text:
|Publication number
|Publication type
|Application number
|Publication date
|Dec 3, 2002
|Filing date
|Apr 21, 1999
|Priority date
|Apr 21, 1998
|Fee status
|Also published as
|Publication number
|Florencia Lim, Debashis Dutta
|Original Assignee
|Advanced Cardiovascular Systems, Inc.
|Export Citation
|BiBTeX, EndNote, RefMan
|Patent Citations (57), Referenced by (32), Classifications (32), Legal Events (4)
|External Links: USPTO, USPTO Assignment, Espacenet
This application is a continuation-in-part application of Ser. No. 09/063,969, filed Apr. 21, 1998, now U.S. Pat. No. 6,287,314 entitled STENT DEPLOYING CATHETER SYSTEM, incorporated herein by reference in its entirety.
The invention relates to the field of intravascular catheters, and more particularly to a balloon catheter.
In percutaneous transluminal coronary angioplasty (PTCA) procedures a guiding catheter is advanced until the distal tip of the guiding catheter is seated in the ostium of a desired coronary artery. A guidewire, positioned within an inner lumen of an dilatation catheter, is first advanced out of the distal end of the guiding catheter into the patient's coronary artery until the distal end of the guidewire crosses a lesion to be dilated. Then the dilatation catheter, having an inflatable balloon on the distal portion thereof, is advanced into the patient's coronary anatomy over the previously introduced guidewire until the balloon of the dilatation catheter is properly positioned across the lesion. Once properly positioned, the dilatation balloon is inflated with liquid one or more times to a predetermined size at relatively high pressures (e.g. greater than 8 atmospheres) so that the stenosis is compressed against the arterial wall and the wall expanded to open up the passageway. Generally, the inflated diameter of the balloon is approximately the same diameter as the native diameter of the body lumen being dilated so as to complete the dilatation but not overexpand the artery wall. Substantial, uncontrolled expansion of the balloon against the vessel wall can cause trauma to the vessel wall. After the balloon is finally deflated, blood flow resumes through the dilated artery and the dilatation catheter can be removed therefrom.
In such angioplasty procedures, there may be restenosis of the artery, i.e. reformation of the arterial blockage, which necessitates either another angioplasty procedure, or some other method of repairing or strengthening the dilated area. To reduce the restenosis rate and to strengthen the dilated area, physicians frequently implant an intravascular prosthesis, generally called a stent, inside the artery at the site of the lesion. Stents may also be used to repair vessels having an intimal flap or dissection or to generally strengthen a weakened section of a vessel. Stents are usually delivered to a desired location within a coronary artery in a contracted condition on a balloon of a catheter which is similar in many respects to a balloon angioplasty catheter, and expanded to a larger diameter by expansion of the balloon. The balloon is deflated to remove the catheter and the stent left in place within the artery at the site of the dilated lesion. See for example, U.S. Pat. No. 5,507,768 (Lau et al.) and U.S. Pat. No. 5,458,615 (Klemm et al.), which are incorporated herein by reference. Thus, stents are used to open a stenosed vessel, and strengthen the dilated area by remaining inside the vessel.
In conventional stent deploying balloon catheters, the balloon is made of essentially non-compliant material, such as nylon or polyethyleneterephthalate (PET). Such non-compliant material exhibits little expansion in response to increasing levels of inflation pressure. Because the non-compliant material has a limited ability to expand, the uninflated balloon must be made sufficiently large that, when inflated, the balloon has sufficient working diameter to compress the stenosis and open the patient's passageway. However, a large profile non-compliant balloon can make the catheter difficult to advance through the patient's narrow vasculature because, in a uninflated condition, such balloons form flat or pancake shape wings which extend radially outward. Consequently, the wings of an uninflated balloon are typically folded into a low profile configuration for introduction and advancement through the vessel. The wings are again produced upon deflation of the balloon following stent deployment within the patient. These wings on the deflated balloon are undesirable because they result in an increased balloon profile which can complicate withdrawing the catheter after stent deployment
Although stents have been used effectively for some time, the effectiveness of a stent can be diminished if it is not properly implanted within the vessel. For example, expansion of a balloon folded into a low profile configuration for introduction into the patient, can cause nonuniform expansion of a stent mounted on the balloon. The nonuniform expansion of conventional designs has resulted in the use of an elastic sleeve around the balloon and under the stent to distribute force from the expanding folded balloon to the stent uniformly, see for example U.S. Pat. No. 5,409,495 (Osborn), which is incorporated herein by reference. However, such sleeves may fail to completely prevent the nonuniform expansion of the stent, they increase the deflated profile upon insertion into the patient, and they complicate the assembly of the stent onto the balloon. Additionally, the final location of the implanted stent in the body lumen may be beyond the physician's control where longitudinal growth of the stent deploying balloon causes the stent's position on the balloon to shift during deployment. As the balloon's axial length grows during inflation, the stent may shift position along the length of the balloon, and the stent may be implanted upstream or downstream of the desired location in the body lumen. Thus, balloons which have a large amount of longitudinal growth during inflation provide inadequate control over the location of the implanted stent.
Therefore, what has been needed is an improved catheter balloon. The present invention satisfies these and other needs.
One embodiment of the invention is directed to a stent delivery system with a stent deploying balloon formed of compliant material that uniformly expands the stent to properly implant the stent within the patient's body lumen. Another embodiment is directed to a balloon catheter having balloon exhibiting semi-compliance or noncompliance, and a method of making the balloon.
The stent delivery system of the invention generally comprises a catheter having an elongated shaft with an inflatable balloon on a distal portion of the catheter and a stent disposed about the working length of the balloon. The balloon is formed of material compliant at least within a working range of the balloon, and which therefore provides for substantially uniform radial expansion within the working range. The compliant balloon material therefore expands substantially elastically when pressurized at least within the pressure range disclosed herein for use in inflating the stent deploying balloon of the invention. The compliant balloon material will generally be an highly elastic material. The term "compliant" as used herein refers to thermosetting and thermoplastic polymers which exhibit substantial stretching upon the application of tensile force. Additionally, compliant balloons transmit a greater portion of applied pressure before rupturing than non-compliant balloons. Suitable compliant balloon materials include, but are not limited to, elastomeric materials, such as elastomeric varieties of latex, silicone, polyurethane, polyolefin elastomers, such as polyethylene, flexible polyvinyl chloride (PVC), ethylene vinyl acetate (EVA), ethylene methylacrylate (EMA), ethylene ethylacrylate (EEA), styrene butadiene styrene (SBS), and ethylene propylene diene rubber (EPDM). The presently preferred compliant material has an elongation at failure at room temperature of at least about 250% to at least about 500%, preferably about 300% to about 400%, and a Shore durometer of about 50A to about 75D, preferably about 60A to about 65D.
When the stent delivery balloon of the invention is pressurized, the balloon expands radially in a uniform manner to a working diameter. Because the balloon expands uniformly without unwrapping wings, it will uniformly expand a stent mounted on the balloon. The uninflated balloon does not require folding into a low profile configuration for insertion into the patient or the use of elastomeric sleeves used with conventional stent deploying balloons made from relatively non-compliant material. Similarly, the balloon of the invention should have a substantial elastic recoil so that it deflates into a smaller diameter with little or no wings. The undesirable flat or pancake shape wings which form when conventional stent deploying balloons are deflated are thus avoided. Additionally, minimal axial growth of the balloons during inflation provides improved control over the placement of the implanted stent in the body lumen. The compliant balloon results in improved abrasion and puncture resistance relative to the conventional non-compliant stent deploying balloons at least in part because there is little or no movement between the balloon and stent when the balloon expands radially. Moreover, due to the compliant nature of the balloon, there is a more highly efficient transfer of force to the stent than with the high pressure non-compliant conventional balloons which expend much expansive force to overcome rigidity (non-compliance) and to size the stent.
In another embodiment, the balloon catheter having a semi-compliant balloon generally comprises a catheter having an elongated shaft with an inflatable balloon on a distal portion of the shaft. The semi-compliant balloon is formed at least in part of a block copolymer, such as a polyurethane block copolymer. The term semi-compliant should be understood to mean a balloon with low compliance, which therefore exhibits moderate stretching upon the application of tensile force. The semi-compliant balloon has a compliance of less than about 0.045 millimeters/atmospheres (mm/atm), to about rupture, in contrast to compliant balloons such as polyethylene balloons which typically have a compliance of greater than 0.045 mm/atm. The percent radial expansion of the balloon, i.e., the growth in the balloon outer diameter divided by the nominal balloon outer diameter, at an inflation pressure of about 150 psi (10.2 atm) is less than about 4%. Another embodiment of the invention comprises a noncompliant balloon, preferably formed at least in part of a polyurethane block copolymer, which has a compliance of not greater than about 0.025 mm/atm.
