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|VirtualBuzzVA is not in any groups
|I'm a Virtual Assistant who specializes with website making, SEO, Social Media Management and Marketing and Virtual Administrative tasks.
How To Be A Virtual Assistant
What is a VA? What does it mean to be freelancer? How to enter the home based worker heaven?
Let us face it. Nobody knows anything about these things until just recently, when it exploded in the media. Nobody entered college planning to be a freelancer someday. It was just not in the book of "Plans". Personally I've never heard of Virtual Assistant until I was in my late 20's. There was no courses for it, no specializations for working at home there are no straight paths to becoming a successful home based worker.
For me, I graduated a Nurse. I did all I can to be a Nurse and I did went out into the adult world as one. But the book of "Plans" was a fiction. It was a figment of a student's imagination. Nothing went as planned. Dreams were crushed, plans were re-scheduled, then re-scheduled, some plans were scrapped and some plans even came earlier that expected. Needless to say, I was stuck in a conundrum on what to do and where to go and if I did want to go away.
That was until one day, I heard of Virtual Assistance in the news and how this one lady became successful and rich because of it, while staying close to her family. It was perfect! My interest was piqued and I started to search about it. I set my mind to it and then I entered the unknown. And now I will tell you what I did and what I wish I did to become a Virtual Assistant.
Research on What Virtual Assistants Do
I researched everything about virtual assistants and what are the kinds of things they can do. I then tried to pick out the skills I already have and can offer the possible clients in the future. Growing up in a high-tech world, I was lucky I had the basic skills under my belt such as -- using the computer, for starters, making websites, making and using social media accounts, etc. Everything will rely on your computer skills and the internet. Literally, everything. Next is, how good your typing skills are, can you use a website and can you navigate an e-mailing platform or an online calendar. If you aren't familiar with them, no worries.
You only need one skill for the moment, and that is to be a good learner.
Research, relax and hone the skills you need.
We will get there.
Join a Virtual Assistant or Freelancing Group
I went to my Facebook and joined various groups and pages. I learned some but I was still lost and confused of the terminologies they were using and had collected more questions than answers. You will need these groups one day and they might probably help you land a job. For the mean time, we have to learn the skills to land them. I did the next possible step.
Join a Freelancing Seminar
By virtue of internet cookies, I was lead to the FVA Consultancy's Freelancing Seminar. I paid the fee, which was by the way, worth all the knowledge I garnered and then I started the month long training. When the training began, I was still managing my online business and it completely slipped my mind. I was behind for week! I tried catching up and did all the portfolios I need and here I am. My tip for you is to focus all you time and energy learning. Limit your mindless scrolling and make the best portfolios you can. These are the very portfolios you will show you future clients.
I learned a lot from them, from choosing my niche to setting up my UpWork, making my own freelancing facebook page to learning new skills such as Social Media Management and Marketing and SEO's.
I highly suggest to use this path as learning on your own can be good, but learning from the experts will be best for your freelancing career.
Keep updating yourself
Just like your cellphone apps, we need to be updated regularly. What's new, what's in and what the world is talking about. What we will enter is a past paced world where tasks depend on information and technology.
Use a Calendar and Be Your Own Assistant
Write down your tasks, make your milestones, schedule your days and be productive. Make time to update you websites and social media accounts and most especially, your portfolios. Learn new skills as you go along and find out what niche you are most comfortable doing and master that
Keep Applying and Keep Looking
There are no instant jobs. You will be lured with money, time and freedom, but these will cost you. You will need to strengthen your resolve and be patient. The right client will come on the right time and on your right skills. If things take time or leads turn sour, just persevere and turn some more rocks. That's the only way to land the Job of your dreams.
If you follow all these then you will be on your way to you Virtual Assistant dream. Even if you are a beginner like me, you will eventually learn the ropes and be one day be your own boss. If you want ideas for your own Virtual Assistant Branding, you can check my website for more tips and ideas.
See you around and I hope you reach your freelancing dreams!
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By Margaret Wight
Well, hey there.
My name is Margaret Wight, but friends call me Marge so feel free to do the same. I am the new graduate assistant at the UMKC Women's Center. I am originally from the small town of New Market, Virginia. I received my Bachelor of Science from James Madison University (go Dukes!) in Communication Sciences and Disorders with a minor in Geriatric Study. I realized that this was not the career I wanted to advance in around my senior year of college. I just spent the last four years getting a degree in a field I no longer wanted to work in – so, now what?
I decided I wanted to continue my education, but this time I wanted to be sure about what career field I wanted to end up in. Since I was still uncertain about what I wanted to do, I could not enroll in grad school just yet, but I could not remain idle either – this lead me to apply to AmeriCorps. I ended up applying, interviewing, and landing a position as a Corps Member in a program called City Year-Kansas City: an education non-profit that focuses on closing the graduation gap created by the economic, academic, and supportive disparities low-income students face every day.
Through working with City Year and reflecting on my time at JMU, I realized I wanted to work on college campuses and focus on creating new programs and practices to increase the number of underrepresented students in postsecondary education. Now here we are, I am currently studying Higher Education Administration with a focus in Student Affairs at UMKC. When I saw the GA position at the Women's Center become available, I knew that was the perfect next step for me.
The reason I was automatically attracted to the Women's Center is because all kinds of #equity is a passion of mine. The Women's Center's mission is "to advocate, educate, and provide support services for the advancement of women's equity on campus and within the community at large," and girl, I can get down with that! Let's talk wage gap, feminism, body positivity, and human rights. I am so excited to be a part of this amazing team and work toward a common goal. Everybody, get hype for the awesome programs we have planned for you this upcoming semester and most importantly – come visit us in the Women's Center!


