text:
|Publication number
|Publication type
|Application number
|Publication date
|Jul 8, 2003
|Filing date
|Jan 5, 2001
|Priority date
|Jan 7, 2000
|Fee status
|Also published as
|Publication number
|Scott C. Meyerson, Paul Alexandre Avan, Bela Buki
|Original Assignee
|Rice Creek Medical, Llc
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (32), Non-Patent Citations (2), Referenced by (104), Classifications (8), Legal Events (11)
|External Links: USPTO, USPTO Assignment, Espacenet
This application claims the benefit of U.S. provisional application No. 60/175,099, Jan. 7, 2000.
The present invention relates generally to intracranial pressure (ICP) monitoring. Specifically, the invention relates to a method and apparatus of non-invasively, without requiring a breach of the skin, skull, or dura, monitoring ICP. More specifically, the invention provides a method and apparatus for stimulating and interpreting predictable external effects of elevated ICP such as changes in cochlear impedance coupling to monitor ICP. In one embodiment, the system non-invasively and continuously monitors ICP by stimulating and interpreting predictable changes measured in the otoacoustic emission (OAE) signal of the patient.
Intracranial pressure is closely related to cerebral perfusion (blood flow in the brain). Elevated ICP reduces cerebral perfusion pressure (CPP), and if uncontrolled, results in vomiting, headaches, blurred vision, or loss of consciousness, escalating to permanent brain damage, and eventually a fatal hemorrhage at the base of the skull. Increased ICP is a medical/surgical emergency. Particular instances where it is desirable to monitor ICP are in traumatic brain injury (TBI) victims, stroke victims, hydrocephalus patients, and patients undergoing intracranial procedures, "shaken baby" syndrome, kidney dialysis, or artificial liver support. Current methods of monitoring ICP are typically invasive, expensive, and/or difficult to perform outside of a hospital setting.
Traumatic Brain Injury
An estimated 1.75 million TBI's occur annually (extrapolated from 1,540,000 TBI's in 1991) in the United States. The U.S. Department of Education, National Institute on Disability and Rehabilitation Research in conjunction with 17 TBI research hospitals around the U.S. have established a set of indicators for classification of TBI:
1) Documented loss of consciousness for an unspecified time;
2) Amnesia for the event. No recall of the actual trauma;
3) A Glasgow Coma Scale (GCS) score of less than 15 during the first 24 hours.
Of these indicators, amnesia assessment is a preferred indicator of TBI severity. Amnesia of one day is considered moderate, while one month of amnesia indicates severe TBI. Although amnesia is a good indicator of TBI severity and a reasonable predictor of long term outcomes, this slow evaluation method provides no help in emergency response to patient diagnosis or treatment.
The GCS is a TBI severity assessment system using subjective observations in three basic categories: eye opening (E), best motor response (M), and verbal response (V). A patient's GCS score is the sum of the patients E, B, and V scores. This sum ranges from 3 to 15 with 3 indicating severe TBS and 15 indicating no or very mild TBS. The non-invasive nature of CT scans make them a very common procedure for TBI patients whose GCS score is mild or moderate, but the data is slow and expensive. The patient must be brought to the equipment and, in many cases, the patient cannot be immediately moved. The cost is compounded because CTs do not provide direct assessment of ICP (two or more scans are required to assess trends) and in 9-13% of patients, the CT will be normal even with elevated ICP. Due to the invasiveness of current ICP monitoring procedures, the general practice is to not start invasive ICP monitoring unless the patient's GCS score is less than or equal to 8, at which time the drawbacks of the procedure are outweighed by the severity of patient condition. This means 90% of hospitalized TBI patients are assessed only with GCS and possibly a CT scan. Significant rehabilitation problems have resulted in patients with mild or moderate GCS scores, highlighting the need for non-invasive ICP monitoring techniques. GCS assessment and CT scans are helpful, but clearly point out the time-sensitive need for more direct data.
First time strokes can unpredictably lead to brain swelling. Strokes are divided into two main categories, (1) hemorrhagic (the bursting of a cerebral blood vessel), and (2) the more common ischemic (the blockage of a cerebral blood vessel). Correct diagnosis of the stroke type is critical because the clot-dissolving drug t-PA (and analogs), used to treat ischemic strokes, is contraindicated for hemorrhagic strokes. Furthermore, the diagnosis of stroke type is time critical because starting t-PA treatment more than 3 hours after stroke could result in a higher rate of bleeding into the brain. Approximately 80% of all strokes each year are ischemic. ICP in this type of stroke initially remains low, but elevates as the loss of blood traumatizes the brain. ICP will also elevate when the clot is removed and blood flow is restored. Hemorrhagic strokes involve the direct complication of elevated ICP.
Ventroperneal shunts are implanted to treat hydrocephalus. A CT scan cannot be used for patients with hydrocephalus because the ventricles of the brain commonly remain swollen even with normal ICP, and the risk of invasive systems cannot be justified. Diagnosis of shunt system problems are currently based on symptoms reported by the patient or caregiver and are thus subjective. OAE is stable over a period of months and an ICP baseline could be stored for these patients and compared with measurements during future visits. Current ICP measurement technology does not provide adequate means for treating patients with hydrocephalus because of the possible inaccurate readings and the risk inherent in invasive measurement procedures.
Intracranial Procedures
There is a current medical need for ICP monitoring for patient recovering from elective intracranial surgery. A retrospective study found elevated ICP postoperatively in 17% of patients who underwent supratentorial or infratentorial surgery. Of these, over one fourth experienced clinical symptoms latent or concurrent to ICP elevation. Medical personnel need to be able to identify these patients and administer therapy before any clinical symptoms are detected. It is interesting to note that during the study, which used invasive methods to measure ICP, the infection rate was 1.2%, highlighting the risk of invasive ICP monitoring.
Laparoscopic and Abdominal Insulflation
Laparoscopic procedures are often performed requiring abdominal insulflation concomitant with Trendelenburg (head down tilt) position. The combination of anesthetic, body position, and insulflation can substantially elevate ICP. Due to the prohibitive additional cost and risk, routine ICP monitoring during these procedures is not done. However, there is growing concern about elevated ICP during these procedures.
Liver and Kidney Support
There is a current medical need to assess ICP variation in patients who are in the latter stages of liver failure and require external liver support (i.e. artificial liver). As the liver fails, toxins build up in the body and this build up generally causes elevation of ICP. One measure of liver function (or therapy function) is to monitor ICP. As toxins build, ICP increases, thus allowing the physician (and possibly the patient) to anticipate when the next therapy session should commence. While on the artificial liver machine, toxins are removed, and ICP should fall, providing an indication of therapy function. A similar situation exists for patients being treated for kidney failure, either by hemodialysis or peritoneal dialysis.
Additional causes for an increase in ICP include the following: meningitis, encephalitis, intracranial abscess, hemorrhage, shunt blockage, tumors, Reye's Syndrome, "shaken baby" syndrome, and benign intracranial hypertension.
Normal intracranial pressure (ICP) for adults is between 5 mm/Hg and 15 mm/Hg. When ICP level is considered abnormal is controversial, however, it becomes a concern as it rises higher than 20 mm/Hg.
ICP is closely related to cerebral perfusion (blood flow in the brain). To a first approximation, the cerebral perfusion pressure (CPP) is the difference between an individual's arterial blood pressure (ABP) and intracranial pressure (ICP). Thus, approximately, CPP=ABP−ICP. If one assumes ABP to be constant, then an increase in ICP results in less blood flow to the brain. Because of this relationship, and the difficulty of measuring CPP directly, ABP and ICP are often measured to assess CPP. In a healthy individual, automatic regulation mechanisms in the body keep ABP, ICP, and thus CPP within a normal range. These automatic regulation systems are often non-functional in brain trauma, stroke, hydrocephalic patients, and patients with liver or kidney failure, so that monitoring and management of ICP becomes a critical aspect of medical care. In addition, during surgeries such as abdominal laparoscopy, cardiac bypass, and following any type of cranial surgery, continuous, non-invasive monitoring of ICP, if it were economically and technically feasible, would be beneficial. Elevated ICP reduces CPP, and if uncontrolled, results in vomiting, headaches, blurred vision, or loss of consciousness, escalating to permanent brain damage, and eventually a fatal hemorrhage at the base of the skull.
