text:
|Publication number
|Publication type
|Application number
|Publication date
|19 Sep 1978
|Filing date
|14 Dec 1976
|Priority date
|14 Dec 1976
|Also published as
|Publication number
|Lanny Louis Lewyn, Glen David Simpson
|Original Assignee
|American Hospital Supply Corporation
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (10), Non-Patent Citations (1), Referenced by (107), Classifications (6), Legal Events (2)
|External Links: USPTO, USPTO Assignment, Espacenet
The present invention relates to cardiac pacers. Many different types of cardiac pacers are known, such as fixed rate pacers and demand or ventricular inhibited pacers. In fixed rate pacers, circuitry generates a train of stimulating pulses of constant period or interval (approximating the interval between natural heartbeats), and these pulses are coupled to the heart to force its rhythm. In a demand type of pacer, the natural activity of the heart is sensed (usually at the ventricle), and this information is used to inhibit the pacer circuitry from generating a pulse. In this type of pacer, it may be said that the electronic circuitry does not "compete" with a natural heartbeat. The interval between the last natural heartbeat to be sensed and the first stimulating pulse is referred to as the "escape interval". It is common practice to have the escape interval in this type of pacer adjusted to a value which will maintain a desired rate of pacing in the absence of naturally-occurring heartbeats.
There are other types of pacers, and there are many variations within each broad classification, such as so-called "hysteresis" pacers which have different escape intervals following sensed or paced beats. For example, the first escape interval may be relatively long, and subsequent escape intervals may be shorter.
Another type of pacer, namely that disclosed in U.S. Pat. No. 3,662,759, granted May 16, 1972, senses a natural heartbeat, and if it occurs, generates a non-stimulating "tracking" pulse in synchronism with a naturally occurring heartbeat. If no natural heartbeat is sensed, then at the end of the escape interval a pulse of greater energy, sufficient to stimulate the heart, is generated. In a non-competing pacer of this type, the tracking pulse may communicate to a physician (over a telephone communication line), that the heart is working in natural sinus rhythm, and that the implanted circuitry is also operational and functioning properly. If, during an examination, the heart is functioning normally and the pacer circuitry quiescent, the tracking pulse assures an examining physician that the circuitry is operative, the power supply functioning, and the electrode system intact (the tracking pulse usually being sensed right at the heart).
Still another type of pacer system is referred to as a threshold tracking pacer. In these systems, the pacing circuitry tries to measure the threshold which is just sufficient to stimulate the heart. It will be appreciated that the stimulating threshold not only varies from person to person, but may vary with time for the same person, and it may change for different electrode systems. Once a stimulating threshold is measured, a system of this type may increase the stimulation by a fixed amount for subsequent pulses, or it may be programmed to seek the threshold anew at fixed times, or each time that natural sinus rhythm is lost. In pacers of this type, it is important to determine when a stimulating pulse is or is not actually stimulating the heart. In this context, "stimulation" means that the pulse transmitted to the heart electrode causes depolarization and contraction of one of the heart chambers, for example, the ventricle. The determination that a stimulating pulse has produced cardiac depolarization or "capture" is referred to as "capture verification". A threshold tracking pacer system is disclosed in an article "Automatic Threshold Tracking Pacemaker", Preston and Bowers, MEDICAL INSTRUMENTATION, Vol. 8, No. 6, November-December, 1974. The article does not disclose the circuitry used, but it describes four separate electrode systems. The first system used four electrodes--two for pacing and two different electrodes for sensing capture. A second electrode system used three electrodes, two of which were positioned in the heart by a catheter, and a third large electrode was remote (perhaps in the abdominal region where artificial pacers are normally implanted). Pacing was from the distal tip electrode to the remote electrode, and sensing was from the second embedded electrode to the remote electrode. The third electrode used a bipolar electrode catheter and a large reference electrode attached to the body surface and, as described, exhibited sensing problems at high current levels. The fourth electrode system used a bipolar catheter with both electrodes used for pacing and sensing. A bipolar catheter is one which has two electrode surfaces, electrically isolated, at the distal end of a catheter. This electrode system, as indicated, produced sensing difficulties due to residual after-potential and electrode polarization. The authors conclude that a three-electrode system is necessary for proper sensing.
Electrode polarization is a well-known phenomenon caused by the interface between the metal surface of the electrode and the ions in solution in the body tissue with which the electrode communicates. In this connection "polarization" refers to a residual voltage resulting from the accumulation of charge at the interface between the electrode metal surface and the electrolyte or body fluid; and it is not to be confused with depolarization of the cells of the heart which accompanies contraction. The polarization voltage may be small, of the order of 0.5-1.7 volts, but it is a significant factor in capture verification because the sensing system is trying to detect the presence of an R wave voltage of the order of 10 millivolts to verify capture, and this signal is small in comparison with normal polarization voltages. In addition to the difference in magnitude between a typical polarization voltage and a stimulated R wave, a polarization voltage does decay with time, and the slope of the decaying voltage even further complicates the detection of a stimulated R wave, as will be further discussed within. Thus, the effect of electrode polarization, in terms of an electrical equivalent circuit, is that it appears to the driving circuitry that the electrode has capacitance which stores some residual charge after stimulation, and reference will be made, then, to an electrode capacitance. The value of the capacitance depends on the material of the electrode and its size.
Another cardiac pacer which senses capture and decreases the amplitude of a succeeding stimulating pulse if a stimulated heartbeat is sensed is disclosed in U.S. Pat. No. 3,757,792, issued Sept. 11, 1973. In this patent, if the circuitry does not sense a stimulated R wave after a stimulating pulse is transmitted to the heart, the next succeeding stimulating pulse is increased in amplitude by a predetermined amount. As stated in the patent, separate pairs of electrodes are used for stimulating and for sensing to avoid the problem of electrode polarization and the resulting refractory period.
The desirability of a single electrode system for both stimulating and sensing capture verification is apparent because of the resulting simplicity in electrode design and operation. However, to our knowledge, workers in the art have been unable to produce an operable, reliable system for indicating capture verification using only a single electrode implanted in the heart for both sensing and detection. The present invention is directed to such a system. The second electrode is remotely located--for example, in the abdomen where the circuitry is normally implanted.
The present invention may be used in many different types of cardiac pacers, such as demand pacers or fixed rate pacers. For simplicity, the present invention is disclosed in a fixed rate pacer. Further, persons skilled in the art will readily appreciate that there are many uses other than automatic threshold tracking described above to which a capture verifying system may be directed. For example, the electrocardiogram of a patient may be sensed and transmitted through telemetry or telephone lines to a physician at his office or to a clinic. If, during such a test the heart is malfunctioning, the information that the pacer is both generating a stimulating pulse and the heart is responding to it would be very important. In connection with EKG telemetry, reference is made to Lewyn, "An Implantable Multichannel Biotelemetry System", PROCEEDINGS IEEE INTERCON, April, 1975. Such a system of telemetry would be particularly useful in the case where it is desirable to amplify and transmit the shape of the QRS following a stimulating pulse. If it is not desired to transmit the shape of the QRS but rather a single pulse which indicates that an R wave was present, then the invention can be used in conjunction with a pacer which also provides a tracking pulse, as described in the above-identified Dabolt patent, which tracking pulse is presently used to indicate that the heart is functioning normally, and the pacer circuitry is operational, but dormant so as not to compete with the heart. Other applications will be apparent to persons skilled in the art, as indicated.
Briefly, according to the present invention, a cardiac pacer system includes an oscillator for establishing the pacing interval and a driver circuit responsive to the output of the oscillator for generating a stimulating signal which is capacitor-coupled to a single electrode engaging the heart.
A sense amplifier operating in a differential mode has its signal input coupled to the heart electrode for sensing an R wave. In particular, the signal input of the sense amplifier is connected to the circuit or "input" side (as distinguished from the heart or "output" side) of the output coupling capacitor by means of a controlled semiconductor switch.
There are a number of electronic switches in the present system for performing the various functions required, and to avoid confusion, each of the principal switches is referred to by a capital letter. The switch just mentioned is referred to as switch D.
Another switch, switch F, is connected in series with the discharging resistor R for the output coupling capacitor. A third switch, switch A, is used to connect the circuit side of the output coupling capacitor to a clamp potential (which in the illustrated embodiment is ground) through a resistor 17.
A fourth switch, switch E, is used to selectively change the gain of the sense amplifier. Finally, there are two switches, referred to as switches B and C, which are used to connect the signal and reference inputs of the differential sense amplifier in common and to a single reference voltage. The functions of these switches, and the timing of operations will be discussed in more detail within. However, briefly, when a stimulating pulse is generated, as signaled by the oscillator circuit, switch F is immediately switched to a non-conducting state to de-couple the discharging resistor from the output coupling capacitor. This resistor is not reconnected until the period has passed during which a stimulated R wave signal is expected. One of the principal reasons for disconnecting the discharging resistor is to eliminate the current which would otherwise flow to discharge the output coupling capacitor and therefore give rise to a time rate of charge of voltage during the time when the sense amplifier is trying to verify capture by sensing a stimulated R wave.
At the same time, that is at the initiation of a stimulating pulse, the signal input to the sense amplifier is uncoupled from the electrode by switch D; and the sense amplifier is restrained by connecting both its signal and reference inputs in common to the reference voltage source via switches B and C. Further, the gain of the amplifier is reduced because the minimum R wave signal response of the heart to an artificial stimulating signal is usually greater than the minimum value of a natural R wave.
