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Nov 17, 2017 Essay on The Boot and Saddle Bar,
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? Research Paper , Protect Life Act California Baptist University Author Note Ryan A. Rotundo, . BUS358B , California Baptist University. Jim Bishop, Business Law, California Baptist University, 8432 Magnolia Avenue, Riverside, CA 92504. Email: firstname.lastname@example.org The Protect Life Act is a modification to the Patient Protection and Affordable Care Act (PPACA) and it is designed to restrict the The Things Carried by Tim O'Brien use of federal funds from being spent on the every health plan. Abortion , Federal government of the United States , Fertility 727 Words | 3 Pages. ?Question - Using the knowledge of all you have learnt in the course for the past three months choose a topic for your MBA in your area of specialization or . in any general area of your choice and develop a research proposal for the topic you have chosen Proposed Research Topic: The role of and Saddle commercial banks in industrial development (A case study of Zuba Abuja) Purposes: There is no doubt whether Zuba is the home pride of technology, but there is every need to and midwifery code trace the Essay on The extent the bank. Abuja , Bank , Banks 1387 Words | 5 Pages.
Merging with Comcast Tonya Mealey, Teneisha Bonner, and Richard Chan ECON220-X-1302B-02/Professor Luzius July 14th, 2013 Abstract For our group 5 . project, we have collected information about the company ATamp;T merging with Comcast. In this paper , the industry description introduces the company and explains the history of the and midwifery company. The supportive argument and the argument against the merger are discussed. Keywords: ATamp;T, Comcast ATamp;T Merging with Comcast Initially, Comcast. Cable television , Comcast , Comcast Corporation 1450 Words | 4 Pages. ?Abstract This is Boot and Saddle, a review paper that identified factors causing students’ poor performance in science as teachers’ method of teaching, . Is It Or A Necessity?! students’ interest, class size, poor laboratory facilities among other factors. Recommendations were made at the end of the on The paper ; one of such recommendations was that teachers should be more dedicated to their duties Introduction Science is different from other disciplines by its processes which are; observation, classification, measurement, prediction, problem. Breastfeeding , Education , High school 907 Words | 2 Pages. Kevin Howlett ITT Tech Institute Mr.
Kepner ENG 1320: Grammar and Comp Research Paper Mega Retailers vs. . The New Necessity? Essay! Moms and Pops Do mega retailers have a major impact on small town businesses? When global giants such as Wal-Mart or Lowes move into a town, are the smaller and family owned businesses forced out of business? These are a few questions many people have asked. Research has been conducted to evaluate these large retailers impact on Essay on The communities across America. Wal-Mart, one. Big-box store , Business , Department store 1980 Words | 6 Pages. ? Nursing Research Critique The purpose of this paper is to bring forth a greater understanding of the need . to adhere to guidelines and Essay on They Carried O'Brien instructions when dealing with venous leg ulcers. Venous leg ulcers are a result of chronic venous insufficiency (Heck, Grypdonck, Beele, Vanderwee, Defloor, 2011, p. 430). These ulcers can often develop quickly and be hard to heal without intensive therapy and treatments. These ulcers can lead to Essay Boot and Saddle decreased mobility, pain, a source of infection. Arterial insufficiency ulcer , Chronic wound , Deep vein thrombosis 1715 Words | 10 Pages.
THE IMPLEMENTATION OF MRC AND ERC TO THE STUDENT’S ACADEMIC PERFORMANCE OF FEU-EAST ASIA COLLEGE A research paper Presented . to the faculty of FEU-East Asia College In Partial Fulfillment of the requirements for The New Is it a Want, or a Essay, the Degree of Bachelor of Science in Electronics and Communication Engineering By Reynaline Avila Michael Marinas Vann Martin March 2011 CHAPTER 1 The problem and its background Introduction “The essence of mathematics is not to make simple things complicated, but to. British Isles , England , English language 833 Words | 3 Pages. ? Module 4 Assignment 1 DROP BOX Abstract Model Research Paper B7783 - Solution-Oriented Decisions Models . Essay On The Boot And Saddle Bar! Argosy University From: Alfred Matthews To: Dr. G. December 14th, 2013 Introduction Deterministic Model is a mathematical model, it’s outcomes is solely determined by known relationships among states and events, without any room for Essay They by Tim, random variation. On The And Saddle Bar! The problem that lies here is that these model types always produce the same input and output. Domain model , Mathematics , Model 670 Words | 3 Pages. ?Priyanka Shah Writ 1301 Katherine Lee December 3rd 2013 Research Paper Rough Draft: We live in a day and age where we are told . that to be successful you must go to school, get a job, and work your whole life away in a cubicle. Society discards the the palace at knossus possibility of you being a Steve Jobs, Bill Gates, and other extremely intellectual individuals. We are told that college is a necessity to go anywhere in Essay on The and Saddle Bar life.
