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Love Has Always Been Our SongItem #: HL.35013460
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Composed by Joseph Martin.
Choral. Voicing/Format: SATB Chorus and Solo. 6.75x10.5 inches. 16 pages. Published by Shawnee Press. (HL.35013460)
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Written for Tim Seelig in celebration of his 20 years as Artistic Director of the Turtle Creek Chorale, this inspirational ballad's lyrics capture the many different musical moments choral singers, teachers, directors, and listeners have experienced in the genre. Love has always been the reason we sing. Available separately: SATB, solo; StudioTrax CD. Duration: ca. 3:50.
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Anybody take this???
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Anybody take this???
hi there, i have been taking organic apple cider vinegar for a few months now - i drink it diluted in water, i also use it as a hair rinse and i use it slightly diluted on my face every night as a toner - i have seen a huge difference in my skin - i use braggs apple cider vinegar and i get mine from omninatural.co.uk - they send you a 10% off coupon with every order - hope that helps!
Love it. Only get the one that says with the mother. I use it on food and salad dressings and on my beetroot x

subset: commoncrawl


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Should have Received Back Payment for all of the Children from Social Security
"I applied for all three children at the same time , we didn't have to wait to long before we started getting their payments, I think somewhere in feild of 4 months or so. Anyways they gave me back pay on two of them and not the third. If I applied the same time, shouldn't all three have gotten back pay? All three children are dx with the same thing as well, in reading your blog, that could have something to do with it. Also the back pay didn't add up with the amount granted. How do I proceed to find out? Social Sec. Isn't being very helpful in the the matter."
One of your children did not receive a back payment. It would seem if everything you have stated in your question is true, you should have received back payment for all of your children. Considering, you filed disability claims for all the children at the same time. SSI disability eligibility begins with the date of filing, so your third child should receive the same back pay as the other children if they were all found medically disabled as of the date you filed their disability claims.
You should read any notices you have received to date from Social Security to make sure there is not an explanation for the difference in back pay. If you still do not have an answer, you should contact your local Social Security office and ask to speak with the claim representative that processed your children 's disability claims. They should be able to explain to you why your third child did not receive any back pay and any discrepancies in the back payment amount.
Return to the Social Security Disability SSI Benefits Blog
Other Posts
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How to File for disability or File for SSI - do it as soon as possible
How can a disability lawyer help you win a Social Security Disability or SSI case?
Social Security Disability Qualifications
Tips for Filling out a Social Security Disability Application
Can you apply for social security disability or ssi if you are working ?
What are the chances of winning Social Security Disability or SSI on an appeal?
How Do You Get Approved for Disability with Social Security?
If you already receive social security disability or ssi benefits, can you work ?
Applying for Disability Based on MS, Multiple Sclerosis
Does Social Security Disability Depend on Your Level of Illness or the type of Work you did?
Herniated Disc, Social Security Disability SSI - Applying for Disability
How Do You Get Approved for Disability with Social Security?
How to get Approved for Disability Benefits - Information on disability claims
Waiting for Social Security disability to be approved can be crushing
Disability hearing


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Warning Signs: Would States Secede to Protect Their Citizens?
Warning Signs: Would States Secede to Protect Their Citizens?.
At one time I thought that most people would automatically stop to help someone who was hurt or dying. There have been many stories lately of people that instead of stopping and helping, just walk on by. Or even sometimes steal from them or abuse them in some way.
I truly believe that this is one of the worst facets of our current culture of death. How can we expect people to respect life and consider the importance of that life, when it is treated with such disregard by a large portion of our society? How can people who are convinced that it is quite okay to kill an unborn baby, believe that life is sacred. How can they believe that life matters when it doesn't seem to to all the people that they know?
We are facing a generation who have no concept of the importance of life, and worse, we have leaders who actively embrace this culture of death. These leaders are at the highest level of our government, from the President on down. And besides their own beliefs, they are determined that those of us who believe in life, must give in to their desires and encourage and promote death. They believe that we should even pay for it and will go to any lengths to force us to do so.
This is the ultimate battle between life and death. Unfortunately, death seems to be in the ascent at this time. It is important that we work together to change this trend. It will be something that God will consider when judgment day comes, because if you are not opposed to this, you are saying that it is okay. There is no fence that you can sit on here. There is no middle of the road. Either you choose life, or you are supporting death. There is an election coming up, and we know that those who are in charge now, support death, I would encourage you to investigate their positions yourself and choose life.
Biltrix has a post up this morning that was inspiring and a wonderful question for all those who would rather pretend that life does not begin at conception. Please take time to visit their site and read this and other important posts.
If Scientist Found Life on another Planet
Obamacare "Secrecy Clause" Demands Payment for Abortions
by Alan Sears
When Congress passed ObamaCare in March 2010, then Speaker Nancy Pelosi (D-Cal.) admitted she didn't know what was in the bill, but promised constituents and fellow politicians, "We'll find out what's in it once we pass it." Talk about a harbinger of things to come.
And in the two years since the bill's passage the American people have not only found out what's in it, they've discovered that part of the legislation purposely hides the fact that ObamaCare covers abortions. (This although politicians supporting ObamaCare repeatedly told the American people that abortion would not be covered.)
When looking through the pages the healthcare overhaul, specifically Sec. 1310(b)(3), on page 781, one finds the "Secrecy Clause." This clause outlines how ObamaCare both demands that insurance companies pay for abortion and that they co-operate with the White House by keeping this coverage secret. Read the rest at LifeNews.com
Choose God
He who keeps the commandment keeps his soul, But he who is careless of his ways will die. Proverbs 19:16
Life is filled with choices, we make them everyday. Sometimes our choices lead us along the wrong path, but sometimes we are forced to make choices where we know one way is the wrong path, and would lead to willful and knowing disobedience to God's will. Such a choice is the HHS mandate on paying for and/or providing the abortifacient.
Obama and many others who have no problem with this, tell up that it is okay, we are deciding this. It isn't your responsibility and we will even put a hedge between you and it, so that the insurance companies do the actual providing. This is supposed to be salve for our conscience so that we can stand before God and say, "it wasn't me Lord, it was them." My friends, you know and I know that God is going to look at us and say take responsibility for your actions as well as your inactions. We are condemning ourselves if we let ourselves be deceived in this way.
There is no middle ground here! You are making the choice for life or for death. And for all those who proclaim their right to make that choice, I would like to remind them that God does not care whether you think that you have a right or not, either way, to Him it is murder. If you are so egotistic to think that for some reason just because it is growing in your body that it is not life, you need to go take some science classes. And if you recognize that it is life and still think that you have the right to end it because it is not human until it reaches a certain point, at which point does it become magically human? It is at the start or it never is.
Or possibly you are one of those who think that you have the right to decide who lives or dies anyway, what makes you different from any other murderer out there? Aren't they making the same decision? Your selfishness leads to destruction but that truly is your choice to make.
I am not going to try to change anyone's mind about abortion, if you do not know that it is wrong, you will find out in God's time. What I am trying to do is remind those who follow Christ, those who accept that he died for our sins that if we make a deliberate choice to condone and promote an evil such as this, we are saying that we accept the evil and we are denying Him. You cannot serve two master's, and this time is either God's or it is against Him.
This is not a time to be silent on this issue. This is a turning point! Allowing harm and condoning the death of the least of God's people is one of the worst violations of His law there is. You know this! It is time for all of Christ's followers to make it clear that when it comes to choosing, we choose Christ!
The story I have an excerpt from below is an excellent example of other times that God's people were forced to make a choice. Please read it. God bless
From Life News.com
Obama HHS Mandate Wasn't Just About Contraception
by Michael Stokes Paulsen
An ancient example of resistance to a tyrant's attempt to coerce violations of religious conscience provides an interesting perspective on resistance to the Obama administration's recent healthcare coverage mandate.
"Contraception" is not exactly the right term. The HHS mandate implementing Obamacare requires insurance plans of religious employers to provide not just contraception but also sterilization and abortion-inducing drugs–"morning-after" (and even "week-after") pills designed to cause the death of a conceived human embryo rather than prevent conception. The technical term for such drugs is abortifacient, though they often are called, euphemistically, "emergency contraception."
"Cram-down"is a perfect term for HHS's policy, however. The whole point, it seems, is to override religious objections to such a policy to the maximum extent politically possible, out of an intense ideological commitment to contraception and abortion as "preventive health care." It is vital, the ideologues say, to prevail over religious objections precisely in order to advance, and permanently entrench, this particular ideology and, further, to vindicate the power of government to impose such policies on everyone. Religious objections must be overcome, in part for the sake of overcoming religious objections.
The Obama administration's HHS policy–and even more so the sham "modification" of it announced on February 10–recalls a memorable story recounted in certain Greek manuscripts traced to the ancient Jewish communities of the Mediterranean, in what is known as the book of Fourth Maccabees. (Some Protestants, like me, treat such inter-testamental religious literature not as scripture, but with respect as part of the "Apocrypha.")
Read the rest at Life News. com
Obama, Sebelius declare war on religious liberty (via Liberty Counsel Action)
Mathew Staver, Chairman
Liberty Counsel Action
Dear Patricia,
President Obama and his Secretary of Health and Human Services (HHS), Kathleen Sebelius, have put people of faith and religious organizations squarely in their crosshairs! The ObamaCare contraceptive and abortifacient mandate that has erupted into front-page news is an overreaching government intrusion into the lives of all Americans – and is patently unconstitutional.
Obama's dictate has stirred up a firestorm of protest from religious organizations and is being likened to a slap across the face to people of faith.
Liberty Counsel Action has been in this war for many, many years, and we feel this latest eruption is unique. Make no mistake – we are wholeheartedly standing with other groups that are strongly opposing this outrage, but we have known for a long time where ObamaCare's implementation was heading!
By coordinating with tens of thousands of deeply concerned patriots like you, we believe we can win not only this particular battle, but make substantial headway in turning back the entire ObamaCare law and further dismantling the Obama/Reid power base! Read my very important message below – Mat.
In a blatant assault on religious liberty, Barack Obama has ventured far out on a limb by openly challenging Christians and their institutions.
This escalating confrontation erupted over the unveiling of yet another unconstitutional "mandate" during the implementation phase of ObamaCare.
And, President Obama has yet again reneged on a promise made to get his healthcare "reform" bill through Congress two years ago: He is retracting an ObamaCare "conscientious exemption" for people of faith and religiously oriented institutions.
++ObamaCare's contraceptive and abortifacient mandate assails the moral integrity of every American who holds religious convictions.
