Artigos de revistas sobre o tema "Mortimer B"

A propos of his earlier attempt to demonstrate, by means of measurements, computer-enhanced images and laser technology, that the archon of IG i311 was Antiphon (418/17), not Habron (458/7), Mortimer Chambers now quotes with approval the favourable verdict of J. Tréheux: ‘la mésure des intervalles entre les lettres, la superposition des photographies multiples et, surtout, le bombardement du marbre par un rayon laser ont prouvé (les photographies en couleur A et B ne permettent pas d'en douter)

Ryegrass staggers is a neurotoxic disorder of livestock grazing perennial ryegrass (Lolium perenne L.) infected with the endophytic fungus Neotyphodium lolii. Ryegrass staggers was first reported in 1880 (Anonymous 1880) although at this stage the cause of the observed tremorgenic disorder was unknown. The presence of an endophyte within perennial ryegrass was first recognised in 1935 (Neill 1941) but it was not until 1981 that the correlation between endophyte infection and the incidence of ryegrass staggers was established (Fletcher & Harvey 1981; Mortimer et al. 1982). The tremorgenic compound, lolitrem B, produced by the endophyte was then isolated and implicated in the disease (Gallagher et al. 1981, 1982, 1984). The future then seemed clear: eradicate the endophyte and solve the ryegrass staggers problem. Endophyte-free plots, however, showed little growth and suffered severe damage from the larvae of Argentine Stem Weevil (Mortimer et al. 1982). The correlation between endophyte levels, weevil numbers and tiller damage was then made (Prestidge et al. 1982) and a few years later the beneficial effects of endophyte were shown to be due to peramine, an antifeedant produced by the fungus (Gaynor & Rowan 1986; Rowan et al. 1986).

Esta pesquisa tem como objetivo analisar o discurso de uma professora de língua inglesa, a fim de identificar como estão materializadas léxico-gramaticalmente as ações dialógicas e monológicas, por ela adotadas, durante o desenvolvimento de uma aula da modalidade do Ensino de Jovens e Adultos (EJA). Para analisar os dados, adotamos uma abordagem híbrida, fundamentada pelo conceito de dialogismo (BAKHTIN, 1981, 1986; SCOTT; MORTIMER; AGUIAR, 2005), procurando depreender as ações monológicas e dialógicas subjacentes ao discurso dessa professora, e salientando como essas ações são constituídas por significados ideacionais e interpessoais, com base na Linguística Sistêmico-Funcional (HALLIDAY; MATTHIESSEN, 2014; FUZER; CABRAL, 2014). A análise revelou que a professora equilibra ações discursivas: a) monológicas (11 ocorrências), caracterizadas por restrições à mediação, materializadas pelo uso de declarações e de processos verbais e relacionais; b) dialógicas (11 ocorrências), ao dar voz aos alunos, por meio de perguntas, materializadas por processos mentais, as quais os levam à reflexão sobre os temas abordados.

Abstract OBJECTIVE AND IMPORTANCE Mycotic aneurysms of the extracranial carotid artery are rare and difficult to diagnose. A search of the world literature published since 1966 reveals at least six cases of mycotic carotid aneurysms due to a Salmonella septicemia. We present an exceptional case of mycotic pseudoaneurysm of the bifurcation of the carotid artery due to Salmonella septicemia and discuss the pathogenesis as well as various aspects of the diagnosis and surgical management. CLINICAL PRESENTATION A 68-year-old man presented in Poland with Salmonella sepsis; 1 month later, he was admitted to the emergency department of the Sir Mortimer B. Davis-Jewish General Hospital in Montreal with a bulky and pulsatile right cervical mass. An angiogram and a computed tomographic scan revealed a voluminous and partially thrombosed aneurysm the size of a tangerine originating from the posterior aspect of the carotid junction. INTERVENTION Balloon trapping was attempted at the Montreal Neurological Hospital. Subsequently, the patient developed a significant neurological deficit, which was quickly reversed by the administration of hypertensive, hypervolemic, and hemodilution therapy. Thereafter, the pseudoaneurysm was resected surgically, and the internal and external carotid arteries were sacrificed. Pathological examination of the excised specimen of the carotid junction revealed a pseudoaneurysm. Bacterial culture of the lesion showed growth of Salmonella. CONCLUSION The postoperative course was satisfactory except for laryngeal paralysis due to involvement of the vagus nerve. Four months later, a computed tomographic scan showed only small lacunae in both centra semiovale.

Background: In the setting of apparently isolated distal fibula fractures, the gravity stress view (GSV) is a validated method to determine mortise stability. There is currently no published data evaluating whether dynamic muscle activation can reduce an unstable mortise. If patients with instability can overcome gravity, resultant images could yield false-negative results. The goal of this investigation was to determine if patient effort can influence medial clear space (MCS) measurements in proven unstable bimalleolar-equivalent ankle fractures. Methods: Patients presenting with Weber B fibula fractures were assessed for mortise stability using the GSV. If the GSV demonstrated instability based on MCS widening >4 mm, 3 additional views were performed: GSV with an assistant maintaining the ankle in a neutral position; GSV with the patient actively dorsiflexing to neutral; and GSV with the patient actively dorsiflexing and supinating the foot. Twenty-four consecutive patients met inclusion criteria, with a mean age of 48.7 (range, 22-85) years. Fifteen patients (62.5%) were female and 9 (37.5%) were male. The laterality was evenly divided. Results: The mean MCS was 5.8 ± 2.0 6.0 ± 2.6, and 6.2 ± 2.7 mm for the manual assist, active dorsiflexion, and active supination radiograph measurement groups, respectively ( P = .434). Only 5 of 24 subjects had any measurable decrease in their MCS with active supination, with a maximum change of 1.2 mm. The remainder of the patients had an increase in MCS ranging from 0.1 to 4.0 mm. Conclusion: There was no significant difference between measurement states indicating that muscle activation is unlikely to yield a false-negative result on GSV. Mortise instability, secondary to deep deltoid injury in the presence of gravity stress, is unlikely to be actively overcome by dynamic stabilizers, supporting the validity and specificity of the GSV. Level of Evidence: Level III, prospective study.

David Brion Davis, Inhuman Bondage: The Rise and Fall of Slavery in the New World (Trevor Burnard)Louis Sala-Molins, Dark Side of the Light: Slavery and the French Enlightenment (R. Darrell Meadows)Stephanie E. Smallwood, Saltwater Slavery: A Middle Passage from Africa to American Diaspora (Stephen D. Behrendt)Ruben Gowricharn, Caribbean Transnationalism: Migration, Pluralization, and Social Cohesion (D. Aliss a Trotz)Vilna Francine Bashi, Survival of the Knitted: Immigrant Social Networks in a Stratified World (Riva Berleant)Dwaine E. Plaza & Frances Henry (eds.), Returning to the Source: The Final Stage of the Caribbean Migration Circuit (Karen Fog Olwig)Howard J. Wiarda, The Dutch Diaspora: The Netherlands and Its Settlements in Africa, Asia, and the Americas (Han Jordaan) J. Christopher Kovats-Bernat, Sleeping Rough in Port-au-Prince: An Ethnography of Street Children &Violence in Haiti (Catherine Benoît)Ginetta E.B. Candelario, Black Behind the Ears: Dominican Racial Identity from Museums to Beauty Shops (María Isabel Quiñones)Paul Christopher Johnson, Diaspora Conversions: Black Carib Religion and the Recovery of Africa (Sarah England)Jessica Adams, Michael P. Bibler & Cécile Accilien (eds.), Just Below South: Intercultural Performance in the Caribbean and the U.S. South (Jean Muteba Rahier)Tina K. Ramnarine, Beautiful Cosmos: Performance and Belonging in the Caribbean Diaspora (Frank J. Korom)Patricia Joan Saunders, Alien-Nation and Repatriation: Translating Identity in Anglophone Caribbean Literature (Sue N. Greene)Mildred Mortimer, Writings from the Hearth: Public, Domestic, and Imaginative Space in Francophone Women’s Fiction of Africa and the Caribbean (Jacqueline Couti)Colin Woodard, The Republic of Pirates: Being the True and Surprising Story of the Caribbean Pirates and the Man Who Brought Them Down (Sabrina Guerra Moscoso)Peter L. Drewett & Mary Hill Harris, Above Sweet Waters: Cultural and Natural Change at Port St. Charles, Barbados, c. 1750 BC – AD 1850 (Frederick H. Smith)Reinaldo Funes Monzote, From Rainforest to Cane Field in Cuba: An Environmental History since 1492 (Bonham C. Richardson)Jean Besson & Janet Momsen (eds.), Caribbean Land and Development Revisited (Michaeline A. Crichlow)César J. Ayala & Rafael Bernabe, Puerto Rico in the American Century: A History since 1898 (Juan José Baldrich)Mindie Lazarus-Black, Everyday Harm: Domestic Violence, Court Rites, and Cultures of Reconciliation (Brackette F. Williams)Learie B. Luke, Identity and Secession in the Caribbean: Tobago versus Trinidad, 1889-1980 (Rita Pemberton)Michael E. Veal, Dub: Soundscapes and Shattered Songs in Jamaican Reggae (Shannon Dudley)Garth L. Green & Philip W. Scher (eds.), Trinidad Carnival: The Cultural Politics of a Transnational Festival (Kim Johnson)Jocelyne Guilbault, Governing Sound: The Cultural Politics of Trinidad’s Carnival Musics (Donald R. Hill)Shannon Dudley, Music from Behind the Bridge: Steelband Spirit and Politics in Trinidad and Tobago (Stephen Stuempfle)Kevin K. Birth, Bacchanalian Sentiments: Musical Experiences and Political Counterpoints in Trinidad (Philip W. Scher)

Category: Ankle; Trauma Introduction/Purpose: Assessment of mortise stability is paramount in determining appropriate management of ankle fractures. While instability is readily apparent in bimalleolar or trimalleolar ankle fractures, determination of instability in the apparent isolated Weber B fibula fracture often requires further investigations such as stress radiography. While several authors have previously demonstrated poor predictive value of physical examination findings such as tenderness, ecchymosis and swelling with instability, no previous investigation has examined the ability of a translational test to determine deltoid ligament injury. The goal of this study is to test the validity of a novel clinical test, the lateral drawer test, in determining mortise instability in a cohort of patients with Weber B fibula fractures. Methods: Patients presenting with isolated fibula fractures were prospectively identified by an orthopaedic nurse practitioner or resident. Three views of the ankle as well as gravity stress views (GSV) were obtained. Prior to examining radiographs, two foot & ankle fellowship-trained orthopaedic surgeons (JYK, CPM) performed and graded the lateral drawer test. (Grade 0: no instability/symmetric to contralateral ankle, Grade I: translation < 5mm, Grade II: translation >= 5mm) While the surgeons were made aware of the presence of a Weber B fibula fracture, radiographs were not visualized prior to conducting the drawer test. Medial clear space (MCS) was measured. VAS pain scores were obtained before and after testing. The results of the lateral drawer test results were compared with radiographic measurements of MCS. Results: The study has thus far prospectively enrolled 14 consecutive patients with Weber B ankle fractures. Six (43%) patients demonstrated radiographic instability with widening of the medial clear space >= 5 mm on GSV. When correlated with MCS measurement, the lateral drawer test demonstrated a sensitivity of 83.3%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 88.9% for determining instability. There was a strong correlation between the lateral drawer test grade and amount of MCS widening (⍴=0.82, p=0.0003). Patients tolerated the lateral drawer test well with an average increase of 1.6 on the VAS pain scale after testing. Conclusion: The lateral drawer test demonstrates high sensitivity, specificity, PPV and NPV for detecting instability in patients presenting with Weber B fibula fractures. While further validation is required in a larger cohort of patients, the lateral drawer test may offer an adjunct tool via physical examination to predict mortise stability.

