text:
|Publication number
|Publication type
|Application number
|Publication date
|Oct 25, 2007
|Filing date
|Jun 13, 2007
|Priority date
|Feb 24, 1998
|Also published as
|Publication number
|David Brock, Woojin Lee, Gary Rogers, Barry Weitzner
|Original Assignee
|Brock David L, Woojin Lee, Gary Rogers, Barry Weitzner
|Export Citation
|BiBTeX, EndNote, RefMan
|Referenced by (4), Classifications (56), Legal Events (1)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation of U.S. application Ser. No. 10/012,586, which is a continuation-in-part of U.S. application Ser. No. 09/827,503, filed Apr. 6, 2001 (now U.S. Pat. No. 6,432,112), which is a continuation of U.S. application Ser. No. 09/746,853, filed Dec. 21, 2000 (now U.S. Pat. No. 6,692,485), which is a divisional of U.S. application Ser. No. 09/375,666 (now U.S. Pat. No. 6,197,017), filed Aug. 17, 1999, which is a continuation of U.S. application Ser. No. 09/028,550, filed Feb. 24, 1998 (now abandoned). This application is also a continuation-in-part of U.S. application Ser. No. 09/783,637, filed Feb. 14, 2001 (now abandoned), which is a continuation of PCT/US00/12553, filed May 9, 2000, which claims the benefit of priority of U.S. Application Ser. No. 60/133,407, filed May 10,1999. This application is also a continuation-in-part of PCT/US01/11376, filed Apr. 6, 2001, which claims priority the benefit of priority of U.S. application Ser. Nos. 09/746,853, filed Dec. 21, 2000 (now U.S. Pat. No. 6,692,485), and 09/827,503, filed Apr. 6, 2001 (now U.S. Pat. No. 6,432,112). This application is also a continuation-in-part of U.S. application Ser. Nos. 09/746,853, filed Dec. 21, 2000 (now U.S. Pat. No. 6,692,485), and 09/827,503, filed Apr. 6, 2001 (now U.S. Pat. No. 6,432,112). This application is also a continuation-in-part of U.S. application Ser. No. 09/827,643, filed Apr. 6, 2001 (now U.S. Pat No. 6,554,844), which claims the benefit of priority to U.S. Application Ser. Nos. 60/257,869, filed Dec. 21, 2000, and 60/195,264, filed Apr. 7, 2000, and is also a continuation-in-part of PCT/US00/12553, filed May 9, 2000, from which U.S. application Ser. No. 09/783,637, filed Feb. 14, 2001, claims priority.
This application also claims the benefit of priority of U.S. Application Ser. Nos. 60/293,346, filed May 24, 2001, 60/279,087, filed Mar. 27, 2001, 60/313,496, filed Aug. 21, 2001, 60/313,497, filed Aug. 21, 2001, 60/313,495, filed Aug. 21, 2001, 60/269,203, filed Feb. 15, 2001, 60/269,200, filed Feb. 15, 2001, 60/276,151, filed Mar. 15, 2001, 60/276,217, filed Mar. 15, 2001, 60/276,086, filed Mar. 15, 2001, 60/276,152, filed Mar. 15, 2001, 60/257,816, filed Dec. 21, 2000, 60/257,868, filed Dec. 21, 2000, 60/257,867, filed Dec. 21, 2000, 60/257,869, filed Dec. 21, 2000.
This application is also related to application Ser. Nos. ______ (Attorney Docket No. HNMD-EA001 CON1), ______ (Attorney Docket No. HNMD-EA001 CON3), ______ (Attorney Docket No. HNMD-EA001 CON4), ______ (Attorney Docket No. HNMD-EA001 CON5), and ______ (Attorney Docket No. HNMD-EA001 CON6), all of which are filed on the same date herewith.
The disclosures of the foregoing applications are expressly incorporated herein by reference. This application further expressly incorporates herein by reference, U.S. application Ser. Nos. 10/014,145 (now U.S. Pat. No. 6,775,582), 10/012,845 (now U.S. Pat. No. 7,169,141), 10/008,964 (now abandoned), 10/013/046 (now abandoned), 10/011,450 (now abandoned), 10/008,457 (now U.S. Pat. No. 6,949,106), 10/008,871 (now U.S. Pat. No. 6,843,793), 10/023,024 (now abandoned), 10/011,371 (now U.S. Pat. No. 7,090,683), 10/011,449 (now abandoned), 10/010,150 (now U.S. Pat. No. 7,214,230), 10/022,038 (now abandoned), 10/012,586, all filed on Nov. 16, 2001.
The present invention relates in general to a remote controlled flexible instrument comprising a flexible shaft, for introduction into a body cavity or body vessel to perform a medical procedure.
Catheters are used extensively in the medical field in various types of procedures, including invasive procedures. Minimally invasive surgery involves operating through small incisions, through which instruments are inserted. These incisions are typically 5 mm to 10 mm in length. Minimally invasive surgery is typically less traumatic than conventional surgery, due, in part, to the significant reduction in incision size. Furthermore, hospitalization is reduced and recovery periods shortened as compared with conventional surgery techniques. Catheters may be tailored to a particular size or form, depending on the incision and the size of the body cavity or lumen.
Due to the small size of the incision, the bulk of the surgery is not visible. Although the surgeon can have visual feedback from the surgical site via a video camera or endoscope inserted into the patient, or via radiological imaging or ultrasonic scanning, the ability to control the relatively simple laparoscopic instruments remains difficult. Even with good visual feedback, the surgeon's tactile and positional senses are physically removed from the operative site, rendering endoscopic procedures slow and clumsy.
Current instrumentation, with forceps, scissors, etc., inserted into the body at the end of long slender push rods is not fully satisfactory. The use of such conventional instrumentation increases operative time, and potentially heightens risk. For example, tissue may be injured when the laparoscopic tool moves outside the visual field. Moreover, there are limitations on the type and complexity of procedures that may be performed laparoscopically due, in part, to the limitations on the instruments that are used.
Development work has been undertaken to investigate the use of robotic work in surgery. Typically, these robotic systems use arms that reach over the surgical table and manipulate surgical instruments. The known robotic systems are large, clumsy to operate and relatively expensive to manufacture. The presence of a robot at the surgical site is problematic particularly when the robot is large and may impede access to the patient during surgery.
In accordance with a first aspect of the present inventions, a medical instrument assembly is provided. The medical instrument comprises an outer probe having an elongated shaft and an inner probe having an elongated shaft coaxially disposed within the outer probe shaft. By way of non-limiting example, the elongated shafts of the inner and outer probes may be flexible catheter shafts. The medical instrument further comprises a plurality of actuating elements configured to be driven by a drive unit to independently effect movement of each of the outer and inner probes within at least one degree-of-freedom, and a support on which the plurality of actuating elements is slidably disposed to distally advance and proximally retract the outer and inner probes, which may occur in unison. The medical instrument assembly may optionally comprise a driver interface module in which the actuators are contained and to which the outer and inner probe shafts are mounted. In this case, the driver interface module is slidably disposed on the support. In one embodiment, the support has a carriage on which the actuators are slidably disposed. In another embodiment, the support is configured for locating the actuating elements over a patient table.
The degree(s)-of-freedom to which the inner and outer probes are independently moved can be varied. For example, the degree(s)-of-freedom may comprise an axial rotation of the outer and inner probe shafts relative to each other. In this case, the actuating elements may comprise a first gear that encircles and effects the axial rotation of the outer probe shaft, and a second gear that encircles and effects the axial rotation of the inner probe shaft. The degree(s)-of-freedom may comprise a deflection of at least one of the outer probe shaft and inner probe shaft. In this case, the medical instrument assembly may further comprise a cable extending within the outer probe shaft or inner probe shaft, and the actuating element(s) may comprise s a pulley that pulls the cable to effect the deflection of the outer probe shaft or inner probe shaft. The degree(s)-of-freedom may comprise an actuation of an end effector associated with the inner probe shaft. In this case, the medical instrument assembly may comprise a cable extending within the inner probe shaft, and the actuating elements may comprise a pulley that pulls the cable to effect the actuation of the end effector.
In accordance with a second aspect of the present inventions, a robotic medical system is provided. The robotic medical system comprises a medical instrument assembly having a coaxial arrangement of an outer probe and an inner probe, and a plurality of actuating elements coupled to the coaxial arrangement. The outer probe, inner probe, and actuating elements may be the same as those described above. The robotic medical system further comprises a support on which the medical instrument assembly is slidably disposed (e.g., to distally advance and proximally retract the outer and inner probes in unison), and a user interface configured for generating at least one command, and a drive unit (e.g., one that has a motor array) coupled to the actuating elements. The robotic medical system further comprises an electric controller configured, in response to the command(s), for directing the drive unit to drive the actuating elements to independently effect movement of each of the outer and inner probes within at least one degree-of-freedom (e.g., an axial rotation of the outer and inner probe shafts relative to each other, a deflection of at least one of the outer probe shaft and inner probe shaft, and/or an actuation of an end effector associated with the inner probe shaft), and to linearly translate the medical instrument assembly along the support.
In one embodiment, the electric controller is configured for directing the drive unit to drive the actuating elements to effect movements of each of the outer and inner probes corresponding to movements at the user interface. In another embodiment, the user interface is located remotely from the drive unit, the electrical controller is coupled to the drive unit via external cabling, and the drive unit is coupled to the actuating elements via external cabling. In still another embodiment, the robotic medical system further comprises a carriage on which the driver interface module is slidably disposed. The medical instrument assembly may optionally comprise a driver interface module in which the actuators are contained and to which the coaxial arrangement is mounted. In this case, the driver interface module may comprise a drivable mechanism to which the coaxial arrangement is mounted, and a receiver to which the drivable mechanism is configured for being removably mated. In one embodiment, the support has a carriage on which the actuators are slidably disposed. In another embodiment, the support is configured for locating the actuating elements over a patient table.
Numerous other objects, features and advantageous of the invention should now become apparent upon a reading of the following detailed description taken in conjunction with the accompanying drawings in which:
The present invention provides a system for remotely controlling a flexible instrument for use in medical applications, typically for operative or other medical procedures. The flexible instrument comprises a shaft or a tube of sufficient dimensions for passing through a small incision or natural body lumen or cavity and ultimately, for positioning a distal end of the shaft within the body at an internal target (operative) site. The flexible instrument can also support a tool at its distal end to allow more intricate medical procedures. A user or surgeon can control the position of the shaft from a master station, allowing operation from another part of the operating room, or even from another room or another building. In one aspect of the invention, the shaft can comprise one or more flexible segments, which a user can controllably bend, providing finer control in directing the shaft toward the target site. The control can result in, for example, a deflection or turning of the shaft, for guiding this shaft through or within various body cavities or lumens. The controllable bending is also useful for more precise positioning of a distal end of the flexible instrument at a desired operative site.
Preferably, the flexible instrument is used to perform minimally invasive procedures. "Minimally invasive procedure," refers herein to a surgical procedure in which a surgeon operates through small cut or incision, the small incision being sufficiently necessary to access the operative site. In one embodiment, the incision length ranges from 1 mm to 20 mm in diameter, preferably from 5 mm to 10 mm in diameter. This procedure contrasts those procedures requiring a large cut to access the operative site. Thus, the flexible instrument is preferably used for insertion through such small incisions and/or through a natural body lumen or cavity, if necessary, so as to locate the catheter at an internal target site for a particular surgical or medical procedure. Examples of such minimally invasive procedures include intravascular procedures, such as the repair of a cardiac valve. The introduction of the flexible instrument into the anatomy may be by percutaneous or surgical access to a lumen or vessel, or by introduction through a natural orifice in the anatomy.
