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DTFAA August – Saturday Jam Session Part 3 – Other news…
It's August now, and things have been great since the last time I posted. Gigs have been solid, working with my homie Mark B locally at various venues, and working with Alex Falk on tracks. DTFAA July went well, and here in a couple days, we've got the second 2011 edition of Don't Techno For An Answer, featuring a couple South Carolinians, Klaws and Konstantin. For those of you in Knoxville, give it a peep this Saturday, 8/20. I'll be playing alongside Alex Falk.
Grey People invited me to Unify in Nashville last weekend. It was a six-room party, with a mix of genres, and went exceptionally well. GP hooked it up with a 2-hour timeslot, which was perfect. Had a killer set for a lot of new faces. We kept the room dancing all night, with a steady flow of people streaming through for bathrooms/drinks, only to get stuck wiggling it on the dancefloor. Apparently we made such an impression that Nashville Scene mentioned our names and room as a highlight of the night.
Next weekend (8/27) I'll be in Atlanta for Archaic Revival. It's primarily a psy-trance party, as far as the main room goes, but we intend on holding it down proper in the techno room, and expecting a load of our friends to attend. Alex Falk and Greg Alan are also on the bill with me, and it'll be going into the late hours, so I doubt we'll be leaving until sometime around sunrise. I love those gigs. Each of us are slated for two hour slots. Expect great things.
Coming up in September, I'm bringing out Matt Wooddy aka Inferno of Heat Promotions from ATL. That's going to be DTFAA, September 17th. After that, Equinox at Deerfields in Asheville. 2-day campout with a variety of great music and artists including a bunch of the Tennessee Techno homies: Grey People, Piltdown Sound, Greg Alan, Mark B, and myself. Also worth checking on our "chillout" stage are Futexture and Perileyes during the daytime, and Paramnesia, whom we had play for us at Headroom when it was still kicking. Futexture has an all-original live set of dubby, downtempo electronica, and will definitely fit the daytime vibe of Deerfields. We booked him for the Kyle Geiger / Kilowatts double headliner event earlier this year, and I couldn't say better things. Do it.
Progress on Proper Trax 002 is going well, with most of the tracks confirmed and testers being sent to respected DJs and producers for feedback. Depending on how things go, you should expect a November release for the 12 inch. I've got some real kickers in store.
In the meantime, I should post Part Three of the Saturday Jam Session from way back in April! Its the final part of that epic mix session, and features a split of techno and house for over two hours of music. I'd drop something fresher for you, but unfortuantely I've had exceedingly bad luck with snagging a good live recording of the gigs. Always forgetting to switch to Line In, power goes out, rec out clips, or some other lameness. That's how it goes though.
Been lazy on the charts this month. Haven't got much new vinyl, but worth a mention is the Vanguard Sound, Vol. 1 available on Hakim Murphy's Machining Dreams imprint. Solid trax from DJ Spider, Amir Alexander, and others. Much love to the Vanguard Sound crew. Raw shit there.
Finally, here's the tracklist for the mix:
——–Techno Mode
1. Grey People – Lethal Response
2. Matador – Minit
3. Robotman – Never (DBX Mix)
4. DJ Hyperactive – Psyko Drum
5. Kyle Geiger – Grit
6. Cusp – Urantum
7. Errorsmith – Untitled A1
8. DBX – Spacetalk
9. The Funnel – Bootyjumper
10. Mike Dehnert – Fompage
11. Marcel Fengler – Thwack
12. Perc – Tension
13. Robert Hood – Obey
14. Peverelist – Infinity Is Now
15. Scuba – Klinik
16. Walt J – Reborn 1
17. Blue Maxx – Course
——–House Mode
18. Deniz Kurtel – Yeah
19. Darabi – Top Drop (Roman Flugel Remix)
20. Anthony Collins – Bruised Inside (Los Update Remix)
21. Deepchild – Statkind
22. Tom Flynn – Rhode Island
23. Walt J – Reborn (DJ Qu Remix)
24. Maya Jane Coles – Don't Tell
25. Matthew Dear – Fred's Bells (Onur Ozer Remix)
26. Maetrik – Socom
27. Matt O'Brien – Into The Red
28. Losoul – The Lords Of Sanity
29. Adonis – No Way Back (Greg Wilson Edit)
30. Kink – E79
31. Nikola Gala – The Vandal
32. EC50 – Oh What A… (Alland Byallo Remix)
33. James Teej – I'm Human Now (Cassy Remix)
34. Leif – Designed With That In Mind (Martinez Remix)


text: I learned of Nobrow Press when I saw one of their 'books' in the shop at the Whitechapel Art Gallery, London. I use quotes because the publication in question, Rise and Fall, by the American Artist, Micah Lindberg, was a text-less accordion fold (or leporello), printed on both sides. I wrote about it when discussing Holiday Books on November 6, 2012. I was struck by the quality of the printing, as well as the format, both of which were closer to a fine art print than to a traditional book. From an e-mail correspondence I learned that the press used ... More » »

subset: commoncrawl


text:
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The Factor Road Shoes by Giro provide the ultimate blend of fit, weight and power transfer.
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|Assistant Coach
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Nick Bradford is entering his second year as an assistant coach with the Missouri Southern men's basketball team. He will be primarily responsible for coaching the post players for the Lions.
In his first season with the Lions, Southern went 25-6, and won the 2014 MIAA Tournament Championship. The team advanced to the NCAA Tournament and finished the season in the round of 32 against eventual National Champion Central Missouri. Post players Jordan Talbert and Slim Magee were both named to the MIAA All-Defensive Team and Magee was named the MIAA Tournament Most Outstanding Player. Magee also set the MSSU single-season record for blocks.
Bradford came to Southern after two seasons as an assistant coach at Labette Community College in Parsons, Kan. Bradford helped lead Labette to back-to- back winning seasons and back-to-back 10-win conference seasons. In 2012-13, he helped the Cards to a third place Jayhawk Eastern division finish, the highest finish for any Labette men's basketball program in over two decades. Bradford helped recruit and develop three All-Jayhawk Conference players, two All-Region VI performers, and has helped send seven players to four-year institutions in just two seasons.
During his time at Labette, Bradford was also the head assistant coach for the Kansas City Run GMC AAU basketball organization. With Run GMC, he helped coach and develop numerous division I basketball players including Dominique Collier and Tory Miller (Colorado), Travis Jorgenson (Georgia Tech) and Conner Frankamp (Kansas).
Bradford came to Labette after completing an
eight-year professional basketball career both in Europe and in the
states. After graduating from Kansas, he played for the 2002 ABA
champion Kansas City Knights before going overseas for the rest of
his career. He had playing stops in France, Iceland, Finland,
England and Romania. Some of his honors in Europe include the 2005
MVP of the finals in Iceland, the 2008 All-Import Team in France
and 2009 Import Player of the Year in Iceland.
A 2000 graduate of the University of Kansas, Bradford was a college teammate of current Lions' Head Coach Jeff Boschee, playing for coach Roy Williams. A four-year letterwinner at Kansas, Bradford was a team captain in 2000 and was given the Phog Allen MVP award that year, as well. He helped the team to three-straight Big 12 titles from 97-99 and was an All-Big 12 selection his senior season.
A native of Fayetteville, Ark., Bradford was a Parade All-American at Fayetteville High School. He earned his bachelor degree of general studies in African & African-American studies from the University of Kansas and is married to the former Brittani Bond. Nick and Brittani have a son, Quenci (8) and Nick has another son, Isaiah (3).


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Sebastian Vettel says his 0.6s advantage over Nico Rosberg in qualifying for the Brazilian GP was a "big surprise"...
Sebastian Vettel says his 0.6s advantage over Nico Rosberg in qualifying for the Brazilian GP was a "big surprise."
The four-time World Champion arrived at the Interlagos circuit for this weekend's Brazilian Grand Prix seeking an unprecedented ninth straight victory in one season.
And the German took a massive step towards that with his ninth pole position of the campaign.
Following a 40-minute delay caused by the bad weather, the drivers ventured out on the wet tyres only to pit for intermediates.
With Pirelli's green-walled tyres onboard, Vettel posted a 1:26.479 which put him a massive 1.1s up on his team-mate Mark Webber, who had been holding down second place at the time.
Vettel was unable to improve on his second flying lap but wasn't far off while Nico Rosberg did improve on his to take second, 0.623s behind Vettel.
"A big surprise," said the Red Bull racer when asked about the gap to second, "I was so happy after qualy especially Q3 where it took a long time for us to get out.
"When we got out and I was surprised how much of the water had gone and went straight onto the intermediates.
"I got a good lap straight away and then I tried again on the second to beat that and was very close so I'm happy with both my laps.
"I was surprised by the margin and when I was told I was very happy.
"It's great in these conditions to get it all right, we had very little practice but still got the car where we wanted it to be."
The German also spoke out in support of the decision to delay the start of Q3 as the standing water on the track was too dangerous for the drivers.
"There was a lot of rain after Q2 - already at the end of Q2 - so we needed to wait if there is too much water on the track," he said.
"It's a shame for people who come out but there was too much water and the risk of aquaplaning was too high."
Related Links
Vettel Secures Brazilian Grand Prix Pole
Qualifying Day At Interlagos