A retrospective radiographic and chart review was performed for the initial 50 patients who underwent Agility (DePuy, Warsaw IN) total ankle arthroplasty by the senior author (M.S.M.). The review focused on the perioperative complications of nerve or tendon lacerations, intraoperative fractures, acute deep infections, wound complications and component positioning. Major wound complications were defined as those requiring a soft-tissue coverage procedure. Minor wound complications did not require soft tissue coverage and included wound breakdowns, wound edge necrosis, and superficial infections. The immediate mortise and lateral postoperative radiographs were reviewed to measure component positioning. The patients were divided into two groups to compare the initial 25 patients (Group A) with the subsequent 25 patients (Group B). There were no major wound complications in either group. Minor wound complications decreased from six in Group A to two in Group B. There were four lacerations (flexor hallucis longus, posterior tibial tendon, deep peroneal nerve, and superficial peroneal nerve), all occurring in Group A. Five patients sustained intraoperative fractures in Group A, as compared with two fractures in Group B. The number of components varying greater than 4° from neutral as measured by the lateral talar, lateral tibial and mortise tibial component angles decreased by 9% from Group A to Group B. The only tibial component to be placed in more than 4° of valgus occurred in Group A. It seems that a notable learning curve exists in the performance of total ankle arthroplasty as demonstrated by a comparison of the initial 25 patients with the subsequent 25 patients performed by one orthopaedic surgeon. This improvement most likely resulted from the use of enhanced techniques and further training with the prosthesis. This information can be used as a teaching tool to decrease the incidence of complications for surgeons performing their initial arthroplasties with this potentially technically demanding procedure.

This paper presents the results of a parallel examination on the strength of oval tenon-mortise joints in two groups of test joints. Joints from group A were made with both shoulders of tenon, while joints from group B were made without the lower shoulder. Examination of strength was conducted on a chair joints rear leg-rail. The results of the examination indicated that joints in group A (oval tenon with the upper and lower shoulder) had a higher average bending moment capacity in comparison with the joints in group B (oval tenon without the lower shoulder). However, the significance of difference in strength between the two groups of joints was not confirmed by the statistical analysis.

Category: Ankle; Trauma Introduction/Purpose: In the setting of apparently isolated distal fibula fractures, the radiographic gravity stress view (GSV) has been validated as a reliable method to determine mortise stability. Based on previous studies demonstrating that plantarflexion can increase the measured medial clear space (MCS), patients are often asked to actively hold their ankle in a neutral position. However, it has not been studied whether dynamic muscle activation in the form of attempted dorsiflexion and/or supination can reduce and realign an unstable mortise. If these efforts can overcome gravity, resultant images could lead to a false negative result and missed diagnosis of instability. The goal of the present investigation is to determine if active effort by the patient can influence MCS measurements in proven unstable bimalleolar-equivalent ankle fractures. Methods: Eighteen consecutive patients with apparently isolated distal fibula fractures (Weber-B type) identified on initial nonweightbearing radiographs were assessed for mortise stability with a standard, unassisted GSV. If the radiograph demonstrated MCS widening > 4 mm, 3 additional views were performed: GSV with an assistant manually maintaining the ankle in a neutral position; GSV with the patient actively dorsiflexing the ankle to the same neutral position; and GSV with the patient actively dorsiflexing and supinating the foot to the same neutral position. All radiographs were digitally obtained and measured using a DICOM measurement tool. The MCS was measured by the senior author (JYK) who was blinded to the nature of the ankle position. Statistical analysis of the data was then conducted. Results: Of the eighteen patients who met inclusion criteria, the mean age was 48.9 years (range: 22-85, SD=18.9). Twelve patients (66%) were female and six (33%) were male. The laterality was evenly split with nine patients presenting with a right ankle injury and nine left ankles. The data was non-parametric; therefore, a Friedman’s test was utilized for analysis between the different MCS measurements per patient. There was no statistically significant difference in the measured MCS in any of the three tested scenarios, χ2(2)=4.261, p=0.119. Only 5 of 18 subjects had any measurable decrease in their MCS when asked to supinate their foot. Of these 5, the maximum reduction was 1.21mm. The remainder of patients had an increase in MCS ranging from 0.1 to 4.0mm. Conclusion: This investigation supports the notion that the gravity stress test is unlikely to yield false negative results when patients attempt to actively maintain a neutral ankle position during imaging. There was a non-significant inverse trend indicating that dynamic effort may in fact further displace the mortise as indicated by an increased MCS in several study participants, rather than reduce it. Thus, one can conclude that despite voluntary effort, patients with bimalleolar-equivalent ankle fractures are unlikely able to overcome the effect of gravity on the unstable mortise.

Category: Trauma; Ankle Introduction/Purpose: Accurate pre-operative diagnosis of syndesmotic injuries can be difficult in the setting of AO 44-B1 fractures. Ankle fractures with syndesmotic injuries have worse reported outcomes. No study has investigated the relative fracture height in determining potential syndesmotic injury. The goal of this study was to establish if pre-operative radiographs could accurately predict syndesmotic injury. Methods: Patients treated for an isolated AO 44-B1 fracture over a ten-year period (2007-2017) were reviewed. Anteroposterior and mortise views of the ankle were used to determine the zone of distal extent of the proximal fracture fragment (Figure 1). Syndesmotic injury was defined as positive intraoperative stress exam that required syndesmotic fixation. Relative risks were determined between zones with a statistical significance set at 0.05. Ten randomly selected radiographs were reviewed by two authors and assessed by intra-class correlation (ICC) for inter- and intra-observer reliability. Results: There were 548 AO 44-B1 fractures that were reviewed; and 287 patients were included in the study. There were 191 zone 1 injuries, 57 zone 2 injuries, and 39 zone 3 injuries. Of these, 17% (33 patients) of zone 1, 42% (24) of zone 2, and 74% (29) of zone 3 fractures had syndesmotic injuries. The relative risk of syndesmotic injury of Zone 1 compared to Zone 2 was 2.4 (p<0.001), Zone 1 to Zone 3 was 4.3 (p<0.001), Zone 2 to Zone 3 was 1.8 (p=0.002). The ICC for inter- and intra-observer reliability was perfect (ICC=1). Conclusion: AO 44-B1 fractures have a varying rate of syndesmotic injury. Weber B fractures that end between the level of the plafond and the physeal scar (Zone 2) are 2.6 times more likely to have a syndesmotic injury compared to those that end below the plafond (Zone 1). This is magnified in those injuries ending above the scar (Zone 3). This simple classification of AO 44-B1 fractures is predictive of syndesmotic injury and may aid in preoperative counseling and planning.

As A. B. Lloyd points out, the passage from Herodotus which includes this sentence is the most important non-Egyptian commentary on Ancient Egyptian shipbuilding. In the years following the discovery of the Dynasty IV ships buried beside Khufu's pyramid at Giza (c. 2500 B.C.), J. S. Morrison suggested a change in the translation of the word (⋯ν)επ⋯κτωσαν. Traditionally, and in Lloyd's commentary, the verb ⋯μπακτ⋯ω has been interpreted as meaning ‘to caulk’. Morrison, however, believes that (⋯ν)επ⋯κτωσαν ought to refer to reinforcement of a ship's fastenings with papyrus ropes. He bases this interpretation on the evidence of the Khufu boats, which are sewn through v-shaped mortises across the hull's width (Fig. 1), and on the argument that caulking is better done from the outside. Lloyd has challenged this translation, but we would like to support it with some further evidence, in particular evidence of Egyptian shipbuilding practice.

We analyzed 50 sets of ankle radiographs to determine the interobserver and intraobserver reliability when obtaining common linear and angular measurements. The radiographs were divided into two groups: one group included 25 normal ankles, and the second group included 25 fractured ankles. Each set of radiographs was evaluated independently by four different observers on two separate occasions under controlled conditions. Six radiographic parameters were measured on all 50 sets of films: syndesmosis A, syndesmosis B, syndesmosis C, the medial clear space, and the talocrural and bimalleolar angles. On the 25 sets of fracture films, four additional measurements of fracture displacement were included: displacement of the medial malleolus (mortise), displacement of the lateral malleolus (AP and lateral), and displacement of the posterior malleolus. Reliability was evaluated with an analysis of variance intraclass correlation coefficient. Among the examiners, 9 of the 10 parameters could be measured reliably. Intraobserver reliability was found to increase with the experience of the examiner.

Background: Anatomic reduction of ankle fractures may influence outcomes but the relationships between these 2 variables are still unknown and require further investigation. The purpose of this study was to investigate the relationships between radiologic alignment of surgically treated ankle fractures and functional outcomes. Methods: This retrospective study included patients who were surgically treated for Weber B and C ankle fractures. The outcome measures consisted of the Olerud and Molander Ankle Score (OMAS) and the foot and ankle disability measure. Standard radiographs included anteroposterior, lateral, and mortise views of the ankle, both on pre- and postoperatively. Between June 2011 and December 2013, a total of 152 patients were treated for ankle fractures and 76 patients with a mean age of 41.3 ± 17.1 years and a mean follow-up of 39.6 ± 8.9 months were included. There were 45 Weber type B fractures (mean age 43.4 ± 17.8, 28 females, 17 males) and 31 Weber type C fractures (mean age 40.7 ± 17.3, 12 females, 19 males). Results: Linear regression did not reveal any significant relationships with the exception of age. There was a moderate correlation between the OMAS outcome score and age ( r2 = 0.46, P = .01). Conclusion: We found that younger age was a moderate predictor of functional outcome following surgical treatment of ankle fractures. Radiographic alignment using standard non-weight-bearing radiographs and fracture severity did not predict functional outcomes at 24 months postoperatively. Level of Evidence: Level III, prognostic, retrospective cohort study.

