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You are here: Home | FLDS | Images show police in Texas was well armed for raid on polygamist retreat
Images show police in Texas was well armed for raid on polygamist retreat
Wednesday April 16, 2008 FLDS, Polygamy
SAN ANGELO, Texas: Police wore body armor, sported automatic weapons and were backed by an armored personnel carrier for a raid on a West Texas polygamist retreat, photos and video show.
Four still photos and a slice of video were released Tuesday to The Associated Press by Rod Parker, spokesman for the Fundamentalist Church of Jesus Christ of Latter Day Saints, which owns the raided Yearning for Zion Ranch near San Angelo in Eldorado.
Sect members took the photos and video during the first few days of a seven-day raid that involved police agencies from six counties, the Texas Rangers, the state highway patrol and wildlife officers. Authorities were looking for a teenage girl who had reported being abused by her 50-year-old husband.
A sect member whose wife shot the video said sect members got the impression that state officials "were doing something more than they said they were going to do." The man declined to give his name for fear that speaking out would cause problems for his children, who are in state custody.
Tela Mange, a state Department of Public Safety spokeswoman, said officers are trained to protect themselves.
"Whenever we serve a search warrant, no matter where or when, we are always as prepared as possible so we can ensure the operational safety of the officers serving the warrant, as well as the safety of those who are on the property in question," Mange said.
The armored car was precautionary and designed to remove someone from the property, not to force entry onto the ranch, she said.
Eldorado is about 200 miles (322 kilometers) southeast of Waco, where federal authorities tried to arrest Branch Davidian leader David Koresh for stockpiling guns and explosives in 1993. Four federal agents and six members of Koresh's sect died in the shootout that ensued. After a 51-day standoff, Koresh and nearly 80 followers died in an inferno that the government says was set by the Davidians but that survivors say started when authorities fired tear gas rounds into their compound.
Law enforcement surrounded the FLDS ranch April 3, carrying a warrant seeking a 16-year-old girl who claimed she was trapped inside the church retreat and had been beaten and raped by her husband. The search also revealed that a soaring white limestone temple at the ranch held a bed where officials believe underage girls were required to consummate their spiritual marriages to much older men.
More than 400 children ? all of whom lived in the large, dormitory-style log homes ? were seized in the raid on suspicion they were being sexually and physically abused. They are being held in the San Angelo Coliseum and are awaiting a massive court hearing Thursday that will begin to determine their fate.
FLDS members carefully documented the raid in notes, video and still pictures of police and child protection workers talking with families, but much of that material was seized when police executed one of two search warrants on the ranch, Parker said.
"We've known from a little bit of experience to document it and prepare to have that presented in court or wherever it's to our benefit," said the FLDS member who declined to give his name. Law enforcement in Arizona and Utah raided FLDS compounds in 1935, 1944 and 1953.
The 416 children held by Texas authorities had been accompanied by 139 women until Monday, when officials ordered all the women away except for those whose children are under 5.
The mothers have complained the state deceived them, revealing the plan only after they and their children boarded buses from historic Fort Concho, where they had been staying, to the larger San Angelo Coliseum. State officials defended that decision Tuesday.
Texas Children's Protective Services spokeswoman Marleigh Meisner said officials decided that children are more truthful in interviews about possible abuse if their parents are not around.
"I can tell you we believe the children who are victims of abuse or neglect, and particularly victims at the hands of their own parents, certainly are going to feel safer to tell their story when they don't have a parent there that's coaching them with how to respond," Meisner said.
Meisner said child welfare officials still can't find birth certificates for many of the children, making parentage and age determinations impossible. She said many of the children don't know who their parents are and many have the same last name but may or may not be related.
"It's a difficult process," she said.
Officials have yet to identify the 16-year-old whose call for help to a Texas domestic violence hotline triggered the raid.
The renegade Mormon sect is led by Warren Jeffs, who was sentenced to prison in Utah for forcing underage girls into polygamous marriages and is awaiting trial in Arizona on similar charges.
A company founded and run by members of the church received more than $1.1 million (€690,000) in government contracts between 2003-2007, a federal online database shows. Most of that money was spent by the Department of Defense on aircraft wheel and brake parts.
NewEra Manufacturing's president and CEO is John Wayman, a sect member who runs the Las Vegas business. NewEra was previously known as Western Precision Inc. and based in Hildale, Utah, where thousands of church members live.
In a 2005 affidavit filed with a Utah lawsuit, former church member and Western Precision worker John Nielsen said workers were underpaid or not paid at all for work they did because they were told their time and earnings were being donated to the church.
Associated Press writers Michael Graczyk in San Angelo and Brock Vergakis in Salt Lake City contributed to this report.
Topics: FLDS, Fundamentalist Church of Jesus Christ of Latter Day Saints, Polygamy
[FLDS] Braided Bloodlines
Sect families hesitant to return to ranch
Texas High Court: Sect Children Can Return to Families
FLDS enclave grows
FLDS reinstituting blood atonement


While the Midwest is getting walloped with an absolutely chilling arctic blast that the National Weather Service says will head to most of the eastern U.S., the bay area is seeing cold air move in that makes things cool, but still quite nice.
A cold front moved through the area Tuesday night into Wednesday morning and was already well on its way south by the morning commute. The front brought with it some cool, dry air that'll hold over the area until Thursday, adding to the already cold air that's kept temperatures below normal for the first half of the week.
Even after almost 100 years, Barbara Collins' home near Ball Street still looked well-kept from the outside. The walls and mailbox were painted a rich purple. Hibiscus trees and a two-foot madonna figurine decorated her front yard.
A new program aims to preserve affordable housing stock by rehabbing homes deemed unsafe or beyond repair. Run by Rebuilding Together Tampa Bay and Hillsborough County, homes that qualify for assistance are demolished and rebuilt in the same footprint. The idea is to help low-income, mostly older homeowners struggling to maintain their houses. Without help, many of those homes will eventually fall into disrepair, reducing the availability of low-cost homes.
In case you haven't been following the story, Hunt was an extraordinary rookie running back in Kansas City in 2017, and a league-wide pariah by the end of 2018.
Video of Hunt in a physical altercation with a young woman in a hotel hallway made its way into the public square, and Hunt reportedly lied to the Chiefs when initially questioned about the incident.
Soon, there were whispers of two other bar fights in the previous year and the Chiefs – in the midst of what looked like a potential Super Bowl season — cut ties with Hunt almost two months ago.
Now come reports that multiple teams, including the Bears, have interest in signing Hunt. And NFL Network analyst Ian Rapoport told WDAE-AM 620 that he expected the Bucs to look into the possibility.
Of course, the Bucs should discuss it. They'd be derelict if they did not. But they should figure out pretty quickly that it would be a self-defeating decision.
Prosecutors on Wednesday dropped their case against Dean McKee over doubts about his guilt in a 1987 Tampa murder.
McKee, 47, is free after serving more than 30 years in prison for the crime. He wept when Assistant State Attorney Megan Newcomb announced the state would not put him through a second trial.
"It's been a long time," he said.
A judge wished McKee good luck and he walked out of the courtroom into the embrace of his fiance.
"We always knew Dean McKee did not commit this crime," said Seth Miller, executive director of the Innocence Project of Florida, which took McKee's case in 2011. "Although the state and I probably disagree about the substance of the case, this was the right result and I want to commend them for doing their due diligence."
The state's decision caps a long-running case that, in recent years, produced DNA results and witness testimony indicating McKee's older brother may have had a greater role in the crime than previously disclosed.
Things will get even more surreal at the Dalí Museum in April, when the "Dalí Lives" experience opens featuring an artificial intelligence version of Salvador Dalí himself.


