Reinvestigation of the direct two-proton decay of the long-lived isomer 94Ag(m) [0.4 s, 6.7 MeV, (21+)].

An attempt to confirm the reported direct one-proton and two-proton decays of the (21+) isomer at 6.7(5) MeV in 94Ag has been made. The 0.39(4) s half-life of the isomer permitted use of a helium-jet system to transport reaction products from the 40Ca + (nat)Ni reaction at 197 MeV to a low-background area; 24 gas DeltaE-(Si)E detector telescopes were used to identify emitted protons down to 0.4 MeV. No evidence was obtained for two-proton radioactivity with a summed energy of 1.9(1) MeV and a branching ratio of 0.5(3)%. Two groups of one-proton radioactivity from this isomer had also been reported; our data confirm the lower energy group at 0.79(3) MeV with its branching ratio of 1.9(5)%.

Prediction of lithium dose: a mathematical alternative to the test-dose method.

A method of estimating the optimal dose of lithium is presented. The charts of 548 patients were reviewed to obtain data regarding the factors thought to affect the lithium dose, and an equation to estimate the dose was derived by stepwise multiple linear regression. The equation was also applied to 390 patients to determine the difference between the estimated and the actual dose; the mean difference was only 19 mg/day and the standard deviation was 325 mg/day. Lithium level, presence of a cyclic antidepressant, age, sex, and weight were found to be important variables for estimation of lithium dose.

The relationship between the clinical performance and large deformation mechanical behavior of retrieved UHMWPE tibial inserts.

Many aspects of the proposed relationship between material properties and clinical performance of UHMWPE components remain unclear. In this study, we explored the hypothesis that the clinical performance of tibial inserts is directly related to its large-deformation mechanical behavior measured near the articulating surface. Retrieval analysis was performed on three conventional UHMWPE and three Hylamer-M tibial components of the same design and manufacturer. Samples of material were then obtained from the worn regions of each implant and subjected to mechanical characterization using the small punch test. Statistically significant relationships were observed between the metrics of the small punch test and the total damage score and the burnishing damage score of the implants. We also examined the near-surface morphology of the retrievals using transmission electron microscopy. TEM analysis revealed lamellar alignment at and below the wear surfaces of the conventional UHMWPE retrievals up to a maximum depth of approximately 8 microm, consistent with large-deformation crystalline plasticity. The depth of the plasticity-induced damage layer varied not only between the retrievals, but also between the conventional UHMWPE and Hylamer-M components. Thus, the results of this study support the hypothesis that the clinical performance of UHMWPE tibial inserts is related to the large-deformation mechanical behavior measured near the articulating surface.

Degradation of mechanical behavior in UHMWPE after natural and accelerated aging.

Ultra-high molecular weight polyethylene (UHMWPE) is known to degrade during natural (shelf) aging following gamma irradiation in air, but the mechanical signature of degradation remains poorly understood. Accelerated aging methods have been developed to reproduce the natural aging process as well as to precondition total joint replacement components prior to joint simulator wear testing. In this study, we compared the mechanical behavior of naturally (shelf) aged and accelerated aged tibial inserts using a previously validated miniature specimen testing technique known as the small punch test. Tibial inserts made-of GUR 1120 and sterilized with 25 to 40 kGy of gamma radiation (in air) in 1988, 1993, and 1997 were obtained; a subset of the 1997 implants were subjected to 4 weeks of accelerated aging in air at 80 degrees C. To determine the spatial variation of mechanical properties within each insert, miniature disk shaped specimens were machined from the surface and subsurface regions of the inserts. Analysis of variance of the test data showed that aging significantly affected the small punch test measures of elastic modulus, initial load, ultimate load, ultimate displacement, and work to failure. The accelerated aging protocol was unable to reproduce the spatial mechanical profile seen in shelf aged components, but it did mechanically degrade the surface of GUR 1120 tibial components to an extent comparable to that seen after 10 years of natural aging. Test specimens showed a fracture morphology consistent with the decreased ductility and toughness which was corroborated by the small punch test metrics of this study. Our data support the hypothesis that UHMWPE undergoes a spatially nonuniform change towards a less ductile (more brittle) mechanical behavior after gamma irradiation in air and shelf aging.