Background: In Weber B/SER2-4 ankle fractures, assessment with weightbearing radiographs to ascertain stability of the ankle mortise has been advised. However, no previous studies report whether this method leads to preservation of normal ankle congruence. The purpose is to evaluate equivalence of ankle congruence of injured ankles after fracture union, vs the uninjured side, for stable SER2 and partially unstable SER4a fracture types. Methods: We conducted a prospective case-control study designed as an equivalence trial to evaluate if weightbearing radiographs predict whether stable/SER2 and partially unstable/SER4a Weber B ankle fractures reach union with preserved normal tibiotalar congruence and without a concomitant increase of treatment failure. A total of 149 patients with a Weber B fracture stable on weightbearing radiographs were recruited into the trial. All participants were treated with a functional orthosis and weightbearing allowed. Results from gravity stress radiographs classified ankles as SER2 or SER4a fracture types. We defined an equivalence margin in medial clear space difference of 1.0 mm. We also evaluated the reliability of obtaining measurements from weightbearing radiographs. Results: No differences in medial clear space between the injured and uninjured ankles were observed after fracture union for the SER2 group (mean difference 0.1 mm, 95% confidence interval [CI] −0.3, 0.0; P = .056), or the SER4a group (mean difference 0.0 mm (95% CI −0.1, 0.1; P = .797). No between-group differences were observed (mean difference 0.0 mm, 95% CI −0.2, 0.2; P = .842). These findings were consistent with equivalence. CIs for the intraclass correlation coefficients indicated excellent reliability. Conclusion: Assessment of stability of Weber B SER2/4a ankle fractures, with weightbearing radiographs, also predicts preservation of normal ankle congruence in those deemed stable, with no difference between SER2 and SER4a fracture types. Further, excellent reproducibility of the method of obtaining medial clear space measurements was demonstrated. Level of Evidence: Level III, case-control.

Salmonella is one of the most common cause of the food borne illness. Salmonella belongs to Enterobacteriacae family and consists of 2 species, which diverge on 6 subspecies.These subspecies consists of 2700 serovars. There are typhoid serovars among them - S. Typhi, Paratyphi A, B, C - which cause typhoid fever in human. The rest of the serovars are non-typhoidal and leads to gastroenteritis both in animal and human. Salmonella enters to a mammal organism as a result of consumption of contaminated food products: meat, eggs, milk and products containing them. The entry of the infection for salmonellosis is the small intestine mucosa. Salmonella attaches to cell walls by fimbria and pili. Salmonella has several systems that are activated in response to adverse conditions such as: high osmolarity, acid or heat shock and nutrient deficiencies. They are based on the principle of a two-component system in which there is a sensor that receives cytoplasmic signals, and a regulator. Regulator (usually DNA-binding protein) initiates the transcription of the virulence genes (Chakraborty, 2015). The sensor is histidine kinase, which phosphorylates the regulatory protein, thereby activating it.During the infectious cycle of salmonella in mammalian organism the formation of specific vacuole SCV takes place (Salmonella-containing vacuole-containing vacuole containing salmonella) in the cytoplasm of the eukaryotic cell (Steele-Mortimer, 2008). SCV is a modified phagosome, which is formed as a result of cytoskeleton rearrangements. The target are usually phagocytic cells : neutrophils, macrophages and epithelial cells of the small intestine mucosa - M-cells (Akhmetova, 2012). Given the specific mechanism of infection, salmonella is considered a facultative intracellular pathogen. Bacterium invades the eukaryotic cell by rearrangement of its cytoskeleton with effector proteins and continue to persistence in a form of SCV. It is well-known nowadays that tolerance to high osmotic pressure is achieved through the EnvZ / OmpR system, which also regulates the expression of the ssrAB operon that is localized on the Salmonella pathogenicity island SPI-2 and triggers the expression of the effector proteins. The ssrAB operon is also regulated by the two-component acid shock response system PhoP / PhoQ (Worley, 2000). The functioning of the PhoP / PhoQ system directly depends on the sigma factor RpoS, which accumulates under low concentrations of magnesium cations (Tu, 2006). According to the researches of transduction between the EnvZ / OmpR components, it is clear that salmonella receives signals from the cytoplasmic environment, and sensory molecules are located on the inner membrane (Kenney, 2019; Wang et al., 2012). The ability to survive under acid shock is provided by the PhoP / PhoQ system, which also operates on the principle of signal transduction. PhoQ is a Histidine Kinase Signal Sensor. Signals are acidic pH, divalent cations and positively charged antimicrobial peptides. An important function of the two-component PhoP / PhoQ system is the control of spi ssa gene expression in a macrophage environment (Bijlsma, 2005). These genes are the main component of the type III secretion systems and are transcribed only when salmonella enters eukaryotic cell. (Bijlsma, 2005). The main regulator of signal transduction systems PhoP/PhoQ and EnvZ/OmpR is sigma-factor RpoS - subunit of bacterial RNA-polymerase - which operates in stationary phase at low pH, high omolarity, heat shock or nutrient deficiency. RpoS protein accumulates in adverse conditions during stationary phase (Mg2+ deficiency, low pH, high osmolarity). Need in magnesium cations is dependent on their ability to act as cofactors in many enzymatic activities. The accumulation begins at exponential (logarithmic) phase of bacterial reproduction. This is the phase of active cell division. Two factors MgtA and MgtB are responsible for Mg2+ transport. Another molecule with the same function is CorA - bivalent cation channel, though its transcriptions doesn’t depent on magnesium concentration in cell. In a case of magnesium deficiency at the stationary phase, RpoS accumulates vigorously an initiates replication of PhoP/PhoQ. PhoP/PhoQ regulates tolerance to inorganic acids. Also, PhoP/PhoQ controls adaptation to magnesium cations deficiency and macrophage activity. Results of many studies on genes coding this system and their mutations led to conclusion the mutation or inactivation of one factor causes decrease in virulence and makes bacterial susceptible to acid environment. To date, the stages of the infectious process for salmonellosis have been studied and described in detail in the literature. Particular attention is paid to signal transduction systems that are common among enterobacteria and help to avoid adverse conditions. Their functioning and regulation are investigated. It is known that salmonella receives signals for the activation of sensors from the cytoplasm, but the nature of these signals is not yet fully understood. Adaptation of the bacteria to adverse conditions and the response to phagocytosis is initiated by the transcription of pathogenic genes and the suppression of the transcription of the operon, which neutralize the conditions in the cytoplasm of salmonella cells. Thus, adapting to the conditions of target cells, salmonella continues to multiply in the body. Key words: salmonella, pH, osmolarity, virulencegenes, operon, signal transduction.

The posterior malleolus of the ankle is the object of increasing attention, with considerable enthusiasm for CT scanning and surgical fixation, as expressed in a recent annotation in The Bone & Joint Journal. Undoubtedly, fractures with a large posterior malleolar fragment that allow posterior talar subluxation from the mortise are served better by fixation. However, in all other situations, the existing literature does not support this widespread change in practice. The available biomechanical evidence shows that the posterior malleolus has little part to play in the stability or contact stresses of the ankle joint. Radiographic studies have not shown that CT scanning offers helpful information on pathoanatomical classification, case selection, or prognosis, or that scanning improves the likelihood of an adequate surgical reduction. Clinical studies have not shown any improvement in patient outcome after surgical fixation, and have confirmed that the inevitable consequence of increased intervention is an increased rate of complications. A careful and thoughtful evaluation of indications, risks, and benefits of this fashionable concept is required to ensure that we are deploying valuable resources with efficacy, and that we do no harm. Cite this article: Bone Joint J 2018;100-B:566–9.

Background: The diagnosis of medial ankle instability in Weber B ankle fractures remains controversial. Manual stress and gravity stress radiographs as well as magnetic resonance imaging (MRI) are used, but there is no consensus gold standard. The purpose of this study was to determine the relationship between initial fibular displacement and medial clear space widening on a gravity stress radiograph as a predictor of instability. Methods: A retrospective review was conducted of all patients with isolated Weber B ankle fractures with both initial injury radiographs and gravity stress view from August 1, 2014, through April 1, 2016. A total of 17 patients were identified. On the mortise view of initial injury radiographs, medial clear space (MCS), superior clear space, lateral fibular displacement (LFDP), and fibular shortening (FS) were measured, and on the lateral view, anterior to posterior fibular gap (A to P FG) was measured. MCS was again measured on the gravity stress view (MCS-W). Statistical analyses identified the correlations of each displacement variable relative to MCS-W as well as the sensitivity and specificity of each parameter. Results: A cutoff point for MCS-W was set as less than 5.0 mm (n = 8) and 5.0 mm or more (n = 9). Strong significant correlations with MCS-W were found for A to P FG (0.84, P < .001), with a trend for LFDP (0.62, P = .008), but no significance with FS (0.38, P = .84). Linear regression analysis revealed significant ability to predict MCS-W for both LFDP ( P = .002) and A to P FG ( P = .001) but not FS. Receiver operating characteristic analysis for A to P FG using a threshold value of 1.0 mm yielded sensitivity and specificity of 100% in predicting an MCS-W of 5.0 mm or more. Conclusion: The initial fibular displacement was a strong predictor of MCS-W in Weber B ankle fractures. On lateral radiographs, an A to P FG greater than 1.0 mm showed a sensitivity and specificity of 100% in predicting an MCS-W of 5.0 mm or more on gravity stress view. Level of Evidence: Level III case series, prognostic.

Category: Ankle Introduction/Purpose: The current standard of care for management of an unstable ankle fracture that includes an oblique Weber B fibula fracture is open reduction and internal fixation (ORIF) using a plate and screws to anatomically reduce and compress the fractured fibula. The most popular first-line techniques include either a lag screw with neutralization plate or an anti- glide plate with or without a lag screw through the plate. However, these techniques can be technically challenging in osteoporotic bone or within fibulas of smaller diameter, and in some cases can result in fragmentation at the fracture site. The purpose of this study is to examine an alternative first-line method for routine treatment of Weber B fibula fractures. Methods: Fifty-two patients undergoing ORIF of a Weber B fibula fracture by a single surgeon were included in this retrospective study. In every case, reduction and clamping of the fracture was attempted. If successful, a lateral locking plate was slid underneath the clamp(s) and applied with cortical screws proximally and locking screws distally. If clamping was unsuccessful, length/alignment/rotation was achieved by alternative methods (i.e. push-pull technique, use of plate to reduce fracture, etc.), and a lateral locking plate was ultimately applied in a similar manner. No screw crossed the fracture in any case. Per published precedent, nonunion was defined as either a gap of >3mm between fracture surfaces >6 months postoperatively or a fracture line >2-3 mm wide and sclerosing of the fracture surfaces >6 months postoperatively. Similarly, malunion was defined as >=1 of the following: talar tilt >2 degrees, talar subluxation >2 mm, or tibiofibular clear space >=5 mm. Results: The mean (+- standard deviation) age of the 52 included patients was 44.2 +- 16.2 years, the mean body mass index was 27.7 +- 6.6 kg/m2, and 63.5% of patients identified themselves as female. The mean follow-up was 6.2 +- 4.4 months. In addition to undergoing fixation of the lateral malleolus, 21 patients also underwent fixation of the posterior malleolus, 27 underwent fixation of the medial malleolus, 29 underwent fixation across the syndesmosis, and seven underwent repair of the deltoid. In all patients, bony anatomic union of the fibula and congruence of the mortise were achieved, with no cases of malunion or nonunion. Conclusion: Routine fixation of Weber B fibula fractures with a lateral locking plate and no lag screw is an alternative method to treat Weber B fibula fractures with excellent radiographic results.

