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Categories > Celebrities > My Chemical Romance
MCR Halloween Special 20121 Reviews
Frank follows Gerard to a Halloween party in which the monsters are all too real.
Frank was running around outside on Halloween, as it was not only his favorite holiday of the year, but also his birthday. Think of it this way, he got a ton of free candy on his birthday. So at any rate, the young Frank Iero was having quite a fun time, when he saw someone that looked awfully familiar. "Gerard!" He yelled, running up to the figure wearing a black cloak, and walking away from him.
Gerard ignored him, until Frank ran right up to the taller man, pulling on his cloak. "Hey Gee? Where'd ya get this thing? It's fuckin' awesome!" He spewed. "How dare you touch me!" Gerard snarled at Frank. "Woah, no need to be bitchy... Wait you're keeping in character aren't ya?" Frank asked, almost oblivious.
"Sure...." Gerard said, but Frank couldn't help but catch the slightest hint of sarcasm running through his words. "Gee, where ya goin? And where's Mikey?"
"The party." Gerard said, not volunteering any more information than that. It seemed to answer both questions. Frank thought nothing of it, as they usually had a party with a Halloween theme for him every year. He followed Gerard into a more decrepit area of town, up to a house that was seemingly bursting at the seams with the noises of a party inside. The clanking chains seemed all too real, as well as the screams. Gerard opened the door, and walked inside. Frank was about to follow him, when his phone buzzed in his pocket. Before the door closed, he saw a guy with ridiculously good zombie makeup. Good to the point it looked like he was missing half his lower jaw and his brain was exposed.
It was a text message. From Gerard.
Where r u M n I @ ur house 4 20 min
Gerard couldn't text worth a shit, but right then, Frank realized something. Whoever, or whatever he followed, wasn't Gerard. And the monsters at the party were all too real. And the street around them, all too quiet. Frank started to run like he'd never run in his life.


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Washable Shaggy Rug
- Low stock, selling fast
49 reviews
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Machine Washable Shaggy Rug in 3 sizes
Made in the UK, this long, deep pile rug comes in a range of gorgeous colours and has an anti-slip backing that's ideal for homes with laminate, wood or tiled floors.
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Available separately is a circular version (item number LK199).
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- Made in the UK
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12 x 8ft Cotswold Shiplap Summerhouse
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6 reviews
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Flymo 330VX Easi Glide 1400-watt Hover Lawn Mower
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203 reviews
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The Flymo Easi Glide 330VX hover lawn mower's cutting-edge technology makes it perfect for tackling medium-sized lawns.
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- Flymo Easi Glide 330VX lawnmower
McCulloch CS360T Petrol Chainsaw
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19 reviews
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This McCulloch CS360T petrol chainsaw is one of the fastest, most effective way of cutting through larger sections of wood like trees and logs.
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16 reviews
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The Flymo EasiCut 600XT is a powerful hedge trimmer with an unique handle design for easier, safer use.
Its powerful 500 watt motor and 60 cm dual action, double sided cutting blades allow you to sculpt your hedge or bushes effortlessly. The 12 metre mains cable means it is ideally suited for medium sized gardens.
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- Flymo EasiCut 600XT hedge trimmer
Furniture Insurance available:
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Corona Solid Pine Coffee Table
- In Stock
12 reviews
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Corona Solid Pine Coffee Table with Storage Drawer
Plus optional home assembly service*
Corona is a rustic range of Mexican-inspired living and dining room furniture crafted from stunning solid pine.
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Get the full Corona look by adding co-ordinating living and dining room furniture in this range, including TV unit, sideboard and console table, which is available separately.
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Please note: we regret that this service is not available to residents of the Isle of Man, Republic of Ireland or the Shetland Islands.Colour: Pine.
480 Blue Icicle Lights - Indoor and Outdoor - FREE lights included!
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Create the perfect Winter Wonderland with these blue icicle lights. Comes with Free battery operated light set in one of these three stunning designs: Snowflake, Star or Berry. 480 Blue LED's. 10m lead cable. Drops of 3, 5 and 7 LED's. 11.8m lit length. IP20 transformer (transformer to be kept indoors). Lights suitable for indoor or outdoor use.
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4-Burner Gas BBQ
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41 reviews
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This family-sized four burner gas barbecue is the perfect way to enjoy alfresco dining in your garden or patio.
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This BBQ is fueled by Propane Gas (37mbar) - not supplied.Colour: Black.
Blackout Roller Blind
- In Stock
73 reviews
- Delivery
Blackout Roller Blind in 6 width options
Whether you want to block out sunlight, or an awkwardly placed street lamp, this blackout roller blind is ideal for making your room as dark as possible.
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- 8 colour options available
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FOREST Solway Fence Panel 6 x 6ft (7 pack) Fence Panels
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0 review
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Solway Fence Panel 6 x 6ft (7 pack)
A pack of seven premium pressure treated fence panels manufactured with sawn boards fixed horizontally into the surrounding framework. Pressure treated for longer life eliminates the need for annual retreatment. No need to use a gravel board.
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Black & Decker ST4525-GB 450-watt Corded Strimmer
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7 reviews
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450-watt corded strimmer, 25 cm swathe. E-drive gear system for high torque and max cutting power. Automatic line feed system. Adjustable 2nd handle to suit all heights. Telescopic tube for height adjustment. 2-year guarantee.BLACK and DECKER helpline: 01753 560 055.

