Journal articles on the topic 'Burn Depth Classification'

World Health Organization (WHO) manage health-related statistics all around the world by taking the necessary measures. What could be better for health and what may be the leading causes of deaths, all these statistics are well organized by WHO. Burn Injuries are mostly viewed in middle and low-income countries due to lack of resources, the result may come in the form of deaths by serious injuries caused by burning. Due to the non-accessibility of specialists and burn surgeons, simple and basic health care units situated at tribble areas as well as in small cities are facing the problem to diagnose the burn depths accurately. The primary goals and objectives of this research task are to segment the burnt region of skin from the normal skin and to diagnose the burn depths as per the level of burn. The dataset contains the 600 images of burnt patients and has been taken in a real-time environment from the Allied Burn and Reconstructive Surgery Unit (ABRSU) Faisalabad, Pakistan. Burnt human skin segmentation was carried by the use of Otsu's method and the image feature vector was obtained by using statistical calculations such as mean and median. A classifier Deep Convolutional Neural Network based on deep learning was used to classify the burnt human skin as per the level of burn into different depths. Almost 60 percent of images have been taken to train the classifier and the rest of the 40 percent burnt skin images were used to estimate the average accuracy of the classifier. The average accuracy of the DCNN classifier was noted as 83.4 percent and these are the best results yet. By the obtained results of this research task, young physicians and practitioners may be able to diagnose the burn depths and start the proper medication.

The incident of burns in children aged 1-4 years is risk get disabled and death. This is caused the children still do not understand about the danger and handling it. The role of a mother is important to give first aid to reduce the severity. First aid for burns that are still often given use such as toothepaste, saliva, coffe, soy sauce and margarine. The purpose of this study to describe the experience of mothers provide first aid in burns of children aged 1-4 years. This study was use qualitative phenomenologycal method. The sampel of this study was a mother have children aged 1-4 years who had suffered burn injury in periode of less than 9 mounth determined by the purposive sampling method. Collecting data was conducted by a in-depth interviews to 7 respondens. After 7 inteviews, found six main themes were identified: (1) first aid, (2) burns, (3) burns reaction, (4) psychological impact, (5) mother's perception of burns, (6) actions to reduce injury. Classification of burns found are mild to moderate burns. First aid for burns done by mothers using aloe vera, water, cooking oil, toothpaste, and tender care (oriflamme). The mother’s reaction to knowing that her child had burns was panic, worry, shoock, and pain. First aid for child burns given by the mother using aloe vera, water, cooking oil, toothpaste, and tender care (oriflamme).

Abstract Introduction Current methods of burn evaluation and treatment are subjective and dependent on surgeon experience, with high rates of inter-rater variability leading to inaccurate diagnoses and treatment. Machine learning (ML) and automated methods are being used to develop more objective and accurate methods for burn diagnosis and triage. Defined as a subfield of artificial intelligence that applies algorithms capable of knowledge acquisition, machine learning draws patterns from data, which it can then apply to clinically relevant tasks. This technology has the potential to improve burn management by quantitating diagnoses, improving diagnostic accuracy, and increasing access to burn care. The aim of this systematic review is to summarize the literature regarding machine learning and automated methods for burn wound evaluation and treatment. Methods A systematic review of articles available on PubMed and MEDLINE (OVID) was performed. Keywords used in the search process included burns, machine learning, deep learning, burn classification technology, and mobile applications. Reviews, case reports, and opinion papers were excluded. Data were extracted on study design, study objectives, study models, devices used to capture data, machine learning, or automated software used, expertise level and number of evaluators, and ML accuracy of burn wound evaluation. Results The search identified 592 unique titles. After screening, 35 relevant articles were identified for systematic review. Nine studies used machine learning and automated software to estimate percent total body surface area (%TBSA) burned, 4 calculated fluid requirements, 18 estimated burn depth, 5 estimated need for surgery, 6 predicted mortality, and 2 evaluated scarring in burn patients. Devices used to estimate %TBSA burned showed an accuracy comparable to or better than traditional methods. Burn depth estimation sensitivities resulted in unweighted means >81%, which increased to >83% with equal weighting applied. Mortality prediction sensitivity had an unweighted mean of 96.75%, which increased to 99.35% with equal weighting. Conclusions Machine learning and automated technology are promising tools that provide objective and accurate measures of evaluating burn wounds. Existing methods address the key steps in burn care management; however, existing data reporting on their robustness remain in the early stages. Further resources should be dedicated to leveraging this technology to improve outcomes in burn care.

Abstract Introduction Blast injuries present unique challenges to civilian and military healthcare providers because of the complex and often severe nature of injuries spanning numerous anatomical regions, tissue types, and organ systems. Due to these factors, we devised a novel wound-focused classification system for implementation during triage and management of blast injuries to optimize outcomes and applied this system to patients treated at an ABA-certified burn center over 5 years. Methods A retrospective analysis of patients treated by an ABA-certified burn center for blast-related injuries from September 1, 2014 to October 31, 2019 was performed. Demographics, mechanism and distribution of injuries, interventions, and outcomes were evaluated. Injuries were classified using a wound-focused classification comprised of four zones: 1) areas closest to blast epicenter that had total or near-total tissue loss from the blast; 2) adjacent areas with thermal and chemical burns; 3) distant sites with shrapnel-related wounds; 4) injuries arising from barotrauma. Results We identified 64 patients who were mostly male (84%), averaging 38 ± 14 years old. Injury mechanisms included fireworks (19%), industrial accidents (16%), volatile fuels and drug labs (45%), and others including can, battery, lighter explosions (20%). All mechanisms had equivalent frequency of Zone 2 injuries with an average TBSA of 17 ± 18%. Drug-related blasts caused the highest TBSA (34 ± 23%) and the most full-thickness burns (33% vs average 23%). Fireworks had over five times (17% vs. 3%) more Zone 3 and three times (25% vs 8%) more Zone 4 injuries compared to the other mechanisms. Upper extremities were involved at twice the rate of other body regions (43% vs 19%). Patients presenting to our burn team over 24 hours after initial injury had infections in 50% of cases – a four-fold increase compared to non-delayed presentations (50% vs 13%). Overall, 45% required surgery (32% grafting, 3% flaps) but 100% of the drug-related blasts needed surgical intervention. Some patients (58%) required ICU admission with the highest rate (83%) in the drug-related group. Conclusions Blast injuries most often required admission for management of the Zone 2 component. Each blast mechanism resulted in distinct distributions of injury although fireworks had the greatest number of Zone 1, 3, and 4 injuries. Firework blasts were often less severe and more likely to present delayed with infectious complications. Larger blast mechanisms including drug-related lab explosions as well as industrial blasts had the highest rates of ICU admission, TBSA, full thickness depth, upper extremity involvement, and need for surgical intervention.

Abstract Millimeter-wave imaging is a promising technology for diagnosing skin burns, that may make it easier to assess and determine the burn depth in the near future. However, up to now, it has not yet been brought to clinical use due to the lack of clinical trails on patients and a millimeter-wave-aided classification of skin burns. In this paper, in a preliminary step, ex-vivo burned porcine skin is utilized to visualize and quantify skin that has been burned in different ways, and to access its effect on millimeter-wave images. For the first time, a 24 hour study of in-vivo human skin visualizes the effect of wound dressings using a fast imaging system operating at frequencies from 70 to 80 GHz. For validation, the effective relative permittivity of the skin and the dressings are measured using a open-ended coaxial probe. An analytical model is applied to calculate the reflection coefficient which are compared to the intensity of the millimeter-wave images to validate the model.

Abstract Background Burns are one of the most severe traumas that an individual can suffer. The World Health Organization (WHO) affirms that injuries related to burns are a global public health problem mainly in low- and middle-income countries. The first step towards reducing any preventable injury is based on accurate information. In Colombia, the basic epidemiological characteristics of burn injuries are unknown. The objectives were establishing the causes, high-risk populations, mortality rate, and tendencies of burn deaths. Methods Observational, analytical, population-based study based on official death certificate occurred between 2000 and 2009. All codes of the International Classification of Diseases-10th Revision (ICD-10) related to burns were included. The mortality rates were standardized using the WHO world average age weights 2000–2025. To determine the tendency, an average annual percent change (AACP) was calculated. Results A total of 5448 deaths due to burns were identified; 78.4 % were men. The crude and adjusted burn mortality rate was 1.270 and 1.302 per 100,000, respectively. The AACP was −5.25 %. Electrical injury caused the greatest number of deaths (49.5 %), followed by fire and lightning injuries. A total of 1197 (22.1 %) children were under 15 years old. The causes of deaths were different among age groups. 59.4 % deaths occurred outside health institutions. Conclusions This study is a first step in identifying the main causes of death and groups with higher mortality rates. Electricity is the main cause of deaths due to burn injury. Further research is required in order to generate awareness among government and community for reducing the number of injuries and burn deaths in our country.