Category: Ankle, Ankle Arthritis, Trauma Introduction/Purpose: It is important to understand which isolated fibular fractures require surgical intervention. Several different radiographic guidelines have been used to interpret and predict stability of the injured ankle. Holmes et al previously described a novel algorithm used to assess stability and the ability to treat the stable injuries non-operatively. The one year results demonstrated favorable outcomes of these non-operative patients, however there is a question about the durability of these results and whether these patients developed post-traumatic degenerative changes over mid to long term follow up. Methods: An observational study based on a previous cohort of 51 patients studied from 2010 to 2013 with isolated Weber B ankle fractures was performed. These were defined as stable at the time of injury when the medial clear space (MCS) was less than 7 mm on the initial gravity stress radiographs along with a normal mortise relationship on weight bearing radiographs. 27 patients that were treated non-surgically, were brought back for a mid-term follow up with a mean of 6.8 years. American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot scores, Olerud-Molander Ankle (OMA) Score, and visual analog scale (VAS) pain score were collected in accordance with the prior study. Patient Reported Outcome Measurement Information System (PROMIS) scores were also collected including lower extremity, physical function, depression, and pain interference. Standing bilateral ankle radiographs were obtained, and assessed for MCS widening, and ankle arthritis using the Kellgren-Lawrence grading scale. Results: Average functional score results were (in comparison to 1-year outcomes): AOFAS Hindfoot, 95.7 (93.2); OMA Score, 95.2 (91.0); and visual analog scale pain score, 0.24 (0.57). Using a Wilcox Signed Ranks Test, there was a statistically significant increase in 5-year AOFAS Hindfoot scores as compared to 1-year scores in those same patients (p=0.005) There was no evidence of significant post-traumatic osteoarthritis based on the Kellgren-Lawrence grading scale. Conclusion: The previously described, novel at the time, algorithm for assessing stability of isolated Weber B ankle fractures and nonsurgical treatment with protected weight bearing has shown to produce excellent results for mid-term follow up with an average of 6.8 years. Additionally, these patients are not at increased risk for rapid progression of post-traumatic osteoarthritis. This further supports initial weight bearing radiographs as a reasonable assessment of ankle stability and validates the aforementioned algorithm as a safe and cost-effective functional treatment regimen.

Category: Ankle, Trauma Introduction/Purpose: The diagnosis of medial ankle instability in Weber B ankle fractures remains controversial. Manual stress radiographs are considered by many to be the gold standard to assess deltoid ligament integrity (Tornetta 2000). Gravity stress examinations have been shown to be equivalent (Gill 2007, Schock 2007), and also offer the advantage of causing less patient discomfort (Schock 2007). Significant fibular displacement likely serves as a surrogate for the large amount of energy required to tear the deltoid ligament. Therefore, the purpose of this study was to determine the relationship between initial fibular displacement and medial clear space widening on a gravity stress radiograph. Methods: A retrospective review was conducted of all patients with isolated Weber B ankle fractures with both initial injury radiographs and gravity stress view from August 1st, 2014 through April 1st, 2016. A total of 17 subjects were identified, age 42.6±17 years, time to GSV 4.6±5 days. On the mortise view of injury radiographs, medial clear space (MCS), superior clear space (SCS), lateral fibular displacement (LFDP) and fibular shortening (FS) were measured, and on the lateral view, anterior to posterior fibular gap (A to P FG) was measured. The gravity stress view was used to measure the medial clear space widening (MCS-W). All statistical analysis was performed using Stata (College Station, TX). T-tests were used to calculate mean and standard deviation of each group, correlation and linear regression analyses were run with each displacement variable relative to MCS-W. ROC analysis was used to determine sensitivity and specificity of the displacement variables. Results: Strong significant correlations with MCS-W were found for LFDP (0.69, p=0.003), and A to P FG (0.72, p=0.001), but not with FS (0.34, p=0.18). Linear regression analysis revealed significant ability to predict MCS-W for both LFDP (coefficient=1.12, R2=0.48, p=0.002) and A to P FG (coefficient=2.57, R2=0.52, p=0.001) but not FS (coefficient=0.67, R2=0.11, p=0.18). When LFDP and A to P FG were combined, they accounted for 65% of the variability in MCS-W (coefficient=0.70, 1.76; R2=0.65, p=0.033, p=0.018). ROC analysis for A to P FG using cutoff values of 0.75 mm, 1.0 mm, and 1.25 mm yielded SN and SP of 100% and 75%, 100% and 100%, and 67% and 100%, respectively for each cut point. Conclusion: The initial fibular displacement is a strong predictor of medial clear space widening in Weber B ankle fractures. On lateral radiographs, an anterior to posterior fibular gap greater than 1.0 mm showed a sensitivity and specificity of 100% in predicting MCS-W=5.0 mm. This provides another tool to aid clinicians in determining the integrity of the deltoid ligament and may help prevent the need for further patient discomfort with a stress view.

Background: Diabetes is a risk factor for complications related to displaced ankle fractures. Limited literature exists comparing complication rates in nonoperative versus operative treatment of displaced ankle fractures in diabetics. No study has highlighted the natural history of nonoperative treatment of displaced ankle fractures in diabetics. Methods: We retrospectively reviewed all adult ankle fractures from September 2011 through December 2014. Inclusion was limited to ambulatory adults (>18 years) with closed, displaced (widened mortise) ankle fractures with diabetes mellitus. Nonoperative treatment consisted of closed reduction and casting. Fractures were classified according to the Lauge-Hansen and AO-Weber classification systems. All operative fractures underwent open reduction internal fixation (ORIF) within 3 weeks of injury. Functional outcomes and complication rates were compared. Of 28 displaced diabetic ankle fractures, 20 were treated nonoperatively (closed reduction and casting) and 8 operatively (ORIF within 3 weeks of injury). Mean follow-up was 7 months (range 3-18 months). Results: Age, insulin-dependent diabetes, and AO type B fracture rate were similar in nonoperative and operative cohorts, but fracture dislocation rate was significantly higher among operative fractures (87.5% vs 40%; P = .04). Nonoperative treatment was associated with a 21-fold increased odds of complication compared with operative treatment (75% vs 12.5%, OR 21.0, P = .004). Complication rate following unintended ORIF for persistent nonunion or malunion in nonoperatively treated patients was significantly greater compared with immediate ORIF (100% vs 12.5%, P = .005). Conclusion: Nonoperative treatment of displaced diabetic ankle fractures was associated with unacceptably high complication rates when compared to operative treatment. Level of Evidence: Level III, retrospective comparative series.

Category: Ankle; Basic Sciences/Biologics; Trauma Introduction/Purpose: Supination-external rotation (SER) injuries make up 80% of all ankle fractures. SER stage 2 injuries (AITFL and Weber B) are considered stable. SER stage 3 injury includes disruption of the posterior malleolus (or PITFL). In SER stage 4 there is either medial malleolus fracture or deltoid injury. SER 4 injuries have been considered unstable, requiring surgery. The deltoid ligament is a key component of ankle stability, but clinical tests to assess deltoid injury have low specificity. This biomechanical cadaveric study specifically investigates the role of the components of the deep deltoid ligament in the stabillity of SER ankle fractures. Methods: In the first phase of the study, three specimens were utilised to standardise dissection of the deltoid ligament and creation and fixation of SER ankle fracture. In phase two, four matched pairs (8 specimens) were tested using this standardised protocol (Figure1). Specimens were sequentially tested for stability when axially loaded with a custom rig with up to 750N. Specimens were tested with: ankle intact; lateral injury (AITFL and Weber B); additional posterior injury (PITFL); additional anterior deep deltoid; additional posterior deep deltoid; lateral side ORIF. Clinical photographs and radiographs were recorded at each stage. In addition, dynamic stress radiographs were performed after sectioning the deep deltoid and following fracture fixation to assess talar tilt in eversion. Results: All specimens behaved in an identical manner when subjected to this standardised protocol. When the posterior deep deltoid ligament was intact, the ankle remained stable when loaded and showed no talar tilt on dynamic stress test. Once the posterior deep deltoid ligament was sectioned, there was demonstrable instability in all specimens. Surgical stabilisation of the lateral side using standard technique with a plate prevented talar shift but not talar tilt. In adequately stabilised ankle specimens, there was no loss of fixation on axial loading. Conclusion: This biomechanical cadaveric experiment demonstrates that under the standardised test conditions, all SER fracture ankle specimens with an intact posterior deep deltoid ligament behaved as stable injuries. The posterior portion of the deep deltoid ligament is a crucial structure in conferring stability to SER stage 4 injuries. The clinical implication of this is that when the posterior deep deltoid ligament is intact, SER fractures may be managed without surgical intervention in a plantigrade cast. We also conclude that without immobilisation, the talus may tilt in the mortise risking long-term deltoid incompetence.

Category: Ankle, Sports, Trauma Introduction/Purpose: The ankle Medial Clear Space (MCS) is frequently used in foot and ankle surgery for determining the competence of the deltoid ligament in Weber B ankle fractures. A widened MCS indicates deltoid ligament incompetence, requiring surgery to prevent lateral talar shift. Controversy still exists regarding Medial Clear Space (MCS) normal and abnormal values, and its possible variation in previously uncontrolled biases. Sex, height, foot position, and type of radiograph were all described as possible influencing factors. The objective of this study was to access how much different degrees of plantar flexion, all performed with and without stress, influence on MCS width. Methods: We submitted 30 volunteers to six different anteroposterior non-weight bearing digital radiographs of the ankle in the following positions: neutral, neutral with external rotation stress, physiologic plantar flexion (FPF), physiologic plantar flexion with external rotation stress, maximum plantar flexion (MPF) and maximum plantar flexion with external rotation stress. The medial clear space MCS oblique (MCSo) and perpendicular (MCSp) were measured in all images by an experienced foot and ankle surgeon. Results: The data analysis showed with statically significance that the position of the foot does influence in the value of both MCSp and MCSo (p<0,05), regardless of three exceptions. MCSo does not change statistically between FPF with stress and MPF with stress. On the other hand, MCSp did not change in two situations: between FPF and Neutral with stress and between MPF and FPF with stress. It is noteworthy that MCSo, on average, was 15% wider than MCSp in all positions tested. It is also noticeable that, from the neutral position, plantar flexing the ankle has a great impact on MCS than external rotation stress, increasing MCSp by 25% and 22% respectively. MCSo follows the same pattern, with 21% and 17% respectively. Conclusion: This study is unique on showing that many different ways of positioning the foot and making stress radiographs do result in completely different MCS values, and that these values differ depending on the anatomical site they are measured. All these data indicates that we need to establish a gold standard for measuring MCS, taking into account patient sex, height, local of measurement of MCS, position of the foot and type of radiograph (AP or Mortise). This study was not able to address all variables that influence directly on MCS and therefore did not intended to establish this new gold standard.

