Precipitation of hydroxyapatite nanoparticles: effects of precipitation method on electrophoretic deposition.

Electrophoretic deposition is a low-cost, simple, and flexible coating method for producing hydroxyapatite (HA) coatings on metal implants with a broad range of thicknesses, from < 1 microm to > 500 microm. As for many other HA coating techniques, densification of electrophoretically deposited coatings involves heating the coated metal to temperatures above 1000 degrees C. Metal substrates tend to react with HA coatings at such temperatures inducing decomposition at temperatures below 1050 degrees C (decomposition for pure HA normally occurs above 1300 degrees C). Therefore, densification of these coatings needs to be conducted at temperatures lower than 1050 degrees C, and this necessitates the use of high-surface-area HA nano-precipitates, rather than commercially available pre-calcined powders, which densify at temperatures typically higher than 1200 degrees C. HA nano-precipitates were prepared by three methods and deposited on metal substrates by electrophoresis: (1) the acid base method, which produced plate-like nano-particles with a 2.5:1 aspect ratio, and severely cracked coatings; (2) the calcium acetate method, which produced needle-like nano-particles with a 10:1 aspect ratio, and slightly cracked coatings; (3) the metathesis method, which produced rounded nano-particles with a 2:1 aspect ratio, and high-quality crack-free coatings. The results suggested that the less equiaxed the nano-particles, the more cracked the coatings obtained by the electrophoretic deposition technique.

Hydroxyapatite-coated metals: interfacial reactions during sintering.

Electrophoretic deposition (EPD) is a low cost flexible process for producing HA coatings on metal implants. Its main limitation is that it requires heating the coated implant in order to densify the HA. HA typically sinters at a temperature below 1150 degrees C, but metal implants are degraded above 1000 degrees C. Further, the metal induces the decomposition of the HA coating upon sintering. Recent developments have enabled EPD of metathesis-synthesised uncalcined HA which sinters at approximately 1000 degrees C. The effects of temperature on HA-coated Ti, Ti6Al4V, and 316L stainless steel were investigated for dual coatings of metathesis HA sintered at 1000 degrees C. The use of dual HA coatings (coat, sinter, coat, sinter) enabled decomposition to be confined to the "undercoat" (HA layer 1), with the surface coating decomposition free. The tensile strength of the three metals was not significantly affected by the high sintering temperatures (925 degrees C < T < 1000 degrees C). XRD/SEM/EDS analyses of the interfacial zones revealed that 316L had a negligible HA:metal interfacial zone (approximately 1 microm) while HA:Ti and HA:Ti6Al4V had large interfacial zones (>10 microm) comprising a TiO2 oxidation zone and a CaTiO2 reaction zone.

Breast cancer action plan for Kentucky.

In 1998, Governor Paul E. Patton established the Kentucky Breast Cancer Task Force (KBCTF) to assess and make recommendations on the availability, accessibility, utilization, quality, and outcomes of breast cancer services across the spectrum of disease. Over a two-year period, the KBCTF reviewed the state of breast cancer control in Kentucky and made recommendations for reducing breast cancer morbidity and mortality. To achieve the provision of optimal breast cancer care, the KBCTF recommended universal adoption of professionally accepted guidelines for breast cancer treatment, pain management, and distress management. To better coordinate public education on breast cancer, the KBCTF recommended the development of a standardized packet of public education materials for dissemination through regional networks of "cancer control partners." KBCTF members also requested the Kentucky Cancer Program to investigate the feasibility of establishing a centralized mammography registry to gather more complete data on screening mammography programs.

Solution ripening of hydroxyapatite nanoparticles: effects on electrophoretic deposition.

Electrophoretic deposition is a low-cost, simple, and flexible coating method for producing hydroxyapatite (Hap) coatings on metal implants. However, densification requires heating the coated metal to high temperatures, which, for commercial HAp powders, generally means at least 1200 degrees C. At such temperatures, the metal tends to react with the HAp coating, inducing decomposition, and the strength of titanium and stainless steel implants is severely degraded. With the use of raw uncalcined nanoparticulate Hap, densification can occur at 900 degrees -1050 degrees C; however, such coatings are prone to cracking due to the high drying shrinkage. This problem was solved by precipitating nanoparticulate HAp by the metathesis process [10Ca(NO3)2 + 6NH4H2PO4 + 8NH4OH] and optimizing the approximately 30 nm of nanoprecipitates by an Ostwald ripening approach, that is, by boiling and/or ambient aging in the mother liquor. While the as-precipitated nanoparticles produced severely cracked coatings, 2 h of boiling or 10 days of ambient aging ripened the "gel-like" mass into unagglomerated nanoparticles, which produced crack-free coatings. Since boiling enhanced particle size but ambient aging did not, crack elimination probably was due to the transition from the highly agglomerated gel-like state to the dispersed nanoparticulate state rather than to particle growth. Furthermore, boiling only reduced the amount of cracking whereas aging completely eliminated cracking.

Interfacial bond strength of electrophoretically deposited hydroxyapatite coatings on metals.