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[latest] Solo Leveling Anime Synopsis, New Storyline, Leaks, Plot & More Spoilers
About the anime adaptation of Solo Levelling
The adaptation of the manhwa, originally scheduled for 2023, was confirmed during Anime Expo 2022. A-1 Pictures, the company behind such smash hits as Sword Art Online and Black Butler, will be in charge of production. As the anime has been licenced by Crunchyroll, the manhwa will undoubtedly appear on the site after its initial run. During this year's Aniplex Online Fest 2022, Tomoko Sudo unveiled two concept sketches for the programme.
The year 2023 has been set as the release year, but the specific day has not been revealed, and neither has the voice-acting cast. The director is Shunsuke Nakashige, and the scriptwriter is Noboru Kimura. Hiroyuki Sawano, whose past works include score compositions for Attack on Titan, The Seven Deadly Sins, and Kill La Kill, will supply the soundtrack. An exciting adaptation of the original manhwa, as promised by the trailer. Twitter followers have been on the lookout for any new information about the release, and their enthusiasm is contagious.
Actors from Solo Leveling
Shunsuke Nakashige will be in charge of directing the series, with Noboru Kimura penning the story. Hiroyuki Sawano, whose resume includes scores for such classic anime as Attack on Titan, The Seven Deadly Sins, and Kill La Kill, will be in charge of the score.
The core members of the production crew are as follows:
DUBU (REDICE StudioChugong, )'s h-goon, and Original Work, Solo Leveling
Producer: Shunsuke Nakashige Director:
Noboru Kimura, Chief Author
Artist Responsible for Character Design: Tomoko Sudo
Score by Hiroyuki Sawano
A-1 Pictures, Animated Film Production
YouTuber Yiman thinks the Japanese hunting culture is portrayed negatively in the Solo Leveling manhwa. Since this is the case, animation companies in Japan are afraid to create an anime based on Solo Leveling.
At long last, an anime dedicated to the practice of solo levelling will be made, with the involvement of some rather prominent names in the field as directors. At this year's Anime Expo, it was announced that the webcomic Solo Leveling will be getting an anime adaptation. This webtoon was inspired by a web book that Chugong just finished in December 2021.
A Narrative of Individual Growth in Anime
In Solo Leveling, we watch as the team's weakest hunter, Sung Jin-Woo, rises through the ranks to become an S-rank hunter with incredible strength. One day, Jin-Woo accidentally enters a dungeon with the appearance of a D-rank but is actually much stronger. When he has given up all hope & accepted his impending death, a mysterious gift is bestowed upon him: the ability to view a task log, much like in video games. Through the successful completion of tasks, he gains experience and power. Thus, he quickly rises to the status of S-rank hunter, and everyone wants him despite his claims that he is only a Solo leveller. Seeing the stunning manhwa brought to life in animation form in an anime will undoubtedly be a treat for fans. As soon as we know anything more about the premiere date and cast for Season 1 of the Solo Leveling anime, we will share it with you.
In light of the fact that the Solo Leveling manhwa has concluded after a total of 179 chapters, readers may be wondering whether and when an anime adaptation of the series would be released. Popular manga and manhwa communities have been rife with speculation about an anime adaptation, so we'd like to set the record straight. Although Solo Leveling was first published as a novel, a manhwa translation was later announced, and the resulting webtoon quickly rose to prominence as one of the most widely read in the history of webcomics. Fans from all around the world are so excited to see the anime adaptation of the series that they have established a petition on Change.org with the lofty goal of collecting 150,000 signatures in order to grab the attention of major anime studios and convince them to consider adapting the series.
One such company is Netflix, and the likelihood of an anime adaptation of Solo Leveling appearing on the service is strong. Many fans have started submitting requests for movies and TV shows to Netflix in addition to signing the petition. Given the widespread confusion, we decided to publish this post with the official release date, trailer and cast to set the record straight.
Schedule for the Anime Version of "Solo: Leveling"
If you're looking for a manhwa with a flawless plot and well-developed characters, go no farther than Solo Leveling. Solo Leveling is a great candidate for an anime adaptation since the narrative of Jin-woo has won the hearts of readers of manga and manhwa all around the world. It is already the summer of 2022, and we still haven't heard anything about Season 1 of Solo Leveling. Some sources even go so far as to say the publishers have officially greenlit the anime adaptation, which is, of course, completely untrue. Unconfirmed sources indicate that the Solo Leveling anime will premiere in March 2023 and may be seen on official streaming services like Crunchyroll and Funimation.
Depending on a number of variables, the premiere date of the Solo Leveling anime might shift. As the worldwide epidemic worsens, the release deadlines for several Webtoons and anime have been moved forward, and it's possible that Solo Leveling's anime adaptation could face the same fate. Our team is certain that an anime adaptation of Solo Leveling will be made in the near future; preparations for it have already begun in the background, and we will be among the first to know when actual production begins. To hint at the possibility of the latest upcoming Solo Leveling anime broadcast, the DNC webtoon even produced a trailer for the series on its YouTube account.
Fans are divided between Madhouse and Ufotable when it comes to which animation studio should make a Solo Leveling anime, with Netflix as the wild card. For now, we ask that you all wait for the formal announcement before getting your hopes up about an anime adaptation. Given that no announcements regarding the anime adaptation or the voice actors for Sung Jin-Woo and the rest of the cast have been made, we can only hope that this information will be made public soon.
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redpajama_set_name: RedPajamaCommonCrawl


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Vivienne Roche: A Light Interlude From The Pulpit • Dnote
Vivienne Roche: A Light Interlude From The Pulpit
Saturday 16 April – Tuesday 21 June 2011
By Vivienne Roche with Katarina Eismann
What happens when a church ceases to be "a church"? What happens when clergy no longer speak to congregation and responses to the clergy fall silent? The fact is that the church, particularly a beautiful one like Christchurch, might still find its voice in such circumstances. This voice, though, will be a kind of undertone.
It is elements of this undertone that have preoccupied me as I tried to bring formerly marginal aspects of this space to the attention of those who newly congregate there. Borges once observed how closely the aesthetic matched the spiritual. I have chosen to follow the light, and reflections of light, within Christchurch. This show of 16 new works is a secular homage to the continuing voice of this church.
Of the infinite number of reflections that move across the interior of Christchurch, I have picked just one (as I did in CIT Cork School of Music) freezing a moment of time in colours supplied by the stained glass windows. I have also taken the theme of the cross and have made a sculpture in glass where the glass is the vehicle for the ways in which colour changes over time in this church. This sculpture adds movement to the static paintings fixed in momentary time.
Churches are fundamentally concerned with issues of death, new life and transcendence. My other works in this show – sculptures, watercolours, drawings and photographs – are my ways of dealing with some of these intrinsic parts of being human. One group is a set of quiet monuments to the passing of five loved people, whom I knew or knew about.
I have invited my friend, the Swedish artist Katarina Eismann to participate in this show with me. I have known Katarina since we exchanged studios in the 1980's. We last showed work together during Kinsale Arts Festival in 1988. Someone older, with life experience, not unlike this church, will be presented by Katarina in a projection. This will anchor Katarina Eismann's piece. But what follows from this?
Those who choose to can elect to be themselves projected onto a screen in Christchurch to mark their becoming an early part of this new human space in Cork. Echoing my fascination with light and reflections, Katarina uses the same light to reflect visitors onto the screen. Those who opt for this experience become early players in this new communal "theatre of life". You don't have to be dead to be commemorated. Why should a church just be a site for commemorating the dead? In its new incarnation this space can also celebrate the living.
Vivienne Roche
Vivienne Roche RHA studied art in Cork and Boston. Her work is included in major public art collections in Ireland. Among her public commissions are a memorial sculpture to President Cearbhall O'Dalaigh in Co.Kerry (1983); Liberty Bell, Dublin (1988); Plumblines, Dublin Castle (1995); Flow, Fingal County Hall (2002); NC Iris and Whitelight Garden, both completed in Dublin in 2006; and Light Ensemble, CIT Cork School of Music (2008). She made Light House, a poem sculpture, with Derek Mahon for the new Dept. of Arts, Heritage and Gaeltacht Affairs HQ in Killarney in 2009.
Tidal Erotics at Dublin City Gallery, the Hugh Lane (1999), with composer John Buckley and The Geometry of Water at Centre Culturel Irlandais, Paris (2010) are just two of the many exhibitions she has created.
Honours include membership of Aosdána (1996), the award of an honorary Doctorate in Laws by U.C.C in 2006 and C.I.T Alumni Award in 2010.
In addition to her work as an artist she has been active in the creation and implementation of cultural policy. Among other things, she was a founder member of the National Sculpture Factory in Cork and a member of the Arts Council (1993-98). She lives in Garrettstown, Co. Cork
www.vivienneroche.com
Katarina Eismann
Katarina Eismann graduated from Royal University College of Fine Arts, Stockholm (1993). In recent years, Katarina Eismann has participated in several major art projects where the objective has been to use documentation and narrative as tools within the artistic process.
Eismann has also produced pieces that build on the concept of creating a space where several artists can contribute and, with their different forms of expression, allow a piece of work to take shape.
Her newest work is "FOLDOUT" (2010), a work in progress and is a survey of different approaches to documentary.
www.katarinaeismann.se
Triskel Christchurch
Tobin Street
Telephone: +353 21 4272022
www.triskelartscentre.ie


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This home is a cozy 2 bedroom mobile in quiet well maintained park. It has an addition built on that was approved from the park that gives you added living space and additional storage. Nicely landscaped. Close to shopping, expressway and entertainment. Lot rent only $325 per month and includes water, trash, snow removal. Only pets that are allowed is 1 cat and that would need to be approved.


Georgia flagged bulk carrier named ?Sea Force? broke down while passing through Canakkale Bosphorus.
Georgia flagged bulk carrier named "Sea Force" broke down while passing through Canakkale Bosphorus.
The vessel -100 metres length, 2,724 gross ton weight- which was carrying 2,483 ton helianthus from Romania to Syria, broke down off the Nara Cape.
The captain have anchored out of route by signing its brokedown to Vessel Traffic Services with wireless. A towboat named "Sonduren 5", which Directorate General of Coastal Safety operates, was sent to the zone.
Authorities reported that the vessel does not cause danger for the other vessels which will pass through the Bosphorus.


