The LAX shootings, as they happened

posted on 16 Sep 2015 19:07 by astonishingwate40
(CBS) LAX shooting suspect in Friday's rampage, Paul Ciancia, arrived at the airport driven by a friend in a Black Hyundai. Ciancia walked into the departure level of terminal 3, looking like any other passenger, pulling a "roller board" suitcase with a backpack riding on top of it. The rolling suitcase and the backpack had been carefully modified. A hole in the top of the suitcase and the bottom of the backpack so that the assault weapon could stand up inside the two bags.

Law enforcement sources say Ciancia then pulled the backpack off the top, lifted the .223-caliber assault rifle up through the hole in the suitcase and shot TSA Officer Gerardo Hernandez.


Hernandez, a TSA Behavioral Detection Officer, was specially trained to observe suspicious behavioral traits among passengers. He was assigned to check documents and boarding passes at the bottom of the escalator that leads up to the TSA checkpoint.

A law enforcement source told CBS News that after shooting Hernandez, Ciancia headed toward the escalator, but saw Hernandez was still moving, so he doubled back and shot him again, killing him.

The new details of the attack emerged from law enforcement sources who have seen or been briefed on statements made by witnesses and the review of images from dozens of airport security cameras that captured various parts of the shootings.

After the first shots, on the ticket counter level, panicked passengers scattered while just upstairs, at the top of the escalator, Ciancia arrived at the TSA checkpoint to find that the TSA officers and passengers had all fled, after hearing the shots fired on the lower level. A lone female passenger stood frozen as Ciancia walked by, ignoring her.

By then, a call had gone out over the Airport Police radio frequency: "SHOTS FIRED, SHOTS FIRED, SHOTS FIRED, TERMINAL THREE." Every available officer began to converge on the scene.

On the upper level, Ciancia walked around the outside of the checkpoint, entering the sterile area behind security by walking down the exit lane reserved for deplaning passengers. He headed down the concourse and, according to law enforcement sources, appeared to be "hunting" TSA Officers.

Investigators told CBS News that some of the passengers wounded may have been hit by rounds Ciancia fired while aiming at TSA officers, easily spotted at a distance in their bright blue uniform shirts.

Los Angeles World Airport Authority (LAWA) police officers arrived on the scene within seconds of the radio call and formed a four officer "contact team" to go after the suspect.

A law enforcement source said within about a minute from the time the call went out, the officers had engaged Ciancia on the concourse and fired, hitting him four times.

As they handcuffed the wounded gunman, the officers asked if he was alone, or if there were others with him. According to law enforcement sources, Ciancia told the officers he acted alone.

When asked where his car was, he told the officers he had been dropped off by a friend. On Saturday, the FBI questioned the friend, reportedly one of Ciancia's roommates, who admitted dropping Ciancia at the airport, but denied any knowledge of his plan, or that he had a weapon concealed in his two bags. The FBI investigation into the man's account is continuing.

Just three and a half weeks earlier, the officers involved in the shooting and capture of Ciancia had been part of a massive "active shooter" training exercise at an empty terminal at the LAWA airport in Ontario, California. The scenario involved multiple gunman who shot their way past a TSA Screening Checkpoint and ran down the terminal intending to hijack an aircraft loaded with passengers. The goal of the drill was to get officers to quickly form small "contact teams" and go after the gunmen. The training is a sea change in decades of law enforcement protocols that called for containing the gunmen within a perimeter while waiting for SWAT teams to arrive. The new procedures, born out of a rash of shootings in public places by emotionally disturbed people with assault weapons takes into account the "hunting behavior" of these shooters, who will continue to seek out victims rather than attempt to hide or flee.

Since Friday's shooting, questions have been raised by the union representing the airport police about a change in procedures taken by the LAWA Police Department several months ago.

Since 9/11, the Los Angeles airports have had an officer stationed behind every TSA screening checkpoint in the airport. When Chief Patrick Gannon took over the airport police a year ago, he revised how police patrol at LAX. Gannon's thinking, according to people who were briefed on it, was that the security posture at LAX had become too stagnant and predictable.

The police, working from "fixed posts" just beyond the security checkpoints, stood at podiums or sat in kiosks. Gannon felt it made the locations of the officers predictable to anyone planning an attack, and limited the amount of ground they could cover. A study of attacks at LAX and other airports supported the idea that the major threats have occurred in front of the security checkpoints, rather than beyond them.