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Yeah, she's an old chick. She's older than the hills. That's a saying around here. She's my moms best friend. She's been sucking my dick since I don't know when. I don't think my mom knows she does it. If she does, my mom never says anything to me about it. Man, she really knows how to suck a dick. I've never had a woman my own age suck my dick half as good as she does.
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Kid President is a family project out to change the world. Follow our adventures on YouTube, TV or on this happy little blog. It's everybody's duty to give the world a reason to dance. Get to it!
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3D Modeler using 3Ds max. Also experienced in Game Maker, Halo CE (custom edition), animation, texturing.
2 comments by MHstudios on Mar 12th, 2012
OK first blog, well I am not a blogger so i don't know what to blog about, so if you want me to blog about something just put it in the comments.
Things are going good, I got a few projects going here and there. Been really busy with other work as well, witch is really nice seeing that I haven't had many was of making $$ after our business burnt down.
You should see some stuff posted soon. I have been working on a full on high poly G36c with every detail, then I plan on baking it, I will post my progress on that as well.
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Study Abroad
Getting Started
How to Apply Study in your Major FAQs Passport Information Financial Aid Eligibility Academic Credit Non-Wake Forest Students Cross Cultural Engagement
WFU Programs
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Pre-Departure Orientation
While Abroad
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For Parents
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Helpful Links
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Home Post-Grad Opportunities
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Disclaimer: While we are familiar with many of the resources listed, WFU and the Center for Global Programs and Studies do not endorse or recommend any organization or website in particular. WFU is not responsible for any issues with the listed resources.
Transitions Abroad: A general website providing information about searching for an international job, internship or volunteer opportunity. This site provides information and links about everything from short-term to long term work abroad as well as English teaching organizations and au-pair. http://www.transitionsabroad.com/listings/work/index.shtml
Idealist: An online network and database of non-profit organizations. Groups, networking tools and searches are available. You can search everything from job opportunities to organizations located in specific places so you may send "cold resumes". Volunteer opportunities and internships are also listed. www.idealist.org
IES-Berlin: IES
BUNAC: A job, teaching, volunteering placement agency offering chances to be placed in various countries throughout the world, for a fee which covers placement, visa issues and insurance. http://www.bunac.org/
CDS International: A non-profit which offers many scholarship and internship opportunities. Most are located in
Interexchange: An organization that organizes internships, work, seasonal jobs and au-pair opportunities, for a fee which covers placement, visa issues and insurance. http://www.interexchange.org/
CIEE: One of the oldest and largest experiences abroad agencies. CIEE offers various opportunities to teach English around the world. Participants must pay a program fee which covers placement, visa issues and insurance. http://www.ciee.org/index.htm#teach
Career Services also has a "City Tour" guide, listing many cities throughout the world, visa and work permit, culture, weather and living information. This list has numerous resources listed for internships, scholarships, companies and job searches. http://www.wfu.edu/career/InternationalCityTour.pdf
Back Door Jobs: A database of many opportunities worldwide. Adventure jobs, teaching opportunities, sustainable living and farming opportunities, internships and youth trip leading jobs are listed. http://www.backdoorjobs.com/
Jobs Abroad: A website with many listings of current job openings from all over the world. Many teaching, au-pair and language camp jobs are listed. www.jobsabroad.com
The Riley Guide: One of the most thorough online listings of job search resources and search engines by region and country. Almost every country or region is listed with links to their most popular job posting sites. This site also includes NGO?s and is recommended if you wish to directly search for a job yourself without a placement agency. http://www.rileyguide.com/internat.html
Experiment in International Living (EIL): A World Learning supported program which takes high school students on educational summer tours abroad. They offer summer positions as trip leaders in an area where you have experience and language skills. Go to their website for recruiting. http://www.usexperiment.org/
American Bar Association (
American Medical Student Association (AMSA): AMSA provides a database of various opportunities for persons with medical backgrounds to gain experience abroad. http://www.amsa.org/global/ih/ihopps.cfm
American Red Cross: The American Red Cross has many opportunities for employment outside of the U.S. Click on their job link. http://www.redcross.org/
International Cooperative Education (ICE): This organization has agreements with many companies and organizations throughout the world. They offer placements for internships and jobs. They charge a fee which covers placement, visa issues and insurance.
Wall Street Journal: The job search engine of the Wall Street Journal. It offers a world wide search option. http://jobs.careerjournal.com/careers/jobsearch?clientid=cj
Teaching Abroad
Japanese Exchange and Teaching Program (JET): JET Program Participants are invited to
Connecting Schools to the World: The goal of CONNECTING is to broaden the minds of Argentine students by placing them in contact with teachers from English-speaking countries. Those selected for the program live with families in rural pueblos throughout
Dave's ESL Cafe: A database of information and jobs for people interested in teaching English as a second language. http://www.eslcafe.com/
Berlitz: One of the largest English as a second language schools in the world. They have hundreds of schools on almost every continent offering courses for all ages of learners. Many times you do not need an ESL certificate to teach groups of children. http://www.berlitz.com/
Wall Street Institute: A school which offers English courses for adults and professionals in many countries throughout the world. http://www.wallstreetinstitute.com/
Teach Abroad: Transitions Abroad's online database of English teaching opportunities. http://www.teachabroad.com
Teach English in
Fulbright Teaching: Fulbright also has teaching opportunities available throughout the world. Sometimes, these opportunities are more accessible than the research grants offered by Fulbright. http://us.fulbrightonline.org/
Service Civil International (SCI): A non-profit, world wide network of individual chapters, in many countries throughout the world that offer various work camps in numerous fields, ranging from one week to months. Long-term opportunities also exist. http://www.sciint.org/
Volunteers for Peace (VFP): A
Willing Workers on Organic Farms: By becoming a member, you have the opportunity to receive free room and board at any of the thousands of WWOOF farms throughout the world. You do not have to have any previous farming experience. http://www.wwoof.org/
Habitat for Humanity: Assist in various projects throughout the world, sponsored by Habitat. http://www.habitat.org/ivp/default.aspx?r=nav
*For more information about these scholarships, contact Dr. Tom Phillips,
*The Rhodes Scholarship: Study at
*The Rotary Foundation: Scholarships can be for 3 months, 6 months or the academic year. You must contact the local district for more information. http://www.rotary7690.org/index.shtm
*Fulbright Scholarship: Fulbright is the largest U.S. international exchange program offering opportunities for students, scholars, and professionals to undertake international graduate study, advanced research, university teaching, and teaching in elementary and secondary schools worldwide. http://us.fulbrightonline.org/
*DAAD Scholarship: Many different scholarships throughout
The American-Scandinavian Foundation (ASF): offers fellowships and grants (to individuals to pursue research or study in one or more Scandinavian country for up to one year. Awards are made in all fields. http://www.amscan.org/fellowship.html


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Law West of the Pecos
April 23 at 6:42pm
Mrs. Castillo, you have a lot of nerve to be running for this position. You did not live up to any of your campaign promises the first time, do you really believe that you will live up to them the second time around? NO! Not only that, but this is the seat that Jim Miller left. You have no shame after the way that you cut him down at that one council meeting. Your so called management and leadership experience did not help the first time around especially after you became a puppet of Danny Tejada. Makes me wonder how you treated employees under you at Frost Bank with those same management and leadership skills. You cannot be trusted and do not deserve a second chance. We know that you are still under Tejada's control and it would not surprise me at all if you try to bring back the idea of the sports complex and try to manipulate the FEDC and the Event Center with your cousin GEM. You are not the right person for this position. VOTE REED!
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The all-new big-screen adventure dives into theaters Nov. 25, 2015, taking moviegoers back to the extraordinary underwater world from the original film. Finding Dory reunites the friendly-but-forgetful blue tang fish with her loved ones, and everyone learns a few things about the true meaning of family along the way.
Finding Dory comes to theaters June 17th, 2016 and stars Ellen DeGeneres, Albert Brooks, Diane Keaton, Eugene Levy, Ty Burrell, Willem Dafoe, Vicki Lewis, Idris Elba. The film is directed by Andrew Stanton.


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As one of the founders of this field and someone who has helped guide its development, DeMello is uniquely situated to write this book. She does an admirable job detailing the history of human--animal studies, its intricate relations to other fields, and its multi/interdisciplinarity. The right book at the right time.


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As I started to track my calories, I decided to have whole grain crackers,
with cheese or hummus like:
-- Wasa - Whole Grain Cracker: 1oz = 91cals
-- Ak-Mak - Cracker: 1oz = 110cals
in the store last night I decide to check my former loaf a bread, an
organic, locally made, whole grain bread.
-- Vital Vittles - Flax-Seed Oat Bread 1oz= 75cals
Of course I had to do all the math for servings sized to get them
to one uniform number 'Ounces"
1 slice(52g) Vital Vittles - Flax-Seed Oat Bread
1 slice(14g) Wasa - Whole Grain Cracker
5 crackers(1 oz) Ak-Mak - Cracker
I'm sort of surprised, a loaf of good bread is both cheaper per ounce
than these crackers, but calorically bread gives me more bang
for the buck. Again, I'm surprised.
I guess the downside is that a slice of this loaf is probably what I'm
going to eat and it is 140 calories and a slice of was is 45. I usually
have two Wasas which still less than the bread.
But I think with discipline, I am going to try getting off these crackers
(which are expensive) and try to have slices of fresh bread.
Message Boards » Food and Nutrition
TOPIC: crackers vs. bread
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Joined Aug 2010
Posts: 212
December 5, 2010 4:18 PM
Joined Nov 2010
Posts: 250
December 5, 2010 4:25 PM
try wholefoods whole wheat small sandwich organic bread. they taste good and are just 80 calories per slice
Joined Oct 2010
Posts: 8
December 5, 2010 4:35 PM
I am also a big cracker fan and they are very expensive. I like a couple slices of toasted bread in the morning and by the way I find your bread really high in calories at 140/slice. All the ones I've had are around that much for 2 slices.
So for me, the calories per portion is approximately the same, but I find the crackers much more versatile and eating 3 Ryvita crackers also satisfies me more than eating 2 slices of bread - which might be more psychological than anything else but whatever works, right?
As for the price issue, I think the Melba toasts are the most reasonable of the healthy crackers. I like the way they're packaged in 8 slice portions too.
Joined Nov 2010
Posts: 102
December 5, 2010 4:39 PM
Gotta say my wholemeal bread is 75 cals per slice but actually I am reducing my intake and are intending to look for a low calorie cracker as a snack.
Joined Aug 2010
Posts: 212
December 5, 2010 9:03 PM
I'm just not sure there is a "low-cal cracker" substitute...that's sort of my point.
Ounce per ounce I think good bread wins out on calories.
As someone else wrote the psychological difference between 3 wasa flat-breads
and a single slice of bread is something to consider
BTW, I calculated the cost differences:
$0.48/oz - Ak-Mak
$0.39/oz - Wasa Multi Grain Crispbread
$0.21/oz - Vital Vittles bread
Edited by mfpchris On December 5, 2010 9:15 PM
Message Boards » Food and Nutrition
Posts by members, moderators and admins should not be considered medical advice and no guarantee is made against accuracy.


