text:
Services on Demand
Related links
- Cited by Google
- Similars in Google
South African Journal of Occupational Therapy
On-line version ISSN 2310-3833
Print version ISSN 0038-2337
S. Afr. j. occup. ther. vol.44 n.1 Pretoria Jan. 2014
Identifying the factors that contribute to hand writing problems experienced by students at a higher education institution in South Africa
Denise FranzsenI; Aimee StewartII
IBSc OT (Wits), MSc OT (Wits); Senior Lecturer, Department of Occupational Therapy, School of Therapeutic Sciences, University of the Witwatersrand
IIBSc Physiotherapy (Wits), MSc Physiotherapy (Wits), PhD (Wits); Associate Professor, Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand
The assessment of the handwriting of students in Higher Education Institutions has received little attention. This study therefore determined the handwriting problems reported by 300 students at the University of the Witwatersrand when writing examinations. These students were also screened for factors related to dysfunction in their hand writing using a short screening copying task and analysed for its quality and errors. A Handwriting Assessment Checklist was used to assess various factors related to handwriting such as posture and pen grasp as observed by two trained occupational therapists.
Students appear to have little understanding of their handwriting problems as those reporting that handwriting affected their ability to finish examinations were not those identified as having dysfunctional handwriting. Speed of writing was significantly affected by poor positioning of the paper (p<0.03), following of text being copied related to motor dysgraphia and oculomotor function (p<0.00), maintenance of grasp on the pen (p<0.04) and accuracy when copying (p<0.02). Legibility in contrast was significantly worse due to holding the pen too close to the tip (p<0.00), pressure used when writing (p<0.0l), deterioration or change in the writing (p<0.0l) errors related to missing words (p<0.02) and spelling mistakes(p<0.003). These factors may be related to motor and/or dyslexic dysgraphia.
These factors should therefore be considered with a speed and legibility score when assessing whether a student presents with a "real" handwriting problem so further appropriate assessment can determine accommodations the student needs to allow them to complete their examinations.
Key words: Legibility, Speed of writing, Motor and dyslexic dysgraphia
Occupational therapists are involved in the remediation of handwriting in children, and a large evidence base which has established practice standards for the assessment of handwriting problems has been developed1. In contrast, the assessment of handwriting skills in adults, including students in Higher Education Institutions (HEI) has received little attention.
The skill of producing fast and legible handwriting in higher education is important as most assessments of academic ability worldwide are still based on written timed examinations and poor handwriting may result in a student under-achieving academically2. Connelly, Dockrell and Barnett3 showed that undergraduate students are significantly constrained in written examinations when they struggle with the speed and legibility of writing. This is a distraction as they use working memory to concentrate on producing writing and cannot focus their full attention on answering the examination questions. The ability to produce letters automatically has been found to be the single best predictor of the quality and length of written composition even in post school years4.
At the University of the Witwatersrand students are required to write examinations lasting between two to four hours twice a year. The Occupational Therapy Department has been involved in the assessment of students in conjunction with the Disability Unit, including students who present with handwriting problems and who request extra time for examinations to compensate for these problems. These students report problems with finishing examinations, complaints about the legibility of their handwriting as well as constraints such as pain in their hands when writing. Approximately 35 to 40 students apply for extra time concessions annually due to problems related to their handwriting, with four or five of these students applying to type their examinations5.
Therefore determining what constitutes dysfunctional handwriting in terms of normal speed and acceptable legibility or dysgraphia in a South African sample of students, as well as the other factors that may affect students' handwriting is important for informing decisions made regarding the extent to which they should be accommodated in terms of extra time for examinations. By establishing which factors can be used to identify significant handwriting dysfunction, students can be screened and referred appropriately for further assessment.
Summers & Catarro6 researched handwriting in a sample of Australian undergraduate students excluding those with any identified problems. They focussed on the importance of handwriting in written examinations, with the need for speed and an acceptable level of legibility in communicating answers within a set time and considered a number of factors including age, gender, pain, fatigue and pencil grasp in relation to writing fluency. They found that all the students reported aching in their hands and /or upper limbs, when writing two and three hour examinations, while 50% reported cramping and one third reported a high level of pain. Pain was associated with fatigue, which 74% of students reported affected their writing speed as well as the quality of their writing. Fatigue resulted in 45% of students having to stop and rest during examinations. Nine percent of students were identified as having to stop and rest in a short three-minute handwriting assessment because of pain.
No significant difference was found by Summers and Catarro6 for speed related to gender, writing style and handedness in the undergraduate students6 even though females and right-handers in another study were found to write faster than left-handers7. In addition Summers and Catarro reported that pen grasp with a lateral as opposed to a dynamic grasp was not associated with slower writing in examinations6. Small differences in the average speed of writing for students between 17 to 25 years have been found, however. In a short handwriting assessment when copying a sentence, on average, the speed is 26 words per minute (wpm) when asked to write neatly and 36 wpm when asked to write as fast as possible8.
In their study Summers and Catarro6 found legibility was not associated with writing speed but that the assessment of legibility was problematic in that it is based on the judgement of assessors. The use of scales ranging from three to seven points or counting of unreadable words are the suggested methods of assessing legibility but no studies on scores for the legibility of hand writing in higher education could be found8.
The handwriting problems described above appear to have been exacerbated by the introduction of technology which means that a large number of individuals are using keyboards and tablets for everyday note taking and assignments9, so students no longer get daily practice in writing and writing motor fluency. Thus writing endurance is decreased, evidenced by discomfort or pain in the hand, and this may lead to legibility and speed being affected which further affects the students' ability to complete their timed examinations. Legibility and presentation associated with poor handwriting have been shown to contribute to differences in examination marks, although the number of words written in an examination is not necessarily directly linked to how fast a student can write, but to other cognitive abilities as well. If the answer is incomplete because they write too slowly or the writing is illegible this will affect the outcome6.
Even when offered the opportunity to type their answers in examinations rather than write them a recent study in the United Kingdom has shown that the majority of students, still opt for writing with only 10% choosing to type9. This choice was made even though it was shown that these same students could type faster than they could write. Most students cited their own lack of practice in using computers in composing answers in examinations and fear of technology failures as the reasons for continuing to write their examinations. Therefore extra time to write is still one of the options offered when a student has dysfunctional hand writing9.
A number of other factors related to dysfunctional speed and quality of handwriting has been reported in studies on children's writing. According to Pollock et al10, children's posture as well as the amount of force they use to hold a pencil and "press" on the paper plays an important role in writing skill. Selin11 also described various components of pencil grasp related to the positioning of the upper limbs, wrist, fingers and thumb which can be considered dysfunctional when writing. Kulp and Schmidt12 also emphasise the importance of efficient oculomotor skills in writing examinations for aspects such as reading, copying and the visual motor integration.
When these factors are considered together and an individual's handwriting is found to be compromised in relation to speed or legibility it can be considered "dysgraphic"13. Symptoms of dysgraphia include an inefficient pen grasp, fatigue and cramping after a short time when writing, accuracy in copying and spelling, poor letter formation, type of writing and reading aloud while copying14. Dysgraphia is characterised as a learning disability by the Diagnostic and Statistical Manual of Mental Disorders (dSM-IV)15 but there is some controversy about whether this involves only the motor skill needed to write or other aspects described by Berninger and Wolf16 which include letter recognition or orthographic skills and spelling as well as finger sequencing. Deuel17 indicated that the different components could be considered as three different types of dysgraphia and related to the motor, dyslexic and spatial aspects of writing all of which result in different handwriting dysfunction.
The aim of this study was therefore to use a short handwriting screening assessment to determine the factors related to handwriting dysfunction and dysgraphia in undergraduate students at the University of the Witwatersrand. The speed and legibility of the students handwriting was determined and the problems that students report with their handwriting when writing examinations were also investigated.
- To determine a cut off point at which writing can be considered dysfunctional in terms of speed and legibility for students at the University of the Witwatersrand.
- To determine the problems with handwriting during examinations reported by students at the University of the Witwatersrand.
- To establish observable factors related to motor, praxis and sensory-perceptual performance skills associated with handwriting dysfunction in relation to slow and illegible handwriting
- To establish which components of handwriting are associated with slow and/or illegible handwriting.
A descriptive cross sectional study was used appropriate for a once off screening of students' handwriting problems. The factors assessed related to their ability to copy a passage and the speed and legibility of their handwriting. Convenience sampling was used to select 300 undergraduate students from the entire student population in the five different faculties at the University of the Witwatersrand. Students with known physical disabilities affecting their handwriting were excluded. The sample size was based on 10 participants per item on the checklist used to assess observable factors and their writing.
A survey questionnaire was used to establish the students' demographics in terms of age, and any handwriting problems they had experienced during long examinations. The close-ended questions determined whether the student could finish writing their examinations without pain or discomfort in their hands, and reported experience of postural and visual strain when writing examinations of two to four hours in length.
In order to screen their handwriting for problems a copying exercise, consisting of all4 word paragraph from a university level text book was used. Students were also asked to write the alphabet repeatedly for 1 minute to assess their ability to form each letter neatly for orthographic-motor integration18. These items could be completed within the time of the nine minutes recommended O'Mahony, Dempsey and Killeen19, for an adult handwriting test, if endurance and fatigue were to be assessed.
Students were asked to note the time it took to complete the copied passage using a timer on an i-Pad and writing speed was determined by the time it took them to copy the 114 words. This eliminated the time consuming exercise of counting the number of words that were written as required in other assessments. Legibility was established by calculating the percentage of unreadable words8. The writing content was also analysed for spelling mistakes, omitted letters, words and lines of text, as well as the misuse of capital letters, punctuation and any other corrections on a scale of l-3.
The passage chosen for the screening assessment did not contain words which are considered as course specific jargon. The use of this paragraph, unlike other assessments that only required repeated copying of a simple sentence which can be remembered, negating the need to read while copying, required the student to follow the text as they copied it. This was important as examinations also require near point reading of complex information. Copying was, therefore, used to observe the students' ability to follow the text in the passage, and how their ability to find their place in a question paper might impact on their writing speed.
