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- Sartaj Anand
- Bangalore
- India
Founder, Egomonk , Melton Foundation
This conversation is closed.
What is the 1 Question you'd ask or Idea you'd share with the TED Team ?
Imagine you have complete access to some of the best speakers in the world, TED Fellows, the TED Team and a bunch of the most talented TEDx organizers on the planet. Now imagine all of this happening in Doha, Qatar on 16th April, 2012.
I'm fortunate enough to have the opportunity to attend the TEDxSummit in Doha and now I ask you to share with me a question or an idea which needs to be heard.
I'll try my very best to ask/share it with them :)
Apr 11 2012: Keeping it simple stupid. Nature has devised simple ways to solve its problems and it has done all of the trial and error work over hundreds of millions of years. So nature knows best what works well and what does not. We should sit back, open our minds, and observe how nature works and extrapolate what we see to formulate ideas that might reveal how nature might fix our own problems in a simple way. Use the concentrated magnified power of the sun to power desalinate sea water through a distillation process. We are then on our way to solving a huge terraculture problem.
Roberta Mura
Mar 19 2012: I would ask if they ever thought of involving people, and particularly the TED community, directly by giving real support so that this great ideas can really spread. What about a TED academy? Or a place where people can really get in touch with TED and start building this fantastic world of the future? TED is a fantastic place but it's in the internet for most of us, and it does not feel like the people involved are really approachable on a daily basis...
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Mar 20 2012: I'm approachable! Now I get the sad face. =(
Hehe, but good point. =PMar 28 2012: Make Live streaming a free service or at least make it a separate service you can purchase. I mean I'm a broke student, spending all my money on my projects trying to get on TED. :D
Apr 12 2012: webstream is indeed separate service and it's called TEDLive - to learn more please check out: http://www.ted.com/pages/TEDLive
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Mar 23 2012: Well, I think they need to hear, that we enjoy getting feedback from them when their talk gets posted.
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It's great when the presenter interacts with us when we post comments. You can thank them for us.
It's also great when those who attend post pictures under the talks......I really enjoy the first hand look at the event.
How exciting!!! I love conventions of all sorts.
Also, I think that it would be interesting if somehow TED or those who attend or are presenters would somehow find a way to invite a commoner, from the online community, to attend....all expenses paid. Then that member can come back and start a conversation about what it was like first hand and I think this would be just phenomenal!!!!!.....We can even help choose the TEDster by nominating individuals on-line......I can dream can't I?
Thank you Sartaj for the opportunity to contribute some whimsical thoughts.
Be Well.Mar 21 2012: Why sea water can not be used for drinking. The solution of fresh water scarcity in the world is to ask scientists to invent a better way to make sea water drinkable.
Mar 22 2012: Supposedly there is a machine to purify cheap and affordable drinking water from sea water, according to this video:
It is pretty interesting. =)Mar 20 2012: Some of the posts on TED are serious requests for different thoughts on a issue. In education some principals ask how to reshape schools or what is ideal, etc .. Administrators often lose touch with the practioners as their focus is totally different. My question is: When a question expires could TED allow the originator to summerize the findings. I would be interested in their takes on the responses and how it has helped them if at all. It would be great if there was a "year later" section that would allow a follow--up on projects / question/ ideas. This would demonstrate the power of the TED community. Thanks for listening. Best. BobMar 19 2012: I want to know how to make the next generation better, so I would ask: What was your biggest obstacle or frustration during your years of conventional education? (Man, as a teacher I would LOVE to see those survey results!)
Mar 19 2012: That is a great question Erik, did you start a conversation to involve the TED community? I would love to comment on it....
Mar 19 2012: Thanks, Roberta! The groups I really want to hear from on this, though, are the TED presenters and attendees.
Mar 20 2012: I am curious of TED presenters and attendees socio-economic situation. Are they 1%?
Roberta Mura
Mar 20 2012: fair enough, so, if you don't mind, I will steal your idea and ask the question myself to the TED community....Mar 27 2012: Id say the biggest obstacle was not being taught how to think, only do. I had a class where the curriculum was thrown out the window, and the teacher made the class think about the material by asking questions relative to how we interacted with the material on a daily basis (the class was on the history of technology)
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I found classes where I had to think about solutions more interesting that the ones where solutions were simply a multiple choice answer on a test.Apr 2 2012: I can tell you my biggest frustration was trying to find a girlfriend!
Mathew Ward
Apr 6 2012: The war on drugs has been raging all my life and drugs seem to be more available and popular than I can ever remember. Unscrupulous people are getting rich off it and not paying tax on their income. This is not new eg the gangsters during prohabition. In the west we conceded the war alcahol but yet we fill goals with drug users and low level suppliers. The idea of making alcohol illegal in the west because some people have a problem has very little support but this is used as a reason to keep other drugs illegal. The illegal nature of drugs has ment that users often don't know what they are taking making their use more unsafe. The hipocracy between alcohol and illegal mind altering drugs seems strange to me and I don't use either. My question is should alcohol be illegal or should other popular illegal drugs be made legal? Some countries have taken this choice what has been their experience what are the pros and cons in doing so? Do we need to rethink the war on drugs as a health issue or do we need to include alcohol in that war?
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Apr 11 2012: I say definitely full legalization. We repealed alcohol prohibition because it created more problems than it solved - by an astonishing degree. Turf wars, cartels enriched, adulterated product, police corruption, high spending on "enforcement" - all the same issues We see with "drug" prohibition - and with the use of drugs (it was never illegal to DRINK alcohol - just manufacture, transport and sell) being illegal, common citizens become "criminals" by merely choosing to exercise Their Human right to ingest whatever They want.
The answer seems pretty clear to Me.
Apr 12 2012: I agree, full legalisation is logical. A human bodily need to 'transcend the mind' dates back to early human civilisations. Just have to bypass the heavy moral roots that it now has in society - not to mention the ones that make the big bucks off it, whether its from those in the streets or in parliament.
Apr 12 2012: And there are so many making money off prohibition! Either directly or indirectly. The CIA, the "drug lords," the pharmaceutical companies, the prison industrial complex, the alcohol & spirits industry, the cotton industry (though here in the US hemp is now allowed to be imported...), the oil companies (hemp oil can run cars and make plastics...), the police departments (property seizure bolsters many departments' coffers - while 80% of People who lose property on mere accusation are never charged with a crime), and on and on.
The solution is to get rid of the need for money, I would say. And it is possible. Add abundantly what money represents: meaningful energy expended, in the form of "free energy" (overunity) and robots to do all necessary work no One wants to do (or not enough People). And overunity has been around since Tesla, but because the power elite know Their power, which relies on money, would dissipate, They keep it hidden and suppressed. Electrogravitics, studied openly in all major aerospace companies in the 1950's, was pulled into black projects late in that decade. It offered overunity and gravity control and drew energy from the zero point field negentropically (negative entropy).
If You are interested in finding out more, check out The End of Entropy in My blog linked in My profile here.Mar 28 2012: What about increasing amount of international TED branches in different countries?
And collaboration with universities.
Apr 2 2012: I think a good idea might be a special out-reach program to selected and recommended students of universities on a temporary basis at first?
Harold Enger
Mar 25 2012: I believe that beings come to earth like we would go say to the desert or the ocean we don't tell every one that were going or coming so why would they.If you are different do you tell people so that they would treat you different,no so if a stranger says there a traveler and you have a beautiful planet .then what?
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Apr 2 2012: Maybe these beings are from the same planet we're all from. Misunderstandings occur and sometimes what we intend to convey isn't easily understood (and some things are not easily said). No one is exactly the same as anyone else but the differences of people are probably not very confusing. Everyone hopes for the best in communicating with other people.
So if someone says they love the planet, it's likely they are expressing a feeling of joy.Mar 23 2012: I am not an engineer and I do not know any thing about electronics or sensors. Yet, I saw a handycam of Sony where when I want to shoot a picture, I saw an icon of Human flashing there. Then I moved it around for a long shot, I saw a tree icon replaced the human icon, when I projected towards sky, then I found clouds icon was there. I was astonished and thought whether these icons can have sounds - so to say - garden, people etc., and if we attach a ear plug can we hear that sound. If that is the case can we input more icons - like bus, troly, car, train, big wall, open drain, gathering, lamp post etc., and with sounds so that - a blind man can wear this handy cam and walk without stick and can hear what is opposite to him?? Is it possible? If it is possible, then we can even input the script of English language and give sound to that...???? Any one in TED convey this to Sony people??? It will help the blind people.
This is my idea...Mar 23 2012: In my profile I wrote the following which in my eyes is still a goal to realized on the short term but I don't hear people about it:
Discriminating is good!