When the stimulating pulse terminates, the discharging of the electrode capacitance is initiated by closing the clamp resistor circuit through switch A. The value of the clamp resistor and the clamp time are such as to remove a certain amount of charge from the electrode capacitance. During clamping, the charge on the output coupling capacitor assists in discharging the electrode capacitance, because during clamping, the output coupling capacitor is connected across the electrode capacitance with an opposite polarity charge so that charge stored on the output coupling capacitor is used to directly discharge the electrode capacitance. This has the effect of greatly reducing, but not entirely eliminating, charge on the electrode capacitance. The electrode is discharged to a level where the voltage slew rate is negligible. There also remains some residual voltage at the output coupling capacitor.
After the clamp is terminated, but before amplifier restraint is removed (inputs still tied in common), the amplifier is reconnected to the output coupling capacitor. At this time both input terminals of the amplifier are connected to a reference voltage. Thus, the amplifier input coupling capacitor is quickly charged to offset the residual voltage on the circuit side of the output coupling capacitor while the amplifier inputs are clamped to the reference voltage. This prevents overdriving the sense amplifier during the time it is being reconnected to the output coupling capacitor. Further, by establishing the offset voltage on the amplifier input coupling capacitor to compensate for residual voltage on the output coupling capacitor, the amplifier does not see a voltage step (which would also overdrive it) when amplifier restraint is removed.
Thus, the amplifier inputs are at the same potential, and the voltage slew rate at the output coupling capacitor is almost zero in a very short period (about 18 Msec.) after a stimulating pulse and prior to the sensing period for verifying capture. During the sensing period, the switches B and C are open. After the sensing period, the (discharging) resistor R for the coupling capacitor is reconnected, and the gain of the sense amplifier is increased to its initial value.
An important aspect of the present invention is that we have discovered that the effect of polarization voltage for materials normally used as heart electrodes can be compensated in a sufficiently short time--typically within 18 milliseconds of the initiation of a stimulating pulse--to permit detection of stimulated R waves. The sense amplifier is selectively coupled to the heart electrode at a time when the signal at the heart electrode is quiescent at least to the extent that a stimulated R wave can be detected when it is expected. Further, the clamping, compensation and sensing technique employed by the present invention is adaptable to different types of electrode materials. This is significant because each type of material exhibits its own characteristic polarization voltage and electrode capacitance.
Another important aspect of the present invention is that it provides a means for removing energy from an electrode, immediately following stimulating, without requiring additional energy from the power source. That is, the electrode energy is removed by passive circuit means (the clamp resistor and output coupling capacitor), and it is effective over a wide range of input currents.
Another important aspect of the present invention is the driver circuit which provides a constant output current for stimulation, and the value of the output current remains constant and is independent of the magnitude of the source voltage over a wide range--down to near failure. This is particularly important in an implanted stimulating device such as a cardiac pacer where it is desirable to maintain a constant output current even under conditions of diminished supply voltage.
Still another important aspect of the present invention is that it provides a capture verification signal for a cardiac pacer using only a single electrode contacting the heart--that is, the same electrode is used for both stimulation and for sensing. This is useful in various types of cardiac pacers, including both fixed rate pacers and non-competing or demand pacers.
As mentioned, the signal input of the sense amplifier is disconnected from the heart electrode, in a single electrode system, during the time that the stimulating pulse is present on the electrode. This, in conjunction with the amplifier restraint, gain reduction and basic amplifier configuration advantageously prevents overloading the sense amplifier. Further, by reducing the gain of the amplifier during the time that a stimulated R wave is being sensed, the same circuitry may be used for sensing both stimulated and naturally occurring R waves; and this may be useful both in fixed rate and demand pacers.
As will be clear from the detailed description following, amplifier restraint begins at the initiation of a stimulated pulse, and it extends until a time beyond which the amplifier is reconnected to the electrode. Thus, the amplifier is not operative to sense capture until sometime beyond which all the switching is performed for electrode compensation, and the amplifier therefore is not responsive to the switching noise. Further, the amplifier is initialized in a manner such that it is not overloaded by the offset voltage present at the circuit side of the output coupling capacitor when the amplifier is reconnected for sensing.
Other features and advantages will be apparent to persons skilled in the art from the following detailed description of one embodiment, accompanied by the attached drawing.
FIG. 1 is a circuit schematic diagram, partly in functional block form, of a cardiac pacer system with a capture verification signal, incorporating the present invention;
FIG. 2 is a timing diagram showing various voltages and relative switching times in the circuitry of FIG. 1;
FIG. 3 is a circuit schematic diagram of the oscillator circuit of FIG. 1;
FIG. 4 is a circuit schematic diagram of a monostable and constant current drive circuit of FIG. 1;
FIG. 5 is a circuit schematic diagram of a circuit for generating the SRWI signal;
FIG. 6 is a schematic diagram of a circuit generating the IWEN signal; and
FIG. 7 is a schematic diagram of the control circuitry and the amplifier circuit of FIG. 1.
Referring now to FIG. 1, reference numeral 10 designates an oscillator circuit for generating a periodic train of pulses. As indicated, the illustrated embodiment is a fixed rate cardiac pacer, and the output pulses of the oscillator circuit may, for example, occur at intervals of 833 milliseconds. These pulses are fed to a monostable circuit 11 which converts each pulse in the output train to a corresponding pulse of fixed time duration or width (0.75 Msec.). The output of the monostable circuit 11 is coupled to a constant current driver 12, the output of which is connected to an output coupling capacitor C1. The other terminal of the output coupling capacitor C1 is connected to the heart electrode, diagrammatically represented by the dashed block 14. The simplified electrical equivalent circuit of the heart electrode 14, due to polarization effect, as discussed above, is a capacitance as diagrammatically shown in dashed line and designated C2. The circuit is completed through the body tissue to a remotely located common electrode. The resistance of the heart and body tissue is shown as a dashed resistor designated RH.
As viewed in FIG. 1, the left side of capacitor C1 is sometimes referred to as the "circuit side" because the pacer circuitry is connected to it, and for analogous reasons, the right side is sometimes referred to as the "heart side". The circuit side of the output coupling capacitor C1 is connected to a series circuit comprising a discharging resistor R and a switching transistor F, the emitter of which is grounded. The base terminal of the switch F is connected to the output of an SRWI signal generator represented by the block 16, which receives its input signal from the output of oscillator circuit 10. Briefly, the SRWI signal generator 16 generates a signal having an interval which defines a time from the beginning of a stimulating pulse until the end of the period in which a stimulated R wave is expected to occur. Hence, this signal is sometimes referred to as the Stimulated R-Wave Interval (SRWI) signal. The signal is shown on line L12 of FIG. 2, and the state of switch F is correspondingly shown on line L13. In this line diagram, a switch in a conducting state is represented by a heavy line, and the absence of such heavy line indicates those times during which the corresponding switch is in a non-conducting state. It will thus be observed by way of example, that switch F is non-conducting (line L13) during the time when the SRWI signal (line L12) occurs.
Returning now to FIG. 1, the circuit side of the output coupling capacitor C1 is also connected to a series circuit comprising a CMOS switch A, and a clamping resistor 17. The same junction is similarly connected to a series circuit comprising a CMOS switch D, a capacitor C3 (sometimes referred to as the amplifier input coupling capacitor) and thence to the signal input 18 of amplifier 20, which is sometimes referred to as a "sense" or "output" amplifier. The output of the amplifier 20 is a signal representative of a stimulated or natural R wave.
The amplifier 20 is preferably a differential amplifier, and it includes a reference input terminal 21 which is connected through a capacitor C4 to ground. Signal input terminal 18 of the amplifier 20 is connected via a CMOS switch C to a reference voltage VREF ; and the reference input terminal 21 is similarly connected by means of a CMOS switch B to VREF. The voltage VREF is derived from the power source for the pacer unit, and is diagrammatically illustrated by a voltage source 23, and a capacitor 24 connected in parallel with the source 23.
A CMOS switch E is connected in the feedback circuit of amplifier 20. This is a schematic representation for the fact, to be discussed more fully below, that when switch E is conducting, the gain of the sense amplifier 20 is decreased by a predetermined amount. In one embodiment, the gain of the amplifier 20 is reduced by a factor of four when the switch E is conducting. The amount by which the gain is decreased depends upon the anticipated differences in magnitude between the minimum value expected for a stimulated R wave and a naturally occurring R wave. The switch E is energized by the complement of the SRWI signal (denoted SRWI*) which is received from inverter 16A. As indicated, it is during this time that the heart electrode is monitored for detection of capture by a stimulating signal.
The output of the oscillator circuit 10 is connected to the input of a circuit 27 which generates a signal called IWEN. This signal is sometimes referred to as the Input Wave Enable IWEN signal. The output of the IWEN generator 27 (line L3 of FIG. 2) is connected to a differentiator circuit 28 (see line L4 of FIG. 2) and to an inverter circuit 29. The differentiator circuit 28 feeds the gate lead of the previously discussed switch D.
