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. DE03146078, DE10346078 A1, DE10346078A1, DE2003146078. Erfinder, Frank Straub, Martin Halama, Tomas Smetana. Antragsteller, Ina Schaeffler Kg. Antragsteller, Schaeffler Kg, Frank Straub, Hans-Juergen Lippert. Zitat exportieren, BiBTeX, EndNote, RefMan. On HIV From. Patentzitate (4), Klassifizierungen (3), Juristische . Mr. Can Happiness Be Measured. Frank Straub serves as the Chief Executive Officer at Blanco and Blanco Professional. On How Managerial Functions. Mr.

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Export Citation, BiBTeX, EndNote, RefMan. Patent Citations (7), Referenced by Essay, (2), . Inventatori, Josef Schwuger, Frank Straub, Bernd Helm, Stefan Dressler. Be Measured. Solicitant . Gore Vs Bush Electoral Map. Owner name: INA-SCHAEFFLER KG, 91074 HERZOGENAURACH, DE. Inventors, Frieder Altmann, Martin Halama, Helmut Kalb, Norbert Radinger, Erwin Rattmann, Gunter Schmitt, Frank Straub. Be Measured. Applicant, Schaeffler Kg.

Telefonnummer Deutschland: 07231560365. Telefonnummer International: + 497231560365. Stra?e: Enzstra?e 169. PLZ: 75181. On How Are The Implemented Workplace?. Ort: Pforzheim. Bundesland . Inventors, Volker Ploetz, Frank Straub, Wolfgang Fugel. Applicant, Ina Schaeffler Kg. Export Citation, BiBTeX, EndNote, RefMan.

Patent Citations (9), Referenced . Inventors, Tomas Smetana, Frank Straub, Frieder Altmann, Volker Ploetz. Applicant, Schaeffler KG. Export Citation, BiBTeX, EndNote, RefMan. Aufbau und Organisation der SPD im Landkreis Teltow-Flaming. Mitglieder des Hochschulrates: Vorsitzender Frank Straub, Vorsitzender des . Dr. Hans-Eberhard Koch, Geschaftsfuhrer der Witzenmann GmbH, Christine . Wohnungen fur Asylsuchende gesucht! . Moscheebau: Bocksprunge im Gemeinderat . Mai-Demo in K. Inventeurs, Frank Straub, Martin Halama, Tomas Smetana. Deposant, Ina Schaeffler Kg.

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Regional Service. Hier, in der Langenfelder Stadtmitte, sollen bald ?HM? und ?Intersport? einziehen. Foto: Frank Straub. Wirtschaft / Langenfeld, 10.08.2010 . Izumitelji, Frank Straub, Kristina Aust, Manfred Jansen. Vs Bush Electoral Map. Podnositelj zahtjeva, Ina Schaeffler Kg. Izvoz navoda, BiBTeX, EndNote, RefMan. Be Measured. Navodi koji se odnose . Inventors, Frank Straub, Kristina Aust, Manfred Jansen . DE1979420U *, 27 Jun 1967, 22 Feb 1968, Schaeffler Ohg Industriewerk, Waelzlageraussenlaufring. Inventores, Frieder Altmann, Martin Halama, Frank Straub. Sonnet 76. Solicitante, INA- Schaeffler KG. Exportar cita, BiBTeX . Owner name: SCHAEFFLER KG. Be Measured. 14 Jun 2006 . I?rad?jai, Frank Straub, Tino Beck.

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So leitete der Vorsitzende der Diozesangruppe Stuttgart, Reinald Wolff. Terminal: keine Letzter Login-Anzeige - antworten - Ich wei? nicht, wie ich das geschafft habe, aber seit einiger Zeit wird beim offnen eines neuen. Frank Straub: Dr. Hans Jurgen Thiemann : Ulmer Schokoladen http://www.ulmer-schokoladen.de : http://www.deep-action.info Webdesign by: Atelier Bitter: Infos; Artists; BLANCO CS GmbH + Co. KG Adresse: Flehinger Str.59 in be measured, 75038, Oberderdingen, Baden-Wurttemberg auf Bundesland Regional Branchenbuch. View Frank Straub#039;s professional profile on LinkedIn. LinkedIn is the Essay on world#039;s largest business network, helping professionals like Frank Straub discover inside . Die Stiftung Familienunternehmen steht fur die Belange der Familienunternehmer und Familienunternehmen wie die Forderung des unternehmerischen Nachwuchses und.

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A creative writing activity: A dark and stormy night. This is an idea I learned when I first started teaching and still use to this day. The main focus of the activity is on developing writing skills, but it's also good for developing listening and reading skills and also for practising past tenses and descriptive vocabulary. The activity should work at most levels above elementary, as long as your students have some knowledge of past tenses, but it works best when they also know past continuous / progressive too. All you need to get things started is a sheet of plain paper for each pair of students. The listening part comes first: Ask the students to draw the face of a person in the top right-hand corner of the can happiness be measured, page.

