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Genogram example social work3/31/2024 Counselors would need this form to help them understand how to help the couple manage the relationship healthily. This sheet can help in tracking the specific behavior that is going on in the environment that the patient is in.Ĭouples that are planning their marriage or are engaged with a huge influence from their families would need to get this diagram as well. Usually, abused patients would be tight-lipped, and drawing a good narrative of the family background can be very difficult. At the same time, their family could possibly be the cause of this. Patients with mental health conditions need a lot of support from their families or the people they have relationships with. Genograms can be used in general medicine as well as helping to track a genetic physiological condition or any inheritable diseases. Some health conditions can be recurring and run in the blood of a specific generation. The following are just a few of the reasons why this is helpful for Mental Health Practitioners: Hence, using this printable PDF worksheet could help understand the specifics of various relationships. Relationships that are not properly identified could have a huge impact on an individual. It is a must-have for those who would need to go deeper into the root cause of a certain condition of a patient. Why Is This Form Useful For Mental Health Practitioners? Once you’re through with identifying the members with their shapes, identifying their relationships, and putting in their details, you have to assemble it in a neat structure to show a good diagram. With this sheet, you will be guided on where to put the birth year and age, or how to draw the pattern if a member is deceased.Ī Genogram Symbol Sheet is more like a puzzle. It will determine the emotional connection between the members connected by the line.ĭates are also crucial for determining relationships. Family relationships will determine the specific connection between two members. There are two lines we need to take note of: family relationship lines and emotional relationship lines. Lines in genogram symbols play a vital role. Determine the relationship between members.Also, identify each member you wish to include and assign them their respective shapes by gender. Usually, we start with the husband and wife or the father and mother. To start a Genogram Symbol Sheet, you need to identify where to start. Start with identifying the family members.The square is for males, and the circle represents females. In this Genogram Symbol Sheet, you will see the significant shapes with their meaning. This time, you need to include specific details about each member and determine particular relationships between them. If you remember how to create a family tree, the Genogram Symbol Sheet will be easy to follow. It also follows color coding to help highlight the specifics. The patterns that are used in a genogram will determine the relationship between two or more symbols. For basics, male members are represented by a square symbol, and a circle is used for female members. Genogram Symbols can analyze the nature of the family, behavior, emotional, and social relationships.Īre graphic representations of a specific member of the family or relationship. Compared to a traditional family chart, as it may seem like one, this goes beyond listing the members with lines. It may be adapted to the family or the environment that an individual is from. A mere mannerism or reaction can be well-traced through a genogram. This tool is an excellent guide to analyzing the complexity of a single line. This Genogram Symbols Sheet is helpful to understand better the symbols for each family member or relationship. A genogram is a well-known tool designed to determine or help highlight the patterns in family relationships. Family lines directly connect to each member even a superficial relationship may spring a specific influence on another member.
