Apparatus and method for dynamic vertebral stabilization
A posterior vertebral stabilizer has a resilient member such as a linear spring, which operates in tension and compression. The resilient member may be kept straight by a stabilization rod extending through the spring, or by a telescoping assembly that encases the resilient member. The ends of the stabilizer are attachable to pedicles of adjacent vertebrae so that the stabilizer adds stiffness to control flexion and extension of the vertebrae. Two such stabilizers may be used, and may be connected together by a crosslink designed to limit relative rotation of the stabilizers. Thus, the stabilizers may restrict axial rotation and lateral bending between the vertebrae, while permitting stiffened flexion and extension. Such stabilizers help provide the stiffness of a healthy intervertebral disc. In the event that fusion of the joint becomes necessary, a set screw or other component may be used to further restrict flexion and extension.
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This application is a continuation of U.S. application Ser. No. 14/640,490, filed on Mar. 6, 2015 and now U.S. Pat. No. 9,486,244, which is a continuation of U.S. application Ser. No. 12/560,776, filed on Sep. 16, 2009 and now U.S. Pat. No. 8,974,499, which is a divisional of U.S. application Ser. No. 11/087,434, filed on Mar. 22, 2005 and now U.S. Pat. No. 7,604,654, which claims the benefit of the filing date of U.S. Provisional Patent Application No. 60/655,298, filed Feb. 22, 2005, the disclosures of which are hereby incorporated herein by reference.BACKGROUND OF THE INVENTION
The present invention relates generally to orthopedic medicine, and more precisely, to systems and methods for restricting relative motion between vertebrae.BRIEF SUMMARY OF THE INVENTION
Many people experience back pain. Back pain is not only uncomfortable, but can be particularly debilitating. Many people who wish to participate in sports, manual labor, or even sedentary employment are unable to do so because of pains that arise from motion of or pressure on the spinal column. Such pains are often caused by traumatic, inflammatory, metabolic, synovial, neoplastic and degenerative disorders of the spine.
The intervertebral discs that separate adjacent vertebrae from each other serve to provide stiffness that helps to restrain relative motion of the vertebrae in flexion, extension, axial rotation, and lateral bending. However, a damaged disc may provide inadequate stiffness along one or more modes of spinal motion. Inadequate stiffness may result in excessive relative vertebral motion when the spine is under a given load, as when the patient uses the muscles of the back. Such excessive relative motion may cause further damage to the disc, thereby causing back pain and ultimately, requiring replacement of the disc and/or other operations to decompress nerves affected by central, lateral or foraminal stenosis.
Some stabilization devices have been proposed to restrict, but not entirely prevent, relative motion between adjacent vertebrae. Such devices are often somewhat complex and/or bulky. Many such devices cannot be tailored to limit the types of motion (i.e., flexion/extension, axial rotation, or lateral bending) that are most painful. Additionally, in the event that stabilization ultimately becomes insufficient, most known stabilization devices do not provide any mechanism that can be used to more fully secure the spinal motion segment.
Various embodiments of the present invention will now be discussed with reference to the appended drawings. It is appreciated that these drawings depict only typical embodiments of the invention and are therefore not to be considered limiting of its scope.
The present invention advances the state of the art by providing systems and methods that can be used to stabilize relative motion between two vertebrae. The present invention can be used as an alternative to spinal fusion to alleviate back pain resulting from traumatic, inflammatory, metabolic, synovial, neoplastic and degenerative spinal disorders. The configuration and operation of at least one embodiment of the invention will be shown and described in greater detail with reference to
In this application, the phrase “telescopic engagement” and variations thereof refer to two members, wherein a portion of one hollow member fits around a portion of a second member to permit relative linear motion of the two members. “Locking” of two members refers to substantially preventing relative translation or rotation between the members along at least one axis. “Generally symmetrical” refers to items that are arranged in a manner that is symmetrical or nearly symmetrical to each other, with no requirement of precise symmetry. For example, the left and right sides of the spinal column may be considered to be generally symmetrical, despite the fact that anatomical differences and asymmetries will exist between them. Two components that are “integrally formed” with each other are formed as a single piece.
As shown, the portion of the spine 10 illustrated in
As shown, the first vertebra 24 has a body 28 with a generally disc-like shape and two pedicles 30 that extend posteriorly from the body 28. A posterior arch, or lamina 32, extends between the posterior ends of the pedicles 30 to couple the pedicles 30 together. The first vertebra 24 also has a pair of transverse processes 34 that extend laterally from the pedicles 30 generally along the medial/lateral axis 20, and a spinous process 36 that extends from the lamina 32 along the posterior direction 18.
The first vertebra 24 also has a pair of superior facets 38, which are positioned toward the top of the first vertebra 24 and face generally medially. Additionally, the first vertebra 24 has inferior facets 40, which are positioned toward the bottom of the first vertebra 24 and face generally laterally. Each of the pedicles 30 of the first vertebra 24 has a saddle point 42, which is positioned generally at the center of the juncture of each superior facet 38 with the adjacent transverse process 34.
Similarly, the second vertebra 26 has a body 48 from which two pedicles 50 extend posteriorly. A posterior arch, or lamina 52, extends between the posterior ends of the pedicles 50 to couple the pedicles 50 together. The second vertebra 26 also has a pair of transverse processes 54, each of which extends from the corresponding pedicle 50 generally along the medial/lateral axis 20, and a spinous process 56 that extends from the lamina 52 along the posterior direction 18.
The second vertebra 26 also has a pair of superior facets 58, which are positioned toward the top of the second vertebra 26 and face generally inward. Additionally, the second vertebra 26 has inferior facets 60, which are positioned toward the bottom of the second vertebra 26 and face generally outward. Each of the pedicles 60 of the second vertebra 26 has a saddle point 62, which is positioned generally at the center of the juncture of each superior facet 58 with the adjacent transverse process 54.
The superior facets 38 of the first vertebra 24 articulate (i.e., slide and/or press) with the inferior facets 60 of the second vertebra 26 to limit relative motion between the first and second vertebrae 24, 26. Thus, the combination of each superior facet 38 with the adjacent inferior facet 60 provides a facet joint 64. The first and second vertebrae 24, thus define two facet joints 64 that span the distance between the first and second vertebrae 24, 26. The inferior facets 40 of the first vertebra 40 and the superior facets 58 of the second vertebra 26 are part of other facet joints that control motion between the first and second vertebrae 24, 26 and adjacent vertebrae (not shown) and/or the sacrum (also not shown). The vertebrae 24, 26 are separated from each other by an intervertebral disc 66.
As shown in
As embodied in
As shown, each apparatus 70 has a bridge 72, a stabilization rod 74 (not visible in
The remainder of the apparatus 70 is secured to the saddle points 42, 62 via the castle nuts 78. The bridge 72 spans the distance between the saddle points 42, 62 in a manner that enables relative cephalad/caudal motion with resilient support. The stabilization rod 74 is movably secured within the bridge 72 via the pins 76 to limit relative motion between the saddle points 42, 62 along the anterior direction 16, the posterior direction 18, and the medial/lateral axis 20. These functions and relationships will be described in greater detail in the discussion of
Each of the first and second ends 92, 94 has a mounting interface 100 that facilitates attachment of the first or second end 92 or 94 to the corresponding saddle point 42 or 62. Each of the first and second ends 92, 94 also has a mounting aperture 102 from which the corresponding mounting interface 100 extends. The mounting interfaces 100 and the mounting apertures 102 may each be sized to permit passage of the corresponding proximal end 84 therethrough. Moreover, the mounting interfaces 100 and mounting apertures 102 are sufficiently large that the proximal end 84 may pass therethrough at a variety of angles nonparallel to the axis of the mounting interface 100 and mounting aperture 102. Thus, the apparatus 70 accommodates spinal morphologies in which the pedicles 30, 50 are not perpendicular to the desired orientation of the bridge 72 by permitting the fixation members 80 to extend non-perpendicular to the bridge 72.
Each mounting interface 100 has a generally concave, semispherical shape that is designed to receive and compress the corresponding castle nut 78 to substantially prevent relative rotation between the bridge 72 and the corresponding fixation member 80. Therefore, the orientation of the bridge 72 with respect to the fixation members 80 may be fixed in any of a variety of orientations to accommodate differing spinal morphologies. The manner in which the castle nuts 78 cooperate with the mounting interfaces 100 will be described in greater detail subsequently.
As shown, each of the mounting interfaces 100 has an interior orifice 106 and an exterior orifice 108. The interior orifices 106 provide communication with a bore 112 of the central portion 96 of the bridge 112, and the exterior orifices 108 provide access to the interior orifices 106. Thus, the stabilization rod 74 may easily be installed in the bore 112 by inserting the stabilization rod 74 through one of the exterior orifices 108, and then through the adjacent interior orifice 106.
The central portion 96 has a pin registration slot 114 adjacent to the first end 92, and a pin registration orifice 116 adjacent to the second end 94. The pin registration slot 114 and the pin registration orifice 116 communicate with the bore 112, and are designed to receive the pins 76. More precisely, the pin registration orifice 116 receives the corresponding pin 76 such that the pin 76 is unable to move with respect to the bridge 72 along the cephalad, caudal, anterior, and posterior directions 12, 14, 16, 18. The pin registration slot 118 receives the other pin 76 such that the pin 76 is unable to move with respect to the bridge 72 along the anterior and posterior directions 16, 18, but may move along the pin registration slot 118 in the cephalad and caudal directions 12, 14.
In addition to the pin registration slot 114 and the pin registration orifice 116, the central portion 96 has a supplemental orifice 118, which may be used to carry out various functions. According to one example, a set screw (not shown in
The central portion 96 also has a resilient section 120, which may take the form of a linear spring integrally formed with the remainder of the bridge 72. The resilient section 120 permits the first and second ends 92, 94 to move toward or away from each other to enable relative cephalad/caudal motion of the saddle points 42, 62 of the vertebrae 24, 26, respectively. The resilient section 120 also provides resilient force tending to push or pull the ends 92, 94 into a relative position in which the resilient section 120 is substantially undeflected. Such a position may correspond to a spinal disposition in which the vertebrae 24, 26 are neither flexed nor extended with respect to each other.
Returning to the embodiment of
The ends 124, 126 may each be sized to fit into the bore 112 of the bridge 72 with relatively little clearance to maintain coaxiality between the bridge 72 and the stabilization rod 74. Alternatively, if desired, coaxiality may be maintained by providing relatively small clearance between the pins 76 and the pin registration slot 114 and the pin registration orifice 116. Maintaining coaxiality between the bridge 72 and the stabilization rod 74 restricts relative motion of the first and second ends 92, 94 of the bridge 72 to motion along the axis of the bridge 72, thereby permitting significant relative motion between the saddle points 42, 62 only along the cephalad and caudal directions 12, 14.
The central portion 128 has a stepped down region 136 with a diameter slightly smaller than that of the first and second ends 124, 126. Thus, clearance exists between the stepped down region 136 and the inward-facing surfaces of the resilient section 120 so that the resilient section 120 will not bind on the central portion 128 as the ends 92, 94 of the bridge 72 move together or apart.
Each of the castle nuts 78 has a torquing end 140 and a compression end 142. The torquing end 140 is designed to receive torque from a tool (not shown) with an end that meshes with the torquing end 140. The compression end 142 has a generally semispherical shape and is compressible to lock the orientation of the castle nut 78 with respect to the corresponding mounting interface 100. This permits locking of the orientation of the bridge 72 with respect to the fixation members 80 to prevent shear slippage of the vertebrae 24, 26 with respect to each other and to generally restrict relative anterior/posterior and medial/lateral motion between the vertebrae 24, 26.
Each castle nut 78 also has a bore 144 that passes through the torquing end 140 and the compression end 142. The bore 144 has threads (not shown) that mate with the threads 86 of the corresponding fixation member 80. The torquing end 140 has a plurality of crenelations 146 that enable the torquing tool (not shown) to interlock with the torquing end 140 without interfering with positioning of the proximal end 84 of the fixation member 80 in the bore 144.
The compression end 142 of each castle nut 78 has a plurality of fingers 148 arrayed in radially symmetrical fashion about the axis of the castle nut 78. The fingers 148 are separated from each other by slots 150 so that the fingers 148 are able to deflect inward upon engagement with the corresponding mounting interface 100. The fingers 148 are deflected inward in response to tightening of the castle nut into the mounting interface 100 as the castle nut 78 is rotated to advance it along the proximal end 84 of the corresponding fixation member 80.
Deflection of the fingers 148 increases the contacting surface area between the compression end 142 and the mounting interface, thereby enhancing frictional engagement of the castle nut 78 with the mounting interface 100. The resulting frictional forces are generally adequate to maintain the relative orientations of the bridge 72 and the fixation members 80 during normal motion of the spine 10. The mating semispherical shapes of the compression ends 142 and the mounting interfaces 100 allow such frictional locking to occur in any of a variety of orientations of the bridge 72 with respect to the fixation members 80, thereby permitting usage of the apparatus 70 with a variety of spinal morphologies.
As shown, each of the end plugs 158 has threads 162 designed to interface with the threads 154 of the corresponding exterior orifice 108. Furthermore, each of the end plugs 158 has a torquing feature 164, such as a hexagonal recess, that facilitates rotation of the end plug 158 through the use of a suitable too such as a hex-head driver. Thus, each end plug 158 can be rotated into engagement with the corresponding exterior orifice 108.
Similarly, the set screw 160 has threads 166 that interface with the threads 156 of the supplemental orifice 118. The set screw 160 also has a torquing feature 168, such as a hexagonal recess, that operates in a manner similar to that of the torquing features 164 of the end plugs 158 to facilitate rotation of the set screw 160 into engagement with the supplemental orifice 118.
Although the ends 92, 94 are substantially secured against rotation with respect to the pedicles 30, 50 via engagement of the castle nuts 78 with the mounting interfaces 100, usage of the end plugs 158 provides additional securement. In alternative embodiments, the ends of a stabilizer may be allowed to dynamically rotate polyaxially with respect to vertebral attachment points. The apparatus 70 may easily modified to provide such polyaxiality. End plugs 158 may then be used to selectively restrict relative polyaxial motion.
The set screw 160 may be sufficiently actuated to cause the leading end of the set screw 106 to press against the first end 124 of the stabilization rod 74. Pressure against the first end 124 tends to arrest sliding of the first end 124 with respect to the first end 92 of the bridge 72, thereby keeping the apparatus 70 from elongating or contracting.
When the apparatus 70 is unable to elongate or contract, the vertebrae 24, 26 are substantially unable to move relative to each other in flexion, extension, lateral bending, and axial rotation. Accordingly, usage of the set screw 160, with or without the end plugs 158, may amount to fusion of the vertebrae 24, 26. If stabilization via the apparatus 70 is unsuccessful in preventing further damage to the intervertebral disc 66 or to the vertebrae 24, 26, the set screw 160 may easily be applied to fuse the vertebrae 24, 26 without requiring removal of the apparatus 70 or further removal of bone tissue.
It may be desirable to provide some structure to limit the ability of the vertebrae 24, 26 to move in axial rotation and/or lateral bending, without significantly limiting flexion or extension. This may be particularly desirable for a stabilizer with end points that are attached to the vertebrae in such a manner that polyaxial rotation between the end points and the vertebrae is permitted. Such polyaxial rotation may permit a pair of stabilizers to “windshield wiper,” or rotate in tandem to permit relatively unrestricted axial rotation. Similarly, relative rotation of stabilizers of a bilateral pair may enable lateral bending.
As shown, the crosslink 180 includes a rod 182, a pair of brackets 184, and a pair of fasteners, which may take the form of screws 186, that hold the brackets 184 to the rod 182 and the left and right apparatus 70. The rod 182 may have a generally cylindrical shape, and may pass generally underneath the spinous process 36 of the first vertebra 24 (shown in
Each screw 186 has a head 200, a shank (not shown), and a torquing feature 202 extending into the head. The torquing feature 202 may take the form of a hexagonal recess like those of the end plugs 158 and the set screw 160, as described previously. The shank may be threaded to interface with corresponding threads (not shown) of the brackets 184.
Each of the brackets 184 has a first grip 210 and a second grip 212. The first grip 210 is designed to secure each bracket 184 to the corresponding end 190, 192 of the rod 182. The second grip 212 secures each bracket 184 to the corresponding apparatus 70. The first and second grips 210, 212 are designed to be energized by the corresponding screw 186 to retain the rod 182 and the corresponding apparatus 70. For example, each of the brackets 184 may have a bore (not shown) extending through both of the grips 210, 212, with threads only on the end of the bore furthest from the end at which the corresponding head 200 will be positioned. Accordingly, tightening of each screw 186 may cause axial compression of the bore of the corresponding bracket 184.
The first grip 210 has a slot 220 with a compression portion 222 and a gripping portion 224. At the compression portion 222, the slot 220 is relatively narrow. At the gripping portion 224, the slot 220 widens to provide a generally cylindrical interior surface shaped to receive the corresponding end 190 or 192 of the rod 182. The sides of the compression portion 222 are drawn toward each other by tightening the corresponding screw 186. As a result, the sides of the gripping portion 224 press inward against the corresponding end 190 or 192 for secure retention.
