuit for delivery to the patient is typically monitored to check the integrity of the circuit and to study the physiological effects of the discharge. This current may reach as much as 125 A, and the corresponding voltage of the discharge may reach as much as 5000 V. Conventionally, the current is monitored using a current transformer whose primary winding is connected in series with the discharge circuit. The secondary winding of the transformer is then connected to a sensing circuit for measuring the current level. The particular choice of transformer is based on the requirement that the component withstand the high current and voltage levels of the discharge circuit; typically such a transformer is disproportionately larger than the other circuit components and is rather expensive. More importantly, such a transformer generates substantial coupling flux between its primary and secondary windings which can severely impact the operation of neighboring circuits. The transformer must thus be physically isolated from circuits having sensitivity to the coupling flux.
It is desirable to frequently test the defibrillator discharge circuit for functionality, due to the critical nature of the emergency situations in which it is needed. Traditionally, such a test is accommodated by providing a characteristic load resistor, say 50 Ω, into which the circuit may be energized to simulate discharge into a patient. The 50 Ω load resistor is typically contained either within the defibrillator equipment or within a separate testing apparatus, with a connection through the equipment housing for contact to the defibrillator electrodes.
Because the defibrillator discharge's high energy (about 360 j) is delivered in a short time (90% in about 3 msec), the peak power requirement of the load resistor is quite substantial, exceeding 100 KW. The resistor must be, well ventilated because the average power may exceed 30 watts, resulting in significant resistive heating, and typically, some type of customized heat sink is required in the location of the resistor. Additionally, a sizeable resistor is required to withstand the discharge's peak voltage of as much as 2500 V. This physical size may use up a substantial portion of the circuitry housing. The high voltage also requires the electrical connection from the defibrillator electrodes to the resistor to regularly withstand such voltage. Finally, the electrical connection on the equipment housing to the resistor must be isolated to prevent accidental contact by an operator; discharge of the circuit with only one electrode connected to the resistor while an operator touches the resistor would dump the high voltage across the resistor to the operator.
In general, in one aspect, the invention features a scheme for discharging a defibrillation discharge circuit across a short circuit load for monitoring defibrillation pulses generated by the circuit to test that the pulses are acceptable; the circuit includes a capacitor for storing the discharge pulse energy and an inductor for shaping the pulse. In the invention, parameters representative of the shape of the defibrillation pulse are detected as the pulse is discharged and are compared to predetermined values characteristic of the shape of an acceptable pulse. Based on the outcome of the comparison, an output is provided indicating whether the pulse is acceptable. This scheme eliminates the disadvantages associated with discharging the defibrillation electrodes into a load resistor located internally to the unit housing, as with the shorting bar it is not necessary to penetrate the housing, and provides a more flexible test analysis than the load resistor scheme.
In preferred embodiments, the capacitor is charged to a prespecified pulse energy and then discharged into the short circuit. In further preferred embodiments, a parameter representative of the defibrillation pulse current is detected and sampled to produce sample values; in more preferred embodiments a sense voltage is measured and sampled; the voltage is developed between the ends of a sense winding wound around the inductor with at least one turn; the sense voltage is integrated to determine corresponding pulse current values, and the peak and valley current values are determined. A ratio of the peak to valley current is determined and based on the ratio, any adjustments in the peak current value are made to compensate for temperature-induced changes in inductor winding resistance. In the preferred embodiment, the adjusted peak current value is compared with a range of peak pulse currents and must fall within the range for the pulse to be determined as acceptable.
Other features and advantages of the invention will be apparent from the following description of a preferred embodiment and from the claims.
FIG. 1 is a perspective view of a portable transcutaneous pace maker and defibrillator unit.
FIG. 2 is a schematic of the pacing circuitry and defibrillation circuitry in the unit of FIG. 1 and illustrates the circuitry interconnection of the invention.
FIG. 3A is a perspective view of a conventional cable connector for use with the unit of FIG. 1.
FIG. 3B is a perspective view of a multifunction cable connector for use with the unit of FIG. 1.
FIG. 4A is a perspective view of an instrument connector for use with the connectors of FIG. 3.
FIG. 4B is a cross sectional view taken at 4B--4B in FIG. 4A of two high voltage connection pins used in the cable connector of FIG. 4A.
FIG. 5 is a schematic of the defibrillator electrode switches of the invention.
FIG. 6 is a schematic of the defibrillation discharge circuit and sensing circuit of the invention.
FIG. 7A is a perspective view of the inductor in the circuit of FIG. 6.
FIG. 7B is a perspective view of the inductor of FIG. 7A and the sense winding in the circuit of FIG. 6.
FIG. 8 is another perspective view of the pace maker and defibrillator unit of FIG. 1, taken from another angle and showing, with portions partially broken away, a short circuit bar for use with the defibrillator paddles.
FIG. 9A is a plot of the voltage waveform developed by the sense winding of FIG. 7 in response to the current in the inductor of FIG. 7.
FIG. 9B is a plot of the current waveform corresponding to the voltage waveform of FIG. 9A when that waveform is integrated.
Referring to FIG. 1, there is shown a portable defibrillator and pacing unit 10 for providing defibrillation energy pulses and transcutaneous pacing stimuli to a patient in cardiac distress. Such a unit is available from Zoll Medical Corporation of Woburn, Mass. under the product name PD1400.
The portable unit 10 includes a cable connector 12 for connecting a pacing electrode cable 14 and defibrillation electrode cables 16 to pacing circuitry and defibrillation circuitry, respectively (shown in FIGS. 2 and located within the unit. Hand held defibrillation electrode paddles 18, which mechanically support the defibrillation electrodes (shown in FIG. 8) are connected to the opposite end of the defibrillation electrode cables.
A screen 20 is provided on the portable unit for displaying operational modes and test results, which are programmed by various operator-controlled switches and knobs 22. Finally, the portable unit includes a power supply compartment 24 for holding a portable battery or other power source.
Referring to FIG. 2, the defibrillation circuitry 30 included in the portable unit comprises a discharge energy generator 32 for charging a discharge capacitor 34 to a defibrillation discharge energy specified by the operator. A switch 36 connects the capacitor to the discharge energy generator, and when the switch is activated by control circuitry (not shown) discharges the capacitor across the positive and negative defibrillation outputs 40A and 40B, respectively. The capacitor is preferably of 46 microfarads and can withstand 5000 volts across its terminals. An inductor 38 is in series with the capacitor for shaping the defibrillation pulse as the capacitor is discharged. The inductor is preferably of 20 millihenries and has an associated winding resistance of about 13 Ω.
The pacing circuitry 42 included in the portable unit comprises an electronic pace generator 44 for generating pacing stimuli and timing the delivery of the stimuli at the pacing circuitry positive and negative pacing outputs 46A and 46B, respectively. In series with the positive output 46A is a positive blocking diode 48A connected so that it is forward biased by the positive sense of the pace stimuli. Similarly, in series with the negative output 46B is a negative blocking diode 48B connected so that it is forward biased by the negative sense of the pace stimuli. The blocking diodes act to isolate the pace generator 44 from the typically high energy defibrillation discharge pulses, as discussed below. Preferably, both of the blocking diodes can withstand a reverse voltage of at least 5000 V and a forward current surge of at least 25A; such a surge could occur if the defibrillation circuit is unintentionally reverse connected to the pacing circuit.
Both the positive and negative defibrillation circuitry outputs 40A and 40B and the positive and negative pacing circuitry outputs 46A and 46B are tapped into an instrument connector 49 in the portable unit housing for connection with either a conventional mating connector 12, shown in FIG. 1, or a multifunction mating connector 53, described below. In the conventional mating connector 12 two pins 50A and 50B correspond to the positive and negative defibrillation circuitry outputs 40A and 40B, respectively, while two pins 52A and 52B correspond to the positive and negative pacing circuitry outputs 46A and 46B, respectively. The defibrillation pins 50A and 50B are connected to defibrillation cables 16 and corresponding electrode paddles 18, as shown in FIG. 1, for application of defibrillation discharge pulses to a patient. Likewise, the pacing pins 52A and 52B are connected to a pacing cable 14 for connection to pacing electrodes positioned on a patient.
In the multifunction mating connector 53, two pins 54A and 54B correspond to the positive and negative defibrillation circuitry outputs 40A and 40B, respectively, while two pins 56A and 56B correspond to the positive and negative pacing circuitry outputs 46A and 46B, respectively, just as in the conventional mating connector. However, in the multifunction connector the positive defibrillation output pin 54A and the positive pacing output pin 56A are connected together; similarly, the negative defibrillation output pin 54B and negative pacing output pin 56B are connected together.
The positive pin connection 54A to 56A and the negative pin connection 54B to 56B each are connected to a single positive cable line 58A and a single negative cable line 58B, respectively; the single pair of cable lines carry either defibrillation discharge pulses or pacing stimuli to a pair of multifunction electrodes (not shown) via a multi use connector 60. This multifunction electrode scheme provides an advantage over the conventional connector and electrode scheme by requiring only one pair of electrodes to be positioned on a patient, rather than both a defibrillation pair and a pacing pair. However, by connecting the positive circuitry pins together in the multifunction connector 53 itself, rather than in the instrument connector 49, the circuitry connector 49 is compatible with both the conventional and the multifunction electrode schemes and the operator may choose one as appropriate.
When in the multifunction connector and electrode configuration, output signals of the defibrillation circuitry are coupled to the pacing circuitry, and output signals of the pacing circuitry are coupled to the defibrillation circuitry. Thus the connector and circuit wiring must be able to carry the 25 A potentially developed in the discharge circuitry. Furthermore, the positive and negative connection pins in the connectors must meet high voltage and current specifications, as discussed below.
High energy discharge pulses generated by the discharge circuitry would damage the pace generator 44 of the pace circuitry if it were not isolated by the blocking diodes 48A and 48B. While the diodes are positioned to be forward biased by the pace generator pacing stimuli, the diodes are reversed biased with respect to the defibrillation circuit discharge pulses, and so block these pulses from the pace generator. Conversely, pacing stimuli generated by the pacing circuit are not blocked from coupling to the discharge circuit because the discharge circuit comprises only one passive component, an inductor, when the pacing circuit is operating. Because the inductor is designed to withstand the high energy defibrillation pulses, it easily withstands the much lower energy pacing stimuli. Thus, without the use of mechanical isolators such as relays, the blocking diodes isolate the pacing circuitry from the high energy defibrillation circuitry, while eliminating the typical space requirements and cost of mechanical isolators.
Referring now to FIG. 3A, the conventional mating connector 12, also shown in FIG. 1, is connected to a pacing cable 14 which delivers the pacing circuitry outputs 46A and 46B (FIG. 2) to pacing electrodes placed on a patient. Separate defibrillation cables 16 deliver the defibrillation circuitry outputs 40A and 40B to defibrillation electrode paddles for placement on the patient. The two sets of cables and the disconnected output pins in the connector isolate the pacing and defibrillation circuitry from each other.
As shown in FIG. 3B, the multifunction mating connector 53 is connected to a single cable 58 for delivering both defibrillation pulses and pacing stimuli on a single positive cable line 58A and a negative cable line 58B (FIG. 2) The cable 58 leads to a multifunction electrode connector 60 which attaches to a single pair of patient electrodes for both transcutaneous pacing and defibrillation. The blocking diodes in the pacing circuit are the only means used for isolating the discharge pulses from the pacing circuitry in this multifunction scheme.
The instrument connector 49, shown in FIG. 4A with its cover 62 pulled back, includes a number of pin connections, four of which are high voltage pins 63 positioned in high voltage labyrinth barrels. Each of the four barrels corresponds to one of the four outputs from the pacing and defibrillation circuitry, the positive and negative discharge outputs 40A and 40B and the positive and negative pacing outputs 46A and 46B. The other pins correspond to low voltage control leads and other wiring necessary for the circuitry.
When mated with either the conventional connector or the multifunction connector, the instrument connector high voltage barrel pins 63 mate with corresponding mating pins 66. The pin connections meet the IEC 601 Part 2 safety specification for defibrillation equipment; two adjacent pin connections can withstand the application of 7500 V between them, and the shortest electrical path 68-70 between two adjacent pin connections, called the creepage distance, is not less than 15 millimeters.
