|Publication number||US6126641 A|
|Application number||US 09/004,621|
|Publication date||Oct 3, 2000|
|Filing date||Jan 8, 1998|
|Priority date||Jan 10, 1997|
|Publication number||004621, 09004621, US 6126641 A, US 6126641A, US-A-6126641, US6126641 A, US6126641A|
|Inventors||Jack W. Shields|
|Original Assignee||Shields; Jack W.|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (3), Referenced by (16), Classifications (9), Legal Events (4)|
|External Links: USPTO, USPTO Assignment, Espacenet|
This application claims benefit of provisional appln No. 60/035,362 filed Jan. 10, 1997. This is a continuation in parts with improvements on Shield's U.S. Pat. No. 5,007,901 (Apr. 16, 1991) and U.S. Pat. No. 5,401,250 (Mar. 28, 1995).
1. Field of the Invention
An IV catheter insertion device which shields users from accidental needlestick injury from the catheter insertion needle and which protects patients from venous injury during accurate IV catheter placement.
2. Prior Art
In health care settings cross-infection of incurable blood-borne virus infections, including Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV), Human T-cell Leukemia Virus (HTLV), and skin-borne antibiotic-resistant bacterial infections, have made it imperative to offer better devices for giving injections and intravenous infusions into patients safely and efficiently. Intravenous silastic catheters have proven extremely useful in hospital settings because, after proper insertion, they may remain in place in a patient for more than a day with minimal venous irritation; and pose no needlestick hazards to health care workers when removed. However, most silastic catheters commonly used in small veins require IV insertion via a hollow-bore steel needle with a sharp beveled tip which is extremely hazardous to users and bystanders and potentially injurious to veins.
Currently, two types of protective devices are commonly used for inserting IV catheters, i.e. devices not filled with infusion fluid before insertion of the catheter and devices filled before insertion of the catheter over-the-needle. Shields' U.S. Pat. No. 5,007,901 (Apr. 16, 1991) applies to both by disclosing an insertion needle guide which breaks away from the trailing end of the insertion needle, such that the entire needle can be trapped during withdrawal into the puncture-resistant housing of the assemby. However, simple specific means for trapping the insertion needle were not clearly specified.
Subsequently, Shields' U.S. Pat. No. 5,401,250 (Mar. 28, 1995) disclosed the use of a hollow cone to wedge impact the hub of a retracted hollow bore steel needle, such that the beveled tip could be safely shielded inside. Further, Shields' U.S. Pat. No. 5,007,901 (Apr. 16, 1991) specified the use of an elastomeric syringe piston for stabilizing the thrust and retraction of the IV catheter insertion needle. However, use of the trailing recess in said piston for manually controlling forward and backward displacement of the hollow-bore steel needle bevel in relation to the leading taper on an IV catheter was not claimed. This innovation, applicable to catheter insertion devices not filled with infusion fluid before insertion of the catheter, remains unclaimed by other inventors. The innovation may prove useful for preventing venous intimal injury, as well as shearing of the catheter by poorly controlled advancement of the needle bevel inside the catheter during the process of IV insertion.
Among competing devices designed for safe user IV catheter insertion via unfilled insertion assemblies, the Critikon PROTECTIV™ and the Becton-Dickinson Insyte™ systems are not structurally comparable because the former depends on a latch mechanism which traps a manually retracted inside-the-catheter insertion needle; and the latter depends on a latched spring mechanism which allows no options for gradually retracting or advancing the insertion needle inside the catheter after IV penetration. Neither is in the best interests of patients, because the former is awkward for users to manipulate between the first and third fingers of the dominant hand with the index finger controlling the relative position of the steel insertion needle; and complications have ensued as a result of catheter shearing by the needle bevel. The latter lacks means for finely adjusting the relationship between the insertion hollow-bore needle bevel and the leading taper in the IV catheter.
Among fluid-filled assemblies, B-D/Deseret currently produce a winged infusion set with a telescoping trailing addition which traps a catheter insertion needle with a vented shank. The instant invention differs in that the catheter insertion needle hub is vented amd trapped by wedge impaction inside the trailing end of the IV catheter insertion assembly.
The object of this invention is to provide a simple, efficient, easily operated and inexpensive means to accurately insert a silastic IV catheter having a standard flanged hub or a winged hub with minimal risks for accidental needlesticks to users, bystanders and personnel responsible for safe disposal of sharp parts of the IV catheter insertion assembly. A unique feature of the invention, not previously claimed, is the use of the trailing recess in a standard syringe piston for controlling the position of the insertion needle in relation to the taper on the leading end of catheter; and the use of a small-bore tuberculin syringe to do so, as well as to test intracatheter flow by means other than venous blood flash-back. In addition, use of such a syringe permits the safe withdrawal of a small amount of blood for testing immediately after successful catheter placement, if so desired, from assemblies not filled with fluid before insertion of the catheter.
FIG. 1 is a schematic mid-axial view of the assembly before use in a patient, but after a scabbard for protecting the IV catheter and catheter insertion needle has been removed. Scale is ±1:1 in this view and remaining views, unless otherwise designated.
FIG. 2 is a similar view of the assembly after the IV catheter has been accurately placed; and the insertion needle is partially withdrawn into the bore of the conical housing.
FIG. 3 is a similar view of the assembly after the IV catheter has been accurately placed; the flange on the hub of the IV catheter needle has become wedge impacted in the conical housing with retraction insofar as possible by means of a standard 1.0 mL. disposable syringe; and the IV catheter is left in the vein of a patient.
FIG. 4 is a ±4× enlarged view of prior art venting of the catheter insertion needle and crimping of the trailing end of said needle over a wire used to guide the insertion needle in a winged IV infusion assembly.
FIG. 5 is a ±4× enlarged view of the instant invention which uses a vented catheter insertion needle hub to display venous blood flash-back; and to releasably grasp the leading end of a larger gauge blunt-tipped controlling wire in a similar winged infusion assembly.
FIG. 6 is a foreshortened similar view of an entire, but modified winged IV infusion assembly whose trailing latex stopper is modified to entrap the aforementioned vented catheter insertion needle hub, such that said insertion wire can slip disconnect.
FIG. 7 is a view similar to that in FIG. 6, showing the catheter insertion needle entrapped by means of its vented hub in a conical trap inside said trailing latex stopper, such that the insertion needle and its trailing hub remain in the puncture-resistant housing comprising the trailing end of a winged infusion assembly having two infusion ports.
FIG. 8 is a view similar to that in FIG. 1, showing a disposable scabbard for protecting the IV catheter and leading end of the catheter insertion needle on the leading end of the assembly; and the use of a cylindric leading end of the assembly attached to a trailing cone, such that fabrication of the assembly cab be mechanically simplified.
FIG. 9 is a view similar to that in FIGS. 1 and 8, showing the effects of retracting an enclosed syringe on the relationships between its leading slip connection and a recess in a larger syringe piston, such that exposure of the beveled tip of the catheter needle can be reversibly enclosed inside the taper on the leading end of an IV catheter.
FIG. 10 is a view similar to that in FIGS. 1 and 8, showing the use of an IV catheter with a winged, as well as a terminally flanged hub for safely infusing fluids into small veins.
FIG. 11 is a view similar to that FIG. 10, showing the sequential disposition of components after the winged IV catheter is accurately placed; and the utiltity of a 1.0 mL. disposable syringe for simultaneously collecting a small quantity of undiluted fresh blood for testing before the trailing end of the catheter hub is attached to an infusion reservoir.
FIG. 12 shows the catheter hub flange and added details.
FIG. 13 shows catheter insertion needle hub details and fitting specifications.
FIG. 14 shows prior art and piston recess details when the piston is fitted to a standard syringe plunger.
FIG. 15 shows piston recess details when used to control the thrust of a flanged catheter insertion needle hub.
FIG. 16 shows additional piston-insertion needle-small guiding syringe details.
The structural features of a preferred embodiment not filled with fluid before use are shown in FIGS. 1-3 and in FIGS. 8-16. Structural features of an embodiment filled with infusion fluid before use are shown in FIGS. 4-7.
FIG. 1 shows a syringe-like hollow cone 11 having a leading frustal end closed by a Luer-Lok 12 used for reversible attachment of the hub of an intravenous catheter 13; and a trailing apical open end 14 through which a small bore Tuberculin syringe 15 slides snugly. The leading end of the small bore syringe has a luer-slip nozzle 16 which reversibly attaches to a trailing recess in the hub 17 of the catheter insertion needle 18. A syringe piston 19 minus the plunger from a syringe of larger bore (such as a standard 3 ml. syringe stabilizes the thrust of the catheter insertion needle 18 which passes through the piston 19; and limits forward motion of the catheter insertion needle hub 17. A circular flange 20 on the catheter needle hub helps control forward motion of the insertion needle 18; and limits backward motion, as shown in FIGS. 2-3.
FIG. 2 shows the catheter insertion needle hub 17 partially retracted into the hollow cone 11 by means of force in the direction of the arrow on the trailing external flange 21 of the small bore syringe 15.
FIG. 3 shows the catheter insertion needle hub 17 retracted as far as possible into the hollow cone 11. Further retraction is stopped at a point of wedge impaction 31 wherein the external diameter of the circular flange 20 on the insertion needle hub 17 becomes equal to or greater than the trailing internal diameter of the hollow cone 11. When the frictional force in the slip connection between the leading luer-slip tip 16 of the small bore syringe 15 and the trailing recess 32 in the catheter insertion needle hub 17 is exceeded, the small bore syringe will break away; and can be safely removed from the cone for further disposition, as indicated by the curved arrow 33. Because the axial length of the hollow cone 11 must be greater than the axial length of the catheter insertion needle 18, the entire needle will be safely trapped and shielded inside the hollow cone 11. The leading catheter 13, then, can be unscrewed from its Luer-Lok connection 12, as indicated by the curved arrow 34; and subsequently be connected to a fluid infusion set, if placement of the IV catheter was accurate. It should be noted, further, that blood leakage from the assembly after catheter placement will be minimal, because the leading end of the hollow cone will be plugged by the large bore syringe piston 19, the trailing end will be plugged by the wedge impacted catheter hub flange 20, and the user can aspirate the contents of the insertion needle 18 into the small bore syringe 15 before it breaks away. A small amount of fluid is depicted at 35 in the small bore syringe, for reasons which will become clear in FIGS. 9-11.
FIG. 4 shows a detail of prior art essential to the use of a hollow bore steel needle for inserting a soft IV catheter on a winged infusion assembly filled with fluid before cannula insertion. The steel needle 41 is crimped 42 onto a guide wire 43 and vented 44 to accommodate venous "flash-back", such that the needle can be retracted after it is certain that the lumen of the needle and the over-the-needle catheter are accurately placed in a vein.
FIG. 5 shows a functionally similar detail in the instant invention wherein the steel needle 41 is fitted with a tiny hub 51 with a trailing recess 52 which slip connects to a guide wire 43 and has a vent 53 distal to the point of slip connection. This alternative form of connecting and venting permits entrapment of the steel inside, instead of outside of the assembly, as shown in FIGS. 6-7.
FIG. 6 shows a soft, over-the-needle catheter 60 enclosing the needle 41 of a winged infusion assembly 61 having a vented hub 51 releasibly attached to the guide wire 43. The guide wire 43 is manipulated by a holder 62 on the trailing end of the assembly whose trailing end is enclosed and accessed by a latex stopper 63 whose interior surface is conical 64 with an open leading frustum and a closed trailing apex. The trailing bulk of the assembly is fitted with two side ports, one of which labeled 65 must be used for filling the assembly and sustaining an IV infusion. The other, not labeled, can be used for intermittent additions of fluids or withdrawing venous blood relatively close to the IV access site, depending on the kind of fittings applied to the port.
FIG. 7 shows the results of manual retraction of the guide wire 43 by means of its holder 62 in the direction of the arrow 71. In short, the steel needle 41 is safely retracted and shielded inside the trailing end of the assembly when its vented hub 51 gets wedge impacted into the conical aperture 64 inside the latex stopper 63. The trailing holder 62 and bulk of the extracted guide wire 43, then become safely disposable, especially if the leading end of the guide wire is blunt and slip connects into the trailing recess 52 in the insertion needle hub 51 properly. The tighter the slip-connection, the further the vented needle hub 51 will be retracted into the conical aperture 64 in the latex stopper 63, before the guide wire 43 breaks away to leave the entire catheter insertion needle 41 securely shielded inside the puncture-resistant housing of the paired infusion ports 65.
FIG. 8 shows additional structural details which simplify the fabrication and extend the usefulness of shielded IV catheter insertion assemblies not filled with fluid before IV insertion. To simplify fabrication, the leading end of a flangeless 3 ml. Luer Lok syringe 81 containing a fitting piston 19 can form the leading end of a catheter insertion assembly whose trailing end is formed by a hollow cone 82 whose frustum is permanently bonded over the trailing end of said flangeless syringe after a 1 ml. Tuberculin syringe 15 releasibly slip-connected to the catheter insertion needle hub 17 has been inserted through the trailing open apex such that the insertion needle hub 17 is advanced forward as far as possible, as shown by the arrow at a; and the insertion needle bevel 83 is advanced as far as possible through the leading taper 84 in the IV catheter 13 releasibly attached to the Luer-Lok 12 in said syringe, as shown by the arrow at b. During assembly a disposable scabbard 85 should be added over the catheteer 13. To further simplify fabrication, the flange 21 on the Tuberculin syringe 15 might be added after assembly of preceding parts.
