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Patent US5674281 - Artificial heart braking system - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsAn artificial heart assembly, designed for implantation into a subject, which may be a total artificial heart or a ventricular assist device. The heart assembly has a blood inlet conduit, a blood outlet conduit, a pumping mechanism for pumping blood from the blood inlet conduit to the blood outlet conduit,...http://www.google.com/patents/US5674281?utm_source=gb-gplus-sharePatent US5674281 - Artificial heart braking systemAdvanced Patent SearchTry the new Google Patents, with machine-classified Google Scholar results, and Japanese and South Korean patents.Publication numberUS5674281 APublication typeGrantApplication numberUS 08/594,042Publication dateOct 7, 1997Filing dateJan 30, 1996Priority dateJan 30, 1996Fee statusPaidAlso published asDE19649675A1Publication number08594042, 594042, US 5674281 A, US 5674281A, US-A-5674281, US5674281 A, US5674281AInventorsAlan J. SnyderOriginal AssigneeThe Penn State Research FoundationExport CitationBiBTeX, EndNote, RefManNon-Patent Citations (30), Referenced by (27), Classifications (16), Legal Events (7) External Links: USPTO, USPTO Assignment, EspacenetArtificial heart braking system
US 5674281 AAbstract
An artificial heart assembly, designed for implantation into a subject, which may be a total artificial heart or a ventricular assist device. The heart assembly has a blood inlet conduit, a blood outlet conduit, a pumping mechanism for pumping blood from the blood inlet conduit to the blood outlet conduit, and means for reversibly driving the pumping mechanism in a opposite directions over a stroke having a length defined by a pair of endpoints. The driving means has a motor which is braked by a braking means which has means for determining the actual speed of the pumping mechanism, means for comparing the actual speed of the pumping mechanism with a braking speed, and means for selectively applying the brake to the motor based upon the relative magnitudes of the actual speed and the braking speed.
1. An artificial heart assembly, comprising:a blood inlet conduit; a blood outlet conduit; a pumping mechanism for pumping blood from said blood inlet conduit to said blood outlet conduit; means for reversibly driving said pumping mechanism in a first direction and a second direction over a stroke having a length defined by a pair of stroke endpoints, said pumping mechanism being moveable through a plurality of position bands between said endpoints, said pumping mechanism being capable of changing between said first and second directions at a rate of at least 30 times per minute and having an actual speed which varies over said stroke, said driving means including a motor; and means coupled to said driving means for braking said motor, said braking means comprising:means for determining said actual speed of said pumping mechanism in one of said position bands of said pumping mechanism; means for storing a plurality of braking speeds, each of said braking speeds being associated with a different one of said position bands including said one position band; means for comparing said actual speed of said pumping mechanism in said one position band with said braking speed associated with said one position band; and means for selectively applying a brake to said motor based upon the relative magnitudes of said actual speed and said braking speed. 2. The artificial heart assembly as defined in claim 1 additionally comprising:means for detecting a motor stall; and means for increasing one of said braking speeds stored in said storing means upon the detection of a motor stall. 3. The artificial heart assembly as defined in claim 1 additionally comprising:means for detecting when said pumping mechanism moves past one of said endpoints; and means for decreasing one of said braking speeds stored in said storing means upon the detection of said pumping mechanism moving past one of said endpoints. 4. The artificial heart assembly as defined in claim 1 wherein said braking means comprises means for repeatedly applying and removing said brake during a single stroke of said pumping mechanism based upon said actual speed of said pumping mechanism.
5. The artificial heart assembly as defined in claim 1 additionally comprising means for detecting a motor stall and wherein said braking means comprises means for removing said brake upon the detection of a motor stall by said stall-detecting means.
6. The artificial heart assembly as defined in claim 1 additionally comprising a membrane defining a blood chamber fluidly coupled to said blood inlet conduit and said blood outlet conduit, wherein said pumping mechanism comprises a pusher plate which makes contact with said membrane to force blood from said blood inlet conduit to said blood outlet conduit.
7. The artificial heart assembly as defined in claim 1 additionally comprising:a first membrane defining a blood chamber fluidly coupled to said blood inlet conduit and said blood outlet conduit, wherein said pumping mechanism comprises a pusher plate which makes contact with said first membrane to force blood from said blood inlet conduit to said blood outlet conduit; a second membrane defining a second blood chamber fluidly coupled to a second blood inlet conduit and a second blood outlet conduit; and a second pusher plate which makes contact with said second membrane to force blood from said second blood inlet conduit to said second blood outlet conduit. 8. An artificial heart assembly, comprising:a blood inlet conduit; a blood outlet conduit; a pumping mechanism for pumping blood from said blood inlet conduit to said blood outlet conduit; means for reversibly driving said pumping mechanism in a first direction and a second direction over a stroke having a length defined by a pair of stroke endpoints, said pumping mechanism having an actual speed which varies over said stroke, said driving means including a motor; and means coupled to said driving means for braking said motor, said braking means comprising:means for determining said actual speed of said pumping mechanism; means for comparing said actual speed of said pumping mechanism with a braking speed; and means for selectively applying a brake to said motor based upon the relative magnitudes of said actual speed and said braking speed. 9. The artificial heart assembly as defined in claim 8 wherein said motor comprises a plurality of motor terminals and wherein said braking means comprises means for connecting all of said motor terminals to ground.
10. The artificial heart assembly defined in claim 8 additionally comprising means for detecting a motor stall.
11. The artificial heart assembly as defined in claim 10 wherein said driving means comprises a DC brushless motor having a stator and a rotor with an angular position that varies with respect to said stator and wherein said stall-detecting means comprises:means for periodically generating a position code based on said angular position of said rotor with respect to said stator; and means for determining whether said code-generating means has generated a position code within a predefined period of time. 12. The artificial heart assembly as defined in claim 8 additionally comprising means for detecting a motor stall and wherein said braking means comprises means for removing said brake upon the detection of a motor stall by said stall-detecting means.
13. The artificial heart assembly as defined in claim 8 wherein said braking means comprises means for repeatedly applying and removing said brake during a single stroke of said pumping mechanism based upon said actual speed of said pumping mechanism.
14. The artificial heart assembly as defined in claim 8,wherein said pumping mechanism is moveable through a plurality of position bands between said endpoints; wherein said means for determining said actual speed of said pumping mechanism comprises means for determining said actual speed of said pumping mechanism in one of said position bands of said pumping mechanism; wherein said braking means additionally comprises means for storing a plurality of braking speeds, each of said braking speeds being associated with a different one of said position bands including said one position band; and wherein said comparing means comprises means for comparing said actual speed of said pumping mechanism in said one position band with said braking speed associated with said one position band. 15. The artificial heart assembly as defined in claim 14 additionally comprising means for modifying one of said braking speeds stored in said storing means.
16. The artificial heart assembly as defined in claim 14 additionally comprising:means for detecting a motor stall; and means for increasing one of said braking speeds stored in said storing means upon the detection of a motor stall. 17. The artificial heart assembly as defined in claim 14 additionally comprising:means for detecting when said pumping mechanism moves past one of said endpoints; and means for decreasing one of said braking speeds stored in said storing means upon the detection of said pumping mechanism moving past one of said endpoints. 18. The artificial heart assembly as defined in claim 8 wherein said means for selectively applying said brake comprises means for selectively applying said brake when said actual speed is greater than said braking speed.
19. The artificial heart assembly as defined in claim 8 wherein said driving means comprises a DC brushless motor with a stator and a rotor having a rotational speed and wherein said means for determining said actual speed of said pumping mechanism comprises means for determining said actual speed of said pumping mechanism based upon said rotational speed of said rotor.
20. The artificial heart assembly as defined in claim 19 wherein said means for determining said actual speed of said pumping mechanism comprises a plurality of position sensors.
21. The artificial heart assembly as defined in claim 8 additionally comprising a membrane defining a blood chamber fluidly coupled to said blood inlet conduit and said blood outlet conduit, wherein said pumping mechanism comprises a pusher plate which makes contact with said membrane to force blood from said blood inlet conduit to said blood outlet conduit.
22. The artificial heart assembly as defined in claim 8 additionally comprising:a first membrane defining a blood chamber fluidly coupled to said blood inlet conduit and said blood outlet conduit, wherein said pumping mechanism comprises a pusher plate which makes contact with said first membrane to force blood from said blood inlet conduit to said blood outlet conduit; a second membrane defining a second blood chamber fluidly coupled to a second blood inlet conduit and a second blood outlet conduit; and a second pusher plate which makes contact with said second membrane to force blood from said second blood inlet conduit to said second blood outlet conduit. 23. A method of operating an artificial heart assembly having a blood inlet conduit, a blood outlet conduit, and a pumping mechanism for pumping blood from the blood inlet conduit to the blood outlet conduit, said method comprising the steps of:(a) reversibly driving said pumping mechanism in a first direction and a second direction over a stroke having a length defined by a pair of stroke endpoints, said pumping mechanism being driven at an actual speed which varies over said stroke; (b) determining said actual speed of said pumping mechanism; (c) comparing said actual speed of said pumping mechanism with a braking speed; and (d) selectively applying a brake to said pumping mechanism based upon the relative magnitudes of said actual speed and said braking speed. 24. The method as defined in claim 23 additionally comprising the steps of:(e) detecting a motor stall; and (f) removing said brake upon the detection of a motor stall. 25. The method as defined in claim 23,wherein said step (a) comprises the step of driving said pumping mechanism through a plurality of position bands between said endpoints, wherein said (b) comprises the step of determining said actual speed of said pumping mechanism in one of said position bands of said pumping mechanism, wherein said artificial heart assembly has a plurality of braking speeds stored therein, each of said braking speeds being associated with a different one of said position bands including said one position band, and wherein said step (c) comprises the step of comparing said actual speed of said pumping mechanism in said one position band with said braking speed associated with said one position band. 26. The method as defined in claim 25 additionally comprising the step of modifying one of said braking speeds associated with one of said position bands.