Referring now to FIG. 5, a relay coil or solenoid 81 actuates the medical grade relay switch 36 (FIG. 2). The relay coil is connected at one of its terminals to a dual 10 V and 20 V power supply 82, 84, and a 470 microfarad capacitor 90 connected to ground 92 for increasing the speed of the relay switch activation. The relay coil is actuated when its other terminal is connected to ground by the simultaneous closure of three switches. One of these switches is a MOS transistor switch 94 whose gate 96 is connected to a control circuit such as a microprocessor. A 56 KΩ shunt resistor 98 is connected across the MOS transistor for sensing the on or off state of the transistor, as discussed below. The MOS transistor is biased by a 2 KΩ resistor 100 and a 100 KΩ resistor 102.
The positive input of an operational amplifier 104 is connected to the MOS transistor sense network 100, 102 and a zener diode 106 having a 4.3 V avalanche voltage. The negative input and the output of the operational amplifier 104 are both connected to a network of two 2 KΩ resistors 108, 110 and a 0.1 microfarad capacitor 112 which together act as a voltage filter. In this configuration, the operational amplifier acts as a voltage follower for sensing the voltage level of the junction 97 of the MOS transistor and the defibrillation paddle switches, as described below. The voltage sense line 114 is connected to the same microprocessor that is connected to the gate of the MOS transistor, for control of the transistor, as described below. The microprocessor digitizes the analog sense voltage and activates the transistor accordingly.
The MOS transistor 94 and its shunt resistor 98 are connected to a pin in the instrument connector 49 (FIG. 2). When this connector is mated with either the conventional mating connector 12 (as shown) or the multifunction connector, the MOS transistor and its shunt resistor are connected in series with two mechanical switches 116, 118. The switches are rated to withstand the 1 A required by the discharge relay coil. Using the conventional connector 12, the first switch 116 is located in one electrode paddle 120 while the second switch 118 is located in the other electrode paddle 122. Conversely, if the multifunction connector is used as shown in FIG. 3B, both switches 116, 118 are connected to buttons 55 located on the multifunction connector housing 53. In either case, the switches are pressure activated by pressing a depressible push button. The switches are electrically connected in series via a jumper wire located in the connector; both the conventional and multifunction connectors provide this jumper wire. One of the other switch terminals is connected to ground via another pin in the connector and the corresponding pin in the instrument connector.
Each of the two switches 116, 118 has a 10 KΩ shunt resistor 124, 126, respectively, connected across the switch. Accordingly, when the switches are open, the discharge energy generation circuit is completed by the two shunt resistors and when the switches are closed the circuit is completed by two direct connections.
Both of the two mechanical switches and the MOS transistor switch can assume two impedance states: a high impedance state when open (or off), and a low impedance state when closed (or on). Being all connected in series, these three switches provide a scheme for sensing the appropriate time to activate the defibrillation discharge circuit and a scheme for verifying the integrity of the switches.
Both the mechanical switches and the MOS switch are normally open; the small current flowing in the shunt resistors 98, 124, 126 in this condition is low enough that the discharge relay coil 98 is not activated. In this condition, the voltage produced at the MOS-paddle switch junction 97 is determined by the bias resistors 98, 100, 102, 124, 126 and the supply voltage 82; this is about 2.6 volts for the resistor values shown in FIG. 5. Closure of either paddle switch 116, or 118 will remove one of the corresponding resistors 124, or 126 from the bias network by short it out. The resulting sense voltage 114 will therefor change to about 1.9 volts and be sensed by the microprocessor. The sensing of this condition triggers the microprocessor to indicate that the switches should be tested for failure.
When an operator presses both paddle switches, the MOS transistor is connected to ground, and the sense voltage decreases to a low value, at or near ground. Upon detection of this low voltage, the microprocessor triggers the gate 96 of the MOSFET, thereby turning the transistor on. Then with all three of the switches closed, the discharge relay activates.
When both switches are open, the MOS transistor may be tested in two ways. First, if it has failed in an "on" condition it will short out its shunt resistor 98, thereby increasing the sense voltage to a high level, between 4.0 and 4.5 volts, which is set by the zener diode 106 and the protection resistor 102. Second, if the transistor is in the "off" state, it may by turned "on" for a short time, say 2 msec, by the microprocessor, and the resultant voltage change monitored to check its integrity--if functioning the sense voltage would increase. Similarly, if the relay coil is broken, or its connector has a faulty contact, the loss of the bias voltage 82 will change the sense voltage 114 to indicate such a fault.
Table 1 below tabulates the six possible different voltage values at the sense line based on the six possible states of the three switches when the electrode resistors have the same shunt resistor values, as in FIG. 5.
TABLE 1______________________________________ Transistor/Relay States: Trans. Trans. CoilMech. Switch States: Off ShortedOpen______________________________________Both Open 2.57 V 4.31 V 0.72 VBoth Closed 0.18 V 0.55 V 0.18 VOne Open 2.04 V 4.30 V 0.58 V______________________________________
Based on the voltage values of Table 1 and a possible power supply range of 8 V-12 V, Table 2 below gives ranges for the sense voltage which indicate each of the various switch states, as well as electrode and transistor conditions.
TABLE 2______________________________________Switch States: Voltage Range______________________________________Trans. off, mech. switches open 2.3 V-2.9 VTrans. off, one mech. switch open 1.7 V-2.3 VTrans. off, mech. switches closed 0.1 V-0.3 VRelay coil unplugged 1.0 V-1.4 VTransistor shorted >4.0 V______________________________________
Ideally, for a given power supply voltage, the three shunt resistors are chosen such that the voltage range for each of the possible switch conditions is distinct and the various ranges do not overlap. For example, the condition of both mechanical switches closed and the transistor turned off corresponds to a voltage range of 0.1 V-0.3 V, from Table 2, while the condition of one mechanical switch stuck closed and the transistor turned off corresponds to a voltage range of 1.7 V-2.3 V. The large differential between these two ranges ensures that the microprocessor does not misinterpret the switch conditions.
Further differentiation between each possible switch state could be accomplished using a different valued shunt resistor for each of the three resistors. Then eight different switch combinations may be detected. More generally, any circuit element having a characteristic impedance or voltage differential may be used in place of the shunt resistors. For example, a zener diode with a characteristic voltage drop may be shunted across the switches. In addition, circuit elements may be only temporarily connected in the circuit across the switches while the functionality of the switches is tested, rather than permanently installed in the circuit. In either case, the shunt resistance scheme allows for both precise triggering of the defibrillation discharge circuit and testing of the circuit's functionality.
Referring now to FIG. 6, the defibrillation discharge circuit 30 is shown in detail. When the discharge energy switch 36 is closed across the circuit, the discharge energy capacitor 34 is discharged to the defibrillation electrode paddles 18, shown schematically. The capacitor forms an RLC circuit with the pulse shaping inductor 38, the thoracic resistance 130 of the patient to which the paddles 18 are connected, and a parasitic winding resistance 132 corresponding to the inductor winding. The characteristic values of each of the capacitive, resistive, and inductive components in the circuit determine the energy and shape of the defibrillation output pulses.
As the capacitor 34 is discharged, current flowing through the inductor winding generates lines of magnetic flux 134 around the winding turns and through the winding core. Taking advantage of this, a flux sense coil 136 is positioned with respect to the inductor such that the current in the inductor, and thus the current in the discharge circuit, can be monitored without direct connection to the circuit. The flux sense coil 136 comprises a conductor which encircles the inductor-produced lines of magnetic flux 134 at least once; electrical voltage is thereby developed in the sense coil in correspondence to the level of magnetic flux change, and thus, the level of current change in the inductor.
This flux coupling between the inductor and the sense winding is detected by circuitry comprising a bias voltage supply 138, set at 5 volts, two bias resistors 140, 142, set at 2 KΩ and 500 KΩ, respectively, and a smoothing capacitor 144, set at 0.1 microfarads. A voltage sense line 146 senses the voltage of the circuitry, which depends on the level of flux coupling in the sense coil and the design of the coil; the greater the number of sense coil turns, the higher the corresponding current and voltage. The voltage sense line is connected to a monitoring circuit, here a microprocessor, for determination of the discharge circuit current level, and hence the discharge pulse current waveform.
The microprocessor determines the pulse current waveform by sampling the voltage sense line 146 over the duration of the capacitor discharge to produce digitized voltage values. Then the voltage values are numerically integrated over the duration of the discharge and scaled by the inverse of the inductor value to determine corresponding current level values. These current values, which represent the pulse waveform current, are stored for further processing, such as peak current detection, discharge circuit load resistance determination, or pulse energy determination.
In place of a digital processor such as the microprocessor, hardware circuitry may process the sense coil signals to determine the discharge circuit's current waveform. Voltage values of the sense voltage line 146 are here digitized by a hardware analog-to-digital convertor and then integrated and scaled by an operational amplifier configured as an integrator. Peak current detection, load resistance determination, and energy determination processing may then be accomplished using further hardware circuit schemes.
As shown in FIGS. 7A and 7B, the pulse shaping inductor 38 is constructed of conductive windings wound around an air core 150. Each winding layer is isolated by an insulating layer 152 of epoxy impregnated paper. Exit leads 154 for series connection in the discharge circuit are located at each end of the winding, which completes 1000 turns around the air core.
The sense coil 136 is wrapped around the outer winding of the inductor, and is electrically isolated from the inductor by several layers of epoxy impregnated paper. Other isolation schemes may be used, but must withstand the 7500 V which can develop between the coil and winding before breaking down. Sensing exit leads 156 are connected at each end of the coil for connection to the sense circuitry.
Additionally, the sense coil should occupy minimum space to keep the unit small and light. To effectively meet all of the above requirements, the sense coil is formed of a 1/8 inch-wide copper band comprising a 0.005 inch-thick copper layer and a 0.0015 inch-thick adhesive layer. This coil configuration is advantageously flat and easily positioned on the inductor winding. However, any effective conductor which can meet the discharge circuit's electrical requirements may be used as the coil, in any desired number of turns which generates a desired level of sense current and voltage.
Referring now to FIG. 8, the portable unit 10 includes design features for conveniently discharging the defibrillation discharge circuit to test the defibrillation discharge circuit's functionality. As shown in FIG. 2, the discharge circuit is connected via either a conventional mating connector or a multifunction connector to a pair of defibrillation electrodes. If the conventional scheme is used, the discharge circuit connects to a pair of hand held defibrillation paddles 18, shown in FIG. 8. Each paddle supports a defibrillation electrode 160 on its underside for application to the chest of a patient.
When not in use, the defibrillation paddles 18 are stored in a well 162 on the portable unit 10. The top side of the paddles are slid under a ledge 164 for securing the paddles in place on the unit housing with the electrodes 160 facing the housing. At the back of the well 162 is a conducting shorting bar 166 which lies on the well bottom and extends laterally under the ledge 164 to lie under the electrodes 160 when the paddles are pushed completely into the well. The lateral edges of the shorting bar 166 are flared upward to exert a positive contacting force on the electrodes when they are in place over the bar.
When the defibrillation discharge circuit is discharged and the electrode paddles 18 are in place in the well such that the electrodes 160 contact the shorting bar 166, a defibrillation pulse is discharged across a short circuit, rather than the thoracic resistance of a patient. As explained below, this discharge pulse is monitored to analyze its characteristics for verifying the acceptability of the pulse. The location of the shorting bar in the paddle well 162 is particularly advantageous because it prevents contact to the bar by an operator during a test discharge. As discussed above, the defibrillation circuit signals may reach quite high levels of voltage and energy, and thus operator coupling to the circuit must be prevented. In its position in the paddle well, the shorting bar is covered by the paddles and inaccessible to operator contact. However, the shorting bar may be located at any convenient position on the portable unit, or even detached from the unit.
Referring again to FIG. 6, during a discharge circuit test into the shorting bar, the thoracic load resistance 130 is replaced by a short circuit. As the defibrillation pulse is discharged into the short circuit, the flux sense coil 136 is coupled to the discharge inductor 38 to produce a sense voltage, and the sense voltage line 146 is monitored by a microprocessor to analyze the discharging pulse. Alternatively, a current transformer, or some other sensing component connected in the circuit could monitor the current.
