Monopolar electrosurgery devices adapted for resecting tonsil and adenoid tissue. The devices minimize thermal injury by employing a plasma generated by pulsed electrical signals to precisely and effectively cut or coagulate the tissues. Suction may also be applied to the tissues to enhance the cutting, coagulation, and tissue manipulation functions. The devices include an interchangeable tip that may be switched for another tip, depending on which tip may be more suitable for tonsillectomy or adenoidectomy.
This claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Application No. 61/495,853, filed Jun. 10, 2011, the contents of which is incorporated herein by reference in its entirety.
The field is electrosurgery, and in particular, tonsillectomy and adenoidectomy.
The tonsils and adenoids are generally located in the back of the human (mammalian) nose and throat, and are part of the lymphatic system that samples bacteria and viruses entering the body. Once sampled, the immune system is activated to produce antibodies that fight infection. When bacteria and viruses become trapped in the tonsils and adenoids, these tissues are able to break down their cell wall and deliver the fragments to areas of the body that produce antibodies modeled against the fragments. However, repeated inflammation of the tonsils and adenoids impedes their ability to destroy the bacteria that become entrapped therein, resulting in bacterial colonization of these tissues. The colonies of bacteria can then serve as a reservoir for repeated infections (e.g., tonsillitis or ear infections). Tonsillectomy and/or adenoidectomy may be indicated when antibiotic treatment fails to remove the bacterial reservoir. Tonsil tissue may also need to be removed if it enlarges to the point of causing airway obstruction, which may manifest as snoring or sleep apnea. Some individuals are also born with larger tonsils that are more prone to cause obstruction. Adenoidectomy may also be required to remove adenoid tissue when ear pain persists, or when nose breathing or function of the Eustachian tubes is impaired.
The devices and techniques used for tonsillectomy and adenoidectomy will usually depend on such factors as the type and amount of tissue to be removed and surgeon preference. The two procedures are routinely performed together. A common method for tonsillectomy and adenoidectomy employs cold surgical dissection. Here tissue is removed using a scalpel or other sharp instrument such as a curette or punch device. Sharp dissection oftentimes results in heavy bleeding, which can be stemmed with electrocautery.
In addition to coagulation, electrosurgery devices (e.g., suction-tipped, blade, or needle tip Bovies) may also be employed to resect tonsil or adenoid tissue. The suction tipped Bovie typically has a hollow center to suction blood, secretions, and smoke from the surgical field, and a rim of metal for cutting and coagulation. A separate aspirator is used when blade and needle tip Bovies are used. Although the use of Bovies reduces blood loss intraoperatively in comparison to cold techniques, it is associated with increased postoperative pain due to spread of the thermal injury from the heat of electrosurgery (average temperatures are above 300° C.). Despite their increased thermal injury profile, use of the Bovie remains the most popular method of tonsil removal in the U.S. due to its speed, convenience, universal availability, and surgeon familiarity with the device.
Other energy-type devices have been commercialized that attempt to minimize thermal injury. These include the Harmonic Scalpel® system (Ethicon Endo-Surgery, Cincinnati, Ohio) (ultrasonic energy), lasers (e.g., KTP, Nd:YAG, or CO2 lasers), and Coblation® devices (Arthrocare, Austin, Tex.) (bipolar radiofrequency ablation). However, the decrease in thermal injury provided by these devices is questionable. Even if they do result in less thermal injury, it is offset by reduced control of bleeding and surrounding tissue trauma, longer operative times, or less precise cutting. Some of the instruments also obscure the surgical field and are difficult to maneuver due to their large size.
When Coblation® devices are employed, the procedure requires saline delivery in order to establish an electrosurgical effect. Pre-operative time is prolonged due to the inclusion of the saline delivery set-up. Coblation® device aspiration lumens also periodically clog during the procedure, which causes saline to pool in the patient's throat. The pooled saline must then be suctioned using a separate aspirator. Additionally, the Coblation® device lumen typically has to be manually cleared in order to finish the surgery.
Accordingly, new devices for resecting tonsil and adenoid tissue would be useful. In particular, devices that precisely cut tonsil and adenoid tissue while effectively controlling bleeding and surrounding tissue trauma would be desirable. Devices that provide easier access to the tonsils and adenoids and manipulation of those tissues would also be desirable.
Described here (but not limiting) are electrically "monopolar" electrosurgical devices that optimize many functions required in performing tonsillectomy or adenoidectomy while minimizing side-effects (the return electrode is applied to the patient remote from the active electrode). For example, the precise cutting of tissue is provided by a thin layer of plasma that surrounds the electrode edge. In some instances the plasma is formed with pulsed radiofrequency (RF) energizing waveforms having a lower range of duty cycles so that tissue has time to cool between pulses. This coupled with the mostly insulated tips helps to reduce thermal damage by limiting the extent of thermal diffusion from the electrode into surrounding tissue. Continuous or 100% duty cycle energizing waveforms may also be employed when faster cutting is desired. When hemostasis is needed, suction and plasma may be directly applied to the target area to mechanically and electrically stop the bleeding. Tension of the electrode surface(s) against the tissue is generally optimized with a configuration where suction is applied through the electrode or in very close proximity thereto. The aspiration port being closely associated with the blade allows a "dry field" surgical technique. This is advantageous here because it allows a concave blade to function well unlike the case with a wet field. This is because current flows from the blade to the tissue only via the part of the blade in actual tissue contact with the dry field. Further, the suction decreases the width of the tissue in contact with the blade, further reducing the contact area and also further drying the tissue. Given that it may be difficult to access the portions of the oropharynx and nasopharynx where the tonsils and adenoids are located, the devices described herein may be designed with one or more malleable portions so that they can be shaped to improve access to these regions and/or accommodate variations in patient anatomy.
It has been found that for ENT (ear-nose-throat) surgery as described here, a monopolar approach is advantageous because the remote return electrode guarantees good electrical contact. In contrast, given the nature of such energizing, a bipolar device with both electrodes on one shaft makes good electrical contact for the return electrode difficult.
The electrosurgical devices generally include an elongate body having a proximal end, a distal end, and an aspiration lumen extending therethrough, an interchangeable tip removably attached to the distal end of the elongate body, and a handle at the proximal end of the elongate body where control mechanisms for cutting and coagulation are located. The interchangeable tip typically also has a proximal end, a distal end, and a tip lumen that is fluidly connected to the aspiration lumen of the elongate body. A housing that is secured to the distal end of the interchangeable tip will usually have an aperture and an integrated blade assembly, e.g., an electrode assembly, that includes an active electrode. The phrases "blade assembly" and electrode assembly" are used herein interchangeably. In some variations, the active electrode is a wire or loop electrode. The blade assembly or portion thereof may define an aspiration port that communicates with the aperture of the housing.
The devices generally include a connector at the proximal end of the interchangeable tips for removably attaching them to the elongate body. In some variations, the connector comprises a compressible barrel and one or more tabs that are located circumferentially around the connector. The compressible barrel may be inserted into the distal end of the elongate body to create a friction fit between the components and to thereby removably attach them to one another. The one or more tabs may be used to attach an ergonomic finger grip to the connector that may make insertion and removal of the interchangeable tip easier.
The interchangeable tips may be specifically configured for adenoidectomy or tonsillectomy. For example, when adenoidectomy is to be performed, the devices may include a blade assembly that optimizes tissue removal using a raking motion. Here the blade assembly may include an active electrode that has a cutting edge and a flat coagulation surface. A plurality of arms extending from the active electrode may secure the active electrode to the housing. The arms may have an angle that positions the cutting edge against the tissue in a manner that allows it to be easily and precisely scooped or shaved into the aspiration port. The particular arm angle may also be useful in achieving hemostasis by optimizing the position of the coagulation surface against the tissue. Alternatively, the electrode is a wire electrode.
When tonsillectomy is to be performed, the devices may include a blade assembly having a curved and tapered active electrode. This curvature may result in a more precise tonsil resection because the electrode surface approximately conforms to the contour of tonsil tissue. The curved and tapered electrode may also define an aspiration port therethrough. Here bleeding may be more effectively controlled since suction may be applied directly through the aspiration port of the electrode when the device is in the coagulation mode. This would combine mechanical pressure with plasma coagulation to achieve hemostasis.
The interchangeable tips may also be configured to be malleable so that their shape can be tailored to navigate access to the tissues or accommodate variations in patient anatomy. In some instances the interchangeable tips may be made for single use. Kits including one or more interchangeable tips are also contemplated.
Methods for resecting tonsil or adenoid tissue may generally include applying a pulsed electrical signal to the active electrode of the devices described herein to form a plasma on the active electrode, and cutting or coagulating the tissue with the plasma. In some variations, suction is applied simultaneously with proximal movement of the electrode to suction cut the tissue. In other variations, the tissue is coagulated while suction is simultaneously applied. In yet further variations, the methods will include exchanging one interchangeable tip, e.g., a tonsillectomy tip, with another interchangeable tip, e.g., an adenoidectomy tip.
FIG. 1A depicts a side view of an exemplary electrosurgical device with an adenoidectomy tip.
FIG. 1B depicts an expanded side view of the adenoid tip shown in FIG. 1A.
FIG. 1C is an expanded perspective view of the blade assembly shown in FIGS. 1A and 1B.
FIG. 1D shows the components of the housing in FIGS. 1A and 1B and how they are joined to integrate the blade assembly of FIG. 1C.
FIG. 1E is an expanded side view of the blade assembly shown in FIGS. 1A-1D.
FIG. 1F shows an expanded inferior view of an exemplary housing and blade assembly for adenoidectomy.
FIG. 1G depicts a variation of the cutting edge that may be used in the blade assembly for adenoidectomy.
FIG. 2A depicts an exemplary housing and blade assembly for tonsillectomy.
FIG. 2B shows the components of the housing in FIG. 2A and how they are joined to integrate the blade assembly also shown in FIG. 2A.
FIG. 3 is an inferior view (showing the bottom surface) of an exemplary adenoid tip including a wire as the active electrode.
FIGS. 4A and 4B depict in various views the two main components of the housing shown in FIG. 3.
Described here are electrosurgical devices that can be customized for either adenoidectomy or tonsillectomy. Customization may be provided by the use of interchangeable tips that can be removably attached to the elongate body of the device. Specifically, the design of the blade assemblies and location of the aspiration port from which suction is applied may be varied to optimize manipulation, cutting, and hemostasis of the tissue being operated on.
The present electrosurgical devices are generally monopolar instead of bipolar. Both types of devices use high frequency alternating current and a pair of electrodes, one designated the active electrode and the other the return electrode. However, the difference lies in the placement of these electrodes. In a monopolar device, current is passed from the active electrode through the patient's body to a grounding pad (return electrode) placed on the body, usually the thigh or shoulder. A monopolar device may be particularly useful in tonsil and adenoid surgery because contact with the body is guaranteed. In a bipolar device, the active and return electrodes are both placed at the site of electrosurgery, for example, on the same shaft of the device, and electrosurgery occurs only on the tissue on the active electrode(s) if there is a conductive path back to the return electrode.
