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Background:The modified Broström (MB) procedure has long been the mainstay for the treatment of chronic lateral ankle instability (CLAI). Recently, suture tape (ST) has emerged as augmentation for this repair. The clinical benefit of such augmentation has yet to be fully established. The purpose of this study was to determine if ST augmentation provides an advantage over the traditional MB.Methods:Adult patients were identified for inclusion in the study based on indications for primary lateral ligament reconstruction for CLAI. The primary outcome measure was time to return to preinjury level of activity (RTPAL). Secondary outcome measures included complications, ability to participate in an accelerated rehabilitation protocol (ARP), patient-reported outcomes (PROs), and visual analog pain scale (VAS). A total of 119 patients with CLAI were enrolled and randomized to the MB (59 patients) or ST (60 patients) treatment arm.Results:Average RTPAL was 17.5 weeks after MB and 13.3 weeks after ST ( P < .001). At 26 weeks, 12.5% of patients in the MB group and 3.6% of patients in the ST group had not managed RTPAL ( P = .14). The complication rate was 8.5% in the MB group vs 1.7% in the ST group ( P = .12). Four patients in the MB group failed to complete the ARP vs 1 in the ST group ( P = .144).Conclusion:Results from this multicenter, prospective, randomized trial suggest that ST augmentation allows for earlier RTPAL than MB alone. ST augmentation may support successful accelerated rehabilitation and did not result in increased complications or morbidity.Level of Evidence:Level II, prospective comparative study.

This article presents three types of (inter)active learning pedagogical tools to better prepare future administrators for complex, real-world tasks. We propose a framework of narrative linearity and responsiveness to examine digital cases, digital simulations, and clinical simulations as bridging pedagogies from abstract class-based methods to fully immersive internships. We illustrate how these characteristics influence learner interaction with the rich, hypothetical contexts these tools offer. A specific example is presented for each tool, and their cognitive demands on the learner are discussed. We raise implications for their use at the course and program levels.

The interrogative sequence אִם‎ . . . הֲ‎ in Biblical Hebrew can be employed in two forms of disjunctive question. The first offers mutually exclusive questions and the second comprises a rhetorical pair. Close examination of the extant examples reveals no difficulty in distinguishing between these two forms and, further, that, when employed to express a rhetorical question, the double rhetorical sequence אִם‎ . . . הֲ‎ anticipates the answer ‘No’. Careful study of a debated example, Jer. 31.20, confirms that a negative answer is implied here, hence the evidence strongly favours this reading in the other contentious passage, Hab. 3.8. Here, triple rhetorical questions introduced by the interrogative particles אִם‎ . . . אִם‎ . . . הֲ‎ are employed in a motivated interrogative sentence, suggesting that a negative answer is therefore expected.

Category: Other; Trauma Introduction/Purpose: There is a paucity of research investigating the harms associated with the orthopaedic knee scooter (OKS) and patient safety perceptions. This prospective study aimed to define the prevalence of OKS-related injuries, identify patient risk factors and describe the patient perceptions of OKS safety. Methods: This single-surgeon prospective study recruited a cohort of 134 consecutive patients undergoing surgery at a community-based orthopaedic clinic from 6/2020 to 4/2021. Our primary outcome informed an a priori power analysis. Standardized data collection protocol included three forms that patients completed. The prevalence of OKS-related injury, patient risk factors, and patient perceptions were analyzed. Alpha values of P Results: There were 118 (88%) patients eligible for analysis. The prevalence of patient falls was 37.3% (44/118), and the prevalence of patient injury was 15.3% (18/118). A sedentary lifestyle was a significant risk factor (P=0.001) for injury, with a relative risk of 3.32 (1.47- 7.46 95CI) and an absolute risk difference of 26%. Age, height, weight, diabetes was not found to be risk factors for injury. Patient perception of OKS safety at study enrollment (P=0.049) and study exit (P=0.004) were significantly lower for injured patients. Conclusion: Despite a high prevalence of patient falls, there is a low absolute risk of injury. Sedentary patients are at increased risk of OKS-related injury. Patients with a history of injury perceive OKSs to be less safe and are less likely to use an OKS in the future but are not less likely to recommend an OKS to a friend. Future studies should verify prevalence data in multiple settings and assess the effectiveness of patient education or surgeon screening measures in reducing OKS-related injury.