The word however has such a 'bad rep' because of an awefull history of supression. Which actually lead to a special meaning of 'discrimination' (the prejudicial treatment of an individual based solely on their membership in a certain group or category. (Wikipedia)) which is obviously bad.
But to discriminate is: "To perceive the distinguishing features of; recognize as distinct: discriminate right from wrong." (dictionairy).
Why is this an idea worth spreading?
These things get mixed up all to often.
There just are things which women do better than men!
The same mix up gets done in being equal.
People are starting to think that women and men are equal. Which is false! We aren't even equally capable as the brain of men and women is different (women excell in other things than men do). But why have people stopped seeing this as a good thing? Because we are not equal does not mean one is superior!
We are not equal. We need to re-start discriminating!
because the profile only allows 1000 chars that's as far as I got... however please also add:
We must also realize that everyone can be passionate about something else... we have to not see this as a problem but as an oppertunity. Encourage people to do what they love and let them love what they do. And don't train everyone to be the same.Mar 20 2012: It wold seem as though almost everyone is concerned about the 'green' movement and reducing our environmental impact, however the most detrimental issue plaguing our planet is the rapid expansion of the human race. It would be a glorious day if we could save every life in every third world country or even domestically, however if such a thing were to occur the scarcity of resources would be ever more apparent. One could even speculate the explosive population boom is the equivalent of the housing market in 2008, just be prepared for it to collapse in a similar way.
Realistically, how can we combat the catastrophic consequences of species over-saturation(human)?Mar 20 2012: How can we make the World a secure place for our children? How can we protect our children, especially 'The Girl Child' in India?
Apr 2 2012: Also, how can we make the World a secure place for everyone?
Denny M
Apr 10 2012: A life (personal) can radically change in one second.
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What could we learn from all the variable ways a life has changed in that one second?
-Does it ultimately lead to a more humanistic outlook on life.
-Does perception change.
-Could the "change" be placed into a category.
-Would this data base of knowledge help someone's life.
-Radically - could we predict the possibility of when, where, etc. or the conditions that would cause a "change" to occur. Or the results of a specific type of "change".
-(My thinking is more towards a personal individual "change" and not the obvious effects caused by a large scale change such as war, famine, recession, etc.- but certainly not totally disregarding such major "changes".)Apr 5 2012: I'm not interested in arguing with a climate denial troll. I just want to point out that you completely missed my point.
Apr 5 2012: Thank You for that ad hom. [smile] Not arguing at all. Just making a point (which does not deny, BTW, but suggests that profit motive drives the push to blame it on Humankind). Anyway, yes... We need to have an action We each can personally take and I bring an opportunity to do that. If You are inclined, check out My blog linked in My profile for details. Specifically the piece called The End of Entropy.
Or You can choose to remain ignorant of what I propose. [shrug]Apr 5 2012: Easy. The specific idea that Humanity has no need for money because We can replace it with what it represents: meaningful energy expended. Add free energy - or as it is known in inventors' circles, overunity - and remove the cost of energy down the line and things at the end are free.
Since I know We have had overunity for over 50 years, I can say We can add free energy. The technology of electrogravitics became highly classified in late 1959 or early 1960. (My father used to tell Me about His work making discs fly and obtaining overunity - until He came home and told Me, "They want it secret for now." And secret it's been ever since.)
On top of that, We are at a unique point in Our development where We can build mechanical slaves to do all the necessary work no One want to do (or not enough People).
This would free the abundance of this planet to flow to all of Us (right now it is hindered by money), and with the interweb, allow Us to affect governance stigmergically (see http://journal.media-culture.org.au/0605/03-elliott.php for a definition) and eliminate the need for government.
I will suggest They (and You) check out My blog for details of all this. I have it linked in My profile. I recommend most the piece entitled, "The End of Entropy."Apr 5 2012: TEDFail.
Don't get me wrong. The diversity of ideas that get presented at TED are what makes it such an extraordinary phenomenon. But some of what TED is about is the nuts and bolts of building a better world. Like any entrepreneur, we can learn as much or more from the failure of some of those ideas as from the successes. We need to check back in a few years later to see how things are going. If we don't, we are just chasing after the next shiny object instead of building on experiment and experience.
A few examples, just off the top of my head:
One Laptop Per Child: The lesson is that hardware is not enough. You need content, and you can't assume that it will magically appear all by itself. A secondary lesson is that you cannot assume that everyone everywhere has reliable internet access. Most schools in the US don't have reliable internet access for their students. The idea of affordable computers for all remains an excellent idea, but it won't work if it's just a bunch of boxes.
Al Gore's climate campaign: Al made a brave and brilliant attempt to convince people to engage with climate change, but gave people nothing that they could do outside of the usual list of self-sacrifice and symbolic participation in a dysfunctional political system. As a result, we are farther now from substantive action than we were five years ago. Playing the inside game is for suckers. We need a better game plan, quickly.
Indra Nooyi's Pepsi challenge: Indra is committed to making Pepsi a sustainable corporation. Pepsi is not committed to becoming a sustainable corporation, and Nooyi is on her way out. I would *love* to see her talking at TED 2013 about where she thinks the sustainable transformation needs to come from within a large corporation. She's demonstrated that CEO commitment to doing the right thing may be necessary, but it's not sufficient. What should we try next?
Getting it right when it didn't work the first time should be part of the TED conversation.
Apr 5 2012: At the risk of being seen as pariah here, I will point out that all the planets are showing climate change. Al Gore was more interested in the profits that carbon tax and cap-and-trade would make Him. Unless Our SUV exhaust is making its way to Pluto, it's most likely that the climate change on this planet is natural, and has a solar or galactic cause.
Just sayin'.
One clue the climate change is NOT what Gore said it was is the fact that, since His film, An Inconvenient Truth, came out, the atmosphere has NOT heated like He said it would. Not even close.Apr 4 2012: Your question has nudged me to imagine. The most talented TEDx organizers on the planet will be gathering at Doha - Qatar (Arab country) and Sartaj is the fortunate few to attend. If you can ask on my behalf the question.
Can TED forum give a thought to implement QARDAN HASANAH (GOOD LOAN WITHOUT INTEREST) ?
This concept is being implemented by the Bohra Community.
http://www.burhaniqardan.org/Apr 4 2012: What is Self-Image? How to evolve a great Self-Image?
How to evolve a global human family - Vasudev Kutumbhkam'? When I am saying Vasudev, I am not representing as a Hindu, mentioned just to connect.
Name the first thing a child must be taught to develop as a human.
With regards
The Mindfood ChefApr 4 2012: Hi Mr. Lloyd. These problems have not been around a " million years " !! These problems are getting out of control.
In this day and age! The only malfuction to evil deeds, in humans. IS other humans. The parents, the bullying, the up bringing. THE social food chain. It has nothing to do with a disease. I do admire your comment! Humans are are always, trying to blame it it on a disease. Respect to ya! :)Apr 3 2012: Which will be the best and worse scenarios for BRIC´s for 2040? in 3 ways:
- Economical
- Cross Cultural
- Political
What about México, South Korea, Turkey, Pakistan?Apr 3 2012: As humans we are aware we will die one day. All religious/ spiritual text indicate the founders of all religion did manage to crack the code of life and death. Today in 2012, why do we:
1. As humans not pay any attention to the purpose of life, continue to be driven by greed anger &foolishness ? Do we really we believe that we are so stupid?
2. What is the fundamental purpose of religion/spirituality/atheism? would be incorrect to say that the fundamental purpose of existence of animate or inanimate life or belief or religion is, more human joy than happiness [considering joy to be more sustainable as it creates beauty, and greater good as well vis-a-vi happiness which can[and is] still be transient?
3. If, our focus is supreme human joy,which can also be termed as maximizing human potential & human security, how do get leaders political and religious to look ahead and create a new future, focusing efforts on finding similarities, rather than getting involved with discussing the differences..... http://enterprise185.biz/wordpress/ .Apr 3 2012: The population of this world has been increasing continuously for a long time. That means at some moment there will be no planet resources to maintain our current life style, and later to maintain our life. It seems that a big part of the seven billion people is not aware - or not interested - about that.
These conditions will probably be a big menace to our civilization and to our planet in the future. What can we do now ?Apr 2 2012: My hypothetical idea is concerned with the melting of the polar icecaps. From what I have read and heard is that the world's oceans will rise by several inches on average. My thoughts are that the oceans near the poles will rise very little while the oceans near the equator will rise the most. This would be caused by the centrifugal force of the earth spinning. This mass of water gathering near the equator will almost certainly have an effect on the earth's rotation and the tectonic plates. It will also have much more effect on the coastlines of countries near the equator.
