3-point System Research Articles

Assessing the waddle: An evaluation of a 3-point gait score system for ducks

Impaired walking ability is an economically important welfare problem that affects poultry raised for meat production, including Pekin ducks. To gain a better understanding of the impacts of walking impairments on duck production, and to identify contributing variables and plausible remedies, an accurate measure of walking ability must first be defined. The viability of a 3-point gait score system for characterizing the walking abilities of Pekin ducks was evaluated. Specifically, we examined whether the qualitative gait score categories corresponded to quantitative gait parameter measures, and evaluated the inter- and intra-rater reliabilities of the gait score system. Commercial Pekin ducks aged 13 to 14 d (14 d; 248 ducks), 20 to 21 d (21 d; 350 ducks), and 30 to 32 d (31 d; 368 ducks), were video recorded and gait scored using a 3-point system (GS0 = best gait; GS2 = poor gait) as they crossed a Tekscan® gait analysis system. Gait structure parameters were calculated based on 4 steps made by each duck. The most prominent differences were observed at 21 d and 31 d of age between the ducks with GS0 and GS2, with GS2 scoring ducks walking a shorter total distance, having greater differences in the amount of pressure applied to the right versus left leg, and the amount of time spent standing on 2 feet between steps. Gait score reliabilities were calculated separately for observers who received minimal training (M, N = 10) and those who viewed and discussed the sample cases (V, N = 13). Both groups assessed the gait of ducks from video footage. Inter-rater reliability (Fleiss kappa) was lowest for 14 d old ducks (M: k = 0.47, T: k = 0.62), and best for the 32 d old ducks (V: k = 0.75; T: k = 0.8). Overall, intra-rater reliabilities (Pearson's correlation) were high and were unaffected by the scorer's level of training (M: r = 0.87; V: r = 0.87; t21 = 0.43). The results indicate that a 3-point gait score system is a promising tool for assessing the walking ability of ducks at 21 d of age and older.

Assessment of Rut Depth Measurement Accuracy of Point-Based Rut Bar Systems Using Emerging 3D Line Laser Imaging Technology

Point-based rut bar systems are commonly used by transportation agencies. However, potential measurement errors exist in these systems because of the limited number of sample points (e.g. 3 to 31 points). Now, advanced sensing technology can acquire high-resolution transverse profiles of more than 4,000 points using 3D line laser imaging technology (termed the 3D line laser hereafter). This study, sponsored by the United States Department of Transportation (USDOT) Research and Innovative Technology Administration (RITA) program, is a) to explore the feasibility of using the 3D line laser to accurately and reliably measure rut depth, and b) to quantify the potential rut depth measurement errors using point-based rut bar systems. The rut depth measurement accuracy and repeatability of the 3D line laser were validated in laboratory and field tests. Results show that the absolute rut-depth measurement error is less than 3 mm, and, therefore, the transverse profiles acquired by the 3D line laser can be used to quantitatively evaluate the accuracy and reliability of point-based rut bar systems. Rut bar systems having 3 to 31 sensors were simulated using transverse profiles acquired by the 3D line laser. Test results show that the relative rut-depth measurement error generally decreases with the increasing number of laser sensors. However, the trend is unclear for rut bar systems with fewer sensors because the rut shape affects the rut depth measurement error more than the number of sensors. Thus, a 3-point rut bar system could outperform a 5-point system occasionally. Test results also show that the commonly used 3-point and 5-point rut bar systems can underestimate rut depth by 16% to 51% and 22% to 64%, respectively. The relative rut-depth measurement error is less than 10% only when the number of sensors is greater than 29.

Topical Timolol Maleate for Superficial Infantile Hemangiomas: An Observational Study

The objective of this study was to assess the clinical effects and safety of topical timolol maleate for the management of superficial infantile hemangiomas (IHs). From October 2012 to March 2014, 35 infants (24 girls and 11 boys; 2 to 10months old; median age, 4.7months) with superficial hemangiomas were treated with the local application of timolol maleate in the authors' department. Thirty-five lesions were treated using topically administrated timolol maleate every 12hours for a mean duration of 22weeks (range, 6 to 45weeks). Follow-up visits were scheduled monthly and changes in tumor size, texture, and color were recorded. Treatment response was scored according to a 3-point scale system as good, partial, or no response. Adverse effects after medication were evaluated and managed accordingly. All patients completed treatment. Of the 35 hemangiomas, 18 (51.4%) showed a good response, 10 (31.4%) showed a partial response, and 6 (17.2%) had no response. The total response rate was 82.8% (29 of 35). Clinically, no systemic or local side effects caused by timolol maleate were observed in the patients. Topical timolol maleate could provide an effective and safe alternative to the systemic use of propranolol for the treatment of superficial IHs. Further prospective studies are needed to confirm the efficacy and safety of topical timolol maleate for the treatment of IHs.

