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U.S. Route 224

U.S. Route 224 (US 224) is a spur of US 24 that runs through the states of Indiana, Ohio and Pennsylvania. It currently runs for 289 mi from US 24 in Huntington, Indiana, east to US 422 Business (US 422 Bus.) and Pennsylvania Route 18 (PA 18) in New Castle, Pennsylvania. It goes through the cities of Canfield, Ohio, Akron, Ohio, and Findlay, Ohio. In Northeast Ohio, US 224 is located a short distance north of the Western Reserve's southern boundary.

Indiana
From the western terminus at US 24, US 224 heads southeast concurrent with State Road 5 (SR 5). US 224 and SR 5 heads through downtown Huntington as one-way streets, with eastbound on Cherry Street and State Street and westbound on Warren Street. From downtown US 224 and SR 5 head southeast then outside of downtown SR 5 heads due south and US 224 heads east. US 224 passes through Markle where US 224 has an interchange with Interstate 69 (I-69) and intersections with both SR 116 and SR 3. US 224 heads east towards Decatur passing through intersections with SR 301 and SR 1. In Decatur US 224 has a short concurrency with US 27 and US 33. US 224 heads east from Decatur towards Ohio passing through a short concurrency with SR 101.

The only section of U.S. Route 224 in Indiana that is included in the National Highway System is the part concurrent with US 27 and US 33. Traffic reports from the Indiana Department of Transportation in 2010 showed that the lowest traffic levels were the 2,420 vehicles and 670 commercial vehicles using the highway daily near the Ohio state line; the highest traffic levels were the 21,680 vehicles and 1,690 commercial vehicles traveling along the section of US 224 that is concurrent with US 27 and US 33.

Ohio
West of its concurrency with US 42 near Lodi, US 224 is a rural arterial highway, mostly two lanes, across western Ohio. It runs roughly parallel to the former Baltimore and Ohio Railroad from its westerly US 42 junction to Tiffin, a city around which it sweeps to the south with intersections at various state highways that radiate out from downtown. US 224 passes through a commercial strip on the south side of Willard, and goes through downtown Findlay and Ottawa, but it otherwise specializes in small towns along its course across northwest Ohio. It crosses US 250 east of Greenwich; State Route 4 (SR 4), a major north–south route, at Attica; US 23 south of Fostoria, and I-75 in Findlay, and has brief concurrences with US 127 and US 30 near Van Wert. It crosses the Ashland Railway just east of Willard, the Norfolk Southern Railway at Attica, CSX Transportation near US 23, in Findlay, and in Ottawa, and the Chicago, Fort Wayne and Eastern Railroad west of Van Wert.

East of Lodi, US 224 meets the western terminus of I-76, with which it forms a concurrency. It is in this area, US 224 enters the Connecticut Western Reserve. Less than a mile later, both routes intersect with I-71. US 224 continues along with I-76 to Akron. Here, I-76 exits and heads north. Continuing on US 224, the route runs concurrently with I-277, a short auxiliary highway running through southern Akron. I-277 quickly ends, leaving US 224 to continue into a heavily wooded area. The highway then intersects with SR 43, SR 44, SR 169, SR 225, SR 14, SR 45 and SR 46. Shortly after crossing over SR 11, US 224 enters Boardman Township in Mahoning County, where it eventually crosses a YSRR right of way perpendicularly on its way to the interchange with I-680 before reaching the village of Poland.

This stretch of US 224, through Canfield, Boardman and Poland, is known for its chronic congestion. The original routing of US 224 through the village of Poland turned southeast on Main Street (formerly SR 90, now SR 170) to Riverside Drive, then north on Riverside Drive to the current alignment. In 1954 a bridge was built across Yellow Creek and a new road was constructed from Main Street to Riverside Drive, including an intersection with Water Street (SR 616). As US 224 leaves the village of Poland it continues through rural terrain as it heads towards Pennsylvania.

Pennsylvania
US 224 crosses into Mahoning Township in Lawrence County and becomes West State Street, a two-lane, undivided road. The road heads through wooded areas with some homes and commercial establishments, heading to the east-southeast. The route curves to the northeast in Peanut and passes over Norfolk Southern's Youngstown Line, coming to an intersection with PA 551. Here, PA 551 turns northeast to form a concurrency with US 224. The road heads through wooded areas and crosses the Mahoning River and CSX's New Castle Subdivision railroad line. PA 551 splits from US 224 by heading north on North Edinburg Road, with US 224 continuing into wooded areas with some farm fields. The road turns to the southeast and enters Union Township. The route continues through wooded areas with some farmland and homes, passing to the south of New Castle Municipal Airport and heading through the community of Parkstown. US 224 heads into commercial areas, gaining a second lane westbound before widening into a six-lane divided highway as it comes to an interchange with I-376/US 422.

Past this interchange, the road becomes a three-lane road with a center left-turn lane and passes through a mix of residences and businesses, running through the community of Oakwood. The route heads into the city of New Castle and passes through wooded areas of development, gaining a second westbound lane and coming to an intersection with US 422 Business. At this point, US 422 Business turns east to join US 224 on four-lane divided West Falls Street, passing more development and crossing over a New Castle Industrial Railroad line and the Shenango River. The road heads to the east and continues through commercial areas. US 224 ends at an intersection with PA 18, at which point US 422 Business turns south to join that route.

History
US 224 was assigned to a portion of the Benjamin Franklin Highway, an auto trail running from Omaha, Nebraska to Philadelphia, Pennsylvania; its number assignment was an alternative to a westward rerouting of US 422 which runs along the Benjamin Franklin Highway farther east.

When US 224 was commissioned in Indiana in 1934, it replaced State Road 16 (SR 16), from Huntington to the Ohio state line.

Although US 224 is only in Pennsylvania for 10 miles, the eastern terminus has changed several times since 1933, ending at various points in New Castle, Pennsylvania or in adjacent Union Township west of the city. The eastern terminus has been moved five times (1936, 1947, 1974, 1977, 2008), the most notable of which was in the 1970s when the New Castle Bypass opened in 1974 and the state extended US 224 through the city and into Shenango Township at the eastern terminus of the bypass, taking over US 422's old alignment after that highway was moved to the bypass.

The route was truncated back at the current interchange with US 422 and I-376 in 1977 while the old alignment through New Castle was replaced by Business US 422. This would be the case until March 20, 2008, when US 224 was officially extended 2 mi to PA 18 inside the New Castle city limits with the placement of new signs. The Pennsylvania Department of Transportation (PennDOT) requested approval from the American Association of State Highway and Transportation Officials (AASHTO) for the extension in August 2007. and received it the following month.

The extension of US 224 marked the second extension of a major highway into downtown New Castle in a little more than a year, as Pennsylvania Route 65 was extended a mile from its previous terminus with Business 422 to the PA 108/PA 168 concurrency in February 2007.

Future
Due to a higher-than-average number of crash-related injuries and fatalities along a stretch of US 224 in Medina County, Ohio, the Ohio Department of Transportation (ODOT) recommended converting three intersections, Vandemark, Westfield and Leroy roads, to restricted crossing U-turns. The highest-priority intersection, with Westfield Road in Westfield Township, was awarded $578,000 in ODOT funding and began construction in May 2019 and finished by the end of summer 2019.

There is a $2.4 million project north of the city of Van Wert to replace the current intersection of US 224, US 127 and Marsh Road (County Road 13) with a roundabout. The project began in January 2022 and was completed in October.

title: U.S. Route 224


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House of Munsö

The House of Munsö (Munsöätten), also called the House of Björn Ironside (Swedish: Björn Järnsidas ätt), the House of Uppsala (Swedish: Uppsalaätten) or simply the Old dynasty (Swedish: Gamla kungaätten), is the earliest reliably attested royal dynasty of Sweden, ruling during the Viking Age. None of the names suggested for the dynasty are universally accepted and most are problematic; the name "House of Munsö" derives from a questionable and speculative theory that they would have ruled from the island of Munsö and the name "House of Björn Ironside" derives from the supposed founder of the dynasty, Björn Ironside, who is often seen as a legendary, rather than historical, figure.

A long and elaborate sequence of kings of the Munsö dynasty can be found in 12th and 13th century Icelandic sagas, but the sagas are overwhelmingly considered unreliable, with the kings that appear in them seen as legendary figures. The sequence of kings in the sagas is contradicted by more contemporary German sources such as the 9th century writings of Rimbert and the 11th century work of Adam of Bremen.

Etymology and historiography
Due to a lack of preserved sources, little concrete information is known of Swedish kings during the Viking Age. Although long and elaborate king lists are provided by Icelandic sagas, sometimes contradictory mixtures of myths and poetry, and poems, these works (including texts such as Ynglinga saga, Hervarar saga, Ynglingatal and Langfeðgatal) are not considered reliable sources by modern scholars. Critically, a majority of them were written in the 12th to 13th century, centuries after the kings they described are supposed to have lived; what is genuine history and what is myth and legend is impossible to determine and everything contained in them must as such be regarded as legendary, if not fictional. The 12th and 13th centuries was a time when royal power was being consolidated in Norway, Denmark and Sweden and as such, king lists may have been created out of a political and social needs (i.e. justifying the rule of a royal dynasty), rather than a desire to tell genuine history. Many of Sweden's legendary kings would have preceded the Viking Age, but historical evidence of early geopolitics in Scandinavia suggests that larger political structures, kingdoms such as medieval Sweden, Norway and Denmark, did not form until the late Viking Age. The centralization of power under one monarch is believed to have resulted from, or at the very least have been connected to, Viking expansion, with petty kings increasing their power through aggressive military ventures directed both to foreign lands (i.e. Viking raids) and against their neighbors.

