Pennsylvania School Research Articles

Impact of the Community Eligibility Provision on meal counts and participation in Pennsylvania and Maryland National School Lunch Programs.

To determine whether school-level participation in the federal Community Eligibility Provision (CEP), which provides free school lunch to all students, is associated with school meal participation rates. Participation in school meals is important for decreasing food insecurity and improving child health and well-being. Quasi-experimental evaluation using negative binomial regression to predict meal count rates per student-year overall and by reimbursement level adjusted for proportion eligible for free and reduced-price lunch (FR eligibility) and operating days. Schools (grades kindergarten to 12th) participating in the National School Lunch Program (NSLP) in Maryland and Pennsylvania, USA, from the 2013-2015 (n 1762) and 2016-2017 (n 2379) school years. Administrative, school-level data on school lunch counts and student enrolment. CEP was associated with a non-significant 6 % higher total NSLP meal count adjusting for FR eligibility, enrolment and operating days (rate ratio = 1·06, 95 % CI 0·98, 1·14). After controlling for participation rates in the year prior to CEP implementation, the programme was associated with a significant 8 % increase in meal counts (rate ratio = 1·08, 95 % CI 1·03, 1·12). In both analyses, CEP was associated with lower FR meal participation and substantial increases in paid meal participation. School-level implementation of CEP is associated with increases in total school meal participation. Current funding structures may prevent broader adoption of the programme by schools with fewer students eligible for FR meals.

Using Telehealth to Address Pediatric Obesity in Rural Pennsylvania

Introduction: While for adults in Pennsylvania, obesity rates tripled from less than 10% in 1990 to 30% in 2015, the combined rates of overweight, obese, and severely obese children and adolescents in Pennsylvania are projected to approach 37.11% by the end of 2018.Method: Pediatric obesity rates in rural areas tend to be even higher than those in urban areas. Pediatric obesity needs to be addressed, since it is strongly correlated with several chronic diseases. Given the scarcity of resources to manage this trend, innovative population-based approaches are needed. Web-based telehealth, telemedicine, mobile health (mHealth), and telephone conferences have been proposed as solutions to treat and prevent childhood obesity in rural areas; the most suitable solution is through a family-based telemedicine intervention. The purpose of this study is to explore the feasibility of such a telehealth application especially for rural Pennsylvania.Results: Telehealth use in healthcare organizations in Pennsylvania is scarce; however, 92% of Pennsylvania’s school districts meet the minimum internet connectivity standards.Discussions: This article, while acknowledging barriers to the adoption of the internet-based telemedicine resources, discusses solutions for increasing their availability and dissemination in rural Pennsylvania. Current internet connectivity standards in Pennsylvania schools reflect ability to participate in telehealth programs in terms of technological background, but schools are not engaged in such programs. An appraisal of the real-life challenges to implement this modality is critical and will pave the way for advocacy and implementation of useful telehealth services in low-resource areas.

Chronic Disease Self-Management During the Monthly SNAP Cycle (P04-193-19)

ObjectivesThis study explored chronic disease self-management over the monthly benefit cycle among primary food shoppers from households receiving Supplemental Nutrition Assistance Program (SNAP) benefits in Philadelphia, Pennsylvania. MethodsIn-depth interviews, participant observation and surveys were conducted with the primary food shopper of SNAP households (n = 18). Interviews and surveys were conducted in a clinical setting, at participants’ homes, and in food procurement settings including grocery stores, food pantries and soup kitchens. ResultsAll households had at least one member with a chronic disease or condition; 5 with a diet-related chronic condition, 5 managing the chronic condition of a family member, and 13 with overweight or obesity. Households reported that the dietary demands of managing chronic illnesses were expensive and mentally taxing. Food and financial shortfalls at the end of the benefit cycle, as well as reliance on charitable food assistance programs, often had negative impacts on chronic disease self-management. ConclusionsDrawing from nearly 50 hours of in-depth qualitative interviews with SNAP participants, this study highlights the dual cognitive burden of poverty and chronic disease and elucidates the particular challenges of food procurement and maintenance of diet quality throughout the benefit month faced by SNAP households with diet-related chronic diseases. Interventions targeted at reducing the cost of medically appropriate, healthy foods may help to improve chronic disease self-management within SNAP populations. Funding SourcesThis work was supported by the University of Pennsylvania Leonard Davis Institute of Health Economics, the University of Pennsylvania Graduate and Professional Student Assembly Provost Award for Interdisciplinary Innovation, the NIH NIDDK Pediatric Endocrine Fellowship Training in Diabetes Research, and the Investment for the Future Initiative in Community Practices, University of Pennsylvania School of Nursing. The sources of financial support had no role in the design, analysis, or writing of this abstract.

