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How To Be More Persuasive
November 25, 2020 by Dr. NerdLove 72 Comments
Doctor's Note: This article was first published on October 31, 2016
Ever gotten into an argument with someone who's clearly wrong, but you can't change their mind? Wish you could just Jedi mind-trick your racist uncle into not voting for a bigot? Or have you just been jealous of people who seem to be natural influencers, who are just so persuasive that everyone seems to agree with them?
"Let's be real: how much better would your life be if you just listened to me?"
More persuasive people understand something that most folks don't get: that bringing someone around to your point of view isn't about logic, it's about emotion. Being more persuasive isn't about having the best, most logical argument, it's about how you get people to listen in the first place. By learning how to connect with people, you can become a master influencer.
How To Build Emotional Strength
October 14, 2020 by Dr. NerdLove Leave a Comment
Right now everything feels like chaos. We're living through the worst pandemic the world has seen in more than 100 years. We are less than three weeks out from an election that feels like our choice is whether to pull America back from the brink of fascism or not. Our lives have been thrown into pandemonium like we've never known, even as people seem to insist that we're fools for being concerned about a virulent disease. Violent extremists are attacking innocent protestors and activists and the people in charge are hosting giant gatherings all but guaranteed to spread the virus.
And yet life stubbornly insists on continuing like normal.
This is legitimately how it feels some days…
It's enough to make you feel like you're going mad. Like you want to give up and just scream.
But even under the best of circumstances — when the world doesn't feel like it's teetering on the verge of collapse — there are times when life feels like it's too much. There are days when you feel like you're hanging on by your fingernails and you just want to let go. There are days when you simply don't feel like you have the strength to keep going. Whether it's chasing your long-term goals and dreams, finding the desire to keep moving forward, or even summoning up the courage to make the hard decisions, you will face moments that will push you to your very limits.
Those are the times when you need to have the resources to keep going. You need to build your emotional strength. You need to have the will and the strength to not just persevere but to thrive.
Here's how.
Learning The (Love) Lessons of End of Evangelion
June 28, 2019 by Dr. NerdLove Leave a Comment
One of the issues that can make discussing dating and self-improvement difficult is just how abstract some of the ideas we talk about can be. It's one thing to talk about concepts like the difference between internal or external validation or what being charming looks like in practice. That's why it can be handy to have an example to turn to, an easily accessible reference that can make some of these concepts a little simpler to understand when we see them played out in front of us.
And now that now that Neon Genesis Evangelion is out on Netflix, we're going to take one of the most cerebral and philosophical and in some cases mindfuckingly weird anime series out there and wring some self-improvement advice out of it and answer some of life's biggest questions.
Yes, like that.
Wait, what do you mean "again?"
And just a head's up: we're going to be talking extensively about both the broadcast series – including the series finale – and the movie End of Evangelion, so consider this your massive spoiler warning.
PART 1: GET IN THE FUCKING THERAPIST'S OFFICE, SHINJI
One of the things that draws people into Evangelion is the character of Shinji Ikari. He's very much the audience's avatar, their entry point into their participation this world — something that's fairly standard for most television series, and especially a mecha-action series like Evangelion; in fact, over the course of the first third of the story, the series is an almost prototypical example of the genre. At first it seems like it's going to be the same story we've seen a thousand times before, just standing out by being more visually striking than other, similar entries, with designs, themes and visuals that other shows and movies would blatantly rip off years later.
Looking directly at you, Pacific Rim: Uprising.
Also it may be more than 20 years old, but the theme song still slaps.
But it's the character of Shinji that's the real draw. Unlike a lot of protagonists in shows like these, he's… well, he's kind of a whiny little jerk. He's pretty much in a constant state of anxiety and self-doubt, always feeling like he's been tossed head first into a life that's continually raging out of his control. He's overwhelmed by his responsibilities, alternately confused and scared of the new status quo he's found himself in and he finds himself almost desperate for the approval of the adults around him… especially his cold and distant father.
And you thought YOU had daddy issues…
Emotionally, he's a wreck; he has no self-confidence to speak of, he vacillates between being attracted to, confounded by and frustrated with the women in his life. He constantly feels like they're teasing and taunting him for no reason and those moments of what seem like sincerity and genuine connection are then met with more mockery.
Half of the time, he wants to run away from his responsibilities and the insanity around him and isolate himself in his own little world, but feels like he has no choice but to come back and deal with it, despite having no goddamn clue what to do.
And despite however hard he works at the one thing that seems to bring his life meaning — the one thing he hopes will gain him the approval of others — it never seems to be enough. Which only increases his constant fear of abandonment.
So hands up if any of that feels familiar to you.
It's not really surprising that so many people find that Shinji really resonates with them; his inner emotional turmoil mirrors what so much of the audience feels. In fact, part of the genesis1 of Evangelion was creator Hideki Anno's dealing with his almost crippling depression; the story of Evangelion — and Shinji in particular — is the story of Anno coming to terms with his lifelong struggle with depression, alienation and the feeling that he lacks self-worth. And he put a LOT of himself in the character of Shinji.
In a way, Shinji is the ultimate wish-fulfillment character; because the audience identifies so strongly with Shinji, we want to see him succeed and get everything he wanted because it feels like the audience succeeds along with him.
Just as importantly though, because so many people identify so strongly with him, Shinji represents an opportunity to talk about how to achieve the goals that he and the audience share — the desire to find the happiness, validation, acceptance and love, that Shinji is longing for.
But in a very real way, Shinji — and by extension, the audience who identifies with him — is the author of his and their own misery.
So without getting too deep into the lore, one of the ideas that is presented is the concept of the AT Field. In the show, this is represented by an impenetrable barrier that the Angels manifest that shields them from harm.
As the show progresses, we discover that all living, sentient beings have AT fields… and the AT Fields are the manifestation of our fear of being hurt, which is keeping us isolated from others. This is reflected in one of the recurring themes of the series: Shinji's isolation and loneliness and the way his unwillingness to connect with others conflicts with his desire to be accepted.
He wants people to validate his existence but by the same token, he can't bring himself to accept it, and his progression as a character is the continual confrontation with the reality that he can't rely on his relationships to other people to define him or give him meaning. Part of the pathos of his character is how often the things he craves most are denied or pulled away from him.
But as cruel as it may seem, those moments of loss and denial are indicative of lessons that Shinji — and by extension, the audience — needs to learn. In fact, we regularly see Shinji literally confronting himself in an attempt to come to terms with what needs to change for him to actually be happy and self-actualized.
The problem… is that Shinji represents two very distinct paths that the people who identify with him tend to travel down down.
Between the broadcast series and the film End of Evangelion, we get two different versions of the end — the end of both the narrative and the world. In both versions, NERV has failed, having been betrayed from within from the very start; the apocalypse is upon us and the Instrumentality Project has begun, causing all life on earth to dissolve as everyone functionally reunites into one universal being… essentially Buddhist concept of the dissolution of the self and ascension to Nirvana.
It starts with an earthquake, birds and snakes and aeroplanes…
But the two versions of the apocalypse go in very different directions.
Now I'm not going to get into the meta-aspects of why the series ended the way it did or why End of Evangelion was made and whether it's Anno's giant middle finger to fandom; that's not really relevant to our discussion here.
Instead, I want to talk about how, in a very real way, the difference between the ending of the broadcast series and the movie represent the two paths that Shinji — and again, the audience — face. One version serving as a guide… and one as a warning.
PART TWO: CRUEL INCEL'S THESIS
The movie End of Evangelion looks at the darker path for Shinji… one that actually seems more than a little prophetic, all things considered.
One of the constants of fiction is that we're often willing to overlook the darker or problematic aspects of characters, especially characters we identify with strongly. This is in part because we're given insight into their thoughts, their feelings and motivations, which tends to cause us to be more understanding, if not sympathetic; we feel like we at least appreciate their reasoning, if not their actions. That, in turn, makes us more inclined to look at their behavior with a certain amount of compassion or even empathy.
Or you might chuck it across the room instead of pondering whether morality means anything when you think you're stuck in a dream…
But it's often also because, well… we recognize those sides in ourselves, and we don't like to acknowledge them.
And in End of Evangelion, both the narrative and the creator are unwilling to overlook or gloss over the less admirable sides of Shinji's personality — and because the audience identifies with him so strongly, they have to take the journey with him. And it isn't pleasant. Just as Shinji does, we aren't just forced to acknowledge our darker, shadow side, we get our faces rubbed in it.
One of the things that the End of Evangelion drives home is just how one-sided Shinji's desire for connection really is. He desperately craves that relationship, but he isn't willing to meet people half-way, not in any way that matters. He ultimately wants them to break through his AT field — as it were — and form that connection for him.
Part of the problem is that Shinji is so absorbed in his own world that he rarely stops to consider or even understand the lives of the people around him.
Now this is understandable; part of the reason for his personality being what it is, is that he's absorbed with his own trauma. And he's gone through some serious shit, from having seen his mother die in front of him, to being deliberately abandoned and isolated by his father, being dragooned into being a literal child soldier in a cosmic, existential war and dumped into multiple situations — sexual and otherwise — that he's just not equipped to handle.
Oh and he's piloting a robot that's powered by the soul of his dead mother.
But understandable isn't the same as acceptable, and the fact that he's dealing with trauma doesn't excuse his behaviors — behaviors that, in many cases he knows to be wrong.
Like when he masturbates over Asuka's comatose body.
(Which, incidentally, isn't the first time he tried to do something to Asuka in her sleep.)
Neither, for that matter, does his suffering from trauma make him unique or special. In fact, pretty much every main character is dealing with major amounts of trauma; Asuka's mother killed herself in front of her, Misato was at ground zero for Second Impact and had to watch her father die in her arms, Rei is isolated and functionally abused by Gendo and NERV.
"No it's cool, we'll make the dying girl get in the creepy robot and fight a goddamn ANGEL instead."
The fact that Shinji is dealing with some real shit doesn't give him a pass, especially when the other characters — who are equally as traumatized — are proving to be more functional and self-actualized than he is.
But the root issue here isn't Shinji's fear of connection or self-absorption, it's his unwillingness to confront it honestly or work to find a solution.
What he wants more than anything else is validation, but he's never willing to give it to himself; he's always looking for it from other people. He pilots the EVA-01 specifically because he feels like it will make him valuable to others and that means that they'll take care of him and never leave him.
He's the definition of somebody who lives for external validation; he relies on others to give his life worth and meaning. And the problem is that he can't have it, certainly not for long. Everyone else has to lead their own lives and are dealing with their own drama. Frankly, most folks are clinging on to their own sanity for dear life as it is; they don't have the capacity to keep other people from drowning. And even the most well-meaning of people can't be relied on to give his life meaning or live his life for him because lives change, priorities change and people leave… or die.
