Partial cricotracheal resection with primary anastomosis in the pediatric age group

The traditional approach to severe subglottic stenosis (SGS) in the pediatric age group is laryngotracheal reconstruction (LTR). This approach may be complex and multistaged, with variable and unpredictable success rates in the individual patient. Excellent results have been reported in adults who had severe SGS and underwent partial resection of the cricoid and primary thyrotracheal anastomosis. This procedure has not been widely reported in infants and children. We report our experience with this procedure in 16 pediatric patients with grade III or IV SGS. Eleven patients had multiple previous LTR operations. The preoperative evaluation, surgical techniques, postoperative care, complications, and final results are described and discussed. Fourteen patients were decannulated after the procedure, 1 patient needed a second open procedure prior to decannulation, and 1 patient with concomitant bronchopulmonary dysplasia remains cannulated, for an overall 94% decannulation rate. Fourteen patients have no limitation of respiration, and 1 patient has moderate exercise intolerance. The results of this series suggest that partial cricotracheal resection with primary anastomosis is a relatively safe and effective procedure for pediatric patients with severe SGS.     

Golden interfaces: The Surface of Self-Assembled Monolayers

Self-assembled monolayers (SAMs) of alkanethiols and disulfides on gold form organic interfaces with properties largely controlled by the end groups of the molecules composing the film. SAMs provide a unique link between the science of organic surfaces and technologies that seek to exploit their adaptable character. Many techniques are useful for probing the structure of SAMs although only scanning tunneling microscopy (STM) at picoamperes reveals the details of the packing of their end groups at the sub-angstrom level. This review demonstrates that STM effectively tests new types of control over the microscopic structure–property relationships characteristic of SAMs on gold that should prove useful to their application.     

The economic impact of uncertainties associated with energy-saving technologies

We will analyze the economic sensitivity of new energy-saving technologies to weather, future energy price, and system lifetime uncertainties. Graphical rate of return analysis is employed. A representative residential solar water heating investment is analyzed to illustrate the impact of uncertainties. The wide range of reasonable rates of return found suggests some considerations for policy makers and some areas of future research.     

A process algebraic approach to the specification and analysis ofresource-bound real-time systems

Recently, significant progress has been made in the development of timed process algebras for the specification and analysis of real-time systems. This paper describes a timed process algebra called ACSR, which supports synchronous timed actions and asynchronous instantaneous events. Timed actions are used to represent the usage of resources and to model the passage of time. Events are used to capture synchronization between processes. To be able to specify real systems accurately, ACSR supports a notion of priority that can be used to arbitrate among timed actions competing for the use of resources and among events that are ready for synchronization. The paper also includes a brief overview of other timed process algebras and discusses similarities and differences between them and ACSR     

Picosecond investigation of the collisional deactivation of OH A 2Sigma+(v' = 1, N' = 4, 12) in an atmospheric-pressure flame

The collisional deactivation of the laser excited states A 2Sigma+(v' = 1, N' = 4, 12) of OH in a flame is studied by measurement of spectrally resolved fluorescence decays in the picosecond time domain. Quenching and depolarization rates, as well as vibrational energy-transfer (VET) and rotational energy-transfer (RET) rates are determined. An empirical model describes the temporal evolution of the quenching and VET rates that emerge from the rotational-state relaxation. Fitting this model to the measured 1-0 and 0-0 fluorescence decays yields the quenching and VET rates of the initially excited rotational state along with those that correspond to a rotationally equilibrated vibronic-state population. VET from the higher rotational state (N' = 12) shows a tendency for resonant transitions to energetic close-lying levels. RET is investigated by analysis of the temporal evolution of the 1-1 emission band. The observed RET is well described by the energy-corrected sudden-approximation theory in conjunction with a power-gap law.     

Community resources for clients with mobility problems

Clients are leaving the hospital "quicker and sicker," and they frequently have acute care needs that must be met by resources outside the hospital setting. Community resources are diverse, vary widely from place to place, and have no central administration. Thus, using them can be challenging for both the nurse, client, and family. Reimbursement mechanisms underlie a person's ability to use resources and receive health care. By presenting two actual case scenarios where clients have mobility problems commonly seen by orthopaedic nurses, the authors discuss the community resources available, avenues of access to them, and their reimbursement mechanisms.