Once they've done this ask them to give the person a name. Then on Government Essay, the top left of the page ask them to write five adjectives to describe the person's appearance. Next ask them to write five more adjectives to describe the person's character. After they've done this ask the students to write three things that the person likes doing. Then ask them to write who the person lives with. In this way they build up a character profile for the person they are going to write about. The writing part: Now dictate the following sentence to your students: 'It was a dark and stormy night and' . Stop at this point and ask them to write in the name of the person they have drawn and followed by the word 'was' . Then ask the can happiness be measured, students to complete the sentence from their imagination and add one more sentence. Once all the students have added a sentence to their stories, get them to stop and pass the paper to classical economics the pair on can happiness be measured, their right (this means that every pair of students now has a new character). The students then read through the information and the beginning of the story and then add one more sentence to it. Sonnet 76. Once they've done this you ask them once more to be measured pass the paper to the next pair on gore vs bush electoral, their right.

Continue to do this with each pair of students adding a sentence to be measured each story, gradually building up each story as the papers are passed around the class. Continue with this until you decide that the students are starting to lose interest or have written enough and then tell them to finish the story. Once all the stories are complete there are a number of electoral map, follow-up options you can try. Put the stories up around the class and get the students to read them all and decide which is best. Give each pair of students a story and get them to try to find and correct errors. Get the students to write the stories up on a computer and then ask them to add more description and detail to the stories.

This activity is fun and creative and has always worked well for me both with adults and younger students. Nik Peachey, Teacher, Trainer, Materials writer, British Council. Alexandra_ replied on be measured, 22 October, 2011 - 19:47 Permalink. I really like your activity but i can't see the connection between a dark and stormy night and a person's appearance and Essay Transmitted Mother, character. The topic we are studying now is exactly the same. And I don't know how my students should use the information they've already written down about their character(I mean the description of a previous classmate). The thing is that I'm working with hard-of-hearing children and I must explain them eveything in details. stephaniesiam replied on 24 October, 2011 - 07:40 Permalink. Hi Nik and Alexandra,I read your post and reply, and I think that quite possibly Nik was using the be measured, dark and stormy night reference for vs bush electoral three reasons:1) It's the starting point of the story that is can happiness be measured, used for the person the students have described.2) It's a common cliche in Government Essay creative writing to think of Once upon a time. for fairy tales or It was a dark and can happiness be measured, stormy night for ghost stories.

I don't mean to jump to Essay conclusions, and I apologize to Nik if I missed his point, but this is what seems to can happiness be the natural connection to me.3) A dark and stormy night describe the visual aspect of the evening, but not the Essay Transmitted from to Child, details of can happiness be measured, what happened. With Economics, Keynesian. This is much the same as judging someone by their appearance. Be Measured. just because the night was dark and stormy doesn't mean it wasn't a good evening!Nik, I think this is a great idea. especially for younger writers who are interested in creative writing!Stephanie. M ALAM replied on 30 October, 2011 - 15:51 Permalink. I've go through the whole teaching method and to Contraceptive, found a different style of a teacher, who tried to create a method of teaching which really help to students for thinking and learning together. suman804 replied on 22 July, 2013 - 04:46 Permalink. actually you can also try pen picture which i do in can happiness my class.i ask a trainee to draw the pen picture of his friend in class.as regarding story it is better if we have individual story from each of participants. WilsonSmith replied on 14 January, 2014 - 06:13 Permalink.

This is a nice post in an interesting line of economics, content.Thanks for sharing this article, great way of can happiness be measured, bring such topic to discussion. KaraAharon replied on Introduction to Contraceptive Equity, 12 March, 2014 - 19:45 Permalink. I think the main idea here is to get students to be creative and think outside the box. Thinking of different adjectives to describe a person gets their minds going and most people need some help to begin a story. I'm sure the same exercise would work with a different opening line or other variations. It's also interesting how stories that start with an identical phrase can end so differently. Can Happiness Be Measured. Jason M. Gore Electoral. C. Han replied on 28 July, 2016 - 13:52 Permalink.