Surgeon's interface 11 is in electrical communication with computing system 12, which is, in turn, in electrical communication with drive unit 13. In one embodiment, drive unit 13 comprises a plurality of motors. The drive unit 13 is in mechanical communication with shaft 30 via conduit 23, which houses a plurality of mechanical cables driven by the plurality of motors in drive unit 13. In one embodiment, drive unit 13 is solely in mechanical communication with shaft 30. Because of the mechanical communication with shaft 30, the electromechanical components in drive unit 13 are disposed in an area remote from the operative site, and preferably in an area outside the sterile field. Preferably, objects that are difficult to sterilize, e.g. motors or electromechanical components, are kept at a sufficient distance from the patient to avoid contamination. This distance is readily ascertainable by doctors, nurses, and other appropriate medical professionals. In one embodiment, the sterile field has the rest surface of the operating table as its lower boundary. Thus, drive unit 13 is preferably located below the plane of the sterile field, i.e. below the rest surface of the operating table. The patient or subject may be further protected from drive unit 13 with a sterile barrier, such as a sterile cloth. With respect to the drive unit, such as drive unit 13 in
Accordingly, one aspect of the present invention provides a drive unit capable of remotely driving articulation of a flexible instrument, where the drive unit is remote from the subject and the flexible instrument. The slave station of the present invention employs, to a large part, a mechanical arrangement that is effected remotely and includes mechanical cables and flexible conduits coupling to a remote motor drive unit. This provides the advantage that the instrument is purely mechanical and does not need to be contained within a sterile barrier. The instrument may be autoclaved, gas sterilized or disposed in total or in part.
Cables in conduit 23 also mechanically drives the translation of receiver 24 along rails 25. The rails, and thus the linear translation extend at an acute angle with respect to the operating table, as well as the subject. This angular arrangement disposes the flexible instrument system in a convenient position over the patient. This arrangement also minimizes the number of components that operate within the sterile field, as drive unit 13 is maintained at a location remote from the sterile field.
More specifically,
In one embodiment, the interlocking mechanism can comprise a magnetic attachment, where a first series of magnets in the mechanically drivable mechanism interacts with a second series of magnets in the receiver. Each series of magnets can couple with the mechanical cables.
For the sake of simplicity,
Regarding the interface 11, computer system 12 and drive unit 13, reference is also made to co-pending application PCT Ser. No. PCT/US00/12553 filed May 9, 2000, and U.S. Provisional Application Ser. No. 60/279,087 filed Mar. 27, 2001, both of which are incorporated by reference herein in their entirety.
A more detailed discussion of the master station, the slave station and computation system or controller 12 is provided below.
In one embodiment, input device E features handles that control the motion of the shaft and a tool. Referring back to
Reference may also be made to copending application docket number 08491-7018, filed of even date herewith, which discloses other details of a master station input device (master positioner) that may be used in carrying out the control described herein.
Display F provides a direct video image of the site surrounding the distal end of the shaft. An endoscope supporting a camera is inserted into the body of a subject, providing the video feed of the operative site. The camera can be mounted on or housed at the distal end of the shaft. The camera can provide a view of the operative site, or may be positioned away from the site to provide additional perspective on the surgical operation.
Other detection systems may be used for providing different images useful in assisting the surgeon in performing the medical procedure. Thus, various signals may be utilized in conjunction with or in alternative to the video image, such as ultrasound (echocardiography, Doppler ultrasound), angiography, electrophysiology, radiology or magnet resonance imaging (MRI). Also, an audio signal could be used for guiding the shaft. These detection techniques can be operated with the flexible instrument of the present invention to enhance guidance of the shaft to the site as well as manipulation at the site.
In association with the input devices of
As discussed previously,
The block diagram of
Communication cables 708 intercouple interface board 704 to eight separate module boards 706. Interface board 704 can be a conventional interface board for coupling signals between digital bus 702 and individual module boards 706. Each module board 706 includes four motion control circuits 710, as illustrated in
The motor control system may be implemented in two ways. In the first method the user may utilize the four types of control modes provided by the motor control sub unit 706: positional control; proportional velocity control; trapezoidal profile control; and integral velocity control. The use of any one of these modes can involve simply specifying desired positions or velocities for each motor, and necessary control actions are computed by motion control IC 710 of the motor control sub unit, thereby greatly reducing the complexity of the control system software. However, in the case where none of the onboard control modes are appropriate for the application, the user may choose the second method in which the servo motor control software is implemented at the PC control station. Appropriate voltage signal outputs for each motor are computed by the PC control station and sent to the motor control/power amplifier unit (706, 712). Even if the computation load is mostly placed on the PC control station's CPU, the use of high performance computers as well as high speed PCI bus for data transfer can overcome this problem.
First, the joint sensors (box 435), which are optical encoders in the present embodiment, of the surgeon's interface system are read, and via forward kinematics (box 410) computation of the interface system, the current positions (see line 429) and orientations (see line 427) of the interface handle can be performed. The translational motion of the surgeon's hand motion is scaled (box 425) whereas the orientations are kept identical, resulting in desired positions (see line 432) and orientations (see line 434) of the catheter's tool. The results are then inputted into the inverse kinematics algorithms for the catheter's tool, and finally the necessary joint angles and insertion length of the catheter system are determined. The motor controller (box 420) then commands the corresponding motors to positions such that the desired joint angles and insertion length are achieved.
The slave station comprises a flexible instrument, e.g. a shaft optionally supporting a tool at its distal end, for insertion into a subject. In one embodiment, the flexible instrument is a catheter. "Catheter" as defined herein refers to a shaft adapted for, but not necessarily limited to, insertion into a subject, and more particularly for insertion into natural body lumens, canals, vessels, passageways, cavities or orifices. The shaft is typically tubular, but any elongate shaft may be adaptable for insertion into the subject. The shaft can be solid or hollow. A subject can be a human, an animal, or even individual organs or tissues that are dead or living.
The introduction of the flexible instrument into the human or animal body, may be by percutaneous or surgical access to a lumen or vessel, or by introduction through a natural orifice in the body. In this regard, examples of natural lumens include body vessels such as a blood vessel (artery, chamber of the heart or vein), urinary system vessels (renal collection ducts, calix, ureter, bladder or urethra), hepatobilliary vessels (hepatic and pancreatic ducts, chyle ducts; common or cystic duct), gastrointestinal tract (esophagus, stomach, small and large intestine, cecum and rectum), gynecological tract (cervix, uterus, fallopian tube or milk ducts and mammary canals of breast), nasopharynx (eustacean tube, sinuses, pharynx, larynx, trachea, bronchus, bronchiole, tear duct) seminal vesicle, spinal canal, or ventricles of the brain. Examples of a natural orifice include oral, rectal, nasal, otic, optic, or urethral orifices.
The shaft can be constructed from a standard 9 French (2.67 mm diameter) coronary guiding catheter.
The shaft may support various forms of tools, typically at its distal end. As depicted in
Exemplary objects implanted in a subject include staples, tacks, anchors, screws, stents, sutures, and a variety of other objects implanted by physicians and medical professionals.
The procedure of delivering (procedure 7, above) can further include delivery of agents including, but not limited to: 1. Adhesives. 2. Cryonics. 3. Drugs. 4. Biologic agents. 5. Radioactive elements. 6. Bulking agents.
Furthermore, the flexible instrument can be used as a sensor. Parameters that may be sensed include, but are not limited to: 1. Force. 2. Pressure. 3. Electrophysiological signals. 4. Chemical, oxygen, Ph, blood gas. 5. Temperature. 6. Vibration.
The slave station also comprises a drive unit capable of articulating the flexible instrument, particularly the shaft and the tool. The drive unit is to drivably coupled to a receiver for receiving the mechanically drivable mechanism. In one embodiment, this coupling occurs via cables. The drive unit is electronically controllable from the master station, as there is an electronic link between the drive unit and a user input device of the master station.
When the receiver receives the mechanically drivable mechanism, the drive unit then has a direct pathway for controlling operation of the shaft and tool. If the shaft has a controlled flexible segment, the drive unit is capable of activating or bending the flexible segment via the mechanically drivable mechanism, for actuation of the shaft, the tool and positioning of the tool at an operative site within the subject. In one embodiment, drive unit is capable of bending the flexible segment via a first set of cables which couple the drive unit to the receiver, and a second set of cables which drivably couple the mechanically drivable mechanism to the flexible segment and the tool.
One aspect of the present invention provides a remote controlled outer (guide) catheter having a distal end disposed at or in an area about an operative site, preferably in the immediate area of an operative site. A coaxial inner (working) catheter nested within the outer catheter can then be used to perform the surgical or medical procedure. Previous surgical procedures involve insertion of a trocar or cannula into the subject at a relatively short depth to provide an opening for receipt of the catheter, which is then guided to the operative site. Typically the catheter is not disposed at the immediate area around the operative or target site. Thus, if the surgeon needs a second catheter, the first catheter must be withdrawn and the second catheter is guided to the target site. Such repeated insertions can aggravate trauma experienced by the patient.
The feature of the present invention, on the other hand, employs an outer catheter disposed at the target site, which allows more than one shaft to be inserted and withdrawn with minimal irritation or trauma experienced at the passageway leading to the operative site. In one embodiment, the outer catheter housing a coaxial inner catheter is disposed at the target site. The inner catheter can immediately function at the operative site. If a second inner catheter is required, the first inner catheter can be quickly withdrawn through the outer guide catheter and the second inner catheter inserted through the outer catheter with minimal injury to the subject.
A feature of this aspect of the present invention allows coaxial multiple shafts to be remote controlled independently of each other.
The rotation of outer shaft 32 and inner shaft 34 about the co-axis can be controlled independently. Control element 60, or gear 60 in interface 26 encircles outer shaft 30 and controls the rotational position of guide shaft 32 in the direction indicated by rotational arrow 65. Gear 68 in interface 26 encircles inner shaft 34. Control element 68 controls the rotational position of the inner shaft 34 in the direction indicated by rotational arrow 69. Rotational arrows 65 and 69 indicate rotation about the "shaft lumen axis", i.e. the axis tangential to the cross section of the shaft lumen.
If a tool were supported at the distal end of inner shaft 34, control element 68 would control the rotational position of the tool about the shaft lumen axis as well. If the distal end were flexed, the shaft would curve and rotation of the shaft would cause the tool to trace a circle, and not cause the tool to rotate about its internal axis. As described below, another control can be positioned in the mechanically drivable interface for solely controlling the tool independent of the shaft controls.
Another aspect of the present invention provides a remote controlled flexible instrument capable of controlled bending, as controlled by a user at a master station. A flexible instrument comprises a shaft having at least one section that is flexible. "Flexible" refers herein to a material that is inherently and sufficiently deformable to readily pass atraumatically through a natural body lumen, cavity, vessel, orifice and the like. In one embodiment, the shaft is sufficiently flexible to readily flex and/or conform to a pathway in an anatomic vessel, lumen, cavity or the like. Non-flexible or rigid catheters can be distinguished from flexible instruments by the following test. By knowing the dimensions of a rigid catheter and the point of entry into the subject, one can calculate the position of the catheter end point inside the subject. In contrast, even if the dimensions and point of entry of a flexible shaft were known, the position of its end point within the subject cannot be calculated with precision because the flexible shaft may bend.
