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C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes. Knowledge on the outcome of C2-fractures is founded on heterogenous samples with cross-sectional outcome assessment focusing on resume csr bank, union rates, complications and technical concerns related to surgical treatment. Reproducible clinical and functional outcome assessments are scant. Validated generic and disease specific outcome measures were rarely applied.
Therefore, the aim of the current study is to investigate the radiographic, functional and ajay somani resume clinical outcome of resume, a patient sample with C2-fractures. Out of a consecutive series of 121 patients with C2 fractures, 44 met strict inclusion criteria and 35 patients with C2-fractures treated either nonsurgically or surgically with motion-preserving techniques were surveyed. Outcome analysis included validated measures (SF-36, NPDI, CSOQ), and a functional CT-scanning protocol for the evaluation of C1#x02013;2 rotation and alignment. Mean follow-up was 64#x000a0;months and mean age of patients was 52#x000a0;years. Classification of C2-fractures at injury was performed using a detailed morphological description: 24 patients had odontoid fractures type II or III, 18 patients had fracture patterns involving the vertebral body and 11 included a dislocated or a burst lateral mass fracture.
Thirty-one percent of patients were treated with a halo, 34% with a Philadelphia collar and 34% had anterior odontoid screw fixation. At follow-up mean atlantoaxial rotation in benefits of writing an undergraduate, left and resume right head position was 20.2#x000b0; and 20.6#x000b0;, respectively. Your. According to resume the classification system of posttreatment C2-alignment established by our group in part I of the C2-fracture study project, mean malunion score was 2.8 points. In 49% of patients the fractures healed in anatomical shape or with mild malalignment. In 51% fractures healed with moderate or severe malalignment. Ajay Somani. Self-rated outcome was excellent or good in 65% of patients and moderate or poor in resume, 35%. The raw data of compare-and-contrast essay, varying nuances allow for comparison in resume csr bank, future benchmark studies and metaanalysis. Compare-and-contrast. Detailed investigation of C2-fracture morphology, posttreatment C2-alignment and resume csr bank atlantoaxial rotation allowed a unique outcome analysis that focused on the identification of risk factors for poor outcome and the interdependencies of outcome variables that should be addressed in studies on C2-fractures. We recognized that reduced rotation of resume, C1#x02013;2 per se was not a concern for resume the patients. However, patients with worse clinical outcomes had reduced total neck rotation and sample rotation C1#x02013;2.
In turn, C2-fractures, especially fractures affecting the lateral mass that healed with atlantoaxial deformity and malunion, had higher incidence of atlantoaxial degeneration and resume osteoarthritis. Patients with increased severity of compare-and-contrast essay, C2-malunion and new onset atlantoaxial arthritis had worse clinical outcomes and significantly reduced rotation C1#x02013;2. The current study offers detailed insight into the radiographical, functional and clinical outcome of C2-fractures. It significantly adds to the understanding of C2-fractures. The online version of this article (doi:10.1007/s00586-009-0901-4) contains supplementary material, which is available to authorized users. The ideal treatment of odontoid and other C2-fractures remains controversial. The lack of a comprehensive treatment-oriented classification of C2-fractures, that guides when to operate and csr bank when to select conservative treatment, reflects the fact that there exists no ideal solution for the clinical problem, yet . Of Writing. In contrast, there is a large body of literature concerning techniques, indications and resume csr bank union rates in C2-fractures , but data regarding the most important outcome measure, the functional and clinical outcome, are scant [24, 68]. Currently, in addition to nonsurgical treatment including semirigid collars or the Halo-thoracic-vest (HTV), contemporary surgical techniques for the treatment of C2-fractures include anterior odontoid screw fixation (AOSF) [2, 62], posterior and anterior transarticular screw fixation C1#x02013;2 , C1-lateral mass and C2-Isthmus/lamina fixation  and plated anterior discectomy and fusion for the unstable Hangman#x02019;s fracture (Hmfx) [46, 83]. These techniques are standardized and, if used for the appropriate fracture subtype, can show favourable results. For the treatment of lead resume sample, isolated odontoid type II fractures in the young patient AOSF is resume, increasingly favoured while accepted standards for the remaining multitude of distinct C2-fracture patterns are lacking.
The question remains which treatment method is appropriate for benefits an undergraduate which fracture pattern to yield superior functional outcome? In addition to the interest in outcomes concerning pain and well-being, the treatment of C2-fractures is csr bank, also to be discussed with regard to compare-and-contrast the impact on the resulting posttreatment function and atlantoaxial motion. Any C2-fracture affects at least theoretically the ability of the C1#x02013;2 complex to take the resume major part in total neck rotation. Using functional CT-scans in 14 patients, Jeanneret  showed that the range of motion (ROM) for book smart vs street smart the rotation C1#x02013;2 (Rot C1#x02013;2 ) was significantly reduced even after anatomical reduction of odontoid fractures with AOSF. Hence, discussions concerning the motion-preserving merits of any technique should be done carefully. Csr Bank. Therefore, the authors intended to add objective outcome data in lead, the C2-fracture research evaluating clinical and resume functional long-term results after non-surgical or surgical treatment of C2-fractures on a homogenous sample of neurologically intact patients. For a detailed insight into functional outcome, validated generic and disease specific outcome measures and the use of functional CT-scanning for benefits of writing thesis the assessment of the resume ROT C1#x02013;2 were indicated. In this context, the malunion rates were also assessed.
Additionally, the of writing authors applied the resume previously established classification of posttreatment C2-alignment . The scoring system enables correlative analysis of posttreatment C2-alignment, ROT C1#x02013;2 and clinical outcome measures. This study was undertaken to: (1) assess the interdependencies between posttreatment C2-alignment and the range of smart vs street smart, ROT C1#x02013;2 , (2) assess the impact of resume, fracture pattern, C2-alignment and ROT C1#x02013;2 on the clinical outcome in terms of validated measures, (3) identify risk factors for poor outcome. With the use of objective outcome measures applied on a homogenous group of resume sample, patients with C2-fractures, the current study is unique in the cervical spine trauma literature. We reviewed all charts of patients treated for csr bank cervical spine injuries at the authors#x02019; institution between 1997 and 2007. Patients#x02019; demographics including injury type description were recorded. A detailed case review indicated 121 patients treated for ajay acute injuries of the C2-vertebra. For the resume purpose of reconstructing a strongly homogenous sample patients had to fullfill the following criteria: (a) C2-fracture with or without stable atlas fracture treated surgically or nonsurgically, (b) age between 18 and 80#x000a0;years at injury, (c) full set of injury cervical spine antero-posterior (ap) or transoral and of writing an undergraduate lateral radiographs, (d) interval between injury and treatment #x02264;10#x000a0;days, (d) understanding of author#x02019;s language, (e) minimum 6-months follow-up, (f) absence of spinal cord injury (ASIA A-D).
Cases were excluded if they met the csr bank following criteria: (a) significant shoulder-girdle injury neccessitating surgery, (b) peripheral nerve injuries, (c) prohibitive medical comorbidity and endstage diseases, (d) drug or alcohol withdrawl, (e) a subaxial cervical spine injury, (f) polytrauma, (g) congenital cervical deformity, (h) injuries from compare-and-contrast essay neoplastic disease, infections or lesions associated with AS or DISH, (i) psychiatric illness necessitating medical treatment, (j) documented osteoporosis, (k) postoperative tracheostoma, (l) grade II or III skull#x02013;brain trauma, (m) prior medical treatment for resume csr bank degenerative cervical disease or trauma, (n) worker#x02019;s compensation claims, (o) fusion of C1#x02013;2. Patients were assessed by written interview prior to follow-up and results were blinded to the authors during clinical survey. Outcome measure included the 36-item short-form health survey (SF-36) version 2, the long-term cervical spine outcome questionnaire (CSOQ)  and the neck pain disability index (NPDI) . Compare-and-contrast Essay. The questionnaires have been validated for issues related to cervical disorders [4, 23, 75] and the methods for scoring as well as the interpretation of results were illustrated in detail in resume csr bank, previous articles [23, 38, 44, 50, 75, 77]. The subjective perception of global outcome was rated by the patients as excellent, good, moderate or poor. The participants#x02019; satisfaction was also expressed according to distinct answers ticked within the CSOQ (No. Ajay Resume. 40#x02013;42). The incidence of dysphagia was evaluated with the grading system of Bazaz .
None, mild, moderate or severe was graded by distinct combinations of difficulties with liquid and solid nutrition. Any medical or surgical complication documented between the index treatment and csr bank follow-up related to compare-and-contrast essay the procedure was recorded. Plain injury ap and lateral radiographs were available in all cases. Injury CT-scans were available in 32 patients (86%). At follow-up, all patients were subjected to resume csr bank functional CT-scanning including a CT-scan in your thesis, neutral position with 0-degree gantry angle. Resume. The cervical spine CT-scans were performed on a 4-row helical CT scanner (Somatom Volume Zoom, Siemens) using a 14#x02013;18#x000a0;cm field of interest (FOI) with 4#x000a0;#x000d7;#x000a0;1#x000a0;mm collimation and overlapping axial slice thickness of of writing an undergraduate thesis, 1#x000a0;mm. Sagittal and resume csr bank coronal reconstructions were performed using standard spine algorithms and ajay somani resume files were stored digitally (PACS Magic View VC 42, Siemens). Digital CT measurements (0.1#x000a0;mm increments) were performed on the reconstructed CT-scans in a commercially available software program (Escape Medical Viewer V3). Radiographs and CT-scans were reviewed for fracture classification. Global radiographical assessment of fracture types was performed with differentiation into resume csr bank, main categories, such as odontoid or Hmfx, using a descriptive taxonomy (see Table#x000a0;1 in Electronic supplementary material).
For the purpose of future data pooling as well as due to lead sample the lack of a single comprehensive classification including all kinds of resume, C2-fracture patterns  detailed stratification of C2- and an undergraduate thesis concommittant C1-injuries was done using a numerical system as templated in resume csr bank, Electronic supplementary material Table#x000a0;2. Through combinations, the numerical classification addresses all kinds of C2 and C1#x02013;2 fracture patterns. It allows for finish thesis nominal statistical analysis and correlative assessment of csr bank, both radiological and clinical outcome. It differentiates straight forward anatomical structures that are affected in C2-fractures (it is purely anatomical). It does not rely on fracture mechanism or morphometric measurements of displacement, but embodies the hierarchy of damage within the C2-vertebra and in particular articulating surfaces. Interpretation of the inherent stability of the various fractures is book vs street smart essay, not different to accepted definitions  e.g., qualifiers of instability like discoligamentous injury C2#x02013;3, axial osseo-ligamentous distraction of C2, rupture of transverse ligament of C1, burst fracture of C2 or displaced odontoid fracture. Assessment of lateral atlantoaxial joint degeneration. On injury-ap radiographs or CT-scans degenerative changes at the lateral C1#x02013;2 joints were assessed.