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Justia Patents Remotely Changing, (e.g., Programming, Pacer) Parameters Or OperationUS Patent for Pacing method and system for cardioprotection during chemotherapy Patent (Patent # 11,179,569)
Pacing method and system for cardioprotection during chemotherapy
Sep 19, 2019 - Cardiac Pacemakers, Inc.
An example of a system and method for protecting a patient diagnosed of cancer from cardiac injury resulting from a chemotherapy treating the cancer. A sequence of cardioprotective pacing sessions may be initiated based on timing of the chemotherapy. Cardiac pacing pulses may be delivered to the patient during each session of the cardioprotective pacing sessions according to a cardioprotective pacing mode for controlling delivery of the cardiac pacing pulses to effect cardioprotection against potential myocardial injury resulting from the chemotherapy. The cardioprotective pacing mode may specifying alternating non-pacing and pacing periods.
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CLAIM OF PRIORITY
This application claims the benefit of priority under 35 U.S.C. § 119(e) of U.S. Provisional Patent Application Ser. No. 62/734,539, filed on Sep. 21, 2018, which is herein incorporated by reference in its entirety.
This document relates generally to cardiac pacing and more particularly to a method and system for providing cardioprotective pacing to cancer patients receiving chemotherapy.
Chemotherapy is a type of widely used cancer therapy known for its efficacy as well as side effects. Cardiovascular dysfunctions are among the significant side effects of chemotherapy drugs. For example, anthracyclines are a class of chemotherapy agents (e.g., doxorubicin, daunorubicin, idarubicin, and epirubicin) commonly applied to treat various types of cancers while being particularly known for cardiotoxicity. Measurable cardiac dysfunctions have been reported in many cancer patients receiving anthracycline-based chemotherapies. Cardiac damage due to the cardiotoxicity is believed to create an underlying substrate for later progression of left ventricular dysfunction (e.g., measured by low ejection fraction) and heart failure. Mortality during and after chemotherapies can be significantly increased by cardiovascular diseases including congestive heart failure.
It is recently estimated that more than 125,000 cancer patients are treated with anthracyclines in the U.S. Cardiotoxicity is cited as a major limitation to dosage, efficacy, and usage of anthracyclines. Anthracycline-based chemotherapies may be more efficaciously utilized for cancer treatment if the associated cardiotoxic side effects can be reduced.
An example (e.g., "Example 1") of a system for delivering cardiac pacing pulses to a patient diagnosed of cancer and receiving chemotherapy treating the cancer may include an implantable cardioprotective pacemaker pre-configured for operation only under a cardioprotective pacing mode for controlling delivery of the cardiac pacing pulses to effect cardioprotection against potential myocardial injury resulting from chemotherapy. The cardioprotective pacing mode may specify alternating non-pacing and pacing periods. The non-pacing periods each include a non-pacing duration during which none of the cardiac pacing pulses is timed to be delivered. The pacing periods each include a pacing duration during which a plurality of pacing pulses of the cardiac pacing pulses is timed to be delivered. The pacemaker may not be reconfigurable for delivering the cardiac pacing pulses according to a pacing mode other than the cardioprotective pacing mode.
In Example 2, the subject matter of Example 1 may optionally be configured such that the pacemaker has a programmability limited to adjusting parameters used for controlling delivery of the cardiac pacing pulses under the cardioprotective pacing mode.
In Example 3, the subject matter of any one or any combination of Examples 1 and 2 may optionally be configured such that the pacemaker is an implantable leadless pacemaker configured for intracardiac placement a percutaneous transluminal procedure.
In Example 4, the subject matter of any one or any combination of Examples 1 to 3 may optionally be configured such that the pacemaker include a pacing output circuit configured to deliver the cardiac pacing pulses and a control circuit configured to control the delivery of the cardiac pacing pulses using the pacing parameters according to the cardioprotective pacing mode. The control circuit includes a sequence initiator configured to initiate the sequence of cardioprotective pacing sessions in response to the sequence starting command and a command receiver configured to receive the sequence starting command.
In Example 5, the subject matter of Example 4 may optionally be configured to further include an external device configured to wirelessly communicate with the pacemaker and to generate the sequence starting command.
In Example 6, the subject matter of Example 5 may optionally be configured such that the external device includes a magnet.
In Example 7, the subject matter of Example 5 may optionally be configured such that the external device includes a programmable electronic device.
In Example 8, the subject matter of any one or any combination of Examples 4 to 7 may optionally be configured such that the control circuit further includes a sequence timer configured to initiate each session of the sequence of cardioprotective pacing sessions after the initiation of the sequence of cardioprotective pacing sessions and a session timer configured to time the pacing and non-pacing periods during the each session in response to the initiation of the each session.
In Example 9, the subject matter of Example 8 may optionally be configured such that the sequence timer is configured to initiate the each session in response to a session starting command, and the command receiver is further configured to receive the session starting command.
In Example 10, the subject matter of any one or any combination of Examples 8 and 9 may optionally be configured such that the control circuit further includes a memory circuit configured to store information required to operate the pacemaker under the cardioprotective pacing mode, the information includes the pacing parameters and a pacing sessions schedule, and the sequence timer is configured to initiate the each session according to the stored pacing sessions schedule.
In Example 11, the subject matter of any one or any combination of Examples 4 to 10 may optionally be configured such that the pacemaker further includes a sensing circuit configured to sense one or more cardiac signals from the patient, and the control circuit further includes a parameter adjuster to adjust the pacing parameters based on the sensed one or more cardiac signals such that the delivery of the cardiac pacing pulses effects the cardioprotection against potential myocardial injury resulting from the chemotherapy.
In Example 12, the subject matter of Example 11 may optionally be configured to further include one or more sensors configured to sense one or more patient state signals, and such that the control circuit further includes an event detector configured to detect an inhibit event using the one or more signals, and the parameter adjuster is configured to inhibit or reschedule the delivery of the cardiac pacing pulses during a session of the sequence of cardioprotective pacing session in response to a detection of the inhibiting event.
In Example 13, the subject matter of Example 12 may optionally be configured such that the one or more sensors include a heart rate sensor configured to sense the patient's heart rate and the event detector is configured to detect the inhibit event when the sensed heart rate exceeds an upper threshold or falls below a lower threshold.
In Example 14, the subject matter of any one or any combination of Examples 12 and 13 may optionally be configured such that the one or more sensors include a posture sensor configured to sense the patient's posture and the event detector is configured to detect the inhibit event when the sensed posture indicates that the patient is at an upright posture.
In Example 15, the subject matter of any one or any combination of Examples 12 to 14 may optionally be configured such that the one or more sensors include an activity sensor configured to sense the patient's physical activity level, and the event detector is configured to detect the inhibit event when the sensed activity level exceeds a threshold activity level.
An Example (e.g., "Example 16") of a method for protecting a patient diagnosed of cancer from cardiac injury resulting from a chemotherapy treating the cancer is also provided. The method may include initiating a sequence of cardioprotective pacing sessions based on timing of the chemotherapy and delivering cardiac pacing pulses to the patient during each session of the cardioprotective pacing sessions according to a cardioprotective pacing mode for controlling delivery of the cardiac pacing pulses to effect cardioprotection against potential myocardial injury resulting from the chemotherapy. The cardioprotective pacing mode may specify alternating non-pacing and pacing periods. The non-pacing periods each include a non-pacing duration during which none of the cardiac pacing pulses is timed to be delivered. The pacing periods each include a pacing duration during which a plurality of pacing pulses of the cardiac pacing pulses is timed to be delivered.
In Example 17, the subject matter of delivering the cardiac pacing pulses as found in Example 16 may optionally include delivering the cardiac pacing pulses from an implantable pacemaker, and the subject matter of initiating the sequence of cardioprotective pacing sessions as found in Example 16 may optionally include initiating the sequence of cardioprotective pacing sessions is response to a sequence starting command received by the implantable pacemaker.
In Example 18, the subject matter of delivering the cardiac pacing pulses from the implantable pacemaker as found in Example 17 may optionally include delivering the cardiac pacing pulses from an implanted intracardiac leadless pacemaker.
In Example 19, the subject matter of any one or any combination of Examples 16 to 18 may optionally include determining the timing of the chemotherapy including a chemotherapy starting time, and the subject matter of initiating the sequence of cardioprotective pacing sessions as found in any one or any combination of Examples 16 to 18 may optionally include initiating the sequence of cardioprotective pacing sessions at a beginning of a pre-chemotherapy duration ending with the chemotherapy starting time
In Example 20, the subject matter of determining the timing of the chemotherapy as found in Example 19 may optionally further include determining a chemotherapy ending time, and the subject matter of Example 19 may optionally further include ending the sequence of cardioprotective pacing sessions at an end of a post-chemotherapy duration starting with the chemotherapy ending time.
In Example 21, the subject matter of any one or any combination of Examples 16 to 20 may optionally further include initiating each session of the sequence of cardioprotective pacing sessions according to a session frequency.
In Example 22, the subject matter of the chemotherapy as found in any one or any combination of Examples 19 to 21 may optionally include a series treatments, the subject matter of determining the timing of the chemotherapy as found in any one or any combination of Examples 19 to 21 may optionally include determining a time for applying each treatment of the series of treatments, and the subject matter of any one or any combination of Examples 19 to 21 may optionally further include further include initiating one or more sessions of the sequence of cardioprotective pacing sessions based on the time for applying the each treatment.
In Example 23, the subject matter of initiating the one or more sessions as found in Example 22 may optionally include initiating one session of the one or more sessions before the each treatment starts.
In Example 24, the subject matter of initiating the one or more sessions as found in any one or any combination of Examples 22 and 23 may optionally include initiating one session of the one or more sessions after the each treatment ends.
In Example 25, the subject matter of any one or any combination of Examples 16 to 24 may optionally further include sensing one or more cardiac signals and adjusting one or more pacing parameters for effecting the cardioprotection against potential myocardial injury resulting from the chemotherapy based on the sensed one or more cardiac signals. The one or more pacing parameters control the delivery of the cardiac pacing pulses according to the cardioprotective pacing mode.
In Example 26, the subject matter of Example 25 may optionally further include detecting a heart rate from the one or more cardiac signals, and the subject matter of adjusting the one or more pacing parameters as found in Example 25 may optionally include setting a pacing rate to a rate substantially higher than the detected heart rate.
In Example 27, the subject matter of any one or any combination of Examples 25 and 26 may optionally further include detecting an intrinsic atrioventricular interval from the one or more cardiac signals, and the subject matter of adjusting the one or more pacing parameters as found in any one or any combination of Examples 25 and 26 may optionally include setting an atrioventricular delay to a time interval substantially shorter than the detected intrinsic atrioventricular interval.
In Example 28, the subject matter of any one or any combination of Examples 16 to 27 may optionally further include sensing one or more signals from the patient, detecting an inhibiting event using the sensed one or more signals, and inhibiting or rescheduling the delivery of the cardiac pacing pulses during the sequence of cardioprotective pacing session in response to a detection of the inhibiting event.
This Summary is an overview of some of the teachings of the present application and not intended to be an exclusive or exhaustive treatment of the present subject matter. Further details about the present subject matter are found in the detailed description and appended claims. Other aspects of the disclosure will be apparent to persons skilled in the art upon reading and understanding the following detailed description and viewing the drawings that form a part thereof, each of which are not to be taken in a limiting sense. The scope of the present disclosure is defined by the appended claims and their legal equivalents.
The drawings illustrate generally, by way of example, various embodiments discussed in the present document. The drawings are for illustrative purposes only and may not be to scale.
FIG. 1 is an illustration of an embodiment of a cardioprotective pacing system and portions of an environment in which the system is used.
FIG. 2 is an illustration of another embodiment of the cardioprotective pacing system and portions of an environment in which the system is used.
FIG. 3 is a flow chart illustrating an embodiment of a method for cardioprotective pacing for a patient receiving chemotherapy.
FIG. 4 is a flow chart illustrating an embodiment of the method for applying the cardioprotective pacing to the patient receiving chemotherapy.
FIG. 5 is a timing diagram illustrating an embodiment of a sequence of cardioprotective pacing sessions timed based on timing of a chemotherapy.
FIG. 6 is a timing diagram illustrating an embodiment of a sequence of cardioprotective pacing sessions for protecting the heart from potential injuries resulting from a chemotherapy.
FIG. 7 is a timing diagram illustrating an embodiment of cardioprotective pacing sessions each timed based on a treatment of a chemotherapy.
FIG. 8 is a timing diagram illustrating an embodiment of cardioprotective pacing sessions timed to be applied periodically.
FIG. 9 is a block diagram illustrating an embodiment of a circuit of a cardioprotective pacemaker.
FIG. 10 is a block diagram illustrating an embodiment of another circuit of a cardioprotective pacemaker.
In the following detailed description, reference is made to the accompanying drawings which form a part hereof, and in which is shown by way of illustration specific embodiments in which the invention may be practiced. These embodiments are described in sufficient detail to enable those skilled in the art to practice the invention, and it is to be understood that the embodiments may be combined, or that other embodiments may be utilized and that structural, logical and electrical changes may be made without departing from the spirit and scope of the present invention. References to "an", "one", or "various" embodiments in this disclosure are not necessarily to the same embodiment, and such references contemplate more than one embodiment. The following detailed description provides examples, and the scope of the present invention is defined by the appended claims and their legal equivalents.