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Welcome to THE EXPERIENCE
XpressWest allows passengers to bypass traffic, traveling at speeds of up to 150 mph non-stop to and from Las Vegas in approximately 80 minutes compared to an average highway drive time of approximately 4 hours. Driving on I-15 can take several more hours during peak times, and longer with any accidents or other delays. XpressWest alleviates congestion on the I-15, providing a better, cleaner, safer, and faster alternative to driving, and an unparalleled transportation EXPERIENCE.
Because visitor trends and demographics clearly indicate the "Las Vegas EXPERIENCE" cannot start early enough, XpressWest will be more than just a mode of travel. It will extend the Las Vegas EXPERIENCE through innovative concepts such as hotel check-in services, dinner and show reservations, and multiple entertainment options all on board the train.
XpressWest will welcome America to our country's first High Speed passenger EXPERIENCE. From the moment you arrive at the station the EXPERIENCE is designed to deliver convenience and Las Vegas EXCITEMENT. Every train is designed with state of the art amenities featuring all first and business class seating, and specially designed full-service entertainment club cars. Food, beverage, wifi, entertainment, concierge services, flexible club seating arrangements, and full handicap accessibility are just a few of the amenities available on every journey. Passengers will EXPERIENCE the most advanced high speed stations built anywhere in the world and designed to provide secure, yet barrier free arrivals and departures. Stations feature secure, covered parking, courtesy door to door baggage handling, a variety of dining and retail amenities; and complete intermodal transportation options.
With the environmental review process complete, all required federal right-of-way approvals in place, and having received the necessary licensing and approvals to construct and operate, XpressWest will provide a foundation for high speed rail infrastructure in the Southwest Corridor. High speed rail represents the future of sustainable, green, high capacity and efficient transportation in the United States. Through private sector investment, XpressWest meets America's need for passenger rail infrastructure with a system that promises interoperability and regional connectivity.
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Flute Magic - An Introduction to the Native American Flute (Third Edition). By Tim R. Crawford. Edited by Dr. Kathleen Joyce-Grendahl. For Flute. Methods. Native American. Beginning. Book. 176 pages. Published by Mel Bay Publications, Inc (MB.99190). ISBN 9780786658169. Native American. 8.75x11.75 inches. This book contains 20 chapters addressing everything from the origin and design of the Native American flute to a method for learning to play the instrument and read its music. Together with the fingering exercises presented in eight lessons, a number of tunes are included for both the five and six-hole Native American flute. Old standards, indigenous music, and original compositions are presented, meeting the needs of beginning to advanced players. This useful and practical guide to the Native American flute is suitable for either individual or classroom instruction.
Pages: 176
Instruments: Flute, Woodwinds
Genres: Americana, Native American, Folk, World
Irish Session Tunes - The Green Book (100 Irish Dance Tunes and Airs). Edited by Geraldine Cotter. For Flute, Tin Whistle, or Bagpipe. Music Sales America. Irish, Folk, Celtic. Book only. 64 pages. Ossian Publications #OMB141. Published by Ossian Publications (HL.14016244). ISBN 1900428563. Irish, Folk, Celtic. 8.25x12 inches. This series contains over 100 Irish dance tunes and airs in each volume. The collections contain a varied selection of widely played and lesser-known tunes, divided into different dance rhythms, and then sorted into sets of similar tunes to be played at Irish sessions. The range of the tunes are particularly suitable for the fiddle, but can be used on other instruments.The "green book" includes jigs, reels, hornpipes, set dances, slow airs and more, in simple form for musicians of all levels. Ideal for the pennywhistle, tinwhistle, flute or pipes. Songs include: Dan the Cobbler • Open the Door • Miss Monaghan • Dunphy's • The Orange Rogue • Anach Cuain • and many more.
Pages: 64
Instruments: Flute, Bagpipe, Tin Whistle, Woodwinds, Folk
Genres: Celtic, Folk, Irish, St. Patrick's Day, World, Celebrations
Concierto Pastoral (1977). (Flute and Piano). By Joaquin Rodrigo (1901-1999). Schott. Piano Reduction with Solo Part. 93 pages. Schott Music #ED11489. Published by Schott Music (HL.49002841). Contents: Allegro • Adagio • Rondó.
Pages: 93
Instruments: Piano, Flute, Piano and Keyboard, Woodwinds
Genres: 20th Century, Spanish, Classical, World
The Celtic Fake Book - C Edition. (C Edition). By Various. For voice and C instrument. Hal Leonard Fake Books. Celtic. Difficulty: easy-medium. Fakebook (leadsheet notation). Vocal melody, lyrics, leadsheet notation and chord names. 256 pages. Published by Hal Leonard (HL.240153). ISBN 0634017276. With vocal melody, lyrics, leadsheet notation and chord names. Celtic. 9x12 inches. The popularity of Celtic music has soared over the last decade due to the resurgence of folk instruments, Celtic dancing, and Irish culture overall. This amazing collection assembles over 400 songs from Ireland, Scotland and Wales - complete with Gaelic lyrics where applicable - and a pronunciation guide. Titles include: Across the Western Ocean * Along with My Love I'll Go * Altar Isle O' the Sea * Auld Lang Syne * Avondale * The Band Played On * Barbara Allen * Blessing of the Road * The Blue Bells of Scotland * The Bonniest Lass * A Bunch of Thyme * The Chanty That Beguiled the Witch * Columbus Was an Irishman * Danny Boy * Duffy's Blunders * Erin! Oh Erin! * Father Murphy * Finnegan's Wake * The Galway Piper * The Girl I Left Behind Me * Has Anybody Here Seen Kelly * I Know Where I'm Goin' * Irish Rover * Loch Lomond * Molly Malone * My Bonnie Lies Over the Ocean * My Wild Irish Rose * The Shores of Amerikay * The Sons of Liberty * That's an Irish Lullaby * When Irish Eyes Are Smiling * Who Threw the Overalls in Mistress Murphy's Chowder * and hundreds more. Also includes many Irish popular songs as a bonus. About Hal Leonard Fake Books A "fake book" contains songs written in a concise format that includes only the melody and chords, letting you interpret the song's performance as you feel is appropriate. This is great for quickly learning songs by yourself or with an ensemble. Each song in a fake book only has a single melody actually written out in notes, which is usually the vocal or lead melody. This melody will have the lyrics written beneath the notes, with each word aligned to its corresponding note. Above the notes of the melody will appear the names of the appropriate chords to play - for example, a "C minor" chord would be written as "Cmin" or Cm", rather than writing out all of the notes in those chords as they appeared in the original version of the song. This format is very compact, which is why you will often see fakebooks containing 500 or more songs.
Pages: 256
Instruments: Piano, Guitar, Voice, Piccolo, Oboe, Recorder, Violin, Piano and Keyboard, Vocal, Flute, Woodwinds, Strings
Genres: Celtic, St. Patrick's Day, World, Celebrations
15 Norwegian Dances and Folk Songs by Edvard Grieg (1843-1907). Edited by Gwilym Beechey. For soprano recorder and piano. This edition: ED 12293. Recorder Music. Grade 3. 36 pages. Published by Schott Music (SD.49030343). ISBN 9790220114830.
Pages: 36
Instruments: Piano Accompaniment, Soprano Recorder, Piano, Piano and Keyboard, Recorder, Woodwinds
Genres: Folk Songs, Scandinavian, Folk, World
Irish Tune from County Derry & Shepherd's Hey (Set for Military Band). By Percy Aldridge Grainger (1882-1961). Arranged by Cecil J. Sharp. Concert Band. For Piano, Piccolo, Flute I, Flute II, Oboe I, Oboe II, Clarinet I, Clarinet II, Clarinet III, Clarinet IV, Alto Clarinet, Bass Clarinet, Bassoon I, Bassoon II, Alto Saxophone I, Alto Saxophone II, Tenor Saxophone, Baritone Saxophone, Bass Saxophone, Trumpet . This edition: The only modern edition approved by the composer. Carl Fischer Classic Band Editions. Score and Set of Parts. Standard notation. 13 pages. Published by Carl Fischer (CF.J240). ISBN 0825834155. With Standard notation.
Pages: 13
Instruments: Piano, Piccolo, Bass Clarinet, Oboe, Alto Saxophone, Baritone Saxophone, Tenor Saxophone, Bassoon, B-Flat Trumpet, Piano and Keyboard, Flute, Woodwinds, Clarinet, Saxophone, Trumpet, Brass
Genres: 20th Century, Irish, St. Patrick's Day, Classical, World, Celebrations
March Past of the Kitchen Utensils (from "The Wasps"). By Ralph Vaughan Williams (1872-1958). Arranged by Herbert Hersom. For recorders (SAT), percussion and piano; Glockenspiel and xylophone ad lib.. This edition: ED 10995. Recorder Music. Score and parts. 24 pages. Published by Schott Music (SD.49002613). ISBN 9790220107214.
Pages: 24
Instruments: Piano Accompaniment, Recorder, Percussion, Xylophone, Glockenspiel, Piano, Piano and Keyboard, Woodwinds
Genres: 20th Century, British, Classical, World
The Jewish Fake Book arranged by Velvel Pasternak. For voice and C instrument. Tara Books. Jewish. Difficulty: medium. Fakebook. Vocal melody, lyrics and chord names. 184 pages. Tara Publications #CLVPA01B. Published by Tara Publications (HL.330350). ISBN 0933676697. With vocal melody, lyrics and chord names. Jewish. 9x12 inches. The definitive Jewish music fake book! 212 songs for every possible occasion, selected by the world's foremost authority on Jewish music. Includes music for weddings, bar/bat mitzvahs, parties, and holidays in all music styles: Klezmer, Israeli, Dance, Yiddish, Sephardic, Hassidic, and more. Everything the professional musician will need for any Jewish event. Includes an alphabetical and category index. Songs include: Adir Hu * Adon Olam * Am Yisrael Chai, Az Der Rebbe Zingt * Bashana Haba'a * Chad Gadya * Choson Kale Mazel Tov * Dayenu * Di Grine Kuzine * Dodi Li * Donna Donna * Eliyahu Hanavi * Freylechs * Hal'lya * Hunkah Blessings * Hatikva * I Have a Little Dreydl * Jerusalem Is Mine * Kol Nidre * Light One Candle * Ma'oz Tsur * Miserlou * Od Lo Ahavti Dai * Oifn Pripitchik * Papirosn * Rumania * S'vivon * Shalen Alechem * Sher * Siman Tov * Tsena Tsena * Ufaratsta * Wedding March * Yidn * Yossel Yossel * Zemer Atik * and many more!
Pages: 184
Instruments: Piano, Guitar, Voice, Piccolo, Oboe, Recorder, Violin, Piano and Keyboard, Vocal, Flute, Woodwinds, Strings
Genres: Jewish, World
2 Pieces from El Amor Brujo. (for Clarinet and Piano). By Manuel de Falla (1876-1946). For Clarinet. Music Sales America. Classical. Book only. 14 pages. Chester Music #CH55563. Published by Chester Music (HL.14010945). Two pieces from El Amor Brujo written in 1915 by Manuel de Falla arranged for clarinet and piano by Charles Schiff.
Pages: 14
Instruments: Piano, Clarinet, Piano and Keyboard, Woodwinds
Genres: Classical, 20th Century, Argentinian, Spanish, Latin, World
Zigeunerweisen, Op. 20 (Gypsy Airs) (Gypsy Airs: for Clarinet in Bb and Piano). By Pablo de Sarasate (1844-1908). Edited by Kalmen Opperman. For Clarinet, Piano. Kalmen Opperman Repertoire Edition. Classical. Solo part with piano reduction. Standard notation. 16 pages. Published by Carl Fischer (CF.W2538). ISBN 0825833388. With Standard notation. classical.
Pages: 16
Instruments: Piano, Clarinet, Piano and Keyboard, Woodwinds
Genres: Classical, Spanish, World
Irish Tune from County Derry & Shepherd's Hey. (Conductor's Score). By Percy Aldridge Grainger (1882-1961). Concert Band. For Piano, Piccolo, Flute I, Flute II, Oboe I, Oboe II, Clarinet (in Eb), Clarinet I, Clarinet II, Clarinet III, Clarinet IV, Alto Clarinet, Bass Clarinet, Bassoon I, Bassoon II, Alto Saxophone I, Alto Saxophone II, Tenor Saxophone, Baritone Saxophone, Bass S. Carl Fischer Classic Band Editions. Score. Standard notation. 13 pages. Duration 3 minutes, 30 seconds. Published by Carl Fischer (CF.J240S). ISBN 0825823242. With Standard notation.
Pages: 13
Instruments: Piano, Piccolo, Bass Clarinet, Oboe, Alto Saxophone, Baritone Saxophone, Tenor Saxophone, Bassoon, Piano and Keyboard, Flute, Woodwinds, Clarinet, Saxophone
Genres: 20th Century, Irish, St. Patrick's Day, Classical, World, Celebrations
Bagpipers by Bela Bartok (1881-1945). For oboe / piano. Score & part. Published by Masters Music Publications Inc. (MT.M1805-SET).
Instruments: Piano, Oboe, Bagpipe, Piano and Keyboard, Woodwinds
Genres: 20th Century, Hungarian, Classical, World
Irish Tunes for Pennywhistle & Flutes by Dennis W. Ritz. For Pennywhistle, Piccolo, 2 Flutes, Alto Flute, Bass Flute. Intermediate. Standard notation. 28 pages. Published by Falls House Press (PR.FCDR1). With Standard notation. Falls House Press brings us a lovely collection of traditional Irish tunes arranged for pennywhistle and flute choir by Shippensburg University Professor of Music Dennis Ritz. Ritz has updated these tunes with the addition of contemporary harmonies, rhythms, and accompaniment patterns, and the arrangements lend themselves to several interpretations and choices of instruments. The book contains nine songs in all, including favorites like "The Girls from Farranfore," "Hanley's Tweed," and "The Red Haired Boy.".
Pages: 28
Instruments: Piccolo, Tin Whistle, Flute, Woodwinds, Folk
Genres: Irish, St. Patrick's Day, World, Celebrations
Sonata in g-minor by Arcangelo Corelli (1653-1713). For alto saxophone and piano (organ). Swiss import. Grade 3+. Score and parts. Published by Editions Marc Reift (MA.EMR-2070E).
Instruments: Piano Accompaniment, Organ, Alto Saxophone, Piano, Piano and Keyboard, Saxophone, Woodwinds
Genres: Classical, Baroque Period, Italian, World
(for Tenor Recorder and B.C.). By Arcangelo Corelli (1653-1713). Originalmusik fur Blockflote (Recorder Library). 34 pages. Schott Music #OFB121. Published by Schott Music
Pages: 34
Instruments: Recorder, Woodwinds
Genres: Classical, Baroque Period, Italian, World
Russian Dance. (Danse russe = Russischer Tanz). By Oskar Bohme. For clarinet and piano. Swiss import. Grade 4+. Score and parts. Published by Editions Marc Reift (MA.EMR-2213).
Instruments: Piano Accompaniment, Clarinet, Piano, Piano and Keyboard, Woodwinds
Genres: Russian, World
From the British Isles (8 Folksongs). Edited by Michael Maxwell. For treble recorder and guitar. This edition: ED 10811. Recorder Music. Playing score. 16 pages. Published by Schott Music (SD.49014206). ISBN 9790220105159.
Pages: 16
Instruments: Guitar, Alto Recorder, Recorder, Woodwinds
Genres: British, Folk Songs, World, Folk
Two Russian Folk Tunes by Anatolij Konstantinowitsch Ljadow. For soprano recorder and piano (soprano recorder). This edition: ED 10935-01. Other Music. Individual part. Published by Schott Music (SD.49029662). ISBN 9790220128707.
Instruments: Piano Accompaniment, Soprano Recorder, Piano, Piano and Keyboard, Recorder, Woodwinds
Genres: Folk Songs, Russian, Folk, World
(Flute and Piano). By Tomaso Giovanni Albinoni (1671-1751). Edited by Henrich Lesk
Pages: 8
Instruments: Piano, Flute, Piano and Keyboard, Woodwinds
Genres: Classical, 20th Century, Italian, World
Big Jig. (An Irish Radio-Fantasy). By Thierry Besancon. For wind band (piccolo, 2 flutes, 2 oboes, english horn, 2 bassoons, contrabassoon, Eb clarinet, 3 Bb clarinets, bass clarinet, 2 alto sax, tenor sax, bariton sax, 6 horns, 6 trumpets, 2 trombones, bass trombone, 2 euphoniums, 2 tubas, 4 celli, contrabass, harp, piano, ). Contemporary. Parts. Composed 2007. Duration 13'. Published by Editions BIM (ET.OV5C).
Instruments: Piano, Flute, B-Flat Clarinet, Bass Clarinet, E-Flat Clarinet, Oboe, Alto Saxophone, Tenor Saxophone, Bassoon, English Horn, Double Bass, Harp, B-Flat Trumpet, Bass Trombone, Euphonium, Tuba, Piano and Keyboard, Woodwinds, Clarinet, Saxophone, Strings, Trumpet, Brass, Trombone
Genres: Irish, St. Patrick's Day, World, Celebrations
Le Bestiaire by Francis Poulenc (1899-1963). For voice, flute, clarinet, bassoon, string quartet. Songs. 20th Century; French. Score and set of parts. Text Language: French. Composed 1919. Published by Masters Music Publications Inc. (MT.M2595-SET). With Text Language: French. 20th Century; French.
Instruments: Voice, Flute, Clarinet, Bassoon, Violin, Cello, Viola, Vocal, Woodwinds, Strings
Genres: 20th Century, French, Classical, World
By Gyorgy Ligeti (1923-). For Soprano, Mezzo-Soprano Soli, SMezATB Choir -3(II&III=Piccolo).3(III=Oboe d'Caccia).3(any player=Eb clarinet,II=Bass clarinet,III=Contrabass clarinet).3(III=Contrabassoon)-4.4(IV=Bb trumpet).3.Contrabass tuba], 3 Percussion, Celeste, Harp, Harpsichord, Str. Modern, Choral. Full score. Composed Composed: 1963/65/97. Duration circa 27 minutes. Published by Edition Peters
Instruments: Choir, Piccolo, Bass Clarinet, E-Flat Clarinet, Oboe, Bassoon, Double Bass, Harp, B-Flat Trumpet, Percussion, Harpsichord, Tuba, Vocal, Flute, Woodwinds, Clarinet, Strings, Trumpet, Brass, Piano and Keyboard
Genres: 20th Century, Hungarian, Classical, World
Russian Christmas Music: English Horn by Alfred Reed (1921-2005). For Concert Band. Instructional. Part. 4 pages. Published by Alfred Music - Digital Sheet Music (AX.00-PC-0002379_E). The theme carefully explored by Alfred Reed in this repertoire standard is ""Carol of the Little Russian Children" which is an ancient Russian Christmas carol. You can hear four distinct sections originally called "Children's Carol," "Antiphonal Chant," "Village Song" and "Cathedral Chorus" all joined in this continuous contemporary setting. The almost overwhelming sound picture with varied tone colors and brilliant brass choir sounds is a classic in every sense. "Russian Christmas Music" by Alfred Reed is a worthy addition to the Belwin Classic Band series. This recording compliments of the United States Air Force Band, Col. Lowell Graham, conductor.List/syllabus: TX UIL PML: Band, Winds, Perc. About Digital Print Sheet Music Digital Print is printable sheet music available anytime, anywhere. Just purchase, print and play! View your online sheet music at home, school, work or anywhere you have a computer connected to the Internet. With Digital Print, you can print your digital sheet music immediately after purchase, or wait until its convenient. And our software installation is easy - we'll guide you through the simple steps to make sure you have Adobe Flash Player, Adobe AIR and the Sheet Music Plus AIR application. Learn more
Pages: 4
Instruments: English Horn, Woodwinds
Genres: Christmas, Russian, Miscellaneous, World
Celtic Air and Dance No. 2 - Eb Alto Saxophone arranged by Michael Sweeney. Concert Band. For Eb Alto Saxophone. Concert; Irish. Individual instrument part. 1 pages. Duration 2:50. Published by Hal Leonard - Digital Sheet Music (HX.119376). This item is the replacement part to the concert band set. It is not recommended to purchase this as a solo piece. About Digital Print Sheet Music Digital Print is printable sheet music available anytime, anywhere. Just purchase, print and play! View your online sheet music at home, school, work or anywhere you have a computer connected to the Internet. With Digital Print, you can print your digital sheet music immediately after purchase, or wait until its convenient. And our software installation is easy - we'll guide you through the simple steps to make sure you have Adobe Flash Player, Adobe AIR and the Sheet Music Plus AIR application. Learn more
Pages: 1
Instruments: Alto Saxophone, Saxophone, Woodwinds
Genres: Celtic, Irish, St. Patrick's Day, World, Celebrations