Flexible instruments of the present invention can also be distinguished from other known catheters that mimic bending motions solely through a series of rigid sections linked by joints. Thus, a "bend" is not the result of a deformation of the catheter material but by the pivoting or rotation of two rigid sections about a joint. In contrast, flexible instruments of the present invention include at least one flexible segment that is bendable without requiring the use of joints. The bending is remotely controlled, allowing deflection at these flexible segments away from the lumen axis of the segment. Bending in this sense is possible by choice of inherent flexibility of the instrument coupled with an induced deflection at the flexible segment. Inherent flexibility can be achieved by choice of a deformable material, such as. Inherent flexibility can also be achieved by designed construction using a more rigid material, for example carving out segments of the material, i.e. slotting the material, such that the material is sufficiently thin for bending. Of course, the flexible instrument can comprise rotatable or pivotable joints, but the flexible capability is not the result of employing such joints, but by the deformability of the shaft material. In one embodiment, the bending is remotely controlled via a drive unit drivably coupled to the receiver for receiving a mechanically drivable mechanism or shaft mount. The shaft mount is then drivably coupled to the controlled flexible segment, thereby providing a drivable bending mechanism.
Those of ordinary skill in the art can appreciate that the shaft can be tailored for a particular body lumen. Factors of the shaft construction include resiliency of the walls of the lumen, curvature of the passageway, location of the target site, diameter of the lumen, etc. For example, a shaft for passing through a colon can be, but is not necessarily, manufactured from a material that is less deformable than a shaft for passing through a small, delicate blood vessel. Lumens that present passageways of high curvature may also require a more easily deformable, and thus more flexible, shaft than does a relatively straight lumen. Deformability of the shaft can also be tailored by varying the dimensions, particularly the diameter, of the shaft.
In this aspect of the invention, a user can controllably bend or flex at least a section of the flexible instrument. In one embodiment, this controlled bend can be provided by a shaft having at least one flexible segment, alternatively a controlled flexible segment. By manipulating controls at the master station, a user can induce a bend in the shaft at the flexible segment. Preferably, the bend at the flexible segment is actuated mechanically, thus distinguishing this aspect of the present invention from prior art catheters where the bends are induced electrically. For example, U.S. Pat. No. 5,238,005 describes a bending mechanism caused by varying the electrical resistance through a catheter material having a negative coefficient. Heating one area of a catheter by increasing its electrical resistance results in contraction of that area, causing the catheter to deflect toward the contracted area. In contrast, the present catheter responds to mechanical forces.
Alternatively, flexible segment 42 may be in the form of a metal coil of diameter similar to the diameter of outer shaft sections 36 and 38.
Referring to both
More than one flex wire can be spaced about the circumference of outer shaft 32 to allow bending along multiple directions different from arrow 55 yet orthogonal to shaft 30. For example,
If inner shaft 34 supports a tool at its distal end, the bending motions, along with the rotation about the co-axis, serves to place the tool at any place in three-dimensional space. Another control element, i.e. pulley 72 controls cable 28, which extends through the hollow area of inner shaft 34, thereby allowing control of a specific tool operation. Depending on the complexity of the device, one or more cables leading to the tool may be required. In one embodiment,
In one embodiment, the system comprising the flexible instrument comprises tool or mini-tool (18), the operative segment (42), the catheter stem (32, 34), the coupler (24, 26) comprising the mechanically drivable mechanism 26 and the receiver 24, the drive unit (13), the controller (12) and the surgeon's interface (11). The coupler provides a translational degree-of-freedom achieved by using a sliding mechanism, i.e. rails 25, onto which the coupler is mounted, as illustrated in
The following describes the mathematical mapping of the physician's command input to the motion of the catheter system.
Flexible instrument system 500 comprises flexible instrument 510 having a shaft 528 extending to mechanically drivable mechanism 526, which interlocks with base (or receiver) 506. Base 506 is supported on carriage 508. Carriage 508 in turn is adapted for linear translation and supported by elongated rails 512 and 514. Rails 512 and 514 terminate at one end via end piece 516, which provides further support. Support base 504 terminates rails 512 and 514 at their other end. Carriage 508 includes bearings or bushings 509 that support the carriage from rails 512 and 514.
Flexible instrument system 500 employs two separate cable bundles for mechanically driving the flexible instrument along rails 512 and 514. Pulley 521 (dotted outline), residing within carriage control module 520, receives a first pair of cables 518. Pulley 521 also receives a second set of cable (see cabling sections 513 and 515 of corresponding
One pair of cables travels through shaft 528 and through appropriate holes in the base 600, wrapping around a curved surface of the link 601 and then attaching to the link. Tension on this pair of cables rotates the link 601 along with the upper and lower grips or jaws 602 and 603 about axis 532.
Two other pairs of cables also extend through the shaft 528 and through holes in the base and then pass between fixed posts 612. These posts constrain the cables to pass substantially through axis 532, which defines rotation of link 601. This construction essentially allows free rotation of link 601 with minimal length changes in the cables passing to jaws 602 and 603. Thus, the cables actuating jaws 602 and 603 are essentially decoupled from the motion of link 601 and are not effected by any rotation of link 601. Cables controlling jaw movement terminate on jaws 602 and 603. These cables permit independent operation of the jaws 602 and 603 in respective clockwise and counter clockwise directions with respect to axis 536. A similar set of cables is present on the under-side of the link 601 (not shown). Each of the jaws 602 and 603, as well as the link 601, may be constructed of metal. Alternatively, link 601 may be constructed of a hard plastic material. Base 600 may also be constructed of a plastic material and may be integral with shaft 528.
Bending of flexible segment 530 is provided via diametrically disposed slots 662, which define spaced ribs 664. Flexible segment 530 also has a longitudinally extending wall 665 through which cabling may extend, particularly for the operation of the tool. One of the pairs of cables of bundle 538 controlling flexible segment 530 terminates where base 600 intercouples with shaft 528. This pair of cables works in concert to cause bending as indicated by arrow J3, i.e. in a direction orthogonal to the pivoting provided at wrist axis 532. In
Receiver 506 and drivable mechanism 526 each comprise enclosed housings supporting a plurality of control elements, such as intercouplable drivewheels and associated pulleys or cams. Inter-engaging gears 540 and 542 are supported respectively in the modules 506 and 526. A pair of cables from bundle 524 engages pulley 544 (see
Drivable mechanism 526 interlocks with receiver 506, providing the mechanical connection that allows the drive unit to run cabling in flexible instrument 510. Blades 606, jutting out from the housing of receiver 506, engage with corresponding slots 608 associated with drivable mechanism 526. Projecting from the proximal end of receiver 506 is ridge 610, which is substantially U-shaped and provides another interlocking feature for mating with a similarly shaped slot 614 at the same end of drivable mechanism 526. Posts 616 protruding from the housing of receiver 506 are adapted to releasably mate with holes 618 in drivable mechanism 526. Posts 616 and holes 618 to interlock with each other, but may be released from each other via side-disposed buttons 620, as illustrated in
Each of cams 626 has an off-center axis 631. As viewed in
As described to this point, the bending or deflection of the shaft can be actuated by mechanical means such as a wire extending along a length of the shaft. Thus, actions at the distal end of shafts may be controlled by mechanical elements, such as cables, wires or other tendons.
Alternatively, actuation of the controlled bending can occur by other means, such as by remote electromagnetic signal couplings.
The flexible instrument depicted in
In the illustration of
It is understood that non-operative segments of the catheter in
Another aspect of the present invention provides a remote controlled flexible instrument operable within the sterile field, and disposable after use. The sterility of reusable medical instruments and implements are maintained by well-known methods such as exposure to sterile solutions and/or autoclaving. For some medical implements, it can be more cost effective to manufacture them from low cost materials and dispose them after a single use, or use on a single patient. But for certain other medical instruments, its manufacture from low cost materials still results in a costly product due to the intricate nature of the individual parts and the labor required to manufacture complex components.
It is another feature of the present invention to provide a design for a remote controlled flexible instrument having disposable components, particularly those components that are exposed to the sterile field. The present design allows the use of injection-molded plastic parts. The disposable component can be easily and quickly engaged into and disengaged from a non-disposable, reusable base. The components can be locked onto the base by snapping or interlocking matched parts, without having to thread cable wires or attach any intricate components.
One aspect of the present invention provides a disposable implement comprising a disposable mechanically drivable mechanism, a disposable shaft extending from the drivable mechanism, and optionally a disposable tool supported on a distal end of the shaft. Referring back to
Another design for a disposable implement is illustrated in
Disposable implement 510 may be considered as comprising a disposable, mechanically drivable mechanism such as the coupler or module 526 interconnected to a tool 534 through an elongated disposable flexible shaft or stem 528. This disposable and flexible implement is mounted so that the mechanically drivable mechanism may be connectable to and drivable from a drive mechanism, such as illustrated in
The disposable implement is purely mechanical and can be constructed relatively inexpensively thus lending itself readily to being disposable. It may be difficult to make only the tool disposable, due to the intricate nature of the tool parts, which may require the user to perform intricate maneuvers and cable threading into the base of the slave station. Here, the disposable implement, i.e. the tool, shaft and drivable mechanism are manufactured as a single piece disposable unit, thus eliminating the need for intricate instrument or tool exchange procedures.
Ideally, the base of the slave station, which contacts the disposable implement, is easily cleanable. It is preferred that the disposable implement, which operates within the sterile field, experiences minimal contamination by contacting the slave station. In one embodiment of the present invention, as illustrated in
One advantage of the present invention is the ease of engaging and disengaging the disposable implement. In a particular medical procedure, a multitude of instrument exchanges may be required, and the system of the present invention is readily adapted for quick and easy instrument exchange. Because the receiver is maintained in a fixed position, the surgeon can easily exchange instruments by readily decoupling at the modules 506 and 526. The ease of exchanging instruments lends to the portability of the slave station. This portable nature of the slave unit comes about by virtue of providing a relatively simple flexible instrument in combination with an adaptor (module 506, module 520, carriage 508 and associated components) for supporting the flexible instrument. Overall, the slave station is of a relatively small configuration. Because the slave unit is purely mechanical, and is decouplable from the drive unit, the operator can readily position the slave unit. Once in position, the slave unit is then secured to the support, and the mechanical cabling of the slave unit is then attachable to the drive unit. This makes the slave unit both portable and easy to position in place for use.
Another aspect of the present invention provides a system for repairing a cardiac valve, such as a mitral valve. Current mitral valve repair techniques, either open or minimal access, require the surgeon to place the patient on cardiopulmonary bypass and stop the heart. The left atrium is then opened and exsanguinated to allow the surgeon to perform the repair. This aspect of the present invention provides a minimally invasive mitral valve annuloplasty technique featuring the following advantages: (1) peripheral venous access; (2) the heart can continue to beat during the repair; and (3) assessment of the correction of valve incompetence in real-time using, for example, Doppler ultrasound guidance.
