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Is this the Dales' latest infidelity?
Don't do it, Kirin!
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Nassau - Bahamas
Property ID: 0983
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Situated directly on the beach, Paradise Island Beach Club offers the perfect location for your tropical getaway. Enjoy our clubhouse with a snack bar and recreation rooms, a small mini mart, and two heated pools.Check-in Time: 16:00Check-out Time: 10:00Check-in Days: SaturdayImportant InformationMinimum age check-in is 21.Pet Information: Animals are not permitted; could result in forfeiture of the unit and/or other penalties.Multi Floor With No Elevator Access: YesMandatory fee: Departure taxes is 18.00 U.S. dollars. Cash or Credit is accepeted.Mandatory fee: Utility surcharge is 100.00 U.S. dollars. Cash or Credit is accepeted.

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Martin Lindstrom | April 25, 2006 | Comments
The value of stories.
I have three rocks at home. If you were to inspect them I'm sure, like everyone else, you'd conclude they're almost identical; same size, weight and color, and therefore worth much the same as each other. But that conclusion would be drawn before I'd told you their stories.
At 10:30 p.m. on November 9, 1989, following lifting travel restrictions for East Germans, the Berlin Wall, which had divided East and West Berlin since 1961, was opened at the Bornholmer Strasse border crossing. In the ensuing hours and days, other border crossing points were opened and the Berlin Wall was dismantled peacefully over the weekend of the 11th and 12th of November. At that historic juncture, one of my friends who was on the spot amongst the international crowd, managed to get hold of a piece of the wall, one of the very first pieces to be dislodged from the structure. So what do you think of that piece of rock's value now? Would you pay a bit more for it than you might have thought at first glance?
But I told you there are three rocks, so the story doesn't stop here. The second was supposedly discovered in July 1969, by a man named Neil. Neil Armstrong, the first man to set foot on the moon. He was in a unique position to gather a couple of rocks as a neat souvenir for mankind. Apparently, one of my three rocks is one of those collected by Commander Armstrong. What would you be prepared to pay for this, were it for sale?
The third rock is from my backyard (a lovely backyard by the way). But no matter how good a salesman I amy be, I'm sure I couldn't persuade you to purchase this specimen. It's simply too ordinary. Yet it looks almost identical to the two other stones which have such colorful provenances.
Which of my three rocks would you choose if you could? I'd be willing to bet the lunar stone would be your first choice, not because it's more beautiful (it's not), or because of any precious minerals it contains (it doesn't), but simply because of its history. The story invests significance in the rock that might persuade you to part with several thousand dollars for it.
And there you have the secret of branding. The rocks' stories made a difference to your perception of these otherwise parochial objects. Their histories create an emotional bond between you and the product. No fancy logo needed, no top-dollar graphics. A simple story is all it takes to inflate the value desirability of the objects.
That's exactly what you should have in mind when you build brands. Yes, the graphics are important. So are other factors such as distribution, product design and, of course, quality of the product. But don't forget the little story that can infuse your product with charisma and bond customers with the product emotionally and intellectually.
Open your mind to your brand's stories, don't discard them. Reveal them, strengthen them, and allow them to define your brand's identity. Share the stories on your Web site and encourage your customers to share their stories about your product. Dig deeper, do some research, and uncover the special heritage of your brand or your category of business.
Branding is all about creating an emotional grid around the product. The more sophisticated the grid of values, the more compatibly they match the core values of your brand, the better your brand is armed against competitors.
Just think about those rocks. Reveal your brand's stories and see if they represent the hidden point of difference for your brand.
Martin Lindstrom is recognized as one of the world's primary on- and offline branding gurus by the Chartered Institute of Marketing. He is the author of several best-selling branding books including his latest, "BRAND sense: Build Powerful Brands through Touch, Taste, Smell, Sight, and Sound," published by Free Press. BRANDsense.com details information about Lindstrom's "BRAND sense" and the BRAND sense Symposium, a branding conference running in 51 cities in 31 countries.
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text:
Persuasive Song YKTTW Discussion
|Persuasive Song
Need to convince people to go along with something? Just sing a song about it.
Description Needs Help Often crosses with Crowd Song.
- In Bebe's Kids, in spite of all the evidence against Kahlil, Leon convinces the court to let him off by singing a song about freedom.
- In the Family Guy episode "Let's Go to the Hop" Peter, in disguise as a high school student, convinces the students to stop licking toads to get high by singing a parody of "You're the One that I Want" from Grease.
- In "Episode 420" Brian convinces the town to legalize marijuana by singing about its benefits. Later when he's forced to delegalize marijuana, he sings another song (which we only hear the tail end of) about why pot is bad.
- In the My Little Pony: Friendship Is Magic episode "Over a Barrel" Pinkie Pie sings a song about friendship to convince the buffalo not to wreck the town. Subverted in that the conflict had already been resolved before she starting singing and her song was so terrible it got the buffalo back to being mad at the town.
Replies: 18


text: Upscale menu with house specialties featuring Mediterranean influence, make this our most memorable dining experience. Our newly minted 18 year old tried rabbit for the first time. It was succulent and melted in your mouth! Nothing heavily spicy for those who like to try new cuisines with full flavors, but featuring some bolder dishes for those who do. Home-made gelato was divine! The steak with blue cheese was perfectly grilled to order, and extremely flavorful. Generous portions encourage sharing, as each of the entrees,salads, side dishes and desserts were perfectly prepared and deserved to be tried!


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tag:www.pdxmonthly.com,2005:/health-and-fitness/kids-health-annual/feed Kids' Health Annual 2013-05-09T12:28:00-07:00 tag:www.pdxmonthly.com,2005:Article/11730 2013-05-09T12:28:00-07:00 2013-05-09T12:28:00-07:00 Welcome to the Kids Health Annual 2013

AT OHSU DOERNBECHER CHILDREN'S HOSPITAL, a vital part of our mission is to share the knowledge gained here with families throughout our community. We are dedicated to bringing you the latest discoveries, treatments, and therapies to help your family stay healthy.

In this issue of the Kids' Health Annual, presented by Doernbecher and SagaCity Media, you'll read advice on vitamins and supplements, vaccines, the importance of oral health, and more. We also provide ideas for entertaining kids staying home from school for the day—and how to help them sleep at night.

Raising a family is more hectic than ever. Work, school, and home responsibilities are increasing, as is the number of screens competing for your (and your kids') attention. Sometimes it all may seem overwhelming. At Doernbecher, we're here to guide you: In addition to pediatric specialty care, our programs, community events, and the information on our blog at Doernbecher.com are all ways you can learn more and keep your family well. You only want the best for your family. At Doernbecher, so do we: Every child deserves the best.

H. Stacy Nicholson, MD, MPH
Chair, OHSU Department of Pediatrics
Physician-in-Chief, Doernbecher Children's Hospital
 We are dedicated to bringing you the latest discoveries, treatments, and therapies to help your family stay healthy. We are dedicated to bringing you the latest discoveries, treatments, and therapies to help your family stay healthy. http://res.cloudinary.com/sagacity/image/upload/c_crop,h_749,w_747,x_0,y_0/c_limit,w_640/KHA13-cover_wq5utr.gif KIDS HEALTH ANNUAL Julie Reposa tag:www.pdxmonthly.com,2005:Article/11707 2013-05-02T15:24:00-07:00 2013-05-02T15:24:00-07:00 What You Should Do if Your Kid Gets a Concussion

Image: Carolyn Richardson

Things that go bump in the night can scare your kids. But a hard enough bump on the head can cause a concussion, the most common brain injury.

Children are more vulnerable to concussions than adults, says Lissa Baird, a pediatric neurosurgeon at OHSU Doernbecher Children's Hospital. Their heads are larger relative to their bodies, so when kids fall they tend to land on their heads. Their weaker necks also make them less able to support and protect their heads. Babies and young children have soft skulls that transmit impact to the brain more readily than harder noggins.