Objective: There is a high rate of death due to burns and wound infections in India. Innovators and manufacturers of wound and burn dressings need to keep themselves abreast of the most current rules governing medical devices. The concept of advanced dressings is emerging in India. However, local manufacturing is hindered by an absence of clear regulatory guidelines. The lack of advanced wound and burn dressings on the market critically affects patient survival rates, while imports from other countries make dressings unaffordable and beyond the reach of most patients. This article presents the details of an approval procedure for advanced dressings and provides manufacturers, innovators and investors with a better understanding of the classification rules, import, export and marketing approval processes. We also discus the reasons for high levels of imports and costs, as well as suggestions on how to address this. Method: A critical analysis was conducted of 54 research and review articles, including regulatory guidelines to control the marketing of wound and burn care dressings recommended by international regulatory agencies. Conclusion: India is highly dependent on imports of advanced dressings. Due to lack of clear, quality regulatory guidelines, innovators and manufacturers are facing issues while showcasing their product in the Indian market. Thus development of clear quality regulatory guidelines is crucial. Therefore, this article may guide and encourage manufacturers to develop advanced dressings in India

The evaluation of the effect of burn severity on forest soils is essential to determine the impact of wildfires on a range of key ecological processes, such as nutrient cycling and vegetation recovery. The main objective of this study was to assess the potentiality of different spectral products derived from RGB and multispectral imagery collected by unmanned aerial vehicles (UAVs) at very high spatial resolution for discriminating spatial variations in soil burn severity after a heterogeneous wildfire. In the case study, we chose a mixed-severity fire that occurred in the northwest (NW) of the Iberian Peninsula (Spain) in 2019 that affected 82.74 ha covered by three different types of forests, each dominated by Pinus pinaster, Pinus sylvestris, and Quercus pyrenaica. We evaluated soil burn severity in the field 1 month after the fire using the Composite Burn Soil Index (CBSI), as well as a pool of five individual indicators (ash depth, ash cover, fine debris cover, coarse debris cover, and unstructured soil depth) of easy interpretation. Simultaneously, we operated an unmanned aerial vehicle to obtain RGB and multispectral postfire images, allowing for deriving six spectral indices. Then, we explored the relationship between spectral indices and field soil burn severity metrics by means of univariate proportional odds regression models. These models were used to predict CBSI categories, and classifications were validated through confusion matrices. Results indicated that multispectral indices outperformed RGB indices when assessing soil burn severity, being more strongly related to CBSI than to individual indicators. The Normalized Difference Water Index (NDWI) was the best-performing spectral index for modelling CBSI (R2cv = 0.69), showing the best ability to predict CBSI categories (overall accuracy = 0.83). Among the individual indicators of soil burn severity, ash depth was the one that achieved the best results, specifically when it was modelled from NDWI (R2cv = 0.53). This work provides a useful background to design quick and accurate assessments of soil burn severity to be implemented immediately after the fire, which is a key factor to identify priority areas for emergency actions after forest fires.

Abstract Despite the fact that obesity is a known risk factor for comorbidities and complications, there is evidence suggesting a survival advantage for patients classified by body mass index (BMI) as overweight or obese. Investigated in various clinical areas, this “Obesity Paradox” has yet to be explored in the burn patient population. We sought to clarify whether this paradigm exists in burn patients. Data collected on 519 adult patients admitted to an American Burn Association Verified Burn Center between 2009 and 2017 was utilized. Univariable and multivariable logistic regression were used to determine the association between in-hospital mortality and BMI classifications (underweight <18.5 kg/m2, normal 18.5 to 24.9 kg/m2, overweight 25–29.9 kg/m2, obesity class I 30 to 34.9 kg/m2, obesity class II 35 to 39.9 kg/m2, and extreme obesity >40 kg/m2). For every kg/m2 increase in BMI, the odds of death decreased, with an adjusted odds ratio of 0.856 (95% confidence interval [CI] 0.767 to 0.956). When adjusted for total BSA (TBSA), being obesity class I was associated with an adjusted odds ratio of mortality of 0.0166 (95% CI 0.000332 to 0.833). The adjusted odds ratio for mortality for underweight patients was 4.13 (95% CI 0.416 to 41.055). There was no statistically significant difference in odds of mortality between the normal and overweight BMI categories. In conclusion, the obesity paradox exists in burn care: further investigation is needed to elucidate what specific phenotypic aspects confer this benefit and how these can enhance the care of burn patients.

Abstract Introduction Acute burn care involves a spectrum of physicians, nurses, and allied health professionals. Similarly, burn surgeons have variable training backgrounds that originate from different specialties. Plastic surgery was founded on the core principles of reconstruction and offers the full spectrum of acute burn care and reconstructive surgery. Previous work has shown that variations in practice within burn surgery are partially driven by training background. We hypothesize that plastic surgery involvement and access to the full reconstructive paradigm will improve inpatient outcomes in the treatment of burn injuries. Methods Acute burn patients with known percent total body surface area (%TBSA) were extracted from the National Inpatient Sample (NIS) from 2012–2014 based on International Classification of Disease 9th Edition codes. Plastic surgery volume per facility for the entire NIS was determined based on ICD-9 codes for flap procedures, breast reconstruction, and complex hand reconstruction. Outcomes included odds of receiving a flap, patient safety indicators (venous thromboembolic event, sepsis, surgical bleeding, pneumonia, wound complications) and mortality. Regression models included the following variables: age, %TBSA, gender, inhalation injury, comorbidities, hospital size, and urban/teaching status. Results The weighted sample included 99,510 burn admissions with a mean age of 37.2 years (standard deviation [SD] 24.3) and mean %TBSA of 12.4% (SD 12.4%). The weighted median plastic surgery volume by facility was 245 cases per year (Interquartile range 115, 495). Compared to the lowest quartile, the upper three quartiles of plastic surgery volume were associated with an increased likelihood of undergoing a flap procedure during admission (p< 0.05). Plastic surgery volume was also associated with decreased likelihood of patient safety indicator events, whereby the highest quartile showed an OR of 0.71 (95% confidence interval 0.59–0.85, p< 0.001). Plastic surgery facility volume was not significantly associated with a difference in the likelihood of inpatient death. Conclusions Burn patients treated at high volume plastic surgery facilities were more likely to undergo flap procedures during their admission compared to low volume centers. High volume plastic surgery facilities were associated with lower likelihood of inpatient complications, although there were no differences in mortality. Applicability of Research to Practice Inform health systems design in the delivery of burn care to provide the best outcomes for burn survivors.

When considering the causes of secularization in the Western societies, one must mention sociological and political consequences of both the World War II and Holocaust. Extermination of the Jewish nation prompted raising the question of “why did God allow Auschwitz?” Many Jewish and Christian theologians attempted to explain the moral collapse in the time of Holocaust. Part of them was related to the so-called Death of God theology, the theological movement which interpreted a radical secularization of the Western culture in many ways. The article discusses theological reflections of the Christian theologian Paul van Buren and the Jewish thinker Richard L. Rubenstein. They are considered to belong to the movement of the Death of God theology, though in both cases such classification is not justified. Both interpret Holocaust in the perspective of God’s silence, and both search for new notions and meanings for God in the secular world after Auschwitz.

Category: Midfoot/Forefoot Introduction/Purpose: Chronic Lisfranc fracture dislocation had been commonly treated with arthrodesis, but were these treatments suitable? The Lisfranc joint has sagittal motion with articular cartilage and functioning as a shock absorber. We reported the middle-term outcomes after performing Lisfranc ligament anatomical reconstruction surgery (LARS), using an optimal route of reconstruction based on anatomical measurements of and biomechanical experiments with cadavers. The purpose of this study is to determine the usefulness of LARS for chronic Lisfranc injuries to preserve the joint function. Methods: We underwent LARS for 8 cases of Chronic Lisfranc injuries (6 males, 2 females) from May 2012 to June 2017. Average age at surgery 26.1 years (18-38), average follow-up period is 28 months (2-46). The reconstruction route was via a burr hole created at a position 6 mm distal to the tarsometatarsal joint on the 2nd metatarsal, and at a depth of 10 mm. A burr hole was then created from the medial cuneiform bone to the 2nd metatarsal bone in a plantar and horizontal direction. The graft tendon was guided through the burr hole from the medial cuneiform bone to the 2nd metatarsal (double-layered side), was looped, and was guided back around the dorsum of the medial cuneiform(single layer) to reconstruct the dorsal ligament. We examined Myerson classification, Kaar evaluation and the postoperative clinical evaluation using Japanese Society for Surgery of Foot (JSSF) midfoot scale. Results: In Myerson classification, Type B2 6 cases and Type C1 2 cases. In Kaar evaluation, transverse instability (TI) 6 cases, longitudinal instability (LI) 2 cases. The average time from injury to surgery is 156 days on average (37-404). JSSF scores averaged 95 points (90-100). X - ray evaluations were almost good, but in 2 cases with weight bearing, a slight diastasis between the base of the first cuneiform and second metatarsal was observed. But there were no clinical symptoms such as pain. In the surgical procedure, scar is mediated in chronic cases. Therefore, we had to take time to obtain the reduction. Conclusion: Arthrodesis is gold standard for chronic Lisfranc joint injuries, but decline in foot flexibility is inevitable. LARS is beneficial for maintaining anatomical reduction, preserving the joint function, and shortening the post-therapy period. LARS gave stable results against Chronic Lisfranc joint injuries. LARS for chronic Lisfranc joint injuries is a useful procedure.

