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Luxury and Comfort Getaway(0 Reviews)
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- Minimum stay:3 nights
- Sleeps:8
- Bedrooms:3
- Bathrooms:3.5
- Property type:House
- Internet:Yes
- Pets considered:Yes
- Wheel chair accessible:N/A
About the Property
House, 3 Bedrooms + Den, 3.5 Baths (Sleeps 8)
Updated single family home sits on the 17th fairway of the Championship Golf Course along the Linville River in the prestigious Grandfather Golf and Country Club community. Home is on a quiet street surrounded by lush trees and foliage providing the perfect mountain get away. It sleeps 10 comfortably but is perfect for your romantic getaway. Beautiful kitchen and stunning fire place make this is the perfect home for entertaining while on vacation. Large porch on the rear of the home that over looks the 17th fair made to provide the perfect serene afternoon for you and your guest. Walking distance to the club house, tennis courts and beach pavilion and fitness facility. Excellent home for a relaxing getaway.
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Member since: 2012
Property Type
- House
House Rules
- Max. occupancy 8
- Children Welcome
- Non Smoking Only
- Pets Considered
Accommodation Type
- Vacation Rental
- Guests Provide Their Own Meals
- Long-Term Renters Welcome
Bedrooms: 3 Bedrooms, Sleeps 8, Beds for 8
Bathrooms: 3 Bathrooms, 1 Half Bathroom
- Churches
- Festivals
- Health/Beauty Spa
- Museums
- Playground
- Restaurants
- Winery Tours
Local Services & Businesses
- ATM/Bank
- Groceries
- Hospital
- Massage Therapist
Leisure Activities
- Bird Watching
- Eco Tourism
- Horseback Riding
- Outlet Shopping
- Paddle Boating
- Scenic Drives
- Shopping
- Sight Seeing
- Sledding
- Walking
- Wildlife Viewing
Location Type
Golf Course View:
Home sits on the 17th fairway of the Championship Golf Course along the Linville River....moreless
Mountain View:
Surrounded by mountains with great views. Minutes from Grandfather Mountain...moreless
Sports & Adventure Activities
- Basketball Court
- Cycling
- Fishing
- Fly Fishing
- Freshwater Fishing
- Hiking
- Kayaking
- Skiing
- Snowboarding
- Swimming
- Water Tubing
- Dining
- Dining Area
- Seating for 8 people
- Air Conditioning
- Clothes Dryer
- Covered Parking
- Garage
- Heating
- Linens Provided
- Parking
- Parking Off Street
- Towels Provided
- Washing Machine
- Wireless Internet
- Wood Fireplace
- Coffee Maker
- Cooking Utensils
- Dishes & Utensils
- Dishwasher
- Ice Maker
- Kitchen
- Microwave
- Oven
- Deck / Patio
- Outdoor Grill
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RatesCurrency Conversion
|Weekend Night
|Monthly *
My Standard Rate
3 night min stay
Additional information about rental rates
- Refundable Damage Deposit $500
- Cleaning $200
- Pet Fee $100
Tenant shall pay Landlord the rent amount for the term in two payments. The first payment is due immediately upon signing contract and includes half the total amount and a $500 security deposit, which will be refunded given the home is returned as it was received. Deposit is nonrefundable due to cancellations. The second half of the payment is due a week before the arrival day.
Owner's cancellation policy:
100% refund for cancellations more than 60 days before check-in date.
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Adding our Vacation Protection services can make sure your getaway goes smoothly, no matter what. We offer Cancellation Protection and Damage Protection so you can truly relax.
The property's calendar has not been updated in over 4 months. You can contact the owner for availability or look for properties with confirmed availability
Minutes from Sugar mountain ski resort, Grand Father Mountain, Hebram Colony. Wonderful lush environment, private home with great landscape. Less than 20 miles away from Historic Downtown Blowing Rock and its restaurants and shops as well as the Blue Ridge Parkway.
Owner info
Year Purchased: 2007
Why the Owner Chose Grandfather, NC, USA:
This home was the perfect home for what I was looking for in the community. As an avid golfer, GGCC was the premier club when I was looking to purchase a home in the area. The privacy of the home is what made me purchase it. I can see the 17th fairway, but the foliage that separates us from the course is just enough to keep me feeling like I am on the mountain side.
The Unique Benefits at this House:
Large open floor plan, great for entertaining. A Master Suite with beautiful tub. Modern, updated kitchen with renovated back splash and all necessary appliances. Large driveway which also accommodates numerous guests. Wireless and cable ready.
Contact us
Send email
- Primary: +000 000
- Secondary: +1 7043617680
Links to more information:
- Click Here to see All My Rental Listings
Front Yard
Living Room
Guest Room 2
Master Bedroom
2nd Master Bedroom/ Guest Room
Living Room
Master Bath
Den, recently re-furnished
Back Porch
This listing was first published here in 2012.
Date last modified - Tuesday, April 18, 2017
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text:
|Publication number
|Publication type
|Application number
|Publication date
|Dec 20, 2005
|Filing date
|Apr 30, 2002
|Priority date
|Apr 30, 2002
|Fee status
|Also published as
|Publication number
|John L. Sommer, Yong Kyun Cho, Lawrence C. McClure
|Original Assignee
|Medtronic, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (38), Referenced by (83), Classifications (22), Legal Events (3)
|External Links: USPTO, USPTO Assignment, Espacenet
The present invention relates generally to an implantable electrical stimulation and/or sensing lead, and more particularly, the present invention relates to a method and apparatus for improved stimulation and sensing of a medical electrical lead having a multiple electrode array.
A wide assortment of implantable medical devices (IMDs) are presently known and in commercial use. Such devices include cardiac pacemakers, cardiac defibrillators, cardioverters, neurostimulators, and other devices for delivering electrical signals to excitable tissue and/or receiving signals from the tissue. Devices such as pacemakers, whether implantable or temporary external type devices, are part of a system for delivering an electrical therapy or monitoring a patient condition. In addition to the pacemaker device, which typically has some form of pulse generator, a pacing system includes one or more leads carrying electrodes for delivering generated stimulation pulses to the heart and for sensing cardiac signals.
Pacemakers treat heart conditions in which the heart beats at a rate that is considered to be too slow, commonly referred to as bradycardia, by sensing cardiac signals and delivering appropriately timed electrical stimulation pulses to the atria and/or ventricles as needed to cause the myocardium to contract. Pacemakers may sense intrinsic cardiac signals that occur when the myocardium depolarizes naturally, causing a normal myocardial contraction or heart beat. A sensed signal associated with ventricular contraction is referred to as an R-wave, and a sensed signal associated with atrial contraction is a P-wave. When an intrinsic R-wave or P-wave is not sensed by the pacemaker, a stimulation pacing pulse is delivered, eliciting an evoked response which causes the myocardium to contract, thus maintaining a desired heart rate.
Pacemakers operate in either a unipolar or bipolar mode, and pace the atria and/or the ventricles of the heart. Unipolar pacing requires a lead having only one distal electrode for positioning in the heart, and utilizes the case, or housing of the implanted device as the other electrode for the pacing and sensing operations. For bipolar pacing and sensing, the lead typically has two electrodes, a tip electrode disposed at the distal end of the lead, and a ring electrode spaced somewhat back from the distal end. Each electrode is electrically coupled to a conductive cable or coil, which carries the stimulating current or sensed cardiac signals between the electrodes and the implanted device via a connector.
Combination devices are available for treating both fast and slow cardiac arrhythmias by delivering electrical shock therapy for cardioverting or defibrillating the heart in addition to cardiac pacing therapies. Such a device, commonly known as an implantable cardioverter defibrillator or "ICD", uses coil electrodes for delivering high-voltage shock therapies. An implantable cardiac lead used in combination with an ICD may be a tripolar or quadrapolar lead equipped with a tip electrode and a ring electrode for pacing and sensing functions and one or two coil electrodes for shock therapies.
