text:
|Publication number
|Publication type
|Publication date
|Dec 23, 1975
|Filing date
|Nov 8, 1974
|Priority date
|Dec 8, 1971
|Publication number
|Janis Gunars Ziedonis
|Original Assignee
|Hoffmann La Roche
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (6), Referenced by (50), Classifications (17), Legal Events (1)
|External Links: USPTO, USPTO Assignment, Espacenet
United States Patent Ziedonis Dec. 23, 1975 ULTRASONIC TRANSDUCER ASSEMBLY blies is disclosed for patient monitoring use and partic- [75] Inventor; Janis Guam ziedonis Cranbury ularly fetal monitoring prior to and during delivery. N J Each assembly is comprised of a flexible material shaped, at least in part, in a cloverleaf type configura- Asslgneel uoffmflnfl-La Roche lllcq u y. tion wherein the cloverleaf arms are independently flexible relative to the center area and to each other [22] Filed. No 8 1974 for easy conformity to the body. Each of the arms cam'es at least one transmitting transducer and the PP- No; 522,171 cloverleaf center area is provided with a receiving Related Us. Application Dam transducer. Each of the transducers is provided with [63] Continuatiomim an of S r N 206-012 D 8 an appropriate lens arrangement for enabling overlap- 197] Pat No 0| 6 e ping direct beam illumination of a substantial portlon of the interior of the body. The middle arm of the basic cloverleaf configuration is extended to include [52] US' Cl 128/2 3 621)? additional transmitting and receiving transducers for [51 im. cm k611i 5 00 great" venge, fixample' a [58] Field of Search U 128/2 P 2 06 E straight extension to the middle arm bearing an addi- 12824 A; 73/715 0 5 8 tional receiving and transmitting transducer in staggered arrangement or mated together under a single [56] References Cited lens yielding greater longitudinal coverage of a fetus as It pro resses down the birth canal durin labor. DlS
UNITED STATES PATENT S closed v riations thereof employ a Y-shape d extension 3,257,637 6/1966 Henry 73/67.7 to the middle arm, wherein the branches of the Y ex- 123/106 5 tension are provided with singular transmitting trans- 61 682 I 5 532 1;; ducers or combined transmitting and receiving trans- 3:780:75 0/1973 Goldberguii l28/2 05 z dimers Lmdel a sing'e i Pmsible combinafic 3,789,833 2/1974 Bom l28/2I05 2 add'mnal rece'v'ng rimsducer owned the Primary Etaminer-William E. Kamm Attorney, Agent, or Firm-Samuel L. Welt; Bernard S. Leon; Mark L. Hopkins [57] ABSTRACT A series of ultrasonic multi-element transducer assembase of the Y extension. Such arrangements provide greater-side-to side coverage as well as extended longitudinal coverage of the lower portions of the abdomen with regard to moving target such as a fetus undergoing the birth process? 47 Claims, 14 Drawing Figures US. Patent Dec. 23, 1975 Sheet 1 of 12 3,927,662
U.S. Patent Dec.23, 1975 Sheet2of 12 3,927,662
US. Patent Dec.23, 1975 Sheet3 of 12 3,927,662
US. Patent Dec.23, 1975 Sheet4of 12 3,927,662
SURFACE Hcm AVERAGE DEPTH OF FETUS FIG. 3
US. Patent Dec.23, 1975 SheetS of 12 3,927,662
U.S. Patent Dec.23, 1975 Sheet6of 12 3,927,662
o nno ouo ono US. Patent Dec.23, 1975 Sheet70f 12 3,927,662
U.S. Patent Dec.23, 1975 SheetSof 12 3,927,662
0000 0 000N0 0%0 0-M A0 0 00000 00/ 0 0 0000 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0000000000030 0 "0 0 00w\- 000 0 w0w0w0 0w0u0w0u000 U.S. Patent Dec.23, 1975 Sheet 10 of 12 3,927,662
3 hqo owow US. Patent Dec. 23, 1975 Sheet 11 of 12 3,927,662
I B $04 0 0&6 uvivo gvvwr m F 23,1975 Sheet 12 of 12 3,927,662
US. Patent Dec.
ULTRASONIC TRANSDUCER ASSEMBLY RELATED APPLICATIONS This application is a continuation-in-part of Ser. No. 206,012, filed Dec. 8, 1971 now US. Pat. No. 3,847,016.
BACKGROUND OF THE INVENTION The present invention relates generally to transducer assemblies and more specifically to ultrasonic transducer assemblies for monitoring targets within the body of a patient.
In ultrasonic exploratory systems for biological investigations, several types of search units have been available. Most of these units are of a type which is manually held against the body; they are bulky in construction and do not readily accommodate for body curvature. In the patient monitoring field, parameters are dictated which indicate the desirability for quick and convenient placement of transducer devices that would serve to provide for accurate and reliable data, and simultaneously be of simple design and versatile in application. However, most transducers are critical in placement and are, therefore, less than ideal for monitoring where a large area of illumination is desirable.
One particular area in the field of ultrasonics, for which little exists or has been developed in the form of ultrasonic transducer devices, concerns monitoring the heart activity of the unborn fetus. In this particular field, it has been found difficult to track the fetal heart for extended periods of time without having to relocate the transducer, to accommodate the wide divergence of fetal heart positions and depths encountered in long term fetal heart monitoring, particularly during the birth process. In order to operate without transducer placement criticality, large area coverage is highly desirable.
Ideally, one would want the ultrasonic transducer assembly to provide continuous satisfactory coverage of the moving target, throughout, from the initial placement. The practitioner utilizing a transducer assembly providing only limited volume coverage would be faced, for example, with the undesirable prospect of having to move the transducer assembly several times in the course of a fetus progress down the birth canal during labor and delivery. Valuable information may be lost with each new placement of the transducer assembly, particularly if supporting equipments need to be readjusted. Also, a new placement itself could all too easily prove to be unsatisfactory, thus necessitating further search for an acceptable location. In the interim, however, no reliable data is taken and the fetus during that time could be undergoing serious yet undetected stress.
SUMMARY OF THE INVENTION A principal objective of the present invention is to provide an ultrasonic transducer assembly capable of assuring reliable long term patient monitoring, such as fetal heart monitoring over a wide range of fetal positions within the maternal abdomen prior to and during labor, while minimizing the need for repositioning the transducer assembly.
To attain this, the present invention contemplates an ultrasonic multiple element transducer assembly at least a portion of which is of cloverleaf type cntiguration, having at least one central portion which is pro- 2 vided with a receiving transducer and at least three peripheral transmitting transducers, each of the latter being associated with a separate arm extending out from the center body portion of the assembly where said at least one receiving transducer is located. Each of the arms is designed to be independently flexible relative to the other arms and to the center portion so as to provide easy conformity to the body. The distances between the centers of each of the transmitting transducers and to the center of said at least one receiving transducer, in conjunction with lenses individually provided on the transducers for proper beam spreading, are such as to provide a three-dimensional coverage of a relatively large portion of the interior of the body, such as, for example, a maternal abdomen anywhere from 5 cm below the abdomen surface inward.
According to the broader aspects of the invention there is provided an ultrasonic multiple element transducer assembly for use particularly in patient monitoring, comprising a substantially flattened base of homogeneous, flexible material composition, which includes a cloverleaf type configuration portion having a center area with at least three arms extending outwardly therefrom, the arrangement of each of said arms being such as to be independently flexible relative to each other and to the center area, with each arm having proximate said center area narrower width and thickness dimensions from the outer arm area and said center area, for enabling the assembly to conform to varying body curvatures, each of said arms being provided proximate the end thereof remote from said center portion with at least one active element in the form of a transmitting means, said transmitting means being arranged and including lens means for providing overlapping direct beam illumination of a predetermined volume of the interior of the patients body intended to be monitored, and said center area being provided with at least one active element in the form of an ultrasonic receiving means, said ultrasonic receiving means including lens means arranged to provide illumination of a substantially greater percentage of the portion of the patient intended to be monitored than that provided by the said transmitting means associated with any of said arms of said cloverleaf portion, for enabling detection by said receiving means of ultrasonic energy from whichever of said transmitting means is illuminating the portion of the patients body intended to be monitored at any time, wherein the middle arm of said cloverleaf configuration portion is extended to provide for additional active elements in the form of additional transmitting and receiving means for predetermined greater longitudinal and/or transverse coverage, with the base of said transducer assembly being constructed so as to virtually eliminate cross coupling of ultrasonic energy therethrough between active elements. For example, in certain embodiments a straight extension to the middle arm is provided bearing an additional receiving and transmitting transducer in staggered arrangement or mated together under a single lens. This type of transducer assembly is particularly effective, for instance, in yielding greater longitudinal coverage of a fetus as it progresses down the birth canal during labor.
Other disclosed arrangements incorporating the basic cloverleaf design employ a Y-shaped extension to the middle arm, wherein the branches of the Y extension are provided with singular transmitting transducers and associated lenses or combined transmitting and receiving transducers under a single lens. The base of the Y extension may also be provided with an additional receiving transducer. Such arrangements are particularly effective in providing greater transverse, i.e. greater side-to-side, coverage as well as extended longitudinal coverage of the lower portions of the abdomen with regard to a moving target such as a fetus undergoing the birth process.
BRIEF DESCRIPTION OF THE DRAWINGS The above-mentioned and other objects and features of this invention will become more apparent by reference to the following description taken in conjunction with the accompanying drawings, in which:
FIG. IA is a plan view of the basic cloverleaf transducer assembly illustrating the geometrical setting of the multiple transducer elements;
FIG. 1B is a diagrammatical representation of the basic configuration of FIG. 1A, illustrating in particular the arrangement of the conductive wires running from the stem of the assembly to the individual transducers;
FIGS. 2A2C are sectional views of FIG. 1!! taken respectively along the lines of A-A, BB and C--C;
FIG. 3 is a schematic cross-sectional view of the basic cloverleaf type transducer assembly in operative application to a human subject;
FIGS. 4A and 5A are respective plan views of additional preferred embodiments of ultrasonic transducer assembly design according to the invention, in which the central arm of the basic cloverleaf assembly is extended to include additional transducers for extended longitudinal coverage;