The devices will generally include an elongate body having a proximal end, a distal end, and an aspiration lumen extending therethrough. Depending on the materials used, all or a portion of the elongate body may be formed to be stiff, flexible, or malleable. Exemplary materials for making the elongate body include, without limitation, fluoropolymers; thermoplastics such as polyetheretherketone, polyethylene, polyethylene terephthalate, polyurethane, nylon, and the like; and silicone. Another material is fluoroelastomer.
The elongate body may be between about 5.0 cm to about 20 cm in length. For example, the elongate body may be between about 5.0 cm to about 15 cm, between about 5.0 cm to about 10 cm, or between about 5.0 cm to about 8.0 cm in length. In some instances, the elongate body may be about 8.0 cm in length. In other instances the devices lack an elongate body, and the interchangeable tip is directly connected to the handle.
In some variations, the elongate body is coated with a lubricious polymer to reduce friction between the mucosa and device during the procedure. Lubricious polymers are well known in the art, and are typically hydrophilic. Exemplary hydrophilic polymers that may be used as lubricious coatings include, without limitation, polyvinyl alcohol, polyethylene glycol, polyvinyl pyrrolidone, cellulosic polymers and polyethylene oxide.
A handle is usually coupled to the proximal end of the elongate body that allows the surgeon to hold the device. The handle may include a hand grip on the bottom and a pad with at least two control buttons on the top. The control buttons may be depressed to activate electric switches for turning on the cutting or coagulation regimes. The button pad and hand grip are incorporated into the handle using spring clips or other well-know attachments and conventional techniques such as overmolding. A standard electrical connector and cable may be used with the handle to connect electrical leads to a generator. The handle may be between about 5.0 cm to about 30 cm, about 5.0 cm to about 25 cm, about 5.0 to about 20 cm, or about 5.0 cm to about 15 cm in length. In one variation, the handle is about 20 cm in length.
The aspiration lumen of the elongate body continues through the handle to a suction connector, which in turn connects tubing to a collection canister. The dimensions of the handle may be varied such that it is comfortably held in a hand, yet able to be manipulated during tonsillectomy and adenoidectomy. In some variations, the handle may be made for single use. As used herein, the term "suction handle" shall refer to the handle when coupled to the elongate body.
An interchangeable tip, as further described below, may be removably attached to the distal end of the elongate body. The interchangeable tip will typically have a proximal end, a distal end, and a tip lumen that is fluidly connected to the aspiration lumen to allow continuous flow of fluids, tissue, smoke, etc. away from the surgical field. The length of the interchangeable tip varies, but may be from about 1.0 cm to about 15 cm. For example, the adenoidectomy tip may be between about 5.0 cm to about 10 cm, and the tonsillectomy tip may be from about 1.5 cm to about 5.0 cm. In one variation, the adenoidectomy tip is about 9.0 cm. In another variation, the tonsillectomy tip is about 2.5 cm. The materials used to make the elongate body may also be employed in forming the interchangeable tip.
In one variation, the interchangeable tip is malleable. Malleability may be provided by wires running through the wall of the elongate body that are capable of being shaped by bending the elongate body. For example, the wires may be made from stainless steel or alloys thereof, nickel-titanium alloy, etc. Malleability may also be provided by forming the elongate body or portions thereof with metals or polymers that can be shaped. In some variations, joints or hinges are included. By having the ability to manipulate the shape of the interchangeable tip, it may be easier and quicker to access the tonsils and adenoids with the devices and easier to accommodate anatomical variations in that area. The interchangeable tips may be bent directly, e.g., by finger manipulation, or remotely through cables or wires using mechanisms commonly employed with steerable catheters. The interchangeable tips may be designed for single use.
The devices generally include a connector at the proximal end of the interchangeable tips for removably attaching them to the elongate body. An ergonomic finger grip may be used on the connector that may ease insertion and removal of the interchangeable tip. In some variations, the interchangeable tip may be configured to rotate about the connector. The connectors may be configured to removably attach to the elongate body by friction fit mechanisms. For example, they may include a compressible component that has a larger diameter when not connected to the elongate body. Compression of the component typically allows it to be slidingly engaged with the elongate body at which point the component is capable of expanding to its uncompressed diameter against the internal wall of the elongate body. In one variation, the connector comprises a compressible barrel and one or more tabs that are located circumferentially around the connector. The compressible barrel may be inserted into the distal end of the elongate body to create a friction fit between the components and to thereby removably attach them to one another. The one or more tabs may be used to attach an ergonomic finger grip to the connector that may make insertion and removal of the interchangeable tip easier.
Connection between the elongate body and interchangeable tip may also be supplied by locking-unlocking mechanisms. For example, the interchangeable tip may include a groove or channel, e.g., a L-shaped channel, in its wall configured so that upon receipt of a pin or other protrusion on the elongate body, the interchangeable tip may be rotated to be locked in placed. Other tongue-and-groove type locks and mechanisms including depressible pins or tabs are also contemplated.
The electrosurgical devices described here also generally include a housing at the distal end of the interchangeable tip for holding and securing the blade assembly thereto. The housing may be a single unit component or be made from multiple components. For example, the housing may be made by pressing together two components, an upper portion and lower portion. In some variations, the housing is configured with a blunt nose. In other variations, the housing is designed with a taper.
The housing may include an aperture through which suction can be applied to the tissues. The aperture may be of any shape and size so long as it provides an opening for aspiration of smoke, tissue, fluids, etc. For example, the aperture may be spherical, elliptical, egg-shaped, rectangular, triangular, diamond-shaped, or heart-shaped. These shapes are not meant to be limiting. When tissue is to be aspirated, the aperture may be larger than conventional suction openings. For example, the aperture may have a diameter from about 0.1 cm to about 1.0 cm. In some variations, the aperture diameter is larger than about 0.4 cm or about 0.5 cm.
In addition, the housing may be made from transparent materials or include a marker to aid visualization or provide an electrode locator in the surgical field. Materials with suitable transparency are typically polymers such as acrylic copolymers, acrylonitrile butadiene styrene (ABS), polycarbonate, polystyrene, polyvinyl chloride (PVC), polyethylene terephthalate glycol (PETG), and styrene acrylonitrile (SAN). Acrylic copolymers that may be particular useful include, but are not limited to, polymethyl methacrylate (PMMA) copolymer and styrene methyl methacrylate (SMMA) copolymer (e.g., Zylar 631® acrylic copolymer).
A blade assembly may be integrated within the housing, and generally includes the active electrode. The active electrode typically defines a cutting edge. The edge, however, is not like that of an ordinary knife which does the cutting solely via mechanical application to the tissue being cut. Instead here the edge of the electrode focuses the electric field induced by the applied electrical signal. This field that is concentrated at the edge generates a local plasma discharge. In some instances, the edge is formed by the onlay of metal foil. The tissue cutting may be assisted by mechanical force supplied by the edge of the electrode, as in conventional cutting, or by application of suction.
The active electrode may be made from any material having suitable electrical properties. For example, the active electrode may include without limitation, metals such as molybdenum, nickel, platinum, stainless steel, tantalum, titanium, tungsten, and alloys thereof. Thickness of the active electrode may be from about 0.1 mm to about 1.0 mm thick with an edge of about 10 μm to about 70 μm in thickness. In one variation, the active electrode thickness is about 0.25 mm (0.01 inch). In another variation, the thickness is about 0.025 mm (0.001 inch). The active electrodes may be etched or stamped or machined out of a large sheet of metal, which has been annealed for hardness. The electrodes may be made from layers, or multiple metals, alloys, or in part from non-conductive materials.
An electric insulating layer may be overlaid upon the active electrode to mostly cover it but leaving an exposed edge or surface that would be used for cutting or coagulation. The insulation is typically a coating of glass or ceramic approximately 0.005 mm to 0.5 mm thick, or in some instances approximately 0.01 mm to 0.2 mm thick. When glass insulation is used, it may be applied by a conventional process of dipping each relevant component prior to assembly in liquid (molten) glass and then annealing the glass. The glass insulation may also be applied by spraying.
The configuration of the blade assembly may vary depending on the intended use of the electrode. For example, technical features that enhance removal of adenoid tissue may differ from other features of interest in tonsillectomy. These design features are further elucidated below.
Adenoid tissue, which lies at the back of the nose/throat, may be removed through the mouth or nose, but typically through the mouth under general anesthesia. Thus, not only are the adenoids difficult to get to, but the presence of an endotracheal tube further cramps an already limited surgical field. The adenoid tips described here are interchangeable tips specifically configured to address many of these difficulties with adenoidectomy.
In one variation, as illustrated in FIG. 1A, electrosurgical device 100 includes an elongate body 102 having a proximal end 104 and a distal end 106. Proximal end 104 is coupled to a handle 108 where a finger grip 110 and pair of control buttons 112 are located. Adenoid tip 114 also has a proximal end 116 and a distal end 118, and is removably attached to the elongate body distal end 106 by a connector 120 positioned at the elongate body distal end 106. Here connector 120 includes a compressible basket 121 that can be depressed and slid into the distal end of the elongate body where it will then decompress to expand and create a friction fit against the internal wall of the elongate body (FIG. 1B). The elongate body 102 may be permanently or removably attached to the handle 108, but will typically be permanently attached. Adenoid tip 114 is malleable and can be bent, as shown in FIG. 1A. Here the adenoid tube 122 comprises a flexible material such as polyurethane, and includes two lumens (not shown) within its wall where bendable wires (not shown) run longitudinally between the adenoid tip distal end 118 and proximal end 116. Additional lumens and wires may be employed as desired.
Although shown as bent upwards, the adenoid tip may be bent in other directions, so long as the device materials or functionality is not compromised. For example, the adenoid tip may be bent to form an angle with the elongate body of up to about 45°, up to about 60°, or up to about 90° or more with respect to the horizontal axis of the elongate body. Adenoid tip 114 may also be rotated to any angle about the axis of the connector 120. As previously mentioned, the bendable nature of the adenoid tip allows easier access to the adenoids. It also provides more precise positioning of the active electrode.
The adenoid distal tip also includes a housing for holding the blade assembly. As shown in FIGS. 1B and 1D, housing 124 is comprised of an upper portion 126 and a lower portion 128 that integrate a blade assembly 130 when both portions are joined together. Upper 126 and lower 128 portions may be joined by snap fitting, adhesives, welding, etc. The lower portion 128 may have an aperture 132 that defines an aspiration port 152 when the blade assembly 130 is integrated into the housing 124. In some variations, the housing may be formed using a single component instead of a plurality of components.
As shown in the enlarged housing-blade assembly of FIG. 1F, the housing 124 and integrated blade assembly 130 may define an aspiration port 152, as explained above, through which suction is applied to aspirate fluids and smoke. However, the aspiration port 152 will generally also be dimensioned so that the device is capable of aspirating tissue through the port. In such instances, the port in cross-section may be spherical, ellipsoid, egg-shaped, rectangular, triangular, diamond-shaped, or heart-shaped, and thus wider than conventional suction openings. Here the aspiration port is about 0.1 cm to about 1.5 cm along its major axis and about 0.1 cm to about 1.0 cm along its minor axis. It is understood that these dimensions are exemplary and not limiting.