A Cam Deformity Is Gradually Acquired During Skeletal Maturation in Adolescent and Young Male Soccer Players

Background: A cam deformity is a major risk factor for hip osteoarthritis, and its formation is thought to be influenced by high-impact sporting activities during growth. Purpose: To (1) prospectively study whether a cam deformity can evolve over time in adolescents and whether its formation only occurs during skeletal maturation and (2) examine whether clinical or radiographic features can predict the formation of a cam deformity. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: Preprofessional soccer players (N = 63; mean age, 14.43 years; range, 12-19 years) participated both at baseline and follow-up (mean follow-up, 2.4 ± 0.06 years). At both time points, standardized anteroposterior and frog-leg lateral radiographs were obtained. For each hip, the α angle was measured, and the anterosuperior head-neck junction was classified by a 3-point visual system as normal, flattened, or having a prominence. Differences between baseline and follow-up values for the α angle and the prevalence of each visual hip classification were calculated. Additionally, the amount of internal hip rotation, growth plate extension into the neck, and neck shaft angle were determined. Results: Overall, there was a significant increase in the prevalence of a cam deformity during follow-up. In boys aged 12 and 13 years at baseline, the prevalence of a flattened head-neck junction increased significantly during follow-up (13.6% to 50.0%; P = .002). In all hips with an open growth plate at baseline, the prevalence of a prominence increased from 2.1% to 17.7% (P = .002). After closure of the proximal femoral growth plate, there was no significant increase in the prevalence or increase in severity of a cam deformity. The α angle increased significantly from 59.4° at baseline to 61.3° at follow-up (P = .018). The amount of growth plate extension was significantly associated with the α angle and hip classification (P = .001). A small neck shaft angle and limited internal rotation were associated with cam deformities and could also significantly predict the formation of cam deformities (α angle >60°) at follow-up. Conclusion: In youth soccer players, cam deformities gradually develop during skeletal maturation and are probably stable from the time of growth plate closure. The formation of a cam deformity might be prevented by adjusting athletic activities during a small period of skeletal growth, which will have a major effect on the prevalence of hip osteoarthritis.

Treatment of superficial infantile hemangiomas with topical propranolol

To evaluate the efficacy and safety of 1% propranolol ointment in the treatment of superficial infantile hemangiomas (IHs). A retrospective chart review was performed on 49 children (34 female and 15 male) with a median age of 4.1 months (range, 1-10 months). A total of 58 superficial IHs were treated with 1% propranolol ointment. Topical propranolol was applied three times daily for a mean duration of 21.1 weeks (range, 5-59 weeks). Changes in the size, texture, and color of the tumor were monitored and recorded at regular intervals. The treatment response was evaluated using a 3-point scale system: good, partial, and no response. Adverse effects after medication were evaluated and managed accordingly. Of the 49 cases, 26 (53.1%) demonstrated good response, 17 (34.7%) showed a partial response, and 6 (12.2%) had no response. The total effective rate was 87.8% . No systemic complication was observed in any of the patients. Topical therapy with 1% propranolol ointment may be a safe and effective method for the treatment of superficial IHs and can be used as an adjuvant treatment measure during the wait-and-see period.

Topical propranolol for treatment of superficial infantile hemangiomas

"Wait-and-see" is a common principle for most superficial infantile hemangiomas (IHs) because of their expected involution. Topical propranolol has recently been reported to be an effective treatment for superficial IHs. The aim of this study was to evaluate the efficacy and safety of 1% propranolol ointment in the treatment of superficial IHs. A retrospective chart review was performed on 25 children (21 female and 4 male) with a median age of 4 months (range, 1-10 months). A total of 28 lesions were treated with 1% propranolol ointment. Topical propranolol was applied thrice daily for a mean duration of 21 weeks (range, 5-59 weeks). Changes in the size, texture, and color of the tumor were monitored and recorded at regular intervals. The treatment response was evaluated using a 3-point scale system: good, partial, and no response. Adverse effects after medication were evaluated and managed accordingly. Of the 28 hemangiomas, 16 (57%) demonstrated good response, 9 (33%) showed a partial response, and 3 (10%) had no response. Among all the IHs, 90% showed either good or partial responses to topical 1% propranolol ointment treatment. No systemic complication was observed in any of the patients. This report is a retrospective uncontrolled study. Topical therapy with 1% propranolol ointment may be a safe and effective method for the treatment of superficial IHs and can be used as an adjuvant treatment measure during the wait-and-see period.