"Symptoms of concussion fall into four basic categories: thinking and remembering, emotional, sleep, and physical symptoms," says Dr. Baird. After a concussion, a child might have trouble thinking clearly, remembering things, or concentrating, or might act cranky, anxious, or hyper. Your child might sleep more or less than normal or have trouble going to sleep. Physical symptoms can include headaches, vomiting, dizziness, balance problems, lack of energy, and sensitivity to light or noise.

Physical and mental rest is the most important part of recovery. Babies should rest and sleep as much as possible. For toddlers, avoid rough play and stimulation from loud music and TV. School-age children should take time off school, including homework. They should also avoid texting, TV, video games, and loud music. "Anything that requires concentration should be off limits while the brain is healing," says Dr. Baird. When your child goes back to school, tell teachers he or she might need extra help for a while.

To avoid another head injury, children and teens should avoid sports, recess games, PE, and vigorous play until cleared by a doctor. "Kids are more vulnerable to another injury if the brain is still healing," says Dr. Baird. Healing can take time, but with rest and care, most kids make a full recovery.

If your child experiences a concussion,
talk with your pediatrician immediately or call 503-346-0640.

 Concussions are different for kids. If your child gets one, here's what to do. Concussions are different for kids. If your child gets one, here's what to do. http://res.cloudinary.com/sagacity/image/upload/c_crop,h_801,w_801,x_104,y_95/c_limit,w_640/kha-2013profile-helmetc_zlsa04.gif KIDS HEALTH ANNUAL Julie Reposa tag:www.pdxmonthly.com,2005:Article/11706 2013-05-02T15:16:00-07:00 2013-05-02T15:16:00-07:00 Healthy Teeth, Healthy Tot

Image: Greg Pizzoli

Tooth decay is one of the biggest health issues our children face today," says John Engle, a pediatric dentist and instructor at OHSU's School of Dentistry, who frequently sees proof of the problem in his own dental chair. "But if we can get parents and families involved early on in developing healthy dental habits, the majority of these instances are entirely preventable."

Given that the mouth is a gateway and barometer for the health of the whole body (recent studies have found possible links between gum disease and increased incidence of diabetes, heart disease, and, for pregnant women, complications such as low birth weight), Dr. Engle counsels parents to begin these habits long before the first baby tooth makes its appearance. From day one, gently wipe out your baby's mouth with a soft piece of cloth or gauze, developing a familiar habit that will make it easier to introduce more complex routines later. When teeth begin to appear, gently wipe those as well, with cloth, gauze, or a store-bought teething brush.

By the time children are in elementary school, flossing should be incorporated into the routine. Kids will need help at first, but at what age should children begin brushing and flossing on their own? Dr. Engle argues against a "one size fits all" answer. "In the old days, they would say to hand them the toothbrush when their handwriting is legible," he jokes. "But for some kids I know, this would mean heading to college with their parents still brushing their teeth." He advises parents to pass on the responsibilities slowly, monitoring children carefully for as long as it takes to develop diligent teeth-cleaning habits of their own.

In the old days, they would say to hand them the toothbrush when their handwriting is legible.

The importance of regular brushing and flossing can't be overstated, but dietary choices have a profound impact on dental health, too. Infants who are put down to sleep with bottles develop tooth decay at a higher rate than those who aren't, as do young children who snack often. "Obviously, carrots are better than gummy bears, but their teeth need a break between snack sessions regardless of what they're eating," Dr. Engle says.

Before he sends them home, Dr. Engle has more than just flossing techniques to pass along to his young patients: "Brush your teeth, clean your room, quit fighting with your sister, and be nice to your parents," he advises. "That's really all you need to know."

If your child needs to be evaluated for gum disease,
talk with your dentist or pediatrician.

 Don't wait to start lifelong habits. Don't wait to start lifelong habits. http://res.cloudinary.com/sagacity/image/upload/c_crop,h_918,w_916,x_55,y_0/c_limit,w_640/kha-2013-tooth_bbuuc5.gif KIDS HEALTH ANNUAL Julie Reposa tag:www.pdxmonthly.com,2005:Article/11702 2013-05-02T15:15:00-07:00 2013-05-02T15:15:00-07:00 The Sick Day Dilemma

Image: Jonathan Hill

Remember staying home from school? Sure, the sniffles and sore throat were no fun, but the novelty of watching TV all day and being waited on by Mom or Dad often made up for it. If you have kids of your own, you now appreciate the decisions they had to make about whether to send you to class or take a day off work themselves to bring you that chicken soup. And they weren't thinking just about you: there were also classmates, other family members, and coworkers to consider, especially during the cold and flu season or local outbreaks like last winter's norovirus.

Jane Kim-Hoffman, a pediatrician at OHSU, has some basic guidelines for when a child should stay out of school. A child sick with a fever, vomiting, diarrhea, or pinkeye may be contagious and needs to stay home until those symptoms have subsided for 24 hours. Take your child's energy level into account as well. As Dr. Kim-Hoffman points out, "If the child is fever-free but not willing to move off the couch, he probably wouldn't do well in class." But if he has a mild cough and no fever, he's probably fine to return to school.

Next comes deciding whether to take a sick day yourself—assuming you have a sick day. In March, the Portland City Council passed a new law requiring paid sick time for most employers, but it takes effect next year.

If you have an enclosed office and can limit your coworkers' exposure, it might be fine to bring your child to work (assuming there's no vomiting or diarrhea). A babysitter, friend, or family member can provide at-home care, but be careful to protect older family members from your child's illness. Dr. Kim-Hoffman says it's not uncommon to see older individuals struggle with their health when they contract the flu or other illnesses as a result of caring for sick grandkids.

To help make these decisions, an OHSU smartphone app and website called MD4Kids can keep recommendations at your fingertips. The app provides useful, reassuring facts, like the normal duration of illnesses and indicators of real emergencies, as well as schedules of action to take based on your child's symptoms, from "Call your doctor now" to "Manage care at home." "MD4Kids is a great resource," says Dr. Kim-Hoffman. "If parents are unsure if they need to go to the emergency room or if they can send their kids to school, it can help answer those questions."

No matter where your child ends up, you'll have to pass the time. The kid who feels well enough to get bored and the parent who thinks six hours of television is pushing it will need to find some other entertainment. Build a fort using couch cushions, pillows, and blankets to create a space where your child can rest or play with toys. Card games, board games, and puzzles can occupy an hour or two at home or at the office. Be prepared for sick kids to get frustrated more easily than normal—this is not the time to challenge them. As an alternative to reading or coloring, you and your child can look through pictures and create a scrapbook, or just flip through family photo albums.

However your family decides to spend the day, if you trust your instincts, use your resources, and go to your doctor with any concerns, you and your child should make it through the next cold and flu season just fine.
 Keeping a child home—and taking a day off work—can be a tough call. Keeping a child home—and taking a day off work—can be a tough call. http://res.cloudinary.com/sagacity/image/upload/c_crop,h_349,w_350,x_0,y_542/c_limit,w_640/kha-2013-sick-days-illustration_wamykp.gif KIDS HEALTH ANNUAL Julie Reposa tag:www.pdxmonthly.com,2005:Article/11703 2013-05-02T15:15:00-07:00 2013-05-02T15:15:00-07:00 Doctors Are Parents, Too

Image: Carolyn Richardson

Breast-feeding at work. Ear infections. How a mom who happens to be a pediatrician balances work and family. All these are topics on the Healthy Families blog from OHSU Doernbecher. Since mid-2012, the blog has offered advice from pediatric health professionals alongside personal stories by patient families, nurses, and doctors.

If you've wondered if doctors are like other people, the blog shows that the answer is yes—and that pediatricians are as concerned about kids' health and safety as any parent. "In medicine, we've become almost paranoid about privacy, which is good—but it's taken away some of the humanity and sense of community," says Nathan Selden, Doernbecher's head of pediatric neurosurgery. "The blog reconnects us to the community in a personal way."

It also helps families get to know the hospital before they ever need help. "It's rare for parents in the community to meet Doernbecher's specialists unless they have a child with an unusual diagnosis," Dr. Selden says. "The blog allows them to get comfortable with what is available to families here."

