Creative writing: A practice-based account of designing and facilitating life-writing workshops for a group With severe mental illness

This chapter is based on the experience and findings of a pilot project developed to investigate the feasibility of providing a writing workshop for people participating in psychosocial rehabilitation programmes provided by a non-government agency in Brisbane, Queensland, Australia. It was a qualitative study, making use of observational data, interviews with participants, and informal reports. We did not seek to test theoretical models concerning the link between creative writing and recovery through the pilot project, but rather to evaluate the immediate impact of a writing workshop conducted in the manner outlined in the preceding chapter by Philip Neilsen (chapter 7).

Is there an athermal region of plastic flow in metals at intermediate temperatures?

The question of the existence or otherwise of an athermal temperature region of plastic flow in metals is examined. It is suggested that the athermal region is absent in metals with large dislocation densities. Such an explanation is provoked by a fairly recent proposition that the unzipping of attractive junctions is a plausible rate-controlling mechanism at high temperatures.

Deformation and stability regression models for soil nail walls

Lateral displacement and global stability are the two main stability criteria for soil nail walls. Conventional design methods do not adequately address the deformation behaviour of soil nail walls, owing to the complexity involved in handling a large number of influencing factors. Consequently, limited methods of deformation estimates based on empirical relationships and in situ performance monitoring are available in the literature. It is therefore desirable that numerical techniques and statistical methods are used in order to gain a better insight into the deformation behaviour of soil nail walls. In the present study numerical experiments are conducted using a 2 4 factorial design method. Based on analysis of the maximum lateral deformation and factor-of-safety observations from the numerical experiments, regression models for maximum lateral deformation and factor-of-safety prediction are developed and checked for adequacy. Selection of suitable design factors for the 2 4 factorial design of numerical experiments enabled the use of the proposed regression models over a practical range of soil nail wall heights and in situ soil variability. It is evident from the model adequacy analyses and illustrative example that the proposed regression models provided a reasonably good estimate of the lateral deformation and global factor of safety of the soil nail walls.

Mixed mode (I and II) crack tip fields in bulk metallic glasses

Stationary crack tip fields in bulk metallic glasses under mixed mode (I and II) loading are studied through detailed finite element simulations assuming plane strain, small scale yielding conditions. The influence of internal friction or pressure sensitivity on the plastic zones. notch deformation, stress and plastic strain fields is examined for different mode mixities. Under mixed mode loading, the notch deforms into a shape such that one part of its surface sharpens while the other part blunts. Increase in mode If component of loading dramatically enhances the normalized plastic zone size, lowers the stresses but significantly elevates the plastic strain levels near the notch tip. Higher internal friction reduces the peak tangential stress but increases the plastic strain and stretching near the blunted part of the notch. The simulated shear bands are straight and extend over a long distance ahead of the notch tip under mode II dominant loading. The possible variations of fracture toughness with mode mixity corresponding to failure by brittle micro-cracking and ductile shear banding are predicted employing two simple fracture criteria. The salient results from finite element simulations are validated by comparison with those from mixed mode (I and II) fracture experiments on a Zr-based bulk metallic glass.

Stationary crack tip fields in elastic-plastic solids: an overview of recent numerical simulations

In this paper, an overview of some recent numerical simulations of stationary crack tip fields in elastic-plastic solids is presented. First, asymptotic analyses carried out within the framework of 2D plane strain or plane stress conditions in both pressure insensitive and pressure sensitive plastic solids are reviewed. This is followed by discussion of salient results obtained from recent computational studies. These pertain to 3D characteristics of elastic-plastic near-front fields under mixed mode loading, mechanics of fracture and simulation of near-tip shear banding process of amorphous alloys and influence of crack tip constraint on the structure of near-tip fields in ductile single crystals. These results serve to illustrate several important features associated with stress and strain distributions near the crack tip and provide the foundation for understanding the operative failure mechanisms. The paper concludes by highlighting some of the future prospects for this field of study.

