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Whether trauma exposure itself or consequent posttraumatic stress disorder (PTSD) is primarily responsible for smoking and failure to quit remains unclear.A cohort of male Australian Vietnam veterans (N = 388) was interviewed twice, 22 and 36 years after their return to Australia using standardized psychiatric diagnostic and health interviews and assessment of combat exposure. The smoking trajectory over time revealed a spectrum of outcomes (never smoked, early quitters, late quitters, and continuing smokers). Analysis used multivariate statistics to assess the relative contributions of combat trauma exposure and PTSD while controlling for potential confounders.The trajectory of smoking over time revealed that 21.9% of veterans had never smoked, 45.1% had quit smoking by the time of wave 1, 16.2% were current smokers at wave 1 who had quit by the time of wave 2, 2.8% were late adopters who were current smokers, and 13.9% were continuing smokers. Smoking was associated in single-predictor models with demographics, intelligence, combat exposure, PTSD symptom clusters and diagnosis, and alcohol disorders. Multivariate analysis revealed that PTSD, combat, and intelligence were related to the smoking spectrum but, after adding demographics and other Axis I psychiatric diagnoses, only combat remained significant. No PTSD symptom cluster uniquely predicted smoking status.The results suggest that trauma exposure in the form of military combat may be a more robust predictor of smoking status over time than PTSD. It may be stress itself, rather than poststress disorder, that is more germane to smoking and failure to quit.Exposure to traumatic stress and development of PTSD have been implicated separately in the maintenance of smoking. This longitudinal cohort study of smoking in war veterans up to three decades postwar enabled evaluation of traumatic stress exposure in combat and the course of PTSD in smoking and quitting while controlling for intelligence, background disadvantage, and other psychiatric conditions. Combat rather than PTSD emerged as more significant to smoking status, suggesting that it may be the traumatic stress itself rather than the development of a poststress disorder that is more germane to smoking in war veterans.

Long-term research on freshwater ecosystems provides insights that can be difficult to obtain from other approaches. Widespread monitoring of ecologically relevant water-quality parameters spanning decades can facilitate important tests of ecological principles. Unique long-term data sets and analytical tools are increasingly available, allowing for powerful and synthetic analyses across sites. Long-term measurements or experiments in aquatic systems can catch rare events, changes in highly variable systems, time-lagged responses, cumulative effects of stressors, and biotic responses that encompass multiple generations. Data are available from formal networks, local to international agencies, private organizations, various institutions, and paleontological and historic records; brief literature surveys suggest much existing data are not synthesized. Ecological sciences will benefit from careful maintenance and analyses of existing long-term programs, and subsequent insights can aid in the design of effective future long-term experimental and observational efforts. Long-term research on freshwaters is particularly important because of their value to humanity.

Dr Paris has dual citizenship in the United States and New Zealand and has practiced physical therapy in the United States, Bermuda, and New Zealand. He founded the University of St Augustine, the nation's only proprietary school graduating doctorally prepared physical therapists. The University is active in Japan, Iceland, and Chile, helping to advance physical therapist practice in those nations by offering degrees and clinical certifications. Although Dr Paris may be most closely associated with his contributions in establishing manual therapy practices as an accepted essential component of physical therapist practice, he also has been a leader in physical therapist education, research, and professional service. He has lectured extensively and presented continuing education courses nationally and internationally. As an author or co-author, Dr Paris has actively promoted the concepts of manual therapy in text chapters, professional journal articles, guest editorials, and proceedings. He also has published textbooks, a film, and a PBS television series on back pain. He currently serves as co-editor of the Journal of Manual and Manipulative Therapy . Dr Paris was instrumental in establishing the Orthopaedic Section of APTA and the International Federation of Manipulative Therapists and has served as president of both organizations. He also was instrumental in establishing the American Academy of Orthopaedic Manual Physical Therapists. He has been a delegate to the APTA House of Delegates and has served on the APTA Board of Directors. Dr Paris was appointed to APTA's Task Force on Clinical Specialization and was an early proponent of recognizing physical therapist clinical specialists. Dr Paris has received ATPA's Chattanooga Research Award and was elected a Catherine Worthingham Fellow of APTA. In 1992, the Orthopaedic Section established the Paris Distinguished Service Award in his honor. He is an honorary fellow of the New Zealand Society of Physiotherapy and an honorary life …