In addition to demystifying doctors, Healthy Families provides reliable, timely medical information. For example, October brings a post on Halloween safety, and flu shots are a hot topic in early winter. "Although it's informal, the blog provides parents with a source of accurate medical information," says Dr. Selden. "There's so much misleading information on the Internet about medicine. Writing the blog helps us correct some of that."

When you read a Healthy Families post, it comes directly from a pediatric health expert. "We try not to edit too much," says OHSU social media manager Brycie Jones. "We want their voices to come through." Doctors, nurses, and pediatric residents take turns writing the posts (including one explaining what a "pediatric resident" is).

Readers can comment directly on the Doernbecher blog, and the blog authors often respond to questions posted there. Readers can also respond on the hospital's Facebook page. "When there's a new Healthy Families post, people who like Doernbecher on Facebook get it in their feeds," Jones says. A recent post on a rock band made up of former OHSU medical students drew 130 "likes" and the suggestion that the band play in the Doernbecher lobby.

Patients and families, including the young designers of the Nike/Doernbecher Freestyle sneakers, also tell their stories on the blog. "We've shared some very personal stories about the care of children," says Dr. Selden. "Every time I've asked a family whether they were willing to share, they've said yes. It's amazing how generous people are. Their experiences can help and encourage other families."

Visit ohsudoernbecher.com/healthyfamilies for more information

 A new blog offers the latest expert medical advice, plus a peek behind the scenes. A new blog offers the latest expert medical advice, plus a peek behind the scenes. http://res.cloudinary.com/sagacity/image/upload/c_crop,h_647,w_646,x_71,y_284/c_limit,w_640/kha-2013blog-3_p185gc.gif KIDS HEALTH ANNUAL Julie Reposa tag:www.pdxmonthly.com,2005:Article/11704 2013-05-02T15:15:00-07:00 2013-05-02T15:15:00-07:00 Myths and Misconceptions About Life-Saving Vaccines

Image: Courtesy Shutterstock

A baby spends months in the ICU. A teen has seizures for three straight days. Another child dies in the hospital. What made them sick? Whooping cough, chicken pox, and bacterial meningitis, all preventable by vaccines.

There's plenty of vaccine information out there, much of it contradictory or from celebrities with no medical background. Who's a parent to trust? Judy Guzman-Cottrill, a pediatric infectious disease specialist at OHSU Doernbecher Children's Hospital, explains how vaccine schedules—what shot to give and when—are developed and dispels some common myths.

"When a vaccine is added to the schedule, it's undergone extensive research," Dr. Guzman-Cottrill says. "When manufacturers create vaccines, they conduct rigorous studies of safety and effectiveness. The Food and Drug Administration reviews those studies, sometimes sending vaccines back for more tests."

Once the FDA approves a vaccine, a group called the Advisory Committee on Immunization Practices makes a recommendation to the Centers for Disease Control and Prevention about who should get it and when. These age recommendations take into account when kids are at the highest risk of contracting the disease and when the disease is likely to do the most damage.

"Despite years of research on vaccine safety, there are still myths, such as that the MMR vaccine causes autism," says Dr. Guzman-Cottrill. "Several well-conducted studies have proved that it doesn't, and the doctor who claimed this was discredited. I know parents who never vaccinated because of autism concerns—and their children have autism."

Another misconception is about thimerosal, a preservative based on ethyl mercury. "It's eliminated from the body and is not the same as the methyl mercury found in the environment," says Dr. Guzman-Cottrill. "But to maintain high immunization rates, virtually all vaccines are now mercury-free." Recently, Dr. Guzman-Cottrill treated a child with a serious infection from chicken pox. "His mom said he didn't get the vaccine because of mercury in the preservatives. She had no idea it was taken out years ago."

When a vaccine is added to the schedule, it's undergone extensive research.

"Parents are afraid vaccines might be harmful," says Dr. Guzman-Cottrill. "They don't see what infectious diseases do to beautiful, healthy children."

Some diseases seem long ago and far away, but with global travel visitors from other countries can bring these infections to kids who never leave home. Dr. Guzman-Cottrill suggests asking parents and grandparents what measles, whooping cough, and other infectious diseases were like before vaccines.

"When the polio vaccine came out, parents stood in line for hours because they'd seen so many children become debilitated or die," she says. "In the US, kids don't suffer and die in those numbers anymore. We're very lucky."

If you have questions about vaccinations,
talk to your pediatrician or call 503-346-0640.

 When it comes to life-saving vaccines, doctors say to rely on rigorous research, not the rumor mill. When it comes to life-saving vaccines, doctors say to rely on rigorous research, not the rumor mill. http://res.cloudinary.com/sagacity/image/upload/c_crop,h_667,w_668,x_38,y_0/c_limit,w_640/kha-2013-paper-cutout_vgbkml.jpg KIDS HEALTH ANNUAL Julie Reposa tag:www.pdxmonthly.com,2005:Article/11705 2013-05-02T15:15:00-07:00 2013-05-02T15:15:00-07:00 Technology & Children's Health

Image: Luke Bott

In some circles, technology has gotten a pretty bad rap—smartphones, video games, movies, and TV have been blamed for everything from rising levels of childhood obesity and ADD/ADHD to sleep disorders, classroom temper tantrums, and risky adolescent sexual behaviors. But technology serves a positive purpose, too: sending a child out of the house with a cell phone in hand and Mom's number on speed-dial calms the nerves of many a parent. Kids are asked to do their homework on computers increasingly often, and are no longer limited to the research they can do in their school library. And whether we like it or not, much of the crucial social development that used to take place on the school playground has migrated to Facebook walls and Twitter feeds.

News headlines lament the loss of a "real human connection," while others celebrate the new opportunities for communication and collaboration offered by media and technology. "There are a lot of people in this discussion with very strong opinions," says Darren Janzen, a pediatric psychologist at OHSU's Doernbecher Children's Hospital and a father of two. "But it's not going away. We can't fear technology, but we can be mindful of it, and we can decide how our kids will interact with it."

"Background media use—that is, parents' consumption of media—distracts them from interacting with their children."

This isn't to say there aren't serious concerns to address. Managing the role that technology use plays in rising child obesity levels is a difficult job for parents of kids who would rather exercise their thumbs on a video game controller than kick a soccer ball around outside. "Obesity is complicated, but at some level it's calories coming in versus calories going out—and if kids aren't active, they're falling behind," explains Carrie Phillipi, a pediatrician at OHSU Doernbecher and a mother of four. She encourages parents to advocate for recess and free-play at their children's schools, where children can get the person-to-person social interaction and the physical exercise they need.

Image: Luke Bott

Attention deficit disorders have been a hot-button issue for parents, politicians, and pediatricians for years, including rising worries about the relationship between technology use and these health issues. "Access to media doesn't cause ADHD—the vast majority of these cases are related to genetics," Dr. Janzen explains. "But because ADHD is a deficit of self-regulation, kids with it can get sucked into TV and video games much more intensely than other kids can. It's not causing the disorder, but there can certainly be greater challenges in pulling away from media and moving to other important activities."

While overexposure to media may not cause clinical attention disorders, it can breed attention-jumping habits. Rather than learning to focus on one task or subject for a long period of time, kids can jump from video to video on YouTube, or scroll through a Facebook feed looking for an interesting snippet of entertainment. "Too much media time may take away from the practice of other important skills or activities," Dr. Janzen says.

Parenting a child in an increasingly technology-saturated world means navigating the ins and outs of rapidly changing communication devices, social media sites, and entertainment options. Restricting access to age-inappropriate material, limiting time spent parked in front of a TV (or smartphone, computer, or tablet), and limiting where and when they access those screens are all crucial aspects of fostering children's healthy relationship with new media and technology. What, where, when, and how much media kids should consume is hotly debated by technology advocates and adversaries—but pediatricians are on the front line, dispensing useful advice to curious and concerned parents.

Image: Luke Bott

START SLOW

Today's children spend an average of seven hours a day tuned in to some kind of entertainment media—televisions, computers, and smartphones are virtually unavoidable, from the screens lining the walls at some restaurants and retail stores to the new computers appearing in grade school classrooms every year. While some exposure to media is unavoidable, parents should be in control of the bulk of the time their children spend engaging with technology.

