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Pee-wee shows his new Apple iPad to the Playhouse Gang!
- January 28, 2010
- 3.5m Views
Pee-wee HermanUploader
Eric AppelDirector
Dustin BowserCamera Operator
BoTown SoundSound
Written by Eric Appel, John Koch, Paul Reubens, Josh Meyers & Natalie Lent
Directed by: Eric Appel
Produced by: Chris Bruss and Mike Farah
DP: Christian Sprenger
Camera: Dustin Bowser
Sound: Bo Sundberg
Props: Katie Byron
Prod Coordinator: Sean Boyle
Lori Alan - voice of Chairry and Magic Screen
Josh Meyers - voice of Clocky and Conky
Lance Roberts - voice of Globey
Artie Esposito - Chairry
Haley Jenkins - Magic Screen
Patrick Johnson - Globey
Sean Johnson - Clocky
Victoria Johnson - Magic Screen
Russ Walko - Conky
Special thanks: Kelly Bush, John Koch, Natalie Lent, Kristina Sorensen, Joe Witt
January 28, 2010
the set of Pee Wee's Playhouse. He is carrying an iPad. He sits down in a
talking chair, voice by Lori Alan.
Lori Alan: What's that thing you have, Pee Wee?
Paul Reubens: Ha, ha, oh my abstinence ring. Ha, ha.
Lori Alan: No, in your other hand.
Paul Reubens: Oh, this things. Ha, ha. It's my new iPad.
A puppet robot, voiced by Josh Meyers, begins moving around.
Josh Meyers: What's an iPad?
A glittery screen, voiced by Lori Alan, pipes up.
Lori Alan: The iPad is Apples latest revolutionary device. The consensus
on the internet is that it's name closely resembles a popular brand of
sanitary napkins.
Josh Meyers (robot): What's a sanitary napkin?
Paul Reubens: Duh, Conky, it's a napkin that's super clean.
A puppet clock on the wall, voiced by Josh Meyers, pipes up.
Josh Meyers (clock): I thought it was a tampon.
A puppet globe, voiced by Lance Roberts, chimes in.
Lance Roberts (globe): Tampa is over here.
The globe moves.
Josh Meyers (robot): It looks like a giant iPhone to me.
Paul Reubens: But, Conky, it's so much more. I can use the iPad to read
books. Ha, ha.
Josh Meyer (clock): But Magic Screen can read books out loud for free.
Lori Alan (screen): I am Sam. Sam I am. I will not eat green eggs and
Paul Reubens: Alright. I get it Magic Screen, but this little baby has
got Google Maps and music.
Lori Alan (screen): But the iPad doesn't allow you to run two programs
at once.
Lance Roberts (globe): But I can play you music and show you maps at the
same time. Aruba, that's over here (globe turns), Jamaica, that's over
here (globe turns), ooh, I want to take ya. Bermuda, that's over here
(globe turns), Bahama...
Paul Reubens: Globey, you're ruining this whole experience for me. Right
now, there's only fifty of these babies in the United States and Steve
Jobs just gave me this one, personally.
John Meyers (robot): How did you get him to give you one, Pee Wee?
Paul Reubens: That's none of your business, ha, ha. I don't have time to
discuss it right now, Conky. Everyone in Puppetland is due over here
any minute to see me use this.
The shot crossfades to show Paul Reubens holding glasses on the iPad.
Paul Reubens offers the puppets a drink.
Paul Reubens: Milk. Milk. Lemonade.
Lori Alan (chair): Nice tray, Pee Wee.
Paul Reubens: Oh thanks, Chairry. Steve Jobs gave it to me. Ha, ha. I'll
be right there everyone.
Paul Reubens walks out of the shot, carrying the drinks on the iPad. The
shot crossfades to just the talking globe.
Lance Roberts: We'll get there fast and then we'll take it slow. That's
where we wanna go. Way down to Kokomo. That's over here. (globe turns)
The shot cuts to black.
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Within the Napa Valley lie many smaller sub-AVAs that lend even more character specifics to the wines. Furthest south is Carneros, followed by Yountville, Oakville & Rutherford. Above those two are St.-Helena and the valley's newest AVA, Calistoga. These areas are situated on the valley floor and are known for creating rich, smooth Cabernet Sauvignon, Merlot and Chardonnay. There are a few mountain regions as well, nestled on the slopes overlooking the valley AVAs. Those include Howell Mountain, Stags Leap District, and Mt. Veeder. Wines from the mountain regions are often more structured and firm, benefiting from more time in the bottle to evolve and soften.
A crisp, refreshing variety that equally reflects both terroir and varietal character, Sauvignon Blanc is responsible for a vast array of wine styles. A couple of commonalities always exist, however—namely, zesty acidity and intense aromatics. The variety is of French provenance, and is important in Bordeaux and the Loire Valley. It also shines in New Zealand and California, while Chile and South Africa are excellent sources of high-quality, value-priced Sauvignon Blanc. High-quality Sauvignon Blanc is also produced in Washington State, Australia, and parts of northern Italy.
In the Glass
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Perfect Pairings
The freshness of Sauvignon Blanc's flavor—from bell pepper and cut grass to passionfruit, gooseberry, and ripe kiwi lend it to a range of light, summery dishes including salad, seafood, and mild Asian dishes. Sauvignon Blanc settles in comfortably at the table with notoriously difficult foods like goat cheese and asparagus. When combined with Sémillon (and perhaps some oak), it can be paired with more complex seafood and chicken dishes.
Sommelier Secret
Along with Cabernet Franc, Sauvignon Blanc is the proud parent of Cabernet Sauvignon. That green bell pepper aroma that all three varieties share is no coincidence—it comes from a high concentration of pyrazines (an herbaceous aromatic compound) inherent to each member of the family.

