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C2-fractures: part II. Internship Essay! A morphometrical analysis of Effectiveness Directors, computerized atlantoaxial motion, anatomical alignment and internship essay, related clinical outcomes. Knowledge on gatsby cars, the outcome of C2-fractures is founded on heterogenous samples with cross-sectional outcome assessment focusing on union rates, complications and internship essay, technical concerns related to essay 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 internship essay current study is to investigate the radiographic, functional and clinical outcome of a patient sample with C2-fractures. Out of how to write, 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. Internship! Outcome analysis included validated measures (SF-36, NPDI, CSOQ), and a functional CT-scanning protocol for of Non-Executive Directors Essay the evaluation of internship essay, C1#x02013;2 rotation and alignment. Mean follow-up was 64#x000a0;months and cars, 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 internship, patients were treated with a halo, 34% with a Philadelphia collar and 34% had anterior odontoid screw fixation. Define! At follow-up mean atlantoaxial rotation in internship left and Bovary by Gustave Essay, right head position was 20.2#x000b0; and essay, 20.6#x000b0;, respectively. According to Acquisition Essay the classification system of essay, posttreatment C2-alignment established by our group in Essay part I of the internship C2-fracture study project, mean malunion score was 2.8 points. Two Paragraph Essay! In 49% of internship essay, patients the fractures healed in great gatsby anatomical shape or with mild malalignment. In 51% fractures healed with moderate or severe malalignment. Self-rated outcome was excellent or good in internship 65% of should be banned, patients and moderate or poor in essay 35%. The raw data of varying nuances allow for comparison in future benchmark studies and delinquents, metaanalysis. Internship! Detailed investigation of Effectiveness of Non-Executive Essay, C2-fracture morphology, posttreatment C2-alignment and internship essay, atlantoaxial rotation allowed a unique outcome analysis that focused on the identification of risk factors for great gatsby poor outcome and the interdependencies of outcome variables that should be addressed in essay studies on C2-fractures. We recognized that reduced rotation of two paragraph, C1#x02013;2 per internship essay, se was not a concern for the patients. Acquisition Essay! However, patients with worse clinical outcomes had reduced total neck rotation and rotation C1#x02013;2.

In turn, C2-fractures, especially fractures affecting the lateral mass that healed with atlantoaxial deformity and internship, malunion, had higher incidence of atlantoaxial degeneration and osteoarthritis. What Is Selectively Membrane! Patients with increased severity of C2-malunion and new onset atlantoaxial arthritis had worse clinical outcomes and significantly reduced rotation C1#x02013;2. Essay! The current study offers detailed insight into the radiographical, functional and clinical outcome of define juvenile delinquents, C2-fractures. It significantly adds to essay the understanding of beauty should be banned, C2-fractures. The online version of essay, this article (doi:10.1007/s00586-009-0901-4) contains supplementary material, which is available to is selectively authorized users. The ideal treatment of internship, odontoid and Effectiveness of Non-Executive Essay, other C2-fractures remains controversial. The lack of a comprehensive treatment-oriented classification of C2-fractures, that guides when to operate and internship, when to select conservative treatment, reflects the fact that there exists no ideal solution for the clinical problem, yet [56]. Great Gatsby Cars! In contrast, there is internship a large body of should be banned, literature concerning techniques, indications and internship, union rates in C2-fractures [72], but data regarding the most important outcome measure, the functional and two paragraph, clinical outcome, are scant [24, 68]. Internship Essay! Currently, in addition to nonsurgical treatment including semirigid collars or the Halo-thoracic-vest (HTV), contemporary surgical techniques for how to compare essay the treatment of C2-fractures include anterior odontoid screw fixation (AOSF) [2, 62], posterior and anterior transarticular screw fixation C1#x02013;2 [51], C1-lateral mass and C2-Isthmus/lamina fixation [32] and plated anterior discectomy and fusion for essay the unstable Hangman#x02019;s fracture (Hmfx) [46, 83]. Beauty Pageants Should Be Banned! These techniques are standardized and, if used for essay the appropriate fracture subtype, can show favourable results. Delinquents! For the treatment of isolated odontoid type II fractures in essay the young patient AOSF is Effectiveness of Non-Executive Directors increasingly favoured while accepted standards for the remaining multitude of distinct C2-fracture patterns are lacking.

The question remains which treatment method is internship essay appropriate for which fracture pattern to Effectiveness of Non-Executive yield superior functional outcome? In addition to internship the interest in pageants should be banned outcomes concerning pain and internship, well-being, the treatment of C2-fractures is also to be discussed with regard to the impact on the resulting posttreatment function and atlantoaxial motion. Compare! Any C2-fracture affects at internship least theoretically the ability of the C1#x02013;2 complex to take the great major part in internship essay total neck rotation. Using functional CT-scans in 14 patients, Jeanneret [39] showed that the Language Acquisition range of essay, motion (ROM) for Effectiveness Directors the rotation C1#x02013;2 (Rot C1#x02013;2 ) was significantly reduced even after anatomical reduction of internship, odontoid fractures with AOSF. Hence, discussions concerning the gatsby motion-preserving merits of any technique should be done carefully. Therefore, the internship authors intended to define juvenile delinquents add objective outcome data in the C2-fracture research evaluating clinical and functional long-term results after non-surgical or surgical treatment of C2-fractures on a homogenous sample of neurologically intact patients. Internship Essay! For a detailed insight into functional outcome, validated generic and delinquents, disease specific outcome measures and internship essay, the use of functional CT-scanning for the assessment of the The Suppression of Homais Bovary Essay ROT C1#x02013;2 were indicated. In this context, the malunion rates were also assessed.

Additionally, the authors applied the previously established classification of posttreatment C2-alignment [44]. Internship Essay! 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 Language interdependencies between posttreatment C2-alignment and internship essay, the range of is selectively membrane, ROT C1#x02013;2 , (2) assess the impact of fracture pattern, C2-alignment and essay, ROT C1#x02013;2 on cars, the clinical outcome in essay terms of validated measures, (3) identify risk factors for poor outcome. With the use of The Suppression in Madame Bovary by Gustave Essay, objective outcome measures applied on internship essay, a homogenous group of patients with C2-fractures, the The Suppression Bovary current study is unique in essay the cervical spine trauma literature. We reviewed all charts of membrane, patients treated for essay cervical spine injuries at the authors#x02019; institution between 1997 and Directors Essay, 2007. Essay! Patients#x02019; demographics including injury type description were recorded. A detailed case review indicated 121 patients treated for acute injuries of the two paragraph C2-vertebra. For the internship essay purpose of reconstructing a strongly homogenous sample patients had to be banned fullfill the following criteria: (a) C2-fracture with or without stable atlas fracture treated surgically or nonsurgically, (b) age between 18 and internship, 80#x000a0;years at pageants be banned injury, (c) full set of internship, injury cervical spine antero-posterior (ap) or transoral and Effectiveness of Non-Executive Directors, lateral radiographs, (d) interval between injury and essay, treatment #x02264;10#x000a0;days, (d) understanding of author#x02019;s language, (e) minimum 6-months follow-up, (f) absence of how to, spinal cord injury (ASIA A-D).

Cases were excluded if they met the 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 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 internship essay degenerative cervical disease or trauma, (n) worker#x02019;s compensation claims, (o) fusion of C1#x02013;2. Cars! Patients were assessed by written interview prior to follow-up and results were blinded to essay the authors during clinical survey. Language Essay! Outcome measure included the 36-item short-form health survey (SF-36) version 2, the long-term cervical spine outcome questionnaire (CSOQ) [4] and essay, the neck pain disability index (NPDI) [77]. Of Homais Flaubert! The questionnaires have been validated for issues related to cervical disorders [4, 23, 75] and the methods for essay scoring as well as the beauty pageants interpretation of essay, results were illustrated in detail in 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 The Suppression in Madame Bovary Essay distinct answers ticked within the internship CSOQ (No. The Suppression Of Homais In Madame Flaubert! 40#x02013;42). The incidence of internship essay, dysphagia was evaluated with the grading system of Bazaz [3].

None, mild, moderate or severe was graded by distinct combinations of difficulties with liquid and essay, solid nutrition. Any medical or surgical complication documented between the index treatment and follow-up related to internship essay the procedure was recorded. Of Non-Executive! Plain injury ap and internship, lateral radiographs were available in great all cases. Injury CT-scans were available in essay 32 patients (86%). At follow-up, all patients were subjected to define functional CT-scanning including a CT-scan in neutral position with 0-degree gantry angle. Internship! 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 define delinquents, overlapping axial slice thickness of internship essay, 1#x000a0;mm. Sagittal and coronal reconstructions were performed using standard spine algorithms and gatsby cars, files were stored digitally (PACS Magic View VC 42, Siemens). Internship Essay! Digital CT measurements (0.1#x000a0;mm increments) were performed on what is selectively membrane, the reconstructed CT-scans in a commercially available software program (Escape Medical Viewer V3). Radiographs and internship essay, CT-scans were reviewed for how to write compare essay fracture classification. Global radiographical assessment of internship, fracture types was performed with differentiation into beauty pageants main categories, such as odontoid or Hmfx, using a descriptive taxonomy (see Table#x000a0;1 in Electronic supplementary material).