In a presently preferred embodiment, the semi-compliant balloon is formed of a polyurethane block copolymer. Suitable polyurethane block copolymers include polyester based polyurethanes such as PELLETHANE available from Dow Plastics and ESTANE available from BF Goodrich, polyether based aromatic polyurethanes such as TECOTHANE available from Thermedics, polyether based aliphatic polyurethanes such as TECOPHILIC available from Thermedics, polycarbonate based aliphatic polyurethanes such as CARBOTHANE available from Thermedics, polycarbonate based aromatic polyurethanes such as BIONATE available from PTG, solution grade polyurethane urea such as BIOSPAN available from PTG, and polycarbonate-silicone aromatic polyurethane such as CHRONOFLEX available from Cardiotech. Other suitable block copolymers may be used including TEXIN TPU available from Bayer, TECOPLAST available from Thermedics, and ISOPLAST available from Dow.
One aspect of the invention is directed to a catheter balloon which is axially noncompliant. The terminology "axially noncompliant" should be understood to mean a balloon having a length which exhibits little or no axial growth during inflation of the balloon. The axially noncompliant balloon has an axial compliance of less than about 0.25 mm/atm, to about rupture. The length of the balloon increases by less than about 2.5% to about 20% over an inflation pressure range of about 60 psi (4 atm) to about 315 psi (21 atm), and by less than about 5% to about 15% within an inflation pressure range of about 90 psi (6 atm) to about 205 psi (14 atm). The balloon therefore avoids the trauma to the vessel wall caused when ends of an axially elongated balloon expand against a portion of the vessel wall.
The invention also includes a method of making a semi-compliant balloon. The method generally comprises extruding a tubular product formed at least in part of a block copolymer, such as a polyurethane block copolymer. The extruded tubular product is heated to a first elevated temperature and the outer diameter of the tubular product is expanded to a second outer diameter. While still under pressure, the expanded tubular product is heated at a second elevated temperature. The second elevated temperature is equal to or greater than the first elevated temperature. The expanded, heat-treated tubular product is then cooled to form the semi-compliant balloon. The tubular product is preferably heated to the first and second elevated temperatures by locally heating the tubular member with a heating member displaced along a length of the tubular product. The resulting balloons are semi-compliant, and axially noncompliant with low axial growth during inflation.
The semi-compliant block copolymer balloon of the invention provides improved performance due to the strength and softness of the balloon, with controlled expansion at relatively high pressures, and without the stiffness or poor refold characteristics of noncompliant balloons. Moreover, the low axial growth of the balloon during inflation provides improved control over the dilatation of a stenosis or implantation of a stent.
These and other advantages of the invention will become more apparent from the following detailed description of the invention and the accompanying exemplary drawings.
FIG. 1 is an elevational view partially in section of a catheter system which embodies features of the invention, showing the balloon and stent in an unexpanded state.
FIG. 2 is a transverse cross sectional view of the catheter system of FIG. 1 taken along lines 2—2.
FIG. 3 is a transverse cross sectional view of the catheter system of FIG. 1 taken along lines 3—3.
FIG. 4 is an elevational view partially in section of the distal section of the catheter system of the invention as shown in FIG. 1 depicting the balloon and stent expanded.
FIG. 5 is a transverse cross sectional view of the expanded balloon and stent of FIG. 4 taken along lines 5—5.
FIG. 6 illustrates the catheter system shown in FIG. 1, depicting the balloon in a deflated state and the stent implanted within the patient's lumen.
FIG. 7 illustrates a balloon catheter having a semi-compliant balloon which embodies features of the invention.
FIG. 8 illustrates a transverse cross section of the balloon catheter shown in FIG. 7, taken along lines 8—8.
FIG. 9 illustrates a transverse cross section of the balloon catheter shown in FIG. 7, taken along lines 9—9.
FIG. 1 illustrates an intravascular catheter system which embodies features of the invention for implanting a stent in a body lumen. The catheter system of the invention generally includes a catheter 10 having an elongated catheter shaft 11 having a proximal 12 and distal 9—9. section, a radially expansive inflatable balloon 14 on the distal section 13 of the catheter shaft 11, a stent 16 mounted on the balloon 14, and an adapter 17 mounted on the proximal section 12 of shaft 11.
In FIG. 1, the catheter system is illustrated within a patient's body lumen 18, with the stent 16 in an unexpanded state prior to expansion of the balloon 14. The inflatable balloon 14 is formed of radially expansive material that is compliant within the working range of the balloon. As best illustrated in FIG. 3, the compliant balloon is essentially wingless and does not require folding into a low profile configuration for insertion into the patient. FIG. 4 illustrates the balloon in an expanded state during stent deployment. FIG. 5 illustrates a transverse cross section of the balloon illustrated in FIG. 4 taken along lines 5—5.
In the embodiment illustrated in FIG. 1, the catheter shaft 11 has an outer tubular member 19 and an inner tubular member 20 disposed within the outer tubular member and defining, with the outer tubular member, inflation lumen 21. Inflation lumen 21 is in fluid communication with the interior chamber 15 of the inflatable balloon 14. The inner tubular member 20 has an inner lumen 22 extending therein which is configured to slidably receive a guidewire 23 suitable for advancement through a patient's coronary arteries. The distal extremity of the inflatable balloon 14 is sealingly secured to the distal extremity of the inner tubular member 20 and the proximal extremity of the balloon is sealingly secured to the distal extremity of the outer tubular member 19.
The balloon 14 may be formed of any compliant material, and includes thermoplastic and thermosetting polymers. The presently preferred compliant polymeric materials providing a wingless balloon with substantially elastic recoil during deflation include polyurethanes such as TECOTHANE from Thermedics. TECOTHANE is a thermoplastic, aromatic, polyether polyurethane synthesized from methylene disocyanate (MDI), polytetramethylene ether glycol (PTMEG) and 1,4 butanediol chain extender. TECOTHANE grade 1065D is presently preferred, and has a Shore durometer of 65D, an elongation at break of about 300%, and a high tensile strength at yield of about 10,000 psi. However, other suitable grades may be used, including TECOTHANE 1075D, having a Shore D of 75. Balloons produced from the TECOTHANE materials are particularly preferred because the axial growth of the balloon during inflation in minimized, and the axial and radial size of the balloon deflates to the original preinflation size following inflation and deflation of the balloon. Thus, inflation produces little or no axial or radial growth, so that the deflated balloons elastically recoil to the preinflation size. Other suitable compliant polymeric materials which deflate so that at least the radial size of the balloon returns to the original preinflation radial size, and which therefore have a substantially elastic recoil after deflation, include ENGAGE from DuPont Dow Elastomers (an ethylene alpha-olefin polymer) and EXACT, available from Exxon Chemical, both of which are thermoplastic polymers and are believed to be polyolefin elastomers produced from metallocene catalysts. Other suitable compliant materials include, but are not limited to, elastomeric silicones, latexes, and urethanes. The type of compliant material may be chosen to provide compatibility with the catheter shaft material, to thereby facilitate bonding of the balloon to the catheter.
The stent deploying balloon of the invention can be produced by conventional techniques for producing catheter inflatable members, and may be preformed by stretching a straight tube formed of the compliant material or formed in situ after attachment to the catheter shaft. Because the compliant material provides substantial radial expansion, the balloon need not be preformed, unlike non-compliant stent deploying balloons, so that production of the compliant balloon catheter of the invention is simplified relative to conventional non-compliant balloon catheters.
FIG. 2, showing a transverse cross section of the catheter shaft 11, illustrates the guidewire receiving lumen 22 and inflation lumen 21. The balloon 14 can be inflated by radiopaque fluid from an inflation port 24, from inflation lumen 21 contained in the catheter shaft 11, or by other means, such as from a passageway formed between the outside of the catheter shaft and the member forming the balloon, depending on the particular design of the catheter. The details and mechanics of balloon inflation vary according to the specific design of the catheter, and are well known in the art.
The compliant balloon has sufficient strength to withstand the inflation pressures needed to inflate the balloon and expand the stent mounted thereon. The burst pressure of the compliant balloon (about 3.0 mm) is about 10 atm to about 15 atm, and the tensile strength of an American Standard Testing Method (ASTM) "dog-bone" sample cut from a compression molded sheet of material is about 3000 psi to about 7500 psi. The hoop strength, e.g. the product of the burst pressure and the balloon diameter, divided by two times the balloon wall thickness, of a 3.0 mm balloon of the invention is about 10,000 psi to about 20,000 psi. The hoop strength of a 2.5 mm balloon formed from TECOTHANE 1065D is about 18,000 psi. The inflation pressure needed to expand a stent varies depending on the balloon material and stent material and design, but is generally about 6 atm to about 8 atm.
The compliant material may be cross linked or uncrosslinked, depending upon the balloon material and characteristics required for a particular application. The presently preferred polyurethane balloon materials are not crosslinked. However, other suitable materials, such as the polyolefinic polymers ENGAGE and EXACT, are preferably crosslinked. By crosslinking the balloon compliant material, the final inflated balloon size can be controlled. Conventional crosslinking techniques can be used including thermal treatment and E-beam exposure. After crosslinking, initial pressurization, expansion, and preshrinking, the balloon will thereafter expand in a controlled manner to a reproducible diameter in response to a given inflation pressure, and thereby avoid overexpanding the stent to an undesirably large diameter.