To identify the problems observed in the students' handwriting a Writing Analysis Checklist was developed based on criteria described by Selin11 and Pollock et al10. Items on the checklist included aspects of motor and praxis skills related to proximal stability and posture in sitting, the need to position the eyes and hands correctly for the task, as well as bilateral function or stabilisation of the paper with the non-preferred hand. Pen grasp, accuracy in copying and spelling, letter formation and type of writing were also observed while the students completed the writing testl4. Sensory perceptual skills observed included the organisation of workspace and the positioning of the paper being written on and the one being copied from. Fatigue and pain were noted by observing repositioning of the pen in the hand and shaking the hand while writing6. All items were scored according to what literature describes as 1 = functional, 2 = mild dysfunction and 3 = dysfunctional10,11. Students were observed by two qualified occupational therapists who had been trained in the use of the Writing Analysis Checklist (inter-rater reliability 0.79) while they completed the writing task.
Once ethical clearance had been obtained from the Human Research Ethics Committee and all stakeholders at the University of the Witwatersrand, the students were asked to sign informed consent forms before being assessed in the second half of the year after the June tests. This time period was chosen, so that even if they were in first year they would have had had a chance to experience any handwriting problems related to writing long examinations at a university level. The test was carried out at tables of the correct height for writing and students were provided with examination pads with feint rule lines to write on and standard ball point pens. The students were able to use their own pens if they so wished.
Demographic data were analysed using descriptive statistics. The mean for speed and legibility of the students handwriting were determined and a cut-off was set at the 10th percentile (-1.5 SD) as there is evidence that this score separates individuals with disabilities from the normal population20. Speed and legibility scores for each item on the Writing Analysis Checklist were analysed and the scores of students who scored 2 or 3 indicating dysfunction were compared to those who scored 1 and were considered to be functional writers. Student t tests were used to establish if there were significant differences on each item of the checklist between the students who scored 1 as compared to those who scored 2 or 3. The level of significance in the study was set at p<0.05.
Speed and Legibility Scores
The mean score for speed of writing on the screening assessment was 22.85 wpm. There were wide variations in both the speed and legibility scores with a mean score for legibility being 15.37% or between 17 to 18 unreadable words in the 114 word copied passage. The cut-off scores which identify handwriting as dysfunctional for speed and legibility were set at the 10th percentile (Table 1). There was a low correlation between legibility and speed of writing (r = 0.26)
Demographics and reported problems with handwriting
The students' ages ranged from 17 to 25 years with the majority falling into the 19-21 year age group (Table 2).
Students who reported that they had been diagnosed previously with a learning disability formed 5.7 % of the sample, with more students reporting they had problems with the legibility of their writing than any other handwriting problem affecting their ability to write examinations. Other problems included writing speed, pain and vision and not being able to hold the pen properly (Table 3).
The correlations between students' reported problems and the scores on the screening assessment for speed and legibility were poor r = 0.15 (p > 0.05) and r = -0.25 (p< 0.01). The legibility scores of 25 (8%) students who did not report legibility as a problem fell below the 10th percentile as they had more than 30.7% of unreadable words. They were unaware that the legibility of their writing was a problem. A similar finding was found for the 28 (9.3%) of students whose writing was slower than 17.58 wpm, with only four of them identifying they had a problem with writing speed.
Just over half of the students reported that endurance in terms of finishing examinations without pain or discomfort in their hands was a problem, with only 32% of the students reporting that they had never experienced discomfort and pain. Of the 68% of the students who reported discomfort, 28% had little discomfort, 33% had moderate discomfort and 28% had high discomfort or little pain with a score of four or below on a pain scale of zero to ten. Seventy five percent of the students reported that they had stopped and shaken their hands during the writing of examinations. Only 9.35% reported moderate pain of between five and six on the pain scale and 1.33% high pain levels There was a moderate correlation between reported pain and fatigue and needing to stop and shake the hand during examinations (r=0.43, p < 0.001).
Writing Analysis Checklist
Table 4 on page 6 illustrates the percentage of students with factors which could be considered dysfunctional, scoring 2 or 3 on the Writing Analysis Checklist.
The speed and the legibility scores of students with observed dysfunction were compared to those who were considered functional in terms of their workspace organisation, pen grasp, ability to copy from written text and aspects of their handwriting.
Speed of writing, recorded as words per minute (wpm), was significantly slower in students who positioned their paper to the side rather than in front of them (1.15 wpm; p= 0.03), took time to find their place in the text they were copying from (3.91 wpm; p=0.001) , repositioned the pen in their hand or stopped to shake their hand in the five minutes writing period (3.91 wpm; p= 0.00), and read aloud or mouthed the words while copying (5.84 wpm; p= 0.01). Those that made more than three corrections when copying (2.09 wpm; p= 0.02) also had significantly slower writing speed.
Legibility, measured by the percentage of unreadable words, was significantly worse when holding the pen too close to the tip (4.46%; p= 0.001), and when pressing very hard on the paper while writing so that the impression of the writing could be seen on the next page, (5.07%; p=0.01). Legibility was also worse when there was a deterioration in the quality of the writing (5.31% ; p = 0.01) with writing no longer on the lines, the size of the writing changing and letter formation being more compromised and a change in writing style in terms of printed and cursive writing, by the end of the copied passage (1.37%; p= 0.01). Inaccuracies in copying reflected by missing words (8.57%; p= 0.02) and three or more spelling mistakes (10.76%; p= 0.00) were also related to significantly worse legibility. Students who repositioned the pen in their hands had significantly more legible writing (5.18%; p=0.04).
Factors that have been described as dysfunctional in handwriting such as flexed posture, resting both forearms on the table, tight pen grasp with hyperextension of the distal interphalangeal (DIP) joint of the index/middle finger and flexion of the interphalangeal (IP) thumb joint to 900 , indicating poor stability in the hand11 or some joint laxity21, were seen in 50% of students when writing. Thus these factors cannot be considered as dysfunctional when assessing students' writing, as the majority of students use these positions of the trunk and hand and components of pen grasp when writing.
The majority of the students (84.3 %) used efficient tripod grasp or quadrupod grasp against the ring finger with an open or narrowed web space. A low correlation (r=0.30: p=0.0l) was found between the efficiency of pen grasp and writing speed. Hand dominance had no effect on the speed and legibility of writing.
Printed writing was used by the nearly half of the sample of students (44.66%) and this type of writing was significantly more legible (p=0.00l) than either mixed cursive-printed writing used by 36.66% of students or the cursive writing used by l8.66% of the student sample. Cursive writing was however found to be significantly faster than printing (p= 0.00l).
The results for the mean score of 22.85 wpm found in this study indicate that when copying a longer passage with complex words, students write more slowly than when repeatedly copying a simple sentence used in the other assessments which report a speed of between 26-36 wpm. It is impractical to assess the handwriting of students in the examination situation, and although it is accepted that the use of short handwriting assessments is not ideal, they are used to identifying problems which may impact on writing in examinations. The use of the longer copied paragraph in this study which required reading of more complex words does reflect the motor, praxis and sensory-perceptual performance skills used in examinations better than copying a simple sentence. The slower mean writing speed therefore probably reflects this and provides a cut-off that can be applied when screening students in the South African context. The cut-off for the score for legibility can possibly be applied in the same way, although no other scores for legibility in this type of population could be found and the inter-rater reliability of the legibility score still needs to be established. There was no association between speed and legibility in this study which was also by found in previous studies on children22,23.
The most common handwriting problems reported by students were illegibility, pain and slow speed of writing. More students reported slow writing and an inability to finish examinations as an issue, with only one student reporting that his marks were affected because the examiner could not read his paper. There was, however, a very low and negative correlation between the students who reported problems and those who scored poorly for legibility and speed on the screening assessment. It appears that students' ability to judge their own handwriting quality in terms of speed and legibility is poor and this is of concern as these students may be compromised in their ability to complete examinations or in the outcome of the examination if their papers cannot be read.
The number of students reporting discomfort and pain during the writing of long two to four hour examinations differs from the findings of Summers and Catarro6 as fewer students in this sample, 68% compared to the 100% in the Australian study reported discomfort in their hand and 9% compared to 33% experienced high levels of pain when writing examinations. It is possible that students in South Africa may still practise writing more often those in a developed country like Australia, as there has been less access to laptops and tablets in lectures, and most students do still take some handwritten notes. This means that their writing endurance may be greater than that of the Australian students, leading to less discomfort and pain when writing for long periods.
When the Writing Analysis Checklist was analysed it was clear that speed and legibility alone could not be considered when screening for handwriting problems. A number of other factors were found that differentiate dysfunctional writing, and these need to be considered as indicative of problems that need further assessment. It was clear that some factors that have been associated with handwriting problems had no significant effect in this study. These include a flexed trunk posture when writing and resting on both forearms on the table which cannot be considered dysfunctional in this population and have no effect on legibility and speed when writing. While poor posture has been linked to writing dysfunction in children10, there was no relationship between speed and legibility and a flexed supported posture in this study. It would appear that in adults this does not influence writing as much.
The same applies for a tight pen grasp with DIP hyperextension of the index finger/middle finger where the thumb IP joint is flexed to 900, with no association between a tight pen grasp and fatigue, pain, speed or legibility of writing, even though both of these have been identified as part of an ineffective pen grasp related to poor stability in the hand11, and joint laxity by21. Schneck24 proposed that the increased pressure on the pencil shaft is used to gain sensory feedback is responsible for excessive range seen in the finger and thumb joints , and a number of authors have indicated this type of pen grasp persists due to a lack of adequate early training in pencil use25,26.
Factors identified on the Writing Analysis Checklist associated with significantly reduced writing speed were the sensory-perceptual skills related to the organisation of the work space with the positioning of the paper to the side of their preferred hand. Those who took time to find their place in the text they were copying also took significantly longer to write the passage. Those who used a finger to follow the text compensated for this problem, and although slower than those who could read quickly, this was not significantly so. This is possibly related to oculomotor function or visual perceptual skills including figure ground perception and all students who stared for a few seconds at the passage they were copying or followed the text with their finger require further assessment for visual functioning27. Reading the text aloud while copying is described as a sign of dysgraphia14 and not unexpectedly significantly slowed down the writing speed of the students who did this.
