Surgical Treatment Method of Isthmic Spondylolisthesis

Surgical Treatment Method of Isthmic Spondylolisthesis Comparison of Two and Three Vertebral Segment Posterolateral Fusion in the Treatment of Isthmic Spondylolisthesis Serkan BILGIC, Omer ERSEN, Tolga EGE, Kenan KOCA, Selahattin OZYUREK, Safak EKINCI, Erbil OGUZ, Ali SEHIRLIOGLU ABSTRACT Background Optimal surgical treatment method of isthmic spondylolisthesis remains unclear. Complications can be invited while saving a segment for lumbar motion. Objective The aim of this retrospective study was to determine the effect of the number of fusion levels on the clinical results of adult isthmic spondylolisthesis patients who had undergone posterior instrumentation and PLF. Patients and Methods This retrospective study comprised 37 (20 male, 17 female) patients with isthmic spondylolisthesis who had undergone posterior instrumentation and PLF (Postero-lateral fusion) between January 2005 and May 2011. Pre and post-operative radiological evaluation was made by anteroposterior, lateral, oblique and lateral flexion-extension x-rays. Preoperative spondylolisthesis slippage grading was evaluated according to the Meyerding classification from the preoperative radiographs. Results The mean age of the patients was 36.4 ± 9.2 years and the mean follow-up period was 34.3 months. Two-level fusion was applied to 22 patients and single-level fusion was applied to 15 patients. Decompression was performed on 7 patients in the two-level fusion group and on 6 patients in the single-level fusion group. There were no neurological complication after surgery in either group. No union complications were seen in the two-level PLF group but in the single-level PLF group, screw loosening occurred in 3 patients and screw breakage in 1 due to the pseudoarthrosis. These four patients were revised with two-level PLF. Conclusions This study has demonstrated that two-level posterior instrumentation and PLF with local bone grafts and DBM have significantly better clinical and radiological results than single-level surgery. To avoid potential complications of PLIF, two-level PLF can be an alternative treatment option. Key words:Istmic spondylolisthesis, Posterior lumbar interbody fusion, Fixation Background Lumbar spondylolisthesis is present in about 5% to 6% of the population with various etiopathogenesis. Due to its variant pathological anatomy, the radiological appearance, age and clinical aspect of the patients are different on diagnosis. It generally starts as spondylolysis, a bilateral pars fatigue fracture and becomes spondylolisthesis with a slip of a vertebra over the adjacent one. As the slip increases, disc degeneration and pain starts (1-3). Although conservative treatment is the first treatment option, surgery for symptomatic spondylolisthesis in adults has been found to have better clinical results than conservative treatment choices (3, 4). However, it remains unclear which surgical strategy should be adopted, as there is limited scientific evidence on which to base an optimal treatment method. Discussions on spondylolisthesis treatment have generally focussed on reduction, fusion levels, graft choices, and surgical techniques (5-7). One of the most preferred surgical treatment options for spondylolisthesis is posterior transpedicular instrumentation of the relevant segments and posterolateral fusion (PLF) (5, 7). However, it is still a matter of controversy in literature as to how many levels should be fused and instrumented. Objectives The aim of this retrospective study was to determine the effect of the number of fusion levels on the clinical results of adult isthmic spondylolisthesis patients who had undergone posterior instrumentation and PLF. Materials and Methods This retrospective study comprised 37 (20 male, 17 female) patients with isthmic spondylolisthesis who had undergone posterior instrumentation and PLF between January 2005 and May 2011. Patients with spondylolisthesis other than Type 2 according to the Wiltse classification were excluded from the study. Pre and post-operative radiological evaluation was made by anteroposterior, lateral, oblique and lateral flexion-extension x-rays. Preoperative spondylolisthesis slippage grading was evaluated according to the Meyerding classification from the preoperative radiographs. The decompression decision was made preoperatively according to magnetic resonance imaging (MRI) and patients preoperative neurological evaluation. Preoperative and postoperative neurological status, duration of surgery, number of fused and instrumented levels, total blood loss and complications were evaluated from the clinical database. For clinical evaluation of surgical outcomes, the Oswestry Disability Index (ODI) a nd Visual Analog Scale (VAS) applied at the