This living for the regard of others make Shinji an ultimately passive character, and once all of those sources of validation are taken from him, he literally has to be dragged and sexually bribed into doing his job.
This version of Shinji is uncomfortable to watch because, honestly, it's seeing a version of him where the comforting excuses get scoured away and we're forced to see him at the ultimate end of his path, where his sense of entitlement and resentment has blinded him both to how others feel, but ALSO why he's so miserable and lonely.
He treats people like literal objects; he may feel awful about it AFTERWARDS but not enough to stop in the moment. He gets angry that other people won't just GIVE him what he wants — love and validation. But the issue isn't that what he wants is unreasonable or that he's unworthy of it, it's that he's demanding it without consideration for others… which reaches its ultimate expression in his sexual assault on Asuka's comatose body.
Nope, not getting past this any time soon.
And then the world ends and Shinji has to confront his own existence and choices and have his soul laid bare. Shinji has no choice but to answer for his life and the decisions he's made as the women in his life call him to account. He — and by extension, the audience — is forced to confront all the ways that he and we sexualize and objectify those characters, reducing them to little more than tits and ass even as he begs them for love and understanding or castigates them for not giving him what he wants
.
Shinji complains that they betrayed him, only to be told that there was nothing to betray; the only thing they "betrayed" was a one-sided belief he had about them as people and what their responsibilities were to him. He complains that it's unfair for them to expect him to understand him when none of them will talk to him, only to have the fact that he never TRIED to understand thrown back into his face.
He demands to know why they couldn't be nice to him and is unable to accept that they HAD been. Instead he launches into a rant that about how they tease and taunt him and mislead him, not realizing that the reason why they seemed to be so confusing and misleading is that they were dealing with their OWN trauma and he never stopped to consider that… because it made HIS life difficult. Even as he switches gears and begs Asuka for her approval, saying that she's the only one for him, she refuses to leave him this final comforting lie and rips even THAT illusion to shreds; he doesn't want her, he just wants someone to fill the hole in his life. She just happens to be the closest warm body, the one who he's the least intimidated by. Meanwhile he's refused to grow, take responsibility or do the work that's needed to be someone who can love and BE loved.
It's at this point that Shinji's loneliness, selfishness, and need for external validation curdles from understandable teen angst to pure anger and HATE. His misery and fear of being hurt gets turned outward in frustration and rage at the people he feels are denying him what he needs and he lashes out with terrifying violence and — even after being given what he theoretically wanted — he ends up more alone than ever.
It's a very incel-y response, more than a decade before Elliot Rodger's murder spree.
Now some will argue that this is unnecessarily harsh, even cruel. But in this path, Shinji repeatedly REJECTS the kinder approach. He refuses to try to understand or to see beyond himself and clings to his belief that he did nothing wrong and was denied the things that he was owed. He projects his AT field even harder, even as he's being implored to let it down. He's unwilling to listen to the kinder, softer arguments and, as a result, he gets those excuses scoured away in the harshest terms possible and is left to suffer in his own impotence and misery.
PART 3 – The Hedgehog's Dilemma
The other path open to Shinji involves not just him coming to terms with his desire to connect with others, but also how to achieve it.
Just as he has his confrontation with himself in the world of the Dirac Sea in episode 16, The Instrumentality Project sees him spend the last two episodes of the broadcast series in a state of unification — seeing not just into the hearts and souls of his friends and loved ones but also confronting his loneliness and fear of abandonment.
However, in this branch, things take a much more hopeful tone.
Just as before, Shinji is confronted with his need for external validation; he only pilots the EVA-01, for example, because feels that it's the only way he can be of use. He sees this as the only way he can get people to acknowledge him and care for him. Shinji feels like he has to be needed by others in order to have worth.
In reality, however, he's trying to avoid being hurt. He feels that if people need him, then they will have to accept him; otherwise he risks rejection. And because he doesn't feel that he has value, he doesn't believe that other people might accept him for himself.
But what he still doesn't realize is that other people can't give him value. The only person who can ultimately give him what he needs is himself. Everything that can be given to him can ultimately be taken away — through time, through change or through death.
However in this version, he's far more willing to listen, to consider that maybe, just maybe, he's wrong. That the world he sees where he's useless is just that: a world of his own creation. And because the world is always changing and evolving, he too can change.
In this branch, because he's willing to listen, he starts to learn. He learns that perfect freedom comes not just without limits but without anything that lets us orient ourselves and becomes meaningless. But in a world with greater structure, a world where we see and interact with others and learn the boundaries of our sense of self, we learn not just who we are but who we can become.
This culminates in his entering a new and entirely different world — a world where he never became an EVA pilot. And while his life is different in that world — he's more confident, more secure — he's still himself. The more self-assured student and the anxious EVA pilot are the same person; he has the potential for both inside himself. He could easily be either of those people… or many many others.
So while his feelings of inadequacy and his fear of rejection are real, they're ultimately the creations of his own mind, to accept or reject and to shape as he chooses.
Unlike the Shinji in End of Evangelion, THIS Shinji makes a break-through: he may hate himself… but he can learn to love himself. And in doing so, he realizes that he can give himself the validation that he needs, that he can learn to understand himself and accept himself. Not only can he improve and grow and become the person he wishes he could be, but also that he has the right to exist, to take up space in this world. More than that… he wants to live, to grow and change.
And with that revelation: the world around him changes in accordance to his expectations and he finds himself surrounded by all the people who love him — including his parents — who congratulate him for finally making his breakthrough.
For the first time, he realizes he's not useless, that he doesn't need other people to justify his existence and — most importantly — that he's truly NOT alone; the world has simply been waiting for him to realize that and let it in.
Which is what WE need to learn: that the things we assume are our limitations and inadequacies are only real because we choose to believe that they're real. But by that same token, we can rebuild, we can advance and that we're not alone… and that we can learn to love ourselves, and, in the process, learn to connect with others honestly, instead of isolating ourselves in our misery, hoping that other people will do the work for us, before it's too late.
badumtish [↩]
Episode #80: How To Make Friends As an Adult
Men on the whole, and white, heterosexual men in particular, tend to have fewer friends than women and the friendships they do have tend to be shallower and less fulfilling. It's really not uncommon for guys to look up and realize just how few friends they have outside of family members and romantic relationships. And by then… it feels like it's too late. After all, it's easy to make friends when you're in college. But how do you go about making friends when you're a grown man?
Show Highlights:
How men train themselves out of having close friends
Why male friendships tend to be shallower than female friendships
Why it's harder to make friends after college
The Friendship Formula: what it takes to make close friends
How to turn acquaintances into lifelong friendships
Men And the Epidemic of Loneliness
Five Secrets To Make People Like You
Building a Closer Friendship Between Men
Finding Strength Through Vulnerability
Don't forget to subscribe and review us on iTunes , Stitcher and on YouTube.
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Want more dating advice? Check out my books at www.www.doctornerdlove.com/books
Ask Dr. NerdLove: What Do I Do About Someone Else's Crush On Me?
May 21, 2018 by Dr. NerdLove Leave a Comment
Hi, Dr. NerdLove;
Thanks for the wonderful column.
I… have a problem with disappearing and I think I need the Chair Leg of Truth. I keep having to deal with other people's very, very inconvenient crushes on me.
Example #1: I gave up my the forums of my beloved hobby when Married Sad Boner Dude "fell in love" with me. He refused to stop talking about how in love with me he was, or work on his relationship with his wife, so I faded. Not before he threatened to kill himself and implied that I, his True Love could save him by encouraging him to make an intercontinental move to court me.
Example #2: I moved away from my hometown when College Experiment with Heterosexuality Sad Boner Dude was "uncomfortable" with the fact that I insisted upon living near him (which is to say: living with my mother, two hours away). I'm not attending reunions and I donate anonymously to my college, because OMG what if the poor dear gets triggered by seeing my name the way he was when he saw me from the train that one day? (To be fair, we did have a serious case of the zombie relationship, and I don't blame him for being relieved to see my toxic-to-him ass retreating.) I gave up all my college friends that had any association with him, too. That hurts to this day.
Example #3: I started working remotely when Sad Boner Co-Worker got a crush on me and started acting in a frightening and quasi-stalkery manner. Good luck advancing in my career without being allowed to come into the office more than once a month!
Example #4: I faded from a local con and skipped the workshop I'd paid for last year when Sad Boner Dance Dude decided that I was The One and refused to let me talk to my friends and tried to follow me to my hotel at 3 a.m. I am going back to that con this year. Maybe. I dunno.
Example #5: I just f-locked the archives and all entries for the foreseeable future on my blog, which was middling popular, because another Married Sad Boner dude kept defiantly trampling my boundaries, getting angry when I refused to chat with him while I was busy at work or at dinner with my daughter, trying to sexually dominate me and requesting to see my ass on video chat.
Doctor Nerdlove, I don't know what to do.
I am RIGHT UPFRONT about being lesbian, about not being even remotely interested in romantic relationships and kind of disgusted by sex with anyone but myself. By PUA standards, I'm a Midwest two when I make the effort, and I never, ever make the effort. I guess I'm kind and friendly and a little funny, and I try to appreciate how awesome every individual is in their own right, but I mention that I'm not available or interested in romance in any way, shape or form. I've even tried not bringing it up. That makes it worse. Not saying "not interested" at the beginning and end of every sentence to a Sad Boner Dude feels like he's going to pounce and say, "Aha! You didn't say 'Simon Says,' NOW YOU HAVE TO MARRY ME. Or at least let me call you my fiancée until I lose interest and wander off."
The worst thing is, these are good men. They'd be horrified if they read this letter. They'd write me eight-page SAD PANTSFEELS LETTERS about how it wasn't like that! If you publish this letter, readers of yours will be curling up like they've been nutkicked because they've done something that remotely resembles this and they feel personally attacked.
But for me, it is like that. Suicide threats. Being followed at night. Getting cornered at the office by a nightmarish 6'3″ ex-cop who keeps telling everyone about how women make shit about abuse up, who then turns up in your parking lot at one in the morning blaring Barry White because he "finds you attractive." Getting badgered because I'm hanging out with my family instead of worshiping the boner, even though a boner, for me, is a Lovecraftian Elder God with whom I want no truck. Eight-page SAD PANTSFEELS letters.
How do I prevent guys getting crushes on me and mistaking them for an excuse to ignore clearly stated boundaries? Look, I'm sure women do this too, but it's not a problem I've run into with women. And for that matter, what do I do with these Sad Boner Men? When guys do get crushes on me, is there a more constructive response than "three strikes, and I run screaming, because it's super-mean to exist and not want to be someone's prize, even though I've skipped to the end of that particular book and, spoiler, horrific ruins for everyone and no-one has any fun getting there and the car chases suck"? It feels like I'm cruel to keep visibly existing, but it's almost always in my own space. Also, I feel like this is one of the reasons you don't see women in male-dominated fields: there's this thing where guys fixate on women and the women leave. I really hate the thought of contributing to that. I want to grow a spine, but dang. It's mean to them and sometimes feels dangerous to me to hang around. I want my blog back. I want my forums back. My mom wants me to visit her.
Is there something I'm missing here? I already carry a taser. Or am I being unreasonable? You'd tell me if I was being unreasonable, right?
The (Vanishing) Villain in the Rom Com

