1.
United States
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Forty-eight of the fifty states and the federal district are contiguous and located in North America between Canada and Mexico. The state of Alaska is in the northwest corner of North America, bordered by Canada to the east, the state of Hawaii is an archipelago in the mid-Pacific Ocean. The U. S. territories are scattered about the Pacific Ocean, the geography, climate and wildlife of the country are extremely diverse. At 3.8 million square miles and with over 324 million people, the United States is the worlds third- or fourth-largest country by area, third-largest by land area. It is one of the worlds most ethnically diverse and multicultural nations, paleo-Indians migrated from Asia to the North American mainland at least 15,000 years ago. European colonization began in the 16th century, the United States emerged from 13 British colonies along the East Coast. Numerous disputes between Great Britain and the following the Seven Years War led to the American Revolution. On July 4,1776, during the course of the American Revolutionary War, the war ended in 1783 with recognition of the independence of the United States by Great Britain, representing the first successful war of independence against a European power. The current constitution was adopted in 1788, after the Articles of Confederation, the first ten amendments, collectively named the Bill of Rights, were ratified in 1791 and designed to guarantee many fundamental civil liberties. During the second half of the 19th century, the American Civil War led to the end of slavery in the country. By the end of century, the United States extended into the Pacific Ocean. The Spanish–American War and World War I confirmed the status as a global military power. The end of the Cold War and the dissolution of the Soviet Union in 1991 left the United States as the sole superpower. The U. S. is a member of the United Nations, World Bank, International Monetary Fund, Organization of American States. The United States is a developed country, with the worlds largest economy by nominal GDP. It ranks highly in several measures of performance, including average wage, human development, per capita GDP. While the U. S. economy is considered post-industrial, characterized by the dominance of services and knowledge economy, the United States is a prominent political and cultural force internationally, and a leader in scientific research and technological innovations. In 1507, the German cartographer Martin Waldseemüller produced a map on which he named the lands of the Western Hemisphere America after the Italian explorer and cartographer Amerigo Vespucci
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Public health
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It is concerned with threats to health based on population health analysis. The population in question can be as small as a handful of people, Public health incorporates the interdisciplinary approaches of epidemiology, biostatistics and health services. Environmental health, community health, behavioral health, health economics, public policy, mental health and occupational safety, the focus of public health intervention is to improve health and quality of life through prevention and treatment of disease and other physical and mental health conditions. This is done through surveillance of cases and health indicators, there is a great disparity in access to health care and public health initiatives between developed nations and developing nations. In the developing world, public health infrastructures are still forming, many diseases are preventable through simple, nonmedical methods. For example, research has shown that the act of hand washing with soap can prevent many contagious diseases. Public health communications programs, vaccination programs and distribution of condoms are examples of public health measures. Measures such as these have contributed greatly to the health of populations, Public health plays an important role in disease prevention efforts in both the developing world and in developed countries, through local health systems and non-governmental organizations. The World Health Organization is the agency that coordinates and acts on global public health issues. Most countries have their own government public health agencies, sometimes known as ministries of health, for example, in the United States, the front line of public health initiatives are state and local health departments. In Canada, the Public Health Agency of Canada is the agency responsible for public health, emergency preparedness and response. The Public health system in India is managed by the Ministry of Health & Family Welfare of the government of India with state-owned health care facilities. Public health programs providing vaccinations have made strides in promoting health, including the eradication of smallpox, antibiotic resistance, also known as drug resistance, was the theme of World Health Day 2011. Although the prioritization of pressing public health issues is important, Laurie Garrett argues that there are following consequences, when foreign aid is funnelled into disease-specific programs, the importance of public health in general is disregarded. This public health problem of stovepiping is thought to create a lack of funds to other existing diseases in a given country. For example, the WHO reports that at least 220 million people suffer from diabetes. Its incidence is increasing rapidly, and it is projected that the number of diabetes deaths will double by the year 2030, the risk of type 2 diabetes is closely linked with the growing problem of obesity. The WHO’s latest estimates highlighted that globally approximately 1.5 billion adults were overweight in 2008, the United States is the leading country with 30. 6% of its population being obese
3.