27. The method as defined in claim 25 additionally comprising the steps of:(e) detecting a motor stall; and (f) increasing one of said braking speeds associated with one of said position bands upon detecting a motor stall. 28. The method as defined in claim 25 additionally comprising the steps of:(e) detecting when said pumping mechanism moves past one of said endpoints; and (f) decreasing one of said braking speeds associated with one of said position bands upon detecting said pumping mechanism moving past one of said endpoints. Description
This patent is subject to Government Contract No. N01-HV-88105 with the National Heart, Lung and Blood Institute and Grant No. R01-HL-13426 with the National Heart, Lung and Blood Institute.
The present invention is directed to an artificial heart assembly having a motorized reciprocating pumping mechanism with a drive system that incorporates a brake to slow the pumping mechanism down as it approaches the ends of its stroke.
As defined herein, an artificial heart assembly intended for use with a subject, such as an animal or human, may be a total artificial heart (TAH) intended to replace the entire heart of the subject, a ventricular assist device (VAD) intended to replace a portion of the subject's heart, or an external blood pump to be used with the subject.
A conventional artificial heart has previously been provided with a DC motor to drive a pumping mechanism for pumping blood through the artificial heart. The DC motor has been provided with a stator and a permanent magnet rotor rotatable with respect to the stator, the rotor being connected to a coupler for translating the rotation of the rotor into linear movement of the blood pumping mechanism. The pumping mechanism reciprocates back and forth between two endpoints in a linear direction at a rate corresponding to that of a natural heartbeat.
It has previously been proposed to incorporate a "brake" into the system for driving the DC motor so that the pumping mechanism is slowed as it approaches both ends of its stroke. The operation of the brake was described by Dr. Alan Snyder in a graduate thesis entitled "Automatic Electronic Control of an Electric Motor-Driven Total Artificial Heart" dated May 1987 as follows: "At a preplanned distance, nb, before the diastolic endpoint, nd, a dynamic brake is applied to the motor (all leads shorted by the power switch). If, through any band between the brake point and the diastolic endpoint, the measured velocity is less than half the desired velocity, nb is decremented, so that the brake is applied later on the ensuing cycle. If the device overshoots the diastolic endpoint, nb is decremented, so that the brake is applied sooner on the next cycle." However, the above manner of applying the brake was found to be unacceptable since it resulted in premature failure of the artificial heart.
The invention is directed to an artificial heart assembly having a blood inlet conduit, a blood outlet conduit, a pumping mechanism for pumping blood from the blood inlet conduit to the blood outlet conduit, and means for reversibly driving the pumping mechanism in a opposite directions over a stroke having a length defined by a pair of endpoints. The driving means has a motor which is selectively braked. The means for braking the motor includes means for determining the actual speed of the pumping mechanism, means for comparing the actual speed of the pumping mechanism with a braking speed, and means for selectively applying the brake to the motor based upon the relative magnitudes of the actual speed and the braking speed.
The artificial heart assembly may be provided with a stall detector in the form of a plurality of position sensors which periodically generate a position code based on the angular position of the rotor of the motor with respect to the stator and means for determining whether the position sensors have generated a position code within a predefined period of time. Upon the detection of a stall, the braking means removes the brake if it was previously applied. Consequently, the braking means may repeatedly apply and remove the brake during a single stroke of the pumping mechanism.
The pumping mechanism may be translatable through a plurality of position bands between its endpoints; the means for determining the actual speed of the pumping mechanism may determine the actual speed in one of the position bands of the pumping mechanism; the braking means may store a plurality of braking speeds, each of which is associated with a different position band; and the comparing means may compare the actual speed of the pumping mechanism in the one position band with the braking speed associated with the one position band.
One of the stored braking speeds associated with one of the position bands may be increased upon the detection of a motor stall to reduce the likelihood of a motor stall in the next stroke in the same direction. One of the stored braking speeds may be decreased upon the detection that the pumping mechanism moved past one of the endpoints to reduce the likelihood that the pumping mechanism will move past that endpoint in a subsequent stroke.
The invention is also directed to a method of operating an artificial heart assembly having a blood inlet conduit, a blood outlet conduit, and a pumping mechanism for pumping blood from the blood inlet conduit to the blood outlet conduit. The method includes the steps of: reversibly driving the pumping mechanism in opposite directions over a stroke having a length defined by a pair of endpoints, determining the actual speed of the pumping mechanism, comparing the actual speed of the pumping mechanism with a braking speed, and selectively applying a brake to the pumping mechanism based upon the relative magnitudes of the actual speed and the braking speed.
The method may also include the steps of detecting a motor stall and removing the brake upon the detection of a motor stall. The pumping mechanism may be driven through a plurality of position bands between the endpoints; the artificial heart assembly may have a plurality of braking speeds stored therein, each braking speed being associated with a different position band; and the actual speed of the pumping mechanism in the one position band may be compared with the braking speed associated with that position band to determine whether the brake should be applied.
The method may also include the steps of detecting a motor stall and increasing one of the braking speeds associated with one of the position bands upon detection of the stall, and detecting when the pumping mechanism moves past one of the endpoints and decreasing one of the braking speeds associated with one of the position bands upon detection that the pumping mechanism moved past the endpoint.
FIG. 1 is a perspective view of an artificial heart, portions of which are shown in cross section;
FIG. 2 is a block diagram of the electronics portion of the artificial heart of FIG. 1;
FIG. 2A is a circuit diagram of the driver circuit shown schematically in FIG. 2;
FIG. 3 is a flowchart of the overall operation of the drive control system of the artificial heart;
FIG. 4 is a flowchart of a forward speed adaptation routine shown schematically in FIG. 3;
FIG. 5 is a flowchart of a sensor routine periodically performed during operation of the artificial heart;
FIG. 6 is a flowchart of a forward routine shown schematically in FIG. 5;
FIG. 7 is a flowchart of a backward routine shown schematically in FIG. 5;
FIG. 8 is a flowchart of an adjust brake routine shown schematically in FIG. 7;
FIG. 9 is a flowchart of a brake routine shown schematically in FIG. 7;
FIG. 10 is a flowchart of a stall routine that may be performed during operation of the artificial heart.
FIG. 1 illustrates an artificial heart assembly 10 intended to be completely implanted within a subject, such as a human or an animal, to take the place of the subject's natural heart. The artificial heart 10 has a housing 12 composed of three sections 12a, 12b, 12c which are held together by a pair of annular V-rings 14, 16.
A blood reservoir within a sac 18 disposed within the housing section 12a is fluidly coupled to a blood outlet defined by an artificial vascular graft 20 connected to the housing section 12a via a threaded connector 22. The graft 20 is connected to the pulmonary artery of the subject via a suture line 24. The blood reservoir 18 is fluidly coupled to a blood inlet chamber defined by an artificial graft 26 which is connected to the housing section 12a via a threaded connector 28 and to the right atrium of the subject via a suture line (not shown). A pair of one-way check valves (not shown) are disposed in the blood inlet 26 and the blood outlet 20 to ensure that blood is pumped in the direction shown by the arrows in FIG. 1. A pusher plate 30 makes contact with and periodically deforms the blood sac 18 to force blood from the blood inlet 26 to the blood outlet 20.
A blood sac 38 disposed within the housing section 12c is fluidly coupled to a blood outlet defined by an artificial graft 40 connected to the housing section 12c via a threaded connector 42. The graft 40 is connected to the aorta of the subject via a suture line 44. The blood reservoir 38 is coupled to a blood inlet chamber defined by an artificial graft 46 which is connected to the housing section 12c via a threaded connector 48 and to the left atrium of the subject via a suture line (not shown). A pair of one-way check valves (not shown) are disposed in the blood inlet 46 and the blood outlet 40 to ensure that blood is pumped in the direction shown by the arrows. A pusher plate 50 makes contact with and periodically deforms the blood sac 38 to force blood from the blood inlet 46 to the blood outlet 40.
The pusher plates 30, 50, which form part of a pump mechanism, are driven laterally back and forth by a DC brushless motor 52 coupled to the pusher plates 30, 50 via a drive screw 54 and a coupling mechanism composed of a plurality of threaded elongate rollers 56 disposed within a cylindrical nut 58 fixed to a rotor (not shown) of the motor 52. Rotation of the rotor causes the nut 58 and rollers 56 to rotate, thus causing the drive screw 54 to be linearly displaced in a direction parallel to its longitudinal central axis. A guide rod 62 is connected between the two pusher plates 30, 50 and passes through a fixed bushing 64 to prevent the plates 30, 50 from rotating. Other mechanisms for coupling the rotor to the pusher plates 30, 50 could be used.
The rotation of the rotor is controlled via the electrical energization of a plurality of windings of a stator (not shown) which is rotatably coupled to the rotor via a pair of cylindrical bearings 72. A wire port 74 is formed in the housing section 12b to allow the passage of wires from the windings to a microcontroller 100 (FIG. 2), which may be implanted in another area of the subject, such as in the subject's abdomen.
ARTIFICIAL HEART ELECTRONICS
Referring to FIG. 2, the controller 100, which may be a conventional integrated circuit chip, has a read-only memory (ROM) 102, a random-access memory (RAM) 104, a microprocessor (MP) 106, a conventional input/output (I/O) circuit 108, and a conventional pulse-width modulator (PWM) circuit 110, all of which are interconnected via an address and data bus 112.
The controller 100 is operatively connected to a commutator circuit 114 which periodically generates a set of commutation signals which are transmitted to a driver circuit 118 via a line 120. The driver circuit 118 generates a set of electrical drive signals that are transmitted to the stator windings of the motor 52 via three lines connected to three terminals of the motor 52.
The commutator 114 is provided with a PWM signal from the PWM circuit 110 via a line 116, a direction signal from the I/O circuit 108 via a line 115 which specifies which direction the motor 52 should be driven, and a brake signal from the I/O circuit 108 via a line 117 which indicates when the "brake" should be applied.
As shown in FIG. 2A, the driver circuit 118 may be composed of three pairs of switching transistors Q1-Q6, each pair having a first transistor with one terminal connected to a voltage source and a second terminal connected to one of the motor terminals and a second transistor with one terminal connected to the same motor terminal and a second terminal connected to ground. Each transistor has a third control terminal which is provided with a control signal from a MOSFET driver (shown in the dotted boxes) that controls whether the current path across its first and second terminals is conductive or nonconductive.