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Director of Audio-Visual Ministries
Part-time Position
Bethlehem First United Methodist Church
709 Christmas Ave.
Bethlehem, Georgia 30620
The Director of Audio-Visual Ministries will be responsible
for the overall projection and audio ministry of the church. The director will
function as the church projectionist and audio director for the Sunday 9:30 am
Celebration Service and the 11:00 am Traditional and Contemporary Services, as
well as Wednesday evening programs, special services and events, including
Christmas Eve, Nativity Scene, Community Thanksgiving, Ash Wednesday, Good
Friday / Holy Week, dress rehearsals for cantatas and community services, Consecration
Sunday, and the annual Charge Conference meeting.
This part time position of 10 hours per week will include Wednesday evenings and Sunday mornings. Other hours will be scheduled as needed. Compensation will be $200.00 per week. Please send a resume and request a full job description from:
Georgia Barnwell


text: Articles Hearing Aids - Adults Cochlear Implants Unidentified and Underserved: Cochlear Implant Candidates in the Hearing Aid Dispensing Practice Unidentified and Underserved: Cochlear Implant Candidates in the Hearing Aid Dispensing Practice Unidentified and Underserved: Cochlear Implant Candidates in the Hearing Aid Dispensing Practice Steve Huart, AuD August 17, 2009 Would you like to earn CEUs for this article? Print Introduction The vast majority of patients with hearing loss visiting a typical audiology private practice or hearing aid dispensing office can be helped with hearing aids. Conventional wisdom would suggest that very few, if any, cochlear implant candidates are seen in private practices today since severe and profound hearing losses comprise a small percentage of overall hearing loss. And if so, there is a variety of hearing aid technology - such as frequency compression and/or frequency transposition, directional microphones and FM compatibility - that might help these people. So, why should a dispensing professional care about cochlear implant candidacy or referral?In the case of severe-to-profound hearing loss, professionals need to provide information on cochlear implants for those who might benefit. Cochlear implant candidacy has changed over the years, just as cochlear implant technology has developed and improved. For the appropriate candidates, cochlear implants may offer the chance at vast improvement in speech recognition over what even the best hearing aids and assistive technology offers them. Professionals have a responsibility to inform patients of all their options, and that means understanding who is a current candidate for a cochlear implant and understanding the potential benefits. In addition to informing patients of their treatment options because it is in the best interest of the patients, professionals also risk losing patients if they are not informed about cochlear implants. Consumers are becoming savvier in this information age in regard to researching health information. They are looking to their health professionals whether it is their physician, audiologist, or hearing care professional to provide current information and options regarding their treatment choices. This article will describe the current cochlear implant candidacy criteria, and provide information for dispensing professionals on the potential benefits of cochlear implants. In addition to providing basic information on cochlear implant performance and issues surrounding the cochlear implant process, some current data indicating a lack of referrals for cochlear implant evaluations will be presented. In providing up to date information and dispelling common myths about this technology, this article makes a case for increased referrals for cochlear implant evaluations from dispensing professionals for their patients who may benefit.Who Are Good Candidates?To determine who is a candidate for a cochlear implant, first consider who is a hearing aid candidate. As a dispensing audiologist, there is information and resources available to help determine this, and to guide best practices for hearing aid fitting. The Joint Committee on Clinical Practice Algorithms (2000), the American Academy of Audiology Guidelines for the Audiological Management of Adult Hearing Impairment (2006), and textbooks such as Valente (2000) and Dillon (2001) are readily available, just to name a few. In addition to performing comprehensive evaluations including recorded speech measures, measured (not predicted) frequency-specific loudness discomfort levels (LDLs) (Mueller & Bentler, 1994), audiologists also have at their disposal measures of speech in noise with the QuickSIN (Killion, Niquette, Gudmundsen, Revit and Banerjee, S. 2004) and the COSI (Dillon, James, & Ginis, 1997) to help identify patient specific wants and needs.Today's tools for hearing aid fitting include verification equipment using probe microphone measurements to ensure that soft sounds are audible and that 90 dB SPL inputs do not exceed LDLs. Frequency and gain of today's hearing instruments can be easily adjusted to soft, medium, and loud signal levels using NAL-NL1 (Dillon, 1999) targets. While the probe is in the ear and stimuli are presented, different hearing aid programs can be activated and measured. Steady state composite noise can be introduced to verify adaptive features such as noise suppression. Other features such as directional microphone technology is available to improve speech understanding in noise, and this can be easily verified in the audiology clinic. Finally, a variety of counseling and validation tools are available to help with orientation and fine-tuning.Even with all these twenty-first century tools available, every audiologist has had the experience of having patients who cannot be sufficiently helped with hearing aids. No matter how experienced the audiologist or how much evidence-based science is applied to the hearing aid fitting, there are going to be some patients who are simply not satisfied. Others may feel the benefit from hearing aids does not justify the cost. This paper is about the people for whom hearing aids are just not enough.Despite the available information and resources, there are no universally accepted criteria regarding who is a good hearing aid candidate or what defines a successful hearing aid fitting. Patient satisfaction may be related as much to clinician counseling and technical skill as it is to hearing aid fit. Candidacy is as much a function of lifestyle and motivation as it is of the audiogram. A 45 dB HL high-frequency hearing loss might not bother a retiree with a sedentary lifestyle but could be devastating to a practicing audiologist who cannot adequately hear her patients or a teacher who cannot hear his students. There is a mind-boggling range of instruments for an infinite variety of hearing impairments. It can be challenging for dispensing professionals to keep up with the continuous introduction of new products and the constant bombardment of manufacturers' claims. However, it is the responsibility of audiologists and hearing instrument specialists to keep current on technology and patient options so that the best possible solutions can be provided to the patients.Cochlear implants can be a solution for those who do not benefit or are no longer satisfied with the limited benefit they receive from hearing aids. Unlike hearing aids, the audiological candidacy criteria for cochlear implantation are well defined as approved by the FDA;it is based on the pure-tone audiogram and the patients' aided speech recognition scores. Of course, there are many other factors that go into the decision to receive an implant beyond these objective measures, including age at onset of the hearing loss, duration of deafness, etiology, motivation, family support, and access to rehabilitation. These factors should be discussed on an individual basis with an experienced cochlear implant team. For now, let us focus on identifying those patients we see who might be better served by a cochlear implant than hearing aids, and thus should be referred to a cochlear implant team for further evaluation.Cochlear Implant CriteriaThe criteria for cochlear implantation have changed dramatically over the years. The first multi-channel cochlear implant device was approved for use in the United States in 1985. At that time, only post-lingually deafened adults with bilateral profound sensorineural hearing loss and 0% aided speech recognition scores were considered candidates. Cochlear implants were not approved for children in the U.S. until 1990. Today, the criteria span the age range from infant to geriatric, and include those with lesser degrees of hearing loss and higher speech recognition scores. The current criteria for Cochlear™ Nucleus® cochlear implants as well as criteria used in 1985, are shown side by side in Table 1. Table 2 provides adult cochlear implant criteria based on sentence recognition performance (HINT sentences in quiet) for two other manufacturers and Medicare.Click Here to View Larger Version of Table 1 (PDF)Table 1. Criteria for CochlearTM Nucleus® cochlear implants, in 1985 and current. *(Multisyllabic Lexical Neighborhood Test;Lexical Neighborhood Test)Click Here to View Larger Version of Table 2 (PDF)Table 2. Adult cochlear implant criteria based on sentence recognition performance (HINT sentences in quiet) for two manufacturers and Medicare. Adapted from Gifford & Dorman, 2008.The fact that the audiologic criteria for cochlear implant candidacy have expanded compared with those of the past is especially important information for professionals who dispense hearing aids, who may not be aware of the information. Adult patients can have only moderate hearing loss in the low frequencies, sloping to profound loss in the mid to high frequencies, and still be excellent candidates for a cochlear implant. It is no longer a requirement that one have "no useable hearing." Aided sentence recognition of 50% or less in the ear to be implanted and 60% or less in the contralateral ear or bilaterally ("best aided condition") is the current criterion for adults. Typically, cochlear implant centers will use recorded HINT sentences presented in quiet, typically at conversational level. Before a patient is considered a cochlear implant candidate, he or she must have been given an opportunity to use well-fit amplification. In terms of age criteria for candidacy, the advantage of implanting an infant who is still in the critical language acquisition stage may seem obvious, but what about the 82-year-old who is socially isolated by a hearing loss? Older adults show no increase in operative time or length of stay in the hospital (Labadie, Carrasco, Gilmer, & Pillsbury, 2000). Speech perception in the implanted elderly is comparable to that of younger recipients (Kelsall, Shallop, & Burnelli, 1995;Vermeire, et al., 2005). Cochlear implants have a significant positive impact on the quality of life of older patients (Francis, Chee, Yeagle, Cheng and Niparko, 2002). There is no upper age limit for cochlear implant candidacy.Figure 1. Audiogram range and speech recognition criteria by age group for Nucleus® cochlear implant candidates.Cochlear Implant Performance, Surgery and Reimbursement Performance with cochlear implants is much better today than it was 25 years ago. In the early 1980s, the best one could hope for was low double-digit open set sentence scores (Figure 2). Over the years, implant technology has advanced in the same way as hearing aid technology. Cochlear implant speech processors and coding strategies have improved, much like noise reduction and adaptive algorithms in hearing aids. Some cochlear implant processors have the capability of multiple programs and some have directional microphones to provide recipients with greater comfort in diverse listening environments. Signal processing strategies and speech coding enhancements now enable many implant users to achieve high open-set word recognition scores and the ability to talk on the telephone- achievements that would have been inconceivable only a few years ago. Click Here to View Larger Version of Figure 2 (PDF)Figure 2. Advances in technology and signal processing in cochlear implants have resulted in improved performance outcomes. Shown are group mean scores for CUNY and HINT sentences in quiet and CNC monosyllabic words from multiple sources: Skinner et al. (1994), Skinner et al. (1991);Pijl et al. (2009).It is because of these improved outcomes that the criteria for implantation have expanded. Previously, the best a patient would expect was perhaps 12% sentence recognition performance with an implant;therefore the prerequisite was 0% speech recognition. As per Figure 2, now that the mean performance on clinical trials has improved to 90% open-set sentence recognition scores in quiet, those who only get 60% or less with hearing aids can consider cochlear implants a viable option if they want to hear better than they do with hearing aid amplification.In addition to current candidacy and performance questions, dispensing professionals may have limited information or misconceptions regarding cochlear implant surgery. It is not uncommon to hear audiologists and dispensers who have not had any recent training or education on cochlear implants state, "My