text:
|Publication number
|Publication type
|Application number
|Publication date
|Sep 23, 1997
|Filing date
|Apr 2, 1996
|Priority date
|Mar 30, 1995
|Fee status
|Also published as
|Publication number
|David Kupiecki, Cong Thach, John E. Ortiz, Neil J. Sheehan
|Original Assignee
|Target Therapeutics, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (13), Referenced by (125), Classifications (17), Legal Events (6)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation-in-part of Ser. No. 08/413,970 filed on Mar. 30, 1995.
The present invention relates to occlusive implants generally. More specifically, the invention involves occlusive implants, such as embolic coils, constructed with varying flow resistance characteristics to facilitate anchoring during hydraulic delivery, and methods of delivery.
Endovascular therapy has been used in treating a variety of different conditions, including control of internal bleeding, occlusion of blood supply to tumors, and relief of vessel wall pressure in the region of an aneurysm. A variety of different embolic agents are known as arguably suitable for such therapy.
One known embolic agent includes injectable fluids or suspensions, such as microfibrillar collagen, various polymeric beads, and polyvinyl alcohol foam. The polymeric agents may be additionally crosslinked, sometimes in vivo, to extend the persistence of the agent at the desired vascular site. These agents are often introduced into the vasculature through a catheter. After such introduction, materials there form a solid space-filling mass. Although they provide good short-term vaso-occlusion, they are ultimately reabsorbed in the process of vessel recanalization.
Polymer resins, typically cyanoacrylates, are also employed as injectable vaso-occlusive materials. The resins are typically mixed with a radio-opaque contrast material or made radiopaque by the addition of tantalum powder. However, placement of the mixture is quite difficult. Inadvertent embolisms in normal vasculature (due to the inability of controlling the destination of the pre-gelled resins) is not altogether uncommon. The material is impossible to retrieve once it has been placed in the vasculature. Such resins have not been FDA approved, and a waiver must be requested in each instance where the materials are applied during human operative procedures.
A number of mechanical vaso-occlusive devices are widely used. One such device is a balloon which may be carried to the vessel site at the end of the catheter and there inflated with a suitable fluid, typically a polymerizable resin, and released from the end of the catheter. The balloon device has the advantage that it effectively fills the cross-section of the occluded vessel. However, when using intravascular balloon embolization of intracranial berry aneurysms, inflation of a balloon into the aneurysm carries some risk of aneurysm rupture due to possible "overfilling" of portions of the sac and due to the traction produced when detaching the balloon from the end of the catheter. Moreover, a vascular balloon is difficult to retrieve after the resin within the balloon sets up, and the balloon cannot be easily visualized using radiographic techniques unless it is filled with contrast material. Balloons have also been known to rupture during filling, or release prematurely during filling, or leak monomeric resin into the vasculature during the period before the monomer sets up into polymeric form.
Another type of mechanical vaso-occlusive device is a wire coil or braid which can be introduced through a catheter in a stretched linear form and which assumes an irregular shape upon discharge of the device from the end of the catheter. A variety of vaso-occlusive coils and braids are known. For instance, U.S. Pat. No. 4,994,069, to Ritchart et al., shows a flexible, preferably coiled, wire for use in small vessel vaso-occlusion. Unlike vaso-occlusive coils previously, Ritchart et al. teaches a coil which is fairly soft and is delivered to the site using a pusher within a catheter lumen. The Ritchart et al. coils are typically pushed into the desired vascular site in a linear configuration. Upon discharge from the catheter, the coil may undertake any of a number of random or regular configurations designed to fill the site. The coils are used for small vessel sites, e.g., 0.5-6.0 mm in diameter. The coils themselves are said to be between 0.010 and 0.030 inches in diameter. The length of the coiled wire is typically 15-20 times the diameter of the vessel to be occluded. The wire used to make up the coils may be 0.002 to 0.006 inches in diameter. Tungsten, platinum and gold threads or wires are said to be preferred. These coils have a variety of benefits, including the fact that they are relatively permanent, they can be easily imaged radiographically, they may be located at a well-defined vessel site, and they can be retrieved.
A variation of the mechanical endovascular coil is the electrolytically detached endovascular coil described in U.S. Pat. No. 5,122,132 to Guglielmi et al. These coils are typically used in intracranial aneurysms because of their effectiveness in quickly forming controlled emboli. The disclosed coils are similar to those of Ritchart et al. (supra) in size and in composition. However, the method of introducing the coil to the vascular site is somewhat different. Rather than mechanically thrusting the coil into the chosen site, the coil is placed at the site and a small voltage is applied to the guidewire supporting the coil so that the coil is electrolytically detached from the distal tip of the guidewire. The step of electrolytically detaching the coil has the added benefit of forming a thrombus as the coil is detached. Again, as noted above, the Guglielmi coils may be stainless steel or platinum or the like, and are typically 0.010 to 0.020 inches in diameter and are made using wire having approximate diameters of 0.001 to 0.005 inches. The coils in this service are typically between 1 and 50 centimeters in length.
There is a need for a liquid coil type fluid delivery embolism forming device that can be delivered to a particular site and anchored thereto.
The present invention provides an occlusive implant device comprising an elongated member having an end, a portion proximal to the end, and a portion distal to the end. The proximal portion is sufficiently flexible so that it can be folded upon itself and maintain that configuration without further restraint. At least a portion of the distal portion is preformed to have a first configuration when in a first state and a second configuration when in a second state. The distal portion second configuration has a flow resistance substantially greater than that of the proximal portion. With this construction, the proximal portion can be forced or accelerated toward the distal portion as the proximal portion is generally forced downstream to the occlusion site. The flexible aspect of the proximal portion facilitates its folding into a ball-like mass as it moves toward and piles against the distal portion. As the mass builds in size, it is believed to frictionally engage the surrounding vasculature wall and anchor the implant thereto. The distal portion secondary configuration may be such so as to engage the surrounding vasculature wall for anchoring the device prior to or at the same time the proximal portion engages the vasculature.
The extremely flexible proximal portion further facilitates achieving very high packing densities which improves occlusion rates. The flexibility of the device also facilitates removal of the implant with a syringe or retriever.
According to a preferred embodiment, the implant is hydraulically delivered. This facilitates delivery through soft flow directed catheters. In addition, the hydraulic delivery improves delivery speed through tortuous anatomy.
According to a further embodiment of the invention, the occlusive implant is provided in an introducer cartridge prior to delivery in vivo. In a preferred embodiment, the introducer cartridge generally includes a first portion having a passage formed therethrough for containing the implant and a second portion having a recess adapted for receiving fluid to eject the implant from the first portion passage into a delivery catheter, for example. According to one aspect of the inventive introducer cartridge, a blocking member is provided in the second portion recess adjacent to the passage. The blocking member preferably is constructed so that fluid can be discharged therethrough for impelling the implant through the catheter while the implant is blocked from backing into the recess. This is especially advantageous where a transition between the recess and passage, for example, may make it difficult or impossible to return the implant to the ejection passage without damaging it.
According to a preferred embodiment of the introducer cartridge, the blocking member comprises porous plastic. It has been found that porous plastic can provide an implant blocking filter that minimizes or eliminates snagging between the implant and filter. A cap may be coupled to the introducer cartridge outlet. The cap is constructed to facilitate the removal of air from the introducer cartridge without permitting implant discharge prior to use.
The above is a brief description of some of the features and advantages of the present invention. Other features, advantages and embodiments of the invention will be apparent to those skilled in the art from the following description, accompanying drawings and appended claims.
FIG. 1 is a diagrammatic view of a hydraulic delivery system for delivering an occlusive device in accordance with the principles of the present invention.
FIG. 2A is a side view of an occlusion device constructed according to the present invention and showing the device as if it were in a radially restrained state.
FIG. 2B is a further view of the occlusion device of FIG. 2A showing the device in a relaxed state.
FIG. 2C is a side view of the coil of FIG. 2A with increased pitch and a thrombogenic bundle positioned therein.
FIG. 3 is a side view of another embodiment of the occlusion device of the present invention showing the device in a relaxed state.
FIG. 4A is a longitudinal section of a preferred introducer cartridge according to the present invention with the occlusive device of FIG. 2A positioned therein.
FIG. 4B is a transverse section of a variation of the introducer cartridge hub shown in FIG. 4A.
FIG. 4C is a transverse section taken along line 4C--4C in FIG. 4A.
FIG. 5 is a sectional view of the catheter of FIG. 1 showing the occlusion device of FIG. 2 prior to ejection therefrom.
FIG. 6 is a further view of the catheter of FIG. 5 showing the occlusion device partially ejected.
FIG. 7 is yet a further view of the catheter of FIG. 5 showing a later ejection stage with the occlusion device partially packed into an anchoring configuration.
FIG. 8 shows the configuration of the occlusion device of FIG. 7 anchored in position after ejection.
FIG. 9 is a side view of an auxilliary occlusion device.
Referring to the drawings in detail, wherein like numerals indicate like elements, occlusive implants or devices and preferred modes for their delivery are shown in accordance with the principles of the present invention.
The occlusive devices of the present invention generally are extremely flexible. The flexibility facilitates their reconfiguration at the selected site to form an occlusion or occlusion forming mass with minimal trauma to the site as will be described in more detail below.
In general, the devices are provided with a slender configuration for delivery to the selected site where they are balled up in a relatively dense occlusive mass having sufficient size to frictionally engage the interior walls of the lumen and anchor the device thereto. In the preferred embodiment, a hydraulic system is used to both deliver these devices, which are difficult to mechanically push due to their lack of significant column strength, and to reconfigure them into an occlusive mass.
Referring to FIG. 1, a catheter apparatus for hydraulically delivering occlusive devices of the present invention is shown. Apparatus 2 generally includes a catheter 4, an adapter or sidearm 6, introducer cartridge (or occlusive device cartridge) 8 and syringe 10. Sidearm 6, which is of conventional design for introducing fluids or apparatus to the catheter, fluidly couples the distal end of introducer cartridge 8 to the proximal end of the catheter. Syringe 10 is of conventional construction and includes a cylindrical barrel 12 and a plunger 14 that is reciprocally mounted therein.
Referring to FIGS. 2A and 2B, an occlusive implant or device 20 is shown constructed according to the present invention. In the illustrative embodiment, occlusive implant 20 comprises a coil. The coil is constructed so that it can assume a linear configuration (more specifically a rectilinear configuration) as shown in FIG. 2A and a compound linear and helical configuration as shown in FIG. 2B. The linear and compound configurations correspond to restrained and unrestrained coil shapes as will be discussed in more detail below.