Emergency department
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The emergency department is usually found in a hospital or other primary care center. In some countries, emergency departments have become important entry points for those without means of access to medical care. The emergency departments of most hospitals operate 24 hours a day, griswold also equipped police and fire vehicles with medical supplies and trained officers to give emergency care while en route to the hospital. Today, a hospital has its emergency department in its own section of the ground floor of the grounds. As patients can present at any time and with any complaint, triage is normally the first stage the patient passes through, and consists of a brief assessment, including a set of vital signs, and the assignment of a chief complaint. Most emergency departments have an area for this process to take place. Most patients will be assessed at triage and then passed to another area of the department, or another area of the hospital. Conversely, patients with serious conditions, such as cardiac arrest, will bypass triage altogether. The resuscitation area, commonly referred to as Trauma or Resus, is a key area in most departments, the most seriously ill or injured patients will be dealt with in this area, as it contains the equipment and staff required for dealing with immediately life-threatening illnesses and injuries. Typical resuscitation staffing involves at least one attending physician, and at least one and these personnel may be assigned to the resuscitation area for the entirety of the shift, or may be on call for resuscitation coverage. Examples of majors include chest pain, difficulty breathing, abdominal pain, Advanced diagnostic testing may be conducted at this stage, including laboratory testing of blood and/or urine, ultrasonography, CT or MRI scanning. Medications appropriate to manage the condition will also be given. Depending on underlying causes of the chief complaint, he or she may be discharged home from this area or admitted to the hospital for further treatment. Patients whose condition is not immediately life-threatening will be sent to an area suitable to deal with them, such patients may still have been found to have significant problems, including fractures, dislocations, and lacerations requiring suturing. Children can present particular challenges in treatment, many hospitals have a separate area for evaluation of psychiatric problems. These are often staffed by psychiatrists and mental health nurses and social workers, there is typically at least one room for people who are actively a risk to themselves or others. Fast decisions on life-and-death cases are critical in emergency rooms. As a result, doctors face great pressures to overtest and overtreat, other common variations include emergency ward, emergency centre or emergency unit
4.
Triage
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Triage is the process of determining the priority of patients treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately, the term comes from the French verb trier, meaning to separate, sift or select. Triage may result in determining the order and priority of emergency treatment, Triage may also be used for patients arriving at the emergency department, or telephoning medical advice systems, among others. This article deals with the concept of triage as it occurs in medical emergencies, including the setting, disasters. The term triage may have originated during the Napoleonic Wars from the work of Dominique Jean Larrey, the term was used further during World War I by French doctors treating the battlefield wounded at the aid stations behind the front. For many emergency medical systems, a similar model may sometimes still be applied. In the earliest stages of an incident, such as one or two paramedics exist to twenty or more patients, practicality demands that the above, more primitive model will be used. However once a full response has occurred and many hands are available, paramedics will usually use the model included in their service policy, as medical technology has advanced, so have modern approaches to triage, which are increasingly based on scientific models. The categorizations of the victims are frequently the result of triage scores based on specific physiological assessment findings, some models, such as the START model may be algorithm-based. As triage concepts become more sophisticated, triage guidance is also evolving into both software and hardware decision support products for use by caregivers in both hospitals and the field and this section is for concepts in triage. This step can be started before transportation becomes available, at its most primitive, patients may be simply marked with coloured flagging tape or with marker pens. Pre-printed cards for this purpose are known as a triage tags, a triage tag is a prefabricated label placed on each patient that serves to accomplish several objectives, identify the patient. Identify the priority of the patients need for treatment and transport from the emergency scene. Track the patients progress through the triage process, identify additional hazards such as contamination. Triage tags may take a variety of forms, some countries use a nationally standardized triage tag, while in other countries commercially available triage tags are used, and these will vary by jurisdictional choice. The most commonly used commercial systems include the METTAG, the SMARTTAG, E/T LIGHT tm, some of these tracking systems are beginning to incorporate the use of handheld computers, and in some cases, bar code scanners. For classifications, see the section for that topic. In advanced triage, doctors and specially trained nurses may decide that some seriously injured people should not receive advanced care because they are unlikely to survive
5.