Current ICP monitoring techniques are generally grouped as either invasive and non-invasive. The invasive group is further divided into soft tissue, for example lumbar puncture, and bone drilling procedures, for example subarachnoid screws or plugs, subdural catheters, and ventriculostomy catheters.
Lumbar Puncture
In a lumbar puncture or spinal tap, a clinician delicately passes a fine needle through the lower region of the back into the fluid of the spinal cord. Once the spinal spaces have been penetrated, ICP can be estimated by attaching a pressure sensor. The communication between the fluid in the spinal column and the cranium allows the physician to ascertain the pressure in the cranium. Though invasive, a lumbar puncture is sometimes preferred because it is a soft tissue procedure rather than a cranial procedure. Generally, a non-neuro clinician will not feel comfortable performing a cranial procedure, but will perform a lumbar puncture. This procedure does allow transient manipulation or sampling of the intracranial fluid system, but is often painful and many times results in after affects, and always raises patient apprehension. It is a short term procedure and is generally not considered for long term ICP monitoring.
Cranial ICP Assessment Methods
There are five common current invasive methods of measuring ICP which breach the skull: ventriculostomy, intraparenchymal fiberoptic catheter, epidural transducer, subdural catheter, and subdural bolt. These have varying degrees of invasiveness. A subarachnoid screw involves inserting the screw in a hole which has been drilled through the skull bone, but does not breach the dura. Such systems can be threaded like a screw, or just a "friction fit" plug. A subdural catheter involves inserting the catheter a hole in the skull and dura, and squeezing the catheter between the dura and the brain itself. Ventriculostomy catheters are inserted through a hole drilled in the skull and dura, and are blindly forced through the gray matter such that the tip of the catheter is positioned in one of the cranial ventricles.
Of these methods, only a ventriculostomy can also be used to deliver therapy, which is usually draining fluid from the ventricles. The epidural approach has the lowest complication rate, but all suffer gradual loss of accuracy. The failure mechanism is stiffening of the dura and/or localized hematomas at the monitoring site. This known degradation starts immediately after implant and will make the transducer unreliable anywhere from 1 to 3 weeks post implant.
This invasive group, although medically accepted and routinely used, suffers several drawbacks. The transducer has to be calibrated in some fashion before insertion. The placement of the system requires a highly trained individual; in almost all clinical settings, this procedure is limited to physicians, and in most cases further limited to a specialist such as a neurosurgeon. This generally limits these procedures to larger medical facilities. Furthermore, there is a relatively short term (32-72 hours) reliability and stability of the system, either because of leaks or plugging of the transducer, or inadvertently being disturbed, or even being pulled out. This concern generally limits these procedures to a more intense monitoring setting such as an ICU. There are also associated risks of transducer placement such as brain or spinal cord damage and infection. Even though these risks are low, these concerns generally limit the group of non-invasive ICP monitoring techniques to the hospital setting and prevents standard use of the techniques in clinic or nursing home settings.
In the non-invasive group, the accepted, commercially available method of monitoring ICP consists of taking a CT or other image of the head, interpreting the image and observing changes in various features. This method requires a high level of skill to read and assess the images and requires that the patient be brought to the imaging equipment. In many cases, a scan is delayed or put off simply because the patient is not stable enough to be moved. Even after the patient is stable, the various tubes and equipment connections to the patient have to be accounted for during the trip to the CT, and many times additional personnel are required, with a respective increase in cost. In addition, the scans themselves are single measurements—"snap-shots" in time, of which at least two are required to assess subtle-changes and variations. A 'series' of scans could approximate continuous monitoring, but is not economically practical.
Other non-invasive ICP monitoring techniques have been developed. A non-invasive ICP monitoring system is taught in U.S. Pat. No. 4,841,986 to Marchbanks. This system is based on fine volume measurements of the external auditory canal during elicitation of the human stapedial reflex. The concept is that at normal ICP, the stapedial reflex will pull on the stapes, resulting in distortion of the tympanic membrane (ear drum). This will define a volume for that ICP level. As ICP increases, the stapes will be pushed away from the cochlea, and the stapedial reflex will pull on the stapes differently, resulting in a different distortion of the tympanic membrane, which can be measured as a delta volume. This system requires a rather loud sound to be output in the patients ear. Severe ambient noise and sealing constraints are inherent in the technology which lead to a cumbersome and time consuming setup. The system has a non-linear response, acting much like a threshold function.
A compliance measuring system taught by Paulat in EP 0933061A1 measures changes in ICP. The system uses micro volume measurements in the auditory canal similar to the Marchbanks system. The system detects the fine volume changes as the time varying ICP waves are communicated to the cochlea via the cochlear aqueduct, through the ossicles to the tympanic membrane. This device is AC coupled so it cannot monitor ICP changes over time (i.e. mean ICP values). It has been proposed that frequencies greater than 10 Hz could not be communicated via the cochlear aqueduct. Stated another way, respiration and heart rate frequencies may not be transmitted through the cochlear aqueduct.
In Bridger in U.S. Pat. No. 5,919,144, a non-invasive system is disclosed based on real-time analysis of acoustic interaction with the brain and changes in tissue acoustic properties as ICP changes.
Other non-invasive techniques include:
electro-magnetic techniques taught by Ko in U.S. Pat. Nos. 4,690,149 and 4,819,648, by Alperin in U.S. Pat. No. 5,993,398, and Paulat in U.S. Pat. No. 6,146,336;
ultra sonic or vibratory techniques such as U.S. Pat. No. 3,872,858 to Hudson et al., U.S. Pat. No. 4,043,321 to Soldner et al., U.S. Pat. Nos. 4,971,061 and 4,984,567 to Kageyama et al., U.S. Pat. Nos. 5,074,310 and 5,117,835 to Mick, U.S. Pat. Nos. 5,388,583 and 5,951,477 to Ragauskas et al., U.S. Pat. No. 5,411,028 to Bonnefous, U.S. Pat. No. 5,617,873 to Yost et al., U.S. Pat. No. 5,840,018 to Michaeli, U.S. Pat. No. 6,086,533 to Madsen, and U.S. Pat. No. 6,117,089 to Sinha;
jugular vein occlusion taught by Allocca in U.S. Pat. No. 4,204,547;
ocular latency in U.S. Pat. No. 4,564,022 to Rosenfeld et al.
Another system stated to be "non-invasive" is described in U.S. Pat. No. 4,141,348 to Hittman and companion U.S. Pat. No. 4,186,751 to Fleischmann. This nuclear powered pressure sensor was not grouped with the other non-invasive systems because it is designed to be implanted totally under the scalp of the patient.
Each of the currently used and medically accepted methods of ICP assessment are deficient in some way, and all require a high skill level to administer. Because of the deficits in current measurement methodologies, there is a need for a non-invasive, easily administered, long-term, continuous assessment of ICP.
To address the difficulties noted above, it is an object of this invention to provide a continuous intracranial pressure monitoring system that is non-invasive and easily administered. The ICP monitoring system of the current invention stimulates and interprets predictable external effects of elevated ICP. In a preferred embodiment, the system non-invasively and continuously monitors ICP by stimulating and interpreting predictable changes measured in the otoacoustic emission (OAE) signal (transient, or cubic distortion) of the patient. The system may alternately non-invasively and continuously monitor ICP by stimulating, measuring, and interpreting other responses which rely on the transmission of vibrations through the middle ear cochlear interface, such as tympanograms (TGRAMs), ocular-acoustic reflex, auditory brainstem response (ABR), or cochlear microphonics. It should be apparent to those skilled in the art that other suitable measurements could be used in monitoring the ICP level. The measurements could be used individually, in conjunction with one another, or in concert with current invasive ICP measuring systems. One, two, or more of the above mentioned measurements may be used in concert with one, two, or more of heart rate, respiration rate, pulse oximeter, blood pressure, or other conventional 'vital signs' measurements.