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A number of treatments are available to treat erectile dysfunction. The typical treatment strategy starts with simple to use, noninvasive therapies and progresses to more invasive surgical therapies as needed. In all men, the first step is determining if there are any modifiable risks factors that can either improve or prevent progression of erectile dysfunction. Since the risk of developing ED is increased in the presence of diabetes, heart disease, and hypertension, it is thought that better control/prevention of these conditions may have a benefit in ED. Similarly, it is thought that lifestyle modifications to improve vascular function such as avoiding smoking, maintaining ideal body weight, and engaging in regular exercise might either prevent or reverse ED. Sexual counseling may also be useful in addressing relationship stressors as you work on improving your erectile function.
Sexual stimulation causes the release of neurotransmitters from cavernosal nerve endings and relaxation factors from endothelial cells lining the sinusoids. NOS produces NO from L-arginine, and this, in turn, produces other muscle-relaxing chemicals, such as cGMP and cyclic adenosine monophosphate (cAMP), which work via calcium channel and protein kinase mechanisms (see the image below). This results in the relaxation of smooth muscle in the arteries and arterioles that supply the erectile tissue, producing a dramatic increase in penile blood flow.
Long-term predictions based on an aging population and an increase in risk factors (eg, hypertension, diabetes, vascular disease, pelvic and prostate surgery, benign prostatic hyperplasia, and lower urinary tract symptoms) suggest a large increase in the number of men with ED. In addition, the prevalence of ED is underestimated because physicians frequently do not question their patients about this disorder.
Risks associated with injection therapy including bleeding, pain with injection, penile pain, priapism, and corporal fibrosis (scarring inside of the corpora cavernosa). There is also concern that repetitive injections in the same area could cause scar tissue to build up in the tunica albuginea that could create penile curvature. Thus, doctors recommended that one alternate sides with injection and perform injections no more frequent than every other day.
Risks associated with injection therapy including bleeding, pain with injection, penile pain, priapism, and corporal fibrosis (scarring inside of the corpora cavernosa). There is also concern that repetitive injections in the same area could cause scar tissue to build up in the tunica albuginea that could create penile curvature. Thus, doctors recommended that one alternate sides with injection and perform injections no more frequent than every other day.
Erectile dysfunction is the inability to develop or maintain an erection that is rigid enough to allow penetration of the vagina, and therefore functional sexual intercourse. Generally, the term erectile dysfunction is applied if this occurs frequently (75% of the time) over a significant period if time (several weeks to months). If this is the case, the term impotence may also be used.
There are hundreds of medications that have the side effect of ED and/or decreased libido. Examples of drugs implicated as a cause of ED include hydrochlorothiazides and beta-blocking agents. Medications used to treat depression, particularly the SSRIs such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Prozac Weekly, Sarafem), fluvoxamine (Luvox, Luvox CR), paroxetine (Paxil, Paxil CR, Pexeva) and sertraline (Zoloft), may also contribute to ED.9 Bupropion (Wellbutrin) which has a predominant effect on blocking the reuptake of dopamine is an antidepressant with lower incidence of ED.10 The side effects of 5ARIs occurring in fewer than 5% of patients can include gynaecomastia, ED, loss of libido and ejaculatory dysfunction.11
Melanocortin receptor agonists were found to induce erections serendipitously. A study investigating the dermatologic use of Melanotan-II (MT-II) was found to generate erections unexpectedly leading to the development of MTII derivatives for ED treatment (120). MT-II was initially used to induce pigment changes in the skin for artificial tanning but has been suspected to induce melanoma, however (121).
You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
It is estimated that up to 20 million American men frequently suffer from impotence and that it strikes up to half of all men between the ages of 40 and 70. Doctors used to think that most cases of impotence were psychological in origin, but they now recognize that, at least in older men, physical causes may play a primary role in 60% or more of all cases. In men over the age of 60, the leading cause is atherosclerosis, or narrowing of the arteries, which can restrict the flow of blood to the penis. Injury or disease of the connective tissue, such as Peyronie's disease, may prevent the corpora cavernosa from completely expanding. Damage to the nerves of the penis, from certain types of surgery or neurological conditions, such as Parkinson's disease or multiple sclerosis, may also cause impotence. Men with diabetes are especially at risk for impotence because of their high risk of both atherosclerosis and a nerve disease called diabetic neuropathy.
Metabolism (breakdown) of vardenafil can be slowed by aging, liver disease, and concurrent use of certain medications (such as erythromycin [an antibiotic], ketoconazole [Nizoral, a medication for fungal/yeast infections], and protease inhibitors [medications used to treat AIDS]). Slowed breakdown allows vardenafil to accumulate in the body and potentially increase the risk for side effects. Therefore, in men over 65 years of age with liver disease, or who are also taking medication(s) that can slow the breakdown of vardenafil, the doctor will initiate vardenafil at low doses to avoid its accumulation. For example,
Can apple cider vinegar treat erectile dysfunction? Apple cider vinegar is thought to have many health benefits, but can it help treat erectile dysfunction (ED)? ED can result from cardiovascular problems, diabetes, and other factors. Apple cider vinegar may help improve symptoms of conditions related to ED. Find out how it may help, and how to use it safely. Read now
Then you have to be able to make the right diagnosis. What is the basis for their erectile dysfunction? Is it psychogenic? Is it some sort of neurological or blood vessel or hormonal issue? So you have to make a diagnosis. You have to be able to make an assessment. And then only after those things are done, then you start to think about medications.
Our physicians can help you treat E.D. with prescription medication. We will recommend a personalized dosage for Viagra, Sildenafil (the same medication as in Viagra), Cialis, or Tadalafil (the same medication in Cialis). You will receive a treatment plan designed by Dr. Seth Cohen, Head of Men's Health, NYU Division of Sexual Medicine and Reconstruction and Dr. Steven Lamm, Director of NYU Men's Health Center. During your online visit, you can tell your doctor if you have a medication preference. Learn more about E.D. treatment
Surgery: If neither drugs nor the vacuum pump works, your doctor may suggest surgery. With surgery, the doctor can place a device in your penis that will cause enough hardness for intercourse. In a few cases, infections may develop after the operation, and the doctor may have to remove the device. Another operation that may help you is rebuilding the blood vessels in the penis to increase blood flow into the penis or decrease blood flow out of the penis. These procedures can help you to get and maintain an erection.
4. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Erectile dysfunction (updated Nov 2015). https://www.niddk.nih.gov/health-information/health-topics/urologic-disease/erectile-dysfunction/Pages/facts.aspx (accessed Nov 2016). myDr myDr provides comprehensive Australian health and medical information, images and tools covering symptoms, diseases, tests, medicines and treatments, and nutrition and fitness.Related ArticlesImpotence causesFind out the physical and psychological causes of impotence, also called erectile dysfunction or ED.Erectile dysfunction: visiting your doctorFind out what questions a doctor may ask when discussing erectile dysfunction (ED, or impotence8 Surprising causes of erectile dysfunctionOccasional erectile dysfunction is not uncommon, but if it's persistent, erectile dysfunction caAdvertisement
Now, there are lots of ways that you can reduce stress and anxiety in your life. One of those things you can do is exercising daily. Now, it doesn't mean getting into a gym all the time, but it can just be doing sit-ups at home, long walks at the grocery store, bicycling, and if you can afford the gym, getting there maybe two to three days a week. But don't forget, a healthy body equals a healthy mind. Meditation, yoga, breathing exercises– now, here's where you can take a few moments to be centered and communicate with your inner self, peace. Healthy eating– now, taking control of the intake of what goes into your body makes you to start feeling better and looking better. That wellness is the opposite of anxiety. And treating issues and tackling things that are weighing you down, taking that very first step is liberating.
If you can't take one of these oral medications, your physician may have you try Caverject (alprostadil for injection), a hormone that you inject into your penis using a fine needle, or Muse (alprostadil urogenital), a tiny suppository that you insert into the tip of the penis. Both of these will bring on an erection within five to 15 minutes without sexual stimulation.
If you have a neurological disorder or spinal cord injury and other erectile dysfunction treatments aren't effective, two types of surgical implants could offer solutions to your ED. "An implantable pump can be used to manually create an erection by pumping fluid into cylinders placed inside the penis," explains Feloney. "The other option is a malleable prosthesis that works like a gooseneck lamp to direct the penis into position for intercourse." Risks for these ED treatments include infection and mechanical breakdown.
Prior to starting with treatment of erectile dysfunction, it is important to make sure that it is safe from a medical standpoint to participate in sexual activity. Sexual activity is physical exertion, and in some men with significant heart disease, this increase in physical exertion can increase the risk of a heart attack. Thus, it is very important to discuss your cardiovascular risks with your doctor prior to trying any medication or treatment for erectile dysfunction.
Implantable penile prostheses are usually considered a last resort for treating impotence. They are implanted in the corpora cavernosa to make the penis rigid without the need for blood flow. The semirigid type of prosthesis consists of a pair of flexible silicone rods that can be bent up or down. This type of device has a low failure rate but, unfortunately, it causes the penis to always be erect, which can be difficult to conceal under clothing.
A vacuum erection device is a plastic tube that slips over the penis, making a seal with the skin of the body. A pump at the other end of the tube makes a low-pressure vacuum around the erectile tissue, which results in an erection. An elastic ring is then slipped onto the base of the penis. This holds the blood in the penis (and keeps it hard) for up to 30 minutes. With proper training, 75 out of 100 men can get a working erection using a vacuum erection device.