patients don't want brain surgery for a hearing loss." Cochlear implantation is not brain surgery. It does take a skilled surgeon to place the electrodes in the right space in the cochlea. Most people tolerate the surgery very well and actually go home from the surgical suite or outpatient clinic the same day.In terms of reimbursement, cochlear implant reimbursement as not the same as hearing aid reimbursement. While Medicare and most insurance companies will not pay for hearing aids this is not the case with cochlear implants. Medicare will, in fact, cover a cochlear implant, as will many private insurance carriers. Bilateral implants are also sometimes covered by insurance.Overcoming ObstaclesOne obstacle to referral of appropriate candidates for cochlear implantation is lack of awareness by both professionals and potential recipients of current candidacy criteria. In a survey taken at the AudiologyNOW! conference in Charlotte, NC in 2008 (Cochlear Americas, 2008a) 437 attendees answered questions regarding the identification and referral of patients for cochlear implant evaluation. Twenty percent (20%) indicated they had not seen a cochlear implant candidate in their practice in the last six months. Fifty-five percent (55%) said they had seen less than five candidates. Combined, 75% of those who took the survey believed that they saw less than five people in their practices who might benefit from a cochlear implant in the previous six months. Attendees were also asked how many patients they had referred for a cochlear implant evaluation in the past six months. Forty-one percent (41%) said none, 50% said less than five. In total therefore, over 90% had referred less than five patients for an implant evaluation in six months. Given the number of current recipients versus the number of people who are candidates as discussed in the next section, these numbers seem low.It is logical that if professionals are not aware of current cochlear implant candidacy criteria, reimbursement, benefits and other up to date issues surrounding cochlear implants, they do not know how to identify candidates. Furthermore, it is probable that if professionals have no experience or contact with a cochlear implant center, they do not know how or where to refer. It is every dispensing professional's responsibility to know this information and overcome these obstacles in order to provide appropriate patients with their options for treatment. Awareness among consumers is not much better. In a large multi-center clinical study, the average time from onset of severe-to-profound hearing loss until receiving a cochlear implant was 12 years (Balkany et al., 2007). However, once people become aware of cochlear implants and discover they are candidates, there is little hesitation to proceed. Cochlear Americas surveyed 1,501 cochlear implant recipients and found that most of them received their implant in less than one year once it was determined that they were candidates (Figure 3). Click Here to View Larger Version of Figure 3 (PDF)Figure 3. Time between awareness of cochlear implant candidacy and actual implantation, n = 1501. From Cochlear Americas. (2008b). In another survey by Cochlear Americas, cochlear implant recipients (n=594) were asked what professional referred them for their initial cochlear implant evaluation (Cochlear Americas, 2008c). Less than half were referred by audiologists or dispensers. Nearly 20% reported they were not referred by any professional. These individuals found out about cochlear implants from friends, family, the Internet, or another source (Table 3). Click Here to View Larger Version of Table 3 (PDF)Table 3. Responses to survey question, "Who recommended that you consider a cochlear implant evaluation?" Note that while n = 594 in this survey, total in table is greater than 594 because some people surveyed selected more than one professional. From Cochlear Americas (2008c). These data indicate that there is a disconnect between professionals and cochlear implant candidates. One would think that most people who end up with a cochlear implant have been in contact with an audiologist or hearing instrument specialist at some point in the history of their hearing loss. The fact that over half of cochlear implant candidates do not hear about implants from a hearing care professional gives cause for reflection. The hearing healthcare profession seems to be missing the mark when it comes to informing people about cochlear implant technology when hearing aids are not enough.How Many Cochlear Implant Candidates Are There?How many patient files in a typical dispensing practice meet FDA-approved criteria for Nucleus™ cochlear implants? Most professionals probably have several such files. How many return to the dispensing office because they are not satisfied or do not receive adequate benefit from hearing aids?Patient satisfaction in hearing aid fitting is an enigma. Since most dispensing professionals do not use standardized outcome measures, the majority may assume a customer who does not return an aid for credit is a satisfied customer. This assumption may be wrong. According to Kochkin (2005b;2005c) there are about 7.4 million hearing aid owners in the United States. Of these, 6.2 million are active users who wear their hearing aids at least once a year. The study also indicates that over 21% of hearing aid owners are not satisfied. For a hearing aid to be satisfactory, Kochkin suggests that people have to hear better aided in 70% of listening environments versus unaided. Seven percent (7%) of active users report that their hearing aids do not improve hearing in any situation. Further, while hearing aids provide some benefit over a wide range of hearing loss, 20% of patients with the worst hearing thresholds (more significant hearing losses) rate satisfaction with amplification lower than those with less severe hearing loss (Kochkin, 2005a). While overall customer satisfaction with hearing aids and the professionals who fit them is relatively high, there is much room for improvement. Could improvements be provided for the 21% of patients who are dissatisfied and for the 7% who report no benefit from hearing aids in any environment? Some of these people may have reached a degree of hearing loss where hearing aids are no longer adequate. Despite the best hearing aid technology and fitting, a referral for a cochlear implant evaluation may be indicated. The exact number of people who can benefit from cochlear implants can only be estimated. While several sources report prevalence of hearing loss in the U.S., only a few report by degree of loss. Agrawal and colleagues (2008) reported 29 million adults with hearing loss. Kochkin's MarkeTrak VII (2005b) indicates hearing loss in the U.S. topped 31 million people in 2005. The Center for Disease Control reports 37 million adults with hearing loss (Schoenborn & Heyman, 2008). Of these, 3.5% self report "a lot of trouble hearing or totally deaf." The Gallaudet Research Institute reports that one million people over the age of five are "functionally deaf" (Mitchell, 2005). Blanchfield (2001) estimates there are between 500,000 and 1,200,000 people with severe to profound hearing loss. Margolis and Saly (2008), reporting on 22,000 ears tested in a large medical center, found that 8% had severe hearing loss and 5% had profound loss. ASHA reports there are 250,000 to 1,000,000 potential cochlear implant candidates in the U.S. (2008). A reasonable estimate may be 1,000,000 people in the U.S. could benefit from cochlear implants. It is estimated that there are currently only about 50-60,000 cochlear implant recipients. It is likely that less than 10% of the people who could benefit from a cochlear implant actually have one. Compare this to a 20-25% penetration rate for hearing aids. According to the NIDCD, 60% of cochlear implant recipients are adults and 40% are children (NIDCD, 2007). Even though the absolute percentage is higher in adults, the ratio of recipients to candidates is lower for adults than for children because hearing loss is more common in adults. Maybe professionals who see children are more convinced of the benefits of implanting children than professionals who see predominantly adult patients. The bottom line is that both groups are significantly underserved, and it is the responsibility of everyone who fits hearing aids to know who, when and where to refer potential implant candidates.While professionals may feel that they do not see patients in their dispensing practices who are cochlear implant candidates, they should not be fooled by conventional wisdom. In a review of several thousand hearing aid charts across several clinics, it was independently found that, in fact, approximately 3% of the audiograms met the FDA criteria for cochlear implantation (Table 3). These were typical hearing aid dispensing practices treating mostly adult patients. It is possible that in large medical or ENT practices the percentage might even be higher. If a dispensing practice sees 100 patients in a month, it is reasonable to suggest that three of those might receive more help from a cochlear implant than from hearing aids. For an established practice, or for experienced professionals who have a few thousand patients in their databases, it is possible that dozens of those may have improved quality of life had they received a cochlear implant.Click Here to View Larger Version of Table 4 (PDF)Table 4. Cochlear implant candidates in a typical hearing aid practice. Results from independent review by author of existing files in five hearing aid offices (unpublished).What's In It For Me?Some would suggest that for professionals who own a dispensing practice or get paid based on the sale of hearing aids, the prospect of referring a patient for a cochlear implant might be bittersweet. Consider that the number one driver of customer satisfaction in the dispensing office is when professionals provide solutions to patients' hearing problems. When hearing aids do not solve the problem and a cochlear implant is recommended, professionals may become the driver of that patient's satisfaction. When patients are satisfied they tell their friends. Only a small percentage of people with hearing impairment will be implant candidates. Any goodwill generated by referring a patient for something as life changing as a cochlear implant is likely to result in more traffic to the professional's office instead of less.Patients who get the least benefit from hearing aids may take up the most time in a dispensing practice. Efforts at reprogramming, fine-tuning and adjustments may still result in a return for credit. Even if a patient does not return an aid for credit but ends up putting it in the drawer, the result may be negative word of mouth about the professional's ability and about hearing aids in general. This is further incentive to refer for a cochlear implant evaluation for appropriate patients. For well-satisfied hearing aid patients, there is no reason to refer for an evaluation at a cochlear implant center. Just because someone meets candidacy criteria does not necessarily make him or her a good cochlear implant candidate. Imagine that a satisfied hearing aid customer refers to his dispensing professional one of his friends who is wearing hearing aids purchased from the Internet. A professional evaluation reveals a pure-tone audiogram that falls in the shaded area on the audiogram in Figure 1. Sentence recognition scores using HINT sentences in quiet at 45 dB HL are 15% unaided, and there is no improvement when using his hearing aids, that do not meet the gain and output requirements of his audiogram. If the current hearing aids cannot be effectively adjusted new, appropriately-selected and fit hearing aids may be recommended. Once the new hearing instruments are fit, the patient reports he hears much better. A repeat of the HINT test using the new instruments reveals a sentence recognition score of 56%. Although it is not as improved as the professional would like, the patient is ecstatic with the new hearing aids. Is he a good cochlear implant candidate?On the other hand, consider the patient who has been seen by his dispensing professional for 10 years. She was fit with her first set of CICs when she just started to notice her hearing was "not as good as it used to be." She was fit with BTEs when her hearing dropped further. She trusted the professional enough to buy power BTEs when she could not carry on a conversation using her mini BTEs and talking on the phone was completely out of the question. Her audiogram is now in the shaded area of Figure 1. Despite the professional's best efforts, her scores on the HINT never exceed 40% in the best aided condition. The new aids are definitely better, and she is satisfied with her professional and the services provided, but, unfortunately, she is afraid that she will probably quit her job or lost it because it is just too hard to hear, even with assistive technology. She reports that she is frustrated that she has to struggle to carry on a conversation with her daughter and grandchildren. She relies on her husband to answer the phone. When she stops by the dispensing office to pick up batteries, she tells the receptionist in confidence "I just wish there was something else available to help me". Is this patient a good cochlear implant candidate?What