Grading of degeneration of the lateral atlantoaxial joints (AAJ) was performed in resume csr bank, two types of atlantoaxial osteoarthritis (AAOA) as previously elaborated . Type A, none or mild degeneration; Type B, advanced degeneration/arthritic joint. At follow-up, lateral atlantoaxial joint degeneration was assessed using above mentioned grading on of writing an undergraduate, coronal CT-scans. In addition, the left and right atlantoaxial joint hights (lAAJH and rAAJH) were measured on injury CT-scans, if available, and on all follow-up CT-scans at the center of the lateral C1#x02013;2 joints as described . For the resume csr bank purpose of comparative studies, AAJ degeneration was assessed using the and men literary essay classification of Lakshmanan  too. Csr Bank. Assessment of fusion and posttreatment C2-alignment. At final follow-up, reconstructed sagittal and coronal CT-scans in neutral head position were assessed for osseus union by three of the authors. Fusion was present if bridging trabeculae were confirmed at least on book, one of the cortices in resume, both the literary sagittal and lateral plane by all observers. With the same CT-reconstructions, assessment of C2-alignment was performed using the resume csr bank classification for posttraumatic C2-alignment (CPA-C2) .
With the CPA-C2 the your thesis morphometrical measurements showed substantial interobserver agreement. Distinct cut-off values of the 95% upper and lower limits of a physiological standard were assigned end-point anchors of 1 or 2 pts delineating non-physiological dimensions. The final grading of the resume csr bank C2-aligment into normal, mild, moderate and lead severe malalignment based on resume csr bank, the summed points . Functional computerized tomography. Lead. Apart clinical examination by the author all patients were subjected to functional computerized tomography. Csr Bank. The assessment of ROT C1#x02013;2 was performed using functional CT-scans in supine position. A reduced radiation exposure with low energy beam was selected with settings of 120#x000a0;kv and 80#x000a0;mA sufficient to delineate bony landmarks, joint configurations and fusion. Because subaxial flexion or extension influences the rotational capacity at your thesis the C1#x02013;2 joints and total neck rotation, meticulous care was given to level the patients#x02019; cervical spine in neutral sagittal alignment.
The subject#x02019;s body was kept in the same supine position for all head rotation sequences. First, a CT-scan scout-view was obtained with neutral vertical head orientation. The field of interest (FOI) was centered between the clivus and resume the C3 vertebra distally. After the neutral CT-scan the patients were asked to rotate their neck to the right, as far as possible. CT-scans were completed following adjustments of the FOI for axial slice reconstructions in the plane of the approximately 20#x000b0; inclined atlas vertebra. Finally, the procedure was repeated for compare-and-contrast essay the assessment of resume csr bank, left-sided rotation. With the functional CT-scans, axial, sagittal and coronal slices were reconstructed and stored digitally.
To investigate the ROT C1#x02013;2 , adjacent motion at the C0#x02013;C1 joints (ROT C0#x02013;1 ), total neck rotation (ROT C0 ) and subaxial rotation (ROT C2 ) computer measurements on the axial slices were as follows (Fig.#x000a0; 1 ): in each head position the occipital midline indicated maximum head rotation (ROT C0 ) delineating the ability of the total cervical spine to rotate to benefits an undergraduate either side. Resume. The landmarks for the occipital midline included the beak of the hard palate, the midline of the clivus and occpital protuberance. Smart Vs Street Smart. Next, the mid-sagittal line of C1, that is a line connecting the anterior atlas tubercle with the middle of the posterior atlas arch, was drawn. Its perpendicularity to a line connecting the resume csr bank center of the two transverse foramina was essential. The mid-sagittal line of C1 was calculated to the vertical axis delineating maximum atlas rotation to either side (ROT C1 ). Resume. Similarly, rotation of C2 was assessed drawing a mid-sagittal line of C2, that is a line perpendicular to the posterior cortical wall of the C2-vertebral body at its most caudad level. If the C2-vertebral body was affected by fracture trace up to the mid-sagittal plane, then the mid-sagittal axis of C2 was the line joining the csr bank slight midline anterior prominence on and men, the C2-body and the cleft of the bifid spine or the resume csr bank perpendicular of the intertransversarium line.
The mid-sagittal line of C2 was calculated to the vertical axis delineating maximum rotation of of mice literary, C2 to either side and maximum rotation of the subaxial cervical spine (ROT C2 ). Resume Csr Bank. Finally, left and compare-and-contrast essay right ROT C1#x02013;2 were calculated and expressed as the separation angle between C1 and resume csr bank C2, i.e., subtracting the C2 angle by and men essay the C1 angle. Similarly, the atlantooccipital rotation (ROT C0#x02013;1 ) was calculated subtracting the C1 by csr bank the C0 angulation. In addition, angulation C1#x02013;2 was calculated as percentage rotation C1#x02013;2 of the total neck rotation, expressed as %ROT C1#x02013;2 . ROT C0 resembles total neck rotation to either side and the results were controlled for age and gender and also expressed as percentage restricted total neck rotation (%restricted neck rotation) compared to data of normals published by sample Castro . With functional CT-scanning, the resume left and right ROT C1#x02013;2 were classified into four types: Type 1 (no restriction), #x02265;30#x000b0;; Type 2 (mild), 20 to of mice essay #x0003c;30#x000b0;; Type 3 (substantial), 10 to #x0003c;20#x000b0;; Type 4 (severe), 0 to #x0003c;10#x000b0;. The worst type of restriction of ROT C1#x02013;2 (left or right) was used for csr bank statistical analysis. We determined a cut-off rendering physiological and pathological ROT C1#x02013;2 as any measure #x0003c;30#x000b0;, that is ajay resume, a deviation of approximately #x000b1;2SD from normalcy. For the purpose of assessing changes of the instantenous center of resume csr bank, rotation (ICR) of the C1#x02013;2 joints the vs street essay authors applied a technique similar to White and resume csr bank Panjabi  on each subject (For technique and results see Electronic supplementary material).
Statistical analysis included parametric methods (independent and dependent two-sided Student t tests, Pearson#x02019;s correlation coefficient) and nonparametric tests (Kruskal#x02013;Wallis ANOVA, Mann#x02013;Whitney U test, Spearman#x02019;s correlations coefficient). Analyses of cross-tabulation tables were done using Pearson Chi-square test and Fisher#x02019;s Exact test. A P value less than 5% indicated statistical significance. All analyses were done using Statistica 6.1 (StatSoft, Tulsa, OK). Of Mice And Men Literary. Statistical analysis was performed by one of the authors (WH). The author (HK) performed the classification of the posttreatment C2-alignment as described  on all CT-scans. As there are currently no data on the reliability of measurements using CT-scans, the author performed the assessment of the csr bank C2-alignment with all indicated measurements on plain radiographs and on CT-scans in six patients having a healed C2-fracture. Reliability was expressed using the intraclass correlation coefficient (ICC). Interpretation of ICC was done as described . Somani. Fourty-four (36.4%) of 121 patients identified met all eligibility criteria.
Five patients (including 3 unstable Hmfx treated with plated ACDF) were lost to follow-up. Of another 4 patients that were successfully tracked, 1 denied taking part in the study because of no sequelae after nondisplaced odontoid type III fracture treated nonsurgically. One 61-years-old patient had a displaced odontoid type III fracture with burst left lateral mass that went to severe malunion. She joined the resume follow-up but could not be included into the study because of mental retardation. She displayed restricted axial rotation in resume sample, flexed position (10#x000b0;#x02013;0#x000b0;#x02013;5#x000b0;), complained of resume, pain during head rotation, had a cock-robin head posture and thesis suffered from left-sided suboccipital neuralgia. Another patient with 8-years follow-up answered to the questionnaires having moderate self-rated outcome after AOSF for dislocated odontoid type III fracture (SF-36 PCS: 31.6, MCS 31.1, NDPI: 32%) but could not take part in further survey because of advanced cardiac disease. One 19-years-old with 2-years follow-up after combined odontoid type II and resume csr bank C1 posterior arch fracture treated with double AOSF was working abroad, doing well as assessed by telephone questioning, but could not be surveyed. Finally, 35 patients could participate resembling a follow-up rate of 80%. Mean age at injury was 46.9#x000a0;#x000b1;#x000a0;21.7#x000a0;years (range 17#x02013;78#x000a0;years) and your 52#x000a0;#x000b1;#x000a0;20.7#x000a0;years (range 18#x02013;80#x000a0;years) at follow-up. There were 12 female and 23 male patients.
Follow-up was 65.4#x000a0;#x000b1;#x000a0;7#x000a0;months on average (range 7#x02013;142#x000a0;months) and mean hospital stay was 12.2#x000a0;#x000b1;#x000a0;9.8#x000a0;days (range 1#x02013;40#x000a0;days). Eleven patients (31.4%) were smokers. Except for mild skull traumas, 12 patients (34.3%) had co-morbidities and concommittant peripheral skeletal injuries (Table#x000a0;3 in Electronic supplementary material). At follow-up, no patient complained about resume csr bank, disability derived from shoulder-girdle injuries or peripheral injuries. Ajay Resume. Main injury mechanism was a motor-vehicle or bicycle accident in 15 patients (42.9%), a skiing casual in 4 (11.4%) and resume a fall from height in book vs street smart, 15 (42.9%). One suffered a direct blow (2.9%). Eighteen patients (51.4%) had initial treatment in a referral hospital and were transferred for definitive treatment. Except for three patients that had plain radiographs, we had injury radiographs and CT-scans available.
Twenty-three patients (65.7%) were subjected to nonsurgical treatment: 11 patients (31.4%) had HTV treatment and csr bank 12 (34.3%) had a Philadelphia collar. Twelve patients (34.3%) had anterior surgical treatment using AOSF and 1 patient had secondary anterior buttress-plating at C2 for redislocation of her odontoid type III fracture. Mean time to benefits index surgery was 2.5#x000a0;days (range 0#x02013;10#x000a0;days). Patients#x02019; characteristics are summarized in Table#x000a0;1 in Electronic supplementary material. Twenty-three patients (65.7%) had 2-part-fractures, 11 (31.4%) had 3-part-fractures and 1 (2.9%) had a 4-part-fracture. There were 24 fractures (68.6%) involving the resume csr bank odontoid that could be classified into 12 (50%) type II fractures (including IIa) and 12 (50%) type III fractures according to the Anderson classification. Eighteen patients (51.4%) had a fracture pattern involving the lead resume vertebral body. Seven patients (20%), out of a total of 8 with an csr bank, atypical Hmfx, had a vertebral body fracture separating the posterior axis wall [45, 46]. In 11 patients (31.4%) the lead resume fracture pattern included a dislocated or a burst lateral mass fracture of C2. At all, 19 patients (54.3%) had an resume csr bank, intraarticular fracture pattern resembling an resume, involvement of the csr bank lateral mass and sample its articular surface inside or outside the weight-bearing zone, displaced or non-displaced. Out of 35 patients, 7 (20%) had a concomittant C1 fracture.
C1 fractures included 1 lateral mass fracture with articular surface involvement and two stable extraarticular Jefferson burst fractures. Resume. Follow-up CT-scans showed that 31 fractures (88.6%) of C2 (and all fractures of C1) went on to union, in 4 cases (11.4%) a nonunion developed. Nonunion was mobile in benefits of writing an undergraduate, 2 (50%) patients, showing a tight fibrous-stable nonunion in resume, the remaining 2 (50%). Stability was established on flexion-extension films at follow-up. Statistical investigation showed that union was not related to of writing follow-up length, age, gender, type of resume csr bank, fracture or any other variable.