Bringing the upper and lower housing portions together with the blade assembly therebetween integrates the blade assembly into the housing. Here the housing is made from a transparent polymer such as Zylar 631® acrylic copolymer (SMMA copolymer) so as not to block visualization at the adenoid tip distal end 118. Although not shown here, a marker can also be included on the surface of upper housing portion 126 to indicate the blade location underneath.
Turning to FIG. 1C, blade assembly 130 includes an active electrode 136 having a cutting edge 138 and a coagulation surface 140. A plurality of arms 142 having a first portion 144 and a second portion 146 secure the active electrode 134 to the housing 124. The arms may be secured to the housing with medical grade adhesives such as cyanoacrylate or epoxy adhesives, and other adhesives, which are well known. Referring to FIG. 1E, first 144 and second 146 arm portions form an angle 148 of about 110° to about 140°. In one variation, a 120° angle is defined between the first 144 and second 146 portions. This angle may optimize opposition of the coagulation surface 140 onto tissue to effectively achieve hemostasis. Further, the angle 148 may optimize the point of contact of plasma to the tissue from the cutting edge 138 to effect a more precise cut as well as resection of tissue while minimizing clogging of the aspiration port.
In another variation, as shown in FIG. 1G, the cutting edge 138 may be shaped to include a leading edge 154. The leading edge may aid initiation of plasma cutting and more effectively remove adenoid tissue. In some variations, the leading edge may extend about 0.2 mm to about 2.0 mm from the cutting edge.
After the blade assembly is integrated into the housing, cutting edge 138 defines an aspiration port 152 with the aperture 132. With this adenoid tip configuration, cut adenoid tissue is directly and immediately suctioned into the aspiration port. Thus, proximal movement (movement toward the operator) of the adenoid tip while simultaneously maintaining suction may result in shaving strips of tissue.
Some variations of the adenoid tip include a wire as the active electrode. Compared to the other electrode configurations described herein, use of a wire electrode may particularly improve the cutting performance of the adenoid tip. This is because the decreased surface area of the wire generally produces less eschar build up, and thus, less sticking of tissue to the electrode. Furthermore, given that cutting is quicker with a wire electrode, contact of the wire electrode with adenoid tissue is less, resulting in decreased thermal injury to the adenoid tissue in comparison to the electrode configuration depicted in FIGS. 1A-1G (see Example 2). Another advantage of the wire design, e.g., instead of using the active electrode shown in FIGS. 1A-1G, is that it allows greater freedom of movement during the adenoidectomy procedure. For example, with the active electrode depicted in FIGS. 1A-1G, adenoid tissue would have to be approached at a specific angle because cutting of the tissue can only be made effectively when made perpendicular to the adenoids. Given the limited operative field, exposure of the adenoids is already difficult. Limiting the angle of approach would thus further frustrate the procedure. When a wire electrode is employed in the electrode assembly, cutting is not orientation specific. Another benefit is that a wire electrode is generally easier to manufacture than the active electrode of FIGS. 1A-1G.
The wire may be completely embedded within the material of the housing except for the portion that extends across the housing aperture at the distal end of the adenoid tip. The wire may be embedded by overmolding the wire into a slot provided in the housing. Seating the wire in the slot may also recess the wire a certain distance from the distal end of the adenoid tip. For example, the wire may be recessed from the distal end of the adenoid tip a distance ranging from about 0.0005 inch (0.013 mm) to about 0.20 inch (5.1 mm). The wire may be of any suitable geometry, but will typically be round or circular in cross-section, and have a diameter ranging from about 0.008 inch (0.20 mm) to about 0.010 inch (0.25 mm). In another variation, the diameter ranges from about 0.005 inch (0.0125 mm) to about 0.020 inch (0.5 mm). In one variation, the wire has a diameter of about 0.008 inch (0.20 mm).
As previously stated, the housing may be of any suitable dimension and geometry. However, when a wire electrode is used, the housing configuration shown in FIGS. 3 and 4A-4B may be particularly suitable. Referring to FIG. 3, adenoid tip 300 includes a housing 302 having a triangular shaped aperture 304. A wire electrode 306 extends across the aperture 304 at the distal end 308 of the adenoid tip 300. The wire electrode 306 is fully encapsulated, i.e., there is no exposed metal, within the material of the housing except for the portion that extends across the aperture 304. Wire electrode 306 is seated in a slot 310 so that the exposed portion of the wire electrode 306 is recessed from the distal end 308 of the adenoid tip 300.
Housing 302 is comprised of an upper portion and lower portion, as better shown in respectively FIGS. 4A and 4B. In FIG. 4A, upper portion 312 (shown in perspective in the upper left part of the figure) has a length of about 0.440 inch (11.18 mm) and is configured to be tapered toward its distal end 308. The taper (shown in the side view, upper right of the figure) extends over a distance of about 0.315 inch (8.0 mm). As shown in the cross-section (lower right in the figure) taken along line A-A, the width of an opening at the distal end 308 is about 0.200 inch (5.1 mm). FIG. 4B shows the lower portion 316 of housing 302 (in an x-ray view, left part of the figure). Here the wire 306 is embedded within the material of the housing lower portion 316 except for the part that extends across triangular shaped aperture 304. The wire 306 is also shown recessed a small distance from the distal end 308. The length of housing lower portion 316 may be about 0.315 inch (8.0 mm). The aperture 304 may be about 0.144 inch (3.7 mm) in length and about 0.170 inch (4.3 mm) in width (at its widest part) (shown in side view, upper right of the figure). The wire 306 will usually extend across the aperture 304 at or near its widest part. Accordingly, in FIG. 4B, the exposed portion of the wire is about 0.170 inch (4.3 mm) long. The housing 302 will generally be configured with a profile suitable for accessing and operating on the adenoids. Is some variations, and as shown in the cross-section (lower right of the figure) taken along line A-A in FIG. 4B, the lower portion of the housing 316 has a smooth, gradually tapering profile.
The upper portion 312 and lower portion 316 are brought together to make the housing 302. The upper and lower portions may be joined by methods previously described. It is understood that features such as tabs, pins, barbs, hooks, etc., and their corresponding grooves, channels, depressions, and the like, may be included to mate the upper and lower portions. The upper and lower portions may be fixedly or removable secured together.
The tonsils are located on either side of the throat and removed under general anesthesia. In this procedure, the unattached end of the tonsil is usually grasped with forceps while an incision is made at the other end to remove it from the throat. Thus, similar to adenoidectomy, access is also difficult and the surgical field cramped. The tonsillectomy tips described here are interchangeable tips specifically configured to address many of these difficulties with tonsillectomy.
The suction handle (handle with the elongate body attached) and connector are generally of the same configuration and made from the same materials as described for the adenoidectomy tips. The tonsillectomy tips may also be malleable and provide the same advantages as those previously described. Further, the housing, blade assembly, and active electrode are typically made with the same materials. However, their configuration will differ.
In one variation, as depicted in FIG. 2A, the tonsillectomy tip has a housing 200 that is tapered. Blade assembly 202 is integrated within the housing 200. An opening in the active electrode 204 defines an aspiration port 206 through which suction may be applied to a tissue surface, usually the tonsil bed, as explained above. A rim of active electrode results that has a rim thickness 205 from about 0.5 mm to about 3.0 mm. The rim is insulated except for a about a 5 mm to about a 20 mm portion running along the outer edge 209. About a 2 mm to about a 15 mm exposed (uninsulated) portion may also run along the inner edge 207. Upon application of an energizing electrical signal (waveform), pulsed or continuous, plasma may be formed along the inner 207 and/or outer 209 edges of the rim to cut or coagulate tissue. As previously mentioned, cutting precision is typically not a result of the degree of sharpness of the electrode edge, and is not the case here. However, in some variations, one or more sides of the active electrode may be sharpened to form about a 10° to 40° edge.
Although shown as a triangular shaped opening in FIGS. 2A and 2B, the aspiration port 206 may take various other shapes. The triangular configuration of the aspiration port may optimize suction at the tip of the device without compromising the preciseness of tissue dissection.
The active electrode may have a length from about 0.1 cm to about 1.5 cm. In one variation, the active electrode has a length of about 0.4 cm. At its widest portion, the active electrode has a width from about 0.1 cm to about 1.0 cm. In some instances, the active electrode has a width of 0.4 cm. The active electrode may also be configured with an upward curve so that it approximately conforms to the curvature of the tonsil (e.g., the palatine tonsil). This upward angle of the active electrode may be of any degree. For example, the upward angle may be from about 5° to about 60°. In some variations, the upward angle is about 30°.
The relationship between the housing and blade assembly components of FIG. 2A is further detailed in FIG. 2B. In FIG. 2B, housing 200 is shown as being formed by an upper portion 208 and a lower portion 210. A pin 212 extending inferiorly from the internal surface of the upper portion 208 is threaded through a hole 216 of the blade assembly 214 to integrate the blade assembly 214 within the housing 200. An adhesive may further be used to secure the housing and blade assembly components to one another.
The housing in FIGS. 2A-2B is shown as tapered, but need not be. In this variation, upper portion 208 is longer than bottom portion 210. The upper portion 208 will generally be from about 0.3 cm to about 3.0 in length. The bottom portion 210 will generally also be from about 0.3 cm to about 3.0 cm in length. The difference in length between the upper and lower portions results in complete coverage of the aspiration port 206 on the top of the active electrode 204 but only partial coverage of the aspiration port 206 on the bottom of the active electrode 204. With this configuration, suction may be provided through the undersurface of the active electrode. The aspiration port 206 may be from about 0.03 cm to about 0.5 cm wide, and about 0.03 cm to about 1.0 cm in length. In one variation, the aspiration port is about 0.17 cm in width and about 0.5 cm in length. A connective piece 218 is also shown in FIG. 2B that allows the integrated housing and blade assembly to be attached to the tip lumen.
The tonsillectomy tips herein described may provide more precise cutting and coagulation because of the particular suction electrode design. Here not only does the aspiration port suction smoke and fluids from the operative field to improve visualization, but suction and coagulation is capable of being directly and immediately placed on the tonsil bed from which the tonsil tissue has been resected. This is the raw surface where hemostasis is needed most, not on the tonsil itself, which is removed from the body. The active electrode rim also provides a larger surface that could be swept across the tissue to more effectively control bleeding.
Furthermore, use of the tonsil devices described here may result in less thermal injury. As further detailed below in Example 1, the depth of thermal injury was found to be less when the instant tonsil devices were employed in comparison to Bovie needles (0.26 mm vs. 0.77 mm) on tonsil tissue. Thermal injury was decreased by 66% when cut settings were used and by 73% when coagulation settings were used.