Evaluation of diagnostic strategies for bladder cancer using computed tomography (CT) urography, flexible cystoscopy and voided urine cytology: results for 778 patients from a hospital haematuria clinic

Evaluation of diagnostic strategies for bladder cancer using computed tomography (CT) urography, flexible cystoscopy and voided urine cytology: results for 778 patients from a hospital haematuria clinic

An Analysis of Home Advantage in the Top Two Spanish Professional Football Leagues

This study examines the effect of the points system on home advantage in the two top Spanish professional football divisions between the 1980-1981 and 2006-2007 seasons. From 1980-81, teams were awarded 2 points for a win. This was increased to 3 points starting in 1995-1996. Lower home advantage was expected with the 3-point system as a consequence of encouraging more attacking play from away teams. The results of an analysis of 20,992 games showed no significant differences in home advantage values between the First Division (66.3% before and 62.1% after the 3-point system) and the Second Division (65.6% before and 59.5% after). Nevertheless, there was a significant decrease in home advantage in both the First and Second Divisions after the introduction of the 3-point system. The results were compared with two similar studies of professional football in England.

A Simplified Tumor Regression Grade Correlates with Survival in Locally Advanced Rectal Carcinoma Treated with Neoadjuvant Chemoradiotherapy

Locally advanced rectal cancer is frequently treated with neoadjuvant chemoradiotherapy to reduce local recurrence and possibly improve survival. The tumor response to chemoradiotherapy is variable and may influence the prognosis after surgery. This study assessed tumor regression and its influence on survival in patients with rectal cancer treated with chemoradiotherapy followed by curative surgery. One hundred twenty-six patients with locally advanced rectal cancer (T3/T4 or N1/N2) were treated with chemoradiotherapy followed by total mesorectal excision. Patients received long-course radiotherapy (50 Gy in 25 fractions) in combination with 5-flourouracil over 5 weeks. By means of a standardized approach, tumor regression was graded in the resection specimen using a 3-point system related to tumor regression grade (TRG): complete or near-complete response (TRG1), partial response (TRG2), or no response (TRG3). The 5-year disease-free survival was 72% (median follow-up 37 months), and 7% of patients had local recurrence. Chemoradiotherapy produced downstaging in 60% of patients; 21% of patients experienced TRG1. TRG1 correlated with a pathological T0/1 or N0 status. Five-year disease-free survival after chemoradiotherapy and surgery was significantly better in TRG1 patients (100%) compared with TRG2 (71%) and TRG3 (66%) (P = .01). Tumor regression grade measured on a 3-point system predicts outcome after chemoradiotherapy and surgery for locally advanced rectal cancer.

Grading Anterior Cruciate Ligament Graft Injury after Ligament Reconstruction Surgery: Diagnostic Efficacy of Oblique Coronal MR Imaging of the Knee

ObjectiveThe purpose of this study was to evaluate the diagnostic efficacy of using additional oblique coronal MRI of the knee for grading anterior cruciate ligament (ACL) graft injury after ligament reconstruction surgery.Materials and MethodsWe retrospectively reviewed 51 consecutive MR knee examinations of 48 patients who underwent both ACL reconstruction and follow-up arthroscopy. The MR examinations included the orthogonal axial, sagittal, coronal images and the oblique coronal T2-weighted images, which were oriented in parallel with the course of the femoral intercondylar roof. Two radiologists independently evaluated the status of the ACL grafts with using the routine knee MRI and then with adding the oblique coronal imaging. The severity of ACL graft injury was graded using a 3-point system from MR images as intact, partial tear or complete tear, and the results were compared with the arthroscopic results. Weighted kappa statistics were used to analyze the diagnostic accuracies of the knee MRI with and without the additional oblique coronal imaging. For each evaluation, the observers reported a confidence level for grading the ACL graft injuries in the two imaging groups.ResultsThe weighted kappa values according to the routine knee MRI were 0.555 (reader 1) and 0.515 (reader 2). The inclusion of additional oblique coronal imaging increased the weighted kappa values to 0.666 (reader 1) and 0.611 (reader 2). The mean confidence levels by each reader were significantly higher (p < 0.01, paired t-test) with the additional oblique coronal imaging than by using the routine knee MRI alone.ConclusionThe additional use of oblique coronal MRI of the knee improves both the diagnostic accuracy and confidence for grading ACL graft injury.