In 2000, an al Qaeda plot to blow up a terminal at LAX was uncovered with the arrest at the Canadian border of Ahmed Ressam. Ressam would later tell the FBI that he'd planned to leave bombs hidden in suitcases inside an LAX terminal by the ticket counter on New Year's Day. When Hesham Mohamed Hadayet, a 41-year-old Egyptian limo driver opened fire at the El Al ticket counter on July 4, 2002, it was also in the entrance of the Tom Bradley International T Terminal, before the security checkpoints. Based in part on that history, the LAX police brass wanted the officers to have more flexibility to move through the terminals to increase visibility and increase the likelihood that they would be nearby if an incident began to unfold.

While Friday's incident -- where a gunman targeted TSA employees at a checkpoint will raise questions as to whether police would return to their "fixed posts" at the checkpoints -- one law enforcement official pointed out that the shooting of the first TSA Officer took place on the main floor of the terminal, opposite the ticket counters, and before he proceeded upstairs to the checkpoint.

"The fact that from the time the call went out, until the officers encountered the suspect was just about a minute, argues that the system worked", said one law enforcement official involved in the investigation. "But you're going to get second-guessed after one of these things no matter what you do. It comes with the territory."

Holes cut in a rolling suitcase and in a backpack placed on top created a tunnel in which the LAX shooter hid his .223-caliber assault rifle.

CBS News

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Mitral Valve Surgery In India At Mumbai And Delhi At Low Cost.

posted on 14 Sep 2015 18:06 by astonishingwate40
Mitral Valve Disease Repair and Replacement in India

What Is Mitral Valve Disease

Heart Specialists at We Care partner hospitals in India are among the most experienced in the country in treating mitral valve disease, evaluating thousands of patients each year. Patients benefit from our partner hospitals state-of-the-art facilities, leading-edge medical treatment, and access to clinical trials and new treatments for the disease.

Heart surgeons in India are renowned for their experience and expertise in repairing and replacement of mitral heart valves. In some cases, surgery can be done with minimally invasive techniques, including robot-assisted surgery, that can result in significantly less pain and recovery time for patients.

Mitral Valve Stenosis

Mitral valve stenosis, (mitral stenosis) is a narrowing of the mitral valve. With narrowing, the valve does not open properly and obstructs blood flow between the left chambers of the heart.

Mitral Valve Replacement Surgery, Mitral Valve Repair India

[ Mitral Valve Stenosis ]

If not treated, mitral stenosis can weaken the heart, lead to heart failure or heart enlargement, and cause irregular heartbeats. Other potentially serious complications can include stroke, heart infection, pulmonary edema (water on the lungs) and blood clots

Within a few days, a team of heart valve disease specialists at from We Care coordinates the patient's care to provide a complete examination, diagnosis and extensive patient education. These specialists see patients ranging from those who might want to have a heart murmur checked, to those who have been told they have advanced mitral heart valve disease.

If surgery is indicated, a cardiac surgeon meets with the patient to thoroughly discuss surgical options and, in most cases, can perform the surgery the following day - depending on the patient's preference.

Symptoms of Mitral Valve Stenosis : -

Signs and symptoms of mitral stenosis depend on how severely and quickly the condition develops. Some people never develop symptoms

Some have mild problems that suddenly get worse. Signs and symptoms of mitral stenosis include : -

Shortness of breath, especially with physical exertion (exercise) or when the person lies down

Fatigue, especially during increased activity

Swollen feet or ankles

Heart palpitations - sensations of a rapid, fluttering heartbeat

Dizziness or fainting spells

Frequent respiratory infections, such as bronchitis

Heavy coughing, sometimes with blood-tinged sputum

Rarely, chest discomfort or chest pain

Causes of Mitral Valve Stenosis : -

The mitral valve can narrow because of conditions that include : -

Rheumatic fever : - In some people, the body's response to the strep throat infection leads to mitral valve damage that causes the valve to become inflamed, thicken, and leak (mitral regurgitation). This inflammatory process can cause the valve to fuse and harden, resulting in mitral stenosis. People who have had rheumatic fever may have both mitral stenosis and mitral regurgitation.

Congenital heart defect : - Some infants are born with a narrowed mitral valve and develop mitral stenosis early in life. Babies born with this problem usually require heart surgery to fix the valve. Others are born with a malformed mitral valve and have a risk of developing mitral stenosis when they're older.

Mitral Valve Regurgitation

Mitral valve regurgitation, or mitral regurgitation, occurs when the mitral valve doesn't close tightly and blood flows backward in the heart. Mitral regurgitation from mitral valve prolapse is the most common reason for surgical treatment. If not treated, mitral valve regurgitation can lead to congestive heart failure. Treatment depends on the severity of regurgitation, how far mitral valve disease has progressed, and signs and symptoms of the disease.