At injury 7 patients had a left-sided AAJ configuration of Type B and 5 of lead resume sample, these had also a right-sided Type B. At time of resume csr bank, injury only book smart vs street two patients showed preexisting advanced atlantodental and lateral atlantoaxial degenerative process. At follow-up nine patients had left-sided and ten had right-sided Type B AAJ changes. Seven patients (20%) had a new onset AAOA of Type B. According to the classification of Lakshamanan  AAOA was a mean of 1.1#x000a0;#x000b1;#x000a0;1.0#x000a0;points (range 0#x02013;3) left and 1.0#x000a0;#x000b1;#x000a0;1.0#x000a0;points (range 0#x02013;3) right at csr bank follow-up. Injury AAJH was assessable in 16 patients (45.7%). LAAJH was a mean of 2.9#x000a0;#x000b1;#x000a0;0.7#x000a0;mm (range 1.6#x02013;4#x000a0;mm) and thesis rAAJH was 3.1#x000a0;#x000b1;#x000a0;0.8#x000a0;mm (range 1.6#x02013;4.5#x000a0;mm). At follow-up lAAJH was a mean of csr bank, 2.9#x000a0;#x000b1;#x000a0;0.8#x000a0;mm (range 1#x02013;4.4#x000a0;mm) and rAAJH was 3.1#x000a0;#x000b1;#x000a0;0.7#x000a0;mm (range 1.5#x02013;4.3#x000a0;mm).
Unlike in book smart, normals  left- and right-sided AAJH at follow-up did not correlate with patients#x02019; age ( P #x000a0;=#x000a0;0.05, P #x000a0;=#x000a0;1.0). There was a significant difference regarding the resume incidence of lead, left- and right-sided AAOA of Type A and resume of Type B between time of injury and somani resume follow-up ( P #x000a0;=#x000a0;0.0001 and P #x000a0;=#x000a0;0.0008, two-tailed test). LAAJH and rAAJH were significantly reduced ( P #x000a0;=#x000a0;0.0007, P #x000a0;#x0003c;#x000a0;0.0001) in patients that had AAOA of Type B (left #x000d8;2.0#x000a0;mm, right #x000d8;2.2#x000a0;mm) compared to patients that had AAOA of Type A (left #x000d8;3.1#x000a0;mm, right #x000d8;3.4#x000a0;mm). Resume Csr Bank. The results of the functional CT-scans are illustrated in Table#x000a0; 1 and ajay compared to data derived from normals. An illustrative case is given in Fig.#x000a0; 2 . Resume Csr Bank. The interdependencies of the cervical rotation angles are ranked in Table#x000a0; 2 . Benefits Thesis. Patients displayed an increased total neck rotation (ROT C0 ) in the presence of resume, increased subaxial rotational capacity (ROT C2 ). As expected, total neck rotation was further increased if the C1#x02013;2 joints (ROT C1#x02013;2 ) could substantially contribute to thesis overall neck rotation. Resume. Likewise, with increasing ROT C1#x02013;2, the %ROT C1#x02013;2 of total neck rotation increased significantly too.
On the contrary, ROT C1#x02013;2 did not correlate with subaxial rotation (%ROT C1#x02013;2 had strong inverse correlation with the subaxial rotation (ROT C2 ) because of the of mice and men literary definition of %ROT C1#x02013;2 ). In case of decreased atlantoaxial rotation the subaxial spine tended towards compensational rotation not reaching significance: In patients with no subaxial degenerative changes we observed a trend of the subaxial spine to compensate for a lack of ROT C1#x02013;2 but a reduced ROT C1#x02013;2 could not be fully compensated by resume csr bank subaxial or atlantooccipital rotational efforts. Our analysis showed a significant difference between left and right ROT C0 ( P #x000a0;=#x000a0;0.01), ROT C1 ( P #x000a0;=#x000a0;0.002) and vs street ROT C2 ( P #x000a0;=#x000a0;0.007) with the resume csr bank higher rotational ability to the right for all measurements. But the ajay somani differences were small (3#x000b0;#x02013;4#x000b0;) and there was no significant difference between left and right %ROT C1#x02013;2 or between left- and right-sided ROT C1#x02013;2 . A unilaterally restricted ROT C1#x02013;2 was not compensated for by a substantially increased contralateral rotation. In contrast, reduced ROM for resume atlantoaxial rotation to the left or right was accompanied by a significantly reduced ROM for the ipsilateral subaxial rotation. Vs Street Smart Essay. Out of resume, 35 patients 4 (11.4%) were identified having ROT C1#x02013;2 according to an undergraduate Type 1, 6 patients (17.1%) Type 2, 20 patients (57.1%) Type 3 and resume csr bank 5 patients (14.3%) Type 4. Thus, more than 70% had substantial (#x0003c;20#x000b0;) or severe (#x0003c;10#x000b0;) restriction of ROT C1#x02013;2 at least to one side. The different types of rotational restriction and the definition of total neck rotation with a cut-off of 30#x000b0; had no impact on the clinical outcome measures. We calculated the rotation against age and encountered a significant inverse correlation (Table#x000a0; 3 ). It was strong for total neck rotation (ROT C0 ) and subaxial rotation (ROT C2 ) but weak for ROT C1#x02013;2 . Calculated separately for isolated odontoid fractures we observed a total ROT C1#x02013;2 of 36#x000b0; on average and a mean total neck rotation of 96#x000b0;. The first author performed all measurements. The analysis of intraobserver reliability demonstrated good to excellent agreement between radiographic and CT-based measurements with intraclass coefficients of #x0003e;0.6 for compare-and-contrast all measurements applied.
There were no measurements performed that were classified as #x02018;pathological#x02019; but otherwise were within normalcy on CT-scans, et vice versa. Resume. According to the author#x02019;s classification and grading of lead, morphometrical alignment  after treatment of C2-fractures, mean malunion score was 2.8#x000a0;#x000b1;#x000a0;2.5#x000a0;points (range 0#x02013;11points). According to the classification , in 5 patients (14.3%) the C2-fracture healed in anatomical shape without any malalignment and in 12 (34.3%) with mild malalignment. Twelve fractures (34.3%) healed with moderate and csr bank 6 (17.1%) with severe malalignment. At all, the finish your thesis C1#x02013;2 complex showed moderate or severe malalignment in 18 fractures (51.4%). Statistical analysis revealed a significantly reduced ROT C1#x02013;2 in patients with the higher malunion score ( P #x000a0;=#x000a0;0.01) and in those classified with a #x02018;moderate#x02019; or #x02018;severe malalignment#x02019; ( P #x000a0;=#x000a0;0.01). Accordingly, patients with higher malunion score had a higher grade of rotational restriction (Types 1#x02013;4, P #x000a0;=#x000a0;0.02). In addition, it striked that patients with higher malunion scores (ANOVA) and moderate/severe malalignment showed a significantly reduced clinical outcome in terms of SF-36 MCS ( P #x000a0;=#x000a0;0.02 and P #x000a0;=#x000a0;0.001), NPDI ( P #x000a0;#x0003c;#x000a0;0.0001 and P #x000a0;#x0003c;#x000a0;0.00001), CSOQ-neck pain severity composite score ( P #x000a0;#x0003c;#x000a0;0.005 and P #x000a0;#x0003c;#x000a0;0.0001), CSOQ-functional disability score (p#x000a0;#x0003c;#x000a0;.0002 and P #x000a0;#x0003c;#x000a0;0.00001), CSOQ-psychological distress score ( P #x000a0;=#x000a0;0.04 and P #x000a0;=#x000a0;0.03), physical symptoms score ( P #x000a0;=#x000a0;0.004 and P #x000a0;=#x000a0;0.0002) and CSOQ-health care utilization score ( P #x000a0;=#x000a0;0.036 and resume P #x000a0;=#x000a0;0.036). Means, SD, and benefits of writing an undergraduate ranges of outcome measures are illustrated in Tables#x000a0; 4 and #x200B; and5. Csr Bank. 5 . Essay. Data are presented in resume, comparison to results of other studies. The outcome measures and questionnaires utilized showed good consistency when assessing differences in of writing thesis, clinical outcome.
Assessment of clinical outcomes with the validated measures (SF-36, NPDI, CSFQ) and their correlation with the resume csr bank patient#x02019;s self-rated clinical outcome (#x02018;excellent#x02019; to #x02018;poor#x02019;) showed strong consistency (Kruskal#x02013;Wallis testing: P #x000a0;=#x000a0;0.03 to P #x000a0;=#x000a0;0.003). There were significant differences within the validated measures if calculated for the 4 groups of global outcome: #x02018;excellent#x02019;, #x02018;good#x02019;, #x02018;moderate#x02019; and somani resume #x02018;poor#x02019; (Table#x000a0;4 in Electronic supplementary material). There was also a significant correlation between the resume csr bank validated outcome measures and inbetween the benefits of writing various scoring items of the queries (Table#x000a0;5 in Electronic supplementary material). Self-rated outcome was judged excellent by 15 patients (44.1%), good by 7 (20.6%), moderate by 10 (28.6%) and poor by 2 patients (5.9%). Resume. So, 65% of patients judged their outcome as good or excellent and 35% as moderate or poor. With the benefits of writing an undergraduate worse self-rated outcome patients displayed a significantly reduced total ROT C1#x02013;2 rotation ( P #x000a0;=#x000a0;0.02) and total neck rotation ( P #x000a0;=#x000a0;0.05). Likewise, reduced total ROT C1#x02013;2 showed slight correlation with decreased outcome measures yielding significance for the SF-36 PCS ( R #x000a0;=#x000a0;0.36, P #x000a0;=#x000a0;0.04), the NPDI ( R #x000a0;=#x000a0;#x02212;0.34, P #x000a0;=#x000a0;0.05) and the CSOQ-shoulder pain severity composite score ( R #x000a0;=#x000a0;#x02212;0.44, P #x000a0;=#x000a0;0.01). Patients with reduced total neck rotation had decreased outcomes yielding stronger significance for the SF-36 PCS ( R #x000a0;=#x000a0;0.53, P #x000a0;=#x000a0;0.002), the NPDI ( R #x000a0;=#x000a0;#x02212;0.37, P #x000a0;=#x000a0;0.04) and the CSOQ-shoulder pain severity composite score ( R #x000a0;=#x000a0;#x02212;0.45, P #x000a0;=#x000a0;0.01). When calculating the age and resume gender matched percentage restriction of total neck rotation  against the clinical outcome measures, correlations existed for the SF-36 PCS ( R #x000a0;=#x000a0;0.54, P #x000a0;=#x000a0;0.001), the NPDI ( R #x000a0;=#x000a0;#x02212;0.38, P #x000a0;=#x000a0;0.03), the CSOQ-shoulder pain severity composite score ( R #x000a0;=#x000a0;#x02212;0.45, P #x000a0;=#x000a0;0.007), the literary essay CSOQ-neck pain severity composite score ( R #x000a0;=#x000a0;#x02212;0.39, P #x000a0;=#x000a0;0.02) and the CSOQ-functional disability score ( R #x000a0;=#x000a0;#x02212;0.35, P #x000a0;=#x000a0;0.04). Summarizing, reduced clinical outcome was more reflected by a decreased total neck rotation rather than a reduced C1#x02013;2 rotation. As it was with the ability to resume rotate the neck, statistical analysis revealed a decreased clinical outcome for elderly patients in somani resume, terms of the NPDI ( R #x000a0;=#x000a0;0.41, P #x000a0;=#x000a0;0.02) and the SF-36 PCS ( R #x000a0;=#x000a0;#x02212;0.56, P #x000a0;=#x000a0;0.001).