Radiation and chemical crosslinking promote strain hardening behavior and molecular alignment in ultra high molecular weight polyethylene during multi-axial loading conditions.

The mechanical behavior and evolution of crystalline morphology during large deformation of eight types of virgin and crosslinked ultra high molecular weight polyethylene (UHMWPE) were studied using the small punch test and transmission electron microscopy (TEM). We investigated the hypothesis that both radiation and chemical crosslinking hinder molecular mobility at large deformations, and hence promote strain hardening and molecular alignment during the multiaxial loading of the small punch test. Chemical crosslinking of UHMWPE was performed using 0.25% dicumyl peroxide (GHR 8110, GUR 1020 and 1050), and radiation crosslinking was performed using 150 kGy of electron beam radiation (GUR 1150). Crosslinking increased the ultimate load at failure and decreased the ultimate displacement of the polyethylenes during the small punch test. Crosslinking also increased the near-ultimate hardening behavior of the polyethylenes. Transmission electron microscopy was used to characterize the crystalline morphology of the bulk material, undeformed regions of the small punch test specimens, and deformed regions of the specimens oriented perpendicular and parallel to the punch direction. In contrast with the virgin polyethylenes, which showed only subtle evidence of lamellar alignment, the crosslinked polyethylenes exhibited enhanced crystalline lamellae orientation after the small punch test, predominantly in the direction parallel to the punch direction or deformation axis. Thus, the results of this study support the hypothesis that crosslinking promotes strain hardening during multiaxial loading because of increased resistance to molecular mobility at large deformations effected by molecular alignment. The data also illustrate the sensitivity of large deformation mechanical behavior and crystalline morphology to the method of crosslinking and resin of polyethylene.

A small punch test technique for characterizing the elastic modulus and fracture behavior of PMMA bone cement used in total joint replacement.

Polymethylmethacrylate (PMMA) bone cement is used in total joint replacements to anchor implants to the underlying bone. Establishing and maintaining the integrity of bone cement is thus of critical importance to the long-term outcome of joint replacement surgery. The goal of the present study was to evaluate the suitability of a novel testing technique, the small punch or miniaturized disk bend test, to characterize the elastic modulus and fracture behavior of PMMA. We investigated the hypothesis that the crack initiation behavior of PMMA during the small punch test was sensitive to the test temperature. Miniature disk-shaped specimens, 0.5 mm thick and 6.4 mm in diameter, were prepared from PMMA and Simplex-P bone cement according to manufacturers' instructions. Testing was conducted at ambient and body temperatures, and the effect of test temperature on the elastic modulus and fracture behavior was statistically evaluated using analysis of variance. For both PMMA materials, the test temperature had a significant effect on elastic modulus and crack initiation behavior. At body temperature, the specimens exhibited "ductile" crack initiation, whereas at room temperature "brittle" crack initiation was observed. The small punch test was found to be a sensitive and repeatable test method for evaluating the mechanical behavior of PMMA. In light of the results of this study, future small punch testing should be conducted at body temperature.

Miniature specimen shear punch test for UHMWPE used in total joint replacements.