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State-ranked Wall used a relentless outside shooting attack here Tuesday to slowly wear down Sweetwater in the teamsŌĆÖ non-district boys basketball contest.
The Hawks hit seven treys to none for the Mustangs, and a 24-5 run in the middle two periods led to their decisive 68-44 win.
Wall and Sweetwater held all three boys games at the middle school gym due to water-related problems at the high school that forced school officials to cancel classes on Tuesday.
CLYDE ŌĆö Playing its first game since the Thanks-giving break, Sweetwater led Clyde 7-6 after the first quarter on Tuesday.
But a disastrous second quarter and cold shooting for the rest of the game were too much for the Lady Mustangs to overcome as Clyde ŌĆö which outscored Sweetwater 21-1 in the second period ŌĆö rolled to a convincing 45-19 victory.
A number of Nolan County high school teams are participating in three-day basketball tournaments starting Thursday.
SweetwaterŌĆÖs varsity boys and girls play at events in Coahoma and Ballinger, re-spectively, while Blackwell is hosting its annual Oak Creek Classic that also in-cludes the Roscoe boys and girls, and HighlandŌĆÖs teams will be at Bronte. Highland hosts its annual tournament next week.
Here are the tournament schedules:
(Sweetwater varsity boys)
10:30 a.m. ŌĆö Stanton vs. Midland High JV (Pool B)
The Sweetwater Goodfellows were started by four Rotarians in approximately 1929.┬ĀThe Goodfellows have gone through many changes over the years.┬Ā Today their mission is ŌĆ£to provide food and toys to needy families with children and food to needy individuals during the Christmas season.ŌĆØ┬Ā
Sweetwater Fire Chief Grant Madden stopped by Sweetwater Middle School on Friday, Nov. 18, 2011 as part of the Speaker's Bureau sponsored by SEED (Sweetwater Enterprise of Economic Development).
The Eighth Grade Career Investigations classes at SMS, taught by Irene Armstrong, learned about ways to approach and prepare for careers from Madden.
Trinity Baptist Church, located at 1506 Santa Fe in Sweetwater, will host a special DivorceCare class called "Surviving the Holidays." Classes will be held Tuesday, Dec. 6 and Tuesday., Dec. 13, both from 6-7:30 p.m. The class is free to anyone wishing to attend. For more information, call the church office at 325-235-2991.
DivorceCare groups meet weekly to help people face challenges of separation and divorce and move toward rebuilding their lives. Each DivorceCare session has two distinct elements:
The Sweetwater Police Department (SPD) received 47 calls for service, issued 10 citations and made one arrest on Nov. 28, 2011.
The SPD received 14, 911 calls.
ŌĆó 1100 block of E. Fourteenth.
Calls for service:
ŌĆó Criminal mischief ŌĆö 1400 block of Hoyt.
Arrested by SPD:
ŌĆó Devin Florres, 19 ŌĆö Assault.
The Nolan County Sheriff's Office (NCSO) had nine calls for service, served one civil paper and made eight arrests on Nov. 28, 2011.
Arrested by NCSO:
ŌĆó DeWhite Scott Wells, 24, of Snyder ŌĆö Warrant/surety withdrawal.
Arrested by DPS:
ROBY-Daphene ŌĆ£Gee GeeŌĆØ (Kinser) Moore, 89, died Sunday, Nov. 27, 2011, at Cogdell Memorial Hospital in Snyder.┬ĀServices will be held at 2 p.m. on Wednesday, Nov. 30, 2011, at the First Baptist Church in Roby.┬ĀBurial will follow at Roby Cemetery under the direction of Weathersbee-Ray Funeral Home. Visitation was held Tuesday evening from 5-6:30 p.m. at the funeral home.
Casey Joe Campbell, along with attorney John S. Young, pled guilty to online solicitation of a minor, a second degree felony, to Judge Glen Harrison during 32nd Judicial District Court proceedings on Monday, Nov. 28, 2011. District Attorney Ann Reed and Assistant District Attorney Barrett Thomas prosecuted the case.
Campbell was indicted in June 2011, on two counts of online solicitation of a minor, second and third degree felonies, enhanced to second and first degree felonies with a prior conviction. Count two was abandoned by the state.
Nolan County hosted its first of five public hearings Monday night in Roscoe to inform citizens about the needs of the county jail and some issues regarding repair to the outside of the courthouse.
Sheriff David Warren was on hand to make a presentation about the current conditions of the Nolan County jail and why he said he believes the county needs to build a new jail. His presentation included a slide show of pictures of the inside of the jail.