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PI118663928Amgen

Job ID: R-95136
Location: West Greenwich, RI, US 02817

Job Summary

Amgen's 10 to 12-week internship program offers meaningful project experiences that impact patient's lives. This internship provides the opportunity for executive and social networking events and to participate in community volunteer projects while providing a competitive compensation. Relocation housing and/or transportation allowance may be available for eligible candidates.

Amgen's manufacturing facility in West Greenwich, RI is looking for students with outstanding academic records and demonstrated leadership capabilities. An internship at Amgen is a hands-on learning experience under the guidance of an Operations Manager. Interns are matched to meaningful and challenging projects.

Participation as an intern has the potential to lead to an offer to join the Rotational Leadership Development Program or other entry-level full-time position upon college graduation, depending on available positions and an evaluation of your performance.

Operational Excellence - Lean Transformation

This position will provide the opportunity to work within the Operational Excellence Department at the Amgen RI Operations Facility s upporting performance improvements of critical processes using Industrial Engineering concepts and tools . Coaching, mentorship, and guidance will be provided to the intern as they engage in the following project areas:

Advance application of Training Within Industry (TWI)

 Identify and lead improvement initiatives to impact process waste, cycle time, and change over reduction

 Perform other IE related tasks as required like time studies, process mapping, and data analyses

Basic Qualifications:

Amgen requires that all individuals applying for an undergraduate internship or an undergraduate co-op assignment at Amgen must meet the following criteria:

18 years or older

Currently enrolled in a bachelor's degree program from an accredited college or university with a 3.0 minimum GPA or equivalent

Completion of at least one year of study from an accredited college or university prior to the internship commencing

Enrolled in a full-time bachelor's program following the potential internship or co-op assignment with an accredited college or university

Must not be employed at the time the internship starts

Preferred Qualifications:

Pursing a degree in Industrial or Systems Engineering

GPA 3.5 or higher

Junior Standing

Strong computer skills including knowledge of MS Office Applications (Excel, Word, PowerPoint, SharePoint), Visio, and Minitab

Experience performing time studies and creating workforce models

Strong communication, interpersonal, organizational, project management, problem solving, analytical and quantitative skills

Demonstrated personal initiative, self-motivation, flexibility and adaptability

Proven leadership experience on campus (e.g., projects, clubs, organizations, sports)

 Join Us

 If you're seeking a career where you can truly make a difference in the lives of others, a career where you can work at the absolute forefront of biotechnology with the top minds in the field, you'll find it at Amgen.

 Amgen, a biotechnology pioneer, discovers, develops and delivers innovative human therapeutics. Our medicines have helped millions of patients in the fight against cancer, kidney disease, rheumatoid arthritis and other serious illnesses.

 As an organization dedicated to improving the quality of life for people around the world, Amgen fosters an inclusive environment of diverse, ethical, committed and highly accomplished people who respect each other but compete intensely to win. Together, we live the Amgen values as we continue advancing science to serve patients.