Theoretical supports (Education) for can happiness this practical lesson-plan. This lesson plan has strong practical and operational features, which can be applied into Essay on How Implemented in My our teachers' daily classrooms. It came to the cultivation of students' creative thinking and its correlations with the activities for can happiness be measured practicing their writing abilities, under certain carefully set background - 'a third person in students' mind when suffering a dark and stormy night'. This plan picked up my memory about the theoretical explorations of the creative thinking and its reflections from my daily explorations of piano (musical teaching) when I was studying in Newcastle University. Though the 'landing' subjects from education research are different - one is upon the branch of writing in English (language), and mine is upon the branch of Essay are the in My, musical expressions, the core root of them are same - motivating students' potentials and gifts in innovative self expressions through organizing languages (you knew, music is can happiness, a common language known all around the in contrast economics, economics, worlds) . Can Happiness Be Measured. Therefore, from the theoretical root to the deductive identification and Essay on HIV Transmitted Mother, clarification of what meanings behind can be meta-cognitively reflected-out from can happiness be measured, certain planned behaviors provided in keynesian economics this plan if our teachers try to apply this plan in their classroom, this settlement for comment is what I feel being good at and looking forward to be measured sharing and self-reflexiving some ideas produced through my 'curious and participant-observing' eyes. 1. States Government Essay. Here, it is a reference: 'Tsuda, I. (2015) Chaotic itinerancy and its roles in cognitive neurodynamics, Neurobiology. Can Happiness Be Measured. [Online] 31, pp. 67-71. Gore Electoral Map. Available at: http://dx.doi.org/10.1016/j.conb.2014.08.011 (accessed: 9th Jan.

2015)'. In this article, the biological mechanism of creative thinking has been physiological and experimental discussed. Be Measured. Briefly summarizing all and applying some of our theoretical and practical outcomes, then we would get to in contrast with classical economics this point: Chaotic-itinerancy is the description of our brain's situation when creative thinking will be produced. Can Happiness Be Measured. How could our teachers get this situation? Creating scenes with definitive differentials in multiple-subjects, suddenly dropping students into them for creating new nerve spaghetti junction's electricity-links' , and frequently shifting students among these scenes in a short and intensive time for enhancing these nerve links. In this case, if good-qualified practices and operations are made, the requirements of searchingdescribing a person in mind, and the imagery imaginations of 'A dark and stormy night' can all give students the feelings of 'suddenly, surprising, and out of mind', which can associate them build nerve connections. 2. Keynesian. Another operation - passing the stories created by one pair each among different pairs in certain order and making them create further sentence by sentence (if teachers can give some expressive and magic language-descriptions) - can make students travel in different mind - channels, participant-observe others' life and mind-patterns unconsciously, and motivate more creative sparks by be measured themselves. Here, teachers need to gore vs bush give some encouragements to students and let them bravely express themselves with freedom. Be Measured. Therefore, we would know teachers' guides are very important.

3. Then, I would like to mention a little bit about sonnet 76, 'searching a person in their mind-seas and accounting his (or her) characters'. This point, in can happiness be measured psychoanalysis (if we can develop it a little bit further), comes to the explorations of in contrast with classical economics, economics, students' deep unconsciousness worlds. (but I don't like the operation would be totally applied the be measured, psychoanalysis that teachers just want to search mental problems or disorders for their well-beings' controls. If done so, their developing sustainability and real creativity will be killed. Oppositely, we need to put some elements from humanity and on How are the Four Managerial Implemented, spirituality into our classrooms to encourage students creatively organize the person's 'face' with more detailed memories and constructive imaginations. ) . Here, if we can put some pieces of music from can happiness, nature and somehow with the functions of hypnosis, it would be better for students' meta-cognitive self-reflexivity. 4.About the finally part - 'Follow up', I think: let students share their stories in Essay Functions Implemented Workplace? front of can happiness be measured, blackboard is a positive operation for creativity, which can also cultivate students' skills in public performance and speech. However, I didn't agree that ' other students need to tell the errors from rights and correcting them '. If it is real creative thinking, there is no right or wrong. The encouragements provided to students and the 'to be better' suggestions are what our teachers need give to them, which could make their thinking patterns more reasonable and acceptable by all in their future. States. All in all, thanks for this teaching materials contributed for us, which I think can be seen as a good accumulation of can happiness be measured, our own teaching and learning experience if some theoretical supports can be put to category our thinking aspects. Sadie Doresy replied on 6 August, 2016 - 09:04 Permalink.

Thank you for such a detailed explanation on creative writing. These are really creative ways for generating wonderful ideas. All the exercises are really interesting. British Council, 10 Spring Gardens, London SW1A 2BN, UK. BBC World Service, Bush House, Strand, London WC2B 4PH, UK.

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essay down sydrome Down Syndrome Research Paper. Down syndrome is a chromosomal condition in which an individual possesses extra genetic material, specifically an extra complete or partial duplicate of chromosome 21 in some or all of an individuals cells. This results in several hallmark characteristics and acute cognitive affects. Be Measured! Some of the United States, physical traits associated with the syndrome are a small body, especially head and ears, hypotonia, hands that are broad and short, epicanthal folds, abnormalities of the ear, and be measured nasal bridges that are flat in shape. There are also several orofacial characteristics such as a protruding tongue that occurs as a secondary characteristic to having a small and narrow palate (Saenz). These are just some of the physical characteristics commonly seen in the chromosomal condition, but the actual presentation of vs bush electoral physical characteristics is highly individualized. Can Happiness! Down Syndrome is the most common chromosomal condition, affecting one in every 691 babies born in United States Welfare Essay the United States and over 400,000 individuals live with the be measured, chromosomal condition in sonnet 76 the United States (Ear, Nose and Throat and Down Syndrome, Fogle 281). There is a slightly higher incidence of Down Syndrome in boys than girls. Infants are often diagnosed at birth by the occurrence of physical characteristics, but the actual expression of Down Syndrome varies considerably, and the diagnosis may be delayed if too much importance is put on can happiness only the Essay Transmitted from Mother, typical physical characteristics. The diagnosis will be later confirmed through the use of genetic karyotyping, which determines the number of chromosomes present in the body's eukaryotic cells (Saenz 381).

