text:
The John Hughes Character You Are Based On Your Zodiac Sign
By Sylvia-Marah Boune/Dec. 29, 2021 5:56 pm EST
John Hughes started his career in entertainment, writing jokes for stand-up comedians like Rodney Dangerfield, before beginning to write screenplays, direct, and produce films. Hughes wrote 53 films during his long career in the film industry. For many, the teen movies he wrote in the mid-1980s (starring members of the Brat Pack) are his most iconic. Films like "The Breakfast Club," "Ferris Bueller's Day Off," "Pretty in Pink," and "Some Kind of Wonderful" maintain their popularity today, in part, because some things about being a teenager haven't changed.
Not only were his films of the moment, but they have also proved to be timeless as well, embraced by younger generations while eliciting nostalgia for longtime viewers. Hughes' films are humorous, but they also strike a chord with audiences by tackling issues teens experience like depression, social and academic pressure, divorce, and uncertainty about their future. If you watched enough of Hughes' teen films, you would meet a character who you felt an affinity for, or often, multiple characters. His characters resonated with audiences then and now because they are archetypal, representing the signs of the zodiac.
These characters' clothing could change, their slang could shift to reflect a new period, but their essence, much like zodiac signs themselves, have remained essentially unchanged throughout western civilization since modern astrology developed out of the Hellenistic astrology of ancient Greece. When teenagers watched Hughes' films, they saw themselves, their friends, and family represented on the screen. The only failing of Hughes' films was in lacking representation of minorities, a problem emblematic of the era.
Aries: Andrew Clark (March 21—April 19)
Aries is a cardinal fire sign ruled by Mars, the god or war. The ultimate hothead, Aries is impulsive, quick-tempered, and has a proclivity toward violence. Sometimes it seems like they have one default emotion — anger. We see this in Andrew Clark, played by Emilio Estevez, in "The Breakfast Club." Andrew tells the character, John Bender, "I will end you," and threatens to beat him up multiple times during Saturday detention. In fact, Andrew has Saturday detention because he got caught bullying, playing a violent prank on a classmate. Andrew is a varsity wrestler, hoping to get a college scholarship. This attribute shows the competitive nature Aries is known for.
But Aries isn't all aggression and anger. As a fire sign, we know them for being energetic, passionate, and motivated. We see this physical energy in the scene where Andrew is running around the second story of the library, after the group gets high on Bender's weed. Andrew, like most Aries, has a strong physical presence and enjoys being active. Aries is also brave, and we see this when Andrew stands up for Claire after Bender teases her. Aries is an ambitious sign, filled with the energy of spring and new beginnings, as its cardinal modality suggests. We see this energy in Andrew, your classic '80s teen "jock."
Taurus: Amanda Jones (April 20—May 20)
Taurus is a fixed earth sign ruled by Venus, the goddess of love and beauty. Taurus is jealous, stubborn, materialistic, sensual, practical, and conservative; we see these traits reflected in Amanda Jones, played by Lea Thompson in "Some Kind of Wonderful." When artistic Kieth asks Amanda out on a date, she agrees, because she is angry with and jealous of her boyfriend, Hardy, flirting with another girl. During family dinner, Kieth's sister, Laura, describes Amanda Jones as "sex." They depict Amanda as enjoying her physical relationship with Hardy despite his poor behavior, and her frustrations with his character defects.
But it isn't only the physical connection she appreciates about this relationship. Hardy has money, and Amanda's family doesn't. She likes nice things and wants to be surrounded by beauty and luxury, which is a common trait for Taurus. Despite their practical down-to-earth nature, they enjoy material things like nice clothes, cars and beautiful homes. This is because of their ruling planet Venus. Despite her desire to be part of the rich group at her high school, Amanda's stubborn nature rises to the surface when she refuses to cancel her date with Keith despite the social fallout she experiences. We can attribute this stubbornness to Taurus' fixed modality. It takes a lot to make a Taurus mad, but once they are, their angry outbursts are often surprising, as we see when Amanda slaps Hardy at his party later in the film.
Gemini: Ferris Bueller (May 21—June 21)
Gemini is a mutable air sign ruled by Mercury, who is a trickster god. Geminis are spontaneous social butterflies who are quick-witted and the life of the party. Like all air signs, Geminis are intelligent, curious, and talkative. Like Mercury, Geminis are mischievous and filled with a playful, sometimes chaotic energy. These attributes perfectly describe Ferris Bueller, played by Matthew Broderick in "Ferris Bueller's Day Off." Ferris is popular, likable, and looking for fun, and like Gemini, he has a creative approach to telling lies. Ferris might lie his face off during the film, but it is obvious he isn't being vindictive. He's just trying to entertain himself, eking joy out of his senior year.
Although Gemini, represented by the twins, can be a conflicted and unpredictable sign, Ferris embodies the more upbeat, sunny twin. But, we see hints at his more cynical side during some of his sarcastic commentaries. Geminis are open-minded, creative, and natural communicators, just like Ferris. He has a way with words and could talk to anyone, as evidenced by his widespread popularity in his community. Known for being charismatic and charming, Geminis are used to getting what they want, as is true with Ferris (other than that car he wanted and never got). Geminis are also often very funny, as Ferris is. They simply have a busy brain and don't enjoy being alone.
Cancer: Allison Reynolds (June 22—July 22)
Cancer is a cardinal water sign represented by the Crab, known for being creative, artistic, sensitive, family-oriented, and empathetic. Allison Reynolds, played by Ally Sheedy in "The Breakfast Club," has all these traits. She is artistic, as we see in the drawing she makes during Saturday detention. She is miserable at home because her parents ignore her, highlighting how much she cares about home and family. We can see her deep empathy by her tearful response to Brian's confession about failing shop, his devastation, and his contemplations of suicide.
The Moon rules Cancer. As this celestial body affects the tides of the ocean on our planet, Cancers have shifting moods that are as swift as these tides. Allison is silent through the beginning of the film, seeming shy and frightened. At one point, she even retreats into the hood of her winter coat, like a turtle might retreat into its shell. While Allison's sensitivity might make her more emotional than those around her, it also makes her a superb listener and confidant, as we see when the group is talking about their problems in a circle during detention. Cancers are the archetypal mothers of the zodiac and are known for being nurturing and loving.
If you or anyone you know is having suicidal thoughts, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).
Leo: Claire Standish (July 23—August 22)
Leo is a fixed fire sign ruled by the Sun. Vain, materialistic, popular, and brave; Leo loves being the center of attention. Claire Standish, played by Molly Ringwald in "The Breakfast Club," is a classic depiction of the Lion. Even her red hair is emblematic of this fire sign. Claire is spending Saturday in detention for cutting class to go shopping, something a Leo would definitely do. They enjoy luxury and expensive things, as we would expect considering their regal symbol, the Lion. We see this in Claire's diamond earrings and even her sushi lunch (sushi was a trendy new thing in the '80s).
As a fixed sign, Leos can be stubborn and domineering, emphasizing their tendency to take the lead in social situations. Like all fire signs, Leos are passionate, as we see in the heated repartee between Claire and Bender. Leos have opinions, and they aren't afraid of sharing them, even hard truths, as Claire does when she says the group won't be friends in school on Monday, despite the bonding they did during detention. Ruled by the Sun, Leos have the energy and social connections to attain their lofty aspirations of fame and fortune.
Virgo: Brian Johnson (August 23—September 22)
Virgo is a mutable earth sign ruled by Mercury. Perfectionistic, responsible, and hard-working, Virgos are known for being analytical and critical of themselves and others. Brian Johnson, played by Anthony Michael Hall in "The Breakfast Club," is a perfect representation of Virgo. He is an excellent student, focused on his GPA and what college he will go to when he graduates from high school. In fact, this obsession leads to him attending Saturday detention. Brian enrolled in shop class thinking it would be an easy A, and was devastated when he failed an assignment, causing him to contemplate suicide, bringing a flare gun to school.
As earth signs, Virgos are responsible, methodical, and practical rule-followers who enjoy organization. The fact Brian was even willing to break a rule only highlights how emotionally unprepared he was for a failing grade. Virgos, like all humans, have feelings, but Virgos tend not to validate their feelings, preferring to intellectualize them rather than experience them. Ruled by Mercury, Virgos are talented with communication and the written word, making Brian the perfect candidate to write their group essay for Saturday detention.