final follow-up were used. 3.1 Surgical procedure: Exposure was obtained from the spinous processes to the transverse processes bilaterally throughout segments planned for fusion. Under fluoroscopic control, 6.5 mm pedicle screws were placed by free-hand technique. No reduction manoeuvre was used. Decompression of the segments, which had been determined by preoperative MRI and clinical examination was performed for the patients with neurological deficit. In all cases PLF was performed. In the area planned for fusion, the spinous processes were resected, peeled off from soft tissues and used for grafting with demineralized bone matrix. Patients were mobilized with a soft brace on the first postoperative day and the brace was continued for 3 months. (Figure 1, 2) 3.2 Statistical analysis We used the SPSS software package (version 15.0, SPSS, Chicago, IL) and expressed categorical variables as percentages and continuous variables as mean ± standard deviation (SD) or median (quartiles). Kolmogorov-Smirnov test was used to evaluate whether the distribution of continuous variables was normal. For parameters that showed normal distribution we used the paired sample t test and for parameters that did not show normal distribution the Mann-Whitney U-test was used. Chi-square test was used to analyze categorical variables. Statistical significance was set at p Results All patients had a history of at least 3 months of lumbar pain due to the spondylolisthesis, which had proved to be resistant to conservative treatment. The mean age of the patients was 36.4 ± 9.2 years and the mean follow-up period was 34.3 months. Low-grade isthmic spondylolisthesis was present at L5-S1 level in 23 patients, at L4-5 level in 13 patients and at L3-4 level in 1 patient. Two-level fusion was applied to 22 patients and single-level fusion was applied to 15 patients. Decompression was performed on 7 patients in the two-level fusion group and on 6 patients in the single-level fusion group. There were no neurological complications after surgery in either group. Mean duration of surgery for single-level and two-level surgery was 160 minutes and 190 minutes (160-240), and average blood loss was 285 ml and 390 ml respectively. There were no differences between the two groups in terms of demographic properties (Table 1). One of the patients in the two-level PLF group had superficial infection and was treated with debridement and antibiotheraphy. No union complications were seen in the two-level PLF group but in the single-level PLF group, screw loosening occurred in 3 patients and screw breakage in 1 due to the pseudoarthrosis. These four patients were revised with two-level PLF. (Figure 3) ODI scores from the final follow-up were 12.2 ±6.2 in the single-level PLF group, and 9.2  ± 6.4 in the two-level PLF group (p=0,035). VAS scores were 3.2 ±1.7 in the single-level PLF group and 2.9 ±1.6 in the two-level PLF group (p=0.043). The ODI and VAS scores of the patients revised with two- level PLF were excluded from the clinical evaluation. Discussion Lumbar spondylolysthesis has several etiopathogenetic factors as was shown by Marchetti and Bartolozzi giving rise to variations in pathological anatomy, radiological findings, age and clinical symptoms of the patients on diagnosis. When conservative treatment options fail, surgery becomes the next step. Although there have been a large number of studies on spondylolisthesis, there is no clear evidence for a single superior treatment option. Anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF) and PLF with/without instrumentation are the most widely accepted surgical methods. Whilst PLF with instrumentation is the most preferred treatment for most authors, there is no scientific evidence showing that PLF is disadvantageous compared to PLIF or circumferential fusion (8-11) even though the major theoretical advantage of PLIF and circumferential fusion seems to have resulted in improved outcomes compared with PLF. Ekman et al (12) found that the type of fusi on, whether PLIF or PLF, did not affect the outcome of surgical treatment of adult isthmic spondylolisthesis over a two year follow-up period. Furthermore, PLIF is a more invasive, technically more difficult method requiring a longer operative time, which may result in increased blood loss and higher complication rates (12, 13). Similarly, Kim et al. could not demonstrate any difference between ALIF and PLF with instrumentation (11). Although circumferential fusion was reported as significantly better than PLF at 6 months and 1 year in a study by Swan, no difference was determined at two years (14). In a systematic review of 29 high quality studies, Jacobs and al. found no difference between different fusion techniques (15). In the current study the treatment choice was PLF