When the brake signal is sent to the commutator 114 via the line 115, the driver circuit 118 brakes the motor 52. This braking may be accomplished, for example, by causing the transistors Q2, Q4, Q6 to become simultaneously conductive so that all three motor terminals are connected to ground via a conductive path through those transistors. This braking of the motor 52 causes it to slow at a relatively fast rate, which slows the motor 52 more quickly than just not providing drive signals to the motor 52.
Three position sensors 124, such as Hall-effect sensors, are associated with the motor 52 and generate a set of position signals that are indicative of the angular position of the rotor with respect to the stator. The position signals are transmitted to the I/O circuit 108 via a line 126 and to the commutator 114 via a line 128.
During operation of the artificial heart 10, the commutator 114 periodically generates a set of commutation signals and transmits them to the driver circuit 118 to drive the motor 52. The commutation signals are generated in a conventional manner based upon a three-bit position signal generated by the position sensors 124 and based upon a PWM signal generated by the PWM circuit 110. The duty cycle or pulse width of the PWM signal controls the amount of acceleration of the motor 52, with a relatively large duty cycle corresponding to a relatively high rate of acceleration and a relatively small duty cycle corresponding to a relatively low rate of acceleration.
FIG. 3 is a flowchart of a computer program, stored in the ROM 102 (FIG. 2) and executed by the microprocessor 106, that: 1) determines the duty cycle of the PWM signal to control the acceleration of the motor 52, and 2) determines when the motor 52 should be braked. The performance of these two functions facilitates the motor's ability to reciprocate the pump mechanism (i.e. the drive screw 54 and the attached pusher plates 30, 50) back and forth at a relatively high rate, in excess of 30 times per minute, to pump blood through the artificial heart 10 along the flow pathways described above. In the absence of the braking function, the speed at which the motor 52 was driven would have to be reduced.
Referring to FIG. 3, at step 200 a number of variables are initialized, and at step 202 the interrupts which may be generated during operation are enabled. These interrupts include a sensor interrupt which is generated each time the position sensors 124 generate a position signal and a stall interrupt which is generated when the rotational speed of the rotor falls below a lower speed threshold, as described below.
Steps 204-210 are continuously repeated during operation so that, after the completion of each full stroke of the pump mechanism, either a forward or a backward speed adaptation is performed, depending on whether the forward stroke (e.g. from left to right in FIG. 1) or the backward stroke was completed.
Steps 204, 208 detect the completion of the forward and backward strokes by a software position counter which counts the number of rotational increments of the motor 52 (as described below, the position sensors 124 generate a position code for each successive increment), with the two ends of linear motion coinciding with fixed increment counts, e.g. the left end of the stroke coinciding with a count of zero and the right end of the stroke coinciding with a count of 198 (33 bands×6 increments per band).
SPEED ADAPTATION ROUTINES
The purpose of the speed adaptation routines 206, 210 is to vary the pulse width of the PWM signal provided to the commutator 114 by the PWM circuit 110 so that the pump mechanism is driven at an actual speed which corresponds to a desired speed.
Each time the rotor of the motor 52 moves through a predetermined increment of rotation, a three-bit position code is generated by the position sensors 124 and a sensor interrupt is generated. A position "band" is defined herein as a predetermined number of rotational increments, e.g. six increments of rotation, in which case the motor 52 would move through a complete band after six sensor interrupts are generated. A complete stroke of the pump, in either the forward or backward direction, is composed of a number of position bands, such as 33 position bands.
For each band in the forward stroke, a desired speed is specified via a desired speed table, a portion of one example of which is set forth below. The values in the following table are exemplary only, and the real values used should be based on the specific motor and pump mechanism used.
______________________________________DESIRED SPEED TABLEBAND        DESIRED SPEED______________________________________23          9024          9025          9026          9027          7028          5029          3530          2531          2032          1533          5______________________________________
Thus, in band 28, the desired speed (e.g. linear travel of the pump mechanism in millimeters per second) is specified to be 50.
A backward speed table having the same configuration is used to specify the desired speed for each band in the backward direction since the desired speeds may not be symmetrical in both directions due to the unequal forces encountered by the pump mechanism in the two directions.
The software also includes a pair of actual speed tables, one for each direction, which store the actual speed of the pump at each band during the previous stroke, and a pair of pulse width tables, one for each direction, that store the pulse width of the PWM signal to be generated by the PWM circuit 110 during each band. The desired speed tables may be stored in the ROM 102, and the actual speed and pulse width tables are stored in the RAM 104.
FIG. 4 is a flowchart of the forward speed adaptation routine 206 shown schematically in FIG. 3. Referring to FIG. 4, the forward speed adaptation routine 206 begins at step 222, where a variable N is set to 1 to specify the first band in the forward stroke direction. At step 224, the actual speed of the pump for the band specified by N is retrieved from the actual speed table for the forward direction. At step 226, the desired speed of the pump for the band specified by N is retrieved from the desired speed table for the forward direction.
At step 228, the actual speed for the specified band is subtracted from the desired speed for the specified band, and at step 230 that speed difference is multiplied by a gain factor (i.e. a constant) to calculate a pulse-width correction. At step 232, the pulse width (i.e. duty cycle) currently specified for the band N is retrieved from the pulse width table, and at step 234 that pulse width is adjusted by adding to it the pulse-width correction determined at step 230. At step 236, the adjusted pulse width determined is stored in the band N position in the pulse width table for the current direction, replacing the previous value of the pulse width for that band.
At step 238, the variable N is incremented, and at step 240, if the pulse widths for all the bands have not been adjusted, the program branches back to step 224 where the process is repeated for the next band specified by the new value of N.
The operation of the backward speed adaptation step 210 is identical to that of the forward speed adaptation routine 206 described above, except that instead of increasing the variable N from 1 to its maximum value, N is decreased from its maximum value to 1. Also, the backward speed adaptation step 210 accesses the desired and actual speed tables and the pulse width table for the backward direction.
SENSOR ROUTINE
FIG. 5 is a flowchart of a sensor interrupt service routine 250 that is performed each time of sensor interrupt is generated. When invoked, the sensor routine 250 temporarily interrupts the performance of the main routine 150.
Referring to FIG. 5, at step 252, the position code generated by the sensors 124 is read. For successive angular increments of the rotor, the sensors 124 generate a unique 3-bit position code, such as those set forth in the table below:
______________________________________POSITION CODE TABLEINCREMENT     POSITION CODE______________________________________1             0002             0013             0114             1115             1106             100______________________________________
At step 254, the position code read at step 252 is compared with a list of six valid position codes (there are two position codes that do not correspond to a position). At step 258, if the position code read at step 252 does not match one of the six valid codes, the program branches to step 258 where the controller 100 is reset, after which the operation begins again at step 200 of the main routine 150.
If the position code was valid, the program branches to step 260, where it is determined whether the pump moved in the forward or backward direction. This is determined by comparing the current position code (read during the current execution of step 252) with the two position codes in the position code table before and after the position code that was read during the prior execution of step 252. For example, referring to position code table set forth above, if the position code read during the previous execution of step 252 was 111 (Increment 4), then the pump moved forward if the current position code read is 110 (Increment 5), or the pump moved backward if the current position code is 011 (Increment 3).
If the pump moved forward as determined at step 260, the program branches to step 270 where a forward routine (shown in FIG. 6) is performed. Otherwise, the program branches to step 280 where a backward routine (FIG. 7) is performed.
FORWARD AND BACKWARD ROUTINES
A flowchart of the forward routine 270 is shown in FIG. 6. The forward routine 270 performs a number of basic tasks, including keeping track of the current position of the pump and measuring the actual speed of the pump.
At step 282, a modulo-six software counter (since one position band is defined as six angular increments) is incremented by one since the position sensors 124 have just detected angular movement of the rotor. As is known, a modulo-six counter automatically resets itself to zero upon reaching a count of six. Step 284 determines whether a band is completed by checking to determine whether the count of the modulo-six counter is zero. If a band has not been completed, the program skips steps 286-300, which are performed only upon the completion of a band.
If a band has just been completed, the program branches to step 286 where the band number (which represents the current band position) is incremented. At step 288, the program determines whether the pump is supposed to be moving in the forward direction by checking the value of a direction flag. In unusual cases, it is possible for the pump to be moving in the wrong direction, for example, due to a fluid pressure surge opposite the movement direction which cannot be overcome by the motor 52. If the pump is supposed to be moving in the forward direction, the program branches to step 290 where a brake adjust routine, described below, is performed.
At step 292, the program determines whether the pump reached its intended destination. This is determined by comparing the current band number (set at step 286) with the expected band destination (which was previously set at step 296). For example, if the pump is moving in the forward direction and the current band number is 25, then the expected band destination is 26. When the next band is completed, the current band number will be incremented by one to 26 at step 286, and will equal the expected band destination of 26 (which will subsequently be incremented to 27 at step 296 to represent the next expected band destination). In unusual circumstances, it is possible that the pump did not reach its expected destination due to a pressure surge in the opposing direction.
If the pump did reach its expected destination as determined at step 292, then the program branches to step 294 where the actual speed of the pump is determined. The actual speed is determined based on measuring the time that elapses between the completion of successive bands (by reading a system clock (not shown) contained in the controller 100). After the actual speed for the band just completed is determined, the actual speed is stored in the actual speed table described above. At step 296, the band destination is incremented.
Step 298 determines whether the end of the stroke has been reached by determining whether the upper band number, e.g. 33, has been reached. If so, the program branches to step 299 where the direction flag is changed to indicate that the pump should be driven in the reverse direction, and at step 302, a brake routine described below is performed.
The operation of the backward routine 280 shown in FIG. 7 is substantially the same as the forward routine 270 just described, except that the modulo-six counter counts down at step 310 of FIG. 7 and the band number and destination are decremented at steps 314, 322 of FIG. 7.
ADJUST BRAKE ROUTINE
FIG. 8 is a flowchart of the adjust brake routine shown schematically as step 290 in FIGS. 6 and 7. The basic function performed by the adjust brake routine 290 is to alter the position during the stroke at which the brake is applied.