Status on pre-surgical deformation apparatus for fracture fixation plates

Purpose: This paper reviews the apparatus used for deformation of bone fracture fixation plates during orthopaedic surgeries including surgical irons, pliers and bending press tools. This paper extends the review to various machineries in non-medical industries and adopts their suitability to clinics-related applications and also covers the evolution of orthopaedic bone plates. This review confirms that none of the studied machineries can be implemented for the deformation of bone fracture fixation plates during orthopaedic surgeries. In addition, this paper also presents the novel apparatus that are designed from scratch for this specific purpose. Several conceptual designs have been proposed and evaluated recently. It has been found that Computer Numerical Control (CNC) systems are not the golden solution to this problem and one needs to attempt to design the robotic arm system. A new design of robotic arm that can be used for facilitating orthopaedic surgeries is being completed.

Microneurovascular free muscle transfer with cross-over nerve grafts in facial reanimation

Microneurovascular free muscle transfer with cross-over nerve grafts in facial reanimation Loss of facial symmetry and mimetic function as seen in facial paralysis has an enormous impact on the psychosocial conditions of the patients. Patients with severe long-term facial paralysis are often reanimated with a two-stage procedure combining cross-facial nerve grafting, and 6 to 8 months later with microneurovascular (MNV) muscle transfer. In this thesis, we recorded the long-term results of MNV surgery in facial paralysis and observed the possible contributing factors to final functional and aesthetic outcome after this procedure. Twenty-seven out of forty patients operated on were interviewed, and the functional outcome was graded. Magnetic resonance imaging (MRI) of MNV muscle flaps was done, and nerve graft samples (n=37) were obtained in second stage of the operation and muscle biopsies (n=18) were taken during secondary operations.. The structure of MNV muscles and nerve grafts was evaluated using histological and immunohistochemical methods ( Ki-67, anti-myosin fast, S-100, NF-200, CD-31, p75NGFR, VEGF, Flt-1, Flk-1). Statistical analysis was performed. In our studies, we found that almost two-thirds of the patients achieved good result in facial reanimation. The longer the follow-up time after muscle transfer the weaker was the muscle function. A majority of the patients (78%) defined their quality of life improved after surgery. In MRI study, the free MNV flaps were significantly smaller than originally. A correlation was found between good functional outcome and normal muscle structure in MRI. In muscle biopsies, the mean muscle fiber diameter was diminished to 40% compared to control values. Proliferative activity of satellite cells was seen in 60% of the samples and it tended to decline with an increase of follow-up time. All samples showed intramuscular innervation. Severe muscle atrophy correlated with prolonged intraoperative ischaemia. The good long-term functional outcome correlated with dominance of fast fibers in muscle grafts. In nerve grafts, the mean number of viable axons amounted to 38% of that in control samples. The grafted nerves characterized by fibrosis and regenerated axons were thinner than in control samples although they were well vascularized. A longer time between cross facial nerve grafting and biopsy sampling correlated with a higher number of viable axons. P75Nerve Growth Factor Receptor (p75NGFR) was expressed in every nerve graft sample. The expression of p75NGFR was lower in older than in younger patients. A high expression of p75NGFR was often seen with better function of the transplanted muscle. In grafted nerve Vascular Endothelial Growth Factor (VEGF) and its receptors were expressed in nervous tissue. In conclusion, most of the patients achieved good result in facial reanimation and were satisfied with the functional outcome. The mimic function was poorer in patients with longer follow-up time. MRI can be used to evaluate the structure of the microneurovascular muscle flaps. Regeneration of the muscle flaps was still going on many years after the transplantation and reinnervation was seen in all muscle samples. Grafted nerves were characterized by fibrosis and fewer, thinner axons compared to control nerves although they were well vascularized. P75NGFR and VEGF were expressed in human nerve grafts with higher intensity than in control nerves which is described for the first time.

