All your passwords and other saved sensitive items are stored in an encrypted manner that is never visible to LastPass in its unencrypted form. Securely share your passwords with friends and familyĪll of your sensitive vault data, including passwords, secure notes, and uploads is protected through comprehensive measures including use of AES 256 encryption with salting and hashing (for more information regarding LastPass' security features, please visit here): Passwords are autofilled for you as you go to your sites - less typing! Protect your LastPass account with multifactor authentication Generate secure passwords to replace weak ones LastPass dark web monitoring alerts you if your information is at risk LastPass Security Dashboard provides and overview of your weak and reused passwords and how to improve them ![]() Anything you save on one device is instantly synced on all your other devices All your data is available on any device for free Save passports, insurance cards and anything else you want to keep safe Fill forms quickly by saving your addresses, credit card numbers and more Store usernames and passwords and LastPass will log you in automatically Stop wasting time getting locked out of accounts or filling passwords and forms online – LastPass simplifies your daily online tasks while keeping you and your family secure. Save all your passwords, addresses, credit cards and more in your secure vault and LastPass will automatically fill in your information when you need it. ![]() LastPass puts you in control of your online life – making it easy to keep your critical information safe and secure so you can access it whenever you want, wherever you are.
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![]() The break may be associated with symptoms or may be asymptomatic. ![]() A break in the retina can be categorized as a tear or a hole. A Cochrane systematic review evaluating surgical interventions for rhegmatogenous retinal detachments is in preparation. This review is concerned with the prophylactic treatment of the asymptomatic retinal breaks and areas of degeneration that might cause rhegmatogenous retinal detachment. Retinal detachments can be rhegmatogenous (caused by a break in the retina) or non-rhegmatogenous (caused by leakage from beneath the retina or by traction (pulling) on the retina). Nevertheless, treatment of these problems is frequently recommended, in spite of the fact that the effectiveness of this therapy is unproven.Ī retinal detachment is a separation of the sensory retina from the retinal pigment epithelium, with an accumulation of fluid in the potential space between them. Retinal tears and holes unassociated with acute symptoms and lattice degeneration are significantly less likely to be the sites of retinal breaks that are responsible for later retinal detachment. This therapy is of value in the management of retinal tears associated with the symptoms of flashes and floaters and persistent vitreous traction upon the retina in the region of the retinal break, because such symptomatic retinal tears are associated with a high rate of progression to retinal detachment. Creation of an adhesion surrounding retinal breaks and lattice degeneration, with laser photocoagulation or cryotherapy, has been recommended as an effective means of preventing retinal detachment. Retinal detachments occur when fluid in the vitreous cavity passes through tears or holes in the retina and separates the retina from the underlying retinal pigment epithelium. Asymptomatic retinal breaks and lattice degeneration are visible lesions that are risk factors for later retinal detachment. ![]() It's Jinja's birthday, and her friends have no clue how to celebrate it. This time he is willing to except the importance of his mother's "calling". But now Chase must say goodbye to his mother all over again. When Beyal and Sofia are cornered, Chase and Jeredy rescue them with their hyper monsunos. At the last moment, Beyal chooses to destroy the book to protect the secret of the five tribes from Droog. Beyal refuses, but HOD threatens Sofia with their Monsuno. The book has a self-destruct device if not opened in a right way. Meanwhile, Beyal and Sofia are trying to make it out of the mountains alive when suddenly they see a SPACESHIP! Droog comes out and demands Beyal to open the BOOK OF THE FIVE TRIBES which he had Bookman steal from the library of Tebab. His mom and Beyal are in trouble, and he takes off with Jeredy in the CLOUD HOPPER to find them. With Beyal and Sofia on the run in the freezing Mandala mountains, Chase is