2001-08-21 Assigned to CYBERONICS, INC. reassignment CYBERONICS, INC. ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: BARRETT, BURKE T., ADKINS, ROBERT A., TERRY, REESE S., JR.
A device for treating patients suffering from congestive heart failure includes an implantable neurostimulator for stimulating the patient's vagus nerve at or above the cardiac branch with an electrical pulse waveform at a stimulating rate sufficient to maintain the patient's heart beat at a rate well below the patient's normal resting heart rate, thereby allowing rest and recovery of the heart muscle, to increase in coronary blood flow, and/or growth of coronary capillaries. A metabolic need sensor detects the patient's current physical state and concomitantly supplies a control signal to the neurostimulator to vary the stimulating rate. If the detection indicates a state of rest, the neurostimulator rate reduces the patient's heart rate below the patient's normal resting rate. If the detection indicates physical exertion, the neurostimulator rate increases the patient's heart rate above the normal resting rate.
This application is related to application Ser. No. 09/417,080, filed Oct. 13, 1999, assigned to the same assignee as the present application, now U.S. Pat. No. 6,473,644, issued Oct. 29, 2002.
It is currently estimated that some five million Americans suffer from congestive heart failure (CHF), a condition of abnormally low cardiac output. More than one million of these afflicted persons are under age 60. An increasing rate of CHF sufferers may be regarded as a sign of progress in the field of cardiology, since it stems in large measure from saving the lives of heart attack victims and patients with other heart problems. But many of the survivors are left with CHF, in which a markedly reduced cardiac output leads to an inability of the heart to maintain the body's need for oxygen-rich blood circulation. As many as 40 percent of CHF patients are at risk of sudden death.
Another fourteen million Americans are diabetic and forty million more exhibit hypertension (persistent elevated blood pressure). A considerable percentage of patients with diabetic neuropathy, hypertension and other pathologies affecting the nervous system are also at higher risk of sudden death.
Diseases such as CHF, hypertension and diabetes are characteristically associated with an increased autonomic cardiovascular drive (see, e.g., Blood Pressure 1998; Suppl 3:5-13). In addition, increased autonomic cardiovascular drive has been associated with myocardial infarction, cardiac transplantation, tetraplegia and anxiety disorders (Circulation 1996; 93:1043-1065, Bio Psychol March 1998; 47(3):243-63). "Tone" is the output that emanates from the central nervous system via sympathetic and parasympathetic efferent nerves. The overall "drive" depends on the balance between inhibitory (parasympathetic or vagal) and excitatory (sympathetic) tone and the responsiveness of the organ of interest to that tone. Responsiveness, in turn, depends on the receptor's properties as well as on the intrinsic functional or anatomic properties of the responding organ. An enhanced autonomic drive, independent of the underlying condition, greatly increases the risk of poor cardiovascular outcomes. It follows that targeting the underlying autonomic imbalance in congestive heart failure, hypertension and diabetes may not only be pathophysiologically sound but may also lead to better outcomes (Juilius, Blood Press 1998; Suppl 3:5-13).
As with any medical therapy, before a therapy is prescribed it is important to identify which patients are at increased risk. For CHF, research has established markers that identify patients at increased risk of sudden death from an imbalance between the sympathetic and parasympathetic systems. Results from a large multi-center trial established that baroreflex sensitivity and heart-rate variability are both predictors of mortality with CHF patients, and when combined, increase the predictive value (Lancet 1988:351:478-484). Similar studies have shown a predictive value of heart rate variability with diabetes (Circulation 1996;93:1043-1065).
The simplest measure of heart rate variability expresses the reciprocal of heart rate (R-R interval) and calculates a standard deviation of all normal beats (SDNN) over a period of time. The baroreflex sensitivity (BRS) is a marker of the capability to reflexly increase vagal activity and to decrease sympathetic activity in response to a sudden increase in blood pressure. It provides a more focused measure of autonomic control than heart rate variability. BRS is calculated from measurement of the rate-pressure response to intravenous phenylephrine.
Treatment strategies for CHF employ methods to decrease the excitatory or sympathetic drive, and/or to increase the inhibitory or parasympathetic drive. The results of clinical trials on two beta-blocker drugs demonstrate the efficacy of decreasing the sympathetic drive for such treatment. The clinical studies confirm earlier reports from dog study models of CHF treated with beta-blockers, that the drugs block the effects of adrenaline which is over-produced in CHF patients. Heart experts suspect that many symptoms of CHF occur as an overreaction of the body to some type of heart-muscle damage. The body misinterprets the situation and reacts as though severe dehydration or serious bleeding were the cause of the lowered blood flow. To stimulate the heart, the body produces more adrenaline, which makes the heart work harder. Deaths were reduced by 35% among patients given the beta-blockers Carvedilol or Metoprolol (Prog. cardiovascular Dis. January-February 1999; 41(4)301-312, which states that beta-blockers should be considered the standard of care for mild-to-moderate heart failure). Unfortunately, beta-blockers—the older versions of which are relatively inexpensive—have side effects that prevent many patients from tolerating this mode of therapy.
Mild exercise has also been demonstrated to improve the sympathetic-parasympathetic balance for CHF patients. In a recent randomized study of 99 patients, Belardinelli reported (Circulation Mar. 9, 1999; 99(9):1173-1182) an 18% mortality in the exercise group compared to a 41% mortality in the non-exercise patient group. This clinical study confirms protective benefits of exercise training in dogs with simulated CHF (Circulation February 1994; 89(2):548552). Heart rate variability (SDNN) also improved by 74% in the dog study, suggesting an improved sympathetic-parasympathetic balance. Although beneficial, exercise is initially risky for the CHF patient until an improved balance of the sympathetic-parasympathetic system can be obtained. Exercise can trigger a heart attack or other adverse cardiac events in patients with unstable CHF. It is essential to monitor the patient closely during the first four to eight weeks of exercise. Even aside from the risk, initiating and maintaining an exercise program is difficult for CHF patients, because of patient fatigue and shortness of breath associated with the disease.
A cardiac defibrillator may be implanted to protect the CHF patient against sudden death upon an event of cardiac fibrillation, but its effect on long term survival is limited (Circulation Dec. 1, 1995; 92(11):3273-3281). The device (as well as the implant procedure) is relatively expensive, and does nothing to correct the underlining imbalance between the sympathetic and parasympathetic systems.
It is a principal aim of the present invention to provide improved methods of treating patients who suffer disorders as a result of increased autonomic cardiovascular drive, including but not limited to CHF, diabetes and hypertension. These improved methods seek to relieve the underlying autonomic imbalance between inhibitory (parasympathetic) and excitatory (sympathetic) tone.
The methods of this invention involve increasing the inhibitory response of the parasympathetic or vagal system. The approach is to stimulate the cardiac branch of the vagus nerve. The protective role of vagal stimulation in the chronic dog CHF model has been reported (Circulation Research 1991;68:1471-1481). Prior to vagal stimulation, 100% of the dogs in the study were at risk of sudden death. After vagus nerve stimulation, only 10% remained at risk, versus 87% of a control group of dogs. The report states that the decrease in heart rate from vagal stimulation is an important but not always essential protective mechanism. The electrophysiological effects secondary to the vagally mediated antagonism of the sympathetic activity on the heart are likely to play a major role. In addition, vagal activity may have antagonized the vasoconstrictor effect of the sympathetic activity by acting on norepinephrine release and also by a direct vasodilatory effect.
Kamath reported on the neurocardiac responses to vagoafferent electrostimulation in eight patients with vagal stimulation for the control of epilepsy (Pace 1992, Vol 15, 1581-1587). These patients were chronically stimulated on the cervical branch below the cardiac branch; therefore, the effects are presumed to be central to the brain. The patients were randomized into High Level and Low Level stimulation groups. Those in the High Level stimulation group had a statistically significant improvement in the LF:HF peak power ratio (an expression of sympathetic dominance) as compared to the Low Level stimulation group, which had no improvement. Although slow and indirect response was elicited, these studies indicate that stimulation of the vagus nerve below the superior cardiac branch can have a long term beneficial effect on the balance of the sympathetic/parasympathetic system. The studies in dogs and humans demonstrate the feasibility of using vagus nerve stimulation to provide the heart with adequate parasympathetic support to promote natural healing.
The present invention, in one of its implementations, provides vagal stimulation to the left vagus nerve above the cardiac branch or on the vagus cardiac branch at a rate determined to limit the upper heart rate of the patient to a physiologically safe limit, such as 100-150 beats-per-minute (BPM). The stimulation is commenced whenever the BPM exceed a predetermined threshold, such as 90 BPM. The rate of cardiac vagus stimulation has an inverse effect on the heart rate. The stimulation rate may be experimentally determined and appropriately adjusted to achieve a particular heart rate for each patient during a treadmill test. For example, vagus nerve stimulation at 6 Hz may be determined to reduce the resting heart rate to 60 BPM. The physician might initiate the treadmill exercise and determine that by programming the vagus nerve stimulation rate to 4 Hz, the heart rate will be limited to about 100 BPM. Each of the vagal stimulation rates should be verified to assure that they do indeed result in the desired heart rate for each particular patient.
An alternative to the above method of limiting the upper heart rate is to sense the heart rate and to stimulate the vagus nerve only when the heart rate exceeds a specified threshold; for example, 100 BPM. Here again, the stimulation rate is experimentally determined by a treadmill test of the patient, to limit the heart rate to the 100-150 BPM range. Alternatively, the stimulation rate is automatically adjusted to maintain the rate within a specified range.
Another alternative method of the invention to limit upper heart rate is to synchronize the VNS to the P or R wave of the patient's EKG, and deliver a burst delayed from the synchronizing signal. The right vagus nerve is preferred for stimulation because it is more responsive to synchronized heart pacing, but the stimulation may be applied instead to the left vagus nerve. The burst is preferably approximately 100 msec in duration. The stimulation rate, burst duration, and delay from the synchronization point is programmed to limit the heart rate within a desired range; for example, 100 to 150 BPM. Exemplary values are VNS pulses delivered at a rate of 65 Hz, and the burst delayed 100 msec from the P wave. The heart rate should be monitored and burst mode parameters, specifically burst frequency, should be automatically adjusted to protect the patient from patterns which could produce a heart rate lower than desired.
The present invention provides left or right cardiac vagal stimulation at a rate determined to limit the heart rate 30-45% below the resting heart rate to allow the heart muscle additional time to rest and allow increased capillary blood flow and increased growth of capillary vessels. Since slowing the heart rate to allow time for the heart muscle to heal and to stimulate capillary growth will affect the patient's exercise tolerance (i.e., the exercise heart rate will be limited by the vagus stimulation rate), it is desirable to maximize the amount of time the heart rate can be slowed without impacting the patient's ability to function during normal daily activities. Preferably, then, the patient is stimulated only when at rest, and most preferably, when asleep. In any event, when a metabolic need for increased heart rate is indicated, the vagus stimulation is ceased or reduced sufficiently to allow the patient's normal heart rate to progress to within the upper rate limit range, such as to a programmed level of from 100 to 150 BPM. Of course, it will be understood that patients with CHF are not likely to be engaging in much, if any, strenuous activity.
Each of these methods should employ safety software to prevent stimulation at a frequency that reduces the heart rate below a physiologically safe level. The software should be designed to discriminate against electrical interference that might be interpreted as a fast cardiac signal. This type of discrimination is commonly used in implantable cardiac pacemakers and defibrillators. The VNS rate limit is tailored by programming for each individual patient.
The stimulator preferably incorporates a metabolic need sensor to detect a metabolic need for increased blood flow through higher heart rate. Examples of a suitable sensor include an activity sensor to detect physical activity by the patient (such as an accelerometer), an O2 saturation sensor, a temperature (central venous blood, or physiology) sensor, a respiration (or minute ventilation) rate sensor, a Q-T interval sensor, and so forth. The metabolic need sensor is arranged and adapted to inhibit or otherwise control the vagus stimulation rate to avoid limiting the heart rate to an inappropriately low level in circumstances of patient exercise or activity, which may even be very slight such as getting up from a chair or slow walking. Alternatively or additionally, the stimulator may be programmed to adjust the target heart rate to a higher ventricular rate upon sensing patient activity, so the patient will receive the benefit of a higher heart rate under conditions of exercise.
Subject to approval by the physician, and appropriate programming, the patient may be given some limited control over the therapy. To that end, an external magnet may be made available to the patient to allow initiating stimulation or inhibiting stimulation. The impanted device may be programmed to assume a different heart rate target when activated by a magnet.
Also, the device may be programmed to commence different heart rate targets during local daytime and nighttime hours.
FIG. 2 is a simplified block diagram of an implantable stimulus generator of a type used in the device of FIG. 1 to trigger VNS according to the present invention.
In FIG. 1, a patient 12 (illustrated in phantom) has an implanted neurostimulator device 10 which may be of the type disclosed in U.S. Pat. No. 5,154,172 to R. S. Terry, Jr. et al., assigned to the assignee of the present application, except with respect to certain improvements according to the present invention as described below. The signal generator or stimulus generator 25 of device 10 is sometimes referred to herein as a NeuroCybernetic Prosthesis orNCP® (registered trademark of Cyberonics, Inc., the assignee herein) prosthetic device.
The housing 14 (generally referred to in the art as a "can" or "case") of the stimulus generator 25 is composed of biocompatible material, e.g., a metal such as titanium or medical grade stainless steel, hermetically sealed to prevent fluid penetration into the electronic components and battery(ies) (sometimes referred to herein as the "electronics package") contained therein. Case 14 has a thin circular, oval, or rectangular shape and is suitably sized for implantation. The device is implanted in a surgically-formed pocket just below the skin, typically in a pectoral region of the patient. An insulated, electrically conductive lead 16 is connected at its proximal end to generator 25 and at its distal end to an electrode array 15 which is to be installed on the right or left branch of the vagus nerve 11, above the cardiac branch. The right vagus electrode placement is believed to be more responsive to synchronized burst stimulation, discussed below, but left vagus stimulation may alternatively be used.
A connector at the proximal end of lead 16 is inserted into a mating connector in header 51 on case 14, to electrically connect the electrode array 15 to the electrical circuitry of the electronics package in the stimulus generator 25. For example, the electrode array may be a bipolar stimulating electrode assembly as shown in U.S. Pat. No. 4,573,481 to Bullara. The electrical output pulse waveform of generator 25 is applied through the lead-electrode system to the vagus nerve at a desired location, such as the cervical location shown in FIG. 1.
Telemetry communication with the implanted stimulus generator for programming and monitoring purposes is performed using a program console external to the patient's body, by asynchronous serial communication. For example, a programming wand 18 is used to transmit parameter changes to device 10 and to receive device parameter and signal information being monitored, in conjunction with computer 20 of the program console. Software installed in the computer facilitates physician-controlled adjustment of selected parameters and communication with the implanted device. An antenna 40 (FIG. 2) within the generator is used for bidirectional telemetry communication between the implanted device and the external program console, via wand 18.
FIG. 2 illustrates a simplified block diagram of NCP stimulus generator 25, including battery(ies) 32 (e.g., a lithium carbon monofluoride cell) which, together with a voltage regulator 33, powers the implanted device, and a logic and control section 35 with a microprocessor 36 that implements and controls the programmable functions of the device. These functions include sensing and stimulation control parameters for the stimulus generator for receipt from or application to lead 16 and distal electrode array 15 in communication from or to vagus nerve 11, as the case may be. The attending physician programs the implanted device to selectively tailor the output pulse waveform of the generator to stimulate or modulate the electrical activity of the vagus nerve for a prescribed therapy regimen for treatment of a patient's autonomic cardiovascular drive disorders by decreasing autonomic nervous system drive. Once the generator is programmed, it operates at the programmed settings until they are re-programmed by the attending physician.
Timing of the logic and control and other functions of the stimulus generator is controlled by a precise signal frequency of a crystal oscillator 37. A magnetically-actuatable reed switch 39 is provided to allow physician-prescribed limited manual activation by the patient of certain functions of the generator with an external magnet (not shown). Alternatively or additionally, the implanted device may be implemented to use techniques of manual and automatic activation disclosed in U.S. Pat. No. 5,304,206 to R. G. Baker, Jr. et al., assigned to the same assignee as the present application. For example, the patient may be allowed to initiate delivery of the output pulse waveform to adjust the stimulation frequency to increase the heart rate during periods of physical activity by the patient, or to reduce the heart rate toward the lower target range when the activity has ceased for a sufficient interval, as noted above in the brief summary of the invention. Manual control may also be used to inhibit stimulation if the patient experiences discomfort with the programmed therapy or in the event of a perceived malfunction.
Logic/control section 35 controls output circuit 42 for producing the output pulse waveform according to the prescribed therapy. The stimulus generator may be programmed for continuous, periodic or sporadic activation of programmed operation as necessary to bring the patient's detected ventricular rate to a target level stored in a comparator. The ventricular rate is monitored by input signal 47 to sensing circuit 45, which delivers a proportional pulse output to timing and state circuit 65. The output of the latter is applied to logic and control circuit 35 to initiate and/or adjust the VNS frequency or rate for proper autonomic nervous system drive.
Techniques for sensing heart rate from the vagus nerve electrode are disclosed in U.S. Pat. No. 5,928,272 to A. Adkins et al, assigned to the same assignee as the present application. The generator 25 is programmed to stimulate the vagus nerve at an initial pulse stimulation frequency, and, when the patient's heart rate begins to move toward the prescribed target rate, to enter into the specified therapy regimen. For certain of the techniques described herein, the generator cannot be used to sense and stimulate from the same nerve electrode, but requires a distinct sensing electrode to avoid missing an event while pulses are being delivered. A separate electrode for sensing may be incorporated as an integral part of the pulse generator, for example at on the header. Alternatively, a separate lead could be used with the sense tip positioned away from the stimulating electrode. Although not required, the sensing tip could be positioned in, or in close proximity to, the heart. This could also be implemented with one lead body, with a ring sense electrode located around the lead body some distance from the stimulation site. However, if the generator is used exclusively in the synchronous burst mode (described below), a separate sensing electrode is not required and the nerve electrode may be used for sensing.