FIGS. 48 and 5B illustrate typical patterns of the respective arrangements depicted in FIGS. 4A and 5A in relation to the actual size of the assemblies;
FIGS. 6A and 7A are respective plan views of two further preferred ultrasonic transducer assembly embodiments according to the invention, in which the central arm of the basic assembly design is modified to include a substantially Y-shaped extension provided with additional transducers for increasing longitudinal and transverse coverage; and
FIGS. 63 and 7B illustrate typical coverage patterns of the respective arrangements depicted in FIGS. 6A and 7A relative to the actual size thereof.
DESCRIPTION OF THE PREFERRED EMBODIMENTS With reference to the figures, there is shown in FIG. 1A a preferred basic design coupling a four-element transducer assembly shaped like a cloverleaf, having a body 11, a receiving transducer or crystal [2 and receiving lens 13, and transmitting transducers or crystals 14, and 16 with transmitting lenses l7, l8 and 19 respectively. A cable 21 preferably coaxial, supplies power to the respective transmitting crystals and is used for routing the returned signals received by receiving crystal 12 to suitable electrical monitoring instrumentation. The conductor leads are particularly shown in FIGS. 18, 2B and 2C. The transmitting crystals 14-16 are electrically intercoupled as illustrated by conducting wire 21:: which extends about the periphery of the assembly. Conducting wire 21b, on the other hand, leads to the central receiving crystal 12. The illustrated pattern and fine gage (eg 50 Mils) of the conducting wires are such as-to enable a high degree of flexibility being achieved in the transducer assembly.
The general or basic configuration, as mentioned, is of cloverleaf design, having the body 11 fabricated of flexible material such as, for example, a polyurethane or other suitable composition which also has high damping characteristics to minimize ultrasonic energy cross-coupling characteristics between crystals. The three arms extending from the center portion are provided with the transmitting crystals l4, l5 and 16 at their extremities. Each of the arms is wider at its outer or free end where the crystal is mounted, as opposed to the neck portion 22 thereof intermediate the center of the assembly and the outer end. In the present embodiment the preferred difference in these width dimensions is approximately 20 percent, allowing greater flexibility of each of the arm units. The ability to independently flex the respective arms containing the transmitting crystals is further enhanced by thinning out (i.e. reducing the thickness of) the neck portions 22 of the arms. This is particularly illustrated in FIG. 2A. In this embodiment the preferred ratio of the neck 22 thickness to the extremity thickness at 23 is approximately a ratio of one to two. This overall construction results in optimum flexibility of each of the arm units. It allows each arm to more readily conform to the body curvature and at the same time introduces almost no compression upon body 11. This in turn avoids interfering stress on the other transmitting crystals and the receiver crystal. The total configuration of each arm of the flexible assembly is such that the flexibility is increased by roughly the cube of the thickness.
Proximate the free end of each arm a cavity 20 (FIG. 2A) is provided for housing the transmitting assembly, for example, crystal I6 and its lens 19, and simultaneously allowing ample room around the lens element for an ultrasonic coupling gel to stay in place, once deposited therein, and thus enhancing the capability for long term monitoring. It should be noted that the depth of the cavities and the thickness of the gel are not critical. Almost any fluid or gel would be operative, for example, water, cream, oil, whether it be high or low viscosity, conductive or nonconductive. A similar recess or cavity is provided with regard to receiving crystal l2 and its lens 13.
It should be noted that the various dimensions between the transmitting and receiving elements are likely to be critical to each of the other dimensions. These dimensions have been developed based on the consideration of utilizing the present transducer assembly for fetal monitoring where an average curvature of the body is about 20 cm. The distance between the centers of adjacent transmitter crystals is approximately 8 cm and the distance center-to-center from each transmitter crystal to the receiver crystal is about 4% cm.
With regard to the crystal characteristics and makeup, the crystals are preferably composed of lead-zirconate-titanate, which material is especially efficient for converting electrical signals to mechanical motion. For the receiving crystal the material used could be quartz, lead-metaniobate or equivalent which has a high efficiency in converting mechanical motion to electrical signals.
Each of the transmitter crystals in a preferred arrangement is cut in the shape illustrated in the dashed lines in FIG. 1A, so that the ultrasonic energy is radiated in selected directions only. For example, with reference to FIG. 3, at the cut-off edge 24 of transmitter lens 18, the ultrasound beam spread radiated from associated crystal 15 is hardly diverted as the cutoff edge is near the center of the lens. Of course, the oper ative surface of each of the transmitting crystals with its associated lens could also be circular in shape, as shown via the dashed lines in FIG. 1A and also shown in FIGS. 18 and 2A.
In the illustrated general embodiment of FIGS. 1-3, the angle a (FIG. 1A) formed by the center arm and one of the side arms is preferably 120. Moreover, the angle [3 formed on the one hand by a line drawn between the centers of the receive crystal 12 and a transmit crystal, e.g. 14, and on the other hand by a line drawn through the center of that transmit crystal and the center of an adjacent transmit crystal, e.g. 16, is preferably 30.
Moreover, the transmitter crystals are preferably approximately 1.9 cm in diameter whereby the cutoff section would amount to a radial distance of 0.635 cm from the outer edge. This provides for an approximate area for each transmitting crystal of 2 cm. The receiving crystal arm is preferably approximately 3.87 cm, or roughly twice that of each of the transmitting crystals. The total area of the transmitting crystals, on the other hand, exceeds the area of the receiving crystal by a ratio of at least 1% to l. The receiving crystal is made considerably larger than the transmitting crystals as it must detect the ultrasonic energy from a considerably larger area then any one of the transmitting crystals illuminated areas.
The lenses 17, 18, 19 for the transmitter crystals and lens 13 for the receiver crystal have approximately the same radius of curvature. However, it may be particularly seen in FIG. 3 that the beam spread provided by the receiving crystal assembly is greater due to the different size of crystal used. In the present embodiment, the transmitter means have approximately an 8 beam spread while the receiver means has approximately l 1 of beam spread, or a total beam spread of 16 and 22' respectively.
In FIG. 3, the three transmitter units are shown to be mounted in the transducer assembly in such a manner that the radiating beams overlap each other to uniformly illuminate a large area. The radiated patterns emitted by crystals and 16 actually overlap to a greater extent than that shown as a result of the side lobes of ultrasonic energy off the crystal edges as well as the scattering effect within the body tissue. In the preferred embodiment of FIGS. 1-3, it was found that the transmitter crystals would illuminate roughly 8 cm at a depth of a 5 cm from the lens whereas the receiving crystal would illuminate roughly 16 cm.
From FIG. 3 it may be seen that utilization of the multiple element transmitter assembly assures the shortest path of ultrasonic energy between the transmitter, target and receiver. For example, assuming that target 27 is at the point indicated, the transmitter-target-receiver path 26, 27 and 28 is shown to be approximately 13.25 cm whereas the transmitteMargetreceiver path 29, 27 and 28 is shown to be 15.25 cm. Assuming use of the conventional single transmitter and receiver assembly where crystals 16 and 12 are positioned, then the path to be travelled would take an additional 2 cm. which would reduce the amplitude of the signal illuminating the target by approximately 4dh, resulting in a lower amplitude signal at the receiver.
It should be understood, of course, that various combinations and permutations of crystal spacing and crystal sizes with lens curvatures might be employed without loss of useful signal. In the instant basic embodiment, for example, spacing between the adjacent transmitter crystal centers might be anywhere from 7 to 9 cm and the spacing between each transmitter crystal and receiver crystal might be anywhere between 4 to 5 cm. Should, however, the spacing between transmitters and receiver be increased considerably, then, due to the 20 cm average body curvature, the transmitters might not illuminate beyond the 11 cm depth, which might thus result in a shallow area illumination. Thus a high percentage of fetal targets which are often at the l4 cm and 16 cm depths, would be missed altogether. On the other hand, with very close spacing between the transmitters and receiver, the ultrasonic beam radiated would not overlap at 5 cm below the surface of the body and, therefore, a fetal target at this location would provide no monitoring signal.
It is to be also noted that due to the symmetry of the basic cloverleaf configuration and the lensing structures, the assembly may be used effectively in a reverse mode, i.e. the transmit crystals may be used in a receive mode and the receive crystal used as a transmitter.
While in the above there has been described the basic cloverleaf design as one preferred embodiment of the invention for an ultrasonic transducer assembly, other preferred embodiments are contemplated which, like the basic cloverleaf design, have achieved a high level of success in experimental and/or clinical testing. These embodiments essentially provide additional crystals in predetermined array to extend the overall illumination in specified manner such as for more specific applications, for example, with regard to a moving target over an extended period of use.
It should be noted that with any of the embodiments of ultrasonic transducer assembly described herein, the patient is electrically isolated, i.e. there is no electrical contact, and the patient is entirely safe.
The first of the preferred alternative embodiments will be described in reference to FIGS. 4A and 4B wherein a six-element transducer assembly is depicted. In the description of this and the remaining embodiments disclosed herein, similar reference designators to those used in describing the basic cloverleaf design (FIGS. l-3) are employed for purposes of clarity.
As in the basic design, the assembly according to FIG. 4A has a body of flexible material 1 1 l, a receiving crystal and appropriate lens structure 112-113, and transmitting crystals 114-116 also with appropriate lens structures 117-119. A double coaxial type cable 121 supplies power to the respective transmitter crystals and couples the received signals to the instrumentation. In this embodiment, however, the middle or central arm 123 of the basic design portion described hereinbefore has been extended outward (extension 1230), as particularly illustrated in FIG. 4A by dashed line 123b, to provide an additional receive crystal 124 and a transmit crystal 125. These crystals are provided with appropriate lens structures 126 and 127 respectively. Y