The second grip 212 similarly has a slot 230 with a compression portion 232 and a gripping portion 234. At the compression portion 232, the slot 230 is relatively narrow. At the gripping portion 234, the slot 230 widens to provide a generally cylindrical interior surface shaped to receive the first end 92 of the bridge 72 of the corresponding apparatus 70. The sides of the compression portion 232 are drawn toward each other by tightening the corresponding screw 186. As a result, the sides of the gripping portion 234 press inward against the end 92 of the bridge 72 of the corresponding apparatus 70 for secure retention.
The brackets 184 enable efficient installation because tightening the screws 186 causes the brackets 184 to simultaneously retain the rod 182 and the left and right apparatus 70. According to one installation method, after the left and right apparatus 70 have been attached to the vertebrae 24, 26, the crosslink 180 can be easily inserted into loose engagement with the left and right apparatus 70, such that the rod 182 is not securely retained. With the vertebrae 24, 26 at the desired relative orientation in axial rotation and lateral bending (presumably a neutral orientation), the screws 186 can be tightened to restrict further relative rotation between the left and right apparatus 70, thereby restricting further axial rotation and/or lateral bending.
According to alternative embodiments, a crosslink need not extend between two stabilizers. For example, a crosslink (not shown) may have a first end attached to one apparatus 70, and a second end attached directly to one of the vertebrae 24, 26. The second end may be attached to any desirable feature such as a pedicle 30 or 50 or a spinous process 36 or 56. Such a crosslink would inhibit rotation of the apparatus 70 with respect to the vertebrae 24, 26 in a manner similar to that of the crosslink 180. Such a crosslink may be particularly desirable if only one stabilizer is used. An end of a crosslink that is “substantially secured” with respect to a vertebra may be attached to a stabilizer such as the apparatus 70 coupled to the vertebra, attached directly to the vertebra, or indirectly attached to the vertebra through the use of a different element such as a fastener or another type of spinal prosthesis.
Additionally, a wide variety of other crosslink embodiments may be used. For example, in place of the brackets 184, retention members (not shown) may be attached to the apparatus 70 or to the rod 182 via adhesives, set screws, clips, or other devices. Furthermore, if desired, a crosslink may be made from fewer pieces. For example, two telescoping rod segments may each have an integrated end capable of being attached to one apparatus 70. As another example, a crosslink may be designed to provide locking as well as crosslinking, thereby making it unnecessary to install a separate locking component. Such a crosslink may have a built-in set screw or other locking component, or may otherwise retain the corresponding stabilizers in such a manner that they are unable to elongate or contract when the crosslink is in place. Those of skill in the art will recognize that a wide range of alternatives may be used within the scope of the present invention.
Usage of the apparatus 70 may beneficially add stiffness in flexion, extension, axial rotation, and lateral bending, whether used with or without the crosslink 180. The crosslink 180 may help to add additional stiffness in axial rotation and lateral bending. The manner in which the apparatus 70 and/or the crosslink 180 may help to restore natural spinal biomechanics will be shown and described with reference to
When applied to a joint motion segment having the pathological displacement curve 238, a stabilizer adds stiffness in flexion, extension, axial rotation, and/or lateral bending across substantially the entire range of motion of the joint. Known stabilizers often have resilient members that provide a single spring constant across the entire range of motion, thereby applying a proportionate increase in stiffness along the range of motion of the joint. The result is to move a spinal motion segment from the motion characteristics of the pathological displacement curve 238 toward those of the corrected displacement curve 236. Since such a stabilizer may not provide any mechanical stops, the corrected displacement curve 236 has a substantially constant slope, which does not accurately replicate natural biomechanics.
As shown, a pair of boundaries 250 illustrates the limits of a neutral zone 252 of the natural displacement curve 240. Within the neutral zone 252, relatively large displacement occurs because the stiffness of the intervertebral disc, ligaments, facet joint capsules and other adjacent tissues is relatively low. Outside the boundaries 250, the natural displacement curve 240 has motion limited zones 254 within which the stiffness of these members is greater due to the fact that they are under higher deflection. Additionally, within the motion limited zones 254, abutment of bone structures such as facet joints may contribute a relative larger stiffness so that relatively small displacement occurs with the incremental addition of moments.
Boundaries 260 similarly illustrate the limits of a neutral zone 262 of the pathological displacement curve 242. Outside the boundaries 260, the pathological displacement curve 242 has motion limited zones 264 within which motion in response to incremental addition of moments is generally more limited than within the neutral zone 262. Generally, the pathological displacement curve 242 exhibits far more motion for any given input moment than the natural displacement curve 240. The slope of the neutral zone 262 is lower than that of the neutral zone 252, and the boundaries 260 are not reached until a higher moment is applied. The slopes of the motion limited zones 264 may even be higher than those of the motion limited zones 254. As mentioned previously, such a condition may accelerate deterioration of, and necessary surgical intervention for, the intervertebral disc due to excessive intervertebral motion.
When applied to a joint motion segment having the pathological displacement curve 242, the apparatus 70 of
More precisely, the resilient section 120 of the central portion 96 of the bridge 72 adds stiffness that increases the slope of the neutral zone 262 to approximate that of the neutral zone 252 of the natural displacement curve 240. The boundaries 260 are thus brought inward proximate the locations of the boundaries 250. Within the motion limited zones 264 of the pathological displacement curve 242, the apparatus 70 provides mechanical stops that limit motion by providing additional stiffness to approximate the motion limited zones 254 of the natural displacement curve 240. Such mechanical stops may include, but are not limited to, the ends of the pin registration slot 114 of the central portion 96 of the bridge 72 because the ends of the pin registration slot 114 limit extension and contraction of the apparatus 70.
It has been discovered that the natural and pathological displacement curves 240, 242 of
The apparatus 70 of
In addition to the castle nuts and fixation members 80, the apparatus 270 includes a bridge 272, a resilient rod 274, a pair of pins 76, and a pair of split spheres 282. The bridge 272 does not provide resiliency, but rather, acts as a stabilization assembly. The resilient rod 274 provides resiliency. Thus, the bridge 272 and the rod 274 cooperate to perform a function similar to that of the bridge 72 and the stabilization rod 74 of the previous embodiment. The pins 76 may be identical to those of the previous embodiment.
Each of the split spheres 282 may be formed of a relatively pliable material such as a polymer. Each split sphere 282 may have a semispherical surface 284 with an open portion 286 that permits the split sphere 282 to flex to enlarge or contract the semispherical surface 284. Furthermore, each split sphere 282 has a pair of end rings 288. Each end ring 288 has a generally tubular configuration that protrudes beyond the adjacent semispherical surface 284. The split spheres 282 operate to enable polyaxial rotation of the apparatus 270 with respect to the vertebrae 24, 26 in a manner that will be described subsequently. The polyaxial rotation is “dynamic,” which means that it is able to occur after the apparatus 270 has been securely attached to the pedicles 30, 50.
As shown, the bridge 272 of
Each end 296 has a mounting interface 302 with a generally semispherical shape that converges to a pair of generally symmetrical mounting apertures 102, only one of which is visible on each mounting interface 302 in
The first telescoping portion 298 has an interior surface 308 with a generally cylindrical shape. The second telescoping portion 300 is designed to slide within the first telescoping portion 298, and therefore has an exterior surface 310 that fits within the interior surface 308 with clearance. The second telescoping portion 300 also has an interior surface 312 within which the resilient rod 274 is generally positionable.
The first containment member 292 has a pin registration orifice 314 positioned generally at the juncture of the corresponding end 296 with the telescoping portion 298. The pin registration orifice 314 is sized to receive the corresponding pin 76 with either clearance or interference, as desired. The second containment member 294 similarly has a pin registration orifice 316 positioned generally at the juncture of the corresponding end 296 with the telescoping portion 300 to receive the corresponding pin 76 with either clearance or interference. The telescoping portion 300 of the second containment member 294 has a stepped down interior surface (not visible in
The resilient rod 274 has a first end 324, a second end 326, and a central portion 328 between the first and second ends 324, 326. The first end 324 has a pin registration orifice 332 designed to receive the corresponding pin 76 in concert with the pin registration orifice 314 of the first containment member 292. Similarly, the second end 326 has a pin registration orifice 334 designed to receive the corresponding pin 76 in concert with the pin registration interface 316 of the second containment member 294.
The central portion 328 has a stepped down region 336 designed to reside within the stepped down interior surface 350 of the telescoping portion 300 of the second containment member 294. The stepped down region 336 may fit into the stepped down interior surface 350 with relatively small clearance so that the engagement of the stepped down region 336 with the stepped down interior surface (not visible in
As in the previous embodiment, the resilient section 338 is integrally formed with the remainder of the resilient rod 274. However, in alternative embodiments (not shown), a resilient section may be a separate piece with the remainder of a resilient rod, and may be attached to the other resilient rod components or may remain coupled thereto by virtue of assembly with the corresponding bridge.
Returning to the apparatus 270 of
The bridge 272 and the resilient rod 274 may be relatively easily assembled by sliding the stepped down region 336 of the resilient rod 274 through the exterior orifice 108, the interior orifice 106, and then into the stepped down interior surface 350 of the second containment member 294. The second end 326 of the resilient rod 274 may be fixed with respect to the end 296 of the second containment member 294 by sliding one of the pins 76 through the pin registration orifice 316 of the second containment member 294, and through the pin registration orifice 334 of the second end 326 of the resilient rod. The first end 324 of the resilient rod 274 may then be fixed with respect to the end 296 of the first containment member 292 by sliding the other pin 76 through the pin registration orifice 314 of the first containment member 292, and through the pin registration orifice 332 of the first end 324 of the resilient rod.
By virtue of the pins 76, the engagement of the interior surface 308 with the exterior surface 310, and/or the engagement of the stepped down region 336 with the stepped down interior surface 350, the first and second containment members 292, 294 may be constrained to remain substantially coaxial with each other and with the resilient rod 274. The resilient section 338 provides resilient force to urge the saddle points 42, 62 to a displacement in which the resilient section 338 is substantially undeflected. Thus, the apparatus 270 performs a function similar to that of the apparatus 70 of
The semispherical surfaces 284 of the split spheres 282 articulate with the mounting interfaces 302 to permit triaxial rotation of each end 296 relative to the fixation member 80 that passes through it. Each of the end rings 288 may serve as a motion stop by contacting the adjacent mounting aperture 102 of the corresponding mounting interface 302 when the end 296 reaches a pre-established orientation with respect to the corresponding vertebra 24 or 26. If desired, alternative embodiments (not shown) may utilize end rings with non-circular peripheries to provide tighter control over the polyaxiality provided by the corresponding split sphere. For example, an oval-shaped, squared, or otherwise deliberately shaped end ring may be used as a cam to permit a higher degree of rotation about one axis than about another.
The end plugs 158 are rotated into the exterior orifices 108 to abut against the split spheres 282, thereby restricting, or even preventing, rotation of the ends 296 relative to the vertebrae 24, 26. More precisely, end interior ends of the end plugs 158 engage the semispherical surfaces 284 of the split spheres 282, thereby restricting rotation of the split spheres 282 within the mounting interfaces 302. Thus, the apparatus 270 is then constrained to remain at a fixed orientation with respect to the vertebrae 24, 26.
As the set screw 340 is tightened into abutment with the exterior surface 310 of the telescoping portion 300 of the second containment member 294, pressure of the set screw 340 against the exterior surface 310 prevents further relative motion between the telescoping portions 298, 300. Thus, the apparatus 270 is unable to elongate or contract, and as with usage of the set screw 160 of the previous embodiment, flexion, extension axial rotation, and lateral bending are substantially prevented. As in the previous embodiments, the set screw 340 and the end plugs 158 may cooperate to lock the apparatus 270 to substantially fuse the vertebrae 24, 26 together. However, as in the previous embodiment, the set screw 340 and the end plugs 158 may be used independently of each other.
Set screws provide only one of many different locking components that may be used to lock an apparatus according to the invention. In alternative embodiments, clips may be used. Such clips may have prongs or other features that are insertable into aligned holes of the two telescoping portions 298, 300. If desired, the telescoping portions 298, 300 may have multiple hole combinations that can be aligned at different relative positions of the telescoping members 298, 300 to permit locking of the telescoping portions 298, 300 at any of the relative positions.
According to another alternative embodiment, a locking component may include a rod (not shown) with ends that have rings or other features that can engage fixation members independently. Such a rod may be attached to the two engagement members 80 parallel to the apparatus 270 to provide intervertebral fusion, or the apparatus 270 may even be removed to permit attachment of the rod in its place.
According to yet another alternative embodiment, a locking component may take the form of a curable resin, bone graft, or the like. Such a material may be injected into an apparatus 270 and allowed to harden to provide locking. Those of skill in the art will recognize that a variety of other locking components may be used. Similarly, many different structures may be used to lock the ends of an apparatus such as the apparatus 270 to restrict or prevent rotation of the ends with respect to the vertebrae 24, 26.
The present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. As such the described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.
1. A method for controlling relative motion between a first vertebra and a second vertebra, the method comprising:
- attaching a first end member of a first stabilizer to the first vertebra;
- attaching a second end member of the first stabilizer to the second vertebra;
- engaging a first stabilization rod with the first end member and the second end member; and
- permitting movement of the first end member with respect to the second end member along a first axis extending along a longitudinal axis of the first stabilization rod, while preventing movement about a second axis.
2. The method of claim 1, wherein the attaching steps include placing a first fixation member through a first opening in the first end member and placing a second fixation member through a second opening in the second end member.
3. The method of claim 2, wherein the first and second fixation members can be placed at a plurality of angles relative to the first and second openings.
4. The method of claim 1, wherein the first and second end members are cannulated.
5. The method of claim 4, wherein the first and second end members are telescopically engaged with one another.
6. The method of claim 4, wherein the engaging step includes placing the first stabilization rod within the first and second end members.
7. The method of claim 1, wherein the engaging step includes placing a first pin through an elongated slot in the first end member and an aperture in the first end of the first stabilization rod.
8. The method of claim 1 further comprising, engaging a resilient member with the first and second end members.
9. The method of claim 8, wherein the resilient member is cannulated and the first stabilization rod is placed within the resilient member.
10. The method of claim 9, wherein the resilient member is a helical spring.
11. The method of claim 1 further comprising, inserting a first locking component to lock the first stabilizer to substantially prevent movement of the first end member with respect to the second end member along the first axis.
12. The method of claim 1 further comprising,
- attaching a third end member of a second stabilizer to the first vertebra;
- attaching a fourth end member of the second stabilizer to the second vertebra; and
- engaging a second stabilization rod with at least one of the third and fourth end members.
13. The method of claim 12 further comprising, inserting a second locking component to lock the second stabilizer to substantially prevent movement of the third end member with respect to the fourth end member along the first axis.
14. The method of claim 13, wherein the first and second locking components can lock the first and second stabilizers at different relative positions.
15. The method of claim 14, wherein a plurality of locking components are provided.
16. The method of claim 1 further comprising,
- connecting a first end of a crosslink to the first stabilizer; and
- connecting a second end of the crosslink to something other than the first stabilizer to prevent axial rotation of the first vertebra with respect to the second vertebra.
17. The method of claim 16, wherein the second end of the crosslink is connected to a second stabilizer.
18. The method of claim 16, wherein the second end of the crosslink is connected to one of the first or second vertebrae.
19. The method of claim 16, wherein the crosslink is a spinal rod.
20. A method for controlling relative motion between a first vertebra and a second vertebra, the method comprising:
- attaching a first end member of a first stabilizer to the first vertebra;
- attaching a second end member of the first stabilizer to the second vertebra;
- positioning a first stabilization rod between the first end member and the second end member; and
- permitting movement of the first end member with respect to the second end member along a longitudinal axis of the first stabilization rod, while preventing movement about a second axis.
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Filed: Oct 11, 2016
Date of Patent: Apr 24, 2018
Patent Publication Number: 20170027613
Assignee: Stryker European Holdings I, LLC (Kalamazoo, MI)
Inventors: T. Wade Fallin (Logan, UT), Daniel E. Gerbec (Logan, UT), Joel Dever (Millville, UT)
Primary Examiner: Pedro Philogene
Application Number: 15/290,805
International Classification: A61B 17/70 (20060101);