A technique employed in the invention is to increase the inhibitory response of the parasympathetic or vagal system (decrease the autonomic nervous system drive) by appropriate stimulation of the cardiac branch of the vagus nerve. In one method, the vagus nerve (left or right branch in the cervical region above the cardiac branch) is stimulated by the generator pulse waveform at a rate which is predetermined to limit the particular patient's upper heart rate to a physiologically safe limit within a prescribed range, e.g., 100-150 BPM. The stimulation rate is experimentally determined during treadmill testing of the patient. Typically, a vagus nerve stimulation rate of about 4 Hz limits the heart rate to about 100 BPM. Since the heart rate varies inversely with the VNS rate, lower stimulation rates produce proportionally higher heart rate limits. In an alternative method, heart rate is monitored and VNS is applied only when the heart rate is detected to fall below a threshold such as 100 BPM. Another alternative is to use feedback to automatically adjust the vagal stimulation rate to maintain the heart rate within the desired range.
It is important to stimulate the vagus nerve above the cardiac branch, since stimulation of the main branch of the vagus in the neck below the cardiac branch will not affect the heart rate. The cardiac cervical branch of the vagus nerve provides the most convenient access location for attaching the electrode, as it branches from the main trunk of the vagus relatively high in the neck, thus providing a sufficiently long section in the neck for electrode attachment. Stimulation of either the left vagus nerve or the right vagus nerve is acceptable.
In another method of adjusting autonomic nervous system drive according to the invention, the VNS may be synchronized to the P wave or R wave of the patient's EKG to time delivery of a pulsed burst from the generator with a predetermined time delay from the synchronizing signal. For example, the burst may commence about 150 to 200 msec after the R wave. An advantage of this method is reduced power (battery) consumption, owing to a lower stimulation duty cycle. The stimulation rate, burst duration (e.g., 100 msec), and time delay (e.g., 100 msec) from the P wave, are programmed to limit the heart rate to a value within the prescribed range of about 100 to 150 BPM. An amplifier may be employed to sense the presence of a P wave, indicating atrial contraction, and an electrode inserted in the atrium for increased sensitivity to P wave signal amplitude. A single amplifier-electrode device with a signal analyzer to differentiate between the P wave and the R wave may be used as an alternative.
The burst mode is programmed with limits on burst frequency, duration, and repetition rate to avoid very low heart rates that can compromise physical performance. But the other methods require similar procedures for the sake of safe treatment of the patient. For example, the software should be designed to place limits on minimum and maximum stimulation rates to avoid very high and very low heart rate levels, as well as to discriminate against improper interpretation of electrical interference as a cardiac signal (commonly employed in implantable cardiac pacemakers and defibrillators). Noise detection algorithms may be used, and when noise is detected the vagus nerve stimulation is automatically inhibited.
For a patient suffering from CHF, heart rate is preferably reduced to within a rate range below (preferably, 10 to 45% below, and more preferably, 30 to 45% below) the low end of the normal resting rate range of the patient. The intent is to provide a longer resting period for the heart muscle between beats and promote additional coronary flow and capillary development. In this regimen, the vagal stimulation frequency may be automatically adjusted as a function of the difference between the actual ventricular rate and the target rate. At the commencement of stimulation, the vagus nerve is subjected to stimulation at a frequency, for example, of one pulse per second. This stimulation frequency is sustained for a specified but relatively brief interval of time, e.g., about one minute, to allow the ventricular rate to stabilize at a new level. The vagal stimulation frequency may then be increased to a level of about two pulses per second, and again, held until the ventricular rate stabilizes. This regimen is continued with further increase in vagal stimulation frequency for each measurable reduction in the heart rate and subsequent stabilization interval, until the ventricular rate reaches the prescribed target rate.
Preferably, the rate of change of increase in the vagal stimulation frequency is programmed according to the therapy regimen to decline to 0.5 pulse per second between successive stabilization intervals, for example, from the prior one pulse per second, as the ventricular rate approaches the target rate range. Alternatively, the controller may take the percentage of difference between the desired and actual ventricular rate, multiplied by a constant factor, and add to the vagus stimulation rate, to achieve a modified vagal stimulation rate by which the heart rate approaches the target rate. The vagus stimulation frequency is increased to lower the ventricular rate towards the desired range, so long as the atrial-ventricular synchrony is present, but if such synchrony is lost the ventricular rate is held in a range just above the rate at which that occurred.
Lowering the patient's heart rate to a ventricular bradycardia in a range of from about 30% to 45% of the baseline resting heart rate, or about 38 BPM to 49 BPM for a resting rate of 70 BPM, is anticipated to promote and enhance the growth of coronary blood vessels, and especially the myocardial capillaries, to provide an increase in coronary blood flow through the heart. And cardiac output is expected to improve gradually over a period of several weeks or longer as a result of increase in the capillaries and the coronary blood flow.
Safeguards should be provided here, also, to prevent inadvertent reduction of the patient's heart rate stemming from electrical noise interference. To that end, a noise rejection algorithm may be used as noted earlier herein, and, additionally, the device is preferably programmed with a maximum vagal stimulation rate that establishes a physiologically safe heart rate lower limit for the patient.
In an alternative therapy protocol, the implanted neurostimulator may be programmed to undergo much less frequent changes, so that the patient's heart rate is reduced periodically and held at the reduced level. To that end, the vagal stimulation rate is increased and held, e.g., for a period of, say, one hour to produce an interim designated ventricular rate. At the end of the one-hour period, the vagal stimulation is ceased or adjusted to a lower frequency for a period of one hour to allow the heart rate to return to and remain at the patient's normal resting rate. The periods of stimulation and non-stimulation (or adjusted stimulation) are sufficient and nominally (but not necessarily) of the same or similar lengths of time, to provide a desirable protocol in circumstances where the patient is unable to tolerate a protracted reduced heart rate.
Severe bradycardia lowers cardiac output in patients as stroke volume falls, especially patients with other underlying heart disease. Aerobic exercise capacity is also impaired in CHF patients. Of course, reducing the heart rate exacerbates that condition. Patient exercise, if tolerated at all, is beneficial because it promotes increased capillary growth and coronary blood flow, so it is desirable to allow the patient to engage in some moderate exercise.
A metabolic need sensor 44 among the examples of suitable sensors noted earlier herein is used to detect physical exertion by the patient, and in response to initiate an inhibition of VNS that would otherwise limit heart rate to an inordinately low level for those conditions. The metabolic need sensor may alternatively or additionally be used to change the vagal stimulation to a rate that allows an increase in the patient's ventricular rate above the predetermined rate upon sensing patient activity. For example, the heart rate might normally be limited to 100 BPM by vagal stimulation, but when exercise is detected the vagal stimulation rate may be decreased to allow the heart rate to increase to as much as 150 BPM.
Even mere changes in position or slow walking are detected by the metabolic need sensor to trigger either an inhibition of the vagal stimulation, or an adjustment of the vagal stimulation frequency to allow an intrinsic higher ventricular rate, with limits on the increase in heart rate to a safe level. Consequently, the patient receives the benefit of a more physiologically appropriate higher heart rate at least during a period of physical activity and receives protection from abnormally high heart rates which could result in tachycardia or sudden death. When the patient returns to a resting condition, the absence of activity (or intrinsic fall-back of the heart rate) is detected by the metabolic need sensor.
A damped feedback loop with hysteresis can be used to maintain the frequency of stimulation of the vagus nerve at a level sufficient to substantially sustain the ventricular rate within a target rate range. Damped feedback makes small or proportionately small changes in the stimulation rate to increase or decrease the heart rate into the desired range. Damping should be provided while increasing the VNS frequency to reduce the heart rate, whereas it is preferred for safety reasons that no damping be employed while decreasing the vagal stimulation frequency to allow an increase in the heart rate when it is too low.
According to another aspect of the invention, the device may be programmed for some patients to undergo vagal stimulation at different target heart rates according to the time of day (e.g., differently during daytime and nighttime hours), or otherwise according to the circadian rhythm of the patient, such as is appropriate to a lower heart rate during sleep or slumber than during the patient's waking hours. This implementation may be achieved in part through the incorporation of a time-of-day clock beyond the clocking provided for operation of the electronics package of the device. The programming for such selected patients may allow a reduction in the target rate during the nighttime hours. However, since the sleep time of individual patients varies, and patients may be expected to travel to different time zones, a more preferred implementation uses a metabolic need sensor. The sensor simply detects the patient's metabolic need and adjusts the rate accordingly. A sophisticated algorithm is not required, but merely two rates—a resting heart rate and a non-resting heart rate.
The times (i.e., intervals) during which the implanted device is activated for stimulation of the vagus nerve to lower (or raise) the heart rate and inhibited (or the stimulation is decreased sufficiently) to return the heart rate back toward the normal (for the particular patient) resting level may be programmed from a range of minutes to hours or even days in length. Also, the implanted device is preferably implemented to detect a heart rate that falls below the prescribed target rate, and to respond by an automatic reduction of the vagal stimulation frequency or cessation of the stimulation entirely, at least until a recovery to that target rate is detected.
Although the invention has been described with respect to treatment of CHF patients by relieving the underlying autonomic imbalance between inhibitory (parasympathetic) and excitatory (sympathetic) tone, by increasing the inhibitory response of the parasympathetic or vagal system through stimulation of the cardiac branch of the vagus nerve, other disorders such as diabetes and hypertension can also be treated by similar techniques of reducing the autonomic nervous system drive.
From the foregoing description, it will be seen that vagus stimulation for the treatment of CHF can accomplish several clinical objectives, although stimulation parameters may need to be changed for specific outcomes. Stimulation of the vagus above the cardiac branch at a rate sufficient to lower the resting heart rate by a specified percentage, such as 10%-45%, is contemplated to be helpful to allow more time for the heart muscle to repair during muscle contractions. This method is also contemplated to be beneficial in stimulating the growth of additional coronary capillaries, which will supply more blood to the heart muscle. Still further, the method may also be beneficial in dilating the coronary vessels and increasing coronary blood flow, which would aid in recovery and strengthening of the heart muscle.
Since the stimulation lowers the heart rate, it also lowers the immediate exercise tolerance of the patient. Therefore, it is advisable to program this therapy to occur only at night or other times during the day when the patient is resting. Preferably, a metabolic need sensor (which could be a motion sensor, an accelerometer or any of a variety of other detectors of physical exercise, the most preferred being those that are simple and effective, e.g., combined within the stimulator itself and not otherwise invasive) may be incorporated in or with the implanted device to sense exercise and disable this mode of therapy during exercise.
Stimulation to limit the heart rate to some prescribed percentage increase above the resting heart rate is a mode of therapy whose purpose is to improve the vagal tone or the balance between the sympathetic and parasympathetic systems. The clinical outcome is to assist the cardiac system to remain in a state of control, rather than reaching a lack of control which can lead to tachycardia, fibrillation and sudden death. This approach should be differentiated from that of defibrillators, which stop the fibrillation but do nothing to help the body reach a better state of control; and differentiated from that of using vagal stimulation to limit the upper heart rate for preventing tachycardia. Direct stimulation of the cardiac branch is believed to have the greatest immediate effect, although stimulation of the cervical vagus nerve also improves the LF:HP peak power ratio, an expression of sympathetic dominance.
A technique which delivers a burst of pulses, synchronized with and delayed from the QRS may be the preferred method.
Techniques for adjusting stimulation patterns may be dependent on the clinical outcome. For example, if the objective is to lower the resting heart rate, the clinician would just measure heart rate. If the objective were to limit the upper heart rate to improve sympathetic/parasympathetic stability, the adjustment may need to be made while the patient is exercising, such as on a treadmill. Alternatively, the heart rate variability and specifically the LF:HF peak power ratio or some other specific parameter associated with sympathetic/parasympathetic balance could be measured. These parameters may not respond immediately and stimulation parameters may need to be adjusted over a period of weeks or months to achieve the desired improvement.
Automatic sensing of metabolic need indicated by way of physical activity may be incorporated into these methods and programmed by the physician to allow the patient some degree of heart rate increase during physical exercise. Timers alone could be used for fixed period of exercise, whereas a motion sensor or activity sensor such as an accelerometer may be used for automatic detection of patient activity. The patient might also be provided with a patient activation mechanism of a type described herein to permit increased heart rate.
Typically, the electrode for vagal stimulation is installed on or at the vagus nerve above the cardiac branch or directly on the cardiac branch, usually in the neck area. If the electrode is installed below the cardiac branch, the stimulation does not have a direct effect on the heart rate, but may improve the autonomic system balance.
Although a presently contemplated best mode of practicing the present invention has been disclosed herein by reference to certain preferred methods and embodiments, it will be apparent to those skilled in the field of the invention from a consideration of the foregoing disclosure that variations and modifications may be made without departing from the spirit and scope of the invention. Accordingly, it is intended that the invention shall be limited only to the extent required by the appended claims and the rules and principles of applicable law.
1. A method of treating patients suffering from congestive heart failure (CHF), which comprises identifying a CHF patient, and reducing the heart rate of the identified patient by vagus stimulation to a rate below the low end of the patient's resting rate range, to rest the heart, promote growth of coronary capillaries, and to increase coronary blood flow.
continuing said electrical stimulation of the vagus nerve to maintain the patient's heart rate substantially at said prescribed target rate for a predetermined portion of the period the patient remains at rest.
3. The method of claim 2, including using an implanted programmable neurostimulator to perform the electrical stimulation of the patient's vagus nerve.
4. The method of claim 3, including applying said electrical stimulation to an electrode installed on a branch of the vagus nerve in the patient's neck.
5. The method of claim 2, including performing said electrical stimulation using an electrical pulse waveform.
6. The method of claim 5, including applying a pulse burst synchronized with the P wave or R wave of the patient's cardiac activity.
ceasing or adjusting said electrical stimulation when the detected metabolic need mandates a heart rate higher than the patient's normal resting rate.
8. The method of claim 7, including using an activity sensor to detect the patient's metabolic need.
9. The method of claim 8, including using an accelerometer as said activity sensor to detect the patient's metabolic need.
10. The method of claim 2, including continuing said electrical stimulation of the vagus nerve to maintain the patient's heart rate substantially at said prescribed target rate in a lower heart rate limit range of from 10% to 45% below the patient's normal resting heart rate.
11. The method of claim 2, including continuing said electrical stimulation of the vagus nerve to maintain the patient's heart rate substantially at said prescribed target rate for the entire period the patient remains at rest.
12. The method of claim 2, including continuing said electrical stimulation of the vagus nerve to maintain the patient's heart rate substantially at said prescribed target rate during the normal sleep time according to the patient's circadian rhythm.
13. The method of claim 5 including adjusting the stimulation frequency of the pulses while the heart rate is declining, to reduce the rate at which the patient's heart rate approaches said prescribed target rate.
14. The method of claim 2, including permitting limited patient control of said electrical stimulation of the patient's vagus nerve.
15. A method of treating a patient suffering from autonomic cardiovascular drive disorder, which comprises the steps of electrically stimulating the patient's vagus nerve at or above the cardiac branch with a pulse waveform delivered at an appropriate stimulation rate determined by subjecting the patient to an exercise test, to adjust the patient's heart rate to a physiologically safe target rate in a prescribed upper heart rate limit range above the patient's normal resting heart rate, and monitoring the patient's heart rate to ascertain when it is within said prescribed upper heart rate limit range.
16. The method of claim 15, including using an implanted programmable neurostimulator to perform the electrical stimulation of the patient's vagus nerve.
17. The method of claim 16, including applying said electrical stimulation to an electrode installed on a branch of the vagus nerve in the patient's neck.
18. The method of claim 15, including prescribing said upper heart rate limit range from about 100 BPM to about 150 BPM.
19. The method of claim 15, including performing said electrical stimulation of the vagus nerve only when the patient's heart rate is detected to be below the lower limit of said prescribed upper heart rate limit range.
20. The method of claim 15, including performing said electrical stimulation of the vagus nerve by applying a pulse burst synchronized with the P wave or R wave of the patient's cardiac activity.
21. The method of claim 15, including using a feedback loop to automatically adjust the vagal stimulation rate to maintain the patient's heart rate within said prescribed upper heart rate limit range.
22. The method of claim 15, including determining said appropriate stimulation rate by subjecting the patient to a treadmill test.
23. The method of claim 15, including using a metabolic need sensor to refine said physiologically safe target rate according to physical exertion of the patient.
24. The method of claim 15, including enabling the patient to adjust the heart rate limit within a prescribed range having an upper limit lower than the upper limit of said prescribed upper heart rate limit range.


