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Around 18% of adults report that they struggle with some type of hearing difficulty. An ENT (ear nose and throat doctor) is an expert that can help. Improving your hearing starts with an accurate diagnosis.
Using state of the art hearing tests an ENT doctor can quickly diagnose hearing problems and provide you with the tools to improve your hearing. A Raleigh ENT doctor is the specialist you need to see for all your ear, nose, and throat needs.
Many people do not realize that the ears, nose, and throat are all one system. They are part of the upper respiratory system and share one membrane. There is a wide range of conditions and illnesses that will affect the ENT system that can cause hearing problems, headaches, and more.
Seasonal allergy sufferers know during allergy season exactly how relative each part is to the other. When one part is affected by allergies all parts are affected. The same is true of a sinus infection or a disease of the throat. Each part affects the other parts' ability to function.
An ear nose and throat medical practice focus on treating disease and dysfunction of this system including providing corrective action for hearing loss. ENT care for both children and adults is available.
There are several different types of hearing loss that an ENT doctor can help to correct. Congenital hearing loss is hearing loss that you are born with. This type of hearing loss is largely related to malformations in the ear.
Infections can also cause hearing damage that can result in hearing loss. For older people, exposure can cause hearing loss. Aging in and of itself can cause hearing loss.
The good news is that hearing loss can be correctable. Using digital technology customizing your hearing aid can be an easy way to improve your hearing. Hearing loss can make you feel isolated, impact your social life and personal relationships.
An ENT doctor can help to improve your hearing. Make your appointment today and learn more about hearing loss correction.
No one wants to wear a hearing aid but, like glasses, this can be a necessary aspect of life. Hearing loss is actually a very common problem that can affect people of any age. Sometimes, it's caused by illness or disease. Sometimes, it's caused by years of exposure to loud noises. It may even be an occupational hazard. In fact, around two to three out of every 1,000 children in the U.S. have a detectable hearing loss in one or both ears when they are born. Hearing aid customization makes it much easier for anyone to comfortably wear hearing aids. They make it possible to hear perfectly without discomfort and sometimes, without others even being able to see the hearing aids.
Hearing aids have a bit of a bad reputation because of their past. Older hearing aids made years ago were big, clunky devices that were difficult to wear. They were unwieldy, uncomfortable and highly visible. But hearing aids have changed a great deal in more recent years. They have become streamlined, comfortable, easy to wear and sometimes, even invisible to others. Individual hearing aids and comfortable hearing aids are possible with customization.
Customizing your hearing aid isn't that much more difficult or expensive than buying a generic model. In fact, it's easier to get hearing aid customization than most people even realize. Today's modern hearing aids are carefully designed based on very precise measurements of your ears. They can fit into the ear canal or right behind the ear, depending on the specific style you choose.
Hearing aid customization is actually necessary when it comes to getting aids for children. They have small ears and don't want to wear something that's uncomfortable. You don't want a very young child to reach up and pull out their hearing aids, for example. Luckily, there are doctors who specialize in creating pediatric hearing aids that are made for children to wear comfortably.
Do you suspect that you have some form of hearing loss? Even a little hearing loss probably isn't going to get better and will, in fact, probably get worse over time. Don't wait for that to happen. Get your hearing checked immediately and find out if you're a candidate for hearing aids.
Hearing tests can be done by many types of doctors. Sometimes, you can even find clinics and mobile medical facilities that test hearing. The tests are pretty standard. Sometimes, you can even get your hearing checked by a mobile booth at a fair or carnival! For children's hearing tests, you may want to consult with a pediatrician or pediatric audiology specialist.
After your hearing evaluations are over, consult with a specialist to find out if you're a candidate for hearing aids. Be sure to bring the results of your hearing tests so they have all the information about your hearing loss. Once you determine that you're a candidate to wear hearing aids. you can find out more about customizing your hearing aid to perfectly suit your ears. With hearing aid customization, you can begin hearing perfectly again.
Hearing loss is not something that is widely talked about or widely discussed. Approximately 15% of American adults over the age of 18 report that they experience problems hearing things in either one or both ears. Sometimes these problems arise after childhood, but chances are there were issues or problems during their childhood years that might have been overlooked. Parents don't overlook simple small signs that their child may have a hearing problem on purpose though, it could easily be brushed off as something else such as stubbornness or distractions. Knowing specific signs to look for in children can help parents notice these issues and address them an ENT for children before the problem gets worse. Below we will explore some of these commonly overlooked signs of hearing problems in children.
Any parent that has had a newborn knows that there is a phase when they get startled at noises. Sometimes even slight noises will startle them, it doesn't always have to be a loud noise. Once your baby is around the age of three months, they should successfully recognize the voice of their mother, father and other people that are around them on a regular basis. If you find that your infant is still startled by your voice or the voice of someone else they should be used to by now then it may be time to talk to your child's doctor about a recommendation to a pediatric ENT specialist.
There are certain milestones that children reach and while there is some wiggle room for these milestones you should still see your child progressing more and more towards them. If you notice, by the time your child is close to one year of age, that you child is not mimicking noises and sounds or starting to say simple words such as "mama" or "dada" then it might be time to talk to your child's doctor to see if they can perform a series of hearing tests. This test will help ensure that your child is hearing okay and there are no issues with their ears.
Babies have a habit of turning their heads when they hear noises, especially noises that they are used to such as the voice of the mother or father. Parents should pay close attention to the movement of their child's head. If you notice that your child is constantly turning their head one way and never the other then that could be a sign that their other ear is not working properly. If they are having a problem hearing out of one ear they will not favor that ear, but will favor the other ear that hears well. If you notice that your child shows these signs it would be a good time to discuss your concerns with your child's doctor so they can schedule some hearing evaluations to further address any issues.
Many parents will notice if their child abnormally starts talking louder than normal as this can sometimes signal an ear infection. It's well known that children talk louder when they aren't able to hear how loud they are. Some parents, however, don't ever take this into consideration when their child has always been loud. Some parents may assume that they just have an overactive or extra loud child, but there could be an underlying issue that only an ENT for children can diagnose. If they test hearing capabilities and discover an issue, they can start early treatment that could possibly remedy the issue or direct the parents to the proper medical professionals for treatment.
No parent ever wants to hear that something is wrong with their child, but a diagnosis from an ENT for children is not the end of the world. A specialized ENT for children is there to help your child and help you as the parent. There are huge advancements that have been made to help children who have problems hearing hear better and an ENT for children can share these advancements with you. Keeping an eye on these common signs can help you spot problems early and begin treatment as soon as possible.
A pediatric ENT is a doctor that specializes in treating children with ear, nose, and throat conditions. They specialize in providing an accurate diagnosis for children experiencing hearing loss, throat problems, and ear conditions including chronic ear infections.
Around four out of every 1000 children are born with measurable hearing impairment. The pediatric ENT is the doctor that provides the care in cases of hearing loss. Experts agree that the sooner hearing impairment is diagnosed the better the outcome for treatment.
When a child is born with a hearing impairment there is a range of potential causes including:
Other causes can be ototoxic drugs during pregnancy. Some genetic conditions can cause deafness in a child including Down syndrome, Usher syndrome, Treacher Collins syndrome, Crouzon syndrome, Alport syndrome, and Waardenburg syndrome. A pediatric ENT is an expert that can test your baby for hearing problems very early on.
Hearing loss can occur in older children from chronic ear infections. Otis Media, other illnesses can also impact a child's hearing permanently. Measles, meningitis, encephalitis, and flu. Your child's hearing can be impacted by a wide range of diseases.
The Pediatric ENT can diagnose any hearing problems and develop a custom treatment plan specifically for your child. If you suspect that a recent illness has impacted your child's hearing it is always best to get it checked by a specialist.
Early diagnosis is vital to early intervention which can help to improve the success of the treatment. The pediatric ENT can test hearing on newborns, and children of all ages. In cases of suspected congenital hearing loss experts agree that diagnosis before the age of three months provides the best opportunity for creating an effective treatment plan.
Hearing impairment can affect speech development and other areas of development. A pediatric audiologist Raleigh NC parents take their children to for care, can help with all the symptoms of hearing loss. Speech therapy, hearing aids, and other treatment options can help your child to overcome hearing impairment.
If you suspect that your child is struggling to hear, make an appointment with the ENT. It is always best to have the testing done and to be proven wrong than to not having the testing done and find out down the road you were right.
Hearing aids consist of three basic parts to make hearing easier: a microphone, an amplifier, and a speaker. Hearing aids aren't one-size-fits-all and come in a variety of styles and sizes with customizability a key factor in their comfort.
One of the most popular types of hearing aids are Lyric hearing aids. But what makes this hearing aid popular in the first place? And is it a good choice for me or my child?
Here's what you need to know about Lyric hearing aids.
Lyric is the first and only completely invisible extended-wear hearing aid that can be worn 24 hours a day, seven days a week, for months at a time. The hearing aid is comfortably placed in the ear canal by a professional audiologist.
Lyric is positioned completely inside the ear canal. This makes it so the hearing aid uses the ear's anatomy to provide localization cues and natural sound quality.
Lyric has a core that's stored safely inside a biocompatible, soft foam seal. This seal contours to the ear canal and makes sure that there's stable placement and natural ventilation.
The Lyric battery is designed to withstand your deep ear environment for long periods of time. The hearing aid uses the natural mechanisms of your ear to amplify sounds and the microphone and receive further enhance this experience.
Lyric is completely safe to wear. Since 2001, Lyric has been cleared by the FDA and has been studied extensively in clinical research for over 15 years.
There have been no reports of serious complications with Lyric hearing aids. Lyric has been safely worn by hundreds of thousands of people since 2007 when the hearing aid was commercially launched.