COMSTOCK TOWNSHIP, MI -- Public health, property values and impact on businesses are among the concerns Comstock Township residents are expressing in light of Enbridge Inc.'s dredging plan to clean up the Kalamazoo River after the massive 2010 oil spill.
The Comstock Township Board of Trustees heard from representatives from Enbridge and the Michigan Department of Environmental Quality Monday in an effort to get more information about the dredging project, which was ordered by U.S. Environmental Protection Agency in March.
Large crews arrived at Morrow Lake near the Kalamazoo River last month and began laying pipeline near the river, which will be used to carry submerged oil, contaminated sediment and water to a dredge pad during the dredging, according to Jason Manshum, spokesman for Enbridge. Dredging is planned to occur in portions of the Kalamazoo River, Morrow Lake Delta and Morrow Lake.
The sediment will then be de-watered, before Enbridge treats the water and hauls the sediment to a landfill.But preliminary work for the project began without the knowledge of Comstock Township residents, business owners or the board of trustees, part of the reason for their frustration.
"When we found out about it, we were PO'd," said David Frazier, who lives near Morrow Lake.
"Why weren't we notified of this?" asked Kelly Blaisdell, who lives on Rosemont Street, a small road near where the project will be taking place. "Why is our little neighborhood taking the brunt of an Enbridge mistake?"
Despite the order from the EPA, Enbridge must wait for approval to dredge the sites from the Michigan Department of Environmental Quality. The DEQ has already received permitting applications, but many Comstock residents and business owners are hoping the project is called off.
That includes Larry Bell, owner of Bell's Brewery Inc, who is worried that his facility will be negatively impacted by the nearby proposed work site.
"It's very important for us to have clean water and clean air around the facility," Bell said. "That water will flow right into my brewery. That air will blow right into my brewery. I'm here to oppose this project in no uncertain terms."
Bell said he is concerned that unclean air and water from the site will cause production of beer to shut down.
"I've faced a lot of challenges in my business career, but I've never thought I'd lose my business," he said. "This makes me worried I'll lose my business. People will not want to buy my beer if they think it might be contaminated."
Jennifer Newton, a Rosemont Street resident, said she is worried about the health of her three young girls.
"This site is parallel to my backyard," Newton said. "When you bring up those materials, what are the short-term health effects? What are the long-term health effects?"
Newton said she is also worried about the impact on her property.
"It makes me concerned about my property value dropping faster than the Dow Jones Market," she said.
The township board heard from more than a dozen residents and business owners during public comment, all of them opposing the project.
Nicole Zacharda, enforcement specialist with the DEQ, promised she would relay the residents' concerns to DEQ officials. Manshum also said he would discuss the complaints with Enbridge officials.
The EPA has given Enbridge a deadline of Dec. 31 to finish the dredging project, so Manshum said the project needs to go "efficiently and safely."
"We want to go home as well," Manshum said in response to a citizen who suggested Enbridge leave Comstock. "But we want to leave you with a river that is as good or better than it was."