Older patients had higher health care utilization demands in terms of the CSOQ ( R #x000a0;=#x000a0;0.36, P #x000a0;=#x000a0;0.04). Elderly patients had a significantly shorter follow-up period ( R #x000a0;=#x000a0;#x02212;0.45, P #x000a0;=#x000a0;0.006) that might put age and outcome related interdependencies into perspective. Csr Bank. It is of note that patients with worse outcomes had reduced total neck rotation, however, the %ROT C1#x02013;2 did not correlate with the clinical outcome reflecting that a reduced absolute rotational ability affecting the whole cervical spine was a factor of essay, aging, motion induced pain and a low functional outcome. Significant gender-related differences existed in terms of the NPDI ( P #x000a0;=#x000a0;0.03), the CSOQ-psychiological distress score ( P #x000a0;=#x000a0;0.005) and the physical symptoms score ( P #x000a0;=#x000a0;0.01). These results have to csr bank be interpreted with the benefits of writing awareness of gender distribution with varying fracture patterns and ages.
So, 8 of 11 patients (73%) with a burst or dislocated lateral mass fracture were female. Similarly, when assessing intraarticular fracture pattern as a variable, 8 of resume csr bank, 12 females depicted reduced motion pattern and increased pain-levels. Of Writing An Undergraduate Thesis. Neither the presence of a nonunion nor combined C1#x02013;2 fractures, nor any complication or whether surgery was performed or not had impact on resume csr bank, clinical outcome or cervical rotation (Table#x000a0; 3 ). Notably, the number of main fragments identified (2-part, 3-part, 4-part-fractures of C2) had significant impact on the %ROT C1#x02013;2 ( P #x000a0;=#x000a0;0.03) but not on somani resume, the clinical outcome measures. If the smallest denominator was assumed to resume be an intraarticular fracture pattern involving the C2-superior articulating facets then patients had significantly reduced total ROT C1#x02013;2 ( P #x000a0;=#x000a0;0.03) and in particular reduced %ROT C1#x02013;2 ( P #x000a0;=#x000a0;0.006). Rotational abilities were strongly affected by somani the presence of an intraarticular fracture pattern.
Calculating any intraarticular fracture pattern against the outcome measures did reveal trends, but did not yield significance. In this context it is resume csr bank, of note that only 11 patients were identified to compare-and-contrast have had a dislocated fracture or burst pattern involving the articular pillar and lateral mass. If calculating rotation and clinical outcome against the presence of a burst or dislocated lateral mass fracture in eight patients at all, the statistical analysis still revealed a trend for reduced %ROT C1#x02013;2 , but it striked that this group of patients had significantly reduced outcomes in terms of the SF-36 MCS ( P #x000a0;=#x000a0;0.006), the NDPI ( P #x000a0;=#x000a0;0.04), the resume csr bank CSOQ-functional disability score ( P #x000a0;=#x000a0;0.01) and the CSOQ-physical symptoms score ( P #x000a0;=#x000a0;0.01). Somani. SF-36 PCS scores did not reach statistical significance but a strong trend existed (SF-36 PCS #x000d8;35.7#x000a0;#x000b1;#x000a0;9.0 vs. #x000d8;43.0#x000a0;#x000b1;#x000a0;10.2). Differences of csr bank, 2.5 points are thought to be a clinically meaningful difference for the SF-36 [18, 80].
Patients that had the vertebral body affected (51%) had reduced total ROT C1#x02013;2 ( P #x000a0;=#x000a0;0.02), but %ROT C1#x02013;2 and total neck rotation were not significantly reduced. Compare-and-contrast. However, these patients had worst scores with the CSOQ-functional disability score ( P #x000a0;=#x000a0;0.007) and the SF-36 MCS ( P #x000a0;=#x000a0;0.05). This group of patients included most of the resume dislocated burst lateral mass fractures, patients with intraarticular fractures and the group with highest malunion scores. And Men Literary Essay. Eleven patients (31.4%) had at least one lateral AAJ of Type B and resume csr bank 6 of and men essay, these 11 (54.5%) had signs of C2-nerve root mediated pain with radiculopathia suboccipitally. At all, 20 patients (57.1%) reported on pain when approaching the mid-range or extremes of resume, axial head rotation in neutral or sagittally flexed head position or reported on compare-and-contrast essay, tenderness and localized pain at the C2-spinous process during daily activities. According to distinct questions within the CSOQ 20% of patients reported that they would need additional treatment for their neck condition in the future.
Sixty-one percent of patients judged they would be extremly or moderately satisfied if their neck condition would be the same as at follow-up, while 20% judged they would be moderate or extremely dissatisfied if the neck condition would remain the same (20% ticked #x02018;neither satisfied nor dissatisfied#x02019;). Twenty-three percent reported that the actual result was somewhat or much worse as expected, 49% reported it was somewhat or much better than expected, and csr bank 28% as expected. Concerning AAOA, the somani presence of Type B changes at follow-up had significant impact on the rotational ability and outcome measures. Type B patients displayed significantly decreased total ROT C1#x02013;2 ( P #x000a0;=#x000a0;0.006) and %ROT C1#x02013;2 ( P #x000a0;=#x000a0;0.04) but not significantly reduced total neck rotation. Clinical outcomes were worse than in patients with Type A changes in terms of the SF-36 PCS ( P #x000a0;=#x000a0;0.01), the SF-36 MCS ( P #x000a0;=#x000a0;0.01), the resume NPDI ( P #x000a0;=#x000a0;0.002), the CSOQ-psychological distress score ( P #x000a0;=#x000a0;0.0005), the CSOQ-physical symptoms score ( P #x000a0;=#x000a0;0.01) and health care utilization score ( P #x000a0;=#x000a0;0.02). The same interdependencies existed even more in patients that had newly developed Type B changes with a significantly decreased total ROT C1#x02013;2 ( P #x000a0;=#x000a0;0.01) and %ROT C1#x02013;2 ( P #x000a0;=#x000a0;0.02) as well as reduced outcome measures in terms of SF-36 MCS ( P #x000a0;=#x000a0;0.0009), NPDI ( P #x000a0;=#x000a0;0.003), the ajay resume CSOQ-neck pain severity composite score ( P #x000a0;=#x000a0;0.04), CSOQ-functional disability score ( P #x000a0;=#x000a0;0.02), CSOQ-psychologic distress score ( P #x000a0;=#x000a0;0.0009), CSOQ-physical symptoms score ( P #x000a0;=#x000a0;0.04) and CSOQ-health care utilization score ( P #x000a0;=#x000a0;0.006). Patients that had preexisting AAOA of Type B, that had just progressed, had significantly reduced left and right AAJH ( P #x000a0;=#x000a0;0.04 and P #x000a0;=#x000a0;0.03) as compared to Type A patients, but clinical outcome measures were not different (Table#x000a0; 4 ). Fracture of the C2 articular pillar. In 8 of 11 patients (72.7%) with displaced or burst lateral mass fractures the left side was affected. Resume. At follow-up, these patients had significantly reduced left-sided AAJH ( P #x000a0;=#x000a0;0.02).
With increasing malunion score, ROT C1#x02013;2 was significantly reduced, the most on the left side ( P #x000a0;=#x000a0;0.0005). When calculating for book smart the intraarticular fracture pattern that affected the left side in 11 of 19 patients (58%) it also striked that left-sided %ROT C1#x02013;2 ( P #x000a0;=#x000a0;0.005) and left-sided ROT C1#x02013;2 ( P #x000a0;=#x000a0;0.02) were significantly affected in comparison to the contralateral side. Resume. The findings of somani resume, left-sided preponderance were incidental, but substantiated that the intraarticular and resume csr bank particularly burst fracture patterns show their main adverse effects on the development of lead, ipsilateral AAOA, reduced total ROT C1#x02013;2 and csr bank %ROT C1#x02013;2 and finish your C2-malunion scores. Csr Bank. The latter had the largest impact on clinical outcome measures. Fourteen patients (40%) were already retired at an undergraduate thesis time of injury unrelated to disorders of the neck. Of 21 patients occupied at time of injury 15 achieved a level of W1 (42.9%) according to csr bank Denis#x02019; Work Scale, 1 had W2 (2.9%), 2 had W3 (5.8%) and 3 patients (85.7%) were not able to thesis resume previous full-time employment or were unable to work because of neck related impairment. Resume Csr Bank. Eighteen patients (85.7%) went back to a full-time employment with a mean time out of work of 17.0#x000a0;#x000b1;#x000a0;6.8#x000a0;weeks (range 3#x02013;24#x000a0;weeks) after injury. With the smart vs street essay dysphagia grading system of Bazaz  the mean score was 1.4#x000a0;#x000b1;#x000a0;0.7 (range 0#x02013;3) for liquids and 1.7#x000a0;#x000b1;#x000a0;1.0 (range 1#x02013;4) for solid nutrition.
Buzz-scores were not significantly affected by anterior surgery. In summary, 7 out of 35 patients (20%) sustained a complication: 1 (2.9%) with odontoid type II fracture had delayed-union in the HTV but eventually fused after 6#x000a0;months. Another patient suffered from neuralgia at a former pin-site with subsequent phobia wearing huts. Resume. One patient had screw-related dysphagia following double AOSF but denied screw removal. Finish Thesis. Another had hard-to-treat C2-referred pain lasting for csr bank 8#x000a0;months after nonsurgical treatment of an odontoid type III fracture with split-impression fracture of the lateral mass. Another had early fracture redislocation after double AOSF for odontoid type III fracture with oblique split-impression fracture of the lateral mass. The fracture healed uneventful. One female patient with 10#x000a0;years follow-up had HTV treatment for a displaced odontoid type III fracture with en bloc fracture-separation of the comminuted lateral mass. Symptomatic nonunion with severe malalignment developed and the patient was subjected to anterior retropharyngeal release with reduction and of mice and men essay C2-buttress-plating 6#x000a0;months after the index treatment. Implant removal was performed 1.5#x000a0;years after index therapy. After 3#x000a0;years the resume patient showed up reporting a progression of of mice essay, myelopathic signs during a 4-weeks period which was found to be related to anterior subluxation of resume, C1 on ajay somani resume, C2.
The patient denied a second trauma. Intraoperatively, there was no significant sagittal motion C1#x02013;C2. After posterior decompression of C1 the patient recovered completely. Resume. Finally, during survey of our patients a 76-year old was subjected to C1#x02013;2 Magerl fixation for lead painful C1#x02013;2 joint destruction (Fig.#x000a0; 3 ). Csr Bank. The patient achieved immediate pain resolution after immobilization of the C1#x02013;2 joints. The current study is a unique approach to the outcome investigation of ajay, C2-fractures, and it is the largest reporting of functional CT-scanning in patients with cervical trauma. The author identified several articles [47, 49, 68] reporting on miscellaneous C2-fractures included into cross-sectional outcome analysis or using nonvalidated instruments; most studies are reluctant to further delineate distinct fracture morphology and outcome variables in heterogenous samples [5, 25#x02013;27, 29, 62, 68]. Therefore, we intended to seek objective outcome data through assessment of validated outcome measures, functional outcome using dynamic CT-scanning, a detailed classification of fracture pattern and an analysis of resume csr bank, posttreatment C2-alignment using a classification system based on valid measurements . The efforts are indicated as there is no consensus on the ideal treatment for all subtypes of C2-fractures [2, 29, 43, 46, 62].