getting one of his Monsuno Sight feelings. Beyal instantly SPINS out GLOWBLADE and the BATTLE is on! But Beyal takes off with Sofia right in the middle of the fight. trucks come to a screeching halt and Beyal and Sofia are surrounded. truck they are sitting in! Suddenly, all four S.T.O.R.M. Little do they know BOOKMAN is back in town and not only has he already hijacked the Library of Tebab, he has hijacked the very S.T.O.R.M. Trucks that are loaded with the original artifacts from the library with S.T.O.R. Meanwhile, Beyal and Sofia are riding in one of four S.T.O.R.M. Chase stays back on the CLOUD CARRIER with TCT. Chase is frustrated and disheartened, but Sofia explains that she is being called to do this by a power greater than the both of them and they must not stand in the way no matter how difficult that may be. But Chase quickly finds out that it's not, when Sofia reveals that she is leaving for the Library of Tebab to re-establish it and Beyal is taking her. With Sofia back in the picture, life is good. This allows them to all EVOLVE their Monsunos for a big FINISH and VICTORY! He's isolated Lock's new frequency and sends it to the kids. the upgrade isn't done yet! And, TCT are once again getting their butts kicked! Luckily, Jeredy does come through. Chase gets in a little hot water with his friends when they find out he jumped the gun. Chase has so much faith that when he and TCT set a little trap for both Klipse/Tallis and Droog/HoD, Chase charges in head first telling his teammates that Jeredy's sending them the upgrade. He has faith in his Dad that Jeredy will unlock the "Evolved Lock" secret and give our heroes the edge they need. Trey, it looks like our heroes are being kept out of the fight. With Strike Squad being sent out by a very smug Lt. Because, it just might hold the key to giving our heroes an edge in this fight against these new Alien Monsunos and the new Dino Monsunos. Lock did something amazing in Part One, and Jeredy needs to understand what it was. Jeredy is meanwhile working on Lock's CORE. is meant to keep this stuff out of the hands of the wrong people! Jon Ace is furious! Chase and TCT try to give ideas on how to change things up, but after their previous work, they're grounded until further notice. stealing a large quantity of Monsuno Essence. Droog and his Hand of Destiny helpers unleash their Alien Monsunos in a sneak attack on S.T.O.R.M. With our heroes of TCT licking their wounds from Part One, they're regrouping and trying to assess what just happened, only they don't get much of a chance. Have lost their Cloud Hopper during the fight, TCT have to walk back to S.T.O.R.M. ![]() Our heroes have lost two big fights in the same day. but they've lost both sides of the battle because Klipse/Tallis get away with a huge stash of DINOSAUR BONES and DROOG/HOD get away with a huge cache of Monsuno Essence. In a last ditch effort, Chase spins out Lock and Lock EVOLVES! This is the only thing that saves our heroes. ![]() Surrounded and out-numbered our heroes get their Cores kicked and will surely be defeated. They've come to pilfer Monsuno Essence so carefully collected by Team Core-Tech. ![]() only to find DROOG and the HAND OF DESTINY (the surviving three are Petros, Tess and Dasha). TCT find themselves outgunned and make a run for it back to their Core Tech Cloud Hopper. Klipse happily "declares war" on the newly established Team Core-Tech of S.T.O.R.M. KLIPSE'S AND PROFESSOR TALLIS' DINO-MONSUNO!! Dr. And, after Chase, Jinja and Bren get a bit of dressing down from Commandant Marshal Jon Ace, a call comes in from Beyal and Dax! They're under attack from some kind of unknown monster!!! When Chase, Jinja and Bren join their friends at the museum, they soon discover a NEW TYPE of MONSUNO! It's DR. This episode starts with Chase, Jinja and Bren on stake out collecting an "illegal" cache of Monsuno Essence while Beyal and Dax are on stake-out at the Westward City Natural History Museum. ![]() ![]() Not this time! An hour later the house smelled normal!! I am impressed with how little dust is in my house and knowing that my air is healthier. Normally the house stinks for a day or two after. I recently cooked some raw Dog food for a sick pup. lastly, they remove nasty smells from your house. First, this is a way better price than Amazon or even the installers cost at Thermal Supply. Unfortunately I did two things at the same time, I upped the MERV rating of my filters and purchased this as recommended by my HVAC friend. Verified purchase: Yes Condition: New Sold by: techprotx2013 I fact, since the replacement