text:
|Publication number||US7090690 B2|
|Application number||US 10/299,171|
|Publication date||Aug 15, 2006|
|Filing date||Nov 19, 2002|
|Priority date||Nov 19, 2002|
|Also published as||EP1562487A2, EP1562487A4, US20040098050, US20060271105, WO2004045367A2, WO2004045367A3|
|Publication number||10299171, 299171, US 7090690 B2, US 7090690B2, US-B2-7090690, US7090690 B2, US7090690B2|
|Inventors||Seth A. Foerster, Norman S. Gordon, Mark A. Ritchart, Gregory H. Bain, George White|
|Original Assignee||Arthrocare Corporation|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (27), Referenced by (100), Classifications (17), Legal Events (7)|
|External Links: USPTO, USPTO Assignment, Espacenet|
The present invention relates to devices and methods for repairing soft tissue, and more particularly to devices and methods for arthroscopic repair of a torn rotator cuff.
It is an increasingly common problem for tendons and other soft, connective tissues to tear or to detach from associated bone. One such type of tear or detachment is a “rotator cuff” tear, wherein the supraspinatus tendon separates from the humerus, causing pain and loss of ability to elevate and externally rotate the arm. Complete separation can occur if the shoulder is subjected to gross trauma, but typically, the tear begins as a small lesion, especially in older patients.
To repair a torn rotator cuff, the typical course today is to do so surgically, through a large incision. This approach is presently taken in almost 99% of rotator cuff repair cases. There are two types of open surgical approaches for repair of the rotator cuff, one known as the “classic open” and the other as the “mini-open”. The classic open approach requires a large incision and complete detachment of the deltoid muscle from the acromion to facilitate exposure. The cuff is debrided to ensure suture attachment to viable tissue and to create a reasonable edge approximation. In addition, the humeral head is abraded or notched at the proposed soft tissue to bone reattachment point, as healing is enhanced on a raw bone surface. A series of small diameter holes, referred to as “transosseous tunnels”, are “punched” through the bone laterally from the abraded or notched surface to a point on the outside surface of the greater tuberosity, commonly a distance of 2 to 3 cm. Finally, the cuff is sutured and secured to the bone by pulling the suture ends through the transosseous tunnels and tying them together using the bone between two successive tunnels as a bridge, after which the deltoid muscle must be surgically reattached to the acromion. Because of this maneuver, the deltoid requires postoperative protection, thus retarding rehabilitation and possibly resulting in residual weakness. Complete rehabilitation takes approximately 9 to 12 months.
The mini-open technique, which represents the current growing trend and the majority of all surgical repair procedures, differs from the classic approach by gaining access through a smaller incision and splitting rather than detaching the deltoid. Additionally, this procedure is typically performed in conjunction with arthroscopic acromial decompression. Once the deltoid is split, it is retracted to expose the rotator cuff tear. As before, the cuff is debrided, the humeral head is abraded, and the so-called “transosseous tunnels”, are “punched” through the bone or suture anchors are inserted. Following the suturing of the rotator cuff to the humeral head, the split deltoid is surgically repaired.
Although the above described surgical techniques are the current standard of care for rotator cuff repair, they are associated with a great deal of patient discomfort and a lengthy recovery time, ranging from at least four months to one year or more. It is the above described manipulation of the deltoid muscle together with the large skin incision that causes the majority of patient discomfort and an increased recovery time.
Less invasive arthroscopic techniques are beginning to be developed in an effort to address the shortcomings of open surgical repair. Working through small trocar portals that minimize disruption of the deltoid muscle, a few surgeons have been able to reattach the rotator cuff using various bone anchor and suture configurations. The rotator cuff is sutured intracorporeally and an anchor is driven into bone at a location appropriate for repair. Rather than thread the suture through transosseous tunnels which are difficult or impossible to create arthroscopically using current techniques, the repair is completed by tying the cuff down against bone using the anchor and suture. Early results of less invasive techniques are encouraging, with a substantial reduction in both patient recovery time and discomfort.
Unfortunately, the skill level required to facilitate an entirely arthroscopic repair of the rotator cuff is inordinately high. Intracorporeal suturing is clumsy and time consuming, and only the simplest stitch patterns can be utilized. Extracorporeal knot tying is somewhat less difficult, but the tightness of the knots is difficult to judge, and the tension cannot later be adjusted. Also, because of the use of bone anchors to provide a suture fixation point in the bone, the knots that secure the soft tissues to the anchor by necessity leave the knot bundle on top of the soft tissues. In the case of rotator cuff repair, this means that the knot bundle is left in the shoulder capsule where it can be felt by the patient postoperatively when the patient exercises the shoulder joint. So, knots tied arthroscopically are difficult to achieve, impossible to adjust, and are located in less than optimal areas of the shoulder. Suture tension is also impossible to measure and adjust once the knot has been fixed. Consequently, because of the technical difficulty of the procedure, presently less than 1% of all rotator cuff procedures is of the arthroscopic type, and is considered investigational in nature.
Another significant difficulty with current arthroscopic rotator cuff repair techniques is shortcomings related to currently available suture anchors. Suture eyelets in bone anchors available today, which like the eye of a needle are threaded with the thread or suture, are small in radius, and can cause the suture to fail at the eyelet when the anchor is placed under high tensile loads.
There are various bone anchor designs available for use by an orthopedic surgeon for attachment of soft tissues to bone. The basic commonality between the designs is that they create an attachment point in the bone for a suture that may then be passed through the soft tissues and tied, thereby immobilizing the soft tissue. This attachment point may be accomplished by different means. Screws are known for creating such attachments, but existing designs suffer from a number of disadvantages, including their tendency to loosen over time, requiring a second procedure to later remove them, and their requirement for a relatively flat attachment geometry.
Another approach is to utilize the difference in density in the cortical bone (the tough, dense outer layer of bone) and the cancellous bone (the less dense, airy and somewhat vascular interior of the bone). There is a clear demarcation between the cortical bone and cancellous bone, where the cortical bone presents a kind of hard shell over the less dense cancellous bone. The aspect ratio of the anchor is such that it typically has a longer axis and a shorter axis and usually is pre-threaded with a suture. These designs use a hole in the cortical bone through which an anchor is inserted. The hole is drilled such that the shorter axis of the anchor will fit through the diameter of the hole, with the longer axis of the anchor being parallel to the axis of the drilled hole. After deployment in to the cancellous bone, the anchor is rotated 90B so that the long axis is aligned perpendicularly to the axis of the hole. The suture is pulled, and the anchor is seated up against the inside surface of the cortical layer of bone. Due to the mismatch in the dimensions of the long axis of the anchor and the hole diameter, the anchor cannot be retracted proximally from the hole, thus providing resistance to pullout. These anchors still suffer from the aforementioned problem of eyelet design that stresses the sutures.
Still other prior art approaches have attempted to use a “pop rivet” approach. This type of design requires a hole in the cortical bone into which a split shaft is inserted. The split shaft is hollow, and has a tapered plug leading into its inner lumen. The tapered plug is extended out through the top of the shaft, and when the plug is retracted into the inner lumen, the tapered portion causes the split shaft to be flared outwardly, ostensibly locking the device into the bone.
Other methods of securing soft tissue to bone are known in the prior art, but are not presently considered to be feasible for shoulder repair procedures, because of physicians' reluctance to leave anything but a suture in the capsule area of the shoulder. The reason for this is that staples, tacks, and the like could possibly fall out and cause injury during movement. As a result of this constraint, the attachment point often must be located at a less than ideal position. Also, the tacks or staples require a substantial hole in the soft tissue, and make it difficult for the surgeon to precisely locate the soft tissue relative to the bone.
As previously discussed, any of the anchor points for sutures mentioned above require that a length of suture be passed through an eyelet fashioned in the anchor and then looped through the soft tissues and tied down to complete the securement. Much skill is required, however, to both place the sutures in the soft tissues, and to tie knots while working through a trocar under endoscopic visualization.
What is needed, therefore, are new approaches for repairing the rotator cuff or fixing other soft tissues to bone, wherein both the bone and suture anchors reside completely below the cortical bone surface, there is no requirement for the surgeon to tie a knot to attach the suture to the bone anchor, and wherein suture tension can be adjusted and possibly measured. The procedures associated with the new approaches should be better for the patient than existing procedures, should save time, be uncomplicated to use, and be easily taught to practitioners having skill in the art.
Accordingly, the inventors have developed new and novel approaches for securing soft tissue to bone, and particularly for axially anchoring suture which attaches the soft tissue to adjacent bone structure.
More particularly, in one aspect of the invention there is disclosed a suture anchoring device, comprising an anchor housing having an outer wall, a compressible plug member disposed within the housing and extending proximally of the housing, and a channel extending through the plug member for accommodating a length of suture. A cap member is provided for enclosing a proximal end of the housing. In operation, the compressible plug member is compressed in order to anchor the length of suture when the cap member is engaged with the housing.
In another aspect of the invention, there is disclosed a suture anchoring device which comprises an anchor body having an interior threaded wall, as well as a suture return member associated with the body, such as a pin, for returning a distally extending length of suture in a proximal direction. A length of fiber is provided, having a first end secured to a distal portion of the body, and a second end extending from an end of the body, the fiber being wrapped about the interior threaded wall of the body a plurality of times. In operation, when the length of fiber is pulled in a predetermined direction, the wrapped fiber becomes tightly engaged about the suture to anchor the suture.
In yet another aspect of the invention, there is provided a suture anchoring device, which comprises an anchor body having an outer wall, and a suture return member disposed at a distal end of the anchor body, for receiving a length of suture extending distally through the body, and returning a portion of the suture length in a proximal direction. A passage extends along an interior surface of the wall for accommodating the length of suture. The passage tapers in width in a proximal direction, for the purpose of permitting the suture to be moved axially when pulled in a first direction, for approximating a portion of soft tissue to which the suture was attached to adjacent bone, and anchoring the suture axially in place when the suture is pulled in an opposing direction.
