Guidelines for the management of the foot health problems associated with rheumatoid arthritis

Background. Rheumatoid arthritis (RA) as a chronic systemic disease, commonly affects the feet, impacting negatively on patients' quality of life. Specialist podiatrists have a prime role to play in the assessment and management of foot and ankle problems within this patient group. However, it has been identified that in many areas there is no specialist podiatry service, with many patients being managed by non‐specialist podiatrists. Therefore, the North West Clinical Effectiveness Group for the Foot in Rheumatic Diseases (NWCEG) identified the need to develop ‘practitioner facing’ guidelines for the management of specific foot health problems associated with RA. Methods. Members of a guideline development group from the NWCEG each reviewed the evidence for specific aspects of the assessment and management of foot problems. Where evidence was lacking, ‘expert opinion’ was obtained from the members of the NWCEG and added as a consensus on current and best practice. An iterative approach was employed, with the results being reviewed and revised by all members of the group and external reviewers before the final guideline document was produced. Results. The management of specific foot problems (callus, nail pathology, ulceration) and the use of specific interventions (foot orthoses, footwear, patient education, steroid injection therapy) are detailed and standards in relation to each are provided. A diagrammatic screening pathway is presented, with the aim of guiding nonspecialist podiatrists through the complexity of assessing and managing those patients with problems requiring input from a specialist podiatrist and other members of the rheumatology multidisciplinary team. Conclusion. This pragmatic approach ensured that the guidelines were relevant and applicable to current practice as ‘best practice’, based on the available evidence from the literature and consensus expert opinion. These guidelines provide both specialist and non‐specialist podiatrists with the essential and ‘gold standard’ aspects of managing people with RA‐related foot problems

Biological Flora of Britain and Ireland: <i>Hammarbya paludosa</i>

1. This account presents information on all aspects of the biology of Hammarbya paludosa (L.) Kuntze (bog orchid, bog adder's-mouth orchid) (Malaxis paludosa (L.) Sw., Ophrys paludosa L.), that are relevant to understanding its ecological characteristics and behaviour. The main topics are presented within the standard framework of the Biological Flora of Britain and Ireland: distribution, habitat, communities, responses to biotic factors, responses to environment, structure and physiology, phenology, floral and seed characters, herbivores and disease, history, and conservation.2. Hammarbya paludosa is a small bisexual perennial forb. It occurs in open habitats in bogs, mires and heaths as well as semi-shaded open woodland and, in some areas, in shaded coniferous forest. It is found in a few locations in the southern England (the New Forest, Dorset, Devon and Cornwall), in Cumbria and Northumberland, and in western counties in Wales. It is rare in Ireland but wide spread but very local in Scotland. H. paludosa has a Holarctic circumboreal range. Ninety per cent of known locations are recorded in Northern Europe and the British Isles.3. Hammarbya paludosa occurs on Sphagnum, other mosses and bare peat, overlying a variety of superficial deposits and sedimentary, metamorphic and igneous rocks. The pH of the rooting substrates ranges from acidic to neutral and slightly alkaline. Its nutrient status is oligotrophic, although occasionally mesotrophic, and very rarely eutrophic. It grows well in conditions of consistent lateral flow of water in the substratum.4. Hammarbya paludosay is visited by small insects of the order Diptera. Two species of gnats are recorded as orchid pollinators: Phronia digitata and Sciara thomae. It produces a small amount of nectar but is often considered as non-rewarding. The seeds are dust-like, dispersed by wind and water and the species has a short-term seed bank. Tiny bulbils (propagules) are formed on the leaf margins. They are dispersed by water.5. Hammarbya paludosa has declined in Britain since the late 19th Century primarily due to drainage of its mire habitats in lowland regions of southern and eastern England and Wales. The decline slowed down by the 2000s, and new locations have been found in Scotland and Ireland

Codes of Commitment to Crime and Resistance: Determining Social and Cultural Factors over the Behaviors of Italian Mafia Women

This article categorizes thirty-three women in four main Italian Mafia groups and explores social and cultural behaviors of these women. This study introduces the feminist theory of belief and action. The theoretical inquiry investigates the sometimes conflicting behaviors of women when they are subject to systematic oppression. I argue that there is a cultural polarization among the categorized sub-groups. Conservative radicals give their support to the Mafia while defectors and rebels resist the Mafia. After testing the theory, I assert that emancipation of women depends on the strength of their beliefs to perform actions against the Mafiosi culture

Soul's Tools

This paper explores the various ways Aristotle refers to and employs “heat and cold” in his embryology. In my view, scholars are too quick to assume that references to heat and cold are references to matter or an animal’s material nature. More commonly, I argue, Aristotle refers to heat and cold as the “tools” of soul. As I understand it, Aristotle is thinking of heat and cold in many contexts as auxiliary causes by which soul activities (primarily “concoction”) are carried out. This, as I argue, is what it means to call them “tools” of soul. An upshot of this investigation is the fuller picture of Aristotle’s conception of efficient causation it provides in general, and the better understanding of the efficient causal operation of an organism’s nature or soul it provides in particular

New Investigations in the Environment, History and Archaeology of the Iraqi Hilly Flanks: Shahrizor Survey Project 2009-2011

Recent palaeoenvironmental, historical, and archaeological investigations, primarily consisting of site reconnaissance, in the Shahrizor region within the province of Sulaymaniyah in Iraqi Kurdistan are bringing to light new information on the region’s social and socio-ecological development. This paper summarises two seasons of work by researchers from German, British, Dutch, and Iraqi-Kurdish institutions working in the survey region. Palaeoenvironmental data have determined that during the Pleistocene many terraces developed which came to be occupied by a number of the larger tell sites in the Holocene. In the sedimentary record, climatic and anthropogenic patterns are noticeable, and alluviation has affected the recovery of archaeological remains through site burial in places. Historical data show the Shahrizor shifting between periods of independence, either occupied by one regional state or several smaller entities, and periods that saw the plain’s incorporation within large empires, often in a border position. New archaeological investigations have provided insight into the importance of the region as a transit centre between Western Iran and northern and southern Mesopotamia, with clear material culture links recovered. Variations between periods’ settlement patterns and occupations are also beginning to emerge