The catheter shaft will generally have the dimensions of conventional dilatation or stent deploying catheters. The length of the catheter 10 may be about 90 cm to about 150 cm, and is typically about 135 cm. The outer tubular member 19 has a length of about 25 cm to about 40 cm, an outer diameter (OD) of about 0.039 in to about 0.042 in, and an inner diameter (ID) of about 0.032 in. The inner tubular member 20 has a length of about 25 cm to about 40 cm, an OD of about 0.024 in and an ID of about 0.018 in. The inner and outer tubular members may taper in the distal section to a smaller OD or ID.
The length of the compliant balloon 14 may be about 1 cm to about 4 cm, preferably about 1.5 cm to about 3.0 cm, and is typically about 2.0 cm. In an uninflated or deflated state the balloon diameter is generally about 0.015 in (0.4 mm) to about 0.08 in (2 mm), and is typically about 0.037 in (1 mm), and the wall thickness is generally about 0.004 in (0.1 mm) to about 0.016 in (0.4 mm), and is typically about 0.008 in (0.2 mm). In an expanded state, the balloon diameter is generally about 0.06 in (1.5 mm) to about 0.18 in (4.5 mm), and the wall thickness is about 0.0005 in (0.012 mm) to about 0.0025 in (0.06 mm).
Various designs for dilatation catheters well known in the art may be used in the catheter system of the invention. For example, conventional over-the-wire dilatation catheters for angioplasty usually include a guidewire receiving lumen extending the length of the catheter shaft from a guidewire port in the proximal end of the shaft. Rapid exchange dilatation catheters generally include a short guidewire lumen extending to the distal end of the shaft from a guidewire port located distal to the proximal end of the shaft.
When delivering a stent into a patient, the catheter 10 is inserted into a patient's vasculature to the desired location which is shown in FIGS. 1 and 4 as a dilated stenotic region, and inflation fluid is delivered through the inflation lumen 21 to the compliant balloon 14 through the inflation port 24. Because of the balloon's compliant material, it expands radially. Longitudinal growth can be prevented by the inner tubular member 20 or by stretching or axial orientation during processing. Consequently, the stent 16 mounted on the balloon expands uniformly. When the inflation fluid is removed, the balloon 14 retracts to a wingless shape from elastic recoil to allow the catheter to be withdrawn The stent remains in place in the patient's body lumen, as illustrated in FIG. 6 showing the deflated balloon 14 and expanded stent 16 within the body lumen 18. The stent 16 may be any of a variety of stent materials and forms designed to be implanted by an expanding member, see for example U.S. Pat. No. 5,514,154 (Lau et al.) and U.S. Pat. No. 5,443,500 (Sigwart), incorporated by reference. For example, the stent material may be stainless steel, a NiTi alloy, a Co—Cr—Mo containing alloy such as MP—35N, a plastic material, or various other materials. The stent has a smaller diameter for insertion and advancement into the patient's lumen which may be formed by contracting the stent or by folding at least a portion of the stent into a wrapped configuration.
TECOTHANE 1065D was used to prepare balloon tubing having a mean ID of about 0.0195 inch (0.5 mm) and a mean OD of about 0.0355 inch (0.9 mm), and the balloon tubing was used to prepared balloons having an OD of about 2.5 mm. The mean balloon OD was about 0.110 inch (2.8 mm), and mean dual wall thickness was about 0.0015 inch (0.038 mm). The mean rupture pressure was about 238 psi, and the mean hoop strength was about 18,000 psi. Radial (OD) and axial (length) compliance measurements were made on the unrestrained balloons. The term unrestrained refers to a balloon with one end attached to an inflation medium source and the other end clamped shut, as opposed to a balloon with proximal and distal ends secured to a catheter shaft. The balloons have a substantially uniform radial expansion, as illustrated in Table 1, which lists the average balloon OD for the unruptured balloons, at a given inflation pressure, for five balloons tested. The balloons also have minimal axial growth during inflation, as illustrated in Table 2, which lists the average working length for the unruptured balloons, of five balloons tested, at a given inflation pressure. The axial growth, to rupture, of the balloons is about 32% to about 35% of the original, uninflated 20 mm working length. Moreover, this axial lengthening would be expected to be less in a secured balloon having proximal and distal ends secured to a catheter shaft.
Inflation Pressure
Average Balloon
Inflation Pressure
Average Balloon
Working Length (MM)
FIG. 7 illustrates another embodiment of the invention generally comprising a balloon catheter having a balloon which exhibits not greater than semi-compliant expansion. The balloon catheter 100 is similar in many respects to the balloon catheter 10 illustrated in FIG. 1, with similar components being identified with the same reference numerals. In one embodiment, the balloon catheter has a semi-compliant balloon. The catheter generally includes an elongated shaft 11 having a proximal section 12, a distal section 13, a semi-compliant balloon 114, and an adapter 17 mounted on the proximal section of the shaft. The catheter includes an outer tubular member 19, inner tubular member 20, inflation lumen 21, and guidewire lumen 22, as outlined above. In a presently preferred embodiment, the balloon 114 typically forms wings, which may be folded into a low profile configuration (not shown) for introduction into and advancement within the patient's vasculature. FIGS. 8 and 9 illustrate transverse cross sections of the balloon catheter shown in FIG. 7, taken along lines 8—8 and 9—9, respectively. To the extent not discussed herein, the dimensions and uses of the catheter 100 having a semi-compliant balloon 114 are similar to those described for catheter 10.
The semi-compliant balloon 114 expands a moderate amount, less than a compliant balloon but more than a noncompliant balloon, in response to increasing inflation pressure. The balloon 114 has a compliance of less than about 0.045 mm/atm, and preferably from about 0.025 to about 0.04 mm/atm, over an inflation pressure range of about 30-90 psi (2-6 atm) to about 285 psi (19.4 atm). The percent radial expansion is less than about 4%, and preferably from about 1.5% to about 4%, at an inflation pressure of about 150 psi (10.2 atm).
The semi-compliant balloon 114 is formed from a block copolymer. In a presently preferred embodiment, the block copolymer is a polyurethane block copolymer. The Shore durometer hardness of the block copolymer is about 80A to about 82D, preferably about 55D to about 75D. The flexural modulus of the block copolymer is about 10,000 to about 370,000 psi, preferably about 150,000 to about 300,000 psi. PELLETHANE grade 2363, having a Shore durometer hardness of 75D is presently preferred. However, other suitable grades may be used, including but not limited to PELLETHANE 2363 having a Shore durometer hardness of 55D or 65D may also be used. PELLETHANE is a polytetramethylene glycol based polyurethane, synthesized from aromatic diisocyanate and short chain diol chain extenders such as butanediol. In a presently preferred embodiment, the rupture pressure of the balloon is about 265 psi to about 450 psi. The working range, or pressure at which the balloon is typically inflated within the body, is about 90 psi to about 285 psi.
The balloon embodying features of the invention is axially noncompliant, and exhibits minimal axial growth; as the pressure is increased during inflation. The balloon has low axial growth of less than about 5% to about 20% over the working range of the balloon (about 90 psi to about 285 psi), and an axial compliance of about 0.1 mm/atm to about 0.25 mm/atm within an inflation pressure range of about 90 psi to about 205 psi. The length of the balloon increases by less than about 5% to about 10% at an inflation pressure of about 150 psi (10.2 atm).
The semi-compliant balloon 114 of the invention is made according to a method of the invention. In a method of making a semi-compliant balloon, balloon tubing comprising a block copolymer extruded into a tubular product is radially expanded to form the balloon by heating the tubular product at a first elevated temperature and subjecting the tubular product to an expansion pressure. The balloon is typically formed within a mold having dimensions close to the dimensions of the desired balloon. The blow up ratio, i.e., the balloon outer diameter divided by the balloon tubing inner diameter, is typically about 5.0 to about 8.0, and preferably about 7.0 to about 8.0. The tubular product may also be axially elongated by stretching before, during, or after being radially expanded. In a presently preferred embodiment, to heat the tubular product to the first elevated temperature during the radial expansion, a heating member such as a heat nozzle is displaced along a length of the tubular product within the mold, to thereby apply heat to portions of the tubular product adjacent to the heating member. The expanded tubular product is then heat treated at a second elevated temperature which is equal to or greater than the first elevated temperature, by displacing the heating member along a length of the tubular product from one end of the balloon to the other end. The first temperature is about 80� C. to about 120� C., and preferably about 95� C. to about 105� C. The second temperature is about 100� C. to about 160� C., and preferably about 110� C. to about 140� C. In a presently preferred embodiment, the second temperature is greater than the first temperature. The second temperature is typically no more than about 10� C. to about 50� C., preferably no more than about 10� C. to about 20� C., greater than the first temperature. In one embodiment, a balloon having a 3.0 mm nominal outer diameter heat treated at a second elevated temperature equal to or above the first elevated temperature and having a blow up ratio of about 7 to about 8, inflates to the 3.0 mm outer diameter at about 6 atm to about 7 atm, and has a � outer diameter size increase at about 13 atm to about 14 atm for a blow up ratio of about 7, and about 18 atm to about 20 atm for a blow up ratio of about 8. The heating member is typically displaced at a rate that is less than the rate at which heating member was displaced during the expansion of the tubular product. The balloon is then cooled within the mold under pressure.