In still another aspect of the invention, there is provided a suture anchoring device, comprising an anchor body having an outer wall, as well as a lumen for accommodating a length of suture within the outer wall. A plurality of members are disposed within the anchor body for contacting the length of suture and creating a tortuous path therefor, in order to anchor the length of suture in place. The device further comprises a member radially extending from the body for anchoring the device in adjacent bone.
In another aspect of the invention, there is provided a suture anchoring device, which comprises an axially extending spring, as well as a suture return member or pin disposed distally of said spring. A length of suture extends axially within the spring and about the suture return member. An actuator is disposed at a proximal end of the device for actuating the spring to a compressed state wherein the suture becomes clamped within the spring.
In yet another aspect of the invention, there is provided a suture anchoring device, which comprises a suture return member and a length of suture extending axially through the device about the suture return member. A plurality of axially stacked, spaced plates, comprising leaf springs, are disposed proximally of the suture return member. The aforementioned length of suture extends through apertures in each of the plates. A mandrel is provided for moving the plurality of stacked plates between a first generally planar orientation, wherein the suture is free to move axially therethrough, and a second folded orientation, wherein the suture is axially clamped within the apertures.
In still another aspect of the invention, there is provided a suture anchoring device, which comprises a body, a core disposed within the body, and a length of suture attached to a piece of soft tissue and extending into the body. A portion of the length of suture is wrapped about the core and attached to a distal end thereof. The core is rotatable to adjustably tension the length of suture, and may be rotationally locked in order to anchor the length of suture in place.
In another aspect of the invention, there is provided a suture anchoring device, which comprises an outer tube, as well as a first plate having a suture receiving aperture disposed therein. A second plate has a suture receiving aperture disposed therein. A connection between the first and second plates is designed to break when a predetermined force is applied thereto. The system is designed so that axial displacement of one of the plates relative to the other of the plates causes application of the predetermined force, to separate the plates, and thus create a tortuous path for a length of suture passing therethrough.
In still another aspect of the invention, there is provided a suture anchoring device. This device comprises an outer tube having a lumen extending axially therethrough, and a length of suture extending distally through the outer tube, about a suture return member, and proximally back through the outer tube. An inner expandable member extends axially through the lumen, between portions of the length of suture, the inner expandable member being actuatable to a radially expanded state in order to compress and clamp the length of suture in place. In one embodiment, the inner expandable member comprises a split elastomeric tube, while in a second embodiment, the inner expandable member comprises a spring coil.
The invention, together with additional features and advantages thereof, may best be understood by reference to the following description taken in conjunction with the accompanying illustrative drawing.
The present invention provides improved knotless suture anchor devices and methods for anchoring a length of suture with respect to a body cavity. In the exemplary embodiments described herein, the inventive devices are used to anchor a length of suture to a bone structure, specifically the humeral bone of the human shoulder. The length of suture is desirably looped through soft tissue, such as a rotator cuff tendon, to approximate and fix the soft tissue with respect to the body cavity (e.g., bone structure). It should be understood, however, that the suture anchor apparatus described herein may be utilized to secure a length of suture to body cavities other than in a bone structure, and may even be used to anchor the suture outside of a body cavity, or merely to a predetermined location within the body. In this regard, the various inventive embodiments include an anchor body within which the length of suture may be anchored without knots. If the anchor body is to be implanted within the body cavity, structure on its exterior or coupled therewith may also be provided for securing the anchor body therein.
As mentioned, the present invention is particularly well-suited for repairing rotator cuff injuries by re-attaching the rotator cuff tendon to the outside of the humeral head. The invention permits minimally invasive surgeries on such injuries and greatly facilitates rapid and secure fixation of the rotator cuff tendon to the humeral head. It should be understood that the same principles described herein apply to the repair of other injuries in which soft tissue is to be re-attached to a bone structure.
With reference first to
After establishing one or more direct conduits to the humeral head 24, the surgeon passes a length of suture through the soft tissue of the rotator cuff tendon 22 so that a loop 32 of suture material is embedded therein, as seen in
The exemplary suture anchor system 20 as illustrated is particularly suitable for anchoring a suture to a body cavity, specifically the humeral head 24 as shown. When anchoring sutures to such a bone structure, a conventional technique is to first form a blind hole or cavity 40 through the cortical layer 42 and into the soft cancellous matter 44, as seen in
The suture anchor 46 performs two functions: anchoring itself within the body cavity and anchoring the sutures therein. In the embodiment as illustrated in
The present invention illustrates a particular anchoring member 48, although any similar expedient will work. For example, a different toggle-like anchoring member may be used such as shown in co-pending application Ser. No. 09/876,488 filed on Mar. 2, 2001, expressly incorporated by reference herein. Alternatively, an anchoring structure that expands into contact with the cancellous matter 44 or a body resembling a screw may also be used. In short, the present invention is not considered to be limited by the particular anchoring structure that secures the suture locking portion to the bone or other body cavity.
The second function of the suture anchor 46 is the anchoring or fixation of the suture with respect to the suture anchor itself, without the use of knots. Desirably, the particular manner of anchoring the suture with respect to the suture anchor 46 permits easy adjustment of the length of suture between the suture anchor 46 and the loop 32 formed in the soft tissue prior to anchoring the suture. This adjustment allows the surgeon to establish the proper tension in the length of suture for effective repair of the soft tissue, and reattachment of the rotator cuff tendon 22 in the illustrated embodiment. So, for example,
Although not shown, the remaining steps in the procedure involve withdrawing portions of the suture anchor from the surgical site as seen in
Although the present invention is described primarily in conjunction with the repair of a torn rotator cuff, the apparatus and method could also be used in arthroscopic repair at other sites, such as the knee, elbow, or hip, for example, as well as in conjunction with other surgical techniques, such as traditional open or mini-open surgical procedures.
Now with reference to
In operation, as shown in
Now with reference to
In operation, the suture length 34 is disposed in the insert 68, from a proximal direction, and wrapped around the primary pin 72, as shown in
Now with reference to
A somewhat similar embodiment to that of
Once the bone lock feature has been deployed, a predetermined applied tensile force proximally on the inner member 122 will cause separation of a proximal portion 142 from the remaining portion of the inner member 122 at the designed point of weakness 128, as shown in
Yet another suture anchoring device 46 f, which may be called a “spring-lock” anchor, is illustrated in
Then, when it is desired to anchor the suture in place, the driver 148 is retracted proximally, in the direction of arrow 160, as shown in
Not illustrated, but contemplated within the scope of the invention, is the inclusion of a compressible sleeve around which the spring 154 may be wrapped, and through which the suture 34 may be threaded. When the spring collapses, the sleeve also collapses on the suture, thereby locking it in place.
Now, with reference to
When the tensioning step has been completed as desired, the mandrel 172 is 20 withdrawn proximally, thereby releasing the leaf springs 164, so that they may return to their undeformed state, as shown in
In operation, a driver (not shown) having a hex head engages a hexagonal aperture 188, and rotates the core 182, in order to further wrap the suture 34 about the core, and to thus tension the suture 34 and approximate the tendon 22 to adjacent bone (not shown). When the suture 34 is tensioned as desired, the core is rotationally locked in place, to thereby anchor the suture in place. During the tensioning step, the fins 184 function to snag the suture and to act as bearings for the core 182.
Another embodiment of a suture anchoring device 46 i is shown in
As shown in
Yet another suture anchoring device 46 j is shown in
Yet another embodiment of a suture anchoring device 46k is illustrated in
Finally, another alternative suture anchoring embodiment 461 is illustrated in
The apparatus and method of the present invention may be embodied in other specific forms without departing from its spirit or essential characteristics. The described embodiments are to be considered in all respects only as illustrative and not restrictive. The scope of the invention is, therefore, indicated by the appended claims rather than by the foregoing description. All changes which come within the meaning and range of equivalency of the claims are to be embraced within their scope.
|Cited Patent||Filing date||Publication date||Applicant||Title|
|US4946468 *||Dec 8, 1989||Aug 7, 1990||Mitek Surgical Products, Inc.||Suture anchor and suture anchor installation tool|
|US5037422 *||Jul 2, 1990||Aug 6, 1991||Acufex Microsurgical, Inc.||Bone anchor and method of anchoring a suture to a bone|
|US5046513 *||Nov 20, 1989||Sep 10, 1991||Mitek Surgical Products, Inc.||Method for anchoring suture to bone|
|US5330442 *||Oct 9, 1992||Jul 19, 1994||United States Surgical Corporation||Suture retaining clip|
|US5364407||Mar 21, 1994||Nov 15, 1994||Poll Wayne L||Laparoscopic suturing system|
|US5383905||Oct 9, 1992||Jan 24, 1995||United States Surgical Corporation||Suture loop locking device|
|US5464427 *||Oct 4, 1994||Nov 7, 1995||Synthes (U.S.A.)||Expanding suture anchor|
|US5514159||Sep 13, 1994||May 7, 1996||United States Surgical Corporation||Guillotine suture clip|
|US5584835||Sep 8, 1994||Dec 17, 1996||Greenfield; Jon B.||Soft tissue to bone fixation device and method|
|US5630824 *||Jun 1, 1994||May 20, 1997||Innovasive Devices, Inc.||Suture attachment device|
|US5702397||Feb 20, 1996||Dec 30, 1997||Medicinelodge, Inc.||Ligament bone anchor and method for its use|
|US5720765||Nov 1, 1995||Feb 24, 1998||Thal; Raymond||Knotless suture anchor assembly|
|US5733307||Sep 17, 1996||Mar 31, 1998||Amei Technologies, Inc.||Bone anchor having a suture trough|
|US5791899||Jun 7, 1996||Aug 11, 1998||Memory Medical Systems, Inc.||Bone anchoring apparatus and method|
|US5868789||Feb 3, 1997||Feb 9, 1999||Huebner; Randall J.||Removable suture anchor apparatus|
|US5980559||Nov 4, 1997||Nov 9, 1999||Bonutti; Peter M.||Suture anchor|
|US6045574||Apr 1, 1999||Apr 4, 2000||Thal; Raymond||Sleeve and loop knotless suture anchor assembly|
|US6086608||Jan 14, 1997||Jul 11, 2000||Smith & Nephew, Inc.||Suture collet|
|US6200329||Aug 31, 1998||Mar 13, 2001||Smith & Nephew, Inc.||Suture collet|
|US6280474||Jul 27, 1999||Aug 28, 2001||Neucoll, Inc.||Devices for tissue repair and methods for preparation and use thereof|
|US6475230||Mar 10, 2000||Nov 5, 2002||Peter M. Bonutti||Method and apparatus for securing a suture|
|US6520980||Nov 2, 2000||Feb 18, 2003||Opus Medical, Inc.||Method and apparatus for attaching connective tissues to bone using a self-locking knotless suture anchoring device|
|US6527794||Aug 10, 1999||Mar 4, 2003||Ethicon, Inc.||Self-locking suture anchor|
|US6575987 *||May 2, 2001||Jun 10, 2003||Scimed Life Systems, Inc.||Quick connect bone suture fastener|
|US6585730||Aug 30, 2000||Jul 1, 2003||Opus Medical, Inc.||Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device|
|US6660023||Feb 27, 2003||Dec 9, 2003||Ethicon, Inc.||Self-locking suture anchor|
|US6855157||Feb 4, 2002||Feb 15, 2005||Arthrocare Corporation||Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device|