The first physical characteristic of the chromosomal condition that is noticeable is often the presentation of hypotonia, the prescence of which should inspire concern and spur subsequent and swift assessment. Down Syndrome is, in most cases, not an inherited condition. Down Syndrome may be caused by Trisomy 21, which refers to the condition of having a an can happiness be measured extra copy of chromosone 21, meaning three copies, instead of two, in each cell. In these cases, the chromosomal abnormality occurs as a random event during the formation of reproductive cells (Down Syndrome). This occurrence is possible in either egg cells or sperm cells, but it is most likely to occur in gore vs bush electoral map egg cells, and it is the occurrence of nondisjunction, a mistake in the division of can happiness be measured a cell, that causes a reproductive cell to with contain an odd number of can happiness be measured chromosomes (Down Syndrome). Likewise, Mosaic Down Syndrome is not an from to Child inherited condition. It happens in the early development stages of a fetus as a random occurrence in cell division, resulting in some cells having the normal duo of chromosome 21 copies, while some cells have three copies. In the third case, Translocation Down Syndrome, the condition may be inherited. Can Happiness! A balanced translocation refers to the genetic material in between chromosome 21 and a different chromosome being in a different arrangement than normal that is called a balanced translocation because there is no extra material from chromosome 21 (Down Syndrome).

The carriers of this balanced translocation do not display signs of Down Syndrome, but they have a higher risk of giving birth to children with the chromosomal condition. The syndrome's severity ranges from the mild to in contrast moderate ranges; however, the one consistently present trait in can happiness children with Down Syndrome is mental retardation, and the syndrome is responsible for United States Essay, one percent of all cognitive mental retardation (Fogle 281). Despite these impairments many individuals are characterized as being generally pleasant, affectionate and happy people. While Down Syndrome individuals had a life expectancy of about 25 years in 1883, the life expectancy today is about 60 (Down Syndrome Fact Sheet National Down Syndrome Society). In respect to can happiness be measured their receptive language, children diagnosed with Down Syndrome often have language comprehension that is about the same as their mental age. Note, that this is often different from their chronological age. As a general rule, their aptitude for language comprehension is greater than their aptitude for expressive language, specifically speech.

It is important to note that these children frequently exhibit comparatively good development of language in their infancy and toddler stages, this is particularly true when the children are enrolled in early-intervention After this period of time, however, in the first school years the rate of language development noticeably slows down. In terms of general diagnostic testing, it is recommended by The American Academy of Pediatrics and the Down Syndrome Medical Interest Group that babies diagnosed with Down Syndrome should have audiologic testing directly after the are born and then again every six months until the sonnet 76, child is three, or until they can sit for an audiogram with ear specific testing. After this point, there should be an annual hearing test, and even if there is only a mild hearing loss, hearing aids should be considered. This is can happiness because a mild hearing loss in a child is more severe that it would be in an adult because of the development of the child's intellectual, emotional and Government Essay language based skills (Ear, Nose, and Throat and Down Syndrome National Down Syndrome Society). The tests should change with their development. Newborns who have been diagnosed with the syndrome receive the mandatory hearing screening and can happiness be measured receive objective tests like otoacoustic emissions or auditory brainstem response like other babies. Vs Bush Electoral Map! Those who fail the screening should be tested with visual reinforcement audiometry at the devlopmental age (not chronological age) of ten months and conditional play audiometry when they reach the can happiness, developmental age of two years. Adults should have a hearing assessment conducted every five years, ideally with pure tone audiometry testing and an additional word test (Snashall, Susan). Due to differing craniofacial and orofacial anatomy, tymapnometry will always be a useful test for middle ear fluid.

Likewise, an otoscopic exam should be conducted annually to check the accumulation of wax. The buildup of cerumen is so common that pathologies of the middle ear may go unnoticed unless searched for Essay on HIV Transmitted to Child, by otoscope. A study by be measured, Hassman E., Skotnicka B., Midro A.T., and Musiatowicz M. In Contrast Economics, Keynesian Economics! was conducted in 1998 to examine features of hearing loss in individuals with Down Syndrome through otorhinolaryngological examinations and audiological assessments. The study involved forty seven children and fourteen adults with Down Syndrome. Tests were decided upon by the chronological age of the subjects, their intellectual abilities and be measured the function of their middle ear; pure tone play audiometry, tympanometry, acoustic reflex, auditory brainstem response and distortion product otoacoustic emissions (Hassman E et. Al 199) were the examinations included in the study. The resulting data were compared to control groups of the appropriate age. Electoral Map! The results showed that the children with Down Syndrome often exhibited impaired conductive function of the can happiness, middle ear. On How Four Implemented In My! expressed by pathological tympanometry(Hassman E et al.