In the sense coil scheme described above, once the defibrillation discharge is initiated, the microprocessor (connected to the sense voltage line) digitally samples the sense voltage line at 60 microsecond intervals and stores the sampled values. The discharge is ended after 25 milliseconds when the discharge capacitor switch is disconnected from the inductor discharge circuit. A. plot 170 of the stored voltage samples, as shown in FIG. 9A, illustrates that the voltage initially rises to some peak voltage 172, after which it falls to a valley voltage 174, and then levels off at a final voltage 176. The peak voltage 172 is typically reached about 6 milliseconds to 8 milliseconds after the discharge has been initiated, and the final voltage 176 is typically reached about 20 milliseconds later.
The microprocessor post-processes the stored voltage data to reconstruct the voltage waveform and convert it to a corresponding current waveform. First each voltage sample is measured to locate the first samples having a voltage value that is at least about 25% greater than the previous values. This indicates the start of the voltage waveform. Then a number of the previous values, say 6, are remeasured and averaged to determine the baseline, or quiescent, value of the waveform. This baseline is defined to be zero volts.
Having determined the waveform baseline, each sample value starting with the first sample above baseline is numerically integrated and scaled to produce current values corresponding to the voltage values. As part of the integration computation, the baseline value is subtracted from each integrated value so that only the waveform value is added in the integration. At the end of the integration interval, the last current value should be zero. If it is not zero, the last current magnitude is measured and proportionately subtracted from all the previous current values to set the baseline value at zero.
A plot of the corresponding current waveform as shown in FIG. 9B illustrates that the current rises to a peak current value 182 and then falls off to a valley current value 184, after which it settles to a final current value 186, which is adjusted to be zero. The current peak 182 corresponds to the first zero crossing 173 of the voltage waveform and the current valley 184 corresponds to the second zero crossing 175 of the voltage waveform. The magnitude of the current peak and valley is determined by the value of the discharge inductor's parasitic resistance (132 in FIG. 6), and thus any changes in the resistance are reflected in the sampled values. As discussed below, the waveform values are adjusted accordingly to compensate for any resistance changes.
The current peak value 182 is detected by measuring the current value samples located between 0.5 milliseconds and 2.5 milliseconds. Once a peak value is located, it is added to the three current samples preceding it and the three current samples following it to produce a 7 sample peak sum. Similarly, the current valley value 184 is detected by measuring the current value samples located between 3.0 milliseconds and 6.0 milliseconds. Once a valley value is located, it is added to the three current samples preceding it and the three current samples following it to produce a 7 sample valley sum. The peak and valley sums are then stored for later computations.
A ratio of the peak current sum to the valley current sum is then computed. This ratio is used to determine any necessary adjustments in the peak current to compensate for changes in the discharge inductor's parasitic resistance. As mentioned above, this resistance may vary; it is particularly dependent on temperature. At 25� C., the resistance of the 1000 turn winding is about 13Ω, but the resistance changes by -0.4% for each �C. drop. Thus, for the range of expected operating temperatures, the parasitic resistance ranges from 10 Ω-14 Ω.
As the parasitic resistance varies, the peak current varies accordingly, because the resistance is part of the RLC circuit which generated the pulse current. The valley current also varies according to the parasitic resistance, and is more strongly effected by resistance changes than is the peak current. With a high load resistance, such as the typical 50 Ω thoracic patient resistance, the current waveform would exhibit no valley current. At a load resistance of about 25 Ω, the circuit would be critically damped, and exhibit a slight current valley. With a short circuit load, as in the discharge test described above, the magnitude of the valley reaches about 30-35% of the peak current magnitude. If the parasitic resistance decreases due to a temperature decrease, the valley current will increase more than the peak current will increase and will thereby produce a smaller peak to valley current ratio than at a higher temperature. In the limiting case, if the resistance of the RLC circuit dropped to zero, the current peak and valley would be equal and the waveform would never dampen out.
The current peak is adjusted based on a comparison of the computed peak to valley current ratio and a range of prespecified peak to valley current ratios. At 25� C. and a discharge energy of 100 joules, the ratio is expected to be 3.1. If the temperature is below 25� C. that ratio will be lower than 3.1, while the ratio will be higher than 3.1 if the temperature is above 25� C.; the change in the parasitic resistance described above effects this ratio change.
If the computed ratio is less than 3.1, then the adjusted peak current sum Ipeak ' is computed based on the measured peak current IPeak as follows:
I.sub.peak '=I.sub.peak +7 * [13*|k|-40];
if the computed ratio is more than 3.1, an adjusted peak current sum Ipeak ' is computed based on the measured peak
I.sub.peak '=I.sub.peak +7 * [10*|R|-31],
where R is the peak to valley current ratio.
The peak current sum is not adjusted if the computed ratio is more than 4.0. This ratio value indicates that a defibrillation discharge to a resistive load (such as a patient), and not a test discharge to the shorting bar, occurred. As explained above, the load resistance of the discharge circuit determines the peak and valley pulse currents, and thus the peak to valley current ratio. When a defibrillation pulse is discharged to a patient, there is little or no current valley, and the ratio is above 4.0. Thus no special test indicator must be operator-activated when a test is to be performed; the microprocessor automatically detects this via the peak to valley current ratio. All that is required is for the energy of the test to be set at 100 joules--the current waveform computations are based on this energy value. If the ratio is above 4.0, no test results are displayed to the operator.
For test discharges, the adjusted peak current value is compared to a preset range of current values to determine if the defibrillation pulse is acceptable. If the peak current falls between 65 A and 78 A, the microprocessor displays a "Test OK" message on the portable unit's screen. Conversely, if the peak current does not fall within the range, a "Test Failed" message is displayed for the operator.
Further waveform analysis may be completed. For example, the total energy of the pulse may be computed by numerically integrating the pulse current value, squared, multiplied by the inductor parasitic resistance over the duration of the pulse. Thus, the total energy of the pulse, Etotal, may be expressed as:
E.sub.total =∫ (i.sup.2 R) dt
where R is the inductor parasitic resistance, i is the pulse current value, and the integral is taken over the duration of the pulse. Based on this energy value, and the initial capacitor voltage sample value, the capacitor value may be verified.
Other waveform analysis includes determining the pulse width by detecting the zero crossings of the current waveform. Additionally, the rise and fall times of the waveform may be computed based on the voltage sample values and their corresponding sample times.
As an alternative to the microprocessor, analog and digital hardware may be implemented to perform the various waveform computations. For example, as described above, an operational amplifier configured as an integrator may be used to complete the various integration calculations. Other hardware circuitry corresponding to the sampling, scaling, and comparing functions of the microprocessor may similarly be implemented.
Other embodiments are within the following claims. For example, certain of the features relating to the defibrillator could be incorporated in a unit not having pacemaking capability.
|Cited Patent
|Filing date
|Publication date
|Jan 8, 1985
|Dec 16, 1986
|Physio-Control Corporation
|Defibrillator adapted for use with accessory cassettes
|Oct 23, 1990
|Jul 23, 1991
|Cardiac Pacemakers, Inc.
|Combined defibrillator pacer system utilizing pacer tip lead switch
|Sum and Dewhurst, "Digtal cardiac defibrillator tester," Nov. 1979, 710-714, Medical and Biological Engineer and Computers, vol. 17, No. 6.
|Sum and Dewhurst, Digtal cardiac defibrillator tester, Nov. 1979, 710 714, Medical and Biological Engineer and Computers, vol. 17, No. 6.
|Citing Patent
|Filing date
|Publication date
|Sep 21, 1995
|Jan 7, 1997
|Heartstream, Inc.
|Defibrillator system condition indictator
|Feb 14, 1996
|Jan 14, 1997
|Heartstream, Inc.
|Electrotherapy method
|Feb 14, 1996
|Feb 11, 1997
|Heartstream, Inc.
|Method for applying a multiphasic waveform
|Apr 14, 1994
|Mar 4, 1997
|Heartstream, Inc.
|Electrotherapy method and apparatus
|Jun 6, 1995
|Apr 8, 1997
|Heartstream, Inc.
|Defibrillator electrode system using a flexible substrate and having electrode test features
|May 24, 1996
|Apr 15, 1997
|Heartstream, Inc.
|Electrotherapy method
|Aug 8, 1995
|Jul 8, 1997
|Survivalink Corporation
|Automated external defibrillator with lid activated self-test system
|May 10, 1996
|Dec 16, 1997
|Survivalink Corporation
|Defibrillator electrodes and date code detector circuit
|Apr 15, 1996
|Feb 10, 1998
|Physio-Control Corporation
|Common therapy/data port for a portable defibrillator
|Feb 20, 1997
|Apr 7, 1998
|Heartstream, Inc.
|Electrotherapy method for external defibrillators
|Jul 31, 1996
|May 12, 1998
|Heartstream, Inc.
|Electrotherapy method utilizing patient dependent electrical parameters
|Aug 2, 1996
|May 12, 1998
|Heartstream, Inc.
|Electrotherapy method utilizing patient dependent electrical parameters
|Feb 20, 1997
|Jul 7, 1998
|Heartstream, Inc.
|Method for applying a multiphasic waveform
|Jan 9, 1997
|Aug 25, 1998
|Survivalink Corporation
|One button lid activated automatic external defibrillator
|Apr 16, 1997
|Sep 1, 1998
|Heartstream, Inc.
|Method for performing self-test in a defibrillator
|Feb 19, 1997
|Sep 8, 1998
|Heartstream, Inc.
|Electrotherapy method and apparatus for external defibrillation
|Aug 12, 1997
|Nov 17, 1998
|Heartstream, Inc.
|Electrotherapy method for producing a multiphasic discharge based upon a patient-dependent electrical parameter and time
|May 10, 1994
|Mar 9, 1999
|Heartstream, Inc.
|External defibrillator with automatic self-testing prior to use
|Aug 7, 1997
|May 4, 1999
|Heartstream, Inc.
|Method and apparatus for aperiodic self-testing of a defibrillator
|Nov 26, 1997
|Jul 6, 1999
|Survivalink Corporation
|Watchdog timer for automated external defibrillator
|Nov 26, 1997
|Oct 26, 1999
|Procath Corporation
|High energy defibrillator employing current control circuitry
|Oct 8, 1997
|Apr 4, 2000
|Heartstream, Inc.
|External defibrillator capable of delivering patient impedance compensated biphasic waveforms
|Nov 25, 1996
|Jun 6, 2000
|Physio-Control Manufacturing Corporation
|System for automatically testing an electronic device during quiescent periods
|Jul 10, 1996
|Jun 13, 2000
|Defibrillator system condition indicator with an electrode interface
|Jan 28, 1999
|Aug 15, 2000
|Heartstream, Inc.
|Method and apparatus for delivering defibrillation and pacing energy from a single power source
|Jan 28, 1999
|Sep 12, 2000
|Heartstream, Inc.
|Method and apparatus for delivering defibrillation energy
|Mar 6, 1998
|Nov 14, 2000
|Cardiac Science, Inc.
|Defibrillation system having segmented electrodes
|Apr 23, 1999
|May 8, 2001
|Agilent Technologies, Inc.
|Apparatus for controlling delivery of defibrillation energy
|Nov 10, 1999
|Jun 26, 2001
|Agilent Technologies, Inc.
|Method for delivering defibrillation energy
|Apr 30, 1999
|Jul 24, 2001
|Agilent Technologies, Inc.
|Defibrillator with automated test load
|Aug 31, 2000
|Oct 9, 2001
|Cardiac Science Inc.
|Defibrillation system
|Aug 31, 2000
|Oct 16, 2001
|Cardiac Science Inc.
|External defibrillator system with diagnostic module
|Aug 31, 2000
|Apr 16, 2002
|Cardiac Science Inc.
|Defibrillation system
|Apr 22, 1999
|Jun 11, 2002
|Koninklijke Philips Electronics N.V.
|Damped biphasic energy delivery circuit for a defibrillator
|Dec 28, 2001
|Apr 26, 2005
|Medtronic Physio-Control Manufacturing Corporation
|Circuit package and method for making the same
|Mar 11, 2002
|Nov 15, 2005
|Medtronic Physio-Control Manufacturing Corp.
|Method and apparatus for self-test of defibrillation and pacing circuits including a patient isolation switch
|Oct 4, 2004
|Jul 18, 2006
|Koninklijke Philips Electronics, N.V.
|Damped biphasic energy delivery circuit for a defibrillator
|May 7, 2002
|Aug 22, 2006
|Medtronic Physio-Control Manufacturing Corp.
|Method for self-test of defibrillation and pacing circuits including a patient isolation switch
|Nov 28, 2002
|Jun 26, 2007
|Desmond Bryan Mills
|Portable defibrillators
|Dec 5, 2003
|Feb 5, 2008
|Nihon Kohden Corporation
|Electric stimulator and defibrillator
|Jun 18, 2014
|Jul 28, 2015
|Cardiac Science Corporation
|Defibrillation system
|Dec 28, 2001
|Jul 3, 2003
|Medtronic Physio-Control Manufacturing Corporation
|Circuit package and method for making the same
|Mar 11, 2002
|Sep 11, 2003
|Medtronic Physio-Control Manufacturing Corp.
|Method and apparatus for self-test of defibrillation and pacing circuits including a patient isolation switch
|Dec 5, 2003
|Aug 19, 2004
|Nihon Kohden Corporation
|Electric stimulator and defibrillator
|Nov 28, 2002
|Apr 21, 2005
|Kevin Herbert
|Portable defibrillators
|Oct 4, 2004
|May 12, 2005
|Lyster Thomas D.
|Damped biphasic energy delivery circuit for a defibrillator
|Nov 9, 1998
|Jun 3, 1999
|Procath Corporation
|Nov 28, 2002
|Oct 2, 2003
|Ixa Group Ltd
|Improvements in and relating to portable defibrillators
|U.S. Classification
|International Classification
|Cooperative Classification
|European Classification
|Apr 10, 1992
Owner name: ZOLL MEDICAL CORPORATION A MA CORPORATION, MASSA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST.;ASSIGNORS:FINCKE, RANDALL W.;LOPIN, MICHAEL L.;REEL/FRAME:006086/0710
Effective date: 19920401
|Jun 25, 1992
Owner name: ZMD, DELAWARE
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST.;ASSIGNOR:ZOLL MEDICAL CORPORATION, F/K/A "ZMI" CORPORATION A CORP. OF MA;REEL/FRAME:006167/0978
Effective date: 19920612
|Jul 26, 1994
|Certificate of correction
|Feb 3, 1997
|Fee payment
Year of fee payment: 4
|Apr 4, 2001
|Fee payment
Year of fee payment: 8
|Mar 22, 2004
Owner name: ZOLL MEDICAL CORPORATION, MASSACHUSETTS
Free format text: OWNERSHIP AND MERGER;ASSIGNOR:ZMD CORPORATION;REEL/FRAME:015127/0153
Effective date: 20031120
|Apr 5, 2005
|Fee payment
Year of fee payment: 12


