|Publication number||US5879374 A|
|Application number||US 08/240,272|
|Publication date||Mar 9, 1999|
|Filing date||May 10, 1994|
|Priority date||May 18, 1993|
|Also published as||DE69435056T2, DE69435324D1, US5591213, US5617853, US5800460, US6016059, US6075369|
|Publication number||08240272, 240272, US 5879374 A, US 5879374A, US-A-5879374, US5879374 A, US5879374A|
|Inventors||Daniel J. Powers, David Cameron, Clinton S. Cole, Thomas D. Lyster, Steven T. Mydynski, Carlton B. Morgan|
|Original Assignee||Heartstream, Inc.|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (30), Non-Patent Citations (6), Referenced by (158), Classifications (4), Legal Events (15)|
|External Links: USPTO, USPTO Assignment, Espacenet|
This application is a continuation-in-part of U.S. patent application Ser. No. 08/063,631, filed May 18, 1993, now abandoned the disclosure of which is incorporated herein by reference.
This invention relates generally to a defibrillator system that performs periodic self-tests and, in particular, to a method and apparatus for performing periodic functional, calibration and safety tests in an automatic external defibrillator to verify that the defibrillator's components and operation are within preset specifications.
Prior art external defibrillators were used primarily in the hospital. In that environment, the frequency with which a particular defibrillator was used was relatively high, e.g., on the order of several times per week. Periodic verification tests for these prior art defibrillators typically amounted to a battery level test and a functional test in which the defibrillator was hooked to a test load and discharged. These tests were usually performed once per day or once per shift per manufacturer recommendations. Other tests, such as recalibration of internal circuit components by a biomedical technician, were performed less often, on the order of twice per year, also pursuant to manufacturer recommendations. Each of these maintenance tests for prior art defibrillators was initiated and performed by human operators.
While adequate for relatively frequently-used hospital-based defibrillators, prior art defibrillator test apparatuses and procedures are not optimal for use with portable defibrillators that are used less frequently. For example, defibrillators carried by emergency medical vehicles might need to be used only on a monthly basis. The burden of performing manual battery and performance tests on a daily basis could outweigh the benefits of carrying the infrequently-used defibrillator on the vehicle. The tests should therefore be performed by the defibrillator automatically.
Because the tests are performed automatically, the tests should be both accurate and reliable. The portable defibrillator's mobile environment could add to the frequency of defibrillator component failure, thus increasing the need for periodic tests. In addition, portable defibrillators could be exposed to environmental conditions (such as severe vibration, sudden impacts, heat or moisture) that require an immediate reevaluation of a defibrillator's operational status.
Also, the nature of the tests performed should be different in the portable defibrillator environment because of the relatively infrequent use of the defibrillators. Deterioration of system components over time could move the defibrillator out of its originally specified operating parameters. An infrequently used defibrillator should provide an operator with an indication not only of whether it will operate at all but also verify that the defibrillator meets its established specifications.
Defibrillators are used in emergency situations in which time is of the essence. The operational status of a particular defibrillator as determined by the self-tests should be therefore readily apparent to an operator.
Finally, there is a need for a defibrillator that can automatically recalibrate itself if certain of its system components drift from their initial values. This automatic recalibration minimizes the burden on the defibrillator's operator or maintainer and lengthens the defibrillator's useful life.
This invention is a defibrillator with an automatic self-test system that includes a test signal generator and a defibrillator status indicator. The test system preferably performs functional tests and calibration verification tests automatically in response to test signals generated periodically and/or in response to predetermined conditions or events and indicates the test results visually and audibly. The invention also relates to a method for automatically determining and indicating a defibrillator's status without human intervention.
The invention is described in more detail below with respect to the drawings.
FIG. 1 is a block diagram showing a defibrillator according to this invention.
FIG. 2 is a schematic diagram showing a testing system of a defibrillator according to this invention.
FIG. 3 is a block diagram showing some of the components of an external defibrillator according to a preferred embodiment of this invention.
FIG. 4 is a block diagram showing the system monitor of the embodiment of FIG. 3.
FIG. 5, parts (a)-(e) shows various aspects of a visual display according to the embodiment of FIG. 3.
FIG. 6 is a table showing groupings of external defibrillator self-tests according to a preferred embodiment of this invention.
FIG. 7 is a block diagram showing the interaction of an ECG front end and a testing system according to a preferred embodiment of this invention.
FIG. 8 is a block diagram showing the interaction of a high voltage delivery system and a testing system according to a preferred embodiment of this invention.
This invention is a method and apparatus for automatically determining the status of a defibrillator, for displaying that status to a user or operator, and, for recalibrating certain defibrillator components. The invention is particularly useful for increasing the reliability of infrequently-used defibrillators by providing an indication of a defibrillator's operational status and by recalibrating the defibrillator, where possible, prior to any attempted use of the defibrillator.
In a preferred embodiment, the defibrillator automatically generates a test signal either (1) periodically in response to the passage of time or (2) in response to a specified event or condition, such as the insertion of a new battery or a manual power-up command from an operator. The test signal initiates a plurality of preset self-tests within the defibrillator. The self-tests may include functional tests that verify the operation of certain defibrillator components and subsystems. The self-tests may also include calibration verification tests that determine whether certain defibrillator components and subsystems are operating at preset specifications or within preset specification ranges. In addition, the defibrillator may automatically recalibrate certain components or subsystems in response to a calibration verification test.
No matter what test or collection of automatic self-tests the defibrillator performs, the defibrillator indicates its operational status as determined by the self-tests, such as through a visual display. The indication is preferably fail-safe so that a failure of the status indication mechanism itself will result in the indication of an inoperable defibrillator status.
FIG. 1 is a schematic representation of a defibrillator constructed and operated according to this invention. The defibrillator 10 includes a battery 12, a high voltage delivery system 13 (preferably consisting of a capacitor or capacitor bank 14, a capacitor charger 16 and a switching mechanism 18), an electrode connector 20 and a controller 22 that operates the charger and switching mechanism to deliver an electric shock from the capacitor to electrodes connected to the electrode connector or interface 20. The defibrillator has a testing system 24 including a test signal generator 26 and a defibrillator status indicator 28. The purpose of testing system 24 is to test the operational status of the defibrillator's components and to provide an indication of that status automatically in response to predetermined events or conditions and/or periodically on a preset schedule.
While the testing system 24 and controller 22 are shown in FIG. 1 as separate elements, they could be combined into a single element that performs all testing and operational control functions. In addition, the testing system 24 may also include components located within other defibrillator subsystems, such as within the high voltage delivery system. In any event, the testing system communicates with the tested defibrillator components and systems via communication channels to control the tests and to gather information about the status of the tested components. The testing system also communicates indicator control signals to the status indicator via communication channels as well.
FIG. 2 is a schematic drawing showing self-testing subsystems making up testing system 24 in the preferred embodiment. It is not necessary that a given defibrillator include each of the subsystems shown in FIG. 2. According to this invention, the defibrillator must include at least one automatic self-test that is initiated in response to a test signal generated either periodically or as a result of a specified event or condition.
Also, it is not necessary for the apparatus performing each test in each subsystem to be in the same physical location. FIG. 2 is a logical grouping and is not intended to be an actual drawing of a defibrillator or defibrillator subsystem.