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Meet the Faculty
The program has well-known and outstanding faculty members who have served and are serving in numerous leadership positions at the local, state, regional and national levels. Three faculty members have served as presidents of the local (MHIMA) and the state professional organization (THIMA). Faculty members have contributed to the knowledge of the field, with chapters in textbooks, editing textbooks, articles in professional journals, editorship of the state Legal Handbook, and are often invited to speak at national and regional conferences.
Beth Bowman
Beth Bowman, MPA, RHIA, FAHIMA, professor emeritus, has been on the faculty since 1974 and retired June 2014. She is on post-retirement contract for the next several years. She is a fellow of the American Health Information Management Association (AHIMA) as well as past Chair of the AHIMA Assembly on Education. Bowman participated on a national curriculum group to develop model curricula for HIA and HIT programs. She is past chair of the American Health Information Management Association (AHIMA) Professional Development Committee and is a past-chair and commissioner of CAHIIM, the Commission on Accreditation of Health Informatics and Information Management Education, which accredits HIM programs. Bowman also has served as President of the UT Health Science Center Faculty Senate as well as the Tennessee Health Information Management Association. Bowman is a recipient of the Tennessee Health Information Management Association's Distinguished Member Award. Bowman has received the UTHSC Chancellor's Distinguished Educator Award, the UT National Alumni Association Outstanding Teacher Award, the THIMA Educator/Mentor Award and the AHIMA Educators Award. She is an AHIMA certified ICD-10 Trainer. She received the UT Public Service Award in 2014.
Dr. Sajeesh Kumar
Sajeesh Kumar KR, PhD., Associate Professor, joined the faculty in 2012 and brings a great research focus to the department. Dr. Kumar's research focuses on design and development of telemedicine technology, healthcare delivery and health informatics technology evaluation. Dr. Kumar has traveled to more than 25 countries and has extensive international experience in healthcare, education and research works. Prior to coming to UTHSC in Memphis, Dr. Kumar was involved in healthcare activities in Pittsburgh-USA, Australia, Singapore, Netherlands, Seychelles, United Arab Emirates and India. He has won several research awards, edited several books on telemedicine, book chapters and scientific papers in high impact journals. Dr. Kumar holds an impressive record of competitive research funding and research awards. He currently serves as a reviewer for Perspectives in Health Information Management.
Charisse Madlock-Brown, PhD, MLS
Charisse Madlock-Brown, PhD, MLS, assistant professor, joined the faculty in 2015. She recently graduated with a PhD in health informatics at the University of Iowa, and has a background in library and information science. Her research area is scientometrics with a focus on bio-medicine. Her research goals are to ground research policy and planning into a concrete framework for evaluation and assessment. Her dissertation project offers a framework for emerging topic detection in medical literature. Policy makers, funding agencies, and researchers could all benefit from a robust emerging topic detection application.
Other recent/current projects include large scale analysis of biomedical literature for purposes of article retraction trend analysis, assessing the impact of publication subject diversity on research performance for individuals, understanding the relationship between gender disparities and collaborative behavior, and assessing the impact of translational science initiatives on collaborative research patterns.
Dr. Marcia Sharp
Marcia Sharp, EdD, MBA, RHIA is an associate professor in the Department of Health Informatics and Information Management. She holds a doctoral degree in Higher and Adult Education, master's degree in Business Administration and is a graduate of the University of Tennessee Health Information Management program. She also serves as the program director for the post-graduate program in Health Informatics and Information Management.
Dr. Sharp has taught HIM students in finance and budgeting, personnel administration, statistics, and leadership. She has had a remarkable career in Health Information Management and Human Resource Management where she held various leadership positions. She is an active member of MHIMA, THIMA, and AHIMA serving on several committees and groups. Previously, Dr. Sharp has been a Tennessee delegate to the AHIMA House of Delegates, member of the THIMA Program Committee, past member of the THIMA Nominating Committee, treasurer of the MHIMA, and member of AHIMA Council for Excellence in Education. Currently, she serves as co-chair of AHIMA's Health Information Management Reimagined taskforce, and reviewer for Perspectives in Health Information Management. Her research interests include faculty development, critical thinking, and online education.
Mary (Mamel) McCain, MPA, RHIA
Professor Emeritus
Mamel served as department chair from 1973 until her retirement in 2008. She is the recipient of three national awards. The first was the 2009 AHIMA Champion Award which recognizes her years of service to the UT HIIM department and the profession. She won the AHIMA Educator-Practitioner Collaboration Award in 1994. MHIMA has recognized her contribution through the Mamel McCain Leadership Academy which was established in her honor to bring outstanding management speakers to MHIMA and the UT educational program. She received the AHIMA Legacy Award in 2010 as co-editor of the AHIMA publication, Fundamentals of Law for Health Informatics and Information Management, which was the first law book in the HIM field edited by HIM professionals for this accomplishment. She was also co-editor of the state THIMA Legal Handbook for ten years.
Dr. Rebecca Reynolds
Rebecca Reynolds, EdD RHIA, FAHIMA, Professor and Chair, is a past president of the Tennessee Health Information Management Association and has served on workgroups for the American Health Information Management Association (AHIMA) as well as on the AHIMA Nominating Committee. She has served on the American Health Information Management Association (AHIMA) Council on Excellence in Education. She joined the faculty in 2002 and is also privacy coordinator for the campus. She serves as editor for the THIMA Legal Handbook and also as a co-editor of the AHIMA publication Fundamentals of Law for Health Informatics and Information Management. Reynolds is a recipient of the Tennessee Health Information Management Association's Distinguished Member Award. Reynolds is well known for expertise in legal and documentation issues through teaching numerous HIPAA, legal, and documentation workshops. She is the editor for the journal EducationalPerspectives in Health Information Management.
Terri Fought, BBA
Academic Coordinator
Terri Fought is the Academic Support Coordinator I for the department. Terri is a graduate of the University of Memphis, where she obtained her Bachelor's of Science degree in Business Administration with a concentration in Production and Operations Management in 2001. She advises potential applicants to the program and works with students for advising and other services. She has been in this role since 2016, prior to that Terri worked in Student Academic Support Services and Inclusion as an Administrative Assistant. In 2014 she moved to the Office of Student Affairs and Enrollment Services where she was the Administrative Assistant to the Associate Vice Chancellor, department budget specialist, and coordinator for Commencement.
Adjunct Faculty
The program employs several adjunct faculty members who are subject-matter experts. These professionals maintain full-time employment in the healthcare industry and have been long-time instructors in the program. The expertise that they each bring to the classroom is invaluable to the students.
Stacy Dorris, MBA, RHIA, CPHQ
Stacy Dorris has been an adjunct member of the UTHSC HIIM faculty since 2009. She has a Bachelor of Arts in Psychology from Ole Miss, a Bachelor of Science in Health Information Management (HIM) from UTHSC, and an Executive Masters of Business Administration (MBA) from the University of Memphis. She has been employed by Qsource, the Medicare Quality Improvement Organization (QIO) for TN since 1999. Her current job responsibilities primarily surround assisting TN hospitals with collection, submission, and QI efforts related to the JC/CMS core measures for inpatients and outpatients. She also serves as a Malcolm Baldrige Examiner for the Tennessee Center for Performance Excellence (TNCPE) and an ISO Internal Auditor for Qsource. She is a past-president of the Tennessee Health Information Management Association and a delegate to the American Health Information Management Association. She teaches the quality courses MHIM 523 and MHIM 601.
Seth Johnson, MBA, RHIA
Seth Johnson is a an adjunct faculty member of the UTHSC faculty. He has Bachelor of Science in Health Information Management (HIM) from UTHSC, and a Masters of Business Administration (MBA) from Milligan College. Seth started his career in the Emergency Department over 10 years ago. Since then, he has managed Operations of a multi-facility HIM Department, and served as Privacy Officer and Assistant Director of the HIM department of a level 1 trauma center. Seth moved into information technology to serve as Director of IT Project Management. While in this role, he managed a multi-million dollar McKesson Horizon implementation and successfully attested for Stage 1 Meaningful Use for 7 hospitals. He then served a dual role as Director of Information Technology leading the Project Management Office and the IS Operations Department for Wellmont Health Systems in Kingsport, Tennessee. Today Seth is an Executive Consultant for Lexmark International providing HIT direction for healthcare providers across North America for the Lexmark Healthcare division.
Seth is a past-president of the Tennessee Health Information Management Association and a delegate to the American Health Information Management Association. He also served as President of the Upper East HIMA of THIMA. He teaches the MHIM 541 Information Technology course.
Richard Warren, MHA, MT (ASCP)SH, DLM
Richard Warren has been an adjunct member of the UTHSC HIIM faculty since 2007. He has a Bachelor of Science in Medical Technology from Mississippi State University, a Master of Health Administration from the University of Memphis. In addition, Richard is licensed in the state of Tennessee as a Medical Laboratory Supervisor and holds certifications from the American Society of Clinical Pathology as a Medical Technologist, Specialist in Hematology, and as a Diplomat in Laboratory Management. Richard has 26 years of total medical laboratory experience including 18 years of management experience. He has been employed by St. Jude Children's Research Hospital as Administrative Director, Pathology since 2001. He is responsible for operations, regulatory compliance, quality management and managing the fiscal and human resource needs of the Pathology Department which has 215 FTEs and an operating budget of $36,000,000.
For the best first-hand knowledge about the field, one should contact local health information professionals and visit their departments. For the name of a contact person in your area, or if you would like a visit and campus tour, please contact the Chair:
Department of Health Informatics and Information Management
The University of Tennessee Health Science Center
920 Madison Avenue
Suite 518
Memphis, Tennessee 38163
Hear From Recent Graduates
Hear From Recent
Master's Graduates
Contact Us
Health Informatics and Information Management
920 Madison Avenue
Suite 518
Memphis, TN 38163
Phone: (901) 448-6486
E-mail: email@example.com


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COLUMBUS, Ohio -- First, Memphis lost a home game. Then the players lost a piece of their identities.
Frustrated with the way his team played in a loss to UTEP last month, coach Josh Pastner took the players' names off the backs of their jerseys, in addition to depriving them of any practice garb that said Memphis on it.
And that wasn't all.
"I locked them out of the locker room," Pastner said. "I stopped feeding them hot meals - gave them a ham and turkey on white bread and bag of chips."
It was just one game. But it was also a teaching moment.
"I wanted them to understand it was a privilege and honor (to wear a Memphis jersey) and even one bad game is not acceptable," Pastner said.
Whether it was that jolt of inspiration or just the ebb and flow of a typical season, the Tigers responded by finishing off a 26-8 season by winning the Conference USA regular-season and tournament titles.
Now they have the No. 8 seed heading into a showdown with ninth-seeded Saint Louis (25-7) on Friday in the second round of the West Regional at Nationwide Arena.
"Coach did that to remind us that we should be playing for the name on the front of our jersey, instead of the names on the back," leading scorer Will Barton said. "He just wanted us to play for each other."
Almost everyone thinks the experiment was a success. The Tigers have won seven in a row - by an average of 24 points - since that tide-turning defeat.
Heading into an NCAA tournament, Pastner summoned up the names of several great Tigers players and coaches - Gene Bartow, Dana Kirk and Larry Finch - to underscore that even after others have moved on the program continues.
"For anyone to forget that, they just needed to be re-energized to understand," Pastner said. "Even if it was one game, I didn't want anything to tailspin from that."
The Tigers are bigger, faster and more athletic than Saint Louis. But the Billikens have sage old-timer Rick Majerus blustering on the sidelines.
Majerus, who took Utah to the national championship game in 1998 among his 11 trips to the NCAA tournament, will put a disciplined, smart, defensive-oriented team on the court.
He has no allusions about his players intimidating Memphis.
"There's no pros on this team," he said simply.
The Billikens will counter all the future pros on the Tigers roster by doing what they do. They have no problem with putting the brakes on Memphis' up-tempo attack.
"They get most of their points in transition. They like to defend you and turn you over and get up and down the floor. We're going to send a few more back than normal to kind of stop that, try to make it a halfcourt game," said guard Kyle Cassity, who sports a full, mountain-man beard. "That's kind of where we're at our best."
The best player for the Billikens is 6-foot-6 forward Brian Conklin, an unassuming kid who averages 13.9 points a game. He will likely be matched up against Memphis' bruising Tarik Black, a 6-8, 243-pound enforcer in the paint.
"They have a good player in Conklin," Barton said. "He's real good. But Tarik is much taller and much stronger. I feel like we have a real big advantage down low with him."
Conklin, making his first trip to the NCAAs, isn't awed by the sights and sounds. Well, except for one.
"I thought the police escort was kinda cool," he said. Then he added, "It's funny, you need a police escort for two blocks?"
Saint Louis, making its seventh NCAA appearance, is 4-1 on neutral courts including winning an early-season tournament in Los Angeles in which it beat Boston College, Villanova and Oklahoma to win the title.
The Billikens swear they won't be afraid of the big stage or the Tigers.
"We've played in front of big crowds before," Conklin said. "There's just all this extra media attention going on. Your name's mentioned on ESPN five more times than it normally is during the season. It's not a big deal. We come out. We know we have Memphis. And it doesn't matter what the name on the jersey is."
Given the Tigers' recent no-name look, that's a good thing.


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Many tactical shooters shared with the company that they wanted the windage adjustment moved to the left side, and that's exactly where you'll find it on the CMR4. It allows the right-handed shooter to make windage adjustment without taking the scope off of the target…or finger off the trigger…and provides the clearance needed for some bolt-action rifle models. Both the windage and elevation turrets feature the "ZRO-LOK" System, which does exactly that – it locks windage and elevation alignment in place, while still allowing minor adjustments to be made in the field, then being able to return to exact zero. Tactical shooters across the country are now recognizing this system as the best available today. Each click of either turret gives 0.1 Mil adjustment, with 8 Mils per full turn of the turret. The CMR4 also comes with protective screw on aluminum turret caps.
The all new and advanced illuminated reticle provides more information to the shooter for quickly assessing the range of an intended target, and to allow for the trajectory of 5.56mm (.223 Remington) or 7.62mm NATO (.308 Winchester) rifles out to 600 meters. In addition to the vertical BDC aiming points, the reticle also includes Mil scales on both the vertical and horizontal lines. Illumination comes in choice of red or green, plus the refined rheostat allows easy adjustment of the lighted reticle intensity, and now includes three night vision settings.
The compact 1-4x CMR4 is destined to become the topic of conversation among tactical shooters – and one tough competitor on the firing line. Many competition shooters and recognized experts in the field of tactical shooting have contributed to the design of this scope – inside and out.
This model is built with other Hi-Lux Optics features that have built the company's reputation for ruggedness and unbeatable value, including Tri-Center spring tension for positive windage and elevation adjustments and Perma-Coat soft luster blue-black finish for long lasting good looks. The CMR4 comes with a Limited Lifetime Warranty. Suggested retail price is $525. For more information on this new model, drop Hi-Lux Optics an e-mail at email@example.com, or call 310 257-8142. If you are attending the SHOT Show January 15-18, be sure to stop by the Hi-Lux Optics booth (No. 1017) and take a look at this great riflescope.