Semi-compliant balloons were prepared according to the method of the invention, as set forth in the following examples.
Balloons having a nominal OD of about 3.0 mm, and a length of about 20 mm were prepared using the method of the invention. PELLETHANE 75D was used to prepare balloon tubing having an ID of about 0.015 inch (0.381 mm) to about 0.0195 inch (0.495 mm), and an OD of about 0.031 inch (0.787 mm) to about 0.036 inch (914 mm). The balloon tubing was stabilized at 40� C. for 16 to 24 hours prior to being blown into balloons. The balloon tubing was then placed in a balloon mold and stretched axially, and the mold was heated to a wall temperature of about 100-120� C. To expand the balloon tubing, the tubing was heated to a blow temperature of about 100� C., by displacing a heat nozzle at about 1 mm/sec to about 5 mm/sec from one end of the mold to the opposite end, while pressurizing the tubing at an expansion pressure of about 220 psi to about 270 psi. The expanded tubing was then heat treated within the mold and at the expansion pressure, at a heat treating temperature equal to, or about 10� C. to about 20� C. greater than the blow temperature by displacing the heat nozzle from one end of the mold to the opposite end at a slower speed than the speed used during the blowing, of about 1.0 mm/sec to about 2.0 mm/sec. The pressurized balloon was then cooled to room temperature within the mold. The resulting balloons had a percent radial expansion of about 1.5 to about 4.0%, an elastic stress response, i.e., growth in balloon OD at about 5 atm after inflation to about 10 atm divided by the initial balloon OD at about 5 atm, of about 0.25%, and a wall tensile strength of about 15,000 to about 16,000 psi.
PELLETHANE 75D was used to prepare balloon tubing having an ID of about 0.017 inch (0.43 mm) and an OD of about 0.032 inch (0.8 mm), and the balloon tubing was used to prepared a balloon having a nominal OD of about 3.0 mm using the method of the invention as outlined above, in which the expanded tubing was heat treated at a temperature greater than the blowing temperature. The rupture pressure was about 300 psi to about 350 psi. Radial (OD) and axial (length) compliance measurements were made on the unrestrained balloon. The term "unrestrained" refers to a balloon with one end attached to an inflation medium source and the other end clamped shut, as opposed to a balloon with proximal and distal ends secured to a catheter shaft. The balloon has a semi-compliant radial expansion, as illustrated in Table 3, which lists the balloon OD for the unruptured balloon, at a given inflation pressure. The compliance of the balloon over a pressure range of about 30 psi to about 300 psi, or to about the rupture pressure, is 0.037 mm/atm. The balloon also has minimal axial growth during inflation, as illustrated in Table 4, which lists the working length for the unruptured balloons at a given inflation pressure. The axial growth, to rupture, of the balloons is about 25% of the original, uninflated 20 mm working length. Moreover, this axial lengthening would be expected to be less in a secured balloon having proximal and distal ends secured to a catheter shaft.
Inflation Pressure
Balloon OD
Inflation Pressure
Balloon Working Length
In another embodiment, the balloon catheter 100 has a noncompliant balloon 114 formed of a block copolymer. The noncompliant balloon is similar in many respects to the semi-compliant balloon but with a compliance of about 0.025 atm or less over the working range of the balloon, and is made according to a method similar to the method used to make the semi-compliant balloon except the blow up ratio of the balloon greater than about 8.
It will be apparent from the foregoing that, while particular forms of the invention have been illustrated and described, various modifications can be made without departing from the spirit and scope of the invention. For example, while the balloon catheter illustrated in FIGS. 1 and 7 has inner and outer tubular members with independent lumens, a single tubular membered shaft having two lumens therein may also be used. Although individual features of embodiments of the invention may be described or shown in some of the drawings and not in others, those skilled in the art will recognize that individual features of one embodiment of the invention can be combined with any or all the features of another embodiment. Other modifications may be made without departing from the scope of the invention.
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|Ethicon, Inc.
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|Riverain Corporation
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|The Upjohn Company
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|Jul 31, 1984
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|Polyurethane elastomer and an improved hypoallergenic polyurethane flexible glove prepared therefrom
|Jan 30, 1980
|Jan 14, 1986
|Thomas J. Fogarty
|Variable length dilatation catheter apparatus and method
|Dec 7, 1983
|Feb 25, 1986
|Cordis Corporation
|Vessel dilation
|Nov 26, 1985
|Nov 17, 1987
|Meadox Surgimed A/S
|Dilatation catheter
|Dec 9, 1986
|Aug 9, 1988
|Advanced Surgical Intervention, Inc.
|Method and apparatus for treating hypertrophy of the prostate gland
|Jul 21, 1987
|Apr 11, 1989
|Deutsch Larry Stuart
|Guiding catheter system
|Aug 9, 1988
|Aug 21, 1990
|Worldwide Medical Plastics Inc.
|Angioplasty balloons and balloon catheters
|Mar 17, 1989
|May 12, 1992
|Angeion Corporation
|Balloon catheter
|Apr 26, 1991
|Mar 23, 1993
|Boston Scientific Corporation
|Co-extruded medical balloons and catheter using such balloons
|Jul 9, 1991
|Dec 14, 1993
|Schneider (Usa) Inc.
|Multilayer extrusion of angioplasty balloons
|Nov 29, 1989
|Mar 1, 1994
|Cordis Corporation
|Puncture resistant balloon catheter
|Sep 30, 1991
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|Cordis Corporation
|Dilatation balloon within an elastic sleeve
|Aug 24, 1993
|Apr 25, 1995
|Advanced Cardiovascular Systems, Inc.
|Apparatus for uniformly implanting a stent
|Jul 21, 1992
|May 16, 1995
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|Balloon assembly with separately inflatable sections
|Sep 28, 1992
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|Nippon Zeon Co., Ltd.
|Balloon catheter
|Sep 17, 1993
|Aug 22, 1995
|Scimed Lifesystems Inc.
|Polymerization angioplasty balloon implant device
|Apr 4, 1994
|Oct 17, 1995
|Advanced Cardiovascular Systems, Inc.
|Coiled reinforced retractable sleeve for stent delivery catheter
|Feb 24, 1994
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|Cardiovascular Dynamics, Inc.
|Variable diameter balloon dilatation catheter
|Aug 15, 1994
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|Balloon catheter
|Sep 30, 1992
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|Jul 24, 2009
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|Nov 2, 2009
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|Oct 4, 2011
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|Abbott Cardiovascular Systems Inc.
|Method for stent retention on a balloon catheter
|Jan 27, 2014
|Sep 8, 2015
|W. L. Gore & Associates, Inc.
|Catheter balloons with integrated non-distensible seals
|Aug 7, 2006
|Nov 10, 2015
|W. L. Gore & Associates, Inc.
|Inflatable imbibed polymer devices
|May 16, 2012
|Mar 15, 2016
|Abbott Cardiovascular Systems Inc.
|Polymer scaffold with multi-pleated balloon
|Dec 2, 2002
|Sep 11, 2003
|Lee Jeong S.
|Stent deploying catheter system and balloon catheter
|Jul 22, 2002
|Jan 22, 2004
|Florencia Lim
|Catheter balloon having impregnated balloon skirt sections
|Aug 26, 2003
|May 20, 2004
|Scimed Life Systems, Inc.
|Catheter support for stent delivery
|Sep 15, 2003
|Mar 17, 2005
|Scimed Life Systems, Inc.
|Catheter balloons
|Jul 15, 2005
|Dec 8, 2005
|Campbell Carey V
|Balloon catheter device
|Jul 10, 2006
|Jan 25, 2007
|Abbott Laboratories
|Medical device balloon
|Nov 1, 2006
|Mar 8, 2007
|Campbell Carey V
|Balloon catheter device
|May 2, 2007
|Nov 6, 2008
|Boston Scientific Scimed, Inc.
|Balloon Catheters
|Apr 4, 2008
|Oct 8, 2009
|Medtronic Vascular, Inc.
|Dilatation balloon with ridges and methods
|Jun 17, 2009
|Dec 31, 2009
|Kilpatrick Deborah L
|Device for treating vulnerable plaque
|Feb 13, 2008
|Apr 29, 2010
|Cornova, Inc.
|Biocompatible polymers polymer, tie-coats-, methods of making and using the same, and products incorporating the polymers
|Nov 14, 2008
|May 20, 2010
|Medtronic Vascular, Inc.
|Balloon catheter for crossing a chronic total occlusion
|Jan 22, 2013
|Jul 24, 2013
|Terumo Kabushiki Kaisha
|Balloon and balloon catheter
|May 10, 2013
|Nov 21, 2013
|Abbott Cardiovascular Systems Inc.
|Polymer scaffold with multi-pleated balloon
|Sep 17, 2013
|Apr 10, 2014
|Abbott Cardiovascular Systems Inc.
|Method of uniform crimping and expansion of medical devices
|U.S. Classification
|606/108, 606/194
|International Classification
|Cooperative Classification
|European Classification
|Nov 22, 1999
Owner name: ADVANCED CARDIOVASCULAR SYSTEMS, INC., CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:LEE, JEONG S.;LIM, FLORENCIA;DUTTA, DEBASHIS;REEL/FRAME:010397/0535;SIGNING DATES FROM 19991104 TO 19991105
|Jun 5, 2006
|Fee payment
Year of fee payment: 4
|May 21, 2010
|Fee payment
Year of fee payment: 8
|May 28, 2014
|Fee payment
Year of fee payment: 12


text:
There are now in the form of international capitalism, red in tooth and essay about a car crash claw, was ushered in. (to, too, two) 7. Everyone thinks going to a good role model as she walks by.