redpajama_set_name: RedPajamaCommonCrawl


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India – Cradle for all non-African people
By jk on March 7, 2005 in History: India
Subhash Kak has a new article in Rediff which, based on the findings of an Oxford University scholar Stephen Oppenheimer, says that
Oppenheimer concludes with two extraordinary conclusions: 'First, that the Europeans' genetic homeland was originally in South Asia in the Pakistan/Gulf region over 50,000 years ago; and second, that the Europeans' ancestors followed at least two widely separated routes to arrive, ultimately, in the same cold but rich garden. The earliest of these routes was the Fertile Crescent. The second early route from South Asia to Europe may have been up the Indus into Kashmir and on to Central Asia, where perhaps more than 40,000 years ago hunters first started bringing down game as large as mammoths.'
This synthesis of genetic evidence makes it possible to understand the divide between the north and the south Indian languages. It appears that the Dravidian languages are more ancient, and the Aryan languages evolved in India over thousands of years before migrations took them to central Asia and westward to Europe. The proto-Dravidian languages had also, through the ocean route, reached northeast Asia, explaining the connections between the Dravidian family and the Korean and the Japanese.
Perhaps this new understanding will encourage Indian politicians to get away from the polemics of who the original inhabitants of India are, since that should not matter one way or the other in the governance of the country. Indian politics has long been plagued by the Aryan invasion narrative, which was created by English scholars of the 19th century; it is fitting that another Englishman, Stephen Oppenheimer, should announce its demise. [The cradle that is India]
To see an animated version of human migration, visit the site of the Bradshaw Foundation. The theory that India was the cradle for all non-African people will be pretty hard to digest for many people.
Ethinic India: A Genomic View A new paper titled Ethnic India: A genomic view with special reference to peopling and structure (via India Archaeology) reports on some interesting facts. The results are based on statistical...
Gypsies came from India It seems there were four waves of migration of Indians to rest of the world. The first was after the earthquakes which caused the drying up the river Saraswati. The...
Romila Thapar: No Aryan Invasion For the many of you who think it was people like Romila Thapar who maintained the Aryan Invasion Theory, here is some news: She was "against it":http://www.hindu.com/2004/03/22/stories/2004032201661001.htm all the time....
The Culprits who found Vedic Sarasvati
Indian History Carnival–79: Monasteries,Wodeyar, Ali Asker, Railways, Feminism
Unraveling the Cheraman Perumal Myth
← Search for the third Buddha
British Newspapers →
4 Responses to India – Cradle for all non-African people
Ravages March 8, 2005 at 7:56 am #
On the other hand I am just A OK with Dravidian being older than Indo European. It kinda was my feeling all these years. Inspite of stiff resistance and disbelief.
You know, there's a saying in Tamil about it's antiquity Apparently,tamil evolved "Kal thondri, man thondra" – When there was rock, but no sand. I think its a brilliant,and (apparently, now more so) true a description.
What is thisfertile crecent? Which country is he talking about?
Selective Amnesia March 8, 2005 at 8:32 am #
Proof enough for ya?
Well, long time readers (have I been beginning too many posts this way?) know that I am an ardent,loud,and often brash supporter of Tamil's antiquity, and haveeven said that Tamil is prolly older than Sanskrit. Readers will also know of my debunking th…
JK March 8, 2005 at 9:39 am #
Ravages, Fertile Crescent is the region shown in these maps
http://images.google.com/images?q=fertile+crescent&hl=en&lr=&c2coff=1&client=firefox-a&rls=org.mozilla:en-US:official&sa=N&tab=ii&oi=imagest
TypeKey March 11, 2005 at 1:41 pm #
but its too bad/good? that ur still an african deep down inside u!


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Now on the button and ready to go, this very early car offers a fantastic investment opportunity whilst the earlier Alloy cars continue to climb in price rapidly.


Wesleigh and I headed into the city last week (Boston) for some cafe hopping, and people watching. While we were there, I thought it would be fun to pop into my friend Alix's bridal shop in Beacon Hill. The shop has this gorgeous window that let's in a ton of light, and pretty white brick walls. It was the perfect setting to show off W's new Pink Chicken dress. I has my eye on this dress for a few months, it's truly stunning in person. There are tiny gold strands running thought the vibrant purple toned fabric. It's going to be great in the summer, but for now, with some layers it's long enough to keep her warm in the winter. Because she looked like a little gypsy babe in it, I paired it with fringe boots from Gracious May, and a baby head-chain made by my friend's jewelry company, Trust. Investing in fashion for Wesleigh that she can wear it year round, makes me think I should do it more often! Just don't tell my husband!


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MaryEllen Tribby is the premiere business consultant and coach to some of today's most successful entrepreneurs in the information publishing and digital marketing arena. She also works with a number of the largest most lucrative traditional corporate publishing organizations in the world.
Her quarter century experience includes but not limited to successfully running multi-million dollar divisions of companies such as Forbes, Crain's New York Business and Times Mirror Magazines.
Later taking the entrepreneurial world by storm as Publisher and CEO of Early To Rise where she was responsible for growing the business from 8 million dollars in sales to 26 million dollars in just 15 months.
Before that, she served as President of Weiss Research where she led the company to 67 million dollars in sales from 11 million in just 12 months.
In 2008, she founded and remains the proud CEO of Working Moms Only, the world's leading Media Company for the empowerment of the working moms.
Her newest venture, The CEO's Edge was born out of necessity. With thousands of entrepreneurs asking her guidance for growing their businesses, she needed to figure out a way to help has as many of them as possible. The CEO's Edge is the answer!
MaryEllen has transformed the role of CEO in her Consulting Business with her multi phase approach. She is able to dissect struggling companies and reengineer them into profitable, respectable organizations. Her belief is in building a solid foundation that will ensure long-term success.
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Her long awaited next book, Reinventing the Entrepreneur: Turning Your Dream Business into a Reality published by Wiley, will be released in September of 2013.
MaryEllen currently resides in Boca Raton, Fl with her husband of 16 years, Patrick, and their three beautiful children – Mikaela, Connor and Delanie, as well as their crazy boxer, Coco.
She sits on the board of several industry associations and has been honored with numerous awards for her excellence in the field of direct response marketing, multi –channel marketing, business and entrepreneurship.
MaryEllen Tribby Presents:
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This electronic Phase 10 game features a sleek, portable housing, illuminated touch screen with adjustable contrast, adjustable volume and two game play modes.
Play the classic game mode and be the first to complete all ten phases, or select quick play mode when you're short on time and choose the number of Phases you want to play. Now your favorite card game goes with you anywhere, anytime and 2 AAA batteries which are included!