For children under 2, doctors recommend no screen time at all. Sorry, parents—this means no "Baby Einstein," either. "Infants and young children learn by playing and interacting with humans, not screens," says Dr. Phillipi. But keeping young kids away from screens is only half the battle. It's especially important in these early stages of development for parents to unplug from their own devices. "Background media use—that is, parents' consumption of media—distracts them from interacting with their children," she says.

After 2 years of age, doctors recommend a maximum of two hours of digital media a day, a guideline echoed by the American Academy of Pediatrics. "This can be hard to follow, though, especially as kids are asked to do more of their schoolwork on the computer," says Dr. Janzen. "I usually start by encouraging parents to limit kids to two hours of media for entertainment purposes, outside of what's needed for school."

Even when media access is carefully controlled at home, kids may have additional exposure elsewhere. Communicating with children, their friends, teachers, and other adults in their lives about the activities that take place when parents aren't present can provide a clearer snapshot of their actual media consumption.

CONTENT IS KEY

After their children are 2, parents should be vigilant about small doses of age-appropriate media. "With young kids, it is best when content is slower-paced, sends a pro-social message, and is educational in some way," Dr. Janzen says.

"Content is a big concern for me," says Dr. Phillipi. While the cool factor of on-screen smoking has been tarnished by the aggressive campaigning of anti-tobacco groups, that still leaves the violence, sexual promiscuity, and other risky behaviors that feature prominently on popular TV shows, websites, and video games. She counsels parents to communicate very clearly and directly about inappropriate media use, and to familiarize themselves with the content and storylines of their kids' favorite shows and games.

There are rating systems in place for movies and video games, which can serve as helpful guidelines for what may or may not be appropriate for your child. "But don't take their word for it—just because a movie is rated PG-13 doesn't mean your 13-year-old is ready for it," Dr. Janzen says. "Similarly, some kids can handle content rated slightly above their age level when appropriate guidance and oversight is provided."

Image: Luke Bott

LEAD BY EXAMPLE

An easy way to demonstrate healthy interaction with technology is to set rules for common areas of the house that all family members have to follow. "No phones at the dinner table, no checking your e-mail while you help with homework," says Dr. Phillipi. Watching TV with one eye and a third-grader practicing handstands with the other means both your favorite show and your gymnast-in-training aren't getting the attention they deserve.

It may seem simple, but parents should be wary of the content they watch while kids are in the room. Even if they're busy with another activity, kids who aren't ready for "grown-up" jokes and plotlines can easily misinterpret the snippets of information they pick up.

Watching shows and movies as a family is an easy way to enjoy time together, while keeping watch on the ways kids react to different types of content. If themes or issues are presented that kids respond negatively to or have questions about, parents can address them right away.

SCREEN-FREE ZONES

Designating "screen-free zones" in the house can also help a parent keep track of the time kids spend with their devices, and what kind of content they consume. Dr. Phillipi recommends setting up a computer for doing homework in the living room or kitchen, where parents are likely to pass by often.

"It is important to consciously reward good behaviors in our children, rather than giving in to bad ones."

For children of all ages, it's important to cut off screen time at least an hour before bed. Set up phone chargers outside of the bedroom, so kids and teens aren't awakened in the middle of the night with a text from a friend (or tempted by the sudden urge to post a photo of their footie pajamas on Instagram).

Image: Luke Bott

STRIKING A BALANCE

Dr. Janzen is no stranger to temptation. When his kids' energy levels are a little too high to be safely contained inside a moving vehicle, the flip-down TV screen in the backseat looks better by the minute. "Doctors struggle with the same things everyone else does," he says. He advises parents to set clear and consistent rules for technology use, and follow them whenever possible, to make saying "no" easier—even in the middle of a full-blown temper tantrum.

Sometimes, though, long-term parenting goals have to yield to surviving a trip to the grocery store—and that's OK. "We try to save screens in the car for long rides, not short trips around town," Dr. Janzen says. "Every once in a while, these things are
 nice to have. However, it is important to consciously reward good behaviors in our children, rather than giving in to bad ones."

For better or for worse, much of the younger generation's social development is wrapped up in media. Complex social interactions take place on Facebook, and profound personal revelations are shared on Twitter. Kids who are completely cut off from social media and other technologies may have trouble relating to their peers, or keeping up with conversations.

Walking the line between too much media, not enough media, the right kinds of media, and media in the right places, at the right times, is a big job—but one that, if managed carefully, can ultimately benefit the entire family.

"Technology isn't all bad," says Dr. Phillipi. "My daughter just left for college, and it's great being able to talk or text with her regularly. We use technology to connect as a family, and I love that."

MEDIA OVERLOAD: WHAT TO WATCH FOR

 Increased Aggression: Kids exposed to violent content can exhibit more of these behaviors when they aren't in front of the screen.

 Flexibility: Can they follow the rules parents have set, or do they throw a tantrum? If kids consistently have a hard time tearing themselves away from the TV, it's time to reevaluate their technology access.

 Sleep Problems: If children have difficulties "winding down" or going to sleep, it may mean screens need to be turned off earlier in the evening.

For more on raising active kids in a tech-heavy world, check out
the Healthy Families blog from OHSU Doernbecher experts.

 Raising kids in today's rapidly changing mediascape, parents face questions of too much, too soon—and the challenge of setting a good example Raising kids in today's rapidly changing mediascape, parents face questions of too much, too soon—and the challenge of setting a good example http://res.cloudinary.com/sagacity/image/upload/c_crop,h_930,w_928,x_20,y_17/c_limit,w_640/kha-2013-gen-tech_cqanqr.gif KIDS HEALTH ANNUAL Julie Reposa tag:www.pdxmonthly.com,2005:Article/11710 2013-05-02T15:14:00-07:00 2013-05-02T15:14:00-07:00 Health & Nutrition for Young Athletes
It's not easy being a kid—growing strong bones, healthy muscles, and a sharp mind is a big job! For young athletes, the physical demands of participating in sports make getting plenty of rest and a balanced diet even more crucial. High-performance athletes age 8 to 80 can get personalized nutrition and training recommendations at OHSU's Human Performance Lab. Its director, Dr. Kerry Kuehl, offers a few reminders for active kids.

Image: Courtesy Shutterstock

Sleep

School, homework, sports, and a social life leave kids with little time for the sleep they desperately need. Balancing these responsibilities is crucial for the young athlete and requires careful monitoring by parents. "Unfortunately, I wish I had a secret," says Dr. Kuehl. "The truth is, if you're burning the candle at both ends, you're going to pay for it sooner or later."

Image: Courtesy Shutterstock

POWER UP

High-protein and high-antioxidant foods—lean meats, lots of vegetables—should power a young athlete's diet. The highest protein intake of the day should come two hours before a workout, with a quick dose of antioxidants coming immediately afterward.

Image: Courtesy Shutterstock

LEAVE THE ENERGY DRINKS BEHIND

"There is absolutely no place for caffeine or energy drinks in the lives of healthy children or healthy athletes," Dr. Kuehl says. "In fact, added to the stress of cardiovascular exercise, they can cause serious health complications."

Image: Courtesy Shutterstock

Be Aware

A balanced diet and plenty of sleep should provide kids with the power they need to perform both on and off the court. If that's not doing the trick, consult a doctor—health concerns unique to athletes (like runner's anemia or other nutritional deficiencies) should be managed by a professional.
 Athletes' strengths lie in smart choices, not pills and energy drinks. Athletes' strengths lie in smart choices, not pills and energy drinks. http://res.cloudinary.com/sagacity/image/upload/c_crop,h_669,w_671,x_0,y_151/c_limit,w_640/kha-2013-broccoli_hl6e3z.jpg KIDS HEALTH ANNUAL Julie Reposa tag:www.pdxmonthly.com,2005:Article/11708 2013-05-02T15:13:00-07:00 2013-05-02T15:13:00-07:00 Combat Childhood Obesity One Meal at a Time

Image: Thomas Cobb

You've heard about childhood obesity so often, it's practically background noise. From kids appearing on TV's The Biggest Loser to the First Lady's "Let's Move" campaign, all the attention on the issue can be overwhelming—but your kids can get healthier with just a few simple tips.