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John J. Dee, 89, died on July 20, 2018. Born in Syracuse, NY in 1929, Jack was the youngest son of the late William J. Dee and Helen Whalen Dee. Jack was a graduate of Most Holy Rosary and attended Syracuse University (1950) on an academic scholarship and its College of Law (1952), where he was President of his law school graduating class. He was a veteran of the Korea Conflict serving three and one-half years as a Judge Advocate and was discharged with the rank of Captain. Following his discharge, Jack became associated with the law firm of Bond, Schoeneck & King (BS&K) where he practiced law for over 50 years. He served as a member of its Executive Committee and Chair of the Litigation Department.
Jack's life was centered on faith, family, and friends. His strong faith was shared by his wife, life partner and best friend, Dorothy "Dodie" Dee who passed away 10 months ago. Together, they had three sons, William (Jennifer), James (Melone), David (Amanda) and a daughter, Sally. He is also survived by four grandsons, Thomas J., Michael, Elliott, and Liam. Jack was predeceased by his brother, Bill (1965).
Jack and Dodie were lifelong residents of Syracuse. Over the years, they resided in Strathmore, Westvale, Onondaga Hill, and Jamesville. Lifelong friendships were made along the way. Jack gave back to the community. He volunteered as a trustee of St. Charles Borromeo Church, served on the Finance Committee at St. Michael's Church, and was a volunteer at St. Camillus Health & Rehabilitation Center. Jack and Dodie were also longtime members of Bellevue Country Club.
Jack enjoyed an outstanding career as a lawyer with BS&K. He was recognized for his skills as a trial lawyer. He effectively served as a mentor and adviser for many attorneys throughout his career. He was active in the Onondaga County Bar Association throughout his legal career and served as its President in 1997 and was a member of many of its committees at various times. He received the Distinguished Lawyer Award in 1993. Jack was also active in the New York State Bar Association, serving as a Vice-President and member of its Executive Committee for several years and was also a member of its House of Delegates. Jack was a member of the Board of Directors of the New York Bar Foundation, and a member of the American Bar Association, and he was elected in 1977 as a Fellow of the American College of Trial Lawyers.
Never did a kinder man walk the earth. Jack was a true gentleman who genuinely impacted the lives of many people with his kindness and consideration for others. Jack's family and friends will deeply miss him.
His memorial Mass will be held at 11 a.m. on Tuesday, July 24, 2018, at Holy Cross Catholic Church in DeWitt, NY. Calling hours will be held from 9 to 11 a.m. at the church prior to his service. Burial will be in St. Agnes Cemetery.
In lieu of flowers, please send donations in Jack's memory to the Francis House, 108 Michaels Ave., Syracuse, NY 13208.