With this brazen (some would say "reckless") policy announcement, the President has used ObamaCare to inflict even more damage on our Constitution.
He and Secretary Sibelius are now declaring that all employers, including nonprofit organizations, must adhere to an ObamaCare contraceptive and abortifacient mandate requiring employers to pay for birth control, contraceptives, sterilization, and abortion-inducing drugs as supplied through their insurance providers.
The January 20th announcement, made by Sebelius but clearly speaking for the President, immediately provoked a firefight between the Obama Administration and religious organizations, especially the Roman Catholic Church.
But the over-reaching and inappropriate severity of the policy impacted EVERY believer in the nation and delivered a stark and chilling message:
"Your religious freedom and conscience protections are not as important as our statist initiatives and bureaucracies. Comply or suffer severe consequences."
Obama and his Administration have so far refused to compromise.
After meeting resistance, President Obama circled his wagons.
Kathleen Sebelius has been on the media circuit with campaign-style rhetoric to make it sound as though the mandate is not as bad as it seems – and actually "respects religion."
Nancy Pelosi called Obama's decision "courageous."
Liberal media outlets are characterizing people of faith opposed to this overarching mandate as "zealots" and are using the new leftist term for citizens who defend their constitutional rights, "sovereignty activists."
But we are returning fire! Catholics, Baptists, and outraged Americans of all denominations are up in arms over the Obama Administration blatantly trampling on our religious liberties!
++Senator Marco Rubio jumps into the fray.
Senator Rubio (R-FL), a pro-life Catholic, scolded the Obama Administration and then offered a congressional counter attack…
"The Obama Administration's obsession with forcing mandates on the American people has now reached a new low by violating the conscience rights and religious liberties of our people….
"Under this President, we have a government that has grown too big, too costly, and now even more overbearing by forcing religious entities to abandon their beliefs."
Rubio's countermeasure: The "Religious Freedom Restoration Act of 2012," about which he says…
"This is a common sense bill that simply says the government can't force religious organizations to abandon the fundamental tenets of their faith because the government says so."
Liberty Counsel Action stands in strong support of Senator Rubio's bill. We began lobbying for such a bill the moment we realized the President had the audacity to try to force this new policy down America's throat by using an administrative vehicle to circumvent the will of the people.
Now, we are calling on 100,000 pro-life, pro-faith, pro-family, and pro-liberty citizens to demand that Congress PASS THIS BILL NOW!
Please, click here to sign the LCA petition to stop Barack Obama's intrusion on our religious civil liberties and to support the "Religious Freedom Restoration Act of 2012":
++This is a call to action!
Liberty Counsel and Liberty Counsel Action would be among the employers forced into adhering to this most recent ObamaCare mandate.
Religious-based hospitals and healthcare providers would no longer have an "out" under Obama's promised "conscience clause." They would be required to comply – or pay stiff fines that would in all likelihood lead to their closing down.
The implementation of ObamaCare has turned out to be one socialist infringement of our personal liberties after another – and it must be stopped NOW!
Patricia, if our President honored his oath of office to uphold the Constitution of the United States, our petition would be unnecessary. But ObamaCare and its mandates are blatantly unconstitutional and this "contraceptive mandate" is not only unconstitutional – it is a total violation of the conscience of the entire nation!
The two most likely methods to turn back this latest outrageous mandate: First, through the Supreme Court's decision that ObamaCare itself is unconstitutional (and Liberty Counsel is filing two briefs at the High Court on this issue). Second, through the "Religious Freedom Restoration Act of 2012," we can stop this most recent infringement on religious liberty.
That's why I am urging all of my Liberty Counsel Action team to take one minute and add your name to this petition. PLEASE, click here to sign:
Mandi Campbell, Director of Public Policy for Liberty Counsel Action, wrote to Senator Rubio about his legislation. He published our letter in a press release:
"Liberty Counsel Action, on behalf of more than 750,000 members nationwide, would like to express support for the Religious Freedom Restoration Act of 2012. … [W]e appreciate the exemption that your bill provides to secure the consciences of those with deep and sincere religious convictions opposed to the coverage of contraceptives (especially those that act as abortifacients) and sterilization, the provision of which is currently mandated by the Patient Protection and Affordable Care Act. Thank you, Senator Rubio, for introducing the Religious Freedom Restoration Act of 2012."
I cannot emphasize strongly enough how important and timely Senator Rubio's bill is – and how urgent it is that we immediately endorse it with the signatures of at least 100,000 grassroots citizens. Right now, Senator Rubio has 21 Senate co-sponsors for the bill.
Please click here to sign our petition of support:
Thank you for taking immediate action on this critical issue!
God bless you,
Mathew Staver, Chairman
Liberty Counsel Action
P.S. The ObamaCare "contraceptive mandate" requires employers to pay for birth control, contraceptives, sterilization, and abortion-inducing drugs as supplied through their insurance providers. This is unconstitutional and immoral! As a counter-assault, LCA is strongly endorsing Senator Marco Rubio's "Religious Freedom Restoration Act of 2012." We are calling for 100,000 signers as soon as possible! Click here to add your name to the petition:
America's Biggest Turkey
|"Warning Signs" is the blog of Mr. Alan Caruba and this article was reprinted with the permission of Mr. Caruba, obtained on 11/26/2011.
|Barack Obama-America's Biggest Turkey Thursday, November 24, 2011
"The 2012 national elections will be held on November 6 and I naturally want to get out ahead of all the other pundits and their predictions about its outcome. I cannot tell you who the Republican winner will be, but I can tell you that Barack Hussein Obamawill be known as a former President.
He has most certainly turned out to be the biggest loser—a turkey—to hold the office of president. I can look back over my writings in 2008 and say "I told you so!" to anyone who voted for Obama.
It was surreal to watch how the mainstream media went out of its way to ignore the fact that there were virtually NO FACTS to cite regarding Obama-the-candidate. Any candidate who had gone to the extent of hiding the ordinary "paper trail" that all of us leave when we attend school, college, serve in the military, acquire a Social Security card, travel, or simply acquire friends and acquaintances, surely had something to hide.
To this day, no one seems to recall being in college with Obama, though he attended Occidental, Columbia, and Harvard. Surely you would think someone would pen a word or two of their memories of him. No student in the classes he taught on the Constitution at the University of Chicago has shared those days. If he dated anyone prior to Michelle, they remain incognito.
Like the fictional Shadow, Obama seemed to be able to "cloud men's minds" when it came to any recall or inquiry about him.
The appalling performance of the mainstream media to get Obama elected was captured by Howard Kurtz, a columnist for The Washington Post who, on November 17, 2008, reported that NBC News was coming out with a DVD titled "Yes We Can: The Barack Obama Story" and that ABC and USA Today were following suit to rush out a book about the election.
"We seem to have crossed a cultural line into mythmaking," said Kurtz. "Whew! Are journalists fostering the notion that Obama is invincible, the leader of what the New York Times dubbed 'Generation O'?" Kurtz asked, "aren't media people supposed to resist this kind of hyperventilating?"
The confidence I have in my prediction that he will be unemployed as of the afternoon of January 20, 2013 lies in the fact that he has spent the last three years being rebuffed on one policy or another, not the least of which was the Affordable Health Act, otherwise known as Obamacare.
Rejected by 26 States that brought suit against it, Obamacare's constitutionality will be addressed by none less than the U.S. Supreme Court; a decision that may come in the spring of 2012. Given the court's long record of precedents on comparable decision, it's toast. Recently, in the electoral battleground State of Ohio, voters resoundingly rejected its mandate requiring everyone to buy health insurance under penalty of a fine.
In March 2010 an estimated one million people representing the Tea Party movement marched on Washington, D.C. to protest against passage Obamacare. They were a sharp contrast to the revelers that showed up for Obama's inauguration and literally left tons of trash in their wake. We have seen this repeated by the Occupy movement participants.
There's a term in boxing when a boxer has been hit hard enough to make him groggy, "stepping in post holes", as he staggers around the ring. It seems an apt term for Obama who is finding fewer supporters and defenders beyond the hard core of liberal Democrats.
From promises to close Gitmo to efforts to try Islamic terrorists held there in civil courts, Obama was rebuffed.
Obama's promises regarding jobs to be created by his "Stimulus" have proved baseless and costly.
On the numbers alone, Obama has been a disaster for America. Obama has presided over the first downgrade in the nation's credit rating in its history. Federal spending has been the highest (25% of GDP) since World War II. Federal debt (67% if GDP) has been the highest since World War II.
Long-term unemployment (45.9%) is the highest since the 1930s. Those dependent on the government, receiving federal benefits (47%) is the highest in American history.
Obama's aggressive anti-energy policies are costing jobs from the Gulf of Mexico to the now delayed Keystone XL pipeline and all points in between. Scandals involving the bankrupt Solyndra, a solar panel company and other "green energy" investments and loans are costing him support. This is true as well wherever coal is mined and where they drill for natural gas and oil.
Americans grew tired of his non-stop speeches and gaffs, with or without the Tele-Prompters that became a national joke. Now they must endure a year of his constant campaigning and his non-stop lies about Republicans and everything else.
His penchant for never accepting blame manifested itself in another punchline, "It's George Bush's fault."
In 2010, voters returned power in the House of Representatives to the Republican Party. Does anyone at this point seriously think that these and other factors point to an Obama victory in 2012?
He will be defeated and by a margin that will astound everyone."
© Alan Caruba, 2011
Reprinted with permission of the author, Alan Caruba/Anne Nowlin
Related articles
- America's Biggest Turkey: Barack Obama – Tea Party Nation (gds44.wordpress.com)
America is fast approaching the "tipping point" (via Liberty Counsel)
Mathew Staver, Founder and Chairman
Liberty Counsel
"Political correctness" and overt anti-Christian bigotry
have been relentlessly pounding our culture for several
decades and these attacks have taken a terrible toll.
Today, there is an increasing need for the kind of
assistance Liberty Counsel was founded to provide just
to keep our culture from being pushed over the edge!
Our litigation team is working hard to keep on top of
attempts to turn America into a European-style, godless,
socialist state and our caseload is growing as never
before. When you add our lawsuit against ObamaCare to
the mix, at times the challenges can seem overwhelming!
Please take a moment to read my important message below – Mat.
After getting the news yesterday that our lawsuit against
ObamaCare is being reviewed by the Supreme Court, I
instinctively took a moment to reassess Liberty Counsel's
current and pending caseload.
I concluded that although Liberty Counsel has been
blessed with amazing opportunities to change our
culture (our fight against ObamaCare alone is one of
the greatest battles for liberty in our nation's history),
these opportunities come with significant challenges.
