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The cured article may need to cholesterol gene test buy 10mg simvastatin amex be worked on from time to cholesterol lowering foods supplements cheap simvastatin 40mg with amex time cholesterol in shrimp cocktail 10 mg simvastatin fast delivery, so systems that can be cut or peeled off may be required. Film Adhesives Latent catalysts used in conjunction with either liquid or solid resins are cast in thin films on plastic or release paper for unsupported films or onto absorbent papers or cloths for supported films and then cured to B stage. Miscellaneous Applications Epoxy adhesives are popular for retail or consumer applications. They may be supplied as liquids, pastes, putties, or as one-pack systems in stick form. Mercaptan accelerators are also used for systems with very short pot life, in automatic dispensing machines which meter the components, mix, and dispense in seconds. Epoxy resins are employed in a number of other niche applications, including adhesives to control static buildup in computer installations, carveable epoxies for pattern making and tooling, and acid-resistant adhesives for fastening tops to automotive batteries and for laminating and repair of glass-reinforced plastics. Flexible formulating, permitting a wide range of pot lives, application conditions, and cured properties. Two-component systems require mixing in correct ratios, with attendant pot-life problems. This means that they are capable of bonding to surfaces simply by the application of light pressure. Although figures are hard to come by, a survey by Business Trend Analysts quoted in the June 1990 issue of Adhesives Age shows that pressure-sensitive adhesives grew from 38% of total adhesive sales in the United States in 1980 to 44. Tack is a word used to describe various phenomena, including wet tack, which is the ability of an adhesive to form a bond while still wet; green tack, which is the ability of certain polymers, specifically rubbers, to bond to themselves for several hours after drying, even though the surfaces do not feel sticky; and pressure-sensitive tack, which is the phenomenon of importance to this section. This relates to the ability of a dried film to bond tenaciously to most surfaces under light pressure. The classic theory of tack is that it arises from the presence of a two-phase system in which an elastic continuous phase provides the strength while a disperse phase acts as a viscous liquid that wets and adheres to the surface. Thus tack is also believed to stem from the viscoelasticity of many polymers, allowing them to conform to the substrate to be adhered and ``wet' it even in the dry state. It follows that a fundamental requirement for tack is a glass transition temperature substantially below the application temperature to permit the necessary degree of flow. Pressure-sensitive adhesives fall into three broad product categories: water based, solvent based, and hot melt. Application areas tend to overlap, and all three types can be used in most of the application areas. Despite this overlap, tapes tend to be produced from solvent-based adhesives, while water-based adhesives are preferred for label stock. Although these applications appear outwardly similar, in fact there are fundamental differences. With tapes the adhesive fills the major role, ensuring adequate adhesion and requiring special properties, which may include high dielectric strength, heat resistance, or low toxicity. In labeling applications the major demands are on the backing, which needs the right lay-flat or curl properties and ease of cutting and printing, with relatively few demands on the adhesive. With tapes the adhesive is usually applied directly to the backing, while label adhesives are usually applied to the release paper and subsequently transferred to the backing. Other pressure-sensitive applications include self-adhesive floor tiles, adhesives for decor papers and flypapers, gloss lamination, disposable diapers and other personal hygiene products, and temporary assemblies. From that time, as an increasing array of elastomers became available, as the price of solvents soared, and as environmental opposition to the use of solvents increased, water-based and hot-melt types made substantial inroads into the solvent-based market. This trend is likely to continue, although solvent-borne adhesives will probably always retain niches in areas where drying speed or ability to key into specific surfaces will outweigh environmental, handling, or price considerations. Solvent-Based Adhesives the three major components are an elastomer, which provides the elastic phase, the tackifier, and the carrier. The earliest pressure-sensitive adhesives used natural rubber tackified with wood rosins, or later, zinc oxide.