"Fighting obesity is about activity as well as healthy eating," says Natasha Polensek, a pediatrician who directs OHSU Doernbecher's Healthy Lifestyles Clinic. "We use the 5-2-1-0 rule: five servings of fruits and vegetables a day, two hours or less of screen time, one hour of vigorous activity, and zero sugar-sweetened beverages, including fruit juice."

Through the clinic, sedentary kids can get a prescription for play. Doernbecher works with the Portland and Tualatin Valley parks and recreation departments to give kids access to local rec centers if doctors think they should be more active.

On the food front, healthy eating starts in the morning. "Kids need breakfast so they don't get too hungry and overeat at lunch," Dr. Polensek says. Cereal is fine, plus an orange, banana, or other fruit for fiber. Other healthy habits include making fruits and vegetables half of every meal, drinking a glass of water before taking second helpings and making second helpings vegetables or fruit.

School lunches can be challenging. "Cafeterias serve calorie-dense foods like pizza and burgers, and many schools are next to fast-food restaurants," Dr. Polensek says. "Salad bars are great, but watch the dressings and cheeses."

Another healthy option is building a sandwich with lean protein, lettuce, tomato, and other vegetables. Some schools let kids carry water bottles so they can avoid sugary drinks from school stores and vending machines. A handful of almonds, loaded with protein and healthy fats, makes a good snack.

Dr. Polensek emphasizes that improving lifestyles is the goal, rather than just losing pounds. Baby steps—a few more minutes of activity, one less sugary drink—help kids of all ages develop better habits.

Find more tips on eating and activity at OHSU/Doernbecher Healthy Lifestyles.

 You don't need a reality show to combat childhood obesity. You don't need a reality show to combat childhood obesity. http://res.cloudinary.com/sagacity/image/upload/c_crop,h_674,w_674,x_0,y_0/c_limit,w_640/kha-nutrition_wuyjxn.gif KIDS HEALTH ANNUAL Julie Reposa tag:www.pdxmonthly.com,2005:Article/11709 2013-05-02T15:13:00-07:00 2013-05-02T15:13:00-07:00 Kids & Vitamins: Playing It Safe

Image: Courtesy Shutterstock

 From the early days of prenatal development through the last of the awkward adolescent growth spurts, kids need a special blend of vitamins and minerals to support the grueling process of growing up. Muscles need strengthening, immune systems need boosting, and the adult teeth that begin forming in early childhood have to be strong enough to last through a lifetime of chomping and chewing.

Confronted with the lofty promises leaping from the shelves of every pharmacy in town ("Enhances Brain Function!" "Supports Healthy Sleep Patterns!"), deciding which dietary supplements kids really need can be confusing at best, and potentially dangerous if done incorrectly. Natasha Polensek, a primary care physician at OHSU Doernbecher's Healthy Lifestyles Clinic, suggests a quick look at the basics: what's usually needed, what's usually not, and what won't hurt to try.

Iron supports healthy blood production and muscle growth in infants and children, and is closely watched by doctors in the first year of life. "After four to six months of breast-feeding, a mother's iron stores are depleted," explains Dr. Polensek. "This puts infants who haven't yet been introduced to solid foods at risk for a deficiency." Pediatricians advise parents to incorporate iron-rich foods into their infant's diet from the moment solid foods are introduced, and to test for anemia at nine to 12 months. For bottle-fed babies, the American Academy of Pediatrics (AAP) recommends an iron-fortified formula, with careful monitoring to determine whether additional supplements are necessary.

After early childhood, iron is especially important to monitor in adolescent girls. Because an overdose of iron can be deadly, work with your doctor to determine whether and how much of the supplement is needed.

In the northern latitudes, we see virtually all vitamin D tests come back with low levels.

While iron deficiencies are determined on a case-by-case basis, there's one vitamin doctors find lacking more often than not in residents of the Pacific Northwest: vitamin D. "In the northern latitudes, we see virtually all tests come back with low levels," says Dr. Polensek.

Sunlight converts a naturally occurring compound in the skin into an active form of the vitamin, but Portland's cloud cover and, when the sun's out, parents' well-intentioned slathering of sunblock prevent this crucial process from taking place. This means most children don't have enough of the vitamin that supports tooth and bone formation and regulates the absorption of other mineral mainstays like calcium. "Vitamin D supports bone density," Dr. Polensek says, "and a relatively small daily dose can protect against bone loss and osteoporosis later in life." Four hundred units of vitamin D a day meets the AAP's daily recommendation for infants, children, and adolescents.

Dr. Polensek's own niece and nephew take a daily multivitamin and a vitamin D supplement, a combination she feels comfortable recommending to most parents of otherwise healthy children. Ideally, most of the vitamins and minerals crucial to childhood development can be incorporated into a healthy diet, but sometimes an "ideal diet" takes a backseat to getting your family through the day in one piece. In these cases—that is, in real life—carefully chosen vitamins and dietary supplements can bridge the gap between the practicalities of parenthood and the complex nutritional needs of growing kids.

If you have concerns about your child's nutrition,
talk with your pediatrician or call 503-346-0640.

 Some supplements make sense at certain times, but parents should use caution. Some supplements make sense at certain times, but parents should use caution. http://res.cloudinary.com/sagacity/image/upload/c_crop,h_667,w_668,x_290,y_0/c_limit,w_640/kha-2013-cereal_gsski7.jpg KIDS HEALTH ANNUAL Julie Reposa


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Written on: 10/07/2010
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Oil, Gas Production Won't Recover Fully Until Summer
Updated: 12/08/2005 - Gulf Coast oil and natural gas production won't fully recover from the effects of a costly hurricane season until next summer, a top federal official said Thursday.
Updated: 12/08/2005 - Gulf Coast oil and natural gas production won't fully recover from the effects of a costly hurricane season until next summer, a top federal official said Thursday.
Updated: 11/17/2005 - The Texas Republican Party reached an agreement with the Travis County Attorney's Office Thursday to avoid prosecution in a corporate money probe.
Updated: 11/16/2005 - Iraq's Sunni party is demanding an international probe into torture allegations.
Updated: 08/29/2005 - News Ten invited Central Texans to weigh in on the anti-war protest staged by Cindy Sheehan near the President's Crawford-area ranch, and Central Texas responded. Click on "full story" to read what your neighbors have to say about the demonstration and the demonstrators.
Updated: 07/22/2005 - Plainclothes police chased a man in a thick coat through a subway station, wrestled him to the floor and shot him to death in front of stunned commuters Friday.
Updated: 07/08/2005
- Desperate Londoners hunted for missing relatives on Friday after suspected al Qaeda bombers killed more than 50 people in rush-hour blasts
Updated: 06/13/2005 - A jury acquitted Michael Jackson on Monday of molesting a 13-year-old cancer survivor at his Neverland ranch, vindicating the pop star who insisted he was the victim of mother-and-son con artists and a prosecutor with a vendetta.
Updated: 06/06/2005 - Former Waco resident and Baylor University Law School graduate Priscilla Owen was sworn in Monday as a federal appeals court judge.
Updated: 05/10/2005 - A recently released Texas prison inmate who s the father of one of the two girls found slain in a park in Zion, Ill. was charged in the deaths of the girls Tuesday.
Posted: 05/09/2005 - Authorities made an arrest Monday in the shooting of a Central Texas deputy during a traffic stop in Llano County.
Updated: 05/05/2005 - A judge Thursday in Santa Maria, Calif. denied a defense motion for an acquittal in the child molestation trial of pop singer Michael Jackson.
Updated: 05/03/2005 - About 250 farmers and ranchers rallied Tuesday at the Capitol to protest Gov. Rick Perry's Trans Texas Corridor plan.
Updated: 04/30/2005 - Insurgents launched a fresh round of attacks Saturday in Iraq, killing at least ten Iraqis. Six U.S. soldiers have died in roadside bombings in the country since Thursday, military officials said.
Updated: 04/21/2005 - The Senate Judiciary Committee voted Thursday to send the controversial nomination of Texas Supreme Court Justice and Baylor Law School graduate Priscilla Owen to the full Senate, setting the stage for a fight over filibuster rules.
Updated: 04/19/2005 - White smoke poured out of the chimney atop the Sistine Chapel just before 11 a.m. CDT Tuesday, signifying the election of a new pope.
Updated: 04/14/2005 - A Fort Hood sergeant who recently returned from Iraq plotted with a woman he met over the Internet to kill her husband, a federal complaint alleges.
Updated: 04/11/2005 - Kraft Foods is recalling nearly 150,000 packages of Jell-O chocolate pudding that may contain unlisted pistachio nuts.
Posted: 04/07/2005 - Texas Representatives worked until the early morning hours Thursday to pass a $137.5 two-year spending plan.
Updated: 04/01/2005 - Crowds packed St. Peter's Square Friday as word spread about Pope John Paul's worsening health.
Updated: 03/23/2005 - The parents of a badly brain damaged Florida woman said Wednesday they will take the case to the U.S. Supreme Court after a federal appeals court in Atlanta refused to order the reinsertion of the feeding tube that has kept their daughter alive for 15 years.
Updated: 03/03/2005 - Two soldiers from Fort Carson died Monday in a vehicle collision in Iraq, military officials said Thursday.
Updated: 02/21/2005 - Waco Mayor Pro Tem Robin McDurham was unanimously selected Monday afternoon to fill the mayor's position until the May 7 election.
Updated: 02/21/2005 - A 26-year-old Army specialist from Houston has died in combat in northern Iraq, military officials said.
Updated: 02/13/2005 - Iraqi Shiites got the most votes in their country's elections, but they didn't get the two-thirds, which would have allowed them to form a government without forging alliances with other groups.
Updated: 02/11/2005 - A soldier from the 1st Cavalry Division's Task Force Baghdad died Friday in a homemade bomb attack.


