bluuebunny/crossref_metadata_2025 huggingface dataset:
A proposal for digital electro-optic switches with free-carrier dispersion effect and Goos-Hanchen shift in silicon-on-insulator waveguide corner mirror
Authors: Sun DeGui
Published: September 2013

In a silicon-on-insulator (SOI) waveguide corner mirror (WCM) structure, with the quantum process of a frustrated total internal reflection (FTIR) phenomenon and the time delay principle in the two-dimensional potential barrier tunneling process of a mass of particles, we derive an accurate physical model for the Goos-Hanchen (GH) shift of optical guided-mode in the FTIR process, and in principle match the GH shift jumping states with the independent guided-modes. Then, we propose and demonstrate a new regime of 1 × N digital optical switches with a matching state between the free-carrier dispersion (FCD) based refractive index modulation (RIM) of silicon to create a GH shift jumping function of a photonic signal at the reflecting interface and the independent guided-modes in the FTIR process, where a MOS-capacitor type electro-optic modulation regime is proposed and discussed to realize an effective FCD-based RIM. At the critical matching state, i.e., the incident of an optical beam is at the vicinity of Brewster angle in the WCM, a mini-change of refractive index of waveguide material can cause a great jump of GH shift along the FTIR reflecting interface, and further a 1 × N digital optical switching process could be realized. For a 350–500 nm single-mode rib waveguide made on the 220 nm CMOS-compatible SOI substrate and with the FCD effect based RIM of silicon crystal, a concentration variation of 1018–1019 cm−3 has caused a 0.5–2.5 μm GH shift of reflected beam, which is at 2–5 times of a mode-size and hence radically convinces an optical switching function with a 1 × 3-1 × 10 scale.
Strong solutions for a 1D fluid-particle interaction non-newtonian model: The bubbling regime
Authors: Song Yukun , Yuan Hongjun , Chen Yang , Guo Zhidong
Published: September 2013

This paper is concerned with the one dimensional fluid-particle interaction model in the so-called bubbling regime which describes the evolution of particles dispersed in a viscous compressible non-Newtonian fluid. We obtained the existence of unique local strong solution to this model. The main difficulty is due to the strong nonlinearity of the system and the initial fluid density admitting vacuum.
Chiral and real ${\cal N}=2$N=2 supersymmetric ℓ-conformal Galilei algebras
Authors: Aizawa N. , Kuznetsova Z. , Toppan F.
Published: September 2013

Inequivalent \documentclass[12pt]{minimal}\begin{document}${\cal N}=2$\end{document}N=2 supersymmetrizations of the ℓ-conformal Galilei algebra in d-spatial dimensions are constructed from the chiral (2, 2) and the real (1, 2, 1) basic supermultiplets of the \documentclass[12pt]{minimal}\begin{document}${\cal N}=2$\end{document}N=2 supersymmetry. For non-negative integer and half-integer ℓ, both superalgebras admit a consistent truncation with a (different) finite number of generators. The real \documentclass[12pt]{minimal}\begin{document}${\cal N}=2$\end{document}N=2 case coincides with the superalgebra introduced by Masterov, while the chiral \documentclass[12pt]{minimal}\begin{document}${\cal N}=2$\end{document}N=2 case is a new superalgebra. We present D-module representations of both superalgebras. Then we investigate the new superalgebra derived from the chiral supermultiplet. It is shown that it admits two types of central extensions, one is found for any d and half-integer ℓ, and the other only for d = 2 and integer ℓ. For each central extension, the centrally extended ℓ-superconformal Galilei algebra is realized in terms of its super-Heisenberg subalgebra generators.
Photovoltaic absorption enhancement in thin-film solar cells by non-resonant beam collimation by submicron dielectric particles
Authors: Simovski Constantin R. , Shalin Alexander S. , Voroshilov Pavel M. , Belov Pavel A.
Published: September 2013