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Tackling a new recipe is hard enough without trying to wrangle unruly pages of a cookbook with food-covered hands. Enter the CookBook, an innovation from Joseph Joseph that props your cookbook within view as you measure, scoop, season, and stir. Holders keep pages in place (whether in a cookbook or printed out), while a nonslip foot ensures that even a tablet is safe from the perils of limited counter space.
Folds flat for easy storage. Nonslip foot at base of spine. Open: H 8.3" W 15" D 8.3" Closed: H 0.8" W 10.3" D 7.9".
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The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
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"5 Assessing the Effects of Diluted Bitumen on Pipelines."
TRB Special Report 311: Effects of Diluted Bitumen on Crude Oil Transmission Pipelines.
Washington, DC: The National Academies Press, 2013.
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Also you may want to check out Ben Heckendorns xbox 360 laptop.
Step 1: Gathering the tools and materials
Soldering iron
Electrical tape
Duct tape
Assorted screwdrivers
xbox 360 (Mine had the red rings)
LCD computer monitor (My dad got a broken one from work and I fixed it)
Now in case you don't have the money to buy a new xbox and monitor see if you can find an xbox with the red rings and a monitor that wont turn on. I fixed my monitor for about $5.00 and it works great (the problem was two bad capacitors).
could the "cold spots" on the inverter cause it to not work at all? if so, how can i tell and do you mean just resolder the inverter's solder points?
You can tell by looking at the inverter at the solder points and if it looks all dry and it would look kind of like this.
If your monitor is not turning on at all it is probably capacitors so I would look for bulges on the top of them. Like this one.
replying to a older post..
i just got this 17" monitor, and it will work fine just displaying basic stuff but once i start to play portal a random number of minutes in the screen will dim the bulbs and then turn them off. the monitor has no bad capacitors and the inverters have no cold spots, and it has done this with every computer except my laptop.
what do you suppose is wrong with it?
I found this link that might help you but I'm not totally sure what the problem is so I can't really explain how to fix it. I will do some research for you and let you know if I find anything else. Anyway here is the link,
I would try googling what the problem is and see if you can find any ideas on how to fix it.


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Belated Happy B'Day DDevil28! I'd rather this was your birthday than mine.
And, yes ... 40. Old Phart. LOL!!
Belated Happy B'Day DDevil28! I'd rather this was your birthday than mine.
And, yes ... 40. Old Phart. LOL!!
Happy Birthday Agua
Happy B-Day.
Reluctantly, I will join you old Pharts in "the club" in about 3 months. That sure is weird to say.
Wow we should get a group discount or something.
Meet MiniPhreak
October 2nd, 2003
have great one! not far behind with '65. aaaaa. hippie offspring....
It seems there is a different person every week that has a B-Day, and so far all of us are getting our wish.
The trend continues!
Seriously though,
Happy Birthday Aqua!
Heres to many more.......
:band: :band: :band: :band:
Happy belated birthday, dude.
Derogatory personal comments directed at other members are not allowed under the FinHeaven house rules. More members are suspended or outright banned for this than for any other violation. Please be cool so everyone can enjoy this site. When you see a violation, click the Alert triangle found at the lower left of each post. Thanks.:cool:


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Ok, I"ve done the search thing and can"t find exactly what I"m looking for so here"s the question...
I"m looking to build a replacement for my wimpy engine stand. It did fine for a small block and some sixes, but my next project is a 460 that will top 700 #s fully dressed. My stand will hold the weight but it"s a strain... and turning it is near impossible. Grease in the head end helped some but....
I want to build something with bearings in the "head" that can support the load and turn easily. I borrowed one once that the Nat Guard built for deisel engines and it was sweet. Bearings front and rear and it turned like a dream. bolt thru welded nut on top applied the brakes. Seriously heavy duty. I"ve heard of one built with the end pieces of truck/car rearends cut down (with the axle bearings in place) and using the axle for the center rod the engine mouting plate was welded to. Also heard of some using front car spindles or trailer spindles.
Anyone got any plans or pics of what I"m talking about. 700#s is a pretty good end load so it needs to be somewhat substantial... I"d rather have one that turned too easily and I had to adapt some braking than one that I can"t turn at all by myself (which is how I do most of my work).
tia and Merry Christmas to all of you here.
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12-25-2007, 07:21 AM #1Junior Member
- Join Date
- Sep 2005
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- 21
easy turn engine stand...bearings ???


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Cheddar Crisps. Recipe courtesy of Cabot.
Category Main Page
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Link to Other Sections:
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Food Fun, Home Zone
September 2006
Given the popularity of mozzarella sticks at restaurants, and the popularity of cheddar cheese everywhere, why aren't the two concepts combined? Cheddar has more punch than mozzarella, resulting in a cheesier cheese stick. Here's the crispy-coated, melted cheese result, compliments of Cabot® Cheese and their award-winning cheddar.
Makes 12 snack servings.
Recipe courtesy of Cabot Creamery and Chef Jon Ashton.
© Copyright 2005-2015 Lifestyle Direct, Inc. All rights reserved. Images are the copyright of their respective owners.