Lyric hearing aids can be purchased through an authorized Lyric partner. Lyric is designed for people who have mild to moderately-severe hearing loss.
If you're interested in a Lyric hearing aid, your authorized Lyric partner will assess your hearing loss, your ear shape, ear size, medical conditions, and lifestyle to determine whether the Lyric hearing aid is the right choice for you.
If you're interested in Lyric hearing aids, hearing tests, or hearing aid customizations, ENT and Audiology Associates is the place for you. For more information about our hearing evaluations and hearing aids, contact ENT and Audiology Associates today.
Hearing loss is a condition that can happen to anyone. However, it usually presents early symptoms that can be diagnosed in order to lead to early treatment. These symptoms may appear gradually, making hearing loss difficult to spot in yourself or in those you love. If you notice symptoms, you should speak to an audiologist who can perform hearing evaluations to help determine the best treatment option.
Muffled Voices
When people are speaking to you, especially children, you find yourself straining to understand them. Their voices will often sound muffled. This is because as your hearing loss progresses, the part of your ear that processes high pitched noises is typically the first to experience damage. This may also happen if you find yourself unable to concentrate on the conversation, as the background noise is seemingly louder than what someone is saying to you. This may be a sign that it is time to visit an audiologist to provide an accurate diagnosis, which may include treatment with the use of hearing aids.
Volume Levels Off
Some people around you may comment that you are turning up the volume higher than what they perceive to be a normal level. If more than a few people have spoken up about the volume that you listen to the radio or tv, it may be time to visit a professional that can perform hearing tests. They may deem that you need hearing aids to help correct your hearing loss.
Tired Easily
When you are experiencing hearing loss, your brain tries to fill in the blanks. This can cause your brain to be working extra hard when you are in social situations, causing you to become tired more frequently. Evaluations that test hearing can be given by an audiologist to rule out any hearing loss situations.
While the symptoms of hearing loss can range drastically, all issues generally fall under three different categories.
Sensorineural hearing loss occurs when the inner ear, called the cochlea, has difficulty functioning. This is the nerve that connects to the brain. Damage to the cochlea can occur due to natural aging, infection, or loud noises. Those who are suffering from sensorineural hearing loss often hear voices as distorted or muffled. Sensorineural hearing loss is irreversible, but can be treated with hearing aids.
Conductive hearing loss is when someone experiences damage to the middle ear. This is when sound can not be conducted properly, but typically due to a physical issue. The causes of conductive hearing loss could be fluid or wax in the middle ear, as well as a damaged ear drum. Normally, conductive hearing loss can be corrected by an audiologist without the need for hearing aids.
Mixed hearing loss occurs when the inner ear and middle ear are both experiencing damage, which is a combination of sensorineural and conductive hearing loss. Although the middle ear issue may be able to be corrected, a person may still require hearing aids to help treat the damage to their inner ear.
Around thirty-seven million American adults experience some type of hearing loss. Early detection is the key to early treatment when it comes to hearing loss. Knowing how to prevent hearing loss will help you to protect one of your most precious senses for years to come.
Avoid Loud Noises
Prolonged exposure to loud noises can have a significant impact on your hearing. If you are in a loud environment, consider measures to help protect your hearing. This may include headphones or earplugs.
Have Routine Check Ups
Visit an audiologist regularly to keep your hearing in check. Some issues are better treated if they are caught early. Staying on top of your hearing health will help your audiologist catch any symptoms that appear abnormal.
A professional audiologist can perform hearing tests and evaluations to assess your hearing loss and any treatment options that may be available to you. Proper ear care helps to improve your overall health and could help prevent other issues from developing down the road. If you notice symptoms of hearing loss, get in touch with a professional audiologist that can perform an evaluation.
Every year around 3 out of 1000 children are born with some type of detectable level of hearing loss. In many cases, hearing loss is missed or not diagnosed. A pediatric ENT specializes in hearing evaluations, hearing tests, and hearing aids for children.
The first step in treating hearing loss is an accurate diagnosis. Hearing loss in children can affect everything from speech development to their ability to learn. It is important that you are able to recognize the signs of a child struggling with hearing problems.
There are several things that can cause hearing loss in children including:
There are many risks to hearing in children. From untreated infections to injuries to listening to headphones, there are many risks out there.
Many parents are not aware of what to look for to determine if they need to make an appointment with a pediatric ENT. Hearing tests are the only way to confirm the hearing loss. Symptoms of hearing loss can include:
There are other signs that your child may be struggling with hearing loss that your pediatric ENT will review with you. If you suspect that your child cannot hear or is experiencing some level of hearing loss, it is time to make an appointment for hearing tests. A hearing test Raleigh NC parents have found can be a very helpful diagnostic tool in making sure their child is getting the right care.
If you suspect there is a problem the best way to find out for sure is by making an appointment for an evaluation. Once you have an accurate diagnosis you can get the care that your child deserves.
Does it seem like you're always asking people to repeat themselves? Maybe your friends complain that your TV volume is always high. Check out these warning signs, chances are, you may be experiencing hearing loss.
Hearing loss may cause you to lose more than you realize. When you cannot hear or respond to conversations, participate in social activities and interactions, you become reclusive and less motivated to participate in life.
According to statistics, over 37.5 million people report having trouble hearing. Further, the condition is spanning through generations as it is the third most prevalent condition among seniors in the country. It falls behind arthritis and hypertension. However, hearing problems among young adults is a cause for alarm.
Even though hearing aids can heal 95 percent of these conditions, only 23 percent of them use these aids. The following are the main signs that you can benefit from test hearing to check the status of this essential sense.
The biggest warning sign is asking people to repeat themselves. At times, people may appear to be mumbling or their conversations are muffled.
In most cases, the high-pitched voices of children and women are difficult to hear. While you'll suffer if you don't hear what people are saying, the ones around you will also suffer. Your spouse, kids, and relatives are missing out on a positive relationship with you. Visit a test hearing facility to get an accurate diagnosis of your case.
Are you having trouble hearing in areas with too much background noise? Well, this is a sign that you're experiencing hearing loss conditions.
Hearing and understanding what other people are saying allows you to participate in family events and other activities. The inability to participate in social conversations may have dire mental consequences. There is evidence showing a strong correlation between hearing loss and cognitive decline. Visit a competent expert for hearing evaluations and possible treatment.
Are you constantly turning up your TV volume to a point where others complain about how loud it is? Well, the issue may not be with your radio or TV.
It is a common warning sign that your hearing may have a problem. If you notice this, make arrangements for test hearing without delay. The experts attending to your case will conduct hearing tests before advising on the course of action.
Exposing yourself to loud noises is harmful to your ears. Such may lead to tinnitus or a ringing sound in your ears. If the ringing persists, consider doing a test hearing.
A 2013 study done in Brazil concluded that 43 percent of those with hearing loss experience tinnitus. The experience can also be a warning sign in children too. If your kid is ever complaining about ringing in the ears, difficulty in hearing, or pain in the ears, take them for a test hearing. Let the doctor assess and prepare a diagnosis before coming up with the best solution.
Well, this is the biggest red flags. For instance, do you sleep through your alarms or miss the call or texts on your phone? When was your last time to hear birds tweeting outside your house?
If you notice that you're missing on one or more of these sounds, visit an expert. Let them handle the situation before it becomes too hard for you to handle.
Do you have challenges talking over the phone, especially in a noisy area? Do you find yourself avoiding calls from your friends and loved ones? Well, not anymore! Have a test hearing exercise done to determine the cause and extent of your problem. This is the first step to reclaiming your hearing. If possible seek intervention sooner rather than later.
You should never fear to seek treatment for hearing loss. It is a painless process.
Approximately 15% of American adults (or 37.5 million people) report some trouble hearing. To many of us, hearing loss is understood as one condition; the truth of the matter is that hearing loss can manifest in a number of different ways, depending on what type of damage has occurred and where it has occurred in the ear. Let's take a look at the anatomy and physiology of the ear to gain a better understanding of how hearing loss — and the ear in general — works.
The outer ear consists of the pinna or auricle. This refers to the visible part of the ear, such as the earlobe and cartilage. The canal leading to the eardrum is referred to as the external auditory canal or tube. When a sound is made outside the outer ear, the sound waves, or vibrations, travel down the external auditory canal and strike the eardrum.
The eardrum, or tympanic membrane, divides the outer ear from the middle ear. The middle ear (also called the tympanic cavity) is comprised of the following:
The inner ear consists of three components: the cochlea, which contains the nerves for hearing, and the vestibule and semicircular canals, both of which contain receptors for balance.
Once sound has entered the external auditory canal and struck the eardrum, the eardrum vibrates. These vibrations travel to the ossicles, which amplify the sound and send the waves to the inner ear and into the cochlea. The sound waves are then converted into electrical impulses, which the auditory nerve sends to the brain; the brain then translates these signals into sound.
If any damage at any point in this sound journey can disrupt the process in different ways. Some may be fixed or improved with the use of Lyric hearing aids or other forms of digital technology, some can be fixed or improved through surgery, and others cannot be changed. Only through hearing evaluations and hearing tests can ENTs determine the source of the problem and how to move forward.
ENT and Audiology Associates is happy to provide hearing evaluations for patients concerned about hearing loss. Whether for yourself or your child, our hearing evaluations will be able to determine the cause of the problem. Call us at (919)782-9003 to make an appointment today.
The ear, nose, and throat are common areas of trouble for children. To avoid further complications down the road, it's often to handle problems with these areas as quickly and accurately as possible. Finding the right ENT for children is an important part of overall health and wellness. Follow our simple tips and you should be well on your way to establishing quality care.