Background: Occupational injuries/diseases are considered as leading problems for workers, especially in less developed countries. Based on International Standard Classification of Occupation (ISCO-08) four broad skill levels are defined. Employment has been established as a fundamental determinant of health and review of occupation/all cause mortality has been carried to observe the impact of occupation skill on cause of death.Methods: A retrograde study conducted on mortality data of State Life Insurance Corporation of Pakistan. Randomly 500 death cases were collected during study period between 2006 to 2018.The death claim instrument were proposal forms and death claim register. The data about occupation and cause of death was inserted on spread sheet of excel and finally analyzed through SPSS for occupation skill and cause of death.Results: Almost equal proportion of data found in skill-1 (14%) and skill-4 (12.6%) while maximum contribution found in skill level-2 (49.40%) followed by skill-3 (24%).The maximum percentages of mortality seen cause wise as CVS (49.39% skill-2), cancer (17.46% skill-4), road side accident (14.28% skill-1), multiple causes (6.67% skill-3), liver disorder (5.71% skill-1), CNS (3.17% skill-4), kidney disorder (5.71% skill-1), GIT (6.35% skill-4), respiration (3.17% skill-4), un-natural (2.02% skill-2), idiopathic (2.85% skill-1), endocrine (1.58% skill-4), body temperature (1.42% skill-1), poisoning (0.83% skill 3), electric shock (2.85% skill-1), sepsis (1.58% skill-4), obstetric (0.83% skill-3) and burn (1.42% skill-1) while lowest found as CVS(46.67% skill-3), cancer (7.14% skill-1), road accident (7.93% skill-4), multiple causes (2.85% skill-1), liver (1.58% skill-4), GIT (2.02% skill-2), respiration (1.61% skill-2) and idiopathic (0.40% skill-2). Many causes in skill-1 and skill-4 found no mortality.Conclusions: Mortality due to cardiovascular diseases found highest in all skills while lower frequency of death seen in other systematic disorders. Mostly highest and lowest mortality percentages found either in skill-1 or skill-4 whereas comparatively higher percentages have steadily been maintained in skill-2 and skill-3.

AbstractSaproxylic insect assemblages inhabiting dead wood in Canadian forests are highly diverse and variable but quite poorly understood. Adequate assessment of these assemblages poses significant challenges with respect to sampling, taxonomy, and analysis. Their assessment is nonetheless critical to attaining the broad goals of sustainable forest management because such species are disproportionately threatened elsewhere by the reductions in dead wood generally associated with commercial exploitation of northern forests. The composition of the saproxylic fauna is influenced by many factors, including tree species, degree of decay, stand age, and cause of tree death. Wildfire and forest harvesting have differential impacts on saproxylic insect assemblages and on their recovery in postdisturbance stands. Exploration of saproxylic insect responses to variable retention harvesting and experimental burns is contributing to the development of prescriptions for conserving saproxylic insects in boreal forests. Understanding of processes that determine diversity patterns and responses of saproxylic insects would benefit from increased attention to natural history. Such work should aim to provide a habitat-classification system for dead wood to better identify habitats (and associated species) at risk as a result of forest management. This tool could also be used to improve strategies to better maintain saproxylic organisms and their central nutrient-cycling functions in managed forests.

O objetivo do estudo foi avaliar o fluxo de atendimento dos pacientes quanto à classificação de risco e seu desfecho. O Estudo analisou de forma retrospectiva, descritiva e exploratória a classificação de risco recebida pelo paciente e como se deu o desfecho dos casos. Foi realizado em um Hospital Municipal de São Paulo através de busca nos prontuários de pacientes maiores de 18 anos que apresentavam dados da classificação de risco e da alta ou do óbito no mês de abril de 2018. A classificação amarela foi a mais recebida com 34,5%, 87% receberam alta e 13 % foram à óbito. Conclui-se que a Classificação de Risco realizada no hospital através do Sistema de Triagem de Manchester é um bom preditor da gravidade e que avaliar como está sendo realizada é de suma importância, tanto para a segurança dos usuários como para a gestão e o planejamento do Sistema Único de Saúde.Descripitores: Classificação de Risco, Manchester, Avaliação. Risk classification help in a safe department of the municipality of São Paulo: analysis of case outcome in studyingAbstract: The objective of the study was to evaluate the flow of care of the patients regarding the classification of risk and its outcome. The study analyzed retrospectively, descriptively and exploratory the classification of risk received by the patient and how the outcome of the cases occurred. It was performed at a Municipal Hospital of São Paulo through a search of medical records of patients older than 18 years who presented data on the risk classification and discharge or death in April 2018. The yellow classification was the most received with 34, 5%, 87% were discharged, and 13% died. It is concluded that the risk classification performed at the hospital through the Manchester Screening System is a good predictor of severity and that assessing how it is performed is of paramount importance, both for the safety of users and for the management and planning of the Health Unic System.Descriptors: Risk Rating, Manchester, Assessment. Hospitalización de clasificación de riesgos en un municipio de São Paulo: análisis de resultados de casosResumen: El objetivo del estudio fue evaluar el flujo de atención al paciente con respecto a la clasificación del riesgo y su resultado. El estudio analizó retrospectiva, descriptiva y exploratoriamente la clasificación de riesgo recibida por el paciente y cómo ocurrió el resultado de los casos. Se realizó en un Hospital Municipal de São Paulo mediante la búsqueda en los registros médicos de pacientes mayores de 18 años que presentaron datos de clasificación de riesgo y alta o muerte en abril de 2018. La clasificación amarilla fue la más recibida con 34, 5%, 87% fueron dados de alta y 13% murieron. Se concluye que la Clasificación de Riesgos realizada en el hospital a través del Sistema de Detección de Manchester es un buen predictor de gravedad y que evaluar cómo se realiza es de suma importancia tanto para la seguridad del usuario como para la gestión y la planificación. Sistema único de Salud.Descriptores: Calificación de Riesgo, Manchester, Calificación.

The fundamental interpretative difficulty in cantos 26 and 27 of the Inferno, especially in recent years, has been to reconcile the diverse crimes of two characters as unlike each other as Ulysses and Guido da Montefeltro, by identifying one sin that would account for their common collocation in the eighth degree of the circle of fraud. Guido da Montefeltro, a relatively pedestrian brand of con artist and a near contemporary of Dante's, is dwarfed by his juxtaposition with the great hero of antiquity, Ulysses, whose epic adventure beyond the known world tends to trivialize any of his particular fraudulent acts enumerated by Dante's guide Virgil (Inf. 26.58–63). Classification is no idle issue, especially for a figure who, apart from his ancient notoriety, has enormous appeal for our own age, an attractiveness he acquired by the grace of the same literary creator who condemned him to hell. Dante's Ulysses, epitome of the most ambitious of secular aspirations — a believer, we might say, in the promise of science and technology, pioneer of research and exploration, and figurehead of enlightened humanism — burns in a tongue of flame as does Guido, a wily military strategist, little more than a common crook. Even if we can organize the various crimes of Ulysses and Guido under one heading of sin, the inescapable focus of both cantos is not on each character's lifetime of trickery but on the moment of his death, where the magnanimity of Ulysses and the pusillanimity of Guido appear most opposed. One of the harshest ironies of the Inferno is that such a gaping discrepancy in chronology, grandeur, historical importance, and apparent moral fiber can be cancelled out completely by a single form of torment. Such a stratification means, in other words, that from the divine perspective Ulysses and Guido are without differentiation.