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TRENTON – A former New Jersey investment adviser has been indicted by a state grand jury for allegedly stealing a total of more than $100,000 from two clients, money that was supposed to be used to purchase annuities, Attorney General Jeffrey S. Chiesa announced.
Janet Fooshee (aka Janet Katz, aka Janet Gurley), 60, currently of Maine, but who formerly lived in Morris County, was charged on Friday, Dec. 14, with theft by deception, theft by unlawful taking, and three counts of impersonation (all in the second degree) as well as theft by deception, theft by unlawful taking, and four counts of impersonation/theft of identity (all in the third degree). Fooshee was also charged with seven counts of fourth-degree forgery and eleven counts of fourth-degree falsifying or tampering with records.
"This alleged crime deceived investors who trusted that the defendant was safely investing their money as she had represented," Acting Insurance Fraud Prosecutor Ronald Chillemi said. "Such deceit will be vigorously prosecuted by my office."
At the time of the alleged crime, Fooshee was an investment adviser representative of First Union Securities, which later became Wachovia Securities, Inc. The indictment alleges that between 2000 and December 2011, Fooshee stole a total of $107,493 from two clients. It is alleged that, in one instance, Fooshee stole $97,493 by falsely claiming to have purchased an annuity from AIG Life Insurance on a client's behalf. In another instance, Fooshee allegedly stole $10,000 by giving the false impression that she purchased the same type of annuity from Fidelity Investments on another client's behalf.
In an attempt to conceal and perpetuate the fraud, between 2005 and 2010 Fooshee allegedly sent numerous fabricated account statements on the letterhead of international financial institutions, including AIG, Alliance Bernstein, and Fidelity Investments. Each of these statements purported to show the annuities, which were not in fact purchased, appreciating in value.
An investigation determined that in each instance, when the clients attempted to cash out or transfer the annuities, they were unable to do so because the annuities had not actually been purchased.
The indictment is merely an accusation and the defendant is presumed innocent until proven guilty. Second-degree crimes carry a maximum sentence of 10 years in state prison and a criminal fine of up to $150,000, while third-degree crimes carry a maximum sentence of five years in state prison and a criminal fine of up to $15,000. Fourth-degree crimes carry a maximum sentence of 18 months in state prison and a criminal fine of up to $10,000.
Deputy Attorney General T.J. Harker and Detective Doug Mattei coordinated the investigation. Chillemi thanked Investigator Kristen Mercer of the North Carolina Department of Insurance for her assistance in the investigation.
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You have a Crampbuster, right? Try resting your fingers on the levers instead of gripping the handlebar. Just make sure the handlebar is cupped between your fingers and thumb. For the throttle, use the heel of your hand on the Crampbuster to maintain the throttle input. Practice this on a non-windy day and you'll eventually figure out that you don't actually have to grip the bars to initiate turns. All you need to do is straighten your arm a little to push on the bars.
I have one on the FZ6 but haven't gotten one on the BMW yet. I'll try as you suggest!


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Braided hairstyles
Mar 7, 2011 at 3:20 p.m. ET
Willow Smith rocked this fun, braided hairstyle when she attended the Never Say Never premiere in downtown LA with her family. She wore a high ponytail that was a combination of braids and curls. She accessorized the hairdo with jewelry for a super sassy look.


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Buck Rogers faced the same problem that vexed Gilligan, the Professor, and the Skipper. Except instead of "Mary Ann or Ginger?" it was "Wilma or Ardala?" You have to admit, that's a pretty tough choice. Especially since both women are tough, calculating, skilled, and in powerful positions. We all know Buck preferred Colonel Wilma Deering (who outranked him), but there were plenty of scenes where he looked ready to "biddi biddi biddi" with Princess Ardala. Which do you think he should have dated? Examine the evidence and sound off in today's thawed-out triviagasm.
- Wilma Deering first appeared in the August 1928 "Armageddon 2419 A.D." story that ran in Amazing Stories magazine, and she is depicted as heroic and beautiful. In the story, she encounters Anthony Rogers (not yet "Buck" Rogers) in the during a war in the far future. Anthony joins her team of fighters, and at end of the story, they get married. *sniffle*
- in the late 20s to the mid 60s, Wilma also appeared in the Buck Rogers comic strip, although she was much more of a stock female character instead of the spunky adventurer from the pulps.
- In the Buck Rogers serial that ran in 1939, Lieutenant Wilma Deering encountered a thawed-out Buck Rogers and Buddy Wade, and together they fought the oppressive regime of Killer Kane.
- In the 1979 television show Buck Rogers in the 25th Century, Wilma was played by Erin Gray, and had made it all the way to Colonel. However, she was now a near-emotionless soldier with little interest in Buck. Although as time went by she opened up and tossed her shiny hair more, while continuing to dazzle as a pilot and a fighter.
- In the Buck Rogers XXV Roleplaying Game, Wilma is described as a strawberry blonde with a fiery temper, and as an "8th level Terran warrior and a freedom fighter." But, she still serves as a love interest for Buck.
- Princess Ardala was one of Buck's enemies in the comic strip, along with her sidekick Kane. However, she didn't appear in the 1939 serial at all.
- Ardala became the vampiest scifi television show vixen on the airwaves when she appeared in the first season of Buck Rogers in the 25th Century, although they didn't bring her back for season two.
- She was portrayed by actress Pamela Hensley, and she frequently wore very little clothing. In most of her episodes, she puts Carrie Fisher's Slave Girl Leia bikini to shame. Fairly racy stuff on television for 1979.
- Buck finds himself in the episode "Awakening" from the 1979 television series, and is first discovered by a Draconian fighter. He's brought aboard the flagship Draconia, where he meets the Draconian emperor Draco extremely briefly, and is then left with the Draconian Princess, Ardala. These people really need to buy a book of baby names or something.
- Surprisingly, Ardala only made four actual appearances on the show, but it's impossible to think of it without remembering her slinky cattiness.
- In one episode of the show, Ardala holds her own "shotgun wedding" where she points a massive orbital weapon at New Chicago, and threatens to blow it off the map if Buck doesn't consent to being her consort. He thwarts her, and she lets him go... looks like she's a fan of captive men.
So, who do you think Buck should choose?


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Law Practice Magazine
Marketing Technology Trends
Ways To Boost Your Business Development In 2008
It's back! The annual look at the trends that will shape practice management and marketing in coming months and years.
As we flip the calendar to the new year, Bob Denney annually shares with us his firm's report on what's sizzling and what's fizzling in the legal services market. From white-collar crime in the States to the white-circle firms of Britain, here is what to watch today, tomorrow and beyond. — The Editors
This is our 19th annual report on what's going on in the legal profession in the United States as well as in other parts of the world. As always, it is based on information we compile throughout the year from many sources. Some of the findings are obvious. Others are not. Nevertheless, this is the picture at the beginning of 2008. — Bob Denney
NOTE: Discussions of additional developments, as well as more detail on some of the issues reported here, are posted in the Writings and Legal Communiques sections at Robert Denney's website.
To receive copies of the "What's Hot and What's Not" report, including periodic updates, contact Robert Denney Associates.
110 W. Lancaster Ave., Wayne, PA 19087
phone: (610) 964-1938
fax: (610) 964-7956
web: www.robertdenney.com
Robert W. Denney is President of Robert Denney Associates, Inc., a management, marketing and strategy consultancy.


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Jul 8, 2011
Recently, I was offered the chance to try out a new product from the folks at ThinkGeek.com. It's a small attachment for your Android or iOS device called the JOYSTICK-IT, a solid aluminum arcade stick that you can easily attach and remove by suction cup without causing any harm to your screen. It's designed to give you more tactile control over your touch-screen based games.
The way it works is through the spongy, wire mesh at the bottom of the stick, completing the circuit between the capacitive touch-screen and your finger tips. By rocking the stick in any direction, the mesh touches those points of the screen and works just as well as if you weren't using the stick at all. It's a simple concept that works pretty darn well with any game that offers a directional pad/analog stick control scheme. Where the JOYSTICK-IT really shines, though, is old-school, arcade games — Pac-Man, Frogger, etc. For reviewing purposes, I used the JOYSTICK-IT with a couple of my old favorites: Meganoid, Grow and a few classic console emulators.
Even though Meganoid only offers left and right controls on the directional pad, the JOYSTICK-IT easily fits between them. Grow is a little tougher, however. It was actually a little harder to dial in the precision controls required to outmaneuver some of the faster fish. In this case, I actually preferred using the touch-screen as is, completely negating the desired effect of the JOYSTICK-IT. As for the emulators I tried, it certainly gave me back the level of control I've been missing, although it's hard to say it was an improvement over more traditional, hardware based directional pads and buttons.
The main downfall of the JOYSTICK-IT is that, while the tiny suction cup has quite a bit of grip to it, it tends to pop right off if you get too aggressive with it. Because of this, it's hard for me to recommend the JOYSTICK-IT as anything more than a gimmick, a pure novelty. You'll also want to be wary of games with "floating" controls as they tend to center where ever the JOYSTICK-IT first touches the screen. If you can, set the controls to a permanent spot to get the most out of the JOYSTICK-IT.
At $17.99 for the mobile phone version, while the construction feels solid, the price is way too high for what little it offers. You can buy a larger version for tablets at $24.99 (or get a 2 pack for $39.99). I haven't tried the larger version, but I can assume the larger surface area of the suction cup would make for a much better grip. Either way, it just doesn't appear worth the money, to me.
The idea and concept behind the JOYSTICK-IT is a sound one, even if the execution leaves me a bit wanting. While it's still attached, it's a great little device that really gives you back that feeling of control you've been missing from most touch-screen based games. Everything from dual analog stick shooters to classic arcade games and emulators for console games of yesterday greatly benefit from having this little gizmo seated firmly between your fingers. But, then, as soon as you get into it, it pops right off and you're left back at square one. My advice is to avoid the JOYSTICK-IT. Again, great idea, but not enough improvement over existing conditions to make it truly useful.
You can find the JOYSTICK-IT for iPhone/Android handsets for $17.99 by going to this page on ThinkGeek.com while the iPad/Android tablet version at $24.99 (2 pack for $39.99) is available on this page on ThinkGeek.com.