Do I Do Next?The first step for professionals is to be familiar with FDA-approved cochlear implant criteria (Joint Committee, 2000). It can be taped up in a conspicuous place so it is in plain view and not filed away and forgotten. Next, identify cochlear implant centers in your area and open lines of communication with them. Discuss with them about how you can share in the care of patients you both serve. About three quarters of those people who have a cochlear implant only have one. As implant criteria expands, people with more usable hearing are being implanted. That means more are likely to benefit from also using a hearing aid in the non-implanted ear (a bimodal device fitting). Finally, become an expert in fitting of bimodal devices (Huart & Sammeth, 2008). Few clinics have the time, equipment, and inclination to fit both hearing aids and cochlear implants. The audiologist who knows about cochlear implant criteria and is also proficient in bimodal fitting will have a distinct advantage in a competitive hearing aid market.Acknowledgements: Dr. Carol Sammeth and Dr. Bobbi Scheinin for their review and comments. Dr. Aaron Parkinson for data in Figure 2.ReferencesAgrawal, Y., Platz, E., & Niparko, J. (2008). Prevalence of hearing loss and differences by demographic characteristics among U.S. adults. Archives of Internal Medicine, 168(14), 1522-1530.American Academy of Audiology Task Force (2006). Guidelines for the audiological management of adult hearing impairment. Audiology Today, 18(5), 32-36.American Speech-Language Hearing Association (2008). Incidence and prevalence of hearing loss and hearing aid use in the United States - 2008 edition. Retrieved March 25, 2009, from www.asha.org/members/research/reports/hearing.htmBalkany, T., Hodges, A., Menapace, C. Hazard, L., Driscoll, C., Gantz, B., Kelsall, D., Luxford, W., McMenomy, S., & Neely, J. (2007). Nucleus Freedom North American clinical trial. Otolaryngology-Head and Neck Surgery, 136(5), 757-762.Blanchfield, B., Feldman, J., Dunbar, J., & Gardner, E. (2001). The severely to profoundly hearing-impaired population in the United States: Prevalence estimates and demographics. Journal of the American Academy of Audiology, 12(4), 183-189.Cochlear Americas (2008a). [AAA 2008 kiosk survey]. Unpublished data. Cochlear Americas (2008b). [Cochlear Americas recipient survey]. May: N=1501. Unpublished data.Cochlear Americas. (2008c). [Hearing aids and cochlear implant recipient survey]. Unpublished data. Dillon H. (1999). NAL-NL1: A new procedure for fitting non-linear hearing aids. The Hearing Journal, 52, 10-16.Dillon, H. (2001). Hearing Aids. New York: Thieme.Dillon, H., James, A., & Ginis, J. (1997). Client Oriented Scale of Improvement (COSI) and its relationship to several other measures of benefit and satisfaction provided by hearing aids. Journal of the American Academy of Audiology, 8(1), 27-43.Francis, H., Chee, N., Yeagle, J., Cheng, A., Niparko, J.K.(2002). Impact of cochlear implants on the functional health status of older adults. Laryngoscope, 112(8), 1482 - 1488. Gifford, R. & Dorman, M. (2008, April). Cochlear implant candidacy indications. Presentation at the American Academy of Audiology annual convention. Dallas, TX.Huart, S. & Sammeth, C. (2008). Hearing aids plus cochlear implants: Optimizing the bimodal pediatric fitting. The Hearing Journal, 11(61), 54-58.Joint Committee on Clinical Practice Algorithms and Statements. (2000, August). Audiology clinical practice algorithms and statements. Audiology Today, Special Issue 2000. Kelsall, D., Shallop, J., & Burnelli, T. (1995). Cochlear implantation in the elderly. American Journal of Otology, 16(5), 609-615.Killion, M.C., Niquette, P.A., Gudmundsen, G.I., Revit, L.J. and Banerjee, S. (2004). Development of a quick speech-in-noise test for measuring signal-to-noise ratio loss in normal hearing and hearing-impaired listeners. Journal of the Acoustical Society of America, 116, 2395-2405.Kochkin, S. (2005a). MarkeTrak VII: Customer satisfaction with hearing aids in the digital age. The Hearing Journal, 58(9), 30-37.Kochkin, S. (2005b). MarkeTrak VII: Hearing loss population tops 31 million. The Hearing Review, 12(7), 16-29.Kochkin, S. (2005c). MakeTrak VII: Obstacles to adult non-user adoption of hearing aids. The Hearing Journal, 60(4), 27-43.Labadie, R., Carrasco, V., Gilmer, C., & Pillsbury, H. (2000). Cochlear implant performance in senior citizens. Otolaryngology-Head and Neck Suregry, 123(4), 419-424. Margolis, R. & Saly, G. (2008). Distribution of hearing loss characteristics in a clinical population. Ear & Hearing, 29(4), 524-532.Mitchell, R.E. (2005). Retrieved from Gallaudet University, Gallaudet Research Institute Web site: gri.gallaudet.edu/Demographics/deaf-US.phpMueller, G.A., & Bentler, R. (1994). Measurements of TD: How loud is allowed? The Hearing Journal, 10, 42-44. National Institute on Deafness and Other Communication Disorders (NIDCD). (2007). Cochlear implants. Retrieved April 14, 2009 from NIDCD Web site: www.nidcd.nih.gov/health/hearing/coch.asp Pijl, S. et al. (2008). The Nucleus Freedom Cochlear Implant System: Adult IDE Clinical Trial Results. Manuscript in preparation.Schoenborn, C.A. & Heyman, K. (2008). Health disparities among adults with hearing loss: United States, 2000-2006. Centers for Disease Control. Retrieved March 25, 2009, from www.cdc.gov/nchs/products/pubs/pubd/hestats/hearing00-06/hearing00-06.pdfSkinner, M.W., Clark, G.M., Whitford, L.A., Seligman, P.M., Staller, S.J., Shipp, D.B. et al. (1994). Evaluation of a new spectral peak coding strategy for the Nucleus 22 channel cochlear implant system. American Journal of Otology, 15(S), 15-27.Skinner, M.W., Holden, L.K., Holden, T.A., Dowell, R.C., Seligman, P.M., Brimacombe, J.A. et al. (1991) Performance of postlinguistically deaf adults with the wearable speech processor (WSP III) and mini speech processor (MSP) of the Nucleus multi-electrode cochlear implant. Ear & Hearing, 12(1), 3- 22. U.S. Department of Health and Human Services. Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2006. Washington, DC: Author. Retrieved from www.cdc.gov/nchs/data/series/sr_10/sr10_235.pdf Valente, M., Hosford-Dunn, H. & Roeser, R. (2000). Audiology Treatment. New York: Thieme.Vermeire, K., Brokx, J.P.L, Wuyts, F.L., Cochet, E., Hofkens, A., & Van de Heyning, P. (2005). Quality of life benefit from cochlear implantation in the elderly, Otology & Neurotology, 26, 188-195. Would you like to earn CEUs for this article? Steve Huart, AuD help dispensing professionals identify and refer those patients who no longer benefit from amplification Steven A. Huart, Au.D., has over 20 years experience in audiology and hearing aid dispensing. Most of his career has been spent in the clinic seeing patients and fitting hearing aids. Huart was an Instructor in Audiology at Mayo Clinic Arizona and Adjunct Faculty at Arizona School of Health Sciences until he became the Director of Professional Development for AmplifonUSA. He joined Cochlear Americas in 2007 where his goal is to help dispensing professionals identify and refer those patients who no longer benefit from amplification. Related Courses Presenters Mary Ellen Nevins, EdD Ashley Garber, MS, CCC-SLP, LSLS Cert AVT Push In or Pull Out: Intervention Ideas for 1-on-1 Services (HOPE) - recording [Recorded Webinar Course] PresentersMary Ellen Nevins, EdDAshley Garber, MS, CCC-SLP, LSLS Cert AVT Course: #4419 CEUs/Hours Offered: AAA/0.1 Intermediate; ACAud/0.1; AG Bell - LSLS/1.0; BAA/1.0; CAA/1.0; IHS/1.0; Kansas DHE, LTS-S0035/1.0; NZAS/1.0 This presentation contrasts two models for individual habilitation: pull out therapy versus in-class support. Considerations for goal setting and case management relative to the role of audition are addressed; specific case studies will be presented. **FOR A GENERAL CERTIFICATE OF PARTICIPATION (No CEUs) PLEASE DOWNLOAD THE "COCHLEAR CERTIFICATE HANDOUT" AFTER REGISTRATION** Course Details View this course for FREE. Need CEUs? Join our CEU Total Access Program to get unlimited CEUs. Only $99/yr Learn More Presenter Ashley Garber, MS, CCC-SLP, LSLS Cert AVT There's an App for That (Professionals, Parents) [Recorded Webinar Course] PresenterAshley Garber, MS, CCC-SLP, LSLS Cert AVT Course: #20088 CEUs/Hours Offered: AAA/0.1 Intermediate; ACAud/0.1; AG Bell - LSLS/1.0 Domain 6; BAA/1.0; CAA/1.0; IHS/1.0; Kansas DHE, LTS-S0035/1.0; NZAS/1.0; SAC/1.0 Do you wonder how you can pry your iPad or smart phone out of your child's hands long enough to work on the auditory and spoken language goals that you have in mind? Or maybe you recognize that today's cool tech "toys" are also highly motivating educational tools that we can, and even should, use to our advantage. Learners in today's session should come away with approaches for integrating technology into existing lessons, new ideas to develop listening and language skills via "apps", and an appreciation for the social competencies that they are simultaneously developing. **FOR A GENERAL CERTIFICATE OF PARTICIPATION (No CEUs) PLEASE DOWNLOAD THE "COCHLEAR CERTIFICATE HANDOUT" AFTER REGISTRATION** Course Details View this course for FREE. Need CEUs? Join our CEU Total Access Program to get unlimited CEUs. Only $99/yr Learn More Presenters Pauline Nott, PhD Andrew Kendrick, M.SpEd, LSLS Cert. AVT Early Language Development and First Words in Young Children (Professionals, Parents) [Recorded Webinar Course] PresentersPauline Nott, PhDAndrew Kendrick, M.SpEd, LSLS Cert. AVT Course: #19995 CEUs/Hours Offered: AAA/0.1 Intermediate; ACAud/0.1; AG Bell - LSLS/1.0 Domain 3, Domain 4; BAA/1.0; CAA/1.0; IHS/1.0; IL EITP/1.0; Kansas DHE, LTS-S0035/1.0; NZAS/1.0; SAC/1.0 This course is designed to provide information about the Diary of Early Language Development (Di-EL) as a tool for monitoring early language development in young children with hearing loss. Material covered includes the rational for such a tool, the design and validation of the Di-EL technique, early language outcomes for children with hearing loss using the Di-EL, and finally, guidelines for use of the Di-EL in the therapy and educational setting. The Di-EL, a new resource for families and professionals in the United States, will be introduced and provided at this session. **FOR A GENERAL CERTIFICATE OF PARTICIPATION (No CEUs) PLEASE DOWNLOAD THE "COCHLEAR CERTIFICATE HANDOUT" AFTER REGISTRATION** Course Details View this course for FREE. Need CEUs? Join our CEU Total Access Program to get unlimited CEUs. Only $99/yr Learn More Presenter Ashley Garber, MS, CCC-SLP, LSLS Cert AVT Auditory Comprehension: Focus on Memory (Professionals) [Recorded Webinar Course] PresenterAshley Garber, MS, CCC-SLP, LSLS Cert AVT Course: #19954 CEUs/Hours Offered: AAA/0.1 Intermediate; ACAud/0.1; AG Bell - LSLS/1.0 Domain 2; BAA/1.0; CAA/1.0; IHS/1.0; Kansas DHE, LTS-S0035/1.0; NZAS/1.0; SAC/1.0 This session is the last in a series that deconstructs the auditory skills hierarchy and takes each level of auditory function in turn to build a complete understanding of auditory skill development. The culminating level of auditory comprehension is examined here with a specific focus on auditory memory and its subskills. Specific treatment techniques for maximizing progress through these particular levels will be discussed with ideas for targeting these skills in all situational contexts. The HOPE Online courses "Getting Started with Auditory Skills or Auditory Skills: A Closer Look are suggested as an introduction to the auditory skills hierarchy for professionals new to auditory learning. **FOR A GENERAL CERTIFICATE OF PARTICIPATION (No CEUs) PLEASE DOWNLOAD THE "COCHLEAR CERTIFICATE HANDOUT" AFTER REGISTRATION** Course Details View this course for FREE. Need CEUs? Join our CEU Total Access Program to get unlimited CEUs. Only $99/yr Learn More Presenters Donna L. Sorkin, MA Linda Day Cell Phones: Not Just for Texting! (Adults, Teens, Parents, Professionals) [Recorded Webinar Course] PresentersDonna L. Sorkin, MALinda Day Course: #19921 CEUs/Hours Offered: AAA/0.1 Intermediate; ACAud/0.1; AG Bell - LSLS/1.0 Domain 1; AHIP/1.0; BAA/1.0; CAA/1.0; Calif. HADB/1.0 Hearing Aid Related; IHS/1.0; Kansas DHE, LTS-S0035/1.0; NZAS/1.0; SAC/1.0 Many adults with progressive hearing loss have not used a voice telephone in a long time and may become accustomed to using captions for phone usage. Teenagers—whether or not they have a hearing loss—use text messaging as their primary method of exchanging information with friends and family members. This course will provide a hands-on review of wireless telephones from the perspective of usability by the hearing impaired listener. We will address telecommunications technology, legal requirements for access features and labeling, and linkage between the personal hearing technology and the phone. Among the specific topics to be discussed and demonstrated are telecoils, use of peripherals such as Bluetooth, building confidence and practice strategies. Although the emphasis will be on cochlear implant compatibility, much of the information will be equally relevant to hearing aid and Baha users. **FOR A GENERAL CERTIFICATE OF PARTICIPATION (No CEUs) PLEASE DOWNLOAD THE "COCHLEAR CERTIFICATE HANDOUT" AFTER REGISTRATION** Course Details View this course for FREE. Need CEUs? Join our CEU Total Access Program to get unlimited CEUs. Only $99/yr Learn More