In his 12th-century work Gesta Danorum, Danish author Saxo Grammaticus wrote that the Swedish kings of the Viking Age were part of the dynasty of the Ynglings, a possibly entirely invented line of ancient Scandinavian kings supposedly descended from Odin, but this does not accord with the Icelandic sagas, which hold that the Ynglings were driven from Sweden in the middle of the 7th century and replaced by other dynasties. There is no preserved contemporary name for the Viking Age dynasty, and there exists no universally accepted name for them in modern historiography. The name "House of Munsö" (Munsöätten) derives from a questionable and speculative theory that the kings of the 9th century transferred their royal seat of power from Uppsala (an important early political center in Sweden) to the island of Munsö in the lake Mälaren. The supportive evidence for this theory; a large burial mound on Munsö and a contemporary account by German missionary Rimbert giving the impression that the Swedish king had his seat near the island-settlement of Birka, is quite thin. Since the name "House of Munsö" arguably takes a stand in favor of this theory, it is commonly avoided in modern Swedish scholarship. The name "House of Uppsala" (Uppsalaätten) derives from the fact that the Icelandic sagas often designate legendary Swedish rulers as kings "in Uppsala", and is similarly problematic. The dynasty is thus sometimes simply designated as "the Old dynasty" (Gamla kungaätten), a more neutral designation. The rarely used name "House of Björn Ironside" (Björn Järnsidas ätt) comes from the dynasty supposedly descending from the legendary Viking Björn Ironside according to the later Icelandic sagas. The big burial mound at Munsö was attributed, without evidence, to Björn Ironside by 18th-century historians, an identification that is not accepted by historians today.

Kings of the Munsö dynasty
The line of Munsö dynasty kings presented by the Icelandic sagas is not accepted by modern historians, the legendary kings (including the supposed founder of the dynasty, Björn Ironside) typically not being recognized as actual historical figures. The four kings of the dynasty whose existence is corroborated by multiple sources, and who are thus generally accepted as real historical kings of Sweden and recognized as such by the modern Swedish monarchy are Eric the Victorious, Olof Skötkonung, Anund Jacob and Emund the Old. The answer to the question regarding who was Sweden's first king depends on what is meant with "Sweden"; the earliest king reliably known to have ruled both Svealand and Götaland, the core territories of the country, was Olof Skötkonung, who is also listed first in most medieval Swedish king lists.

Hervarar saga ok Heiðreks
The Hervarar saga ok Heiðreks has in some versions an addition which gives a regnal list of Sweden following the death of Ingjald Illråde, the last king of the Yngling dynasty. Sweden was first ruled by Ivar Vidfamne, then Harald Wartooth and his son Eysteinn Beli, before Björn Ironside conquered Sweden. He founded the House of Munsö, and the saga then follows his descendants until Philip of Sweden.

The following chart maps the descendants of Björn Ironside according to the saga:

Vita Ansgari and Adam of Bremen
Rimbert, who travelled with the bishop Ansgar to Sweden as a missionary in the 9th century, wrote about several kings in Vita Ansgari. As Rimbert was a contemporary to the kings he writes about, the Vita is seen as a believable source. Adam of Bremen alludes to the kings mentioned by Rimbert and expands the list of kings to cover the following centuries. However, the distance in time is greater, and he is thus seen as a weaker source for the time before Eric the Victorious. Though no genealogical information is provided by either which confidently connects the kings they mention with Eric the Victorious and his descendants, they are typically assumed to have been part of the same royal dynasty. Attempts have been made to harmonize Rimbert's and Adam of Bremen's kings with the kings mentioned in the sagas (whose existence is otherwise seen as contradicted by their writings), but due to a lack of documented evidence, such attempts have to be considered unreliable and unverifiable.

Kings from the Vita

 * Björn, who reigned c. 829 when Ansgar first visited Sweden at the important port-settlement of Birka. Björn was reportedly friendly to the missionaries but chose not to convert to Christianity (although one of his chief councilors, Hergeir, did).
 * Anund, who is not mentioned as ruling over Birka (possibly ruling somewhere else in Sweden), having been driven from Sweden and taken refuge among the Danes. Anund promised Birka to the Danes as a reward for helping him gain revenge and attacked Birka c. 840. As Birka continues to be ruled by Swedish kings, it is unlikely that the attack succeeded.
 * Eric, who was recently deceased by the time Ansgar visited Sweden for the second time c. 852. According to Rimbert's writings, some of the Anti-Christian Swedes suggested that Eric be worshipped as a god alongside the rest of the Nordic pantheon instead of the new Christian God.
 * Olof, who reigned c. 852, during Ansgar's second visit to Sweden, having then only recently come to the throne. Olof's position of power was weak, since he did not dare support Ansgar's and Rimbert's Christianization mission out of fear of upsetting his people. According to Rimbert, Olof had to negotiate with his own nobles and the will of the gods (i.e. what should be done) was eventually determined through a lottery-like system, the results of which was determined by a council of religious figures rather than the king. Olof apparently warred against Courland.

Kings from Adam of Bremen

 * Ring, possibly together with his sons Eric and Emund. If he co-ruled with his sons, they reigned c. 936. If there was not a co-regency, Ring might have ruled earlier, with his second son Emund reigning c.  936.
 * Eric, son of Ring and either his co-ruler or direct successor.
 * Emund, son of Ring and either co-ruler with Ring and Eric Ringsson, or the direct successor of Eric Ringsson.
 * Emund, son of Eric and the direct successor of Emund Ringsson (or some co-ruler arrangement of the previous three monarchs). Adam of Bremen gives this king as Eric the Victorious's predecessor.

Other kings
There are also a few kings mentioned in various sources, but which are inconsitenstly placed in the regnal list, or not at all. These include:
 * Eric, attested by the Sparlösa Runestone (from c. 800) as a king at Uppsala.
 * Eric Weatherhat
 * Erik Årsäll

Theory

 * Ragnvald Ingvarsson, historian Omeljan Pritsak speculated that he could be related to Munsö house due to his rank in Varangian guards.
 * Ingvar the Far-Travelled

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: House of Munsö


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Talk:Guido Borelli

Untitled
A blatant vanity page, by an anonymous contributor (under two ISPs) with no other intesrest in wikipedia (see History). Wetman 21:11, 15 Aug 2004 (UTC)

 * I know. See my my archived talk. I've toned it down considerably, and if it doesn't turn into an ad again, it might be just marginally encyclopedic (the guy has some 600 Googlits, which might be enough for the article to survive a VfD listing). Still, if it does turn into an ad again, I'll list it on VfD myself. The original version also was a copyvio, although the poster later claimed to be the painter himself and has given permission even though he also stated that he wasn't the author of the copied text. This minor (and disputed) copyvio is now still in the page history. Lupo 07:09, 16 Aug 2004 (UTC)

title: Talk:Guido Borelli


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United States congressional delegations from Wisconsin

These are tables of congressional delegations from Wisconsin to the United States House of Representatives and the United States Senate.

The current dean of the Wisconsin delegation is Senator Tammy Baldwin (D), having served in Congress since 1999.

Current members
List of members, their terms in office, district boundaries, and the district political ratings according to the Cook Partisan Voting Index (CPVI). The delegation has a total of 8 members, including 5 Republicans, 2 Democrats, and 1 vacancy.


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U.S. Route 129

U.S. Route 129 (US 129) is an auxiliary route of US 29, which it intersects in Athens, Georgia. US 129 currently runs for 582 mi from an intersection with US 19/US 27 ALT/US 98 in Chiefland, Florida, to an interchange with Interstate 40 (I-40) in Knoxville, Tennessee. It passes through the states of Florida, Georgia, North Carolina, and Tennessee. It goes through the cities of Macon, Athens, Gainesville, and Knoxville.

The section that is located beside Deals Gap on the North Carolina–Tennessee state line is known as The Dragon or The Dragon's Tail from its winding course. It is a popular motorcycle and sports car destination. This segment runs from Tab Cat Creek to Deals Gap and has about 318 curves in this 11 mile section.

Florida

US 129 begins at US 19/US 27 Alternate/US 98 in Chiefland, Florida, along hidden SR 47 until it reaches SR 26 in Trenton. From there, the road is signed along hidden SR 49. It then moves west, briefly overlapping US 27 (hidden SR 20) and heads north again in Branford, before that road intersects SR 349, which used to also serve as US 129 Alternate. From here, it intersects with US 90/SR 51 in Live Oak, taking SR 51 as the new hidden state road, then meets I-10 at exit 283, and later I-75 at exit 451. During a concurrency with US 41 in Jasper, US 129 loses SR 51 as a hidden route after the concurrency ends and runs northwest along SR 100 into Georgia.

Georgia
US 129 provides the primary route between central Georgia and Athens. It approaches Athens from the south where it joins SR 10 Loop, a mostly interstate-grade bypass that rings Athens-Clarke County. Here US 129 turns right, toward the northeast, where it runs concurrently with US 78/US 29/US 441/SR 15 (and unsigned SR 422) along the bypass. US 129 intersects with US 29 northeast of Athens and continues along SR 10 Loop westward before exiting at Jefferson Road where it winds northwesterly towards Gainesville as one of several routes to I-85 from Athens.

North Carolina
From the Georgia state line, it travels northeast to Topton, where it goes north to Robbinsville followed by Tennessee, through Deals Gap.

Tennessee
US 129 enters Tennessee to the west of Great Smoky Mountains National Park and rides along Chilhowee Lake for a short distance before turning due north. In this 11 mi stretch after the Tennessee–North Carolina state line, drivers will encounter 318 curves in a distance of around 11 miles. These curves make this stretch of highway a well-known motorcycle/sports car destination named Tail Of The Dragon. On weekends, through spring to the fall months, visitors are likely to see numerous riders and drivers on this stretch of the highway to experience the thrill and scenery. US 129 then travels due north, becoming known as Alcoa Highway and passing through the city of Maryville. It travels through Alcoa, passing by McGhee Tyson Airport, and then intersecting I-140. US 129 then crosses the Tennessee River on the James E. "Buck" Karnes Bridge into Knoxville. Shortly thereafter, US 129 becomes a limited-access highway for a short distance. It has an interchange with US 11/US 70 immediately after entering Knoxville. Shortly thereafter, US 129 meets its northern terminus, an interchange with I-40.