Emergency medical services
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This is most likely an emergency department at a hospital. In such services, the EMS is not summoned by members of the public, in some jurisdictions, EMS units may handle technical rescue operations such as extrication, water rescue, and search and rescue. Training and qualification levels for members and employees of emergency medical services vary widely throughout the world, in some systems, members may be present who are qualified only to drive ambulances, with no medical training. In contrast, most systems have personnel who retain at least basic first aid certifications, additionally many EMS systems are staffed with Advanced Life Support personnel, including paramedics, nurses, or, less commonly, physicians. Emergency care in the field has been rendered in different forms since the beginning of recorded history, the New Testament contains the parable of the Good Samaritan, where a man who was beaten is cared for by a Samaritan. Luke 10,34 - He went to him and bandaged his wounds, pouring on oil, then he put the man on his own donkey, took him to an inn and took care of him. Also during the Middle Ages, the Knights Hospitaller were known for rendering assistance to wounded soldiers in the battlefield, the first use of the ambulance as a specialized vehicle, in battle came about with the ambulances volantes designed by Dominique Jean Larrey, Napoleon Bonapartes chief surgeon. Larreys projects for flying ambulances were first approved by the Committee of Public Safety in 1794, in civilian ambulances, a major advance was made with the introduction of a transport carriage for cholera patients in London during 1832. This tenet of ambulances providing instant care, allowing hospitals to be spaced further apart, the first known hospital-based ambulance service operated out of Commercial Hospital, Cincinnati, Ohio by 1865. In June 1887 the St John Ambulance Brigade was established to provide first aid and it was modelled on a military-style command and discipline structure. Named the Vienna Voluntary Rescue Society, it served as a model for similar societies worldwide and this was followed in 1900 by New York City, who extolled its virtues of greater speed, more safety for the patient, faster stopping and a smoother ride. These first two ambulances were electrically powered with 2 hp motors on the rear axle. Canadian historians dispute this with the city of Toronto claiming The first formal training for ambulance attendants was conducted in 1892, two-way radios became available shortly after World War I, enabling for more efficient radio dispatch of ambulances in some areas. Prior to World War II, there were areas where a modern ambulance carried advanced medical equipment, was staffed by a physician. In many locations, however, ambulances were hearses - the only vehicle that could carry a recumbent patient - and were thus frequently run by funeral homes. These vehicles, which could serve either purpose, were known as combination cars, prior to World War II, hospitals provided ambulance service in many large cities. With the severe manpower shortages imposed by the war effort, it became difficult for many hospitals to maintain their ambulance operations, City governments in many cases turned ambulance services over to the police or fire department. No laws required minimal training for personnel and no training programs existed beyond basic first aid
6.
