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Global Summer Institute
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Global Reproductive and Sexual Health Summer Institute
Offered by the University of Michigan School of Nursing, with faculty from across the health sciences, this second annual UMSN Summer Institute is designed to help participants gain a broad insight into contemporary issues in reproductive and sexual health. This short, intensive course will allow participants to gain the skills and knowledge to advance their inquiry in global reproductive and sexual health through a two-day conference followed by a five-day workshop. Participants may choose to attend the two-day conference only, or both the conference and the workshop.
The University of Michigan School of Nursing Summer Institute in Global Reproductive and Sexual Health is intended, but not limited to: nurses, midwives, social workers, physicians, junior faculty, post-doctoral fellows, researchers or investigators, the ministry of health personnel, non-governmental organization monitoring and evaluation staff, and others with an interest in global reproductive and sexual health and research.
2-day Conference
The two-day conference will focus on reproductive coercion, human trafficking, and gender-based violence with experts in the field presenting up-to-date research and practical clinical approaches to working with vulnerable populations.
Describe the different forms of gender-based violence
Describe reproductive coercion and how it is linked to gender-based violence
Describe how reproductive coercion is measured
Identify the consequences of reproductive coercion
Discuss programs and interventions for reducing reproductive coercion
Identify the types and venues of human trafficking around the world
Explore screening questions and tools that might be useful to identify victims of human trafficking
Discuss models for educating healthcare providers about gender based violence
Describe the neurobiology of trauma
Discuss potential prevention programs for gender-based violence and human trafficking
5-day Workshop
Building on the content from the 2-day conference, this 5-day workshop will give participants an opportunity to develop beginning competencies in the design and evaluation of culturally and developmentally appropriate interventions to improve reproductive and sexual health across a multitude of settings.
Understand how to design impactful studies
Discuss different measurement aspects of a study
Understand the steps that are required when designing quantitative research studies
Describe the differences in quantitative research designs
Understand and articulate issues of reliability and validity
Explore the ethical issues associated with a range of research designs
Describe how to connect program objectives to key monitoring tasks
Develop a program monitoring plan with key essential components
Download the full agenda.
University of Michigan School of Nursing, 426 N. Ingalls Street, Ann Arbor, MI 48109
Dates: May 10-17, 2019
May 10-11 Conference: Reproductive Coercion and Human Trafficking
Title: Beyond #MeToo: A Look at Gender Based Violence and Reproductive Coercion Globally
May 13-17 Workshop: Designing and evaluating culturally appropriate interventions to improve reproductive and sexual health
Title: Designing and Evaluating Culturally Appropriate Interventions to Improve Reproductive & Sexual Health
For questions and more information, please email umsn-summerinstitute@umich.edu. Registration is now closed.
Nursing Contact Hours
Michigan Medicine Professional Development & Education is an approved provider of continuing nursing education by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. (OBN-001-91) For information about receiving nursing contact hours contact umsn-summerinstitute@umich.edu
Keynote Speaker Dr. Elizabeth Miller: Reproductive Coercion
Dr. Elizabeth Miller is a Professor in Pediatrics, Public Health, and Clinical and Translational Science at the University of Pittsburgh School of Medicine and Director of the Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh. Trained in Internal Medicine and Pediatrics and medical anthropology, she has over 15 years of practice and research experience in addressing interpersonal violence prevention and adolescent health promotion in clinical and community settings.
Keynote Speaker Dr. Hanni Stoklosa: Human Trafficking
Hanni Stoklosa, MD, MPH, is the Executive Director of HEAL Trafficking, an emergency physician at Brigham and Women's Hospital (BWH) with appointments at Harvard Medical School and the Harvard Humanitarian Initiative. She is Director of the Global Women's Health Fellowship at BWH, Connors Center. Dr. Stoklosa is an internationally-recognized expert, advocate, researcher, and speaker on the wellbeing of trafficking survivors in the U.S. and internationally through a public health lens. She has advised the United Nations, International Organization for Migration, U.S. Department of Health and Human Services, U.S. Department of Labor, U.S. Department of State, and the National Academy of Medicine on issues of human trafficking and testified as an expert witness multiple times before the U.S. Congress. Moreover, she has conducted research on trafficking and persons facing the most significant social, economic, and health challenges in a diversity of settings including Australia, China, Egypt, Guatemala, India, Liberia, Nepal, Kazakhstan, the Philippines, South Sudan, Taiwan, and Thailand. Among other accolades, Dr. Stoklosa has been honored with the U.S. Department of Health and Human Services Office of Women's Health Emerging Leader award, the Harvard Medical School Dean's Faculty Community Service award, has been named as an Aspen Health Innovator and National Academy of Medicine Emerging Leader. Her anti-trafficking work has been featured by the New York Times, National Public Radio, Glamour, Canadian Broadcasting Corporation, STAT News, and Marketplace. Dr. Stoklosa published the first textbook addressing the public health response to trafficking, "Human Trafficking Is a Public Health Issue, A Paradigm Expansion in the United States."
Dana Beck
Dana Beck, BA, BSN, RN, FNP-BC, a Robert Wood Johnson Foundation Future of Nursing Scholar, at Johnson & Johnson, is interested in improving the health of vulnerable women and girls globally through increased access to comprehensive reproductive health services. Specifically, she is interested in the process of community mobilization enacted through socially accountable, gender transformative research and the longitudinal impact on the community.
Beck earned her Bachelor of Arts in Anthropology and Bachelors of Science in Nursing from the University of Michigan and her Master's of Science in Nursing as a Primary Care Family Nurse Practitioner from the University of Michigan.
She worked as a healthworker at the Atlanta Feminist Women's Health Center and as a Clinical Research Assistant in the Department of Psychiatry at the University of Maryland School of Medicine before returning to school to obtain her nursing degree. As a nurse, Beck worked in a cardio-thoracic surgical step down unit for 2.5 years before transitioning to work on the child and adolescent mental health unit at the University of Michigan Health System in Ann Arbor. During this time, she also worked per-diem at Henry Ford Hospital in Detroit as a float nurse on their telemetry units and gained experience as a Research Assistant at the University of Michigan School of Nursing.
Beck lives in Detroit, Michigan.
Carol Boyd: Career Planning: Four Components to Planning your Research Career Destination and Impact: What will you and your research be known for?
In addition to the School of Nursing, Dr. Carol Boyd also holds U-M appointments as Professor, Women's Studies Department, LSA; Research Professor, Addiction Center, Dept. of Psychiatry; Research Professor, Institute for Research on Women & Gender. She is also the Director of the Center for the Study of Drugs, Alcohol, Smoking and Health (DASH). She has conducted mixed-method studies that use innovative technologies to examine the relationship between gender, health and drug, alcohol and nicotine use. She has had extramural funding to conduct mixed-method studies with women crack smokers (1989-1995, NIH funded), prisoners (1999-2004, MDOC and Robert Wood Johnson funded), adolescents and college students (2003-present, NIH funded), and secondary analytic studies of substance use among high risk populations, including LGB sub-populations (2016-present, NIH funded). Moreover, Dr. Boyd has used innovative technologies to survey adolescents and young adults on substance use and related behaviors. Dr. Boyd was the first researcher (as a Principal Investigator) to develop two web-based surveys, Student Life Survey and Secondary Student Life Survey, to examine substance use and related behaviors among adolescents and emerging adults. The Student Life Surveys were the foundation for five NIH funded studies and the Secondary Student Life Survey is now being used on smart phones. Dr. Boyd's international experiences includes teaching, mentoring and research in China, Ghana, Liberia, Poland and Zambia.
Mike Brinich: Using media to communicate research and program findings
Mike Brinich has more than 15 years of experience developing media outreach and marketing strategies for universities, private equity firms, and sports entertainment groups. Prior to joining the University of Michigan, he specialized in content strategies for Wayne State University in Detroit to raise public awareness about the school's health equity research and outreach. He holds an M.A. in public relations and advertising from Michigan State University, and a B.A. in advertising and mass communications.
Lindsay Cannon: Overview of Gender Based Violence
Lindsay Cannon, MPH, MSW, is a Clinical Research Coordinator at the University of Michigan School of Nursing. She received her Bachelor's degrees in Neuroscience and Psychology from The Ohio State University, and her Master's degrees in Social Work and Public Health from the University of Michigan. Her research interests include access to family planning, integration of reproductive healthcare and substance use treatment, and prevention interventions for sexual violence, reproductive coercion, and intimate partner violence. She has volunteered as an advocate for sexual violence and intimate partner violence survivors for 8 years and currently facilitates a support group for women who have experienced intimate partner violence who are currently incarcerated.
Bridgette Carr: Human Trafficking in the Global Context
Professor Bridgette Carr, '02, has dedicated her career to advocating for the rights of human trafficking victims and advancing comprehensive domestic and international anti-trafficking policies. Her work focuses on driving paradigm shifts in the way human trafficking victimization is perceived and addressed, and helping reintegrate victims by developing legal solutions that address the complex issues of coercion and victimization around compelled service and its aftermath.
As the founding director of the University of Michigan Law School's Human Trafficking Clinic, the first clinical law program solely devoted to addressing this issue comprehensively, Professor Carr, her colleagues, and a new generation of trainees have provided free legal services to victims since 2009, supporting the wide-ranging needs of men, women, and children, both foreign nationals and U.S. citizens, who have been victimized by a range of trafficking crimes. Using the U-M clinic as a model, Professor Carr is working with university partners around the world to develop similar programs to combat human trafficking and train law students, and has helped establish university law clinics in Mexico, Ethiopia, and Brazil to broaden the network of legal experts who can address the issues of compelled service that transcend international borders. She is the lead author of the first casebook on human trafficking law and policy, which examines the cross-section of criminal justice, civil and human rights, immigration, and international law that frames these issues.