In order to achieve stimulation or sensing in the right side of the heart, a lead may be positioned against the endocardium by advancing the lead through the vena cava into the right atrium for right atrial applications, or further advancing the lead into the right ventricle for right ventricular applications. In order to achieve stimulation or sensing in the left heart chambers, a lead, often referred to as a "coronary sinus lead," may be positioned within the vasculature of the left side of the heart via the coronary sinus and great cardiac vein. This endovascular lead placement is sometimes referred to as "epicardial" placement since electrodes on a coronary sinus lead will sense or stimulate epicardial heart tissue.
In order to work reliably, cardiac leads need to be positioned and secured at a targeted cardiac tissue site in a stable manner. Unacceptable pacing or sensing thresholds measured during an implant procedure may require lead repositioning. Shifting or dislodgement of the lead over time may result in changing thresholds, sometimes requiring programming adjustments in order to maintain an appropriate level of therapy. At the same time, increased pacing thresholds decrease the useful life of the battery in the implantable device, requiring earlier device replacement. Poor or inaccurate sensing of naturally occurring heart signals may result in inappropriate withholding or delivery of therapy.
To address these problems, an electrode may be passively secured in a desired endocardial position by the use of tines located at the distal end of a lead. The tines engage with the endocardial trabeculae, holding the distal lead end in place. Alternatively, an electrode may be actively secured by the use of a rotatable fixation helix. The helix exits the distal end of the lead and can be screwed into the body tissue. The helix itself may serve as an electrode or it may serve exclusively as an anchoring mechanism to locate an electrode mounted on the lead adjacent to a targeted tissue site. The fixation helix may be coupled to a drive shaft that is further connected to a coiled conductor that extends through the lead body as generally described in U.S. Pat. No. 4,106,512 issued to Bisping et al. A physician rotates the coiled conductor at a proximal end to cause rotation of the fixation helix via the drive shaft. As the helix is rotated in one direction, the helix is secured in the cardiac tissue. Rotation of the fixation helix in the opposite direction removes the helix from the tissue to allow for repositioning of the lead at another location.
These fixation methods, however, are not entirely appropriate in left heart stimulation and sensing applications when the lead is positioned endovascularly. A helical coil would puncture a cardiac vein. Tines would make lead re-positioning difficult because retraction of a tined lead within a narrow vein could potentially damage the valves within the vein. Tissue encapsulation of various passive and active fixation devices is normally encouraged to further stabilize an endocardial lead position. Tissue encapsulation is undesirable in stabilizing an endovascular lead, however, since such tissue ingrowth may obstruct blood flow. Methods for stabilizing an endovascular lead must allow for unimpeded blood flow. One method for stabilizing an endovascular lead is disclosed in U.S. Pat. No. 6,161,029, issued to Spreigl, et al., and includes an expanded stent that is lodged against the blood vessel wall to inhibit movement of the stent and a distal electrode support. The expanded stent lumen is aligned with the electrode support lumen for allowing blood to flow through the aligned electrode support lumen and expanded stent lumen.
Another problem encountered in left heart stimulation is that conventional circumferential tip or ring electrodes on a coronary sinus lead will direct current in the direction of the adjacent epicardium but also in directions away from the targeted tissue, which may reduce stimulation efficiency. Stray current may also cause undesired extraneous stimulation, such as phrenic nerve stimulation or atrial stimulation during ventricular pacing. A coronary sinus lead would preferably direct current only in the direction of the targeted myocardium. Correctly positioning an endovascular lead having an electrode on only one side, however, would be difficult and time consuming.
Lead failure sometimes occurs when a conductor becomes fractured or the insulation between electrodes and/or conductors fails. A unipolar lead failure generally requires a surgical procedure to replace the failed lead. In the case of a bipolar lead, a bipolar stimulation or sensing configuration may be reprogrammed to unipolar if one electrode on the lead remains functional. However, the remaining functional electrode may be positioned at a different location relative to the targeted cardiac tissue and may not provide as effective or efficient sensing or stimulation as the bipolar pair. Furthermore, in some patients, unipolar sensing does not provide an acceptable signal-to-noise ratio.
For effective cardiac pacing, a delivered stimulation pulse must be of adequate energy to cause depolarization of the myocardium, referred to as "capture." The lowest pulse energy that successfully captures the heart is referred to as the pacing threshold. In order to verify that a pacing pulse has captured the heart, modern pacemakers are equipped with automatic capture detection algorithms. Capture may be verified by various methodologies known in the art such as sensing for an evoked R-wave or P-wave after delivery of a pacing pulse, sensing for the absence of an intrinsic R-wave or P-wave during the refractory period after a pacing pulse, or detecting a conducted depolarization in an adjacent heart chamber. Various capture verification methods are described in U.S. Pat. No. 5,601,615 issued to Markowitz et al., U.S. Pat. No. 5,324,310 issued to Greeninger et al., and U.S. Pat. No. 5,861,012 issued to Stroebel, each of which patents are incorporated herein by reference in their entirety. If capture is not verified, the pacing pulse energy may be automatically increased.
An electrode configuration used for pacing and evoked response sensing for capture detection may utilize a bipolar lead on which a tip electrode provides unipolar pacing and the tip and ring electrode pair provide bipolar sensing of the evoked response. A limitation of using the same electrode for pacing and evoked response sensing is that the pacing pulse and ensuing after-potential and electrode-tissue polarization artifact mask the evoked response until they dissipate, after which the evoked response, if any, has typically passed the sensing electrodes. Therefore, it is desirable to use an electrode pair that does not include the pacing electrode for sensing an evoked response. To overcome the problems of after-potential and the electrode-tissue polarization artifact, capture verification methods have been proposed which involves sensing for a conducted depolarization at a site away from the pacing electrode. For example, sensing a ventricular depolarization after an atrial pacing pulse has been delivered is evidence that the atrium was captured and the evoked depolarization was conducted to the ventricle.
For accurate evoked response detection, however, it is desirable to sense the evoked response using a bipolar sensing electrode pair in the vicinity of the stimulated cardiac tissue site. Unipolar sensing or sensing in other areas of the heart could lead to erroneous evoked response detection due to noise or other myopotentials being sensed as an evoked response. Furthermore, sensing for an evoked response in another area of the heart may not be possible in patients having conduction disorders.
What is needed, therefore, is an improved lead design that allows accurate targeting of excitable tissue in both endovascular and endocardial applications. A lead having an electrode arrangement that allows for reliable pacing and evoked response sensing for the purpose of capture verification is also desirable. Such a lead must be stabilized in a way that, when used endovascularly, does not cause undue vessel damage during fixation or repositioning and allows for unimpeded blood flow. Furthermore, an improved lead design should provide for alternative stimulation or sensing configurations without compromising effectiveness and efficiency of therapy delivery in case one electrode fails.
The present invention is directed to implantable electrical lead that includes an elongated lead body that extends between a proximal lead end and distal lead end, and a plurality of electrodes located along the distal lead end. An insulating material is positioned between each of the plurality of electrodes to electrically isolate each of the plurality of electrodes, and a plurality of insulated electrical conductors are each connected to a respective electrode of the plurality of electrodes. A microprocessor performs a threshold search corresponding to combinations of one or more electrodes of the plurality of electrodes to determine an optimal threshold, and selects the electrodes of the plurality of electrodes corresponding to the optimal threshold.
Features and advantages of the present invention will be readily appreciated as the invention becomes better understood by reference to the following detailed description considered in connection with the accompanying drawings, in which like reference numerals designate like parts throughout:
In the following detailed description, references are made to illustrative embodiments of medical leads adapted to be located in the heart or cardiac blood vessels in which aspects of the present invention may be implemented. It is understood that the invention may be practiced in other body implantable leads positioned for sensing or stimulating excitable tissue.
