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Foreword
The skeletal system gives the body its form, facilitates movement, and protects internal organs
from traumatic forces. Any disease, drug, or biological process that influences bone directly
influences the fundamental mechanical function of the skeleton. Skeletal imaging data and quan-
titative assessments of bone composition and histomorphology are often important only because
they reflect something about mechanical competence. To truly assess the mechanical competence
of the skeleton, however, it is imperative that we assess the mechanical characteristics of the bone
and bone–implant constructs.
Early investigations of the mechanical properties of bone in the last half of the twentieth century
by Evans, Yamada, Katz, Ascenzi, Currey, Burstein, Bonfield and Lanyon helped form the modern
foundation for how bones should be tested and viewed from a mechanical and material perspective.
From these initial pioneers, new investigators began to build a research literature and a series of
laboratory approaches for the mechanical testing of bone and bone–implant systems. The mechan-
ical testing of bone and the bone–implant interface has progressively become an important aspect
of a wide variety of research projects on bone growth, adaptation, regeneration, and aging. This
work has resulted in a better understanding of the material mechanical properties of bone and
greater standardization of testing protocols.
This collection by editors Yuehuei H. An and Robert A. Draughn marks a transition in the role
of mechanical testing of bone and bone–implant systems. It addresses the field of bone mechanics
not so much as an arena of basic science but rather as a compendium of practical research tools
and mechanical assay techniques. It is a wonderful addition to the literature in that it summarizes
much of the data generated in recent years. The greatest value of the book, however, is that it
provides a synopsis of laboratory approaches that a broad range of investigators have used and
continue to use in their research.
The treatise begins at a very basic level and can therefore serve as an effective introduction to
those without significant previous experience in bone mechanics. The 39 chapters of the book are
separated into three sections that progress from concise descriptions of techniques used to charac-
terize and test bone to more specialized laboratory studies. The perspectives of the many contributors
to the book who work in many different laboratories contribute to the richness and breadth of the
book. The coherence of the book is maintained under the clear direction of the editors. The emphasis
is on teaching the reader “how to do it.” This theme is maintained throughout and is surely enhanced
by the involvement of the editors as coauthors in many chapters.
This book serves as a comprehensive primer for the mechanical testing of bone. For new
investigators in this area, it is an invaluable tool. For the more experience investigators, it serves
as a touchstone for evaluating new testing protocols and data. This text has a great deal to offer
all of us.

Dennis R. Carter, Ph.D.

Director, Palo Alto VA Rehabilitation R&D Center
Professor, Biomechanical Engineering Division
Mechanical Engineering Department
Stanford University
Preface
Biomechanics is an integral part of the study of bone as an organ or tissue. Mechanical testing of
bone specimens is a basic method in bone-related research. The mechanical properties of whole
bones or bone tissues and bone–implant interfaces are equally important as their morphological or
structural aspects. The former is evaluated by mechanical testing and the latter is mostly studied
using histological techniques.
This book is an outgrowth of the editors’ own quest for information on mechanical testing of
bone and, more importantly, a response to significant needs in the orthopaedic research community.
Most researchers are not well trained in biomechanics and assistance from an expert is not always
readily available. What many researchers really need to know are basic mechanical principles in
bone-related research and most importantly how to conduct mechanical testing of bone specimens.
This book is designed to be an experimental guide for orthopaedic or dental residents, bioengi-
neering graduate students, orthopaedic or dental researchers, biomaterials scientists, laboratory
technicians, and anyone not well trained in biomechanics who plans to conduct mechanical testing
of bone specimens. Most readers belong to societies in the fields of orthopaedic or dental research,
biomechanics, or biomaterials, such as the Orthopaedic Research Society, American Society of
Biomechanics, American Society of Mechanical Engineers, American Society for Bone and Mineral
Research, Society for Biomaterials, or Materials Research Society. This text is intended to be a
“beginner’s” guide, and no prior training in biomechanics is required to understand the contents.
It should also serve as a useful handbook for biomechanical and bioengineering researchers and
students at all levels.
This is the first inclusive and organized reference book on how to perform mechanical testing
of bone. The topic has not been adequately covered by any existing textbook on bone biomechanics.
The 39 chapters of this book are divided into three major parts: Section I — mechanical properties
of bone and general considerations and basic facilities for mechanical testing; Section II — specific
mechanical testing procedures on bone tissues; and Section III — mechanical testing procedures
on the bone–implant interface.
The book is designed to be concise as well as inclusive and more practical than theoretical.
The text is simple and straightforward. Numerous diagrams (~150), tables (~150), line drawings
(~150), and photographs (~150) are included to help readers better understand the main principles.
Full bibliographies at the end of each chapter guide readers to more detailed information. A book
of this length cannot discuss every method in biomechanical testing of bone that has been conducted
over the years, but it is hoped that major methods and their applications have been included.