The output of the inverter circuit 29 is the IWEN* signal (the complement of a signal again being indicated by an asterisk) (line L8 of FIG. 2); and it is coupled to the gate terminals of switches B and C, and to the input of a gate circuit 30. The IWEN* signal defines a short period of time following a stimulating signal (18 Msec. in the illustrated embodiment) and prior to the period when the circuit is to determine whether the stimulating signal has actually stimulated or "captured" the heart, within which the electrode capacitance is compensated. The gate circuit 30 is shown as having an inhibit input I, which is received from a circuit 32 which generates a signal called OW*, which is derived from the output of the monostable circuit 11. Briefly, the OW* signal inhibits the transmission of the IWEN* signal through the gate 30 for a period of time equal to the time duration or width of the stimulating pulse, as will be further discussed below. The OW* signal is shown on line L7 of FIG. 2, and the output signal of the gate 30 is shown on line L9. The output signal of gate 30 is fed to a differentiator circuit enclosed within the dashed block 33; and it includes a resistor 34, a switch 35, having two positions A and B, and first and second capacitors 36, 37. Depending upon the position of the switch 35, one of the capacitors 36, 37 will be connected in series with the resistor 34. The capacitors 36, 37 are selected so as to provide different time constants, depending upon the electrode material, and more particularly, upon the electrode capacitance, as will be made clear below. The differentiated output signal of gate 30 is connected to the gate lead of switch A.
Referring to FIGS. 1 and 2, the output of the oscillator circuit 10 is connected to trigger the monostable circuit 11 at To which generates an output pulse having a duration of 0.75 Msec. This signal is then fed to the current driver 12 which generates a negative-going output current pulse, shown on line L1 of FIG. 2, having a constant magnitude and fixed duration of 0.75 Msec. This is the pulse that is transmitted through the output coupling capacitor C1 to the heart electrode for stimulation; hence it is sometimes referred to as a stimulating pulse. If the heart is stimulated, a corresponding signal (called a stimulated heart signal) will be sensed in the period 18-110 Msec. of the initiation of each cycle. The corresponding voltage at the circuit side of the output coupling capacitor is shown in idealized form on line L2 of FIG. 2 as pulse 40. The actual output voltage includes the effects of electrode capacitance, and, hence, it looks more like the waveform shown on line L6, as will be further explained.
Referring now to line L3 of FIG. 2, the output signal of the IWEN generator 27 is shown as a signal having a duration of 18 milliseconds, terminating at time T5 in the timing diagram. This signal is differentiated in differentiator circuit 28, the output of which is coupled to switch D. The differentiated IWEN signal is shown in line L4, and when it goes negative, switch D becomes non-conducting (see line L5) to thereby isolate the signal input 18 of the amplifier 20 from the output of the current driver 12. When the differentiated IWEN signal rises to a predetermined threshold level indicated by the line 41, and determined by the threshold voltage of the switch D, the switch D will again become conducting, as indicated at time T4 in FIG. 2. It will be apparent that time T4 (which may be about 15 milliseconds) is prior to time T5 which marks the end of the IWEN* period. This means that the amplifier restraint is removed only after the signal input 18 of the amplifier 20 is reconnected to the output coupling capacitor C1, as will be more fully explained below.
Referring now to line L6 of FIG. 2, there is shown a more realistic voltage waveform as might exist on the circuit side of the output capacitor C1 for a given electrode material. The curve is characterized by an initial negative-going step, a less negative-sloped portion (during the stimulating current pulse) which is caused by electrode polarization, followed by a positive-going step when the stimulating pulse terminates, then a decaying positive portion caused by discharging of the output coupling capacitor, and finally a residual level indicated by a dashed line when the clamp is removed.
The IWEN generator 27 is a monostable circuit which generates a pulse of duration of 18 milliseconds as shown on line L3 of FIG. 2 and previously explained. This pulse is inverted in the inverter circuit 29, the output pulse of which is shown on line L8 of FIG. 2. The OW* signal generator is responsive to the output of the monostable circuit 11 to generate a pulse having a width equal to the width of the stimulating pulse, as shown in line L7 of FIG. 2. This signal is used to inhibit the transmission of the IWEN* signal through gate 30. Hence, the resulting signal [IWEN* �OW*] is shown on line L9 as extending from the period 0.75 milliseconds to 18 milliseconds. This pulse is differentiated in the differentiator circuit 33, as shown in line L10 with the switch 35 in the A position (capacitor 36 connected in circuit). The output of the differentiator circuit 33 causes the switch A to conduct, thereby clamping the circuit side of the output coupling capacitor C1 to ground through the clamping resistor 17. The value of the clamping resistor 17 is small compared with the value of the discharging resistor R, and it thereby rapidly discharges the output coupling capacitor C1. Further, by clamping the circuit side of the output coupling capacitor C1 to ground, this capacitor is now discharged in parallel with the electrode capacitor C2, with the polarities of stored charges opposing, whereas during stimulating, they had been charged in series. In other words, during stimulation, the charges on the capacitor C1, C2 are cumulative, whereas during clamping, they are opposing so that some of the charge on capacitor C1 is used to discharge the electrode capacitor C2. Thus, the output coupling capacitor is rapidly discharged, and some of the charge on the output coupling capacitor is used to discharge the electrode capacitance. Compensation for the electrode capacitance is thus effected by passive circuit means, and it is considered an important aspect of the present invention that the discharge of the output cooling capacitor and electrode compensation be accomplished within a time period prior to that during which a stimulated heart signal is expected to occur because during this time, the signal input of the amplifier 20 is disconnected and, therefore, not able to sense the R wave. The time during which the output coupling capacitor C1 is clamped to ground (determined by the differentiator circuit 33) and the value of the clamping resistor 17 are related to the various parameters, such as the electrode material (which determines electrode capacitance), and the value of the output coupling capacitor so as to achieve this discharge in the required time. It is considered an advantage of the invention that proper compensation can be achieved by this method for a wide range of stimulation current levels. As indicated on line L6, after the clamp is removed, and during the time period for verifying capture (18 milliseconds to 110 milliseconds) as indicated by the dashed portion, there is a residual charge resulting in voltage level 42, but the rate of change of voltage is very small compared to the rate of change of voltage that would otherwise occur if there were no clamping. The slight offset voltage 42 is a function of system parameters; and it is accounted for when the amplifier is reconnected.
The output of the IWEN generator 27 is also fed to a second differentiator circuit 28, the output of which is connected to the gate of switch D. The time constant of the differentiator circuit 28 is longer than the longest time constant for the differentiator 33, but less than the duration of the IWEN signal so that the signal input 18 of the amplifier 20 may be disconnected during stimulation and clamping, but reconnected to the heart electrode prior to removal of amplifier restraint, to be discussed presently. This is illustrated in lines L4 and L5 which show respectively the differentiated IWEN* signal when diminishes until it reaches the previously described threshold 41, during which time the switch D is in a non-conducting state.
Referring now to lines L12 and L13 of FIG. 2, the SRWI signal causes switch F to become non-conducting from the beginning of a stimulating pulse until the time period for capture verification has ended, after which time switch F becomes conducting to enable the output coupling capacitor C1 to completely discharge. The SRWI* signal, as mentioned, is fed to switch E to change the gain of the amplifier 20; see lines L16 and L17 of FIG. 2.
Turning now to the circuitry which restrains the amplifier 20, the IWEN* signal is repeated beneath line L13 as line L13A of FIG. 2. This signal also causes switches B and C to conduct from a time beginning with the initiation of a stimulating pulse until the beginning of the actual sensing period (18 milliseconds after the initiation of a stimulating pulse).
When switches B and C are conducting, the signal input 18 and reference input 21 of the amplifier 20 are connected together. Thus, insofar as any signal at the heart electrode is concerned, the amplifier is changed from a differential mode of operation to a common mode of operation. Because amplification is much greater in the differential mode of amplification (gain of the amplifier being unity in the common mode), signals of large magnitude during this period do not overdrive the amplifier. Further, the signal input 18 and the reference input 21 of the amplifier 20 are connected to a reference voltage VREF. This voltage provides a reference to which the residual voltage on the output coupling capacitor is restored after the clamp is removed (see voltage 42 on line L6 of FIG. 2). The residual voltage must be prevented from appearing an a signal at the amplifier 20 because this would overload the amplifier. The amount of residual voltage depends upon the electrode material, and referring to line L6, it may be relatively small for a platinum electrode or it may be relatively large for an Elgiloy electrode, the two most commonly used materials. Both amplifier inputs 18 and 19 are directly connected to VREF (switches B and C are closed) at the time the amplifier is reconnected to the output coupling capacitor (switch D becomes conducting). Thus, when switch D conducts, the amplifier input coupling C3 charges to a voltage necessary to offset any residual voltage on the output coupling capacitor C1, and the amplifier is prevented from responding to any such residual voltage.
To summarize the operation and timing of compensation using a single electrode, immediately after the stimulating pulse terminates, switch A conducts to clamp the circuit side of the output coupling capacitor C1 through the resistor 17 to ground. At the same time, capacitor C1 has a charge which has an opposing polarity to the charge on the electrode capacitance C2 during clamping. Thus, the charge on capacitor C1 is used to partially discharge or neutralize the charge on the electrode capacitance during clamping.
Clamping ends at time T3 in FIG. 2--well before the end of the IWEN* period and before, it will be observed, the amplifier is reconnected when switch D closes at time T4. Between time T4 and the end of the IWEN period, time T5, the amplifier input coupling capacitor C3 is charged to a voltage sufficient to offset any residual voltage on the output coupling capacitor C1, such as that represented by the offset voltage 42 on line L6 of FIG. 2. This occurs while the amplifier inputs are connected in a common mode and they are both connected to the reference voltage source. Hence, the amplifier does not "see" or respond to any of the abrupt voltage changes that may be occurring due to the switching of switches A and D. Finally, after the input coupling capacitor C3 is sufficiently charged to offset any residual voltage on the output coupling capacitor C1, amplifier restraint is removed by causing switches B and C to become non-conducting. All of this occurs within 18 milliseconds of initiation of a stimulating pulse, and prior to the time during which a stimulated heart signal is detected, which would verify capture.