Those who made three or more corrections when copying had significantly slower writing speed, while legibility was significantly compromised in those with three or more spelling mistakes. These factors are possible identifiers for dyslexic dysgraphia when recognition and accurate spelling, along with the ability to write legibly are affected17. Students should be referred for further assessment for dyslexia in such cases.
The repositioning of the pen in the hand or stopping to shake the hand in the first five minutes of writing, while slowing the students down, did result in significantly more legible writing. Other factors, associated with motor and praxis performance skills and motor dysgraphia17 were found to significantly affect legibility. These included holding the pen too close to the tip, pressing very hard on the paper while writing, and deterioration in the writing or change in the type of writing from print to cursive by the end of the copied passage. All of these factors have been related to dyspraxia associated with poor fine motor control as described by Smits Engelsman and Van Galen28 and legibility problems in writing neatly.
Unlike the results of the Summers and Catarro's study6, significant differences were found between the types of writing students use. The majority of students used printing, which was more legible than either mixed print and cursive or cursive writing. As with their findings, there was no relationship between handedness and speed and legibility.
This study identified a cut-off for both speed and legibility which can be applied when screening undergraduate students with handwriting problems. It is clear however that the screening should include the assessment of factors that significantly affect the speed and legibility of handwriting so that problems identified can be further assessed using appropriate standardised tests.
Only a small percentage of students reported problems with their handwriting and their handwriting affecting their ability to finish examinations. However the students who identified their writing as illegible were not those who scored poorly on the Writing Analysis Checklist legibility score indicating that students themselves are often unaware of what constitutes a problem with legibility. It is suggested that students in higher education may need to be screened to determine if they have a handwriting problem as they are not aware of the problems they have and how this may affect their academic achievement.
In this study factors which significantly affect speed like visually tracking text, reading aloud as well as the number of corrections made while copying and repositioning of the pen in the hand related to dysfunctional handwriting have been identified that can be used to establish if students present with a "real" handwriting problem. Factors which significantly affect legibility were identified as the pressure used on the paper when writing, deterioration or change in writing after five minutes and the number of missing words, and spelling mistakes. Further, appropriate assessment can determine the amount of extra time needed or whether the students need to change their writing to printing to make it more legible.
1. Feder K, Majnemer A. Handwriting development, competency, and intervention. Developmental Medicine & Child Neurology, 2007; 49(4): p. 312-317. [ Links ]
2. National Handwriting Association. Why is Handwriting Important? [2013 [accessed 16 December 2013]. Available from: http://www.nha-handwriting.org.uk/handwriting/why-is-handwriting-important. [ Links ]
3. Connelly V Dockrell J, Barnett J. The Slow Handwriting of Undergraduate Students Constrains Overall Performance in Exam Essays. Educational Psychology,2005 February; 25(1:99-107): 99-107. [ Links ]
4. Peverly S. The Importance of Handwriting Speed in Adult Writing. Developmental Neuropsychology,2006; 29(l: 197-216). [ Links ]
5. Konur O. Teaching disabled students in higher education. Teaching in Higher Education,2006; 11(3): 351-363. [ Links ]
6. Summers J, Catarro F. Assessment of handwriting speed and factorsinfluencing written output of university studentsin examinations. Australian Occupational Therapy Journal, 2003; 50(2): p. 148-157. [ Links ]
7. Graham S, Weintraub N. A review of handwriting research: Progress and prospects from 1980-1994. Educational Psychology Review1996; 8(1): 7-87. [ Links ]
8. Barnett A, Henderson S, Scheib B, Schulz J. Detailed Assessment of Speed of Handwriting (DASH 17+). 2010 [accessed 10 August 2010]. Available from: http://www.psychcorp.co.uk/Education/As-sessments/WritingSpeed/DetailedAssessmentofSpeedofHandwriting/ DetailedAssessmentofSpeedofHandwriting.aspx. [ Links ]
9. Mogey N, Cowan J, Paterson J, Purcell M. Students' choices between typing and handwriting in examinations. Active Learning in Higher Education, 2012; 13(2): 117-128. [ Links ]
10. Pollock N, Lockhart J, Blowes B, Semple M, Webster M, Farhat L, et al. Handwriting Assessment Protocol. 2nd ed. Hamilton: CanChild Centre for Childhood Disability Research, School of Rehabilitation Science,McMaster University; 2009. [ Links ]
11. Selin AS. Pencil Grip:A Descriptive Model and Four Empirical Studies. PhD Dissertation. Abo: Abo Akademi University; 2003. [ Links ]
12. Kulp M, Schmidt P. Visual predictors of reading performance in kindergarten and first grade children. Optometric Vision Science, 1996; 73(4): 255-262. [ Links ]
13. Marr D, Cermak S. Predicting handwriting performance of early elementary students with the Developmental Test of Visual-Motor Integration. Perceptual Motor Skills, 2002; 95: 661-669. [ Links ]
14. International Dyslexia Association. Understanding Dysgraphia.2009 [accessed 31 August 2010]. Available from: http://www.interdys.org/ewebeditpro5/upload/Understanding_Dysgraphia_Fact_ Sheet_l2-0l-08.pdf. [ Links ]
15. American Psychiatric Association. Diagnostical and Statistical Manual of Mental Disorders: DSM-IV-TR: 4th Edition Text Revision. 4th ed. Washington DC: American Psychiatric Association; 2000. [ Links ]
16. Berninger V Wolf B. Teaching students with dyslexia and dysgraphia: Lessons from teaching and science, Baltimore: Paul H. Brooks Publishing Co; 2009. [ Links ]
17. Deuel R. Developmental dysgraphia and motor skills disorders. Journal of Child Neurology, 1995; 10 (suppl l:S6-S8). [ Links ]
18. Berninger V, Mizokawa D, Bragg R. Theory-based diagnosis and remediation of writing disabilities. Journal of Educational Psychology, 1991; 29(1): 57-59. [ Links ]
19. O'Mahony P, Dempsey M, Killeen H. Handwriting speed: duration of testing period and relation to. Occupational Therapy International, 2008; 15 (3): 165-177. [ Links ]
20. Shaywitz S, Shaywitz B, Fletcher J, Escobar M. Prevalence of reading disability in boys and girls. Journal of the American Medical Association,1990; 291: 998-1002. [ Links ]
21. Summers J. Joint laxity in the index finger and thumb and its relationship to pencil grasps used by children. Australian Occupational Therapy journal, 2001; 48: 132-141. [ Links ]
22. Schwellnus H, Carnahan H, Kushki A, Polatajko H, Missiuna C, Chau T. Effect of pencil grasp on the speed and legibility of handwriting in children. American Journal of Occupational Therapy, 2012; 66(6): 718-726. [ Links ]
23. Ziviani J. The development of graphomotor skills. In Henderson A, Pehoski C, editors. Hand function in the child: Foundations for remediation. St. Louis: Mosby; 1995. 184-193. [ Links ]
24. Schneck C. Comparison of pencil-grip patterns in first graders with good and poor writing skills. American Journal of Occupational Therapy, 1991; 45(8): 701-709. [ Links ]
25. Benbow M. Principles and practices of teaching handwriting. In Henderson A, Pehoski C, editors. Hand function in the child. St. Louis: Mosby; 1995: 255-281. [ Links ]
26. Blote AW, Dijkstra JF. Task effects on young children's performance in manipulating a pencil. Human Movement Science, 1989; 8(5): 515-528. [ Links ]
27. Goldstand S, Koslowe K, Parush S. Vision, Visual-Information Processing, and Academic Performance Among Seventh-Grade Schoolchildren: A More Significant Relationship Than We Thought? American Journal of Occupational Therapy, 2005; 59(4): 377-389. [ Links ]
28. Smits Engelsman B, Van Galen G. Dysgraphia in children:lasting psychomotor deficiency or transient developmental delay? Journal of Experimental Child Psychology, 1997; 67(1): 164-184. [ Links ]
Denise Franzsen


text:
Tissue connector apparatus and methods
Tissue connector assemblies having at least two piercing members, each releaseably coupled to a surgical fastener such as a surgical clip. A flexible member such as a suture may be used to couple one or both piercing members to respective ends of the fastener.
The present invention relates to instruments and methods for connecting body tissues, tissue and prostheses, tissue and graft or any combination thereof.BACKGROUND OF THE INVENTION
Minimally invasive surgery has allowed physicians to carry out many surgical procedures with less pain and disability than conventional, open surgery. In performing minimally invasive surgery, the surgeon makes a number of small incisions through the body wall to obtain access to the tissues requiring treatment. Typically, a trocar, which is a pointed, piercing device, is delivered into the body with a cannula. After the trocar pierces the abdominal or thoracic wall, it is removed and the cannula is left with one end in the body cavity, where the operation is to take place, and the other end opening to the outside. A cannula has a small inside diameter, typically 5-10 millimeters, and sometimes up to as much as 20 millimeters. A number of such cannulas are inserted for any given operation.
A viewing instrument, typically including a miniature video camera or optical telescope, is inserted through one of these cannulas and a variety of surgical instruments and refractors are inserted through others. The image provided by the viewing device may be displayed on a video screen or television monitor, affording the surgeon enhanced visual control over the instruments. Because a commonly used viewing instrument is called an "endoscope," this type of surgery is often referred to as "endoscopic surgery." In the abdomen, endoscopic procedures are commonly referred to as laparoscopic surgery, and in the chest, as thoracoscopic surgery. Abdominal procedures may take place either inside the abdominal cavity (in the intraperitoneal space) or in a space created behind the abdominal cavity (in the retroperitoneal space). The retroperitoneal space is particularly useful for operations on the aorta and spine, or abdominal wall hernia.
