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STUDENT DIGITAL NEWSLETTER ALAGAPPA INSTITUTIONS |
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Richard Martin, MD, FAAEM
Mixed hearing loss is the result of damage to conductive pathways of the outer and/or middle ear and to the nerves or sensory hair cells of the inner ear prostate oncology youth generic flomax 0.4 mg with mastercard. Configuration of Hearing Loss the configuration mens health lunch box 0.2mg flomax fast delivery, or shape prostate cancer hormone injections flomax 0.2mg, of the hearing loss refers to the degree and pattern of hearing loss across frequencies (tones) mens health fat burners bible flomax 0.4mg on line, as illustrated in a graph called an audiogram. Even if a child has passed a hearing screening before, it is important to look out for the following signs. Mixed hearing loss is caused by a combination of one or more causes of conductive hearing loss and one or more causes of sensorineural hearing loss. This sometimes is mistaken for not paying attention or just ignoring, but could be the result of a partial or complete hearing loss. This is sometimes mistaken for not paying attention or just ignoring, but could be the result of a partial of complete hearing loss. A hearing screening will be provided to children during the initial speech and language evaluation unless results of a comprehensive audiological assessment has been completed. The following should be included: Consultation with the audiologist who performed the hearing evaluation. Ongoing assessment of communication skills is important because these skills are dynamic and may change over time. Auditory-Verbal Therapy promotes early diagnosis, one-on-one therapy, and state-of-the-art audiologic management and technology. Ultimately, parents and caregivers gain confidence that their child can have access to a full range of academic, social, and occupational choices. Treatment Plan Timeline Frequency and duration of services is based upon the specific needs of the individual at the time of the evaluation. Therefore, discharge planning will involve consideration of maximum potential achieved and individual family circumstances. Major Stages of Auditory Development Detection- the ability to indicate the presence of sound in the environment Discrimination- the ability to differentiate between two sounds (same/different) Identification/Recognition- the ability to attach meaning to a sound. Ex: Identify the correct picture when a word is spoken Comprehension- the ability to understand conversational speech with only auditory input. Early Intervention the American Academy of Pediatrics recommends beginning the process for early intervention at birth for children diagnosed with hearing loss. The following goals were developed by the American Academy of Pediatrics to support access to early intervention for this population. Ensure newborn hearing screening results are communicated to all parents and reported in a timely fashion according to state laws, regulations, and guidelines. Children with hearing loss have the potential to maintain development with same age peers if appropriate amplification and intervention services are pursued. The earlier appropriate amplification is fit and monitored, the better the prognosis for speech and language development in infants and toddlers. Children with hearing loss may not reach full maturity in speech sound development without early intervention with appropriate amplification. Infants and young children with a pre-linguistic onset of hearing loss can exhibit noticeable delays in their entire speech production system. Speech and language intervention along with appropriate amplification is critical to communication development. An interdisciplinary approach ensures that both components for successful outcomes are present. Amplification must be monitored at intervals to verify that the patient is receiving adequate input from his or her device. The elimination of either of these factors can lead to significant delays in development and the lack of appropriate use of the technology available. The auditory stages of development include a hierarchy of four levels of auditory skill. Some auditory development will develop naturally, particularly with early, high quality, monitored amplification. However, skilled therapy is critical to address those skills that need direct instruction in both early invention and school age children. School Age As children progress into school age years, the expectations for language utilization in both academic and social settings increases. Children who have not received the benefits of both early intervention and appropriate amplification often need speech and language services at an increased intensity as they attempt to play "catch up" with their peers. Children who have received these services however, can be on level with peers and need less frequent or possibly maintenance level support. Services to support success in social and academic settings is often needed throughout the school age years. Adolescent/Young Adult An increase in the incidence of acquired hearing loss versus congenital hearing loss occurs in this age group. Speech therapy services include support and maintenance care for patients who were born hearing impaired, and then those who have experienced acquired hearing loss due to a medical issues, trauma, or abusive behaviors such as drugs or excessive loud noise. Noise Induced Hearing Loss is the leading cause of acquired hearing loss in the adolescent/young adult population. Personal listening devices used without monitoring decibel levels have resulted in an increase in hearing loss. Adult Hearing loss in the adult population