Libra: Duckie (September 22—October 23)
Libra is a cardinal air sign ruled by Venus, the goddess of love and beauty. Duckie, played by Jon Cryer in "Pretty in Pink," is definitely a Libra. Duckie is Andie's fashionable best friend, and he has a huge crush on Andie. Duckie is an indecisive, hopeless romantic who can't stand being alone, as we see when Andie comes home to multiple phone messages from Duckie left in a brief period. Like most Libras, Duckie dislikes conformity but loves harmony. Duckie will avoid conflict at all costs, but Libras sure know how to hold a grudge once there is conflict, as we see when Duckie stops talking to Andie after finding out she had a date with Blane.
Like other air signs, Libras can have difficulty focusing, as we see when Andie tries to help Duckie with his history paper. Libras, like all air signs, are intelligent, curious and communicative, loving lively discussions with friends. Ruled by Venus, Libras love L-O-V-E and enjoy surrounding themselves with beauty and entertainment. Duckie's lip-sync of an Otis Redding song in the record store is evidence of Libra's love of music and theater. Duckie's unique style is also indicative of his sign; Libras are known for taking fashion risks and having their own style.
Scorpio: John Bender (October 23—November 21)
Often associated with a bad-boy persona, John Bender, played by Judd Nelson in "The Breakfast Club," is a classic representation of Scorpio. A fixed water sign, Scorpio is moody, dramatic, intense, honest, and emotionally complex. We see Scorpio's characteristic brutal honesty in some of Bender's sarcastic and insightful rants, revealing just how well he can read people. Like the ocean, there is a lot going on under the surface of a Scorpio's too-cool facade, and this is true for Bender. His unhappy home life is a cloud hanging over his head, hinting at the darkness Scorpio is known for. Like all water signs, Scorpio is emotionally sensitive and insightful, but Scorpio's fixed modality gives them an edge other water signs lack.
Ruled by Mars in ancient astrology and Pluto in modern astrology, Scorpios are warriors-poets. Mars' associations with the god of war imbue Scorpio with the tenacity, bravery, and assertiveness of warriors, while Pluto brings the emotional depth and darkness associated with tortured artists — and the emotional repression of our shadow content. We often associate Scorpio with death, sex, and our more self-destructive tendencies, which we certainly see in John Bender's personality. He is combative, makes crude comments about sex to Claire, and practically begs for more detention by inciting arguments with their principal. But Scorpio has a softer side, hinted at in quieter moments Bender spends with Claire. Scorpios can be loving partners and are known for their passion, even though the only thing they are afraid of is vulnerability. This fear can cause problems in Scorpios' intimate relationships because they can be controlling and jealous.
Sagittarius: Keith Nelson (November 22—December 21)
A mutable fire sign symbolized by the Archer, Sagittarius is generous, artistic, and idealistic. Filled with solar energy like all fire signs, Archers are known as the travelers of the zodiac. Open-minded and curious, Sagittarius makes friends everywhere they go, as Keith Nelson, played by Eric Stoltz, does in "Some Kind of Wonderful." We see Sagittarius' ability to connect with various social groups when Keith strikes up a friendship with Duncan in detention. Like other fire signs, Sagittarius is passionate and impulsive, making split-second decisions and opinions on emotions, as Keith does when Amanda Jones catches his eye at school one day, sparking his romantic interest. Optimistic, like the average Sagittarius, Keith asks Amanda Jones out even though she is "out of his league," as his sister Laura states as a matter of fact.
Sometimes Sagittarius finds it difficult to distinguish between friendship and love, much how Keith does with his best friend Watts, only realizing at the end of the film that Watts has feelings for him and that Keith reciprocates these feelings. As a mutable fire sign, we know Sagittarius starts projects with passion but sometimes struggles to maintain the focus necessary to follow through on these projects. Likewise, managing finances can be a struggle for Sagittarius as they are generous and prone to overspending, as we see when Keith blows his college savings on diamond earrings.
Capricorn: Ed Rooney (December 22—January 19)
Principal Ed Rooney, played by Jeffrey Jones in "Ferris Bueller's Day Off," is a classic Capricorn. As a cardinal earth sign, Capricorns love rules, are responsible and disciplined, resenting those who shirk their responsibilities or break the rules, encapsulating Mr. Rooney's issue with Ferris Bueller and his proclivity for cutting class. Being a school principal is a good job fit for a Capricorn,\ because they can manage a large staff, and they are serious and traditional by nature. Co—Star even wrote that "elementary school hall monitor" was a likely career in their humorous descriptions of Capricorn's traits.
Capricorns are driven by duty and demand respect, so obviously a student as chaotic and mischievous as Ferris would get under Mr. Rooney's skin, aggravating his intrinsic need for order and conformity. Capricorns are often called workaholics, and we can see how much Mr. Rooney's position as principal is a part of his identity, explaining why he takes Ferris' truancy personally. As an earth element, Capricorns are practical but also a little stiff and set in their ways. It makes sense a mutable air sign's devil-make-hair attitude would push Rooney's buttons, making him go a little nuts while trying to catch Ferris in his lies.
Aquarius: Andie Walsh (January 20–February 18)
Andie Walsh, played by Molly Ringwald in "Pretty in Pink," is an Aquarius. As a fixed air sign, Aquarians march to the beat of their own drum. Individualistic Andie has her own style; Aquarians are known for their creative fashion choices. Aquarius values equality, as we see when Andie stands up to her principal about how the rich students treat the poor students. Aquarians are often portrayed as outcasts, and this describes how Andie sees herself. She struggles with bullying at school, but true to her fixed modality; she will not change who she is to suit others.
Like all air signs, Aquarians are smart, demonstrated by Andie's good grades and goal of getting a scholarship for college. Andie is more comfortable in the realm of ideas, like other air signs, becoming overwhelmed by her emotions, as we see when she tries to tell Blane that she doesn't want him to take her home because she doesn't want him to see where she lives. Despite having trouble expressing their emotions, Aquarians are honest and hate broken promises, as we see when Andie gets angry when Blane says he can no longer take her to prom.
Aquarius is a sign ruled by Saturn in ancient astrology and Uranus in modern astrology. Uranus is associated with liberation, rebellion, and anarchy, giving Aquarius its reputation as an outcast and revolutionary. We can see this in Andie. She stands up for herself, embracing her authentic self, regardless of the social ramifications. It is fascinating how Aquarius' ancient ruler is Saturn (a planet associated with restrictions and rules), when Aquarius is all about progress and rebellion — but you need something to fight against if you want to start a rebellion, and Saturn provides this counterpoint for Aquarius.
Pisces: Cameron Frye (February 19—March 20)
As a mutable water sign, Pisces are gentle and compassionate people who might be addicted to misery. They can have powerful depressive episodes as Cameron Frye, played by Alan Ruck, does in "Ferris Bueller's Day Off." These emotionally sensitive Fish are also known for avoiding unpleasant realities, as Cameron does when he dissociates after discovering the miles the parking attendants added to the odometer of his father's prized Ferrari. Despite wanting to avoid reality, Pisces is known for accepting responsibility for others, often taking on the role of a selfless martyr, as we see when Cameron accepts the responsibility for the destroyed Ferrari.
Ruled by Jupiter in ancient astrology and Neptune in modern astrology, Pisces are creative people who must find an artistic outlet to express their complex inner life. Cameron's talent for accents and sense of humor is obvious when Ferris enlists Cameron's help to get Sloane excused from class. Cameron's love of music, something common to Pisces, is hinted at when we see him lying in bed listening to atmospheric music in the morning when Ferris calls, asking Cameron to spend the day together. Pisces are deeply intuitive and can sense when something is wrong, as we see in Cameron's astute observations about his parents' loveless marriage.


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Five Ways to Improve Congregational Singing
February 18, 2014 |
My wife, Kristyn, and I recently returned from a tour where we had the privilege of sharing our music in cities across North America. As we do on our tours, we partnered with most of our concert sponsors to host a lunch and time of discussion with local pastors, worship leaders, and other church musicians.