For the internship essay purpose of future data pooling as well as due to the lack of a single comprehensive classification including all kinds of how to, C2-fracture patterns [47] detailed stratification of C2- and internship, concommittant C1-injuries was done using a numerical system as templated in Electronic supplementary material Table#x000a0;2. Through combinations, the gatsby numerical classification addresses all kinds of C2 and essay, C1#x02013;2 fracture patterns. Gatsby Cars! It allows for nominal statistical analysis and essay, correlative assessment of both radiological and clinical outcome. It differentiates straight forward anatomical structures that are affected in Acquisition C2-fractures (it is internship essay 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. Should! Interpretation of the inherent stability of the internship various fractures is not different to accepted definitions [56] e.g., qualifiers of instability like discoligamentous injury C2#x02013;3, axial osseo-ligamentous distraction of C2, rupture of Essay, transverse ligament of C1, burst fracture of C2 or displaced odontoid fracture. Assessment of internship, 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 Effectiveness of Non-Executive Essay two types of atlantoaxial osteoarthritis (AAOA) as previously elaborated [44]. 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 internship essay, coronal CT-scans. Beauty Should Be Banned! In addition, the internship left and two paragraph essay, right atlantoaxial joint hights (lAAJH and internship essay, rAAJH) were measured on injury CT-scans, if available, and on Directors, all follow-up CT-scans at the center of the internship essay lateral C1#x02013;2 joints as described [44]. Acquisition! For the internship essay purpose of Acquisition, comparative studies, AAJ degeneration was assessed using the classification of internship, Lakshmanan [54] too. Compare! Assessment of internship, fusion and write essay, posttreatment C2-alignment. At final follow-up, reconstructed sagittal and coronal CT-scans in essay neutral head position were assessed for osseus union by three of the essay authors. Fusion was present if bridging trabeculae were confirmed at least on internship, one of the Language Acquisition Essay cortices in both the sagittal and lateral plane by internship, all observers. Effectiveness! With the same CT-reconstructions, assessment of internship, C2-alignment was performed using the classification for Directors posttraumatic C2-alignment (CPA-C2) [44].

With the CPA-C2 the internship morphometrical measurements showed substantial interobserver agreement. Distinct cut-off values of the great gatsby 95% upper and essay, lower limits of a physiological standard were assigned end-point anchors of 1 or 2 pts delineating non-physiological dimensions. Two Paragraph! The final grading of the C2-aligment into internship normal, mild, moderate and great gatsby, severe malalignment based on essay, the summed points [44]. Functional computerized tomography. Permeable! Apart clinical examination by internship, the author all patients were subjected to functional computerized tomography. The Suppression Of Homais In Madame By Gustave Flaubert! The assessment of ROT C1#x02013;2 was performed using functional CT-scans in internship essay supine position. Define Delinquents! A reduced radiation exposure with low energy beam was selected with settings of internship essay, 120#x000a0;kv and great, 80#x000a0;mA sufficient to delineate bony landmarks, joint configurations and fusion. Internship! Because subaxial flexion or extension influences the rotational capacity at Language 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 the C3 vertebra distally. After the neutral CT-scan the patients were asked to essay rotate their neck to pageants should be banned the right, as far as possible. CT-scans were completed following adjustments of the essay FOI for juvenile axial slice reconstructions in the plane of the essay approximately 20#x000b0; inclined atlas vertebra. The Suppression Bovary By Gustave! Finally, the essay procedure was repeated for Essay the assessment of essay, left-sided rotation. With the Effectiveness of Non-Executive Directors Essay functional CT-scans, axial, sagittal and internship essay, coronal slices were reconstructed and stored digitally.

To investigate the Essay ROT C1#x02013;2 , adjacent motion at the C0#x02013;C1 joints (ROT C0#x02013;1 ), total neck rotation (ROT C0 ) and internship, subaxial rotation (ROT C2 ) computer measurements on the axial slices were as follows (Fig.#x000a0; 1 ): in each head position the Effectiveness of Non-Executive occipital midline indicated maximum head rotation (ROT C0 ) delineating the ability of the internship essay total cervical spine to pageants should be banned rotate to essay either side. Should! The landmarks for the occipital midline included the beak of the essay hard palate, the define delinquents midline of the essay clivus and occpital protuberance. Next, the Language Acquisition mid-sagittal line of C1, that is essay a line connecting the Essay anterior atlas tubercle with the internship middle of the posterior atlas arch, was drawn. Should! Its perpendicularity to a line connecting the center of the essay 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 ). Similarly, rotation of C2 was assessed drawing a mid-sagittal line of C2, that is permeable membrane a line perpendicular to the posterior cortical wall of the internship C2-vertebral body at compare and contrast its most caudad level. If the internship essay C2-vertebral body was affected by Directors Essay, fracture trace up to internship essay the mid-sagittal plane, then the mid-sagittal axis of write compare, C2 was the line joining the essay slight midline anterior prominence on the C2-body and delinquents, the cleft of the bifid spine or the essay perpendicular of the is selectively membrane intertransversarium line.

The mid-sagittal line of essay, C2 was calculated to the vertical axis delineating maximum rotation of C2 to either side and maximum rotation of the subaxial cervical spine (ROT C2 ). Define Juvenile! Finally, left and right ROT C1#x02013;2 were calculated and expressed as the separation angle between C1 and internship essay, C2, i.e., subtracting the Effectiveness Directors Essay C2 angle by the C1 angle. Similarly, the essay atlantooccipital rotation (ROT C0#x02013;1 ) was calculated subtracting the C1 by compare and contrast, 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 . Internship! 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 Language, normals published by essay, Castro [9]. With functional CT-scanning, the essay left and right ROT C1#x02013;2 were classified into internship four types: Type 1 (no restriction), #x02265;30#x000b0;; Type 2 (mild), 20 to of Non-Executive #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 internship essay statistical analysis. Define Juvenile Delinquents! We determined a cut-off rendering physiological and pathological ROT C1#x02013;2 as any measure #x0003c;30#x000b0;, that is a deviation of approximately #x000b1;2SD from normalcy. Essay! For the Effectiveness Essay purpose of assessing changes of the instantenous center of rotation (ICR) of the C1#x02013;2 joints the authors applied a technique similar to White and essay, Panjabi [81] on each subject (For technique and results see Electronic supplementary material).

Statistical analysis included parametric methods (independent and two paragraph, dependent two-sided Student t tests, Pearson#x02019;s correlation coefficient) and essay, 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 Effectiveness Essay, 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). Internship! Statistical analysis was performed by one of the gatsby authors (WH). The author (HK) performed the classification of the posttreatment C2-alignment as described [44] on all CT-scans. Internship Essay! As there are currently no data on what membrane, the reliability of internship essay, measurements using CT-scans, the author performed the assessment of the C2-alignment with all indicated measurements on gatsby, plain radiographs and on internship, 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 [44]. Write Compare! 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 internship follow-up. Of another 4 patients that were successfully tracked, 1 denied taking part in the study because of beauty should, 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 internship essay severe malunion. Cars! She joined the internship essay follow-up but could not be included into the study because of pageants, mental retardation. Internship! She displayed restricted axial rotation in gatsby cars flexed position (10#x000b0;#x02013;0#x000b0;#x02013;5#x000b0;), complained of essay, pain during head rotation, had a cock-robin head posture and Directors, 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 internship essay 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 define, advanced cardiac disease. One 19-years-old with 2-years follow-up after combined odontoid type II and C1 posterior arch fracture treated with double AOSF was working abroad, doing well as assessed by telephone questioning, but could not be surveyed. Internship Essay! Finally, 35 patients could participate resembling a follow-up rate of Language Essay, 80%. Mean age at internship essay injury was 46.9#x000a0;#x000b1;#x000a0;21.7#x000a0;years (range 17#x02013;78#x000a0;years) and Essay, 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). Essay! Eleven patients (31.4%) were smokers. Except for The Suppression of Homais Essay mild skull traumas, 12 patients (34.3%) had co-morbidities and concommittant peripheral skeletal injuries (Table#x000a0;3 in internship Electronic supplementary material). At follow-up, no patient complained about disability derived from shoulder-girdle injuries or peripheral injuries. Main injury mechanism was a motor-vehicle or bicycle accident in 15 patients (42.9%), a skiing casual in Essay 4 (11.4%) and internship, a fall from height in beauty should be banned 15 (42.9%). One suffered a direct blow (2.9%). Internship Essay! Eighteen patients (51.4%) had initial treatment in a referral hospital and gatsby cars, were transferred for definitive treatment. Internship! Except for great three patients that had plain radiographs, we had injury radiographs and internship, CT-scans available.

Twenty-three patients (65.7%) were subjected to is selectively permeable nonsurgical treatment: 11 patients (31.4%) had HTV treatment and 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 internship essay C2 for is selectively permeable redislocation of essay, her odontoid type III fracture. Great Gatsby! Mean time to internship index surgery was 2.5#x000a0;days (range 0#x02013;10#x000a0;days). Patients#x02019; characteristics are summarized in how to Table#x000a0;1 in internship essay Electronic supplementary material. Twenty-three patients (65.7%) had 2-part-fractures, 11 (31.4%) had 3-part-fractures and juvenile delinquents, 1 (2.9%) had a 4-part-fracture. There were 24 fractures (68.6%) involving the internship essay odontoid that could be classified into 12 (50%) type II fractures (including IIa) and Essay, 12 (50%) type III fractures according to essay the Anderson classification. Eighteen patients (51.4%) had a fracture pattern involving the vertebral body. Seven patients (20%), out of Language Acquisition, a total of essay, 8 with an atypical Hmfx, had a vertebral body fracture separating the posterior axis wall [45, 46]. Beauty Pageants Should! In 11 patients (31.4%) the fracture pattern included a dislocated or a burst lateral mass fracture of C2. At all, 19 patients (54.3%) had an essay intraarticular fracture pattern resembling an Effectiveness Directors Essay involvement of the essay lateral mass and define delinquents, its articular surface inside or outside the essay weight-bearing zone, displaced or non-displaced. Out of The Suppression of Homais Bovary Flaubert Essay, 35 patients, 7 (20%) had a concomittant C1 fracture.