text:
Q: Multiple (distinct) workspaces per monitor Ubuntu 22.04 / Gnome 3 + tweaks.
I am looking for a way, to have a "distinct group of workspaces per monitor", just like MacOS does (I think it's an incredible productivity increasing feature). However, I can't seem to find a way (or a theme for that matter) which does this
Basically the following:

*

*Laptop with a group (g1) of i workspaces: L_1, ..., L_i.

*Monitor "a" with a group (g2) of k workspaces: M(a)_1, ..., M(a)_k.

*Monitor "b" with a group (g3) of n workspaces: M(b)_1, ..., M(b)_n.

I would like to be able to have "distinct" groups of workspaces per monitor, which I'll be swiping through depending on where my cursor is.
Thoughts?

redpajama_set_name: RedPajamaStackExchange


The Pennsylvania Senate reconvened last week, so in the coming weeks I'll do my best to keep you informed about the latest developments, important debates and pieces of legislation that we are working to pass, improve or defeat. The legislature will be in and out of session just about every week from now through the end of the year, so if you are interested in tracking our progress, contact me directly or visit www.pasenate.com.
If you need help, don't hesitate to call my district office at 215-952-3121, e-mail me at farnese@pasenate.com or visit us at 1802 S. Broad St., Monday through Friday, 9 a.m. to 5 p.m. I also have a mobile office at the Neumann Senior Housing Center (1601 Palmer St.) from 9 a.m. to Noon on the first Wednesday of every month.
Do you have a home evacuation plan? Do you have working smoke detectors on every level of your home? And, do you know what to do if you have a kitchen fire? If not, then you have some work to do to keep you and your family safe. For more information about Fire Prevention Week and how you can prevent and safely respond to a fire, visit www.fpw.org. Also during Fire Prevention Week, all of Philadelphia's fire stations will host open houses between 10 a.m. and 4 p.m. so please stop by to say hello, thank your local firefighter for their service and learn more about fire safety from some of our city's finest first responders.
Your opportunity to apply for health insurance under the Affordable Care Act begins on October 1, 2013, so you can take full advantage of the program when the requirements for personal health coverage go into effect on January 1, 2014. It's an easy process that only requires your household income, monthly budget, Social Security number and health care needs. To learn more you can call 1-888-475-6186 or visit www.healthcare.gov.
Click here to download a checklist of what you need to apply for health insurance.
The Crosstown Coalition of Taxpayers has two new guides to help Philadelphia property owners navigate the city's Actual Value Initiative (AVI) and appeals process: An AVI Appeal Guide and AVI Survival Guide. The guides, which can be found at www.crosstowncoalitiontax.wordpress.com, have information on real estate tax relief programs, homeowner and tenant rebate programs, and senior citizen relief programs.
Remember, the deadline to file an appeal before the Board of Revision of Taxes (BRT) is Monday, October 7, so don't hesitate to call my district office at 215-952-3121 if you have questions or need more information about AVI and your options.
The Philadelphia Gas Works' (PGW) new EnergySense rebate program can help you save money on your energy bills. The $150 professional home assessment will identify ventilation and insulation problems, reduce moisture, control pests and highlight faulty energy equipment that should be replaced. After the assessment, PGW customers can choose to move forward with the recommended work and take advantage of $3,500 in rebates and third‐party financing.
EnergySense is a suite of commercial and residential energy‐efficiency programs that is available to all PGW residential, commercial and industrial customers who own or rent their property. More information is available at www.pgwenergysense.com or by calling 215‐764‐5468.
7 p.m., Frankford Hall, 1210 Frankford Ave.
7 p.m., World Café Live, 3025 Walnut St.
7:30 p.m., Free Library of Philadelphia Central Branch, 1901 Vine St.
Follow me on Facebook and Twitter for the latest news and updates.