Our study yielded for a homogenous sample. We assessed different fractures (odontoid, vertebral body, Hmfx,#x02026;), but unlike prior studies with difficulties addressing all fracture patterns, the authors#x02019; characterization of essay, C2-fractures at injury and at follow-up implicates the focus on identical morphological characteristics within the C2-fracture subtypes. Consequently, beside general outcome analysis of resume, C2-fractures, we sought to analyse the essay influence of distinct morphological subtypes (intraarticular fracture pattern, number of main fragments, burst component,#x02026;) on the remaining rotation C1#x02013;2 and the clinical outcome. We wanted to identify risk factors for poor outcome and thereby identified the resume csr bank severity of malunion. Ajay Somani. We aimed out being able to identify at an early stage of treatment those fractures prone to symptomatic malunion and poor outcome, thus resulting in an adaption of treatment protocols (nonsurgical vs. Resume Csr Bank. surgical, nonfusion vs. fusion procedure).
Rarely, the type of anatomical alignment and associated outcome after various motion-preserving treatments is reported [1, 10#x02013;12, 21, 26, 34, 41, 42, 46, 47, 57, 63, 71, 74, 78]. Lead Resume Sample. A meaningful number of subtypes of C2-fractures exists where complete reduction, normal C1#x02013;2 rotation and resume a physiological anatomy is difficult to restore [1, 10, 11, 34, 42, 43, 71, 82]. Likewise, a non-anatomical posttreatment C2-alignment, resembling a malunion, can cause significant symptoms even indicating fusion C1#x02013;2 [13, 26, 30, 42, 47, 51, 52, 67, 70, 71, 78, 79] as it had to be done in one of our cases (Fig.#x000a0; 3 ), two others being scheduled (Fig.#x000a0; 4 ). Malunion in C2-fractures can produce significant sequelae and lead resume sample we sought to csr bank stratify those C2-fracture subtypes prone to lead resume sample malunion after motion-preserving therapy: In the literature, the approximate rate of malunion in csr bank, odontoid fractures was reported to be 12#x02013;22% [57, 63]. Using the classification we established in part I of the project  we identified 49% of patients having either no or only mild malalignment but 51% having moderate or severe malalignment of C2 or the C1#x02013;2 complex. Patients with advanced malalignment had significantly reduced ROT C1#x02013;2 and, even more important, the presence of advanced malunions had a strongly significant adverse impact on all clinical outcome measures. Resume. This study offers evidence for the correlation between a distorted posttreatment C2-alignment, including distortion of the csr bank physiologic C1#x02013;2 relationships, and worse clinical outcomes, both involving restricted ROT C1#x02013;2 . Our findings substantiate previous studies that noted reduced outcomes in patients with distorted C1#x02013;2 joint configurations [19, 26]. Dvorak  reported on 34 Jefferson fractures and demonstrated that patients with residual lateral displacement of the lateral mass of C1#x000a0;#x02265;#x000a0;7#x000a0;mm were more likely to resume sample report worse functional status in terms of the resume csr bank SF-36.
In another study  on 90 isolated subaxial facet injuries, the group of 18 patients treated nonoperatively contained the of writing an undergraduate most benign fracture patterns but had significantly worse clinical outcomes (NASS, SF-36 subscales). Dvorak hypothesized that the worse outcome even after non-displaced, non-surgically treated facet fractures is due to csr bank the development of secondary degenerative changes with malalignment at the injury level. Similarly, we observed that malunion as a result of distorted C2-lateral mass, altered C2-articular surfaces, widening of the resume sample vertebral body or increased odontoid tilt caused a remarkable drop in outcome measures and csr bank ROT C1#x02013;2 . Lead Resume. We demonstrated that maintaining anatomic C2-alignment has a decisive role for clinical outcomes (Table#x000a0; 5 ). Functional outcome and atlantoaxial rotation. Resume. After motion-preserving C1-ring osteosynthesis in five Jefferson fractures, Ruf  reported a mean left and right ROT C1#x02013;2 of 20.6#x000b0; and 18.6#x000b0; using dynamic MRI-scans. Vs Street Smart. The patient with worst C1#x02013;2 incongruency had the worst functional and clinical outcome which was attributed to the distorted C1-2 articular surface pattern. Jeanneret  measured left and right ROT C1#x02013;2 25#x000b0; and resume csr bank 24#x000b0; after AOSF using functional CT-scans.
Likely due to sample size and fracture analysis, the study did not find any correlation between residual ROT C1#x02013;2 and resume fracture pattern, quality of reduction or osteosynthesis. We investigated the ROT C1#x02013;2 after treatment of C2-fractures. Csr Bank. In our sample with 35 patients, only 30% had normal ROT C1#x02013;2 or mild restriction, but 70% had substantial (#x0003c;20#x000b0;) or severe (#x0003c;10#x000b0;) restriction of ROT C1#x02013;2 at least unilateral. Likewise, in Jeanneret#x02019;s sample only 38% had normal motion C1#x02013;2 and Verheggen  noted that only 61% of essay, patients revealed standard rotation after AOSF. We explored the rotational interdependencies (Table#x000a0; 2 ) and observed that in case of resume csr bank, decreased C1#x02013;2 rotation, the subaxial spine yielded for compensation, but did not reach significance and finish your thesis is suggested to be an effect of pain-mediated (due to malunions) overall restriction of rotation and coincident a factor of aging. Concerning age, some elderly patients showed advanced subaxial spondylosis and csr bank normally the C1#x02013;2 rotation increases compensatorically with aging . Calculating the ability for neck rotation against age we observed a significant inverse correlation, pronounced for total neck rotation (ROT C0 ) and subaxial rotation (ROT C2 ). Although we expected an increased %ROT C1#x02013;2 in of mice literary, the elderly, the correlations were weakest for resume the %ROT C1#x02013;2 and book smart vs street ROT C1#x02013;2 rendering other factors decisive for reduced ROT C1#x02013;2 also in the elderly patients. Concerning compensational mechanisms we observed that unilaterally restricted ROT C1#x02013;2 was not compensated for by a substantially increased contralateral rotation. In addition, reduced ROT C1#x02013;2 to one side was accompanied by a significantly reduced ipsilateral subaxial rotation. We did not observe a significantly increased C0#x02013;1 rotation in case of reduced ROT C1#x02013;2 as it was in children with pathological stickiness C1#x02013;2 [58, 60].
We had a mean ROT C0#x02013;C1 of 2.6#x000b0; and 2.7#x000b0; to the right and left suggesting a normal coupling between C0 and C1 . Only a few patients exhibited increased motion above 2SD but never achieved ranges of 30#x000b0; as in resume, the forementioned study. Overall, we demonstrated a significant reduction of ROT C1#x02013;2 in the C2-fractures with decreasing order in odontoid, vertebral body and atypical Hmfx, and fractures affecting the articular pillar of C2. Like Jeanneret, we investigated the reasons for reduced ROT C1#x02013;2 . While reduction of total neck rotation after the C2-fractures is assumed to be a function of pain-related restriction of overall motion , aging and degenerative processes, we showed the reduction of essay, ROT C1#x02013;2 and %ROT C1#x02013;2 to be significantly associated with the degree of anatomical distortion and the severity of malunion, outperforming the statistically analysed influence of pain in terms of the outcome vehicles. Our patients had no other cervical injuries and the source of resume, pain could be focused at C1#x02013;2. Book Vs Street Smart. Statistically a pain-related reduction of ROT C1#x02013;2 and an associated reduction of total neck rotation existed, but the severity of resume csr bank, malunion had the highest effect on lead resume sample, the rotational ability of C1#x02013;2.
There was a slight correlation between total ROT C1#x02013;2 and clinical outcome measures, but no correlation existed for the %ROT C1#x02013;2 and the clinical outcome. It seemed that the restriction of rotation was perceived by the patients to be an acceptable #x02018;price#x02019; to pay causing less disability if they did not perceive motion induced pain. Likewise, Grob  reported the residual neck rotation in 35 fusions of csr bank, C1#x02013;2 for AAOA with a mean of 58#x000b0;. Lead Sample. Notably, rotation was not different between the patients reporting a #x02018;good#x02019; or a #x02018;poor#x02019; outcome. Our current findings substantiate that loss of ROT C1#x02013;2 and total neck rotation do not cause worse outcomes. In normals the C1#x02013;2 joints are responsible for up to 60% of resume csr bank, total neck rotation equaling 30#x000b0;#x02013;45#x000b0; [16, 25, 58, 64, 73]. Even though the osseus contour of the lateral C1#x02013;2 joints looks concave on radiographs, the smart smart padding of joint cartilage converts the articulating surfaces to biconvex discs  with the csr bank cartilage cover averaging 1.5#x02013;2#x000a0;mm [48, 51]. The spaces anterior and posterior where the articular surfaces diverge are filled by intra-articular meniscoids . Your Thesis. In neutral head position the summit of the atlantal convexity rests on resume, the convexity of the axial facet.
As C1 rotates, one atlantal facet slides down the thesis posterior slope of its axial facet, and the contralateral atlantal facet slides down the anterior slope of resume, its facet (Fig.#x000a0; 4 ) . Because of the convex shape of the articular surfaces each facet of C1 and C2 moves downwards and forwards/backwards at the same time during rotation [15, 69]. The articular surfaces of C1 and C2 touch each other at the mid- point during the rotational process. The understanding of this process is of writing an undergraduate thesis, crucial for recognizing the C1#x02013;2 joints as a source of pain. Pang  established the blue print of normal rotation C1#x02013;2 by analysing CT-based motion curves containing three distinct phases [58, 59]: a single motion phase (C1#x000b0;#x000a0;=#x000a0;0#x000b0;#x02013;23#x000b0;) when only resume csr bank C1 turns; a double motion phase (C1#x000b0;#x000a0;=#x000a0;24#x000b0;#x02013;65#x000b0;) when both C1 and C2 are turning in of mice literary, the same direction because of ligamentous yoking; and a unison motion phase (C1#x000b0;#x000a0;=#x000a0;65#x000b0;#x02013;90#x000b0;) when both C1 and C2 turn as a fixed couple. The authors showed that neck rotation was initiated at the C1#x02013;2 joints and rotation of C1 occured before C2 rotated . Therefore, any rotation of the resume head is conferred to finish thesis the C1#x02013;2 facets and in csr bank, the current sample with an overall reduced total ROT C1#x02013;2 of resume sample, 40#x000b0; the articulating surfaces of C1 and resume C2 must, at some point, have encountered a restraint.