Insulin receptors are internalized by endothelial cells to facilitate their physiological processes; however, the impact of hyperinsulinemia in brain endothelial cells is not known. Thus, the aim of this study was to elucidate the impact hyperinsulinemia plays on insulin receptor internalization through changes in phosphorylation, as well as the potential impact of protein tyrosine phosphatase 1B (PTP1B). Hippocampal microvessels were isolated from high-fat diet fed mice and assessed for insulin signaling activation, a process known to be involved with receptor internalization. Surface insulin receptors in brain microvascular endothelial cells were labelled to assess the role hyperinsulinemia plays on receptor internalization in response to stimulation, with and without the PTP1B antagonist, Claramine. Our results indicated that insulin receptor levels increased in tandem with decreased receptor signaling in the high-fat diet mouse microvessels. Insulin receptors of cells subjected to hyperinsulinemic treatment demonstrate splice variation towards decreased IR-A mRNA expression and demonstrate a higher membrane-localized proportion. This corresponded with decreased autophosphorylation at sites critical for receptor internalization and signaling. Claramine restored signaling and receptor internalization in cells treated with hyperinsulinemia. In conclusion, hyperinsulinemia impacts brain microvascular endothelial cell insulin receptor signaling and internalization, likely via alternative splicing and increased negative feedback from PTP1B.

Category: Sports; Ankle; Arthroscopy Introduction/Purpose: The modified Brostrom (MB) procedure has long been the mainstay for the treatment of chronic lateral ankle instability (CLAI) despite concerns about the strength of the repair. Recently, the InternalBraceTM (IB) has emerged as augmentation for this repair. The clinical benefit of such augmentation has yet to be established. The purpose of this study is to determine whether or not IB augmentation provides an advantage over the traditional MB. The preliminary results of this study are presented. Methods: Patients were identified for inclusion in the study based on indications for primary lateral ligament reconstruction for CLAI, age over 18, and able to provide informed consent. Exclusion criteria included pregnancy, cognitive disability, concomitant bony correction, inadequate soft tissue for MB, or prior ankle surgery affecting the lateral ligament complex. Preliminary outcome measures included complication rates, ability to participate in an accelerated rehabilitation protocol, and time to return to pre- injury level of activity. Complications were identified during post-operative clinical evaluations. Conversion from accelerated to traditional rehabilitation protocol was determined by patient’s self-reported ability to participate or VAS >= 5 per the physical therapist. Patients were contacted every 2 weeks from 6 to 26 weeks post-operatively to determine return to pre-injury level of activity. Results: 119 patients with CLAI who met criteria were enrolled in the study and randomized to the MB (59 patients) or IB (60 patients) treatment arm. At six months 11 patients (18.6%) of the MB arm and 4 patients (6.7%) of the IB arm were lost to follow up. 6/48 patients in the MB group and 2/56 patients in the IB group had not returned to preinjury activity level (p =.115). The complication rate was 8.5% in the MB group versus 1.7% in the IB Group. 4 patients in the MB group failed to complete the accelerated rehabilitation protocol versus 1 in the IB group. Average time to return to pre-injury level of activity was 17.6 weeks after MB and 13.2 weeks after IB (pConclusion: Preliminary results from this multicenter, prospective, randomized trial suggest that IB augmentation allows for faster return to pre-injury level of activity than MB alone. IB augmentation may support successful accelerated rehabilitation. IB augmentation did not add any additional risk of post-operative complication. Further areas of investigation include longer-term follow up and patient reported outcome scores.