Referring to FIG. 8, step 340 determines if the pump is past its stroke endpoint by comparing the current band number with the upper band limit (e.g. 33) for the forward direction or comparing the current band number with the lower band limit (e.g. 1) for the backward direction.
At step 342, if the motor 52 stalled with the brake on, which is determined by checking the status of a stalled-with-brake-on flag, the program branches to step 344 where the stalled-with-brake-on flag is cleared. If the motor 52 did not stall with the brake on as determined at step 342, the program branches to step 346.
Steps 346-350 act to cause the brake to be applied one band earlier (assuming the pump approaches the endpoint at the same speed during the next stroke), so that the pump is less likely to move past its stroke endpoint during the next stroke in the same direction. At step 346, the program retrieves from memory the number of the position band in which the brake was first applied. At step 348, the program retrieves from the actual speed table the actual speed for the band during which the brake was first set.
Then, at step 350, a brake table (there is a separate brake table for each direction) which determines when the brake is applied during a stroke, is revised to cause the brake to be put on one band earlier in the next stroke in the same direction since the pump moved past its stroke endpoint (as determined at step 340). Referring to the table set forth below, for each of a number of bands adjacent the end of a stroke, the brake table stores a braking speed. If the actual speed of the pump during any band surpasses the braking speed for that band, the brake is applied. For example, if the actual speed for the band 30 was 32, the brake would be applied since the actual speed was in excess of the braking speed.
______________________________________BRAKE TABLEBAND        BRAKING SPEED______________________________________23          10024          10025          10026          10027          10028          5029          4030          3031          2432          2133          11______________________________________
At step 350, the braking speed for the band just prior to the band in which the brake was applied is increased to the actual speed for that band minus one. Thus, if the brake was applied in band 30 and the actual speed in band 29 was 37, the braking speed for band 29 would be changed from 40 to 36, in which case (assuming the actual speed for the next stroke in the same direction was the same), the brake would be put on in band 29 instead of in band 30, and the pump would be less likely to move past its endpoint.
BRAKE ROUTINE
FIG. 9 is a flowchart of the operation of the brake routine 300 shown schematically in FIG. 7. The basic function of the brake routine 300 is to apply the brake if the pump is moving too fast for a particular band and to reapply, or "pump," the brake if a previous application of the brake caused the motor to stall.
Referring to FIG. 9, step 360 determines (by checking the stalled-with-brake-on flag) if the motor stalled with the brake on. That would occur if a previous execution of the brake routine 300 caused the brake to be applied during a stroke and if the application of the brake caused the motor to stall. In the case of a stall, the brake is removed (as described below in connection with FIG. 10), so that if the motor stalled with the brake on as determined at step 360, the brake would not be on. In that case, the program branches to step 374 where the brake is reapplied.
If the motor did not stall with the brake on, the program branches to step 362. At step 362, if the brake is not on, the program branches to steps 364-368 where it determines whether the brake should be applied because the pump is moving too fast for the current band. In particular, at step 364 the actual speed for the band just completed is retrieved from the actual speed table, and at step 366 that actual speed is compared with the braking speed for the band just completed (from the brake table for the current direction). At step 368, if the actual speed is not less than the braking speed, the program branches to step 374 where the brake is applied.
If the actual speed is less than the braking speed, the program branches to steps 370-372 where the desired pulse width of the PWM signal sent to the commutator 114 is transmitted to the PWM circuit 110. This is accomplished by retrieving at step 370 the pulse width for the next band from the pulse width table for the current direction (as described above in FIG. 6, the brake routine 300 is only performed upon completion of a band as determined at step 284) and transmitting that pulse width to the PWM circuit 110 at step 372.
STALL ROUTINE
A flowchart of a stall interrupt service routine 380 is shown in FIG. 10. The stall routine 380 is performed upon the occurrence of a stall interrupt, which is automatically generated when the position sensors 124 fail to generate a new position code after a predetermined time period elapses. The predetermined time period, which is measured by a stall timer, is selected to be twice the estimated completion time for the next band. The estimated completion time for the next band is determined based upon the desired speed of the pump in that band.
The stall routine 380 performs a number of functions, including modifying the pulse width of the PWM signal in an attempt to prevent a future stall and to modify the brake table to attempt to prevent a future stall due to the application of the brake.
Referring to FIG. 10, at step 382 the present pulse width for the current band is retrieved from the pulse width table for the current direction. At step 384, the present pulse width correction is retrieved. If the stall routine is being performed for the first time, this correction is zero. If the stall routine has already been performed at least once for this band, the present correction is the value stored at step 388 during the most recent execution of the stall routine 380.
At step 386, the present correction retrieved at step 384 is incremented by a predetermined amount (e.g. by an amount which causes the duty cycle of the PWM signal to increase by 7%), and the new correction is stored at step 388. At step 390, the new correction is added to the pulse width stored in the pulse width table for the current band and direction.
At step 392, if the brake is on, meaning that the application of the brake caused the stall, the program branches to step 394 where the brake is removed and then to step 396 wherein the stall-with-brake-on flag is set. Steps 398-400 are then performed to cause the brake to be applied later in the next stroke to prevent a stall (assuming the actual speed of the pump as it approaches the endpoint is the same during the next stroke). At step 398, the actual speed in the band in which the brake was applied is retrieved from the actual speed table for the current direction, and at step 400 the braking speed in the brake table for that band and direction is increased. In particular, the braking speed for that band is made equal to one more than the actual speed for that band so that (assuming the actual speed is the same during the next stroke in the same direction) the brake will not be applied in the same band of the next stroke. At step 402, the new pulse width determined at step 390 is transmitted to the PWM circuit 110.
Non-Patent CitationsReference1Lau et al., "Sensorless Position Control of a Brushless Motor in Circulatory Assist Devices", Mechatronics vol. 1, No. 3, pp. 277-292, 1991.2 *Lau et al., Sensorless Position Control of a Brushless Motor in Circulatory Assist Devices , Mechatronics vol. 1, No. 3, pp. 277 292, 1991.3 *Lau Siu Wo, An Experimental Study in Sensorless Commutation of the Penn State Artificial Heart , The Pennsylvania State University, Dec.1990.4Lau Siu-Wo, "An Experimental Study in Sensorless Commutation of the Penn State Artificial Heart", The Pennsylvania State University, Dec.1990.5Pae, Jr., et al., "Ventricular assist devices for postcardiotomy cardiogenic shock", The Journal of Thoracic and Cardiovascular Surgery, vol. 104, No. 3, Sep. 1992, pp. 541-553.6 *Pae, Jr., et al., Ventricular assist devices for postcardiotomy cardiogenic shock , The Journal of Thoracic and Cardiovascular Surgery, vol. 104, No. 3, Sep. 1992, pp. 541 553.7Pierce et al., "A long-term ventricular assist sytstem", The Journal of Thoracic and Cardiovascular Surgery, vol. 105, No. 3, pp. 520-524, Mar. 1993.8 *Pierce et al., A long term ventricular assist sytstem , The Journal of Thoracic and Cardiovascular Surgery, vol. 105, No. 3, pp. 520 524, Mar. 1993.9Poirier et al., "An Ambulatory, Intermediate Term Left Ventricular Assist Device", vol. XXXV Trans Am Soc Artif Intern Organs 1989, pp. 452-455.10 *Poirier et al., An Ambulatory, Intermediate Term Left Ventricular Assist Device , vol. XXXV Trans Am Soc Artif Intern Organs 1989, pp. 452 455.11Rintoul et al., "Continuing Development of the Cleveland Clinic-Nimbus total Artificial Heart", ASAIO Journal 1993, pp. M168-M171.12 *Rintoul et al., Continuing Development of the Cleveland Clinic Nimbus total Artificial Heart , ASAIO Journal 1993, pp. M168 M171.13Rosenberg et al., "In Vivo Testing of a Clinical-size Totally Implantable Artificial Heart", Assisted Circulation 4, pp. 236-248, 1995.14 *Rosenberg et al., In Vivo Testing of a Clinical size Totally Implantable Artificial Heart , Assisted Circulation 4, pp. 236 248, 1995.15Snyder et al., "In Vivo Testing of a Completely Implanted Total Artificial Heart System", ASAIO Journal 1993; pp. M177-M184.16Snyder et al., "Indirect Estimation of Circulatory Pressures For Control of an Electric Motor Driven Total Artificial Heart", pp. 87-88, 1985.17 *Snyder et al., In Vivo Testing of a Completely Implanted Total Artificial Heart System , ASAIO Journal 1993; pp. M177 M184.18 *Snyder et al., Indirect Estimation of Circulatory Pressures For Control of an Electric Motor Driven Total Artificial Heart , pp. 87 88, 1985.19Snyder, A Thesis in Bioengineering, "Automatic Electronic Control of an Electric Motor-Driven Total Artificial Heart", The Pennsylvania State