In addition to assessing the health of your child's nose and throat, ENT care facilities perform hearing tests. Hearing loss is a common affliction among children and adults alike. In the United States, about 2 to 3 out of every 1,000 children are born with a detectable level of hearing loss in one or both ears. A lot of hearing issues can be mitigated if they are detected and addressed early on in life. When you choose your ENT doctor, they will administer comprehensive hearing evaluations, and if necessary, provide recommendations on hearing aids. If hearing aids are needed, a reliable ENT can help you in customizing your hearing aid and providing ongoing care to monitor progress.
ENT for children also covers ear infections. Infections of the ear are one of the more common conditions that arise in children. There are many strategies for dealing with infections, as well as many factors that can cause them. Exposure to other viruses, such as respiratory viruses will be considered by your doctor, as well as environmental factors, family history, and the potential of infections that were experienced in the early life of your child.
Searching for the right ENT care provider does not have to be a complicated process. Begin by consulting with trusted friends and family, as word of mouth suggestions can often provide all the assurance you need. You can also reference the wealth of information and reviews available online. By establishing a relationship with a quality ENT care facility, you are taking the right steps toward providing your child with a happy, healthy life as they grow, learn, and develop.
Studies show that 2 or 3 of every 1,000 children born in the United States have considerable hearing problems in one or both years. The studies continue to highlight that most of the children end up losing their hearing, especially if their problems are not detected by their parents. Therefore, parents have to observe specific hearing problems so that they can consult pediatric audiology and solve the hearing problem at an earlier stage.
Pediatric audiology will only help your child if you can detect hearing problems at an earlier stage. Here are some of the signs that should compel you to seek the services of pediatric audiology.
Children are supposed to develop language at an earlier stage in life because they are interacting with older children who can speak. Moreover, they are constantly hearing their parents mention things followed with actions, which makes them name things. However, if your child demonstrates delayed language development, you need to consult pediatric audiology for an accurate diagnosis. Maybe the child is not hearing, which explains why he has not developed any language skills.
Ear infections are not a sign of a hearing problem, but a probable cause of hearing problems. This is very difficult because a young child may not be able to show the actual cause of the problem. However, an observant parent can easily detect ear infections. Continues flow of fluids from the one or both ears is a clear sign of ear infection. A child putting fingers in the ears is an obvious problem that something is wrong. A pediatric ENT will easily detect ear infection and offer the necessary solution.
Daydreaming is a clear indication that the child is not hearing what is happening within the surrounding. Parents tend to confuse daydreaming with being inattentive. They could be right but consistent daydreaming for about a week is a danger sign that your child has hearing problems. A test hearing, done by experienced pediatric audiology could highlight the problem with your child. If diagnosed and treated properly, the child will start responding to the noises from the surrounding environment.
This is a common aspect to many children because they are curious, and they want to see the source of the sound. However, it's a clear indication that your child is having critical hearing problems. He could be hearing the sounds but not the actual words being pronounced. That's why he is turning to face the movement of the lips to try and understand the meaning of the sounds. A pediatric is supposed to conduct hearing tests to the child before recommending hearing aids, which will help the child to listen to the words clearly without looking at the movement of the lips.
It is the nature of young children to grab or point at familiar objects in the room. It is expected that a child will be highly interested in feeding cups, towels, and toys. Those are familiar objects. But it becomes critical when the child grabs or points it familiar objects when they are mentioned. This is a clear indication that the child cannot name the objects and cannot hear their names but can understand what others are saying through lip movement. This is a clear warning that your child needs hearing tests to determine whether he has hearing loss.
Reacting to loud sounds is a clear indication that the child did not hear before the sound was increased. He can now hear and deduce the meaning of the sound. That's why he is reacting. Children with this type of hearing problem tend to remain calm while at the same time, paying huge attention to the person speaking. However, a slight increase in the volume of the sound makes them react. They can now hear without problems, and that's why they are being excited or annoyed depending on the sounds produced.
There is a considerable number of people in the United States who have hearing problems. Most of these hearing difficulties started at an earlier stage but were not solved and were allowed to develop. It is upon you to take your children to pediatric audiology after detecting danger signs of hearing problems.
Acute sinusitis, also known as a sinus infection, is not a pleasant thing to have. If you've ever had one, then you know what we mean. If you have, then you'll agree that the extreme symptoms, which range from a feeling of fullness in the sinus cavity region to fatigue and aches and pains, all add up to a very unpleasant illness.
Thankfully, there are some symptoms to watch for, and if you catch your acute sinusitis early enough, you'll be able to treat it before it gets worse. Here's what you need to know about sinus infections.
It All Starts With a Sore Throat
In most cases, a sinus infection starts with nasal congestion followed by pain or pressure in your face. There may also be colored nasal discharge.
Fatigue and a Fever Come Next
The very next symptoms of acute sinusitis involve your entire body. You'll feel very tired and fatigued. You might be tempted to spend the day in bed recuperating. You might even have the aches and pains that tend to appear with illnesses like the flu, only you don't have the flu – you have a sinus infection.
You might even have a minor fever, which can be treated with some over the counter medications, like Tylenol. All of these are signs that your body is fighting off an infection.
Additional Symptoms
On top of the symptoms listed above, there are many more that need to be mentioned. Your sinuses will feel full, and you might even notice that your face looks slightly swollen in the area under your eyes, and next to your nose. This means that your sinuses are filled with mucus.
You might also feel as though your ears are clogged. Your eyes might itch, and you'll definitely feel as though you got hit by a bus or a train. You might even be a bit dizzy. Really, acute sinusitis can take a lot out of you.
How Are Sinus Infections Diagnosed?
There are many ways that an ENT expert can diagnose and treat a sinus infection. It all starts with a history (your story of your illness) and a physical exam. The doctor will ask you a number of questions and take note of your symptoms. They then conduct a physical exam, which involves looking into your ears, nose, and throat, and listening to your cough.
You'll more than likely be very congested and have a slight fever. It's easy to think that a sinus infection and a cold are one and the same, but they aren't, as the sinus infection is much worse. Once you've been diagnosed with a sinus infection, the treatments can begin.
Medications Are Prescribed
Antibiotics, steroids, Afrin spray, and sinus rinses are all possible treatments. The best combination will be individualized for you.
Douglas K. Holmes, MD, FACS ENT & Audiology Associates PLLC
3820 Ed Drive Raleigh, NC 27612
phone 919 782 9003 fax 919 782 9303
practice website: www.drdougholmes.com
Elizabeth is one of our amazing patients. She was diagnosed with hearing loss around age 4, and has been wearing hearing aids ever since. Next week is her birthday, and instead of presents, she wants to raise money for other kids like her to get hearing aids. We are so inspired by Elizabeth's generosity, and proud to know her. Please consider donating to help her reach her birthday goal!
To help Elizabeth reach her birthday goal, please visit: https://support.starkeyhearingfoundation.org/fundraiser/1239076
If an audiologist has recently diagnosed you with hearing loss, you're not alone. Hearing loss affects a significant number of Americans, so don't be alarmed. With the help of ENT & Audiology's Raleigh audiologists, you'll be able to find the best solutions for your hearing loss.
If your audiologist confirms that your hearing problem stems from damaged hair cells found in the inner ear, you may have what is known as sensorial hearing loss, which is treated with hearing aids.
Hearing aids are small electronic devices worn inside or behind the ears, which consist of a microphone, speaker, and amplifier, and are useful for making sounds loud enough for the ears to hear clearly and the mind to comprehend in order for an individual to communicate effectively. Hearing aids also make it possible for people with hearing loss to hear clearly both in noisy and quiet environments.
As mentioned, hearing aids consist of three basic parts, each with a vital role to play.
i. Microphone – The microphone is what receives external sound. It then changes these sound waves into electrical signals before transferring them to the amplifier.
ii. Amplifier – Once the amplifier receives the electric signals, it multiplies the intensity of the signals accordingly.
iii. Speaker – The amplified sound is transferred to the ear through the speaker and once the remaining hair cells picks the sound, they convert them into neural signals which the brain is able to pick
The strength of a hearing aid amplification required by an individual is determined by the level of damage to the inner ear. However, there is a level at which even the largest amplification a pair of hearing aids can offer will not be of any assistance. In this case, your audiologist will make alternative recommendations e.g. having a cochlear implant.
Hearing aids are classified into two major categories based on where they are worn.
In-the-ear (ITE) Style Hearing Aids
ITE style hearing aids include:
Behind-the-ear (BTE) Style Hearing Aids
BTEs are more popular now than before because current hearing aids now come in a smaller size for those who prefer being discreet, which represents a significant percentage of people with hearing loss problems. Despite their size, they can still accommodate different features to suit specific hearing loss challenges.
Some include:
To ensure the best fit, here are some things to consider:
Generally, hearing aids will vary with the extent of the hearing loss. However, other factors will certainly come into play.
These include:
All in all, one needs to first get a recommendation from the doctor and then weigh the pros and cons of each option available before settling on what's best for their specific needs.
The most basic hearing aids maintenance practice is professional cleaning, you need to rid it of dust, moisture or wax using a soft dry cloth at least daily. Making regular appointments with your audiologist are also crucial to ensure your hearing aids are operating at the optimal levels.
Tinnitus can be diagnosed as hearing noise when there is no external noise present. It commonly affects 1 out of every 10 adults aged 60 and above. It is generally a symptom to an underlying ear complication, most likely a damaged cochlea.
The noise manifests as buzzing, whistling, roaring, clicking, hissing, or other noises that vary in pitch and frequency from one person to another. Continuous tinnitus can be very bothersome and cause stress for the patient.
Subjective Tinnitus: This is the most common form of tinnitus in which only the patient can hear the noises.
It has several causes including:
Objective Tinnitus: Objective tinnitus can be heard by the patient and their medical doctor during check up. This form of tinnitus is not as common as subjective tinnitus.
This can be caused by:
Those suffering from tinnitus can experience symptoms of:
Tinnitus currently has no cure, however, there are some new treatments available to help control tinnitus and drastically improve a patient's life.
Some tinnitus management tips include:
Some of the causes of tinnitus can easily be prevented, like smoking or exposure to loud noise. It is better to address risk factors early before they cause permanent damage.


