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Slate Cheese Board
Presentation is everything. Brooklyn Slate Company manufactures a rustic slate slab perfect for displaying cheeses at your next dinner party. They even provide a soapstone pencil to identify your...
Bistro Citrus Juicer by Bodum
Who doesn't like to wake up to breakfast in bed with a fresh glass of juice? Available in six flashy shades, it's a great gift (not to mention subtle hint) to your significant other (or roommate!)....
Organic Basil Bamboo Grow Pot
I deem having fresh basil on hand a necessity. Presented in a sustainable bamboo pot, this is one green gift that keeps on giving.
Homemade Cookie Stamp
This adorable stamp puts the age-old question to rest, "did you make these from scratch?" Skip the pre-made cookie aisle and pull out Grandma's famous sugar cookie recipe, because you...
Heath Tea Towels
Heath Ceramics has been creating beautiful tiles and tableware for over half a century, so it's no surprise that we fell in love with these tea towels. This unique design features silhouettes of...
Taika Plate
A friend who recently got married registered for Taika dinnerware, and I was immediately smitten with Klaus Haapaniemi's whimsical illustrations for this Iitalia line. Taika (which means "...
Kuksa Finnish Camping Cups
We love these hand-carved cups, made from rare arctic birch burl and outfitted with a reindeer leather strap. Apparently the cups are antiseptic and don't need to be cleaned between uses, so they...
Plus Salt and Pepper Grinder
This salt and pepper grinder, designed by Norway Says for Muuto, is available in white, black, and natural beech wood, but our favorite is this playful multi-colored version. The stacked components...
Fold Unfold Tablecloth
I ogled this digitally printed tablecloth at the design store HAY in Copenhagen, and was pleased to discover it's available stateside as well. The design, by Copenhagen-based textile and color...
Cork Trivet
The simplest and cutest trivet I've seen in a while, from the Danish company Ferm Living. A chain of cork balls on a raw leather string—so simple, so clever. Plus, affordable!
Edition 10 Headphones
Yes, there is a pair of headphones that costs as much as a home audio system. The price of the limited-edition Ultrasone Edition 10 is only slightly justified by the fact that only 2,010 pairs of...
NPR Radio
The NPR radio connects via wireless to over 20,000 internet radio stations across the globe, and a portion of the price tag goes right to the beloved non-profit radio station.
Site of Sound: Of Architecture and the Ear Vol. 2
The anticipated follow-up to volume one from 1999, this anthology explores the space between sound and architecture, from "acoustical technologies" to public art and urban planning. Plus,...
Rough Trade Album-of-the-Month
London's Rough Trade pioneered the music-as-retail strategy, so trust that this isn't your average CD subscription service. A 3-, 6-, or 12-month membership locks down the must-hear album of the...
Speak-er Desktop Speakers
Desktop speakers aren't known for their high aesthetic factor; luckily, designers like music, too, and are working to jazz up the littles boxes of sound.
Masters Chair
For this versatile indoor/outdoor seat, Philippe Starck mined the silhouettes of the Arne Jacobsen Series 7, Eames Shell chair, and Saarinen Tulip armchair. Available at the Dwell Store
Keep your desktop writing implements neat and tidy with this silicone holder available in red, black, and white.
Round & Round Calendar
A spin of the finger rotates the plastic panels to reveal the day of the week, date, and month.
Cubes Perpetual Calendar
A plastic rendition of classic wooden blocks, Cubes makes a splashy desktop addition. Its petite size keeps its bright colors from overtaking your workspace.
Perpetual Calendar
Magnets rule! One sphere miraculously "floats" toward the month while the other slides along the horizontal rail to indicate the date.
Calendario Bilancia
Move these wood strips side to side to align the date in the middle, but beware: They're a bit wobbly and won't stay completely parallel when left or right of center.
Letter Opener and Paperweight
Our Stone Age ancestors used flint as a primitive tool and today, more than 700,000 years later, French designer Ora-Ïto looked to this artifact to influence his elegant letter opener and...
Krenit Bowl
When the enameled steel Krenit bowl was first released in the 1950s, its designer Herbert Krenchel said, "The idea was to make a beautiful bowl, preferably so functional and delicate that it...
Claude Dresser
The special edition Claude dresser marries two of the 1970s favorite colors, avocado green and mustard yellow, with a rich walnut frame. This blast from the mid-century past and can add a retro...
Artek Shelving System
The grown-up version of Ikea, Naoto Fukasawa's Shelving System for Artek is a vision of modular minimalism. Taking another step in cementing Artek's legacy of Scandinavian simplicity, the lacquered...


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OSBR: Women in Open Source issue
ROSE Blog: Rikki's Open Source Exchange
I'm so happy (thrilled, really) to have been the guest editor for the June 2009 issue of The Open Source Business Resource: Women in Open Source. Inside this issue you'll find articles by Cathy Malmrose, Cat Allman, Angela Byron, Emma Jane Hogbin, Audrey Eschright, Stormy Peters, Melanie Groves VonFange, Selena Deckelmann, and Amanda McPherson. I owe a big thanks to Dru Lavigne for asking me to be a part of this cool issue, and to all the women who spent their time and energy writing such great articles.
Even though the theme of this issue is Women in Open Source, the articles are useful for anyone interested in the world of free and open source software. More than just women, the noticeable theme running through all the articles is inclusion – the authors don't just discuss getting more women involved in open source, they look at how to help any and everyone join our vibrant community.
I look forward to working with all the women involved with this issue again in the future, and I hope you enjoy reading their articles as much as I did.comments powered by Disqus
Issue 26: Linux Shell Handbook 7th Ed./Special Editions
Buy this issue as a PDF
SUSE Joins the Microsoft Test Drive Program
Customers can take a free test drive of SLES for HPC on the Azure Cloud
SiFive Launches a Line of Open Source Chips
San Francisco-based chip company announces their first fully open source chip platform.
Fedora 24 Released
The whole distro gets rebuilt on glibc 2.3
Canonical Announces Cross-Distro Support for Snaps
Ubuntu Vendor tries to solve app packaging and distribution problem across distributions.
ownCloud Forked
Founder of ownCloud launches the Nextcloud project.
HP Enterprise Unveils a Futuristic Computer
Will The Machine change the way future programmers think about memory?
CoreOS Announces Distributed Storage System
The new Torus distributed storage system is available under an open source license on GitHub
Google Beats Oracle in the Android Lawsuit
Juries decides Google's use of Java APIs Was Fair Use
Linux is the Largest Software Development Project in History
But if you are not using the latest Linux kernel, your system is insecure.
Linksys Says Yes to Open Source Firmware
Home routers will give room for custom firmware but still comply with FCC rules

subset: commoncrawl


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Add the classic look of the BULLITT Mustang to your S197 with these 2005-2009 Mustang Bullitt wheels. Featuring a 5 spoke retro design, these wheels will give your Mustang a new show winning look. Available in anthracite, black, and chrome, it's easy to find the perfect match for your paint job. Want a more aggressive look? Choose a wheel kit with deep dish wheels for the staggered look and wider tires in the rear.
Fitment: 2005, 2006, 2007, 2008, and 2009 Mustangs.
Spring is around the corner . Updated photos on a beautiful week end . 1 up grade done installed 3:73 rear end gears over the past week .wow,! What a difference that made .


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Norwich OH Real Estate & Homes for Sale
6 Properties Found
The median home value in Norwich, OH is $122,750.
This is
higher than
the county median home value of $103,400.
The national median home value is $177,414.
The average price of homes sold in Norwich, OH is $122,750.
Approximately 84.78% of Norwich homes are owned,
compared to 6.52% rented, while
8.7% are vacant.
Norwich real estate listings include condos, townhomes, and single family homes for sale.
Commercial properties are also available.
If you see a property you're interested in, contact a Norwich real estate agent to arrange a tour today!
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115 Country Cir Norwich, OH 43767
Courtesy: Carol Goff & Associates
View additional info
Absolutely gorgeous! 4 bedroom brick and cedar one floor plan home. Vaulted great room with fireplace (opens to kitchen) 2 large Master suites. Formal dining room. Oversized garage plus extra building w/ concrete floor. Wet bar in lower level. Public water, gas heat, central air.