Coil 20 preferably comprises a wire thread or filament 21 that is wound to form a primary coil structure having multiple windings 22 (primary windings). The coil generally includes a proximal portion 24 and a distal portion 26. At least a portion of distal portion 26 portion, designated with reference numeral 27, is formed to create a secondary coil structure 28. Secondary coil structure 28 has multiple windings 30 (secondary windings) as shown in FIG. 2B where the coil is depicted in a relaxed condition. The secondary windings may be described as being superposed on the primary windings.
Although secondary coil structure 28 is shown as a generally uniform diameter helix, other configurations can be used. For example, a helix having a progressively increasing or decreasing diameter from end to end (tapered helix) can be used. In addition, a helix having a varying diameter in the axial direction can be used. This includes, for example, a helix having its diameter progressively increase or decrease in both directions away from the center region of the helix. It also should be noted that secondary coil structure 28 can terminate at the distal extremity of occlusive device 20 or be spaced therefrom.
The generally rectilinear configuration shown in FIG. 2A is used in placing the coil at the desired site, for example, by advancing it through a catheter. When the coil is released from the catheter into the vessel, portion 27 assumes its secondary shape so that proximal portion 24 can be folded and intertwined therewith to form a relatively dense mass for occluding a vessel or forming an embolism. It is important that the occlusion device is extremely flexible so that it can be packed or folded into such a dense mass. The following physical characteristics have been found to provide the desired results.
The device flexibility is generally uniform throughout its length. The occlusive device also is constructed such that a one centimeter section or length of the device deflects more than about 20� under its own weight when one end of the section is supported and the other end is free or unrestrained. Most preferably that centimeter deflects at least 45�.
The flexibility can be achieved by using a wire (wire 21 ) having a diameter (diameter 34) of ≦0.001 inches (1 mil), in combination with a coil structure having minimal space between windings and a primary coil diameter of about 0.006 inches to 0.018 inches. However, it is believed that a wire diameter of ≦ about 0.002 inches (2 mil) also may provide suitable results. The ratio of space between windings to the wire diameter preferably is about 0 to 2:1. That is, the space between windings preferably is about 0 to 2 wire diameters. Thus, for a 1 mil diameter wire, for example, a suitable space size between adjacent turns is 0.001 inches, providing a total coil pitch of 0.002 inches. However, since increasing the space between windings increases flexibility, larger spaces can be provided and an equivalent flexibility achieved when using larger diameter wire (generally, the smaller the diameter of the wire the more flexible the coil). Minimal space between windings is preferred since a coil with large spaces may generate thrombic reactions in the catheter which, in turn, can result in sufficient friction to prevent effective flow of the occlusive device. The length of the coil generally may be between 5 mm and 80 cm, preferably is about 5 mm to 30 cm, but may be as small as 1 mm.
Occlusion device 20 can be formed by wrapping or winding fine filament or wire 21 about a spinning mandrel using well-known coil-manufacturing techniques. In manufacturing the coil, the winding process preferably is adjusted to produce a single-layer coil (i.e., a coil where the windings are close packed). That is, preferably, the windings are sufficiently close so that virtually no gap (i.e., little or no gap) is formed between adjacent windings when it is placed in a straight, unstretched configuration (FIG. 1 ). The preferred pitch is about 0.001 to 0.004 inches, and more preferably about 0.001 to 0.003 inches, for a 1 mil diameter wire. In addition, the mandrel diameter is selected so that the outside diameter 36 of the primary windings 22 preferably will be in the range of about 0.006 to 0.018 inches.
The soft, flexible coil thus produced is cut to desired lengths after removal from the mandrel. Portion 27 of distal portion 26 of each cut length is then wound around a larger diameter mandrel to form helical winding 28. The mandrel is selected so as to form a secondary helical structure 28 including helical windings 30 with an outer diameter, indicated with reference numeral 38, that is preferably at least about 2 times the diameter 36 of primary windings 22, more preferably at least about 6 times diameter 36 and typically at least 10 times diameter 36. Diameter 38 preferably is about 0.040-0.120 inches (1.0-3.0 mm) and more preferably about 0.080-0.120 inches (2.0-3.0 mm). Proximal portion 24 may have an axial length (l1) in the range of about 100-1200%, and typically about 100-500% of the axial length (l2) of helical structure 28 to facilitate coil packing as will be described in more detail below. However, it is contemplated that other ratios also may be used.
After formation of the coil, its interior may be filled with a drug material and/or thrombogenic material such as a drug concentrate and its ends partially sealed for slow drug release from the coil in an in vivo aqueous environment. The ends of the coil may be sealed by a water-soluble plug for storage, if so desired. The coil may also (or alternatively) be coated with a thrombotic or medicinal material.
Alternatively, an end cap 32 may be included at one or both ends of coil 20. Cap 32 may be a separate piece or a fused portion of the coil or a bit of a filled material such as an epoxy. The major function of the end piece is to prevent the coil from catching on the interior of the catheter lumen or vessel. However, it is acceptable for devices of this size (the primary coil diameter is less than about 0.018 inches) to simply cut the coil ends and not use such an end cap.
Occlusive device 20 (and the variations described below) may be produced from any of a number of different materials. Some portion of the material preferably is radiopaque so that the coil and its position may be readily monitored within the human vasculature. Suitable materials include biocompatible metals, polymers, and alloys. For instance, biocompatible, radiopaque metals include silver, gold, palladium, platinum, tungsten, iridium, and various stainless steels. Other alloys such as platinum and tungsten (preferably 92% platinum and 8% tungsten) are suitable and, indeed, are often most preferred. The platinum-tungsten alloys desirably have a tensile strength of at least about 180 kpsi and, for a wire of a nominal 0.001 inch diameter, have a breaking load of 0.17 lb with a minimum elongation of 2% measured at a speed of 1.0 in/min. Various biocompatible polymers including polyethylene, polyurethane, polypropylene, and the like are suitable for use in these devices, but, because of their lack of radiopacity, must usually be teamed with a radiopaque marker or filled with a radiopaque filler to allow proper positioning of the coil within the body. Similarly, other inorganic materials such as fibrous carbon are suitable and may be used in the invention.
Although the windings shown in FIG. 2A have a generally uniform pattern, they may be arranged in an irregular pattern, e.g., one with varying pitch. In addition, although implant 20 is shown as coil-type implant, other constructions can be used. For example, a bundle 39 of thrombogenic fibers can be axially disposed in coil 20' as shown in FIG. 2C. Coil 20' is the same as coil 20 with the exception that coil 20' includes bundle 39 and preferably has more space between windings to expose the bundle to blood and, thus, enhance the device's thrombogenecity. Other configurations such as those disclosed in PCT publication no. WO 94/10936 (which is hereby incorporated herein by reference) can be used as well. For example, braid can be incorporated into the device as shown in FIG. 3.
Referring to FIG. 3, a combination coil-braid vaso-occlusive device 20" is shown according to the invention. Device 20" includes an alternating sequence of primary coils 40 and braid 42 and a secondary coil structure 44. Primary and secondary coils 40 and 44 are similar in construction to the primary and secondary coils described above. Lengths of the various coils 40 and braids 42, which are preferably 2 mm to 20 cm in length, are joined together at their respective ends to form the device. In another variation, the braid can be woven on the exterior of the coil. In a further embodiment, the coils may be formed as a double helix coil.
Each of the variations discussed above, when provided in the proper size range and materials, is an extremely soft and flexible device. These devices exert little if any radial force on the blood vessels into which they are placed. The fluid-like properties of the device enables it to conform to the complex geometry of certain fragile, abnormal blood vessels, and in so doing, minimize the risk of causing trauma to or even perforation of those blood vessels. Such flow properties also enable placement of the inventive device at sites in the vasculature currently unreachable by catheterization, such as those within an arteriovenous malformation (AVM).
As apparent from the foregoing, the occlusive implants exhibit relatively little column strength. Accordingly, they preferably are hydraulically delivered to the desired site as opposed to being mechanically pushed. A preferred introducer cartridge for introducing an occlusive device of the present invention is shown in longitudinal cross-section in FIG. 4A.
Referring to FIG. 4A, introducer cartridge 8 generally includes a hub 50 for receiving the discharge end of a syringe, such as syringe 10, and flexible, elongated tubular member 52 for discharging the occlusive device packaged therein into the catheter. In the illustrative embodiment, hub 50 is formed with first, second and third cylindrical recesses 54, 56 and 58, respectively. Recess 54 is configured to frictionally engage the discharge end (not shown) of syringe 10. Hub 50 may be configured with a conventional Luer or Luer lock fitting to mate with the discharge end of the syringe, for example. Recess 54 is fluidly coupled to smaller diameter recess 56 through tapered or conical region 60, and recess 56 is fluidly coupled to recess 58, which has a smaller diameter than recess 56. Recess 56 preferably contains an occlusive device blocking member, which may comprise a membrane or filter (such as a porous polymer type filter), for example, for permitting the working fluid (which preferably is a saline solution) to be discharged therethrough for impelling the occlusive device through the catheter, while blocking or preventing the occlusive device from backing into the hub. Such a blocking member is shown and designated with reference numeral 61 in FIG. 4A. Although the blocking member may have a relatively small axial dimension as indicated with dashed line 61a, this dimension may be larger as indicated with line 61b to facilitate placing the blocking member in the hub.
Blocking member 61 preferably comprises a filter generally having a flow resistance that facilitates forward fluid flow therethrough and minimizes the risk of filter displacement from the position shown in FIG. 4A when negative pressure (or fluid flow in the proximal direction) occurs. One material that has been found to provide desirable results is a high density porous plastic, and more particularly UHMW 1900, an ultra high molecular weight polyethylene commercially available from Himont, Inc. (N.J). In this example, the material also preferably has a porosity in the range of about 50μ to 100μ, more preferably 60-80μ and most preferably about 70μ. Typically, filter 61 may be from about 0.10 to 0.20 inches in length, most preferably about 0.15 inches in length with a diameter of 0.125 inch when used with an introducer cartridge having a 0.120 inch inner diameter in the vicinity of recess 56, a combined axial dimension for recesses 54 and 56 of about 0.8 inch and about a 0.017-0.025 inch inner diameter tubular member 52 although differently sized tubular members are contemplated to be used as well. It should be understood that other materials such as sintered metal or polymer foam, for example, may be used to construct the blocking member as would be apparent to one of ordinary skill. However, porous plastic has been found desirable in view of its characteristic smooth surface that typically does not snag a coil-type implant.