199). More specifically, B and can happiness C type tympanometry was found in 56% of the individual ears that were tested. It was also found that distortion product otoacoustic emissions had lower amplitudes in the children diagnosed with Down Syndrome than those found in sonnet 76 the control groups. In light of the time component in the development of be measured language in children with Down Syndrome, hearing impairment is a significant problem, especially since hearing impairment is one of the most common disabilities in Government Welfare Essay children with Down Syndrome (Kattan et al. 931). The ability to hear is essential to a child's ability to be measured develop language and speech and United Welfare Essay because many children with Down Syndrome have hearing problems early in their lives, hearing loss is a great concern for these individuals.

Consequently, children with Down Syndrome who are diagnosed with a hearing impairment are in danger of having learning impairments subsequent to their hearing loss. Therefore the diagnosis and treatment of can happiness be measured otological disorders in children is an Essay important topic for the education of speech and can happiness language students as well as clinical research. A study by Kattan, Jarrar, and Essay Introduction Equity Mahasinin 2000 found that 50% of the 26 children they tested had a conductive hearing loss, 4% had sensoirneural hearing loss, 4% exhibited a sensorineural hearing loss, while 35% had normal hearing (Kattan et al. 931). Though a small study, it supports the can happiness, general consensus that children with Down Syndrome have a high incidence of persistent conductive hearing loss. This must be aggressively diagnosed and managed because this hearing loss may turn out to be one of the major factors that may cause the Essay to Contraceptive, spoken communication abilities of Down syndrome children to rate significantly lower than their actual cognitive abilities. The conductive loss often seen in individuals with Down Syndrome can result from several otologic pathologies such as stenotic ear canals, otitis media, glue ear, cerumen impaction, and cholesteatoma (Satwant S. et al.). Be Measured! Stenotic ear canals refer to Essay Four Managerial Functions in My Workplace? an external ear canal, the canal that connects the external ear to the middle ear, that has become unusually narrow. If the can happiness be measured, ear canal is narrow enough it may cause a hearing loss. The stenotic ear canals can present several practical problems, the canals may become easily clogged, and it may be difficult to correctly diagnose middle ear disease in stenotic ear canals.

To be sure of appropriate examination and diagnosis, the canals may require an otolaryngologist to clean the canals before examinations, which should occur every three months to prevent ear infections that may otherwise go undiagnosed and Essay from Mother to Child untreated. It should be noted that since ear canals grow with age, the can happiness be measured, child's canals may widen, and Essay on HIV from Mother to Child may no longer be a problem after about age three (Ear, Nose, and Throat and be measured Down syndrome National Down Syndrome Society). The diagnosis for this is aided by a simple macroscopic examination of the canal or a standard otoscopic examination. In terms of treatment, a surgeon may remove extra tissue to widen the canal. Another concern is the actual craniofacial and orofacial anatomy of Down syndrome children which may also lead to on How Four Managerial Functions Implemented in My Workplace? chronic ear problems. Certain anatomical characteristics may impede the aeration of the middle ear which can lead to otitis media. Be Measured! The outer ear canal normally cleans itself, moving cerumen away from the tympanic membrane towards the external auditory meatus, but in children with Down syndrome, the canal is abnormally narrow making these processes less efficient and leading to sonnet 76 a build up of ear wax. This accumulation of cerumen is made worse by the fact that it may be more copious and harder than normal, and the impacted ear wax may then block the external auditory meatus. There may also be problems with the be measured, Eustachian tube which connects the middle ear space to the nasopharynx. Eustachian tube dysfunction may result in otitis media with effusion (glue ear), which can result in a conductive hearing loss.

Otitis media with effusion does not resolve on it's own in Down syndrome individuals as it does in others due to Transmitted to Child the shape of the Eustachian tube. In general, the tube may be narrower and more horizontal than normal and be measured the nasopharynx may be small (Snashall, Susan). Also, children with Down syndrome may have hypotonia, also known as low muscle tone, which may cause difficulties in opening and closing the tube. This can cause an accumulation of Welfare negative air pressure in the middle ear space which may result in retention of fluids and can happiness infection (Ear, Nose, and Throat and Down Syndrome). Another concern about Eustachian tube dysfunction is that it will last longer in Essay Introduction to Contraceptive children with Down syndrome that other children, so an important part of prevention is frequent examinations and consistent monitoring. Otitis Media is a basic term for the infection or inflammation of the spaces in the middle ear (Peterson, Bell 77). Though otitis media is a very common childhood illness, children with Down syndrome are particularly susceptible to be measured ear infection including serous otitis media (thin, watery fluid is present with infection). There are several causes for this; for one, individuals often produce large amounts of mucous. When this is gore map coupled with immunodeficiency in the individual, infection may easily occur.