This is a guide on GDPR intended to help our customers understand the new regulations, and what they need to do to ensure that their website is compliant. It is not a comprehensive guide to the GDPR, nor is it a substitute for legal advice on the specifics of how the GDPR affects your business.
The General Data Protection Regulation is an EU regulation which comes into force on the 25th of May 2018. It is a regulation which aims to improve data protection for everyone within the EU, by introducing stronger guidelines on data usage, and stiffer penalties for mis-use or mis-handling of data. It replaces the Data Protection Act, which had been in force since 1998. And yes, the changes will still come into place regardless of Brexit.
With a large scale data breach happening almost daily, it's clear that there's a need for better regulation around the handling of personal data, so we're pleased to see this change. And we're working with our clients to understand what we all need to do, in order to ensure compliance.
The legislation talks about 'controllers' and 'processors' of data. In the context of our clients, the controller is the owner of the data (you) and the processor is the organisation that manages or stores your data (us). We both have responsibilities under the new regulations.
The GDPR is designed to bring more effective penalties to bear – to the tune of up to €20 million or 4% of your global annual turnover, whichever is greater. That's the headline. However, the ICO (the organisation responsible for policing the GDPR in the UK) has been clear that it would prefer to educate and support organisations with compliance rather than fine for non-compliance – and that therefore fines will be a last resort.
Almost certainly. If your business collects, processes or stores data from any individuals within the EU, then the new regulation will affect you. Hopefully you'll already be aware of the various ways in which the GPDR will affect your business – here we want to look specifically at how it affects your website.
So how does the GPDR affect my website?
If your website processes any personally identifiable information (sometimes referred to as PII) – even if that's just via enquiry form submissions stored into a database, you're handling personal information and the GPDR applies. So the chances are, changes will need to be made.
For the majority of our clients, the personal data being processed is marketing information. While it's not highly sensitive, it categorically falls within the remit of GDPR, so you will need to understand the new regulations and ensure you're compliant.
All websites will also need to be reviewed in terms of their technical data security measures. In particular it is likely that older websites will need some technical changes, such as migrating from HTTP to HTTPS. We will be able to advise on these specific elements on a case-by-case basis.
Who do I talk to for help with this?