FIG. 9 illustrates a unique feature of the assembly in that the insertion needle bevel 83 can be retracted inside the leading taper 84 of the IV catheter 13, as shown at b, by appropriate retraction of the external flange 21 on the 1 ml. Tuberculin syringe 15 in the direction of the arrow shown at c. The fit of the leading taper 91 on the catheter insertion needle hub 17 into the recess 92 in the trailing end of the large bore syringe piston 19 can be adjusted to palpably as well as visibly facilitate forward and backward movement of the leading Tuberculin syringe taper 91 within the axial length of the piston recess 92 as depicted by the arrows at a. A good fit will be assured by making the leading diameter of the taper 91 slightly larger than the opening diameter of the of the recess 92 in the piston 19, such that the elastic material of the piston must stretch slightly to restrict insertion and will grasp the taper after insertion to a depth limited by the recess 92 in the piston 19 or the circular flange 20 on the insertion needle hub 17. These relationships are illustrated by comparing the outline of the recess with that of the leading hub taper in FIGS. 1,2,3,8,9,10 and 11. This unique feature, along with a snug fit of the tuberculin syringe 15 through the trailing apical aperture 14 of the cone 82, enables the user to reversibly retract and extend the needle bevel 83 a critical distance in relation to the leading catheter taper 84, such that the catheter can be advanced through a vein without exposing a sharp protruding needle bevel capable of passing through the wall of the selected vein or causing intimal injury. Moreover, the critical distance being equal to the depth of the recess 92 in the piston 19, shearing of the catheter becomes unlikely because insufficient length of catheter to allow bending will lie beyond the needle bevel 83 during catheter advancement.
FIG. 9 shows an additional feature, labeled 35 in FIG. 3, unlabeled in FIGS. 2 and 10, and labeled 93 to signify a small amount of blood in the bore of the leading taper or in leading end of the tuberculin syringe 15. This show of visible blood, called "flash-back" in the leading taper 93, as well as in a transparent catheter insertion needle hub 17, usually signifies accurate venous entry of the needle bevel 83 and the taper 84 on the leading end of the catheter 13. However, the use of a Tuberculin syringe 15 having its own piston 94 and attached plunger 95, enables the user to manipulatively check accuracy of IV catheter insertion and flow character at all stages of insertion after observation of initial "flash-back"; and, if desired, safely withdraw a small quantity of undiluted fresh venous blood for testing.
FIGS. 10-11 recapitulate sequential positions of parts in the IV catheter insertion assembly, using a winged infusion modification of the catheter hub 101 having trailing flanges 112 for reversible attachment to the leading Luer-Lok 12. FIG. 10 shows the assembly ready for intravenous insertion with a leading needle scabbard (not shown) removed, and no blood in the assembly. FIG. 11 shows sequential positions of parts just before and after successful placement of the IV catheter with a winged hub 101.
a. the tuberculin syringe 15 is withdrawn by means of its trailing flange 21 in the direction of the arrow 113 until the circular flange 20 on the catheter insertion needle hub becomes wedge impacted 31 in the trailing apical end of the hollow cone 82.
b. further retraction in the same direction will cause the Tuberculin syringe 15 to break away and exit, as indicated by the arrows at 114. The Tuberculin syringe 15 will exit variably filled with blood 93, as indicated at b. and b.', depending on the choices of the users for withdrawing blood samples vs. emptying the syringe and catheter needle before retraction.
c. counter-clockwise rotation of the leading end of the assembly depicted by curved arrow at 34 will allow the separated IV catheter with a winged hub 101 to remain in place, as the remains of the assembly are displaced, as indicated by the arrow at 115.
FIGS. 12-16 show hub and piston details which are common in the prior art, but require minor adjustments to work optimally in this shielded IV catheter insertion assembly. FIG. 12 shows the catheter hub 13 with a circular trailing flange 121. When cross-sectioned at a--a, it will be noted that the circular trailing flange 121 is eccentric on each side, as shown in a, with a constant apogee diameter of ±7.76 mm.; and an perigee diameter which varies in needles made by different manufacturers. Alternatively, as shown at a', the flange 122 is round, but extra flanges 123 are appended on each side to yield a maximal transverse diameter of ±7.76 mm. Such trailing flange deviations from being perfectly round are essential to the reversible attachment of standard IV catheters and standard hollow bore steel needles to standard Luer-Loks on leading ends of syringes or leading connectors on IV infusion sets. As shown at b, IV infusion catheters, are sometimes made with auxiliary wing-like flanges 124 appended substantially ahead of the trailing flanges 121 in order to facilitate finger manipulation of the catheter after retraction of the catheter insertion needle and to provide secure taping to the skin overlying a selected vein. Here, a small flange 124 is shown appended on each side in order to prevent rotation of the catheter hub when the Luer-Lok is rotated counter-clockwise to disengage the catheter hub, as shown in FIGS. 3 and 11. It should be noted, further, that addition of wings 101 on the catheter hub, as shown in FIGS. 10-11, accomplishes the same purpose.
FIG. 13 shows the catheter insertion needle hub 17 with the leading part of the insertion needle 18 cut off. This type of hub with variations in the form and size of the flange shown at 20 is characteristic in IV catheter placement assemblies lacking shields for protecting the catheter insertion needle after use; and which depend on direct manual operation of the needle hub to insert the catheter; or, alternatively, attachment to a standard syringe with or without a Luer-Lok for guiding insertion. Characteristically, such insertion needle hubs are optically transparent and made with large recessed chambers 131 for observing venous blood "flash-back" from the leading end of the catheter insertion needle 18 after accurate intravenous insertion. Modifications essential to efficient use in this unfilled IV catheter insertion assembly are:
a. the external diameter of the circular flange 20, cross-sectioned at a--a, must be more than the external diameter of the small bore syringe used to guide insertion; less than the internal diameter of the leading end of the hollow cone; and more than that in the trailing end of the hollow cone adapted to wedge impact this circular flange 20, as shown in FIGS. 3 and 11. Because standard 3.0 ml. cylindric syringes produced by different manufacturers vary in internal bore from a diameter of ±8.66 to 9.10 mm., larger bore syringes can vary more, and the internal diameters of cylindric syringes inserted into hollow cones, as depicted in FIG. 8, can vary even more in differing parts, it is not possible to be more specific concerning the precise optimal external diameter of said circular flange 20.
b. the inside configuration of the trailing end of the catheter insertion needle hub 17, cross-sectioned at b--b, is characteristically standard in that it lacks external flanges, and is uniformly adapted internally to accept a syringe nozzle to comprise a reversible standard luer-slip connection, as shown in FIGS. 1,2,8,9,10.
c. However, as shown at c. (to the right) where the arrow indicates the direction of insertion of the leading luer slip connector on a standard tuberculin syringe 15, the depth of the recessed chamber 131 can vary to display more or less venous blood "flash-back", before the syringe is used to assess accuracy of catheter insertion, as previously described.
FIG. 14 shows how a configured recess 141 in the trailing end of a standard syringe piston 142 is normally configured to irreversibly grasp the leading end of an inserted syringe plunger 143. The piston elastomer compresses and bends enough to allow insertion of the plunger tip, but does not stretch or bend enough to allow extraction when both are axially aligned inside a syringe.
FIG. 15 shows how the configuration of the recess 92 in a plungerless syringe piston 19 can be altered to reversibly accept and release the leading end of a catheter insertion needle hub 17, such that resistance to hub entry and hub extraction can be finely adjusted, as described with FIG. 9 and illustrated further, using an arrow 161 in FIG. 16. With good adjustment, the user should be able to feel, as well as see,when the leading end of the catheter insertion needle hub slides in and pops out, because the leading end of the catheter needle hub 17 is slightly larger than the trailing opening of the aperture 92 in an elastomer capable of stretching and recoiling under properly aligned pressures. It should be mentioned, further, that elastomeric syringe pistons are characteristically made with leading and trailing ends of greater external diameter than the internal diameter of the cylindric syringe bore, such that the pistons are compressed and prevent leakage into the trailing bore of the syringe during activation. However, when the piston is not connected to a securely attached plunger the piston will neither rotate nor displace backward because a relatively large area of frictional contact between the piston and syringe bore resists displacement. Thus, in this assembly, the piston will not move backwards significantly if the elastomer to catheter insertion needle hub taper are optimally co-adjusted. Moreover, being housed in the frustum of a hollow cone 11, 82 whose bore progressively decreases toward the apex, the piston can not be expected to retract sufficiently toward the apex to interfere with the usefulness of the assembly.
In use of this unfilled assembly, as specified, the user sequentially:
1. Carefully selects a vein to be catheterized.
2. Properly prepares and sterilizes the overlying skin.
3. Puts on a proximal tourniquet.
4. Takes the assembly out of its sterile package (not shown) and removes the disposable needle scabbard 85.
5. Inserts the leading needle bevel 83 and taper 84 of the catheter 13 through the skin subcutaneous tissue and wall of the selected vein, more or less like he/she would do, using an ordinary hollow bore steel needle attached to a syringe with a leading Luer-Lok.
6. When "flash-back" of venous blood is observed into the recess 131 of catheter insertion needle hub 17, or into the tapered nozzle 91 of the Tuberculin syringe, the user advances a little further by combinations of feeling, experience and observation of continued "flash-back to be sure that lumen of the vein has been accessed.
7. The user, then, pulls back on the trailing flange 21 of the Tuberculin syringe 15 to recess the bevel 83 of the insertion needle 18 into the taper 84 of the catheter 13, as shown in FIG. 9.
8. Continuing to feel and observe "flash-back", the user advances the catheter up through the lumen of the vein without touching the trailing flange 21 on the Tuberculin syringe, until the catheter 13 is fully inserted, such that only the hub remains visible.
9. If there is any question about position or patency during this advancement, the user may activate the plunger 95 in the trailing end of the Tuberculin syringe 15 to aspirate blood or flush blood forward.
10. When the catheter 13 is fully inserted, the user should activate the plunger 95 again, or for the first time, to be sure of accurate positioning and patency with the venous lumen.
11. If the user chooses to withdraw a small sample of undiluted venous blood for testing, the tuberculin syringe should be one-half to two-thirds filled at this time. If the user doesn't want a sample, the contents of the Tuberculin syringe can be flushed back into the vein.
12. The catheter having been successfully placed, the user withdraws the Tuberculin syringe by means of its trailing flanges 21, as shown in FIG. 11. When the retraction of the tuberculin syringe is temporarily stopped by the initiation of a wedge impaction 31 of the circular flange 20 on the insertion needle hub 17 into the apex of the hollow cone 11,82, the user should flush the remaining contents of the Tuberculin syringe 15 and the catheter insertion needle 18 into the lumen of the hollow cone 11,82, if he/she doesn't want to obtain a venous blood sample for testing.
13. The tourniquet, if one was applied, should be removed from the patient.
14. The Tuberculin syringe 15 should be completely extracted by further traction on its trailing flanges 21 and, then, be safely disposed when convenient.
15. A sterile pledget (not shown) should be placed over the venipuncture site.
16. With finger pressure from the user's non-dominant hand over the pledget and catheter hub 13 to prevent venous bleeding and to prevent rotation and backward movement of the catheter, the remaining parts of the catheter insertion assembly should be screwed off the trailing flanges 121 of the catheter hub originally attached to the leading Luer-Lok 12 on the leading end of the hollow cone 11.
17. The dominant hand, customarily used for inserting the assembly and leading catheter should dispose of the enclosed and shielded catheter insertion needle, while the non-dominant hand is used to maintain pressure over the venipuncture site long enough to preclude venous bleeding and oozing, preferably with elevation of the patient's arm or hand to reduce venous pressure.
18. Finally, the leading end of an IV infusion set should be securely attached to the trailing end of the catheter hub by means of a Luer-Lok or a Luer-slip connector.
When using a filled version of this assembly 65, the sequential procedure is fundamentally similar, but differs in that a winged catheter hub 61 is usually used to insert the catheter 60 over a catheter insertion needle 41 which is guided by a retractible wire 43 which breaks away from a vented 53 catheter insertion needle hub 51 to become trapped and shielded in the trailing stopper 64 of the assembly with retraction of the guide wire. Thus, the user is obliged to gauge accuracy of catheter insertion by feel, experience, observing the patterns of venous blood "flash-back" through the insertion needle hub vent 53, and testing if flow from a pre-attached infusion set is patent. After successful catheter insertion, only the retracted guide wire is detached, and needs to be discarded safely.
The unique structural features of this invention are the disclosure of a catheter insertion needle hub which breaks away from its proximal guide, when wedge impacted into hollow conical trap which leaves the insertion needle safely shielded inside the assembly; the use of a small bore syringe, such as Tuberculin syringe, as a shielded catheter insertion needle guide; and the use of a syringe piston to delicately control the thrust of the catheter insertion needle with respect to a leading taper on the catheter. The embodiments, as specified, are exemplary only and not intended to be limiting. It will be appreciated by those skilled in the art that wide variation in details can be made without departing from the spirit of the invention as hereinafter claimed.
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|US9095683||Feb 24, 2012||Aug 4, 2015||C. R. Bard, Inc.||Medical component insertion device including a retractable needle|
|US20030073956 *||Oct 11, 2001||Apr 17, 2003||Hoffman Douglas B.||Safety catheter with non-removable retractable needle|
|US20040020311 *||Jul 30, 2002||Feb 5, 2004||Cullion Rebecca Noel||Method and apparatus for differential test probe retention with compliant Z-axis positioning|
|US20050027256 *||Aug 31, 2004||Feb 3, 2005||Barker John M.||Medical device with shield having a retractable needle|
|USD733289||Sep 6, 2012||Jun 30, 2015||C. R. Bard, Inc.||Catheter placement device|
|USD735321||Sep 6, 2012||Jul 28, 2015||C. R. Bard, Inc.||Catheter|
|WO2006032995A2 *||Sep 23, 2005||Mar 30, 2006||Tecnomedica S.R.L.||Cannula device|
|WO2006032995A3 *||Sep 23, 2005||Oct 5, 2006||Tecnomedica S R L||Cannula device|
|U.S. Classification||604/192, 604/162|
|International Classification||A61M5/32, A61M25/06|
|Cooperative Classification||A61M25/0637, A61M25/0631, A61M5/322|
|European Classification||A61M25/06D3, A61M25/06D2|
|Oct 8, 2003||FPAY||Fee payment|
Year of fee payment: 4
|Apr 14, 2008||REMI||Maintenance fee reminder mailed|
|Oct 3, 2008||LAPS||Lapse for failure to pay maintenance fees|
|Nov 25, 2008||FP||Expired due to failure to pay maintenance fee|
Effective date: 20081003