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Joy pony download pc free3/31/2024 The graphics in the game Joy Pony APK are beautifully designed and sharp. These features help create a fun and exciting game for My Little Pony fans, allowing them to interact and explore the world of Equestria with their favorite Pony. You can change your outfit, hairstyle, home decor and many other actions to create a personalized and unique experience. Interactivity and creativity: The game encourages player interaction and creativity.In-game audio is carefully crafted to create an immersive and interactive online experience. Attractive graphics and sounds: Joy Pony Online has beautiful graphics with bright colors and lovely design.There are a wide range of communication options to explore and interact with Pony in your own way. Talk and interact: You can interact with Pony by talking and performing other interactive actions.You can participate in these activities to keep Pony fun and increase engagement with them. Fun Activities: Joy Pony provides many entertaining activities such as Pony races, jumping through fire circles, pranks and other games.There are many options to choose from and change at will. Costume and Hairstyle: You can change Pony's outfit and hairstyle to create your own style.You can choose from a wide variety of furniture and decor to create a living space to suit Pony's taste. Home Design: The game allows you to design and decorate your Pony's house. Make sure Pony is always healthy and happy. Pony Care: You can take care of Pony by feeding, bathing and grooming them.Pony Selection: Players can choose one of the ponies from the My Little Pony series to care for and interact with.Here are some key features of Joy Pony game android: The game is also highly interactive, allowing the player to interact with Pony by choosing actions and talking to them. Joy Pony kill APK has beautiful graphics and immersive sound, providing players with an enjoyable online experience and suitable for fans of My Little Pony. With interaction with Pony, design of houses and costumes, exciting activities and beautiful graphics, this game promises to give players a fun and creative online experience. Joy Pony Download is a cute and fun game for fans of My Little Pony. The game offers the player a wide range of exciting activities, including taking care of the Pony, designing the Pony's house, adjusting the costume and hair style, and participating in various activities such as racing the Pony Game, jump through circles of fire, and more. In Joy Pony mediafıre, players will be transformed into a new friend of the Pony and explore the world of Equestria, where the Pony lives. This game allows players to interact with their favorite Ponies in a colorful virtual world. Good luck with your time with Pony.Joy Pony APK is an online game developed based on the famous cartoon series "My Little Pony: Friendship is Magic". When the Pony gets hungry - feed him, because it is so important for the normal full development of the pet. You can successfully change these tinctures, so this will need to be done. On the left is a menu with many settings. In order to start playing, you first need to deal with navigation. It is important to understand that the gameplay will be accompanied by light and cheerful music, so you will be interested. To do this, use clothes, Pony size, accessories, background, and many other things that can be changed. Try to make the look of the Pony perfect from your point of view. There are a lot of settings in order to create a beautiful Pony in this game, so you will obviously have something to do during the gameplay. In this game, you will dress up Ponies, feed them, play with them, and spend time with them in a different way. Before you game Joy Pony online in which you will have the opportunity to get to know your favorite main characters. They are so cute and kind, colorful and cheerful.
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String libraries not kontakt3/31/2024 Part of an extremely well thought out family of products. The close mics are not perhaps as dry as some libraries, so it has less relevance for some pop styles (but they have this covered, both with the Chamber Strings and with some of the smaller ensemble libraries like Spitfire Solo Strings. It works seamlessly in conjunction with the chamber ensemble should you wish to layer things (which I often do) and as mentioned above, the performance legatos are stunning! There are 16 1st Violins, 14 2nd Violins, 12 Violas, 10 Cellos & 8 Basses and 175 articulations to choose from! And each section is recorded in its correct place for an orchestra – so without panning anything it all “sits” together. It’s perfect for lusher large ensemble sounds and the portamento (slide) transitions which you get when playing a gentle velocity are glorious. Without completely repeating what I’ve said above, it works almost identically to the Chamber Strings library – the only difference being the number of players in each part of the ensemble. Here’s an example of a small mockup to show some of the different sounds of my a selection of my chosen libraries and how they compare to the stock EXS sounds in Logic. If you haven’t read my article How To Choose Orchestral Sample Libraries - An Introduction, then use might want to bookmark this page, go and read my introduction and then come back to this page. I should also say that I’ve not included solo string libraries like Embertone Joshua Bell Violin (amongst others) as I’ve concentrated on ensemble libraries of both big and small. The biggest trade-offs are between the achievable sound, the workflow to achieve it, how hard it pushes my computer and how much I enjoy working with it. This is somewhat harder for strings, and I can't promise to choose just one! I will, however, reveal my desert island choice at the end. But this is mine!Īs each library has a signature sound, and particular strengths and weaknesses, I tend to blend libraries to create a unique sound, rather than relying on one. This selection will doubtless be controversial, and 10 composers will give you 10 different lists. Continuing my series on Orchestral Sample Libraries, let’s move onto the family that is most likely to divide opinion – The strings.