The lead body 12 takes the form of an extruded tube of biocompatible plastic such as silicone rubber. The lead body 12 includes multiple lumens for carrying multiple insulated conductors from the connector assembly 16 to the corresponding electrodes arrays 20 and 30 and electrodes 40 and 50 located at or near the distal lead end 14. The multi-lumen lead body 12 may correspond generally to that disclosed in U.S. Pat. No. 5,584,873 issued to Shoberg et al., incorporated herein by reference in its entirety. Two of the insulated conductors carried by lead body 12 may be stranded or cabled conductors, each electrically coupled to one of the ring electrode 40 and the defibrillation coil 50. The cabled conductors may correspond generally to the conductors disclosed in U.S. Pat. No. 5,246,014, issued to Williams et al., incorporated herein by reference in its entirety. A third and fourth conductor are preferably multi-filar coiled conductors, for example of the type described in U.S. Pat. No. 4,922,607 issued to Doan et al., incorporated herein by reference in its entirety. Each filar of the multi-filar coiled conductors is coupled to an individual electrode within the tip electrode array 20 or the ring electrode array 30. The filars are electrically insulated from each other for example by polytetrafluoroethylene (PTFE) or ethyl tetrafluoroethylene (ETFE) tubing.
The connector assembly 16 includes multiple connector extensions 22, 32, and 52 arising from a trifurcated connector sleeve 18, typically formed of silicone rubber. The connector extensions 22, 32 and 52 couple the lead 10 to an implantable medical device such as an implantable cardioverter defibrillator (ICD).
Connector extension 22 is shown as a tri-polar connector including three connector rings 24. Connector extension 22 houses a multi-filar coiled conductor of which each filar is electrically coupled at a proximal end to one of the connector rings 24 and at a distal end to one of the three electrodes included in tip electrode array 30. A stylet 60 may be advanced within an inner lumen of the coiled conductor carried by connector extension 22 toward the distal end of the lead 10 to aid in lead placement during an implant procedure.
Connector extension 32 is shown as a quadrapolar connector including three connector rings 34 and a fourth connector ring 36. The three connector rings 34 are electrically coupled to individual filars within a multi-filar coiled conductor extending to the ring electrode array 30. The distal end of each filar is coupled to one of three electrodes included in ring array 30. The fourth connector ring 36 is coupled to an insulated cabled conductor that extends to ring electrode 40.
Connector extension 52 carries a single connector pin 54 that is electrically coupled to an insulated cable extending the length of the lead body 12 and electrically coupled to the defibrillation coil electrode 50. While the lead 10 depicted in
The insulator 64 optionally provides a center port 56. When the electrode array 20 is used as a tip electrode, as shown in
In the same way, the ring electrode array 30 includes three, approximately equally-sized, circumferentially arranged electrodes separated from each other by a layer of insulating material 66.
The ring electrode array 130 shown in
Electrodes 37 and 39 included in ring array 30 are each provided with connection tabs 92 to allow electrical coupling to individual filars 94 included in the multi-filar coiled conductor 90. Multi-filar conductor 90 is connected at its proximal end to connector rings 34 (
An alternative embodiment of the lead 10 is shown by the side cutaway view of
The helix 100 is shown in
Expansion of the tip array 20 in this way provides a passive fixation mechanism for stabilizing the lead position. When used as an endocardial electrode, the expanded electrode array 20 may engage with the endocardial trabeculae, holding the distal lead end in place. If the initial lead position does not result in acceptable pacing or sensing thresholds, the helix 100 may be retracted, contracting the tip array 20, to allow easy removal and lead repositioning. This reversible fixation mechanism is particularly useful when the lead 10 is used as an endovascular lead. Contraction of the tip array 20 allows easy retraction of the lead within a narrow vein without undue damage to vessel walls or vein valves. Furthermore, the expanded electrode array provides stable lead positioning within a blood vessel without blocking the flow of blood or puncturing the blood vessel walls.
Another advantage of expanding the tip electrode array 20 relates to the benefit of increasing the inter-electrode distance when the tip array 20 is used for pacing and evoked response sensing. If, for example, one electrode of tip array 20 is used for pacing in a unipolar configuration with a device housing or in a bipolar configuration with any of ring electrode array 30 or ring electrode 40, the remaining two electrodes within tip array 20 are available for sensing an evoked response in the same vicinity of the delivered pacing pulse. Sensing for an evoked response at the site of stimulation delivery enables accurate capture detection since other myopotentials, which may be present at more remote sensing sites, are less likely to interfere with evoked response sensing. By using electrodes different than the electrode used for pacing, problems associated with post-pace polarization artifacts can be avoided. The increased inter-electrode distance in an expanded tip array further enhances the ability to sense the evoked response using electrodes within the same array because the post-pace polarization artifact will diminish as the distance from the placing electrode increases.
An alternative embodiment of an expansion member is shown in
In one embodiment, the expansion member may be coated with a substrate or solvent carrying a pharmaceutical agent, such as an anti-inflammatory drug. The expansion member may be dip-coated in a solvent, such as acetone, in which a steroid has been dissolved. The steroid will elute from the coating over time after implantation and prevent a hyper-inflammatory response at the implant site. A method for treating an electrode with a steroid solution, which may be adapted for use in the present invention for treating the expansion member, is generally described in U.S. Pat. No. 5,987,746 issued to Williams, incorporated herein by reference in its entirety.
A functional schematic diagram of the ICD 410 is shown in
With regard to the electrode system illustrated in
The connection terminals 325, 327 and 329 provide electrical connection to the electrodes 25, 27 and 29, respectively, within tip electrode array 20. The connection terminals 335, 337 and 339 provide electrical connection to the electrodes 35, 37 and 39, respectively, within ring electrode array 30. The connection terminal 340 provides electrical connection to the ring electrode 40. The connection terminals 325, 327, 329, 335, 337, 339, and 340 are further coupled to a switch matrix 208.
Switch matrix 208 is used to select which of the available electrodes are coupled to a ventricular sense amplifier (AMP) 200 for sensing ventricular signals. Selection of the electrodes is controlled by the microprocessor 224 via data/address bus 218. The selected electrode configuration may be varied according to the various sensing, pacing, cardioversion and defibrillation functions of the ICD 410.
The ventricular sense amplifier 200 preferably takes the form of an automatic gain controlled amplifier with adjustable sensing thresholds. The general operation of the ventricular sense amplifier 200 may correspond to that disclosed in U.S. Pat. No. 5,117,824 issued to Keimel et al., incorporated herein by reference in its entirety. Whenever a signal received by the ventricular sense amplifier 200 exceeds a ventricular sensing threshold, a signal is generated on the R-out signal line 202.
Switch matrix 208 is also used to select which of the available electrodes are coupled to a wide band amplifier 210 for use in digital signal analysis. Signals from the electrodes selected for coupling to bandpass amplifier 210 are provided to multiplexer 220, and thereafter converted to multi-bit digital signals by A/D converter 222, for storage in random access memory 226 under control of direct memory access circuit 228. Microprocessor 224 may employ digital signal analysis techniques to characterize the digitized signals stored in random access memory 226 to recognize and classify the patient's heart rhythm employing any of the numerous signal processing methodologies known in the art.
The telemetry circuit 330 receives downlink telemetry from and sends uplink telemetry to an external programmer, as is conventional in implantable anti-arrhythmia devices, by means of an antenna 332. Data to be uplinked to the programmer and control signals for the telemetry circuit are provided by microprocessor 224 via address/data bus 218. Received telemetry is provided to microprocessor 224 via multiplexer 220. Numerous types of telemetry systems known for use in implantable devices may be used.
