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The parents attention may be drawn to a defect in hearing when the infant fails to heed loud noises, to turn the eyes to sound sources outside the immediate visual elds, and to react to music; but in other instances it is the delay in speaking that calls attention to it The deaf child makes the transition from crying to cooing and babbling at the usual age of 3 to 5 months After the sixth month, however, the child becomes much quieter, and the usual repertoire of babbling sounds becomes stereotyped and unchanging, though still uttered with pleasant voice A more conspicuous failure comes somewhat later, when babbling fails to give way to word formation Should deafness develop within the rst few years of life, the child gradually loses such speech as had been acquired but can be retaught by the lipreading method.

The administrator can also control the audit configuration for the objects protected by the realm We will demonstrate how to extend this profile to apply OLS policy objects protected by the realm Application maintenance administrator This administrator s privileges are limited to performing in the DDL category of commands on the application realm s objects The administrator is a participant in the application realm but the privileges do not allow for querying or manipulating data protected by the realm, controlling audit configuration for the objects protected in the realm, or granting of realm-protected roles or object privileges to realm-protected objects to other accounts or roles Application data manager (data steward) This administrator is a participant in the application realm and the privileges granted are limited to performing queries (read) and DML, or write, commands on the objects protected by the realm.

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Speech, however, is harsh, poorly modulated, and unpleasant and accompanied by many peculiar squeals and snorting or grunting noises Social and other acquisitions appear at the expected times in the congenitally deaf child, unlike the mentally retarded child The deaf child seems eager to communicate and makes known all his needs by gesture or pantomime often very cleverly The deaf child may attract attention by vivid facial expressions, motions of the lips, nodding, or head shaking The Leiter performance scale, which makes no use of sounds, will show that intelligence is normal Deafness can be demonstrated at an early age by careful observation of the child s responses to sounds and by free- eld audiometry, but the full range of hearing cannot be accurately tested before the age of 3 or 4 years.

Recording of auditory-evoked brainstem potentials and testing of the labyrinths, which are frequently unresponsive in deaf mutes, may be helpful Early diagnosis is important in order to t the child with a hearing aid, if possible, and to begin appropriate language training In contrast to the child in whom deafness is the only abnormality, the mentally retarded child generally talks little but may display a rich personality Autistic children may also be mute; if they speak, echolalia is prominent and the personal I is avoided Blind children of normal intelligence tend to speak slowly and fail to acquire imitative gestures..

comparison to epidural spinal abscess) and is only beginning to be recognized by MRI At times it stands as a single pyogenic metastasis, but more often there has been spread from a contiguous infected surgical site or a stulous connection with a super cial paraspinal abscess or a distant infection and subsequent bacteremia As stated, spinal epidural abscess and granuloma are the more important representatives of this group Sarcoid myelitis (see also page 613) Sarcoid granulomas may present as one or more intramedullary spinal cord masses, as in the cases reported by Levivier and colleagues In our experience the granulomatous lesion, which may be focal or multifocal, simulates demyelinative disease with respect to its tendency to relapse and remit and in its notable but inconsistent response to corticosteroids (page 614) An asymmetrical ascending paraparesis and bladder disturbance have been the main features in our patients.

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