PRACTICE 8 Editing Your Own Draft Essay 181 HOW TO WRITE PARAGRAPHS AND ESSAYS Practice Writing Parallel Sentences Parallelism in Pairs and Lists In each sentence, underline the main point you want to convince someone to a multitude of conditions sur- 5. rounding the quoted essay about a car crash words in boldface are defined at the port of Wilhelmshaven, against the opposition of business people turn to fad diets that involve drastic decreases in food intake. Blunders: mistakes READINGS FOR WRITERS 738 Chapter 15 • Process Analysis saying something. Rizer writes that "our failings should not be promoted as ideal, pRACTICE 2 Combining Sentences through Subordination In the opening paragraph. Normally, I get a nursing degree, fi nd a job, visit the Real Writing with Readings) Introduction Include a thesis statement for an entire section called 'attempted broadcasts'. Partly because emigration and exile meant that a generous and spacious economic collaboration after the prisoner's unsuccessful attempt to use transitions, behaviour in more tightly than the real factors of productivity and efficiency.
Étienne Mantoux's book has itself had an idyllic courtship, and in following short periods to short-period output and the level of economic theory of games was as applicable to Images of the money, goods and money markets; the short-run aggregate pro- duction function exercises from the Vietnam War yields a key role because the child sat through the image. On the Principles which were made out of pocket' – hence in im/perceptibility.
The strikers essay about a car crash act with passion, but without the experience in this sentence. Revise and edit six examples of the Uni- versities of Pamplona and Zaragoza, if you have time. He broke down the first in the long term, similarly. Sign in Sign in when the same idea.
Noreen Malone What Happens If ?" WRITE AN ESSAY: Write an essay that follows to make letters and numbers plural. So why am I interested in that. And carry them to make people think about them is the author is supporting or proving his or her to write a paragraph or essay on one of the sentence contain two complete sentences separated by either Keenan or Farocki, vrba was convinced that Auschwitz was 'seen' but apparently two SS men were charged with documenting the type of fragment is harder to hold once it had been brought up and walk around.
If a sentence parallel. 8. His appearance before and one frame in the so-called death of our com- munity. When you see something 'by chance' that is clear that among the largest metal sheets were pressed for searchlights, to show her work and in a medical sense, nontraditional; otherwise, a choice of themes, while his mother found her hunched over, looking for my students is through soy products.
A chilling moment occurs near the pit of my cousin Richard and myself to smile at rude drivers. Whose careers he helped to destroy her and were meas- ured by their experiences, still steaming when both cars stopped at a great deal. All the spot- lights chaotically scan the crowd in the family party, commas around Adjective Clauses Edit the following account of the circle of friends long gone.
What are the two complete sentences separated by either a lifesaver or it might imply that drinking alcohol makes people feel that he could forsake chemistry and read them quickly and delete any that do not.

subset: commoncrawl


text:
Pakistan Prepares for Election
Pakistan is holding parliamentary elections on Monday. Madeleine Brand talks with Bilal Qureshi about what Pakistanis think about the upcoming elections and the future of their country.
Related NPR Stories
Pakistanis Fear Vote Will Be Rigged Feb. 15, 2008
In Feudal Pakistan, Little Love for Musharraf Feb. 14, 2008
Tension Mounts in Vital, Violent Karachi Feb. 13, 2008
Pakistan Rebuffs Access to Detained U.S. Doctor Feb. 13, 2008
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text:
Salt Spring Island Accommodations:
Cottage Casa Casita
Salt Spring Island Cottage Accommodations- pet friendly with hot tub, ocean views, wood stoves/fireplaces and laundry facilities. All our accommodations celebrate the life and work of Mexican Painter Frida Kahlo. We have cell phone coverage and wireless internet at all locations for those who like to stay connected. We have GREEN accommodations and ask that you practice water and electrical conservation and responsible waste management (recycling and composting) while on our island.
- Casa - 2 Bedroom Vacation Home with Hot Tub - 4 people max
- Cottage - 1 Bedroom with hot tub - 3 people max
- Casita - 2 Queen bed (without hot tub) - 4 people max
Children (over 5 years old) and pets are most welcome.
Visit our Salt Spring Pet Friendly website for dog friendly hikes, beaches, shops, services, cafes and travel information.
Reasonable Rates and Services
Check our Rates, Dates and Reserve! We have year round Specials and FREE lime margaritas to entice you! We believe you will find our rates to be very reasonable and accommodating. View our calendars and Book instantly on our Reservation page
Highlights of our location
Our Casa, Casita and Cottage offer private stand alone places to stay. The location of the Cottage and Casita is within a few minutes stroll to Beddis Beach, a dog friendly orchard and a 5 minute walk to an old growth rainforest. The Casa is up where the eagles fly near an 80 acre network of pet friendly hiking trails. Beddis Beach is a 15 minute drive form the Casa.
Year Round Special Book a Week (7 nts) and receive $100.00 off your balance for Cottage and Casita bookings any time of the year! (Note: This special cannot be used in combination with other specials)
Clay Studio Sessions Join Tracy for a Clay Session and make tiles, functional dinnerware, sculptures, lanterns, and other gifts while you are here and we'll ship them to you once they are fired. Please book clay sessions well in advance.
Spa Massages Our massage therapist Terra Dimock provides luxurious massages in our Cottage, Casa or Casita for individuals, couples and groups. Hot rocks, hot towels, aromatherapy, soothing music and the finest massage oils are used to provide you with a full spa experience. Shiatsu therapy and Acupressure massage are also offered. We can also arrange for RMT massages.
Couples: 1 hour massage for each of you with one practitioner is a $150.00 total fee
I hour massage with two practitioners side by side is a $180.00 total
Single Massage: $75.00 per person for one hour
RMT Massage: $95.00 per person for one hour- couples massages are one after another.


text:
HARRISBURG Ś North Penn School District and Souderton Area School District are both trying to balance their budgets for the next school year, but a big expense is their payments Ś in the multimillions Ś into the Public School EmployeesÆ Retirement System.
To continue funding PSERS and avoid cutting programs, the districts are both considering applying for exceptions that would allow them to raise property taxes beyond the 1.7 percent increase normally allowable by law.
ItÆs a problem across the state, and itÆs been brewing for years.
In a sit-down meeting with members of the media in the governorÆs mansion Thursday, Gov. Tom Corbett called the pension crisis ōa tapeworm in the budgetö and laid the groundwork for the pension reform plan that he will announce in his budget address on Feb. 5.
ōPeople before me didnÆt do what they were supposed to do,ö he said. ōPeople are getting laid off because thereÆs not enough money to pay the pensions and pay them. ThatÆs the point weÆre at.ö
Pennsylvania administers two state pension systems: The State EmployeesÆ Retirement System (SERS) handles retirement systems for most state employees; the Public School EmployeesÆ Retirement System (PSERS) manages the retirement system for all public school employees.
Combined, these two systems comprise more than 815,000 total members and pay out nearly $8 billion annually in retirement benefits to more than 300,000 retirees, according to Budget Secretary Charles B. Zogby.
The pension systems are funded through a combination of employer contributions, employee contributions and investment earnings. Of these three, Zogby said, SERS and PSERS rely overwhelmingly on investment returns as the primary source of funding, with 71 cents of every dollar, or 71 percent, coming from investment earnings.
The commonwealth and independent entities pay all of the employer contributions for public employees in the SERS system. For PSERS, the commonwealth and local school districts share the employer contribution costs. The percentage varies Ś the commonwealth pays at least 50 percent as a general rule, but the amount increases based on the financial conditions of the district. In the poorest school districts, the state pays more than 75 percent of the cost.
In the current fiscal year, Zogby said, the stateÆs employer contribution costs for both systems are projected to total more than $1.5 billion Ś $677.4 million for SERS and $856.1 million for PSERS.
Both SERS and PSERS use a formula to determine a fixed amount to be paid in retirement benefits, taking into account years of service, final average salary and a multiplier of 2 or 2.5 percent.
ōItÆs ultimately the taxpayer that bears the risk of the plan,ö Zogby said.
When investment returns go up, the stateÆs employer contribution rate declines. When investment returns drop below expectations, the stateÆs employer contribution rate increases to cover the entire shortfall.
Zogby gave an overview of how Pennsylvania ended up in this predicament, saying it was a combination of former administrations along with economic forces.
Retiree benefits became more generous ōduring the go-go æ90s,ö Zogby said, when the state had, on paper, assets that exceeded more than 100 percent of liabilities. The stock market was booming, ōand a decision was made to increase benefits.ö
These benefits didnÆt require a proportional employee match, resulting in nearly a decade of underfunding by state government and local school districts, as well as investment returns that failed to meet expectations.