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Elijah priscilla shirer bible study3/31/2024 Learn to trust in the goodness and faithfulness of God and His purposes for your life. Join Priscilla Shirer in a 7-session video bible study on the life of Elijah.Be encouraged to wait on God’s good work in your heart and mind, even in seasons when you feel like no one sees.Understand the value of seasons of growth and testing in your spiritual maturity.Articles to enhance your study and application of the content.Seven enriching teaching videos, approximately 30–40 minutes per session, available for purchase or rent.Personal study segments to complete between 7 weeks of group sessions.Leader guide to help with questions and discussions within small groups.And how the emboldened, fiery faith you desire is being fashioned by God in your life right now. Join Priscilla Shirer on this 7-session journey through the life and times of the prophet Elijah to discover how the fire on Mount Carmel was forged in the valley of famine. Those who patiently wait on God in the darkness emerge with their holy loyalty cemented, their courage emblazoned, and their confident belief in Him set afire. Strength of faith, character, and boldness can only be shaped in the hidden fires of silence, sameness, solitude, and adversity. Yet few are willing to go through the process required to get them there. Join Priscilla Shirer on this 7-session journey through the life and times of the prophet Elijah to discover how the fire on Mount Carmel was forged in the valley of famine. Old Testament heroes are best known for their most celebrated moments: Moses dividing the Red Sea David slaying Goliath Gideon routing an insurmountable army Joshua marching around the defiant walls of Jericho.Īnd Elijah-calling down fire on Mount Carmel.īlinded by the remarkable narratives of our biblical heroes, we can forget they each had a backstory-months and years of development, even difficulty, which fortified their spiritual muscle and prepared them for the tasks that made their lives unforgettable.Įvery serious believer longs to summon up the kind of boldness and faith that can stand firm on Mount Carmel and pray down heaven into impossible situations.
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Poster paper size3/30/2024 (63 x 94.5 in.) issued horizontally or 320 x 120 cm. Grande: 160 x 120 cm (63 x 47 in.) Vertical format, machine folded.ĭouble Grande: 160 x 240 cm. (31.5 x 23.5 in.) Vertical format, issued machine folded. (15.7 x 23.6 in.) Vertical format, issued machine folded. (84 x 59 cm.) Vertical format, scarcer than the A3.Ī3: Approx. This size was commonly used from 1977.Ī1: 33 x 23 in. This size was commonly used until 1977.ī1: 39 x 27 in. (20 x 25.5 cm.) Horizontal format, printed on card stock in sets of eight for display in cinema lobbies.Ī1: 33 x 23 in. (206 x 102 cm.) Vertical format, printed on two or more overlapping sheets for pasting onto a wall outside a cinema.įront of House: 8 x 10 in. (102 x 69 cm.) Vertical format, issued folded for use in other countries. Until the 1980's was usually issued machined folded with one horizontal fold and three vertical folds.ĭouble Crown: 30 x 20 in. (76 x 102 cm.) The standard British poster, vertical format. A full set usually includes a Title Card and seven Scene Cards. (28 x 35.5 cm.) Horizontal format, printed on card stock in sets of eight for display in cinema lobbies. Midget Window Card: 14 x 8 in.35.5 x 20 cm.) Produced to advertise in the windows of local stores. (56 x 35.5 cm.) Vertical format, printed on card stock, with the top portion left blank for the cinema to add their details. Often issued as a set of designs for use on cinema entrance doors for major productions. Produced to advertise on a roadside billboard. (269 x 594 cm.) Landscape format, printed in approximately 12 overlapping sections, issued folded. theatre lobbies, or on the outside of a building.Ģ4 Sheet: Approximately 106 x 234 in. Produced for use in large cinema lobbies, or to be pasted on the outside of a building. (206 x 206 cm.) Printed on four overlapping sheets, issued folded. (114 x 150 cm.) Horizontal format, produced to advertise in US subway systems, mostly in New York. Produced for outside display at drive in theatres, so few have survived. (102 x 76 cm.) Vertical format, printed on card stock, issued unfolded. Produced for outside display at drive in theatres, so few have survived.Ĥ0 x 30: 40 x30 in. (152.5 x 102 cm.) Vertical format, printed on card stock, issued unfolded. (206 x 104 cm.) Vertical format, printed on two or more overlapping sheets for pasting onto a wall outside a cinema.Ħ0 x 40: 60 x 40 in. (91.5 x 35.5 cm.) Vertical format, printed on card stock. (56 x 71 cm.) Horizontal format, printed on card stock, often issued folded. Until the 1980's was usually issued machine folded with one vertical fold and three horizontal folds. (104 x 69 cm.) The standard American poster, vertical format. Linen backed posters will also have an additional border of up to 1 inch all around. At Rock Paper Film, we will always state the exact dimensions of the poster. This is a guide to the most common formats, although it is important to note that sizes are approximate and actual sizes can vary depending on date, studio and printer. Sometimes they would re-use the country of origin artwork in some form, or sometimes they would produce their own artwork. Each different country would produce different poster designs in different sizes, and often a number of different sizes for different uses. Original film posters have always been produced in a range of shapes and sizes, varying from country to country.