Each self-test in each group of FIG. 2 responds to a test initiation signal from signal generator 26, and the result of each self-test in each group affects the status is indicated on status indicator 28. This collection of self-testing subsystems may be added to or subtracted from without departing from the invention. In addition, while there may be other tests performed by the defibrillator that do not meet these criteria, such tests form no part of this invention.
The first testing subsystem is the functionality tester 23. The self-tests performed by this subsystem test the operability and functionality of defibrillator components and/or subsystems. Examples include the testing of switches within the switching mechanism of the high voltage delivery system and the testing of registers within the defibrillator's controller.
The second testing subsystem is the calibration verifier 25. The self-tests performed by this subsystem determine whether certain defibrillator components and/or subsystems meet preset specifications. Examples include determining the capacitance of the defibrillator's capacitor and checking the response of the controller to capacitor voltage values.
The testing system also may include a recalibrator 27 that adjusts a component or subsystem of the defibrillator in response to a determination that the component or subsystem is no longer, or no longer operates, at a specified value or within a specified range of values. For example, parameters used by the defibrillator's controller to control operation of the high voltage delivery system may be changed to reflect changes in the values of defibrillator components.
The actual self-tests automatically performed by a defibrillator's testing system depend in part on the defibrillator's structure and in part on reliability goals set by the defibrillator's designer. Trade-offs may be made between the completeness of a given self-test (which adds to the reliability of the defibrillator product) and the cost of implementing a complete and accurate self-test. A particular implementation of a defibrillator and its self-testing system is described below. The discussion merely illustrates a preferred embodiment of the invention. Our invention covers other defibrillator designs and other collections of defibrillator self-tests as well.
FIG. 3 is a block diagram showing a preferred configuration for the defibrillator of this invention. Some of the elements are described in more detail further below. Defibrillator elements not specifically described in this application may be configured and operated in the manner described in U.S. patent application Ser. No. 08/227,553, now U.S. Pat. No. 5,607,454 "Electrotherapy Method and Apparatus," filed Apr. 14, 1994, the disclosure of which is incorporated herein by reference.
As shown in FIG. 3, external defibrillator 30 has a power source such as a removable battery 32, a controller such as CPU 34, and a high voltage delivery system 36 including a capacitor or capacitor bank and appropriate switches (not shown) to deliver a pulse of electrical energy to an electrode connector or interface 38 and then to a patient via electrodes 40. Delivery of the electrical pulse is controlled by CPU 34. A test and isolation relay 76 and a test load 78 are provided for reasons explained below.
An ECG front end system 35 acquires and preprocesses the patient's ECG signals through electrodes 40 and sends the signals to CPU 34 via a system gate array 56. System gate array 56 is a custom application specific integrated circuit (ASIC) that integrates many of the defibrillator's functions, such as display control and many of the instrument control functions, thereby minimizing the number of parts and freeing up main CPU time for use in other tasks. The system gate array could be replaced by discrete logic and/or another CPU, of course, as known in the art.
The external defibrillator shown in FIG. 3 also has a memory device 80 (such as a removable PCMCIA card or a magnetic tape), a microphone 81, a speaker 82, a LCD panel 83 and a set of illuminated push-button controls 84. None of these elements is critical to the present invention.
A system monitor mediates the external defibrillator's self-testing functions by watching for scheduled test times and unscheduled power-on events. The system monitor generates test signals periodically at scheduled times and in response to specified events. The system monitor is also responsible for operating a fail-safe defibrillator status indicator or display. The system monitor communicates test signals to the CPU via a communication channel, and the CPU controls and gathers information from tested defibrillator components via other communication channels, some of which pass through system gate array 56.
In the embodiment shown in FIG. 3, system monitor 42 is separate from CPU 34 so that power can be provided to the system monitor without powering any other part of the defibrillator. Thus, system monitor 42 has its own power supply 44 apart from the defibrillator power supply 46, as shown more specifically in FIG. 4. This dedicated power supply 44 draws approximately 30 microamps from battery 32 and is active whenever power is available from the battery. The dedicated system monitor power supply may also have its own battery apart from the main battery.
As shown in more detail in FIG. 4, the other major element of system monitor 42 is a low-power gate array 48. In this preferred implementation, gate array 48 is a 44-pin custom ASIC. Gate array 48 is preprogrammed to perform the functions of the system monitor. As an alternative, the system monitor could be implemented with a low power CPU and/or with discrete logic components.
Gate array 48 operates a 32.768 kHz crystal oscillator to provide the defibrillator testing system's scheduling function. The gate array divides the oscillator's frequency repeatedly to generate periodic (e.g., daily, weekly, monthly) test initiation signals. The system monitor also sends a 32.768 kHz clock signal out on line 52 to be used by the defibrillator system to perform other functions.
In addition to the periodic tests, certain defibrillator self-tests are performed rapidly in response to activation of the defibrillator's ON button (shown schematically as element 54 in FIG. 4) by an operator. Activation of the ON button 54 prompts the system monitor to generate a power-on test initiation signal.
The system monitor indicates the status of the defibrillator as a result of the periodic and power-on self-tests. The status indicator should be fail-safe so that the indicator will indicate an inoperable status if the system monitor should fail. The system monitor communicates control information to the status indicator through communication channels.
In a preferred embodiment, the system monitor 42 powers a status indicator consisting of a visual display 58 and a piezo buzzer 60 to indicate the operational status of the defibrillator to a user. As shown in more detail in FIG. 5, visual display 58 may be a multiple-part LCD 62 powered by the system monitor via AC-coupled drive 72. The top plate 64 of the LCD is a clear window with an "OK" symbol printed on its back. The middle plate 66 is an LCD shutter that is biased so as to be opaque when driven by the system monitor via drive 72. The bottom plate 68 has an international "Not" symbol on its top surface. Middle plate 66 also includes a separately addressable portion 70 driven by the system monitor via AC-coupled drive 74.
In operation, the system monitor 42 drives LCD shutter 66 only when confirmation of successful testing is received within an expected time window. The visual display would then appear as in FIG. 5, part (d). Failure to receive proper test confirmation within the allotted time window will cause the system monitor to cease issuing drive signals to shutter 66. Shutter 66 will then go transparent to superimpose an international "Not" symbol on the "OK" symbol in the LCD as shown in FIG. 5, part (c). The system monitor will also then begin powering a piezoelectric failure alert buzzer 60, preferably for 200 msec, every 10 sec, so long as there is power enough to do so.
The primary advantages of the visual display of the preferred embodiment are its low power requirements and the fact that it is powered by an AC signal rather than a DC signal. This latter point ensures the display's fail-safe nature, since the shutter of middle plate 66 cannot be maintained opaque without the active involvement of the system monitor generating the AC signal.
Separately addressable portion 70 serves as a positive indication (in addition to the fail-safe "OK" symbol) that the defibrillator has power and is functioning properly. Portion 70 blinks periodically through the alternating driving and releasing of the signal to portion 70 through drive 74.
In an alternative embodiment, an LCD shutter covering an "OK" symbol is driven open to display the "OK" symbol to indicate an operational defibrillator status. The shutter is permitted to close to cover the "OK" symbol to indicate that the defibrillator is not operational. Another alternative category of fail-safe indicators include electromechanical devices, such as those used for aircraft instrumentation.
In response to the generation of a test initiation signal, the system monitor commands the defibrillator's power system to turn on. The CPU then issues an appropriate series of commands to perform the required tests. The tests performed in response to the periodic and power-on test initiation signals are described in more detail further below with reference to the table shown in FIG. 6.
FIG. 6 shows the scheduling of some of the tests that can be performed by the self-test system of this invention. Some of the tests are performed when a battery is inserted, some are performed daily, some are performed weekly, some are performed monthly, some are performed when an operator powers-up the external defibrillator, and some are performed during operation of the defibrillator. FIG. 6 is not an exhaustive list of possible tests, nor is performance of any particular test listed in FIG. 6 essential to the invention. The tests and test groupings shown in FIG. 6 are merely an example illustrating this invention.