The portability and ease of the invention enables more frequent ICP assessment in the areas identified previously as well as expansion of ICP assessment into areas heretofore considered economically or technically unfeasible. These new areas include first responders such as EMT's, medics, ambulances, and law enforcement officers; long term care situations such as nursing homes, assisted living, and home care; athletic trainers (during, for example, concussion assessment), and military battlefield application.
In a preferred embodiment, the invention provides a system which utilizes predictable changes in OAE signals to assess and record changes in ICP over time—a system which is compact enough to be strapped to the patients' arm during ambulance or other transport. This system allows EMT's or other first responders to start monitoring changes in ICP, requiring only simple interface(s) to the patient. Examples of these simple interfaces include, but are not limited to; a plug transducer or tube inserted into the patients ear; pulse oximeter type clip on the finger or ear lobe; a stretchy band about the thorax to detect respiration. After arriving at the hospital or trauma center, the ICP history can be downloaded. Starting ICP monitoring early advantageously provides ER physicians expanded and prior time history of the patients changes in ICP to assist in diagnosis and treatments decisions. Many times a patient arrives at a health care facility with no apparent symptoms and is sent home, only to succumb to symptoms of elevated ICP later, resulting in another emergency transport to the hospital.
Another scenario where the invention is especially useful is for a non-symptomatic patient with a known head trauma arriving at a small regional health care facility with no neuro related specialists on staff. Currently, the ER physician is confronted with the decision to; send the patient to a larger facility via ground transport, wait and monitor the patient and if their condition deteriorates, or send the patient to a larger facility via air ambulance. With the present invention, the ER physician is provided with time history of the changes in ICP before sending the patient to a larger facility or home. The device can also be sent home with the non-symptomatic patient to continue ICP monitoring. By home monitoring following a possible brain trauma, a second emergency trip back to the hospital can be avoided.
In another embodiment, the invention is used in conjunction with an invasive pressure transducer such as a subarachnoid screw, or lumbar puncture, and the stored ICP data is characterized and quantified based on this reference. This is also used as a reference for future stored data. The pressure transducer interface may be incorporated within the invention apparatus, or a connection from the invention to a current pressure measuring system could be made using a wired or wireless (IR, RF, etc.) means. Also contemplated is the direct entry of the 'reference' pressure via keypad or other entry system.
In another embodiment, the invention is used as a continuous bedside monitor—a system which is portable in terms of size, weight, and power. This allows ICP monitoring to be started on a patient pre-operatively and follow the patient as the patient is moved to the operating room, recovery room, and hospital room. This advantageously allows physicians to monitor ICP during and following cranial, laparoscopic, or other procedures.
In another embodiment, a 'template' of the patients normal ICP signal is captured and stored in the invention, and sent home with the patient, home care provider (parents or other guardians) or long term care provider (i.e. nursing homes). This allows the monitoring of the patients' ICP to be continued following hospital or clinic discharge. This advantageously reduces the cost of long term ICP monitoring by moving the patient from the hospital setting to the nursing home setting, and makes periodic or even continuous ICP monitoring by home care givers economically feasible.
Hydrocephalic infants, brain trauma, or stroke survivors who cannot communicate internal symptoms can be monitored at a greatly reduced cost, yet without increasing risk to the patient. This is also advantageous in the clinical follow up of shunted patients since their ventricles remain swollen even under 'normal' ICP, rendering CT assessment of ICP worthless. Physicians would like to know the ICP of the patient, but are unwilling to subject the patient to an invasive procedure.
An aspect of the invention, which may be included in any of the embodiments, involves other signals (such as pulse rate, blood pressure, oxygen saturation, respiration rate, etc.) measured either as part of the apparatus of the invention, or measured and communicated by other equipment. The additional signals are analyzed in concert with the ICP data to further characterize and qualify the data.
Another aspect of the invention, which may be included in any of the embodiments, is to combine ICP and pulse oximeter (or other suitable measurement) inputs to provide an estimate of cerebral oxygenation.
Another aspect of the invention, which may be included in any of the embodiments, is to combine ICP and blood pressure (or other suitable measurement) inputs to provide the physician with an estimate of cerebral perfusion pressure (CPP).
Another aspect of the invention, which may be included in any of the embodiments, is an accelerometer or other suitable position sensor which is incorporated within the invention to compensate or otherwise offset the postural influences in ICP measurements.
Another aspect of the invention, which may be included in any of the embodiments, is to measure ICP using both ears and provide hemispheric information to the physician.
Another aspect of the invention, which may be included in any of the embodiments, includes a noise canceling system to enhance the signal to noise ratio (SNR) of the ICP signal.
Another aspect of the invention, which may be included in any of the embodiments, synchronizes the ICP measurement to the same phase of the cardiac rhythm or respiration rhythm, or both, to improve the SNR of the ICP signal.
Another aspect of the invention, which may be included in any of the embodiments, synchronizes the ICP measurement to the same phase of the cardiac rhythm or respiration rhythm, or both, to assess the patency of the cochlear aqueduct.
Another aspect of the invention, which may be included in any of the embodiments, is to measure the ICP synchronized to at least two known phases of the cardiac rhythm or respiration rhythm, or both, preferably at diastole and systole/inhalation and expiration, and use that delta to further quantify the ICP reading.
Another aspect of the invention, which may be included in any of the embodiments, is to measure the ICP synchronized to cardiac diastole and systole and/or respiration inhalation and expiration in at least two distinct ICP levels, the levels being manipulated by head tilt, or forced by some chemical means, such as ingestion of glycol. This allows at least 4 different ICP readings, and can be used to further qualify and quantify the ICP reading.
Another aspect of the invention, which may be included in any of the embodiments, is to measure the ICP using OAEs around 2 khz to assess the presence of non-equalized middle ear pressure which can distort or mask the ICP signal in OAE's.
FIG. 1 is a drawing of three current invasive methods of measuring ICP.
FIG. 2 is a drawing of another invasive method, a lumbar puncture, of measuring ICP.
FIG. 3 is a drawing of one embodiment of the invention strapped to a patients arm.
FIG. 4 is a drawing of a bedside embodiment of the invention.
FIG. 5 is a graph typical TEOAE signal and the change in response to elevated ICP.
FIG. 6 is a graph of respiration modulating the ICP signal at two distinct absolute pressures.
FIG. 7 is a drawing of the anatomy of the ear and surrounding cranial spaces showing the communication between the cranial spaces and the cochlea.
FIG. 8 is a flowchart of one method of operating the invention.
FIG. 7 generally depicts the anatomy of the ear and surrounding cranial spaces. During normal hearing, auditory stimuli enter the external auditory meatus 5 and cause tympanic membrane 6 to vibrate. The vibrations are communicated through the ossicular chain 10 (including malleus 7, incus 8, and stapes 9), to the cochlea 4. The base or footplate of stapes 9 communicates auditory vibrations to the fluid in cochlea 4 via oval window 11. Residing within the cochlea 4 are hair cells (not shown) which convert the fluid vibrations into nerve impulses which are subsequently perceived by the brain as sound. During the process of converting vibration into nerve impulses, a portion of the hair cells "contract" and physically move. It is this movement or "mobility" which gives the mammalian ear extraordinary dynamic range by "amplifying" soft sounds more than loud sounds. As a consequence of the movement of the hair cells, small vibrations are generated in the fluid of the cochlea 4, which in turn are reflected 'backwards' through the oval window 11, ossicular chain 10 and tympanic membrane 6. These small vibrations, being emitted by the ear in response to auditory stimulation are known as Otoacoustic Emissions or OAE's. Although many times very small, with a sensitive microphone and signal processing, these vibrations can be measured and used to screen the hearing ability of the cochlea 4. One such system is taught in U.S. Pat. Nos. 4,374,526 and 4,884,447 issued to Kemp and to Kemp and Bray respectively.