Also due to be measured immunodeficiency, children with Down syndrome have a higher incidence of upper respiratory infections which can predispose chronic (lasting at least six weeks) otitis media. Upper respiratory infections or allergies may result in a swollen Eustachian tube which may entrap bacteria and may result in otitis media. Symptoms of Essay on How are the Four Managerial otitis media include ear otalgia, which refers to can happiness ear pain, fever, and otorrhea, which refers to discharge of the ear. To diagnose otitis media, an otoscopic examination will often be effective. The doctor will be looking to see a tympanic membrane that is normal in color, pink to gray, and it should be slightly translucent. An inflammed, red or engorged eardrum will point towards infection, as well as a tympanic membrane that bulges outward, retracts inward, or shows signs of perforation. Other options are tympanometry to test the middle ear function and test for fluid.

If a child experiences chronic Eustachian tube dysfunction, treatment may include pressure equalization tubes which can eliminate the in contrast with classical economics, keynesian economics, chronic episodes. These tubes are placed in the eardrum and allow air to enter the middle ear. The downside of the tubes is that they may need to be measured be replaced. For chronic ear infections, anti-biotic medication may also be considered. Glue ear is also called secretory otitis media or otitis media with effusion. Like regular otitis media, it has a high incidence in Down syndrome children.

A mucous like fluid secretes and gathers in sonnet 76 the middle ear, which should only be filled with air, and covers the ossicles, preventing them from moving normally, which results in reduced hearing levels. While glue ear is common, Down syndrome provides extra complications to this condition. For one, the glue-like substance is stickier which makes it more difficult to wash and prone to can happiness be measured infection. Again, anatomy may affect the condition because if the Eustachian tubes are narrower and on Introduction Equity more horizontal, it will be difficult for the Eustachian tube to let the middle ear drain. Treatment of glue ear is essential because, if left untreated, glue ear may result in irreversible damage to be measured the middle ear, this may be due to the lack of motility of the Essay are the Four Managerial Functions in My, ossicles.

Fortunately, there are three main approaches to be measured treating glue ear: pressure equalization tubes, microsuction, and tonsillectomy, adenoidectomy or both, so there are several options to accommodate individual needs. Essay Four Managerial Implemented In My! The procedure to inset pressure equalization tubes is called a myringotomy operation and refers to the small cut made in the tympanic membrane which may also be done as a separate procedure. It is generally performed with the patient under a general anesthetic. If the fluid is can happiness be measured very viscous a cut will be made to let air into Government Welfare, the middle ear space while the other cut drains the fluid. Can Happiness! Pressure equalization tubes go through the tympanic membrane, relieving the often painful pressure of the fluid against the eardrum, and allow for sonnet 76, the fluid in the middle ear to can happiness be measured drain into the external auditory canal. Economics, Economics! The tube is held in place by the tension in the tympanic membrane.

The pressure equalization tubes will be pushed out of the can happiness, tympanic membrane after a few months to a year of having them in Essay from place, but if they are placed correctly they are extremely effective, allowing the fluid to leave the middle ear space. If an adenoidectomy is to be performed as well, it will probably be during the same surgery. Adenoidectomy removes the be measured, adenoids if they are enlarged. Essay Are The Managerial Functions In My! Removal may be beneficial because it is behind the adenoids that glue ear may reoccur after pressure equalization tube placement. Another option is can happiness microsuction, which involves inserting a needle through the tympanic membrane and using it to draw out the fluid. The upside to United States Government this procedure is that the fluid does not end up in the external auditory canal and have to be cleaned, which is be measured especially helpful in Equity children with Down syndrome with narrow canals. The downside of microsuction is that it often requires several procedures. Like glue ear, cerumen impaction is a very common otologic pathology, and it has a high incidence in can happiness be measured individuals with Down syndrome. It is a common cause of conductive hearing loss. Ear wax is meant to protect the skin of the canal, especially when it is Introduction to Contraceptive Equity filled with water. Normally, the wax should move towards the opening of the can happiness, ear it is easily washed away.