In one embodiment, the present cardiac valve repair system employs a guide shaft extending from a site outside a patient to an area about the cardiac valve. The guide shaft receives a flexible inner shaft for disposing a tool at the area about the cardiac valve, where the tool is supported at the distal end of the guide shaft. Preferably, the inner shaft has a relatively small diameter enabling percutaneous intravascular and endoscopic surgery. Even more preferably, the inner shaft, and optionally the guide shaft, is capable of accessing the mitral valve from the peripheral circulation, eliminating the need for incisions through the chest wall. In one embodiment, the inner shaft can have a diameter ranging from 8 to 15 French (2.5-5.0 mm). The outer catheter may be constructed from a standard 9 French coronary guide catheter, having a diameter of 2.67 mm and a wall thickness of 0.1 mm. In other embodiments, the inner catheter can have an outer diameter of 1.1 mm and an inner diameter of 0.09 mm. In yet another embodiment, the braided stainless steel cables are 0.63 mm in diameter and are capable of transmitting 178 Newtons (40 lbs. approx.).
A feature of this aspect of the present invention is that the percutaneous access to the mitral valve can be accomplished on a beating heart, eliminating the risks associated with cardiopulmonary bypass (CPB). To enable a procedure on the beating heart, preferably the procedure can be performed under physiologic conditions. The physician may monitor the procedure by, for example, transesophageal echocardiography, instead of a video image. This technique enables real-time assessment of the correction of the mitral valve regurgitation (MR) during the procedure, further enabling intra-operative provocative cardiac testing, with preload and afterload challenges and cardiac pacing all under trans-esophageal echo and trans-thoracic ultrasound guidance to optimize repair.
The tool can be remote controlled, as described herein, and can be designed for use in any procedure of the cardiac valve repair process. For example, a first set of tools is capable of percutaneous mitral valve annuloplasty. This represents a paradigm shift in management of disease from MIS and open surgical to intraluminal interventions. While this catheter-based intervention is described in connection with mitral annuloplasty, the technique can also be applied to other structures such as, by way of example and not limiting, the billiary tree, the genitourinary tract and intraventricular neurosurgery.
The system further includes a retainer at the area of the cardiac valve, where the retainer is attached to an annulus of the cardiac valve. As will be described in greater detail below, the retainer is closeable via the tool to draw the annulus into a smaller diameter.
In one embodiment, a trans-septal guide catheter is used to guide and support an inner catheter. The guide catheter is introduced by percutaneous access, and allows the clinician to access the left atrium via the venous circulation, i.e. through the heart wall (see
Once access to the left atrium is established, the inner catheter is threaded into the left atrium through the guide catheter. The inner catheter contains attachment anchors for deployment at desired points around the mitral valve annulus. A remote controlled 5-degree-of-freedom tool and wrist can be utilized to precisely reach the annulus. Ultrasound may be used to visualize the system and guide the anchor positioning and placement. This ultrasound may be trans-esophageal ultrasound or trans-thoracic ultrasound, for example. Furthermore, electrophysiologic signals of the heart may be used to aid in precisely locating the position of the tool at the fibrous mitral valve annulus.
There is now described a number of techniques employing the catheter apparatus of the present invention. These techniques are described herein primarily in connection with mitral valve repair.
In one embodiment, threading or sewing a ring about the annulus reduces the annulus diameter, where the ring is closeable. The annulus comprises relatively tough tissue just above the top of leaflets. As viewed in
To carry out the technique of the present invention, a guide catheter 230 is employed, such as a transseptal atrial guide catheter. The access for catheter 230 is via the vena cava to the right atrium 221. This access may be from above via the jugular vein or below by way of the femoral vein. A puncture is made in the wall 238 of the right atrium into the left atrium 220, allowing distal end 232 of catheter 230 to pass into the left atrium 220.
Once the straightened wire 100 has passed through the catheter, it assumes the position shown in
As an alternate to the use of a balloon 234, a malecot 236 may be used. This is a mechanical device with expandable wings, as illustrated in
After guide catheter 230 is in place with the balloon 234 inflated to secure it in position, flexible catheter 240 is threaded through guide catheter 230 to a position just about the mitral valve, as illustrated in
After a single threading or sewing has occurred, such as in
Initially, once the threading through the base of the valve ring is completed, the outer tube 254 engages securing piece 256 moving it downwardly in the view of
Once the securing piece and the retaining button are firmly held to the wire 212, then the member 250 may be withdrawn through the guide catheter 230. The flexible catheter member 240 may then be reinserted with a different tool such as a pair of scissors for cutting the exposed end of the fiber 212.
Another possible technique for reducing the annular diameter involves a loop of cable that extends through hooks or anchors placed in the annulus, as illustrated in
In one embodiment, the flexible instrument comprises a guide catheter 150, as illustrated in the diagram of
Guide catheter 150 may be approximately 8 French in diameter with a computer controlled flexible end portion, illustrated in
A tensioning cable, such as the cable or wire 162 illustrated in
After the crimping or securing step, then the cable crimper is removed and the cutting catheter 182 is introduced as also illustrated in
As indicated previously, the proximal end of the catheter is comprised of a disposable coupling mechanism that engages a drive mechanism, such as is shown in
In one embodiment, a drive unit is coupled with the inner shaft and the guide shaft independently, the drive unit capable of independently effecting movement of each shaft to at least one degree of freedom.
For each coupler element, rotary disks transmit motion from the remotely controlled drive system to the catheter articulations. By way of example, in a first coupler element, a horizontal disk may drive the distal flexure. Another element may include disks, which control the axial and/or rotary positions of the inner catheter and, for example, the advance of the anchors. All of the coupling elements are mounted on a slider or sliders, which allows independent control of the linear advance of the outer and inner catheters. Again, refer to
In accordance with the technique, such as described in
Another feature of the present invention provides a system for closing the base of a cardiac valve, such as a mitral valve. The closing can occur primarily by a stapling technique in which staples are attached to the valve ring or annulus to draw the annulus into a smaller diameter. In this way the leaflets are then more appropriately positioned for opening and closing.
Balloon 334 may be supported at distal end 332 of guide catheter 330. Once guide catheter 330 is positioned at a desired location, balloon 334 is inflated to secure guide catheter 330 to the wall with end 332 extending into the left atrium. Once balloon 334 is inflated, it can be snugged back against the septal wall between left atrium 220 and right atrium 221. The inner diameter of the catheter 330 may be on the order of approximately 5 mm in diameter. As an alternative to balloon 334, a malecot may be used, i.e. a mechanical device having expandable wings capable of securing catheter 330 against septal wall 238.
Guide catheter 330 coaxially nests flexible catheter 340 and its associated staple delivery system 342. With regard to this catheter construction, reference is made to a co-pending provisional application, Ser. No. 60/269,200 filed Feb. 15, 2001, as well as pending application PCT serial number PCT/US00/12553, filed Nov. 16, 2000, both of which are incorporated by reference herein in their entirety.
After balloon 334 is inflated to secure guide catheter 330 in position, flexible inner catheter 340 is threaded through guide catheter 330 to a position just above mitral valve 210, as illustrated in
Flexible catheter 340 is manipulated to cause a stapling about annulus 211 of mitral valve 210. The releasing of each staple is controlled by a mechanism preferably within flexible catheter 340 and operable from a user interface station remote from the subject. Once all of the stapling has occurred, wire 312 is pulled in the direction of arrow 361 in
A plurality of staples 350 having loops 353 encircling fiber 312, secures fiber 312 to the annulus of the mitral valve, terminating at points 345 and 356. The procedure of looping fiber 312 and stapling can be performed via remote control from a master station under surgeon control with multiple degrees-of-freedom of the tool so as to accurately locate the implant fiber 312 and staples 350.
Fiber 312 is fixedly secured to end staple 350 at point 345. The remaining staples are free to glide along fiber 312. When all the staples are secured about the annulus, fiber 312 may be cinched down under ultrasonic guidance, watching for a reduction or elimination of the valve regurgitation. Once adequate tension has been placed on the cable 312, tension can be maintained without disengaging the closure system. This allows the clinician to monitor the patient for some period of time to confirm that the repair has taken place. Once the clinician is satisfied with the repair, the cable can be locked off with a crimp or by some other technique and the cable may then be cut.
Another feature of the present invention is that the technique can be performed under physiologic conditions. The physician can monitor the procedure by, for example, transesophageal echocardiography, instead of a video image. The aforementioned "lasso" technique enables real-time assessment of the correction of the mitral valve regurgitation (MR) as the "lasso" is tightened. This enables performance of intra-operative provocative cardiac testing, with preload and afterload challenges and cardiac pacing all under trans-esophageal echo and trans-thoracic ultrasound guidance to optimize repair.
An alternate embodiment of a staple is illustrated in
Once the catheter and balloon are in place, such as illustrated in
After the anchors are seated, as illustrated in
Several different techniques may be used for guiding the catheter 402. For example, transesophageal ultrasound or transthorasic ultrasound may be employed. Also, radiopaque dye fluoroscopy or electrophysiologic techniques may be employed for positioning of the catheter.
The tether can be placed about the mitral valve and tightened by using coaxial inner and outer catheters. The concepts illustrated in
The aforementioned techniques for guiding the catheter may also be used for monitoring the effectiveness of the technique of the present invention. By monitoring the positioning of the balloon, one can assure that the ends of the tether are preferably at the trigone area. Also, as the tether is tightened, the surgeon may monitor the mitral valve activity to determine whether the valve base ring has closed properly so as to reduce or eliminate valve regurgitation. Tether ends may be secured by knotting the ends thereof so as to hold the tether in a closed position.
The techniques described herein may also be applied in other medical procedures involving repair of other anatomic body members. For example, the techniques described in
The present invention provides a relatively simple system, both in the construction and in its use. The capability to decouple components at the drive unit and the receiver results in a readily portable and readily manually insertable flexible instrument system that can be handled quite effectively by the surgeon or assistant when it is to be engaged with the patient. Only a minimal number of components are positioned within the sterile field, enabling facile manipulation about the surgical site. An advantage of the system of the present invention is the decoupling nature of the system. In the system of the present invention, the instrument, drive unit and controller are inherently decoupled (attachable and detachable). The decouplable design enables the slave station to be readily portable. The instrument can be maintained as sterile but the drive unit need not be sterilized.
The instrument of the present invention is relatively small because the actuators are not housed in any articulating structure in the system of this invention. Because the actuators are remote, they may be placed under the operating table or in another convenient location and out of the sterile field. Because the drive unit is fixed and stationary, the motors may be arbitrary in size and configuration. Finally, the design allows multiple, specialized instruments to be coupled to the drive unit, allowing a user to design the instrument for particular surgical disciplines.
Having now described a limited number of embodiments of the present invention, it should now be apparent to those skilled in the art that numerous other embodiments and modifications thereof are contemplated as falling within the scope of the present invention.
|Citing Patent
|Filing date
|Publication date
|Jun 13, 2007
|May 29, 2012
|Hansen Medical, Inc.
|Coaxial catheter system
|Jul 11, 2006
|Jun 19, 2012
|Catheter Robotics, Inc.
|Remotely controlled catheter insertion system
|Mar 18, 2011
|Mar 18, 2014
|Catheter Robotics Inc.
|Remotely controlled catheter insertion system
|Feb 18, 2014
|Aug 21, 2014
|The Research Foundation For The State University Of New York
|End effector for surgical system and method of use thereof
|U.S. Classification
|International Classification
|Cooperative Classification
|European Classification

