text:
|Publication number
|Publication type
|Application number
|Publication date
|Sep 29, 1998
|Filing date
|Aug 13, 1996
|Priority date
|Oct 7, 1994
|Fee status
|Also published as
|Publication number
|Peter W. J. Hinchliffe, Dawn J. Pappalardo, Scott Larsen, Ian J. Tovey, Christopher McDonnell
|Original Assignee
|United States Surgical Corporation
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (43), Referenced by (15), Classifications (17), Legal Events (4)
|External Links: USPTO, USPTO Assignment, Espacenet
This is a divisional, of U.S. application Ser. No. 08/319,853 filed Oct. 7, 1994. Now U.S. Pat. No. 5,547,463.
1. Technical Field
The present disclosure relates to an apparatus for supporting and immobilizing a patient's hand and wrist during surgery, and, more particularly, relates to a reusable surgical hand support apparatus to be used in conjunction with surgical procedures involving the treatment of carpal tunnel syndrome.
2. Background of Related Art
Surgical procedures involving a person's hand require the hand to be fully supported and immobilized during the surgical procedure and, preferably, retained in a prostrate manner permitting full access for the introduction of surgical instrumentation within the targeted area. This is particularly significant in procedures involving the treatment of carpal tunnel syndrome, where access to the carpal tunnel ligament must be unimpeded to permit insertion of surgical instrumentation within the carpal tunnel defined by the ligament.
Surgical hand support devices are well known in the art. For example, U.S. Pat. No. 5,140,998 to Vickers describes a surgical hand restrainer including a plate for supporting the hand, a clamping member for restraining the fingers and a restraining device for retaining the thumb on the support plate. The clamping member is biased to a closed position by a spring. Other restraint devices for supporting a patient's hand are disclosed in U.S. Pat. Nos. 4,982,744 (an immobilizing apparatus including a composite sheet having an adhesive surface and an arm board) and 4,941,480 (splint for immobilizing a patients arm). U.S. Pat. Nos. 5,025,801, 4,909,264, 3,762,401 and 2,266,230 teach various other devices for temporarily restraining or supporting the hand and/or lower forearm area of the patient.
Certain disadvantages with known surgical hand restraint devices such as those taught in the aforementioned patents are apparent. One disadvantage concerns the relative complexity of the devices, which, consequently, limits accessibility to the patient's hand and increases the difficulty of sterilizing the device after each use. Sterilization of surgical instrumentation has become of extreme significance in recent years due to the increased presence of transmittable diseases such as AIDS, hepatitis, etc. . . The particular structures of known hand support devices do not lend themselves well to sterilization due to the complex arrangement of their component parts which are often inaccessible to sterilization fluids or gases. Consequently, these devices must be either disposed after each use or disassembled and then sterilized. However, due to their structural complexity, disassembly and consequent reassembly of known devices is a tedious and time consuming task. Additionally, certain components of the device may not be adequately sterilized due to their inaccessibility.
U.S. patent application Ser. Nos. 954,383 filed Sep. 16, 1992 and application Ser. No. 08/101,708 filed Aug. 4, 1993 to Berger teach a surgical hand support apparatus particularly contemplated to be used in the treatment of carpal tunnel syndrome. The Berger apparatus includes a base block, a finger support bar which is adjustable toward and away from the base block, a thumb lock assembly having a thumb containment hook and a wrist holding assembly for engaging the patient's wrist. Although the Berger apparatus is well suited for its intended purpose, the present disclosure is directed to further advancements to more effectively assist the surgeon in surgery of the hand, particularly, surgery involving the carpal tunnel ligament. The apparatus of the present disclosure is relatively simple in construction. Further, the present apparatus can be readily disassembled such that each component part may be thoroughly sterilized and subsequently reassembled with relative ease for subsequent use.
Generally stated, the present disclosure is directed to a surgical hand support apparatus to support a patient's hand and wrist during surgery, particularly surgery contemplated to relieve the symptoms of carpal tunnel syndrome. The apparatus includes a support member defining a supporting surface on which the patient's hand and wrist are supported. A finger securing mechanism including a finger restraining member is mounted to the support member. The finger restraining member is movable relative to the supporting surface to be positioned to engage the fingers of the patient. A thumb restraining mechanism may also be mounted to the supporting surface. The thumb restraining mechanism includes a thumb restraining member also movable relative to the supporting surface to be positioned to engage the thumb of the patient. In a preferred embodiment, the finger restraining member and the thumb restraining member are each movable in both a general longitudinal and a general vertical direction to thereby accommodate hands of various sizes. The apparatus may also include a wrist securing mechanism having a wrist restraining member. The wrist restraining member is movable in a general vertical direction to engage and retain the patient's wrist against the supporting surface.
At least one quick release mechanism is associated with the finger restraining member, thumb restraining member and wrist restraining member to selectively lock each of the these components at a predetermined position relative to the supporting surface. The preferred quick release mechanism includes a locking latch which is movable between an engaged position wherein the respective restraining member is locked at the predetermined position and a disengaged position wherein the respective restraining member is capable of moving relative to the supporting surface. Preferably, the finger and wrist restraining member has two quick release mechanisms, one on each side of the respective member.
The apparatus further includes an instrument support member mounted to the wrist restraining mechanism. The instrument support member incorporates supporting means for supporting a surgical instrument used in surgery in a fixed position relative to the supporting surface of the support member. The preferred supporting means includes at least one groove formed in an upper surface of the instrument support member and dimensioned to accommodate the surgical instrument. The angular orientation of the instrument support member may be adjustable, thereby providing the capability of adjusting the angular orientation of the surgical instrument supported thereby. A set screw, may be provided to limit movement of the instrument support member in one direction and to pivot the support member in another direction.
A method of use of the surgical hand support apparatus with a guiding instrument and a balloon catheter for carpal tunnel surgery is also disclosed.
Preferred embodiments of the disclosure are described hereinbelow with reference to the drawings wherein:
FIG. 1 is a perspective view of a surgical hand support apparatus constructed in accordance with the principles of the present disclosure;
FIG. 2 is a side plan view of the apparatus of FIG. 1 with a patient's hand shown supported by the apparatus;
FIG. 3 is an exploded perspective view of the apparatus of FIG. 1;
FIG. 3A is a perspective view of an alternate embodiment of the wrist retraining member;
FIG. 4A is a cross-sectional view taken along the lines 4A--4A of FIG. 2 illustrating the finger restraining member in position to engage the fingers of the patient;
FIG. 4B is a view similar to the view of FIG. 4A illustrating the range of vertical movement of the finger restraining member;
FIG. 5 is a perspective view of the apparatus of FIG. 1 illustrating movement of the release mechanism for disassembling the apparatus;
FIG. 6 is an enlarged perspective view of the finger restraining member illustrating the method for its disassembly;
FIGS. 7A-7B are enlarged perspective views of the quick release mechanism illustrating the method for its disassembly;
FIGS. 8A-8B are enlarged plan views of the locking stud of the quick release mechanism of the apparatus of FIG. 1 illustrating the reciprocal orientation of the locking flange portions on each side of the locking stud;
FIG. 9 is an enlarged perspective view of the wrist restraining member illustrating the method for disassembling the instrument support member from the wrist restraining member;
FIG. 10 is a view similar to FIG. 9 illustrating the instrument support member removed from the wrist restraining member;
FIG. 11 is an enlarged perspective view of a surgical guiding instrument to be used in conjunction with the apparatus of FIG. 1;
FIG. 11A illustrates a perspective view of an alternate embodiment of a surgical guiding instrument;
FIG. 12 is a perspective view of a catheter housing.
FIG. 13 is an exploded perspective view of the catheter housing, connectors and tubing;
FIG. 14 is a perspective view of the catheter housing with the housing half sections separated to illustrate the syringe assembly positioned therein;
FIG. 15 is a side cross-sectional view of the catheter housing;
FIG. 16 is a top plan view of the apparatus of FIG. 1 illustrating the surgical guiding instrument of FIG. 11 supported by the instrument support member of the apparatus and positioned within the patient's hand;
FIG. 17 is a view similar to the view of FIG. 16 illustrating the guiding instrument of FIG. 11 securely retained within the instrument support member by a slidable locking member;
FIG. 18 is a side plan view illustrating the catheter positioned within the patient's hand in accordance with a preferred method for treating carpal tunnel syndrome; and
FIG. 19 is top plan view with portions cut away of the patient's hand illustrating the catheter positioned proximal the transverse carpal tunnel ligament to stretch the carpal ligament in accordance with the preferred method for treating carpal tunnel syndrome.
Referring now to the drawings in detail in which like reference numerals identify similar or identical elements throughout the several views, FIG. 1 illustrates in perspective view the surgical hand support apparatus in accordance with the principles of the present disclosure.
Apparatus 10 is intended to support and restrain the patient's hand and wrist in a fixed position during surgery. Apparatus 10 is particularly contemplated for use during surgery to relieve the symptoms of carpal tunnel syndrome although it is to be appreciated that the apparatus has application in other types of surgical procedures to support the hand such as vascular repair, nerve repair and re-attachment of digits. As will be appreciated from the description provided below, apparatus 10 is capable of being fully disassembled, i.e., the apparatus may be taken apart to its basic components. This feature facilitates sterilization of the components so that the apparatus 10 can be re-used.
Referring now to FIGS. 1-3, apparatus 10 includes support member 12, finger restraining member 14, thumb restraining member 16 and wrist restraining member 18. Support member 12 is advantageously dimensioned to support the patient's hand and wrist in a prostrate position, e.g., with the palm of the patient facing upwardly. Support member 12 has a slightly arcuate upper surface 20 upon which the patient's hand and wrist are positioned. The curved configuration of upper surface 20 accommodates for the natural curvature defined at the juncture of the patient's wrist and hand to fully support these bodily components as best shown in FIG. 2.
Support member 12 includes first and second pairs of apertures 22, 24 extending longitudinally in opposed side walls 26 of the support member and a third pair of apertures 28. Apertures 22, 24 serve to mount finger restraining member 14 and thumb restraining member 16, respectively, as will be appreciated from the description provided below. Similarly, apertures 28 serve to mount wrist restraining member 18. A plurality of openings 30 may be provided in upper surface 20, preferably parallel thereto, to enable the insertion of pegs or rods to keep selected fingers spread apart during the surgical procedure.
