ABSTRACT
Tungsten carbide thin films have been prepared by reactive rf sputtering from a tungsten target in various Ar-CH(4) mixtures. The composition, structure, microstructure and chemical state of the films have been investigated by the complementary use of RBS, NRA, XRD, GIXRD, TEM and XPS analyses. These characteristics of the films were then correlated to their mechanical properties determined by hardness (H), Young's modulus (E(r)) and friction coefficient measurements. Under low CH(4) pressures, the formation of a mixture of nanocrystalline WC(1-x) and W(2)C phases has been observed. A pure WC(1-x) phase was observed in films having a composition close to W(1)C(0.9). With increasing CH(4) pressure, the amount of carbon in the films increases, leading to a progressive amorphization of tungsten carbide deposited layers. Nanocomposite films appeared to be formed, with WC(1-x) nanograins (<3 nm) dispersed in an amorphous carbon matrix. The film deposited at 30% of CH(4) exhibits a-C:H phase. The nature of the phases present in the films plays an important role on their mechanical properties, as shown by the wide domain of variation of the films' hardness (between 22 and 5.5 GPa) and the plastic deformation parameter H(3)/E(r)(2) (between 0.08 and 0.04).
ABSTRACT
The Forensic Algorithm Project (FAP) was born of the need for a holistic approach in the treatment of the inmate with schizophrenia. Schizophrenia was chosen as the first entity to be addressed by the algorithm because of its refractory nature and high rate of recidivism in the correctional setting. Schizophrenia is regarded as a spectrum disorder, with symptom clusters and behaviors ranging from positive to negative symptoms to neurocognitive dysfunction and affective instability. Furthermore, the clinical picture is clouded by Axis II symptomatology (particularly prominent in the inmate population), comorbid Axis I disorders, and organicity. Four subgroups of schizophrenia were created to coincide with common clinical presentations in the forensic inpatient facility and also to parallel 4 tracks of intervention, consisting of pharmacologic management and programming recommendations. The algorithm begins with any antipsychotic medication and proceeds to atypical neuroleptic usage, augmentation with other psychotropic agents, and, finally, the use of clozapine as the common pathway for refractory schizophrenia. Outcome measurement of pharmacologic intervention is assessed every 6 weeks through the use of a 4-item subscale, specific for each forensic subgroup. A "floating threshold" of 40% symptom severity reduction on Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale items over a 6-week period is considered an indication for neuroleptic continuation. The forensic algorithm differs from other clinical practice guidelines in that specific programming in certain prison environments is stipulated. Finally, a social commentary on the importance of state-of-the-art psychiatric treatment for all members of society is woven into the clinical tapestry of this article.
Subject(s)
Algorithms , Forensic Psychiatry/methods , Prisons/methods , Psychotropic Drugs/therapeutic use , Schizophrenia/drug therapy , Ambulatory Care , Clozapine/administration & dosage , Clozapine/therapeutic use , Crisis Intervention , Decision Trees , Hospitalization , Humans , Mental Disorders/drug therapy , Outcome Assessment, Health Care , Patient Care Planning , Patient Compliance , Prisoners/psychology , Psychiatric Status Rating Scales/statistics & numerical data , Psychotropic Drugs/administration & dosage , Schizophrenia/diagnosis , Schizophrenic PsychologyABSTRACT
Entre enero de 1996 y diciembre de 1997 se trataron 12 pacientes con el diagnóstico clínico confirmado mediante resonancia magnética de desplazamiento anterior del disco modular sin reducción. Los pacientes en los que fracasó el tratamiento conservador fueron tratados mediante artrotomía y discoplastia clásica, fijando el disco al polo lateral y posterior del cóndilo mandibular mediante un ancla Mitek(r). Los pacientes se estudiaron de forma perspectiva a los 3, 6, 9, 12, 15, 18, 21 y 24 meses tras el tratamiento quirúrgico midiendo las siguientes variables: dolor articular (usando una escala analógica visual: 1-15), máxima apertura oral (MAO), protrusión mandibular (PM), lateralidad (LM) y presencia de ruidos articulares. Se realizaron estudios mediante resonancia magnética (cine-RMN sagital e imágenes coronales) antes y tras 6 meses de la cirugía. La edad media fue de 35,7 años (rango entre 19 y 66 años). Nueve eran mujeres y tres varones. El dolor articular subjetivo preoperatorio fue de 11,4ñ1,8, y de 3,2ñ2,1 a los 24 meses de la cirugía, La MAO preoperatoria fue de 29,1ñ2,5 mm y experimentó un aumento estadísticamente significativo (35,7ñ3,2 mm) a los 24 meses del tratamiento inicial. Se observó crepitación articular en 10 ariculaciones antes de la cirugía, persistiendo dicho signo en 8 de los casos y apareciendo en dos chasquidos reciprocos. El estudio por RMN obtenido a los 6 meses demostró una posición normal del disco en 10 articulaciones y un desplazamiento anterior del disco con reducción en los otros dos casos (AU)