is primarily due to aging, but trauma and other medical conditions are factors as well. A skilled audiologist is able to provide appropriate amplification to support activities of daily living. Speech therapy for this population is primarily maintenance to support the utilization of new amplification. Aural rehabilitation is typically not a primary cause of concern, as a consistent foundation of auditory skill has already been established. Providing family members, caregivers, employers, co-workers, and other communication partners training in communication techniques and strategies to facilitate effective communication with the hearing impaired individual is critical part of the speech therapist role. Counseling and support may be needed as patients adjust to the knowledge of their hearing loss and the impact on activities of daily living. Services should focus on a program designed to treat the specific areas of weakness with focus on improving functional communication so that the individual may participate in a variety of communication situations within his or her community or employment. Referral Guidelines If improvement does not meet the above guidelines or improvement has reached a plateau: Refer patients to the referring physician or specialist to explore other alternatives. Discharge Criteria the patient has acquired age appropriate communication skills the patient has not shown progress towards reasonable goals, and has reached a plateau. The Roles of Speech-Language Pathologists and Teachers of Children Who Are Deaf and hard of Hearing in the Development of Communicative and Linguistic Competence 2004. Auditory-Verbal therapy as an intervention approach for children who are deaf: a review of the evidence. The age at which young deaf children receive cochlear implants and their vocabulary and speech-production growth: Is there an added value for early implantation Communication development in children who receive the cochlear implant younger than 12 months: risks versus benefits. Systematic review of the literature on the clinical effectiveness of the cochlear implant procedure in paediatric patients. Listen up: Children with early indentified hearing loss achieve age appropriate language outcomes by 3 years-of-age. Considerations for pediatric cochlear implant recipients with unilateral or asymmetric hearing loss: Assessment, device fitting, and habilitation. The efficacy of auditory-verbal therapy in children with hearing impairment: A systematic review from 1993-201. Generic quality of life in persons with hearing loss: a systematic literature review. The impact of early identification of permanent childhood hearing impairment on speech and language outcomes.
The change in the raw numbers for murder interrogations is dramatic: Police officers committed misconduct in 119 interrogations in exonerations from murder convictions through 2002; they used or threatened physical violence in 86 of those interrogations prostate oncology 24 purchase flomax 0.2 mg online. Police committed misconduct in only seven murder interrogations of exonerees who were convicted since the beginning of 2003-a decrease by a factor of 17 (119/7) androgen hormone 2 ep4 cheap 0.2mg flomax. They used or threatened violence only twice in interrogations since the beginning of 2003 androgen hormone junkie purchase 0.2 mg flomax otc, a decrease by a factor of more than 40 (86/2) prostate 8 ucsf buy generic flomax 0.4mg line. This is not, of course, the final word on murder exonerations from convictions between 2003 and 2018. Exonerations yet to come may include additional instances of misconduct and violence in interrogations, but those future cases are unlikely to reverse a trend as strong as what we see here. The proportion of murder exonerations with violent or otherwise abusive interrogations is a better measure of change than the raw numbers of cases. The proportion of murder exonerations with misconduct in interrogations went from 46% (50/108) to 20% (2/10) in Chicago, and from 10% (69/674) to 4% (5/116) in other places; use of violence dropped from 46% (50/108) to 20% (2/10) in Chicago, and from 6% (39/674) to less than 1% (1/116) in the rest of the country. Among murder cases, 4% of exonerations though 2002 included forensic fraud (35/782), but only 1% of those since 2003 (1/126). Before 2003, 64% of murder exonerations with false confessions included misconduct in interrogations (119/186), and 46% included violence (85/185); since 2003, the comparable rates are 39% (7/18) and 11% (2/18). The value of a change in the proportion of murder exonerations with misconduct or violence in interrogations as a measure of change in the occurrence of those types of behavior would be undercut if murder exonerations with abusive interrogation have longer time lags from conviction to exoneration than other murder exonerations. That is the case, but the differences are too modest to account for the large disparities in rates of misconduct. For exonerations of murder convictions through 2002, the average time from conviction to exoneration was 16 years for all murder cases, 17. As with misconduct in interrogations, we are likely to see additional exonerations with forensic fraud for convictions since 2003, but the decrease from earlier years is so great that we are confident the observed decline is real. Thirty-two of the 46 federal white-collar exonerees were convicted in the 15 years from 2003 through 2017, more than twice as many as the 14 exonerees who were convicted of federal whitecollar crimes in the 15 years from 1988 through 2002. The number of federal white-collar exonerations with official misconduct doubled from the earlier to the later period, 20 compared to 10. That means