Development and Validation of a Frontal Impact 6-Year-Old Occupant and Wheelchair Computer Model

Many children with disabilities use their wheelchair as a vehicle seat when traveling. To date, few studies have focused on pediatric wheelchair users in transit. A computer model representing a manual pediatric wheelchair seated with a Hybrid III 6-year-old anthropomorphic test device subjected to a 20-g/48-kph (30-mph) frontal crash was developed in MADYMO. The wheelchair was secured using a 4-point tiedown system, and the occupant was restrained using a 3-point belt system. The time history profiles of the computer model were tuned to those of the sled tests. The peak value for key variables was compared between the sled tests and the model. To evaluate model variable time histories, Pearson's correlation coefficients (r) between the sled test and the model outcome measures were determined. The correlation coefficients ranged from .86 to .95, with an average r of .91. This indicates that there are “high” correlations between the model and sled tests across all variables. The pediatric wheelchair model developed and validated in this study will provide a foundation for studying the response of a manual pediatric wheelchair in frontal impacts and associated injury risks for pediatric wheelchair users.

Anterior Cruciate Ligament Tear: Reliability of MR Imaging to Predict Stability after Conservative Treatment

ObjectiveThe aim of this study is to evaluate the reliability of MR imaging to predict the stability of the torn anterior cruciate ligament (ACL) after complete recovery of the ligament's continuity.Materials and MethodsTwenty patients with 20 knee injuries (13 males and 7 females; age range, 20-54) were enrolled in the study. The inclusion criteria were a positive history of acute trauma, diagnosis of the ACL tear by both the physical examination and the MR imaging at the initial presentation, conservative treatment, complete recovery of the continuity of the ligament on the follow up (FU) MR images and availability of the KT-2000 measurements. Two radiologists, who worked in consensus, graded the MR findings with using a 3-point system for the signal intensity, sharpness, straightness and the thickness of the healed ligament. The insufficiency of ACL was categorized into three groups according to the KT-2000 measurements. The statistic correlations between the grades of the MR findings and the degrees of ACL insufficiency were analyzed using the Cochran-Mantel-Haenszel test (p < 0.05).ResultsThe p-values for each category of the MR findings according to the different groups of the KT-2000 measurements were 0.9180 for the MR signal intensity, 1.0000 for sharpness, 0.5038 for straightness and 0.2950 for thickness of the ACL. The MR findings were not significantly different between the different KT-2000 groups.ConclusionMR imaging itself is not a reliable examination to predict stability of the ACL rupture outcome, even when the MR images show an intact appearance of the ACL.

Management of scoliosis with special seating for the non-ambulant spastic cerebral palsy population––a biomechanical study

Objective. To investigate the effects of special seating on lateral spinal curvature in the non-ambulant spastic cerebral palsy population with scoliosis. Design. Prospective study with matched pairs (same subject pre- and post-intervention). Background. It is thought that special seating can improve the sitting posture of individuals with spastic cerebral palsy. However, there is little known about how the seating can affect a scoliosis. Method. The shape of the spine was measured with subjects sitting in an assessment chair with a clear backrest. The measurement recorded was the “spinous process angle”, an approximation to the Cobb angle. The forces exerted on the subject by the chair were measured by electrical resistance strain gauged transducers attached to the lateral support pads and seat base. Measurements were taken with three alternative arrangements of lateral support pads: upper body unsupported in configuration 1; two lateral pads at the same height in configuration 2; body supported by a 3-point force system in configuration 3. Results. Configuration 3 gave a mean correction of +35% in the spinous process angle compared to configuration 1 ( P=0.000) and the forces applied through the two lateral thoracic pads were, on average, of similar magnitude (mean values of 51 and 47 N). In comparison, for configuration 2 the mean correction was only +18.7% ( P=0.004) and on average the pad on the concave side of the scoliosis applied a much larger force to the chest wall than the pad on the convex side (mean values of 36 and 17 N respectively). Conclusions. Significant static correction of the scoliotic spine can be achieved with an arrangement of lateral pads on a seating system that applies a 3-point force system to the sides of the body. Relevance The results suggest that the position of the lateral pads on a special seating system is important and, by the careful configuration of these supports, significant correction of a scoliosis can be obtained for a person with spastic cerebral palsy. Also the methodology and equipment from this study are potentially useful for the assessment and fitting of special seating for individuals with scoliosis.