Teaching students to integrate Christian faith with psychological theories is a multifaceted responsibility. In this article, we encourage educators to utilize a three-fold integration approach to foster the development of students' knowledge, skills, and values in counseling and psychology by teaching students to think Christianly, intervene competently, and advocate effectively. Using examples from the integration literature, professional standards, research on effective teaching strategies, and our own experience, we offer resources for course content and provide specific teaching strategies. Psychological theories are sets of ideas or principles that provide a framework for understanding the complex systems producing human behavior. Theory provides the lens for interpreting and predicting mental processes and behaviors. From psychological theories, we develop interventions to improve human welfare. Theories are also laden with values and world-view assumptions about the nature of personhood, social relationships, and society. Christian educators in psychology and counseling have the opportunity to teach students about psychological theories and at the same time provide critical thinking skills to evaluate these philosophical assumptions. Additionally, we strive to help our students apply psychological theory in the service of Christ's Kingdom for the healing of a hurting world. This requires not only an evaluation of theories from a Christian perspective, but also recognition of the cultural limitations of our psychological assumptions. The job of the Christian educator is multifaceted, and involves the development of students' knowledge, skills, and values in the integrative endeavor. In this article, we suggest a three-fold integration approach to teaching undergraduate and graduate students psychological theories. First, students need to learn the critical thinking skills necessary for thoughtful appraisal of psychological theories from a Christian worldview. Often referred to as theoretical or faith and science integration (Stevenson, Eck, & Hill, 2007), this important area of integration provides a necessary intellectual foundation for the relationship between the science of psychology and Christian faith. A second integration task involves teaching students the competent application of theory to address individual and systemic problems, and to incorporate Christian beliefs and practices with psychological interventions. Applied integration (Stevenson et al., 2007) includes attention to clinical and counseling techniques, ethics, person of the therapist, and spiritual formation. A third integration task fosters the development of service-oriented values and convictions and nurtures a passion for compassionate justice that results in advocacy for underserved and marginalized populations. Also termed faith-praxis integration (Bouma-Prediger, 1990) and integration as service (Canning, Pozzi, McNeil, & McMinn, 2000), students develop a vision for how psychological theory and Christian faith can be faithfully integrated into their larger calling to serve the church and build Christ's kingdom through addressing the real needs in the world today. We propose that the intended outcome of this three part integrative task is to produce students who are able to think Christianly (knowledge), intervene competently (skills), and advocate effectively (values). In this article, we will provide recommendations for content and teaching strategies in each of these three proposed tasks. Drawing from the integration literature, professional standards, research on effective teaching strategies, and our own teaching experiences, we hope to provide an array of practical suggestions that can improve our effectiveness in engaging and inspiring students to invest themselves in the important work of integration in our discipline (see Appendix A for a summary of teaching resources). APPENDIX A Resources for Teaching the Integration of Psychological Theory and Faith Appraisal Rooks and Jones and Butman (2010) articles Johnson(2010) Stevenson, Eek, & Hill (2007) Videos Professional Society for the Exploration Of organizations psychotherapy integration and web (septweb. …

Articulating cartilage wear plays an important role in cartilage degeneration and osteoarthritis (OA) progression. This study investigated the changes of mechanical properties and surface roughness of sheep cartilages with wear progression at a nanometre scale. Young sheep’s rear legs were subjected to a series of wear tests to generate worn cartilage samples to simulate the OA progression. Atomic force microscopy (AFM) was used to determine the effective indentation modulus and to measure the surface morphology of moist cartilage surfaces. The study has found that the mean effective indentation modulus values of worn cartilages were lower than that of healthy cartilage as the control sample. A medium-to-strong correlation between the effective indentation modulus values and the OA grades has been found. The relation between surface topography and effective indentation modulus values of the cartilage surfaces with OA progression was weakly correlated. The method established in this study can be implemented to investigate the effective indentation modulus values of clinical osteoarthritic cartilages and to assist in the understanding and assessment of OA.

Avulsion fracture of the base of the second metacarpal is a rare injury due to the stability of the carpometacarpal joints. There are few documented cases in the literature of extensor carpi radialis longus (ECRL) avulsion. The ECRL avulses from the base of the second metacarpal usually as a result of forced wrist hyperflexion and can be exacerbated with the hand in ulnar deviation. This is often as a result of a fall and the patient usually presents with pain in the region of, and dorsal to, the anatomical snuffbox. The base of the second metacarpal articulates with the base of the third metacarpal, capitate, trapezium and trapezoid. The ECRL has its origin on the lower third of the lateral epicondyle and the supracondylar ridge of the humerus and inserts distally into the base of the second metacarpal. The actions of ECRL are wrist radial deviation and wrist extension, the ECRL imparting a greater moment for radial deviation than the extensor carpi radialis brevis, while the opposite relationship is found for wrist extension. This paper presents the case of a patient with this injury, the diagnostic images, subsequent surgical and therapy management and final outcome.

Although many types of mass lesions within the carpal tunnel have been implicated in causing carpal tunnel syndrome, osteochondromas in this location rarely have been described. We describe a case of recurrent carpal tunnel syndrome 5 years after endoscopic carpal release, with intraoperative and pathologic analyses proving the mass to be this unusual but benign tumor.