Postoperative soft tissue defects in the ankle area : The etiology and methods of reconstruction

The risk is obvious for soft tissue complications after operative treatment of the Achilles tendon, calcaneal bone or after ankle arthroplasty. Such complications after malleolar fractures are, however, seldom seen. The reason behind these complications is that the soft tissue in this region is tight and does not allow much tension to the wound area after surgery. Furthermore the area of operation may be damaged by swelling after the injury, or can be affected by peripheral vascular disease. While complications in this area are unavoidable, they can be diminished. This study attempts to highlight the possible predisposing factors leading to complications in these operations and on the other hand, to determine the solutions to solve soft tissue problems in this region. The study consists of five papers. The first article is a reprint on the soft tissue reconstruction of 25 patients after their complicated Achilles tendon surgeries were analysed. The second study reviews a series of 126 patients after having undergone an operative treatment of calcaneal bone fractures and analyses the complications and possible reasons behind them. The third part analyses a series of corrections of 35 soft tissue complications after calcaneal fracture operations. The fourth part reviews a series of 7 patients who had undergone complicated ankle arthroplasties. The last article presents a series of post operative lateral defects of the ankle treated with a less frequently used distally based peroneus brevis muscle flap and analyses the results. What can be conducted from these studies is that in general, the results after the correction of even severe soft tissue complications in the ankle region are good. For the small defects around the Achilles tendon, the local flaps are useful, but the larger defects are best treated with a free flap. We found that a long delay from trauma to surgery and a long operating time were predisposing factors that lead to soft tissue complications after operatively treated calcaneal bone fractures. The more severe the injury, the greater the risk for wound complication. Surprisingly, the long-term results after infected calcaneal osteosyntheses were acceptable and the calcaneal bone seems to tolerate chronic infections very well if the soft tissue is reconstructed successfully. Behind the complicated ankle arthroplasties, unexpectedly high number of cases experiencing arteriosclerosis of the lower extremity was found. These complications lead to ankle fusion but can be solved with a free flap if the vascularity is intact or can be reconstructed. For this reason a vascular examination of the lower extremity arteries of the patients going to ankle arthroplasty is strongly recommended. Moreover postoperative lateral malleolar wound infections which typically create lateral ankle defects can successfully be treated with a peroneus brevis muscle flap covered with a free skin graft.

The incidence and outcome of severe sepsis in Finland : The Finnsepsis Study

Severe sepsis is associated with common occurrence, high costs of care and significant mortality. The incidence of severe sepsis has been reported to vary between 0.5/1000 and 3/1000 in different studies. The worldwide Severe Sepsis Campaign, guidelines and treatment protocols aim at decreasing severe sepsis associated high morbidity and mortality. Various mediators of inflammation, such as high mobility group box-1 protein (HMGB1) and vascular endothelial growth factor (VEGF), have been tested for severity of illness and outcome in severe sepsis. Long-term survival with quality of life (QOL) assessment is important outcome after severe sepsis. The objective of this study was to evaluate the incidence, severity of organ dysfunction and outcome of severe sepsis in intensive care treated patients in Finland (study I)). HMGB1 and VEGF were studied in predicting severity of illness, development and type of organ dysfunction and hospital mortality (studies II and III). The long-term outcome and quality of life were assessed and quality-adjusted life years and cost per one QALY were estimated (study IV). A total of 470 patients with severe sepsis were included in the Finnsepsis Study. Patients were treated in 24 Finnish intensive care units in a 4-month period from 1 November 2004 to 28 February 2005. The incidence of severe sepsis was 0.38 /1,000 in the adult population (95% confidence interval 0.34-0.41). Septic shock (77%), severe oxygenation impairment (71.4%) and acute renal failure (23.2%) were the most common organ failures. The ICU, hospital, one-year and two-year mortalities were 15.5%, 28.3%, 40.9% and 44.9% respectively. HMGB1 and VEGF were elevated in patients with severe sepsis. VEGF concentrations were lower in non-survivors than in survivors, but HMGB1 levels did not differ between patients. Neither HMGB1 nor VEGF were predictive of hospital mortality. The QOL was measured median 17 months after severe sepsis and QOL was lower than in reference population. The mean QALY was 15.2 years for a surviving patient and the cost for one QALY was 2,139 . The study showed that the incidence of severe sepsis is lower in Finland than in other countries. The short-term outcome is comparable with that in other countries, but long-term outcome is poor. HMGB1 and VEGF are not useful in predicting mortality in severe sepsis. The mean QALY for a surviving patient is 15.2 and as the cost for one QALY is reasonably low, the intensive care is cost-effective in patients with severe sepsis.