Grading articular cartilage of the knee using fast spin-echo proton density-weighted MR imaging without fat suppression.

The objective of this work was to determine the accuracy of fast spin-echo proton density-weighted MR imaging in the evaluation of the articular cartilage of the knee using arthroscopy as a gold standard. We retrospectively reviewed MR images of the knee in 54 patients for whom arthroscopic results were available. All MR imaging studies included fast spin-echo proton density-weighted coronal and axial sequences as part of our routine protocol. Evaluation of the articular surfaces was performed by three independent observers who were unaware of the arthroscopic results. The cartilage surfaces were graded using a 3-point system, and results were compared with arthroscopic findings. Of 324 cartilage surfaces evaluated, arthroscopy showed 241 surfaces as normal, 56 as containing partial-thickness defects, and 27 as containing full-thickness defects. Compared with arthroscopic data, sensitivity of MR imaging for the three reviewers was 59-73.5%; specificity, 86.7-90.5%; positive predictive value, 60.5-72.6%; negative predictive value, 86.0-90.8%; and accuracy, 79.6-86.1%. Interobserver variability for the presence of disease, which was measured using the kappa statistic, was 0.63. Fast spin-echo proton density-weighted MR imaging sequences can be used to evaluate the cartilage of the knee with accuracy comparable to that of previously reported cartilage-specific sequences.

A simple technique for preventing bar displacement with the nuss repair of pectus excavatum

Background/Purpose: The most common complication of the minimally invasive technique for repair of pectus excavatum (MIRPE) is bar displacement, which has been reported to occur in 9.5% of all cases, particularly in teenaged patients. The use of a lateral stabilizing bar has improved stability but has not eliminated the occurrence of this problem. The authors report a new technique added to the standard MIRPE that creates an additional third point of fixation of the pectus bar to prevent displacement. Methods: The technique requires the simple placement, via a spinal needle, of a nonabsorbable suture next to the sternum, encircling a rib and the bar, using a single 3-mm stab wound and thoracoscopic guidance. The suture simply is buried under the skin. Since 1998, this technique has been applied to 20 patients who underwent MIRPE. Results: The average age was 14 years; 80% were boys. Average operating time was 75 minutes, and all patients had thoracoscopy with the MIRPE. A lateral stabilizing bar also was used in 14 patients. Four patients had 2 struts placed. Average length of stay was 5.5 days. There were no early complications. Mean follow-up was 12 months. Bar displacement occurred in 1 patient early in the series in which an absorbable suture was used for fixation. One patient had a prolonged hospital stay of 7 days because of postoperative pain. Conclusions: This modification to the original technique of MIRPE creates a 3-point fixation system that minimizes the risk of bar shifting even in teenaged patients. It does not add any significant time or cost to the operation, and it is fairly simple to perform. The authors believe that this technique decreases the occurrence of bar displacement, and they recommend its use for all patients with pectus excavatum considered candidates for the Nuss repair. J Pediatr Surg 36:1266-1268. Copyright © 2001 by W.B. Saunders Company.

Automobile crash simulation with the first pregnant crash test dummy

OBJECTIVE: Our goal was to develop a pregnancy insert for the Hybrid III (First Technology, Farmington, Mich.) crash dummy allowing evaluation of the effects of various restraint conditions on energy transmission to both the fetal and maternal compartments. STUDY DESIGN: A pregnancy insert with an elasticized vinyl uterine shell, simulated silicon amniotic fluid, and a 28-week simulated fetus was fitted to a female crash dummy. The fetus was instrumented with accelerometers in the head and thorax and a transducer to measure force transmission through the uterus. Thirty-nine crash tests were run under six different restraint conditions at speeds ranging from 10 to 25 miles/hr. Fetal responses were compared for different restraint conditions. RESULTS: Increasing speed of the crash resulted in greater force transmission through the uterus. Placement of the lap belt over the uterus instead of under the uterus resulted in a threefold to fourfold increase in force transmission through the uterus at all speeds tested. Air bag deployment in the unbelted or out-of-position dummy (laying against air bag) appears to impart significant energy transmission to the fetus. CONCLUSIONS: Energy transmission can be measured in terms of both abdominal force and acceleration within the fetal head and thorax. This new dummy demonstrates substantial transmission of energy, which is accentuated in some restraint conditions commonly used by pregnant women. The use of the 3-point restraint system appears to reduce the likelihood of injury in this model. (Am J Obstet Gynecol 1996;175:977-81.)