Professor Carr regularly provides human trafficking training to law enforcement, government officials, and health care providers, as well as consultations to state and national authorities on the issue of human trafficking. She is a member of the Michigan Human Trafficking Taskforce, a collaborative effort to identify and rescue victims, prosecute offenders, restore victims, and educate people in Michigan about human trafficking, in both sexual and labor exploitation. In 2013, she was appointed to Michigan's first Commission on Human Trafficking by Attorney General Bill Schuette. She also has served as a consultant to the United Nations Office on Drugs and Crime (UNODC), the UN agency focused on criminal justice for victims of human trafficking and migrant smuggling. She has appeared as an expert on human trafficking on The Today Show, MSBNC, and National Public Radio, and has been quoted in The New York Times and many other news outlets. Professor Carr received her BA, cum laude, from the University of Notre Dame and earned her JD, cum laude, from Michigan Law. During law school, she was a Michigan refugee and asylum law fellow with Amnesty International. Prior to joining the Law School faculty, she was an associate clinical professor at the University of Notre Dame Law School, where she led the Immigrant Rights Project. In 2008, she was awarded a Marshall Memorial Fellowship to study human trafficking issues in Europe
Lisa Fedina: Human Trafficking: Directions for Research
Lisa Fedina received her BSW (2008) and MSW (2009) from the University of Toledo and her PhD from the University of Maryland, Baltimore (2018). Her research interests include gender-based violence and developing multidisciplinary and culturally responsive interventions aimed at improving the health and wellbeing of survivors. Her dissertation research was funded by the U.S. Department of Justice, National Institute of Justice (Award: 2016-R2-CX-0016) and investigated the role of social determinants (i.e. race, ethnicity, economic insecurity) in health outcomes associated with sexual violence among women using data from the National Intimate Partner and Sexual Violence Survey (NISVS). Lisa completed a pre-doctoral Graduate Research Assistantship at NIJ in the Violence Against Women and Family Violence Program, where she led several studies on sexual violence, intimate partner violence, and stalking and served on task forces to promote cross-agency collaboration, including the White House Task Force to Protect Students from Sexual Assault. Lisa has previously worked with survivors of sexual assault, intimate partner violence, and human trafficking and led community organizing and policy advocacy initiatives to address gender-based violence.
Yasamin Kusunoki: Overview of Gender Based Violence
Dr. Kusunoki's research focuses on understanding sources of gender, racial/ethnic, and socioeconomic disparities in reproductive health behaviors and outcomes during adolescence and emerging adulthood, particularly the role of young people's social contexts such as their intimate relationships, families, neighborhoods, and schools. She is Co-I on the NICHD-funded, longitudinal study, the Relationship Dynamics and Social Life (RDSL), which investigates the dynamic factors that contribute to the risk of unintended pregnancy during emerging adulthood. She is PI on an NICHD-funded R03 and several internal grants from the Population Studies Center and the Institute for Research on Women and Gender using these data to examine the correlates and consequences of intimate partner violence. She is a Co-I on an NICHD-funded R03 that investigates trajectories of sexual violence victimization and perpetration among adolescents in middle and high school and a Co-PI on an Injury Center pilot grant studying attitudes and behaviors related to sexual violence perpetration among emerging adults. She is also conducting translational research funded by MICHR and the Injury Center that is collecting pilot data on intimate partner violence and reproductive coercion experiences among women in reproductive health clinic settings in order to inform the development of an intimate partner violence and reproductive coercion intervention.
Dr. Kusunoki's teaching philosophy is grounded in her experiences as a student, teacher, and mentor. She has trained and mentored undergraduate and graduate students on both survey research methods and substantive topics. Her main goals for student learning are the acquisition of information and the development of three key skills: critical thinking, problem-solving, and the ability to articulate ideas both verbally and in writing. These skills are not only necessary to learn the information being taught but will also help students realize their career and life-long objectives. She is currently teaching Research Synthesis for DNP students in the School of Nursing and guest lecturing on topics that include adolescent development, adolescent sexual and reproductive health, unintended pregnancy, and intimate partner violence in a number of courses in the School of Public Health.
Elizabeth K. Kuzma: Educating Health Care Providers
Dr. Elizabeth Kuzma is a Family Nurse Practitioner and currently practices in the University of Michigan Health System (UMHS) Regional Alliance for Healthy Schools (RAHS) clinic at Pathways to Success Academic campus. In this practice, she works with vulnerable and underserved youth for their health promotion, primary care, and acute care needs. Dr. Kuzma is the FNP Program Lead teaches in the Health Behavior and Biological Sciences department. Dr. Kuzma's research and scholarship focus includes a variety of adolescent health issues, particularly related to trauma, sexuality and gender identity.
Jody Lori: Global Panel: Workshop participants from the international community discuss GBV, human trafficking and reproductive coercion in their home countries – current perspectives, challenges, and opportunities
Dr. Lori is Director, PAHO/WHO Collaborating Center.
Dr. Lori's program of research contributes to the design and testing of innovative models of care to improve maternal and newborn health in areas of the world challenged by a lack of human resources, long distances to care, and cultural, gender, and socio-economic barriers. The design of the interventions utilizes a human rights framework to tackle the intractable problems of preventable maternal and newborn death through strengthening health systems and influencing reproductive health policy. Her research has contributed to the development of models of care to reduce the burden of maternal and newborn mortality on individuals, their families, and society through a program of participatory action research in low-resource countries.
The key policy issues driving her research are the 300,000 maternal deaths, 2.6 million stillbirths, and 2.8 million neonatal deaths that occur each year worldwide – with the vast majority occurring in low resource countries. Funding for her program of research has come from diverse intramural and extramural sources including the National Institutes of Health/Fogarty International Center, the United States Agency for International Development (USAID), multiple private foundations including the Bill & Melinda Gates Foundation, ELMA, and Merck for Mothers. She has extensive field work experience in Ghana, Guatemala, Ethiopia, Liberia, Mexico, and Zambia.
Heather L. McCauley: Measurements and Interventions Used in Reproductive Coercion Research
Dr. Heather McCauley is a social epidemiologist and Assistant Professor in the Department of Human Development & Family Studies (HDFS) at Michigan State University. Her research focuses on the health impacts of and intervention strategies to reduce intimate partner violence, sexual assault and reproductive coercion, with emphasis on victimization among populations who experience marginalization (e.g. sexual and gender minorities). Her currently funded projects focus on homelessness among survivors of domestic violence, resources for victims of crime, and violence victimization in the transgender community. Dr. McCauley has authored or co-authored more than 60 peer-reviewed journal publications and has given more than 100 regional and national addresses on her work. At MSU, Dr. McCauley is the Chair of MSU's Sexual Violence Advisory Committee. At the national level, Dr. McCauley serves on grant review panels for the National Institute of Justice and the National Institutes of Health. She is Associate Editor of the multidisciplinary research journal Psychology of Violence."
Alain Mukwege: Overview of Gender Based Violence
Alain Mukwege is a Congolese born physician and a human right activist. His work was inspired by his father's, Denis Mukwege, who has been nominated multiple times to the Nobel peace prize for his advocacy against sexual violence in conflict zones. Alain Mukwege is a member of the advisory board of Panzi Foundation USA, a non-profit organization whose mission is to provide holistic care to victims of sexual violence and to advocate to end violence against women and girls in DR Congo and beyond its borders. He holds a Master a Clinical research and Translational Science and his research interests lie in the development of mechanisms to improve of Women's health and to prevent gender based violence.
Presently living in Ann Arbor Michigan to prepare for a training in Obstetrics and Gynecology, his work also involves building partnerships between American institutions and Panzi Hospital to help develop local Congolese capacities to address local problems. This framed collaborations with notably, the University Of Michigan School Of Nursing and with World without Genocide. He believes that the cessation of violence against women would be indispensable in the advancement of healthy communities and that violence against women in addition to be a violation of basic human rights is also a global health hazard.
Michelle Munro-Kramer: Human Trafficking in the Global Context
Dr. Michelle Munro-Kramer's program of research focuses on trauma, comprehensive care of vulnerable populations, and missed opportunities for care within domestic and international contexts. Her research projects approach these topics using a trauma-informed and patient-centered lens. She uses mixed methods and participatory action research to understand the experiences of vulnerable populations in order to inform future intervention development.
Dr. Munro-Kramer is currently adapting and piloting a web-based app focused on healthy relationships and sexual violence using a life skills perspective at the University of Michigan. She is also working on adapting and piloting a primary prevention sexual violence intervention to the University of Cape Coast in Ghana. Her global health field work has included Ethiopia, Ghana, Liberia, and Zambia.
Quyen Ngo: Educating Health Care Providers
Dr. Ngo is a Research Assistant Professor in the Department of Emergency Medicine's Injury Prevention Center at the University of Michigan. She also serves as the Internship Lead of the Training and Education Core at the U-M Injury Prevention Center, teaching and mentoring future generations of academic and clinical researchers. Dr. Ngo is a fully-licensed Clinical Psychologist with experience working with high-risk youth and training in trauma-informed therapeutic approaches and has expertise in substance use, violence and trauma, contemplative practice, and technology-assisted psychological interventions. Dr. Ngo is developing technology-enhanced interventions to reduce co-occurring substance use and violence perpetration among youth.
Michelle Pardee: Human Trafficking: Directions for Research
The focus of Dr. Pardee's clinical scholarship is adolescent medicine, with her primary interests centering around healthcare for runaway and homeless adolescents, trauma-informed care, as well as human trafficking. Acting on these interests, she currently practices in a school-linked health center.
Dr. Pardee teaches in first and second year graduate level clinical courses with AGPCNP, FNP, and PCPNP students, as well as in the interprofessional team-based decision making course. In addition to her classroom work, she serves as a clinical preceptor for graduate students at the Taylor Teen Health Clinic where she currently practices. As an instructor, Dr. Pardee's pedagogy centers around the idea that everyone is capable of learning and that it is her job to adapt her teaching strategies so that can happen. In addition, she believes that showing her passion for nursing and the nurse practitioner profession is important to motivating and educating future nurse practitioners.
