![]() It is calculated as the average of the peak systolic longitudinal strain from all LV segments in apical four, three and two chamber views. Moreover, it improves risk prediction beyond LVEF assessment in patients with HFrEF. Global longitudinal strain may be more sensitive than LVEF as a measure of LV systolic function, allowing early changes in patients at high risk to be detected. Strain is defined as the change in length of a myocardial segment relative to its resting length, while strain rate is defined as the rate of such deformation. Moreover, it permits the measurement of myocardial strain and strain rate. It allows fast and highly automated LV chamber quantification, producing accurate and reproducible LVEF estimation. Speckle tracking echocardiography analyses LV deformation by tracking cardiac motion from image intensities (the speckled pattern of the myocardium). However, it remains dependent on good acoustic windows and scanning technique, rendering it subject to many of the same limitations as 2D TTE.Īssessment of myocardial deformation is an emerging technique that may have an important clinical role in the diagnosis of HFrEF. 3D echocardiography provides volumes with minimal postprocessing requirements, and is more accurate and reproducible than 2D assessment. More comprehensive evaluation of LV systolic function is possible using advanced imaging techniques, such as 3D echocardiography, speckle tracking and cardiac MRI (CMR). Reproduced with permission from BioMed Central under a Creative Commons CC-BY 2.0 licence. B: On cardiac MRI, contours are drawn on the short axis cine stack in end-diastole and end-systole. The endocardial borders are traced in the four chamber and two chamber views in end-diastole and end-systole. This may concomitantly allow the diagnosis of LV thrombus when present.Īssessment of Left Ventricular Ejection Fraction on Transthoracic Echocardiography and Cardiac MRIĪ: Left ventricular ejection fraction can be assessed on 2D transthoracic echocardiography using the biplane method. ![]() If required, intravenous contrast can be administered to better delineate the endocardial border, increasing the feasibility of biplane volume analysis and improving the accuracy of LVEF estimation. ![]() Moreover, poor image quality can lead to foreshortening of the ventricles and, therefore, underestimation of the volumes. This method relies on assumptions regarding the geometric shape of the LV. Measurement areas are acquired in two single planes from which inferences are made to estimate the LV shape and obtain 3D volumes ( Figure 1A). 2D LVEF is typically calculated using the biplane method of disks (modified Simpson’s) method. 2D transthoracic echocardiography (TTE) remains the initial modality recommended for the assessment of LVEF. Accordingly, accurate estimation of LVEF remains the cornerstone of HFrEF diagnosis. The current European Society of Cardiology guidelines define HFrEF as the presence of signs and symptoms of HF and a reduced ejection fraction (LVEF ≤40%). The Role of Imaging in the Diagnosis of HFrEF This review summarises the role of cardiac imaging in HfrEF, with a focus on diagnosis, phenotyping, assessment of aetiology, therapy planning and prognostication. In addition to providing accurate volumetric assessment, cardiac imaging has evolved to offer functional, haemodynamic and tissue characterisation. Furthermore, identification of the underlying aetiology is of great importance, allowing the personalisation of treatment and prognostication. What makes cardiac imaging the cornerstone of the assessment of HFrEF is the identification of impaired left ventricular contraction and reduced left ventricular ejection fraction, which are the essentials of diagnosing HFrEF, which is followed by initiating disease-modifying therapy. Approximately half of all HF patients have reduced ejection fraction (LVEF <40%) at rest. Three distinct phenotypes based on left ventricular ejection fraction (LVEF) have been described: HF with preserved ejection fraction (HFpEF), HF with mildly reduced ejection fraction and HF with reduced ejection fraction (HFrEF). The prevalence of HF in the developed world approximates 1–2% of the adult population, rising to >10% in those aged >75 years. Heart failure (HF) remains an important cause of morbidity and mortality worldwide.