Matteo's main responsibility is to coordinate and monitor of the meetMED activities and to report to the European Commission on its implementation. Previously, Matteo worked as senior energy investment expert at the Energy Charter Secretariat and as senior arbitration associate with a large law firm in Geneva, where he acted in investment and commercial disputes concerning among others the electricity, gas and oil industry. Matteo holds a Ph.D. in International Economic Law (Bocconi) and an LL.M. in International Energy Law and Policy (CEPMLP).


text:
Petiville ist der Name folgender Gemeinden in Frankreich:

 Petiville (Calvados)
 Petiville (Seine-Maritime)

redpajama_set_name: RedPajamaWikipedia


Inviting, fully- furnished villa includes and plexi- hurricane shutters with new A/C, continuous bamboo-laminate flooring and has been newly painted. Move in ready- ideal for 6-month lease or snowbirds. Perfectly maintained by original owners, never rented and in the quietest section of the community. Ever popular, Villagewalk is an non-CDD community, amenity-rich and conveniently located near beaches, shopping, golf course and restaurants.


text:
MLS MVP Award Name Change
By Kaleb Page
The game of soccer in the United States is still on the upswing and still has vast improvements to be made not only in international play, but also here in the states as part of Major League Soccer.
A major factor in the growth of soccer here would be a player that not only was an exceptional athlete on the field but an even better person off of it. This player would be none other than Landon Donovan. A player that is easily the most recognized faces in the soccer community (and by casual fans) as not only an ambassador for the sport but as someone who was there for the tough times in U.S. soccer that have led to a bigger and better following today.
This Thursday at the MLS Superdraft, the MLS made sure to pay tribute to the player who lead countless U.S. men's national soccer teams and finished his career being the all-time leading scorer in the league. This tribute made by the MLS was to re-name the MVP trophy the "Landon Donovan MVP award."
Donovan was on hand to be presented with the honor and went on to say:
"I am incredibly honored. I will try to live my life in a way that is worthy of having a MVP award named after you." – Landon Donovan
Fox Sports talked with MLS commissioner Don Gerber on what made the league do this and the answer was simple. He said that the league wanted to enshrine Donovan's achievements permanently after his influential role in the growth of the league over the past decade.
I think it is cool for this league to make it a point to honor and remember someone who put in the effort and work to make the league better than it once was. Donovan had all the talent to go play in other more top flight leagues at the time, and instead looked to stay home in hopes of one day making the MLS a league worthwhile.
In his 14 seasons as a player in the MLS Donovan has a resume to be proud of, amassing over 144 goals, 136 assists and a record six MLS Cup titles. It is safe to say the MLS made the right decision in making this living American soccer icon the title bearer on its highest trophy to an individual player. An appropriate way to commemorate the man who carried the torch for U.S. soccer for so long, and now can sit back and watch how this sport will grow for years to come. This being in large part to the foundation he laid and passion he brought to the game.
Thank you for all you did #10.
This entry was posted in Soccer and tagged landon donovan, MLS, MVP Trophy, usa soccer on January 20, 2015 by Kaleb Page.
About Kaleb Page
Kaleb is a Senior, sport management major with a minor in journalism at Bowling Green State University. Including his involvement in the Maxwell Project, Kaleb is also an active member of the Sport Management Alliance and the Bowling Green Radio Sports Organization. He enjoys watching all types of sports competition from the traditional forms of basketball and football to the emerging areas like mixed martial arts. His favorite teams are the Pittsburgh Steelers, Tottenham Hotspur FC, Cincinnati Reds, Ohio State Buckeyes (football &basketball) and Columbus Crew SC.
View all posts by Kaleb Page →
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In the past many people have made fortunes in Network Marketing Business and many still do it today. Today they live their lives and enjoy a freedom that most people only dream about. Usually, it was only a small number of people went on to become the top money earners in any company. "Generally it was the Individuals who already had marketing skills and knew how to put them into action." This left the majority of Distributors/Associates out in the cold, failing to achieve any measurable level of success.
Our greatest glory is in never falling but in rising at every time we felt. That's why we call it a Revolution, not just a Business.
Our Aim is to make each and every of our Associates financially free by the Year 2020 and to touch every heart which has a dream still alive in his mind and has a burning desire to do something to taste success. Because here we have designed this platform in such a way that anyone can get instant success with very less effort.
It aims to bring happy and prosperous life to millions of people by forming meaningful ,long lasting and mutually rewarding business association.The starting point for every journey is knowledge, if you have the knowledge about the path on which you have to travel, then the journey is going to be easier and more successful.


text:
Das Taubenhaus von Holland House ist ein Taubenhaus auf der schottischen Orkneyinsel Papa Westray. 1971 wurde das Bauwerk in die schottischen Denkmallisten in der Kategorie B aufgenommen. Zusätzlich ist es zusammen mit Holland House und weiteren Außengebäuden Teil eines Denkmalensembles der Kategorie B.

Geschichte
Der Soldat Thomas Traill erwarb die Ländereien auf Papa Westray im Jahre 1637. Mitte des 17. Jahrhunderts erbaute er die ältesten Teile von Holland House. Traill machte sein Vermögen in der Kelpindustrie (siehe auch Braunalgen#Verwendung). Das Taubenhaus gehört zu den älteren Gebäuden des Anwesens und stammt aus dem frühen oder mittleren 18. Jahrhundert. Das Anwesen wurde über Generationen innerhalb der Familie vererbt und verblieb mit Ausnahme einer Phase zwischen 1886 und 1928 bis 1952 durchgängig in ihrem Besitz.

Beschreibung
Das Taubenhaus befindet sich westlich von Holland House und der zugehörigen Holland Farm. Er weist einen rechteckigen Grundriss auf und ist heute nur noch als dachlose Ruine erhalten. Das Mauerwerk besteht aus Bruchstein, der mit Harl verputzt ist. Unterhalb des auskragenden Satteldaches verläuft traufseitig ein Vorsprung. An der Ostseite sind darüber zwei quadratische Aussparung im Mauerwerk zu finden, die als Einflugöffnungen diene. Darunter befindet sich die Eingangstüre. Die Giebel waren einst als Staffelgiebel gearbeitet, sind heute aber nur noch teilweise erhalten. Im Innenraum laufen Vorsprünge um, auf welchen Nistplätze eingerichtet werden können.

Einzelnachweise

Weblinks

Erbaut im 18. Jahrhundert
Ruine auf Orkney
Kategorie-B-Bauwerk auf Orkney
Holland
Papa Westray


text:
Grizzly Peak Blvd. closed to bikes, cars and pedestrians for July 4 weekend to prevent fires
By Keith Burbank
OAKLAND, Calif. - Grizzly Peak Boulevard will be closed between Skyline Boulevard in Oakland and Centennial Drive in Berkeley for 24 hours starting at 5 a.m. Saturday due to fire danger and to ensure emergency access, Oakland fire officials said.
There have been five vegetation fires along the road in Oakland since June 1, at least one caused by illegal fireworks, Oakland fire spokesman Michael Hunt said.
The boulevard will be closed to all vehicle, pedestrian and bicycle traffic.
"We want to take every precaution necessary to protect life and property," Hunt said.
The closure in Oakland is a pilot program, he said, and was prompted by heavy traffic on the Oakland end of Grizzly Peak over the years when Berkeley has closed its stretch of the road.
When people double park along the boulevard, it is hard for first responders to get through. In one instance it took firefighters 30 minutes to go three miles on Grizzly Peak, Hunt said.
"Every delay can cost lives," he said. A portion of the road closure is just east of where the 1991 Oakland Hills Firestorm started in the backyard of a house on Buckingham Boulevard.
That fire killed 25 people and consumed nearly 3,500 houses and apartment units, East Bay Regional Park District officials said.