bulbs (required every 2 years) aren't cheap, I wired it up to a separate UPS so it would be less likely to experience any power fluctuations. We leave our HVAC fan on all the time, and I wired the Reme Halo in so it stays on all the time (as recommended in the instructions). Also, my wife said her previously excessively dry throat was feeling a lot better after the first day. It seemed to make a noticeable difference in pet smells in the house after a day or two, which is the main reason why we purchased it. And our house is less than 1600 sq ft, so I fully closed the grill that surrounds the lamp (process is well described in the included instructions). So I used some plywood to attach it to an old LED TV stand, and placed it just below the filter on the bottom of our HVAC unit. Though installing on the HVAC output (supply side) is recommended in the instructions, they also mention that as a last resort, it's okay to put it on the return side (input). ![]() Read more It was factory sealed, price was very good, and I was able to install it myself in a couple of hours. ![]() It was factory sealed, price was very good, and I was able to install it myself in a couple of hours. Afghanistan, Albania, Algeria, Andorra, Angola, Anguilla, Antigua and Barbuda, Argentina, Armenia, Aruba, Australia, Austria, Azerbaijan Republic, Bahamas, Bahrain, Bangladesh, Belgium, Belize, Benin, Bermuda, Bhutan, Bolivia, Bosnia and Herzegovina, Botswana, Brazil, Brunei Darussalam, Bulgaria, Burkina Faso, Burundi, Cambodia, Cameroon, Canada, Cape Verde Islands, Cayman Islands, Central African Republic, Chad, Chile, China, Colombia, Costa Rica, Cyprus, Czech Republic, Côte d'Ivoire (Ivory Coast), Democratic Republic of the Congo, Denmark, Djibouti, Dominican Republic, Ecuador, Egypt, El Salvador, Equatorial Guinea, Eritrea, Estonia, Ethiopia, Fiji, Finland, France, Gabon Republic, Gambia, Georgia, Germany, Ghana, Gibraltar, Greece, Greenland, Grenada, Guatemala, Guinea, Guinea-Bissau, Guyana, Haiti, Honduras, Hong Kong, Hungary, Iceland, India, Indonesia, Ireland, Italy, Jamaica, Japan, Jordan, Kazakhstan, Kenya, Kiribati, Kuwait, Kyrgyzstan, Laos, Latvia, Lebanon, Lesotho, Liberia, Liechtenstein, Lithuania, Luxembourg, Macau, Macedonia, Madagascar, Malawi, Malaysia, Maldives, Mali, Malta, Mauritania, Mauritius, Mexico, Moldova, Monaco, Mongolia, Montenegro, Montserrat, Morocco, Mozambique, Namibia, Nauru, Nepal, Netherlands, New Zealand, Nicaragua, Niger, Nigeria, Norway, Oman, Pakistan, Panama, Papua New Guinea, Paraguay, Peru, Philippines, Poland, Portugal, Qatar, Republic of Croatia, Republic of the Congo, Romania, Rwanda, Saint Helena, Saint Kitts-Nevis, Saint Lucia, Saint Pierre and Miquelon, Saint Vincent and the Grenadines, San Marino, Saudi Arabia, Senegal, Serbia, Seychelles, Sierra Leone, Singapore, Slovakia, Slovenia, Solomon Islands, South Africa, South Korea, Spain, Sri Lanka, Suriname, Swaziland, Sweden, Switzerland, Taiwan, Tajikistan, Tanzania, Thailand, Togo, Tonga, Trinidad and Tobago, Tunisia, Turkey, Turkmenistan, Turks and Caicos Islands, Uganda, United Arab Emirates, United Kingdom, United States, Uzbekistan, Vanuatu, Vatican City State, Vietnam, Wallis and Futuna, Western Samoa, Yemen, Zambia, Zimbabwe ![]() Links are provided for reference only and. Before moving to Tads current city of Oklahoma City, OK, Tad lived in Stillwater OK and Nichols Hills OK. "You've got to do something to motivate people to be more vigilant about trying to find this young girl, because this is not going to end well if we don't get her home, and get her home soon," he said. Tad Cooper is 61 years old today because Tads birthday is on. Prior to being a teacher he was a respiratory therapist. Meanwhile, a former coworker of Cummins is offering a $5,000 reward for information leading to his arrest.Ĭhandler Anderson, a nurse practitioner in Columbia, Tennessee, first met Cummins in 1998. NEW PICTURE: Here's Tad Cummins and Elizabeth Thomas at school in January, days before his alleged inappropriate contact with her. "'I saw you standing next to you backpack this morning' and makes a reference to a body part of hers and how nice that looked," said Marcus Alright with the Maury County Sheriff's Department. The lead investigator on the case shared one of the emails with WAAY. "If you read them you would immediately recognize you are reading messages between two people who have a romantic interest in each other," Cooper said. This has a strong internal framework formed by 0. Divisions include petroleum equipment, Learn more about Tad Cooper's work