|Citing Patent||Filing date||Publication date||Applicant||Title|
|US7280865||Dec 20, 2001||Oct 9, 2007||Accuray Incorporated||Anchored fiducial apparatus and method|
|US7517357 *||Jan 9, 2003||Apr 14, 2009||Linvatec Biomaterials||Knotless suture anchor|
|US7582105 *||Aug 7, 2006||Sep 1, 2009||Silhouette Lift Societad Limitada||Suture for wound closure, tissue approximation, tissue support, suspension and/or fixation|
|US7585311||Jun 1, 2005||Sep 8, 2009||Kfx Medical Corporation||System and method for attaching soft tissue to bone|
|US7588587 *||Mar 9, 2006||Sep 15, 2009||Tyco Healthcare Group Lp||Suture anchors|
|US7625386||Mar 3, 2005||Dec 1, 2009||Covidien Ag||Medical suturing tool|
|US7645286||Jan 12, 2010||Neotract, Inc.||Devices, systems and methods for retracting, lifting, compressing, supporting or repositioning tissues or anatomical structures|
|US7674274||Mar 25, 2003||Mar 9, 2010||Arthrocare Corporation||Method and apparatus for attaching connective tissues to bone using a cortical bone anchoring device|
|US7682374||Mar 13, 2006||Mar 23, 2010||Arthrocare Corporation||Knotless suture lock and bone anchor implant method|
|US7695494||Jun 29, 2004||Apr 13, 2010||Arthrocare Corporation||Method and apparatus for attaching connective tissues to bone using a knotless suture anchoring device|
|US7722628 *||Apr 4, 2007||May 25, 2010||Ethicon Endo-Surgery, Inc.||Device for plicating and fastening gastric tissue|
|US7758594||May 20, 2005||Jul 20, 2010||Neotract, Inc.||Devices, systems and methods for treating benign prostatic hyperplasia and other conditions|
|US7799040||Apr 4, 2007||Sep 21, 2010||Ethicon Endo-Surgery, Inc.||Device for plicating and fastening gastric tissue|
|US7803166||Apr 4, 2007||Sep 28, 2010||Ethicon Endo-Surgery, Inc.||Method for plicating and fastening gastric tissue|
|US7815653 *||Apr 4, 2007||Oct 19, 2010||Ethicon Endo-Surgery, Inc.||Method for plicating and fastening gastric tissue|
|US7896891||Jul 24, 2006||Mar 1, 2011||Neotract, Inc.||Apparatus and method for manipulating or retracting tissue and anatomical structure|
|US7901455||Dec 27, 2007||Mar 8, 2011||Shriners Hospitals For Children||Tendon or ligament bioprostheses and methods of making same|
|US7909836||Jul 9, 2007||Mar 22, 2011||Neotract, Inc.||Multi-actuating trigger anchor delivery system|
|US7918868||May 22, 2007||Apr 5, 2011||Scandius Biomendical, Inc.||Method and apparatus for meniscal repair|
|US7938847||Jan 4, 2006||May 10, 2011||Tornier, Inc.||Ring cinch assembly to attach bone to tissue|
|US7951158||May 31, 2011||Neotract, Inc.||Devices, systems and methods for retracting, lifting, compressing, supporting or repositioning tissues or anatomical structures|
|US7951159||Apr 4, 2007||May 31, 2011||Ethicon Endo-Surgery, Inc.||Method for plicating and fastening gastric tissue|
|US8043309||Oct 25, 2011||Neotract, Inc.||Devices, systems and methods for retracting, lifting, compressing, supporting or repositioning tissues or anatomical structures|
|US8083769 *||Nov 1, 2006||Dec 27, 2011||Depuy Mitek, Inc.||Wired sutures|
|US8100942||Jan 24, 2012||Kfx Medical Corporation||System and method for attaching soft tissue to bone|
|US8105355||May 18, 2006||Jan 31, 2012||C.R. Bard, Inc.||Suture lock fastening device|
|US8109969||Feb 7, 2012||Kfx Medical Corporation||System and method for attaching soft tissue to bone|
|US8114128||Nov 1, 2006||Feb 14, 2012||Depuy Mitek, Inc.||Cannulated suture anchor|
|US8118835 *||Sep 28, 2005||Feb 21, 2012||Surgical Solutions, Llc||Suture anchor|
|US8137381 *||Apr 21, 2008||Mar 20, 2012||Arthrocare Corporation||Knotless suture anchor having discrete polymer components and related methods|
|US8167906||Nov 1, 2006||May 1, 2012||Depuy Mitek, Inc.||Suture anchor with pulley|
|US8177839||Dec 27, 2007||May 15, 2012||Shriners Hospitals For Children||Woven and/or braided fiber implants and methods of making same|
|US8197497||Jun 19, 2006||Jun 12, 2012||Medtronic Vascular, Inc.||Method and apparatus for applying a knot to a suture|
|US8202295 *||Apr 14, 2008||Jun 19, 2012||Kaplan Lee D||Surgical instruments|
|US8267948||Nov 24, 2009||Sep 18, 2012||Tyco Healthcare Group Lp||Method and apparatus for meniscal repair|
|US8267964||Feb 6, 2012||Sep 18, 2012||Kfx Medical Corporation||System and method for attaching soft tissue to bone|
|US8277484||Aug 25, 2009||Oct 2, 2012||Tyco Healthcare Group Lp||Suture anchors|
|US8308765 *||May 7, 2004||Nov 13, 2012||Usgi Medical, Inc.||Apparatus and methods for positioning and securing anchors|
|US8348966||Aug 6, 2010||Jan 8, 2013||Thayer Intellectual Property, Inc.||Systems and methods for treatment of compressed nerves|
|US8367148||Oct 9, 2009||Feb 5, 2013||Mimedx Group, Inc.||Methods of making biocomposite medical constructs and related constructs including artificial tissues, vessels and patches|
|US8425536 *||May 12, 2011||Apr 23, 2013||Arthrocare Corporation||Implant and delivery system for soft tissue repair|
|US8425555||Dec 19, 2011||Apr 23, 2013||C.R. Bard, Inc.||Suture lock fastening device|
|US8430918 *||Apr 10, 2012||Apr 30, 2013||Zimmer Spine S.A.S.||Vertebral fixing system|
|US8444674||Mar 6, 2012||May 21, 2013||Lee D. Kaplan||Surgical instruments|
|US8469975||Jun 6, 2012||Jun 25, 2013||Nobles Medical Technologies, Inc.||Method and apparatus for applying a knot to a suture|
|US8500758||Aug 11, 2011||Aug 6, 2013||Covidien Lp||Auxiliary device for a puncture needle|
|US8540735||Dec 16, 2010||Sep 24, 2013||Apollo Endosurgery, Inc.||Endoscopic suture cinch system|
|US8545520||Aug 24, 2009||Oct 1, 2013||Coloplast A/S||Tissue suturing method|
|US8545521||Aug 22, 2012||Oct 1, 2013||Coloplast A/S||Suturing system and assembly|
|US8597336||Dec 28, 2007||Dec 3, 2013||Howmedica Osteonics Corp.||Apparatus for discrete tissue anchoring for soft tissue repair and method of use|
|US8603106||Jun 1, 2010||Dec 10, 2013||Neotract, Inc.||Integrated handle assembly for anchor delivery system|
|US8613756||Oct 21, 2010||Dec 24, 2013||Depuy Mitek, Llc||Knotless suture anchor|
|US8623033 *||Mar 8, 2012||Jan 7, 2014||Coloplast A/S||Suture system with capsule eyelet providing multiple suture tissue fixation|
|US8652157||May 18, 2012||Feb 18, 2014||Thayer Intellectual Property, Inc.||Systems and methods for treatment of compressed nerves|
|US8663280||Jun 1, 2012||Mar 4, 2014||Lee D. Kaplan||Surgical instruments|
|US8672955||Jun 29, 2010||Mar 18, 2014||Covidien Lp||Medical suturing device|
|US8721650||Mar 22, 2007||May 13, 2014||Tornier, Inc.||Bone anchor installer and method of use|
|US8721668||Dec 18, 2012||May 13, 2014||Thayer Intellectual Property, Inc.||Systems and methods for treatment of compressed nerves|
|US8753364||Jun 27, 2011||Jun 17, 2014||Thayer Intellectual Property, Inc.||Systems and methods for treatment of compressed nerves|
|US8758406||Mar 5, 2008||Jun 24, 2014||Tomier, Inc.||Tack anchor systems, bone anchor systems, and methods of use|
|US8777990||Sep 8, 2008||Jul 15, 2014||Howmedica Osteonics Corp.||Knotless suture anchor for soft tissue repair and method of use|
|US8840644||Mar 24, 2011||Sep 23, 2014||Howmedica Osteonics Corp.||Toggle bolt suture anchor|
|US8858633 *||Feb 20, 2008||Oct 14, 2014||Shriners Hospital For Children||In vivo hydraulic fixation including bio-rivets using biocompatible expandable fibers|
|US8870916||Jul 5, 2007||Oct 28, 2014||USGI Medical, Inc||Low profile tissue anchors, tissue anchor systems, and methods for their delivery and use|
|US8876842||Mar 16, 2010||Nov 4, 2014||Covidien Lp||Meniscal repair device|
|US8882801||Sep 14, 2007||Nov 11, 2014||Depuy Mitek, Llc||Dual thread cannulated suture anchor|
|US8920440||Aug 5, 2010||Dec 30, 2014||Coloplast A/S||Suture assembly and system|
|US8926638||Nov 3, 2010||Jan 6, 2015||Covidien Lp||Method and apparatus for meniscal repair|
|US8926663||Nov 19, 2013||Jan 6, 2015||Kfx Medical Corporation||System and method for attaching soft tissue to bone|
|US8940001||Aug 3, 2007||Jan 27, 2015||Neotract, Inc.|
|US8945152||Jul 9, 2007||Feb 3, 2015||Neotract, Inc.||Multi-actuating trigger anchor delivery system|
|US8951265||Oct 23, 2012||Feb 10, 2015||Rdc Holdings, Llc||Fixation system for orthopedic devices|
|US8956391||Oct 21, 2010||Feb 17, 2015||Cook Medical Technologies Llc||External retention mechanics for suture anchor|
|US8968343||Jun 18, 2009||Mar 3, 2015||Covidien Lp||Puncturing needle assisting tool|
|US8986378||Nov 2, 2012||Mar 24, 2015||Mimedx Group, Inc.||Implantable collagen devices and related methods and systems of making same|
|US8992550||Jul 21, 2011||Mar 31, 2015||Coloplast A/S||Suture system with capsule eyelet providing multiple suture tissue fixation|
|US8992573||Nov 14, 2012||Mar 31, 2015||Howmedica Osteonics Corp.||Knotless suture anchor for soft tissue repair and method of use|
|US8998925||Jan 17, 2013||Apr 7, 2015||Rdc Holdings, Llc||Fixation system for orthopedic devices|
|US9044226||Sep 5, 2013||Jun 2, 2015||Kfx Medical Corporation||System and method for attaching soft tissue to bone|
|US9072509||Oct 9, 2008||Jul 7, 2015||Howmedica Osteonics Corp.||Toggle bolt suture anchor kit|
|US9078646||Nov 13, 2013||Jul 14, 2015||Depuy Mitek, Llc||Knotless suture anchor|
|US9078775||Oct 9, 2009||Jul 14, 2015||Mimedx Group, Inc.||Methods of making collagen fiber medical constructs and related medical constructs, including nerve guides and patches|
|US9089325||Sep 11, 2013||Jul 28, 2015||Apollo Endosurgery, Inc.||Methods of applying a suture cinch|
|US9101355||Jun 29, 2012||Aug 11, 2015||Pivot Medical, Inc.||Method and apparatus for re-attaching the labrum to the acetabulum, including the provision and use of a novel suture anchor system|
|US9107655||Feb 11, 2013||Aug 18, 2015||Cook Medical Technologies Llc||External suture securement devices and methods|
|US20040138706 *||Jan 9, 2003||Jul 15, 2004||Jeffrey Abrams||Knotless suture anchor|
|US20040236336 *||Oct 21, 2003||Nov 25, 2004||Opus Medical, Inc.||Method and apparatus for attaching connective tissues to bone using a suture anchoring device|
|US20040260298 *||Jun 16, 2004||Dec 23, 2004||Kaiser Ryan A.||Device and method of fastening a graft to a bone|
|US20050245932 *||Apr 15, 2005||Nov 3, 2005||Fanton Gary S||Apparatus and methods for securing tissue to bone|
|US20080140117 *||Oct 31, 2007||Jun 12, 2008||Peter M Bonutti||Method and apparatus for securing a suture|
|US20100262185 *||Oct 14, 2010||Suspension Orthopaedic Solutions, Llc||Method and apparatus for aperture fixation by securing flexible material with a knotless fixation device|
|US20110009884 *||Sep 17, 2010||Jan 13, 2011||Kaplan Lee D||Surgical instruments|
|US20110213417 *||Sep 1, 2011||Foerster Seth A||Implant and delivery system for soft tissue repair|
|US20110238113 *||Sep 29, 2011||Tornier, Inc.||Ring cinch assembly to attach bone to tissue|
|US20120116451 *||Apr 19, 2010||May 10, 2012||Slobodan Tepic||Suture attachment method and apparatus|
|US20120197298 *||Apr 10, 2012||Aug 2, 2012||Zimmer Spine S.A.S.||Vertebral fixing system|
|US20130023906 *||Jan 24, 2013||Coloplast A/S||Suture system with capsule eyelet providing multiple suture tissue fixation|
|US20130035720 *||Aug 4, 2011||Feb 7, 2013||Smith & Nephew, Inc.||Suspension device to anchor tissue graft|
|WO2011097672A1 *||Feb 9, 2011||Aug 18, 2011||Macropace Products Pty Ltd||Suture anchor|
|WO2013177488A1 *||May 24, 2013||Nov 28, 2013||Suspension Orthopaedic Solutions, Llc||Collapsible suture anchor|
|International Classification||A61B17/04, A61B17/064|
|Cooperative Classification||A61B2017/0454, A61B17/0401, A61B2017/0427, A61B2017/0424, A61B2017/0435, A61B2017/0414, A61B2017/0412, A61B2017/042, A61B2017/0437, A61B2017/0453, A61B2017/045, A61B2017/0451, A61B2017/0409|
|Nov 19, 2002||AS||Assignment|
Owner name: OPUS MEDICAL, INC., CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:FOERSTER, SETH A.;GORDON, NORMAN S.;RITCHART, MARK A.;AND OTHERS;REEL/FRAME:013518/0708;SIGNING DATES FROM 20021112 TO 20021118
|Jan 3, 2005||AS||Assignment|
Owner name: ARTHROCARE CORPORATION,TEXAS
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:OPUS MEDICAL, INC.;REEL/FRAME:015509/0008
Effective date: 20041221
|Mar 21, 2005||AS||Assignment|
Owner name: ARTHROCARE CORPORATION,TEXAS
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:OPUS MEDICAL, INC.;REEL/FRAME:015931/0782
Effective date: 20041221
|Feb 2, 2006||AS||Assignment|
Owner name: BANK OF AMERICA, N.A.,WASHINGTON
Free format text: PATENT SECURITY AGREEMENT;ASSIGNOR:ARTHROCARE CORPORATION;REEL/FRAME:017105/0855
Effective date: 20060113
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Owner name: ARTHROCARE CORPORATION,TEXAS
Free format text: RELEASE OF PATENT SECURITY AGREEMENT RECORDED AT REEL 017105 FRAME 0855;ASSIGNOR:BANK OF AMERICA, N.A.;REEL/FRAME:023180/0892
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Year of fee payment: 4
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Year of fee payment: 8