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In some infants with congenital hydrocephalus cholesterol olive oil cheap simvastatin 10mg on-line, natural arrest occurs cholesterol guidelines aafp cheap simvastatin on line, presumably as a result of recanalization of the subarachnoid spaces how much cholesterol in eggs benedict buy generic simvastatin 10mg. In the remainder, there is steady progression with inevitable mental deterioration and high mortality unless adequate treatment is instituted. For noncommunicating (obstructive) hydrocephalus, direct removal of the occluding mass lesion is desirable. In non-communicating (obstructive) hydrocephalus, an artificial outlet may be created through the floor of the third ventricle into the basal cisterns (endoscopic third ventriculostomy). To be able to recognize the severity of a head injury and understand the principles of management. Recognizing a severe head injury and administering prompt and appropriate care is important for all medical practitioners who, if not receiving patients with such injuries under their care, may nevertheless be bystanders witnessing such an injury. Head injuries are generally classified as closed (concussional) or open (penetrating). However, if the injury occurred when the head was stationary, in the absence of acceleration and deceleration, consciousness may not be lost and neither the patient nor the doctor may appreciate the true extent of the injury. Skull injuries Injuries to the skull are a result of crushing or some other severe force. The skull fractures along its weakest plane, which varies according to the position of the injuring force. Typically, this is a linear fracture of the skull vault, but may extend into the skull base. A simple crush injury to a stationary head may leave the scalp intact and not disturb consciousness in the absence of acceleration and deceleration forces, although the subsequent skull X-ray may show extensive fractures. A skull fracture is most important as an indicator of the force of the injury, and the risk of intracranial haemorrhage. There are several other facets of a skull fracture that are important to note (Box 15. Types of injury Injuries are usefully classified according to the structures involved (scalp, skull and underlying brain) together with the mechanism of the injury, be it penetrating or blunt, and whether an acceleration/deceleration and/or a rotational brain injury occurred. In reality, isolated injuries are uncommon, and patients more typically experience blunt injury fracturing the skull in which acceleration/deceleration of the brain also occurs. Scalp injuries Most scalp injuries are simple penetrating injuries, which are readily managed by debridement and suture. When the skull is also penetrated, the Lecture Notes: General Surgery, 12th edition. Fractures involving paranasal air sinuses: cerebrospinal fluid rhinorrhoea Fractures extending through any of the paranasal air sinuses (frontal, ethmoid or sphenoid) communicate with the outside and are therefore compound (open) fractures, as the overlying dura is usually breached. This external communication may manifest as a runny nose, the clear Head injury 115 Box 15. The following are the common causes to be considered, the first three groups accounting for the great majority of cases. Fractures through the temporal bone: middle meningeal vessels A fracture through the temporal bone may disrupt the middle meningeal artery and/or vein as they traverse the bone, and result in an extradural haemorrhage, which may not manifest immediately (see p. The depressed bone may be left if it is not deeply depressed (less than the skull thickness) and not otherwise troublesome. Indications for elevation include the debridement of a contaminated wound, depression greater than the bone thickness, associated intracranial haematoma or epileptic focus. Secondary brain injuries occur after the initial event and are the result of hypoxia, hypercapnia, hypotension (ischaemia), intracranial haemorrhage or meningitis. Diffuse brain injury Diffuse neuronal injury occurs as a result of shearing movements, the worst being rotational shearing, as occurs when a blow is delivered off centre. The result is axon damage and rupture of the small vessels, particularly serious in the brain stem. A severe rotational shearing force may be transmitted down along the axis of the brain, and such forces shearing through the brain stem are usually fatal. Orbital haematoma Fractures of the anterior and middle cranial fossae are very frequently associated with orbital haematoma; blood tracks forward into the orbital tissues, into the eyelids and behind the conjunctiva. There may also be some confusion in making a diagnosis between a subconjunctival and conjunctival haemorrhage. The subconjunctival haemorrhage extends from the orbit, forwards and deep to the conjunctiva; there is therefore no posterior limit to the haemorrhage.