It is important that the filter remain securely abutted against the proximal end or inlet of tube 52. In the preferred embodiment, the filter is cylindrical and press fit into recess 56; it has a diameter that provides an interference preferably of about 0.003-0.010 inch with the inner wall of hub 50 that forms recess 56. In the embodiment shown in FIG. 4A, that inner wall has a cylindrical configuration.
Other interference designs also may be used. For example, the inner wall configuration of hub 50 may be star shaped. One such configuration is shown in FIG. 4B. The star configuration generally facilitates manufacturability. It has less sensitivity to filter and hub tolerances which are important to provide an effective press fit. It also permits fluid flow through radial channels 51 rendering filter porosity sensitivity less important.
Returning to FIG. 4A, tubular member 52 has a proximal end, which is secured within hub recess 58, and a distal end adapted for being releasably secured within an inlet of sidearm 6, or in the alternative, with a conventional inlet hub of the catheter 4. Tubular member 52 includes a passage 62 sized to contain an occlusive device of the present invention in a linear configuration. Thus, passage 62 is sized to restrain the secondary structure of the occlusion device to a diameter essentially equal to that of the proximal section of the occlusion device.
More specifically, the inner diameter of passage 62 is slightly greater than the outer diameter of the proximal nonpreformed portion of the occlusion device so that the secondary windings can expand a very small amount to reduce the friction between the inner wall of tubular member 52 and section 27 of the device. This enhances uniform displacement of the device through the introducer cartridge (the catheter lumen is similarly sized to enhance discharge of the device). According to the embodiment illustrated in FIG. 4A, a removable cap 64 is provided on the distal end of tubular member 52. Cap 64 is constructed to maintain the implant in tubular member 52 during shipping or handling prior to use. Cap 64 also is preferably constructed to facilitate the removal of air from the introducer cartridge without implant discharge prior to use.
In the preferred embodiment, cap 64 includes a discharge port or opening 64a and a blocking member or filter 65 disposed therein. The blocking member 65 is sized so as not to pass through opening 64a, preferably has a cylindrical form and preferably comprises a porous plastic material as described above in conjunction with filter 61. In addition, tubular member 52, blocking member 65 and opening 64a preferably are coaxial. Cap 64 further preferably comprises plastic, such as polyethylene or polypropylene, and is configured to form a press fit onto the distal end of tubular member 52 and with blocking member 65. In the preferred embodiment, the inner wall of the cap is formed with a plurality of longitudinally and radially extending, circumferentially spaced ribs 67 (FIGS. 4A and C) that form a press fit with tubular member 52 and blocking member or filter 64. The ribs can be configured so that they are somewhat crushed against tubular member 52 when the cap is press fit on the tubular member as would be apparent to one of ordinary skill. The cap may be heated and positioned on a mandrel with negative regions to form the ribs or by other conventional techniques such as injection molding. Other cap constructions also may be used. For example, the cap may comprise porous plastic.
Although a particular introducer cartridge has been described, other introducer cartridges having varied configurations to accommodate the needs of particular syringes or catheters, for example, can be used as would be apparent to one of ordinary skill.
Merely to exemplify the operation of the invention, the following example in which a vaso-occlusive device constructed according to the embodiment illustrated in FIGS. 2A & B is provided. This example is provided for illustrative purposes and is not intended to limit the invention. Vaso-occlusive device 20 is delivered through a catheter, e.g., catheter 4. Catheter 4 generally comprises an elongate tubular member having proximal and distal end portions 4a and 4b. The catheter is preferably between about 50-300 cm in length, and typically between about 60-200 cm in length. The catheter also is designed for accessing a vessel site at which, for example, vaso-occlusion is desired. For example, the vessel site can be within a small diameter vessel having 1-5 mm lumen diameter and accessible by way of a tortuous vessel path which may involve sharp vessel turns and multiple vessel branches. In this case, the catheter preferably has a small diameter, flexible construction with a lumen diameter of less than about 0.8 mm and preferably between about 0.5 to 0.7 mm. Catheters of this type, which are typically used for accessing deep brain vascular sites, are commercially available.
The catheter is inserted through a vessel lumen to the site to be occluded (e.g., a vascular malformation, arteriovenous fistula or mininginoma type tumor). Conventional catheter insertion and navigational procedures involving a guidewire or flow-directed means (such as disclosed in U.S. Pat. No. 5,336,205) may be used to access the site with the catheter. Thus, although not shown, catheter 4 may include a guidewire usable therewith to guide the distal end of the catheter toward the desired or selected occlusion site. Guidewires of this type are commercially available, and generally include an elongate wire having a tapered, wire-wound distal end region which is adapted to be advanced through a tortuous vessel path, with the catheter being moved axially along the advanced guidewire.
Once the distal end of the catheter is positioned at the selected site (its location may be determined by a coating at the distal end of the catheter with a radiopaque material or otherwise affixing such a material to the distal end of the catheter or incorporating such a material into the distal end of the catheter), the catheter is cleared. For example, if a guidewire has been used to position the catheter, it is withdrawn from within the catheter.
Prior to delivering a vaso-occlusive device in vivo, a syringe (e.g., a 3 cc syringe) is attached to hub 50 of the introducer cartridge with cap 64 positioned on the distal end of tubular member 52. Human compatible fluid, such as saline, is injected slowly from the syringe and through hub 50 and tubular member 52 to purge all the air from the introducer cartridge. The distal end of the tubular member 52, including the cap 64, is then submerged in a saline solution filled container or basin. Alternatively, cap 64 can be submerged in the saline solution during the purging step. The syringe plunger is then pulled back such that the occlusive device is urged proximally away from cap 64 to prevent the device from exiting the introducer cartridge prematurely when removing the cap. The introducer cartridge is placed in a horizontal position for inspection. If air remains in the introducer cartridge, the purging steps described above are repeated. If the air has been completely purged from the introducer cartridge, cap 64 is removed and the introducer cartridge is coupled to the proximal end of the catheter via sidearm 6.
The plunger in syringe 12, which preferably is loaded with a saline solution as described above, is slowly pushed down to displace the vaso-occlusion device from introducer cartridge 8 down through catheter 4 to the injection site (FIG. 5). As the plunger continues to be pushed inwardly, portion 27 of distal portion 26 is discharged from the catheter where it returns to its secondary configuration (FIG. 6). As the fluid from syringe 12 continues to force vaso-occlusive device 20 from the catheter, the proximal portion is discharged from the catheter and piles against, around and/or in portion 27 in a random fashion to form an occlusive mass. It is believed that since the proximal portion of the vaso-occlusion device has a significantly lower flow resistance configuration than that of the secondary structure in the distal portion, the discharge fluid accelerates the proximal portion through the blood toward secondary windings 28 to form the occlusive mass (FIGS. 7 and 8).
The flexibility of the proximal portion described above allows the proximal portion to fold over the secondary windings 28 and remain in that position without the need for external forces or other restraining mechanisms. The proximal portion can, however, become intertwined with secondary windings 28 and other portions of the proximal portion.
As the proximal portion balls up in a dense mass, it expands volumetrically, frictionally engages the inner walls of vessel 70 and anchors the vaso-occlusion device in that position as shown in FIG. 8. The flexibility of the device allows it to ball up as desired under a hydraulic pressure of about 50 to 150 psi. Occlusive masses volumetrically filling about 40-75% of an imaginary sphere that surrounds the mass can be achieved. This high volume packing efficiency facilitates very high occlusion rates.
After the vaso-occlusion device is positioned and/or anchored at the desired site, additional devices may be injected by exchanging the empty introducer cartridge with another loaded with another occlusion device. The additional (secondary) occlusion devices may be configured as described above or they may be configured otherwise. For example, the secondary occlusion devices may comprise a coil configured with a generally uniform helical secondary shape such as shown in FIG. 9 or a straight coil with no secondary shape. It is believed that the secondary coils add to the mass of the first positioned occlusion device and facilitate or enhance anchoring the first positioned occlusion device in place.
Additionally, the method of the present invention may include the step of introducing polymer resins, such as cyanoacrylate resins (particularly n-butylcyanoacrylate) to the intended site after the inventive coils, braids, and/or chains are in place. That is, the inventive devices form a substrate for these tissue adhesives, or particulate embolization materials such as microparticles of polyvinyl alcohol foam, or various chemotherapeutic agents.
Throughout this application, various publications, patents and patent applications are referred to by an identifying citation. The disclosures of these publications, patents and published patent applications are hereby incorporated by referenced into this application.
The above is a detailed description of particular embodiments of the invention. It is recognized that departures from the disclosed embodiments may be made within the scope of the invention and that obvious modifications will occur to a person skilled in the art. The full scope of the invention is set out in the claims that follow and their equivalents. Accordingly, the claims and specification should not be construed to unduly narrow the full scope of protection to which the invention is entitled.
|Cited Patent
|Filing date
|Publication date
|Jun 29, 1966
|Jul 1, 1969
|Us Catheter & Instr Corp
|Controlled vascular curvable spring guide
|Jul 8, 1987
|Jul 25, 1989
|Joseph Grayzel
|Diagonally tapered, bevelled tip introducing catheter and sheath and method for insertion
|Nov 2, 1988
|Feb 19, 1991
|Target Therapeutics
|Vaso-occlusion coil and method
|Mar 13, 1990
|Jun 16, 1992
|The Regents Of The University Of California
|Endovascular electrolytically detachable guidewire tip for the electroformation of thrombus in arteries, veins, aneurysms, vascular malformations and arteriovenous fistulas
|Nov 9, 1990
|Jul 28, 1992
|Catheter Research, Inc.
|Embolus supply system and method
|Jul 30, 1990
|Aug 18, 1992
|Peter J. Balsells
|Axial canted coil springs in sinusoidal form
|Jun 7, 1991
|Jun 8, 1993
|Marks Michael P
|Retractable-wire catheter device and method
|Oct 11, 1991
|Oct 26, 1993
|W. D. Ensminger
|Vascular catheterization system with catheter anchoring feature
|Aug 4, 1992
|Apr 19, 1994
|Medamicus, Inc.
|Dilator - Introducer locking hub and sheath valve apparatus
|Sep 22, 1992
|May 17, 1994
|Target Therapeutics, Inc.
|Assembly for placement of embolic coils using frictional placement
|Apr 9, 1993
|Aug 2, 1994
|Cook Incorporated
|Vascular occlusion assembly
|Feb 25, 1993
|Aug 9, 1994
|Target Therapeutics, Inc.
|Flow directed catheter
|Oct 15, 1993
|May 26, 1994
|Target Therapeutics Inc
|Ultrasoft embolism devices and process for using
|Citing Patent
|Filing date
|Publication date
|Jun 18, 1998
|Nov 9, 1999
|Target Therapeutics, Inc.
|Water-soluble coating for bioactive vasoocclusive devices
|Mar 11, 1998
|Feb 15, 2000
|Target Therapeutics, Inc.
|Vaso-occlusive coil with conical end
|Oct 14, 1997
|Jun 13, 2000
|Target Therapeutics, Inc.
|Delivery catheter for occlusive implants
|Jun 2, 1998
|Jul 18, 2000
|Musc Foundation For Research Development
|Anatomically shaped vasoocclusive device and method of making the same
|Aug 25, 1998
|Oct 24, 2000
|Micrus Corporation
|Vasoocclusive coil
|Feb 6, 1998
|Dec 12, 2000
|Micrus Corporation
|Three dimensional spherical micro-coils manufactured from radiopaque nickel-titanium microstrand