Referring still to FIGS. 1-3, finger restraining member 14 includes a cross bar 32 which traverses upper surface 20 of support member 12 and first and second leg portions 34 extending downwardly from the cross bar 32. Leg portions 34 each include an elongated aperture 36 extending along its length. The cross bar 32, as shown, curves toward the front of support member 12 to accommodate different finger lengths. A quick release mechanism, generally identified as reference numeral 38, is provided to releasably lock finger restraining member 14 at desired longitudinal and vertical locations relative to support member 12. Quick release mechanism 38 consists of locking stud 40 having circumferential flange 42 at one end and a locking latch 44 pivotally mounted to the locking stud 40 at its other end. In the preferred embodiment, locking latch 44 includes two spaced bifurcations 46. Each bifurcation 46 has a slot 48 formed therein which accommodates a pivot pin 50 extending transversely from locking stud 40 to pivotally mount the locking latch 44 to the locking stud 40. The particular features of pivot pins 50 will be discussed in greater detail below. In the mounted position of quick release mechanism 38, locking stud 40 extends through apertures 22, formed in side walls 26 of support member 12 and through apertures 36 of leg portions 34 of finger restraining member 14, with circumferential flange 42 abutting against the interior portion of side wall 26 and locking latch 44 mounted about pivot pins 50.
Quick release mechanism 38 is readily movable between a secured position where finger restraining member 14 is securely fixed at a desired position relative to upper surface 20 and a release position where the positioning of finger restraining member 14, both horizontal and vertical, may be selectively adjusted. FIG. 4A depicts the secured position of quick release mechanism 38. In such position, locking latch 44 is positioned downwardly whereby the outer arcuate portions 52 of each spaced bifurcation 46 frictionally engages the leg portions 34 of finger restraining member 14.
In the release position of quick release mechanism 38, each locking latch 44 is pivoted upwardly as shown in FIG. 4B such that the outer arcuate portion 52 releases from its frictional engagement with leg portions 34 of finger restraining member 14. Consequently, finger restraining member 14 is free to move in a first direction, e.g., longitudinal, and a second direction, vertical. It is to be appreciated that the particular dimensioning of apertures 22 in side walls 26 permit adjustability of finger restraining member 14 in the longitudinal direction while apertures 36 in finger restraining member 14 permit adjustability of the finger restraining member 14 in the vertical direction. FIG. 4B illustrates the range of vertical movement of finger restraining member 14.
Referring again to FIGS. 1-3, the pair of thumb restraining members 16 will now be described. In the embodiment shown, two thumb restraining members 16 are provided, one on each side of support member 12 so that the apparatus 10 may accommodate either the left or right hand of the patient. It is also contemplated that in an alternate embodiment, a single thumb restraining member 16 could be provided which could be mounted on either side of the support member 12 to accommodate the right or left hand of the patient. Each thumb restraining member 16 includes an arcuate thumb engaging portion 54 and a leg portion 56 extending downwardly from the thumb engaging portion and having an elongated aperture 58 formed therein. The curved thumb engaging portion 54 engages and immobilizes the patient's thumb when thumb restraining member 16 is in a secured position. Each thumb restraining member 16 includes a quick release mechanism 38 for positively securing the thumb restraining member, which is identical to the quick release mechanism described above in connection with finger restraining member 14. Thus, through the provision of quick release mechanism 38, in conjunction with the aperture 24 formed in side wall 26 and aperture 58 of thumb restraining member 16, the positioning of the thumb restraining member 16 can be selectively adjusted in both a first, e.g., longitudinal, direction and a second, e.g., vertical, direction.
Wrist restraining member 18 includes horizontal wrist engaging portion 60 and two leg portions 62 extending downwardly from the wrist engaging portion 60. Wrist engaging portion 60 engages and immobilizes the patient's wrist when restraining member 18 is in a secured position. Leg portions 62 each possess a channel 64 (FIG. 3) which partially extends along its length to accommodate quick release mechanism 38. Wrist restraining member 18 is selectively movable in a general vertical direction through the provision of channels 64 and can be securely fixed at a desired vertical position by a quick release mechanism 38. Quick release mechanism 38 functions in an identical manner to the quick release mechanism 38 described in connection with finger restraining member 14 and thumb restraining member 16.
In an alternate embodiment of FIG. 3A, wrist restraining member 18' includes wrist engaging portion 60' which is curved in a proximal (rearward) direction to increase the mobility of the guiding instrument discussed below with respect to FIG. 11.
An instrument support member 66 is mounted to wrist restraining member 18. Support member 66 is intended to support a surgical instrument, such as a guiding instrument, catheter, grasping instrument, etc. . . , used during a surgical procedure. An example of an instrument intended to be used with apparatus 10 during carpal tunnel surgery is illustrated in FIG. 11. This instrument will be discussed in greater detail below. Instrument support member 66 includes a plurality (preferably 5) of generally longitudinally extending grooves 68 (FIG. 1) formed in its upper surface which accommodates the instrument. An instrument holder 70 is slidably mounted to the instrument support member 66 and is adapted to move to substantially enclose the instrument received within groove 68 to prevent lateral and vertical movement of the instrument.
As shown in FIGS. 1-3, instrument support member 66 is mounted to wrist restraining member 18 via a pair of pin projections 72 extending outwardly from each side of instrument support member 66 and received within slots 74 formed in upright portions 76 which extend upwardly from wrist engaging portion 60. This particular mounting method permits the angular orientation of instrument support member 66 to be selectively adjusted relative to the support member 20 (i.e., the instrument support member is capable of pivoting about its mounting projections 72). Consequently, the orientation of the surgical instrument supported by instrument support member 66 is also adjustable, the significance of which will be described hereinbelow. Preferably, pin projections 72 are disposed toward the rear end portion of instrument support member 66 whereby the forward end portion naturally drops downwardly toward support member 12. An adjusting screw 78 extends through instrument support member 66 to contact wrist engaging portion 60 of the wrist restraining member 18. Adjusting screw 78 is rotatable to press firmly against wrist engaging portion 60, thus preventing pivotal movement of support member 66 downwardly towards support member 16 (in the direction of arrow C in FIG. 5). This is described in more detail below.
Referring now to FIGS. 5-9, disassembly of apparatus 10 will now be discussed. As previously noted, the apparatus of the present disclosure can be readily disassembled to its basic component parts whereby the component parts are sterilized and then reassembled for another use. Disassembly of apparatus 10 is as follows. Each quick release mechanism 38 which secures finger restraining member 14 is moved to its release position by pivoting locking latch 44 upwardly such that the latch 44 is generally transverse to sidewall 26 as shown in FIG. 5. Thereafter, finger restraining member 14 is moved forwardly as shown by the directional arrow A in FIG. 5 to align the apertures 36 of finger restraining member 14 with the apertures 22 in side wall 26 as shown in FIG. 6. (In this aligned position, finger restraining member 14 lies below the bottom portion of the support member 12 which is lifted off the table.) Thereafter, the locking latch 44 on both sides is pushed inwardly through aperture 36 in leg portions 34 and aperture 22 in side wall 26 such that locking stud 40 and locking latch 44 are removed from their engagement with the apparatus as shown in FIG. 6. Thereafter, finger restraining member 14 is removed. Each thumb restraining member 16 is disassembled from support member 20 in a similar manner, i.e., locking latch 44 is pivoted upwardly to a release position, thumb restraining member 16 is rotated forwardly to align aperture 58 of the restraining member with aperture 24 of side wall 26 and the locking latch 44 is pushed through the respective apertures to remove the thumb restraining member 16.
Wrist restraining member 18 is disassembled by moving both quick release mechanisms 38 securing the wrist restraining member 18 to their release positions, sliding restraining member 18 upwardly to remove it from locking stud 40, rotating the locking latches 44 to align with apertures 28 of support member 12 and pushing each locking latch 44 and locking stud 40 inwardly. Clearly, alternatively, the thumb restraining member 16 or wrist restraining member 18 can be disassembled first.
FIGS. 7A-7B illustrate the disassembly of quick release mechanism 38 to its component parts. As stated above, locking latch 44 of quick release mechanism 38 is detachably is connected to locking stud 40 via the reception of mounting pins 50 of the locking stud 40 with slots 48 of the locking latch 44. In addition, as detailed in FIGS. 7A-7B, mounting pins 50 each include a flange portion 80 having a generally semicircular shape. Such semicircular shape of flange 80 defines a dimension "a" which is less than a dimension "b" of the flange 80 where dimension "b" is substantially equal to the diameter of the flange 80 (see also FIGS. 8A-8B). Locking latch 44 includes a circumferential recess 82 on a side surface of each bifurcation 46. Recess 82 is in communication with opposed release groove portions 84. In the mounted condition of locking latch 44 as shown in FIG. 4A, flange portion 80 is retained within circumferential recess 82 by engagement thereof with the portions defining the recess 82. More specifically, locking stud 40 is rotationally oriented such that the flange portion 80 defining dimension "b" engages the portions defining recess 82. To disassemble locking latch 44 from locking stud 40, locking latch 44 is pivoted upwardly approximately 270� to the position shown in FIG. 7A such that dimension "a" of flange portion 80 is in alignment with release groove portions 84. Thereafter, locking latch 44 is removed from locking stud 40 by sliding the latch 44 off mounting pin 50 as shown in FIG. 7B.
It is to be appreciated that locking latch 44 cannot be removed from locking stud 40 while the quick release mechanism 38 is mounted to support member 20 because locking latch 44 cannot be pivoted sufficiently upwardly, i.e. 270�, to the position of FIG. 7A because it will be blocked by support member 20.
FIGS. 8A and 8B are side plan views of a single locking stud 40. As detailed in the Figures, flange 80 on a first side of locking stud 40 is angularly offset or rotated 180� relative to the opposed flange 80 on the second side of the locking stud. Such reciprocal orientation of the flanges 80 ensures that locking latch 44 and locking stud 40 are correctly reassembled so the latch 44 is in the proper orientation.
