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He was a legally licensed driver, working for Crete Carrier based in Lincoln, Nebraska. The driver had eight prior traffic violations, including speeding, driving with a suspended license and operating a mo to r vehicle in an unsafe condition. The parents of those two killed children are suing the driver and the trucking company. Approximately 10 months after the accident, the driver was charged with seven counts of vehicular homicide and seven counts of manslaughter by culpable negligence ( Simulations generally other organizations, federal involve lane tracking, maintaining a constant speed and reaction agencies and corporations con time, along with moni to ring brain waves for evidence of vened a national summit and ini momentary brief episodes of sleep (Moller et al. This finding may explain the observation that sleep combat the problems of fatigued related crashes frequently involve leaving the road or hitting driver impairment. When studied in driving simula to rs, the worst drivers among truckers are those who routinely got less than five hours of sleep per day (Pack et al. Recent studies have confirmed a 10 percent increase after driving 10 hours, and a 25 percent greater risk after driving 12 hours (Tucker 2000). One of the contentious aspects of the 2003 rules was the eleventh hour of driving. As an example of how difficult it is to identify precise limits for long work hours, two expert investiga to r groups (the Virginia Tech Transportation Institute and the Pennsylvania Transportation Institute) reached different and incompatible conclusions about the eleventh hour. The Pennsylvania team found that the eleventh hour of driving posed a significant crash risk, while the Virginia Tech investiga to rs could detect no statistical difference between the tenth and eleventh hours of driving. In other words, a 10 hour driving limit would cost more than $63 million per life saved. Sleep apnea is assessed in a sleep labora to ry by measuring breathing, airflow and brain waves while an individual sleeps (Figure 2. Due to this, the brain awakens, though the person might not be aware of their disturbed sleep. Mild to moderate sleep apnea is when these brief sleep interruptions occur 5 to 30 times an hour, while severe sleep apnea is when these interruptions occur more than 30 times an hour. The researchers also identified that for certain individuals, sleep apnea may have a multiplying effect on driver fatigue. They observed that the prevalence of sleep apnea depended on the average duration of sleep prior to the study.

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The University expects staff and students to treat each other with dignity and respect and will not to lerate discrimination based on gender identity. This might include: legal name change, preferred name, updating title, email update, advising their manager and colleagues, changes to hours of work, returning to work considerations, flexible working arrangements, special considerations, University counselling, support services and gender transition paid leave. As well as the need for emotional support, there are systems considerations, such as changing an email account name or the gender on student systems. A Student Gender Transition Plan can assist the conversation between a student and Student Adviser to identify the aspects a student would like assistance or advice. The plan sets out the actions agreed upon by both the student and their Student Adviser related to their study at Deakin. Page | 20 the Gender Transition Procedure provides information and sets out University processes for supporting staff and students undertaking a gender transition. Important: the Gender Transition Plan is designed to cover all areas of support and consideration for a transitioning student so all questions within the plan should be covered in the initial meeting. The student will not ask for a Gender Transition Plan, it is the responsibility of the Student Adviser to ask further questions of the student to make them aware of what Deakin offers to support transgender students. Some aspects may need to be case managed to avoid the student going from one Student Adviser to another repeating their personal s to ry. Academic considerations Academic extension Advise students who wish to seek an extension for an assignment that they will need to apply by email directly to their Unit Chair as soon as they are aware that they may have difficulty in meeting the scheduled deadline, and at least three days before the due date. An academic extension is for two weeks only; beyond this, advise them that they will require special consideration. Special consideration Advise the student that, if granted, special consideration will give them an opportunity either: fi to undertake an assessment task at another time or fi to take additional time to complete the assessment task Special consideration is used when a two week academic extension is not enough to meet academic requirements. They may be able to apply based on: medical grounds or based on hardship or trauma related to their social transition. Please remember to ask the student if they require assistance to : fi inform their student coordina to r (primary support person) of their decision to gender transition fi meet with their student coordina to r to discuss their gender transition needs and the impact of their gender transition on their studies fi contact professional and support services for additional guidance and support. Taking a break from study Make sure students are aware that they can apply for a break in their study. International students may apply for Leave of Absence for up to 10 days for travelling overseas for family emergencies or essential surgery. Updating gender, name and title details Updating gender details Current Deakin students: advise that they can update their gender by completing the online change of gender form.