In each of those leadership events, I posed the question, "What are the things you ask yourself on Monday morning, in reviewing Sunday's services?" Generally, the responses centered around production values, stylistic issues, people management, pleasing the pastor, or finishing the service on time. I do not recall that any one asked, "How did the congregation sing?"
It seems curious that in a generation that has produced innumerable conferences, articles, blogs, and even university degree programs on "worship," the topic of congregational singing hasn't been raised more often. But even if we had been discussing congregational participation, would we know what goal we're aiming to hit each week?
I do not pretend to be qualified to write a theological treatise on this particular subject. Congregational singing is a holy act, and as I organize my thoughts, I hear my old pastor, Alistair Begg, reminding me that in our song worship, we have to be spiritually alive (dead people don't sing), spiritually assisted (through the enabling of the Holy Spirit), and spiritually active (committed to daily walking with the Lord).
I offer here some practical advice on strengthening our congregational singing, drawn from both our experience as musicians and also what we have seen and learned in our travels.
1. Begin with the pastor.
Look at any congregation not engaged in worship through singing and the most consistent correlation is a senior pastor equally as disengaged. Ultimately the buck stops with him in congregational worship.
Every pastor must be intimately involved in the language being placed in the congregation's mouth, for that singing ultimately affects how they think, how they feel, how they pray, and how they live. The congregation should be treated as those who have been invited to a feast at the table of the King; don't hand them junk food! C. S. Lewis believed singing completes our faith, explaining in his book Reflections on the Psalms, "I think we delight to praise what we enjoy because the praise not merely expresses but completes the enjoyment; it is its appointed consummation." This is why I believe many of our pastoral heroes such as Martin Luther, Charles Spurgeon, J.C. Ryle, and Philip Schaaf produced hymn books in addition to preaching and teaching. Other leaders such as Horatius Bonar, Richard Baxter, and John Calvin wrote hymns themselves.
Pastors not only have a duty to be involved in preparing for the time of congregational singing, they also have a responsibility to personally model and demonstrate the importance of it. We need pastors who constantly delight in their congregation's singing and the musicians who serve them and who also joyfully and authentically participate themselves.
Pastors, take up your duty in this act of worship called congregational singing. Worship leaders, pray for your pastor faithfully and do your part to develop a thriving relationship with him. The most influential worship leaders in history have almost always had close (though often tense) relationships with their pastors.
2. Sing great songs.
If congregational singing is a holy act, and if we are what we sing, then we can't be lazy in selecting songs. We must sing great songs—songs that artfully exult Christ with deeply meaningful lyrics and melodies we can't wait to sing. Better to have a small repertoire of great songs (that you will sing well) than a catalog full of songs recycled for sentimental reasons or chased after because they are the "latest" thing.
Writing or selecting great songs is not an exercise in lyrical propaganda or marketing. It is not merely laying scriptural truth alongside any melody. It is an art form that arrests our emotions and intellect in mysterious ways. Just as a master chef selects ingredients that are at the same time nutritious, aromatic, and flavorful, the selection of songs for congregational singing must excite at a number of levels.
Great songs have stood the test of time. They have been passed on to us from our fathers, and we should pass them along to our children. Assemble any Christian group, and practically everyone can join you in singing "Amazing Grace" confidently and passionately. We're drawn to sing great music, much like we're drawn to stand in awe of a beautiful painting.
There are great new songs—they breathe fresh air into our singing and help connect age-old truth with modern sounds. These are appropriate, too, though harder to find.
Recently I invited two unbelieving friends to a Christian event. The artists on stage played songs with interesting lyrics but awful melodies. I asked my friends what they thought about the concert. "These people obviously don't take their subject matter very seriously," one friend replied. Now, I know for a fact this is not true. But art ultimately expresses life, and low-quality songs do not reflect spirited, serious believers.
3. Cultivate a congregation-centered priority in those who lead.
From the individual who leads music, to the worship teams standing up front, to those of us who follow as members of the congregation, it's vital to build a culture where everyone realizes our corporate responsibility before God and to each other is to sing together. Throughout Scripture, the command to sing is given to God's people more than 400 times. Ephesians 5:19 instructs believers to address one another in "psalms and hymns and spiritual songs." Week after week, we are spiritually renewed, realigned, and sanctified by singing to the Lord and singing to each other as the body of Christ.
Sadly, some of the churches with the newest facilities and most forward-thinking pastors are weakened substantially by lackluster congregational singing. It is an awful witness for outsiders to watch believers so disinterested in singing to their Creator and Redeemer.
Many of our common challenges—the overly exuberant drummer, the diva-like background vocalist, the subversive choir member, or an unhealthy priority on performance—can be corrected when we teach and encourage those involved in our music to be excited about using their many rich and colorful gifts for the purpose of supporting the congregation. Every singer, instrumentalist, and choir member should share in facilitating the high calling of congregational singing.
4. Serve the congregation through musical excellence.
Scripture often commands us to make music that is both good and excellent. For example, Psalm 33 tells to both "shout for joy in the Lord" and also play our instruments "skillfully" (verse 3). This instruction is consistent with our calling as believers to work heartily at whatever we do, as for the Lord and not men (Colossians 3:23). The music need not be complex or style-specific, but we must take seriously our role in such holy activity. This leadership requires people who are trained and well-prepared. As with all work that involves creativity (whether preaching, mothering, or running a business), we should constantly seek to be fresh, interesting, and connected with our congregations. Listen to new music, arrangements, and sounds. Examine our heritage of liturgies for insight to ordering the song service. Reach across the aisle, meeting with leaders from different churches and denominations to learn about their music selections.
In scoring for films, the composer and performers use all of their musical excellence in service of the story. In similar fashion, the singers and musicians should bring to bear their musical excellence in service of the congregation. There is no dichotomy between musical excellence and congregational worship provided the excellence is given in service of the congregation.
5. Manage the congregation's repertoire intentionally.
Having progressed in each of the areas above and putting them into regular practice in services, be intentional about what is sung and when. Don't treat your library of congregational choices like selecting "shuffle" on you iPod. Instead, be intentional in ordering the service, heeding Eric Alexander's caution that congregational praise begins with God and his glory, not man and his need. Ask why you are singing at a given point in the service, and be sure that the selection for that moment is appropriate. Also, learn from the rich heritage of liturgy and how it provides a pathway of ordering songs for a service.
And finally . . .
Why not in 2014 begin the Monday morning review by asking, "How did the congregation sing?" and, "How can we help them do it better?" Starting here, we may find that the other questions begin to resolve themselves.
Editors' note: Keith and Kristyn Getty are modern-hymn writers with an acclaimed repertoire of 21st-century hymns revered both for their theologically astute lyrics and beloved melodies. Many such hymns are included on the Live at The Gospel Coalition album recorded at the TGC National Conference last April. You can also sing along with the Gettys and worship God together at The Gospel Coalition National Women's Conference, June 27-29 in Orlando, Florida.
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redpajama_set_name: RedPajamaCommonCrawl


text:
Reversible myelopathy in a 34-year-old man with vitamin B12 deficiency
Sean J. Pittock, Troy A. Payne, C. Michel Harper
Vitamin B12 deficiency is common, with most patients lacking classic features of advanced severe deficiency. Early diagnosis and treatment prevent severe anemia and irreversible damage to the nervous system. We describe a 34-year-old man with pernicious anemia who presented with clinical and radiologic features of early myelopathy and borderline low serum levels of vitamin B12. Prompt diagnosis based on the measurement of serum methylmalonic acid and treatment with cyanocobalamin injections led to rapid resolution of clinical manifestations and magnetic resonance imaging abnormalities. We review the literature of magnetic resonance imaging in vitamin B12 deficiency myelopathy and discuss the issues relating to diagnosis and early treatment of this potentially reversible condition.
https://doi.org/10.4065/77.3.291
MMA = methylmalonic acid
MRI = magnetic resonance imaging
SCD = subacute combined degeneration
10.4065/77.3.291
Dive into the research topics of 'Reversible myelopathy in a 34-year-old man with vitamin B12 deficiency'. Together they form a unique fingerprint.