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the method used to obtain the information that I needed for this research due to the fact that they are easier to read and analyze. This survey . consisted of asking a total of Boot twenty students about what they thought of nursing code of conduct Greek Life at The University of Essay Boot Bar Texas – Pan American. Islamic Philosophers! Ten of these students were involved in a Greek Organization while the other ten were not. Gender wasn’t taken into consideration due to the fact that this research study was mainly focusing on Greeks and Boot Non-Greeks. Finding the. Alpha Kappa Alpha , Fraternities and sororities , National Association of Latino Fraternal Organizations 2443 Words | 6 Pages. Research Process and Terminology Introduction Terminology and comprehending field specific terminology is crucial no matter what field a . Consumerism: A Want, Or A Necessity? Essay! person is Essay Bar, in. Terminology field is on They by Tim O'Brien, specific in on The and Saddle Bar differentiate terms that might find associations to at knossus other fields of Essay Boot and Saddle Bar study or the marketing spoken English language. Bar! Experts use terminologies categorize the academic information making sure that it is relevant to study. Criminology and The New Consumerism: a Want, or a Necessity? Essay criminal justice also have their own set of terminology in on The topics regarded to islamic the theories. Deductive reasoning , Qualitative research , Quantitative research 1041 Words | 3 Pages.
Will Greene Mr. On The! King Eng 101-16 Research Paper December 4, 2012 Meeting Dr. Death Walking down dull white . hallways, seeing disease, and experiencing death are just a few things that have been experienced by myself and many others in the hospice wing of a hospital. There are some things that an individual cannot bear to electronic see while in this wing as terminally ill patients are forced to on The and Saddle Bar live through the pain of Consumerism: a Want, or a their illness. Essay And Saddle! Without being able to do anything but lay in bed day after.
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Powerful New Grad Resumes and Cover Letters: 10 Things They Have in Essay on The and Saddle Bar, Common. by Katharine Hansen, Ph.D. OK, you’re graduating from college soon. Time to give your resume and cover letter a checkup to The New Consumerism: Is it a Want, or a Necessity? Essay ensure they are as powerful as they can be. Powerful new grad resumes and Essay cover letters have several things in common, so you can kill a number of birds with one stone with this checkup. 1. Powerful resumes and cover letters are used as direct-mail (or e-mail) sales tools. It’s important to remember the purpose of a resume and cover letter. They don’t have to perform the task of getting you a job since very few people are hired sight unseen. On The Things They Carried! All they have to do is get you an interview.
So the primary mission of a resume and cover letter is arouse the reader’s interest and sell yourself enough so that you get asked to meet with the employer. The lesson here is to Essay Boot Bar keep your documents concise and to the point. Electronic! You don’t have to Essay on The and Saddle Bar include everything about yourself, and you should not include anything that’s not relevant. You don’t have write your autobiography. Now, granted, some college students have the opposite problem. Instead of limiting the information they list on Essay The Things Carried by Tim O'Brien, their resumes, they worry about not having enough. Essay And Saddle Bar! Others are tempted to list every class they’ve taken, every award, and every extracurricular activity.
Many of these items may be worthy resume components, but for every item you’re considering inserting into Consumerism: a Want, Necessity? your resume, ask yourself, is it relevant to Boot the kind of job I’m seeking? Course work usually isn’t necessary unless it’s unusual or you have very little else to list in your resume. Honors, awards, and activities are generally good resume fodder, but don’t go overboard, especially at the expense of islamic philosophers work or internship experience. I knew one new grad who had an Essay Boot impressive list of Consumerism: Is it or a Necessity? Essay honors and and Saddle Bar awards. But it was so long that her work experience was buried at the bottom of the resume. Marketing! Consider omitting activities that reveal ethnicity, and especially political or religious affiliations.
Let go of high-school activities and honors unless they are truly exceptional or demonstrate an early interest in your chosen career. Essay On The Bar! Your college accomplishments should supplant what you did back in electronic marketing, high school. 2. Powerful resumes and on The and Saddle cover letters must be targeted to the employer’s perspective. When constructing your resume and Consumerism: a Want, or a cover letter, put yourself in the mind-set of the employer. Ask not what the employer can do for you but what you can do for the employer. There’s a temptation, especially among college students, to Essay on The and Saddle Bar tell employers what you’re looking for in a job.
Objective statements that say, “Seeking challenging position with growth potential,” are passe; in fact, all objective statements are out of fashion. Employers want to know what you can do for them, how you will benefit their companies, how you will impact their bottom lines. While they’re not totally oblivious to islamic philosophers your career hopes and dreams, your aspirations are not their primary concern. To read more about using a cover letter to Essay tell how you’ll benefit the employer, see Emphasize What You Can Do for the Employer in our Cover Letter Tutorial. 3. Powerful resumes and cover letters are focused and as specific as possible. The sad truth is that resumes and cover letters are read in as few as 6 seconds. So you have only the briefest moment to catch the The New Is it Essay, employer’s interest. The employer wants to know as quickly as possible: What do you want to do and what are you good at? He or she doesn’t have time to wade through lots of text to find out. So how can you sharpen the Essay Boot and Saddle Bar, focus of your resume and cover letter?
Include a Professional Profile. A profile section, also known as a “Summary of Qualifications,” can help sharpen your resume’s focus by ocean presenting 3-4 bullet points that encapsulate your best qualifications and on The Bar selling points. It’s often a good idea to why are currents important list relevant computer and Boot and Saddle foreign-language skills in this section instead of burying them at the bottom of your resume, as many job-seekers do. You can find a large collection of real, high-quality new college grad resume and cover letter samples for improving your job, internship, grad-school search here: Real New College Grad Resume and Cover Letter Job-Search Samples. Tailor cover letters to specific jobs. An effective cover letter must target a specific position, which should be mentioned in the first paragraph. Don’t list several possible positions or say that you’re willing to consider any position. Currents! If you do, the employer will see you as unfocused or even desperate. Read more about cover letter specifics: Cover Letter Success is All About Specifics and consider using our Cover Letter and Resume Customization Worksheet. Specifically tailor your resume.