experience, education, connections & more by visiting their profile. The Compact References enclosure is made using what TAD calls Structurally Inert Laminated Enclosure Technology (SILENT). Nvestigators said the pair wrote inappropriate messages to each other, but Cooper declined to elaborate. Oversees all operations of energy services firm. "The other person would log in, read the message and then delete it and then write another message that was saved as a draft." ![]() "They would write the message and let it save as a draft," Maury County District Attorney Brent Cooper explained to ABC affiliate WAAY in Huntsville, Alabama. ![]() Thomas and Cummins wrote emails to each other but did not send them - instead they would save the email in the drafts folder of Cummins' school email account, the Maury County District Attorney and the Sheriff's Office revealed Friday. (ABC NewsOne) - As law enforcement officers across the country continue to hunt for Tennessee teen Elizabeth Thomas and her former teacher Tad Cummins - the 50-year-old man who allegedly kidnapped the 15-year-old - investigators have shed light on their relationship, revealing that emails between the pair have uncovered a "romantic interest in each other." ![]() we do not have New Order faction, but few selected ships from new canon may appear in the mod in the future if they fit and don't look stupid. The Mandalorians remain splintered and embattled over the remaining territory, and bounty hunters and pirates find easy pickings in the chaos of the Empire’s sudden retreat.ĬANON OR LEGENDS: this mod is loosely based on both, but priority is given to the original trilogy and prequels era with some additions of new canon only where it makes sense and does not look out of place. Without the strong hand of the Empire, the Independent Commerce Guild is seizing control of systems and markets along the Outer Rim, leading them into regular conflict with the Corporate Sector Authority. Meanwhile, the Alliance continues to liberate more systems and establish order through providing security, although not all member planets wish to be part of the New Republic. The newly formed New Republic is in a fragile, infantile state, holding the core and nearby systems but still struggling to build galactic support. The Galactic Empire has fractured into parts and been pushed out of the galactic core. As with that expansion, come on, wouldn't it just be awesome seeing a TIE Fighter or a Droid Tri-Fighter alongside a Star Destroyer or a Republic Cruiser?Īfter version 0.1 is released, in version 0.2 I will add the Republic Era, and then after that, the Old Republic, and New Republic.It is 10 years after Emperor Palpatine’s death. With the release of the expansion coming this year, I will wait for it, and then begin working on ships and battle cards and all the combat stuff. But before then I will release multiple versions with heroes and factions, etc, etc. Once all heroes and factions are added, version 0.1 will be complete. I plan to have at least one of these 3 factions completed, either the Galactic Empire, Rebel Alliance, or Fringe. In the next update to be released, there will be a new "Applied Sciences" Tech Tree, pictures for the technologies might come when all 4 are completed though. To make up for the delay in release, mostly because of real life conflicts of time, I will explain what is being done with specifics! So a brief update, things are progressing smoothly. And as far as heroes go, let's just say that I have over 150 heroes planned that range from all eras.Įveryone Who Suggested Anomalies and WondersĪnd I am wanting to change the Dust to Credits, I just need to find out how lol. I am thinking of removing the "Fringe" faction and adding the Hutt Cartel. I will keep the Old Republic and the Rebel Alliance and the New Republic for those that wish to set up era-specific battles. ![]() It will have a mild mix of "what if" scenarios. That will be the joy of this mod, that factions can research technologies that we have only imagined them having. ![]() The Star Forge is definitely on the list of wonders.