|Feb 5, 1999
|Jan 2, 2001
|Micrus Corporation
|Micro-strand cable with enhanced radiopacity
|May 4, 1998
|Jan 2, 2001
|Micrus Corporation
|Method and apparatus for occlusion and reinforcement of aneurysms
|Aug 27, 1998
|Jan 9, 2001
|Micrus Corporation
|Three dimensional, low friction vasoocclusive coil, and method of manufacture
|Nov 10, 1998
|Feb 13, 2001
|Target Therapeutics, Inc.
|Bioactive coating for vaso-occlusive devices
|Jul 12, 1999
|May 15, 2001
|Scimed Life Systems, Inc.
|Bioactive coating for vaso-occlusive devices
|Jun 4, 1999
|Aug 28, 2001
|Scimed Life Systems, Inc.
|Polymer covered vaso-occlusive devices and methods of producing such devices
|Oct 8, 1999
|Oct 9, 2001
|Target Therapeutics, Inc.
|Water-soluble coating for bioactive vasoocclusive devices
|Apr 25, 2000
|Oct 23, 2001
|Micrus Corporation
|Vasoocclusive coil
|May 27, 1999
|Mar 19, 2002
|Impra, Inc.
|Fluid containing endoluminal stent
|Dec 15, 1998
|May 7, 2002
|Micrus Corporation
|Variable stiffness coil for vasoocclusive devices
|Aug 22, 2000
|Oct 22, 2002
|Scimed Life Systems, Inc.
|Fast detaching electrically isolated implant
|Jan 2, 2001
|Nov 5, 2002
|Micrus Corporation
|Micro-strand cable with enhanced radiopacity
|Feb 29, 2000
|Apr 8, 2003
|Cordis Neurovascular, Inc.
|Embolic coil hydraulic deployment system with purge mechanism
|Aug 11, 2000
|Apr 8, 2003
|Scimed Life Systems, Inc.
|Vaso-occlusive coils with selectively flattened areas
|Oct 6, 1999
|Apr 22, 2003
|Board Of Regents The University Of Texas System
|Vasoocclusion coil device having a core therein
|Aug 16, 2001
|May 27, 2003
|Scimed Life Systems, Inc.
|Bioactive three loop coil
|May 29, 2001
|Jul 1, 2003
|Scimed Life Systems, Inc.
|Absorbable implantable vaso-occlusive member
|Mar 30, 2001
|Aug 5, 2003
|Scimed Life Systems
|Embolic devices capable of in-situ reinforcement
|Dec 8, 1999
|Sep 9, 2003
|Scimed Life Systems, Inc.
|Radioactive compositions and methods of use thereof
|Dec 4, 1998
|Sep 9, 2003
|Micrus Corporation
|Vasoocclusive device for treatment of aneurysms
|Oct 11, 2001
|Sep 23, 2003
|Impra, Inc.,
|Fluid containing endoluminal stent
|Jun 8, 2000
|Oct 28, 2003
|Micrus Corporation
|Three dimensional, low friction vasoocclusive coil, and method of manufacture
|Jan 31, 1997
|Oct 28, 2003
|Transvascular, Inc.
|Methods and apparatus for blocking flow through blood vessels
|Nov 15, 2001
|Dec 2, 2003
|Micrus Corporation
|Variable stiffness coil for vasoocclusive devices
|Apr 6, 2001
|Apr 20, 2004
|Scimed Life Systems, Inc.
|Bioactive three loop coil
|Sep 3, 1997
|Aug 17, 2004
|William Cook, Europe A/S
|Embolization device for positioning in a blood vessel
|Dec 5, 2000
|Feb 1, 2005
|Scimed Life Systems, Inc.
|Implant delivery assembly with expandable coupling/decoupling mechanism
|Nov 10, 2003
|Mar 29, 2005
|Micrus Corporation
|Variable stiffness coil for vasoocclusive devices
|Aug 8, 2003
|Apr 19, 2005
|Bard Peripheral Vascular, Inc.
|Method of recapturing a stent
|Mar 10, 2000
|Aug 30, 2005
|Scime Life Systems, Inc.
|Detachable aneurysm neck bridge (III)
|May 20, 2002
|Jun 13, 2006
|Boston Scientific Scimed, Inc.
|Foldable vaso-occlusive member
|Jun 22, 2004
|Jul 17, 2007
|Cordis Neurovascular, Inc.
|Activatable bioactive vascular occlusive device
|Apr 8, 2004
|Jul 24, 2007
|Cordis Neurovascular, Inc.
|Activatable bioactive vascular occlusive device
|Dec 17, 2003
|Nov 13, 2007
|Corris Neurovascular, Inc.
|Activatable bioactive vascular occlusive device and method of use
|Aug 29, 2003
|Dec 4, 2007
|Medtronic Vascular, Inc.
|Methods and apparatus for blocking flow through blood vessels
|Apr 25, 2003
|Jul 14, 2009
|Scimed Life Systems, Inc.
|Absorbable implantable vaso-occlusive member
|Oct 27, 2003
|Jan 12, 2010
|Boston Scientific Scimed, Inc.
|Vaso-occlusive devices with in-situ stiffening elements
|Jun 12, 2006
|Mar 2, 2010
|Codman & Shurtleff, Inc.
|Modified headpiece for hydraulic coil deployment system
|Dec 9, 2005
|Mar 23, 2010
|Spinal Ventures, Llc
|Non-soft tissue repair
|Mar 24, 2005
|Apr 13, 2010
|Boston Scientific Scimed, Inc.
|Polymer covered vaso-occlusive devices and methods of producing such devices
|Nov 17, 2006
|Aug 3, 2010
|Codman & Shurtleff, Inc.
|Modified headpiece for hydraulic coil deployment system
|Sep 23, 2003
|Sep 7, 2010
|Boston Scientific Scimed, Inc.
|External activation of vaso-occlusive implants
|Mar 30, 2004
|Feb 22, 2011
|William Cook, Europe A/S
|Embolization method for endovascular occlusion
|Oct 26, 2007
|Jun 7, 2011
|Medtronic Vascular, Inc.
|Methods and apparatus for blocking flow through blood vessel
|Apr 9, 2003
|Sep 13, 2011
|Stryker Corporation
|Bioactive components for incorporation with vaso-occlusive members
|Mar 12, 2010
|May 8, 2012
|Stryker Corporation
|Polymer covered vaso-occlusive devices and methods of producing such devices
|Dec 19, 2008
|Jun 5, 2012
|Microvention, Inc.
|System and method of detecting implant detachment
|Aug 31, 2010
|Jul 24, 2012
|Stryker Corporation
|System for embolizing a target site in a body by application of an external energy
|Jan 9, 2006
|Nov 13, 2012
|Stryker Corporation
|Foldable vaso-occlusive member
|Feb 27, 2008
|Dec 11, 2012
|Covidien Lp
|Implant including a coil and a stretch-resistant member
|Mar 5, 2013
|Pulsar Vascular, Inc.
|Systems and methods for supporting or occluding a physiological opening or cavity
|Jun 4, 2012
|Jun 11, 2013
|Microvention, Inc.
|System and method of detecting implant detachment
|Oct 7, 2004
|Sep 17, 2013
|DePuy Synthes Products, LLC
|Vasoocclusive coil with biplex windings to improve mechanical properties
|Jan 3, 2006
|Oct 1, 2013
|Pulsar Vascular, Inc.
|Implantable aneurysm closure systems and methods
|Apr 19, 2007
|Oct 8, 2013
|Pulsar Vascular, Inc.
|Methods and systems for endovascularly clipping and repairing lumen and tissue defects
|Aug 20, 2012
|May 27, 2014
|Bayer Essure Inc.
|Occlusion devices and methods
|Nov 19, 2012
|May 27, 2014
|Bayer Essure Inc.
|Occlusion devices and methods
|Nov 12, 2009
|May 27, 2014
|Spinal Ventures, Llc
|Device and method for securing a fastener
|Aug 30, 2011
|Jul 15, 2014
|Covidien Lp
|System and method for mechanically positioning intravascular implants
|Sep 30, 2011
|Jul 15, 2014
|Covidien Lp
|System and method for mechanically positioning intravascular implants
|May 17, 2006
|Jul 29, 2014
|DePuy Synthes Products, LLC
|Three dimensional, low friction vasoocclusive coil, and method of manufacture
|Aug 30, 2011
|Aug 5, 2014
|Covidien Lp
|System and method for mechanically positioning intravascular implants
|Aug 30, 2011
|Aug 5, 2014
|Covidien Lp
|System and method for mechanically positioning intravascular implants
|Feb 27, 2008
|Aug 12, 2014
|Covidien Lp
|Implant, a mandrel, and a method of forming an implant
|Apr 16, 2007
|Oct 21, 2014
|Covidien Lp
|System and method for mechanically positioning intravascular implants
|Aug 18, 2008
|Oct 28, 2014
|DePuy Synthes Products, LLC
|Twisted primary coil for vascular therapy
|Aug 22, 2013
|Nov 18, 2014
|DePuy Synthes Products, LLC
|Vasoocclusive coil with biplex windings to improve mechanical properties
|Jun 23, 2010
|Dec 30, 2014
|Depuy Synthes Products Llc
|Modified headpiece for hydraulic coil deployment system
|May 3, 2006
|Jan 13, 2015
|Microvention, Inc.
|Intracorporeal occlusive device and method
|Feb 22, 2013
|Mar 17, 2015
|Pulsar Vascular, Inc.
|Systems and methods for supporting or occluding a physiological opening or cavity
|Jan 20, 2012
|Apr 21, 2015
|Covidien Lp
|Aneurysm treatment coils
|Feb 11, 2013
|Jun 9, 2015
|Covidien Lp
|Medical implant
|Oct 5, 2012
|Sep 1, 2015
|Pulsar Vascular, Inc.
|Devices, systems and methods for enclosing an anatomical opening
|Feb 20, 2013
|Sep 1, 2015
|Covidien Lp
|Occlusive implants for hollow anatomical structures, delivery systems, and related methods
|Jan 2, 2002
|May 16, 2002
|Scimed Life Systems, Inc.
|Liquid based vaso-occlusive compositions
|Dec 27, 2000
|Jun 27, 2002
|Elaine Lee
|Bioactive materials for aneurysm repair
|Mar 25, 2002
|Jul 25, 2002
|Marks Michael P.
|Method and apparatus for detaching an intracorporeal occlusive device
|Apr 9, 2003
|May 13, 2004
|Hanh Ho
|Bioactive components for incorporation with vaso-occlusive members
|Aug 29, 2003
|May 20, 2004
|Trans Vascular, Inc.
|Methods and apparatus for blocking flow through blood vessels
|Mar 30, 2004
|Sep 23, 2004
|William Cook, Europe A/S
|Embolization method for endovascular occlusion
|Feb 6, 2004
|Oct 14, 2004
|Brian Cox
|Mechanism for the deployment of endovascular implants
|Jul 2, 2004
|Jan 6, 2005
|Cook Incorporated
|Occluding device and method of occluding fluid flow through a body vessel
|Sep 23, 2003
|Mar 24, 2005
|Scimed Life Systems, Inc.
|Energy activated vaso-occlusive devices
|Sep 23, 2003
|Mar 24, 2005
|Scimed Life Systems, Inc.
|External activation of vaso-occlusive implants
|Nov 12, 2002
|Apr 14, 2005
|Hans Henkes
|Medical implant
|Oct 27, 2003
|Apr 28, 2005
|Scimed Life Systems, Inc.
|Vaso-occlusive devices with in-situ stiffening elements
|Nov 12, 2003
|May 12, 2005
|Dadourian Daniel G.
|Ostial locator device and methods for transluminal interventions
|Dec 17, 2003
|Jun 23, 2005
|Jones Donald K.
|Activatable bioactive implantable medical device and method of use
|Jun 15, 2004
|Jun 23, 2005
|Jones Donald K.
|Activatable foam expandable implantable medical device and method of use
|Dec 17, 2003
|Jul 7, 2005
|Jones Donald K.
|Activatable bioactive vascular occlusive device and method of use
|Jan 3, 2005
|Jul 14, 2005
|Scimed Life Systems, Inc.
|Implant delivery assembly with expandable coupling/decoupling mechanism
|Apr 19, 2005
|Aug 25, 2005
|Bard Peripheral Vascular, Inc.
|Method of recapturing a stent
|Mar 24, 2005
|Sep 1, 2005
|Scimed Life Systems, Inc.
|Polymer covered vaso-occlusive devices and methods of producing such devices
|Apr 8, 2004
|Oct 13, 2005
|Lorenzo Juan A
|Activatable bioactive vascular occlusive device
|Jun 22, 2004
|Oct 13, 2005
|Lorenzo Juan A
|Activatable bioactive vascular occlusive device
|May 26, 2004
|Dec 1, 2005
|Nasser Razack
|Device for the endovascular treatment of intracranial aneurysms
|Jan 11, 2005
|Dec 1, 2005
|Marks Michael P
|Intracorporeal occlusive device and method
|Jan 9, 2006
|Jun 1, 2006
|Scimed Life Systems, Inc.
|Foldable vaso-occlusive member
|Dec 9, 2005
|Aug 17, 2006
|Zwirkoski Paul A
|Non-soft tissue repair
|Jan 19, 2006
|Sep 14, 2006
|Tekulve Kurt J
|Vascular occlusion device
|May 17, 2006
|Oct 26, 2006
|Ferrera David A
|Three dimensional, low friction vasoocclusive coil, and method of manufacture
|May 3, 2006
|Nov 23, 2006
|Marks Michael P
|Intracorporeal occlusive device and method
|May 3, 2006
|Nov 30, 2006
|Marks Michael P
|Intracorporeal occlusive device and method
|Feb 26, 2007
|Jun 28, 2007
|Julian Nikolchev
|Contraceptive transcervical fallopian tube occlusion devices and their delivery
|Mar 22, 2007
|Sep 27, 2007
|Cook Incorporated
|Aneurysm coil and method of assembly
|Feb 27, 2008
|Jul 22, 2010
|Tekulve Kurt J
|Variable stiffness occluding device
|Nov 17, 2011
|Thill Gary A
|Stentless Support Structure
|Apr 2, 2010
|Feb 23, 2012
|The Regents Of The University Of Colorado, A Body Corporate
|Vascular Occlusion Devices
|Apr 27, 2012
|Aug 16, 2012
|Thill Gary A
|Stentless Support Structure
|May 15, 2013
|Oct 24, 2013
|HLT, Inc. (formerly Heart Leaflet Technologies, Inc.)
|Stentless Support Structure
|Nov 10, 2006
|Sep 27, 2011
|Micrus Corporation
|Expandable curvilinear strut arrangement for deployment with a catheter to repair an aneurysm
|Mar 27, 2002
|Aug 13, 2008
|Boston Scientific Scimed, Inc.
|Embolic devices capable of in-situ reinforcement
|Dec 18, 2006
|Sep 3, 2008
|Boston Scientific Limited
|Embolic coils made from a wound ribbon
|Aug 5, 1998
|Feb 18, 1999
|Boston Scient Ltd
|Detachable aneurysm neck bridge (i)
|Aug 4, 1998
|Feb 25, 1999
|Target Therapeutics Inc
|Detachable aneurysm neck bridge
|Apr 3, 2002
|Oct 17, 2002
|Scimed Life Systems
|Bioactive occlusion coil
|May 6, 2002
|Nov 14, 2002
|Concentric Medical
|Bioactive polymer vaso-occlusive device
|May 29, 2002
|Dec 5, 2002
|Scimed Life Systems Inc
|Absorbable implantable vaso-occlusive member
|Aug 1, 2002
|Feb 27, 2003
|Scimed Life Systems Inc
|Bioactive occlusion coil
|U.S. Classification
|606/191, 606/198
|International Classification
|Cooperative Classification
|European Classification
|Jun 3, 1996
Owner name: TARGET THERAPEUTICS, INC., CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:KUPIECKI, DAVID;THACH, CONG;ORTIZ, JOHN E.;AND OTHERS;REEL/FRAME:007985/0967;SIGNING DATES FROM 19960516 TO 19960521
|Dec 16, 1997
|Certificate of correction
|Feb 26, 2001
|Fee payment
Year of fee payment: 4
|Dec 3, 2004
|Fee payment
Year of fee payment: 8
|Feb 24, 2009
|Fee payment
Year of fee payment: 12
|Mar 15, 2011
Effective date: 20110103
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:TARGET THERAPEUTICS, INC.;REEL/FRAME:025957/0313
Owner name: STRYKER NV OPERATIONS LIMITED, IRELAND
Owner name: STRYKER CORPORATION, MICHIGAN
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:TARGET THERAPEUTICS, INC.;REEL/FRAME:025957/0313
Effective date: 20110103