Referring now to FIGS. 9-10, instrument support member 66 may also be disassembled from wrist restraining member 18. Mounting pins 72 of instrument support member 66 have a semicircular shaped flange 86 similar in configuration to flange 80 of locking stud 40 of quick release mechanism 38. Similarly, upright posts 76 include a circumferential recess 88 and opposed release grooves portions 90 in their side surfaces which are similar to circumferential recess 82 and groove portions 84 of locking latch 44. Thus, in the mounted condition of instrument support member 66, mounting pins 72 are retained within circumferential recesses 88 by engagement of the semicircular shaped flange 86 with portions of upright member 76 defining the circumferential recess. To release instrument support member 66, the instrument support member 66 is pivoted upwardly as shown in FIG. 9 such that the portion of semicircular flange 86 having the smaller dimension is in alignment with the opposed release grooves 90. Thereafter, the instrument support member is removed by sliding flange 86 between the boundaries defined within the opposed grooves 90. FIG. 10 depicts instrument support member 66 disassembled from wrist restraining member 18. Note that similar to the flanges 80 of locking stud 40, the flanges 86 of support member 66 are angularly offset by 180� to ensure correct reassembly of support member 66 and wrist restraining member 18.
After removal of the wrist restraining member 66, the adjusting screw 78 is removed from member 66 and instrument holder 70 is slid off member 66 in the direction of arrow D.
After removal of all the locking latches 44, and restraining member 14, 16 and 18, support member 66, adjusting screw 78 and instrument holder 70, the apparatus 10 is in its fully disassembled condition with the component parts taken down to their basic elements and can then be sterilized. Sterilization of the apparatus is facilitated since the components are fully accessible to the sterilization fluids or gases. After sterilization, the apparatus may thereafter be reassembled to be used in subsequent surgical procedures.
Referring now to FIG. 11, there is illustrated a guiding instrument intended for use with apparatus 10 during carpal tunnel surgery. Guiding instrument or director 100 is intended to be inserted into the carpal tunnel to guide an instrument such as a balloon catheter into the tunnel. Guiding instrument 100 includes a handle 102 and an elongated member 104 extending distally from the handle 102. Handle 102 defines a depressed area 106 ergonomically dimensioned to be engaged by the thumb of the user and also possesses a longitudinal bore formed therein (not shown). Elongated member 104 consists of a proximal portion 108 having a substantially planar upper surface 110 and a distal end portion 112 having a flat distal tip 114 which frictionally receives end cap 103 which is adhesively secured to the balloon described below. An aperture 116 is formed in a wall of distal end portion 112.
Referring now to FIGS. 12-14, a catheter support 200 is shown for supporting a catheter to perform surgery in relieving the symptoms of carpal tunnel syndrome. Catheter support 200 includes frame 202. An elongated flexible catheter tube 204 is connected to the frame 202 in a manner described below. A flexible membrane 206 e.g. a balloon, is mounted at the distal end portion of the catheter tube 204. Preferably, the balloon and catheter are attached to the guiding instrument 100 during manufacturing and shipped as an integral unit. That is, distalmost tip 207 of catheter tube 204 and/or the distal edge of the balloon are bonded to end cap 103 of guiding instrument 100. Alternately, the catheter tube 204 and balloon can be sold as a separate unit and inserted into the guiding instrument by the user.
Referring to FIGS. 13-15, in conjunction with FIG. 12, frame 202 accommodates a syringe unit 208 having syringe housing 210 and plunger 212 at least partially disposed within the syringe housing 210. Frame 202 includes two half sections 202a, 202b which are attached along their respective peripheries by spot welding, adhesives or the like. Syringe housing 210 accommodates a supply of fluid such as saline which is dispensed through catheter tube 204 to inflate flexible membrane 206. Plunger 212 includes screw threads 214 which cooperate with threads 216 of frame 202. Accordingly, rotation of plunger 212 in a first direction causes distal axial movement of the plunger due to the cooperation of the engaged threads, to thereby dispense the fluid into flexible membrane 206. Rotation of plunger 212 in a second (reverse) direction causes proximal axial movement of the plunger and, consequently, deflation of flexible membrane 206. Thus, due to the provision of the threads of plunger 212 and frame 202, the surgeon may selectively incrementally control the inflation and deflation of flexible membrane 206. Plunger 212 includes a control knob 218 dimensioned to be grasped by the user to rotate the plunger 212.
Catheter support 200 also includes a pressure monitor gauge 220 in fluid communication with the interior of syringe housing 210 via T-connector 222 and tubes 223, 225 and luer lock 226 to monitor the fluid pressure being dispensed from the syringe housing 210. Pressure gauge 220 is advantageously angularly oriented to be readily viewed by the surgeon, i.e., the pressure gauge 220 is mounted on a portion of frame 202 which is angularly offset from the remaining portion of the frame.
Referring now to FIGS. 13-14, and particularly to FIG. 13, the connection of catheter tube 204 to syringe housing 210 will be discussed. Catheter tube 204 has a luer lock 205 positioned at its proximal end which connects to valve assembly 230 via male luer lock 232. A female luer lock 234 connects valve assembly 230 to tubing 236 via luer lock 238. Tube 236 is connected to T-connector 232. Catheter tube 104 is fabricated from a flexible material and includes openings at its distal end to allow passage of the inflation fluid into the flexible membrane 206. Flexible membrane is preferably fabricated from a polyester resin such as polyetheylene teraphthalate or other suitable material. Valve assembly 230 includes junction block 231 and check valve 233 to prevent overinflation of the flexible membrane 206. Check valve 224 may be any conventional valve capable of leaking fluid when the pressure in the catheter exceeds a predetermined value. Alternatively, a valve which shuts off the flow of fluid when the inflation pressure exceeds a predetermined valve could be provided.
In an alternate embodiment illustrated in FIG. 11A, the flexible membrane, e.g. balloon, can be welded directly to the guiding instrument 100' adjacent the aperture 116', and the channel in the guiding instrument itself could provide a passageway for the inflation fluid. This would eliminate the need for a separate catheter tube 204.
The use of apparatus 10 with guiding instrument 100, catheter housing 200 and catheter tube 204 for surgery to relieve the symptoms of carpal tunnel syndrome will now be described. Referring to FIG. 2, the patient's hand is placed prostrate on support surface 20 with the palm facing upwardly. Finger restraining member 14 is adjusted both longitudinally and vertically. The quick release mechanism is secured by moving locking latch 44 downwardly to thereby positively fix the finger restraining member 14 at the desired position. Thumb restraining member 16 and wrist restraining member 18 are likewise moved to the desired position to accommodate the patient's hand and are secured by rotation of locking latch 44 downwardly. Once in a fully secured position, guiding instrument 100, which has the catheter tube 104 fixed positioned inside so that flexible membrane 206 is adjacent aperture 216, is placed within a groove 68 formed in instrument support member 66 (as shown in FIG. 16) and positioned within a previously formed incision in the patient's wrist. Guiding instrument 100 may then be advanced to a location under the carpal tunnel ligament. Instrument holder 70 is slid over the guiding instrument 100 to enclose the device thereby maintaining the instrument 100 within the general confines of the groove. FIG. 17 illustrates the positioning of instrument holder 70 over guiding instrument 100. The planar upper surface 110 of guiding instrument 100 (FIG. 11) provides increased surface area to enhance frictional locking engagement of instrument holder 70 with the instrument 100. FIG. 18 illustrates, in side plan view, guiding instrument 100 positioned within the hand. Adjusting screw 78 is then rotated to pivot instrument support 66 in the direction of arrow D of FIG. 18, thus lifting the guiding instrument 100 towards the palm of the patient's hand to lift the ligament further from the underlying median nerve.
Control knob 218 of plunger 212 is rotated in a first direction to cause distal advancement of the plunger to dispense fluid through catheter tube 204 and into flexible membrane 206. Flexible membrane 206 inflates and expands through aperture 116 in the guiding instrument 100 to contact and stretch the transverse carpal ligament thereby relieving pressure off the median nerve. Note that aperture 116 is formed in only the top surface to allow expansion of the membrane in only the upward direction. This protects the underlying median nerve. FIG. 19 illustrates the positioning of flexible membrane 206 and guiding instrument 100 adjacent the carpal tunnel ligament. It is to be appreciated that the pressure of flexible membrane 206 is easily controlled through the screw threads of the plunger 212 and frame 210 as previously noted. Further, the fluid pressure during inflation can be monitored by the surgeon with pressure gauge 220. Preferably the desired pressure is approximately 150 psi, although clearly other pressures are contemplated. If pressure in the catheter 200 exceeds a predetermined valve, check valve 224 will relieve the pressure by leaking the fluid supply to flexible membrane 206, thus avoiding overinflation which could cause possible damage to the transverse carpal ligament or other bodily tissue within the tunnel. If a small flexible member is utilized, it can be moved, if desired, to engage distal and proximal regions of the ligament by simply advancing or retracting guiding instrument 100 or advancing or retracting the catheter housing 200.
While the above description contains many specifics, these specifics should not be construed as limitations on the scope of the invention, but merely as an exemplification of a preferred embodiment thereof. Those skilled in the art will envision other possible variations that are within the scope and spirit of the invention as defined by the claims appended hereto.
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|Linvatec Corporation
|Apparatus for performing endoscopic surgery
|Title not available
|Sep 17, 1985
|Mar 27, 1986
|Australian Biomedical Corporation Limited
|Hand surgery table
|Sep 14, 1993
|Mar 31, 1994
|Berger J Lee
|Surgical hand support apparatus
|Citing Patent
|Filing date
|Publication date
|Jul 22, 2002
|Oct 11, 2005
|Imp Inc.
|Tibial distraction device
|Jun 11, 2009
|Mar 6, 2012
|Intact Vascular LLC
|Device and method for tacking plaque to a blood vessel wall
|Jul 23, 2009
|Dec 4, 2012
|Allen Medical Systems, Inc.
|Operative arm support
|May 16, 2012
|Dec 30, 2014
|Jennifer Bennett Carlin
|Forearm and hand positioning device
|Mar 1, 2011
|Jan 17, 2017
|Intact Vascular, Inc.
|Device and method for tacking plaque to blood vessel wall
|Nov 25, 2013
|Mar 28, 2017
|Intact Vascular, Inc.
|Endoluminal device and method
|Jan 24, 2013
|Aug 15, 2017
|Intact Vascular, Inc.
|Endoluminal device and method
|Jul 22, 2002
|Jan 22, 2004
|Hay Michael T.
|Tibial distraction device
|Jun 7, 2006
|Dec 7, 2006
|Lubbers Lawrence M
|Surgical Tray
|Apr 4, 2008
|Oct 9, 2008
|John Edward Ivey
|Therapy Device to Increase Flexibility and Range of Motion to the Wrist, Fingers, and Thumb
|Jun 11, 2009
|Oct 14, 2010
|Peter Schneider
|Device and method for tacking plaque to a blood vessel wall
|Dec 28, 2011
|Jul 5, 2012
|Cook Medical Technologies Llc
|Occlusion device
|Jul 26, 2016
|Feb 1, 2017
|Dietmar Hekers
|Hand positioning plate for hand surgery
|Dec 12, 2013
|Jun 19, 2014
|Torregrosa Javier Ferrer
|Guiding and holding device for minimum incision foot surgery
|Dec 16, 2013
|Jun 18, 2015
|U.S. Classification
|600/183, 128/898, 602/20, 600/102, 606/192
|International Classification
|Cooperative Classification
|European Classification
|Mar 28, 2002
|Fee payment
Year of fee payment: 4
|Apr 16, 2002
|Maintenance fee reminder mailed
|Mar 29, 2006
|Fee payment
Year of fee payment: 8
|Mar 29, 2010
|Fee payment
Year of fee payment: 12