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by Hannah Greenfield Friday, 21 September 2012
A car has gone flying into the upstairs bedroom of a house in Epsom, Surrey.
This story has expired.
You must be logged in to your account to add a comment about this article.
Gemma W (Age 13)
wrote on Saturday, 22 September 2012 @ 13:25
That's totally crazy! I know it sounds mad, but it must have been a little fun! LOL!
Abigail L (Age 12)
wrote on Sunday, 23 September 2012 @ 16:33
OH NO! That must have been freaky for both sets of people
Abdullah A (Age 13)
wrote on Monday, 24 September 2012 @ 17:11
Crazy driver putting him and others at risk!!!!!!!
Lucy K (Age 10)
wrote on Sunday, 30 September 2012 @ 07:50
Kitty B (Age 12)
wrote on Sunday, 30 September 2012 @ 11:47
I'm just puzzled about how it could happen?
Maeve Anne C (Age 12)
wrote on Saturday, 6 October 2012 @ 10:08
Totally crazy! :b
Katie G (Age 9)
wrote on Saturday, 27 October 2012 @ 09:09
That was crazyier than I thought.
Millie P (Age 14)
wrote on Wednesday, 30 January 2013 @ 18:56
Oh My Gosh the exact same thing happens down my road a couple of years ago😱 I remember my road was on tv as well but I think the people involved weren't hurt but quite shaken up. I would hate for this to happen to anyone I know or anyone else for that matter of fact. Milzymoo12