And beyond the demands of our major cases, every day we are
approached with requests for legal help from citizens across
the country who are facing serious infringements of their
constitutional rights, encountering overt religious bigotry,
or suffering assaults on their personal liberty by radical
liberal groups.
We represent upstanding American citizens like Jerry
Buell, our client in Central Florida, who we helped
get reinstated in his teaching duties after his rights
were infringed upon by an overzealous and misinformed
school administration. His "offense"? Jerry expressed
pro-family sentiments on his own Facebook page, on his
own computer, on his own time!
Another of our clients, Dakota Ary, a high school freshman
in Fort Worth, Texas, was suspended from school for merely
stating his Christian view on homosexuality to a classmate.
Liberty Counsel defended Dakota against a misguided teacher's
accusations and an uninformed administration's abuse of his
rights. Dakota was fully exonerated and the teacher was
placed on administrative leave!
These cases are representative of today's intensifying assaults
on First Amendment rights by leftist bullies who use intimidation
to silence those who speak from a different viewpoint than
their own.
++Anti-Christian violence is a sign of our nation's moral crisis.
Pro-homosexual vandals recently attacked an Illinois Christian
academy at which the pro-family group Americans for Truth About
Homosexuality (AFTAH) was preparing to hold a banquet to honor
an evangelical Christian leader.
Following the news of the Illinois attack, Matt Barber, Vice
President of our affiliate group, Liberty Counsel Action,
strongly denounced this criminal act. I reiterate a comment
Matt made in a subsequent statement to the media:
"Your terrorist tactics have failed, and you will not
succeed in silencing God's truth."
++We will not be silenced!
In Liberty Counsel's more than twenty years' of ministry,
we have never seen the ACLU and other special interest groups
so active and so maniacally intent on forcing their will on
our society!
This assault on freedom is taking place at the same time that
our economy is suffering from ill-considered, leftist fiscal
policies that have left most Americans in worse financial
shape than at any time since the Great Depression. Of course,
a sinking economy has an adverse effect on charitable giving
and most American non-profit organizations have seen declining
support in recent months.
Because of the nation's financial downturn, Liberty
Counsel has experienced a challenging period – but our
strain is mostly caused from being engaged in more
crucially important battles than ever before!
Nonetheless, we need consistent financial help to
confront the numerous challenges we are facing right
now and those on the near horizon.
Patricia, I know that you do not want radical
leftists reshaping the moral, religious, and political
landscape of our nation. I also know that these economic
times present a multitude of challenges to most Americans.
But could you prayerfully consider a generous gift right now
to help Liberty Counsel continue to defend and restore our
precious liberties? No gift is too large or too small. I
simply ask that you support Liberty Counsel's vital work in
the way the Lord leads:
++Liberty Counsel aggressively confronts radical activists!
Leftist and anti-religious, anti-family, anti-life organizations
like the ACLU, Planned Parenthood, GLSEN (Gay, Lesbian, Straight
Education Network), and many other such groups have been greatly
encouraged by a sympathetic president, his ultraliberal
administration, and a devious Senate Majority Leader.
Consider these events on the national scene…
*President Obama is touring the nation telling his
audiences that he will bypass Congress to enact as
many of his agenda items as possible through executive
orders, through his "czars," and through mandates issued
by federal agencies – all strategies designed to get
around the checks and balances established by the
* The FCC is seizing control of the Internet in the
name of "net neutrality," thus taking over one of
the few remaining portals of free speech.
* While President Barack Obama and Attorney General
Eric Holder act as "supreme judges" in deciding not
to defend the Defense of Marriage Act (DOMA) they deem
to be "unconstitutional," they have committed unlimited
amounts of taxpayer money to defend the blatantly
unconstitutional ObamaCare healthcare "reform' law.
* Our military is now being forced to accept a
homosexual-driven "cultural overhaul." Same sex
"marriages" are now permitted on military installations,
thus breaking the well-established DOMA federal law.
* This week approximately six thousand babies will lose
their lives at Planned Parenthood (PPH) facilities
because the United States Senate, under Majority
Leader Harry Reid, refused to defund them, even while
facing a desperate need to reduce government spending.
++We don't have to accept moral and economic collapse!
Patricia, this is my challenge to you: If you are
also outraged over attempts to make America a socialist
nation…if you are alarmed by our deepening economic crisis…
and if you are concerned about this nation's ever-increasing
immorality and rapidly declining respect for human life…
…then please remember that Liberty Counsel is standing
at the epicenter of the battle for the soul of America!
We are actively engaged on many fronts in our aggressive
defense of liberty, life, and family.
The reality is that we are facing powerful and dangerous
adversaries on the battlefield for liberty. And because our
opponents are so well funded – and in a growing number of cases
supported by federal tax dollars – it is necessary that I ask
for your help to continue fielding the best possible defense
(and offense!) to counter these attacks.
We depend on friends who give $20, $30, $50, $100 – whatever the
Lord leads – so we can stay involved in these crucial battles.
Would you consider making a special gift to Liberty Counsel
to meet these pressing needs? Please go here:
With God's blessing and favor, Liberty Counsel long ago emerged
as one of the leading voices for faith and freedom in America.
Every day we are turning back attacks from the ACLU, fighting
ultraliberal initiatives from the Obama Administration in court,
and rallying hundreds of thousands of citizens to take action
in defense of our shared values.
But we simply cannot fight these battles without the
faithful and generous support of friends like you. That's
why your continuing support is so crucial.
Please go here to send a special gift, even if you have done so
before – perhaps even many times before:
May God bless you! Thank you for being an integral part of
our Liberty Counsel team and co-laborer in Liberty Counsel's
God-given mission.
Mathew Staver, Founder and Chairman
Liberty Counsel
P.S. Your prayers and sacrificial giving literally make it
possible for us to continue fighting moral decay, the rise
of Big Government, constant attacks from the ACLU and other
radical groups, and the moral destruction wrought by pro-
homosexual activists. Please, consider making a special
gift to Liberty Counsel today:
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Note: Please do not "reply" directly to this e-mail message.
This e-mail address is not designed to receive your personal
messages. To contact Liberty Counsel with comments, questions
or to change your status, see the link at the end of this e-mail.)
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Liberty Counsel, with offices in Florida, Virginia and
Washington, D.C., is a nonprofit litigation, education and
policy organization dedicated to advancing religious freedom,
the sanctity of human life and family.
Liberty Counsel . PO Box 540774 . Orlando, FL 32854 .800-671-1776


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April 2009 Opinions
Please click on Opinion number to view entire opinion.
|Opinion #
The Honorable Richard L. Saslaw
The Honorable Robert D. Hull
The Honorable James M. Scott
No authority under § 46.2‑1209 for county to enact ordinance prohibiting persons from parking and leaving vehicles 'unattended' on public residential streets. Term 'unattended' should be given its ordinary meaning, 'lacking a guard, escort, caretaker, or other watcher' or 'unaccompanied.' Pursuant to § 46.2‑1213, county may enact ordinances to provide for removal of certain vehicles that are: (1) left unattended on public highways or other public property that constitute traffic hazard; (2) illegally parked; (3) left unattended for more than ten days on public property; or (4) immobilized on public roadway by weather or other emergency conditions. Pursuant to § 46.2‑1220, county may enact ordinance to regulate parking, stopping, and standing of vehicles within its jurisdictional limits, subject to limitations imposed in other sections of Article 3, Chapter 12 of Title 46.2.


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A Quiet Reality is a heartwarming and hopeful story that invites you to join Chaplain Marrero in this exciting journey through Iraq as he ministered to U.S. Marines. Join him through an exhilarating tactical convoy during his first night in Iraq, through the painful ministry to the wounded and dead. Reflect with him as he ponders on this quest as a man in uniform and a pastor. Walk with him through the ancient ruins of Nebuchadnezzar's Palace in Babil and join him on an exciting quest to open biblical history to his Marines while he seeks to care for the Iraqis around him. A Quiet Reality is a hopeful commentary on a selfless quest to be true to ones faith and one's calling in the most trying of times. A wonderful Chrisitan inspirational story that provides deep insight into how Americans and Iraqis touched one another.
"Chaplain Emilio Marrero has written a brilliant and moving account of his experiences in the Iraq War. It is a side of war we rarely know. His personal and passionate story is wonderfully told and a must read for those who want to understand a side of combat seldom described." – General Anthony C. Zinni USMC (Retired)
Please visit the author's website for more information and to purchase the book. 10% of all profits made from the sale of this publication will be donated to the Injured Marine Semper Fi Fund.


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One of the many tasks of your friendly average librarian is to do the routine shelf-read, which is to check all the call numbers in a row to make sure they are in order. I had to learn to focus on the Dewey Decimal system while doing this task, not to get distracted by the titles. The distractionation really depends on the topic. You'll find me snoozing, drooling on the shelf in the 612s: Nursing and Health. But sometimes the books, the BOOKS! sometimes they are just too much.
Here's some I found interesting, (which I have refrained from checking out and lugging around, thank you very much):
this list is hyperlinked to Amazon and WorldCat, depending on which system had a photo of the cover.
The World of Odysseus, M. I. Finley
Manetho: translated by W. G. Waddell
Europe in the Central Middle Ages, 962-1154, Christopher Brooke
Minoans: Life in Bronze Age Crete, Rodney Castleden
The Road to Ubar: finding the Atlantis of the Sands, Nicholas Clapp
Sheba: searching for the legendary queen, Nicholas Clapp
Sailing from Byzantium: how a lost empire shaped the world, Colin Wells


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I adopted my puppy from a shelter last May (memorial day weekend) and she had giardia when I got her. After at least 8 rounds of treatment (flagyl and sometimes with Panacur). During the last 2 rounds of treatments, she didn't visit any dog parks, and was wiped down after every walk, as recommended by the vet. She still test positive for Giardia. Is there something that is missing? Why does it seem imposible to get rid of this?
Giardia for 9 months and counting
posted at 2/4/2013 3:50 PM EST
Re: Giardia for 9 months and counting
posted at 2/6/2013 8:57 PM EST
Welcome to the pet forum. I hope your dog's condition improves, the giardia must be at least weakening with each treatment...
Is your dog still having symptoms or just testing positive?
Is your vet a specialist...ask what else can be done?
Even with treatment sometimes the infective trophozoite form in the dogs small intestine remains.