subset: commoncrawl


text:
Arts And Crafts
At-Home Crafts For A Rainy Summer Day
Summer showers may not happen very often where you live but when the sky does open up and the kids can't play outside then it's time to get creative.
Homemade Mother's Day Gifts Kids Of All Ages Can Make
For a unique Mother's Day gift, you can't go wrong with a homemade craft from your child. The following crafts are geared to specific ages, but all are sure to delight mom.


text:
The North Face Mens Redpoint Jacket is the mountain mans insulated jacket for all seasons. The nylon shadow rip stop shell is insulated with PrimaLoft© Eco which uses a minimum of 50% recycled fibres. Great as a base camp or belay jacket, it is also ideal as a backup insulated layer as it packs up into its own pocket for ease of storing. Bound cuffs and a hem cinch cord help lock out heat sapping wind. The North Face Mens Redpoint Jacket is an essential mountain coat for trekkers and climbers alike.
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text:
MURRAY — On the brink of heading into overtime, and the postseason dreams of Murray's 21-1 boys basketball team in serious jeopardy at home, coach Darin Wookey decided it was best to let things play out.
An upstart Martensdale-St. Marys team, coming in at 12-10, had tied Tuesday's Class 1A District 12 semifinal game at 47-47 on a drive by Gage Gavin with eight seconds left.
Mustang assistant Danny Jensen turned to Wookey and asked if he wanted to take a timeout.
"Heck no," Wookey responded. "We're going to let him go the full length of the floor and see what happens."
Not a bad plan when the guy with the ball is senior Austin Halls, a 2,000-point scorer, the state's all-time steals leader and one of the top assist leaders. A playmaker.
Flying full-speed up the middle of the court, Halls saw teammate Pat Kilmer — who made a clutch tip-in at :39 to put Murray up 46-45 — running down the right side of the court. Several Blue Devil defenders started to converge on Halls to slow his progress.
"I thought I had a pass to Patrick on a back-door cut to the hole, because he beat his guy down the floor," Halls said. "All I had was a defender in the way, so I thought if I jumped, he'd step up. And he did. By that time I was getting slapped on the wrist, and just followed through (shooting motion)."
With three seconds left, Halls was sent to the free throw line after Trent Verwers was called for the shooting foul in 3-point territory.
Halls missed the first attempt, but made the next two. Martensdale-St. Marys tried to quickly advance the ball up the right side of the floor, but there was a slight fumble on the pass and the buzzer sounded before a shot could be taken.
Murray advanced with a 49-47 victory to the district final matchup with Mount Ayr, scheduled Thursday at Truro. Mount Ayr knocked off Lamoni, 44-40, in Lamoni.
"Words can't express it," senior Cody Scroggie said, upon seeing Verwers whistled for the foul against Halls. "He's a confident free throw shooter and we all have trust in him. As a senior, you don't want to see your year end. As hard as we've worked since sixth grade."
Shooting woes
The game was close because Murray couldn't convert steals to points in the first half. A barrage of missed layups and 0-for-10 shooting from behind the arc contributed to 7-of-33 shooting from the field in taking a 19-16 halftime lead.
"The one thing we did praise our team on at halftime was their defense," Wookey said. "Give Martensdale-St. Marys credit, they came out and hit some big shots in the second half and just hung around. I just kept looking out there at all of our seniors, and I thought they're going to get this done. I just know they are."
Scroggie, all-state receiver who signed a National Letter of Intent this week to play football at Graceland University, got a hot hand in the second half with 15 of his team-high 18 points. Halls, meanwhile, shot 8-10 at the free throw line in finishing with 14 points.
Martensdale-St. Marys coach Joe Franey was disappointed after the game about such a critical foul call at the end. He said his team carried out the game plan.
"After everything they let go, and then call that," he said, shaking his head. "Overtime is where it should have been. We defended them much better than when we played two weeks ago, and we were more aggressive to the hole."
Franey said Kilmer's timely putback on Scroggie's miss with 39 seconds left was the key. Moments later Murray's Andrew Rider stole the ball and was fouled, making one free throw for a 47-45 Mustang lead.
"We're up one and they get that rebound and putback with about 30 seconds left," Franey said. "If we get the rebound there, who knows? They'd have to foul us, being up one."
District final
The Mustangs found a way to survive and advance. Next up is a talented Mount Ayr team that has been bolstered late in the season by the return of post player Jacob Sobotka from a football ankle injury.
"They have (Braydee) Poore, (Jake) Still and Sobotka, all those guys are good players we grew up playing against," Halls said. "We know Mount Ayr, on any given night, can beat anyone else. If we shoot better, we're pretty confident. Our defense is playing well."
Wookey said it's a tougher challenge awaiting his eighth-ranked team than when the Mustangs opened with a 64-50 victory over the Raiders on Nov. 26.
"Mount Ayr is a good ballclub," he said. "With Sobotka back, they are even more dangerous than they were. We're going to have to play. We will not shoot that bad again."
The Mustangs missed their first 15 3-point attempts before Scroggie converted from behind the arc with 1:45 left in the third period. For the game, Murray was 2-20 on treys, and only 31 percent from the field overall.
The winner of the district final takes on the District 11 winner of 11th-ranked Ankeny Christian vs. Guthrie Center Saturday at Urbandale.
MARTENSDALE-ST. MARYS (47) — Gage Gavin 6 2-4 17, Garrett Gehringer 5 3-6 13, Miller Hatcher 1 3-4 5, Eddy Kraber 1 2-4 5, Trent Verwers 1 0-0 3, Luke Anctil 1 0-0 2, Connor Dunn 1 0-0 2. Totals — 16 10-145 47. 3-point goals — 5 (Gavin 3, Kraber 1, Verwers 1). Team fouls — 17. Fouled out — Hatcher.
MURRAY (49) — Cody Scroggie 6 4-6 18, Austin Halls 3 8-10 14, Sam Rockhold 3 0-0 6, Matt Johnston 2 0-0 4, Andrew Rider 0 3-8 3, Eddie Otto 1 0-0 2, Pat Kilmer 1 0-0 2. Totals — 16 15-24 49. 3-point goals — 2-20 (Scroggie 2). FG shooting — 16-51(31.4 percent). Rebounds — 25 (Johnston 7, Halls 4, Rockhold 4). Assists — 5 (Halls 4). Steals — 17 (Halls 6, Rider 6, Scroggie 4). Blocked shots — 3 (Kilmer 2, Johnston 1). Turnovers — 11. Team fouls — 16. Fouled out — None.
Mart.-St. Marys — 8 16 28 47
Murray — 10 19 31 49


