Explore the vast range of titles available.

This book brings together ten essays on John Donne and George Herbert composed by an international group of scholars. The volume represents the first collection of its kind to draw close connections between these two distinguished early modern thinkers and poets who are justly coupled because of their personal and artistic association. The contributors' distinctive new approaches and insights illuminate a variety of topics and fields while suggesting new directions that future study of Donne and Herbert might take. Some chapters explore concrete instances of collaboration or communication between Donne and Herbert, and others find fresh ways to contextualize the Donnean and Herbertian lyric, carefully setting the poetry alongside discourses of apophatic theology or early modern political theory, while still others link Herbert's verse to Donne's devotional prose. Several chapters establish specific theological and aesthetic grounds for comparison, considering Donne and Herbert's respective positions on religious assurance, comic sensibility, and virtuosity with poetic endings. 

With thirteen editions of 7he Temple appearing before 1700, Herbert was one of the bestselling English poets of the Seventeenth Century - and letters, diaries, commonplace books and other documents from the period show that the most frequent and appreciative references to Herbert were to this gateway poem, with its straightforward and pithy proverbial wisdom delivered in rhymes about prudent life management.' (II. 1-6) This is the \"sweetened pill\" theory of poetry, or to put it more formally, this is aesthetic utilitarianism: as Horace famously suggested in Ars Poetica, the purpose of art is to teach and to delight, and in traditional Christian practice this usually means that the delight serves the teaching.· The further embarrassment offered by \"The Church-porch\" is related to this aesthetic utilitarianism: that is, its very prudence, its pragmatic, instrumentalist attitude to spiritual life and human relations. Strier is hardly alone in noting the sometimes jarring differences between the stress on external behavior and self-advancement in this opening poem and the emphasis on interior grace and self-denial in the lyrics that follow. To put this explanation succinctly: the broad organizational structure of The Temple functions as a kind of narrative, a difficult but hopeful narrative of what we might call progressive unsuccess.

Literary theory has always been theology by other means, a claim borne out by this essay’s brief survey of modern theoretical approaches as points of view and as failed god’s-eye views. Like John’s Apocalypse, my alarming title is more hopeful than it sounds; for while humanistic literary study is indeed doomed to increased disintegration and irrelevance if it continues to be cut off from its roots in biblical exegesis, Christian aesthetics, and moral theology, the human heart always will have its reasons for making, telling, and interpreting poems and stories. Thus the likely institutional collapse of secular literary humanism over the next decade or two into a welter of competing propagandas will be the moment of revelation and rebirth, if Christian readers and critics are wise enough to reject the tyranny of the postmodern non serviam and get on with their proper business: being good servants of beauty and truth.

Pseudoaneurysms are a rare complication of foot and ankle surgeries that can potentially lead to serious sequelae, especially when there is delay in the diagnosis. Due to the rarity of this occurrence, guidelines for management are limited for orthopedic surgeons. Once diagnosed, the surgeon has to decide quickly on many options for how to best manage the patient. In this case report, we present the occurrence of a dorsal second metatarsal artery pseudoaneurysm that occurred after removal of hardware. We also discuss the most current literature on the subject to help guide other surgeons in the diagnosis and management of this condition.

Abstract Rationale The management of chronic thromboembolic pulmonary hypertension (CTEPH) has changed over recent years with the growth of pulmonary endarterectomy surgery and the availability of disease-modifying therapies. Objectives To investigate the prognosis of CTEPH in a national setting during recent years. Methods All incident cases diagnosed in one of the five pulmonary hypertension centers in the United Kingdom between January 2001 and June 2006 were identified prospectively. Information regarding baseline characteristics, treatment, and follow-up was subsequently collected from hospital records. Measurements and Main Results A total of 469 patients received a diagnosis, of whom 148 (32%) had distal, nonsurgical disease. One- and three-year survival from diagnosis was 82 and 70% for patients with nonsurgical disease and 88 and 76% for those treated surgically (P = 0.023). Initial functional improvement in patients with nonsurgical disease was noted but did not persist at 2 years. Significant functional and hemodynamic improvements were seen in surgically treated patients with an increase in six-minute-walk distance of 105 m (P < 0.001) at 3 months. Five-year survival from surgery in the 35% of patients who survived to 3 months but had persistent pulmonary hypertension was 94%. Conclusions The prognosis in nonsurgical disease has improved. We have confirmed the previously described good outcome in surgically treated disease. However, we have also demonstrated that the long-term prognosis for patients who have persistent pulmonary hypertension at 3 months after surgery is good. The observed improvements in outcome during the modern treatment era reinforce the importance of identifying patients with this increasingly treatable condition.

The evolution and development of human mortuary behaviors is of enormous cultural significance. Here we report a richly-decorated young infant burial (AVH-1) from Arma Veirana (Liguria, northwestern Italy) that is directly dated to 10,211–9910 cal BP (95.4% probability), placing it within the early Holocene and therefore attributable to the early Mesolithic, a cultural period from which well-documented burials are exceedingly rare. Virtual dental histology, proteomics, and aDNA indicate that the infant was a 40–50 days old female. Associated artifacts indicate significant material and emotional investment in the child’s interment. The detailed biological profile of AVH-1 establishes the child as the earliest European near-neonate documented to be female. The Arma Veirana burial thus provides insight into sex/gender-based social status, funerary treatment, and the attribution of personhood to the youngest individuals among prehistoric hunter-gatherer groups and adds substantially to the scant data on mortuary practices from an important period in prehistory shortly following the end of the last Ice Age.