The remainder of the circuitry illustrated in
During pacing, escape interval counters within pacer timing and control circuitry 212 are reset upon sensing of R-waves as indicated by signals on Rout signal line 202. The durations of the escape intervals are determined by microprocessor 224 via data/address bus 218. The value of the count present in the escape interval counters when reset by sensed R-waves can be used to measure R-R intervals for detecting the occurrence of a variety of arrhythmias. In accordance with the selected mode of pacing, if the ventricular escape interval expires pacing pulses are generated by ventricular pacer output circuit 216. The pacer output circuit 216 is coupled to the desired pacing electrodes via switch matrix 208 along signal line 217. The escape interval counters are reset upon generation of pacing pulses, and thereby control the basic timing of cardiac pacing functions, including antitachycardia pacing. When a pacing pulse is delivered, a signal is generated by pacer timing and control 212 on blanking signal line (V BLANK) 211 to prevent saturation of the sense amplifier 200 during the pacing pulse.
Thus, complete programmability of the electrodes used in pacing and/or sensing is possible via switch matrix 208. Any of the electrodes included in tip array 20, ring electrode array 30 and ring electrode 40 may be selected individually or in any combination as the anode for unipolar pacing with the ICD housing 411 serving as the cathode. For bipolar or multi-polar electrode configurations, the electrodes within tip array 20, ring array 30 and ring electrode 40 may be selected in any combination. For example, one or more of the electrodes within an array may be selected to serve as an anode with any or all of the remaining electrodes in the same array selected as the cathode. Alternatively, electrodes may be selected from one array 20 or 30 to serve as the anode and from the other array to serve as the cathode. Electrodes within arrays 20 or 30 may also be selected to function with ring electrode 30 in a bipolar configuration.
The ICD 410 is preferably equipped with a capture detection algorithm executed under the control of microprocessor 224. Following delivery of a pacing pulse by ventricular pacer output circuit 216, a desired pair of electrodes may be selected via switch matrix 208 to sense for the evoked response. If an evoked response is not detected, the pacing pulse amplitude may be adjusted by pacer circuitry 212 under the control of microprocessor 224. Exemplary circuitry for detecting an evoked response is described in previously incorporated U.S. Pat. No. 5,601,615 issued to Markowitz et al., U.S. Pat. No. 5,324,310 issued to Greeninger et al., and U.S. Pat. No. 5,861,012 issued to Stroebel.
Pacer timing and control circuitry 212 is coupled to lead recognition circuit 250 for determining availability of pacing or sensing paths. The lead recognition circuit 250 may include impedance measuring circuitry such that valid lead pathways may be identified when a measured impedance between electrodes falls within an acceptable range. Lead recognition circuit 250 is coupled to possible electrode configurations via switch matrix 208 along signal line 252. A lead recognition apparatus and method that may be used in ICD 410 is generally described in U.S. Pat. No. 5,534,018 issued to Wahistrand et al., incorporated herein by reference in its entirety.
The microprocessor 224 includes associated ROM in which stored programs controlling the operation of the microprocessor 224 reside. A portion of the memory 226 may be configured as a number of recirculating buffers capable of holding a series of measured intervals for analysis by the microprocessor 224 for predicting or diagnosing an arrhythmia.
In response to the detection of tachycardia, anti-tachycardia pacing therapy can be delivered by loading a regimen from microcontroller 224 into the pacer timing and control circuitry 212 according to the type of tachycardia detected. In the event that higher voltage cardioversion or defibrillation pulses are required, microprocessor 224 activates the cardioversion and defibrillation control circuitry 230 to initiate charging of the high voltage capacitors 246 and 248 via charging circuit 236 under the control of high voltage charging control line 240. The voltage on the high voltage capacitors is monitored via a voltage capacitor (VCAP) line 244, which is passed through the multiplexer 220. When the voltage reaches a predetermined value set by microprocessor 224, a logic signal is generated on the capacitor full (CAP FULL) line 254, terminating charging. The defibrillation or cardioversion pulse is delivered to the heart under the control of the pacer timing and control circuitry 212 by an output circuit 234 via a control bus 238. The output circuit 234 determines the electrodes used for delivering the cardioversion or defibrillation pulse and the pulse wave shape.
The flow chart shown in
In regard to the implantable system illustrated in
When the method 500 begins at step 505, the electrode configuration selected is a default configuration. Typically, the default configuration is the simultaneous selection of all the electrodes included in an electrode array. This default configuration will be used for designated pacing or sensing functions until a more optimal configuration is identified. For example, electrodes 25, 27 and 29 may be selected simultaneously to serve as the anode during unipolar pacing as the default pacing configuration. A default sensing configuration may be set as the bipolar combination of the simultaneously selected tip array electrodes 25, 27 and 29 paired with the simultaneously selected ring array electrodes 35, 37 and 39.
At decision step 510, the microprocessor 224 determines if an electrode scan is enabled. The electrode scan feature is preferably enabled or disabled by a physician using an external programmer in telemetric communication with the ICD 410. If the electrode scan is disabled, the electrode selection remains in the default configuration. Alternatively, a physician may manually program an electrode configuration to override the default selection.
If the electrode scan is enabled, a scan is initiated at step 515. An electrode scan may be initiated by any of a number of triggering events. Upon implantation of the lead 10 and ICD 410, a detection of valid electrode pathways by lead recognition circuitry 250 may trigger the initiation of the electrode scan at step 515. Other triggering events for an electrode scan may include detection of a lead failure or a change in lead status. Reference is made to previously incorporated U.S. Pat. No. 5,534,018 and to U.S. Pat. No. 6,317,633 issued to Jorgenson et al., incorporated herein by reference in its entirety. A scan may also be triggered manually, on a scheduled or periodic basis, or in response to a loss of capture.
At step 520, the microprocessor 224 performs a threshold search on each electrode within an array individually and in any number of desired combinations. A threshold search may be performed according to methods known in the art. For example, a threshold search may be performed by successively reducing the pacing pulse amplitude until capture is lost. For an exemplary threshold search algorithm, reference is made to U.S. Pat. No. 3,757,792 issued to Mulier, incorporated herein by reference in its entirety.
In regard to the electrode configuration shown in
An electrode scan may be performed automatically as described or semi-automatically under the supervision of a clinician such that observation of any extraneous stimulation or undersensing or oversensing may be made. Final selection of the optimal electrode configuration may then be made manually to eliminate electrode configurations producing extraneous stimulation or inaccurate sensing.
At decision step 535, the microprocessor 224 determines if a preset amount of time, for example 24 hours, has elapsed. Once this time is elapsed, an electrode scan may be automatically repeated. Threshold changes may occur over time as electrodes become encapsulated by fibrotic scar tissue or with changes in a patient's physiologic condition, the use of drugs, or changes in disease state. By repeating the electrode scan periodically, the optimal electrode configuration and appropriate pacing energy or sensing threshold settings may be updated in response to such changes.
The present invention is realized in an implantable medical lead possessing one or more electrode arrays, each comprising multiple electrodes that are electrically insulated from each other. The electrodes within an array are preferably arranged circumferentially in relation to the lead body and may be located substantially in the area normally occupied by a conventional tip or ring electrode.
A lead provided by the present invention includes a lead body extending between a proximal lead end and distal lead end for carrying multiple, insulated conductors. The conductors are each electrically coupled to an associated electrode at or near the distal lead end and to connectors at the proximal lead end for establishing connection to an implantable medical device. The lead may be equipped with a tip electrode array and/or one or more ring electrode arrays comprising two or more, preferably three, electrodes each. The electrodes within an array may be spaced from each other around the circumference of the lead and/or along its length. The electrodes within an array are electrically insulated from each other by nonconductive material, such as a ceramic, layered between each electrode in the array.
In one embodiment, a tip electrode array may be expandable in order to improve the contact of one or more electrodes with a targeted cardiac tissue site. Expanding the tip array advantageously increases the spacing between electrodes to improve sensing and stimulation performance. Moreover, expansion of the tip array against the walls of a blood vessel stabilizes the lead position. If used as an endovascular lead, blood will easily flow between the expanded electrodes. A tip array may be expanded by advancing an expansion member toward the distal lead end. The expansion member is preferably conical such that as it is advanced through an electrode head assembly carrying the tip array, the widening circumference of the expansion member causes radial expansion of the electrodes in the array.