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![]() Either way, we’re waiting to see what comes of these recent and seemingly unlikely pregnancy claims.ĩ0 Day Fiance: The Other Way airs Mondays at 9/8c on TLC. The debate is still raging as to whether Laura really is pregnant with Aladin’s baby or if she’s making this all up for attention and to potentially stall a divorce. 'Its actually Aladdine but he prefers just Aladdin,' Laura writes. “If the baby comes out purple, it’s the vibrators but if it comes out half Arabic… You are the father!” Laura wrote in a private message that has been screenshotted and shared. Under this same, apparent pregnancy announcement post (or prank), she responded to a fan’s confusion. That Laura responded again to on Instagram and apparently, Aladin was just kidding when he made the joke about Laura’s purple vibrator. It took quite a while for him to respond at all to the news that he’s going to be a father.īut when someone asked him about Laura’s pregnancy claims in the comments of one of his photos, Aladin responded.Īladin asked, “wish baby you talk about !!! maybe from the purple friend ? Lmfao.”īut speculation over what’s going on inside Laura’s uterus doesn’t end there. Days after 90 Day Fianc: The Other Way stars Aladin and. ![]() There is a story there and I want to know it On Liam: he has lived a hard life with his Mom constantly bringing me in his life. Laura Jallali claims she is pregnant and her marriage with Aladin Jallali is solid. ![]() During the season, the couple dealt with numerous marital issues. Since we all know how much of a liar Laura is, I want Aladin to spill what all happened. Just three days into Laura’s trip to Qatar, Aladin, 29, proposed, and they tied the knot in Tunisia in July 2018. A post shared by ѕнιтѕ мcgee one seemed to be more surprised than Aladin though. Laura lied about a pregnancy as well as Aladin allegedly physically abusing her. Aladin and Laura Jallali had a bitter divorce after they appeared on TLCs '90 Day Fiance: The Other Way.' Since then, Laura has come out with a man she claims is her 'new love,' while Aladin has. ![]() I also have a relly big (23x7cm) surprise for you between my legs. I'm 23 years old and have a very nice feminin body. Would 10000000% recommend.Text is available in the following languages: She also made me laugh while we chatted which I genuinely think is a first for me during a punt lol.Īll in all, I feel like Carla had come to London and shown what a punt is supposed to be like, she has instantly become one of the best ever I’ve ever met. ![]() I ran over the hour by about 15 minutes and she at no point tired to rush me/checked the time. We then cleaned up and laid on the bed for about 20 minutes chatting. I honestly think I rode her for about 30 seconds before I exploded all over her tits and she filled the bag with her cum at the same time. We both noticed I had precum dripping out of my cock so she then said “cum all over my tits while you ride me baby”. She laid down on her back and I lowered myself onto her cock. We fucked in all different positions before she told me she wanted me to ride her. She then flipped me over and put my legs over her shoulders so she could fuck me whilst kissing me and letting me suck on her tits. I could literally feel myself losing control of my body as she hit my gspot so good. She got harder and faster until her body was literally slapping against my ass to the point I thought I was going to cum with no hands. She then used her legs to push my legs apart and fuck me deeper, all whilst kissing the back of my neck and moaning in my ear. She worked her way in deeper and deeper until she could feel I was able to take her fully. I was moaning away and she didn’t tell me to be quiet. She then eased herself in slowly, allowing me to get used to her size. She then pushed my body flat against the bed and teased her cock around my ass, running it up and down my ass hole to make sure the lube was rubbed all over. You could tell she really knew what she was doing. I was bent over on the bed in front of her while she put on a condom, and expertly allowed her lube to drip right into my ass hole. She was playing with my ass while I sucked her and then she got up implying she couldn’t wait any longer to fuck me. She even made gestures/noises as if she was about to cum which was such a turn on. She then laid down on the bed and I continued to suck her cock while she ran her fingers through my hair and told me how good it felt. It was way too big to fit it all in my mouth due to the girth but I gave it my best shot. I started sucking it and she instantly started moaning, her hygiene was impeccable. I dropped to my knees and she pulled out her extremely impressive cock, it looked amazing. My hand then made its way down to her bulge which was growing by the second. She’s extremely sensual/passionate which I love. I turned around and we started heavy DFK, which was such a turn on. I asked if I could take a quick shower and she provided me with a clean towel, whilst making light conversation to put me at ease (once again, her English is really good.) I returned to the bedroom and as I was putting down my things she immediately started kissing the back of my neck while her hands reached around my body. ![]() When I arrived at the apartment Carla greeted me at the door in sexy lingerie and walked me through to the bedroom. For me it was the perfect ratio of length/girth.