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So, these are the new Masteries as I imagine them : 3 trees with 8 horizontal lines each. So, let's set the rules for picking them: 1) Lines 1,3,5,7 have masteries of 4 Points, from which you may pick as many as you like, while Lines 2,4,6 and 8 have Masteries of 1 Point. 2) You can only pick one of the 2 or 3 available choices in Lines 2,4,6. 3) Picking masteries from Line 2 requires having invested 4 Points in Line 1. Line 3 requires 5 points in the respective Tree, Line 4 requires 9 Points, Line 5 Requires 10 Points, Line 6 requires 14 Points, Line 7 requires 15 points, Line 8 (the line of "keystone" masteries) requires 19 Points. Therefore, the most usual Mastery Build will be like 20-10-0, or possibly 20-5-5, but there can be more combinations like 10-10-10 etc. Now then, let me explain each mastery, starting always from left to right, as you look on the tree: Ferocity Tree Line 1: -Fury: +1/2/3/4% Attack Speed -Sorcery: 0.5/1/1.5/2% increased Ability damage. -Destruction: 1/2/3/4% increased Damage on turrets. Line 2: all 3 masteries (First Blood, Feast, Expose weak) remain the same way as they currently are. Line 3: -Brute Force: +1/2/3/4 Attack Damage. -Mental Force: +1.5/3/4.5/6 Ability Power. -Lethal Blows: +2.5/5/7.5/10% Critical Damage. Line 4: -Bounty Hunter: deal 1% increased damage for each unique champion you have killed. -Double-Edged Sword: deal 3% additional damage, receive 1.5% additional damage. -Oppressor: Deal 2% damage on movement-impaired units. Line 5: -Havoc: Deal 0.5/1/1.5/2% increased damage -Natural talent: Gain 0.11/0.22/0.33/0.44 Attack Damage and 0.13/0.27/0.4/0.53.0.67 Ability power per lvl (+8 Attack Damage and 12 Ability Power at lvl 18) -Vampirism: +0.5/1/1.5/2% Lifesteal and Spell Vamp Line 6: -Frenzy: grants 5% Attack Speed after landing a critical strike. This stacks up to 3 times. -Arcane Blade: your basic attacks deal bonus magic damage equal to 5% of your Ability Power. - Battle Trance: Gain up to 5% increased damage over 5 seconds when in combat with enemy Champions. Line 7: -Battering Blows: +1.25/2.5/3.75/5% Armor Penetration. -Piercing Thoughts: +1.25/2.5/3.75/5% Magic Penetration Line 8: -Executioner: Deals +5% damage (as true damage) against targets below 35% Health. Cunning Tree Line 1: -Energy Boost: +5/10/15/20 Energy -Expanded Mind: +15/30/45/60 Mana -Savagery: Single target attack and spells deal +1/2/3/4 Bonus damage against minions and monsters. Line 2: All 3 Masteries (Runic Affinity, Secret Stash, Assassin) remain the same as they currently are. Line 3: -Greed: Grants 0.4/0.8/1.2/1.6 Gold per 10 seconds. -Strength of Spirit: Grants 0.5/1/1.5/2 bonus Health Regen for every 400 mana you have. -Wanderer: + 0.75/1.5/2.25/3% Movement Speed out of combat. Line 4: -Greenfather's Gift: Stepping into brush causes your next damaging attack or ability to deal 2.5% of your target's current health as bonus magic damage (90 seconds cooldown) -Bandit: Gain 3 gold (10 if melee) when hitting an enemy champion with a basic attack (5 seconds cooldown) -Dangerous Game: Champion kills and assists restore 3% of your missing health and Mana Line 5: -Merciless: Deal 1/2/3/4% increased damage to champions below 40% health. -Meditation: regenerate 0.3/0.6/0.9/1.2 of your missing Mana every 5 seconds. -Awareness: Increase experience earned by 1/2/3/4%. Line 6: -Stormraider's Surge: Dealing 30% of a champion's max health within 2.5 seconds grants you 30% Movement Speed and 60% Slow Resistance for 3 seconds (10 seconds cooldown) -Thunderlord's Decree: Your 3rd attack or damaging spell against the same enemy champion calls down a lightning strike, dealing magic damage in the area. Damage: 8 per lvl, plus 15% of your Bonus Attack Damage and 5% of your Ability Power (25-15 seconds cooldown, based on lvl). -Windspeaker's Blessing: Your heals and shields are 8% stronger. Additionally, your heals and shields on other allies increase their armor by 3-20 (based on level) and their magic resistance by half that amount for 3 seconds. Line 7: -Precision: Gain 2/4/6/8 Lethality and 0.75/1.5/2.25/3 + 0.07/0.15/0.22/0.3 per level magic Penetration -Intelligence: Your Cooldown Reduction cap is increased to 41.25/42.5/43.75/45% and you gain 1.25/2.5/3.75/5% Cooldown Reduction. Line 8: -Mastermind: enhances each one of your Summoner Spells in a unique way (see more in my "Summoner Spells" section) Resolve Tree Line 1: -Recovery: +0.4/0.8/1.2/1.6 health per 5 seconds. -Unyielding: +1/2/3/4% Bonus Armor and Magic Resist -Good Hands: reduces time spent dead by 2.5/5/7.5/10% Line 2: All 3 Masteries here (Explorer, Tough Skin, Siegemaster) remain the same as they are. Line 3: -Perseverance: Grants health regeneration equal to 0.2/0.4/0.6/0.8 of your missing health when out of combat. -Hardiness: Grants 1.25/2.5/3.75/5 Armor -Resistance: Grants 1.25/2.5/3.75/5 Magic Resist Line 4: -Reinforced Armor: Reduces damage taken from critical strikes by 8% -Evasive: Reduces the damage taken by area of effect magic damage by 3%. -Safeguard: Reduces damage taken from turrets by 5% Line 5: -Insight: Reduces the Cooldown of Summoenr Spells by 2.5/5/7.5/10% -Runic Armor: Shields, healing, regeneration and lifesteal on you are 1.5/3/4.5/6% stronger. -Veteran's Scars: +10/20/30/40 health. Line 6: -Grasp of the Undying: every 4 seconds in combat, your next attack against an enemy champion deals damage equal to 1.5% of your max health and heals you for the same amount (halved for ranged champions, deals magic damage) -Strength of the Ages: Gain +10 Maximum health each time you or a nearby allied champion kill a siege minion, large or epic monster (maximum of +200 max health). -Fearless: Gain 10% +1 per level bonus Armor and Magic Resist when damaged by an enemy champion for 2 seconds (9 seconds cooldown). Line 7: -Swiftness: +2.5/5/7.5/10% tenacity and Slow Resist. -Legendary Guardian: +0.5/1/1.5/2 Armor and Magic Resist for each nearby enemy champion. Line 8: -Bond of Stone: +4% damage reduction. 6% of the damage taken by the nearest allied champion is dealt to you instead. Damage is not redirected if you are below 5% of your maximum health. So, what do we have here? Let me explain myself: -Of course I know these drastic changes should come along with huge balance issues, but maths can't really help before these masteries are tested in-game. -I see that the season of 9 distinct Keystone Masteries isn't really working. This is because some Keystones have similar features (Almost every AD Champion that likes Fervor of battle also likes Warlord's Bloodlust), resulting that, whenever the meta changes ever so slightly, certain masteries are rendered useless and certain others are permapicked (we will never forget the Patch of 10 Thunderlords or the tanky supports with Grasp). I, in the other hand, suggest going back to the 1 keystone mastery for every tree, while the old keystones can be moved to lower Mastery Tiers. -I really want back the Summoner Spells enhancing masteries… and I think it's worth putting this feature on the Utility Tree's keystone mastery. -With multiple Lines and multiple choices on each line, we can bring back many fancy features, like demolishing turrets, or critically striking to your heart's content! HASAGI ! Once more, thanks for your patience and I hope you have found my ideas useful!