C1 fractures included 1 lateral mass fracture with articular surface involvement and internship, two stable extraarticular Jefferson burst fractures. Follow-up CT-scans showed that 31 fractures (88.6%) of what, C2 (and all fractures of C1) went on internship essay, to union, in pageants should 4 cases (11.4%) a nonunion developed. Internship! Nonunion was mobile in of Non-Executive Directors 2 (50%) patients, showing a tight fibrous-stable nonunion in the remaining 2 (50%). Stability was established on flexion-extension films at follow-up. Statistical investigation showed that union was not related to follow-up length, age, gender, type of fracture or any other variable.

At injury 7 patients had a left-sided AAJ configuration of Type B and internship essay, 5 of Essay, these had also a right-sided Type B. Internship Essay! At time of how to compare, injury only internship essay two patients showed preexisting advanced atlantodental and lateral atlantoaxial degenerative process. At follow-up nine patients had left-sided and write compare, ten had right-sided Type B AAJ changes. Essay! Seven patients (20%) had a new onset AAOA of Flaubert Essay, Type B. According to the classification of Lakshamanan [54] 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 internship follow-up. Injury AAJH was assessable in 16 patients (45.7%). LAAJH was a mean of two paragraph, 2.9#x000a0;#x000b1;#x000a0;0.7#x000a0;mm (range 1.6#x02013;4#x000a0;mm) and essay, rAAJH was 3.1#x000a0;#x000b1;#x000a0;0.8#x000a0;mm (range 1.6#x02013;4.5#x000a0;mm). How To And Contrast! At follow-up lAAJH was a mean of essay, 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 normals [44] left- and of Homais in Madame Bovary Flaubert, right-sided AAJH at internship essay follow-up did not correlate with patients#x02019; age ( P #x000a0;=#x000a0;0.05, P #x000a0;=#x000a0;1.0). Is Selectively Membrane! There was a significant difference regarding the incidence of left- and internship essay, right-sided AAOA of Type A and of Type B between time of two paragraph, injury and essay, 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 two paragraph essay patients that had AAOA of internship essay, Type B (left #x000d8;2.0#x000a0;mm, right #x000d8;2.2#x000a0;mm) compared to patients that had AAOA of how to write compare essay, Type A (left #x000d8;3.1#x000a0;mm, right #x000d8;3.4#x000a0;mm). Internship! The results of the of Homais by Gustave Essay functional CT-scans are illustrated in essay Table#x000a0; 1 and Effectiveness of Non-Executive Directors, compared to data derived from normals. Internship! An illustrative case is in Madame by Gustave Essay given in Fig.#x000a0; 2 . The interdependencies of the cervical rotation angles are ranked in internship essay Table#x000a0; 2 . How To Essay! Patients displayed an increased total neck rotation (ROT C0 ) in the presence of internship essay, increased subaxial rotational capacity (ROT C2 ). Juvenile! As expected, total neck rotation was further increased if the internship C1#x02013;2 joints (ROT C1#x02013;2 ) could substantially contribute to Effectiveness of Non-Executive overall neck rotation. Internship Essay! Likewise, with increasing ROT C1#x02013;2, the two paragraph essay %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 essay subaxial rotation (ROT C2 ) because of the two paragraph essay definition of internship essay, %ROT C1#x02013;2 ). In case of Acquisition, decreased atlantoaxial rotation the internship essay subaxial spine tended towards compensational rotation not reaching significance: In patients with no subaxial degenerative changes we observed a trend of the juvenile subaxial spine to internship compensate for pageants be banned a lack of ROT C1#x02013;2 but a reduced ROT C1#x02013;2 could not be fully compensated by 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 internship essay, ROT C2 ( P #x000a0;=#x000a0;0.007) with the define juvenile higher rotational ability to essay the right for all measurements. But the great 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 . Internship Essay! A unilaterally restricted ROT C1#x02013;2 was not compensated for by a substantially increased contralateral rotation. In contrast, reduced ROM for Essay atlantoaxial rotation to internship essay the left or right was accompanied by a significantly reduced ROM for the ipsilateral subaxial rotation. What Is Selectively Permeable Membrane! Out of internship essay, 35 patients 4 (11.4%) were identified having ROT C1#x02013;2 according to Type 1, 6 patients (17.1%) Type 2, 20 patients (57.1%) Type 3 and 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 define, rotational restriction and the definition of total neck rotation with a cut-off of 30#x000b0; had no impact on essay, the clinical outcome measures. Essay! We calculated the rotation against age and encountered a significant inverse correlation (Table#x000a0; 3 ). Internship Essay! 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 what permeable, 36#x000b0; on essay, average and a mean total neck rotation of 96#x000b0;. Essay! The first author performed all measurements. The analysis of intraobserver reliability demonstrated good to internship essay excellent agreement between radiographic and CT-based measurements with intraclass coefficients of juvenile delinquents, #x0003e;0.6 for internship all measurements applied.

There were no measurements performed that were classified as #x02018;pathological#x02019; but otherwise were within normalcy on beauty pageants, CT-scans, et vice versa. According to internship essay the author#x02019;s classification and what membrane, grading of internship essay, morphometrical alignment [44] 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 [44], in delinquents 5 patients (14.3%) the C2-fracture healed in internship anatomical shape without any malalignment and in permeable 12 (34.3%) with mild malalignment. Internship Essay! Twelve fractures (34.3%) healed with moderate and two paragraph, 6 (17.1%) with severe malalignment. Internship Essay! At all, the C1#x02013;2 complex showed moderate or severe malalignment in beauty 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 essay 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). What Membrane! In addition, it striked that patients with higher malunion scores (ANOVA) and moderate/severe malalignment showed a significantly reduced clinical outcome in terms of essay, SF-36 MCS ( P #x000a0;=#x000a0;0.02 and define, 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 internship, 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 P #x000a0;=#x000a0;0.036). Of Non-Executive! Means, SD, and internship essay, ranges of outcome measures are illustrated in beauty pageants be banned Tables#x000a0; 4 and #x200B; and5. 5 . Data are presented in comparison to results of other studies. Internship! The outcome measures and questionnaires utilized showed good consistency when assessing differences in gatsby cars clinical outcome.

Assessment of essay, clinical outcomes with the validated measures (SF-36, NPDI, CSFQ) and essay, their correlation with the internship 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 Language P #x000a0;=#x000a0;0.003). There were significant differences within the internship essay validated measures if calculated for the 4 groups of The Suppression of Homais by Gustave Flaubert, global outcome: #x02018;excellent#x02019;, #x02018;good#x02019;, #x02018;moderate#x02019; and essay, #x02018;poor#x02019; (Table#x000a0;4 in Electronic supplementary material). There was also a significant correlation between the Language Essay validated outcome measures and inbetween the various scoring items of the queries (Table#x000a0;5 in Electronic supplementary material). Internship! Self-rated outcome was judged excellent by Effectiveness of Non-Executive, 15 patients (44.1%), good by internship, 7 (20.6%), moderate by permeable, 10 (28.6%) and poor by internship, 2 patients (5.9%). So, 65% of patients judged their outcome as good or excellent and Bovary by Gustave, 35% as moderate or poor. With the worse self-rated outcome patients displayed a significantly reduced total ROT C1#x02013;2 rotation ( P #x000a0;=#x000a0;0.02) and internship, 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 what permeable, the CSOQ-shoulder pain severity composite score ( R #x000a0;=#x000a0;#x02212;0.44, P #x000a0;=#x000a0;0.01). Internship Essay! 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 two paragraph NPDI ( R #x000a0;=#x000a0;#x02212;0.37, P #x000a0;=#x000a0;0.04) and internship, the CSOQ-shoulder pain severity composite score ( R #x000a0;=#x000a0;#x02212;0.45, P #x000a0;=#x000a0;0.01). When calculating the age and gender matched percentage restriction of total neck rotation [9] against the clinical outcome measures, correlations existed for the SF-36 PCS ( R #x000a0;=#x000a0;0.54, P #x000a0;=#x000a0;0.001), the great gatsby 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 internship essay CSOQ-neck pain severity composite score ( R #x000a0;=#x000a0;#x02212;0.39, P #x000a0;=#x000a0;0.02) and what is selectively membrane, 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. Internship! As it was with the ability to define juvenile rotate the neck, statistical analysis revealed a decreased clinical outcome for internship elderly patients in 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 The Suppression Bovary by Gustave terms of the internship 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 essay, outcome related interdependencies into internship essay perspective. In Madame Bovary By Gustave Flaubert Essay! It is internship essay 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 define juvenile delinquents whole cervical spine was a factor of aging, motion induced pain and a low functional outcome. Internship! Significant gender-related differences existed in terms of the Language 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 internship be interpreted with the should awareness of gender distribution with varying fracture patterns and ages.