that changes in the numbers of exonerations are a better measure of underlying behavior for federal white-collar cases, since we probably already know about the great majority of exonerations for such crimes that will ever occur. More important, the impact of a time lag from conviction to exoneration depends on the direction of the observed change. It means that an observed decrease in the number of cases may be misleading because there are more exonerations to come. But when we see an increase- as we do for the number of federal white-collar exonerations, with and without misconduct-a time lag to exoneration can only mean that the true increase in federal white-collar exonerations may be larger than what we see so far because future exonerations may further increase the rate for recent cases. In short, judging from exonerations, the number of convictions of innocent federal white-collar crime defendants has increased sharply since 2003; most of those cases (before and after 2003) 236 Our conclusion is limited to forensic fraud in prosecutions for violent felonies, which account for 95% of exonerations with forensic fraud. None of those cases have produced exonerations to date, and it is likely that the great majority of the defendants were guilty. As we discuss below, that sort of misconduct is easier to conceal in cases that routinely produce quick guilty pleas rather than the trials that occur in most exonerations. We know of 32 exonerations from non-white-collar federal convictions before 2003, and 34 since 2003; 21 of those exonerations from the earlier period included misconduct, and 17 of those from the later period. We now pull back and address two fundamental questions: Why do law enforcement officials commit misconduct that leads to convictions of innocent criminal defendants On the first question, we conclude that the most important causes of official misconduct in criminal cases are systemic: pervasive practices that permit if not encourage bad behavior; lack of the resources needed to train, supervise and conduct high quality investigations and prosecutions; and ineffective leadership by police commanders, crime lab directors and chief prosecutors. If these systemic problems are corrected, misconduct is less likely to occur-and when it does happen, more likely to be counteracted before innocent people are condemned. On the second question, we are confident that misconduct in criminal cases can be reduced, perhaps dramatically. We discuss several categories of reforms that address the varieties of misconduct we have examined. All have been tried, at least in part, and all will improve the operation of the criminal justice system beyond reducing false convictions. Misconduct that leads to convictions of innocent defendants also does harm in other cases. Guilty defendants are deprived of their rights, and innocent defendants who are not ultimately convicted are arrested and charged- they must defend themselves, and may held in custody for long periods. In addition, changes that prevent this sort of misconduct will also reduce other poor practices that can lead to errors. Reforms that prevent misconduct that sends innocent people to prison will benefit criminal justice across the board. Morton spent 24 years in prison for a crime that he did not commit-a crime that was itself an unspeakable tragedy for him and his family. He pled guilty to contempt of court, spent four days in jail, was disbarred, and was forced to resign from the position he then held as a judge. There is extensive evidence that all of us, including prosecutors, have a hard time paying attention to evidence that contradicts a theory we have already adopted. Findley & Michael Scott, the Multiple Dimensions of Tunnel Vision in Criminal Cases, 2006 Wisconsin Law Review 291. Plus, in most cases prosecutors are right: suspects arrested by the police are usually guilty. Like anybody else, they can make the disastrous mistake of confusing usually right with always right. That account, however-if true-only explains why Anderson probably believed, in the face of strong evidence to the contrary, that Morton bludgeoned his wife to death. It may be that Anderson concealed critical evidence of innocence for reasons peculiar to the murder of Christine Morton. Perhaps he was deeply concerned to get a conviction because the case had attracted a great deal of attention. That explanation, if true, just pushes the question back a level: Why did he do it all the time In most cases, the defendants were guilty-in many, there would have been no dispute about guilt-and the overwhelming majority pled guilty. It took that perfect storm to bring this outrage to light; many lesser tragedies may remain hidden. In at least one case, his First Assistant District Attorney, Paul Womack, followed that example. In 1993, he persuaded Troy Mansfield to plead guilty to second-degree indecency with a child by threatening Mansfield with a life sentence if he went to trial. Mansfield served three months in jail under his plea bargain, and 10 years on probation-and he was required to register as a sex offender for life. His officers had arrested a man named Anthony Holmes on suspicion of murder and wanted him to identify an accomplice. When Holmes refused, the officers left him handcuffed in an Area 2 investigation room and went to find Burge. A few minutes later, Burge strolled into the interrogation room with a mysterious box in a brown paper bag. The box had a hand crank on one end and two wires with alligator clamps coming out the other end. Then everything went black, and when he woke up, Burge was putting a fresh plastic bag over his head-the terrible panic of suffocation compounded the pain of the electric shocks.