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Although originally applied exclusively to cholesterol jama purchase simvastatin now intemperate or chronic dependent alcohol use cholesterol rich foods buy discount simvastatin, the disease model of addiction has broadened to cholesterol test leicester discount simvastatin 20 mg without a prescription encompass various instances or patterns of psychoactive substance use that are labeled "abuse" (discussed above), a social construction of deviance that is objectively indistinguishable from use per se. A paradigmatic example of the expanded scope of the "drugs as pathogens" metaphor is evident in the characterization of the popular use of psychedelics in the early 1970s as a "plague," for which "philosophical and spiritual preoccupation" was identified as a defining clinical symptom (Donlon, 1971, p. Today, the "drugs as pathogens" metaphor supports a vast industry of medical, public health, and prevention research and practice professionals. Drawing on the discourses of hygiene and disease, this metaphor is evident in the use of terms such as "clean" to describe individual abstinence (Weinberg, 2000). To the same end, other forms of anti-drug mental vaccination are disseminated through public service announcements, or even surreptitiously embedded in popular entertainment (Forbes, 2000; see also Boyd, 2007). Although both prevention of use and treatment of addiction have perennially yielded at best marginal returns in reducing illegal drug demand (Caulkins, Rydell, Everingham, Chiesa, & Bushway, 1999; Midford, 2010), the medical model for addressing psychoactive substance use that the "drugs as pathogens" metaphor supports remains politically popular in rhetoric, if not in budget allocations (DeBeck, Wood, Montaner & Kerr, 2009). These two metaphors have circulated in professional, public and political discourses on various kinds of psychoactive substance use since not long after the emergence of the public sphere in the early 18th century. In concert with the broader tri-partite schema of modern social constructions of drugs, non-drugs, and medicines described above, the dominant drug metaphors 73 Education is a somewhat euphemistic label for some school-based drug prevention programs-especially those led by law enforcement officers or others with an equivalent drug warrior ideological temperament-as their prescribed knowledge, attitudinal and behavioural outcomes make them practically indistinguishable from indoctrination (Tupper, 2008b). Although they have fundamental differences, which entail divergent policy responses (criminalization and medicalization), these two metaphors have come to coexist in public discourse for most of the 20th century without their underlying incongruences seriously undermining their duopolistic hegemony in the policy arena. Indeed, they have gradually and symbiotically evolved to become an ideologically unified frame for modern governance and social control. For example, the much-discussed difference between the "British" and "American" approaches to narcotic drug addiction in the 20th century may be seen as a reflection of the degree to which one metaphor had slightly more currency than the other in each country. The "malevolent agents" and "pathogens" metaphors have been foundational to the definition of the drug problem in the past century and continue to inform it today (Sharp, 1994). Stone makes a similar point in her assertion that "buried in every policy metaphor is an assumption that if a is like b, then the way to solve a is to do what you would with b" (2002, p. What the two dominant drug policy metaphors share is an attribution of causality to drugs themselves, and such causal attribution to a particular thing, social condition, or series of events is often a critical aspect of how a policy problem is defined (Rochefort & Cobb, 1994). With both metaphors, the complexities of substance use, addiction and associated harms are glossed over in a simplistic reductionism-what Reinarman and Levine (1997) identify as "pharmacological determinism"-which casts the very existence of drugs as the intrinsic root of many associated types of illness, crime and social harms. Instead of interrogating how modern consumeristic cultural attitudes, socio-economic determinants of health, or free-market capitalism itself might influence psychoactive substance use patterns in the population (Alexander, 2008; Eckersley, 2005; Gitlin, 1990), the status quo understanding of the drug "problem" focuses primarily on the drugs themselves. Thus, policy makers (and the general 148 public) often infer that the availability of drugs per se is the crux of the drug "problem," and that their extirpation from human societies-through the twin pillars of international control, supply reduction and demand reduction-the obvious solution (Room, 1999). The subtle control achieved by the cooperative power of the "malevolent agents" and "pathogens" metaphors for psychoactive substances occurs not least through what Foucault identified as a crucial aspect of the power of discourse, the capacity to constitute individual subjectivities through micro-power structures pervading all language use. The line of inquiry he recommended was "to discover how it is that subjects are gradually, progressively, really and materially constituted through a multiplicity of organisms, forces, energies, materials, desires, thoughts etc. Following this approach, Foucault showed that the constitution of the subject is realized in part through the categories for existence that are made available to the individual by their discursive environments. Indeed, people who use illegal psychoactive substances