In one embodiment the expansion member may be a fixation helix mounted on a drive shaft that is coupled to a rotatable coil extending to the proximal lead end. Rotation of the proximal end of the coil causes rotation of the drive shaft, advancing the cone-shaped helix. The helix may be used as an active fixation device to further stabilize lead position. Alternatively, a conically-shaped expansion member may be mounted on a drive shaft having a screw-like head. A stylet equipped with a screwdriver-like blade may be used to engage the shaft head and, when rotated, cause advancement of the expansion member.
The lead provided by the present invention may be used with a cardiac pacing device or ICD equipped with a microprocessor-based control system for controlling device functions, a pulse generator for generating electrical impulses to be applied to the heart, and sense amplifiers for sensing cardiac signals. The device is preferably equipped with a switch matrix for selectively connecting one or more of the electrodes within an array in varying combinations for associated sensing and pacing functions. For example, one electrode within an array may be used for pacing and the other two electrodes within an array may be used for sensing the evoked response. Such a configuration advantageously overcomes the problem of polarization artifacts normally encountered when sensing for an evoked response using the same pair of electrodes as used for pacing. The pacing device or ICD is also equipped with a memory for storing cardiac data and, in particular, data relating to the pacing threshold or sensing threshold associated with various electrodes within an array.
In operation, the cardiac pacing device or ICD performs an electrode scan to determine which electrode or combination of electrodes within an array provides the lowest pacing threshold. Once the electrode configuration providing the lowest pacing threshold is identified, the control system of the device automatically selects this configuration as the pacing electrode configuration via the switch matrix. Alternatively or additionally, if an electrode array is to be used for sensing, a sensing threshold search may be performed in which the electrode(s) providing the highest signal amplitude or greatest signal-to-noise ratio may be determined and selected as the sensing electrode configuration via the switch matrix.
According to the present invention, when the lead is placed endovascularly for left heart applications, the electrode(s) within an array that are in closest contact with the heart tissue may be selected for stimulation and/or sensing. Stray current is minimized. If phrenic nerve stimulation or undesired atrial pacing occurs after implantation of a coronary sinus lead for left ventricular pacing, an alternative electrode within a given electrode array may be selected that still provides an acceptable pacing threshold at the targeted ventricular tissue site without extraneous stimulation.
According to the present invention, an electrode pair is selected for sensing an evoked response that is in the same vicinity of the paced tissue site but does not include the pacing electrode. In addition, battery longevity of the stimulation device may be improved by minimizing the surface area used to stimulate a targeted tissue site. A smaller electrode surface area associated with selecting one or two electrodes within an array increases the pacing impedance resulting in less current drawn from the battery. Furthermore, the electrode selection is "fine-tuned" by selecting only the electrode(s) within an array that provide the lowest pacing threshold, eliminating stray current and further extending the useful life of the device. Device performance may be also be improved by the ability to select an optimal sensing electrode configuration such that accurate sensing of cardiac signals is achieved.
The lead provided by the present invention may be stabilized by an expandable tip array and still be readily deployed and repositioned when used as an endovascular lead. Stabilizing the lead position over time may ensure stable pacing and/or sensing thresholds. By providing a lead with a reversible fixation device, the lead is easily advanced or retracted through a vascular pathway so that the surgical time required for positioning the lead may be reduced, with fewer complications encountered. If an electrode should fail, other electrodes within the same array may be used for targeting the same tissue site.
Thus a medical lead that allows accurate targeting of excitable tissue has been described and with which extraneous stimulation may be avoided and improved evoked response sensing may be achieved. The lead is readily deployed, secured and repositioned, if necessary, and provides alternative electrode configurations should a lead failure occur. A method for using the medical lead has also been described in which optimal electrode configurations may be automatically, or semi-automatically, selected. While the medical lead and associated method included in the present invention have been described according to specific embodiments in the above disclosure, these embodiments should be considered exemplary, rather than limiting, with regard to the following claims.
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|U.S. Classification
|607/28, 607/27
|International Classification
|Cooperative Classification
|European Classification
|Sep 10, 2002
Owner name: MEDTRONIC, INC., MINNESOTA
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|May 21, 2009
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text:
In a filing that will be heard October 26, Kesha has asked for a standard protective order to safeguard her many gynecological, psychiatric, and rehabilitation medical records from the past 10 years, which she handed over to Lukasz "Dr. Luke" Gottwald's legal team as part of her sexual assault lawsuit against him. He has refused her request.
In August, Kesha dropped her lawsuit against Dr. Luke in California in order to concentrate on the case in New York. She is also back to recording music, though her contract still ties her to the man she claimed sexually assaulted her. In this latest development, BuzzFeed News reports that Dr. Luke's legal team says Kesha waived her right to privacy by "publicly disclosing details of her alleged medical diagnoses and treatments and putting them at issue in this case, all in an effort to bolster her baseless claims against our clients."


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Chippewa National Forest
Chippewa National Forest, home of the largest nesting population of Bald Eagles in the lower 48 states. The Forest has a rich history, ranging from prehistoric times to early logging era and CCC days. The forest boundary encompasses about 1.6 million acres, with about 660,000 acres manages by the Chippewa National Forest. The remaining lands are State, County, Indian and private. The Leech Lake Indian Reservation is also within the Forest boundary.
Chippewa National Forest / Walker Ranger District
201 Minnesota Ave. E (218) 547-1044
Walker, MN 56484
Drive the Woodtick Trail, hike the Shingobee Hills or canoe down the incredible Boy River.
Deep Portage
Located in central Cass County, Deep Portage is a meeting place for community, education, and the environment. There are miles of trails to enjoy, a visitors' center, and year-round educational programming. Summer is a great time to paddle, hike, bike or otherwise explore the forests and lakes!
Itasca State Park
Itasca State Park, headwaters of the Mississippi River, is just 35 miles from Walker. The park is open from May through October. There is limited access to the park in the winter months. Over two dozen vistas and historic spots are located along this scenic route. View the Itasca State Park map on the DNR website.
Lake Country Scenic Byway
Lake Country Scenic Byway invites you to discover the old fashioned charm of the Lake Country. You'll travel 88 miles through prime northern Minnesota vacation country. The Byway unties the famed vacation areas of Walker, Park Rapids and Detroit Lakes along Highway 34 and scenic Itasca State Park on Highway 71 north.
Paul Bunyan State Forest
The Paul Bunyan State Forest is more then 72,000 acres of woods and lakes. There are over 50 miles of groomed snowmobile trails and 15 miles of ungroomed snowmobile trails, and countless hiking, biking and cross country ski trails
North Country National Scenic Trail


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This page explains the astronumerology analysis of the abbreviation DFAPAS. Below, you also find the detailed meaning of each letter in the DFAPAS acronym.
DFAPAS has a life path of 2. DFAPAS means: With a Life Path 2, your numbers are (11/2, 20/2). Two is the symbol of duality and love. It represents equality, balance and is considered as the most feminine among all numbers and is second in command after masculine 1. It portrays partnership, the coming together of like minds and ideal. Although it is flexible and patient, it is unnoticed and operates from the shadows. Number two coveys the meaning of union, division, dependence, conflict or verification of facts. Number two also covey comparism and contrast. Two is the smallest and first prime numbers and the only even prime number because it has many divisions. Negative attributes of number two. It is believed that two had the power to bring firth evil – by Pythagoreans. It is weak will, indecisive, stagnant. 11 Represents equality, it is the light of all numbers, filled with love of peace, gentleness, possesses qualities f intuition, honesty, sensitivity. In numerology eleven, is considered as the master number, extremely creative, energized and inspirational. It further explains number eleven as a number of trials, test and treachery. From the biblical point of view, number eleven symbolize disorder and judgment – irresponsibility of breaking the law. In England eleven appears in the decoration of Easter cakes using almond paste decorations representing the twelve disciples excluding Judas Iscariot. Twenty is twice ten and means a complete waiting period. For the Mayas, it represents God's order. According to R. Allendy and J Boelime, it places the world into two antagonistic poles, material world opposed by the spiritual world.