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Orange mackerel tabby cat3/30/2024 Male orange tabby cats outnumber females approximately 4 to 1.įor reasons that are not fully understood, about 80% of orange tabby cats are male. Other than that he has 3 huge rooms to play in and halls and stairs. I never allow cats on my counters or kitchen table, and I don’t want him up on the fire place. I am very close to finding him a new home. I love him, but I don’t see ever being able to open up my rooms again. I bought a cat tree, lots of toys, claiming medicine. Do you think he will ever clam down, obey rules. If he goes where I don’t want I tell him no and he doesn’t do it again. My other cat is only 2 weeks younger and us so sweet clam. Now if he sees there us somewhere you don’t want him on, he does his best to jump on it. I had to remove my lamps, and things off the fireplace mantle. I had to block the living room and dining room. Took about 2 weeks before they became friends.Īnyway, he is now 4 months old and has tired my house up. Someone said you need to tired him out and play with him more. After a few weeks he got stronger and then started biting us. We had to feed him around the clock and do everything for him. If you want to see her pictures, she’s on twitter…I’ve got quite a few I need to post tomorrow of her weeks adventures…and yes, she’s spoiled rotten, has more toys than we can even donate to the local shelter.and she deserves EVERY BIT of the spoiling, and love she gets…and gives back 100x more! We live in a VERY small town, so, as I said, most people know about Leela and know it’s just the two of us here. She also LOVES the local firefighters who worked with me so she wouldn’t be afraid of them if something were to happen again-whenever she sees the lights or hears the sirens, she bounces from window to window & wakes me up if I’m asleep. Between her beginnings, (she STILL “asks” to be rocked sometimes), the fact it’s always me and her, AND I trained her to “help” me-in case I fall or need help in another room, she’ll bring me her phone. The kids all talk to her every morning, and some afternoons and most adults around here know Leela’s name, but not mine. Obviously, she made it and because I’m disabled and rarely leave the house, (although in warm weather, she LOVES putting her “pretty dress” on and going across the street to the park where she plays with kids.and drives local dogs NUTS! She LOVES giving kids hugs and kisses and I had to put a cat tree in my front window where there’s a bus stop. I was told Leela wouldn’t make it and basically lived in my rocking chair for over a month, giving her IV Fluids, tube feeding her, and rocking & singing to her. I think Leela is super special though because when a friend brought her to me as a VERY sick abandoned 3-4wk old baby-I had JUST been released from 4 weeks in the hospital, (heart attack), and had lost everything in a fire just 2 months before-including my 9yr old silver kitty. They had quite the childhood as I co-founded a wildlife rescue & rehab back home, long before they were even born. But my kids would be the first to tell you-I’ve ALWAYS had “strange” animals…to put it mildly. As a Vet Tech since 1978, I’ve known a LOT of cats over the years-although Leela is only my 2nd indoor only kitty. Leela is a VERY strange, but VERY LOVING Ginger. □□ (long story)Īnyways, back to mice.she also likes chipmunks (“big Mousey”) that got into the house last year and they batted nuts back and forth in my kitchen. I sent some of her Chinese friends pictures on twitter, but don’t remember if I posted them to her twitter yet-she has a LOT of fans in China and they send her things so often, my mailman knocks on the door to announce “Another delivery from China for Princess Leela”. We had this same argument a few days ago, after I first put it together, and I was FaceTiming my daughters-who were in hysterics. We’ve had some arguments about this-yes, Leela argues with me either audibly or whispering her mews & meows, and stomping her paw if it goes on for more than a minute.in fact, we just had one a little while ago when she wanted her dinner on my new over-the bed table. Leela is 5 and ever since she was a kitten I.’ve watched with awe at her playing with them, (she LOVES putting one in a small box and dragging the poor thing around the house!), feeding them-bringing them her cookies, napping with them.and I HAD to draw the line with her gently carrying them in her mouth like a baby, and hopping up on OUR (HER) bed. My Leela is the same way! In the winter, we have small field mice come into the house to get warm.