text:
Guidance for Data Users >
Comparing ACS Data >
Comparing 2010 American Community Survey Data
Back to Comparing ACS Data
The 2009 ACS and 2010 ACS 1-year estimates use a different Census base year for the population estimates used in the ACS weighting. As a result, users should use caution when making comparisons across years. Specifically, estimates of the number of people in a given location (population size) are not strictly comparable between these two years. In general, the change to more current population estimates is not expected to have a meaningful impact in the percent distributions, rates, or ratios for non-demographic characteristics for many of the largest geographic areas. The Census Bureau is currently researching the effect on these distributions.
For more details, visit the ACS Research Note
2010 American Community Survey Research Note: Change in Population Controls [<1.0 MB]
Change in Population Controls
Learn more about making the following comparisons:
Comparing the 2010 ACS estimates with Census 2000 (second column below)
Comparing the 2010 ACS 1-year with the 2009 ACS 1-year estimates (third column below)
Comparing the 2010 ACS estimates with 2010 Census (fourth column below)
To learn more about comparing the 2008-2010 ACS 3-year estimates with the 2005-2007 ACS 3-year estimates visit the 3-year to 3-year Comparison Guide page.
Subject Area*
2010 ACS 1-Year,
2008-2010 ACS 3-Year, and 2006-2010 ACS 5-Year with Census 2000
2010 ACS 1-Year with 2009 ACS 1-Year
2010 ACS 1-Year, 2008-2010 ACS 3-Year, and 2006-2010 ACS 5-Year with 2010 Census
Age and Sex (01)
2010 ACS with Census 2000
Age Compare with Caution
The entire population continually ages into older age groups over time and babies fill in the youngest age group. So, the population of a certain age is made up of a completely different group of people from one time period to the next. Since populations occasionally experience booms/increases and busts/decreases in births, deaths, or migration (for example, the postwar Baby Boom from 1946-1964), one should not necessarily expect that the population in an age group in Census 2000 should be similar in size or proportion to the population in the same age group in different data year(s). For example, Baby Boomers were age 36 to 54 in Census 2000 while they were age 46 to 64 in the 2010 ACS 1-year, between ages 44 to 64 in the 2008-2010 3-year period, and between ages 42 to 64 in the 2006-2010 5-year period. So, the age group 55 to 59 would show a considerable increase in population when comparing Census 2000 data with the single year or multiyear ACS data.
Compare with Caution
Data from the 2010 ACS were controlled to independent estimates of the population by sex, age, race, and Hispanic origin that were based on the 2010 Census counts. Estimates of these demographic variables may vary in size and distribution compared to prior ACS years which were based on Census 2000 population counts. For more details, visit the ACS Research Note Change in Population Controls [PDF - <1.0 MB].
Sex Compare
Beginning with the 2008 ACS questionnaire, the layout of the sex question response categories was changed to a horizontal side-by-side layout from a vertically stacked layout on the mail paper ACS questionnaire. For more information on differences in the questionnaire, see 2007 ACS Grid-Sequential Test report.
Race Compare with Caution
The ACS question on race was revised in 2008 to make it consistent with the Census 2010 race question. Any change, compared with Census 2000, may be due to demographic changes, questionnaire changes, differences in ACS population controls, and/or methodological differences in the population estimates.
In addition, the observed changes between the 2009 ACS and the 2010 ACS race estimates may be attributed to a number of factors. Demographic change since 2009, which includes births and deaths in a geographic area and migration in and out of a geographic area, will have an impact on the resulting 2010 ACS estimates. Additionally, changes in race reporting patterns, as well as changes in the coding of race write-in responses and editing to follow 2010 Census guidelines may have influenced the results of the 2010 ACS. Also, while the ACS produces population, demographic and housing unit estimates, the 2010 Census provides the official race and Hispanic origin counts of the U.S. population and housing units.
An error was discovered in the processing of the 2009 ACS data for four of the detailed checkboxes within the Asian category (Japanese, Korean, Vietnamese, and Other Asian). These errors impact the data for the detailed Asian groups and, therefore, comparisons of the 2009 and 2010 estimates should be made with caution. Users may compare estimates for all other groups.
Hispanic Origin (03)
Hispanic or Latino Origin Compare with Caution
The ACS question on Hispanic origin was revised in 2008 to make it consistent with the Census 2010 Hispanic origin question. Any change, compared with Census 2000, may be due to demographic changes, questionnaire changes, differences in ACS population controls, and/or methodological differences in the population estimates.
Data from the 2010 ACS were controlled to independent estimates of the population by sex, age, race, and Hispanic origin that were based on the 2010 Census counts. Estimates of these demographic variables may vary in size and distribution compared to prior ACS years which were based on Census 2000 population counts. In addition, the 2010 ACS implemented a variety of new Hispanic origin coding changes to be consistent with the 2010 Census coding rules for Hispanic origin. These coding changes may have influenced the 2010 ACS Hispanic origin results. For more details, visit the ACS Research Note Change in Population Controls [PDF - <1.0 MB].
Ancestry Compare
Ancestry is the only item for which a "not reported" category is published since missing ancestries are never assigned or allocated. The extent of missing ancestry answers was higher in Census 2000 than in the ACS. The difference in the level of response may contribute to the difference in the two distributions.
The 2009 ACS and 2010 ACS 1-year estimates use different Census base years for the population estimates used in the ACS weighting. Estimates of population size are not comparable between 2009 and 2010. Estimates of percent distributions, rates, and ratios should be compared with caution. For more details, visit the ACS Research Note Change in Population Controls [PDF - <1.0 MB].
In addition, the ancestry coding rules changed in 2010.
The question was not asked in the 2010 Census
Foreign Born; Citizenship; Year of Entry; Nativity (05)
Citizenship Status Compare Compare with Caution
Nativity Compare Compare with Caution
Year of Entry Compare
Census 2000 represents data collected as of April 1, 2000 and thus the "2000" year of entry category accounts for the first quarter (Jan-Mar) in 2000 only. The ACS represents data collected throughout the entire year and thus the "2000" year of entry category accounts for the entire year of 2000.
Place of Birth (06)
Place of Birth Compare Compare with Caution
Residence 1 year ago; Migration (07)
Residence 1 Year Ago (Migration) Do Not Compare
The ACS asked for residence 1 year ago whereas Census 2000 asked for residence 5 years ago.
Journey to Work; Workers; Commuting (08)
Means of Transportation to Work Compare
The ACS excludes taxicabs in the tabulation category of "public transportation" and includes them in the category "taxicab, motorcycle, bicycle or other means." However, Census 2000 includes taxicabs in the "public transportation" tabulation category.
Place of Work Compare Compare with Caution
Private Vehicle Occupancy Compare Compare with Caution
Time Leaving Home Compare Compare with Caution
Travel Time to Work Compare Compare with Caution
Children; Household Relationship (09)
Relationship to Householder Do Not Compare
The ACS used a joint relationship/marital status edit and Census 2000 did not. Also, Census 2000 provided more response categories because of a write-in option that was not used in the ACS. Differences in weighting schemes between the census and the ACS could produce inconsistencies in comparisons.
Do Not Compare
The ACS used a joint relationship/marital status edit and Census 2010 did not. The ACS also has a category for foster children which is not in Census 2010. Differences in weighting schemes between the census and the ACS could produce inconsistencies in comparisons.
Grandparent; Grandchildren (10)
Grandparents as Caregivers Compare Compare with Caution
Household Type; Family Type; Subfamilies (11)
Household/Family Type Do Not Compare
The ACS used a joint relationship/marital status edit and Census 2000 did not--these edits are used to determine categories of family types. Also, Census 2000 provided more response categories because of a write-in option that was not used in the ACS. Differences in weighting schemes between the census and the ACS could produce inconsistencies in comparisons.
Subfamilies Do Not Compare
Census 2000 had more detailed relationship categories than were available in the ACS to derive estimates of subfamilies. In addition, the weighting schemes that were used to produce the final estimated numbers of subfamilies were different.
Marital Status and History (12)
Marital Status Compare
The ACS used a joint relationship/marital status edit and Census 2000 did not.
Marital History The question was not asked in Census 2000 Compare with Caution
Fertility The question was not asked in the 2010 Census Compare with Caution
School Enrollment (14)
Type of School & School Enrollment Compare
The ACS reference period was 3 months preceding the date of interview, while the Census 2000 reference period was any time since February 1, 2000.
Educational Attainment (15)
Educational Attainment Compare
The ACS has two separate categories for completing high school - "Regular high school diploma" and "GED or alternative credential". Census 2000 has only one category for completing high school - "HIGH SCHOOL GRADUATE - high school diploma or equivalent (for example: GED)". As a result, users may see differences in distributions when comparing Census 2000 to ACS data from 2008 and later years.
Field of Degree The question was not asked in Census 2000 Compare with Caution
In addition, the 2010 ACS field of degree codes differ slightly from 2009 ACS field of degree codes. Changes in the resulting distribution of field of degree are small but may be most impacted by the movement of general science from "Multi-Disciplinary Fields" to "Physical and Related Science Fields".
Language Spoken at Home and Ability to Speak English (16)
Ability to Speak English Compare Compare with Caution
Language Spoken at Home Compare Compare with Caution
Poverty Status of Families and People in Families Compare with Caution
The ACS collects data throughout the year on an on-going, monthly basis and asks for a respondent's income over the "past 12 months" Census 2000, however, collected the income data for a fixed period of time -- "during 1999" (the last calendar year). For example, the 2010 ACS 1-year data reflect incomes over 2009-2010, the 2008-20010 ACS 3-year data reflect incomes over 2007-2010, and the 2006-2010 ACS 5-year data reflect incomes over 2005-2010. In a comparison study between Census 2000 income data and the 2000 ACS, income collected in Census 2000 was found to be about 4 percent higher than that in the 2000 ACS. For more information on the differences of income in the ACS and Census 2000, see Income in the American Community Survey: Comparisons to Census 2000. For specific questions and answers about sources of poverty data, see Questions and Answers about Sources of Poverty Data [PDF - <1.0 MB].
In addition, as ACS data are collected every month of the year, adjacent years will have some reference months in common. Hence, comparing the 2010 ACS 1-year with the 2009 ACS 1-year estimates is not an exact comparison of the economic conditions in 2010 with those in 2009. For a discussion of this and related issues, see Howard Hogan´s "Measuring Population Change Using the American Community Survey," in Applied Demography in the 21st Century (by Steven H. Murdock and David A. Swanson eds., Springer Netherlands, 2008). For specific questions and answers about sources of poverty data, see Questions and Answers about Sources of Poverty Data [PDF - <1.0 MB].
Poverty Status of All People in the Poverty Universe Compare with Caution
The ACS collects data throughout the year on an on-going, monthly basis and asks for a respondent's income over the "past 12 months." Census 2000, however, collected the income data for a fixed period of time -- "during 1999" (the last calendar year). For example, the 2010 ACS 1-year data reflect incomes over 2009-2010, the 2008-20010 ACS 3-year data reflect incomes over 2007-2010, and the 2006-2010 ACS 5-year data reflect incomes over 2005-2010. In a comparison study between Census 2000 income data and the 2000 ACS, income collected in Census 2000 was found to be about 4 percent higher than that in the 2000 ACS. For more information on the differences of income in the ACS and Census 2000, see Income in the American Community Survey: Comparisons to Census 2000. For specific questions and answers about sources of poverty data, see Questions and Answers about Sources of Poverty Data [PDF - <1.0 MB].
Hearing / Vision difficulty Do Not Compare
The 2010 ACS disability questions are different from the Census 2000 disability questions, thus comparisons cannot be made.
Cognitive / Ambulatory / Self-care difficulty Do Not Compare
Independent Living difficulty Do Not Compare
Income (Households and Families) (19)
Household and Family Incomes Compare with Caution
The ACS collects data throughout the year on an on-going, monthly basis and asks for a respondent's income over the "past 12 months." Census 2000, however, collected the income data for a fixed period of time -- "during 1999" (the last calendar year). For example, the 2010 ACS 1-year data reflect incomes over 2009-2010, the 2008-2010 ACS 3-year data reflect incomes over 2007-2010, and the 2006-2010 ACS 5-year data reflect incomes over 2005-2010. In a comparison study between Census 2000 income data and the 2000 ACS, income collected in Census 2000 was found to be about 4 percent higher than that in the 2000 ACS. For more information on the differences of income in the ACS and Census 2000, see Income in the American Community Survey: Comparisons to Census 2000. The Census Bureau recommends using CPI-U-RS adjustment factors published annually by the Bureau of Labor Statistics (BLS) to adjust 1999 median, mean, and per capita income dollar amounts shown in Summary File 3 to 2010 dollars by multiplying the 1999 dollar amounts by the CPI-U-RS factor of 1.30854107. For CPI-U-RS inflation adjustment factors for other years see: BLS Consumer Price Index. Furthermore, direct comparisons of income and earnings distributions between Census 2000 and the 2010 ACS are not possible due to inflation. Users interested in making distribution comparisons need to inflation adjust individual income records using the Public Use Microdata Samples (PUMS) files from Census 2000.