As Jeanneret , Pang , Ruf , Kim  and others pointed out, soft or bony interlock can have its source in compare-and-contrast essay, malunited vertebral bodies, odontoid or lateral mass fractures, intraarticular scarring and pieces of cartilage wedged into the joint spaces, or can be a sequelae of capsular and periarticular ligamentous scarring like arthrofibrosis. We demonstrated that an altered joint anatomy of resume csr bank, C1#x02013;2 caused reduced ROT C1#x02013;2 and resume %ROT C1#x02013;2 , sometimes deformation being striking and the restraint of axial rotation obvious (Fig.#x000a0; 3 j). Concerning the loss of rotation, our findings echo previous observations describing significantly reduced rotation C1#x02013;2 after prolonged immobilization, e.g., with temporary Magerl fixation [7, 71], after ligamentous and capsular injuries to the C1#x02013;2 joints  and after intraarticular or malunited fractures of C2 [52, 57]. Resume Csr Bank. In addition to articular surface deformities, distortion of the rotational axis of C1 and thesis C2 in terms of deviated instantaneous center of rotation (ICR C1#x02013;2 ), e.g. Resume Csr Bank. as a sequelae of a widened C2-vertebral body, deformed lateral mass or tilted odontoid is thought to contribute to benefits an undergraduate thesis reduced ROT C1#x02013;2 . We investigated the ICR C1#x02013;2 and observed a trend towards an csr bank, anterior shift of the ICR C1#x02013;2 (Electronic supplementary material). Currently there is no definition of normal ICR C1#x02013;2 or grading of book smart, any deviation of the ICR C1#x02013;2 , so observations warrant further research. Jeanneret noted three patients with restricted ROT C1#x02013;2 and resume explained the decreased motion with intraarticular comminution of the and men essay C1#x02013;2 joints that was supposed to produce painful posttraumatic AAOA . AAOA can disrupt the smooth, gliding joint motions  and a clinical hallmark of resume, AAOA is known to be the significantly reduced ROT C1#x02013;2 [20, 31, 35, 66]. Accordingly, our patients with AAOA (preexisting and new onset Type B joints) had significantly decreased total ROT C1#x02013;2 and %ROT C1#x02013;2 . The same interdependencies were stressed if calculated separately for patients with new onset degeneration of Type B as a result of intraarticular fracture pattern or lateral mass comminution.
The patient#x02019;s subjective perception of the treatment-related outcome has increasingly become the focus in your thesis, spinal care. The current study is one of the csr bank first to sample assess clinical outcomes of csr bank, fractures at C1#x02013;2 using validated outcome measures  applied on a sample, homogenous for lead resume sample the neurologically intact, with exclusion of many confounding patient based variables through hard selection process. Notably, we identified significant impairment in generic (SF-36) and csr bank disease specific (CSOQ, NPDI) outcome vehicles. The use of benefits an undergraduate thesis, validated measures allowed an objective comparison of resume csr bank, C2-fractures morphologically classified with other spinal injuries: Tables#x000a0; 4 and lead #x200B; and5 5 illustrate that our outcome was better than reported with, e.g., Jefferson burst fractures, except for resume the SF-36 MCS. Your Thesis. On the other hand in csr bank, comparison to, e.g., subaxial discoligamentous injuries in the neurologically intact treated with plated ACDF our results were inferior. For our purpose of identifying prognostic factors we investigated whether pain and disability in patients with reduced outcomes depended on (1) a restricted ability for axial rotation, (2) distortion of C1#x02013;2 anatomy and essay severity of malunion, or (3) intraarticular damage with subsequent degeneration and development of AAOA. The statistical analysis revealed that clinical outcome was in csr bank, the majority influenced by the severity of malunion.
Malunion was a frequent sequelae of essay, intraarticular and particularly burst lateral mass fractures with subsequent evolvement of AAOA over csr bank, time. At all, 65% of of writing an undergraduate, patients judged their outcome as good or excellent. But 35% judged their outcome as moderate or poor and 20% assumed that they would need additional treatment for their neck condition in the future. In contrast, in literature the results of various treatment modalities for C2-fractures, particularly for odontoid fractures, were frequently recognized as #x02018;good#x02019; if not #x02018;excellent#x02019; [25, 62, 72]. In the resume past, detailed data have been sparse commonly not exceeding cross-sectional assessments and finish your despite the prevailing opinion that overall outcome was favourable, long-term analysis identified persisting symptoms of pain and stiffness in a meaningful number of patients [1, 11, 57, 76]. Platzer  reported on 110 patients subjected to AOSF. Outcome was 1.4#x000a0;points on a #x02018;Smiley-Webster#x02019; scale, judged #x02018;good to excellent outcome#x02019;. Astonishingly, only resume csr bank 14% were reported complaining about limitations in daily living, occasional or chronic pain symptoms and decrease of book vs street essay, cervical motion. Unfortunately, the sample was heterogenous including neurologically injured, one-third was reported to have significant co-morbidities or injuries and csr bank morphological characteristics of C2-fractures were lacking.
In contrast, after AOSF subjective-rated pain can be found in 10#x02013;40% [1, 11, 57, 76]. M#x000fc;ller  reported on finish your, 27 odontoid fractures subjected to AOSF. Fourty-one percent of csr bank, patients demanded pain medication and 29% noted motion related pain, only 18% were completely satisfied with their outcome and 22% of vs street essay, fractures went on to malunion. Several patients were noted to have combinations of reduced ROM, persistant pain, a malunion or AAOA. M#x000fc;ller  stressed the importance of anatomical alignment in C2-fractures and the findings of the current study give evidence that with an increasing number of C2-fragments, deformation of the C2 vertebral body and particularly fractures of the resume C2 lateral mass clinical outcome drops: Fractures involving the C2 articular pillar can be isolated articular or lateral mass fractures or extensions of vertebral body fractures [5, 26] and were found to book smart vs street smart essay be prone to a high rate of non-anatomical union  frequently indicating secondary fusion of C1#x02013;2 [30, 67, 70]. Up to 50% of Hmfx involve the csr bank articular facets of C2 and in the largest sample regarding anterior fusion C2#x02013;3 for thesis the treatment of unstable Hmfx, Koller  observed a decreased functional and resume clinical outcome with a subset of patients having reduced rotation C1#x02013;2 and motion induced C2-referred pain. Your. Similar to our study, several of these patients showed incongruency and deformity of the C1#x02013;2 joints and a positive correlative relationship between the severity of malunion C1#x02013;2 and reduced clincial outcomes. Likewise, Fujimura et al.  reported on 31 C2-vertebral body fractures subjected to nonsurgical treatment including 3 burst and 17 sagittal fractures of the lateral mass. In 15 of 17 sagittal fractures malunion C1#x02013;2 was recognized at csr bank follow-up, 8 of the 17 fractures (47%) went to AAOA reporting moderate or severe nuchal pain.
At all, patients that had suffered from lateral mass fractures had moderate to lead severe pain in resume, 82%. Since Jeanneret#x02019;s series, several reports substantiate that C2-fractures affecting the upper facets of C2 can show symptomatic C1#x02013;2 incongruency at follow-up [26, 40, 42, 52] and our study adds objective data delineating a significantly decreased outcome in terms of validated measures with increasing C2-malunion. Accordingly, from the current results the authors support primary fusion C1#x02013;2 in C2-fractures with comminuted or displaced C1#x02013;2 joints showing a high risk of resume, malunion and poor outcomes. Csr Bank. Literature [20, 26, 31, 35, 39, 40, 52, 66] and our current results demonstrate that the C1-2 facet joints can be a meaningful source of pain. Thirty-one percent of our patients had at least one lateral C1#x02013;2 joint displaying advanced AAOA, more than half had signs of somani resume, C2-nerve root conferred radiculopathy and motion induced suboccipital pain. The pain was not caused by nerve root or C2-ganglion compression, as there was no abnormal interlaminar space at C1#x02013;2  in any patient. Facet joint pain is likely to be transmitted by unencapsulated receptors and free nerve endings in the joint capsule and csr bank synovial lining . With aging or posttraumatic changes, degeneration with capsular laxity and synovitis can occur and sample finally AAOA can arise with a mechanical nature of pain [35, 36].
As in our sample, pain derived from the C1#x02013;2 facet joints is frequently described in nonneuropathic terms such as #x02018;pressurelike#x02019;, #x02018;deep boring#x02019;, #x02018;dull#x02019;, and #x02018;heavy#x02019; [20, 35] and located almost exclusively at csr bank the ipsilateral retromastoid and occipital region [14, 20, 22, 28, 31, 35, 66]. Ajay Somani. As in the current study the main manifestations of C1#x02013;2 degeneration and AAOA are pain with significantly restricted ROM [22, 31], elicited or exacerbated by ipsilateral neck rotation [20, 22, 28, 35, 66]. Our current findings are in line with previous authors#x02019; symptoms predominating on the side of the more significant lateral mass arthropathy, some patients even reporting crepitation [22, 45]. Csr Bank. The pain in AAOA is secondary to ajay somani an irritative phenomenon in the joint itself. When motion is eliminated in the joint, the irritation within ceases and pain generation is halted .
Therefore, immobilization and definite posterior fusion C1#x02013;2 relieves pain in patients with sequelae of AAOA [22, 28, 31, 35, 55] like in csr bank, one of our cases with intractable pain resulting from a C2-vertebral body fracture with a burst pattern at the lateral mass (Fig.#x000a0; 3 , #x200B; ,4). 4 ). Several authors noticed AAOA to be a distracting source of pain [20, 31, 35, 36] and one of the sequelae following C1#x02013;2 fractures [26, 33, 39]. In part I of our project we elaborated the lead incidence of resume csr bank, AAOA with 5% in normals with a mean age of 50#x000a0;years . Nevertheless, degenerative AAOA [28, 31] and posttraumatic AAOA seem to be a neglected and underdiagnosed clinical entity [20, 22, 35, 36, 39]. Thus, we sought to contribute to the understanding and finish your awareness of C2-joint referred pain. With a detailed assessment of clinical and radiographic outcome, we identified posttraumatic AAOA in 20% of cases. We observed a strong correlation between the resume presence of smart essay, posttraumatic AAOA and csr bank worse clinical outcome.
Hence, beside its influence on your thesis, ROT C1#x02013;2 , the restoration of C1#x02013;2 anatomy is resume csr bank, another important factor to be considered in thesis, C2-fracture treatment to avoid C2-malunion and accelerated atlantoaxial degeneration. With growing awareness and the more liberal use of CT-scans using 3D-reconstructions, distinct fracture subtypes that frequently come along with odontoid, Hmfx or vertebral body fractures (e.g. articular surface involvement of C2 or vertebral body widening) will be diagnosed more often. The current study entailed a new approach to the outcome investigation of C2-fractures emphasizing the morphological stratification of distinct fracture subtypes. Using a functional CT-scanning protocol to assess rotation C1#x02013;2, validated outcome vehicles and applying a validated classification for the posttreatment alignment of csr bank, C2 and the C1#x02013;2 complex, we demonstrated that malunion in C2-fractures had strong association with development of AAOA and a significant impact on of writing an undergraduate thesis, clinical outcomes, atlantoaxial and total neck rotation. Further studies will have to analyse the impact of different treatment strategies not only on fusion rates, but also on resume, the anatomical alignment achieved and its effect on resume, outcome.
Electronic supplementary material. Resume. Below is the link to the electronic supplementary material.
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An Exam Reader#039;s Advice on csr bank Writing. Lakeland High School. During my experience as a Reader, I have learned a few things about writing that I would like to share with other teachers. I hope you’ll find my observations helpful as you think about encouraging your students to do their best on the writing section of the lead resume sample AP English Literature Exam. Csr Bank. Students should not begin writing until they fully comprehend the prompt and/or the benefits of writing passage. Mere parroting of the prompt often leads to resume csr bank floundering around instead of developing a clear direction.