text:
Stephen Downes leads the Learning and Performance Support Systems program at the National Research Council, a multi-year effort to develop personal learning technology and learning analytics. He is one of the originators of the Massive Open Online Course, is a leading voice in online and networked learning, has authored learning management and content syndication software, and is the author of the widely read e-learning newsletter OLDaily.
Where are MOOCs Going? What is the Future of Distance Learning?
Stephen Downes, [Sept] 26, 2015, International MOOC Conference 2015, Anacapri, Italy
In this presentation I outline where the new MOOCs missed the real innovations in our connectivist MOOCs - not just the idea of 'open', but also the distributed architechture. From this foundation I describe the new approach to personal learning based on an experiential and immersive approach to learning. Slides are similar to my recent talk in Glasgow but the content is quite different.
Stephen's Web and OLDaily: http://www.downes.ca
Half an Hour Blog: http://halfanhour.blogspot.com
Huffington Post Blog: http://www.huffingtonpost.com/stephen-downes
All publications: http://www.downes.ca/me/presentations.htm
All presentations: http://www.downes.ca/me/presentations.htm
(presentations include slides and audio recordings)
Videos: http://www.downes.ca/me/videos.htm
RSS Feed: http://www.downes.ca/news/OLDaily.xml
Podcast: http://www.downes.ca/news/audio.xml
Key Articles
The Future of Online Learning: http://www.westga.edu/~distance/ojdla/fall1998/downes13.html
Learning Objects: Resources for Distance Education Worldwide: http://www.irrodl.org/index.php/irrodl/article/view/32/378
Resource Profiles: http://www-jime.open.ac.uk/2004/5/
e-Learning 2.0: http://www.elearnmag.org/subpage.cfm?article=29-1§ion=articles
Learning Networks and Connective Knowledge: http://ictlogy.net/bibciter/reports/projects.php?idp=614
Things You Really Need to learn: http://www.downes.ca/post/38502
Social Network
Twitter: http://twitter.com/downes
Slideshare: http://www.slideshare.net/Downes/
Facebook: http://www.facebook.com/downes
Flickr: http://www.flickr.com/photos/stephen_downes/
Google: http://www.google.com/profiles/sfdownes
Blip.tv: http://downes.blip.tv/
Contact: email@example.com email@example.com
Skype: Downes
I want and visualize and aspire toward a system of society and learning where each person is able to rise to his or her fullest potential without social or financial encumberance, where they may express themselves fully and without reservation through art, writing, athletics, invention, or even through their avocations or lifestyle.
Where they are able to form networks of meaningful and rewarding relationships with their peers, with people who share the same interests or hobbies, the same political or religious affiliations - or different interests or affiliations, as the case may be.
This to me is a society where knowledge and learning are public goods, freely created and shared, not hoarded or withheld in order to extract wealth or influence. This is what I aspire toward, this is what I work toward.
Canadians who gave their lives in service in Afghanistan
Hundreds of my IAAF Track & Field Photos from Moncton 2010
Stephen Downes
Web - Today's OLDaily
Web - This Week's OLWeekly
Email - Subscribe
RSS - Individual Posts
RSS - Combined version
JSON - OLDaily
National Research Council Canada
All My Articles
About Stephen Downes
About Stephen's Web
About OLDaily
Subscribe to Newsletters
Threads Discussions
Privacy and Security Policy
Social Network
Stephen's Web and OLDaily
Half an Hour Blog
Google Plus Page
Twitter Feed
Flickr Photos
Huffington Post Blog
Blip TV
Email: email@example.com
Email: firstname.lastname@example.com
Skype: Downes
My eBooks