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|02 Mar 2014
Acer Aspire Timeline Win7 not working properly
Hi,only joined a week ago,not really into computers that much,but being a bit silly,got one second hand,it does work,but I have had a few problems,the windows update didn't work,but went onto Microsoft site and sorted that,there were a few other things that needed to be looked at,but the main thing that's come upis,i wanted to get windows live up&working because I use Gmail,and for some reson when I logged on it came up page not found most of the time,however the windows live will not or cant send or receive email,no matter what is done,so I got a scan done by Microsoft & it came back with a lot of things that are not up to date,or not set right,the list is fairly long.
So in my mind I wonder if the best way to resolve thease and any other unkown problems would be to look at having the old 7 completely removed & a new windows 7 installed,as I don't really know what,or whatnot has been done on this laptop.
Any help/thoughts/ideas would be welcome.Dont buy second hand already learnt!!!!!
Cheers Goldman ITs An Acer Aspire Timeline X4820T
|My System Specs
|02 Mar 2014
You can use Recovery to restore the computer to it's Factory New state.
Users Guide is here: http://global-download.acer.com/GDFi...C=ACER&SC=PA_6
|My System Specs
|02 Mar 2014
Hi,thanks for that,only problem I have with doing something like that is am really out of my depth with it,it all sounds streight forward from reading this,but to be honest I am not confident in myself to do it,i don't know anyone who could help me if it went pear shaped.
|My System Specs
|02 Mar 2014
It's either do it that way which really is easy or download a legal copy of Windows 7 and do a clean install which means formatting the drive during the install process.
The Recovery method is far simpler and is the way I would recommend you go.
Otherwise, take it to a reputable repair shop and have them do it for you.
|My System Specs
|03 Mar 2014
Hi,yes I had a look at the acer recovery,and had a read about it all,it dose seem sort of easy to do,just as a matter of interest,i have found that if I put the google webpage & also the gmail login page in the Compatibily View Box,which I found on internet settings when on the webpage,it seems to work fine,but both come up in an older format,but without any problems,so could this mean its my Win 7 OS that's not up to date,or of course its got some sort of problem,as it stands at the moment,am going to give it a bit of time before I do anything,as for a new install,i would be looking to have it done if that's what it comes to,i just don't know anything like enough to do it myself.
Cheers Goldman
|My System Specs
|04 Mar 2014
Remember, before you do anything, backup any data you don't want to lose as a Recovery will almost surely wipe it out.
|My System Specs
|04 Mar 2014
Hi,as it happens I don't really have a great deal on it,and I can transfer the stuff I do have off my netbook I have,so that's something not to have to worry about,i will see how it goes ,and then decide which way to go with it.
Thanks for the help.
|My System Specs
|04 Mar 2014
Please let me know what you decide and ask away if you have any questions.
|My System Specs
|05 Mar 2014
Hi,yes I will let you know as & when & what I do with it,think it going to have to be done myself,even though I don't really do a lot on it,it needs to be right.
Cheers Goldman
|My System Specs
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Tuition, Funding & Scholarships
Tuition for the EMBA in Digital Transformation 2018-2019 cohort is $89,000 CAD and includes:
- All course material
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- In-course meals and select event dinners
Tuition does not include airfare or any other transportation to or from module locations.
A $5,000 deposit is due within 10 business days of acceptance into the program. The remainder will be due in three installments of $28,000 prior to the start of Modules 1, 2 and 3 (2018-2019 dates TBD). Instalement dates for 2017-2018:
- First installment: July 1, 2017
- Second installment: January 6, 2018
- Third installment: April 5, 2018
For information on how to make payments, visit McMaster's Student Accounts & Cashiers website.
For individuals:
Tuition tax credit
If you are self-funding, tuition fees for the EMBA in Digital Transformation may be partially tax deductible. For details please consult the Canada Revenue Agency or your tax professional.
Lifelong Learning Plan
You or your spouse may be eligible to make tax-free withdrawals from your RRSPs (up to $20,000 each) under the Canada Revenue Agency's Life Long Learning Plan. Please visit the LLP website for more information.
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DeGroote EMBA in Digital Transformation Scholarships
The program currently has 5 scholarships available for incoming students. The application deadline to apply is May 1, 2017 and the forms are available below to download and submit. If you have any questions, please contact email@example.com.
- Women in Leadership – $10,000
Awarded to one female student who has demonstrated exceptional professional and community leadership in business.
- Entrepreneurial Leadership – $10,000
Awarded to one student who has successfully launched and operated their own business (preference will be given to applicants in the technology sector).
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Awarded to one student who has demonstrated outstanding leadership and managerial competency in the healthcare industry.
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- Dean's Scholarship for McMaster Alumni – $10,000
Awarded to one student who is a graduate of McMaster University, and in the judgement of the EMBA Admissions Committee, is an exceptional EMBA candidate.
For employers:
If you are paying for an employee to attend the EMBA in Digital Transformation, your organization may be eligible for certain tax deductions. Please consult with the Canada Revenue Agency or your accounting department for details and/or eligibility.


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Discussion in 'Android Devices' started by peterluke, Oct 6, 2010.
i canot install a new software not can i access the sd card help me
Welcome to the Android Forums community! Glad you signed up and posted! I hope you feel free to join the conversations around the forum!
To get new programs on your phone, you need to go through the app called "Market". If your brand new to this, which it seems you are, I'm not going to delve into other ways as it will just confuse you being new. So just open your drawer and find the app called Market and you'll be off and running.
Regarding you SD card, you cannot add any apps onto the SD card with the 1.6 OS (which is what we all have, for now). You can use your PC companion Software program on your computer to access your SD card for music and photos. The program within the one I just mention to do all of that is called Media Go. Self explanitory once your there.
Anything else let us know and WELCOME!


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I just finished reading Why the Garden Club Couldn't Save Youngstown: The Transformation of the Rust Belt by Sean Safford. It's a very good book. Safford compares the histories of Youngstown, Ohio and Allentown, Pennsylvania in an effort to discover why Allentown has been able to recover economically from the collapse of its primary industry (steel), while Youngstown hasn't. He starts by tracking and comparing the social and economic histories of the two cities – which shows that differences in their social structures at the time of founding (200 years ago!) led to differences in social structures now, and that these differences explain a fair bit of their current situations. The main story is that the business elites in Youngstown formed a fairly closed circle, which was recreated across a number of social settings, while in Allentown there is much more of a history of cooperation across classes leading to effective collective action.
The story concludes with a very nice piece of network analysis, which supports this story. Safford looks at the interlocking board membership networks in both cities in 1950 and 1977 (both sample times precede instances of substantial economic change). He includes information about civic groups that are oriented around both business and community. What he finds is that in Youngstown the membership of business and community boards overlaps almost completely, while in Allentown these form two quite different networks. He concludes that this supports his earlier story – that in Youngstown the business elites faced a time of crisis and responded by mostly just talking to themselves, while in Allentown the business leaders encountered a broader range of opinion, which led to a better response to the economic changes.
This short summary obviously doesn't do the book justice, and it's definitely worth checking out yourself. It is a beautifully written book (even though it includes academic data, it reads like the sort of thing you could find in The New Yorker). It is also a very good example of how to put together a coherent research project, which PhD students can use as a model. The reviews of the book have been very positive. One thing that has struck me is that many people are pointing to the novelty of Safford's use of network analysis.
While I think his combination of network analysis and more traditional sociological techniques is very well conceived and executed, I also think this is a bit of a strawman argument. There are obviously some prominent streams of network research that treat network structure as the only driver of action within the network (mostly coming from the physics-based literature). But I think that most people that are using network analysis in the social sciences (even some econophysicists!) acknowledge that agency is important, and try to take into account the impact that people and their relationships have on the formation and maintenance of networks. The fantastic work of Pip Pattison, Garry Robins and their research group is a good example of researchers that take these issues very seriously. Even in work that is more structurally based, agent-level action is taken pretty seriously – I was struck recently by parallel findings concerning the interplay between network structure and individual attributes in research by Andrew Stephen and Oliver Toubia (see their paper Explaining the Power-Law Degree Distribution in a Social Commerce Network) and some of my findings concerning the international trade network (while that particular piece of research doesn't have much room for agency, the point is that the interplay between structure and actor is there, which is something I'm taking very seriously in my current work). And in our research group, Sam MacAulay, John Chen and Marco Fahmi are all doing studies that take the human side of networks very much into account.