220 Linvale Dr Norwich, OH 43767
Courtesy: Carol Goff & Associates
View additional info
Fabulous updated 3 BR 2 Bath Ranch in EMSD. Finished basement w/ FR and an additional bedroom & laundry room. Slightly over 1/2 acre level lot. Beautifully landscaped. Original owners.
10775 Belle Dr Norwich, OH 43767
Courtesy: Carol Goff & Associates
View additional info
Immaculate 3 bedroom, 2 1/2 bath brick ranch. Fully appliance kitchen w/ corian countertops. Open floor plan opens to family room w/ fireplace and newer sunroom. Large lot w/ great patio. 4' hall ( handicap access). Finished walk out lower level. All windows have been replaced with energy efficient windows. 1st floor laundry, gas heat, public water, c/a, paved drive.
475 Zane Grey Rd Norwich, OH 43767
Courtesy: Lepi & Assoc.
View additional info
Brick home on 5 acres , 2 acres with electric fencing , building has and electric , water great for an animals , home offers 5 bedrooms 2 fireplaces full kitchen in lower level great for in-law suite and great for entertaining . Great room has a cathedral ceiling stone fireplace that flows out to a covered deck . 2 car attached garage plus 2 car detached
1655 S Cove Ln Norwich, OH 43767
Courtesy: Lepi & Assoc.
View additional info
Excellent property for horses! Well maintained 3BR ranch on 10 acres with beautiful views of the countryside. Oversized storage building.
Courtesy: Carol Goff & Associates
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4 bedroom, 1 bath for**** RENT ***** $950 per month plus utilities. RENTAL ONLY
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Norwich ZIPs43767 Homes for Sale


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Grey Gelding, "Zeke" 17 years old Canadian Horse Breed, no papers Approx 14 h. h. good feet quiet, gentle, well-mannered has been driven, been…SOLD
Terracotta is a very sweet horse she will walk right up to you. She stands for the farrier, loves taking baths, loves to be hosed off in the summer when…SOLD
Gazel is train under saddle & harness in single & double. She did parades under harness and under saddle, she is not afraid of anything. She has a good…SOLD
Torial is broke to ride, and you can walk right up to him. Torial loves to ride for hours and loves kids. He is a very easy to load into a trailer as well…SOLD
SOLD SOLD SOLD !!! We call them " Canazzans ". This horse crossbreed develops slower than most other breeds (just like the Canadians and Lipizzans do)…SOLD
Canadian / Lipizzan Cross - We call them " Canazzans ". This horse crossbreed develops slower than most other breeds (just like the Canadians and Lipizzans…SOLD
Adonis is a registered 8 year old, big, strong black Canadian gelding. He is 15.1 hands. I never have to chase him, he catches me! He puts his head in…SOLD
Katch me is an athletic 11yr old 16hh registered Canadian Horse gelding (Laroche Fidele Kevin). Proven eventer at the Preliminary level, and has recently…SOLD


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Monarca Hoteles, Buenos Aires
- Free WiFi
Main amenities
- 35 guestrooms
- Restaurant and bar/lounge
- Breakfast available
- Business center
- Airport shuttle
- Childcare
- 24-hour front desk
- Daily housekeeping
- Car rentals on site
- Front desk safe
- Snack bar/deli
- Laundry service
What's around
- In Downtown Buenos Aires
- Plaza San Martin (0.5 mi / 0.8 km)
- Torre de los Ingleses (0.5 mi / 0.9 km)
- Teatro Colon (0.7 mi / 1.1 km)
- Obelisco (0.9 mi / 1.4 km)
- Plaza de Mayo (0.9 mi / 1.4 km)
For families
- Free cribs/infant beds
- Babysitting or childcare (surcharge)
- Rollaway/extra beds (surcharge)
- Refrigerator
- Private bathroom
- Premium TV channels
Monarca Hoteles, Buenos Aires
Hotel Info: 866-539-8117from $52
- Triple Room, 3 Single Beds
- Quadruple Room
- Standard Room
- Monarca Promotion
Also popular with travelers from the USA
At a glance
Key facts
Hotel size
- This hotel has 35 rooms
- This hotel is arranged over 6 floors
- Check-in time 2 PM-midnight
- Check-out time is 10 AM
- Express check-in
Airport shuttle service is available on request. Contact the property in advance to make arrangements.
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
- Minimum check-in age is 18
Travelling with others
- Children (2 years old and younger) stay free when occupying the parent or guardian's room, using existing bedding
- Babysitting/childcare *
- No pets or service animals allowed
- Free WiFi and wired Internet access in public areas
- Free WiFi and wired Internet access in rooms
- Airport shuttle (available on request) *
- No parking
- Discounted offsite parking
- Area shuttle *
Nearby Three Star Buenos Aires hotels
In the hotel
- Buffet breakfast daily (surcharge)
- Restaurant
- Bar/lounge
- Coffee shop/café
- Snack bar/deli
- Room service (during limited hours)
- Business center
- Conference space size (feet) - 926
- Conference space size (meters) - 86
- One meeting room
- 24-hour front desk
- Concierge services
- Tours/ticket assistance
- Dry cleaning/laundry service
- Laundry facilities
- Luggage storage
- Wedding services
- Porter/bellhop
- Number of buildings/towers - 1
- Year Built 2009
- Elevator/lift
- Safe-deposit box at front desk
- Accessible bathroom
- In-room accessibility
In the room
- In-room climate control (air conditioning)
- Air conditioning
- Minibar
- Iron/ironing board (on request)
- Turndown service
- Premium bedding
- Private bathroom
- Shower only
- Hair dryer
- 26-inch LCD TV
- Premium TV channels
- Desk
- Free newspaper
- Free WiFi
- Phone
- Refrigerator
- Daily housekeeping
- In-room safe (laptop compatible)
Top Buenos Aires hotels
Recently reviewed hotels in Buenos Aires
- BoBo Hotel and RestaurantFrom
"had a fantastic time; everyone was super helpful!"Jun 13, 2016
- Two Hotel Buenos AiresFrom
"This hotel was built in the recent years and maintains its condition. Room s are not large, but there is room for everything. Beds are comfortable, rooms and all facilities are…"Jun 13, 2016
- Tango de Mayo HotelFrom
"Could not figure out when lobby bar open. It was there but never saw it open. "Jun 12, 2016
- CasaSur Bellini HotelFrom
"I have nothing but incredible things to say about this hotel. This may have been the best hotel I've stayed in my life. The room was both very stylish and comfortable and the…"Jun 12, 2016
Nearby hotels
Special features
DiningMonarca - This diner serves lunch and dinner. Guests can enjoy alfresco dining (weather permitting).
Monarca Hoteles, Buenos Aires's small print
Also known as
- Monarca Hoteles
- Monarca Hoteles Buenos Aires
- Monarca Hoteles Hotel
- Monarca Hoteles Hotel Buenos Aires
Only registered guests are allowed in the guestrooms.
Optional extras
Rollaway beds are available for ARS 350 per night
Buffet breakfast is offered for an extra charge of ARS 140 per person (approximately)
Babysitting/childcare is available for an extra charge
Airport shuttle service is offered for an extra charge
Area shuttle service is offered for an extra charge
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.
Recent reviews
Good 3.8 /5 from 130 reviews
Loved Hotel Monarca! The location was great and a short walk to to Casa Rosada and Avenida 9 De Julio. The room was very comfortable. The breakfast was a bit lacking though there needed to be something else besides just bread items but hotel staff was friendly and I enjoyed my stay here and would stay here again in Buenos Aires!
Nothing fancy and few additional amenities, but a clean stay in the heart of downtown. Well worth the price.
If you want to be near microcentro. This is a good budget option.
Pleasent small hotel in good position, helpfully staff
pleasant staff, very helpful and friendly. The room was OK and served our purposes.
Is the description of this hotel not correct? Tell us


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3 Reviews
Great! I made this a while back and made only half the recipe which still made a whole lot. One thing I did differently was that I always soak the wheat berries for several hours before I cook them (typically overnight). I had the standard mozarella from the grocery story. This was delicious. I will definitely make it again - and it could be changed up with different vegetable ingredients. Thanks for posting!