Sarah Peitzmeier: Violence Among Trans Individuals
Sarah Peitzmeier is a mixed-methods researcher focusing on violence and sexual health in marginalized populations. Her dissertation work examined the effects of different types of violence – client, police, pimp, and intimate partner violence (IPV) – against sex workers in Russia on propagating HIV risk, and how multiple types of violence synergistically impact risk. This work builds on her quantitative and qualitative researched investigating the role of violence against female sex workers and men who have sex with men in the HIV epidemic in Baltimore, the Gambia, Camaroon, and Mongolia, as well as work on IPV victimization and perpetration globally. She is also conducting ongoing work around sexual health and violence in LGBT populations, including issues of sexual violence, IPV, and HPV and cervical cancer risk in transgender populations and lesbian and bisexual women.
Gurpreet Kaur Rana: Investigation and awareness-building of SRH data sources and toolkits
Global Health Coordinator, Taubman Health Sciences Library
I lead the Taubman Health Sciences Library's Global Health Program, establishing partnerships, promoting and fostering international relationships, and creating opportunities in research, teaching and learning in the health sciences. In my role as Global Health Coordinator, I implement a range of efforts to contribute to the University's efforts in global health and health equity. The library's Global Health Program leverages the informationist role in global health, creates educational partnerships within the U-M health sciences community, explores the role of informatics in health equity, conducts expert searching, investigates data sources, and takes part in global health research -- working towards lessening health inequity around the world through the power of information.
Julia S. Seng: Counseling based interventions for Gender Based Violence
Dr. Seng's research focuses on the effects of posttraumatic stress disorder (PTSD) on women's health and childbearing. Her projects approach this topic from a variety of perspectives. She used qualitative, participatory action research to understand women's experiences and to inform intervention development. Epidemiological analyses have established that PTSD is associated with pregnancy complications and worse physical health across the lifespan for women. Clinical studies currently are examining neuroendocrine pathways that link PTSD to preterm birth, lower birth weight, and pregnancy complications. Implementation study of a psychoeducation program for women with abuse-related PTSD, known as the "Survivor Moms' Companion" is underway.
Charlene Y. Senn: Educating Health Care Providers
Charlene Y. Senn is a Tier 1 Canada Research Chair in Sexual Violence and Professor of Psychology and Women's & Gender Studies at the University of Windsor. Her research centres on effective interventions for sexual violence (SV) and puts feminist and social psychological theories into practice.
With Canadian Institutes of Health Research funding, she developed the Enhanced Assess, Acknowledge, Act (EAAA, aka Flip the Script) sexual assault resistance education program for university women that reduces the SV they experience by 50% across one year. The positive effects last for at least two years. EAAA is being implemented on campuses in North America, New Zealand, and Australia, and adapted in Swaziland and for younger girls (14-17) and transgender students (SARECentre.org). With Anne Forrest, Charlene also works on another piece of the campus SA prevention puzzle to institutionalize effective bystander education for students of all genders (www.uwindsor.ca/bystander) and to evaluate its impact.
Akshay Sharma: Managing Data Quality
Trained as a physician and an epidemiologist, Dr. Sharma's research interests include examining new approaches for increasing the frequency of HIV and STD testing among men who have sex with men in the United States, with a focus on telehealth and home self-testing. He is also interested in evaluating behavioral and biomedical interventions for HIV prevention, and epidemiologic study design and methodological issues such as identifying analytical approaches to improve the detection of true underlying benefits of primary prevention strategies. Before moving to the United States, Dr. Sharma was involved in community HIV and STD risk reduction activities such as encouraging safe sex and promoting the use of barrier contraceptives in rural areas in the southern Indian state of Karnataka.
Vijay Singh: Educating Health Care Providers
Vijay Singh, M.D., M.P.H., M.S., Clinical Assistant Professor in the Departments of Family Medicine, Internal Medicine, and Emergency Medicine, earned his medical degree from Northwestern University's Feinberg School of Medicine (2002) and master's degree in public health from Bloomberg School of Public Health at Johns Hopkins University (2003), where he also completed a post-doctoral research fellowship (2004). His family medicine residency training was at University of California at Los Angeles (2007), where he served as an academic chief resident. He additionally obtained a master's degree in health and health care research at University of Michigan (U-M) (2009), where he completed the Robert Wood Johnson Foundation Clinical Scholars Program (2010).
Dr. Singh is a family medicine physician who works clinically in Medical Short Stay Unit, a hospitalist service at the U-M Health System. He served as interpersonal violence curriculum director for U-M Medical School, where he has taught intimate partner violence (IPV) screening to over 1,800 medical students. He recently adapted and delivered an IPV screening curriculum to over 200 medical students in Ghana. His research interest is in health care identification of and response to IPV. His research has been supported by grants from the World Health Organization, American Academy of Family Physicians Foundation, Society of Teachers of Family Medicine Foundation, and Michigan Institute for Clinical and Health Research. He is a core faculty member of U-M Injury Prevention Center, and he is a member of the American Academy of Family Physicians and U-M Institute for Healthcare Policy and Innovation.
Laura Sinko: Educating Health Care Providers
Laura Sinko is a second year doctoral student at the University of Michigan. She is a member of the third cohort. Laura is also a registered nurse on Mott Children's Hospital's Child and Adolescent Psychiatry unit and has a passion for psychoeducation and improving trauma-informed care in this area. Laura's research interests include healing and help-seeking after unwanted sexual experiences, and other forms of gender-based violence. Laura is particularly interested in understanding and defining the trauma recovery process and improving trauma-informed care to better support survivor healing. Through their research together, Laura has traveled to Portugal, Ireland, and Iceland to aid in expanding their cross-cultural help-seeking after gender-based violence study. Laura's dissertation research is on understanding the individual and contextual factors that influence healing from unwanted sexual experiences on a college campus, using patient-centered methods of narrative interviewing and Photovoice. Results of this study will support the development of an intervention prototype to promote self-awareness and healing for survivors of unwanted sexual experiences as well as provide data to inform instrument development to better measure survivors' healing trajectories. This study is the first step in a program of research focused on holistic, survivor-centered interventions for college survivors of sexual violence.
Rob Stephenson: Overview of Gender Based Violence
Trained as a demographer and epidemiologist, Dr. Stephenson's work focuses on a range of sexual and reproductive health issues globally and locally. Dr. Stephenson's work is centered primarily on sexual and reproductive health, with a specific focus on the development and testing of HIV prevention interventions and the intersection between violence and health. Stephenson is particularly interested in the development and testing of interventions to increase HIV prevention and HIV care engagement, and interventions that tackle the intersection of violence and sexual health. Stephenson has a long history of work in women's sexual and reproductive health, with a specific focus on maternal health issues in resource poor countries, examining how climates of gender inequity put women at risk of poor maternal health outcomes. Stephenson is also director of The Center for Sexuality and Health Disparities.
Dr. Stephenson's teaching focuses on providing students with research skills and skills around program monitoring and evaluation. His approach to teaching is skills based, providing a space in the classroom for students to develop and practice new skills. Stephenson places a strong emphasis on mentoring, and currently mentors students at the Masters and Doctoral level. Stephenson is also involved in the training of HIV counselors and testers on couples HIV counseling and testing methods.
Mieko Yoshihama: Overview of Gender Based Violence
Professor Yoshihama's research interests are violence against women, immigrants, mental health, and community organizing. Combining research and social action at local, state, national, and international levels over the last 25 years, Dr. Yoshihama focuses on the prevention of gender-based violence and promotion of the safety and wellbeing of marginalized populations and communities. Dr. Yoshihama's research in both the U.S. and Japan is diverse methodologically, spanning from participatory action research to surveys with complex sampling design, from epidemiologic investigation to intervention/prevention research, including a nationwide survey in Japan, a study of Japanese American women in Los Angeles, and Life History Calendar studies of battered women in Michigan, Tokyo, and San Francisco. In Michigan, she directs participatory action research projects aimed at organizing and mobilizing local community members to promote collective action to prevent domestic violence. One recent project involves developing, implementing, and evaluating a broad communications campaign in a local Indian community. In addition to serving on the steering committee of the Asian & Pacific Islander Institute on Domestic Violence, Dr. Yoshihama serves on advisory committees of various organizations dedicated to ending domestic violence.
Summer Institute participants are responsible for their own travel arrangements and room and board. Below are helpful links as you make your plans. Ann Arbor is a vibrant small city with a lot of activity. The Summer Institute will be held at the School of Nursing, located at 426 N. Ingalls Street, Ann Arbor, MI 48109.
The closest airport to Ann Arbor is Detroit-Metro Airport.
Greyhound bus service and Amtrak train service are available from U.S. and Canadian cities. Parking on campus is limited and we cannot offer on-site parking.
A complete list of Ann Arbor accommodations can be found at visitannarbor.org
Suggested Parking locations:
Maynard Parking Structure
324 Maynard Street, Ann Arbor, MI 48104
(12 minute walk to School of Nursing)
Liberty Square Parking Structure
510 East Washington Street, Ann Arbor, MI 48104
Palmer Parking Structure
N18 Parking Lot, Ann Arbor, MI 48109
(8 minute walk to School of Nursing)
Download a Walkmap
For those who require a visa, please check the requirements at your local Embassy or Consulate and the University's of Michigan's International Center. Contact us at UMSN-GlobalOutreach@med.umich.edu with any questions.
The Summer Institute is sponsored by a number of university partners including CEW+ Frances and Sydney Lewis Visiting Leaders Fund, the Office of the Provost, the African Studies Center, Institute for Research on Women & Gender, the Center for Southeast Asian Studies and the Center for Latin American and Caribbean Studies.
Frances and Sydney Lewis Visiting Leaders Fund
Learn about our 2018 Summer Institute on Global Reproductive and Sexual Health.