An anchoring mechanism and method for anchoring a device within a biological conduit include an expandable element configured for retaining the device at a desired angle relative to a central axis of the biological conduit. A steering mechanism is preferably provided for orienting the device prior to operation of the anchoring mechanism. The anchoring mechanism and method are employed in drug delivery devices, brachytherapy devices or for anchoring a catheter or sheath to provide a working channel for reliable guidance of a wide range of tools to a target location within the body.
This application is a divisional of U.S. patent application Ser. No. 12/271,175 filed Nov. 14, 2008 entitled Directional Anchoring Mechanism, Method And Applications Thereof, which is a continuation-in-part of U.S. application Ser. No. 10/597,747 filed Aug. 6, 2006 entitled Directional Anchoring Mechanism, Method And Applications Thereof, now abandoned, which is a National Phase of International Patent Application No. PCT/IL2005/000159, International Filing Date Feb. 9, 2005, entitled Directional Anchoring Mechanism, Method And Applications Thereof, which claims priority from U.S. Provisional Patent Application 60/542,280 filed Feb. 9, 2004 entitled Intrapulmonary Therapeutic Devices And A Directional Anchoring Mechanism, all of which are hereby incorporated herein by reference in their entireties.
The present invention relates to intra-body anchoring mechanisms and, in particular, it concerns anchoring mechanisms and methods for anchoring a device at a desired angle relative to a biological conduit, and associated applications of such mechanisms in devices and methods.
One aspect of this invention deals with drug delivery. There are treatments for lung diseases for which the continuing application of drugs is required. One example is the treatment for destroying lung lesions. Although the drug is applied in a systemic manner to the entire body, it is concentrated inside cells having high metabolic activity. Beyond a certain level of concentration, the cell is destroyed. Cancerous cells, which are the target of such drugs, have such high metabolic activity. However there are additional body organs that attract the drug to concentrate in them. As a consequence, besides destroying the lesion, the drug also has a strong side effect of poisoning other organs in the body. There is an advantage to giving the medicine in high doses directly to the infected lung area either as a supplement or as a replacement to the traditional treatment.
Hence, there is an advantage of having a method and apparatus to apply a medicine or plurality of medicines directly to a certain location inside the lung, and furthermore to doing it continuously according to the required delivery profile.
FIG. 1 is a general description of the concentration of a drug in the patient's blood when the drug is given in doses. Every time the dose is given, the concentration is increased sharply and then decays over time. However the drug has the desired therapeutic effect only when its concentration in the blood is higher than a % and lower than b %, where a and b are individuals to the nature of the specific drug and patient condition. When the concentration is lower than a %, the drug is not sufficiently effective. When the concentration is higher than b %, the concentration is so high that it is likely to cause damage to the patient.
Therefore, it is preferred to give the drug constantly in order to keep its concentration within the patient's blood within the desired range. Devices for slow release or delayed release of drugs are well known in the art. An example is U.S. Pat. No. 3,760,984 to Theeuwes titled "Osmotically Powered Agent Dispensing Device With Filling Means", which is fully incorporated here by its reference. It describes a dual chamber capsule, with one chamber internal to the other. The internal chamber is formed of contractible foil and contains the drug to be delivered. The external chamber contains an osmotic solution. The outer layer is formed of a substance that is permeable to external fluid and impermeable to the internal solute. The osmotic pressure developed in the outer chamber contracts the internal layer and pushes the drug through an orifice.
The outer shape of the prior art devices is pre-shaped to the volume needed for containing the drug and the osmotic solution. Therefore they are not suitable for being delivered through the working channel of a bronchoscope which, for those in regular use by bronchoscopists, is less than 1.8 mm in diameter. Therefore it would be of benefit to have a drug delivery device that is sufficiently flexible and thin to be inserted through the working channel of the bronchoscope and can be directed through the pulmonary tree to a desired destination in the periphery of the lung, where the width of the bronchial airways is as small as 1 to 2 mm. It would also be of benefit to have a container for the drug which holds enough volume for long-term treatment and yet is able to pass through a sheath fine enough to enter airways of the aforementioned dimensions. It would also be of benefit to have an anchoring mechanism for securing the position of the device, once inserted, at its designated location for the duration of the treatment, while allowing its release and withdrawal after the treatment is done.
Brachytherapy or Seed implant is a technique of radiotherapy in which small seeds of radioactive materials implanted adjacent to the cancerous lesion. In the lung, this procedure is performed by inserting a thin flexible catheter via the working channel of the bronchoscope, into the designated lung airway, which is left there during the entire emission of the radiation. Since it is extremely inconvenient to remain for a long period of time with this catheter inserted through the bronchus, seeds emitting high dose radiation are often used to shorten the exposure time. This high-dose emission has the undesirable side effect of causing bleeding. On the other hand, using seeds of lower emission prolongs the treatment, which is undesirable too.
Often drugs are given to the patient as part of this treatment such as antibiotics and pain relief. Hence, in certain conditions it might be of benefit to incorporate brachytherapy in conjunction with said drug delivery device.
Another aspect of the invention is the need for a directional anchoring mechanism when performing a pulmonary needle biopsy and other similar procedures.
Currently, needle biopsy is performed through the working channel of the bronchoscope. First, the bronchoscope is guided through the pulmonary tree to the location where the biopsy has to be taken. Then, a flexible catheter having a biopsy needle at its distal tip is inserted through the working channel and punctured through the wall of the pulmonary passageway to the center of the lesion. This procedure is often dangerous because vital organs such as big blood vessels can be damaged if the needle mistakenly hits them. Guiding the needle according to 3 dimensional (3D) imaging data such as Computer Tomography (CT) data may avoid such damage.
PCT application WO 03/086498 to Gilboa, titled "Endoscopic Structures and Techniques for Navigating to a Target in Branched Structure", fully incorporated here by reference, describes methods and apparatus for navigating and leading bronchoscopic tools to the periphery of the lung in context of CT data. A steerable locatable guide, having a location sensor and a deflection mechanism incorporated at its distal tip, is inserted encompassed in a sheath and is used to navigate and place the distal tip of that encompassing sheath at a designated target location inside the lung.
This sheath is subsequently used effectively as an extension to the working channel of the bronchoscope to the periphery of the lung, where the bronchoscope itself cannot reach because of its thickness. First, registration between the CT data and the body of the patient is performed. Then, the locatable guide can be navigated through the branches of the pulmonary tree using the measured location coordinates of the guide's tip overlaid on the CT images. After bringing the tip to the target, the guide is withdrawn and a bronchoscopic tool is inserting into the empty sheath and pushed through it up to the target.
This method and apparatus may be used for bringing a biopsy needle to the target. The sheath has to have a diameter that is sufficiently large to allow insertion of tools through it, and yet sufficiently small for itself being inserted through the working channel of the bronchoscope. Therefore there is insufficient room for incorporating a steering mechanism as part of the sheath itself, and navigation should rely on the steering mechanism of the guide. When the tip is at the target, the guide has to be deflected in order to direct the end portion of the sheath toward the lesion, which is usually located at the side of the passageway. As a consequence, when the guide is withdrawn, the tip of the sheath loses its support, and might not be pointing to the direction of the target anymore. Hence it would be of benefit to have an anchoring mechanism for holding the tip of the sheath correctly oriented (angled) in the direction of the target, even when the guide with its steerable mechanism is withdrawn.
The present invention is an anchoring mechanism and method for anchoring a device at a desired angle relative to a biological conduit, and associated applications of such mechanisms in devices and methods.
According to the teachings of the present invention there is provided, a method for deploying and retaining a distal portion of a catheter within a biological conduit with a central axis of the distal portion of the catheter at a desired non-zero angle relative to a central axis of the conduit, the method comprising the steps of: (a) introducing the catheter into the biological conduit; (b) employing a steering mechanism at least temporarily associated with the distal portion of the catheter so as to deflect the distal portion of the catheter so that the central axis of the distal portion lies substantially at the desired non-zero angle relative to the central axis of the biological conduit; and (c) actuating an anchoring mechanism at least temporarily associated with the distal portion of the catheter, the anchoring mechanism including at least one expandable element configured to grip internal surfaces of the biological conduit in such a manner as to retain the distal portion of the catheter at the desired angle within the biological conduit.
According to a further feature of the present invention, the anchoring mechanism initially assumes a collapsed state having a first maximum diameter no more than 20 percent greater than an outer diameter of the distal portion of the catheter, the anchoring mechanism being expandable to an anchoring state in which the anchoring mechanism provides a plurality of contact regions disposed substantially on an ellipsoid profile so as to anchor the distal portion of the catheter within the biological conduit with the device axis at any desired angle within a pre-defined range of angles relative to the central axis of the conduit.
According to a further feature of the present invention, the anchoring state of the anchoring mechanism exhibits a maximum radial dimension, and wherein a distance from a distal end of the distal portion of the catheter to the anchoring mechanism is no greater than the maximum radial dimension.
There is also provided according to the teachings of the present invention, an anchorable device for deployment within a biological conduit at any desired angle within a pre-defined range of angles relative to a central axis of the conduit, the device comprising: (a) a catheter arrangement including a catheter and a steering mechanism for deflecting a distal portion of the catheter, the distal portion of the catheter having an outer diameter and defining a device axis; and (b) an anchoring mechanism at least temporarily associated with the distal portion of the catheter, the anchoring mechanism including at least one expandable element which initially assumes a collapsed state having a first maximum diameter no more than 20 percent greater than the outer diameter of the distal portion and which is expandable to an anchoring state in which the anchoring mechanism provides a plurality of contact regions disposed substantially on an ellipsoid profile so as to anchor the distal portion of the catheter within the biological conduit with the device axis at any desired angle within a pre-defined range of angles relative to a central axis of the conduit, wherein the anchoring state of the anchoring mechanism exhibits a maximum radial dimension, and wherein a distance from a distal end of the distal portion of the catheter to the anchoring mechanism is no greater than the maximum radial dimension.