Yuehuei H. An, M.D.

Charleston, South Carolina
The Editors
Yuehuei H. (Huey) An, M.D., graduated from the Harbin Medical University, Harbin, Northeast
China in 1983. He completed residency training in orthopaedic surgery at Ji Shui Tan Hospital in
Beijing, China and went on to a fellowship in hand surgery at Sydney Hospital in Sydney, Australia.
In 1991, Dr. An joined Dr. Richard J. Friedman in the Department of Orthopaedic Surgery at the
Medical University of South Carolina to establish the MUSC Orthopaedic Research Laboratory,
which is now a multifunctional orthopaedic research center.
Soon after beginning his career in orthopaedic research, Dr. An developed an interest in bone
mechanics and he learned much about practical mechanical testing by “trial and error.” His under-
standing of the importance of biomechanical principles and mechanical testing techniques to
researchers in bone-related fields of work led to his desire to organize this effort.
Dr. An has published more than 70 scientific papers and book chapters and more than 60
research abstracts. He has edited three reference books. His first book, Animal Models in
Orthopaedic Research, a major contribution to orthopaedic research, was published by CRC
Press in 1998. His third book, Handbook of Bacterial Adhesion — Principles, Methods, and
Applications, will be published by Humana Press in late 1999. He created many of the line
drawings used in his books and papers. He is an active member of eight academic societies
including the American Society of Biomechanics, Orthopaedic Research Society, Society for
Biomaterials, and the Tissue Engineering Society. Dr. An’s current research interests include
bone and cartilage repair using tissue engineering techniques, bone or soft tissue ingrowth to
implant surfaces, bone structure and biomechanics, bacterial adhesion and prosthetic infection,
and animal models in orthopaedic research.

Robert A. Draughn, D.Sc., is Professor and Chairman of the Department of Materials Science at
the Medical University of South Carolina, Charleston, South Carolina. He is also an Adjunct Associate
Professor of Bioengineering at Clemson University, Clemson, South Carolina. Dr. Draughn earned
his Doctor of Science degree in Materials Science from the University of Virginia in 1968. He has
been on the faculty of the College of Dental Medicine at the Medical University of South Carolina
since 1973. His principal research interests have been in the general area of biomedical applications
of composite materials. The emphasis of much of his work has been the mechanical properties of
particle-reinforced polymers and hard tissues as well as studies of adhesive bonding processes.
Dr. Draughn has over 70 publications and over 90 research presentations and published
abstracts. He is active in several professional organizations. His activities have included Chairperson
of the Biomaterials Section of the American Association of Dental Schools, Chairperson of the
Gordon Research Conference on the Science of Adhesion, and membership on the executive
committee of the Adhesion Society.
Contributors
C. Mauli Agrawal, Ph.D. William R. Barfield, Ph.D.
Associate Professor Assistant Professor
Department of Orthopaedics Orthopaedic Research Laboratory
University of Texas Health Science Center Department of Orthopaedic Surgery
at San Antonio Medical University of South Carolina
San Antonio, Texas Charleston, South Carolina

Yuehuei H. An, M.D., M.Sc. Christopher V. Bensen, M.D.