PS: I have a pet shop dog that had loose stools (off and on) for the first 7-8 months and then miraculously it stopped. I never got her diagnosed as she was healthy otherwise and remains so today at 9+ years. I had other dogs in the household and they never got it. "knock on wood"
Maybe AngellVets will comment the next time they check in.
Robin aka dog-lady
Re: Giardia for 9 months and counting
posted at 2/11/2013 10:18 AM EST
Hi Yuki-Chan,
This is a somewhat common and frustrating problem for many veterinarians and pet owners, so I feel your pain! A few things I would want to know are: 1) Is your pup symptomatic for giardia infection? Hallmark signs of this protozoan parasite that infects the GI tract of dogs and humans would be diarrhea, although fl@tulence, weight loss, and other GI symptoms are sometimes seen less commonly. 2) What test is coming back positive? I would be more concerned (i.e., more likely to treat) if giardia cysts are seen on a test we call "fecal float." 3) What doses of medication and for how long was she treated each time? These are all things you could confirm with your veterinarian. If there is a complete absence of symptoms, I would trust in how she is feeling and acting. Good luck!
Dr. Susan O'Bell, Angell Animal Medical Center


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Monday, April 16, 2012
Spring Firsts and a Rhubarb Pie
I love these first days of Spring when we all start to shake off the chill of winter and stretch our limbs towards the sun. Every week more flowers pop open, trees get their leaves back after months of naked branches, and I watch as my lucky neighbors sweep off their patios and start replanting their tiny city gardens. One of the things that surprises me most about living on the East Coast is how much I have grown to enjoy the seasons and the transitions that come with them.
This weekend marked a lot of Spring firsts. My first bbq of the season, my first rooftop cocktails, my first subway ride home when I smelled charcoal smoke in my hair and on my skin. I'm sure it doesn't come as a surprise to anyone when I say that the first pie of the season tops my list of favorites.
While I made this pie last Sunday, I practically vibrated with excitement at the thought of eating it outside with the sun shining on my face. Add to that the novelty of trying out a new mixing technique in my quest to improve my pie crust and my favorite vegetable disguised as fruit and you've got my dream day all wrapped up.
I am happy to report that this pie was as revolutionary as I hoped it would be. It was so tart and flaky and lightly vanilla scented that alternate titles I considered for this post included: We Don't Need no Stinking Strawberries, I am a Pie Ninja, and Holy Shit, This Is The Best Pie I've Ever Made. That last one was the exact phrase that popped out of my mouth when I pulled the bubbling beaut out of the oven. I didn't even have to taste it to know.
I wrapped it up in a big cloth tied at the top and proudly carried it on the train to its rightful resting place: a rooftop picnic table full of friends in the sunshine, with a view of the city in the distance.
For the Crust
This crust comes to you from Brandi Henderson of I made that! and The Pantry at Delancey where she teaches a class called "How to be a Pie Ninja" and she is not messing around. Brandi uses a technique called fraisage which creates long sheets of buttery flakes throughout the dough instead of little pockets of butter. Delightful!
12 oz pastry flour
8 oz cold butter
4 oz ice water
1/2t salt
1. Mix the flour and salt together, then pour the whole lot on a large cutting board or countertop.
2. With a bench scraper, cut in half of the butter until it is the size of lima beans, then cut in the other half of the butter until it is the size of quarters.
3. Using your fingers, flick the water on to the butter flour mixture and gently fold it in with your bench scraper. You have added enough water when you can pick up a handful of the dough and squeeze it together without it falling apart.
4. Then, get this, you smear the butter into the dough. With the heel of your hand push a section of the dough down and away from you. Congratulations, you have just created a sheet of butter which is going to turn delicious flaky crust. Scrape your sheet off of the board and place it in a bowl to the side. Repeat until you have worked through all of the dough, pushing it down and away from you in sections. Once you've gone through all of the dough gently remove it from the bowl, press it together, then split it in half, and wrap each half in plastic wrap and form into a disk. Chill the dough for at least one hour before using. I chilled mine overnight.
If this sounds confusing, check out the link above for a really helpful photo tutorial.
For the Filling
20 oz of rhubarb (about 5 slightly heaping cups), chopped into 1/2'' pieces (if your rhubarb is tough or stringy, remove the strings by pulling them down the stalk)
11.5 oz sugar
2.25 oz flour
1/2 vanilla bean, scraped
1t orange zest
big pinch salt
For the Topping
1 egg, beaten
A few tablespoons of coarse sugar like turbinado or light demerara
To Assemble and Bake
Preheat oven to 450º
1. On a lightly floured surface, roll out one piece of the dough into a 12'' circle about 1/8'' thick and place it into a 9'' pie pan. Place in the fridge while you prepare the rest of the pie.
2. Roll out the other piece of dough into a 12'' circle about 1/8'' thick and place it in the fridge to chill while you prepare the filling.
3. In a large bowl, rub the vanilla bean seeds and orange zest into the sugar to evenly distribute. Add in the rhubarb, vanilla/zesty sugar, flour, and salt and toss to combine evenly. Fill the prepared pie shell with the rhubarb mixture and top with the second crust, crimp the edges and cut a few vents. Alternately, you can top the pie with a lattice-style crust as I've done in the photos above. Here is a link to a great photo tutorial on Simply Recipes. When I make a lattice topped pie, I like to use nice thick strips of dough, so the one's pictured above are about 1'' wide.
4. If the crust seems soft or warm, slide the whole pie into the fridge or freezer for about 15min before you bake it. When you are ready to bake brush the top of the pie with a beaten egg and sprinkle with a healthy dose of coarse sugar.
5. Put the pie on a baking sheet to catch any drips and bake for 15min on the lowest rack of your oven, then lower the oven temp to 350º and bake for 40-50min or until the crust is deep golden brown and the rhubarb juices bubble. Cool at least 2 hours before serving.
Thanks to Shawn for the shot of me holding the pie and to Ellie for the Holga shot on the bottom left.
20 comments:
That is one beautiful pie! Jealous of your rooftop BBQs. Moving to the east coast this summer and excited to experience it's seasons.ReplyDeleteReplies
Thanks Melissa, good luck with the move! Let me know if you ever jaunt down to NYC, we'll have to meet up and have a coffee or something.Delete
Can't wait for my rhubarb to start popping up - my growing season is about 2 months behind yours. But when it's ready I'm so making this pie. While I many not be eating it on a rooftop, I'll make sure the sun is shining on my face :)ReplyDeleteReplies
Well, as long as you've got some sunshine on your face, I think you'll be okay :)Delete
i need to get some rhubarb now. lovely photos!ReplyDelete
-jocee <3
You little Pie Ninja you!ReplyDelete
Ohhhhh your pastry looks sublime! I am definately going to try your recipe. If only I could will my little rhubarb plant to yield more stalks... I could always just buy some from the store... :)ReplyDelete
Word- that pie is gorgeous and the crust magnificent! I can't wait to give the technique a try. Looks like you enjoyed a beautiful spring day, and now I'm craving some rooftop time myself. Great post!ReplyDelete
will definitely have to try this as more rhubarb becomes available! it was so funny reading this post, since i've been known to get EXCITED (i mean like screaming expletives/obscenities nonstop excited) about food and food only - it's pretty much the only thing that gets me in that kind of fit. god knows i've written many an email about food to friends only to have to go back and pretty much remove any obscenities/downplay my excitement a bit so they don't think i'm nuts. :)ReplyDelete
Yoss, I am about to share this blog with my 6th grade Writing class as an example of incorporating sensory images into poetry and prose. I don't even care that it has "Shit" in it, because it's that good. Thanks for sharing! And, you must be a ninja to attempt that pie crust technique. Even for a pro like you, it sounds super complicated. You should film it and put it on YouTube for us visual learners...ReplyDelete
Love, EmilyReplies
Thanks Emily! How did the lesson go?Delete
I am a big fan of pie ninja-ing ... and recipes by Brandi (and Molly, for that matter). Nice work, fellow rhubarb lover. She's gorgeous.ReplyDelete
Just gorgeous. Nothing better than a rhubarb pie, except maybe this particular rhubarb pie. My favorite is a rhubarb custard pie, but as soon as the rhubarb is up, I'll be trying this one!ReplyDelete
Holly hell lady I must try this pie. I thought I had myself the worlds most kickass rhubarb pie recipe already, but this one looks like it just may top it. Not that I'm sure my baking skills can handle your brilliant recipe though! I suppose we shall see. I love LOVE these photographs and your ordering of them. Be-A-U-tiful Yossy!ReplyDeleteReplies
Thanks lady, I still want to try your recipe. As far as I'm concerned, you can never have too much pie!Delete
What a beautiful pie! Pie is my absolute favorite dessert without question. I have made hundreds of pie crusts in my life but never using this technique. Can't wait to try it.ReplyDelete
I love the photo of you cracking up. So sweet.ReplyDelete
That pie looks so good. Love all the pics!! I am starting Mouth Watering Mondays on my site and will be adding this with a link. Cheers, TaraReplyDelete
I know this is an older post but I had to say thank the lord there is someone out there that does not mess up rhubarb pie with strawberries. Rhubarb is my FAVORITE pie.ReplyDelete
I've had this post saved for an entire year and just tried it this weekend with the rhubarb from the market. So lovely, the orange zest is a perfect compliment and I also love the subtle pink hue the rhubarb lends. Is 11.5 oz of sugar the correct amount? I found it was quite sweet and could have lessened a bit, but I didn't want to alter your beautiful pie recipe.ReplyDelete


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Cities around the country heavily regulate taxis and Birmingham is no different. The ordinance governing taxis, limousines and other "vehicles for hire" stretches 40 pages and covers everything from the types of credit cards taxis are supposed to accept to how frequently seats are wiped down.
But it also says cab drivers aren't allowed to drive around looking for passengers. Also, it's illegal for someone to hail a taxi outside of downtown or Lakeview.
Birmingham City Councilwoman Kim Rafferty, who chairs the transportation committee, says it used to be illegal everywhere in the city to hail a taxi until the city code was changed in 2012 to add those two specific neighborhoods. She says she's working to further update the ordinance.
"There's a lot [in the code] that didn't make any sense," said Rafferty. "It needs to be practical. It needs to be serviceable. And that's what we've been working on."
Rafferty says she was told the restriction on taxis cruising for passengers was put in place because people complained about cabs driving through residential areas. Similarly, taxi drivers didn't want to be forced to pick up a passenger hailing them if they happened to be in an unsafe or questionable part of town.
Rafferty says allowing cruising and hailing is most practical, but must be balanced with safety. She says she expects taxis would gravitate to the city center and entertainment areas anyway so that doesn't need to be spelled out in the ordinance.