The other point of my concern is the change of mass at the poles. I believe the north pole is mostly pack ice on/in water and the south pole is mostly glacial ice on land. Which if true, then the change in mass at the north pole would be relatively less than the change in mass at the south pole. The reason behind this is that ice in water displaces an equal mass of water. Where as, when the ice melts off the land at the south pole that mass is gone and will gather closer to the equator. What effect will this change in mass at the south pole relative to the north pole have on the tilt of the earth and also the rotation of the earth?
Vidya G
Apr 2 2012: What can the world learn from India?Apr 2 2012: Why do people in society label each other?Apr 2 2012: How do we better communicate to the average person, that we are all a part of the Global community of mankind? and as such are all equally responsible to insure peace here on our world. Most people I talk to have a difficult time relating their actions into the global community. For Example: each time they purchase a tank of gas, they are contributing to the loss of a natural resource, or choosing to shop at Walmart and the increase in using child labor and slave wages to keep costs in check.Apr 2 2012: I am disturbed by the focus on high cost communication technologies that close out the impoverished from accessing any benefit from these technologies. Wouldn't it be wise to create internets for the poor, the homeless, the disadvantaged that uses high security at nexus-points between users but is made for access at user-end by low bandwidth and minimal computer resources? I'd suggest a text based internet optionally accentuated by 16-bit graphical interfaces.
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However I'd like the suggestion of learned men on this issue. Is this viable? Is it worth seeking? Would Facebook agree to such a thing? Would a common hardware structure be designed, assembled, and distributed by multiple companies to those humans who are in need, to help them reap the benefits of human achievement? Could it work?Mar 27 2012: How can you make TED events more accessible? The videos on the site are great, but being at an event is always better. So when a conference cost $7,500 to attend, is there a way to make it more accessible to more people?
Mar 27 2012: isn't the magic of TED that it's not easily accessible?
Mar 27 2012: The magic is the ideas being shared. I'm not saying to change the speakers or anything like that, but if you shut out people that might have good ideas but not that kind of money I think we lose something as well.
Mar 27 2012: The speakers don't have to pay they are invited....
Maybe it would be an idea to let TED give out a few free entries into a converence on universities. Where the uni can than give this to an outstanding student or something like that. But other than that I don't see what other filter you can use. Many people think they have great ideas but just very few do... and the ones that do are wealthy enough to go to a converence. The ones that think they do however.... well they should be held as far away from these converences as possible ;)Mar 28 2012: I just found this site, so I think I misunderstood the conferences. I would like to rephrase my question. How do we get more people tied into this information available on this site and the many conferences and events? We need this information able to be disseminated to the pubic in a way to build public support.
Apr 2 2012: ted say my information is invalid and vague. but there is a number of the community that would like to talk about relationships to tell thier story. the most important thing is these people really want to talk about something important to them as someone else would benifit from it iether if editors or administrators dont as i have just had my beginning of a story removed. i only want to reach out and find some people interested to write or find new stories to tell!!! !!!!! DApr 2 2012: I find this statement incredibly self-serving,and pompous.
But other than that I don't see what other filter you can use. Many people think they have great ideas but just very few do... and the ones that do are wealthy enough to go to a converence. The ones that think they do however.... well they should be held as far away from these converences as possible ;)
what you Must remember is that you would exclude Albert Einstein early in his career, Steve Job, Bill Gates and Michael Dell, if they were young also. and What a shame it would have been if those voices were silenced because they did not have 7500.00Apr 2 2012: How about summaries instead. A relaxing sense of privacy encourages growth during certain stages. There's always Science and Technology News magazines and websites.Mar 27 2012: I am a graduate student teacher candidate who is graduating the Spring of 2012. I teach on Long Island and have a secure, well paying full-time night job. I currently work part-time in a youth organization. I am currently running designing both a literacy and songwriting program.
I like the freedom given to me while currently developing programs. I feel the public school system is highly political and stress driven at the moment. I do not know if I want to put my name on substitute lists. First, I am afraid I would start working way too many hours, and secondly, I do not know if I want to work directly in a public school.
I am in a certification program that requires a certain amount of sub hours within a five year period to become fully certified.
I am already aware of some opportunities outside public school districts, such as home bound instruction or tutoring. My Masters degree is in Elementary Education. With my current credits, I am also eligible to get a Special Ed and Literacy Ed certification. What are some alternate job routes you know of I could explore? Thank you.
Mar 27 2012: Well I can answer that question.
First you have to stop starting every line with I.
Second find something which you really love to do. Something that brings joy to your every day work.
Then you do it...Mar 27 2012: Can you ask them this: "How do you exactly use that to influence the world to rampage towards change?"Mar 27 2012: Hello Sartaj! ( please excuse my spelling ) Congrats! I would ask this fine, TED Team, what are we do to with the humans that kill, beat, torture, etc., their baby's and children? I would ask them, that! :(
Apr 2 2012: The problems of a million years are not solved so quickly! Extreme crime is a particularly upsetting problem, all the more upsetting because news companies have latched onto disturbing reports as a means of keeping viewers. Cruelty is not so wide-spread as some would portray. There are billions of people. Reports of extreme violence are not so common. Estimates vary widely and any estimate might intend to deceive so as to serve a political or financial agenda.
There are certain illnesses, such as toxoplasmosis, that can cause criminal behavior. Certain forms of epilepsy and brain trauma can also cause dangerous actions. Neurologists are studying the basis of irrational and senseless violence. If we can understand an organic malfunction that leads to evil deeds, we might be able to cure some forms of evil.
Because of technological limitations, the best we can do is take legal action and hope our capable scientists are able to discover answers.
Mar 27 2012: How will our impending technological singularities and social connectivities change our regard for one another - each and every one?Mar 23 2012: Thank you!!!
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Whoops - this is in response to my API question. I'm so thrilled that I didnt reply in the right spot!Mar 22 2012: Please, ask the TED team this:
"Where is the TED API for developers who wish to share/spread the incredible TED community in new, creative ways with other people?"
They announced it a year ago and I have not seen/heard an update since!
Mar 22 2012: I think this will help answer your question regarding the API... :)
http://labs.ted.com/?page_id=20Mar 22 2012: As an older member, I am ready to let our younger members take responsibility for decisions about global events. What can we do, as older members, do to support our younger members in a meaningful way?Mar 21 2012: I did M8 i wasnt as lucky as you are..good luck hope the team you get involved are switch on!!Mar 20 2012: Great question Sartaj,
My question is how can my generation (I'm 62) retire and live a secure life after undermining life support systems across the global for future generations? How can there be such a disconnect? Who is accountable, responsible and viable for the environmental, economic and social destruction that is part and parcel to the so called, modern society? We have privatized the profits and socialized the liabilities in spades across the globe. I am ashamed and sad for grand children everywhere.Mar 19 2012: I would ask whether or not the organisation that I work for could use the TED comments/conversations software for our own site. In return we would make it clear that we were using TED's software and promote TED talks on our site.Mar 19 2012: That was just one thought. I live near a large city and often see wasteful practices. I feel sad for the children who grow up thinking that waste is an acceptable part of life.Mar 19 2012: Here in the US, my generation grew up with the phrase "Reduce, Reuse, Recycle" I want to take that a step further and I beleive if every generation goes one step further, then we truly become "self sustainable". In our world of globalization we are learning that the system of supply and demand rapidly becomes no supply and all demand. Along with the collapse of a financial system based on this supply and demand principle. My idea called "Re-living" is a thought in which we use after school programs as a platform to inform and instruct students how and what to Reduce, Reuse, Recycle. Everything from rain water, pet waste and toe nail clippings to batteries and plastic bottles. In this day and age there is nothing that can't be "Reduced, Reused, Recycled
When children and young adults see the benefits and results of this practice, there is no doubt in my mind that this "Re-living" revolution will grow with them, taking "Reduce, Reuse, Recycle" one step further. We will become a global society, a global tribe in harmony with the earth. And growing with them will be ideas greater than I could imagine along with the technology to back them up.
I believe children have a drive to do good. Iif we teach them now then they will have the chance to "Re-live" a hundred times happier, healthier and more creative.Mar 19 2012: What is a good paying job that is realistic, non-time consuming and works at my time, at home or from any location with internet access or once a week travel, can help me save enough to have my own small place to live, got perks and benefits, requires no out-of-pocket expense, isn't multi-level marketing, pays me enough for buying a car and other necessities, and is stable?
Demanding, but that is my question. =)
Mar 19 2012: Once this job is identified I will be the second person to apply for its, thats assuming you are the first.
Roberta Mura
Mar 19 2012: I am applying too....if you ever find one and they are looking for more staff let me know! ;)
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Mar 20 2012: Awesome, I will definitely spread the news through snail mail.....haha! =PMar 20 2012: You could start a computer coding/programming business and use your friendly local libraries computer.