University, The Graduate School, Bioengineering Program, Table of Contents and pp. 1-166, 1987.20 *Snyder, A Thesis in Bioengineering, Automatic Electronic Control of an Electric Motor Driven Total Artificial Heart , The Pennsylvania State University, The Graduate School, Bioengineering Program, Table of Contents and pp. 1 166, 1987.21Tatsumi et al., "A Blood Pump with an interatrial Shunt for Use as an Electrohydraulic Total Artificial Heart", ASAIO Journal 1992, pp. M425-M430.22 *Tatsumi et al., A Blood Pump with an interatrial Shunt for Use as an Electrohydraulic Total Artificial Heart , ASAIO Journal 1992, pp. M425 M430.23The Institute of Electrical and Electronics Engineers Inc., Case Studies in Medical Instrument Design, "Development Of A Totally Implantable Artificial Heart Concept to Implementation", pp. 95-111, 1992.24 *The Institute of Electrical and Electronics Engineers Inc., Case Studies in Medical Instrument Design, Development Of A Totally Implantable Artificial Heart Concept to Implementation , pp. 95 111, 1992.25The Institute of Electrical and Engineers Inc. Computer Society Press Reprint article, "Microcomputer Control of Permanently Implanted Blood Pumps", pp. 154-157, 1989.26 *The Institute of Electrical and Engineers Inc. Computer Society Press Reprint article, Microcomputer Control of Permanently Implanted Blood Pumps , pp. 154 157, 1989.27Weiss et al., "Progress Toward a Completely Implantable Left Ventricular Assist Device at the Pennsylvania State University", Assisted Circulation 4, pp. 124-137, 1995.28 *Weiss et al., Progress Toward a Completely Implantable Left Ventricular Assist Device at the Pennsylvania State University , Assisted Circulation 4, pp. 124 137, 1995.29Yu et al., "A Compact and Noise Free Electrohydraulic Total Artificial Heart", ASAIO Journal 1993, pp. M386-M391.30 *Yu et al., A Compact and Noise Free Electrohydraulic Total Artificial Heart , ASAIO Journal 1993, pp. M386 M391.* Cited by examinerReferenced byCiting PatentFiling datePublication dateApplicantTitleUS6395027Apr 25, 2000May 28, 2002The Penn State Research FoundationArtificial heart with arrhythmia signallingUS6432136Apr 25, 2000Aug 13, 2002The Penn State Research FoundationApparatus and method for removing a pocket of air from a blood pumpUS6451055Apr 25, 2000Sep 17, 2002The Penn State Research FoundationArtificial heart data communication systemUS6458164Apr 25, 2000Oct 1, 2002The Penn State Research FoundationArtificial heart with energy recoveryUS6478820Apr 25, 2000Nov 12, 2002The Penn State Research FoundationArtificial heart with synchronous rectificationUS6579315Apr 25, 2000Jun 17, 2003The Penn State Research FoundationArtificial heart power supply systemUS6669726Feb 4, 2000Dec 30, 2003Juan M. GiambrunoOrthotopic total artificial heartUS6770024Mar 28, 2000Aug 3, 2004Stony Brook Surgical Innovations, Inc.Implantable counterpulsation cardiac assist deviceUS6843145 *Mar 14, 2003Jan 18, 2005Data Spectrum CorporationCardiac phantomUS7481760Jun 22, 2004Jan 27, 2009Pptt LlcImplantable counterpulsation cardiac assist deviceUS8286656Dec 24, 2008Oct 16, 2012Pptt LlcImplantable counterpulsation cardiac assist deviceUS8545381 *Mar 22, 2009Oct 1, 2013Sun Medical Technology Research CorporationAuxiliary artificial heart pump drive device and auxiliary artificial heart systemUS8608798Dec 3, 2010Dec 17, 2013Richard WamplerTotal artificial heartUS8727960Aug 23, 2013May 20, 2014Sun Medical Technology Research CorporationAuxiliary artificial heart pump drive device and auxiliary artificial heart systemUS9173985Nov 19, 2013Nov 3, 2015Oregonheart, Inc.Total artificial heartUS20030213317 *Mar 14, 2003Nov 20, 2003Jaszczak Ronald J.Cardiac phantomUS20040236171 *Jun 22, 2004Nov 25, 2004Rastegar Jahangir S.Implantable counterpulsation cardiac assist deviceUS20060030746 *Aug 9, 2004Feb 9, 2006Marius GrossmannLinear blood pumpUS20090118568 *Dec 24, 2008May 7, 2009Pptt LlcImplantable counterpulsation cardiac assist deviceUS20110015732 *Mar 22, 2009Jan 20, 2011Sun Medical Technology Research CorporationAuxiliary artificial heart pump drive device and auxiliary artifical heart systemUS20110144744 *Dec 3, 2010Jun 16, 2011Richard WamplerTotal artificial heartCN101518661BApr 3, 2009Feb 27, 2013北京工业大学Ventricle auxiliary system based on physiological signalEP1417979A2Aug 3, 2000May 12, 2004Marono Juan Manuel GiambrunoOrthotopic total artificial heartEP1485617A1 *Feb 4, 2003Dec 15, 2004Terumo Cardiovascular Systems CorporationDynamic brake with backlash control for peristaltic pumpEP1485617A4 *Feb 4, 2003Mar 8, 2006Terumo Cardiovascular SysDynamic brake with backlash control for peristaltic pumpWO2011069109A2 *Dec 3, 2010Jun 9, 2011Richard WamplerTotal artificial heartWO2011069109A3 *Dec 3, 2010Nov 17, 2011Richard WamplerTotal artificial heart* Cited by examinerClassifications U.S. Classification623/3.28, 600/16, 623/3.3International ClassificationF04B43/09, A61M1/10, F04B49/06Cooperative ClassificationF04B2203/0209, F04B43/09, F04B2201/0202, A61M1/1086, F04B49/065, A61M1/1049, A61M1/1037European ClassificationF04B43/09, F04B49/06C, A61M1/10RLegal EventsDateCodeEventDescriptionApr 3, 1996ASAssignmentOwner name: PENN STATE RESEARCH FOUNDATION, THE, A PENNSYLVANIFree format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:SNYDER, ALAN J.;REEL/FRAME:007874/0867Effective date: 19960129Jul 15, 1996ASAssignmentOwner name: NATIONAL INSTITUTES OF HEALTH, THE, MARYLANDFree format text: CONFIRMATORY LICENSE;ASSIGNOR:PENNSYLVANIA STATE UNIVERSITY, THE;REEL/FRAME:008034/0819Effective date: 19960603Aug 18, 1998CCCertificate of correctionFeb 27, 2001FPAYFee paymentYear of fee payment: 4Dec 16, 2003CCCertificate of correctionMar 23, 2005FPAYFee paymentYear of fee payment: 8Feb 23, 2009FPAYFee paymentYear of fee payment: 12RotateOriginal ImageGoogle Home - Sitemap - USPTO Bulk Downloads - Privacy Policy - Terms of Service - About Google Patents - Send FeedbackData provided by IFI CLAIMS Patent Services

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Re: I think you should update this for the latest thinking...Jovan Popovic19-Apr-12 4:31 Re: I think you should update this for the latest thinking...Sacha Barber19-Apr-12 6:01 Great! [modified]lily3319-Apr-12 3:17 Good explanation, thanks!
My vote of 5manoj kumar choubey29-Feb-12 18:11 My vote of 5Anurag Gandhi28-Feb-12 18:50 My vote of 5HoyaSaxa9328-Feb-12 3:46 My vote of 5member6027-Feb-12 21:53 My vote of 5RogerDW27-Feb-12 20:19 Re: My vote of 5Jovan Popovic27-Feb-12 21:45 Any benchmarking for performance?LikesToSki26-Oct-11 3:51 Last Visit: 31-Dec-99 18:00 Last Update: 7-Dec-13 8:19Refresh« Prev12345 Next »
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8 Chapel street, Llandudno, LL30 2SY, United Kingdom – Excellent location - show map
Lock in a great price for Hafan-y-Mor Guesthouse - rated 9.5 by recent guests.
Very friendly, helpful staff, nice,clean and cosy place for a short stay. Small but modern bathroom.
This property is 4 minutes walk from the beach. Situated a 5-minute walk from Llandudno’s North Shore and a 10-minute walk from the West Shore, Hafan-y-Mor Guesthouse provides en suite accommodation in the centre of the Victorian town. With free Wi-Fi, Hafan-y-Mor is just a 15 drive from scenic hikes in the coastal Mynydd y Dref Hills.
Hafan-y-Mor Guesthouse has been welcoming Booking.com guests since 3 Apr 2012.
Room facilities: Radio, Seating Area, Free toiletries, DVD Player, CD Player, Toilet, Bathroom, Heating, Carpeted, Flat-screen TV, Electric kettle, Wardrobe/Closet
Room facilities: Shower, Hairdryer, Radio, Seating Area, Free toiletries, DVD Player, CD Player, Toilet, Patio, Bathroom, Heating, Carpeted, Flat-screen TV, Alarm clock, Electric kettle, Wardrobe/Closet, City view, Outdoor furniture, Toilet paper
Room facilities: Shower, Hairdryer, Radio, Seating Area, Free toiletries, DVD Player, CD Player, Toilet, Heating, Carpeted, Flat-screen TV, Electric kettle, Wardrobe/Closet, Upper floors accessible by stairs only
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Baron Hill Golf Club 11.4 miles
Facilities of Hafan-y-Mor Guesthouse Great facilities! Review score, 9.2
See the 30 best B&Bs and inns in Llandudno, based on 20,836 verified B&B and inn reviews on Booking.com.
All reviewers Families (19) Couples (48) Groups of friends (9) All review scores Superb: 9+ (62) Good: 7 – 9 (14) Okay: 5 – 7 (0) Poor: 3 – 5 (0) Very poor: 1 – 3 (0)
5-star hotel 9.0 Superb 430 reviews
4 stars 8.2 Very good 1,025 reviews
8.8 “Everywhere was very clean. Soya milk was provided without any fuss & as a bonus soya yoghurt was also provided.”
9.6 “very good breakfast..we were on the top floor,,nearly needed oxygen”
9.6 “Friendliness and helpful.food was well cooked and no waiting .close to the centre of town,didn't need to use the car.”
10 “A really lovely guest house in the heart of Llandudno. Beautiful and very comfortable room and a very welcoming host. The breakfast was excellent and plentiful with fresh local produce. We look forward to staying again very soon. Thanks!”
9.2 “Felt like a traditional guesthouse with modern comfortable rooms”
10 “The owners were a lovely couple, very friendly and the breakfast was really good quality produce, ie bacon and sausages”
10 “This Little guesthouse situated in the middle of Llandudno lived up to our expectations and more. Our room was excellent, cleaning perfect, bed comfortable and the breakfast immense! Richard and Mair were super friendly people, we will definitely stay here again.”
10 “staff were polite,comfy beds,variety of breakfasts,close to town,had two televisions one in our room other in the childrens, en suite with clean towels.”
10 “We were made very welcome and would definitely go again. Mair and Richard were lovely host”
9.6 “Very friendly, helpful staff, nice,clean and cosy place for a short stay. Small but modern bathroom.”
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“A Little Gem in the Heart of Llandudno”
눇A really lovely guest house in the heart of Llandudno. Beautiful and very comfortable room and a very welcoming host. The breakfast was excellent and plentiful with fresh local produce. We look forward to staying again very soon. Thanks!
