Here’s an example of a story hook for an essay about the differences between British and American English. Your story can be personal or someone else’s story. The key to a great story hook is making sure the story directly connects to your essay or paper topic. Readers love stories, especially a well-written story that is memorable. This is a hook where you begin with a short story or episode that relates to your topic. An example of a simile is : Writing a research paper is like running a marathon when it’s 95 degrees Fahrenheit.Ī simile hook for the essay about business blogging could be:Ī business blog is like a magnet that pulls clients to a company. A simile is less strong than a comparison in a metaphor. Both compare two unrelated things to each other, but a simile uses the words like or as to connect them. If your essay topic is on business blogging you could write the metaphor hook:Ī business blog is a magnet pulling clients to a company.Ī simile is like a metaphor. The boyfriend is not really a rat, but he behaves like one. An example of a metaphor is: Her boyfriend is a rat. Your audience wonders what you mean and how you compare a topic to something that seems unconnected.Ī metaphor is a figure of speech that directly compares one thing to another, but these two things seem unrelated. The metaphor/simile hook engages your readers because it makes them think about a topic in a different way. The Pew Research Center, “America’s Relationship With Guns: An In-Depth Look at the Attitudes and Experiences of US Adults” Here’s an example of a factual hook about an essay on gun ownership in the United States.Īlmost two-thirds of American adults at some point in their life lived in a home with at least one gun. Some places to visit for statistics are The Pew Research Center, and The CIA World Fact Book. Evaluate your information and make sure it comes from a credible source. But, you need to include facts that are accurate, interesting, and reliable. You can impress your reader with your knowledge and evidence from the very beginning of your essay. Either way, you are curious about what the writer says.įacts and statistics hook your reader because they give real information about a topic. This statement either supports your point of view about the vegan diet, or it makes you want to argue against it (especially if you love meat). Vegans are the healthiest group of people in the world. This is an example of a strong statement on the topic of the vegan diet. They will want to see how you support your statement. It connects to the thesis statement and shows the importance of your essay or paper.Ī strong statement is a great technique because it doesn’t matter if your reader agrees or disagrees with your statement. The goal of this essay hook is to make you want to learn what students who succeed in college do, and what college students who don’t succeed in college do wrong.Ī strong statement hook is a sentence that makes an assertive claim about your topic. What is the difference between successful college students and unsuccessful college students? Here’s an example of an interesting question hook on the topic of succeeding in college: So, when you start your essay with a question hook, this signals to your readers that if they keep reading you’ll give them the answer. If we don’t have an answer then we need to find out. When we hear or read a question we want to know the answer. And the only way a person can know the answer to that question is by reading your writing. Here are 7 writing hooks that make readers want to find out what you will say in the rest of your essay.Īn interesting question hook is when you ask a question that relates to your essay or paper. Let’s dive in and look at essay hooks that will elevate your writing style! When you write essay hooks that make your rea ders curious, you’ve taken the first step toward making them fall in love with your writing. If you want to see all the elements of great introductions for research papers check my post, How to Write a Strong Introduction to a Research Paper at. Hooks also make an introduction stand out (which raises your chance of getting a high grade on your essay). You want whoever reads your essay to wonder what happens next. Usually, a hook is a sentence or group of sentences that draw people into reading your essay or research paper. So, what is a hook? It’s a piece of writing at the beginning of your essay that engages your reading audience. The best way to do that is by using attention-grabbing essay hooks. The secret is to get them interested in reading your essay by making the first part of your introduction intriguing. Do you want people to feel excited when they read your essay?