Chemical weapon
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A chemical weapon is a specialized munition that uses chemicals formulated to inflict death or harm on humans. Munitions or other devices designed to deliver chemical weapons, whether filled or unfilled, are also considered weapons themselves. Chemical weapons are classified as weapons of destruction, though they are distinct from nuclear weapons, biological weapons. All may be used in warfare and are known by the military acronym NBC, Weapons of mass destruction are distinct from conventional weapons, which are primarily effective due to their explosive, kinetic, or incendiary potential. Chemical weapons can be dispersed in gas, liquid and solid forms. Nerve gas, tear gas and pepper spray are three examples of CW. Lethal, unitary, chemical agents and munitions are extremely volatile, unitary agents are effective on their own and do not require mixing with other agents. The most dangerous of these are agents, GA, GB, GD, and VX as well as vesicant agents, which are formulations of sulfur mustard such as H, HT. They all are liquids at room temperature, but become gaseous when released. Widely used during the First World War, the effects of so-called mustard gas, phosgene gas and others caused lung searing, blindness, death and maiming. As of 2016, CS gas and pepper spray remain in use for policing and riot control, while CS is considered a non-lethal weapon. Under the Chemical Weapons Convention, there is a binding, worldwide ban on the production, stockpiling. Notwithstanding, large stockpiles of CW continue to exist, usually justified as a precaution against putative use by an aggressor. A separate declaration stated that in any war between signatory powers, the parties would abstain from using projectiles the object of which is the diffusion of asphyxiating or deleterious gases. The Washington Naval Treaty, signed February 6,1922, also known as the Five-Power Treaty, aimed at banning CW, the subsequent failure to include CW has contributed to the resultant increase in stockpiles. It was signed at Geneva June 17,1925, and entered force on February 8,1928. 133 nations are listed as state parties to the treaty, ukraine is the newest signatory, acceding August 7,2003. This treaty states that chemical and biological weapons are justly condemned by the opinion of the civilised world
7.
Food and Drug Administration
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The Food and Drug Administration is a federal agency of the United States Department of Health and Human Services, one of the United States federal executive departments. As of 2017, 3/4th of the FDA budget is funded by the pharmaceutical companies due to the Prescription drug user fee act and these include regulating lasers, cellular phones, condoms and control of disease on products ranging from certain household pets to sperm donation for assisted reproduction. The FDA is led by the Commissioner of Food and Drugs, appointed by the President with the advice, the Commissioner reports to the Secretary of Health and Human Services. Dr. Robert M. Califf, MD is the current commissioner, who took over in February 2016 for Dr. Stephen Ostroff, the FDA has its headquarters in unincorporated White Oak, Maryland. The agency also has 223 field offices and 13 laboratories located throughout the 50 states, the United States Virgin Islands, in 2008, the FDA began to post employees to foreign countries, including China, India, Costa Rica, Chile, Belgium, and the United Kingdom. The site was renamed from the White Oak Naval Surface Warfare Center to the Federal Research Center at White Oak, the first building, the Life Sciences Laboratory, was dedicated and opened with 104 employees on the campus in December 2003. Only one original building from the facility was kept. All other buildings are new construction, the project is slated to be completed by 2017, assuming future Congressional funding While most of the Centers are located in the Washington, D. C. The Office of Regulatory Affairs is considered the eyes and ears of the agency, the Office of Regulatory Affairs is divided into five regions, which are further divided into 20 districts. Districts are based roughly on the divisions of the federal court system. Each district comprises a main office and a number of Resident Posts. ORA also includes the Agencys network of laboratories, which analyze any physical samples taken. Though samples are usually food-related, some laboratories are equipped to analyze drugs, cosmetics, the Office of Criminal Investigations was established in 1991 to investigate criminal cases. Unlike ORA Investigators, OCI Special Agents are armed, and dont focus on aspects of the regulated industries. In many cases, OCI pursues cases involving Title 18 violations, OCI Special Agents often come from other criminal investigations backgrounds, and work closely with the Federal Bureau of Investigation, Assistant Attorney General, and even Interpol. OCI receives cases from a variety of sources—including ORA, local agencies, OCI is a smaller branch, comprising about 200 agents nationwide. The FDA frequently works with federal agencies, including the Department of Agriculture, Drug Enforcement Administration, Customs and Border Protection. Often local and state government agencies also work with the FDA to provide regulatory inspections, the FDA regulates more than US$1 trillion worth of consumer goods, about 25% of consumer expenditures in the United States
8.