I recommend that you advise your students to write directly on the passage and make quick notes and outlines in the margins. This planning enables most writers to organize their ideas more efficiently. I have found that teaching students acronyms for reading and writing strategies (DIDLS, TP-CASTT, etc.) can work wonders. (These terms are discussed in the AP Vertical Teams Guide for English , 2002.) While your very best students might not need them, less able students can find them useful ways to begin. I often suggest that my own students not only mark up the passage, but also use the margins to ajay fill in some of the csr bank acronym steps. This active planning takes an finish thesis extra five minutes or so, but I’ve found that it’s well worth the resume csr bank time. Students who fail to smart vs street smart read closely frequently wind up paraphrasing rather than analyzing the passages. Resume Csr Bank. Planning helps them stay focused.
Although AP Readers are instructed to read the ajay resume entire essay and not to be prejudiced by csr bank, a weak introduction, a strong opening paragraph can be a real asset to a student’s paper. When answering the free-response part of the AP English Exams, writers should answer the question quickly and lead resume, avoid beginning with ideas that do not relate directly to the prompt. The following hypothetical introduction for Question 1 on the 2002 AP English Literature Exam provides an example of csr bank, what not to do: “All people at some point in time have encountered a great deal of trouble in their lives. Lead Resume Sample. I know of so many people who have been embarrassed by resume csr bank, parents that will wave at you from across a room. I have a friend who told me that her parents did this very same thing.” Such generalities often signal a writer’s inability to respond in a thoughtful manner, suggesting that the rest of the paper also may be incoherent or rambling. Lead Resume Sample. The Reader might begin to suspect that the student is just trying to bluff his or her way through the question.
One-sentence perfunctory introductions—especially ones that repeat the wording of the prompt—also work poorly, suggesting to the Reader that the csr bank student isn’t particularly interested or doesn’t care. Sample. I recommend that teachers tell students to create an introduction strong enough to earn a grade of 3 all by itself. That means that students should learn ways to resume csr bank answer the entire prompt—not simply repeat it—in the sample introduction. This indicates to the Reader that the paper could be heading into the upper-half zone. One way to help students improve their beginning is by providing them with several introductory paragraphs from papers that have earned a wide range of scores and asking them to identify stronger and weaker openings. (Sample papers are available on the Exam homepage for the course.) Rubrics especially designed for introductory paragraphs also can be helpful. After having students collect examples of several strong openings, you may want to ask them to develop their own rubric for introductory paragraphs. Use paragraphs and topic sentences.
Although it may seem like a small matter, students should indent paragraphs clearly. Resume. A paper without indentation or with unclear indentation often confuses a Reader. Paragraphs create the benefits of writing thesis fundamental structure of the essay, and without them good ideas can get muddled. Most essays I’ve seen that do not use paragraphs tend to be full of confused and rambling thoughts. Many writers find topic sentences a useful tool both for organizing paragraphs and also for resume, helping Readers navigate through the essay. Lead Resume Sample. To score at least a 3, students would be wise to make use of pertinent references from the text. Encourage them to use specific quotations to back up their assertions. Csr Bank. However, remind them that they must explain their quotes clearly and demonstrate how they are relevant to the question. It is important for young writers to realize that offering long quotes without explanation bogs down the essay and can give the finish your thesis undesirable impression that the student is trying to fill up space rather than answer the prompt!
Short, choppy sentences without variety indicate a student who has little background in grammar and style, perhaps someone who has read and resume, written minimally. Teach students how to and men literary essay connect ideas with transitional wording, participial phrases, appositives, subordinate clauses, etc. I ask my students to imagine children making the resume csr bank same tower or castle each time they played with blocks. They soon would become bored. Likewise, both writers and readers get bored when everything is formulaic, lacking some individual pizzazz! I suggest asking them to experiment with different sorts of syntactical devices to help them develop a sense of style. An arsenal of appropriate vocabulary and analytical wording reveals a brilliant mind at ajay resume work, but writers should make certain that the resume csr bank words fit. Essay. Some students stick in big words just to sound scholarly.
Ironically, some of their papers score only a 2 because they lack clarity and resume, sometimes say nothing of relevance to the prompt. I advise my students to use the active voice as much as possible as one remedy for sample, repetition and other superfluous wording. I also suggest encouraging them to develop a mental thesaurus, so they will have a large variety of words available as they compose.
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College Students Engaging in Risky Behavior. During the first few weeks of college, students, especially freshmen, are at the highest risk of alcohol-related harm. Csr Bank? With the pressures of book smart classes and social acceptance, freshmen feel more anxious about making their way into the college life. We see a spike then because anxiety is high, and resume csr bank, the rigors of coursework haven't yet taken hold” (Cleveland). The drinking problem starts with the way college is portrayed—as a life that revolves around alcohol.
Freshmen come in expecting it to lead resume, be that way, so behave that way, the excessive drinking and reckless behavior are all mirrored from movies and resume, media. Essay? According to national surveys conducted by Harvard School of Public Health, 44 percent of all college students binge drink and many suffer alcohol-induced blackouts. Scott Walters, professor of csr bank behavioral health at University of North Texas Health Science Center, looked at data gathered from surveys of compare-and-contrast 77,000 incoming freshman. The students were questioned about their drinking behavior during the two months before college started and during their first month of freshman year. Not only were freshman drinking more in the fall than in the summer. . Confession of a college student Dwanna Dorsey GEN/195 June 29, 2011 Regina Ford I came into this world on the 14th day of March, in resume, the island of the Philippines. My parents named me Dwanna, which is unique and of mice and men, throughout the years, it fits my personality.
When I turned 12, my mother moved my two sisters and csr bank, me to Carson City, Nevada. The state is beautiful in resume sample, many ways; outdoor activities are widely available, wildlife is vast, individuals here are welcoming and pleasant. Ever since I was little my mother always said, “Everything happens for a reason,” it was until my mother passed that I understood what she meant. I came to realize life is short. Resume? Without any warnings, my life changed. When my beloved son had arrived, I was ecstatic. Resume Sample? My family gathered and my sisters asked, “Now that your son is born. What are your plans?” As a result, I read many reference books about how to accomplish goals to ease some thoughts and questioned myself “what am I going to show and tell my son about resume csr bank, what I have accomplished in life?” Therefore, I decided to attain a degree in literary, business and accounting.
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After forty years without any major updates, The Commons recently underwent a complete overhaul of the interior, with contract operator Aramark putting its Fresh Food Company concept designs into place , complete with new equipment and a signi?cant upgrade in of writing an undergraduate, food options. “As student’s eating habits change, it’s important for resume csr bank us to change and resume sample, update our facilities with them,” says Phil Dibenedetto, resident district manager. Csr Bank? “With our introduction of the Fresh Food P H O T O : The interior was designed to keep with colonial surroundings while offering a restaurant-like atmosphere. (Right.) Phil Dibenedetto (above). recent survey by the trend search organization,Y-Pulse asked 175 college and university students aged 18-25—83% full time and 17% part time—about their eating habits and opinions related to food and beverages. The survey explores subjects such as where students choose to resume sample, eat, factors that in?uence choice of dining locations, favorite foods, beverage options as well as views on healthy lifestyles, diet fads and. Words: 1669 - Pages: 7. . Risky Adolescent Sexual Behavior: The Lack of Parental Supervision and Family Structure At the brink of the twenty-first century, some of the most controversial social issues come from the lack of parental supervision and family structure in resume csr bank, the home; some of these issues include teenage pregnancy, statutory rape and the possibility of engaging in sexual activities that result in catching one or more sexually transmitted diseases. One might have a belief that engaging in sexual activity at a young age or before marriage is an immoral act. However, when adolescents grow up by themselves, they struggle to sample, learn a normal sense of morality. Thus, lack of resume csr bank parental supervision and family structure in and men essay, the home has a negative effect on adolescent sexual behavior.
Social norms are the csr bank criteria that are used in today’s society in essay, order to differentiate between right from resume, wrong and what is considered normal and what is considered simply absurd. One of the “social norms” that society looks upon as abnormal is the lack of parental supervision and literary essay, family structure in the home. Csr Bank? People in this society tend to insinuate that parents should teach their children right from wrong, as they develop into young adults entering into vs street essay the “real world”. Sexual Intercourse is natural and usually occurs in every person’s lifetime; however, when there is a lack of csr bank supervision and an undergraduate, family structure in the home an adolescent’s sexual behavior begins to go astray. Rex Forehand, et al.(1999) states in the. Words: 2372 - Pages: 10. . Resume Csr Bank? If a student is not able to trust the adults they encounter on a daily basis, they will not be willing to take risks and book smart essay, venture outside of resume their comfort zone. Because students spend the majority of their time in book smart, a school setting, it is vital that the environment be a retreat in which students feel safe and cared for. Students with EBD may have built up walls of protection in order to resume, cope with fears and uncertainty. In order to help students progress socially and academically, it is necessary to break down these barriers. This can be done through consistent expectations, engaging curriculum, and positive relationships with involved staff.
Cultural Factors Students come from a variety of backgrounds that consist of different values, attitudes, and norms. When they enter our classrooms, they bring with them the beliefs and vs street smart essay, relationship styles of their communities (Spivak). Cultural factors that influence behaviors are closely related to family factors due to the connections between the two. Children typically learn about how to resume, treat others, appropriate behaviors, and social norms from their families. These are all aspects of culture, and they vary from benefits of writing an undergraduate thesis, family to family in some degree. Values Within one classroom, a teacher may have students who know exactly what college they are going to and the academic requirements to resume, get in, students who plan to graduate high school and hope to further their education at some point, and students who are counting. Words: 1623 - Pages: 7.
Stress on your College Student-Athletes. . Resume? Stress amongst College Athletes Non-Athletes Jeff Bennett University of and men essay Mount Union Abstract Athletic participation and resume csr bank, academic stress has been a challenging topic and one that has made many question about. With all the extracurricular activities that students have, they don’t realize that their stress could be affecting them more than they may know. This study examines the stress level results amongst 10 college student athletes and 10 non-athletes. The results present a rare finding regarding stress amongst the students. Stress has become an on-going issue that has affected the college satisfaction of a student. Many people don’t realize that they have stress and it’s affecting them in some sort of somani way or some may know they have stress but don’t want to take any type of resume action towards getting help. Possible explanations for the findings and implications for stress amongst athletes and non-athletes of the University of finish thesis Mount Union are provided.
Introduction Stress has been a rising issue concerning not only college students but also college athletes. With all the extracurricular activities the students take on in college along with the academic part of it have led to very high stress level. Controlling time and having an organized schedule is the main fix to this problem. Resume? Whether you’re a college athlete or just a normal college student, everyone has stress or has experienced stress. The purpose of this study was to figure out whether or not there is a. Words: 1088 - Pages: 5. How to Be a Successful College Student. . How to be a successful College Student Being successful in college is harder than I thought. To be a successful college student requires hard work, patience, persistence and book smart smart, dedication. Success is born from inside of each one of us. Resume? Success is the desire of each one of ajay somani resume us to be a better person and commit ourselves to the path that will take us there.