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The female might weigh 50 to 70 pounds and the male 60 to 80 pounds. The female Bullboxer Pit might range from 16 to 19 inches in height, whereas the male might be 17 to 20 inches. In most dog breeds, one of the differences between males and females is in size and weight. Your vet will check your dog’s thyroid, eyes, and will conduct skin and allergy tests. The American Pit Bull Terrier is also prone to hypothyroidism and a variety of skin problems such as mange and skin allergies. The Boxer might suffer from colitis, twisted spleen, corneal disease, and hypothyroidism. Your vet will check your dog’s hips, spine, elbows, and will run heart tests as part of a physical exam. Your Bullboxer Pit is a hybrid and not nearly as likely to experience these health issues, but having your vet check for the possibility is always a good idea. The American Pit Bull Terrier might also experience spinal cord disease and hip dysplasia, as well as kneecap dislocation, congenital heart defects, congenital eye defects, and particularly a predisposition to cataracts. The Boxer is prone to cardiomyopathy, hip dysplasia, heart disease, and sometimes spinal cord disease and brain tumors. Start trimming your dog’s nails and brushing its teeth on a regular basis while they are puppies, and it will become a normal part of their routine. The Bullboxer Pit has floppy ears that should be regularly cleaned as they might contain excess oils and wax. They should only be given a bath when necessary (no more than once a month) with a dog shampoo. However, they do tend to shed, and weekly brushing will help with this. Grooming is easy for these dogs thanks to their short coat of fur. Artistic, romantic, and musical in its composition, this pattern has all the qualities of this intuitive water sign. What better way to express your inner Pisces-the fish of the zodiac world-than with a trip down into the darkest depths of the sea with Underwater World. Pisces, February 19-March 20: Underwater World (Gold) If you look at the world as a place full of possibilities, just like Aquarians, then take a dive into the deep end with this folk-art inspired pattern. Represented by the water-bearer, Aquarians are independent, eccentric, and original, just like the mermaids in our one-of-a-kind Mermaids wallpaper. Shop PalmaĪquarius, January 20-February 18: Mermaids (Ocean) All the Gemini Wallpaper a strict filtering by the publication, which guarantees excellent quality of the pictures. Lovers of discipline, and quite serious by nature, Capricorns will find a sense of home in the orderly patterning of Palma, making it perfect for a home office, reading nook, or anyplace where concentration may be needed. Gemini Wallpaper features a lot of handpicked amoled images perfect for making your device look even cooler Gemini Wallpaper is an android app for phones and tablets which contain Gemini Wallpaper. Download and use 70,000+ Desktop Wallpaper Aesthetic Gemini stock photos for free. Shop PombalĬapricorn, December 22-January 19: Palma (Sand) Inspired by Portuguese azulejo tiles, Pombal will ignite the wanderlust of all Sagittarians-and anyone else who’s been bitten by the travel bug. Sagittarius is the biggest traveler of all the zodiac signs, delighting in experiencing new cultures, philosophies, and outlooks on life. Sagittarius, November 22-December 21: Pombal (Navy) A modern twist on the traditionally delicate floral, Bloom is perfect for this bold water sign. Passionate and assertive, just like Scorpio, Bloom brings a dose of this sign’s defining characteristics to your home. Scorpio, October 23-November 21: Bloom (Dusty Rose) Fair-minded and peaceful, Libras will swoon over Andanza’s gentle nature and harmonious swoops and loops. There’s nothing a Libra likes more than balance and symmetry, and Andanza has both in spades. Libra, September 23-October 22: Andanza (Green) One of the most careful signs of the zodiac, Virgos will find calm and peace in the cozy quilting effect this pattern lends to any space. Virgo, August 23-September 22: Quilt (Celadon)Īnalytical Virgos will appreciate the methodical patterning of our Quilt wallpaper. Mighty Leo lions, unite! The king of the jungle takes center stage with this king of wallpapers, perfect for a bedroom where the confident lion can take stock of his kingdom from his magnificent perch. Download and use 70,000+ Desktop Wallpaper Aesthetic Gemini stock photos for free. Deeply intuitive and just a bit