United States Environmental Protection Agency
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The EPA was proposed by President Richard Nixon and began operation on December 2,1970, after Nixon signed an executive order. The order establishing the EPA was ratified by committee hearings in the House, the agency is led by its Administrator, who is appointed by the president and approved by Congress. The current administrator is Scott Pruitt, the EPA is not a Cabinet department, but the administrator is normally given cabinet rank. The EPA has its headquarters in Washington, D. C. regional offices for each of the ten regions. The agency conducts environmental assessment, research, and education and it has the responsibility of maintaining and enforcing national standards under a variety of environmental laws, in consultation with state, tribal, and local governments. It delegates some permitting, monitoring, and enforcement responsibility to U. S. states, EPA enforcement powers include fines, sanctions, and other measures. The agency also works with industries and all levels of government in a variety of voluntary pollution prevention programs. In 2016, the agency had 15,376 full-time employees, more than half of EPAs employees are engineers, scientists, and environmental protection specialists, other employees include legal, public affairs, financial, and information technologists. Beginning in the late 1950s and through the 1960s, Congress reacted to increasing concern about the impact that human activity could have on the environment. Senator James E. Murray introduced a bill, the Resources and Conservation Act of 1959, the 1962 publication of Silent Spring by Rachel Carson alerted the public about the detrimental effects on the environment of the indiscriminate use of pesticides. In the years following, similar bills were introduced and hearings were held to discuss the state of the environment, in the colloquium, some members of Congress expressed a continuing concern over federal agency actions affecting the environment. The National Environmental Policy Act of 1969 was modeled on RCA, President Nixon signed NEPA into law on January 1,1970. The law created the Council on Environmental Quality in the Executive Office of the President, NEPA required that a detailed statement of environmental impacts be prepared for all major federal actions significantly affecting the environment. The detailed statement would ultimately be referred to as an impact statement. On July 9,1970, Nixon proposed a reorganization that consolidated many environmental responsibilities of the federal government under one agency. After conducting hearings during that summer, the House and Senate approved the proposal, the agency’s first administrator, William Ruckelshaus, took the oath of office on December 4,1970. In May 2013, Congress renamed the EPA headquarters as the William Jefferson Clinton Federal Building, the EPA is led by an Administrator of the Environmental Protection Agency. As of 2017 Scott Pruitt is the 14th administrator, each EPA regional office is responsible within its states for implementing the Agencys programs, except those programs that have been specifically delegated to states
9.
Drug Enforcement Administration
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The Drug Enforcement Administration is a United States federal law enforcement agency under the U. S. Department of Justice, tasked with combating drug smuggling and use within the United States. S. It has sole responsibility for coordinating and pursuing U. S. drug investigations both domestic, and abroad, the Drug Enforcement Administration was established on July 1,1973, by Reorganization Plan No.2 of 1973, signed by President Richard Nixon on July 28. It proposed the creation of a federal agency to enforce the federal drug laws as well as consolidate and coordinate the governments drug control activities. Congress accepted the proposal, as they were concerned with the availability of drugs. From the early 1970s, DEA headquarters was located at 1405 I Street NW in downtown Washington, however, then–Attorney General Edwin Meese determined that the headquarters had to be located in close proximity to the Attorney Generals office. Thus, in 1989, the relocated to 600–700 Army-Navy Drive in the Pentagon City area of Arlington, Virginia. On April 19,1995, Timothy McVeigh attacked the Alfred P, security measures include hydraulic steel roadplates to enforce standoff distance from the building, metal detectors, and guard stations. In February 2003, the DEA established a Digital Evidence Laboratory within its Office of Forensic Sciences, the DEA is headed by an Administrator of Drug Enforcement appointed by the President of the United States and confirmed by the U. S. Senate. The Administrator reports to the Attorney General through the Deputy Attorney General, the Administrator is assisted by a Deputy Administrator, the Chief of Operations, the Chief Inspector, and three Assistant Administrators. Other senior staff include the financial officer and the Chief Counsel. The Administrator and Deputy Administrator are the only presidentially-appointed personnel in the DEA, DEAs headquarters is located in Arlington, Virginia across from the Pentagon. It maintains its own DEA Academy located on the United States Marine Corps base at Quantico and it maintains 21 domestic field divisions with 227 field offices and 86 foreign offices in 62 countries. With a budget exceeding 2 billion dollars, DEA employs over 10,800 people, becoming a Special Agent or Intelligence Analyst with the DEA is a competitive process. DEA agents starting salary is $49, 746–$55,483, after four years working as an agent, the salary jumps to above $92,592. Upon graduation, recruits earn themselves the title of DEA Special Agent, the DEA excludes from consideration job-applicants who have a history of any use of narcotics or illicit drugs. Investigation usually includes a polygraph test for special-agent, diversion-investigator, exceptions to this policy may be made for applicants who admit to limited youthful and experimental use of marijuana. The DEAs relatively firm stance on this issue contrasts with that of the Federal Bureau of Investigation, the DEA Aviation Division or Office of Aviation Operations is an airborne division based in Fort Worth Alliance Airport, Texas. The current OA fleet consists of 106 aircraft and 124 DEA pilots, rapid Response Teams was decommissioned by DEA Administrator Chuck Rosenburg on March 2017 via memorandum
10.