redpajama_set_name: RedPajamaCommonCrawl


An electrical lead includes an elongate body having a proximal end portion and a distal end portion, a first electrode disposed adjacent and joined to the distal end portion of the elongate body. Current flow within the first electrode is limited when a predetermined condition occurs, such as the generation of an electromagnetic field having a predetermined frequency range. The medical electrical lead may further comprise one or more second electrodes disposed adjacent the first electrode and joined to the elongate body to shunt current to body tissue when the predetermined condition occurs.
This application is a continuation-in-part of application Ser. No. 09/999,381 filed Oct. 31, 2001 entitled "Apparatus and Method for Shunting Induced Currents in an Electrical Lead".
This invention relates to a method and apparatus for providing electrical stimuli to tissue or receiving electrical stimuli corresponding to one or more conditions in tissue.
Since the introduction of the first implantable pacemakers in the 1960s, there have been considerable advancements in both the fields of electronics and medicine, such that there is presently a wide assortment of commercially available body-implantable electronic medical devices. The class of implantable medical devices (IMDs) now includes therapeutic and diagnostic devices, such as pacemakers, cardioverters, defibrillators, neural stimulators, and drug administering devices, among others. Today's state-of-the-art implantable medical devices are vastly more sophisticated and complex than their early counterparts, and are capable of performing significantly more complex tasks. The therapeutic benefits of such devices have been well proven.
Modern electrical therapeutic and diagnostic devices for the heart require a reliable electrical connection between the device and a region of the heart. Typically, an electrical contact, commonly referred to as a "lead," is used for the desired electrical connection. One type of commonly used implantable lead is a transvenous lead. Transvenous leads are generally positioned through the venous system to attach and/or electrically connect at their distal end via a tip electrode to the heart. At their proximal end, they are typically connected to the electrical therapeutic and/or diagnostic device, which may be implanted. Such leads normally take the form of a long, flexible, insulated conductor. Among the many advantages of transvenous leads is that they permit an electrical contact with the heart without physically exposing the heart itself, i.e., major thoracic surgery is not required.
Other advancements in medical technology have led to improved imaging technologies, for example magnetic resonance imaging (MRI). MRI generates cross-sectional images of a human body by using nuclear magnetic resonance (NMR). The MRI process begins with positioning the body to be imaged in a strong, uniform magnetic field, which polarizes the nuclear magnetic moments of protons within hydrogen molecules in the body by forcing their spins into one of two possible orientations. Then an appropriately polarized radio-frequency field, applied at resonant frequency, forces spin transitions between these orientations. The spin transitions create a signal, an NMR phenomenon, which can be detected by a receiving coil.
Further, shortwave diathermy, microwave diathermy, ultrasound diathermy, and the like have been shown to provide therapeutic benefits to patients, such as to relieve pain, stiffness, and muscle spasms; to reduce joint contractures; to reduce swelling and pain after surgery; to promote wound healing; and the like. Generally, energy (e.g., shortwave energy, microwave energy, ultrasound energy, or the like) is directed into a localized area of the patient's body.
Traditionally, however, use of these technologies have been discouraged for patients having such implanted medical devices, as the environment produced by the MRI or diathermy apparatuses is generally considered hostile to such implantable medical devices. The energy fields, generated during the MRI or diathermy processes, may induce an electrical current in leads of implantable medical devices. In conventional leads, the electrical current is typically dissipated via the lead's tip electrode into tissue adjacent the distal end of the lead. The dissipation of this electrical current may cause resistive heating in the tissue adjacent the electrode and may result in damage to the tissue in some cases.
In one aspect of the present invention, an electrical lead is presented. The medical electrical lead includes an elongate body having a proximal end portion and a distal end portion, a first electrode disposed adjacent and joined to the distal end portion of the elongate body, and a first conductor extending between the proximal end portion and the distal end portion of the elongate body and being electrically coupled to the first electrode. The medical electrical lead further comprises a second electrode disposed adjacent the first electrode and joined to the elongate body and a capacitive device electrically coupled to the first conductor and the second electrode. The lead further includes a current-limiting component within the lead body to limit the flow of current through the first electrode. Current may be limited upon detection of a predetermined condition, such as the existence of an electromagnetic field within a predetermined frequency range.
The current-limiting component may include an inductor, an active circuit component such as a Field Effect Transistor (FET), or a Micro-Electrical-Mechanical system (MEMs) switch. This component may be activated by a signal generated by a Hall-Effect sensor or another magnetic field sensor.
In another aspect of the present invention, a shunting assembly is presented. The shunting assembly includes an electrode, a conductor, and a capacitive device electrically coupled with the electrode and the conductor. The shunting assembly further comprises a device to limit current within the electrode upon detection of a predetermined condition, such as an electromagnetic field within a predetermined frequency range.
In another aspect of the present invention, a method is presented including selectively limiting current in a primary current path within a lead body when a predetermined condition is present. During this time, current may be directed via a secondary path to body tissue.
FIG. 8 is a block diagram of a method according to the present invention.
FIG. 9 illustrates yet another embodiment of the lead of FIG. 6.
FIG. 10 illustrates an alternative embodiment of the lead of FIG. 6 that omits the shunting assembly.
FIG. 11 illustrates still another embodiment of the lead of FIG. 6 that employs active circuit components to limit current flow within the lead.
FIG. 12 illustrates another embodiment of the lead of FIG. 6 that employs Micro-Electrical-Mechanical system (MEMs) switches within the lead.
Embodiments of the present invention concern body-implantable medical devices having one or more leads that may be used to stimulate a tissue of a body and/or sense one or more conditions in the tissue. Examples of such implantable medical devices are implantable coronary pacing devices, pulse generators, defibrillators, neural stimulation devices, electrogram devices, and the like. Generally, these devices operate by monitoring one or more conditions in the tissue and/or by delivering electrical stimuli to the tissue via the lead or leads. For example, such devices may be used to sense cardiac activity, to deliver electrical pacing stimuli to a portion or portions of a heart, to deliver electrical defibrillating stimuli to a portion or portions of the heart, to deliver electrical stimuli to a nerve, to deliver electrical stimuli to a portion or portions of a nerve bundle, or to deliver electrical stimuli to a portion or portions of a brain. While the description provided herein is directed to an implantable medical device used in a coronary setting, the present invention encompasses any implantable medical device, such as those described above, used in any setting.
FIG. 1 illustrates an embodiment of an implantable medical device 102 according to the present invention that has been implanted in a patient 104. The implantable medical device 102 includes an implantable electronic device 106 (e.g., a control unit or the like) housed within a hermetically-sealed, biologically-inert canister 108. The canister 108 may itself be conductive so as to serve as an electrode in a circuit of the implantable medical device 102. One or more leads 110, 112 are electrically coupled to the implantable electronic device 106 and extend via a vein 114 of the patient 104 to a tissue, e.g., a portion of a ventricle 116, a portion of an atrium 118, a nerve (not shown), a nerve bundle (not shown), or the like. The implantable medical device 102 may be programmed by using a programming unit 120, which may send instructions to and receive information from the implantable medical device 102 via radio-frequency signals.
As shown in FIG. 2, one or more exposed, electrically-conductive electrodes, such as a tip electrode 202 or the like, are disposed generally near a distal end portion 204 of a body 205 of the lead 110, as well as a distal end of the lead 112 (not shown), if present. As indicated above, the tip electrode 202 may be used to sense electrical signals in a tissue, such as in the ventricle 116, in the atrium 118, in a nerve (not shown), in a nerve bundle (not shown), or the like. Further, the tip electrode 202 may be used to deliver electrical stimuli to the tissue, such as to deliver electrical stimuli to a portion, or portions, of a heart, to a nerve, or to a portion, or portions, of a nerve bundle. The lead 110 further includes a conductor set 206, electrically coupling the implantable electronic device 106, or an electrical extension (not shown) extending from the implantable electronic device 106, and one or more electrodes (e.g., the tip electrode 202 or the like) of the lead 110. Thus, the conductor set 206 extends from a proximal end portion (i.e., a portion joinable with the implantable electronic device 106 or the like) to the distal end portion 204 of the body 205.
In a first embodiment, the implantable medical device 102 is a unipolar device in which the tip electrode 202 may serve as a cathode and the canister 108 may serve as an anode for pacing, stimulation, or sensing circuitry (not shown) of the implantable medical device 102. In this embodiment, as illustrated in FIGS. 2 and 3, a shunting assembly 208 includes a ring electrode 302, which is the portion of the shunting assembly 208 visible in FIG. 2. The conductor set 206 includes a tip conductor 304 that extends through the shunting assembly 208 to the tip electrode 202. The tip conductor 304 may be a continuous conductor or may be a plurality of conductors that are electrically interconnected. A capacitor 306 is electrically coupled between the tip conductor 304 and the ring electrode 302. The capacitor 306 may take the form of a single capacitive device, a plurality of capacitive devices that are electrically interconnected, or one or more capacitive devices electrically interconnected with other electronic devices.
In a second embodiment, as illustrated in FIGS. 2 and 4, the implantable medical device 102 is a bipolar device in which the tip electrode 202 may serve as a cathode for the pacing, stimulation, or sensing circuitry (not shown) of the implantable medical device 102. In this embodiment, the shunting assembly 208 includes a ring electrode 402, which is the portion of the shunting assembly 208 visible in FIG. 2. Further, the ring electrode 402 may serve as an anode for the pacing, stimulation, or sensing circuitry of the implantable medical device 102. The conductor set 206 includes a tip conductor 404 that extends through the shunting assembly 208 to the tip electrode 202. The tip conductor 404 may be a continuous conductor or may be a plurality of conductors that are electrically interconnected. The conductor set 206 further includes a ring conductor 406 extending into the shunting assembly 208 and to the ring electrode 402. As in the tip conductor 404, the ring conductor 406 may be a continuous conductor or may be a plurality of conductors that are electrically interconnected. A capacitor 408 is electrically coupled between the tip conductor 404 and the ring electrode 302. The capacitor 408 may take the form of a single capacitive device, a plurality of capacitive devices that are electrically interconnected, or one or more capacitive devices electrically interconnected with one or more other electronic devices.
In a third embodiment, as illustrated in FIGS. 5 and 6, an implantable medical device 102 is a bipolar device in which the tip electrode 502 may serve as a cathode and a first ring electrode 503 may serve as an anode for the pacing, stimulation, or sensing circuitry (not shown) of the implantable medical device 102. In this embodiment, a shunting assembly 504 includes a second ring electrode 604, which is the portion of the shunting assembly 504 visible in FIG. 5. A conductor set 506 includes a tip conductor 606 that extends through the first ring electrode 503 and the second ring electrode 604 to the tip electrode 502. The tip conductor 606 may be a continuous conductor or may be a plurality of conductors that are electrically interconnected. The conductor set 506 further includes a ring conductor 608 extending to the first ring conductor 503. As in the tip conductor 606, the ring conductor 608 may be a continuous conductor or may be a plurality of conductors that are electrically interconnected. A capacitor 610 is electrically coupled between the tip conductor 606 and the second ring electrode 604. The capacitor 610 may take the form of a single capacitive device, a plurality of capacitive devices that are electrically interconnected, or one or more capacitive devices electrically interconnected with other electronic devices.
It is often advantageous for patents suffering from certain conditions to be examined using MRI processes or to be therapeutically treated using diathermy processes. However, patients having implantable medical devices within their bodies have typically been discouraged from undergoing such processes, as described above. The present invention, as illustrated in FIGS. 2-6, seeks to reduce this detrimental effect by dissipating induced current in the tip conductor 304, 404, 606 into tissue adjacent the ring electrode 302, 402, 604, as well as into tissue adjacent the tip electrode 202, 502. In this way, the heat, produced by the dissipating currents, is dispersed over a larger portion of tissue, thus decreasing the likelihood of damage to the tissue.
It is desirable, however, for pacing, stimulation, or sensed signals (e.g., signals of an electrogram or the like) being transmitted over the tip conductor 304, 404, 606, from or to the tip electrode 202, 502, not to be transmitted through the ring electrode 302, 402, 604. Rather, it is desirable for substantially all of such signals to be transmitted between the implantable electronic device 106 and the tip electrode 202, 502. Accordingly, the capacitors 306, 408, 610 perform filtering functions. A high frequency current such as is induced within the lead conductors during MRI or diathermy procedures are routed both to the ring electrodes 302, 402, 604, respectively, and the tip electrodes 202, 502. However, substantially all of the low-frequency pacing, stimulation, and/or sensed signals traveling over the tip conductors 304, 404, 606 are routed only to the tip electrodes 202, 502. For the purposes of this disclosure, the phrase "substantially all" of the pacing, stimulation, or sensed signals is defined as a level of signal at which the implantable medical device 102 is capable of operating properly.
The shunting assembly 208, 504 operates by employing the variable impedance characteristics of the capacitor 306, 408, 610. Generally, currents induced in conductors (e.g., the tip conductor 304, 404, 606) by energy fields emitted by MRI and diathermy equipment are greater than about one megahertz (MHz). Further, signals, such as pacing signals, stimulation signals, sensed signals, and the like, generally have frequencies of less than about 500 hertz (Hz). According to embodiments of the present invention, by taking into account the inherent electrical impedance of tissue of about 500 ohms (Ω), the capacitance of the capacitor 306, 408, 610 can be determined such that a portion of the current induced in the tip conductor 304, 404, 606 by the MRI or diathermy equipment is passed through the capacitor 306, 408, 610 to the ring electrode 302, 402, 604, while signals, such as pacing signals, stimulation signals, sensing signals, and the like are not passed through the capacitor 306, 408, 610, but are rather transmitted over the tip conductor 304, 404, 606 directly to the tip electrode 202, 502. In other words, the capacitor 306, 408, 610 acts as a filter to only allow currents having frequencies within a certain range to be routed to the ring electrode 302, 402, 604. In one embodiment, the capacitor 306, 408, 610, in combination with the impedance of the tip electrode 202 and the tissue, allows a high-pass filter to be created at certain frequencies such as those exceeding 1 MHz.