Major intersections

 * Florida
 * in Chiefland
 * east-southeast of Branford. The highways travel concurrently to Branford.
 * in Live Oak
 * north-northeast of Live Oak
 * north-northeast of Suwannee Springs
 * southeast of Jasper. The highways travel concurrently to Jasper.

 * Georgia
 * in Stockton
 * east-northeast of Lakeland. The highways travel concurrently to Lakeland.
 * in Alapaha. The highways travel concurrently to northeast of Alapaha.
 * in Ocilla. The highways travel concurrently to Fitzgerald.
 * in Abbeville
 * in Hawkinsville. The highways travel concurrently to northwest of Hawkinsville.
 * north of Sofkee. The highways travel concurrently to Macon.
 * in Macon. The highways travel concurrently through Macon.
 * in Macon. The highways travel concurrently through Macon.
 * in Macon
 * in Eatonton. The highways travel concurrently to Athens.
 * in Madison
 * in Madison. The highways travel concurrently to northeast of Madison.
 * in Athens. The highways travel concurrently through Athens.
 * in Jefferson
 * in Gainesville. The highways share an unsigned concurrency to northeast of Gainesville.
 * in Turners Corner. The highways travel concurrently to Topton, North Carolina.
 * in Blairsville.

 * North Carolina
 * in Ranger. US 64/US 129 travels concurrently to Murphy. US 74/US 129 travels concurrently to Topton.

 * Tennessee
 * south-southeast of Clover Hill. The highways travel concurrently to Maryville.
 * in Maryville
 * in Alcoa
 * in Knoxville
 * in Knoxville

In popular culture
U.S. 129 is mentioned in the popular country song Bottoms Up by Brantley Gilbert: "I see you and me riding like Bonnie and Clyde, Goin 95 burning down 129."

U.S. 129 is known particularly for being a route containing hundreds of mountainous curves and turns (in the Tennessee section). With the rise of the internet and telecommunications, the Tennessee section of the route has become popularized by its motoring enthusiasts who share their experiences through social messaging boards and media outlets. This small stretch of around 11 miles starting at Deals Gap just before the Tennessee state line in North Carolina, has been nicknamed Tail Of The Dragon.

title: U.S. Route 129


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Walter C. Alvarez

Walter Clement Alvarez (July 22, 1884 – June 18, 1978) was an American medical doctor of Spanish descent. He authored several dozen books on medicine, and wrote introductions and forewords for many others.

Biography
He was born in San Francisco and spent his childhood in Hawaii, where his father was a government physician. In 1910, having received his medical education in Stanford University, he began his practice.

From 1913 to the end of 1925, Alvarez practiced internal medicine in San Francisco and conducted research at the University of California, Berkeley. He lived at 3837 Clay Street raising his family. In 1934, he became Professor of Medicine at the University of Minnesota (Mayo Foundation) and later served as Consultant in Medicine Emeritus.

His father was Luis F. Alvarez, who worked as a physician in California and Hawaii and developed a method for the better diagnosis of macular leprosy. His sister was California artist and oil painter Mabel Alvarez.

Alvarez was married to the former Harriet Skidmore Smythe and the couple had four children: Gladys, Luis, Robert and Bernice. Luis later became a Nobel Prize-winning physicist.

His grandson is Walter Alvarez, a Professor of Geology at the University of California, Berkeley.

Beginning after his retirement in 1951, Alvarez began writing a medical column which soon became syndicated throughout North America in hundreds of daily and weekly newspapers. The Walter C. Alvarez Memorial Award is named in his honor and is presented to a member or nonmember of the American Medical Writers Association to honor excellence in communicating health care developments and concepts to the public. He is most notable for his enlightened approach to homosexuality and his efforts to educate the medical profession and the broader public about the topic. He is regarded as an ally of the homophile movement in the 1950s-1970s.

Alvarez' syndrome, a syndrome of hysterical or neurotic abdominal bloating without any excess of gas in the digestive tract, and Alvarez-waves, painless uterine contractions occurring during the length of pregnancy, are named after him.

Alvarez was the first to investigate electric activity of a stomach and, thereby, became the founder of a new diagnostic gastroenterology branch — electrogastrography.

He died in California in 1978.

His personal papers are held by Lane's Archives and Special Collections.

Publications
• Alvarez on Alvarez, 1977

• Walter C. Alvarez: American Man of Medicine, 1976

• Inglenook Doctor Book, 1975

• Dr. Walter C. Alvarez on Health & Life, 1975

• Gay Liberation and Homosexuality and Other Forms of Sexual Deviance (co-written with Sue March), 1974

• The New Home Medical Encyclopedia (co-authored with Samuel L. Andelman), 1974

• Nerves in Collision, 1972

• Danger Signals: How to Recognize the Warnings of Serious Diseases, 1966

• Little Strokes, 1966

• Incurable Physician, An Autobiography, 1963

• Minds that Came Back, 1961

• Geriatrics: Devoted to Research and Clinical Study of the Diseases, 1958

• Practical Leads to Puzzling Diagnoses: Neuroses that Run Through Families, 1958

• Live at Peace with Your Nerves, 1958

• How to Live with Your Arthritis, 1953

• The Neuroses: Diagnosis and Management of Functional Disorders and Minor Psychoses, 1951

• How to Live with Your Ulcer, 1951

• Brief Psychotheraphy: A Handbook for Physicians on the Clinical Aspects of Neuroses (co-written with Bertrand S. Frohman and Evelyn P. Frohman), 1948

• Nervousness, Indigestion and Pain, 1943 (Previously issued as Nervous Indigestion)

• Help Your Doctor to Help You When You Have Food Allergy, 1941

• Help Your Doctor to Help You When You Have Gallstones and Disease of the Gallbladder, 1941

• The March of Medicine (co-written with Karl A. Menninger), 1940

• An Introduction to Gastroenterology, 1940

• How to Live with your Ulcer, 1933

• Nervous Indigestion, 1931

• The Mechanics of the Digestive Tract: An Introduction to Gastroenterology, 1928

• The Mechanics of the Digestive Tract, 1922

title: Walter C. Alvarez


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Unconditional election

Unconditional election (also called sovereign election or unconditional grace) is a Calvinist doctrine relating to predestination that describes the actions and motives of God prior to his creation of the world, when he predestined some people to receive salvation, the elect, and the rest he left to continue in their sins and receive the just punishment, eternal damnation, for their transgressions of God's law as outlined in the Old and New Testaments of the Bible. God made these choices according to his own purposes apart from any conditions or qualities related to those persons.

The counter-view to unconditional election is the Arminian view of conditional election, the belief that God chooses for eternal salvation those whom he foreknows will exercise their free will to respond to God's prevenient grace with faith in Christ. God's election was for a clear unalterable purpose, to elect those who will believe.

Summary
In Calvinist theology, unconditional election is considered to be one aspect of predestination in which God chooses certain individuals to be saved. Those elected receive mercy, while those not elected, the reprobates, receive justice without condition. This unconditional election is essentially related to the rest of the TULIP (five points of Calvinism) doctrinal outline and hinges upon the supreme belief in the absolute sovereignty of God over the affairs of humans. God unconditionally elects certain people even though they are sinful as an act of his saving grace apart from the shortcomings or will of man. Those chosen have done nothing to deserve this grace.

In Calvinist and some other churches (Waldensians, Katharoi, Anabaptists, Particular Baptists, etc.) this election has been called "unconditional" because his choice to save the elect does not depend on anything inherent in any person chosen, on any act that a person performs or on any belief that a person exercises.

According to the doctrine of total depravity (the first of the five points of Calvinism), the influence of sin has so inhibited the individual's volition that no one is willing or able to come to or follow God apart from God first regenerating the person's soul to give them the ability to love him and take part in the salvation process. Hence, God's choice in election is, and can only be based solely on, God's own independent and sovereign will and [not] upon the foreseen actions of man.

Scholastic Calvinists have sometimes debated precisely when, relative to the decree for the fall of man, God did his electing – see supralapsarianism and infralapsarianism – though such distinctions are not often emphasized in modern Calvinism.

The Reformed position is frequently contrasted with the Arminian doctrine of conditional election in which God's eternal choice to save a person is conditioned on God's certain foreknowledge of future events, namely, that certain individuals would freely exercise faith and trust in response to God's offer of salvation. The Arminian doctrine agrees that the influence of sin has so inhibited the individual's volition that no one is willing or able to come to or follow God, but the Arminian doctrine of prevenient (or "enabling") grace is considered sufficient to enable a person to repent and believe before regeneration. Based upon God's foreknowledge of each individual human response to the gospel of Jesus Christ, God justly and sovereignly elects to salvation those he foresees exercising free will to repent, believe in the gospel of Jesus Christ and follow God.

History
The doctrine was first articulated and popularized by 4th century Church Father Augustine of Hippo during his debates with Pelagius, and he taught that saving grace is bestowed by God on the elect according to his sovereign decrees. Few later theologians prior to the Reformation would take up this idea. However, prominent exceptions include Thomas Aquinas.

Unconditional election was first codified in the Belgic Confession (1561), re-affirmed in the Canons of Dort (1619), which arose from the Quinquarticular Controversy, and is represented in the various Reformed confessions such as the Westminster Standards (1646). Today, it is most commonly associated with the Reformation teachings of John Calvin as one of the five points of Calvinism and is often linked with predestination.