Referring now to FIG. 3, there is shown a conventional oscillator circuit including transistors 50 and 51 connected in cascade, the base of transistor 50 being connected to the collector of a transistor 51. Capacitors 53, 54 are connected between ground and the emitter of transistor 51, and an RC time constant is determined by the value of the capacitance and the combined resistance of a fixed resistor 55 to a variable resistor 56. In operation, when the transistors 50, 51 conduct, they discharge the capacitors so that the output voltage goes toward ground. A very fast leading edge is produced by the regenerative effect caused by transistors 50, 51. After the capacitors have discharged, the transistors 50, 51 become non-conducting, and the output signal goes negative as determined by the RC time constant. The repetition rate of the pulses may be varied by adjusting the resistor 56. Transistor 50A is connected as a diode, and together with its associated biasing resistors acts to keep the base of transistor 51 at a constant voltage. Transistor 52 is used as a means of turning off the oscillator after it has been reset, if desired, so that during the reset cycle, if transistor 52 is caused to conduct, the base of emitter 50 is clamped to the negative supply, and the oscillator will reset.
Turning now to FIG. 4, a circuit schematic is shown for the monostable circuit 11 and current driver 12. The monostable circuit 11 acts as a buffer amplifier for the output signal taken from node 57 of the oscillator circuit of FIG. 3, and it includes transistors 59, 60, 61 and 62. The output of transistor 59 is coupled to the cascaded transistors 60, 61, and the output signal is taken from the junction between the collector of transistor 60 and a coupling capacitor 60A connected to the base of transistor 61. This monostable circuit is also of conventional design. When transistor 60 conducts, a voltage is fed through capacitor 60A to turn on transistor 61. When base current stops flowing through transistor 61 (the capacitor discharges) the circuit turns off. The output signal of the monostable circuit 11 is connected to the base of a transistor 64. The signal OW* is taken from the collector of transistor 54.
The remaining circuitry of FIG. 4 forms the constant current driver 12, and this circuit is considered to be very advantageous in use because the output signal remains constant in current over a very wide range of source voltages and it represents an improvement over previous designs in this respect. It will be appreciated that this characteristic is especially important in an implanted cardiac pacer. Further, as is also desirable in a cardiac pacer, the circuit has the characteristic of a low output saturation voltage even though the output voltage swing is very nearly equal to the voltage of the power source. This permits better use of the available voltage.
The driver circuit includes a first transistor 66 which is connected in series with diodes 67, 68 and a resistor 69 in a conventional manner to form a constant current source. The diodes 67, 68 are forward biased, and the emitter-base junction of transistor 66 is also forward biased. Hence, the voltage across resistor 69 is constant, and the collector current remains constant. The base current is kept constant by a first current mirror comprising a transistor 70, resistor 70A, and a transistor 71. Transistor 71 is used as a common diode in a second current mirror which includes transistor 72. The output of the circuit is taken from the collector of transistor 72, the capacitors 73 forming the output coupling capacitor to the heart electrode. The terminal 74 is connected directly to switches A and D, as disclosed above. The collector of transistor 72 is also connected through a resistor 75 to the input of the SRWI generator (FIG. 5, to be discussed).
In operation, the current mirror formed by the transistor 70 and diode 71 act as a feedback circuit to establish a constant current in the diodes 67, 68. A resistor 77 is present from the base of transistor 66 to the negative supply, but it has a large value, and even with its presence, as indicated, the feedback current mirror acts to stabilize the operating current of the constant current source. The current gain in the feedback loop consisting of transistors 69 and 70 is less than one to insure stability. With this circuit, namely, by using a current mirror to establish a constant current in the diodes 67, 68 in the base circuit of transistor 66, the operating voltage of the diodes is rendered substantially independent of fluctuation in the supply voltage. With a constant voltage established at the base of the transistor 66, a constant voltage is established across the resistor 69, and the output current is substantially independent of supply voltage.
The second current mirror, including transistor 72, forms a trans-conductance amplifier with a gain of approximately twenty since resistor 80 (which may be omitted for even higher gain) is much smaller than resistor 70A. This current mirror is driven by the constant current source just described. A variable resistor 81 is included in circuit with the transistor 71, and it is adjustable for adjusting the level of output current. With the output current adjusted on the order of six milliamps, the transistor 72 is capable of delivering a voltage in excess of 5.32 volts from a 5.52 volt battery system. This represents a voltage efficiency of 96.37 percent. Thus, the output voltage capable of being delivered by this system is within 0.2 volts of the terminal voltage, whereas existing circuits can deliver a voltage up to approximately 0.6 volts less than the supply voltage.
Turning now to FIG. 5, the SRWI signal generator is a conventional monostable circuit including transistors 87, 88 which receives its input from the output terminal 85 of FIG. 4. The signal generated at the collector of transistor 88 is the SRWI signal, and it is this signal, as indicated previously, that is fed to the base of transistor F, which is also seen in FIG. 5. The collector of transistor F, as indicated, is connected to the charging resistor R of FIG. 1. The monostable circuit, as indicated, generates a positive-going pulse of a duration of 110 milliseconds which is used to disconnect the charging resistor R (by causing switch F to become non-conducting) and to change the gain of the amplifier 20 (by causing switch E to open via inverter 16A).
Turning now to FIG. 6, there is shown a monostable circuit for generating the IWEN signal. The circuit includes transistors 90, 91 which form the monostable circuit; and a transistor 92 which provides a buffer amplifier. The IWEN signal is taken from the collector of transistor 92. The monostable circuit generates a pulse having a duration of 18 milliseconds which is determined by the time constant of the resistor 93 and capacitor 94. The collector of transistor 92 is connected via terminal 93 to the inverter circuit 29 (FIGS. 1 and 7). In FIG. 7, the inverter 29 is shown as a NAND gate connected as an inverter because it is an element of an integrated circuit 95. That is, the integrated circuit includes two additional NAND gates 96 and 97. The output of the inverter 29 is the IWEN* signal, and it is coupled to one input of the NAND gate 96 and to the gate terminals of CMOS switches B and C (see the lower left-hand corner of FIG. 7), which have already been described.
The SRWI signal is coupled to the base of a transistor 99 which acts as an inverter, and the signal SRWI* is taken from the collector of the transistor 99, and fed to the gate lead of switch E (see the lower central portion of FIG. 7).
The OW* signal is fed to the second input of the NAND gate 96, and the output of gate 96 is coupled to an input of NAND gate 97, which is connected as an inverter circuit. Hence, the output signal of NAND gate 97 is the signal IWEN*.OW*. Thus, the NAND gates 96, 97 of FIG. 7 provide the gate 30 of FIG. 1; and the output signal thereof is coupled to the wiper arm of the switch 35, and thence to the differentiator 33, described above. The output of differentiator 33, as indicated, is connected to the gate of switch A, the operation and function of which has already been described.
Still referring to FIG. 7, the IWEN signal is also connected to a capacitor 100 and a resistor 101 which forms the differentiator circuit 28 of FIG. 1. The output signal of the differentiator circuit 21 is connected to the gate lead of switch D, which disconnects the amplifier 20 from the output coupling capacitor, as shown. In a preferred embodiment, the amplifier 20 comprises two instrumentation-type differential amplifiers 105 and 106. The positive input of amplifier 105 comprises the signal input 18, and the positive input of amplifier 106 comprises the reference input 21, the capacitors C3 and C4 being as shown in FIG. 7. Connected between the negative input terminals of amplifiers 105, 106 is the switch E, which, when conducting, shorts out resistors 107, 108 to increase the gain of the amplifier.
The positive input of amplifier 105 is connected to the switch C, as shown, and to a resistor 115. Similarly, the positive input of amplifier 106 is connected to the switch B, and to a resistor 116. The switches B and C short out the resistors 116, 115, when they are in a conducting state, to change the operation of the amplifier from the normal differential mode to a common mode, as explained above.
As mentioned, the gain of the amplifier is determined by the values of resistors 107, 108 and 109 when switch E is non-conducting. When a stimulating pulse has been transmitted to the heart, the gain of the amplifier is reduced by opening switch E and no longer shorting out resistors 107, 108. The values of these various resistors will be determined by the extent to which it is desired to reduce gain during sensing of the stimulated R wave.
Connected between the negative terminals of the amplifiers 105, 106 is a differentiator 110. The function of the differentiator circuit 110 is also important in enhancing the noise immunity of the sense amplifier. Referring to FIG. 2, and particularly, to line L6, after switch A has opened, the voltage at the coupling capacitor will drift slightly negatively, as illustrated by the dashed line. This negative drift is offset by the differentiator 110 which causes a slight offset in the reference voltages in the amplifiers 106 and 107 in a direction opposite to the drift exhibited in line L6.
To summarize the timing of the operation of the amplifier 20, there is a first period (0-18 Msec.) when the input to the amplifier is disconnected from the output coupling capacitor. Following this period (18 Msec.-110 Msec.), the amplifier is connected to sense a stimulated heart signal, but its gain is reduced. This has been referred to as the period during which a stimulated heart signal is expected to occur.
Having thus described in detail one embodiment of the invention, persons skilled in the art will be able to modify certain parts of the system which have been illustrated and to substitute equivalent circuitry for that disclosed while continuing to practice the principle of the invention; and it is, therefore, intended that all such modifications and substitutions be covered as they are embraced within the spirit and scope of the appended claims.
|Cited Patent
|Filing date
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|11 Jan 1967
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|5 Nov 1998
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|5 Nov 1998
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|U.S. Classification
|607/13, 607/28
|International Classification
|Cooperative Classification
|European Classification
|2 Mar 1987
Owner name: BAXTER TRAVENOL LABORATORIES, INC. A CORP. OF DE
Free format text: MERGER;ASSIGNOR:AMERICAN HOSPITAL SUPPLY CORPORATION INTO;REEL/FRAME:004760/0345
Effective date: 19870126
|30 Jan 1990
Owner name: BAXTER INTERNATIONAL INC.
Free format text: CHANGE OF NAME;ASSIGNOR:BAXTER TRAVENOL LABORATORIES, INC., A CORP. OF DE;REEL/FRAME:005050/0870
Effective date: 19880518