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Corel motion studio 3d 20183/30/2024 With its explosions and fire effects, there’s no risk of titles not catching an audience’s attention Preview performance is massively improved, though, which is perhaps enough reason in itself for this software to find a new audience. Most significantly, the render engine is showing its age – there are 3D lighting effects but no ray tracing for photorealistic shadows, refractions and reflections. The interface looks modern with its charcoal colour scheme and tabbed panels, but functionally it’s largely identical. However, a bit of digging revealed that this is essentially a repackaged version of Ulead Cool 3D – a program that was last updated in 2002. We’re used to seeing animations with impossibly high production values on TV and at the cinema, and the effort required to produce even the simplest animations can leave home users feeling deflated.Īs such, Corel’s announcement of a brand new 3D animation package took us by surprise. If that's the case, then be prepared to spend a lot more money on your software.It takes a fair amount of skill and determination to get into 3D animation. But, if you're looking to get extremely granular in your animations, and you need a more professional level of control, then MotionStudio 3D might not be what you're looking for. With its array of presets, powerful, yet simple features, and intuitive interface, it's a fantastic choice for newcomers and experienced motion graphics artists alike. Overall, we think Corel MotionStudio 3D provides a nice, affordable entry into the world of motion graphics. And as expected, MotionStudio lets you easily output projects as 3D anaglyphs viewable with 3D glasses, or as side-by-side images playable on compatible 3D TVs-all with a single click. Meanwhile, it can output to a wide variety of video and still image formats including GIF and Flash (SWF) for the Web. It can handle vector and raster graphics, and lets you easily work with files from other 3D applications. The program also includes tons of animation presets, and lets you manipulate light sources, mimic motion blur, and adjust depth of field among other aspects.Īnd for the prosumers out there, MotionStudio 3D also boasts some rather powerful import and export capabilities. Powerful, yet simple features like this are sure to attract casual users who aren't necessarily motion graphics wizards. The tool even lets you make minor adjustments to the particles' properties such as texture, density, color, rotation, and more. On top of its basic 3D titling and text animation capabilities, MotionStudio also includes a realistic particle effects tool that recreates the appearance and movement of elements like bubbles, fire, smoke, and snow. MotionStudio makes it simple to click around, experiment with these effects, and undo when necessary. Here you'll find 3D Models, Text Objects, Lathe Objects, Shapes, and even simple extrusion effects. The EasyPalette contains all of the preset effects available, and can be supplemented by plug-in effects. And with each property having its own independent timeline, it's easy to choreograph several different animated elements to work in concert. Here is where you set the key frames that guide your animation. The Timeline Window spans the bottom of the interface, and is relatively simple to navigate. Also, you can drag objects directly within the Edit Window for a more tactile way to customize basic aspects like position, rotation, and size. The Edit Window displays your project as you work, and can reflect changes in near real-time-with virtually no waiting for rendering. MotionStudio's interface is intuitive, which should be comforting to motion graphics novices. Geared more toward novices and prosumers than professionals, this capable newcomer lets you create 3D text and titles, lathe objects, and a variety of animations with relative ease. Meet MotionStudio 3D, Corel's inaugural entry into the animation and motion graphics software category.