In addition,as ACS data are collected every month of the year, adjacent years will have some reference months in common. Hence, comparing the 2010 ACS 1-year with the 2009 ACS 1-year estimates is not an exact comparison of the economic conditions in 2010 with those in 2009. For a discussion of this and related issues, see Howard Hogan´s "Measuring Population Change Using the American Community Survey," in Applied Demography in the 21st Century (by Steven H. Murdock and David A. Swanson eds., Springer Netherlands, 2008). For specific questions and answers about sources of poverty data, see Questions and Answers about Sources of Poverty Data [PDF - <1.0 MB].
Sources of Income (households) Compare with Caution
The ACS collects data throughout the year on an on-going, monthly basis and asks for a respondent's income over the "past 12 months." Census 2000, however, collected the income data for a fixed period of time -- "during 199" (the last calendar year). In a comparison study between Census 2000 income data and the 2000 ACS, income collected in Census 2000 was found to be about 4 percent higher than that in the 2000 ACS. For more information on the differences of income in the ACS and Census 2000, see Income in the American Community Survey: Comparisons to Census 2000. The Census Bureau recommends using CPI-U-RS adjustment factors published annually by the Bureau of Labor Statistics (BLS) to adjust 1999 median, mean, and per capita income dollar amounts shown in Summary File 3 to 2010 dollars by multiplying the 1999 dollar amounts by the CPI-U-RS factor of 1.30854107. For CPI-U-RS inflation adjustment factors for other years see: BLS Consumer Price Index. Furthermore, direct comparisons of income and earnings distributions between Census 2000 and the 2010 ACS are not possible due to inflation. Users interested in making distribution comparisons need to inflation adjust individual income records using the Public Use Microdata Samples (PUMS) files from Census 2000.
Earnings and Income (Individuals) (20)
Per Capita Income, Earnings (people), and Income (people) Compare with Caution
The ACS collects data throughout the year on an on-going, monthly basis and asks for a respondent's income over the "past 12 months." Census 2000, however, collected the income data for a fixed period of time -- "during 1999" (the last calendar year). For example, the 2010 ACS 1-year data reflect incomes over 2009-2010, the 2008-2010 ACS 3-year data reflect incomes over 2007-2010, and the 2006-2010 ACS 5-year data reflect incomes over 2005-2010. In a comparison study between Census 2000 income data and the 2000 ACS, income collected in Census 2000 was found to be about 4 percent higher than that in the 2000 ACS. For more information on the differences of income in the ACS and Census 2000, see Income in the American Community Survey: Comparisons to Census 2000. The Census Bureau recommends using CPI-U-RS adjustment factors published annually by the Bureau of Labor Statistics (BLS) to adjust 1999 median, mean, and per capita income dollar amounts shown in Summary File 3 to 2010 dollars by multiplying the 1999 dollar amounts by the CPI-U-RS factor of 1.30854107. For CPI-U-RS inflation adjustment factors for other years see: BLS Consumer Price Index . Furthermore, direct comparisons of income and earnings distributions between Census 2000 and the 2010 ACS are not possible due to inflation. Users interested in making distribution comparisons need to inflation adjust individual income records using the Public Use Microdata Samples (PUMS) files from Census 2000.
The 2009 ACS and 2010 ACS 1-year estimates use different Census base years for the population estimates used in the ACS weighting. Estimates of population size are not comparable between 2009 and 2010. Estimates of percent distributions, rates, and ratios should be compared with caution. For more details, visit the ACS Research Note
Change in Population Controls [PDF - <1.0 MB].
The question was not asked in 2010 Census
Veteran Status (21)
Period of Military Service
Since Census 2000, the period of military service categories on the ACS questionnaire were updated to: 1) include the most recent period "September 2001 or later;" 2) list all "peace time" periods without showing a date-breakup in the list; and 3) update the Korean War and World War II dates to match the official dates as listed in US Code, Title 38. While the response categories differ slightly from those in Census 2000, data from the two questions can still be compared to one another.
The ACS has two separate questions, whereas in Census 2000, it was a two part question. However, the actual questions remain the same. 2010 ACS splits the answer category for the question: "Has this person ever served on active duty in the U.S. Armed Forces, military Reserves, or National Guard" into two more detailed categories. However, the data from this question can still be compared across these two survey years.
Service-Connected Disability Status and Ratings The question was not asked in Census 2000
Food Stamp Benefit The question was not asked in Census 2000
Employment Status; Work Experience; Labor Force (23)
The reference periods are different due to year-round ACS data collection. The ACS reference period is the week prior to the respondent completing the interview, or the field representative conducting the interview. Because questionnaires are mailed-out and field interviews are conducted throughout the year, there is a revolving reference period. For Census 2000, the reference period was the week prior to Census Day (April 1, 2000). The Census 2000 Summary File 3 (SF3) labor force data for some places where colleges are located appear to overstate the estimates of people in the labor force, the unemployed, and the percent unemployed because of data capture errors.
The ACS reference period is 12 months preceding the date of interview, while the Census 2000 reference period was the 1999 calendar year.
Weeks Worked
Industry & Occupation; Class of Worker (24)
The 2010 ACS Industry by Class of Worker tables combine "Unpaid family workers" with "Self-employed in own not incorporated business workers." The Census 2000 tables use different tabulation categories than the ACS. Also, the Census 2000 tables did not include the "full-time, year-round" population and there were no median earnings Class of Worker tables. Thus, comparisons cannot be made for this population or characteristic.
Census 2000 codes are 3-digit codes and are based on the NAICS 1997. The 2010 ACS industry codes are 4-digit codes and are based on the 2007 NAICS. Codes and descriptions, particularly within the Electronic Shopping, Wholesale, and Information categories changed.
Census 2000 occupation codes are 3-digit codes based on Standard Occupation Classification (SOC) 2000. The 2010 ACS occupation codes are 4-digit codes based on SOC 2010. Codes and descriptions, particularly within the information technology, healthcare, printing, and human resources occupation categories changed. For a summary of 2010 code changes and a Census 2002 to 2010 occupation crosswalk, visit http://www.census.gov/people/io/methodology/.
The 2009 ACS and 2010 ACS 1-year estimates use different Census base years for the population estimates used in the ACS weighting. Estimates of population size are not comparable between 2009 and 2010. Estimates of percent distributions, rates, and ratios should be compared with caution. For more details, visit the ACS Research Note <br> <a href=">Change in Population Controls [PDF - <1.0 MB].
In addition, the 2009 ACS occupation codes are 4-digit codes based on Standard Occupation Classification (SOC) 2000. The 2010 ACS occupation codes are 4-digit codes based on SOC 2010. Codes and descriptions, particularly within the information technology, healthcare, printing, and human resources occupation categories changed. For a summary of 2010 code changes and a Census 2002 to 2010 occupation crosswalk, visit http://www.census.gov/people/io/methodology/
Bedrooms Compare with Caution
Beginning in 2008, the ACS bedrooms question contained different wording and response options than the Census 2000 question.
Contract and Gross Rent Do Not Compare
For Census 2000, tables were not released for total renter-occupied units. The universe in the ACS is "renter occupied" whereas in Census 2000 the universe was "specified renter-occupied housing units," thus comparisons cannot be made.
Cost of Utilities Compare Compare with Caution
Gross Rent as a Percentage of Household Income Do Not Compare
For Census 2000, tables were not released for total renter-occupied units. The universe in the ACS is "renter occupied" whereas in Census 2000, the universe was "specified renter-occupied housing units," thus comparisons cannot be made.
House Heating Fuel Compare Compare with Caution
Kitchen Facilities Compare with Caution
Changes made between 2007 and 2008 to the ACS question wording as well as the response option resulted in an increase in the "Lacking Kitchen Facilities" category compared with pre-2008 ACS and Census 2000. For more details, see Errata #53.
Monthly Rent Compare Compare with Caution
Mortgage Status Compare
With a mortgage/without a mortgage released in Census 2000 for both total owner-occupied units and specified owner-occupied units.
Occupants per Room Compare with Caution
Beginning in 2008, the ACS rooms question contained different wording and response options than the Census 2000 question.
Owner Costs as a Percentage of Household Income Compare with Caution
For Census 2000, tables with full distribution were released for total owner-occupied units but medians were not shown. When available, compare like universes.
Plumbing Facilities Compare with Caution
Changes made between 2007 and 2008 to the ACS question wording as well as the response option resulted in an increase in the "Lacking Plumbing Facilities" category compared with pre-2008 ACS and Census 2000.
Real Estate Taxes Do Not Compare
The universe in the ACS is "owner occupied" whereas in Census 2000, the universe was "specified owner-occupied housing units," thus comparisons cannot be made.
Rooms Compare with Caution
Selected Monthly Owner Costs Compare with Caution
For Census 2000, tables with full distributions were released for total owner-occupied units but medians were not shown. When available, compare like universes.
Telephone Service Compare with Caution
In 2008, there was a change in the wording and response options for the the ACS question on telephone service.
Tenure Compare Compare with Caution
Units in Structure Compare Compare with Caution
Vacancy Status Compare with Caution
The tabulation category "Rented or sold, not occupied" in Census 2000 is separated into two categories "Rented, not occupied" and "Sold, not occupied" in the ACS.
Because the 2010 Census and the American Community Survey differ in their design and data collection methods, users should note that estimates of vacancy rates may also differ. For more information on vacancy rates in the 2010 Census and ACS, visit the ACS User Note or preliminary results report.
Value of Property Compare with Caution
Unlike Census 2000, the ACS allowed a write-in for values over $250,000 until 2007. Beginning in 2008, value was collected as a continuous variable. For Census 2000, tables with full distribution, medians, and aggregate values were released for both specified owner-occupied units as well as total owner-occupied units. ACS only releases tables for total owner-occupied units. When making comparisons users should compare like universes.
Vehicles Available Compare Compare with Caution
Year Moved In Compare Compare with Caution
Year Structure Built Compare Compare with Caution
Group Quarters (26)
Group Quarters Population Compare with Caution
The total group quarters (GQ) population in the ACS may not be comparable with Census 2000 because: 1) There are some Census 2000 GQ types that were out of scope in the ACS such as domestic violence shelters and soup kitchens. Also, there are some Census 2000 GQ type categories that are no longer valid (residential care facility providing "Protective Oversight," hospitals/wards for the chronically ill and hospitals/wards for drug/alcohol abuse). The exclusion of these GQ types from the ACS may result in a small bias in some ACS estimates to the extent that the excluded population is different from the included population. 2) A sample of GQ facilities throughout the United States and Puerto Rico were selected for the ACS. ACS controls the GQ sample at the state level only. Therefore, for lower levels of geography, particularly when there are relatively few GQs in a geographic area, the ACS estimate of the GQ population may vary from the estimate from Census 2000.
Compare with Caution - Do Not Compare below State level
The group quarters data from the 2010 ACS were controlled to independent estimates based on the 2010 Census counts. Estimates of the group quarters population may vary in size and distribution compared to prior ACS years which were based on Census 2000 population counts. The weighting for the group quarters (GQ) population is controlled at the state level, but not at sub-state levels. For this reason, users may observe greater fluctuations in year-to-year ACS estimates of the GQ population at sub-state levels than at state levels. The causes of these fluctuations typically are the result of either GQs that have closed or where the current population of the GQ is significantly different than the expected population as reflected on the sampling frame. Substantial changes in the ACS GQ estimates can impact ACS estimates of total population characteristics for areas where either the GQ population is a substantial proportion of the total population or where the GQ population may have very different characteristics than the total population as a whole. Users can assess the impact that year-to-year changes in sub-state GQ total population estimates have on the changes in total ACS population estimates by accessing Table B26001 on American Fact Finder. Users should also use their local knowledge to help determine whether the year-to-year change in the ACS estimate represents a real change in the GQ population or may be the result of the lack of adequate population controls for sub-state areas. For more details, visit the ACS Research Note Change in Population Controls [PDF - <1.0 MB].
Compare with Caution at National and State level - Do Not Compare below State level
The ACS group quarters (GQ) population at sub-state levels may not be comparable to the 2010 Census data. The weighting for the group quarters (GQ) population is controlled at the state level, but not at sub-state levels. For this reason, users may observe larger differences between the ACS and 2010 Census population at sub-state levels than at state levels. The causes of these differences typically are the result of either GQs that have closed or where the current population of the GQ is significantly different than the expected population as reflected on the sampling frame. Substantial changes in the ACS GQ estimates can impact ACS estimates of total population characteristics for areas where either the GQ population is a substantial proportion of the total population or where the GQ population may have very different characteristics than the total population as a whole.
Health Insurance The question was not asked in Census 2000 Compare with Caution
*Each subject area is listed with its 2-digit code identifier. This code corresponds to the second and third characters of the ACStable number. For example, Table B08303 - Travel Time to Work has the second and third digits of "08" which corresponds to the subject Journey to Work; Workers; and Commuting.