text:
PowerPoint Presentations for the Construction & Architecture Industry
Winning a contract in the construction or architecture industry is a lot easier when you have a good looking presentation.
Since 1995, The Presentation Team has developed proposals and presentations for numerous architects and construction companies throughout the United States. Our efforts have helped them to win more projects, train more people, and support their operation more effectively than any in-house solution...translating to more revenue and growth for our clients!
Our experience has given us a solid knowledge of the construction and architecture industries, allowing us to quickly and cost-effectively create (or enhance/improve) presentations and marketing materials that succinctly meet RFP/RFQ requirements with a blend of professionalism and creative flair.
If you're looking for a company that knows the construction/ architecture industry and can create a presentation to give you an edge over the competition, give The Presentation Team a call.

subset: commoncrawl


text:
(Christy Bristol Astrology Mysteries)
ISBN 978-1-892343-57-4, Oak Tree Press, March 2009
Psychic-astrologist Christy Bristol sometimes gets the details wrong in her "eyelid movies" but she leads the reader through fog and U-turns while following red matchbook clues looking for a missing man. She links his disappearance to three men who died from apparent heart attacks and agrees with one detective, a newcomer from New York, who thinks they've been murdered in the small California town. Christy's job as a clerk in the sheriff's department helps and hurts her investigation, especially when Christy and her best friend Lennie explore the world of leather and sex clubs. Sunny Frazier's distinctive voice in Where Angels Fear echoes with humor and rings true with procedural details. This mystery begs to be read through to the end in one sitting. Highly recommended.


text:
Posted April 14th, 2012, 11:22 PM
Last edited by Bucky3; April 14th, 2012 at 11:26 PM
One time, we were on the Star from Sydney to Los Angeles. In Fiji, we were on a bus with about 60 very fun and crazy cruise critic roll call friends on a tour NOT purchased through the ship. We were about 10-15 minutes late when we finally arrived back and had to dodge our way through the military marching band to board. It seemed as if the whole ship was on that side watching the band and we had many shouts, laughing and clapping from the other passengers. We just kept telling ourselves that certainly the ship would not sail off without that many passengers...... but we will never want to cut it that close again!!!Peggy - Was that the Star Fall '09 cruise? If so, we were two of those along with other cc roll call members cheering you all on as you boarded! It was a kick watching you all dodge the military band members as you raced for the ramp! We did that cruise b/b so for us it was SF to Sydney to LA - that was a wonderful cruise.
We watched a little fishing boat race three people out to catch the ship when leaving a Mexican port one time a few years back. When I saw they didn't put out a platform and those people had to climb a rope ladder to get onboard , it was plenty enough to remind me NEVER to be late for sailing!!


text:
- Details
HALLHUBER top perfect for elevating casual looks to the next level. The obvious highlight is of course the amazing shirt collar made of sheer lace! But this lace collar top offers great attention to detailing throughout, featuring a cinched cut with formfitting silhouette and cap sleeves that include small gatherings at the sleeve inserts for slender-looking shoulders. Crafted from viscose jersey, this lace collar top offers a flowing drape and super soft skin-feel. To ensure easy use it is fitted with buttoned slit neck at the reverse.
- Material: 92% viscose, 8% elastane
- Length (in) for size 8: 24
- Colour: shell
- Reference: 1710122481348L
- Soft program wash (30 degrees)
- Do not bleach
- Do not dry
- Dry cleaning
- Ironing stage I
- All prices incl. 20 % tax
- Returns
You have 14 days to return any item. To ensure your item is processed quickly, please return it complete with the original packaging if possible. Please note that only returned items bearing their original labels will be accepted. You can take your parcel to any post office. The customer bears the costs for return shipments.


text:
Playing strengths
QPR's squad is packed with players who have only been accustomed to the Premier League in their careers but Harry Redknapp will undoubtedly need to strengthen. He may have weeded out the dressing room dissenters from their disastrous season in the top flight but they have hardly lit up the Championship. Yes
Top-flight experience
Redknapp's experience of the Premier League is vast and all the suggestions he would retire this summer are probably redundant now after promotion. His squad have nearly 2,000 appearances in the top tier to their name and know the league. Yes
Loftus Road remains a traditional, no-frills stadium and what is lacks in capacity it makes up for in character. QPR's training ground at Harlington previously belonged to Chelsea and is a decent facility. Yes
Spending power
Tony Fernandes will have learned lessons from their previous season in the Premier League but is expected to provide Redknapp with financial backing this summer. Promotion may have been secured but QPR are still expected to face financial punishment due to the losses incurred this season. Yes


text:
About Jack Lester - a Spireite legend
He scores from the leeeeeeft, He scores from the riiighggggghhht, Super Jack Lester, He'll make you look sh*te...
About Jack Lester - a Spireite legend
Pa Diego Forlan!
We Don't Need the Playoffs Chant
Sung when we went up as champions '08
A classic used at a lot of teams but atill a good un
Celebrate Like We Won the Cup Chant
Taking the right p*ss out of Russell Slade
Grito de Guerra Fúria Jovem Chant
Grito de guerra da Fúria Jovem enaltecendo os valores dessa torcida organizada.
You're the Spurs of Merseyside! Chant
Not even best in town
Small mercies...
Met zijn alle
Worlds Greatest team
The bizarre ones are the best
One for our star striker
Un clásico FanChant del Galeano
Sang at Dean Court to the Bournemouth fans who think we have a rivalry


text:
Vintage Goebel / Hummel Print Music Box - Lara's theme - Swiss Musical movement.
Sold for:
Start Free Trial
or Sign In to see what it's worth.
- Sold Date:
- Source: eBay
This is a Vintage Hummel / Goebel Print Kissing Girl Music Box made in West Germany. The music comes from Superstar Swiss Musical Movement. Lara's theme Dr Zhivago. Music Box has normal wear and tear (little scratch see photo) and has a piece missing on one white foot, otherwise in good condition. Please view all the photos for closer examination and condition before you bid. ..sold as is.. I try to describe and photograph items as good as I can and the photos are a part of the description. If you have any questions please mail me for more information if it is not in my description or photographs. I will try to answer your questions to the best of my knowledge about the item listed. Will be well wrapped for transit . Payment required through PayPal within seven days of auction end. Items will be shipped within 3 business days after receipt of payment. Thanks for looking