Category: Ankle Arthritis Introduction/Purpose: The incidence of fibula fractures continues to increase. The exact incidence of distal fibula malunions after fibular reconstructions is not known, but incidence up to 33% is described in the literature. The most frequent malunions of the fibula are shortening and malrotation, resulting in the widening of the ankle mortise and talar instability. It has been demonstrated that substantial fibular displacement may substantially increase the contact pressures in the ankle joint. Therefore distal fibular malunion is a risk factor for development of posttraumatic ankle osteoarthritis. The objectives of this study were to (1) describe our treatment algorithm and surgical technique in patients with posttraumatic fibula malunions; (2) determine intra- and postoperative complications rates, (3) to describe mid-term clinical and radiological outcomes and quality of life. Methods: 21 consecutive patients (12 male, 9 female, mean age 42 years) with symptomatic fibular malunions were included into this prospective study. The initial injury was Weber B and C fracture in 7 and 14 ankles. The mean time between the injury and reconstructive surgery was 17.5 months. In all patients a z-shaped osteotomy of the fibula was performed to achieve the appropriate length/rotation of the fibula. Fixation was performed using a plate. If necessary, supramalleolar and inframalleolar deformities were corrected by supramalleolar tibial and calcaneal osteotomies, respectively. Prior to the osteotomies an anterior ankle arthroscopy was performed in all patients. All patients were evaluated pre- and postoperatively (mean follow-up 5.6 years). Radiological outcomes were assessed using standardized weight-bearing radiographs. Clinical outcomes were assessed using visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale, SF-36 questionnaire. Results: There were no intraoperative complications. In two patients early wound healing problems were observed, and resolved with i.v. antibiotics. Osseous healing was observed in all ankles within 10 weeks after surgery. The length and rotation of the fibula was improved in all patients, according to Weber criteria. All patients experienced significant pain relief (VAS: 6.5 ± 1.1 to 1.1 ± 0.9, P < 0.001) and functional improvement (AOFAS hindfoot scale: 47.1 ± 14.5 to 85.0 ± 7.5, P < 0.001; ROM:37° ± 6° to 45° ± 5°, P < 0.001). The SF-36 score also significantly increased in all 8 subgroups. In 11 patients hardware was removed due a discomfort after a mean of 11.7 months (range 7.2 – 22.8). Conclusion: A z-shaped osteotomy is an efficient and successful method to restore fibula length and rotation in patients with posttraumatic malunion. Our findings in this series of 19 ankles confirm that this realignment surgery results in significant pain relief and functional improvement.

Abstrak: Secara umum penelitian ini bertujuan untuk mendeskripsikan tentang kepemimpinan kepala sekolah perempuan di SMP Kristen Palangka Raya. Penelitian ini merupakan penelitian kualitatif dengan rancangan studi kasus. Prosedur pengumpulan data menggunakan observasi, wawancara mendalam dan studi dokumentasi. Analisis data menggunakan pola interaktif data. Pengecekan keabsahan data dilakukan dengan metode triangulasi dan member check. Hasil penelitian menunjukkan bahwa efektivitas kepemimpinan dalam mewujudkan sekolah efektif bukan ditentukan oleh karakteristik gender. Kunci keberhasilan kepala sekolah perempuan dalam mewujudkan sekolah efektif ditentukan oleh kemampuannya dalam merancang dan merealisasikan visi dan misi serta tujuan sekolah serta kemampuanya dalam mengelola sekolah dengan efektif melalui pendayagunaan seluruh potensi yang dimiliki sekolah serta jalinan kerjasama yang sinergis dengan stakeholders sekolah.
 Abstract: In general, this study aims to describe the leadership of the female school principal at Palangka Raya Christian Middle School. This research is a qualitative research with a case study design. Data collection procedures using observation, in-depth interviews and study of documentation. Data analysis using interactive data patterns. Data validity was checked by triangulation and member check methods. The results showed that the effectiveness of leadership in realizing effective schools was not determined by gender characteristics. The key to the success of female school principals in realizing an effective school is determined by their ability to design and realize the vision and mission and goals of the school as well as their ability to manage schools effectively through the utilization of all the potential of the school as well as synergistic collaboration with school stakeholders.
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Considering a sociocultural perspective, the role of language in the teaching and learning process in Chemistry goes beyond a simple vehicle for the transfer of information, such as names of substances, laboratory glassware and formulas. This new reading of the role of language in the process of teaching and learning is anchored in Vygostsky's studies, which emphasizes the importance of the social and cultural nature of mental activities. The Tomasello's ideas can clarify the discussion about cultural processes at the origin of language acquisition. For this discussion, in the form of a theoretical essay, from contemporary readings of these authors, some approximations between their ideas are established, highlighting some implications on language in the teaching and learning process in Chemistry, such as: i) students need to participate in their own acquisition of the scientific language; (ii) this acquisition is not through memorization, but through problematization, and (iii) teachers must recognize how students are perceiving that language and not simply consider it as already acquired. However, this debate on the new role of language must be investigated by researchers in the field, since in addition to the difficulties pointed out in this essay, the nominalization process and the grammatical metaphor, for example, are important sources of difficulties found in the acquisition of scientific language.Resumo A partir de uma perspectiva sociocultural, o papel da linguagem no processo de ensino e aprendizagem em Química ultrapassa a característica de um simples veículo para a transferência de informações, como por exemplo, nomes de substâncias, vidrarias de laboratório e fórmulas. Neste contexto, o papel da linguagem no processo de ensino e aprendizagem baseado nos estudos de Vigostski ressalta a importância da natureza social e cultural das atividades mentais. E, a inserção das ideias de Tomasello enriquece a discussão dos processos culturais no desenvolvimento da aquisição da linguagem. Para essa discussão, em forma de ensaio teórico, a partir de leituras contemporâneas desses autores, são estabelecidas algumas aproximações entre suas ideias. A apresentação dessas semelhanças permite clarear o entendimento dos professores acerca do novo papel da linguagem, além de enfatizar implicações importantes relacionadas ao processo de ensino e aprendizagem em Química, tais como: i) os estudantes precisam participar de sua própria aquisição da linguagem científica; ii) essa aquisição pode ser mais efetiva pela problematização, e não pela memorização e, iii) os professores devem reconhecer como os estudantes estão percebendo essa linguagem, e não, simplesmente, considerá-la como já adquirida. No entanto, esse debate sobre o novo papel da linguagem deve seguir adiante pelos pesquisadores da área, visto que, além das dificuldades apontadas neste ensaio, há de se considerar que, o processo de nominalização e a metáfora gramatical, por exemplo, são fontes importantes de dificuldades para a aquisição da linguagem científica.ResumenDesde de una perspectiva sociocultural, el papel del lenguaje en el proceso de enseñanza y aprendizaje en Química excede la característica de un vehículo para la transferencia de informaciones, como por ejemplo nombres de sustancias, vidriería de laboratorio y fórmulas. En este contexto, el papel del lenguaje en el proceso de enseñanza y aprendizaje se ancla en los estudios de Vygostsky, que resalta la importancia de la naturaleza social y cultural de las actividades mentales. Y la inserción de las ideas de Tomasello enriquece la discusión de los procesos culturales en el desarrollo de la adquisición del lenguaje. Para esta discusión, en forma de ensayo teórico, a partir de lecturas contemporáneas de esos autores, se establecen algunas aproximaciones entre sus ideas. La presentación de estas semejanzas permite clarificar el entendimiento de los profesores acerca del nuevo papel del lenguaje, además de enfatizar implicaciones importantes relacionadas al proceso de enseñanza y aprendizaje en Química, tales como: i) los estudiantes necesitan participar de su propia adquisición del lenguaje científico; ii) esa adquisición puede ser más efectiva por la problematización, no por la memorización y, iii) los profesores deben reconocer cómo los estudiantes están percibiendo ese lenguaje, y no, simplemente, considerarla como ya adquirida. Sin embargo, este debate sobre el nuevo papel del lenguaje debe seguir adelante por investigadores del área de Educación, ya que, además de las dificultades señaladas en este ensayo, hay que considerar que el proceso de nominalización y la metáfora gramatical, por ejemplo, son fuentes importantes de dificultades para la adquisición del lenguaje científico.Keywords: Sociocultural perspective, Chemistry Education, Language.Palabras clave: Perspectiva sociocultural, Educación Química, Lenguaje.Palavras-chave: Abordagem sociocultural, Educação em Química, Linguagem.ReferencesÁLLAN, S.; Souza, C. B. A. O modelo de Tomasello sobre a evolução cognitivo-linguística humana. Psicologia: Teoria e Pesquisa, v. 25, n. 2, p. 161-168, 2009.CHILDS, P. E.; MARKIC, S.; RYAN, M. C. The role of language in the teaching and learning of Chemistry. In: GARCÍA-MARTÍNEZ, J.; SERRANO-TORREGROSA, E. (Eds.). Chemistry Education: Best Practices, Opportunities and Trends. Weinheim: Wiley-VCH Verlag GmbH & Co, 2015. Cap. 17. p. 421-445.DRIVER, R.; ASOKO, H.; LEACH, J.; MORTIMER, E.; Scott, P. Constructing scientific knowledge in the classroom. Educational Researcher, v. 23, n. 7, p. 5-12, 1994.HALLIDAY, M.A.K. Some grammatical problems in scientific English. In: Halliday, M. A. K.; MARTIN, J. R. Writing science. London: Falmer Press, 1993.HODSON, D. Teaching and learning science: towards a personalized approach. Berkshire, UK: Open University Press, 1998.JACOB, C. Interdependent operations in chemical language and practice. HYLE–International Journal for Philosophy of Chemistry, v. 7, n. 1, p. 31-50, 2001.KOKKOTAS, Panagiotis V.; RIZAKI, Aikaterini A. Does history of science contribute to the construction of knowledge in the constructivist environments of learning? In: KOKKOTAS, Panagiotis V.; MALAMITZA, Katerina S.; RIZAKI, Aikaterini A. (Eds.). Adapting historical knowledge production to the classroom. Rotterdam: Sense Publishers, 2011. Cap. 5, p. 61-84.LABINGER, Jay A.; WEININGER, Stephen J. Controversy in chemistry: how do you prove a negative? – The cases of Phlogiston and Cold Fusion. Angewandte Chemie International Edition, v. 44, p. 1916-1922, 2005.MARKIC, S.; CHILDS, P. E. How to deal with linguistic issues in chemistry classes. In: Eilks, I.; Hofstein, A. (Eds). Teaching chemistry: a study book. Rotterdam: Sense Publishers, 2013. Cap. 5. p 127-152.MARKIC, S.; CHILDS, P. E. Language and teaching and learning of chemistry. Chemistry Education Research and Practice, v. 17, p. 434-438, 2016.MORTIMER, E. F. Construtivismo, mudança conceitual e ensino de Ciências: para onde vamos? Investigações em Ensino de Ciências, v. 1, n. 1, p. 20-39, 1996.MORTIMER, E. F.; SCOTT, P. Atividade discursiva nas salas de aula de Ciências: uma ferramenta sociocultural para analisar e planejar o ensino. Investigações em Ensino de Ciências, v .7, n. 3, p. 283-306, 2002.MORTIMER, E. F. Linguagem e formação de conceitos no ensino de Ciências. Belo Horizonte: Editora UFMG, 2011. 373 p.MORTIMER, E. F.; SCOTT, p.; EL-HANI, C. N. Bases teóricas e epistemológicas da abordagem dos perfis conceituais. Tecné, Episteme y Didaxis, n. 30, p. 111-125, 2011.MORTIMER, E. F.; EL-HANI, C. N. Uma visão sócio-interacionista e situada dos conceitos e a internalização em Vygotsky. In: IX ENCONTRO NACIONAL DE PESQUISA EM EDUCAÇÃO EM CIÊNCIAS, 2013, Águas de Lindóia. Anais... São Paulo: IX ENPEC, 2013. p. 1-9.PEREIRA, A. P. Distribuição conceitual no Ensino de Física Quântica: uma aproximação sociocultural às teorias de mudança conceitual. 2012. 210f. Tese (Doutorado em Ensino de Física) – Instituto de Física, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, 2012.TABER, K. S. Exploring the language(s) of chemistry education. Chemistry Education Research and Practice, v. 16, p. 193-197, 2015.TOMASELLO, M. Origens culturais da aquisição do conhecimento humano. Martins Fontes: São Paulo, 2003.VIGOTSKI, L. S. A formação social da mente: o desenvolvimento dos processos psicológicos superiores. 5. ed. São Paulo: Martins Fontes, 1994.VYGOTSKY, L. S. The genesis of higher mental functions. In: WERTSCH, J. V. (Ed.). The concept of activity in Soviet psychology, Armonk, NY: Sharpe, 1931/1981. p. 144-188.WELLS, G. Learning and teaching “scientific concepts”: Vygotsky’s ideas revisited. Conference, “Vygotsky and the Human Sciences”, Moscow, Sept. 1994.WERTSCH, J. V. Vygotsky y la formacion social de la mente. Barcelona: Ediciones Paidós, 1988.WOCH, J. The language of chemistry: A study of English chemical vocabulary. Beyond Philology, v. 12, p. 77-108, 2015.