According to one research study, employers want resumes to show a clear match between the applicant and a particular job’s requirements. A “general” resume that is and Saddle not focused on a specific job’s requirements is seen as not competitive. Now it may not be realistic or practical to change your resume for electronic marketing, every job you apply for, but you can change certain elements, such as the aforementioned Professional Profile section. Another alternative is to have more than one version of your resume. Boot And Saddle Bar! Let’s say you want a marketing career, but you’re open to both marketing research and promotions. You could craft a version of your resume for electronic, each niche. See our article, Your Job-Search Resume Needs a Focal Point: How Job-Seekers Can Add Focus to Resumes. Consider adding a graphic. On The Boot Bar! This suggestion is pretty radical, and it’s not for everyone, but a very small, tasteful graphic on your resume and/or cover letter could sharpen your focus. One of my former students, for example, wanted a career working with horses.
She placed a tiny horse graphic at the top of her resume. Her career focus was instantly apparent. Another student pursuing a law career used a tasteful scales of justice graphic; another interested in the palace at knossus, international business had a small world map graphic. Note that this technique is only for resumes seen by the human eye — in networking or career-fair situations, or after the resume has passed a screening through the employer’s Applicant Tracking Software and is viewed by Essay on The people. 4. Powerful resumes and cover letters make the most of your college experience. Too many college students miss the opportunity to exploit valuable experience on their resumes and marketing cover letter because they overlook unpaid experience. On The Boot! Experience is experience. Islamic! It doesn’t have to Essay on The Boot and Saddle Bar be paid. Anything you’ve done that has enabled you to develop skills that are relevant to the kind of job you seek is worth consideration for resume and cover letter mention.
That’s especially true if you don’t have much paid experience. The key, as noted in #1, is was excavated relevance . Consider the Boot, following in marketing, evaluating what experience and skills you’ve gained that are relevant to on The Boot what you want to islamic do when you graduate: Internships Summer jobs Campus jobs (work-study) Sports Entrepreneurial/self-employed jobs Temporary work Volunteer work: school, church, club, not-for-profit organizations Research papers/projects Campus activity positions Fraternity/sorority/social club positions Extracurricular or sports leadership positions. And go ahead and list material from on The Boot and Saddle these areas under your Experience section. Don’t confuse the reader with a bunch of differently labeled experience sections, such as Internship Experience, Work Experience, and islamic Project Experience. 5. Powerful resumes and cover letters portray your skills as transferable and applicable to what you want to do. You may think what you’ve done is not relevant to your future career, but you can probably spin the experience so that it demonstrates the transferable and Boot and Saddle applicable skills that most employers want: The value of transferable skills is a major reason I urge students to list sports in the Experience sections of their resumes — because athletics so often provide the teamwork, leadership experience, and Consumerism: Is it a Want, or a competitive drive that employers seek.
6. Powerful resumes and on The cover letters focus on or a Essay, ACCOMPLISHMENTS, NOT job duties and responsibilities. In a research study, content elements that propelled employers to immediately discard resumes included a focus on duties instead of accomplishments, while documented achievements were highly ranked among content elements that employers look for. Therefore, NEVER use expressions like “Duties included,” “Responsibilities included,” or “Responsible for.” That’s job-description language, not accomplishments-driven resume language that sells. Instead, emphasize the special things you did to set yourself apart and do the job better than anyone else. Admittedly, it’s not easy to come up with accomplishments from the kinds of on The Boot and Saddle jobs that college students typically hold.
But it’s important to: Start tracking your accomplishments NOW. Start HAVING accomplishments NOW! You may not think you can have accomplishments in your lowly restaurant server or pizza delivery job, but try to. Ask your boss what you can do to improve. The Palace! Strive to win any awards (such as Employee of the Month) that your employer offers. Find ways to go above and beyond your job description. 7. Powerful resumes and cover letters use KEYWORDS and Essay and Saddle Bar action verbs! Because more than 90 percent of resumes are searched for electronic, job-specific keywords, keywords are among the most important aspects of today’s resume. Most employers rely on Essay and Saddle Bar, placing job-seeker resumes in keyword-searchable databases and using software to search those databases for specific keywords — usually nouns — that relate to job vacancies. Most Fortune 1000 companies, in The New a Want, or a Essay, fact, and many smaller companies now use these technologies.
The bottom line is that if you apply for on The, a job with a company that searches databases for keywords, and your resume doesn’t have the keywords the company seeks for the person who fills that job, you are pretty much dead in the water. The profile or summary sections mentioned in and midwifery council code, #3 can be important for front-loading your resume with those all-important keywords. Action verbs in your resume and cover letters are also important, as they increase the strength of your writing and make you sound dynamic to employers. Luckily, there is no lack of sources for lists of action verbs; you can find them all over Essay on The Bar, the Web (including Quintessential Careers’ Job-Seeker Action Verbs) and in why are ocean currents, nearly every resume and cover-letter book. Almost as important as using action verbs is avoiding weak verbs: Do. Essay On The Bar! Try “conduct,” “perform,” or “orchestrate.” Forms of the verb “to be.” Instead of “was,” say “served,” “functioned,” “acted.” Work. Everyone works. Be more specific. Job-seekers often use “work” in terms of “working with” someone else, such as other team members.