Category: Midfoot/Forefoot; Basic Sciences/Biologics; Sports; Trauma Introduction/Purpose: Flexor tendon injuries of the hallux are uncommon overall but when they happen, the flexor hallucis longus (FHL) tendon is the most frequent one affected. The rupture of FHL usually results from open injuries and deep cuts in the sole at the base of the toe;4 complete subcutaneous ruptures are extremely rare.5 There are around 36 cases reported of complete or partial closed ruptures of the FHL tendon along its entire course6 and the majority of the partial ruptures correspond to dancers and athletes.7 As far as FHB, we found a few reports of calcific tendinitis of the medial bundle and cases of calcifying tendinitis.8 To the best of our knowledge, this is the only case report of isolated closed rupture of the FHB tendon. Methods: A 33-year-old man, amateur soccer player, presented with mild swelling, ecchymosis, and increasing pain in the left hallux triggered by movement and palpation, relieved by rest. He sustained a direct axial blow and blunt force trauma with a soccer ball plus hyperextension. Standard bilateral weightbearing feet radiographs were normal. Physical exam revealed the left hallux normally aligned but with limited painful motion of 20° each way and no obvious instability. Palpation of the left first metatarsophalangeal joint was tender but not particularly over the sesamoids. MRI revealed an avulsion of the flexor Hallucis Brevis tendon off the proximal aspect of the medial sesamoid accompanied by fluid and edema, effusion in the first MTP joint and bone contusions in the first metatarsal head and dorsal base of the first proximal phalanx. Treatment with a toe spacer and postop sandal with the toe straight with an extension block was decided. Results: Tendon's blood flow around the sesamoids is limited making it susceptible to degenerative rupture. The most common mechanism of complete tendon rupture is direct open injury. Closed rupture is very rare and complete rupture in closed injury is even more. We did not find reports on third degree type of injuries, neither for any kind of isolated rupture of FHB. In our patient's case, dorsiflexion stretched all plantar soft tissue around the first MTP but he was able to do active movement of the great toe probably due to the FHL and lateral FHB insertion integrity. We found few reports of second-degree strain injury of FHL and FHB in a chronic setting, all treated conservatively with partial immobilization and strapping of the hallux to prevent extension. After conservative treatment at 3 months follow-up, our patient presented with no subjective complains, normal motion, stability and alignment of the hallux. Conclusion: Despite an extensive literature search, we did not find a similar injury, and this is probably the first time it is described. As found in our research, the most common injury related to the flexor tendons of the hallux are in soccer players and involve the FHL or both.23 These findings made us conclude that these injuries are either under-diagnosed or exceptional.

Category: Bunion; Lesser Toes Introduction/Purpose: Surgical correction of hallux valgus can be achieved through various techniques with minimally invasive surgery (MIS) gaining popularity in recent years amongst surgeons. The use of MIS 1st distal transverse metatarsal and Akin osteotomy has been associated with good functional outcomes and low complication rates. However, there is limited literature on the time to union following moderate and severe hallux valgus repair using this technique. Literature in orthopedic trauma has indicated that 3 neocortices on postoperative radiographs were associated with high likelihood of union. In this study, we conducted a retrospective analysis to investigate the time to union and its relationship with cortical formation and post-operative degree of displacement of the 1st metatarsal in patients undergoing HV repair. Methods: We retrospectively analyzed seventy-two consecutive patients with moderate to severe hallux valgus who underwent MIS 1st distal metatarsal and Akin osteotomy between 2019 and 2022. The procedures were performed by three fellowship-trained foot and ankle orthopedic surgeons. Postoperative weightbearing X-rays were taken at 6 weeks, 3 months, 6 months, and 12 months to assess time to radiographic union and overall union rate. Two orthopedic surgeons independently reviewed the radiographs. Radiographic measurements included the scale of displacement between the proximal and distal portions of the first metatarsal and the degree of cortex formation. Complete union was defined as the presence of three new cortices on postoperative X-ray films. Patients were divided into four groups based on the percentage of shift on the first metatarsal head (0-25, 25-50, 50-75, 75-100%) for the purpose of our analysis. Results: The cohort consisted of 63 women and 9 men, with an average age of 56.6 years. The mean BMI was 25.96. On average, 2 cortices were observed at 16.9 weeks, and 3 cortices were observed at 26.8 weeks. When the metatarsal shift was greater than 50%, two cortices were observed at an average of 20.14 weeks, compared to 13.7 weeks when the shift was less than 30% (p=0.004). Further analysis of the time required to observe 3 cortices showed no statistically significant difference between metatarsal shifts greater (25.26 weeks) and less than (23.74 weeks) 50% (p=0.4734). In all patients, 4 cortices were observed at the medial, lateral, superior, and inferior aspects of the first metatarsal at the 6-month and 12-month time points. Conclusion: In patients who underwent MIS 1st metatarsal distal transverse and Akin osteotomies for HV repair, the degree of displacement between the proximal and distal portions of the 1st metatarsal is not associated with statistically significant delay in new cortical formation, with an average time to union of 26.9 weeks across all groups, regardless of the percentage of displacement. Independent evaluations of union were consistent with the time points at which 2 and 3 cortices were formed on postoperative radiographs.