redpajama_set_name: RedPajamaCommonCrawl


text:
NYWIFT Names Jamie Zelemyer Board of Directors President
New York Women in Film & Television has named Jamie Zelermyer as its new board of directors president. Zelermyer has served on the NYWIFT board for four years, most recently as vice president of special events through which she oversaw the production of the 2017 and 2018 NYWIFT Muse Awards. She has been a New York-based producer and production executive for over 20 years and is currently producing Independent Feature Project's signature program, IFP Week.
Zelermyer was the VP, physical production at Focus Features / Rogue Pictures for six years, where she oversaw films including Admission, One Day, Jane Eyre, Sin Nombre and Miss Pettigrew Lives For A Day. Most recently, she was the program manager of the Made In New York: Pilot Competition, a program founded by The Mayor's Office of Film Media and Entertainment to tackle gender inclusivity in the television industry; she executive produced the two winning half hour pilots and executive produced season one of the winning show, Half Life.
"We are thrilled to have Jamie Zelermyer lead NYWIFT into a new era of increased advocacy and awareness for women's representation, equality, and safety in film, television and digital media," said NYWIFT executive director Cynthia Lopez. "Her decades of industry experience as well as her intimate understanding of the needs of the NYWIFT community will make her a bold, compassionate and astute leader for our organization."
"I am humbled and honored to take over the presidency of New York Women in Film & Television and to collaborate with the other distinguished women on our board," said Zelermyer. "The organization's mission of equity and advocacy are as important as ever and I look forward to working with Cynthia Lopez and the entire NYWIFT team as we continue to support women at every level throughout the industry."
Zelermyer succeeds former president Simone Pero, the founder of For Impact Productions. Pero's championing of women is a hallmark of her work as a producer of social impact film including Jennifer Fox's Emmy-nominated The Taleon HBO and as executive producer of Tom Donahue's documentary This Changes Everything about gender discrimination in media.
"We are infinitely grateful to Simone Pero for her leadership, insight and unparalleled dedication to advancing women across all levels and facets of the industry," said Lopez. "I look forward to collaborating with her in a new capacity through NYWIFT's Advisory Board."
NYWIFT is also pleased to announce the results of the 2019 board of directors election. Seven spots on the board have been filled, with four new members and three returning members.
The new members are Alex Cirillo, Kerry Fulton, Gretchen McGowan and Zenaida Mendez. Returning members are Christine Bragan, Kathryn O'Kane and S. Casper Wong.
New York Women in Film & Television http://www.nywift.org


Joining two separate apartments at 1880's building located in the heart of London (near Hyde Park) TG Studio creates elegant modern living space in a location that hasn't been renovated for over 40 years. The designers won the commission by suggesting some major changes with the architectural layout of the space (merger of rooms, moving the entertainment area in the front, forming a new corridor, etc.) combined with bold and stylish approach to the interior design, The project successfully merges modern innovations and appliances, for a comfortable lifelifestyle, with thoughtful attention to the art elements of the interior; the heated floors trough the apartment are covered with stylish wood panels, the kitchen is hilly functional with clean lines and minimalistic, individually manufactured design.
Every room and space in this apartment deserves special attention thanks to its unique architectural solution, high quality furnishing and artful elements that bring modern but earthly look to the outcome. The bathrooms – finished in grey marble and wood paneling are exceptionally stylish but not boring thanks to a few art elements and splashes of color. In the master bedroom, the attention is drawn by the oak and metal cantilevered bookshelves that are custom made for this space. The whole interior of the apartment is decided in the classical beige- gray –whitish tonality but with livening notes of dazzling blue, yellow and red. Very playful indeed- the whole apartment interior is revolving around that- clean classical lines and colors with dazzling art elements like the cushions of the sofa- reference to Picasso painting- or the stone sculptures placed at the custom made shelves and African design tables. An apartment created to stimulate the imagination as well as the sense of style and elegance.


text:
Q: Owl Carousel 'loop' duplicating items unnecessarily I'm having a hard time trying to make the loop option, when enabled, not duplicate the elements needed to cause the illusion of loop when the markup doesn't have enough items.
For example, with this markup:

I've defined the basic structure that fits 3 images visible in Bootstrap 4 col-md-7. The others stay hidden, accessible through the Carousel, with not much of a special configuration:
$( '.owl-carousel' ).owlCarousel({

      loop: true,
      margin: 10,
      dots: false,
      navText: [ '', '' ],
      responsive:{

        0: {
            items: 1,
            nav: false
        },

        1000: {
            items: 3,
            nav: true
        }
    }
})

It would be perfect if I always have at least three

 and that's the problem. Because it's "pseudo-dynamic' (with Hugo), when published, it's not going to have much content, so it's obvious that this Carousel will not have this minimum amount.
I've searched for a solution and found this but it didn't work for me, even though it should. I created a Fiddle to isolate the issue, with multiple Carousels to simulate what I really have and, at first it worked, no unnecessary duplication, but then I saw the execution was set in the windows.onload which, for some reason I'm not aware of, was making that ternary always eval to false.
First I thought it could be because jQuery.size() doesn't exist anymore, but even changing it to the native length it was still repeating.
I've reviewed the source-code several times to see if Hugo was generating the correct markup and, except for some fancies here and there of the real implementation that could interfere, it was all good.
A workaround that made it almost work was by generating dummy

 after Hugo's "loop" (range). But as side effect this brought the navigation arrows/buttons that, if clicked a few times, eventually will position Owl's offset at the blank, fake entries.
Any ideas of what else could be wrong?


Electric shades seem like a luxury until you have them. Then you wonder how you did without. Installing powered blinds can add an impressive finishing touch to your home theater, offer security when your family's on vacation or create a convenient motorized solution for hard-to-reach blinds.
Improve viewing and impress your friends with a realistic home theater experience—set the mood with power curtains that close automatically when your entertainment center is turned on.
Electric shades are great for large or out-of-reach windows, and can be set to open and close when you're not home for an added security feature.


Living so close to one of the United States largest deltas, South Alabama waterfowl hunters are truly blessed. This large wetland area is home to thousands of annual feathered visitors. Each December, large numbers of ducks migrate into the Mobile-Tensaw Delta with equally large numbers of hunters eagerly awaiting to start their delta duck hunting.
There's no question that the sport of duck hunting has seen a great increase in popularity over the last five to 10 years. Many people place the blame on the reality TV show, Duck Dynasty. Duck hunting is now 'cool.' Others credit the introduction of shallow drive mud motors that have taken a lot of the work out of what once was a grueling, difficult sport. Whatever the reason, South Alabama hunters love their ducks!
The primary area of the Lower Mobile-Tensaw Delta, where delta duck hunting takes place, is the W.L Holland Wildlife Management Area. This area is comprised of prime duck habitat. Grassy shallow water bays, grass-lined creeks and tucked away potholes all hold lots of ducks at various times of the season. The Holland WMA holds gadwalls, teal, shovelers, pintail, widgeon, scaup, redheads, wood ducks, mallards and mottled ducks. Of all the ducks just mentioned, gadwalls are the 'bread and butter" ducks taken most often.
Tommy Lovell of Mobile is looking forward to his 57th year of hunting ducks on the Mobile-Tensaw Delta. Starting back in 1960, Lovell has seen the best and worst of times delta duck hunting. Some things make him shake his head in disgust and some things make him smile from ear to ear.
When Lovell began his Causeway hunting career, things were tough! Every duck you got – you earned! No tunnel hull boats or mud motors back then, hunters used muscle power to get to the ducks.
The pressure from hunters was much less than now as well, according to Lovell. Blinds were not set as close to each other as the crowded conditions today seem to promote.
Tommy Lovell used his more than 55 years of experience to take these fine specimens.
Taking delta ducks is still a do-able thing despite the pressure. You just have to pay more attention to details. It's the little things that make the difference.
Decoy usage is quite important for delta ducks. Lovell had this advice to improve your odds hunting the delta.
Concealment is very important when hunting the highly pressured ducks of the Mobile-Tensaw Delta. Wary ducks inspect everything before committing to the decoys. Lovell's thoughts on blinds can help both the novice or veteran hunters.
Lovell also has some thoughts about blind location. "I try and stay close to the bank when using my pop-up blind. I don't like to be way out in the middle without any background breakup," Lovell said.
Despite the heavy pressure, the Mobile-Tensaw Delta will start to thin out as duck hunters experience tough hunting with meager results. Lovell had these thoughts.
"When the hunting gets really tough and the weather turns harsh, a lot of folks quit. That's probably a big mistake. We get our best hunting then. We need the weather to bring down the ducks, along with high winds to push the ducks off Mobile Bay and up into the Mobile-Tensaw Delta," Lovell explained.
Almost no duck hunting experience can be complete without the use of a duck call to attract the ducks to your decoy spread. With highly pressured ducks, calling them can really be tricky.
This year, the state put a couple areas in the Delta either off-limits are restricted the use of gas-powered engines. Lovell had these comments on those new rules.
The Mobile-Tensaw Delta ducks are some of the most highly pressured ducks on the Gulf Coast. By following a delta veteran like Tommy Lovell's advice, you too can experience the "good old days." See you in the marsh!
Mike Thompson, AKA "Capt. T-Bone," is a longtime coastal communicator. Through his print, radio and personal appearances, he has entertained coastal sportsmen for decades.
Having a father who along with L G Adams, Tom Bagwell, Buddy Green and a host of other dedicated duck hunters from "back in the day", mid 60's to middle 70's, I was able to delta duck hunting at its best. I hunted with a couple of friends who like myself at the time, would rally on every occasion to venture up the river towards Mudhole Creek. Rain, fog, wind. Didn't matter. We were going. It was a lot different then in that you pretty much knew most of the hunters up there. To the point that at first light, heck, you would know who shot the first shot and got the morning kicked off. The delta is an amazing place. To be respected no different than the mighty Gulf of Mexico. It can reward you and it can beat you down in the same trip. Know where your going, let others know where that is, and, if it changes please tell someone. Experience is a good thing, but not a pass that something out of the ordinary could happen and leave you needing help.
Have respect for your fellow hunters as well. Communication is the key to making sure that every chance you get to head to the delta, is a safe and successful one.
Listen to what Mike says. He along with a couple of his good friends are as good as it gets.


Feature any location on the face of one of these wooden map letters. Choose any letters to spell any word you wish. Keep a memory of a honeymoon or wedding location of far-flung destinations. A perfect honeymoon keepsake gift for a couple. You really can us them any location and we will feature it on the wooden initial of your choice.