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Category Benefits
Bikes Buyers GuideBikes Buyers Guide Close
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With so many different bikes to choose from, it can be a pain trying to find one that's right for you. Luckily, we're here to help. Take a look at our Bike Size Guide, which includes information on the sizing of bikes we've got, and how you can choose the right size bike for you.
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If you want an exciting Christmas gift ideas for your little one, than take a look at our selection of junior road bikes. We've also got a fantastic range of balance bikes for the really little ones.


text:
biomonitoring systems Companies in Missouri
microLAN On-line Biomonitoring Systems
based in Waalwijk, NETHERLANDS
microLAN, based in Waalwijk, the Netherlands, is a company specialized in early warning systems for water quality monitoring, based on optical measurements. The company started in 2003 as a trade agency for water quality measuring equipment, including lab and online testing for aquatic toxicity and algae monitoring. In 2014 microLAN took over a patent for automated ...
Commonwealth Biomonitoring
based in Indianapolis, INDIANA (USA)
We are an environmental laboratory located in Indiana with a passion for keeping our waters clean and healthy so that all life can benefit. Our company specializes in biological, ecological, and chemical assessments of water quality with techniques such as aquatic toxicity testing of wastewater effluents to complete watershed diagnostic studies. We work hard to meeting ...
Exposmeter AB
based in Tavelsjö, SWEDEN
A major supplier of products and services with over 20 years experience for time-integrative passive sampling, screening and analysis of lipophilic (PCBs, PAHs, OCPs, dioxins, furans etc.) and hydrophilic (pesticides, prescription and OTC drugs, steroids, hormones, antibiotics, personal care products, biocides, fungicides, etc.) compounds, VOCs, metals and phosphate. ...
Environmental Consulting & Testing
based in Superior, WISCONSIN (USA)
Environmental Consulting & Testing is operated and owned by biologists experienced in aquatic testing and aquaculture. We have over 30 years of experience in these fields and have a reputation for competitive prices and quality products and service. ECT is experienced and capable of providing biomonitoring (WET), sediment, chemical, bioaccumulation tests and site-specific ...
Brooks Rand Labs, LLC
based in Seattle, WASHINGTON (USA)
Specialty metals testing laboratory with more than 20 years experience offering specialized analytical services, products, and analytical instrumentation for ultra trace level metals analysis and metals speciation. Expertise includes ultra low level detection limits, difficult matrices, metals speciation, and consulting in the commercial and R&D sectors. Services include ...
LAR Process Analysers AG
based in Berlin, GERMANY
In more than 25 years LAR AG has established itself as world`s leading manufacturer of high quality online water analysers. Since its foundation in 1986 the Berlin-based company has been developing, manufacturing and supplying innovative customized online measurement systems for sum parameters such as TOC, TP, TNb, TOD, COD, BOD and toxicity. LAR offers a wide range of ...
H2O Inc. and H2O Biofouling Solutions B.V.
based in Lafayette, LOUISIANA (USA)
H2O Inc. and its joint venture H2O Biofouling Solutions B.V. have built an enviable reputation of providing the highest quality water treatment systems. A water system is more than simply equipment used to produce, store and transfer water. It must include procedures and training to ensure the platforms water is safe for your personnel and meets government standards. From ...
Merck Millipore
based in Darmstadt, GERMANY
Merck Millipore is the Life Science subsidiary of Merck, Darmstadt, Germany. As part of the global Life Science business of Merck, Merck Millipore offers a broad range of innovative performance products, services and business relationships that enable our customers' success in research, development and production of biotech and pharmaceutical drug therapies. Through ...
Liquid Analytical Resource, LLC
based in Shirley, MASSACHUSETTS (USA)
Liquid Analytical Resource, LLC is a U.S. company dedicated to helping our customers lower their processing costs while improving water quality, and reducing non-compliant waste through online process monitoring, analysis and control. LAR`s high quality products and innovative technology is unsurpassed. Our customers benefit from service and support throughout North ...
EnSolve Biosystems, Inc.
based in Raleigh, NORTH CAROLINA (USA)
EnSolve Biosystems manufactures proprietary "green", portable biotreatment systems that cost-effectively purify hydrocarbon contaminated wastestreams. EnSolve`s products address oily bilgewater from ships as well as hydrocarbon contaminated process wastes, groundwater, and `Frack` wastes.
Need help finding the right suppliers?
Let the XPRTs do the work for you