Associate Professor and Director Orthopaedic Surgery Resident
Orthopaedic Research Laboratory Department of Orthopaedic Surgery
Department of Orthopaedic Surgery Medical University of South Carolina
Medical University of South Carolina Charleston, South Carolina
Charleston, South Carolina
and Alessandro Benvenuti, Ph.D.
Adjunct Assistant Professor Research Associate
Department of Bioengineering Department of Experimental Medicine
Clemson University and Pathology
Clemson, South Carolina University of Rome La Sapienza
Rome, Italy
Antonio Ascenzi, Ph.D.
Professor Emeritus Aivars Berzins, M.D.
Department of Experimental Medicine Assistant Professor
and Pathology Department of Orthopaedic Surgery
University of Rome La Sapienza Rush Medical College
Rome, Italy Rush-Presbyterian-St. Luke’s Medical Center
Chicago, Illinois
Maria-Grazia Ascenzi, Ph.D.
Mathematical Researcher Ermanno Bonucci, Ph.D.
Department of Sciences Professor and Chairman
University of California Extension Department of Experimental Medicine
Los Angeles, California and Pathology
University of Rome La Sapienza
Kyriacos Athanasiou, Ph.D., P.E. Rome, Italy
Associate Professor of Orthopaedics
and Engineering Matthew S. Crum, B.Sc.
Director of Musculoskeletal Undergraduate Student
Bioengineering Center Department of Mechanical Engineering
Director of Orthopaedic Biomechanics Clemson University
The University of Texas Health Science Center Clemson, South Carolina
at San Antonio
San Antonio, Texas
John M. Cuckler, M.D. José Luis Ferretti, M.D., Ph.D.
Professor and Chairman Director
Department of Orthopaedic Surgery Centro de Estudios de Metabolismo
University of Alabama Fosfocalcico (CEMFoC)
Birmingham, Alabama Hospital del Centenario
National University of Rosario
A. U. (Dan) Daniels, Ph.D. and
George Thomas Wilhelm Endowed Professor Instituto/Fundacion de Investigaciones
Department of Orthopaedic Surgery Metabolicas (IDIM)
University of Tennessee Buenos Aires, Argentina
Memphis, Tennessee
Richard J. Friedman, M.D., FRCSC
James R. Davis, B.Sc., FRCS Professor
Research Fellow Department of Orthopaedic Surgery
Department of Orthopaedic Surgery Medical University of South Carolina
University of Maryland Charleston, South Carolina
Baltimore, Maryland and
Adjunct Professor of Bioengineering
Wouter J. A. Dhert, M.D., Ph.D. Department of Bioengineering
Professor Clemson University
Department of Orthopaedics Clemson, South Carolina
Utrecht University Hospital
Utrecht, the Netherlands Benjamin R. Furman, M.S.
Research Associate
Robert A. Draughn, D.Sc. Division of Biomaterials
Professor of Materials Science Department of Restorative Dentistry
Department of Materials Science University of Texas Health Science Center at
College of Dental Medicine San Antonio
Medical University of South Carolina San Antonio, Texas
Charleston, South Carolina
and Vasanti M. Gharpuray, Ph.D.
Adjunct Associate Professor of Bioengineering Associate Professor
Department of Bioengineering Department of Bioengineering
Clemson University Clemson University
Clemson, South Carolina Clemson, South Carolina

Lisa A. Ferrara, M.Sc. Steven A. Goldstein, Ph.D.