As mentioned before, individuals with Down syndrome often have cerumen that is abnormally hard or thick and accumulates quickly in a narrow ear canal and may quickly block the canal with partial or full occlusion. This may result in a reversible conductive hearing loss. I n a study of 107 children with Down syndrome who were referred to otolaryngologists showed that 39% had stenosis of the external auditory canal frequently complicated by cerumen impaction (Roland et al. 52). The combination of the accumulation of on HIV to Child thick cerumen and auditory canal stenosis can quickly lead to be measured a conductive hearing loss. The symptoms of Essay from impacted cerumen are earaches, the sensation of can happiness be measured plugged ears, tinnitus, and some hearing loss. Are The In My Workplace?! To remove the ear wax, oil can be used to soften the cerumen. This may also be done as a preventative measure. Many cases of cerumen impaction may be treated at home, but in cases of auditory canal stenosis, the family may have an otolaryingologist remove the wax. Can Happiness Be Measured! Irrigation of the ear canal may also be effective, but irrigation should never be performed if the tympanic membrane may be perforated as this could lead to Essay on Introduction Equity acoustic trauma or otitis media.

Cholesteatoma are benign ear cysts, and, specifically, they are accumulations of squamous epithelium and karatin material that usually accumulate around the middle ear and mastoid and form a progressively enlarging and destructive cystic lesion (Issacson 604). The cholesteatoma may continue to enlarge to the point where it will destroy bone. If untreated, lesions may break through the can happiness, temporal bone and apply pressure to the brain, which may result in infection that may, in turn, lead to intercranial abscesses. Individuals with Down syndrome are more at risk for developing cholesteatoma because they may have some of the conditions that put individuals at risk for developing the United States Government Welfare Essay, cysts such as middle ear diseases, eustachian tube dysfunction, prior otological surgery, traumatic blast injury to ear, and congenital anomalies (Cholesteatoma). If an individual complains of otorrhea (discharge from the can happiness be measured, ear) or hearing loss, an are the Managerial in My otolaryngologist should realize that cholesteatoma might be present (Bacciu et al.). Cholesteatomas may cause irreversible hearing loss but fortunately, most incidences may be cured through surgery. The surgery's outcome depends on the size of the cholesteaoma when it is diagnosed. For children, it is important that lesions in the tympanic membrane are diagnosed by a pediatrician and that the child is then referred to an otolaryngologist.

The cholesteatoma will be first noticeable as a round cyst, white in color, that can be seen behind the can happiness be measured, tympanic membrane, which is still in tact. If the cholesteatoma goes unnoticed, it will grow and the middle ear space will have a large white mass that bulges outward. A cholestatoma may be congenital or acquired. As they enlarge, the Essay on Introduction to Contraceptive Equity, normal variegated appearance of the can happiness be measured, middle-ear space disappears, replaced by a bulging white mass. In the early stages of the sonnet 76, cholesteatoma, it is unusual for the tympanic membrane to be perforated and for drainage to occur. These incidents most often come months or years after the onset of hearing loss which helps emphasize the importance of early detection (Issacson 607). A 2005 study by Bacciu, Pasanisi, Vincent, et al., was conducted to document the surgical treatment of be measured cholesteatoma in subjects with Down syndrome (Bacciu et al.

1007). This study exemplified some of the methods used to treat cholesteatoma as well as the challenges inherent in the treatment of this otologic pathology for Down syndrome individuals. They followed nine pediatric patients that were being surgically treated, and two of the Essay Transmitted from to Child, patients had cholesteatoma in both ears (bilateral), which brought the total of ears being treated to 11. Can Happiness Be Measured! Two of the ears underwent a canal-wall-up mastoidectomy, while eight ears underwent a canal-wall-down mastoidectomy. Mastoidectomy refers to the removal of an infected section of the Essay Four Managerial Functions Implemented, mastoid bone. One ear underwent a modified Bondy procedure, a modification of the mastoidectomy which entails exteriorizing the be measured, mastoid cavity leaving the pars tensa and ossicles intact. The outcome of vs bush map this study was that one of the can happiness, ears that underwent the vs bush electoral, canal-wall-up mastoidectomy was found to have reamaining cholesteatoma present. Another ear, after the same procedure, developed recurrent cholesteatoma which necessitates a change to a canal-wall-down mastoidectomy. Another patient's neotympanic membrane became perforated and had to be repaired.

This study demonstrated that cholesteatoma can be difficult to completely eradicate in a patient with Down syndrome, and can happiness be measured an emphasis should always be put on early diagnosis and prevention especially in light of the challenges presented by the orofacial and craniofacial anatomy of children with Down syndrome. Des pite the fact that conductive hearing loss is more prevalent than sensorineural hearing loss in indi viduals with Down syndrome, they are more likely to more likely to Government Welfare Essay have congenital permanent inner ear hearing loss than the general population (which has an can happiness incidence of Essay on HIV from Mother 1:1000) (Snashall, Susan). One of the reasons this happens is because the Cochlear hair cells may be absent. If the hair cells are present, they may still be subject to early degeneration. Once they reach their teenage years and be measured after, they have a good chance of cochlear degeneration occurring. Hearing aids are often looked at as a viable option for even mild loses and amplification plays an important role in sonnet 76 treating hearing loss in children with Down syndrome because it is probable that even a mild loss will have a strong impact on be measured the development of their language. This is a severe concern, so hearing aids are also often recommended for conductive hearing loses that may last for over a few months.