Abstrak: Darah merupakan salah satu komponen paling penting yang ada dalam tubuh, mengingat fungsinya sebagai alat transportasi. Kekurangan darah di dalam tubuh dapat memacu sejumlah penyakit dimulai dari anemia, hipotensi, serangan jantung, dan beberapa penyakit lainnya. Beberapa kasus lain seperti kecelakaan, luka bakar dan proses persalinan juga memerlukan tranfusi darah akibat tingginya kemungkinan pendarahan. Terdapat dua jenis penggolongan darah yang paling penting adalah penggolongan A-B-O dan Rhesus (faktor Rh). Transfusi darah dari golongan yang tidak kompatibel dapat menyebabkan reaksi transfusi imunologis yang berakibat anemia hemolisis, gagal ginjal, syok, dan kematian. Banyak diantara kita belum mengetahui jenis golongan darah yang kita miliki. Kasus ini menjadi sangat krusial ketika individu tersebut mengalami musibah, seperti kecelakaan yang mengakibatkan darah banyak keluar. Tindakan penanganan pasien menjadi terlambat, karena individu ini belum mengetahui jenis golongan darah yang ia miliki. Berdasarkan hasil observasi dengan siswa, Kepala Sekolah dan guru-guru Madrasah Aliyah NW Bagik Polak, dapat disimpulkan bahwa sebagian besar siswa di sekolah ini belum mengetahui golongan darah yang ia miliki. Kejadian ini menjadi dasar kami untuk melakukan pengabdian kepada masyarakaat dalam hal ini siswa untuk mengecek golongan darah yang mereka miliki.Abstract: Blood is one of the most important components in the body, given its function as a means of transportation. Blood deficiency in the body can spur some diseases starting from anemia, hypotension, heart attack, and some other diseases. Some other cases such as accidents, burns, and childbirth also require blood transfusions due to the high likelihood of bleeding. There are two most important types of blood type which are the A-B-O and Rhesus (RH) classification. Incompatible blood transfusions can cause immunological transfusion reactions that result in hemolysis anemia, renal failure, shock, and death. Many of us do not know the type of blood group we have. This case became very crucial when the individual suffered a calamity, such as accidents that caused many types of blood to come out. The patient's treatment was delayed, as the individual did not know what type of blood he had. Based on the results of the observation with the students, the principal, and teachers of Madrasah Aliyah NW Bagik Polak, it can be concluded that most students in this school do not know the blood type he has. This incident is the basis for our devotion to the community in this case students to check the blood group they have.

This study used methodologies of descriptive and quantitative statistics to identify the contributing factors most affecting occupational accident outcomes among electrical contracting enterprises, given an accident occurred. Accident reports were collected from the Occupational Safety and Health Administration’s fatality and catastrophe database. To ensure the reliability of the data, the team manually codified more than 600 incidents through a comprehensive content analysis using injury-classification standards. Inclusive of both fatal and non-fatal injuries, the results showed that most accidents happened in nonresidential buildings, new construction, and small projects (i.e., $50,000 or less). The main source of injuries manifested in parts and materials (46%), followed by tools, instruments, and equipment (19%), and structure and surfaces (16%). The most frequent types of injuries were fractures (31%), electrocutions (27%), and electrical burns (14%); the main injured body parts were upper extremities (25%), head (23%), and body system (18%). Among non-fatal cases, falls (37%), exposure to electricity (36%), and contact with objects (19%) caused most injuries; among fatal cases, exposure to electricity was the leading cause of death (50%), followed by falls (28%) and contact with objects (19%). The analysis also investigated the impact of several accident factors on the degree of injuries and found significant effects from such factors such as project type, source of injury, cause of injury, injured part of body, nature of injury, and eventtype. In other words, the statistical probability of a fatal accident—given an accident occurrence—changes significantly based on the degree of these factors. The results of this study, as depicted in the proposed decision tree model, revealed that the most important factor for predicting the nature of injury (electrical or non-electrical) is: whether the source of injury is parts and materials; followed by whether the source of injury is tools, instruments, and equipment. In other words, in predicting (with a 94.31% accuracy) the nature of injury as electrical or non-electrical, whether the source of injury is parts and materials and whether the source of injury is tools, instruments, and equipment are very important. Seven decision rules were derived from the proposed decision tree model. Beyond these outcomes, the described methodology contributes to the accident-analysis body of knowledge by providing a framework for codifying data from accident reports to facilitate future analysis and modeling attempts to subsequently mitigate more injuries in other fields.

In this paper, the objective is to propose a set of novel features for the classification of different burn depths by using an image mining approach. Both colour and texture features were studied on skin burn dataset comprising skin burn images categorized into three burn depths by the burn specialist. The performance of the proposed feature set was evaluated using linear SVM on 10-fold cross validation method. The empirical results showed that the six proposed novel features, when used together with the common image features, was the best set of features that was able to classify most of the burn depths in terms of accuracy, precision and recall measures with the values of 96.8750%, 96.9697% and 96.6667% respectively. Automated classification of skin burn depths is essential because the initial burn treatment provided to patients are usually based on the first evaluation of the skin burn injuries by determining the burn depths. However, the burn specialist may not always be available at the accident site. In conclusion, the features extracted that represent the burn characteristics specifically in terms of colour and texture were able to effectively characterise the depth of burns in accordance to burn depth classification.

In the United States, an estimated 450,000 patients with burns are treated in medical facilities annually. On assessment of burn patients, Advanced Trauma Life Support protocols should be followed because these patients often suffer from concomitant trauma; chemical exposure and airway compromise should also be considered in the initial assessment. Mortality from burn injuries increases with the patient’s age, the extent of the burn, and the presence of inhalation injury. This review covers the epidemiology, pathophysiology, assessment and stabilization, diagnosis, treatment and disposition, and outcomes of patients with burn injuries. Figures show the structure of the skin, and photographs of partial-thickness and full-thickness burns. Tables list burn classification by depth, indications for intubation, American Burn Association 2010 guidelines for calculating IV fluid resuscitation, indications for escharotomy in patients with circumferential trunk and extremity burns, and indications for burn center referral. This review contains 3 highly rendered figures, 5 tables, and 33 references.

ObjectiveThe aim of this study is to present the syndromic groups that will be routinely monitored for the reactive mortality surveillance based on free-text medical causes of death.IntroductionIn 2004, Santé publique France, the French Public Health Agency set up a reactive all-cause mortality surveillance based on the administrative part of the death certificate, in the final objectives 1/ to detect unexpected or usual variations in mortality and 2/ to provide a first evaluation of mortality impact of events.In 2007, an Electronic Death Registration System (EDRS) was implemented, enabling electronic transmission of the medical causes of death to the agency in real-time. To date, 12% of the mortality is registered electronically. A pilot study demonstrated that these data were valuable for a reactive mortality surveillance system based on causes of death [1].A strategy has thus been developed for the analysis in routine of the medical causes of death with the objectives of early detection of expected and unexpected outbreaks and reactive evaluation of their impact. This system will allow approaching the cause accountability when an excess death will be observed.MethodsMortality syndromic groups (MSG) were defined as clusters of medical causes of death (pathologies, syndromes or symptoms) that meet the objectives of the surveillance system. The causes of death are available reactively in free-text (words, terms, expressions) and with a delay of 6 to 24 months in ICD10 codes format.We explored multiple biomedical classifications such as the Mesh, SNOMED, UMLS or ICD10 to learn from their various ways to classify diseases. Based on ICD10, we defined MSGs by a list of ICD10 codes, each codes belonging to a unique MSGs. Each MSG definition was then discussed in working group including medical and epidemiological experts.Additionally, we used a dictionary (provided by the Epidemiology Center on Causes of Death (Inserm-CépiDc)) of each term/expression found in the death certificates since the early 2000 to enrich variety of expression of each MSG.We classified causes of death into MSGs from E-death certificates from 2012 to 2016: 1/ using the ICD10 codes assigned by Inserm-CépiDc based on rules defined by WHO in order to produce the national mortality statistics and 2/ using a linear Support Vector Machine (SVM) method to classify free-text causes of death. Then we compared the fluctuations of the weekly numbers of each MSG built by using both classification methods (ICD10 codes and the SVM classification) [2].ResultsA list of a hundred MSGs was defined, divided into 20 topics (Respiratory conditions, Digestive conditions, Infectious conditions, Cardio and Cerebrovascular conditions, General symptoms…). 60 MSGs were dedicated to alert and detection of both expected seasonal epidemics (12 MSGs) and unexpected events (42 MSGs). They contain unspecific or acute pathologies and symptoms. 40 MSG included medical causes of death related to chronic diseases and medical history.The list of established MSGs was composed of:- MSGs for detection of expected seasonal events such as: “Influenza”, “Low acute respiratory infection”, “Gastroenteritis”, “Chikungunya”, “Heat related death”, “Dehydration”…- MSGs for detection of the impact of unexpected events such as: “Epilepsy”, “Choc”, “Coma”, “Unspecified fever”, “Headache”, “Suicide”, “Drugs/opioids poisoning”…- MSGs for Chronic diseases and Medical history: “Chronic digestive diseases”, “Chronic endocrine diseases”, “Genitourinary chronic diseases”, “History of diseases”…The weekly number of MSGs built using SVM classification was close and highly correlated to the weekly number of MSGs built using ICD10 codes (Figure 1). Seasonality and peaks were visible using both classifications. For instance, the increase of the MSG “Influenza” occurred during winter months which are known to be the circulating months of the influenza virus (Figure 1, left) [3].For unusual and rare events such as death due to burns, we observed that the weekly numbers of MSG “Burns” were also similar using both methods. We observed (Figure 1, right) that the outbreak that occurred in September 2016 related to a major bus accident was found using ICD10 codes or SVM classification.ConclusionsThe use of free-text causes of death for reactive mortality surveillance requires the development of a strategy for the analysis of these data. Defining MSGs was essential for the implementation of automatic classification methods of the death certificates in routine.The dynamic of MSGs using ICD10 codes or SVM classification were comparable. However, the use of ICD10 codes for reactive mortality surveillance is not an option due to the delay of availability of the codes. The uses of machine learning methods, thus, enable to harness free-text causes of death for the reactive mortality surveillance with an objective of detection and early impact assessment.References1. Lassalle M, Caserio-Schönemann C, Gallay A, Rey G, Fouillet A: Pertinence of electronic death certificates for real-time surveillance and alert, France, 2012–2014. Public Health 2017, 143:85-93.[1]2. Baghdadi Y, Bourrée A, Robert A, Rey G, Gallay A, Zweigenbaum P, Grouin C, Fouillet A: Automatic classification of medical causes from free-text death certificates for reactive mortality surveillance in France. Int J Med Inf 2018, Under review.[2]3. Bedford T, Riley S, Barr IG, Broor S, Chadha M, Cox NJ, Daniels RS, Gunasekaran CP, Hurt AC, Kelso A et al: Global circulation patterns of seasonal influenza viruses vary with antigenic drift. Nature 2015, 523(7559):217-220.[3]