text:
1. Ventricular fibrillation. Ventricular fibrillation is a chaotic electrical activity with no discernible QRS complex. Immediate defibrillation is necessary to restore normal rhythm.
2. Ventricular tachycardia (VT). VT can be classified as sustained or nonsustained, with a generally accepted cutoff of 30 seconds. The rhythm may arise from the ventricular myocardium, the distal conduction system, or both. Causes of VT include ischemic heart disease, cardiomyopathy or heart failure, myocarditis, heart valve disease, and idiopathic VTStable patients are treated with amiodarone; patients with unstable VT are treated with synchronized cardioversion; and patients with pulseless VT need immediate defibrillation.
3. Torsades de pointes. Torsades de pointes is a specific type of polymorphic ventricular tachycardia associated with QTc prolongation and characterized by a gradual change in amplitude and twisting of the QRS complexes around the isoelectric line on the ECG. The rhythm may terminate spontaneously or may degenerate into ventricular fibrillation, which can be deadly. The most common causes of acquired QT prolongation are drugs, such as antiarrhythmic agents, antibiotics, antipsychotics, and antidepressants. Other causes include electrolyte imbalances, such as hypokalemia and hypomagnesemia, and genetic mutations. Treatment of torsades de pointes include magnesium sulfate or electrical cardioversion.
4. Atrial fibrillation. Atrial fibrillation is characterized by no discernible P waves and an irregularly irregular heart beats. It has strong associations with heart failure, coronary artery disease, valvular heart disease, diabetes mellitus, and hypertension. Common medications for managing atrial fibrillation include diltiazem, verapamil, digoxin, and amiodarone. Anticoagulant therapy may be necessary to prevent the formation of blood clots in the atria, which can lead to stroke.
5. Atrial flutter. Atrial flutter is a supraventricular arrhythmia that is usually about 150 beats per minute. It is characterized by a "saw-toothed" flutter appearance on the ECG that represents multiple P waves for each QRS complex. Adenosine or calcium channel blockers are commonly used to treat atrial flutter.
6. Paroxysmal supraventricular tachycardia. PSVT is characterized by episodes of rapid, regular heart rate that begins suddenly and ends suddenly. Treatment options include vagal maneuvers, adenosine, calcium channel blockers, and beta blockers.
7. First degree AV block. First-degree AV block is characterized by a prolonged PR interval greater than 0.20 seconds. It usually requires no treatment. Atropine may be indicated when symptomatic.
8. Second degree AV block type I (Wenckebach). Second-degree AV block type I is characterized by a progressive lengthening of the PR interval until a beat is dropped. It usually requires no treatment. Atropine may be indicated when symptomatic.
9. Second degree AV block Type II. Second-degree AV block type II is characterized by intermittent dropped beats with a constant PR interval. Symptomatic patients may require a pacemaker, bridged with dopamine or epinephrine infusion.
10. Third degree AV block (complete AV block). Third-degree AV block is characterized by no conduction between the atria and ventricles. Symptomatic patients may require a pacemaker, bridged with dopamine or epinephrine infusion.