text:
We recommend upgrading to the latest Internet Explorer, Google Chrome, or Firefox.
If you are using IE 9 or later, make sure you turn off "Compatibility View".
Handpicked brands for you
We got more stickers! Email your address and how many you want to email@example.com to get yours! #free99 #Forsake


text:
Scottish addicts get drugs in the mail
POSTMEN are being used as unwitting drug couriers, a report highlighting Scotland's drug problems has revealed.
The Royal Mail and companies such as Parcel Force, have delivered drugs all over the country for websites selling "legal highs" online.
The report, No Quick Fix by the Centre for Social Justice (CSJ), reveals the rate of "problematic drug use" in Scotland is 1.6 adults to every 100, double that of England and Wales.
The CSJ said that, since the rise of new legal high psychoactive substances, the amount of drugs being delivered across the UK by postal workers has risen.
FREE NEWS UPDATES 24/7...FOLLOW THE SCOTTISH EXPRESS ON TWITTER: www.twitter.com/scotexpress
More than 130 websites, such as the Silk Road, known as the eBay of drugs, allow people to buy drugs online anonymously.
The black market website then ships the drugs out for delivery to any home in Britain.
The CSJ was set up by Iain Duncan Smith after his visit to Easterhouse in Glasgow.
More rigorous conditions on welfare benefits have meant that some are no longer able to maintain their habit
The report claims that reducing welfare payments could help tackle Scotland's drug problems.
It said: "More rigorous conditions on welfare benefits have meant that some are no longer able to maintain their habit.
"One local authority commissioner of addiction treatment said some addicts receiving welfare benefits had been able to maintain a relatively comfortable living standard and would not engage in treatment.
"She told the CSJ that with the reforms to welfare, some were starting to realise they could no longer maintain such a lifestyle and continue their drug taking."
The report also said that Scotland's policy on weaning addicts off heroin using methadone has resulted in the replacement drug becoming responsible for 47 per cent of all drug-related deaths.
Christian Guy, director of the CSJ, said: "While our addiction problem damages the economy, it is the human consequences that present the real tragedy.
"Drug and alcohol abuse fuels poverty and deprivation, leading to family breakdown and child neglect, homelessness, crime, debt, and long-term worklessness."


text:
GU34 5HY, Joanne Hatherley and Peter Hatherley: environmental permit application advertisement
This publication was withdrawn on
The consultation period for this application has ended. You can view current licences on the Public Registers.
View the application submitted by Joanne Hatherley and Peter Hatherley for 151 Winchester Road, Four Marks, Alton, Hampshire, GU34 5HY.


text:
The Cobb County Public Library System's next semi-annual Book Sale will be held Friday and Saturday, March 13-14 from 9 a.m. to 5 p.m., and Sunday, March 15 from 1 p.m. to 5 p.m. at the Jim R. Miller Park at 2245 Callaway Road in Marietta.
Donated items for the book sale include books, textbooks, DVD and VHS movies, and children's books. All profits from the sale will go directly to buying more items for the 16 Cobb libraries.
For more information, please call Patty Latch at (770) 528-2345 or Jill Tempest at (770) 528-2330.
Book Sale: March 13-15!


text:
Deals of the Day: BofA's Beating May Be Worse Than You Think?
Deals of the Day compiles this morning's biggest news about mergers and acquisitions, private equity and more. Catch us on Twitter, @WSJDealJournal
Mergers & Acquisitions
Pringles: Some walnut growers have challenged Diamond Foods's explanation of mysterious payments to them, further tangling an accounting question that has delayed the snack maker's planned $2.35 billion acquisition of Pringles from Procter & Gamble. [WSJ]
LSE-FTSE: London Stock Exchange Group PLC said Monday that it will buy the remaining 50% stake in FTSE International Ltd. that it doesn't already own from Pearson PLC for £450 million in cash ($705.2 million) as part of broader moves to diversify. [WSJ]
Virgin Atlantic: The airline is seeking to trump a bid from arch-rival British Airways for Deutsche Lufthansa AG's BMI unit after persuading the German carrier to grant due diligence for a rival offer. [Bloomberg Businessweek]
Tokyo Stock Exchange-Osaka Securities Exchange: Japan's top two stock exchanges are starting campaigns to lure overseas investors after agreeing last month to a merger amid falling trading volumes. [WSJ]
Sinopec: ConocoPhillips and Origin Energy Ltd. have placed a large bet on China's booming energy demand by agreeing to sell most of the output from a US$20 billion Australian gas-export venture to China Petrochemical Corp., known as Sinopec. [WSJ]
Viper Strike: European missile maker MBDA said on Monday it had bought the Viper Strike munitions business from Northrop Grumman in what its officials described as the first European acquisition of a fully-fledged guided weapon system in the U.S. [Reuters]
Financial Institutions
Bank of America: BofA has taken more of a beating in recent months than investors may realize. [WSJ]


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Tin-men.net ranks
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I work as the resident web nerd at a mac support and implementation company as well as a freelance web developer . I'm a computer geek with a particular weakness for Apple products. I love music, particuarly metal and drum & bass. I'm often found in Jillys . (I need to find somewhere fun to go in London - any suggestions? ) ... Favourite blogging position: In front of the TV. I have a few other sites, grahamgilbert.com , firesuite and emoscum . ...
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text:
Do you have a friend or acquaintance who seems to know everyone?
Not necessarily every specific person, but every "type" of person?
You know what I mean, you mention that you want to visit a certain country and he says, "Oh, I just met someone from there"
Or you say that you would like to change jobs and he says, "I knew a guy who did that"
Or you tell him that you love a certain kind of food and he tells you that he knew a girl who cooked that kind of food better than anyone else.
Well, let me guess something about that guy: He's always meeting new people, isn't he?
While you're usually staying at home, he's always out and, when he is out, he's actively meeting and talking to new people.
Ok, maybe he isn't exactly the greatest ladies man in the world, but that's not the point, the point is that he lives a life full of interesting and exciting people.
Now, consider how this compares to approaching women
Have you noticed that I put more emphasis on the approach than almost any other pickup coach?
You may think I do that because meeting women is just "a numbers game," which is true to an extent, but, more importantly, approaching a lot of different women is the best way for anyone to live a life of sexual diversity.
Let me put it like this, I don't want to sound like I am bragging here, but I have had sex with women with just about every skin and hair color, from every continent except Antarctica.
I have had sex with women I met on every vacation I went on (unless I had a girl with me and, sometimes with both of them) since I learned pickup.
I have had sex with women with whom I didn't even speak a common language.
I have had sex with strippers whom I met while they were working and others I met while they were off-work.
I have had sex with expensive escorts and call girls who command top prices and get very expensive tips and presents from their customers without paying them (I found out about what they do for work while we were laying around and talking afterwards)
I have had more one night stands than I can count.
I have had threesomes with two girls and have "helped guys tag-team their wives" (no homo!)
Like I said, I'm not saying this to brag, rather to illustrate how easy it is to live the kind of sex life that most guys think you need to be rich or a porn star to experience.
If you just go out and approach women often enough, you'll have opportunities to have just about every kind of sex with just about every kind of woman you can think of
Do you want to meet a nymphomaniac and make her your girlfriend? GO OUT AND APPROACH WOMEN — A LOT!
Do you want to sleep with a woman who is into a certain kind of sex? GO OUT AND APPROACH WOMEN — A LOT!
Do you want to have sex with an especially beautiful woman? GO OUT AND APPROACH WOMEN — A LOT!
Do you want to go on crazy adventures like when you meet a girl, leave with her, go somewhere to have sex where people usually don't have sex, part ways and realize that you didn't even talk much with her, much less find out what her name is? GO OUT AND APPROACH WOMEN — A LOT!
Do you want to meet a nice girl, fall in love and get married to her? GO OUT AND APPROACH WOMEN — A LOT!
They're not going to climb up your wall and knock on your bedroom window. If you want them, you have to go out and meet them and, believe me, you'll be amazed at the kinds of women you'll meet if you just go out and approach a lot of women!
Until next time, go out there and be awesome!
PS: If anxiety, fear or worry is holding you back from approaching as often as you would like, then check out my complete training on overcomming approach-, social- and sexual-anxiety