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I, like many hammered-dulcimer players I've met, have a bag full of hammers. However, I find that I only ever use one pair, a set of double-headed hammers (padded on one side, unpadded on the other). Is this typical, or am I missing out on some important aspect of playing by not varying my hammers? If I should be using more than the one set, what are the characteristics that matter most? Weight? Width of the striking surface? Something else?
Take the 2-minute tour ×
Music: Practice & Theory Stack Exchange is a question and answer site for musicians, students, and enthusiasts. It's 100% free, no registration required.
The ability to phrase your playing into an almost vocal-singing-like quality versus the ability to energize your playing into highlighting the percussive nature of your instrument, to me, is indeed an 'important aspect of playing' hammered-dulcimer. Long-flexible-light-soft-bouncy hammers affords vocal quality more readily, and short-stiff-heavy-hard-unpadded hammers brings out percussive quality more easily. the 'bag full of hammers' are useful for uncountably more subtle choices like long-and-stiff, heavy-but-really-padded, etc. Of course, choosing which hammers to use depends on the feel of the song.
Examples of vocal-like playing:
Examples of energy-percussive playing:


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by Adele
Released: Jan 2011
Label: XL Recordings/Columbia
Adele's shtick seems to be album titles that completely belie the old soul inside. 21 sounds like no 21-year-old. Adele spends most of her sophomore album dominating styles she has no business knowing how to sing so intuitively, from the rafters-shaking, revival-ready "Rolling in the Deep" to the big, brassy '70s rock of "I'll Be Waiting." Elsewhere, she croons weathered ballads that sound more lovelorn than someone so young should (see "Turning Tables," a "Chasing Pavements" redux down to the syllabic structure). Still, her rich, distinctive, well-aged vintage pop has serious legs: 21 sent Adele skyrocketing to the top of the charts.


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Home > Electronics > iPod & iPhone Accessories > iPhone & iPod Speakers > Crosley iDeco iPhone/iPod Stereo
Crosley iDeco iPhone/iPod Stereo
Listen to music off your iPhone® or iPod® in style.
Finally, a compact speaker system designed for your iPod® and iPhone® that produces amazing sound quality to match it's unique look.
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Slim line remote wirelessly controls the Crosley iDeco and your iPod devices. Includes remote control, PAR cable, and an AC adapter.
Dimensions: 6.75" L x 11" W x 6.75" H
Weight: 5 lbs.
iPhone and iPod are trademarks of Apple Inc., registered in the U.S. and other countries.
Crosley iDeco iPhone/iPod Stereo
Crosley iDeco iPhone/iPod Stereo
Our innovative products will provide you and your family with years of enjoyment. And with the Brookstone Protection Plus service and replacement plans, you'll have the added peace of mind knowing that if the unexpected does happen, we will simply repair or replace your covered product. Our enhanced coverage goes above and beyond the manufacturer's warranty, saving you time and money.
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anyone know the exact amount?
anyone know the exact amount?
Well, we have a start by knowing that the NFL salary cap will be $109mil.Originally Posted by BornSlippy
So if we only knew what players' salaries will go up next year, we can do the math.
If we go by how much their "amoritized" money is, which is evenly spread out throughout the contract term...then we have a certain amount to gauge.
Then we know that Traylor, Holiday, Zgonina, Vickerson, Spragan, Bowens, Adams, Newman, Maxwell, Radar, Jacox, Tillman, Bell, Jackson, Lehan, Welker, Vick, Lemon, Morris, Barnes, Minor, MacIntosh, Denney, and Jones all come off the books next year as FA's.
So basically we'll have:
Culpepper, Harrington, Brown, Williams, Chambers, Booker, Hagan, Mcmichael, Peele, Shelton, Carey, James, Hadnot, Mckinney, Toledo, Anderson, Alabi, Mare, Carter, Taylor, Wilkinson, Roth, Evans, R.Wright, M.Wright, Thomas, Crowder, Pope, W.Allen, J.Allen, Daniels, Goodman, Poole, and Hill will be under contract.
Aside from players' contracts and amoritized cap hits...some players have roster bonuses tied to their contracts. Of course roster bonuses and salaries can be partially or fully guaranteed depending on who the player is.
Also, we should have "exclusive rights" to Vickerson, Berger, and Vick which means if we re-sign them it can be for minimum contracts.
Booker is a player who's contract can be completely cleared by cutting/trading him. $4mil.
So he will be a prime player that can be bound to this being his last season.
if the cap is 109 then we would we 7 million under right now
don't how easily we could increase that
dumping Booker could bring us to 10
Man,i was just thinking about the team,and i can't figure out is much talent as we have on our team(i know we dont have superduper stars or anything)why the aren't clicking.There's enough playmakers there to be doing alot better than 1-6.Its sad to see another season go to waste.
Nah, your math is incorrect. We will have much more space then $7mil. You are going by what our roster number is this year.Originally Posted by tonto_phin
You must subtract the contracts of Traylor, Holiday, Zgonina, Vickerson, Spragan, Bowens, Adams, Newman, Maxwell, Radar, Jacox, Tillman, Bell, Jackson, Lehan, Welker, Vick, Lemon, Morris, Barnes, Minor, MacIntosh, Denney, and Jones. Plus some players won't have roster bonuses counting again next year.
We are going to have more than $10mil of cap space trust me.
By cutting Booker and re-structuring some contracts...we should have around $15mil of cap space. Of course the draft picks and the $1mil we leave open through the season will bring us back to $10mil to spend on free agents and/or re-signing some of our players like Bell, Jones, Barnes, and maybe Bowens, Lemon, and MacIntosh. Vick and Vickerson will only cost us the league minimum because of exclusive rights.
not nearly enough...sound about right??
I think its enough to sign at least one top tier free agent. Maybe a LBOriginally Posted by johngarry
As of right now, we're about $25 million under a projected $109 million salary cap for 2007. This, of course, is citing Clumpy's last update (which we have yet to publish).
What you have to keep in mind is that we only have about 36 guys under contract for next season. So we will need to use a good portion of that money just to fill the roster.
From what I've seen so far, we won't have to worry about any performance bonuses being paid out.


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Bluewater and Harryhausen Deliver Jason and the Argonauts
Press Release
After recently announcing the sell-out of the first title in their RAY HARRYHAUSEN PRESENTS line of comics, Bluewater is back for more with the release of their second all-star packed Harryhausen series, JASON AND THE ARGONAUTS: KINGDOM OF HADES!
"I think Jason and the Argonauts probably came the closest to becoming the motion picture I imagined when we began pre-production. I suppose you could call