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High speed video is everywhere these days, but the cameras and necessary equipment is a bit out of reach for a hobbyist. [Bassam] found a compromise and came up with a way to shoot high-speed photographs using a sound triggered flash.
Sound activated christmas lights
Christmas is coming up pretty quickly. [tinkernut] shows us how to do a quick and dirty music activated Christmas light setup. Simply crack open a pair of old computer speakers and wire the speaker leads to a relay. Use that to power an outlet and you have music controlled lights. The section at the beginning of the video is a bit misleading as that kind of choreography would be rather difficult with this setup. This may look familiar as we mentioned an almost identical project back in 2006.


text:
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1 Comment [1]
POSTED: Thursday, February 14, 2013 - 10:28pm
UPDATED: Friday, February 15, 2013 - 11:36am
(CNN) — The Carnival cruise ship Triumph has reached the dock in Mobile, Alabama.
This comes just four days after the ship was disabled by an engine fire in the Gulf of Mexico with more than 4,200 people aboard.
No YouTube


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Senior basketball captain Dustin Barth has recently become a member of the 1000th point club at West Lutheran High School. During the West Lutheran basketball game against Legacy Christian Academy Lions on Thursday, January 10, Dustin scored 23 points to acheive this milestone. Dustin is the sixth Warrior boys basketball player to score 1000 or more points.
In addition, the Warrior were victorous against the Lions with a 70-42 win.
Congratulations Dustin and the Warriors!


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Vue Apartments Trinity Beach
78-86 Moore Street , Trinity Beach QLD 4879
Located beachside, the property is designed to maximise exposure to natural lighting, ocean breezes and the spectacular views of the Coral Sea. The resort complex wraps around a magnificent horizon pool framed with a barbeque pavilion.
Offering a choice of one, two and three bedroom apartments, each apartment offers gourmet kitchen with European appliances, a modern entertainment centre with plasma television, DVD and wireless broadband internet access. All apartments are surrounded by open walkways creating a breezeway throughout and offer panoramic ocean views from spacious balconies.
- Apartments
- Bar on Premises
- Barbecue
- Lift
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- Safety Deposit Box Available
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Reception Hours:
Reception Hours:
8:00am - 6:00pm | Monday to Friday
9:00am - 12:00pm | Saturday to Sunday
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Check In/Out Info:
Please refer to travel documentation regarding access out of reception hours.
Number Of Rooms:
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Distance To Nearest Airport:
21 kilometres from Cairns Airport. Ideally positioned on the Trinity Beach hill top overlooking the Esplanade, with views of Trinity beach. Offering beachfront location with easy access to the swimming beach, restaurants and bars located along the shore front. Port Douglas is located 60 kilometres north of Trinity Beach.
Distance To Nearest Beach:
10 metres
Restaurant Info:
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Credit Cards Accepted:
Note that a credit card may be requested upon check-in as a form of security deposit.
Important Information:
Dates and Passenger details
1300 551 669 within Australia
+61 7353 54534 worldwide


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Wight will take over city Rec Dept.July 31,2013By Gordon Dritschilo
Staff Writer
He's not using the word "interim," but Mayor Christopher Louras said Cindi Wight will take over the city Recreation Department, at least temporarily, upon the departure of Superintendent EJay Bishop.
Wight, whose title in the department is "recreation director," said she was confident she could step into the role with little or no difficulty.
"We have a great staff here that works hard to support the city," she said. "I have good people behind me."
Wight said Bishop had also pledged to stay in touch as she comes up to speed on the department's various projects.
Bishop handed in his resignation Monday, effective Aug. 5. Louras said he and the city attorney were still researching the process for putting a new superintendent in place, and that he did not want to call Wight the "interim" director because he did not know if the term would carry any connotations under the city charter.
"I expect that Cindi Wight will exercise the duties of the superintendent until a full-time person is named," Louras said Wednesday.
Wight, who recently earned a master's degree in parks and recreation management, said she was "definitely" interested in being the permanent superintendent and that it would be an honor to run the department.
"It's a bittersweet moment for me," she said. "To be a department head is something I've been working to make myself ready to be. ... EJay was a wonderful man."
Louras would not indicate any preference for selecting a permanent replacement from within the department or searching outside.
"I always look for the most qualified individual, no matter how it's done," he said. "That's my philosophy — find the right person for the job with the understanding that this is an appointment. ... All appointees are key members of the administration staff."
The superintendent of the Recreation Department is appointed by the mayor and confirmed by the Board of Aldermen.
Bishop's resignation followed the revelation that he spent roughly $50,000 from the recreation activities fund on architectural services without consulting the Board of Aldermen. While the money was spent in increments of no more than $2,900, keeping payments below the threshold at which purchases must go out to bid, Bishop entered contracts with the architect.
The city charter requires board approval for all contracts.
Board President David Allaire has said he still expects the aldermen to conduct an inquiry into the expenditures, likely starting at the next board meeting, Aug. 5.
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Level :Bachelor of Community Welfare (Family and Community) (AREP/METRO) | Stream :Arts
"frm wher cn i do a language course?"
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Jawaharlal Nehru Award For International Understanding - Dr. Angela Merkel Scholarship: Applications Open - Scholarship Notification : August 21, 2014 - October 1, 2014
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Swiss Government Excellence Scholarships 2015 - Scholarship Notification : August 12, 2014 - November 12, 2014
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text:
Todd Erickson is a news and features writer for the Storage Media Group. He previously edited and wrote for Boardwatch Magazine, CLEC Magazine, ISPWorld.com, RF Design magazine and Defense Electronics magazine. Todd graduated from The Colorado College and has a J.D. from the University of Denver College of Law. He lives in Denver.
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Contributions from Todd Erickson
- Storage monitoring tools cut hospital's outages
- Virtualization changes storage performance monitoring
- 10 steps to a records retention management system
- Dataglobal merges storage resource management, ECM
- Digitiliti's data management system gets cloud friendly
- Dexrex Gear launches Blackberry app for IM archiving
- Mobile devices require proactive storage planning
- How to choose the right clustered NAS system
- Double-Take stretches Flex to boot from HPC iSCSI SANs
- RainStor updates OEM structured data archive solution
- SRM services offer visibility and optimization advice
- E-discovery vendors update products, forge partnerships
- Symantec adds SSD discovery, Hyper-V support
- IBM upgrades midrange disk arrays with DS5020 Express
- Vendors take steps to lock down cloud storage
- Overland Snap Server NAS watches rock star exhibits
- Coraid EtherDrive teaches Ohio school about AoE storage
- Storage Decisions: Plan around needs, not technologies
- Digital Reef, Microsoft become FAST friends
- Multiprotocol storage arrays gain interest, adoption