So, 8 of internship essay, 11 patients (73%) with a burst or dislocated lateral mass fracture were female. How To Essay! Similarly, when assessing intraarticular fracture pattern as a variable, 8 of 12 females depicted reduced motion pattern and increased pain-levels. 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 internship essay, clinical outcome or cervical rotation (Table#x000a0; 3 ). Notably, the great gatsby cars number of essay, 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 Language Acquisition Essay, the clinical outcome measures. If the essay smallest denominator was assumed to great cars be an essay 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 be banned particular reduced %ROT C1#x02013;2 ( P #x000a0;=#x000a0;0.006). Rotational abilities were strongly affected by the presence of an essay intraarticular fracture pattern.

Calculating any intraarticular fracture pattern against the outcome measures did reveal trends, but did not yield significance. How To Write! In this context it is of note that only internship 11 patients were identified to in Madame by Gustave Flaubert Essay have had a dislocated fracture or burst pattern involving the articular pillar and lateral mass. If calculating rotation and internship, clinical outcome against the presence of a burst or dislocated lateral mass fracture in Language Acquisition Essay eight patients at internship essay 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 permeable membrane CSOQ-functional disability score ( P #x000a0;=#x000a0;0.01) and the CSOQ-physical symptoms score ( P #x000a0;=#x000a0;0.01). Essay! 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 how to write, 2.5 points are thought to essay be a clinically meaningful difference for compare and contrast the SF-36 [18, 80].

Patients that had the essay 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. Of Homais In Madame Bovary By Gustave Essay! However, these patients had worst scores with the CSOQ-functional disability score ( P #x000a0;=#x000a0;0.007) and internship essay, the SF-36 MCS ( P #x000a0;=#x000a0;0.05). This group of gatsby cars, patients included most of the internship essay dislocated burst lateral mass fractures, patients with intraarticular fractures and the group with highest malunion scores. Be Banned! Eleven patients (31.4%) had at least one lateral AAJ of Type B and 6 of 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 two paragraph mid-range or extremes of axial head rotation in essay neutral or sagittally flexed head position or reported on tenderness and localized pain at how to write and contrast the C2-spinous process during daily activities. According to distinct questions within the internship essay CSOQ 20% of Language Essay, patients reported that they would need additional treatment for their neck condition in essay the future.

Sixty-one percent of define juvenile delinquents, patients judged they would be extremly or moderately satisfied if their neck condition would be the essay same as at great cars follow-up, while 20% judged they would be moderate or extremely dissatisfied if the internship neck condition would remain the how to compare and contrast essay same (20% ticked #x02018;neither satisfied nor dissatisfied#x02019;). Twenty-three percent reported that the essay actual result was somewhat or much worse as expected, 49% reported it was somewhat or much better than expected, and gatsby, 28% as expected. Internship! Concerning AAOA, the Acquisition Essay presence of internship, Type B changes at follow-up had significant impact on the rotational ability and write and contrast essay, 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 internship SF-36 MCS ( P #x000a0;=#x000a0;0.01), the The Suppression Bovary by Gustave Flaubert NPDI ( P #x000a0;=#x000a0;0.002), the internship CSOQ-psychological distress score ( P #x000a0;=#x000a0;0.0005), the CSOQ-physical symptoms score ( P #x000a0;=#x000a0;0.01) and Essay, 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 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 internship, 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 essay, 11 patients (72.7%) with displaced or burst lateral mass fractures the essay left side was affected. Directors! 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 internship essay most on the left side ( P #x000a0;=#x000a0;0.0005). When calculating for Essay the intraarticular fracture pattern that affected the left side in essay 11 of two paragraph, 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. Internship! The findings of Effectiveness of Non-Executive, left-sided preponderance were incidental, but substantiated that the essay intraarticular and particularly burst fracture patterns show their main adverse effects on the development of ipsilateral AAOA, reduced total ROT C1#x02013;2 and The Suppression Bovary Flaubert, %ROT C1#x02013;2 and internship essay, C2-malunion scores. Essay! The latter had the internship largest impact on The Suppression in Madame Bovary by Gustave Flaubert Essay, clinical outcome measures. Essay! Fourteen patients (40%) were already retired at time of essay, injury unrelated to internship disorders of the neck. Of 21 patients occupied at time of Language, injury 15 achieved a level of internship, W1 (42.9%) according to Denis#x02019; Work Scale, 1 had W2 (2.9%), 2 had W3 (5.8%) and The Suppression of Homais Bovary by Gustave, 3 patients (85.7%) were not able to resume previous full-time employment or were unable to internship essay work because of what permeable membrane, neck related impairment. Eighteen patients (85.7%) went back to a full-time employment with a mean time out of internship essay, work of 17.0#x000a0;#x000b1;#x000a0;6.8#x000a0;weeks (range 3#x02013;24#x000a0;weeks) after injury. Acquisition Essay! With the internship dysphagia grading system of Bazaz [3] the Language mean score was 1.4#x000a0;#x000b1;#x000a0;0.7 (range 0#x02013;3) for essay 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 great gatsby cars a former pin-site with subsequent phobia wearing huts. Internship Essay! One patient had screw-related dysphagia following double AOSF but denied screw removal. Effectiveness! Another had hard-to-treat C2-referred pain lasting for 8#x000a0;months after nonsurgical treatment of an internship essay odontoid type III fracture with split-impression fracture of the lateral mass. Cars! 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 internship comminuted lateral mass. Symptomatic nonunion with severe malalignment developed and pageants, the patient was subjected to essay anterior retropharyngeal release with reduction and define delinquents, C2-buttress-plating 6#x000a0;months after the internship index treatment. Gatsby Cars! Implant removal was performed 1.5#x000a0;years after index therapy. After 3#x000a0;years the patient showed up reporting a progression of myelopathic signs during a 4-weeks period which was found to internship essay be related to anterior subluxation of beauty should be banned, C1 on C2.

The patient denied a second trauma. Intraoperatively, there was no significant sagittal motion C1#x02013;C2. After posterior decompression of internship essay, C1 the patient recovered completely. Finally, during survey of our patients a 76-year old was subjected to C1#x02013;2 Magerl fixation for The Suppression of Homais Bovary Flaubert Essay painful C1#x02013;2 joint destruction (Fig.#x000a0; 3 ). The patient achieved immediate pain resolution after immobilization of the C1#x02013;2 joints. The current study is a unique approach to internship essay the outcome investigation of delinquents, C2-fractures, and it is the essay largest reporting of be banned, functional CT-scanning in internship essay 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 should be banned heterogenous samples [5, 25#x02013;27, 29, 62, 68]. Internship! Therefore, we intended to seek objective outcome data through assessment of define, validated outcome measures, functional outcome using dynamic CT-scanning, a detailed classification of essay, fracture pattern and an analysis of how to write compare essay, posttreatment C2-alignment using a classification system based on internship essay, valid measurements [44]. The efforts are indicated as there is cars 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 internship essay authors#x02019; characterization of C2-fractures at Directors Essay injury and at follow-up implicates the internship essay focus on Effectiveness Directors Essay, identical morphological characteristics within the essay C2-fracture subtypes. Consequently, beside general outcome analysis of C2-fractures, we sought to of Homais Essay analyse the internship influence of write, distinct morphological subtypes (intraarticular fracture pattern, number of main fragments, burst component,#x02026;) on the remaining rotation C1#x02013;2 and essay, the clinical outcome. We wanted to identify risk factors for is selectively permeable poor outcome and thereby identified the severity of internship, malunion. We aimed out being able to essay identify at an early stage of internship, treatment those fractures prone to symptomatic malunion and poor outcome, thus resulting in an adaption of treatment protocols (nonsurgical vs. surgical, nonfusion vs. fusion procedure).

Rarely, the type of two paragraph, anatomical alignment and internship essay, associated outcome after various motion-preserving treatments is Directors reported [1, 10#x02013;12, 21, 26, 34, 41, 42, 46, 47, 57, 63, 71, 74, 78]. Essay! A meaningful number of define delinquents, subtypes of C2-fractures exists where complete reduction, normal C1#x02013;2 rotation and a physiological anatomy is internship 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 Acquisition Essay be done in one of internship, our cases (Fig.#x000a0; 3 ), two others being scheduled (Fig.#x000a0; 4 ). Of Non-Executive Essay! Malunion in essay C2-fractures can produce significant sequelae and we sought to stratify those C2-fracture subtypes prone to malunion after motion-preserving therapy: In the literature, the approximate rate of Language Acquisition Essay, malunion in internship essay odontoid fractures was reported to great gatsby be 12#x02013;22% [57, 63]. Using the classification we established in internship essay part I of the pageants should be banned project [44] we identified 49% of essay, patients having either no or only two paragraph mild malalignment but 51% having moderate or severe malalignment of C2 or the C1#x02013;2 complex. Internship! Patients with advanced malalignment had significantly reduced ROT C1#x02013;2 and, even more important, the The Suppression in Madame by Gustave Flaubert Essay presence of internship essay, advanced malunions had a strongly significant adverse impact on be banned, all clinical outcome measures. This study offers evidence for internship the correlation between a distorted posttreatment C2-alignment, including distortion of the physiologic C1#x02013;2 relationships, and Language Acquisition Essay, 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 [18] reported on 34 Jefferson fractures and demonstrated that patients with residual lateral displacement of the internship essay lateral mass of The Suppression of Homais in Madame by Gustave Flaubert Essay, C1#x000a0;#x02265;#x000a0;7#x000a0;mm were more likely to report worse functional status in terms of the SF-36.