This document discusses, among other things, a method and system for delivering cardiac pacing to a cancer patient being treated by chemotherapy to protect the patient from drug-induced cardiac damage and potentially heart failure. Many chemotherapy agents, with anthracyclines being a particular example, are known for cardiotoxicity causing cardiac damages leading to cardiovascular dysfunctions and eventually heart failure.
Various methods have been developed for preventing or reducing cardiac damages caused by cardiac ischemia. Such methods use various types of stimulation to induce cardioprotective signaling in a patient, thereby activating or augmenting the patient's natural cardioprotective mechanism. For example, brief periods of ischemia are known to elicit cellular signaling changes that can protect a patient from a larger cardiac ischemic event and subsequent damage (e.g., myocardial infarction, or MI), should it occur later. Such brief periods of ischemia may be induced in a patient's heart before occlusion or during reperfusion (referred to as ischemic pre-conditioning and post-conditioning, respectively), when a cardiac ischemic event is anticipated, such as during an angioplasty procedure. Brief periods of ischemia may also be induced to a site in the patient other than the heart, such as in a limb, for similar effects (referred to as remote conditioning). Exercise is also known for inducing the cardioprotective signaling. However, such methods may not be feasible or acceptable considering the invasiveness and/or burden of the procedure given the health state of the patient.
Cardiac pacing can also provide a patient with cardioprotection. For example, brief periods of right ventricular pacing (known as intermittent pacing therapy, or IPT) change myocardial activation patterns and creates abnormal myocardial stress that has been shown to elicit cardioprotective cellular signaling. IPT has been studied for cardioprotection against ischemia resulting from occlusion of a coronary artery. It was found that, for example, IPT before occlusion or during reperfusion dramatically reduced MI size in animals, and IPT slowed or stopped increases in left ventricular size and/or mass in animal models of heart failure (i.e., showing preventative effects), but IPT did not decrease left ventricular size and/or mass in animal models with established heart failure (i.e., not showing restorative effects). Application of IPT for its preventive effects is hindered by difficulty in predicting whether and when a cardiac ischemia event may occur (except for induced cardiac ischemia such as during an angioplasty procedure).
The mechanisms of myocardial cell death resulting from chemotherapy are similar to those of MI. Examples of such mechanisms include necrosis and apoptosis resulting from generation of reactive oxygen species and creation of unfavorable cell signaling (in the mitochondria). Prevention of cardiac damage (cell death) caused by chemotherapy cardiotoxicity is highly desirable. Unlike cardiac ischemia, the timeframe of onset is known in the setting of chemotherapy as it is correlated to the therapy schedule.
Therefore, the present subject matter provides cancer patients receiving chemotherapy with cardioprotective pacing such as IPT. A pacemaker for providing a patient receiving chemotherapy with cardioprotective pacing can be a pacemaker with endocardial lead(s) or a leadless pacemaker. The pacemaker can be implanted into an at-risk patient prior to the start of the chemotherapy. The pacemaker can be configured to deliver a pacing therapy such as an IPT for a sequence of cardioprotective pacing sessions before, during, and/or after the chemotherapy. For each cardioprotective pacing session, the pacemaker may be configured to deliver a pacing sequence including alternating non-pacing and pacing periods. The non-pacing periods each include a non-pacing duration during which no pacing pulse is timed to be delivered. The pacing periods each include a pacing duration during which a plurality of pacing pulses is timed to be delivered using pacing parameters specified for effecting cardioprotection against potential myocardial injury resulting from chemotherapy.
In this document, a "chemotherapy" can include one or more treatments. Each "treatment" can include an infusion (e.g., intravenously), an injection (e.g., to the cancer, the site from which the cancer was removed, or any skeletomuscular site), an oral dosage, or any other viable manner of dosage of one or more chemotherapy drugs. For example, a chemotherapy may include a series of infusions each lasts about 1-4 hours long. The infusions may be applied to the patient about every 1-4 weeks until all the infusions have been applied. A "sequence of cardioprotective pacing sessions" can be applied for each chemotherapy. Thus, a cardiac pacing therapy, which includes a sequence of cardioprotective pacing sessions, can be applied to the patient who receives a chemotherapy, which includes a series of infusions (or other treatments), in a temporally coordinated manner. Details of such temporal coordination are discussed in this document, for example with references to FIGS. 3-8.
In various embodiments, the pacemaker for providing a patient receiving chemotherapy with cardioprotective pacing (e.g., the IPT) can be a single-purpose pacemaker made for delivering only the cardioprotective pacing or a multifunctional programmable pacemaker programmable for delivering the cardioprotective pacing. If the patient has no reason for receiving any pacing therapy other than the cardioprotective pacing (e.g., the IPT), the single-purpose pacemaker can provide a desirable small size and can be the most cost-effective. Such a single-purpose pacemaker does not need to switch between pacing modes, requires a battery having a capacity just sufficient for delivering the cardioprotective pacing, and may need only one or more external commands to control timing of the sequence of cardioprotective pacing sessions.
FIG. 1 is an illustration of an embodiment of a cardiac pacing system 100 and portions of an environment in which system 100 is used. System 100 includes an implantable system 105, an external system 115, and a wireless link 112 providing for communication between implantable system 105 and external system 115. System 100 can provide a patient receiving chemotherapy with cardioprotective pacing.
Implantable system 105 can include an implantable medical device 110 and a lead system 108. In various embodiments, implantable medical device 110 can include one or more of a pacemaker, a cardioverter/defibrillator, a cardiac resynchronization therapy (CRT) device, a cardiac remodeling control therapy (RCT) device, a neruostimulator, a drug delivery device or a drug delivery controller, and a biological therapy device, and be programmed to perform the cardioprotective pacing. In various other embodiments, implantable medical device 110 can be a dedicated cardioprotective pacing device that does not provide for any other pacing or non-pacing therapies. As illustrated in FIG. 1, implantable medical device 110 is implanted in a body 102. In various embodiments, lead system 108 includes leads for sensing physiological signals and delivering pacing pulses, cardioversion/defibrillation shocks, neurostimulation, pharmaceutical agents, biological agents, and/or other types of energy or substance for treating cardiac disorders. In various embodiments, electrodes placed in a heart 101 or other portions of body 102 can be used to sense physiological signals and deliver pacing pulses, cardioversion/defibrillation shocks, neurostimulation, pharmaceutical agents, biological agents, and/or other types of energy or substance for treating cardiac disorders. In one embodiment, lead system 108 includes one or more pacing-sensing leads each including at least one electrode placed in or on heart 101 for sensing one or more electrograms and/or delivering pacing pulses. In one embodiment, lead system 108 allows pacing pulses to be delivered to multiple atrial and/or ventricular sites.
To perform the cardioprotective pacing (e.g., IPT), implantable medical device 110 can include sensing and pacing circuitry for delivering intermittent cardiac pacing to heart 101 according to a sequence of cardioprotective pacing sessions. In some embodiments in which implantable medical device 110 is programmable for various types of therapies, in addition to the cardioprotective pacing, implantable medical device 110 also delivers one or more other cardiac pacing therapies, such a bradycardia pacing therapy, CRT, and RCT. If another pacing therapy is being delivered when a cardioprotective pacing session of the sequence of cardioprotective pacing sessions is to be started, that pacing therapy can be temporarily suspended to allow the delivery of the cardioprotective pacing and resumed upon completion of the cardioprotective pacing session. In one embodiment, implantable medical device 110 controls the delivery of one or more of other therapies such as neurostimulation therapy, drug therapy, and biologic therapy in coordination with the cardioprotective pacing.
Implantable medical device 110 can include a hermetically sealed can to house electronic circuitry that performs sensing and therapeutic functions. Examples of such electronic circuitry is discussed below with reference to FIGS. 7 and 8. In one embodiment, the electronic circuitry is entirely housed within the hermetically sealed can. In another embodiment, the electronic circuitry includes internal components housed within hermetically sealed can and external components located external to the hermetically sealed can but communicatively coupled to the internal components.
External system 115 allows a user such as a physician or other caregiver or a patient to control the operation of implantable medical device 110 and/or obtain information acquired by implantable medical device 110. External system can include a programmer, a magnet, a remoter controller, and/or any device that is capable of controlling the operation of implantable medical device 110 to any extent and/or receive any information from implantable medical device 110.
Wireless link 112 allows for communication between implantable medical device 110 and external system 115. Examples of wireless link 112 include a magnetic couple (e.g., when external system 115 includes the magnet), a Bluetooth or other short-range communication link (e.g., when external system 115 includes the remote controller), and/or an inductive or far-field radio frequency telemetry link (e.g., when external system 115 includes the programmer). When external system 115 includes the programmer, the telemetry link can be used for, for example, transmitting real-time physiological data acquired by implantable medical device 110, extracting physiological data acquired by and stored in implantable medical device 110, extracting therapy history data stored in implantable medical device 110, extracting data indicating an operational status of implantable medical device 110 (e.g., battery status and lead impedance), programming implantable medical device 110 to acquire physiological data, programming implantable medical device 110 to perform at least one self-diagnostic test (such as for a device operational status), and programming implantable medical device 110 to deliver one or more therapies.
FIG. 2 is an illustration of an embodiment of a cardioprotective pacing system 200 and portions of an environment in which system 200 is used. System 200 differs from system 100 in that its implantable system includes an implantable leadless medical device 210 that functions without a lead system. In various embodiments, system 200 can be used to perform any function of system 100 that does not need the lead system. For example, when implantable leadless medical device 210 is placed in a chamber of heart 101 (e.g., in the right ventricle), the therapy delivery site may be limited to that chamber. In various embodiments, implantable leadless medical device 210 can be placed in a chamber of heart 101 (e.g., in the right ventricle) using a percutaneous transluminal procedure. Examples for implantable leadless medical device 210 can include those discussed in U.S. Pat. No. 8,644,934 B2, "CARDIAC STIMULATION USING LEADLESS ELECTRODE ASSEMBLIES", assigned to Boston Scientific Scimed Inc., and U.S. Patent Application Publication No. US 2015/0057558 A1, "LEADLESS PACEMAKER WITH TRIPOLAR ELECTRODE", assigned to Cardiac Pacemakers, Inc., which are incorporated herein by reference in their entireties.
In various embodiments, implantable medical device 110 or implantable leadless medical device 210 can deliver cardioprotective pacing according to a cardioprotective pacing mode to a patient diagnosed of cancer and receiving chemotherapy treating the cancer. The cardioprotective pacing mode can specify alternating non-pacing and pacing periods, the non-pacing periods each including a non-pacing duration during which none of the cardiac pacing pulses is timed to be delivered, the pacing periods each including a pacing duration during which a plurality of pacing pulses of the cardiac pacing pulses is timed to be delivered. This cardioprotective pacing mode can also be referred to as an intermittent pacing mode or IPT mode.
In various embodiments, implantable medical device 110 or implantable leadless medical device 210 can be a single-mode cardioprotective pacemaker that is pre-configured for operation only under the cardioprotective pacing mode for controlling delivery of the cardiac pacing pulses to effect cardioprotection against potential myocardial injury resulting from chemotherapy. The single-mode cardioprotective pacemaker may not be reconfigurable (e.g., not re-programmable or otherwise modifiable) for delivering the cardiac pacing pulses according to a pacing mode other than the cardioprotective pacing mode. The single-mode cardioprotective pacemaker can have programmability limited to adjusting parameters used for controlling delivery of the cardiac pacing pulses under the cardioprotective pacing mode.
In various other embodiments, implantable medical device 110 or implantable leadless medical device 210 can be a multi-mode programmable pacemaker that can be programmed for delivering cardiac pacing pulses to the patient according to the cardioprotective pacing mode. The multi-mode programmable pacemaker is reconfigurable (e.g., re-programmable or otherwise modifiable) for delivering the cardiac pacing pulses according to various cardiac pacing modes including the cardioprotective pacing mode. Examples of the various pacing modes in addition to the cardioprotective pacing mode can include various anti-bradycardia, anti-tachycardia, CRT, and RCT pacing modes. The multi-mode programmable pacemaker can have programmability allowing for adjusting parameters used for controlling delivery of cardiac pacing pulses under each pacing mode selected from the various cardiac pacing modes.
In various other embodiments, implantable medical device 110 or implantable leadless medical device 210 can be manually commanded (by manually issuing a sequence stating command) to start the sequence of cardioprotective pacing sessions without using a conventional pacemaker programmer. For example, the patient or his physician or other caregiver can manually trigger the start of the sequence of cardioprotective pacing sessions before, during, or after the chemotherapy infusion. Such manual triggering can be done, for example, with the magnet or the remote controller, while the programmer, when available, can also be used. Each of implantable medical device 110 or implantable leadless medical device 210 can include one or more safety features limiting the response to the manual triggering according to one or more safety rules. For example, the sequence of cardioprotective pacing sessions can be triggered only once for a specified time interval. In some embodiments, if the pacing sessions are automatically triggered by the pacemaker according to a specified pacing sessions schedule once the cardioprotective pacing period is triggered, the pacemaker can be manually commanded to interrupt or stop the sequence of cardioprotective pacing sessions.