text:
It seems my fan isn't kicking on, on my millermatic 200 I'll be welding hot and it will slowly decrease to cold. Any ideas of how to check to see if my fan is still good? Thanks jake
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Thread: fan not working
07-27-2013, 12:43 PM #1Junior Member
- Join Date
- Jul 2012
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- 12
fan not working
There is a thermostat/thermocouple somewhere on the transformer (TP1). It could be failing. That would be the first thing I would check. Or jumper it and see if the fan stays on.
Great machine, worth fixing.Nothing welded, Nothing gained
Miller Dynasty700DX
3 ea. Miller Dynasty350DX
Miller Dynasty200DX
ThermalArc 400 GTSW
MillerMatic200 with spoolgun
Lincoln SP-170T
Linde UCC305 (sold 2011)
Hypertherm 1250
Hypertherm 800
PlasmaCam CNC cutter
Fadal Toolroom CNC Mill
SiberHegner CNC Mill
2 ea. Bridgeport
LeBlond 15" Lathe
Haberle 18" Cold Saw
Doringer 14" Cold Saw
6 foot x 12 foot Mojave granite
07-29-2013, 08:06 AM #3Senior Member
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It depends on serial number if it has fan on demand


text:
Troya Renee Yoder, MS
Most people have heard over the years that cardiovascular disease is the number one killer in the United States. Cardiovascular disease comes in many forms, any of which may lead to a
heart attack
stroke. What you may not know is that men and women may have different heart attack risk factors and warning signs.
If you're a woman, heeding the subtle warnings can make a significant difference.
Your heart is a constantly running pump and needs a constant source of oxygen for fuel. The oxygen is picked up in the blood and delivered to the heart muscle through blood vessels called arteries. Blockages or damages to these coronary arteries slow or block the flow of blood to the hard working heart muscle. In a short period of time the lack of blood flow causes damage to the heart muscle and a heart attack. If the oxygen is restored quickly, long term damage may be prevented. Continued lack of oxygen can cause significant damage to the heart which can lead to disability or even death.
The most common cause of a heart attack is
coronary artery disease
(CAD). These conditions are caused when fatty deposits, called plaque, build up on the walls of the arteries. This build up causes a narrowing of the arteries that restricts the blood flow. This plaque can also cause a tear or rupture in the artery, which leads to the formation of a blood clot. The blood clot can cause a sudden blockage in the blood flow in the artery.
Sometimes, a blood clot can break free from another part of the body and make its way into one of the arteries that supplies the heart. This clot will also block the blood flow. Other times, a spasm of the artery can contribute to a heart attack.
When it comes to heart attack symptoms, men and women share several similarities.
Similarities in symptoms include:
Women often have other, more subtle symptoms that may seem confusing, and not so obvious.
Other common symptoms in women may include:
Remember that some of these symptoms can occur over hours, days, or weeks. If you feel these symptoms, don't wait more than five minutes to call for medical help. Even if you have a friend or relative with you, call for medical help rather than drive. If necessary, paramedics can start life-saving treatment on the way to the emergency room. This early care can determine how well you recover.
Most women believe that the breast cancer is their biggest threat to good health. The fact is, heart disease kills six times as many women as breast cancer. This makes heart disease is the number one killer among women as well as men.
There are several factors that increase your chance of having a heart attack. The more factors you have, the higher the risk of a heart attack. In men and women, many risk factors are the same.
Uncontrollable risk factors are those you can't change. These factors include:
Controllable risk factors include those that can be modified by lifestyle changes and medications. These include:
Other factors that are specific to women include:
Before menopause, women have a slightly lower risk of heart attack than men. However, postmenopausal women have similar risk for heart attack as men.
To help reduce your chances of a heart attack, take these steps to modify your lifestyle:
In addition to lifestyle changes, you need to monitor and take care of other health conditions. You can do this by:
Change is not always easy, so start slowly. The more risk factors you control, the better chance you have to ward off a heart attack. Talk with your doctor about the best course of action for you.
Take the time to learn the signs of a heart attack, and don't be afraid to call for medical help.
American Heart Association
National Coalition for Women with Heart Disease
Heart and Stroke Foundation
Public Health Agency of Canada
Cardiovascular disease prevention overview. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed/what. Updated June 13, 2013. Accessed August 12, 2013.
Coronary artery disease major risk factors. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed/what. Updated July 1, 2013. Accessed August 12, 2013.
Coronary artery disease possible risk factors. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed/what. Updated August 5, 2013. Accessed August 12, 2013.
Explore how the heart works. National Heart, Lung, and Blood Institute website. Available at:
http://www.nhlbi.nih.gov/health/health-topics/topics/hhw. Updated November 17, 2011. Accessed August 12, 2013.
Heart attack symptoms in women. American Heart Association website. Available at:
http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Heart-Attack-Symptoms-in-Women_UCM_436448_Article.jsp. Updated June 25, 2013. Accessed August 12, 2013.
Heart disease. Women's Heart Foundation website. Available at:
http://www.womensheart.org/content/HeartDisease/heart_disease.asp. Accessed August 12, 2013.
Mosca L, Benjamin E, Berra K, et al. Effectiveness-based guidelines for the prevention of
cardiovascular disease in women—2011 update. Circulation. 2011;123(11):1243-1262.
Non-invasive tests and procedures. American Heart Association website. Available at:
http://www.heart.org/HEARTORG/Conditions/HeartAttack/SymptomsDiagnosisofHeartAttack/Non-Invasive-Tests-and-Procedures_UCM_303930_Article.jsp. Updated April 15, 2013. Accessed August 12, 2013.
ST-elevation myocardial infarction (STEMI). EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed/what. Updated August 8, 2013. Accessed August 12, 2013.
The healthy heart handbook for women. National Heart, Lung, and Blood Institute. Available at:
http://www.nhlbi.nih.gov/health/public/heart/other/hhw/hdbk_wmn.pdf. Updated March 2007. Accessed August 12, 2013.
Warning signs of a heart attack. American Hearth Association website. Available at:
http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Warning-Signs-of-a-Heart-Attack_UCM_002039_Article.jsp. Updated March 22, 2013. Accessed August 12, 2013.
Last reviewed August 2013 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.
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text:
Lazy Hill Cambridge Lantern Post
The Cambridge Lantern Post stands out in front of any home for welcoming feel to your home.
Lazy Hill lanterns posts have dignity and charm and are as welcoming in the daylight as they are when illuminated at dusk.
These handcrafted Natural Northen cedar posts will endure the elements year after year. All lantern posts are of sufficient length to allow for up to a 30" burial and made to accept a standard 3" collar lantern. Lantern not included.
Made in the USA.
Dimensions: 4.5" L x 4.5" W x 104" H; 53 lbs.
Lazy Hill Cambridge Lantern Post
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Book now to enjoy your gift on the day or make a last minute purchase and save the experience for a later date! Whether you're after something special for a secret crush, the perfect gift for a hot date or you just want to show your partner how much they mean to you, let us play Cupid and browse our range of Valentine's Day gifts and experiences to suit every taste and budget.
We have a number of gifts for him from driving experiences to stadium tours, as well as a great selection of gifts for her including afternoon tea experiences, relaxing spa days and pamper breaks for her. Perhaps go down the more traditional route and choose from our range of Valentine's Day flowers.
If you want to make the evening even more memorable, we also offer a wide choice of restaurant and theatre vouchers for top locations all over the UK - or why not combine the two with any of our dining packages with a London show? Want to really push the boat out? Then how about taking the one you love on a romantic day trip to Paris?
For something a little more adventurous, one of our exhilarating adrenaline experiences is sure to impress. Choose from a wide selection of activities including a hair-raising lover's leap tandem bungee jump or an exhilarating tandem skydiving experience.
Whatever you choose, we can help make this Valentine's Day, one to remember.
234 Products found in Valentine's Day


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If you're the kind of person who pours yourself into the details of your space—the shape of a molding, the feet of a sofa, the finish of a floor—you know that even a single bulb can redefine a room. The Hairpin T9, part of Bulbrite's new Nostalgic Collection, is a vintage-inspired Edison lightbulb that will glow invitingly, evoking the warmth of a different era.
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At what other event could the secretary of Homeland Security sit down with the bombshell announcer from ESPN? Where else could "Donny" from The Big Lebowski sit down with the senator who replaced Ted Kennedy. The answer: No place other than the White House Correspondents' Dinner, the annual presidential roasting (or light toasting) attended by members of the media, their guests, and their sources. Media organizations are starting to release their guest lists for this year's dinner, which will take place on April 30. Click through to see some of the biggest—and most surprising—names announced so far.
The New Yorker: Zach Galifianakis, the Coen Brothers, and Jon Hamm.