1605-P: Profiling Risk among Sepsis Survivors with Diabetes in Home Care

Diabetes mellitus (DM) increases the risk of developing infectious complications, including sepsis. Little is known about sepsis survivors with DM. Overall, there are limited and conflicting information regarding outcomes of patients with diabetes after a hospitalization for sepsis. The purpose of this study was to profile the characteristics and outcomes for sepsis survivors with (n = 80,312) and without DM (n = 84,916). The sample included Medicare beneficiaries discharged from the hospital to home health care (HHC) after a sepsis admission between July 1, 2013 and June 30, 2014. We utilized Medicare administrative claims and the Outcome and Assessment Information Set Version C start of care assessments. The incidence of older adults with DM and sepsis in HHC was 48.6%; a much higher rate than the 20-30% reported in the general hospitalized population. Those with DM and sepsis had a higher proportion of 30-day rehospitalization (24.3% verse 20.8%, p < .001) and were more likely to have a prior sepsis admission (9.28% verse 3.35%, p < .001) than sepsis patients without DM. They had more comorbid conditions (5.19 versus 3.8, p<.001) including higher rates of depression, vision loss, obesity, hypertension, heart failure, pulmonary disease, and renal failure than non-DM sepsis survivors. Approximately 50% were taking injectable medications and only 12.8% of them were able to do so independently. For those who required caregiver assistance over 25% of caregivers reported needing additional training. Sepsis survivors with DM experience significantly higher readmission rates than non-DM patients. HHC clinicians should flag the sepsis survivor with DM as high risk and target interventions to manage the increased comorbid conditions, medication management, and caregiver training issues that may be contributing to the higher readmission rates. Disclosure C.R. Whitehouse: None. L. Jordan: None. K. Bowles: None. C.M. Murtaugh: None. Funding National Institute of Nursing Research (R01NR016014); Visiting Nurse Service of New York; Ruth L. Kirschstein National Research Service Award; University of Pennsylvania School of Nursing

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Brandon G. BusbeeBrandon G. BusbeeDr Brandon G. Busbee received his undergraduate and Medical Doctorate at Wake Forest University, North Carolina, USA, graduating magna cum laude. Dr Busbee completed his ophthalmology residency at Wills Eye Hospital in Philadelphia, USA, during which he was elected Co-Chief Resident. After residency, Dr Busbee completed a two-year vitreoretinal fellowship at Tufts-New England Eye Center and Ophthalmic Consultants of Boston, USA, and held staff appointments and teaching responsibilities at Tufts-New England Eye Center, Mass Eye and Ear Infirmary and Harvard Medical School, USA. In 2004, Dr Busbee moved to the Nashville area and joined Tennessee Retina (formerly Retina-Vitreous Associates). He was honored in 2005 with the Achievement Award from the American Academy of Ophthalmology (AAO) and graduated from the AAO Leadership Development Program in 2007. Dr Busbee has published numerous articles in peer-reviewed journals. His recent writings and presentations have focused on the areas of age-related macular degeneration, anesthetic techniques, healthcare policy, endophthalmitis, diabetic eye disease, macular surgery and retinal detachment. Dr Busbee has previously served at the AAO, American Society of Retina Specialists (ASRS), ARVO and Retina Society. He has contributed on the editorial boards of the journal Retina MD, the ASRS Retinal Image Bank and the ASRS Online. John W. KitchensJohn W. KitchensJohn W. Kitchens, MD, is a vitreoretinal surgeon with the Retina Associates of Kentucky in Lexington, Kentucky, USA. He received his Bachelor of Science degree from the University of Evansville, Indiana, USA, and Doctor of Medicine from the Indiana University School of Medicine, USA. He completed his internship at Indiana University, followed by a residency at the Department of Ophthalmology, University of Iowa, USA. After his residency, Dr Kitchens undertook a vitreoretinal fellowship at the Bascom Palmer Eye Institute, USA, where he was also Chief Resident and an instructor. Dr Kitchens practice focuses on medical and surgical diseases of the retina. His research interests include macular hole surgery, retinal detachment, ocular imaging, and ocular histoplasmosis syndrome. Currently, he is undertaking two studies; on lucentis for ocular histoplasmosis and another on the pharmacogenetics of AMD. Jason HsuJason HsuDr Jason Hsu is Co-Director of Retina Research at the Retina Service of Wills Eye Hospital, a partner at Mid Atlantic Retina, and an Associate Professor of Ophthalmology at Thomas Jefferson University. After graduating from Princeton University with a BSE in Electrical Engineering, Dr Hsu earned his medical degree at the University of Pennsylvania School of Medicine. He completed his ophthalmology residency at the University of Pennsylvania Scheie Eye Institute followed by his vitreoretinal surgery fellowship at Wills Eye Institute. Dr Hsu has a special interest in clinical retina research and has received funding from Wills Eye Innovation Grants and the J. Arch McNamara Memorial Research Fund. He has authored over 90 peer-reviewed articles and book chapters. Dr Hsu serves as section editor for Current Opinion in Ophthalmology and Retina Times. He is an associate editor for Retinal Cases & Brief Reports and currently serves on committees for the American Academy of Ophthalmology and the Retina Society. Dr Hsu has received the American Society of Retina Specialists Honor Award and Senior Honor Award as well as the American Academy of Ophthalmology Achievement Award. Sunir J. GargSunir J. GargDr Sunir J. Garg, MD, is Professor of Ophthalmology at the Retina Service of Wills Eye Hospital, Thomas Jefferson University, and is a partner with Mid Atlantic Retina. He is co-director of the Retina Research Unit at Wills Eye Hospital. He has published over 100 papers and book chapters and serves on the editorial board of the American Journal of Ophthalmology. He is ophthalmology editor for the Merck Manual, Retina Committee Chair for the American Academy of Ophthalmology ONE Network, an official clinical spokesperson for the American Academy of Ophthalmology and is Editor-in-Chief of Retina Times, an official publication of the American Society of Retina Specialists.