text:
AR-News: (US_WA) Second boy gets deferred sentence in killing of cat
wolfcrest at hotmail.com
Sun Sep 7 18:13:50 EDT 2003
Second boy gets deferred sentence in killing of cat
Spokane Valley teen could have charge erased
Jesse Tinsley - The Spokesman-Review
Rusty Rardon wipes away a tear Thursday during a court appearance on animal
The second of two Spokane Valley teenagers who abducted a cat and set it on
fire also will get a felony animal cruelty charge erased if he completes a
Rusty Rardon was given a deferred sentence Thursday by Superior Court Judge
Richard Schroeder, hearing a Juvenile Court case.
Rardon's buddy, Jason Brumback, also was given a deferred sentence on
Tuesday by Schroeder.
"This court has to be consistent in applying the law to both of them,"
Schroeder said in granting the deferred sentence to Rardon.
Like Brumback, Rardon also must complete 150 hours of community service,
including 50 hours in an animal care or treatment facility. The teens must
pay $592 to county animal control for the cat's medical bills and $250
apiece for their public defenders.
If Rardon or Brumback violate any conditions imposed during the one-year
period, they will be brought back to Juvenile Court for direct sentencing
with a felony record.
The judge said he based part of his reasoning on Washington state law, which
says only juveniles convicted of crimes of violence are ineligible for
First-degree animal cruelty is not currently defined under Washington state
law as a "crime of violence."
"I know what I did was wrong," Rardon told the judge and Bernie Womack, who
owned the 2-year-old brown tabby her family called "Max."
The cat was abducted from Womack's front porch at 11:30 p.m. on July 20 by
the two teens, who told deputies they were bored.
At the time, Brumback was a runaway from his family's home in Northwood and
Rardon was living in a single-parent home with his mother, who works nights.
The boys, who had obtained gasoline, drove the cat in Brumback's Dodge truck
about five blocks to a darkened school field.
Brumback doused the cat with gasoline and Rardon struck the match, turning
the animal into a "running fireball." The cat was euthanized three days
"I apologize," Rardon said. "I'm very sorry."
Both boys were charged with first-degree animal cruelty, a felony.
Schroeder, who is retiring, was assigned the high-profile case by Judge Greg
Sypolt after it ignited a firestorm of public outcry this summer, including
a petition drive.
If the two 17-year-olds complete a checklist of conditions, including spot
drug testing, they will have the felony charge wiped from their records next
Like she did in Brumback's case, Deputy Prosecuting Attorney Sandra Gabriel
argued that Rardon should have a permanent felony record and not get a
Gabriel said Rardon lied about what occurred and "did not accept
responsibility" until his defense attorney moved for the deferred sentence.
Juvenile Court probation officer Michelle Barbeau also argued against a
Among her reasons, the probation officer said Rardon violated terms of his
home detention when juvenile court officers found marijuana residue and a
bong-pipe at his home in August.
His father committed suicide three years ago and his brother took his life
five years ago, Barbeau told the court.
The judge also was told the boy may suffer from a bi-polar mental disorder
and have Attention Deficit Disorder, but is receiving no treatment or
Megan Manlove, Rardon's court-appointed public defender, requested the
deferred sentence so Rardon can join the Marines without a felony record
when he completes high school.
The judge's ruling didn't rest well with courtroom spectators, including a
young woman who murmured, "This is a joke."
Others, including Chris and Bob Anderlik said the case shows the Legislature
needs to redefine animal cruelty as a crime of violence.
The judge also said he couldn't order more confinement for Rardon because he
already has completed 30 days of home confinement, the maximum allowed by
the law for first-degree animal cruelty.
Under the law, a day of home detention equals a day in Juvenile Detention.
Both Brumback and Rardon were given credit for 30 days of home detention.
That law just changed, and home detention prior to a juvenile conviction
won't count as a day in juvenile detention, court officials said.
Rardon's mother, Bonnie Mustain, was in the courtroom, but did not address
the judge. His grandmother, Jackie Mustain, who lives in Montana, said her
grandson deserved the break a deferred sentence would give him.
"If I'd heard this from anybody but my daughter, I wouldn't have believed
it," Jackie Mustain said of the crime.
Neighbor Jaynee Anderson, who described herself as an "animal lover," also
urged the court to give Rardon the deferred sentence.
Since the crime, she has befriended the boy, and he has come to her home to
help her administered injections to her cat who's dying of cancer, Anderson
told the judge.
Rardon also checked in with her by phone when he was on home detention,
Rardon's neighbor said "nobody was there for Rusty" when his brother and
father separately committed suicide.
"Now we need to be there for him as a community," Anderson said after the
Womack, standing nearby, said she expected the deferred sentence. "It will
make him or break him," she said.
"I do feel both sets of parents need to take responsibility for what
happened here," Womack said.
"I'm just glad it's over," the cat's owner said.
Then she went to the prosecutor's office to pick up a bouquet of flowers
delivered Thursday to the Womack family.
The card was only signed, "Love, Max."
Bill Morlin can be reached at (509) 459-5444 or by e-mail at
billm at spokesman.com.
In fact, if one person is unkind to an animal it is considered to be
cruelty, but where a lot of people are unkind to animals, especially in the
name of commerce, the cruelty is condoned and, once large sums of money are
at stake, will be defended to the last by otherwise intelligent people.
-- Ruth Harrison, author of Animal Machines
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domain: news