mysterious, this pattern gets at the heart of who you are. Let the imagination your known for run wild, dear Cancer, with one of our most playful and whimsical patterns, Foret. Cancer, June 21-July 22: Foret (Midnight) Gentle, affectionate, and curious, Peonies in a sunshine-y yellow will appeal to the Gemini in all of us. Gemini represents two dueling personalities, which makes it a perfect match for a pattern that’s simultaneously modern yet traditional. Taurus, April 20-May 20: Nethercote (Rose)Ī lover of romance and gardening, Taurus signs will feel right at home in a room outfitted in Nethercote (Rose) where lush English gardens meander across the walls in a blushing colorway. Since Aries often marks the beginning of something energetic, we think this Zodiac and pattern pairing would be perfect for a look-at-me entryway. Aries, March 21-April 19: Otomi (Red)Ĭourageous, confident, and passionate, Aries will love this bold pattern outfitted in fiery red. Keep scrolling to learn more about your pattern destiny. But what does it say about your pattern style? We just had to find out, so we looked to the stars for a little guidance, and they did not disappoint. Download and use 10,000+ 4k Gemini stock photos for free. The Omaticaya clan has a spiritual head named. I know how it feels watching Halo games on youtube while you cannot play them because you don't have Xbox console.But that has been changed for me forever.I'm an Xbox 360 owner now for a month and few weeks.Your zodiac symbol can provide great insight into your personality, strengths, and weaknesses in every area of your life from business to romance. Jack Sulley represents both extremes of the Gemini personality type. Texture backgrounds Hd pattern wallpapers experimental. Yeah man,nostalgic feeling in your heart.Same here buddy.Btw PC is something special,even if we cannot play later games (after Halo 2) we find some good ways to keep our love for Halo game.Also don't forget about CMT's remastered Halo Combat Evolved.I'm going to off-topic just a bit and put trailer about that here: ah-shi-sle-pah wilderness study area new mexico ah-shi-sle-pah. He asked the committee not to pay him a salary in 2020 due to the COVID-19 pandemic. The league paid him almost $32 million in 2015, according to ESPN, which was the final year the NFL published those records. Goodells annual pay has been cut 12.5 million since 2012. Goodells latest counterproposal includes an annual salary of almost 50 million and lifetime use of a private jet. Goodell replaced commissioner Paul Tagliabue in 2006, and signed a five-year extension in 2017 worth up to $200 million, per the report. The NFL paid Roger Goodell 31.7 million in 2015, which means his salary was cut by more than 2 million from the year before. Negotiations between Roger Goodell and the NFL have been tense from the start. He said Tuesday that he will not release a report on the investigation the NFL conducted, but that he believes Washington Football Team owner Daniel Snyder was “held accountable.” Goodell has received criticism in recent weeks over his handling of the NFL’s investigation into the Washington Football Team’s reported misconduct. The NFL also announced several new television and media deals through 2033 that are reportedly worth more than $100 million. Over the past two years under Goodell, NFL players narrowly passed a new collective bargaining agreement and the league expanded its schedule to 17 regular season games. That, per The New York Times, makes him one of the top-five paid CEOs in the world. Specifically, Goodell was paid $63,900,050 each year - which totals up to $127.8 million. About 90% of Goodell’s pay over the past two years came from bonuses alone, four sources told The New York Times - which was so large “because he had helped secure such favorable labor and media deals.” That figure, per the report, was discussed at the league-wide owners meeting in New York earlier this week. NFL commissioner Roger Goodell was paid nearly $128 million over the past two years through his salary, bonuses and other benefits, according to The New York Times. The available Camtasia options for PowerPoint include, Record (for starting the recording of your presentation), Record Audio, Record Camera (webcam), Camera Preview (to preview webcam), Camtasia Studio Recording Options and Open Help Topic.