The first test grouping is the Battery Insertion Test or BIT. The BIT tests all internal subsystems, allows the user to verify PCMCIA card type, setup parameters, and the proper operation of systems that are only externally observable (e.g., LCD operation and button functionality). The BIT is performed whenever a good battery is inserted into the defibrillator, unless the defibrillator's electrodes are attached to a patient.
The second test grouping shown in FIG. 6 is the Monthly Periodic Self-Test (MPST). The MPST performs the same automated tests as the BIT, but in order to conserve power it does not run the externally observable systems (e.g., LCD, LED's, etc.). The MPST is performed once every 28 days so long as a good battery is maintained in the defibrillator.
The third test grouping shown in FIG. 6 is the Weekly Periodic Self-Test (WPST). The WPST performs essentially the same automated tests as the MPST, except the test shock is not performed in order to conserve power. The WPST is performed once every 7 days so long as a good battery is maintained in the defibrillator.
The fourth test grouping shown in FIG. 6 is the Daily Periodic Self-Test (DPST). The DPST performs fewer tests than the WPST in order to conserve power.
The fifth test grouping shown in FIG. 6 is the Power-On Self-Test (POST). The POST is performed whenever an operator turns the defibrillator from OFF to ON in preparation for use of the defibrillator on a patient. The tests performed in the POST are selected to provide the highest confidence of instrument functionality in the shortest possible time.
The final grouping of tests in FIG. 6 is the Runtime Tests. These tests are performed continually during runtime to assess the safety and effectiveness of portions of the defibrillator. The tests are explained in more detail below.
The self-tests listed in FIG. 6 are not necessarily listed in the order performed. The performance order depends in part on the interrelationship of the components and functions tested. To the extent there is no such relationship, then the self-test order is arbitrary.
In general, failure of a self-test results in an indication of an inoperable status or error status by the defibrillator's status indicator. For example, in the defibrillator described above, failure of a self-test would result in the display of the "Not OK" symbol by the system monitor and activation of the audible failure signal. The system monitor takes this action if it receives a signal from the CPU or from the system gate array that a test has failed (i.e., that a tested component is not functional or that the component's calibration could not be verified) or if the system monitor does not receive information showing that the currently-scheduled self-test has passed before the expiration of the watchdog's time-out period (e.g., 200 msec.).
In a preferred embodiment of this invention, self-test scheduling and result information may be stored in system memory for later diagnosis of the defibrillator by a technician or operator. For example, in the defibrillator described above, date and time information regarding the self-tests performed are stored in internal memory and/or in the removable memory 80 (e.g., PCMCIA card) so that a history of performed tests can be obtained by a technician or operator. In addition, if a self-test indicates that a component or subsystem is not functional or is out of calibration, or if any recalibration has been performed, detailed information about that test is stored in internal memory and/or in removable memory. Information regarding environmental conditions (temperature, humidity, moisture, impacts) may also be stored for use in later diagnosis.
The CPU self-test is a functional test. During the CPU self-test the CPU tests its internal register integrity and verifies its access to local and external memory locations. If the CPU does not pass these initial tests, it attempts to notify the user of a system failure by writing to a system failure register in the system monitor, resulting in a status display showing "Not OK". If the CPU does not respond to the system monitor within 200 msec of power on, the system monitor assumes the CPU is dead, and the "Not OK" symbol is displayed.
The System Gate Array self-test is also a functional test. In the System Gate Array self-test, the CPU verifies that it can write to and read from the system gate array register set. This test also tests other components of the system gate array, such as whether defibrillator waveform control state machines are functioning correctly. Test failures are handled as for the CPU self-test above.
The System Monitor Gate Array self-test is a functional test as well. The System Monitor Gate Array self-test verifies that the CPU can write to and read from the system monitor.
At the beginning of the Program ROM CRC (Cyclic Redundancy Check) self-test, the CPU resets the system monitor watchdog and executes a CRC on program ROM. This test is a functional test.
In the System RAM Checksum self-test (a functional test), RAM used for data memory is verified using a test pattern that has a high probability of identifying both address and data faults within RAM. Once the pattern has been written to system RAM, the test calculates a checksum based on the system RAM contents.
In the Video RAM Checksum self-test, RAM used for video memory is verified in the same manner as for the system RAM. This self-test is a functional test.
In the Device Flash ROM Checksum self-test, a checksum of the voice data pointer and voice data record is calculated and compared with the checksum value stored in the internal flash ROM. This self-test is a functional test as well.
In the System Watchdog Verify self-test, the CPU verifies the watchdog by writing a known watchdog time-out into the watchdog register and looping until the watchdog time-out register in the system monitor indicates that the watchdog timer has expired. During this test, the watchdog outputs, NMI, and RESET are disabled. The CPU signals a failure if the watchdog timer does not expire within the expected time frame.
The PCMCIA Card Verify self-test is a functional test that checks for the presence and type of the removable memory.
The next four self-tests listed in FIG. 6--Front End Gain, Artifact System, CMR Channel, and Defibrillator Connector/Relay--are all part of the ECG front end tests. These tests verify the functionality and verify the calibration of the ECG input circuitry and the patient/electrode connection circuitry. These tests are not performed during the POST since the tests assume that there is no load attached to the defibrillator output connector.
An explanation of some special features of the external defibrillator of this invention is required as background for the ECG front end tests. FIG. 7 shows the ECG front end 35 in relationship to the system gate array 56, the high voltage delivery system 36, a test and isolation relay 76 and the patient connector 38, as well as communication channels among some of these elements. The test and isolation relay 76 is normally in the state shown in FIG. 7 so that no shock can be delivered from the high voltage delivery system 36 to the patient connector 38 and to the electrodes 40 attached to a patient.
In this state, any signals from electrodes 40 will pass through a pair of protective resistors 86 and 88 to an ECG amplifier 90. A high resolution A/D convertor 92 digitizes the ECG data and sends it to the system gate array 56 for processing by the CPU to determine whether a shock is required. The system gate array 56 also sends control signals to the A/D convertor 92.
The ECG front end 35 also has a patient/electrode connection tester consisting of a signal generator 94 connected to the ECG signal input lines through a pair of protection resistors. The signal generator 94 receives input from the ECG analog output and carrier frequency commands from the gate array. The patient/electrode connection tester also produces an artifact test signal which is sent through ECG amplifier 90 to the CPU via line 98. ECG signal collection and analysis and artifact detection are not part of the present invention.
During automated testing, the system gate array 56 uses the signal generator 94 as a test signal injector to verify the function of the various ECG front end elements, wiring to the patient connector 38, and the normally-open contacts of the test and isolation relay 76. To test the ECG processing elements, the system gate array 56 causes the signal generator 94 to inject a small, low-frequency signal mimicking the amplitude and frequency characteristics of an ECG signal, thereby simulating a patient being monitored by the defibrillator. As the frequency of this test signal is varied, the digital data stream from the system gate array is checked by the CPU for values indicative of proper gain and filtering characteristics of the ECG front end, thus verifying the functionality and calibration of the analog and A/D conversion pathways.