The existing rules are confusing, particularly for out-of-town visitors who may expect to be able to flag a cab they see driving by.
"I've seen people trying to hail cabs and I'm sure they're highly confused why they never stop," Rafferty said. She adds the city needs to do a better job marketing this rule because nobody will read the transportation code to figure out if you can hail a taxi.
~ Andrew Yeager, June 11, 2014
| Some Taxis at Birmingham's Airport May be Skirting the Rules


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Namni Goel, Ph.D.
Research Associate Professor of Psychology in Psychiatry
Division of Sleep and Chronobiology
Department of Psychiatry
University of Pennsylvania School of Medicine
Namni Goel, Ph.D., is a Research Associate Professor in Psychiatry in the School of Medicine, University of Pennsylvania. Dr. Goel received her B.A. in Psychology and Anthropology from the University of California, Berkeley and her Ph.D. in Biological Psychology from the University of Michigan (Ann Arbor). As a graduate student, she researched the behavioral and neuroanatomical substrates underlying circadian rhythms in an animal model. As a postdoctoral fellow at Columbia and Cornell Universities, Dr. Goel made the transition to human work, conducting studies on basic human physiological sleep and on seasonal affective disorder (SAD), a mood disorder which may result from circadian rhythm pathophysiology.
Dr. Goel's research investigates how genetic, physiological, behavioral and environmental factors affect circadian rhythm physiology and sleep-wake functions and regulate mood and cognition. Dr. Goel has spear-headed studies of candidate genes for sleep homeostasis and human neurobehavioral vulnerability to sleep deprivation and also collaborates with Dr. Dinges on physiological and neurobehavioral experimental studies of sleep deprivation in healthy adults. Additionally, Dr. Goel collaborates on work investigating the circadian basis of Night Eating Syndrome and on ongoing research on the effects of blue spectrum light on alertness and cognitive performance in healthy humans.
Dr. Goel has obtained prior funding from NIA and NIMH, and was recently a Co-Principal Investigator of a phenotype-genotype grant from Penn's Genomic Frontiers Institute (PGFI) awarded through Penn's Institute for Translational Medicine and Therapeutics (ITMAT). She is currently the Principal Investigator of a 5-year Department of Defense grant investigating candidate genes for sleep homeostasis and human neurobehavioral vulnerability to sleep deprivation.
In recognition of her contributions to the field, Dr. Goel was elected and served from 2008-2010 as President of the Society for Light Treatment and Biological Rhythms (SLTBR), a major international scientific organization. She is also a member of the Sleep Research Society, the Society for Research on Biological Rhythms, and the Society for Neuroscience. Dr. Goel is an ad hoc member of NIH Study Sections F02B and MESH, and has reviewed grants for many other national and international agencies including the National Aeronautics and Space Administration (NASA), the Canadian Institutes of Health Research (CIHR), the Wellcome Trust, and the Royal Society . Dr. Goel is on the Board of Directors of the Center for Environmental Therapeutics, is Co-Chair of the Neurobehavioral and Psychosocial Factors Workgroup for the NASA Decadal Review of the Role of Sex/Gender in Adaptation to Spaceflight, and serves on one of the National Sleep Foundation's expert review panels. Dr. Goel is also an Academic Editor for PLoS ONE, an Associate Editor for SLEEP, and a Review Editor for Frontiers in Behavioral and Psychiatric Genetics. She also serves on the Editorial Boards of 4 other journals (Chronobiology International, Journal of Circadian Rhythms, Journal of Neurology Research, and Journal of Sleep Disorders: Treatment and Care).
Research Interests
Sleep, circadian rhythms, and depression: biological, environmental treatments. Nonphotic and photic stimuli's effects on mammalian sleep, circadian rhythms and mood. Individual (gender, diagnostic, personality, etc) differences in sleep, circadian rhythms and mood including differential vulnerability to sleep deprivation. Behavioral and genetic biomarkers for sleep loss.
Selected Bibliography
Goel, N., Basner, M., Rao, H., Dinges, D.F.: Circadian rhythms, sleep deprivation and human performance. Progress in Molecular Biology and Translational Science, in press.
Basner, M., Rao, H., Goel, N., Dinges, D.F.: Sleep deprivation and neurobehavioral dynamics. Current Opinion in Neurobiology 23, in press.
Spaeth, A.M., Dinges, D.F., Goel, N.: Effects of sleep restriction on weight gain, caloric intake and meal timing in healthy adults. SLEEP 36: 981-990, 2013.
Basner, M., Dinges, D.F., Mollicone, D., Ecker, A., Jones, C.W., Hyder, E.C., Di Antonio, A., Savelev, I., Kan, K., Goel, N., Morukov, B.V., Sutton, J.P.: Mars 520-d mission simulation reveals protracted crew hypokinesis and alterations of sleep duration and timing. Proceedings of the National Academy of Sciences USA 110(7): 2635-2640, 2013.
Goel, N.: Genetics of sleep timing, duration and homeostasis in humans. (selected to be reprinted from 2011 invited review in a special issue). Sleep Medicine Clinics, Biology of Sleep 7: 443-454, 2012.
Goel, N.: Searching for genetic clues at the interface of sleep and mood. SLEEP 35: 739-740, 2012.
Goel, N., Dinges, D.F.: Predicting risk in space: Genetic markers for differential vulnerability to sleep restriction. Acta Astronautica 77: 207-213, 2012.
Spaeth, A.M., Goel, N., Dinges, D.F.: Managing neurobehavioral capability when social expediency trumps biological imperatives. Progress in Brain Research 199: 377-398, 2012.
Goel, N., Banks, S., Lin, L., Mignot, E., Dinges, D.F.: Catechol-O-Methyltransferase Val158Met polymorphism associates with individual differences in sleep physiologic responses to chronic sleep loss. PLoS ONE 6(12): e29283, 2011.
Goel, N., Dinges, D.F.: Behavioral and genetic markers of sleepiness. Journal of Clinical Sleep Medicine 7(5): S19-S21, 2011.
Mullington, J.M., Czeisler, C.A., Goel, N., Krueger, J.M., Balkin, T.J., Johns, M., Shaw, P.J.: Panel discussion: current status of measuring sleepiness. Journal of Clinical Sleep Medicine 7(5): S22-S25, 2011.
Goel, N.: Genetics of sleep timing, duration and homeostasis in humans. (invited review). Sleep Medicine Clinics 6: 171-182, 2011.
Goel, N., Dinges, D.F.: Sleep deprivation: biomarkers for identifying and predicting individual differences in response to sleep loss. Sleepiness: Causes, Consequences and Treatment. Thorpy MJ, Billiard M (eds.). Cambridge University Press: Cambridge, UK, Page: 101-110, 2011.
Goel, N., Van Dongen, H.P.A., Dinges, D.F.: Circadian rhythms in sleepiness, alertness, and performance. Principles and Practice of Sleep Medicine (5th edition). Kryger MH, Roth T, Dement WC (eds.). Elsevier: Philadelphia, PA, Page: 445-455, 2011.
Goel, N., Banks, S., Mignot, E., Dinges, D.F.: DQB1*0602 predicts interindividual differences in physiologic sleep, sleepiness and fatigue. (Subject of Editorial in Neurology). Neurology 75: 1509-1519, 2010.
Dinges, D.F., Goel, N.: Identification and prediction of substantial differential vulnerability to the neurobehavioral effects of sleep loss. Neurocognitive and Physiological Factors During High-Tempo Operations. Kornguth S, Steinberg RM, Matthews MD (eds.). Ashgate Publishing, Ltd: Aldershot, UK, Page: 93-103, 2010.
Goel, N., Banks, S., Mignot, E., Dinges, D.F.: PER3 polymorphism predicts cumulative sleep homeostatic but not neurobehavioral changes to chronic sleep restriction. PLoS ONE 4(6): e5874, 2009.
Goel, N., Stunkard, A.J., Rogers, N.L., Van Dongen, H., Allison, K.C., O'Reardon, J.P., Ahima, R.S., Cummings, D.E., Heo, M., Dinges, D.F. : Circadian rhythm profiles in women with night eating syndrome. Journal of Biological Rhythms 24: 85-94, 2009.
Goel, N., Rao, H., Durmer, J.S., Dinges, D.F.: Neurocognitive consequences of sleep deprivation. Seminars in Neurology 29(4): 320-339, 2009.
Goel, N., Dinges, D.F.: Genetic resistance to sleep deprivation. Frontiers in Neuroscience 3(3): 432, 2009.
Allison, K.C., O'Reardon, J.P., Ahima, R.S., Dinges, D.F., Goel, N., Stunkard, A.J.: Neuroendocrine levels, circadian profiles, and sleep in night eating syndrome: Integration of findings. Sociedad Iberoamericana de Información Científica (SIIC), 2008.
Goel, N., Lao, R.P.: Sleep changes vary by odor perception in young adults. Biological Psychology 71: 341-346, 2006.
Goel, N.: An arousing musically-enhanced bird song stimulus mediates circadian rhythm phase advances in dim light. American Journal of Physiology- Regulatory, Integrative and Comparative Physiology 291: R822-R827, 2006.
Goel, N., Etwaroo, G.R.: Bright light, negative air ions and auditory stimuli produce rapid mood changes in a student population: A placebo-controlled study. Psychological Medicine 36: 1253-1264, 2006.
Goel, N.: Late-night presentation of an auditory stimulus phase delays human circadian rhythms. American Journal of Physiology- Regulatory, Integrative and Comparative Physiology 289: R209-R216, 2005.
Goel, N., Kim, H., Lao, R.P.: An olfactory stimulus modifies nighttime sleep in young men and women. Chronobiology International 22: 889-904, 2005.
Goel, N., Kim, H., Lao, R.P.: Gender differences in polysomnographic sleep in young healthy sleepers. Chronobiology International 22: 905-915, 2005.
Goel, N., Terman, M., Terman J.S., Macchi, M.M., Stewart, J.W.: Controlled trial of bright light and negative air ions for chronic depression. Psychological Medicine 35: 945-955, 2005.


text:
|Publication number
|Publication type
|Application number
|Publication date
|15 Aug 2002
|Filing date
|11 Apr 2002
|Priority date
|20 Jul 1998
|Also published as
|Publication number
|Robert Shartle, Herbert Chow, Christa Hartmann
|Original Assignee
|Shartle Robert Justice, Herbert Chow, Christa Hartmann
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (5), Referenced by (10), Classifications (41), Legal Events (1)
|External Links: USPTO, USPTO Assignment, Espacenet
[0001] This application claims the benefit of U.S. Provisional Application No. 60/093,421, filed Jul. 20, 1998
[0002] 1. Field of the Invention
[0003] This invention relates to a fluidic medical diagnostic device for measuring the concentration of an analyte in or a property of a biological fluid.