with instrumentation which is a relatively easy method with a shorter operating time and lower blood loss compared to other techniques in literature. When performing PLF, slip reduction can be achieved during the same procedure. The advantages of slip reduction include improved spine biomechanics, better nerve root decompression and a better opportunity for fusion by relieving tension and shear forces (5). Although the major disadvantage of slip reduction is increased risk of neurological injury, there have been numerous studies evaluating slip reduction for adult low grade spondylolisthesis (14, 16-18). In the current study, slip reduction was not performed to avoid the possibility of potential neurological damage and as all the cases had low grade isthmic spondylolisthesis. To protect one more mobile segment, some authors have preferred single-level postero-lateral instrumentation and fusion instead of two-level (6, 13, 15). However, there is no scientific proof to help determine the number of fusion levels and this decision is based on the surgeon’s empirical experience. In a prospective study by Inage et al, two-level fusion with local bone grafts was shown to cause increased pseudoarthrosis (6). Similarly in a study by Deguchi et al, single-level fusions showed an 82% fusion rate, and two-level fusions, a 74% rate radiologically (19). Higher fusion rates in the two-level fusion group were achieved with rigid spinal implants. The clinical success of that study correlated with the radiological fusion rates. Contrary to the information in literature, local bone grafts mixed with demineralized bone matrix (DBM) were used in the current study to achieve union for both groups and no union problem was seen in the two-level fusion group. Pseudoarthros is was observed in four cases in the one -level fusion group. Although some authors have reported incongruity between the clinical results of spondylolisthesis patients and union rates, VAS and ODI are the most reliable clinical tests to evaluate spondylolythesis (9, 10, 20). The results of the current study reveal that two-level posterior instrumentation with PLF has better results than single-level surgery according to VAS and ODI. This study has some limitations. Firstly, the retrospective design did not allow for uniformity of the groups. The number of patients was also limited to achieve generalized results. Although the pedicle screws were all 6.5 mm in size, they were not all from the same manufacturer, so implant problems were disregarded. In conclusion, this study has demonstrated that two-level posterior instrumentation and PLF with local bone grafts and DBM have significantly better clinical and radiological results than single-level surgery. To avoid potential complications of PLIF, two-level PLF can be an alternative treatment option. References 1.Floman Y. Progression of lumbosacral isthmic spondylolisthesis in adults. Spine. 2000;25(3):342-7. 2.Fredrickson BE, Baker D, McHolick WJ, Yuan HA, Lubicky JP. The natural history of spondylolysis and spondylolisthesis. The Journal of bone and joint surgery American volume. 1984;66(5):699-707. 3.Osterman K, Schlenzka D, Poussa M, Seitsalo S, Virta L. Isthmic spondylolisthesis in symptomatic and asymptomatic subjects, epidemiology, and natural history with special reference to disk abnormality and mode of treatment. Clinical orthopaedics and related research. 1993(297):65-70. 4.Moller H, Hedlund R. Surgery versus conservative management in adult isthmic spondylolisthesisa prospective randomized study: part 1. Spine. 2000;25(13):1711-5. 5.Floman Y, Millgram MA, Ashkenazi E, Smorgick Y, Rand N. Instrumented slip reduction and fusion for painful unstable isthmic spondylolisthesis in adults. Journal of spinal disorders techniques. 2008;21(7):477-83. 6.Inage K, Ohtori S, Koshi T, Suzuki M, Takaso M, Yamashita M, et al. One, two-, and three-level instrumented posterolateral fusion of the lumbar spine with a local bone graft: a prospective study with a 2-year follow-up. Spine. 2011;36(17):1392-6. 7.Zagra A, Giudici F, Minoia L, Corriero AS, Zagra L. Long-term results of pediculo-body fixation and posterolateral fusion for lumbar spondylolisthesis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2009;18 Suppl 1:151-5. 8.Bernhardt M, Swartz DE, Clothiaux PL, Crowell RR, White AA, 3rd. Posterolateral lumbar and lumbosacral fusion with and without pedicle screw internal fixation. Clinical orthopaedics and related research. 1992(284):109-15. 9.Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT. 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine. 1997;22(24):2807-12. 10.Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. The Journal of bone and joint surgery American volume. 1991;73(6):802-8. 