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What is the Sensitivity of Ocean Biogeochemistry to the Efficiency of the Biological Carbon Pump?
OCCI Funded Project: 2008
SummaryThe factors controlling the efficiency with which particulate organic carbon is transferred from surface to depth are still not well understood, and as a result, the biological carbon pump is crudely represented in global models. Here, we propose a three step data analysis and modeling project:
1) to test the sensitivity of a global ocean
biogeochemical-ecosystem-circulation model to the representation of the
biological pump,
2) to use the new data syntheses to develop and incorporate
more mechanistic rules for the
representation of the biological pump in the ocean model, and
3) to test the response of the biological pump to future changes in climate.


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The Texas AgriLife Extension Service has launched the RanchTV online learning center Web site to extend educational resource and information to beef cattle producers via the Internet.
The Web site, developed by Dr. Dan Hale with the help of Bryan Waters of Solutions by Waters, offers more than 150 short videos on beef cattle industry topics. The site can be reached at http://ranchtv.org.
"The goal of the online digital library is to provide cattle producers easy access to information that will help their bottom line and teach best management practices," Hale said.
In 2009, the Meat Science and Beef Cattle Extension groups developed two online learning centers, Hale said.
"This was accomplished using video from past projects sponsored by the Texas Beef Council," he said. "Both learning centers are part of a digital strategy to provide educational tools and resources to the over 100,000 cattle producers in the state of Texas, as well those across the United States."
The beef quality and safety digital learning strategy includes a digital video library called RanchTV and a series of online training courses packaged together at CowsenseU.
The online Beef Quality Assurance training for the Texas Beef Quality Producer Program is the flagship course for CowsenseU, Hale said.
From low-stress cattle handling to food safety and grid marketing, RanchTV includes info about almost every aspect of beef production.
"RanchTV will be an evolving online learning center for cattle producers, with many more videos scheduled to be added over the year," Hale said.
RanchTV topics include:
- Beef Quality Assurance.
- Carcass Grid Marketing & Meats. - Cattle Evaluation.
- Cull Cow Management.
- Environment and Biosecurity.
- Food Safety.
- Health.
- Horses.
- Low-stress Handling of Livestock.
- Nutrition and Feeding.
- Ranch to Rail Program.
- Reproduction.
- Selection & Genetics.
- Transporting Cattle.
- Youth Beef Cattle Projects.
"It is the goal to continually add new videos on the latest issues facing the beef cattle industry," Hale said.
The RanchTV online learning center was developed in part through the checkoff funds provided by the Texas Beef Council.


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Red Cross always looking for blood donors
According to statistics provided on the American Red Cross' website, as of 2006 there were around 9.5 million blood donors in the U.S., even though less than 38 percent of the population is eligible to give blood. Blood cannot be manufactured and its only source is donors who participate in bloodmobiles such as ones run by the American Red Cross. Pat Schwarzmueller, team supervisor for the American Red Cross bloodmobile operation that covers northwestern Pennsylvania, explained that only about five percent of the population actually donates blood on a regular basis. "It's a very small [percentage], and there's a lot of reasons but a lot of it is convenience," Schwarzmueller said. "The number one reason people don't donate is convenience. If you don't come to them, they don't always come to you."People can begin donating blood as young as age 16, though parental permission is needed. Beginning at age 17 teenagers no longer need parental permission. "It also depends on your health how long you can donate, but there's no number to cut it off. Weight [is also a factor as] you have to be at least 110 pounds and in good health," Schwarzmueller said. For more on this story see the Dec. 9 edition of The Daily Press.


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Anders Nørgaard always stays true to his Danish design heritage that was very much part of his own upbringing and education. 'I grew up with functionalism and craftsmanship. Danish architects of the 50s and 60s were friends of my parents and among my teachers at the School of Architecture.' While furniture has to work and fit into your daily life, it still has to look beautiful. 'Functionality can overrule beauty, but if you think outside the box and pay attention to the small details, you achieve a refined and characteristic expression.'
The Osaka is one of our bestsellers and for so many good reasons. Osaka is a classic and elegant sofa that looks amazing from every angle and can be made to fit your needs. Anders Nørgaard has a unique talent for designing modular sofas, like the Osaka, that look great no matter how you put them together. So, whether you need a small 2-person sofa for a one-bedroom apartment or a large corner sofa for a big family, the Osaka will do the job brilliantly.
I love sofas. They form the ideal gathering point in most homes and they are the heroes of the living room


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In the latest setback for the rollout of Obamacare, the U.S. Department of Health and Human Services announced Thursday that small businesses in 36 states can't enroll their workers into health coverage through the new federally run insurance marketplaces until at least Nov. 1 – one month later than previously announced.
The delay appears to be the result of computer and information technology problems in the Small Business Health Option Program, known as SHOP, an online insurance marketplace specifically for small employers.
Employers still will be able to compare coverage options and begin the application process on Oct. 1, but they won't be able to sign up workers for coverage until November.
Glitches and hiccups can occur when sprawling new federal programs are enacted.
The SHOP marketplace was supposed to fully open for business on Oct. 1, along with the state marketplaces where individuals can purchase their 2014 coverage through March 31 to comply with the Affordable Care Act's individual mandate, which requires most Americans to have insurance or pay a penalty.
Small employers can enroll in insurance plans through SHOP on a monthly basis throughout the year. They will have until Dec. 15 to enroll for coverage that begins on Jan. 1. The time lag has allowed Maryland to phase in its state-run SHOP program.
The enrollment delay is the second major change in the SHOP program in recent months. Earlier this summer, the Obama administration announced that SHOP programs in federally run marketplaces and those operated jointly with states would have only one plan to choose from to cover their employees in 2014.
Earlier this week, the administration announced that a Health and Human Services Spanish-language website would not be able to enroll people into coverage on Oct. 1 as expected. In July, it issued a one-year delay in the employer mandate, which requires companies with 50 or more full-time workers to provide health insurance.


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Home / Colleges / Art Schools Articles
Art Schools Articles
The Difference in Degrees
Remember, any college degree is better than no college degree!
Published February 2, 2018
College by Dr. Dre
What would you do with a degree in "disruption?"
Published June 4, 2013
School of Style
There's a new school in season and it's got a big name backing it.
Published May 20, 2013
First Things First: Passion or Practicality?
"What do you want to be when you grow up?" This was easy to answer when we were kids: "I want to be a ballerina. An astronaut. A racecar driver. A ...
Published September 4, 2008
Types of Schools
Are you interested in training to enter a trade, or do you want to pursue a broader academic path? Do you want to study with leading researchers, or with professors who ...
Published June 4, 2008


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Grilled Brussels Sprouts
If you like it, save it!
Save and organize all of the stuff you love in one place.Got it!
If you like something…
Click the heart, it's called favoriting. Favorite the stuff you like.Got it!
Author Notes: My husband turned me into a huge Brussels Sprouts fan with this recipe. He varies it a little each time, but the result is always delicious. —kitchenwitchcookie
Food52 Review: We were drawn to this recipe because it approaches brussels sprouts in a way we'd never tried before. First, you blanch the sprouts in boiling salted water, and then you coat them in a mixture of olive oil, celery salt, onion and garlic powder, salt and pepper before charring them lightly on the grill. Another toss in the seasoned oil, and they're ready to eat. Grilling the brussels sprouts gives them a nice smokiness, and it really wakes up the flavors in the onion and garlic powders. Of the optional ingredients, we chose to add only the lemon zest and really liked the extra bit of perfume. Kitchenwitchcookie rightly insists that you blanch the sprouts for no more than 5 minutes -- if you like your sprouts a bit firm, as we do, you can get away with a minute or two less. If you don't have an outdoor grill (or if you're making these in the dead of winter), a grill pan will work just fine. - A&M —The Editors
Serves: 2
Cook time: 15 min
small to medium Brussels Sprouts
tablespoons olive oil
teaspoons kosher salt
teaspoons cracked black pepper
teaspoons onion powder
teaspoons garlic powder
teaspoons celery salt
handful crumbled bacon (optional)
teaspoon lemon zest (optional)
tablespoon parmesan cheese grated or shreded (optional)
- First, clean the sprouts. Trim the cut ends back without interferring with the leaves, and peel any withered leaves off the bulb. Score the bottoms; one cut will suffice.
- Then place the sprouts in boiling, salted water for no more than five minutes. NO MORE!
- Drain, drizzle with oil and toss in a bowl with the salt, pepper, onion powder, garlic powder and celery salt.
- When the sprouts are nice and coated, place on a hot grill (but keep the bowl handy), turning every four minutes for a total of twelve minutes.
- Remove from the grill back to the seasoning bowl and toss to coat with any remaining seasoning.
- If desired, add any or all of the remaining three ingredients (bacon, lemon zest, parmesan cheese)
- Best Brussel Sprouts Contest Winner!
More Great Recipes:
Vegetable|Brussel Sprouts|Side|Fall|Winter|Grill/Barbecue


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Ryan Gosling praises 'super' George
Ryan Gosling has praised George Clooney for being a "superhuman" on set.
The 30-year-old actor stars in Clooney's new movie 'The Ides of March' - which he stars in, co-wrote, produced and directed - and he was amazed every day when he came to work to see how much energy the 50-year-old Hollywood hunk had.
Ryan said: "It was impressive to watch someone do so much. He's a superhuman person. I don't think I could ever multi-task like him. He's the writer, producer, director, star on 'The Idea of March'. And he's got practical jokes going on all the time."
The 'Drive' star has nothing but praise for George as a director and insists he did everything he could to create a calm shooting environment for the cast, which included Paul Giamatti, Marisa Tomei, Evan Rachel Wood and Philip Seymour Hoffman.
He added: "I'm sure it's very stressful but he actively ensures you don't feel any of that stress, so the atmosphere is great."
In the movie, George plays Democratic Presidential hopeful Pennsylvania Governor Mike Morris who is embroiled in sex scandal, while Ryan portrays Stephen Meyers, the mastermind behind Morris' campaign.