Minimally invasive surgery has virtually replaced open surgical techniques for operations such as cholecystectomy and anti-reflux surgery of the esophagus and stomach. This has not occurred in either peripheral vascular surgery or cardiovascular surgery. An important type of vascular surgery is to replace or bypass a diseased, occluded or injured artery. Arterial replacement or bypass grafting has been performed for many years using open surgical techniques and a variety of prosthetic grafts. These grafts are manufactured as fabrics (often from DACRON® (polyester fibers) or TEFLON® (fluorocarbon fibers)) or are prepared as autografts (from the patient's own tissues) or heterografts (from the tissues of animals) or a combination of tissues, semi-synthetic tissues and or alloplastic materials. A graft can be joined to the involved artery in a number of different positions, including end-to-end, end-to-side, and side-to-side. This attachment between artery and graft is known as an anastomosis. Constructing an arterial anastomosis is technically challenging for a surgeon in open surgical procedures, and is almost a technical impossibility using minimally invasive techniques.
Many factors contribute to the difficulty of performing arterial replacement or bypass grafting. See generally, Wylie, Edwin J. et al., Manual of Vascular Surgery, (Springer-Verlag New York), 1980. One such factor is that the tissues to be joined must be precisely aligned with respect to each other to ensure the integrity and patency of the anastomosis. If one of the tissues is affixed too close to its edge, the suture can rip through the tissue and impair both the tissue and the anastomosis. Another factor is that, even after the tissues are properly aligned, it is difficult and time consuming to pass the needle through the tissues, form the knot in the suture material, and ensure that the suture material does not become tangled. These difficulties are exacerbated by the small size of the artery and graft. The arteries subject to peripheral vascular and cardiovascular surgery typically range in diameter from several millimeters to several centimeters. A graft is typically about the same size as the artery to which it is being attached. Another factor contributing to the difficulty of such procedures is the limited time available to complete the procedure. The time the surgeon has to complete an arterial replacement or bypass graft is limited because there is no blood flowing through the artery while the procedure is being done. If blood flow is not promptly restored, sometimes in as little as thirty minutes, the tissue the artery supplies may experience significant damage, or even death (tissue necrosis). In addition, arterial replacement or bypass grafting is made more difficult by the need to accurately place and space many sutures to achieve a permanent hemostatic seal. Precise placement and spacing of sutures is also required to achieve an anastomosis with long-term patency.
Highly trained and experienced surgeons are able to perform arterial replacement and bypass grafting in open surgery using conventional sutures and suturing techniques. A suture has a suture needle that is attached or "swedged on" to a long, trailing suture material. The needle must be precisely controlled and accurately placed through both the graft and artery. The trailing suture material must be held with proper tension to keep the graft and artery together, and must be carefully manipulated to prevent the suture material from tangling. In open surgery, these maneuvers can usually be accomplished within the necessary time frame, thus avoiding the subsequent tissue damage (or tissue death) that can result from prolonged occlusion of arterial blood flow.
A parachuting technique may be used to align the graft with the artery in an end-to-side anastomosis procedure. One or multiple sutures are attached to the graft and artery and are used to pull or "parachute" the graft vessel into alignment with an opening formed in a sidewall of the artery. A drawback to this procedure is the difficulty in preventing the suture from tangling and the time and surgical skill required to tie individual knots when using multiple sutures. Due to space requirements, this procedure is generally limited to open surgery techniques.
The difficulty of suturing a graft to an artery using minimally invasive surgical techniques has effectively prevented the safe use of this technology in both peripheral vascular and cardiovascular surgical procedures. When a minimally invasive procedure is done in the abdominal cavity, the retroperitoneal space, or chest, the space in which the operation is performed is more limited, and the exposure to the involved organs is more restricted, than with open surgery. Moreover, in a minimally invasive procedure, the instruments used to assist with the operation are passed into the surgical field through cannulas. When manipulating instruments through cannulas, it is extremely difficult to position tissues in their proper alignment with respect to each other, pass a needle through the tissues, form a knot in the suture material once the tissues are aligned, and prevent the suture material from becoming tangled. Therefore, although there have been isolated reports of vascular anastomoses being formed by minimally invasive surgery, no system has been provided for wide-spread surgical use which would allow such procedures to be performed safely within the prescribed time limits.
As explained above, anastomoses are commonly formed in open surgery by suturing together the tissues to be joined. However, one known system for applying a clip around tissues to be joined in an anastomosis is disclosed in a brochure entitled, "VCS Clip Applier System", published in 1995 by Auto Suture Company, a Division of U.S. Surgical Corporation. A clip is applied by applying an instrument about the tissue in a nonpenetrating manner, i.e., the clip does not penetrate through the tissues, but rather is clamped down around the tissues. As previously explained, it is imperative in forming an anastomosis that tissues to be joined are properly aligned with respect to each other. The disclosed VCS clip applier has no means for positioning tissues. Before the clip can be applied, the tissues must first be properly positioned with respect to each other, for example by skewering the tissues with a needle as discussed above in common suturing techniques or with forceps to bring the tissues together. It is extremely difficult to perform such positioning techniques in minimally invasive procedures.
Therefore, there is currently a need for other tissue connecting systems.SUMMARY OF THE INVENTION
The present invention involves apparatus and methods for connecting material, at least one of which is tissue. The invention may, for example, be used to secure one vessel to another, such as in a vascular anastomosis.
According to one aspect of the invention, a tissue connector assembly is provided comprising a surgical fastener, such as a surgical clip, a first tissue piercing member and a second tissue piercing member. The fastener may be adapted to assume a loop configuration. The fastener has a first end portion and a second end portion. The first tissue piercing member is coupled to the first end portion and the second tissue piercing member is coupled to the second end portion. The multiple piercing member construction facilitates threading ends of the assembly from inner to outer walls of material, such as tissue, which may eliminate or minimize the possibility of dislodging material from the inner wall of a vessel, for example.
According to another aspect of the invention, a flexible member, such as a suture, may be provided between at least one piercing member and the fastener to facilitate threading the fastener and/or "parachute" techniques, for example.
According to another aspect of the invention, synchronized piercing member release mechanisms may be provided. In one embodiment, the tissue connector assembly may include a first coupling, which couples the first tissue piercing member arid first end portion of the surgical fastener, and a second coupling, which couples the surgical fastener second end portion and second piercing member. The first coupling releases the other coupling in response to releasing the first coupling. According to one aspect of this embodiment, multiple tissue piercing members may be decoupled from the surgical fastener with one release actuator. Accordng to another aspect, the piercing members may be decoupled essentially simultaneously.
The above is a brief description of some deficiencies in the prior art and advantages of the present invention. Other features, advantages, and embodiments of the invention will be apparent to those skilled in the art from the following description, accompanying drawings, and claims.BRIEF DESCRIPTION OF THE DRAWINGS
Corresponding reference characters indicate corresponding elements throughout the drawings.DESCRIPTION OF THE INVENTION
The present invention generally involves methods and devices for manipulating, aligning and/or connecting tissues, tissue and prosthesis, tissue and graft, or any combination thereof. As used herein, the term graft includes any of the following: homografts, autologous grafts, xenografts, allografts, alloplastic materials, and combinations of the foregoing. Tissue connector assemblies are disclosed, which, for example, may be used in vascular surgery to replace or bypass a diseased, occluded, or injured artery by connecting a graft vessel to a coronary artery or vein in an anastomosis as shown in FIGS. 16A-F. Assemblies constructed in accordance with the invention may be used in open surgical procedures or in minimally invasive or endoscopic procedures for attaching tissue located in the chest, abdominal cavity, or retroperitoneal space. It should be understood, however, that these examples are provided for illustration and are not intended to limit the scope of the invention.
Tissue connecting assemblies and methods are disclosed in copending U.S. patent application Ser. Nos. 09/089,884 and 09/090,305, both entitled Tissue Connector Apparatus and Methods and having a filing date of Jun. 3, 1998. The entirety of the disclosures of the cited '884 and '305 applications is hereby incorporated herein. One aspect of the present invention is the provision of multiple tissue piercing members. More specifically, tissue connecting assemblies constructed according to the present invention generally include a plurality of tissue piercing or penetrating members coupled to a surgical fastener. The multiple piercing member construction facilitates threading ends of the assembly from inner to outer wall(s) of material, such as tissue, which may eliminate or minimize the possibly of dislodging material, such as plaque, from the inner wall of calcified arteries, for example, as will become more apparent from the description provided below. In a preferred embodiment, two piercing members, each of which may comprise a needle, are releaseably coupled to a fastener. One or both of the piercing members may be attached to a flexible member, such as a suture, which in turn is releaseably coupled to the fastener. Double and single flexible member embodiments are illustrated in
Each of penetrating or piercing members 16 and 17 may be in the form of a needle (such as a 7-0 or 8-0 needle) having a sharp pointed tip (30 or 31) at its distal end for penetrating tissue. Members 16 and 17 may be bent as shown in
The flexible members 18 and 19 may be in the form of a suture formed from conventional filament material, metal alloy, such as nitinol, polymeric material, or any other suitable material. The material may be non-stretchable or stretchable, solid or hollow (as shown, for example, in
Referring to
Referring to
Referring to
It is to be understood that the shape memory alloy may also be heat activated, or a combination of heat activation and pseudoelastic properties may be used, as is well known by those skilled in the art.
The cross-sectional diameter of wire 34 and length of the wire will vary depending on the specific application. The diameter "d" of wire 34 may be, for example, between 0.001 and 0.015 inch. For coronary bypass applications, the diameter is preferably between 0.001 and 0.008 inch with a diameter "D" of the loop (
One end of wire 34, which may be referred to as the proximal end of wire 34, may include an enlarged portion 36 having a cross-sectional area greater than the cross-sectional area of the wire to resist the coil from passing thereover. The enlarged portion 36 also may be provided to cooperate with a release mechanism as will be discussed in more detail below. Enlarged portion 36 may be formed by attaching a member to the end of wire 34 by welding, gluing or other suitable attachment means or may be formed integrally with the wire by deforming the end of the wire. The other end of wire 34, which may be referred to as the distal end of wire 34, also may include an enlarged portion 38 for engagement with a restraining device, such as restraining device 24 (see. e.g.,
Referring to FIGS. 3A-C, fastener 20 is shown in open and closed configurations. When wire 34 is in an undeformed or closed configuration, the fastener is closed (as shown in
Wire 34 may be formed in the above described shape by first wrapping the wire onto a mandrel and heat treating the wire at approximately 400-500 degrees Celsius for approximately 5 to 30 minutes. Wire 34 is then air quenched at room temperature. The mandrel may have a constant diameter or may be conical in shape.