text:
|Publication number
|Publication type
|Application number
|Publication date
|Sep 27, 1994
|Filing date
|Dec 22, 1992
|Priority date
|Dec 22, 1992
|Fee status
|Also published as
|Publication number
|Geoffrey S. Martin
|Original Assignee
|Med-Pro Design, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (16), Referenced by (80), Classifications (13), Legal Events (6)
|External Links: USPTO, USPTO Assignment, Espacenet
This invention relates to co-axial dual lumen catheters for use in haemodialysis treatments and more particularly to such a catheter for placement in a jugular vein.
Haemodialysis treatments have been developed since the early 1960s using a variety of combinations and arrangements of catheters. The earliest treatments were conducted using two needles in the same vein and this subsequently led to pioneer work done by Dr. Shaldon in England who used two flexible catheters which could be left in place for limited periods. It was recognized by some practioners that it would be preferable to use a single incision rather than to use two and this led to the development of techniques involving dual flow catheters. There are two basic types. The first to be attempted was a co-axial catheter with the intake lumen surrounding the return lumen. While this had advantages, there were some difficulties of manufacture. The other approach is to use side-by-side lumens either in individual tubes connected to one another or in a single tube divided by an interior septum so that the lumens are D-shaped. Although such structures have become popular with many surgeons, they also had disadvantages. The most notable disadvantage is that because the lumens are side-by-side, the intake openings must be in one side of the catheter. As a consequence of this, there is a tendency for the suction at the opening to draw the catheter towards the wall of a blood vessel with the result that the flow could stop. Medical staff then have to move the catheter by rotating it until blood again flows.
The side-by, side structures have advantages in manufacture due to the fact that the two lumens can be created simultaneously in an extrusion. This has led to great activity in developing devices having side-by-side D-shaped lumens at the expense of co-axial structures. Nevertheless, due to the inherent disadvantages of the side-by-side structures, there has been renewed interest in developing suitable co-axial devices. This is primarily because the intake lumen can have openings in any part of the wall of the catheter.
Dialysis catheters are commonly inserted in either the subclavian or jugular veins. It has been found that the subclavian vein is more desirable from the standpoint of patient acceptance due primarily to the fact that the proximal (i.e. external) portions of the catheter can be readily taped to the patient without interfering significantly with the patient's movements. However, it has been found that jugular placement has resulted in less vein stenosis, and consequently jugular placement is finding more favour among surgeons although the proximal portions of the catheter can be an irritant for the patient because the portions tend to project upwardly near the ear of the patient.
It is therefore an object of the present invention to provide a co-axial catheter particularly for placement in a jugular vein and which has a minimal upwardly projecting proximal portion.
It is also an object of the invention to provide such a catheter which will also permit periodic rotation of the catheter in place to ensure continued patency.
Accordingly, in one of its aspects, the invention provides a dual lumen catheter having a main body, a tip section at a distal end of the main body, an attachment positioned on the main body for fixing the catheter relative to the patient, a proximal U-shaped portion extending from the attachment, a junction at a proximal end of the U-shaped portion, and a pair of tubes attached to the junction and forming continuations of the respective lumens for coupling the catheter to dialysis equipment.
This and other aspects of the invention will be better understood with reference to the drawings and the following description, in which:
FIG. 1 is a side view of a catheter a according to a preferred embodiment of the invention;
FIG. 2 is a sectional view on line 2--2 of FIG. 1 and drawn to a larger scale;
FIG. 3 is a sectional view on line 3--3 of FIG. 1 and drawn to the same scale as FIG. 2;
FIGS. 4 and 5 are diagrammatic views illustrating steps in the procedure of manufacturing the distal end (tip end) of the catheter;
FIG. 6 is a sectional view to a larger scale than that used for FIG. 1 and illustrating a step in the manufacture of a U-shaped proximal portion of the catheter; and
FIG. 7 is a partially sectioned view to a scale larger than that used for FIG. 1 and showing a junction at the proximal end of the catheter and demonstrating both the structure and the method of making the junction.
Reference is made firstly to FIG. 1 which illustrates a co-axial catheter designated generally by the numeral 20 and useful for withdrawing blood through an intake 22 and returning treated blood through an outlet 24. The intake and outlet include prospective flexible tubes 26, 28 which can be clamped using conventional devices such as device 30 shown on tube 28 and which terminate at respective luer connectors 27, 29. The tubes meet at a junction 32 at the proximal end of a U-shaped proximal portion 34 which terminates at its distal end in a proximal transition portion 36 leading to a main section 37 and hence to a tip section 38 which meets the main body at a distal transition portion 39. Blood is withdrawn through side openings 40 and returns through further side openings 42 and end opening 44. As a result of this arrangement the tubes 26, 28 extend generally in parallel with the main section 37 and lie to one side of the section 37.
As seen in FIG. 2, the main section 37 includes an outer tube 46 containing an inner tube 48 which also extends through an outer tube 60 in the proximal portion 34 as will be explained. The inner tube 48 is therefore continuous having a first part inside outer tube 46 in the main section 37 and the second part inside the outer tube 60 forming part of the proximal portion 34. The inner tube 48 is free but for attachments at its ends as will be explained. The openings 40, shown in FIG. 1, supply blood to an intake lumen 50 formed between the tubes 46, 48 and, in the proximal portion, between tubes 60 and 48. Blood returns by a return lumen 52 defined by the inner tube 48. The junction 32 at the proximal end of the U-shaped proximal portion 34 connects tubes 48, 60 to the tubes 26, 28 (as will be explained) and the catheter is completed by provision of an attachment in the form of a wing structure 54 used to hold the catheter in place in a patient in conventional fashion. It is preferable that the wing structure be rotatable on the catheter and provision is made for this with longitudinal location provided by a tapered sleeve 56 and a distal end of the portion 34. These parts are elements of the transition portion 36 as will be explained with reference to FIG. 3.
The side openings 40 and 42 are typical of openings that can be provided around the periphery of the catheter to ensure flow into and out of the catheter from anywhere about the catheter. Consequently, if the catheter should be positioned so that some of the openings are occluded by engagement with the wall of a vein, other openings will provide the essential flow.
Reference is next made to FIG. 3 to describe a preliminary step in the manufacture of the catheter. As seen in FIG. 3, outer tube 46 extends through the tapered sleeve 56, then through a tubular central part 58 of the wing structure 54, and ends inside a distal end of the outer tube 60 of the proximal portion 34. Details of this arrangement will become evident as the method of assembly is described.
As a preliminary, the outer tube 46 is placed in a suitable conventional injection moulding machine and positioned suitably to mold the sleeve 56 about the tube. The materials are compatible thermoplastics so that the sleeve becomes an integral part of the tube 46. Next, the outer tube is used in an assembly shown in FIG. 4. In this step the inner tube 48 has a leading part indicated by numeral 68 within a corresponding part 70 of the tip section 38. These parts can of course be deformed to fit together in this way, but as shown, round tubing is selected for these parts so that they fit within one another quite readily but at the same time quite closely. If preferred, the parts can be attached to one another using a suitable adhesive. Typically the inner tube is #6 French and the tip section #8 French. After this step has been completed, the outer tube 46 is placed about the inner tube 48 and a leading part 72 of the outer tube overlaps part 70 of the tip section. Consequently the parts 68, 70 and 72 are located about one another. Again an adhesive can be used to fix the assembly.
A tubular cylindrical mandrel 74 is proportioned to fit inside the outer tube 46 and about the inner tube 48. Typically the outer tube is #12 French and the materials of all of the inner and outer tubes and the tip section are polyurethane with the selection of the materials being chosen to give the physical characteristics desired. For instance if a soft tip is required, then a material of a suitable Durometer is provided for the tip section 38 and of course sufficient rigidity must be provided in the outer tube 48 to ensure that the catheter is stable during insertion and when in place. It should be noted that the inner tube is protected to some extent against collapse by the outer tube so that the inner tube can be of a relatively soft thin walled polyurethane. As will be described, this assists in forming the U-shaped proximal portion 34 as well as maximizing the space available for flow in the catheter.
A solid second mandrel 76 is provided to support the inner tube so that this tube extends between the mandrels 74 and 76. Mandrel 74 has a rounded end and stops against the part 70 of the tip section 38 whereas the inner mandrel 66 projects into the tip section 38. This provides support along the space occupied by two halves of a mold 78 which are operable to move into contact with the assembly.
The mold 78 is used to form the transition portion 39 by moving the mold halves into contact with the assembly shown in FIG. 4 under the influence of heat and pressure sufficient to cause the material of the parts 68, 70 and 72 to flow. Once this is completed the structure is allowed to cool and the mandrels removed. The result is shown in FIG. 5.