Vitamin B 12 Deficiency Medicine & Life Sciences 100%
Spinal Cord Diseases Medicine & Life Sciences 84%
Vitamin B 12 Medicine & Life Sciences 54%
Methylmalonic Acid Medicine & Life Sciences 37%
Pernicious Anemia Medicine & Life Sciences 34%
Magnetic Resonance Imaging Medicine & Life Sciences 32%
Serum Medicine & Life Sciences 22%
Anemia Medicine & Life Sciences 20%
Pittock, S. J., Payne, T. A., & Harper, C. M. (2002). Reversible myelopathy in a 34-year-old man with vitamin B12 deficiency. Mayo Clinic proceedings, 77(3), 291-294. [62363]. https://doi.org/10.4065/77.3.291
Reversible myelopathy in a 34-year-old man with vitamin B12 deficiency. / Pittock, Sean J.; Payne, Troy A.; Harper, C. Michel.
In: Mayo Clinic proceedings, Vol. 77, No. 3, 62363, 2002, p. 291-294.
Pittock, SJ, Payne, TA & Harper, CM 2002, 'Reversible myelopathy in a 34-year-old man with vitamin B12 deficiency', Mayo Clinic proceedings, vol. 77, no. 3, 62363, pp. 291-294. https://doi.org/10.4065/77.3.291
Pittock SJ, Payne TA, Harper CM. Reversible myelopathy in a 34-year-old man with vitamin B12 deficiency. Mayo Clinic proceedings. 2002;77(3):291-294. 62363. https://doi.org/10.4065/77.3.291
Pittock, Sean J. ; Payne, Troy A. ; Harper, C. Michel. / Reversible myelopathy in a 34-year-old man with vitamin B12 deficiency. In: Mayo Clinic proceedings. 2002 ; Vol. 77, No. 3. pp. 291-294.
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title = "Reversible myelopathy in a 34-year-old man with vitamin B12 deficiency",
abstract = "Vitamin B12 deficiency is common, with most patients lacking classic features of advanced severe deficiency. Early diagnosis and treatment prevent severe anemia and irreversible damage to the nervous system. We describe a 34-year-old man with pernicious anemia who presented with clinical and radiologic features of early myelopathy and borderline low serum levels of vitamin B12. Prompt diagnosis based on the measurement of serum methylmalonic acid and treatment with cyanocobalamin injections led to rapid resolution of clinical manifestations and magnetic resonance imaging abnormalities. We review the literature of magnetic resonance imaging in vitamin B12 deficiency myelopathy and discuss the issues relating to diagnosis and early treatment of this potentially reversible condition.",
keywords = "MMA = methylmalonic acid, MRI = magnetic resonance imaging, SCD = subacute combined degeneration",
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AU - Payne, Troy A.
AU - Harper, C. Michel
N2 - Vitamin B12 deficiency is common, with most patients lacking classic features of advanced severe deficiency. Early diagnosis and treatment prevent severe anemia and irreversible damage to the nervous system. We describe a 34-year-old man with pernicious anemia who presented with clinical and radiologic features of early myelopathy and borderline low serum levels of vitamin B12. Prompt diagnosis based on the measurement of serum methylmalonic acid and treatment with cyanocobalamin injections led to rapid resolution of clinical manifestations and magnetic resonance imaging abnormalities. We review the literature of magnetic resonance imaging in vitamin B12 deficiency myelopathy and discuss the issues relating to diagnosis and early treatment of this potentially reversible condition.
AB - Vitamin B12 deficiency is common, with most patients lacking classic features of advanced severe deficiency. Early diagnosis and treatment prevent severe anemia and irreversible damage to the nervous system. We describe a 34-year-old man with pernicious anemia who presented with clinical and radiologic features of early myelopathy and borderline low serum levels of vitamin B12. Prompt diagnosis based on the measurement of serum methylmalonic acid and treatment with cyanocobalamin injections led to rapid resolution of clinical manifestations and magnetic resonance imaging abnormalities. We review the literature of magnetic resonance imaging in vitamin B12 deficiency myelopathy and discuss the issues relating to diagnosis and early treatment of this potentially reversible condition.
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text:
Meet Author David J!
Meet author David J author of Apocalypse Chow. Apocalypse Chow is a parody retelling of Joseph Conrad's Heart of Darkness, served with generous portions of Francis Ford Coppola's film, Apocalypse Now. Learn more about the inspiration behind David's work in his interview below.
I started writing in high school, contributing pieces to my local daily newspaper and publishing my own zine. That work and experience got me into journalism school and I spent more than a decade working as a journalist and communications consultant. I've now shifted to creative writing, which is more difficult but far more rewarding.
What is your most recent literary/artistic project? I've recently self-published a book called "Apocalypse Chow", which is a parody of Heart of Darkness and Apocalypse Now, set in the restaurant trade and northern Ontario. I put myself through journalism school by working in restaurants and bars in Toronto, which inspired me to write the book. I'm also in the process of editing my first full-length novel, "The Piper of Paradise".
That's a great question. On the one hand, I feel compelled to tell stories, as if the tales are alive inside of me and pushing to get out. On the other hand, I'm intensely conscious of my own mortality, something I think about every day. So I feel that my body of work will be the legacy I leave behind when I die. Morbid, perhaps, but an excellent motivator.
Who's your favorite author and why?
I'd have to say it's a tossup between Hemingway and Somerset Maugham. Hemingway is an easy choice given his discipline and ruthless pursuit of the craft of writing. Somerset Maugham is less well-known but a master of the human condition. I'm also a fan of other great observers of humanity such as John Steinbeck, Raymond Carver, and Margaret Atwood.
What advice can you give to other authors or writers?
My advice to other authors and writers is to tell them to write about subjects that they are passionate about and if they would do that, they will find that the writing part becomes very easy.
Where can readers go to find out more information about your work? Apocalypse Chow is available on Amazon, and you can find my website at iamdavidjw.com
#books #DavidJ #writers #authors #authorinterview
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CHARLESTON, W.Va. (AP) — A hearing has been scheduled for a lawsuit over whether West Virginia Gov. Jim Justice should be required to live in the state's capital of Charleston.
The Intelligencer reports the court on June 5 will hear motions to dismiss or stay the lawsuit by Democratic Del. Isaac Sponaugle.
Sponaugle says Justice should be ordered to live in Charleston because the state constitution requires the governor to "reside at the seat of government." Justice said he lives at his Lewisburg home, not at the governor's mansion.


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Devices similar to hearing aids include the osseointegrated auditory prosthesis (formerly called the bone-anchored hearing aid) and cochlear implant.
Real ear measurements (or probe microphone measurements) are an assessment of the characteristics of hearing aid amplification near the ear drum using a silicone probe tube microphone.
There are many types of hearing aids (also known as hearing instruments), which vary in size, Electric power and circuitry.
File:Vintage Telex Transistor (Body) Hearing Aid, Model 70A, Made in the USA (12483173304).jpg|Transistor body-worn hearing aid.
File:BTEhearingaids.png|Pair of BTE hearing aids with earmolds.
Body worn aids were the first portable electronic hearing aids, and were invented by Harvey Fletcher while working at Bell Laboratories. Body aids consist of a case and an earmold, attached by a wire. The case contains the electronic amplifier components, controls and Battery (electricity) while the earmold typically contains a miniature loudspeaker. The case is typically about the size of a pack of playing cards and is carried in a pocket or on a belt.
Without the size constraints of smaller hearing devices, body worn aid designs can provide large amplification and long battery life at a lower cost. Body aids are still used in emerging markets because of their relatively low cost.
Behind the ear hearing aids are one of two major classes of hearing aids - Behind the ear (BTE) and In the ear (ITE). These two classes are distinguished by where the hearing aid is worn. BTE hearing aids consist of a case which hangs behind the Auricle (anatomy) The case is attached to an earmold or dome tip by a traditional tube, slim tube, or wire. The tube or wire courses from the superior-ventral portion of the pinna to the concha, where the ear mold or dome tip inserts into the Ear canal. The case contains the electronics, controls, battery, and microphone(s).The loudspeaker, or receiver, may be housed in the case (traditional BTE) or in the earmold or dome tip (receiver-in-the-canal, or RIC). The RIC style of BTE hearing aid is often smaller than a traditional BTE and more commonly used in more active populations.