While that angle isn't unique, this doesn't take away from the value of Safford's book. It is a very well thought out piece of research, and he tells the story really nicely. It's definitely worth a read.


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Outfit Inspiration: Dreaming Of Fall
Fall is my favourite season and I ain't afraid to say it! I've often dreamed of living somewhere with Autumn-like weather all year long… that'd be rather magical don't you think? Or would it lose its appeal?
I don't know about you, but the sweaty summer, frigid winters, and wet springs aren't my forte. Give me pumpkin, give me crunchy leaves, lattes, layered outfits, and gorgeous sunsets.
Today, in honour of what I'd like to call THE BEST SEASON EVER, I'm sharing an outfit that I'd very much like to sport myself. Take a peek below and be sure to pin it to your favourite style board for future outfit inspiration!
Out On The Deck Cardigan | Alex & Chloe Paws Tee | Talented Totes Mr. Squirrel Shopping Bag | 1969 Always Skinny Skimmer Jeans | Casual Influence Boot
I just want to wear all of the layers RIGHT NOW and say goodbye to the humidity forever. Don't hate!
What're your favourite things about Fall?


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Marvels biggest slap in the face!!!
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Juicy J
Join Date: Oct 2011
Location: Mars
Posts: 1,362
Re: Marvels biggest slap in the face!!!
I would agree, I think Ang Lee's Hulk is still to this day my least favorite comic book movie. I was 11 when that came out and even at that young age, where I honestly loved any and every movie I saw just out of sheer naivety, I thought it was a heaping pile of garbage. I tried watching it all the way through a few years ago and couldn't make it more than 45 minutes. It's not just that it's a bad movie, it definitely is, it's just that there's this dark, depressing vibe around the whole film. It's humorless and dour, which would be fine if it were a decent movie, but it's not. I know there are people out there that adamantly defend it but for the life of me I don't get it.
SM3 atleast had bits and pieces that I liked.
Oh, and X-men origins Wolverine probably takes a close second. I hated that crapfest almost as much.
Juicy J
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|Dreamy tropical summer breakfast!
I am a smoothie addict! While I tend to opt for heavier flavors using things like raw cacoa, peanut butter, cinnamon, and sweet potatoes in the colder months, in the summer I tend to use more fresh fruit and flavors. This strawberry lime margarita smoothie is a perfect way to begin the day when the temperature is blazing.
Strawberry Lime Margarita Smoothie Recipe (vegan)
serves 1-2 (makes about 16-18 ounces)
In a blender combine:
- 1 cup coconut milk (The carton kind, not from a can! I used unsweetened.)
- 1 ripe banana
- 1 small lime (Add the zest and juice.)
- 1 cup frozen or fresh organic strawberries
- 1 tsp vanilla
- sweetener (I tend not to use any, but if you like your smoothies sweet, options are: 1 TB agave, two dates, 1/2 TB coconut sugar, or 1/2 TB maple syrup. Add to your taste!)
- Your favorite smoothie add-ons: I used 1/2 TB of raw coconut oil, 1 TB flax, 1 TB hemp protein powder.
- A few ice cubes
Blend until well combined and enjoy!


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Jennifer Morrison
- Birthday
- Apr 12, 1979
- Birthplace
- Chicago, Illinois
Bio: An actress who first earned her critical laurels (and reeled in a substantial television fanbase) as Dr. Alison Cameron on the blockbuster medical drama House (2004), Jennifer Morrison grew up well outside the realm of Hollywood, in a middle-class family in the Chicago suburb of Arlington Heights, Illinois. As a preteen and teenager, Morrison entered showbusiness… More Bio: An actress who first earned her critical laurels (and reeled in a substantial television fanbase) as Dr. Alison Cameron on the blockbuster medical drama House (2004), Jennifer Morrison grew up well outside the realm of Hollywood, in a middle-class family in the Chicago suburb of Arlington Heights, Illinois. As a preteen and teenager, Morrison entered showbusiness via modeling, appearing in innumerable print campaigns and gracing the cover of Sports Illustrated for Kids at one point; after wrapping up high school, she attended Loyola University as a theater major (reportedly graduating in only three years) and subsequently trained with the legendary Steppenwolf theatrical ensemble, onetime home to such stars as John Malkovich, Gary Sinise, and Glenne Headly. From there, Hollywood fame was merely a short leap away; by the time of her Loyola graduation, Morrison had already officially debuted onscreen, with a small part as the daughter of Richard Gere and Sharon Stone in the psychological drama Intersection (1994) and a more significant role as a missing girl who psychically haunts Kevin Bacon in the supernatural thriller Stir of Echoes (1999). Morrison signed for her first lead with a role that many felt unworthy of her talents and intelligence: that of Amy Mayfield, a young film student who gets in way over her head amid a thesis project on urban legends, in John Ottman's slasher outing Urban Legends: The Final Cut (2000). Subsequent projects included Michael Davis's teen-oriented romantic comedy 100 Women (2002), Casey La Scala's teen comedy Grind (2003), and -- as something of a nadir -- the critically despised holiday gross-out fest Surviving Christmas (2004), in which she played Ben Affleck's snotty girlfriend.As indicated, House represented Morrison's breakthrough and the role that finally brought her public attention. The long-running Fox drama told of Dr. Gregory House (Hugh Laurie), a diagnostician with an astounding degree of medical knowledge and an absolute dearth of social skills. As Dr. Cameron (an immunologist with a not-so-secret crush on the physician), Morrison brought a much-needed dose of warmth and vulnerability to the series.Morrison subsequently made headlines in 2007, when she was tapped to appear as Winona Kirk, James T. Kirk's mother, in J.J. Abrams's much-anticipated 11th installment of the Star Trek series. Despite it being a fairly small role, Morrison still managed to make a big impression in Star Trek, and a somewhat meatier role in 2011's Warrior, as the wife of a natural born fighter from a fractured family, preceded her departure from House the following year. Her ties to television remained tight, however, thanks to a recurring role on the hit CBS comedy series How I Met Your Mother starting in 2010, with a turn as Emma Swan -- a mother who doesn't believe in fairy tales -- in ABC's Once Upon a Time revealing that Morrison possessed a flair for fantasy as well.
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text:
Anything Goes
The aim of expressive poetry writing is not to write clever poetry, but to roam, feeling free to express anything that comes to your mind. Poetry is almost like a form of mental dancing. Your mental "mind-moves" do not need to make rational sense.
We all have a free and creative voice that is uncensored and is not carefully planning what to say next. To find mental fluidity of expression takes daily practice, like building a muscle over time. Spontaneous poetry invites new insights into expression.
Expressive Poetry
1. Reach into the edge of your own mind to express what is unique, free, honest and uniquely you.
2. Explore the edge of what you think your should say from your mind, and what you really need to say from your emotions.
3. Lean into what feels forbidden for you to say, and create a poem that expresses what you honestly feel.
4. Be creative with your poem's structure. Try writing very short poems that take a few minutes and long poems that take days to write.
Writing poetry is a way to listen to your original voice. Writer Henry Miller found his original voice by allowing himself to write from the edges of his mind, "Immediately I heard my own voice, I was enchanted: the fact that it was a separate, unique voice sustained me. It didn't matter to me if what I wrote should be considered bad. Good and bad dropped out of my vocabulary....My life became a work of art. I had found my voice. I was whole again."