As seen in FIG. 5, the intake lumen 50 terminates at a blind annular end wall 80 at the transition portion 39. The intake lumen 50 is contained between outer tube 46 and inner tube 48 and the openings 40 are provided immediately adjacent the transition portion 39 to allow blood flow into the lumen 50. More openings can of course be provided further away from the transition portion (as seen in FIG. 1) if required.
The return lumen 52 formerly described with reference to the inner tube 48, now continues through the transition portion, 39 and through the tip section 38. The transition portion ends the intake lumen 50 and blends smoothly from the outer surface of the tip section to the outer surface of the main section, and in particular to the outer surface of the outer tube 46.
It should be noted in FIG. 5 that the three parts, namely the outer and inner tubes 46, 48 and the tip section 38, are shown as three individual parts by the shading. Where they meet at the transition portion 39, the shading has been omitted because this is a portion where the materials flow into one another and it is indefinite where the parts begin and end after molding. However by comparison between FIGS. 4 and 5 it is evident that the parts 68, 70 blend into one as do the parts 70 and 72 resulting in the transition portion 36. Preferably, the parts are all polyurethane with the grades and sizes being chosen to provide the desired physical characteristics such as a soft pliable tip section and a stiffer outer tube with a thin walled inner tube.
After the assembly has been molded as demonstrated in FIGS. 4 and 5, the tip section 38 is deformed in a conventional manner to create a tapered tip 82 about the end opening 44.
Next the proximal transition portion 36 is completed. Referring to FIG. 3, the standard wing structure 54 is slipped over the outer tube 46 into engagement with the tapered sleeve 56. Next the proximal outer tube 60 of the U-shaped proximal portion 34 is slipped over the inner tube 48 (not shown in FIG. 3) and engaged on the tube 46. The tube 60 is held in place by chemical bonding or heat sealing in a position which permits the wing structure to rotate. This assembly takes place before the tube 60 is bent. It should be noted that the numeral 54 could also indicate a conventional cuff which would be located in the same way as the wing structure.
The assembly is now complete from the proximal transition portion 36 to the distal end of the catheter. The outer tube 60 of the portion 34 contains part of the inner tube 48 which, as was described, ends at and is anchored in, the distal transition portion 39. The next step is to give the proximal portion 34 its U-shape. To do this, a flexible tubular mandrel indicated as 86 in FIG. 6 is engaged over the inner tube 48 and inside the outer tube 60. The mandrel is of a synthetic elastomeric material, preferably that sold under the trademark TEFLON.
As seen in FIG. 6, the mandrel 86 is pushed until it reaches the proximal transition portion 36 and then the portion 34 is curved manually to fit into a die indicated diagrammatically by numeral 87. This die has a channel to receive the portion 34 and a similar second part of the die closes over the first part to trap the portion 34 in the desired U-shaped configuration. The die and catheter are then subjected to heating to about 120 degrees C. (250 degrees F.) to cause the inner and outer tubes to take a new set. The mandrel resists this temperature.
After cooling in the die, the proximal portion 34 has a U-shaped configuration as seen in FIGS. 1 and 6.
The last step is to form the proximal end structure or junction 32 reference is now made of FIG. 7. After trimming the inner and outer tubes 48, 60 as required, the assembly is prepared by first positioning a proximal end of the proximal portion 34 in a mold (not shown) which is to create the junction 32 by injection molding using conventional techniques. The portion 34 is positioned using first and second mandrels 94, 96. The mandrel 96 has a cylindrical portion 98 blending into a converging generally conical portion 100, which in turn blends into a cylindrical end part 102 angled with respect to the portion 100. The part 102 fits closely inside a proximal end of the inner tube 48 and this tube is maintained in a position in engagement with the outer tube 60 by the mandrels 94, 96.
The mandrel 94 has an outer cylindrical portion 104 which blends into a converging and generally conical portion 106 ending at a projection 108. This projection has a generally U-shaped cross-section (as will be explained) and is angled with respect to the conical portion 106.
The projection 108 on the end of the mandrel 94 is shaped to fit the space provided when the inner tube 48 is held against the inner surface of the outer tube 60. As a result it has a generally U-shaped configuration. The angular offsets of the projection 108 and the end part 102 of lumen 96 result in the projection and end part 102 extending in parallel axially with respect to the proximal portion 34. The cylindrical portions 98 and 104 diverge sufficiently with respect to the axial main section that the ends of the respective intake and outlet tubes 26, 28 can be accommodated on the mandrels with the ends positioned in the mold to become entrapped in the junction 32.
Once the assembly shown in FIG. 7 has been completed, the mold is closed and injection takes place to form the junction 32. The material is preferably polyurethane although other materials can be used provided that the usual requirements of compatibility etc. are met.
The mandrels are removed, and because there is some flexibility in the material, the mandrels can be pulled out without causing any damage.
The structure shown in FIG. 7 has particular significance in the resulting flow through the catheter. Unlike previous co-axial catheters, the flow tends to remain linear due to the fact that the intake and return tubes 26, 28 are generally in line with the portion 34. Previously, one of these tubes was in line and the other was connected through the side of the junction so that the flow must pass through a significant angle which in some instances approached 90 degrees. This is most undesirable because any changes in direction of this kind will result in turbulance in the blood flow with potential for damage to the blood. It is well established that pressure fluctuations in blood flow paths should be minimized, and this structure tends to limit such variations.
The angle shown as "A" in FIG. 7 indicates the divergence between the tubes 26, 28 as they meet the junction 32. Because of the construction it is possible to maintain this angle in the order of 15 to 20 degrees and is readily maintained below 30 degrees. As a result, the flow into and out of the catheter is essentially axial with reference to the portion 34 at all times. This is because the angle of each of the tubes 26, 28 with reference to the axis of the portion 34 where it meets the junction 32 is half of the range up to 30 degrees.
The catheter is now complete but for the final shaping of the proximal portion 34. Up to this point this portion has remained straight and consists of the outer tube 60 and part of the inner tube 48 which starts at the junction 32 (FIG. 1) and ends at the distal transition portion 39.
Reference is now made to FIG. 7 to describe forming the proximal portions 34.
The catheter shown as a preferred embodiment is typical of catheters that could be made in accordance with the invention. As mentioned earlier it is possible to proportion the tip and/or provide soft material for the tip to ensure that after insertion the tip will flex and will not damage veins. At the same time, there is sufficient rigidity in the transition portion to maintain the relationship between the tip and the inner and outer tubes so that the intake lumen 50 remains patent while the insertion takes place and during use.
It will be apparent that the structure can be varied within the scope of the invention. In particular, the tip section need not be tapered and in some cases (depending upon requirements) the distal end of the catheter could be closed. Also, the proximal transition portion could be arranged with a cuff instead of the wing structure 20. Either of these attachments can be used advantageously.
The proportions of the parts can be varied and it would be possible to do some preforming before assembly.
In a typical embodiment the various tubes used in the structure are polyurethane. The outer tube 46 is a firm polyurethane having a 65D Durometer. It is 3.175 mm inside diameter and 3.734 mm outside diameter. The tip section is also 65D with an inside diameter of 1.727 mm and an outside diameter of 2.667 mm. The inner tube is of a soft thin walled polyurethane dimensioned to fit into the assembly shown in FIG. 3, and the tube 60 is proportioned to fit over the outer tube 46. The tube 60 has a wall thickness of about 1.31 mm and a hardness of 85A to minimize the risks of kinking and to protect the inner tube.
It is important to note that this catheter overcomes disadvantages in the art. Firstly, the structure is such that the inner tube can be thin walled because it is protected by the stiffer outer tube 46 in the main section 37 and by the outer tube 60 in the curved proximal portion 34. The thin-walled soft inner tube takes up minimal cross-sectional space thereby permitting the portion of the co-axial catheter which is to be inserted to have a smaller cross-section. Another feature is the fact that there is a minimum of upwardly extending structure beyond the attachment 36 when the catheter is placed in a jugular vein. This is very important to the comfort of the patient. Also, because attachment takes place where the catheter exits the incision, manipulation of the tubes to make connections etc. will have less likelihood of dislodging or moving the catheter.
The invention incorporates all variations within the scope of the claims and is not restricted to the embodiments disclosed.
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|U.S. Classification
|604/43, 604/507
|International Classification
|Cooperative Classification
|European Classification
|Apr 13, 1994
Owner name: MED-PRO DESIGN, INC., CANADA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:MARTIN, GEOFFREY S.;REEL/FRAME:006937/0763
Effective date: 19940408
|Nov 26, 1996
|Reissue application filed
Effective date: 19960927
|Mar 17, 1998
|Fee payment
Year of fee payment: 4
|Jun 17, 1998
Owner name: VAS-CATH INCORPORATED, CANADA
Free format text: ARTICLES OF AMALGAMATION;ASSIGNOR:MED-PRO DESIGN, INC.;REEL/FRAME:009279/0701
Effective date: 19970226
|Feb 28, 2002
|Fee payment
Year of fee payment: 8
|Mar 6, 2006
|Fee payment
Year of fee payment: 12


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