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|Publication number
|Publication type
|Application number
|Publication date
|Jun 15, 2006
|Filing date
|Jan 25, 2006
|Priority date
|Jan 23, 1998
|Also published as
|Publication number
|John Dobak
|Original Assignee
|Innercool Therapies, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Referenced by (5), Classifications (17), Legal Events (11)
|External Links: USPTO, USPTO Assignment, Espacenet
This is a continuation patent application of co-pending U.S. patent application Ser. No. 10/160,611 filed on May 30, 2002, entitled "PATIENT TEMPERATURE REGULATION METHOD AND APPARATUS", which is a continuation of U.S. patent application Ser. No. 09/373,112, filed on Aug. 11, 1999, entitled "PATIENT TEMPERATURE REGULATION METHOD AND APPARATUS", now Pat. No. 6,843,800, which is a continuation-in-part of U.S. patent application Ser. No. 09/292,532 filed on Apr. 15, 1999, entitled "ISOLATED SELECTIVE ORGAN COOLING METHOD AND APPARATUS", which is a continuation-in-part of U.S. patent application Ser. No. 09/052,545 filed on Mar. 31, 1998, entitled "CIRCULATING FLUID HYPOTHERMIA METHOD AND APPARATUS", now U.S. Pat. Nos. 6,231,595; and 09/103,342 filed on Jun. 23, 1998, entitled "SELECTIVE ORGAN COOLING CATHETER AND METHOD OF USING THE SAME", now U.S. Pat. No. 6,096,068; the later of which is a continuation-in-part of U.S. Ser. No. 09/047,012 filed Mar. 24, 1998, entitled "SELECTIVE ORGAN HYPOTHERMIA METHOD AND APPARATUS", now U.S. Pat. No. 5,957,963, which is a continuation-in-part of U.S. patent application Ser. No. 09/012,287 filed on Jan. 23, 1998, entitled "SELECTIVE ORGAN HYPOTHERMIA METHOD AND APPARATUS", now U.S. Pat. No. 6,051,019, all of which are incorporated herein.
Not Applicable
1. Field of the Invention
The present invention relates generally to the lowering and control of the temperature of the human body. More particularly, the invention relates to a method and intravascular apparatus for cooling the body without the adverse consequences associated with prior methods of total body cooling. The invention also relates to a method and intravascular apparatus for cooling the body without causing thermoregulatory suppression of the cooling.
2. Background Information
Organs in the human body, such as the brain, kidney and heart, are maintained at a constant temperature of approximately 37� C. Hypothermia can be clinically defined as a core body temperature of 35� C. or less. Hypothermia is sometimes characterized further according to its severity. A body core temperature in the range of 33� C. to 35� C. is described as mild hypothermia. A body temperature of 28� C, to 32� C. is described as moderate hypothermia. A body core temperature in the range of 24� C. to 28� C. is described as severe hypothermia.
Hypothermia is uniquely effective in reducing brain injury caused by a variety of neurological insults and may eventually play an important role in emergency brain resuscitation. Experimental evidence has demonstrated that cerebral cooling improves outcome after global ischemia, focal ischemia, or traumatic brain injury. For this reason, hypothermia may be induced in order to reduce the effect of certain bodily injuries to the brain as well as other organs.
Cerebral hypothermia has traditionally been accomplished through whole body cooling to create a condition of total body hypothermia in the range of 20� C. to 30� C. The currently-employed techniques and devices used to cause total body hypothermia lead to various side effects. In addition to the undesirable side effects, present methods of administering total body hypothermia are cumbersome.
Catheters have been developed which are inserted into the bloodstream of the patient in order to induce total body hypothermia. For example, U.S. Pat. No. 3,425,419 to Dato describes a method and apparatus of lowering and raising the temperature of the human body. Dato induces moderate hypothermia in a patient using a rigid metallic catheter. The catheter has an inner passageway through which a fluid, such as water, can be circulated. The catheter is inserted through the femoral vein and then through the inferior vena cava as far as the right atrium and the superior vena cava. The Dato catheter has an elongated cylindrical shape and is constructed from stainless steel. By way of example, Dato suggests the use of a catheter approximately 70 cm in length and approximately 6 mm in diameter. Thus, the Dato device cools along the length of a very elongated device. Use of the Dato device is highly cumbersome due to its size and lack of flexibility.
U.S. Pat. No. 5,837,003 to Ginsburg also discloses a method and apparatus for controlling a patient's body temperature. In this technique, a flexible catheter is inserted into the femoral artery or vein or the jugular vein. The catheter may be in the form of a balloon to allow an enhanced surface area for heat transfer. A thermally conductive metal foil may be used as part of a heat-absorbing surface. This device fails to disclose or teach use of any ability to enhance heat transfer. In addition, the disclosed device fails to disclose temperature regulation.
Therefore, a practical method and apparatus that lowers and controls the temperature of the human body satisfies a long-felt need.
In one aspect, the apparatus of the present invention can include a heat transfer element that can be used to apply cooling to the blood flowing in a large vein feeding the heart. An optional heating element may be used to supply warming to a portion of the remainder of the body to provide comfort to the patient and to allow a low target hypothermic temperature to be achieved. The heating element may be applied before or after a target temperature is achieved. The warming operation can be accomplished by means of local heating of the vein or artery with an external heat applicator or by means of substantially whole body warming with a heating blanket. The warming operation can be accomplished per se or in combination with thermoregulatory drugs.
The heat transfer element, by way of example only, includes first and second elongated, articulated segments, each segment having a mixing-inducing exterior surface. A flexible joint can connect the first and second elongated segments. An inner lumen may be disposed within the first and second elongated segments and is capable of transporting a pressurized working fluid to a distal end of the first elongated segment. In addition, the first and second elongated segments may have a mixing-inducing interior surface for inducing mixing within the pressurized working fluid. The mixing-inducing exterior surface may be adapted to induce mixing within a blood flow when placed within an artery or vein. In one embodiment, the flexible joint includes a bellows section that also allows for axial compression of the heat transfer element as well as for enhanced flexibility. In alternative embodiments, the bellows section may be replaced with flexible tubing such as small cylindrical polymer connecting tubes.
In one embodiment, the mixing-inducing exterior surfaces of the heat transfer element include one or more helical grooves and ridges. Adjacent segments of the heat transfer element can be oppositely spiraled to increase mixing. For instance, the first elongated heat transfer segment may include one or more helical ridges having a counter-clockwise twist, while the second elongated heat transfer segment includes one or more helical ridges having a clockwise twist. Alternatively, of course, the first elongated heat transfer segment may include one or more clockwise helical ridges, and the second elongated heat transfer segment may include one or more counter-clockwise helical ridges. The first and second elongated, articulated segments may be formed from highly conductive materials such as metals.
The heat transfer device may also have a supply catheter with an inner catheter lumen coupled to the inner lumen within the first and second elongated heat transfer segments. A working fluid supply configured to dispense the pressurized working fluid may be coupled to the inner catheter lumen or alternatively to the supply catheter. The working fluid supply may be configured to produce the pressurized working fluid at a temperature of about 0� C. and at a pressure below about 5 atmospheres of pressure.
In yet another alternative embodiment, the heat transfer device may have three or more elongated, articulated, heat transfer segments each having a mixing-inducing exterior surface, with additional flexible joints connecting the additional elongated heat transfer segments. In one such embodiment, by way of example only, the first and third elongated heat transfer segments may include clockwise helical ridges, and the second elongated heat transfer segment may include one or more counter-clockwise helical ridges. Alternatively, of course, the first and third elongated heat transfer segments may include counter-clockwise helical ridges, and the second elongated heat transfer segment may include one or more clockwise helical ridges.
The mixing-inducing exterior surface of the heat transfer element may optionally include a surface coating or treatment to inhibit clot formation. A surface coating may also be used to provide a degree of lubricity to the heat transfer element and its associated catheter.
The present invention is also directed to a method of inducing hypothermia in the body by inserting a flexible, conductive cooling element into a vein that is in pressure communication with the heart, e.g., the superior or inferior vena cavae or both. The vena cavae may be accessed via known techniques from the jugular vein or from the subclavian or femoral veins, for example. The heat transfer element in one or both vena cavae may then cool virtually all the blood being returned to the heart. The cooled blood enters the right atrium at which point the same is pumped through the right ventricle and into the pulmonary artery to the lungs where the same is oxygenated. Due to the heat capacity of the lungs, the blood does not appreciably warm during oxygenation. The cooled blood is returned to the heart and pumped to the entire body via the aorta. Thus, cooled blood may be delivered indirectly to a chosen organ such as the brain. This indirect cooling is especially effective as high blood flow organs such as the heart and brain are preferentially supplied blood by the vasculature. A warming blanket or other warming device may be applied to portions of the body to provide comfort to the patient and to inhibit thermoregulatory responses such as vasoconstriction. Thermoregulatory drugs may also be so provided for this reason.
The method further includes circulating a working fluid through the flexible, conductive cooling element in order to lower the temperature of the blood in the vena cava. The flexible, conductive heat transfer element preferably absorbs more than about 150 or 300 Watts of heat.
The method may also include inducing mixing within the free stream blood flow within the vena cava. It is noted that a degree of turbulence or mixing is generally present within the vena cava anyway. The step of circulating may include inducing mixing in the flow of the working fluid through the flexible, conductive heat transfer element. The pressure of the working fluid may be maintained below about 5 atmospheres of pressure.
The present invention also envisions a method for inducing therapeutic hypothermia in the body of a patient which includes introducing a catheter, with a cooling element, into a vena cava supplying the heart, the catheter having a diameter of about 18 mm or less, inducing mixing in blood flowing over the cooling element, and lowering the temperature of the cooling element to remove heat from the blood to cool the blood. In one embodiment, the cooling step removes at least about 150 Watts of heat from the blood. In another embodiment, the cooling step removes at least about 300 Watts of heat from the blood.
The mixing induced may result in a Nusselt number enhancement of the flow of between about 5 and 80.
In another aspect of the method, the invention is directed to a method of lowering the temperature of the body while prohibiting intervention of the body's thermoregulatory responses. Steps of the method may include delivering a drug to lower the thermoregulatory setpoint of the body such that thermoregulatory responses, including shivering and vasoconstriction, are not triggered above a certain temperature, wherein the certain temperature is lower than normal body temperature. The temperature of the blood in a major vein such as the vena cavae is then lowered to induce hypothermia in the body. The thermoregulatory drugs provide patient comfort. If even lower body temperatures are desired or required, heating blankets may be provided to further ensure patient comfort. Generally, for one degree of body core cooling, the heating blanket should be 5� C. above the skin temperature to provide patient comfort. However, the temperature of the blanket should generally not exceed 42� C.
Advantages of the invention are numerous. Patients can be provided with the beneficial aspects of hypothermia without suffering the deleterious consequences of the prior art. The procedure can be administered safely and easily. Numerous cardiac and neural settings can benefit by the hypothermic therapy. For example, ischemia and re-stenosis can be minimized. Other advantages will be understood from the following.
The novel features of this invention, as well as the invention itself, will be best understood from the attached drawings, taken along with the following description, in which similar reference characters refer to similar parts, and in which:
A one or two-step process and a one or two-piece device may be employed to intravascularly lower the temperature of a body in order to induce therapeutic hypothermia. A cooling element may be placed in a high-flow vein such as the vena cavae to absorb heat from the blood flowing into the heart. This transfer of heat causes a cooling of the blood flowing through the heart and thus throughout the vasculature. Such a method and device may therapeutically be used to induce an artificial state of hypothermia.