We propose the enhancement of the photovoltaic absorption in thin-film solar cells using densely packed arrays (not obviously regular) of non-absorbing submicron or micron-sized dielectric spheres located on top of the cell. The spheres can decrease reflection forming an effective blooming layer. Simultaneously, they can suppress the transmission through the photovoltaic layer transforming the incident radiation into a set of collimated beams. The focusing of the light inside the photovoltaic layer allows enhanced absorption in it leading to the increase of the photovoltaic current. Every sphere focuses the incident wave separately—this mechanism does not require collective effects or resonances and therefore takes place in a wide spectral range. Since the fabrication of such the coating is easy, our light-trapping structure may be cheaper than previously known light-trapping ones and perhaps even than flat anti-reflecting coatings.
Switching phase separation mode by varying the hydrophobicity of polymer additives in solution-processed semiconducting small-molecule/polymer blends
Authors: He Zhengran , Li Dawen , Hensley Dale K. , Rondinone Adam J. , Chen Jihua
Published: September 2013

Lateral and vertical phase separations play critical roles in the performance of the next-generation organic and hybrid electronic devices. A method is demonstrated here to switch between lateral and vertical phase separations in semiconducting 6,13-bis(triisopropylsilylethynyl) pentacene (TIPSE pentacene)/polymer blend films by simply varying the alkyl length of the polyacrylate polymer component. The phase separation modes depend on intermolecular interactions between small molecule TIPSE pentancene and polymer additives. The blend film with a dominant vertical phase separation exhibits a significant enhancement in average mobility and performance consistency of organic thin-film transistors.
Identification of photo-induced spin-triplet recombination centers situated at Si surfaces and Si/SiO2 interfaces
Authors: Otsuka M. , Matsuoka T. , Vlasenko L. S. , Vlasenko M. P. , Itoh K. M.
Published: September 2013

A recombination center at Si surfaces and Si/SiO2 interfaces was identified using highly sensitive spin-dependent recombination (SDR) detection of electron paramagnetic resonance (EPR). The defect (Si-KU1) has a spin-triplet (S = 1) state owing to excitation by band-edge light employed in measurement. The Si-KU1 SDR-EPR spectrum exhibits orthorhombic symmetry along two equivalent ⟨110⟩ axes running parallel to the interface, which disappears upon mechanical lapping of the surface oxide or heat treatment above 400 °C. However, removal of surface oxide with diluted HF solution sharpens the Si-KU1 SDR-EPR lines. A plausible structural model of the center responsible for Si-KU1 is presented.
OH radicals distribution in an Ar-H2O atmospheric plasma jet
Authors: Li L. , Nikiforov A. , Xiong Q. , Britun N. , Snyders R. , Lu X. , Leys C.
Published: September 2013

Recently, plasma jet systems found numerous applications in the field of biomedicine and treatment of temperature-sensitive materials. OH radicals are one of the main active species produced by these plasmas. Present study deals with the investigation of RF atmospheric pressure plasma jet in terms of OH radicals production by admixture of H2O into argon used as a feed gas. Generation of OH radicals is studied by laser-induced fluorescence spectroscopy. The excitation dynamics of OH radicals induced by the laser photons is studied by time-resolved spectroscopy. It is shown that vibrational and rotational energy transfer processes, which are sensitive to the surrounding species, can lead to the complication in the OH radicals diagnostics at high pressure and have to be considered during experiments. The axial and radial 2D maps of absolute densities of hydroxyl radicals at different water contents are obtained. The highest density of 1.15 × 1020 m−3 is measured in the plasma core for the case of 0.3% H2O. In the x–y-plane, the OH density steeply decreases within a range of ±2 mm from its maximum value down to 1018 m−3. The effect of H2O addition on the generation of OH radicals is investigated and discussed.
Double negative-metamaterial based Terahertz radiation excited by a sheet beam bunch
Authors: Duan Zhaoyun , Guo Chen , Guo Xin , Chen Min
Published: September 2013