Ĭamtasia Studio Recording Options provide essential features to help you customize the way you wish to record your presentations. After the installation of this add-in, you are also presented with a walkthrough regarding the use of the Camtasia. Once you install the Camtasia application, a PowerPoint add-in is automatically added to the Add-ins tab. In such a case they can use the Camtasia Studio add-in to record a screencast of their presentation with on screen video, audio and webcam footage. For example, a company may require demonstrating the benefits of their product via a PowerPoint presentation at numerous conventions. The Best Alternative to Camtasia Video Editor and Screen Recorderĭownloading the latest version of Camtasia editor doesn't overwrite the already installed versions, so you can have multiple versions downloaded at a time.This add-in can be used to create dynamic screencasts with recordings from your PowerPoint document or PPT templates, voice and webcam. If you want to install the latest version, follow these steps for Camtasia download. 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The best thing about Camtasia editor is the availability of a wide range of elements and video clips that can be added to videos and easily customized. You can get a visual readout to adjust the audio volume level in the editor. Therefore, users need to take assistant from Camtasia review to learn about this feature. The Camtasia video editor can mix background commentary and music. You can drag and drop this mixed audio onto the clip by adjusting the volume. Organization and Sharing:Ĭamtasia cheap video editor combines all specific video projects to make a new project file. You can quickly transfer it to another computer and share it with colleagues. Groups have been a proven way in Camtasia Mac to organize items and sections on a timeline. If you want to edit and display high resolution and large videos, the Camtasia screen recorder provides the option of proxy video. These copies can be edited quickly because of low data volume and returned to the original recording. Within a short time interval, Camtasia editor has become a reliable choice. So let's discuss the pros and cons of this application to explore more about this tool. Options functionality needs improvement in response time to avoid crash of software. Software initialization takes more time to operate, so it's a time-consuming process. The users have to pay for each upgrade separately. Screenflow VS Camtasia > Full Review of Camtasia:Ĭamtasia editor has become the standard for quality, simplicity, and powerful features among various editing apps. Please note: The customer is 100% responsible for rack assembly and installation. **Customer is 100% responsible for securing bikes & boats for transportation. *Please allow 48 hours (max.) for Bike purchases BD Black Diamond ATC XP is a bucket insulator that accepts ropes with a diameter between 7.7 mm and 11 mm and can be used as a descender and as an insurer. Kittery Trading Post is open 9am-7pm, daily. A $0.25 Maine bag fee applies to all curbside pickup orders. Orders not picked up within 30 days will be returned to stock. Kittery Trading Post will not have any liability for any order delays. The Black Diamond ATC is a simple, versatile tool for belaying and rappelling. Kittery Trading Post does not make any guarantee that your order will be available at any specific time. NOTE: Firearms must be picked up and processed inside the store. Flip it around and use the teeth for greater holding power catching a lead fall. When top-roping with large, stiff gym ropes, regular friction mode can save you lots of energy. For documentation and your protection we will record vehicle plate number and date/time of pickup. With two friction modes, the ATC XPallows you to match the holding power to the circumstances.Once confirmed, they will place your order in your vehicle's backseat or trunk. (On vehicle or trailer if a Bike, Boat or SUP**). A KTP team member will confirm purchase via printed or digital receipt and Valid ID shown through vehicle window.You can very well control the speed when abseiling and the holes on the side of the material help to keep the device cool. When you hear the greeting, dial EXT 330, to connect to the Curbside Pickup department. When rappelling, the Black Diamond ATC XP is in no way inferior to a belay device with brake assist such as the GriGri. Park in one of the numbered parking spots near the marked pickup door in the back of our south parking lot. (Bikes, Boats & SUPS have a separate marked pickup area). 24.95 (42) 42 reviews with an average rating of 4.8 out of 5 stars.