Background: Heart Failure (HF) is the most common cause of death in Friedreich’s ataxia (FRDA), an inherited mitochondrial disease. Myocardial fibrosis is a well-documented histopathological feature among FRDA patients with HF. Objectives: In this study we will investigate the myocardial extracellular volume fraction (ECV) and intracellular water lifetime (τ ic ), using T1-weighted CMR imaging, in a cohort of patients with FRDA without signs of heart failure. We will also investigate whether myocardial tissue phenotyping by CMR can highlight particular characteristics of LV remodeling in FRDA’s cardiomyopathy, beyond those currently assessed with imaging-based classification of disease severity. Methods: Twenty-six FRDA’s patients (age 26.6±9.3 years, 15 women) without signs of HF, and 10 healthy controls (32.6±7.3 years, 5 women) underwent cardiac magnetic resonance (CMR) studies for assessment of left ventricular (LV) function, myocardial T1, late gadolinium enhancement (LGE), extracellular volume fraction (ECV), and intracellular water-lifetime (τ ic ) as marker of cardiomyocyte size. Neurological decline was determined using the FRDA rating scale (FARS 3). Results: FRDA patients had normal LV ejection fraction (LVEF: 67.66±11.4 vs. 63.9±9.0, P=0.311), larger LV mass index (LVMASSi: 61.03±22.1 vs. 45±4.2g/m 2 , P<0.001), and decreased LV end-diastolic volume index (LVEDVi 53.42±12 vs. 75.7±16.1, P=0.002), compared with controls. ECV and τ ic , were increased in FRDA patients (ECV: 0.36±0.05 vs. 0.25±0.02, P<0.0001; τ ic : 0.13±0.07 vs. 0.06±0.03, P=0.001). ECV was positively associated with LV mass-to-volume ratio (r=0.628, P<0.001). FARS 3 correlated positively with disease duration (r=0.669, P<0.001), and negatively with τ ic , (r=0.478, P=0.039). LVMASSi and cardiomyocyte mass-index [(1–ECV)LVMASSi] declined with age, indicating that LV hypertrophy may transition to a “burn-out” phase with LV atrophy. Conclusions: LV hypertrophy in FRDA reflects an expansion of the myocardial interstitium and an increase in cardiomyocyte size. In contrast, the neurological decline was more likely with decreasing cardiomyocyte size, possibly an early sign of myocardial “burn-out” in FRDA.