The electrical signals (radio frequency in this case) for generating the plasma may be provided by generators and electrical circuits of the kind well known in the art, or by those described in pending co-owned application Ser. Nos. 11/982,734 and 12/136,683, which are incorporated by reference in their entirety. The electrical signals are conventionally applied to the electrode by a conductor(s) extending through the electrosurgical device and not shown here. As previously mentioned, the plasma is formed along the edge of the active electrode by application of the electrical signals to the electrode. To further decrease the heat accumulation and associated collateral tissue damage, low duty cycle waveforms may be used. As well known, duty-cycle refers to the proportion of time that the electrical energy is actually being applied. Low duty-cycle here typically refers to duty-cycles of less than 10% which may be, for instance, 1% or less, or 0.1% or less. In some cases the low duty-cycle refers to the pulse voltage regime that is applied to the active electrode. For instance, a pulsed low duty-cycle signal may include a plurality of pulse bursts that are separated by more than one millisecond (e.g., has a frequency of less than 1 KHz) where each burst is shorter than one millisecond. The burst of pulses may include pulses that are biphasic (e.g., of alternating polarity) and the pulses may have different peak voltages. Again, none of this is limiting. The low duty-cycle is intended to minimize the spread of thermal injury, including tissue charring or burning. However, in some instances the devices described here may employ continuous waveforms or duty cycles of greater than about 50% or greater than about 75%.
Cutting or coagulation is generally obtained by energizing the active electrode with a suitable electrical signal (typically of different frequency, duty-cycle, etc.) for each surgical function. For example, when cutting is desired, the applied signal is an RF (radio frequency) signal having a frequency in the range of 100 KHz to 10 MHz. This energy may be applied in the form of bursts of pulses. Each burst will typically have a duration in the range of 10 microseconds to 1.0 millisecond. The individual pulses in each burst typically each have a duration of 0.1 to 10 microseconds with an interval therebetween of 0.1 to 10 microseconds. The actual pulses are typically square waves and bi-phasic, that is alternating positive and negative amplitudes. Generally the interval between pulses must be shorter than a lifetime of the plasma vapor cavity in order to maintain the cavity and the plasma regime during each pulse burst. In one variation the bursts each are separated by a duration of at least one millisecond. Typically the time between the pulse bursts is sufficient so that the duty-cycle is relatively low as explained above. This minimizes the undesirable heating effects. Coagulation may be achieved in the same manner, but by increasing output power of the device.
The generator associated with the electrosurgical devices may also allow varying degrees of cutting and coagulation. For example, in addition to a default power setting when the device is turned on, other settings to which the device could be adjusted are provided. This would provide in some instances higher hemostasis when cutting.
The electrosurgical devices described here are intended for single use, and can be employed with tonsillectomy, adenoidectomy, or combined procedures. In use, the tonsils and/or adenoids are accessed and a pulsed electrical signal applied to the active electrode of the interchangeable tip to form a plasma. In some variations, the active electrode is a wire electrode. The tissue is then cut or coagulated with the plasma. Suction may or may not be used when cutting or coagulating. In some instances, suction is applied simultaneously with proximal movement (pulling) of the device to suction cut the tissue. In other instances, suction is applied through the active electrode, as described above.
The electrosurgical devices described here may also be useful in "dry field" surgical procedures where there is no electrically conductive fluid added to the surgical field to, for example, aid conduction of energy between the active and return electrodes and/or to provide a cooling effect to the electrodes. When a dry field approach is employed, energy is typically transmitted only by the portion(s) of the active electrode that contacts tissue. In this instance the energy can be selectively provided to the areas in which it is desired. The application of suction to the tissue may further remove body fluids that would be naturally present in the field to further facilitate tissue contact.
Contrastingly, in a wet field (e.g., when the active and/or return electrodes are immersed or submerged in an electrically conductive fluid provided from outside the body), all parts of the active electrode that are in contact with the electrically conductive fluid provide energy. As a result, more energy than required is generally transmitted to the tissue, and less precisely.
Moreover it has been found that a concave blade does not operate well in a wet field (conductive medium) because components of the blade's electric field directed in opposite directions cancel each other. This does not occur in a dry field since current (energy) only flows to the tissue from that part of the blade in direct contact with the tissue. Hence a dry field approach is advantageous here, so the use of aspiration as described here is beneficial to create the dry field. Further, the suction (aspiration) here directed from the center of the blade pulls the tissue into the aspiration port thereby further decreasing the width of the tissue touching the blade and rendering the field even drier, thereby further improving the accuracy of current flow and the electric field effects described above.
The interchangeable tip may be exchanged for another at any time during the procedure. Thus, it may be useful to provide the suction handle and interchangeable tips with blade assemblies in a kit. Given that the device is intended for single use, one or more suction handles could be packaged with one or more interchangeable tips with blade assemblies. The interchangeable tips could be of the same type, e.g., all adenoidectomy tips or all tonsillectomy tips, or a mixture of the two types. In other instances, the kits may include a plurality of interchangeable tips without the suction handle. The interchangeable tips and suction handles may also be individually packaged.
The kits will also generally contain instructions for use. The instructions may include directions on how to start, operate, and shut down the device, as well as directions on how to adjust power level settings. Steps for changing one interchangeable tip to another, e.g., an adenoidectomy tip for a tonsillectomy tip, may also be provided.
The invention described herein will be further understood by the following non-limiting example.
Excised human palatine tonsils were subjected to a series of surgical incisions using conventional "Bovie" needle tips at settings of 30 W Cut and 30 W Coag. Additional incisions were made using the electrosurgical tonsillectomy devices described here ("Tonsil Blade") on settings of Cut 5 (20 W power output) for cutting and Coag 6 (30 W power output) for coagulation. Histology samples were harvested immediately after incision and evaluated for residual thermal injury using microscopy. A comparison of the depth of thermal injury (mm) and percent reduction in thermal injury is provided in Table 1.
Excised porcine adenoid tissue was subjected to a series of incisions using an electrosurgical device comprising the active electrode configuration shown in FIGS. 1A-1G at settings of Cut 9 (power output 40 W at 600 Ohms with 1930 Volts peak to peak maximum) for cutting and Coag 7 (power output 30 W at 1000 Ohms with 3960 Volts peak to peak maximum) for coagulation and Cut 10 (power output 50 W at 600 Ohms with 2110 Volts peak to peak maximum) for cutting and Coag 10 (power output 50 W at 1000 Ohms with 5000 Volts peak to peak maximum) for coagulation. Thermal injury from these incisions was compared to thermal injury resulting from an electrosurgical device using the wire electrode and housing design of FIGS. 3 and 4A-4B at the same settings. Histology samples were harvested immediately after incision and evaluated for residual thermal injury using microscopy. A comparison of the depth of thermal injury (mm) is shown in Table 2.
d) an electrode assembly in the housing and comprising an active electrode, wherein the electrode assembly or a portion thereof defines an aspiration port communicating with the aperture in the housing.
2. The electrosurgical device of claim 1, wherein the active electrode is a wire.
3. The electrosurgical device of claim 2, wherein the wire has a diameter in the range of about 0.0125 mm to about 0.5 mm.
4. The electrosurgical device of claim 3, wherein the wire has a diameter of about 0.2 mm.
b) cutting or coagulating the tissue with the plasma.
6. The method of claim 5, further comprising the act of applying suction to the tissue through the aspiration port.
7. The method of claim 6, wherein the suction is applied during proximal movement of the electrode to suction cut the tissue.
8. The device of claim 1, wherein a return electrode associated with the active electrode is located remote from the active electrode.
9. The device of claim 1, wherein the tip is malleable.
10. The device of claim 1, wherein the active electrode is partly covered with an electric insulating layer, with an exposed portion.
11. The device of claim 1, wherein the active electrode has a cutting edge and an adjacent planar surface adapted to coagulate tissue.
12. The device of claim 1, further comprising a plurality of arms securing the active electrode to the housing, each arm defining a bend having an angle in the range of 110° to 140°.
13. The device of claim 11, wherein the active electrode cutting edge includes a leading edge portion extending from a remainder of the cutting edge by a distance in the range of 0.2 mm to 2.0 mm.
14. The device of claim 11, wherein the cutting edge and aperture together define the aspiration port.
wherein the tip includes a plurality of bendable wires extending from the proximal end to the distal end of the tip, whereby the tip is malleably bent and rotated around a longitudinal axis of the elongate body.
wherein the active electrode defines a substantially triangular central opening that is the aspiration port.
17. The device of claim 16, wherein a rim of the active electrode surrounding the central opening has a thickness in the range of 0.5 mm to 3.0 mm and is partially covered with an electric insulating layer, with a part of an outer edge and an inner edge of the rim being exposed.
18. The device of claim 16, wherein the active electrode has a length and width of about 4 mm.
19. The device of claim 16, wherein the active electrode curves at an angle of about 30°, thereby to conform to curvature of a human tonsil.
20. The device of claim 16, wherein the housing tapers towards its distal end at the electrode assembly, wherein the housing covers the aspiration port on one side of the active electrode and only partly covers the aspiration port on an opposing side of the active electrode.
21. The device of claim 16, wherein the aspiration port is about 1.7 mm wide and about 5 mm long.
applying suction to the aspiration port via the aperture, thereby to suction the cut or coagulated tissue, while moving the electrode relative to the tissue.
EP0672841A3 (en) 1994-03-16 1996-10-02 Freudenberg Carl Fa Method for manufacturing a centering sleeve.
Cushing, H. (Dec. 1928). "Electro-Surgery as an Aid to the Removal of Intracranial Tumors," Surgery, Gynecology and-Obstetrics, XLVII(6):751-784.
Cushing, H. (Dec. 1928). "Electro-Surgery as an Aid to the Removal of Intracranial Tumors," Surgery, Gynecology and—Obstetrics, XLVII(6):751-784.
European Examination Report mailed on Dec. 12, 2008, for EP Application No. 04755740.0 filed on Jun. 18, 2004, four pages.
European Examination Report mailed on Sep. 2, 2010, for EP Application No. 03733930.6, filed on May 2, 2003, six pages.
Extended European Search Report mailed on Aug. 22, 2011, for EP Application No. 10175129.5, filed on Apr. 11, 2008, seven pages.
Extended European Search Report mailed on May 24, 2011, for EP Application No. 07861654.7, filed on Nov. 1, 2007, eight pages.
International Preliminary Report on Patentability mailed on May 14, 2009, for PCT Application No. PCT/US2007/023130, filed on Nov. 1, 2007, seven pages.
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International Search Report mailed on Nov. 30, 2009, for PCT Application No. PCT/US2009/030180, filed on Jan. 6, 2009, nine pages.
Invitation to Pay Additional Fees mailed on Sep. 24, 2009 for PCT Application No. PCT/US2009/030180, filed on Jan. 6, 2009, five pages.
Jones, H.M. et al. (Jan. 14, 1995). "Development of Pulsed Dielectric Breakdown in Liquids," J. Phys. D: Appl. Phys. 28(1):178-188.
Jones, H.M. et al. (Jan. 15, 1995). "Pulsed Dielectric Breakdown of Pressurized Water and Salt Solutions," J. Appl. Phys. 77(2):795-805.
Miller, J.M. et al. (Jun. 2003). "Precision and Safety of the Pulsed Electron Avalanche Knife in Vitreoretinal Surgery," Arch Opthalmol 121:871-877.
Mylrea, K.C. et al. (Jul.-Sep. 1981). "Introduction to Electrosurgery," Journal of Clinical Engineering 6(3):185-191.
Palanker, D. et al. (2002). "Effect of the Probe Geometry on Dynamics of Cavitation," Proc. SPIE 4617:112-117.
Palanker, D. et al. (Jun. 1, 1997). "Electrical Alternative to Pulsed Fiber-Delivered Lasers in Microsurgery," J. Appl. Phys. 81(11):7673-7680.
Supplemental European Search Report mailed on Jul. 18, 2007, for EP Application No. 04755740.0 filed on Jun. 18, 2004, four pages.
Supplemental European Search Report mailed on Jul. 3, 2008, for EP Application No. 04711134.9 filed on Sep. 14, 2005, five pages.
Written Opinion mailed on Aug. 28, 2012, for PCT Application No. PCT/US2012/040799, filed on Jun. 4, 2012, seven pages.
Written Opinion mailed on Dec. 8, 2005, for PCT Application No. PCT/US04/19785, filed on Jun. 18, 2004, three pages.
Written Opinion mailed on May 15, 2008, for PCT Application No. PCT/US2007/023130, filed on Nov. 1, 2007, five pages.
Written Opinion mailed on Nov. 30, 2009, for PCT Application No. PCT/US2009/030180, filed on Jan. 6, 2009, ten pages.