Īs for the meet, as I said, it was incredible. It’s not the longest I’ve ever seen but very girthy. She has a great body with an absolute weapon of a cock. When she took them off she was still a good few inches taller than me. I was quite surprised at how tall she is! I’m 5’10 and with heels on she towered above me. It’s in a really nice area of London (Belgravia.) She told me she shares the flat with another TS SP, Roberts Cortes, however I didn’t see her during the session.Ĭarla looks exactly the same as her pictures/videos. The apartment was nice, albeit quite small. I didn’t try and negotiate her any lower. Her price is £300 for one hour, so she’s obviously on the pricey side, however considering how popular she is online I actually find that price quite a bargain. She was very patient with me in doing so also. I was a little sceptical that the ad was potentially fake/a scam since she’s quite well-known in the TS world, so I asked if she was able to verify herself which she did immediately. And she absolutely did not disappoint.Ĭomms were great, Carla replies instantly and her English is near enough perfect. I’ve been out of action for the past couple months, but when I saw Carla Brasil was in London I couldn’t pass up the opportunity to see her. Ok, right off the bat, this punt was incredible. This is a review of a transsexual escort, so if that’s not your thing, don’t read! ![]() Severe cases can require hospitalisation. Patients are prone to exacerbations characterised by periods of acute worsening of symptoms such as dyspnoea, cough, airway inflammation, and excess sputum production (hypersecretion). COPD is the fourth largest cause of death. This response is caused by prolonged exposure to noxious particles or gasses, most commonly cigarette smoke, occupational dusts (from stone cutting, mining, metal grinding etc.) or other environmental dusts (e.g., woodworking). Data on user experience of the device were also collected during post-study follow-up.Ĭhronic obstructive pulmonary disease (COPD) is characterised by non-reversible airflow limitation due to an abnormal inflammatory response in the lungs. The aim of the current study was to initially evaluate the safety of the prototype in patients with COPD over a period of 1 month to ensure no adverse events, negative impacts on lung function, exercise tolerance, or quality of life. ![]() The device was previously evaluated successfully in a group of paediatric CF patients. Adherence to cleaning regimens for respiratory devices is often poor and in response to this, a prototype disposable OPEP device-the ‘UL-OPEP’ (University of Limerick-Oscillating Positive Expiratory Pressure device)-was developed to mitigate the risk of contamination by pathogens. Current devices are reusable and require regular cleaning and disinfection to prevent harbouring potentially pathogenic organisms. Handheld oscillating positive expiratory pressure (OPEP) devices have been a mainstay of treatment for patients with hypersecretory conditions such as cystic fibrosis (CF) and chronic obstructive pulmonary disease (COPD) since the 1970s. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Conclusion: The present study concluded that both autogenic drainage and flutter are equally effective in improving PEFR, SpO2 and FEV1 but flutter is more effective in improving FEV1 and easier for the patient to learn and less time consuming than autogenic drainage.Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Result: Both the techniques were effective in improving PEFR, SpO2 and FEV1 but flutter was more effective in improving FEV1. Treatment was given once daily for 5 days. Method: Forty-four patients having moderate to severe COPD participated of which 22 were given autogenic drainage and 22 were given flutter and its effect was seen on PEFR, SpO2 and FEV1. ![]() Aim: To compare the effect of Autogenic Drainage and Flutter device on PEFR, SpO2 and FEV1 in moderate to severe COPD patients. Flutter and autogenic drainage can be self administered by the patients and are easy to learn. ![]() Bronchial hygiene techniques like Postural drainage, ACBT, manual hyperinflation, flutter, acapella and autogenic drainage are used to remove secretions. Hypersecretion in COPD leads to obstruction in airways. Chronic obstructive pulmonary disease is a common, preventable, treatable disease that is characterized by persistent respiratory symptoms and airflow limitations that is due to airways and/or alveolar abnormalities usually caused by significant exposure to noxious particles /gases. Stream It Or Skip It: 'Rose Red' on Hulu, the 2002 Stephen King Miniseries That's the Sleeper Hit of 2023's Spooky Season Stream It Or Skip It: ‘Chucky: Season 3’ on Syfy and Peacock, in Which the Nasty Murderdoll Infiltrates the White House Stream It Or Skip It: ‘Appendage’ on Hulu, Where New-School Psychology Meets Old-School Body Horror Where To Watch All Of The 'Madagascar' Movies The Disney Legacy Animated Film Collection Is Now Available to Preorder ![]() Stream It Or Skip It: ‘Monster High 2’ on Paramount+, in Which the Live-Action Musical Franchise Reboot Gets Political (Sort Of)įormer Disney Star Christy Carlson Romano Reveals She Got Breast Implants As A Teen After 'Cadet Kelly' Gave Her "Big Time" Body Image Issues 'Mixtape' Is One Of The Best Hip Hop Documentaries Of All Time Olivia Rodrigo's Sony LinkBuds Collab is Now Available to Preorder ‘The Elephant 6 Recording Co.’ Unravels The Mystery Behind Famed Indie Rock Collective Stream It Or Skip It: ‘The Ringleader: The Case of the Bling Ring’ on Max, Another Documentary Digging Digging Through The Infamous Celeb-Burglary Caseĭemi Lovato's 'A Very Demi Holiday Special' Coming Soon To Roku Ken Jeong Brought To Tears After Guessing Constance Wu Is Behind The Gazelle Mask On 'The Masked Singer': "Even If It's You, I Just Want You To Know I'm Thinking About Wu" Vance's TalentĪ24 Bets Their Midas Touch Can Make Paris Hilton Hot Once Again By Optioning 'Paris: The Memoir'īilly Porter Speaks Out Against The "Unacceptable" American Education System For Refusing To Acknowledge "A Lot Of The Queer Stories Of People Who Were Invisible" Stream It Or Skip It: ‘Heist 88’ on Showtime, a Dullsville Heist Flick That's a Waste of Courtney B. Stream It Or Skip It: ‘Street Flow 2’ on Netflix, an Engaging Dramatic Return to the Saga of Three Brothers' Struggles in a Parisian Project 'Legends Of The Fall' Star Julia Ormond Sues Harvey Weinstein For Sexual Assault - And Disney For Enabling It Stream It Or Skip It: 'Super Pumped: The Battle For Uber' On Netflix, A Scripted Account Of Uber's Early Days Stream It Or Skip It: ‘The Swan,’ ‘The Rat Catcher’ and ‘Poison’ on Netflix, a Trio of Shorts Demonstrating Wes Anderson’s Darker SideĮmma Stone’s 'Poor Things' Sex Scenes Were “A Very Important Part of Her Journey," According To Director Yorgos Lanthimos ![]() Get In, Losers, We're Streaming 'Mean Girls' For Free Stream It Or Skip It: 'Beth Stelling: If You Didn't Want Me Then' On Netflix, A Comedian Comes Home To Revisit Her Childhood Upbringing ![]() This will enable us to create a scheme to maximize your space to suit your budget. If you were to appoint ADB we would suggest a meeting with you and our architect to discuss your budget and requirements.We allow our clients to pay for each stage of the build as it is completed and satisfactory. The most common concerns are having enough money to pay for the build or worry that fees will escalate to be more expensive than the original quote.Īt ADB we give our clients a comprehensive stage payment plan to avoid any unexpected fees. It is natural before a build takes place on your property to have concerns about budgeting. Whether it be a large master suite, several bedrooms or a games room, a loft extension can give vital extra space for a growing family.Ī new extension is a good investment that can add to the value of your property and also provide the additional space required which will enable you to make the most effective use of your home. If you need more space, it’s well worth investing time and money exploring all the possibilities.įor any family, space plays a vital role in how and when you interact together and for those with young children, an open-plan family room or one that can be easily seen from the kitchen is a great way to keep an eye over the kids as they play while parents can cook or work.Īs children get older, in addition to having a room to enjoy time as a family, parents and teenagers alike appreciate their own privacy-children want a space to relax, play music or hang out with friends, while parents want a quiet space to watch TV or a room for entertaining.