text:
MAY I INTRODUCE YOU TO
Vita Kin is the absolutely most chic thing in the fashion atmosphere at this very moment. It is inspired by traditional Ukrainian folk embroidery on linen by its namesake Vita Kin. Made of 100% linen that is finely embroidered to the hilt and then belted is the height of what is of the moment in fashion. It’s almost the end of summer and heading into the resort season this is the perfect companion. It is also worn for fall, layered of course in like color cashmere.
This is my favorite thing for fall.
Available at BLAKE
212 West Chicago Ave
“TELL THEM I SENT YOU”

domain: design


text:
This unusual dish combines sweet maple-glazed salmon with your favorite grilled vegetables. The fact that the fish and the side dish can be made on the grill eliminates the need for running to and from the kitchen. The maple and citrus flavors are beautiful with the salmon and, if you are also cooking for carnivores, this combination would be good with pork.
You can use any vegetables you want in the vegetable packets. Use a range of flavors and colors. Bell peppers, carrot, and bright green vegetables are nice to use because they are so colorful. You can also use a couple of different kinds of mushrooms, zucchini, eggplant, or anything else you fancy.
If you want to use dense veggies like carrots or potatoes it is a good idea to parboil them first, so that all the vegetables are tender at more or less the same time. If you do not want to use potatoes in the vegetable packets, you might like to serve them on the side, with the finished dish, or serve a potato salad or some rice with this instead. It is totally up to you and you can use whichever combination of veggies you are happy with.
- 3 tablespoons maple syrup
- ¼ cup rice wine vinegar
- 2 tablespoons orange juice
- ¼ teaspoon salt
- ¼ teaspoon black pepper
- 4 skinned salmon filets, 6 oz each
- 2 cups finely chopped vegetables (perhaps bell pepper, mushrooms, zucchini, red onion etc)
- 2 tablespoons butter
- Combine the orange juice, maple syrup and rice wine vinegar in a big Ziploc bag. Add the fish, seal the bag, and let it marinate in the refrigerator for 3 hours.
- Preheat the grill to moderately high.
- Take the salmon out of the bag. Pour the marinade into a pan and boil it for 5 minutes or until it reduces to 2 tablespoons.
- Fold 4 sheets of heavy duty aluminum foil in half lengthwise and add the vegetables. Divide the butter between them.
- Sprinkle salt and pepper on top and fold the foil sheets up, to seal them tightly.
- Grill the vegetable packets for 15 minutes, then turn them over and cook them for 10 minutes more or until the veggies are tender.
- Grease the grill with cooking spray and cook the salmon for 4 minutes on each side, basting it occasionally with the reserved marinade.
- Sprinkle salt and pepper over the fish and serve it with the grilled vegetables.
You can see from the photo how nice the maple salmon looks with the mixed veggies. You can either drain the vegetable packets before serving or pour the butter over the plate. It also goes well with the fish and adds moisture. Alternatively, if you want lots of sauce like in the picture, you can make a basic white sauce or a white wine sauce. This is up to you. Grilled salmon has a beautiful flavor, especially if you use a charcoal grill and the grilled vegetable packets are simple to do. You can be creative with them, experimenting with your favorite vegetables. You might even like to add some herbs or spices to them.
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domain: food


text:
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text:
Timothée Chalamet is making waves in the entertainment industry at the moment, enhanced by his fantastic performance in Dune. While the actor has been a rising star in recent years, did you know before this he used to mod his own Xbox 360 controllers with his own secret YouTube account?
During his YouTube career, he says he made three videos, in which he used to paint controllers and charge $10 for his designs.
He made $30 overall.
Fans have been quick to investigate and seem to have uncovered the account. A YouTuber by the name of ModdedController360 exists, with three videos available - as Chalamet originally pointed out.
Everything lines up and the voice does sound like a much younger Chalamet (these videos are over 11 years old). While his modding career perhaps didn't propel him to the dizzying heights he'd hoped for, at least his acting career has kicked off with a bang.
Would you have purchased any of Chalamet's modded controllers? Let us know in the comments below.