We examined the relative efficiency of non-clinical sites to screen for chlamydia in youth and young adults. Chlamydia screening targeting youth (under 30 years of age) was performed at non-clinical sites in high-morbidity neighbourhoods of two California counties. Venues were subdivided into community outreach, schools, parenting centres and drug treatment/correctional facilities. Relative efficiency was estimated with multivariate Poisson regression using incidence of chlamydia per person-hours labour adjusting for strategy and county. Among the 1514 youths screened, the overall prevalence of chlamydia was 5.5%. By venue, the highest prevalence was in drug treatment/correction facilities at 11.1% followed by parenting centres at 6.3%, community outreach at 4.9% and schools at 4.6%. Drug treatment/correctional facilities were the most labour time efficient at 9.9 person-hours per chlamydia case. Schools and parenting centres had the lowest cost per screen at 0.9 person-hours per screen. Adjusted relative labour time efficiency (chlamydia cases per paid person-hour) was significantly higher in schools, 2.0 (95% confidence interval [CI] 1.0–4.2), parenting centres, 3.2 (95% CI 1.6–6.6) and drug treatment/correctional facilities, 2.9 (95% CI 1.0–7.8), compared with community outreach. In conclusion, parenting centres and drug treatment centres and correctional facilities are the most efficient venues for chlamydia screening.

Background: Many surgical procedures have been described for the correction of metatarsus primus varus associated with hallux valgus deformity. The purpose of this study was to present the results of the proximal metatarsal opening wedge (PMOW) osteotomy using the Arthrex LPS® first metatarsal system. Materials and Methods: Eighty-four patients (90 feet) underwent PMOW osteotomy with distal bunionectomy. There were 78 patients (93%) and 84 (93%) feet available for followup. Mean followup was 2.4 (range, 2.0 to 3.2) years from the time of the index surgery. Pre- and postoperative clinical examination, level of activity, patient derived subjective satisfaction score, radiographic measurements, and visual analogue scale (VAS) score for pain were obtained and evaluated retrospectively. Results: The mean preoperative VAS score was 5.9 (± 2.2), compared with a mean postoperative score of 0.5 (± 0.8). The mean 1–2 IMA preoperatively was 14.5 (±3.3) degrees, compared with postoperative measurements of 4.6 (± 2.8) degrees. The mean hallux valgus angle (HVA) improved from a mean of 30 (range, 22 to 64) degrees preoperatively to 10 (range, −15 to +18) degrees. The mean time to radiographic union was 5.9 (range, 4 to 14) weeks. There was one nonunion, one delayed union, mild hallux varus in two patients, severe hallux varus in two patients, recurrent hallux valgus in three patients (including the nonunion) and no instances of plate failure there was no significant difference in mean preoperative (74.8 degrees ± 11) compared to postoperative (67.9 degrees ± 10) total MTP joint range of motion. Ninety percent of patients reported good to excellent subjective results after the index surgery. Conclusion: We believe PMOW osteotomy was near ideal in terms of reliable, predictable correction and healing. Length of the first metatarsal was maintained and patients ambulated safely in a CAM walking boot immediately after surgery. We believe a first web space release may result in hallux varus and increased distal metatarsal articular angle (DMAA) was associated with hallux valgus recurrence. Level of Evidence: IV, Retrospective Case Series

Human suffering is a major concern to the fields of psychology and theology; however, the effect of suffering is controversial to many. In this study, nine Chinese pastors, who had experienced religious persecution to the extent of confinement, were interviewed about their experiences during the persecution, the effect related to their suffering, and their ways of coping. The transcripts were coded into major themes by adapting a hermeneutic phenomenology method with a committee approach. Results showed that the suffering in religious persecution involved losses of personal freedom, physical trauma, spiritual isolation, and collapse of social support. Eight themes emerged as unique ways to respond and cope during the suffering–-experiencing God's presence, letting go and surrender to God, identification with the passion of the Christ and His disciples, preparing to suffer, normalizing their suffering, worshipping and reciting Scriptures, fellowships and family support, and believing in a greater purpose. The first three of the coping methods significantly predicted positive affect. The pastors also reported transformation after the suffering, which can be categorized into four themes–-switching the focus from self to the churches, embracing the humility and limits within oneself, increased trust in God's provision, and redefining their views on suffering. This study sheds light on post-traumatic growth and religious coping. Christian counselors are also encouraged to explore the meaning and emotion of suffering in therapy, as well as to utilize culturally sensitive coping mechanisms.