domain: medical


text:
Sony Entertainment CEO Michael Lynton to resign
Mr. Lynton will step down after 13 years with Sony to be chairman of the Board of Snap Inc.
Mr. Lynton began in 2004 as Chairman and CEO of Sony Pictures Entertainment, and in 2012 was named CEO of Sony Entertainment, expanding his oversight to include Sony Pictures and also the music companies, Sony Music Entertainment and Sony/ATV Music Publishing.
In April 2016, he was appointed as Corporate Executive Officer of Sony Corporation in charge of the Pictures and Music businesses.
He has led each of the entertainment companies through a period of significant change in the film, television and music industries by focusing on digital transformation, reorientation to global audiences, content diversity and the creation of new distribution platforms.
For the next six months, Mr. Lynton will stay on as Co-CEO of Sony Entertainment, overseeing the Pictures and Music businesses, and as CEO of Sony Pictures Entertainment and Sony Corporation of America, to work with Sony Corporation’s President and CEO Kazuo Hirai to find a replacement, in particular for the leadership of Sony Pictures Entertainment.
During the transition, Mr. Lynton will work closely with Mr. Hirai, who will take on the additional title of Chairman and Co-CEO of Sony Entertainment.
Mr. Hirai will also have a second office at SPE’s offices in Culver City, California, to oversee the management of the entertainment companies, namely Sony Pictures Entertainment, Sony Music Entertainment and Sony/ATV Music Publishing, as well as Sony Corporation of America.

domain: entertainment


text: How Compound Interest Works Use this calculator to better see the potential impact of compound interest on an asset. You are viewing this website at a small screen resolution which doesn't support calculators. Click here to view this calculator. Have A Question About This Topic? Name Email Address Message Thank you! Oops! Related Content A Fruitful Retirement: Social Security Benefit Taking your Social Security benefits at the right time may help maximize your benefit. How Boomers and Millennials Differ The YOLO Economy is a focus on experiences over material possessions, prompting Boomers to consider a similar mindset. Retiring the 4% Rule A portfolio created with your long-term objectives in mind is crucial as you pursue your dream retirement.

domain: economics


text:
Gambling is a type of entertainment that involves placing a wager on a random event in order to win something of value. It can be done on the internet, in casinos, or even at home through video game consoles. While many people enjoy gambling, it can become an addiction for some. If you’re worried that your gambling is becoming problematic, there are treatment options available.
The negative effects of gambling include the potential for increased debt and financial instability, as well as psychological distress. It can also result in family problems, as gamblers are more likely to leave their spouses for gambling-related reasons. In addition, those who rely on gambling for income may find it difficult to sustain employment.
Despite these disadvantages, gambling has some positive effects on society. It provides employment to a significant number of people and contributes to the economy of countries around the world. In addition, it is a popular leisure activity and can offer people the opportunity to socialize in a fun environment.
In terms of personal benefit, gambling can help people manage unpleasant emotions, unwind after a long day, and improve their mental health. However, it is important to note that there are healthier and more effective ways to cope with these feelings. For example, instead of gambling to relieve boredom or loneliness, you can try spending time with friends who don’t gamble, engaging in hobbies, or practicing relaxation techniques.
When it comes to societal benefits, gambling can also reduce crime rates in certain areas. For example, in Las Vegas, about 60% of the population works in the casino industry. This helps to occupy idlers who may otherwise engage in criminal activities such as burglary, robbery, drug peddling, and prostitution.
Another benefit of gambling is that it helps to stimulate economic development in regions where it is prevalent. For instance, it contributes a substantial amount to the GDP of the United States and many other nations. Furthermore, it is a major source of tourism.
There are various approaches to studying the impacts of gambling, including a cost-of-illness approach used in alcohol and drug studies, an economic impact model, and an environmental impact framework. In addition, there are other specialized models that examine the impacts of specific forms of gambling such as sports and horse racing.
It is possible to overcome a gambling addiction, but it takes a lot of strength and courage. For some, it is especially hard because of the social stigma associated with gambling. But it is important to remember that many other people have been in your shoes and successfully recovered. The first step in the recovery process is admitting that you have a problem and seeking help. If you are unable to stop gambling on your own, seek out inpatient or residential treatment and rehab programs for those with severe addictions. These programs offer round-the-clock support to help you break the habit. In addition, they will teach you coping skills so that you can deal with triggers when they occur.