Despite the critical role that shear is hypothesized to play in the damage modes that limit the performance of total hip and knee replacements, the shear behavior of ultra-high molecular weight polyethylene (UHMWPE) remains poorly understood, especially after oxidative degradation or radiation crosslinking. In the present study, we developed the miniature specimen (0.5 mm thickness x 6.4mm diameter) shear punch test to evaluate the shear behavior of UHMWPE used in total joint replacement components. We investigated the shear punch behavior of virgin and crosslinked stock materials, as well as of UHMWPE from tibial implants that were gamma-irradiated in air and shelf aged for up to 8.5 years. Finite element analysis, scanning electron microscopy, and interrupted testing were conducted to aid in the interpretation of the shear punch load-displacement curves. The shear punch load-displacement curves exhibited similar distinctive features. Following toe-in, the load-displacement curves were typically bilinear, and characterized by an initial stiffness, a transition load, a hardening stiffness, and a peak load. The finite element analysis established that the initial stiffness was proportional to the elastic modulus of the UHMWPE, and the transition load of the bilinear curve reflected the development of a plastically deforming zone traversing through the thickness of the sample. Based on our observations, we propose two interpretations of the peak load during the shear punch test: one theory is based on the initiation of crystalline plasticity, the other based on the transition from shear to tension during the tests. Due to the miniature specimen size, the shear punch test offers several potential advantages over bulk test methods, including the capability to directly measure shear behavior, and quite possibly infer ultimate uniaxial behavior as well, from shelf aged and retrieved UHMWPE components. Thus, the shear punch test represents an effective and complementary new tool in the armamentarium of miniature specimen mechanical testing methods for UHMWPE used in total joint replacement components.

Validation of a small punch testing technique to characterize the mechanical behaviour of ultra-high-molecular-weight polyethylene.

The small punch or miniaturized disc bend test has been used successfully to characterize the ductility and fracture resistance of metals and ceramics with specimens measuring 0.5 mm in thickness. This study was performed to demonstrate the feasibility of performing small punch tests on implant grade ultra-high-molecular-weight polyethylene (UHMWPE). Large-deformation finite element simulations were developed and validated to explore the hypothesis that the macroscopic constitutive behaviour of UHMWPE may be inferred from a miniature specimen testing technique which can be used to characterize the ductility and work to failure for UHMWPE. The load-displacement curve was insensitive to cyclic preconditioning of the test specimen and only mildly sensitive to the loading rate. Furthermore, the initial slope of the small punch load-displacement curve was used to determine the elastic modulus of the UHMWPE with the help of the inverse finite element method. The ultimate goal of this research is to develop the capability to perform local measurements of material tensile and static fracture properties in as-manufactured, as-sterilized and as-retrieved UHMWPE components.

The yielding, plastic flow, and fracture behavior of ultra-high molecular weight polyethylene used in total joint replacements.

The yielding, plastic flow, and fracture behavior of UHMWPE plays an important role in wear and failure mechanisms of total joint replacement components. The primary objective of this study was to compare the yielding, plastic flow, and fracture behavior of two implantable grades of UHMWPE (GUR 1120 vs 4150 HP). The first part of this work explored the hypothesis that up to the polymer yield point, the monotonic loading behavior of UHMWPE displays similar true stress strain behavior in tension and compression. Uniaxial tension and compression tests were conducted to compare the equivalent true stress vs strain response of UHMWPE up to 0.12 true strain. During monotonic loading, the equivalent true stress strain behavior was similar in tension and compression up to the yield point. However, investigation of the unloading behavior and permanent plastic deformations showed that classical deviatoric rate independent plasticity theory may dramatically overpredict the permanent strains in UHMWPE. A secondary goal of this study was to determine the ultimate true stress and strain for UHMWPE and to characterize the fracture surfaces after failure. Using a fracture mechanics approach, the critical flaw sizes were used in combination with the true ultimate stresses to predict the fracture toughness of the two resins. A custom video-based strain measurement system was developed and validated to characterize the true stress-strain behavior up to failure and to verify the accuracy of the incompressibility assumption in calculating the true stress-strains up to failure. In a detailed uncertainty analysis, theoretical expressions were derived for the relative uncertainty in digital video-based estimates of nominal strain, true strain, homogeneous stress, and true stress. Although the yielding behavior of the two UHMWPE resins was similar, the hardening and plastic flow behavior clearly discriminated between the GUR 1120 and 4150 HP. A statistically significant difference between the fracture toughness of the two resins was also evident. The long-term goal of this research is to provide detailed true stress strain data for UHMWPE under uniaxial tension and compression for future numerical simulations and comparison with more complex multiaxial loading conditions.

Prevalence of common psychiatric disorders among American Indian adolescent detainees.