Success in resume csr bank, life or in anything someone does comes through hard work and perseverance. It's essential for me to ajay somani, stay focused on my academic goals. This means attending my classes regularly and on time, paying attention to my instructors and tracking my academic progress. There are times, like test and quizzes, which requires me to force knowledge into my head. The best way and the only one to resume, obtain knowledge is by studying. Study habits are one of the essential tools that I must obtain or enhance in order to be successful. It’s not something that can be brushed off. Having a good study habit, avoiding distraction, and having a strong resolve has lead me to accomplishing my first semester here at TC3. When tackling assignments I had to and men literary, make sure to plan well in advance; break down projects into manageable chunks, and setting goals along the way.
Completing homework and class readings on time and resume csr bank, avoid waiting until the book smart smart last minute for important deadlines. Studying involves reading the textbooks, understand them, being able to explain it to others and sometimes memorize the most important concepts. It is important to. Words: 662 - Pages: 3. College Students Engaging in Risky Behavior. . How many of you are under 21 and drink? I’ve heard that college is supposed to be the best four years of resume your life—we have classes that assign heavy workloads, work-study during the week, on of mice the weekends we get to let loose and “turn up”, and resume csr bank, that we will meet some of the an undergraduate best people here, along with finding out who we really are. Some of us think college is like what movies portray them; everybody’s drinking, smoking, and partying, with very little studying and barely any homework.
The realities of college don’t set in resume, until students encounter the coursework that presumably consume their time. Until then, college students tend to have more fun than they usually would back home because of the lack of parental supervision. Lead Sample? During the first few weeks of college, students, especially freshmen, are at the highest risk of alcohol-related harm. With the pressures of classes and social acceptance, freshmen feel more anxious about making their way into the college life. We see a spike then because anxiety is resume csr bank high, and the rigors of coursework haven't yet taken hold” (Cleveland). Of Mice Literary Essay? The drinking problem starts with the way college is portrayed—as a life that revolves around alcohol. Freshmen come in expecting it to be that way, so behave that way, the resume csr bank excessive drinking and reckless behavior are all mirrored from finish your, movies and media. According to national surveys conducted by Harvard School of Public Health, 44 percent of all college students binge drink and many suffer alcohol. Words: 1018 - Pages: 5. Raising a Successful College Student. . Resume? assignments being done on time and turned in for credit or socializing with your peers becomes an finish issue that students face.
This is when students develop time management skills. Resume? They are faced with choosing which clubs to join, which functions to compare-and-contrast essay, attend and making sure their class work remains top priority. Csr Bank? With the guidance of of writing an undergraduate thesis their parents these tough decision can be conquered. Resume? Developing good time management skills will be a huge factor in whether they will be a successful college student in ajay somani resume, the future. As noted by Githens (1996), “Kids need to learn responsibility at an early age, and also to be independent – especially now a days, with all of the peer pressure. If they start learning to csr bank, think about choices they have, they’ll start making choices that will be beneficial to them, rather than choices that somebody has thrown at compare-and-contrast essay them.” (p. 2) When the time comes for a young adult to resume csr bank, enroll into college, a student may finally realize that all of the things they have learned as a child have helped form a strong responsibility foundation.
As the student begins their adventure into college they are faced with their first test of vs street personal responsibility, choosing what college to attend. Csr Bank? Once that choice is compare-and-contrast essay made their main focus is deciding on what will become their area of study. These choices can be influenced by their peers or their parents but a student who has a strong responsibility foundation will use their reasoning skills to help them make this. Words: 1196 - Pages: 5. . Setting high expectations for csr bank responsible student behavior is an essential part of any teacher’s education plan. The knowledge and understanding of these expectations will help students learn valuable skills within social settings, as well as teach them the important fact that there will always be consequences to all of their actions.
These expectations are effective teaching tools during in-class activities as well as out-of-class activities. Ajay Resume? One very common in-class activity would be students answering question during any given lesson. It is very common during this time of the school day for resume csr bank students to compare-and-contrast essay, begin asking questions randomly, which can disrupt the csr bank teacher’s rhythm and interrupt the entire lesson. A behavioral expectation for this activity would be for the students to raise their hand when they have a question, and then wait to be called on before they ask it. This behavior will help students understand the value and importance of patience as well as begin to finish your thesis, condition them to recognize and resume csr bank, accept acceptable patterns of behavior.
Another behavioral expectation would be for the students to only ask questions that are relevant to essay, the lesson at hand. Resume Csr Bank? It is very easy for young children to drift of topic and begin asking questions about subjects they would rather be discussing. By requiring students to only ask questions that pertain to the immediate topic of discussion, they are more likely to stay focused and of mice and men literary, gain a better understanding of the lesson being taught. Words: 1139 - Pages: 5. Student Dropout Problems in College. . Various causes contribute to the student dropout problem in colleges. One of the top reasons for leaving college is that it is hard to have to support oneself and go to school at the same time. Csr Bank? Balancing work and benefits an undergraduate, school is a bigger barrier than finding money for resume csr bank tuition for many.
In fact, more than a third of the thesis dropouts said that even if they got a grant that covered their books and tuition, it would be hard to go back to school, given their work and family commitments (Lewin, 2009). For many, the financial burdens of college are too overwhelming. Often students will plan the finances for only the csr bank first year or the first semester, but they will not look ahead at how they will be paying for the rest. Some students are fortunate, however to have family that can help with their tuition, but that is not the case for all. Only one in five of the vs street students who enroll in two-year institutions graduate within three years. And even at four-year colleges, only two in five complete their degrees within six years. (Lewin, 2009). With government funding dropping, colleges rely largely on higher student tuitions. According to the College Board, the average cost of tuition and resume, fees for the 2013–2014 school years was $30,094 at private colleges, $8,893 for state residents at public colleges, and $22,203 for an undergraduate out-of-state residents. (College Data, 2014). However, college administrators estimate that almost a third of all college students drop out of resume school sometime during. Words: 514 - Pages: 3. . Phenomenon of risky behavior: NSSI •Health behavior models and theories for understanding risky behavior Human behavior is complex and and men, describing and predicting it continues to be a challenge in social science.
Social influence, such as drugs, family, peers, media, has a great impact on development of negative behavior that would require intervention or prevention to make changes in resume csr bank, health and benefits thesis, behavioral habits by examining the behaviors of findings based on current research and theories /models of behavioral change. Per Heilbron et al. (2008) many current research focused on prevalent and resume csr bank, risky group of self –harm behaviors that are growing mostly due to social, peer influence engaging in of mice literary, NSSI. Resume Csr Bank? Nonsuicidal self-injury (NSSI) is one of prevalent health behavior risks in pre-adolescence and adolescence, and lead resume sample, many fields have offered theories and models that can be important applications for research on peer influence and change of behavior in resume csr bank, NSSI groups for behavioral change (Heilbron et al. 2008). Your Thesis? Behavioral theories of peer influence are one application to determine NSSI based on Social Cognitive Theory (SCT, originally social learning theory) (Ragin, 2011). Resume? Social cognitive theory (SCT) is the psychological model of sample behavior developed by the work of Albert Bandura (1977; 1986). SCT (Ragin (2011) suggests that cognitive processes are serious to the acquisition and regulation of behaviors, and individuals learn through modeling, direct operant reinforcement with. Words: 1750 - Pages: 7. . The difference between highschool and csr bank, college life is the incredible increase in literary essay, free time.
In high school, every day was a constant grind and I neverhad any free time. In college I have a surplus. Instead of classes six hours a day, they take up a mere three hours. I'm no longer forced to sit in the same building all day. This newfound time provides many luxuries that can easily be abused. I can be productive or goof off. Time management is the resume csr bank most difficult or stressful about college life. There were many times this semester when I had to write a paper and heard my friends were going to a party. That always happened on resume days that I'd had time to get work done but had wasted it instead. Then I couldn't go out. My biggest fear was how to adjust to this new freedom.
I knew living on resume csr bank my own meant my parents were not going to be breathing down my neck to do my work. They were not going to have me home at a certain hour. I was in complete control. These two aspects of being on my own were very exciting but I wondered how I would do without myparents holding my hand. Once things got rolling I realized I would beall right as long as I stayed motivated. The best advice I could offer future freshman to make the resume adjustment process easier is to stay on top of things. Don't get so caught up in the social atmosphere of resume csr bank college that you get behind in your studies. Remember what you're there for. There is nothing worse than approaching the end of a semester and.
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You might need to focus more on paying attention in class than taking notes; a mini recorder can help. Establish a study group. This is csr bank very helpful in learning material. Since your professor may not always be around to answer your questions, the people in your study group may be able to help. Not only can they help you but a study group is benefits of writing way more fun than doing it alone. It is also a way to meet people in your classes.
Also, make sure you have a regular time and quiet place for studying every day. Managing the time is an important factor that every good student must possess. All time management begins with planning. Use lists to set priorities. Create a weekly calendar to make a time budgeting guide. Write down all the resume csr bank things you want to do include homework due dates, or subjects you want to of writing an undergraduate, draw attention to. Csr Bank? Often delaying the tasks, such as writing assignments, reading text books, etc, may. Words: 472 - Pages: 2. . Cesar Monterroso Jr February 23rd, 2016 FY 101 PL01 Professor George Gonzalez College Student Ethics The college years are marked by social changes and behavioral experimentation which may increase risk of suicidal thoughts.
There seems to be a pathway for the development of suicidal thoughts between two established suicide risk factors, loneliness and drug use, As suicide is the third leading cause of your death among individuals aged 15 to resume, 24 years. (Centers for Disease Control Prevention, 2010) Within that same age group, the suicide rate has tripled since 1950. College students may be at particular risk for suicidal thoughts and behavior, especially since it is the second most common death among that same social group. We often wonder what are the triggers that lead the students to commit such acts? Students are put into a brand new environment. Most students often deal with being away from home for their first times, put into dorms with complete strangers and work under extreme pressures. The biggest take-away is the abrupt transition.
Students are often left with dealing their own finances for the first time in their lives. Now you add the large college workload, personal struggles such as family or relationship problems, pressures to compare-and-contrast, succeed, academic failure, financial stableness and you have a deadly mixture. Suicide just does not come when a person goes to college, it develops through the student’s childhood and life. This sense of helplessness goes to. Words: 692 - Pages: 3. . Assignment 3.1: Determining Causes and Effects – Revised Version Pacience Jordan February 16, 2016 Professor Roger Fontana English 115 Determining Causes and Effects – College Stress There are many different things that seem to cause stress on college students.
College students do not seem to get a break from the workload. Csr Bank? Even when they are not physically doing the work it still happens to be on their mind. Many college students have to battle with work, school, and even children at sample home. Resume Csr Bank? It may seem like it isn’t a lot to deal with but it can be very stressful. Increased Responsibility and Independence During college change is ajay somani a very big factor in a freshman’s life. Deal with change for csr bank many people can be very difficult. Essay? For many people leaving home and going to college is csr bank a sign that they are now on their own.
They are now adults and have to make decisions for themselves to finish, better their future. Being faced with making very important decision that could affect the rest of your life can be stressful. Overachieving Other college students are stress out resume csr bank, because simply because they are being pushed by their parents to be the best that they can be. They are pushed to lead, get into resume csr bank the finest schools so they acquire the best career. Even though it is not a bad way of thinking it can cause a boat load of stress.
Students seem to take on more than.