Interlude 3 mixed emotions Dirt bleed mix Breathing In Fumes apocalypse mix Dream On moment of madness The Defector allegiance mix Rush amylnitrate female intervention. Drifting darkspringxl's poisoned dub Shunt heart of darkness mix Curse anti-matter remix Freeze subtle kisses mix Stalker night of the hunter mix Chrome the crucible remix The Sermon slow burning remix Supreme fragile mix Electro Blues For Bukka White disturbed mix Curse deja vu extended version Grain excerpt Stone dm's reprise The Sermon dm's reprise The Defector transpose mix.
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Jezebel lethargic dance mix Black Box reaps edit Jezebel ambient mix Black Box depmodey's technified version Jezebel fatherless child version Black Box extract from Jezebel muon instrumental mix. Black Box fusion mix Want diversify mix Jezebel transpose mix Breath Control prolonged mix Last Call For Liquid Courage prolonged mix Strange Hours prolonged mix Supreme 12 inch vary mix Chrome transpose mix Vertigen prolonged mix.
Black Box devoted edit version Want devoted edit version Jezebel devoted edit version Breat Control devoted edit version Last Call For Liquid Courage devoted edit version Strange Hours devoted edit version Vertigen devoted edit version With coincidence of the two signals, the green passive light switches to a red active light indicating that the patient should start active expiration breathing.
Thus the operator selects the addresses from the front panel at which he wants the active light to occur and the patient to start active breathing.
When the addresses from multiplexer 16 increments to that point and there is an error indicating the active breathing has not started, then the light becomes red. When the error is below the selected amount, the light will turn green again. Each of these blocks can contain more than one eight-bit ROM.
The number of ROMs stacked will depend on the number of different waveforms desired. The waveform selection switches for ratio, inspiration and expiration vary the higher order address bits of the respective ROMs to select different waveforms. The lower order address bits address the data to be displayed on the TV screen.
The data out of ROM's 33 and 34 are added together in item 31, an eight bit adder, and that output is then added with the ouput of 32 in the adder 30, an eight bit adder. Element 29 represents eight tristate buffers which enable the ideal wave data to feed into the comparator Comparator 44 has a different error margin, generally smaller, which can also be selected from the front panel by the physician.
The 4. The output of the oscillator is counted and divided by N in the counter This counter provides an enable signal every Nth column, causing a dashed line representing the ideal waveform to be displayed on the TV screen. The output of the oscillator is also counted by a column counter 11 to provide addresses for the ROM through the multiplexer When the column counter counts bits, it overflows and resets. The overflow signal provides a horizontal sync for the TV modulator and increments the line counter The means for detecting of initial inspiration serves as a reset function and to synchronize the readout of the ideal waveform from the ROM's as well as the read in and read out of data from the RAM for the sensed respiration cycle.
The rate of readout is a function of the column counter and thus of the display, so that dots are generated for each of the two waveforms in a typical TV display.
Several comparators are used in the circuit, however, multi-function comparators may be employed on a time-sharing basis. Comparator 26 is used for the display function. Here, the line counter 28 responding to the lines of the raster and thus the height along the raster supplies a count up to comparator 26 corresponding to the physical position of the scanning beam on the CRT screen. Depending on the current state of the multiplexer, one or the other of the digital words read out from the ROM or the RAM, and which is simultaneously presented to the comparator 26, provides the data input which is compared with the current CRT scanning beam position by comparator 26 which then either generates a video display signal or no signal.
Erratic breathing patterns by the subject may make if difficult to properly initiate the desirable waveform breathing pattern. In such cases, it may be desirable to reset the cycle manually instead of by detecting inspiration flow. An inspiration override switching device allows a technician or operator to interact with the patient and the system to integrate patient needs properly into desirable machine generated performance parameters.
Once initiated, the subject patient would then better be able to relate to the desirable breathing patterns. Referring to FIG. This manual override device could take two forms. The first would be the display of individual single breathing patterns in the usual mode of operation.
The start of inspiration pulse output by the one shot 6 can be parallelled by a switch which will also give a start of inspiration pulse. The start of inspiration pulse resets the integrator 5 and thereafter the operation is as described for FIG. This allows the operator control of the start of the display to coincide with the start of breathing of the patient.
A second approach might be to display a series of breathing patterns in a prescribed program. For example, in the series of breathing patterns required by the Lamaze obstetrical method, at the beginning of a labor pain, the patient could press the manual override switch and initiate a program of multiple breaths in multiple ways in individual breaths to achieve a desired obstetrical breathing pattern.
The multiple breath display would require only an additional logic which would not depart from the scope of this invention. The expiration portion of the cycle may also be provided with manual override switch by modifying the circuit of FIG. By activating this switch, the output of oscillator 7 is interrupted and whatever display is presented at that time will be preserved in the display without progression.
Ideal breathing patterns of necessity require the patient be in a stable state in order to utilize said optimize breathing patterns.
This would imply previous unstable states, such as chest overinflation known commonly in the art as "airtrapping" be initially obviated. This is so because the act of expiration in emphysema patients is more difficult than the act of inspiration, thus promoting a perpetual state of airtrapping overinflation. To come from a state of airtrapping overinflation to one of relative normal chest volume, the manual inspiration override program might be initiated.