 Amgen is an Equal Opportunity employer and will consider all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

PI118663928

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Journal Menu► ▼ Journal Menu
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Special Issue "New Advances in Self-Compacting Concrete and Geopolymer Concrete"
A special issue of Materials (ISSN 1996-1944). This special issue belongs to the section "Construction and Building Materials".
Deadline for manuscript submissions: 31 May 2020.
Special Issue Editor
Guest Editor
Interests: Advanced Cementitious Materials; Concrete Technology; Reinforced Concrete Structures; Fire Performance of Reinforced Concrete Structures
Special Issues and Collections in MDPI journals
Special Issue Information
Dear Colleagues,
The aim of New Advances in Self-Compacting Concrete and Geopolymer Concrete—Special Issue is to publish the best research on self-compacting concrete (SCC) and geopolymer concrete (GC) incorporating fiber reinforcement, lightweight aggregates, heavyweight aggregates, recycled concrete aggregates, tire derived aggregates, recycled glass aggregates, rice husk ash, etc. In doing so, this Special Issue will present the results of research on the properties and performance of SCC and GC; novel experimental techniques; the latest analytical and modelling methods; the examination and the diagnosis of real SCC and GC structures; and the potential for improved and innovative SCC and GC.
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- Self-compacting concrete
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- Fibers reinforcement
- Recycled concrete aggregates
- Tire derived aggregates
- Lightweight aggregates
- Heavyweight aggregates
- High temperatures
- Durability
- Concrete technology
Dr. Farhad Aslani
Guest Editor
Manuscript Submission Information
Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.
Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Materials is an international peer-reviewed open access semimonthly journal published by MDPI.
Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.
- Self-compacting concrete
- Geopolymer concrete
- Fibers reinforcement
- Recycled concrete aggregates
- Tire derived aggregates
- Lightweight aggregates
- Heavyweight aggregates
- High temperatures
- Durability
- Concrete technology.