Director Henry Ruppenthal Family Professor of
Spine Research Laboratory Orthopaedic Surgery and Bioengineering
Department of Neurosurgery Professor of Mechanical Engineering and
Cleveland Clinic Foundation Applied Mechanics
Cleveland, Ohio Director of Orthopaedic Research
Interim Associate Dean for Research and
Graduate Studies
University of Michigan
Ann Arbor, Michigan
C. Edward Hoffler, M.S. Thomas R. Katona, Ph.D., DM.D.
M.D./Ph.D. Candidate Associate Professor of Orthodontics
Orthopaedic Research Laboratories Indiana University School of Dentistry
The University of Michigan Associate Professor of Mechanical Engineering
Ann Arbor, Michigan Purdue University School of Engineering
and Technology
Sarandeep S. Huja, Ph.D., B.D.S., IUPUI Biomechanics and Biomaterials
M.D.S., M.Sc. Research Center
Graduate Dental Student Indianapolis, Indiana
Section of Orthodontics
Indiana University School of Dentistry J. Lawrence Katz, Ph.D.
Indianapolis, Indiana Professor, Department of Biomedical
Engineering
Ivan Hvid, M.D., D.M.Sc. Case Western Reserve University
Professor Cleveland, Ohio
Department of Orthopaedics
Aarhus University Hospital Tony S. Keller, Ph.D.
Aarhus, Denmark Associate Professor
Department of Mechanical Engineering
Kenneth S. James, Ph.D. University of Vermont
Associate Director of Orthopaedic Programs Burlington, Vermont
Tissue Engineering, Inc.
Boston, Massachusetts Fadi M. Khoury, M.Sc.
School of Engineering and Applied Science
John A. Jansen, D.D.S., Ph.D. University of Pennsylvania
Professor and Head Philadelphia, Pennsylvania
Department of Biomaterials
University of Nijmegen Dental School Ivars Knets, Ph.D.
Nijmegen, the Netherlands Professor of Biomechanics
Department of Mechanical Engineering
Riyaz H. Jinnah, M.D., FRCS Riga Technical University
Professor of Orthopaedic Surgery Riga, Latvia
The University of Maryland School of
Medicine David H. Kohn, Ph.D.
Baltimore, Maryland Associate Professor
Department of Biologic and Materials Sciences
Qian Kang, M.D. School of Dentistry
Associate Chief Surgeon University of Michigan
Department of Orthopaedic Surgery Ann Arbor, Michigan
Beijing Ji Shui Tan Hospital
Beijing, China Michael A. K. Liebschner, Ph.D.
Former Research Fellow (1995–1997) Orthopaedic Research Laboratory
Orthopaedic Research Laboratory University of California at Berkeley
Department of Orthopaedic Surgery Berkeley, California
Medical University of South Carolina
Charleston, South Carolina Frank Linde, M.D., DM.Sc.
Consultant Orthopaedic Surgeon
Department of Orthopaedics
Aarhus University Hospital
Aarhus, Denmark
Robert A. Lofthouse, M.A., FRCS Shigeru Nishiguchi, M.D.
Research Fellow Research Assistant
Department of Orthopaedic Surgery Department of Orthopaedic Surgery
University of Maryland School of Medicine Graduate School of Medicine
Baltimore, Maryland Kyoto University
Kyoto, Japan
Mandi J. Lopez, D.V.M., M.S.
Postdoctoral Fellow George M. Pharr, Ph.D.
Comparative Orthopaedic Research Laboratory Professor
School of Veterinary Medicine Department of Mechanical Engineering and
University of Wisconsin-Madison Materials Science
Madison, Wisconsin Rice University
Houston, Texas
Mark D. Markel, D.V.M.
Professor William S. Pietrzak, Ph.D.
Comparative Orthopaedic Research Laboratory Director
School of Veterinary Medicine Resorbable Technology
University of Wisconsin-Madison Biomet Co.
Madison, Wisconsin Warsaw, Indiana

Barbara R. McCreadie, M.S. Jae-Young Rho, Ph.D.

Ph.D. Candidate Assistant Professor
Orthopaedic Research Laboratories Department of Biomedical Engineering
University of Michigan University of Memphis
Ann Arbor, Michigan Memphis, Tennessee

Brodie E. McKoy, M.D. W. Eugene Roberts, D.D.S., Ph.D.

Orthopaedic Surgery Resident Professor of Orthodontics
Department of Orthopaedic Surgery Indiana University School of Dentistry
Medical University of South Carolina Professor of Physiology and Biophysics
Charleston, South Carolina Indiana University School of Medicine
and
Peter L. Mente, Ph.D. Professor of Mechanical Engineering
Assistant Professor Purdue University School of Engineering
Department of Biological and Agricultural and Technology
Engineering Indianapolis, Indiana
North Carolina State University
Raleigh, North Carolina Timothy C. Ryken, M.D.
Assistant Professor
Sanjiv H. Naidu, M.D., Ph.D. Division of Neurosurgery
Assistant Professor University of Iowa School of Medicine
Department of Orthopaedic Surgery Iowa City, Iowa
Pennsylvania State University
Hershey, Pennsylvania Subrata Saha, Ph.D.
Professor
Takashi Nakamura, M.D., Ph.D. Department of Bioengineering
Professor Clemson University
Department of Orthopaedic Surgery and
Kyoto University Director
Kyoto, Japan Bioengineering Alliance of South Carolina
Clemson, South Carolina
David R. Sarver, B.Sc. Charles H. Turner, Ph.D.
Product Development Engineer Associate Professor and Director of
Biomet Co. Orthopaedic Research
Warsaw, Indiana Department of Orthopaedic Surgery and
Biomechanics and Biomaterials
Naoki Sasaki, D.Sc. Research Center
Associate Professor Indiana University Medical Center
Division of Biological Sciences Indianapolis, Indiana
Graduate School of Science
Hokkaido University Rong-Ming Wang, Ph.D.
Sapporo, Japan Associate Professor
Head of Metal Physics and
Rakesh Saxena, Ph.D. Failure Analysis Laboratory
Department of Mechanical Engineering Beijing Institute of Aeronautical Materials
The University of Vermont Beijing, China
Burlington, Vermont
Xiaodu Wang, Ph.D.
Chris W. Smith, Ph.D. Assistant Professor
Research Fellow Department of Orthopaedics
Department of Engineering University of Texas Health Science Center
University of Exeter at San Antonio
Exeter, United Kingdom San Antonio, Texas