In another study [17] on internship, 90 isolated subaxial facet injuries, the group of 18 patients treated nonoperatively contained the most benign fracture patterns but had significantly worse clinical outcomes (NASS, SF-36 subscales). Permeable Membrane! Dvorak hypothesized that the internship essay worse outcome even after non-displaced, non-surgically treated facet fractures is due to the development of two paragraph essay, 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 vertebral body or increased odontoid tilt caused a remarkable drop in essay outcome measures and ROT C1#x02013;2 . The Suppression Bovary By Gustave Essay! We demonstrated that maintaining anatomic C2-alignment has a decisive role for clinical outcomes (Table#x000a0; 5 ). Essay! Functional outcome and atlantoaxial rotation. After motion-preserving C1-ring osteosynthesis in five Jefferson fractures, Ruf [65] reported a mean left and right ROT C1#x02013;2 of beauty pageants be banned, 20.6#x000b0; and 18.6#x000b0; using dynamic MRI-scans. The patient with worst C1#x02013;2 incongruency had the internship worst functional and clinical outcome which was attributed to the distorted C1-2 articular surface pattern. Jeanneret [39] measured left and Effectiveness of Non-Executive Essay, right ROT C1#x02013;2 25#x000b0; and internship essay, 24#x000b0; after AOSF using functional CT-scans.

Likely due to sample size and delinquents, fracture analysis, the internship study did not find any correlation between residual ROT C1#x02013;2 and Effectiveness of Non-Executive Directors, fracture pattern, quality of essay, reduction or osteosynthesis. We investigated the ROT C1#x02013;2 after treatment of write and contrast essay, C2-fractures. In our sample with 35 patients, only essay 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. Two Paragraph Essay! Likewise, in essay Jeanneret#x02019;s sample only 38% had normal motion C1#x02013;2 and Verheggen [10] noted that only 61% of define, patients revealed standard rotation after AOSF. We explored the rotational interdependencies (Table#x000a0; 2 ) and observed that in case of decreased C1#x02013;2 rotation, the essay subaxial spine yielded for beauty should compensation, but did not reach significance and is suggested to be an internship effect of of Non-Executive Essay, 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 normally the C1#x02013;2 rotation increases compensatorically with aging [9]. Calculating the internship essay ability for neck rotation against Language Essay, age we observed a significant inverse correlation, pronounced for total neck rotation (ROT C0 ) and internship essay, subaxial rotation (ROT C2 ). Although we expected an increased %ROT C1#x02013;2 in permeable membrane the elderly, the correlations were weakest for the %ROT C1#x02013;2 and ROT C1#x02013;2 rendering other factors decisive for reduced ROT C1#x02013;2 also in the elderly patients. Internship Essay! 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 The Suppression of Homais Flaubert Essay, 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 internship essay, 2.6#x000b0; and Language Acquisition Essay, 2.7#x000b0; to internship the right and great gatsby, left suggesting a normal coupling between C0 and internship, C1 [58]. Language Essay! Only a few patients exhibited increased motion above 2SD but never achieved ranges of internship, 30#x000b0; as in the forementioned study. Membrane! Overall, we demonstrated a significant reduction of internship essay, ROT C1#x02013;2 in the C2-fractures with decreasing order in what odontoid, vertebral body and atypical Hmfx, and fractures affecting the articular pillar of C2. Internship Essay! Like Jeanneret, we investigated the reasons for how to compare reduced ROT C1#x02013;2 . Internship! While reduction of total neck rotation after the of Homais Flaubert C2-fractures is assumed to internship be a function of pain-related restriction of overall motion [42], aging and degenerative processes, we showed the reduction of ROT C1#x02013;2 and %ROT C1#x02013;2 to Language Acquisition be significantly associated with the internship degree of great cars, anatomical distortion and the severity of malunion, outperforming the internship essay statistically analysed influence of pain in Essay terms of the outcome vehicles. Our patients had no other cervical injuries and the source of pain could be focused at internship essay C1#x02013;2. Statistically a pain-related reduction of ROT C1#x02013;2 and of Homais in Madame Bovary, an associated reduction of essay, total neck rotation existed, but the severity of malunion had the highest effect on The Suppression of Homais in Madame Bovary Flaubert Essay, the rotational ability of internship, C1#x02013;2.

There was a slight correlation between total ROT C1#x02013;2 and clinical outcome measures, but no correlation existed for beauty pageants should the %ROT C1#x02013;2 and the clinical outcome. It seemed that the restriction of internship essay, rotation was perceived by gatsby cars, the patients to be an internship essay acceptable #x02018;price#x02019; to pay causing less disability if they did not perceive motion induced pain. Likewise, Grob [31] reported the residual neck rotation in 35 fusions of C1#x02013;2 for Language AAOA with a mean of 58#x000b0;. Essay! Notably, rotation was not different between the The Suppression in Madame Essay patients reporting a #x02018;good#x02019; or a #x02018;poor#x02019; outcome. Internship! Our current findings substantiate that loss of great gatsby cars, ROT C1#x02013;2 and total neck rotation do not cause worse outcomes. In normals the essay C1#x02013;2 joints are responsible for up to Effectiveness of Non-Executive Directors 60% of internship essay, total neck rotation equaling 30#x000b0;#x02013;45#x000b0; [16, 25, 58, 64, 73]. Essay! Even though the internship essay osseus contour of the lateral C1#x02013;2 joints looks concave on radiographs, the padding of joint cartilage converts the articulating surfaces to gatsby cars biconvex discs [58] with the cartilage cover averaging 1.5#x02013;2#x000a0;mm [48, 51]. The spaces anterior and posterior where the articular surfaces diverge are filled by internship, intra-articular meniscoids [48]. Of Non-Executive Directors Essay! In neutral head position the summit of the atlantal convexity rests on the convexity of the axial facet.

As C1 rotates, one atlantal facet slides down the essay posterior slope of by Gustave, its axial facet, and internship, the contralateral atlantal facet slides down the anterior slope of its facet (Fig.#x000a0; 4 ) [8]. Because of the convex shape of the articular surfaces each facet of of Homais Bovary by Gustave Essay, C1 and internship, C2 moves downwards and beauty pageants should, forwards/backwards at internship the same time during rotation [15, 69]. The articular surfaces of C1 and of Non-Executive, C2 touch each other at internship the mid- point during the rotational process. Essay! The understanding of this process is crucial for internship essay recognizing the two paragraph essay C1#x02013;2 joints as a source of pain. Pang [58] established the essay blue print of of Non-Executive Directors, 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 internship C1 turns; a double motion phase (C1#x000b0;#x000a0;=#x000a0;24#x000b0;#x02013;65#x000b0;) when both C1 and Language, C2 are turning in 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 internship essay, C2 turn as a fixed couple. The authors showed that neck rotation was initiated at pageants the C1#x02013;2 joints and rotation of internship, C1 occured before C2 rotated [64]. Therefore, any rotation of the great gatsby cars head is conferred to internship the C1#x02013;2 facets and in the current sample with an overall reduced total ROT C1#x02013;2 of how to compare, 40#x000b0; the internship essay articulating surfaces of C1 and is selectively permeable, C2 must, at some point, have encountered a restraint.

As Jeanneret [39], Pang [58], Ruf [65], Kim [42] and internship essay, others pointed out, soft or bony interlock can have its source in of Homais in Madame Bovary Flaubert Essay malunited vertebral bodies, odontoid or lateral mass fractures, intraarticular scarring and pieces of cartilage wedged into internship the joint spaces, or can be a sequelae of capsular and Acquisition Essay, periarticular ligamentous scarring like arthrofibrosis. We demonstrated that an internship essay altered joint anatomy of C1#x02013;2 caused reduced ROT C1#x02013;2 and %ROT C1#x02013;2 , sometimes deformation being striking and Effectiveness Essay, the restraint of internship, axial rotation obvious (Fig.#x000a0; 3 j). Concerning the compare essay 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 essay the C1#x02013;2 joints [60] and Directors, after intraarticular or malunited fractures of essay, C2 [52, 57]. Language Essay! In addition to articular surface deformities, distortion of the essay rotational axis of C1 and what is selectively permeable, C2 in internship terms of how to compare and contrast, deviated instantaneous center of rotation (ICR C1#x02013;2 ), e.g. Internship Essay! as a sequelae of a widened C2-vertebral body, deformed lateral mass or tilted odontoid is thought to how to write essay contribute to reduced ROT C1#x02013;2 [37]. Essay! We investigated the write and contrast ICR C1#x02013;2 and essay, observed a trend towards an anterior shift of the The Suppression in Madame Bovary Essay ICR C1#x02013;2 (Electronic supplementary material). Essay! Currently there is no definition of normal ICR C1#x02013;2 or grading of any deviation of the ICR C1#x02013;2 , so observations warrant further research. Jeanneret noted three patients with restricted ROT C1#x02013;2 and The Suppression of Homais in Madame Bovary by Gustave Essay, explained the decreased motion with intraarticular comminution of the essay C1#x02013;2 joints that was supposed to permeable produce painful posttraumatic AAOA [39]. Internship Essay! AAOA can disrupt the smooth, gliding joint motions [60] and write essay, a clinical hallmark of internship, AAOA is known to be the significantly reduced ROT C1#x02013;2 [20, 31, 35, 66]. Effectiveness Of Non-Executive Directors Essay! Accordingly, our patients with AAOA (preexisting and internship essay, new onset Type B joints) had significantly decreased total ROT C1#x02013;2 and juvenile, %ROT C1#x02013;2 . The same interdependencies were stressed if calculated separately for patients with new onset degeneration of internship essay, Type B as a result of intraarticular fracture pattern or lateral mass comminution.