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Environmental Science/Oceanography
Transfer Planning Guides | Course Descriptions | Class Schedule | Faculty | Resources | Web Cams
Program Information
Environmental science is the study of the interactions among the physical, chemical and biological components of the environment; with a focus on pollution and degradation of the environment related to human activities; and the impact on biodiversity and sustainability from local and global development.
It is inherently an interdisciplinary field that draws upon not only its core scientific areas, but also applies knowledge from other non-scientific studies such as economics, law and social sciences. Physics is used to understand the flux of material and energy interaction and construct mathematical models of environmental phenomena. Chemistry is applied to understand the molecular interactions among natural systems. Biology is fundamental to describing the effects within the plant and animal kingdoms.
Transfer Degree: Associate of Arts Degree
Designed to provide students with a broad liberal arts background of study during their first and second years of college with an emphasis on Environmental Sciences. The state's two-year and four-year schools developed transfer agreements that allow students from a community college to transfer at least 90 credits (60 semester credits) to a four-year college or university. The degrees satisfy some - or all - general requirements for a bachelor's degree.


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HEREFORD Roller Skating Club has set the wheels in motion to create a new community hub in the city.
The group, which trains at Aylestone Business and Enterprise College, will soon be competing at Foley Trading Estate.
The club has changed its name to "the Core" and has set its sights on running other sports in the city.
Archery, radio-controlled cars and laser quest are all set to be played at the site, while it will also be fitted out for birthday parties and other functions.
"We are a community interest company that is registered with Companies House but has the benefits of a charity," said Samantha Bushkes, creator of the Core.
"I want people to say that it is a mini leisure centre and for small groups to use it.
"We want to have solar panels to insulate the building, a strong maple floor and a bar.
"I am very keen for it to be a community hub – that is my dream."
The Core will receive the keys to the building on Friday after being awarded £3,000 from Hereford City Council.
Two grants worth a total of £115,000 have also been applied for to Sport England and the Veolia Environmental Trust to ensure that the club's dream can be realised.
"We aim to replace all the windows and doors and create disabled access to the facility," said Mrs Bushkes.
"We are in desperate need for volunteers and have started a paint appeal.
"The walls need a fresh coat of paint and many people have half tins of paint in their sheds and garages.
"Ideally, we would like white, magnolia or cream paints."
Anyone who can help can call 07799 266266 or email firstname.lastname@example.com


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PITTSBURGH, December 3, 2001 — University of Pittsburgh Medical Center (UPMC) gastroenterologists are the first in the state to offer the world's first capsule endoscopy system, in which patients swallow a pill-size camera that transmits images of the digestive tract that can be read on a computer.
"This pill allows us to see the entire length of the small bowel, which traditional endoscopic procedures were unable to do," said Adam Slivka, M.D., Ph.D., associate professor of medicine and chief of endoscopy, division of gastroenterology, hepatology and nutrition at the University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center. "This will help patients who have undergone endoscopy with inconclusive findings."
The Given Diagnostic Imaging System is approved for use in patients with undiagnosed occult gastrointestinal bleeding. The capsule system helps the physician localize sources of bleeding that are invisible to diagnostic radiologic studies and inaccessible to standard endoscopy.
In the procedure, the patient swallows a capsule that contains a miniature color video camera, a light source, a miniature transmitter, batteries and an antenna. The capsule, which is the size of a large vitamin, passes through the digestive tract, where it takes video pictures of the small intestine and transmits them through radio frequency to a recorder attached to a belt worn by the patient.
The capsule passes through the body in approximately eight hours. The recorder is then returned to the physician who downloads the pictures into a computer. The computer compiles the images, allowing the physician to view the capsule's progress through the small intestine. The system also transmits information that allows the physician to determine the location of the pill at a given time.
"This pill currently has limited uses, but has great potential," said Dr. Slivka, who is also the medical director of the GI Lab at UPMC Presbyterian. "It will be interesting to see how this grows into other uses in the field."
For more information on the Given Diagnostic Imaging System, visit their website at http://www.givenimaging.com.
Affiliated with the University of Pittsburgh Schools of the Health Sciences
Supplemental content provided by Healthwise, Incorporated. To learn more, visit www.healthwise.org
For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.
UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, gender identity, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.
Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.
Pittsburgh, PA, USA | UPMC.com


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Home ·
McCombs Alumni Network ·
Get Involved ·
Chapter President Resources
We offer the following resources and tools to assist our alumni leaders to set up and maintain local chapters. If you are already a chapter president, we recommend that you bookmark this page as we will update the information frequently. If you are interested in establishing a chapter in your local area, please email Robin Vallilee.
Page last updated: 4/17/2018
By phone: (512) 471-5921
2110 Speedway, B6000
Austin, TX 78705
McCombs School of Business,
The University of Texas at Austin |
Contact Us