įor the tech trees, if you look at all the different factions, they all have things in common. Maybe I can use an existing faction from Endless Space for the ship graphics? The others will have custom graphics down the road. The hard part for both though will be the ship design, as I cannot find any place that has them in it. I will definitely put in the Chiss Ascendancy and most likely the Infinite Empire. Great ideas folks! I will do my best to implement most, if not all, of them. ![]() Įngines were updated in as a part of the facelift and the new 320 CDI was powered by a 2987 cc OM642 V6 engine delivering 224 hp at 3,800 rpm and 540 N⋅m (400 lb⋅ft) at 1,600–2,800 rpm. The E 320 remained unchanged, producing 165 kW of power. Engine outputs of E 240 and E 270 models from the previous W210 E-Class were given a 5 kW increase to 130 kW, while the E 500 uses the 225 kW 5.0-litre V8 from the W220 S-Class to supersede the W210 E 430. V6, V8, inline-4, and supercharged inline-4 engines were offered. The transmission options were 5 or 7-speed automatic or 6-speed manual. The W211 was the first E-Class since 1985 equipped with two windshield wipers. The 2003 E-Class was offered in sedan and 5-door station wagon configurations in three trim lines, marketed as Classic, Elegance, and Avantgarde. The W211 is a more complex car than its predecessor, with a programmable serial bus and many automated systems. Options included multicontour front seats and dual control air suspension system marketed as Airmatic DC.Īir suspension was standard equipment in the top-of-the-range E 500 V8 model and was available as an option on all other E-Class models. The redesigned 2003 model featured electrohydraulic braking system marketed as Sensotronic Brake Control (SBC), which was standard equipment in the E-Class. Mercedes-Benz claimed to have reduced the fuel consumption of the new E-Class by up to 0.9 litres per 100 km compared with the outgoing model. It offered gasoline or diesel engines with a choice of rear or 4-wheel drive. The 2003 E-Class was larger than its predecessors while offering less interior space, particularly in the estate version, than the W210 it replaced. Pre-facelift interior E220 CDI Classic (2003-2006)Īt the 2002 European Motor Show Brussels featuring twin-headlights, angled slightly rearward. The W/S211 looked similar to the previous generation, but with a more modern and polished design. The W211 Platform was also the base foundation for which the newly re-introduced Chrysler LX cars were engineered from ( Chrysler 300, Dodge Charger, Dodge Magnum). Pilot production went into testing in the summer of 2001, and the W211 E-Class debuted at the Brussels Motor Show in January 2002. ![]() Development ended in 2001 after 48 months, at a total cost of €2 billion. The final designs were chosen in 1999, and German patents were filed on Decemutilizing an E 500 prototype. The W211 development program began in 1997, followed by design work. Before North American sales began, the car was shown in the 2002 movie Men in Black II. Launched in 2002 for the 2003 model year, the W211 E-Class was another evolution of the previous model. The C219, marketed as the CLS, was introduced as a niche model in 2005, based on W211 mechanicals. The Mercedes-Benz W211 is the third generation Mercedes-Benz E-Class made from 2002 to 2009 in sedan/saloon and station wagon/estate configurations – replacing the W210 E-Class models and superseded by the Mercedes-Benz W212 in 2009. The Newsday team then reviewed the cases based on responses from agencies, agents and their representatives. We invited them to meet with our reporting team to ask questions and to seek their reactions and responses. If both experts found evidence of unequal treatment, Newsday contacted the real estate agencies and agents involved to make available a review of video we recorded of interactions among testers and agent and maps of listings offered. ![]() We then notified all agents and agencies that were tested. We engaged two nationally recognized experts in fair housing standards to analyze the results of our testing and then undertook a rigorous and thorough review of the findings. Newsday engaged the Fair Housing Justice Center in Long Island City, an organization with the nation’s most extensive paired-testing experience, to help structure and implement testing and train testers. So we undertook the task in a three-year investigation that is one of the most extensive ever conducted by Newsday. Newsday found that authorities had not conducted significant government fair housing testing among Long Island’s 27,000 licensed real estate agents for almost a decade. The results are then scrutinized for evidence of fair housing violations such as “steering” testers to communities. Posing as buyers, white and minority testers make identical requests to agents for help finding houses. Federal law specifically protects homebuyers from discrimination based on race, color, national origin, religion, sex, familial status and disability.