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|Method for transforming diaphragm muscle cells
|April, 2003
|Liu et al.
|Methods for trapping emboli
|May, 2007
|July, 2009
|Zucherman et al.
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|June, 2008
|January, 2010
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|Operation aid system
|September, 2003
|Antenna Assemblies for Medical Applications
|April, 2010
|Rossetto et al.
|Vertebral arthrodesis device
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|Sgier et al.
|Guide assembly
|November, 2004
|Kermode et al.
|OR ready
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The present invention relates generally to devices and methods for a surgical tool for creating access to and/or cutting a material or substance. More specifically, the devices and methods are useful for resecting nerve and/or soft tissue via a minimally invasive procedure to alleviate pain.
Standard methods of cutting tissue may include using a scalpel, scissors, and radio frequency energy. Electrosurgical procedures and techniques using radio frequency energy are currently used since they generally reduce patient bleeding and trauma associated with cutting operations. Additionally, electrosurgical ablation procedures, where tissue surfaces and volume may be reshaped, cannot be duplicated through other treatment modalities.
Minimally invasive procedures in nerve and/or soft tissue such as the spine or the breast, however, are difficult to perform using standard scissors and scalpel. Furthermore, in a closed environment, radio frequency current dissipates into the surrounding tissue causing a decreased ability to achieve a current at the cutting electrode of sufficiently high density to initiate a cut. To overcome this problem, high power settings are often required to initiate the cut which often is painful and increases thermal damage to the tissue whether using a standard or a custom electrosurgical generator.
Another problem associated with cutting tissue is the control of bleeding. Radio frequency energy controls bleeding by coagulating small blood vessels. Another method of controlling bleeding is through the use of heat. For example, some commercially available scalpels use direct heat to control bleeding. However, while the bleeding is generally controlled, the cutting of tissue is often slower than with radio frequency energy and the knife edge readily dulls. Other commercially available scalpels use ultrasonic energy generally at 50 kHz to heat the tissue so as to coagulate severed blood vessels but cut slower than a standard electrosurgical electrode and are costly as a custom ultrasonic generator is required.
A further disadvantage of using radio frequency energy is the generation of smoke. The smoke is malodorous and can contain airborne viral particles that may be infectious. Furthermore, the smoke often obscures visualization of the procedure. When the smoke becomes too dense, the procedure is delayed until the smoke is released through one of the trocar ports and after enough carbon dioxide gas has re-insufflated the abdominal cavity. This unnecessarily prolongs the operative time.
Radiofrequency (RF) energy is used in a wide range of surgical procedures because it provides efficient tissue resection and coagulation and relatively easy access to the target tissues through a portal or cannula. Conventional monopolar high frequency electrosurgical devices typically operate by creating a voltage difference between the active electrode and the target tissue, causing an electrical arc to form across the physical gap between the electrode and tissue. At the point of contact of the electric arcs with tissue, rapid tissue heating occurs due to high current density between the electrode and tissue. This high current density causes cellular fluids to rapidly vaporize into steam, thereby producing a "cutting effect" along the pathway of localized tissue heating. Thus, the tissue is parted along the pathway of evaporated cellular fluid, inducing undesirable collateral tissue damage in regions surrounding the target tissue site. This collateral tissue damage often causes indiscriminate destruction of tissue, resulting in the loss of the proper function of the tissue. In addition, the device does not remove any tissue directly, but rather depends on destroying a zone of tissue and allowing the body to eventually remove the destroyed tissue.
Present electrosurgical techniques used for tissue ablation may suffer from an inability to provide the ability for fine dissection of soft tissue. The distal end of electrosurgical devices are wide and flat, creating a relatively wide area of volumetric tissue removal and making fine dissections along tissue planes more difficult to achieve because of the lack of precision provided by the current tip geometries.
In addition, identification of the plane is more difficult because the large ablated area and overall size of the device tip obscures the physician's view of the surgical field. The inability to provide for fine dissection of soft tissue is a significant disadvantage in using electrosurgical techniques for tissue ablation, particularly in arthroscopic, otolaryngological, and spinal procedures.
Traditional monopolar RF systems can provide fine dissection capabilities of soft tissue, but may also cause a high level of collateral thermal damage. Further, these devices may suffer from an inability to control the depth of necrosis in the tissue being treated. The high heat intensity generated by these systems causes burning and charring of the surrounding tissue, leading to increased pain and slower recovery of the remaining tissue. Further, the desire for an electrosurgical device to provide for fine dissection of soft tissue may compromise the ability to provide consistent ablative cutting without significant collateral damage while allowing for concomitant hemostasis and good coagulation of the remaining tissue.
Another problem with currently available RF nerve ablation devices is that they attempt to destroy nerve tissue from a central location including the tip of the device and a 3-D spherical or cylindrical zone around it. As a result, the further away the resecting ability is from the central zone the less effective the nerve destruction. Consequently, often the nerve is not adequately ablated leading to continued pain symptoms.
Further, the health care practitioner may have difficulty positioning the tip of the device in the optimal location to get an optimal and consistent clinical result. This may also result in unwanted necrosis of adjacent tissue, which can lead to clinical adverse events including subsequent repair of the necrotic tissue.
Other devices such as mechanical rongeurs can be used to remove soft tissue. However, these devices require the insertion of relatively large cannulas that further complicate the surgical procedure and can cause nerve compression and pain with variable clinical efficacy.
Accordingly, there is a need for devices and methods to provide efficient severing or cutting of nerve and/or soft tissue that can be used during a minimally invasive procedure and/or during an open surgical procedure. Further, there is also a need for devices and methods that provide fine dissection capabilities of nerve and/or soft tissue. Devices and methods that do not cause a high level of collateral thermal damage and allow for the control of necrosis in the tissue being treated are also needed. Devices and methods that provide efficient, controlled and safe debulking of tissue would also be beneficial.
This application is directed to a surgical device for enlarging the diameter of a hole in tissue. The surgical device includes an elongated shaft extending between a proximal end and a distal end and including an outer surface. A stylet is disposed within the elongated shaft. The stylet is configured to retractably extend out of the elongated shaft so as to contact tissue. A cutting portion is disposed on a portion of the outer surface of the elongated shaft. The cutting portion is configured to cut tissue as the shaft is inserted into the tissue so as to enlarge the diameter of the hole in the tissue. In one embodiment, the cutting portion can also be a heating portion designed to cut tissue such that the tissue does not reapproximate its previous position after a working cannula is removed.
In one embodiment, a device for expanding a diameter of a hole in tissue is provided. The device includes an elongated shaft extending between a proximal end and a distal end and including a first portion and a second portion extending parallel to the first portion. A rod disposed within the elongated shaft, the rod being configured to retractably expand the elongated shaft such that the first portion and the second portion from a first collapsed orientation such that the first and second portion are disposed adjacent to each other to a second expanded orientation such that the first and second portion are disposed at a distance from each other so as to enlarge the hole in the tissue.
In one embodiment, a method of using a device to enlarge a hole in tissue comprising cutting a hole in the tissue is provided. A cannula is inserted into or on the anatomy of a patient. The cannula comprises an elongated shaft extending between a proximal end and a distal end and including a first portion and a second portion extending parallel to the first portion. A rod is disposed within the elongated shaft, the rod being configured to retractably expand the elongated shaft such that the first portion and the second portion from a first collapsed orientation such that the first and second portion are disposed adjacent to each other to a second expanded orientation such that the first and second portion are disposed at a distance from each other so as to enlarge the hole in the tissue. The rod is manipulated by a medical practitioner to expand the first and second portion to the expanded orientation to expand the hole in the tissue. In the alternative, cannulas that do not expand but are sequentially larger in diameter may be used to increase the size of the working/hole in the tissue.
Additional features and advantages of various embodiments will be set forth in part in the description that follows, and in part will be apparent from the description, or may be learned by practice of various embodiments. The objectives and other advantages of various embodiments will be realized and attained by means of the elements and combinations particularly pointed out in the description and appended claims.
In part, other aspects, features, benefits and advantages of the embodiments will be apparent with regard to the following description, appended claims and accompanying drawings where:
FIG. 1 is a perspective view of an embodiment of the device in accordance with the principles of the present disclosure;
FIG. 2 is perspective view of components of the device shown in FIG. 1;
FIG. 3 is a perspective view of an embodiment of the device in accordance with the principles of the present disclosure;
FIG. 4 is a perspective view of an embodiment of the device in accordance with the principles of the present disclosure;
FIG. 5 is a perspective view of an embodiment of the device in accordance with the principles of the present disclosure;
FIG. 6 is a side view of an embodiment of the device in accordance with the principles of the present disclosure; and
FIG. 7 is a cross section view of components of the device shown in FIG. 6.
Devices for efficient severing or cutting of a material or substance such as nerve, soft tissue and/or bone suitable for use in open surgical and/or minimally invasive procedures are disclosed. The following description is presented to enable any person skilled in the art to make and use the present disclosure. Descriptions of specific embodiments and applications are provided only as examples and various modifications will be readily apparent to those skilled in the art.
Lumbar spinal stenosis (LSS) may occur from hypertrophied bone or ligamentum flavum, or from a lax ligamentum flavum that collapses into the spinal canal. LSS can present clinical symptoms such as leg pain and reduced function. Conventional treatments include epidural steroid injections, laminotomy, and laminectomy. Surgical interventions which remove at least some portion of the lamina are usually performed through a relatively large incision, and may result in spinal instability from removal of a large portion of the lamina. Consequently, a percutaneous approach which removes just enough tissue (lamina or ligamentum flavum) to be effective is provided and may be beneficial.
In one embodiment, a blunt stylet is nested within a cannula to penetrate soft tissue. An outer wall of the cannula has ring of exposed metal to deliver RF energy to contact soft tissue. The tissue may either be cut or heated. The remaining portion of outer wall of the cannula is insulated. In one embodiment, successive cannulas may be placed over the stylet to increase the size of a hole in the soft tissue.
In one embodiment, the cannula has single or multiple rasps or grater-like openings on the side wall. The rasp opening is configured to cut and enlarge a bony opening. The cannula is twisted about its axis to shave bone. The bony fragments are collected in the cannula lumen and may be evacuated via suction or with mechanical method, such as an auger.
In one embodiment, the cannula is created from two halves of tubing. Each tubing half has ratchet feature that mates with corresponding ratchet feature in other tubing half. An expandable stylet is placed in cannula lumen to increase cannula diameter and separate the first half form the second half.
The present disclosure may be understood more readily by reference to the following detailed description of the disclosure presented in connection with the accompanying drawings, which together form a part of this disclosure. It is to be understood that this disclosure is not limited to the specific devices, methods, conditions or parameters described and/or shown herein, and that the terminology used herein is for the purpose of describing particular embodiments by way of example only and is not intended to be limiting of the claimed disclosure.