Mar 21 2012: Oh computers are not my specialty at the least. I am also financially not fit to be starting anything radical anytime soon, maybe an entrepeneurship that cost little and takes advantage of my consulting abilities, or my desire for protecting the environment, or creativity, or sales.....well I pretty much got many skills/interest I can put down, but I am not knowledgeble about coding/programming/computers/technologies. Not my field of interest or expertise, I think.
Another idea perhaps?Mar 18 2012: How to deal with demagogic comments through the Internet?


text:
|Publication number
|Publication type
|Application number
|Publication date
|14 Sep 2006
|Filing date
|11 Mar 2005
|Priority date
|11 Mar 2005
|Also published as
|Publication number
|Julia Moffitt, Sophia Wang, Bruce KenKnight, Imad Libbus
|Original Assignee
|Julia Moffitt, Sophia Wang, Kenknight Bruce H, Imad Libbus
|Export Citation
|BiBTeX, EndNote, RefMan
|Referenced by (41), Classifications (8), Legal Events (4)
|External Links: USPTO, USPTO Assignment, Espacenet
This patent application is related to the following co-pending and commonly assigned U.S. patent applications, the disclosures of which are herein incorporated by reference in their entirety: "Multi-Site Ventricular Pacing Therapy With Parasympathetic Stimulation," Ser. No. 10/700,368, filed Nov. 3, 2003; "Lead for Stimulating the Baroreceptors in the Pulmonary Artery," Ser. No. 10/746,861, filed Dec. 24, 2003; "Combined Remodeling Control Therapy and Anti-Remodeling Therapy By Implantable Cardiac Device," Ser. No. 10/850,341, filed May 20, 2004; and "Integrated Lead for Application of Cardiac Resynchronization Therapy and Neural Stimulation Therapy;" Ser. No. ______, filed ______ (Attorney Docket No. 279.765US1).
This patent application pertains to methods and apparatus for the treatment of cardiac disease. In particular, it relates to methods and apparatus for improving cardiac function with electro-stimulatory therapy.
Following myocardial infarction (MI) or other cause of decreased cardiac output, a complex remodeling process of the ventricles occurs that involves structural, biochemical, neurohormonal, and electrophysiologic factors. Ventricular remodeling is triggered by a physiological compensatory mechanism that acts to increase cardiac output due to so-called backward failure which increases the diastolic filling pressure of the ventricles and thereby increases the so-called preload (i.e., the degree to which the ventricles are stretched by the volume of blood in the ventricles at the end of diastole). An increase in preload causes an increase in stroke volume during systole, a phenomena known as the Frank-Starling principle. When the ventricles are stretched due to the increased preload over a period of time, however, the ventricles become dilated. The enlargement of the ventricular volume causes increased ventricular wall stress at a given systolic pressure. Along with the increased pressure-volume work done by the ventricle, this acts as a stimulus for hypertrophy of the ventricular myocardium. The disadvantage of dilatation is the extra workload imposed on normal, residual myocardium and the increase in wall tension (Laplace's Law) which represent the stimulus for hypertrophy. If hypertrophy is not adequate to match increased tension, a vicious cycle ensues which causes further and progressive dilatation.
As the heart begins to dilate, afferent baroreceptor and cardiopulmonary receptor signals are sent to the vasomotor central nervous system control center, which responds with hormonal secretion and sympathetic discharge. It is the combination of hemodynamic, sympathetic nervous system and hormonal alterations (such as presence or absence of angiotensin converting enzyme (ACE) activity) that ultimately account for the deleterious alterations in cell structure involved in ventricular remodeling. The sustained stresses causing hypertrophy induce apoptosis (i.e., programmed cell death) of cardiac muscle cells and eventual wall thinning which causes further deterioration in cardiac function. Thus, although ventricular dilation and hypertrophy may at first be compensatory and increase cardiac output, the processes ultimately result in both systolic and diastolic dysfunction. It has been shown that the extent of ventricular remodeling is positively correlated with increased mortality in post-MI and heart failure patients.
FIGS. 1A-E illustrate embodiments of the present subject matter in relation to a heart.
FIGS. 4A-D illustrate examples of how the intensities of ART and RCT may be individually time-varied.
Clinical data has shown that cardiac resynchronization therapy (CRT), achieved through synchronized biventricular pacing, results in a significant improvement in cardiac function. It has also been reported CRT can be beneficial in preventing and/or reversing the ventricular remodeling that often occurs in post-MI and heart failure patients. As explained in detail below, the present subject matter relates to an implantable cardiac device capable of providing remodeling control therapy (RCT) by controlling ventricular activation with cardiac resynchronization pacing and providing anti-remodeling therapy (ART) by stimulating the baroreflex in order to inhibit sympathetic activity. The combined application of these two therapies provides a greater therapeutic benefit than either of them individually. The device controls ventricular activation through synchronized pacing of the right and left ventricles. In addition, the device may provide a combination of parasympathetic stimulation and sympathetic inhibition. Parasympathetic stimulation can be achieved through a nerve cuff electrode placed around the cervical vagus nerve bundle, while sympathetic inhibition can be achieved through baroreflex stimulation, either through a nerve cuff electrode placed around the aortic or carotid sinus nerve, or though a stimulation lead designed to stimulate baroreptors in the pulmonary artery. The device controls the delivery of RCT and ART independently in either an open-loop or closed-loop fashion, the latter based upon a cardiac function assessment performed by the device.
1. Remodeling Control Therapy by Cardiac Resynchronization Pacing
Implantable cardiac devices that provide electrical stimulation to selected chambers of the heart have been developed in order to treat a number of cardiac disorders. A pacemaker, for example, is a device which paces the heart with timed pacing pulses, most commonly for the treatment of bradycardia where the ventricular rate is too slow. Atrio-ventricular conduction defects (i.e., AV block) and sick sinus syndrome represent the most common causes of bradycardia for which permanent pacing may be indicated. If functioning properly, the pacemaker makes up for the heart's inability to pace itself at an appropriate rhythm in order to meet metabolic demand by enforcing a minimum heart rate. Implantable devices may also be used to treat cardiac rhythms that are too fast, with either anti-tachycardia pacing or the delivery of electrical shocks to terminate atrial or ventricular fibrillation.
Implantable devices have also been developed that affect the manner and degree to which the heart chambers contract during a cardiac cycle in order to promote the efficient pumping of blood. The heart pumps more effectively when the chambers contract in a coordinated manner, a result normally provided by the specialized conduction pathways in both the atria and the ventricles that enable the rapid conduction of excitation (i.e., depolarization) throughout the myocardium. These pathways conduct excitatory impulses from the sino-atrial node to the atrial myocardium, to the atrio-ventricular node, and thence to the ventricular myocardium to result in a coordinated contraction of both atria and both ventricles. This both synchronizes the contractions of the muscle fibers of each chamber and synchronizes the contraction of each atrium or ventricle with the contralateral atrium or ventricle. Without the synchronization afforded by the normally functioning specialized conduction pathways, the heart's pumping efficiency is greatly diminished. Pathology of these conduction pathways and other inter-ventricular or intra-ventricular conduction deficits can be a causative factor in heart failure, which refers to a clinical syndrome in which an abnormality of cardiac function causes cardiac output to fall below a level adequate to meet the metabolic demand of peripheral tissues. In order to treat these problems, implantable cardiac devices have been developed that provide appropriately timed electrical stimulation to one or more heart chambers in an attempt to improve the coordination of atrial and/or ventricular contractions, termed cardiac resynchronization therapy (CRT). Ventricular resynchronization is useful in treating heart failure because, although not directly inotropic, resynchronization can result in a more coordinated contraction of the ventricles with improved pumping efficiency and increased cardiac output. Currently, a common form of CRT applies stimulation pulses to both ventricles, either simultaneously or separated by a specified biventricular offset interval, and after a specified atrio-ventricular delay interval with respect to the detection of an intrinsic atrial contraction or delivery of an atrial pace.