In Memoriam: Douglas C. Heiner, MD, PhD (1925-2018)

Dr Douglas Cragun Heiner, 93, passed away peacefully of natural causes at home in Alpine, Utah, on September 19, 2018. He graduated from the University of Pennsylvania School of Medicine with honors in 1950. After a 1-year internship, he began active duty at the US Army Hospital in Aberdeen, Maryland, and then was ordered to the Expeditionary US Army Headquarters in Seoul, Korea, where he served for 15 months as a preventive medicine officer.

Making success: What does large-scale integration of making into a middle and high school look like?

Making is a movement present in the United States which fosters creativity and invention through the creation and sharing of products. This case study of one Western Pennsylvania school district’s integration of Making into its lower and upper secondary schools shows how the investment in space and equipment, guided by visionary leadership, can bring about innovation. Our findings after year 1 of this 2-year project indicate that Elizabeth Forward School District has been successful in fostering an atmosphere where students and teachers are given permission to fail, thereby allowing for experimentation, exploration, and the integration of girls into this normally male-dominated field.

Net Pension Liability Impact on School Districts after Incorporation of Governmental Accounting Standards Boards (GASB) Statement Number 68

This paper analyzes twenty school districts in the state of Pennsylvania and applies ratio analysis to understand the potential effect of GASB number 68 on the financial statements of these entities. The financial statements were picked on a random basis from the Electronic Municipal Market Access [1] database. EMMA is a research and data retrieval system of the Municipal Securities Rulemaking Board (MSRB). The MSRB provides resources to trade municipal bonds and access to the financial statements of entities selling these securities. The paper was developed as a result of the requirement by GASB to “recognize their long-term obligation for pension benefits as a liability for the first time, and to more comprehensively and comparably measure the annual costs of pension benefits” [2]. The public schools in Pennsylvania incorporated GASB number 68 for the fiscal year ended June 30, 2015 and restated the financial statements for the fiscal year ended June 30, 2014. The effects of these restatements created a situation where most of these districts now show a negative fund balance caused by an increase of liabilities of over one hundred percent. Many of the decision makers are uncertain of the long-term changes that this recognition will have on the operations of the school district. Bond ratings have suffered because of the volatility and uncertainty causing negative effects on the balance sheet, increased current recognition of pension expenses, and a possible interest rate increase. All of these effects are illustrated in this paper. This is at a time where many people are questioning the performance of many of the school districts.