domain: psychology


text:
The staff of the Kono Subarashii Sekai ni Shukufuku o! (KonoSuba – God’s blessing on this wonderful world!!) anime adaptation have taken to Twitter to announce some big news for the anime. A second season for the KonoSuba anime has been greenlit. You can check out the Tweet announcing the news below.
— TVアニメ『このすば』公式ツイッター (@konosubaanime) March 16, 2016
In celebration of the announcement, the original illustrator for the KonoSuba light novels, Kurone Mishima, posted an image to celebrate. You can check out that picture below.
— 三嶋くろね (@mishima_kurone) March 16, 2016
Kono Subarashii Sekai ni Shukufuku o! is written by Natsume Akatsuki and illustrated by Kurone Mishima. It is published by Kadokawa Shoten under their Kadokawa Sneaker Bunko imprint. The series was first published in 2013 and currently has 8 volumes released.
A synopsis for the series is provided by ANN:
Kazuma Satō is a hikikomori (shut-in) die-hard fan of games, anime, and manga. A traffic accident brings his disappointingly brief life to an end, or it should have, but he wakes up and sees a beautiful girl who introduces herself as a goddess. She asks him if he’d like to go to another world but he can only bring one thing with him. Kazumi chooses to bring the goddess. With that, he is transported to another world and his great adventure subjugating the demon king begins, but first the hard work of finding food, clothing, and shelter begins. Kazuma wants to live in peace, but the goddess raises one problem after another, and then the demon king’s army has its eyes set on him.
The first season of the anime ran for 10 episodes and first premiered on January 13, 2016. The series was streamed by Crunchyroll as it aired in Japan.


text:
(This review may contain spoilers).
Despite feeling like the prequel to this didn’t quite live up to its potential, I enjoyed this second movie a lot.
I thought it was good to see how the Horsemen were affected by having to be in hiding, especially when it came to Atlas. I thought the first scenes at the beginning did a really good job of establishing tension and engaging me from the start.
There were a lot of really cool magic tricks used and although some of them were obvious about how they were performed, quite a lot of them were really cleverly one.
I really liked the fact there were conflicts in the group, particularly between Dylan and Atlas. It was also really good to see what each of their groups were doing alongside each other.
I liked that each member of the horsemen had their own skills and abilities, though it was cool to see Jack and Merritt trying to teach each other their skills. I thought the way the hypnotism worked was really cool… though I was a little disappointed that there wasn’t much in the way of Merritt using the card tricks later.
I did think it was interesting to see the tension in the relationship between Merritt and Chase and it was good to learn a bit more about Merritt’s past. I was disappointed not to get an explanation for Henley’s disappearance (at least in character), but I did think that Lula did a good job of taking her place. Even though I didn’t get the chance to know her as well as the others, I still liked her. But I did think the whole ‘hat out of a rabbit’ was brought up a few too many times.
There were some really good elements of tension and also some really moments of humour. I did feel the scene with the card throwing did seem to take a little too long… and was unnecessary, given what was revealed later… but it was cleverly done.
I thought there were some really good periods of foreshadowing and I was able to see some of the events coming. It was good to see Dylan forced to work with Thaddeus, even though I didn’t especially like the latter.
I thought there were a lot of really good effects and the film kept my attention throughout. While some of the things that happened were a bit difficult to believe after the fact, the movie was still entertaining and the characters were easy to like. This is probably a film I’d be interested in watching again.

domain: artistic


text:
Center for Adventist Research Spring Book Sale
The Center for Adventist Research book sale is back! The 2014 Spring book sale begins Monday, March 24, at 5:00p.m. There will be hundreds, of used Seventh-day Adventist books, pamphlets, periodicals, audio-visuals, and Ellen White books for sale. There is also a limited amount of audio-visual equipment and some office supplies for sale. The books range from the very old to the relatively recent; from excellent condition to poor condition. Included are a number of pioneer writings. The best titles tend to disappear quickly, so don’t delay.
We accept cash or checks. (Credit and/or debit cards will not be accepted.) The sale begins March 24 at 5:00p.m. and will run to match the Center’s public hours: Monday to Thursday 9 am to 9 pm, Friday 9 am to 1 pm, and Sunday 4 pm to 8 pm. For more information, you may call the Center at (269) 471-3209.
Contact Center for Adventist Research for more information at firstname.lastname@example.org or by calling 471-3209.

domain: library


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We offer both our lab equipment and expertise to investigators and are open for new collaborations. Please consult our list of capacities and contact us for any further questions.
For general questions, not related to listed machines or procedures, please contact Head of Lab Janne Reseland.
Photo: Olí Sigúrjonsson
Our multidisciplinary team
The multidisciplinary team includes researchers trained in molecular biology, cell biology, odontology, medicine, microbiology, biochemistry, chemistry and materials science. The staff is dedicated to research focusing on development or modification of biomaterials, bone regeneration and integration of biomaterials into bone and related hard tissues.
Close relation to the
The research facilities are excellent, fully equipped for atomic force microscopy, profilometer, molecular force probing, confocal microscopy, atom absorbance, molecular imaging, protein and peptide separation techniques, cell culture, molecular biology including real-time PCR in addition to the basic laboratory equipment. Advanced equipment like scanning and transmission electron microscopy, mass spectroscopy and flow cytometry are available in the local network at collaborating laboratories.
List of instruments
|Carousel tissue processor||Catherine Heyward|
|Cutting-grinding system||Catherine Heyward|
|Parafin microtome||Catherine Heyward|
|Cell lab facilities||Aina Lian|
|Luminex 100 and Luminex 200||Aina Lian|
|Protein and DNA electrophoresis||Janne E. Reseland|
|Real-time PCR||Aina Lian|
|Freeze dryer||Alejandro Barrantes|
|Gritblasting system||Hanna Tiainen|
|High speed laboratory dissolver||Hanna Tiainen|
|High temperature ovens||Hanna Tiainen|
|SEM sample preparation||Hanna Tiainen|
|UV/ozone cleaner||Alejandro Barrantes|
In addition we have close collaborations with numerous laboratories in the region that could supplement any assignments.

domain: chemistry


Solar Powered Radiant Heat
Domestic warm water and Space warming With long-term Passive Heat Storage
Here is the most effective associated with the Radiantec home heating systems. It is a "hybrid" system that combines the most effective options that come with "active" and "passive" technologies while leaving behind their respective drawbacks.
ADVANTAGES AND BENEFITS
A substantial benefit of the Solar solution we system usually it's effective at satisfying the majority of of a domestic type building's home heating requires, in rather challenging climates. Another advantage is exceptionally high performance that very low operating conditions entail. "Substantial improvements were noted in system effectiveness, efficiency, preliminary price and architectural freedom. An increase in collector performance results in less solar panel systems, lowered expenses, and simpler design integration into accepted building types. A sizable thermal size, incorporated in the building's framework provides extended solar power storage space, radiant comfort and additional decreased prices."
-Report to US division of Energy
The Solar Option I does apply to brand new slab on level structures. It uses the dwelling's inherent capacity to keep heat power and therefore must be developed in from the beginning.
The sunlight will shine upon 7 or higher solar enthusiasts. Solar technology would be kept within an 120 gallon solar power storage container for domestic heated water and within a 2' dense slab and compacted earth bed for long-lasting area home heating storage.
A very big thermal closet is created with slab on level building. The storage space includes the slab it self or more to two foot of compacted sand or gravel. The storage space information might have hardly any or no extra expense based upon insulation. Despite reports towards the contrary, there aren't any annualizing benefits, or storage space that carries over from period to season.
|The very big thermal storage space, whenever combined to solar power collectors produces high solar power enthusiast effectiveness, a potential for high solar power heating fractions, reasonable very first price and very great expense benefits, all within a startling simple design.|
|Installation within joisted floors
Installation in a joisted floor is simple in new building and is additionally a straightforward retrofit in an existing house if you have accessibility your floor joists from below. The wooden floor system won't shop the maximum amount of power as a slab system, however it can still shop significant temperature and can cause a really comfortable and cozy floor.
|Domestic hot-water plus radiant-heat
The solar domestic water heater is itself a stylish alternative. It's not constantly convenient to offer the very huge temperature storage space mass that is used using Solar solution One. Also, it is not always feasible to put in many solar energy panels. In such cases, a domestic hot-water heater with a supplemental home heating potential can have price. When a less intense storage size can be used, particularly a topping slab over plywood, or porcelain flooring tiles and on occasion even a consistent lumber flooring system, a floor system can still supply appreciable advantage.