Referring to
Referring to
Referring to
It is to be understood that the fasteners may have undeformed or deformed configurations different than those shown herein without departing from the scope of the invention. In addition, a locking clip (not shown) may also be attached to connect the ends of the fastener (such as fastener 20, 40, 41, 43) when the fastener is in its closed position to prevent possible opening of the fastener over time. The locking clip may also be integrally formed with one end of the fastener.
As shown in
When coil 26 is in its free state (with the wire in its undeformed configuration), loops of the coil are generally spaced from one another and do not exert any significant force on the wire 34 (
Referring to
Tubular member 50 is movable between a locked position (
Proximal end 54 of tubular member 50 includes a bore 62 having a diameter slightly greater than the outer diameter "d" of wire 34, but smaller than the diameter of enlarged portion 38 at the distal end of the wire and the outer diameter of the coil 26. Bore 62 extends into a cavity 64 sized for receiving the enlarged portion 38 of wire 34. Tubular member 50 may be described as having an annular flange 61 for releasably securing enlarged portion 38. As shown in
Preferably, a rod 162 extends from tapered section 2 to facilitate fixation of the strands thereto. The coupling of the strands to tapered section 2 is preferably accomplished by gluing or soldering to rod 162, although other equivalent or similar known joining techniques may be employed (e.g. welding, threadably attaching, etc). Similarly, rod 162 is preferably glued, soldered or threaded into the needle or transition element. In an alternate arrangement, the flexible member may extend through tapered section 2 and form a substitute structure for rod 162. This may be preferred when the flexible member is a metal wire.
The end portions 106b of the strands in the vicinity of the fastener strands include notches 109 which are formed into the strands to a depth equal to approximately half the diameter of the strand 106. When the strands are arranged in the circular configuration described above, the notches 109 form a chamber 108 configured for receiving and holding enlarged portion 38. Although enlarged portion 38 is shown as having a spherical shape, it may have other shapes including a barrel shape, or other shape that may be easily grasped and easily released. The notches are preferably placed about 0.015″ from the free ends of the strands, but this distance, of course, can be modified, depending upon the amount of compression of spring 26 that is desired when ball 38 is inserted into and held by notches 109.
After placement of ball 38 within chamber 108 formed by notches 109, a shrink wrap layer, preferably a shrink tubing 110 may be provided over at least free end portions 106b of wires or strands 106, and the tubing heated to compress against strands 106 and hold them in place against ball 38, preferably symmetrically against ball 38. Together, tubing 110 and strands 106 effectively hold ball 38 captive within notches 109. Alternatively, other plastic or elastic restraining members may be mounted around the distal portions of the wires or strands to aid in maintaining them in place, preferably symmetrically against ball 38. Still further, strand members may be designed with an elastic spring force sufficient to maintain notches 109 in place with sufficient force to maintain the ball 38 captive therein under the tensile forces normally experienced during a suturing procedure. Although a seven strand embodiment is shown, it should be understood that fewer or more than seven strands may be used. The number of strands may vary depending on, for example, the size of the clip or the size of the strands. Typically, the number of strands may range from two to ten. In a coronary anastomosis, the number of strands preferably will range from five to seven although other numbers may be used.
In assembling, enlarged portion 38 of wire 34 is placed in chamber 108. Tubing 110 is wrapped around at least a portion of the strands (as shown in the drawings) and heated to maintain enlarged portion 38 captive within the cavity formed by the strands. Compression coil or spring 26 is slid over wire 34 and compressed against portions 106b such that the fastener is in its open configuration. Enlarged portion 36 may then be formed or attached to wire 34 to maintain the fastener in its open configuration.
Release mechanism 28c is movable between a locked position (
Movement of the release mechanism to the open position is accomplished by applying a compressive force to the shrink tube 110 and bundle of strands 106, as shown in
Referring to
Release mechanism members 121 have tapered ends 126, which are configured for positioning between coil 26 and fastener wire 34 as shown in
Flexible member 19 is threaded through channel 134 and between tapered member 3′ and annular member 115. When coil 26 is in a compressed state as shown in
It is to be understood that locking devices other than those described above may be used without departing from the scope of the invention. For example, a locking device (not shown) may comprise a tubular member having an opening formed in a sidewall thereof for receiving an end portion of the wire. The end of the wire may be bent so that it is biased to fit within the opening in the sidewall of the tubular member. An instrument, such as a needle holder may then be used to push the wire away from the opening in the tubular member and release the wire from the tubular member. Various other types of locking devices including a spring detent or bayonet type of device may also be used. Further, the fastener or wire end portions may be configured differently than that shown. For example, one or both of the fastener or wire end portions may be provided with grooves instead of enlarged portions and the release mechanisms or locking device arms, such as, for example, fingers 81 or strands 106, may be provided with projections to releaseably engage with the grooves.
Referring to
As noted above, tissue connector assemblies described above have many uses. They may be especially useful for minimally invasive surgical procedures including creating an anastomosis between a vascular graft 12 and an artery 14. The anastomosis may be used to replace or bypass a diseased, occluded or injured artery. A coronary bypass graft procedure requires that a source of arterial blood flow be prepared for subsequent bypass connection to a diseased artery. An arterial graft may be used to provide a source of blood flow, or a free graft may be used and connected at the proximal end to a source of blood flow. Preferably, the source of blood flow is one of any number of existing arteries which may be dissected in preparation for the bypass graft procedure. In many instances it is preferred to use the left internal mammary artery (LIMA) or the right internal mammary artery (RIMA), for example. Other vessels which may be used include the saphenous vein, gastroepiploic artery in the abdomen, radial artery, and other arteries harvested from the patient's body as well as synthetic graft materials, such as DACRON®) (polyester fibers) or GORETEX® (expanded polytetrafluoroethylene). If a free graft vessel is used, the upstream end of the dissected vessel, which is the arterial blood source, will be secured to the aorta to provide the desired bypass blood flow, as is well known by those skilled in the art. The downstream end of the graft vessel is trimmed for attachment to an artery, such as the left anterior descending coronary (LAD). It is to be understood that the anastomosis may be formed in other vessels or tissue.
The patient is first prepped for standard cardiac surgery. After exposure and control of artery 14, occlusion and reperfusion may be performed as required, an arteriotomy is performed on artery 14 to provide an opening 120 for receiving a graft vessel. After the snared graft vessel 12 has been prepared as would be apparent to one of ordinary skill in the art, a tissue connector assembly 11 is attached to the free end of the graft vessel along an edge margin of the vessel. In order to attach the connector assembly 11, the surgeon grasps needle 16 with a needle holder (e.g., surgical pliers, forceps, or any other suitable instrument) and inserts needle 16 into the tissue of graft vessel 12 in a direction from the interior of the vessel to the exterior of the vessel. The surgeon then releases the needle 16 and grasps a forward end of the needle which is now located outside graft vessel 12 and pulls the needle and a portion of suture 18 through the vessel. Needle 17 is passed through opening 120 formed in the sidewall of the artery 14 and inserted into the tissue of the artery. in a direction from the interior of the artery to the exterior of the artery. The surgeon then grasps needle 17 located outside the artery 14 and pulls the needle and a portion of suture 19 through the arterial wall. A second tissue connector assembly 11 may be inserted as described above at a location generally 180 degrees from the location of the first tissue connector in a conventional "heel and toe" arrangement.
Once the tissue connector assemblies 11 are inserted, graft vessel 12 is positioned above and aligned with opening 120 in the sidewall of the artery 14 (
A surgical instrument (e.g., needle holder) is used to radially squeeze each locking device 28 to release the locking device from the fastener 20. Upon removal of each locking device 28, each coil 26 moves to its free uncompressed state which allows fastener wire 34 to return to its original undeformed closed position (
The tissue connector assemblies 300 are subsequently inserted at circumferentially spaced locations around the periphery of the graft vessel to sealingly fasten graft vessel 12 to artery 14. Needle 16 of fastener 300 is inserted into graft vessel 12 from the exterior surface of the graft vessel and pushed through the graft vessel and artery 14 tissue. The needle holder is then used to pull the needle 16 through the arterial wall. An instrument (same needle holder or other suitable instrument) is used to apply a squeezing force to the locking device 28 to release fastener 20 from needle 16. This allows coil 26 to move to its uncompressed configuration and the wire to move to its closed position. It should be noted that the tissue connector assemblies 11 may remain with their fasteners in their open position while tissue connector assemblies 300 are inserted into the tissue and moved to their closed position. The locking devices 28 of the tissue connector assemblies 11 may subsequently be removed from the fasteners 20 to allow the fasteners to move to their closed position. The number and combination of tissue connectors assemblies 11 and 300 required to sealingly secure the connecting tissues together may vary. For example, only tissue connector assemblies 11 may be used to complete the entire anastomosis.
Although coils 26 are shown remaining on the fastener or wire (
As an alternative to inserting tissue connector assemblies 11 at "heel and toe" locations described above, a number of tissue connector assemblies 11 may be inserted generally around the location of the heel. The graft vessel may then be pulled towards the artery to determine whether the opening formed in the sidewall of the artery is large enough before completing the anastomosis. It also should be understood that tissue connector assemblies 211 may be used instead of or in conjunction with assemblies 11.
Although the suturing procedure has been described for an end-to-side anastomosis, it should be appreciated that the procedure is applicable to an end-to-end and side-to-side anastomosis, connecting various tissue structures including single and multiple tissue structures, and puncture sites, and connecting tissue to a prosthetic graft or valve, for example.