Benefits of Poetry Therapy
1. The use of rhythm in poetry can tap into the verbal form of music that can express your original voice.
2. The abstract nature of poetry can better support the expression of painful emotions that might feel too threatening to express directly.
3. Expressive poetry can gradually release the imprints of challenging experiences in a gentle and inspired way.
4. Poetry can reframe difficult emotions by providing leaps, contrasts and surprises through free-form verbal expression.
Poetry Coursework:


text:
|Publication number
|Publication type
|Application number
|Publication date
|Dec 3, 1996
|Filing date
|May 8, 1995
|Priority date
|Jul 30, 1987
|Fee status
|Also published as
|Publication number
|Reinhard Kowatsch, Toby Soto, Charles Howlett
|Original Assignee
|Johnson & Johnson Medical, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (31), Non-Patent Citations (4), Referenced by (97), Classifications (25), Legal Events (4)
|External Links: USPTO, USPTO Assignment, Espacenet
This is a continuation-in-part of application Ser. No. 08/120,303 filed Sep. 13, 1993, which is a continuation of application Ser. No. 07/864,151 filed Apr. 2, 1992, now abandoned, which is a continuation of application Ser. No. 07/464,843 filed Jan. 16, 1990, now abandoned, which is a division of application Ser. No. 07/079,550 filed Jul. 30, 1987, now U.S. Pat. No. 4,943,414, issued Jul. 24, 1990.
1. Field of Invention
The invention relates to the vapor sterilization of articles such as medical instruments having long narrow lumens therein, and more particularly, to a device for delivering a gaseous antimicrobial directly into the lumen of an article during the sterilization process.
2. Background Information
The need to sterilize articles such as medical instruments and others for use in the agriculture and fermentation industries is well known. In recent years, many methods of vapor sterilization have been developed. While these methods offer the advantage of being generally faster than sterilization by immersion in an antimicrobial solution, they suffer from one major disadvantage, namely the inability to sterilize the interior of a long narrow tube in a short period of time. Thus, with regard to medical instruments such as endoscopes, the difficulty in sterilizing the lumen can often negate the general advantage of using vapor sterilization.
One way of overcoming the above disadvantage is set forth in U.S. Pat. Nos. 4,410,492 and 4,337,223. The apparatus described therein comprises a sterilizing chamber with means for introducing an antimicrobial gas into the chamber and circulating the gas within the chamber. Disposed within the chamber is a socket for receiving the tubular end of a medical instrument. The socket is connected to a valve and a recirculating pump and the antimicrobial gas is recirculated from the chamber through the lumen of the instrument. The commercial apparatus employs ethylene oxide as the antimicrobial and requires a sterilization times of about 3 hours for flexible endoscopes and about 2 hours for the shorter, rigid endoscopes. Ethylene oxide is a known toxic substance and the process thereby experiences concomitant toxicity problems. In addition, the method and apparatus described in these references cannot be used to sterilize an instrument within a sterile pack since one end of the instrument must be attached to the socket.
Thus there is a current need for an effective method to sterilize medical instruments such as endoscopes in a reasonably short period of time, preferably in one hour or less. The method and device of the present invention makes vapor sterilization of such instruments practical by delivering vapor directly to the interior of the lumen in the endoscope, whether or not it is in a sterile pack.
The present invention comprises a method and device for providing antimicrobial vapor directly into the long narrow lumen of medical instruments and similar articles. The device and method are intended for use with solution vapor sterilization procedures. In these procedures, the article is placed within a sterilization chamber, the pressure in the chamber is reduced, and a liquid solution of antimicrobial agent is introduced into the chamber where it vaporizes. Alternatively, an antimicrobial vapor may be introduced directly into the chamber after the pressure therein has been reduced. In either case, the instrument is sterilized by exposure to the vapor or active species generated from it rather than by direct contact with a liquid antimicrobial. The procedure may further involve the use of heat or, e.g., low pressure gas plasma to enhance the antimicrobial activity, reduce sterilization times, and/or remove residual any antimcrobial agent from the instrument.
In its simplest form, the device of the present invention comprises a vessel containing a small amount of the antimicrobial solution, and a means for connecting the vessel to the lumen of the instrument to provide a source of antimicrobial vapor directly to the lumen during the vapor sterilization process. The device is placed on the instrument prior to disposing the instrument in the sterilization chamber. As the pressure in the chamber is reduced, the antimicrobial solution contained in the vessel is vaporized and passes from the vessel into the lumen of the instrument.
With the use of the device and method of the present invention, vapor sterilization times for endoscopes can be reduced to one hour or less. In addition, the method and the device may be used to sterilize endoscopes in a sterile pack since the device of the present invention may be attached to and packaged with the endoscope before the endoscope is placed within the sterilization chamber. Upon opening of the pack, the device may be retrieved for re-use or preferably discarded with the pack.
The device and method of the present invention reduce sterilization time required for instruments having long narrow lumens therein. Reduced sterilization times are also achieved with the instruments encased in a package designed to maintain sterility after the removal from the sterilized chamber. In addition, as antimicrobial vapor is provided directly into the lumen of the instrument, lower concentrations of antimicrobial solutions may be used in the sterilizer, and this together with the reduced sterilization times provides improved materials compatibility with respect to both the instrument components and the packaging or wrapping materials.
A device according to the inventions delivers an antimicrobial vapor to a lumen of an article during solution vapor sterilization. The device comprises a first member which comprises a vessel having an inner sealed chamber containing an antimicrobial solution and a wall forming at least a portion of the chamber. A connector connects the vessel to the article lumen. A second member connects to the first member in moveable relation thereto. The second member comprises an opening member whereby movement of the second member in a predetermined direction relative to the first member moves the opening member toward wall to open the wall and place the chamber into fluid communication with the article lumen.
Preferably, the opening member opens the wall via penetration thereof and comprises a spike having a first end and a second end, and wherein the first end faces the wall and comprises a sharpened tip. Preferably, a central lumen extends coaxially through the spike and communicates with the connector whereby the vessel is placed into fluid communication with the article lumen through the spike lumen when the spike penetrates the wall.
Preferably, the first and second members interconnect in telescoping relationship with each other. A detent and surface on the opposing members preferably limits the degree to which the first and second members can telescope apart.
To ease the breaching of the wall a threaded interconnection can be provided between the first and second members wherein rotation of the first and second members relative to each other moves them together to breach the wall. A tactile detent can be provided to let a user know when the members are fully rotated together.
Preferably, a guard is disposed between abutting surfaces on the first and second members to prevent the first and second members from moving together sufficiently to breach the wall. The guard preferably has a contrasting appearance to the first and second members whereby the presence or absence of the guard can easily be visually determined. In a preferred form, the guard comprises a ring encircling the device between the first and second members and is inelastic so that to remove the ring from between the first and second abutting surfaces it must be deformed beyond its elastic limit.
FIG. 1 is a perspective view of one embodiment of the device, according to the present invention, attached to the end of a tube;
FIG. 2 is a perspective view of another embodiment of the device of the present invention, showing the end of the device for making a connection to a tubular member;
FIG. 2A is a perspective view of a variation of the device of FIG. 2;
FIG. 3 is a plan view of another embodiment of a device of the present invention;
FIG. 3A is a variation of the device of FIG. 3;
FIG. 4 is a plot of sterilization time verses efficacy and showing enhanced efficacy of attaching an H2 O2 device to a lumen prior to sterilization;
FIG. 5 is an exploded view of a further embodiment of a device of the present invention;
FIG. 6 is an exploded view in section of the device of FIG. 5;
FIG. 7 is an end view of the opener of the device of FIG. 5;
FIG. 8 is a plan view in section of the assembled device of FIG. 5, prior to use;
FIG. 9 is a plan view in section of the assembled device of FIG. 5, during use;
FIG. 10 is a perspective disassembly view of a further embodiment of a device of the present invention;
FIG. 11 is a plan view in section of the assembled device of FIG. 10, during use;
FIG. 12 is a close-up plan view of a distal portion of a capsule portion of the device of FIG. 10; and
FIG. 13 is a sectional view taken along lines 13-13 of FIG. 12.