text:
Top 10 Forgotten JRPG's
Script written by Allen-Michael Harber
Top 10 Forgotten JRPG Games
While big names like "Final Fantasy" have gotten all the glory, these gems have been hidden away. Join http://www.WatchMojo.com as we countdown our picks for the Top 10 Forgotten JRPGs.
For this list we are counting down RPG's that were considered pretty good when they were released but was never given the chance to shine. This means that games like "Golden Sun" don't count because even though they aren't as big as other RPG's they are still pretty well known.
#10: "Eternal Sonata" (2007)
"Eternal Sonata" already begins on a unique note, pun intended, with its inclusion of classical music into its story. Polish composer Frederic Chopin is on his death bed and during his final moments he has a dream, which becomes the game. Pretty much everything in this game is based off Chopin's work as well as classical music as a whole. Character and town names are based off musical terms, and each part of the story is based on one of Chopin's compositions.
#9: "Odin Sphere" (2007)
In this artistic action RPG, the protagonists must stop the Demon Lord Odin from finding the Crystallization Cauldron and thereby preventing armageddon. What makes "Odin Sphere" different is that the story is told through the perspective of five different characters each with their own chapter. Each character has their own stories and motivations which intertwine with each other setting certain conflicts in motion. Characters range from the Daughter of the Demon Lord to a cursed prince who must traverse the underworld.
#8: "Alundra" (1997)
Sharing the name with its main protagonist, "Alundra" is about a boy who has the power to enter people's dreams and must rescue the inhabitants of Inoa from a dark curse. As well as its Action RPG elements, "Alundra" emphazises puzzle solving and exploration, with the puzzles becoming unsolvable unless you have cleared certain parts of the game. Despite all the praise for its dark story and challenging but rewarding puzzles it was quickly overshadowed by others of its kind, however it did gain its own sequel.
#7: "Lunar: Silver Star Story Complete" (1999)
A remake of the Sega CD's "Lunar: The Silver Star." It follows the adventures of Alex, who must claim the title of Dragon-master. He does this by passing trials laid before him by ancient dragons, all while trying to stop an evil sorcerer from controlling the world. The story was adapted from its original game, but with improved graphics, fluid animation and additions to the games cast and story. Even though this game has been several times on different systems it still has only managed to achieve a cult following.
#6: "Wild Arms" (1997)
Although this game might feature your standard save the world plotline it is centered in a unique landscape which is based off the wild west. You play as Rudy who is able to use an ancient weapon known as ARMs which resembles a firearm. Keeping with the Western motif you get to explore huge wastelands and do it all to a western inspired soundtrack. This game was not only one of the few RPGs to be based on the wild west, but also one of the very best titles on the playstation.
#5: "Legend of Dragoon" (2000)
Released late in the PlayStation's life cycle," Legend of Dragoon" was written off as just another average JRPG. However, what makes this game unique is the Additions combat system which has you entering button combinations as you attack allowing you to deal extra damage. Another next mechanic is the ability to transform into Dragoons, which grant the characters new abilities as well as some cool armor. Nowadays "Legend of Dragoon", has gained a sizable fanbase who have been begging for a sequel for quite some time.
#4: "Dark Cloud 2" (2003)
Also known as "Dark Chronicle" in Japan, you take control of Max and Monica who are from the present and the future respectively, and must travel back in time to stop Emperor Griffin from destroying the future. Unlike most RPGs your character does not level up, but it is their weapon instead which gains experience by defeating enemies. There is also a city building aspect to the game where you can create and rearrange buildings for villagers to live in, provided you have the items.
#3: "Shadow Hearts: Covenant" (2004)
Taking place in the midst of World War 1, you play as german lieutenant Karin Koenig and Yuri, a man capable of turning into different types of demons. "Shadow Hearts" features the Judgement Ring which is a roulette that dictates what actions the player will take and how they will affect the outcome of the battle. You are able to customize these rings with different abilities and items. It's not often you see a war game that's not an FPS in World War II, let alone playing as a German.
#2: "Phantasy Star" (1988)
The "Phantasy Star" series has garnered its share of attention, however most people seem to be oblivious to the game that started it. "Phantasy Star" on the Sega Master System was one of the pioneers of the traditional turn-based combat seen in RPGs including, overworld maps with towns and dungeons to explore, as well as random enemy encounters. From here it has spawned a few sequels and even the "Phantasy Star Online" series, ensuring that it is not totally forgotten.
Before we unveil our top pick, here are a few honorable mentions.
"Quest 64" (1998)
"The Last Remnant" (2008)
"The Last Story" (2012)
"Infinite Undiscovery" (2008)
"Tales of Vesperia" (2008)
"Vandal Hearts" (1997)
#1: "Skies of Arcadia" (2000)
In out list of the Top 10 Overlooked Games of All Time list, we mentioned that Skies of Arcadia has never gotten the attention it deserves and we stand by that. Playing as the air-pirate Vyse, you must stop the resurrection of ancient weapons with the power to destroy the world. "Skies of Arcadia" features gorgeous scenery, an amazing soundtrack, colorful characters and of course airship battles. Despite amazing reviews and even a GameCube release, this game is still severely under appreciated.
Chances are that due to the nature of this list, it's likely that a few of your Favourite JRPG's were forgotten, or so obsure we didn't know. So let us know what RPG's you think get no love these days For more top 10's that aren't easily forgotten be sure to subscribe to WatchMojo.com.
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text:
They are characterized by soft muddy soil with high concentration of salt and very low levels of oxygen and exposed to a high intensity of sunlight.
Avicennia sp. Hv long underground cable roots tat support them in the soft and muddy soil and protect them from strong coastal wind. These root produce breathing roots called pneumatophores.
Rhizophora sp. Hv prop roots. These are aerial roots that not only anchor the plants to the mud, but also play an important role in aeration. Aeration can take place through lenticels found on the tree barks of Rhizophora sp.
The leaves of mangrove hv thick cuticle which reduce transpiration during hot weather. The leaves are succulent to store water. The root cell of mangroves hv higher osmotic pressure than the surrounding salt water. Thus the cell sap of the root does not lose water by osmosis. The salt water tat enter the root cell is excreted through hydathodes.
Mangrove seeds are able to germinate while still being attached to the parent tree. This phenomenan is called viviparity. Viviparity increase the chances of survival of the seedlings as they can float on the water and be washed up sand where they settle to establish new populations.
The seaward zone is fully exposed to high tides twice a day. The sp. Tat inhabits this zone include Avicennia sp.and Sonneratia sp. The middle zone is inhabited by Rhizophora sp. The inland zone is Bruguiera sp.
The pioneer species in mangrove r Avicennia sp.and Sonneratia sp. The extensive root systems of these mangrove trees collect sediments,including organic matter from decaying plant. As time pass, the soil become more compact and firm. This condition favour the growth of Rhizophora sp. This species gradually replace the pioneer sp. The arching roots of Rhizophora trao silt and mud creating a firmer soil structure. The ground become higher and the soil become drier. Tis condition now become suitable for Bruguiera sp. The buttress root of B. sp. form loops which...


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The Echo Presents
Screaming Females
Upset, Benny The Jet Rodriguez, MC Sean O'Conner
1822 W. Sunset Blvd
The Echoplex is located below The Echo, enter through the alley at 1154 Glendale Blvd
Los Angeles, CA, 90026
This event is 18 and over
Screaming Females' seven years as a band, four full-length albums and 700 globe-spanning live shows has made them difficult to miss. Through it all, the New Brunswick, New Jersey trio have continued to exude a frenetic energy which is built upon the zeitgeist of America's punk and indie underground yet has always remained forward-looking. Fittingly, for Screaming Females' 5th album Ugly, the band enlisted legendary recording engineer Steve Albini, famed for his unique ability to capture the ferociousness of a live performance while delivering gorgeous sonic clarity. The album's 14 tracks reaffirm the touchstones of the band; they can still shred and front-woman Marissa Paternoster can still unleash a powerful howl. But it doesn't end there. The album ushers in new explorations for the band, a truly remarkable feat considering their already prolific output. Ugly has the perfect combination of raw energy and honed musicianship that produces the type of rock & roll which is still a force to be reckoned with.
For the past few years, Ali Koehler has been best known as the drummer of the pop group Best Coast and the noisy girl punk trio Vivian Girls. After her departure from Best Coast, Koehler decided to step up from behind the kit to front a band of her own, embracing her melodic punk-spirited songwriting impulses with Upset. Joined by Patty Schemel (of Hole) on drums and Jennifer Prince on lead guitar and vocals, Upsetwill release its massively hooky debut record, She's Gone, this fall.
With 12 songs in just under 30 minutes, it's a pop-punk album that immediately sounds classic, full of unshakeable hooks and the sincerest of shouts. It is fitting that She's Gone will see a release with Don Giovanni Records; the record could easily fit in the record collections of Ergs or Lemuria fans. She's Gone was recorded primarily at Koehler's house in April of 2013 by Kyle Gilbride of Swearin'.
As a songwriter, Koehler draws on the snarky angst and punk simplicity of her previous bands, with a delivery that masks angry and cheeky lyrics with a sweet-sung and wide-eyed infliction. She's Gone opens with "Back To School," conveying that sense of first-day anxieties and uncertainty that comes with a return to an old routine. "First day back's a heart attack," Koehler sings. It's an intro to the sort of personal and relatable lyrics she sings throughout, full of anxious introspection. "Game Over" (written and sung by Jenn Prince) is bored and angsty, channeling distant vox and 90s-indebted noise-pop guitars; "Never Wanna" is an urgent and impatient earworm. "I just don't know what to do / I can't stop thinking of you," Koehler sings.
"Queen Frosteen" uses childlike, upbeat rhymes and a sticky chorus to set up her indictment of a friendship gone wrong. "When she sets the scene / it's a sugarcoated fantasy," she sings, in a way that's so overly sugar-sweet, it almost sounds sarcastic. "Queen Frosteen, my enemy / she's everything and I'm nobody / Queen Frosteen, my enemy." The closing track sounds similarly burned and pissed about it. "This was a lesson learned / this is goodbye," the band sings, girl-gang style. "That's not what friends are for."
She's Gone has moments of self-doubt and resonant angst ("I can't remember feeling worse than this," Koehler sings on "Oxfords and Wingtips") but it has a sense of humor about it as well; "About Me" even starts with a giggle. It's a sort of record that's not afraid to have sincere open-book, downer moments, but doesn't take itself too seriously.
estimony by Baby J (Stoned At Heart/Can of Beans):
Keepin the San Pedro scene poppin is Benny The Jet Rodriguez! They emerged way back in the summer of 2012 originally a two piece featuring a studdly queer babe, L. Freeman, and the handsome drummer with the chops, Joey Centofanti.
BTJR has become a trifecta with the addition of Todd C.(FYP/Toys That Kill) on the keys. Together they are making magic happen, and smoking tons of weed while doing it. BTJR songs are written by a sweet baby genius! Songs you wish you wrote with harmonious keyboard melodies on top of righteous dirty chord progressions, backed by crashy head bobbin' drums and vocal chorus' that are guaranteed to get stuck in your head.
BTJR= Straight up, pumped up, high side of the lo-fi, feel good, heart felt, innovative pop punk with some grrl power sprinkled on top. New, fresh, young, fun, rockin and uh rollin.
$11.00 - $13.00
Upcoming Events
Fri, November 24
Club 90s - Lady Gaga Ball
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Brass Box
Mon, November 27
Monday Night Residency - Superet
Wed, November 29
Dub Club
Thu, November 30
Downtown Boys