Hydroxyapatite (HAp) coatings were deposited onto substrates of metal biomaterials (Ti, Ti6Al4V, and 316L stainless steel) by electrophoretic deposition (EPD). Only ultra-high surface area HAp powder, prepared by the metathesis method 10Ca(NO3)2 + 6(NH4)2HPO4 + 8NH4OH), could produce dense coatings when sintered at 875-1000degreesC. Single EPD coatings cracked during sintering owing to the 15-18% sintering shrinkage, but the HAp did not decompose. The use of dual coatings (coat, sinter, coat, sinter) resolved the cracking problem. Scanning electron microscopy/energy dispersive spectroscopy (SEM/EDS) inspection revealed that the second coating filled in the "valleys" in the cracks of the first coating. The interfacial shear strength of the dual coatings was found, by ASTM F1044-87, to be approximately 12 MPa on a titanium substrate and approximately 22 MPa on 316L stainless steel, comparing quite favorably with the 34 MPa benchmark (the shear strength of bovine cortical bone was found to be 34 MPa). Stainless steel gave the better result since -316L (20.5 microm mK(-1)) > alpha-HAp (approximately 14 microm mK(-1)), resulting in residual compressive stresses in the coating, whereas alpha-titanium (approximately 10.3 microm mK(-1)) < alpha-HAp, resulting in residual tensile stresses in the coating.

Evaluation of oral cancer screening.

BACKGROUND: Oral cancer screening procedures are designed to collectively allow early detection of cancers in a body area accessible to visual and physical examination, as well as to facilitate timely treatment, awareness, and the ongoing education of the public. METHODS: A state fair was selected for this activity because of the availability of a random population compatible with meeting these goals. A total of 1,151 individuals participated in this free elective activity. RESULTS: Of this number 4.17% were deemed to have oral pathologic states necessitating professional intervention, and 1.82% were clinically diagnosed as having potential dysplastic or precancerous lesions. No clinical oral cancer was detected in this population. Nevertheless, by virtue of screening and detecting clinically premalignant lesions, the screening test advanced the diagnosis of potential oral cancers. CONCLUSIONS: The outcome adds support to oral cancer screening as a procedure applicable in reducing morbidity and mortality from oral cancers.

Beliefs and mammography screening.

INTRODUCTION: Breast cancer is a leading form of preventable cancer among women in the United States. Despite improvements in mammography and other early detection techniques, special populations, including older and minority women, continue to experience high incidence and mortality rates. Knowledge, attitudes, and beliefs are ubiquitous constructs in preventive medicine, health behavior, and behavioral epidemiology. These constructs often are used to explain variation in health screening behavior. While all three have been examined in relation to mammography screening, concentration on the single category of beliefs and the relation between specific beliefs and mammography screening practices has remained largely uninvestigated. METHODS: Using logistic regression modeling, we examined the relationship between four individual beliefs and mammography screening in a cross-sectional study of 407 women. RESULTS: After we controlled for confounding factors in a multivariable analysis, belief in the efficacy of early detection in improving breast cancer outcome (odds ratio [OR] = 2.98; 95% confidence intervals [CI] = 1.62, 5.47) and perceived risk (OR = 0.49; 95% CI = 0.26, 0.94) were significantly associated with screening practice. Belief that mammography is dangerous (OR = 0.46; 95% CI = 0.18, 1.18) or painful (OR = 1.25; 95% CI = 0.75, 2.08) was not significantly associated with screening practice. CONCLUSIONS: Information on the relationship between beliefs and screening practices may be used both to understand screening behaviors and to develop targeted strategies to improve mammography compliance.

From Carper's patterns of knowing to ways of being: an ontological philosophical shift in nursing.

Carper's 1978 article in the premiere issue of Advances in Nursing Science encouraged nurses to consider four fundamental patterns of knowing. Through illustrations from literature and the performing arts, the authors address Carper's patterns of knowing in the context of an emerging philosophical shift. First, they critique the major strengths and limitations of the article. Next, they explore an emerging philosophical shift in nursing from Carper's epistemological focus to ontological reflections on ways of being. Finally, they discuss the significance of the emerging philosophical shift and the ways of being for the science-art of nursing.

Sintering effects on the strength of hydroxyapatite.

Mechanisms underlying temperature-strength interrelations for dense (> 95% dense, pores closed) hydroxyapatite (HAp) were investigated by comparative assessment of temperature effects on tensile strength, Weibull modulus, apparent density, decomposition (HAp:tricalcium phosphate ratio), dehydroxylation and microstructure. Significant dehydroxylation occurred above approximately 800 degrees C. Strength peaked at approximately 80 MPa just before the attainment of closed porosity (approximately 95% dense). For higher temperatures (closed porosity), the strength dropped sharply to approximately 60 MPa due to the closure of dehydroxylation pathways, and then stabilized at approximately 60 MPa. At very high temperatures (> 1350 degrees C), the strength dropped catastrophically to approximately 10 MPa corresponding to the decomposition of HAp to tricalcium phosphate and the associated sudden release of the remaining bonded water.