text:
10 Maple St, Norwood NJ
10/12 Horizon Blvd, South Hackensack NJ
35 Horizon Blvd, South Hackensack NJ
14 Central Blvd, South Hackensack NJ
14/24 East Wesley St, South Hackensack NJ
21/23 Empire Blvd, South Hackensack NJ
25 Empire Blvd, South Hackensack NJ
335 Chestnut St, Norwood NJ
4 Alsan Way, Little Ferry NJ
481 Edward H. Ross Drive, Elmwood Park NJ
Court Plaza
Elmwood Park Plaza
Glenpointe
Heights Plaza
Alfred N. Sanzari Medical Arts Building
Summit Plaza
The Ivanhoe
Nottingham Manor
Willow Gardens
Prospect/Passaic
Riverside Terrace
Greenway Village
Marriott at Glenpointe Hotel and Conference Center
Hampton Inn & Suites by Hilton
About Sanzari
Premier Montvale Address Draws Renters to Nottingham Manor
| Sep 24 2018
by Alfred Sanzari Enteprises
Nottingham Manor, a premier garden apartment complex developed by Alfred Sanzari Enterprises and professionally managed by FirstService Residential, benefits from the unique attributes of its location in Montvale. This picturesque and family-oriented borough in the heart of the Pascack Valley region is among Northeastern Bergen County's most vibrant suburban communities.
The complex, which has consistently high occupancy levels, is home to a wide mix of residents from young singles and couples to growing families and empty-nesters. This year, modifications are being made to include open floor plans and modern, updated kitchens for new residents moving to the property. In addition, gardens and landscaping throughout the 10-acre property have a fresh new look, according to John Tantsits, residential building technician.
"We are bordered by natural woods and a stream alongside the property," Tantsits said. "At the same time, we are within walking distance to abundant amenities in town including a supermarket and other stores."
"There's a real sense of community here," he added. "Many of our residents have lived here for 10 or more years and are 'renters by choice' because of the high-quality, low-maintenance lifestyle."
Bordering New York's Rockland County, Montvale is just 15 miles from New York City via the George Washington Bridge and within close proximity to NJ Transit and major highways, shopping, dining, healthcare facilities, and cultural attractions. Locally, the municipality is home to the corporate headquarters of multinational corporations.
Four parks encompass 32 acres in Montvale, with recreational pursuits including tennis, basketball, football, baseball, roller hockey, softball, soccer and two playgrounds. The highly-regarded Montvale School District, among the top-rated districts in the state, makes the borough particularly well-suited for families with young children.
A Great Place to Call Home
Located at 1-186 Nottingham Court, Nottingham Manor is a mix of one-bedroom apartments ranging in size from 700 to 750 square feet, and two-bedroom duplex units ranging from 1,040 to 1,140 square feet. All apartments include open concept floor plans, ample closet space and polished hardwood floors. Tenants benefit from an on-site laundry room, quiet and well-manicured grounds, and convenient parking throughout the complex.
Whenever an apartment becomes available at Nottingham Manor, it is carefully inspected and modernized, said Tantsits. "With each new tenant we refresh every unit and perform required repairs and upgrades. Every tenant who moves into Nottingham Manor is getting a clean, freshly painted and fully updated apartment with a full kitchen appliance package. An experienced on-site property management team ensures tenants' needs are exceeded throughout the duration of their leases."
For more information or to inquire about leasing specials contact Rafael Dalmasi at 201-741-2333. Prospective renters also can visit www.sanzari.com to view property photos and download rental applications.
Headquartered in Hackensack, Alfred Sanzari Enterprises is a multi-generation family owned and managed business, and one of New Jersey's premier real estate developers, owners and managers of commercial and hospitality real estate. The organization continues to strategically expand and diversify its industry-leading portfolio through both development and acquisitions. The company prides itself on its integrity and is known for the quality design and construction of its buildings, proactive and responsive property management team and outstanding relationships with its tenants. Many of Alfred Sanzari Enterprises' office, industrial, medical, residential and hospitality properties are iconic landmarks in their respective markets, including the Alfred N. Sanzari Medical Arts Building in Hackensack and Glenpointe in Teaneck.
(201) 342-2777|
Alfred Sanzari Enterprises, Inc. Court Plaza North| 25 Main Street, Hackensack, NJ 07601 (201) 342-2777
© 2019 Alfred Sanzari Enterprises. All rights reserved.
David Taylor Design | NJ Website Design Company