The method and device of the present invention relates to the sterilization of articles such as medical instruments having a long narrow tube therein. The term instruments as used herein applies to medical or surgical devices such as endoscopes, catheters, tubing, or similar instruments or articles having am internal lumen which is preferably used in a sterile condition as in, for example, the agricultural or fermentation industries. The method and device of the present application show particular advantages in the solution vapor sterilization of lumens exceeding ten centimeters in length and having an internal diameter of about 7 millimeters or less. As endoscopes typically have lumens with internal diameters of 1 to 4 millimeters and lengths of up to 1.5 meters or more for flexible endoscopes and at least 45 centimeters for rigid endoscopes, the method and device of the present application have particular applicability to the sterilization of these instruments. With the use of the device of the present invention, antimicrobial vapor is supplied directly to the lumen or interior of the tube of the instrument during the vapor sterilization process.
The antimicrobials used with the method and device of the present invention include solutions of glutaraldehyde, hydrogen peroxide, chlorine dioxide or other antimicrobials in an inert solvent, the only requirement being that the solution be liquid at atmospheric pressure and a vapor at the temperature and pressure of the sterilization process. Though the higher concentration solutions of antimicrobials are more effective, problems with materials compatibility and shipping and handling may arise at very high concentrations. For example, a 30% to 50% solution of hydrogen peroxide in water is both very effective and presents few shipping and handling problems, while higher concentrations of up to 70% become increasingly more difficult and dangerous to handle.
In solution vapor sterilization, the procedure generally used is as follows: The article to be sterilized is placed within the sterilization chamber, the chamber is sealed, and a vacuum is drawn on the chamber to reduce the pressure to less than about 50 torr, and preferably to 20 torr or less. An antimicrobial solution is then injected into the chamber where it vaporizes and contacts the exposed surfaces of article. The time necessary for total kill of specific microbial agents varies with the type and concentration of antimicrobials present, and with the degree of exposure to the microbial agent. Microbials disposed in cracks, crevices or internal tubular structures are somewhat protected from the antimicrobial agent and require more time for total kill than microbials on the external surface of the article. Heat or high frequency radiation may be used to increase the effectiveness of the antimicrobial and its penetration into remote areas of the instrument.
The device of the present invention comprises a vessel for containing a small amount of antimicrobial solution, and a means for connecting the vessel directly to the lumen or the end of the tube of the article to be sterilized. When the article with device containing antimicrobial solution is disposed in the sterilization chamber and a vacuum drawn on the chamber, antimicrobial vapor generated from the solution within the vessel flows directly into the lumen.
The effectiveness of the method and device of the present invention was demonstrated by the following experiments:
50 inch (127 centimeters) lengths of Tygon tubing having a 2 millimeter inside diameter were used to simulate an endoscope in the sterilization test. A paper strip (2 mm�13 mm) containing approximately 2.0�106 Bacillus subtilis (var. globigii) spores was placed in each tube equidistant from each end. A syringe containing 0.05 milliliters of 10% by weight hydrogen peroxide solution in water was provided for each tube. Each of the samples was individually packaged in a TYVEK™/MYLAR™ envelope prior to sterilization.
One third of the samples (three units) were placed in the package with the syringe unattached to the end of the tube. Another one-third of the samples were packaged with the syringe attached. Individual samples were placed within a 65 liter sterilization chamber and sent through a hydrogen peroxide vapor sterilization cycle wherein the pressure within the chamber was reduced to 3 torr for the total exposure time minus 15 minutes, and 0.5 torr for the final 15 minutes of exposure. No additional hydrogen peroxide was injected into the chamber.
The remaining one-third of the samples, packaged with the syringe attached to the end of the tube as described above, were sent through a hydrogen peroxide vapor sterilization cycle supplemented with high frequency radiation plasma which is known to generate an active species from the hydrogen peroxide. Again a 65 liter chamber was used, and the pressure within the chamber was reduced to 3.0 torr for the total exposure time minus 15 minutes and 0.5 torr for the final 15 minutes of exposure. Again, no additional hydrogen peroxide was injected into the chamber. Plasma was generated only during the final 15 minutes of exposure at 2.05 MHz with 320 watts of power, pulsed 0.3 milliseconds on to 1.0 milliseconds off.
At the conclusion of the sterilization cycle, the paper strip was removed from each tube and placed in a glass vial containing 10 ml of a sterile pH 7.0 phosphate buffer solution. This solution contained 10 milligrams of TWEEN 80 to aid in removal of any spores from the paper strip and 0.0066 milligram of catalase to neutralize any remaining hydrogen peroxide. Five glass beads were placed in the solution, and the solution was vortexed for two minutes to completely macerate the paper strip. Three decimal dilutions of the solution were made with sterile pH 7.0 phosphate buffer, and the original solution and the decimal dilutions were poured into sterile glass Petri plates. A culture medium was added and the plates were incubated for four days at 30� C. After incubation the number of viable organisms in each plate was counted, and the number of spores on the paper strip calculated by multiplying the spore count by the appropriate dilution factor.
The results of the experiments are presented in Table I below, and plotted in FIG. 4, where S/S0 represents the ratio of the number of organisms surviving the test to the initial number of organisms which were placed on the paper strip prior to the test. As shown by these data, no reduction in microbial population was achieved in samples where the syringe was not attached to the tubing, even after an exposure time of 75 minutes. Attaching the syringe to the end of the tube according to the method of the present invention produced total kill in 35 minutes without low temperature gas plasma, and in 25 minutes when the antimicrobial activity was enhanced by the use of low temperature gas plasma.
TABLE I______________________________________ SterilizationSample Time - Min. Efficacy (S/S.sub.0)______________________________________A 35 8.6 � 10.sup.-1 45 8.9 � 10.sup.-1 75 1.1 � 10.sup.-0B 20 7.0 � 10.sup.-1 25 5.8 � 10.sup.-1 35 0C 20 8.5 � 10.sup.-3 25 0 35 0______________________________________ Sample A Syringe unattached Sample B Syringe attached Sample C Syringe attached plus plasma
A preferred embodiment of the device to be used in accordance with the teaching of the present invention is shown in FIG. 1. The device indicated generally at 10 is shown attached to a tube 12. In the device depicted in FIG. 1. the means for connecting the vessel 14 to the end of the tube comprises an expandable sheath 16, one end of which is securely attached to the vessel, and the other end of which comprises an elastic ring 18 making a releasable attachment about the end of the tube. The sheath 16 may be attached to the vessel in any known manner and, as shown in FIG. 1, the sheath 16 is attached to the vessel by a second elastic ring 20 disposed over the lip 22 about opening 24 of vessel 14. Though the vessel shown is cylindrical, the vessel may comprise any three dimensional container preferably of semi-rigid material, having an opening therein. The vessel may be made of, e.g., polyethylene, polypropylene, glass or any other material which is nonreactive to the antimicrobial solution of vapor. The sheath may also be formed of polyethylene, polypropylene or other material which is relatively nonreactive to the antimicrobial vapor. The elastic rings may be formed of natural latex or butyl rubber which are relatively resistant to the antimicrobial vapors; however, resistivity is less critical when the device is constructed for one time use. Disposed within the vessel may be a substrate 26 comprising a woven or nonwoven fabric or sponge for containing the liquid antimicrobial solution. The vessel preferably has a means 28 associated with the opening for attaching a closure cap over the opening prior to use in order to maintain the antimicrobial solution therein. As shown in FIG. 1, means 28 comprises threads for a screw cap fitting about the lip of the vessel.