text:
Touch Beauty 3-in-1 Electric Facial Cleanser & Massager - Mint/White
Give your face a spa date with the 3-in-1 Electric Facial Cleanser & Massager. Featuring 3 unique detachable heads for the ultimate in deep cleaning and cleansing. Simply add your favourite cleanser or make-up remover and voila! The spare heads are conveniently stored inside the base of the stand, ready for when they are needed.
- Touch Beauty appliances
- 3-in-1 Facial Cleanser & Massager
- Model: AS-1282
- Colour: Mint/White
- Package contents:
- Ergonomic hand held device
- Storage stand
- Soft brush
- Fine silicon brush
- Sponge
- AC adaptor
- Rechargeable device
- Water resistant IPX5
- 360° rotation
- Deeply cleanses your face
- Kindly cares for your skin texture
- Keeps you looking youthful
- Two speed settings
- Low speed suitable for sensitive skin
- Storage stand can hold 2 attachment heads inside
- Power: 100-240V, 0.2A
- Dimensions (approx. cm):
- Hand held device: 12 (L)
- Base: 8.5 x 5.5 (L x W)
- Materials: ABS plastic/silicone/nylon
- Please note: Contents are as pictured and stated in above features. Please disregard the box.
Customer Reviews
5 Star
4 Star
3 Star
2 Star
1 Star