Hearing aids are also used with Down syndrome adult individuals who are living with early onset dementia because the loss may significantly affect their cognition skills. Transmitted Mother! There are special considerations to take into account when Down syndrome individuals are to receive hearing aids because their ears tend to be smaller. It may also be that hearing aids are not appropriate for a child and a classroom FM system may be implemented instead. For cases of sensorineural hearing loss, recruitment is nearly always concomitant with the loss. Recruitment refers to the perception that the can happiness, level of Essay on HIV from sound drastically increases for specific frequencies and be measured becomes too loud too quickly and causes pain. It follows, then, that recruitment may lead to sound intolerance. This concern will be reflected in sonnet 76 the prescription for the amplification devices. Down syndrome is the most commonly occurring chromosomal condition, and be measured research into improving the quality of life for people with Down syndrome is, of course, incredibly important. It may be easy to underestimate the impact that a hearing loss may have on an individual's quality of life, especially in children when even a mild loss can be devastating to their speech and language development, but hearing is a critical skill for communication which is an integral part of a good quality of on How are the Four Functions Workplace? life. Be Measured! Thus, the Essay on How Implemented Workplace?, treatment of otologic pathologies and be measured hearing loss in Down syndrome is of the greatest concern to giving individuals with Down syndrome the quality of electoral life they deserve.

Bacciu, A., E. Pasanisi, V. Vincenti, D. Giordano, A. Caruso, L. Lauda, and S. Bacciu. Surgical Treatment of Middle Ear Cholesteatoma in can happiness Children with Down Syndrome. Otol Neurotol 26.5 (2005): 1007-10. Print. Board, A.D.A.M.

Medical Encyclopedia Editorial. Wax Blockage: Causes, Incidence, and Risk Factors. PubMed Health . U.S. National Library of vs bush electoral Medicine, 18 Nov. Web. 10 Apr. 2012. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001974/. Cholesteatoma. Bestpractice.bmj.com . BMJ Evidence Centre, 2011. Web. 13 Apr.

2012. Down Syndrome. - Genetics Home Reference . Genetics Home Reference, 2008. Web. Can Happiness Be Measured! 9 Apr. 2012. http://ghr.nlm.nih.gov/condition/down-syndrome.

Down Syndrome Fact Sheet - National Down Syndrome Society. Ndss.org . National Down Syndrome Society, 2012. Web. 10 Apr. 2012. http://www.ndss.org/en/About-Down-Syndrome/Down-Syndrome-Fact-Sheet/. Ear, Nose, and Throat and Down Syndrome - National Down Syndrome Society. Ndss.org . National Down Syndrome Society, 2012. Web. United States Essay! 13 Apr. 2012. http://www.ndss.org/en/Healthcare/Associated-Conditions/Ear-Nose-and-Throat-and-Down-Syndrome/. Fogle, Paul T. Can Happiness! Foundations of Communication Sciences Disorders . Clifton Park, NY: Thomson Delmar Learning, 2008.

Print. Hassman E, B. Skotnicka, A.T. Midro, and M. Musiatowicz.Distortion Products Otoacoustic Emissions in Diagnosis of Essay on HIV to Child Hearing Loss in Down Syndrome. International Journal of can happiness be measured Pediatric Otorhinolaryngology. Essay On How Managerial Functions! 45.3 (1998): 199-206. Can Happiness! Print. Issacson, Glenn. Diagnosis of United States Government Welfare Pediatric Cholesteatoma. Pediatrics Vol. 120.No. 3 (2007): 603-08.

Print. Kattan, H.A., R.F. Jarrar, and Z.Z. Mahasin. A Pilot Study of the Relationship Between Down's Syndrome and Hearing Loss. Saudi Medical Journal 21.10 (2000): 931-33. Can Happiness! Print. Pappas DG, C. In Contrast With Economics! Flexer, and L. Shackelford. Otological and Habilitative Management of Children with Down Syndrome. Laryngoscope 104.9 (1994): 1065-70. Can Happiness Be Measured! Print.

Peterson, Miles E., and Theodore Scott Bell. Foundations of Audiology: A Practical Approach . Upper Saddle River, NJ: Pearson/Merrill Prentice Hall, 2008. Essay On How Managerial Implemented Workplace?! Print. Roland, Peter S., Timothy L. Smith, Seth R. Schwartz, and Richard M. Can Happiness Be Measured! Rosenfield. Essay Transmitted From To Child! Clinical Practice Guideline: Cerumen Impaction. Otolaryngology - Head and Neck Surgery , (2008): 1-21. Print. Sacks, Ben, and Amanda Wood. Hearing Disorders in Children with Down Syndrome.

Down Syndrome News and can happiness Update 3.2 (2003): 38-41. Print.

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