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Lib Dems make welfare cuts a red line – mostly
Nick Clegg has said that he would not enter coalition with the Conservative party again after May's election if the party insists on introducing its proposed £12bn of social security cuts. [The Guardian]
Good, but not quite the full story. The Lib Dem manifesto costings I wrote-up yesterday include some curbs on welfare spending, particularly extending the 1% cap on increases in welfare benefits (excluding those for people with disabilities, which aren't capped) for an extra year. I think these are just within the bounds of what's reasonable and given the huge deficit still to sort a regrettable necessity. They're also a huge world away from the Tory plans for £12bn of welfare cuts – and indeed even further away from Labour, who are promising to be even tougher on welfare than the Tories.

subset: commoncrawl


text:
Whilst there is no obvious promotion of Espace Killy; both Val d'Isere and Tignes maintain their own websites and apps, all the ski data and piste maps are of the. Download Piste Maps: L'espace Killy (Val d'Isère, Tignes) and enjoy it on your Why are ski maps stuck in the last century? Robster27pop, 08/01/ No slope desires are left unanswered in Espace Killy! Optimally prepared slopes stretch from m to just short of m to the Grande Motte Glacier and the.
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Well, if you are into some off-piste, powder etc. About Us Help Center. Val Thorens Snow Report.
Piste map from the mid s showing the La Daille sector. Ski deals including ski pass. Optimally prepared slopes stretch from m to just short of m to the Grande Motte Glacier and the Glacier de Pissaillas. We will keep on working night and day to make the whole 'Chalet Le Bullou' experience even better and have new wines, products and facilities implemented all the time.
Val D'Isere village map Year Published: Grattalu run in Tignes. Zoom on the Val d'isere glacier section.
There are numerous easy, intermediate and difficult slopes. Sound advice by VSB. Test result Evaluation criteria Awards. Promote Your Ski Business " Pistes are very hard and fast so take care of your speed, it will also help to avoid little rocks – the cover is thin.
Add a Map Year Published: Show Prices Compare best prices from top travel sites. Lift operator Tourist info.
Most accurate source of Espace Killy piste/lift info? – (Tignes) – France
The views and opinions presented in the J2Ski Forums are solely those of their respective authors and do not represent those of J2Ski Ltd. Downhill Master Plan Size: Country icons by kampongboy92 are under a Creative Commons license. Alpe d'Huez Snow Report. That's great, thanks Andy.
Template modified from original by nodethirtythree under Creative Commons license. Look forward to enjoy a Val d'isere summer skiing during Best ski resorts France.
Love the snow dance vid by the way. Hi all, I'm struggling to find consistent info on the open pistes and fspace in the Espace Killy. French Snow Reports Where is there snow in France? Tips for the mp holiday. A friend is currently on a bump course in Tignes, says skiing on glacier is good and there are bumps that are skiable, but caution is needed as the snow cover is not optimal. Slowly opening – link to VDI working now.
All of your saved places can be found here in My Trips. Contact Legal notice Press.
Most accurate source of Espace Killy piste/lift info?
Tignes Summer Skiing Year Published: Objectionable Content may be notified by sending a Private Message to Admin. Les Brevieres on far right, Val d'Isere on far left. Check In – Check Out 1 room. Run at the Cascade Express on the Glacier de Correlates with reports of conditions on other fora. Open ski areas include French Ski Resorts. Les Arcs Snow Report.
Some sources say pretty much everything is open including the connection between Tignes and Val, others say it's still less than half. Beginning of the difficult Sache piste. Whether you are a beginner, intermediate, expert, or freerider, you will find limitless slopes to fit your style.
See all 65 reviews.


