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The ability to incorporate polarity-modifying groups will also play a major role in transport processes order lopid 300 mg free shipping, of great importance in both catalysis and membrane processes cheap lopid 300 mg amex. Many other opportunities exist due to the enormous flexibility of the preparative method, and the ability to incorporate many different species. Very recently, a great deal of work has been published concerning methods of producing these materials with specific physical forms, such as spheres, discs and fibres. Such possibilities will pave the way to new application areas such as molecular wires, where the silica fibre acts as an insulator, and the inside of the pore is filled with a metal or indeed a conducting polymer, such that nanoscale wires and electronic devices can be fabri- cated. Initial work on the production of highly porous electrodes has already been successfully carried out, and the extension to uni-directional bundles of wires will no doubt soon follow. The ability to produce threads, discs and spheres of defined size and structure will be of great importance when the very promising initial results from catalytic studies are applied on a larger scale. Processes using heterogeneous catalysts require the ability to control particle size and shape in order to ensure good mixing of all the reaction components, and separations after reaction. A further application of this technology will certainly be the fabrica- tion of membranes of these materials. Membrane reactors have shown great utility in many systems, where one component of a reaction mixture can be separated by permeation through a membrane, thus driving a reac- tion forwards, by continuous separation. Looking further ahead, the pores in these materials could be consid- ered as analogous to ion channels in cell walls. The encapsulation of the enzyme inside the cell could then possibly be used to protect the enzyme from harsh conditions outside the cell, while allowing reaction components to diffuse in, react, and diffuse out again. Already, some effort is being expended on silica/biological composites, with significant advances being made. MACQUARRIE discovery of the MTSs in 1992, such major advances will no doubt become reality in the early years of the twenty-first century. May School of Chemistry, University of Bristol, Bristol BS81TS, UK Diamond has some of the most extreme physical properties of any material, yet its practical use in science or engineering has been limited due its scarcity and expense. With the recent development of techniques for depositing thin films of diamond on a variety of substrate materials, we now have the ability to exploit these superlative properties in many new and exciting applications. In this paper, we shall explain the basic science and technology underlying the chemical vapour deposition of diamond thin films, and show how this is leading to the development of diamond as a twenty-first century engineering material. They were prized for their scarcity for centuries, and still remain a symbol of wealth and prestige to this day. Diamonds were first mined in India over 4000 years ago, but the modern diamond era only began in 1866, when huge diamond deposits were discovered in Kimberley, South Africa, creating a huge rush of European prospectors. The wealth this created helped to underwrite the British Empire, and changed the fates of many African countries. Apart from their appeal as gemstones, diamonds possess a remarkable 75 76 P. Some of the outstanding properties of diamond • Hardest known material giving extreme wear resistance • Highest bulk modulus, i. Indeed, a glance at any compendium of material data properties will prove that diamond is almost always ‘the biggest and best’. Amongst other properties, diamond is the hardest known material, has the highest thermal conductivity at room temperature, is transparent over a very wide wavelength range, is the stiffest material, the least compressible, and is inert to most chemical reagents. With such a wide range of excep- tional properties, it is not surprising that diamond has sometimes been referred to as ‘the ultimate engineering material’. Unfortunately, it has proved very difficult to exploit these properties, due both to the cost and scarcity of large natural diamonds, and the fact that diamond was only available in the form of stones or grit. It had been known for 200 years that diamond is composed solely of carbon, and many attempts were made to synthesise diamond artificially using as a starting material another commonly occurring form of carbon, graphite. This proved extremely difficult, mainly because at room temperature and pres- sure, graphite is more stable than diamond. Although the difference in stability between the two forms of carbon is actually quite small, their structures are so different that it would require a large amount of energy to convert between them.