Erica A. Smith, M.S. Keith R. Williams, B.Sc., Ph.D.

Ph.D. Candidate Reader
Orthopaedic Research Laboratories Department of Basic Dental Science
University of Michigan Dental School
Ann Arbor, Michigan University of Wales College of Medicine
Cardiff, Wales, United Kingdom
Dale R. Sumner, Ph.D.
Professor and Chairman Franklin A. Young, Jr., D.Sc.
Department of Anatomy Professor
and Department of Materials Science
Professor College of Dental Medicine
Department of Orthopaedic Surgery Medical University of South Carolina
Rush Medical College Charleston, South Carolina
Rush-Presbyterian-St. Luke’s Medical Center
Chicago, Illinois Peter Zioupos, Ph.D., MIPEM
Lecturer
John A. Szivek, Ph.D. Department of Materials and Medical Sciences
Professor Cranfield University
Orthopaedic Research Laboratory Shrivenham, United Kingdom
Department of Surgery
University of Arizona School of Medicine
Tucson, Arizona
Acknowledgments
The editors would like to acknowledge Kylie Martin for her tireless assistance in communication
with contributors, manuscript review, and editorial assistance. We would also like to thank
Drs. Christopher Bensen and Brodie McKoy for revising manuscripts and preparing figures. We
are also grateful to Drs. Richard Friedman and Angus McBryde, Jr. and all members of the
Departments of Orthopaedic Surgery and Materials Science of the Medical University of South
Carolina for their continuous administrative support of our work. Finally, we wish to thank Liz
Covello, Acquiring Editor at CRC Press, for her help on this and the previous text, Animal Models
in Orthopaedic Research.
 To Kay Q. Kang, M.D.
Without her love, inspiration, and support,
this book would not have been possible

Yuehuei H. An, M.D.

To Donna, Sally, and Margaret

Robert A. Draughn, D.Sc.

Contents
Section I — General Considerations

Chapter 1
Basic Composition and Structure of Bone........................................................................................3
Ermanno Bonucci

Chapter 2
Basic Concepts of Mechanical Property Measurement and Bone Biomechanics..........................23
Yuehuei H. An, William R. Barfield, and Robert A. Draughn

Chapter 3
Mechanical Properties of Bone........................................................................................................41
Yuehuei H. An

Chapter 4
Factors Affecting Mechanical Properties of Bone ..........................................................................65
Peter Zioupos, Chris W. Smith, and Yuehuei H. An

Chapter 5
Basic Facilities and Instruments for Mechanical Testing of Bone .................................................87
Christopher V. Bensen and Yuehuei H. An

Chapter 6
Methods of Evaluation for Bone Dimensions, Densities, Contents, Morphology,
and Structures ...............................................................................................................................103
Yuehuei H. An, William R. Barfield, and Ivars Knets

Chapter 7
General Considerations of Mechanical Testing.............................................................................119
Yuehuei H. An and Christopher V. Bensen

Chapter 8
A Hierarchical Approach to Exploring Bone Mechanical Properties...........................................133
C. Edward Hoffler, Barbara R. McCreadie, Erica A. Smith, and Steven A. Goldstein

Chapter 9
Nondestructive Mechanical Testing of Cancellous Bone..............................................................151
Frank Linde and Ivan Hvid

Chapter 10
Synthetic Materials and Structures Used as Models for Bone .....................................................159
John A. Szivek
Section II — Methods of Mechanical Testing of Bone

Chapter 11
Tensile and Compression Testing of Bone....................................................................................175
Tony S. Keller and Michael A. K. Liebschner

Chapter 12
Bending Tests of Bone...................................................................................................................207
Mandi J. Lopez and Mark D. Markel