are themselves no less influenced by the dominant metaphors in public discourse, and so to some degree cannot help but internalize the social and political categories that construct them as bad or sick (Bailey, 2005; Davies, 1997). At the same time, through what Hacking describes as "the looping effect of human kinds" (1995), there is always a reflexive interactivity that means "people of these [socially constructed] kinds can become aware that they are classified as such. They can make tacit or even explicit choices, adapt or adopt ways of living so as to fit or get away from the very classification that may be applied to them" (Hacking, 1999, p. Conversely, the label "drug user" conveniently allows people who consume legal. In the public sphere, another important factor in how the drug metaphors of "malevolent agents" and "pathogens" function cooperatively to sustain certain types of power structures is the way in which they contribute to the stigmatization and scapegoating of people who use some kinds of psychoactive substances. The metaphoric implication of these tropes renders the drug user an object of anger, contempt or disgust, not only for violating the criminal law (in the case of illegal drug use), but for deliberately transgressing modern civil codes of order, rationality and sobriety, and moral codes of cleanliness and purity. While the "pathogens" metaphor would seem to open up an avenue for compassion (by constructing the drug user as a victim) that the "malevolent agents" metaphor precludes, even this has not resulted in a significant departure from the overall punitive nature of drug control efforts or a rupture in the coherence of the drug war paradigm over the past century (Room, 2005).

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Deposited coatings often provide better bond durability than native surface treatments high cholesterol chart australia purchase simvastatin american express. They serve to cholesterol levels ati order 20 mg simvastatin with amex stabilize the surface from degradation and to cholesterol levels in beef discount simvastatin on line form physical bonds with the adhesive/primer. Smaller-grain coatings tend to be preferred over larger-grain coatings as they provide better physical bonding and greater resistance to fracture. Again, differences in the adherend metallurgy can cause differences in the coating morphology and chemistry. Nonetheless, such conversion coatings and other deposited coatings provide the best durability for steel bonds. Alternative deposited coatings involve thermal spray, such as plasma spray or twowire arc [60]. Substrate alloy effects are minimal and coating chemistry and morphology can be designed for specific applications. Joints made with steel and other metals can also be subject to cathodic disbondment if they are immersed in an electrolyte and subjected to a cathodic potential, such as that created when the adherend is in electrical contact with a more electrochemically active metal [65]. Although corrosion of the adherend is suppressed via cathodic protection, the rate of bond failure is increased. After an induction period that depends on the imposed cathodic potential and temperature [65], interphasal debonding occurs [66,67]; such disbondment does not occur in the absence of a cathodic potential. An example would be clad aluminum adherends where a thin layer of pure aluminum overlays the base alloy. Such a surface layer is designed to be more corrosion resistant than the alloy, but to act as a sacrificial anode should corrosion occur. Although this approach works well for corrosion protection of the substrate material, it can be a disaster for bonded material if the adherend surface/interface corrodes. As a result, American companies tend to use unclad aluminum for bonding and provide other means of corrosion protection, such as painting [1,70]. In contrast to aluminum and steel, titanium adherends are stable under conditions of moderately elevated temperatures and humidity. Identical results were also observed for wedge tests performed in boiling water, i. For moderate conditions, the key requirement for a titanium treatment is a convoluted microrough surface to promote physical bonding. Critchlow and Brewis extensively reviewed reported results of different surface treatments for titanium [76]. At elevated temperatures where titanium alloys would be the adherend of choice, a different failure mechanism becomes important. Consequently, stresses are concentrated over small areas at the interface and the joint fails at low stress levels [75,77]. Such phenomena have been observed for adherends exposed to 600 C for as little as 1 hour or 300 C for 710 hours prior to bonding [75] and for bonds using a high-temperature adhesive cured at 371 C [78] or 400 C [75]. Two types of surface treatments that show some Figure 7 Schematic representation of oxygen diffusing or dissolving from the oxide into the titanium metal at high temperatures. The interphase is weakened with the formation of voids, porosity, and microcracks and with the embrittlement of the interphasal metal region. Plasma-sprayed metallic titanium coatings were proposed at first and showed promising initial results [75,79]. By properly controlling the deposition parameters, a fractal-like microrough coating is obtained that provides physical bonding with the adhesive. Only a thin native oxide is present and this is apparently insufficient to cause the type of failure described above. Plasma-sprayed adherends have been heated to 450 C for 165 hours prior to bonding and tensile testing and have been bonded with a 400 C-curing adhesive and wedge-tested at 230 C for 1000 hours [18,75].