It has also been found that CRT can be beneficial in reducing the deleterious ventricular remodeling which can occur in post-MI and heart failure patients. Presumably, this occurs as a result of changes in the distribution of wall stress experienced by the ventricles during the cardiac pumping cycle when CRT is applied. The degree to which a heart muscle fiber is stretched before it contracts is termed the preload, and the maximum tension and velocity of shortening of a muscle fiber increases with increasing preload. When a myocardial region contracts late relative to other regions, the contraction of those opposing regions stretches the later contracting region and increases the preload. The degree of tension or stress on a heart muscle fiber as it contracts is termed the afterload. Because pressure within the ventricles rises rapidly from a diastolic to a systolic value as blood is pumped out into the aorta and pulmonary arteries, the part of the ventricle that first contracts due to an excitatory stimulation pulse does so against a lower afterload than does a part of the ventricle contracting later. Thus a myocardial region which contracts later than other regions is subjected to both an increased preload and afterload. This situation is created frequently by the ventricular conduction delays associated with heart failure and ventricular dysfunction due to an MI. The increased wall stress to the late-activating myocardial regions is most probably the trigger for ventricular remodeling. By pacing one or more sites in a ventricle in a manner which causes a more coordinated contraction, CRT provides pre-excitation of myocardial regions which would otherwise be activated later during systole and experience increased wall stress. The pre-excitation of the remodeled region relative to other regions unloads the region from mechanical stress and allows reversal or prevention of remodeling to occur.
2. Anti-Remodeling Therapy by Modulating Autonomic Activity
As noted above, activity of the autonomic nervous system is at least partly responsible for the ventricular remodeling which occurs as a consequence of an MI or due to heart failure. It has been demonstrated that remodeling can be affected by pharmacological intervention with the use of, for example, ACE inhibitors and beta-blockers. Pharmacological treatment carries with it the risk of side effects, however, and it is also difficult to modulate the effects of drugs in a precise manner. The present subject matter employs electrostimulatory means to modulate autonomic activity, referred to as anti-remodeling therapy or ART. When delivered in conjunction with ventricular resynchronization pacing, such modulation of autonomic activity acts synergistically to reverse or prevent cardiac remodeling.
3. Device Embodiments
As shown in
Shown in the
The electrodes of each bipolar lead are connected via conductors within the lead to a MOS switching network 70 controlled by the microprocessor. The switching network is used to switch the electrodes to the input of a sense amplifier in order to detect intrinsic cardiac activity and to the output of a pulse generator in order to deliver a pacing pulse. The switching network also enables the device to sense or pace either in a bipolar mode using both the ring and tip electrodes of a lead or in a unipolar mode using only one of the electrodes of the lead with the device housing or can 80 serving as a ground electrode. A shock pulse generator 60 is also interfaced to the controller for delivering a defibrillation shock via a pair of shock electrodes 61 to the atria or ventricles upon detection of a shockable tachyarrhythmia.
The controller 10 controls the overall operation of the device in accordance with programmed instructions stored in memory, including controlling the delivery of paces via the pacing channels, interpreting sense signals received from the sensing channels, and implementing timers for defining escape intervals and sensory refractory periods. The controller is capable of operating the device in a number of programmed pacing modes which define how pulses are output in response to sensed events and expiration of time intervals. Most pacemakers for treating bradycardia are programmed to operate synchronously in a so-called demand mode where sensed cardiac events occurring within a defined interval either trigger or inhibit a pacing pulse. Inhibited demand pacing modes utilize escape intervals to control pacing in accordance with sensed intrinsic activity such that a pacing pulse is delivered to a heart chamber during a cardiac cycle only after expiration of a defined escape interval during which no intrinsic beat by the chamber is detected. Escape intervals for ventricular pacing can be restarted by ventricular or atrial events, the latter allowing the pacing to track intrinsic atrial beats. CRT is most conveniently delivered in conjunction with a bradycardia pacing mode where, for example, multiple excitatory stimulation pulses are delivered to multiple sites during a cardiac cycle in order to both pace the heart in accordance with a bradycardia mode and provide pre-excitation of selected sites. An exertion level sensor 330 (e.g., an accelerometer, a minute ventilation sensor, or other sensor that measures a parameter related to metabolic demand) enables the controller to adapt the pacing rate in accordance with changes in the patient's physical activity and, as explained below, can enable the controller to modulate the delivery of neural stimulation and/or cardiac resynchronization pacing. A telemetry interface 82 is also provided which enables the controller to communicate with an external programmer or remote monitor.
Neural stimulation channels are incorporated into the device for delivering parasympathetic stimulation and/or sympathetic inhibition, where one channel includes a bipolar lead with a ring electrode 44 and a tip electrode 43, a pulse generator 42, and a channel interface 40, and the other channel includes a bipolar lead with a ring electrode 54 and a tip electrode 53, a pulse generator 52, and a channel interface 50. Other embodiments may use unipolar leads in which case the neural stimulation pulses are referenced to the can or another electrode. The pulse generator for each channel outputs a train of neural stimulation pulses which may be varied by the controller as to amplitude, frequency, and duty-cycle.
4. Sites for CRT and Neural Stimulation
In various embodiments, a neural stimulation channel uses a lead adapted to be intravascularly disposed to transvascularly stimulate an appropriate nerve, e.g., near a baroreceptor in the case of a sympathetic inhibition channel or near a parasympathetic nerve in the case of a parasympathetic stimulation channel. Some CRT devices include an atrial lead to pace and/or sense the right atrium, a right ventricle lead to pace and/or sense the right ventricle, and a left ventricle lead fed through the coronary sinus to a position to pace and/or sense the left ventricle, such as illustrated in
According to various embodiments, the device is designed to sense a refractory period, and to deliver the neural stimulation from an electrode or electrodes within the coronary sinus during the refractory period to avoid unintentionally capturing cardiac tissue and inducing an arryhthmia such as atrial fibrillation.
Various lead embodiments implement a number of designs, including an expandable stent-like electrode with a mesh surface dimensioned to abut a wall of a predetermined blood vessel, a coiled electrode(s), a fixed screw-type electrode(s), and the like. Various embodiments place the electrode(s) inside the blood vessel, into the wall of the blood vessel, or a combination of at least one electrode inside the blood vessel and at least one electrode into the wall of the blood vessel. The neural stimulation electrode(s) can be integrated into the same lead used for CRT or in another lead in addition to CRT lead(s). In various embodiments, the neural stimulation can be performed by a satellite stimulator located intravascularly and controlled by a planet such as an implantable medical device performing CRT functions.
Transvascular leads can be used to stimulate other nerve sites. For example, an embodiment feeds a transvascular stimulation lead into the right azygos vein to stimulate the vagus nerve; and an embodiment feeds a transvascular stimulation lead into the internal jugular vein to stimulate the vagus nerve. Various embodiments use at least one lead intravascularly fed along a lead path to transvascularly apply neural stimulation and electrically stimulate a cardiac muscle, such as ventricular pacing, as part of CRT.
Other transvascular locations have been mentioned with respect to
The stimulation electrode(s) are not in direct neural contact with the parasympathetic nerve when the transvascular approach to peripheral nerve stimulation is used. Thus, problems associated with neural inflammation and injury commonly associated with direct contact electrodes are reduced.
Various embodiments use at least one lead fed along a lead path and adapted to be epicardially-disposed near an appropriate neural stimulation site for vagal nerves and an appropriate site for electrically stimulating cardiac muscle, such as ventricular pacing, as part of CRT. In various embodiments, a satellite unit to provide neural stimulation is epicardially-disposed near an appropriate neural stimulation site. Such satellite units are capable of being integrated with implantable CRM devices that are performing CRT functions using either epicardial leads or transvascularly-fed leads.
According to various embodiments, the device is designed to sense a refractory period, and to deliver the neural stimulation from an electrode or electrodes within the coronary sinus during the refractory period to avoid unintentionally capturing cardiac tissue and inducing an arryhthmia such as atrial fibrillation. The myelinated vagal nerve fibers of a parasympathetic nervous system is much lower than that of myocardial tissue. Thus, when stimulating these myelinated vagal nerve fibers, parasympathetic stimulation can be applied in the absence of myocardial stimulation.
In various embodiments, the leads of the neural stimulation electrodes are replaced by wireless links, and the electrodes for providing parasympathetic stimulation and/or sympathetic inhibition are incorporated into satellite units. The wireless link may be, for example, a radio-frequency (RF) link or an acoustic link.
Increased sympathetic nervous system activity following ischemia often results in increased exposure of the myocardium to epinephrine and norepinephrine. These catecholamines activate intracellular pathways within the myocytes, which lead to myocardial death and fibrosis. Stimulation of the parasympathetic nerves (vagus) inhibits this effect. According to various embodiments, the present subject matter selectively activates the vagal cardiac nerves in addition to CRT in heart failure patients to protect the myocardium from further remodeling and arrhythmogenesis. Other potential benefits of stimulating vagal cardiac nerves in addition to CRT include reducing inflammatory response following myocardial infarction, and reducing the electrical stimulation threshold for defibrillating. For example, when a ventricular tachycardia is sensed, vagal nerve stimulation is applied, and then a defibrillation shock is applied. The vagal nerve stimulation allows the defibrillation shock to be applied at less energy.