Many factors had to be considered in receiving and positioning all the equipment that arrived on the scene prostate with grief order flomax 0.2mg free shipping. Not all of them were used prostate meaning buy flomax 0.4mg fast delivery, but at the time of the alarms man health week buy 0.2 mg flomax otc, the full scope of the incident was not known and they had to be prepared to handle a range of possible contingencies healthy prostate order 0.4 mg flomax with amex. The area became congested and fire personnel had some difficulties maintaining open lanes for the ambulances. One officer asked for assistance from another firefighter and he took charge of managing the equipment when they arrived at the bottleneck at University Circle. Fire Administration/Technical Report Series Figure 7: Fire Department Staging Area Rather quickly fire officials recognized that Lot 21 was not large enough to handle the number of responding units, and switched the Staging Area from Lot 21 to Lot 20, which was directly across from Lot 21. The shift was made when some pieces of equipment experienced problems turning around and maneuvering in Lot 21. However, even at that location, due to the layout of the campus, responders had to walk about 150 yards to get to Cole Hall. Cole Hall Burlington Ambulance #1352 DeKalb Ambulance Medic #3 DeKalb Ambulance Medic #2 14. Cole Hall DeKalb Fire Car #4 Rochelle Ambulance #7 DeKalb Ambulance Medic #2 DeKalb Medic #5 (Self transport) Patient Location 1. Fire Administration/Technical Report Series As operations began to close down, DeKalb fire officials made a wise decision to hold back several of the approximately 16 ambulances in the event they would be needed to transport some of the patients at Kishwaukee Hospital to other medical facilities, if helicopters could not carry out that mission. The greater alarm ambulances (six) were held to ensure there was reserve capacity. The hospital and the DeKalb Fire Department intend to add this consideration to their plans, ensuring that there are other available transports in case helicopter operations are ruled out for reasons of weather, maintenance, or unavailable due to other prior calls for service. Due to high winds grounding helicopter operations, all transport from the scene had to be by ground via ambulance or other vehicles to several different hospitals. Kishwaukee Hospital was not allowed to divert because it is the only hospital within 30 miles of another hospital. All victims were taken first to Kishwaukee, and if necessary, transferred to other hospitals. Law enforcement units were staged at the Wirtz building near the telecommunications and public safety offices of the university. Throughout the late afternoon and evening, law enforcement officers guarded Cole Hall as seen in Figure 10. Figure 11 shows the placement of operations, including the Holmes Student Center where police officials interviewed witnesses, and the boundaries of the hard and soft perimeters around the crime scene. February 15) Time 3:03 pm 3:06 3:07 3:07 3:08 3:08 3:09 3:10 3:10 3:11 3:12 3:15 3:16 Public Affairs calls President for emergency alert authorization. DeKalb Fire Department Battalion 1 receives report of possible shooting at Cole Hall. Event Shooter appears on stage of Cole Hall classroom and shoots students; then commits suicide. Families and friends begin arriving and are taken to the Conference Center at the lower level. Two radiologists report to do wet reads; laboratory assessed O-Negative blood supply and called for more. Phlebotomist reports to help label specimens and send to lab via pneumatic tube system. Campus Police report crime scene has been closed off for the investigation to begin. The Communiversity Incident Management Team received support from the Chicago Fire Department Incident Management Team and the State of Illinois Incident Management Team. The rapid decision by the President, and the rapid response from Public Affairs meant that the campus received information very quickly on what had happened and what actions they were instructed to take. They understood the importance of immediate notification through a direct chain of command, rather than waiting until the crisis management team was assembled to discuss the situation in a meeting. Looking out some of the windows, resident students saw emergency medical personnel treating wounded victims who had run out of Cole Hall. Intercom systems inside the dormitories alerted students