Introduction "Doesn't that wreck your records?" This is one of the first things I generally get asked when someone watches me at work in my home or while spinning at a party. It reminds me of a different but related question I once asked someone who worked at Rotate This!, a particularly popular Toronto DJ refuge, a few days after I had bought my first turntable: DJO: "How do you stop that popping and crackling sound your record gets when you scratch back and forth on the same spot for a while?" CLERK: "You buy two copies of everything, one you keep at home all wrapped-up nice and never use, and the other you mess with." My last $150 had just managed to pay for an old Dual direct drive record player. The precious few recently-released records I had were gifts. I nodded my head and made my way over to the rows of disks which I flipped through to make it look like I was maybe going to buy something. Lp cover after lp cover stared back at me all with names I had absolutely never heard of before, organised according to a hyper- hybridised classification scheme that completely escaped my dictionary-honed alphabetic expectations. Worst of all, there seemed to be only single copies of everything left! A sort of outsider's vertigo washed over me, and 3 minutes after walking into unfamiliar territory, I zipped back out onto the street. Thus was to begin my love/hate relationship with the source of all DJ sounds, surliness and misinformation--the independent record shop. My query had (without my planning) boldly pronounced my neophyte status. The response it solicited challenged my seriousness. How much was I willing to invest in order to ride "the wheels of steel"? Sequence 1 Will Straw describes the meteoric rise to prominence of the CD format, If the compact disk has emerged as one of the most dazzlingly effective of commodity forms, this has little to do with its technical superiority to the vinyl record (which we no longer remember to notice). Rather, the effectiveness has to do with its status as the perfect crossover consumer object. As a cutting-edge audiophile invention, it seduced the technophilic, connoisseurist males who typically buy new sound equipment and quickly build collections of recordings. At the same time, its visual refinement and high price rapidly rendered it legitimate as a gift. In this, the CD has found a wide audience among the population of casual record buyers.(61) Straw's point has to do with the fate of musical recordings within contemporary commodity culture. In the wake of a late 70's record industry slump, music labels turned their attention toward the recapturing of casual record sales (read: aging baby boomers). The general shape of this attempt revolved around a re-configuring of the record- shopping experience dedicated towards reducing "the intimidation seen as endemic to the environment of the record store."(59) The CD format, along with the development of super-sized, general interest (all-genre) record outlets has worked (according to Straw) to streamline record sales towards more-predictable patterns, all the while causing less "selection stress."(59) Re-issues and compilations, special-series trademarks, push-button listening stations, and maze-like display layouts, combined with department store-style service ("Can I help you find anything?") all work towards eliminating the need for familiarity with particular music "scenes" in order to make personally gratifying (and profit engendering) musical choices. Straw's analysis is exemplary in its dissatisfaction with treating the arena of personal musical choice as unaffected by any constraints apart from subjective matters of taste. Straw's evaluation also isolates the vinyl record as an object eminently ready (post-digital revolution) for subcultural appropriation. Its displacement by the CD as the dominant medium for collecting recorded music involved the recasting of the turntable as outdated and inferior, thereby relegating it to the dusty attic, basement or pawn shop (along with crates upon crates upon crates of records). These events set the stage for vinyl's spectacular rise from the ashes. The most prominent feature of this re-emergence has to do not simply with possession of the right kind of stuff (the cachet of having a music collection difficult for others to borrow aside), but with what vinyl and turntable technology can do. Bridge In Subculture: The Meaning of Style, Dick Hebdige claims that subcultures are, cultures of conspicuous consumption...and it is through the distinctive rituals of consumption, through style, that the subculture at once reveals its "secret identity" and communicates its forbidden meanings. It is basically the way in which commodities are used in subculture which mark the subculture off from more orthodox cultural formations.(103 Hebdige borrows the notion of bricolage from Levi Strauss in order to describe the particular kind of use subcultures make of the commodities they appropriate. Relationships of identity, difference and order are developed from out of the minds of those who make use of the objects in question and are not necessarily determined by particular qualities inherent to the objects themselves. Henceforth a safety pin more often used for purposes like replacing missing buttons or temporarily joining pieces of fabric can become a punk fashion statement once placed through the nose, ear or torn Sex Pistols tee-shirt. In the case of DJ culture, it is the practice of mixing which most obviously presents itself as definitive of subcultural participation. The objects of conspicuous consumption in this case--record tracks. If mixing can be understood as bricolage, then attempts "to discern the hidden messages inscribed in code"(18) by such a practice are not in vain. Granting mixing the power of meaning sets a formidable (semiotic) framework in place for investigating the practice's outwardly visible (spectacular) form and structure. Hebdige's description of bricolage as a particularly conspicuous and codified type of using, however, runs the risk of privileging an account of record collecting and mixing which interprets it entirely on the model of subjective expression.(1.) What is necessary is a means of access to the dialogue which takes place between a DJ and her records as such. The contents of a DJ's record bag (like Straw's CD shopping bag) are influenced by more that just her imagination, pocket book and exposure to different kinds of music. They are also determined in an important way by each other. Audio mixing is not one practice, it is many, and the choice to develop or use one sort of skill over another is intimately tied up with the type and nature of track one is working with. Sequence 2 The raw practice of DJing relies heavily on a slider integral to DJ mixers known as the _cross-fader_(ital). With the standard DJ set up, when the cross-fader is all the way to the left, the left turntable track plays through the system; vice versa when the fader is all the way to the right. In between is the "open" position which allows both inputs to be heard simultaneously. The most straightforward mixing technique, "cutting," involves using this toggle to quickly switch from one source to another--resulting in the abrupt end of one sound- flow followed by its instantaneous replacement. This technique can be used to achieve a variety of different effects--from the rather straightforward stringing together of the final beat of a four bar sequence from one track with a strong downbeat from something new in order to provide continuous, but sequential musical output, to the thoroughly difficult practice of "beat juggling," where short excerpts of otherwise self-contained tracks ("breaks") are isolated and then extended indefinitely through the use of two copies of the same record (while one record plays, the DJ spins the other back to the downbeat of the break in question, which is then released in rhythm). In both cases timing and rhythm are key. These features of the practice help to explain DJ predilections for tracks which make heavy, predictable use of their rhythm sections. "Blending" is a second technique which uses the open position on the cross-fader to mix two inputs into a live sonic collage. Tempo, rhythm and "density" of source material have an enormous impact on the end result. While any two tracks can be layered in this way, beats that are not synchronized are quick to create cacophony, and vocals also tend to clash dramatically. Melodic lines in general pose certain challenges here since these are in particular keys and have obvious starts and finishes. This is one reason why tracks produced specifically for DJing often have such long, minimal intros and exits. This makes it much easier to create "natural" sounding blends. Atmospheric sounds, low-frequency hums, speech samples and repetitive loops with indeterminate rhythm structures are often used for these segments in order to allow drawn-out, subtle transitions when moving between tracks. If an intro contains a fixed beat (as is the case often with genres constructed specifically for non-stop dancing like house, techno and to some extent drum and bass), then those who want seamless blends need to "beat match" if they want to maintain a dancer's groove. The roots of this technique go back to disco and demand fairly strict genre loyalty in order to insure that a set's worth of tracks all hover around the same tempo, defined in beats-per- minute, or BPMs. The basic procedure involves finding the downbeat of the track one wishes to mix through a set of headphones, releasing that beat in time with the other record while making fine tempo- adjustments via the turntable's pitch control to the point where the track coming through the earphones and the track being played over the system are in synch. The next step is "back-spinning" or "needle dropping" to the start of the track to be mixed, then releasing it again, this time with the cross-fader open. Volume levels can then be adjusted in order to allow the new track to slowly take prominence (the initial track being close to its end at this point) before the cross-fader is closed into the new position and the entire procedure is repeated. Scratching is perhaps the most notorious mixing technique and involves the most different types of manipulations. The practice is most highly developed in hip hop (and related genres like drum and bass) and is used both as an advanced cutting technique for moving between tracks as well as a sonic end-in-itself. It's genesis is attributed to a South Bronx DJ known as Grand Wizard Theodore who was the first (1977) to try to make creative use of the sound associated with moving a record needle back and forth over the same drumbeat, a phenomena familiar to DJs used to cueing-up downbeats through headphones. This trick is now referred to as the "baby scratch," and it along with an ever-increasing host of mutations and hybrids make- up the skills that pay the bills for hip hop DJs. In the case of many of these techniques, the cross-fader is once again used heavily in order to remove unwanted elements of particular scratches from the mix, as well as adding certain staccato and volume-fading effects. Isolated, "pure" sounds are easiest to scratch with and are therefore highly sought after by this sort of DJ--a pastime affectionately referred to as "digging in the crates." Sources of such sounds are extremely diverse, but inevitably revolve around genre's which use minimal orchestration (like movie-soundtracks), accentuated rhythms with frequent breakdowns (like funk or jazz), or which eschew musical form all together (like sound-effects, comedy and children's records). Exit To answer the question which started this investigation, in the end, how wrecked my records get depends a lot on what I'm using them for. To be sure, super-fast scratching patterns and tricks that use lots of back-spinning like beat-juggling will eventually "burn" static into spots on one's records. But with used records costing as little as $1 for three, and battle records (2.) widely available, the effect of this feature of the technology on the actual pursuit of the practice is negligible. And most techniques don't noticeably burn records at all, especially if a DJ's touch is light enough to allow for minimal tone-arm weight (a parameter which controls a turntable's groove-tracking ability). This is the kind of knowledge which comes from interaction with objects. It is also the source of a great part of the subcultural bricoleur's stylistic savvy. Herein lies the essence of the intimidating power of the indie record shop--its display of intimate, physical familiarity with the hidden particularities of the new vinyl experience. Investigators confronted with such familiarity need to find ways to go beyond analyses which stop at the level of acknowledgment of the visible logic displayed by spectacular subcultural practices if they wish to develop nuanced accounts of subcultural life. Such plumbing of the depths often requires listening in the place of observing--whether to first-hand accounts collected through ethnography or to the subtle voice of the objects themselves. (1.) An example of such an account: "DJ-ing is evangelism; a desire to share songs. A key skill is obviously not just to drop the popular, well-known songs at the right part of the night, but to pick the right new releases, track down the obscurer tunes and newest imports, get hold of next month's big tune this month; you gather this pile, this tinder, together, then you work the records, mix them, drop them, cut them, scratch them, melt them, beat them all together until they unite. Voilà; disco inferno." Dave Haslam, "DJ Culture," p. 169. (2.) Records specifically designed by and for scratch DJs and which consist of long strings of scratchable sounds. References Haslam, David. "DJ Culture." The Clubcultures Reader. Oxford: Blackwell Publishers. 1997 Hebdige, Dick. Subculture: The Meaning of Style. London: Melvin and Co. Ltd.. 1979 Straw, Will. "Organized Disorder: The Changing Space of the Record Shop." The Clubcultures Reader. Oxford: Blackwell Publishers. 1997