In the Defibrillator Connector/Relay self-test, the function of the test and isolation relay contacts 100 and 102 and patient connector wiring are tested. The system gate array 56 causes the signal generator 94 to emit a 100 microamp, 600 Hz test signal and concurrently switches the test and isolation relay 76 to the normally-open position (shown in phantom in FIG. 7). The test current signal is carried to a 4-wire connection 104 and 106 directly on the patient connector contacts, through the relay common connection, and into the high voltage delivery subsystem 36, where both signal lines are held at ground potential. The relay 76 is then switched to its normally closed position. Carrier voltage is measured in both positions is indicative of the resistance of the circuit tested. When the relay is in normally open position, the carrier voltage should be approximately equal to the full scale voltage of signal generator 94. When the relay is in the normally closed position, carrier voltage should be approximately zero.
Finally, in the Artifact System self-test, the system gate array causes the signal generator 94 to emit signals indicative of artifact generation at the electrodes. Proper receipt of artifact signals of the expected amplitude at the CPU verifies the function and calibration of this channel.
There are three battery-related self-tests that are members of each of the test groupings in the preferred embodiment. The battery tests described below are based on a defibrillator design using the battery capacity indicator described in U.S. patent application Ser. No. 08/182,605, now U.S. Pat. No. 5,483,165 filed Jan. 14, 1994, (specifically, the embodiment of FIG. 2) the disclosure of which application is incorporated herein by reference. Other battery charge sensor arrangements and other battery charge subsystem self-tests may be used, of course, without departing from the scope of the invention.
The Battery Sense Cell Measurement self-test listed in FIG. 6 refers to a battery capacity test described in Ser. No. 08/182,605 now U.S. Pat. No. 5,483,165 in which a parameter of a single battery cell is monitored to determine the remaining capacity of the entire battery. In the preferred defibrillator configuration, this functional self-test determines whether the remaining battery capacity is sufficient for performing one more use of the defibrillator by determining whether the voltage of the sense battery cell is above a threshold value of approximately 2 volts. If not, then a Low Battery Warning State is entered. If this state is entered during a BIT, DPST, WPST or MPST, the unit returns to Stand-by mode displaying the "Not OK" symbol. If this state is entered during a POST or during runtime, the user is alerted by a symbol appearing on the LCD display 83 and with an audible prompt.
The second listed battery self-test is the Battery Sense Cell Load Check. This calibration verification self-test verifies the sense cell additional load circuitry described in Ser. No. 08/182,605 now U.S. Pat. No. 5,483,165 by turning the additional load circuitry on and off and measuring the voltage load across the load resistor. This test can actually be performed while performing the first battery self-test.
The third listed battery self-test is the Battery Stack Check. This functional test measures the voltage of the entire battery cell stack as a cross-check against the Battery Sense Cell Measurement test. If a portion of the battery stack other than the sense cell has been damaged, the voltage of the entire stack could be different than that which would have been expected based on the sense cell test.
In the Power Supplies Check calibration verification self-test, the system monitor activates the defibrillator's power supply system to supply power to all of the instrument's elements. Scaled representations of the voltages from the supplies are input for verification to the main CPU A/D convertor. For example, the major power supplies are: +18 volt switched battery; +5 volt for system monitor; +5 volts for main logic and analog; -5 volt for analog only; -14 to -22 volt CPU adjustable for LCD bias; +20 volts for IGBT switch drives; +2.5 volt reference for ECG front end; +5 volt reference for main CPU A/D convertor; and 50 ma current source supply for LCD backlight (tested by voltage developed). In addition, the high voltage supply is tested by its ability to charge the capacitor.
The HV Isolation Relay self-test determines the functionality of the test and isolation relay 76. In the first part of the test, the system gate array 56 moves the test and isolation relay to its normally open position, i.e., with the switches against contacts 100 and 102. The ECG front end measures the impedance across conductors 96 and 97. If the measured impedance corresponds to a predetermined impedance value, then the relay passes this part of the test.
The ECG front end then measures the impedance across conductors 96 and 97 with the test and isolation relay 76 in the normally closed position shown in FIG. 7. The measured impedance should be high (>14 k Ohms). If not, either a load is present at electrodes 40 or the relay failed to move completely to the normally closed position. In either case, the test fails, and the system monitor displays the "Not OK" symbol on the status indicator. In addition, failure to meet both parts of the Isolation Relay test prevents the defibrillator from performing the High Voltage Discharge Test described below.
Under normal conditions, the defibrillator used to implement and practice the preferred embodiment of this invention delivers a biphasic waveform to the patient, as described in more detail in U.S. patent application Ser. No. 08/227,553now U.S. Pat. No. 5,607,454. FIG. 8 provides further information regarding the preferred defibrillator's high voltage delivery system and how its operation is verified and calibrated during self-test.
High voltage delivery system 36 has a capacitor or capacitor bank 112 which can be charged to a preset voltage through a high voltage charger 114 connected to the power supply system 46 and battery 32. Operation of the high voltage charger is controlled by system gate array 56. A high voltage switch 110 consisting of five switches A-E and a shunt resistor RBITE controls delivery of the biphasic waveform from capacitor 112 to the patient connector 38 through test and isolation relay 76 under the control of system gate array 56.
Information regarding charge, current and voltage parameters at the capacitor is provided to system gate array 56 by a current and charge measurement device 116, an overvoltage detector 118 and a voltage divider 120. As described in more detail in Ser. No. 08/227,553 now U.S. Pat. No. 5,607,454, current and charge measurement device 116 is preferably a comparator that trips when a preset charge amount has been transferred from capacitor 112. The time required for this charge transfer is determined by system gate array 56 and is used to determine first and second phase durations via a look-up table in system gate array 56. All information and control signals pass among the elements via communication channels, some of which are shown schematically in FIG. 8.
As explained in Ser. No. 08/227,553 now U.S. Pat. No. 5,697,454, resistor RBITE is part of an overcurrent protection mechanism to protect circuit components from the effects of high current in the event that the impedance load between electrodes 40 is too low. Unless the initial current as measured by current and charge measurement device 116 is below a preset threshold, RBITE is kept in the waveform delivery circuit to limit the current flowing from capacitor 112 through the switching mechanism 110.
The high voltage delivery system has an overvoltage protector that protects switching circuit components from the effects of excessive voltage in the event of a higher than expected patient load resistance by preventing any transition from a first biphasic waveform phase to a second biphasic waveform phase. Analog voltage information from the capacitor is fed from a voltage divider 122 to an overvoltage detector 118. Overvoltage detector 118 is preferably a comparator that trips at a preset voltage. The status of the comparator is communicated to system gate array 56, which controls operation of the switching mechanism 110.
Finally, analog information regarding the charge state of capacitor 112 is sent to CPU 34 via voltage divider 120, where it is converted to digital form. This capacitor voltage information is used by the CPU to control capacitor charging.
The High Voltage Delivery Subsystem self-test actually includes a number of individual self-tests. Capacitor 112 is charged to full voltage (e.g., approx. 1710 volts). As the capacitor voltage rises, the calibration of the overvoltage detector 118 is checked to see that it trips at the proper threshold voltage. If it fails to trip, the system gate array returns a signal to the system monitor to show "Not OK" on the status indicator.
After the capacitor has been fully charged, the system gate array 56 sets the high voltage switch 110 to its normal initial discharge position (switches A and E closed, all other switches open) and commences discharge of the capacitor through the test and isolation relay 76 to the test load resistance RL. RL simulates the load of a patient to whom the defibrillators electrodes may be attached. RL is preferably approximately 10 ohms, however, which is smaller than the minimum allowable patient resistance for the defibrillator. This low resistance assures that the test stresses all of the elements tested in the high current pathways for worst-case patient conditions.
During this part of the High Voltage Delivery self-test, the system gate array verifies overcurrent detection calibration by determining whether the CPU correctly identifies the overcurrent condition detected by current and charge measurement device 116. The system gate array also checks for proper operation of the charge threshold detector and that the overvoltage detector 118 trips properly when the capacitor voltage drops below the safe voltage threshold, in both cases by determining whether these events occur at their expected times. If either of these parameters is not its expected value, the system monitor displays "Not OK" on the status indicator.