domain: medical


The storms on Jupiter, the fifth planet from the Sun, are forty miles high and span over half the width of a continent. Regular winds are fast, and the equivalent of hurricanes on Earth and lightning is three times as strong as we are used to seeing on our home planet.
These storms last for hundreds of years, making Jupiter stay true to its name, which comes from the Roman god of thunder and skies, leader of the Roman pantheon of gods.
Despite having been studied for over 400 years, data about the agitated atmosphere of the biggest planet in our solar system is still hard to find, as per official reports.
Fortunately, the accumulated work of researchers, using combined data from he Gemini Observatory, the Juno spacecraft, and the Hubble Space Telescope, has provided the opportunity to probe Jupiter’s system of storms.
Impressive storms on Jupiter
That all, in the hope of finding the source of the outbursts of lightning and making a map of the cyclonic vortices. Perhaps, this will explain some of the mysteries which lie in Jupiter’s Great Red Spot.
This project is enabling scientists to investigate the weather on Jupiter and approximate the humidity found in the planet’s atmosphere, resulting in some certain information about the inner workings of Jupiter and other planets in our over four billion years old solar system.
NASA’s Hubble Space Telescope and the ground-based Gemini Observatory in Hawaii have teamed up with the Juno spacecraft to probe the mightiest storms in the solar system, taking place more than 500 million miles away on the giant planet Jupiter.
Researchers from the Gemini Observatory, found in Hawaii and the Hubble Space Telescope, belonging to NASA, have started a collaboration with the Juno spacecraft to find information about the strongest storms found in our solar system on the planet Jupiter, which is over 500 million miles away.


text:
Author: Neil Majithia
Institution: Virginia Commonwealth University
Date: October 2008
An NIH study published on October 2 in the online edition of Immunity suggests that the genetic material of bacteria living in the intestines of humans may function in fighting infection. The findings expand the known role of gut bacteria, or commensals, which include aiding in digestion.
It is normal for a person to have anywhere from 300 to 500 different species of bacteria living in their intestines. The relationship between two species can be classified into three main groups: parasitism, in which one species benefits at the expense of the other; commensalism, in which one species benefits and the other is not harmed; and mutalism, in which both species benefit. It is well-established that bacteria live in the gut without causing any harm to humans, and for years researchers have categorized this relationship as commensal. However, recent research seems to be characterizing a more mutualistic interaction.
"Within the body of a healthy adult, microbial cells vastly outnumber human cells. Research to understand these microbial communities is an exciting scientific frontier," says Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID). "Among many opportunities related to the so-called microbiome,' targeting beneficial bacteria may offer new avenues for therapy against infectious and immune-mediated diseases."
The exact mechanism of how friendly bacteria help ward off pathogens isn't known. However, the report indicates the gut microbes bind to the body's disease-fighting cells known as T-cells in order to boost their activity.
"There is a balance of regulatory immune signals in the body," notes Dr. Yasmine Belkaid, lead investigator of the study. "During an infection, we've found that commensals can break this balance in favor of an infection-fighting response."
In healthy individuals, intestinal T-cells known as Tregs regulate the commensals and guard them from immune system attack. Dr. Belkaid's team found that during an infection the commensals will bind to a specific site on the Tregs, gearing them into attack mode. The Tregs then specifically seek out the pathogens and ward off the invasion.
The team is excited about the findings because they may lead to a better understanding of how to go about treating autoimmune disorders such as rheumatoid arthritis and Stokes disease. The harmonious relationship between gut microbes and humans illustrates the perfect paradigm for synthetic treatments: protect the good, attack the bad.
Written by: Neil Majithia
Edited by: Brittany Raffa and Falishia Sloan
Published by: Hoi See Tsao

domain: news


text:
They promise paradise and it was for us. After a 3,5 hour bustrip from Nadi airport(only 10 FJD per person one way in a aircondintioned bus... taxi would take only 2 hours but would be 180 FJD) we were dropped in front of the resort... a dusty road to the resort. A friendly "Bula" from the security guide and then you step in to paradise! All green gardens, authentic Bures, nice swimmingpool, good restaurant and friendly staff and a beach full of palmtrees and beqa island in the distance. We booked a beachfront bure. This is a spacious authentic bure, no airconditioning but the fan was good enough. The veranda is great. You can sit there all day in the shade, or dry if a Fijian shower is passing by. The personal outside shower was fun, handy too, no sandy feet in the bure.
Lots of activity possible,we hired a jetski and we went out snorkling. Ask before you enter the boat how much time you have. We didn't know and jumped back in too quickly. The reef 500 meters in front of the resort is terrific. No need to dive.
There isn't that much to do outside the resort. Pacific Harbour has a nice art village, with some shops, a supermarket and some restaurants. Suva is 45 minutes by minibus.
We didn't trust to leave the resort in the dark, but this wasn't necessary. The restaurant provides enough variation for a week of good diners and lunches.
They had a great party at New Years eve. We liked it that local people visit Uprising for drinks or enjoying the beach.
- Official Description (provided by the hotel):
- Stylishly nestled on 2 kilometers of sandy beachfront between tropical palms, Uprising offers adventure, relaxation and sheer natural beauty all in one stunning safe location. Imagine a fun friendly place right on the beach where the young and young-at-heart come to play.Authentic Fijian accommodation options range from traditional thatched beachfront Villas and Bures (cottages) to fun tree-house shared facilities. Choose to relax on the beach or by the pool, and have a beachside massage, or take advantage of the many activities on offer. Scuba dive world famous Beqa Lagoon and experience shark diving and soft coral scuba sights, or head into the mountains for a whitewater rafting trip. Other daily activities include game fishing, jet ski island safari’s, golf, shopping at the Arts Village & Cultural Centre of Pacific Harbour. ... more less
- Reservation Options:
- TripAdvisor is proud to partner with Hotels.com, Expedia, Booking.com, Agoda, Priceline, Ebookers, Traveltool, S.L.U., TripOnline SA, Cancelon, Evoline ltd and HotelQuickly so you can book your Uprising Beach Resort reservations with confidence. We help millions of travellers each month to find the perfect hotel for both holiday and business trips, always with the best discounts and special offers.
- Also Known As:
- Uprising Beach Hotel Pacific Harbour
- Hotel Uprising Beach
- Uprising Beach Resort Fiji, South Pacific - Pacific Harbour