Another embodiment of the device of the present invention is depicted in FIG. 2 where the device is indicated generally at 30. The means for connecting the vessel 34 to the end of a tubular instrument comprises a bushing 36 disposed within the open end of the vessel. In the particular embodiment shown in FIG. 2, the bushing comprises a series of rings 38 and 40 of inwardly extending plastic flaps defining a flexible aperture 32 to receive the tubular instrument. The flaps can be made of any flexible material which is non-reactive to the antimicrobial solution or vapor, such as polyethylene, and of sufficient thickness that the flaps provide resistance to withdrawal of a tube inserted through the aperture. Disposed within the vessel is a substrate 42 containing the antimicrobial solution. Preferably, the vessel 34 is provided with means 44 for attaching a closure cap thereto prior to use. As shown in FIG. 2, means 44 comprise threads for attaching a screw cap (not shown) within the opening of the vessel.
FIG. 2A illustrates a variation in the design of the device of FIG. 2 which utilizes the same basic vessel and means for attachment to a tubular device. In the device shown in FIG. 2A, end 45 of the vessel opposite the open end is provided with aperture 46 for attaching a disposable cartridge 47 containing a supply of antimicrobial on a substrate such as a woven or nonwoven fabric or sponge 48 as illustrated. The aperture 46 of the vessel is designed in conjunction with neck 49 of the cartridge to provide quick and easy attachment and release of the cartridge and the vessel. In the embodiment shown in FIG. 2A, aperture 46 is provided with reverse threads for engaging the threads of the neck 49 of the cartridge. In this variation of the device it is not necessary for a substrate containing the antimicrobial solution to be disposed within the vessel since the antimicrobial solution is provided in pre-measured aliquots in the cartridges. With the device of FIG. 2A one achieves the convenience and accuracy of disposable, pre-measured aliquots of antimicrobial solution without the expense associated with the device of FIG. 2.
The following table sets forth the effectiveness of the devices depicted in FIGS. 1 and 2 in a sterilization procedure described below.
TABLE II______________________________________Effect of Devices on Efficacy of SterilizationInside Tubes Efficacy (S/S.sub.0) I. D. Length DeviceMaterial (cm) (cm) No Device FIG. 1 FIG. 2A______________________________________Surgical Tygon 0.64 10 0 -- -- 0.64 20 4.4 � 10.sup.-5 -- -- 0.64 30 1.1 � 10.sup.-2 -- -- 0.64 45 8.8 � 10.sup.-1 0 0Rubber Tubing 0.64 25 1.7 � 10.sup.-1 -- -- 0.64 45 7.9 � 10.sup.-1 0 0______________________________________
The efficacy is recorded in terms of the ratio of the number of microorganisms surviving the test, S, to the number of challenge organisms, S0 (approx. 1�106) on a paper strip disposed within the tube equidistant from the ends. In the sterilization procedure, 100 microliters of 30% aqueous H2 O2 solution was supplied in each of the devices. The devices were attached to the ends of tubes of the indicated length and 0.64 cm in internal diameter. All of the tube samples were placed within TYVEK'/MYLAR' packaging prior to sterilization, The packaged tubes were placed within the sterilizing chamber and the pressure therein was reduced to about 0.1 torr in about 10 minutes. Additional 30% H2 O2 solution was injected into the chamber to achieve a concentration of 2.0 milligrams H2 O2 per liter of chamber volume. Following injection of the H2 O2, the tubes were retained in the chamber an additional 50 minutes.
Injection of the H2 O2 solution raised the pressure in the chamber to about 6 torr and the pressure was again reduced to about 0.1 torr. During the last 10 minutes of exposure, low temperature gas plasma was generated in the chamber at 300 watts. The challenge micro organisms used in the test were Bacillus subtilis (var. globigii) spores.
As shown in Table II above, when the tube length was only 10 centimeters, sterilization was achieved without the use of the device according to the present invention. However, for tubing of 20 and 30 centimeters in length, a device of the present invention would be needed in order to achieve sterility within the exposure time of the test. For tubes of 45 centimeters in length, total kill was achieved during the 1 hour exposure time of the test, using either of the devices depicted in FIG. 1 and FIG. 2.
A further experiment used 7 mm medical grade Teflon tubing 183 cm in length. The tubing was cut into three pieces to obtain a 5 cm long center section which was joined in the end sections by external tubing connectors. In the experiment, approximately 1.0�104 Bacillus (var. globigii) spores were deposited in the center section of the Teflon tubing. The tubing was assembled and subjected to sterilization with hydrogen peroxide vapor as described above at a concentration of 2.0 mg./liter of chamber volume. The chamber was evacuated to a pressure of 0.1 torr before the peroxide was injected as an aqueous solution and allowed to vaporize. After 20 minutes, a continuous gas plasma was generated in the chamber at 300 watts, 13.5 MegaHertz and the sterilization continued for an additional 5 minutes after which the vacuum was released with sterile, filtered air, and the number of surviving spores determined.
The experiment was first conducted without a device of the present invention attached to the tubing, then repeated with a device of FIG. 3 as described below containing 100 ml of 30% hydrogen peroxide attached to one end of the tubing. The experimental results of the tests are presented in Table III below.
TABLE III______________________________________Sterilization of 1 mm TubingEfficacy (S/S.sub.0)Material I.D. Length No Device FIG. 1 Device______________________________________Teflon 1 mm 183 cm 1.9 � 10.sup.-1 0______________________________________
The data of Table III demonstrate the efficacy of the method of the present invention in sterilizing of very long tubes having very small diameters used in certain endoscopic procedures.
Additional embodiments of the device of the present invention are depicted in FIGS. 3 and 3A. The device shown in FIG. 3 indicated generally at 50, comprises a vessel 52 in the form of a pouch constructed of a flexible material. The means for connecting the vessel or pouch 52 to the end of an instrument tube comprises a first drawstring 54, and preferably a second drawstring 62. These drawstrings are preferably arranged in the configuration as shown in FIG. 2 to be drawn from opposite sides of the pouch. The pouch is preferably provided with an airtight seal to maintain the antimicrobial solution therein prior to use, and includes a means for creating an opening in the sealed pouch so that it may be disposed over the end of a tube. The seal may be created by sealing the ends 66 of the pouch, and of the lumen as often the means for opening the sealed pouch may comprise, for example, a line of weakening at 68, preferably in combination with a notch also shown generally at 68, to permit the pouch to be opened by tearing off one end.
FIG. 3A shows a device indicated generally at 50A, similar to device 50, but wherein the airtight seal and the means for creating and opening the sealed pouch is a line of fastening 64 similar to a "zip-lock" closure. Optionally, opening flaps 70 may be provided on either side of the pouch adjacent closure 64 of FIG. 3A, or the line of weakening 68 of FIG. 3. These flaps are firmly secured to the pouch. In use, after the sealed end 66 of the pouch of FIG. 3 has been removed along the line of weakening 68, the flaps when pulled oppositely from each other will distend the opening of the pouch for disposal around the end of an instrument tube. The flaps of FIG. 3A, when pulled in opposite directions, can be used to open the zip-lock fastening, or if the fastening is already opened, to distend the opening for disposal around the end of an instrument tube. A substrate 72 such as a woven or nonwoven fabric or sponge may be disposed within the pouch for containing the antimicrobial solution.
In a preferred construction, the drawstrings are provided with a locking means as illustrated. Though many means for locking or catching a drawstring are known in the art and may be used in conjunction with the present invention, the locking means depicted at 56 at FIG. 3 comprise a catch 60 for a serrated edge 58 provided on the drawstring. As shown in FIG. 3, the catch, comprising an opening for disposing one end of the drawstring therethrough, is located at the opposite end of the drawstring. The catch, however, may be provided by a flap, opening therein, attached to the edge of the pouch, provided the other end of the drawstring must also be attached to the pouch. When two drawstrings are used, one or both drawstrings may be provided with a locking means. By pulling the end 73 of the drawstring, the flexible pouch is gathered and a firm fastening may be made to a tube inserted within the pouch.
Preferably, a highly concentrated solution of hydrogen peroxide is used as the liquid antimicrobial in the device of the present invention. However, in high concentrations, hydrogen peroxide can quickly cause damage to living tissue. A system for applying such solution to an instrument lumen while reducing the chances of accidental exposure of a user to the antimicrobial solution is highly desirable. The following embodiments provide such advantage.