text:
Chuck Baggett - 07/14/2013
Heb. 8:13-9:28
God loves a hungry child . . . Nay, I say it is more glory to God, to knock a while at a locked door, than if the door were open to us night and day. We see not that hunger is often better for us than a full stomach. ~ Samuel Rutherford

subset: commoncrawl


text:
When Oklahoma State big man Michael Cobbins went down, it dealt a blow to an already thin Oklahoma State frontcourt. Without the big man, the Cowboys are forced to rely on Sophomore Kamari Murphy to do much of the dirty work down low, as he's the only Cowboy taller than 6'7".
Offensively, Murphy could very well be up to the task: he is shooting 64% on the year and has a pretty good 12% offensive rebounding rate. His offensive numbers are even better than Cobbins', but with Murphy playing under 20 minutes per game, it remains to be seen whether he'll be able to adjust to playing many more minutes.
The bigger problem is defensively. While Murphy's block rate is comparable to Cobbins's (6.3% to 7.5%), the Cowboys were allowing teams to shoot under 50% at the rim. Oklahoma State's defense allowed over a point per possession for the 5th time this year in Cobbins's first game out with an injury.
The impact of Cobbins and Murphy down low has been immense. Without Cobbins, they'll have to rely on Freshman Leyton Hammonds for depth. Hammonds doesn't really look like a rim protector and it will likely cause the Cowboys' block percentage to fall around 5%. That is huge for a number of reasons. First, it will allow their opponents to shoot close to 5% higher at the rim, which will in turn raise their eFG by as much as 5%. The other impact is offenses won't fear attacking the paint against OSU, and it will result in more attempts at the rim (and Oklahoma State is already allowing a lot of attempts at the rim). It will also put more pressure on the guards to keep ballhandlers from getting into the paint and, barring superstar calls, will increase their fouls as well.
Michael Cobbins wasn't playing a lot, and he wasn't posting superstar offensive numbers. But his defensive work at the rim and the resulting lack of depth make his loss a huge one for Oklahoma State's Big 12 and NCAA tournament hopes.