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21 Aug
- By Scott Taylor
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December 1, 2017 @ 2:00 PM – 4:00 PM
December 1: Onward and Upward! – Snowshoeing
- 2:00 – 4:00 pm, FSM 112A (Off the Beaten Path)
Time to crawl out of hibernation mode and get outside to enjoy the fluffy white stuff! Snowshoeing is a great way to explore areas around Alaska you normally can't get to in summer because it's too overgrown or there are too many mosquitoes. If you have never tried it, now is the time! If you have done it before, come on out and help others learn to enjoy this fun winter sport.
Adventure activities focusing on team work, creating authentic relationships, building self-efficacy, mindfulness, goal setting and more! Equipment will be provided for each session. These are outdoor activities. Participants should dress appropriately for the weather and bring water and snacks.


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Beloved music studio in West Humboldt Park closing down
FOX 32 NEWS - Several local bands are scrambling after getting forced out of their longtime rehearsal space.
Potomac Studios is a sanctuary for the thriving musicians in Chicago's West Humboldt Park neighborhood.
"It offers a safe environment, a cool environment to come. Like I said, it's available 24/7, so we can come whenever we want and hang out together, practice together, rehearse our music," said Josh Boyer, singer/guitarist of The Bombats.
The Bombats have called the warehouse their home for the past two years.
"A little over a week ago we were practicing or one of the other bands was practicing and they just slid a cryptic note under the door that said, California Studios is being evicted and to spread the word. Stay at our own risk," Boyer said.
There is much confusion over that cryptic note. It says "California Studios," but this location is Potomac Studios. Some say the bands should have been given 30 days notice to vacate, but they were offered only until May 1st or risk being locked out.
"We've been trying to put the pieces together the same as everybody else. We don't really know why or who's taking control or what the deal is," Boyer said.
Boyer says there are close to 100 rooms in this warehouse. Sometimes three or four bands occupy one rehearsal space.
Many of the musicians are still in disbelief as the notice came without much notice.
"Kind of a shock for us because we've been here for about 2 years, pretty comfortable and we've gotten to like the space. Now all of a sudden it's being taken away," Boyer said.
The Bombats are still trying to figure out where they will practice once the warehouse closes.
FOX 32 tried to reach out to the person who runs the studios, but we have yet to receive a response.


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MyEssayWriting.com - Essay Writing Services.
Now anyone with an interest in basic, practical trigonometry can master it -- without formal training, unlimited time, or a genius IQ. In Trigonometry Demystified, best-selling author Stan Gibilisco provides a fun, effective, and totally painless way to learn the fundamentals and general concepts of trigonometry.
With Trigonometry Demystified you master the subject one simple step at a time -- at your own speed. Unlike most books on trigonometry, this book uses prose and illustrations to describe the concepts where others leave you pondering abstract symbology. This unique self-teaching guide offers questions at the end of each chapter and section to pinpoint weaknesses, and a 100-question final exam to reinforce the entire book.
Simple enough for beginners but challenging enough for professional enrichment, Trigonometry Demystified is your direct route to learning or brushing up on trigonometry.


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Do Tell: Have You Had an Embarrassing Moment at the Gyno?
Even at its best, a trip to the gynecologist is usually pretty uncomfortable and can be down right awkward. Since going to a doctor's appointment already makes most of us feel vulnerable, being naked in front of a doctor only makes things even more nerve-wracking. Anxiety, discomfort, nudity, and discussing sex and birth control are just about the perfect equation for an embarrassing moment to arise. So ladies, do tell, have you ever had an embarrassing mishap at the gyno?
— Additional reporting by Alexis Nordby
Image Source: Shutterstock


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GRiZ Gives Funky Present to Fans and Announces Spring Release of New Album
As a true connoisseur of funk, Grant Kwiecinski – better known as GRiZ – treated his fans to a wonderful present this week called, "A Fine Way to Die," featuring Orlando Napier. In a statement to the press, GRiZ expressed that "between recording horn lines, drums, writing guitar lines, and recording the most killin' vocals, this song took a full year to make. I really hope you guys enjoy this monster of a tune!!"
Along with this breath of fresh funk, the Detroit native also announced his plans to release an album sometime in the spring of 2015. In the meantime, look forward to a special hometown holiday performance, GRiZmas, set for Saturday December 20th at the Masonic Temple Theatre in Detroit, MI. Snag tickets here during the 12 days of GRiZmas, before time runs out!
Follow GRiZ:


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Perfect for play in and out of the water, our
Lace-Up Rash Guard
is quick drying, lightweight and made with the highest quality zinc oxide sun protection built right into the fibers of our Aqua SUNTECT fabric. Our girls rash guard is rugged enough to withstand chlorine, saltwater and endless hours of sand play, but gentle enough to be worn by little ones with the most delicate skin. End the sunscreen battle and extend their playtime with confidence knowing their most sun prone areas are safely covered. (Be sure to pair with one of our bucket hats.)


text:
Why we can't change our past?
the inescapable outcome
Of our multiple choices
We can not change past easily
For we cannot change
The choices we made in past
But we can change the future
By changing our choices
Right now.
The one
who is stronger than God,
is also weak like us,
feels like us,
and is now
one of us.
some people
truly love
but they never
get a chance
So they
keep waiting
They become
a house
without a door
inside which
love stays trapped
Sometimes you smile
After letting
Someone you love go
Knowing that
You never deserved
That someone
I may never get married, But I would definitely be a father in my 30s. Through adoption. I would allow a small girl to adopt me as father
— s a t y a (@POETICandFUNNY) June 1, 2015
True love Is always Unfinished… #micropoetry made with #lettrs https://t.co/i9v49bHESb pic.twitter.com/1fZAHnE1H6
— s a t y a (@POETICandFUNNY) May 25, 2015
4 of 5 stars to The Thousand-and-Second Tale of Scheh… by Edgar Allan Poe http://t.co/Jd6WnPcwqs
— Hurairah, Numey. (@BerryNumey) May 5, 2015
looking back with eyes of salt dissolving
— Jocelyn (@Jocelynx44) May 3, 2015
the moon calls your name, and tells you how wrong you've been
— Modpop (@modpop) May 3, 2015
only a perfect void allows for creation
— ~Shadow~ (@luminousword) May 2, 2015
For the love of cats #doodle #cats #illustration #art #micron #VSCOcam https://t.co/YqoBYxMys4
— Ritu Agarwal (@RituAgrwal) May 3, 2015
It's not freedom If some persons Can control it Using their wealth.
— Satya (@POETICandFUNNY) May 3, 2015
Attraction is natural Not lust For the men don't dare to lust the women who are their mothers and sisters , even inside their heads.
— Satya (@POETICandFUNNY) May 3, 2015
If i am honest to one I am loyal But if i am loyal to a cause And not a person I am honest.
— Satya (@POETICandFUNNY) April 30, 2015
right beside you.""
— Poems Porn (@PoemPorns) May 2, 2015
#POETRY: With You {http://t.co/oEyvWxh0fy} via @POETICandFUNNY pic.twitter.com/0daIOKvYN1
— lettrs (@lettrs) April 30, 2015
#POETRYMonth: {http://t.co/RHJV9uwFF1} #lettrs pic.twitter.com/TCqCLIfc7E
— lettrs (@lettrs) April 29, 2015
LETTER: "Seek and Find…" {http://t.co/g0PHTQ75Ip} pic.twitter.com/Eu42iS1QFW
— lettrs (@lettrs) April 30, 2015
I've relapsed far more times on feelings than I have on any substance…
— MindFucked (@keyblur_justin) April 30, 2015


text:
Fox News contributor Charles Krauthammer said following the Iowa caucuses on Monday that a choice made by Donald Trump less than a week ago may have cost him votes.
Appearing on The Kelly File, the conservative commentator said, "I think this was a major inflection point in the Republican campaign."
Krauthammer said he agreed with winner Sen. Ted Cruz's recent assessment that if Trump had won in Iowa, he would probably win in New Hampshire, and then "run the table."
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"This is now a three-man race. There is not an establishment lane," said Krauthammer. "There's a Cruz campaign, which is sort of austere conservatism. There's a Trump campaign, which is populist, and you've got Rubio, who is the mainstream, more moderate conservative."
TRENDING: Rand Paul's Wife Breaks Silence on Husband's Attack: 'This Was Not A Scuffle'
Krauthammer thought it did. "Imagine, if he'd been in the debate, he would be the center of all the coverage," said the commentator. "He didn't show up and it allowed the others to shine, and it really helped Rubio."
The Florida senator surged six points ahead of his Real Clear Politics average of polls going into the Iowa caucuses, while Cruz performed four points better and Trump came in four points worse.
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Krauthammer noted that Rubio had twice as many late deciders vote for him compared with Trump. "I think (skipping the debate) cost him a few votes, and it was a four-point spread and he beat Rubio by only one point," the Fox News personality said.
According to a Des Moines Register poll conducted late last week, nine percent of likely caucus-goers had not made up their mind, though 45 percent reported they could be persuaded to change.
As reported by Western Journalism, Trump decided not to participate in last Thursday's Fox News' Republican presidential debate, citing differences with the network and what he characterized as unfair treatment by Megyn Kelly in the first debate in August.
h/t: TheBlaze
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text:
Water is an element which is necessary for all living beings. No one on this planet can live without water. Nowadays, water has become polluted all over the world. Due to this, all living beings suffer from different kinds of diseases because of drinking polluted water, therefore it is essential for every living being to drink pure and clean water.
Home Shop 18 Shopping – Latest Air Conditioner At Lowest Price
Many online shopping malls provide or link to supplemental product information, such as directions, exhibition, manufacturer, specifications and safety procedures. While there are some online stores provide background information, suggestion and guides planned to help consumers decide which product to buy, some products information given below:
Ecommerce Solution For Big And Small Business
Ecommerce means doing online business using the web. Ecommerce solution enables the website to provide online shopping services. Online shopping services can be applied to products sale or service sale. Ecommerce sites should possess shopping cart facilities and secure payment gateways to collect payments.