FIG. 5 illustrates a further embodiment of a device 100 according to the invention. The device 100 comprises in gross a capsule 102, an opener 104, and a safety ring 106 positioned between the capsule of 102 and the opener 104. Turning to FIG. 6, the capsule 102 comprises a cylindrical body 108 having a distal end 110 and a proximal end 112. At the proximal end 112, the capsule body 108 expands radially to form a cup shaped well 114. A membrane wall 116 is disposed within the capsule body 108 adjacent to well 114.
A cap 118 of generally discoidal shape has a distally projecting annular flange 120 which fits within the well 114. The cap 118 is sonically welded to the capsule 102 at the proximal end 112 to seal a quantity of antimicrobial solution 122 within a chamber 124 defined between the cap 118, membrane wall 116 and capsule body 108. During storage the antimicrobial solution 122 may tend to diffuse through the capsule 102 and out of the chamber 124 thereby decreasing its quantity and potency. The antimicrobial solution 122 thus preferably comprises 197 mg of 59% hydrogen peroxide solution upon construction such that after a reasonable storage period such as ten months, the chamber 124 will retain approximately 100 mg of a 45% hydrogen peroxide solution.
So that it may be more easily breached, a central portion 126 of the membrane wall 116 has a slightly thinner thickness than the remainder of the membrane wall 116. Six radial ribs 128 extend from the capsule body 108 towards, but not into, the membrane wall central portion 126 to support the membrane wall 116 during the breaching process.
At the capsule body distal end 110, an annular flange 130 slopes outwardly and proximally, thus providing a barbed appearance in cross-section. The distal flange 130 preferably slopes in a gentle fashion, such as a 17� slope from an imaginary coaxial centerline 132 of the device 100. A central annular flange 134 slopes outwardly and proximally from the capsule body 108 at a slightly more aggressive angle than the distal flange 130. A pair of diametrically opposed slits 136 extend proximally in the capsule body 108 from its distal end 110 to allow some flexibility in the capsule body 108 and to thereby ease its entry into the opener 104.
The opener 104 comprises a cylindrical body 140 having a proximal end 142 facing the capsule 102 and a distal end 144. A hollow spike 146, coaxially disposed within the opener body 146, extends toward the membrane wall 116 and terminates in a beveled and sharpened tip 148. Preferably, the tip 148 is beveled at a 30� angle from the device center line 132. Also, a central lumen 150 extends coaxially through the spike 146.
Three equilaterally spaced posts 152 extend outwardly radially from a fixed end of the spike 146 to the opener body 140 and thereby support the spike 146 therein. Preferably, each of the posts 152 has a distally facing fillet brace 154 for added support. A circumferentially interrupted annular embossment 156 extends radially inwardly in a very shallow manner from the opener body 140 (see also FIG. 7). When the capsule 102 is inserted into the opener 104 with the capsule distal flange 130 beyond the opener embossment 156, engagement therebetween prevents the capsule 102 from being easily removed from the opener 104 while still allowing a relative degree of movement between the opener 104 and capsule 102 as will be more fully described hereinafter.
A retaining ring 158 holds a mist-filter screen 160 within the opener body distal end 144. The mist-filter screen 160 is round with a diameter exceeding that of the opener body 140 whereby it is frictionally retained within the opener body 140 by the retaining ring 158. Preferably, the mist-filter screen 160 has a mesh opening of 105 microns and is formed of polypropylene. A plurality of axially aligned embossments 162 on an outer surface of the retaining ring 158 ease insertion and securely retain the mist-filter screen 160 and retaining ring 158 within the opener body 140 (see also FIGS. 8 and 9).
Alternatively, a series of detents (not shown), each with a distally facing camming surface and a proximally facing radial surface could be provided within the opener body 140, axially adjacent the posts 152. The mist-filter screen 160 would thus have a diameter equal to the inside diameter of the opener body 140 and be held between the posts 152 and the proximally facing surfaces of the detents. The screen could be easily inserted through the opener distal end 144 and cammed over the detent camming surfaces into place between the posts 152 and detents.
The safety ring 106 separates the opener 104 from the capsule 102. With the safety ring 106 trapped between the opener body proximal end 142 and the lip 115 on the capsule 102, the spike 146 is prevented from contacting the membrane wall 116 (see also FIG. 8). The safety ring 106 is provided with a thin wall section 164 and a diametrically opposed pull tab 166 whereby manual pressure applied to the pull tab 166 is sufficient to deform the thin wall section 164 beyond its elastic limit, preferably breaching the thin wall section 164, thereby permitting removal of the safety ring 106 from the device 100.
FIG. 8 illustrates the assembled device 100 prior to use, with an adapter 170 affixed thereto. The adapter 170 comprises a cylindrical tubular body 172 formed of a soft thermoplastic elastomer, such as Schafer, GmbH THEKA-FLEX, S 2030 M. A shallow inwardly facing annular flange 174 at a proximal end 176 of the adapter body 172 is received within a correspondingly shallow annular groove about the opener body 140 to hold the adapter 170 to the device 100.
A truncated cone 178 extends inwardly, proximally, from a distal end 180 of the adapter body 172 and terminates in a central opening 182. A luer fitting 184 of an instrument to be sterilized 186 having a lumen 188 therein, is shown received within the opening 182. Those of skill in the art will appreciate that the dimensions of the cone 178 can be varied to accommodate various types of instruments to be sterilized and that other engaging means may be substituted therefor.
To use the device 100, an appropriately sized adapter 170 is selected for the particular instrument 186 to be sterilized. The adapter 170 is attached to the device 100 as shown in FIG. 8. The pull-tab 166 on the safety ring 106 is grasped and pulled to separate the safety ring thin wall section 164 and remove the safety ring 106 from the device 100. To aid the user in removing the safety ring 106 and in later rotating the capsule 102 relative to the opener 104, the opener body 140 is provided with several textured finger indentations 190 for easier grasping. After the safety ring 106 is removed, the capsule 102 and opener 104 are pushed together so that the spike 146 breaches the membrane wall 116 as shown in FIG. 9. Preferably, the capsule 102 is then rotated one full turn to ensure proper breaching of the membrane wall 116. The antimicrobial 122 is then free to leave the chamber 124 and flow into the instrument lumen 188.
In general practice, the device 100, with adapter 172 and instrument 186 attached as the membrane wall breached 116 as shown in FIG. 9 are then placed into the sterilization chamber (not shown ) of a solution vapor sterilizer (also not shown). A vacuum applied to the sterilization chamber causes the antimicrobial 122 to vaporize and migrate into the instrument lumen 188 to effect sterilization thereof.
FIGS. 10 to 13 illustrate a further embodiment of a device 200 according to the invention. The device 200 is similar in nearly all respects to the device 100 with the exception of the following differences. Accordingly, portions of the device 200 which are identical to the device 100 and were previously described with respect thereto, will be designated with like referenced numerals having a prime symbol (').
To reduce the force a user must exert to breach the membrane wall 116' the capsule 102' threads into the opener 104'. A raised embossment 202 surrounds the capsule body 108' adjacent the lip 115'. A pair of threads 204 formed in the embossment 202 receive, respectfully, a pair of pins 206 which project into the opener body 140'. Each thread 204 comprises a camming portion 208 and a circumferential portion 210.
The pins 206 enter the threads 204 through the camming portions 208 as the capsule 102' is rotated relative to the opener 104', thereby pulling the capsule 102' axially into the opener 104'. The circumferential portion 210 of the threads 204 allows the capsule 102' to be rotated an additional one quarter turn after it is fully received within the opener 104' to insure proper breaching of the membrane wall 116'.
In the previous embodiment, the interaction of the central flange 134 and the opener body 140 seals the capsule 102 to the opener 104 to prevent antimicrobial 122 from leaking out of the device 100 between the capsule 102 and opener 104. In the present embodiment, an O-ring 212 about the capsule body 108' replaces the central flange 136 and engages the opener body 140' to seal the capsule 102' therein.