This was healthy and tasty, but I think I'd use less onions if I make it again. It's very filling and perfect for summer!
This salad was SOOOO GOOOOOD!!! I'd never tried wheat berries before, and I really loved it. It was delicious and healthy, a dish that feels good to eat. Great to just have in the fridge if you get hungry and need something quick , healthy and filling. Thanks for posting a fantastic recipe, ALIONO!! UPDATE: I made this again, halving the recipe with the left over barely and wheatberries from the first time I made it. I made a few changes; this recipe is very versatile. I didn't have corn or mozzarella, so I subbed blanched asparagus and chunks of good parmesan. It is SO GOOD!!!


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Hot answers tagged email
You can use Evernote to append to Existing Notes via Email
Quicksilver, despite being often referred to as just an application launcher, does index everything on your desktop machine; then it provides all kind of actions once you have located a set of items to work upon. Together with a well-thought file tagging policy (OSX feature), you have a dynamic metaview of all your assets. IMHO all efforts are useless if ...
I would consider using OneNote by Microsoft. You can have Gmail for email and manage it using Microsoft Outlook with POP/IMAP turned on. You can also manage Google Cal via Outlook as well. You wouldn't need to be online all the time. Only when you want to refresh data from gmail or gCal. This solution will also work on MacOSX.
Recently I have become really into CintaNotes. It's a desktop application for Windows, which allows you to quickly clip text from other applications. It doesn't require any plugins and works really fast. Each time I come across any doable task while reading my emails, I just select this text and press Ctrl+F12 and that's it. CintaNotes automatically ...
Only top voted, non community-wiki answers of a minimum length are eligible


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Why are there no free really good themes for Classified Ads? The ones for sale are not good enough, and, even worse, most of them actually lock you in for life since you lose all updates after you stop your subscription.
I am looking for a theme that I can use for Classified Ads and integrate with BuddyPress and WooCommerce. Can anyone please recommend the best theme for this purpose.
Can any really good WP theme creators out there create such a theme - there are literally thousands of WP users looking for such a theme.


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December 20, 2013
Emergency hauling declarations, suspending hours of service rules for truck drivers, are piling up across the nation.
In Iowa, Gov. Terry Branstad has approved one for drivers of commercial motor vehicles transporting propane. The order is in effect through Jan 2.
The problem also extends to New Hampshire, but covers truckers hauling several types of fuels, including diesel and gasoline. The hours of service exemption for qualified haulers of fuels is in effect through the end of the year.
Finally in Massachusetts, an emergency declaration has been issued suspending hours of service rules for truckers hauling gasoline. It is in effect through Dec. 23.
So far this month at least five other states have issued emergency hauling declarations due to various fuel shortages, with most remaining in effect.
You can see all current and past emergency declarations on the FMCSA website.
If the hos is about SAFETY why in the world would they be suspending them for the most dangerous products?
We offer e-newsletters that deliver targeted news and information for the entire fleet industry.
The expert, Brian Fletcher from Eaton, will answer your questions
Gates Offers 6 Heavy-Duty Water Pumps
Reyco Granning DM400e is Lighter Than Predecessor
Baldwin Filters Offers Aftermarket Filter Designed for Kenworth Models
ARI Introduces Driver Scorecard for Simple Analysis


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Smart design paves the way for optimal building-grid interactions.
Implement a water management plan without ballooning your budget.
Snap-in designs cut installation cost for office and high-bay applications.
Utility charges for commercial and industrial facilities are made up of two major parts, energy charges and peak demand charges. Energy usage, measured in kilowatt hours (kWh), reflects the total amount of energy consumed during a billing cycle; peak demand, measured in kilowatts (kWp), reflects the greatest amount of power or load during a specific period over the billing cycle (typically calculated for a 15-minute interval). In many regions of the U.S., peak demand charges are the fastest growing part of utility bills for commercial and industrial customers and can often represent as much as 50 percent of a company's monthly utility bill. Behind-the-meter energy storage solutions are now emerging which can cost-effectively cap peak demand usage. Here are 5 Things You Need to Know about Energy Storage:
1) It Can Reduce the Peak Demand Usage Part of your Utility Bill Without Changing Day-to-Day Operations
As mentioned above, the peak demand charge is typically derived from the greatest power load over a 15-minute interval during a billing cycle. Energy storage systems used for demand management store energy during periods of low building load (often during off-business hours) and deploy that energy when building load is at its highest – decreasing the amount of peak power being drawn from the grid and lowering peak demand usage. This is an alternative to a curtailment program and allows the building to maintain its normal daily operations.
2) Solar Doesn't Make Sense? Solar Plus Storage May
In some cases, installing solar on its own may make economic sense if a large enough system can be deployed to benefit from a favorable utility tariff. However, many buildings simply do not have enough rooftop space to support a solar system large enough to offset a sufficient amount of the building's energy requirements. But, for these customers, a smaller solar installation paired with storage can be economically viable. Coupling an energy storage system with sophisticated analytics and system controls to manage the release of energy at an optimal time, together with a solar installation, enables optimized utility bill savings on both peak demand and energy usage. A solar PV system makes storage more effective by narrowing the demand peaks and storage makes solar more effective by firming the demand savings - the two work in concert.
3) You Don't Need an Engineering Degree to Manage a System
As a building owner or facility manager, you don't need to put a lot of thought into your system. The right system will not only predict the building's energy consumption, but will know when a peak is about to begin. It will then discharge its battery to offset those peaks. Effective energy storage systems will be able to do this automatically, without any intervention from the building owner. When you select a system, you should also take into consideration the supplier's available warranty and service agreement. Many systems today include maintenance packages that remove the headaches of managing a system and can eliminate operating and maintenance (O&M) costs. However, since energy storage is an emerging market, it's important to understand and trust the company backing the system.
4) ROI Can Be Seen in Four Years or Less
The economics of solar plus storage are increasingly attractive. Select systems can provide a good return on investment with a payback period of less than four years in areas with high utility charges. We are also beginning to see the introduction of zero-down financing options for these systems, making them more financially accessible for those of you looking to take control of your bottom line but don't want to worry about upfront costs.
5) Big or Small, Storage May Be a Good Solution For Your Building Size
There is not one specific building type or building size that is suitable for energy storage. Actually, there are a wide variety of commercial and industrial buildings that would benefit from an energy storage system for demand management, especially when the system is deployed together with solar PV. What matters in making this determination is the energy usage profile of the building itself. In general, facilities that are likely candidates for energy storage have somewhat consistent day-to-day operations, where they experience times of high energy demand throughout the day. For example, manufacturing facilities where heavy machinery is consistently operating at near maximum capacity every weekday between 10 a.m. and noon and again between 1 p.m. and 4 p.m., or schools that run most of their electricity between 8am and noon and again between 1 p.m. and 3 p.m. are likely candidates for peak demand management. Another factor in determining if your building is a good candidate for a demand management system is if your building is in a region being hit by high peak demand charges, such as California, Hawaii, Massachusetts, New York, Arizona, Colorado and New Mexico.
Carl Mansfield is General Manager and Founder of Sharp Electronics Corporation's Energy Systems and Services Group (ESSG).
Facility managers have been asked to do more and more as their budgets have decreased, equipment has aged, and experts in the field are retiring. It's no surprise, given the constraints they face, day-to-day that buildings are not run as efficiently as they could be.
Verifying that a building's HVAC and lighting systems perform efficiently and according to the design intent and owner's project requirements can offer enormous savings. The DOE estimates that a building that is not running correctly costs 8-20% more to operate.
The same DOE energy study of 60 commercial buildings reported that:
Many facility managers are turning to modern centralized standardized reporting, to help prioritize work and move from a reactive to proactive approach to facility operations.
This type of software pulls data from existing systems and identifies areas for improvement. It provides more context around issues to help teams manage their work flow more efficiently. In particular, new plug-and-play software allows small-to-medium sized commercial buildings to use automated data alignment for rapid and affordable onboarding. Most buildings have data that can help reduce operation time of equipment, improve tenant comfort, and potentially make an impact on the environment, and centralized standardized reporting can turn that data into actionable insights used to streamline operations.