FIG. 3 is a flow chart illustrating an embodiment of a method 320 for cardioprotective pacing for a patient receiving chemotherapy. Method 320 can be performed using a pacemaker, such as implantable medical device 110 or implantable leadless medical device 210. Implantable medical device 110 or implantable leadless medical device 210 can be the single-mode cardioprotective pacemaker pre-configured for performing method 320 or the multi-mode programmable pacemaker programmed for performing method 320.
At 321, timing of the chemotherapy is determined. The determination can include receiving the treatment schedule for the chemotherapy from the physician attending the cancer patient. The chemotherapy can include one or more treatments (e.g., one or more infusions). The timing of the chemotherapy can include a schedule for the one or more treatments, which can specified one or more of a time when the chemotherapy (or the first treatment of the chemotherapy) is to be started, a time when the chemotherapy (or the last treatment of the chemotherapy) is to end, a starting time for each of the one or more treatments, the ending time for each of the one or more treatments, the duration for each of the one or more treatments, or a frequency of the treatments. At 322, a sequence of cardioprotective pacing sessions based on the timing of the chemotherapy is determined. This includes determination of when the sequence of cardioprotective pacing sessions is to be started and ended relative to the timing of the chemotherapy as well as various adjustable pacing parameters. In various embodiments in which the chemotherapy includes a series of treatments, the cardioprotective pacing sessions can be synchronized to the treatments. For example, a cardioprotective pacing session can be started before, during, and/or after each treatment of the chemotherapy. In various other embodiments in which the chemotherapy includes a series of treatments, the cardioprotective pacing sessions are not synchronized to the treatments, but for example are started on a periodical basis that can be independently timed. At 323, the sequence of cardioprotective pacing sessions is applied to the patient. Each session of the sequence of cardioprotective pacing sessions includes alternating non-pacing and pacing periods. The non-pacing periods each include a non-pacing duration during which no pacing pulse is timed to be delivered. The pacing periods each include a pacing duration during which a plurality of pacing pulses is timed to be delivered using pacing parameters set for effecting cardioprotection of patient against potential myocardial injury resulting from the chemotherapy.
FIG. 4 is a flow chart illustrating another embodiment of a method 430 for applying the cardioprotective pacing to the patient receiving chemotherapy. Method 430 can be performed as step 323 of method 320. Method 430 can be performed using a pacemaker, such as implantable medical device 110 or implantable leadless medical device 210. Implantable medical device 110 or implantable leadless medical device 210 can be the single-mode cardioprotective pacemaker pre-configured for performing method 430 or the multi-mode programmable pacemaker programmed for performing method 430.
At 430, the sequence of cardioprotective pacing sessions is initiated. The sequence of cardioprotective pacing sessions can be initiated in response to a sequence starting command. The sequence starting command can be an external sequence starting command in any formed that can be received by the pacemaker. For example, the external sequence starting command can be a magnetic signal produced by a magnet brought to proximity of the pacemaker. The external sequence starting command can also be a remote control signal produced by a remote controller such as a dedicated remote controller for the pacemaker or a generic device configured to communicate with the pacemaker, such as a computer or a cellphone. A pacemaker programmer can also be used to produce and transmit the remote control signal. In some embodiments, the remote controller or the pacemaker programmer can also be used to present status of operation of the pacemaker including timing for the sequence of cardioprotective pacing sessions, whether one of the cardioprotective pacing sessions is ongoing, and or the number of the cardioprotective pacing sessions delivered and/or remaining. The sequence of cardioprotective pacing sessions is initiated based on the timing of the chemotherapy.
FIG. 5 is a timing diagram illustrating an embodiment of the sequence of cardioprotective pacing sessions timed based on the timing of a chemotherapy. The sequence of cardioprotective pacing sessions is initiated at a beginning of a pre-chemotherapy duration ending with the chemotherapy starting time. The pre-chemotherapy duration can be about 1 day (e.g., 1 to 30 days, with 1 day being a specific example). The sequence of cardioprotective pacing sessions is ended at an end of a post-chemotherapy duration starting with the chemotherapy ending time. The post-chemotherapy duration can be about 6 weeks (e.g., 1 to 24 weeks, with 6 weeks being a specific example). The timing as illustrated in FIG. 5 represents an example, rather than a limitation, of timing of the sequence of cardioprotective pacing sessions determined relative to the timing of the chemotherapy. In various embodiments, as determined by the physician or another qualified professional, the sequence of cardioprotective pacing sessions can be initiated before the chemotherapy starting time (pre-chemotherapy duration>0), at the chemotherapy starting time (pre-chemotherapy duration=0), between the chemotherapy starting time and the chemotherapy ending time (−chemotherapy duration<pre-chemotherapy duration<0), at the chemotherapy ending time (pre-chemotherapy duration=−chemotherapy duration), or after the chemotherapy ending time (pre-chemotherapy duration<−chemotherapy duration), and can be ended before the chemotherapy starting time (post-chemotherapy duration<−chemotherapy duration), at the chemotherapy starting time (post-chemotherapy duration=−chemotherapy duration), between the chemotherapy starting time and the chemotherapy ending time (−chemotherapy duration<post-chemotherapy duration<0), at the chemotherapy ending time (post-chemotherapy duration=0), or after the chemotherapy ending time (post-chemotherapy duration>0). The total length of the sequence of cardioprotective pacing sessions, the sequence duration, is the sum of the pre-chemotherapy duration, the chemotherapy duration, and the post-chemotherapy duration. The chemotherapy duration can be the total time interval between the beginning of the first treatment and the end of the last treatment of the series of treatments (e.g., infusions) of a chemotherapy.
Referring back to FIG. 4. At 432, each session of the sequence of cardioprotective pacing sessions is initiated. The sessions can be initiated according to a pacing sessions schedule. FIG. 6 is a timing diagram illustrating an embodiment of the sequence of cardioprotective pacing sessions. In various embodiments, a session of the sequence of cardioprotective pacing sessions can be initiated manually in response to an external session starting command received by the pacemaker. The external session starting command can be issued in the same manner as the external sequence starting command. In some embodiments, each pacing session can be manually triggered once during a specified time interval (e.g., 8 am to 5 μm with 11 am being a specific example). For example, the pacing session can be manually triggered by the physician, other caregiver, or the patient prior to start of each treatment of the chemotherapy. In various embodiments, a session of the sequence of cardioprotective pacing sessions can be initiated automatically by the pacemaker according to the pacing sessions schedule stored in the pacemaker. When the pacing sessions are not synchronized to the treatments of chemotherapy, the pacing sessions schedule can specify a session frequency of about 1 session per day (e.g., 1 to 4 sessions/day with 1 sessions/day being a specific example). The session frequency corresponds to the session period in FIG. 6 (session frequency=1/session period). The pacing sessions schedule can also specify a time of a day for initiating each session of the sequence of pacing sessions (e.g., a time at night when the patient is likely sleeping). When the pacing sessions are synchronized to the treatments of chemotherapy, the pacing sessions schedule can be based on a schedule of the series of treatments of the chemotherapy.
FIG. 7 is a timing diagram illustrating an embodiment of cardioprotective pacing sessions each timed based on a treatment of a chemotherapy. In the illustrated embodiment, the cardioprotective pacing sessions are synchronized to the treatments of the chemotherapy, and each cardioprotective pacing session starts prior to a treatment of chemotherapy. In various embodiments, one or more cardioprotective pacing session can be started before, during, and/or after a treatment of chemotherapy. In various embodiment, one or more cardioprotective pacing sessions can be scheduled for each treatment of the chemotherapy, each of these sessions can start before the treatment (e.g., 0 to 6 hours before the treatment starts, with 15 minutes being a specific example), during the treatment (e.g., 0 to 2 hours after the treatment starts, with 1 hour being a specific example), or after the treatment (e.g., 0 to 6 hours after the treatment ends, with 15 minutes being a specific example). FIG. 8 is a timing diagram illustrating an embodiment of cardioprotective pacing sessions timed to be applied periodically. In the illustrated embodiment, the cardioprotective pacing sessions are not synchronized to the treatments of the chemotherapy, and are applied periodically (e.g., 1 to 4 sessions/day with 1 sessions/day being a specific example).
Referring back to FIG. 4. At 433, cardiac pacing pulses are delivered to the patient during each of the cardioprotective pacing sessions according to the cardioprotective pacing mode for controlling delivery of the cardiac pacing pulses to effect cardioprotection against potential myocardial injury resulting from chemotherapy. In various embodiments, the cardiac pacing pulses can be delivered from an implantable pacemaker (such as implantable medical device 110) through one or more leads each including one or more electrodes (such as lead system 108). In various embodiments, the cardiac pacing pulses can be delivered from a leadless pacemaker (such as implantable leadless medical device 210) through electrodes incorporated onto the leadless pacemaker.
At 434, the delivery of the cardiac pacing pulses is controlled according to the cardioprotective pacing mode. The controlling includes timing the pacing and non-pacing periods during each cardioprotective pacing session at 435 (in response to the initiation of the session) and determining and/or adjusting pacing parameters at 436. As illustrated in FIG. 6, the cardioprotective pacing mode specifies a number of alternating non-pacing and pacing periods. The non-pacing periods ("PACING OFF") each include a non-pacing duration during which none of the cardiac pacing pulses is timed to be delivered. The pacing periods ("PACING ON") each include a pacing duration during which a plurality of pacing pulses of the cardiac pacing pulses is timed to be delivered. Each session of the sequence of cardioprotective pacing sessions can include 3 to 15 pairs of alternating non-pacing and pacing periods, with 3 pairs being a specific example. The non-pacing duration can be 30 seconds to 30 minutes, with 3 minutes being a specific example). The pacing duration can be 30 seconds to 30 minutes, with 3 minutes being a specific example.
The pacing parameters are determined to effect cardioprotection against potential myocardial injury resulting from chemotherapy. One or more parameters of the pacing parameters can be determined or adjusted automatically by the pacemaker. In various embodiments, one or more cardiac signals are sensed, the one or more parameters of the pacing parameters are determined or adjusted based on the sensed one or more cardiac signals. In one various embodiments, the cardiac pacing pulses can be delivered to the right ventricle with an adjustable pacing rate and/or atrioventricular delay providing for relative atrial synchrony (if desirable). For example, the pacing rate can be adjusted to be about 15% faster than the patient's intrinsic ventricular rate (e.g., 10 to 100% faster, with 15% being a specific example), and/or the atrioventricular delay can be adjusted to about 50% of the patient's intrinsic atrioventricular interval (e.g., 10 to 100% of the patient's intrinsic atrioventricular interval, with 50% being a specific example). In one embodiment, the cardiac pacing pulses are delivered to the right ventricle without using an atrioventricular synchrony.
If the session is not completed at 437 (based on the number of the pairs of alternating pacing and non-pacing periods specified for the session), the cardiac pacing pulses continue to be delivered at 432 according to the pacing sessions schedule. In some embodiments, each session of the sequence of cardioprotective sessions and/or the sequence itself can be suspended or terminated in response to certain event. For example, one or more signals indicative of an inhibiting event can be sensed. The inhibiting event includes any event indicating that continuing delivery of the pacing pulses under the cardioprotective pacing mode may be ineffective and/or detrimental to the patient's health. In response to a detection of the inhibiting event, the delivery of the cardiac pacing pulses during the sequencer of cardioprotective pacing session can be cancelled or rescheduled (e.g., delayed until the inhibiting event is no longer detected), and/or an ongoing cardioprotective pacing session can be stopped. In various embodiments, the pacemaker can include one or more sensors and use one or more sensed signals to inhibit pacing when one or more inhibiting events are detected from the one or more sensed signals. For example, the pacemaker can (1) include a heart rate sensor to sense the patient's heart rate and inhibit the cardioprotective pacing when the sensed heart rate exceeds an upper threshold or falls below a lower threshold, (2) include a posture sensor to sense the patient's posture and inhibit the cardioprotective pacing when the sensed posture indicates that the patient is at an upright posture, and/or (3) include an activity sensor to sense the patient's physical activity level and inhibit the cardioprotective pacing when the sensed activity level exceeds a threshold. An inhibited sequence of cardioprotective pacing sessions, or any inhibited portion of the sequence, may be delivered after the one or more sensed signals indicate that an undesirable period has ended. Other types of sensors can be used for sensing and detecting any types of inhibiting event.
If the sequence of cardioprotective pacing sessions is not completed at 438 (based on the number of the cardioprotective pacing sessions specified in the pacing sessions schedule), the next session is initiated at 432 according to the pacing sessions schedule. If the sequence of cardioprotective pacing sessions is completed at 438, the sequence is ended at 439. In various embodiments, the sequence of cardioprotective pacing sessions can be ended automatically by the pacemaker based on the chemotherapy duration or the chemotherapy ending time. In various embodiments, the sequence of cardioprotective pacing sessions can also be ended in response to an external sequence ending command received by the pacemaker. The external sequence ending command can be issued in the same manner as the external sequence starting command. The external sequence end command can be used to stop the sequence of cardioprotective pacing sessions for an unexpected reason, such as early termination of the chemotherapy or a medical condition for which continuing the cardioprotective pacing may be detrimental to the health of the patient.
FIG. 9 is a block diagram illustrating an embodiment of a pacemaker circuit 950, which represents an example of portions of the electronic circuitry of implantable medical device 110 or implantable leadless medical device 210. In one embodiment, pacemaker circuit 950 is configured for delivering cardiac pacing pulses to a patient diagnosed of cancer and receiving chemotherapy treating the cancer, such as being used to perform method 430. In the illustrated embodiment, pacemaker circuit 950 includes a sensing circuit 951 to sense one or more cardiac signals, a pacing output circuit 952 to produce and deliver cardiac pacing pulses, a control circuit 953 to control the delivery of the cardiac pacing pulses using pacing parameters according to the cardioprotective pacing mode (as discussed above), and a battery 954 to supply power needed for the operations of pacemaker circuit 950.