The interaction of the tympanic membrane 6, ossicular chain 10, and the fluid in the cochlea 4 is a vibration transmission system. Variation of the components of this system will modify the transmission of vibrations, to and from the hair cells. Variations can be caused by several factors, one of which is the pressure within the cochlea 4. The change in cochlear pressure influences the stapes 9/cochlea 4 interface.
The characteristics of the OAE response changes with ICP, and thus can be used as a relative indicator of ICP. In the healthy ear, the pressure within the cochlea 4 is equivalent to the ICP. Both the endolymphatic sac 1 and the cochlear aqueduct 3 communicate pressure between the cranial spaces and the cochlea 4. As ICP varies, the pressure changes are communicated to the cochlear fluids via cochlear aqueduct 3 and endolymphatic sac 1, thereby influencing stapes 9 position and tension against its muscle and ligament attachment. These physical changes in the mechanical system of the ear affectthe input transmission of the stimulus as well as the reverse transmission of the OAE response. Thus the pressure within the cochlea 4 is a reflection of the ICP. Since OAEs are hearing based, this relationship will not exist in patients with greater than 30-40 dB senorineural loss at 1 kHz. Temporary or permanent conductive losses will also limit OAE signal. Also, muscle relaxants may reduce the tension on stapes 9 thus attenuating the ICP-OAE relationship. Similarly, if cochlear aqueduct 3 is plugged, the device will measure no changes in OAE transmission, and thus report that there was no change in ICP.
Any process or system which utilizes this vibration transmission system will be more or less sensitive to ICP changes reflected as changes in one or more of the system components. In most processes, such as normal hearing and measurements to assess hearing (such as OAE's and ABR's), changes in transmission characteristics are either easily ignored, or compensated for by the compliance of the process itself. The present invention concentrates on measuring, and quantifying the changes in transmission characteristics to determine changes in ICP.
An OAE response can be elicited by several modes of stimulation, two of which have become dominant—Transient Evoked Otoacoustic Emission (TEOAE) and Distortion Product Otoacoustic Emission (DPOAE). A TEOAE system introduces a wide band audio burst in the ear, then listens for the response, which occurs 4-20 milliseconds later. The signal-to-noise-ratio (SNR) of the system is enhanced by ensemble averaging the response synchronous to the stimulus, usually around 1000 samples in the average. Limitations in the repetition rate of the stimulus burst coupled with the rather large number of samples restrict a new measurement of the entire hearing spectrum approximately every minute. In contrast, a DPOAE system introduces two pure tones (f1 and f2) into the canal and listens for the response while the stimulus is being delivered. The emission in this case appears as the distortion product (2f1−f2), and is easily separated from the stimulus tones using Fast Fourier Transform (FFT) signal processing techniques. DPOAE results (for a single f1/f2 combination) can be obtained in seconds. The present invention can use either of these stimulation modes.
In a first embodiment, measuring, and quantifying the changes in transmission characteristics to determine changes in ICP is accomplished by analyzing the phase in a DPOAE signal, after first validating the patency of the communication between the cerebral spaces and the cochlea, and ruling out distortion caused by unequalized middle ear pressure.
In another embodiment, a TPOAE signal is analyzed to determine the optimum OAE response frequency. The DPOAE distortion product (2f1−f2) is then set to the optimum OAE response frequency according to the TPOAE analysis and frequencies f1−f2 are output accordingly. The changes in transmission characteristics are then measured and quantified to determine changes in ICP.
As seen in FIG. 8, first and second audio output generators 70 and 71 respectively are used to generate first and second frequencies, f1 and f2 respectively. The output levels of first and second audio output generators may be any level suitable for obtaining a 2f1−f2 cochlear distortion. In one embodiment, the ratio of f2/f1 is 1.2 and the 2f1−f2 frequency is below about 1 khz. Alternately, the ratio of the first and second audio output levels may be 6/5. In another embodiment, the distortion product (2f1−f2) is set to the optimum OAE response frequency as determined by a TPOAE analysis. In one embodiment, this ratio is achieved by setting the first audio output level to 60 dB SPL and the second audio output to 50 dB SPL. First and second generators may further include rotating buffers. Optionally, first and second outputs are communicated through amplifier 72 and attenuator 73. Either directly after generation or after amplification and/or attenuation, first and second outputs are communicated to first and second output transducers, 74 and 75 respectively, within the patients external auditory canal.
The sound is reflected back as an otoacoustic signal emission of the cochlea. This OAE signal is the audio input used by the invention. Audio input transducer 76, including a 2f1−f2 cochlear distortion, converts the audio input into a response signal. Optionally, the audio input transducer may be an acoustic microphone. In a first embodiment, first and second audio output transducers 74 and 75 and audio input transducer 76 are non-invasively coupled to the human auditory canal of the subject. The non-invasively coupling may be accomplished with a plug 77. Plug 77 may be manufactured of soft foam or soft plastic or any other suitable material. In one embodiment, the plug has three tubes, 78, 79 and 80, passing through it. The proximal end of each tube is connected to the first and second audio output generators and the distal end of each tube terminates in the auditory canal of the subject.
Signal processor 82 then processes the response signal to determine the intracranial pressure. Optionally, the response signal may be amplified by amplifier 81 before communication to the signal processor. In one embodiment, the intracranial pressure is processed further in control processor 83. Readings from other vital sign monitors, for example a pulse oximeter, respirator, or heart rate monitor, may be input into control monitor 83 (and optionally amplified by amplifier 85 prior to input). These readings may be interpreted in conjunction with the ICP value for additional information, for example, cerebral oxygenation or cerebral perfusion pressure. The intracranial pressure and other desired information is then displayed on display 83.
The response signal may be validated to ensure better ICP monitoring. A validation signal is generated to validate the response signal. The validation signal may be physiological (respiratory or cardiac, for example) or from an external source (from a respirator, kidney dialysis machine, or liver support machine, for example) In one embodiment, a respiration signal is generated representative of the inhalation and exhalation of the subject. The respiration signal may be generated using impedance plethsmography. Alternately, it may be an elastic sensor in contact with the chest of the subject or may be communication with a respirator party system. The signal processor isolates the 2f1−f2 cochlear distortion signal from the response signal and measures the phase of the isolated 2f1−f2 cochlear distortion signal to validate the relationship between the phase of the 2f1−f2 cochlear distortion and the ICP of the subject. The isolation step may be performed with an FFT calculation wherein the FFT length, sample rate, f1 and f2 are advantageously chosen such that 2f1−f2 frequency is represented by a single bin of the FFT calculation. In one embodiment, the phase measurement is the imaginary portion of the FFT calculation of the bind representative of the 2f1−f2 frequency.
Validation of the result is almost as important as the result itself and is an important aspect of the first embodiment. The occurrence of a false negative, that is a reading of normal ICP when in reality it is elevated, could be fatal. To validate the patency of the cochlear aqueduct, the phase of the DPOAE signal is analyzed in concert with the respiration signal. At any ICP level, respiration should modulate the phase of the DPOAE. If it is not detected, either the patient's cochlear aqueduct is not patent, or, the patient has a ventropeneal shunt. In either case, this is indicated to the physician as an anomaly. In addition, the phase of the DPOAE is measured over the 2 Khz region. Unequalized middle ear pressure (ear 'popping' in an elevator or airplane) distorts the phase signal in the desired measurement region, and has a characteristic 'hump' in the 2 Khz region if the middle ear pressure is not equalized. Thus, it is advantageous to determine the presence of equalized middle ear pressure by verifying the absence of a phase hump in the 2 khz region.
After validation, the signal processor converts the phase to intracranial pressure. In one embodiment, the conversion is done with a formula calculation, for example, ΔICP=(Δφ(deg))*5. It may also be advantageous to calibrate the conversion mechanism. This calibration may be done by entering an absolute reading, by deriving a calibration from an invasive intracranial sensor, by changing the patient's posture, or by any other means suitable for calibration. If the patient's posture is changed, a particularly preferred method includes moving the patient from prone position to head tilted down 30�. The intracranial pressure may be displayed or printed for physician viewing.