As the capacitor voltage drops during discharge through the test load, the current measured by the current and charge measurement device 116 drops as well. The CPU marks the time the current drops below the overcurrent threshold (t0). As the current continues to fall, the CPU marks the time (t1) that the current reaches a value that is 37% of the overcurrent threshold. The difference of these two times is the time constant given by the product of the capacitor value C and the series resistance:
t.sub.1 -t.sub.0 =(R.sub.L +R.sub.BITE)* C.
Switch D is then closed to short out RBITE. This results in another overcurrent situation, and the CPU once again marks the time (t2) of capacitor decay to the overcurrent threshold and the time (t3) to 37% of the threshold. Since RBITE has been removed,
t.sub.3 -t.sub.2 =R.sub.L *C.
Since the time measurements can be made very accurately, the relationships between the resistive and capacitive components (and therefore their calibration) can be verified very accurately as well: ##EQU1## If the calculated resistance value differs from the expected value by more than a predetermined amount (e.g., 1%), or if the calculated capacitance value differs from the expected value by more than a predetermined amount (e.g., 5%), the system monitor displays the "Not OK" symbol.
In the preferred embodiment, the gain of the comparators of the current and charge measurement subsystems are determined by the particular values of the components used during assembly of the device. Due to allowable tolerance variation of the components, the times that the currents pass associated threshold values (t0 and t2) may vary from ideal values (t0 (ideal) and t2 (ideal)). Actual values of t0 and t2 are measured during self-test of the instrument and compared to stored t0 (ideal) and t2 (ideal). If the actual values of t0 and t2 measured during the High Voltage Discharge Test differ from the ideal values by less than a preset amount, then the gain on the comparator of the current and charge measurement device 116 is automatically recalibrated by the CPU to a range closer to the ideal value. If the actual values differ from the ideal by the preset amount or more, the test fails and the system monitor displays the "Not OK" symbol on the status indicator.
In a similar manner, the expected time for times for the measured charge delivery to cross the charge threshold used to determine first and second phase durations in normal operation is compared to the actual time. If the difference is less than a preset value, the CPU recalibrates the phase durations by recalculating the phase duration values according to a predetermined equation and storing the new values in the look-up table. Alternatively, the CPU could simply replace the original look-up table with another that is correlated with a particular time difference. If the time difference is equal to or greater than the preset value, then the test fails and the system monitor displays the "Not OK" symbol on the status indicator.
Another feature of the external defibrillator of preferred embodiment is an undercurrent detector. If the patient to whom the electrodes are attached has an impedance greater than a specified value, or if one of the electrodes has become dislodged or unattached, in normal operation the defibrillator's discharge will abort. This condition is detected by the current and charge measurement device 116 in conjunction with the CPU.
The High Voltage Delivery self-test verifies calibration of the undercurrent detector by determining whether the low current condition is detected as the capacitor continues its discharge and the discharge current falls. If the CPU fails to detect the undercurrent condition, the test fails and the system monitor displays the "Not OK" symbol on the status indicator.
After the capacitor has completely discharged, it is recharged and discharged through the second current path by opening all switches in high voltage switch 110, then closing switches B and C. Many of the same parameters described above can be measured to verify the functionality of switches B and C.
The Waveform Delivery self-test is performed only while the defibrillator is operating in normal mode (e.g., connected to a patient). The defibrillator evaluates the measured and calculated waveform parameters after each delivered shock to determine if the waveform was delivered as expected. For example, if the defibrillator is constructed and operated according to U.S. patent application Ser. No. 08/227,553 now U.S. Pat. No. 5,607,454, the defibrillator will analyze waveform parameters such as start voltage, phase 2 end voltage, phase 1 duration and phase 2 duration. If the delivered waveform parameters cannot be reconciled with other information available to the defibrillator, the defibrillator warns the operator of a potential fault condition by, e.g., displaying a warning on the defibrillator's LCD.
The three Calibration Standard self-tests are an automatic way of verifying that defibrillator system standards have not drifted out of calibration. The standards are the values of RL, RBITE, the system monitor clock, the CPU clock, the CPU A/D convertor reference voltage and the ECG front end A/D convertor reference voltage. For all test groupings except the run time test, the voltage references are checked against each other to determine if either has drifted far enough from its expected value to affect the accuracy of the defibrillator. Specifically, the analog reference voltage for the ECG front end A/D convertor (which has an expected value of 2.5 volts in the preferred embodiment) is measured by the CPU A/D convertor. If the measured digital value differs from 2.5 volts by more than a predetermined tolerance, then at least one of the two reference voltages (i.e., either the ECG front end A/D convertor reference voltage or the CPU A/D convertor reference voltage) has drifted so far so as to affect the reliability of the device.
The time references are cross-checked in a similar way. The CPU counts the clock pulses from the system monitor clock for a predetermined amount of time (as measured by the CPU clock). If the number of counted system monitor clock pulses differs from its expected value by more than a predetermined amount, then at least one of the two clocks has drifted out of the tolerance range.
In addition, as discussed above, the High Voltage Delivery self-test cross-checks the values of RL and RBITE. Verification of the calibration of all three sets of reference variables is a prerequisite to the overcurrent detection calibration and charge threshold detection calibration described above.
In normal stand-by mode, the contacts beneath all buttons should be open. The Stuck Button self-test determines whether any of the contacts are closed. If so, the test returns a "Not OK" signal.
The remaining tests require user intervention and/or observation and are therefore part of only the BIT or POST test groupings. In the Button test, the user is prompted to depress identified buttons on the instrument to determine whether the buttons are functioning properly. All of the other tests run without user intervention. They each require the user to observe that the defibrillator elements tested are functioning correctly.
In addition to performing the self-tests according to the periodic schedule and in response to the battery insertion and operation of the defibrillator (as shown in FIG. 6), a group of self-tests can be performed automatically in response to environmental events, such as mechanical shock, e.g. as in a fall (as measured by an accelerometer); vibration (also as measured by an accelerometer); the invasion of moisture into the defibrillator housing (as measured by a humidity sensor); or exposure of the defibrillator to temperature extremes (as measured by a thermocouple, thermistor or other temperature sensor).
Variations of the structure and methods described above are within the scope of this invention. Tests and test structures may be tailored to meet the needs of a particular defibrillator design and its intended use environment.
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|Jul 1, 1994||AS||Assignment|
Owner name: HEARTSTREAM, INC., WASHINGTON
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:POWERS, DANIEL J.;CAMERON, DAVID;COLE, CLINTON S.;AND OTHERS;REEL/FRAME:007048/0393
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Watch Smallville Season 4 Episode 2 Online. Best and Free Online streaming for Smallville TV Show. We picked the best sites to stream s04e02. Simply pick a site below and click "Watch Now!" button next to it. Some of the links may be broken, please upvote the working and good links so other users see those links for Smallville Season 4 Episode 2 s04e02 at the top of the list.
If you hate the charaters so much then ust stop watching. I personally like most characters except from lionel and lois' father
But as always, Clark is still a crying sob, narcissist-complex ridden guy, complaining about Lex trying to find Truth, while conveniently ignoring how he himself has been lying to everyone’s faces, and damaging Lex over the years. Clark Kent is pathetic.
Lana lang, the useless, f*ck*d up character, comes back to Smallville. Oh, and she leaves her good, hot guy back in Paris. But this dude comes back again. He looked like an insect getting coming in to get trapped in to the venomous female spider's web. About Clark, he finds out eventually Chloe is alive & kicking well. Thanks to Lex. But as always, Clark is still a crying sob, narcissist-complex ridden guy, complaining about Lex trying to find Truth, while conveniently ignoring how he himself ha