“Great friendly modern guest house”
눇Felt like a traditional guesthouse with modern comfortable rooms
눇The owners were a lovely couple, very friendly and the breakfast was really good quality produce, ie bacon and sausages
“Felt fantastic in this excellent place run by friendly and service-minded peple”
눉If there is anything negative to say, if you're plus size like me the shower was not very large.
눇This Little guesthouse situated in the middle of Llandudno lived up to our expectations and more. Our room was excellent, cleaning perfect, bed comfortable and the breakfast immense! Richard and Mair were super friendly people, we will definitely stay here again.
눇staff were polite,comfy beds,variety of breakfasts,close to town,had two televisions one in our room other in the childrens, en suite with clean towels.
눇We were made very welcome and would definitely go again. Mair and Richard were lovely host
296529,298984|3,289769,298945,298079,298664,299793,276494,300237,296105,278901,291469,293631,298502,298273,294402|1,285927,298653,296048,294452,296001,286043,298536,299828,276486,299796|1,298366,281314,296978,296485,274013,284776,287532,295885,298733,297410,295666,298984,263851,298694,299980|1,289913,295973,297196,298644,288822|2,294402,265547|1,294427,292359,298455,293136,296696,295969,276088,296481,279725,299067,291129,299415,298921,287512|1,292689,299796,297397,290695,298702,294434,288822,289497,297712,299431,300210,298373,288995,296026,258972,298959,297431,288961,293089,297166,296520,296031,299050,299980,269862,298500,288308,279817,295599,292093,290005,293261,297824,287512|4,298925,288822|1,291703,298921|2,295134,265547,296696|1,289504,295115,289943,298268,296120|1,291851,298364,287512|8,299646,299198,299243,293629,293904,290583,287401,295958,298301,299887,289974,297776,298090,291052,299183,296022,287512,292689|1,244517,291385,286043|2,291448,299167,296111,294525,299165,292609,296178,297745,292197,296350,295939,294377,296120,297871,280104,296460,299905,294102

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Chocolate treats - Review of Bubo Barcelona Cafe, Abu Dhabi, United Arab Emirates - TripAdvisor
Chocolate treats - Bubo Barcelona Cafe
Review of Bubo Barcelona Cafe
Ranked #538 of 2,658 Restaurants in Abu Dhabi
Description: BUBÓ concept gathers together nouvelle cuisine, avant-garde pastry shops, the talent of chef Carles Mampel and the chocolate factory. Its reason to be is offering an innovative product, always of the highest quality. To achieve this, we use the best ingredients, an exclusive design, not only in our products but also in the packaging, and a unique shop image. Bubo Barcelona Café is a member of the prestigious Relais Desserts, which brings together the best pastry shops around the world. In 2005 the pastry chef Carles Mampel and the interior design studio Grumax, opened the first Bubó store in Spain. Bubó has 3 stores and 1 restaurant in Barcelona and this year will open new store in Japan. Now offering delicious creations of Bubo Barcelona Café, which just opened its doors in Abu Dhabi, Khalifa City A and in Dubai, City Walk 2. Visit Bubó Barcelona Cafe to enjoy delicious selection of artisan pastries, bakery and fantastic sweets selection. Do not miss the opportunity to test the famous Spanish dishes created and prepared by Spanish chef and his team such as tapas (citrus marinated mussels, Spanish omelette, Grilled prawns with garlic mousseline and lemon confit...) or main curses (paella or Beef Tenderloin with tonka catalan cream, glazed shallots and cocoa bean...) serve with wide selection of beverages to enjoy at breakfast, lunch or dinner.
If you love chocolate you definitely need to visit.
They may be small, but they are the most exquisite hand made chocolates I have ever tasted.
I just go here for a 3 chocolates and an expresso
and I’m in heaven .
Ask suewhitehouse67 about Bubo Barcelona Cafe
it was an nice experience at bubo barcelona cafe .Abudhabi ..i strongly recommended place in Abudhabi for Spanish food ... i am sure that no one will get an bad experience from this place...Staffs are so friendly and they have good knowledge about their product especially mr,yousuf.... Thanks all of u and i will be visiting again...
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The value of pelvic lymphadenectomy in the surgical treatment of bl... - PubMed - NCBI
Display Settings:AbstractFormatSummarySummary (text)AbstractAbstract (text)MEDLINEXMLPMID ListApplySend to:Choose DestinationFileClipboardCollectionsE-mailOrderMy BibliographyCitation managerFormatSummary (text)Abstract (text)MEDLINEXMLPMID ListCSVCreate File1 selected item: 4692375FormatSummarySummary (text)AbstractAbstract (text)MEDLINEXMLPMID ListMeSH and Other DataE-mailSubjectAdditional textE-mailDidn't get the message? Find out why...Add to ClipboardAdd to CollectionsOrder articlesAdd to My BibliographyGenerate a file for use with external citation management software.Create File
See comment in PubMed Commons belowJ Urol. 1973 Mar;109(3):414-6.The value of pelvic lymphadenectomy in the surgical treatment of bladder cancer.Dretler SP, Ragsdale BD, Leadbetter WF.PMID: 4692375 [PubMed - indexed for MEDLINE] ShareMeSH TermsMeSH TermsAdenocarcinoma/mortalityAdenocarcinoma/surgery*Carcinoma, Squamous Cell/mortalityCarcinoma, Squamous Cell/surgery*Carcinoma, Transitional Cell/mortalityCarcinoma, Transitional Cell/surgery*HumansLymph Node Excision*Lymphatic MetastasisPelvisUrinary Bladder Neoplasms/mortalityUrinary Bladder Neoplasms/surgery*LinkOut - more resourcesMedicalBladder cancer - Genetic AllianceBladder Cancer - MedlinePlus Health InformationPubMed Commons home

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text: I just gave up after three hours--I couldn't listen to any more of the author's self-important spiel. This was one of the most unsympathetic narrators/protagonists I have ever come across. I hoped this would be funny and a voyeuristic peek into the professional world of cooking but it turned out to be mean-spirited and boring. What a jerk...and an awful writer.

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13, 2012Itron, Inc.Endpoint classification and command processingUS8417264May 14, 2009Apr 9, 2013Spring Spectrum L.P.Method and apparatus for determining location of a mobile station based on locations of multiple nearby mobile stationsUS8436744Jan 29, 2009May 7, 2013Itron, Inc.Prioritized collection of meter readingsUS8730056Nov 11, 2008May 20, 2014Itron, Inc.System and method of high volume import, validation and estimation of meter dataUS8749378 *Apr 7, 2006Jun 10, 2014National University Of SingaporeSystem and method for searching physical objectsUS20090128302 *Apr 7, 2006May 21, 2009Vikram SrinivasanSystem and Method for Searching Physical ObjectsUS20100026517 *Jul 1, 2009Feb 4, 2010Itron, Inc.Utility data collection and reconfigurations in a utility metering systemUS20100188260 *Jun 11, 2009Jul 29, 2010Itron, Inc.Endpoint classification and command processingUS20100265095 *Apr 20, 2009Oct 21, 2010Itron, Inc.Endpoint classification and command processingCN101187987BNov 22, 2007Jun 2, 2010富士通株式会社Information access system, reader/writer device, and active-type contactless information storage deviceDE10357023A1 *Dec 3, 2003Jul 14, 2005GOSCH, J�rgenLost object location system uses passive object markers with standard protocol link through transmission units to recognition unitsEP1866665A1 *Apr 7, 2006Dec 19, 2007National University of SingaporeA system and method for searching physical objectsWO2006107282A1Apr 7, 2006Oct 12, 2006Univ SingaporeA system and method for searching physical objects* Cited by examinerClassifications U.S. Classification340/8.1, 340/569, 342/419, 340/10.31International ClassificationG01S19/46, G01S5/14, G01S13/79, G01S13/87, G01S13/76, G01S13/75, H04Q7/34, G01S5/00Cooperative ClassificationG01S5/0081, G01S13/878, G01S5/14European ClassificationG01S13/87E, G01S5/14, G01S5/00R4Legal EventsDateCodeEventDescriptionJan 22, 2008FPExpired due to failure to pay maintenance feeEffective date: 20071202Dec 2, 2007LAPSLapse for failure to pay maintenance feesJun 18, 2007REMIMaintenance fee reminder mailedAug 29, 2003ASAssignmentOwner name: KONINKLIJKE PHILIPS ELECTRONICS N.V., NETHERLANDSFree format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:U.S. PHILIPS CORPORATION;REEL/FRAME:014434/0382Effective date: 20030811Owner name: KONINKLIJKE PHILIPS ELECTRONICS N.V. GROENEWOUDSEWAug 2, 2000ASAssignmentOwner name: U.S. PHILIPS CORPORATION, NEW YORKFree format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:AVERY, DAVID M.;REEL/FRAME:011112/0582Effective date: 20000713RotateOriginal ImageGoogle Home - Sitemap - USPTO Bulk Downloads - Privacy Policy - Terms of Service - About Google Patents - Send FeedbackData provided by IFI CLAIMS Patent Services


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Category talk:1994 establishments in New Zealand - Wikipedia
Category talk:1994 establishments in New Zealand
Retrieved from "https://en.wikipedia.org/w/index.php?title=Category_talk:1994_establishments_in_New_Zealand&oldid=742779415"
This page was last edited on 5 October 2016, at 18:57.