In the previous embodiment, the spike 146 is provided with a simple bevelled tip 148 to penetrate the membrane wall 116. In the present embodiment, the bevelled tip 148 is replaced by a cutting tip 214 which is placed off of the central axles of the spike 146' and which acts in a fashion similar to that of a can opener to cut open the membrane wall 116. It will be understood that the cutting tip 214 may take various
forms, however a sharp apex 216 and a sharp leading cutting edge 218 improve its cutting ability.
Proper breaching of the membrane wall 116' is a prerequisite to adequate sterilization. Accordingly, operators of the devices 100 or 200 prefer some tactile, audible, visual or other feedback that the device has been operated properly. In the previous embodiment, breaching of the membrane wall 116 tends to occur suddenly, thus driving the capsule 102 and opener 104 together in a violent manner creating both an audible and tactile snap. Also, the lip 115 will abut or closely approach the capsule body proximal end 142 in this position to provide a visual indication of proper operation.
In the present embodiment, the threading interaction between the capsule 102' and opener 104' breaches the membrane wall 116' more gently than in the previous embodiment. Thus, the user receives less tactile feedback that the membrane wall 116' has been breached. It may be desirable to provide such feedback in the form of a snapping interaction between parts on the capsule 102' and opener 104' or perhaps to provide a visual indication or other feedback that the opener 104' is fully actuated.
FIGS. 12 and 13 illustrate one method of providing such feedback. As each pins 206 travels its respective thread circumferential portion 210, it encounters a detent 220. The pins 206 cam over the detents 220 and snap over a sharp trailing edge 222 thereon to become trapped beyond the detents 220. Thus, the detents 220 provide both an audible and tactile feedback that the proper interaction has been achieved between the capsule 102' and opener 104'. Further, they prevent the capsule 102' and opener 104', and further prevent the capsule 102' from being easily backed out of the opener 104'. Alignment marks (not shown) or other visual indicia mark also be provided on the capsule 102' and opener 104' to indicate full actuation.
Although the present invention has been described in terms of specific devices for use in a preferred method of vapor sterilization, it will be understood that various modifications in the device and method will be apparent to those skilled in the art and are within the scope of this invention.
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|U.S. Classification
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|International Classification
|Cooperative Classification
|European Classification
|May 8, 1995
Owner name: JOHNSON & JOHNSON MEDICAL, INC., TEXAS
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:KOWATSCH, REINHARD;SOTO, TOBY;HOWLETT, CHARLES;REEL/FRAME:007638/0504;SIGNING DATES FROM 19950503 TO 19950504
|May 16, 2000
|Fee payment
Year of fee payment: 4
|May 19, 2004
|Fee payment
Year of fee payment: 8
|May 23, 2008
|Fee payment
Year of fee payment: 12


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Description of the accommodation:
Rooms, services Guests looking for accommodation in La Maddalena are welcome to book 309 nicely furnished rooms at Santo Stefano ClubViaggi Maddalena La Maddalena. The hotel is offering you freshly prepared fine local meals in its restaurant every day. You may also enjoy refreshing wellness services at the hotel. Your valuables may be the safely secured in the safe. To learn more about the exact range of services of Santo Stefano ClubViaggi Maddalena La Maddalena (including services for an extra fee) and the exact equipment of the rooms, please check the information sheet below.
Payment In order to finalize the reservation you may be required to provide credit card guarantee or advance payment by credit card, depending on the chosen room, date and price.
Arrival, opening hours The earliest time to check in to your room is 14:00, the latest time to check out of your room is 12:00. The personnel speaks Italian and English.
Santo Stefano ClubViaggi Maddalena La Maddalena rooms Rooms
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Accommodation services
- Wellness section, relaxation
- Finnish sauna
- Pool (Outdoor - seasonally open)
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Own restaurant
Hairdryer, Fridge, Desk in the room, Mini-bar


text: 25May 2014 DIY Paint Can Lid Flowers by Alicia ⋅ Leave a Comment Made some paint can lid flowers yesterday for the side of the barn, mostly Paint Couture The Collection lids that I have been saving up for awhile. Before I installed them I needed to protect them with an outdoor poly then figure out how to attach them to each other and the barn! This is so much fun for me, if I could just do these kind of art projects all the time I would! In the above picture you can see the color difference that an oil based outdoor sealant makes. Some colors are effected more by the yellowish tint. The light pink is really changed the most, and a white would yellow. But this is the price you pay to protect from the weather! Thank you to the worlds best husband! we are using a drill press and rivets to put these together, there is some serious hardcore crafting going on here! The rivets and the tool are very inexpensive and can be ordered from amazon or picked up at a local hardware store. Here's a list of the colors I used from Paint Couture The Collection Sea Glass, Vera at the Ballet, Recharge, Lovely, Abundance, Spanish Sunrise, Parrot, Barbados Blue and Imagine. I have not made leaves yet but I may use some cans by cutting them with some tin snips to make small leaves. Then maybe slice the hose and insert and glue the leaves. Of course this would be a lot of work…maybe just wood. Posted in: Blog


text:
I noticed it last month. A 4 pounder that is now 5" tall. Whether it's a flower or not I'm not sure yet.
My 13 pounder is still sleeping though.....
It's getting close to spring, One Konjac starting to grow!
I noticed it last month. A 4 pounder that is now 5" tall. Whether it's a flower or not I'm not sure yet.
I have a few that are just starting to put up a spike. Mine are always late... someone posted a photo on another forum, her flower opened the beginning of this week!
I don't think mine is a flower but we'll see.
All my Amorphs are still growing well except for the pranii. For some reason it went into dormancy although there's still a few months of growing season left. My largest is a paeoniifolius, it stopped growing by late December when it reached 227 centimetres (7.45 feet). This is it this morning, in the rectangular pot.
Looks lovely, tropicbreeze. Another Australian just posted a photo of his 30+ cm paeoniifolius bulb- planted with mulch and chicken poo. I'm so envious!
FWIW, my prainii did the same thing, it never grew long enough to build up a big tuber. The tuber just got smaller and smaller until it croaked.
Lakesidecallas, I haven't seen that other post of the A. paeoniifolius, which forum is it in?
My A. prainii I only bought last year as a growing plant, not my prefered way with Amorphs, but the only way they had it. I think they must have got it going early in the season. I haven't dug it up yet to see how the tuber is. Just want it to be completely dormant first. Anyway, I won't be able to know if it has grown or shrunk.
Sorry, I didn't make that clear. It was on Aroid-L, the email list.
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last post by JojotolJun 17, 20170Jun 17, 2017


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Chris Kriegstein is a man on the move, with a global career that catapults his family across North America, Europe, and Asia. For his wife, Elise, the hardship of chronic relocation is soothed by the allure of reinvention. Over the years, Elise shape-shifts: Once a secretive Southern Baptist, she finds herself becoming a seasoned expat in Shanghai, an unapologetic adulterer in Thailand, and, finally, a renowned interior decorator in Madison.
But it's the Kriegstein daughters, Leah and Sophie, who face the most tumult. Fiercely protective of each other - but also fiercely competitive - the two sisters long for stability in an ever-changing environment. With each new move, the girls find they can count on only one thing: the consoling, confounding presence of each other.
When the family suffers an unimaginable loss, they can't help but wonder: Was it meant to be, or did one decision change their lives forever? And what does it mean when home is everywhere and nowhere at the same time? With humor and heart, Brittani Sonnenberg chases this wildly loveable family through the excitement and anguish of their adventures around the world.
"Home Leave is a rich, lively novel. Original in conception and set in various continents, it describes migrations as a contemporary existential condition. More importantly, it shows how this condition effects change, loss, and growth in the migrants. It offers many insights that are true." (Ha Jin, National Book Award winner for Waiting)
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