The new technologies which act as a cloud-based analysis tool, work with existing and legacy systems, and address the issues of fault detection and diagnostics. Data can be monitored and analyzed 24-hours a day.
When the data is examined, what are the major problems? How can buildings leverage it to lower costs and increase environmental impact?
Problems tend to fall into three distinct areas:
How often your data should be reviewed and audited will depend on how often your building has schedule changes and the variation in your area's seasons. Sequences can be set up and appear to run fine in winter and colder months, but issues can become apparent during summer time. Experts recommend checking setpoints and schedules quarterly and sequences during cooling and heating periods in fall and spring.
While interim measures such as raising or lowering the setpoint so the unit is always heating or cooling can be temporarily effective, they don't address the actual issue. Consider resetting all setpoints during unoccupied hours. This will reduce the runtime of your equipment increasing its overall life.
Minimums and maximums should also be applied. Deadbands should not just be +/- one or two degrees on a general setpoint. ASHRAE design standards recommend not allowing heating setpoints above 70 or 72, and cooling setpoints shouldn't be lower than 74 or 76. Each degree outside of intent increases the runtime of your equipment, reducing its life. It also makes equipment cycle rapidly, reducing tenant comfort.
Additionally, equipment performance needs to be verified. Just because the schedule is set correctly does not meant the equipment is following it, so FMs need to verify schedule adherence with runtime data from the equipment.
Maximum schedule resolution will result when zone level scheduling is used. Buildings should avoid a single schedule for the entire building. For example, holiday and exception scheduling can be nested to apply global changes from one location. Finally, effective optimal start maintains a memory and trains itself to heat or cool based on the individual zones rate of change in heating or cooling mode.
While many of these things can be manually identified, the time to do so reduces the amount of time the facility team can be in the field fixing problems and working with tenants. By leveraging modern analytics, teams are realizing improvements not only to their team's effectiveness but also to their building operations and tenants' happiness.
Jason Burt is the VP Product Manager & Co-CEO of BuildPulse. You can reach him at www.buildpulse.com or by e-mail at email@example.com.
Whether you need to heat, cool, power, sweep, lift or reach, Sunbelt Rentals has the equipment and unlimited solutions to solve any challenge. 24/7. Nationwide.
5 Amazing Facts About Room Temperature!! 20 Industry-Leading Solutions for Energy-saving HVAC Systems!! Armstrong Design Envelope
Red Hawk: A comprehensive range of contemporary fire and security solutions. One that's just right for your business. That's the power of experience.
Dynamic floorplans can help simplify facility operations, check out this valuable industry advice to learn more.
Read the rest of entry »
Continuous power monitoring could benefit your building's operations – check out this valuable industry advice to learn more.
Energy efficient lighting is now providing long-term higher quality of light while offering a short-term return on investment. Check out these tips to achieve better energy efficiency in your building.
Take a look at these services that security personnel may be able to fulfill in addition to regular duties.
Put your building on the track to efficient operations with these energy management tips.
Cut energy consumption in your building with these HVAC tips.
No matter how large or small your operation is, make sure your security solution can keep up with expected growth.
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Manual of Structural Kinesiology Paperback – Nov 13 2008
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About the Author
R.T. Floyd is in his thirty-second year of providing athletic training services for the University of West Alabama. Currently, he serves as Director of Sports Medicine and Athletic Training for the UWA Athletic Training & Sports Medicine Center, Program Director for the CAAHEP accredited athletic training education program, and as Chair and professor in the Department of Physical Education and Athletic Training. A licensed athletic trainer and emergency medical technician, Dr. Floyd is a certified member of numerous professional organizations including the National Athletic Trainers' Association (NATA), the National Strength and Conditioning Association, and the Athletic Equipment Managers' Association. He also retains active membership in the American College of Sports Medicine, the American Orthopaedic Society for Sports Medicine, the American Osteopathic Academy of Sports Medicine, and the American Alliance for Health, Physical Education, Recreation and Dance. He represents the Southeast Athletic Trainers Association (SEATA) and District IX of the NATA as District Director to the NATA Board of Directors. He also serves as Member Development Chair on the NATA Research and Education Foundation Board of Directors. Floyd has served as the Head Athletic Trainer for the Blue-Gray All-Star Football Classic in his native Montgomery for 25 years, after spending two years on the annual event's athletic training staff. He is a 1974 graduate of Lowndes Academy, where he worked as an all-sports athletic trainer for four years, before earning a B.S. and M.A.T. in Physical Education from UWA in 1980 and 1982, as well as an Ed.D. in Human Performance Studies from the University of Alabama in 1995. Floyd was named to the UWA Athletic Hall of Fame in 2001, the Alabama Athletic Trainers' Association Hall of Fame in 2004, and tabbed an "Outstanding Young Men of America" in 1982, 1983, 1984 and 1986. He was presented the Most Distinguished Athletic Trainer Award by the NATA in 2003 and received the organization's Service Award in 1996. He received the District IX Award for Outstanding Contribution to the field of Athletic Training by SEATA in 1990 and the organization's highest award, the Award of Merit, in 2001. In 2004, he was inducted into the Alabama Athletic Trainers' Association Hall of Fame. He was named to Who's Who Among America's Teachers in 1996, 2000, 2004, and 2005. In 1996 he was presented the UWA Achievement Award by the University of West Alabama National Alumni Association. In 1997, the UWA Faculty and Board of Trustees recognized Floyd for outstanding achievement in scholarship, teaching, and leadership by presenting him with a Loraine McIlwain Bell Trustee Professorship. Previously, Floyd served as President of the UWA Faculty Senate and completed two terms as President of the Alabama Council of University Faculty Presidents.
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However, the Manual of Structural Kinesiology by Floyd has been a fantastic read with excellent information, it is very well written and only covers what is essential to kinesiology students. All the muscles are displayed, explained, with pronunciation for those like myself who have a hard time reading some of these Greek/Latin terms. In the back of the book there is a chart that lists muscle groups precises, so you will better understand what muscles are being used during the most common exercises.
I will end it there. Seeing that you are here, you are probably buying this book for class. This book is worth buying for sure, don't rent it. Unlike other books, this one is something you will want to keep and highlight and book mark for sure. I will be going back and forth to this book for a very long time. I would highly recommend reading it in its entirety.
One of the most important things you will get out of this book is to ALWAYS make sure you have good posture... Stand of straight and keep the erector spinae muscles strong!
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Holiday Lodge Motel Antioch features barbecue grills, a picnic area, and laundry facilities. High-speed wireless Internet access is complimentary. Complimentary self parking is available on site.
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text:
|Publication number
|Publication type
|Application number
|Publication date
|Feb 28, 2006
|Filing date
|Nov 4, 2004
|Priority date
|Oct 7, 1999
|Fee status
|Also published as
|Publication number
|Archibald I. J. Brain
|Original Assignee
|Indian Ocean Medical Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (106), Non-Patent Citations (42), Referenced by (38), Classifications (12), Legal Events (3)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation of application Ser. No. 10/684,048, filed Oct. 10, 2003, which is a continuation of application Ser. No. 09/413,970, filed Oct. 7, 1999, now U.S. Pat. No. 6,631,720.
The present invention relates generally to medicine, and more particularly, to anesthesia, emergency medicine, intensive therapy, and veterinary medicine.
The laryngeal mask airway (LMA) disclosed in U.S. Pat. No. 4,509,514 is an artificial airway device designed to facilitate ventilation of an unconscious patient, and is used in over 80 countries. An unconscious patient, undergoing ventilation whether spontaneous or controlled via an LMA, may regurgitate or vomit gastric contents, as may happen if the stomach is not empty before such ventilation. Leakage of such gastric contents into the lungs should be prevented because it may be fatal. U.S. Pat. No. 5,241,956 describes modified laryngeal masks including a tube for entry into the oesophagus (i.e., gullet) to drain liquid gastric contents therefrom. A laryngeal mask including a drainage tube for extraction of gastric drainage is also disclosed in U.S. Pat. No. 5,632,271.