domain: entertainment


text:
Articles tagged "fairy-tale"
Happy Friday, friends! Our #FridayReads have multiple starred reviews:
DOWN AMONG THE STICKS AND BONES by Seanan McGuire — 3 starred reviews!
“Beautifully crafted and smartly written, this fairy-tale novella is everything that speculative fiction readers look for: fantastical worlds, diverse characters, and prose that hits home with its emotional truths.” — Library Journal, starred review
“McGuire’s exquisitely written fairy tale is about the choices that can alter the course of a life forever, lost innocence, and what it is to love and be loved.” — Publishers Weekly, starred review
“Exquisitely crafted, this is the rare companion novel that can stand alone.” — Booklist, starred review
MY LIFE WITH BOB: Flawed Heroine Keeps Book of Books, Plot Ensues by Pamela Paul
“Titles about reading and books abound, but this memoir stands in a class by itself. Bibliophiles will treasure, but the addictive storytelling and high-quality writing will vastly increase its audience. Highly recommended.” — Library Journal, starred review
“Readers will be drawn to this witty and authentic tribute to the extraordinary power of books.” — Publishers Weekly, starred review readmoreremove
Now McLemore is back with WHEN THE MOON WAS OURS, a second stunning novel tinged with magic, about a girl with roses that grow from her wrist who happens to be hiding the truth, a boy with past secrets who paints moons and hangs them in trees, and four sisters rumored to be witches, who could ruin them both.
WHEN THE MOON WAS OURS is on the 2016 National Book Awards Longlist for Young People’s Literature and has THREE starred, rave reviews:
“Love bests every opponent in this surreal exploration of familial bonds and sexual identity. Amid the ordinariness of the small-town setting, McLemore winds arabesques of magical realism. Readers who stick with this novel will be rewarded with a love story that is as endearingly old-fashioned as it is modern and as fantastical as it is real.” — School Library Journal, starred review
“With luminous prose infused with Latino folklore and magical realism, this mixes fairy-tale ingredients with the elegance of a love story, with all of it rooted in a deeply real sense of humanity. Lovely, necessary, and true.” — Booklist, starred review
“McLemore mesmerizes once again with a lush narrative set at the thresholds of identity, family, and devotion. Luxurious language infused with Spanish phrases, Latin lunar geography, and Pakistani traditions is so rich it lingers on the tongue, and the presence of magic is effortlessly woven into a web of prose that languidly unfolds to reveal the complexities of gender, culture, family, and self. Readers will be ensnared in this ethereal narrative long before they even realize the net has been cast. ” — Kirkus Reviews, starred review

domain: artistic


text:
Most CBD cannabis products fail to meet standards, say Swiss chemists
In Switzerland, the vast majority of products sold containing the cannabis extract cannabidiol (CBD) do not meet legal requirements, according to the Swiss Association of Cantonal Chemists.
Sellers of foodstuffs carrying the CBD label do not fulfil their legal obligations to self-monitor, or do so only to a very limited extent, the food safety oversight body said on Tuesday, describing the situation as "disastrous".
Out of 100 products analysed by the association, 85 were found to be non-compliant and 73 were banned from sale. The sales bans mainly concerned CBD oils (43 banned out of 46 analysed). The amount of the psychoactive ingredient tetrahydrocannabinol (THC) they contained was found to be too high, or unauthorised hemp extracts were used.
In addition to CBD oils, the cantonal chemists analysed dietary supplements, hemp infusions, chewing gum and chocolate as part of a national campaign.
They checked whether the legal requirements for their marketing were met, such as composition and THC content.
Legal cannabis has become a flourishing business in Switzerland, which changed its laws in 2011 to let adults buy and use cannabis with up to 1% THC – the active ingredient that gets smokers high. It is used alongside another active ingredient, cannabidiol (CBD), in a growing range of cannabis-related products.
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If you want to start a conversation about a topic raised in this article or want to report factual errors, email us at email@example.com.


text:
BEST VIEWED LARGER
The ruby red doors of Carcassonne Cathedral in Carcassonne of southern France.
Carcassonne Cathedral (Cathédrale Saint-Michel de Carcassonne) is a cathedral and designated national monument in Carcassonne, France. It is the seat of the Roman Catholic Bishop of Carcassonne.
The building was built in the thirteenth-century as a parish church, dedicated to Saint Michael. Following war damage in the fourteenth century it was subsequently rebuilt as a fortified church.
In 1803 St Michael’s was elevated to cathedral status, replacing the pre-Revolutionary cathedral dedicated to Saints Nazarius and Celsus. The old cathedral now serves as the Basilica of St. Nazaire and St. Celse.
*Photograph taken with Nikon D7000, 10-20mm Sigma lens @ 10mm, iso100, f5.64, 1/320 sec, handheld. HDR created from 3 bracketed exposures (-2, 0 +2), tonemapped in Photomatix. Final processing in PS CS4.

domain: geography


text: The objective of this study is to explore and discover previous work researching the links and integration between lean production and green production in manufacturing processes. Number of papers were reviewed based on comprehensive literature assessment to develop understanding of lean and green harmonious synergy. The theoretical frameworks of them are described with structured according to the disciplines, trends and opportunities, focused drivers and parameters, applied technique/approached, and summarized findings. The outcome of this paper is a conceptual model of eco-socio-lean production, in the form of input-process-output framework that supported by green-lean business objectives, resources, production process, improvement techniques, and output measurements. The model shows that by synergizing lean production principles and technique with green production practice simultaneously will impact to future organization's sustainable productivity and quality. The results of this study are expected to make a significant contribution to the world of practical and knowledge of manufacturing systems.

domain: library


If you easily get nauseated by insects, then this might not be for you.
Entomilk, a special milk produced from farmed insects by a local South African company, Gourmet Grubb has begun selling on the South African market.
Scores of people are already not enthused with the product, raising safety concerns. But the company behind it has been emphasizing on the nutritious benefits of the insect milk.
“Think of Entomilk as a sustainable, nature-friendly, nutritious, lactose-free, delicious, guilt-free dairy alternative of the future,” the company said.
It added that the product has a high level of protein content and also rich in minerals such as calcium, iron and zinc.
About two billion people around the world are already eating insects as part of their diet.
“From ants to beetle larvae – eaten by tribes in Africa and Australia as part of their subsistence diets – to the popular, crispy-fried locusts and beetles enjoyed in Thailand, it is estimated that insect-eating is practiced regularly by at least 2 billion people worldwide,” according to the 2013 report by the UN Food and Agriculture Organisation.
The report said that many people eat insects because they consider them as quite healthy and a nutritious alternative to common protein sources like chicken, beef, pork and fish.
Entomilk comes two years after a special milk from the insect, the viviparous cockroach, named Diploptera punctate, was produced and introduced into the market.
Indian researchers subsequently conducted a study and found that the cockroach milk is estimated to contain over three times the energy of the equivalent mass of cow milk.
The milk will soon hit supermarkets, to the amazement of scientists who were not expecting to find the product in the market that soon.
The milk subsequently had safety and name issues.