domain: geography


text:
FAB WARHOL SUNDAY B MORNING MARILYN SUITE OF 3 with COA
FABULOUS SUNDAY B MORNING WARHOL MARILYN MONROE PRINTS
HIGHEST EXCELLENT QUALITY WARHOL FINE ART PRINT
SUNDAY B MORNING WARHOL ARTWORK!
STUNNING MARILYN BY ANDY WARHOL SUNDAY B MORNING SCREEN PRINTS!, These are fabulous exciting screenprint. These are Sunday B. Mornings editions screenprints that are stamped on the verso in blue ink Published By Sunday B Morning fill in Tour Own Signature. The 'Blue inks' are the 1980's editions and the quality and integrity of the prints is impeccable. They are printed on 'museum board' with the highest quality archival inks. These are highly sought after by collectors for their quality, rarity and exciting vibrant colors. Certificates of Authenticity available upon request. " THIS ITEM IS SUBJECT TO AVAILABILITY!"
WE CARRY OVER 100 ANDY WARHOL Art works in our inventory.
Andy Warhol (1928-1987)
Iconic Artist, filmmaker, music producer, commercial illustrator, designer, and magazine publisher was born Andrew Warhola in 1928. Andy Warhol was a founder and major proponent of the Pop Art movement. He remains one of the most talented and influential artists of the 20th century. Warhol pioneered the development of the process of photo-mechanical silkscreen, where enlarged photographic images are transferred to a silk screen that is then placed on a canvas and inked from the back creating mass-media images.
Warhol is known for his paintings of commercial subjects and iconic images, from the Campbells Soup can series, to his portraits of celebrities from Marilyn Monroe to Jackie Kennedy.
Andy Warhol (1928-1987), founding father of the American Pop-Art Movement.World renowned for his work as a painter, filmmaker, producer, & author.Popular among diverse social circles comprised of distinguished intellectuals, celebrities, & wealthy aristocrats.As seasoned Andy Warhol Specialists, We Buy, Sell, & Consign Andy Warhol Prints with high admiration.Fineartgasm.com

domain: artistic


Everything You Want to Know about the 2019 Mercedes-Benz AMG® CLS
Fans of Mercedes-Benz have been eagerly anticipating news of the 2019 Mercedes-Benz AMG® CLS, which is set to redefine driving for everyone. The third generation of the Mercedes-Benz AMG® CLS is the 2019 model, and it is going to feature a completely new redesigned look. There are some stunning new features added to the car, which has gotten fans excited about it. At Mercedes-Benz Brampton, we are the #1 Mercedes-Benz dealership in Brampton, Ontario, and have got the inside scoop on the car.
We are going to be sharing what everyone can expect from the four-door coupe, 2019 Mercedes-Benz AMG® CLS. If you had been looking for news of the car, then you came to the right place.
The first look
You can easily mistake the 2019 Mercedes-Benz AMG® CLS on first glance, because the striking front-end grille of the CLS coupe looks remarkably like the one on the Mercedes- AMG® GT. The CLS coupe has been given an aggressive look with a widened base, and the muscular rear shoulder line of the car will blend seamlessly into the flat rear-end. This offers it a stunning and classic CLS body styling, and the front-end of the model is forward slanted, which gives it the resemblance of a shark’s nose.
What is it like inside?
The inside of the 2019 CLS features a 12.3-inch high resolution central display, with 64-color ambient lighting, and this is the signature technology, which has been used in the Mercedes-Benz S-Class models. The 2019 CLS coupe is the flagship sedan of Mercedes-Benz and comes with features like ENERGIZING Comfort, which allows drivers to choose from 6 different massage modes, and adjust the ventilation, heat, and fragrance of the cabin!
What about the performance?
The 2019 Mercedes-Benz AMG® CLS is a hybrid, and Mercedes-Benz unveiled a brand-new line of AMG® drivetrains at the 2018 North American International Auto Show (NAIAS), which also included the AMG® CLS 53. Apart from that the 2019 AMG® CLS features a brand new inline-six engine, with a 48-volt onboard electrical system, and EQ Boost.
The all-new engine is expected to deliver an outstanding level of performance, like that of an eight-cylinder engine, and comes with extremely low fuel consumption. All that makes the 2019 Mercedes-Benz AMG® CLS the next Mercedes-Benz model you should get for yourself.
Take it for a test drive
If you want more information about the 2019 Mercedes-Benz AMG® CLS, then visit Mercedes-Benz Brampton today. We are the #1 Mercedes-Benz dealership in Brampton, Ontario, and have the complete line of Mercedes-Benz AMG® CLS in our showroom.


text:
Department for Climate Change of the Ministry of Agriculture and Environmental Protection is implementing EU-funded Twinning Project “Creation of a monitoring, reporting and verification system for the successful implementation of the EU Emissions Trading System (EU ETS)”. This is an IPA 2012 funded project. Overall goal of the project is to contribute to reduction of greenhouse gas emission in an effective and economically viable way. Purpose of the project is to establish sustainable system for monitoring, reporting and verification (MRV) for effective implementation of the EU Directive 2009/29/EC on the emission trading system (EU ETS). One of the project results would be development of legislative and institutional framework for implementation of the EU ETS Directive. Project has been initiated on 16 September 2013 and will last until September 2015. Twinning partners are competent institutions from France, Germany and Austria.
So far, a number of expert missions have been arranged, preliminary list of the EU ETS facilities was produced and Training Programme was prepared for representatives of relevant institutions, industry and potential verifiers. Besides that, preparation of relevant laws and by laws that are necessary for complete implementation is in progress. Assessment of transition measures for compliance with the system was performed as well as analysis of the costs for energy sector and implementation plan for stationary facilities and plane operators for the pre accession period. Government of Serbia approved Report on establishment of institutional arrangements for implementation of MRV.
More information can be found at: http://ets-srbija.klimatskepromene.rs

domain: law


text:
This is Rabeca. Her community in Sussundenga region was hit hard by Cyclone Idai in 2019. Family homes were torn down and their only source of clean water was destroyed.
Rabeca stepped up. Previously she’d only thought of herself as a mother of two and sadly a widow, but now she’s Volunteer Community Activist too.
She took it upon herself to support her village and neighbouring communities through what were some of the most trying weeks and months of their lives. She teamed up WATSAN, our local partners, to help teach families about the importance of good hygiene practice to prevent waterborne disease – especially important in the wake of a disaster
We ensure in every village and school project that women like Rabeca make up at least half of the water committee. They take ownership of the water pump and are trained how to look after it.
Most of our well construction teams are made up of men. It is traditionally ‘a man’s job’. We ensure our training is accessible to local women who are interested in these learning, like Gracious, the first female driller we ever trained.
Because how can we really achieve equitable water, sanitation and hygiene education (WASH) access if women are not a part of the conversation?
From the women at Village Water to every one reading this, let’s keep working together because, like Rabeca, our work is not yet done.
Celebrate the achievements, the hard work and the wonderful things women do with our International Women’s Day Gallery.

domain: sociology


text:
DALLAS — Pip is a 5-month-old male that is available for adoption at Blue Chip. He is playful and loves toys that let him jump or spin. He loves people, but is a little shy at first. Pip gets along with other cats, as far as dogs he has not met any to date. If interested in adopting Pip or finding out more information, stop by Blue Chip Farm or visit our website at www.bcfanimalrefuge.org.
Blue Chip Farms Animal Refuge
974 Lockville Road
Tuesday, Thursday, Saturday and Sunday, noon to 5 p.m. Other hours by appointment.

domain: pet


The price of Bitcoin keeps smashing resistance levels while reclaiming previously lost territory. Unlike other rallies into the current area, this price action might suggest a persistent trend and a new dawn for the industry following months of collapsing companies and bankruptcies.
As of this writing, Bitcoin (BTC) trades at $22,800 with sideways movement in the last 24 hours. In the previous week, the cryptocurrency records a 10% profit. Other cryptocurrencies in the top 10 by market capitalization are experiencing similar price action with substantial profits over this period.
Is Bitcoin Finally At Bottom Levels?
According to an analyst at Jarvis Labs, the current Bitcoin rally results from a long period of consolidation below the 200-Day Moving Average (MA). This moving average is one of BTC’s most important levels operating as critical support during the bearish cycles.
As Bitcoin reclaims the 200-day MA at around $19,520, the analyst wants to see a consolidation above this level. The rally might extend if the cryptocurrency can hold above it, pushing BTC into further highs, solidifying “a flip of the 200-day MA from resistance to support.”
As seen in the chart below, during the 2019 bear market, BTC saw a long consolidation below its 200-day MA before reclaiming these levels later in the year. According to the analyst, the longer the consolidation, the better the improvement for BTC’s overall market structure as other moving averages rise.
The above does not imply that Bitcoin will continuously trend to the upside, back to its all-time high of $69,000. Instead, it suggests that BTC’s market health is improving, with the foundation for further gains increasing.
This new status quo makes any potential decline an opportunity for optimistic investors. The Jarvis Labs analyst wrote:
(…) And while there is still a reasonably high probability that early January price levels will be revisited again at some point in 2023, there is also a strong piece of data which suggests any such retest would present a prime buying opportunity.
Accumulation Levels Hint At 2019 Like BTC Bottom
In addition to this period of consolidation below the 200-day MA, which hints at a 2019-like bottom, BTC has seen “persistent accumulation.” The image below shows that Bitcoin investors have been “moderately accumulating” (Blue dots in the chart below) more of the cryptocurrency.
Similar to the 2018-2019 bear market, this accumulation period preceded market rallies. In the coming months, Bitcoin should see more aggressive accumulation (Red dots in the chart below) to support another bullish season.
The US Federal Reserve (Fed) remains the biggest obstacle to a Bitcoin rally. The financial institution is hiking interest rates to reduce inflation while hurting financial markets.
Market participants expect the Fed to pivot its monetary policy, but gains in stocks and crypto, combined with sticky inflation, could trigger the opposite. If this happens, optimistic investors might see the buying opportunity presented by the Jarvis Labs analyst.