Providing a laryngeal mask which retains the ease of use of the original but also has a tube for drainage of gastric contents, may be difficult. Additionally, installation in a patient of a laryngeal mask having a large-bore gastric drainage tube (e.g., as described in U.S. Pat. No. 5,241,956) may be more difficult as compared to a standard LMA device. Also, while a laryngeal mask having a smaller-bore gastric drainage tube is typically easier to install in a patient, the flow capacity of such a drainage tube for gastric contents (resulting, for example, from vomiting) may be more limited. Moreover, a laryngeal mask having a smaller-bore gastric drainage tube may not be able to accommodate a large stomach tube (e.g., of greater than 6 mm OD).
The disclosures of all of the above referenced patents are hereby incorporated by reference.
As used herein, the anatomical terms "anterior" and "posterior," with respect to the human body, refer to locations nearer to the front of and to the back of the body, respectively, relative to other locations. The anatomical terms "proximal" and "distal," with respect to the human body, refer to locations nearer to the outside of and to the inside of the body, respectively, relative to other locations. The term "lateral" refers to a location to the right or left sides of the body, relative to other locations. "Bilateral" refers to locations both to the left and right of the body, relative to other locations. The anatomical term "medial" or "medially" refers to a location toward the center or midline of the body, relative to locations both to the left and right of the body.
It is an object of the invention to provide a laryngeal mask for humans and other mammals which offers ease of insertion, and in addition accommodates a large-bore "gastro-tube", typically larger than the airway tube(s) of the device and up to 15-mm inside diameter in adult human sizes. In the event of reflux of gastric contents, the larger-bore tube permits substantially unobstructed passing of such matter from the oesophagus to the exterior of the mouth. Also, a large-bore drainage tube may be used as a conduit for other applications such as temperature monitoring, endoscopy, suction or alimentation, which may be accommodated through a gastro-tube.
It is a further object to provide a gastric drain tube that is collapsible at its distal end to facilitate device insertion, but that, when the device is installed and inflated, tends to become open as permitted by the anatomy.
An object of preferred aspects of the present invention is to arrange the airway and gastro-tube features so as to reduce the bulk and stiffness of the LMA structure thereby to increase the tolerance by the patient of the LMA, and facilitate insertion of the LMA into the patient; and to simplify the LMA structure.
Other objects of preferred aspects are to provide an LMA that secures continuous airway accommodation of the patient, and that optionally may provide further functions such as adjustable-rate removal of waste gases by reduction in the so-called dead space or space not contributing to gas exchange, unobstructing guidance of an insertable inspection or manipulating device within the airway, avoidance of any epiglottic obstruction to passage of gases to and from the lungs, and avoidance of obstruction of the gastric drain tube by compression from surrounding anatomical structures.
In a preferred embodiment, the invention achieves the foregoing objects and provides further advantageous features in an LMA construction wherein a large-bore gastro-tube is integrated with an inflatable/deflatable masking ring which provides an LMA seal around the laryngeal inlet and with adjacent independent airway supply to the patient's lungs, and in which the prior art requirement for a backing plate is avoided. A gastro-tube is externally and tangentially bonded to a first, more proximal, region of the inflatable/deflatable masking ring as it traverses the same. The gastro-tube is also bonded to a second and more distal region of the inflatable/deflatable masking ring, and has externally sealed passage through wall portions of the distal region of the inflatable/deflatable masking ring to a distally open end, such that gastric drainage is provided at substantially the distal limit of the masking ring.
For embodiments providing independent airway-supply, two flexible tubes are bonded along opposite sides of the gastro-tube at least in the course of traversing the first more proximal region and continuing to the point of first intercept with the second more distal region of the masking ring. In some embodiments, the airway tubes and gastro-tube are sealed to each other to create an external cover for the interior space of the mask, thus enabling bonded masking closure of the space within the annulus of the inflatable masking ring by continuous bonding of the masking ring to adjacent wall structure of the airway tubes. In some embodiments, apertures for airway communication through the thus-formed masking closure are provided as slotted laterally open features of the airway tubes, on the anterior or larynx-exposed side of the masking closure; and the distal ends of the like airway tubes are cut diagonally to form twin gutters with distally pointed ends, the concavity of the gutters facing the laryngeal opening.
The employment of two airway tubes enables various optionally available further features, as follows:
Other advantages and features of various aspects of the invention will appear in the course of the accompanying detailed description.
Corresponding reference characters indicate corresponding parts throughout the several views of the drawings.
A laryngeal-mask airway system embodying the present invention is designated generally by the reference numeral 20 in
As discussed in more detail below, airway system 20 includes a mask structure 52 at the distal ends of a flexible gastro-tube 75 and a pair of airway tubes 125, 127. The gastro-tube and airway tubes conform to the curvature of the patient's airway when flexed. The proximal end 134 of gastro-tube 75 may be connected to a conventional, external gastro suction apparatus 137. The proximal tube 144, 147 of airway tubes may be connected to a conventional ventilating system 156 external of the patient. Air inflation/deflation tube 72 also passes from external of the patient and through the patient airway to the mask structure.
Airway system 20 is inserted into anatomical airway 22 the upper surface of which is bounded by hard and soft palates 25, 27. The mask 52 of airway system 20 is lodged in pharynx 30 of anatomical airway 22 at the base of hypopharynx 32 where the airway divides into trachea 35 (i.e., windpipe) and oesophagus 37. A lower portion of airway system 20 extends to sealing engagement with the upper oesophageal sphincter.
Masking Ring
Mask 52 comprises a generally elliptical inflatable/deflatable masking ring or sealing cushion 55, the proximal portion 65 of which is attached to the distal end of inflation tube 72. The periphery of masking ring 55 is closed thereby defining an inner space bowl 57 between its transversely spaced walls. Masking ring 55 has a major axis 60 extending between its distal and proximal regions 62, 65, as shown in
Masking ring 55 may conveniently be made from silicone with a typical wall-thickness of approximately 0.5 to 1 mm but thinner walls may be suitable for enhanced sealing capability, for example 0.1–0.3 mm. Masking ring 55 may alternatively be made of, or may be filled with, cellular material.
The somewhat wider transverse diameter of the inner space 57 of masking ring 50, in relation to the aryepiglottic folds, is sufficient to accommodate the large-bore gastro-tube 75 without obstructing gas access to and from laryngeal inlet 50. Gastro-tube 75 is placed in bisecting longitudinal relation of the major axis 60 of masking ring 55 such that, when installed in the patient, epiglottis 45 may be supported against the anterior surface of the gastro-tube in bowl 57.
In the disclosed embodiment, the anteriorly-facing surface of the cushion of masking ring 55 is generally elliptical and, when the masking ring is in place, may deform as required to provide the desired anatomical seal. Optionally, soft and yielding ridges (not shown) may be bilaterally disposed on the anteriorly-facing distal region 62 of the generally elliptical-shaped cushion of masking ring 55, over an area corresponding generally to about one-half of the total longitudinal extent of the masking ring, to fit into the anatomical grooves (e.g. the pyriform fossae) disposed on either side of the glottis. To increase the pressure of the masking ring against the anatomic structures to which it is sealed, the generally elliptical cushion of masking ring 55 optionally may also include a second wedge-shaped horse-shoe-like crescent (not shown) of similar elastic hollow material, mounted on the anterior surface of substantially the proximal one-half of the masking ring which includes proximal region 65, to increase the pressure with which the mask is urged into position surrounding the laryngeal inlet. The thinner edge of such a wedge-shaped crescent is directed distally, i.e., towards the more pointed distal region 62 of masking ring 55, so enhancing the anterior-posterior depth of the masking ring progressively towards its wider proximal region 65.
Masking ring 55 is adapted for placement in anatomical airway 22 such that inner space 57 surrounds laryngeal inlet 50 of the patient. Masking ring 55 may then be inflated through inflation tube 72 connected to the masking ring. Masking ring 55, when so positioned and inflated, sealingly engages the tissues surrounding laryngeal inlet 50, described more fully herein below.