5. Assessment of Cardiac Function
In one embodiment of the invention, the delivery of RCT and/or ART is modulated in accordance with an assessment of cardiac function performed by the implantable device. One means by which cardiac function may be assessed is by measuring cardiac output and comparing it with the patient's measured exertion level. Cardiac output may be measured by an impedance technique in which transthoracic impedance is measured and used compute stroke volume. In one embodiment, the exertion level sensor is a minute ventilation sensor which includes an exciter and an impedance measuring circuit. The exciter supplies excitation current of a specified amplitude (e.g., as a pulse waveform with constant amplitude) to excitation electrodes that are disposed in the thorax. Voltage sense electrodes are disposed in a selected region of the thorax so that the potential difference between the electrodes while excitation current is supplied is representative of the transthoracic impedance between the voltage sense electrodes. The conductive housing or can may be used as one of the voltage sense electrodes. The impedance measuring circuitry processes the voltage sense signal from the voltage sense electrodes to derive the impedance signal. Further processing of the impedance signal allows the derivation of signal representing respiratory activity and/or cardiac blood volume, depending upon the location the voltage sense electrodes in the thorax. (See, e.g., U.S. Pat. Nos. 5,190,035 and 6,161,042, assigned to the assignee of the present invention and hereby incorporated by reference.) If the impedance signal is filtered to remove the respiratory component, the result is a signal that is representative of blood volume in the heart at any point in time, thus allowing the computation of stroke volume and, when combined with heart rate, computation of cardiac output. The stroke volume integrated over time (or averaged and multiplied by heart rate) gives the patient's cardiac output. A look-up table or other function may be used to compute what cardiac output is considered adequate for a given exertion level. Measurement of cardiac output or a determination of the adequacy of the cardiac output may be used by the device to modulate the delivery of RCT and/or ART.
Another means for assessing cardiac function is by determining the autonomic balance of the patient. It is well-known that an increase in the activity of the sympathetic nervous system may be indicative of metabolic stress and the need for increased cardiac output. One means by which increased sympathetic activity may be detected is via spectral analysis of heart rate variability. Heart rate variability refers to the variability of the time intervals between successive heart beats during a sinus rhythm and is primarily due to the interaction between the sympathetic and parasympathetic arms of the autonomic nervous system. Spectral analysis of heart rate variability involves decomposing a signal representing successive beat-to-beat intervals into separate components representing the amplitude of the signal at different oscillation frequencies. It has been found that the amount of signal power in a low frequency (LF) band ranging from 0.04 to 0.15 Hz is influenced by the levels of activity of both the sympathetic and parasympathetic nervous systems, while the amount of signal power in a high frequency band (HF) ranging from 0.15 to 0.40 Hz is primarily a function of parasympathetic activity. The ratio of the signal powers, designated as the LF/HF ratio, is thus a good indicator of the state of autonomic balance, with a high LF/HF ratio indicating increased sympathetic activity. An LF/HF ratio which exceeds a specified threshold value may be taken as an indicator that cardiac function is not adequate. A cardiac rhythm management device can be programmed to determine the LF/HF ratio by analyzing data received from its atrial ventricular sensing channels. The intervals between successive atrial or ventricular senses, referred to as beat-to-beat or BB intervals, can be measured and collected for a period of time or a specified number of beats. The resulting series of RR interval values is then stored as a discrete signal and analyzed to determine its energies in the high and low frequency bands as described above. Techniques for estimating the LF/HF ratio based upon interval data are described in commonly assigned U.S. patent application Ser. No. 10/436,876 filed May 12, 2003, and Ser. No. 10/669,170 filed Sep. 23, 2003, the disclosures of which are hereby incorporated by reference.
Other means of assessing cardiac function may also be employed to modulate the delivery of ART and/or RCT. The impedance technique for measuring cardiac output discussed above may also be used to measure ventricular volumes at various stages of the cardiac cycle such as end-diastolic and end-systolic volumes and used to compute parameters reflective of cardiac function such as ejection fraction. The implantable device may also be equipped with other sensing modalities such as a pressure transducer. Such a pressure transducer may be attached to an intravascular lead and be appropriately disposed for measuring diastolic filling pressures and/or systolic pulse pressures.
6. Implementation Examples
In an embodiment of the invention, an implantable device for delivering cardiac therapy to post-MI patients includes one or more pacing channels for delivering pacing pulses to one or more ventricular sites and a sympathetic inhibition channel for stimulating nerves which inhibit sympathetic nerve activity. The controller is programmed to deliver remodeling control therapy (RCT) by delivering ventricular pacing in a cardiac resynchronization mode which pre-excites a region of the ventricular myocardium so as to mechanically unload that region during systole. The cardiac resynchronization therapy may be delivered as biventricular pacing where one of the ventricles is pre-excited relative to the other as determined by a programmed biventricular offset interval. Alternatively, in patients suffering from delayed activation of the left ventricle, a left ventricle-only resynchronization pacing mode may be employed. In another embodiment, the pacing therapy may be delivered as multi-site ventricular pacing where at least one of the ventricles is paced at a plurality of sites so as to pre-excite one or more of the sites relative to the other sites. In any case, the ventricular pacing may be delivered in a non-atrial tracking mode where a ventricular escape interval is defined between ventricular paces, or in an atrial tracking mode where the ventricular paces are delivered after a defined atrio-ventricular escape interval following an atrial sense. In a patient who is chronotropically incompetent, an atrial pacing channel may also be provided for pacing the atria, with the ventricular pace(s) delivered upon expiration of the atrio-ventricular escape interval following the atrial pace.
The controller is further programmed to delivery anti-remodeling therapy (ART) in conjunction with the RCT by inhibiting sympathetic nerve activity via the sympathetic inhibition channel. The sympathetic inhibition channel may include a pulse generator for outputting neural stimulation pulses and a lead incorporating an electrode adapted for disposition near an arterial baroreceptor or afferent nerve of a baroreflex arc. Stimulation of the baroreflex arc then results in inhibition of sympathetic activity. The electrode of the sympathetic inhibition channel may be intravascularly positioned in a blood vessel or elsewhere proximate to a baroreceptor or afferent nerve such as in a pulmonary artery or a cardiac fat pad. In another embodiment, the device may further include a parasympathetic stimulation channel, where the anti-remodeling therapy delivered by the controller further includes stimulation of parasympathetic nerve activity, and the parasympathetic stimulation channel includes a pulse generator for outputting neural stimulation pulses and an electrode for stimulating a parasympathetic nerve. The electrode may be a nerve cuff electrode adapted for disposition around a parasympathetic nerve or an intravascular electrode for transvascularly stimulating a parasympathetic nerve adjacent to a blood vessel. As described above, for either the sympathetic inhibition channel or the parasympathetic stimulation channel, the electrode and pulse generator may also be incorporated into a satellite unit which includes an RF receiver. The implantable device then further comprises an RF transmitter interfaced to the controller for controlling the operation of the satellite unit via an RF link.
The device may be programmed to deliver RCT and ART in open-loop fashion where the RCT and ART are delivered simultaneously or separately at programmed intervals. The RCT and ART may be delivered at a constant or time-varying intensity, where the intensity of the ART may be adjusted by varying the amplitude, frequency, or duty-cycle of the neural stimulation pulses, and the intensity of the RCT may be adjusted by varying one or more parameters which affect the amount of pre-excitation delivered to the ventricles such as the biventricular offset interval and the atrio-ventricular escape interval.
In another embodiment, the device is programmed to deliver RCT and ART in closed-loop fashion, where the intensities of RCT and ART are modulated in accordance with an assessment of cardiac function performed by the controller. The device may also separately modulate the intensities of parasympathetic stimulation and sympathetic inhibition which are delivered as part of the ART in accordance with the assessment of cardiac function. Cardiac function may be assessed by the device using several different modalities, either alone or in combination. In one embodiment, the device incorporates a sensor for measuring cardiac output, and the controller is programmed to modulate the delivery of RCT and ART in accordance with the measured cardiac output. As described above, such a cardiac output sensor may be a trans-throracic impedance measuring circuit. Another means for assessing cardiac function is an arterial blood pressure sensor, where the controller is programmed to modulate the delivery of RCT and ART in accordance with the measured blood pressure. The blood pressure sensor may take the form of a pressure transducer and lead adapted for disposition within an artery. Alternatively, a measure of the patient's respiratory activity taken by a minute ventilation sensor may be used as a surrogate for blood pressure. Cardiac function may also be assessed by measuring the patient's exertion level (e.g., using either a minute ventilation sensor or an accelerometer) together with a measure of cardiac output and/or blood pressure, where the controller is then programmed to modulate the delivery of RCT and ART in accordance with the combined measurements.