text:
freelance web app developer and web designer
Croatia - Tests: 4 - Portfolio: 4
PHP, SQL, Javascript, jQuery => ARE NOT foreign languages to me. Knowing and using HTML, CSS with no problems. I have done projects with CakePHP framework, Wordpress, Joomla, Prestashop, Magento. I have a bachelor's degree in physics and computer science, almost done with masters degree :-) Currently doing projects based on CakePHP framework and exploring PHP in general and MongoDB.


text:
Welcome to the Muppet Central Forum!
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The Muppets "Hostile Makeover"
From Miss Piggy and Josh Groban to Fozzie and Jay Leno, discuss all aspects of "The Muppets" latest episode.
In Their Own Words: Jim Henson
Discuss one of the best Jim Henson documentaires ever. Featuring new interviews from the Henson Family, Frank Oz, Dave Goelz, Carroll Spinney, Fran Brill and more. Miss the show? Order the DVD.
MINDstyle to make 25th Ann. Fraggle figures!
Discussion in 'Fraggle Rock' started by Cosmic Cow, Feb 5, 2008.


text:
If you're on FB and want to join a secret group (nobody can see that you're in it jor any of your posts but members of the group), send me a message on bbc - tell me your FB email or full name on fb and I'll friend you. Then I can add you to the group.
See you here and there. - rorenoco


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Latest tweets from @jackattack1992
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text:
The researchers found this to be the case all over the world in different cultures. In other words, young sluts are everywhere, people! Do with this information what you will. This was surprising to the scientists who believed that only poor people have no moral compass.
"It's remarkable to find these patterns in the students in the study," said Daniel Kruger, research scientist at the University of Michigan School of Public Health. "We have seen many examples where people do this out of necessity, but we still see these tendencies in people who are already well provided for."
(For some reason, the study refers to sexual favors as "nuptial gifts." I like that because it sounds like a wedding gift. The next time a friend of mine is getting married, I'm going to ask them if they'd like a "nuptial gift." Then when they say yes, I'll sit on their face naked. It'll be hilarious!)


text:
All hotels in Madrid, Spain
1 room, 2 adults
Calle Hortaleza 7, Madrid, Madrid, 28013, Spain, 1-877-214-4288
Residencia Lemus - Madrid
Lowest price$21
available on 10/15/15
City-center hotel within walking distance of Puerta del Sol
- Free WiFi
- Airport within 5 mi/8 km: Madrid (XOC-Atocha Train Station)
Residencia Lemus is a budget city center Madrid family-friendly hotel in Gran Via within a 10-minute walk of Fuencarral Market and Puerta del Sol. Staying here, you'll also be within 15 minutes of Plaza Mayor and Prado Museum.
This hotel offers free WiFi, an elevator (lift) and laundry facilities. Staff are available to provide tour/ticket assistance.
This hotel offers free WiFi, an elevator (lift) and laundry facilities. Staff are available to provide tour/ticket assistance.
Main amenities
- 13 guestrooms
- Room service
- Daily housekeeping
- Front desk safe
- Self-serve laundry
- Luggage storage
- Tour/ticket assistance
What's around
- In Gran Via
- Puerta del Sol (0.4 mi / 0.6 km)
- Thyssen-Bornemisza Museum (0.6 mi / 0.9 km)
- Plaza Mayor (0.6 mi / 1 km)
Very cheap and well placed in central Madrid, but old and noisy. Only for people who…
It was decent, good for the price.great location!
TripAdvisor Traveller Rating: 2.5
From 62 reviews
Enter dates to check prices
Hotel Info: 1-877-214-4288from $21
- Double Room, Private Bathroom
- Double Room, Shared Bathroom
- Single Room, Shared Bathroom
- Triple Room, Private Bathroom
- Quadruple Room, Private Bathroom
- Triple Room, Shared Bathroom
- Quadruple Room, Shared Bathroom
Also popular with travelers from the USA
At a glance
Key facts
Hotel size
- This hotel has 13 rooms
- This hotel is arranged over 1 floor
- Check-in time 4:00 PM-11:30 PM
- Check-out time is 11 AM
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
Travelling with others
- No pets or service animals allowed
Extra people
- Roll-away beds available, charges may apply*
- Free WiFi in public areas
- Free WiFi in rooms
- No parking
In the hotel
Food and drink
- Room service
- Tours/ticket assistance
- Laundry facilities
- Luggage storage
- Number of buildings/towers - 1
- Elevator/lift
- Safe-deposit box at front desk
In the room
Freshen up
- Hair dryer
Be entertained
- Plasma TV
Stay connected
- Free WiFi
- Daily housekeeping
- In-room safe
Residencia Lemus - Madrid's small print
Cash transactions at this property cannot exceed EUR 2500, due to national regulations. For further details, please contact the property using information in the booking confirmation.
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.


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Is this restaurant family-friendly?
Does this restaurant serve Asian food?
Is it known for dessert?
Does this restaurant accept reservations?
Is this restaurant good for dinner?
Does this restaurant serve Chinese food?
Is this restaurant good for lunch?
Does this restaurant serve Indian food?
Does this restaurant serve Malaysian food?
Is this restaurant good for breakfast?
Thanks for helping!
This is a favorite neighborhood restaurant. There is something on this menu for everybody. Service is always friendly, offering suggestions or explanations if you are uncertain or unfamiliar. The food is quite tasty and portions are generous.
I have a new profound love for Malaysian Food! Granted this is the only place where I have eaten Malaysian food so I am certainly no expert and can't tell if this place is pretty authentic; but I can definitely say it's tasty!!!
I have been here about 4 times already and usually I always make an effort to try...
We had their seafood lemongrass soup, chicken wings, Belacan fried rice, daging kecap manis (beef) and sambal tumis shrimp. Everything was delicious! The beef and shrimp were very spicy but you can ask them to lessen the spice if you wish.
The Malaysian food is here consistently delicious. You would be hard pressed to find better mango chicken. Belacan pronounced 'Bell lot chen' is a style in which the food is prepared. The eggplant belacan is one of our favorites. Daging Kecap Manis is another one of our favorites, a must try.
Its subtitled a Malyasian Bistro which is more appropriate four this nice restaurant that served outstanding fare!
We really annoyed the Crab Rangoon appetizer. Other items we tried were the Coconut Shrimp, Chow Mein, Ayam Masek Merah, Kung Pao Chicken and the Honey Sesame Beef. All were very good and can be recommended. Entrees were between $9.00 and $14.00.
Went for dinner with friends as the food is supposedly really good here.
Ordered for some Fresh Coconut and the water was really sweet and refreshing.
Tried the Roti Canai and Chicken Wings for starters and the Roti Canai was outstanding.
For the main course, we tried the Fish Curry with Rice and Nasi Goreng and Spicy Shrimp Fried Rice....
As our week-long family vacation in Southern California drew to a close, we wanted to eat something that we couldn't back home. A quick online search led us to Belacan Grill.
What an amazing, wonderful, tasty delight this was!! The best way to describe Malaysian food is that it is a cross of Thai and Indian -- but...
Recently refurbished, this eatery continues to serve a wide and representative selection of Malaysian-Asian dishes. Conveniently located off the 55 Freeway with easy parking.... good for a quick lunch or more leisurely dinner. Menu comprises of both Chinese and Malaysian selections. For starters Roti Canai or Curry Puffs are good; followed by a variety of soups ( lemon grass and...
I happen to like Curry Mei. Theirs is to die for!!! All of their food is well prepared and graciously served! They have several meeting areas which I've used either for intimate meetings or groups upwards of 60 people. Bee is one of the most gracious hostesses you can find! Just so you will know, Malaysian food is similar to...
I have visited this restaurant numerous times, but this time was extremely disappointing. Even though the restaurant was not very occupied (maybe a quarter of tables?) I was seated at a table that did not appear to have been cleaned (water/liquid and crumbs still on table and seats) and the hostess did not respond when I mentioned this observation. I...
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Posts Tagged 'CSI Ratings'
January 13th, 2014 at 11:18 am
Live+7 DVR Ratings: '20/20' & 'Nikita' Tie for 18-49 Ratings Increase, While 'Nikita' Tops Percentage Gains & '20/20' Leads Viewership Increase in Week 14
During the fourteenth week of the 2013-2014 season (December 23-29), 20/20 & Nikita topped the rankings for the week's DVR viewing[Read-More]
January 9th, 2014 at 8:39 am
TV Ratings Wednesday: Solid Start for 'Chicago PD', 'Revolution', 'Law & Order: SVU' & 'The Middle' Return Up, 'People's Choice Awards' Down
CBS was number one in adults 18-49 and with total viewers.[Read-More]
January 7th, 2014 at 8:18 am
TV Ratings Broadcast Top 25: 'NFL Playoffs' Tops Week 15 With Adults 18-49 and Total Viewers
Broadcast top 25 rankings for the week.[Read-More]
January 6th, 2014 at 2:05 pm
Wednesday Final Ratings: 'The Goldbergs' Repeat Adjusted Down
Wednesday's final ratings.[Read-More]
January 6th, 2014 at 9:29 am
Live+7 DVR Ratings: 'How I Met Your Mother' Tops Adults 18-49, 'Almost Human' & 'Hawaii Five-0' Lead Percentage Increase, 'Person of Interest' Biggest Viewership Gains in Week 13
During the thirteenth week of the 2013-2014 season (December 16-22), How I Met Your Mother topped the rankings for the week's[Read-More]
January 2nd, 2014 at 8:37 am
TV Ratings Wednesday: Repeats of 'Hawaii Five-0', 'Criminal Minds' and 'CSI' Lead CBS to Nightly Win
CBS and Univision tied for number one in adults 18-49, but CBS won with total viewers.[Read-More]
December 31st, 2013 at 7:56 am
TV Ratings Broadcast Top 25: 'Sunday Night Football' Tops Week 14 With Adults 18-49 and Total Viewers
Broadcast top 25 rankings for the week.[Read-More]
December 30th, 2013 at 10:37 am
Live+7 DVR Ratings: 'The Big Bang Theory' Tops Adults 18-49 & Viewership Gains, 'Grimm' Leads Percentage Increase in Week 12
During the eleventh week of the 2013-2014 season December 2-December 8), The Big Bang Theory topped the rankings for the week's[Read-More]