Online Stratifcation: How Academic Performance Indicators Relate to Choices between Cyber Charter Schools

Background/Context A primary argument that supports charter school policy assumes students favor schools with high academic performance ratings, leading to systemic school improvement. Previous research challenges this assumption but has limited generalizability because geographic and enrollment constraints limit student choice sets. Purpose/Objective This study examines student enrollment patterns within cyber charter schools in Pennsylvania, a state where elected policymakers tend to view choice as a means for school improvement. Cyber charter schools are advantageous to study in this context because they have fewer enrollment barriers, helping researchers account for constraints found in previous studies. Research Design Using consecutive years of student-level enrollment data, we use descriptive statistics and multinomial logistic regression analyses to answer the following questions: Is a particular cyber charter school more popular if it displays relatively higher performance on academic indicators? To what extent do enrollments in the highest performing cyber charter school relate to the demographics of students and school environments that they left? Findings/Results The findings suggest that despite the more accessible choice sets inherent in the cyber charter school sector, academic performance indicators still are not linked to popularity within the sector. Enrollment clustering persists along student demographics and feeder district traits. Conclusions/Recommendations These findings suggest that even in the cyber charter school sector where key enrollment restrictions are removed, inequitable enrollment patterns persist. These findings continue to challenge basic assumptions used in school choice policy framing. Policymakers should consider this evidence when and if they design and implement charter school policy, creating policy that accounts for inequitable enrollments that occur under current policy logic.

Addressing Specific Forms of Bullying: A Large-Scale Evaluation of the Olweus Bullying Prevention Program

The purpose of this study was to evaluate the effectiveness of the Olweus Bullying Prevention Program (OBPP) in reducing specific forms of bullying—verbal bullying, physical bullying, and indirect/relational bullying, as well as cyberbullying and bullying using words or gestures with a sexual meaning. This large-scale longitudinal study, which involved more than 30,000 students in grades 3–11 from 95 schools in central and western Pennsylvania over the course of 3 years, employed a quasi-experimental extended age-cohort design to examine self-reports of being bullied, as well as bullying others. Findings revealed that the OBPP was successful in reducing all forms of being bullied and bullying others. Analyses by grade groupings (grades 3–5, 6–8, and 9–11) revealed that, with only a few exceptions, there were significant program effects for all forms of bullying for all grade groupings. For most analyses, program effects were stronger the longer the program was in place. Most analyses indicated similar and substantial effects for both boys and girls, but a number of program by gender interactions were observed. Program effects for Black and White students were similar for most forms of being bullied and bullying others. Although Hispanic students showed results that paralleled the development for Black and White students for particular grade groups and variables, they were overall somewhat weaker. The study provided strong support for the effectiveness of the OBPP among students in elementary, middle, and early high school grades. Program effects were broad, substantial, and largely consistent, covering all forms of bullying—verbal, physical, indirect, bullying through sexual words and gestures, and, with somewhat weaker effects, cyberbullying—both with regard to being bullied and bullying others. Strengths and limitations of the study, as well as future research directions, are discussed.

Safe Medication Disposal.

Safe disposal of expired or unused medications is essential for individual and environmental safety, yet many patients report not having received education on proper medication disposal. Unused medications in homes and improper medication disposal create various risks including intentional or accidental misuse, overdose, addiction in humans, as well as toxic effects in pets. As part of their community health clinical experience, senior nursing students from the University of Pennsylvania School of Nursing visited patients of a large home care and hospice agency in a Philadelphia suburb throughout the semester. A survey conducted with a small number (N = 15) of home care patients suggested the majority of patients had inadequate knowledge about safe medication disposal. The nursing students created and presented a tip sheet on safe medication disposal and a list of local prescription medication disposal sites to home care patients. They also obtained and provided medication disposal bags for patients and caregivers who were unable to get to medication disposal sites.

Compete, Conform, or Both? School District Responses to Statewide Cyber Charter Schools

ABSTRACTThere are two competing understandings on how school organizations behave when faced with competition. One is they respond to competitive pressure with innovation. The other is they pursue strategies of isomorphism, copying practices and avoiding innovation. This study examines competitive response patterns related to cyber charter schools in Pennsylvania. Cyber charter schools gain enrollees from across the state, allowing for a study on how school districts across contexts respond to enrollment threats over time. The findings reveal that response patterns vary based on context and that policymakers need nuanced understandings of context when considering plans related to educational innovation.