domain: entertainment


text:
Rate this post
March 21, 2024 @ 23:39 +03:00
– GBPCAD broke support level 1.7200
– Likely to fall to support level 1.7070
GBPCAD currency pair continues to fall after recently breaking the support level 1.7200 (former monthly high from February, which has been reversing the pair from last month).
The breakout of the support level 1.7200 accelerated the active short-term impulse wave c.
Given very strongly bearish sterling sentiment seen today, GBPCAD currency pair can be expected to fall to the next support level 1.7070, coinciding with the support trendline from September.

domain: news


text:
Popular fashion designern & icon, Remi Osholake (a.k.a. Remi Lagos) has passed away at the age of 51. She died on yesterday (Saturday, the 3rd of November) morning at Harley Street Clinic in London after undergoing a surgical operation to treat her cancer. Osholake trained at the East Croydon School of Art & Design, Chelsea School of Art & Design and Inchbald School of Art & Interior Design. She successfully expanded the creative phases of Remi Lagos on prestigious fashion runways in Europe, the United States of America and Africa. Tributes have been pouring in from her friends, colleagues and loved ones.
TV presenter, Funmi Iyanda, who was a close friend to the deceased posted the following on Twitter
My dearest friend Ms Remi Osholake (Remi Lagos) passd on dis morning. She had cancer. She was a remarkable, creative force 2 d end. Life is.
— Funmi Iyanda (@Funmilola) November 3, 2012
Designer Adebayo Jones, another close friend & colleague to Osholake also posted the following message on his Facebook wall:
Thanking You All for Your Support and Prayers. Sadly my dear friend who has been in hospital treating for Cancer, whom most of you have prayed for and sent goodwill messages, has passed away moments ago. I am still in shock. I just don’t get it how someone can be diagnosed and be gone within two weeks. I saw her on Thursday and she was in a very delicate state which greatly distressed me the whole night and Friday. I really did wish there was something I could have done. This morning just about 12 noon, I was praying for another friend going through an operation as I write, and I spent the rest of the time praying for my dear friend Remi and pleading God’s mercy. Got the message just after I finished praying. May her soul find perfect peace AMEN. Thank you all for your prayers and God bless you all.
Dear Remi .. You will be greatly missed as a truly beautiful soul and a great Artisan.. You have left a big mark that cannot be easily equaled. It’s been quite a while and a blessing knowing you since 1987 just after returning from England to set up your first outlet Freaky Designs.. The joy for me is that you experienced LOVE right to the end.. We all Loved you and you Loved us back equally.. I will not forget your words.. You told me “Tell The World I Love Them” and just so you know dearest Remi, We Love You Too… Peace and love to all the family… Have to stop here. Have no more words at the moment. We will miss your beautiful smile! Rest in Peace.
May her soul rest in peace