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Ghost Loft
~ Person
Danny Choi, better known by his stage name Ghost Loft, is an American musician based in Los Angeles.
The artist's genres include Electronic and R&B. Ghost Loft has remixed tracks by artists such as Two Door Cinema Club and The Neighbourhood.
Showing official release groups by this artist. Show all release groups instead, or show various artists release groups.


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Capital Markets
Company Overview of Westwind Investors, LP
Executive Profile
Henry S. Burdick
Strategic Partner, Westwind Investors, LP
|Total Calculated Compensation
|This person is connected to 2 Board Members in 2 different organizations across 6 different industries.
See Board Relationships
Mr. Henry S. Burdick is a Partner in La Quinta Golf Properties. Mr. Burdick is a Partner at B&L Properties , which he founded in 1975. Mr. Burdick is a Strategic Partner at Westwind Investors, LP. He was previously a Partner at Westwind Investors. He has been an Investment Partner and Close Advisor to Westwind's Principals' since 1996, during which time he has collaborated on some of its Principals' most legacy investments. Mr. Burdick served as Executive Officer of ...
Corporate Headquarters
917 Tahoe BoulevardPhone: 775-832-5527
Incline Village, Nevada 89451
United States
Fax: --
Board Members Memberships
Vice Chairman and Member of Product Committee
California State University, Northridge
Other Affiliations
Annual CompensationThere is no Annual Compensation data available.
Stocks OptionsThere is no Stock Options data available.
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The third single cask release from Goa's John Distilleries, showcasing their single malt whisky with this bourbon-matured dram. Expect fruit and cream, with a touch of spice.
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The Whisky Exchange is the registered trademark of Speciality Drinks Limited.
Registered in England and Wales (Company No. 4449145). Registered Office: Elixir House, Whitby Avenue, Park Royal, London NW10 7SF, UK.


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Presbyterian/St. Luke's Medical Center
Sponsored By
Woman Meets Life Savers After Going Into Cardiac ArrestA woman who was saved when she went into cardiac arrest met the people who kept her alive on Thursday.
Denver Hospital First In Region To Obtain Latest-Generation Da Vinci RobotA Denver hospital says it is only a few months away from using their impressive new robotic system in surgeries.
Colorado Hospitals Finalizing Ebola ProtocolsColorado hospitals are training staff to handle possible Ebola patients, but setting up the protocols is still a work in progress.
Bionic Ankles Provide New Spring In The Step Of AmputeesA veteran who lost both his legs in the war in Afghanistan is now fitted with bionic ankles, new technology that will help him walk better.
Colorado West Nile Death Traced To Cleared BloodA Colorado West Nile death has been traced to a transfusion of blood that was screened for the virus, federal health officials reported Thursday.
Tiny Babies Make Move To Brand New Intensive Care UnitThe tiniest babies made a big move on Wednesday as they were wheeled from Presbyterian/St. Luke's Medical Center to the brand new intensive care unit at the Rocky Mountain Hospital for Children.
Presbyterian/St. Luke's Implements Precautions To Stop Spread Of MRSAThe Hospital Corporation of America recently released information on a national study to prevent methicillin-resistant staphylococcus aureus (MRSA) in hospitals.
'Dog Days' Ease Anxiety For Hospitalized Pregnant WomenCBS4 Health Specialist Kathy Walsh found a Denver hospital making sure moms-to-be get to see their best friends on four legs.
Denver Doctor Helps Cowboys Keep Their Fingers In TactColoradans like to say the frigid temperatures lately are "Stock Show weather." The competition is well under way at the National Western Complex, and all that riding and roping can be tough on a cowboy's body.
Colorado Surgeon, Students Design Permanent Artificial LegA Denver surgeon has teamed up with college students to improve the lives of amputees. They are designing a permanent artificial leg.
Hospital Says Colorado Girl With Plague Is RecoveringOfficials say a 7-year-old Colorado girl diagnosed with bubonic plague has been moved out of intensive care and is recovering.
Group Rallies To Raise Awarness About C-Section RateIt's something many mothers and doctors make the decision to do, but one group held a rally Monday saying scheduled cesarean sections are happening too much and they may not be the best thing for the baby.