Pierre quality 300mg lopid, Emile had no letters of Robert Judet and has achieved worldwide accept- support to compete adequately for an orthopedic ance buy discount lopid 300 mg online. A friend suggested he contact Professor education in the understanding of the complex Robert Judet and he did this out of desperation nature of acetabular fractures. The major textbooks on acetabular surgery, all with meeting with Robert Judet was very brief. Professor Judet asked him where he and the third, Fractures of the Acetabulum in came from and Emile responded “St. The 6-month position lasted 12 months and found contributions to orthopedic surgery that Emile subsequently became Judet’s assistant. Professor Letournel to associate professor and finally professor in qualified uniquely for this honor as he was still 1970. He became head of the Department of alive when the commission was given to pay Orthopedic Surgery at the Centré Medico tribute to his life achievements in fracture surgery. Chirurgical de la Port de Choisy in southeast Unfortunately, he died 2 weeks before this journal Paris. He remained at the Choisy hospital until his was published with his dedication issue. In addition to his interest in acetabular and rugged and energetic and he lived life with great pelvic fractures, he performed over 6,000 total hip eagerness and excitement. His mere presence in arthroplasties, developed implant designs and sur- the operating theater created movement. As he gical techniques for management of calcaneal would scrub for surgery, his intensity to take on fractures and had extensive expertise in the sur- his worthy fracture adversary would bubble forth gical treatment of bone infection. His position at as he would review in his mind the preoperative Choisy provided him an unlimited exposure to plan of surgical approach and internal fixation. His distinctive vocal tal, and Professor Letournel never charged a commentary (always in French) on a particularly surgeon’s fee to any patient throughout his entire stubborn fragment reduction or repeated failed career at Choisy for his services. He was admit- surgical maneuver or the worthlessness of a par- ted to the French Academie de Medicine et ticular instrument to perform its function would Chirurgie in 1981 and received the “Legion create absolute silence from the operating theater d’Honneur” from President Mitterrand of France staff until a universal sigh of relief would resound in 1988. These honors were very special to Emile throughout the room when he was finally satisfied and were public recognition of his stature in with his reduction. Of special mention is Profes- French medicine and his accomplishments in the sor Letournel’s most trusted medical assistant, field of orthopedic trauma surgery. Following Remy Ser, who was the master of the Judet frac- his death, the elected officials of St. He could position any extremity on the Miquelon passed a resolution naming a street on fracture table into the desired position during the the island of his birth, “Emile Letournel. Remy Ser was an extremely dedicated who have been able to study with him at the professional and stayed with Emile for over 15 “Letournel School of Acetabular Surgery” gained years until the day he died. He was an integral tremendous insight into his diagnostic and surgi- part of the Letournel team perpetuating the cal acumen and the steadfastness with which he excellence that was the hallmark of Professor pursued every acetabular fracture to obtain “the Letournel’s surgery. He would continually Clinical Orthopedics and Related Research, ded- vocalize to himself all the possibilities and con- icated to Professor Letournel and his significant sequences of his technique while performing his contributions to orthopedic surgery. His genius had an enormous 193 Who’s Who in Orthopedics ability to comprehend spacial relationships, leading him to understand quickly the complexi- ties of a particular fracture and develop a plan of reduction based on his extensive experience. He was a masterful surgeon who knew well his abil- ities and limitations. He lived for the difficult trial, whether it was in the operating room or performing the ritualistic decapitation of a bottle of Dom Perignon with a saber, he was always the same wonderful man. His admirers encompassed the entire world of orthopedic and trauma surgery. His presentations were legendary and as uncommonly entertain- ing as his own form of English (an ingenious Letournel dialect), which created within the audience a profound awareness of the complexity Jacques LEVEUF of acetabular fractures and the importance of his 1886–1948 pioneering original and lifelong contributions to acetabular fracture surgery. This remarkable individual was not enormous Leveuf was born in Limoges and studied in the in physical stature, but he was immense in per- School of Medicine in Paris.

It is fairly straightforward to design your transparency on a computer then print it using a colour printer discount lopid 300 mg mastercard. Avoid using yellow cheap 300 mg lopid otc, orange, and red, as these colours are difficult to see. You can write and draw directly on to the transparencies with felt tipped pens. Use permanent markers to avoid smudging, and place a sheet of ruled paper underneath so that the writing is evenly spaced. You can also use a photocopier to copy print on to a transparency, but remember that you may need to enlarge it to Paper copies of transparencies and slides make the text readable. One commonly used presentation method is to store transparencies in clear plastic sleeves that can be filed in a ring binder. When showing transparencies, do not overuse the technique of covering the transparency and revealing a little at a time—many learners find this irritating. Making your own slides can be difficult, so get help from the local illustration department or 47 ABC of Learning and Teaching in Medicine a commercial company. Ensure that the text is large enough to see when projected and that the slides are marked so that they are loaded in the projector correctly. Dual projection is rarely done well and rarely necessary unless you are using visual images (for example, x ray films, clinical photographs) with accompanying text. If you use dual projection make sure that each of the slides is labelled for the correct projector. Computer generated slides The ability to make computer generated slides (for example, PowerPoint) has transformed the way that many people create teaching materials and has greatly reduced the use of 35 mm slides. Try not to get seduced by the technology, however, and remember that it is just another educational tool. Having tried all of the colours and slide layouts available, many experienced lecturers now prefer simple formats that are easy to read and in which the medium