Symptoms of Mitral Valve Regurgitation

Signs and symptoms of mitral regurgitation depend on how severely and quickly the condition develops. Most often, mitral regurgitation is mild, and severe mitral regurgitation develops slowly. If no symptoms develop for decades, the patient may not know the condition is present.

Signs and symptoms can develop gradually because, for some time, the heart can compensate for the defect. The first notable sign is usually an abnormal sound, or heart murmur. Sometimes, however, the disorder develops quickly, and the patient may experience the abrupt onset of more severe signs and symptoms.

Indicators of mitral regurgitation include : -

Shortness of breath, especially with physical exertion or when the person lies down

Fatigue, especially during increased activity

Cough, especially at night or when lying down

Awakening at night with shortness of breath

Heart palpitations - sensations of a rapid, fluttering heartbeat

Swollen feet or ankles

Causes of Mitral Valve Regurgitation

Any condition that damages the mitral valve can cause regurgitation, including : -

Mitral valve prolapse

Mitral regurgitation from mitral valve prolapse is the most common reason for surgical treatment. Mitral valve prolapse occurs when the leaflets and supporting cords of the mitral valve have excess tissue, and they weaken. With each contraction of the left ventricle, the valve leaflets bulge (prolapse) into the left atrium. This common heart defect may prevent the mitral valve from closing tightly and lead to regurgitation. Mitral valve prolapse is common. Many who have it never develop severe regurgitation.

Damaged cords

Mitral regurgitation may result from damage to the cords that anchor the flaps of the mitral valve to the heart wall. Over time, these cords may stretch or suddenly tear, especially in people who have mitral valve prolapse. A sudden tear can cause substantial leakage through the mitral valve. Repair may involve emergency heart surgery.

Deterioration of the valve with age

The mitral valve opens and shuts tens of thousands of times a day. Age-related wear and tear on the valve can lead to mitral regurgitation. Our partner hospitals have extensive experience in successfully treating elderly patients who have mitral regurgitation.

Prior heart attack

A heart attack can damage the area of the heart muscle that supports the mitral valve, affecting the function of the valve. If the damage is extensive enough, a heart attack may result in sudden and severe mitral regurgitation.


The mitral valve can be damaged by endocarditis - an infection inside the heart that can involve the heart valves. Read more about endocarditis prevention.

Congenital heart defect

Some infants are born with defects in their heart, including a leaking mitral valve.

Diagnosis of Mitral Valve Disease

Diagnosis begins with a complete physical examination by a team of heart specialists. Patients will be asked about their general health, including signs and symptoms of potential problems, and whether their family has a history of heart disease. Tests listed below may be used to determine the possible cause of a heart valve defect, the severity of the problem, and whether the mitral valve must be surgically repaired or replaced. Specialists trained and experienced in the various diagnostic procedures perform these tests.

Chest X-ray

An X-ray image of the chest shows the physician the size and shape of the heart and whether the heart's left atrium (upper left chamber) and/or left ventricle (lower left chamber) are enlarged - a possible sign of a damaged mitral valve. By viewing a chest X-ray, the physician can also evaluate the lungs. A damaged mitral valve may result in blood backing up into the lungs. Congestion is visible on an X-ray.

Electrocardiogram (ECG)

An ECG provides information about heart rhythm and, indirectly, heart size. With mitral valve disease, the heart's left atrium (upper left chamber) and left ventricle (lower left chamber) may be enlarged, and heart rhythms may be irregular (arrhythmias).

Echocardiogram (Doppler Echocardiogram)

Sound waves produce detailed images of the patient's heart. Transmitted through a wandlike device (transducer) held on the patient's chest, sound waves bounce off the heart and are reflected back through the chest wall. The sound waves are processed to produce video images of the heart and a close look at the mitral valve. A Doppler echocardiogram may be used to measure the volume of blood flowing backward through the mitral valve.

Transesophageal Echocardiogram

During this test, somewhat similar to an echocardiogram, a tiny transducer (sound device) is inserted into the mouth and down the esophagus, which extends behind the heart. This test provides an even more detailed image of the mitral valve and blood flow through the valve.

Exercise Tests

Different exercise tests can help measure the patient's tolerance for activity and check the heart's response to physical exertion (exercise).