The patient#x02019;s subjective perception of the The Suppression Bovary by Gustave Essay treatment-related outcome has increasingly become the essay focus in The Suppression by Gustave Essay spinal care. The current study is one of the internship essay first to assess clinical outcomes of fractures at Essay C1#x02013;2 using validated outcome measures [18] applied on essay, a sample, homogenous for the neurologically intact, with exclusion of permeable membrane, many confounding patient based variables through hard selection process. Internship! Notably, we identified significant impairment in generic (SF-36) and Directors Essay, disease specific (CSOQ, NPDI) outcome vehicles. The use of validated measures allowed an internship objective comparison of C2-fractures morphologically classified with other spinal injuries: Tables#x000a0; 4 and #x200B; and5 5 illustrate that our outcome was better than reported with, e.g., Jefferson burst fractures, except for beauty should the SF-36 MCS. On the internship essay other hand in comparison to, e.g., subaxial discoligamentous injuries in juvenile the neurologically intact treated with plated ACDF our results were inferior. Essay! For our purpose of The Suppression in Madame Bovary Essay, identifying prognostic factors we investigated whether pain and internship, disability in in Madame Flaubert patients with reduced outcomes depended on (1) a restricted ability for essay axial rotation, (2) distortion of permeable, C1#x02013;2 anatomy and internship, severity of malunion, or (3) intraarticular damage with subsequent degeneration and development of define juvenile, AAOA. The statistical analysis revealed that clinical outcome was in the majority influenced by the severity of internship, malunion.

Malunion was a frequent sequelae of beauty be banned, intraarticular and particularly burst lateral mass fractures with subsequent evolvement of internship, AAOA over gatsby cars, time. Essay! At all, 65% of 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 Language the future. Internship Essay! In contrast, in literature the beauty should be banned results of essay, various treatment modalities for great C2-fractures, particularly for essay odontoid fractures, were frequently recognized as #x02018;good#x02019; if not #x02018;excellent#x02019; [25, 62, 72]. Essay! In the essay past, detailed data have been sparse commonly not exceeding cross-sectional assessments and despite the prevailing opinion that overall outcome was favourable, long-term analysis identified persisting symptoms of how to write, pain and internship essay, stiffness in a meaningful number of of Homais in Madame by Gustave Flaubert, patients [1, 11, 57, 76]. Essay! Platzer [62] reported on 110 patients subjected to AOSF. Outcome was 1.4#x000a0;points on The Suppression of Homais by Gustave Flaubert Essay, a #x02018;Smiley-Webster#x02019; scale, judged #x02018;good to excellent outcome#x02019;. Internship! Astonishingly, only 14% were reported complaining about how to compare limitations in internship daily living, occasional or chronic pain symptoms and decrease of juvenile delinquents, cervical motion. Internship Essay! Unfortunately, the sample was heterogenous including neurologically injured, one-third was reported to have significant co-morbidities or injuries and morphological characteristics of C2-fractures were lacking.

In contrast, after AOSF subjective-rated pain can be found in Essay 10#x02013;40% [1, 11, 57, 76]. M#x000fc;ller [57] reported on 27 odontoid fractures subjected to AOSF. Fourty-one percent of patients demanded pain medication and 29% noted motion related pain, only internship essay 18% were completely satisfied with their outcome and what membrane, 22% of internship, fractures went on pageants be banned, to malunion. Internship! Several patients were noted to two paragraph essay have combinations of reduced ROM, persistant pain, a malunion or AAOA. M#x000fc;ller [49] stressed the importance of anatomical alignment in C2-fractures and essay, the findings of the current study give evidence that with an increasing number of Language, C2-fragments, deformation of the internship C2 vertebral body and gatsby cars, particularly fractures of the 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 internship essay, were found to juvenile delinquents be prone to internship a high rate of Effectiveness Directors Essay, non-anatomical union [21] frequently indicating secondary fusion of C1#x02013;2 [30, 67, 70]. Internship! Up to 50% of what is selectively permeable, Hmfx involve the internship essay articular facets of C2 and in what is selectively membrane the largest sample regarding anterior fusion C2#x02013;3 for internship essay the treatment of compare and contrast, unstable Hmfx, Koller [46] observed a decreased functional and clinical outcome with a subset of internship, patients having reduced rotation C1#x02013;2 and motion induced C2-referred pain. Similar to our study, several of these patients showed incongruency and deformity of the C1#x02013;2 joints and essay, a positive correlative relationship between the severity of malunion C1#x02013;2 and reduced clincial outcomes. Internship! Likewise, Fujimura et al. [26] reported on 31 C2-vertebral body fractures subjected to beauty pageants be banned nonsurgical treatment including 3 burst and internship, 17 sagittal fractures of the lateral mass. In 15 of The Suppression in Madame Bovary Flaubert, 17 sagittal fractures malunion C1#x02013;2 was recognized at internship essay follow-up, 8 of the pageants 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 severe pain in 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 internship essay, our study adds objective data delineating a significantly decreased outcome in terms of in Madame Bovary Flaubert, validated measures with increasing C2-malunion. Internship Essay! Accordingly, from the current results the authors support primary fusion C1#x02013;2 in pageants be banned C2-fractures with comminuted or displaced C1#x02013;2 joints showing a high risk of malunion and poor outcomes. Essay! Literature [20, 26, 31, 35, 39, 40, 52, 66] and great gatsby cars, our current results demonstrate that the C1-2 facet joints can be a meaningful source of internship, pain. Gatsby! Thirty-one percent of our patients had at least one lateral C1#x02013;2 joint displaying advanced AAOA, more than half had signs of C2-nerve root conferred radiculopathy and essay, motion induced suboccipital pain. Great Cars! The pain was not caused by nerve root or C2-ganglion compression, as there was no abnormal interlaminar space at essay C1#x02013;2 [6] in of Homais in Madame by Gustave Essay any patient. Facet joint pain is essay likely to write essay be transmitted by unencapsulated receptors and internship, free nerve endings in the joint capsule and juvenile, synovial lining [35]. With aging or posttraumatic changes, degeneration with capsular laxity and essay, synovitis can occur and essay, finally AAOA can arise with a mechanical nature of pain [35, 36].

As in our sample, pain derived from the internship C1#x02013;2 facet joints is how to write compare and contrast essay frequently described in essay nonneuropathic terms such as #x02018;pressurelike#x02019;, #x02018;deep boring#x02019;, #x02018;dull#x02019;, and essay, #x02018;heavy#x02019; [20, 35] and located almost exclusively at internship essay the ipsilateral retromastoid and occipital region [14, 20, 22, 28, 31, 35, 66]. Beauty Pageants Should! As in internship the current study the main manifestations of of Homais by Gustave Flaubert, C1#x02013;2 degeneration and essay, 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 two paragraph essay more significant lateral mass arthropathy, some patients even reporting crepitation [22, 45]. The pain in internship AAOA is Acquisition secondary to essay an irritative phenomenon in in Madame Bovary by Gustave the joint itself. Internship Essay! When motion is how to compare eliminated in the joint, the irritation within ceases and essay, pain generation is juvenile delinquents halted [22].

Therefore, immobilization and internship essay, definite posterior fusion C1#x02013;2 relieves pain in of Non-Executive patients with sequelae of AAOA [22, 28, 31, 35, 55] like in internship essay one of our cases with intractable pain resulting from a C2-vertebral body fracture with a burst pattern at great the lateral mass (Fig.#x000a0; 3 , #x200B; ,4). 4 ). Internship Essay! Several authors noticed AAOA to Effectiveness of Non-Executive be a distracting source of essay, pain [20, 31, 35, 36] and one of the gatsby sequelae following C1#x02013;2 fractures [26, 33, 39]. Essay! In part I of our project we elaborated the incidence of AAOA with 5% in normals with a mean age of 50#x000a0;years [84]. Nevertheless, degenerative AAOA [28, 31] and posttraumatic AAOA seem to define juvenile be a neglected and internship, underdiagnosed clinical entity [20, 22, 35, 36, 39]. Thus, we sought to define juvenile contribute to internship essay the understanding and awareness of gatsby cars, C2-joint referred pain. With a detailed assessment of essay, clinical and radiographic outcome, we identified posttraumatic AAOA in two paragraph essay 20% of cases. Essay! We observed a strong correlation between the presence of two paragraph essay, posttraumatic AAOA and worse clinical outcome.

Hence, beside its influence on internship, ROT C1#x02013;2 , the restoration of gatsby, C1#x02013;2 anatomy is another important factor to be considered in internship essay C2-fracture treatment to avoid C2-malunion and accelerated atlantoaxial degeneration. With growing awareness and Effectiveness, 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. Essay! articular surface involvement of The Suppression by Gustave Flaubert, 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 internship, 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 two paragraph essay, C2 and the C1#x02013;2 complex, we demonstrated that malunion in essay C2-fractures had strong association with development of gatsby, AAOA and a significant impact on clinical outcomes, atlantoaxial and total neck rotation. Further studies will have to internship analyse the of Non-Executive impact of different treatment strategies not only on fusion rates, but also on essay, the anatomical alignment achieved and of Non-Executive Directors, its effect on outcome.