11.Kim NH, Lee JW. Anterior interbody fusion versus posterolateral fusion with transpedicular fixation for isthmic spondylolisthesis in adults. A comparison of clinical results. Spine. 1999;24(8):812-6; discussion 7. 12.Ekman P, Moller H, Tullberg T, Neumann P, Hedlund R. Posterior lumbar interbody fusion versus posterolateral fusion in adult isthmic spondylolisthesis. Spine. 2007;32(20):2178-83. 13.Madan S, Boeree NR. Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis. Spine. 2002;27(14):1536-42. 14.Swan J, Hurwitz E, Malek F, van den Haak E, Cheng I, Alamin T, et al. Surgical treatment for unstable low-grade isthmic spondylolisthesis in adults: a prospective controlled study of posterior instrumented fusion compared with combined anterior-posterior fusion. The spine journal : official journal of the North American Spine Society. 2006;6(6):606-14. 15.Jacobs WC, Vreeling A, De Kleuver M. Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2006;15(4):391-402. 16.Sears W. Posterior lumbar interbody fusion for lytic spondylolisthesis: restoration of sagittal balance using insert-and-rotate interbody spacers. The spine journal : official journal of the North American Spine Society. 2005;5(2):161-9. 17.Spruit M, van Jonbergen JP, de Kleuver M. A concise follow-up of a previous report: posterior reduction and anterior lumbar interbody fusion in symptomatic low-grade adult isthmic spondylolisthesis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2005;14(9):828-32. 18.Suk SI, Lee CK, Kim WJ, Lee JH, Cho KJ, Kim HG. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine. 1997;22(2):210-9; discussion 9-20. 19.Deguchi M, Rapoff AJ, Zdeblick TA. Posterolateral fusion for isthmic spondylolisthesis in adults: analysis of fusion rate and clinical results. Journal of spinal disorders. 1998;11(6):459-64. 20.Ohtori S, Suzuki M, Koshi T, Takaso M, Yamashita M, Yamauchi K, et al. Single-level instrumented posterolateral fusion of the lumbar spine with a local bone graft versus an iliac crest bone graft: a prospective, randomized study with a 2-year follow-up. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2011;20(4):635-9. Tables Table 1. Paramaters of groups during surgery 1

Aesthetics Essay -- Art

Aesthetics Kant defined aesthetic as both, â€Å"the analysis of taste and the analysis of sensible cognition or intuition† . Aesthesis, means â€Å"sensation†, the Greeks made a distinction between aesthesis autophues (natural sensation) and aesthesis epistemonike (acquired sensation). We may say that aesthetics is both the study of aesthetic objects and of the specific and subjective reactions of observers, readers, or audiences to the work of art. Aesthetics is necessarily interdisciplinary and may be interpretive, prescriptive, descriptive, or a combination of these. The big, obvious question about aesthetic value is whether it is ever ‘really in’ the objects it is attributed to. This issue parallels the realism/anti-realism debates elsewhere in philosophy. Though there is little reason to assume that aesthetic value will behave in just the say way as for example, moral value. An extreme realist would say that aesthetic values reside in an object as properties independent of any observer’s responses, and that if we make the judgment ‘That is a beautiful flower’, or ‘this painting is aesthetically good’, what we say is true or false – true if the flower or painting has the property, false if it does not. We will tend to like the object if we recognize the aesthetic value in it, but, for the realist, whether we recognize it and whether it is are two separate questions. Consequently, much work in aesthetics has gone into trying to specify the nature of aesthetic experience or aesthetic response. One factor is pleasure, satisfaction, or liking. The second is experience: the response we are looking for must be a way of attending to the object itself. In the case of music, it must be a response to perceived patterns of s... ...bility, however, so that a new question emerges: The music all by itself somehow seems to point to, or stand for emotions – how? Aesthetics has yet to come to terms with this issue. There is a similar pattern in the case of artistic representation. In the question of what a picture depicts, what role is played by the artist’s intentions, and what by the interpretations which an observer may conjure up? Or does the painting itself have a meaning by standing in symbolic relations to items in the world? If the latter, how similar, and how dissimilar are depiction and linguistic representation?. Once one starts to address problems at this level, the philosophy of art starts to concern the nature of philosophy as a whole. Work Cited Kant, Immanuel. Critique of Judgement. Trans. J. H. Bernard. Hafner Library of Classics. New York: Hafner Press-Macmillan, 1951.