According to a further feature of the present invention, the maximum radial dimension of the anchoring state of the anchoring mechanism is greater than the first maximum diameter in the collapsed state of the anchoring mechanism.
According to a further feature of the present invention, the steering mechanism is implemented as part of a guide element removably deployed within the catheter.
According to a further feature of the present invention, the guide element further includes a position sensor element forming part of a position measuring system for monitoring the position and attitude of the distal portion of the catheter within the biological conduit.
According to a further feature of the present invention, the anchoring mechanism includes an inflatable element, the catheter including at least one lumen deployed for introduction of a filler material into the inflatable element.
According to a further feature of the present invention, the inflatable element includes a first compartment for receiving a fluid therapeutic substance, the first compartment being in fluid communication with a dispensing arrangement.
According to a further feature of the present invention, the inflatable element further includes a second compartment for receiving an osmotic solution, the second compartment having at least one water permeable region.
According to a further feature of the present invention, the dispensing arrangement includes a cannula deployable so as to project substantially parallel to the device axis beyond the distal portion of the catheter, the cannula having an inlet in fluid communication with the first compartment.
According to a further feature of the present invention, the inflatable element is formed with a plurality of axial channels for allowing fluid flow along the biological conduit when in the anchoring state.
According to a further feature of the present invention, the inflatable element is formed with a plurality of external channels such that the inflatable element includes a plurality of lobes, thereby allowing fluid flow along the biological conduit between the lobes when in the anchoring state.
According to a further feature of the present invention, the anchoring mechanism includes a mechanical anchoring mechanism for deploying the plurality of contact regions from the collapsed state to the substantially ellipsoid profile.
According to a further feature of the present invention, there is also provided a carrier arrangement associated with the anchoring mechanism and carrying at least one brachytherapy seed.
According to a further feature of the present invention, the anchoring mechanism is configured to define a predefined non-zero angle between the distal portion of the catheter and the central axis of the biological conduit.
There is also provided according to the teachings of the present invention, a drug delivery device for deployment within a biological conduit and for delivering a drug into tissue adjacent to the biological conduit, the device comprising: (a) a first compartment for receiving a fluid therapeutic substance; (b) a cannula deployable so as to project from the device, the cannula having an inlet in fluid communication with the first compartment; (c) a second compartment for receiving an osmotic solution, the second compartment having at least one water permeable region; and (d) wherein the first compartment and the second compartment share a common displaceable wall such that absorption of water by the osmotic solution causes displacement of the displaceable wall so as to expel the fluid therapeutic substance from the first compartment along the cannula into the tissue.
According to a further feature of the present invention, the first and second compartments make up at least part of an inflatable anchoring device configured for retaining the device against walls of the biological conduit with the cannula projecting in a direction non-parallel to a central axis of the biological conduit.
According to a further feature of the present invention, the inflatable anchoring device assumes an anchoring state in which a plurality of contact regions are disposed substantially on an ellipsoid profile so as to anchor the drug delivery device within the biological conduit with the cannula projecting at any desired angle within a pre-defined range of angles relative to the central axis of the biological conduit.
FIGS. 13A and 13B illustrates schematically a mechanical variant of the anchoring mechanism of the present invention.
The principles and operation of anchoring mechanisms and methods according to the present invention may be better understood with reference to the drawings and the accompanying description.
Referring now to the drawings, FIGS. 2-12 show various examples of anchorable devices, constructed and operative according to the teachings of the present invention, for deployment within a biological conduit at a desired angle relative to a central axis of the conduit. Generally speaking, in each case, the device includes a catheter arrangement including a catheter and a steering mechanism for deflecting a distal portion of the catheter. An anchoring mechanism, at least temporarily associated with the distal portion of the catheter, includes at least one expandable element which initially assumes a collapsed state for insertion and is expandable to an anchoring configuration for retaining the distal portion of the catheter at a desired angle.
The method of the present invention generally proceeds by introducing the catheter into the biological conduit and employing the steering mechanism to deflect the distal portion of the catheter so that the central axis of the distal portion lies substantially at the desired non-zero angle relative to the central axis of the biological conduit. The anchoring mechanism is then actuated so that at least one expandable element grips internal surfaces of the biological conduit in such a manner as to retain the distal portion of the catheter at the desired angle within the biological conduit.
In a preferred structural implementation, the collapsed state has a first maximum diameter no more than 20 percent greater than the outer diameter of the distal portion. The expandable element is expandable to an anchoring state in which the anchoring mechanism provides a plurality of contact regions disposed substantially on an ellipsoid profile so as to anchor the distal portion of the catheter within the biological conduit with the device axis at any desired angle within a pre-defined range of angles relative to a central axis of the conduit. In order to provide a relatively large range of anchoring angles, the distance from the distal end of the distal portion of the catheter to the distal end of the anchoring mechanism is preferably no greater than the maximum radial dimension of the anchoring mechanism when in its anchoring state.
At this stage, it will be appreciated that the anchoring mechanism of the present invention offers considerable advantages over conventional balloon or mechanical anchoring mechanisms. Specifically, the anchoring mechanism itself provides stabilization of the distal portion of the catheter not only axially but also in attitude (angularly) relative to the biological conduit, allowing the distal portion of the catheter (or a device associated therewith) to be directed reliably at a location in the wall of the conduit. This and other advantages of the apparatus and method of the present invention will become clearer from the detailed description below.
Before addressing the present invention in more detail, it will be useful to define certain terminology as used herein in the description and claims. Firstly, the invention is described for use in a "biological conduit". This phrase is used herein to refer to any tube-like structure within the human or animal body including, but not limited to, bronchial passageways, blood vessels and passageways of the digestive, renal and reproductive systems. Of particular importance are bronchial applications in which context the various applications of the present invention will be exemplified.
Reference is also made to "a plurality of contact regions" of the expandable element of the anchoring mechanism. It should be noted in this context that the "plurality of contact regions" may be discrete regions or may be regions of one or more continuous surface. In preferred cases, these regions are described as lying substantially on an "ellipsoid profile." The term "ellipsoid" is used herein loosely to refer to any configuration which appears primarily roughly oval as viewed in a side view. This terminology refers to a range of shapes including shapes approximating to spherical, an elliptical solid of revolution about the axis of the catheter with the major axis of the ellipse parallel to the catheter axis, an elliptical solid of revolution about the axis of the catheter with the minor axis of the ellipse parallel to the catheter axis, and various other structures in which outwardly-bowed elements are deployed around the distal portion of the catheter such as will be described below with reference to FIGS. 11A and 11B.
Reference is also made to a "maximum radial dimension" of the expandable element in its anchoring state. In the case of a roughly spherical expandable element, this is simply the radius of the sphere in its fully open state. In the case of a non-spherical ellipsoid, the maximum radial dimension is preferably defined to be half of the diameter of the fully open expandable portion measured perpendicular to the axis of the catheter. This distance is then used to define the proximity of the expandable portion to the distal end of the catheter, namely, that the part of the expandable element closest to the end of the catheter lies within a distance equal to the maximum radial dimension from the end of the catheter. Most preferably, the expandable portion terminates substantially at the end of the catheter, thereby maximizing the angular range of positions which can be accommodated. Preferably, the maximum radial dimension of the anchoring state of the anchoring mechanism is greater than the first maximum diameter in the collapsed state of the anchoring mechanism.
Finally with respect to definitions, reference is made to "osmotic solution" in the context of an osmotic pump drug delivery system of the present invention. The term "osmotic solution" is used herein to refer to any composition which creates an osmotic gradient relative to surrounding moisture or body fluids, thereby causing absorption of water and consequent volume increase in the osmotic solution. The principles of such pumps, and examples of materials suitable for implementing them, are well known in the field, for example, in the aforementioned U.S. Pat. No. 3,760,984 to Theeuwes.
Turning now to the various implementations of the present invention, it should be noted that the aforementioned catheter arrangement may either be an integral part of a device to be anchored, or some or all of its components may serve as a withdrawable deployment system. In most preferred examples, at least the steering mechanism is implemented as part of a guide element removably deployable within the catheter so as to leave an inner lumen of the catheter available for guiding additional tools or other devices to a target location.
One particularly preferred example of this functionality employs a guide element further including a position sensor element forming part of a position measuring system for monitoring the position and attitude of the distal portion of the catheter within the biological conduit. The resultant system is essentially as described in the aforementioned PCT application WO 03/086498 to Gilboa, titled "Endoscopic Structures and Techniques for Navigating to a Target in Branched Structure" with addition of the directional anchoring features of the present invention. This provides a greatly enhanced level of confidence that the guide has not shifted angularly during withdrawal of the guide element and insertion of a tool, thereby greatly improving the reliability of biopsy results or other procedures performed by the system.