c=the capacitance of the capacitor (F).
Thus, in this example, the induced currents would pass through the tip electrode 202, 502, as well as through the capacitor 306, 408, 610 to the ring electrode 302, 402, 604, since the electrical impedance of the capacitor 306, 408, 610 is about 160Ω, which is less than the electrical impedance of tissue adjacent the tip electrode 202, 502 and the ring electrode 302, 402, 604 (500 Ω). In this case, the induced currents would be divided approximately 14 percent (80 Ω/580 Ω) to the tip electrode 202, 502 and approximately 86 percent (500 Ω/580 Ω) to the ring electrode 302, 402, 604. The sensed signal would be substantially unaffected, since the electrical impedance of the capacitor 306, 408, 610 is about 1.6 MΩ at 100 Hz, thereby providing a high-pass filtering effect.
In one embodiment, the electrical impedance of the capacitor 306, 408, 610 at frequencies typical of the induced current is below about one-fifth (about 20 percent) of the impedance of the tissue adjacent the tip electrode 202, 502 and adjacent the ring electrode 302, 402, 604 (e.g., 100 Ω in the example). In another embodiment, the electrical impedance of the capacitor 306, 408, 610 at frequencies typical of pacing, stimulation, or sensed signals is about ten times the impedance of the tissue adjacent the tip electrode 202, 502 and adjacent the ring electrode 302, 402, 604 (e.g., 5000 Ω in the example). Further, by sizing the surface area of the ring electrode 302, 402, 604 to be at least about three times the surface area of the tip electrode 202, 502, the current density may be reduced by at least about four times, thus leading to a commensurate reduction in temperature rise in the tissue adjacent the tip electrode 202, 502 and the ring electrode 302, 402, 604. In one embodiment, the surface area of the tip electrode 202, 502, as discussed herein, refers to the surface area of the tip electrode 202, 502 omitting any surface area attributed to microstructural pits, crevices, indentations, or the like that may be conventionally used to increase the electrical contact area of the tip electrode 202, 502. Such microstructural pits, crevices, indentations, or the like, in one embodiment, may have diameters of less than about 200 micrometers.
A shunting assembly 702 according to one embodiment of the present invention is illustrated in FIG. 7. The shunting assembly 702, which may, in one embodiment, be hermetically sealed, includes a tube 704 that is joined (e.g., by welds 706 or the like) to end caps 708, 710. Capacitors 712, 714 are electrically connected with and joined (e.g., by welds 716 or the like) to the end caps 708, 710, respectively. In one embodiment, the capacitors 712, 714 are discoidal capacitors or the like having central contacts 711, 713, respectively, and peripheral contacts 715, 717, respectively. The shunting assembly 702 further includes pins 718, 720 that are interconnected by a central conductor 722 by joints 724. The pins 718, 720 are electrically connected with the central contacts 711, 713, respectively. Further, the pin 718 is electrically connected with a proximal conductor 726 (shown in phantom) of the lead 110, which is electrically connectable with the implantable electronic device 106. The pin 720 is electrically connected with a distal conductor 728 (shown in phantom) of the lead 110, which is electrically connected with the tip electrode 202, 502 (FIGS. 2 and 5). Thus, the proximal conductor 726, the pin 718, the central conductor 722, the pin 720, and the distal conductor 728 comprise the tip conductor 304, 404, 606 (FIGS. 3, 4, and 6).
The capacitors 712, 714 are selected as described above, such that signals having a certain range or ranges of frequencies (i.e., induced currents) may flow both through the tip conductor 304, 404, 606 to the tip electrode 202, 502 and through the tube 704, which serves as the ring electrode 302, 402, 604. Signals having another range or ranges of frequencies (i.e., pacing, stimulation, sensed signals, or the like) may substantially only flow through the tip conductor 304, 404, 606 to the tip electrode 202, 502, as the capacitors 712, 714 have sufficient impedance to prevent the signals from flowing therethrough. While two capacitors 712, 714 are illustrated in FIG. 7, the present invention encompasses a shunting assembly 702 having one or more capacitors such as the capacitors 712, 714. Thus, the shunting assembly 702 is one embodiment of the shunting assembly 208, 504 illustrated in FIGS. 2-6.
A method according to one embodiment of the present invention is illustrated in FIG. 8. In one embodiment, the method includes selectively routing an electrical current traveling through a conductor (e.g., the tip conductor 304, 404, 606 or the like) electrically coupled with body tissue (e.g., tissue of the patient 104 or the like) over at least one of a primary path and a secondary path to the body tissue based upon the characteristic of the electrical current (block 802). In one embodiment, the primary path may be through the tip conductor 304, 404, 606 and the tip electrode 202, 502. Further, the secondary path may be through the capacitor 306, 408, 610 and the ring electrode 302, 402, 604. In one embodiment, the characteristic of the electrical current comprises the frequency of the electrical current.
In another embodiment of the present invention, selectively routing the electrical current, as described above, further comprises routing the current over the primary path and the secondary path to the body tissue if the current is induced in the conductor by a field (block 804). In a further embodiment, selectively routing the electrical current, as described above, further comprises routing the current only over the primary path to the body tissue if the current is not induced in the conductor by a field (block 806).
FIG. 9 illustrates yet another embodiment of the lead of FIG. 6. As in FIG. 6, implantable medical device 102 is a bipolar device in which the tip electrode 502 may serve as a cathode and a first ring electrode 503 may serve as an anode for the pacing, stimulation, or sensing cardiac signals. Tip conductor 606 extends to tip electrode 502, and ring conductor 608 extending to first ring conductor 503. A capacitor 610 is electrically coupled between the tip conductor 606 and second ring electrode 604. The capacitor 610 may take the form of a single capacitive device, a plurality of capacitive devices that are electrically interconnected, or one or more capacitive devices electrically interconnected with other electronic devices. In this embodiment, second ring electrode 604 is further coupled via a second capacitor 902 to first ring electrode 503.
Also shown in FIG. 9 is an optional inductor 904. This inductor provides a high impedance path to the tip electrode 502 when high frequency signals are induced within conductor 606, as when the lead is subjected to RF electromagnetic fields. This high-impendence path further decreases the current flowing through the tip, thereby further minimizing heating effects at the lead tip. A similar inductor may be incorporated into any of the foregoing embodiments in a similar manner to that shown in FIG. 9. This inductor may be positioned at any location along conductor 606, but is optimally positioned substantially proximate to the tip electrode. In yet another embodiment, the inductor may be positioned at a more proximal location on conductor 606.
The embodiments discussed above include a shunting assembly. It may be noted, that in another embodiment of the invention, this shunting assembly is omitted, with only an inductor being used to limit current flow within one or more conductors of the lead.
FIG. 10 is a side view of a unipolar lead without a shunting assembly. Second ring electrode 604 is omitted, as is ring electrode 503. Inductor 904 is provided is relatively close proximity to tip electrode 502. As noted above, this inductor attenuates the frequencies of electrode magnetic signals used for MRI.
The foregoing examples discuss the use of passive components within the lead to minimize tissue injury when the lead is subjected to magnetic fields. In another embodiment, active components may be used instead of, or in addition to, passive components to reduce current flow within the lead. For example, a CMOS Field Effect Transistor (FET) may be used as a switch within a lead body to prevent current flow when the lead is exposed to RF electromagnetic energy.
FIG. 11 illustrates still another embodiment of the lead of FIG. 6. In this embodiment, one or more active circuit components 1000 are provided in series with conductor 606. Conductors 606 and 608 are shown coupled to an implantable medical device (IMD) 1002. A control signal 1004 is provided to one or more active components 1000 when the presence of a high-frequency electromagnetic field is detected. This detection may be accomplished using a frequency-sensitive hall-effective sensor, a magnetoresistive magnetic field sensor, or any other type of sensor 1006 that has been adapted to sense the presence of electromagnetic signals within a predetermined frequency range. In the illustrated embodiment, the sensor 1006 resides within the housing of the IMD, and the detection signal is provided by sensor and associated control circuitry as control signal 1004. In another embodiment, the sensor may be included within, or on, the lead body in proximity to the one or more active circuit components 1000, with the control signal being routed between the one or more active components 1000 and the sensor 1006.
As stated above, the one or more circuit components may include a FET, with the gate of the transistor being coupled to the control signal 1004 so that the flow of current through the distal portion of conductor 606 may be selectively disabled. This prevents all current from flowing through the tip electrode 502 when the lead is placed within a high-frequency electromagnetic field. Any other active circuit component that may be adapted for use in a switching network and employable to control currents induced by RF electromagnetic fields as discussed herein may be used in the alternative. It may be noted that in another embodiment, the lead of FIG. 10 need not include ring electrodes 503 and 604. In this instance, tissue heating and subsequent injury at tip electrode 502 is prevented by opening the switching circuit comprised of active circuit components 1000. Finally, it may be noted that active circuit components may be incorporated into any of the foregoing lead embodiments in a similar manner as shown in FIG. 10.
In yet another embodiment of the invention, Micro-Electrical-Mechanical system (MEMs) switches may be used in place of one or more transistor networks in a manner similar to that discussed above. For example, FIG. 12 illustrates MEMs switching network 1100 coupled to control signal 1004 to control current flow in conductor 606. Such switches, which have dimensions in a range of less than 10 microns, can be manufactured on silicon, as described in U.S. Pat. Nos. 6,070,101, 6,081,748, 6,122,545, and 6,148,234 incorporated herein by reference in their entireties. These switches may be opened or closed using control signals such as control signal 1004. Use of MEMs technology within an implantable medical device is described in commonly-assigned U.S. Patent Application entitled "MEMs Switching Circuit for an Implantable Medical Device", incorporated herein by reference in its entirety. As discussed above in reference to FIG. 10, the lead of FIG. 11 need not include ring electrodes 503 and 604. Tissue heating is prevented by opening the MEMs switching network 1100. MEMs components may be incorporated into any of the foregoing lead embodiments in a similar manner as shown in FIG. 11.
While the operation of the present invention has been disclosed relative to energy fields emitted by MRI and diathermy equipment, the present invention is not so limited. Rather, the operation of the present invention is equally applied to energy fields emitted by equipment other than MRI and diathermy equipment.
a component coupled to the first conductor to selectively limit current through the first electrode.
2. The lead of claim 1, wherein the component is an inductor.
3. The lead of claim 1, wherein the component is a switch.
4. The lead of claim 3, wherein the component is coupled to a sensor capable of detecting an electromagnetic field.
5. The lead of claim 4, wherein the sensor is capable of detecting an electromagnetic field in a predetermined frequency range.
6. The lead of claim 5, wherein the switch includes active circuit components.
7. The lead of claim 5, wherein the switch includes Field Effect Transistors (FETs).
8. The lead of claim 5, wherein the switch includes at least one Micro-Electrical-Mechanical System (MEMs) switch.
9. The lead according to claim 1, further comprising a second conductor extending between the proximal end portion of the elongate body and the second electrode end being electrically coupled to the second electrode.
a second conductor extending between the proximal end portion of the elongate body and the third electrode and being electrically coupled to the third electrode.
the second electrode is electrically coupled with the peripheral contact.
the capacitive device has an electrical impedance substantially less than electrical impedance of the body tissue at signal frequencies greater than those used to sense biological signals or deliver electrical stimulation to the body tissue.
the capacitive device has an electrical impedance substantially greater than an electrical impedance of the body tissue at signal frequencies used to sense biological signals or deliver electrical stimulation to the body tissue.
14. The lead according to claim 1, wherein an area of the second electrode is at least three times an area of the first electrode.
15. The lead according to claim 1, wherein the capacitive device is capable of allowing at least a portion of a current, induced in the first conductor by a field, to be routed to the second electrode.
a component coupled to the elongate body to limit the flow of current through the electrode upon detection of the predetermined physiological condition.
17. The lead of claim 16, wherein the sensor is adapted to sense an electromagnetic field.
18. The lead of claim 17, wherein the component is configured to limit the flow of current through the electrode upon detection of an electromagnetic field in a predetermined frequency range.
19. The lead according to claim 18, wherein the component is an active circuit component.
20. The lead according to claim 19, wherein the component is a field effect transistor.
21. The lead according to claim 18, wherein the component is a Micro Electrical-Mechanical system (MEMs) switch.
22. The lead according to claim 18, and further comprising a shunting assembly coupled to the elongate body to dissipate heat when the lead is exposed to the electromagnetic field in the predetermined frequency range.
23. The lead according to claim 22, wherein the shunting assembly comprises a capacitive device.
24. The lead according to claim 23, wherein the capacitive device is a discoidal capacitor having a central contact and a peripheral contact, wherein the electrode is electrically coupled with the peripheral contact, and further comprising a conductor electrically coupled with the central contact.
c.) providing at least one secondary current path to carry current when the predetermined condition is sensed.
26. The method of claim 25, wherein the predetermined condition of step b.) is the presence in the primary current path of a current having a frequency within a predetermined frequency range.
27. The method of claim 26, wherein step b.) includes limiting current via a inductor placed within the primary current path.
28. The method of claim 25, wherein step b.) comprises sensing an electromagnetic field, and limiting current when the sensed electromagnetic field has a magnetic field strength within a predetermined range.
29. The method of claim 28, wherein step b.) comprises limiting current by opening a switch.
30. The method of claim 29, wherein step b.) comprises opening a MEMs switch.
31. The method of claim 28, wherein step b.) comprises using an active circuit component to limit current flow.
32. The method of claim 31, wherein step b.) comprises using an FET to limit current flow.
d.) routing current from the primary current path to the secondary current path when the predetermined condition is present.
34. The method of claim 33, wherein step d.) includes providing a capacitor between the primary current path and the secondary current path to shunt current having a frequency within a predetermined frequency range there between.