As depicted in FIG. 3, in one embodiment of the invention, the electronics and display module may be housed in an arm-band display module 50. The display module is connected to ear probe 51 for insertion in the external auditory canal of the patient. Optionally, elastic sensor 52 in contact with the patient's chest may be used to monitor the patient's respiration in order to validate the intracranial pressure reading.
FIG. 4 depicts an alternate embodiment of the invention wherein the display module 53 is bedside. Display module 53 is connected to ear probe 54. Ear probe 54 is configured for insertion into patient's external auditory canal. Optionally, the display module may be in contact with pulse oximeter 55, ECG 56, or respirator 57 for further quantifying the intracranial pressure data.
While particular embodiments in accordance with the present invention have been shown and described, it is understood that the invention is not limited thereto, and is susceptible to numerous changes and modifications as known to those skilled in the art. Therefore, this invention is not limited to the details shown and described herein, and includes all such changes and modifications as encompassed by the scope of the appended claims.
|Cited Patent
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|Jan 31, 1978
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|Feb 22, 1983
|National Research Development Corporation
|Hearing faculty testing and apparatus therefor
|Mar 12, 1982
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|Massachusetts Institute Of Technology
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|Arminas Ragauskas
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|Gregory Zlatko Grudic
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|Statistical, Noninvasive Measurement of Intracranial Pressure
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|Robert Isenhart
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|Mar 10, 2010
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|Elvir Causevic
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|Terry A. Fuller
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|John Gregory Aceti
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|U.S. Classification
|600/561, 600/559
|International Classification
|Cooperative Classification
|European Classification
|Apr 23, 2003
Owner name: RICE CREEK MEDICAL, L.L.C., MINNESOTA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:MEYERSON, SCOTT C.;AVAN, PAUL ALEXANDRE;BUKI, BELA;REEL/FRAME:013984/0366
Effective date: 20010420
|Jan 24, 2007
|Maintenance fee reminder mailed
|Jul 8, 2007
|Reinstatement after maintenance fee payment confirmed
|Aug 28, 2007
|Expired due to failure to pay maintenance fee
Effective date: 20070708
|Oct 3, 2007
|Surcharge for late payment
|Oct 3, 2007
|Fee payment
Year of fee payment: 4
|Feb 25, 2008
|Patent reinstated due to the acceptance of a late maintenance fee
Effective date: 20080228
|Jan 5, 2011
|Fee payment
Year of fee payment: 8
|Feb 13, 2015
|Maintenance fee reminder mailed
|Jul 7, 2015
|Fee payment
Year of fee payment: 12
|Jul 7, 2015
|Surcharge for late payment
Year of fee payment: 11


text: Current TV's official body count: 30 gone, 30 shuffledPaul Boutin11/11/08 5:40pmFiled to: confirmedLayoffsCurrent TvmeltdownsCurrentCurrent.comCurrent MediaValleywag5EditInvite manuallyPromoteDismissUndismissHideShare to KinjaToggle Conversation toolsGo to permalink This just in: Current TV's director of public relations sent us an email designed to be printed in its entirety. (Thanks for that. Since Valleywag fired everyone else, I spend way too much time editing.) Current didn't just cut staff, they reshuffled a couple dozen employees. Instead of the economy, Current blames "a new, innovative programming strategy." That's gotta make everyone feel better. A tipster tells us, "The few spared [in San Francisco] are being made to choose between unemployment or a move to L.A." Here's the statement: Hi Paul, The company statement is below. For what it's worth, I'd be very appreciative if you used the entire statement: "Current Media today announced changes to its structure and staffing. Approximately 60 positions have been eliminated in the company's three U.S. offices and approximately 30 new positions created. Many of those whose positions were eliminated have been placed in the new positions. Current will have approximately 410 employees (after these staffing adjustments). These changes result from the development of a new, innovative programming strategy built around eight cross-platform channels, including news, comedy, music and technology, slated to premiere in the first quarter of 2009. Current's new programming strategy expands upon its pioneering use of viewer created content to include additional opportunities for participation, creating a far more viewer-influenced network, and further unifies the Company's online and TV platforms by having each web channel paired with a companion TV show. In addition, these changes enable Current Media to reduce its cost structure, thereby assuring that it will be comfortably profitable in 2009 regardless the depth and length of the recession." Reply5 repliesLeave a reply

subset: commoncrawl


text:
Connect with Nature
Field Trips and Events in Maryland and DC
Outdoor Adventures ~ Social Hours ~ Volunteer
Check this space often for updated listings of events, field trips, and volunteer opportunities. And if you haven't already, be sure to "like" us on Facebook and follow us on Twitter to stay up to date on Chapter happenings and share your involvement with friends.
If you have questions or want to get involved, email Kate Arion at email@example.com with requests, ideas, or event RSVPs. We'll see you there!
Ongoing Special Events
Jewels of Appalachia
Smithsonian's National Zoo
Reptile Discovery Center
3001 Connecticut Ave., NW
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October 17, 2015
Explore this new exhibit sponsored by The Nature Conservancy The Appalachian region is home to the most biodiverse community of salamanders in the world. Nearly 14 percent of the planet's salamander species can be found there. Learn more about these re... Learn more
Thank you for your interest in volunteering for The Nature Conservancy. Currently there are no volunteer opportunities available. Please check back soon for upcoming events.


text:
Our sectors
Health & Wellbeing
We are expert in navigating the complexities of healthcare and wellbeing communication.
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text: U.S. Troops Were 1,800 Yards from Osama bin Laden in 2008, Training Pakistanis How to Catch HimJohn Cook5/03/11 4:08pmFiled to: close callsOsama Bin LadenMissed ConnectionsTerrorismPakistanFrontier CorpsTweetgTweetdTweetvFb71EditInvite manuallyPromoteDismissUndismissHideShare to KinjaToggle Conversation toolsGo to permalink According to Wikileaks documents, about 100 U.S. troops deployed to Abbottabad, Pakistan, in 2008, just yards from Osama bin Laden's lair. They were there to train the Pakistani military how to capture or kill Al Qaeda terrorists. It didn't take. The Guardian caught the diplomatic cable, which recounted a meeting between then deputy secretary of state John Negroponte and Pakistan's foreign minister, Shah Mehmood Qureshi to discuss U.S. military aid to Pakistan. It doesn't appear to be among the 12,000 or so cables released by Wikileaks yet—the Guardian has the full database—and the paper didn't publish the cable itself. But it mentions "US Training-of-Trainers for the Frontier Corps starting in Abbottabad in October" of 2008. And that sounds a lot like this plan, reported in the New York Times in March 2008, to send 100 or so troops to train Pakistan's Frontier Corps, which the Times decribes as a "Pakistani paramilitary force that is the vanguard in the fight against Al Qaeda." If such training were indeed taking place in Abbottabad, as the cable reports, then it almost certainly took place at the Pakistan Military Academy, roughly 1.7 kilometers from the compound where Osama bin Laden lived from 2005 or so until Sunday night.Reply71 repliesLeave a reply


text:
DistributionRead full entry
Range DescriptionThis species can be found in the Olympic Peninsula, Washington, south through the southern Cascades and Willapa Hills to streams that drain into the Columbia River Gorge in northwestern Oregon, USA (Stebbins 1985). It can be found from near sea level to about 975m asl (Leonard et al. 1993).


text:
Disc Armature DC Motors Datasheets
from Dart Controls, Inc.
These motors have an entirely paint. free exterior with 300 series stainless. steel motor body, conduit box lid, shaft. extension, hardware, fasteners and an. etched motor data plate. To enhance chemical and corrosion. resistance, all surfaces of the endbells and. conduit box are processed using a... [See More]
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Our ElectroCraft DirectPowerTM Plus 240 Series features up a rugged, heavy-guage steel housing construction for long-life and durability. This high-efficiency motor includes dynamically balanced armatures, sealed ball bearings, and replaceable brushes. [See More]
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text:
Diabetes Health Center
Type 1 Diabetes - Surgery
Some complications from type 1 diabetes are treated with surgery. For example, surgery to remove the vitreous gel (vitrectomy) may improve eye disease.