Turning now to other examples of the present invention, FIGS. 2A-9 show various examples of a drug delivery system according to the teachings of the present invention. These examples illustrate implementation of the anchoring mechanism as one or more inflatable element, where the catheter arrangement defines at least one lumen deployed for introduction of a filler material into the inflatable element.
Specifically, FIG. 2 a through 2 c shows a general description of both method and apparatus of the drug delivery mechanism, according to this patent. A flexible thin catheter 100 has a body 110 and a drug delivery device 120 which is attached to the distal end of body 110. The device is inserted and navigated to a designated lung target in airway 10. While in insertion mode, as shown in FIG. 2 a, the drug delivery device 120 is empty from drug and folded to have a diameter similar to the diameter of the catheter. After the device is located at the target, the drug, or drugs, are injected through the catheter and by filling device 120 inflating it as shown in FIG. 2 b. The outer diameter of device 120 in the inflated mode is large enough to firmly press against the wall 10 of the airway. After complete inflation of the device, the catheter body 110 is parted from device 120 and withdrawn, as shown in FIG. 2 c. The drug delivery device 120 is left in the airway, being held in place by the friction between the outer surface of the device and the airway wall. The drug is then released slowly from the device.
FIG. 3 shows a first embodiment of device 120. It is comprised of a cylindrical body 122, which is attached to catheter body 110. A balloon 124, made of relatively non-stretchable material such as Polyester or Nylon, is folded on tube 122 similar to the way an umbrella is folded. At least part of balloon 124 is made to be permeable to outer fluids. A steerable locatable guide 20, having a location sensor 25 at its distal tip as described in PCT application WO 03/086498, is inserted along the inner of body 112 and tube 122. A lumen 112 is implemented along body 110, which its orifice located inside balloon 124 through a valve 126. The drug, mixed with osmotic solution 130 is pressed through said lumen, to inflate balloon 124, as shown in FIG. 4. Body 110 together with the guide 20 can be detached from device 120.
FIG. 5 shows an alternative device 150. A cylindrical body 151 attached to a hollow body 111. A first balloon foil 154 made of stretchable material such as Latex, enveloped cylinder 151. A drug solution 162 can fill the space between body 151 and foil 154 through a first lumen 152, which implemented along body catheter 111 and a valve 153. A second balloon foil 157, made of non-stretchable material, is enveloping the first balloon 154. Foil 157 made at least in part to be permeable to outer fluids.
The latter may be filled with an osmotic solution 164 trough lumen 155, which is implemented along body catheter 111 and valve 156 as shown in FIG. 6.
After device 120 or the alternative device 150 are filled, inflated and detached from the body catheter, it works similarly to the device described in U.S. Pat. No. 3,760,984 and sold by ALZA, a company owned by Johnson & Johnson, under the name OROS-Oral Delivery Technology. The osmotic material either 130 or 164 cause fluids from outside of the device to flow inside and increase the internal osmotic pressure. This causes the drugs to drop out in a constant flow through an orifice (not shown). Because fluids from outside of the device replace the subtracted volume resulted from the dropped out drug, the balloon is not shrunk. Hence, while the balloon is kept intact, the device is kept secured in place.
It will be noted that the directional anchoring of the present invention may be of importance even in these needleless drug delivery devices, for example, where the drug release orifice is turned towards a specific target region so as to maximize the concentration of the drug adjacent to the target region.
In some procedures, it is required to inject the drug directly into the body tissue rather than release it at the lung airways. FIGS. 7 a through 7 d show an adaptation of the above-described method for using with an injection needle. As in FIGS. 5 and 6, the inflatable element here includes a first compartment for receiving a fluid therapeutic substance, and a second compartment having at least one water permeable region for receiving an osmotic solution. In this case, the device further includes a cannula deployable so as to project substantially parallel to the device axis beyond the distal portion of the catheter, the cannula having an inlet in fluid communication with the first compartment. Absorption of water by the osmotic solution causes displacement of a displaceable wall between the first and second compartments so as to expel the fluid therapeutic substance from the first compartment along the cannula into the tissue.
Reference is now made to FIG. 7 a. A catheter 700 assembled of a catheter body 710 having one or more lumens 712, each terminating in a valve 714. A drug delivery device 720 attached to the distal tip of the catheter assembled from a cylindrical body 723, one or more balloons 722, identical to the above description balloons 124 or 154 and 157. At its distal end, it comprises an intermediate chamber 724, constructed of an internal valve 726 and a frontal foil 728. As before, a steerable locatable guide 20 having a location sensor 25 is used to navigate and placed the device 720 at its destination site. Using the plurality of lumen 712, the plurality of balloon 722 is filled and inflated, as shown in FIG. 7 b. After the balloon is inflated, guide 20 is withdrawn and a needle (cannula) 752, which is mounted at the tip of guide 750, is inserted through the internal valve 726 which also locks the needle in place and through a puncture in the frontal foil 728, as shown in FIG. 7 c, into the body tissue. FIG. 7 d shows the said needle delivery device after guide 750 is dismantled and withdrawn. After osmotic pressure builds up inside the device the drug is slowly injected through orifice 730 between the frontal chamber 724 and the balloon, and through a hole 754 into the internal lumen of the needle.
Prior to the use of the needle, the device has to be directed towards the target.
FIGS. 8 a trough 8 d describe a method of using a steerable-locatable guide in combination with a balloon to direct the insertion of a needle toward a designated target. A sheath 800, having an inflatable balloon 810 at its distal tip, is guided to a target 802 in the pulmonary tree using guide 20 and location sensor 25 as described in PCT application WO 03/086498. Upon reaching the target, guide 20 is deflected in the direction of target 802, as is seen in FIG. 8 a. Holding the tip in that direction, balloon 810 is now inflated, as shown in FIG. 8 b. The diameter of the balloon should be greater than the diameter of the airway by at least by 10%, preferably by 50%. The pressure exerted by the outer surface of the balloon 810 on the airway wall holds the internal tube 815 in the direction of target 802, allowing the guide 20 to be withdrawn and replaced by guide 825, as shown in FIG. 8 c, and while tube 815 is maintaining its direction. In a first preferred embodiment, guide 825 incorporates a needle biopsy 825 at its distal tip. After taking the biopsy, the balloon is deflated and the sheath 800 is taken out together with the guide 820 and its needle 825. On a second preferred embodiment, the said sheath is the above described needle drug delivery device 700, the said balloon is the drug container 722 and the said needle is the injection needle 752. FIG. 8 d shows the drug delivery device 720 after it is set to operate while its needle is directed into the target according to the method described herein.
As mentioned earlier, the above described method for directing and holding the distal end portion of a sheath can be used to direct various catheter tools towards a designated target in the body of the patient. Examples are biopsy tools such as forceps and biopsy needles, drug delivery tools such as sprayers and injection needles, RF and cryo ablating electrodes, light emitting probes for ablation or for photo-dynamic therapy, etc. Thus, in a generalized statement, the corresponding method of the present invention includes the steps of: inserting a steerable guide into the catheter lumen for navigating the catheter (sheath) to a target body portion, deflecting the steerable section of the guide so as to direct the end portion of the sheath towards said target body portion, and inflating the inflatable portion of the sheath in order to secure the direction of the sheath's distal end portion towards the target, even once the steerable guide is removed to free the lumen for insertion other catheter tools.
The shape of the outer balloon according to this invention may be spherical or elliptical as mentioned. However in some cases it preferably has a modified shape in order to prevent blocking fluid flow along the biological conduit. In such cases, the inflatable element is preferably formed with a plurality of axial channels for allowing fluid flow along the biological conduit when in the anchoring state. In one preferred example, the inflatable element is formed with a plurality of external channels such that the inflatable element includes a plurality of lobes with the channels passing between them. FIG. 9 shows an example of such a balloon having channels along its length in order to allow air to flow around the balloon, while still having enough friction to secure the device in place. Alternative implementations may provide enclosed channels passing through the balloon (not shown).
FIGS. 10A and 10B illustrate a further application of the present invention which includes a carrier arrangement associated with the anchoring mechanism and carrying at least one brachytherapy seed. Brachytherapy is a well-known method of killing a cancerous lesion by placing radioactive seeds adjacent to the lesion. The drug delivery device allows combining brachytherapy seed placement together with drug delivery while the drug can be selected to be one or more of the following: Chemotherapy, antibiotics, pain relief, gene therapy or other therapy. FIG. 10 a shows how a thin catheter holding the seeds of the brachytherapy is placed into the drug delivery device, and in FIG. 10 b how it is left secured by said device. Here too, the directional anchoring techniques provided by the present invention may be used to advantage for ensuring proximity between the brachytherapy seeds and the specific tissue to be targeted.
The above-described device may be built from biocompatible materials. It may be left in the body after its function is ended, or it may be released from its position and pulled out. The latter may be performed using the system and methods described in PCT application WO 03/086498 by navigating a bronchoscopic forceps to the device, puncturing the balloon and pulling it out exactly in the same technique currently used for removing foreign bodies from the lung.
Although illustrated thus far with reference to an inflatable element, it should be noted that most of the applications of the present invention may alternatively be implemented using a mechanical anchoring mechanism for deploying the plurality of contact regions from the collapsed state to the substantially ellipsoid profile. One non-limiting example of a mechanical anchoring mechanism is shown schematically in FIGS. 11A and 1 in.
Specifically, the distal portion 850 of a catheter is here provided with a plurality of initially straight leaf spring elements 852 deployed between a pair of collars 854 and 856. An actuator (not shown) is configured to selectively displace one of the collars towards the other, thereby causing the leaf spring elements 852 to bow outwards so as to engage the wall of the biological conduit 858. The material of leaf spring elements 852 is chose, or the spring elements are coated, so as to produce high friction engagement with the conduit wall. FIGS. 11A and 11B show the use of this anchoring mechanism in conduits of different diameters, illustrating differing degrees of opening of the mechanism to accommodate the differing diameters. It will be appreciated that this mechanism also generates contact surfaces lying on a generally ellipsoid profile which are suited to retaining the catheter and/or an associated device at any desired angle within a range of angles relative to the axis of the biological conduit.