Centers for Disease Control and Prevention
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The Centers for Disease Control and Prevention is the leading national public health institute of the United States. The CDC is a United States federal agency under the Department of Health and Human Services, headquartered near Atlanta and its main goal is to protect public health and safety through the control and prevention of disease, injury, and disability in the US and internationally. The CDC focuses national attention on developing and applying disease control, the Communicable Disease Center was founded July 1,1946, as the successor to the World War II Malaria Control in War Areas program of the Office of National Defense Malaria Control Activities. Preceding its founding, organizations with global influence in malaria control were the Malaria Commission of the League of Nations, the Rockefeller Foundation greatly supported malaria control, sought to have the governments take over some of its efforts, and collaborated with the agency. The new agency was a branch of the U. S, Public Health Service and Atlanta was chosen as the location because malaria was endemic in the Southern United States. The agency changed names before adopting the name Communicable Disease Center in 1946, Offices were located on the sixth floor of the Volunteer Building on Peachtree Street. Among its 369 employees, the jobs at CDC were originally entomology. In CDCs initial years, more than six and a million homes were sprayed. In 1946, there were only seven officers on duty. Under Joseph Walter Mountin, the CDC continued to advocate for health issues. In 1947, the CDC made a payment of $10 to Emory University for 15 acres of land on Clifton Road in DeKalb County. CDC employees collected the money to make the purchase, the benefactor behind the “gift” was Robert W. Woodruff, chairman of the board of The Coca-Cola Company. Woodruff had a long-time interest in control, which had been a problem in areas where he went hunting. The same year, the PHS transferred its San Francisco based plague laboratory into the CDC as the Epidemiology Division, the mission of CDC expanded beyond its original focus on malaria to include sexually transmitted diseases when the Venereal Disease Division of the U. S. Public Health Service was transferred to the CDC in 1957, shortly thereafter, Tuberculosis Control was transferred to the CDC from PHS, and then in 1963 the Immunization program was established. It became the National Communicable Disease Center effective July 1,1967, the organization was renamed the Center for Disease Control on June 24,1970, and Centers for Disease Control effective October 14,1980. An act of the United States Congress appended the words and Prevention to the name effective October 27,1992, however, Congress directed that the initialism CDC be retained because of its name recognition. Currently the CDC focus has broadened to include chronic diseases, disabilities, injury control, workplace hazards, environmental health threats, and terrorism preparedness
11.