text:
3/831 Park Street BRUNSWICK
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text:
Titled Positions
2003-present: Director of Orchestral Activities & Conductor of the Conservatory Orchestra, The Boston Conservatory (Boston, MA)
1998-present: Artistic Director and Conductor, Orchestra of Indian Hill (Littleton, MA)
2010-2013: Conductor, Gordon Symphony Orchestra, Gordon College, (Wenham, MA)
2004-2006: Conductor, Boston Symphony Orchestra Youth Concerts
2002-2006: Principal Pops Guest Conductor, Boston Pops (Boston, MA)
1996-2003: Artistic and General Director, Portland Opera Repertory Theatre
1998-1999: Acting Resident Conductor, Kansas City (MO) Symphony
1997-1999: Acting Resident Conductor, Utah Symphony
1995-1997: Conductor Laureate, Omaha Symphony
1994-1995: Artistic Director, Portland Opera Repertory Theatre
1992-1995: Artistic Director and Principal Conductor, Omaha Symphony
1984-1992: Music Director and Conductor, Omaha Symphony
1976-1986: Music Director and Conductor, Portland (Maine) Symphony
1975-1979: Music Director and Conductor, Arapahoe Chamber Orchestra
1975-1979: Associate Conductor, Denver Symphony Orchestra
1973-1975: Assistant Conductor, Denver Symphony Orchestra
1972-1973: Assistant Conductor, Syracuse Symphony Orchestra
1972-1973: Conducting Assistant, Buffalo Philharmonic Orchestra
1972-1973: Faculty Conductor-in-Residence, Eastman School of Music
Guest Conducting
Classical subscription concerts
Radio & Television Orchestra of Tirana, Albania
Portland Symphony Orchestra
Camerata (Bloomington)
Edmonton, Alberta Symphony Orchestra
Florida Philharmonic (Ft. Lauderdale)
Minnesota Orchestra
New York Philharmonic
ARCO string ensemble, New Jersey
Rochester (NY) Philharmonic Orchestra
Richmond Symphony Orchestra
Santa Barbara Symphony
Charlotte Symphony Orchestra
Grand Rapids Symphony Orchestra
Columbus Symphony Orchestra
Lansing Symphony Orchestra
Buffalo Philharmonic Orchestra
Louisville Orchestra
Tulsa Philharmonic Orchestra
San Antonio Symphony
Fargo (North Dakota) Symphony
New Zealand Sym. Orch. (Wellington)
Shizuoka (Japan) Symphony Orchestra
Taiwan Symphony Orchestra (Taipei)
Mesa (Arizona) Symphony
New Haven Symphony Orchestra
Fargo-Moorhead Opera, Fargo, ND
Maine Opera Company
Chicago Opera Theater
Tacoma Opera
The Boston Conservatory
Pops, summer & other concerts
Cincinnati Pops Orchestra
Detroit Symphony Orchestra
New Zealand Symphony Orchestra
Springfield (MA) Symphony Orchestra
Hamilton, Ontario Symphony Orchestra
Dallas Symphony Orchestra
Portland (ME) Symphony Orchestra
Naples (FL) Philharmonic
Edmonton Symphony Orchestra
Boston Symphony
Oregon Symphony
Boston Pops Orchestra
Boston Pops Esplanade Orchestra
Louisville Orchestra
Jacksonville Symphony Orchestra
Houston Symphony Orchestra
San Francisco Symphony
Pittsburgh Symphony Orchestra
Alabama Symphony Orchestra
The Florida Orchestra (Tampa)
Atlanta Symphony Orchestra
Minnesota Orchestra
New Mexico Symphony
Baltimore Symphony Orchestra
St. Louis Symphony
National Arts Centre Orchestra (Ottawa)
New Jersey Symphony Orchestra
Buffalo Philharmonic Orchestra
Santa Barbara Symphony Orchestra
Syracuse Symphony Orchestra
Colorado Springs Symphony Orchestra
Spokane Symphony Orchestra
Hartford Symphony Orchestra
Nassau (NY) Symphony Orchestra
New Music New Haven
Great Woods Festival Orchestra
Music New to New York
Eastman School "Musica Nova"
Educational – Orchestral guest conducting
Collegiate Orchestras
The Boston Conservatory
Eastman School of Music Philharmonia Orchestra
Oberlin College-Conservatory Orchestra
Hartt School of Music Orchestra
California Institute of the Arts
Colorado Philharmonic Orchestra
New England Conservatory Orchestra
"All-State" High School Orchestras
New York
Rhode Island
New Hampshire
Other Educational/Youth Orchestra guest conducting
Youth & Muse Orchestra, Chichibu City, Japan
Denver City-Wide Youth Orchestra
Maine ASTA conference
Colorado State University Summer Music Camp
Portland Symphony Youth Orchestra
Norfolk (Virginia) summer music camp
Omaha Area Youth Orchestras
Present Master Classes at Youth & Muse Summer Music Camp, Boston
Lincoln (Nebraska) City-wide Orchestra
Massachusetts Northeastern District Orchestra
Massachusetts Eastern District Orchestra
Special "Side-by-Side" workshops, rehearsals and concerts with talented young people and the orchestras of Indian Hill, Denver, Portland, Omaha
Central Massachusetts Youth Orchestra
1972, 1973: Conducting Fellow: Berkshire Music Center, Tanglewood, Massachusetts
(Seiji Ozawa, Leonard Bernstein, Gunther Schuller, Michael Tilson Thomas, Stanislaw Skrowaczewski, Bruno Maderna, Joseph Silverstein)
1970--1972: All course work completed towards a Master of Music degree in musicology, Eastman School of Music (Erich Schwandt, Charles Warren Fox)
1970: Bachelor of Music degree in Conducting, Eastman School of Music (Walter Hendl, Laszlo Halasz, Willis Page)


text:
Hello everyone
The book I'm currently writing—and by the way, don't expect anything until 2021—has a liar at it's center. While everyone knows he was happy to lie, he also told the truth, occasionally. This got me thinking about how and why we lie and how we navigate around lies.
But first, a word about Clementina.
Clementina has just been reviewed by the author Charles Harris.
If you're wondering whether Clementina is right for you, then head over to Charles's website and read his review.
The Breaking of Liam Glass
Reviews like Charles's review for Clementina are important, obviously, because they tell people about my book. But this review matters for me because I respect Charles as a novelist.
I really enjoyed his novel The Breaking of Liam Glass, a satire of today's society where the death of our children on city streets is little more than a way for people to make money.
If you haven't met Charles or heard about Liam Glass, then check out his website. You can also watch Charles talk about the background to the book.
Obviously, get hold of and read Clementina first and then read the next Leathan Wilkey novel, Diplomatic Baggage. But once you've done that, then check out Charles and Liam Glass.
Truth and Lies
Lies are part of our everyday currency. Sometimes we tell untruths with the best of intentions, however, usually our motives are less pure. Whether a lie then matters is a combination of many factors.
But how do we think about lies in novels which are, by definition, collections of lies?.
Killing Eve, season two
I've now watched the second series of Killing Eve.
Like the first series, the characters and the acting were outstanding—in particular, Jodie Comer playing Villanelle and Kim Bodnia playing her former handler, Konstantin.
While the acting was great and each individual scene was compelling to watch, the story was thin. The central premise of this second series was fairly contrived and adding more contrivance didn't make a more satisfying story.
The stakes for the characters were manufactured. At any time, any person could walk away and it wouldn't be obvious that there would be any real difference for that person. However, the story would have fallen apart so what I was left with had the overall feeling of a collection of internet memes strung together.
Series two ends with a whole bunch of loose ends and a cliffhanger for the next series. Having reached the end, it felt as if every plot point in the series was planned just to lead to the event that gave the cliffhanger.
And as a brief aside, the cliffhanger isn't a cliffhanger. The person who appears to be dead isn't dead—if she were, then there would be no series three.
As I said at the start, the series has great characters and great acting, but a weak story. If you liked the last series and are relaxed about the contrivance, you'll probably like each individual scene, but don't expect too much more.
Until August
That's it until August. Try spending some of the time between now and then noting how often you feel the need to lie 😄
All the best


text:
What was I doing before Do Something Different?
I was working in a small data mining consultancy, developing software to analyse large datasets in the retail, energy, social media and defence sectors. I also worked directly with clients on their projects, helping them extract useful insights from their data. I worked with some very smart mathematicians, and learned a lot.
Why did I join?
Do Something Different's explicitly stated aim of making the world a better place appealed to me very much, as did the commitment to "make decisions as people first, and as a business second". Many companies make statements about "corporate social responsibility" as a veneer, but at Do Something Different it is genuine and at the heart of everything we do.
What do I do?
I look after the data at Do Something Different. When somebody starts a programme, we ask them questions about their personality, habits and wellbeing, and we use the answers to personalise their programmes. At the end of their programme, we ask them the same questions, to see how they have changed. I look at this data to better understand how people interact with their programmes, and we are continually looking for ways to improve our Doers' experience.
What do I most want to change in the world?
I would like to live in a society that is run for the benefit of all its citizens, rather than a privileged few. For all its faults Star Trek presents one vision of what might be possible, with Captain Picard remarking that in their society "the accumulation of wealth is no longer the driving force in our lives; we work to better ourselves, and the rest of humanity".
What do I most want to change about me?
I would like to spend more of my time on things that are important but not urgent, rather than the other way around!
What am I doing differently?
I recently decided to learn to play rugby, so I started training with a local team. My friends and family were quite surprised when I told them, but I wanted to challenge myself. To begin with I had no idea how it worked or what the rules were, but bit by bit it started to make sense, and I've played in a couple of matches so far.