As used in the specification and including the appended claims, the singular forms "a," "an," and "the" include the plural, and reference to a particular numerical value includes at least that particular value, unless the context clearly dictates otherwise.
Ranges may be expressed herein as from "about" or "approximately" one particular value and/or to "about" or "approximately" another particular value. When such a range is expressed, another embodiment includes from the one particular value and/or to the other particular value.
Similarly, when values are expressed as approximations, by use of the antecedent "about," it will be understood that the particular value forms another embodiment. It is also understood that all spatial references, such as, for example, horizontal, vertical, top, upper, lower, bottom, left and right, are for illustrative purposes only and can be varied within the scope of the disclosure.
For purposes of the description contained herein, with respect to components and movement of components described herein, "forward" or "distal" (and forms thereof) means forward, toward or in the direction of the forward, distal end of the probe portion of the device that is described herein, and "rearward" or "proximal" (and forms thereof) means rearward or away from the direction of the forward, distal end of the probe portion of the device that is described herein. However, it should be understood that these uses of these terms are for purposes of reference and orientation with respect to the description and drawings herein, and are not intended to limit the scope of the claims.
Spatially relative terms such as "under", "below", "lower", "over", "upper", and the like, are used for ease of description to explain the positioning of one element relative to a second element. These terms are intended to encompass different orientations of the device in addition to different orientations than those depicted in the figures. Further, terms such as "first", "second", and the like, are also used to describe various elements, regions, sections, etc. and are also not intended to be limiting. Like terms refer to like elements throughout the description.
As used herein, the terms "having", "containing", "including", "comprising" and the like are open ended terms that indicate the presence of stated elements or features, but do not preclude additional elements or features.
For purposes of the description contained herein, "vacuum" means pressure within a space that is lower by any amount than atmospheric or ambient pressure, and although not exclusive of a condition of absolute vacuum defined by a complete absence within a space of air, fluid or other matter, the term as used herein is not meant to require or be limited to such a condition.
The headings below are not meant to limit the disclosure in any way; embodiments under any one heading may be used in conjunction with embodiments under any other heading.
Reference will now be made in detail to certain embodiments of the invention, examples of which are illustrated in the accompanying drawings. While the invention will be described in conjunction with the illustrated embodiments, it will be understood that they are not intended to limit the invention to those embodiments. On the contrary, the invention is intended to cover all alternatives, modifications, and equivalents that may be included within the invention as defined by the appended claims.
Radiofrequency (RF) ablation devices have been available to surgeons to treat many medical conditions, for example, in the treatment of tumors in lung, liver, kidney, bone and other body organs. Pulsed RF has also been used for treatment of tumors, cardiac arrhythmias, chronic and post-operative pain, bone fracture and soft tissue wounds.
The components of the cutting device can be fabricated from biologically acceptable materials suitable for medical apparatuses, including metals, synthetic polymers, ceramics, thermoplastic and polymeric material and/or their composites. For example, the components of the holding device, individually or collectively, can be fabricated from materials such as stainless steel alloys, commercially pure titanium, titanium alloys, Grade 5 titanium, super-elastic titanium alloys, cobalt-chrome alloys, stainless steel alloys, superelastic metallic alloys (e.g., Nitinol, super elasto-plastic metals, such as GUM METAL® manufactured by Toyota Material Incorporated of Japan, Fe—Mn—Si and Fe—Ni—Co—Ti composites), ceramics and composites thereof such as calcium phosphate (e.g., SKELITE™ manufactured by Biologix Inc.), thermoplastics such as polyaryletherketone (PAEK) including polyetheretherketone (PEEK), polyetherketoneketone (PEKK) and polyetherketone (PEK), carbon-PEEK composites, PEEK-BaSO4 polymeric rubbers, polyethylene terephthalate (PET), fabric, silicone, polyurethane, silicone-polyurethane copolymers based materials, polymeric rubbers, polyolefin rubbers, semi-rigid and rigid materials, thermoplastic elastomers, thermoset elastomers, elastomeric composites, rigid polymers including polyphenylene, polyamide, polyimide, polyetherimide, polyethylene, epoxy, and composites of metals and calcium-based ceramics, composites of PEEK and calcium based ceramics, and combinations of the above materials.
Various components of the holding device may have material composites, including the above materials, to achieve various desired characteristics such as strength, rigidity, elasticity, compliance, and biomechanical performance, durability and to provide a non-stick surface. The components of the holding device may be monolithically formed, extruded, coextruded, hot molded, cold molded, press molded, integrally connected or include fastening elements and/or coupling components, as described herein.
In one embodiment, as shown in FIGS. 1-3, device 10, in accordance with the present disclosure, includes an elongated shaft 12. Shaft 12 extends between a proximal end 14 and a distal end 16. Shaft 12 includes an inner surface 18 and an outer surface 20. Inner surface 18 defines a passageway 22. It is envisioned that all or only a portion of shaft 12 may have various cross section configurations, such as, for example, cylindrical, flat, oval, oblong, triangular, square, polygonal, irregular, uniform, non-uniform, offset, staggered, undulating, arcuate, variable and/or tapered. It is contemplated that surfaces 18, 20 includes various surface configurations, such as, for example, smooth, rough, mesh, porous, semi-porous, dimpled and/or textured. In various embodiments, the navigational sources can be coupled with pre-procedure imaging means such as for example, CT, MRI, PET scan, etc. so that the target nerve or soft tissue to be cut can be identified and accurately located during the procedure. In some embodiments, shaft 12 can be operatively connected to semi-steerable or navigational sources for easier guidance into tissue. A stylet 24 is configured for retractable placement into and through passageway 22 of shaft 12 such that a distal end 26 extends past distal end 16 of shaft 12 to contact tissue.
A cutting portion, such as, for example, a cutting band 28 is disposed around surface 20. In one embodiment, cutting band 28 includes electrodes 30 configured to emit a RF frequency adapted for cutting nerve and/or soft tissue. In one embodiment, cutting band 28 is configured to emit pulsed plasma signals adapted for cutting nerve and/or soft tissue. In one embodiment, device 10 includes an electrically insulated layer adjacent to and exposing cutting band 28 such that the energy transmitted from the RF frequency and/or the plasma is centralized at cutting band 28. In some embodiments, the coating or insulating layer can be glass or ceramic having a thickness from about 0.005 to about 0.5 mm thick or from about 0.01 to about 0.2 mm thick. By rotating shaft 12 back and/or forth the RF or plasma signals will cut the tissue and enlarge the hole in the tissue. In one embodiment, the ring extends around either the majority of the entire circumference or the entire circumference of the cannula so that the cannula does not have to be rotated.
In one embodiment, shaft 12 includes a connection to engage a vacuum (not shown) to remove the resected nerve and/or soft tissue. Alternatively, an additional channel is possible for delivering fluid to the surgical site. At its proximate end, shaft 12 can be operatively connected to the vacuum for providing suction to resected nerve and/or tissue. A vacuum line may be used to transmit vacuum from a vacuum source (not shown) to a receiving aperture connected to shaft 12. The vacuum is in communication with opening 22 such that as tissue is resected from a target area, the tissue will be removed via suction. The vacuum may be provided inside opening 22 or, alternatively, may be provided through an additional lumen separate from opening 22. Any suitable aspirator, cylindrical or otherwise, or other mechanism that creates vacuum upon the movement of an actuating member thereof, may be utilized as a vacuum source, such as, for example, a syringe or mechanical vacuum.
The present disclosure also provides methods for cutting or resecting nerve and/or soft tissue. The methods comprise positioning a distal region of shaft 12 of device 10 within a hole in tissue. Distal end 16 is positioned at the area where the tissue enlarged. To enlarge the diameter of the hole, shaft 12 is rotated back and forth, shown by arrows A and AA, such that cutting band 28 burns or cuts the tissue to enlarge the hole. In the alternative, a larger cannula is inserted in order to increase the diameter.
In one embodiment, a diameter d increases from distal end 16 to proximal end 14 such that movement of shaft 12 into the hole allows the larger diameter portion of shaft 12 to enlarge the hole. In one embodiment, increased diameter shafts 12 can be placed over a smaller diameter shaft such that the hole is enlarged as the increased diameter shaft is placed over the smaller diameter shaft.
In one embodiment, as shown in FIG. 4, shaft 112 includes a cutting portion 128 that includes a rasp or grater-like cutting opening 129. As shaft 112 is rotated the rasp opening 129 cuts or shaves tissue to enlarge the hole. Cut tissue fragments are collected in passageway 122 of shaft 112. Rasp opening 129 is sharp so as to facilitate cutting of bone tissue. The vacuum within or outside of shaft 12 is utilized to remove the cut nerve, soft tissue, and/or bone tissue such that device 10 can be reinserted for additional cutting.
The present disclosure provides for a method for cutting or resecting bone tissue using surgical device 110. Distal end 116 is positioned in a hole at a predetermined target area by a medical practitioner. In various embodiments, navigational sources can be coupled with pre-procedure imaging means such as for example, CT, MRI, PET scan, etc. so that the target nerve or soft tissue to be cut can be identified and accurately located during the procedure. Once distal end 116 is positioned at a targeted hole on a bone that is to be enlarged, shaft 112 is rotated in a circular motion such that rasp opening 129 cuts evenly and circumferentially to enlarge the hole in the bone tissue. A vacuum within or outside of shaft 112 is utilized to remove the cut nerve, soft tissue, and/or bone tissue such that device 110 can be reinserted for additional cutting.
In one embodiment, as shown in FIGS. 5-7, shaft 212 extends between a proximal end 214 and a distal end 216. Shaft 212 includes an inner surface 218 and an outer surface 220. Inner surface 218 defines a passageway 222. Shaft 212 includes at least two portions, such as, for example, a first portion 224 and a second portion 226. Portions 224, 226 are configured to retractably expand shaft 212 such that portion 224 and portion 226 move from a first collapsed orientation in which the first and second portion are disposed adjacent to each other, to a second expanded orientation in which the first and second portion are disposed at a distance from each other so as to enlarge the hole in the tissue.
An expandable stylet 228 is configured to be placed within shaft 212 such that expansion of stylet 228 causes expansion of shaft 212. Stylet 228 is configured for retractable placement into and through passageway 222 of shaft 212 such that as stylet 228 moves through passageway 222, stylet 228 expands shaft 212 by pushing portions 224 and 226 away from each other in the direction shown by arrow B. In one embodiment, a rod 250 is engaged with stylet 228 by a ratchet mechanism or as shown, a threaded outer surface 252 of rod 250. Inner surface 230 of stylet 228 includes a threaded surface 232 configured for engagement with threaded surface 252. As rod 250 translates through stylet 228, threaded surface 252 engages threaded surface 232 to expand sytlet 228 and portions 224, 226, as shown in FIG. 7. As such, shaft 212 inserted within hole H has an initial diameter of d1, as shaft 212 expands, hole H and shaft 212 are enlarged to a diameter d2, wherein d2 is large than d1. Threaded surfaces 252 and 232 allow for incremental enlargement of hole H so as to enlarge hole H slowly to prevent damage to the tissue.
In one embodiment, shaft 12 is operatively coupled to a source of navigational capability to allow easier pushing through the tissues. In various embodiments, the methods of cutting disclosed herein can include a pre-procedure step wherein the probe or needle can be coupled to a CT or MRI machine so that the target nerve and/or soft tissue to be cut can be identified and accurately located during the resection procedure.
The methods for cutting described hereinabove allow complete resection of the nerve avoiding the problems and partial effectiveness of current RF and cryoablation devices available in the art, and also allow for easier, more efficient, more complete, and safer removal of soft tissue that is causing stenosis pain symptoms.
It will be apparent to those skilled in the art that various modifications and variations can be made to various embodiments described herein without departing from the spirit or scope of the teachings herein. Thus, it is intended that various embodiments cover other modifications and variations of various embodiments within the scope of the present teachings.