In that context, “collaborate(d)” is often a good substitute. Islamic Philosophers! Received. This verb, especially in the context of receiving an award sounds so passive, as though you deserve no credit for whatever you received. Always say you “earned” an award or honor rather than “received” it. 8. Powerful resumes and on The Boot and Saddle cover letters contain NO typos or misspellings. This characteristic should go without saying, yet in our resume-writing service, we still see typos and misspellings with alarming frequency. Remember that it’s not enough to spell-check your documents because you may have used a perfectly spelled word — but it wasn’t the word you wanted. For example, a word frequently seen on resumes and electronic cover letter is “possess,” but some job-seekers accidentally spell it “posses,” which is the plural of “posse.” Proofread your resume and Essay Bar cover letter.
Put them down for a few hours, come back, and proofread again. Then get a friend or family member with a good eye to proof them for you. 9. Powerful resumes and They by Tim O'Brien cover letters are reader-friendly. Research ranks easy readability highest of all resume characteristics in terms of Essay on The Boot and Saddle first impressions. The employers surveyed ranked use of bullets second highest.
Use the following to make your documents reader-friendly: Bullets in and midwifery, resumes (and sometimes in cover letters) White space. Make sure your documents have reasonable margins. In my opinion, the default margins in Microsoft Word are wider than they need to be (1.25? on the left and right and 1? at the top and bottom). Margins can be as narrow as .75? if needed. My partner uses the “thumb test.” When he’s holding a resume or cover letter, he wants enough white space on the left and right so that his thumbs don’t touch the text.
Of course, he has big thumbs, so 1? left and right margins suit him better. Also make sure you have a line of space between all the on The Boot Bar, jobs listed on your resume and The New a Want, or a Necessity? Essay between all resume sections. For cover letters, equalize the white space at the top and bottom of the letter so that it is centered vertically on the page. On The Boot! Type large enough to read (no smaller than 10.5 point). Building Tools That Build Better Work Lives. Since 2005, LiveCareer’s team of career coaches, certified resume writers, and savvy technologists have been developing career tools that have helped over 10 million users build stronger resumes, write more persuasive cover letters, and develop better interview skills.
Use our free samples, templates, and writing guides and our easy-to-use resume builder software to help land the job you want. Katharine Hansen, Ph.D., creative director and associate publisher of Quintessential Careers, is an educator, author, and blogger who provides content for marketing, Quintessential Careers, edits QuintZine, an electronic newsletter for jobseekers, and blogs about storytelling in the job search at A Storied Career. Katharine, who earned her PhD in organizational behavior from Essay on The and Saddle Union Institute University, Cincinnati, OH, is Essay on They Carried O'Brien author of Boot and Saddle Bar Dynamic Cover Letters for Consumerism: or a Necessity? Essay, New Graduates and A Foot in the Door: Networking Your Way into the Hidden Job Market (both published by Ten Speed Press), as well as Top Notch Executive Resumes (Career Press); and with Randall S. Hansen, Ph.D., Dynamic Cover Letters, Write Your Way to a Higher GPA (Ten Speed), and Essay Boot Bar The Complete Idiot’s Guide to The New Is it or a Study Skills (Alpha). Essay On The And Saddle! Visit her personal Website or reach her by e-mail at The New Necessity?, email@example.com. Check out Dr. Hansen on Essay Boot and Saddle, GooglePlus. I AM A STUDENT This page is for all students and prospective students (high school, college, graduate school), where you will find some expert free resources and tools for nursing council code of conduct, furthering your education. Students have been one of the Essay Boot and Saddle, primary priorities of electronic marketing Quintessential Careers since our founding in Boot and Saddle, 1996, and we have a large number of  10 Best Job Interview Tips for Jobseekers.
10 Best Job Interview Tips for philosophers, Jobseekers by Boot and Saddle Bar Randall S. Hansen, Ph.D. When you have successfully mastered cover letters, resumes, and electronic job applications and are receiving requests for interviews, it’s time to understand how to succeed in the job interview so that you are ever closer to on The Bar your goal of obtaining one or more job  Personal Career Branding #038; Self-Marketing Tools for the palace was excavated by, Job-Seekers and Essay on The Career Activists. Personal Career Branding Self-Marketing Tools for Job-Seekers and islamic Career Activists Where job-seekers can find some expert articles, tools, and resources for Essay, developing your personal career brand, as well as key self-marketing techniques to get hired or promoted.Quintessential Careers Career Branding Marketing Articles Resources: Job SeekerPersonal Brand Building Your Online Career Brand: Five  Quintessential Careers: Career and Job-Hunting Blog.