The transmitting crystal is cut in substantially the same shape as transmitting crystals 114 and 116 to effect radiation of ultrasonic energy therefrom, as hereinbefore described, in only the selected direction(s). Though not particularly shown, the thickness of the extended portion 1234 of middle or central arm 123 as well as the width thereof is reduced in similar manner to that described for the arms of the basic design portion for providing greater flexibility and conformity to the body curvature. These dimensional reductions, as before, occur between the locations of the active ele- 7 ments, i.e. the transmit and receive crystals, including that portion of the assembly of FIG. 4A lying proximate dashed line 1231).
The basic design center-to-center spacing between the transmitting crystals 114-116 and the receiving crystal 113 has been preserved in the extended portion of middle arm 123, wherein new receive crystals [24 is spaced apart from transmit crystal 115 and new transmit crystal 125 is spaced apart from receive crystal 124, each by the dimension c. A preferred value for dimension c would be 4% cm. The cengento-center spacing d between transmitter crystals 114-116 in the basic design portion of the FIG. 4A embodiment also remains the same. A preferred value for this dimension is 8 cm.
The full routing of the very fine (typically 45 mil) wires intercoupling the various active elements shown in FIG. 4A retains the design goal of the basic cloverleaf structure to maximize flexibility of the assembly for conformity to the body curvature. This is true of all remaining embodiments described herein. In this particular instance the wire routing of the standard cloverleaf portion is amended first of all by the inclusion of a conductor running as shown between receive crystals 112 and 124, which crosses over the already provided conductor wire running betwen transmitting crystals 114 and 115. The conductors at this cross-over point are, of course, well isolated. Additionally, there is provided a new conductor running as shown between transmitting elements 115 and 125. Thus it is, that all transmitting transducers are electrically coupled together and all receiving transducers are coupled likewise.
FIG. 48 illustrates a typical area coverage of the transducer assembly of FIG. 4A. There is shown in FIG. 4B the area of most active coverage 160 provided by the assembly, as well as an area of additional but less active coverage 161. These areas are, relative to the size of the assembly illustrated in FIG. 5B, essentially to scale. Both the most active and lesser active areas of coverage appropriately exhibit the abruptness of cutoff of activity resulting from the cut shape of transmitting crystals I14, 116 and 125.
The configuration of transducer assembly depicted in FIGS. 4A and 4B was conceived principally for the purpose of increasing the length of illumination of an expectant mothers abdomen. f major concern in leading to the development of this configuration is the consideration that the fetus should be monitored continuously as it moves down the birth canal, without requiring a repositioning of the transducer assembly as a result of said fetal movement. Thus, the transducer assembly would normally be placed such that the extended arm portion points in the general direction of the fetal movement during the birth process. It should be noted that as the fetus moves closer to the cervix, it is more limited as to side-to-side movement, due to the narrowing of the birth canal. Therefore, with the transducer assembly configuration of FIGS. 4A and 4B the desired continuous monitoring throughout the birth process is achievable without the need for relocating the assembly.
In this embodiment, as in all embodiments described herein, the beam spread of the lenses is predetermined such that a fetal target as close as 5 cm to the surface will be satisfactorily detected. The pattern illustrated in FIG. 4B, for example, is that which would exist for the configuration of FIG. M at a depth of about I l cm.
The transmitting crystals 114, 116 and 125 are cut in the preferred shape illustrated such that when mounted in the associated lens structures, they will illuminate the area specifically selected for maximum fetal activity and best system sensitivity. It is to be noted that the transmitting crystal is a round disc, the circular active surface being provided in this case for illumination in all directions. This is in particular relation to the fact that this active element is situate between the two receive crystals 115 and 125, Both receiving crystals 113 and 124 are disc-shaped to provide circular active surfaces for full 360 coverage. They are larger than the transmitting crystals for ensuring the capability of receiving energy from all directions as generated by the transmitting crystals, and particularly to ensure reception regardless which of the transmitting crystals is most directly illuminating the target. Thus, even as the fetal target moves and the return signal might then be coming from another direction, there is every likelihood that it would be satisfactorily received without having to move the assembly.
Preferred area dimensions for the operational faces of the various active elements are as follows. The area of the individual transmitting crystals 114, 116 and is 2.0 cm and the remaining transmitting crystal 115 is 2.84 cm. Thus, the total transmitting crystal area in this configuration is 8.84 cm, an increase of some 32 percent over the basic cloverleaf design. The area of the receiving crystals 112 and 124 is in each case 3.87 cm, for a total receiving crystal area of 7.74 cm, which doubles the area for receiving elements over the basic cloverleaf design.
The lenses for the transmitting and receiving crystals have approximately the same radius of curvature, i.e. preferably 2.5 em, but it should be noted that the re ceiver lenses provide greater coverage due to the larger dimensioned active areas of the receiving crystals. While a preferred spacing provided between adjacent active elements is given as c=44 cm in the above, and while this also represents the standard preferred dimension of the basic design, it should be noted that if the lens curvatures were to be changed, then different spacing could obtain for the same area coverage.
Referring to FIGS. 5A and SB, there is illustrated therein a six-element transducer assembly which in essence represents an intermediate between the basic cloverleaf design and the particular embodiment illustrated in FIGS. 4A and 4B. The construction of the FIG. 5A embodiment differs from that depicted in FIG. 4A only in the specific arrangement of the extension of the middle arm 223. As before, similar reference designators are used where appropriate. In this instance, the middle arm 223 is extended, as defined by dashed line 223b, by a portion 22311 which houses only a single additional transducer/lens location. However, in this embodiment there is found under lens 223 a receiving crystal 230 and a transmitting crystal 231. Each is slightly less than one-half the area of the full size crystals employed elsewhere, such as crystals 212 and 215 respectively, and these additional crystals resemble half circles in shape. The two crystals 230 and 231 face each other via their cut-off sides, so as to entirely fit beneath the single lens 233. This lens is preferably of a larger radius, such as around 5 cm. The remaining lenses and crystals do not differ substantially from those described with regard to the FIG. 4A embodiment as to location or function, etc.
The conductive intercoupling wiring employed in the arrangement of FIG. A retains that provided for the basic cloverleaf design, amended only to add wiring to couple new elements 230 and 231 thereto. In this instance a first new line runs as shown from receiving crystal 212 to receiving element 230 and a second new line runs in the manner shown between transmitting crystal 218 and transmitting half-crystal 231.
Just as in the case with the FIG. 4A embodiment, it is seen that the basic cloverleaf design has been extended in the one direction, i.e. longitudinally, via the middle arm to illuminate the fetus as it moves towards the cervix. However, this transducer assembly is somewhat shorter in its overall longitudinal dimension than the one depicted in FIG. 4A. In fact, the center-to-center separation e between lens location 218 and lens location 233 preferably is 4 cm. A major advantage of this embodiment would be for use on smaller women as to whom this arrangement would likely prove superior over the FIG. 4A assembly.
FIG. 58 illustrates the coverage provided by this smaller embodiment, broken away, as before, into the most active 260 and lesser active 261 areas. It is to be particularly noted that the coverage of this assembly ranges significantly beyond the physical tip of the extended middle arm, thus enabling greater coverage, particularly for smaller women, throughout the birth process.
Referring now to FIG. 6A, there is illustrated therein an 8-crystal transducer assembly designed to widen as well as lengthen the field of illumination of the standard or basic cloverleaf design. In place of the half-crystal pair arrangement on the straight extended portion of the middle arm as depicted in FIG. 5A, this assembly provides for a relatively wide Y-shaped or hammerhead type extension of the middle arm, with both the left and right side portions of the extension housing a half-crystal pair arrangement under a single lens structure.
More particularly, middle arm 323 of the basic design has been extended by a wide Y or hammerheadshaped portion 323a, as defined by dashed line 3231). Associated with the left side portion 323a of extended portion 323a is a transmitting crystal 340, a receiving crystal 341 and a lens 342 housing both the aforesaid crystals. This is possible, again, because of the half-circle shapes of active elements 340 and 341 facing each other via their cut-off sides. Transmitting crystal 340 is, for example, of slightly less than half the surface area of transmitting crystal 315. Receiving crystal 341, moreover, has slightly less than half the surface area of, for example, receiving crystal 312. Transmitting and receiving crystals 340 and 341 are situate under a lens having essentially the same dimensions, and in particular the same radius of curvature, as lens 233 illustrated in FIG. 5A. In the FIG. 6A embodiment the center-tocenter separation between lens location 342 and lens location 318 is the dimension 0, i.e. preferably 4% cm.
Thus, the preferable separation here is the same as found in the basic cloverleaf design between the central receiving transducer and the outlying transmitting transducers.
As to the right side portion 323d of extension 3230 the location, shape, size and arrangement of the additional active elements and lens provided, i.e. transmitting element 343, receiving element 344, and lens 345 are identical with that described with reference to the left side portion 3230. It is noted that the parallel cutoff edges of the crystals 340-343! and of the crystals 343-344 respectively form acute angles with a line drawn between the location centers of their respective lenses, which angles preferably would be in the vicinity of 45. The center-to-center separation f between the lens locations 342 and 345 is in this assembly preferably 5% cm.