text:
TIM MONTAGUE
PERSPECTIM PRODUCTIONS
Review: Up Down Boy (Myrtle Theatre Company)
Cheltenham Everyman Studio
"We're not going to treat him any differently."
Up Down Boy is an uplifting comedy full of charm and touching moments. A tale about a young man with Down's syndrome preparing to leave home with his mother's determined encouragement as he begins this new journey. Myrtle Theatre Company have collaborated with new writer Sue Shields to tell a coming-of-age story inspired by her experiences and anecdotes whilst bringing up her own son, Nathan Bessell, who plays the character Matty in this production.
Matty's mother, Odette, sincerely and sympathetically played by Heather Williams, naturally voices out loud her thoughts, concerns and memories as a constant narrative throughout the play, as she prepares to launch her beloved youngest son into the adult world.
Her teenage son, Matty, is preparing to leave for college; her son that she has brought up with his five brothers and sisters; her son who has Down's syndrome, but who she has always resolved to treat no differently to his siblings.
The most difficult challenges for their family have not come from within the home, but have been due to the outside prejudices of people and situations, bureaucracy and lack of understanding where and when they have needed it most.
The play does not dwell on these darker moments though; Shields' writing gives precedent to the reminiscent anecdotes experienced throughout Matty's young life. The audience are taken on his journey, learning about the lives of both these characters on stage and how they feel about this moment in time; understanding the gradual acceptance that this devoted mother and her son have had to come to terms with in order for him to leave home and begin an independent life.
The play is built upon this relationship between a mother and her son. Williams' mostly one-sided conversation as Odette, telling stories that burst with realism, make up the main dialogue of the play with occasional contributions from Bessell, but more important than speech is the instinctual sign-language that he employs. The transition from spoken dialogue to sign-language is mesmeric when it occurs; the organic movements complimenting these intimate family exchanges.
Michael Straun's lighting is refreshingly uncomplicated; focus is given to the storytelling without distracting from the action on stage. The scene is clearly set in the cosy atmosphere and reality of Matty's bedroom, sometimes emphasising the tender moments shared between mother and child, and then in contrast – the vivid imagination that he possesses and escapes into…
The audience glimpse the world through Matty's eyes when it is projected onto the rear wall of the space in animated scenes, accompanied by a playful soundtrack composed by John O'Hara. These cartoon shorts, provided by Evil Genius Animations, depict a dramatic fantasy world that Bessell performs in front of, either in choreographed dance routines or movement that physically interacts with the projections. Bessell is an amazingly disciplined actor with great commitment and timing, obviously dedicated to bringing this story to life with an honest integrity and an immense warmth and respect that is shared between both actors.
Shields' debut play opens a window into the world that she knows, a world that she is not alone in, but one that many might approach hesitantly. The story unfolds without airs or graces or any pretence; the audience are privileged in essentially witnessing an intimate hour of these characters' lives at an extremely poignant, life-changing moment in time.
What results is a wonderfully moving theatrical experience that leaves us heartened, full of hope and with a greater insight and understanding of what it means to grow up and let go, whatever our challenges in life might be.
Myrtle Theatre Company's production Up Down Boy, in association with Salisbury Playhouse, was written by Sue Shields and directed by Heather Williams and Gareth Machin, and is on tour until the end of November 2013. TM
Review: Jeeves and Wooster in Perfect Nonsense (The Goodale Brothers)
Review: Elephant Man (Fourth Monkey Ensemble)
Review: The Hypochondriac (Theatre Royal Bath)
© 2020 Tim Montague