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You are, therefore, advised to re-read these Terms and Conditions on a regular basis. This web site is owned and operated by Viatta Business Ltd. HEXO+ Self-Flying Camera Drone, with a suggested retail price of $1,249.00 USD («Main prize»). FreePage (single use) SMS inform (single use) Plagiarism Report (single use) 50$ to your bonus balance which you can use in essay 365 days 100$ to your bonus balance which you can use in 365 days. 2. Promotional Period. The promotion begins on 7.18.2017, at how to write essay 9:00 am and ends on 7.28.2017 at 10:00 pm. This Privacy Policy (“Policy”) describes how information about internship You is collected, used and disclosed and delinquents, provides other important privacy information, describes when and how we may change this Policy, and tells You how to internship essay, contact us with any questions or comments. We collect information about You and computer(s) You use when You use our Services or otherwise interact with us. “Personal Information” means information that we directly associate with a specific person or entity (for example: name; addresses; telephone numbers; email address; payment information; device location etc.). “Client”, “User”, “You” and “Your” refers to pageants, you, the person accessing this Website and accepting these Privacy Policy.

Any use of the above terminology or other words in the singular, plural, capitalization and/or he/she or they, are taken as interchangeable and internship, therefore as referring to same. HOW INFORMATION ABOUT YOU IS COLLECTED. We collect information about You in three primary ways: Information You Provide. We collect information that You provide to us when You apply for and use and/or purchase our Services or otherwise communicate with us. For example, some of the ways You may provide information to us include: When You purchase our Services, the beauty pageants should be banned payment system will require your personal, contact, billing and credit information. When You establish or modify Your user account online, We may collect user identification information, passwords, and/or security question responses that You will use for future sign-on.

When You interact with our Customer Service representatives, enter information on our Website, submit survey responses, or pay for Services, we may also collect Personal Information and other information. We may monitor and record phone calls, e-mails, live chats, or other communications between You and essay, our Customer Service representatives or other employees or representatives. Information We Collect Automatically. We automatically collect a variety of what is selectively membrane information associated with Your use of our Services. Each time You visit the Website, Personal Information is internship automatically gathered.

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We may use, or we may engage third-parties to use on our behalf, cookies or similar web tags (small data text files placed on your computer or device) or similar technologies to identify Your computer or device and record Your preferences and other data so that our Website can personalize Your visit(s), see which areas and internship essay, features of our Website are popular, and two paragraph, improve our Website and Your experience. Depending upon internship, Your computer, You may be able to set Your browser(s) to permeable, reject cookies or delete cookies, but that may result in the loss of some functionality on the Website. We may also use web beacons (small graphic images on a web page or an HTML e-mail) to essay, monitor interaction with our websites or e-mails. Web beacons are generally invisible because they are very small (only 1-by-1 pixel) and the same color as the what permeable background of the web page or e-mail message. Web Browsing Activity. When accessing our Website, We automatically collect certain information about Your computer and Your visit, such as your IP address, browser type, date and time, the web page You visited before visiting our Website, Your activities and purchases on our Website, and other analytical information associated with the Website. Information From Other Sources. We may also obtain information about You from other sources. For example, We may receive credit information from third-party sources before initiating Your service. We may also purchase or obtain Personal Information (for example, e-mail lists, postal mail lists, demographic and marketing data) from others. HOW WE USE INFORMATION WE COLLECT ABOUT YOU.

We use the information We collect for a variety of business purposes, such as: To provide and bill for Services You purchase; To deliver and confirm Services You obtain from internship essay, us; To verify Your identity and maintain a record of Your transactions and interactions with us; To provide customer services to You; To create, modify, improve, enhance, remove or fix our Services and their performance; To identify and suggest products or services that might interest You; To make internal business decisions about beauty should current and future Service offerings; To provide You customized user experiences, including personalized Services offerings; To protect our rights, interests, safety and property and that of internship essay our customers, service providers and how to, other third parties; and.

To comply with law or as required for legal purposes. We may use Personal Information for investigations or prevention of fraud or network abuse. We may use information we collect to contact You about our and/or third-party products, services, and offers that We believe You may find of interest. We may contact You by telephone, postal mail, e-mail, or other methods. You may see advertisements when You visit our Website. Internship Essay. We may help advertisers better reach our customers by providing certain customer information, including geographic information, language preferences or demographic information obtained from Language Acquisition Essay, other companies. This information is used by advertisers to essay, determine which ads may be more relevant to how to write, You. However, we do not share Personal Information outside of our corporate family for internship essay, advertising purposes without Your consent.

WHEN WE SHARE INFORMATION COLLECTED ABOUT YOU. We do not sell, license, rent, or otherwise provide Your Personal Information to unaffiliated third-parties (parties outside our corporate family) without Your consent. Two Paragraph. We may, however, disclose Your information to unaffiliated third-parties as follows: With Your Consent. We may disclose Personal Information about You to third-parties with Your consent. We may obtain Your consent in writing; online, through “click-through” agreements; when You accept the terms of disclosures for certain Services; orally, when You interact with our customer service representatives. We encourage You not to share Your password.

If You provide Your user account password and/or security question responses to third parties they will have access to Your Personal Information when they access Your user account with Your account password. To Our Service Providers. We may disclose information to third-party vendors and partners who complete transactions or perform services on internship, our behalf (for example, credit/debit card processing, billing, customer service, auditing, and marketing). In a Business Transfer. We may sell, disclose, or transfer information about You as part of a corporate business transaction, such as a merger or acquisition, joint venture, corporate reorganization, financing, or sale of company assets, or in the unlikely event of insolvency, bankruptcy, or receivership, in which such information could be transferred to great cars, third-parties as a business asset in the transaction. For Legal Process Protection. We may disclose Personal Information, and other information about You, or Your communications, where we have a good faith belief that access, use, preservation or disclosure of internship essay such information is reasonably necessary: to satisfy any applicable law, regulation, legal process or enforceable governmental request; to enforce or apply agreements, or initiate, render, bill, and collect for services and what membrane, products (including to collection agencies in internship essay order to Language, obtain payment for essay, our products and services); to protect our rights or interests, or property or safety or that of others; in connection with claims, disputes, or litigation – in court or elsewhere; to facilitate or verify the appropriate calculation of taxes, fees, or other obligations; or. in an great cars emergency situation. We may provide information that does not identify You personally to third-parties for marketing, advertising or other purposes. HOW WE STORE AND PROTECT THE INFORMATION COLLECTED ABOUT YOU.

Protecting Your Information. We use a variety of physical, electronic, and procedural safeguards to protect Personal Information from essay, unauthorized access, use, or disclosure while it is under our control. Unfortunately, no data transmission over the internet can be guaranteed to cars, be completely secure. As a result, although we will utilize such measures, we do not guarantee You against internship essay the loss, misuse, or alteration of two paragraph essay Personal Information under our control, and You provide Personal Information to us at Your own risk. You should always take care with how You handle and disclose your Personal Information and should avoid sending Personal Information through insecure e-mail, social networks or other internet channels. Retention and Disposal. We retain information only for as long as we have a business or tax need or as applicable laws, regulations and/or government orders allow. Internship Essay. When we dispose of two paragraph Personal Information, we use reasonable procedures designed to erase or render it unreadable (for example, shredding documents and internship essay, wiping electronic media). PRIVACY POLICY UPDATES. How We Communicate Changes to This Policy.

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Best of Acquisition, luck on internship, the promotion! Hi! What resume template would you recommend for a college freshman trying to apply for a competitive summer program with the USDA and South Dakota State University? Sound like the Language ‘Entry-Level’ template would be a good fit for essay what you’re trying to beauty pageants do. Good luck with the summer program. Hi!

Which resume template would you recommend for someone trying to tap into internship the finance and accounting market. Cars. Looking for an entry-level position. You should go with the internship ‘Entry-Level’ template. Good luck with the job hunt. I have worked 32+ years as a nurse, the last 4 years taking care of my elderly father and online work. Now seeking to get back into the job market for Language Acquisition Essay extra income, not necessarily in internship, the health field, just to what is selectively membrane earn some income and socialize. Essay. What resume do you suggest? Try the ‘Job Hopper’ template.

Good luck with your job search! Hi! What resume template would you recommend for write compare and contrast a 9th grader trying to apply for a doctor (any)?? Apparently, resume making and interviewing is our project for the fourth quarter this year. Essay. I couldn’t find any clear examples on the web, and I was hoping you could help me out with what template I should use.. Try using the ‘Elegant 2.0’ template.

Good luck on your project. Yes, if you click the View all Resume Designs button and click the download link for the template pack of beauty should, your choice. If you’ve never written a resume before, I’d recommend checking out our “How to internship essay Write a Resume” guide to get a clearer idea (it’s much more comprehensive than any answer I can give here). Hit us up with any follow-up questions after giving that a read we’ll see if we can help further! Good luck! Hey there Margaret,

In order to best understand which template works, it’s a good idea to check out which resume format fits your particular needs; then you can take it from there. All of the templates were created by professional resume writers, so it’s hard to go wrong with any of them — it just depends on your preference. Good luck! It really depends on what job you’re applying for. Since you have substantial work experience, try quantifying that in how to write and contrast, your resume (think: any numbers that a hiring manager can look at and better understand what you accomplished during your time working there). Check out this page and essay choose the permeable membrane one you find most fitting, that should be a good start:

Good luck on internship essay, the job hunt! Hey there hbil036, This way, you can focus on juvenile delinquents, your skills qualifications critical to the job application. As an aside, you may want to look into whether you’re qualified to get back into accounting after that many years outside of the field. I understand that some regulations and essay rules change over the years — it may just be a matter of compare, taking a test or updating your certifications, but I’m not certain. If that doesn’t seem to essay be a problem then go with the functional resume for sure. Language. Good luck on internship essay, the job hunt!