A heat transfer element that systemically cools blood should be capable of providing the necessary heat transfer rate to produce the desired cooling effect throughout the vasculature. This may be up to or greater than 300 watts, and is at least partially dependent on the mass of the patient and the rate of blood flow. Surface features may be employed on the heat transfer element to enhance the heat transfer rate. The surface features and other components of the heat transfer element are described in more detail below.
One problem with hypothermia as a therapy is that the patient's thermoregulatory defenses initiate, attempting to defeat the hypothermia. Methods and devices may be used to lessen the thermoregulatory response. For example, a heating blanket may cover the patient. In this way, the patient may be made more comfortable. Thermoregulatory drugs may also be employed to lower the trigger point at which the patient's thermoregulatory system begins to initiate defenses. Such drugs are described in more detail below. A method employing thermoregulatory drugs, heating blankets, and heat transfer elements is also disclosed below.
Anatomical Placement
The internal jugular vein is the vein that directly drains the brain. The external jugular joins the internal jugular at the base of the neck. The internal jugular veins join the subclavian veins to form the brachiocephalic veins that in turn drain into the superior vena cava. The superior vena cava drains into the right atrium of the heart as may be seen by referring ahead to
A cooling element may be placed into the superior vena cava, inferior vena cava, or otherwise into a vein which feeds into the superior vena cava or otherwise into the heart to cool the body. A physician percutaneously places the catheter into the subclavian or internal or external jugular veins to access the superior vena cava. The blood, cooled by the heat transfer element, may be processed by the heart and provided to the body in oxygenated form to be used as a conductive medium to cool the body. The lungs have a fairly low heat capacity, and thus the lungs do not cause appreciable rewarming of the flowing blood.
The vasculature by its very nature provides preferential blood flow to the high blood flow organs such as the brain and the heart. Thus, these organs are preferentially cooled by such a procedure as is also shown experimentally in
Heat Transfer
When a heat transfer element is inserted approximately coaxially into an artery or vein, the primary mechanism of heat transfer between the surface of the heat transfer element and the blood is forced convection. Convection relies upon the movement of fluid to transfer heat. Forced convection results when an external force causes motion within the fluid. In the case of arterial or venous flow, the beating heart causes the motion of the blood around the heat transfer element.
The magnitude of the heat transfer rate is proportional to the surface area of the heat transfer element, the temperature differential, and the heat transfer coefficient of the heat transfer element.
The receiving artery or vein into which the heat transfer element is placed has a limited diameter and length. Thus, the surface area of the heat transfer element must be limited to avoid significant obstruction of the artery or vein and to allow the heat transfer element to easily pass through the vascular system. For placement within the superior vena cava via the external jugular, the cross sectional diameter of the heat transfer element may be limited to about 5-6 mm, and its length may be limited to approximately 10-15 cm. For placement within the inferior vena cava, the cross sectional diameter of the heat transfer element may be limited to about 6-7 mm, and its length may be limited to approximately 25-35 cm.
Decreasing the surface temperature of the heat transfer element can increase the temperature differential. However, the minimum allowable surface temperature is limited by the characteristics of blood. Blood freezes at approximately 0� C. When the blood approaches freezing, ice emboli may form in the blood, which may lodge downstream, causing serious ischemic injury. Furthermore, reducing the temperature of the blood also increases its viscosity, which results in a small decrease in the value of the convection heat transfer coefficient. In addition, increased viscosity of the blood may result in an increase in the pressure drop within the artery, thus compromising the flow of blood to the brain. Given the above constraints, it is advantageous to limit the minimum allowable surface temperature of the cooling element to approximately 5� C. This results in a maximum temperature differential between the blood stream and the cooling element of approximately 32� C. For other physiological reasons, there are limits on the maximum allowable surface temperature of the warming element.
The mechanisms by which the value of the convection heat transfer coefficient may be increased are complex. However, it is well known that the convection heat transfer coefficient increases with the level of "mixing" or "turbulent" kinetic energy in the fluid flow. Thus it is advantageous to have blood flow with a high degree of mixing in contact with the heat transfer element.
The blood flow has a considerably more stable flux in the superior vena cava than in an artery. However, the blood flow in the superior vena cava still has a high degree of inherent mixing or turbulence. Reynolds numbers in the superior vena cava may range, for example, from 2,000 to 5000. Thus, blood cooling in the superior vena cava may benefit from enhancing the level of mixing with the heat transfer element but this benefit may be substantially less than that caused by the inherent mixing.
Boundary Layers
A thin boundary layer has been shown to form during the cardiac cycle. Boundary layers develop adjacent to the heat transfer element as well as next to the walls of the artery or vein. Each of these boundary layers has approximately the same thickness as the boundary layer that would have developed at the wall of the artery in the absence of the heat transfer element. The free stream flow region is developed in an annular ring around the heat transfer element. The heat transfer element used in such a vessel should reduce the formation of such viscous boundary layers.
Heat Transfer Element Characteristics and Description
The intravascular heat transfer element should be flexible in order to be placed within the vena cavae or other veins or arteries. The flexibility of the heat transfer element is an important characteristic because the same is typically inserted into a vein such as the external jugular and accesses the superior vena cava by initially passing though a series of one or more branches. Further, the heat transfer element is ideally constructed from a highly thermally conductive material such as metal in order to facilitate heat transfer. The use of a highly thermally conductive material increases the heat transfer rate for a given temperature differential between the working fluid within the heat transfer element and the blood. This facilitates the use of a higher temperature coolant, or lower temperature warming fluid, within the heat transfer element, allowing safer working fluids, such as water or saline, to be used. Highly thermally conductive materials, such as metals, tend to be rigid. Therefore, the design of the heat transfer element should facilitate flexibility in an inherently inflexible material.
It is estimated that the cooling element should absorb at least about 300 Watts of heat when placed in the superior vena cava to lower the temperature of the body to between about 30� C. and 34� C. These temperatures are thought to be appropriate to obtain the benefits of hypothermia described above. The power removed determines how quickly the target temperature can be reached. For example, in a stroke therapy in which it is desired to lower brain temperature, the same may be lowered about 4� C. per hour in a 70 kg human upon removal of 300 Watts.
One embodiment of the invention uses a modular design. This design creates helical blood flow and produces a level of mixing in the blood flow by periodically forcing abrupt changes in the direction of the helical blood flow. The abrupt changes in flow direction are achieved through the use of a series of two or more heat transfer segments, each included of one or more helical ridges. The use of periodic abrupt changes in the helical direction of the blood flow in order to induce strong free stream turbulence may be illustrated with reference to a common clothes washing machine. The rotor of a washing machine spins initially in one direction causing laminar flow. When the rotor abruptly reverses direction, significant turbulent kinetic energy is created within the entire wash basin as the changing currents cause random turbulent motion within the clothes-water slurry. These surface features also tend to increase the surface area of the heat transfer element, further enhancing heat transfer.
The first heat transfer segment 20 is coupled to a second elongated heat transfer segment 22 by a first bellows section 25, which provides flexibility and compressibility. The second heat transfer segment 22 includes one or more helical ridges 32 with one or more helical grooves 30 therebetween. The ridges 32 and grooves 30 have a right hand, or clockwise, twist as they proceed toward the distal end of the heat transfer segment 22. The second heat transfer segment 22 is coupled to a third elongated heat transfer segment 24 by a second bellows section 27. The third heat transfer segment 24 includes one or more helical ridges 36 with one or more helical grooves 34 therebetween. The helical ridge 36 and the helical groove 34 have a left hand, or counter-clockwise, twist as they proceed toward the distal end of the heat transfer segment 24. Thus, successive heat transfer segments 20, 22, 24 of the heat transfer element 14 alternate between having clockwise and counterclockwise helical twists. The actual left or right hand twist of any particular segment is immaterial, as long as adjacent segments have opposite helical twist.
In addition, the rounded contours of the ridges 28, 32, 36 allow the heat transfer element 14 to maintain a relatively atraumatic profile, thereby minimizing the possibility of damage to the blood vessel wall. A heat transfer element according to the present invention may include two, three, or more heat transfer segments.
The bellows sections 25, 27 are formed from seamless and nonporous materials, such as metal, and therefore are impermeable to gas, which can be particularly important, depending on the type of working fluid that is cycled through the heat transfer element 14. The structure of the bellows sections 25, 27 allows them to bend, extend and compress, which increases the flexibility of the heat transfer element 14 so that it is more readily able to navigate through blood vessels. The bellows sections 25, 27 also provide for axial compression of the heat transfer element 14, which can limit the trauma when the distal end of the heat transfer element 14 abuts a blood vessel wall. The bellows sections 25, 27 are also able to tolerate cryogenic temperatures without a loss of performance. In alternative embodiments, the bellows may be replaced by flexible polymer tubes, which are bonded between adjacent heat transfer segments.
The exterior surfaces of the heat transfer element 14 can be made from metal, and may include very high thermal conductivity materials such as nickel, thereby facilitating heat transfer. Alternatively, other metals such as stainless steel, titanium, aluminum, silver, copper and the like, can be used, with or without an appropriate coating or treatment to enhance biocompatibility or inhibit clot formation. Suitable biocompatible coatings include, e.g., gold, platinum or polymer paralyene. The heat transfer element 14 may be manufactured by plating a thin layer of metal on a mandrel that has the appropriate pattern. In this way, the heat transfer element 14 may be manufactured inexpensively in large quantities, which is an important feature in a disposable medical device.
Because the heat transfer element 14 may dwell within the blood vessel for extended periods of time, such as 24-48 hours or even longer, it may be desirable to treat the surfaces of the heat transfer element 14 to avoid clot formation. In particular, one may wish to treat the bellows sections 25, 27 because stagnation of the blood flow may occur in the convolutions, thus allowing clots to form and cling to the surface to form a thrombus. One means by which to prevent thrombus formation is to bind an antithrombogenic agent to the surface of the heat transfer element 14. For example, heparin is known to inhibit clot formation and is also known to be useful as a biocoating. Alternatively, the surfaces of the heat transfer element 14 may be bombarded with ions such as nitrogen. Bombardment with nitrogen can harden and smooth the surface and thus prevent adherence of clotting factors. Another coating that provides beneficial properties may be a lubricious coating. Lubricious coatings, on both the heat transfer element and its associated catheter, allow for easier placement in the, e.g., vena cava.