redpajama_set_name: RedPajamaCommonCrawl


Supply chains are becoming increasingly complex, not only in the number of participants that must be identified and tracked, but also in the geographic dispersion of those participants. Gathering all the data just to stay aware of the issues at all nodes throughout the extended supply chain is hard enough. Distilling all those volumes of data from disparate sources to find meaningful insights that drive the right actions is even harder.
One of the first challenges is that internal data typically resides on multiple systems. Data on suppliers, products, contracts, transportation, inventory and more, can be incredibly difficult to access, particularly in real-time.
On top of that, data from external resources is needed to provide the complete picture. Whether that data is on financial viability, environmental conditions, compliance records, legal actions, or a host of other issues, it must be pulled from multiple external sources. That requires a relationship and integration with every data source in order to facilitate instant access to data that could make or break your business.
Once the data is assembled, the challenge becomes taming the complexity to provide clear and valuable insights. Sophisticated algorithms can help sort through the information and pinpoint the most serious issues. An intuitive and easily-configured interface will help put valuable insights in the hands of professionals with minimal training and support.
Want to learn how VSAAM tackles these challenges? Find out how we're addressing these and other issues for clients like the Department of Defense and NASA.


text:
Amid the global coronavirus crisis Storytel sees subscribers grow 38%, streaming revenue 45%, even as publishers that sidelined digital struggle for survival
Posted by Mark Williams | May 12, 2020 | Audiobooks, Digital Audio, Digital subscription, Global Publishing, Scandinavia, Storytel | 0 |
The only surprise with the latest results from Sweden-based Storytel would have been if subscriber rates and earnings had dipped amid a global crisis that has left print-focussed publishers imperiled.
That of course did not happen, and while streaming revenue took a notional hit at SEK 429m ($44m) compared to the SEK 438m forecast, this in large part was down to "negative currency effects from the Norwegian Krone and an increase in Family subscriptions during the period."
Overall Storytel's Q1 results came in at 33.5% revenue growth (streaming and non-streaming) to SEK 513.2 million ($52.7) and a subscriber boost of 71,400, taking Storytel's total subscribers to 1.54 million.
The average number of paying subscribers in the Nordic segment was 785,800, while 43,200 subscribers were added outside the Nordics, taking total non-Nordic subscription levels to 369,000.
Tellander issued a Q2 forecast of 1.25 million global subscribers, amounting to 41% YOY growth, and a 43% YOY revenue growth to SEK 458m ($47m), with the caveat that the coronavirus crisis meant there was an element of uncertainty about how things might pan out.
Addressing shareholders, Tellander, echoing a common theme that audiobook downloads had dipped as commuters stayed at home, said that afternoon and evening consumption "more than compensated" for the downturn in commuter consumption.
About the Covid-19 pandemic Tellander said,
It is impossible to describe the first quarter of 2020 without addressing the coronavirus situation around the world. Storytel's vision is to make the world a more empathetic and creative place with great stories to be shared and enjoyed anywhere, anytime, and by anyone. And this vision has arguably never been as relevant for society as it is in these times of the coronavirus pandemic. During the quarantine we all sacrifice established and comfortable habits, and for a limited period we embrace restricted liberty of action to protect at-risk groups and for unburdening heroic health care staff and hospitals. The quarantine imposed on many markets throughout the world has also fueled peoples' already high interest in audiobooks and the service we offer.
Tellander talked of consumers becoming more "digitally savvy" and noted that,
New consumption patterns have started to emerge as a result of lockdown on many markets. Morning listening while commuting has gone down in some markets for obvious reasons, but this is more than compensated for by a higher rate of listenings in the afternoons and evenings. In the Nordics, we also see a clear growth in consumption on Sundays and at the beginning of the week.
Crime & Thriller and Fiction have kept their positions as the most consumed genres in our service, but the influx of new users, combined with families spending more time with each other at home, has boosted the Children category to third place. At bedtime this category actually surpasses Fiction and is the second-most popular genre among our customers. Biographies and Personal Development are two other genres that have grown pronouncedly during the coronavirus pandemic.
Addressing the bigger picture of print struggling globally in the pandemic era, Tellander told shareholders,
It is obvious that the popularity of audiobooks and the digital transformation of the book market are increasing in both speed and impact due to the coronavirus pandemic. Publishing houses are currently experiencing rapidly decreasing physical sales and might find it difficult to stay profitable. This makes them more dependent on digital sales and audiobooks. The publishers that are likely to come out on top in this situation are those that manage to pivot or have invested in audiobooks at an early stage and already earn a large portion of their sales on audio.
That statement is worth picking up on for its focus on audiobooks, which of course is the mainstay of the Storytel operation, but the lesson here is that all digital formats are soaring as consumers discover the digital advantage.
Here at TNPS I've been wondering how the pandemic might affect Storytel's global ambitions –
40 markets by 2023. 1.5 million subscribers, $200 million revenue by end 2020. Sweden's Storytel gets into second gear
but Tellander had words of assurance on that point.
Thanks to our innovative mindset and experience in using technological solutions for remote working, Storytel's global audiobook production has been up and running on all markets during the quarter, and we have experienced a relatively small impact on our production during this period.
PreviousLockdown exposes the deep flaws in Data Guy's Bookstat guessing game
NextRIP Carolyn Reidy. CEO Simon & Schuster. Publishing legend
Data Guy rewrites the historical Author Earnings US ebook statistics. 2016 US unit ebook sales of 487 million now 525 million. What are we to believe?
SprinNG launches new $275 prize for female Nigerian authors – not to publish, but to promote, distribute and buy an already published book
Sweden's Storytel partners with Poland's T-Mobile to deliver audiobooks
The largest purchaser of short fiction in the United States