subset: commoncrawl


text:
When you experience a condition where the computer suddenly feels hotter, the fan work more often and perhaps slowing the performance of your computer is in a state that is too high CPU usage.
This condition is more annoying if it turns out you do not do anything, and where the High CPU load comes from? Of a number of issues that arise, the cause is bugs in wmiprvse.exe, fortunately for addressing computer user CPU is too high due to bugs wmiprvse.exe easy to overcome.
How to Solve High CPU Usage Due To Windows Bugs1. First you have to do is make sure the cause of the decrease CPU usage of computer performer, not a virus or another. How to right click on the toolbar of your computer and click Start Task Manager, or press Crtl + Alt + Del.
2. On the Windows task manager, click the Performance menu and note the CPU usage level, if it reaches 50% and above then your suspicions are true.
3. Then click the start menu and type Services, at the start menu you will see several options, click Services.
4. Then find the services Windows Management Instrumentation, right-click on the selection and click Stop or Restart.
The situation is quite often experienced by users who have not done the latest update, Microsoft itself has released a patch that you can download from this link: http://www.microsoft.com/en-us/download/details.aspx?displaylang=en&id = 1157
As an option, you could do a similar way to Solve High CPU Usage Due To Windows Bugs.
Read previous topic : How to Convert Media Audio and Video Using Junkie in Linux Format


text:
Shipping Information within Australia:
To calculate shipping costs simply add items to the shopping cart and proceed to the checkout where shipping costs will be displayed without placing an order.
Shipping & Delivery:
At this time, we ship our merchandise to all locations with a postal service via Australia Post or courier service.
How long will it take to get my order?
Gel Treatment Packs & Accessories: orders will be dispatched same or next business day from the receipt or your order and payment. Orders are shipped via Express Post takes 1 - 2 business days depending on your location.
Starter Kits: orders will be dispatched within 1-5 business days from receipt or your payment.
Shipping takes 1 - 6 business days depending on your location.
All dispatch times are subject to slight variation.
International Shipping:
Customs and import duties may be applied to International orders when the shipment reaches its destination. Such charges are the responsibility of the recipient of your order and vary from country to country. Contact your local customs office for details. Additional charges will apply for international shipping.
Dispatch Quality Assurance:
All products and equipment are thoroughly checked prior to dispatch. If you do receive something that has been damaged in transit we will solve the problem for you in the most efficient way possible. If you receive gels which have been affected in any way during transit we will send you replacements with no need to return them. If you do need to return an item we will provide you with the a return address either our office, warehouse or postal address depending on which best suits the item.
Lay-by is welcome and has no additional charges, however, your order will not ship until it is paid in full. Read more about lay-by HERE
We offer our customers the highest level of customer service and back our products 100%. If something fails to meet your expectations we want to know about it. It is our aim at Celebrity Whitening to exceed your expectations in products and service. We believe our after sales service is the best in the industry, but no need to take our word for it ... see for yourself!
Changed your mind? Equipment, lamps and non consumables may be returned if you change your mind as long as they are in unused condition and in original packaging. The return must be agreed to prior by one or our management staff in writing. The return must be agreed to prior by one or our management staff in writing. The return must be initiated with tracking within 7 days of it being received, attempted delivery or awaiting collection at the post office or couriers collection center. The goods must be returned to us at your cost and tracking is required. There is no refund on postage and a 20% restocking fee applies. We are unable to accept returns of consumables i.e. cheek retractors, swabs and gel products if you change your mind as we are unable to resell them once they have left our facility due to hygiene and storage requirements. We will accept returns of these items only if they are faulty.
Gel Kit Guarantee:
We offer a 30 day money back guarantee on all our gels and gel kits. If our products don't give you great results please contact us within 30 days. You may have replacement gel pens without returning the product or alternatively return the unused products for a refund less delivery. Please note that although all care is taken gels can become hot during transit especially in summer months. If the gels you receive are leaking or seem ineffective please let us know so we can replace them for you.
Returns after 30 days are unable to be accepted as the treatment and storage of gels plays an important roll in their effectiveness. A complete guide to storage is provided as part of our training.
Please note: Returned gels will be discarded and not resold.
LED Lamp and Equipment Warranty:
We offer a 12 month warranty on all our equipment. Please contact us as soon as possible if you experience a fault so we can work out the best way to resolve it for you. Most lamp issues can be solved by either replacing the fuse or the power cord. If this does not solve your issue return the lamp to us for inspection. Where the equipment is deemed faulty we will have your item repaired or replaced (whichever is practicable at our discretion) in the shortest time possible to have you operational again.
Exclusions: Consumables are not covered by warranty. We do not cover any item which shows evidence of being dropped, roughly treated, left in extreme heat or elements or damaged through being mishandled or misused. We do not cover the cost of freight to return the item to us. The warranty does not include damage due to misuse, water damage, power surges or accidental damage. If there is evidence the lamp has been damaged (scuffs, chips or cracks on the machine etc) the warranty would be voided.