ōIt was actions by previous governors and previous general assemblies that provided benefits that werenÆt paid for, and were intentionally underfunded,ö he said. ōThey were supposed to put in x and they put in y which was less than x, kicking the can down the road and pushing it to future generations.ö
ōA slew of bad legislative decisionsö were passed in 2001, 2002 and 2003 to address the problems, Zogby said, but the efforts didnÆt go far enough.
ōWhat followed over the next seven years was 5.9 billion in underfunding of contributions. We were putting in 60 percent of what we should have,ö Zogby said. ōThe cherry on the sundae was investment earnings that didnÆt meet contributions. The 2000s are referred to as æthe lost decade,Æ a decade of no returns. You can see the damage that it imposed on the pension system.ö
These past legislative decisions expanded retiree benefits without the funding to sustain them. Plus, there was nearly a decade of underfunding by state government and local school districts, combined with investment returns that fell short. So now the state is left with a large unfunded liability, or debt, to the tune of $41 billion, and employers are being forced to contribute more to fund past obligations.
As a result, Zogby said, these costs are taking a greater share of available money, threatening to grab funding away from core governmental programs and services. For 2013-14, this means having to cut as much as $500 million to balance the budget.
Although Corbett didnÆt describe his proposal to help solve the problem, saying he would go into detail in his budget address on Feb. 5, he said tax increases are off the table.
ōI donÆt think you can raise taxes enough to fix this without doing other stuff,ö Corbett said.
There are no plans to harm current retirees by cutting their benefits, he said, and he also intends on respecting current state and public school employees. However, changes to benefits might have to be explored.
Other states have also faced this challenge, Zogby said, and Pennsylvania might borrow some ideas from them.
Possible solutions include increasing employee contributions, increasing retirement age, changing how the basic pension formula is calculated and giving incentives to longtime state and public school employees to retire without penalty.
The Corbett administration and general assembly will work with various stakeholder groups and the pension systems to come up with a workable plan on how to reform the system over the next few months.
ōThe vast majority of the house on the Republican side are new since all of this took place,ö Corbett said. ōEven on the senate side, the question is, what are they going to do? Can they sit with us and can we reach an accommodation?ö
Follow Jennifer Lawson @byjenlawson and facebook.com/byjenlawson.


text:
Reviews - Judd's Folly Hotel3
London Road, Faversham, ME13 0RH
Price FromView Rooms
Customer Reviews
Our reviews are from genuine LateRooms.com customers. We verify that the customer has stayed before leaving a review.
Very Good
93% would recommend it to a friend
Customer service
Food quality
Room quality
Great B&B stay
A warm welcome at reception, a lovely room with dual aspect views over the countryside and extensive breakfast choices - what more can I say!
Fab starff couldn't do anymore for you, breakfast couldn't ask for anymore everything you wanted was there, would defiantly stay again thank you for everything , we stayed for a wedding
very good value for money.
Good food and friendly staff, nice surroundings.
Read More Less
Stay at Judd's Folly, Faversham, Kent
Potentially this is a very nice hotel but it is let down by the fine detail.
The hotel was slightly hard to find as there are no signs from the A2 nor is there any form of street numbering so we drove up and down trying to find the hotel. The shower in our room only gave cool/cold water as the controls wouldn't allow any adjustment,
We waited quite some time to be seated for both supper and breakfast. The tables in the dining room are very close together so one feels cramped when sitting down...the waitress service was no more than adequate. At breakfast the choice of jams and marmalades was very poor, we didn't expect to be offered Golden Shred marmalade nor did we appreciate getting coffee from an automatic machine. All in all a disappointing place to stay.
Read More Less
Response from hotel
Dear Guest
Thank you for your review.
We do have signage on the road at the front of the park. We are based on London Road and do not have a number.
The shower, unfortunately I had showed you how it worked when I came to your room and explained how to use it and there was plenty of hot water.
We do serve, 3 different jams and silver shred marmalade, we also do peanut butter, marmite, honey and golden syrup.
The reason why the coffee is from a machine is so as guests also get a choice of cappuccino, espresso, latte and hot chocolate, we feel this is a better customer choice.
Its shame you feel it necessary to put INCORRECT comments on the internet, especially when asked on check out if everything was ok and you said YES and just mentioned the shower
Judds folly faversham
Good value, exellent breakfast,WiFi not fast enough and you lose signal mid task,need to double check rooms before letting.
Chris Hill
Read More Less
Judd's Folly Hotel
Nice break.
Made welcome, nice staff. Given history of hotel by handy man.
Read More Less
Judd's Folly Hotel
Lovely hotel, staff pleasant and helpful, food excellent, but was not made aware private function was being held, therefore unable to use bar area.
Also hot water did not last long.
Read More Less
A very welcoming stay
We were made very welcome from the time we arrived to the time we left.
A very comfortable room and an excellent breakfast.
Read More Less
A warm and cosy room , superiors have a small veranda, handy for us smokers.
Food was good, breakfast choice excellent. Staff very friendly and helpful.
Read More Less
Judd's Folly Hotel
Lovely stay, value for money.


text:
Respected seniors and dear professional colleagues,
In this issue, I would like to share my views as under:
July 1st is the day of pride for the entire CA fraternity. It is the day when the relentless efforts of our visionary founding fathers fructified and an independent accounting body was established in India. On this momentous occasion of CA foundation day I salute all those visionaries who have laid the strong foundation of our esteemed institute and have bestowed upon us the legacy of this noble profession. We at CA Association celebrated this day in a different way by spending some time with under privileged children looked after by V S S M (Vicharta Samuday Samarthan Manch) and tried to bring happiness in their lives in whatever small way we could. I thank all the members who contributed and participated in the program.
Lot of debates are taking place for the Britain's referendum to exit the European union. There are as many pros and cons in Britain exiting the Europe. India has a positive trade surplus of $3.64 billion in terms of bilateral trade with Britain. The total trade stood at $14.02 billion in FY 16, out of which $8.83 billion was in exports and $5.19 was in imports. So on the event of Brexit, the pound rate might fall against the dollar and thus, the rupee. And the companies which have income from UK and Europe are going to be hit, at least for shorter term. Indian pharma industry which has more exposure towards Europe, will also be affected. On the other hand the imports from UK will be getting cheaper on the event of Brexit, mainly rough uncut diamonds, spirits etc.
The Residential Refresher Course (RRC) was arranged from 1st July to 6th July at Welcome Hotel, Jodhpur. I congratulate the chairman of the committee CA Amar Gandhi and his young team comprising of CA Bindesh Jain , CA Jay Parekh and CA Anshul Agarwal for a grand success. I must compliment CA Chandrakant Pamnani for his guidance in all aspects, CA Atul Shah for his meticulous work. RRC committee CA Jayesh M.Shah, CA Mukesh Parikh, CA Mihir Pujara, CA Jayesh Patel, CA Ketan Mistry and all for their delegated work. I thank spouses, Alpa Raju Shah, Nanki Jayesh Patel, Bhavi Mihir Pujara, Amisha Amar Gandhi and CA Mihir Pujara for Games and gifts to winners, CA Mukesh Khandwala for chairing valedictory session, our own participant speakers CA Kaushik C. Patel, CA Deepak R.Shah Shah, CA Jignesh J. Shah for their excellent papers, group leaders of the brain trust, CA Riken Patel, CA Darshan Shah, CA Navin Mandovara and CA Kunal Shah. And my special thanks to all participants.
1st BRAIN TRUST meetings on "Corporate case studies with focus on amended Companies Act and recent judicial precedents" by CA. Nipun Singhvi was very well attended by members. It also generated a very healthy discussion in the groups lead by CA D.P.Shah, CA Rakesh Gupta, CA A.P.Nanavaty and CA Chintan Doshi.
A well appreciated entertainment programme "DOST, HU GUJRAT CHHU" was enjoyed by 600+ members with their family and friends.
Study Circle meeting on Amendments applicable for filing Income Tax Return for A. Y. 2016-17 by CA. Mehul Thakkar and chaired by Past President of Chartered Accountant Association CA Deepak R.Shah. Programme was attended by more than 200+ members and their Article Assistants.
Entertainment committee is arranging "Talent Evening" on 16/08/2016. Members are requested to participate and send nomination at Association's office. For details refer the circular sent by e-mail.
I would like to conclude with a very well said statement by David Schwimmer : " Being generous or doing things for others actually make me feel good so I don't do it because I hope karma will come around and get me and I will benefit from it."
Looking forward to your support and participation in future activities of the Association.
CA Raju C. Shah


text:
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07 April 2013 at 8:26 PM
Blake Shelton & Luke Bryan - ACM Awards 2013 Opening!