text:
Goo Hara Passes Away
November 25, 2019 | 1170 Visits
The K-Pop and J-Pop world lost another star as Goo Hara (KARA) was found dead this evening in her home.
Hara was found unconscious at her private residence at 6pm KST Sunday November 24, 2019 according to the Gangnam Police Department. Production Ogi, Hara's Japanese agency, released a statement confirming the news following the discovery.
We are here to deliver tragic and unfortunate news.
Family members and friends of Goo Hara are deeply shocked and anxious at the moment.
Therefore, we earnestly request that you refrain from writing speculative articles and spreading rumors. In addition, we ask the media and fans to refrain from making condolence calls.
We apologize for conveying this sudden news, and we are sorry once again for requesting that [the media and fans] refrain from making condolence calls.
Currently, Hara's cause of death is under investigation, so any news regarding manner of death is speculation at this point. Unlike in May, Hara did not post a goodbye message on Instagram, but her last update was a selfie that simply said "goodnight."
잘자
A post shared by 구하라 (@koohara__) on Nov 22, 2019 at 10:04am PST
Hara, 28, was rescued from a suicide attempt in May of this year. She has been struggling with depression.
Since September 2018, Hara's private life has been the subject of the media following a lawsuit she filed against her ex-boyfriend, Choi Jong-Bum, following abuse and allegations that he was going to release sexually exploitive videos of the idol. Choi, in-turn, alleged abuse happened against him as well. Hara and her legal team presented evidence showing Hara's side and explained that his marks were due to her fighting back in self-defense. In August 2019, Choi received a suspended jail sentence for property damage, physical assault, unnecessary force, and blackmail after three trials. He was not found guilty of sexual assault regarding illegal video footage as the court ruled Hara was aware of the footage but did not ask for it to be deleted.
In September, Choi and his legal team filed an appeal of the judge's ruling and asked for a lighter sentence. Prosecutors, in turn, wanted more sexual assault charges on the table. Because of the appeal, the court cases between Hara and Choi were still ongoing.
Since Hara's passing on November 24, fans have trended #최종범_처벌 (punish Choi Jong-Bum) on social media.
Korean women find it more and more difficult to report crimes as victims because they see female artists facing even greater backlashes & trauma because how the public, police and the justice system respond to sexual assault, and that sends a clear message to all women in Korea.
— Jihye Lee 이지혜 (@TheJihyeLee) November 24, 2019
Hara, who was an actress and singer in both South Korea and Japan, made her debut in 2008 as a member of the Korean girl group KARA after Sunghee departed. In 2009, she joined the cast of Invisible Youth, and debuted as an actress in 2011 when she starred as Da-hye in City Hunter. In 2015, Hara debuted as a solo artist with Alohara (Can You Feel It?) and the single "Choco Chip Cookies," which was a collaboration with rapper Giriboy.
In June 2019, Hara signed an exclusive contract with Production Ogi and recently made her Japanese comeback with "Midnight Queen."
In light of Hara's passing, several celebrities canceled appearances, teasers, and other schedules out of respect. Many have shared words of sorrow, disbelief, and remembrance.
Breaks my heart RIP
A post shared by 한예슬 (@han_ye_seul_) on Nov 24, 2019 at 5:25am PST
Rest in peace, Hara. I am so saddened and heartbroken by this loss. We can't afford any more of these beautiful souls to leave us. We just can't.
A post shared by soy kim 소이김소이김소연 (@soy_weird) on Nov 24, 2019 at 3:27am PST
Currently, Production Ogi is considering holding a private funeral for the fallen star.
"There is currently nothing that we can say right now, but we have plans to hold her funeral privately," a representative said. "However, we must also consult Goo Hara's parents and the bereaved family."
We send out condolences to Hara's friends, family, and labelmates during this difficult time.
An investigation into her death is still ongoing.
—-Olivia Murray
2022 Kcrush America K-Pop Music Awards: The Winners
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text:
Home Resources Synaxarium
Coptic Synaxarium
Daily Stories of the Saints
Fri, 3rd June 2011 -- Bashans 26, 1727 AM
The Twenty-Sixth Day of the Blessed Month of Bashans
Bashans 26
Martyrdom of St. Thomas, the Apostle
On this day St. Thomas the apostle was martyred. He was born in Galilee, and the Lord chose him among the twelve disciples (Mathew 10:3). When the Lord wanted to go to raise Lazarus from the dead, Thomas said to the other disciples: " (John 11:16). He also asked the Lord at the supper: " (John 14:5-6). When the Lord Christ appeared to the disciples after the resurrection, and said to them "Receive the Holy Spirit", Thomas was absent. On his return, the disciples told him, "We have seen the Lord." He said to them: " (John 20:19-29). After the outpouring of the Holy Spirit on the day of Pentecost in the Upper room in Zion, the apostles dispersed everywhere to preach the Gospel, Thomas went to India. He worked there as a slave at one of the friends of the king, whose name was Lukios, who brought him to the king who inquired about his profession. Thomas said: "I am builder, carpenter and a physician. He preached in his master's palace, and Lukios' wife believed and all his household. The king asked him about his achievements, and he said: "The palaces that I built were the souls that have become the temples of the King of Glory; the carpentry that I did was the Gospel that removes the thorns of sin; and the medicines I practiced are the Holy Mysteries which heal the poison of the evil one. The king became angry and tortured him, and bound him among four poles, cut off his skin and rubbed his wounds with salt and lime. The apostle Thomas endured the pains. Lukios' wife saw him suffering, and she fell from the window and died. Lukios came to him and said: "If you raise my wife from the dead, I believe in your God." Thomas went to the room where the dead body was, and said: "Arsabona (Arsonia), rise up in the Name of the Lord Jesus Christ. " She rose instantly and bowed to the Saint. When her husband saw that, he believed and many more with him from the people of the city, and Thomas baptized them. Once the sea drove a huge tree to the shore that no one could lift it up. St. Thomas asked the king for permission to lift it up and to use its wood in building a church. He got the permission, he made the sign of the cross, and he raised it and later he built the church, to which he ordained a bishop and priests.
St. Thomas left and went to a city called "Kantoura" (Kontaria), where he found an old man weeping bitterly because the king killed his six children. The Saint prayed over them, and the Lord raised them up. The idol priests were angry, and wanted to stone him. The first raised a stone to throw it at him, and his hand was paralyzed. The Saint prayed over his hand, he was healed instantly, and all the idol priests believed in the Lord Christ. Then St. Thomas went to the city of "Parkenas" and other cities, where he preached in the Name of Jesus Christ. The king heard about him, and he put him in prison. When he found out that he was teaching the prisoners the way of God, he tortured him, and at last he cut his head off, and he received the crown of martyrdom. He was buried in "Melibar", then his body was relocated to El-Raha.
May His prayers be with us and Glory be to our God forever. Amen.
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Mansi Hitesh
Alumni of Colby College
A zealous learner on the lookout for meaningful exchanges with different communities and organizations.
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Mansi Hitesh Named to Highly Selective Dean's List at Colby College
Mansi Hitesh of Ujjain, Madhya Pradesh was recently named to the highly selective Dean's List at Colby College in Waterville, Maine, for outstanding academic achievement during the spring semester ...
June, 26 2019 - Verified by Colby College
Mansi Hitesh Graduates from Colby College
Mansi Hitesh, of Ujjain, Madhya Pradesh, India, was one of 462 seniors who graduated from Colby College in Waterville, Maine, May 26, 2019, receiving a bachelor of arts degree at the College's 198t...
Mansi Hitesh Named to Colby College's Highly Selective Dean's List
Mansi Hitesh of Haryana, India, was recently named to the highly selective Dean's List at Colby College in Waterville, Maine, for outstanding academic achievement during the fall semester of the 20...
February, 06 2019 - Verified by Colby College
Mansi Hitesh Named to Colby's Highly Selective Dean's List
Mansi Hitesh of Haryana was recently named to the highly selective Dean's List at Colby College in Waterville, Maine, for outstanding academic achievement during the spring semester of the 2017-18 ...
Mansi Hitesh Named to Dean's List at Colby College
Mansi Hitesh of Haryana, India, was named to the Dean's List at Colby College in Waterville, Maine, for outstanding academic achievement during the spring semester of the 2016-17 year. Hitesh is on...
Mansi Hitesh of Haryana 122002 Enrolls at Colby College
Mansi Hitesh of Haryana 122002, India, enrolled at Colby College in Waterville, Maine, this fall. Before classes began Sept. 6, Hitesh took part in a weeklong orientation that included a civic enga...
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Internship at Greenpeace India
Work at Home Intern for the Mobilisation unit responsible for carrying campaign messages to the public through digital, online and offline channels and maintaining the main database and website at Greenpeace.
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Research Intern at Ondede: Dignity-Voice-Sexuality
Conducted field research on the present narratives of Male-to-Female transgendered and transsexual persons in Bengaluru, transcribed interviews, framed funding proposals, wrote annual reports, ideated concept notes and maintained the official blog at Ondede.
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Answer phones, type, file and do computer work related to calendars, etc. Assist in entering scheduling requests on the department scheduling software. Also work on various mailings.
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Published: Feb. 13, 2014 at 09:04 p.m.
Updated: Feb. 13, 2014 at 11:02 p.m.
Cleveland Browns wide receiver Davone Bess' time away from football could wind up costing him a lot of money.
Mike Florio of ProFootballTalk reports that the Browns plan to take the position that Bess' guaranteed salary in 2014 has voided. His salary was fully guaranteed for skill and injury, but the Browns reportedly believe the guarantees evaporated when Bess couldn't play at the end of last season.
Bess, who is set to earn $3.14 million, was placed on the non-football illness list late last season. He was reported to have a serious family issue. Bess has subsequently been arrested on multiple charges after an airport incident and drew attention for a pair of social media photos that appeared to contain marijuana. NFL Media Insider Ian Rapoport reports that Bess has been in a medical treatment center following the season, according to a person with knowledge of his situation.
New Browns general manager Ray Farmer said Wednesday that the organization is "concerned" with Bess, saying Bess was going to "get the care" necessary to get better. While Florio points out that Bess could theoretically still remain with the team despite the guarantee voiding, its hard to imagine Bess getting that salary.


text:
Q: How to use NSTextFinder with NSOutlineView? There is not much information about how to use NSTextFinder and most of them are about NSTextView. I am interested to learn how to use it with NSOutlineView. This is what I have done.
On storyboard, I dragged an NSTextFinder onto a view controller where it contains an NSOutlineView. I connected the client to the view controller and the find bar container to the NSScrollView that encloses the NSOutlineView. I made an @IBOutlet to the NSTextFinder and enabled incremental searching and dim content view.
My code looks something like this.
class ViewController: NSViewController {
    @IBOutlet var outlineView: NSOutlineView!
    @IBOutlet var textFinder: NSTextFinder!

    // ...

    @IBAction func findSomething(_ sender: Any?) {
        print("findSomething(_:) was called!")
        textFinder.performAction(.showFindInterface)
    }
}

I connected findSomething(_:) as a first responder to one of the NSMenuItem. The method is called and a find bar actually appear.
How do I actually get it to search strings in the NSOutlineView? I am not interested in find-and-replace. I just want it like Safari find bar.
Apple documentation on NSTextFinder is very hard to understand and there is no example code I could look into.