Background:Prior to treatment decisions concerning isolated Weber type B ankle fractures, assessment of the stability of the ankle joint is mandatory. The gravity stress (GS) radiograph is a radiographic tool to determine stability. We hypothesized that this additional GS radiograph would lead to fewer operative treatments by applying the criterion of operative treatment when medial clear space (MCS) > superior clear space (SCS) + 2 mm on the GS radiograph, compared with the nonstressed mortise view criteria of advising operative treatment in case of MCS > SCS + 1 mm.Methods:This retrospective comparative cohort study analyzed 343 patients aged between 18 and 70 years with an isolated Weber type B ankle fracture diagnosed at the emergency department between January 2014 and December 2019. The cohort was divided into 2 groups based on whether an additional GS radiograph was performed. Group I consisted of 151 patients in whom a regular mortise and lateral radiograph were performed. Group II comprised 192 patients, with an additional GS radiograph. Primary outcome was type of treatment (conservative vs operative). Secondary outcomes were patient-reported functional outcomes and pain.Results:Baseline characteristics of both groups did not differ. In group I, surgery was performed in 60 patients (39.7%) compared with 108 patients (56.3%) in group II ( P = .002). In the operatively treated patients, the mean MCS on regular mortise view was significantly smaller in patients in whom an additional GS radiograph was performed compared to patients without an additional GS radiograph (4.1 mm vs 5.2 mm, P < .001). Mean Olerud-Molander Ankle Score and mean visual analog scale (VAS) for pain did not differ significantly between groups I and II.Conclusions:Contrary to what was hypothesized, the introduction of an additional gravity stress radiograph, by which operative treatment was indicated if the MCS was wider than the SCS + 2 mm, did not result in reduced operative treatment of Weber type B ankle fractures when operative treatment was indicated for MCS > SCS + 1 mm on non-gravity stress radiographs.Level of Evidence:Level III: retrospective comparative study.

AbstractObjectiveTo determine whether treatment of isolated stable Weber B type ankle fractures with a cast or a simple orthotic device for three weeks produces non-inferior outcomes compared with conventional immobilisation in a cast for six weeks.DesignRandomised, pragmatic, non-inferiority, clinical trial with blinded outcome assessment.SettingTwo major trauma centres in Finland, 22 December 2012 to 6 June 2016.Participants247 skeletally mature patients aged 16 years or older with an isolated Weber B type fibula fracture and congruent ankle mortise in static ankle radiographs.InterventionsParticipants were randomly allocated to conventional six week cast immobilisation (n=84) or three week treatment either in a cast (n=83) or in a simple orthosis (n=80).Main outcome measuresThe primary, non-inferiority, intention-to-treat outcome was the Olerud-Molander Ankle Score at 12 months (OMAS; range 0-100; higher scores indicate better outcomes and fewer symptoms). The predefined non-inferiority margin for the primary outcome was −8.8 points. Secondary outcomes were ankle function, pain, quality of life, ankle motion, and radiographic outcome. Follow-up assessments were performed at 6, 12, and 52 weeks.Results212 of 247 randomised participants (86%) completed the study. At 52 weeks, the mean OMAS was 87.6 (SD 18.3) in the six week cast group, 91.7 (SD 12.9) in the three week cast group, and 89.8 (SD 18.4) in the three week orthosis group. The between group difference at 52 weeks for the three week cast versus six week cast was 3.6 points (95% confidence interval −1.9 to 9.1, P=0.20), and for the three week orthosis versus six week cast was 1.7 points (−4.0 to 7.3, P=0.56). In both comparisons, the confidence intervals did not include the predefined inferiority margin of −8.8 points. The only statistically significant between group differences observed in the secondary outcomes and harms in the two primary comparisons were slight improvement in ankle plantar flexion and incidence of deep vein thrombosis, both in the three week orthosis group versus six week cast group.ConclusionImmobilisation for three weeks with a cast or orthosis was non-inferior to conventional cast immobilisation for six weeks in the treatment of an isolated stable Weber B type fracture.Trial registrationClinicalTrials.govNCT01758835.

Introduction: Ankle injuries comprise a major group of lower limb trauma. Many of these injuries can be treated by manipulative reduction and conservative treatment and some of these yield satisfactory results, so present study was undertaken to know the effectiveness of surgical management of ankle fractures. Method: 42 surgically treated displaced fractures are included and studied in detail of age, sex, occupation, type of fracture, mode of injury, type of treatment, Clinical evidence of fracture union, Radiological evidence of fracture union, Relation of talus in the ankle mortise, Range of mobility of the ankle, Residual disability and pain, Ability to walk and time of return to duty and complications were noted. Result: 42 cases were surgically treated, most of the patients were operated on an emergency basis within 24 hours of injury. Based on the mechanism of injury Pronation- External Rotation (30.9%) and Based on Ao Classification Type B - B2 (53.3%) were the major type of fractures. In the majority of cases, Malleolar screws type of implants used. In overall the final status of patients is good (ability to walk). Conclusion: Displaced ankle fractures need accurate open reduction and internal fixation and postoperative immobilization for 6 weeks. This will suffice to get good results. Post-operative rigid immobilization and protected weight bearing for 12 weeks is minimal to achieve good union followed by physiotherapy to restore the maximum range of movements
 Keywords: Ankle Fractures; Surgical management, Stability; Effectiveness.

BACKGROUND: - The incidence of distal tibiofibular syndesmotic injury in ankle fractures is about 13%. The integrity of syndesmosis is a critical factor which stabilizes ankle mortise during weight-bearing besides load transmission. The primary purpose of the study was to assess the functional outcome in patients with Weber B and C fractures and to decide whether the syndesmotic screws are to be removed or not before weight-bearing. MATERIALS AND METHODS: - This was a prospective observational study involving patients (>18 years of age) who had undergone open reduction and internal fixation of an ankle fracture belonging to Weber B or C classification who had screw stabilization of a disrupted syndesmosis. The study period was three years commencing from August 2014. They were divided into two groups based on the syndesmotic screw retention or removal before weight-bearing. The patients were then regularly followed up with American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score and Visual Analogue Score-Foot and Ankle (VAS-FA) score were used to assess the functional outcome. Clinical and radiographic evaluations were done with each follow-up at 4,6,9,12 months. RESULTS: - We identified 32 fractures in 32 patients. Treatment undertaken was open reduction and internal fixation for the malleolli and syndesmotic screw fixation in all patients, and syndesmotic screws were removed in 17 and retained in 15. None of the patients were managed conservatively. We lost a patient to long-term follow-up. The AOFAS score was seen to be progressively increasing (92.3 – 96.75) and higher in the removed group as compared to retained. The VAS-FA score was also seen to be increasing besides being higher in the removed group (160.17 to 187). None of the patients failed the operative stabilization. Also, none of the patients had long-term complications like non-union, mal-union or screw back out excepting one patient who had persistent pain in the retained group. CONCLUSION: It is safe and better to remove the syndesmotic screw prior to weight bearing, when compared to retaining them insitu. Level of evidence IV-prognostic