[0004] 2. Description of the Related Art
[0005] A variety of medical diagnostic procedures involve tests on biological fluids, such as blood, urine, or. saliva, and are based on a change in a physical characteristic of such a fluid or an element of the fluid, such as blood serum. The characteristic can be an electrical, magnetic, fluidic; or optical property. When an optical property is monitored, these procedures may make use of a transparent or translucent device to contain the biological fluid and a reagent. A change in light absorption of the fluid can be related to an analyte concentration in, or property of, the fluid. Typically, a light source is located adjacent to one surface of the device and a detector is adjacent to the opposite surface. The detector measures light transmitted through a fluid sample. Alternatively, the light source and detector can be on the same side of the device, in which case the detector measures light scattered and/or reflected by the sample. Finally, a reflector may be located at or adjacent to the opposite surface. A device of this latter type, in which light is first transmitted through the sample area, then reflected through a second time, is called a "transflectance" device. References to "light" throughout this specification and the appended claims should be understood to include the infrared and ultraviolet spectra, as well as the visible. References to "absorption" are meant to refer to the reduction in intensity as a light beam passes through a medium; thus, it encompasses both "true" absorption and scattering.
[0006] An example of a transparent test device is described in Wells et al. W094/02850; published on Feb. 3, 1994. Their device comprises a sealed housing, which is transparent or translucent, impervious, and rigid or semi-rigid. An assay material is contained within the housing, together with one or more assay reagents at predetermined sites. The housing is opened and the sample introduced just before conducting the assay. The combination of assay reagents and analyte in the sample results in a change in optical properties, such as color, of selected reagents at the end of the assay. The results can be read visually or with an optical instrument.
[0007] U.S. Pat. No. 3,620,676, issued on Nov. 16, 1971 to Davis, discloses a calorimetric indicator for liquids. The indicator includes a "half-bulb cavity", which is compressible. The bulb is compressed and released to form a suction that draws fluid from a source, through a half-tubular cavity that has an indicator imprinted on its wall. The only controls on fluid flow into the indicator are how much the bulb is compressed and how long the indicator inlet is immersed in the source, while the bulb is released.
[0008] U.S. Pat. No. 3,640,267, issued on Feb. 8, 1972 to Hurtig et al., discloses a container for collecting samples of body fluid that includes a chamber that has resilient, collapsible walls. The walls are squeezed before the container inlet is placed into the fluid being collected. When released, the walls are restored to their uncollapsed condition, drawing fluid into and through the inlet. As with the Davis device, discussed above, control of fluid flow into the indicator is very limited.
[0009] U.S. Pat. No. 4,088,448, issued on May 9, 1978 to Lilja et al., discloses a cuvette, which permits optical analysis of a sample mixed with a reagent. The reagent is coated on the walls of a cavity, which is then filled with a liquid sample. The sample mixes with the reagent to cause an optically-detectable change.
[0010] A number of patents, discussed below, disclose devices for diluting and/or analyzing biological fluid samples. These devices include valve-like designs to control the flow of the sample.
[0011] U.S. Pat. No. 4,426,451, issued on Jan. 17, 1984 to Columbus, discloses a multi-zone fluidic device that has pressure-actuatable means for controlling the flow of fluid between the zones. His device makes use of pressure balances on a liquid meniscus at the interface between a first zone and a second zone that has a different cross section. When both the first and second zones are at atmospheric pressure, surface tension creates a back pressure that stops the liquid meniscus from proceeding from the first zone to the second. The configuration of this interface or "stop junction" is such that the liquid flows into the second zone only upon application of an externally generated pressure to the liquid in the first zone that is sufficient to push the meniscus into the second zone.
[0012] U.S. Pat. No. 4,868,129, issued on Sep. 19, 1989 to Gibbons et al., discloses that the back pressure in a stop junction can be overcome by hydrostatic pressure on the liquid in the first zone, for example by having a column of fluid in the first zone.
[0013] U.S. Pat. No. 5,230,866, issued on Jul. 27, 1993 to Shartle et al., discloses a fluidic device with multiple stop junctions in which the surface tension-induced back pressure at the stop junction is augmented; for example, by trapping and compressing gas in the second zone. The compressed gas can then be vented before applying additional hydrostatic pressure to the first zone to cause fluid to flow into the second zone. By varying the back pressure of multiple stop junctions in parallel, "rupture junctions" can be formed, having lower maximum back pressure.
[0014] U.S. Pat. No. 5,472,603, issued on Dec. 5, 1995 to Schembri (see also U.S. Pat. No. 5,627,041), discloses using centrifugal force to overcome the back pressure in a stop junction. When flow stops, the first zone is at atmospheric pressure plus a centrifugally generated pressure that is less than the pressure required to overcome the back pressure. The second zone is at atmospheric pressure. To resume flow, additional centrifugal pressure is applied to the first zone, overcoming the meniscus back pressure. The second zone remains at atmospheric pressure.
[0015] European Patent Application EP 0 803 288, of Naka et al., published on Oct. 29, 1997, discloses a device and method for analyzing a sample that includes drawing the sample into the device by suction, then reacting the sample with a reagent in an analytical section. Analysis is done by optical or electrochemical means. In alternate embodiments, there are multiple analytical sections and/or a bypass channel. The flow among these sections is balanced without using stop junctions.
[0016] U.S. Pat. No. 5,700,695, issued on Dec. 23, 1997 to Yassinzadeh et al., discloses an apparatus for collecting and manipulating a biological fluid that uses a "thermal pressure chamber" to provide the driving force for moving the sample through the apparatus.
[0017] U.S. Pat. No. 5,736,404, issued on Apr. 7, 1998, to Yassinzadeh et al., discloses a method for determining the coagulation time of a blood sample that involves causing an end of the sample to oscillate within a passageway. The oscillating motion is caused by alternately increasing and decreasing the pressure on the sample.
[0018] The present invention provides a fluidic diagnostic device for measuring an analyte concentration or property of a biological fluid. The device comprises
[0019] a first layer and second layer at least one of which has a resilient region over at least part of its area, separated by an intermediate layer, in which cutouts in the intermediate layer form, with the first and second layers,
[0020] a) a sample port for introducing a sample of the biological fluid into the device;
[0021] b) a first measurement area, in which a physical parameter of the sample is measured and related to the analyte concentration or property of the fluid;
[0022] c) a first channel, having a first end and a second end, to provide a fluidic path from the sample port at the first end through the first measurement area;
[0023] d) a first bladder at the second end of the first channel, comprising at least a part of the resilient region in at least the first or second layer and having a volume that is at least about equal to the combined volume of the first measurement area and first channel; and
[0024] e) a first stop junction in the first channel between the first measurement area and first bladder that comprises a co-aligned through hole in at least the first or second layer, the through hole being overlaid with a third layer.
[0025] In another embodiment, the device comprises
[0026] a first layer, which has a resilient region over at least a part of its area, and a second layer, separated by an intermediate layer, in which recesses in a first surface of the intermediate layer form, with the first layer,
[0027] a) a sample port for introducing a sample of the biological fluid into the device;
[0028] b) a measurement area, in which the sample undergoes a change in a physical parameter that is measured and related to the analyte concentration or property of the fluid;
[0029] c) a channel, having a first end and a second end, to provide a fluidic path from the sample port at the first end through the measurement area; and
[0030] d) a bladder, at the second end of the channel, comprising at least a part of the resilient region in the first layer and having a volume that is at least about equal to the combined volume of the measurement area and channel; and
[0031] a stop junction in the channel between the measurement area and bladder that comprises two passages substantially normal to the first surface of the intermediate layer, each passage having a first end in fluid communication with the channel and a second end in fluid communication with a recess in a second surface of the intermediate layer, which recess provides fluid communication between the second ends of the passages.
[0032] The device is particularly well adapted for measuring prothrombin time (PT time), with the biological fluid being whole blood and the measurement area having a composition that catalyzes the blood clotting cascade.
[0033]FIG. 1 is a plan view of a device of the present invention.
[0034]FIG. 2 is an exploded view of the device of FIG. 1.
[0035]FIG. 3 is a perspective view of the device of FIG. 1.
[0036]FIG. 4 is a schematic of a meter for use with a device of this invention.
[0037]FIG. 4A depicts an alternative embodiment of an element of the meter of FIG. 4.
[0038]FIG. 5 is a graph of data that is used to determine PT time.
[0039]FIG. 6 is a plan view of an alternative embodiment of a device of this invention.
[0040]FIGS. 6A, 6B, and 6C depict a time sequence during which a sample is admitted to the device of FIG. 6.
[0041]FIG. 7 is a schematic of a device having multiple measurement areas in parallel, multiple stop junctions in parallel, and a single bladder.
[0042]FIG. 8 is a schematic of a device having multiple measurement areas in series, with a single stop junction, a single bladder, and a filter over the sample port.
[0043]FIG. 9 is a schematic of a device having multiple measurement areas and multiple stop junctions arranged in an alternating series, as well as multiple bladders.
[0044]FIG. 10 is a schematic of a device that includes multiple measurement areas in parallel, a single bladder, and a single bypass channel.
[0045]FIG. 11 is a schematic of a device having multiple measurement areas in series, multiple stop junctions in series, multiple bladders in series, and multiple bypass channels.
[0046]FIG. 12 is an exploded view of an injection-molded device of this invention.
[0047]FIG. 13 is a perspective view of the device of FIG. 12.
[0048] This invention relates to a fluidic device for analyzing biological fluid. The device is of the type that relates a physical parameter of the fluid, or an element of the fluid, to an analyte concentration in the fluid or to a property of the fluid. Although a variety of physical parameters—e.g., electrical, magnetic, fluidic, or optical—can form the basis for the measurement, a change in optical parameters is a preferred basis, and the details that follow refer to an optical device. The device includes a sample application area; a bladder, to create a suction force to draw the sample into the device; a measurement area, in which the sample may undergo a change in an optical parameter, such as light scattering; and a stop junction to precisely stop flow after filling the measurement area.