Category: Bunion; Other Introduction/Purpose: Minimally invasive techniques for surgical treatment of hallux valgus (HV) has gained popularity over the past few years. Most published reports involve combined minimally invasive Chevron and Akin osteotomies (MICA) performed by a single surgeon. This study reports radiographic and clinical results on patients who underwent minimally invasive transverse distal 1st metatarsal and Akin osteotomies by 3 fellowship trained Foot & Ankle orthopedic surgeons. Methods: 192 consecutive patients (213 feet) between 2019 and 2022 with symptomatic hallux valgus without 1st tarsometatarsal or metatarsal phalangeal joint arthritis or TMT joint instability were followed for at least one year. The average age was 56.5, average final follow-up of 13.4 months, and 86.5% (166) of patients were women. Primary radiographic outcomes include pre- and post-operative HV (HVA), inter-metatarsal (IMA), and proximal inter-metatarsal angles (pIMA). Foot and Ankle Ability Measure (FAAM) scores were used to determine functional outcomes. Pain relief was measured by Visual Analog Scale (VAS) scores. Complication, re-operation and radiographic recurrence rates were also determined. Radiographic recurrence was defined as a change in HVA >10 degrees. Results: Additional procedures were performed on 83 feet (39%), the most common being lesser metatarsal osteotomies, which was performed in 88% of those patients. Among corrected bunions, 8.5% were classified as severe (HVA >40 degrees) and 79% were moderate (HVA >20 and < 40 degrees). Average pre-op HVA and IMA were 28.4 and 12.8 degrees and improved to 8.4 and 4.2 degrees (p < 0.001). Statistically significant increases in FAAM-ADL, FAAM-Sports and VAS scores were observed (p < 0.001). There were no cases of superficial or deep infections. There were 10 radiographic recurrences, 3 symptomatic recurrences and 2 non-unions requiring re-operation, and 13 (6%) hardware removals. Conclusion: The fourth-generation MIS HV surgery has demonstrated promising results in treating moderate and severe hallux valgus (HV), exhibiting favorable clinical and radiographic outcomes over an average follow-up period of 12.4 months. This technique has showcased remarkable safety and efficacy, with our cohort experiencing minimal recurrence, revision, and complication rates. Both instances of non-unions achieved successful union following re-operation.

Background: The use of fourth-generation minimally invasive hallux valgus surgery with metaphyseal extra-articular transverse and Akin osteotomy, recently dubbed “META,” is a new generation of minimally invasive surgical (MIS) technique and a recent focus of foot and ankle orthopaedic literature associated with good functional outcomes and low complication rates. Literature in orthopaedic trauma has indicated that 2 or 3 neocortices on postoperative radiographs are associated with high likelihood of union. In this study, we conducted a retrospective analysis to investigate the time to bony union for patients undergoing fourth-generation MIS hallux valgus repair as well as the relationship between intraoperative degree of first-metatarsal displacement and time to bony union. Methods: We retrospectively analyzed 217 consecutive patients with moderate to severe hallux valgus who underwent fourth-generation MIS first distal metatarsal and Akin osteotomy between 2020 and 2023 and were followed for up to 1 year. Radiographic measurements included the scale of displacement between the proximal and distal portions of the first metatarsal as a percentage and the number of neocortical bridge formations at the osteotomy site. Postoperative weightbearing radiographs were recorded at 6 weeks, 3 months, 6 months, and 1 year to assess time to union and patient clinical outcomes. Two orthopaedic surgeons independently reviewed the radiographs to assess progression to bony union. Any discrepancy in analysis was resolved by a third-party clinician. Complete union was defined as the presence of at least 2 new cortical bridge formations on postoperative X-ray films. Patients were divided into 3 groups based on the percentage of shift on the first metatarsal head (≤50%, 51%-75%, ≥76%) for the purpose of our analysis. Results: Union (≥2 cortices) was observed in 17%, 70%, and 90% of patients at 6 weeks, 3 months, and 6 months, respectively. At final follow-up (mean 13 ± 6.9 weeks), 92% achieved union. No significant differences in time to union were observed across metatarsal shift groups. Complications include 3 nonunions, 3 revisions, 16 cases that necessitated removal of hardware, 1 case of superficial wound infection, 1 case of deep wound infection, and 6 deformity recurrences. Conclusion: Time to union after META procedure typically occurred by 13 weeks, independent of shift magnitude. Surgeons may consider ≥2 cortices and absence of symptoms as sufficient indicators for advancing weightbearing. These findings may assist in patient counseling and postoperative planning. Level of Evidence: Level IV, retrospective case series. Visual Abstract This is a visual representation of the abstract.