BTEs are generally capable of providing more output and may therefore be indicated for more severe degrees of hearing loss. However, BTEs are very versatile and can be used for nearly any kind of hearing loss. BTEs come in a variety of sizes, ranging from a small, "mini BTE," to larger, ultra-power devices. Size typically depends on the output level needed, the location of the receiver, and the presence or absence of a telecoil. BTEs are durable, easy to repair, and often have controls and battery doors that are easier to manipulate. BTEs are also easily connected to assistive listening devices, such as Frequency modulation systems and induction loops. BTEs are commonly worn by children who need a durable type of hearing aid.
In the ear aids (ITE) devices fit in the outer ear bowl (called the Pinna (anatomy)). Being larger, these are easier to insert and can hold extra features. They are sometimes visible when standing face to face with someone. ITE hearing aids are custom made to fit each individual's ear. They can be used in mild to some severe hearing losses. Audio feedback, a squealing/whistling caused by sound (particularly high frequency sound) leaking and being amplified again, may be a problem for severe hearing losses. Some modern circuits are able to provide feedback regulation or cancellation to assist with this.
Traditionally, ITEs have not been recommended for young children because their fit could not be as easily modified as the earmold for a BTE, and thus the aid had to be replaced frequently as the child grew. However, there are new ITEs made from a silicone type material that mitigates the need for costly replacements.
ITE hearing aids can be connected wirelessly to FM systems, for instance with a body-worn FM receiver with induction neck-loop which transmits the audio signal from the FM transmitter inductively to the telecoil inside the hearing instrument.
Mini in canal (MIC) or completely in canal (CIC) aids are generally not visible unless the viewer looks directly into the wearer's ear.Eisenberg, Anne (24 September 2005) [https://www.nytimes.com/2006/09/24/business/yourmoney/24novel.html?ex=1164517200&en=dba8306ee44bce99&ei=5070 The Hearing Aid as Fashion Statement] . ''NY Times''.Dybala, Paul (6 March 2006) [http://www.audiologyonline.com/articles/article_detail.asp?article_id=1542 ELVAS Sightings – Hearing Aid or Headset] . AudiologyOnline.com. These aids are intended for mild to moderately severe losses. CICs are usually not recommended for people with good low-frequency hearing, as the occlusion effect is much more noticeable.Ross, Mark (January 2004) [http://www.hearingresearch.org/ross/hearing_loss/the_occlusion_effect.php The "Occlusion Effect" – What it is, and What to Do About it] , hearingresearch.org. Completely-in-the-canal hearing aids fit tightly deep in the ear. It barely visible. Being small, it will not have a directional microphone, and its small batteries will have a short life, and the batteries and controls may be difficult to manage. Its position in the ear prevents wind noise and makes it easier to use phones without feedback. In-the-canal hearing aids are placed deep in the ear canal. They are barely visible. Larger versions of these can have directional microphones. Being in the canal, they are less likely to cause a plugged feeling. These models are easier to manipulate than the smaller completely in-the-canal models but still have the drawbacks of being rather small.
In-the-ear hearing aids are typically more expensive than behind-the-ear counterparts of equal functionality, because they are custom fitted to the patient's ear.
In fitting, the audiologist takes a physical impression (Polyvinyl siloxane) of the ear.
The mold is scanned by a specialized Computer-aided design system, resulting in a 3D model of the outer ear.
During modeling, the venting tube is inserted.
The digitally modeled ''shell'' is printed using a rapid prototyping technique such as stereolithography.
Invisible in canal hearing aids (IIC) style of hearing aids fits inside the ear canal completely, leaving little to no trace of an installed hearing aid visible. This is because it fits deeper in the canal than other types, so that it is out of view even when looking directly into the ear bowl (concha). A comfortable fit is achieved because the shell of the aid is custom-made to the individual ear canal after taking a mould.
Invisible hearing aid types use venting and their deep placement in the ear canal to give a more natural experience of hearing. Unlike other hearing aid types, with the IIC aid the majority of the ear is not blocked (occluded) by a large plastic shell. This means that sound can be collected more naturally by the shape of the ear, and can travel down into the ear canal as it would with unassisted hearing. Depending on their size, some models allow the wearer to use a mobile phone as a remote control to alter memory and volume settings, instead of taking the IIC out to do this. IIC types are most suitable for users up to middle age, but are not suitable for more elderly people.
A bone anchored hearing aid (BAHA) is an auditory system prosthetic based on bone conduction which can be surgically Implant (medicine). It is an option for patients without external ear canals, when conventional hearing aids with a mold in the ear cannot be used. The BAHA uses the Human skull as a pathway for sound to travel to the inner ear. For people with conductive hearing loss, the BAHA bypasses the external auditory canal and middle ear, stimulating the functioning cochlea. For people with unilateral hearing loss, the BAHA uses the skull to conduct the sound from the deaf side to the side with the functioning cochlea.
Individuals under the age of two (five in the USA) typically wear the BAHA device on a Softband. This can be worn from the age of one month as babies tend to tolerate this arrangement very well. When the child's skull bone is sufficiently thick, a titanium "post" can be surgically embedded into the skull with a small abutment exposed outside the skin. The BAHA sound processor sits on this abutment and Transmission (telecommunications) sound vibrations to the external abutment of the titanium implant. The implant vibrates the skull and inner ear, which stimulate the nerve fibers of the inner ear, allowing hearing.
The surgical procedure is simple both for the surgeon, involving very few risks for the experienced ear surgeon. For the patient, minimal discomfort and pain is reported. Patients may experience numbness of the area around the implant as small superficial nerves in the skin are sectioned during the procedure. This often disappears after some time. There is no risk of further hearing loss due to the surgery. One important feature of the Baha is that, if a patient for whatever reason does not want to continue with the arrangement, it takes the surgeon less than a minute to remove it. The Baha does not restrict the wearer from any activities such as outdoor life, sporting activities etc.
A BAHA can be connected to an FM system by attaching a miniaturized FM receiver to it.
Two main brands manufacture BAHAs today – the original inventors Cochlear Baha, and the hearing aid company Oticon.
Temple (anatomy) pieces of the spectacles.. Today, people who use both glasses and hearing aids can use in-the-ear types, or rest a BTE neatly alongside the arm of the glasses. There are still some specialized situations where hearing aids built into the frame of eyeglasses can be useful, such as when a person has hearing loss mainly in one ear: sound from a microphone on the "bad" side can be sent through the frame to the side with better hearing.
This can also be achieved by using CROS hearing aid or bi-CROS style hearing aids, which are now wireless in sending sound to the better side.
These are generally worn by people with a hearing loss who either prefer a more cosmetic appeal of their hearing aids by being attached to their glasses or where sound cannot be passed in the normal way, via a hearing aids, perhaps due to a blockage in the ear canal. pathway or if the client suffers from continual infections in the ear.
Spectacle aids come in two forms, ''bone conduction spectacles'' and ''air conduction spectacles''.
Sounds are transmitted via a receiver attached from the arm of the spectacles which are fitted firmly behind the boney portion of the skull at the back of the ear, (mastoid process) by means of pressure, applied on the arm of the spectacles. The sound is passed from the receiver on the arm of the spectacles to the inner ear (cochlea), via the bony portion. The process of transmitting the sound through the bone requires a great amount of power. Bone conduction aids generally have a poorer high pitch response and are therefore best used for ''conductive hearing losses'' or where it is impractical to fit standard hearing aids.
Unlike the bone conduction spectacles the sound is transmitted via hearing aids which are attached to the arm or arms of the spectacles. When removing your glasses for cleaning, the hearing aids are detached at the same time. Whilst there are genuine instances where spectacle aids are a preferred choice, they may not always be the most practical option.
Hearing aid application (abbreviated HAA) is a software which, being installed on a mobile computational platform, transforms it into a hearing aid.