In another embodiment, the cardiac function assessment includes an assessment of the patient's autonomic balance. Autonomic balance may be assessed directly with a sensing channel for measuring electrical activity in sympathetic and parasympathetic nerves with appropriately positioned sensing electrodes, or if the patient is chronotropically competent, by measuring the intrinsic heart rate. As described above, measuring heart rate variability provides one means for assessing autonomic balance. Thus, the device may include circuitry for measuring and collecting time intervals between successive intrinsic beats, referred to as a BB interval, where the BB interval may be an interval between successive atrial or ventricular senses. The device stores the collected intervals as a discrete BB interval signal, filters the BB interval signal into defined high and low frequency bands, and determines the signal power of the BB interval signal in each of the low and high frequency bands, referred to LF and HF, respectively. The device then computes an LF/HF ratio and assesses autonomic balance by comparing the LF/HF ratio to a specified threshold value.
In certain embodiments, data gathered by the device in performing the assessment of cardiac function performed is transmitted to a remote monitor via an RF telemetry link. The remote monitor may record the data for later analysis by a clinician and/or transmit it to another location over a network such as the internet. In response to network communications, the remote monitor may also program the implantable device via the RF telemetry link in order to modify the delivery of RCT and ART.
Although the invention has been described in conjunction with the foregoing specific embodiments, many alternatives, variations, and modifications will be apparent to those of ordinary skill in the art. Such alternatives, variations, and modifications are intended to fall within the scope of the following appended claims.
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|U.S. Classification
|International Classification
|Cooperative Classification
|European Classification
|9 Aug 2006
Owner name: CARDIAC PACEMAKERS, INC., MINNESOTA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:MOFFITT, JULIA;WANG, SOPHIA H.;KENKNIGHT, BRUCE H.;AND OTHERS;REEL/FRAME:018085/0221;SIGNING DATES FROM 20060306 TO 20060317
|21 Sep 2010
|Certificate of correction
|3 May 2011
|Certificate of correction
|6 Feb 2013
|Fee payment
Year of fee payment: 4

subset: commoncrawl


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Hidden Talent: I am known to be called Shakira Gringa for my belly dancing, flexibility, and moving my hips all the time.
What inspires you to dance? Dance is not only an inspiration, but it's a form of expression. Dance inspires me because I will always have room for improvement and I will always want to know more and to be better.
Word that best describes you... Friendly
Childhood Cartoon: I love X-Men and would watch it all the time with my brother and I would even read the comic books too!
Photography by Bryan Anderson
Dancer photo make-up - Mayra Ponce


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Raising the nation's borrowing limit, and thus avoiding a historic default, isn't enough to prevent a potential downgrade. Not by a long shot.
Like a child who kicks and screams and whines before agreeing to do a chore, Congress can't evade punishment by taking necessary action at the last possible second, experts said. Lawmakers have to prove they they're mature enough to act on their own—to address America's ballooning debt or risk the wrath of a downgrade to the nation's top-notch credit rating.
"It's like loan officers in banks," said Bo Becker, a finance professor at Harvard Business School. "They're supposed to look at your character to judge when they make a business loan and [credit-rating agencies are] doing the same for the U.S. government. It's an important part of deciding how creditworthy someone is, what's their moral fiber."
The federal government is expected to breach its debt ceiling as early as mid-February, according to Treasury Department and private estimates. If lawmakers fail to raise it, the government may be unable to pay its lenders, thus resulting in a historic and rare default on the nation's debt. Such an event "would have severe economic consequences," Goldman Sachs economists wrote in a recent research note. Therefore, many expect Congress to raise the ceiling.
But even if lawmakers do raise the nation's borrowing limit, it might not be enough to prevent another historic downgrade of the nation's credit rating. (The first came from Standard & Poor's during the 2011 debt-ceiling fight, when the U.S. was downgraded from AAA to AA+.) And earlier this week, Fitch, one of the three main credit-rating agencies, put lawmakers on notice: A downgrade hinges not just on addressing the debt ceiling, but on Congress's ability to tackle the government's growing deficits.
"In the absence of an agreed and credible medium-term deficit reduction plan ... the current Negative Outlook on the 'AAA' rating is likely to be resolved with a downgrade later this year even if another debt-ceiling crisis is averted," the agency wrote in a news release.
Raise the debt limit, they said, but don't stop there.
The question on which corporate and government credit ratings are evaluated is a simple one: Is the borrower able and willing to pay the money it owes?
"Are they capable of paying back the IOU on time, that's exactly it," said Lee Ohanian, a UCLA economics professor and adviser to the Federal Reserve Bank of Minneapolis.
When it comes to the United States—and most governments, for that matter—the answer to the first part of the question is, yes, governments have the means to pay off their loans.
"Nation-states like the U.S., they have such immense ability to repay things through their taxing rights, but then it becomes more of a question of their willingness to honor debt," Becker said. As lawmakers push off dealing with ever-expanding deficits, the money the nation owes continues to swell. And as that debt grows, so too does the size of the tax hikes and spending cuts needed to pay it down, making the decisions lawmakers face increasingly difficult.
Since they last clashed over raising the debt limit in 2011, lawmakers have tried to tackle the nation's long-term debt problem. They famously set up a "super committee" whose recommendations would have required a lower-than-normal threshold to be passed into law, but none were issued. Congress also designed a package of spending cuts—also known as sequestration—so egregious that it would have forced them to tackle spending in a more thoughtful way. Ultimately, they just postponed the onset of those cuts until March 1.
The political climate is far from the only factor that goes into credit-rating decisions, but right now it's the one that matters.
"The economy's doing OK, it's not fantastic, but it's doing OK.… It really is mostly just down to the politics, to be honest," said Paul Ashworth, chief U.S. economist at Capital Economics.
Though a credit downgrade could reinforce pessimism about the budget, the United States could weather it, the experts said. Crises abroad mean that the U.S. will likely continue to be viewed by investors as the safest place to park their money. And it's not as though serious global investors are unaware of the state of affairs in Washington. The S&P downgrade during the last debt-ceiling fight didn't have much of an effect.
"Typically when countries are downgraded their interest rates go up on the basis of that," Ohanian said. "That hasn't happened in the U.S. and the reason is because the world still likes the U.S. better than the alternative. And that's been a sort of saving grace for us."
But while a downgrade might not deal the devastating blow hitting the debt ceiling would, it would still be a sign that the nation is heading farther and farther down a very dangerous path. Dropping from an AA+ to an AA might not seem so bad, but it would be one more signal of Washington's disarray.
How Washington's Disarray Could Prompt Another Credit Downgrade
Raising the nation's borrowing limit, and thus avoiding a historic default, isn't enough to prevent a potential downgrade. Not by a long shot.


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Treatment of lung cancer metastases
Lung cancer that has spread is usually treated with chemotherapy or in certain circumstances, targeted therapy. Other approaches may be used, depending on the part of the body where the cancer has spread.