It will be observed from the foregoing that the tissue connector assemblies of the present invention have numerous advantages. Importantly, the assemblies are easier and faster to apply than conventional sutures which require tying multiple knots. The assemblies also may be used in minimally invasive procedures including endoscopic procedures.
All references cited above are incorporated herein by reference.
The above is a detailed description of particular embodiments of the invention. It is recognized that departures from the disclosed embodiments may be made within the scope of the invention and that obvious modifications will occur to a person skilled in the art. The full scope of the invention is set out in the claims that follow and their equivalents. Accordingly, the claims and specification should not be construed to unduly narrow the full scope of protection to which the invention is entitled.
1. A tissue connector assembly comprising a surgical fastener, which is adapted to assume a loop configuration, a first tissue piercing member and a second tissue piercing member, said surgical fastener having a first end portion and a second end portion, said first tissue piercing member being coupled to said first end portion and said second tissue piercing member being coupled to said second end portion.
2. The tissue connector assembly of claim 1 further including a flexible member, said flexible member having a first end portion coupled to said first tissue piercing member and a second end portion coupled to said first end portion of said fastener.
3. The tissue connector assembly of claim 2 further including a second flexible member, said second flexible member having a first end portion coupled to said second tissue piercing member and a second end portion coupled to said second end portion of said fastener.
4. The tissue connector assembly of claim 3 wherein said first flexible member comprises a suture.
5. The tissue connector assembly of claim 3 wherein each of said flexible members comprises a suture.
6. The tissue connector assembly of claim 3 wherein at least one of said flexible members comprises metal.
7. The tissue connector assembly of claim 2 wherein said flexible member comprises a suture.
8. The tissue connector assembly of claim 2 wherein said flexible member comprises metal.
9. The tissue connector assembly of claim 1 wherein at least one of said tissue piercing members comprises a needle.
10. The tissue connector assembly of claim 1 wherein each of said tissue piercing members comprises a needle.
11. The tissue connector assembly of claim 1 further including a coupling, said first tissue piercing member and said first end portion of said surgical fastener being coupled to said coupling.
12. The tissue connector assembly of claim 11 wherein said coupling comprises a tubular member having movable portions and said surgical fastener includes an enlarged portion adapted for receipt in said movable portions.
13. The tissue connector assembly of claim 12 wherein said enlarged portion is spherical.
14. The tissue connector assembly of claim 12 wherein said movable portions comprise a plurality of strands.
15. The tissue connector assembly of claim 14 wherein a plurality of said strands include a notch for receiving a portion of said enlarged portion.
16. The tissue connector assembly of claim 14 wherein said strands comprise wires.
17. The tissue connector assembly of claim 14 wherein said strands comprise cables.
18. The tissue connector assembly of claim 11 including a second coupling, said surgical fastener second end portion and second piercing member being coupled to said second coupling.
19. The tissue connector assembly of claim 18 wherein said surgical fastener includes an enlarged portion and said second coupling comprises a generally tubular member having movable portions adapted to receive at least a portion of said second portion.
20. The tissue connector assembly of claim 19 wherein said movable portions comprise a plurality of strands.
21. The tissue connector assembly of claim 19 wherein a plurality of said strands include a notch for receiving a portion of said enlarged portion.
22. The tissue connector assembly of claim 18 wherein said second coupling releases the coupling between said second piercing member and said surgical fastener in response to releasing said fastener first end portion coupling.
23. The tissue connector assembly of claim 18 further including a coil surrounding said surgical fastener and wherein said fastener includes first and second enlarged portions and said fastener first end portion coupling and said second coupling are adapted for receipt of said fastener first and second enlarged portions, respectively, said second coupling including members having portions that have a radially outward bias and extend within said coil when said coil is compressed against said second coupling.
24. The tissue connector assembly of claim 18 further including a flexible member and a coil, said flexible member having a portion coupled to said second tissue piercing member and a portion coupled to said second coupling, said coil surrounding said surgical fastener and being compressed against said second coupling, said fastener including an enlarged portion and said fastener first end portion coupling being adapted for receipt of said enlarged portion, said second coupling including a first member fixedly secured to said fastener and a second member slidably coupled to said fastener, and said flexible member being compressed between said second coupling members when said coil is compressed against said slidably coupled member.
25. The tissue connector assembly of claim 18 wherein said fastener includes a groove and projection and said second coupling includes a member having a groove and projection and a sleeve slidably mounted thereon, said fastener groove and projection being configured to mate with said coupling member groove and projection.
26. The tissue connector assembly of claim 18 further including a flexible member having a portion coupled to said second tissue piercing member and a knotted portion, said second coupling including a tubular member having a bore, said knotted portion being in said bore and said bore having a portion with a diameter less than that of a section of said knotted portion.
27. The tissue connector assembly of claim 18 wherein said second coupling comprises an annular blade coupled to said second piercing member, said annular blade surrounding and being secured to a portion of said surgical fastener.
28. The tissue connector assembly of claim 1 wherein said surgical fastener comprises a surgical clip.
29. The tissue connector assembly of claim 28 wherein said surgical clip comprises a wire.
30. The tissue connector assembly of claim 29 further including a coil surrounding at least a portion of said wire and having confined ends.
31. The tissue connector of claim 29 wherein said wire comprises shape memory material.
32. The tissue connector assembly of claim 28 wherein said surgical clip has an open configuration and a closed configuration.
33. The tissue connector assembly of claim 32 wherein said surgical clip is in said closed configuration when in a relaxed state.
34. The tissue connector assembly of claim 32 wherein said surgical clip is generally U-shaped when in said open configuration.
35. The tissue connector assembly of claim 32 wherein said surgical clip assumes a spiral configuration when in said closed configuration.
36-82. (Cancelled)
Type: Application
Filed: Aug 28, 2003
Publication Date: Apr 7, 2005
Patent Grant number: 7892255
Inventors: Laurent Schaller (Los Altos, CA), Barry Gardiner (Orinda, CA), Art Hill (Sausalito, CA), John Nguyen (San Jose, CA), Liem Ho (Mountain View, CA), Isidro Gandionco (Fremont, CA)
Application Number: 10/653,027

subset: commoncrawl


text:
Visit Hull & East Yorkshire
Events in Hull and East Yorkshire
What's on this week
|Sun 23 Feb
|Nature's Magic at Bempton Cliffs at RSPB Bempton Cliffs
|Sun 23 Feb
|Swan Lake at Spotlight Theatre
|Sat 22 - Sun 23 Feb
|Rudston Snowdrop and Aconite Walk at Rudston
|Mon 24 Feb
|Dutty Disco Mondays at Atik
|Tue 25 Feb
|Parents Carers & Guardians Community Event at Flemingate Shopping Centre
A visit to Hull and East Yorkshire is the start of a great journey. Whether walking and cycling on the Yorkshire Wolds or enjoying a city break in Hull you will have a fantastic visit.
Visit Hull and explore its historic old town heart and cultural venues. All of the city's museums and galleries are free to enter so spend some time in the Ferens gallery or immerse yourself in Hull's maritime history at the Maritime Museum. Take a city tour or take it at your own pace following the famous fish trail. Bring the kids and enjoy highlights like the museums quarter or a visit to the award winning The Deep.
The stunning market town of Beverley has beauty in abundance. With an awe-inspiring Minster, popular racecourse, historical buildings, vibrant festivals and small town charm, there is something for everyone.
Visit the Yorkshire Coast for the best place to see sea birds in England, at RSPB Bempton or spend time exploring the coves and open sandy beaches.
Plan Your Visit
Create your Shortlist
Choose from a wide range of accommodation, from city hotels and guesthouses to countryside lodges and glamping.
Read our suggestions for a fantastic day out for all of the family at the top attractions in Hull and East Yorkshire.
East Yorkshire is home to an abundance of wildlife and the Yorkshire Nature Triangle provide detailed information on how best to enjoy the natural surroundings.
Hull and East Yorkshire is full of history and heritage waiting to be discovered, from the impressive heights of Beverley Minster to Hull's Old Town.
We have a range of brochures available to help plan your visit. You can request copies of our brochures or download them to view instantly.


text:
Product Description
Pear or teardrop shaped semi precious gemstone Polish Flint matched pair designer cabochons 28 mm by 19 mm and slightly domed on both sides. They are 7 mm thick.
These cabochons weigh about 24.5 carats each.
Polish Flint (or flintstone) is a semi precious gemstone variety of chalcedony.
What is rare in this gemstone cabochon material is the internal layering. This type of flint, called banded flint, only occurred in the Jurassic limestone in Poland (160 million years ago).
The irregular banding creates extremely picturesque internal structures making very special designer cabochons.
Metaphysical Properties: Polish Flint is said to help those too focused on past hurts to move on. It calms emotional drama.
Cabochons are stones cut for jewelry and are measured in mm. One inch is equal to about 25 mm.
Shipping terms: Cabochons are shipped First Class within the U.S. for FREE. You can upgrade to Priority Mail Small Flat Rate Box for $5.00.
We offer First Class International shipping for $5.00. First Class usually takes from 2 weeks up to 8 weeks internationally and it is NOT tracked. You can choose to upgrade to Priority Mail for $20.00 to Canada or $22.00 anywhere else.


text:
Acer Iconia Smart wallpapers
Ratings :
Click the stars to rate
238,015 Rated by :
63 user(s)
Click the stars to rate
- 1
- 2
- 3
- 4
- 5
238,015 Rated by :
63 user(s)
Retail Price: N/A
AP Price: N/A
AP Price: N/A
Acer Iconia Smart is an Android smartphone which features a 4.8 inch display with a resolution of 1024 x 480 pixels and a 21:9 widescreen aspect ratio. Other specifications on the Acer Iconia Smart include Dolby Surround technology, a 1GHz Qualcomm Snapdragon processor, plus high speed HSDPA 14.4 Mbps.
Top, New and Popular Wallpapers for Acer Iconia Smart. The collection of Free Wallpapers for Acer Iconia Smart right here to be download. We update the collection of Wallpapers daily.