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An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries. Michael J. Bosse, M.D., Ellen J. MacKenzie, Ph.D., James F. On The And Saddle. Kellam, M.D., Andrew R. Burgess, M.D., Lawrence X. Webb, M.D., Marc F. Swiontkowski, M.D., Roy W. Sanders, M.D., Alan L. Jones, M.D., Mark P. McAndrew, M.D., Brendan M. Ocean Currents. Patterson, M.D., Melissa L. McCarthy, Sc.D., Thomas G. Travison, Ph.D., and on The and Saddle Renan C. Castillo, M.S. N Engl J Med 2002; 347:1924-1931 December 12, 2002 DOI: 10.1056/NEJMoa012604. Islamic. Limb salvage for and Saddle severe trauma has replaced amputation as the primary treatment in many trauma centers. However, long-term outcomes after limb reconstruction or amputation have not been fully evaluated. We performed a multicenter, prospective, observational study to determine the functional outcomes of 569 patients with severe leg injuries resulting in ocean reconstruction or amputation. The principal outcome measure was the Sickness Impact Profile, a multidimensional measure of self-reported health status (scores range from 0 to on The Boot and Saddle Bar, 100; scores for the general population average 2 to electronic, 3, and scores greater than 10 represent severe disability). Secondary outcomes included limb status and the presence or absence of Essay on The and Saddle Bar major complications resulting in rehospitalization. At two years, there was no significant difference in scores for the Sickness Impact Profile between the amputation and reconstruction groups (12.6 vs. 11.8, P=0.53).
After adjustment for the characteristics of the patients and their injuries, patients who underwent amputation had functional outcomes that were similar to those of patients who underwent reconstruction. Predictors of a poorer score for why are important the Sickness Impact Profile included rehospitalization for a major complication, a low educational level, nonwhite race, poverty, lack of private health insurance, poor social-support network, low self-efficacy (the patient's confidence in being able to resume life activities), smoking, and involvement in disability-compensation litigation. Patients who underwent reconstruction were more likely to be rehospitalized than those who underwent amputation (47.6 percent vs. 33.9 percent, P=0.002). Similar proportions of Essay on The and Saddle patients who underwent amputation and patients who underwent reconstruction had returned to work by two years (53.0 percent and 49.4 percent, respectively). Patients with limbs at high risk for amputation can be advised that reconstruction typically results in two-year outcomes equivalent to and midwifery of conduct, those of amputation. Medical and surgical advances of the past two decades have improved the on The and Saddle ability to reconstruct severely injured legs. 1-3 Limbs that once would have been amputated are now routinely managed with complex reconstruction protocols. 4,5 Because most studies evaluating reconstruction have been small and retrospective, the results are not definitive. 2,3,6,7 Although the results are contradictory, some investigators have suggested that functional outcome is often poorer after successful limb reconstruction than after treatment with early amputation and a good prosthesis.
4,6-9 We performed a prospective observational study comparing functional outcomes of a large cohort of patients from eight level I trauma centers who underwent reconstruction or amputation. Our hypothesis was that after adjustment for electronic marketing the severity of the limb injury, the presence and Essay on The severity of other injuries, and other characteristics of islamic patients, those undergoing amputation would have better outcomes than those undergoing reconstruction. Patients 16 to 69 years old who were admitted to eight level I trauma centers for the treatment of high-energy trauma below the distal femur were eligible. 10 High-energy trauma was defined as complicated fractures (Gustilo grade IIIB and IIIC fractures 11 and selected grade IIIA fractures), dysvascular limbs (knee dislocations, closed fractures of the tibia, or penetrating wounds with vascular injury), major soft-tissue injuries (degloving or severe crush or avulsion injury), and severe foot and ankle injuries (Gustilo grade IIIB ankle fractures, all grade III intraarticular fractures of the distal tibia [pilon], 11 and severe hind or midfoot injuries). Essay Bar. (The specific types of fractures are defined in Supplementary Appendix 1, available with the Essay on They by Tim full text of Essay this article at http://www.nejm.org.) Excluded were patients with a score on Consumerism: Is it a Want, or a Essay the Glasgow Coma Scale of less than 15, indicating some impairment in consciousness, 21 days after hospitalization or discharge 12 ; patients with a spinal cord deficit, prior amputation, or third-degree burns; patients who were transferred more than 24 hours after the injury; patients who did not speak English or Spanish; patients with a documented psychiatric disorder; and patients who were on active military duty. We enrolled 601 patients between March 1994 and June 1997. And Saddle. For the philosophers present analysis, 32 patients who had bilateral injuries that met the study criteria were excluded. An additional 24 patients were excluded owing to a lack of follow-up (i.e., they were enrolled at the time of hospital discharge but could not subsequently be located). Of the on The Boot remaining 545 patients, 149 underwent amputation during the initial hospitalization (including 37 traumatic amputations). After the initial hospital discharge, 25 additional patients underwent amputation: 12 by nursing code of conduct three months, 6 by six months, and and Saddle Bar 7 after six months.
Most injuries resulted from motor vehicle collisions (29 percent), motorcycle collisions (22 percent), or collisions involving pedestrians and motor vehicles (13 percent). The study was approved by the institutional review board at the coordinating center and Essay The Things They Carried each study site. Written informed consent was obtained from all study participants. The patients were evaluated at on The and Saddle Bar, base line (before hospital discharge) and 3, 6, 12, and 24 months after the injury. At each point, patients were evaluated by an orthopedic surgeon to ascertain limb status and the presence or absence of complications, by a physical therapist to evaluate the extent of impairment, and by a research nurse to assess the patients' perception of functional outcome. Of the Essay on O'Brien 545 patients, 502 (92.1 percent) were evaluated at 3 months, 503 (92.3 percent) at 6 months, 493 (90.5 percent) at 12 months, and 460 (84.4 percent) at 24 months. All available data on these 545 patients were used in the outcome analysis. Although patients with incomplete follow-up data were more likely to be male, nonwhite, and without a high-school education than those with complete follow-up data (P0.05 for all comparisons), the rates of and Saddle follow-up did not differ significantly between the Essay on Carried amputation group and the reconstruction group. Functional outcome was measured with use of the Sickness Impact Profile. 13 The Sickness Impact Profile is a multidimensional measure of self-reported health status, consisting of 136 statements about limitations in 12 categories of function: ambulation, mobility, body care and movement, social interaction, alertness, emotional behavior, communication, sleep and rest, eating, work, home management, and recreation.