The routing of the fine gage wires intercoupling the various active elements in this arrangement is somewhat more complicated as regards the extended portion of the middle arm. In this case a new line is run from receive crystal 312, much like that depicted in FIG. 4A, crossing over the line intercoupling transmit crystals 314 and 315, and passing around the right side of the crystal 315 location to a junction point. There this line devides to run more or less directly to receive half crystals 341 and 344. In a similar manner, an extension lead is brought out from the left side of transmit crystal 315 to be run up the left side of the extension of arm 323 to a second junction point, whereat it divides in leading to the two transmit half crystals 340 and 343. However, between this second junction point and transmit crystal 343, this line crosses over the extended receive conductor just below its junction point. Again, adequate isolation is provided at these crossover points.
Instead of the junction point arrangement described, it may be advantageous from a commercial standpoint as well as flexibility to provide a wire connection running from element 315 along the periphery of the left side of the assembly to contact element 340 at about 9 o-clock. Another wire may be run from element 340 at l 2 o-clock along the periphery of the top portion of the assembly over to element 343 where it would make contact with the latter at the 2 o-clock position. Similarly, a wire conductor could run from receive element 312 along the periphery of the right side of the assembly up to element 344 to make contact therewith at the 7 o-clock position. Then another conductor would be run between element 344 and 341 making contact therewith respectively at the eleven o-clock and one o-clock positions. This conductor would also be arranged along the top periphery of the assembly but inside the transmitting conductor running between elements 340 and 343.
A major advantage of this assembly is that it widens the field of illumination in the lower abdominal area including the area around the cervix, which is perhaps the most critical area for fetal coverage during labor. This assembly is designed to anticipate the situation where the target moves sideways during contractions, and as a result, there would, barring extreme cases, obtain continuous recognizable signals representative of the fetal heartbeat, by reason of the additional wire coverage in the direction of extension of the middle arm.
As is the case with the FIG. 4A and FIG. 5A assemblies, transmit crystals 314 and 316 and receive crystal 312 of the FIG. 6A assembly are identical in size, shape, position, lensing and function to corresponding crystals described with reference to the basic design. Transmit crystal 315 is, of course, circular in shape to illuminate in all directions. Transmitting crystals 340 and 343, while being cut to less than half the area of, for example, transmit crystal 315, are intentionally mounted on the outside at lens location 342 so as to illuminate beyond theassembly proper (see FIG. 6B). Whereas receive crystal 312 is of standard size, receiving crystals 341 and 344 are of a somewhat smaller radius.
The typical field pattern for the FIG. 6A assembly is illustrated in FIG. 6B. This pattern, as is the case in the other embodiments, is dependent in large part on the lenses employed with the active elements of the assembly. In the preferred case the lenses 313, 317, 318 and 319 respectively are the same radius of curvature as that provided for the active elements in corresponding locations of the basic design. The lenses 342 and 345 have equal radii of curvature, considerably less than that of the other lenses. As a result, it is assured that the return beam from a target, rather than exceeding the critical operational angle, will be detected by the adjacent receiving crystal.
As before, typical pattern depicted in FIG. 6B of the areas of most sensitive illumination is broken into the most active 360 and lesser active 36] areas ofillumination. To be noted from this coverage pattern, again is the usual lower half coverage characteristic of the basic cloverleaf design, coupled in this instance with the extended upper area of coverage featuring wider illumination due to the presence of the active elements associated with the hammerhead extension 3230 of the middle arm.
The spacing between the transmit and receive halfcrystals housed by a single lens is filled with, for example, tungsten powder in combination with an epoxy mixture. This reduces to acceptable levels any ultrasonic cross-coupling between these elements, which is a very important consideration for the type of transmission-reception here depicted. This same provision is made for the noted half-crystals employed in the assembly of FIG. 5A.
FIG. 7A illustrates yet another alternative embodiment of preferred transducer assembly, which bears similarity in shape to the assembly depicted in FIG. 6A. The seven-element assembly of FIG. 7A, like the FIG. 6A assembly, is provided with an extension 423a (as defined by dashed line 423b) to the middle arm 423 of the basic design, which extension is shaped like a wide Y. Proximate the base of this extension as defined at 423b there is located in a substantially straight line with standard crystals 412 and 415, an additional receiving crystal 424 and appropriate lensing structure 426. Receive crystal 424 preferably may be spaced apart from transmit crystal 415 in symmetry with the receive crystal 412 position (i.e. by a separation c).
Associated with the left (423c) and right 423d) side portions of the Y-shaped extension 4230, proximate the free ends thereof, is an additional transmit crystal 450, 451 respectively, together with appropriate lensing structures 452 and 453. The center-to-center spacing between these transmit crystal locations respectively and the receive crystal 424 location may preferably be the same as that existing in the basic design, i.e. the spaced separation between receive crystal 424 and any adjacent transmit crystal (415, 450, 451), is c. Also, FIG. 7A shows the center-to-center separation between transmit crystals 450 and 451 and transmit crystal 415 to be the same as the basic design spacing between transmit crystals 414/416 and transmit crystal 415, i.e. the dimension :1. That is, the design of this assembly in the preferred configuration is not unlike a mirror image type arrangement of two basic cloverleaf configuration assembled together. However, it is to be noted that whereas a double cloverleaf arrangement coupled together via the respective middle arms would provide for two consecutive transmit crystals adjacent 12 to the junction point of the two center arms, the arrangement of FIG. 7A intentionally provides instead a single transmit crystal, i.e. 415, symmetrically placed at this junction area.
The concept of a double cloverleaf design, though entirely operable in concept and within the scope of the present invention, is not as practical from a power standpoint as, for example, the FIG. 7A assembly. A double cloverleaf arrangement would have a total of eight crystals, i.e. two receive and six transmit. The FIG. 7A arrangement, on the other hand, provides with very reliable operation the same of superior coverage with only seven crystals. This enables more ultrasonic power output relative to crystal surface area. Since in most instances it is preferable, if not essential, to have associated with such transducer assemblies as described herein a fixed electrical power output from the associated electronic equipment, and since ultrasonic output is related to the area of the crystals, then the larger the total crystal area, the lower the ultrasonic power output.
As to the conductive wires intercoupling the various active elements, there is illustrated in FIG. 7A along with the Y-shaped extended portion of middle arm 423 a conductive coupling line provided which runs between receive elements 412 and 424, not unlike that described with reference to the embodiment depicted in FIG. 4A. Additional transmit conductive wires are provided which run as shown respectively between transmit elements 415 and 450 on the one hand and elements 450 and 451 on the other hand.
The principal purposes and advantages of this FIG. 7A assembly are essentially the same as that of FIG. 6A arrangement, namely, for example, to effectively extend the area of illumination both transversely, i.e. side-to-side, and longitudinally. This may be seen in FIG. 78, wherein a typical coverage pattern is illustrated for the most active (460) and lesser active (461) areas of assembly sensitivity. The illumination and power distribution of this embodiment can be made to appear almost exactly like that of the FIG. 6 assembly, particularly if transmitting crystals 450 and 451 (and also transmitting crystals 414 and 416), instead of being shaped and positioned as illustrated in FIG. 7A, have circular surface area or are oriented essentially the same as to the transmitting crystals 340 and 343 (and also 314 and 316) associated with the FIG. 6A assembly. By this assembly, as is the case with the FIG. 6A assembly, one can illuminate both sides of a normal expectant mother, and more easily and quickly determine what position the baby is in as well as on which side it is situate. This type of wider coverage assembly, then, provides easier target location for subsequent operation without having to relocate the assembly as a result of substantial movements of the fetal target. The assembly is particularly applicable for illuminating a highly active fetus as it moves toward the cervix.
While the principles of this invention have been described above in connection with specific apparatus, it is to be understood that this description is made by way of example and not as a limitation on the scope of the invention as set forth in the objects and features thereof or in the accompanying claims.
What is claimed is:
1. An ultrasonic multiple-element transducer assembly for use particularly in patient monitoring, comprising a substantially flattened base of homogeneous, flexible material composition, which includes a cloverleaflike configured portion having a center area with at least three arms extending outwardly therefrom, the arrangement of said arms being such as to be independently flexible relative to each other and to the center area, with each arm having proximate said center area narrower width and thickness dimensions than the other arm area and said center area, for enabling the assembly to conform to varying body curvatures, each of said arms being provided proximate the end thereof remote from said center portion with at least one active element in the form of a transmitting means, said transmitting means being arranged and including lens means for providing overlapping direct beam illumination of a predetermined volume of the interior of the patient's body intended to be monitored, and said center area being provided with at least one active element in the form of an ultrasonic receiving means, said ultrasonic receiving means including lens means arranged to provide illumination of a substantially greater percentage of the portion of the patient intended to be monitored than that provided by the said transmitting means associated with any of said arms of said cloverleaf portion, for enabling detection by said receiver means of ultrasonic energy from whichever of said transmitting means is illuminating the portion of the patients body intended to be monitored at any time, wherein the middle arm of said cloverleaf configured portion is extended to provide for at least one additional active element for predetermined greater longitudinal and/or transverse coverage.
2. An assembly according to claim 1 wherein a pair of additional active elements is prov'ided on said extension portion of said middle arm in the form of a transmitting means and a receiving means.