For more information, see:
Pancreas surgery
When insulin isn't enough to keep blood sugar in your target range, a pancreas transplant might be an option. If it's successful, you may no longer have symptoms or need to treat diabetes.
But you may still get complications from diabetes. If you already have complications, they may continue to get worse as time goes on.
The success rate for pancreas transplants is improving because of new surgical techniques and new medicines.
If you get a transplanted pancreas, you must take medicine to keep your body from rejecting the new organ.
A pancreas transplant can be done at the same time as a kidney transplant .
Pancreatic islet cell surgery
Research continues on pancreatic islet cell surgery. It involves inserting a small group of donated pancreas cells (islet cells) through a vein in your liver. After surgery, these cells begin making insulin. If they can make enough, you may no longer need insulin injections.
Because the surgery is simpler than a pancreas transplant, there are usually fewer complications. But you must still take medicine to prevent rejection.
In this article
WebMD Medical Reference from Healthwise
Type 1 Diabetes Topics
Today on WebMD
WebMD Special Sections
- Managing Diabetes, Insulin, and High Blood Sugar
- Your Child and Type 1 Diabetes
- Next-Level Fitness When You Have Diabetes
- Type 2 Diabetes: Learn How New Treatments Can Help You
- Live Better Daily With Diabetes
- 8 Snacks That Won't Spike Your Blood Sugar
- Living with Diabetes Assessment
- Diabetes: Keys to Better Daily Control
- Diabetes as You Age: Stay Active, Live Better
- Diabetes: Ready to Lower Your Blood Sugar?


text:
I wish....sometimes....
The fact that, at times, I wish I felt like I was healing.
Pair that with the fact that, at times, I don't care. At times, I don't want to heal.
I don't know if it's simply my depression talking. Or my anxiety.
But it's just so frustrating, because I can get to the point where I want to work hard at my healing. And then, it's like I suddenly just turn totally the other way, and I don't want to do anything to help myself heal.
And then I get angry. Mostly at myself.
And that just doesn't help.
And then I get more depressed. More anxious.
And then I want to SI. Or I feel like I could care less if I was even alive.
I don't know if any of that makes any sense to anyone. Can anyone relate?
It's like this horrid rollercoaster ride. And I wish I could get off.


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It'd be interesting to see what would happen if everyone wore a name tag everywhere they went. That way, if you were artist Fahamu Pecou standing in the endless self-checkout line at Kroger and you happened to turn around and notice fellow artist Bethany Marchman behind you, you might strike up a conversation with her even though you'd never formally met. And then you might discover that, even though your styles are totally different, you and she are exploring similar ideas in your artwork. You might even decide to get together sometime to discuss.
But people don't wear name tags everywhere they go.
Until they do, there's Neda Abghari, photographer, Atlanta native, and founder of the photo-documentary series the Creatives Project. Abghari started the project in 2007 while living in New York City in an effort to expose Big Apple artists to Atlanta talent. She returned home in 2008 with the specific goal of using the Creatives Project to help connect the different pockets of artists throughout the city.
Abghari wants to see "people mingling who don't normally mingle, and people engaging in conversations that they don't normally engage in," she says. "My goal is always, always, to bring community together."
Abghari's next curatorial effort, JUNG at HeART, which opens Friday, is a collaboration between Abghari, self-appointed hip-hop art star Pecou, and pop art surrealist Marchman. The show's work taps into the thinking of Swiss psychiatrist Carl Jung to explore the different ways in which childhood experiences manifest themselves in adulthood. The show will include photos by Abghari and paintings by Pecou and Marchman based on the photography.
"They are two artists but on completely opposite ends of the spectrum creatively within the city, so the photography is like the binding thread," says Abghari. "We chose the concept — it was kind of floating around in all of our heads."
JUNG at HeART will also act as a coming-out party and benefit for the Creative Community Housing Project, a Creatives Project spin-off that aims to provide housing and studio space on the cheap for working artists. Atlanta is saturated with vacant properties and "there is a need. There are artists whose lives need to be supported. ... And, there's the need for education programming," she says. So through CCHP, a property owner donates a lease, an artist gets a place to create, and in return he or she gives back to the community through artistic outreach.
CCHP will start taking applications from artists March 1. In the meantime, the organization's working on its 501(c)(3) with the goal of securing official nonprofit status by early 2012.
"It's not by any means an original idea. It's been happening in Europe for years. It's been happening in the United States," says Abghari. "However, with our program we really want it to have this human element so that the investor knows who the artists are, and they are working with the artist, and the artists are working with the community and everyone benefits."


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Victory. That word, more than any other, sums up the gospel of Jesus Christ. And preaching that victorious gospel to the world has been Kenneth Copeland's driving purpose for more than 30 years.
An ordained minister, author and internationally recognized preacher, Brother Copeland began his ministry in 1967. Since then, Kenneth Copeland Ministries has grown to include not only its headquarters in Fort Worth, Texas, but offices in Canada, England, South Africa and Australia as well.
Best known for his exuberant proclamation that "Jesus is Lord!", Kenneth Copeland has introduced people the world over to the saving message of faith. However, the vision of KCM includes more than simply introducing people to Jesus Christ. Theirs is a vision of taking believers on to maturity in the principles of faith, love, healing, prosperity, redemption and righteousness.
Every day that vision becomes more of a reality through Kenneth Copeland Ministries daily and weekly television broadcasts, monthly magazine, books, teaching tapes, gospel music recordings, meetings and conventions. Through these KCM outreaches, every day thousands of believers from Jacksonville to Johannesburg are moving from defeat, self-doubt and discouragement - to a life of God-given victory.
Blessed to Be A Blessing: Understanding True, Biblical Prosperityby Kenneth Copeland
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God wants to bless you. He has made all of heaven's supply available to you. But the blessings of God are not automatic. You have a part to play. To find it, you'll need to look no further than the Holy Bible. Throughout His Word, God has indicated His desire to prosper His people. In both the Old and New Testaments, God describes His plan and purpose for prospering you - He wants to bless you abundantly, so you can be a blessing to others.
There are some who claim God doesn't promise us physical prosperity, just spiritual. But they're mistaken. God's Word is full of promises about the practical kind of prosperity that gets your bills paid, buys your kids' clothes, and helps pay your pastor's salary.
Find out the truth about God's promises and how to tap in to heaven's economy. Discover that God is not keeping prosperity from you, but has provided a sure way to get it to you. Learn how to take action on His promises and become a valuable asset to the kingdom as you are Blessed to Be a Blessing!
Product Details
- 2940015907193
- Publisher:
- Harrison House LLC
- Publication date:
- 11/05/2012
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- Barnes & Noble
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- NOOK Book
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- 206
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Meet the Author
Victory. That word, more than any other, sums up the gospel of Jesus Christ. And preaching that victorious gospel to the world has been Kenneth Copeland's driving purpose for more than 30 years.
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Products & ServicesSee also: Categories | Featured Products | More Information
Supplier: Dart Controls, Inc.
Description: , power on indicator lamp, front access fuse, as well as convenient input and output cords and plugs. The heart of the control is a triac fired in a manner to adjust phase and thereby vary speed. The 55 Series is designed to work with shaded pole, permanent split capacitor, permanent split-phase
Show More
- Style: Wall Mount
- Display: Other
- AC Output: Phase: Single-Phase
- AC Output Voltage: 0.0 to 240 volts
Supplier: Chromalox
Description: 1/4 DIN Format 2 Control Loops Large Graphical / Text LCD Display Inputs - 2 Analog, 9 Digital, Remote Setpoint 9 Outputs - Relay, SSR Drive, Triac, Analog (Linear) Up to 7 Programmable Event Outputs Simplified Programming Wizard Cascade and Ratio Control Valve Motor Drive Control
Show More
- Number of Inputs: 11 inputs
- Number of Control Outputs: 9 outputs
- Controller Inputs: DC Voltage Input, Current Loop (Transmitter) Input, Other
- Control Signal Output: Analog Voltage, Current Loop, Switch / Relay Output, Serial / Digital, Network / Fieldbus Output
Description: The sensitive gate TRIAC is a bidirectional AC switch and is gate controlled for either polarity of main terminal voltage. It is used primarily for AC switching and phase control applications such as motor speed controls, temperature modulation controls and lighting controls.