Respondents are asked to endorse statements that describe their health status on a given day. Scores are computed for the overall instrument, for on The Boot Bar each of the 12 categories and for 2 major dimensions of health (physical health, which reflects limitations noted in the first 3 categories, and psychosocial health, which reflects limitations noted in the second 3 categories). The reliability and validity of the Sickness Impact Profile have been well tested, 14 especially with respect to the outcome after injury. 15 The overall scores can range from 0 to 100; scores greater than 10 represent severe disability, and differences in scores of 2 to 3 points reflect meaningful differences in function. 16 Scores average between 2 and marketing 3 points for Essay on The Bar the general population.
17. Patients were evaluated by the orthopedic surgeon, and the subsequent limb treatment was based on the best clinical judgment of the surgeon and, in some cases, the desires of the patient. 18 Because treatment assignments were not randomized, comparisons of outcomes based on the Sickness Impact Profile were adjusted for potential confounders, including the characteristics of the patients and their injuries. The injuries were prospectively characterized according to the type and extent of bony damage, the extent of soft-tissue injury, and the initial pulse assessment and plantar sensation (Supplementary Appendix 1). Two orthopedic trauma surgeons who were unaware of the patients' injury classification and eventual treatment reevaluated the case histories by on They Carried by Tim reviewing radiographs, photographs of the wounds, and operative findings. Forty-one (7.5 percent) injuries were reclassified on and Saddle Bar the basis of this second evaluation. Islamic. Amputations were further classified according to the level and type of closure (typical elective skin-flap design or atypical, best-possible skin coverage, including split-thickness skin grafts and free-tissue transfers). Associated injuries were classified with the use of the Abbreviated Injury Scale, 19 the Injury Severity Score, 20 and two scores on on The and Saddle the Abbreviated Injury Scale denoting the maximal severity of nonstudy injuries to and midwifery council code of conduct, the contralateral and Essay on The Bar ipsilateral leg and pelvis. Shock was defined by a systolic blood pressure lower than 90 mm Hg before the electronic initiation of resuscitation. 21 To account for the effect of complications on recovery, a variable was constructed to indicate rehospitalization for Essay one or more of the following conditions: late amputation or stump revision, fracture nonunion, hardware failure, flap failure, wound infection, or osteomyelitis. Data collected on the characteristics of the patients that were hypothesized to influence the at knossus treatment assignment or outcome have previously been described in detail.
10 They included age; sex; race or ethnic group; education; income level 22 and insurance status before the injury; work status, occupation, 23 and physical demands of the job before the injury 24 ; personality characteristics, as measured by the Neuroticism, Extroversion, and Openness (NEO) Personality Inventory 25 ; social support, measured with use of Boot and Saddle Bar a modified version of the Inventory of the palace at knossus by Socially Supportive Behaviors, which assesses a patient's level of on The Boot and Saddle Bar support in terms of tangible assistance, directive guidance and emotional support 26,27 and self-efficacy 28 (how confident patients were at the time of hospital discharge in their ability to resume their chief life activities). Why Are Ocean Currents. Additional measures were self-rated health and the presence or absence of chronic conditions before the injury; exercise, smoking, and drinking habits before the injury 29,30 ; and whether compensation was received for the injury and legal services were retained. 31. On The Boot And Saddle Bar. Longitudinal multivariate regression techniques were used to the palace by, assess associations between treatment and outcomes over Essay on The and Saddle Bar, a two-year period, after adjustment for characteristics of the patients and their injuries. The Palace Was Excavated. 32 Both additive and multiplicative regression models were considered, but the multiplicative model was chosen because we observed that although scores for the Sickness Impact Profile continually improved, the rate of this improvement declined over time.
Treatment was defined with the use of five categories: amputations above the knee, through the knee, below the on The Bar knee, or of the whole or partial foot and marketing reconstruction. The 12 amputations that occurred within the first three months after injury were classified according to the site of the amputation. The 13 patients who underwent amputation more than three months after injury were considered to have undergone reconstruction. An analysis was performed including and excluding these 13 patients. When included, they were identified as having a major complication. The results of both analyses were similar; therefore, the on The Boot results presented reflect the inclusion of these patients. Because the number of variables describing the nature and extent of injuries was large, a summary score, indicating the why are currents important likelihood of undergoing amputation given a patient's injury profile, was derived with the use of logistic regression that modeled the decision to amputate or reconstruct as a function of the characteristics of the injury. 18 Traumatic amputations (for which underlying characteristics of the injury itself were not documented) were assigned a summary score of 1. Multivariate models that included all characteristics of the injury as separate covariates yielded results similar to Essay Boot Bar, those obtained with the use of models that included the summary scores; therefore, results based on the more parsimonious model, which used the summary score, are presented. Stepwise modeling techniques were used to construct the final model, which included the the palace was excavated by treatment variables, the summary score, the occurrence of Boot and Saddle Bar a major complication resulting in rehospitalization, and all characteristics of the patients that remained associated with an outcome at a P value of less than 0.10. The extent to which the effect of these variables on the outcome varied according to the time since injury or to treatment was examined, and interaction terms were incorporated where indicated.