The Cultural and Sub Cultural Influence of Narcotics Anonymous Essay ex

The Cultural And Sub Cultural Influence of Narcotics Anonymous. The Subculture of N.A is a life outside of any expectations formed by the main Cultural Influence. It is a very private organization that I belong to which became a way of life for me. It has values, traditions, beliefs, sanctions and roles. This is the only outside influence in my life that made me develop meaning to my life again. I was a complete and total crack addict who finally hit the bottom of the barrel and started looking for a way to climb out of the grave I dug myself into. Narcotics Anonymous is a group that has taught me many values. They have twelve values, twelve traditions, and twelve steps. As a group we learn to accept all of the above for mentioned beliefs. There is what you call a home group. That is your main meeting session with your sponsor, (if you choose to have one which is recommended), sharing time, to talk about whatever you choose i.e. your day, if there was a relapse, a stressful day, and just trying to talk to others who understand every struggle we have on a daily basis to stay clean. N.A‘s Values are as follows: 1. Trust: Bonding from addict to addict. 2. Loyalty: Acts of contribution (since they are a self sustaining group). 3. Submission to the spiritual life because that is instilled in many ways especially since it is a part of Traditions, Twelve Steps and values. 4. Courage to change, 5.Caring and sharing, 6.Spiritual Humility, 7. Courage to try, 8. Sincerity: Honest Intentions, 9. Integrity: Honest Intentions, 10. Perseverance and Good Faith, 11. Conscious contact with our higher power, 12. And most importantly: Living Clean. To live by these values is sometimes very hard. The beliefs would be like the Narc... ...rs or more to be sponsors, group leaders and other appointed officials. As a result from their hard work it has obviously helped Narcotics Annoonymous. They have grown so much since 1973 when the organization was first incorporated into Society. They have now reached 100 countries and 31,000 meetings weekly. (This Group is na class of its own. It helps people achieve what they want (sobriety), while also teaching them rules and values, and the tools that you need in life to succeed sober. Personally, I believe it is a subculture that is growing due to the fact that more and more are turning to drugs to cope with reality. Eventually when people decide to accept a higher being which has power over them, they will turn to N.A. either after rehab or on their own. Either way if they are open to help they will turn to us. As living proof I am 508 days sober.)

Buffalo 66 :: essays papers

Buffalo 66 Buffalo ‘66, a movie directed and written by Vincent Gallo starts with a baby picture of Billie Brown (played by Vincent Gallo himself), and then goes into shots of Billie getting out of prison. Billie the fresh free man is looking for a bathroom but has no luck in finding one. The shots used in the scenes where he’s on the search for a bathroom are some handy shots (a bit shaky), they cut in the middle and they are also shot from above this is, in my opinion to emphasize on the situation Billie is in. He really needs to go to the bathroom but has no fortune, until he enters a dance studio. There he meets Layla (played by Christina Ricci) a young blond girl that simply wanted some dance lessons. Billie asked her for a quarter to call his mother, and then suddenly decided to kidnap her. The reason for that was that he didn’t want to disappoint his parents, his parents thought he was successful and married. After all this Billie didn’t find a bathroom yet until they drove off to his house. In the scene where he finally pees, there is a close up shot of Billie’s face, to show the audience his reaction. He enters the car, and he is more calm he apologizes to Layla for being so aggressive, while he’s apologizing to her there is a close up shot of her and his voice in the background, this emphasizes on Layla’s reaction. During the drive back to Billie’s home there’s alot of shots of the neighborhood, in my opinion this is to enlighten the audience on the type of surrounding Billie grew up in, this helps in understanding his character. Billy and Layla finally arrive to his house, in front of the house there’s a huge sign: â€Å"Go Buffalo† this is a clue on the environment Billie lived in at home. It is obvious his parents are huge football fans by the decoration of the house. Layla get in the character of being Billy’s wife, she makes up a story that Billy works for the CIA and that she really adores him. The next scene shows us three of the characters sitting around a table, and every minute it keeps switching. It seems like the camera is going through a point of view of one of the characters, and it keeps changing each time someone else speaks.