Select Other Phone Model
Select Other Phone Model


text:
FridaysUpdate: Opposites attract? Season closers bring back pop-rock
For a Fridays After Five season to start with a college-aged pop-rock group may speak to the popularity of the group. But for a Fridays After Five season to start and end with college-aged pop-rock groups can indicate that local bands may just be putting the "pop" back into popular music.
While the season began with Williamsburg expatriates Ultraviolet Ballet, who traverse the frat and Corner bar scene with their "vintage" '70s pop, it ends with two variations on the pop-rock sound– a diverse, blues-infused version from UVA grads Tim Be Told and brightly-colored '60s-era pop from In Technicolor.
For Tim Be Told, UVA's 2008 Battle of the Bands winner, life after graduation doesn't equal one void of learning. The quintet recently underwent a crash course in public relations, exploring the inner workings of the music industry while still maintaining their ties to UVA with their poppy, gospel/blues rock.
"We're still playing a lot of college events, but when you're a college band, there's not as much at stake," frontman Tim Ouyang says. "Now we're traveling a lot more and can devote all our time to it."
With ambitious regional tours across the country, both on campuses and in high-profile music hubs, and plans for an international jaunt in the works, the band continues to prove its worth outside UVA. Striking close relationships with other local up-and-comers, TBT– still only a few years old with its current lineup– plans to bring pop back into prominence with locals, without being lumped into a specific age demographic.
"I would say we bring a happy medium between the more pop stuff and the alternative indie stuff," Ouyang explains. "I see us bridging that stylistic gap."
Meanwhile, fellow rockers In Technicolor hope to garner more "indie" cred in order to reach a widespread public.
"We're not trying to be indie-serious, but more along the lines of the Rolling Stones, old rock and roll," says lead singer Drew Morris. "When I need an uplifter, I go to music, so I hope that's the way it translates when we play."
Fusing '60s pop with modern electronica and dance influences, IT began in early 2008 with a group of James Madison University graduates. The brainchild of frontman Morris, IT fostered an image attractive to the college demographic– buoyant, danceable beats combined with outgoing, brightly-garbed band members– yet hoping to utilize the UVA scene in conjunction with a more music-savvy, Downtown Mall traversing audience.
"It's pretty vital in Charlottesville to be integrated in the college scene," Morris says. "But half the battle is getting them to go downtown."
For both bands– IT being praised as the one up-and-coming pop-rock band to watch by the Washington Post– the prospect of years of hard work and dedication is no deterrence. Learning from the experiences of fellow rockers Parachute, IT and TBT plan to utilize the college scene to further their post-graduate rocker image.
And for sharing the stage for the final Fridays? According to the guys of TBT, splitting the stage with friends and brightly-hewed rockers IT will be an entertaining balance to the more intimate, brooding blues-pop they play. "Our music fits in with the summer theme of Fridays," IT's Morris agrees. "The colors are more representative of what music is to me– a happy thing."
"For me, there's a little bit of pressure to put on the best show that we can," TBT percussionist Jim Barredo says. "But it's interesting to note that how we dress speaks to our music– In Technicolor has bright colors, and we're usually black and grey."
Tim Be Told and In Technicolor close the Fridays After Five season on 9/11. The show starts at 5:30 pm, and admission is free.
6 comments
can we say MR MOJO RISEN
Someone better let these guys know.
I am coming back from the dead to see this show
This is Jim Morrison again, I live thru Drew Morris, he's a true genius, If I HAD HALF OF HIS ABILITY, I wouldn't have drank myself to death, I drank myself to death, so he could conquer this era,
This is Jim Morrison again, I live thru Drew Morris, he's a true genius, If I HAD HALF OF HIS ABILITY, I wouldn't have drank myself to death, I did that (DRINKING MYSELF TO DEATH) so he could conquer this era, if I was around now, it would only hold him back..................................
Stop pissing around that your dead. Its your turn to do the dishes. Elvis made a mess of cooking dinner.


text:
|Deletions are marked like this.
|Additions are marked like this.
|Line 12:
|Line 12:
Local news about BOV member Rock Mackie, Garage member Daniel Litvak, and former student Eric Ronning, finalists in the 2016 Governor's Business Plan Contest http://news.wisc.edu/five-uw-spinoffs-among-finalists-in-governors-business-plan-contest/
Garage Physics
The Garage Physics lab in B613 Sterling Hall is a makerspace for student-driven interdisciplinary innovation. Garage offers UW-Madison students an unstructured safe environment to explore technologies and to develop creative ideas through project-oriented just-in-time learning. Want to make something or make something happen? You have come to the right place.
Garage Physics is described in the UW-Madison communications story http://news.wisc.edu/24040, the WKOW news story http://www.wkow.com/story/30139090/2015/09/29/students-create-inventions-of-the-future-in-uw-madison-garage , and the Badger Herald story https://badgerherald.com/news/2015/10/13/tinker-away-garage-physics-helps-realize-student-inventions/.
In the news, receipt reduction: http://news.wisc.edu/24056?utm_source=iUW&utm_medium=email&utm_campaign=iUW2015-10-01 and https://badgerherald.com/news/2015/10/02/university-dining-halls-go-paperless/ and UW–Madison's 2016 Administrative Improvement Award: http://news.wisc.edu/administrative-employees-honored-for-improving-the-campus-experience/.
Local news about the Badgerloop project (pod under construction in Chamberlin Hall): http://news.wisc.edu/uw-madison-places-among-top-teams-in-spacex-hyperloop-competition/ and https://badgerherald.com/news/2016/02/15/badgerloop-team-prepares-for-next-steps-after-success-in-texas/. National/international news: http://www.geekwire.com/2016/mit-leads-in-first-round-of-spacexs-hyperloop-contest-but-uw-is-in-the-race/, http://www.popsci.com/behind-scenes-at-spacexs-hyperloop-pod-competition
Local news about BOV member Rock Mackie, Garage member Daniel Litvak, and former student Eric Ronning, finalists in the 2016 Governor's Business Plan Contest http://news.wisc.edu/five-uw-spinoffs-among-finalists-in-governors-business-plan-contest/
Garage Physics offers limited support for R&D materials for scientists, innovators, and entrepreneurs. Apply at the following link: https://www.physics.wisc.edu//GaragePhysicsVenturewellSupportApplication .
For further information or questions about access to the Garage or accessibility, please contact Professor Duncan Carlsmith, firstname.lastname@example.com , or Instructional Lab Manager Brett Unks, email@example.com .
About Garage Physics - General information for students about joining and working in Garage Physics
Safety - Important safety information
Office Hours - Need a hand? Looking for a meeting to get involved?
Projects - What are you working on? Look here for on-going and suggested projects.
Equipment - What do we have? What would you like?
Classes - Learn something. Teach something!
Software - Collaboration, design tools, and more
Makerspace links - Makerspace and innovation center links
Entrepreneurship clinic - Entrepreneurship inspiration, education, and local and national resources
Sustainability - WI Make Sustain resources and sustainability related suggested projects
MadisonTech - Madison community tech group links
Campus connections - UW connections
Conferences - Outreach, conferences and other news
Research funding - Resources for undergraduate and graduate research, internships, and careers
Publish - Opportunities to publish and present your findings
Awards - Garage students in the news
Readings - Quiet time inspiration
History - B613 Sterling History
Links and information on this website are for education purposes and do not constitute an endorsement of any product, company, or cause.


text:
Refine your search
Browsing Venues
You are searching for Venues
A small family run café with homemade healthy eating.
19 A The Springs, Wakefield, WF1 1QE
tel: 01924 375773
A long established magic shop in the centre of Wakefield
15 The Springs, Wakefield, WF1 1QE
tel: 01924 339933
Wakefield Comics-616 is your gateway to a multiverse of Pop Culture.
Wakefield Comics-616, 3 The Springs, Wakefield, WF1 1PU
tel: 019224 375234
Wool N Stuff is a family run independent yarn shop in the heart of Wakefield City Centre.
Wool N Stuff Ltd, 46 Upper Kirkgate, Wakefield, WF1 1TQ
tel: 01924 565740
7A is a big, bright open plan space which gives local practitioners to prepare oversize projects for national and international exhibitions.
Thornes Mill, Denby Dale Road, Wakefield, WF2 7AZ
tel: 01924 200069
The Aagrah Restaurant offers a delicious selection of Kashmiri cuisine.
Barnsley Road, Sandal, Wakefield, WF1 5NX
tel: 01924 242222
Ackworth Fisheries is a Stillwater fishery located in West Yorkshire.
Long Lane, Low Ackworth, Pontefract, West Yorkshire, WF7 7EZ
tel: 01977 701495
The Library is located in Airedale, just outside Castleford
The Airedale Centre, The Square, Airedale, Castleford, WF10 3JJ
tel: 01924 305906
Children's play area at Anglers Country Park
Haw Park Lane, Wintersett, Wakefield, WF4 2EB
tel: 01924 303980
Looking for an exciting adventure in the outdoors? Haw Park Wood is the place!
Anglers Country Park, Haw Park Lane, Wintersett, Wakefield, WF4 2EB
tel: 01924 860280
At BEST WESTERN Hotel St Pierre, Wakefield, pride themselves on theirfriendly and professional hospitality and aim to make your stay with them an unforgettable experience, for all the right reasons.
Best Western Hotel St Pierre, 733 Barnsley Road, Wakefield, WF2 6QG
tel: 01924 255596
Bier Huis is the multi award winning specialist drinks retailer with over 400 beer, 80 ciders & 50 gins plus a lot more. We also host a number of night time tasting sessions.
17 Towngate, Ossett, West Yorkshire, WF5 9BL
tel: 01924 565121
Spend a relaxing a day by the waters of Birkwood Farm Fisheries and see if you can net your personal best!
Birkwood Farm Fisheries, Altofts, Wakefield, West Yorkshire, WF6 2JE
tel: 01924 892251
Bistro 42 is a family owned business in the heart of town. Both local and people from the surrounding area are regular visitors. We strive to produce excellent quality at reasonable prices utilising only the freshest ingredients.