3. An assembly according to claim 2 wherein both the cloverleaf and extended portions of said base are constructed so as to virtually eliminate cross-coupling of the ultrasonic energy therethrough between active elements.
4. An assembly according to claim 2 wherein said cloverleaf portion includes a stem appendage by way of which a pair of external conductive coupling elements are introduced into said base to extend therewithin to make electrical contact respectively with said each receiver means and each transmitting means.
5. An assembly according to claim 4, wherein said conductive coupling elements are of fine gauge and are predeterminably disposed in general proximate the periphery of said base and extending from active element to active element, the fine gauge and routing of said coupling elements using such as to optimize the flexibility of the assembly for conformity to the body.
6. An assembly according to claim 2 wherein the thickness and width dimensions of the middle arm are uniformly narrowed between each of the locations of active elements associated therewith in predetermined amount.
7. An assembly according to claim 6 wherein the narrowed width dimension constitutes approximately a percent width reduction and the narrowed thickness dimension constitutes approximately a 50 percent thickness reduction.
8. An assembly according to claim 2 wherein each of the transmitting means associated with the left and right side arms of said cloverleaf portion is predeterminably shaped relative to the lens means associated therewith for limiting radiation of ultrasonic energy to preselected directions, and wherein the receiving means associated with said cloverleaf portion is provided with an operational surface area approximately twice the operative surface area of any one of said predeterminably shaped transmitting means.
9. An assembly according to claim 8 wherein the total operating surface area provided for said transmitting means associated with said cloverleaf portion exceeds the total operative surface area provided for said receiving means associated with said cloverleaf portion approximately by the ratio of 1% to 1.
10. An assembly according to claim 8 wherein the lens means associated with the individual transmitting and receiving means of said cloverleaf portion have approximately the same radium of curvature.
11. An assembly according to claim 10 wherein the beam spread associated with said receiving means of said cloverleaf portion is greater than the beam spread of any one of the transmitting means associated with said cloverleaf portion.
12. An assembly according to claim 1 wherein the side arms of said assembly are symmetrically disposed on either side of said middle arm and wherein each said side arms forms a predetermined angle a with the middle arm.
13. An assembly according to claim I wherein said extension to said middle arm is a substantially straight extension having at least one location at which there is provided said at least one additional active element.
14. An assembly according to claim 13 wherein said transducer assembly has a longitudinal axis of symmetry and the straight extension to said middle arm is directed along said axis and said at least one active element location is on said axis.
15. An assembly according to claim 14 wherein said extended portion has a plurality of active element locations, each of which having associated therewith at least one active element.
16. An assembly according to claim 15 wherein said transducer assembly has a longitudinal axis of symmetry along which said straight extension is situate and each of said plurality of active element locations is centered on said axis, and wherein said plurality of locations constitutes a pair of locations each having a single active element and corresponding lens means associated therewith.
17. An assembly according to claim I6 wherein the active element location of said extended portion closest to said cloverleaf portion is provided with a receiving means having a circular operating surface, and the remaining active element location of said extended portion is provided with a transmitting means having an operative surface shaped 'relative to the lens means associated therewith for limiting radiation of ultrasonic energy to predetermined directions.
18. An assembly according to claim 17 wherein said cloverleaf portion includes a stern appendage by way of which a pair of external conductive coupling elements are introduced into said base to extend therewithin to make electrical contact respectively with each said receiving means and each transmitting means, the conductive coupling element associated with the transmitting means being extended along the periphery of said base to electrically couple to said transmitting means associated with said extended portion and the conductive element associated with the receiving means being extended along the periphery of said base to electrically couple to said receiving means associated with the said extended portion, the extensions of said conduc-
|Cited Patent
|Filing date
|Publication date
|Nov 20, 1962
|Jun 21, 1966
|Branson Instr
|High scan rate ultrasonic inspection system
|Sep 24, 1965
|Apr 30, 1968
|Int Rectifier Corp
|Electrical pickup structure for electrocardiographs and the like
|Jan 11, 1968
|Jan 5, 1971
|Hoffmann La Roche
|Ultrasonic transducer assembly for biological inspections
|Sep 23, 1968
|Nov 2, 1971
|Univ Ohio State
|Ultrasonic nondestructive thickness gauge
|Mar 4, 1971
|Dec 25, 1973
|Smith Kline Instr
|Fetal heartbeat monitoring system with plural transducers in one plane and at different angles thereto
|Mar 23, 1972
|Feb 5, 1974
|Medische Faculteit Rotterdam
|Heart examination by means of ultrasound waves
|Citing Patent
|Filing date
|Publication date
|Jun 24, 1976
|Oct 24, 1978
|Herbert Karsh
|Motion monitor
|Jun 26, 1981
|Apr 3, 1984
|Matsushita Electric Industrial Company, Limited
|Arc scan transducer array having a diverging lens
|Aug 3, 1982
|Sep 11, 1984
|Matsushita Electric Industrial Co., Ltd.
|Arc scan ultrasonic imaging system having diverging lens and path-length compensator
|Apr 25, 1983
|Aug 6, 1985
|Hokanson D Eugene
|Focusing mechanism for an ultrasound device
|Aug 19, 1991
|Jul 20, 1993
|Mannesmann Ag
|Ultrasound testing device for the non-destructive testing of workpieces
|Aug 1, 1995
|Sep 16, 1997
|Wilk; Peter J.
|System and associated method for providing information for use in forming medical diagnosis
|Apr 24, 1997
|Feb 16, 1999
|Wilk; Peter J.
|Ultrasonic medical system and associated method
|Jul 16, 1997
|Feb 8, 2000
|Wilk; Peter J.
|Ultrasonic medical system and associated method
|Apr 20, 1998
|Aug 22, 2000
|Wilk; Peter J.
|Medical imaging device and associated method including flexible display
|Feb 22, 1999
|Oct 31, 2000
|Wilk; Peter J.
|Ultrasonic medical system and associated method
|Sep 15, 1998
|Oct 23, 2001
|Peter J. Wilk
|Ultrasonic medical system and associated method
|Oct 15, 1997
|Nov 20, 2001
|Peter J. Wilk
|Imaging device and associated method
|Feb 28, 2000
|Feb 11, 2003
|Wilk Patent Development Corporation
|Ultrasonic imaging system and associated method
|Jan 28, 2003
|Oct 23, 2007
|Nohara Timothy J
|3D ultrasonic imaging apparatus and method
|Feb 28, 2000
|Mar 3, 2009
|Wilk Ultrasound Of Canada, Inc.
|Ultrasonic medical device and associated method
|Sep 16, 2003
|Oct 6, 2009
|Wilk Peter J
|Ultrasonic medical device and associated method
|Jun 25, 2004
|Mar 29, 2011
|Wilk Ultrasound Of Canada, Inc.
|Real-time 3D ultrasonic imaging apparatus and method
|Feb 11, 2011
|Mar 20, 2012
|Kona Medical, Inc.
|Methods to deliver high intensity focused ultrasound to target regions proximate blood vessels
|Oct 19, 2006
|May 1, 2012
|Kona Medical, Inc.
|Systems and methods for ultrasound applicator station keeping
|Mar 6, 2008
|Aug 7, 2012
|Wilk Ultrasound of Canada, Inc
|Ultrasonic medical device and associated method
|Feb 11, 2011
|Oct 2, 2012
|Kona Medical, Inc.
|Methods and devices to target vascular targets with high intensity focused ultrasound
|Jan 11, 2010
|Oct 23, 2012
|Kona Medical, Inc.
|Method and system to inhibit a function of a nerve traveling with an artery
|Sep 26, 2011
|Feb 12, 2013
|Kona Medical, Inc.
|System and method for treating a therapeutic site
|Feb 1, 2011
|Feb 12, 2013
|Kona Medical, Inc.
|Nerve treatment system
|Jan 21, 2011
|Mar 5, 2013
|Kona Medical, Inc.
|Methods and apparatus for focused ultrasound application
|Mar 15, 2011
|Jun 25, 2013
|Kona Medical, Inc.
|Energetic modulation of nerves
|Jun 27, 2012
|Aug 20, 2013
|Kona Medical, Inc.
|Energetic modulation of nerves
|Mar 15, 2011
|Aug 27, 2013
|Kona Medical, Inc.
|Energetic modulation of nerves
|Dec 13, 2010
|Oct 15, 2013
|Kona Medical, Inc.
|Flow directed heating of nervous structures
|Oct 8, 2008
|Jan 7, 2014
|Kona Medical, Inc.
|Controlled high efficiency lesion formation using high intensity ultrasound
|Apr 12, 2012
|May 6, 2014
|Kona Medical, Inc.
|Methods and devices to modulate the autonomic nervous system with ultrasound
|Aug 19, 2010
|Dec 16, 2014
|Sonovia Holdings Llc
|Flexi-PCB mounting of ultrasonic transducers for enhanced dermal and transdermal applications
|Mar 15, 2011
|Mar 24, 2015
|Kona Medical, Inc.
|Energetic modulation of nerves
|Mar 15, 2011
|Mar 24, 2015
|Kona Medical, Inc.
|Energetic modulation of nerves
|Jun 14, 2012
|Mar 31, 2015
|Kona Medical, Inc.
|Energetic modulation of nerves
|May 19, 2011
|Apr 14, 2015
|Kona Medical, Inc.
|External autonomic modulation
|Apr 20, 2011
|Sep 1, 2015
|Kona Medical, Inc.
|Energetic modulation of nerves
|Oct 29, 2012
|Sep 1, 2015
|Kona Medical, Inc.
|Methods and devices to modulate the autonomic nervous system via the carotid body or carotid sinus
|Dec 6, 2013
|Sep 8, 2015
|Kona Medical, Inc.
|External autonomic modulation
|Oct 11, 2010
|Nov 3, 2015
|Kona Medical, Inc.
|Energetic modulation of nerves
|May 16, 2013
|Dec 1, 2015
|Kona Medical, Inc.
|Energetic modulation of nerves
|Sep 14, 2012
|Dec 29, 2015
|Kona Medical, Inc.
|System and method for treating a therapeutic site
|Jan 27, 2013
|May 31, 2016
|Kona Medical, Inc.
|Nerve treatment system
|Mar 9, 2012
|Jun 7, 2016
|Kona Medical, Inc.
|Intravascular catheter to deliver unfocused energy to nerves surrounding a blood vessel
|Jun 1, 2012
|Feb 28, 2017
|Kona Medical, Inc.
|Nerve treatment system
|Mar 6, 2008
|Sep 18, 2008
|Wilk Ultrasound Of Canada, Inc.
|Ultrasonic medical device and associated method
|Feb 3, 2015
|May 28, 2015
|Highland Instruments, Inc.
|Interface apparatus for stimulation of biological tissue
|Apr 23, 1998
|Oct 29, 1998
|Wilk Patent Development Corporation
|Medical imaging device and associated method
|Sep 2, 1998
|Mar 18, 1999
|Redano Richard T
|Method and apparatus for hemodynamic stimulation and monitoring
|Dec 13, 2016
|Jun 29, 2017
|Valeo Schalter Und Sensoren Gmbh
|Ultrasonic sensor device comprising a circuit board which is flexible at least in some regions, ultrasonic sensor arrangement and motor vehicle
|U.S. Classification
|600/459, 73/641, 601/2, 73/642
|International Classification
|Cooperative Classification
|European Classification
|Jun 28, 1982
Owner name: KONTRON INCORPORATED, EVERETT, MASS. A CORP. OF DE
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST.;ASSIGNOR:ROCHE MEDICAL ELECTRONICS INC. A CORP. OF NJ.;REEL/FRAME:004011/0651
Effective date: 19820526
Owner name: ROCHE MEDICAL ELECTRONICS INC., NUTLEY, NJ A CORP.
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST.;ASSIGNOR:HOFFMANN-LA ROCHE INC.;REEL/FRAME:004048/0917
Effective date: 19820525
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:HOFFMANN-LA ROCHE INC.;REEL/FRAME:004048/0917
Owner name: ROCHE MEDICAL ELECTRONICS INC., A CORP. OF NJ, NEW