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Guest DJ: Travis
Check out Travis' Guest DJ'd station on iHeartRadio
Travis has been rocking all over the world for over 20 years now. And this year, the Scottish band has released their 7th studio album called Where You Stand.
[Buy Where You Stand on iTunes]
Travis teamed up with iHeartRadio when they were in New York City recently to Guest DJ a radio station that represents their personal taste. Check out their favorite tracks and the stories behind them below!
1. Pink Floyd - "Bake"
Fran: I first heard this in 1990 on an art course in Scotland, and I'm a very late developer, musically. I didn't have brothers or sisters; we didn't get a record player until I was like 13. When I heard this song it sort of blew my mind and we played it a lot and we learned [it] on guitar, and we played [it] to death (laughs). Whenever I hear [the song], like most songs, it transports you back to that moment. Actually I went out and bought The Piper at the Gates of Dawn and actually the other day played that Vinyl. It's so scratched, it's ridiculous you can barley hear the music note. So we used that for our intro music.
2. ACDC - "Back in Black"
Andy: This song is the reason I play the guitar. When I was young I never really listened to Pop or Rock music, it was always like classical music for some reason. And then I heard this song, and I just thought I have to have the guitar. It just makes it sound like the coolest thing in the world and it still does. When I hear "Back in Black" it makes me wanna play a guitar.
Fran: Joni Mitchell, sort of the reason why I started writing songs, the way I write songs. This song is called "A Case of You" it's from the album Blue. The whole record is this immense sort of emotional trip. She had just split up with Graham Nash, she went to Europe to sort of clear her head and this song is very much typical of that record. There's a great line in it where she says, well it's the hook line, "I can drink a case of you and I'd still be on my feet" which is amazing, beautiful. But she's saying "I can take you, I'm just so much better than you, but yeah I love you, I could drink a case of you" and what a lovely thought.
3. Teenage Fanclub - "The Concept"
Andy: They were a band that we always aspired to be like when we were floating around in Glasgow, cause they made it, and it made us feel like we can do it too.
Fran: I remember when we were doing our demo before we moved to London. Teenage Fanclub were in the same recording place with Alex Chilton from Big Star and they were rehearsing for a show in Glasgow. I remember Norman coming over and just popping his head around and we were this little band. He gave us his equipment. He's like "look at your gear it's rubbish, you have really rubbish gear" and he's like "here" and gave us his box amp and his big giant Gibson guitar they all they were just… So yeah, they're a great band.
4. Friends - "I'm His Girl"
Fran: This is by a band from Brooklyn, or New York. I saw them play, and one of the cool things about living in Berlin is that a lot bands come through the city and you get to see them in really small venues. And my friend Wolfgang, German name, took me to see Friends. He really liked this band. Wolfgang is 60 years old and he works for the German "Rolling Stone." He's kind of like the John Peel of Germany. So yeah we went to see Friends and we had no idea that one of her things, she comes off the stage and rubs guys faces in a really funny way. And it happens quickly, so we were maybe two [rows] back and she sort of hopped off the stage, and thankfully she got the guy in front of us. I've never seen my friend Wolfgang move so fast in his whole life.
5. U2 - "The Unforgettable Fire"
Andy: This to me is the U2 album, the whole album The Unforgettable Fire and that's what I kind of love about U2 is everyone's got an album that sort of defines themselves a bit. Everyone's different, but this reminds me of being at a hospital in Glasgow with my appendix out, and those little walkman tape players. And it was the only thing I had, and there was nothing to do except listen to this all day, and it just was brilliant.
6. The Small Faces - "Lazy Sunday"
Andy: This is one of the songs in high school, everybody used to buy a bottle of cheap wine. Well we used to drink Thunderbird wine and Douglas, which I believe is a tramp wine! But it did the job and we couldn't really afford much more at the time. So me and Douglas we'd get a bottle of Thunderbird wine, everyone would grab an acoustic guitar and head up to the Plint making building, which is just a good old building for everyone to sit in. It had nice acoustics, and [we would] sit and play songs and sing songs and get drunk, and this was one of the big songs we'd usually end a night with. It just makes me think of Thunderbird wine.
7. Pavememnt - "Trigger Cut"
Fran: I heard [this song] again when we were all at art school. A friend of ours, Toby, played it to us, and that album became the soundtrack to my first year of art school. Fast-forward to just last year, and I heard that Steve Malkmus was in Berlin, and I thought, I knew Nigel Godrich, and I met Steve when I worked with Nigel. So I got his e-mail, and said "hey man let's go out for a drink." We figured it out and the night came and I'm a super fan, so I'm trying to be really cool. And so my door goes and I open the door and there's Steve and he's like "Dude, I live across the street (laughing) I can see in your house from my window." I go "oh my God, had you told me that when Toby first played me that all those years ago!" Anyway we went out and had a great night – he still doesn't know I'm a super-fan. He's back now in America, so maybe he'll hear this ... and if you do it's a confession – I love you! (laughing)
8. Talking Heads - "Once In A Lifetime"
Andy: Obviously done by Brian Eno, the Talking Heads, and we had good fortune to do a couple of days with Brian in the studio. One thing I never realized of him - cause you think all this cool music – is he just loves to sing. It's the one thing more than anything he loves to do is sing. And this record you can hear him all over it cause he's got really polished voices. We were doing stuff with him and he'd take it back to the studio, and just sing all over it.
Fran: There would be 100 voices on it like a barber shop. He's right in the barber shop (laughing). So whenever I hear this all I can hear is Brian's voice in the background.
9. R.E.M. - "Sweetness Follows"
Fran: It's one of those art school soundtrack records – it's autumn, I'm outside the Calvin Grove Art Gallery in Glasgow, this is on my car stereo on repeat all the time. Whenever I hear this song it takes me back to that moment.
Andy: It was kind of a template for a band their was something to aim towards.
Fran: Yeah R.E.M. are, for me, if we could be like R.E.M. that would be – so I think there's a lot of R.E.M. in Travis even if you don't really hear it.
Listen to Travis' "Where You Stand" below!
Photo Credit: Katherine Tyler for iHeartRadio


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USA made nectar feeder boasts art quality kiln-fired colored glass for a chic new way to attract hummingbirds. Schrodt Designs Ruby Hummingbird Lantern Feeder features elegant, modern styling warmed up with hand-lathed redwood and brass hardware. Made from imported French bottles, kiln-fired to an iridescent luster, this gorgeous feeder is sure to draw the attention of hummingbirds as well as fellow hummingbird lovers.
Schrodt Designs Ruby Hummingbird Lantern Feeder is easy to fill and clean, featuring a redwood cap and a redwood base with a molded perching ring for hummingbirds. Protective brass cone features three ruby flower-feeding ports designed to discourage unwanted yellow jackets and bees. Guaranteed leak-free design. 2-3/4" long brass hanging chain included.
Schrodt Designs Ruby Hummingbird Lantern Feeder measures approximately 5" x 5" x 13"high. 14 oz capacity.
Shop all Wild Bird Feeders.
Please click on "More Information" for directions for use.


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Kalani Luau Lantern
Create an awesome lightning effect.
The perfect functional decor for any room or party theme.
The Kalani Luau Lantern™ is a polyresin piece that may be used indoors and outdoors with its removable electric cord set. You can easily replace it with a candle or Sterno and liven up your room with a tropical feel!
Dimensions: 4"L x 4"W x 6"H
Weight: 6 lbs.
Kalani Luau Lantern
Kalani Luau Lantern
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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Sew Lovely
This beautiful new Sew Lovely collection from Papermania has been inspired by crafting at home and the increase in popularity of homemade gifts. These sewing inspired images are on-trend and you can layer up or freestyle to create your own designs.
See Jen and Cyn's video on what you could make with this brilliant new papercraft range!
Sew Lovely Products
Sew Lovely - A5 Stitched Decoupage Medley Card KitSKU: 703424
Only £1.69


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Ghosts of Girlfriends Past
Comedy, Romance
Celebrity photographer Connor Mead loves freedom, fun and women--in that order. A committed bachelor who thinks nothing of breaking up with multiple women on a conference call, Connor's mockery of romance proves a real buzz-kill for his kid brother, Paul, and a houseful of well wishers on the eve of Paul's wedding. Just when it looks like Connor may single-handedly ruin the wedding, he is visited by the ghosts of his former jilted girlfriends, who take him on a revealing and hilarious odyssey through his failed relationships-past, present and future. Together they attempt to find out what turned Connor into such an insensitive jerk and whether there is still hope for him to find true love... or whether he really is the lost cause everyone thinks he is.
Cast: Jennifer Garner, Matthew McConaughey
Produced by: Jonathan Shestack
Directed by: Mark Waters
Written by: Jon Lucas, Scott Moore, Jeff Nathanson
Running time: 1hr 40min
Opens: May 01, 2009 Nationwide
|Theaters for Today
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on this day.