Objective: To review the biology of interleukin-1 (IL-1) in the pathogenesis of rheumatoid arthritis (RA), as well as the biology of its natural inhibitor, IL receptor antagonist (IL-1Ra), and the clinical efficacy and safety of the recombinant form, anakinra. Data Sources: A MEDLINE search (1966–January 2007) of English-language articles was conducted using the key words anakinra, arthritis, clinical trial, interleukin-1 receptor antagonist, and Kineret. Study Selection and Data Extraction: Over 79 research articles and literature reviews were used to compile a discussion of the biology of IL-1 and IL-1Ra. Ten of these articles were selected to discuss the clinical safety and efficacy of anakinra. Data Synthesis: In RA, IL-1 primarily acts locally to mediate erosion of cartilage and bone. IL-1Ra serves to modulate its activity through competitive inhibition of cellular receptors. Administration of anakinra to animals with experimental arthritis reduced inflammation and joint damage. In clinical trials, anakinra was reasonably well tolerated; however, injection site reactions were frequent and there was a slight increased risk of serious infection. Alone or in combination with methotrexate, anakinra significantly reduced the symptoms and clinical signs of RA at the American College of Rheumatology 20% response level. However, no additive benefit was observed following coadministration with etanercept, a soluble tumor necrosis factor antagonist, and anakinra had no beneficial effect in patients that failed treatment with etanercept. Conclusions: Laboratory studies have indicated that IL-1 is primarily responsible for cartilage destruction and bone erosion in RA. The selective inhibition of IL-1 through administration of anakinra may offer symptomatic relief of RA in some patients.

The mission of the National Advanced Driving Simulator is to conduct highway safety research that will reduce annual loss of life on U.S. roadways. The simulator is well suited in its ability to replicate vehicle dynamics—and associated motion and visual cues—realistically to conduct complex experiments. It is unique in its ability to study vehicle control and loss-of-control situations in a safe and controlled environment. These capabilities make it an appropriate device to study the effectiveness of electronic stability control (ESC) systems, in which proper handling during loss of vehicle control is critical to assess system efficacy. The focus of the study is on challenges associated with creating repeatable yet unexpected scenario events in which loss of control is imminent for most drivers. Scenario events designed for a large-scale experiment to study ESC systems are detailed, data derived from these scenarios are discussed, and findings of scenario effectiveness are presented. A discussion of what constitutes loss of control and how to measure its effect effectively is provided.

The number of wireless phone subscribers in the U.S. is constantly growing. Studies have shown that use of wireless phones while driving contributes to crashes. Efforts to pass legislation allowing only hands-free wireless phone use while driving are widespread and based on the assumption that a hands-free interface is safer than a hand-held one. The National Highway Traffic Safety Administration conducted a driving simulator study to examine the effects of phone interface type on driving performance and drivers' ability to perform phone tasks. Participants' phone interface preferences were also recorded. Fifty-four participants drove a simulated freeway route with each of three phone interfaces: hand-held, headset hands-free (voice dialing and headset), and voice dialing hands-free (voice dialing with cradle-mounted speaker phone). Although post-drive questionnaire results show that participants rated the hand-held interface to be most difficult to use, this interface was associated with the fewest dialing errors and significantly faster dialing times than the two hands-free interfaces. Drivers answered the phone more quickly when using the voice dialing hands-free phone interface than when using the hand-held or headset hands-free interfaces. Younger drivers answered the phone significantly more quickly than the older drivers. Hang up times were significantly faster in the voice dialing hands-free condition and were slowest in the headset hands-free condition. Conversation task performance did not differ as a function of phone interface. Thus, although drivers considered them easier to use than hand-held phone interfaces, hands-free interfaces were more time-consuming to interact with while driving. Further analyses of these data will investigate how other aspects of phone task performance are related to eye glance behavior and driving performance.

The use of dynamic traction splintage is established in the treatment of complex intra-articular phalangeal fractures. Several different systems have been used and we report our experience with one of these, the Pins and Rubber Traction System. A cohort of 14 patients with complex intra-articular fractures at the base of the middle phalanges of the fingers were treated and assessed prospectively over a 2.5-year period (mean, 20 months; range, 7-28 months). The mean active range of motion regained, at the proximal interphalangeal joint, was 74 degrees (range, 0-100 degrees ). The mean total active motion of the injured digit was 196 degrees (range, 40-275 degrees ). Refinements in the regime are suggested as a result of this investigation.