Gastro-tube 75 generally bisects the space between the proximal and distal regions 65, 62 of masking ring 55. Throughout most of its length, gastro-tube 75 may conveniently be molded or extruded from a flexible or elastomeric material such as silicone or other plastic or rubber, preferably of durometer hardness in the range 50 to 80 Shore. For use in adult humans, the inner diameter (i.d.) of gastro-tube 75 may be about 10 to 15 mm, and the radial wall thickness may be about 1 to 2 mm.
The distal portion of gastro-tube 75 comprises a relatively short, more flexible and, typically, thinner-walled and more easily flattened tube, which is bonded to distal end of the major length (e.g., the portion 122 of the gastro tube which is generally within the mask 55 and the portion 132 of the gastro tube which is proximal to mask 55) of the gastro-tube and provides a lip portion 77. The distal end of lip tube 77 defines an open distal end 80 which, when masking ring 55 is inserted via the anatomical airway 22 of the patient into position opposite laryngeal inlet 50, communicates with the oesophageal inlet. The center of distal end 80 coincides with the axis of intersection between first and second planes 67, 70, as shown in
Lip portion tube 77 including distal end 80 extends through the distal region 62 of masking ring 55, and is sealed to ring 55 at both its proximal entrance into and distal exit from the distal region of the ring. To enable lip portion tube 77 to so extend through distal region 62, two openings are provided on, respectively, the distal and proximal sides of crotch portion 82 of distal region 62, as shown in
For attachment to lip portion tube 77, the distal end of portion 122 of gastro tube 75 is cut at an angle to the central axis of the gastro tube, providing a distal pointed nib 123 and an anteriorly facing elongated opening 125. The configuration of nib 123 is such that, as shown in
When masking ring 55 is deflated, the cross-section of distal end 80 of lip portion 77 is flattened in equatorial first plane 67, as shown in
It thus will be seen that airway system 20 provides a device whereby the distal or innermost-reaching end 80 of the large-bore gastro-tube 75 may change its transverse configuration from a relatively closed, anterior-posteriorly flattened wedge-shaped slit when the sealing component (i.e.; cushion or masking ring) device is in its flattened or reduced volume state for insertion into a human patient, towards a relatively open, e.g. an oval or roughly circular opening, when the device is installed in the human or animal patient and the sealing mask is expanded, particularly in response to the opening of the adjacent oesophageal sphincter which engages the distal end of the mask. The inflation pressure of the masking ring is typically chosen so that the force tending to open the lips is too low to force the anatomy open in normal circumstances, but is strong enough to open the lips to receive gastric contents if the anatomy itself relaxes as during the process of reflux or vomiting. The reason for this arrangement is that if these lips are always fully to open during mask inflation, this could tend to force the sphincter of the oesophagus to open as well, an undesirable effect. In the embodiment in which the generally elliptical masking ring 55 is made of a hollow flexible material, the mask is typically inflated using an external inflation device 72, e.g., a syringe which may also be used to deflate the mask when so desired.
When mask is inflated as shown in
For controlling the opening (during use) and closing (during insertion) of distal aperture 80, a pair of generally circular in cross-section, wedged-shaped distal support plugs 85 are lodged in the inside of distal region 62 of masking ring 55. A support plug 85 is provided on each of the diametrically opposite sides of lip portion 77 of gastro-tube 75, between the gastro tube and the inner surface of distal region 62, as shown in
Each support plug 85 is formed of a sponge-like, open-cell or air-permeable, material. When masking ring 55 is deflated by substantial evacuation of the interior of masking ring 55 through tube 76, the deflation causes the distal support plugs 55 to be substantially flattened. On inflation of masking ring 55, the distal plugs expand, support the sides of thin-walled lip portion 77 to which they are attached, and prevent the air pressure within the masking ring from collapsing the thin-walled portion. It will be noted that in embodiments in which the distal ends 117 of the plugs are themselves sealed, the plug ends themselves may form at least a portion of lip portion to be 77.
Backing portion 122 of gastro tube 75, proximal to the lip portion 77, extends between lip portion 77 and proximal region 65 of masking ring 55. Typically, the cross section of backing portion 122 is substantially more resistant to flattening than is lip portion 77; and the intermediate region of backing portion 122 preferably has a pear shaped or tear-drop shaped cross section, where the apex of the pear or tear-drop cross-section faces anteriorly relative to the equatorial first plane 67. Less preferably, backing portion 122 of gastro-tube 75 between distal and proximal regions 30, 28 may have more elliptical or semi-elliptical cross section.
Gastro-tube 75 is bonded tangentially to the proximal region 65 of masking ring 55 on the posterior side thereof such that the axis of the backing portion 122, like that of lip portion 77, is contained in medial second plane 70. The tube 75 thus is posteriorly offset relative to equatorial first plane 67 of the elliptical masking ring 55 such that, in proximal region 65, the gastro-tube 75 passes tangential and posterior to the generally circular cross-section of the inflatable masking ring. The cross-section of backing portion 22 is substantially circular where it is bonded in posterior tangential contact with the proximal region 65 of masking ring 55.
Proximal to the portion thereof having a pear- or tear drop-shaped cross section, the internal diameter (ID) of backing portion 122 in adult-sized devices is in the range of 10 to 15 mm, and the wall thickness may be in the range of 1 to 2 mm.
The portion 132 of gastro-tube 75 proximal of masking ring 55 is integrated with backing portion 122 and is preformed with a generally arcuate longitudinal bend for substantial conformance with curvature of the back of a human tongue where flexed. The proximal end portion 134 of gastro-tube 75, extends outside the patent's mouth and may be connected to gastro-apparatus 137 external of the patent.
Proximal of mask 155, portion 132 may have a concave cut-away portion comprising a curvilinear gutter, shown in cross-section in
Airway Tubes
As indicated above, airway system 20 further comprises a pair of like airway tubes 125, 127 located on opposite sides of, and respectively sealed to and in bonded relation with gastro-tube 75. In preferred embodiments, airway tubes 125, 127 each have a smaller diameter than that of gastro-tube 75. Typically, the interior cross-section area of gastro tube 75 is also at least as large as the combined internal cross sectional areas of airway tubes 125, 127. The inside diameter of each of the airway tubes 125, 127 typically is in the range of 6 to 10 mm, as compared to the 10 to 15 mm inner diameter of gastro tube 75. In devices for adult use, airway tubes 125, 127 typically have an outer diameter of 8 to 10 mm, less than that of the gastro-tube, a wall thickness of 1.25–1.75 mm, and an internal diameter of approximately 7 to 8 mm. Airway tubes 125, 127 are of elastomeric material of durometer hardness in the range 50 to 80; one possible durometer hardness of the material is 70.
It will be recognized that the maximum sizes of the air tubes and gastro tubes are limited by the patient anatomy and the need to provide flexibility; and that the minimum sizes are those required to provide sufficient air flow and permit passage of regurgitated stomach contents. In a typical adult mask, the internal cross-section area of each air tube will be in the range of about 50 to as much as about 80 square mm, and that of the gastro tube will be in the range of about 80 to perhaps as large as about 175 square mm. In the illustrated embodiment, in which the air tubes are 8 mm in internal diameter and the gastro tube has a internal diameter of 10 mm, the total cross-section of the two air tubes is, thus, 100 square mm, about 1.25 times that of the about 80 square mm cross section of the gastro tube.
Airway tubes 125, 127 each have a respective truncated distal end 139, 142 that opens into inner space 57. Since inner space 57 faces laryngeal inlet 50 when masking ring is fully inserted into anatomical airway 22, truncated distal ends 139, 142 communicate with the laryngeal inlet anteriorly on either side of the anteriorly ridged aspect of gastro-tube 75. Each of the truncated distal ends 139, 142 is defined by an elongate slanted truncation with the proximal edge of the truncation of each airway tube being adjacent the top (as viewed in
The portions of the airway tubes 125, 127 adjacent the diagonally-cut medial edges of tapered truncated distal ends 139, 142 are bonded both to the opposite sides of gastro-tube 75 and to the adjacent inner sides of inflatable masking ring 55. Airway tubes 125, 127 are laterally and continuously bonded, e.g. using a hermetic sealant, in side-by-side adjacency to the backing portion 122 of gastro-tube 75 from the distal end to the proximal region 65 of masking ring 55. It will be noted that the bonds between the airway tubes and the masking ring, and also the bonds between the backing portion 122 of gastro tube 75 and the distal and proximal ends of the masking ring, are the equatorial plane of the masking ring, thus insuring that inner space 57 has the desired concavity. It will also be noted that, together, the airway tubes and gastro tube completely close the anterior side of inner space 57.
