Downstream changes in river avulsion style are related to channel morphology.

One of the most dramatic events in river environments is the natural diversion, or avulsion, of a channel across its floodplain. Though rarely witnessed, avulsions can cause massive floods, and over geologic time they create most of the fluvial stratigraphic record. Avulsions exhibit behavior ranging from reoccupying abandoned channels to constructing new channels and splay complexes. To quantify avulsion behavior, or style, we measure avulsion-related floodplain disturbance in modern environments. We show that for 63 avulsions from Andean, Himalayan, and New Guinean basins, avulsion style correlates with channel morphology and changes systematically downstream. Avulsions in braided rivers reoccupy abandoned channels, whereas avulsions in meandering rivers often produce flooding and sediment deposition during channel construction. These downstream changes in avulsion style can explain the abrupt transition from channel-dominated to floodplain-dominated facies commonly observed in foreland basin stratigraphy. These dynamics also explain why some avulsions are more hazardous than others.

Medical risk report: improving patient management and record keeping through a problem-oriented approach.

The problem-oriented record satisfies the needs of the contemporary practitioner by addressing the transition from diagnosis to treatment. The technique organizes collected data, identifies all patient problems (medical and dental), defines solutions and/or management of those problems, and documents treatment rendered. Predictably, the problem-oriented record will avoid problems associated with malpractice litigation, conform to regulations of third-party payers, and facilitate practice analyses and quality assessment, i.e., through computer-assisted tracking of patient care based on problems and not just treatment rendered. As many practices today focus on a "patient-centered" approach to practice, the problem-oriented record clearly supports such a philosophy in its completeness of managing patient care information. The dentist, in consultation with other health care providers, can and should feel confident treating patients from the growing population of patients with medical risk. By integrating the problem-oriented approach into patient management and record keeping, dentists can more easily develop a plan for the complexities that accompany patients. Whether these complexities are of a medical, dental, or combined nature, the problem-oriented record helps the practitioner organize information, plan for treatment, and document patient care in a complete and concise manner.

The contribution of the three columns of the spine to spinal stability: a biomechanical model.

UNLABELLED: The load carrying capacity (LCC) of the human spine was evaluated in 10 human cadaver spines. The specimens consisted of segments from T11 to S1 with markers placed on the specimens at each vertebral level in both Ap and lateral planes. The specimens were loaded to 1250 N and spinal deflections were recorded and photographed at 125 N intervals during the loading cycle. In 5 specimens, axial and flexion loads were applied to the intact spine. The anterior and middle columns were destroyed in sequence at L2 and the loading process repeated. In the remaining 5 specimens, axial and extension loads were applied with the spine intact and after the posterior and middle columns were destroyed in sequence at L2. Load deflection curves were generated for each test and comparisons were made between intact spines and spines with single and double column destruction. RESULTS: When the axis of loading was anterior to the posterior longitudinal ligament (PLL), destruction of the anterior and middle columns reduced the LCC by 46% and 68% respectively and destruction of the posterior and middle columns reduced the LCC by 30% and 63% respectively. There was minimal change in the LCC when the axis of loading was posterior to the PLL and the anterior and middle columns were destroyed. Two column destruction of the spine reduced its load carrying capacity for flexion loads by 70%. In thoracolumbar spinal fractures where flexion loads are predominant and anticipated, the authors conclude that surgical stabilisation is indicated with double column failure.

The contribution of the three columns of the spine to rotational stability. A biomechanical model.

A function of the spine as a structural column is its ability to resist torsion. The goal of this study was to evaluate the contribution of the columns of the spine to torsional rigidity. Ten human cadaver spines were harvested and frozen. The specimens, consisting of segments from T11 to S1, were subjected to torsional loads of up to 20 N-m. Rotation was recorded throughout the loading cycle. The columns of the spine were destroyed at the L2-3 interspace in a predetermined fashion and loading was repeated. The data were plotted as torsion versus rotation in degrees. The curves of each loading cycle were compared and the ratios of the intact and compromised specimens were calculated. The contribution of each column of the spine to torsional rigidity was determined. In an intact lumbar spine, the anulus was the most effective structure in resisting torsion. Experience gained in this study supports the following conclusion: Flexion-distraction injuries of the thoracolumbar and lumbar spine involving soft tissue destruction of the anterior column and anulus result in rotational instability.