text: Joey Hess wrote: > > David Whedon wrote: > > pump(22k) - no one has said anything nice about it, and some have strongly > > recommended that it not be used. > > Well pump's not too bad if you don't mind the violation of the dhcp rfc. > It's easy and it works for short usage periods (no lease renewel, > right?), which is ok for an installer. redhat uses pump, but it didn't seem to work too consistently to me. I use dhcpcd which works fine now, but dhclient is also good (even better I guess as others have commented) -- Eray (exa) Ozkural Comp. Sci. Dept., Bilkent University, Ankara e-mail: email@example.com www: http://www.cs.bilkent.edu.tr/~erayo

subset: commoncrawl


text:
Studded tyres are a significant amount of the harmful PM10 emissions in some Scandinavian countries in winter. Hence measures are being implemented to reduce their use.
The Norwegian studded tyre fee allows studded tyres to be used, but discourages their use in cities.
The scheme has been successful in decreasing the proportion of studded tyres by 30-40%.
For more information see our access regulations impacts page.
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text:
Jay SchmaltzRugby, North Dakota, US
You have heard the other voices over and over and so has everyone else, now is the time for a new voice with the talent, background and experience to get the job done and a quality sound to leave the clients impressed. I have a very strong yet comforting voice with lots of diversity. I also offer a wide range of dialects and comic voices I love to use. I have received awards for writing, producing and voicing comedy programs and commercials as well. I was the Signature Voice for Catholic Radio in the Fargo-Moorhead ND area. I have also done narration work for Advertising Agencies across the United States. I bring over 25 years of experience to the table. My sports (high school and college athletics and play-by-play experience) my outdoors background (hunting and fishing) along with my culinary skills (owner of my own restaurant and also Head Chef) allow me to take your script and put the feel and emphasis where it is needed. Before you grab the same old voice that everyone has heard over and over go with the choice that will catch the listeners attention and not sound like everyone else's commercial…put Jay Schmaltz to work for you!
Australian, German, Scottish (Standard Scottish English)
Middle Aged, Senior, Young Adult
Special Skills
Audiobooks, Business, Cartoons, Documentaries, Educational, Internet, Jingles, Movie Trailers, Podcasting, Radio, Telephone, Television, Videogames
I have been writing and recording Radio & TV Commercials for over 25 years. I have owned my own station which I designed and built and have built 2 others besides my own. I have also been Operations Manager at 7 different stations in North Dakota, South Dakota and Minnesota. I have a vast engineering background which has allowed me to build my own in home studio for the best quality product and fastest turn around. Also I have a great passion for sports and have over 25 years of Play-by-Play experience as well. I spent a year and a half as owner Head Chef at my own Restaurant.
Many Happy Stations can't be wrong!
WDSM-AM Duluth, Minnesota
WEBC-AM Duluth, Minnesota
KZIO-FM Duluth, Minnesota
KNDK-AM Langdon, ND
KNDK-FM Langdon, ND
KDLM-AM Detroit Lakes, Minnesota
KVLR-FM Detroit Lakes, Minnesota
KJAM-AM Madison, SD
KJAM-FM Madison, SD
KBRK-FM Brookings, SD
KUSD-FM Vermillion, SD
KAOC-FM Grafton, ND
KAUJ-FM Grafton, ND
KXPO-AM Grafton, ND
KXPO-FM Grafton, ND
KQLX-AM Lisbon, ND
KQLX-FM Lisbon, ND
KDLR-AM Devils Lake, ND
KDVL-FM Devils Lake, ND
KZZJ-FM Devils Lake, ND
KQZZ-FM Devils Lake, ND
KCJB-AM Minot, ND
KRZZ-AM Minot, ND
KZZJ-AM Rugby, ND
KHND-AM Harvey, ND
KDAK-AM Carrington, ND
KBTO-FM Bottineau, ND
WECO-AM Wartburg, Tenn
WECO-FM Wartburg, Tenn
WIXV-FM Savannah, Georgia
KTHC-FM Sidney, MT
KDSR-FM Williston, ND
KEYZ-AM Williston, ND
KVXR-FM Fargo, ND
KVOX-FM Fargo, ND
KFGO-AM Fargo, ND
KCFB-FM St. Cloud, Minnesota
WDAZ Grand Forks, ND
KVRR Fargo, ND
KELO Sioux Falls, SD
KMOT Minot, ND
KXMC Minot, ND
I was a Graduate of Brown Institute in Minneapolis in 1979. Before that I attended the University of South Dakota majoring in Journalism and also North Dakota College of Science majoring in Electronics.
Electro-Voice RE-20,
Computer & Software
Dell Vostro 1500
Special Equipment
Alesis 12 channel Multi mix board, DBX pro 1066 compressor and also I have hooked to this a Tascam MDCD1 Dual Well CD player and Minidisc Recorder.
Delivery Methods
Via E-mail or Regular Mail
Turnaround Time
24-72 hours
Service Description
It's about You! You deserve a Quailty Product at a fair price in a timely manner. You can trust that when I work on your product you have my 100% effort to get it done to your satisfaction and on time!
It sounds great, I liked the flavor you added, a job well done!The Crawford Group Orlando Florida
Payment Terms
Hire Jay as a voice actor. Payment is made through Voices.com SurePay, an escrow service that guarantees your work is done to your satisfaction. Send payment securely by Visa, Mastercard or PayPal through Voices.com then download your files from the website.
Watch a video to see how to make a payment
Next Steps
To contact Jay Schmaltz about your project, request a quote today. We'll walk you through the process step-by-step. It's fast and easy.
Hire Jay Schmaltz as a voice actor. Working with Jay Schmaltz is fast and easy. We'll walk you through the process step-by-step.
Request a quote for your project today.


text:
Featuring Model Prices and Specifications, plus Reviews,News and Videos.
***MERCEDES-BENZ FACTORY 2-YEAR WARRANTY*** ONE OWNER - LOG BOOK HISTORY Fastidiously maintained since new with full Mercedes-Benz service records. This car is a credit to the previous owner and would satisfy even the most particular of buyers. ---KEY FEATURES--- 19 AMG alloy wheels Electrically adjustable luxury front seats (heated & ventilated) with memory function COMAND navigation (voice activated) Electric tilt/reach adjustment of steering column Panoramic sunroof Keyless Go (entry & start) Reversing camera Harman/Kardon Dolby Digital surround sound Cruise control and speed limiter function Intelligent LED headlamps Front & rear parking sensors Dual-zone climate control Bluetooth phone and music 2-YEAR MERCEDES-BENZ CERTIFIED WARRANTY & ROADSIDE ASSISTANCE. When you purchase a Mercedes-Benz Certified vehicle you receive the following exclusive benefits: - 2-year unlimited km nationwide factory warranty - 2-year 24hr roadside assistance - 116-point vehicle inspection - Full Mercedes-Benz service history - Access to Mercedes-Benz owners online - Mercedes-Benz Magazine subscription - Mercedes-Benz Welcome pack We are located on Sydney's Northern Beaches and have been Sydney's favourite Mercedes-Benz dealer for over 54 years.
Interested in a new car? Simply tell us the vehicle you are interested in and we can take care of the rest.
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text: Editor's Note: Any reference to TheStreet Ratings and its underlying recommendation does not reflect the opinion of TheStreet, Inc. or any of its contributors including Jim Cramer or Stephanie Link. All three major indices are trading down today with the Dow Jones Industrial Average ( ^DJI) trading down 128 points (-0.8%) at 16,374 as of Friday, April 25, 2014, 1:00 PM ET. The NYSE advances/declines ratio sits at 926 issues advancing vs. 2,054 declining with 148 unchanged. The Health Services industry currently sits down 0.9% versus the S&P 500, which is down 0.7%. On the negative front, top decliners within the industry include PerkinElmer ( PKI), down 3.4%, Intuitive Surgical ( ISRG), down 1.6%, Aetna ( AET), down 1.6%, Thermo Fisher Scientific ( TMO), down 1.1% and UnitedHealth Group ( UNH), down 1.1%. TheStreet would like to highlight 3 stocks pushing the industry lower today: 3. Covidien ( COV) is one of the companies pushing the Health Services industry lower today. As of noon trading, Covidien is down $1.82 (-2.6%) to $69.14 on heavy volume. Thus far, 3.8 million shares of Covidien exchanged hands as compared to its average daily volume of 2.1 million shares. The stock has ranged in price between $67.68-$69.50 after having opened the day at $69.39 as compared to the previous trading day's close of $70.96. Covidien plc develops, manufactures, and sells healthcare products for use in clinical and home settings worldwide. Covidien has a market cap of $31.8 billion and is part of the health care sector. Shares are up 4.2% year-to-date as of the close of trading on Thursday. Currently there are 15 analysts that rate Covidien a buy, no analysts rate it a sell, and 2 rate it a hold. TheStreet Ratings rates Covidien as a buy. The company's strengths can be seen in multiple areas, such as its revenue growth, notable return on equity, reasonable valuation levels, good cash flow from operations and largely solid financial position with reasonable debt levels by most measures. We feel these strengths outweigh the fact that the company has had sub par growth in net income. Get the full Covidien Ratings Report now. STOCKS TO BUY: TheStreet Quant Ratings has identified a handful of stocks that can potentially TRIPLE in the next 12 months. Learn more.


text:
'She refuses to do it'
Western Bureau:
A new musical concept, designed to bring back live music to the city of Montego Bay, will unfold tonight with the first offering in a series dubbed 'We are Reggae: Unplugged', at the scenic Doctor's Cave Beach on the city's Hip Strip.
"The idea behind 'Unplugged' is to afford patrons the opportunity to experience live performances without the filter of complex stage production," said reggae artiste/actor Peter Lloyd of the 'We are Reggae' team. "This is an acoustic set that will present some of Jamaica's most iconic and beloved performers in a very intimate format."
"... It is noteworthy that, as it stands, there are no regular live music reggae showcases in Montego Bay, the nation's tourism capital," added Lloyd. "We intend to make 'Unplugged' the fix for that situation.
In a bid to start the event with a bang, while emphasising the intent on featuring the very best local acts, tonight's performer will be the iconic Freddie McGreggor, the captain of the Big Ship and the owner of a fantastic catalogue, which dates back over 40 years.
"We are starting with Freddie McGreggor because he is easily one of our most love reggae artistes," said Lloyd. "He is a prolific hit-maker and he is always a hit with the fans, especially the ladies. We are looking for an unforgettable performance from him on Saturday night (tonight)."
trademark hits
In fact, if one should examine the Freddie McGregor catalogue, it contains a string of trademark hits to include the likes of Big Ship, Push Come to Shove, Bobby Babylon, Loving Pauper, Sitting in the Park and We Got Love, among others.
"With a target audience of 300-400 attendees per show, and iconic names such as Freddie McGregor, 'Unplugged' presents a unique branding opportunity to be associated with a new entertainment offering," said Lloyd.
The venue, a scenic delight for visitors to the island for over 40 years, will feature a 10x10 stage erected on the main deck of the Doctor's Cave complex (restaurant), affording the audience close proximity to the artiste.
"The concerts will commence at 9 p.m., and run for an hour, with a 20-minute break mid-set," said Lloyd. "Provisions will be made for the video recording of the concert to be re-broadcast both locally and internationally. The furthest a patron will be from the artiste performing is approximately 25 metres. In addition, the artiste will access the stage by walking though the audience, giving the patrons unusual proximity to these legends of reggae."
Among the acts already confirmed for upcoming stagings of 'Unplugged' are the likes of the firebrand Sizzla, I Octane, dancehall queen Lady Saw, Peter Lloyd and the 'girl's dem sugar', Beenie Man.


text:
If you had to choose two people from the snowboard industry to be your guide through life, who would they be? Maybe a reknowned coach to help you learn new tricks, or maybe Travis Rice so you could just take one of his Red Bull helicopters anywhere you want? For us, it would be Peter Line and Eddie Wall because in addition to having two of the most well-rounded resumes in the biz, but they also pop bottles with models— the truest measure of success.
Lucky for us, and you, if you agree Snowboarder Magazine is bringing the hilariously-named Peddie Files. There's nothing really NSFW about it, but it could trigger some red flags if your teacher or boss sees that you've been watching Peddie File videos every Tuesday (when the weekly vids will come out on www.snowboardermag.com )
Up this week is the teaser for the series and it already looks amazing. You get antics and abilities from these two as they drop bangers and drink beers while filmer Greg Weaver lets the world in on the action. Will their personalities combine to create the greatest stories ever told? Or will they just try to outshine each other and end up with one of those Kobe and Shaq type deals? Tune in weekly to find out, we're expecting it to be the video version Peter's work from the back of so many Snowboarder issues.