[0049] Preferably, the device is substantially transparent over the measurement area, so that the area can be illuminated by a light source on one side and the transmitted light measured on the opposite side. The measurement on the sample may be of a parameter that is not changing, but typically the sample undergoes a change in the measurement area, and the change in transmitted light is a measure of the analyte or fluid property of interest. Alternatively, light that is scattered from a fluid sample or light that passes through the sample and is reflected back through a second time (by a reflector on that opposite side) can be detected by a detector on the same side as the light source.
[0050] This type of device is suitable for a variety of analytical tests of biological fluids, such as determining biochemical or hematological characteristics, or measuring the concentration in such fluids of proteins, hormones, carbohydrates, lipids, drugs, toxins, gases, electrolytes, etc. The procedures for performing these tests have been described in the literature. Among the tests, and where they are described, are the following:
[0051] (1) Chromogenic Factor XIIa Assay (and other clotting factors as well): Rand, M. D. et al., Blood, 88, 3432 (1996).
[0052] (2) Factor X Assay: Bick, R. L. Disorders of Thrombosis and Hemostasis: Clinical and Laboratory Practice. Chicago, ASCP Press, 1992.
[0053] (3) DRVVT (Dilute Russells Viper Venom Test): Exner, T. et al., Blood Coag. Fibrinol., 1, 259 (1990).
[0054] (4) Immunonephelometric and Immunoturbidimetric Assays for Proteins: Whicher, J. T., CRC Crit. Rev. Clin Lab Sci. 18:213 (1983).
[0055] (5) TPA Assay: Mann, K. G., et al., Blood, 76, 755, (1990).; and Hartshorn, J. N. et al., Blood, 78, 833 (1991).
[0056] (6) APTT (Activated Partial Thromboplastin Time Assay): Proctor, R. R. and Rapaport, S. I. Amer. J. Clin. Path, 36, 212 (1961); Brandt, J. T. and Triplett, D. A. Amer. J. Clin. Path., 76, 530 (1981); and Kelsey, P. R. Thromb. Haemost. 52, 172 (1984).
[0057] (7) HbAlc Assay (Glycosylated Hemoglobin Assay): Nicol, D. J. et al., Clin. Chem. 29, 1694 (1983).
[0058] (8) Total Hemoglobin: Schneck et al., Clinical Chem., 32/33, 526 (1986); and U.S. Pat. No. 4,088,448.
[0059] (9) Factor Xa: Vinazzer, H., Proc. Symp. Dtsch. Ges. Klin. Chem., 203 (1977), ed. By Witt, I
[0060] (10) Colorimetric Assay for Nitric Oxide: Schmidt, H. H., et al., Biochemica, 2, 22 (1995).
[0061] The present device is particularly well suited for measuring blood-clotting time—"prothrombin time" or "PT time"—and details regarding such a device appear below. The modifications needed to adapt the device for applications such as those listed above require no more than routine experimentation.
[0062]FIG. 1 is a plan view of a device 10 of the present invention. FIG. 2 is an exploded view and FIG. 3 a perspective view of the device. Sample is applied to sample port 12 after bladder 14 has been compressed. Clearly, the region of layer 26 and/or layer 28 that adjoins the cutout for bladder 14 must be resilient, to permit bladder 14 to be compressed. Polyester of about 0.1 mm thickness has suitable resilience and springiness. Preferably, top layer 26 has a thickness of about 0.125 mm, bottom layer 28 about 0.100 mm. When the bladder is released, suction draws sample through channel 16 to measurement area 18, which preferably contains a reagent 20. In order to ensure that measurement area 18 can be filled with sample, the volume of bladder 14 is preferably at least about equal to the combined volume of channel 16 and measurement area 18. If measurement area 18 is to be illuminated from below, layer 28 must be transparent where it adjoins measurement area 18. For a PT test, reagent 20 contains thromboplastin that is free of bulking reagents normally found in lyophilized reagents.
[0063] As shown in FIGS. 1, 2, and 3, stop junction 22 adjoins bladder 14 and measurement area 18; however, a continuation of channel 16 may be on either or both sides of stop junction 22, separating the stop junction from measurement area 18 and/or bladder 14. When the sample reaches stop junction 22, sample flow stops. For PT measurements, it is important to stop the flow of sample as it reaches that point to permit reproducible "rouleaux formation"—the stacking of red blood cells—which is an important step in monitoring blood clotting using the present invention. The principle of operation of stop junctions is described in U.S. Pat. No. 5,230,866, incorporated herein by reference.
[0064] As shown in FIG. 2, all the above elements are formed by cutouts in intermediate layer 24, sandwiched between top layer 26 and bottom layer 28. Preferably, layer 24 is double-sided adhesive tape. Stop junction 22 is formed by an additional cutout in layer 26 and/or 28, aligned with the cutout in layer 24 and sealed with sealing layer 30 and/or 32. Preferably, as shown, the stop junction comprises cutouts in both layers 26 and 28, with sealing layers 30 and 32. Each cutout for stop junction 22 is at least as wide as channel 16. Also shown in FIG. 2 is an optional filter 12A to cover sample port 12. The filter may separate out red blood cells from a whole blood sample and/or may contain a reagent to interact with the blood to provide additional information. A suitable filter comprises an anisotropic membrane, preferably a polysulfone membrane of the type available from Spectral Diagnostics, Inc., Toronto, Canada. Optional reflector 18A may be on, or adjacent to, a surface of layer 26 and positioned over measurement area 18. If the reflector is present, the device becomes a transflectance device.
[0065] The method of using the strip of FIGS. 1, 2, and 3 can be understood with reference to a schematic of the elements of a meter shown in FIG. 4, which contemplates an automated meter. Alternatively, manual operation is also possible. (In that case, bladder 14 is manually depressed before sample is applied to sample port 12, then released.) The first step the user performs is to turn on the meter, thereby energizing strip detector 40, sample detector 42, measurement system 44, and optional heater 46. The second step is to insert the strip. Preferably, the strip is not transparent over at least a part of its area, so that an inserted strip will block the illumination by LED 40 a of detector 40 b. (More preferably, the intermediate layer is formed of a non-transparent material, so that background light does not enter measurement system 44.) Detector 40 b thereby senses that a strip has been inserted and triggers bladder actuator 48 to compress bladder 14. A meter display 50 then directs the user to apply a sample to sample port 12 as the third and last step the user must perform to initiate the measurement sequence. The empty sample port is reflective. When a sample is introduced into the sample port, it absorbs light from LED 42 a and thereby reduces the light that is reflected to detector 42 b. That reduction in light, in turn, signals actuator 48 to release bladder 14. The resultant suction in channel 16 draws sample through measurement area 18 to stop junction 22. Light from LED 44 a passes through measurement area 18, and detector 44 b monitors the light transmitted through the sample as it is clotting. When there are multiple measurement areas, measurement system 44 includes an LED/detector pair (like 44 a and 44 b) for each measurement area. Analysis of the transmitted light as a function of time (as described below) permits a calculation of the PT time, which is displayed on the meter display 50. Preferably, sample temperature is maintained at about 37� C. by heater 46.
[0066] As described above, the detector senses a sample in sample port 12, simply by detecting a reduction in (specular) reflection of a light signal that is emitted by 42 a and detected by 42 b. However, that simple system cannot easily distinguish between a whole blood sample and some other liquid (e.g., blood serum) placed in the sample port in-error or, even, an object (e.g., a finger) that can approach sample port 12 and cause the system to erroneously conclude that a proper sample has been applied. To avoid this type of error, another embodiment measures diffuse reflection from the sample port. This embodiment appears in FIG. 4A, which shows detector 42 b positioned normal to the plane of strip 10. With the arrangement shown in FIG. 4A, if a whole blood sample has been applied to sample port 12, the signal detected by 42 b increases abruptly, because of scattering in the blood sample, then decreases, because of rouleaux formation (discussed below). The detector system 42 is thus programmed to require that type of signal before causing actuator 48 to release bladder 14. The delay of several seconds in releasing bladder 14 does not substantially affect the readings described below
[0067]FIG. 5 depicts a typical "clot signature" curve in which the current from detector 44 b is plotted as a function of time. Blood is first detected in the measurement area by 44 b at time 1. In the time interval A, between points 1 and 2, the blood fills the measurement area. The reduction in current during that time interval is due to light scattered by red cells and is thus an approximate measure of the hematocrit. At point 2, sample has filled the measurement area and is at rest, its movement having been stopped by the stop junction. The red cells begin to stack up like coins (rouleaux formation). The rouleaux effect allows increasing light transmission through the sample (and less scattering) in the time interval between points 2 and 3. At point 3, clot formation ends rouleaux formation and transmission through the sample reaches a maximum. The PT time can be calculated from the interval B between points 1 and 3 or between 2 and 3. Thereafter, blood changes state from liquid to a semi-solid gel, with a corresponding reduction in light transmission. The reduction in current C between the maximum 3 and endpoint 4 correlates with fibrinogen in the sample.
[0068] The device pictured in FIG. 2 and described above is preferably formed by laminating thermoplastic sheets 26 and 28 to a thermoplastic intermediate layer 24 that has adhesive on both of its surfaces. The cutouts that form the elements shown in FIG. 1 may be formed, for example, by laser- or die-cutting of layers 24, 26, and 28. Alternatively, the device can be formed of molded plastic. Preferably, the surface of sheet 28 is hydrophilic. (Film 9962, available from 3M, St. Paul, Minn.) However, the surfaces do not need to be hydrophilic, because the sample fluid will fill the device without capillary forces. Thus, sheets 26 and 28 may be untreated polyester or other thermoplastic sheet, well known in the art. Similarly, since gravity is not involved in filling, the device can be used in any orientation. Unlike capillary fill devices that have vent holes through which sample could leak, the present device vents through the sample port before sample is applied, which means that the part of the strip that is first inserted into the meter is without an opening, reducing the risk of contamination.
[0069]FIG. 6 is a plan view of another embodiment of the device of the present invention, in which the device includes a bypass channel 52 that connects channel 16 with bladder 14. The function and operation of the bypass channel can be understood by referring to FIGS. 6A, 6B, and 6C which depict a time sequence during which a sample is drawn into device 10 for the measurement.
[0070]FIG. 6A depicts the situation after a user has applied a sample to the strip, while bladder 14 is compressed. This can be accomplished by applying one or more drops of blood.
[0071]FIG. 6B depicts the situation after the bladder is decompressed. The resulting reduced pressure in the inlet channel 16 draws the sample initially into the measurement area 18. When the sample reaches stop junction 22, the sample encounters a back pressure that causes it to stop and causes additional sample to be drawn into the bypass channel.
[0072]FIG. 6C depicts the situation when a reading is taken. Sample is isolated and at rest in measurement area 18. Excess sample and/or air has been drawn into bypass channel 52.