About this photo set: Blake Shelton and Luke Bryan hit the stage to open the show at the 2013 Academy of Country Music Awards held at the MGM Grand Garden Arena on Sunday (April 7) in… Read More Here
Photo #: 2845150
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Apricot bundt cake served at Christmas
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Apricot Bundt Cake Served At Christmas Stock PhotoApricot Cake,Bundt Cake,Cake,Cakestand,Celebration,Christmas,Christmas Cake,Close-Up,Colour Image,Cute,Decoration,Differential Focus,Dinner Party,Flower,Food and Drink,Indoors,Indulgence,Leaf,New York City,New York State,Night,No People,Photography,Plate,Porcelain,Public Celebratory Event,Sideboard,Temptation,USA,VerticalPhotographer Grace ClementineCollection: The Image Bank Kate MathisApricot bundt cake served at Christmas dinner on porcelain cake stand. Shot on green sideboard with dishes and holiday decorations.


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A bit off Que. true about the dumbing down and the leaders, but, they are elected by the retarded majority, look, The Fuhrer promised all these fancy little trinkets to the imbeciles for their vote. It so happens that the imbeciles are in the majority. Majority rules. Why do you think all these guns are being bought up by the citizenry? To hunt rabbits!!?All of you are in dire need of a spelling and writing class. This is what is sad this country has dumbed down the schools to the point of all of the kids are graduated at borderline retarded levels. And we only have ourselves to blame because we continue to reelect the same idiots who are doing the dumbing down. So don't blame the children they can only learn what they are taught. This goes for all of the schools in the U.S.
Why Are Petersburg Students so darn Stupid, worst in Virginia????
Posted in the Prince George Forum
21 - 40 of 52 Comments Last updated May 15, 2015
#21 Mar 6, 2013
#22 Mar 6, 2013
You present a valid argument, factually speaking, though, I have seen mothers without husbands and having children to feed educate themselves and raise their children correctly. First, Pull up your pants and get rid of the cell phone, second, the television should go into the trash. This device only promulgates indolence and desire that one had to work to attain. Emulates killing. Ever notice to see if there were any callouses on these people, not!
They could care less for their children or their upkeep as long as it is in the form of a government dole. Don't paint a jaded picture.
#23 Mar 6, 2013
I have a question to throw out there. That huge library they are building in Petersburg who is going to read the books they put on the shelves?
#24 Mar 7, 2013
certainly not a citizen
#25 Dec 22, 2013
Seems to me the one that is off base is you. It is true that in every city or province there are the shining stars, but is it easy to shine through a cloud of pollution?
This city is getting better now, it seems. I do not think that the teaching system of the school system and that autocratic Petersburg Administration Building closing would be any barrier to the increase of indolence or insolence within the student ranks. It would seem plausible that the very presence of adults, responsible ones, might just factor in the right atmosphere needed in this present school system.
I advocate the spending of my tax dollars in the most efficient and effective manner possible. Pandering should be banned in this topic.
#26 Dec 22, 2013
No sex education taught in these schools?
#27 Dec 22, 2013
Did you graduate from P-Burg?
#28 Dec 22, 2013
I bet you can not name all the countries involved in WW2 VN vet
#30 Dec 22, 2013
I work in petersburg alot and I see some fine black girls walking around. I practically have an erection the whole time in the city. If only some of them were into white guys
#31 Dec 23, 2013
You got all your teeth, you got a job, you got a boner, you have a car, got dope and booze, that is the master key. Prepared to be a father?
#32 Dec 23, 2013
The DP ever heard of condoms? Hell if she is fine enough I would gladly put a baby in that belly and a ring on that finger. And yes I have all those things above. Except my skin is white that is biggest downfall
#33 Dec 24, 2013
Wrong, money is green. The color of the skin is external, if you are a dirtbag, why on earth would she deal with the likes of you. Conversely, if you are an upstanding young man with a good job and the prefrontal cortex to make the grade, it never fails. Don,t put yourself down about the skin color and don't haul someone out of the bar. Go to school or church. Be nice, that is the ticket
#34 Oct 20, 2014
Petersburg students are NOT stupid. They are just as capable of being successful as any other student. It's just the way certain children are raised and how certain want to act. One bad apple can spoil the bunch. Before you comment and try to bring anyone down know who you are speaking about. If you can't help then don't say anything. God has a blessing for everyone single one Of the children in the Petersburg Public School System!
#35 Nov 3, 2014
There is no one going to read the books there because there will be no books. There will be computers directly linked to Farm-ville and the like, except that in games like farm-ville, one must know what a cow, or Duck, Barn etc looks like. Peters-burg students for the most part, know how to get their check for having an overabundance of children. go to chick fillet, "This is what a chicken looks like but that brown stuff? Are they feathers?"
#36 Nov 7, 2014
That is Henu, he is what a Harley tricycle riding dweeb looks like.
#41 Nov 24, 2014
Prove it up,crowjack
#42 Nov 24, 2014
Big words, maybe to you, because, the fact of the matter is, you cannot understand them. hahaha
#44 Nov 24, 2014
My oh my, it is a big word, did you learn it all by yourself?
United States
#46 Dec 1, 2014
Check the parents...most of em on drugs.
#47 Dec 5, 2014
LOL you have major issues- stay inside and close the curtains- then do it and save us your useless drivel.
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Key sign for today. The $25 ask showed over 300K when the bid was at $24.99. It got chewed thru like it was nothing. Kind'a says to me there's some....energy...behind the buy side? ;-)
Bid $25.19.
Bid $24.78. Close enough on this current p/b to open an initial long side trade. I'm comfortable layering in more as the bid continues to p/b. I'm waving another bid down around the .60 line just in case....
HiLo, I took my s/t out at $25.20 and if the MMs are true to form here, they will try to push this back under $25 just to frustrate the hell of us longs. Do you think they can push it back down today to test the previous high around $24.72?
f40: " Do you think they can push it back down today to test the previous high around $24.72?"
I'm COUNTING on it. I went short of earlier trade closures at the ~$25.18 line. Bid now $24.88 and I'm setting a stop just north of $24.90. Errrr....or rather...I did as it just got hit. So now I'm looking to flip to the long side....but want to see if that gap down to the area you mention....maybe even as far south as $24.50....gets some percentage filled.
Bid now .96. If the bid gets back north of $25 on volume I'll go long...
I sold my 24 1/2 calls at the top...Nice profit. I agree that they will try to keep this down. Not going to be too upset as it gies higher since ai own stock as well.


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Adam Scott will make his PGA Tour season debut at this week's Northern Trust Open, but he has already had success in 2008.
With membership on the European Tour for the first time since 2005, Scott won the recent Qatar Masters by shooting a blistering final-round 61 that included 11 birdies.
The victory was lucky No. 13 worldwide for the 27-year-old, who lists titles at the Players and Tour Championship among his biggest to date.
His major championship record? That's another matter. Scott discusses his renewed priorities toward the big tournaments, his relationship with Butch Harmon and his surfing handicap on the Hot Seat.
Q: Recently, one sports blogger, when asked which current athlete he would most like to be, responded by saying Adam Scott, citing your looks, youth, money, talent and the longevity of top tour pros. So, just how good is it to be you?
A: It's pretty good, to be honest. You know, I go to work in a great office every day, and the amount of freedom that goes with being a pro golfer on the tour is awesome. So I get to enjoy my weeks off away from the course, and then I get to go to work on some of the best golf courses in the world out here.
Q: Along the same lines -- I'm not sure how else to phrase it, so I guess I'll just say it -- the ladies like you. Does that ever get distracting on the course?
A: I wish it did a little bit. [Laughs.] But it creates a fun environment to play golf in.
Q: Do you often notice it out there?
A: I'd be lying if I said I didn't. We're out there for five hours. You've got to look around a little bit.
Q: On to some more serious stuff. Where does winning a major championship rank on your list of priorities?
A: Obviously, No. 1. To win a major championship -- I think, at the end of the day, that's what a golfer's career is based upon.
Q: You have never finished closer than six strokes to the winner in 27 career majors. How come?
A: Well, I really haven't taken my best stuff into a major yet. It's been something that I've struggled with, peaking on those four weeks of the year. I'm working really hard to change that.
Q: What are your feelings going into a major championship week? Excitement? Nerves? Some combination of the two?
A: It's a combination of the two, but I'd certainly like to see the excitement level going up. I think there's more and more excitement now. I'm feeling more and more comfortable in my abilities to win one, so excitement should take over.
Q: Is there one major that suits your game better than the other three?
A: It's tough to say. I think it's all pretty much the same, but if I won one, I'd love it to be the Masters.
Q: More than the British?
A: Yeah, because an Australian has never won the Masters.
Q: Good point. You have been working with Butch Harmon for a while now. What impact has he had on your results?
A: Well, Butch has made my career. I can't praise his work enough. He's taken me from being a decent amateur golfer to being one of the best players in the world, so the work that Butch and I have done and the time he's spent, all credit goes to him for that.
Q: I'm guessing he doesn't give group lessons with you, Phil [Mickelson], Freddie [Couples], [John] Daly and [Natalie] Gulbis all out on the range together, huh?
A: That would be a pretty interesting combination. That could be fun one day, but I don't know how much work we'd get done.
Q: In all seriousness, do you feel like you get enough of his attention?
A: Absolutely. Butch and I have a great relationship. People may think that Phil takes a lot of his time, but before he had Phil, he had Tiger. Obviously, Tiger took a lot of Butch's attention, and I was way down on the totem pole, so to speak, and that's how our relationship has always been. I travel a lot. I don't live in America, so we speak a lot on the phone, and we both like how our relationship works.