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Kanye West 'Theraflu': MC Admits Love for Kim Kardashian, Takes Aim at Kris Humphries
Kanye West leaves nothing to the imagination on his new track "Theraflu," which features DJ Khaled and production by "N----s in Paris" hitmaker Hit-Boy. The candid G.O.O.D. Music rapper admits his love for Kim Kardashian on the track and subsequently bashes her ex-


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Drudge Report Thinks New Spider-Man 'Could Be Gay,' Glenn Beck (and Colbert) Protest Diversity
The media has predictably worked itself into a frenzy over the news that the new Spider-Man of Marvel Comics's Ultimate line is going to be half-black and half-Hispanic, with right-wing commentator Glenn Beck bizarrely attributing the character to First Lady Michelle Obama, and the Drudge Report even more bizarrely suggesting that the character "could be gay." I mean, I don't know. I guess he could be gay, in the same way anyone you meet at random could potentially be gay. And yet I so rarely drop that afte


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We are proud to offer ground-breaking technologies like Air Protect® and use advanced testing facilities in Columbus, Indiana to take our products to the next level. Check out our articles and videos to learn more about our technologies and how we make our products the best.
Air Protect + The Latest in Car Seat Safety
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Meet the innovative Safety 1st Advance 70 Air + convertible car seat which incorporates both Air Protect® and GCell HXTM, making this car seat positively the safest choice in full body side impact protection.
Success Stories
Air Protect in car seats has made a real difference in the lives of families across the country. View success stories from actual Air Protect customers.
How Air Protect® Saves Lives
Air Protect® Technology is the most innovative safety feature ever offered in a car seat. The technology protects our children at their most vulnerable -- the head.
About Air Protect® Technology
Air Protect® Side Impact Protection is the most innovative safety feature ever offered in infant, convertible and booster car seats. The technology protects our children at their most vulnerable – the head.
The Impact of Side Impact Collisions
Over the past 20 years, the number of deaths related to front impact crashes has declined, while side impact crash fatalities have increased.
Car Seat Testing
Watch how Dorel Juvenile Group crash tests car seats in their new state-of-the-art Technical Center for Child Safety.
Dorel Technical Center
Welcome to the Dorel Technical Center for Child Safety. Take a sneak peek at behind-the-scenes footage of what goes into making a car seat.
Focus on Safety
Learn about how Dorel Juvenile Group helps save the lives of children by manufacturing child safety products.
Dorel Technical Center for Child Safety Tour
Safety 1st recently held an open house at its Dorel Technical Center for Child Safety in Columbus, Indiana. We know most of you couldn't come to Indiana, so our Consumer Safety Expert, Julie Vallese would like to give you a behind the scenes look at how Safety 1st products are tested. Check out the video!
Zero Waste Facility
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Ella's Story - Air Protect
Air Protect is the most innovative safety feature ever offered in a car seat, designed specifically to protect a child during the most dangerous collision of all: a side impact crash. Ella Rose is just one example of a child whose life was saved by this truly remarkable technology.


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Michigan State University on a fall Saturday afternoon...there's no other place like it for Spartans fans! This spectacular poster features a breathtaking aerial view of Spartan Stadium on gameday, packed with green-clad fanatics roaring with delight at every big play. Whether you are a season-ticket holder, an alumnus, or simply an armchair college football fan, this print is for you! Perfect for the wall of home or office.
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The Metropolitan Opera: Tristan und Isolde
Program, Musical
Fathom presents the excitement of The Metropolitan Opera Saturday Matinees - in HD on the Big Screen! The LIVE broadcast of Wagner's Tristan und Isolde will be shown for one day only on Saturday, March 22 at 12:30PM ET / 9:30AM PT in select theatres nationwide. Met Music Director and eminent Wagnerian James Levine conducts this much anticipated revival. Deborah Voigt, one of the world's most celebrated Wagnerian sopranos, undertakes this iconic role for the first time at the Met. The leading Tristan of our time, Ben Heppner, portrays the other half of this archetypal couple on their mystical journey of love, sex, and death.
Produced by:
Directed by:
Written by:
Running time: 5hr 35min
Opens: Mar 22, 2008 Limited
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joey kovar
Singer Mindy McCready Dies In Apparent Suicide
The former country star appears to have taken her own life Sunday afternoon in Heber Springs, Ark. Authorities say McCready died of an apparent self-inflicted gunshot to the head and an autopsy is planned. She was 37, the mother of two young sons.


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Avatar Press Nov 2007 Solicitations
Warren Ellis BLACKGAS TPB
Retail Price: $19.99 US
Cover: Jacen Burrows
Writer: Warren Ellis
Art: Max Fiumara
Readership: MR
Format: Full Color, 144 pages
All six issues of Warren Ellis zombie outbreak tale are collected here for the first time! A tiny little island off the East Coast of America, that sits on its own tiny little fault on the underlying tectonic plate. An odd little history ignored by almost everyone. Until the night of the


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Gertrude Hawk Chocolates is dedicated to crafting the best selection of chocolate products. Our signature Caramel Dipped Apples start with a crisp Granny Smith Apple that are hand dipped in our creamy caramel. Choose to have your caramel apple dipped in milk chocolate, dark chocolate or white chocolate with a variety of yummy toppings. They are dressed up and decorated for every holiday and perfect for all occasions!
Gertrude Hawk Chocolates Caramel Apples are perfect holiday gifts, anniversary gifts, birthday gifts and are perfect for sharing in the office or at dinner parties. Made with only the best ingredients, give a Gertrude Hawk Chocolate Caramel Apple as a gift today!
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Sorry there are no shows for Muffinz Power Quartet (The Muffin Men) right now.
What people are saying about Muffinz Power Quartet (The Muffin Men)
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http://abcnews.go.com/blogs/entertai...-dads-support/Magic Johnsons support for his openly gay son is being applauded.
In the midst of all this media attention i would like to say that i am truly blessed to have parents that love and support me, Earvin Johnson III, one of the former L.A. Lakers stars three children with wife Cookie, tweeted earlier today.
EJ, as he is known, was photographed Tuesday, hand-in-hand with his boyfriend.
In a statement to TMZ, his basketball legend father said, Cookie and I love E.J. and support him in every way. Were very proud of him.
Current Lakers star Kobe Bryant praised Johnson for his statement while pointing out that it shouldnt be surprising.
Of course Magic is supportive of and loves his son. Why should anyone be surprised? Bryant told TMZ. What I cant tolerate is a lack of tolerance.


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Amanda Visell's Wood Idols Return With Batman, Woverine, Wonder Woman And More
A few weeks back, we took a look at Amanda Visell's Wood Idols, a series of hand-carved, hand-painted wooden statues of pop culture icons. This week, Vissell's back with more, and they somehow manage to be even more awesome that first round.
Maybe it's the inclusion of signa


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Information Technology Services
IT Services
VoIP FAQs
What is Voice-over IP (VoIP)?
VoIP, or IP Telephony, is a communication services through voice, facsimile, and/or voice messaging applications that are transported via the Internet, rather than the public switched telephone network. The need to support advanced network applications and emerging technologies with converged technology has become a reality in the industry and, particularly, within the university community. This state-of-the-art system enables Armstrong to build a strong foundation for the future. This allows the campus the ability to manage our phone system internally, enabling us to have access to more features and more applications (i.e., employees will be able to configure various features, such as speed dial), directly on the phone.
What features are available on the IP phone?
The basic features on every phone line are programmed into the new system. Optional features such as speed dial, call display, or distinctive ringing, can be customized by the end user. Other, more enhanced features will be added in the future.
Can I access my voicemail from off campus?
Yes. Voicemail can be accessed from off campus by dialing 344.2501. Press the "#" key as soon as the system answers. You will then be prompted to enter your 5-digit mail box number (your 5-digit extension). After you have entered your mail box number, the system will prompt you to enter your security code. The system will then allow you to check your messages, change your standard greeting, etc
Does the VoIP telephone system provide long distance savings?
The long distance savings is minimal. The real savings comes from the monthly cost of the telephone lines.
Does the VoIP system affect my computer?
No. In some locations the computer is plugged into the phone. This does not impact the usage of your computer.
Will my phone work during a power failure?
Yes. For a limited duration the phone system will have a UPS back-up and will remain useful for at least 30 minutes if power in a building goes out. There will also be emergency phones placed in buildings that will be outside of the phone system in the event of a system wide outage.
Can I view the call logs on my VoIP telephone set?
Yes. There is a call log button on the telephone to view missed, answered, and outgoing calls.
Will I be able to see who is calling?
Yes. The system allows you to see the incoming telephone number and name similar to caller ID.
Do the VoIP telephones have speaker phone capabilities?
All phones have speaker capability.
Can I make my number private?
To have your phone number be private for off campus calls, each time Dial *67, then 9 followed by the off campus phone number. This will work for local and long distance calls.
Can I have my telephone number deleted from the directory?
All phone numbers are listed in the directory. You can change your name to a title or to the phone number but it will not be removed from the directory.
Can I move my telephone to a new office?
No. Please keep all telephones in their current locations.
How do I move my telephone number to my new office location?
Using the VoIP system you can log out of one location and then log into the new location and keep your current telephone number. Click here for the log in/out process.
How do new employees receive telephone numbers?
New employees receive their telephone numbers when they receive their email account. This form should be completed to request a telephone number and email account.
How can I get my side car programmed or pick up groups set up?
Send an email request to the firstname.lastname@example.com and include in the email the telephone numbers you need programmed into the sidecar or pickup group. The Helpdesk staff will create a ticket and get the process started. You will be notified once the process has been completed. If you have questions or problems, please contact the Helpdesk at 344.2518 or by email firstname.lastname@example.com.
Conference Bridge
Log in/out Process
Voicemail and Unified Messaging
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Lau is a contemporary folk three-piece from Scotland, named after an Orcadian word meaning "natural light." The band is composed of Kris Drever (guitar, vocals), Martin Green (accordion, piano) and Aidan Oâ[][]Rourke (fiddle). To date, the band has released two studio albums and a live album. Their debut album, Lightweights and Gentlemen, was released through Reveal Records in 2007. The band subsequently won the "Best Group" at the BBC Folk Awards, 2008. In December 2007, Lau recorded a live set at the Bongo Club, Edinburgh, and in early 2008, released Live. In 2008, they appeared at the Winnipeg Folk Festival, Vancouver Festival and the Calgary Folk Festival. In 2010, the group recorded and released a five-track EP, Evergreen, in collaboration with singer-songwriter Karine Polwart.
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5 December 2006Important buildings in Galashiels, including Gala Fairydean stadium, now have legal protection following a resurvey of the area by Historic Scotland.
For further information


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Would it be permitted to pray in a place where there are services that are mixed with Jews and gentiles? Meaning, a synagogue that also invites gentiles to pray with the Jews (but they all pray from a Sidur).
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Mi Yodeya is a question and answer site for those who base their lives on Jewish law and tradition and anyone interested in learning more. It's 100% free, no registration required.
I've never heard of a synagogue that checks whether people coming in are Jewish or not, turning away those who aren't, so allowing Jews and gentiles to pray together is presumably not forbidden, and therefore, entering a building in which this happens is presumably also not forbidden.
In fact, given that gentiles were invited to bring certain kinds of offerings to the Temple, and entering the Temple certainly wasn't forbidden (at least, not for that reason!), it would stand to reason that synagogues that behave similarly would be treated similarly.