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Beneficial local effect was 28% for radiation alone, and 46% for combined treatment. The control rate for radiation therapy alone was 41%, while that for combined treatment was 59%. The greatest Page 17 of 272 effect was observed in patients with recurrent lesions in previously irradiated lesions where further irradiation was limited to low doses (Vernon, 1996) 3. In addition, the study reports a statistically significant improvement in survival at five years and no increased to xicity from combined modality therapy (Valdagni, 1994) References: 1. Randomised trial of hyperthermia as adjuvant to radiotherapy for recurrent or metastatic malignant melanoma. Radiotherapy with or without hyperthermia in the treatment of superficial localized breast cancer: results from five randomized controlled trials. In the event no target is localized, blocking and patient set-up is accomplished through typical alignment of bony structures using portal imaging; appropriate coding for port films would apply. It may be necessary to check with the individual health plan directly before billing this code for this purpose. In the hospital-outpatient setting, G6017 is considered image guidance and is packaged in to the primary service payment. For all other purposes, this code is considered carrier-priced and may be accepted or refused by different health plans and Medicare contrac to rs. Radiation dose from cone beam computed to mography for image-guided radiation therapy. Clinical experience with image-guided radiotherapy in an accelerated partial breast intensity-modulated radiotherapy pro to col. Validating fiducial markers for image-guided radiation therapy for accelerated partial breast irradiation in early-stage breast cancer. Neutron beam radiotherapy is considered medically necessary for salivary gland cancers that are inoperable, recurrent, or are resected with gross residual disease or positive margins. Key Clinical Points Neutron beam radiotherapy differs from other forms of radiation particle treatment such as pro to ns or electrons as neutrons have no electrical charge.

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When requesting additional evaluation from a specialist, the specialist must understand the role and function of a driver; therefore, it is helpful if you include a copy of the Medical Examination Report form description of the driver role and a copy of the applicable medical standards (page 4) and guidelines with the request. Brain tumors may alter cognitive abilities and judgment, and these symp to ms may occur early in the course of the condition. Sensory and Page 157 of 260 mo to r abnormalities may be produced both by brain tumors and by spinal cord tumors, depending on the location. For some benign tumors, certification may be possible after successful surgical treatment. The length of time an individual is seizure free and off of anticonvulsant medication is considered the best predic to r of future risk for seizures. Page 158 of 260 Moni to ring/Testing Since meningiomas may be multiple, residual examinations must show no evidence of recurrent or new tumors. Evaluation should be performed by a neurologist or physiatrist who understands the functions and demands of commercial driving. Dementia Dementia is a progressive decline in mental functioning that can interfere with memory, language, spatial functions, higher order perceptual functions, problem solving, judgment, behavior, and emotional functions. Neither disease has a specific diagnostic test, with mild symp to ms typically present for years before the diagnosis is made. Static Neurological Conditions Static neurological conditions include common cerebrovascular disease, as well as head and spinal cord injuries. Drivers with several types of cerebrovascular disease are also at risk for recurring events that can happen without warning. Drivers with ischemic cerebrovascular disease are also at high risk for acute cardiac events, including myocardial infarction or sudden cardiac death. Head injury recommendations include complete physical examination, neurological examination, and neuropsychological testing with normal results and the use of the seizure guidelines to determine certification status. Any weakness should be evaluated to determine whether the deficit interferes with the job requirements of a commercial driver. Any driver with a neurological deficit that requires special evaluation and screening should have annual medical examinations.

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