Education in Nigeria Essay

Education in Nigeria is overseen by the Ministry of Education. And the local authorities take responsibility for implementing policy for state-controlled public education and state schools at a regional level. The education system is divided into Kindergarten, primary education, secondary education and tertiary education. Primary education Primary education, Yoruba, and Igbo. Private schools would also offer Computer science, French, and Fine Arts. Primary school students are required to take a Common Entrance Examination to qualify for admission into the Federal and State Government Secondary schools, as well as private ones. The Universal Basic Education, UBE, came as a replacement for Nigeria’s Universal Primary Education scheme of the 6-3-3-4 system of primary education. The 9-3-4 system of education was designed in conformity with the MDGs and Education For All, EFA (Kayode, 2006). The UBE involves 6 years of Primary School education and 3 years of Junior Secondary School education, culminating in 9 years of uninterrupted schooling, and transition from one class to another is automatic but determined through continuous assessment. This scheme is monitored by the Universal Basic Education Commission, UBEC, and has made it â€Å"free†, â€Å"compulsory† and a right of every child. [1] Therefore, the UBEC law section 15 defines UBE as early childhood care and education. The law stipulates a 9-year formal schooling, adult literacy and non-formal education, skill acquisition programs and the education of special groups such as nomads and migrants, girl child and women, Al-majiri, street children and disabled people (Aderinoye, 2007). [2] Secondary education. Students spend six years in Secondary School, that is 3 years of JSS (Junior Secondary School), and 3 years of SSS (Senior Secondary School). By Senior Secondary School Class 2 (SS2), students are taking the GCE O’Levels exam, which is not mandatory, but most students take it to prepare for the Senior Secondary Certificate Examination. The Senior Secondary School Exam is taken in the last year of secondary school (SS3). Private organizations, the State government or the Federal government manage secondary schools in Nigeria. The Federal Republic of Nigeria is made up of thirty-six States and the Federal Capital Territory. There are about two Federal Government Colleges in each state. These schools are funded and managed directly by the Federal Government through the Ministry of Education. Teachers and staff are Federal Government employees. Teachers at the Federal Government schools possess a Bachelors degree in Education or in a particular subject area, such as, Mathematics, Physics etc. These schools are supposed to be model schools carrying and maintaining the ideals of secondary education for Nigerian students. Admission is based on merit, determined by the National Common Entrance Examination taken by all final year elementary school pupils. Tuition and fees are very low, approximately sixteen thousand naira ($100), because funding comes from the Federal Government. [2] State-owned secondary schools are funded by each state government and are not comparable to the Federal government colleges. Although education is supposed to be free in the majority of the state owned institutions, students are required to purchase books, uniforms and pay for miscellaneous things costing them an average of thirty thousand naira ($200) in an academic year. Teachers in State-owned institutions usually have a National Certificate of Education or a Bachelors Degree, but this is not always the case as many secondary schools in Nigeria are filled with unqualified teachers who end up not being able to motivate the students. Often these schools are understaffed due to low state budgets, lack of incentives and irregularities in payment of staff salaries. [2] Some state-owned secondary schools are regarded as elite colleges because of the historically high educational standard and producing alumni who have prominent citizens in the various careers. These included King’s College, Lagos and Queen’s College, Lagos. However, the college ranking of these institutions have since dropped because of the arrival of some private institutions. Private secondary schools in Nigeria tend to be quite expensive with average annual fees averaging from one hundred and sixty to three hundred and twenty thousand naira($1000. 00 – $2000. 00). These schools have smaller classes (approximately twenty to thirty students per class), modern equipment and a better environment. Most teachers in these institutions possess at least a Bachelors Degree in a specific course area and are sent for workshops or short term programs on a regular basis. [2] Promotional examinations With the introduction of 6-3-3-4 system of education in Nigeria, the recipient of the education would spend six years in primary school, three years in junior secondary school,three years in senior secondary school, and four years in tertiary institution. The six years spent in primary school and the three years spent in junior secondary school are merged to form the nine in the 9-3-4 system. Altogether, the students must spend a minimum period of six years in Secondary School. During this period, students are expected to spend three years in Junior Secondary School and three years in Senior Secondary School. [2] The General Certificate of Education Examination (GCE) was replaced by the Senior Secondary Certificate Examination (SSCE). The SSCE is conducted at the end of the Secondary School studies in May/June. The GCE is conducted in October/November as a supplement for those students who did not get the required credits