Įnforcement agencies rely on undercover tests - which reveal sometimes hidden inequalities in treatment - to investigate whether real estate agents deny equal opportunities in home buying. They are expected to uphold federal, state and local laws requiring equal treatment for all and equal access to all communities. They are licensed by the state and their industry is regulated by federal and state agencies. Real estate agents are central to homebuying and so important is their role that their training is specified by New York state. Today, even though ours is an increasingly diverse region, the lines of separation stubbornly persist. ![]() But opportunities were not the same for everyone in what was also an era of racially exclusive covenants and blockbusting tactics that separated communities along color lines. In the decades after World War II, Long Island experienced explosive growth as its communities swelled with returning veterans investing in homes and establishing roots. The answer should be equal treatment for all by real estate agents and equal access for all communities. Johnson signed the federal Fair Housing Act to prohibit discrimination in housing, this remains a core question for one of America’s oldest, most populous and most segregated suburbs. More than 50 years after President Lyndon B. What happens when white and minority prospective homebuyers seek real estate agents to help them find houses on Long Island? ![]() As the war effort intensified, electric lamps were temporarily discontinued by 1943.Īladdin was granted permission to use copper by the War Production Board, because the use of Aladdin kerosene lamps reduced the need for copper wire to electrify homes. WWII played a significant role in the history of Aladdin lamps. The sixth model won a gold medal at the Panama Pacific International Exhibition in 1915.ĭue to the partnership with Plume & Atwood, the Aladdin brand was no longer dependent on the engineering and technology of just a few companies in Germany.ĭue to Germany’s role in World War I, German lamp parts became unavailable in America.Īs electrification progressed, Johnson decided to open an international office and formed Aladdin Industries in 1919.īy 1926, Johnson had purchased a glass manufacturing company in order to gain full control over manufacturing. ![]() The company also began forming partnerships with retailers. Long before World War I, Johnson recognized the importance of marketing to the company’s success and overall growth.įrequently advertised in Newspaper periodicals, the radio and movie theater pre-shows. Lampshades were made of glass while mantles and chimneys were imported from Germany, but the company soon began contracting independent glass companies to produce their own hardware at their own in-house manufacturing facility.Īfter introducing Aladdin models one and two with cap mantles that sat on cone-shaped openings on the galleries, Johnson and his team receive the first patent for a “Kone Kap” mantle design that made it much easier to operate the lamp. The first Aladdin lamp model came with several variations to choose from: three table lamps, two hanging lamps, a wall-mounted lamp, and an oil pot lamp. Johnson then established a small research department to improve quality and continue advancement. The name “Aladdin” was inspired by the famous folktale Arabian Knights in which a genie is found residing in an old oil lamp.īecause it was so much more efficient than any other lamp on the market, initial sales of the Aladdin lamp exceeded all expectations. Wirth and manufactured by Plume & Atwood, Johnson soon introduced the first Aladdin lamp in 1909. Johnson began searching for a better version.Īfter acquiring the center-draft burner patented by Charles E. This mantle burner was designed to fit into most American-made fonts, but it required constant attention because it often went out of alignment and chimneys were susceptible to cracking. ![]() When properly adjusted, the Practicus burner produced a white light with an output equivalent to about 60 candles. Less than a year later, Johnson moved his company to Chicago where he incorporated the Mantle Lamp Company of America in February of 1908. His company obtained the rights to sell the Practicus mantle burner and other foreign-made lamp parts. Johnson also saw the potential for sales, particularly in rural areas where electricity was still many years from widespread adoption. Having studied in poorly lit rooms as a child, Johnson immediately recognized a need for better lighting. ![]() Johnson founded and incorporated the Western Lighting Company in Minneapolis, MN in 1907.