This study evaluated the effectiveness of distal tarsal tunnel release with a partial plantar fasciotomy for chronic subcalcaneal pain syndrome in patients who failed nonoperative management through a retrospective review of all patients undergoing this procedure between 1994 and 1999. Distal tarsal tunnel release and a partial plantar fasciotomy were offered only to those patients with disabling heel pain and were performed under general anesthesia or ankle block. Seventy-five patients (80 heels), averaging 20 months of nonoperative treatment, were identified (group I). Postoperative outcome questionnaires (SF-36 and Foot Function Index [FFI]) were sent to these patients and 44 (46 heels) responded (group II). In group I, 88% of patients had a good to excellent result. Many continued with mild to moderate residual symptoms, which typically did not limit their activity. In group II, 91% of patients were somewhat to very satisfied with their outcome. Visual analogue scale scores for pain were reduced by a mean of 55. SF-36 scores, matched against a control group of patients receiving just nonoperative treatment, showed a statistically significant improvement in all pain and functioning subcategories. We conclude that a distal tarsal tunnel release with a partial plantar fasciotomy may successfully increase function and decrease pain in patients who fail nonoperative treatment.

Treated and untreated wool fibers are analyzed by methodologies based on atomic force microscopy. Untreated fibers are known to have an intact native surface lipid layer, while KOH treatment has the effect of removing this layer as well as disrupting the molecular substructure. The effective bulk Young's modulus of the untreated fibers is measured in air and in situ during exposure to water. There is a nearly instantaneous drop by a factor of two from approximately 1.2 GPa. after onset of aqueous exposure. The surface stiffness of both untreated and KOH treated fibers is measured in situ during aqueous exposure for durations up to 12 X 103seconds. A decrease by a factor of two is observed for the untreated surface, while there is a more rapid decrease by a factor of ten for the KOH treated surface. Measurements of an equivalent Young's modulus for the near-surface layers obtained by transverse compression of less than 200 nm by the tip result in values of less than 1 MPa. Because wool is an inhomogeneous and anisotropic medium, the outcomes of the two different measurements of the modulus are complementary but not comparable. Tip-to-surface adhesion is also monitored during aqueous exposure, with the KOH treated surface exhibiting the lower value by a factor of approximately ten. There are also trends showing lower adhesion with duration of exposure. Rapid ingress of water into the bulk appears to be associated with decreased bulk stiffness, but has little immediate effect on surface and near-surface properties. The decrements in surface stiffness and observed effects on adhesion from aqueous exposure are then due to a much slower radial ingress of water, which is additionally rate-limited by the native lipid layer.

The current project asks the questions: Do “women's ways of knowing,” particularly women's ways of knowing God as evidenced in the literature on women's spirituality, imply that women have a unique contribution to make to the integration literature? Do feminine perspectives on integration provide a necessary ‘corrective’ to the largely theoretica literature? Based on a review of feminist contributions to theology, spirituality, philosophy, and psychology, it was hypothesized that female authors' contributions to the integration literature would emphasize practical, clinical, and experiential integration. A content analysis of the past ten years of integration articles in the Journal of Psychology and Theology and the Journal of Psychology and Christianity was conducted to examine the relationship between gender and type of integration. Significant variations in the frequency of male and female first authorship across types of integration were found. Gender differences in the frequency of interdisciplinary, intradisciplinary-clinical, and faith-praxis integration articles contributed most towards the variations: Female authors were more likely to author clinical and faith-praxis integration articles, and male authors were more likely to author interdisciplinary integration articles. Implications are explored regarding the benefits of including feminine thought as an integral partner in the task of integration and spiritual formation.

We have used the double pulp flap technique described by Buck-Gramcko for nail fold creation in 75 fingertips after separation of 38 complete syndactyly webs in 27 patients. The operative technique is described and the results are discussed. Nail patterns in these complex syndactyly webs are analysed and a classification is proposed.

The author argues that Plato, Aristotle, St. Augustine, Machiavelli, Kant, and Nietzsche each contribute to the contemporary understanding of the warrior and his morality. However, none presents what we take to be a complete picture. Our views are a blend of classical and modern elements, and these views change and tend to emphasize various components of classical or modern theory depending on our level of optimism, or cynicism, with respect to the role of the United States in the world order. The article makes the case that by examining the Western ethical tradition as a whole, we will have a more comprehensive understanding of the potential virtues and vices of the warrior morality.