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Fantasy Battle-Mech Free low-poly 3D model
Low-poly model of combat battle-mech. A total of 7539 polygons. Render is made in Marmoset Toolbag. Textures created in the Substance painter. The UV scan of the entire model is performed. PBR textures have a resolution of 4k, png format for Corona, V-Ray, UE4, Unity and Marmoset. In the scene, the textures are customized for V-Ray and Corona.
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Guests attending MB Fashion Week Tbilisi, November' 2019
Last update: 06/11/2019
EDITORIAL by angel.ge presents you pictures of attending guests Mercedes-Benz Tbilisi Fashion Week SS2020 collections. Street Style shot specially by Anna Batsikadze.
Tbilisi Fashion Week Street Style
November 2019, Tbilisi, Georgia.
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Last update: 06/11/2019
we have lots of great designers in Tbilisi, but let me tell you... We have our favourites!
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Aleksandre Akhalkatsisvhili, GEORGE KEBURIA, JANASHIA, LALO, Salakaia, LIYA


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This article originally appeared on the Stamford Patch
STAMFORD, CT — City officials confirmed Wednesday a Stamford resident and former member of he city's Board of Representatives, has died as a result of the new coronavirus. This is the first city resident to die as a result of the virus, also referred to as COVID-19.
Arthur Augustyn, a spokesperson for the city of Stamford, confirmed Wednesday evening in an email to Patch that former board member Anthony "Tony" Spadaccini has died from COVID-19 complications. (To sign up for Stamford breaking news alerts and more, click here.)
Mayor David Martin provided the following statement:
"I am saddened to share with you that one of Stamford's own has passed away from the deadly coronavirus," Mayor David Martin said in a statement. "We have lost a husband and a father, and our hearts go out to the family. While I believe most people in Stamford are taking this pandemic seriously, this death should be a wake-up call to those who are not."
COVID-19 is caused by a member of the coronavirus family that's a close cousin to the SARS and MERS viruses that have caused outbreaks in the past.
According to numbers released Wednesday by the state Department of Health, there are 48 confirmed cases of COVID-19 in Stamford.