The principle of Hearing aid application operation corresponds to the basic principles of operation of traditional hearing aids: the microphone receives an acoustic signal and converts it into a digital form. Sound amplification is achieved by the means of a Mobile device, in accordance with the degree and type of users Hearing loss. The processed audio signal is transformed into audio signal and output to the user into the headphones/Headset (audio). Signal processing is implemented in Real-time computing.
Constructional features of Mobile device imply preferred use of stereo Headset (audio) with two speakers, which allows carrying out binaural hearing correction for the left and right ear separately. Hearing aid application can work with both wired and wireless Headset (audio) and headphones.
As a rule, Hearing aid application have several operation modes: ''setup mode'' and ''hearing aid mode''. ''Setup mode'' involves the user passing an Real ear measurement procedure, which determines the user's hearing characteristics. ''Hearing aid mode'' is a hearing correction system that corrects the user's hearing in accordance with user's Absolute threshold of hearing. Hearing aid application also incorporates background Active noise control and Audio feedback suppression.
The user can independently choose a formula to enhance the sound, as well as adjust the level of the desired amplification according to his subjective feelings.
the user does not need to purchase and carry any separate device.
because of the microphone is not located in the ear, it does not use the functional advantages of the auricle and the natural acoustics of the outer ear.
The first electrical hearing aid used the carbon microphone of the telephone and was introduced in 1896. The vacuum tube made electronic amplification possible, but early versions of amplified hearing aids were too heavy to carry around. Miniaturization of vacuum tubes lead to portable models, and after World War II, wearable models using miniature tubes. The transistor invented in 1948 was well suited to the hearing aid application due to low power and small size; hearing aids were an early adopter of transistors. The development of integrated circuits allowed further improvement of the capabilities of wearable aids, including implementation of digital signal processing techniques and programmability for the individual user's needs.
Acoustically: the ''sound'' from the phone's speaker is picked up by the hearing aid's microphone.
Electromagnetically: the ''signal'' inside the phone's speaker is picked up by the hearing aid's "telecoil" or "T-coil", a special loop of wire inside the hearing aid.
Note that telecoil coupling has nothing to do with the radio signal in a cellular or cordless phone: the audio signal picked up by the telecoil is the weak electromagnetic field that is generated by the voice coil in the phone's speaker as it pushes the speaker cone back and forth.
The electromagnetic (telecoil) mode is usually more effective than the acoustic method. This is mainly because the microphone is often automatically switched off when the hearing aid is operating in telecoil mode, so background noise is not amplified. Since there is an electronic connection to the phone, the sound is clearer and distortion is less likely. But in order for this to work, the phone has to be hearing-aid compatible. More technically, the phone's speaker has to have a voice coil that generates a relatively strong electromagnetic field. Speakers with strong voice coils are more expensive and require more energy than the tiny ones used in many modern telephones; phones with the small low-power speakers cannot couple electromagnetically with the telecoil in the hearing aid, so the hearing aid must then switch to acoustic mode. Also, many mobile phones emit high levels of electromagnetic noise that creates audible static in the hearing aid when the telecoil is used. A workaround that resolves this issue on many mobile phones is to plug a wired (not Bluetooth) headset into the mobile phone; with the headset placed near the hearing aid the phone can be held far enough away to attenuate the static. Another method is to use a "neckloop" (which is like a portable, around-the-neck induction loop), and plug the neckloop directly into the standard audio jack (headphones jack) of a smartphone (or laptop, or stereo, etc.). Then, with the hearing aids' telecoil turned on (usually a button to press), the sound will travel directly from the phone, through the neckloop and into the hearing aids' telecoils.
When operating in acoustic (Microphone) mode, the ratings are from M1 (worst) to M4 (best).
When operating in electromagnetic (Telecoil) mode, the ratings are from T1 (worst) to T4 (best).
The best possible rating is M4/T4 meaning that the phone works well in both modes. Devices rated below M3 are unsatisfactory for people with hearing aids.
Computer programs that allow the creation of a hearing aid using a PC, tablet or smartphone are currently gaining in popularity. Modern mobile devices have all the necessary components to implement this: hardware (an ordinary microphone and headphones may be used) and a high-performance microprocessor that carries digital sound processing according to a given algorithm.
Application configuration is carried out by the user himself in accordance with the individual features of his hearing ability. The computational power of modern mobile devices is sufficient to produce the best sound quality. This, coupled with software application settings (for example, profile selection according to a sound environment) provides for high comfort and convenience of use.
is adjusted using audiometry procedures.
Functionality of hearing aid applications may involve a hearing test (Audiometry#Types of audiometry) too. However, the results of the test are used only to adjust the device for comfortable working with the application. The procedure of hearing testing in any way cannot claim to replace an audiometry test carried out by a medical specialist, so cannot be a basis for diagnosis.
Apps such as Oticon ON for certain iOS (Apple) and Android devices can assist in locating a lost/misplaced hearing aid.http://www.oticon.global/solutions/accessories/connectivity, Retrieved 2016-09-25.
Recent hearing aids include wireless hearing aids. One hearing aid can transmit to the other side so that pressing one aid's program button simultaneously changes the other aid, so that both aids change background settings simultaneously. FM listening systems are now emerging with wireless receivers integrated with the use of hearing aids. A separate wireless microphone can be given to a partner to wear in a restaurant, in the car, during leisure time, in the shopping mall, at lectures, or during religious services. The voice is transmitted wirelessly to the hearing aids eliminating the effects of distance and background noise. FM systems have shown to give the best speech understanding in noise of all available technologies.
FM systems can also be hooked up to a TV or a stereo.
2.4 gigahertz Bluetooth connectivity is the most recent innovation in wireless interfacing for hearing instruments to audio sources such as TV streamers or Bluetooth enabled mobile phones. Current hearing aids generally do not stream directly via Bluetooth but rather do so through a secondary streaming device (usually worn around the neck or in a pocket), this bluetooth enabled secondary device then streams wirelessly to the hearing aid but can only do so over a short distance. This technology can be applied to ready-to-wear devices (BTE, Mini BTE, RIE, etc.) or to custom made devices that fit directly into the ear.
Many theatres and lecture halls are now equipped with Assistive Listening Devices that transmit the sound directly from the stage; audience members can borrow suitable receivers and hear the program without background noise. In some theatres and churches FM transmitters are available that work with the personal FM receivers of hearing instruments.
Most older hearing aids have only an omnidirectional microphone. An omnidirectional microphone amplifies sounds equally from all directions. In contrast, a directional microphone amplifies sounds from one direction more than sounds from other directions. This means that sounds originating from the direction the system is steered toward are amplified more than sounds coming from other directions. If the desired speech arrives from the direction of steering and the noise is from a different direction, then compared to an omnidirectional microphone, a directional microphone provides a better signal to noise ratio. Improving the signal-to-noise ratio improves speech understanding in noise. Directional microphones have been found to be the second best method to improve the signal-to-noise ratio (the best method was an FM system, which locates the microphone near the mouth of the desired talker).
Many hearing aids now have both an omnidirectional and a directional microphone mode. This is because the wearer may not need or desire the noise-reducing properties of the directional microphone in a given situation. Typically, the omnidirectional microphone mode is used in quiet listening situations (e.g. living room) whereas the directional microphone is used in noisy listening situations (e.g. restaurant). The microphone mode is typically selected manually by the wearer. Some hearing aids automatically switch the microphone mode.
FM systems have been found to provide a better signal to noise ratio even at larger speaker-to-talker distances in simulated testing conditions.
Telecoils or T-coils (from "Telephone Coils") are small devices installed in hearing aids or cochlear implants. An Audio induction loop generates an electromagnetic field that can be detected by T-coils, allowing audio sources to be directly connected to a hearing aid. The T-coil is intended to help the wearer filter out background noise. They can be used with telephones, FM systems (with neck loops), and induction loop systems (also called "hearing loops") that transmit sound to hearing aids from public address systems and TVs. In the UK and the Nordic countries, hearing loops are widely used in churches, shops, railway stations, and other public places. In the U.S.A., telecoils and hearing loops are gradually becoming more common. Audio induction loops, telecoils and hearing loops are gradually becoming more common also in Slovenia.