Reliability, specificity, and Validity of three event-related potential (ERP) indices of non-attended and attended auditory information processing [the mismatch negativity (MMN), the novelty-P3a and the target-P3b] were assessed in 21 healthy subjects and 25 schizophrenic patients while performing a Visual discrimination task (Ignore condition) and, subsequently, an auditory discrimination task (Attend condition). Re-test reliability, as measured in a subset of 10 healthy subjects and 9 patients respectively, ranged from r = 0.4 to r = 0.8 In both groups P3a was found to be smaller in the Ignore than in the Attend condition. Patients had significantly larger P3a amplitudes than healthy subjects while their MMN and P3b amplitudes were smaller. Two ERP factors were extracted in healthy subjects: (I) 'novelty reaction' with high loading scores for P3a and (2) 'deviant detection' with high loading scores for MMN. P3b was predominantly loading on the first factor thus confirming partly overlapping P3a and P3b generators. However, considerable variance was also shared by the second factor, particularly in patients. External validity of the ERP factors was confirmed post hoc. Particularly ERP indices of deviant detection were found to be associated with negative symptoms. In order to assess further clinical relevance, therapy response to clozapine was followed-up over 3 yr in a sub-sample of 17 patients. Poor treatment response was associated with high Novelty Factor scores and large P3a amplitudes whereas good response was associated with high Deviant Factor scores and relatively intact MMN. It is concluded that ERP abnormalities provide a severity index of brain impairment and a measure of predicting therapeutic outcome.

Background and Purpose. The purpose of this case report is to describe the evaluation, treatment, and short-term outcome for an individual with chronic, progressively worsening instability of the knee during gait associated with anterior cruciate ligament (ACL) insufficiency.Case Description. The patient was a 34-year-old man who sustained bilateral ACL injuries. Subsequently, an autograft reconstruction of the left knee ACL was performed. Eight months post-reconstruction, the left knee was unstable despite bracing. Gait analysis and tests to determine the presence of muscle inhibition were performed prior to and after 12 weeks of training. Isometric torque of the knee extensors and flexors was measured with the knee in 90 degrees of flexion. A training program primarily consisted of electromyographic biofeedback during thigh muscle exercises, balance exercises, and gait.Outcomes. Muscle inhibition decreased and maximal isometric knee flexion and extension torques increased during the 12-week training period. Gait analysis demonstrated a 50% decrease in the maximum knee extensor moment and an increase in walking speed.Discussion. Selected gait variables, torque production, and muscle inhibition may change in a person with an unstable knee. The measurement of variables that have previously been documented as mechanisms of knee instability during walking allows for the selection of a specific treatment approach.

R ecent flooding in the Pacific Northwest vividly illustrates the complexity of watershed and ecosystem responses to floods, especially in steep forest landscapes. Flooding involves a sequence of interactions that begins with climatic drivers. These drivers, generally rain and snowmelt, interact with landscape conditions, such as vegetation pattern and topography, to determine the capability of a watershed to deliver water, sediment, and organic material to downstream areas (Figure 1). Land-use practices can affect watershed responses to flooding through the influences of managed vegetation patterns and roads on delivery of water, sediment, and wood to streams. Watershed responses to floods include geophysical processes, such as landslides and channel erosion, and related disturbances of aquatic and riparian organisms and their habitats. We explore these geophysical-ecological interactions using a recent flood in

R iparian zones are the interfaces between terrestrial and aquatic ecosystems. As ecotones, they encompass sharp gradients of environmental factors, ecological processes, and plant communities. Riparian zones are not easily delineated but are comprised of mosaics of landforms, communities, and environments within the larger landscape. We propose a conceptual model of riparian tones that integrates the physical processes that shape valleyfloor landscapes, the succession of terrestrial plant communities on these geomorphic surfaces, the formation of habitat, and the production of nutritional resources for aquatic ecosys