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The silent movie camera is expected to fetch between £70,000 and £90,000 at Christie's in London on 25 July.
Chaplin bought the Bell & Howell 2709 model in 1918 for use at his Chaplin Studios in Hollywood.
Screen legend Chaplin was born in south London in 1889 and moved to the US in 1912 where he later found fame with his iconic tramp character.
The Bell & Howell 2709 was considered a classic camera of its age before the advent of sound around 1930.
Record set
It was actually used up until the 1950s for animation and the creation of titles, which did not require sound recording.
Chaplin was awarded an honorary Oscar for his contribution to film in 1975.
The camera will be auctioned as part of Christie's motion picture camera sale and will be on view at the auction house's South Kensington branch from 21 July.
A hat and cane used by Charlie Chaplin sold for almost $140,000 (£77,000), a record price for a piece of the actor's memorabilia, in Los Angeles last year.
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Spin Kick Sound
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New Delhi : Arriving here with a "message of peace", Pakistan Prime Minister Nawaz Sharif on Monday said that he intends to pick up the threads with Narendra Modi from where he and then Prime Minister Atal Bihari Vajpayee left off in 1999.
Sharif, who is in the national capital for the swearing-in and staying overnight, arrived here from Lahore, where he said he was going to New Delhi with a "message of peace".
Later, speaking in the Capital, the Pakistan Prime Minister said both governments have a strong mandate and this could help in "turning a new page in our relations". Sharif will have a bilateral meeting with Modi on Tuesday during which the two sides are expected to discuss ways to enhance cooperation.
The Pakistan leader also said that this was a chance to reach out to each other while noting that no two nations have ever possessed so much cultural and traditional similarities as India and Pakistan. "Why not turn the similarities into our strength. I very much look forward to meeting Mr Modi. We should remove fears, mistrust and misgivings about each other," he was quoted as saying. Both countries should rid the region of instability and security that has plagued it for decades, he added.
Sharif's visit is seen as significant by political observers given that hawkish elements in Pakistan tried to scuttle his trip. No breakthrough is expected during the current visit but it will provide the two leaders an opportunity to cultivate personal relations which may go a long a way in reducing tensions.
Sources said it is expected that Sharif will also extend a formal invitation to Modi for a visit.
After the swearing-in ceremony, Sharif said he felt honoured to be part of the event. "I think people of both countries are very happy… I feel honoured to be part of the ceremony," he said replying to a question by reporters.
(For all the latest News, Mumbai, Entertainment, Cricket, Business and Featured News updates, visit Free Press Journal. Also, follow us on Twitter and Instagram and do like our Facebook page for continuous updates on the go)


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|1. Cylinder head cover
2. Cylinder head cover gasket
|3. Camshaft position sensor (CMPS)
4. Oil filler cap
Hyundai Kona (OS) 2018-2020 Service Manual: ESP Control Unit Repair procedures
Removal 1. Turn the ignition switch OFF and then disconnect the negative (-) battery cable. 2. Separate the intercooler inlet hose (A) from the turbocharger and then remove the inter cooler inlet pipe (B). [Gasoline 1.6 T-GDI] ...
Hyundai Kona (OS) 2018-2020 Owners Manual: Closing the tailgate
Lower the tailgate lid and press down until it locks. To be sure the tailgate lid is securely fastened, always check by trying to pull it up again without pressing the tailgate handle button. WARNING Always keep the tailgate lid completely closed while the vehicle is in motion. If it is left ope ...


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Only if really necessary
after Knee Active Program
Dutch Arthroscopy Society 2011-2014
Medial collateral ligament heals if diagnosed and treated early
may be indicated with cruciate ligament surgery
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surgery with your own hamstring tendons
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Risk of arthrofibrosis is least if knee has good function before surgery, with limited swelling and adequate gait pattern
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at MMC Eindhoven (Netherlands)
injuries also occur in children
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See Protocols
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Running causes 6x body weight load on your knee
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The secret for best clinical practice
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Prof. RPA Janssen MD PhD will present a guest lecture at the Pediatric Trauma Congress at Erasmus Medical Center, Rotterdam, The Netherlands. Title of his presentation is Knee: Anterior cruciate ligament injuries in children.


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