text:
Carl Frampton brought the house down in his hometown win over Horacio Garcia.
Belfast boxer Paddy Barnes is the new WBO Intercontinental champion.
The Republic of Ireland soccer team gear up for the second leg of their World Cup play off with Denmark this afternoon. Come on you boys in green!
Celebrating the everyday GAA volunteer willingly to give their time in communities across Ireland all year round not just for the All-Ireland!
Conor McGregor's dad has said that he wanted his son to become a plumber. I wonder how he feels about his son's career choice now?
Does Floyd Mayweather really struggle against left-handed fighters? That's what UFC Chief Dana White seems to think.
McGregor has undoubtedly tremendous fighting skills but his skills outside the ring have arguably helped him even more. Here are his best quotes.
This is where it all began for the Notorious.
A highly regarded sports journalist left Irish readers bemused at the description of Dublin as somewhere close to a war-torn country.
Guinness heap praise on the volunteers who keep local GAA going in a heartwarming, beautiful introduction to four people dedicated to their local GAA club.
No firm favorite has been established - but Floyd Mayweather thinks Conor McGregor has an advantage.
Two of Ireland's biggest stars might be making appearances at McGregor's fight.
The US President is "100 percent interested" in attending, according to his friend and UFC President Dana White.
Pete Flynn, a native of County Leitrim, and an original Met dating back to 1962, has passed away.
Build your custom vacation around the biggest Irish sports calendar event, the GAA All-Ireland Championship Finals.
Ty Kelly revisits his Jewish roots and finds a connection.
After the major success of the text games in Chicago in 2016 rugby is set to take the USA by storm
People are buying the chips, the dips, the wings and the face paint as they get ready for the big game on Sunday.
Irish boxing star goes pro with Madison Square Garden March 2017 match on the cards.
Irish politician Brid Smith believes the Irish team's stay could send the wrong message to US voters on November 8.
Irish golfers predicts gold medals if their boxing is as good as their tweeting.
The Irish Olympic delegation has been thrown into turmoil after the arrest of its most senior delegate in Rio.
Long before the O'Donovan brothers arrived on the scene, one Irish "commentator" was confusing international media.
Dublin sailor Annalise Murphy took silver in the Women's Laser Radial (Dinghy) sailing competition.
Michael Conlan, the last of Ireland's boxing hopes, also faced a shattering defeat this morning.
What you should know about the history of your Irish surname
How the Irish saved Thanksgiving
John F. Kennedy very likely had celiac disease
Does Black Friday ruin Thanksgiving?
Irish Thanksgiving blessings, toasts, and sayings for your family and friends
Kid-friendly and adult-friendly Irish Thanksgiving jokes
Michael Fitzgerald: Who Is Frances Fitzgerald's Husband?
Courtney Cox surprised Johnny McDaid with a star-studded video at the Irish Post Awards
LISTEN: The Great Famine podcast series – the Irish rebel Anne Devlin
Little Irish boy with cancer has best day ever on the set of 'Vikings'
Thanksgiving leftovers recipe: turkey enchiladas with olives


text:
I was feeling so alone and really believed I was the only person in the world dealing with dementia, but I did the best I could.
By Olga Brunner
Her dementia and diabetes were out of control and she needed a daughter .
Now, caregiving is not meant for everyone and as we all know, there are some very god sons out there as well. Be that as it may, I began my indoctrination into the world of memory loss, repetitiveness, medications management, and doctor appointments.
|Subscribe to the Alzheimer's Reading Room
Although I had approximately 20 years of health care experience under my belt, I knew very little about the world of dementia.
Reluctantly I left behind the sunny skies, fair winds, and sailing the waters of San Diego and headed for the heat and hurricanes of South Florida. Once here I was committed to helping mom as best as I could.
Because of her diabetes, she needed regular fasting lab tests and doctor visits so I was getting her to the medical office by 8:00 am for lab draws, endless waiting for the doctor to arrive (he was always late), a drive to Denny's for breakfast, then over to her day center before heading for work.
I was already feeling so alone and really believed I was the only person in the world dealing with dementia and diabetes but I did the best I could. I continued advocating as best I could but the doctor kept telling me it was just "old age".
This morning I couldn't take it anymore and yelled "look I am the one living with her. I want you to refer her to a neurologist!"
Leaving his office with my referral, I drove mom to Denny's and mistakenly made a right turn on the red; soon the 2 blue and white police cars were blaring their lights behind me as if I were a criminal. All I wanted was to feed mom some breakfast – geeze!
I made light of it since I did not want to upset mom, took my ticket, and got breakfast at Denny's making sure she had nourishment. Soon we were out and headed for the adult day center.
On my arrival the receptionist remarked, "Nice to see you Olga, it's been a long time", and I broke down, crying for 3 hours at least. It just wouldn't stop.
I felt as if the pressure that had been building inside me just burst open and the dam just flooded. Soon it was to the social worker's office where a call was made to my employer stating they shouldn't expect me today. But I got the help I needed that day and I learned I was not alone.
There were support groups, counselors, respite care, and relief so that I could get out to a movie once in a while or visit a neighbor for a glass of wine.
If you are feeling trapped, there is plenty of help available. Seek some help.
Support groups are wonderful – they help you sort out feelings and point you in the direction of receiving good medical care for your loved one. You don't need to feel as alone as I did back then.
In the U.S. today, we are experiencing the opening of Memory Cafés in many communities. They provide an opportunity for individuals with early memory loss and their care partners to come together with others in their peer group for coffee, treats, and enjoyable activities at no charge.
Geriatric Care Managers are a valuable source of information as well. Even if you don't hire one, call one and find out how you can begin to get help. Help is available.
Mom passed in 2003 and I became a geriatric care manager. Our agency is soon going to open a Memory Café in Boca Raton. I have finally come full circle.
A Good Daughter Elder Care Management, and was recognized for demonstrated dedication, leadership and excellence in geriatric care management by Cambridge Who's Who. Ms. Brunner resides in Boca Raton, Florida.
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Original content the Alzheimer's Reading Room


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All new models of Kodak LED TVs has just launched in India and price for the base model starting at Rs 13500. This new TV range from Kodak comes with appealing specifications and options. Kodak is a famous brand, well known for making cameras. Now they have just forayed into TV market and introduced five new TVs.
Kodak LED TVs are manufactured by Super Plastronics, which is a license partner of Kodak. Among the 5 models, three are Smart TVs and other two are regular TVs. You can choose from 32, 40 and 53 inch Smart TVs. These models packed with latest Interface, USB to USB copy, MHL, 4 GB Flash storage, 512 MB memory, MHL and Air Mouse. While those 40 and 50 inch TVs sport 300 nits Samsung Panel.
The Smart LED TV variants includes Kodak 32 HDXSMART, Kodak 40 FHDXSMART and Kodak 50FHDXSMART. This models gets HD LED TVs with wide 178X178 viewing angles, 'Progressive scan', 512MB RAM, a 4GB of flash storage, Air Mouse feature, MHL, 'YPrPb resolution', response time less than 8 ms, Samsung display etc.
The normal TVs are Kodak 32HD X900S and Kodak FHDX900S. This is packed with features and options like 250 nits display brightness, USB to USB copy feature, inbuilt games and Samsung display panel. Both the 32 inch TVs supports 1366×768 pixel resolution.The televisions are supported by ARM Cortex A7 for best performance.
The 40 inch vanilla TV from Kodak supports 300 nits of Samsung display panel, USB to USB copy features etc. The 40 and 50 inch models features full HD (1920×1080 pixels) resolution. Those three Smart TVs have Android KitKat OS, WiFi and Miracast facilities. You have 2 HDMI and 2 USB ports too. Only 50 inch model gets 3 HDMI and 3 USB ports.


text:
Shane Co.
Round Traditional Sapphire and Round Diamond Earrings
Description & Specifications
These diamond-shaped earrings beautifully feature two round traditional sapphires (approx. .61 carat TW), one centered in each earring. The blue sapphires are accented by a total of 12 round diamonds (approx. .09 carat TW) pavé-set on one side in quality 14 karat white gold. The total gem weight of these earrings is approximately .70 carat.
Item Number: 41070964
Item Number: 41070964
- *Total Carat Weight3/4 ct. t.g.w.
- Sapphire ColorBlue
- *Metal FinishPolished
- Metal Type14K White Gold
- Stone TypeTraditional Sapphire
- Setting TypeMultiple Types
- Stone ShapeRound


text:
Although Derrick Lewis bombed out Travis Browne at UFC Fight Night 105 to extend his winning streak to six, the powerful fighter isn't proclaiming he's the best heavyweight on the planet just yet…
Lewis appeared to be in trouble early on, after Browne landed some hard body kicks that had his opponent wincing in pain. But in round two, Lewis floored Browne with a right hook and then finished the deal with pounding punches from above. It marked the fifth time in six fights that the heavyweight has stopped an opponent.
Following the memorable and impressive win, however, Lewis had this to say (quote via MMA Fighting):
"I gotta work on my overall game," Lewis said. "The guys in the top five, they're good everywhere. Me, I'm just almost one-dimensional. I believe I've got the most heart in this division. it carries me the whole way through this six-fight win streak. The heart, that beast mode kicks in, and thank god for that."
There's no question that Lewis has shown a ton of heart and toughness in some of his recent outings. Lewis battled Shamil Abdurakhimov into the fourth round before he finally stopped the Russian. Lewis went three rounds with Roy Nelson and earned the split decision win. As noted above, he took some hard kicks from Browne, but stayed in there and came back to finish the 6'7 tall heavyweight.
Lewis is also right, however, in that there's some very dangerous and well rounded heavyweights at the top. Cain Velasquez and Stipe Miocic are dangerous standing and can wrestle. Fabricio Werdum is ridiculously athletic, can strike and is deadly on the mat. Junior dos Santos can crack and he has great TD defense.
Lewis also said he plans to take a break from fighting after a busy 12 month campaign, but it will be interesting to see who he faces in his return.