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There are many types of virtualization- server, network, storage, and more. In this article, we will demystify these complex terms, explain what they can do for you, and name specific products that provide these functions. So prepare for the smoke to be cleared...
What is Server Virtualization?
Out of all three of the different types of virtualization discussed in this article, I believe that server virtualization is the type of virtualization you are most familiar with. When people say "virtualization", they are usually referring to server virtualization. However, they should really clarify what type of virtualization they are talking about because there are multiple types.
The Wikipedia defines virtualization as "a broad term that refers to the abstraction of computer resources". Another definition, also from Wikipedia is "a technique for hiding the physical characteristics of computing resources from the way in which other systems, applications, or end users interact with those resources".
With those definitions as our background, what is server virtualization? Simply put, server virtualization software allows you to run multiple guest computers on a single host computer with those guest computers believing they are running on their own hardware. By doing this, you gain all the benefits of any type of virtualization: portability of guest virtual machines, reduced operating costs, reduced administrative overhead, server consolidation, testing & training, disaster recovery benefits, and more.
Examples of server virtualization products are:
- VMware Server, Workstation, Player, and ESX Server
- Microsoft Virtual PC and Virtual Server
- Xen
- Virtual Iron
- And more
That said, different products provide different levels of virtualization. There are:
- full virtualization - guest OS is unmodified and believes it is running on the same hardware as the host OS
- para virtualization - guest OS is modified, as with Xen
- emulation - guest OS is unmodified but it is running on a software emulated CPU
There is no doubt that server virtualization is the wave of the future. Consider these facts:
- A 2007 Forrester Research study found that 40% of businesses are using server virtualization. Of those 40%, 50% of those are using VMware products and 9% are using Microsoft.
- Microsoft will be including Server Virtualization as part of the next release of the Windows Server operating system, codename Viridian.
- Cisco has announced a strategic investment in VMware and Cisco has stated that they believe that virtualization (across the board) is the future of computing. Cisco has made virtualization part of their Data Center 3.0 strategy.
- Microsoft will make the Windows Server 2008 virtualization software "Xen-Friendly"
Here is what Server Virtualization looks like:
What is Network Virtualization?
When I first heard of network virtualization, I thought of VLANs. I thought, "don't we already have network virtualization when we use VLANs?" I mean, a VLAN is a "virtual LAN", which sounds like a virtual network to me. While this logic makes sense, there is much more to network virtualization than just VLANs.
Like these other forms of virtualization, network virtualization is not that new. Sun and HP have been talking about network virtualization for years. Now, Cisco has picked up the network virtualization ball and run with it. They are touting NV as the next big thing and as an integral part of their Data Center 3.0 strategy.
What does network virtualization do? The theory behind network virtualization is to take many of the of the traditional client/server based services and put them "on the network". To Cisco, this means making routing and switches perform more services. Cisco says that the 3 parts of network virtualization are: access-control, path isolation, and service edge. This can be ambiguous when you first read about it but Cisco has a nice diagram that lays it all out to better visualize what it can do for you. As you can see from the diagram, inside Cisco's routers and switches you would find services like security, storage, VoIP, mobility, and application delivery. To Cisco, it is their strategy to continue generating revenue from their strong network infrastructure offerings. To me, this just helps to increase the value of your network devices and leverage the network infrastructure that is already required.
Network virtualization is still in its early stages and it is too soon to really say what it will or won't do for IT Pros like you and I.
What is Storage Virtualization?
Recently, I attended a conference on storage virtualization. The main presenter was Datacore. They have some fascinating products but they aren't the only storage virtualization products available. However, they may be one of the more reasonably priced.
So what is Storage Virtualization (SV)? Again, like network virtualization, when I first heard about storage virtualization, I thought that if I had a SAN, I was already doing it. However, like network virtualization, there is more to it than that. Wikipedia defines storage virtualization is "the abstraction at any layer in the storage software and hardware stack.". This is what a SAN can do, in general, but there are many more features that SV can bring you.
Let's look at an example. In most data centers, you only use a small percentage of your storage because, even with a SAN, you have to allocate a full disk LUN to the server (or servers) attaching to that LUN. Say that that LUN fills up but you have disk space available on another LUN. It is very difficult to take disk space away from one LUN and give it to another LUN. Plus, it is very difficult to mix and match storage and make it appear all as one. Storage virtualization works great for mirroring traffic across a WAN and for migrating LUNs from one disk array to another without downtime.. Additionally, you can perform thin-provisioning with SV where you can create new LUNs for new servers but you over allocate the disk space on the server, compared to what the SAN is really configured with. Say, for instance, the Windows server disk manager thinks that you have 500GB allocated but, really, you only allocated 1GB. While the utilization may grow to 6GB when Windows is installed, lets say that you never grow the server beyond that. You have just saved 494GB of disk space but you still have the flexibility to grow your data on that LUN without doing anything else.
In summary, the Virtualization creates "virtually" an unlimited number of possibilities for system administrators. The trouble with it, is being able to understand the different types of virtualization, what they offer, and how they an help you. To aid in your understanding, here is a quick summarization:
- Server Virtualization = physical server hardware is separated from Guest opearting systems (servers), providing additional capabilities and benefits - think VMware
- Network Virtualization = network applications are moved into the network devices, providing additional capabilities and benefits -think Cisco, 3Com ON
- Storage Virtualization = disk storage complexityies are hidden from operating systems and additional capabilities and benefits - think Datacore
Got a question? Post it on our VMware Forums!Advertisement


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WORCESTER COUNTY, Md. - In Wednesday's Meet The Money Givers, WMDT introduced an organization looking for creative talent. If you can sing, dance, or even sculpt and you live in Worcester County, this scholarship is for you.
"I was blown away by the talent, the children are just so talented," said Sharon Sorrentino, Scholarship Committee Member.
The Worcester County Arts Council knows a thing or two about artistic ability. Not only is it their field of expertise, but they also see hundreds of talented applicants, vying to be awarded with one of their eight scholarships.
"We have students applying representing the artistic form of art such as visual arts, performing arts, creative writing, poetry, and music," said Anna Mullis, Executive Director of the Worcester County Arts Council.
"Katherina Burton who is a fantastic singer, I know personally, and is now attending Towson University," said Sorrentino.
She was one of the Worcester County students to qualify for the money last year. Each of the 8 students chosen this year, get a $1,000 check towards a bachelor of arts degree.
"If they don't receive it for some reason when they graduate high school, if they go into college and they're pursuing the arts they may apply in college as long as they're in undergrad," said Sorrentino.
The deadline for this scholarship is March 15th, so try and get your applications in now. For more information on the program, head to our homepage and click on the DEF Logo.


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amg review
Their debut full-length album shows the Post taking various sounds and mixing them together with their college rock background. On many of the songs there is a hypnotic tribal beat, followed by other songs with an ambient sway. The vocals work into the music almost as another instrument, wavering and swirling with the distorted guitars. With little to no effort the band is able to switch gears from seductive to intimate and from there to something else totally new. While they may pick up influences from Joy Division, Godspeed You Black Emperor!, and Talking Heads, the Post are also just about as original as any of the aforementioned acts are. Backwards is certainly a strong debut album. ~ Kurt Morris, Rovi