text:
Can he turn the rhetoric into results?
Last updated at 17:13 26 April 2004
In clear and sensible terms, the leader of the opposition spelt out a 'historic choice' between big government under Labour and small government under the Tories.
Both Labour and LibDem politicians have branded Mr Howard's talk of cutting spending as 'extremist', which shows how ludicrously out of touch with aggrieved tax and council tax payers they are.
In fact, Mr Howard will have struck a chord with millions by linking the everincreasing rate of taxation with the consistent failure of the Blair administration to improve public services.
By invoking the fear that a country that elects Mr Blair for a third term might end up, before long, finding the more socialist Gordon Brown as Prime Minister instead was also clever.
An opinion poll also showed that 20 per cent of people feel they are more likely to vote Conservative since Mr Howard became leader.
Coupled with the decline in Labour's performance and the electorate's perception of the dwindling integrity of Mr Blair and his colleagues, the Tories at last have a very fair wind behind them.
It is also true that many Tory MPs and candidates are reporting rising levels of membership recruitment for the first time since the Thatcher era.
And with big business giving money again in gratifying large quantities, a momentum that has evaded the party since its last electoral victory in 1992 does seem to have returned.
However, translating yesterday's admirable rhetoric into results remains a formidable task. The small state Mr Howard is quite rightly wedded to establishing cannot be achieved painlessly.
Labour's own governmental efficiency review, under Sir Philip Gershon, has identified savings far exceeding those promised by Shadow Chancellor Oliver Letwin.
Gershon's cuts would be achieved only by sacking perhaps 100,000 civil servants, something the Tories are loath yet to admit.
There is probably as much, if not more, money to be saved in local government, where Labour has created hundreds of thousands of posts for its own clientgroups and the Tories ought not to be afraid to say so.
It is quite possible, given Mr Brown's profligacy and the prospect of a £15billion spending black hole opening up this year, that an incoming Tory government would have even less money to play with than it expects.
It would then face a choice of going back on much of its campaigning rhetoric or of being far tougher than it is prepared to be.
In the interests of the country's economic health, competitiveness and growth, it must take the second course.
Tories still have an organisational problem to overcome, too. The party needs to double the number of seats it holds, from 165 to 330, to achieve a majority of one in the Commons.
It could well win scores of seats in rural England, and some semirural ones too. However, in large stretches of urban England, and in Wales and Scotland, the party is still off the map.
At least in having some firm principles to talk about, the Tories have the basis of a decent campaigning strategy.
But the key task is not so much persuading those who have supported Labour or the LibDems to come back to the Tories, as to persuade millions of disaffected Tory voters who abstained at the last two elections to vote again.
In Mr Howard, the Tories have a talented, committed and experienced leader who commands respect and is feared by his opponents.
The tide of ideas is now, once more, running in favour of the Tories. Mr Howard's speech should propel a party that is still in the recovery room towards greater appeal to the public.
However, having identified the issues that really matter, the party must not be afraid to deal with them robustly in a way that will serve the interests not just of their own real and potential supporters, but of the whole country.

domain: politics


text:
NFTS students and staff today unveiled a sculpture of much loved stop motion animation character Gromit at the School. The sculpture was specially commissioned to mark the upcoming 30th anniversary of Wallace & Gromit being created by NFTS Directing Animation MA alumnus Nick Park at the School for his Oscar® nominated graduation film, A Grand Day Out, which premiered in 1989.
NFTS Director, Jon Wardle said: “We are thrilled to unveil our very own Gromit so students, staff and visitors to the School can enjoy and celebrate one of the School’s proudest moments. Nick Park and Wallace & Gromit are very much part of the fabric of the NFTS so it’s incredibly fitting that we now have a lasting tribute to two of the UK’s most loved characters being created right here at the School.”
Bethany Smith, Brand Manager at Aardman said: “It’s fantastic that the NFTS now has a permanent Gromit sculpture. We are very proud of our and Nick’s connection with the School and enjoy working closely with the students on a regular basis to help inspire the next generation of animators.”
A bespoke sign to accompany Gromit, explaining the heritage has been made by students on the new Model Making for Animation Diploma course. The sign will encourage students and visitors to take selfies with Gromit using the #WallaceandGromitNFTS hashtag.
John Lee, Head of Model Making explained: “We wanted to design and make something that would really bring Wallace and Gromit’s story to life. The main part of the sign is modelled to look like Wallace’s favourite food, cheese and features rocket motifs from Nick Park’s NFTS graduation film, A Grand Day Out. This specially made sign sculpted by NFTS Model Making for Animation student Sophie Monks and the incredible achievements of our animation department are testament to the fact that our students are following in Nick’s footsteps and ensuring that stop motion animation and model making continues to be a hugely important part of the School’s output. I can also reveal that the model making department will be working on something very special to mark the 30th anniversary next year. Watch this space for more information!”
More information on plans to celebrate Wallace & Gromit’s 30th anniversary in 2019 will be announced soon!


text:
for Treatment (800) 429-7690
Phoenix Center Behavioral Health Services
Phoenix Center Behavioral Health Services
The facility name, logo and brand are the property and registered trademarks of Phoenix Center Behavioral Health Services, and are being used for identification and informational purposes only. Use of these names, logos and brands shall not imply endorsement. BetterAddictionCare.com is not affiliated with or sponsored by Phoenix Center Behavioral Health Services.
I'm very impressed and pleased. Great nursing staff, adminstration is always willing to help and the counselors are great. Peer Support Program I highly recommend getting involved in. Besides being able to get to learn and user coping skills, staff and peers are helpful.
Jennifer G, 1 year ago
It's a treatment facility for alcohol and drug addiction. I believe it is a 12 bed facility.
Jerry Coile, 2 years ago
Before I tell you about my experience go to the pavilion and get help through them, and you can get indigent care so there’s no need for insurance or anything with payment see dr Dan he’s better than dr pursell and dr chaperella Also there is no intensive case management there’s only critical and minor no intensive so don’t buy their we want to help you, you have a better chance winning the lottery than getting better This so called behavioral health services, I’ve been going there for over a year and I had case management services, and I had a case manager that helped me a lot and they switched me, to summon it up they help you for a while and then screw you over and make you believe it’s your fault I overdosed and could have died, because they say they want to help you but they only care about making money, whatever they do they will blame you and make you feel like everything is your fault. I lost all hope on getting better just because everyone I thought was helping me just wanted to screw me over and make me feel worse than ever and expect me to have them help, they hurt you more than help you. You can go there but don’t expect any results in getting better. Go to the Pavillion. And see dr Dan, and get Casemanagement through them.
matt bravo, 2 years ago
I went in for a drug detox and had the best experience ever..the nurses and environment were awesome..they made sure that when i left i was on the medication i needed and had follow up care..i cant speak for the other care they offer. But my experience was great
Roxanne Hughes, 3 years ago
127 SOUTH SIXTH STREET, Warner Robins, Georgia 31093
At Phoenix Center Behavioral Health Services, located in scenic Warner Robins, Georgia, individualized addiction treatment programs are aimed at fitting the specific requirements of the patient. With unique treatment plans that are tailor-made to suit the individual, addicts will have every opportunity to overcome their addiction.
Just before the patient begins treatment at Phoenix Center Behavioral Health Services, a comprehensive patient assessment will be conducted in order to determine which treatment method will work best. No matter what age group the individual belongs to, treatment is available to those of all ages . In order to obtain a life that is free of addiction, the addict has to be in the mindset of ‘recovery’. This means that the idea of sobriety is already planted in the individual’s mind and therefore will want to work toward achieving that goal.
The dedicated staff members at Phoenix Center Behavioral Health Services are committed to the recovery of the patient and will do everything in their power to help them throughout this trying time. Reaching personal life goals is possible but it requires the addict to kick the habit of abusing drugs and alcohol in order to obtain them. This is exactly why facilities for addiction treatment exist.
There is no reason that treatment shouldn’t begin today, so contact Phoenix Center Behavioral Health Services and discuss the various treatment options today. Breaking the cycle of addiction is difficult which is why treatment facilities are here to help. Typically speaking, addicts fail when it comes to seeking treatment on their own as not all facilities out there are as reputable as others. At Phoenix Center Behavioral Health Services, the staff is dedicated to helping their patients succeed in recovery. It’s never too late to seek help and assistance with drug or alcohol addiction.
Phoenix Center Behavioral Health Services strives to show addicts that there is a life outside of addiction and through treatment; Addicts will be able to take control of their lives. Patients are also urged to attend relapse prevention programs even after treatment is completed in order to mitigate the chances of relapse in the future.
The time to get help for addiction is now. Contact Phoenix Center Behavioral Health Services today at www.Phoenixhealthcenter.Com/ and learn how treatment can change life around for the better.

domain: medical


text:
Inside the secret research complex, I came across Sitenero. I currently have high relations with everyone except for the Dominion.
However, when I meet Sitenero, the encounter always ends in a fight, with a character saying "In the name of Anfarel, I sentence you to die". However, this contradicts with the quest I have from the People to escort him out of the complex.
I'm not given a choice in dialogue to execute him or spare him, it will always go to execution. To note, I don't have the quest from the undead Anfarel to go into the complex. (I didn't take it since it tanks my rep with the Forge, despite both of the factions being allied now).
I think there's supposed to be a dialogue option to decide what your party does with Sitenero once you meet him?
Edit To Add: If I tank my relationship with the Rebellion (by accepting the Forge quest), you get the option between killing him and letting him come with you, rather than being forced to kill him. To note, in neither play have I accepted the final rebellion quest.