Relationships of nurses' critical thinking ability and perceived patient self-disclosure to accuracy in assessment of depression.

This descriptive study examined the relationships of nurses' critical thinking ability and perceived patient self-disclosure to accuracy in nursing assessment of depression in older medical patients. The sample consisted of 120 female nurse-patient dyads. Critical thinking ability was measured by the Watson-Glaser Critical Thinking Appraisal. Accuracy in nursing assessment was measured by deviations between the patient's SDS observed score and the patient's SDS predicted score. The patient's predicted score was based on the relationship between the Depression Status Inventory and Self-Rating Depression Scale. Perceived patient self-disclosure was measured by a 3-point system on patients' disclosure of information on symptoms of depression. A Pearson product-moment correlation and multiple regression analysis were used to analyze the data. The result showed that nurses' education was not significantly related to accuracy in assessment but related to critical thinking ability (r = .26; p = .004). Nurses' critical thinking ability was significantly related to accuracy in nursing assessment depression (r = -.24; p = .008). Perceived patients self-disclosure was not significantly related to accuracy in nursing assessment of depression.

Field effectiveness of two restraint systems: The 3-point manual belt versus the 2-point motorized-shoulder/ manual lap belt

The research question addressed in this paper is whether or not occupant death, injury, and ejection outcomes differ between vehicles equipped with 3-point manual belts versus 2-point motorizedshoulder/manual-lap (motorized/manual) belt systems. Census crash data sets for the states of Washington and Texas, and the Fatal Accident Reporting System (FARS) were subset to provide data on front-outboard occupants of Ford Escorts involved in crashes in calendar years 1981–1991. Logistic regression analyses showed that occupants of vehicles equipped with the motorized/manual system experienced 11.7% to 26.4% fewer K- or A-level injuries than occupants of vehicles equipped with the 3-point system. Similar analyses of FARS data showed lower ejection rates for occupants of vehicles with the motorized/manual system in both rollover and nonrollover crashes. The installation of the motorized/manual system provided a substantial safety benefit over the manual 3-point system in the time periods examined.

A critical analysis of the fatal injuries resulting from the Continental flight 1713 airline disaster: evidence in favor of improved passenger restraint systems.

To examine the mechanisms of injury and death in a commercial airline disaster and to propose preventative safety measures based on this analysis. Denver County Coroner's Office and the National Transportation Safety Board. Those patients suffering fatal injuries as a result of the Continental Flight 1713 Airline crash. Autopsy records from the Denver County Coroner's Office were reviewed with the causes of death determined. In many instances there was significant injury to more than one anatomic region in a single individual, each analyzed independently. There were 28 fatalities: nine died of mechanical asphyxiation, one of a penetrating cranial injury, and 18 of blunt trauma. The blunt injuries were remarkably similar to the deceleration injuries seen in high-speed motor vehicle crashes. Head trauma was the most common fatal blunt injury, followed by injuries to the chest and the abdomen. Thirty-six percent of the head injuries and 27% of the chest injuries had associated cervical and thoracic spine fractures, respectively. Analysis revealed a marked similarity in injury pattern sustained by seatmates, with a high incidence of fatal and serious injuries suffered by those passengers sitting in the front half of the airplane. Fatal blunt injury secondary to deceleration forces was the most common cause of death seen in this analysis. The use of a lap belt restraint system alone is not adequate to protect passengers against these forces as shown convincingly in the automotive industry literature. What impact a better passenger restraint system may have had on survival in this disaster is unknown, however, at a minimum, it would have significantly improved survival for 6 of 28 passengers dying of isolated blunt head trauma. Minor alterations in aircraft design (secure bolting of passenger seats to the airplane superstructure) and passenger restraints (3-point lap and shoulder harness system) is proposed to positively influence survival during an airplane crash at negligible increased airline expense or passenger inconvenience.

Splinting proximal interphalangeal joint flexion contractures: a new design.

Proximal interphalangeal joint flexion contracture is a common and persistent problem in hand rehabilitation. This article discusses the advantages and disadvantages of several current splint designs for correcting this contracture and introduces an alternate design that uses wire in a 3-point pressure system. The advantages of this design include ease of fabrication, patient appeal, and effectiveness.