Vortex magnetic separation (VMS) is a new technique (1-3) which can not only greatly increase selectivity of high gradient magnetic separation but can also provide a much higher material throughput because high slurry velocity is used. This technique will have a wide range of applications in fields as diverse as mineral processing, biochemical engineering, sewage and wastewater treatment and industrial effluent treatment. At present in high gradient magnetic separation (HGMS) low Reynolds numbers (with respect to the wire diameter) are usually used and the magnetic product is captured on the upstream side of the wire matrix which results in a serious mechanical entrainment problem that is very detrimental to the purity of the magnetic fraction and to the reduction of the quantity of non-magnetic fraction (4). Vortex magnetic separation runs at moderate Reynolds number ( Re = 6–40) which leads to the formation of vortex flow in the neighbourhood of the matrix. Magnetic particles in the slurry are first concentrated in the boundary layer flow around the matrix and then brought into the magnetically attractive area on the matrix downstream side. The magnetic deposit on the downstream side of the matrix does not suffer the direct collisions with non-magnetic particles in the slurry, so the quality of the magnetic product is drastically improved. As will be described below, a new invention has been made with regard to the VMS matrix which allows capture to take place on both the upstream and downstream sides of the matrix without mechanical entrainment. This paper reviews experimental and theoretical work on the mechanisms involved in vortex magnetic separation.

This paper extends the debate over the ideal of the sustainable city, particularly as it relates to transport, by providing empirical evidence, from five case-study cities in the United Kingdom and one in the Netherlands on the links between urban form and energy consumption in transport. It also links energy use measures to the physical, economic, and social structure of the city to determine whether there are significant relationships. Energy-use measures combine all the characteristics of travel (mode, distance, and frequency), together with occupancy, to give a new set of composite measures of travel. The conclusions reached are mixed in that significant relationships have been found, principally between energy use in transport and physical characteristics of the city, such as density, size, and amount of open space. But comparability problems make it difficult to establish definitive relationships.

Using data from a 1987 nationwide survey of U.S. cities of 25,000 population and above, this research analyzes the formal authority and the informal powers associated with the office of mayor. We divide cities by mayor-council or council-manager form. The findings confirm that elected chief executives in mayoral cities possess considerably more formal authority than their counterparts in manager communities, yet informal mayoral powers are quite comparable among these two forms of government. Using ANOVA (GLS), we also predict variations in mayoral power using five demographic and political variables. Among mayor-council cities, location in a central city and large size are the best explanatory variables. For manager cities, regional location and the presence of partisan ballots and ward elections are the best predictors of mayoral power.

When the motion of an object is influenced by gravity (eg free fall, pendulum, wave motion), that influence may provide a cue to computing the absolute distance and/or size of the object. Formal analysis supports the claim that the distance and size of moving objects are generally computable with reference to the gravitational component of motion. Informal evidence from judgments of realism in films is consistent with this gravity-cue hypothesis.

An hypothesis is developed which proposes that mortality rates from heart disease are a function of a nation's dominant religious tradition, with predominantly Catholic countries having lower rates than the more Protestant countries. The hypothesis was tested on data from 24 economically developed Western countries. A significant inverse relationship of −0.588 was found between the proportion of Catholics in the 24 nations and mortality rates from heart disease, which supports the hypothesis.

With their failure rate of 15-18% in teenagers condoms are a risky form of contraception. In addition if they fail to prevent pregnancy they can also fail to prevent the spread of sexually transmitted diseases including AIDS and chlamydia. Despite propaganda which touts condoms as cure-alls a third of sexually active teenagers will acquire a sexually transmitted disease before they graduate from high school. Teenagers should practice sexual abstinence instead of "safe" sex. They should learn self-respect and self-control rather than sort-of-safe self-indulgence.

Two cases of migration of silastic rods into the forearm after the first stage of flexor tendon grafting are reported. A CT scan shows the rods well if they are not visible on a plain X-ray. Possible factors involved in distal detachment of the rods are the composition of the tendon spacer, method of distal fixation, method of proximal fixation and the time between the stages of reconstruction.