Cardiac Catheterization

A thin tube (catheter) is inserted into a blood vessel in the patient's arm or groin and threaded up to the heart. The catheter is used to deliver dye into the heart chambers and heart blood vessels. The dye, appearing on X-ray images as it moves through the heart, shows physicians detailed information about the heart and heart valves.

Computed Tomography (CT)

A CT scan uses a series of X-rays to create a detailed image.

Magnetic Resonance Imaging (MRI)

An MRI uses powerful magnets and radio waves to create a detailed image.

Holter Monitor

A patient wears this portable device to record a continuous ECG, usually for 24 to 72 hours. Holter monitoring is used to detect intermittent heart rhythm irregularities that may be associated with mitral valve disease.

Electrophysiology (EP)

For patients with irregular heart beats, We Care partner hospitals provide electrophysiology assessments. These tests are performed by electrophysiologists and cardiologists trained in the diagnosis and treatment of heart rhythm disorders, including those caused by heart valve defects. We Care partner hospitals in India have the latest technology to analyze and record heart rhythms. Other tests at We Care partner hospitals in India use nuclear medicine (radioactive materials) for detailed imaging and advanced analysis of the heart and heart valves.

Treatment of Mitral Valve Disease

Treatment options for mitral valve disease can include : -

Careful Monitoring : - If tests reveal a mild to moderate condition and the patient has no symptoms, the physician might suggest regular medical checkups to carefully monitor the mitral valve.

Medications : - Medications can help reduce the heart's workload and regulate its rhythm. In some cases, medication can slow progressive mitral valve disease. However, no medications can cure heart valve disease.

Surgery for Mitral Valve Disease in India

At some point, the risks from a leaking or narrowed heart valve (including blood clots, heart enlargement, stroke, and heart failure) become greater than the risks of surgery to fix the problem. We Care partner cardiovascular experts assess these risks and advise patients if and when surgery is necessary. We Care Partner surgeons have extensive experience and a strong record of excellence in heart valve repair and replacement.

When is Surgery Needed ?

The most common reason for mitral valve surgery is regurgitation (leakage) due to mitral valve prolapse and other causes. Valves with regurgitation are usually repairable and rarely require replacement.

The other main reason for surgery is mitral valve stenosis (narrowing). Usually, narrowed valves require replacement. We Care partner hospitals offer minimally invasive heart surgery options for both surgeries.

Cardiovascular surgeons generally agree that, whenever possible, a heart valve should be repaired instead of replaced. Heart valve repair leaves patients with their own normally functioning tissue, which is resistant to infection and does not require taking blood-thinning medication.

In some cases, such as with valves damaged by rheumatic heart disease, the valve may be too damaged and must be replaced with a prosthetic (artificial) valve.

Surgery to Treat Mitral Regurgitation - Mitral Valve Repair in India

Surgery to fix leaking (regurgitation) due to mitral valve prolapse (bulge due to weakening) depends on the prolapse's location. The mitral valve is a bileaflets valve; it has two flaps or leaflets: posterior and anterior

Mitral Valve Repair India, Balloon Mitral Valve Syndrome, Balloon Valvuloplasty Balloon Mitral Valve Syndrome, Balloon Valvuloplasty, India Hospital Tour

Prolapsing mitral valve repair Annuloplasy band added

for protection

If the prolapse occurs on the posterior leaflet, We Care partner surgeons repair it by removing a section from the bulging area, sewing the cut edges back together, and sewing an annuloplasty band into the posterior section of the annulus (ring of fibrous tissue surrounding the leaflets) to reduce its circumference and ensure that the leaflets close properly. The durability of this repair is very good; only about 0.5 percent of patients per year require a second surgery.

If the prolapse occurs on the anterior leaflet, the approach is to replace a torn or stretched-out supporting cord (chordae tendinae) with an artificial cord (neochordae) to better anchor the leaflet to the heart wall. Sometimes a section from the bulging area is also removed.

As in repair to a posterior leaflet, an annuloplasty band is added for additional support. If prolapse occurs on both leaflets (bileaflet), a combination of these techniques may be used.

Surgery to Treat Mitral Valve Stenosis in India

Surgery to eliminate mitral valve stenosis is sometimes accomplished by surgically separating or shaving back the valve leaflets (called commissurotomy). However, most patients with narrowed mitral valves require valve replacement.

Mitral Valve Replacement

Mitral valve replacement involves replacing the defective valve with a prosthetic (artificial) valve that is sewn to the annulus of the natural valve. Two kinds of replacement valves are available:

Mechanical valves

Mechanical valves made of synthetic materials are reliable and long-lasting. Because blood tends to stick to mechanical valves and create blood clots, patients with these valves need to take blood-thinning medicines (anticoagulants) for the rest of their lives.