We describe a new method to generate enhanced terahertz (THz) surface wave (SW) via its coupling with reversed Cherenkov radiation (RCR), excited by a sheet beam bunch which travels in a vacuum above an isotropic double negative metamaterial (DNM). The physical mechanism for the enhancement is that the DNM can support a RCR which can resonantly interact with a sheet electron beam bunch, resulting in an enhanced SW due to its coupling with the enhanced RCR. Numerical results show strong enhancement effect for the SW and RCR in the THz band. This enhanced THz radiation has potential applications to high-power THz radiation sources and Cherenkov detectors which require large signals.
Thermal transport and Matthiessen's rule in ultra-scaled Si nanowires
Authors: Luisier Mathieu
Published: September 2013

The thermal transport properties of ultra-scaled Si nanowires are investigated in the presence of anharmonic phonon-phonon scattering and surface roughness. These two effects are either treated simultaneously (accurate method) or combined together through Matthiessen's rule (approximation). In both cases, an advanced quantum transport simulator relying on the Non-equilibrium Green's Function formalism expressed in a modified valence-force-field basis is employed. As key results, it is found that the thermal conductivities produced by Matthiessen's rule follow the same trends as the accurate ones but overestimate their values, especially at temperatures where anharmonic phonon-phonon scattering starts to become important.
Dual-wavelength sensitive AlGaN/GaN metal-insulator-semiconductor-insulator-metal ultraviolet sensor with balanced ultraviolet/visible rejection ratios
Authors: Lee Chang-Ju , Kwon Young-Jin , Won Chul-Ho , Lee Jung-Hee , Hahm Sung-Ho
Published: September 2013

We proposed and fabricated a metal-insulator-semiconductor-insulator-metal type dual-wavelength sensitive UV sensor by using an AlGaN/GaN hetero-structure layer epitaxially grown on a sapphire substrate and a thin Al2O3 layer inserted between AlGaN and Ni Schottky electrodes to reduce dark current and improve the UV/visible rejection ratio. The proposed sensor shows high photo-responsive current to both UV wavelength regimes with a significantly improved UV/visible rejection ratio under the regime of the GaN-related UV response. Cut-off wavelengths can be controlled by changing the bias below and above 10 V.
Three-phase slug flow in microchips can provide beneficial reaction conditions for enzyme liquid-liquid reactions
Authors: Čech Jiří , Přibyl Michal , Šnita Dalimil
Published: September 2013

Here, we introduce a solution to low stability of a two-phase slug flow with a chemical reaction occurring at the phase interface in a microfluidic reactor where substantial merging of individual reacting slugs results in the loss of uniformity of the flow. We create a three-phase slug flow by introducing a third fluid phase into the originally two-phase liquid-liquid slug flow, which generates small two-phase liquid slugs separated by gas phase. Introduction of the third phase into our system efficiently prevents merging of slugs and provides beneficial reaction conditions, such as uniform flow pattern along the whole reaction capillary, interfacial area with good reproducibility, and intensive water-oil interface renewal. We tested the three-phase flow on an enzyme hydrolysis of soybean oil and compared the reaction conversion with those from unstable two-phase slug flows. We experimentally confirmed that the three-phase slug flow arrangement provides conversions and pressure drops comparable or even better with two-phase liquid-liquid arrangements.
Influence of hydrodynamics on the growth kinetics of glass-adhering Pseudomonas putida cells through a parallel plate flow chamber
Authors: Mbaye S. , Séchet P. , Pignon F. , Martins J. M. F.
Published: September 2013

The objective of this work was to investigate the influence of hydrodynamics on the growth kinetics of surface-adhering Pseudomonas putida cells. The results showed in particular that under non substrate-limiting conditions, the early step of bacterial apparent growth rate is lower than those measured with suspended cells. Contrary to previously cited authors which explain this behavior to the different adhesive properties of the “daughter”-cells (which makes more probable the detachment of these daughter-cells), in our experimental conditions, that explanation does not hold and we show a clear dependence of growth kinetics with flow conditions, due to the formation of boundary layer concentration at low Reynolds number. These results revealed that using Monod law in the modeling of biofilm growth in fixed-biomass processes should be performed with care.
Raman spectroscopy investigations of chemically derived zigzag edge graphene nanoribbons
Authors: Nishinakagawa R. , Matsuda K. , Arai T. , Sawada A. , Terashima T.
Published: September 2013