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The Place Beyond the Pines is a reunion of sorts for actor Ryan Gosling and writer-director Derek Cianfrance. They last worked together on the beautifully haunting romance Blue Valentine and audiences expecting that kind of magnetism from their new venture will be sorely disappointed. It's a different experience with moments of brilliance but at times it's also frustrating and wildly uneven.
The film's title refers to Schenectady, New York, the place where all three acts of this two-hour-plus film take place. Every act is anchored by a different male character, each transitioning into the next. The first and most rewarding segment follows Luke, a traveling motorcycle stunt rider who has come back to town after a year-long hiatus. His taste for thrills is quickly eradicated when he learns he now has a son from his tryst the year before. Young Jason may be new in Luke's life but it's enough to make him drop everything and settle down to be a good provider.
Money for a burned-out daredevil doesn't come easy so with the help of newfound friend Robin (Ben Mendelsohn), a recipe for disaster is born. They will pair up on bank robberies that eventually keep raising the stakes and after one of these jobs goes incredibly awry we are thrown into the POV of rookie cop Avery Cross (Bradley Cooper) for act two.
Avery's story is a disparate one as it follows our man in blue from the aftermath of the bank robbery to his commendation on the force, much to the chagrin of his family who would rather see him putting his law degree to better use. The rectitude of staying on the right side of the law is what fuels Avery's story as he weighs the decision to stay on the job amidst police corruption or use his father's contacts to land a different life instead.
The third act takes a huge leap in time and focuses on the now teenage sons of both Luke and Avery. They are Jason and AJ and their story is the most jarring and questionable of the trio. In this time frame, we see them as friends who attend the same high school and slowly learn the truth about each other's past. The sins of the father come back to haunt them and when things come to a natural head the result lands with a bizarre sense of dissolution.
Cianfrance has stated that The Place Beyond the Pines has been a constant labor of love and it shows. Each story, while varying in quality, shows a confident voice steering the ship. The end result may not always be perfect but The Place Beyond the Pines tackles issues of morality and guilt in ways most films don't even attempt anymore.
Grade: B
Rated: NR
The Place Beyond the Pines was picked up by Focus Features for a release some time in 2013, and was screened at the 2012 Toronto International Film Festival.


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Blue Sparkle Deluxe Recycler Rig/Bub Combo
Chappell Glass
Sporting sparkling blue with green slyme accents, this gorgeous glass recycler has the added functionality of being used as both a rig and a bubbler. This piece has a female downstem with reclaim chamber that fits your choice of any standard 14mm flower bowl or male quartz banger (see picture). Has a fixed inline diffusion system, 2 opal marbles, and stands at approximately 11 inches tall.
Also available in Slyme, Ruby Red, Pink Slyme, and Green Sparkle.
Product Category:Concentrate & Vapor Rigs
Combo Bubbler / Dab Rig
Sherlock Bubblers
Concentrate and Vapor Products
Smoking Glass
Chappell Glass


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Impuesto de Patrimonio
subir impuestos a las personas que más tienen es justicia social y solidaridad en tiempos de crisis
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text:
New Lower School Admission Director, Andrea Dominic Lubrano
Andrea Dominic Lubrano joins the Friends' Central community from her position as Director of Admission at Friends School Haverford where her responsibilities also included development and marketing. Andrea earned an MEd from Arcadia University and a BA in communications with a focus on advertising from Temple University. Throughout her career, Andrea has worked in schools in the Philadelphia region, including Friends Select and programs in six area public schools on the Main Line. Andrea is the mother of an adult son who teaches farm education in Portland, Oregon, and is stepmother to a school-age daughter. We are looking forward to adding Andrea's experience and knowledge to our Admission team.
Our Admission Team
The members of Friends' Central's Admission Team bring a wide range of experience and expertise to the job. There are Admission offices located in both the Lower School and Middle/Upper School campuses, and members of the team are available to answer any questions you may have.
Susan Robinson
Director of Enrollment Management
Skidmore College - BA
Dwight Dunston
Assistant Director of Admission
Friends' Central School '06
Kathy Coleman-Martin
Assistant Director of Admission
Francesca Zelnick
Admission Associate
Temple University - BA
Andrea Dominic Lubrano
Lower School Director of Admission
Temple University - BA
Arcadia University - MEd
Ginger Fifer
Assistant Principal of Lower School
Anna Miano
Lower School Admission Office Assistant
Hobart and William Smith Colleges - BA


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Hours and Admission
Arrowhead is now open daily for house tours. The visitors center opens at 9:30, the first tour is at 10:00. Tours are hourly, last tour at 4:00.
General information about visiting Arrowhead:
In season (May 22 – mid-October), guided tours of Herman Melville's Arrowhead start at 10 a.m. and are approximately 45 minutes long with tours every hour on the hour. The last tour is 4 p.m. See admission below for cost of the guided tours. There are also self-guided tours of the property which include the nature trail. The grounds and nature trail are open year round, daylight hours. No motorized vehicles allowed off the driveway or parking lot. Please contact us regarding guided tours by appointment.
Parking and admission to the property are free. Rates for guided tours of Melville's house are: adults $15.00, seniors $13.00, students $10.00 and children $8.00. Members of the Berkshire County Historical Society receive FREE admission.
The offices of the Berkshire County Historical Society are usually open Monday-Friday from 10 am. to 4 pm. Offices are closed state and federal holidays. The Margaret H. Hall Library and Archives are open year-round by appointment with the Curator. Contact the curator here.


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A PLACE in the last four of the Dorset Senior Trophy is up for grabs tomorrow when Upwey & Broadwey take on the Witches at Redlands (1.30pm).
Upwey's league and cup double hopes suffered a big setback last weekend but boss Steve Reynolds is confident they will bounce back at the first attempt against Witchampton this weekend.
The Weymouth outfit appeared to be cruising against table-toppers Chickerell United last Sat-urday but from 2-0 up at half-time against 10 men, they went on to lose the game 3-2.
That defeat was their first in nine in the Dorset Senior League, leaving them six points adrift of the Chickens in fourth spot.
Reynolds said: "Chickerell could not get the ball off us in the first half but we became too lethargic and paid the price.
"It was a disappointing result but there is still a long way to go, and we need to get on another run now as soon as possible.
"Hopefully we can start that tomorrow in what is another big game."
Sean Stewart and Sean Zima, pictured, will both be unavailable to Upwey this weekend but Steve Alcock and Lewis Ironside are expected to return. New signing Robbie Rolls could also feature.
Chickerell and Port-land United Rese-rves are also at home in league action tomorrow against Corfe Mullen and Kingston Lacy respectively (2pm).
Chickens boss Steve Coward, who will be without the services of Nick Etherington, said: "We have got Corfe at home followed by Portland away the week after, which are going to be two more very tough games.
"All we can do is concentrate on one at a time and look to put in a big performance.
"We played a bottom-three side in the Trophy before Christmas and lost, so we know we need to play to our best in every game otherwise there is every chance we could drop points."
The Blues, who have not been in action since December 14, have lost their last two in the league and currently sit sixth. Corfe and Lacy lie fifth and 13th respectively.


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I am trying to upgrade the MDSE on my server to SP4. The message I received was "unable to run scripts". I have the msdeverbose.txt log It shows configuration failed. and Note:1: 1729.
I would appreciate any help as this SQL server instance is hanging intermittently causing problems with production, not to mention my growing headache with users screaming that their programs aren't working.
Thanks in advance
6 Replies
May 29, 2010 at 2:12 UTC
Haven't had any experience with upgrading MSDE as we have the full version of SQL Server however here are a couple of links that might help out:
May 29, 2010 at 7:12 UTC
Niagara Technology Group (NTG) is an IT service provider.
Since MSDE is based on SQL Server 2000, are you able to update to SQL Express 2005 or, better yet, 2008?
May 29, 2010 at 7:40 UTC
Thanks for the links Pobblebonk aka Mat. I will read those over the weekend and see if they help.
Scott, I am unsure if I can upgrade. I will have to check with the vendor of the software that uses the MSDE.
Hope you both have a great weekend!
May 29, 2010 at 9:25 UTC
Niagara Technology Group (NTG) is an IT service provider.
SQL Express is just a rename of MSDE, so it's not a product change, just a new version. MSDE = SQL Server 2000 Express (but that name was never used.) The later versions are faster and have higher limits on the free version so they are better choices whenever the application supports them.
Jun 2, 2010 at 12:32 UTC
Thanks to both of you. The long weekend delayed my reply. I have not upgraded to either of the other versions of SQL server. Since attempting the upgrade to SP4, the errors that necessitated the install of SP4 have dissappeared. I am crossing my fingers.
Jun 2, 2010 at 4:08 UTC
Niagara Technology Group (NTG) is an IT service provider.
Well then "good enough" I say ;)
This discussion has been inactive for over a year.
You may get a better answer to your question by starting a new discussion.


text: A perfect choice for families! Set in the tranquil coastal village of Sanur amidst beautifully landscaped gardens this resort offers spacious 1 to 3 bedroom family apartments furnished in a blend of traditional and modern Balinese style and the best in Balinese hospitality. Fantastic facilities are available on site including Camp Splash! for the children and a free shuttle service operates between the resort and the sister Sanur Paradise Plaza Hotel shopping areas and the beach. Adult recreational choices are first class including outdoor pool with pool terrace and bar table tennis gym and The Spa with a range of traditional Balinese massage treatments to soothe body and soul. All day supervised activities are available for the children at Camp Splash!. They will love the dedicated pool with 30 metre waterslide gaming arcade kids beauty salon arts & crafts activities Sharkies Caf with its big screen movies and the playground with climbing structures and adults will love the break! All 1 to 3 bedroom airconditioned suites are well finished in a Balinese style with local fabrics and offer garden or pool views. Each boasts a spacious lounge area fullyequipped kitchen and all modern amenities. For dining enjoy Kids Menus at the Sharkies Caf alfresco dining and live Sunday night music at the Terrace Restaurant & Bar and cocktails and cook your own BBQ fare poolside.