domain: game


Following discussions with Waterford TD John Deasy, Enterprise Ireland has agreed to collaborate with the Department of Agriculture, Food and the Marine to determine what benefit the agency can bring to the State’s fishing ports, including Dunmore East.
“Enterprise Ireland is the agency responsible for marketing our export food sector. I felt they should be involved in our ports and seafood industry,” the Fine Gael deputy said.
The Dáil Public Accounts Committee recently published a report on the six fishery harbour centres which shows their economic potential is not being realised.
The problem of idle, under-utilised and badly run properties has plagued many ports for years — “despite the fact that demand exists for these facilities,” the PAC found. Protracted legal wrangles have ensued in some cases, with poor relations between the Department and harbour users in general.
Deasy, who is vice-chairman of the PAC, said: “While the situation is worse in other ports, there are still some difficulties locally in Dunmore East, including complex issues surrounding arrears.
“But we now have a very proactive harbourmaster and the Department is making progress in dealing with legacy issues it inherited on taking over the marine portfolio eight years ago.”
The Committee’s report identified “a history of inefficiency” across the six centres, from poor property management to “archaic” accounts and lax financial controls, with facilities left vacant and revenues due to the State left uncollected.
In formulating its recommendations, and recognising the need for a more strategic approach, Deasy met with Enterprise Ireland CEO Julie Sinnamon — whose background is in the food industry — with a view to utilising its expertise.
“I put it to her that her agency should have a role in the future of these buildings for seafood processing or related commercial activity and her reaction to the suggestion of collaborating with BIM and the Department was positive.”
Briefing the PAC about the progress made in implementing new administrative and oversight structures for the harbours, Department secretary general Aidan O’Driscoll told Deputy Deasy that the involvement of Enterprise Ireland is “an excellent idea… and I am delighted about the idea of involving it in this process.”
The Committee has recommended that the largely-shelved business blueprint drawn up for the six ports in 2009 be revisited by a newly Fishery Harbours Development Board. It also wants a new arbitration-based dispute resolution mechanism established, and a clear segregation between the Department’s control functions and responsibility for harbour development.
Deasy added: “Landings are up but this is about maximising the local economic benefit. A number of people have approached me about processing shellfish and getting involved in seafood for export in the past six months in particular.
“Enterprise Ireland is the obvious agency to look at the assets we have in each of these ports and use their expertise to help market the industry abroad.”
Waterford Fine Gael TD John Deasy says the “resilient” fishing community of Dunmore East has endured “a legacy of bitter disappointment” due to Government “inaction”.
He made his criticisms after hearing confirmation at today's Public Accounts Committee meeting that a €4 million dredging contract for the inner harbour has been delayed until next year.
The Fine Gael deputy quoted “a litany” of consultants reports and studies into the proposed redevelopment of the State fishery port dating back almost a decade and a half — including a shelved €50-60m upgrade.
“There comes a point when you can’t answer reasonable questions from a fisherman or a business person in Dunmore any longer. I’ve become hesitant about giving affirmation to any Government announcement as it affects Dunmore East...”
Addressing officials from the Dept of Agriculture, Food and the Marine, he went back over the myriad findings, recommendations, “and frankly the lack of activity that has occurred” — starting with the 2000 KPMG technical and socio-economic review of infrastructural requirements in Dunmore East.
This, he said, was followed in 2003 by the Department-commissioned Kirk McClure and Morton Report. Involving preliminary designs and environmental impact assessment, it found the existing harbour was too small, and that the set-up didn’t permit proper development — “effectively a reiteration of the previous report.”
A public consultation process commenced in 2004, and planning permission for the development of the fishery harbour centre was granted the following year. In 2006 €300,000 was provided for design and a similar sum for site investigations.
Mr Deasy then referred to a 2007 cost-benefit analysis by Poseidon Aquatic Resource Management Ltd for the Dept of the Marine into a large-scale State investment highlighted the old age of the harbour, the lack of dredging since the early nineties, and the absence of safe access to the shore for yachts.
The first phase was scheduled to start in 2008 — “and then the economy collapsed.”
However, hopes were raised in March when funding of €4m was announced for the first dredging operation in Dunmore in 22 years. The build-up of sediment has seriously hampered the port’s activities, with larger fishing vessels unable to dock and having to steam to Cork or Howth instead.
The amount allocated under the capital programme is just to dredge the inner basin — “the idea of overall harbour redevelopment is not being spoken of,” Deputy Deasy said. The tender process was to be have been completed by July, but “now we learn that there’s a delay in that.”
Department General Secretary Tom Moran confirmed “we had intended to spend money this year ... [but] we ran into a difficulty with the tender”.
Cecil Beamish, Assistant General Secretary in the Marine Division, explained that the contract has to be re-tendered because the bids received “were deemed, after assessment, not to be value for money for the State and involve potential cost exposures for the State for claims.”
Before seeking new, “more precise” tenders “there is further sampling and analysis being done in greater detail on all the sediments because one of the issues is the level of contamination [by heavy metals] in some of the sediment areas,” he said. Alternative ways of dealing with the material are also being looked at.
Asking when this ongoing pre-tender analysis would be finished, Mr Deasy said: “I need to actually give some certainty to the people in Dunmore East now. I think that’s very important at this point”.
Mr Beamish said “there are a number of steps to go through” but the objective is to get a new specification ready “as early as possible... Clearly the earlier in the year that that can be done the easier it will be for a contractor to carry out the works in reasonable weather conditions, and also taking account of the other [harbour] users.”
Tom Moran added that “there’s an absolute intention to conclude, or begin that, as soon as possible in the new year under next year’s capital programme. So it’s a top priority.”
But Mr Deasy said “When it comes to Dunmore East there’s a legacy of bitter disappointment as to what Government has promised and what Government has actually delivered. Or not delivered.
“There comes a point,” he said, “when you can’t answer reasonable questions from a fisherman or a business person in Dunmore any longer. I’ve become hesitant about giving affirmation to any Government announcement as it affects Dunmore East... it’s got to that point.”
While acknowledging that capital funding had been granted in the past eight years — including €450,000 in 2013 for the widening and extension of the west wharf slipway (after a lot of lobbying) — he surmised that an equivalent amount had gone into the other State harbours over the same period.
Deputy Deasy said the local community, despite countless setbacks, had proved itself “very resilient”, noting that another meeting had been held the previous evening to examine ideas in conjunction with Waterford IT, who have received funding under the Fisheries Local Area Development Scheme for a local economic stimulus feasibility study.
“They’re trying very hard to keep this village vibrant: they had a meeting last night, again, about all of these issues. Some focus and concentration needs to be given by the Department when it comes to Dunmore East and the infrastructural issues that have been identified — ad nauseam — over the last 20 years but have not been acted upon.”
Ultimately, he said, “It’s a neglected port. It has been for a long time. I mean, the litany of reports and non-action as a result is incredible, I have to say. It’s absolutely incredible. I’m going to press you on this. I’m going to chase you with regard to this particular project, for as long as it takes to get the dredging done.
“We were talking, not so long ago, about investing €60m in the harbour there. And those studies were done... There is a case to be answered... The deficit has been on the Government side here,” he said.


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Education system starting to ‘normalise’The Economist.
But South Korea’s enthusiasm for education has also been likened to a “fever”. Students spend long hours in hagwon, private cram schools, trying to outdo their peers in crucial exams and tests that have lasting consequences for their subsequent careers. In principle these tests are simply a measuring device, allowing universities and employers to rank students according to their underlying abilities.
The man in charge of this inspiring and intimidating education system is Seo Nam-soo, who became minister of education in March 2013. In an interview, Seo argued that South Korea’s passion for university was “normalising”. He also pointed out that universities were looking beyond tests results to take a broader view of applicants. Finally, he suggested that South Korean society itself was becoming more diverse and less “monotonous” in its aspirations.
Full report on The Economist site


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Pharmacy Forward 2019 will be taking place at the Birmingham Conference and Events Centre (BCEC).
Conveniently located in the heart of Birmingham, next to New Street Station, there are a wealth of travel and accommodation options.
The BCEC is just a 5 minute walk from Birmingham New Street Station using John Lewis Southside Exit.
If using a sat nav, the postcode is B5 4EW.
There are several car parks within walking distance of the venue.
Discounted hotel rates
Please click here to find local accommodation options.


text:
Paper Folding 3D helps you create origami designs with beautiful textures.
Paper Airplane is a software program teaching you how to make paper planes.
Easily scan, categorize, store, and retrieve your documents digitally.
NoteWorthy Software, Inc.
A free viewer for NoteWorthy Composer files (NWC and NWCTXT.
Sibelius First is the easiest way for everyone to start to write and share music.
Encore offers a flexible environment to compose music with ease and precision.
Bentley Systems, Incorporated
It is an application for composing plot sets from DGN and DWG files.
Bagpipe Player is a music engraving and playing software program.
PhotoCombiner lets you create beautiful sketches and combine different pidtures.
Easy Music Composer Free is a automatic composer.
Put scraps of virtual paper on your desktop with the simplicity of pen and paper.
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GSTrainer Paper Console is a paper trading for GS Trader.
With Nedjosoft PaperForm you can precisely fill and print your paper forms. Just scan your paper for....
Solution for paper form applications which need a paper copy of the form .
You can print your questionnaire on paper for a paper survey.
Tired of preparing test paper?Now prepare online With the Cube Paper Preparation.
A-PDF Paper Manager Lite allows you to manage your paper documents with ease.
Save a paper world invaded by pink critters using a paper cannon.
Image Composer is a professional tool for composing two images.