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Battlefield 3 gameplay footage: Caspian BorderAugust 16th, 2011 by WordPlop
This game looks amazing, and will definitely be better and more fun than whatever the new version of Call of Duty will be. Check out this amazing gameplay footage of Battlefield 3 below.
Posted in Gaming, Multimedia
10 Free Useful Android Apps »


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Imagine your very own geodesic dome cabin secluded in a wooded forest in the Great North Woods. This unique property has over 12 acres with lovely stone walls meandering through and offers a small stream not far from the cabin. This off-grid getaway is truly a magical place to escape the hustle and bustle of the world. Don't want to camp? Stay in the cabin while you build your dream home. Located on a town maintained road for year round access. Hunt on your own land. Snowmobile trail access nearby.
See our video tour


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Download RollerCoaster Tycoon Classic v22.214.171.1243021 Android Money and All Unlocked Cheat MOD APK + DATA
RollerCoaster Tycoon® has added a whole new game! RollerCoaster Tycoon® Classic, a fun simulation game, will be your challenge. You will struggle to undertake and fulfill your duties. When you are able to fulfill your duties in the game, you can progress to the levels you have achieved and thus you have performed well in your game. If you want to play this entertaining game, you can download it free of charge from "MobilApk.com" and start playing immediately. Have fun!
Name Of Game : RollerCoaster Tycoon Classic
Category : Simulation Games
Publish Date : 18.06.2017
Size : 257 MB
Developer Firm : Atari, Inc.
File Type : .apk
Google Play Rating : 4,5
How Many Times Downloaded : 100.000+
1- Set up the ".APK" to your device
2- Copy the " com.atari.mobile.rctc " folder in to "android/obb"
3- Enter the game. Just this. Have fun!
Download RollerCoaster Tycoon Classic v22.214.171.1243021 Mod Apk


text:
Home :: Disney Movies :: Knight In Camelot, A
Knight In Camelot, A
NR | 90 min | Sunday, November 8, 1998
Movie Description
Mark Twain had many visions of Camelot, but it's safe to say he probably never envisioned the ruckus caused by the visit of Dr. Vivien Morgan. Armed with a laptop and a boom box, Dr. Morgan takes Camelot's court by storm.
Genre: Adventure Comedy Science Fiction
Disney Movie Rating:
66.79 out of 100. Total of 31 votes.
Knight In Camelot, A Trailer
Notable Cast
This film does not yet have notable Disney actors/actresses associated with it.


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Bernard Martin
- 30 years old
- Date of birth: Mar 4, 1942
- Place of birth:
Salford, United Kingdom
- Date of passing: Jan 15, 1973
- Place of passing:
Swinton Manchester, United Kingdom
|Let the memory of Bernard be with us forever
This memorial website was created in memory of our loved one, Bernard Martin, 30, born on March 4, 1942 and passed away on January 15, 1973. We will remember him forever.
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"Forever in my thoughts xx"
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GraphicRiver Corporate Business Card Vol.38 6352198
Category: Print Template | Comment: ( 0 )
GraphicRiver Corporate Business Card Vol.38 6352198
Print Template \ Business Cards \ Corporate
Business \ Ready \ Print \ Pattern \ Personal \ Code \ Reddish \ Vector \ Visiting
Print Template - Corporate Business Card Vol.38 6352198 by realisticgraphic @ GraphicRiver
Print Template \ Business Cards \ Corporate
Graphics Files Included: Vector EPS, AI Illustrator ; Layered: Yes ; Minimum Adobe CS Version: CS ; Print Dimensions: 3.5x2 .
An Elegant, Stylish, Simple, Professional and Clean Corporate Business Card for all personal or commercial use.
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By Art Martone
FOXBORO -- Coming into Sunday's New England-New York AFC East showdown, the Patriots had defensive worries. And the Jets? They had offensive problems.
Hard to know, then, whether what transpired in the first quarter was a case of New England fixing its issues, or New York's woes continuing.
The Pats' defense held the Jets to 31 total yards, and actually stopped New York on all three of its third-down attempts. It helped carry New England to a 7-0 lead after one period.
The Patriots broke on top with a five-play, 64-yard drive in which BenJarvus Green-Ellis did the bulk of he work; he carried the last four plays of the drive and bulled in from the 3 for the score with 7:32 left in the quarter. But Green-Ellis' journey to the end zone was set up by a 32-yard completion from Tom Brady to Wes Welker, which moved the ball from the Pats' 41 to the Jets' 27.
It was the highlight of an otherwise nondescript period for Brady and the Pats' offense, which was forced to punt on two of its three possessions.
Art Martone can be reached at email@example.com.


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The GW Medical Faculty Associates Department of Emergency Medicine (DEM) provides emergency patient care to three hospitals, educates the next generation of health professionals and provides a wide range of innovative emergency medicine consulting services.
The DEM is actively involved in a wide range of Emergency Medicine-related clinical, educational, research, and consulting programs. In support of our medical student, resident, and fellowship education programs and clinical research programs, the DEM staffs the ED's of three hospitals. To learn more about our education and training programs, visit The GW School of Medicine & Health Sciences website. The DEM also offers a wide range of Emergency Medicine consulting activities including: medical support for the travel assistance and commercial shipping industries, staffing solutions for remote clinics, telemedicine-related services, community-oriented emergency care programs.
Our mission is to provide excellent emergency patient care, train the next generation of health professionals, create new knowledge in the fields of Emergency Medicine and Emergency Management, and continually innovate.
For those of you who think the Emergency Room is a hospital's loss leader, Neal Sikka would beg to differ. Sikka, an associate professor at the George Washington University Department of Emergency ...More
A diagnosis may only be a Skype call away for some patients. GW's Health Workforce Institute has partnered with the Health Resources and Services Administration to tackle the medical ...More
Kris Lehnhardt, MD, Department of Emergency Medicine, will receive his Aviation Medical Examiner (AME) designation from the Federal Aviation Administration. ...More


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Results 1 to 4 of 4
Thread: Passing parameters to subreports
11-25-04, 21:34 #1Registered User
- Join Date
- Nov 2004
- Posts
- 5
Unanswered: Passing parameters to subreports
How do I pass in pararmeters to the subreports from the main one?
Can anyone offer me a solutions?
Thank you
11-26-04, 04:54 #2Registered User
- Join Date
- Jan 2004
- Location
- Jersey, UK
- Posts
- 108
Try this:
Create parameter fields in your main report; insert them into your main report. Suppress those fields so they don't show.
Now in the subreport, edit your links to the main report to include the parameters.
That should do it I think. Let me know if it doesn't work as I have some reports where I've done this. The above is a quick guess.
Regards - Andy
11-26-04, 05:47 #3Registered User
- Join Date
- Nov 2004
- Posts
- 5
Hrm, i guess i post this on the wrong Heading.
I'm currently working on SQL Server Reporting Service, and not Crystal Report.
Very Sorry to post on the wrong place.
But, does your reply works for SQL Sever Reporting Service too? :?
Thank you so much Andy
11-26-04, 05:51 #4Registered User
- Join Date
- Jan 2004
- Location
- Jersey, UK
- Posts
- 108
Lol, no worries.
Unfortuntaely I've never used the SQL Reporting Service so can't help you there. However the logic is sound so it should be possible.
Good luck.