Substituting this into the above equations we find thatĪ P = 2.2 m/s 2 (centripetal acceleration)Īt the top of the Ferris wheel the passengers experience 0.78 g (they feel lighter).Īt the bottom of the Ferris wheel the passengers experience 1.2 g (they feel heavier). Two full revolutions per minute translates into w = 0.21 radians/s. Let's say we have a Ferris wheel with a radius of 50 meters, which makes two full revolutions per minute. It's informative to look at an example to get an idea of how much force acts on the passengers. they are at the same height as the center of the Ferris wheel). This occurs when the riders are exactly halfway between the top and bottom (i.e. The riders only feel their "true weight", when the centripetal acceleration is pointing horizontally and has no vector component parallel with gravity, and as a result it has no contribution in the vertical direction. So basically, the motion of a Ferris wheel affects your bodies "apparent" weight, which varies depending on where you are on the ride. This means that the passengers feel "heaviest" at the bottom of the Ferris wheel, and the "lightest" at the top. Therefore, the velocity and acceleration of these two points are the same. This is because point C does not move relative to point P. The acceleration of the passengers at point C is equal to the acceleration of the Ferris wheel at point P. To solve for N 1 and N 2 we must apply this equation in the vertical direction. At these two positions a P is a vector which is aligned (parallel) with gravity, so their contributions can be directly added together. At the top of the circle a P is pointing down. So at the bottom of the circle, a P is pointing up. The centripetal acceleration always points towards the center of the circle. So at location (1) this acceleration is pointing directly down, and at location (2) this acceleration is pointing directly up. This acceleration is always pointing towards the center of the wheel. N 2 is the force exerted on the passengers (by the seats) at point C, at location (2)Ī P is the centripetal acceleration of point P. Mg is the force of gravity pulling down on the passengers, where m is the mass of the passengers and g is the acceleration due to gravity, which is 9.8 m/s 2 N 1 is the force exerted on the passengers (by the seats) at point C, at location (1) The figure below shows a free-body diagram for the passengers at these locations. We wish to analyze the forces acting on the passengers at locations (1) and (2). The forces acting on the passengers are due to the combined effect of gravity and centripetal acceleration, caused by the rotation of the Ferris wheel with angular velocity w. W is the angular velocity of the Ferris wheel, in radians/s Point C is where the passengers sit (on the gondola) Point P is where the gondolas are attached to the Ferris wheel (1) is the top-most position and (2) is the bottom-most position The figure below shows a schematic of the Ferris wheel, illustrating the essentials of the problem. To analyze the Ferris wheel physics, we must first simplify the problem. As a result, the gondolas always hang downwards at all times as the Ferris wheel spins. These gondolas can freely pivot at the support where they are connected to the Ferris wheel. The Ferris wheel consists of an upright wheel with passenger gondolas (seats) attached to the rim. Ferris wheel physics is directly related to centripetal acceleration, which results in the riders feeling "heavier" or "lighter" depending on their position on the Ferris wheel. Simply follow the steps outlined below to figure out how to burn Blu-ray to DVD. How to Convert Blu-ray to DVD with Handbrake So, if you want to convert Blu-ray to DVD with freeware, Handbrake is the perfect free software to do so. For example, the latest update Handbrake 1.0.7 adds Blu-Ray support to the program. What is great about the Blu-ray to DVD converter freeware is its open source nature, which means it is constantly being updated. You can convert one video format into several others without having to pay anything. Handbrake is an open-source video conversion software and is the best free Blu-ray to DVD converter. It is still possible to convert Blu-ray to DVD with a free download by using Handbrake. If you are hesitant for Wondershare DVD Creator, then consider a Blu-ray to DVD converter for free. Get the best Blu-ray DVDs with Wondershare DVD Creator. It is an excellent way to become familiar with the Blu-ray disk burner and decide if you are interested in it. The best part about the best Blu-ray to DVD software is the free trial, you have access to all features free of charge for a while. This is because DVD to Blu-ray converter is specifically made for burning content onto DVD and Blu-ray discs. With Blu-ray to DVD with this software, you will