DFAPAS acronym or abbreviation means:
D: Meaning of D in DFAPAS. D is a closed letter indicating self sufficiency. It displays self-reliance, a caring attitude and broadmindedness. It's broadmindedness can be seen in the fat that the letter D has a side that looks like an upright pole, it branches from the top and bottom to explore outwards, gain worldly knowledge, but its steady and slow, meticulous and self-reliance brings it back to itself.
F: Meaning of F in DFAPAS. The letter F is like the letter E, but without the bottom rung. Even without this rung, F shows remarkable stability on its single leg. It means devotion, loving, uncomplaining, defensive, calm. F stands up straights and exemplifies straightforwardness, accountability and harmoniousness.
A: Meaning of A in DFAPAS. The letter A has two bars connected at a pointed edge and a cross bar holding them together. From an open end to a pointed edge signifies that all energies are trained to a point to achieve the most singularly important goal. The cross bar shows caution. Failure is avoided by stringing all required resources together. A also looks like a Pyramid with the peak as the apex of the Pyramid. Pyramids are iconic. A therefore symbolizes prominence and a desire to be recognized for ones achievements. The cross bar also represents a rung in ladder. To get to the top, one has to first step on the rung. It also means originality, a strong will power and an enterprising ability. The upper-case version consists of the two slanting sides of a triangle, crossed in the middle by a horizontal bar. It shows aspiration, the dominance to be successful, positive attitude, an optimistic world view and egotism.
P: Meaning of P in DFAPAS. P has a heavy top standing on just a point to show it's strenght. It means strong, the ability tp perceive weakness and opportunities easily and clear-sightedness. By standing on its own, it shows self-centeredness, a thriving attitude and rigorousness. P also shows disconnection, strong will to go even alone and impartiality.
S: Meaning of S in DFAPAS. S is a single strand that goes forward and backwards. It shows a willingness to explore. Friendliness, perceptiveness and accommodating are all S qualities. The ends pointing forward and backwards shows a conflicting nature with itself and a degree of puzzlement.
Words, meanings, sentences and phrases similar to DFAPAS
Tags: Meaning of DFAPAS. The astrological definition of DFAPAS. Did you find the astrological meaning/definition of DFAPAS? Please, add a definition of DFAPAS if you did not find one after searching for DFAPAS.
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The crimes were six years apart, but the circumstances behind them were too chillingly similar for investigators to overlook: two homeless men run down by a car in dark alleys, no witnesses, and two elderly women coming forward, claiming to be relatives of the victims.
Helen Golay, 75, and Olga Rutterschmidt, 72, were arrested last week after they allegedly collected more than $2m (£1.1m) in life insurance from policies issued in the names of two homeless men killed in hit-and-run crashes in 1999 and 2005, authorities said.
Police not only believe the women were befriending other men to set up more insurance policies but may have driven the killer car themselves. "Anyone would think they would leave the actual dirty work to someone else or hire someone," said Detective Dennis Kilcoyne. "We're not so sure about that any more ... We're focusing directly at Helen and Olga for the murder investigation."
The women allegedly provided the men with apartments in exchange for signing a life insurance policy. According to investigators, the women duplicated their victims' signatures on rubber stamps and used them to secure more than a dozen other policies.
They appeared in court on Thursday for making false insurance claims, and were held without bail. Each faces up to 160 years in prison if convicted.
Investigators discovered the alleged scam while looking into a fatal hit-and-run accident. One investigator had mentioned the case of two women who had taken out large life insurance policies on 50-year-old Kenneth McDavid, when another recalled working on a similar case in 1999, in which 73-year-old Paul Vados was killed.
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The European Commission has asked a panel of experts to investigate the possible risks and benefits of "snus", a tobacco product that is banned across most EU countries.
Snus is a small pouch of tobacco that is sucked rather than chewed or smoked. The only member state where it is legal is Sweden, which negotiated an exemption from the ban because of the popularity of the product among its population.
British American Tobacco last year launched a pilot in Sweden selling branded snus, and believes it is a healthier alternative. The argument for snus is that the lack of smoke reduces the dangers normally associated with tobacco.
BAT has long been lobbying the EC to reconsider its stance on snus and chief executive Paul Adams confirmed that the panel had been set up and was due to report its findings at the end of this year. "The European Commission have asked a scientific committee to look at snus," he said. "They are looking at the science of it."
BAT, along with other tobacco groups, has already made submissions to the committee.
"Bear in mind that some pretty substantial scientific observers espouse the view that snus is far less harmful than cigarettes," he added. "Nobody is saying that snus is harmless, but it's a lot less harmful than cigarettes."
A number of public health authorities around the world are moving towards bans on tobacco use, rather than backing often controversial alternatives that are still harmful to health. In the UK, the ban on smoking in public places comes into force next year.
However, Mr Adams said the number of smokers in the world - currently at around 1 billion - was still set to grow. "In 10 years' time, there will be more smokers than there are now. So it's unrealistic to say everyone should just quit. Better to accept that this is the way the world is going to be."Reuse content


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NEW ORLEANS -- Cameron Heyward plays football for moments like this.
It's not as if the Ohio State standout defensive lineman slacks off for non-marquee games. But he understands what it means to play on the big stage against top competition, and he'll do so for the final time as a Buckeye on Tuesday night against Arkansas in the Allstate Sugar Bowl.
"It's a very big game," Heyward said. "They have a very talented offensive line [quarterback Ryan Mallett] likes to sling the ball. One of my goals is always play my best in adverse situations, and we might have some adverse situations, so I'm looking forward to the challenge and ready to get after it."
Heyward entered the season tabbed as one of the nation's top defensive linemen. While his numbers aren't eye-popping -- 42 tackles, 9.5 tackles for loss, 2.5 sacks, 1 interception, 1 fumble recovery, 1 safety -- he had an undeniable presence on a strong Ohio State defensive line.
As a junior, Heyward's hallmark was his performances in big games. He made life miserable for USC's heralded offensive line in a loss to the Trojans, recording seven tackles, including two tackles for loss and a sack. Two months later in Happy Valley, Heyward looked like the most dominant player on the field, recording 11 tackles, including three for loss and two sacks.
Heyward wasn't nearly as effective in Ohio State's loss to Wisconsin earlier this year, as the Badgers' offensive line imposed their will. He made a bigger impact in Ohio State's defense-driven win at Iowa, recording two tackles for loss, a sack and a quarterback hurry.
The future NFL lineman sets his sights on another pro prospect in Mallett on Tuesday night.
"You always want to play against the best, and he's definitely one of the best quarterbacks we've played this year," Heyward said. "It's going to be tough, but you live for these situations to step up."
The setting for Heyward's final collegiate game adds to its significance. His late father, former NFL running back Craig "Ironhead" Heyward, played the first five of his 11 pro seasons with the Saints, where he was a fan favorite.
"It's been kind of neat seeing him here," Ohio State coach Jim Tressel said. "People bump into him that knew his dad and maybe give him a little bit of a story about, 'I remember when ...' He knows he's got a tremendous challenge, and he will play every play the way he has for Ohio State for four years.
"And I think when he's done, he'll have an emotional reaction that he got to do that here in the city where his dad loved so much."


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A day after our journey, some habits stuck. I found myself walking up to random strangers. I found myself wondering about who they were, where they were going. I found myself wondering if I could help somehow.
All along the trail, we'd found generous, kind people. Wells had joked early on that Missourians were either very nice, or very drunk, and we never encountered the latter kind. There was just a warmer kind of people than you encounter in your day to day life.