Introduction Films with deaf characters often do not focus on the condition of deafness at all. Rather, the characters seem to satisfy a role in the story that either furthers the plot or the audience’s understanding of other hearing characters. The deaf characters can be symbolic, for example as a metaphor for isolation representative of ‘those without a voice’ in a society. The deaf characters’ misunderstanding of auditory cues can lead to comic circumstances, and their knowledge can save them in the case of perilous ones. Sign language, because of its unique linguistic properties and its lack of comprehension by hearing people, can save the day in a story line. Deaf characters are shown in different eras and in different countries, providing a fictional window into their possible experiences. Films shape and reflect cultural attitudes and can serve as a potent force in influencing the attitudes and assumptions of those members of the hearing world who have had few, if any, encounters with deaf people. This article explores categories of literary function as identified by the author, providing examples and suggestions of other films for readers to explore. Searching for Deaf Characters in Film I am a sign language interpreter. Several years ago, I started noticing how deaf characters are used in films. I made a concerted effort to find as many as I could. I referred to John Shuchman’s exhaustive book about deaf actors and subject matter, Hollywood Speaks; I scouted video rental guides (key words were ‘deaf’ or ‘disabled’); and I also plugged in the key words ‘deaf in film’ on Google’s search engine. I decided to ignore the issue of whether or not the actors were actually deaf—a political hot potato in the Deaf community which has been discussed extensively. Similarly, the linguistic or cultural accuracy of the type of sign language used or super-human lip-reading talent did not concern me. What was I looking for? I noticed that few story lines involving deaf characters provide any discussion or plot information related to that character’s deafness. I was puzzled. Why is there signing in the elevator in Jerry Maguire? Why does the guy in Grand Canyon have a deaf daughter? Why would the psychosomatic response to a trauma—as in Psych Out—be deafness rather than blindness? I concluded that not being able to hear carried some special meaning or fulfilled a particular need intrinsic to the plot of the story. I also observed that the functions of deaf characters seem to fall into several categories. Some deaf characters fit into more than one category, serving two or more symbolic purposes at the same time. By viewing and analysing the representations of deafness and deaf characters in forty-six films, I have come up with the following classifications: Deafness as a plot device Deaf characters as protagonist informants Deaf characters as a parallel to the protagonist Sign language as ‘hero’ Stories about deaf/hearing relationships A-normal-guy-or-gal-who-just-happens-to-be-deaf Deafness as a psychosomatic response to trauma Deafness as metaphor Deafness as a symbolic commentary on society Let your fingers do the ‘talking’ Deafness as Plot Device Every element of a film is a device, but when the plot hinges on one character being deaf, the story succeeds because of that particular character having that particular condition. The limitations or advantages of a deaf person functioning within the hearing world establish the tension, the comedy, or the events which create the story. In Hear No Evil (1993), Jillian learns from her hearing boyfriend which mechanical devices cause ear-splitting noises (he has insomnia and every morning she accidentally wakes him in very loud ways, eg., she burns the toast, thus setting off the smoke detector; she drops a metal spoon down the garbage disposal unit). When she is pursued by a murderer she uses a fire alarm, an alarm/sprinkler system, and a stereo turned on full blast to mask the sounds of her movements as she attempts to hide. Jillian and her boyfriend survive, she learns about sound, her boyfriend learns about deafness, and she teaches him the sign for orgasm. Life is good! The potential comic aspects of deafness may seem in this day and age to be shockingly politically incorrect. While the slapstick aspect is often innocent and means no overt harm or insult to the Deaf as a population, deafness functions as the visual banana peel over which the characters figuratively stumble in the plot. The film, See No Evil, Hear No Evil (1989), pairing Gene Wilder with Richard Pryor as deaf and blind respectively, is a constant sight gag of lip-reading miscues and lack-of-sight gags. Wilder can speak, and is able to speech read almost perfectly, almost all of the time (a stereotype often perpetuated in films). It is mind-boggling to imagine the detail of the choreography required for the two actors to convince the audience of their authenticity. Other films in this category include: Suspect It’s a Wonderful Life Murder by Death Huck Finn One Flew over the Cuckoo’s NestThe Shop on Main StreetRead My Lips The Quiet Deaf Characters as Protagonist Informants Often a deaf character’s primary function to the story is to give the audience more information about, or form more of an affinity with, the hearing protagonist. The deaf character may be fascinating in his or her own right, but generally the deafness is a marginal point of interest. Audience attitudes about the hearing characters are affected because of their previous or present involvement with deaf individuals. This representation of deafness seems to provide a window into audience understanding and appreciation of the protagonist. More inferences can be made about the hearing person and provides one possible explanation for what ensues. It is a subtle, almost subliminal trick. There are several effective examples of this approach. In Gas, Food, Lodging (1992), Shade discovers that tough-guy Javier’s mother is deaf. He introduces Shade to his mother by simple signs and finger-spelling. They all proceed to visit and dance together (mom feels the vibrations on the floor). The audience is drawn to feel ‘Wow! Javier is a sensitive kid who has grown up with a beautiful, exotic, deaf mother!’ The 1977 film, Looking for Mr. Goodbar presents film-goers with Theresa, a confused young woman living a double life. By day, she is a teacher of deaf children. Her professor in the Teacher of the Deaf program even likens their vocation to ‘touching God’. But by night she cruises bars and engages in promiscuous sexual activity. The film shows how her fledgling use of signs begins to express her innermost desires, as well as her ability to communicate and reach out to her students. Other films in this category include: Miracle on 34th Street (1994 version)Nashville (1975, dir. Robert Altman)The Family StoneGrand CanyonThere Will Be Blood Deaf Characters as a Parallel to the Protagonist I Don’t Want to Talk about It (1993) from Argentina, uses a deaf character to establish an implied parallel story line to the main hearing character. Charlotte, a dwarf, is friends with Reanalde, who is deaf. The audience sees them in the first moments of the film when they are little girls together. Reanalde’s mother attempts to commiserate with Charlotte’s mother, establishing a simultaneous but unseen story line somewhere else in town over the course of the story. The setting is Argentina during the 1930s, and the viewer can assume that disability awareness is fairly minimal at the time. Without having seen Charlotte’s deaf counterpart, the audience still knows that her story has contained similar struggles for ‘normalcy’ and acceptance. Near the conclusion of the film, there is one more glimpse of Reanalde, when she catches the bridal bouquet at Charlotte’s wedding. While having been privy to Charlotte’s experiences all along, we can only conjecture as to what Reanalde’s life has been. Sign Language as ‘Hero’ The power of language, and one’s calculated use of language as a means of escape from a potentially deadly situation, is shown in The River Wild (1996). The reason that any of the hearing characters knows sign language is that Gail, the protagonist, has a deaf father. Victor appears primarily to allow the audience to see his daughter and grandson sign with him. The mother, father, and son are able to communicate surreptitiously and get themselves out of a dangerous predicament. Signing takes an iconic form when the signs BOAT, LEFT, I-LOVE-YOU are drawn on a log suspended over the river as a message to Gail so that she knows where to steer the boat, and that her husband is still alive. The unique nature of sign language saves the day– silently and subtly produced, right under the bad guys’ noses! Stories about Deaf/Hearing Relationships Because of increased awareness and acceptance of deafness, it may be tempting to assume that growing up deaf or having any kind of relationship with a deaf individual may not pose too much of a challenge. Captioning and subtitling are ubiquitous in the USA now, as is the inclusion of interpreters on stages at public events. Since the inception of USA Public Law 94-142 and section 504 in 1974, more deaf children are ‘mainstreamed’ into public schools than ever before. The Americans with Disabilities Act was passed in 1993, opening the doors in the US for more access, more job opportunities, more inclusion. These are the external manifestations of acceptance that most viewers with no personal exposure to deafness may see in the public domain. The nuts and bolts of growing up deaf, navigating through opposing philosophical theories regarding deaf education, and dealing with parents, siblings, and peers who can’t communicate, all serve to form foundational experiences which an audience rarely witnesses. Children of a Lesser God (1986), uses the character of James Leeds to provide simultaneous voiced translations of the deaf student Sarah’s comments. The audience is ushered into the world of disparate philosophies of deaf education, a controversy of which general audiences may not have been previously unaware. At the core of James and Sarah’s struggle is his inability to accept that she is complete as she is, as a signing not speaking deaf person. Whether a full reconciliation is possible remains to be seen. The esteemed teacher of the deaf must allow himself to be taught by the deaf. Other films in this category include: Johnny Belinda (1949, 1982)Mr. Holland’s OpusBeyond SilenceThe Good ShepherdCompensation A Normal Guy-or-Gal-Who-Just-Happens-to-Be-Deaf The greatest measure of equality is to be accepted on one's own merits, with no special attention to differences or deviations from whatever is deemed ‘the norm.’ In this category, the audience sees the seemingly incidental inclusion of a deaf or hearing-impaired person in the casting. A sleeper movie titled Crazy Moon (1986) is an effective example. Brooks is a shy, eccentric young hearing man who needs who needs to change his life. Vanessa is deaf and works as a clerk in a shop while takes speech lessons. She possesses a joie de vivre that Brooks admires and wishes to emulate. When comparing the way they interact with the world, it is apparent that Brooks is the one who is handicapped. Other films in this category include: Sympathy for Mr. Vengeance (South Korea, 1992)Liar, LiarRequiem for a DreamKung Fu HustleBangkok DangerousThe Family StoneDeafness as a Psychosomatic Response to Trauma Literature about psychosomatic illnesses enumerates many disconcerting and disruptive physiological responses. However, rarely is there a PTSD response as profound as complete blockage of one of the five senses, ie; becoming deaf as a result of a traumatic incident. But it makes great copy, and provides a convenient explanation as to why an actor needn't learn sign language! The rock group The Who recorded Tommy in 1968, inaugurating an exciting and groundbreaking new musical genre – the rock opera. The film adaptation, directed by Ken Russell, was released in 1975. In an ironic twist for a rock extravaganza, the hero of the story is a ‘deaf, dumb, and blind kid.’ Tommy Johnson becomes deaf when he witnesses the murder of his father at the hands of his step-father and complicit mother. From that moment on, he is deaf and blind. When he grows up, he establishes a cult religion of inner vision and self-discovery. Another film in this category is Psych Out. Deafness as a Metaphor Hearing loss does not necessarily mean complete deafness and/or lack of vocalization. Yet, the general public tends to assume that there is utter silence, complete muteness, and the inability to verbalize anything at all. These assumptions provide a rich breeding ground for a deaf character to personify isolation, disenfranchisement, and/or avoidance of the harsher side of life. The deafness of a character can also serve as a hearing character’s nemesis. Mr. Holland’s Opus (1995) chronicles much of the adult life of a beleaguered man named Glenn Holland whose fondest dream is to compose a grand piece of orchestral music. To make ends meet he must teach band and orchestra to apparently disinterested and often untalented students in a public school. His golden son (named Cole, in honor of the jazz great John Coltrane) is discovered to be deaf. Glenn’s music can’t be born, and now his son is born without music. He will never be able to share his passion with his child. He learns just a little bit of sign, is dismissive of the boy’s dreams, and drifts further away from his family to settle into a puddle of bitterness, regrets, and unfulfilled desires. John Lennon’s death provides the catalyst for Cole’s confrontation with Glenn, forcing the father to understand that the gulf between them is an artificial one, perpetuated by the unwillingness to try. Any other disability could not have had the same effect in this story. Other films in this category include: Ramblin’ RoseBabelThe Heart Is a Lonely HunterA Code Unkown Deafness as a Symbolic Commentary on Society Sometimes films show deafness in a different country, during another era, and audiences receive a fictionalized representation of what life might have been like before these more enlightened times. The inability to hear and/or speak can also represent the more generalized powerlessness that a culture or a society’s disenfranchised experience. The Chinese masterpiece To Live (1994) provides historical and political reasons for Fenxi’s deafness—her father was a political prisoner whose prolonged absence brought hardship and untended illness. Later, the chaotic political situation which resulted in a lack of qualified doctors led to her death. In between these scenes the audience sees how her parents arrange a marriage with another ‘handicapped’ comrade of the town. Those citizens deemed to be crippled or outcast have different overt rights and treatment. The 1996 film Illtown presents the character of a very young teenage boy to represent the powerlessness of youth in America. David has absolutely no say in where he can live, with whom he can live, and the decisions made all around him. When he is apprehended after a stolen car chase, his frustration at his and all of his generation’s predicament in the face of a crumbling world is pounded out on the steering wheel as the police cars circle him. He is caged, and without the ability to communicate. Were he to have a voice, the overall sense of the film and his situation is that he would be misunderstood anyway. Other films in this category include: Stille Liebe (Germany)RidiculeIn the Company of Men Let Your Fingers Do the ‘Talking’ I use this heading to describe films where sign language is used by a deaf character to express something that a main hearing character can’t (or won’t) self-generate. It is a clever device which employs a silent language to create a communication symbiosis: Someone asks a hearing person who knows sign what that deaf person just said, and the hearing person must voice what he or she truly feels, and yet is unable to express voluntarily. The deaf person is capable of expressing the feeling, but must rely upon the hearing person to disseminate the message. And so, the words do emanate from the mouth of the person who means them, albeit self-consciously, unwillingly. Jerry Maguire (1996) provides a signed foreshadowing of character metamorphosis and development, which is then voiced for the hearing audience. Jerry and Dorothy have just met, resigned from their jobs in solidarity and rebellion, and then step into an elevator to begin a new phase of their lives. Their body language identifies them as separate, disconnected, and heavily emotionally fortified. An amorous deaf couple enters the elevator and Dorothy translates the deaf man’s signs as, ‘You complete me.’ The sentiment is strong and a glaring contrast to Jerry and Dorothy’s present dynamic. In the end, Jerry repeats this exact phrase to her, and means it with all his heart. We are all made aware of just how far they have traveled emotionally. They have become the couple in the elevator. Other films in this category include: Four Weddings and a FuneralKnowing Conclusion This has been a cursory glance at examining the narrative raison d’etre for the presence of a deaf character in story lines where no discussion of deafness is articulated. A film’s plot may necessitate hearing-impairment or deafness to successfully execute certain gimmickry, provide a sense of danger, or relational tension. The underlying themes and motifs may revolve around loneliness, alienation, or outwardly imposed solitude. The character may have a subconscious desire to literally shut out the world of sound. The properties of sign language itself can be exploited for subtle, undetectable conversations to assure the safety of hearing characters. Deaf people have lived during all times, in all places, and historical films can portray a slice of what their lives may have been like. I hope readers will become more aware of deaf characters on the screen, and formulate more theories as to where they fit in the literary/narrative schema. ReferencesMaltin, Leonard. Leonard Maltin’s 2009 Movie Guide. Penguin Group, 2008.Shuchman, John S. Hollywood Speaks. Urbana and Chicago: University of Illinois Press, 1988. Filmography Babel. Dir. Alejandro Gonzalez Inarritu. Central Films, 2006. DVD. Bangkok Dangerous. Dir. Pang Brothers. Film Bangkok, 1999. VHS. Beyond Silence. Dir. Caroline Link. Miramax Films, 1998. DVD. Children of a Lesser God. Dir. Randa Haines. Paramount Pictures, 1985. DVD. A Code Unknown. Dir. Michael Heneke. MK2 Editions, 2000. DVD. Compensation. Dir. Zeinabu Irene Davis. Wimmin with a Mission Productions, 1999. VHS. Crazy Moon. Dir. Allan Eastman. Allegro Films, 1987. VHS. The Family Stone. Dir. Mike Bezucha. 20th Century Fox, 2005. DVD. Four Weddings and a Funeral. Dir. Mike Newell. Polygram Film Entertainment, 1994. DVD. Gas, Food, Lodging. Dir. Allison Anders. IRS Media, 1992. DVD. The Good Shepherd. Dir. Robert De Niro. Morgan Creek, TriBeCa Productions, American Zoetrope, 2006. DVD. Grand Canyon. Dir. Lawrence Kasdan, Meg Kasdan. 20th Century Fox, 1991. DVD. Hear No Evil. Dir. Robert Greenwald. 20th Century Fox, 1993. DVD. The Heart Is a Lonely Hunter. Dir. Robert Ellis Miller. Warner Brothers, 1968. DVD. Huck Finn. Stephen Sommers. Walt Disney Pictures, 1993. VHS. I Don’t Want to Talk about It. Dir. Maria Luisa Bemberg. Mojame Productions, 1994. DVD. Knowing. Dir. Alex Proyas. Escape Artists, 2009. DVD. Illtown. Dir. Nick Gomez. 1998. VHS. In the Company of Men. Dir. Neil LaBute. Alliance Atlantis Communications,1997. DVD. It’s a Wonderful Life. Dir. Frank Capra. RKO Pictures, 1947. DVD. Jerry Maguire. Dir. Cameron Crowe. TriSTar Pictures, 1996. DVD. Johnny Belinda. Dir. Jean Nagalesco. Warner Brothers Pictures, 1948. DVD. Kung Fu Hustle. Dir. Stephen Chow. Film Production Asia, 2004. DVD. Liar, Liar. Dir. Tom Shadyac. Universal Pictures, 1997. DVD. Looking for Mr. Goodbar. Dir. Richard Brooks. Paramount Miracle on 34th Street. Dir. Les Mayfield. 20th Century Fox, 1994. DVD. Mr. Holland’s Opus. Dir. Stephen Hereck. Hollywood Pictures, 1996. DVD Murder by Death. Dir. Robert Moore. Columbia Pictures, 1976. VHS. Nashville. Dir. Robert Altman. Paramount Pictures, 1975. DVD. One Flew over the Cuckoo’s Nest. Dir. Milos Forman. United Artists, 1975. DVD. The Perfect Circle. Dir. Ademir Kenovic. 1997. DVD. Psych Out. Dir. Richard Rush. American International Pictures, 1968. DVD. The Quiet. Dir. Jamie Babbit. Sony Pictures Classics, 2005. DVD. Ramblin’ Rose. Dir. Martha Coolidge. Carolco Pictures, 1991. DVD. Read My Lips. Dir. Jacques Audiard. Panthe Films, 2001. DVD. Requiem for a Dream. Dir. Darren Aronofsky. Artisan Entertainment, 2000. DVD. Ridicule. Dir. Patrice Laconte. Miramax Films, 1996. DVD. The River Wild. Dir. Curtis Hanson. Universal Pictures, 1995. DVD. See No Evil, Hear No Evil. Dir. Arthur Hiller. TriSTar Pictures,1989. DVD. The Shop on Main Street. Dir. Jan Kadar, Elmar Klos. Barrandov Film Studio, 1965. VHS. Stille Liebe. Dir. Christoph Schaub. T and C Film AG, 2001. DVD. Suspect. Dir. Peter Yates. Tri-Star Pictures, 1987. DVD. Sympathy for Mr. Vengeance. Dir. Park Chan-wook. CJ Entertainments, Tartan Films, 2002. DVD. There Will Be Blood. Dir. Paul Thomas Anderson. Paramount Vantage, Miramax Films, 2007. DVD. To Live. Dir. Zhang Yimou. Shanghai Film Studio and ERA International, 1994. DVD. What the Bleep Do We Know?. Dir. Willam Arntz, Betsy Chasse, Mark Vicente. Roadside Attractions, 2004. DVD.