subset: commoncrawl


text:
1 – 10 of 26
- show: 10
- |
- sort: year (new to old)
Embed this list
<iframe src=""
- 2013
The influence of different storage conditions and fat bloom on sensory characteristics of pralines
2013) FOOD SCIENCE AND LAW. 4(2). p.45-51 Mark(
- 2011
- Food choice questionnaire revisited in four countries: does it still measure the same?
- 2010
- Emotional consumers prefer unusual flavours
- Differences in detection time of fat bloom formation on pralines
- 2008
- Sensory evaluation of fresh and processed vegetables by Belgian consumers
- Consumer behaviour towards lemon grass tea in the Philippines
- Innovation in fruit wine market and consumer sensory preferences in the Philippines
- 2007
- Exploring consumer sensory preferences: the case of processed carrots
- Methodology Applied to Analyse Food Consumption of Low Income Population Groups
- Food Consumption in Poland and Belgium on the base of secondary data


text:
Cosmic Consciousness
For thousands of years, humanity has struggled to understand the place of men and women in the universe. All sorts of explanations have been brought forward, but ultimate agreement has never been ...View Article
Welcome to Spine Care Associates of Alexandria! Our Alexandria-based office has been serving patients from the Franconia, Kingstowne, Springfield, Lorton, Rose Hill and Ft. Belvoir communities for over twenty years. Our lead chiropractor, Dr. Philip Connolly, has helped many patients overcome chronic back pain, neck pain, headaches and sciatica to live a full and active life. If you or someone you know is struggling to find natural pain relief that doesn't depend on prescription medication, you've come to the right place!
Dr. Connolly gives patients the highest quality care using the latest chiropractic techniques. He uses non-invasive treatments, including chiropractic care, massage therapy, spinal manipulative therapy, myofascial techniques, and non-surgical spinal decompression to correct a herniated disc, relieve low back pain and help patients manage chronic pain and recover from injuries.
If you are new to chiropractic care or non-invasive treatments, we understand that you may have questions about how these treatments work. We invite you to visit the "Services and Techniques" part of our website to learn more about approach to whole body wellness. The science behind each of our treatments is explained in detail, including how decompression back treatment can correct a herniated disc and restore alignment to a patient's body.
Our goal with every treatment is to restore movement and function to your body, ease pain, and resolve the underlying musculoskeletal issue that is causing you pain. Whether you suffer from neck pain, back pain or sciatica, we know that every patient is different and will tailor a treatment program specifically for your needs. We may also recommend complimentary care, such as massage therapy or physical therapy, to speed the healing process.
Dr. Connolly's treatment approach focuses on the spine's structure and function, and how the spine and nervous system interact to affect one's lifestyle. Many causes of pain, such as a herniated disc, are the result of an alignment problem with skeletal system that results in one or more discs putting pressure on the nerves. Dr. Connolly uses hands-on spinal manipulative therapy (SMT) to help heal not only the spinal joints, but also the muscles supporting the spine. By restoring alignment, this removes pressure from the nerves and relieves back pain, neck pain and leg pain.
At Spine Care of Alexandria, we believe that a complementary approach to treatment produces the best results. Our chiropractor frequently combines spinal manipulative therapy with another conservative, non-invasive treatment such as myofascial tissue release. Myofascial tissue release is a form of massage therapy that promotes healing in the soft, connective tissues in the body. Our massage therapists also combine elements of myofascial release with acupressure and trigger point therapy during deep tissue and sports massages.
We believe that a whole body approach to wellness is the best way to heal your body and treat pain. An important part of this treatment process is proper nutrition. Our Certified Holistic Health Counselor, Amy Andrejewski, can help you live a better, healthier life through basic dietary and lifestyle changes. Each person is different, and no one diet works for everyone. That's why each of Amy's programs are completely personalized for your lifestyle and dietary needs. Through better nutrition, you can overcome common health complains, including headaches, chronic fatigue and digestive issues.
We offer military discounts for active duty service members and their families. Don't let neck and back pain stop you from living a full life. There are safe, natural and effective alternatives to prescription painkillers. Medication only covers up pain -- a decompression back treatment can solve the underlying problem, so you can live your life pain-free without being dependent on medication. Come visit your Alexandria chiropractor, Dr. Connolly, and take back your life! Call us at 703.719.7302 to schedule an appointment.
Spine Care of Alexandria
Featured Articles
For thousands of years, humanity has struggled to understand the place of men and women in the universe. All sorts of explanations have been brought forward, but ultimate agreement has never been ...View Article
All of us have thought, at one point or another, and possibly more than once, "I wish I knew then what I know now." It's been famously said that "hindsight is 20/20". Our clarity of thought with r ...View Article
It has long been known that over evolutionary time the human organism developed in tandem with a vast host of microbial fellow travelers. The 100 trillion microorganisms inhabiting our gastrointes ...View Article
Climbing a hill is a useful metaphor for activities involved in accomplishing a major goal, overcoming longstanding obstacles, or achieving a noteworthy milestone. But you must be prepared to enga ...View Article
The metaphor linking the human brain with computer hardware is now so well known that it features regularly in news media stories. The metaphor linking the code embedded in human DNA and computer ...View Article
Having a pair of healthy hips is a key to healthy aging. But healthy hips are not only important for people in their 60s, 70s, and beyond. Your hips are one of your most important structural compo ...View Article
Contact Us
6285 Franconia Rd
Alexandria, VA, 22310
Email: Spine Care Associates of Alexandria
Launch 3D Spine Simulator
Office Hours
|9 - 2
|3 - 7
|3 - 7
|9 - 2
|3 - 7
|3 - 7
|8 - 3


text:
You asked and Slash answered. In the fifth episode of #AskSlash, Slash answers questions submitted about creativity and where he got his first top hat.
Category Archives: In the Press
"World On Fire" Lyric Video Available Now!
The new lyric video for "World On Fire" is out now. Watch the video below:
"World On Fire" is available now on iTunes at http://smarturl.it/slashworldonfire
The new single from Slash ft. Myles Kennedy and The Conspirators is AVAILABLE NOW on iTunes in the US & Canada at http://smarturl.it/slashworldonfire
"World On Fire" will be available for download on iTunes in the UK & Europe on Monday 6/16.
Stream the new single, "World On Fire", in full now on YouTube and Spotify.
"World On Fire" Sneak Peek
Here's a sneak peek of the new single, "World On Fire", look for a full stream available Friday the 13th!
Classic Rock Slash Fanpack
Classic Rock Presents Slash ft Myles Kennedy & The Conspirators New Album 'World On Fire' Fanpack Edition
On sale a full four weeks before the regular UK album release, Classic Rock's Slash Fan Pack includes the guitar hero's fantastic new album World On Fire with Myles Kennedy & The Conspirators, plus an in-depth, glossy, full-colour magazine dedicated to every aspect of how the album was written and recorded. Read: exclusive
#AskSlash – Episode 2, Favorites
You asked and Slash answered. In the second episode of #AskSlash, Slash answers questions submitted about some of his favorite things.
Slash Announces Headline Europe and UK Tour Dates!
Slash Ft. Myles Kennedy and The Conspirators will be touring Europe and the United Kingdom in 2014. Tickets go on sale on Friday May 30, or pre-order his new album to get access to an exclusive pre-sale starting on Wednesday 28th May at 10AM.
Pre-order "World on Fire" here: http://smarturl.it/Worldonfire-digital
Slash Ft. Myles Kennedy and The Conspirators 2014 European Tour Dates
11/10 – Dublin, Ireland @ O2 Arena
11/12 –
Slash Ft. Myles Kennedy and The Conspirators Announce New Album!
SLASH and his bandmates Myles Kennedy and The Conspirators will release their new album WORLD ON FIRE on September 15 via SLASH's own label Dik Hayd International distributed through Roadrunner Records (Europe, Middle East, Africa, & Latin America).
The group revealed the cover artwork for WORLD ON FIRE designed by American contemporary artist Ron English today. Featuring the blazing title track as the first single the disc marks SLASH's third
#AskSlash And Your Questions Were Answered
You asked your questions and Slash has answered! Beginning next Tuesday, May 20th at 10 AM PST, we will be rolling out the first episode of #AskSlash on Slash's Youtube channel: http://www.youtube.com/user/slash
We collected a ton of great questions and Slash has answered the best ones on video! Make sure you tune in each week to see if he answered your question.
Five New Slash Ft. Myles Kennedy and The Conspirators Tour Dates Added!
There have been five new summer tour dates with Slash ft. Myles Kennedy and The Conspirators added for this summer.
Those tour dates are:
7/9 Hampton Beach, NH Hampton Beach Casino Ballroom
7/20 Northfield, OH Hard Rock LIVE (Rocksino)
7/26 N. Kansas City, MO Harrah's N. Kansas City – Voodoo Lounge
8/1 Scottsdale, AZ Talking Stick Resort & Casino – Ballroom
8/15 Coquitlam, British Columbia Hard Rock Casino – Vancouver


text:
Select Local Merchants
Surf and Sand TanRead MoreDon't let the winter weather get you down! Head to Surf and Sand Tan in Bellevue for a relaxing and toasty tanning treatment. These full service tanning salons will help your skin look brighter and bolder. tanning beds, spray tan, and airbrush tan are just some places to start. If you decide to opt for an alternative treatment, such as acne treatment, this salon has you covered. If you're planning a trip to somewhere warm, head on over to Surf and Sand Tan for a base glow.400 Fairfield AveBellevue, KY US
Inner Peace Holistic CenterRead MoreThe warm, earthy tones of Inner Peace Center swaddle clients with a sense of tranquility that permeates the on-site Thai reflexology room, yoga studio, and nail stations. The staff handpicks a variety of high-end products—from the organic, biodynamic, and botanical-based Éminence skincare products to the vegan, formaldehyde-free nail-care products from SpaRitual. They also use Premierlash eyelash extensions crafted from 100% cruelty-free mink fur or nylon-based materials. Going below the surface, Inner Peace Center indulges guests with spiritual services administered by a Reiki master, hypnotherapist, yoga instructor, holistic life coach, and clairvoyant. The retired nurse who oversees and performs these services aims to assist clients in navigating their life path, demagnetizing the needle of anyone's internal compass.811 Walnut Street, 3rd FloorCincinnati, OH US
Sunsations Tanning SalonRead MoreWith comfortable facilities, you'll feel at home when you visit Newport's Sunsations Tanning Salon for an incredible tanning experience. This salon knows paleness isn't forever. With services like tanning beds, spray tan, and airbrush tan offered, you'll leave looking bolder and brighter. Seeking alternative medical services? Check out the selection at this salon, including acne treatment. So when you're craving some warmth and a sun tan, Sunsations Tanning Salon is here for you.648 Monmouth StreetNewport, KY US
Richard's Store and TanningRead MoreGetting a tan from Richard's Store and Tanning in Newport is the best way to show off those muscle lines you have been working so hard at. This salon knows paleness isn't forever. With services like tanning beds, spray tan, and airbrush tan offered, you'll leave looking bolder and brighter. This salon offers a wide range of services, including alternative treatments, to help you reach your beauty goals. Kickstart your weekend with a visit to Richard's Store and Tanning and receive a fresh and new tan.720 Monmouth StreetNewport, KY US
9TH STREET LAUNDRY and TANRead More9TH STREET LAUNDRY and TAN in Newport features exclusive indoor tanning services to keep guests tan all year long. This salon will have you feeling like it's summer all year round with its tanning salon boasting such services like tanning beds, spray tan, and airbrush tan. 9TH STREET LAUNDRY and TAN offers clean and natural-looking tanning solutions so book an appointment today and treat yourself to a beautiful glow.403 E 9th StNewport, KY US
Tina's TanningRead MoreDitch the self-tanning lotion and head to Dayton's Tina's Tanning for a professional tanning service. Tina's Tanning offers tanning services for every skin type, such as tanning beds, spray tan, and airbrush tan. If alternative medical services are more appealing to you, check out this salon. Don't let these great and affordable tanning deals slip through your fingers - call Tina's Tanning today and book an appointment.618 6th AveDayton, KY US


text:
Division Series - San Francisco Giants v Cincinnati Reds - Game Five
Brandon Crawford of the San Francisco Giants tries to throw out Joey... NyhetsfotoAmerican league,Baseboll - Sport,Brandon Crawford,Cincinnati,Cincinnati Reds,Great American Ball Park,Helkroppsbild,Horisontell,Idrottsarena,Joey Votto,Kasta,Major League Baseball Playoff,Matchomgång 5,National League,National League-serie,Ohio,Playoffs,San Francisco Giants,Sport,USAPhotographer Jonathan DanielCollection: Getty Images Sport 2012 Getty ImagesCINCINNATI, OH - OCTOBER 11: Brandon Crawford #35 of the San Francisco Giants tries to throw out Joey Votto of the Cincinnati Reds in Game Five of the National League Division Series at the Great American Ball Park on October 11, 2012 in Cincinnati, Ohio. The Giants defeated the Reds 6-4. (Photo by Jonathan Daniel/Getty Images)