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"Dear Jon, Student – Due to illness will be commiting suicide early January If a student with pretty much no estate other than a tv and an xbox was to give said "tv and xbox" away as christmas presents. Then, took out £500-£10,000+ from these various payday loan companies at the maximum amount and time period to pay back (So ... Read More »
I Am Disabled Due to a Hyper Virus Causing Blindness in One Eye. – Shayna
"Dear Steve, I have a history of hyper's virus of both my eyes. My riight eye is totally blindness,and left eye is 20/20 vison. Over the 14 years, my retina doctor Dr. Jacobson It taken me off medication and every time I come off the medication my hyper's virus returns. I am labeled disable and receive SSI and medicaid. I ... Read More »
Can You Show Me How to Settle My Sallie Mae Student Loan Debt I Cosigned For? – Alexandra
"Dear Steve, I am a 76 year old retired professor. I was not educated in this country and my daughter took out all her own loans for her education in the nineties. So in the last five years with out realizing what I was getting into I co-signed for an educational loans for one of my mentees to get an ... Read More »
I Need a Debt Settlement Letter I Can Use for My Sallie Mae Student Loans. – Mary
"Dear Steve, settlement offer from collection agency Allied One I want some advice on getting settlement successfully with agency, the loans were originally from Sallie Mae. Hi, I have massive student loan debt through Sallie Mae. With interest and collections fees it has soared from 40k to 80k. I have not paid on the loans and they went into default, ... Read More »
I Got Out of the Military, Went to Wyotech, and Now Want to Kill Myself Over Student Loans. – Dustin
"Dear Steve, I guess it all started after I got out of the military. I knew I needed to go to school in some capacity to hold a decent paying job. I decided life as an automotive technician would be great, I knew lots of relatives that had a modest life with such a career, which is all I wanted. ... Read More »
I Co-Signed for a Sallie Mae Student Loan for an Ex-Boyfriend. – Lisa
"Dear Steve, When I was 18 I co-signed a Sallie Mae loan for my boyfriend. I am now 29 and we broke up about 2 years ago. He has fallen on hard times and stopped paying his loans and they are coming after me for the money. It is damaging my credit and I may need to move back in ... Read More »
I Recently Settled the Balance Due on My Private Student Loans. – Viet
"Dear Steve, Hi Steve, I just recently settled on my private student loan for less than the total amount that I owe simply because I didn't want to risk getting sued. The total amount was about $25,000.00. I currently have 4 credit cards, a car loan and 1 personal loan. 3 of my credit cards and personal loan are fairly ... Read More »
Student Loan Servicers Suck
by Marian Wang ProPublica, The parallels between the mortgage market and the student loan industry have been frequently noted. Both involve big borrowing and have a history of lax underwriting by lenders. But the two are also strikingly similar in another way: When it comes to both mortgages and student debt, the servicers, or companies that handle loan payments, sometimes ... Read More »
Sallie Mae and American Education Services Generate Most Student Loan Complaints
A report out today from the Consumer Financial Protection Bureau outline the major problems facing American's today when it comes to dealing with private student loans. Not surprisingly, Sallie Mae tops the list of most complained about student loan company, with 46 percent of all private student loan complaints. American Education Services (PHEAA) was a distant second. And while those ... Read More »
Can I Just Pay Sallie Mae What I Can Afford To? – Kate
"Dear Steve, I will not lament about Sallie Mae; I think we all know how crooked they are. My question is: I owe around 58k and have recently applied for Income Repayment Sensitivity. They have responded with letting me know my payments will be just under 15% of my disposable income. This is too high of a payment. My main ... Read More »
Is It True That Sallie Mae Loans Have to be Forgiven After 10 Years? – Lynn
"Dear Steve, I'm trying to help out my son and his wife. They initially borrowed 64k from Sallie Mae for Student Loans. I believe it was a priviate loan. Through eight years and a couple of consolidations; they are still in trouble paying back the loan. They have tried to keep up on payments but haven't always. They are seriously ... Read More »
Can I Move to Australia and Get Married if I Have a Delinquent Private Student Loan? – Mike
"Dear Steve, private student loan debit took out – and never went to school for 2 reasons. One had major issues with the school it's self. I got a private student loan (thanks to Grandpa co-sign) which was to cover school, room/board, and all other related cost. Bags packed ready to go on the road trip with the parents. Check ... Read More »
I Went to Kartherine Gibbs School and They Suddenly Closed. How Can I Repay My Student Loan? – Christina
"Dear Steve, In 2006 I made a loan with Sallie Mae to go to Kartherine Gibbs School in Norristown, PA. Around April 2007 my father got very ill and I had to discontinue with my education to help my father. My father's wish was to die in his native land, so we packed up and moved to Puerto Rico. Once ... Read More »
DeVry Called Me and Told Me I Could Qualify for Student Loans. – Maria
"Dear Steve, less than a yr ago i ask for online school information…devry called and offer me financial aid together with my career… they told me since i wasn't with my parents no more that i could qualify for students loan…i started taking classes one by one…than on my first classes my grades drop because wasn't doing my homework i ... Read More »
I Attended the International Academy of Design & Technology IADT in Chicago Won't Release My Transcript. – Sam
"Dear Steve, I attended IADT in Chicago Fall 1999. I met with an academic adviser who I soon learned was a salesperson not an adviser, I expressed my concern over the high tuition costs and was told that I need to pay an enrollment fee and that the rest would be covered by financial aid and loans. I did what ... Read More »


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Accepts Credit Cards
Price Point
$ $ - Cheap Eats (Under $10)
$$ - Moderate ($11-$25)
$$$ - Expensive ($25-$50)
$$$$ - Very Pricey (Over $50)
Good for Kids
Outdoor Seats
Millard Roadhouse ($$)
Breakfast, Brunch, Diner
Leo's Diner ($)
Diner, American, Burgers, Sandwiches, Soups, Salads
Scotty's Go-Go Grill ($)
American, Breakfast, Brunch, Diner
Johnny Sortino's Pizza Parlor ($$)
Pizza, Subs, Sandwiches
Is this your restaurant? Click to add your description here.
Accepts Credit Cards
Price Point
$ $ - Cheap Eats (Under $10)
$$ - Moderate ($11-$25)
$$$ - Expensive ($25-$50)
$$$$ - Very Pricey (Over $50)
Good for Kids
Outdoor Seats
08/16/2009 - virginia
staff with a " could care less" attitude..took 10 -15 minutes to even get our DRINKS to the table..and they got the order wrong 45 min after ordering we finally received our breakfast's..no apology, they didn't care! Our food was lukewarm and had to wave our arms to get attention to get refills on our drinks! SUBSTANDARD, downright offensive..disgusted, that we actually had to PAY money to get treated to the worst service EVER. SAVE your money...head somewhere (ANYWHERE) else.
01/20/2009 -
I went there for a late dinner, in oct. my husband and I were the last patrons to leave the establishment, as they locked the door behind us. I accidently left my purse there. One of the employees took my purse, went to a gas station used my bankcard to fill her tank up with gas, then over the course of the last few months has used my checks at various stores in Omaha. I spoke with general manager about this, the day after mypurse was stolen, he acted like I was lieing. If you want to deal with having your hard earned money stolen and constantly having tocheck your credit report for fraduulent charges, this is the place you want to have your meals.<br />
We have been coming to Jerzees for 6 years. We have never had great service (except when Silvia was our waitress.) but kept coming back because we lik... read more2. Big Fred's Pizza Garden (Omaha, NE)
Worst pizza I've ever had not to mention we got there and ordered there was nobody else in the restaurant for lunch yet except us took over 30 min to ... read more3. Fat Shack BBQ (Omaha, NE)
I ate here on July 3rd, 2015. I ordered potato salad, baked beans. The potato salad was horrible, they do not know how to make potato salad, the baked... read more4. Brick Oven Pizza (Omaha, NE)
My first time eating here was Saturday 6/6/15 and the pizza and wings were good.... read more5. Chopsticks House (Omaha, NE)
Loved the food amazing place and prices ... read more
Omaha Restaurant Guide: See Menus, Ratings and Reviews for Restaurants in Omaha and Nebraska


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Photo Gallery
Malaysia widens search for missing plane
1 of 1
A crew member of a Royal Malaysian Air Force CN-235 aircraft looks out the window during a search and rescue operation for the missing Malaysia Airlines plane over the Straits of Malacca, Thursday, March 13, 2014. Planes sent Thursday to check the spot where Chinese satellite images showed possible debris from the missing Malaysian jetliner found nothing, Malaysia's civil aviation chief said, deflating the latest lead in the six-day hunt. The hunt for the missing Malaysia Airlines flight 370 has been punctuated by false leads since it disappeared with 239 people aboard about an hour after leaving Kuala Lumpur for Beijing early Saturday. (AP Photo/Lai Seng Sin)
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Analysis: Shannon Elizabeth
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The coffee berry borer has become a huge pain in the thorax for the coffee industry since it can withstand huge doses of caffeine by burrowing into beans. So why didn't they call this thing the jitterbug?
These crop circle towels add a touch of alien beauty to any home, whether you believe spacecrafts have landed on Earth or not.
Tiny radio-frequency identification chips attached to bees will be paired with Intel Edison boards to monitor the bees' activities and help the fight against colony collapse disorder.
A new product called Go Cubes on Indiegogo promises portable, edible coffee in the form of gummies made out of real cold brew.
The geological features on dwarf planet Ceres are now named after agricultural gods and goddesses, while we're still waiting to hear about the sci-fi names chosen for features of Pluto's moon.
The free game is available now in Apple's App Store and the Google Play marketplace.
New Hyperlapse apps for Windows Phone, Windows and Android accelerate your video into a smooth, fast-paced version -- just like on Instagram.
Anyone can see the full-size version of your profile pic -- here's how to fix that.
Whether you're looking to reduce clutter or share fond memories online, here are three methods for digitizing your print photo collection.
Finally, a way to upload photos to Instagram from a Mac.