Also, the same result could be obtained by activation of a manual expiration override switch which could be utilized in two formats. The first would be a simple manual override switch 7A which would delay the beginning of the video display of the next cycle, during which time the patient would be instructed to continue the act of exhalation, thereby emptying his chest of undesirable volumes of air prior to initiation of next inspiration. In a second mode of operation, utilizing a simple timing delay device, the active exhalation could be prolonged for a prescribed period of time, for example 2, 3, or 4 seconds per superimposed cycle of prolonged expiration and thereby delayed inspiration time of the next cycle.
This modification is also shown in FIG. The timer could be activated by a manual switch, as described, or automatically from a simple end of expiration timing means. A manual override on expiration can be accomplished by disabling oscillator 7 into the column counter This will allow the operator to stop the display while the patient continues breathing out or at any point in the cycle.
To avoid stray pulses due to bouncing of a switch, a gated amplifier can be inserted in series with the output of oscillator 7.
The gate of the amplifier can be controlled by a set - reset flipflop, which in turn is controlled by a manual switch and clocked by the output oscillator itself. Real time performance deficiencies will be indicated by departure of a solid performance line from a broken desirable parameter line. In an alternative embodiment of the video incentive positive biofeedback display, the broken line display of ideal performance is enhanced by a progressive real time optical blinking display.
The display of the dotted or broken ideal performance curve is enhanced in biofeedback modes by making the stationary dotted display blink progressively in real time sequentially along the programed dotted display of a stationary type. This would more precisely enhance the positive biofeedback mode of operation. A representative blinking display is shown in FIG.
The real time position indicator circuitry for blinking dot display can be obtained by modifying the circuitry of FIG. The blink position is kept just leading the real time data. Its position is determined by adding one count to the data counter in the data plus 1 counter 12A. Each bit of the data plus one counter 12A and the address from the multiplexer 16 are input to a decoder 12B.
The decoder contains an inverted exclusive OR for each bit of the address. The output of each of these is input to an AND circuit. When there is coincidence on all lines of the AN circuit, gated oscillator 12C is gated on by the output from decoder 12B. The output of oscillator 12C alternately inhibits and enables the inverter This will inhibit the input, causing the video to turn off for several frames and on for several frames.
The frequency may be selected to provide an optimum blinking rate. The video output of comparator 26 is utilized in a modulator oscillator mixer circuit which feeds the TV display.
Referring now to FIG. All inputs are TTL level. The circuit is shown with preferred values of resistance and capacitance. Transistors 27B and 27C may be type 2N Variable inductance L, may be constructed with 4 turns of No.
This circuit is designed to operatively connect to the twin lead to a standard television set. It can easily be replaced by other commercially available systems which require horizontal and vertical synchronized video inputs to input data to a TV set.
The visual display may be any dynamic electro-optic device capable of accepting the pulmonary program and patient data on a real time basis.
For purposes of simplicity, emphasis is placed on the kinescopic display adaptable for use with a standard television receiver set. The rectilinear raster scanning systems are commercially available and are advantageous for use with the present invention with little or no modification.
The typical raster scanning circuits can be easily adapted for interfacing with the present data input. Various modifications of the display device are feasible, including electrically-activated grids, such as those employing liquid crystal elements. While the preferred displays are conventional, with time on the abscissa horizontal axis reading left to right respiratory volume being shown on the ordinate vertical axis , other visually discernable displays are contemplated, for instance, a circular CRT display with expanding circles for the prescribed volume and measured flow conditions.
Various optional equipment may be employed as part of the invention. In training emphysema patients, dynamic bronchial compression may be overcome by achieving a "pursed lip effect". In this technique a variable outlet orifice can be employed with the mouthpiece to obtain a constant back pressure, which minimizes this form of bronchial compression.
As a further embodiment to evaluate and quantitate patient performance, mainly for quality control and research purposes, an additional device can be adapted in convenient modular fashion into the basic units.
These may be "phantom" waveforms parallel to the desired waveform. The ideal pattern may be pre-set by selecting a circuit board or special memory chip integrated circuit or the like, having the desired values of tidal volume, respiratory rate, etc. These may be economical fixed values in the selected simple circuit, as shown in FIG. These are substantially wider than would ordinarily be used and provide for extreme patterns, if desired.
If a matrix memory is employed for storing the waveform, the outputs of memories can serve as direct addresses to the display.
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Ideally, one should shoot during the respiratory pause after exhaling while the body is the most motionless If the shot is not made in time, another full breath with release should take place Combat breathing should start as soon as you are alerted to the potential need for violence Against a spontaneous threat, you will most likely hold your breath while shooting; stop doing this as soon as you recognize it and make breathing part of your tactical response and follow through If you make the deliberate decision for a perfect shot, you should set up the breath, which sets you up mentally for the fundamentals of marksmanship; The skill is to snap into position, breath out, and take a deliberate fully aimed shot as quickly as possible Example: Run, Stop, Shoot Officer chases and armed bad guy until he gets a clear shot, the officer stops quickly, forces out a quick exhalation, finds the sights fully and shoots in a compressed time frame.
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