It is important to note that the same mechanisms that govern the heat transfer rate between the exterior surface 37 of the heat transfer element 14 and the blood also govern the heat transfer rate between the working fluid and the interior surface 38 of the heat transfer element 14. The heat transfer characteristics of the interior surface 38 are particularly important when using water, saline or other fluid that remains a liquid as the working fluid. Other coolants such as Freon undergo nucleate boiling and create mixing through a different mechanism. Saline is a safe working fluid, because it is non-toxic, and leakage of saline does not result in a gas embolism, which could occur with the use of boiling refrigerants. Since mixing in the working fluid is enhanced by the shape of the interior surface 38 of the heat transfer element 14, the working fluid can be delivered to the cooling element 14 at a warmer temperature and still achieve the necessary cooling rate. Similarly, since mixing in the working fluid is enhanced by the shape of the interior surface of the heat transfer element, the working fluid can be delivered to the warming element 14 at a cooler temperature and still achieve the necessary warming rate.
This has a number of beneficial implications in the need for insulation along the catheter shaft length. Due to the decreased need for insulation, the catheter shaft diameter can be made smaller. The enhanced heat transfer characteristics of the interior surface of the heat transfer element 14 also allow the working fluid to be delivered to the heat transfer element 14 at lower flow rates and lower pressures. High pressures may make the heat transfer element stiff and cause it to push against the wall of the blood vessel, thereby shielding part of the exterior surface 37 of the heat transfer element 14 from the blood. Because of the increased heat transfer characteristics achieved by the alternating helical ridges 28, 32, 36, the pressure of the working fluid may be as low as 5 atmospheres, 3 atmospheres, 2 atmospheres or even less than 1 atmosphere.
Referring back to
A working fluid is circulated up through an inner lumen 56 defined by an insulating tube 58 to a distal tip of the heat transfer element 50. The working fluid then traverses an outer lumen 60 in order to transfer heat to the exterior surface 52 of the heat transfer element 50. The inside surface of the heat transfer element 50 is similar to the exterior surface 52 in order to induce turbulent flow of the working fluid. The inner protrusions can be aligned with the outer protrusions 54 as shown in
Method of Use
The method of inserting the catheter into the patient and routing the cooling element 14 into a selected vein is well known in the art. Percutaneous placement of the heat transfer element 14 into the jugular vein is accomplished directly, since the jugular vein is close to the surface. The catheter would reside in the internal jugular and into the superior vena cava or even the right atrium.
Although the working fluid supply 10 is shown as an exemplary cooling device, other devices and working fluids may be used. For example, in order to provide cooling, freon, perflourocarbon, water, or saline may be used, as well as other such coolants.
The cooling element can absorb up to or more than 300 Watts of heat from the blood stream, resulting in absorption of as much as 100 Watts, 150 Watts, 170 Watts or more from the brain.
Heating Blankets
The heating blanket 66 serves several purposes. By warming the patient, vasoconstriction is avoided. The patient is also made more comfortable. For example, it is commonly agreed that for every one degree of core body temperature reduction, the patient will continue to feel comfortable if the same experiences a rise in surface area (skin) temperature of five degrees. Spasms due to total body hypothermia may be avoided. Temperature control of the patient may be more conveniently performed as the physician has another variable (the amount of heating) which may be adjusted.
As an alternative, the warming element may be any of the heating methods proposed in U.S. patent application Ser. No. 09/292,532, filed on Apr. 15, 1999, and entitled "Isolated Selective Organ Cooling Method and Apparatus", and incorporated by reference above.
The practice of the present invention is illustrated in the following non-limiting example.
Referring to
Thermoregulatory Drugs
The above description discloses mechanical methods of rewarming a patient, or portions of a patient, to minimize the deleterious consequences of total body hypothermia. Another procedure which may be performed, either contemporaneous with or in place of mechanical warming, is the administration of anti-vasoconstriction and anti-shivering drugs. Such drugs minimize the effect of vasoconstriction which may otherwise hinder heat transfer and thus cooling of the patient. In general, hypothermia tends to trigger aggressive thermoregulatory defenses in the human body. Such drugs also prohibit responses such as shivering which may cause damage to cardiac-compromised patients by increasing their metabolic rate to dangerous levels.
To limit the effectiveness of thermoregulatory defenses during therapeutic hypothermia, drugs that induce thermoregulatory tolerance may be employed. A variety of these drugs have been discovered. For example, clonidine, meperidine, a combination of clonidine and meperidine, propofol, magnesium, dexmedetomidine, and other such drugs may be employed.
It is known that certain drugs inhibit thermoregulation roughly in proportion to their anesthetic properties. Thus, volatile anesthetics (isoflurane, desflurane, etc.), propofol, etc. are more effective at inhibiting thermoregulation than opioids which are in turn more effective than midazolam and the central alpha agonists. It is believed that the combination drug of clonidine and meperidine synergistically reduces vasoconstriction and shivering thresholds, synergistically reduces the gain and maximum intensity of vasoconstriction and shivering, and produces sufficient inhibition of thermoregulatory activity to permit central catheter-based cooling to 32� C. without excessive hypotension, autonomic nervous system activation, or sedation and respiratory compromise.
These drugs may be particularly important given the rapid onset of thermoregulatory defenses. For example, vasoconstriction may set in at temperatures of only � degree below normal body temperature. Shivering sets in only a fraction of a degree below vasoconstriction.
The temperature to which the blood is lowered may be such that thermoregulatory responses are not triggered. For example, thermoregulatory responses may be triggered at a temperature of 1-1� degrees below normal temperature. Thus, if normal body temperature is 37� C., thermoregulatory responses may set in at 35� C. Thermoregulatory drugs may used to lower the temperature of the thermoregulatory trigger threshold to 33� C. Use of the heating blankets described above may allow even further cooling of the patient. For example, to lower the patient's temperature from 33� C. to 31� C., a 2� C. temperature difference, a 2 times 5� C. or 10� C. rise is surface temperature may be employed on the skin of the patient to allow the patient to not "feel" the extra 2� C. cooling.
A method which combines the thermoregulatory drug methodology and the heating blanket methodology is described with respect to
As shown in
An alternate way to lower the thermoregulatory threshold is to use a heating blanket. As noted above, a common rule-of-thumb is that a patient's comfort will stay constant, even if their body temperature is lowered 1� C., so long as a heating blanket, 5� C. warmer than their skin, is applied to a substantial portion of the surface area of the patient (step 114). For a 2� C.-body temperature reduction, a 10� C. (warmer than the skin temperature) blanket would be applied. Of course, it is also known that blankets warmer than about 42� C. can damage patient's skins, this then being an upper limit to the blanket temperature. The patient's body temperature may then continue to be lowered by use of a heating blanket. For each 1� C. reduction in body temperature (step 116), the heating blanket temperature may be raised 5� C. (step 118). After each reduction in body temperature, the physician may decide whether or not to continue the cooling process (step 120). After cooling, other procedures may be performed if desired (step 122) and the patient may then be rewarmed (step 124).
It is important to note that the two alternate methods of thermoregulatory response reduction may be performed independently. In other words, either thermoregulatory drugs or heating blankets may be performed without the use of the other. The flowchart given in
Vasoconstrictive Therapies
An alternate method of performing the same function is to provide separate vasoconstrictive drugs which affect the posterior hypothalamus in such a way as to vasoconstrict the peripheral circulation while allowing heart and brain circulation to proceed unimpeded. Such drugs are known and include alpha receptor type drugs. These drugs, as well as the cooling blankets described above, may also enhance counter-current exchange, again forcing cooling towards the heart and brain. Generally, any drug or cooling blanket that provides sufficient cooling to initiate a large scale cutaneous peripheral vasoconstrictive response would be capable of forcing the cooling blood flow towards the brain and heart (i.e., the "central" volumes). In this application, the term "peripheral circulation" or "peripheral vasculature" refers to that portion of the vasculature serving the legs, arms, muscles, and skin.
Additional Therapies
Turning now from thermoregulatory drugs to additional therapies, the method and device according to the embodiments of the invention may also play a significant role in treating a variety of maladies involving cell damage.
A patent application incorporated by reference above discloses devices and methods for enhancing fibrinolysis of a clot by cooling blood flowing in an artery. The present invention may also use blood cooling to substantially reduce platelet aggregation as there is a significant reduction in platelet activity at reduced temperatures. Such reduction may take place by inhibiting enzyme function, although the actual methodology is unclear. This reduction in platelet aggregation, as well as the enhanced fibrinolysis noted above, may reduce or eliminate current dependence on such drugs as tPA or Rheopro.
Myocardial Infarction
The above-described venous cooling may also provide a number of benefits for patients undergoing myocardial infarction.
Current therapies for treating myocardial infarction involve three areas. Thrombolysis or stenting are used to establish reflow. The oxygen supply is increased by directly supplying the patient with oxygen and by vasodilation with nitrates. And the oxygen demand is lessened by decreasing the heart rate and the blood pressure.
Devices and methods according to the present invention can work well in combination with these current therapies. For example, the device and method may lessen the heart's demand for oxygen by providing cooled blood to the heart. The cooled blood in turn cools the inner chambers of the heart, essentially from the inside. Hearts undergoing myocardial infarction may beat very fast due to an agitated state of the victim. However, cooled blood may induce a state of bradycardia that reduces the demand for oxygen by the heart per se.
To establish reflow and the oxygen supply, the enhanced fibrinolysis, discussed above, may also dissolve the clot, allowing more blood flow and more oxygen delivered to the heart. As mentioned above, platelet aggregation may be reduced. Additionally, conduction through the subendocardium, cooling the heart, may reduce the overall metabolic activity of the heart as well as protect the subendocardium from cell damage.
It is additionally noted that reflow is often accompanied by reperfusion injury which can further damage cells. Neutrophil activation occurs as part of reperfusion injury. Hypothermia can limit such activation and thus can limit reperfusion injury.
Thus, numerous therapies may be delivered by one device. Therefore, e.g., currently-employed "beta-blocker" drugs used to reduce heart rate in patients undergoing infarcts may not need to be employed in patients undergoing these hypothermic therapies.
Another application of the device and method may be in the treatment of stenotic arteries. Stenotic arteries are vessels that have narrowed due to a build-up of tissue and/or plaque atheroma. Stenotic vessels are treated by angioplasty or stenting, which opens the artery. During treatment the vessel wall may be injured. Such injuries often (20-50%) cause an inflammatory reaction that eventually causes the vessel to undergo re-stenosis after a period of time, which may range from 6-12 months or even several years later.
Hypothermia is known to mitigate inflammatory responses. For example, one of the initial steps in the process of re-stenosis is the migration of macrophages or white blood cells to the injured area. Hypothermia can limit this migration. Hypothermia can also inhibit reactions and processes initiated by molecules acting in an autocrine or paracrine fashion. Hypothermia may also limit the release of several growth factors (at the site of injury) such as PDGF and EGF that act in these fashions.
While the invention herein disclosed is capable of obtaining the objects hereinbefore stated, it is to be understood that this disclosure is merely illustrative of the presently preferred embodiments of the invention and that no limitations are intended other than as described in the appended claims.
|Citing Patent
|Filing date
|Publication date
|Oct 25, 2002
|Mar 30, 2010
|Emory University
|Catheter for modified perfusion
|Apr 18, 2007
|Nov 9, 2010
|Medivance, Inc.
|Apparatus and method for cooling liquid in intravascular cooling system
|May 18, 2009
|Nov 1, 2011
|Medivance Incorporated
|Apparatus and method for cooling liquid in intravascular cooling system
|Oct 18, 2012
|Advanced Cooling Therapy, Llc
|Devices and methods for controlling patient temperature
|Feb 15, 2013
|Jun 5, 2014
|Advanced Cooling Therapy, Llc
|Devices and methods for controlling patient temperature
|U.S. Classification
|128/899, 607/105, 607/113
|International Classification
|Cooperative Classification
|European Classification
|Aug 31, 2007
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