text:
Jon Nordmeyer
WIDA International Programs Director
Jon Nordmeyer is WIDA's International Programs Director. Jon guides the research, development and implementation of WIDA resources to support English language learners in international schools. He comes to WIDA with more than 25 years of experience teaching at international schools in China, Ecuador, The Netherlands, Taiwan, Turkey and Thailand. He has presented at AAIE, AASSA, ACAMIS, AISA, EARCOS, ECIS, ELLSA, Learning Forward, NFI NESA and TESOL conferences and has taught graduate seminars at Harvard Graduate School of Education and Tibet University. He has published articles in the Journal of Staff Development and International Schools Journal. He is the co-editor of Integrating Language and Content (TESOL 2010).
Contact Information
Phone: (608) 890-1325
Office: 753C Ed Sciences


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European Common Crane
Stockphoto ID: 2244832
File name: EuropeanCrane12598.jpg
Format: digital, 3000+ pixels longest side
Property release: no Model release: no
Source: photographer Based in: United Kingdom
Description: European common crane
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This image is copyright protected. There is a fee for any use. This website is not a source of free images.


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Cape Dance Company
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Cape Dance Company is a non-profit organisation.
Registration number 005/029914/08


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text: On 2011-03-08, Ralph <ralph at depth.net> wrote: > > >> When are you going to start working on it? >> ... or are you asking others to do free programming >> for you, to work around your unique problem? > > Maybe I deserve that flame for having ranted a bit, but > I hardly think the problem of clock time that won't behave > within a linux guest VM is 'unique'. Do a google search on > it, I'm clearly not the only one with this problem. Of course it is not unique. It is also unsolveable. A VM simply does not run in a way that it can keep accurate time. the only way to do it is to have the underlying OS that runs the VM keep accurate time and to have the VM gets its time from there. think about it-- there is no clock tha tthe VM can discipline to keep accurate time. Clocks based on CPU cannot work because the VM can be interrupted at will and stopped. Clocks based on hardware cannot work because you would run into the problem of 5 different VM all fighting over the same hardware and constantly changing what the other had done. > > And are you saying that the mentality of the open source > world ought to be one of 'no one is allowed to complain about > anything because they ought to code the fix themselves'? I've No. It is because you believe that there is a solution-- so impliment it. People have thought about it, and come to the conclusion that it is really hard to do. You walk in and state it is not. Prove it-- or was that just hot air. > participated in many open source projects and I enjoy contirbuting > to the community, but I don't think that one ought to have to > be a contributor to be a user. If open source isn't supposed to > have consumers that aren't contributors from a coding perspective, > then it is most certainly a doomed concept - and I sincerly hope that > is not the case. But it also means that you have to put up with what others have done, and you then should not sit there ranting about what they have not done. And you are ranting again. > > >> If you have never had a problem, what are you complaining about? > > I've never had a problem with a Windows guest. I'm complaining about > it being so difficult to find the answer to getting a properly running > clock with a linux guest. > >> Nothing that can't be fixed by the VM ware vendors, I'm sure. > > And if they gave a flying flip about the many different flavor of linux, I'm > sure the world would be a better place. But in the meantime, since I'm not > running one of the very few flavors that they actually support, I have > to find other solutions.


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text:
When Headteacher Miles Wallis-Clarke was the target of homophobic graffiti, little did he know there was soon to be a heartwarming show of support from the pupils of his school.
Wallis-Clarke has always been upfront about his sexuality. He told Chronicle Live "I am a gay man, I make no secret of that at school and I'm very open and I talk about it." He was upset to find graffiti outside the gates of Hotspur Primary School in Heaton, Newcastle, directly targeting him.
"There was quite a bit of graffiti outside the school which was very personal about me and homophobic. It had been put there so parents and students would see…I have been at the school for 15 years and I have never ever had anything like that."
Wallis-Clarke shared the incident in an online school bulletin, adding "How am I feeling? A little damaged to be honest. Sometimes angry and then quite sad."
On returning to the school on Monday, the headteacher was touched to see pupils had decorated the four entrance gates of Hotspur with handmade rainbow hearts and flags.
Lovely spontaneous demonstration of support by pupils and parents of @HotspurPrimary after a nasty homophobic incident last week #loveislove pic.twitter.com/MHFNUI5KpX
— Cllr Gareth Kane (@GarethKaneLD) September 30, 2019
"It was just lovely," he shared. "I always stand outside in the morning and I was given cards and letters, and people saying 'what can we do to help', and it was just incredible."
He continued, "We always do a lot of work on equality and diversity and we know our children are going to live in a diverse society. Talking about that is really important and we are looking at what we can do to reinforce that we don't accept homophobia.
"Our children are really well adjusted and able to say; 'That's not right'."
The show of support is similar to events in Manchester where neighbours decorated their homes with rainbow flags to support a young man who was subjected to homophobic abuse.
The Northumbria police are investigating the graffiti incident as a hate crime. They appealed for witnesses and released the statement: "Nobody should be victimised for being who they are and we are taking this incident very seriously – and will take robust action against those responsible."
© 2019 GCN (Gay Community News). All rights reserved.
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text:
Shouting Stones – Prayerful Tuesday
contemplation, Creation, Creator, Ecology, Environment, faith, God, Gospel of Luke, Grace, Gratitude, Holy Mystery, life, listen, Mystery, Mythology, Nature, prayer, spiritual practice, Star Dust, Universe
Luke 19:40: He answered, "I tell you, if these were silent, the stones would shout out." Power of 10 Are We Alone in the Universe, Updated May 3, 2011 by Securityscience Several years ago someone sent me this video that imagines going out from a 1 meter distance by a power of 10 up to 1020 Km or 10 million light years, then coming back to earth to 1 meter starting point and doing a reverse trip into a leaf by a power of ten to 10-16 meters or 100 Atómeters (that's 0.0000000000000001 meters). What has always fascinated me we could have kept going forever if we are traveling away from earth, there is no limit that we know of to the distance we can travel. However, 10-16 is the smallest we can get if we reverse the trip. After this point all is mystery. What lies beyond that limit