Control circuit 953 cab include a memory circuit 955, a sequence initiator 956, a command receiver 957, a sequence timer 958, a session timer 959, and a parameter adjuster 960. Memory circuit 955 store information required to operate pacemaker circuit 950 under the cardioprotective pacing mode, including the pacing parameters and the pacing sessions schedule. Sequence initiator 956 can initiate the sequence of cardioprotective pacing sessions in response to the sequence starting command. Command receiver 957 can receive the sequence starting command, which can be a magnetic or electromagnetic signal produced by an external device such as the magnet, the remote controller, or the programmer of external system 115. Sequence timer 958 can initiate each session of the sequence of cardioprotective pacing sessions after the initiation of the sequence. In various embodiments, sequence timer 958 can initiate each session according to the stored pacing sessions schedule. In some embodiments, sequence timer 958 can initiate each session in response to a session starting command, and command receiver 957 can also receive the session starting command. Sequence timer 958 can also end the sequence of cardioprotective pacing sessions (e.g., to stop initiating new sessions of the sequence of cardioprotective pacing sessions). In various embodiments, sequence timer 958 can end the sequence according to the stored pacing sessions schedule (e.g., by timing the sequence duration or counting the number of cardioprotective pacing sessions). In some embodiments, sequence timer 958 can end the sequence in response to a sequence ending command, and command receiver 957 can also receive the session ending command. Session timer 959 can time the pacing and non-pacing periods during each session of the sequence of cardioprotective pacing sessions. Parameter adjuster 960 can adjust the pacing parameters for effecting cardioprotection against potential myocardial injury resulting from chemotherapy. In various embodiments, parameter adjuster 960 adjusts the one or more parameters based on the sensed one or more cardiac signals. Battery 954 can supply power for the operation of pacemaker circuit 950. In embodiments in which pacemaker circuit 950 is part of the single-mode cardioprotective pacemaker that is pre-configured for operation only under the cardioprotective pacing mode, battery 954 can be configured to have an energy capacity sufficient for delivering the cardioprotective pacing to a patient receiving chemotherapy and not substantially beyond. For example, the energy capacity of battery 954 can be determined based on an estimation the energy required for delivering the cardioprotective pacing and a safety margin such as 10 to 100 percent, with 50 percent as a specific example. The determination of battery capacity can also include considerations of factors contributing to extension and/or reapplication of chemotherapy due to non-responsiveness of the patient to a particular drug and/or relapse of the cancer, such as based on statistical data.
FIG. 10 is a block diagram illustrating an embodiment of a pacemaker circuit 1050, which represents another example of portions of the electronic circuitry of implantable medical device 110 or implantable leadless medical device 210. In one embodiment, pacemaker circuit 1050 is configured for delivering cardiac pacing pulses to a patient diagnosed of cancer and receiving chemotherapy treating the cancer, such as being used to perform method 430. In the illustrated embodiment, pacemaker circuit 1050 includes sensing circuit 951 to sense one or more cardiac signals, pacing output circuit 952 to produce and deliver cardiac pacing pulses, a control circuit 1053 to control the delivery of the cardiac pacing pulses using pacing parameters according to the cardioprotective pacing mode (as discussed above), sensors 1065 to sense one or more signals (in addition to the one or more cardiac signals), and battery 954 to supply power needed for the operations of pacemaker circuit 1050. In other words, pacemaker circuit 1050 includes elements of pacing circuit 750 and sensors 1065, with control circuit 1053 controlling the delivery of the cardiac pacing pulses using the one or more signal sensed by sensors 1065 in addition to the parameters used by control circuit 953.
In the illustrated embodiment, sensors 1065 includes a heart rate sensor 1067, a posture sensor 1068, and an activity sensor 1069. In various embodiments, sensors 1065 can include any one or any combination of heart rate sensor 1067, posture sensor 1068, activity sensor 1069, and other sensors capable of sensing one or more signals that can be used to control the delivery of the cardiac pacing pulses using pacing parameters according to the cardioprotective pacing mode. In addition to memory circuit 955, sequence initiator 956, command receiver 957, sequence timer 958, session timer 959, and a parameter adjuster 1060, control circuit 1053 includes an event detector 1066 to detect an adjustment event using the one or more signals sensed by sensors 1065. The adjustment event is indicative of a need for adjusting the pacing parameters, and parameter adjuster 1060 can adjust the pacing parameters in response to a detection of the adjustment event. The adjustment event can be an inhibiting event for stopping the delivery of the cardiac pacing pulses. Parameter adjuster 1060 can inhibit or reschedule (e.g., delaying) the delivery of the cardiac pacing pulses during each cardioprotective pacing session in response to a detection of the inhibiting event. For example, parameter adjuster 1060 can allow the inhibited delivery of the cardiac pacing pulses to be delivered after the inhibiting event is no longer detected by the pacing inhibitor. In the illustrated embodiment, heart rate sensor 1067 can sense the patient's intrinsic heart rate (e.g., ventricular rate), and event detector 1066 can detect the inhibiting event when the sensed heart rate exceeds an upper threshold or falls below a lower threshold. Posture sensor 1068 can sense the patient's posture, and event detector 1066 can detect the inhibiting event when the sensed posture indicates that the patient is at an upright posture. Activity sensor 1069 can sense the patient's physical activity level, and event detector 1066 can detect the inhibiting event when the sensed activity level exceeds a threshold.
In various embodiments, pacemaker circuit 950 and 1050 may each be implemented using a combination of hardware and software. For example, control circuits 953 and 1053 may each be implemented using an application-specific circuit constructed to perform one or more particular functions or a general-purpose circuit programmed to perform such function(s). Such a general-purpose circuit includes, but is not limited to, a microprocessor or a portion thereof, a microcontroller or portions thereof, and a programmable logic circuit or a portion thereof.
It is to be understood that the above detailed description is intended to be illustrative, and not restrictive. Other embodiments will be apparent to those of skill in the art upon reading and understanding the above description. The scope of the invention should, therefore, be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled.
1. A method for protecting a patient diagnosed of cancer from cardiac injury resulting from a chemotherapy treating the cancer, comprising:
initiating a sequence of cardioprotective pacing sessions based on timing of the chemotherapy, including timing the initiation of the sequence relative to a chemotherapy starting time; and
delivering cardiac pacing pulses to the patient during each session of the cardioprotective pacing sessions according to a cardioprotective pacing mode for controlling delivery of the cardiac pacing pulses to effect cardioprotection against potential myocardial injury resulting from the chemotherapy, the cardioprotective pacing mode specifying alternating non-pacing and pacing periods, the non-pacing periods each including a non-pacing duration during which none of the cardiac pacing pulses is timed to be delivered, the pacing periods each including a pacing duration during which a plurality of pacing pulses of the cardiac pacing pulses is timed to be delivered.
2. The method of claim 1, wherein delivering the cardiac pacing pulses comprises delivering the cardiac pacing pulses from an implantable pacemaker, and initiating the sequence of cardioprotective pacing sessions comprises initiating the sequence of cardioprotective pacing sessions is response to a sequence starting command received by the implantable pacemaker.
3. The method of claim 2, wherein delivering the cardiac pacing pulses from the implantable pacemaker comprises delivering the cardiac pacing pulses from an implanted intracardiac leadless pacemaker.
4. The method of claim 1, further comprising determining the timing of the chemotherapy including the chemotherapy starting time, and wherein initiating the sequence of cardioprotective pacing sessions comprises initiating the sequence of cardioprotective pacing sessions at a beginning of a pre-chemotherapy duration ending with the chemotherapy starting time.
5. The method of claim 4, wherein determining the timing of the chemotherapy further comprises determining a chemotherapy ending time, and further comprising ending the sequence of cardioprotective pacing sessions at an end of a post-chemotherapy duration starting with the chemotherapy ending time.
6. The method of claim 1, further comprising initiating each session of the sequence of cardioprotective pacing sessions according to a session frequency.
7. The method of claim 1, wherein the chemotherapy comprises a series treatments, and further comprising:
determining the timing of the chemotherapy including a time for applying each treatment of the series of treatments; and
initiating one or more sessions of the sequence of cardioprotective pacing sessions based on the time for applying the each treatment.
8. The method of claim 7, wherein initiating the one or more sessions comprises initiating one session of the one or more sessions before the each treatment starts.
9. The method of claim 7, wherein initiating the one or more sessions comprises initiating one session of the one or more sessions after the each treatment ends.
sensing one or more cardiac signals; and
adjusting one or more pacing parameters for effecting the cardioprotection against potential myocardial injury resulting from the chemotherapy based on the sensed one or more cardiac signals, the one or more pacing parameters controlling the delivery of the cardiac pacing pulses according to the cardioprotective pacing mode.
11. The method of claim 10, further comprising detecting a heart rate from the one or more cardiac signals, and wherein adjusting the one or more pacing parameters comprises setting a pacing rate to a rate substantially higher than the detected heart rate.
12. The method of claim 10, further comprising detecting an intrinsic atrioventricular interval from the one or more cardiac signals, and wherein adjusting the one or more pacing parameters comprises setting an atrioventricular delay to a time interval substantially shorter than the detected intrinsic atrioventricular interval.
sensing one or more signals from the patient;
detecting an inhibiting event using the sensed one or more signals; and
inhibiting or rescheduling the delivery of the cardiac pacing pulses during the sequence of cardioprotective pacing session in response to a detection of the inhibiting event.
14. A system for delivering cardiac pacing pulses to a patient diagnosed of cancer and receiving chemotherapy treating the cancer, comprising:
an implantable cardioprotective pacemaker pre-configured for operation only under a cardioprotective pacing mode for controlling delivery of the cardiac pacing pulses to effect cardioprotection against potential myocardial injury resulting from chemotherapy, the cardioprotective pacing mode specifying alternating non-pacing and pacing periods, the non-pacing periods each including a non-pacing duration during which none of the cardiac pacing pulses is timed to be delivered, the pacing periods each including a pacing duration during which a plurality of pacing pulses of the cardiac pacing pulses is timed to be delivered,
wherein the pacemaker is not reconfigurable for delivering the cardiac pacing pulses according to a pacing mode other than the cardioprotective pacing mode.
15. The system of claim 14, wherein the pacemaker comprises:
a pacing output circuit configured to deliver the cardiac pacing pulses; and
a control circuit configured to control the delivery of the cardiac pacing pulses using pacing parameters according to the cardioprotective pacing mode, the control circuit including: a sequence initiator configured to initiate a sequence of cardioprotective pacing sessions in response to a sequence starting command; and a command receiver configured to receive the sequence starting command.
16. The system of claim 15, further comprising an external device configured to wirelessly communicate with the pacemaker and to generate the sequence starting command.
17. The system of claim 15, wherein the control circuit further comprises:
a sequence timer configured to initiate each session of the sequence of cardioprotective pacing sessions after the initiation of the sequence of cardioprotective pacing sessions; and
a session timer configured to time the pacing and non-pacing periods during the each session in response to the initiation of the each session.
18. The system of claim 17, wherein pacemaker further includes a sensing circuit configured to sense one or more cardiac signals from the patient, and the control circuit further comprises a parameter adjuster to adjust the pacing parameters based on the sensed one or more cardiac signals such that the delivery of the cardiac pacing pulses effects the cardioprotection against potential myocardial injury resulting from the chemotherapy.
19. The system of claim 18, further comprising one or more sensors configured to sense one or more patient state signals, and wherein the control circuit further comprises an event detector configured to detect an inhibit event using the one or more signals, and the parameter adjuster is configured to inhibit or reschedule the delivery of the cardiac pacing pulses during a session of the sequence of cardioprotective pacing session in response to a detection of the inhibiting event.
20. The system of claim 19, wherein the one or more sensors comprises one or more of a heart rate sensor configured to sense the patient's heart rate, a posture sensor configured to sense the patient's posture, or an activity sensor configured to sense the patient's physical activity level, and the event detector is configured to detect the inhibit event in response to one or more of the sensed heart rate exceeding an upper threshold or falls below a lower threshold, the sensed posture indicating that the patient is at an upright posture, or the sensed activity level exceeding a threshold activity level.
5360437 November 1, 1994 Thompson
7295874 November 13, 2007 Prinzen et al.
7366568 April 29, 2008 Pastore et al.
7437191 October 14, 2008 Pastore et al.
7532933 May 12, 2009 Hastings et al.
7647109 January 12, 2010 Hastings et al.
7668594 February 23, 2010 Marina et al.
7711420 May 4, 2010 Baynham et al.
7774057 August 10, 2010 Pastore et al.
7885710 February 8, 2011 Sih et al.
7894896 February 22, 2011 Tamara et al.
7917210 March 29, 2011 Baynham et al.
7962208 June 14, 2011 Shuros et al.
8140155 March 20, 2012 Zielinski et al.
8412326 April 2, 2013 Arcot-Krishnamurthy et al.
8452400 May 28, 2013 Shuros
8483826 July 9, 2013 Zielinski et al.
8548586 October 1, 2013 Arcot-Krishnamurthy et al.
8615296 December 24, 2013 Pastore et al.
8644934 February 4, 2014 Hastings
8805497 August 12, 2014 Dong et al.
8812104 August 19, 2014 Mokelke et al.
8958873 February 17, 2015 Arcot-Krishnamurthy et al.
20080071315 March 20, 2008 Baynham
20080221636 September 11, 2008 Pastore
20140379041 December 25, 2014 Foster
20150088155 March 26, 2015 Stahmann et al.
Filed: Sep 19, 2019
Assignee: Cardiac Pacemakers, Inc. (St. Paul, MN)
Inventor: Stephen J. Hahn (Shoreview, MN)
Primary Examiner: Brian T Gedeon
Current U.S. Class: Remotely Changing, (e.g., Programming, Pacer) Parameters Or Operation (607/30)
International Classification: A61N 1/362 (20060101); A61N 1/365 (20060101); A61N 1/372 (20060101); A61N 1/375 (20060101);