not see a drop in quality and resolution. This software guarantees to convert Blu-ray to DVD Mac or PC in high quality. Then finish the Burn Settings such as disc label, TV standard, burner, and others on the pop-up window and click Burn button to start burning Blu-ray content to DVD format. When you finish everything, go to the Burn tab and select Burn to disc option. If you are unhappy with anything, just return to the previous tabs for further adjustments. Once you are satisfied with the new DVD, click on the Preview button to check everything. You can further customize your DVD menu by changing background pictures or music, adding text, creating chapters and more, click the related icons at the top of the interface to achieve. Click the Menu button and select your favorite design from the right column. If you do not need to make any change, just skip this step.Ĭhoose a DVD menu template before burning Blu-ray to DVD. Choose functions including crop, trim, add effects and others to edit your Blu-ray video. Click the pencil-like icon on the thumbnail and a Video Editor window will open. Make some adjustments on your Blu-ray video if you want. Then the program will display the loaded video as thumbnails on the left of the interface. Navigate to where Blu-Ray files are stored on the computer, or go to the Blu-Ray disc in the Blu-ray DVD drive. Click on the " + " button under the Source tab to get a pop-up window. The Blu-ray to DVD converter will now bring up a blank home screen. Step 1 Choose DVD Disk Typeĭownload Wondershare Blu-ray to DVD converter via the download button above and run it after installation. Step-by-step Guide on How to Convert Blu-ray to DVD with Wondershare DVD Creatorįollow the steps below to know how to convert Blu-ray to DVD format with Wondershare DVD Creator. Video Tutorial of How to Burn Blu-ray Disc Videos to DVD on Windows Thus, in this article, you will learn how to convert Blu-ray into the DVD player. Hence, people want to copy Blu-ray content to DVD to view their favorite movie whenever they want instead of Blu-ray DVD writer. you are more likely to find DVD players in cars, DVD drives in laptops etc. Even the best Blu-ray burner cannot be taken outside the living room. a Blu-ray disc burner is not mobile friendly. There is also a significant technological disparity between DVD and Blu-Ray. DVD players are much more affordable compared to Blu-Ray players hence many people want to create Blu-ray DVDs for sale. Unless you are really invested in technology, a Blu-ray disk writer is simply not worth the cost. One reason is the accessibility of Blu-Ray players are very expensive compared to DVD players and is not worth getting for most people. Best 2 Common Ways to Convert Blu-ray to DVDĪre you wondering what is Blu-ray to DVD conversion and why do some people would want it? There are several reasons why people would transfer content from Blu-ray to DVD. Thanks for stopping by! Your support is appreciated. I want you to be happy doing business with me so any questions are welcome. We are always trying to improve our products so any recommendations or thoughts are greatly appreciated. If you need something custom made, feel free to reach out. We take pride in creating simple, but comprehensive products at an affordable price. Basic Checkbook Register Google Sheets Spreadsheet.2 Checkbook Registers with automated monthly and annual summaries.Checkbook Register Google Sheets Spreadsheet with automated monthly and annual summaries.Please do not copy, share, redistribute or resell these spreadsheets. These products are meant for personal and not commercial use. Due to the type of product, these digital products are non-refundable. Support: If you need help with this product or have inquiries, contact us.If there are any issues, here's an article about how to download digital items. How to Download: Once payment is complete, the digital file(s) will be available for download and an email will be sent to you.Editable: I've locked some cells to prevent accidental changes to formulas and graphs, but all cells can be unlocked.Easily Editable, Printable, Downloadable. A Google Sheets Ledger Template is like a digital notebook that helps you manage your finances in a trouble-free, organized way. Google Sheets: This product has been designed for use in Google Sheets. It might not function or look the same in Excel. Download this Checkbook Register Template Design in Excel, Google Sheets Format.Here's an instructional video on a variation of this Checkbook Register (without monthly summaries) to give you an inside look at the spreadsheet: There is also an extensive instructions manual containing how to use this Google Sheets Checkbook Register as well as additional tips on how to save and make more money. 