Database
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A database is a well organized collection of data. It is the collection of schemas, tables, queries, reports, views, a database management system is a computer software application that interacts with the user, other applications, and the database itself to capture and analyze data. A general-purpose DBMS is designed to allow the definition, creation, querying, update, well-known DBMSs include MySQL, PostgreSQL, MongoDB, MariaDB, Microsoft SQL Server, Oracle, Sybase, SAP HANA, MemSQL and IBM DB2. Sometimes a DBMS is loosely referred to as a database, formally, a database refers to a set of related data and the way it is organized. The DBMS provides various functions that allow entry, storage and retrieval of large quantities of information, because of the close relationship between them, the term database is often used casually to refer to both a database and the DBMS used to manipulate it. Outside the world of information technology, the term database is often used to refer to any collection of related data. This article is concerned only with databases where the size and usage requirements necessitate use of a management system. Update – Insertion, modification, and deletion of the actual data, retrieval – Providing information in a form directly usable or for further processing by other applications. The retrieved data may be available in a form basically the same as it is stored in the database or in a new form obtained by altering or combining existing data from the database. Both a database and its DBMS conform to the principles of a database model. Database system refers collectively to the model, database management system. Physically, database servers are dedicated computers that hold the actual databases and run only the DBMS, Database servers are usually multiprocessor computers, with generous memory and RAID disk arrays used for stable storage. RAID is used for recovery of data if any of the disks fail, hardware database accelerators, connected to one or more servers via a high-speed channel, are also used in large volume transaction processing environments. DBMSs are found at the heart of most database applications, DBMSs may be built around a custom multitasking kernel with built-in networking support, but modern DBMSs typically rely on a standard operating system to provide these functions. Since DBMSs comprise a significant market, computer and storage vendors often take into account DBMS requirements in their own development plans, databases are used to support internal operations of organizations and to underpin online interactions with customers and suppliers. Databases are used to hold information and more specialized data. A DBMS has evolved into a software system and its development typically requires thousands of human years of development effort. Some general-purpose DBMSs such as Adabas, Oracle and DB2 have been undergoing upgrades since the 1970s, general-purpose DBMSs aim to meet the needs of as many applications as possible, which adds to the complexity
12.
Telecommunications device for the deaf
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A telecommunications device for the deaf is a teleprinter, an electronic device for text communication over a telephone line, that is designed for use by persons with hearing or speech difficulties. Other names for the device include teletypewriter, textphone, and minicom, the typical TDD is a device about the size of a typewriter or laptop computer with a QWERTY keyboard and small screen that uses an LED, LCD, or VFD screen to display typed text electronically. In addition, TDDs commonly have a spool of paper on which text is also printed – old versions of the device had only a printer. The text is transmitted live, via a line, to a compatible device. Special telephone services have developed to carry the TDD functionality even further. In certain countries there are systems in place so that a person can communicate with a hearing person on an ordinary voice phone using a human relay operator. There are also services, enabling people who can hear but cannot speak. The term TDD is sometimes discouraged because people who are deaf are increasingly using mainstream devices and technologies to carry out most of their communication, the devices described here were developed for use on the partially-analog Public Switched Telephone Network. They do not work well on the new internet protocol networks, thus as society increasingly moves toward IP based telecommunication, the telecommunication devices used by people who are deaf will not be TDDs. In the US for example, the use of the term TDD is discouraged to avoid confusion with these devices being referred to as TTYs. Furthermore, these were referred to by the TTY initialism. When computers had keyboard input mechanisms and page printer output, before CRT terminals came into use, the TDD concept was developed by James C. Marsters, a dentist and private pilot who became deaf as an infant because of scarlet fever, and Robert Weitbrecht. APCOM collected old teleprinter machines from the Department of Defense and junkyards, the entire configuration of teleprinter machine, acoustic coupler, and telephone set became known as the TTY. Weitbrecht invented the acoustic coupler modem in 1964, the actual mechanism for TTY communications was accomplished electro-mechanically through frequency shift keying allowing only half-duplex communication, where only one person at a time can transmit. During the late 1960s, Paul Taylor combined Western Union Teletype machines with modems to create teletypewriters and he distributed these early, non-portable devices to the homes of many in the deaf community in St. Louis, Missouri. He worked with others to establish a local telephone wake-up service, in the early 1970s, these small successes in St. Louis evolved into the nation’s first local telephone relay system for the deaf. The battery-powered MCM was invented and designed by a news anchor and interpreter, Kit Patrick Corson, in conjunction with Michael Cannon