Effectiveness of the Adolescent Depression Awareness Program (ADAP) on Depression Literacy and Mental Health Treatment.

Analysis of data from a NIMH-supported study was conducted to evaluate the effectiveness of the Adolescent Depression Awareness Program (ADAP) in promoting depression literacy and help-seeking behavior. Eighteen Pennsylvania schools were matched on size, sex, race, test scores, median income, and free/reduced lunch status. Schools randomized to the intervention implemented ADAP as a compulsory part of the schools health curriculum, while control schools collected study measures. Post-randomization analysis revealed no significant differences by sex on the pre-assessments between intervention and control schools. In the intervention schools, a total of 1427 students received ADAP. Written parental consent and adolescent assent was obtained from 33.7% students. The online REDCap survey was completed by 41.78% of the consenting students. The Adolescent Depression Knowledge Questionnaire (ADKQ) findings suggest that ADAP significantly improved depression knowledge (Est. =1.07, SE =.25, p < .001), compared to those in the control group. ADAP was found to facilitate help-seeking behavior by student report in those participating in the REDCap survey 4 months following the ADAP curriculum. Results of the survey suggests that ADAP facilitates help-seeking behaviors in teens. This study supports the efficacy of a teacher delivered school-based universal prevention program, ADAP, on depression literacy.

Jewels and Ladders: Visualizing and Resisting the Racialization and Dehumanization of E/Im-migrants and Refugees

Abstract While attending seminary school in Pennsylvania, Martin Luther King Jr. cultivated “the arts of pulpit oratory,” the habit of visualizing philosophical problems and other objects of criticism by invoking many-sided jewels and multi-runged ladders. This article appropriates King's jewels and ladders as tools for humanizing juridico-discursive practice toward migrants/emigrants/immigrants and refugees. By drawing attention to the process whereby persons are subordinated and become subpersons, we are able to see how the standpoint of racialized dehumanization is historically patterned and furthermore involves an overlap of legal, political, and artistic expressions. Consequently, jewels and ladders become theoretical as well as practical tools for visualizing the moral standing of migrant/refugee populations in modernity.

The Effect of Demographic Factors on the Implementation of Quality Physical Education

The Effect of Demographic Factors on the Implementation of Quality Physical Education Keri S Kulik; Hannah J. Brewer, D.Ed; Julien S. Baker, PhD Abstract The Society of Health and Physical Educators (SHAPE) has developed specific guidelines for quality physical education, including recommendations for the amount of instruction time, teacher qualifications and instructional facilities. The focus of this study was to describe these components in high schools, and to determine whether there are demographic characteristics of the school (size, location, and socio economic status (SES)) that affect these components. An electronic survey that assessed instruction time, teacher qualifications, and facilities was completed by 39 public high schools in Southwestern Pennsylvania, USA. The demographic factors of the schools were classified based on size, location and SES. Results suggest that the schools do not meet the specific SHAPE guidelines for instruction time; however, they meet the requirements for teacher qualifications and instructional facilities. Moreover, the pattern of results does not appear to be affected by school size, location or SES. While this study found no significant effect of the demographic factors on the SHAPE components, this lack of association may be misleading because the survey instrument assessed physical education instruction time rather than physical activity. Much of current literature has focused on the influence of demographic factors on participation in physical activity rather than instruction time. Full Text: PDF DOI: 10.15640/jpesm.v6n2a1

Fibrodysplasia Ossificans Progressiva – a presentation of cases and literature review

The authors thank prof. Frederick Kaplan (The Isaac & Rose Nassau Professor of Orthopaedic Molecular Medicine and Chief of the Division of Molecular Orthopaedic Medicine at the University of Pennsylvania School of Medicine) for inspirations, directions and discussion during writing this article. The authors thank prof. David Aebisher for his help in text editing and English corrections.

Editorial introductions

Editorial introductions

Body Mass Index Screening and Follow-Up: A Cross-Sectional Questionnaire Study of Pennsylvania School Nurses.