Although T-coils are effectively a wide-band receiver, interference is unusual in most hearing loop situations. Interference can manifest as a buzzing sound, which varies in volume depending on the distance the wearer is from the source. Sources are electromagnetic fields, such as CRT computer monitors, older fluorescent lighting, some dimmer switches, many household electrical appliances and airplanes.
The states of Florida and Arizona have passed legislation that requires hearing professionals to inform patients about the usefulness of telecoils.
In the United States, the Hearing Aid Compatibility Act of 1988 requires that the Federal Communications Commission (FCC) ensure that all telephones manufactured or imported for use in the United States after August 1989, and all "essential" telephones, be hearing aid-compatible (through the use of a telecoil).
"Essential" phones are defined as "coin-operated telephones, telephones provided for emergency use, and other telephones frequently needed for use by persons using such hearing aids." These might include workplace telephones, telephones in confined settings (like hospitals and nursing homes), and telephones in hotel and motel rooms. Secure telephones, as well as telephones used with public mobile and private radio services, are exempt from the HAC Act. "Secure" phones are defined as "telephones that are approved by the U.S. Government for the transmission of classified or sensitive voice communications."
In 2003, the FCC adopted rules to make digital telecommunications wireless telephones compatible with hearing aids and cochlear implants. Although analog wireless phones do not usually cause interference with hearing aids or cochlear implants, digital wireless phones often do because of electromagnetic energy emitted by the phone's Antenna (radio), backlight, or other components. The FCC has set a timetable for the development and sale of digital wireless telephones that are compatible with hearing aids. This effort promises to increase the number of digital wireless telephones that are hearing aid-compatible. Older generations of both cordless telephone and mobile phone phones used analog technology.
An audio boot or audio shoe is an electronic device used with hearing aids; hearing aids often come with a special set of metal contacts for audio input. Typically the audio boot will fit around the end of the hearing aid (a behind-the-ear model, as in-the-ear do not afford any purchase for the connection) link these with another device, like an FM system or a cellphone or even a digital audio player.
Direct audio input (DAI) allows the hearing aid to be directly connected to an external audio source like a CD player or an assistive listening device (ALD). By its very nature, DAI is susceptible to far less electromagnetic interference, and yields a better quality audio signal as opposed to using a T-coil with standard headphones. An audio boot is a type of device that may be used to facilitate DAI.
Every electronic hearing aid has at minimum a microphone, a loudspeaker (commonly called a receiver), a battery, and electronic circuitry. The electronic circuitry varies among devices, even if they are the same style. The circuitry falls into three categories based on the type of audio processing (analog or digital) and the type of control circuitry (adjustable or programmable). Hearing aid devices generally do not contain processors strong enough to process complex Algorithm for sound source localization.
Adjustable control: The audio circuit is analog with electronic components that can be adjusted. The hearing professional determines the gain and other specifications required for the wearer, and then adjusts the analog components either with small controls on the hearing aid itself or by having a laboratory build the hearing aid to meet those specifications. After the adjustment the resulting audio does not change any further, other than overall loudness that the wearer adjusts with a volume control. This type of circuitry is generally the least flexible. The first practical electronic hearing aid with adjustable analog audio circuitry was based on US Patent 2,017,358, "Hearing Aid Apparatus and Amplifier" by Samual Gordon Taylor, filed in 1932.
Programmable control: The audio circuit is analog but with additional electronic control circuitry that can be programmed by an audiologist, often with more than one program. The electronic control circuitry can be fixed during manufacturing or in some cases, the hearing professional can use an external computer temporarily connected to the hearing aid to program the additional control circuitry. The wearer can change the program for different listening environments by pressing buttons either on the device itself or on a remote control or in some cases the additional control circuitry operates automatically. This type of circuitry is generally more flexible than simple adjustable controls. The first hearing aid with analog audio circuitry and automatic digital electronic control circuitry was based on US Patent 4,025,721, "Method of and means for adaptively filtering near-stationary noise from speech" by D Graupe, GD Causey, filed in 1975. This digital electronic control circuitry was used to identify and automatically reduce noise in individual frequency channels of the analog audio circuits and was known as the Zeta Noise Blocker.
Digital data audio, programmable control: Both the audio circuit and the additional control circuits are fully digital. The hearing professional programs the hearing aid with an external computer temporarily connected to the device and can adjust all processing characteristics on an individual basis. Fully digital circuitry allows implementation of many additional features not possible with analog circuitry, can be used in all styles of hearing aids and is the most flexible; for example, digital hearing aids can be programmed to amplify certain frequencies more than others, and can provide better sound quality than analog hearing aids. Fully digital hearing aids can be programmed with multiple programs that can be invoked by the wearer, or that operate automatically and adaptively. These programs reduce acoustic feedback (whistling), reduce background noise, detect and automatically accommodate different listening environments (loud vs soft, speech vs music, quiet vs noisy, etc.), control additional components such as multiple microphones to improve spatial hearing, transpose frequencies (shift high frequencies that a wearer may not hear to lower frequency regions where hearing may be better), and implement many other features. Fully digital circuitry also allows control over wireless transmission capability for both the audio and the control circuitry. Control signals in a hearing aid on one ear can be sent wirelessly to the control circuitry in the hearing aid on the opposite ear to ensure that the audio in both ears is either matched directly or that the audio contains intentional differences that mimic the differences in normal binaural hearing to preserve spatial hearing ability. Audio signals can be sent wirelessly to and from external devices through a separate module, often a small device worn like a pendant and commonly called a "streamer", that allows wireless connection to yet other external devices. This capability allows optimal use of mobile telephones, personal music players, remote microphones and other devices. With the addition of speech recognition and internet capability in the mobile phone, the wearer has optimal communication ability in many more situations than with hearing aids alone. This growing list includes voice activated dialing, voice activated software applications either on the phone or on the internet, receipt of audio signals from databases on the phone or on internet, or audio signals from television sets or from global positioning systems. The first practical, wearable, fully digital hearing aid was invented by Maynard Engebretson, Robert E Morley, Jr. and Gerald R Popelka. Their work resulted in United States patent law 4,548,082, "Hearing aids, signal supplying apparatus, systems for compensating hearing deficiencies, and methods" by A Maynard Engebretson, Robert E Morley, Jr. and Gerald R Popelka, filed in 1984. This patent formed the basis of all subsequent fully digital hearing aids from all manufacturers, including those produced currently.
The signal processing is performed by the microprocessor in real time and taking into account the individual preferences of the user (for example, increasing bass for better speech perception in noisy environments, or selective amplification of high frequencies for people with reduced sensibility to this range). The microprocessor automatically analyzes the nature of the external background noise and adapts the signal processing to the specific conditions (as well as to its change, for example, when the user goes outside from the building).
Analogue hearing aids make louder all the sounds picked up by the microphone. For example, speech and ambient noise will be made louder together. On the other hand, digital hearing aid (DHA) technology processes the sound using digital technology. Before transmitting the sound to the speaker, the DHA microprocessor processes the digital signal received by the microphone according to a mathematical algorithm. This allows just making louder the sounds of certain frequency according to the individual user settings (personal audiogram), and automatically adjusting the work of DHA to various environments (noisy streets, quiet room, concert hall, etc.).
For users with varying degrees of hearing loss it is difficult to perceive the entire frequency range of external sounds. DHA with multi-channel digital processing allows a user to "compose" the output sound by fitting a whole spectrum of the input signal into it. This gives users with limited hearing abilities the opportunity to perceive the whole range of ambient sounds, despite the personal difficulties of perception of certain frequencies. Moreover, even in this "narrow" range the DHA microprocessor is able to emphasize the desired sounds (e.g. speech), weakening the unwanted loud, high etc. sounds at the same time.
Digital signal processing helps to reduce noise and distinguish the speech signal from the overall spectrum of sounds which facilitates speech perception.
Reducing of background noise level increases the user's comfort (especially in noisy environments, e.g. on the street).
Setting flexibility provides selective amplification of certain frequencies (in accordance with the personal characteristics of the hearing impaired).
Possibility to use directional microphones, which greatly facilitates the perception of sound in certain environments, e.g., when talking face to face, or listening to the remote lecturer.