Jodie Marie's highly anticipated debut single, 'On the Road', will be released on October 31st through Verve, Decca's newly re-launched label.
The video for On the Road plays out like a mock behind the scenes video. It makes no attempt to hide Jodie walking on a treadmill in front of projections of various moving scenery, the runners revealing the band behind Jodie, or the very same runners setting up stage curtains. Indeed, it is this honest glimpse into a music video that makes it very charming.
At only nineteen years of age, Jodie's story of her rise to fame sounds like a fairy story. She started performing in local gigs in Wales at the tender age of seven; by the time she was sixteen she was sought after for weddings. A landlady at a local pub encouraged to listen to 'local plumber's daughter's music', her demo CD was sent off to London and the rest, as they say, is history. Jodie has already drawn comparisons to Carole King.
Jodie is set to tour with fellow songstress Nerina Pallot, fresh from a tour of the Highlands.
He'll be performing a new residency at an intimate theatre.
Queens of the Stone Age front man Josh Homme has described their new music as ''an experience''.
Vicky Cornell explains that they're planning to pay tribute with a sculpture.
It's their first foray into television.
Luc Besson has loved the Valerian story for many, many years.


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Cashless stores are excluding millions of American who live below the poverty line. People who live below the poverty line do not have enough income to sustain an active bank account. And without that, they are excluded from cashless grocery stores like AmazonGo. Amazon Go For Everyone will change that by transferring food stamp into in-store credit, allowing American working poor to be included in this new technology.
Digital advertisement created by S.I. Newhouse School of Public Communications, United States for Amazon, within the category: Retail Services.


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Are there unusual crossovers of the new China ADIZ (Air Defense Identification Zone) with both Taiwan and South Korea? There are and the Taiwan piece is perhaps something that most people do not know. Is China’s new ADIZ over the Senkaku islands a precursor to further ADIZs China may have in mind? What is this new Air Defense Zone that China has imposed in the East China Sea all about? How did we get here? What about the schizophrenic, wires-crossed responses coming out of the Pentagon and the State Department?
“Asia in Review” host David Day engages in a fascinating conversation with special guest Michael Sacharski. Mr. Sacharski has lived and worked in China as an American executive and entrepreneur for some 3+ decades and shares some interesting insights into the Chinese thinking behind this new strategy. Mr. Sacharski is the CEO of Pacific Enterprise Capital.

domain: geography


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Keto Beta-Hydroxybutyrate – Look at Exogenous Ketone Supplements – Keto Supplement Safe
If you have actually begun the ketogenic diet plan, or are even just interested adequate to start your research, you’ll have heard the term “exogenous ketones” or keto BHB prior to.
That’s because lots of keto dieters, whether they’re experienced or brand-new to the diet plan, usage exogenous ketones as a supplement to their low-carb diet to: Keto Supplement Safe
- Rapidly attain the metabolic state of ketosis
- Curb carb cravings and reduce cravings
- Accelerate keto weight-loss
- Ease or avoid the keto influenza.
- Here’s what you need to learn about BHB, its numerous benefits, who should use it (and when), and how it works.
What Is BHB?
Beta-Hydroxybutyrate (BHB) is a ketone body produced from fat by the liver for energy when glucose isn’t available. It ultimately ends up being the body and brain’s primary source of energy.
Despite the fact that it has a strange-sounding name, BHB is a naturally taking place particle produced by your body throughout ketosis.
You may hear BHB referred to as “exogenous ketones”. These are BHB salts. BHB salts are supplemental ketone bodies that you can take to reach a state of ketosis more quickly.
Since it spends some time for your body to adapt to utilizing fat for fuel instead of glucose (carbs), you might feel some adjustment pains, like tiredness, hunger (yearnings for sugar, a faster energy source), and mental cloudiness. These are the signs that specify what keto followers call the “keto influenza.”
Supplementing BHB on a keto diet can have an extensive favorable impact to brand-new keto dieters adhering to the diet plan. Keto Supplement Safe
When you’re looking for your BHB supplement, make certain to select one with appropriate levels of salt, potassium, calcium, and magnesium, like Keto BHB.
Understand though that because of the levels of these minerals, numerous BHB items can have a chemical aftertaste. We specifically developed Keto BHB to taste fantastic without compromising on efficiency since we were sick of grinning and bearing the horrible taste of other supplements on the marketplace.
BHB Exogenous Ketones
Control cravings and fuel your body! Consume BHB throughout those afternoon energy “plunges,” or to fuel physical and psychological performance.
What Are The Advantages Of BHB?
BHB easily crosses the blood-brain barrier resulting in easily accessible energy to the brain and muscle tissues, becoming a source of energy after going into the mitochondria, being transformed to Acetyl-CoA, and after that ATP through the Krebs cycle (the exact same procedure that glucose goes through to end up being ATP).
This eventually results in:
- Reduced sensations of hunger
- Enhanced mental performance
- Increased physical performance
- Longer lasting energy
- Reaching ketosis faster
- Minimizing or preventing “low-carb flu” or “Keto flu” symptoms
- Enhanced immune health
The minerals in BHB salts are like a powerful electrolyte, which assists you combat keto-related sleeping disorders, muscle cramps and convulsions. Keto Supplement Safe
How Does BHB Effect Immune System Health?
Let’s take a better search BHB’s effect on immune health. Research study shows that BHB can help reduce inflammation in the brain and other locations of your body. It does this with its ability to block inflammasomes from forming when you get ill. Having ketones in your body, which is what occurs when your body is in a state of ketosis from eating a keto diet plan, appears to assist reduce immune system damage when your body is infected with a virus or germs.
A Yale Study published in Jan 2020 indicates that remaining in a state of ketosis from the keto diet plan can lower swelling and reduce the threat of diabetes. Researchers discovered that throughout ketosis, the body begins to produce ketone bodies as an alternative source of fuel to change carbs. When the body starts using ketones for energy (i.e., remains in fat-burning mode), immune cells called gamma delta T-cells start expanding throughout the body. These tissue-protective cells help improve the body’s metabolic process and lower blood sugar level levels and swelling. The study was done on mice and additional research study is being pursued for more information about the health benefits of the keto diet.
When Should You Take BHB?
You can actually take BHB anytime, however it’s best to avoid taking it with meals because that’s when you’ll already be providing your body with energy. Why waste a scoop, right? Here’s how BHB can work in your meal plan:
First thing in the morning (in place of breakfast) to assist keep your ketones up.
In in between meals to eliminate cravings and energy crashes. Keto Supplement Safe
Prior to, throughout and after workouts to supplement with easily offered energy.
Lots of people find that they feel energetic after taking exogenous ketones like Keto BHB. It’s best to avoid taking it a couple of hours prior to bed to avoid problem in dropping off to sleep.
Is Keto BHB Safe?
Yes. Beta hydroxybutyrate is a dietary supplement active ingredient that is self-affirmed Generally Acknowledged As Safe (GRAS).
Given that BHB is a naturally happening metabolite formed throughout fat digestion and metabolism, it’s not only safe it’s natural! Keto Supplement Safe
Just like glucose is the energy particle stemmed from carbohydrates/sugars, and amino acids are stemmed from proteins, ketones are energy molecules stemmed from fat. BHB is an energy thick molecule that naturally fuels the brain, heart, and muscles throughout durations of low carb consumption.


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Poppy Curious Sitting Hare Sculpture in Cold Cast Bronze. Perfectly capturing a curious alert hare with paws raised, this beautiful sculpture would make a wonderful present for the wildlife enthusiast or animal lover.
This lovely sculpture (original by Harriet Glen) is carefully manufactured in cold cast bronze.
Cold Cast Bronze is a process of mixing bronze powder and resin. This is then hand polished to develop a patina with a very similar feel and appearance to Hot Cast or Foundry Bronze. It produces a quality item with weight at a fraction of the cost of solid bronze.