text:
Out of stock
Coffea arabica, more commonly known as the Coffee plant, is native to the southwestern Highlands of Ethiopia. It is an evergreen plant that can grow up to 1.5m tall. Plants are best kept in a slightly moist substrate with partial shade.
Well Drained Moist Soil

domain: biology


text:
Like John Butler, all of the rugs in our house came from Shawn. This includes the beautiful runners that he had made for our staircases. He spoke to weavers in Pakistan and asked them to make specific size runners for us. They are absolutely...
Mar 03, 2023
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Hyrbrid mode balances energy savings and available hot water convenience.
This Trigger fires every time the water heater is placed in hybrid mode. Hybrid mode balances energy savings and available hot water convenience.
This action will send a notification to your devices from the IFTTT app.
IFTTT social media solutions connect instagram, twitter, & facebook with time saving automations
A Ring camera is one of the best security systems. Click to learn the pros and cons of using a Ring Camera.
Introducing the Twitter AI Assistant - New Twitter automation tool
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Notifications and GE Appliances GeoSpring™


text:
Howdy! I am finally doing some catch up on my card posting. In October my hubby turned 60. We stayed in Lake Tahoe in a house for about 10 days. We love Tahoe and have stayed there many times. We had our two dogs with us and my son was with us for the first time for most of the time. We did dog walks to the river, hiking, bike riding and just hanging out. It was a great trip.
Here is the card I made for him. I made most of it there except the die cutting because I can’t take my die cutting machine with. He has 3 guitars. I have one guitar stamp. The one on the right is an electric guitar and the style of the guitar doesn’t look much like his but I colored it like his. I was sneaky and took pictures of all of them for reference.
The background is stamped with a music background stamp.
The guitars are stamped with a random guitar stamp I have. I stamped in brown and black and colored with Copics. I used a white glaze pen to put accents (not sure what you call all those things) on. The sentiment and 60 are die cut. I got a long Tim Holtz die that wouldn’t have worked that well in my old die cutting machine but works great with the Big Shot. It has numbers and letters.
Here is a little something else I colored for him. We both like to watch hawks him even more so. He bought this hawk stamp online to make something. He gave it to me after so I decided to stamp and color this for his birthday. It’s just a panel not a card.
Here’s a few photos from our Tahoe trip. We also had a family and friends dinner when we got back home.
Stampington & Company – Large Sheet Music
Rubber Hedgehog – Hawk
Random Guitar stamp (can’t read company name on stamp)
Here’s a little card I made for my son for his birthday. He turned 27 this year. When I saw this stamp pop up over at Hero Arts I had to get it. When my son went to Costa Rica a few years ago he really liked the sloths so of course he was going to get a card made with this stamp.
The card base – I embossed it with an embossing folder and went over it lightly with some darker brown ink.
I first stamped the sloth. Then I made a mask of the sloth and branch to cover it so I could ink over a stencil to create kind of a jungle look. The sloth is colored with Copics.
My husband and I just got back from visiting Arches, Canyonlands, Mesa Verde and Rocky Mountain National Parks. In Rocky Mountain NP we saw a whole bunch of elk and some deer. So while going back to Utah to fly home we drove through Wyoming. I found a fab scrapbook store in Laramie called Scrap Tree. What a great store that was! I bought the die cut deer from there. So when I got to making the card for my husband I got out the aspen looking stencil and the die cut deer/elk. I was looking around in Pinterest for ideas for using the stencil and found this card as my inspiration.
I inked over the stencil with blue Distress ink which went on pretty darn nice. I struggle with applying Distress ink sometimes. I place a circle under the stencil while inking so I could make a moon. This idea came from my inspiration card. She did hers with light blue ink which looked very nice. I decided to make mine a more dominant moon. The sentiment is from Hero Arts set It’s Your Day (CL661) and stamped with the same blue Distress ink. The rectangle was cut with a My Favorite Things die set called Pierced Rectangles Stax. The deer/elks eye is a black rhinestone. The sentiment inside is a great stamp I found and had to get it. It is by Impression Obsession. We are music fans and that is a great birthday song! The notes are a separate stamp.

domain: design


HP G62-147NR NOTEBOOK RALINK WLAN DRIVER DETAILS:
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|Supported systems:||Windows All|
|Price:||Free* (*Free Registration Required)|
HP G62-147NR NOTEBOOK RALINK WLAN DRIVER
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US Seller USB Audio Sound Board for Sony Vaio VPCEA VPCEB VPCEC IFX-565 IFX567
We will provide the best service and reliable products for every customer, however, accident may happen sometimes,We believe good cummunication can solve every problem happily, so pls contact us to solve any issue before leaving a negative feedback. When you have finished HP G62-147NR Notebook Ralink WLAN configuration of the system, it is recommended to restart everything the router and all computers involved. This can occur if you are running windows in safe mode or if windows install is not properly installed.
I'm not running in safe mode Thank you so much, I used the fix it guy and it fixes the problem, I was able to install the printer wireless without problem Problems printing from laptop to wireless network I've had problems for months now print wirelessly from my laptop to my printer. When I click on print a document, I get a warning on my laptop that the driver for the HP G62-147NR Notebook Ralink WLAN is offline.
I tried to restart my laptop, disconnect and reconnect to the internet, restarting printer, disconnect and reconnect it to the internet, uninstalling and reinstalling the printer using the existing driver and replace. Sometimes one of these 'corrections' HP G62-147NR Notebook Ralink WLAN, other times not. Tonight I tried to restart the two, reconnect the two and then uninstalled and am trying to reinstall it but my laptop cannot find the printer to install it. I am at a total loss. I work from home, sometimes and I bought a wireless printer for the convenience that he cannot stand on my desk next to my laptop to connect to the computer. Also don't know what happened to the cord for the printer on the laptop, presumingI got with the printer.
Both devices say they are connected to the internet. I can test my laptop and the internet connection works fine, don't know how to test the connection of the printer, but it says connected and has an IP etc.
I also tried disconnecting everything but the computer laptop and wireless network printer, and it won't always connect to print. Can anyone offer any fixes?
HP Ralink 802.11 b g n WiFi Adapter Drivers Download
This becomes incredibly frustrating when I sit down to work and fight with the printer for hours. I see that you have connectivity problems.
I would like to help. I recommend you to perform a power reset.
Unplug the power cord from the printer HP G62-147NR Notebook Ralink WLAN the power outlet, then wait 60 seconds. After 60 seconds, plug back in the printer. Make sure that you connect the printer directly to a wall outlet. HP G62 Notebook PC Added newly supported WLAN modules to spare parts listings in the Ralink RTBC4 b/g/n 1x1 WiFi and g: NR. Download the latest driver, firmware, and software for your HP GUS Notebook is HP's official website to download drivers free of cost for your HP Missing: NR.


98 Saturn SL1 - Heat blows cold at Highway Speeds, A/C works great, HELP!
I have a 1998 Saturn SL1 with the 1.9L 4cyl. She is a complete base model
(5spd Manual, crank windows, no power steering, etc). I owned a 94 SL1
about 10 years ago that was totaled in an accident that I absolutely loved
(she had 212k miles on her and didn't burn, or leak a drop of oil).
The 98 I bought about 3 months ago, it was a 1 owner with just 99,305 miles
on it. I picked it up for $900. The 2nd day I had it, the "low coolant" light
came on and I immediately took her to the shop. They explained that that
radiator had a split down the side and she was leaking coolant very bad. I
had them replace the radiator, the thermostat, and the coolant overflow cap
(as I had heard the cap often fails on these engines). So for most of the
summer I used the car as a commuted to work because of the
ASTOUNDING gas mileage you get out of these cars. The A/C works very
well and I never saw any more engine heat up, nor had any other problems
with the car.
I have a much nicer vehicle that I prefer to garage in the sometimes brutal
winters here in Idaho (a 2012 E350) to avoid getting the de-icer used on the
roads on the paint, gravel pits from the sand, and from risk of collision
(either by myself or another driver), but I digress.
The problem with the Saturn is, that she has no heat. If I start the car and let
it idle for a half hour, I will get in and the heat gauge shows she's running
perfectly, just between the quarter mark and the half mark on the heat
gauge. She does have a little heat however, if I put the blower on full, within
30 seconds the air goes cold. During my commute, the car blows cold the
whole way (Roughly 20 miles). Since the radiator, thermostat, and coolant
overflow cap have been replaced, what could be causing this?
There is no leakage of oil or antifreeze on neither my garage floor at home,
or my parking space in the garage at work. I checked all fluid levels when
the car was cold, and they are all at appropriate levels. I also inspected the
heater controls themselves and the mechanism that changes the airflow (the
little slider that goes from blue to red, or cold to hot) and it works perfectly,
opening the correct "door" to the cabin. Could this be due to a blown head
gasket? Note: I do notice after driving for some time, at idle, that if the
heater is off and the car is running, the heat gauge goes up to the 1/2 mark
and the cooling fans kick on bringing the temp gauge back down to a
normal level. After spending just about $1200 total on this car (the purchase
price and the radiator, hose, thermostat, and overflow cap, replacements), I
am hesitant to repair it for another $500-$1000 for the gasket. Any help
would be greatly appreciated!
First let vehicle reach operating temp and feel the heater hoses going into and out from heater core if the both feel hot and the same temperature blend door cable may have come off.
It could be that they installed the thermostat backwards you know when it was replaced I don't know I would go back to the repair shop and let them deal with it cuz in a way they might have created the problem?
Thank you both @firebird338 and @akasnacker after pulling it apart to do some preventative (and albeit needed repairs for a 18 year old car) I noticed in fact that they did install the thermostat incorrectly. I have it reversed and resumed normal operation).
Im glad we both could help you. Now go forth and pay it forward! Happy motoring!
hmm.. the thermostat is in the water outlet.. I just changed mine. I don't see how it could be installed backwards.
I have a 1996 SC1 with just over 300,000 miles that is doing the same exact thing. I checked and all hoses are warm Also the water temp and the water level warning lights have started blinking. I was told that the water resivor may need to be taken out and thoroughly cleaned as there is a sensor or sensor inside that cause malfunctions when the become dirty and corroded. It was also recommended that I drain and flush the entire cooling system which sound logical. I am going to do both and would also like to check this blend box thing as well. Can someone tell me where this is located. All I know is there are no obvious causes and would appreciate any feedback. Thank you.
Blend box thing?
Did you mean Thermostat?
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Amitabh Bachchan is all set to make his debut in Tamil film industry with the film film Uyarndha Manithan, directed by Tamilvanan. He will be sharing the screen space with SJ Suryah.
The actor signed the film last year, but the shoot of the film will begin in March this year. Amitabh has apparently allotted bulk dates to the makers and is likely to complete the film in forty days.
On the work front, Amitabh is shooting for Brahmastra with Ranbir Kapoor and Alia Bhatt as well as for Nargraj Manjule’s Jhund.