from their SSCE results. The standards of the two examinations are basically the same. A body called West African Examination Council (WAEC) conducts both the SSCE and GCE. A maximum of nine and a minimum of seven subjects are registered for the examination by each student with Mathematics and English Language taking as compulsory. [2] A maximum of nine grades are assigned to each subject from: A1, B2, B3 (Equivalent to Distinctions Grade); C4, C5, C6 (Equivalent to Credit Grade); D7, E8 (Just Pass Grade); F9 (Fail Grade). Credit grades and above is considered academically adequate for entry into any University in Nigeria. In some study programs, many of the universities may require higher grades to get admission. [2] The Federal Government policy on education is adhered to by all secondary schools in Nigeria. Six years of elementary school is followed by six years of secondary school. Senior Secondary school consists of the SS I, SS 2, and SS 3 which is equivalent to the 10th, 11th and 12th Grade. The Senior Secondary School Examination (SSCE) is taken at the end of the SS 3. The West African Examination Council (WAEC) administers both exams. Three to six months after a student has taken the SSCE examination, they are issued an official transcript from their institution. This transcript is valid for one year, after which an Official transcript from the West African Examination Council is issued. National Examination Council is another examination body in Nigeria Senior Secondary School Examination (SSCE)in June/July. The body also administer General Certificate of Education Examination (GCE)in December/January. The students often take both WAEC and NECO examinations in SSS 3. [2] Tertiary education The government has majority control of university education. The country has a total number of 128 universities registered by NUC among which federal and state government own 40 and 38 respectively while 50 universities are privately owned. First year entry requirements into most universities in Nigeria include: Minimum of SSCE/GCE Ordinary Level Credits at maximum of two sittings; Minimum cut-off marks in Joint Admission and Matriculation Board Entrance Examination (JAMB) of 180 and above out of a maximum of 400 marks are required. Candidates with minimum of Merit Pass in National Certificate of Education (NCE), National Diploma (ND) and other Advanced Level Certificates minimum qualifications with minimum of 5 O/L Credits are given direct entry admission into the appropriate undergraduate degree programs. [2] Students normally enter university from age 18 onwards, and study for an academic degree. Historically, universities are divided into several tiers: First Generation Universities Five of these Universities were established between 1948 and 1965, following the recommendation of the Ashby Commission set up by the British Colonial Government to study the necessity of university education for Nigeria. These universities are fully funded by the federal government. They were established primarily to meet a need for qualified personnel in Nigeria and to set basic standards for university education. These universities have continued to play their roles for the production of qualified personnel and the provision of standards, which have helped to guide the subsequent establishments of other generations of universities in Nigeria. Universities in this tier include the University of Nigeria, Nsukka and the University of Ibadan. [2] Second Generation Universities With the increasing population of qualified students for university education in Nigeria and the growing needs for scientific and technological developments, setting up more universities became imperative. Between 1970 and 1985, 12 additional universities were established and located in various parts of the country. [2] Third Generation Universities The need to establish Universities to address special areas of Technological and Agricultural demand prompted the setting up of 10 additional Universities between 1985 and 1999. [2] State Universities. Pressures from qualified students from each state who could not readily get admissions to any of the Federal Universities continued to mount on States Governments. It became imperative and urgent for some State Governments to invest in the establishment of Universities. [2] Private Universities In recognition of the need to encourage private participation in the provision of university education, the Federal Government established a law in 1993, allowing private sectors to establish universities following guidelines prescribed by the Government. [2] The typical duration of undergraduate programs in Nigerian universities depends largely on the program of study. For example, Social Sciences/Humanity related courses are 4 Years, Engineering/Technology related courses are 5 Years, Pharmacy courses are 5 Years, and Law courses are 5 Years, each with two semester sessions per year. Medicine (Vet/Human) degrees take 6 Years and have longer sessions during the year. [2] Women in education Education has been recognized as a basic human right since the 1948 adoption of the Universal Declaration of Human Rights. A positive correlation exists between the enrollment of girls in priary school and the gross national product and life expectancy. [3] Because of this correlation, enrollment in schools represents the largest component of societal investment into human capital. [4] Rapid socioeconomic development of a nation has been observed to depend on the calibre of women and their education in that country. [5] Education bestows on women a disposition for a lifelong acquisition of knowledge, values, attitudes, competence and skills. [6].