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Joined: 05 August 2012
Posts: 1993
The perfect jodi : Anandi ShivRaj Shekhar and ShivRaj Shekhar
ShivRajcomes from an army background and is a man of authority. He comes in Jaitsar as the Collector and is an energetic,well groomed yet impatient self made man of today.
++++::::::::::::::::::::::::::::++++..::The journey till now::..Their 1st meeting.Shiv entered Balika Vadhu in typical hero fashion, as a knight in shining armour to rescue Anandi when she was in danger. When a wayward horse pulled Anandi's carriage recklessly, Shiv rescued the sarpanch of Jaitsar.Anandi's saviour turns out to be the Collector of the newly minted Jaitsar district. This is revealed at a function held to felicitate Anandi. Shiv is praised by to the high heavens which paves the way for his promising work in Anandi's hometown....The initial discomfort n verbal volleysShiv and anandi initially shared a professional bond. But after some sorts of roughness eventually both impressed with each other's different shades and qualities. shiv's frd ashi's words made shiv to realize that his dream girl is similar to anandi. Anandi's simplicity and charm starts affecting shiv.shiv again proved as anandi's savior while stopping a child marriage and got to know that she is a balika vadhu too and his respect towards anandi increased....Shiv's uncontional love...Anandi's pain...n the ghost from pastShiv is now completely smitten and even accepts ds's proposal to marry anandi but anandi refused due to the fear of rejection.Shiv understood anandi's pain and decided wait for her and devimaa's final decision...AND he realized that he is in love with anandi...In the mean while Anandi and jagdish got divorced finally. Anandi agreed to marry shiv to fulfill her mother's last wish. Shiv's family happily agreed with the marriage alliance of Ansh . Due to some pasr revelation jagat broke up with gauri and went to jetsar to get his family n anandi back .he reached at the mean time when Ansh were getting engaged , he stunned but backed off. AnSh finally got engaged without any interruptions....The failed revenge of her past...and AnSh's unbreakble bond...Jagiya tried to get forgiveness from everyone but failed and went into revenge mode.By hook or crook he tried hard to create disturbances in anandi's life. For peace in family and to come out from her own guilt anandi forgave jagiya. Meantime shiv confessed his love to anandi. Jagiya tried again last time to separate AnSh and tried to convinced Shiv not to marry anandi but This time anandi chose her future and AnSh come out as winner again.And marriage preparation is going on in full swing.after the haldi ceremony Shiv got arrested in railway forgery which was jagdeesh's crime to trap shiv. Anandi show her unshakable support during the low phase n jagiya surrendered.Finally in "samuhik vivah" Anandi n Shiv got married ... declared as man n wife......Life as Man & Wife...blossoming Love...still someknown & unknownfears
After marriage AnSh tried to adjust with their new life, with their families, with lots of hope. But Shiv promised to give anandi her time n space as she is still being affected by her echo of past. With some new challenges n difficulties...their relationship has started blossoming.
The most awaited Realization...
when shiv was in rescue mission for ganga's kid...anandi got worried for him imaging shiv being shot in the movie(hallucination)...She unintentionally blurt out how much she loves shiv in front of choti maa...her heart filled with new joy n happiness realizing she is in love with her husband...herbanka sajeela beendh sa...she started dreaming shiv like deewani...due to some temporary separation n circumstances..her confession is still remain incomplete...
The three magical words...
Finally Anandi manages to gather courage and expresses her love to Shiv. She takes Shiv to the same place where they first met. Shiv is pleasantly surprised and reminisces the moment they had met. Anandi shares how his coming had created ripples of happiness in her life. Shiv then holds her and says I love you. Anandi who wants to confess her feelings shyly asks him to close his eyes. Shiv then slowly kisses the temple on her forehead. Anandi asks him yet once again to close his eyes but when she sees Shiv coming nearer to kiss her on her lips she shyly runs away. Shiv finally abides to her wishes and closes his eyes. Anandi runs behind the trees me makes noises with her anklets. Then she plays the already recorded confession. Shiv looks around and finds Anandi hiding behind a tree. He then slowly approaches and takes away her cell, and asks to her repeat. Anandi finally confesses her feelings to Shiv but shiv naughtily asks her repeat once again. Anandi steps back , slips and pulls shiv along with her and falls in the pond. Shiv grabs her and Anandi finally hugs Shiv. Then she once again says the three magical words ......
Together Forever...You & Me
Due to shiv's transfer to Udaipur, both settled in kesarbug. After few hiccups shiv gave HM surprise to anandi which left anandi elated. With full of dreams AnSh went to Kashmir. In the beautiful mountains, sikara, houseboat, snow field their dream became true one by one. Breaking all barriers they became truly AnSh by all means.
The following 5 member(s) liked the above post:
Aakanksha_7, umam, Mithi_vani, RainbowSun, blushing,
Joined: 05 August 2012
Posts: 1993
The following 5 member(s) liked the above post:
Aakanksha_7, umam, Mithi_vani, RainbowSun, blushing,
Joined: 05 August 2012
Posts: 1993
The following 5 member(s) liked the above post:
Aakanksha_7, umam, Mithi_vani, RainbowSun, blushing,
Joined: 05 August 2012
Posts: 1993
AnSh rista pakka - 14th AUGAnSh Sagaai/engagement - 31st AUGAnSH Become friends after Shiv gives Anandi yellow roses - 12th Septshiv's windchime gift to anandi - 19th SepAnSh's 1st dinner date at CH- 8th octAnSh day out - 15th octAnSh marriage card out n Shiv's ILU to anandi- 31 octShiv asked anandi to marry him- 6th novAnSh haldi-19,20th novAnsh mehendi-27th novAnsh Sangeet-29th- 30th novAnsh Marriage- 10th to 14th decAnandi's bidaai- 17th decAnandi's grihapravesh- 19th/20th decAnSh's SR-28th decAnandi's 1st gift a sweater to shiv on sankranti and AnSh hug - 2nd feb 13Anandi realised she loves shiv...dream confession-13th feb 2013Anandi's half confession on basant panchami- 28th febAnandi confesses her love at the place where AnSh first met-Mar 22nd '13AnSh holi -10/11 apr 13AnSh second Kiss (well on the cheek :)) - Apr 22 '13AnSh first fight :( April 25th 2013AnSh Honeymoon Announcement- April 27th 2013AnSh Suhag Raat - May 8th 2013AnSH 2nd SR - July 20th 2013
The following 4 member(s) liked the above post:
Aakanksha_7, umam, RainbowSun, blushing,
Joined: 05 August 2012
Posts: 1993
Ansh at Link 1 to 50 (all in this link)
!!AnSh!! enter AT your own risk!!50!!
Ansh at Link 51 to 98 (all in this link)
AnSH AT 149 You are my everything AnSh AT 150 ||Together forever...You and Me||
AnSh AT 151||Kuch Hoga ya Kuch Bhi Nahi|| AnSh AT 152|| Hungama Ho Gaya||
AnSH AT 153 Pati Patni aur Parivar AnSH AT 154 Sorry ! maan javo maiya mori.!
AnSh AT 155 ||Stolen Moments of Bliss|| AnSh AT 156 ||babu samjo ishare!||
AnSh AT 157 - Saajan Chale Sasural AnSh AT 158 ***** Kahi Golmaal Kahi behaal *****
AnSh AT 159**Ujale ki Ore** AnSH AT 160 Rishton ki Uljhan AnSh AT 161||Badlate Rishto ki Gatha||MODNOTE pg89 AnSh AT 162 || The Gatha continues...||
AnSh AT 163 || Dil Jale Ya Ghar..that is question.? AnSh AT 164 " Rishto ka bhawar BV ka suffar "
AnSh AT 165 || Naye Sapno ki Aur AnSH AT 166 | Nayi Umeed Ki Kiran AnSh
AT 167 || THe Jaitsar Returns || Ansh || Aaa ab lout chale..|| AT 168 AnSh AT Koshish Ek Asha 169
|AnSh AT 170 | KarmaYudh Ka Shanknaad
BalikaVadhu Times #1( naya safar nayi shurvat)
BVTimes#2(Nafrat Aur Pyar Mai Jeet Sirf Pyar Ki)
BalikaVadhu Times#3 (Nafrat ki Haar pyar ka Vaar)
Balikavadhu Times #4 |Pyar ki Saugat Ansh ke Sath|
BV Times#5 ...khushiyo ka sath...shadi ki shurvat
Bv Times #6 |Kahin Pyaar Khile Toh Kahi Dil Jale|
BalikaVadhu Times #7...New Start with New Hope...
Balikavadhu times # 8 ||~pyar ka ijhaar~||
BalikaVadhu Times#9: Story disaster roller coaster
Bv Times #10 "Emotional Atyachaar Story Ka Achar"
BVTimes#11 - Sanchi ki gatha BV ki mahadasha
BV Times#12 "Kahi Jail To kahi Plan Fail"
AnSh BG tune by mona
Ansh video collection by suchi
Pratyusha's profile Siddharth's profile Toral's profile
Vms by sou
AnSh FF /SS/OS collection by dixie
"Choudhury" AnSh BG song thread n gallery by Vedo
AnSh BG Song (Download Link Added)
rashu shop
Here is new shop is added on this all are request to send you siggy/avi list to this shop so you can get awesome siggies of ansh.. send pictures to her..
Thanking you
Don_theEvil & khushi.
share ur views on AnSh here in colors official website too
Our Record Breaking AnSh Saadi Thread
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I wanted to informed all at members form now on stick to ansh.. talk about them as general chit chat is allowed.. but do not discuss.. actor or actress in at which lead at in to war zone... There no need to discussion about p or t' because character matters not actors.. so do not discuss about reason.. p leaving Or t joining or any inside or outside source.. or about there previous shows.. I know many members will realize it how much important this because I don't want any war in at..so.. .. Form now on' stick to ansh for healthy atmosphere of at.. if I saw the discussion continue going on p or t.. member will be get warning first and face ban for 2 or more then days.. so please.. try to keep peace of this at..
**************************************BENAAM NAAM - EDITION 9 (REVISED)PERMITTED NAMESFor AnSh:* Kachuas* TurtledovesFor Anandi:* Mallika-e-Jaitsar* Teacherjee* Casnovi* Bheegi billiFor Shiv:* Lambhu* Kambha* Pahad/Khoobsurat pahad* Traffic signal/light* Fruit salad* Banana split with cherry on top* Golden banana* Gulab jamun* Halwa* Jalebi* Tomato* Karela* Neem chada* Khargosh/Bunny rabbit* Teddy bear/Pink teddy* Blushing machine* Casanova* Mandakini* Majnu* Bechara* Bechara casanova* Bhukkad* Golmol* Khadoos* Muchewale Anandi* Mr Rotlu* Hatta katta jawan* Laadla/LaadesaarFor Vikram* Vicky* Bhooth* Mahaasur muche* VampPENDING APPROVAL* Godzilla* Joru ka GhulamRESTRICTED NAMESFor Anandi:* Mother India* Jagatmata* Mrs. Mahan* Ms. Know-it-all* BhasanjeeFor Shiv:* Joru ka ghulam (?)* Mr Mahan* Mr Puppy Face* Hulk
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We knew it was coming. This man, this rescuer, this knight. We knew he would save her and become her Surya Badal. We knew that one day, some day, she would fall for this prince and he for her. What we perhaps didn't expect was just how hard we would fall for them. And fall we did.
This couple, this jodi, gave us something so precious and special. Two more beautiful and meant-to-be characters I had never seen. Two halves of a whole as they say. It was in their looks, their talks and the moments they shared together. Moments that made us smile, cry, dance and slowly go mad. We waited with baited breath for the next glimpse. That next moment. And once we saw it, we watched it again and again. We daydreamed, we blushed, we hummed to ourselves and forgot where we were. It was almost as if we were falling in love ourselves.
Their love went from strength to strength and so did our pagalpan. We shared in their tribulations and triumphs. We made them our own. They didn't just exist on our screens but in our hearts. And just as they built their castle of dreams, so did we; about them, their lives ahead and their bond with one another. Finally, we saw their love beginning to bloom and we rejoiced thinking our dreams were about to a become reality for our beloved AnSh.
But just as quickly as that dream came true, our castle was shaken to its core. All that we had yearned for, waited for and were on the verge of realizing was collapsing in front of our eyes. We stood by helpless as forces stronger than us seemingly swept away these characters who had stolen our hearts. What happened and why it happened, we may never get a satisfactory answer. And even now, asking that question of why still hurts.
But what I know for sure is that the love and appreciation that we have for these two characters and their story has made us persevere through this difficult time. We waited and waited to see our AnSh again. We held on, with an almost blind faith, that they would come back. Sometimes it felt like they would never return and our hopes were for nothing. And yet at other times, we felt the joy of seeing beloved friends again and our patience was rewarded.
They say time is a great healer but how much time and how much healing is required is unknown. We fell to the ground from high above but we managed to drag ourselves to our feet. The story continued and we waited. Some of us soared again and returned to that magical place we all once were. Some rise and fall carried on the wings of hope whilst others are still left waiting patiently on the ground. What we share in common is that we are all still holding on. This determination, faith and hope, more than anything, shows just how wonderful these two characters and their story is. That despite everything that went awry and still continues to go off tangent, we still believe that AnSh lives. On our screens, in our imagination and in our hearts.