I asked a man on the bus in Champaign if he was alright and he said "Yes," then asked, "Why?" suspiciously. But on the trail, there was only "Yes," and "Thank you." There was Bob the Brewer and Kansas City man. There were store owners who would leave their stands completely open and unmanned and trust on the goodhearted nature of the bikers to pay anyway. We stopped to ask for directions and a woman handed us ice cold water bottles from the rear seat of a truck, completely unasked for.
Wells and I got into the habit that most everyone on Katy Trail had been practicing the whole time we'd been biking. We got into the habit of kindness.
When I think back on it, there's only a few other times where I've experienced such camaraderie, the most recent example being the 2011 Illinois Marathon. There's something about doing difficult things that brings everyone together. We all fight our own demons on the trail, or on the track, or on the road, but the fight is easier knowing that someone else is there with you, that someone else has come before you, and that you pave the trail for those who come after you.
That's why we smile when we see each other on the trail. "Fight the good fight," we urge each other, "I'm rooting for you." And if we can, we help each other out. We tell each other about fallen trees along the way, abandoned towns to avoid, and we tell each other about "bug hour." We stop worrying just about ourselves and we worry about each other, because we're all in it together. You and I becomes "we." And that mentality is what is so strikingly missing from our day to day life.
Think about the last time you saw a stranger and you thought something negative. Maybe you thought they were a bad driver, or had an annoying voice, or that they had no sense of style. Maybe you thought that whatever it was, it just made them a bad person somehow, someone not as good as yourself.
It saddens me when I catch myself thinking this way, and I think that way plenty. But why? Why do we think like this? Because in reality, we are all toiling away at something difficult. We are all on some sort of path – a life path. We know the destination. We know how the story will end. It's incredibly hard work to make what comes between worth it. We are in it together.
I have stopped feeling the urge to go up to strangers and ask them how they're doing, what the weather is like, and inquire how I can help them. I have stopped practicing trail etiquette. I have stopped practicing the habit of kindness.
That's something I'm working on.
By the way, the road ahead is rough, but the sky is bright and the people are kind.


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US: Harbor names new Impulse vp, brand manager
Harbor Footwear Group has appointed Courtney Delmore as the new vice president and brand manager of the Impulse division, where he will be heading up brand development and coordinating sales.
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Many reputable international universities and other educational institutions offer the opportunity for greater personal development via law courses. These courses discuss current issues and trends involved in such fields as intellectual property and regulatory theory.
The USA remains the world's most popular destination for international students. Universities in the US dominate the world rankings and the country also offers a wide variety of exciting study locations. State university systems are partially subsidized by state governments, and may have many campuses spread around the state, with hundreds of thousands of students.
Washington state is one of the most progressive and advanced states in the country. It is home to many universities that provide some of the best trainings in nearly every possible major.
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Twenty One (21) Year Old Whisky has been maturing in cask for twenty one years. When blending a twenty one year old whisky, the master blender may incorporate older whiskies, but not younger ones. This guarantees that your 21 year old single malt has whisky aged for at least 21 years in the cask.
21 year old whisky is often given as a 21st birthday present, a gift for fathers day or a Christmas present.
Twenty one year old whiskies have generally taken on a huge amount of complexity and character from the cask they were matured in. Often the colour of a 21 year old whisky will be darker and more intense than younger whiskies.
1990 was a year that many notable occurrences occurred some involved single malt whisky, others bourbon. Notable occurrences in 1990 included:
In 1990, on January the 31st, McDonald's opened their first store in Moscow. Everyone knows nothing washes down a Big Mac better than a fine glass of sherry cask matured Speyside single malt whisky. Yummers!
In April 1990, the Hubble Space Telescope was launched aboard the Discovery space shuttle. Whisky would probably not have been used as fuel.
Many a whisky glass would have been raised in October the 14th 1990 in memory of Leonard Bernstein, the legendary US composer, who sadly passed away.
In February 2009 a group of Tasters and Managers gathered to choose single cask expressions to represent each of Diageo's 27 malt whisky distilleries. This Teaninich has a very unique character, part… More info
A cask strength 11 year old single malt from the Easter Highland distillery, Edradour, finished in Super Tuscan wine casks. More info
The 21 year old is a really refined blend. Ballantines base their whiskies around malt whisky from distilleries like Glenburgie and Miltonduff. More info
A cask strength 10 year old from Edradour, this bottling has been finished in wine casks from the Cotes de Provence, this single malt is part of a limited release of just 459 bottles. More info
A 50cl bottling distilled in 1996 and finished in Madeira. A thick, sweet Edradour release. More info
Speymalt is the name of Gordon and MacPhail's range from Macallan. This was distilled in 1996 and matured in refill sherry hogsheads. More info
A blended malt from Bennachie, this 21 year old was crafted to exhibit the sweet, gentle style of Speyside. More info
This 21 year old Highland whisky from Glen Garioch is a rich, powerful single malt with as much flavour as one could wish for, we highly recommend this. More info
The volcanic power of Talisker caressed with the juicy, fruity character of an Amroso sherry cask. This 1996 distillers edition is superb, particularly in balance, with a tarry, thick mouthfeel.… More info
A delicious dram, one of our favourites, it exudes effortless balance and, despite its strength, goes down with the greatest of ease. At 21 years, this single malt from Glengoyne exudes loads of… More info
A 21 year old from the Speyside distillery, Glenglassaugh, presented in a beautiful decanter. More info
A beautifully packaged Arran, with a rather splendid looking peacock on the tube and bottle. This is part of the Icons of Arran Distillery range, this will sell out quickly. More info
A Lowland single cask, bottled for Douglas Laing's award-winning Old Malt Cask range. This was distilled at Bladnoch in December 1983 and aged for 21 years in refill hogshead number 421 before… More info
Distilled at Macallan on the 25th May 1988, and matured in hogsheads 4948 and 4949 for 21 years before bottling on the 11th December 2009. Bottled by Signatory as part of their Unchillfiltered range. More info
This was distilled in the Winter of 1996 and matured for 10 years in two casks (refill hogsheads 3227 and 3228) before bottling for Douglas Laing's Provenance range in Winter of 2006. More info
From the NC2 range from Duncan Taylor - a range of whiskies that are non-chillfiltered and non-caramel coloured. This was distilled at Springbank in 1996 and bottled in 2009. More info
A sherry finished, peated single malt from Loch Lomond, part of a release of just 380 bottles, distilled in January 1996 and bottled in September 2005 under the Croftengea label. More info
A single cask from the Aultmore distillery. This was distilled in Winter of 1996 and matured for 13 years in single sherry butt number 4856 before bottling in Winter 2009 by Douglas Laing for their… More info
This was distilled in September 1988, matured for 21 years in cask number 6978 and bottled by Duncan Taylor in February 2010. Part of a release of 256 bottles of cask strength Glen Moray, bottled as… More info
Distilled at Arran in September 1996 and matured in a refill puncheon for 12 years before bottling for Douglas Laing's Old Malt Cask range in December 2008. Part of a release of 687 bottles. More info
This 1996 vintage bottling from Gordon and MacPhail's Connoisseur's Choice is a veritable exhibition of Caol Ila's character, there is a fruity freshness underpinning phenols and a strong coastal… More info
A 13 year old unchillfiltered single cask Glen Elgin, bottled by Signatory. Rather interestingly, this was matured in a virgin oak barrel! More info
A sherry matured Arran. This was distilled on the 12th August 1996 and aged for 13 years in cask number 536 before bottling on the 5th February 2010. A release of 325 individually numbered bottles. More info
Matured in first fill and refill sherry casks, this 21 year old is a rich, toffeed single malt with full-body and spice distilled at the Benromach distillery, Speyside's smallest working distillery. More info
A very special Hanyu bottled by Number One Drinks. This was distilled in 1988, aged for 21 years in Spanish Oak Sherry Butt number 9306 before bottling in 2009. A release of 625 bottles. This has one… More info


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Trying to live a simpler life in a small village on 1/2 acre with my husband, gardens, chickens, spinning shelties,and play some tunes with friends along the way. Céad Míle Faílte!