There were no significant differences in sociodemographic characteristics between patients who underwent reconstruction and those who underwent amputation ( Table 1 Table 1 Base-Line Characteristics of the 545 Patients Who Underwent at Least One Follow-up Evaluation. ). Patients who underwent amputation had more severe injuries, as evidenced by their greater frequencies of bone loss, soft-tissue damage, initial pulse deficit, and lack of plantar sensation. Table 2 Table 2 Clinical Status of 460 Patients Evaluated 24 Months after Injury. summarizes the clinical status of patients 24 months after injury. A moderate proportion of patients had not fully recovered, as indicated by the fact that 10.9 percent of patients who underwent reconstruction had unhealed fractures, 3.9 percent of those who underwent reconstruction and 9.1 percent of those who underwent amputation had unhealed soft-tissue injuries, and 19.1 percent of those who underwent reconstruction and 5.0 percent of those who underwent amputation had an anticipated need for additional surgery. The last known status of patients who were followed for less than 24 months (15.6 percent of all patients) was similar to that of patients with complete 24-month follow-up. There were no significant differences between the treatment groups in the percentage of patients with an islamic philosophers, unhealed fracture, the percentage with an unhealed soft-tissue injury, or the Bar percentage requiring additional surgery.
More than one third of the patients were rehospitalized at least once for a complication; patients who underwent reconstruction were more likely to nursing council code of conduct, have been rehospitalized than those who underwent amputation (47.6 percent vs. 33.9 percent, P=0.002). Mean scores for the Sickness Impact Profile were 14.5 at 12 months and 12.0 at 24 months; at 24 months, 42.0 percent of the patients had scores greater than 10. There were no significant differences in scores between the treatment groups ( Table 3 Table 3 Scores for Essay Boot Bar the Sickness Impact Profile for 493 Patients Evaluated 12 Months after Injury and 460 Patients Evaluated 24 Months after Injury. ). Islamic. Scores for the work subscale were particularly high. At 24 months, 53.0 percent of the patients who underwent amputation and 49.4 percent of those who underwent reconstruction had returned to work (P=0.48). Table 4 Table 4 Association between Clinical and Demographic Characteristics and Boot and Saddle Bar Scores for the Sickness Impact Profile. presents estimates of the magnitude of the palace by change in scores associated with several covariates, including amputations of various types (as compared with reconstruction). The regression analysis confirms the absence of an overall difference in outcomes between groups after adjustment for potential confounders.
Although patients who underwent amputation through the knee had worse scores than patients who underwent other types of procedures, these differences were not statistically significant. To underscore the similarity in scores after amputation or reconstruction, mean adjusted scores (derived from the Essay on The final regression model) are presented according to the type of treatment in philosophers Table 5 Table 5 Mean Scores for the Sickness Impact Profile for the 460 Patients Who Were Evaluated 24 Months after Injury. . In multivariate analyses, factors that were significant predictors of a poor outcome (as indicated by a high Sickness Impact Profile score) included being rehospitalized for Essay Boot Bar a major complication, having less than a high-school education, having a household income below the philosophers federal poverty level, being nonwhite, having no insurance or having Medicaid, having a poor social-support network, having a low level of self-efficacy (confidence in one's ability to resume one's chief life activities), smoking, and involving the legal system for injury compensation. Essay Boot Bar. Predictors of a poor outcome were the same in both groups. The association between having private insurance and a disability, however, changed over time; private insurance was associated with the greatest improvement in scores at 6 to 12 months. Essay Carried. The characteristics of the injury (according to the summary score) were not significantly correlated with the outcomes measured by the Sickness Impact Profile, nor was the Boot Bar presence or severity of other injuries to ipsilateral and contralateral limbs. After adjustment for on Carried by Tim O'Brien the severity of the injury and various other characteristics, patients who underwent amputation had functional outcomes that were similar to those of patients who underwent reconstruction. However, the levels of disability at two years were high in both groups: more than 40 percent had a score greater than 10 on the Sickness Impact Profile, reflecting severe disability. Except for the scores for the eating and communication subscales, at 24 months scores for all subscales of the Sickness Impact Profile were substantially higher than published norms for the general population. Essay On The Bar. 17 Only about half of all patients had returned to work by 24 months. Except for the score for the psychosocial-functioning subscale, there were significant improvements in the scores over time in both treatment groups. Poor psychosocial outcomes after serious injuries have been reported by other investigators 36,37 and was excavated by may be associated with post-traumatic stress disorder.
38,39. Essay Bar. Neither the severity of fracture and soft-tissue injury nor the presence of associated injuries of the ipsilateral and contralateral leg significantly affected functional outcome. Why Are Ocean Currents. This lack of on The and Saddle association may be a reflection of the inclusion criteria, in that only patients with the most severe limb injuries were included. These injuries affected the patient's ability to walk and most likely masked the effect on functional outcome of other injuries to electronic, the leg and foot. Factors that were not related to the injury that were associated with a poorer outcome, regardless of the type of injury or treatment, included a low level of education, nonwhite race, poverty, lack of private health insurance, smoking, and Essay on The Boot and Saddle Bar involvement with disability-compensation litigation. These results suggest that major improvements in outcome might require greater emphasis on nonclinical interventions, such as early evaluation by psychosocial and vocational rehabilitation specialists. Our findings confirm previous research that identified both social support and self-efficacy as important determinants of of conduct outcome. 40,41 Interventions aimed at improving patients' perceptions of self-efficacy, in particular, may benefit those who are facing a challenging recovery. The limitations of our study must be acknowledged.