įor those who cannot extend out but are able to extend up into the loft space can create a whole new floor to a property. Changing the layout of your house will have a massive impact on your family and how you spend time together. ![]() Extending your family home rather than moving can prove to be a much more economic and satisfactory solution that suits your family’s present and future needs. ![]() Overall, Zen gardens are an ancient Japanese art form that is still very popular today. ![]() The Zen gardens are often changed and updated over time, with new elements added, and old elements removed. Zen gardens are also an art form, and many Zen gardens are created by master gardeners who have dedicated years to perfecting the craft of creating these beautiful, peaceful gardens. Many Zen gardens also include small, simple structures such as a pagoda or a teahouse, which can be used as a focal point for meditation. The simplicity of the design helps to clear the mind and allows the viewer to focus on the present moment. Zen gardens are also designed to be simple, in order to encourage a sense of calm and peacefulness. The rocks and gravel represent mountains, the sand represents water, and the moss represents trees and forests. The Zen garden is a miniature of nature, with the elements of the garden representing the natural elements of the landscape. Zen gardens are also called karesansui, which means “dry mountain and water.” The elements of the garden are arranged in such a way as to create the illusion of a mountain landscape and a body of water. They are often created using a limited number of elements such as rocks, gravel, sand, and moss. The gardens are typically small and are intended to be viewed while seated. They are often created to be an aid in meditation or as an aid to focus the mind. Zen gardens are traditionally intended to be viewed from a single perspective, such as a porch or veranda. ![]() Zen gardens are commonly found at Buddhist temples and monasteries, but can also be found in private homes and gardens. The design of a Zen garden is intended to be simple, yet evocative, and is often used as a tool for meditation and contemplation. If you want to know about the interior room wise or standard detail or staircase detail, please click the link.Ī Zen garden, also known as a Japanese rock garden or karesansui, is a type of dry landscape garden that is typically composed of gravel or sand, rocks, and carefully placed moss, trees, and other plants. ![]() ![]() ![]() Microorganisms (Anaerobic bacteria, Viruses, Microbes, Cysts, etc.Disinfectants & Disinfectant Byproducts.Filter Media: 0.2-micron Ceramic filter, Activated Carbon, Zeolites, Silica Sand, and Ion Exchange. 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Enjoy Whole Process of Hatching – It can meet the research needs of data records.Digital Temperature Control – This egg incubator allows for temperature settings and easy operation which can show important information about temperature, humidity, hatching day and egg turning time.Automatic Egg Turning – Every 2 hours, built-in fan to circulate the air for even temperature and humidity,easy use and clean.“48 egg incubator temperature and humidity” “jaedo automatic egg incubator instruction manual” You see this or that article showing up at the top of search results page and you think that it’s the right thing you needed. Same is the case with Google when you search for anything related to digital marketing or do online business. When you want to buy a product from Amazon, it’s just a click away. Don’t make this mistake – read this article before buying! This can lead to you getting a poorly designed egg incubator. In fact, there might be various features in an incubator that you don’t fully understand how it works in certain conditions. Looking for egg incubator manual pdf? Picking a “good” or “reliable” egg incubator is not as simple as people think. The author talked about hatching chickens but never even mentioned eggs or incubators! But, reading through this manual that came with my machine showed me it wasn’t because they were poorly written. So, I figured for such a low price these manuals must be written poorly, and that’s why people charge so little for them. They don’t teach you anything about what’s actually happening in the incubator and why it looks the way it does inside. It’s only 24 pages, black and white with not much more than diagrams and some other stuff