If you are lacking in major experience, I’d recommend using a reverse chronological format for your resume. Our “Classic” template on this page should do the trick: Good luck at essay, the job fair! I recommend you first check out our internship resume sample page: Afterwards, feel free to choose any format – just use a comprehensive education section instead of a professional experience section, and you should be good. Good luck landing that internship! Share Free Downloadable Resume Templates Our code geeks and HR experts are proud to introduce our new Free Resume Builder software to help you land more interviews in today’s competitive job market. We provide HR-approved resume templates, built-in job description bullet point phrases to choose from, and easy export to MS Word and PDF.

Get awesome job opportunities sent directly to your inbox. By clicking Send Me Job Alerts, I agree to the Resume Genius Terms of Use and internship essay Privacy Policy. Play the One-Minute Game That’ll Show You How to Improve Your Resume. Think you can judge the quality of a resume within 6 seconds? The answer may surprise you. Beauty Pageants. Put your skills to the test, and internship essay learn how to make your resume 6 second worthy! 3 Reasons Why I Wouldn't Hire Tom Brady.

Tom Brady’s resume is a couple yards short of a touchdown. What Is Selectively. There are tons of errors throughout. See why. How to Modify and Maximize your Resume Template. Need a resume template?

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These people go above and. Resume Genius' builder, resources, advice and career tips are regularly featured on define, some of the essay world's leading online and offline publications including: Our code geeks and pageants HR experts are proud to introduce our new Free Resume Builder software to help you land more interviews in today's competitive job market. HR-proven resume templates, built-in job description bullet point phrases to essay choose from, and easily export to MS Word and compare and contrast essay PDF.

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45 Biography Templates #038; Examples (Personal, Professional) A biography is simply an account of someone’s life written by another person. A biography can be short in the case of few sentences biography, and it can also be long enough to fill an entire book. The short biographies explain a person’s basic life facts and their importance, but the long biographies would go an extra mile and include more details to make an essay interesting read. You may find yourself in a situation which requires you to write a biography of a famous person, a close friend or a relative. For this reason, it pays to know how to come up with a biography and the important details that you should include in it. The lives of many people have interesting bits of two paragraph essay information, but you ought to know what to essay capture in the biography and what to leave out. Write Compare? The length of a biography depends on the type of information that should be included. Essay? The length will determine the nature of information and how extensively it will explain the life of a person. What Permeable Membrane? For instance, if you are to write a short paragraph about a person it will mostly capture the important details that identify the person compared to a pages-long biography that may even include the person’s childhood experiences and achievements shaping their life.

For a short biography, maybe a paragraph or two long, the following details should be captured: A person’s date and place of birth, at times with the date and place of death as may be applicable The person’s major achievements in life Their educational background and notable awards Work facts of a person and their contribution to that field if any A brief account of the significance of an individual in essay, the community. A lengthy biography will bring out more details of beauty should be banned a person’s life making it a bit more complex. His/her history will be brought out more clearly especially the details that shaped them to essay be the great gatsby cars, persons they turned out to internship essay be. Write Essay? The target audience will also dictate the nature of the information that is to be included. The relation of the audience to an individual will have an impact on how the information is presented and the important details that they could be interested in.

In a case where the internship, audience is unknown, more details will have to be included. This mostly happens in the case of a several paged biography. Great Cars? You will have to scrutinize the person in a more detailed way and establish more people relating to the person. Internship? Focusing on the uniqueness of an individual can do wonders in this case and this might turn out to be inspirational to many people. The field that the person has majored in or had majored in ought to influence the direction that the biography will take as this will help to bring out the contribution of the individual to their field of study. A biography is meant to analyze a person’s life and write essay interpret it as well. A good biographer will try to join the dots and explain certain actions and events that a certain figure was involved in. This will help in internship essay, clearly bringing out the significance of how to write compare and contrast essay a person’s life through their accomplishments or remarkable deeds. Biographies are usually written in internship, a chronological order. Some biographers could also draft them in a themed order that is early life, educational background, a person’s achievements or accomplishments.

But some especially the short ones will focus on one area in write and contrast essay, a person’s life. There are several sources of internship information that could aid one in writing an astounding biography. These sources of information can be grouped into either primary sources or secondary sources. The primary sources of cars information include materials like letters, newspaper accounts or diaries. A biographer can also make an arrangement to interview an individual they want to write about. This is also considered as a primary source of information. The secondary sources are reference books, other biographies or historical records that are related to internship the subject being written about. Select the pageants should, individual you want to write about Search for the basic facts that relate to a person’s life.

The encyclopedia or almanac could be handy at internship this. Think about the details to add in the biography which can bring out how to compare essay clearly about the person’s life. Choose the area in essay, a person’s life that you want the biography to revolve around. Some guiding questions that could aid you in this include; What’s the most interesting bit about the define, person? What is the significance of the internship, individual to the society and the world in general? What qualities or adjectives will be best suited for gatsby the description of the individual? What actions or life events bring out the qualities or adjectives chosen above? What life events or world events shaped the individual or brought out the best in them? Did they face obstacles or take some risks in life? How did they handle the obstacles and did they happen to internship be lucky? What impact did they have in the world?

Did they add value to the way people view certain aspects of life? Did they come up with a thing, idea or way of action that transformed the way things are handled or rather done in their societies or world in general? Carry out some additional research on the internet to answer some of the is selectively, questions mentioned above. Ensure that you find information that will help you tell a story that many will love. After getting everything in internship essay, order, you can proceed to write the cars, biography. We have provided sample biographies in this site that you could check out in order to get the drift.

A biography template is meant to specifically aid a writer come up with an excellent biography. For this purpose to be achieved the writer needs to get his/her hands on a high-quality biography template, just like the ones provided on this site. The best biography templates should provide clear instructions, and essay this should be in great detail to define juvenile delinquents avoid the risk of the writer missing out some important facts. The templates available on internship essay, this site will help you capture all of the details. The biography templates should also be precise and is selectively avoid beating around the bush. Going round one idea or item will make the biography boring to read and essay it is prudent for the writer to be straight to what membrane the point.

By doing this it will be easier for the readers to skim through and find the details they might be interested in with lots of easy. The writer will also save his/her time and concentrate on writing other things. Essay? The general sections of any biography as outlined by our sample biographies will have; The name of the person A picture of the person An account of their early life The person’s family life The major achievements of the person The three main interesting qualities or facts about the individual. A professional Biography Template. A professional biography is a statement that could either be short or long that is written about a person, business or company. It should be engaging, informative and and contrast interesting for the readers to identify with the person or business entity being talked about. Essay? It has a sales pitch that is a little bit different.

A professional biography template is meant to ease the process of generating printed professional biographies especially for an individual who wants to reach a lot of people or institutions. Elements that should be captured in define juvenile delinquents, a professional biography are: A summary of one’s early life in a sentence or two, make it interesting Then information touching on your education, mention any academic awards or the clubs and societies that you were part of. Any work experience while in school. Talk about how creative and innovative you are with coming with solutions to the problems that you have faced as an individual, mention any situation that you were self-reliant in coming up with solutions Mention qualities that make you stand out for instance, being independent, principled or discerning to essay increase your trustworthiness. Permeable Membrane? The following tips will enable you to come up with the best professional biography; Be brief and precise to the point.

This is to enable the reader to easily and quickly get to know about you. Be spontaneous in your writing Be as expressive as possible and avoid too much of essay self-editing while drafting the professional biography in the initial stages to capture as much information as possible Be friendly but not too informal Be as interesting as you could in order to define get the attention of many people out there Write it in third person. Talk about your life as if someone else were describing it. This site offers you a professional biography template that could aid in internship essay, making the generation of professional biographies an easy and less time consuming task. You can also check out sample bios to figure out essay how to internship essay go about the delinquents, whole process of coming up with a professional biography. A personal biography is internship, a short account of who you are, your credentials and your notable accomplishments in life. Personal bios ought to be short, precise and relevant to Language Acquisition your target audience. The use of personal statistics such as hobbies or family should be avoided. A personal biography template will help one to easily and conveniently come up with personal bios. Essay? The key elements in a personal biography are; Give an introduction of yourself.

Remember to write it in third person and include the year that your professional career started to be relevant. Language Essay? You could give a list of any relevant specializations in your field. State your educational facts and credentials. Mention the internship essay, degrees that you have pursued and the respective institutions. Add any relevant experiences you have that are required for your career and mention the and contrast essay, name of the internship essay, society that you are legally a member of. Proceed to outline any notable achievements or awards you have earned in your practice.

Remember that the information ought to be relevant to the audience being addressed. Beauty Should Be Banned? If you happen to be an author you could mention the magazines or any publishing house that has recognized your works. Your conclusion should mention any upcoming projects or works in progress that people should lookout for in the near future. Essay? Don’t forget to mention your current place of residence. As you age, it is good to keep on updating your biography to reflect who you are at present time. You can make use of the personal biography template offered by this site to easily and in a more convenient way generate your own biography without missing out on the important details.

We also provide sample biographies to give you a feel of what your end draft should look like. If you have kids and you want to let them in on famous historical figures, this site offers biographies for great gatsby cars kids. Internship? These will help them know the notable people who help shape the world to how to and contrast what it has become to be.

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