42 High Street, Horbury, WF4 5LE
tel: 01924 278123/275325
Blacker Hall Farm Shop is an award winning farm shop specialising in local produce.
Branch Road, Calder Grove, Wakefield, WF4 3DN
tel: 01924 267202
Bring your bino's for to spot some of the fantastic wildlife that calls Bullcarr Mires their home.
Upton, WF9 1JS
tel: 01924 860280


text:
Monday, May 2, 2011
Some things are bigger than The Game. We Got HIM!
11 comments:
Thank you Joe...God bless buddy!ReplyDelete
- AnonymousMay 2, 2011 at 9:34 AM
This is awesome. Gotta get this published. More people need to see this! Thank you for sharing your talent.ReplyDelete
Awesome tribute.ReplyDelete
- vickyrexMay 2, 2011 at 1:20 PM
This is fantastic. Love your blog.ReplyDelete
Joe, I have posted a couple links to your page on my blog! Your stuff is incredible! Do you sell any of your work?ReplyDelete
I sell a lot of my Rock n Roll art and Ali. I am about to publish my journal work as fine art. I will keep you all posted!ReplyDelete
Really fantastic work there, Joe.ReplyDelete
- AnonymousMay 4, 2011 at 1:27 AM
Breathtakingly beautiful, Joe!ReplyDelete
A great piece!ReplyDelete
- AnonymousMay 21, 2011 at 9:26 AM
thank you for thisReplyDelete
Subscribe to: Post Comments (Atom)


text:
Tutorial LA-WEB 2006
Digital collections management using xmLibrisCIRIA 302
en espańol
Antonio RazoResearcher
Laboratory of Interactive and Cooperative Technologies ICT
Universidad de las Américas, Puebla
This tutorial will introduce the requirements and steps to build and manage digital collections using xmLibris.
xmLibris is a tool Developer within the CUDI 2005 project "Public Software for the Digitalization and Dissemination of Ancient Repositories." Among the characteristics of xmLibris we could highlight the following: Web interface for managing and consulting documents, annotations and handling images, metadata and full texts searches, and the usage of standards for supporting the interoperability between collections.
All these functionalities are ready to use once the application is installed. xmLibris was developed using Java Server Pages (JSP) along with a XML data base and requires an application Server. The minimum requirements for xmLibris are the following:
Java SDK 1.4 or later.
Tomcat Server 4.1 or later.
5 Mb of free space for the application.
Free space for storing the collections.
About the speaker
M.S. Antonio Razo is currently a researcher for the Interactive and Cooperative Technologies (ICT) at the University of The Americas, Puebla. During 2005, he was an active member of the CUDI project "Public Software for the Digitalization and Spreading of Ancient Repositories." In this project he had a role as technical responsible for the development of the xmLibris software.
He obtained his graduated degree and M.S. degree as Computer Science Engineer from the University of the Americas, Puebla (UDLA). His interest areas include visualization, geographic information systems, XML technologies and Web Services.


text:
- Font:
- +
- -
A 35-year-old military veteran has died at a hospital after shooting himself Thursday in an Occupy Wall Street encampment in Vermont's largest city, a spokesman said.
The public was not believed to be at risk after the afternoon shooting at City Hall Park in Burlington, but the circumstances were still being investigated, said Burlington Police Deputy Chief Andi Higbee. Police would not confirm that the shooting was a suicide, but witnesses said the man shot himself.
The shooting followed the Wednesday night arrest of dozens of protesters at the University of California, Berkeley campus, and as officials in Portland, Oregon, said an encampment in their city will be shut early Sunday.
The Vermont victim's identity will not be released until his family has been notified, Higbee said.
People who know him say the man is a military veteran. Occupy Vermont leader Emily Reynolds says he "clearly needed more help than we were capable of giving him."
"He was my buddy," Joe Edwards, of Burlington, said of the victim, who had been at the encampment for about a week.
The encampment has been in the park since Oct. 28. The city had threatened to evict the protesters because the park is closed from midnight until 6 a.m., but city officials made special accommodation for the protesters.
Almost two dozen tents have remained in the park, and the number of protesters has varied.
The first Occupy encampment sprang up in New York in September, and the movement has since spread to cities around the country and world. Protesters object to corporate influence on politics and what they call an unequal distribution of wealth.
Burlington is a community of just under 40,000 people on the shores of Lake Champlain known for its left-leaning politics.
In Berkeley, authorities twice clashed with protesters trying to set up encampments.
The bulk of the arrests came Wednesday night, as authorities in riot gear confronted demonstrators.
Television news footage from outside the university's main administration building showed officers pulling people from the steps and nudging others with batons as the crowd chanted, "We are the 99 percent!" and "Stop Beating Students!"
Thirty-two people were arrested on suspicion of resisting and delaying police officers and failing to disperse, UC Berkeley police Lt. Alex Yao told the Daily Californian.
University police didn't immediately return calls from The Associated Press.
The university reported earlier that an administrator had told the protesters they could stay around the clock for a week, but only if they didn't pitch tents or use stoves or other items that would suggest people were sleeping there.
The protesters voted not to comply with the demand and to go ahead with setting up a tent site they dubbed "Occupy Cal" to protest financial policies they blame for causing deep cuts in higher education spending.
The move to create a campus off-shoot of the Occupy Wall Street camps around the country came after hundreds of students, teachers and Berkeley residents rallied on campus before marching peacefully to a Bank of America branch.
"The university supports the efforts of any group to speak out freely, but everyone is expected to follow campus policies, the law, and respect the rights of others to go to class, to teach, to do their work," campus spokeswoman Janet Gilmore said.
In Portland, shortly after Mayor Sam Adams announced at a Thursday morning press conference that the city will close down Occupy Portland encampments early Sunday, protesters marched to City Hall and the doors of the building were locked as a safety precaution.
The protesters said they planned to hold a meeting of their general assembly in front of that building as well.
The mayor said the protesters need to clear out of Lownsdale and Chapman Squares by midnight Saturday, in order for the city to make repairs, clean up the parks and ensure the safety of everyone involved.
He added that the Occupy Portland movement can still move forward with speeches and other events, as long as they obtain the necessary permits.Occupy Wall St. activists interrupt Bachmann speech
"We have sought to be as supportive as we possibly can, but I cannot wait for someone to die in the camp. I cannot wait for someone to use the camp as camouflage to inflict bodily harm on someone else," Adams said.
Adams said Portland police and federal officers will be working together to end the encampments, including any protesters remaining at Terry Schrunk Plaza.
In Oakland, Calif., a man was shot near the Occupy Oakland encampment just after 5 p.m. Witnesses told KNTV that the people involved in shooting did not appear to be part of the protests. A statement from the Oakland Police Department said officers responding to reports of a shooting found a victim suffering from a gun shot wound, but did not have any additional information. KNTV and other local news sources later reported the victim had died.
In Los Angeles, organizers affiliated with the OccupyLA movement called on protesters from around the country to join them in a move to peacefully "occupy" the Rose Parade in Pasadena, Calif. Organizers said they would set up encampments along the parade route and planned to march in a massive "human float" during the Tournament of Roses parade, scheduled on Monday, Jan. 2, Reuters reported.
In Norfolk, Va., six people were arrested after the Occupy Norfolk overnight camping permit at the Commercial Plaza Park expired. City officials said they decided not to re-issue a camping permit because the camp was not designed for camping and it needed a cleanup. City did re-issue a permit to assemble and parade 9 a.m. to 9 p.m.
In Cambridge, Mass., dozens of Harvard University students set up about 25 tents in Harvard Yard to protest what they say is a growing wealth gap in the country and the university's perceived role in creating that inequality. The tents were set up after some tense moments when university police and security guards blocked and locked the gates to Harvard Yard to keep more than 300 protesters out. School officials say they wanted to keep people who were not Harvard students out, but many protesters pushed at the gates while holding up Harvard IDs.
In New York, Jonathan Lethem, writer of the novels "Fortress of Solitude" and "Chronic City," among others, showed up at Occupy Wall Street to read a prepared speech. Accompanying him was novelist Jennifer Egan, winner of the 2010 Pulitzer Prize in Fiction for "A Visit From the Goon Squad." Lethem called Occupy Wall Street "the greatest service call ever made," and he exhorted the protesters in their dealings with authority to "summon these words: 'I'd like to speak to your supervisor.'"
In Nashville, Tennessee Gov. Bill Haslam will ask prosecutors to drop charges against 55 Occupy Nashville protesters arrested last month for trespassing, his office said Thursday in light of a federal judge's ruling that the state couldn't enforce a curfew on the grounds around the state Capitol.
In Mount Pleasant, S.C., about 30 people claiming to be with Occupy Charleston shouted down presidential candidate Michele Bachmann when she was about 10 minutes into a foreign policy speech aboard the USS Yorktown, a World War II aircraft carrier. The group accused Bachmann of "dividing Americans" and promoting discrimination. "You cater to the 1 percent," they yelled. After they left, Bachmann resumed her speech, saying, Don't you love the First Amendment?" she said. "We have a great country... We are here because we love this country, and we want it to be better."
In Providence, R.I., Public Safety Commissioner Steven M. Pare defended the Nov. 2 use of thermal-imaging on an Occupy Providence encampment in a city park to determine how many tents were occupied during the cold weather. The Providence Journal reported that Pare said thermal imaging was for public safety and that no one's privacy was invaded and that there was no surveillance or "constant monitoring."
In Wilmington, Del., a judge ruled that Occupy Delaware protesters can use a downtown plaza as they see fit pending a hearing Friday in a lawsuit claiming that the city is violating their rights of assembly and free speech. Assistant City Solicitor Rosamaria Tassone-Dinardo says the protesters can enter the plaza and sit on benches day or night, but they cannot establish an "encampment" without a permit. Given that Occupy Delaware has no formal membership, anyone could take part in the group's encampment and use it as an opportunity "to basically have a terrorist act" by hiding a bomb inside a tent, she suggested.
Reuters and The Associated Press contributed to this report.