Patients were not randomly assigned to undergo amputation or reconstruction. Patients who underwent amputation were, on average, more severely injured than those who underwent reconstruction. Although an adjustment was made for Essay on The Boot these differences in the multivariate analysis, the currents possibility of Essay on The Boot and Saddle Bar residual confounding cannot be ruled out. Although the overall rates of follow-up exceeded 80 percent at 2 years, the patients who were lost to islamic philosophers, follow-up (including 24 patients for whom no follow-up data were available and 85 who were followed for less than 24 months) were of lower socioeconomic status than those with complete follow-up. The results may therefore underestimate the overall extent of disability. However, the rate of loss to Boot Bar, follow-up was similar in the two groups, and islamic all available data on the 545 patients who underwent at least one follow-up evaluation were used in Essay on The Boot and Saddle the analysis. Also, the extent of Is it a Want, or a Essay healing of fractures and Boot and Saddle Bar soft-tissue wounds at Essay on Carried, 12 months was similar among those with and those without subsequent follow-up data at 24 months. On The Boot. The generalizability of council code our results beyond level I trauma centers is uncertain. Essay On The Boot Bar. The outcomes may have been influenced by the expertise of physicians and other caregivers.
Finally, the results are based on outcomes during the Essay on The Things Carried first two years after injury, a period in which many patients have not yet completely recovered. Eventual amputation of dysfunctional or chronically painful limbs and the resolution of fractures may ultimately improve function among patients who undergo reconstruction. Continued modification of the fit of the prosthesis and increasing experience with the device could improve function among patients who undergo amputation. 42 Although not considered in this study, the costs of treatment and rehabilitation (including lifetime costs of prostheses) will also be important in guiding treatment decisions. Contrary to our hypothesis, at two years, the Boot Bar outcomes among patients who underwent reconstruction were not significantly different from those among patients who underwent amputation. Thus, patients with limb injuries that put them at high risk for amputation can be advised that reconstruction typically results in two-year outcomes equivalent to the palace at knossus by, those of amputation. Essay On The Boot. However, reconstruction is associated with a higher risk of complications, additional surgeries, and rehospitalization.
Funded by a grant (R01-AR42659) from the National Institutes of Health. Ocean Currents Important. Dr. On The Boot And Saddle Bar. Burgess reports having consulted for Howmedica; Dr. Consumerism: Essay. Webb reports having consulted for Zimmer, Orthofix, and AO Foundation; and Dr. Jones reports having consulted for Stryker and for Essay and Saddle Smith, Nephew and Richards. We are indebted to The New a Want, or a Necessity?, the coprincipal investigators, study coordinators, and physical therapists at each of the Essay on The Boot Bar eight study sites, including Julie Agel, A.T.C., Jennifer Avery, P.T., Denise Bailey, P.T., Wendall Bryan, Debbie Bullard, Carla Carpenter, P.T., Elizabeth Chaparro, R.N., Kate Corbin, M.D., Denise Darnell, R.N., B.S.N., Stephanie Dickason, P.T., Thomas DiPasquale, D.O., Betty Harkin, P.T., Michael Harrington, P.T., Dolfi Herscovici, D.O., Amy Holdren, R.N.C., A.N.P., M.S.N., Linda Howard, P.T., Sarah Hutchings, B.S., Marie Johnson, L.P.N., Melissa Jurewicz, P.T., Donna Lampke, P.T., Karen Lee, R.N., Marianne Mars, P.T., Maxine Mendoza-Welch, P.A., J. Wayne Meredith, M.D., Nan Morris, P.T., Karen Murdock, P.T., Andrew Pollak, M.D., Pat Radey, R.N., Sandy Shelton, P.T., Sherry Simpson, P.T., Steven Sims, M.D., Douglas Smith, M.D., Adam Starr, M.D., Celia Wiegman, R.N., John Wilber, M.D., Stephanie Williams, P.A., Philip Wolinsky, M.D., Mary Woodman, B.A., and Michele Zimmerman, R.N. From the Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, N.C. (M.J.B., J.F.K.); the Center for Injury Research and Policy, Johns Hopkins University Bloomberg School of Hygiene and Public Health, Baltimore (E.J.M., T.G.T., R.C.C.); the electronic marketing R Adams Cowley Shock Trauma Center, University of Maryland at Baltimore, Baltimore (A.R.B.); the Department of Orthopedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, N.C. Bar. (L.X.W.); the Department of Orthopedic Surgery, Harborview Medical Center, Seattle (M.F.S.); the Orthopedic Trauma Service, Tampa General Hospital, Tampa, Fla. (R.W.S.); the Department of the palace Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas (A.L.J.); the Department of Orthopedics and Rehabilitation, Vanderbilt University School of on The Boot and Saddle Bar Medicine, Nashville (M.P.M.); the Department of Orthopedic Surgery, Cleveland MetroHealth Medical Center, Cleveland (B.M.P.); and Johns Hopkins School of Medicine, Baltimore (M.L.M.). Address reprint requests to Dr.
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