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Ben Affleck & Rachel Weisz Starring in Terrence Malick's Next?
by Alex Billington
August 12, 2010
Source: The Wrap, TulsaWorld.com
What the heck is Terrence Malick up to? Although we haven't even seen his latest film, The Tree of Life, which no one knows when we even will see it or even what the heck it's even about, that's not stopping the filmmaker from starting work on his next film. The Wrap reports that Malick has already begun casting and location scouting for his latest currently untitled project. Oscar winners Ben Affleck and Rachel Weisz have reportedly joined the cast and interesting reports from various remote shooting locations are starting to trickle in, too. This is that same "romance" project announced in February at the Berlin Film Festival.
In that original announcement, Malick's next project was described as a "romantic drama" and a "powerful and moving love story." But as anyone who's seen Malick's work knows, referring to one of his films as just a "romance" isn't exactly accurate, as there's always a lot more depth to them. Christian Bale, Javier Bardem, Rachel McAdams and Olga Kurylenko were all announced originally, but word is that Affleck is replacing Bale, and Weisz may just be joining (not replacing anyone). Production is scheduled to begin the first week of October in Oklahoma, which is where some odd celebrity reports have been popping up recently as well.
Our friends at AICN point out that TulsaWorld.com recent published an article saying that Ben Affleck and his wife Jennifer Garner were spotted at a local store in Bartlesville, OK buying fishing supplies. Malick grew up in Bartlesville and apparently Christian Bale and Rachel McAdams were also spotted in the same area last year, scouting for this exact Malick film, which is why it makes sense that Affleck has replaced Bale and is out getting familiar with the area as well. Affleck apparently told an employee at the fishing shop hat he was filming a movie in Bartlesville, playing a fisherman, and needed to buy some fishing equipment.
Considering Malick's projects are always very secretive, that's about as much as we'll probably know about this until he finishes editing it some two or three years from now. It's always interesting to learn about the next project from someone as incredible as Terrence Malick (Badlands, Days of Heaven, The Thin Red Line, The New World), but I'm more interested in figuring out when we'll finally get to feast our eyes on Tree of Life. We'll keep you updated on anything related to Malick and his two upcoming films, so stay tuned here.
Follow Alex's main profile on :


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Perfect Drift Stands Out in Hawthorne Gold Cup
Multiple graded stakes winner Perfect Drift is a clear standout in a six-horse field for Sunday's 67th running of the $750,000 Hawthorne Gold Cup (gr. II) at Hawthorne Race Course.
Multiple graded stakes winner Perfect Drift is a clear standout in a six-horse field for Sunday's 67th running of the $750,000 Hawthorne Gold Cup (gr. II) at Hawthorne Race Course.
Led by 2002 winner Strut the Stage, 3-year-old Mobil will face a tough field of older runners in Sunday's Sky Classic (Can-II) over 11 furlongs at Woodbine.
The New York Racing Association, poised to make major reorganizational changes in a bid to keep its racing franchise intact, has hired a new high-level executive to oversee its much-criticized finances.
The Maryland Jockey Club announced Friday that it will close the Pimlico Race Course backstretch from Nov. 29 until Feb. 29, 2004 in order to complete backstretch refurbishing projects. Pimlico will reopen for training on March 1, 2004.
The 2003 Oak Tree Racing Association at Santa Anita gets an auspicious start to its 32-day meeting Sunday with four graded stakes races and plenty of Breeders' Cup possibilities. Of course, the meet is highlighted by the 20th edition of the Breeders' Cup World Thoroughbred Championships on Oct. 25.
Macho Uno, the 2000 champion juvenile colt, has been retired and will stand in 2004 at Frank Stronach's Adena Springs near Ocala, Fla. No stud fee was announced.
Dollar Bill, who ran third in the July 5 Suburban Handicap (gr. I) in his only start this year, has been retired. The 5-year-old horse, owned by Gary and Mary West, is by Peaks and Valleys out of the Saratoga Six mare Saratoga Dame.
The National Thoroughbred Racing Association Sept. 26 approved the position of chief security officer in keeping with a recommendation from Giuliani Partners and its Wagering Technology Working Group in the wake of the Breeders' Cup Ultra Pick 6 fraud of 2002.
Gulfsream Park announced its 2004 stakes schedule today, with 41 added-money events worth $8.5 million to be run during the Jan. 3 to April 25, meet.
The Racing Medication and Testing Consortium has made substantial progress on a model policy for the horse racing industry and also has allocated $275,000 for four research projects tied to its initiatives.
To comply with a court order handed down Thursday, Youbet.com will delay its annual shareholders meeting so it can provide information on the ramifications of a majority buyout by Gemstar Inc., parent company of Television Games Network.


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GraphicRiver Table Lamp Set 5258124
Category: Stock Vector | Comment: ( 0 )
GraphicRiver Table Lamp Set 5258124
Stock Vector \ Objects \ Man-made objects
Retro \ Object \ Lightbulb \ Lamp \ Light \ Shine \ Sign \ Vector \ Yellow \ Various
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intro to dosage calculation
Converting within the Metric System...
the "dancing decimal"
Converting within the Metric System...
when going from a smaller unit (mL) to a larger one (L), move the decimal to the
going to a larger unit, the number gets smaller
when going from a larger unit (L) to a smaller one (mL), move the decimal to the
going to a smaller unit, the number gets larger
Practice Conversions
Rules of Expression
Metric System
most accurate
Apothecary System
no longer relevant
Household System
convert to metric
Unit System
heparin, insulin
Milliequivalent System
Keep calm and use the metric system...
Household System
teach patients for liquid home medications
not as accurate as Metric
convert volumes to Metric for I&O documentation
need-to-know conversion:
1 kg = 2.2 pound
1 cup = 8 oz
1 oz = 30 mL
1 tsp = 5 mL
1 tbsp = 15 mL
Unit System
independent system- cannot convert among other systems
some antibiotics
some hormones
for example...
500 mL (smaller) = 0.5 L (larger)
so as we convert to a larger unit, the number gets smaller
Metric Units of Measure
centimeter (cm)
-convert inches to cm
milliliter (mL or ml)
liter (L)
microgram (mcg)
milligram (mg)
gram (g)
kilogram (kg)
-convert pounds to kg
Abbreviations: the do's
and the do-not's
Systems of
Professor Jennifer Thankachan, RN, MSN
(related to medication administration)
1 L = 1,000 mL
1 g = 1,000 mg
1 mg = 1,000 mcg
its a matter of 3 decimal places
an inverse relationship
0.25 mg (larger) = 250 mcg (smaller)
as we convert to a smaller unit, the number gets larger
500 mL = ____ L
250 mcg = ____ mg
1.5 L = ____ mL
25 mg = ____ mcg
1,000 mg = ____ g
1 g = ____ mcg
use correct abbreviation & label every value with a unit
use decimals, not fractions
always include leading zero
drop trailing zeroes
(convert 500 mL to 0.5
; becomes 0.5)
Milliequivalent System
independent system- cannot convert among other systems
Frequently Used Conversions
1 kg = 2.2 lb
5 mL = 1 t, tsp
15 mL = T, tbs
30 mL = 1 oz
240 mL = 1 cup
2.54 cm = 1 inch
Drug Orders
date & time
name of drug
dosage form
administration frequency
(if applicable)
HCP signature; reg. # for controlled drugs
What's missing here?
40 mEq IV daily
Digoxin 0.25 mg daily
Nifedipine 10 mg PO
Rounding Rules
if your answer is less
than 1, round to the
hundredth place
(two decimal spaces)
if your answer is greater
than 1, round to the tenth
place (one decimal space)
p. 781
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intro to dosage calculation
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Jennifer Thankachanon 15 January 2016
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What kind of format does iMovie record in?
I am an art professor and looking for solutions for my students. We need record, edit and submit mp4 files to a jury and I am wondering about the iMovie format. Thanks for your help!
- Asked by Beth H
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It turns out the New York Jets will be sending players to the Pro Bowl after all. After failing to have a single player named to the original roster, center Nick Mangold and cornerback Antonio Cromartie were added to the team yesterday. Mangold will replace Seattle Seahawks center Max Unger, who obviously will be playing in the Super Bowl. Cromartie was brought in as an injury replacement for New England Patriots cornerback Aqib Talib, who suffered a knee injury in the AFC Championship.
Mangold narrowly missed making the Pro Bowl originally, but he had a slightly down year by his own lofty standards and the other centers who made the team were certainly worthy. However, Mangold is still considered one of the elite centers in the NFL by most, and no will complain about him making his fifth Pro Bowl appearance.
Cromartie, on the other hand, is an entirely different story. Cromartie was an extremely deserving Pro Bowl selection last season, but his performance suffered a major drop off this year. Cromartie himself stated that he had "one of the worst seasons of my career" this year. There is no way that Cromartie is deserving of his third trip to the Pro Bowl, and his presence is more evidence to the fact that the voting process simply doesn't work. Cromartie got so many votes because he is a big name and many voting fans simply don't follow the NFL closely enough to know who is having a good year at positions that aren't involved in fantasy football.
It is unfortunate that a more deserving player wasn't given Cromartie's spot, but the Jets will surely be pleased that two of their players made the team, saving them the embarrassment of not having anyone in Honolulu. Ironically, Muhammad Wilkerson remains the Jets' best player and most deserving Pro Bowl candidate, but he will not playing in the game. His absence and the presence of Cromartie just goes to show that the Pro Bowl process still needs a lot of fixing.
Greg Sulik is a New York Jets writer for Rant Sports. Follow him on Twitter @GregSulik or add him to your network on Google


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