to remain calm and stay in their rooms. A dorm monitor reportedly would not allow students to walk in the hallways and made sure they stayed in their rooms with the doors locked. The dorm monitor demonstrated excellent leadership and responsibility and acted exactly as one would hope during such emergencies. As the situation evolved and information was updated, they used one page that sequentially documented each update. A crisis Web site replaced the homepage with special headings: Latest Information, News and Notices, Counseling, Resources and Related Links. Links to condolences, vigils, and community response were added on the second day. That press conference and all subsequent press conferences were streamed live on the Web site, which was heavily accessed by parents, alumni, and others. Providentially, the office had reached out to the Public Affairs Office at Virginia Tech several months after that tragedy to ask what advice they might have on preparing for and dealing with a mass casualty incident. The Virginia Tech Public Information Officer was generous with his time and shared information about the lessons they had learned. The Public Affairs Office was deluged with calls from parents seeking information about their children, foreign consulates wanting to know if any of their students were affected, and the media. All the local media indicated they were on their way to the campus and the sound of media helicopters overhead followed shortly. The crisis team decided to cancel classes until further notice, acted to make counseling available, scheduled a news conference for 5:30 p. University officials had experience setting up and using a hotline because the previous semester they had needed to activate a hotline operation twice: during a flood in late August on the day before fall classes were to have begun, and in December, when a graffiti threat was discovered in a residence hall bathroom. Also, hotlines were part of the mass casualty drill they had practiced during homecoming. The Division of Student Affairs staffed the hotlines and had at their disposal the most up-to-date information about the incident and what was being released to the public. It was recognized the President needed to be highly visible, and as much information as possible needed to be released as quickly as possible. They had an edge on the university in reporting some details because the media had dozens of reporters near the scene and all over campus. Key timeline entries for the public information that was communicated are included in the earlier timeline table. It is an affiliate hospital in the Illinois Trauma System-not a Level 1 Trauma Center, but nevertheless can handle, and does handle trauma patients within the Emergency Department. One of the doctors, who was managing the Emergency Department at Kishwaukee Hospital the afternoon of February 14, participated in a comprehensive debriefing on February 28, 2008. The details contained in this section are drawn heavily from the transcript of that debriefing and from the after action presentation the hospital representatives gave at a conference later that year. An additional nurse and physician were en route to the hospital to open their Fast Track area at 4 p. Once notified of the shooting, the hospital quickly formed a team of doctors, surgeons, nurses, and other technical staff to handle the incoming patients. The doctor in charge assembled five doctors, four general surgeons, and six orthopedic surgeons. Other medical staff, nurses, radiologists, laboratory personnel, and so forth supported the surge requirements to treat the wounded. Rockford Memorial Hospital, as the lead hospital for the region in which Kishwaukee is located, helped to manage additional medical-related resources. The lead hospitals in the system are responsible for finding extra ambulances at the required levels (basic, advanced life support, etc. They draw resources from other hospitals and transport services in the region and coordinate with the Illinois Emergency Management Agency. The designated hospital establishes a command site and remotely manages support from that location. The afternoon and evening of the shooting, Rockford worked to obtain helicopters from the east and the south because one of the helicopters normally used was down for maintenance, and weather problems to the north affected the availability of helicopters in that area.
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