domain: artistic


text:
A new resolution introduced in the House of Representatives would encourage the vice president and the Cabinet to have President Donald Trump undergo a physical and mental health exam to determine if he is stable enough to stay in office.
Rep. Zoe Lofgren (D-Calif.) introduced the resolution on Friday. Should the results of said exam be unfavorable, the resolution calls for Vice President Mike Pence and members of the Cabinet to remove Trump from office.
The move would invoke the 25th Amendment, a rarely used constitutional provision that allows the vice president and a majority of Cabinet members to jointly remove the president from office and replace him with the vice president.
In a statement announcing the resolution, Lofgren asked if the president suffers “from early stage dementia.”
“Has emotional disorder so impaired the President that he is unable to discharge his duties,” she continued. “Is the President mentally and emotionally stable?”
Lofgren pointed out that Trump has not yet released a “serious” medical evaluation to the public.
Lofgren, who represents California’s 19th District, is not a professional psychiatrist or psychologist, according to Mercury News.
She doesn’t expect the resolution to pass, but she told the newspaper “it will stimulate conversation,” adding that Trump would get the evaluation if “he cares about the country.”
Lofgren has often criticized Trump’s remarks and policies throughout his presidency. The representative suggested on Tuesday that “something is seriously wrong with President Trump,” responding to his off-the-cuff remarks on the Charlottesville white supremacist riot made during an impromptu Q&A with reporters in New York.
“Why can’t he just condemn Nazis,” she asked on Twitter. “Unscripted words today show who he really is. Shameful!”
Lofgren isn’t the first politician or critic to suggest invoking the 25th Amendment to boot the 45th president out of the White House.
In June, Rep. Jamie Raskin (D-Md.) led 25 House Democrats to co-sign a bill that would create a congressional commission able to oust Trump from the Oval Office under the amendment. Commenting on his bill, Raskin told Yahoo News “in case of emergency, break glass.”
Articles and op-eds exploring the 25th Amendment in detail have also been published in the Washington Post, Rolling Stone, New York Times and Time Magazine since Trump took office. Meanwhile, Trump has continued to draw ire across the country for issues such as his harsh policies on immigration, his travel bans agains people from predominantly Muslim countries, his push to pass health care bills that would lead to millions losing coverage and his remarks suggesting there were “fine people” among those attending a white supremacist rally.
This summer, the hashtag #25thAmendment began trending on Twitter.
That’s why Lofgren is calling for Pence and other Cabinet members to “quickly secure ... medical and psychiatric professionals” to evaluate Trump’s mental health and any possible impairments.
“If it was a physical ailment, you would be getting the advice of doctors,” Lofgren told Mercury News. “The same thing should be true to take a look at his stability here.”
CORRECTION: A previous version of this story mischaracterized the resolution. It is not a bill, and its text “urges” but does not mandate that the president undergo mental health evaluation.


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- Major crypto companies like Coinbase and Gemini have been hit by the economic downturn.
- But even amid high-profile layoffs and bankruptcies, demand for blockchain engineers remains high.
- Industry experts told Insider what these changes mean for crypto-related companies and engineers.
His timeline at OpenSea mirrors the boom and fall of major crypto players in recent months as the sector flourished, but once the economy and tech industry became increasingly frail, layoffs and bankruptcy flooded in.
Leaked emails revealed in July that Coinbase was shutting down its US affiliate-marketing program, crypto bank Celsius filed for bankruptcy that same month, and crypto's market cap fell 66% from its peak in fall 2021.
"But at the same time, you've got 150 new companies that just raised — maybe not on the order of magnitude of $100 million — but like $15 million or $20 million for their crypto finance startup," Bachik said. "And they're definitely looking for people. I'm not in this position where I don't have people to talk to. I have, actually, interview meetings all day today."
Major companies like Deloitte, Accenture, Google, and Affirm are currently hiring blockchain engineers, while many startups are also hiring within the space.
Hiring experts and engineers similarly observed that amid high-profile layoffs, the job market for crypto-related roles remains ripe and that there remains more openings than qualified job candidates within the field.
Crypto crashes can better the industry
Crypto has had multiple well-documented crashes within the past two decades: 2011, 2014, 2018, and now 2022.
Robert James, a managing director at compensation advisory company Pearl Meyer and a personal crypto enthusiast, said these crashes — or corrections — are not necessarily bad, since they help industries differentiate strong and innovative companies.
But even with the recent market downturn, the 12-24 months of "exuberance" to get into the crypto space has kept the demand and compensation for blockchain engineers high.
"Because the talent pools are so small, and if you are really in this space on blockchain and Solana developers or blockchain developers, you just pay what is required to get them in because the best of the best can transform that business," James said.
He added that the companies that flourish during these uncertain times will likely only end up getting stronger due to attracting and hiring the best talent later on.
Blockchain and crypto-related hiring numbers
i-Recruit, an online recruitment agency, started its blockchain and cryptocurrency category in 2020, and it shared quarter-to-quarter job site traffic paired with inquiries from qualified employers who were looking to hire people.
The number of qualified employer inquiries mirrored stock market performance between the third and fourth quarters of 2021 and has plummeted since. But opposite to the nosedive, unique job site traffic to the crypto and blockchain categories skyrocketed in that same time period.
Jim Ortega, a senior account manager for i-Recruit, told Insider that the company has not received a single qualified employer lead in North America since early June. A qualified lead is an inquiry that comes from a legally registered entity that currently employs a minimum of 5 full-time employees.
"This year started off strong but the market experienced a sudden shift in February and new leads dried up completely due to hiring freezes," Ortega said, noting how i-Recruit has only successfully placed seven blockchain engineers this year so far when it placed 52 blockchain engineers throughout 2021, making it well below pace.
"By March most of our active job orders were pulled on request of clients and some even started rescinding job offers from candidates who were waiting for their start date," he added.
Ortega said the concern at the beginning of the year pertained to "supply and quality of candidates" but now the slowdown has prompted i-Recruit to shift its resources to other IT industry teams — a reallocation that he does not think will reverse until stock price growth returns.
Trevor Talley, The Crypto Recruiters recruiting director, told Insider that this market uncertainty has changed the tone of people in the industry — from previously just handing over their resume for an open job to asking thoughtful questions about the companies with openings: company size, turnover rate, years of existence and more.
And this could translate to greater worker power, Talley added, highlighting how the shift empowers people, especially since the amount of qualified engineers remains far lower than the demand for blockchain engineers.
"It's a blessing for [crypto jobseekers] because they probably didn't know how valuable they were until now because they were already secured in a position," Talley said. "Now that they were laid off, they're getting calls and they're starting to figure out the market is valuing these people a lot more."
Are you a tech worker or recruiter with career or compensation insights to share? Contact Diamond Naga Siu at firstname.lastname@example.org or through the secure messaging app Signal at 310-986-1383. Please reach out using a non-work device. Twitter DM at @diamondnagasiu. Check out Insider's source guide for other suggestions on how to share information securely.


Winch bumpers for Defender and other 4x4
Many car manufacturers sell their vehicles with cheapish plastic or very thin steel bumpers. Most off-road drivers, however, prefer a bumper that can do more than just looking good. Depending on your requirements and design preferences we offer various bumper models: ruggted and simple for proper style winch mounting, rallye raid competition bumpers or with additional lights.
Winch bumpers for off-road vehicles
Especially in difficult terrain, on sandy or muddy ground, it is possible to get stuck. For such situations there are winch bumpers and appropriate winches which allow the self-recovery of the own vehicle as well as the recovery of abnother vehicle.
The integrated mounting of a winch in one of our specially made bumpers at the front of the vehicle is especially well suited for such self-recovery scenarios. With a bumper with a mounting location you can choose from a variety of manufactures such as Warn, Superwinch, Bearwinch etc. Our latest models even allow for the hidden mounting of a winch and thus leave the characteristic shape of your vehicle untouched.
Strengthened winch bumpers also protect your vehicle - e.g. when making contact with trees or rocks, preventing expensive repairs and annnoying downtime.
More safety due to better lighting
Apart from using a bumper to mount a winch, it is also possible to improve lighting of the road ahead. Have a look at our bumpers with integrated LED lights for main beam, fog or day-driving. The supplied light systems of course all come E-marked for legal use on public roads.