Biblical passages
A number of passages are put forth to support the doctrine, including (quotations are from the KJV):

 * Isaiah 42:1: "Behold my servant, whom I uphold; mine elect Chosen One, in whom my soul delighteth; I have put my spirit upon him: he shall bring forth judgment to the Gentiles."
 * John 1:12,13: "But as many as received him, to them gave he power to become the sons of God, even to them that believe on his name: Which were born, not of blood, nor of the will of the flesh, nor of the will of man, but of God."
 * Acts 13:48: "And when the Gentiles heard this, they were glad, and glorified the word of the Lord: and as many as were ordained to eternal life believed."
 * Romans 9:15–16: "For he saith to Moses, I will have mercy on whom I will have mercy, and I will have compassion on whom I will have compassion. So then it is not of him that willeth, nor of him that runneth, but of God that sheweth mercy."
 * Romans 9:22–24: "What if God, willing to shew his wrath, and to make his power known, endured with much longsuffering the vessels of wrath fitted to destruction: And that he might make known the riches of his glory on the vessels of mercy, which he had afore prepared unto glory, Even us, whom he hath called, not of the Jews only, but also of the Gentiles?"
 * Ephesians 1:4–5: "According as he hath chosen us in him before the foundation of the world, that we should be holy and without blame before him in love: Having predestinated us unto the adoption of children by Jesus Christ to himself, according to the good pleasure of his will,"
 * Ephesians 1:11: "In whom also we have obtained an inheritance, being predestinated according to the purpose of him who worketh all things after the counsel of his own will:"
 * Philippians 1:29: "For unto you it is given in the behalf of Christ, not only to believe on him, but also to suffer for his sake;"
 * 1 Thessalonians 1:4–5: "Knowing, brethren beloved, your election of God. For our gospel came not unto you in word only, but also in power, and in the Holy Ghost, and in much assurance; as ye know what manner of men we were among you for your sake."
 * 2 Thessalonians 2:13: "But we are bound to give thanks alway to God for you, brethren beloved of the Lord, because God hath from the beginning chosen you to salvation through sanctification of the Spirit and belief of the truth:"
 * 2 Timothy 1:9: "Who hath saved us, and called us with an holy calling, not according to our works, but according to his own purpose and grace, which was given us in Christ Jesus before the world began,"

Some biblical passages are put forth as evidence that human volition, not just divine action, plays a central role in salvation (see conditional election):
 * Deuteronomy 30:19: "I call heaven and earth to record this day against you, that I have set before you life and death, blessing and cursing: therefore choose life, that both thou and thy seed may live:"
 * Joshua 24:15: "And if it seem evil unto you to serve the Lord, choose you this day whom ye will serve; whether the gods which your fathers served that were on the other side of the flood, or the gods of the Amorites, in whose land ye dwell: but as for me and my house, we will serve the Lord."

Calvinists generally understand the former passages as giving a window into the divine perspective and the latter passages as speaking from the human perspective in calling people to work out the salvation God has given them.

title: Unconditional election


text:
User:Andries/reference material

Religion incl. new religious movements

 * http://hirr.hartsem.edu/ency/index.html
 * http://www.apologeticsindex.org published by user:Anton Hein

German History

 * http://www.dhm.de/lemo/home.html German language website

General
http://www.britannica.com/

title: User:Andries/reference material


text:
Talk:Airhead

"In addition, in the event of a hypothetical hot war with the Soviet Union, it is considered likely that the Soviets would have captured remote areas such as Iceland and Norway via airheads." This sentence vividly demonstrates how nationalistic military thinking is ossified in 1980s paradigms. Very informative. But not very informative about this topic. Wetman 21:20, 15 Aug 2004 (UTC)
 * I think you're reaching, personally. My sole purpose is to illustrate potential uses for airheads. And it's just a start, mind you. Much more needs to go here. -Joseph 02:59, 2004 Aug 16 (UTC)

title: Talk:Airhead


text:
U.S. Route 231

U.S. Route 231 (US 231) is a north–south U.S highway that is a parallel route of US 31. It runs for 912 mi from St. John, Indiana, at US 41 to south of US 98 in downtown Panama City, Florida. One of its most notable landmarks is the William H. Natcher Bridge, a 0.853 mile long cable-stayed bridge that connects Rockport, Indiana, to Owensboro, Kentucky, spanning the Ohio River.

Florida
In Florida, US 231 is paired with unsigned State Road 75. The southern terminus is at Business US 98 (unsigned State Road 30) in downtown Panama City. The highway is carried by Harrison Avenue until its intersection with US 98. Continuing north, US 231 passes through Youngstown, Fountain, Alford, Cottondale, and Campbellton before entering Alabama. Major intersections include Business US 98, US 98, SR 77, SR 20, Interstate 10, US 90, SR 73, SR 273, and SR 2.

Alabama
In Alabama, US 231 is an alternate north-to-south route to Interstate 65, the main north-to-south thoroughfare in the state. U.S. Route 231 serves the east-central part of the state, with I-65 further west and US 431 further east. While both US 231 and US 431 connect the major cities of Dothan and Huntsville, US 231 has a shorter route through fewer cities and terrain changes, avoiding the mountainous cities of Albertville, Gadsden, Oxford, and Heflin. However, there are some mountainous cities along the route, such as Arab and Oneonta.

U.S. Route 231 is divided along two-lane roads, three-laned roads, and four-laned undivided and divided highways. The entire stretch south of Montgomery is four-laned, mostly divided with some undivided stretches; as it is a critical connector in the National Highway System, which is a very important web of highways critical to U.S. infrastructure. The stretch between Arab and the state line is an almost entirely four-lane divided highway.

Through Huntsville, Alabama, the route functions as Memorial Parkway - the main north-to-south freeway through downtown. The road is a freeway with frontage roads and Texas U-Turns, with some stretches with six lanes plus a frontage road exit lane in each direction. In the medical district of Huntsville, the freeway gains US 431 and loses the SR 53 designation. The road widens to ten lanes on the south side of Interstate 565, with the gained lanes used as access lanes for US 72 or I-565. On the north side of I-565, the road once again goes to six lanes and an exit lane, which is carried along its concurrency with US 72. About a mile north of the second junction with US 72, the route loses its frontage roads and reverts to a four-lane divided highway. In general, the route is an important connector between Dothan, Montgomery, and Huntsville, three of the most populous cities in the state.

Tennessee
US 231 enters Tennessee from Alabama in a concurrency with US 431 until it reaches Fayetteville. North of there it runs through Shelbyville and later passes through the eastern part of the Nashville metro area, passing through the cities of Murfreesboro and Lebanon. By the time it reaches Bethpage, it joins U.S. Route 31E in another concurrency to the northeast before finally crossing the Kentucky State Line north of Westmoreland. The route is approximately 121 mi from Tennessee's northern border to its southern border.

Kentucky
US 231 parallels Interstate 65 before reaching Bowling Green. From Bowling Green, US 231 closely parallels I-165 (formerly the William H. Natcher Parkway) until it reaches Owensboro. At Owensboro, US 231 joins US 60 (also known as the Wendell H. Ford Expressway) around the city's east side, which it then follows to just north of Maceo. US 60 then leaves toward the east while US 231 turns to the north, leaving the state via the William H. Natcher Bridge across the Ohio River.

A portion of the Owensboro-area route is relatively new; in 2014, a new section from Kentucky 54 to Kentucky 2830 opened, bypassing the former bypass route. Part of that former route has been renumbered as Kentucky 603. The remainder, south of 603, is partly a dead-end city street and an abandoned lane that will eventually become part of the David Adkisson Greenbelt trail.

Indiana
In Indiana, US 231 has the distinction of being the state's longest continuous highway. It covers approximately 297 mi in the Hoosier State. US 231 passes through the towns of Dale, Huntingburg, Jasper, and Loogootee before reaching Bloomfield. In Bloomfield, US 231 passes Shawnee Field, a local airport. US 231 slices through central Indiana before reaching West Lafayette, where it runs just south and west of Purdue University. Next it mostly zigzags north and west, staying close to Interstate 65, before heading straight west from Crown Point, terminating at US 41.

Indiana's Major Moves program, which derives its funding from the lease of the Indiana Toll Road to private interests, has made it possible for the state to build many new miles of roadway throughout the state. As part of this program, US 231 is currently being updated to a new-terrain four-lane highway from the Indiana-Kentucky border through Spencer County to Interstate 64. This segment of US 231 has been named the Abraham Lincoln Memorial Parkway.

As of April 2011, the Lincoln Parkway is complete from the Kentucky line to the interchange at I-64 and the bypass of Dale at the northernmost end of the project. It is a fully operational partial cloverleaf and the previous two-lane 231 overpass has been demolished. It has been replaced by a new four-lane overpass.

The section from SR 162 to Indiana State Highway 70 near Chrisney was the last to be opened, after a ribbon-cutting ceremony on March 15, 2011, much sooner than the original July 2011 projected date.

In addition to the Spencer County project, a four-lane bypass of the Dubois County cities of Huntingburg and Jasper is also in the planning stages, but funding has not been secured. A firm timetable for construction has yet to materialize.

History
U.S. Route 152 was commissioned in 1934, connecting Indianapolis with Hammond. It followed US 52 from Indianapolis to northwest of Lafayette, where it turned north to end at US 20 in Hammond. In 1938, the route was decommissioned, and became a southern extension of State Road 53 from northwest of Lafayette to Crown Point, a new State Road 152 from Highland to Hammond, and was simply dropped in favor of the overlapping US 52, State Road 8, and US 41 elsewhere. These parts of SR 53 and SR 8 became US 231 in 1952, when US 231 was extended north from Montgomery to US 41 south of St. John.