domain: entertainment


text:
Neurosurgery Open, 2(2), 2021
Full text: Unavailable
ABSTRACT BACKGROUND Few studies have attempted to make a direct comparison of the risk of visual impairment following extradural anterior clinoidectomy (EAC) with and without the use of a power drill. OBJECTIVE To evaluate postoperative visual outcomes between groups of patients with paraclinoid carotid artery aneurysms (PCAAs) who underwent surgical clipping with and without the use of a power drill during EAC. METHODS Between January 2010 and November 2019, 90 patients, 7 with ruptured and 83 with unruptured PCAAs, underwent clipping surgery at our hospital. The authors retrospectively analyzed postoperative visual complications from the medical records of these patients. RESULTS Among the 85 patients (excluding 3 patients with disturbance of consciousness caused by subarachnoid hemorrhage and 2 patients with preoperative visual disturbance) evaluated, EAC was conducted using a power drill in 64 patients and using a microrongeur in 21 patients. Permanent postoperative visual impairment developed in 14 (21.9%) patients in the drill group: 9 patients had ipsilateral lower nasal quadrant hemianopsia (ILNQH) and 5 patients had ipsilateral visual acuity reduction. Transient ILNQH developed in only 1 patient in the no-drill group. The incidence of permanent postoperative visual impairments was significantly lower in the no-drill group than in the drill group (P = .020). Seventeen (26.6%) patients developed transient oculomotor nerve palsy in the drill group, while no patients developed oculomotor nerve palsy in the no-drill group. CONCLUSION EAC using a microrongeur versus a power drill significantly improved visual outcomes after clipping surgery for PCAAs.


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by Mikhaeyla Kopievsky
Recently, I committed to making 2022 a year of editing. As part of that commitment, I’m reading a lot of craft books on writing and editing in the hopes their general wisdom will help push my many manuscripts into that ideal ‘P’ zone that George Saunders talks about. And, as promised, I’m going to share what I find with you, so that we can all improve both our manuscripts and our chances of being published and engaging readers.
In this first instalment, I’m going to share with you Matt Bell’s “Refuse to Be Done: How to Write and Rewrite a Novel in Three Drafts”, which comes out in March (but that is available for pre-order now). I was lucky enough to score an Advanced Reader Copy, and I devoured it in a few days.
Bell, author of the New York Times Notable Book, Appleseed, and the award-winning In the House upon the Dirt between the Lake and the Woods, previously worked at a small publishing house, and now teaches creative writing at Arizona State University. And, in Refuse to Be Done, his experiences along that broad spectrum come together in a way that pragmatically addresses the challenges of revisions, while offering kindness, hope, and encouragement.
Refuse to Be Done is, above all, a generous book – it draws not only on the author’s extensive experience, but shares the insights and wisdom of other writers from a range of genres and styles and actively encourages the reader to seek out other books on the writing and editing craft. And this all happens right from the get go – in the epigraph, Bell quotes Karen Russell, American novelist and short story writer whose debut novel, Swamplandia!, was a finalist for the 2012 Pulitzer Prize: “Writing a novel is kind of like scaling Mt Everest and passing by your own bones on the way”.
Bell gets it; he understands the uniquely personal aspects of writing and editing, and he prefaces his own advice with a caveat. This book is not to turn you into the kind of novelist he is (which, to be honest, wouldn’t be a bad thing…), but to “help you become more yourself, on the page and throughout your process…to serve you and your book.”
Now that we know we’re all on the same page, let’s get into what makes this book so useful to the writer who is editing (even, sometimes, as they write).
The core underlying belief of this book is that “rewriting and revision necessarily occur at every stage of the process”. The book itself is organised into three parts to match these key stages, what Bell terms ‘the three drafts’.
In the first draft, Bell looks at ‘generative revision’ – the kind of revision that allows you to rewrite while still maintaining progress towards finishing your manuscript. Here, the focus is on having fun and exploring the story organically. There are some great ‘hacks’ to trick your brain into generating and maintaining creative output (and avoid writers block), and excellent advice around not letting this stage of creating a book be weighed down and tightly constrained by too much planning. In amongst these prompts are some of my favourite ‘rules of thumb’ – 1) In every scene, have your character doing something that causes a change in them or around them, 2) Know the stories your characters are telling themselves, with all their secrets, misunderstandings, heuristics, and biases – their ‘meta-narratives’ – and explore the conflict this creates, and 3) Turn your character’s ongoing, habitual action into a specific incident that sets that behaviour as natural and habitual.
(As I work through my own edits next year, I’ll be returning to these and many others explored in Refuse to Be Done – testing them out and sharing with you the outcomes).
The second draft is what Bell calls ‘narrative revision’ – where the big decisions about how to restructure and rewrite your story’s dramatic material to maximum effect comes into play. It is in this stage that the most significant improvements to plot and story can happen. Central to creating this draft is understanding your story better – knowing its key parts intimately and understanding the through-lines of cause and effect. Interestingly, Bell suggests that the best way to do this is to write a detailed outline and work on that and not the manuscript, until you’ve got the outline of the novel you wanted to write (but maybe/possibly/probably didn’t on your first time around). In this part, Bell offers advice on how to turn that outline into a plan, and what key things to look out for along the way.
And, then we get to the third draft, where we encounter the ‘polishing revision’ – and where the book’s title really comes into play. It is in the third draft that authors must refuse to be done – “What you want now is to stay inside your novel as long as possible, giving yourself every chance to transform this pretty good draft into a novel that’s as great as it can be.” What follows is a layered approach to revision – editing tasks and checklists that continue to fine tune the piece until it’s pitch perfect. Here, the focus is less on figuring out what happens, and more on the best way of showing it happening. This part of the book is like having an editor beside you as you work, pointing out what could be fixed, and offering suggestions for how to fix it (and is, no doubt, a product of Bell’s experiences reading and marking student work, working at a small publication house, and working with respected editors for his own works).
I’m really looking forward to using Refuse to Be Done as a quasi-workbook next year and sharing with you all the process as it occurs. Don’t forget you can also grab your copy from March (or save yourself the reminder and pre-order now).
0 comments on “In the Editing Trenches: Refuse to Be Done”

domain: library


Anyone had issues with front crank harmonic balancer pulleys on a TD27 EDi?
My truck decided it didn't like the drive belts while the Mrs was using it the other day. She told me that the lights came on the dash the previous day but forgot to tell me. But that's another issue GRRRRRR
I put some more on thinking that it was just a belt that failed and went through the others. The new PS belt keeps flipping round now. The others are OK.
Checked alignment of the pulleys. All seem to be in line.
Checked front pulley and it looks OK but has a slight wobble at idle. Read that is common with them though.
Checked bolt is tight as well.
Checked PS pump mounting is ok and not slogged out.
Thought maybe the harmonic balancer could be shitting out.
Tried another PS belt (using Gates belts from Repco) and it seems to be Ok now. Given the truck a good run up and the belts aren't coming off.


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Color the Wind
Annual Clear Lake Kite Flying Event
Date: February 18, 2023
Time: 11 a.m. – 4 p.m.
Event Description: Color the Wind is back! Join us in Clear Lake for the Midwest’s largest and most colorful winter kite festival, featuring huge inflatable kites of all kinds flown by serious kite-flyers from across the United States. Free admission, donations are appreciated!
Expect to be dazzled by this event! The display of beautiful colors, the sheer size of some of the kites, and the incredible choreography of the musical numbers are really something to behold.
Visitors will flock to Clear Lake’s frozen oasis to see the most spectacular display of kite-flying around. The festival is a big hit for everyone! Young or old – seasoned kite flyer or newbie to the hobby.
Keep in mind, this is a winter event, so it could be very cold. Please dress accordingly, and don’t forget, to avoid a day spent squinting at the kites, so bring your shades!
Parking: We will have updated parking & shuttle routes for 2023, stay tuned!
You may drive along N Lakeview Drive to view the kites without getting out of your car.
Kites will be available for purchase at the Lakeview Room. You may also bring your own kite to fly, just steer clear of the large kites and their lines!
In addition to these local restaurants, we will have a couple food trucks parked across from the Clear Lake Yacht Club.
You may NOT drive or park your car on the ice downtown in the designated festival area.
Other Saturday activities:
Wind Discovery Fundraiser
Surf Ballroom is open from 9am-1pm.
Clear Lake Arts Center is open from 10am-4pm.
Parking Restrictions TBA
Color the Wind Committee
Christy Bredeson, Deb Cash, Larry Day, Deb Sharar, Sheila Steely, & Mark Tesar
Staff: Trish Fundermann & Jenny Fasbender
Presenting Sponsor 2022
Wind Twister Sponsors 2022
Freestyle Sponsors 2022
Event Blog Posts
Check out our recent entries for all of the latest and greatest news about your favorite event!
Thursdays on Main event to help Kids & Families in Need BY: RACHEL WUMKES There are not many activities less enjoyable in life than shopping for school supplies. I mean, it’s supposed to be fun and exciting. Parents everywhere should be rejoicing, right? Wrong....
Don’t Miss Out on the Ultimate Girls’ Day! BY: RACHEL WUMKES Time to break out the shackets and wide-brimmed hats, ladies. Today is all about Harvest Festival! Wait. What? Seems a bit odd as we are smack-dab in the middle of having all the summer fun. But you see,...
After a two-year hiatus, this spectacular event is back! BY: RACHEL WUMKES When the Clear Lake Arts Center wrapped up the 2019 Art Sail event, there was no way to know the massive detour they would soon take. Closings. Cancellations. Modified exhibits. But finally,...
Count Memories… Not Calories BY: RACHEL WUMKES There are so many things to love about the 4th of July in Clear Lake. The parade down Main Avenue. Evans United Carnival in the park. Enjoying an afternoon in the Bingo tent with friends. Appreciating an evening of...
Here we go again, folks. BY: RACHEL WUMKES The countdown to the biggest, best, most amazing celebration in all North Iowa is only days away. Five of them, to be exact. The Clear Lake 4th of July Extravaganza kicks off the weeklong festivities on Wednesday, June 29th...