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The financial structure of the firm and the problem of control
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Cited by:
- Buettner, Thiess & Wamser, Georg, 2013.
"Internal Debt and Multinational Profit Shifting: Empirical Evidence From Firm-Level Panel Data,"
National Tax Journal,
National Tax Association;National Tax Journal, vol. 66(1), pages 63-95, March.
- Thiess Buettner & Georg Wamser, 2009. "Internal Debt and Multinationals' Profit Shifting - Empirical Evidence from Firm-Level Panel Data," Working Papers 0918, Oxford University Centre for Business Taxation.
- A. Baglioni, 1995. "Incomplete contracts, renegotiation, and the choice between bank loans and public debt issues," The European Journal of Finance, Taylor & Francis Journals, vol. 1(3), pages 257-278.
- Thiess Büttner & Georg Wamser, 2007. "Intercompany Loans and Profit Shifting – Evidence from Company-Level Data," CESifo Working Paper Series 1959, CESifo Group Munich.
- Aleksandra Jovanovic, 2001. "Legal rules, governance structures and financial systems," ICER Working Papers 19-2001, ICER - International Centre for Economic Research.
- Martin Ruf, 2011. "Why is the Response of Multinationals' Capital-Structure Choice to Tax Incentives That Low? Some Possible Explanations," FinanzArchiv: Public Finance Analysis, Mohr Siebeck, Tübingen, vol. 67(2), pages 123-144, June.
- Hartmann-Wendels, Thomas, 2004. "Die Bedeutung des Leasings für die Unternehmensfinanzierung: Theoretische Perspektiven und empirische Ergebnisse," Leasing - Wissenschaft & Praxis, Universität zu Köln, Forschungsinstitut für Leasing, vol. 2(2), pages 7-40.
- Hellwig, Martin F., 2009.
"A reconsideration of the Jensen-Meckling model of outside finance,"
Journal of Financial Intermediation,
Elsevier, vol. 18(4), pages 495-525, October.
- Martin Hellwig, 2007. "A Reconsideration of the Jensen-Meckling Model of Outside Finance," Discussion Paper Series of the Max Planck Institute for Research on Collective Goods 2007_8, Max Planck Institute for Research on Collective Goods.
- Eisenbach, Thomas M., 2017.
"Rollover risk as market discipline: A two-sided inefficiency,"
Journal of Financial Economics,
Elsevier, vol. 126(2), pages 252-269.
- Thomas M. Eisenbach, 2013. "Rollover risk as market discipline: a two-sided inefficiency," Staff Reports 597, Federal Reserve Bank of New York, revised 01 May 2016.
- Patrick Artus & Philippe Ducos & Francois Lecointe, 1992. "Rachats d'entreprise avec endettement (LBO et MBO) : motivations micro-économiques, effets sur l'efficacité des entreprises et risques macro-économiques," Économie et Prévision, Programme National Persée, vol. 102(1), pages 89-104.
- Taoufik Rajhi & Michel Guillard, 1993.
"Croissance et développement : le rôle des rationnements financiers,"
Revue Économique,
Programme National Persée, vol. 44(2), pages 229-256.
- Guillard, M. & Rajhi, T., 1992. "Croissance et developpement; le role des rationnements financiers," Papiers d'Economie Mathématique et Applications 92.29, Université Panthéon-Sorbonne (Paris 1).
- Scheepens, Joris P. J. F., 1995. "Bankruptcy litigation and optimal debt contracts," European Journal of Political Economy, Elsevier, vol. 11(3), pages 535-556, September.
- Buettner, Thiess & Overesch, Michael & Schreiber, Ulrich & Wamser, Georg, 2012. "The impact of thin-capitalization rules on the capital structure of multinational firms," Journal of Public Economics, Elsevier, vol. 96(11), pages 930-938.
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Framework to build the system is to enhance business management is a very effective means, but also by more and more enterprises attention. Standardization is a system of work, the standard is also an organic link as a whole, in order to Frame System Scaffolding protect the success of standardization, the primary problem is to set up a standard system framework. Standard system framework to build the basic principle is "horizontal to the edge, vertical in the end", that is, the standard system is to cover all aspects of the content, but also covers all levels of units, can not leave management gaps and management gaps. The construction of the frame structure system includes two aspects: the horizontal system frame structure and the vertical system frame structure.
1, horizontal system frame structures
The core of the horizontal system framework is to solve the problem of how to divide the professional sub-systems. Enterprise activities involving a wide range of both the management activities, but also business activities, professional sub-system structures must be fully considered the three major issues:
(1) the company's development strategy
The development strategy of the company has a very important influence on the construction of the professional sub-system. In Frame System Scaffolding the process of constructing the professional sub-system, the company's development strategy must be fully considered to ensure that the system is forward-looking and conforms to the development needs of the company.
First, we must consider the company's future business development direction. Different business operations and management methods may be different, the requirements of the standard system construction is also different. Therefore, the professional sub-system to build must take full account of the company's future business direction. Clear whether the company's future business direction will be adjusted? Is to keep the existing business direction unchanged, or will enter the new business areas? Whether it will shrink some of the business, out of some business? When building a standard framework, it is necessary to take full account of the company's business resilience, both to fully cover the existing business, and to retain the increase or decrease of the interface, so that with the company's business development needs, can be added and added sub-system.
Second, we must clarify the future development of the company's regional business planning. With the regional business changes, the company's management will change, the demand for the standard system will change. Therefore, in the process of building sub-system, we must fully consider the company's regional business may change, the system framework design must be Frame System Scaffolding fully flexible and scalable, in accordance with the company's development needs, timely adjustment and improvement of the system framework. For example, we must fully consider whether the company will operate transnational, open up international business, how to manage international business? Or whether the proportion of the company's regional business will be a major adjustment, the regional business management will be a major change.
(2) the organizational structure of the company
The company's organizational structure and the future direction of the possible adjustment is also the framework of the horizontal system must be fully considered the problem. The end user of the standard system is the company's various departments and units, therefore, the framework of the system and the company departments and units set the more consistent, the more convenient to use the various units. Although the architecture of the framework must be fully considered when the organizational structure of the design issues, but the system framework can not be built in accordance with the existing departments and units of the design, but also need to consider the company's strategy and business value chain and other issues.
The framing system will serve people at all levels and units. Different levels and units of staff on the standard system focus is different. For example, the company leaders, department heads, grassroots employees and collaboration units on the Frame System Scaffolding standard system of the focus is different, in order to ensure that the standard system is more layered, more convenient for the use of all levels of personnel, we must scientifically set the standard system vertical level frame. For example, ISO quality management manual, from the vertical level is divided into quality manuals, program files, work instructions and quality records, from macro to micro, and gradually refine. Standard system construction must also be such an effective division of the vertical level, layers of decomposition, and gradually refined.


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Reed laces up a new artist that you NEED to know every day at 4pm with his Top Prospects, only on Go 96.3.
Today on Top Prospects we have new music from American rock band from Bowling Green, KY, the Grammy Award Winning Cage The Elephant! Formed by brothers Matt and Brad Schultz, Cage has consistently been one of my favorite alternative bands, having more #1 alternative songs than any other band in the last decade. They dropped their 5th studio album, Social Cues (maybe my favorite album of the entire year), which has been nominated for Best Rock album at the 2020 Grammy's. In "Black Madonna" you'll get a shifty, suspicious, but smooth and nonchalant break up song, that is one of my favorite songs on the album.
Top Prospects is brought to you by:


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Circular 08/2019 issued on 06 May 2019 by the Department of Merchant Shipping advises Owners, Managers, Masters and Representatives of Ships under the Cyprus Flag as to the revised procedure and instructions regarding the issuance of Continuous Synopsis Record Document for Cyprus Flag Ships.
Please note below general information on the Continuous Synopsis Record, as also provided in the Guidelines attached to the Circular mentioned above,
The International Convention for the Safety of Life at Sea 1974, as amended, (SOLAS 74), Chapter XI-1, Regulation 5 requires every ship to which Chapter I of SOLAS applies to be issued with a Continuous Synopsis Record (CSR) document.
The CSR document is to be kept onboard and provides the history of the ship with respect to the information recorded therein.
The relevant requirements apply to cargo ships of more than 500 gross tonnage and all passenger ships engaged on international voyages.
Definitions & Abbreviations applicable:
"Administration" means the government whose flag the vessel is entitled to fly
"Cargo Ship" means any ship which is not a passenger ship
"Company" means the owner of the ship or any other organisation or person such as the manager, or the bareboat charterer, who has assumed the responsibility for the operation of the ship from the owner of the ship (regulation IX/1 of SOLAS 74)
"CSR" means Continuous Synopsis Record "CSR Document" issued by the Administration "CSR Form 1": Application for Continuous Synopsis Record Document for the Ship with IMO Number: "CSR Form 2": Amendments to the Continuous Synopsis Record Document No…. for the Ship with IMO Number: "CSR Form 3": Index of amendments to the Continuous Synopsis Record Document No…. for the Ship with IMO Number:
"DoC": Document of Compliance
"ISSC": International Ship Security Certificate
"Passenger Ship" means a ship which carries more than twelve passengers
"SMC": Safety Management Certificate
"SOLAS 74": The International Convention for the Safety of Life at Sea, 1974, as amended.
The first CSR document issued to a ship is numbered "1" and subsequent CSR documents are to be numbered accordingly. The sequential numbering continues across change of flag for the life of the ship.
Each original CSR shall be sent to the ship and kept on-board throughout its lifetime.
The Administration is required to keep a copy of each CSR document issued to the ship.
Whenever issuing a CSR document to a ship, the Administration will have to provide all requested information, indicating with "N/A"any information which does not apply to the particular case. For example, the information regarding the bareboat charterer has to be completed if the ship is actually bareboat chartered.
Application for issuance and amendments may be made from: (i) The owner of the ship; or (ii) The Management Company of the ship; or (iii) The Master of the ship; or (iv) An Authorised representative of the owner or management company, provided that the name and contact details have been communicated to the Administration by either the owner or the manager of the ship prior to the submission of the application / forms.
Regarding the First CSR Document (for new builds),in such case the Company or Master must complete the CSR Form 1 (Application for First CSR Document). The original CSR Form 1 must be kept on-board the ship's CSR File until original CSR No.1 is delivered on board.
Regarding a change of Flag , in such case a new CSR Document the Company or Master must complete the CSR Form 2 (Amendments to the CSR Document No.) and CSR Form 3 (Index of amendments to the CSR Document No.). The original CSR Forms 2 & 3 must be attached on the current CSR document until the new original CSR document is delivered on-board.
For the issuance of new CSR document, the following documents (if applicable) must be forwarded to this Administration: (i) Copies of CSR Forms 2 & 3, and (ii) Copies of all previous CSR documents, and (iii) Copy of company's DoC, (iv) Copy of ship's SMC, and (v) Copy of ship's ISSC, and (vi) Copy of ship's Class Certificate.
For the issuance of amended CSR for existing ships on the Register of Cyprus Ships in case of any changes of the information record on the current Cyprus CSR document, the Company or Master must fill in only these changes on CSR Form 2 and complete CSR Form 3. The original CSR Forms 2 & 3 to be attached on the current CSR document until the amended original CSR is delivered on-board. For the issuance of amended CSR document the following documents must be forwarded to the Administration: (i) Copies of CSR Forms 2 & 3, and (ii) Relevant documents for changes.
In cases where the said ship is to leave the Register of Cyprus Ships –the Closed CSR Document must be issued. When a ship is to be deleted from the Register of Cyprus Ships and in order to speed up the issuance of the closed CSR document, the owners / managers / master / authorised representatives must communicate in writing the name of ship's new flag
In cases of Parallel-In and Parallel-Out Registered Ships:
Parallel-In (i.e. a ship remains registered in a foreign register but flies the flag of Cyprus ) the procedures for the issuance of new, amended or closed CSR documents apply.
Parallel-Out Registered (i.e. when a ship remains registered in the Register of Cyprus Ships but flies the flag of foreign country), a CSR document evidencing such transaction must be issued. Therefore, the owners are requested to ensure that a relevant request is submitted to and the relevant CSR document is received prior of the issuance of new CSR document from the foreign registry.
When receiving the Original CSR document on-board, the Master must check the sequential number and review the document to ensure that all entries are correct and in accordance of the amended form(s) attached to the current CSR document (if not the first CSR Document). After having verified that sequential number and entries are correct the Master shall date and sign the second page of the CSR document. The CSR document shall then be placed in the ship's CSR File. If the Master identifies any inconsistencies or mistakes on the new CSR document received on-board, the Registry shall be immediately informed for further actions.
If for any reason, the CSR document(s) issued by the Administration is/are lost or damaged, the owners / managers / Master / authorised representatives should contact the Registry in order to provide signed and stamped duplicates. For ships deleted from the Register of Cyprus Ships where the original CSR document or CSR documents issued are not onboard the ship, all missing CSR documents will be re-issued provided that: (i) A written request is submitted by the new owner providing sufficient reasoning; and (ii) the new owner has appointed an authorised representative (name of whom to be notified to this) to collect these documents from the offices of the Shipping Deputy Ministry in Limassol – Cyprus; and (iii) The appropriate fees have been paid in advance.