Īfter seeing the superior light produced by a German kerosene mantle burner called the “Practicus”, Johnson decided to form his own company. The Aladdin Mantle Lamp Company of America Originally sourced from coal tar and shale oils, kerosene was later derived from petroleum, after the first oil well was drilled in Pennsylvania in 1859. Kerosene oil was discovered by Canadian physician Abraham Gesner in the late 1840s The danger associated with the Whaling industry coupled with the declining population of whales and the growing need for more oil leads to the search for a better burning, more abundantly sourced oil. Whale oil was not only not very brightly burning but also was smelly and due it not being very clean burning was dirty and left soot marks not only on the chimney but on the ceilings and surrounding in whatever room it was used. Prior to the invention and widespread use of electric lighting in homes across America, life was illuminated by candlelight and lamps fueled with whale oil. ![]() The areas of interest are from the velopharynx to the upper esophageal sphincter (UES). Once the catheter is positioned within the pharynx, participants rest for 5?10 minutes for adaptation prior to swallowing. Manometric catheter is lubricated with a 2% lidocaine jelly to ease the passage of the catheter through the pharynx. 4 A 10% lidocaine spray is applied through the nasal passage. Participants are instructed not to eat for 4 hours and not drink liquids for 2 hours prior to testing in order to avoid any potential confounding effects of satiety. The examination is performed at a neutral head and sitting position. In the present review, we will discuss the methods to use HRIM, including the interpretation of its parameters, to assist in the evaluation of pharyngeal dysphagia. The main reason may be that the test method and result interpretation are not easily applicable and standardized. 2 Although HRIM provides precise pharyngeal pressure information, it has yet to be applied to routine clinical practice as the assessment method for dysphagia. It also has improved sensitivity, reliability, and accuracy. HRIM has pressure sensors at 1?2 cm intervals and uses a solid catheter, which enables the evaluation at the sitting position. Recently, high-resolution impedance manometry (HRIM) was developed and used to evaluate pharyngeal dysphagia. There exists a correlation between the abnormalities in generating adequate pharyngeal pressure and developing pharyngeal dysphagia therefore new methods to evaluate and analyze the pharyngeal pressure events are required to reveal the underlying pathophysiology of dysphagia.Īs conventional manometry uses hydrostatic pressure, only the limited sensors and positions (supine) were allowed therefore, its application to pharyngeal dysphagia was nearly impossible. However, VFSS could only evaluate the movement of anatomic structures and bolus, and could not evaluate the generated pharyngeal pressure. Until now, a videofluoroscopic swallow study (VFSS), an X-ray-based analysis of swallowing, has been a gold standard in analyzing the swallowing function in patients with dysphagia. Pharyngeal swallow is a complex event that requires subsequent muscular contractions and pressure generation to move a bolus from the mouth to the esophagus. Dysphagia results from diverse etiologies, and its likelihood of occurrence increases with age. Keywords: Deglutition disorders, Diagnosis, Manometry, Pharynxĭysphagia means difficulty in swallowing, which may be followed by aspiration and inadequate nutrition. In the present review, we will review how to apply HRIM for the evaluation of pharyngeal dysphagia, including the interpretation of its parameters. With HRIM, the pressure and timing data could be obtained at a precise anatomical structure. The anatomical landmarks for HRIM parameters are velopharynx, tongue base, epiglottis, low pharynx, and upper esophageal sphincter. The main reasons are thought to be that the test method and result interpretation are not easily applicable and standardized. ![]() Although HRIM provides precise pharyngeal pressure information, it has yet to be used as part of routine clinical practice for the assessment of dysphagia. Recently, high-resolution impedance manometry (HRIM) was developed and used for the evaluation of pharyngeal dysphagia. ![]() The pharyngeal phase of swallowing is a complex event consisted with subsequent muscular contractions and pressure generation to move a bolus from the mouth to the esophagus. |
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