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Apparently cholesterol medication list australia simvastatin 20mg discount, below some minimum thickness list of ldl cholesterol lowering foods order simvastatin in united states online, a joint is adhesive starved and the interphase is rife with voids cholesterol levels in fish and shellfish discount simvastatin 20mg with mastercard. Above the optimum thickness, stress concentrations are heightened by cure-shrinkage stresses in the adhesive layer. The narrow optimal thickness range disappears if the adhesive modulus is greatly reduced. In the study by Takatani and Sasaki [13], an epoxy adhesive was flexibilized by the addition of 20, 40, and 60 parts of polysulfide. Although these additions failed to increase toughness of joints with the thin adhesive layer, toughness increased dramatically with each increment of adhesive thickness. In these joints the crack initiation energy increased from about 330 J/m2 to 1100 J/m2 in specimens with adhesive layers 1. It is probable that very high fracture toughness values in wood joints bonded with thicker, lower-modulus adhesive layers may be due to the enhancement of an existing energy-dissipating mechanism such as microcracking of the wood as well as the adhesive. Grain Angle Structural joints are purposely not designed with the fibers intersecting the plane of the bondline as a result of the weakness of this design. Furniture and picture frames often contain mitered joints in which the fibers intersect. Generally, fracture toughness increases with increasing grain angle, although there is usually a minimum toughness between about 10 and 30. The shape of the relationship varies from almost flat to very steep as a function of species and the type of adhesive. There is usually a minimum in the range 15 to 30 above the bondline and a maximum at 90. White [33] attributed the increased toughness at large grain angle to increased penetration and reinforcement of the interphase. The depth of penetration of loblolly pine (Pinus taeda) by a resorcinol adhesive increased nine times and the fracture toughness doubled as the grain angle was increased from 0 to 45. A grain angle effect has also been reported in the shear strength of bonded joints. This effect is due to the disparity between the tensile and compression strengths of the wood and to adhesive penetration. When the grain direction is not parallel to the surface, the adhesive is very likely to penetrate the wood deeply. Adhesive penetration adds little to the tensile strength of wood perpendicular to the grain. However, in the closing mode, plugs of adhesive in the cell lumens increase the compression strength across the grain. This was evident in the results of Furuno and others [43], who used tensile single lap joints for their experiments. Joints loaded in the closing mode were 25% stronger than parallel-grain joints and 45% stronger than joints loaded in the opening mode. Fracture of a joint with one adherend in the opening mode and one in the closing mode. Swietliczny [59] conducted a similar experiment using compression block shear specimens and found the opposite results. The difference can be attributed to the method of loading, particularly the support of the specimen during loading, which inhibited opening or tensile fracture. Moisture the moisture content of both the wood and the adhesive affect the fracture behavior of adhesive bonded joints. Wood joints are especially sensitive to moisture effects as a result of the porosity and permeability of wood, which allows ready access by water to both the interior of the wood member and the adhesive layer.

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