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Click to Watch in HD > Christmas Gift For Kids -Top 20 Christmas Gifts for Kids In 2016
Watch Christmas Gift For Kids Best Christmas Gifts for Kids In 2016 With Christmas just around the corner, we're starting to feel a little bit festive here at Life Unexpected. Our Christmas family traditions are in full swing and we are gearing up, and wrapping up, for this big family occasion. The hot topic on everyones agenda at the moment, is what do I buy for my loved ones? Well, I think we might just be able to help you out with that! If you follow Life Unexpected, you'll know we are huge supporters of Mums who have, or are starting their own businesses – *waves Mumpreneur flag*. Therefore, it seemed so fitting to put together a select gift guide, curated from one of our absolute favourite websites and supporters of all things made by mums – All By Mama. Want to support fellow mums this Christmas? Then check out these beautiful handmade gifts, all made by mums! Oh…and how about 10% off today so you can get all your shopping done with a gorgeous little discount? From personalised letter crayons, to educational flashcards, and beautiful beaded bracelets, we are literally spoiled for choice with gifts to fit in those stockings. Personalised Hanger – We adore this Personalised Hanger that displays your kids artwork. We are definitely getting one of our own to hang as a feature piece on our daughters bedroom wall. Personalised Crayons – Does your child love drawing? Spell out any name or phrase with these personalised crayons or even just buy the alphabet, to get them learning letters while they create their next masterpiece. Gorgeous Bracelet – JewelBox Cornwall is one of our favourite jewellery brands. We were lucky enough to interview the mama behind the beads this year and to review some of her jewellery. These beads are perfect for any little princess and some even come with matching necklaces. Mama-made quality for sure. Alphabet Flash Card – I'm just starting out trying to teach my toddler letter formations. We love that these flashcards have both the capital and small letters, to help them recognise both. Personalised Wooden Toys There is something so enchanting about wooden toys, isn't there? They have such timeless appeal, at the same time as being so durable. Although all made by the same Mum, we found it so hard to choose just one of these toys to feature, so decided to give them a section to themselves. Mama Abbey runs The Laser Boutique. She takes wooden toys to the next level, by completely personalising them and creating a timeless, yet very stylish appeal for your children to enjoy. Listed below, and featured above, are a few of our favourites. Solar System Egg Board – Watch out, here comes the personalised wooden train set, coming speedily around our Christmas tree! I wish our first train set was as adorable as this Fairy themed one. First Roadway Set – Simple, yet stylish is one way to put it. This cute personalised set can teach your kids road rules. Perhaps allow them to develop their own rules of the road too. Easy to put together and easy to tidy up, sounds good to me. Solar System Egg Board – Okay, this board is too cool not to feature. To be honest I want one of these personalised boards for myself! They offer the perfect way to eat your breakfast and teach your child about the solar system. Play Cheese Board – This cheese board couldn't get more real, all it needs is some quince and we're good to go. This can be used during role play on many occasions. I absolutely love this item, it's just so original! Beautiful Fabric Gifts One thing I've always wanted to do, is be able to use a sewing machine, especially to sew my child amazing gifts for Christmas. How talented are the Mamas who have sewn these beautiful items together? For soft play dates and comfy wears, these Christmas gifts are just perfect. watch also:How to Crochet a Christmas Tree- Tutorial HD 2016 https://www.youtube.com/watch?v=bzv-NKL8rTo
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text: That NSA wiretap story appears to have conservatives somewhat divided. Hyperventilating over at the Washington Times is Bruce Fein, who has concluded, ridiculously, that "President Bush presents a clear and present danger to the rule of law," and who can't resist the rote incantation of the Supreme Court's ruling on Harry Truman's seizure of the nation's steel mills in 1952. At the Washington Post, George Will makes a respectable (though somewhat Panglossian) political argument that the president should have asked for explicit authority from Congress for the wiretaps. On the legal questions, he is is casual and conclusory. For a better constitutional argument, also at today's Post, see William Kristol and Gary Schmitt. Better still, on the constitutional issue, is today's unsigned Wall Street Journal editorial. But the prizes for best political and legal analysis, respectively, go to NRO's own Byron York and James Robbins, who explained it all yesterday (and Byron is back at it today). If Will and Fein in particular had read Robbins first, they might not have joined the chorus blithely proclaiming that President Bush has violated the Foreign Intelligence Surveillance Act. (Will: the president's wiretap authorization "contravened a statute's clear language." Fein: "the eavesdropping clashes with" FISA.) He hasn't, and Robbins has the goods on that bogus argument.


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Sorry but my camera sucks a little bit... it makes me look kinda scary but i'm not that scary in real life i tell you, lol
Anyway ignore my face and focus on the haircut
Most Helpful Girl
It could be like a 8/9, but that depends on if you're planing to always leave it like that or if you're gonna mix it up with gel or wax :300|00|0
oh... thanks for your grade. no i like to leave it like that, i won't change it as long as i like it. i just want to see other people's grades :-)


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Tough At Home
LeBron James led an overachieving Cleveland Cavaliers team to the NBA Finals last season, but the Cavaliers remained a few key role players shy of capturing their first championship. Devin Brown could prove to be one of those players.
James and Brown look to help the reigning Eastern Conference champions to their first back-to-back wins of the season when the Cavaliers visit the Los Angeles Clippers on Sunday.
Oddsmakers from Bodog have made Cleveland -1.5 point spread favorites (NBA Odds) for todays game, the over/under has been set at 195 total points (Matchup). Our public betting information shows that 58% of bets for this game have been placed on Los Angeles +1.5 (View NBA Bet Percentages).
Brown, who played for four teams in his first five seasons, joined his fifth team when he signed with the Cavaliers about a month before the season opener. He wasn't productive in the first five games, but contributed 20 points and a career-high 11 rebounds off the bench as Cleveland (3-3) beat Sacramento 93-91 on Friday.
"I wasn't playing hard, and wasn't doing anything to help the team," said Brown, who averaged a career-high 11.6 points in 58 games with New Orleans in 2006-07. "I worked tonight and kept working to get shots, just letting my teammates know I'm ready.
"I'll do whatever it takes to help this team win. I let (coach) Mike Brown know, when you call on me, I'll be ready."
Coach Brown recognized his new reserve's efforts Friday after his club narrowly avoided a loss in the fourth game of a six-game road trip against Western Conference teams.
"The guy that stands out to me was Devin Brown," he told the Cavaliers' official Web site. "I thought his gritty play was terrific."
While Brown's performance was a pleasant surprise, James delivered another solid line with 26 points, four rebounds and four assists. He had eight points in the final three minutes to help the Cavs secure the victory.
"You've just got to seize the moment," James said. "For the first three quarters, I didn't force anything. I like to just take what the offense gives me, and I make plays happen. In the fourth, I was able to get some rebounds and force the issue more, and it turned into good things. The team did a great job feeding off me."
On Sunday, the Cavaliers face tougher competition in the Clippers (4-1), who are coming off a blowout loss after putting together their first 4-0 start since 1985-86.
Los Angeles was outplayed in nearly every facet of the game Friday and fell 103-79 at Detroit. The Clippers shot 35.1 percent to the Pistons' 48.3, had 12 assists to the Pistons' 27 and were outrebounded 53-33.
"They controlled the glass and the tempo of the game and shot the ball really well," Los Angeles coach Mike Dunleavy said. "We didn't have guys make shots."
Despite the Clippers' overall poor game, center Chris Kaman had another strong effort as he continued to pick up the slack in the absence of injured forward Elton Brand. Kaman led the Clippers with 25 points and seven rebounds, and is averaging 18.4 points and 14.6 boards while shooting 52.9 percent - all career highs.
Brand, the team's leading scorer in each of the last three seasons, will miss the first several months after undergoing surgery to repair a ruptured Achilles' tendon.
The Clippers had won their previous three home games against the Cavaliers, but were swept in the two-game season series in 2006-07, which included a 104-92 defeat at Staples Center on Jan. 13. Cleveland pulled the sweep even though James averaged just 19.5 points on 38.9 percent shooting in those games.
By: Marc Young - theSpread.com - Email Us
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text: THE STARTER REPORTED:a) GADGET MAN (G Behr) which was restless in the stalls, jumped awkwardly outwards and made contact with JACK BLACK (L Africa).THE STIPENDIARY STEWARDS REPORTED: (CvA) a) The Off time was rescheduled due to the delay in Race 2.b) IMPERIAL CAPTAIN (D Ashby) refused to parade and proceed to the start, dislodged the rider and was led to the start by a lead pony. Trainer Mrs C Bass-Robinson will be advised that should this gelding behave in a similar manner in its future engagement it may be suspended.c) In view of the performance from PERGOLA (R Fourie) (6.85 lengths, betting 7/2), which was hanging out and tired quickly in the latter stages, the Veterinary Surgeon was requested to examine the gelding on its return to the unsaddling enclosure and submit a report.d) Jockey O Noach (BLACK PIMPINEL) reported that he felt something amiss with this gelding in running. The Veterinary Surgeon was requested to examine the gelding on its return to the unsaddling enclosure and submit a report.e) GADGET MAN (G Behr) was hanging out from the 300m.f) LOADSHEDDER (A Domeyer), the winner, was selected for the taking of specimens for analysis. Trainer W A Nel was advised. (SN)JOCKEY AND/OR EQUIPMENT CHANGES:a) PERGOLA (R Fourie) raced fitted with a full set of alumites. (declared 11 January 2017 / 07h51)RACE CARD CHANGES / OTHER:a) TRIPPLE EXPLOSION (J Jordaan) rode plus ½ kg (60,9kg).THE VETERINARY SURGEON REPORTED:a) PERGOLA (R Fourie) returned fatigued.b) BLACK PIMPINEL (O Noach) returned coughing.THERE WERE NO SCRATCHINGS