Chapter 13
Torsional Testing of Bone..............................................................................................................219
Benjamin R. Furman and Subrata Saha

Chapter 14
Indentation Testing of Bone...........................................................................................................233
Brodie E. McKoy, Qian Kang, and Yuehuei H. An

Chapter 15
Penetration Testing of Bone Using an Osteopenetrometer ...........................................................241
Ivan Hvid and Frank Linde

Chapter 16
Microhardness Testing of Bone .....................................................................................................247
Sarandeep S. Huja, Thomas R. Katona, and W. Eugene Roberts

Chapter 17
Nanoindentation Testing of Bone ..................................................................................................257
Jae-Young Rho and George M. Pharr

Chapter 18
Single Osteon Micromechanical Testing .......................................................................................271
Maria-Grazia Ascenzi, Alessandro Benvenuti, and Antonio Ascenzi

Chapter 19
Micromechanical Testing of Single Trabeculae ............................................................................291
Peter L. Mente

Chapter 20
Strain Gauge Measurements from Bone Surfaces ........................................................................305
John A. Szivek and Vasanti M. Gharpuray

Chapter 21
Screw Pullout Test for Evaluating Mechanical Properties of Bone .............................................321
Matthew S. Crum, Franklin A. Young, Jr., and Yuehuei H. An

Chapter 22
Viscoelastic Properties of Bone and Testing Methods..................................................................329
Naoki Sasaki
Chapter 23
Observation of Material Failure Mode Using a SEM with a Built-In Mechanical
Testing Device................................................................................................................................349
Rong-Ming Wang and Yuehuei H. An

Chapter 24
Ultrasonic Methods for Evaluating Mechanical Properties of Bone ............................................357
Jae-Young Rho

Chapter 25
Evaluating Mechanical Properties of Bone Using Scanning Acoustic Microscopy.....................371
Charles H. Turner and J. Lawrence Katz

Chapter 26
Peripheral Quantitative Computed Tomography for Evaluating Structural
and Mechanical Properties of Small Bone....................................................................................385
José Luis Ferretti

Chapter 27
Computer Modeling for Evaluating Trabecular Bone Mechanics ...............................................407
Rakesh Saxena and Tony S. Keller

Section III — Methods of Mechanical Testing of the Bone–Implant Interface

Chapter 28
Factors Affecting the Strength of the Bone–Implant Interface.....................................................439
Brodie E. McKoy, Yuehuei H. An, and Richard J. Friedman

Chapter 29
Implant Pushout and Pullout Test..................................................................................................463
Aivars Berzins and Dale R. Sumner

Chapter 30
The Validity of a Single Pushout Test ...........................................................................................477
Wouter J. A. Dhert and John A. Jansen

Chapter 31
Tensile Testing of Bone–Implant Interface ...................................................................................489
Takashi Nakamura and Shigeru Nishiguchi

Chapter 32
Fracture Toughness Tests of the Bone–Implant Interface.............................................................499
Xiaodu Wang, Kyriacos A. Athanasiou, and C. Mauli Agrawal

Chapter 33
In Vitro Measurements of Implant Stability..................................................................................515
Aivars Berzins and Dale R. Sumner
Chapter 34
In Vitro Testing of the Stability of Acetabular Components.........................................................527
James R. Davis, Robert A. Lofthouse, and Riyaz H. Jinnah

Chapter 35
In Vitro Testing of the Stability of Femoral Components ............................................................541
Sanjiv H. Naidu, Fadi M. Khoury, and John M. Cuckler

Chapter 36
Screw Pullout Test .........................................................................................................................551
Lisa A. Ferrara and Timothy C. Ryken

Chapter 37
Finite Element Analysis for Evaluating Mechanical Properties of the
Bone–Implant Interface..................................................................................................................567
Keith R. Williams

Chapter 38
Fatigue Testing of Bioabsorbable Screws in a Synthetic Bone Substrate....................................581
William S. Pietrzak, David R. Sarver, and David H. Kohn

Chapter 39
Testing Intervertebral Stability after Spinal Fixation....................................................................593
Kenneth S. James and A. U. Daniels

Appendix 1 ....................................................................................................................................607

Appendix 2 ....................................................................................................................................609

Index ..............................................................................................................................................611
Section I
General Considerations