Major intersections

 * Florida
 * 6th Street and Harrison Avenue in Panama City
 * in Panama City
 * south of Cottondale
 * in Cottondale

 * Alabama
 * in Dothan
 * in Dothan. The highways travel concurrently through Dothan.
 * in Troy
 * south-southeast of Pike Road. The highways travel concurrently to Montgomery.
 * in Montgomery. The highways travel concurrently through Montgomery.
 * in Montgomery
 * in Sylacauga. The highways travel concurrently to Harpersville.
 * in Pell City
 * in Pell City
 * in Ashville. The highways travel concurrently through Ashville.
 * in Ashville
 * in Ashville
 * south-southwest of Summit
 * in Huntsville. The highways travel concurrently to Fayetteville, Tennessee.
 * in Huntsville.
 * in Huntsville. The highways travel concurrently through Huntsville.

 * Tennessee
 * in Fayetteville. US 64/US 231 travels concurrently through Fayetteville.
 * in Murfreesboro
 * in Murfreesboro. The highways travel concurrently through Murfreesboro.
 * in Lebanon
 * in Lebanon
 * west-southwest of Bransford. The highways travel concurrently to Scottsville, Kentucky.

 * Kentucky
 * in Bowling Green
 * in Bowling Green
 * in Bowling Green. The highways travel concurrently through Bowling Green.
 * in Beaver Dam. The highways travel concurrently through Beaver Dam.
 * in Owensboro. The highways travel concurrently to Maceo.

 * Indiana
 * in Dale
 * in Loogootee. The highways travel concurrently through Loogootee.
 * west-northwest of Scotland
 * in Cloverdale
 * north-northwest of Cloverdale
 * east of Morton
 * in Crawfordsville
 * in Crawfordsville
 * northwest of West Lafayette. The highways travel concurrently to Montmorenci.
 * south of Wolcott
 * in Wolcott. The highways travel concurrently to Remington.
 * east of Remington
 * north of Remington
 * in Crown Point
 * in St. John

title: U.S. Route 231


text:
City (novel)

City is a 1952 science fiction fix-up novel by American writer Clifford D. Simak. The original version consists of eight linked short stories, all originally published in Astounding Science Fiction under the editorship of John W. Campbell between 1944 and 1951, along with brief "notes" on each of the stories. These notes were specially written for the book, and serve as a bridging story of their own. The book was reprinted as ACE #D-283 in 1958, cover illustration by Ed Valigursky.

A ninth City tale was published in 1973, called "Epilog". Many later editions include the ninth tale.

Plot introduction
The fixup novel describes a legend consisting of eight tales that the pastoral, pacifist Dogs recite as they pass down an oral legend of a creature known as Man. Each tale is preceded by doggish notes and learned discussion.

An editor's preface notes that after each telling of the legend the pups ask many questions:

"What is Man?" they'll ask. Or perhaps: "What is a city?" Or: "What is a war?" There is no positive answer to any of these questions.

The Tales
As the tales unfold, they recount a world where humans, having developed superior transportation, have abandoned the cities and moved into the countryside. Hydroponic farming and decentralized power allow small communities to become self-sufficient. In the beginning, the driving force for dispersion is the fear of nuclear holocaust, but eventually humans discover they simply prefer the pastoral lifestyle.

The tales primarily focus around the Webster family and their robot servant, Jenkins. The name Webster gradually becomes "webster", a noun meaning a human. Themes familiar to Simak readers recur in these stories, notably the pastoral settings and the faithful dogs.

Each successive tale tells of further breakdown of urban society. As mankind abandons the cities, each family becomes increasingly isolated. Bruce Webster surgically provides dogs with a means of speech and he gives them contact lenses for better vision. The breakdown of civilization allows wandering mutant geniuses to grow up unrestrained by conventional mores. A mutant called Joe invents a way for ants to stay active year-round in Wisconsin, so that they need not start over every spring. Eventually, the ants form an industrial society in their hill. The amoral Joe, tiring of the game, kicks over the anthill. The ants ignore this setback and build bigger and more industrialized colonies.

A later tale tells of a research station on the surface of Jupiter. (This story, first published as Desertion in 1944, was one of the first stories about pantropy.) Simak's version of Jupiter is a cold, windswept, and corrosive hell where only advanced technology allows the station to exist at all. A scientist is accompanied by Towser, his tired and flea-bitten old dog. But there is a problem: Men permanently transformed to survive unaided on Jupiter's surface leave the station to gather data and inexplicably fail to return. Finally, the scientist transforms himself and his canine companion into the seal-like beings that can survive the surface. They leave the station in their new form and experience Jupiter as a paradise. Towser's fleas and irritations are gone and he is able to talk telepathically to his former master. Like the previously transformed station personnel, the scientist decides never to return.

He eventually does return, to share with all humankind what he has discovered. It seems impossible – how can he show them the wondrous Jupiter that he and Towser perceive? Joe steps in again, once more out of sheer mischief. He knows a mind trick to allow people to broadcast meaning to others' minds as they speak. By means of a kaleidoscope-like instrument, he can twist the minds of other people so they can perform the mind trick. Thus all humanity learns the truth about Jupiter, and most elect to leave Earth, give up their physical humanity and live transformed on Jupiter's surface.

Simak's vision of human apocalypse is unusual, not one of destruction, but simply of isolation. Much of humankind becomes so lonely that it eventually dies off. Some favor starting over as a completely different species capable of experiencing on Jupiter the simple bliss that humans have otherwise lost.

Ten thousand years in the future, Jenkins is provided with a new body so he can better serve the few remaining "websters". By then, the dog civilization has spread all around the Earth, including the rest of the animals whom, little by little, the dogs introduce to their civilization. All of them are significantly intelligent, and Simak appears to mean that they were so all the while even though humans were not able to notice it. This civilization is a pacifist and vegetarian one. The dogs intervene in nature and distribute food to wild animals, managing to end virtually all predation. Besides, they also look for doors between dimensions through which some beings from different worlds are able to pass. At this point, a wraithlike creature called a "cobbly" appears, having traveled from another world on the time thread. Before it is driven away, Jenkins's new telepathic sense enables him to read the creature's mind to discover how it moves from world to world. Realizing that humanity cannot peacefully coexist with the Dogs and the other animals, Jenkins uses the knowledge to take his human charges to one of the other worlds. Eventually, the human race dies out on the new world.

However, returning to the initial Earth in the final tale of the book, Jenkins finds the dogs dealing with the ever-growing Ant City, which is taking over the Earth. Jenkins travels to Geneva, where a last small group of humans sleep in suspended animation. He asks his former master, a Webster, how to deal with the ants. The answer is typically human – poisoned bait, enough to kill but not before the bait is taken back to the ant colony to kill widely there. Jenkins is saddened because he realizes the Dogs will never accept this solution. He tells the dogs that the "websters" had no answer. The Dogs leave Earth for one of the other worlds.

The original eight stories were written and published during World War II and reflect the attitude that humans are unable to live at peace with their fellow beings. There is an underlying theme throughout the book that humans possess a fundamental aggressive flaw they will never be able to overcome.

The Coda
Simak wrote the ninth and last tale in the City saga in 1973, twenty-two years after he wrote the previous episode. Jenkins is on the original Earth, living at the old Webster home, surrounded on all sides by the Ant City. He comes to realize that the Ant City is dead, just as a spaceship returns to take him to the robot worlds. Breaking through the wall of the city, he sees nothing but infinitely repeated versions of a single sculpture; a human boot kicking over an anthill.

Reception
Groff Conklin described City as a "strange and fascinating program ... completely enthralling". Boucher and McComas praised the volume as "a high-water mark in science fiction writing" adding, "Here is a book that caused these reviewers to chuck objective detachment out the window and emit a loud, partisan 'Whee! P. Schuyler Miller placed the novel among the best science fiction books of 1952, although he felt the added interstitial matter was inferior to the original stories. In his "Books" column for F&SF, Damon Knight selected City as one of the 10 best sf books of the 1950s. Algis Budrys called it "the outstanding example of a pasteup that had been begging to be done". Michel Houellebecq, in a 2010 interview with the Paris Review, describes the book as a masterpiece.

Awards and nominations

 * International Fantasy Award, 1952

title: City (novel)


text:
Pressure ulcer

Pressure ulcers, also known as pressure sores, bed sores or pressure injuries, are localised damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of usually long-term pressure, or pressure in combination with shear or friction. The most common sites are the skin overlying the sacrum, coccyx, heels, and hips, though other sites can be affected, such as the elbows, knees, ankles, back of shoulders, or the back of the cranium.

Pressure ulcers occur due to pressure applied to soft tissue resulting in completely or partially obstructed blood flow to the soft tissue. Shear is also a cause, as it can pull on blood vessels that feed the skin. Pressure ulcers most commonly develop in individuals who are not moving about, such as those who are on chronic bedrest or consistently use a wheelchair. It is widely believed that other factors can influence the tolerance of skin for pressure and shear, thereby increasing the risk of pressure ulcer development. These factors are protein-calorie malnutrition, microclimate (skin wetness caused by sweating or incontinence), diseases that reduce blood flow to the skin, such as arteriosclerosis, or diseases that reduce the sensation in the skin, such as paralysis or neuropathy. The healing of pressure ulcers may be slowed by the age of the person, medical conditions (such as arteriosclerosis, diabetes or infection), smoking or medications such as anti-inflammatory drugs.

Although often prevented and treatable if detected early, pressure ulcers can be very difficult to prevent in critically ill people, frail elders, and individuals with impaired mobility such as wheelchair users (especially where spinal injury is involved). Primary prevention is to redistribute pressure by regularly turning the person. The benefit of turning to avoid further sores is well documented since at least the 19th century. In addition to turning and re-positioning the person in the bed or wheelchair, eating a balanced diet with adequate protein and keeping the skin free from exposure to urine and stool is important.