We fabricated graphene nanoribbons (GNRs) chemically derived from expandable graphite. All GNRs exhibit atomically smooth edges that extended over their entire length. We investigated four of the fabricated GNRs using Raman spectroscopy. Two of the investigated GNRs show Raman spectra with a missing D-band peak, while D-band peaks can be clearly observed for the other two GNRs. The two GNRs which do not show the D-band peak are GNRs with zigzag edges, and the two other GNRs which show clearly the D-band peaks are possibly GNRs with armchair edges.
Development of a histone deacetylase 6 inhibitor and its biological effects
Authors: Lee Ju-Hee , Mahendran Adaickapillai , Yao Yuanshan , Ngo Lang , Venta-Perez Gisela , Choy Megan L. , Kim Nathaniel , Ham Won-Seok , Breslow Ronald , Marks Paul A.
Published: September 2013

Significance

We discovered a hydroxamic acid-based small-moleculeN-hydroxy-4-(2-[(2-hydroxyethyl)(phenyl)amino]-2-oxoethyl)benzamide selectively inhibits histone deacetylase 6 catalytic activity in vivo and in vitro.
Basic Processes in Reading Aloud and Colour Naming: Towards a Better Understanding of the Role of Spatial Attention
Authors: Robidoux Serje , Rauwerda Derek , Besner Derek
Published: September 2013

Whether or not lexical access from print requires spatial attention has been debated intensively for the last 30 years. Studies involving colour naming generally find evidence that “unattended” words are processed. In contrast, reading-based experiments do not find evidence of distractor processing. One theory ascribes the discrepancy to weaker attentional demands for colour identification. If colour naming does not capture all of a subject's attention, the remaining attentional resources can be deployed to process the distractor word. The present study combined exogenous spatial cueing with colour naming and reading aloud separately and found that colour naming is less sensitive to the validity of a spatial cue than is reading words aloud. Based on these results, we argue that colour naming studies do not effectively control attention so that no conclusions about unattended distractor processing can be drawn from them. Thus we reiterate the consistent conclusion drawn from reading aloud and lexical decision studies: There is no word identification without (spatial) attention.
Does the Jack of All Trades Hold the Winning Hand? Comparing the Role of Specialized versus General Skills in the Returns to an Agricultural Degree
Authors: Artz Georgeanne M. , Kimle Kevin L. , Orazem Peter F.
Published: September 2013

This paper examines the roles of specialized versus general skills in explaining variation in the returns to an agriculture degree among graduates working both inside and outside the agricultural industry. The focus on returns by sector of employment is motivated by our finding that most agricultural graduates are employed in non‐agricultural jobs. In that study, a sample of alumni graduating from a large Midwestern public university between 1982 and 2006 shows that alumni with majors more specialized in agriculture earned a premium from working in the agriculture industry, but this advantage has diminished over time. Agricultural graduates with more general training earn more outside than inside agriculture. Higher‐ability graduates in more industry‐focused curricula tend to sort into the agricultural industry, while higher‐ability graduates in broader curricula tend to choose jobs outside of agriculture. All graduates are more likely to accept agricultural employment when the farm economy is strong, but agricultural graduates who enter agricultural jobs when the farm economy is weak suffer lifetime earnings reductions. These findings suggest that greater levels of specialization may limit a graduate's ability to adjust to changing economic circumstances. Agriculture degree programs could benefit from curriculum innovations that focus on developing more generalized skills.
Both mutated and unmutated memory B cells accumulate mutations in the course of the secondary response and develop a new antibody repertoire optimally adapted to the secondary stimulus
Authors: Kaji Tomohiro , Furukawa Koji , Ishige Akiko , Toyokura Itsumi , Nomura Masaki , Okada Mariko , Takahashi Yoshimasa , Shimoda Michiko , Takemori Toshitada
Published: September 2013