Turning finally to FIG. 12, it should be noted that the fine adjustment of angle of the distal portion of the catheter relative to the axis of the biological conduit is not required for all applications of the invention. Thus, in certain cases, it is sufficient to anchor the distal portion of the catheter at a predefined angle relative to the conduit axis, thereby ensuring an appropriate approach angle to a target region on or behind a side wall of the conduit. This can be achieved with a simple structure such as that illustrated schematically in FIG. 12.
Specifically, FIG. 12 shows a substantially cylindrical anchoring balloon 860 which tends to align itself when inflated with the direction of the biological conduit. The distal portion of a catheter 862 is mounted within anchoring balloon 860 with at least its tip at a predefined angle. Inflation of balloon 860 inherently orients the distal portion of the catheter facing towards the wall of the conduit at the predefined angle. This may be performed even without provision of a steering mechanism, but is more preferably performed in a controlled manner by first employing a steering mechanism to direct the distal portion of the catheter at roughly the desired angle so that inflation of the balloon merely fixes the catheter in its position.
Balloon 860 may be implemented by generally known techniques. By way of non-limiting example, the balloon may be implemented as a folded balloon of flexible substantially inelastic (non-stretching) material. Alternatively, an elastic balloon which has variable wall thickness may be used to force the material to inflate selectively in the desired directions to achieve the non-coaxial inflated state.
In yet another embodiment of the present invention, a variant of a mechanical anchoring mechanism may employ an expandable anchoring cage. With reference to FIGS. 13A and 13B, a steerable locatable guide 20, having a location sensor 25 at its distal tip, may be inserted along an inner lumen 910 of catheter body 900. The catheter body 900 may optionally employ a longitudinally oriented, visible or radio opaque marker 905 along its length or a portion thereof, as shown in FIG. 15.
An anchoring cage 920 is permanently associated or secured to the distal end 930 of catheter body 900. In a collapsed or retracted state, illustrated in FIG. 13A, anchoring cage 920 may be retained by a retaining sheath 940 surrounding catheter body 900. To deploy the anchoring cage 920, the retaining sheath 940 is retracted from the distal end 930 of the catheter body 900. As the retaining sheath 940 is retracted, the filamentous members 950 (FIG. 13B) of anchoring cage 920 assume an expanded configuration. An example of an expanded or protracted anchoring cage 920 is illustrated in FIG. 13B.
The anchoring cage 920 may, for example, comprise a woven filamentous members 950. The filamentous members 950 may, for example, be constructed of a material such as stainless steel, Nitinol, or other suitable biocompatible material. The characteristics of retractability and expandability of the filamentous members 950 may be due to the elasticity or thermomechanical shape memory characteristics of the material from which the filamentous members 950 are made. It is noted that the plurality or singularity of the term "filamentous member(s) 950" is not intended to limit the configuration of the anchoring cage 950. For example, anchoring cage 920 may be constructed from a single contiguous filamentous element or from multiple independent or noncontiguous filamentous elements. The anchoring cage 920 may but need not be made of homogonous filamentous elements 950, i.e. certain filamentous members 950 of the same anchoring cage 920 may be fabricated of different materials. The filamentous members 950 may have circular, elliptical, or asymmetrical cross-sectional shapes. The filamentous members 950 may further have longitudinal profiles that are either symmetrical, of equal or uniform width over the length of a single filament, or nonsymmetrical, of irregular width over the length of a single filament.
Upon expansion, the anchoring cage 920 acts against the interior wall 960 of the biological conduit 970. To further provide anchoring action, all or certain of the filamentous members 950 of the anchoring cage 920 may be textured, coated, or otherwise treated so as to produce a high friction engagement with the interior wall 970 of the biological conduit 960. The anchoring cage 920 may employ either a circular, elliptical, rectangular, triangular, or other symmetrical or nonsymmetrical expanded shape. As the retaining sheath 940 is retracted from the distal portion 930 of catheter body 900, expansion of the anchoring cage 920 may begin at the distal portion of anchoring cage 920, i.e. expansion may begin where the anchoring cage 920 is first exposed from retaining sheath 940. Alternatively, the anchoring cage 920 may be configured to selectively expand during or after retaining sheath 940 is fully retracted, e.g. expansion may begin at an approximate midpoint 990 of the anchoring cage 920 after the retaining sheath 940 has been fully transposed.
Similar to the embodiment illustrated in FIG. 12, in a mechanical anchoring mechanism of the present embodiment it may be sufficient to anchor the distal portion of the catheter body at a predefined angle relative to the biological conduit axis, thereby ensuring an appropriate approach angle to the target on or behind the interior wall of the biological conduit. In such a configuration, the anchor cage may be constructed in a shape similar to the shape illustrated in FIG. 12. Specifically, the mechanical anchoring mechanism may be a substantially cylindrical anchoring cage which, when expanded, tends to align itself with the direction of the biological conduit. Expansion of the anchoring cage would inherently orient the distal portion of the catheter body along the interior wall of the biological conduit at the predefined angle. This may be performed even without provision of a steering mechanism, but is more preferably performed in a controlled manner by first employing a steering mechanism to direct the distal portion of the catheter body at roughly the desired angle so that expansion of the anchoring cage merely fixes the catheter body in its position.
Certain embodiments of the present invention, as shown in FIG. 14, may employ one or more anchoring cages 925 positioned along the length of catheter body 900. The anchoring cages 925 are constructed and function in a manner substantially identical to those described above for the anchoring cage 920. The primary difference between anchoring cages 925 and 920 being that anchoring cage 920 is positioned at the distal end 930 of catheter body 900. In contrast, one or more of the anchoring cages 925 may be positioned along the length of catheter 900. The anchoring cages 925 function to secure the catheter 900 within the biological conduit 960 at multiple points and to thereby further decrease the possibility of the catheter 900 moving during a procedure.
It will be appreciated that an anchoring cage mechanism according to the present embodiment may provide certain advantages. First, once deployed, an anchoring cage may not substantially restrict the flow of fluids or air through the biological conduit in which the anchoring cage is utilized. This may allow for safer prolonged usage of the anchoring cage without the complications or risk associated with reduced flow in the biological conduit. Second, in contrast to an inflatable or balloon-type anchoring device, deployment or expansion of an anchoring cage does not require the translocation of an inflation substance, e.g. saline. This greatly simplifies the catheter design and reduces catheter manufacturing costs.
an anchor permanently associated with the distal tip of the catheter and configured to act against an internal surface of a biological conduit, to orient the distal tip of the catheter at a desired angle relative to a central axis of the biological conduit.
2. The instrument of claim 1, wherein the anchor comprises an anchoring cage.
3. The instrument of claim 2, wherein the anchoring cage comprises at least one filamentous element.
4. The instrument of claim 3, wherein the filamentous element comprises a material selected from the group of materials comprising: stainless steel and Nitinol.
5. The instrument of claim 3, wherein the filamentous element is woven.
6. The instrument of claim 1, wherein the anchoring cage is configured to expand to an anchoring state and contract to a retracted state.
7. The instrument of claim 6, wherein, in said anchoring state, the anchoring cage is configured to align itself in a predefined orientation relative to a central axis of the biological conduit.
8. The instrument of claim 6, wherein the instrument body comprises a sheath configured to retain the anchoring cage in the retracted state.
9. The instrument of claim 1, further comprising a position sensor element forming part of a position measuring system for monitoring a position and attitude of said distal portion of said instrument body.
10. The instrument of claim 9, wherein the position sensor is associated with a steering mechanism operable to deflect the distal tip of the instrument body.
11. The instrument of claim 10, wherein the steering mechanism is implemented as part of a guide element removably deployable within the instrument body.
12. The instrument of claim 1, wherein the anchor is configured to produce high friction engagement with the interior surface of the biological conduit.
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You are here: Home / Read Our Blog / IT Shed / Hybrid IT: Are You Ready For The Next Revolution?
The world is being taken over by technology. Various applications are generating data that is crucial to today's digital economy. Therefore, it is essential to be able to develop and incorporate applications into your business. Companies want a simple and efficient way to run these items so that their needs are met. Unfortunately, it is not always easy to receive flexibility from a traditional IT infrastructure. Businesses need to uncover applications that help them grow, increase revenue, and provide a valuable product, which serves the public.
Most business owners are familiar with public and private cloud storage systems. It is a fact that the public cloud is often slower and less powerful than the private cloud. Intellectual property may be compromised, and service agreements do not always mesh with company standards. Also, it can be quite expensive. However, the private cloud has problems as well.
No matter what type of organization you are running, you are probably balancing traditional IT and cloud-based systems. For more seamless results, a hybrid system should be considered. Since most businesses have data contained in a variety of locations, it makes sense to consider hybrid technology. This helps a company find the correct blend of scale, speed, and price.
A hybrid storage system accommodates a business's changing data needs. It keeps your company's operations moving smoothly and affordably. It is a simple way to update without much expense. In the end, your business will gain time to develop new applications that heighten revenue.
Dropbox is just one example of a company that utilizes a hybrid system. In the beginning, it used the public cloud. However, the price began growing too high. To lower the costs and to keep up with evolving needs, it is presently running on a mixture of private, public, and traditional systems.
Every CIO understands that IT needs are always changing. It is his or her responsibility to find the blend that works best. Therefore, hybrid IT is the answer. It keeps a company moving forward.
It is especially important for every business, even ones with a small IT department, to push information technology to its limits. A hybrid storage system provides flexibility and allows a business to harness the best parts of the public and private cloud environments. It accommodates time for traditional applications as well.
No matter the size of your business, it is most likely facing a digital transformation. With the correct blend of IT technology, your company can enjoy updated applications. It is a smart way to heighten resources that are needed to develop new applications, to grow, and to become more profitable. It is essential to be ready and to take the leap into hybrid storage so that you remain ahead of your competition.
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