This research report is based on a Master's Dissertation, whose objective was to analyze whether the CTS (Science, Technology and Society) approach and the EMC (Critical Mathematics Education) approach can contribute to the contextualized teaching of Mathematics. In the first stage, we carried out an analysis of Mathematics issues contemplated in the ENEM (National High School Examination), from 2012 to 2016, in order to investigate if these questions had in their context, questions pertinent to the CTS approach, as well as to examine if they would be related to other areas of knowledge, in an interdisciplinary approach. The ENEM was created in 1998 with the purpose of evaluating students' performance at the end of basic schooling, as well as verifying the fundamental competences for the full exercise of citizenship. This research is qualitative, of descriptive character, based on the content analysis of Bardin (2011). Among the 225 questions analyzed, we found that 62.2% do not have in their context the relation between Science and Technology with the Society or other areas of knowledge, nor do they allow questions that contribute to the critical formation of students for the exercise of citizenship. In the second moment, we carried out an Extension Course addressing the CTS approach and the EMC, directed to teachers who teach Mathematics. In this course, we use the analyzed issues of the ENEM as a teaching-learning tool to discuss possibilities of insertion of these approaches in the teaching of Mathematics. In this research report we will present the pertinent discussions to the first moment of the research, which are the analyzes of the ENEM questions.ResumoEste relato de pesquisa está embasado em uma Dissertação de Mestrado, que teve o objetivo de analisar se a abordagem CTS (Ciência, Tecnologia e Sociedade) e a EMC (Educação Matemática Crítica) podem contribuir para o ensino contextualizado da Matemática. No primeiro momento, realizamos uma análise das questões de Matemática contempladas no ENEM (Exame Nacional de Ensino Médio), no período de 2012 a 2016, a fim de investigar se essas questões possuíam em seu contexto, questionamentos pertinentes à abordagem CTS, bem como examinar se estariam relacionadas com outras áreas de conhecimento, em uma abordagem interdisciplinar. O ENEM foi criado em 1998 com o propósito de avaliar o desempenho dos estudantes ao final da escolaridade básica, além de verificar as competências fundamentais ao exercício pleno da cidadania. Esta pesquisa é qualitativa, de caráter descritivo, tendo como base a análise de conteúdo de Bardin (2011). Dentre as 225 questões analisadas, constatamos que 62,2% não possuem em seu contexto a relação da Ciência e da Tecnologia com a Sociedade ou com outras áreas de conhecimento, sequer possibilitam questionamentos que contribuam com a formação crítica dos estudantes para o exercício da cidadania. No segundo momento, realizamos um Curso de Extensão abordando o enfoque CTS e a EMC, direcionado a professores que ensinam Matemática. Neste curso, utilizamos as questões analisadas do ENEM como instrumento de ensino-aprendizagem para discutir possibilidades de inserção dessas abordagens no ensino de Matemática. Neste relato de pesquisa apresentaremos as discussões pertinentes ao primeiro momento da pesquisa, que são as análises das questões do ENEM.Palavras-chave: Ensino de matemática, Ciência e educação, Abordagem educacional, ENEM.Keywords: Mathematics education, Science and society, Interdisciplinary approach, College entrance examinations.ReferencesAULER, Décio; BAZZO, Walter A. Reflexões para a implementação do movimento CTS no contexto educacional brasileiro. Ciência & Educação, Bauru, v.7, n.1, p.1-13, 2001.AULER, Décio. Enfoque Ciência-Tecnologia-Sociedade: pressupostos para o contexto brasileiro. Ciência & Ensino, Campinas, v. 1, n. especial, p. 01-20, 2007.BARDIN, Laurence. Análise de conteúdo. Tradução Luís Antero Reto e Augusto Pinheiro. São Paulo: Edições 70, 2011, 229p.BAZZO, Walter A., et al. Introdução aos estudos CTS Ciência, Tecnologia e Sociedade. Cadernos de Ibero-América, Editora OEI, 2003, 170p.BORBA, Marcelo C.; SKOVSMOSE, Ole. A Ideologia da Certeza em Educação Matemática. Educação Matemática Crítica: a questão da democracia. Campinas: Papirus, 2001. p. 127-148.BRASIL. Exame nacional do ensino médio. Portaria Ministerial nº. 438, de 28 de maio de 1998. Brasília, MEC, 1998.BRASIL. Parâmetros curriculares nacionais: Ensino Médio: Bases Legais. Brasília: MEC, 2000. p.109.BRASIL. Parâmetros curriculares nacionais: Ensino Médio: Ciências da Natureza, Matemática e suas Tecnologias. Brasília: MEC, 2000. 58 p.BRASIL. Parâmetros curriculares nacionais + (PCN+) - ciências da natureza e suas tecnologias. Brasília: MEC, 2002.BRASIL. Exame nacional do ensino médio no exercício de 2009. Diário Oficial da União, Brasília, DF, 28 maio 2009. Seção 1, n. 100, p. 56.BRASIL. ENEM - Exame nacional do ensino médio: documento básico. Inep. Brasília, 2002. Disponível em: http://www.inep.gov.br/. Acesso em janeiro de 2019.D’AMBROSIO, Ubiratan. Educação matemática, tecnologia e sociedade. Conferência no VII EPREM, Foz do Iguaçu, 21-24/11/2002. Disponível em < http://www.sbemparana.com.br/arquivos/anais/epremvii/palestras/palestra_de_abertura.pdf> Acesso em: 26 de abril de 2018.D’AMBROSIO, Ubiratan. Tendências e perspectivas historiográficas e novos desafios na história da matemática e na educação matemática. Educação Matemática e Pesquisa. São Paulo, v.14, n.3, p.336-347, 2012.FREIRE, Paulo. Pedagogia da autonomia: saberes necessários à prática educativa. São Paulo: Paz e Terra, 1996.GUAZELLI, Iara R B, et. al. Alfabetização científica crítica e cultura em uma perspectiva CTSA. In: AMARAL, Carmen Lúcia Costa; CURI , Edda (orgs). Pesquisas e Práticas de Ensino em Química & Biologia. São Paulo: Terracota, 2009, p.12-41.MACHADO, Renato Q. Ciência, Tecnologia, Sociedade/ CTS na formulação de questões de matemática do Exame Nacional do Ensino Médio (2009-2011): quais são as referências de contextualização? 2012. 169p. Dissertação de Mestrado em Educação - Universidade Metodista de Piracicaba, Piracicaba, 2012.PINHEIRO, Nilcéia A. M. Educação crítico-reflexiva para um ensino médio científico-tecnológico: a contribuição do enfoque CTS para o ensino-aprendizagem do conhecimento matemático. 2005. 305p. Tese de Doutorado em Educação Cientifica e Tecnológica - Universidade Federal de Santa Catarina, Florianópolis, 2005.PINHEIRO, Nilcéia A.M.; BAZZO, Walter. Caso simulado no ensino-aprendizagem de matemática: ensinar sob uma abordagem crítica. Bolema, Rio Claro, n. 32, p.101-122, 2009.SANTOS, Wildson L. P.; MORTIMER, Eduardo F. Uma análise de pressupostos teóricos da abordagem CTS (Ciência-Tecnologia-Sociedade) no contexto da educação brasileira. Ensaio Pesquisa em Educação e Ciências, Belo Horizonte, v. 2, n. 2, p. 110-132, dezembro 2000.SANTOS, Wildson L. P. Contextualização no ensino de ciências por meio de temas cts em uma perspectiva crítica. Ciência & Ensino, Campinas, vol. 1, número especial, novembro 2007.SASSERON, Lucia H.; CARVALHO, Anna M. P. de. Alfabetização científica: uma revisão bibliográfica. Investigações em Ensino de Ciências – vol.16, n.1, p. 59-77, março 2011.SBRANA, Maria de F. C. A contextualização da matemática a partir da abordagem cts na perspectiva da educação matemática crítica. 2017. 145p. Dissertação de Mestrado em Ensino e História de Ciências e Matemática - Universidade Federal do ABC, Santo André, 2017.SKOVSMOSE, Ole. Educação Matemática Crítica: a questão da democracia. Campinas: Papirus, 2001, Coleção Perspectivas em Educação Matemática, SBEM, 160 p.SKOVSMOSE, Ole. Desafios da reflexão em educação matemática crítica. Campinas: Papirus, 2008, 144p.SKOVSMOSE, Ole. Ole Skovsmose e sua educação matemática crítica. Revista Paranaense de Educação Matemática. Campo Mourão, Paraná, v.1, n.1, jul-dez. 2012. Entrevista concedida a Amauri Jersi Ceolim; Wellington Hermann.