text:
U.S. Capitol by Sterling
- Depicts the United States Capitol Building, a hallowed symbol and shining example of American architectural Neoclassicism.
- Beautifully hand painted.
- Stylish Black mahogany frame.
With its iconic central dome, columned porticos, and magnificent central rotunda, the U.S. Capitol building is not only the most hallowed symbol of representative government in the United States, but a most shining example of American architectural Neoclassicism. Beautifully hand painted. Stylish Black mahogany frame.
|Bulb Type||No Bulb|
|Color||Handpainted Clear White,Signature Black|
|WARNING: Cancer and Reproductive Harm - www.P65Warnings.ca.gov|

domain: politics


text:
From THINK PROGRESS HEALTH:
In their latest assault on women’s health, this week House Republicans will take up HR 358, the ironically titled “Protect Life Act.” Opponents have rechristened the measure the “Let Women Die” bill because it would allow hospitals that receive federal funds to turn away a woman seeking an abortion in all circumstances, even if an abortion is necessary to save her life […]
Original movie poster
Filed under abortion, Catholicism, Congress, humor, movies, parody, politics, religion, Republicans, snark, Wordpress Political Blogs
From the Los Angeles Times:
The Bush administration announced its “conscience protection” rule for the healthcare industry Thursday, giving doctors, hospitals, and even receptionists and volunteers in medical experiments the right to refuse to participate in medical care they find morally objectionable.
“This rule protects the right of medical providers to care for their patients in accord with their conscience,” said outgoing Health and Human Services Secretary Mike Leavitt.
The right-to-refuse rule includes abortion and other aspects of healthcare where moral concerns could arise, Leavitt’s office said, such as birth control, emergency contraception, in vitro fertilization, stem cell research and assisted suicide.
The rule, to be published today in the Federal Register, takes effect the day before President Bush leaves office.
Original DVD cover.
Filed under 2008 election, abortion, Barack Obama, Chimpy, Congress, Family Research Council, Gay rights, George W. Bush, Health and Human Services Department, Hillary Clinton, Homophobia, Homosexuality, humor, movies, parody, politics, religion, Republicans, snark, Tony Perkins, Wordpress Political Blogs

domain: medical


text:
Title: Children and Food Security
One of the most imperious issues directly affects the world poverty acceleration is the increasing threats of food security. Food security is considered one of the basic human rights that every human being should be able to have access to adequate and clean fresh food. However, things always go contrary to our wishes. A report from household food insecurity in the United States in 2012 indicates that, 10% of the households in US have food-insecurity issues, meaning that they all lack of access to adequate healthy food due to stagnant family income as well as other limitations (Miller, Nepomnyaschy, Ibarra, & Garasky, 2014). Poverty is always the fundamental factor that leads to food insecurity. According to Martin and Lippert (2011), food insecurity can be categorized into four scales from food secure to very low food security. Among these, low food security means that lacking of means to buy different kinds of food, which will result in the insufficient of variety of people's diet. Very low food security takes place when people do not have means to purchase enough food which leads to insufficient food intake. Moreover, children are more vulnerable to damage during the period of growth and development when they do not have adequate food intake. This is also what makes food insecurity a significant social problem, a great number of children die every year due to malnutrition and hunger-related diseases. Children who are food-insecure are more easily in the condition of poor health and are more likely to be developmentally at risk than those who have access to healthy, clean food. A great deal of severe health problems, behavior deficits, and cerebral dysplasia are associated with food insecurity (Miller et al, 2014). For the great amount of children in the world who do not get enough clean food regularly would cause stunted growth, ill health, and reducing resistance to diseases. Severe impacts not only occurs on health, but also on social and environmental problems. Poor people do not have access to adequate clean food. Farmers who do not have enough food to feed the,selves are not capable of growing productive lands to feed other people, which will cause a cycle of poverty. Seeking for solutions to alleviate poverty on a worldwide scale is crucial to the problem of food insecurity. Achieving food security also needs the support of sufficient water supply and good environment as powerful backings. However, water is a scarce resource in many areas in the world, and those ares are also where most food insecurity occurs. The causes of food insecurity can be summarized by a complex combination of perishing social conditions, depressing economics, and severe environmental degradation. Based on the work of Cook et al (2006) that young, vulnerable children come from a household with low-income are a high-risk population of poor health affected by food insecurity. This paper presents a study about exploring the causes and impacts of food insecurity on children and the relevant responses from the International community, such as the research methods used in the study of food insecurity and children, as well as the work of those correlative organizations and programs working on a better future of food security. All the references used in composing this paper are found in the following databases: Social Sciences Abstracts (H.W. Wilson), EBSCO Host, CAB Abstracts, and ProQuest Environmental Sciences and Pollution Management addressed with the keywords children and food insecurity, using the criteria limited to peer reviewed articles.
In recent years, abundant researches have been done observing whether local food availability plays a role in giving rise to childhood obesity (Lee,2012). According to Lee's (2012) study on whether local food availability a determinant of childhood obesity, she points out that the availability of food retailers in

domain: literature


text:
“Before entering the stage as Hitler, I was to be showered in sump oil, naked, by Dawn Fraser”
Category: The Iconic and Vintage Information Page.
Paint it, Black. The Darkness and Light of Titane Laurent.
Her work is as bold as her name meaning ‘a heroine on a battlefield in ancient times’
Become Part Of The Clip’D Story : Patrons Urgently Needed!
Become Part Of The Story Clip’D is part of The National Treasures Series and celebrates Australia’s finest actors and best … More
Hunter Page-Lochard. The Midnight Prince.
“Believing in yourself and in your dream is a hard thing to keep constant, especially in this generation, the distractions are endless”
The Hunter Page-Lochard Interview and short film ‘Midnight Man’ Words by Nick Cave (permission kindly granted)
*Australian Film Festival Nomination*.
Eduardo Santos. Nature’s Formidable Painter
From the rivers of the Amazon…
The Eduardo Santos Interview.
Trailer :: Hunter Page-Lochard in Midnight Man
The Midnight Man Trailer. Hunter Page-Lochard starring in a short film celebrating Nick Cave.
The Grounded Lovers of La La Land. Felicity Price and Kieran Darcy-Smith.
Australian National Treasures Overseas :: LA based Felicity Price and Kieran Darcy-Smith.
Photographer Alina Gozin’a
Leaving a Legacy.
The Tragedy and Legacy of Danii Meads-Barlow
Cool to the Corr
“It was a dark time, I still think of it often, it’s the kind of thing that haunts you if you let it and it’s also the kind of thing that changes you forever”
The Ryan Corr Interview and short film ‘Supernaturally’ Words by Nick Cave (Permission kindly granted)
*Australian Film Festival Nomination*
Man of Music. Man of Light. Ben Marshall
“I love all art forms but music sends me the furthest the fastest” Ben Marshall, Head of Contemporary Music, Sydney Opera House and Curator Of Vivid Festival LIVE.