Show More
- Thyristor Type: Triac
Description: The sensitive gate TRIAC is a bidirectional AC switch and is gate controlled for either polarity of main terminal voltage. It is used primarily for AC switching and phase control applications such as motor speed controls, temperature modulation controls and lighting controls.
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- Thyristor Type: Triac
- IC Package Type: TO-220
- VRRM: 600 volts
- IT(RMS): 4 amps
Description: Optoisolator, TRIAC Driver Output, Forward Current 60 mA Lamp ballasts Motor controls Static AC power switch Solid state relays Incandescent lamp dimmers The NTE3047 optoisolator consists of a gallium arsenide infrared emitting diode, optically coupled to a silicon bilateral switch
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- Optocoupler Output: Other
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- Operating Temperature: -40 to 185 F
- Mounting Option: Surface Mount
Supplier: Leister USA
Description: The TRIAC AT is the successor to the popular TRIAC PID and a cost-effective alternative to the widely used TRIAC S. It is designed for demanding plastic welding and shrinking jobs that require precise temperature and processing control. •Closed-loop control•Save preferred parametersShow More
Supplier: West Control Solutions
Description: The 8170+ single loop controller is part of the Plus series range and has 3-point stepping control designed specifically for open loop, valve motor drive (VMD) applications. The 8170+ incorporates advanced tuning algorithms, with selectable pre-tune and self-tuning for easier setup. The self-tune
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- Number of Control Outputs: 5 outputs
- Controller Inputs: DC Voltage Input, Current Loop (Transmitter) Input
- Control Signal Output: Switch / Relay Output, Serial / Digital
- Control Technique: Advanced / Nonlinear Control
Supplier: Erdmann Corporation
Description: , ±10% Control power supply: 110/220V AC 1 PH, 50/60Hz, ±10% Duty cycle(on-off): 70% Max 1800 start/hour Duty cycle(modulating): 70% Max 1800 start/hour Motor: Reversible Induction motor Limit switches: Open / Close, SPDT, 16A 1/2HP 125/250VAC, 0.6A 125VDC, 0.3A 250VDC Additional limit
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- Actuation Method: Electric
- Actuator Torque: 1350 In-lbs
- Number of Turns (For Multi-turn Actuators): 11
- AC Phase: Single Phase, Three Phase
Find Suppliers by Category Top
Featured Products Top
Dart Controls, Inc.
Variable AC Voltage Supply 55AC
A dependable, economical and compact variable AC voltage supply manufactured especially for the vibratory feeder, fan, pump, heating, and lighting industries. All models feature single-phase AC input and fully variable AC output. The enclosed version comes with a rugged housing, power on/off switch, power on indicator lamp, front access fuse, as well as convenient input and output cords and plugs. The heart of the control is a triac fired in a manner to adjust phase and thereby vary speed... (read more)
Browse AC Motor Drives Datasheets for Dart Controls, Inc.
Microchip Technology, Inc.
Expansion of its 8-bit PIC® Microcontroller (MCU)
to reduce design complexity, by eliminating the need for additional code and external components. This high level of integration makes these MCUs appealing to a broad range of applications, such as monitoring and fail-safe systems (e.g., industrial machinery, power supplies), and products with variable-speed motor control (e.g., fans, home appliances). . . First PIC MCUs to offer hardware Zero Cross Detect (ZCD), which is essential for designers looking to simplify TRIAC... (read more)
Browse Microcontrollers (MCU) Datasheets for Microchip Technology, Inc.
More Information Top
CR4 - Thread: Diode speed control and uneven brush wear
Personally I would a triac motor control unit as it would give much greater flexibility and steadier torque.
Design Considerations for Microcontroller Based Process Control for Washing Machine
Fig.7 Triac Controlled Motor Driver Circuit .
Active vibration control of a kitchen hood via piezoelectric patch
These frequencies are produced by the triac motor speed control , which cuts the feeding voltage to reduce the motor velocity.
1994 Combined Subject Indexes - IEEE Industry Applications S
2-phase capacitor induction motor control , triac , simul.
IEEE transactions on magnetics cumulative index 1985-2000 volumes 21-36 [Subject Index]
effect of ferrite mag. wedge on characteristics of split-phase capacitor motor under triac control .
Index Subject
… motor with flux regulation; Sen, Paresh C.; T-IECI Feb 81 17-21 supersynchronous Scherbius induction motor system; state equations for control system synthesis; Tsuchiya, Takeshi; T-IECI Aug 81 194-200 two-phase motor controlled by triac ; torque performance; Karybakas, C …
Performance prediction of shaded pole induction motors
… aims mainly at the following: To present a simplified analysis that extends the con- cepts introduced by Desai and Mathew [17] to a general case to predict the steady-state characteristics of shaded pole motors controlled by triac to investigate the effect …


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This item from Catisfaction's Glass Gallery is now in the Shop Backroom
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Peggy Karr Fused Glass Bowl Pears Fruit Art Glass Signed
Item ID:BF015040c
Peggy Karr is one of the most popular Fused glass artists of her day. Producing a myriad of botanical, animal and artsy patterns.
I am pleased to be able to offer you this single bowl with a Pear design. The plate measures 8 1/2" in diameter and is signed P. Karr on the rim followed by some more letters I cannot make out.
In very good condition it has some light wear from age but no chips, nicks or cracks at all.
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When Candy Fisher's dog, Chrissy, was attacked by a pit bull two years ago, she spared no expense getting her the best medical treatment at her vet.
Candy says, "I don't even think about these things. I take her all the time because I want to be sure that she's taken care of."
Candy's not alone. Even during this recession, spending on pets grew to $48-billion last year. But Consumer Reports finds there are plenty of ways to tame your pet costs and still get good care.
First, comparison shop for veterinary care. A good benchmark is how much a vet charges for a physical exam.
Greg Daugherty with Consumer Reports says, "You probably won't find huge differences in the costs, but this could be a good indicator of other costs, such as major procedures that can add up to a lot of money."
Also, if your pet needs any medication, don't automatically buy the meds from the vet. Vets typically charge at least 100% more than wholesale and sometimes even more than that.
Greg explains, "Some medicines have an even bigger markup, like a whopping one-thousand percent markup on the antibiotic amoxicillin."
And if your pet is taking a medicine that's also prescribed for humans, check into filling the prescription at your pharmacy. You may be able to save a lot of money.
Also consider new money-saving options for flea and tick control treatments. Some highly effective ones are now available since the patent expired on a key ingredient in Frontline Plus.
The savings - a three-month supply of Walmart's PetArmor Plus costs $28, less than half of what Frontline Plus goes for.
So there are lots of ways to save without sacrificing care.
As for pet insurance, Consumer Reports says it's rarely worth the expense.
In its latest comparison of pet-insurance policies, Consumer Reports found that only in the most uncommon cases - when medical bills reached the high four figures - did it pay to have pet insurance.


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LOUISVILLE, Ky. -- Louisville athletic director Tom Jurich knows the lurid details that came to light during the trial of a woman who tried to extort millions from Rick Pitino could affect some people's perception of the highly successful coach.
Jurich isn't one of them.
He reiterated his support for Pitino on Thursday after a jury found Karen Cunagin Sypher guilty of three counts of extortion, two counts of lying to the FBI and one count of retaliating against a witness.