domain: hobby


Becky Lynch is one of the most beloved female wrestlers to walk the planet today--be it her wrestling or her promo skills, "The Irish Lass Kicker" is one who exceeds expectations on all fronts. Well, fortunately for fans of this talented young woman, the WWE lately seems to have taken great interest in promoting the Irishwoman as one of the Women's Division's top stars.
Notwithstanding, the fact remains that Lynch could be better utilized by the company--not only in its storylines, but also on the corporate front as a strong, assertive representative of the company. Despite the WWE's recent push of Lynch, one simply cannot deny the argument the hordes of her fans make--alleging that she ought to rightfully be accorded a more significant amount of the spotlight in the WWE Universe.
In light of Lynch's recent heel turn, which was rather unsurprisingly followed by the WWE altering its booking and presenting her as a tweener (i.e. neither heel nor face)--today, we are going to be looking at why Lynch's star-power is so very influential that the global media conglomerate that is WWE was coerced to depict this Superstar as a beloved anti-hero rather than a run-of-the-mill heel.
Bear in mind, Lynch's current situation in WWE is eerily similar to that of "Stone Cold" Steve Austin's back in the day when--despite him initially being portrayed as a heel--the WWE Universe chose to cheer him and boo the babyface in the feud, Bret Hart! This discussion is about to get heated!
Often times in the world of professional wrestling, athletes who possess a decent amount of experience from other legitimate sporting competitions--for instance, boxers, football players, power-lifters, et cetera--are given a considerable degree of preference over performers who've done nothing but professional wrestling.
Notwithstanding, when one talks about a legitimately intimidating character in pro-wrestling, names such as former UFC Heavyweight Champion Brock Lesnar, MMA legend Ronda Rousey, 3-time Golden Glove boxing champion Baron Corbin, and a few others come to mind. However, a select few individuals who don't boast the legitimate sporting credentials as the aforesaid trio does, still somehow manage to get themselves 'over' with the fans as legitimate badasses.
"Stone Cold" Steve Austin had that aura of a true renegade, as does Becky Lynch! Frankly speaking, these naturally-gifted Superstars don't need any qualifications to justify their rebellious behavior. Lynch has an aura of a hell-raising agitator, which makes her anti-hero depiction in WWE the best option moving forward...


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Interest-Based Ads Beta blockers Latest Headlines If you don’t have type 2 diabetes, your doctor may sign off on this drug if you’re obese and struggling to lose weight. But again, metformin isn’t a substitute for healthy eating and regular exercise, which are keys to sustainable weight loss. These habits also encourage weight loss if you have type 2 diabetes but can’t take metformin.
Advanced Cancer and Caregivers Real Estate Metformin is used for treating type 2 diabetes in adults and children. It may be used alone or in combination with other diabetic medications.
Life insurance The presence of high levels of blood sugar prevents white blood cells, which are important in the body's defense against bacteria and in cleaning up dead tissue and cells, from working properly. Improper cell function leads to wounds which take longer to heal and have the potential to become infected more often. Diabetes that has been present for a lengthy period of time is associated with thickening of the blood vessels. This can prevent proper circulation, which is needed in order to deliver nutrients and oxygen to tissues in the body.
Your doctor may start you on a low dose of metformin and gradually increase your dose not more often than once every 1–2 weeks. You will need to monitor your blood sugar carefully so your doctor will be able to tell how well metformin is working.
Common culprits and what you can do. metabolic syndrome Anti-diabetic medication
Vascular Disease 15 Video: Keeping Your Family Healthy During Flu Season For You Dangers of Mixing Medications
Enter Email AddressWhat's this?Submit EN Obesity and weight loss fact sheet Common symptoms of diabetes:
Diabetes Mellitus Per-Olof Berggren, Ph.D. Qty: Shop Diabetes
Type 1 diabetes also results from progressive failure of the pancreatic beta cells, the only cell type that produces significant amounts of insulin. Share on Google Plus Keratosis Pilaris
Bethesda, MD 20814-1621 Type 1 diabetes is partly inherited, with multiple genes, including certain HLA genotypes, known to influence the risk of diabetes. In genetically susceptible people, the onset of diabetes can be triggered by one or more environmental factors, such as a viral infection or diet. Several viruses have been implicated, but to date there is no stringent evidence to support this hypothesis in humans. Among dietary factors, data suggest that gliadin (a protein present in gluten) may play a role in the development of type 1 diabetes, but the mechanism is not fully understood.
53. January 16, 2017 at 7:17 pm Independent of diet and lifestyle factors, your genetics can affect your risk for type 2 diabetes, too. Tags: adult, diabetes, Diabetes Medicines, elderly, gestational, Health Maintenance, obesity, teenager
Here are six steps to help reduce your risk. View all the latest top news in the health sciences,
alleviating pain or harshness American Association of Diabetes Educators Menke, A., Orchard, T. J., Imperatore, G., Bullard, K. M., Mayer-Davis, E., & Cowie, C. C. (2013). The prevalence of type 1 diabetes in the United States. Epidemiology, 24(5), 773–774.
Diabetes Symptoms in Women The Report Authority control
4 Norwegian Bokmål Better health for everyone » Sarcolipin Tricks Muscles Into Using More Energy Tips to Better Manage Your Migraine Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. Insulin lowers the blood glucose level. When the blood glucose elevates (for example, after eating food), insulin is released from the pancreas to normalize the glucose level by promoting the uptake of glucose into body cells. In patients with diabetes, the absence of insufficient production of or lack of response to insulin causes hyperglycemia. Diabetes is a chronic medical condition, meaning that although it can be controlled, it lasts a lifetime.
Study 1: Dose finding study RSS Feeds Post to Reddit MedlinePlus links to health information from the National Institutes of Health and other federal government agencies. MedlinePlus also links to health information from non-government Web sites. See our disclaimer about external links and our quality guidelines.
A: Metformin also reduces the risk of lung (by 29%) and respiratory system cancer (by 15%). However, the lack of distinction between cancer patients who smoked and who did not be a limitation of this meta-analysis [R].
Inside Dr. Axe A rare side effect of metformin is lactic acid build up. Condiments & Natural Sweeteners Genetics of Diabetes Most of the symptoms of diabetes are common in both men and women. They can include:
A1C test is not just used for diagnosis of diabetes. It allows your doctor to see the average of blood glucose values over the last 3 months. This is a good indication of how well your blood glucose has been in control overall and allows your doctor to manage your diabetes more effectively. A1C is usually measured every 3 to 6 months.
Not for use in patients >80 years unless normal renal function establishedInitial and maintenance dosing of metformin should be conservative in patients with advanced age due to the potential for decreased renal function in this population
Tablet, Extended Release Other Hearst Subscriptions About the Data Feeling frightened or anxious Cancer risk and prognosis Related articles submit
Smoking: Artículos en Español The Spruce What conditions does Metformin HCL treat? MD Link Croup Cough Diabetic hyperlipidemia sounds a bit intimidating, doesn’t it? As we always do here on EndocrineWeb, we’re going to break down that concept for you, and that’s why we’ve put together this Patient Guide to Treating High Cholesterol and Diabetes.
Making Healthy Food Choices It is important to learn to keep blood sugar levels as even as possible. Equally important is maintaining an accurate record of the person's insulin dosages and blood sugar levels; health care providers will need this information in order to provide treatment and management of diabetes for them. Pursuing a consistently healthy diet that is right for their weight and size is just as important in the effort to control the person's blood sugar levels.
Symptoms of diabetes
not enough insulin—glucose can’t enter the body’s cells ACL Tear Generally, Glucophage tablets are standard release. They should be taken two or three times each day with meals, or immediately after meals.
Metformin Won't Aid Breast Cancer Survival in Diabetics Testes
Immunizations - diabetes Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Related Galleries gas (flatulence) See all (368) 4 Rogers D. Bigger Subsidies Under New Farm Bill Program. Politico. March 9, 2015. Online. (Accessed September 2015)
Medical Links Actual Study Completion Date : December 2017 Byetta Metformin hydrochloride is a white hygroscopic crystalline powder, which is odorless and has a bitter taste. Hawa MI,
View all the latest top news in the physical sciences & technology, 62.
Diabetes Mellitus Seniors Blurred vision occurs when there are rapid changes in blood sugar — from low to high or high to low — and the eye muscles have not yet adapted to it, Einhorn says. Blurred vision is one of the early warning signs of type 2 diabetes. The body later adapts to the sugar levels, and your vision will go back to normal.
Limit intake of processed foods. Discuss Blurred vision. Workshop Bariatric surgery A consistent diet that includes roughly the same number of calories at about the same times of day helps the health-care professional prescribe the correct dose of medication or insulin.
Your doctor may increase your dosage by 500 mg weekly or 850 mg every 2 weeks, up to a total of 2,550 mg taken per day in divided doses. Breast Cancer: What Happens Next
Diabetes is a common life-long health condition. There are 3.5 million people diagnosed with diabetes in the UK and an estimated 500,000 who are living undiagnosed with the condition
Increase physical activity levels. Aim for moderately vigorous physical activity for at least 30 minutes every day. Done The signs of diabetes may all be there, but the often-overlooked fact is that type 2 diabetes is completely preventable and nearly 100 percent curable. Some of the signs that you may be diabetic are:
Find Studies 4 Norwegian Bokmål Journals for Professionals Summary Ask about an EKG even if you don’t think you’ve had a silent attack. If you have diabetes and are at high risk for a heart attack, your doctor may order an EKG to confirm that your ticker’s OK. Recommendations differ about whether everyone with diabetes should have an EKG; some medical organizations, such as the Choosing Wisely campaign and the American College of Physicians, recommend them for people with symptoms like chest pain, shortness of breath, irregular heartbeats and for people with diabetes who want to start an exercise program. So it’s smart to discuss it with your doctor, says Dr. Soliman.
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- Product Information
Product DescriptionInquiring minds will want to know who the hunk is on the front of the National Enquirer. Our fabric National Enquirer Magazine Cover Costume just slips over your head and you are a walking billboard of a scandalous celebrity. Dress up with a wild celebrity makeover this Halloween with our humourous National Enquirer costume or use this costume as a great photo prop for all the guests of your party. Our Magazine Cover Costume is sold by the piece. Please order in increments of 1 piece.
- Questions & Answers
- Hilarious costume guys!! Review by Fat Guy In Litt
I decided to shop around for my Halloween costume early this year and came across this one. This is just perfect for me. I'm a pretty big guy, so this should be hilarious! Good stuff.
(Posted on 7/14/10)
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Create a black and gold themed photo booth with these simple do-it-yourself tips!
Let the kids have one last hoorah before the summer ends with a carnival-themed celebration. Set up games, foods and other fun carnival activities!