Biological valves

Biological valves are made from animal tissue (called a xenograft) or taken from the human tissue of a donated heart (called an allograft or homograft). Sometimes, a patient's own tissue can be used for valve replacement (called an autograft/Ross procedure). Patients with biological valves usually do not need to take blood-thinning medication. However, these valves are not as durable as mechanical valves and may need to be replaced. Biological valves are used most often in elderly patients.

Minimally Invasive Robotic Mitral Valve replacement of repair surgery in India

By applying advanced endoscopic and robotic technology, cardiovascular surgeons at We Care partner hospitals in India are performing an ever-growing number of heart surgeries with minimally invasive techniques. We Care partner hospital is one of only a few centers in the India experienced in performing minimally invasive heart surgery in children.

Our partner surgeons use two minimally invasive surgery methods: robot-assisted (the da Vinci system) and thorascopic. Both approaches access the heart through small incisions in the right chest wall and avoid having to split the breastbone (sternotomy).

Mitral Valve Replacement Surgery, Balloon Mitral Valve Syndrome, Heart Valve Repair Surgery

Minimally invasive surgery approaches the heart from the side

Avoiding sternotomy reduces pain and recovery time for most patients, enabling them to resume normal daily activities sooner. Minimally invasive surgery also leaves smaller, less-noticeable scars than open heart surgery, has a lower risk of infection, and may involve less blood loss.

Besides reducing trauma for the patient, minimally invasive surgery also allows the surgeon a better view of some parts of the heart anatomy than the view with open heart surgery.

Minimally invasive heart surgery still requires that blood flow be diverted from the heart, and the heart must be stopped with cardiopulmonary bypass.

Minimally invasive surgery may be used to treat congenital (present at birth) heart problems or those that have developed later in life. Minimally invasive surgical procedures that We Care partner hospitals in India include Mitral Valve repair and replacement surgery.

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Car And Truck Air Conditioning And Heating System Facts For Brecksville Ohio Car Owners

by: Claude Whitacre

Your car's engine is the car's power source for both the heating and air conditioning systems. Here's what transpires when you turn on the heat or the air conditioner:

In the car or truck's heating system, heat will be a byproduct of the engine's combustion process. The heat is absorbed by the coolant in the car or truck's radiator. The coolant is afterward circulated through the heater core before going back to the radiator. The car's heating system also has a series of air ducts, a blower motor and fan, and temperature and duct controls, that pick the preferred temperature and point the flow of hot air.

Your car or truck's air conditioning system shares air ducts, controls and a blower with the heater, however has its own refrigerant system. The car's air conditioning system is comprised of the following components:

The car or truck's compressor really is a pump that pressurizes and circulates the refrigerant through the system. As the refrigerant passes through the condenser, the condenser gives up heat and converts from gas to liquid.

Your car or truck's receiver, dryer or accumulator is the place clean, dry refrigerant is stored as it circulates through the system.

The orifice tube or expansion valve is actually a metering device that controls the flow of refrigerant through the system.

Refrigerant enters the evaporator core as a liquid. Warmth from the air converts the liquid refrigerant back into a gas, which cools the air just before it enters you car.

While you are getting the car or truck's air conditioning or heating system inspected and serviced at your neighborhood service station, be sure that the technician doing the work is an ASE Certified technician. Using this method you will appreciate that the customer service you get is from a greatly trained professional, and could save you returning for added repairs.

Your technician should inspect every single one of the following, record their condition, and compare the parts to the factory specifications. The technician can then make good suggestions consistent with the Motorist Assurance Program Uniform Inspection Guidelines:

The technician will inspect the car or truck's complete heating and air conditioning system. The technician will then visually check the interior controls as well as the blower. The car's technician should then check the radiator coolant level, the hoses, the pressure cap, and the thermostat. Your technician can afterward check the air conditioner compressor belt for condition and proper tension. The technician will then check for leaks or some other observable damage.

Your technician will at that time pressure test the engine cooling system. Air conditioning system pressures will then be measured and compared to manufacturer's specifications. The air conditioning system is in that case leak tested

Both the heater and air conditioning system must be performance tested by means of checking the outlet air temperature at the discharge vents.

These tests, inspections, and customer service will save you cash, and provide you with a cooler traveling experience in the hot summer months, and maintain you toasty warm while traveling in the bitter winter months.