Hi Toni,I notice you have an out-of date link to Molly Golver. She is here now -http://someothermountain.blogspot.com/Cheers and a Happy New Year....Bernard.
Very nice :)A peaceful weekend to you too, Toni. And wishing you a happy new year, all the best for 2012!!


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need help on my website
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I just build a website for selling pictures online with Wordpress using plugin Next Gen, everything nearly ready except I have a problem with one page. when you click on the picture the lightbox appear but the price list doesn't it just keep loading.
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Not normally one for animal photography, the new book 'Creature' by Andrew Zuckerman struck me as an interesting blend of zoology and art. Hi-res, super-sharp photographs all on a white background, they focus on form and texture as much as on the animals' characters. Or as Zuckerman says, "when a subject is stripped from its context, its behavior, rather than its purpose, is all that remains." The result is that these animals look at once familiar and alien.
Here's two examples, the Masked Lovebird and the African Crested Porcupine. (No fable intended.)
Via Wired, which also has an article 'Creature From the Artist and Filmmaker's Perspective', explaining the technical process behind these photos.


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'At primary school I had been in friendly competition with a boy who was also tall, to see which of us was going to reach six foot first. It was fun and being tall seemed a positive thing, but the first few years of secondary school were a nightmare. I was teased mercilessly, victimised and bullied. I could not get a school uniform that fitted, so I always looked odd, and people used to steal my books, steal bits of clothing and reduce me to tears.'
Sarah, a personnel manager from Cambridge, is now 38 and 6ft 4in tall. 'I finally came to terms with my height in my late twenties, when I had my first serious boyfriend,' she says. 'I now find it useful in business because it gives me authority.'
Growing up is painful for most people, but growing up the 'wrong' shape or size can make adolescence a misery. Teenagers who are perceived by themselves or others as too tall or too short, too fat or too thin, can suffer teasing, bullying and humiliation from their peers and develop strong feelings of inferiority that follow them into later life.
The effects of teenage obsession with body shape are well attested in the increasing number of girls who develop eating disorders such as anorexia nervosa or bulimia. Around 15 per cent of teenage girls are now underweight, and about one per cent anorexic. Teenage boys, too, worry about obesity, although it is rare in this age group. A recent survey by Jane Thomas of the nutrition and dietetics department at King's College, London, showed that among 12- to 13-year-olds a fifth of boys and two-fifths of girls wanted to lose weight.
To achieve the perfect figure, teenagers themselves can go to extraordinary lengths. To reach the right height, however, requires even more drastic action. In these cases, the parents are frequently more worried than the child, many having suffered teasing themselves when they were young. Where do these people turn for help and what are the options open to them?
'It is relatively easy to treat girls who are going to grow extremely tall,' says Professor Charles Brook, who runs a growth clinic at the Middlesex Hospital, London, treating about 600 new patients a year. 'We know that girls grow only 30cm (1ft) from the onset of puberty, so if you do not want a girl to grow to more than 180cm (6ft), you need to induce puberty early, when she is no more than 150cm (5ft).' Puberty can be brought on artificially early by giving girls small doses of the hormone oestrogen.
Helping children who are going to be exceptionally small is harder, however. Professor Brook's clinic has, in the past, offered human growth hormone injections for children who are constitutionally small, rather than growth- hormone deficient (which leads to other problems such as a failure to reach sexual maturity), but such treatment rarely adds more than an inch to their final height. 'Human growth hormone should be reserved for those who are deficient in it. Otherwise children suffer 10 years of daily injections, costing pounds 7,000 a year, to gain just one inch.'
Professor Brook believes strongly that medical intervention should be used sparingly. 'When children are being given human growth hormone, it is the parents who have to administer the injections. Each time they do so, they are giving the child the message that there is something wrong in being small. We have often had to provide a great deal of psychological support for those who have gone through the treatment.'
The danger of intervening medically is well illustrated by the tragic events now unfolding as a result of patients being given human growth hormone in the 1970s and early 1980s. Twelve people have developed the fatal brain disorder Creutzfeldt-Jakob disease, after being given hormone extracted from the pituitary glands of infected dead bodies. Since the disease has a 15-20 year incubation period, it is not known how many more of the 2,000 children treated will develop it. The hormone was withdrawn in 1985, and since then a synthetic version has been used.
'We as parents do not always make the best decisions for our children,' Professor Brook adds. 'It is often better to help them to come to terms with their height than to try and manipulate it.'
Dr David Weeks, a consultant psychologist at the Royal Edinburgh Hospital, who knows all about the problem of size since he is only 5ft 2in, agrees wholeheartedly. 'Parents should not adopt a vigorously interventionist approach. I know a very tall teenage girl whose father wanted her to have an operation to remove some of the bone from her legs to make her shorter. She said to him: 'Look, I am training to be an engineer and I know that if you break things that support weight they are never as strong afterwards. Thanks, but no thanks.' '
Dr Weeks does not think that the answer lies in medical intervention, but in helping adolescents to came to terms with their perceived 'problem'. 'If human growth hormone had been around when I was 14 or 15, I would have demanded some. I am now glad it was not,' he says. He remembers having a hard time in his teens. 'From 11 to about 16, I had a great sense of inferiority. I thought that if only I would grow, it would be a magic solution to all my problems. It would put everything right. I was very sports orientated. I played American football (I grew up in New York city) with people who weighed two and a half times as much as me, which was a dangerous thing to do.'
Dr Weeks now lectures on 'heightism' and the discrimination that small people often face. 'People tend to think that short men are going to be inappropriately assertive to prove their machismo, but there is no evidence for that at all,' he says.
For many parents, it is extremely painful to watch their children go through these problems. So what should they do? 'It is important that parents do not express their own anxieties,' says Dr John Coleman, director of the Trust for the Study of Adolescence in Brighton. 'Kids have enough anxieties about their bodies without parents adding to them.
'Parents should not be saying: 'Oh dear, you are much smaller than everyone else in the class. Perhaps I should take you to the doctor.' Or: 'Your breasts are not developing. Perhaps you should have hormone injections.' If the parents are very worried they should go and see the doctor, without the child. There is a lot of pressure towards the perfect physique, from the media and so on. Parents should help their children understand that we are all different and that a person's physique is not all there is to someone.'
Adults should also realise that adolescents develop at different rates. 'Puberty does not necessarily start or end at the same time for everyone. For some children, it can start at nine or 10. For others it is delayed until 13 or 14. This does not have any implications for their later development.'
Both Coleman and Weeks believe that the single most important thing that parents can do to help children who are worried about their size and shape is to build up their self confidence. 'Look for the things they are good at. Support what they do. We know that one of the most powerful factors that affects a teenager's self-esteem is his or her parents' interest,' says Dr Coleman.
'All the evidence shows that parents are as important to teenagers as they are to young children, but in a different way. It is often hard for parents during this period, because teenagers are often rejecting towards them, but research shows that teenagers do not want their parents to say: 'OK. Go ahead. You are on your own now.' '
Dr Weeks says: 'It is the parents' responsibility to maximise their children's gifts. They have to balance the perceived deficit that the teenager is focusing on with his or her other gifts, and show them that their shape is only a small part of their overall personality.
'Growing up as an exceptionally small teenager, I was always struck by the cruel tactlessness of adults. Like all teenagers, I wanted to look older, or at least as old as my age. But this common feeling seemed to be beyond their understanding.
' 'How old are you now?' they would inquire. 'Sixteen,' I would say, trying very hard to look taller than my 5ft. 'Goodness, are you? You only look about 12.' 'And how old you now?' I wanted to say. 'Forty-two? Goodness, you look at least 60.' '
'Teenagers in the Family', including booklet and cassette, is available from Trust for the Study of Adolescence, 23 New Road, Brighton, East Sussex BN1 1WZ, price pounds 7.95.
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