text:
GraphicRiver Vegetable Icons 7976250
Stock Vector \ Objects \ Food
Illustrator \ Editable \ Broccoli \ Cabbage \ Included \ Version \ Minimum \ Carrot
Stock Vector - Vegetable Icons 7976250 by shabzfaiz @ GraphicRiver
Stock Vector \ Objects \ Food
Vegetable Icons editable in Adobe Illustrator Cs
The two main files are editable in Adobe Illustrator first is EPS file and the other is AI file both can be edit with Adobe Illustrator minimum CS version.
Files included Adobe Illustrator Cs, PNG, EPS 10 & Jpeg.
Layered: Yes; Graphics Files Included: Transparent PNG, JPG Image, Vector EPS, AI Illustrator; Minimum Adobe CS Version: CS.
Communication Icons; Travel Icons; Document Icons; Audio Music Icons; Book Icons; Media Icons; Server Icons.
Keywords: asparagus, beet, bio, broccoli, cabbage, carrot, cauliflower, celery, chili, corn, cucumber, eggplant, food, healthy, icons, mint, mushroom, nature, onion, organic, pea, pepper, potato, prepare, radish, rice, tomato, turnip, vegetable, vegetarian.


text: Upon shopping in Opening Ceremony last week, I came across these hand embroidered Olympia Le-Tan minaudiers. They are super pricey, but could not be more beautiful. There's a huge variety, but I love the clutches modeled after classic novels. They even inspired me to read Madame Bovary for the first time. That particular little one was real pretty. Too bad I don't have the bank for one of these. Highly suggest you check out her website if you do, or if you don't. http://www.olympialetan.com/


text:
Top Five Miranda Lambert Performances [WATCH]
There's no doubt that Miranda Lambert was destined for the country spotlight. Her 2005 debut album, 'Kerosene,' reached platinum sales in the United States right off the bat. And, Miranda's history of winning awards is nothing short of impressive- she's won a combined thirty Academy of Country Music and American Country Awards!
Miranda's latest album (her sixth) is called "The Weight of These Wings' and has the current single "Mr. Tin Man,' a song you'll no doubt hear at the Hawk's Taste of Country Music Festival when Miranda takes the stage on Saturday, June 10th.
In celebration of Miranda's upcoming appearance at the Taste of Country Music Festival, I give you my top five favorite Miranda Lambert performances.


text:
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The Wildlife Sciences Cedar Suet Plug Feeder (777C) has a bevel cut post construction that is simple and can easily blend to any garden. The wood construction attracts the suet eating birds to your area. This bevel post plug feeder is made from Cedar wood. The package comes with a heavy-duty eye screw hanger so you can hang this immediately on your dining stations or a tree branch.
|For use in:
|Feeding suet to a wide variety of birds on any garden or backyard.
|Can be placed on a tree branch or on a bird station together with other bird feeders.
|3.50 x 3.50 x 12.50
|Light Brown
|Material / Construction:
|Cedar Wood
|Parts Included:
|Comes with a heavy-duty eye screw hanger
|Shipping Weight:
|1.50 lbs
|Manufactured By:
|Wildlife Sciences (Mfg. Number: 777C)
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text:
|18 Mar 2013
how to get a copy of win 7 SP 1
As the title suggest i am looking for a copy of or download of SP1 for win7, the only reason i ask is that i am fed up with the hours of waiting when i do a fresh install, i have retail and oem discs of win7 would just like SP1
|My System Specs
|18 Mar 2013
Take a look here:
Windows 7 Direct Download Links
|My System Specs
|18 Mar 2013
Win 10 Pro x64
Here's the download for the stand alone SP1,
Download Windows 7 and Windows Server 2008 R2 Service Pack 1 (KB976932) from Official Microsoft Download Center
Or, Windows 7 with SP1 ISO download,
Windows 7 Direct Download Links
|My System Specs
|18 Mar 2013
Everything you need is here to get a perfect Clean Reinstall - Factory OEM Windows 7, which steps are the same for retail.
|My System Specs
|18 Mar 2013
This is where you can get it on DVD: Get Windows 7 Service Pack 1 (SP1) on DVD
|My System Specs
|19 Mar 2013
thanks for the links rep added
Close this i think
|My System Specs
|Thread Tools
|Similar help and support threads
New HP laptop, want to add a copy of 7 pro while keeping stock copy?
Okay brand new HP Pavilion DV6t-7000, it has 7 home premium on it from the factory which i dont mind but i have a few copies of 7 pro, i am about to go into my junior year of college as a Information Systems Major, ive worked some on an IT helpdesk as well this is just a little background to say im...
|General Discussion
transfer data through windows 7 by copy and paste perfect copy?
Hello, I have one internal drive with 1 TB. The data there is very important to me , so I bought External removable drive for backup. Now, I want to copy the data from one drive to the second drive but I have to be sure I have a perfect copy of the data. The data is mostly songs movies and...
|Hardware & Devices
Can I install a new, legal copy of Seven over my 'evaluation' copy...
....without erasing my other programs/tunes etc? I probably jumped the gun a bit, thinking the Windows 7 Enterprise OS that was on my new/used computer was "mine to keep". I went ahead an installed several programs including iTunes and about 8,000 songs. Turns out the seller had only put a...
|General Discussion
I want to Copy & Rename, not Copy & Replace
When I drag a file into a folder that has a similarly named file, I am asked to either "Copy and Replace" or "Don't Copy". I would love it if there was a third option "Copy and Rename". I would get so much done so much faster. I'm hoping there is some kind of registry tweak I can do to get...
|General Discussion
evaluation copy to permanent copy
Hello everyone, till now i was using Evaluation copy, Build 7100 of windows 7. now i have the full released version. i want to know how can i convert my current evaluation copy to permanent copy and still maintain all my current data and settings. i tried changing the key, but it didn't work......
|Installation & Setup
win7 evaluation copy to a retail copy install
I am getting win7 Ultimate (it should be in the mail right now), I install the win7 evaluation copy with a build I did back in the summer & installed win7 evaluation copy with a clean install. Now I want to do another clean install to get rid of the junk I have collected over the last couple months...
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text:
The group added that there was a growing national consensus on the need for economic reform.
"Egypt faces many challenges. During the prolonged political transition, growth fell and unemployment and poverty increased to high levels. Budget deficits grew and external pressures led to a fall in foreign exchange reserves," read the group's statement.
(READ MORE: S&P affirms Egypt's rating, fiscal position remains weak)
"The authorities recognise these challenges and have set appropriate economic objectives, including raising growth and steadily reducing inflation."
The IMF said the government was seeking to reduce the budget deficit to 8–8½ per cent of GDP and the budget sector debt to 80–85 per cent of GDP by 2018/19.
According to the group, the government of Egypt intends to increase spending on health, education, and research & development as mandated by the constitution, as well as on infrastructure.
Structural reforms planned by the authorities focused on improving the business climate, promoting investments and financial sector development, while addressing poverty and social gaps.
The authorities are also seeking to improve Egypt's external position, though additional external financing will still be needed through the medium term.
"The authorities have already begun to take the action needed to achieve their objectives. They have begun bold subsidy and tax reforms, are pursuing a disciplined monetary policy, expanding social policies, and have initiated wide-ranging regulatory and administrative reform efforts to improve the business environment and boost investment," added the IMF.
"Policies implemented so far, along with a return of confidence, are starting to produce a turnaround in economic activity and investment. We now project that growth will reach 3.8 per cent in FY 2014/15."
According to the group, the country saw headline inflation rising to 11.8 per cent in October.
"Swift interest rate action by the Central Bank of Egypt (CBE) has helped contain the second-round impact of those increases, which were associated with subsidies reform, as reflected in core inflation which fell to 8.5 percent. This has helped anchor inflation expectations," said the group.
(READ MORE: Fitch affirms Egypt's rating as government amends 2014/15 fiscal budget)
The IMF also called for a more flexible exchange rate which is policy focused on achieving a market-clearing rate and avoiding real appreciation would improve the availability of foreign exchange, strengthen competitiveness, support exports and tourism, and attract foreign direct investment.
This would foster growth and jobs and reduce financing needs.
"The banking system has been resilient in the face of economic stagnation in recent years," said the IMF.
"The CBE has appropriately reinforced the supervisory framework by strengthening regulations, further developing on-site and off-site supervision, and advancing implementation of Basel II and III. We welcome the CBE's commitment to increase the timeliness and scope of disclosure of banking sector data."