We'll forgive a thousand wrongs for one beautiful moment and we'll look for the magic where others say there is none. We've all been left changed in unexpected ways. It's hard to look back because it makes us think of what once was but isn't anymore. It's easier to look forward but how can we truly do so without looking back in appreciation of how far they and we have come. I hope one day all of us will be able to see all the beautiful moments of AnSh that made us believe in love, destiny, soul mates and magic. On that day, the pain and remorse we carry in a corner of our hearts will be surpassed by wonder again but until that day we still have each other and this AT to bolster us and continue on. Just as AnSh's dark night had a beautiful dawn so will we ours. All we need is them and each other.
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|Last Post
Himalay ki godh main - Ansh OS (for Ansh lovers)
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|26 October 2013 at 7:12am by maahi11
Ansh vm...update ansh vm 15/05 on pg11
Author: ...Hanna... Replies: 85 Views: 19381
|26 September 2013 at 6:47am by -Lavanya
AnSh SS- :: AnSh Instant Khichidi :: (2)
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|25 May 2013 at 5:21am by Illumination
AnSh || Ansh, Jaitsar Aur transfer || AT 125
Author: anshbalikavadhu Replies: 1189 Views: 36278
|01 April 2013 at 9:38am by khusi_*
AnSh, AnSh n AnSh..
Author: frozen.devil Replies: 3 Views: 4650
|05 January 2013 at 5:44am by frozen.devil
And it has been a while..
This love story will be airing on Colors.
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text:
Barclays Premier League
Sunday, September 23. Kick-off: 1330
Brendan Rodgers made 11 changes for Liverpool's win over Young Boys in the Europa League and will recall the likes of Steven Gerrard and Luis Suarez to his starting line-up.
Raheem Sterling could also continue, having been one of the Reds' most impressive players so far this season
Robin van Persie and Patrice Evra were both rested for Manchester United's defeat of Galatasaray on Wednesday, and should both get starts at Anfield
There will be no place for Wayne Rooney or Ashley Young, however, who are both out injured with thigh and hip problems respectively.
Ferguson: Occasion may get to players
Sir Alex Ferguson stated his full support for Liverpool following the revelations of the independent Hillsborough panel, but hopes the events of the past week will not have an effect on the players of either side on Sunday.
The weekend meeting between the two great rivals represents Liverpool's first Anfield outing since the club's fans were exonerated from wrongdoing in 1989, during which 96 Reds lost their lives at Hillsborough.
And Ferguson said it would be foolish to assume that the players from both Liverpool and Manchester United would not have been distracted by the full extent of last week's revelations.
"It's a possibility, I don't deny that. Human nature can be that way," said the Manchester United manager.
"For instance, when we played Manchester City for the 50th anniversary of Munich, the place was so flat in the dressing room before the game. I even felt it myself.
"We just couldn't perform and we were just glad to get it out the way because it was such an emotional day for us. It could be that way on Sunday.
"But I don't think we should get into that now. I think we should let the players get on with it. There is enough pressure on them at the moment anyway. Liverpool have done their bit and we've done our bit, so let the game go on."
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text:
Swallowing disorders - interpretation of radiographic studies
Robin Smithuis
Radiology department of the Rijnland Hospital in Leiderdorp, the Netherlands
In this overview a simple method of interpreting swallowing disorders is presented.
We will concentrate on four basic findings:
- Asymmetric swallowing
- Stasis of contrast
- Cricopharyngeal dysfunction
- Aspiration
Normal Swallowing
Swallowing is a complex movement.
It requires the coordination of nerves and muscles in the buccolabial area, the tongue, the palate, the pharynx, the larynx and finally the esophagus.
Abnormal Swallow
Look at the video on the left.
It is clear that this patient has a swallow disorder, but when you try to analyze the video, it can be quite difficult even in slow motion .
We will discuss a systematic approach on how to analyse these videos, but first a short introduction on normal swallowing is given.
Oral phase
In the oral phase food is prepared for swallowing and then transported to the pharynx.
This is a preparatory phase in which the food is held within the mouth while the base of the tongue and the soft palate close the oral cavity posteriorly to prevent food spilling into the open larynx and trachea.
A bolus is formed in the central portion of the tongue and then pushed posteriorly toward the pharynx with an anterior-to-posterior tongue elevation.
As the bolus enters the pharynx the actual swallow or pharyngeal reflex is triggered.
Pharyngeal phase
This phase is a reflex action. The bolus passes through the pharynx quickly and then enters the esophagus.
This takes place in less than a second.
The initiation of this process starts when the bolus passes the anterior faucial arch and reaches the posterior pharyngeal wall.
Elevation of the soft palate prevents material from entering the nasal cavity.
This stage is followed by the pharyngeal constrictor muscles pushing the bolus further into the pharynx, toward the cricopharyngeal sphincter.
The larynx prevents material from entering the trachea by respectively closing the true vocal cords, false vocal folds, and aryepiglottic folds.
Contraction of the lower pharyngeal constrictor is followed by relaxation of the cricopharyngeal muscle, allowing the bolus to pass into the esophagus.
Fluoroscopic imaging
The most important images of the swallowing study are those taken of the lateral view.
Click through the images 1-8 on the left.
- The base of the tongue and the soft palate close the oral cavity posteriorly (arrow) to prevent spill of food into the open larynx.
- Hyoid bone and base of the tongue move in a cranial direction and lift the larynx (arrow).
- Soft palate elevates to prevent spill into the nasopharynx (thin arrow) and the larynx closes by contraction of the aryepiglottic folds (broad arrow)
- Contraction of the upper pharyngeal constrictor (arrow)
- Contraction of the middle pharyngeal constrictor (arrow)
- Contraction of the lower pharyngeal constrictor and relaxation of the cricopharyngeal muscle (arrow)
- Epiglottis elevates to regain its resting position and the larynx opens.
- Epiglottis in resting position and larynx is open (arrow).
Video of lateral view
The AP-view is less important than the lateral view in the analysis of patients with dysphagia.
It is especially important to look for asymmetry.
Once a good series of the pharyngeal phase has been acquired, follow the contrast bolus all the way down to the gastroesophageal junction.
- Contrast enters the pharynx.
- The lateral food chanels fill symmetrically as the epiglottis divides the bolus into a left and right portion (blue arrows).
- Contrast reaches the hypopharynx.
- Cricopharyngeus opens and contrast enters the esophagus.
- Pharyngeal constrictors squeeze all the contrast into the esophagus.
- No stasis.
Indications for a radiographic swallowing study
Indications for a swallowing study are dysphagia, globus sensation and aspiration.
Dysphagia is a general term used to describe the inability to move food properly from the mouth to the stomach.
Globus sensation is a term to describe the feeling, that there is something in the throat, that is in the way or needs to be swallowed.
Aspiration is the most severe form of a swallowing disorder and can result in aspiration pneumonia, chronic lung disease or choking.
In some patients with chronic lung disease a swallowing study can be performed to look for 'silent aspiration'.
Study of Swallowing
When starting a study, try to find out exactly what the patients problem is, so you can customize the series.
Is there a risk of aspiration (i.e. wet voice, recurrent pneumonia, aspiration).
If so, do not start the examination with barium contrast, but instead use non-ionic water-soluble contrast.
If, during the first few swallows no aspiration takes place, you can switch back to barium, as this gives better quality images.
When solid food is the problem, you may want to add a solid substance to the barium (for instance biscuits or bread).
The examination of patients with a possible swallowing disorder consists of:
- Fluorographic study of the actual swallowing.
- Double-contrast images of the pharynx.
- Examination of the esophagus.
We start with one or two lateral swallows followed by a lateral double-contrast view of the pharynx (see later).
Then an AP-swallow is recorded followed by an AP double-contrast view of the pharynx.
Next the passage through the esophagus is recorded, followed by double-contrast views of the gastroesophageal junction.
Before we start the examination, the procedure is explained to the patient and we practise certain manoeuvres (i.e. modified Valsalva).
Fluorographic study of the actual swallowing
The act of swallowing is recorded on video or some sort of digital recording.
We use grabs from the fluographic images and store them into the PACS-system, where we can play them back and forth for analysis.
It is very important to always start with the lateral view first, because when the patient aspirates, the lateral view will tell you how and why it happened.
If you have to stop the examination, the most important images will already have been recorded.
If you start with an AP-view and the patient aspirates, you may have to stop the examination and you will never find out why aspiration occurred and what the real problem is.
Use only a small amount of barium for the first swallow and if the patient is doing fine, coninue with larger portions.
Aspiration of a small amount of barium is usually not a big problem, but you don't want a lot of barium filling the bronchi.
Double contrast images of the pharynx
For the lateral view, ask the patient to sing an aaa, as this will move the tongue in an anterior position and give a better view on the oro- and hypopharynx.
In Dutch this will be the letter eee, as it is pronounced the same as the english aaa.
For the AP-view the modified Valsalva manoeuvre is performed.
The patients has to blow air through the tightened lips as in trumpet-playing, while relaxing the neck region.
Always practise this manoeuvre prior to the examination, so the patient knows what to do.
On the left DC views of the pharynx.
Outpounching of the lateral wall of the pharynx is normal and can be quite severe (Dizzy Gillespie).
These are called 'lateral pharyngeal ears'.
Examination of the esophagus
Always follow the passage of barium through the esophagus until it enters the stomach.
Disorders of the gastroesophageal junction are often experienced as a problem within the throat.
The rationale for this is that in patients with a distal obstruction, gastroesophageal reflux or a motility disorder, the cricopharyngeal muscle has to work very hard to prevent foodspillage back into the pharynx - along with its risk of aspiration.
This increased muscle tone gives the patient the sensation that there is a problem in the throat.
The patient on the left complained of globus sensation.
This was due to severe reflux and subsequent increased tone of the cricopharyngeal muscle.
A complex paraesophageal hernia is seen.
Excellent views of the gastroesophageal junction can be achieved by doing the following:
- Ask the patient to swallow zoru-granules for optimal gas filling of the stomach.
- Tell the patient not to belch, but to keep the air in the stomach until the moment of swallowing.
- Place the patient in the left anterior oblique position.
- Lift the table top 45 degrees.
- Swallow high density barium for optimal esophageal coating.
- Images are taken when air regurgitates from the stomach into the barium-coated esophagus.
How to Analyze Swallowing Disorders
A simple way to analyze a swallowing study is to concentrate on four easily detectable findings.
These are:
- Asymmetry
- Stasis
- Cricopharyngeal dysfunction
- Aspiration
These findings are mostly already apparent during the examination, but analysis of all the images will clarify the mechanisms that cause these abnormal findings.
These imaging findings may be isolated findings or may be related to each other.
For instance, premature closure of the cricopharyngeal muscle may lead to stasis of contrast in the pharynx, which may result in aspiration as the larynx opens at the end of swallowing.