BRUSSELS – The European Union must help Greece manage its border with Turkey and ensure the right to asylum for those who need it, several members of the European Parliament (MEPs) said on Tuesday.
The EP’s plenary session dedicated to the situation at the Greek-Turkish border was shortened to one day and took place in Brussels instead of Strasbourg because of concerns linked to the spread of coronavirus.
In an earlier statement explaing the special session, the Europarliament said that “since the beginning of March, thousands of people have been trying to cross the Greek-Turkish border by land and sea, following [Turkish President Recep Tayyip] Erdogan’s announcement that his country will no longer prevent them from doing so, as it did in 2016 in exchange for EU financial assistance,” referring to the EU-Turkey joint statement of 2016.
MEPs examined the repercussions of Turkey’s stance on its relations with the EU, the actions of the Greek police towards refugees and migrants, as well as the Greek government’s decision to stop accepting asylum applications for a month.
In a debate with Home Affairs Ylva Commissioner Johansson and the Croatian Presidency of the Council, a majority of speakers criticised Erdogan for using people’s suffering for political purposes,” a Europarliament statement said. “Many also underlined that the 2015 refugee crisis should not be repeated and insisted that the EU needs to update its common rules on asylum,” it further pointed out.
According to the debate, some political group leaders called for a revision of the deal with Turkey, while others showed deep concern about the deteriorating humanitarian situation both at the border with Turkey and on the Greek islands, where thousands of asylum-seekers, many of them unaccompanied minors, are stranded.
The need to respect the Geneva Convention and offer protection to refugees, the allegations about police violence against people attempting to cross the border and the risk that jihadists could be entering EU territory were also raised during the discussion.


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Posterior reversible encephalophaty syndrome
Citation, DOI and case data
Eclampsia and postpartum seizure.
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There are bilateral asymmetrical nonrestricted T2/FLAIR high signal intensity within the cortex and subcortical region of both parietal and occipital and frontal lobes and right external capsule and lentiform nucleus. ADC signal is increased in affected regions due to increased diffusion.
Asymmetric expression and basal ganglia and external capsule involvement in PRES are not common. Partial or asymmetric PRES is more frequently recognized in patients with eclampsia and solid organ transplantation. Awareness of this variability in the pattern is important in proper recognition of PRES, when present.

domain: biology


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Stretch scuba knit with cut outs and ruffles. Approx. 35"L from shoulder to hem, 30"L from bust line to hem (front and back). Asymmetric ruffled neckline. One-shoulder; ruffled cap right sleeve. Side zip. Hem falls above knee. Nylon/spandex;....
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Michael Kors stretch matte jersey dress with allover beading and sequins. Approx. 45 1/2"L from shoulder to hem (size 6). One-shoulder neckline. Wide shoulder coverage on right side. Hidden side zip. Asymmetric ruched seam across front. Skirt....
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Rhodomagnetic Digest was a science fiction fanzine pulished in Berkeley, California, U.S.A.
The first six issues of Rhodomagnetic Digest were edited by George T. Blumendson, published between 1949 and 1950. edited by Don Fabun. The editorial staff was Gladys Fabun, George Finigan, William Nolan and Maggy Garrison. It was published by the Elves' Gnomes' and Little Men's Science Fiction, Chowder and Marching Society. It was published from 1949 till 1951.
Contributing artists included Bob Beestem, Kenn Davis, Elizabeth Farmer, William F. Nolan, and H. Richardson.
Covers were by Kenn Davis, and George Faraco, among others.
Contributing writers included Poul Anderson, George Blumenson, Anthony Boucher, Ray Bradbury (Futuria Fantasia), Greg Calkins, Arthur C. Clarke, Es Cole, Les Cole, J. Lloyd Eaton, George Ebey, Don Fabun, Gladys Fabun, George Finigan, Andrew Gregg, Hazelle Hersh, C.G. Higgins, John Larkins, Bob McCary, Annette McComas, Donald Baker Moore, Gary Nelson, William F. Nolan, Darrell C. Richardson, Sam Sackett, Leland Sapiro, Bob Shaw, William F. Temple (Novae Terrae), Jack Vance, and Elliot Zands.


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Jun 07, 2019
By Christine Ross
Toronto actress and playwright Nonnie Griffin has died less than two weeks before debuting a new one-woman show.
The 85-year-old passed away Fridayin hospital of an aortic aneurysm that ruptured earlier this week. Griffin was a seasoned stage performer known for roles on TV, radio, theatre and Zoomers of a certain age will remember her many classic TV commercial appearances.
Griffin began writing her own parts while in her 70s, starting with “Sister Annunciata’s Secret,” in which she played six different characters. She followed that with 2014’s “Marilyn After,” which imagined what Marilyn Monroe would have been like if she were alive 50 years after her death. Griffin had been preparing to return to the stage June 19 with the self-financed production “Before Scarlett,” in which she was to portray “Gone with the Wind” author Margaret Mitchell. Friends say Griffin lived her life with gusto, joy and was a radiant beauty. She’d been preparing to return to the stage in just over a week with “Before Scarlett,” in which she was to portray “Gone with the Wind” author Margaret Mitchell.

domain: celebrity


There are some good things to say about the newest film by director James McTeigue (“Ninja Assassin,” “V For Vendetta“), a combination of “Sleepy Hollow,” “Saw,” “Se7en” and the latter-day Sherlock Holmes films.
First, it acquaints the uninitiated with the works of Edgar Allan Poe, one of America’s most creative and tortured writers (Poe, while unappreciated in his time, wrote “The Murders of the Rue Morgue,” which is considered by many to be the first detective story). Secondly, it gives the author the Sir Arthur Conan Doyle treatment, bringing his literary characters to life and trying to make them cool superhero modern-day detectives (which is a nice change of pace as several of the previous adaptations in the 60’s starred Vincent Price and were directed by Roger Corman).
The Raven, the newest installment, is also one of the first to actually tell the story of the troubled, alcoholic novelist and begins by reminding us that he was found near death on a park bench in Baltimore on Oct. 7, 1849. For years, it was assumed he died of the effects of alcoholism and exposure, but a recent investigation and documentary has fueled the possibility it may have actually been murder.
The story here definitely takes one side of this argument, revolving around events during the last month of his life.
While an angry, drunken, almost destitute Poe (John Cusack, “2012,” “High Fidelity”) scrounges out a living writing critical reviews of other, better-known poets and authors (Longfellow, Emerson, etc.), a series of murders takes place in the Maryland city. Soon, police detective Fields (Luke Evans, “The Immortals,” “Clash Of the Titans“) sees a familiar pattern: The crimes are eerily similar to Poe’s stories — and the writer is a prime suspect. Once he is cleared of suspicion, however, he becomes Fields’ right hand man in helping to solve the killings, which reach a level of horrid gore, with throats slashed, limbs hacked, bodies cleaved in half and lips sewn together, among other niceties.
Things hit home, though, when the mad person kidnaps his beloved fiancée, Emily Hamilton (Alice Eve, “She’s Out of My League,” “Sex and the City 2”), in a situation straight out of “The Masque of the Red Death.” It’s now personal, so The Raven becomes somewhat of an action/adventure tale, as well.
It’s all a decent ride, but not nearly as exciting as the rebooted Sherlock Holmes franchise, and Cusack is no Robert Downey, Jr. (or even a Johnny Depp, who brought Icabod Crane to life in the Tim Burton adaptation of Washington Irving). He plays a convincing violent drunk, but his scenes with Evans are not very effective and there is little chemistry between him and Eve.
Adding some small, but intriguing support is Brendan Gleeson (“Braveheart,” “The Guard“) as Emily’s father, Captain Hamilton, and Kevin McNally (“Valkyrie,” “Pirates Of the Caribbean”) as Maddux, Poe’s perpetually ticked-off newspaper editor (are there any other kind?).
The movie, though, is expected to carried by the two male leads (as Eve spends most of the time hidden away), and they just barely manage to pull it off.
Their lack of bravado isn’t the only issue with The Raven, however. There were a few other problems, too, including newspapers which scream with 40 column headlines, “Grisly Double Murder” and “Serial Killer At Large.” Anyone who knows ANYTHING about such publications in the 19th Century realizes that they were printed in vertical columns, sometimes eight to 10 across the page and the huge headlines as we know them today did not become fashionable until the 1940s (if they know that they’ll also know that the term “serial killer” was not even coined until the 1960s). Poe also drops the “F” bomb, which certainly did not exist as an expletive in 1849 (it was an acronym from the 1930s), and seemed to be inserted only as a nod to modern audiences (if not modern — often questionable — sensibilities).
Those are minor details, I know, but when making a period piece, it is nice to actually stick to the period. As far as sets and costume design, the film is fairly accurate, which is certainly appreciated.
Overall, The Raven is an engaging mystery thriller that suffers from some drawbacks that can’t be overlooked (especially by a purist). And thanks to a dragging second act that could have used some judicious editing, the movie is about 10-15 minutes longer than necessary, despite the fact that it only has a 111-minute running time.