To the Editor: As chairman of one of the two doctoral degree in physical therapy (DPT) programs currently being offered in the United States, I wish to respond to the letter to the editor by Deusinger and co-authors and to the Journal Editor's “Response” published under the title “DPT Controversy” in the May 1993 issue of Physical Therapy . The Institute of Physical Therapy is well aware of the controversy surrounding its introduction of a post–entry-level doctorate in physical therapy, and it regrets that there has not been more discussion within the profession, which may have produced less of a difference between the two programs now being offered. The Institute first proposed its DPT program in 1982 and has since that time advocated that a post–entry-level master's degree was needed by the profession in response to entry-level master's degree programs.… [ ARTICLE][1] [1]: /lookup/volpage/73/329?iss=5

In Denmark, juries' determine guilt in criminal trials in the High Courts (Landsretter) when the prospective prison sentence is four years or more (Retsploeeloven ? 687.2.1-the Law on Judicial Procedure, hereinafter cited as "Rpl"). A verdict against the defendant on any question requires the concurrence of eight out of twelve jurors (Rpl ? 897.2). After rendering a guilty verdict, the jurors participate with the three professional judges in setting sentence (Rpl ? 906a). Juries are also used in cases of involuntary confinement, other than in prison, (Rpl ? 687.2.2) and for all criminal cases, however minor, which are characterized as political (Rpl ? 687.2.3). For most other lesser, but still serious criminal cases, two lay judges sit alongside one professional judge in the Municipal Courts (Byretter)(Rpl ? 18.2). In appeals from Municipal Court cases to a High Court, three lay judges participate with three jurists (Rpl ? 6.2). Neither jurors (Rpl ?? 869, 885.3) nor lay judges (Rpl ? 91.2) participate in preliminary or procedural matters. There are 84 Municipal Courts (Rpl ? 12) and two High Courts, one for the Islands, the Eastern High Court, headquartered in Copenhagen, and one for the peninsula of Jutland, the Western High Court, whose main seat is in Viborg (Rpl ? 4). The Maritime and Commercial Court (SOog Handelsret) in Copenhagen is comparable in rank to the High Courts. In this Court, either two or four lay judges, experts (sagkyndige) in maritime or commercial matters, sit

This article presents spinal dysfunction (as opposed to disease) as being an altered state of mechanics demonstrating either an aberrant motion or an increase or decrease from the expected range. Examination techniques, including passive intervertebral motion testing, are outlined, as is the grading system for recording results. Mobilizations and positional distraction are advocated for treating restricted range, and the neurophysiological and mechanical effects are explained along with their indications and contraindications. Pain is presented as a misleading symptom that cannot be relied upon to monitor the results of treatment. The author considers that exercise routines have no place in the treatment of spinal dysfunction, although selected exercises may be given for the patient's particular requirements. Walking is advocated to maintain mobility and function, but running, cycling, and swimming are generally discouraged.

Reliable measurements are prerequisite to the successful conduct of outcome studies. In a study of the performance of physical therapists (n = 5) in evaluating passive mobility of the vertebral column with normal subjects (n = 5), several sources of measurement variability were assessed: the reliability within and between therapists, the criteria for grading, and the subjects themselves. Intratherapist reliability was found to be dependable; intertherapist reliability was not. Problems that merit further study were identified as idiosyncratic behaviors that may develop with experience, subject characteristics, and the instrument itself. Periodic assessment of the reliability of therapists in performing evaluations is recommended because of its importance to therapeutic programming.

Judicial independence shields the bench from improper influence, particularly from political pressure, but there is a worldwide trend toward subjecting judges to scrutiny to improve judicial conduct and performance. This article compares and contrasts some of the methods now in use, or proposed for use, to insure judicial accountability without reducing too far the political insulation of independence.