The bonded-together lateral extent of airway tubes 125, 127 and gastro-tube 75, as viewed in
Proximal to masking ring 55, airway tubes 125, 127 may be secured to proximally extending portion 132 of gastro-tube 75 in continuously bonded relation, similar to manner in which the portions of the airway tubes are bonded to backing portion 122 or to longitudinal portions of the proximally extending portion. If extending portion 132 includes the gutter, described above, the respective airway tubes 125, 127 may be in continuously bonded relation to the respective arcuate limits of the gutter or bonded medially to the gutter. In either construction, such bonding may be accomplished by an adhesive cement 143 such as is shown in
As shown in
Throughout most of its periphery, cover 149 is sealed generally along the center of the top of the inflatable tube of masking ring 55. The proximal portion of cover tapers inwardly, and is bonded to masking ring 55 closely adjacent the sides of airway tubes 126, 127. Tis arrangement prevents possible ballooning of the proximal portion of the cover when it is inflated, and contributes to better sealing. It will also be noted that cover 149 is typically elastomeric, and that the overall unexpanded extent of cover 149 is such that, when it is deflated, the cover conforms closely to the adjacent surfaces of the masking ring, airway tubes and gastro tube, without any folding or creasing of the cover.
Proximal to masking ring 55, airway tubes 125, 127 may be secured to proximally extending portion 132 of gastro-tube 75 in continuously bonded relation, similar to manner in which the portions of the airway tubes are bonded to backing portion 122 or to longitudinal portions of the proximally extending portion. If extending portion 132 includes a gutter, as described above, the respective airway tubes 125, 127 may be in continuously bonded relation to the respective arcuate limits of the gutter or bonded medially to the gutter. In either construction, such bonding may be accomplished by an adhesive cement 143 such as is shown in
The portions of airway tubes 125, 127 extending proximally from masking ring 55 are generally parallel to each other as they curve away from to the equatorial first plane 67 of sealing ring 55 to exit from the mouth of the patient, and terminate at respective proximal ends proximal of region 65. Alternatively, the portions of airway tubes 125, 127 extending proximally from masking ring 55 may converge to a Y-connection, via a fitment (not shown), externally of the patient, and communicate with a single tube proximal thereof. In either event, the proximal end(s) of the airway tubes may be connected to ventilating apparatus 156.
Other Embodiments
A second embodiment of the lip portion of the gastro tube and the manner in which the lip portion is attached to the backing portion of the gastro tube illustrated in
Lateral hinges 87, 90 are symmetrically disposed on opposite sides of lip portion 77 a, i.e., on opposite sides of medial second plane 70 a. Each lateral hinge 87, 90 is also contained in equatorial first plane 70 a. As shown, each lateral hinge 87, 90 is also located approximately in a first plane 70 a, at least at the distal end of gastro tube 75. Depending on their length, the proximal portions of each hinge may be inclined posteriorly relative to first plane 70 a.
Medial (mid-line) hinges 92, 95 are symmetrically disposed adjacent to the top and bottom of lip portion 77 a, on opposite sides of equatorial first plane 70 a and circumferentially midway between lateral hinges 87, 90. Each mid-line hinge 92, 95 is closely adjacent medial second plane 67 a. The cross section of lip portion 77 a accordingly effectively comprises four equally sized arcuate sections joined by lateral and medial hinges 87, 90, 92, 95.
Flattening of lip portion 77 a from the partially expanded condition illustrated in
Since the force required to flex the lateral and medial hinges 87, 90, 92, 95 is substantially less than that required to flex the full-thickness portions of lip portion 77 a between the hinges, the hinges reduce the radial force required to flatten lip portion 77 a from the partially expanded to flattened conditions illustrated in
When lip portion 77 a is in its fully expanded configuration, the adjacent side edges of each hinge abut each other. This provides lip portion 77 a, when fully expanded, with substantially the same resistance to collapse from externally applied pressure, e.g., pressure from the inflated tube of masking ring 55, as the lip portion would have it were a continuous tube without any hinges.
With particular reference to
At the extreme distal end of lip portion 77 a, the exterior periphery of the lip portion tube preferably is continuous so as to insure a hermetic seal with the adjacent portion of the inflatable tube of masking ring 55. This may be provided in a number of ways, e.g., additional adhesive may be deposited in the groove of the lateral hinges adjacent the distal end, or the lateral hinges may terminate just short of the distal end. Preferably, the latter is the case and, at the extreme distal end, a short V-shaped groove may be provided on the inside of lip portion 77 a in alignment with each of the respective lateral hinges.
Although support plugs, such as plugs 85 in the first described embodiment, may be employed with a hinged lip portion tube 77 a, the additional wall thickness of tube 77 a typically makes such plugs unnecessary.
In use, an inflation/deflation device attached to tube 72 is actuated to withdraw air from masking ring 55 sufficient fully to deflate it prior to insertion of the mask through the mouth of the patient. Such air withdrawal also deflates cover 149 to collapse it onto the posterior surfaces of gastro-tube 75, airway tubes 125, 127 and masking ring 55 (
Lip portion 77 has a relatively lower resistance to flexure, e.g., due to its thin wall thickness throughout its passage through distal region 62 of inflatable/deflatable masking ring 55, and/or because it includes hinges. When masking ring 55 is deflated, lip portion 77 of gastro-tube 75 is flattened in the equatorial first plane 67 of masking ring 55 progressively towards its open distal end 80. As a result, when masking ring 55 is deflated, open distal end 80 and the contiguous part of lip portion 77 of gastro-tube 75 resembles a slit or almost closed fish-mouth shape, as illustrated in
The substantially flattened mask which results when airway device 20 is fully deflated, is passed easily through the mouth of the patient and, by being pressed against hard and soft palates 25, 27 as it is pushed inward, may be guided distally by the soft palate onto the posterior wall of pharynx 30. Deflated masking ring 55 further enters into its correct position opposite laryngeal inlet 50 without colliding with anterior structures such as the posterior surface of the tongue, the epiglottis 45, or the arytenoids. Further disclosure of insertion of deflated airway system 20 through anatomical airway 22 may be had by reference to previously incorporated U.S. Pat. No. 5,632,271, the entire disclosure of which also is hereby incorporated by reference.
Proximally extending portion 132, and preferably backing portion 122, have together sufficient wall thickness to provide a greater resistance to flexure than masking ring 55. The relative stiffness of these portions of gastro-tube 75 enables backing portion 122 and proximally extending portion 132 to pilot or guide the substantially flattened flexible lip of distal region 62 (resulting from a deflated condition of masking ring 55) to smoothly ride or track posterior contours of the throat and pharynx 30 and to assure that the deflated mask or ring is positioned with its distal end located immediately above, and preferably abutting, upper sphincteral region 42 of oesophagus 37, such that the inner space of masking ring 55 overlies and is adjacent to laryngeal inlet 50, as shown in
Lip portion 77 of gastro-tube 75 and distal region 62 of masking ring 55 are sufficiently flexible to allow anterior and posterior deflection of distal region 62 in medial second plane 70 when the masking ring is fully deflated, as shown in
Proximally extending portion 132 extends proximally to the extent of lapped relation with soft palate 27, and may extend proximally to the extent of substantially full lap with the incisor teeth. If a gutter is present, it typically stops short, i.e., distal, of the teeth, and preferably distal to the soft palate, thus permitting nasal passage of tubes into the gastro tube. The region of gastro-tube 75 adjacent hard palate 25 extends upwardly and posteriorly beyond airway tubes 125, 127 such that the combined arrangement of the three tubes fills into the dome of the palate. Airway tubes 125, 127 are spaced inwardly of the sides of the throat at the level of the inner borders of the mandibular bones posteriorly to avoid damage to the lingual nerves.