In PilsenTwenty-six Station Road,She climbed to the third floorUp stairs which were all that was leftOf the whole house,She opened her doorFull on to the sky,Stood gaping over the edge.For this was the placeThe world ended.Thenshe locked up carefullylest someone stealSiriusor Aldebaranfrom her kitchen,went back downstairsand settled herselfto waitfor the house to rise againand for her husband to rise from the ashesand for her children’s hands and feet to be stuck back in placeIn the morning they found herstill as stone, sparrows pecking her hands.Five Minutes after the Air Raidby Miroslav Holub(Calder 287) Holding Still Detonation. Affect. During the Second World War, London and other European cities were subjected to the terrors of aerial bombardment, rendered through nightmarish anticipations of the bomber (Gollin 7) and the material storm of the real air-raid. The fall of bombs plagued cities and their citizens with the terrible rain of explosives and incendiary weapons. A volatile landscape was formed as the urban environment was ‘unmade’ and urged into violent motion. Flying projectiles of shrapnel, debris and people; avalanches of collapsing factories and houses; the inhale and exhale of compressed air and firestorms; the scream of the explosion. All these composed an incredibly fluid urban traumatic, as atmospheres fell over the cities that was thick with smoke, dust, and ventilated only by terror (see for instance Sebald 10 and Mendieta’s 3 recent commentary). Vast craters were imprinted onto the charred morphologies of London and Berlin as well as Coventry, Hamburg and Dresden. Just as the punctuations of the bombing saw the psychic as well as the material give way, writers portraying Britain as an ‘volcano island’ (Spaight 5) witnessed eruptive projections – the volleys of the material air-war; the emotional signature of charged and bitter reprisals; pain, anguish and vengeance - counter-strikes of affect. In the midst of all of this molten violence and emotion it seems impossible that a simultaneous sense of quiescence could be at all possible. More than mere physical fixity or geographical stasis, a rather different sort of experience could take place. Preceding, during and following the excessive mobilisation of an air raid, ‘stillness’ was often used to describe certain plateuing stretches of time-space which were slowed and even stopped (Anderson 740). Between the eruptions appeared hollows of calm and even boredom. People’s nervous flinching under the reverberation of high-explosive blasts formed part of what Jordan Crandall might call a ‘bodily-inclination’ position. Slackened and taut feelings condensed around people listening out for the oncoming bomber. People found that they prepared for the dreadful wail of the siren, or relaxed in the aftermath of the attack. In these instances, states of tension and apprehension as well as calm and relief formed though stillness. The peculiar experiences of ‘stillness’ articulated in these events open out, I suggest, distinctive ways-of-being which undo our assumptions of perpetually fluid subjectivities and the primacy of the ‘body in motion’ even within the context of unparalleled movement and uncertainty (see Harrison 423 and also Rose and Wylie 477 for theoretical critique). The sorts of “musics of stillness and silence able to be discovered in a world of movement” (Thrift, Still 50), add to our understandings of the material geographies of war and terror (see for instance Graham 63; Gregory and Pred 3), whilst they gesture towards complex material-affective experiences of bodies and spaces. Stillness in this sense, denotes apprehending and anticipating spaces and events in ways that sees the body enveloped within the movement of the environment around it; bobbing along intensities that course their way through it; positioned towards pasts and futures that make themselves felt, and becoming capable of intense forms of experience and thought. These examples illustrate not a shutting down of the body to an inwardly focused position – albeit composed by complex relations and connections – but bodies finely attuned to their exteriors (see Bissell, Animating 277 and Conradson 33). In this paper I draw from a range of oral and written testimony archived at the Imperial War Museum and the Mass Observation wartime regular reports. Edited publications from these collections were also consulted. Detailing the experience of aerial bombing during the Blitz, particularly on London between September 1940 to May 1941, forms part of a wider project concerning the calculative and affective dimensions of the aeroplane’s relationship with the human body, especially through the spaces it has worked to construct (infrastructures such as airports) and destroy. While appearing extraordinary, the examples I use are actually fairly typical of the patternings of experience and the depth and clarity with which they are told. They could be taken to be representative of the population as a whole or coincidentally similar testimonials. Either way, they are couched within a specific cultural historical context of urgency, threat and unparalleled violence.Anticipations The complex material geographies of an air raid reveal the ecological interdependencies of populations and their often urban environments and metabolisms (Coward 419; Davis 3; Graham 63; Gregory The Colonial 19; Hewitt Place 257). Aerial warfare was an address of populations conceived at the register of their bio-rhythmical and metabolic relationship to their milieu (Adey). The Blitz and the subsequent Allied bombing campaign constituted Churchill’s ‘great experiment’ for governments attempting to assess the damage an air raid could inflict upon a population’s nerves and morale (Brittain 77; Gregory In Another 88). An anxious and uncertain landscape constructed before the war, perpetuated by public officials, commentators and members of parliament, saw background affects (Ngai 5) of urgency creating an atmosphere that pressurised and squeezed the population to prepare for the ‘gathering storm’. Attacks upon the atmosphere itself had been readily predicted in the form of threatening gas attacks ready to poison the medium upon which human and animal life depended (Haldane 111; Sloterdijk 41-57). One of the most talked of moments of the Blitz is not necessarily the action but the times of stillness that preceded it. Before and in-between an air raid stillness appears to describe a state rendered somewhere between the lulls and silences of the action and the warnings and the anticipatory feelings of what might happen. In the awaiting bodies, the materialites of silence could be felt as a kind-of-sound and as an atmospheric sense of imminence. At the onset of the first air-raids sound became a signifier of what was on the way (MO 408). Waiting – as both practice and sensation – imparted considerable inertia that went back and forth through time (Jeffrey 956; Massumi, Parables 3). For Geographer Kenneth Hewitt, sound “told of the coming raiders, the nearness of bombs, the plight of loved ones” (When the 16). The enormous social survey of Mass Observation concluded that “fear seems to be linked above all with noise” (original emphasis). As one report found, “It is the siren or the whistle or the explosion or the drone – these are the things that terrify. Fear seems to come to us most of all through our sense of hearing” (MO 378). Yet the power of the siren came not only from its capacity to propagate sound and to alert, but the warning held in its voice of ‘keeping silent’. “Prefacing in a dire prolepsis the post-apocalyptic event before the event”, as Bishop and Phillips (97) put it, the stillness of silence was incredibly virtual in its affects, disclosing - in its lack of life – the lives that would be later taken. Devastation was expected and rehearsed by civilians. Stillness formed a space and body ready to spring into movement – an ‘imminent mobility’ as John Armitage (204) has described it. Perched on the edge of devastation, space-times were felt through a sense of impending doom. Fatalistic yet composed expectations of a bomb heading straight down pervaded the thoughts and feelings of shelter dwellers (MO 253; MO 217). Waves of sound disrupted fragile tempers as they passed through the waiting bodies in the physical language of tensed muscles and gritted teeth (Gaskin 36). Silence helped form bodies inclined-to-attention, particularly sensitive to aural disturbances and vibrations from all around. Walls, floors and objects carried an urban bass-line of warning (Goodman). Stillness was forged through a body readied in advance of the violence these materialities signified. A calm and composed body was not necessarily an immobile body. Civilians who had prepared for the attacks were ready to snap into action - to dutifully wear their gas-mask or escape to shelter. ‘Backgrounds of expectation’ (Thrift, Still 36) were forged through non-too-subtle procedural and sequential movements which opened-out new modes of thinking and feeling. Folding one’s clothes and placing them on the dresser in-readiness; pillows and sheets prepared for a spell in the shelter, these were some of many orderly examples (IWM 14595). In the event of a gas attack air raid precautions instructions advised how to put on a gas mask (ARPD 90-92),i) Hold the breath. ii) Remove headgear and place between the knees. iii) Lift the flap of the haversack [ …] iv) Bring the face-piece towards the face’[…](v) Breathe out and continue to breathe in a normal manner The rational technologies of drill, dressage and operational research enabled poise in the face of an eventual air-raid. Through this ‘logistical-life’ (Reid 17), thought was directed towards simple tasks by minutely described instructions. Stilled LifeThe end of stillness was usually marked by a reactionary ‘flinch’, ‘start’ or ‘jump’. Such reactionary ‘urgent analogs’ (Ngai 94; Tomkins 96) often occurred as a response to sounds and movements that merely broke the tension rather than accurately mimicking an air raid. These atmospheres were brittle and easily disrupted. Cars back-firing and changing gear were often complained about (MO 371), just as bringing people out of the quiescence of sleep was a common effect of air-raids (Kraftl and Horton 509). Disorientation was usually fostered in this process while people found it very difficult to carry out the most simple of tasks. Putting one’s clothes on or even making their way out of the bedroom door became enormously problematic. Sirens awoke a ‘conditioned reflex’ to take cover (MO 364). Long periods of sleep deprivation brought on considerable fatigue and anxiety. ‘Sleep we Must’ wrote journalist Ritchie Calder (252) noticing the invigorating powers of sleep for both urban morale and the bare existence of survival. For other more traumatized members of the population, psychological studies found that the sustained concentration of shelling caused what was named ‘apathy-retreat’ (Harrisson, Living 65). This extreme form of acquiescence saw especially susceptible and vulnerable civilians suffer an overwhelming urge to sleep and to be cared-for ‘as if chronically ill’ (Janis 90). A class and racial politics of quiescent affect was enacted as several members of the population were believed far more liable to ‘give way’ to defeat and dangerous emotions (Brittain 77; Committee of Imperial Defence).In other cases it was only once an air-raid had started that sleep could be found (MO 253). The boredom of waiting could gather in its intensity deforming bodies with “the doom of depression” (Anderson 749). The stopped time-spaces in advance of a raid could be soaked with so much tension that the commencement of sirens, vibrations and explosions would allow a person overwhelming relief (MO 253). Quoting from a boy recalling his experiences in Hannover during 1943, Hewitt illustrates:I lie in bed. I am afraid. I strain my ears to hear something but still all is quiet. I hardly dare breathe, as if something horrible is knocking at the door, at the windows. Is it the beating of my heart? ... Suddenly there seems relief, the sirens howl into the night ... (Heimatbund Niedersachsen 1953: 185). (Cited in Hewitt, When 16)Once a state of still was lost getting it back required some effort (Bissell, Comfortable 1697). Cautious of preventing mass panic and public hysteria by allowing the body to erupt outwards into dangerous vectors of mobility, the British government’s schooling in the theories of panicology (Orr 12) and contagious affect (Le Bon 17; Tarde 278; Thrift, Intensities 57; Trotter 140), made air raid precautions (ARP) officers, police and civil defence teams enforce ‘stay put’ and ‘hold firm’ orders to protect the population (Jones et al, Civilian Morale 463, Public Panic 63-64; Thomas 16). Such orders were meant to shield against precisely the kinds of volatile bodies they were trying to compel with their own bombing strategies. Reactions to the Blitz were moralised and racialised. Becoming stilled required self-conscious work by a public anxious not to be seen to ‘panic’. This took the form of self-disciplination. People exhausted considerable energy to ‘settle’ themselves down. It required ‘holding’ themselves still and ‘together’ in order to accomplish this state, and to avoid going the same way as the buildings falling apart around them, as some people observed (MO 408). In Britain a cup of tea was often made as a spontaneous response in the event of the conclusion of a raid (Brown 686). As well as destroying bombing created spaces too – making space for stillness (Conradson 33). Many people found that they could recall their experiences in vivid detail, allocating a significant proportion of their memories to the recollection of the self and an awareness of their surroundings (IWM 19103). In this mode of stillness, contemplation did not turn-inwards but unfolded out towards the environment. The material processual movement of the shell-blast literally evacuated all sound and materials from its centre to leave a vacuum of negative pressure. Diaries and oral testimonies stretch out these millisecond events into discernable times and spaces of sensation, thought and the experience of experience (Massumi, Parables 2). Extraordinarily, survivors mention serene feelings of quiet within the eye of the blast (see Mortimer 239); they had, literally, ‘no time to be frightened’ (Crighton-Miller 6150). A shell explosion could create such intensities of stillness that a sudden and distinctive lessening of the person and world are expressed, constituting ‘stilling-slowing diminishments’ (Anderson 744). As if the blast-vacuum had sucked all the animation from their agency, recollections convey passivity and, paradoxically, a much more heightened and contemplative sense of the moment (Bourke 121; Thrift, Still 41). More lucid accounts describe a multitude of thoughts and an attention to minute detail. Alternatively, the enormous peaking of a waking blast subdued all later activities to relative obsolescence. The hurricane of sounds and air appear to overload into the flatness of an extended and calmed instantaneous present.Then the whistling stopped, then a terrific thump as it hit the ground, and everything seem to expand, then contract with deliberation and stillness seemed to be all around. (As recollected by Bill and Vi Reagan in Gaskin 17)On the other hand, as Schivelbusch (7) shows us in his exploration of defeat, the cessation of war could be met with an outburst of feeling. In these micro-moments a close encounter with death was often experienced with elation, a feeling of peace and well-being drawn through a much more heightened sense of the now (MO 253). These are not pre-formed or contemplative techniques of attunement as Thrift has tracked, but are the consequence of significant trauma and the primal reaction to extreme danger.TracesSusan Griffin’s haunting A Chorus of Stones documents what she describes as a private life of war (1). For Griffin, and as shown in these brief examples, stillness and being-stilled describe a series of diverse experiences endured during aerial bombing. Yet, as Griffin narrates, these are not-so private lives. A common representation of air war can be found in Henry Moore’s tube shelter sketches which convey sleeping tube-dwellers harboured in the London underground during the Blitz. The bodies are represented as much more than individuals being connected by Moore’s wave-like shapes into the turbulent aggregation of a choppy ocean. What we see in Moore’s portrayal and the examples discussed already are experiences with definite relations to both inner and outer worlds. They refer to more-than individuals who bear intimate relations to their outsides and the atmospheric and material environments enveloping and searing through them. Stillness was an unlikely state composed through these circulations just as it was formed as a means of address. It was required in order to apprehend sounds and possible events through techniques of listening or waiting. Alternatively being stilled could refer to pauses between air-strikes and the corresponding breaks of tension in the aftermath of a raid. Stillness was composed through a series of distributed yet interconnecting bodies, feelings, materials and atmospheres oriented towards the future and the past. The ruins of bombed-out building forms stand as traces even today. Just as Massumi (Sensing 16) describes in the context of architecture, the now static remainder of the explosion “envelops in its stillness a deformational field of which it stands as the trace”. The ruined forms left after the attack stand as a “monument” of the passing of the raid to be what it once was – house, factory, shop, restaurant, library - and to become something else. The experience of those ‘from below’ (Hewitt 2) suffering contemporary forms of air-warfare share many parallels with those of the Blitz. Air power continues to target, apparently more precisely, the affective tones of the body. Accessed by kinetic and non-kinetic forces, the signs of air-war are generated by the shelling of Kosovo, ‘shock and awe’ in Iraq, air-strikes in Afghanistan and by the simulated air-raids of IDF aircraft producing sonic-booms over sleeping Palestinian civilians, now becoming far more real as I write in the final days of 2008. Achieving stillness in the wake of aerial trauma remains, even now, a way to survive the (private) life of air war. AcknowledgementsI’d like to thank the editors and particularly the referees for such a close reading of the article; time did not permit the attention their suggestions demanded. Grateful acknowledgement is also made to the AHRC whose funding allowed me to research and write this paper. ReferencesAdey, Peter. Aerial Geographies: Mobilities, Bodies and Subjects. Oxford: Wiley-Blackwell, 2010 (forthcoming). 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