Your posts are like the proverbial busses in their frequency. But no less welcome. Looks a smashing walk.
Stunning. Horses can be a nuisance when wild camping. They have a habit of smelling food cooking and coming to investigate.
BMW 330 nice wheels! The new model looks great.
Today dawned clear after being overcast all yesterday. We discovered that if we had gone on our planned route we would have been in thick mist all day. So off we went up the huge ascent from Luchon, up to Refuge de Venasque, culminating in a huge series of zigzags. After we reached the refuge the cloud from France engulfed us and we adjourned to the 'mess tent'. This small refuge sleeps 14 people, on two bunks taking 7 each. We three are next to a family of four. One of them snores. The toilet is a concrete hole in the ground in a metal shack. The soup is warm and needs salt. The main course is adequate but not as good as our 'home cooking'. It's cold, so we are all in bed by 9 pm."
Funnily enough Martin I was enjoying re-reading your Pyreneean posts only last night.
Just sent you an email about it!


In my previous post, Using Jena and SHACL to validate RDF Data, I have looked at how RDF data can be validated using SHACL. A closely related concern to that of constraints checking, is rule execution, for which SHACL can also be used.
Note that ex:InvalidRectangle has been ignored because it does not adhere to sh:condition ex:Rectangle, since it does not have ex:height and ex:width properties. Also, ex:NonSquareRectangle is a rectangle, not a square.
In this post I gave a brief overview of how SHACL can be used to implement rules on RDF data. This code example is available at shacl tutorial.
By Henriette Harmse in Semantic technologies, SHACL on March 14, 2018 .