Pitino acknowledged during six hours of testimony that he had a sexual encounter with Sypher at a Louisville restaurant in July 2003. She demanded millions in exchange for her silence, leading Pitino to eventually tell authorities about the plot.
"I feel very proud in the fact that he did own up to everything," Jurich said. "He understood the consequences taking this to the U.S. Attorney, taking this to the government. He knew his name would be dragged through the mud but he also wanted the facts out there because the only thing that would vindicate him in this case were the facts."
Jurich stressed "there were no winners" in the process but added the university would not discipline Pitino for his conduct. Pitino publicly apologized last summer for what he then called an "indiscretion" at the request of university president James Ramsey.
Pitino, who was not available for comment after the verdict was announced, signed a four-year contract extension in the spring that will keep him at Louisville through 2017.
"He's a grand ambassador for this athletic program," he said. "When he came here [in 2001], it was a difficult time for all of us and he's made it much, much better. This is an error in judgment, which he's always said and been up front with and I certainly think it won't happen again."
Juror Charles Smith, who acknowledged he's a Louisville fan, said he didn't come to any conclusions about Pitino or his character.
"He was not the one on trial here," Smith said. "Whatever was being said about him during the trial never affected me at all."
Jurich has no concerns whether the trial will impact Pitino's job performance, pointing out that Pitino went straight from the witness stand to the recruiting trail.
"He spent the last days of the live [recruiting] period going 180 mph, so he's very committed to making this work," Jurich said.


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PHOENIX-When GLL Real Estate Partners recently paid $21.6 million to acquire the 159,764-square-foot Papago Spectrum as part of a CMBS package from special servicer C-III Asset Management LLC in Irving, TX, the German buyer received a class A, multi-tenant building that was 91% occupied. However, as Jones Lang LaSalle senior managing director Dennis Desmond tells GlobeSt.com, getting to the closing table was an interesting process.
"The entire process took about 18 months," confesses Desmond, who partnered with JLL senior vice president Brian Ackerman to market the office building at 1225 W. Washingtonon behalf of the seller. "An encroachment was uncovered." The encroachment in question was an Salt River Project Power & Water (SRP) line running under the building. "It took a lot of doing to determine if a) it was live; b) it was secure and c) who should do something about it," Desmond says. Adding to the issue was that, during the process of determining responsibility for the power line, the servicer that had hired JLL was sold to another servicer, further muddying the waters.
It should probably come as no surprise that Papago Spectrum's escrow period was somewhat rocky. The office building came online in 1999 and was acquired by Triple Net Properties LLC in 2005 for $26.3 million. But Triple Net, which went through several incarnations of its own because of the Great Recession, ran into problems with the loan, and Papago Spectrum was foreclosed on in 2010.
But Desmond says that, despite the woes befalling the building and its former owner, Papago Spectrum had done fairly well during the Great Recession and its aftermath. He and Ackerman received a great deal of interest during the marketing period.
But even as closing approached, another issue came up. "Not too many weeks before closing, University of Phoenix (which is one of the main tenants of the building) identified space it was going to put on the market for sublease," Desmond comments. Though this might seem to be alarming, "the buyer wasn't too concerned about it," Desmond says. "That submarket has been historically strong. During the past 5-6 years, the vacancy has been around 5%." GLL is planning cosmetic upgrades, mainly to clean up the common areas and the lobby.
In the meantime, Desmond has some kind words for the buyer, which has been active in the Phoenix area. "GLL was the buyer we selected through the marketing process, and they were terrific to work with," he says. "It wasn't an easy transaction, but they stuck with it."


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Curry and ginger add an interesting spice to squash, while apple adds a touch of sweetness. Serve as the first course before a pork or beef entrée.
8 servings (serving size: 1 cup)
More from Oxmoor House
Recipe Time
Prep: 15 Minutes
Cook: 49 Minutes
Nutritional Information
Calories 114
Caloriesfromfat 21 %
Fat 2.7 g
Satfat 1.3 g
Protein 4.6 g
Carbohydrate 20.1 g
Fiber 2.9 g
Cholesterol 8 mg
Iron 1 mg
Sodium 358 mg
Calcium 113 mg
1 teaspoon canola oil
1 3/4 cups onion, diced (about 1 large)
2 garlic cloves, minced
1 tablespoon curry powder
1 medium butternut squash, peeled and cubed (about 3 1/2 cups)
1 large Granny Smith apple, peeled and chopped (about 2 cups)
2 teaspoons bottled minced ginger
1 (32-ounce) container fat-free, less-sodium chicken broth
1/2 cup reduced-fat sour cream
3/4 cup fat-free milk
1. Heat oil in a Dutch oven over medium-high heat. Add onion and garlic; sauté 4 minutes. Add curry powder, and sauté 1 minute. Add squash and next 3 ingredients. Bring to a boil; reduce heat, and simmer, uncovered, 30 minutes.
2. Place half of squash mixture in a blender; process until smooth. Repeat procedure with remaining squash mixture. Return to pan. Stir in sour cream and milk; cook over medium heat until thoroughly heated.
October 2006


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Walking to Ease Knee Pain
It's a catch-22 when you have knee pain from osteoarthritis. It hurts, so you don't want to move. But if you exercise, it can eventually make your knees feel better. "I've gone a period of time when I haven't moved a joint much and, when I first start, it's a little bit sore," says Denver physical tRead Full Article
Knee Replacement Brings Less Pain, Better Function
By Steven Reinberg HealthDay Reporter WEDNESDAY, Oct. 21, 2015 (HealthDay News) -- Total knee replacement usually results in greater pain relief and better joint function after a year than nonsurgical arthritis treatment, researchers report. But baby boomers shouldn't automatically rule out physicalRead Full Article
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By Steven Reinberg HealthDay Reporter WEDNESDAY, June 17, 2015 (HealthDay News) -- Arthroscopic surgery to relieve chronic knee pain in middle-aged and older patients is only temporarily effective and might be harmful, a new analysis suggests. Researchers who reviewed 18 studies recommended againstRead Full Article
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PRO Research
Asanko Gold Is An Undervalued Long-Term Gold Play; 137% Upside Potential
Christopher De Sousa
Christopher De Sousa
Asanko Gold's Risk/Reward Is Far Less Favorable Than It Was
Ben Kramer-Miller
Ben Kramer-Miller
Dec. 17, 2013, 8:27 AM
- Asanko Gold (AKG) agrees to acquire PMI Gold (PMVGF) in an all-stock transaction valued at ~C$183M, to create an emerging mid-tier gold producer with a pathway to 400K oz. of annual gold production.
- A highlight of the deal will be the combination of the neighboring Esaase and Obotan gold projects in Ghana, with a combined resource base of 7.5M oz. measured and indicated resources and an additional 2.9M oz. inferred resources, of which 4.8M oz. are proven and probable mineral reserves.
- A merger attempt last year by the two Ghana miners was dropped when it appeared the deal wouldn't get enough support from PMI shareholders.
Feb. 19, 2013, 9:29 AM
Keegan Resources (KGN) and PMI Gold (PMVGF.PK) agree to terminate their merger plans, saying it was unlikely PMI's shareholders would approve transactions related to the arrangement. The companies say the termination was not caused by "any differences between the respective boards about valuation issues or on account of any new facts having come to their attention."| Feb. 19, 2013, 9:29 AM
Dec. 5, 2012, 9:39 AM
Keegan Resources (KGN -2.5%) and PMI Gold (PMVGF.PK) agree to merge, forming a new West African gold development company that will operate as Asanko Gold. The new entity expects a boost in near-term production from a unitized project comprised of nearby Obotan and Esaase gold deposits.| Dec. 5, 2012, 9:39 AM
Company Description
Asanko Gold, Inc. is a natural resource company, which engages in the acquisition and exploration of mineral resources in West Ghana. Its projects include Esaase Gold and Asumura Gold. The company was founded by Ivan James Bebek and Shawn Kristen Wallace on September 23, 1999 and is... More
Sector: Basic Materials
Industry: Gold
Country: Canada
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