text:
Q: The derived category of the dual numbers? Let $k$ be a field, and let $R = k[x]/x^2$ be the ring of dual numbers over $k$. Let $\mathcal D(R)$ be the derived category of $R$. I'm interested in getting a complete understanding of the structure of $\mathcal D(R)$ as a triangulated category. I'm guessing this appears in the exercises of some standard text, but I don't know where exactly. Where can I learn about the category $\mathcal D(R)$?

A: Here are a few things I've learned about the ring $k[x]/x^2$, which I'll denote $k[\epsilon]$, and its derived category $\mathcal D(k[\epsilon])$. I'll use cohomological indexing.

*

*$k[\epsilon]$ is self-injective. So regardless of whether we take projective or injective resolutions, we find that every chain complex is quasi-isomorphic to one which is levelwise a direct sum of $k[\epsilon]$'s. Call such a chain complex levelwise free.

*Every levelwise-free chain complex $C_\bullet$ splits as the direct sum $C_\bullet = A_\bullet \oplus B_\bullet$ where $A_\bullet$ is acyclic and $B_\bullet$ has the property that every differential is divisible by $\epsilon$. The proof is an exercise in carefully picking bases in each degree. Call such a complex $B_\bullet$ good (i.e. $B_\bullet$ is "good" if it is levelwise free and each differential is divisible by $\epsilon$). Thus every chain complex is quasi-isomorphic to a good chain complex.

*If $V$ is a vector space over $k$, then write $V[\epsilon] = V \otimes_k k[\epsilon]$. Let $C_\bullet$ be a good chain complex. Then we may write $C_n = V_n[\epsilon]$ for some vector space $V_n$ over $k$. Moreover, because the differential $\partial_n: V_n[\epsilon] \to V_{n+1}[\epsilon]$ is divisible by $\epsilon$, we have $\partial_n = \epsilon \varphi_n$ for some $k$-linear map $\varphi_n: V_n \to V_{n+1}$, in the sense that the equation $\partial_n(v + \epsilon w) = \epsilon \varphi_n(v)$ for all $v+\epsilon w \in V_n[\epsilon]$. The map $\varphi_n$ may be chosen arbitrarily, since $(\epsilon \varphi_n) (\epsilon \varphi_{n-1}) = 0$ for any $k$-linear maps $\varphi_{n-1},\varphi_n$.
Thus, modulo the choice of identification $C_n \cong V_n[\epsilon]$, the data of a good chain complex $C_\bullet$ over $k[\epsilon]$ is equivalent to the data $(V_\bullet, \varphi_\bullet)$ which we will call an $A_{\mathbb Z}$-representation which may be described in any of the following equivalent ways:

*

*$(V_n)_{n \in \mathbb Z}$ is a $\mathbb Z$-indexed sequence of vector spaces over $k$ and $(\phi_n: V_n \to V_{n+1})_{n \in \mathbb Z}$ is an arbitrary sequence of $k$-linear maps.

*$(V_n)_{n \in \mathbb Z}$ is a $\mathbb Z$-graded vector space over $k$ and $\varphi_\bullet: V_\bullet \to \Sigma V_\bullet$ is a graded $k$-linear map.

*$(\cdots \xrightarrow{\varphi_{n-1}} V_n \xrightarrow{\varphi_n} V_{n+1} \xrightarrow{\varphi_{n+1}} \cdots)$ is a functor $\mathbb Z \to Vect_k$ where $\mathbb Z$ is $\mathbb Z$ considered as a linearly ordered set.

*$(\cdots \xrightarrow{\varphi_{n-1}} V_n \xrightarrow{\varphi_n} V_{n+1} \xrightarrow{\varphi_{n+1}} \cdots)$ is a representation of the quiver $A_{\mathbb Z}$, which has one vertex for each $n \in \mathbb Z$ and one edge $n \to n+1$ for each $n \in \mathbb Z$.
There is a natural notion of morphism of $A_{\mathbb Z}$-representations $f_\bullet: (V_\bullet, \varphi_\bullet) \to (W_\bullet, \psi_\bullet)$, which can be inferred from any of the above descriptions. It comprises $k$-linear maps $f_n: V_n \to W_n$ such that $f_{n+1} \varphi_{n} = \psi_{n} f_{n}$.

*Let $C_\bullet, D_\bullet$ be good chain complexes represented by $A_{\mathbb Z}$-representations $(V_\bullet, \varphi_\bullet), (W_\bullet, \psi_\bullet)$. A map of chain complexes comprises $k[\epsilon]$-linear maps $f_n = g_n + \epsilon h_n : V_n[\epsilon] \to W_n[\epsilon]$ (where $f_n, g_n: V_n \to W_n$ are $k$-linear maps) such that $f_\bullet: V_\bullet \to W_\bullet$ is a map of $A_{\mathbb Z}$-representations, but $g_\bullet : V_\bullet \to W_\bullet$ is just a (degree-0) graded $k$-linear map. Composition is the obvious thing, so the category of $A_{\mathbb Z}$-representations is both a subcategory and a quotient category of the category of good chain complexes and chain maps. In fact, this exibits the latter category as a sort of semidirect extension of the former.