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Select Japanese yuzhi matcha, and 'Taiwan maru zuo' use the same matcha, where is the same taste.
Uji matcha is a brand matcha produced by uji matcha corporation and its subsidiaries in Japan
The origin of Japanese tea can be traced back to the 16th century, but the introduction of tea was accomplished by ambassadors in the tang dynasty. In ancient Japan, there was no native tea tree and no habit of drinking tea. Tea has taken root in Japan since the Japanese ambassadors of nara's time brought it back to Japan.
Unlike the Chinese method of fermenting tea leaves, Japanese tea leaves are naturally dried after being steamed, and the powdered tea is called matcha (ground tea). By the muromachi era, tea farmers in gini held tea tasting parties to rate tea leaves, which developed into recreational activities for many people to taste tea leaves and developed the original tea ceremony etiquette. For centuries, matcha in Kyoto has been synonymous with the highest level of matcha in Japan.
Lactose in milk can promote the absorption of calcium in the intestinal wall of the human body, with the absorption rate up to 98%, thereby regulating the metabolism of calcium in the body, maintaining the concentration of serum calcium, and enhancing the calcification of bones. Good absorption is especially critical for calcium supplementation. So there is a scientific reason for the claim that milk supplements calcium.
Nanjing xima brand management co. LTD
Join in the phone:400-686-0363
Company address:no.7-16, building F, zhengda Himalayan, yuhuatai district, nanjing
Frequently asked questions:
WeChat scan qr code
Copyright © 2019 Nanjing xima


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Lilo the Goofy One...
TSD's Hawaiian Lullaby He Mele No Lilo MSDP
Chocolate Based Red Dapple Piebald Smooth
Weight: 15.9 lbs.
Carries: Cream & Dilute
Lilo is a 4th generation baby for us. Our little Lilo the spit fire! She is petite but so spunky! I guess with her being a red head and all! LOL! Lilo is always happy, and often times will just stop playing to run over to me to get a little pet and then back to it. She is full of personality, and makes me laugh daily. So happy to have this little girl. Her full sister is Ohana.
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Palmilla Springs Homes for Sale - Far West Fort Worth
Search for Palmilla Springs homes for sale below! For more information about the Fort Worth area, and Arbor Hill homes for sale, search our MLS listings below.
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Want to purchase a home in Palmilla Springs? Call your Far West Fort Worth real estate team, VIP Realty at (817) 840-7490. Your neighborhood Palmilla Springs REALTORS and agents are here to help with the DFW housing market.
Any family stands to benefit a lot from living in the properties in this residential community, which are centrally located, beautiful, and have a peaceful atmosphere. These homes are among the best gifts you can give your loved ones.
Palmilla Springs Homes For Sale
Far West Fort Worth, Texas, is full of beautiful properties and family-friendly neighborhoods, and Palmilla Springs homes for sale are not exempt from this. These residences are traditional American houses that have 1 or 2 floors, 1- or 2-car garages, and moderately sized yards. The homes for sale in Palmilla Springs are also surrounded by plenty of greenery, which will benefit you, your kids, and your pets.
Palmilla Springs Real Estate Listings
Palmilla Springs real estate listings are detached single-family homes. These were constructed not too long ago, which means that they are still in mint condition and are not likely going to require any major (read: expensive) repair in the near future. The real estate listings in Palmilla Springs are also made of only premium materials, so they are definitely built to last.
Getting to work or school is not difficult for residents in Palmilla Springs because of the favorable location of this neighborhood. Offices, shops, and other types of businesses are just a short drive away, so you can say goodbye to having to rush for early morning appointments and meetings.
At the same time, Waverly Park Elementary, Western Hills high, and Leonard Middle are just some of the numerous public schools that are situated close to the homes. There are private educational institutions as well, and they are just as accessible.
The crime rate in the area is low, which only goes to show the effectiveness of the security measures being implemented in this neighborhood. Furthermore, the current residents are friendly and know one another, which helps create some sense of security for new residents.
With all of these advantages combined, Palmilla Springs is an unbeatable residential neighborhood for your family. It has a good balance of everything: location, aesthetics, and security.
Palmilla Springs Home Values
Presently averaging at $320,000, Palmilla Springs home values are among the most attractive in this side of Fort Worth, Texas. The home values in Palmilla Springs are definitely a good reflection of the prevailing market trends in the local real estate industry at present. This should be another reason for you to choose Palmilla Springs over similar areas.
Are you considering buying or selling a home in Palmilla Springs? Our local Fort Worth Texas real estate agents will help guide you through buying your next property or expertly negotiate the sale of your current Palmilla Springs home. As your local Palmilla Springs real estate agents, contact VIP Realty at (817) 732-8477 or TOLL FREE at 1-877-FLAT-MLS, we're experts on the market dynamics unique to the Palmilla Springs real estate market. We will work for you today!
Users may not reproduce or redistribute the data found on this site. The data is for viewing purposes only. Data is deemed reliable, but is not guaranteed accurate by the MLS or NTREIS.
Listing information last updated on March 28th, 2020 at 7:00pm CDT.


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Year: 2004-2005
Client: Land Transport Authority (LTA)
Tasks: Conduct Detailed Design Road Safety Review and check traffic performance
Kallang/Paya Lebar Expressway (KPE) is the underground road system that connects the East Coast Parkway Expressway (ECP) in the south to the Pan Island Expressway (PIE) and the Tampines Expressway (TPE) in the north. It is approximately 12 kilometres long consisting of about 8.5km of main tunnel and the rest is at-grade expressway. A Detailed Design Safety Review (DDSR) of KPE was required to identify potential safety problems for road users and other affected parties, and to ensure that measures to eliminate or reduce the problems were considered fully. Ali was the team leader for conducting the road safety review. Several key safety hazards were identified and the overall design was revised to include the reviewer's recommendations. VISSIM models were developed to ensure there would be no congestions with other linked nodes.