Having a First Year Marriage Baby

A new baby inevitably shifts the balance of your relationship. For some this is a positive shift, but for many others it can bring up a range of challenging issues. A baby changes everything as they say. If a couple has a strong marriage before having children, chances are it will remain as such, if not strengthen due to the bond between the husband and wife who must now parent together. If a couple's relationship was weak, either they will grow more distant after a baby is thrown into the mix, or once again, the bond of being parents will bring them closer together.In fact, contrary to the popular belief that having a baby brings couples closer, studies on marriage often show that having children leads to a decrease in marital satisfaction and happiness. One of the negative ways a baby affects marriage is the amount of time and energy she requires from her parents. A parent who cares for this demanding human day and night may have little left to offer his or her spouse. The lack of intimacy that can result and cause resentment on one or both sides can be crippling.For starters, couples have about one-third the time together as they did before the birth of their child, and they have added financial responsibilities. One thing that will change is your conversations. You will find that you are talking less about current events and more about future events This is certainly not to say that having a child means your marriage is doomed. What it means is you should take the time to care for and nurture your marriage, whether you’re a parent already or soon plan to be.

Autobiography Essay

As a child, I suffered hardships in many areas of my life, so much so, that even as a young child, I knew my life was considerably different than other children my age. While most children were carefree and out playing, I was inside cooking for myself, cleaning up the house, or watching after my mother. These were normal duties for me and had been for the past 2 years. My mother was in the prime of her addiction and nothing else in life seemed to matter except her drugs and her next high. I did what I had to do to take care of myself, my home, and my mom. I always believed she would wake up one day and realize what she was doing and make things right, end all the madness that my life had become. Norman Vincent Peale once said, â€Å"In every difficult situation is potential value. Believe this, then begin looking for it. † The potential value, the opportunity came looking for me. The Department of Family and Children Services showed up at my house when I was 9 years old. A new neighbor had called and complained that my mother was not fulfilling her duties as a mother and that they were worried about me. DFCS placed me with the Nelson Family, a grounded, stable, and devoutly religious foster family that promised to give me a better life. They were part of Winshape Homes, an organization of foster homes that was founded and supported by Truett Cathy, the founded of Chick-fil-a. Rosemary and Rob, my foster parents, were licensed to have up to 15 children at a time in the household, so I viewed them as experts at raising kids. They showered me with unconditional love and showed me what a â€Å"real† family was all about. Even with 12 other siblings in the household, they took care of our individual needs, loved us the way we needed to be loved, and taught us everything they could. I spent 9 wonderful years with them before I graduated high school and moved onto college. I was dealt a bad hand, so to say, as a child, but I wouldnt change anything in my past. Everything I went through made me stronger, helped me to appreciate what I have, and has taught me to not take things for granted. My mother was never there for me but I am an awesome mother to my children because of her. I am thankful for the family I have now and I am grateful that I have lessons and wisdom to teach my kids. There is always a light at the end of the tunnel, but you have to make it through the tunnel before you see the light.