text:
Itajime is a form of shibori dyeing that uses clamped shapes to create the resist. Traditionally, the cloth was compressed between two pieces of wood held in place with string before starting the fabric dyeing process.
Artist Susan Brubaker Knapp is known for her beautifully detailed quilts accomplished by painting on fabric and thread sketching. But when she wanted to add quotes to her quilts, she found fabric paints too heavy for writing on fabric, especially to achieve the fine lines and small printing she desired.
Shibori techniques, or pattern resist dyeing, have been used for hundreds of years. The resulting shibori fabric (traditionally indigo blue) is treasured by fiber artists (I have an entire collection).
Is it a coincidence that the word "text" can be found in "texture" and "textiles"? Maybe so. But whether you scribble on background fabric with a permanent pen or make a focal point with 3-D embellished letters, text adds texture to textiles.
Looking back over the last 12 months, I'd have to say that portraiture was a big trend in modern and creative quilting. From pixel quilts made of tiny fabric squares to mixed-media quilts that enhanced fabric with paint or colored pencil, quilt artists made a lot of faces.
Remember the paper snowflakes we made as kids? Well, here's a little twist on them. These fabric snowflake coasters are made using freezer paper stencils and painting on fabric.
Today is Thanksgiving Day in the U.S., a day when we gather with family and friends, stuff ourselves with traditional foods (or their vegetarian, gluten-free, low-sodium versions), and reflect on what we are thankful for. Some of us also watch football.
Two items I'm always short on: storage and gift wrap. Two things I always have plenty of: fabric and the urge to play in my studio. This fabric painting project by Lynn Krawczyk solves both problems with my favorite solutions
Fans of indigo-dyed fabrics, blue-and-white pottery, or just the color blue must love the results of the cyanotype printmaking process. Also known as blueprints, these gorgeous cyan blue-toned negatives or images emerge with printmaking supplies like cyanotype chemicals or pre-treated fabric.
How do you find time to work on your fabric art? It's a question I hear often (sometimes in my own head).
Monoprinting techniques make me feel like a kid in art class: most are easy, fun, and a little messy. But making collograph prints has to be the most kid-like of all.
Thread sketching can add lots of texture and movement to your quilts. But as anyone who has tried it knows--if you don't stabilize your work, your fabric will draw up and pull out of shape.
No matter which fabric dyeing techniques you use, dyeing fabric can be a fun--some might even say transformative--creative experience. Pulling the hand-dyed fabric from the dye bath to reveal the colors and patterns you have created is absolutely magical.
Let's face it, lately quilters and fiber artists seem to love creating portraits--from pixel quilt designs, to collaged faces, to thread painting and sketching techniques.
I've been thinking a lot about radishes lately. These tangy roots tinged with pink and purple are the first crop of my garden, and were a huge inspiration to me earlier this summer.
© 2015 F+W All rights reserved.Use of this site signifies your agreement to the Terms and Privacy Policy, updated March 2007


text:
Korean promotion Road FC is set for another action packed card featuring a fun flyweight title unification bout, along with a battle of long time stars from PRIDE and K-1. Here are the complete weigh read news >>
The UFC is close to finalizing the main event for its debut event in South Korea. According to sources close to the promotion, the UFC is targeting a welterweight fight between Benson Henderson and T read news >>
A disappointing UFC career continues for The Korean Superboy. Doo Ho Choi, the 24-year-old South Korean featherweight who made a name for himself with his highlight-reel knockouts, has again been for read news >>
Korean fight promotion Road FC is turning back the clock and bringing back several Pride FC veterans for its first foray into Tokyo. read news >>
If you thought "The Korean Zombie" was bummed before, wait until he hears this. Ultimate Fighting Championship (UFC) will be making its long-awaited debut in Seoul, South Korea, when the world's larg read news >>
UFC on Saturday announced that it will bring its first ever live event to Seoul, South Korea, in November. read news >>
The announced today that it is heading to Seoul, South Korea for the first time in the fall. Today following the Ultimate Fighting Championship's successful Philippines debut in Manila at UFC Fight N read news >>
The UFC has visited Japan, the People's Republic of China, and the Philippines in its quest to establish itself in Asia. Next on the list: South Korea. Saturday, the company announced its debut event read news >>
An intriguing featherweight matchup between hard-hitting Sam Sicilia and South Korean super-prospect Doo Ho Choi now seems like it might be back on the UFC docket, months after the original date was read news >>
UFC 187 receives another great fight, as South Korean welterweight contender Dong Hyun Kim faces Josh Burkman in Las Vegas on May 23rd. Another fight is now official for the UFC's spectacular-looking read news >>
Unsurprisingly, "The Korean Zombie" is off the UFC rankings ballot after his recent confirmation that he will be away from the sport for at least 2 years. As of today, the UFC featherweight rankings read news >>
UFC featherweight competitor Chan Sung Jung discusses his mandatory two-year military service in South Korea and how this will impact his future in the sport. After spending more than a year away fro read news >>
"It's not something that was a surprise. Since all able-bodied men are obligated to serve, I knew that it was something that I'd have to do at some point. It's the law and a duty of all Korean men. T read news >>
Word got out last week that Chan Sung Jung, a.k.a "The Korean Zombie," would be sidelined for two years from MMA to fulfill his mandatory military service required of South Korean male citizens. The read news >>
According to a report from MMA in Asia, beloved UFC featherweight "The Korean Zombie" Chan Sung Jung will be out of action until October of 2016 due to mandatory military service duties in his native read news >>


text:
Here, we look at an infographic from VoucherBin that shows the value of vouchers for online shoppers.
Keeping promises between e-retailers and customers seems like a simple concept but more than you'd think get it wrong: here's how to avoid joining the naughty list
WordPress is quickly becoming the platform of choice for SMEs building websites: but are you aware of how to keep your site secure?
Expansion and successful IPOs making business one of Germany's most successful exports
IT consultancy provides expertise in both civil and forensic trials
Is your business protected against the loss of business-critical data? Rockford IT MD Darren Kirby explains why many are more exposed than they realise
E-commerce sites that people love happen when business owners understand how customers view, browse and use their site, says iWeb Solutions managing director Nick Pinson.
Glenn Porter, general manager of international identity verification at GB Group, provides a run down on what needs to be done to enter the Brazilian e-commerce market.
Falling foul of Google is a situation which can be both costly and time-consuming for a business. Tamlin Roberts, managing director at Mercurytide, reveals what needs to be done.
Despite a predicted fall in the amount of exporting by British businesses, PayPal UK managing director Cameron McLean believes that UK businesses should still be viewing the global market as a growth opportunity.
Chris Kerwin, co-founder of digital commercial strategy firm Can-did, looks at how growing businesses can maximise online revenues.
British importers and exporters make hundreds of thousands of international payments everyday, but about one third of businesses encounter payment delay or failure because of avoidable mistakes.
Entrepreneurs reveal their top tips for boosting web-based revenues.
If you're getting plenty of visitors to your website but not many sales, you're not alone. Most websites convert visitors to customers at a very low rate, often less than 3 per cent. Here are seven tips to help.
Five ways to keep your email clean and secure
Legitimate websites are now spreading viruses
How online marketing company Infoserve cut £700,000 worth of costs by focusing on its strategic objectives and letting go of projects which were unlikely to make short-term returns.
Exporting data from one database to another can be a source of real problems for a growing business. Often, the task has to be performed manually which, aside from being time consuming, generates a lot of errors such as typos or multiple entries.
An industry has sprung up that takes the old adage of 'knowing your customer' that stage further.
When you're gearing up for the biggest sales opportunity of the year, being well-prepared is everything – and online is no different. Mario Thomas, MD of Leeds-based digital agency Chapter Eight, offers his tips for getting your website ready for the rush.
Structure of UK banking puts UK entrepreneurs on the back foot compared to counterparts in other markets, according to OakNorth Bank CEO Rishi Khosla
Support from no lesser authority than the governor of the Bank of England is offering his support for SRI – so is the appetite there to take up the mantle?
The value of business degrees for those looking to earn a sizeable salary has long been a source of fierce debate: but they may be worth more than some want you to believe...
The most complete review of directors' remuneration on AIM, including basic salary, bonus and benefits.


text:
Take a break from your road trip at our Super 8 Belen hotel and enjoy comfortable accommodations at affordable rates. Located just off Interstate 25 at Exit 191 and 30 miles south of Albuquerque, our pet-friendly hotel is near golf, great restaurants and beautiful desert attractions. Each of our 43 spacious rooms is equipped with free Wi-Fi Internet access, allowing you to stay in touch with family and friends online. Many rooms feature a recliner, desk, table and chairs, and some offer microwaves and refrigerators. Non-smoking and handicapped-accessible rooms and suites are also available. Keep clothes fresh in our guest laundry facilities or simply fade off to sleep in a king or queen bed. Awake energized and enjoy free 8-item SuperStart breakfast bonanza before getting back out on the road. Kids 17 and under stay free with an adult at our Belen hotel near University of New Mexico -Valencia. LOCAL ATTRACTIONS Learn about Belen railroad history — where 100 trains still pass through daily — at Harvey House Museum behind our hotel or play a round of golf at Tierra Del Sol Golf Club just minutes away. Explore the wonders of Salinas National Monument or see exotic bird migrations at Bosque del Apache Wildlife Refuge, both about 20 miles from our hotel. If gambling gets you going, place your bets at Hard Rock Casino near Albuquerque. DINING OPTIONS There are a dozen family-style restaurants within walking distance of our Belen, NM, hotel for you to enjoy. If you like Southwestern-style chili, head up Main Street to Rutilios New Mexican Foods and, if briquette baskets sound good, try PO Boys Smoke Shack. Stop into Harla Mays Fat Boy Grill near Onate Theater for creative appetizers and barbeque combos. Montanos Restaurant, Fat Sats Bar and Grill and China King are also nearby. BUSINESS AND EVENT FACILITIES Our Belen hotel offers fax services.Wyndham Hotel Group
24 hour front desk
Business center
Complimentary breakfast
Laundry facilities
Laundry service
Meeting/Banquet facilities
Free parking
Wheelchair accessible
Get Rates
Get Flight + Hotel


text:
One of Holy Cross Health's primary goals is to keep our community healthy and informed. In addition to our many fitness classes, support groups, and special events, we also offer a variety of other health and wellness classes and programs, including those listed below.
Blood Pressure ScreeningFree blood pressure screenings are offered on a walk-in basis at several community locations. Community Locations | Senior Source
Chronic Disease Self Management ProgramJoin this free six-week program to help you enjoy a healthier life! Learn how to maximize your potential even when a long-term health condition may require you to alter your activities. View schedule and registration information.
Diabetes Education ClassDiabetes self-management classes, taught by a registered nurse and dietitian, prepare the participant to self-manage their disease in partnership with their physician. The class includes four group sessions and one individual visit with a dietitian. View schedule and registration information.
Diabetes Prevention ProgramThis free 12-week classroom program is designed to help individuals who have pre-diabetes to make lifestyle changes, such as weight loss and exercise, which can prevent or delay the onset of diabetes or cardiovascular disease. Nutrition guidance, cooking demonstrations, free exercise classes, problem solving, and support for maintaining motivation is provided. View schedule and registration information.
Falls AssessmentThis assessment utilizes the state-of-the-art Biodex Balance System and gait and balance testing to determine your personal falls risk. Pre-registration is required. Space is limited. View schedule and registration information.
Fertility Care - Natural Family PlanningFertilityCare is a method of holistic fertility awareness that can benefit women from teens through the menopausal years. Combined with medical care, it can be used as an effective method of natural family planning or as a treatment for underlying causes of pain, irregularity and miscarriage/infertility issues. View schedule and registration information.
First AidThis three-and-a-half-hour class covers basic First Aid techniques and includes hands-on practice. Participants will receive a card from the American Heart Association. View schedule and registration information.
Healthy AgingJoin us to learn about holistic nutrition, body movement, relaxation and breathing awareness. This 12-week program provides information and strategies that support healthy lifestyle changes to help you attain your ultimate health and wellness goals. View schedule and registration information.
Look Good...Feel BetterIf you have started a course of radiation or chemotherapy treatment you may experience some temporary changes in the appearance of your skin and hair. Learn about new hairstyles, skin care, cosmetics tips, and nail care. Sponsored by the American Cancer Society. View schedule and registration information.
Meditation ClubExplore meditation to benefit specific areas of well-being such as physical health, pain relief, emotional wellness, creativity, communication and relationships. View schedule and registration information.