Gastro-tube 75, if having the gutter described herein above, may form the reception for an introduction tool (not shown) of relatively rigid tubular material having a distal end adapted for insertional guidance in the concavity of the arcuate section of the longitudinal bend of the gutter. The distal end of the introduction tool is further adapted for removably keyed engagement to gastro-tube 75 at the distal end of the gutter. The introduction tool and laryngeal-mask airway system 20 may both be included in a kit.
The introduction tool includes a curved rigid hollow tube with a guiding handle which may be inserted into the gastro-tube 75 at proximal region 65 of masking ring 55, for purposes of facilitating insertion of the masking ring into the patient. Also, the introduction tool may, if required, act as a guide for insertion of a tube into or through gastro-tube 75, for example, in order to drain stomach contents.
When masking ring 55 is correctly positioned, distal end 80 of gastro-tube 75 contacts the upper oesophageal sphincter 40. This is detected by the user as a resistance to insertion of masking ring 55 into oesophagus 37. Masking ring 55 is then inflated with sufficient air, by inflation device 72, to obtain a seal against the laryngo-pharyngeal perimeter. Further disclosure of the manner of positioning masking ring 55 may be had by reference to previously incorporated U.S. Pat. No. 5,241,956.
Inflation of masking ring 55 after the tube had been inserted into the patient up to pressure of approximately 60 cm of water, causes expansion of distal region 62 enabling it to adapt to hypopharynx 32 and upper sphincteral region 42 of oesophagus 37. Inflation of masking ring 55 also causes the gas or fluid supplied to the interior of masking ring 55 to flow through ports 153 into enclosed space 151 resulting in inflation of cover 149, as shown in
Anteriorly facing inner space 57 of masking ring 55 is normally wider than the transverse distance between the edges of laryngeal inlet 50 as defined by the so-called aryepiglottic folds which bilaterally border the laryngeal inlet, thus encouraging a sealing contact between the ring or cushion and the pharyngeal tissues as well as the tissues bordering the laryngeal inlet. Masking ring 55 is thus functionally a pharyngo-laryngeal mask airway forming an end-to-end seal against larynx 47. If the mask is one in which soft and yielding ridges, as previously discussed, are bilaterally disposed on the anteriorly-facing distal region 62 of masking ring 55, those ridges are suitably contoured to fill the anatomical grooves known as the pyriform fossae to increase the sealing efficacy of masking ring 55. In some embodiments, again as previously discussed, the sealing efficacy of masking ring 55 may be further increased by the optional wedge-shaped crescent in sealing contact with the anterior surface of substantially the proximal one-half of the masking ring.
Epiglottis 45 is supported against a region of gastro-tube 75 in laterally adjacency to and between airway tubes 125, 127. The portion of gastro tube 75 projects in the anterior direction defining a stop to prevent epiglottis 45 of the patient from interfering with communication between airway tubes 125, 127 and laryngeal inlet 50. This stop is provided by the formation of the transverse diameter section of gastro-tube 75, lying within inner space 57 enclosed by masking ring 55, into a roughly pear or tear-drop shape whose pointed end or apex faces anteriorly thus faces toward and in contact with the epiglottis 45. This creates adequate space posterior to epiglottis 45 for passage of gases bilaterally, such that gases passing to and from the trachea 35 are divided into two streams adjacent to gastro-tube 75. The anteriorly-pinched shape in cross section of gastro-tube 75 thus combines with the wider transverse diameter masking ring 55 (i.e., mask or cushion) to permit adequate and free gas communication between the airway tubes 125, 127 and trachea 35, while simultaneously preventing obstruction to such gas flow by epiglottis 45.
Inflation of masking ring 55 expands distal region 62, resulting in bilateral compression of the flattened distal end 80 of gastro-tube 75 and opening lip portion 77, including distal end 80 to the extent permitted by the anatomy abutting the distal end. The flexible material/thin wall thickness of lip portion 77, or hinges illustrated in
Typically, distal end 80 forms an end-to-end junction with upper esophageal sphincter 40. Thus, the configuration of distal end 80 when mask 55 is inflated may to a significant extent depend on opening and closing of the sphincter. The bilateral compression of flattened distal end 80 causes tube end 80 to tend to assume an oval or roughly circular cross-section; however, this is resisted by the junction between the distal end and the sphincter. However, when sphincter 40 opens as when the patient regurgitates or vomits, it simultaneously permits distal end 80 to open, permitting discharge from the oesophagus to flow into the gastro tube.
The junction between distal end 80 of gastro-tube 75 and distal region 62 of masking ring 55 also provides a seal that obstructs communication between the oesophagus 37 and inner space 57, e.g., leakage of contents from the oesophagus 37 into trachea 35, via inner space 57.
The side-by-side adjacency of gastro-tube 75 and airway tubes 125, 127 prevents kinking of the drainage and airway tubes when they bend around the curved space of oropharynx. Additionally, airway system 20 provides increased flexibility of the artificial airway tubing 125, 127 so that the device is not easily displaced from its sealing engagement both with the oesophagus 37 and larynx 47 by accidental pulling or twisting of the parts of the device external to the patient. Use of a pair of the airway tubes 125, 127 allows a reduced individual tube cross-section diameter while still retaining equal or better gas flow.
After positioning masking ring 55 opposite laryngeal inlet 50 as described herein above, ventilating apparatus 156 is actuated, as needed, to provide anesthesia gas to trachea 35 through airway tubes 125, 127. Separate connection of proximal ends 144, 147 to ventilating apparatus 156 permits a reduction in the so-called "dead space" of the device, which refers to the volume of space enclosed by the device in which gases entering the lungs become mixed with gases emerging from the lungs. This reduction is achieved by arranging for inspired gases to pass into one of the double airway tubes, e.g., 125, while expired gases pass out through the other airway tube, e.g., 127.
Gastro-apparatus 137 may also be actuated, as needed, typically to apply a suction to gastro-tube 75 for drainage or removal of gastric contents from oesophagus 37, or to serve as a guide for passage of tubes into the stomach or oesophagus for drainage, feeding, monitoring or other functions.
An additional internal gastro-tube (not shown) having a smaller OD than the ID of gastro-tube 75 may be telescopically inserted into proximal end 134 of gastro-tube 75. After masking ring 55 has been inserted into upper sphincteral region 42 such that distal end 80 engages upper oesophageal sphincter 40 and the masking ring is fully inflated, the additional gastro-tube may be inserted further into gastro-tube 75 so to emerge from distal end 80 and pass through the upper oesophageal sphincter 40 into oesophagus 37 and subsequently into the stomach thereby facilitating removal of gastric contents.
While this invention has been described with reference to particular devices, other and different devices, including those obvious to those skilled in the art, will embody the invention and are within the scope of the following claims.
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|Intersurgical Ag
|Airway device
|Mar 23, 2012
|Sep 2, 2014
|Intersurgical Ag
|Medical device package
|Dec 3, 2013
|Jul 21, 2015
|Intersurgical Ag
|Medical device package
|Aug 20, 2008
|Feb 26, 2009
|Samir Bhatt
|Laryngeal airway nerve monitor
|U.S. Classification
|128/207.14, 604/96.01, 128/207.15
|International Classification
|Cooperative Classification
|European Classification
|Jul 29, 2009
|Fee payment
Year of fee payment: 4
|Aug 3, 2010
Effective date: 20100610
Owner name: THE LARYNGEAL MASK COMPANY LIMITED, SEYCHELLES
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:INDIAN OCEAN MEDICAL INC.;REEL/FRAME:024779/0139
|Mar 1, 2013
|Fee payment
Year of fee payment: 8


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Film and Video Librarians
Take classes in English, history, science, foreign languages,
art, computer science, and mathematics to prepare for this career.
Classes that require you to write numerous research papers will
give you good experience in writing and utilizing different library
resources. Film and video librarians will often give class lectures
or hold discussion groups. If you dread speaking in front of a
small group, consider taking a speech class or join the debate team
to hone your verbal communication skills.
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