does not get in the way of the message. However, the computer package has many useful tools—diagrams and “clip art” can help to conceptualise difficult problems. Video clips can be inserted into a presentation, but be certain that they are there to illustrate a point and not simply to show off your own technological skills. Use advanced formats for PowerPoint presentations only if you are well practised and Ground rules for slide preparation (35 mm or PowerPoint) comfortable with the medium. Ensure that the computer you are planning to use is x Use a clear font that is easily readable x Use a type size of 20 points or greater compatible with the multimedia projector. Similarly, if you have x Use a light text on a dark background for slides (in contrast with stored your presentation on a CD or floppy disk (or any one of OHP transparencies) the other portable storage formats), make sure that this is x Use short sentences and small tables supported at the venue. The latest version of the presentation x Restrict the overall number of words on each slide to about 40 or software can give you access to many features that may not fewer work on the computer provided at the teaching venue, so a wise x Avoid patterned backgrounds—they are extremely distracting precaution is to save your presentation as an older version of x Limit the number of colours on your slides to a maximum of three x Use highlighting to emphasise items in lists the software. Special units were established that were able to resuscitate patients at high risk of developing cardiac arrest, and special hospital cardiac arrest teams were created. After coronary care units were established for patients with acute myocardial infarction, it became apparent that most deaths from the condition occurred in the early stages, not because the myocardium was severely damaged, but because of potentially treatable disturbances in the cardiac rhythm. Once the effectiveness of resuscitation in hospital was established, the realisation that two thirds of deaths from coronary heart disease occurred before hospital admission led to attempts to provide coronary care, and particularly defibrillation, in the community. The credit for this development goes to Pantridge in Belfast, who pioneered the first mobile coronary care unit staffed by a doctor and nurse. This early experience confirmed the high incidence of lethal arrhythmias at the onset of myocardial infarction and many patients attended by the mobile units were successfully resuscitated from cardiac arrest. Pantridge and his coworkers also drew attention to the value of cardiopulmonary resuscitation (CPR) performed by bystanders before the arrival of the mobile unit. In the early 1970s, Leonard Cobb, a cardiologist in Seattle, inspired by these results, equipped paramedics with defibrillators and trained firefighters to act as first responders and perform basic life support. The fire service in Seattle is highly coordinated and a standard fire appliance can reach any part of the city within four minutes. CPR was, therefore, already in progress when more highly trained ambulance paramedics arrived some minutes later. Two factors were found to be crucial determinants of survival from cardiac arrest. The first was the presence of bystanders able to perform basic life support.

He did as much as he needed to do 138 People Talking to Their Physicians in two visits buy generic lopid 300mg on-line. Sanderson underscored something emphasized by many interview- ees: that physicians should refer patients to specialists for problems outside their expertise buy discount lopid 300mg line. People do not see referrals as admissions of inadequacy; they know medical knowledge is vast and continually expanding. Referrals to specialists show respect, concern, and a desire to do everything possible. Some people are reluctant to ask for referrals, afraid of offending the doctor. Sanderson hadn’t asked her physician for a referral—she just didn’t want to: “He was very upset when he found I had gone to another doctor. Visits to physicians grow shorter and shorter as financial pres- sures mount. For most [other] black people I’ve seen, they rush you in and rush you out. People like Erna Dodd, who had em- physema, diabetes requiring insulin, congestive heart failure, seizures, obesity, and arthritis, need considerable attention to manage active illness (e. Ironically, addressing the full range of health-related concerns may require multiple office visits for the people least able to get around. Beyond limited discussion times, shortened appointments have physical consequences. Some people simply cannot move as quickly as the physi- cian wants, for example, climbing onto examining tables. Andrea Banks, a primary care physician, told me about a young man with cerebral palsy whose aunt brings him to appointments in his wheelchair. Banks examined the patient in his wheelchair, thinking it would be easier for him. She never asked the patient if he preferred to get onto the examining table. She ruefully acknowledged needing addi- tional assistance to help people with mobility problems onto the examin- ing table—assistance that consumes precious minutes. Interviewees feel that being rushed can defeat the purpose of what’s supposed to be a therapeutic interaction. Talking about one’s pain is difficult, whether with family, friends, co-workers, or physicians. Pain is a popular public topic much in the news recently, with highly publicized releases of new drugs, such as the controversial COX-2 (type 2 cyclooxygenase) in- hibitors. Drugs do exist to control even excruciating pain, drugs as old as the hills—narcotics, the descendants of opium. The dark side of pain control involves complex societal and personal fears of addiction and its myriad, destructive consequences. People can feel trapped by societal and personal prejudices and misconceptions. But nobody wants to give me any pain pills except silly things like Motrin, naprosyn. Because of conflicting emotions, people find pain particularly difficult to discuss with physicians. You think I’m crazy or 140 People Talking to Their Physicians something, that I’m not really in pain? I could tell there was more, but I didn’t ask, re- specting her privacy. Harris had told me about many complexities in her life, including alcoholism. Harris fits one oft-held stereotype of the “drug seeker,” medical slang for people who want narcotics, presumably to feed addictions. And she knows these views well: “You gotta understand, where we live at, so many people is preju- diced, and they don’t want no black people. For Mattie Harris, as for mil- lions of others, no quick solution exists. Pain is a lonely state, outside the preferred medical paradigm of being easily quantified, measured objec- tively (by an outsider), visualized, or scanned.