The rate of pressure ulcers in hospital settings is high; the prevalence in European hospitals ranges from 8.3% to 23%, and the prevalence was 26% in Canadian healthcare settings from 1990 to 2003. In 2013, there were 29,000 documented deaths from pressure ulcers globally, up from 14,000 deaths in 1990.

The United States has tracked rates of pressure injury since the early 2000s. Whittington and Briones reported nationwide rates of pressure injuries in hospitals of 6% to 8%. By the early 2010s, Lyder and colleagues had research the rate of pressure injury to drop to about 4.5% across the Medicare population, following the introduction of the International Guideline for pressure injury prevention. Padula and colleagues have witnessed a +29% uptick in pressure injury rates in recent years associated with the rollout of penalizing Medicare policies.

Complications
Pressure ulcers can trigger other ailments, cause considerable suffering, and can be expensive to treat. Some complications include autonomic dysreflexia, bladder distension, bone infection, pyarthrosis, sepsis, amyloidosis, anemia, urethral fistula, gangrene and very rarely malignant transformation (Marjolin's ulcer - secondary carcinomas in chronic wounds). Sores may recur if those with pressure ulcers do not follow recommended treatment or may instead develop seromas, hematomas, infections, or wound dehiscence. Paralyzed individuals are the most likely to have pressure sores recur. In some cases, complications from pressure sores can be life-threatening. The most common causes of fatality stem from kidney failure and amyloidosis. Pressure ulcers are also painful, with individuals of all ages and all stages of pressure ulcers reporting pain.

Cause
There are four mechanisms that contribute to pressure ulcer development:
 * 1) External (interface) pressure applied over an area of the body, especially over the bony prominences can result in obstruction of the blood capillaries, which deprives tissues of oxygen and nutrients, causing ischemia (deficiency of blood in a particular area), hypoxia (inadequate amount of oxygen available to the cells), edema, inflammation, and, finally, necrosis and ulcer formation. Ulcers due to external pressure occur over the sacrum and coccyx, followed by the trochanter and the calcaneus (heel).
 * 2) Friction is damaging to the superficial blood vessels directly under the skin. It occurs when two surfaces rub against each other. The skin over the elbows can be injured due to friction. The back can also be injured when patients are pulled or slid over bed sheets while being moved up in bed or transferred onto a stretcher.
 * 3) Shearing is a separation of the skin from underlying tissues. When a patient is partially sitting up in bed, skin may stick to the sheet, making the skin susceptible to shearing in case underlying tissues move downward with the body toward the foot of the bed. This may also be possible on a patient who slides down while sitting in a chair.
 * 4) Moisture is also a common pressure ulcer culprit. Sweat, urine, feces, or excessive wound drainage can further exacerbate the damage done by pressure, friction, and shear. It can contribute to maceration of surrounding skin thus potentially expanding the deleterious effects of pressure ulcers.

Risk factors
There are over 100 risk factors for pressure ulcers. Factors that may place a patient at risk include immobility, diabetes mellitus, peripheral vascular disease, malnutrition, cerebral vascular accident and hypotension. Other factors are age of 70 years and older, current smoking history, dry skin, low body mass index, urinary and fecal incontinence, physical restraints, malignancy, vasopressin prescription, and history of prior pressure injury development.

Pathophysiology
Pressure ulcers may be caused by inadequate blood supply and resulting reperfusion injury when blood re-enters tissue. A simple example of a mild pressure sore may be experienced by healthy individuals while sitting in the same position for extended periods of time: the dull ache experienced is indicative of impeded blood flow to affected areas. Within 2 hours, this shortage of blood supply, called ischemia, may lead to tissue damage and cell death. The sore will initially start as a red, painful area. The other process of pressure ulcer development is seen when pressure is high enough to damage the cell membrane of muscle cells. The muscle cells die as a result and skin fed through blood vessels coming through the muscle die. This is the deep tissue injury form of pressure ulcers and begins as purple intact skin.

According to Centers for Medicare and Medicaid Services, pressure ulcers are one of the eight preventable iatrogenic illnesses. If a pressure ulcer is acquired in the hospital, the hospital will no longer receive reimbursement for the person's care. Hospitals spend about $27 billion annually for treatment of pressure injuries. Whereas, the cost of pressure injury prevention is cost-effective, if not cost-saving, and would cost less than half the amount of resources to prevent compared to treat in health systems.

Sites
Common pressure sore sites include the skin over the coccyx, the sacrum, the ischia/ischium, the heels of the feet, over the heads of the long bones of the foot, buttocks, over the shoulder, and over the back of the head.

Reduce Pressure
Pressure must be removed from high risk body areas by frequent changes in position in bed or chair including turning side to side. Chair cushions and air mattresses should be used for immobile patients. Heels should be off of the bed.

Adequate Calories and Protein
Eating by mouth is preferred and intake of food and fluid should meet calorie, protein and fluid needs. Work with a dietician if needed. Supplements may be needed.

Biofilm
Biofilm is one of the most common reasons for delayed healing in pressure ulcers. Biofilm occurs rapidly in wounds and stalls healing by keeping the wound inflamed. Frequent debridement and antimicrobial dressings are needed to control the biofilm. Infection prevents the healing of pressure ulcers. Signs of pressure ulcer infection include slow or delayed healing and pale granulation tissue. Signs and symptoms of systemic infection include fever, pain, redness, swelling, warmth of the area, and purulent discharge. Additionally, infected wounds may have a gangrenous smell, be discolored, and may eventually produce more pus.

In order to eliminate this problem, it is imperative to apply antiseptics at once. Hydrogen peroxide (a near-universal toxin) is not recommended for this task as it increases inflammation and impedes healing. Cleaning the open wound with hypochlorous acid is helpful. Dressings with cadexomer iodine, silver, or honey have been shown to penetrate bacterial biofilms. Systemic antibiotics are not recommended in treating local infection in a pressure ulcer, as it can lead to bacterial resistance. They are only recommended if there is evidence of advancing cellulitis, bony infection, or bacteria in the blood.

Classification
The definitions of the pressure ulcer stages are revised periodically by the National Pressure Injury Advisory Panel (NPIAP) in the United States and the European Pressure Ulcer Advisory Panel (EPUAP) in Europe. Different classification systems are used around the world, depending upon the health system, the health discipline and the purpose for the classifying (e.g. health care versus, prevalence studies versus funding. Briefly, they are as follows:
 * Stage 1: Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. The area differs in characteristics such as thickness and temperature as compared to adjacent tissue. Stage 1 may be difficult to detect in individuals with dark skin tones. May indicate "at risk" persons (a heralding sign of risk).
 * Stage 2: Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister. Presents as a shiny or dry shallow ulcer without slough or bruising. This stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration or excoriation.
 * Stage 3: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. The depth of a stage 3 pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and stage 3 ulcers can be shallow. In contrast, areas of significant adiposity can develop extremely deep stage 3 pressure ulcers. Bone/tendon is not visible or directly palpable.
 * Stage 4: Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling. The depth of a stage 4 pressure ulcer varies by anatomical location. The bridge of the nose, ear, occiput and malleolus do not have (adipose) subcutaneous tissue and these ulcers can be shallow. Stage 4 ulcers can extend into muscle and/or supporting structures (e.g., fascia, tendon or joint capsule) making osteomyelitis likely to occur. Exposed bone/tendon is visible or directly palpable. In 2012, the National Pressure Injury Advisory Panel stated that pressure ulcers with exposed cartilage are also classified as a stage 4.
 * Unstageable: Full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels is normally protective and should not be removed.
 * Deep Tissue Pressure Injury (formerly suspected deep tissue injury): Intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister. Pain and temperature change      often precede skin color changes. Discoloration may appear differently in darkly pigmented skin. This injury results from intense and/or prolonged pressure and shear forces at the bone-muscle interface. The wound may evolve rapidly to reveal the actual extent of tissue injury, or may resolve without tissue loss. If necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle or other underlying structures are visible, this indicates a full thickness pressure injury (Unstageable, Stage 3 or Stage 4). Do not use DTPI to describe vascular, traumatic, neuropathic, or dermatologic conditions.

The term medical device related pressure ulcer refers to a cause rather than a classification. Pressure ulcers from a medical device are classified according to the same classification system being used for pressure ulcers arising from other causes, but the cause is usually noted. Pressure injury from medical devices on mucous membranes should not be staged.

Ischemic fasciitis
Ischemic fasciitis (IF) is a benign tumor in the class of fibroblastic and myofibroblastic tumors that, like pressure ulcers, may develop in elderly, bed-ridden individuals. These tumors commonly form in the subcutaneous tissues (i.e. lower most tissue layer of the skin) that overlie bony protuberances such as those in or around the hip, shoulder, greater trochanter of the femur, iliac crest, lumbar region, or scapular region. IF tumors differ from pressure ulcers in that they typically do not have extensive ulcerations of the skin and on histopathological microscopic analysis lack evidence of acute inflammation as determined by the presence of various types of white blood cells. These tumors are commonly treated by surgical removal.

Prevention
There are various approaches that are used widely for preventing pressure ulcers. Suggested approaches include modifications to bedding and mattresses, different support systems for taking pressure off of affected areas, airing of surfaces of the body, skin care, nutrition, and organizational modifications (for example, changing the care routines in hospitals or homes where people require extended bedrest). Overall, unbiased clinical studies to determine the effectiveness of these types of interventions and to determine the most effective intervention are needed in order to best prevent pressure ulcers.

Clinical guidelines for preventing pressure ulcers
Numerous evidence-based and expert consensus-based clinical guidelines have been to developed to help guide medical professionals internationally and in specific countries including the UK. The Standardized Pressure Injury Prevention Protocol (SPIPP) Checklist is a derivative of the International Guideline that was designed to facilitate consistent implementation of pressure injury prevention. In 2022, United States Congress passed legislation updating the Military Construction and Veterans Affairs and Related Agencies Appropriations Act, 2015 to establish the SPIPP Checklist as law that United States Department of Veterans Affairs (VA) facilities should adhere to in order to keep patients safe from harm.