Extended frequency range (the ability to hear a large range of sounds).
"Self-learning" adaptive adjustment which facilitates usage of the device for a number of users.
Possibility of connecting devices (phones, smartphones, etc..).
In general, the maximum purification of the sound transmitted to user.
These advantages of DHA were confirmed by a number of studies, relating to the comparative analysis of digital hearing aids of second and first generations and analog hearing aids.
Personal Sound Amplification Products (abbreviated PSAP) are classified by the FDA as "personal sound amplification devices." These compact electronic devices are designed for people without hearing loss. Unlike hearing aids (which FDA classifies as devices to compensate for hearing impairment) use of PSAP does not require medical prescription. Such devices are used by hunters, naturalists (for audio observation of animals or birds), ordinary people (for example, to increase the volume of the TV in a quiet room), etc.
PSAP models differ significantly in price and functionality. Some devices simply amplify sound. Others contain directional microphones, equalizers to adjust the audio signal gain and filter noise.Beck, Melinda, [https://www.wsj.com/articles/SB120156046709123567 "Getting an Earful: Testing A Tiny, Pricey Hearing Aid"], ''The Wall Street Journal,'' Jan. 29, 2008. Retrieved 2013-05-23.
The invention of the carbon microphone, transmitters, digital signal processing chip or Digital signal processor, and the development of computer technology helped transform the hearing aid to its present form.Howard, Alexander (26 November 1998). [https://www.nytimes.com/1998/11/26/technology/hearing-aids-smaller-and-smarter.html "Hearing Aids: Smaller and Smarter."] The work was conducted with the help of the "big" computer of that time. Although they could not claim to be a real hearing aids (their performance was not enough for audio processing in real time – not to mention the size), they carried out successful studies of the various hardware circuits and algorithms for processing audio signals. The software package BLODI (stands for Block of Compiled Diagrams) developed by Kelly, Lockbaum and Vysotskiy in 1961 allowed to simulate any sound system provided in the form of a block diagram. With its help a special phone for users with hearing impairments was created. In 1967, Harry Levitt used BLODI to simulate a hearing aid on a digital computer.
Almost ten years later the second step was taken – the creation of "quasi-digital" hearing aid, in which the analog components and digital programmable module was combined into a single compact case. In this device the digital controller not only controlled the analog components (amplifiers, filters and signal limiter), but it could be programmed by connecting an external computer (in the laboratory – with medical supplies of hearing aids).
The concept of quasi-digital device was very successful from a practical point of view because of the low power consumption and compact size. At that time, low-power analog amplifier technology was developed very well – in contrast to the semiconductor chips necessary for a "real" digital camera. The combination of high performance analog components and digital signal processing capability has led to the creation module successful production parts.
The hearing aid of this type was developed by Etymonic Design. A little later, Mangold and Lane created a programmable multi-channel hearing aid. A similar approach was applied by Similarly, Graupe with co-authors for developing of an adaptive noise filter on a single crystal. This relatively small chip had low power consumption and fit in the case of ordinary BTE or ITC hearing aid.
The third stage of development was the appearance of "real" digital hearing aids. In DHA all stages of sound processing are carried out in binary form. To do this, an external sound from a microphone first converted into a binary code, and after the conversion the reverse transformation is carried out (to analog signal transmitted by the ear speaker in the form of sound). The first "real" DHA were models developed by Graup in 1970 on the basis of the 8080 microprocessor, which replaced the analog components (amplifier, limiter and filters). The possibilities of a programmable processor made the device self-adjusting, which opened the prospects for the use of advanced signal processing techniques, noise reduction, etc. Although the 8080th processor was relatively slow and big in size.
Further development of the DHA is associated with the creation of microprocessors with parallel processing of data arrays. As a result, a significant decrease of calculations time gave the opportunity to conduct processing of audio signal in real time. The small size of microchips (as of 1987) allowed creating compact hearing aids not exceeding the dimensions of their analog "predecessors" on their basis. However, for ITC aids these processors were not yet sufficiently compact. In all other respects, "full" DHA of that period was very similar to modern models.
Like much of the Irish health care system, hearing aid provision is a mixture of public and private.
Hearing aids are provided by the State to children, OAPs and to people whose income is at or below that of the State Pension. The Irish State hearing aid provision is extremely poor; people often have to wait for two years for an appointment.
It is estimated that the total cost to the State, of supplying one hearing aid, exceeds €2,000.
Irish taxpayers can also claim tax relief, at the standard rate, as hearing aids are recognised as a medical device.
Hearing aids in the Republic of Ireland are exempt from VAT.
Hearing aid providers in Ireland mostly belong to the Irish Society of Hearing Aid Audiologists.
Ordinary hearing aids are Medical device#Class I: General controls regulated medical devices under Federal Food and Drug Administration (FDA) rules. (a) (2005). A 1976 statute explicitly prohibits any state requirement that is "different from, or in addition to, any requirement applicable" to regulated medical devices (which includes hearing aids) which relates "to the safety and effectiveness of the device." Inconsistent state regulation is preempted under the federal law.Missouri Board of Examiners for Hearing Instrument Specialists v. Hearing Help Express, Inc., 447 3d 1033 (8th Cir. 2006) In the late 1970s, the FDA established federal rules governing hearing aid sales,Final Rule issued in Docket 76N-0019, (15 February 1977). and addressed various requests by state authorities for exemptions from federal preemption, granting some and denying others.
Exemption from Preemption of State and Local Hearing Aid Requirements; Applications for Exemption, Docket No. 77N-0333, (10 October 1980).
Several industrialized countries supply free or heavily discounted hearing aids through their Publicly funded health care.
The Australian Department of Health and Ageing provides eligible Australian citizens and residents with a basic hearing aid free-of-charge, though recipients can pay a "top up" charge if they wish to upgrade to a hearing aid with more or better features. Maintenance of these hearing aids and a regular supply of batteries is also provided, on payment of a small annual maintenance fee.
In Canada, health care is a responsibility of the Provinces and territories of Canada. In the province of Ontario, the price of hearing aids is partially reimbursed through the Assistive Devices Program of the Ministry of Health and Long-Term Care (Ontario), up to $500 for each hearing aid. Like eye appointments, audiological appointments are no longer covered through the provincial public health plan. Audiometric testing can still easily be obtained, often free of charge, in private sector hearing aid clinics and some ear, nose and throat doctors offices. Hearing aids may be covered to some extent by private insurance or in some cases through government programs such as Veterans Affairs Canada or Workplace Safety & Insurance Board.
In India hearing aids of all kinds are easily available. Under Central and state government health services, the poor can often avail themselves of free hearing devices. However, market prices vary for others and can range from Rs 1,000 to Rs 275,000 per ear.
From 2000 to 2005 the Department of Health worked with Action on Hearing Loss (then called RNID) to improve the quality of NHS hearing aids so every NHS audiology department in England was fitting digital hearing aids by March 2005. By 2003 Over 175,000 NHS digital hearing aids had been fitted to 125,000 people. Private companies were recruited to enhance the capacity, and two were appointed – David Ormerod Hearing Centres, partly owned by Alliance Boots and Ultravox Group, a subsidiary of Amplifon.
While there are some instances that a hearing aid uses a rechargeable battery or a long-life disposable battery, the majority of modern hearing aids use one of five standard Watch battery Zinc–air battery. (Older hearing aids often used mercury battery cells, but these cells have become banned in most countries today.) Modern hearing aid button cell types are typically referred to by their common number name or the color of their packaging.
They are typically loaded into the hearing aid via a rotating battery door, with the flat side (case) as the positive terminal (cathode) and the rounded side as the negative terminal (anode).
These batteries all operate from 1.35 to 1.45 volts.
The type of battery a specific hearing aid utilizes depends on the physical size allowable and the desired lifetime of the battery, which is in turn determined by the Electric power draw of the hearing aid device. Typical battery lifetimes run between 1 and 14 days (assuming 16-hour days).
[http://www.american-hearing.org/ American Hearing Research Foundation] funds research in hearing and aims to help educate the public in the United States.
[http://www.rnid.org.uk/information_resources/ Royal National Institute for Deaf] Information and resources about hearing loss.