text:
Vintage Limousine of Hudson Valley ...
New Paltz is a great place to visit, and Vintage Limousine of Hudson Valley LLC will make sure its spectacular with a fantastic Party Bus today.
Knights Airport Limousine Svc
You'll never have to worry about ditching a party early when you have a Luxury Sedan by Knights Airport Limousine Svc on standby.
Ultimate Limousine Service LLC
Our drivers are practiced in the arts of observation and professionalism so Ultimate Limousine Service LLC Standard Limos always exceed your discerning expectations.
MG Limo
People expect something extravagant from you, so meet their expectations with an awesome Party Bus. Call MG Limo to reserve it.
Absolute Transportation LLC
Whether you are just arriving, or ready to leave New Paltz, call Absolute Transportation LLC and arrange for expert Super Stretch Limo services today.


text:
Had to give a client a lesson on oldstyle vs. lining numerals today because they thought the font was "weird." I explained the difference and that we could change it to lining if that's what they preferred.
So now I'm curious...which do you prefer? And when?
I read (on wiki- ha!) that oldstyle is best with lowercase, and lining is best with all-caps? Thoughts?
keyboard shortcuts: ← previous shot → next shot L or F like Z toggle zoom
Show and tell for designers
What are you working on? Dribbble is a community of designers sharing screenshots of their work, process, and projects.
Copyright © 2009–2015 Dribbble LLC. All screenshots © their respective owners. Shipped from Salem, Mass. USA.


text:
Jazz celebrate Marvin Williams' return with jab at Lakers
Published December 12, 2013 6:21 pm
This is an archived article that was published on sltrib.com in 2013, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
Riding a four-game losing streak coming into Wednesday night's game in Sacramento, the Jazz were plenty excited to get forward Marvin Williams back in the lineup. The team's Game Night staff also took the opportunity to poke at the Lakers, who put together a pretty ostentatious video for Kobe Bryant's return.
Here's the original:
Reader comments on sltrib.com are the opinions of the writer, not The Salt Lake Tribune. We will delete comments containing obscenities, personal attacks and inappropriate or offensive remarks. Flagrant or repeat violators will be banned. If you see an objectionable comment, please alert us by clicking the arrow on the upper right side of the comment and selecting "Flag comment as inappropriate". If you've recently registered with Disqus or aren't seeing your comments immediately, you may need to verify your email address. To do so, visit disqus.com/account.comments powered by Disqus
See more about comments here.
See more about comments here.


text:
prints, motley crue prints, nikki sixx prints, tommy lee prints, vince neil prints, mick mars prints, 1984 prints, donnington park prints, monsters of rock prints, england. prints
"Motley Crue" print by David Plastik. Ships within 3 - 4 business days and arrives rolled in a tube. Choose from multiple print sizes, papers, mats, and frames.
All prints ship in durable cardboard tubes.
Fine Art America is one of the largest, most-respected giclee printing companies in the world with over 40 years of experience producing museum-quality prints. All of our prints are produced on state-of-the-art, professional-grade Epson printers.
We use acid-free papers and canvases with archival inks to guarantee that your prints last a lifetime without fading or loss of color. Paper prints include a 1" white border around the image to allow for future framing and matting. Canvas prints include a 2.5" white border to allow for future stretching on stretcher bars.
Prints ship within 3 - 4 business days in durable cardboard tubes.
Motley Crue backstage at Monsters of Rock Concert in 1984 in England.
During the 1980's, I photographed many of the great rock stars that toured during that time. At the age of 16 I started to bring my camera to rock concerts. After a couple of years my work got published in Rolling Stone, Billboard, Hit Parader, Cream, Guitar & many other publications. Here are some of my photos.
Our return policy is very simple:
If you're not happy with a purchase that you made on FineArtAmerica.com, for any reason, you can return it to us within 30 days of the order date. As soon as it arrives, we'll issue a full refund for the entire purchase price. Please note - Fine Art America does not reimburse the outgoing or return shipping charges unless the return is due to a defect in quality.
Fine Art America sells thousands of pieces of artwork each month - all with a 100% money-back guarantee.
If you've hesitated to purchase artwork online in the past, why not give us a try? You have nothing to lose!
We take great pride in the fact that 337,702 artists have chosen Fine Art America to fulfill their orders, and we look forward to helping you select your next piece!
Customer Service: 877-807-5901
(Call Any Time - 24 Hours Per Day)
All prints ship from our production facility within three business days of your order.
Please Wait...
Beverly Hills, CA (United States)
Sign up for our newsletter for exclusive deals, discount codes, and more:
Unsubscribe at any time.
Server Status OK
Copyright © 2015 FineArtAmerica.com - All Rights Reserved


text:
The first two formal protests against the General Services Administration's One Acquisition Solution for Integrated Services (OASIS) multiple-award contract likely won't be the last, especially after responses come in next month for the $60 billion vehicle.
"I'm not surprised," Larry Allen, president of Allen Federal Business Partners, said of the two protests filed against the OASIS request for proposals on Aug. 9. More protests are likely given the complexity of the OASIS evaluation criteria for vendors, he said.
One of the protests was by a group called the Voice of Small Business in America. That protest is backed by Aljucar, Anvil-Incus and Co., an international financial advisory and program and venture management consultancy based in Washington, D.C. Rudy Sutherland, the firm's head of practice, told FCW that the evaluation criteria in the RFP is unfair to small companies. The firm's position is that the pass/fail requirements for relevant experience on the OASIS unrestricted solicitation are unduly restrictive. The unrestricted pass/fail requirements in the RFP conflict with federal policy that lets vendors team up, according to the consultancy.
Sutherland said the RFP is like many other GSA efforts that tip the evaluation scale toward larger competitors at the expense of smaller ones.
While the GSA tried to incorporate smaller company needs in the contracts proposal, Sutherland said the agency ultimately wound up making it harder for them to compete. The OASIS RFP was issued in two documents -- one tailored for small businesses and the other unrestricted. The Voice of Small Business protest was against how small businesses were handled in the unrestricted contract.
All in all, Sutherland said, he'd rather rely on the FAR (Federal Acquisition Regulation) rather than trying to shoehorn small business set-asides into contracts such as OASIS. The FAR, he said, provides better checks and balances for small businesses than specialized contracts like OASIS.
Sutherland said he is meeting with GSA later in the week of Aug. 12 to discuss the issue.
GSA made the evaluation criteria precise for a reason, Sutherland said. "It wanted companies capable of performing on task orders. It takes rigorous to a whole new level" that some companies might not be comfortable with, he said.
USFalcon, of Morrisville, N.C., filed the other protest. USFalcon protested through the Government Accountability Office while the Voice of Small Business went straight to GSA.
GSA released the final RFPs on July 31 for what it envisions as a one-stop management and consulting, professional engineering, logistics, and finance services contracting vehicle. Proposals from vendors are due Sept. 17.
About the Author
Mark Rockwell is a staff writer covering acquisition, procurement and homeland security. Contact him at email@example.com or follow him on Twitter at @MRockwell4.
E-Mail this page
Printable Format
Advanced Search
Meet 100 women and men who are doing great things in federal IT.
Click here for the full list
A technology roadmap can help agencies reap the benefits FITARA has to offer. Here are the four stages of a successful effort.
In the newest Federal Employee Viewpoint Survey, feds show they're feeling better than they have over the past few years – but there's still room for improvement, especially in mission-critical IT.
The General Services Administration's Enterprise Infrastructure Solutions contract will anchor the agency's NS 2020 telecommunications strategy.
House and Senate both approve a measure to maintain funding at fiscal 2015 levels through Dec. 11.
The aviation regulator missed a Congressional deadline to develop rules of the sky-ways for drones.
Agency heads, acquisition officers and even CIOs don't need to be hard-core techies. FCW's four-part look at the expertise that's really required to make federal IT run.
FCW recognizes 14 individuals having an outsized impact early in their careers.
As Steve Kelman returns from a summer of aggressive medical treatment, he considers the all-too-common aversion to short-term sacrifices.
Massive open online courses can offer specialized IT instruction on a flexible schedule and on the cheap. That may not always mesh with government's preference for structure and certification, however.
OASIS is a jobs creation program for GSA employees. The sad truth is GSA does not like small business they prefer big companies where they all plan to go after retiring from civil service at age 55.
What does OASIS do that the Schedules Program plus a reporting engine cannot?
8609 Westwood Center Drive, Suite 500Vienna, VA 22182-2215 703-876-5100
© 1996-2013 1105 Media, Inc. All Rights Reserved. This copy is for your personal, non-commercial use only.To order presentation-ready copies for distribution to colleagues, clients or customers, visit: www.1105Reprints.com


text:
adobe pagemaker 6.0 (1 program)
Sort by:
Portable Scribus 188.8.131.52
- Icon
- Description
Open source desktop publishing app. ... much like Adobe Pagemaker, which can ...
- Category
- Presentation software
- License
- Free
- Language
- English
- 69,861
- Total downloads
Articles adobe pagemaker 6.0
AVG Protection and Need For Speed No Limit, just two of this week's best apps
We are back with five of the week's best, most interesting, and just downright oddest apps. This... See more
PES 2016 gives FIFA 16 a good kicking in our comparison
This week on Click-Swipe-Play, we have the clash of giants as we pit the two most popular games of the... See more
AVG Performance and AVG Security: the perfect pairing to protect and enhance your PC
AVG, the famous antivirus and internet-security company, has just launched two new suites - AVG... See more


text:
We just walked in to get a room and they were very helpful ( we were unable to reach our original destination). The person at the front desk did speak a little English which was helpful. However, the place wasn't very clean, the shower did not have hot water or really any water pressure. No one in the restaurant spoke any English. The view of the beach from our room was very nice, but when we walked across the street to get an up close view of the beach, it wasn't so great. We only stayed the one night and then moved on to our original destination. We won't go back.
Location: Costa Rica > Province of Puntarenas > Puntarenas
Bar / Lounge Beach Casino and Gambling Free Breakfast Free High Speed Internet ( WiFi ) Free Parking Restaurant Room Service Swimming Pool Wheelchair access
Ranked #16 of 21 Hotels in Puntarenas
Price Range (Based on Average Rates): $
Number of rooms: 37


text:
BROOKLET — The year may be new, but Southeast Bulloch's region schedule is already nearing the halfway mark.
** Subscribers Log in to read this full article.
Thanks for reading the Statesboro Herald online. You have reached your monthly limit of free premium articles. To continue reading this article, and to read more articles, you must be a subscriber. Print subscribers can register for FREE access by clicking the Register Free tab at the top of the page. ', ' Login or subscribe to continue', '', '', ' ' + 'Subscribe', 'False'); });