Risk assessment
Before turning and repositioning a person, a risk assessment tool is suggested to determine what is the best approach for preventing pressure ulcers in that person. Some of the most common risk assessment tools are the Braden Scale, Norton, or Waterlow tools. The type of risk assessment tool that is used, will depend on which hospital the patient is admitted to and the location. After the risk assessment tool is used, a plan will be developed for the patient individually to prevent Hospital- Acquired Pressure Injuries. This plan will consist of different turning and repositioning strategies. These risk assessment tools provide the nursing staff with a baseline for each patient regarding their individual risk for acquiring a pressure injury. Factors that contribute to these risk assessment tools are moisture, activity, and mobility. These factors are considered and scored using the scale being used, whether it be the Braden, Norton, or Waterlow scale. The numbers are then added up and based on that final number, a score will be given and appropriate measures will be taken to ensure that the patient is being properly repositioned. Unfortunately, this is not always completed in hospitals like it should be.

Efforts in the United States and South Korea have sought to automate risk assessment and classification by training machine learning models on electronic health records.

Redistribution of pressure
An important aspect of care for most people at risk for pressure ulcers and those with bedsores is the redistribution of pressure so that no pressure is applied to the pressure ulcer. In the 1940s Ludwig Guttmann introduced a program of turning paraplegics every two hours thus allowing bedsores to heal. Previously such individuals had a two-year life-expectancy, normally succumbing to blood and skin infections. Guttmann had learned the technique from the work of Boston physician Donald Munro. There is lack of evidence on prevention of pressure ulcer whether the patient is put in 30 degrees position or at the standard 90 degrees position.

Nursing homes and hospitals usually set programs in place to avoid the development of pressure ulcers in those who are bedridden, such as using a routine time frame for turning and repositioning to reduce pressure. The frequency of turning and repositioning depends on the person's level of risk.

Various interventions have been developed to redistribute pressure including the use of different bed mattresses, support surfaces, and the use of static chairs.

Support surfaces
The use of different types of mattresses including high density foam, surfaces with reactive fibers or gels in them, and surfaces that incorporate reactive water are sometimes suggested to redistribute pressure. The evidence supporting these interventions and whether they prevent new ulcers, increase the comfort level, or have other positive or more negative adverse effects is weak. Many support surfaces redistribute pressure by immersing and/or enveloping the body into the surface. Some support surfaces, including antidecubitus mattresses and cushions, contain multiple air chambers that are alternately pumped. Methods to standardize the products and evaluate the efficacy of these products have only been developed in recent years through the work of the S3I within NPUAP.

There is some evidence that the use of foam mattresses is not as effective as support approaches that include alternating pressure air surfaces or reactive surfaces. It is not clear if interventions that include a reactive air surface are more effective than reactive surfaces that include water or gel or other substrates. In addition, the effectiveness of sheepskin overlays on top of mattresses is not clear.

Static chairs (as opposed to wheelchairs) have also been suggested for pressure redistribution. Static chairs can include: standard hospital chairs; chairs with no cushions or manual/dynamic function; and chairs with integrated pressure redistributing surfaces and recline, rise or tilt functions. More research is needed to establish how effective pressure redistributing static chairs are for preventing pressure ulcers.

For individuals with limited mobility, pressure shifting on a regular basis and using a wheelchair cushion featuring pressure relief components can help prevent pressure wounds.

Nutrition
The benefits of nutritional interventions with various compositions for pressure ulcer prevention are uncertain. The International Guideline on Pressure Injury Prevention and Treatment and many evidenced based recommendations for prevention of pressure injury and their treatment.

Organisational changes
There is some suggestion that organisational changes may reduce incidence of pressure ulcers, with healthcare professionals central to the prevention of pressure ulcers in both hospital and community settings. It is not clear from studies on the effectiveness of these approaches as to the best organisational change that would benefit those at risk of pressure ulcers including organisation of health services, risk assessment tools, wound care teams, and education. This is largely due to the lack of high-quality research in these areas.

Wound care and dressings
Caring for wounds and ulcers that have been started and the use of creams are also considerations in preventing worsening to ulcers and new primary ulcers. Creams containing fatty acids may be more effective in reducing incidence of pressure ulcers compared to creams without fatty acids. Silicone dressings may also reduce pressure ulcer incidence. There is no evidence that massage reduces pressure ulcer incidence. Controlling the heat and moisture levels of the skin surface, known as skin microclimate management, may also play a role in the prevention and control of pressure ulcers. Skin care is also important because damaged skin does not tolerate pressure. However, skin that is damaged by exposure to urine or stool is not considered a pressure ulcer. These skin wounds should be classified as Incontinence Associated Dermatitis.

Treatment
Recommendations to treat pressure ulcers include the use of bed rest, pressure redistributing support surfaces, nutritional support, repositioning, wound care (e.g. debridement, wound dressings) and biophysical agents (e.g. electrical stimulation). Reliable scientific evidence to support the use of many of these interventions, though, is lacking. More research is needed to assess how to best support the treatment of pressure ulcers, for example by repositioning.

Debridement
Necrotic tissue should be removed in most pressure ulcers. The heel is an exception in many cases when the limb has an inadequate blood supply. Necrotic tissue is an ideal area for bacterial growth, which has the ability to greatly compromise wound healing. There are five ways to remove necrotic tissue.
 * 1) Autolytic debridement is the use of moist dressings to promote autolysis with the body's own enzymes and white blood cells. It is a slow process, but mostly painless, and is most effective in individuals with a properly functioning immune system.
 * 2) Biological debridement, or maggot debridement therapy, is the use of medical maggots to feed on necrotic tissue and therefore clean the wound of excess bacteria. Although this fell out of favor for many years, in January 2004, the FDA approved maggots as a live medical device.
 * 3) Chemical debridement, or enzymatic debridement, is the use of prescribed enzymes that promote the removal of necrotic tissue.
 * 4) Mechanical debridement, is the use of debriding dressings, whirlpool or ultrasound for slough in a stable wound.
 * 5) Surgical debridement, or sharp debridement, is the fastest method, as it allows a surgeon to quickly remove dead tissue.

Dressings
It is not clear if one topical agent or dressing is better than another for treating pressure ulcers. There is some evidence to suggest that protease-modulating dressings, foam dressings or collagenase ointment may be better at healing than gauze. The wound dressing should be selected based on the wound and condition of the surrounding skin. There are some studies that indicate that antimicrobial products that stimulate the epithelization may improve the wound healing. However, there is no international consensus on the selection of the dressings for pressure ulcers. Evidence supporting the use of alginate dressings, foam dressings, and hydrogel dressings. and the benefits of these dressings over other treatments is unclear.

Some guidelines for dressing are:

Other treatments
Other treatments include anabolic steroids, medical grade honey, negative pressure wound therapy, phototherapy, pressure relieving devices, reconstructive surgery, support surfaces, ultrasound and topical phenytoin. There is little or no evidence to support or refute the benefits of most of these treatments compared to each other and placebo. It is not clear if electrical stimulation is an effective treatment for pressure ulcers. In addition, the benefit of using systemic or topical antibiotics in the management of pressure ulcer is still unclear. The benefit of using systemic or topical antibiotics in the management of pressure ulcer is still unclear. When selecting treatments, consideration should be given to patients' quality of life as well as the interventions' ease of use, reliability, and cost. The benefits of nutritional interventions with various compositions for pressure ulcer treatment are uncertain.

Epidemiology
Each year, more than 2.5 million people in the United States develop pressure ulcers. In acute care settings in the United States, the incidence of bedsores is 0.4% to 38%; within long-term care it is 2.2% to 23.9%, and in home care, it is 0% to 17%. Similarly, there is wide variation in prevalence: 10% to 18% in acute care, 2.3% to 28% in long-term care, and 0% to 29% in home care. There is a much higher rate of bedsores in intensive care units because of immunocompromised individuals, with 8% to 40% of those in the ICU developing bedsores. However, pressure ulcer prevalence is highly dependent on the methodology used to collect the data. Using the European Pressure Ulcer Advisory Panel (EPUAP) methodology there are similar figures for pressure ulcers in acutely sick people in the hospital. There are differences across countries, but using this methodology, pressure ulcer prevalence in Europe was consistently high, from 8.3% (Italy) to 22.9% (Sweden). A recent study in Jordan also showed a figure in this range. Some research shows differences in pressure-ulcer detection among white and black residents in nursing homes.

title: Pressure ulcer


text:
Limited atonement

Limited atonement (also called definite atonement or particular redemption) is a doctrine accepted in some Christian theological traditions. It is particularly associated with the Reformed tradition and is one of the five points of Calvinism. The doctrine states that though the death of Jesus Christ is sufficient to atone for the sins of the whole world, it was the intention of God the Father that the atonement of Christ's death would work itself out in only the elect, thereby leading them without fail to salvation. According to Limited Atonement, Christ died for the sins of the elect alone, and no atonement was provided for the reprobate. This is in contrast to a belief that God's prevenient grace (or "enabling grace") enables all to respond to the salvation offered by God in Jesus Christ undefined so that it is each person's decision and response to God's grace that determines whether Christ's atonement will be effective to that individual. A modified form of the doctrine also exists in Molinism.

History
The second century document Martyrdom of Polycarp said that Christ "suffered for the world of the saved", which can be interpreted to support an idea like limited atonement, however it is not certain to teach a form of particular redemption and the book can also be understood in other ways, which do not necessate the view of limited atonement.

The elements of the doctrine to be known as limited atonement were held by Gottschalk of Orbais (c. 808 – c. 867), Thomas Bradwardine (c. 1290 – 1349), and Gregory of Rimini (c. 1300 – 1358), though there was less precision regarding the extent of the atonement before the Reformation period.