Mechanics of Deformation under Traction and Friction of a Micrometric Monolithic MoS2 Particle in Comparison with those of an Agglomerate of Nanometric MoS2 Particles

Tribology of small inorganic nanoparticles in suspension in a liquid lubricant is often impaired because these particles agglomerate even when organic dispersants are used. In this paper we use lateral force microscopy to study the deformation mechanism and dissipation under traction of two extreme configurations (1) a large MoS2 particle (similar to 20 mu m width) of about 1 mu m height and (2) an agglomerate (similar to 20 mu m width), constituting 50 nm MoS2 crystallites, of about 1 mu m height. The agglomerate records a friction coefficient which is about 5-7 times that of monolithic particle. The paper examines the mechanisms of material removal for both the particles using continuum modeling and microscopy and infers that while the agglomerate response to traction can be accounted for by the bulk mechanical properties of the material, intralayer and interlayer basal planar slips determine the friction and wear of monolithic particles. The results provide a rationale for selection of layered particles, for suspension in liquid lubricants.

Amorphization by dislocation accumulation in shear bands

Microcrystalline γ-Y2Si2O7 was indented at room temperature and the deformation microstructure was investigated by transmission electron microscopy in the vicinity of the indent. The volume directly beneath the indent comprises nanometer-sized grains delimited by an amorphous phase while dislocations dominate in the periphery either as dense slip bands in the border of the indent or, further away, as individual dislocations. The amorphous layers and the slip bands are a few nanometers thick. They lie along well-defined crystallographic planes. The microstructural organization is consistent with a stress-induced amorphization process whereby, under severe mechanical conditions, the crystal to amorphous transformation is mediated by slip bands containing a high density of dislocations. It is suggested that the damage tolerance of γ-Y2Si2O7, which is exceptional for a ceramic material, benefits from this transformation.

γ-Y2Si2O7, a machinable silicate ceramic: Mechanical properties and machinability

In this paper, the mechanical properties of bulk single-phase γ-Y2Si2O7 ceramic are reported. γ-Y2Si2O7 exhibits low shear modulus, excellent damage tolerance, and thus has a good machinability ready for metal working tools. To understand the underlying mechanism of machinability, drilling test, Hertzian contact test, and density functional theory (DFT) calculation are employed. Hertzian contact test demonstrates that γ-Y2Si2O7 is a "quasi-plastic" ceramic and the intrinsically weak interfaces contribute to its machinability. Crystal structure characteristics and DFT calculations of γ-Y2Si2O7 suggest that some weakly bonded planes, which involve Y-O bonds that can be easily broken, are the sources of the low shear deformation resistance and good machinability.

A numerical study of crack tip constraint in ductile single crystals

In this work, the effect of crack tip constraint on near-tip stress and deformation fields in a ductile FCC single crystal is studied under mode I, plane strain conditions. To this end, modified boundary layer simulations within crystal plasticity framework are performed, neglecting elastic anisotropy. The first and second terms of the isotropic elastic crack tip field, which are governed by the stress intensity factor K and T-stress, are prescribed as remote boundary conditions and solutions pertaining to different levels of T-stress are generated. It is found that the near-tip deformation field, especially, the development of kink or slip shear bands, is sensitive to the constraint level. The stress distribution and the size and shape of the plastic zone near the crack tip are also strongly influenced by the level of T-stress, with progressive loss of crack tip constraint occurring as T-stress becomes more negative. A family of near-tip fields is obtained which are characterized by two terms (such as K and T or J and a constraint parameter Q) as in isotropic plastic solids.