Asymmetric swallowing on an AP-view is usually the result of an asymmetric tilting of the epiglottis.
Sometimes it is caused by rotation of the head, but in many cases no real explanation is found.
Even when the head is not rotated, the epiglottis can tilt asymmetrically when it hits the posterior pharyngeal wall.
This is more likely to occur when only a small bolus is given,as the pharynx will not fully distend.
An asymmetric swallow may be followed by a symmetric swallow in the same patient when a larger bolus is given.
In the case on the left rotation of the head closes the side to which the head is turned (Figure).
If a patient has a unilateral pharyngeal paresis, turning of the head towards the affected side will help the patient in preventing aspiration.
By turning the head towards the affected side, this side will be closed preventing stasis on this side and possible secondary aspiration.
Here a video to show you another example of asymmetrie due to head turn.
Due to the head turn the contrast passes only via the right "food channel".
This gives the impression of a tumor on the left side.
However before you decide that it is a normal finding you have to exclude a pharyngeal tumour or unilateral paresis.
The double-contrast views can be helpful in these cases.
In unilateral paresis the paralysed side will protrude during the modified Valsalva.
When a tumour is present in the pharynx, it is usually visible on the DC views.
Sometimes endoscopy is necessary to solve the problem of an asymmetric swallow.
Asymmetry (2)
The case on the left is an odd case, but it nicely demonstrates the difficulty that sometimes exists in determining the cause of asymmetry.
On the far left asymmetry is seen on the fluorographic study (green arrow).
A tumour in the right pyriform sinus has to be excluded.
On the DC view on the right the piryform sinus is normal (green arrow), but at the level of the vallecula on the right a lobulated proces is seen (yellow arrow) and at a higher level a smooth indentation of the oropharynx is seen (blue arrow).
The lobulated tumor at the level of the valleculae proved to be remnants of the tongue tonsil, which is a common finding and sometimes difficult to differentiate from cancer of the tongue base.
In some cases endoscopy is needed to differentiate the two.
Next image is the CT of this patient.
Asymmetry (3)
On the left we see a CT image of the same patient.
The smooth indentation of the oropharynx on the right was caused by an elongated internal carotid artery.
So indeed this is a very uncommon case in which on the fluorographic study a tumor was suspected in the piriform sinus.
Finally a proces was found within the oropharynx and a proces compressing the wall from outside at a higher level.
Due to these processes there was an asymmetric passage of contrast in the hypopharynx simulating a proces in the piriform sinus.
Stasis is the result of insufficient cleansing of the pharynx, either due to an obstruction (i.e. dysfunction of the cricopharyngeus) or due to insufficient contraction of the pharyngeal constrictors.
Insufficient contraction is the result of pharyngeal paresis resulting from a neuromuscular disorder.
Excessive movements of the tongue base and larynx are sometimes seen on lateral fluorographic studies to compensate for the loss of function of the pharyngeal constrictors.
When the patient resumes breathing, aspiration can occur (Figure).
Stasis (2)
On the left a set of images demonstrating a patient with a paresis of the pharynxconstrictors.
This is usually associated with a disturbed relaxation of the cricopharyngeal muscle.
In this example we can see how the patient tries to compensate for the loss of pharyngeal constriction by excessive movement of the tongue and the head.
This patient is in extreme stress, because he knows that when he starts breathing and the throat is not empty, he will aspirate.
- 1-3. No contraction of the posterior wall of the pharynx is seen. Cricopharyngeus does not open properly.
- 4-7. Contrast enters the larynx, but does not enter the trachea.
- 8-10. Excessive movements of the head in order to squeeze the bolus into the esophagus.
In some of these cases cricopharyngeotomy is the only solution to facilitate the passage of food to the esophagus.
Cricopharyngeal Dysfunction
Insufficient opening and premature closure are the most common problems of the cricopharyngeal muscle.
Normally you should not see an impression of the cricopharyngeus during passage of the bolus, but a small non-obstructive indentation is sometimes seen and is not clinically significant (Figure).
It can however sometimes explain the symptoms of the patient.
It is assumed that the passage of food irritates the mucosa that covers the cricopharyngeal muscle resulting in a globus sensation.
Cricopharyngeal dysfunction (2)
Premature closure of the cricopharyngeus results in an increased pressure in the hypopharynx, just above the cricopharyngeus, as the pressurewave of the pharyngeal constrictors pushes the bolus downwards.
This increased pressure can result in an outpouching at a weak spot in the posterior pharyngeal wall (Killian's dehiscence).
First this will result in a small pouch, that in time can increase and form a true Zenker's diverticulum (Figure).
A Zenker's diverticulum is always the result of cricopharyngeal dysfunction.
Cricopharyngeal dysfunction (3)
On the left a patient who complained of globus sensation in the throat and difficulty of swallowing with regurgitation of undigested food.
The digital recordings nicely demonstrate the filling of a large Zenker's diverticle, just above the contracted cricopharyngeal muscle (yellow arrow).
The contraction of the lower pharyngeal constrictors is indicated by the blue arrow.
The contraction of the lower pharyngeal muscle against the closed cricopharyngeal muscle causes the posterior outpouching.
Cricopharyngeal dysfunction (4)
On the left a video of a patient with a Zenker diverticulum.
Notice that the insufficient opening of the cricopharyngeal muscle is the cause of the diverticulum.
There are three instances when aspiration can occur: before, during or after the actual swallow.
- Aspiration before swallowing is either the result of insufficient closure of the oral cavity during the preparatory phase or inability to start the swallow reflex when contrast enters the pharynx.
- Aspiration during swallowing is due to insufficient closure of the larynx.
- Aspiration after swallowing is the result of stasis of contrast in the pharynx - when the larynx opens the contrast leaks into the trachea.
Webs usually occur at the level of the hypopharynx or the upper esophagus, producing dysphagia for solids.
Liquids usually pass well, but in many cases a 'jet' is seen.
The passage of solid food may produce irritation or damage to the mucosa, resulting in a globus feeling.
They are best diagnosed on the lateral projection of the barium swallow.
Webs are frequently overlooked at esophagoscopy unless special attention is given to this area.
During esophagoscopy they may rupture, but in many cases recurrence is seen.
Aspiration before swallowing
When tongue or soft palate are unable to prevent spillage of food into the pharynx, aspiration may occur since the larynx is still open.
Weakness of these muscles in the mouth and the throat is due to paralysis or myopathy.
On the left a video of a patient who aspirates prior to the actual swallowing reflex.
On the left the same video images step by step.
- Notice that contrast enters the pharynx, but does not trigger a swallowing reflex.
- No swallowing reflex
- Contrast reaches the hypopharynx, but still no swallowing reflex.
- Contrast enters the larynx, which is still open and not yet elevated
- At this moment the swallowing reflex starts and the larynx elevates
- Contrast is transported to the esophagus and the larynx closes, but there is already contrast in the trachea.
- Proper relaxation of the cricopharyngeus and finally there is good closure of the larynx.
- Notice that there is no stasis at the end of the swallow .
We have to assume that a failure of the sensory nerves in the pharynx is the problem.
Notice also that there is no coughing reflex.
This patient probably has silent aspiration.
Aspiration during swallowing
This is due to an insufficient closure of the larynx when it should be closed.
Closure of the larynx is a result of anterosuperior lifting of the larynx which allows the true cords, false cords and finally, the aryepiglottic folds to contract, followed by a backwards folding of the epiglottis over the closed larynx.
The aryepiglottic folds are the main gatekeepers, while the epiglottis plays only a minor role in preventing aspiration.
Both failure of these intrinsic muscles of the larynx as well as failure of the extrinsic muscles (i.e. muscles that lift the larynx) may lead to aspiration during swallowing.
Weakness of the extrinsic muscles is seen after radiotherapy, in neurologic disorders and in recurrens nerve paralysis (i.e. neuromuscular dysfunction).
Aspiration during swallowing (2)
On the left a digital recording of a patient who complained of a sore throat and a wet voice.
Notice that when the contrast enters the throat, the swallowing reflex is not triggered immediately.
This allows for barium contrast to enter the larynx, where it sits on the vocals cords.
Once the swallowing reflex is initiated, the larynx closes properly, but contrast is already in.
Notice also that while the contrast enters the larynx, it does not initiate a cough reflex.
Althoug the digital recording perfectly explains the complaints of the patient, it is difficult to say what causes this problem.
Usually when there is aspiration during swallowing, the problem is at the level of the larynx.
Mostly it is the larynx that is unable to close either due to weakness of the intrinsic laryngeal muscles or weakness of the extrinsic muscles that lift the larynx and allow it to contract (for instance after neck radiation or surgery).
In this case the problem is probably at the level of the sensory nerves in the pharynx, who are not triggered properly.
You could also argue, that this maybe is aspiration before swallowing, because it happens before the actual swallowing reflex.
Maybe a more forcefull push of the bolus posteriorly from the mouth into the oropharynx could help in triggering these nerves instead of allowing the bolus to slide over the back of the tongue.
Aspiration after swallowing
This is the result of stasis of contrast in the pharynx due to insufficient contraction of the pharyngeal constrictors or insufficient opening of the cricopharyngeal muscle.
When the larynx opens the contrast may leak into the trachea.
On the left a patient who aspirates after swallowing.
There is severe stasis.
Aspiration occurs as the patient inhales to start breathing again.
- Contrast enter the pharynx and initiates a swallow reflex.
- The larynx elevates and closes. Only minor contraction of the upper pharyngeal constrictors.
- No contraction of middle and lower constrictors.
- Stasis of contrast at the end of the swallow.
- As the larynx opens, the contrast enters the larynx.
- Contrast enters the trachea
The total absence of pharyngeal contraction due to paresis is the primary problem in this patient.
As a result there is stasis of contrast and secondary aspiration as the patient starts to breath again.
Diagnosis and Swallowing Rehabilitation
The results of the swallowing examination help in establishing a final diagnosis.
Based on this examination alone however, a specific diagnosis usually cannot be made, since most severe swallowing disorders are the result of a complex neuromuscular dysfunction.
Hence the swallowing study should be regarded as part of the total evaluation of the patient by gastroenterologist, neurologist and speech therapist.
The strength of the fluoroscopic examination is, that it is the only examination that can show us, what is really going on during swallowing and can therefore lead to a rehabilitation plan.
Swallowing Rehabilitation
Swallowing rehabilitation is a specialty on its own.
Here we will make some brief comments on rehabilitation as it may help you to better understand the dynamics of swallowing.
In unilateral pharyngeal paralysis stasis can be prevented by closing down one of the lateral food channels by turning the head towards the affected side or by manually compressing it.
Patients with aspiration before swallowing due to insufficient closure of the mouth, can be helped by flexing their head during chewing and thus holding the food in the anterior part of the oral cavity.
In patients with aspiration during or after swallowing the 'supraglottic swallow' may help.
Before swallowing a deep breath is taken.
Air is prevented to leak out of the airways by compressing the vocal cords.
Immediately after swallowing the patient has to cough forcefully in order to clear the airways and the throat from any residual food.
Some patients only aspirate when they ingest fluids.
These patients can be helped by changing their fluid intake into jelly-like liquids.