OBJECTIVES: To examine the prevalence of common psychiatric disorders among adolescents detained on a Northern Plains reservation. METHODS: Prevalence data were gathered using lay interviewers administering structured diagnostic instruments based on DSM-III-R criteria to 150 youths booked into a reservation-based juvenile detention center from July 1995 through April 1996. RESULTS: Approximately 49% of the sample had at least one alcohol, drug, or mental health disorder; 12.7% had two disorders; and 8.7% had three or more disorders. The most common diagnoses were substance abuse/dependence (38%), conduct disorder (16.7%), and major depression (10%). Females were significantly more likely than males to have major depression and/or anxiety disorders and were significantly more likely to have three or more disorders. These rates were higher in comparison with general and Indian adolescent community samples. CONCLUSIONS: These American Indian adolescent detainees had a high prevalence of psychiatric disorders. Local juvenile justice systems should be vigilant for the presence of psychiatric disorders and appropriately connected with psychiatric services to address this considerable need. Careful psychiatric assessment is necessary to ensure a more coordinated community service response to juvenile delinquency.

Utilization of alcohol, drug, and mental health treatment services among American Indian adolescent detainees.

OBJECTIVE: To describe the relationship between psychiatric status and the use of alcohol, drug, and mental health (ADM) services among a sample of American Indian (AI) juvenile detainees. METHOD: A structured diagnostic and service use interview was administered to 150 AI youths detained in a juvenile detention center located on a Northern Plains reservation. RESULTS: Forty percent of AI youths with a diagnosed substance use disorder and 34.1% with a diagnosed anxiety, mood, or disruptive behavior disorder reported lifetime use of services for substance use and emotional problems, respectively. While services for substance use problems were most commonly provided in residential settings, services for emotional problems were most commonly provided in outpatient settings. Traditional healers and pastoral counselors provided services to 23.7% and 29.6% of youths who received services for substance use and emotional problems, respectively. Detained youths were more likely to receive ADM services than AI adolescents living at--large in another, comparable Northern Plains reservation community. Still, the vast majority of youths in detention who suffered from psychiatric disorders did not report use of ADM services. CONCLUSIONS: Detention facilities serving AI adolescents need to screen carefully for the presence of psychiatric disorders and facilitate the use of ADM services.

Comparative pathogenicity of selected bovine viral diarrhea virus isolates in gnotobiotic lambs.

The infectivity and pathogenicity of selected bovine viral diarrhea virus (BVDV) isolates were determined in gnotobiotic, colostrum-deprived neonatal lambs. Five-day-old cesarean-derived gnotobiotic lambs were exposed to 1 of 10 BVDV isolates via aerosol suspension. These isolates were from tissues or secretions of calves or lambs affected with respiratory tract disease, weak neonatal calves, aborted bovine fetuses, or reference Singer or Draper BVDV. The pathogenicity of each isolate, relative to the others, was evaluated in lambs by measurement of the neutralizing antibody response, virus isolation from nasal secretions or tissues, and postmortem lesions. The BVDV isolates varied in their infectivity and pathogenicity. Singer, the cytopathic reference strain, was the most lymphotrophic isolate and stimulated the greatest neutralizing antibody response. Encephalitis was the most consistent lesion observed and was used as the final determinant of relative pathogenicity of the viruses. The most neuropathogenic isolates were the 2 viruses originating from lambs affected with respiratory tract disease, the 2 weak neonatal calf isolates, and 1 isolate from an aborted bovine fetus. The least pathogenic isolates were the 2 reference isolates, Draper and Singer; the 2 mucosal disease isolates; and 1 isolate originating from an aborted bovine fetus.

Measurement of the Ec.m. = 184 keV resonance strength in the 26gAl (p, gamma)27 Si reaction.

The strength of the Ec.m. = 184 keV resonance in the 26gAl(p, gamma)27 reaction has been measured in inverse kinematics using the DRAGON recoil separator at TRIUMF's ISAC facility. We measure a value of omega gamma = 35 +/- 7 microeV and a resonance energy of Ec.m. = 184 +/- 1 keV, consistent with p-wave proton capture into the 7652(3) keV state in 27Si, and discuss the implications of these values for 26GAl nucleosynthesis in typical oxygen-neon white-dwarf novae.