like hydration calculator, how to count days from when your last egg was laid until the eggs hatch and how many incubation hours you’ll need per day based on your locale. They charge around $100 for a 48 Egg Incubator Manual, although I paid more for mine at one of those places that sells everything. I was amazed at some of the online sellers and their prices. ![]() In this way, all the letters in the square have a coordinate between ‘11’ (A) and ‘55’ (Z). The letter ‘A’, for example, can be found in the first row on the first column, which gives the coordinate 1-1, written as ‘11’. In a basic square these are the numbers one to five for both rows and columns every letter in the square thus gets a coordinate. Polybius square: a 5×5 square in which a modern 26-letter alphabet is arranged (author’s illustration based on Salomon 2003)Īll rows and columns in the square have a number. ![]() Since only sender and receiver knew how Aeneas’ and Polybius’ method worked, it was perfect for transmitting secret messages, especially when the enemy was nearby. What is more, when using Polybius’ system any possible alphabetic message could be sent between communicating parties, instead of only a series of pre-arranged messages. Although Polybius’ method was still extremely laborious, it was clearly a significant improvement over Aeneas Tacticus’ system, since Polybius did not require a pair of water clocks to run in parallel. One could then send messages letter by letter, whereby each fire signal represented one letter. Like Aeneas Tacticus, Polybius still used torches, but replaced the water clocks with tablets on which the letters of the Greek alphabet were written. See for a parallel from Roman times Julius Africanus, Kestoi, 77. Then he would have raised the second set of torches on the right to indicate what letter on the tablet the receiver should write down. The dispatcher of the message would raise the first set of torches on the left side indicating which tablet was to be consulted (from 1 to 5). If all worked well, the receiving party could then read off the intended message.įive tablets with the letters of the Ancient Greek alphabet used for fire-signalling, as discussed by Polybius (Histories 10.45.6–12) (author’s illustration based on Savard 1998–9). When the intended message on the rod had descended to reach the top of the vessel, the sending party would wave a torch again to let the receiving party know that they had to put the cork back into the vessel and check the intended message. Then both groups would pull out corks from the vessels to let the water run out, which would cause the rods gradually to sink. When the two distant parties wanted to send a message to each other, one would first wave torches to attract the other’s attention. In each section they would write the most evident and ordinary events that occurred in war (e.g., “ Enemy approaching with ships from the west”). Then they would take a rod graduated into sections. Communicating parties would fill large vessels of the same size with water. This passage, and others from Polybius cited in this article, can be read in English and Greek here. Aeneas Tacticus’ system is discussed in a now lost work on military preparations, but its basic design has been handed down to us via Polybius at Histories 10.44. The 4 th-century BC Greek general and military author Aeneas Tacticus (“the Tactician”) accordingly invented a more useful system for sending more than one message by using water clocks and torches. As it was only possible to send one prearranged message using this archaic system of fire-signalling, communicating parties needing to communicate on urgent matters faced significant limitations. To take just one famous example, Aeschylus – in his Agamemnon – described how Clytemnestra received word from Agamemnon that he was returning from Troy by means of beacons – signals that were speedily and efficiently sent from one hilltop station to the next. There are numerous extant references to this strategy for long-distance communication from the ancient world, in works not only of history but of literature too. ![]() To be used in addition to the search bar which allows you to find tools by keywords.Very early on in Greek history, extant sources reveal that mountain tops were clearly used both as watchtowers and as signalling stations from which secret and non-secret messages could be sent over long distances by lighting strategic fires. List of all dCode's tools, avaiable online, sorted by categories (click to expand). |
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