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Precast concrete deck blocks3/30/2024 If there is a roof over the deck, additional uplift loads must be accounted for. This metal bracket also has an inch of a standoff that reduces the decay of the post or column.Ĭlick here to see this porch post base on Amazon. When positioning a post for the porch, just put it on top of the porch post base and secure it with bolts. The deck should be framed first to get the most accuracy. Porch Post BaseĪ concrete pier block with a porch post base is commonly used to support permanent porch framing throughout the construction stage. We discuss the different brackets that may be attached to the blocks below. Whichever bracket type they come with, these concrete pier blocks must be positioned correctly and have an adequate bearing area. You have to bury them at least 12 inches below frost level on stable ground or place them directly on top of the soil. These precast blocks are often used in building decks. The blocks serve to evenly distribute the weight at the bottom of a structure on firm soil and to brace beams for support. Using Concrete Pier Blocks With Metal BracketsĪs a conventionalized precast foundation recognized by building codes, a concrete pier block is subject to all requirements like a typical footing despite being pre-formed. Keep reading as we cover them in greater detail below. In this post, we'll discuss these metal brackets and what you need to know about how they function. Adjustable post base/saddles with wind-uplift.You can use concrete pier blocks that have a metal bracket with decks, floors, sheds, and walkways, depending on which of the metal brackets below is attached to the block: If you have chosen to work with concrete pier blocks but don’t know how to use them, you're on the right page! We have researched available information for you, and this is what we found. There are different foundation or support types to choose from when constructing a house, building, or deck.
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Ultimate chicken horse free pc download3/30/2024 There is also a one-minute time limit for them to finish. In Sudden Death the players keep respawning when they die and the first one to reach the goal wins the game. In the case of a simultaneous arrival at the point limit (scores need not be equal) by multiple players or an equal amount of points between them when the time/round limit is reached, sudden death is activated. Free play mode also features a selection of exclusive permanent blocks and allows the blank level in the treehouse to be selected. While in this mode, players can also hold B (or RMB) to switch between item placement mode and level testing mode at all times. Uploading and playing in other modes later. The players have an unlimited supply of blocks at hand and can use it to create a custom level layout for saving. In contrast to the other three this game mode is not competitive. Each round is estimated to last a minute. The winner of the match is the player who reaches a set number of points or has the most points after a set number of rounds. Points are awarded each round for various achievements, such as reaching the goal first, or setting a successful trap. Players add obstacles designed to challenge their opponents, while also making sure they themselves can handle their handiwork. The goal of each game is to score points by building a platform level one piece at a time (per player) and race each other to a flag on the other side of the level. Ultimate Chicken Horse is a platform video game where players assume the role of one of various animals. When played with multiple players at the same time, the average of all their times will count towards special leaderboards. For every level there are two leaderboards: One for the overall fastest time and one for the fastest time with all coins. This mode allows players to compete for the fastest completion times in custom levels which have been uploaded. It’s also possible for the host to configure the amount of blocks a player can place (or move) per round in Creative mode. Already placed blocks may be moved instead of placing something new. The decision of what to pick is not absolute in this mode as players can go back and choose something else if they change their mind. Sheltered 2Ĭreative Mode This game mode is very similar to Party Mode but instead of choosing from the Party Box the players can open their inventories and pick any block they want to. By default, If there are only two players playing and the Double Party Box option in the Game Rules is enabled, they will receive two boxes every round. If the round or time limit is reached before that, the player with the most points wins. The winner of the game is the one who manages to reach the point limit first. This