BackgroundChildhood overweight and obesity health concerns can affect a student’s academic performance, so it is important to identify resources for school nurses that would help to improve self-efficacy, knowledge, and confidence when approaching parents with sensitive weight-related information and influence overall obesity prevention efforts in the school setting.ObjectiveThe purpose of this study was to conduct a Pennsylvania (PA) state-wide 29-item survey addressing school nursing barriers and practices, supplementing information already known in this area. Although the survey covered a range of topics, the focus was body mass index (BMI) screening and its related practice within the schools.MethodsWe conducted a state-wide Web-based survey of school nurses in PA to understand current areas of care, find ways to address child health through school BMI screenings and follow up, and identify current educational gaps to assist school nurses with providing whole child care within the realm of weight management. Chi-square test of independence was conducted to determine the relationship between BMI screening follow up and interest in a BMI toolkit.ResultsNurse participants (N=210), with a 42% (210/500) response rate, represented 208 school districts across PA. Participants were asked about their current process for notifying parents of BMI screening results. The majority (116/210, 55.2%) send a letter home in the mail, while others (62/210, 29.5%) send a letter home with students. A small number (8/210, 3.8%) said they did not notify parents altogether, and some (39/210, 18.6%) notify parents electronically. More than one-third (75/210, 35.7%) of nurses reported receiving BMI screening inquiries from parents; however, under half (35/75, 46.7%) of those respondents indicated they follow up with parents whose child screens overweight or obese. Overall, the vast majority (182/210, 86.7%) do not follow up with parents whose child screens overweight or obese. The majority (150/210, 71.4%) of the nurses responded they would benefit from a toolkit with resources to assist with communication with parents and children about BMI screenings. A significant association between respondent follow up and interest in a BMI toolkit was observed (P=.01).ConclusionsSchools must start recognizing the role school nurses play to monitor and promote children’s health. This goal might include involving them in school-based preventive programs, empowering them to lead initiatives that support whole child health and ensuring opportunities for professional development of interest to them. Nonetheless, the first step in facilitating obesity prevention methods within schools is to provide school nurses with meaningful tools that help facilitate conversations with parents, guardians, and caregivers regarding their child’s weight status and health through a BMI screening toolkit.

Part 1: CBCT EVALUATION OF ATLANTOAXIAL/ATLANTO-OCCIPITAL JOINTS FOR CERVICAL INSTABILITY RISK ASSESSMENT

Background In dental radiography, the vertical atlantoaxial index (VAAI)1 measures the vertical relationship of the atlas and the axis. Based on prior studies, value less than 0.8 might present a predisposition toward cervical instability. The Powers ratio (PR) is the ratio between the distance of 2 lines: (B–P): from basion to posterior arch of C1 (O–A): from opisthion to the anterior arch of atlas. The normal ratio is 1:1, if the ratio exceeds 1, it indicates atlanto-occipital instability. The basion–axial interval (BAI) is the horizontal distance between basion and posterior dens.4 The basion–dens interval (BDI) is the distance between the basion and the tip of the dens.4 Objective The objective of this study was to determine the potential risk for atlantoaxial/atlanto-occipital instability2 in patients who underwent cone beam computed tomography (CBCT) imaging of the head. The research was conducted at the Oral and Maxillofacial Radiology clinic of the University of Pennsylvania School of Dental Medicine (Philadelphia, PA). Materials and Methods After institutional review board approval, a preliminary study was performed on patients undergoing either preimplantation assessment of jaws or evaluation of atypical facial pain, and measurements were recorded. A total of 50 CBCT volumes were identified for the selected craniocervical cephalometric measurements. Analysis of the CBCT volumes and cephalometry were performed to record various craniocervical measurements and determine the potential risk of atlantoaxial atlanto-occipital instability. The measurements were done by using the midsagittal-view CBCT images. These measurements included BAI, BDI, VAAI, and PR. It was anticipated that these measurements would provide a risk estimate for cervical instability that could potentially result in spinal cord injury. All CBCT volumes were acquired by using the Carestream CS9300 machine (Carestream, Atlanta, GA). Results Based on the preliminary results, the average VAAI measurement was 0.7626, the average BAI was 4.970 mm, the average BDI was 5.043 mm, and the average PR was 0.6961. Discussion Apart from VAAI, BDI, and BAI, the PR3 was utilized in this study to find out the atlantoaxial dissociation (normal PR = 1:1). A ratio over 1 indicates atlanto-occipital dissociation (AOD. BAI is the horizontal distance between basion and the posterior cortex of the axis (normal ≤12 mm). BDI is the distance between the basion and the tip of the dens (normal ≤8.5 mm). Both BAI and BDI are used to diagnose AOD injuries.

Editorial introductions

Editorial introductions