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Words containing gadocios | Words that contain gadocios
http://www.thefreedictionary.com/words-containing-gadocios
Dictionary, Encyclopedia and Thesaurus - The Free Dictionary 10,202,990,507 visitors served
Words containing gadocios
Found 1 words containing gadocios. Browse our Scrabble Word Finder, Words With Friends cheat dictionary, and WordHub word solver to find words that contain gadocios. Or use our Unscramble word solver to find your best possible play! Related: Words that end in gadocios
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[Light therapy in 3 children with winter depression]. - PubMed - NCBI
Format: AbstractFormatSummarySummary (text)AbstractAbstract (text)MEDLINEXMLPMID ListApplySend toChoose DestinationFileClipboardCollectionsE-mailOrderMy BibliographyCitation managerFormatSummary (text)Abstract (text)MEDLINEXMLPMID ListCSVCreate File1 selected item: 8569869FormatSummarySummary (text)AbstractAbstract (text)MEDLINEXMLPMID ListMeSH and Other DataE-mailSubjectAdditional textE-mailDidn't get the message? Find out why...Add to ClipboardAdd to CollectionsOrder articlesAdd to My BibliographyGenerate a file for use with external citation management software.Create File
See comment in PubMed Commons belowNed Tijdschr Geneeskd. 1995 Dec 23;139(51):2664-6.[Light therapy in 3 children with winter depression]. [Article in Dutch]Meesters Y1.Author information1Academisch Ziekenhuis, afd. Biologische Psychiatrie, Groningen.AbstractIn three children, boys of 5 and 13 years old and a girl aged 10, seasonal affective disorder was diagnosed based on mood changes (listlessness, fears) and increased sleepiness in the winter season. They were treated successfully with light therapy (5 consecutive days 30 min 10,000 lux of full spectrum light without ultraviolet). In two patients the disorder recurred in the fall/winter the year(s) thereafter, and they were again treated successfully.PMID: 8569869 [Indexed for MEDLINE] SharePublication types, MeSH termsPublication typesCase ReportsEnglish AbstractMeSH termsAdolescentChildChild, PreschoolDepression/diagnosisDepression/etiologyDepression/therapy*FemaleHumansMaleMedical History TakingPhototherapy/methods*Seasons*LinkOut - more resourcesMedicalDepression - Genetic AllianceDepression - MedlinePlus Health InformationPubMed Commons home


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Raider Power MailbagJarret Johnson05/06/2016RaiderPower.com senior writer Joe Yeager, reporter Alyssa Chrisope and publisher Jarret Johnson answer questions from subscribers about Texas Tech football, basketball, baseball and recruiting.Topics discussed this week in the Mailbag include: Kingsbury the disciplinarian
Impact of Steele and Akamnonu?
Basketball attrition Big 12 expansion
Best meal in last month
Share on Facebook Share on TwitterTrending on ScoutRobinson Announces for Mississippi StateVideo: 5-star QB Fields works at UF's FNLUnder Armour Camp: Friday notesTexas Lands 2019 4-Star QB PledgeDickerson believes Rams should start MannionInside the Red Raiders Top StoriesHakeem White Talks Texas Tech CommitmentWaco Midway offensive lineman Hakeem White discusses his decision to commit to Texas Tech.by Zach TannerInside the Red RaidersYesterday at 11:39 AMKesean Carter Talks Texas Tech CommitmentThe Woodlands prolific receiver and Texas UIL Class 6A 100 meter state champ Kesean Carter discusses his decision to commit to Texas Tech.by Zach TannerInside the Red RaidersWednesday at 6:30 AMJah'Shawn Johnson Yells BingoTexas Tech safety Jah'Shawn Johnson got creative during Big 12 Media Day on Monday.by Jarret JohnsonInside the Red RaidersMonday at 1:38 PMKingsbury Presser at Big 12 Media DayTexas Tech head coach Kliff Kingsbury answered questions from gathered media Monday at Big 12 Media Day.by Jarret JohnsonInside the Red RaidersMonday at 10:14 AMRecruiting Scoop: July VisitorsInside the Red Raiders reporter Zach Tanner and publisher Jarret Johnson discuss which recruits are expected to visit Texas Tech this month and what type of impact they could have…by Jarret JohnsonInside the Red Raiders07/15/2017Critical 20: No. 10 D.J. Polite-BraySenior writer Joe Yeager ranks the 20 most critical players on Texas Tech's roster heading into the 2017 season. Next up is senior defensive back D.J. Polite-Bray.by StaffInside the Red Raiders07/14/2017Insider Mailbag: How Many TD's for Coutee?Senior writer Joe Yeager and publisher Jarret Johnson answer questions from subscribers about Texas Tech football, basketball, baseball and recruiting.by Jarret JohnsonInside the Red Raiders07/14/2017Exclusive Interview with Kliff KingsburyInside the Red Raiders caught up with Texas Tech football coach Kliff Kingsbury regarding recent facility improvements, the upcoming season, what happened last season, injury…by Jarret JohnsonInside the Red Raiders07/11/2017Video: Texas Tech Unveils New Locker RoomTexas Tech unveiled its sparkling new football locker room Monday night and Inside the Red Raiders was there to shoot some video of the new digs.by Jarret JohnsonInside the Red Raiders07/10/2017Cam Batson is Winning On and Off the FieldTexas Tech starting inside receiver and punt returner Cameron Batson defended his title as the fastest man on the team this offseason and will graduate with honors in August.by Jarret JohnsonInside the Red RaidersMonday at 3:46 PMDecision Coming Soon for LB Cameron WilkinsInside the Red Raiders caught up with Del Valle (TX) standout Cameron Wilkins for an update on where he stands with Texas Tech and his overall recruitment. Is Texas Tech in the mix…by Zach TannerInside the Red Raiders07/14/2017Top Five Recruits of the Kingsbury EraThe following is the third story in a series previewing Year 5 of the Kliff Kingsbury era at Texas Tech in which Inside The Red Raiders will rank five Top 5 aspects of the football…by Jarret JohnsonInside the Red Raiders07/12/2017Load More

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Pizza Man At Connie's - Hudson, NH | Groupon
All Deals 5397 Automotive 70 Beauty & Spas 224 Food & Drink 231 Health & Fitness 250 Home Services 39
Meal Prep & Wine Delivery 127 Online Learning 91 Personal Services 1161 Personalized Items 1703 Retail 2448 Things To Do 349
Pizza Man At Connie's
+16035779866
Whether you prefer sausage, 'roni, or all-around veggie, Pizza Man's easy-to-please pizza has fans dishing out top-notch ratings for this Hudson joint. For food the whole family can enjoy, check out the pizzeria's pizza options and pasta choices. The healthy menu items at Pizza Man will leave you with a full stomach. Complete your meal with the perfect glass of wine or beer from this pizzeria's drink list. Tots are more than welcome to dine with their parents at this pizzeria. Access the Internet free of charge via Pizza Man's complimentary wifi. Pizza Man caters to all party sizes, both large and small.
Be sure to make reservations so you can get seated right away. Jeans are just right for a meal at Pizza Man, which embraces a casual vibe. This pizzeria will deliver their delicious dishes right to your door, or you can stop in and pick up some great takeout.
The parking lot near Pizza Man will have you in and out in a jiffy. If your preferred mode of transit is of the two wheel variety, you're in luck ? there's tons of bike parking outside the pizzeria.
Most items on the menu are reasonably priced, so expect to spend around $30 per person at Pizza Man. Convenience is essential at Pizza Man, and food is served from morning until night. Roni, sausage, and veggie are just a few of the delicious options at Pizza Man. Taste the shining reviews for yourself when you head to Pizza Man for a tasty pizza pie.
Prosciuttos Pizza
Goffes Falls (3.8 mi)
Southeast Manchester (4.5 mi)
Londonderry (4.5 mi)
Groupon has verified that the customer actually visited Pizza Man At Connie's.

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Tylomelania wallacei - Wikipedia
Tylomelania wallacei
An apertural view of a shell of Tylomelania wallacei.
Species: T. wallacei
(Reeve, 1860)
Melania perfecta var. wallacei Reeve, 1860
Tylomelania wallacei is a species of freshwater snail with an operculum, an aquatic gastropod mollusk in the family Pachychilidae.
This species occurs in Maros karst, Sulawesi, Indonesia.[2]
Tylomelania wallacei is a riverine species.[2]
^ The IUCN Red List of Threatened Species. Version 2014.1. <www.iucnredlist.org>. Downloaded on 05 July 2014.
(in German) Sarasin P. & Sarasin F. (1898). Die Süßwassermollusken von Celebes. Band 1. In: Sarasin P. & Sarasin F. (1898–1901). Materialien zur Naturgeschichte der Insel Celebes. Kreidel's Verlag, Wiesbaden. 26-27, table 3, figure 27; tab. 5, fig. 68; tab. 6, fig. 93.