Impact of removing oral neuroleptic liquids from the formulary of a large psychiatric hospital.

Oral liquid formulations of neuroleptic medications have been claimed to offer advantages in treatment of psychotic patients, particularly as a means of ensuring compliance. After a review of the literature, this 900-bed psychiatric facility found no substantial support to indicate that liquids are superior to solid dosage forms. Because of their higher cost, liquid neuroleptics were removed from this formulary. Few changes in prescribing practices were measured after removal of liquids; dosages remained constant and injectable neuroleptic and sedative use actually decreased. Replacing liquid neuroleptic dosage forms with solid dosage forms resulted in an estimated annual savings of nearly $60,000 at this institution. The authors conclude that liquid neuroleptics appear to offer no benefits over solid dosage forms in adult psychiatric patients and can be removed from drug formularies without disruptive effects on psychotropic prescribing practices or clinical care. However, further research is needed to determine the benefits of liquid neuroleptics in special clinical or psychiatric settings.

A miniature specimen mechanical testing technique scaled to articulating surface of polyethylene components for total joint arthroplasty.

The small punch test was developed to investigate the mechanical behavior of polyethylene using miniature specimens (< 14 mg) measuring 0.5 mm in thickness and 6.4 mm in diameter. The objective of this study was to demonstrate the feasibility and reproducibility of the small punch test when applied to clinically relevant polyethylenes. Mechanical behavior was characterized during 66 tests performed on GUR4150HP and GUR4120 specimens following alternate sterilization methods and 4 weeks of accelerated aging at 80 degrees C. The small punch test was found to be highly reproducible with regard to characterizing the ductility, ultimate strength, and fracture resistance of sterilized and aged polyethylene. In the future, the small punch test can be used to directly measure mechanical properties near the articulating surface of retrieved components.

Pharmacy-based screening program for tardive dyskinesia.

An ongoing screening program using pharmacists to detect tardive dyskinesia (TD) was developed, and a pharmacy-based prevalence survey of TD in chronic hospitalized psychiatric patients was undertaken to determine the extent of abnormal involuntary movements. The results show that older patients and women in particular are at higher risk for developing abnormal movements. Higher doses of neuroleptics were used in non-TD patients, indicating a possible masking effect caused by these drugs. By using a standardized rating method such as the Abnormal Involuntary Movement Scale, pharmacists can and should be utilized in the surveillance of TD.

Plasticity-induced damage layer is a precursor to wear in radiation-cross-linked UHMWPE acetabular components for total hip replacement. Ultra-high-molecular-weight polyethylene.

The mechanism for the improved wear resistance of cross-linked ultra-high-molecular-weight polyethylene (UHMWPE) remains unclear. This study investigated the effect of cross-linking achieved by gamma irradiation in nitrogen on the tribologic, mechanical, and morphologic properties of UHMWPE. The goal of this study was to relate UHMWPE properties to the wear mechanism in acetabular-bearing inserts. Wear simulation of acetabular liners was followed by detailed characterization of the mechanical behavior and crystalline morphology at the articulating surface. The wear rate was determined to be directly related to the ductility, toughness, and strain-hardening behavior of the UHMWPE. The concept of a plasticity-induced damage layer is introduced to explain the near-surface orientation of the crystalline lamellae observed in the wear-tested acetabular liners. Cross-linking reduces abrasive wear of acetabular components by substantially reducing--but not eliminating--the plasticity-induced damage layer that precedes abrasive wear.

21Na(p,gamma)22Mg reaction and oxygen-neon novae.

The 21Na(p,gamma)22Mg reaction is expected to play an important role in the nucleosynthesis of 22Na in oxygen-neon novae. The decay of 22Na leads to the emission of a characteristic 1.275 MeV gamma-ray line. This report provides the first direct measurement of the rate of this reaction using a radioactive 21Na beam, and discusses its astrophysical implications. The energy of the important state was measured to be E(c.m.)=205.7+/-0.5 keV with a resonance strength omegagamma=1.03+/-0.16(stat)+/-0.14(sys) meV.