The Synod of Dort was convened in 1618 in order to decide a controversy between the followers of Jacobus Arminius (Arminians), and other Calvinists. One of the issues involved had to do with the reason for the limitation of the efficacy of Christ's satisfaction for sin (roughly, atonement). Both sides of the controversy agreed that this efficacy was limited to the elect. The disagreement had to do with the grounds for this limitation. For Arminius, the ground was the free choice of people to believe, foreknown by God, with God predestining people based on this foreseen faith. For the opponents of Arminius, whose views are represented in the Canons of Dort, this efficacy was limited based on God's predestination, without any foreknowledge of human choice. Calvin clearly taught this second view, and it is also the view of Reformed theologians following the Synod of Dort.

The doctrine of limited atonement also includes the claim that the purpose for which Jesus gave his life was limited to the elect - the atonement is limited in its purpose. For this reason, the so-called "four-point Calvinists", such as the 17th century English Puritan Richard Baxter, reject the doctrine of limited atonement and instead believe that the atonement is available to all who will believe in Christ. They also argue that it was never endorsed by Calvin or the Synod of Dort. They refer to both Calvin's claim that "It is also a fact, without controversy, that Christ came to atone for the sins 'of the whole world'" and to Article 3 of the Second Main Point of Doctrine of the Synod of Dort which states that "This death of God's Son is the only and entirely complete sacrifice and satisfaction for sins; it is of infinite value and worth, more than sufficient to atone for the sins of the whole world.". Others, however, claim that Calvin and the Canons of Dort are somewhat vague on this issue and accept the claim of limited atonement that the efficacy of his death was limited both in purpose and scope to the elect, though they believe his death was sufficient payment for the sin of the whole world.

With regard to the limited purpose or intent of the atonement to save only the elect, another argument was put forth later in the 17th century. Moses Amyraut and several others (Amyraldists) proposed a system called hypothetical universalism, which taught that in God's decree for Christ to be a sufficient atonement for all sin, his intention was to save all on condition that they believe. This decree was prior to his decree to elect some people for whom the atonement was to be efficacious, and so the efficacy of the atonement was still limited to the elect. Most of the Reformed rejected this view because it envisioned a decree of God (the conditional decree to save all) that was intentionally not realized.

Theology
The doctrine of the limited scope (or extent) of the atonement is intimately tied up with the doctrine of the nature of the atonement. It also has much to do with the general Calvinist view of predestination. Calvinists advocate the satisfaction theory of the atonement, which developed in the writings of Anselm of Canterbury and Thomas Aquinas. In brief, the Calvinistic refinement of this theory, known as penal substitution, states that the atonement of Christ pays the penalty incurred by the sins of men—that is, Christ receives the wrath of God for sins and thereby receives in himself the penalty of the sins of men.

The doctrine of limited atonement is often argued from the theological argument of double jeopardy. In the limited view, Jesus Christ has taken the penalty of the elect - that Jesus died for those who would believe, so that those for whom Christ died must be saved and cannot be damned as it would be unjust for God to punish the same sins twice (double jeopardy). If Jesus died for all, they argue, then all must be saved. The penal theory of the atonement is therefore the basis of the necessity for a limited atonement.

The Calvinist view of predestination teaches that God created Adam in a state of original righteousness, but he fell into sin and all humanity in him as their federal head. Those elected to salvation were chosen without a view to their faith or good works but by the sovereign will of God.

The Calvinist atonement is called definite by some because they believe it certainly secures the salvation of those for whom Christ died, and it is called limited in its extent because it effects salvation for the elect only. Calvinists do not believe the power of the atonement is limited in any way, which is to say that no sin is too great to be expiated by Christ's sacrifice, in their view. Among English Calvinistic (Particular) Baptists, the doctrine was usually known as particular redemption, giving its adherents the name Particular Baptists. This term emphasizes the intention of God to save particular persons through the atonement, as opposed to mankind in general as General Baptists believe.

Biblical passages
The classic Bible passage cited to prove a limited extent to the atonement is in which Jesus uses shepherding practices as a metaphor for his relationship to his followers. A shepherd of those times would call his sheep from a mix of flocks, and his sheep would hear his voice and follow, while the sheep of other flocks would ignore any but their own shepherd's voice. In that context, Jesus says, "I am the good shepherd. I know my own and my own know me, ...and I lay down my life for the sheep," and he tells the Pharisees that they "do not believe because [they] are not part of [his] flock." He continues, "My sheep hear my voice, and I know them, and they follow me. I give them eternal life, and they will never perish, and no one will snatch them out of my hand." Since Calvinists (and many other Christians) believe that not all have eternal life with God, Calvinists conclude that there are only two possibilities: either Jesus was wrong in saying that he would lose none of his sheep (a conclusion they reject), or Jesus must not have laid down his life for everyone, as they understand John 10 to imply. Formally, the Calvinist position can be expressed this way:

 * 1) Jesus lays down his life for the sheep.
 * 2) Jesus will lose none of his sheep.
 * 3) Many people will not receive eternal life.$[ Matthew 7:13-14$
 * Therefore, the Calvinist position is that Jesus did die for everyone, but his atoning death will only save those whom the Father purposed to save.

Additionally, in the high priestly prayer, Jesus prays for the protection and sanctification of those who believed in him, and he explicitly excludes praying for all: "I am not praying for the world but for those whom you have given me, for they are yours.". Paul instructs the elders in Ephesus "to shepherd the church of God which He purchased with His own blood,"[ Acts 20:28 ] and he says in his letter to the same church that "Christ loved the church and gave himself up for her." Likewise, Jesus foreshadows that he will lay down his life "for his friends," and an angel tells Jesus' earthly father Joseph that he "will save His people from their sins". Calvinists believe that these passages demonstrate that Jesus died for the church (that is, the elect) only.

Opponents to Calvinism often cite passages such as those below they believe clearly contradict limited atonement:

 * 1) Jesus promises that whosoever believes in him has everlasting life. John 3:16
 * 2) Peter proclaims that everyone who calls upon Jesus will be saved. undefined
 * 3) God calls all people everywhere to repent. ,
 * 4) God desires all people to be saved. undefined
 * 5) Jesus is a ransom for all. undefined
 * 6) Jesus is the propitiation "for our sins, and not for ours only but also for the sins of the whole world." undefined

Confessional positions
Chapter 3, paragraph 6 of the Westminster Confession of Faith says, "Neither are any other redeemed by Christ, effectually called, justified, adopted, sanctified, and saved, but the elect only."

The Canons of Dort assert that "This death of God's Son is the only and entirely complete sacrifice and satisfaction for sins; it is of infinite value and worth, more than sufficient to atone for the sins of the whole world" (Section 2, Article 3). Article 8 of the same section says For it was the entirely free plan and very gracious will and intention of God the Father that the enlivening and saving effectiveness of his Son's costly death should work itself out in all his chosen ones, in order that he might grant justifying faith to them only and thereby lead them without fail to salvation. In other words, it was God's will that Christ through the blood of the cross (by which he confirmed the new covenant) should effectively redeem from every people, tribe, nation, and language all those and only those who were chosen from eternity to salvation and given to him by the Father; that he should grant them faith (which, like the Holy Spirit's other saving gifts, he acquired for them by his death); that he should cleanse them by his blood from all their sins, both original and actual, whether committed before or after their coming to faith; that he should faithfully preserve them to the very end; and that he should finally present them to himself, a glorious people, without spot or wrinkle.

Objections to the doctrine
Limited atonement is contrasted with the view popularly termed unlimited atonement, which is advocated by Arminian, Methodist, Lutheran, Messianic Jewish, and Roman Catholic theologians (among others) and which says Christ's work makes redemption possible for all but certain for none. (This doctrine should not be confused with concepts of universal reconciliation, in which God saves his entire creation). Though Lutherans and Catholics share a similar doctrine of the nature of the atonement with Calvinists, they differ on its extent, whereas Arminians and Methodists generally accept an alternate theory of the nature of the atonement such as the Governmental theory of atonement. The elect in such models are all the people who choose to avail themselves of God's gracious offer of salvation through Christ, not a pre-determined group. Thus, these systems place a limit on the efficacy of the atonement rather than on its extent, like Calvinists.

Some have contended that the doctrine of particular redemption implies that Christ's sacrifice was insufficient to atone for the sins of the whole world, but Calvinists have universally rejected this notion, instead holding that the value of the atonement is infinite but that God intentionally withholds its efficacious availability only to the elect.

Comparison among Protestants
This table summarizes three different Protestant beliefs.

In the Lutheran confessions, the Formula of Concord on the article on the doctrine of election states:

"The eternal election of God, however, vel praedestinatio (or predestination), that is, God's ordination to salvation, does not extend at once over the godly and the wicked, but only over the children of God, who were elected and ordained to eternal life before the foundation of the world was laid, as Paul says, Eph. 1:4. 5: He hath chosen us in Him, having predestinated us unto the adoption of children by Jesus Christ."

The Canons of Dort, one of the earliest Calvinist confessions, state in the Second Head, Article 8:

"[...]it was the will of God that Christ by the blood of the cross, whereby He confirmed the new covenant, should effectually redeem out of every people, tribe, nation, and language, all those, and those only, who were from eternity chosen to salvation and given to Him by the Father;[...]"

In contrast, James Arminius states in his works the following:

"[...]To these succeeds the fourth decree, by which God decreed to save and damn certain particular persons. This decree has its foundation in the foreknowledge of God, by which he knew from all eternity those individuals who would, through his preventing (prevenient) grace, believe, and, through his subsequent grace would persevere, according to the before described administration of those means which are suitable and proper for conversion and faith; and, by which foreknowledge, he likewise knew those who would not believe and persevere.[...]"

title: Limited atonement