process continues to repeat itself until a player wins the game or the time/round limit is reached. As soon as all contestants have reached the goal or died, points are distributed and the Party Box appears again. After placement is over, the characters appear and they are able to go through the level. In Party mode at the beginning of each round the so-called Party Box appears, containing several random blocks players can choose between and then place. Party Mode This is the default game mode. There are currently 4 game modes to select from. Te Game Mode is one of the game rules that can be found in the Treehouse menu. Challenge levels can be created and played alone, but unlocking characters and levels requires playing one of the main game modes (like Party Mode) which are only multiplayer. One that doesn’t appear to be much at first but once you get into it it’s addictive and fun and infuriating all at the same time.Ultimate Chicken Horse Free Download RepacklabĬompete for global best times on Challenge levels across all platforms, Huge library of blocks to create an infinite variety of levels, Customizable rule sets and game modes, Shared controller mode to play multiplayer with one controller or keyboard, Play as a chicken, horse, sheep, raccoon and other wonderful animals, Fun, cartoony art style, Sweet funky soundtrack this is primarily a multiplayer game. The game has a fun cartoony art style and a sweet, funky soundtrack.Īll in all, Ultimate Chicken Horse is a weirdly entertaining game. Play as a chicken, horse, sheep, raccoon, and other amazing creatures in the shared controller mode using one controller or a keyboard.Use a large library of blocks to create a limitless number of levels. Compete for worldwide best times on Challenge levels across all platforms.18 levels with various features, online and local play for up to 4 players, a unique game flow that ranges from strategic block placement to twitch control platforming, and the ability to create and share custom levels.In the party platformer game Ultimate Chicken Horse, you construct the level as you go along by setting up obstacles and traps to humiliate your friends while avoiding humiliating yourself.
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Hard signs of neck trauma3/30/2024 In stable patients with penetrating neck trauma, a reasonable approach is to perform a complete physical exam including an evaluation of the neck. Soft signs of penetrating neck trauma include: Hard signs of vascular or aerodigestive injury include: In unstable patients or those who have clear evidence (hard signs) of vascular or aerodigestive injuries, surgical exploration is indicated. More current technology using Multi-Detector Computed Tomographic Angiography (MDCTA) has allowed the safe and non-invasive evaluation of the critical neck structures and is now the gold standard for evaluating stable injuries in any zone that are causing symptoms. In what has been called the “selective approach,” zone II injuries underwent surgical exploration in the operating room, while patients with injuries in zone I and zone II underwent endoscopy and angiography. These zones have been used to help guide management, as injuries in zone II are most accessible to surgical intervention. (reproduced with permission from Color Atlas of Emergency Trauma, Second Edition) The superficial fascia lies anterior to the platysma, while the deep fascia lies posteriorly. Wounds that do not penetrate the platysma do not generally lead to significant morbidity or mortality. The platysma muscle stretches from the facial muscles to the thorax, and anatomically divides superficial from deep wounds. The neck can also be divided anatomically into facial planes. The spinal cord is the most significant structure in the posterior triangle of the neck.įor the management of penetrating trauma, the anatomy of the neck has historically been divided into three zones, which will be described in the section on penetrating injuries. The posterior triangle is bordered by the sternocleidomastoid anteriorly, the clavicle inferiorly, and the anterior border of the trapezius muscle posteriorly. The internal jugular vein, as well as the vagus and hypoglossal nerves, are contained within the anterior triangle. The common carotid artery bifurcates into the external and internal carotid arteries in the anterior triangle, which also contains the aerodigestive tract and cranial nerves VII, IX, X, XI, and XII. The anterior triangle of the neck is bordered superiorly by the inferior border of the mandible and posteriorly by the medial aspect of the sternocleidomastoid muscle. Areas of greatest concern include vascular injuries, neurologic injuries, and injuries to the aerodigestive tract. The neck contains a number of vital structures condensed into a relatively small area. |