*Finally, $\mathcal D(k[\epsilon])$ is equivalent to the category of good chain complexes and chain maps modulo chain homotopy equivalence. Let $C_\bullet,D_\bullet$ be good chain complexes, identified with $A_{\mathbb Z}$-represntations $(V_\bullet, \varphi_\bullet), (W_\bullet, \psi_\bullet)$. A chain map $f_\bullet + \epsilon g_\bullet: C_\bullet \to D_\bullet$ is nullhomotopic if and only if $f_\bullet = 0$ and there exist $k$-linear maps $h_n: V_n \to W_{n-1}$ such that $g_n = h_{n+1} \varphi_{n} + \psi_{n-1} h_n$. Thus the category of $A_{\mathbb Z}$-representations is both a subcategory and a quotient category of $\mathcal D(k[\epsilon])$. Again, the latter is a semidirect extension of the former.
In particular $C_\bullet$ and $D_\bullet$ are quasi-isomorphic if and only if $(V_\bullet,\varphi_\bullet)$ and $(W_\bullet, \psi_\bullet)$ are isomorphic $A_{\mathbb Z}$-representations. However, I think an object $C_\bullet$ typically has more automorphisms as an object of $\mathcal D(k[\epsilon])$ than just as an $A_{\mathbb Z}$-representation.

redpajama_set_name: RedPajamaStackExchange


In an effort to continue down the path of exploring meaning and gratitude, here is another thought provoking question, courtesy of my illustrious therapist.
List five hobbies you have or you think you might like to have. After each hobby, list the most positive aspects (meanings) the hobby holds for you.
Hands down, my favourite pastime. My husband tells me I take too many photos and not only that, but I take too many of the same photo (which I do because I know that someone is going to blink or cause a blur!).
It can be something as natural and serene as a ladybug sitting upon a delicate leaf, to my children making funny faces! A moment frozen in time. That single moment; that single expression, will never happen again. But, I can preserve it in a photo. Sear it into my memory with a photo. Cherish it forever in a photo.
Once preserved, I move to scrapbooking. By scrapbooking, I mean both digital and traditional. I am a hands on, visual person so the old school, paper scrapbooking is my preference. But, it is time consuming. Really, really time consuming. Add my perfectionism to the mix and a one page scrapbook layout can literally take me hours. So, I usually resort to digital scrapbooking. Nothing too fancy. I prefer solid black backgrounds with little embellishment (opposite of my taste in paper scrapbooking – not sure why that is).
Photography gives meaning to my life because it preserves my dearest memories.
One day, hopefully a long, long time from now, my mind will fail me.
I won't remember the details of that vacation to Disneyworld or last year's Thanksgiving dinner.
I won't remember what my children looked like with no front teeth or the look on my son's face when his team won gold at a hockey tournament.
I won't remember the baby birds in the nest on our eavestrough or the double rainbow after a spring storm swept through our town.
Photography gives meaning to my life because it tells a story. My story.
I could open a bookstore. Truly. In fact, I just ordered a bunch of new books online this morning. More and more books! My husband is going to have a complete meltdown. I pray he is at work when the delivery arrives! Ha!
My husband believes that in this digital age of ours there is no longer a need for paper books. For anything made of paper. Ever. Okay, maybe toilet paper. But that's it!
He, of course, is wrong (about the books, not the toilet paper).
To feel a book in your hands and smell its pages is a piece of heaven. I have an e-reader and it is not the same. Not even close.
I read everything: Fiction, youth fiction, non-fiction, self help, cookbooks, magazines and literary classics. You name it, I read it.
Reading takes you to another world. It is an escape.
Reading means making time for yourself. To recharge. Set your worries aside. To visit a world outside of this realm and get to know an old friend, a queen or a vampire.
It also provides an opportunity to spend time with your children. To cuddle up in bed and enter a fantasy world. Alice in Wonderland, Harry Potter, The Wizard of Oz. All great adventures that are even better when they are shared with those you love.
What does physical health look like?
Ya, I'm not really sure. I don't do anything physical. Walking up a flight of stairs is about as physical as I get. I know. That's terrible. Which is why it is on my list of hobbies "you think you might like".
I have tried yoga before and loved it. Really loved it. But it was far. Door to door, the whole experience would take about three hours a day (and I tried to go three times a week). That's a lot of time. The good news is a yoga studio opened up much closer to home and I am hoping to start going next week!
What does that mean to me? Well, physical exercise, as we all know, is beneficial to your body. More specifically, yoga can help many ailments including anxiety. It also means that I am going to take an interest in making choices that are good for my body and thus, good for my mind.
I kept a large selection of my children's baby clothes so that one day, I could make them quilts. Great idea right? It is, except for the fact that I can't sew!
As a first step, I need to find a person who can teach me to sew and then have them teach me to quilt. Well, that doesn't sound too difficult, right?!
Once I find the talented individual who is going to teach me, I will be off to the races; creating magical quilts full of my love. Full of memories of when my children were babies. Telling a story of their infancy and toddlerhood; of their trip home from the hospital, their first giggles and first steps. These quilts will be priceless. I can only hope that my children will wrap themselves in them and know how much I love them. Every stage, every age. I love them with all of my being.
Lastly, I want to explore traditional artistic expression. I loved studying art in high school (many moons ago) and I especially loved pencils and oils. I think a trip to my local art supply store is in order.
The meaning is simple. Expression of yourself and your surroundings. Visual expression of your worldview; of your emotions; your thoughts. When they say get it down on paper, it doesn't mean you are confined to lined paper and a ballpoint pen. Experiment using canvas and oils or a 6B pencil and archival quality paper. Markers, chalk, pencil crayons, pastels or good ol' Crayolas. Journalling doesn't just take form in the written word, your story can be told through visual art.
So go ahead, tell your story.
It is important that we take time to reflect on the choices that have brought us to where we are today.
The decisions that have helped form us into the person we have become.
The values that we hold dear to us and help shape our worldview.
This idea is not a new one and is certainly not mine. My therapist, who I thankfully speak with twice a week, created a list of questions for her patient's to contemplate in an effort to identify the meaning in their lives. Not only does this practice serve to help you identify meaning, it also serves to highlight the things in your life that you are grateful for; the day to day thoughts, interactions and experiences that may go by, seemingly unnoticed.
Being grateful for what you have, both in the tangible sense and more importantly in the spiritual and emotional sense, is sometimes difficult to do. There is so much in our lives that is taken for granted. With that in mind, I am looking forward to formally detailing the meaning and gratitude in my life.
List one of your favourite experiences for each of your five senses. Describe the underlying values you associate with each of these experiences.
Being mesmerized by the waves rolling in and rolling out.
Nature is beautiful. It provides an opportunity for me to stop and take notice of the beauty all around me. It makes me smile. It makes me happy. It is serene. A calmness comes over me; I am still.
Just the other day, I stood at the top of our stairs, leaning against the wall, listening to my son laugh and laugh and laugh. His friends were over and they were having a great time. Hearing his laugh, hearing the happiness in his voice, was magical and overwhelming. I could listen to my children laugh all day.
A child's laughter is the purest form of innocence and youth, and a reminder that in a blink, they will be grown and they won't need you the same way. They won't need your cuddles, your kisses on boo boos, or snuggles in your bed when they have a nightmare. Cherish these times with your little ones. Cherish their innocence and remember you are never too old to laugh. Even at yourself.
You probably thought I would have noted something more maternal; the smell of my children when they were babies perhaps. But no, I love the smell of this candle. It is the Bath & Body Works Fresh Balsam candle.* It. Is. Heavenly. I could smell it all day. The crisp, clean smell of winter evergreens. It reminds me of nature and of Christmas. The smell of family, togetherness and tradition. It reminds me of home.
I love chocolate. Milk, dark, white, semi-sweet, bitter. You name it, I love it. I value the people who harvest the cocoa beans and the brilliant bakers who transform the cocoa beans into velvety, rich chocolate. I cherish how it makes me feel; calm and happy. It is like a drug.
There is nothing better in this world than hugs from my little ones. Their warmth; their unconditional love; the type of hug that only a mother and a child can share. Nothing can compare to it. Love in its purest form. The love between a mother and her child is unparalleled. To hold their hands, brush their hair, snuggle, cuddle and hug. It reminds me that I am loved. I am important to someone. I mean something to them. They love me, unconditionally. Just as I love them.
This was such an interesting exercise, one that should be done every single day to ensure that you never lose sight of the love and kindness that is all around you. Perhaps I will start a gratitude journal where I can write one or two things every day that I am grateful for; nature, laughter, candles, chocolate and my children. I am truly blessed.
*I have no affiliation with Bath & Body Works nor have I received commissions for mentioning their product. I just love their Fresh Balsam candle. There. That's it. My legal disclaimer.


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Pully blocks at 1/350 scale will be pretty minute, I've got some for the Revell 1/96 scale Cutty Sark and they're pretty small. I'd suggest you try the folks at "Modelwarships.com" as that site is a dedicated ship building site.
Well, the biggest rigging blocks I've ever seen IRL are about a foot long and half that wide, which will be under 1mm long by 0.5mm wide in 1:350. The thinnest modeling rigging cord I've ever encountered is 0.3mm, which is about scale for a mooring hawser in 1:350.
Ah yes, it we're actually talking crane/derrick blocks they can be much bigger; how big depends on the SWL of the machine, and you'll need a real subject matter expert rather than an observer to tell you about that.
What about simulating the blocks with blobs of superglue gel.