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“March”ing Ants Usher Fans To The Final Four
ATLANTA – March 23, 2007 – Thousands of basketball fans aren’t the only ones colonizing at the Georgia Dome next weekend. Atlanta-based Orkin, Inc., the 106-year-old pest control company, is staking its claim in the unofficial marketing blitz surrounding the 2007 men’s college basketball national championship.
The company installed nearly 2,500 oversized ants throughout the Georgia Dome MARTA station to march thousands of basketball fans to this year’s championship games, which are taking place March 31 and April 2. In fact, according to the Atlanta Sports Council, the 2007 Final Four is expected to draw 75,000 out-of-town fans and generate an economic impact of $53 million in Metro Atlanta alone. And Orkin is antsy to generate local buzz.
“Throngs and throngs of people will experience the Orkin ants marching in the Georgia Dome MARTA station over the next week and during the upcoming basketball games,” said Kevin Smith, vice president of marketing for Orkin, Inc. “Elimination, protection, defender – it’s a perfect parallel from the basketball rounds to Orkin''''s protective services.”
As part of Orkin’s MARTA station takeover, company banners and posters feature timely slogans like, “Spider Sidelined with Eight Shoulder Injuries” and, “Keep the Termites off the Board.” Additionally, a team of three to six Orkin employees will share bug trivia and hand out coupons during the semi-finals and finals.
According to officials at MARTA, the Georgia Dome MARTA station could easily average 30,000 to 40,000 passengers per day during a special event weekend like the Final Four.
The teams coming to Atlanta will be announced after the Sweet Sixteen – being played this weekend across the country.
About Orkin, Inc.
Founded in 1901, Atlanta-based Orkin Inc. is an industry leader in essential pest control services and protection against termite damage, rodents and insects in the United States, Canada, Mexico, Costa Rica and Panama. With more than 400 locations, Orkin’s almost 8,000 employees in the United States and Canada serve approximately 1.7 million customers. Orkin is a wholly owned subsidiary of Rollins Inc., which is traded on the New York Stock Exchange (ROL). Learn more about Orkin by visiting www.orkin.com and www.rollins.com.

domain: news


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With the arrival of spring, now is the perfect time to spruce up your garden ready for the warmer months ahead. It is also the perfect activity if you are social distancing or self-isolating at home right now. Here are a few ideas of how to get your garden looking spick and span.
Weeding & Pruning
If you want your garden to look neat and tidy ready for the spring, get the elbow grease out and pluck out all of those pesky weeds that have appeared over the winter. And remember to get right down under the roots to ensure they don’t grow back. Now is also a good time to prune back trees, shrubs and plants to allow them to bloom new buds over the coming months.
Potting Plants and Hanging Baskets
One of the easiest ways to lift your garden and add a pop of colour is to place a few potted plants around your patio or hang some flower baskets. Choose plants that will brighten up your outdoor space, or why not add some herbs or strawberries into the mix.
Now is the best time to tend to grassy areas. If you have any bare or thin patches, rake the grass to remove any dead grass or weeds and aim to sow grass seeds and fertilizer in April to make sure your lawn looks verdant and lush ready for the summer.
With all of the storms we’ve had this winter, you’ll likely have a few fallen fences or rickety ones at best. Now is a good time to get them fixed or replaced before flower beds bloom and climbing plants begin to grow. If your fences have survived the turbulent weather (lucky you!), give them a fresh lick of paint or varnish to give your garden a smart and tidy backdrop.
Decking and Patios
If you have a patio or decking area, it might look a bit dingy with the build-up of mould and mildew from the wet and damp weather over the winter months. Wash off the loose dirt with a hose and gently scrub with a gentle cleaning solution of soap and warm water to bring them back to life – you’ll now have a clean space in which to relax come the summer.
Shade and Privacy
The thought of hot afternoons and low evening sunshine may feel like a world away right now, but come the summertime you’ll be glad of some extra shading in your garden. A retractable awning is a great way to provide some respite from the sun, as well as provide some extra privacy. An awning can also add an extra sense of cosiness when relaxing outside, especially in the evening.
Make sure you have somewhere comfortable to sit and enjoy your garden with family and friends as soon as the weather warms up and the sunshine appears. Gather around a large dining table for a summer feast, or snuggle into a hammock or comfy reclining chair with a good book and a glass of wine.
Create a warm and welcoming space in which to relax after dark with atmospheric garden lighting. Drape twinkling fairy lights in bushes and along fences and place solar powered torches along garden paths. If you have an awning, integrated LED spotlights are a great way of illuminating your patio or decking area for alfresco dining.
Find Out More
Now is the perfect time to order an awning to be installed ready for the spring. If you would like to know more about getting an electric awning for your outdoor space, contact our friendly and expert awning sales team – call 02381 290170 or email email@example.com.

domain: agronomy


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Maneuvering performance in the colonial siphonophore, Nanomia bijuga
Sutherland, Kelly R.
Gemmell, Brad J.
Colin, Sean P.
Costello, John H.
MetadataShow full item record
The colonial cnidarian, Nanomia bijuga, is highly proficient at moving in three-dimensional space through forward swimming, reverse swimming and turning. We used high speed videography, particle tracking, and particle image velocimetry (PIV) with frame rates up to 6400 s−1 to study the kinematics and fluid mechanics of N. bijuga during turning and reversing. N. bijuga achieved turns with high maneuverability (mean length–specific turning radius, R/L = 0.15 ± 0.10) and agility (mean angular velocity, ω = 104 ± 41 deg. s−1). The maximum angular velocity of N. bijuga, 215 deg. s−1, exceeded that of many vertebrates with more complex body forms and neurocircuitry. Through the combination of rapid nectophore contraction and velum modulation, N. bijuga generated high speed, narrow jets (maximum = 1063 ± 176 mm s−1; 295 nectophore lengths s−1) and thrust vectoring, which enabled high speed reverse swimming (maximum = 134 ± 28 mm s−1; 37 nectophore lengths s−1) that matched previously reported forward swimming speeds. A 1:1 ratio of forward to reverse swimming speed has not been recorded in other swimming organisms. Taken together, the colonial architecture, simple neurocircuitry, and tightly controlled pulsed jets by N. bijuga allow for a diverse repertoire of movements. Considering the further advantages of scalability and redundancy in colonies, N. bijuga is a model system for informing underwater propulsion and navigation of complex environments.
© The Author(s), 2019. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Sutherland, K. R., Gemmell, B. J., Colin, S. P., & Costello, J. H. Maneuvering performance in the colonial siphonophore, Nanomia bijuga. Biomimetics, 4(3), (2019): 62, doi:10.3390/biomimetics4030062.
Suggested CitationSutherland, K. R., Gemmell, B. J., Colin, S. P., & Costello, J. H. (2019). Maneuvering performance in the colonial siphonophore, Nanomia bijuga. Biomimetics, 4(3), 62.
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domain: literature


In October, 2019 JSC “558 ARP” delivered overhauled Su-27UBK to the Customer. The aircraft is 2000th aircraft overhauled by our experts! Overhaul of Su-27/Su-30 aircraft has been mastered in 2003. Up to now JSC “558 ARP” have overhauled and upgraded more than 40 aircraft of Su-27/Su-30 aircraft*. Upgrade allows to create a multifunctional aviation complex which is able to hit surface and air targets by the wide range of weapons. Upgraded avionics allow to use the missiles of “air-to-air” type, PBB-AE and different weapons (including corrected) of “air-to-surface” type. It includes X-31A missile which is designated for hitting the naval targets, Х-31П – antiradar missile; laser homing missiles Х-25МЛ and Х – 29Л and missiles with television self-homing head X-29T. JSC “558 ARP” also perform overhaul and upgrade of MiG-29, Su-25, Su-22 aircraft and Mi-8/17/171 and Mi-24/35 helicopters. * The numeration of overhauled aviation materiel started 1981 when JSC “558 ARP” had been the leading plant on overhaul of Su-17/su-22 aircraft.


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Cookie Debosser Be Nutty
Cookie Debosser Be Hoppy
One thing is sure about this new series of "Be" cookie debossers...they'll be your go to designs for all your "be"loved people.
Make beautiful Toppers for your cookies and cupcakes! This super detailed debosser allows you to create 3D raised text on your Sugarpaste/Fondant, modelling chocolate and Gum paste, so it looks like a perfectly piped message in a fraction of the time!! It's easy: - Roll your Fondant approx. 3mm thick - Place the debosser on top of the Fondant and press down with your hands or rolling pin. - Lift up the debosser to reveal the design. - Paint or leave unpainted as desired.
- Perfectly sized to fit the average cookie and Cupcake Topper (fits on a 2-3/4"-3" circle)
- Hand washing advised with warm water.
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domain: hobby


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The sheer size and weight of HGVs means that they are susceptible to certain risks not shared by all other road users. One of these is jack-knifing, an exceptionally dangerous phenomenon that’s one of the deadliest type of accidents that …
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Vehicle safety company Vision Techniques have broken all the records by being the first company to win the Best Innovation in Vehicle, Plant and Equipment Award for three years in a row at the CIWM Awards.
Posted on 1st Nov, 2017 by Dominic Benabda
Award-winning safety experts Vision Techniques are proud to announce the appointment of three new Sales Managers and five new engineers after a record-breaking year of continued growth and a thriving customer base.