A: willeke is correct: Make your viewController, which owns the NSOutlineView, the client of the NSTextFinder and implement the NSTextFinderClient protocol. For an outline view, you implement the methods func stringLength() -> Int and func string(at: Int, effectiveRange: NSRangePointer, endsWithSearchBoundary: UnsafeMutablePointer<ObjCBool>) -> String - you want to give the NSTextFinder the illusion that there's one giant string, broken into pieces.
Example when it asks for the piece that contains location 512, you return the string from 500 to 600, and store NSMakeRange(500, 100) into its effecive range argument.
When it actually finds something, it will call your selectedRanges setter for you to move the selection there.
To make this work. You'll need to do some work up front: to provide the illusion that your document is one giant range, you'll need to build a data structure that lets you map a range from NSTextFinder to a piece of your data.

redpajama_set_name: RedPajamaStackExchange


text:
Gerhard Feige (Halle (Saale), 19 de novembro de 1951) é bispo católico romano de Magdeburg .

Vida
Gerhard Feige estudou após a graduação na escola August Hermann Francke na teologia católica Halle em Erfurt. Em 1 de abril de 1978, ele recebeu em Magdeburg pelo bispo John Brown, a ordenação .

Como vigário, ele trabalhou em Salzwedel e Magdeburg. Ele então trabalhou a partir de 1982 nos Estudos Filosóficos-Teológicos - hoje Faculdade de Teologia Católica da Universidade de Erfurt - como assistente. Depois da sua promoção ao doutorado em teologia em 1988 e uma viagem de estudo de um ano para Roma , ele era um professor de história da igreja primitiva, Patrística e Teologia Ecumênica em Erfurt. Em 1994, foi nomeado Professor de História da Igreja Antiga, Patrologia e Estudos da Igreja Oriental.

Em 19 de julho de 1999, o Papa João Paulo II nomeou o Bispo auxiliar de Gerhard Feige em Magdeburgo e Bispo Titular de Tisedi . Gerhard Feige recebeu a consagração episcopal em 11 de setembro de 1999 pelo bispo Leo Nowak, na Catedral de São Sebastião, em Magdeburg. Como co-consecrators assim ajudou os bispos Joachim Wanke de Erfurt e Paul-Werner Scheele de Würzburg. Seu lema é Vigilate et orate ("assistir e rezar") e vem dissoEvangelho de Mateus ( Mt 26,41  EU ).

Após a demissão do Bispo de Magdeburgo, Leo Nowak foi aceito pelo Papa em 17 de março de 2004 por motivos de idade, o Capítulo da Catedral de Magdeburg escolheu Feige como administrador diocesano para a época da vaga de Sedis .

Em 23 de fevereiro de 2005, o Papa João Paulo II o nomeou sucessor de Leo Nowak como bispo diocesano. A inauguração ocorreu em 16 de abril de 2005, em sua Igreja episcopal de São Sebastião em Magdeburg pelo núncio apostólico, Dom Erwin Josef Ender, e o Metropolitano da província eclesiástica de Paderborn, arcebispo Hans-Josef Becker.

A preocupação especial do bispo é o ecumenismo e, especialmente, a relação com a ortodoxia com forte interesse pessoal para as igrejas uniadas. Já em 1983 recebeu permissão para adorar no rito bizantino (ver Biritualismo ). Desde 1993, pertence à Comissão Conjunta do Metropolita Ortodoxa Grega da Alemanha e à Igreja Católica Romana na Alemanha. Mesmo durante seu tempo de professor, ele regularmente realizou viagens de seminário com estudantes para Lviv na Ucrânia . Veja também Cardeal Ljubomyr Husar, Arcebispo Maior da igreja católica grega unificada com Roma.

Em 1992, a Conferência Episcopal Alemã nomeou Feige como seu delegado à Associação das Igrejas Cristãs na Alemanha. Além disso, o bispo Feige é membro do Grupo de Trabalho Teológico Ecumênico na Alemanha Oriental. Feige foi o novo presidente da Comissão Ecumênica da Conferência Episcopal Alemã desde setembro de 2012 . Ele sucede ao arcebispo Gerhard Ludwig Müller, que foi nomeado Prefeito da Congregação para a Doutrina da Fé e foi reeleito para o cargo de conferência dos bispos no outono de 2016.

Em 22 de julho de 2014, ele foi nomeado pelo Papa Francisco como membro do Pontifício Conselho para a Promoção da Unidade dos Cristãos.

Posições
Em fevereiro de 2014, Feige se solidarizou com as declarações do bispo Stephan Ackermann da diocese de Trier e também pede uma reforma do ensino moral sexual . Era "finalmente o momento de encarar abertamente a realidade imperturbável e ser sensível e justo no espírito de Jesus Cristo por soluções responsáveis e vivificantes". A homossexualidade vivida responsável não deve ser classificada pela igreja como não natural, disse o bispo.

Links da Web

 Bischof Feige auf der Homepage des Bistums Magdeburg

Naturais de Halle (Saale)
Bispos da Alemanha
Teólogos

redpajama_set_name: RedPajamaWikipedia


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• Twin Bed: 44"W x 82"D x 52"H •Media TV Chest: ~ 49" x 18" x 45"H ~ 139 lbs.
Includes: Full Headboard/Footboard with Rails, Dresser, Mirror and Night Stand.


text:
Heinrich August Georg Schiøtt (17 December 1823 – 25 June 1895) was a Danish portrait painter.

Biography
August Schiøtt was born in  Helsingør, Denmark. He was the son of Heinrich Erpecum Schiøtt and Anna Sophie Marie Fleron.
His father was a customs official. After his confirmation, he was sent to school in Copenhagen where he later entered the Royal Danish Academy of Fine Arts and had an undistinguished academic record. For a short time, he was a private student of Christoffer Wilhelm Eckersberg. His first portrait (of a child) was created in 1844, two years before his graduation. After that, he painted six to eight portraits every year.

Altogether, he presented over 150 portraits at the Charlottenborg Spring Exhibition, including several of the Royal Family: Caroline Amalie of Augustenburg (three times), Prince Ferdinand, Princess Caroline and Prince (later King) Christian. In addition to these portraits, his most notable include those of Baron Carl Frederik Blixen-Finecke, who was the grandfather-in-law of Karen Blixen, General Gerhard Christoph von Krogh, and the history painter J.L. Lund.

He was married in 1850, to Betty Augusta Ultima Søth (1820-1853), but she wife died three years later, after they returned from an Academy supported study trip to France, England and Italy. In 1854, he was named a member of the Academy. He remarried in 1855, to Mariane Ogilvie (1836-1857) and, in 1866, became a titular professor.

In 1872, he received ""; a grant for composers, writers and artists. This enabled him to visit Southern Europe, Egypt and Palestine where he made numerous sketches of people and landscapes.
In addition to his portraits, he created numerous figure compositions, such as King Wermund with his son Offa, Christ at Gethsemane and genre scenes of peasant life.

He was awarded the Order of the Dannebrog in 1880. He died at  Hellebæk in 1895 and was buried at Garrison Cemetery, Copenhagen.

One of his children, Elisabeth Schiøtt (1856-1893), studied with P.S. Krøyer and Laurits Tuxen and became a landscape painter. In 1938, an auction of his and his daughter's remaining works was held at the Academy and the proceeds were used to establish a scholarship.

References

External links

ArtNet: More works by Schiøtt.

1823 births
1895 deaths
19th-century Danish painters
Danish male painters
Danish portrait painters
People from Helsingør
Royal Danish Academy of Fine Arts alumni
Academic staff of the Royal Danish Academy of Fine Arts
Knights of the Order of the Dannebrog
Burials at the Garrison Cemetery, Copenhagen
19th-century Danish male artists


text:
Melbourne in Glasgow / Joshua Petherick
'Nachinat-Glazz-Smot-Messel-Vareet-Dorogoy'
Glasgow Subway, Glasgow
For 'Melbourne in Glasgow', Joshua Petherick presented a series of posters on Glasgow's Subway system. A series of ambiguous 'advertisement' works, whose titles, all derived from Nadsat, the constructed teenage argot of Anthony Burgess' 'A Clockwork Orange', punctuated various sites throughout one of the world's oldest underground systems, the Glasgow subway, a system often referred to by locals as The Clockwork Orange. Works were situated at Buchanan Street, Kelvinbridge, Kelvinhall, Partick, St Enoch and St George's Cross stations.
Joshua Petherick (born 1979, Adelaide, Australia) melds modern technologies and a variety of media to create playful riddles, fictions and questions – each designed to engender a critical appraisal in the way we encounter and value things, pictures and words.
Solo projects include 'Saratogian Bedding', Croy Nielsen, Berlin, and 'Simultaneous Solitudes', Y3K Gallery, Melbourne (both 2011), 'Joshua Petherick', Australian Centre for Contemporary Art at Mirka Tolarno, Melbourne and 'Nom Abbamon', Y3K Gallery, Melbourne (w. Christopher L.G. Hill) (both 2010), 'Bootleg at The Manor', Y3K Gallery, Melbourne, and 'Austin & Petherick', Neon Parc, Melbourne (w. Nick Austin) (both 2009). Projects include Hopkinson Cundy, Auckland; Gertrude Contemporary, Melbourne; CCP (Centre for Contemporary Photography), Melbourne.
Joshua Petherick is represented by Croy Nielsen, Berlin
Project / 'Melbourne in Glasgow'


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