New parking machines have been installed along Herne Bay seafront. Residents have welcomed their introduction, hoping that it will reduce the number of cars in the area. But they have also prompted fears that they may have a negative impact on tourism in the town. Until just over a week ago it had been free to park cars along Marine Parade but the council has introduced a series of pay machines along the waterfront. It now costs 60p an hour to park along Marine Parade and parking is limited to two hours. However, visitors to the seaside town were less than happy with the new parking arrangements.


text:
Rok je moško osebno ime.

Različice imena
moške oblike imena:Roki, Roko
ženska oblika imena: Roka

Tujejezikovne oblike imena
Roky, Rocco (it.), Roch (fr.),  Rocha (luž.), Rochi, Rocho, Rochus, Rock, Rocky

Izvor imena
Ime Rok izhaja iz latinskega ali nemškega imena Rochus, ki ga razlagajo kot latinizirano obliko germanskega imena Rocho, ki pa je skrajšana oblika imena Rochwald, zloženega iz  dveh starovisokonemških besed rohôn »rjoveti, tudi bojna pesem pri Germanih« in iz waltan »vladati«.

Pogostost imena
Po podatkih Statističnega urada Republike Slovenije pa je bilo na dan 31. decembra 2007 v Sloveniji število moških oseb z imenom Rok: 9.234. Med vsemi moškimi imeni pa je ime Rok po pogostosti uporabe uvrščeno na 25. mesto.

Osebni praznik
V cerkvenem koledarju je ima Rok god 16. avgusta. Rok je na Slovenskem precej znan svetnik. Bil je Francoz iz Montpelliera, ki je romal v Rim in tam stregel kužnim bolnikom. Zbolel je za kugo, se po legendi zavlekel v gozd in tam ob negi angela in psa ozdravel. Umrl je 16. avgusta 1327. Velja za enega najpomembnejših zavetnikov proti kugi in kačjemu piku, priporočali pa so se mu še žanjice, šivilje, krojači, zidarji in tesarji.

Izpeljava priimka
Rok je tudi priimek v Sloveniji in na Hrvaškem. Tako je bilo v Sloveniji 45 oseb, ki so po podatkih SURS-a na dan 30. junija 2006 uporabljale ta priimek. Priimek Rok je  po pogostosti uporabe zasedal 7924 mesto.

Dogodki
Na dan sv. Roka je v Dravogradu, Radljah ob Dravi in v Dravljah Rokov sejem.

Pregovori
 Sveti Rok varuj me rok in nog, da me kača ne piči.
 Pomagaj ti Bog in sveti Rok.

Zanimivosti
Svetemu Roku v čast so na Slovenskem predvsem južno od Drave postavili precej manjših cerkvic. V letu 1985 jih je bilo še 33. Po Sv. Roku je dobilo ime več naselij predvsem na Hrvaškem, kjer je Sv. Rok tudi deželni patron. Najbolj znano umetniško upodobitev  svetega Roka je izdelal italijanski slikar Tintoretto. Slika se nahaja v Šoli sv. Roka v Benetkah, kjer se nahajajo tudi relikvije tega svetnika.

Glej tudi
 seznam osebnih imen na R
 seznam najpogostejših imen v Sloveniji

Viri

Moška osebna imena

redpajama_set_name: RedPajamaWikipedia


Danny Guggenheim is a partner in the Los Angeles office of Pircher, Nichols & Meeks LLP, and dedicates the bulk of his practice to the representation of private equity funds, real estate companies, non-bank lenders and other investors in connection with commercial real estate joint ventures, financings, acquisitions and dispositions.
He has been recognized with the "AV Preeminent" peer review rating from Martindale-Hubbell since 2015, and has been included in The Best Lawyers in America in the practice area of Real Estate Law since 2014, and in the Southern California Super Lawyers list since 2017.
Guggenheim speaks frequently on a variety of real estate topics, and is the author or co-author of "HVCRE-What? Managing Uncertainty Around HVCRE Loans," Commercial Property Executive (June 7, 2017), "Programmatic JVs: Structural Distinctions, Key Considerations," Commercial Property Executive (July 6, 2016), "The IRR Ate My Capital! How IRR Hurdles in Real Estate JVs May Cannibalize Contributions Made After Promote Distributions," Commercial Property Executive (April 21, 2015), "Contribution Default Remedies in a Real Estate Venture," Business Entities (November/December 2013), and "Important Issues in Purchasing and Resolving Distressed Real Estate Debt," BNA Inc. Real Estate Industry & Law Report (March 2009). He also holds a California real estate broker license.
Guggenheim received his BA in 2000 from Columbia University, and his JD in 2004 from the University of Southern California. While at USC Gould, he served as an Introduction to Lawyering Skills (ILS) instructor and as president of the Student Bar Association, was a member of the National Moot Court Team, and received the Shattuck Award for Leadership as well as the Order of the Laurel and Palm Award for Leadership and Service. Guggenheim served on the USC Gould Alumni Association's Executive Committee from 2014-2016 as chair of regional programs, and remains an active member of the USC Gould community.


We will have a rainy Sunday and it is starting now! I didn't noticed it was raining after checking out the window outside.. I have notice that the house gets darker and darker until it is pouring outside. Now we can't go to the fair because the big man in the house procrastinates of going. And oh! They put up the tent! Yet he never knew exactly what is going on.
This is so hard of not having your driver's license, you end up being dependent. If I have a choice and money, I could get an instructor to help me with this and get my road test at once. I know I am not having a very good Sunday, maybe because it is raining? However, I am still fortunate that inspite of all those humid week days. We finally got rain and cools our ground as well as me.
For now, I'll just check abode taps where I might be able to find an appliances that would replace our refrigerator in the house.