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To describe the use of balloon dilation with non-invasive ventilation in the treatment of pregnant patients with idiopathic subglottic stenosis.
The medical charts of four consecutive patients who underwent jet ventilation or high-flow nasal cannula oxygenation with balloon dilation for the treatment of idiopathic subglottic stenosis during pregnancy were reviewed.
Objective improvement of subglottic stenosis was seen in all four cases, with end-result Myer–Cotton grade 1 lesions down from pre-procedure grade 3 lesions. Patients also reported subjective improvements in symptomatology, with no further airway issues. All patients delivered normally, at term.
Laryngeal dilation with continuous radial expansion pulmonary balloons using non-invasive ventilation for the treatment of idiopathic subglottic stenosis in pregnant patients is safe and efficacious, and should be the first line treatment option for this patient population. The improvement in symptoms, and lack of labour and pregnancy complications, distinguish this method of treatment from others reported in the literature.
The transition from adolescent to adult mental health services (AMHS) is associated with disengagement, poor continuity of care and patient dissatisfaction. The aim of this retrospective and descriptive study was to describe the ‘care pathways’ in an independent mental health service when adolescents reach age 18 and to investigate the level of engagement of those who transitioned to independent AMHS.
This is a retrospective, naturalistic and descriptive study in design. All patients discharged from the St Patrick’s Adolescent Mental Health Service aged 17 years and 6 months and older, during a 3-year period between January 2014 and December 2016, were included. Electronic records were used to collect socio-demographic and clinical details and to determine engagement rates in adolescents who transferred to independent adult services.
A total of 180 patients aged over 17 years and 6 months were discharged from the adolescent service. Of these, 45.6% were discharged to their GP, 28.9% to public mental health services and 25.6% to independent mental health services. The majority who transitioned to independent AMHS went to a Young Adult Service, which had high engagement rates at 3 and 12 months post-transition.
In this independent mental health service, less than half of adolescents who reach the transition age are referred onto AMHS. Engagement rates were found to be high among those referred on to a specialised young adult service.
The use of coal, as either a primary energy source or as a source of feedstock chemicals, has been complicated by the noxious and toxic chemical species formed in its gaseous effluents and also by the huge quantities of ash vhich result from its processing. Both the noxious gases and the ash have been the subjects of Federal legislations.
X-ray powder patterns (XRPP), composed of atom-pair and self x~ray scattering and the diffraction produced by crystalline phases, have long been used to investigate coals and particularly their combustion ashes (1-3). Over twenty different crystalline phases have recently been reported to exist in certain lignite fly ash (3). Analysis of the crystalline phases has typically been emphasized in previous papers involving coals and ashes, but the amorphous scattering has been given little treatment.
The photons resulting from the interaction of beta particles and matter have a certain complexity of origin; but the spectrum is made up, in large part, of two primary components, one of these being the white radiation continuum produced by the external bremsstrahlung mechanism of beta acceleration at the target atom. The second fraction consists of the characteristic K and L X-rays of the target atom. Published beta-excited X-ray spectra are centered about a small fraction of the available pure beta emitters and a restricted group of target materials. Furthermore, intercomparisons between references are difficult, due to an infinite variety of source and detector parameters influencing the data.
This laboratory has begun a comprehensive reference compilation of these spectra, done on a comparative basis and simplified and standardized for sensible cataloging and easy reproduction of the experimental design. The prime purpose is to make available coherent data for many beta-excited X-ray sources in which beta activities, target geometries, and other critical parameters are known, controlled, and constant. Spectral sets for given source-target combinations may, therefore, be intercompared, and application of the beta-excited X-ray may be made with the best possible source-target atom combination.
The spectra are studied by three proportional counters (operating down to the 1 kV energy range) and two standard scintillation crystals, accumulated in a 256-channel analyzer, and are presented in sets (representing one beta source-target combination) consisting of a minimum of eight spectra, six of which represent the most critical transmission target geometry.
Examples of the cataloging of the spectral sets, for the mixture, apposition, and compound isotopic X-ray sources, are presented.
The analysis of coal and the understanding of the combustion process is complex, due to the heterogeneous nature of the material and the myriad of high-temperature reactions inherent in this fossil fuel. The research presented below utilizes recently-developed x-ray diffraction methods to analyze the coal combustion products generated from a laboratory-scale entrained-flow reactor. The reactor was designed, constructed, and tested, as planned for the initial phase of a long-term project to evaluate the coals located in Mississippi. In this initial phase a well-characterized coal was used, supplied by The Pennsylvania State University. The proximate, ultimate, and sulfur analyses of the coal, PSOC 1368p, are outlined in the Appendix. X-ray diffraction techniques have been used In the past to characterize coals. An analysis of the mineral transformation during coal combustion has also been performed using x-ray diffraction instrumentation. The semi-quantitative results of the pyrite (FeS2) phase transformation at variable temperatures and the percent combustion of the coal, as determined by x-ray methods are reported below.
In Sweden, leishmaniasis is an imported disease and its epidemiology and incidence were not known until now. We conducted a retrospective, nationwide, epidemiological study from 1993 to 2016. Probable cases were patients with leishmaniasis diagnoses reported to the Swedish Patient registry, collecting data on admitted patients in Swedish healthcare since 1993 and out-patient visits since 2001. Confirmed cases were those with a laboratory test positive for leishmaniasis during 1993–2016. 299 probable cases and 182 confirmed cases were identified. Annual incidence ranged from 0.023 to 0.35 per 100 000 with a rapid increase in the last 4 years. Of 182 laboratory-verified cases, 96 were diagnosed from 2013 to 2016, and in this group, almost half of the patients were children under 18 years. Patients presented in different healthcare settings in all regions of Sweden. Cutaneous leishmaniasis was the most common clinical manifestation and the majority of infections were acquired in Asia including the Middle East, specifically Syria and Afghanistan. Leishmania tropica was responsible for the majority of cases (42%). A combination of laboratory methods increased the sensitivity of diagnosis among confirmed cases. In 2016, one-tenth of the Swedish population were born in Leishmania-endemic countries and many Swedes travel to these countries for work or vacation. Swedish residents who have spent time in Leishmania-endemic areas, could be at risk of developing disease some time during their lives. Increased awareness and knowledge are needed for correct diagnosis and management of leishmaniasis in Sweden.