Learn more about metastatic cancer and its treatment
Metastatic cancer (National Cancer Institute)
Progress in the treatment of metastatic lung cancer (CancerCare)
Medical update on metastatic lung cancer (CancerCare)
Metastatic brain tumors (International Radiosurgery Association)
Understanding brain metastases: A guide for patient and caregiver (National Brain Tumor Association / Lung Cancer Alliance)
Brain metastases: Treatment and management (Medscape)
Single brain metastasis and multiple brain metastases (American College of Radiology's Appropriateness Criteria)
Radiation therapy for patients with cancer and bone involvement (Bone and Cancer Foundation)
Metastatic bone disease (American Academy of Orthopaedic Surgeons)
Non-spine bone metastases (American College of Radiologist's Appropriateness Criteria)
What lung cancer patients need to know about bone health (Bone and Cancer Foundation)
Adrenal gland
Metastases to the adrenal gland(American Association of Endocrine Surgeons Patient Education Site)
Liver metastases (MedLinePlus)


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Over the past few months there has been a lot of unfriendly press for the SEO industry and sadly for those businesses taking part in linking buying, a definite no-no if you want to stay within Google's Webmaster Guidelines. With the recent outings of JC Penny, Overstock and more recently Milanoo, a China-based B2C apparel…Read More
In a move that is sure to please pro privacy advocates while simultaneously upsetting many marketing managers and SEO consultants, Google has officially killed referred data for users who conduct a search query while logged into a Google service. Anyone not signed in though will continue to send referrer data. What does this mean to marketers and…Read More
Getting to the top of the rankings in a single country is tough enough. Trying to replicate that same feat in multiple markets can lead to tears. Do you use a single domain name with a directory for each country, like IBM or do you use subdomains? Do you go local and use country specific…Read More
Google are continually looking to serve more relevant results as quickly as possible. Leveraging information from people you know, to customise and improve your search engine results. The new talking point from Google is the launch of the +1 button on search pages. Launched in the US yesterday, it's only a matter of time before…Read More
First it was the New Yorks Time's unmasking of JC Penney's blatant link buying. Now Overstock.com, a dotcom survivor started in 1999, has also fallen afoul of Google's Webmaster Guidelines for excessive links building. Overnight, the Wall Street Journal published the grim results of Google's punishment on Overstock's attempt to game the system. The WSJ…Read More
Google are placing a greater emphasis on the location aspect of their search results and increasing relevance to the user. Place Search and Google Places is becoming one of the fastest growing commodities in search. Developed to deliver highly relevant results which lead to quality clicks and improvement in site engagement, as well as improving…Read More
I know it's almost been a month since Oprah was in Sydney but I've only calmed down from the all the hysteria now to be able to write about my date with Oprah.Read More
Understanding the opportunity of advertising on the Google Content Network Launching a campaign on the Google Content Network gives you opportunity to reach another very targeted audience; often in a very different consideration phase than users on the search network. In competitive verticals like insurance, travel or finance, CPCs on the search network are high…Read More
It was inevitable. Any news about Christmas shopping mentioned it. Australians were just not spending as much as experts had predicted. Why not? Was it because in these economically unstable times (what up, Spain?) people are being more cautious about spending and deciding to spend less on superfluous material goods? No, according to Myer, David…Read More
Over the last few months we've watched Google roll out a host of innovative changes to their organic search results including Google Instant, Places (local results) and Preview. In their continued effort to enhance the user experience (and we suspect keep visitors at their site longer), they have now started to expand the type of…Read More


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You are hereHome › Programs & Events › Readings & Conversations ›
Taha Muhammad Ali and Peter Cole: A Reading and Conversation
Date and Time:
October 3, 2006 - 7:00PM
Event Location:
Poets House
Palestinian Taha Muhammad Ali's poetry is driven by a storyteller's vivid imagination, disarming humor, and unflinching honesty. This evening illuminates his life and work through readings by him and award-winning translator Peter Cole.
Event Sponsored By:
Poets House
Event Type:
Readings and Conversations
Upcoming Readings and Conversations
Current Exhibition
June 12, 2015 to September 19, 2015


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Drug information provided by: Micromedex
Azelaic acid is used to treat mild to moderate acne. It works in part by stopping the growth of skin bacteria that can help cause acne. Azelaic acid also helps to lessen acne by keeping skin pores (tiny openings on the skin's surface) clear.
It may also be used to treat other conditions as determined by your doctor.
Azelaic acid is available only with your doctor's prescription.
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, azelaic acid is used in certain patients with the following medical condition:
This product is available in the following dosage forms:
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Studies of this medicine have been done only in adult patients, and there is no specific information comparing use of azelaic acid in children with use in other age groups.
Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of azelaic acid in the elderly with use in other age groups.
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
When applying the cream, use only a small amount of medicine and apply a thin film to clean, dry skin that is affected by acne. It is important to rub it in gently but well.
After applying azelaic acid cream, wash your hands well to remove any medicine that may remain on them.
Keep this medicine away from the eyes, other mucous membranes, such as the mouth, lips, and inside of the nose, and sensitive areas of the neck. If the medicine accidently gets on these areas, wash with water at once.
To help clear up your acne completely, it is very important that you keep using this medicine for the full time of treatment , even if your symptoms begin to clear up after a short time. If you stop using this medicine too soon, your acne may return or get worse.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
If your acne does not improve within 4 weeks, or if it becomes worse, check with your health care professional. However, it may take longer than 4 weeks before you notice full improvement in your acne even if you use the medicine every day.
If this medicine causes too much redness, peeling, or dryness of your skin, check with your doctor. It may be necessary for you to reduce the number of times a day that you use the medicine or to stop using the medicine for a short time until your skin is less irritated.
If your doctor has ordered another medicine to be applied to the skin along with this medicine, it is best to apply them at different times. This may help keep your skin from becoming too irritated. Also, if the medicines are used at or near the same time, they may not work properly.
You may continue to use cosmetics (make-up) while you are using this medicine for acne. However, it is best to use only water-base cosmetics. Also, it is best not to use cosmetics too heavily or too often. They may make your acne worse. If you have any questions about this, check with your doctor.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Portions of this document last updated: April 01, 2015
Original article: http://www.mayoclinic.org/drugs-supplements/azelaic-acid-topical-route/description/drg-20062084
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A park for all seasons…
The Parkdale Park wetland occupies about 0.35 acres in the south end of the park, near the stormwater ditches. It consists of shallow (vernal) wetlands that hold water in the spring and dry out in the summer. Marion County planted native grasses, flowers, and sedges in the wetland area. This vegetation will be mowed annually to discourage brush growth and weedy species. Seventy Oregon ash trees were also planted on the site to help cool the stormwater, stabilize the soil, and uptake excess nutrients. Once they are established, the trees will be pruned of their lower branches to ensure that the park has clear lines sight (to help discourage unwanted activities)Diagram of Wetland
Sports facilitiesThough the wetland occupies a small section of the park, the remainder of the park could serve as sports playing fields. The soil removed from the wetland area was used to raise and smooth the northern area of the site. This area was planted with turf grasses to encourage informal sports activities. Your voiceWe are interested in hearing your ideas about Parkdale Park. Feel free to contact Russ Dilley, Marion County Parks Coordinator, at (503) 588-5036.
LocationTake Cordon Road NE and turn left on Hayesville Drive. Park is past Janice Street on the left.
Powered by Google™These driving directions are provided as a general guide only. No representation is made or warranty given as to their content, road conditions or route usability or expeditiousness. You may find that construction projects, traffic, weather, or other events may cause conditions to differ from the map results, and you should plan your route accordingly. The user assumes all risk of use.


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|News » Archives
Saturday, January 29, 2011
JOHNSON CITY, Tenn. (Jan. 29, 2011) - Senior guard Tara Davis (Murfreesboro) scored a team-high 21 points and eclipsed the 1,000-point mark for her career, as the ETSU women's basketball team opened the second half with an impressive offensive run to dismantle Atlantic Sun Conference foe Kennesaw State 85-61 Saturday afternoon inside the ETSU/MSHA Athletic Center.
Davis, who became the 19th ETSU women's player to reach 1,000 points in a career, got the milestone with a free throw at the 17:05 mark of the second half. Along with Davis' scoring, the Lady Bucs also got a double-double effort from freshman forward Destiny Mitchell (Bluffton, Ga.), who finished with 17 points and 13 rebounds, while junior forward Gwen Washington (Manassas, Va.) pitched in 12 points.
With the win, ETSU improves to 12-9 overall, 9-3 in league action, while KSU drops to 6-13, 3-8.
"We're really proud of Tara and what she has done for this program over the last four years has been special," said ETSU head coach Karen Kemp, whose team outscored KSU 21-3 in the opening five minutes of the second half to run away with the victory. "She did a great job for us again tonight, and Destiny continues to play well. I thought we really stepped up our intensity in the second half."
Kennesaw State managed to battle in the first half, putting together a 9-2 offensive run early on to take a 16-11 lead with just under 12 minutes left before the intermission. The Lady Bucs answered at that point, going on a run of its own and outscoring the Owls 13-4 over the next six minutes to hold a 24-20 edge with 5:39 left on the clock.
The Owls regained the advantage at 25-24 before a pair of free throws by Davis and a jumper from Washington made it 28-25 at the half.
In the first half, the Bucs shot just 26 percent from the floor, while KSU hit on 46 percent of its shots. ETSU also struggled to find its range from outside, hitting on just 2-of-12 shots (17 percent) from beyond the 3-point arc. The Owls committed a sobering 17 turnovers in the first 20 minutes, meaning they took just 22 shots in the opening 20 minutes, compared to 43 shots by the Lady Bucs.
ETSU played inspired basketball after the break, clapping down on the defensive end, forcing numerous KSU turnovers, and capitalizing with easy baskets on the other end of the floor. The result was the game-deciding 21-3 run to open the second half. KSU was never able to recover.
In the second half, the Lady Bucs shot 68 percent from the floor and 50 percent from beyond the 3-point arc. Meanwhile, ETSU forced the Owls into another 12 turnovers (29 for the game) and held KSU to just 38 percent shooting in the second half.
For the game, the Lady Bucs out-rebounded the Owls 41-36 and collected 13 steals. ETSU shot 42 percent from the field and 91 percent from the foul line.
KSU was led by a game-high 26 points from Angie Smith, while Tamasha Bolden netted 11.
The Lady Bucs will return to action on Monday evening as part of doubleheader action against Mercer inside the Dome. Tip is set for 4:45 p.m., followed by the men's game at 7 p.m.