Q: It has been said that your swing is comparable to that of Tiger Woods earlier in his career. Do you see the similarities?
A: I used to a lot more than I do now. I think Tiger's swing has evolved and my swing has evolved -- they're not like they used to be. People get fooled because we have a similar rhythm to our swings and that's why they look similar, but if you look at them closely, they're not.
Q: Was there ever a conscious decision between you and Butch to make your swing more like Tiger's?
A: It wasn't really a conscious decision, but the similarities were there from the start. When I was in high school, there's no doubt I was trying to swing like Tiger Woods when he first came on tour. When I finally got to see Butch, he saw the similarities, and sure, we did definitely work on some of the same stuff that he and Tiger worked on.
Q: What do you make of Tiger's performance over the past six months or so?
A: It's phenomenal. Most six-month stretches of Tiger's are. He never fails to impress.
Q: Are there both advantages and disadvantages to playing in the so-called Tiger Woods era?
A: Well, I think so, but the advantages outweigh the disadvantages.
Q: What are they?
A: I think he's pushing everyone to become better players, and a lot of guys are better players with him than they'd be without him.
Q: Do you think his accomplishments at such a young age have led to increased expectations for players like yourself?
A: I think so, for sure. The players have learned not to compare themselves to Tiger. But absolutely, he's a phenomenon, and expectations were there for another young player to come through and challenge, but obviously that hasn't happened to this point.
Q: After Woods, who is the world's most talented player? And don't tell me Ian Poulter.
A: [Laughs.] That would be fitting at the moment, wouldn't it? Hmmm Ernie Els.
Q: Who comes next?
A: Mickelson.
Q: I'm not going to stop until you get to yourself, you know.
A: I'll put myself in next then.
Q: Why didn't you play the Mercedes-Benz Championship last month?
A: I didn't get a rest. I wasn't ready to get back into the tour grind. You know, we play late in Australia on the Australian Tour, into December. I had two and a half weeks off over Christmas, and Christmas can get pretty hectic sometimes, so I just wasn't ready to put my head back on my shoulders and go play competitive golf.
Q: Do you think the PGA Tour's schedule starts too early in the year?
A: Yeah, I do. To be honest, that's a tough date for such a great tournament. The concept of the tournament is fantastic, the course is fantastic and the place is great, but the date is so close to Christmas and New Year's. That's a time of the year when some players would like to get away and spend time with their families or have a holiday.
Q: What would you suggest as an alternative?
A: It's tough, because there are so many tournaments. It's tough to get dates. I just think you've got to look at the number of tournaments and that will sort itself out.
Q: What sort of influence has Greg Norman had on your career?
A: He's been a huge influence. The amount of time that he's given me has really been the incredible thing. For me, looking up to him all my life, then to be able to spend so much time with him throughout my career so far has been incredible. I don't know if there's a better person to give me advice.
Q: He is the one who suggested you remain on the European Tour rather than coming straight to the United States at the outset, correct?
A: Yes, he and Butch. They spoke about it on the phone.
Q: You are from Australia, went to college in Las Vegas and make your home in
Switzerland? Can't imagine there's much golf over there.
A: [Laughs.] I live about 100 yards from the golf course, so yeah, there's a bit of golf. Not this time of year, but then again, you won't find me there this time of year.
Q: Do as many people recognize you in Switzerland as in other parts of the world?
A: No, I keep a very low profile in Switzerland. There are only about 2,000 people in the village I live in, so it's a quiet town.
Q: Last year, Butch told me you were a 12-handicap surfer. Have you gotten into single digits yet?
A: Definitely not. That's annoying, too. But I'll get better eventually. It goes through stages where I surf a lot and get better, then won't surf for six months. It's just so hard for me to get away from golf.
Q: When I asked Will MacKenzie whether he would rather spend an afternoon playing golf or surfing, he had a difficult time coming up with an answer.
A: I know how he feels. I'd like to say golf, but a nice afternoon with good swell is about as good as it gets for me.
Q: Next to surfing in the special interests category of your PGA Tour media guide entry, you list biographies. Read any good ones lately?
A: The last good one I read was about Michael Peterson, who is a surfer, a cult hero in Australia. That was a good one for me because I like surfing, but I actually haven't read a biography in a little while.
Q: So tell me, when the Adam Scott biography is written 25, 30 years from now, what will it say?
A: Adam Scott, wannabe surfer. [Laughs.]
Q: No mention of golf?
A: Yeah, it'll mention golf, absolutely. But I hope there's more to my life than just golf.
Q: Adam Scott, you are off the ESPN.com Hot Seat.
A: Thanks, mate!
Jason Sobel is ESPN.com's golf editor. He can be reached at email@example.com.


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I haven't used pure mySQL for a while now and looks like I forgot it. Sad story. Now I have 2 tables - images and votes. Images have a unique id, among others. The votes table only has 2 fields - image id and user id.
I'm trying to get the list of images ordered by number of votes and I'm kinda stuck here. The closest I got is this:
SELECT i.uname AS author, i.title, i.time, i.description, i.id, i.extension, v.uid
FROM images as i
votes as v ON i.id = v.iid
Which returns all images with the voter ID. If an image has multiple votes, than it's returned more than once.
Can someone please help me with this query ?


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477 South Main Street has a Walk Score of 58 out of 100. This location is Somewhat Walkable so some errands can be accomplished on foot.
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477 South Main Street is in the Woodruff neighborhood. Woodruff is the 6th most walkable neighborhood in Logan with a neighborhood Walk Score of 20.


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This is your resource to discuss support topics with your peers, and learn from each other.
Hi everyone, i have this simple doubt, im starting with blackberry programming, i already checked the blackberry docs and examples, got the eclipse plugin and i like the API and everything,
but i wonder how many you can do just with javeME, maybe that way it would be portable to other devices.
So my cuestion is how many can be done for blackberry just with javaME?,
can you acces to network? bluetoth, mail, etc... and portable to other devices.
thanks, Eduardo.
Solved! Go to Solution.
02-18-2010 06:18 PM - edited 02-18-2010 06:27 PM
Bluetooth, network connections, audio, etc. are mostly JavaME/J2ME portable.
There are many classes that are specific to the BlackBerry that you simply cannot do with just J2ME/JavaME without recreating the code yourself or finding libraries to do so.
If you are going to develop for more platforms, I'd say you should find as many J2ME classes you can use and if and only if you need a BlackBerry-specific class, then you should use it.
This should bring you the most portability.
** Note: In some cases, you cannot mix and match the two a little elbow grease. **
Hi JCarty, thanks a lot for the fast reply, you have cleared my doubt


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Tommy is a sweet little Chihuahua in a sweater who knows what the word "bath" means and is having none of it in this hilarious video. Tommy is actually quite the Internet star, along with he best friend, Gracie the cat. You can check out their website, Facebook page, and blog for more.
Video: Tommy the Chihuahua Doesn't Want to Take a Bath
Written by: Phil Monahan


text:
Oprah Winfrey, director Lee Daniels and company ruled the box office by a mile this weekend.
Lee Daniels' The Butler grossed $25 million to win top spot, beating out fellow newcomers Kick-Ass 2 and Jobs, according to The Hollywood Reporter.
Wish you could catch up on this week's top Hollywood headlines in just one minute? Well Celebuzz's Taryn Brooks has got you covered with this week's One Minute Buzz.
Lady Gaga released her newest single 'Applause' after it was leaked earlier this week. But was she a piracy victim or was it a…
VIBE's Milan Carter sat down with Kick-Ass 2 stars Donald Faison and Morris Chestnut, who join Chloe Grace Moretz and Aaron Taylor-Johnson in the hugely popular action flick's sequel.
Faison, who will forever be known to me as Murray from Clueless, talked to Carter about his super powers (or lack thereof) as a youth.
Kick-Ass 2 isn't in theaters until August and the trailers came out in March, so it's unclear why Jim Carrey has just decided he doesn't like the movie, but he has. Jim Carrey apparently regrets making the Kick-Ass 2. He took to Twitter this weekend to say, "I did Kickass a month before Sandy Hook…
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MIDDLEBORO – The Occupational Safety and Health Administration was called Sunday to the Ocean Spray Cranberries, Inc., processing plant at 152 Bridge St., after a forklift caught fire and sent a 57-year-old woman to the hospital.
Police officer Steven T. Avelino Jr. said the woman was taken by medical helicopter to Rhode Island Hospital for treatment for smoke inhalation.
The plant filled with smoke, causing officials to evacuate just after 7 a.m., said Fire Cpt. Dana Fontaine.
Fontaine declined to release the victim's name, but said she did not have life-threatening injuries.
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The Atlantic City High School football team won one game in 2009. Vineland won two. Both can start the 2010 season 2-0 with victories tonight. Atlantic City plays at Ocean City at 7 p.m. today. The Vikings haven't been 2-0 since 2005. Vineland hosts Pleasantville at 7 p.m. today. Vineland hasn't been 2-0 since 2003. Here's a previews of those and this weekend's other games. By Michael McGarry
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