A study of the evolution of agency in artificial life was designed to access the potential emergence of purposiveness and intentionality as these attributes of behavior have been defined in psychology and philosophy. The study involved Darwinian evolution of mobile neural nets (autonomous agents) in terms of their adaptive weight patterning and structure (number of sensory, hidden, and memory units) that controlled movement. An agent was embedded in a 10 × 10 toroidal matrix along with “containers” that held benefit or harm if entered. Sensory exposure to content of a container was only briefly available at a distance so that adaptive response to a nearby container required use of relevant memory. The best 20% of each generation of agents, based on net benefit consumed during limited lifetime, were selected to parent the following generation. Purposiveness emerged for all selected agents by 300 generations. By 4000 generations, 90% passed a test of purposive intentionality based on Piaget's criteria for Stage IV object permanence in human infants. An additional test of these agents confirmed that the behavior of 67% of them was consistent with the philosophical criterion of intention being “about” the container's contents. Given that the evolved neural structure of more than half of the successful agents had only 1 hidden and 1 memory node, it is argued that, contrary to common assumption, purposive and intentional aspects of adaptive behavior require an evolution of minimal complexity of supportive neural structure.

A comparison between the American states with .10, .08, and no illegal per se alcohol levels for vehicle drivers showed slightly higher than expected motor vehicle accident death rates for those states with the .08 level.

The partnership form of business has become increasingly popular in the United States and may account for a significant portion of new business formation in the future. In spite of the growth of partnerships, there has been little formal analysis of their formation or behavior. In this article, we consider the possibility that the level of partnership formation is inefficient and find conditions under which tax-subsidy schemes yield welfare-improving changes in the level of partnership formation. We also determine the effects of income taxation on partnership activity. Finally we examine the impact of government expenditure programs on partnership behavior. We find that some of these programs, for example those that are ostensibly designed to foster new business, may actually inhibit partnership formation and increase the likelihood of partnership failure.

The Progress Evaluation Scales (PES) provide an efficient measuring devicefor evaluating current functioning, setting treatment goals, and assessing change over time in clinically relevant aspects of personal, social, and community adjustment. The PES can be completed by patients, significant others, and therapists, making it possible to obtain various points of view of the outcome of mental health services. This article describes the seven domains measured by the PES and the underlying dimensions they were designed to tap, and presents the generalizability, validity, and usefulness of the scales as applied to an adult mental health center population.

There is a popular belief that females are more socially oriented than males, while males are more nonsocially or object oriented than females. A 2 × 2 factorial design was employed to examine this, with independent variables of sex and age (young and older adults). The subjects were presented with six pairs of pictures, each consisting of an object and a person. Each presentation lasted 30 s; the time spent looking at each stimulus was taken as a measure of interest. The hypothesis that in this choice situation males and females would differ in their preference for object and person stimuli was confirmed. However, the sex difference was confined to young adults; older subjects of both sexes showed more (and equal) interest in the social stimuli than in the object stimuli. Masculinity and femininity scores on the Bem Sex Role Inventory showed some relationship with object–person preferences but failed to throw much light on the absence of a sex difference in older adults.

In order to assess the performance of the14C-glycocholic acid breath test as an indicator of bacterial colonisation of the jejunum, 145 combined breath tests and jejunal aspirate cultures were carried out on a total of 50 subjects who had an increased probability of being colonised. Ninety-one of the 145 cultures were positive while only 31 of the breath tests were positive. This poor performance of the breath test relative to the aspirate culture can be predicted with reasonable accuracy from known bile deconjugating capabilities of bacteria found in the small intestine.

In a group of 20 patients with heavy alcohol intake a relation was found between withdrawal symptoms and fall in serum potassium. Total body potassium (TBK) was measured in all subjects and was lower in the group of subjects who displayed symptoms than in the group who did not. The subgroup of the four most severe reactors had a mean TBK value significantly less than the ‘non-reactor’ group. The minimum serum potassium levels observed for all subjects in the four day period following alcohol withdrawal correlated with their TBK values. We suggest that the mechanism for the serum potassium fall might be overactivity of the Na-K pump caused by ethanol consumption. There was also an association between withdrawal reaction and abnormal liver function and a transient rise in serum phosphate in the more severely reacting subjects.

SummaryThe effects ot two β-adrener-gic receptor-blocking agents, timolol and propranolol, on resting PRA and on the hydralazine-induced increase in PRA were studied in SHR and in two strains of normo-tensive rats [Wistar (NWR) and Sprague-Dawley (NSDR)]. With single oral doses, these β-adrenergic-blocking drugs reduced PRA in a dose-dependent manner in SHR but not in NWR or NSDR. After four daily doses, timolol antagonized the hydralazine-induced increase in PRA in SHR and lowered PRA in NWR. Timolol lowered PRA in NSDR only at 10 mg/kg/day p.o. for 4 days. It was concluded that SHR are more sensitive than normotensive rats to the PRA-lowering effects of β-adrenergic-blocking drugs.