12 summaries of each monthly checkbook register 12 monthly checkbook registers for every month of the year There are 24 tabs on this Checkbook Register: It's easy to use and fully automated with a summary of the completed and pending transactions ! This Checkbook Register Google Sheets Spreadsheet with Monthly Summaries will help you track your transactions digitally on the go with your phone, tablet or laptop! The present study aimed to determine the within- and between-subject intra- and inter-rater reliability of pressure and vibration senses measurements with SWM presented with a 6-piece foot kit and 128 and 256 Hz tuning fork in diabetic patients. Reliability of SWM and tuning fork on/off tests are important in the evaluation of periodic clinical sensation. Previous studies demonstrated that SWM and tuning fork are appropriate tools to clinically evaluate pressure and vibration senses, respectively. Limited studies evaluated the reliability of graduated tuning fork for the detection of fracture- and immune-mediated polyneuropathies however, the tuning fork on/off test reliability was overlooked. Tuning fork test determines the ability of subjects to discriminate vibration sensation. The graduated tuning fork and tuning fork on/off tests are available in every dialectology clinic. Reliability of SWM in healthy and elderly people was evaluated by the previous studies. Monofilaments are used to detect the pressure sensation in neuropathic patients. The higher the value of the monofilament, the stiffer and more difficult it is to bend. Monofilaments, often called SWM, are calibrated, single fiber nylon threads, identified by values ranging from 1.65 to 6.65 that generate reproducible buckling stress. Monofilaments and tuning fork are non-invasive, available and easy to use instruments. Previous studies demonstrated that Semmes-Weinstein Monofilament (SWM) and tuning fork are appropriate tools for the clinical evaluation of pressure and vibration sense, respectively. Several instruments are frequently used to screen peripheral neuropathies such as monofilaments, tuning fork, and biothesiometry. The ideal instrument for neuropathy examination should be easily accessible, simple to use, and reliable with high sensitivity and specificity. This test is a complex, costly, and time consuming method and not suitable for clinical evaluations. Nerve conduction velocity is a gold standard test to detect neuropathy. According to the Polish Diabetes Society, diabetic patient’s feet should be examined at every medical visit. Periodical sensory examinations are appropriate to detect neuropathy and decrease the risk of diabetic foot ulcer. Early diagnosis of PSN is important in diabetic patients to prevent diabetic foot problems. Approximately 50% of diabetic patients experience peripheral neuropathy and more than 50% of them experience symptomatic neuropathy. Previous research recognized sensory neuropathy as the major cause of ulceration in diabetic patients. Peripheral neuropathy involves sensory, motor and autonomous systems and causes decreased pressure sensation, increased vibration perception threshold, foot deformities, and dry skin. We conclude that the Rydel-Seiffer graduated tuning fork is a suitable tool for screening for sensation loss and that diabetic patients with a tuning-fork score of less than or equal to 4.0 are vulnerable to ulceration.Peripheral Sensory Neuropathy (PSN) is the main risk factor for foot ulceration and lower extremity amputations in diabetic patients. The tuning fork score was less than or equal to 4.0 in 95% of the ulcerated feet. Age-related Rydel-Seiffer tuning fork vibration sensation was impaired in 79% of 38 ulcerated feet of 26 patients. It correlated well (r = -0.90, p less than 0.001) with the thresholds obtained with an electromagnetic instrument (Vibrameter) in diabetic patients, in whom vibration perception score was impaired compared with control subjects (4.0 +/- 1.8 (+/- SD) vs 5.4 +/- 1.4, p less than 0.001). Vibration perception score measured with the tuning fork declined with age (p less than 0.001) in the control subjects. The performance of the Rydel-Seiffer graduated tuning fork was examined in healthy subjects and in various groups of diabetic patients in order to evaluate its efficacy for identifying patients whose loss of vibration sensation may expose them to the risk of foot injury. |
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