Wikidata: Q18355481
NCBI: 246332
Retrieved from "https://en.wikipedia.org/w/index.php?title=Tylomelania_wallacei&oldid=835791983"
Gastropods described in 1860


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Chloe Donato on Scribd | Scribd
UploadLog InSign upBrowseBooksBiographyBusinessCookbooks & FoodFiction & LiteratureHistoryHobbies, Crafts, & HomeKids & TeensMysteryReligionRomanceScience FictionOther ContentBrochuresCourt FilingsCreative WritingLegal formsInstruction manualsMapsGraphic ArtPresentationsRecipes/MenusSchool WorkChloe Donato912followers763followingSee MoreSee lessScribd SelectsA Sport and a PastimeJames SalterWhen We Danced on Water: A NovelEvan FallenbergOn CatsDoris LessingAsk the DustJohn FantePretty Little MistakesHeather McelhattonAstonishing Splashes of ColourClare MorrallBeetRoger RosenblattOn the RunDavid DibenedettoLeaving Unknown: A NovelKerry ReichsWaiting for Sunrise: A NovelWilliam BoydStuck in Downward DogChantel GuertinThe Professor and the MadmanSimon Winchester97 Orchard: An Edible History of Five Immigrant Families ...Jane ZiegelmanThe Ice PalaceTarjei VesaasThe House on First StreetJulia ReedMrs. Darcy and the Blue-Eyed StrangerLee SmithLetters to the End of LoveYvette WalkerLet the Northern Lights Erase Your NameVendela VidaTubes: A Journey to the Center of the InternetAndrew BlumBounce: Mozart, Federer, Picasso, Beckham, and the Scienc...Matthew SyedFooling Houdini: Magicians, Mentalists, Math Geeks, and t...Alex StoneKitchen Chinese: A Novel About Food, Family, and Finding ...Ann MahConquest of the Useless: Reflections from the Making of F...Werner HerzogShakespeareBill BrysonDreamlandKevin BakerBright Shiny MorningJames FreyUnbelievable: Investigations into Ghosts, Poltergeists, T...Stacy HornThe Taste of Tomorrow: Dispatches from the Future of FoodJosh SchonwaldFive Days Apart: A NovelChris BinchyAll Aunt Hagar's ChildrenEdward P. JonesTales of the CityArmistead MaupinThe Natural History of UnicornsChris LaversThe Loneliness of the Long Distance Book RunnerBill ReesThe Curious Death of Peter Artedi: A Mystery in the Histo...Theodore W. PietschSolitude; Seeking Wisdom in Extremes — A Year Alone in th...Robert KullThe Darling NorthAnne KennedyThe DissidentNell FreudenbergerContinental DriftRussell BanksThe Scent of Lemon LeavesClara SanchezBeing Wrong: Adventures in the Margin of ErrorKathryn SchulzGame Change: Obama and the Clintons, McCain and Palin, an...Mark HalperinThe Future of Love: A NovelShirley AbbottChange by DesignTim BrownThe Sheltering SkyPaul BowlesThe TreeJohn FowlesThe Bronze HorsemanPaullina SimonsUnless: A NovelCarol ShieldsGirlfriend in a ComaDouglas CouplandThe Sisters BrothersPatrick deWittBlue AngelFrancine ProseDomestic VioletsMatthew NormanBlue White Red: A NovelAlain MabanckouThe Man Who RainedAli ShawGods and MonstersChristopher BramShort MoneyPete HautmanIt’s a Long Road to a Tomato: Tales of an Organic Farmer ...Keith StewartAboutBrowseAbout ScribdTeamBlogJoin our team!Contact UsSubscriptionsSubscribe todayYour subscriptionGift cardsAdvertise with usGet startedAdChoicesSupportHelpFAQPressPurchase HelpPartnersPublishersDevelopers / APILegalTermsPrivacyCopyrightGet Scribd MobileMobile Site© Copyright 2014 Scribd Inc.Language:Choose the language in which you want to experience Scribd:English中文EspañolالعربيةPortuguês日本語DeutschFrançaisTurkceРусский языкTiếng việtJęzyk polskiBahasa indonesia

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text:
Isabel de Meiroz Dias - Semantic Scholar
José Vílton Da Costa5
J. Scheidler5
Stefan Carlsson5
Pantaleo Greco5
Giuseppe Loverro5
5Mary K O'Boyle
5Katy Vincent
5K E Webster
5N. Sangeeta Meena
5Nancy E Budorick
Transvaginal ultrasonography and hysteroscopy in postmenopausal bleeding: a prospective study.
Rita G Sousa, M J Silvestre, +5 authors Henrique M. Oliveira
OBJECTIVE To determine the diagnostic value of transvaginal ultrasonography and hysteroscopy in patients with postmenopausal bleeding. MATERIAL AND METHODS Between January 1, 1998 and June 30,… (More)
Endometrioid adenocarcinoma arising in endometriosis foci six years after estrogen replacement therapy: a case report.
Ana Luísa Areia, Vitor Sousa, Cristina Frutuoso, Isabel de Meiroz Dias, Maria Irene Martins, Carlos Freire de Oliveira
We present a case of a 53-year-old woman who developed an endometrioid adenocarcinoma six years after total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO), who was on… (More)
Paraovarian tumor of borderline malignancy--a case report.
A L F A De Areia, Cristina Frutuoso, Natália Amaral, Isabel de Meiroz Dias, Carlos Alexandre Ferreira de Oliveira
A case of a 23-year-old woman with a paraovarian tumor is presented. The patient complained of pelvic pain and abdominal swelling. Cystectomy was the initial surgical treatment, but after the… (More)
Isabel Maia, Sónia Xará, Isabel de Meiroz Dias, Bárbara Parente, Teresa Freitas Amaral
Undernutrition is associated with worse clinical outcomes and so screening is recommended. Given the paucity of information on nutritional status and on the clinical impact of undernutrition in… (More)
[Comparison of coronary arteriosclerosis in patients with myocardial infarction and angina pectoris].
Waldomiro Carlos Manfroi, Alcides José Zago, +8 authors Isabel de Meiroz Dias
PURPOSE To compare the severity of the coronary heart disease and the presence of coronary risk factors between angina and myocardial infarction (MI) patients. METHODS We studied 62 patients with… (More)
Creation of a Neovagina by Laparoscopic Modified Vecchietti Technique: Anatomic and Functional Results.
Eduardo V P Baptista, Giselda Marisa Costa Carvalho, Carlos Nobre, Isabel de Meiroz Dias, Isabel Torgal
Purpose To evaluate the anatomic and functional results of a laparoscopic modified Vecchietti technique for the creation of a neovagina in patients with congenital vaginal aplasia. Methods… (More)
Methodology For Web Presence Strategy Formulation: A Case Study
Isabel de Meiroz Dias, Nicolau Reinhard
The objective of this research was to identify how a specific methodology of strategy formulation for the Internet addresses the Business Model concept. We see the Business Model concept as a basis… (More)
Ana Patrícia Rodrigues Domingues, Helena Lopes, Isabel de Meiroz Dias, Carlos Freire de Oliveira
The malignancy risk of endometrial polyps in postmenopausal women was correlated with the presence or absence of abnormal uterine bleeding. Of 481 postmenopausal women who presented with endometrial… (More)
Acromesomelic dwarfism: a new variation.
F G Ferraz, Pierre Maroteaux, +5 authors Luis Gil Santos
The rate skeletal disorder, acromesomelic dwarfism, is characterized by short stature and short limbs. Bone dysplasia is evident. We report two cases of a variation of this disorder in a Portuguese… (More)
Creation of a Neovagina by Laparoscopic

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Venin Abyss 1 Türkçe | eBay Please enable JavaScript Our new search experience requires JavaScript to be enabled. Please enable JavaScript on your browser, then try again.
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Klotten Map and Hotels in Klotten Area – Klotten
When do you want to go to Klotten?
Weinhotel Hubertus...Rooms per night as low as USD 127Hotel Zur Post...Rooms per night as low as USD 135Hotel-Restaurant-Weingut KapellenhofVery nice personal approach; they really go the extra mile to make you feel welcome. Rooms nice and well equiped...Rooms per night as low as USD 1101 ReviewsHotel Zur LindeA lovely place right across from the Mosel, with free parking. Convenient to Cochem and to Burg Eltz. Modern and comfortable....Rooms per night as low as USD 119Hotel-Pension DorfschänkeThe rooms were spotlessly clean and modern, breakfast good, and restaurant menu ample, ( try the spare ribs they are delicious) the couple who run the...Rooms per night as low as USD 165Zum Achten HimmelThe hosts were very friendly and welcoming. We enjoyed meeting them. The also made an excellent dinner recommendation (Zur Post) in Klotten. The beds ...Rooms per night as low as USD 102Ferienwohnung AmbientePerfectly furnished appartment including all kitchen utensils, comfy beds, pleasent terrace, very nice owners and attractive surroundings with many ac...Rooms per night as low as USD 138Gasthaus / Pension MosellaVery cozy and family place.
Our dogs felt very welcome....Rooms per night as low as Geary FerienwohnungWe had all we need it, clean and confortable. Nice place to know the region....Rooms per night as low as Weinhaus ThomasThe room was really comfortable and immaculately clean. Bathroom compact but with good quality sink etc and a good supply of towels. Breakfast was exc...Rooms per night as low as Haus Legler...Rooms per night as low as Haus Mosel...Rooms per night as low as Appartement Haus AlberichGreat location, pleasant owners, clean and tidy appartment...Rooms per night as low as Gasthaus Castor...Rooms per night as low as View another area?
In and around Klotten Restaurants and Cafes
Klotten is one of Klotten's most visited destinations. With a wide number of attractions to discover, this sought-after part of town will not cease to amaze you. Klotten has a lot to offer: famous sites, great restaurants and a range of exciting entertainment. Plan your next trip in Klotten or any other area in Klotten with agoda.com, guaranteeing the best possible rate available. Explore a full list of accommodations and find the perfect place for you. To locate the best hotel deals in Klotten, simply fill your travel dates in the search box.
Featured Hotels in Klotten, Klotten Best seller – limited supply!
Area: Klotten
This family-run hotel enjoys a quiet location in the centre of the wine-producing town of Klotten,...
Offering a terrace with scenic views of the River Moselle, traditional food from the...
Very nice personal approach; they really go the extra mile to make you feel welcome. Rooms nice and well equiped.
Agnes, Netherlands January 17, 2017 Hotel Zur Linde
Razreader, United States January 17, 2017 Hotel-Pension Dorfschänke
The rooms were spotlessly clean and modern, breakfast good, and restaurant menu ample, ( try the spare ribs they are delicious) the couple who run...
Barbara, United Kingdom January 17, 2017 Zum Achten Himmel
The hosts were very friendly and welcoming. We enjoyed meeting them. The also made an excellent dinner recommendation (Zur Post) in Klotten. The...
James, Germany January 17, 2017 Ferienwohnung Ambiente
Perfectly furnished appartment including all kitchen utensils, comfy beds, pleasent terrace, very nice owners and attractive surroundings with many...
Anonymous, Czech Republic January 17, 2017 Gasthaus / Pension Mosella
Vinícius, Germany January 17, 2017 Geary Ferienwohnung
David, Spain January 17, 2017 Weinhaus Thomas
The room was really comfortable and immaculately clean. Bathroom compact but with good quality sink etc and a good supply of towels. Breakfast was...
Peter, France January 17, 2017 Haus Legler
Haus Legler offers 3 holiday apartments and is located directly on the River Moselle in the...
Featuring free WiFi throughout the property, Haus Mosel offers pet-friendly accommodation in...
Great location, pleasant owners, clean and tidy appartment.
Rima, Lithuania January 17, 2017 Gasthaus Castor
See all hotels in Klotten
Hotels in Klotten: Appartement Haus AlberichFerienwohnung AmbienteGasthaus / Pension MosellaGasthaus Castor
Geary FerienwohnungHaus LeglerHaus MoselHotel Zur Linde
Hotel Zur PostHotel-Pension DorfschänkeHotel-Restaurant-Weingut Kapellenhof
Places of Interest in Klotten: Da Giovanni PizzeriaGaststatte Zur Linde

value: This website is a Singaporean online travel agency and metasearch engine for hotels, vacation rentals, flights, and airport transfer. It is owned by Agoda Company Pte.