[0073] The bypass channel of FIG. 6 provides an important improvement over the operation of the "basic" strip of FIGS. 1-3. In the basic strip, stop junction 22 stops the flow of sample after it fills measurement area 18. As was discussed earlier, it is important to stop the flow in order to facilitate rouleaux formation. As was also discussed earlier, the stop junction accomplishes the flow stoppage as a result of surface tension acting on the meniscus at the leading edge of the fluid at an abrupt change in cross section of the flow channel. In the basic strip, the pressure on the bladder side of the stop junction remains below atmospheric pressure while the pressure on the sample side remains open to atmosphere. Thus, there is an ambient pressure imbalance on the two sides. The greater the imbalance, the greater the risk that the stop junction will leak and that sample will flow through the stop junction, interfering with rouleaux formation, and, consequently, providing inaccurate values of PT.
[0074] Bypass channel 52 minimizes that risk. The reduced pressure on the bladder side of the stop junction draws sample into the bypass channel (FIGS. 6B, 6C) until the ambient pressure is equalized at atmospheric pressure on both sides of the stop junction. Note that the (reduced) pressure on the bladder side is relatively uncontrolled. The bypass channel 52, by enabling the pressures on the two sides of the stop junction to equilibrate, permits the use of larger bladders that have greater suction. Larger bladders, in turn, provide more reliable operation of the system.
[0075]FIG. 7 depicts an embodiment of the present invention in which there are multiple (three are shown) measurement areas "in parallel". That is to say that the channels 116P, 216P, and 316P fill substantially simultaneously (assuming they have the same dimensions). The situation depicted in FIG. 7, with channels and measurement areas filled with blood, is achieved, as discussed above, by applying sample to sample port 112 while bladder 114 is compressed, then releasing bladder 114. As discussed above, the first step is to apply sample to sample well 112 while bladder 114 is compressed. The second step is to release the bladder. Sample flows to measurement areas 118P, 218P, and 318P, and flow stops when sample reaches stop junctions, 122P, 222P, and 322P, respectively. The optional second and third measurement areas may contain, for example, reagents that neutralize the presence of interferents (such as heparin) in the blood, or that provide a built-in control on the PT measurement, or that measure another blood parameter (such as APPT)
[0076]FIG. 8 is a schematic illustration of an embodiment in which multiple measurement areas are "in series", meaning that they fill sequentially. In this embodiment, measurement areas 118S, 218S, and 318S fill sequentially, through a single channel 116S, until the sample reaches stop junction 122S. A potential drawback of this design is that sample passing from one measurement area to the next may carry over reagent.
[0077]FIG. 9 is a schematic of another embodiment of a device that is adapted for multiple sequential tests. In that embodiment stop junctions 122T, 222T, and 322T permit a user to control the timing of sequential filling of measurement areas 118T, 218T, and 318T. In operation, bladders 114, 214, and 314 are all compressed before a blood sample is applied to sample well 112. Bladder 114 is then released to draw blood into measurement area 118T to stop junction 122T. At a selected later time, bladder 214 is released to permit blood to break through stop junction 122T and enter measurement area 218T to stop junction 222T. Finally, when the user wishes to use measurement area 318T, bladder 314 is decompressed, permitting sample to break through stop function 222T and flow to stop junction 322T. The device of FIG. 9 must be carefully formed, since the force drawing sample into the device—caused by decompressing a bladder—must be balanced against the opposing force—exerted by a stop junction. If the drawing force is too great, a stop junction may prematurely permit sample to pass; if it's too small, it will not draw the sample through a stop junction, when that is intended.
[0078]FIG. 10 depicts a preferred embodiment of the present device. It is a parallel multi-channel device that includes bypass channel 152P. Bypass channel 152P serves a purpose in this device that is analogous to that served by bypass channel 52 in the device of FIG. 6, which was described above. Measurement area 118P contains thromboplastin. Preferably, measurement areas 218P and 318P contain controls, more preferably, the controls described below. Area 218P contains thromboplastin, bovine eluate, and recombinant Factor VIIa. The composition is selected to normalize the clotting time of a blood sample by counteracting the effect of an anticoagulant, such as warfarin. Measurement area 318P contains thromboplastin and bovine eluate alone, to partially overcome the effect of an anticoagulent. Thus, 3 measurements are made on the strip. PT time of the sample, the measurement of primary interest, is measured on area 118P. However, that measurement is validated only when measurements on areas 218P and 318P yield results within a predetermined range.
[0079] If either or both of these control measurements are outside the range, then a retest is indicated. Extended stop junction 422 stops flow in all three measurement areas.
[0080]FIG. 11 depicts a device that includes bypass channels 152S and 252S to permit timed filling of measurement areas 118T and 218T. Operation of the device of FIG. 11 is analogous to that of the device of FIG. 9, described above, with the following exception. First bypass channel 152S has a region in which a reagent that causes clotting, such as thromboplastin, is coated. As a first measurement is made in reagent area 118T, a clot forms in blood that had been drawn into bypass channel 152S. Thus, when the second bladder is decompressed, blood is blocked from being drawn through bypass 152S and instead is drawn though stop junction 122T to measurement area 218T and bypass channel 252S.
[0081] All the previous figures depict the device of this invention as a laminated strip structure; however, the device could also be an injection-molded structure of the type shown in FIGS. 12 and 13. FIG. 12 is an exploded view of an injection-molded device 110, including top layer 126 and bottom layer 128 sandwiching intermediate layer 124. The intermediate layer has depressions in its top surface that form sample port 112, channel 116, measurement area 118, and optional bypass channel 152. Stop junction 122 passes through the thickness of intermediate layer 124. Sample flow stops at the interface between stop junction 122 and channel A, which is formed by a depression in the bottom surface. Thus, the sample flows from sample port 112 through channel 116 to measurement area 118 into stop junction 122.
[0082] The principle of operation of the injection molded device is the same as described above. It provides greater flexibility in the design of the stop junction, as well as the other elements of the device, because a wide range of channel cross sections are feasible. The molded structure also provides more rigidity, although it is substantially more costly.
[0083] The following examples demonstrate the present invention in its various embodiments, but are not intended to be in any way limiting.
[0084] A strip of this invention is made by first passing a double-sided adhesive tape (RX 675SLT, available from Scapa Tapes, Windsor, Conn.) sandwiched between two release liners into a laminating and rotary die-cutting converting system. The pattern shown in FIG. 6, with the exception of the stop junction, is cut through the top release liner and tape, but not through the bottom release liner, which is then removed as waste, along with the cutouts from the tape. Polyester film treated to be hydrophilic (3M9962, available from 3M, St. Paul, Minn.) is laminated to the exposed bottom side of the tape. Reagent (thromboplastin, available from Ortho Clinical Diagnostics, Raritan, N.J.) is then printed onto the reagent area (18) of the polyester film by bubble jet printing, using printing heads 51612A, from Hewlett Packard, Corvallis, Oreg. A sample port is cut in untreated polyester film (AR1235, available from Adhesives Research, Glen Rock, Pa.) and then laminated, in register, to the top of the double-sided tape (after removing the release layer). A die then cuts the stop junction through the three layers of the sandwich. Finally, strips of single-sided adhesive tape (MSX4841, available from 3M, St. Paul, Minn.) are applied to the outside of the polyester layers to seal the stop junction.
[0085] A procedure that is similar to the one described in Example 1 is followed to make a strip of the type depicted in FIG. 10. Reagent that is bubble-jet printed onto areas 118P, 218P, and 318P is, respectively, thromboplastin; thromboplastin, bovine eluate, and recombinant Factor VIIa; and thromboplastin and bovine eluate alone. The bovine eluate (plasma barium citrate bovine eluate) is available from Haemotologic Technologies, Burlington, Vt.; and recombinant Factor VIIa from American Diagnostica, Greenwich, Conn.
[0086] Measurements made on a whole blood sample using the strip of this Example yield a curve of the type shown in FIG. 5 for each of the measurement areas. The data from the curves for the controls (measurement areas 218P and 318P) are used to qualify the data from the curve for measurement area 118P. As a result, the PT time can be determined more reliably than can be done with a strip having a single measurement area.
[0087] The device of FIGS. 12 and 13 is formed by sandwiching middle layer 124 between top layer 126 and bottom layer 128. The middle and bottom layers are injection molded polycarbonate (Lexan*121) and have thicknesses of 6.3 mm and 1.5 mm, respectively. Top layer 126 is made by die cutting 0.18 mm Lexan* 8010 sheet. The elements are ultrasonically welded after the reagent of Example 1 is applied to reagent area 118. The Lexan* material is available from General Electric, Pittsfield, Mass.
[0088] The invention having been fully described, it will be apparent to one of ordinary skill in the art that many modifications and changes may be made to it without departing from the spirit and scope of the present invention.
|Cited Patent
|Filing date
|Publication date
|4 May 1936
|28 Mar 1939
|American Box Board Co
|Title not available
|Title not available
|Title not available
|Title not available
|Citing Patent
|Filing date
|Publication date
|14 Mar 2002
|6 Jan 2004
|Lifescan, Inc.
|Test strip qualification system
|14 Mar 2002
|27 Jan 2004
|Lifescan, Inc.
|Test strip qualification system
|12 Nov 2003
|28 Dec 2004
|Lifescan, Inc.
|Test strip qualification system
|12 Nov 2003
|1 Feb 2005
|Lifescan, Inc.
|Test strip qualification system
|5 Nov 2002
|23 May 2006
|Lifescan, Inc.
|Method for manufacturing a tissue factor-based prothrombin time reagent
|5 Nov 2002
|6 May 2004
|Richard Jenny
|Method for manufacturing a tissue factor-based prothrombin time reagent
|12 Nov 2003
|20 May 2004
|Harshad Patel
|Test strip qualification system
|12 Nov 2003
|3 Jun 2004
|Harshad Patel
|Test strip qualification system
|9 Dec 2004
|14 Jul 2005
|Harshad Patel
|Test strip qualification system
|13 Mar 2009
|11 Apr 2012
|Scandinavian Micro Biodevices ApS
|Microfluidic system for coagulation tests or agglutination tests
|U.S. Classification
|International Classification
|Cooperative Classification
|European Classification
|11 Apr 2002
Owner name: LIFESCAN, INC., CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:SHARTLE, ROBERT JUSTICE;CHOW, HERBERT;HARTMANN, CHRISTA;REEL/FRAME:012798/0865;SIGNING DATES FROM 20000324 TO 20000329