Identifying the loading conditions under which the femur is most likely to fracture may aid the prevention of hip fracture. This study quantified the effect of force direction on fracture load, a factor inherently associated with fracture risk. Finite element (FE) models of four femora were used to determine the force directions associated with the lowest fracture loads. Force directions were varied three-dimensionally for two types of loading, one representing impact from a fall and one similar to joint loading during daily activities (atraumatic loading). For the fall configuration, the force direction with lowest fracture load corresponded to an impact onto the posterolateral aspect of the greater trochanter. For atraumatic loading, the lowest fracture loads for the force directions analyzed occurred when posterior force components were relatively large or when posterior and lateral components were both small, similar to conditions while standing on one leg or climbing stairs. When both fall and atraumatic configurations are considered, the type of loading associated with greatest fracture risk, i.e., with the greatest applied force and lowest fracture load, is impact from a fall onto the posterolateral aspect of the greater trochanter. Therefore, evaluation of hip fracture risk and development of fracture prevention technologies should focus on this high-risk loading condition.

Objective. To determine whether elevated soluble Fas/APO-1 (sFas/APO-1) levels are associated with either autoimmune disease or evidence of flares in autoimmune disease.Methods. Thirty-seven serum samples were retrospectively obtained from normal controls and patients with laboratory evidence of autoimmune disease activity. These samples were assayed for sFas/APO-1 levels by an enzyme-linked immunosorbent assay, and hospital medical records were retrospectively reviewed for clinical and laboratory characteristics of the patients.Results. Soluble Fas/APO-1 levels did not correlate with clinical diagnoses or laboratory abnormalities. The mean and range of sFas/APO-1 levels were similar in systemic lupus erythematosus patients (including those with active disease), patients with other autoimmune diseases, and normal controls.Conclusion. These data strongly suggest that measurement of sFas/APO-1 levels is unlikely to hold clinical value or play a role in the pathogenesis of autoimmune disease.Fas/APO-l/CD95 is a cell surface receptor belonging to the tumor necrosis factor a receptor family (1-3). Mutations in the Fas/APO-1 gene and the Fad APO-1 ligand gene have been shown to be the primary defect in the fpr and gfd mouse models of autoimmunity (1-3). The phenotypic characteristics of these single gene mutations together with appropriate back-

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This article offers an alternative methodology for practitioners and researchers to use in establishing interrater reliability for testing purposes. The majority of studies on interrater reliability use a traditional methodology where by two raters are compared using a Pearson product-moment correlation. This traditional method of estimating interrater reliability uses a correlation of the two raters' scores for the same subject. This study used an observer-rater paradigm in which 20 observers' scores were compared to the scores of an expert rater. Results bring into question the common practice of examining interrater reliability. The correlation of two raters may not be a reliable way of determining if every evaluator using the instrument will obtain scores that accurately report the developmental status of young children.Early intervention practitioners are increasingly interested in the reliability and validity of instruments used to evaluate very young children (i.e., birth to age 3). Many new instruments (e.g., play-based, curriculum-based) are being constructed to assist in the early detection of developmental delays in young children and a growing number of studies have looked at the technical adequacy of these instruments

Clinical and immunological parameters in 14 patients with rheumatoid arthritis (RA) receiving sulphasalazine (SASP) were evaluated, to determine whether their clinical response was reflected by any quantitative changes in their peripheral blood lymphocytes after 12 weeks. Whilst disease activity markers fell significantly, no such changes were noted in the percentage or absolute numbers of lymphocytes or their subsets. The lymphocytes of a further 21 patients before and after receiving SASP for 12 weeks were then studied qualitatively. The suppression mediated by in vitro SASP on ex vivo PHA stimulated lymphocytes showed a decrease at 12 weeks. This change was more marked and reached statistical significance only in those patients who showed a good clinical response. It is postulated that this may in some way be related to expression of activation markers and concomitant SASP binding.