High-affinity memory B cells are preferentially selected during secondary responses and rapidly differentiate into antibody-producing cells. However, it remains unknown whether only high-affinity, mutated memory B cells simply expand to dominate the secondary response or if in fact memory B cells with a diverse VH repertoire, including those with no mutations, accumulate somatic mutations to create a new repertoire through the process of affinity maturation. In this report, we took a new approach to address this question by analyzing the VH gene repertoire of IgG1+ memory B cells before and after antigen re-exposure in a host unable to generate IgG+ B cells. We show here that both mutated and unmutated IgG1+ memory B cells respond to secondary challenge and expand while accumulating somatic mutations in their VH genes in a stepwise manner. Both types of memory cells subsequently established a VH gene repertoire dominated by two major clonotypes, which are distinct from the original repertoire before antigen re-exposure. In addition, heavily mutated memory B cells were excluded from the secondary repertoire. Thus, both mutated and unmutated IgG1+ memory cells equally contribute to establish a new antibody repertoire through a dynamic process of mutation and selection, becoming optimally adapted to the recall challenge.
Introduction
Authors: Peacock Janet
              L. , Kerry Sally
              M.
Published: September 2013

Chapter 1 gives and introduction and description of the resource in general, and
describes the presentation of required statistical information through the entire
research process, from the development of the research proposal, through to applying for
ethical approval, to analysing the data, and then writing up the results. We use the
term ‘statistical information’ to include describing the study design, the calculation
of sample size, and data processing, as well as the data analysis and reporting of
results. It is written for researchers in medicine and in the professions allied to
medicine.
Single group studies
Authors: Peacock Janet
              L. , Kerry Sally
              M.
Published: September 2013

Chapter 6 discusses single group studies, and covers prevelence, presenting results,
screening studies, presenting sensitivity and specificity, rare conditions, extensions,
and further reading.
Analysing matched or paired data
Authors: Peacock Janet
              L. , Kerry Sally
              M.
Published: September 2013

Chapter 8 covers analysing matched or paired data, and includes the paired t-test,
non-normal data, matched case–control data, cohort data, and further reading.
Multifactorial analyses
Authors: Peacock Janet
              L. , Kerry Sally
              M.
Published: September 2013

Chapter 10 covers multifactorial analyses, including one-way analysis of variance,
multiple regression, logistic regression, and further reading.
Presenting a randomised controlled trial
Authors: Peacock Janet
              L. , Kerry Sally
              M.
Published: September 2013

Chapter 12 covers presenting a randomised controlled trial, including the CONSORT
statement and checklist, intention to treat analysis, and presenting trials with other
designs.
Chronic lymphocytic leukaemia
Authors: Zent Clive S. , Polliack Aaron
Published: September 2013

Chronic lymphocytic leukaemia/small lymphocytic lymphoma (CLL) is the most prevalent lymphoid neoplasm in Europe and North America. The ‘cell of origin’ is a mature B lymphocyte that has a rearranged immunoglobulin gene. CLL cells express modest amounts of surface immunoglobulin, and are characterized by defective apoptosis. The cause of CLL is unknown....
Aerobic fitness
Authors: Armstrong Neil , Welsman Joanne
                R.
Published: September 2013

Maximal oxygen uptake (VO2· max), the highest rate at which an individual can consume O2 during exercise, is widely recognized as the best single measure of adults’ aerobic fitness.1,2 Maximal VO2· ultimately limits an individual’s capacity to perform aerobic exercise but it does not describe fully all aspects of aerobic fitness. The transient kinetics of VO2· best reflect the integrated response of the O2 delivery system and the metabolic requirements of the exercising muscle to rapid changes in exercise intensity. Furthermore, VO2· max is not the best index of an individual’s ability to sustain submaximal aerobic exercise and despite its derivation from anaerobic metabolism, measures of blood lactate accumulation during submaximal exercise provide useful indicators of aerobic fitness.

As the assessment of VO2· kinetics is addressed in Chapter 22, in this chapter, we will focus on the assessment of VO2· max and blood lactate accumulation.
Pulmonary Physiology
Authors: Kerensky Todd , Jones Stephanie
Published: September 2013

Chapter 2 contains 69 questions and answers regarding pulmonary physiology.
Anesthesia and Disease States, Part I
Authors: Novalija Jutta , Khatri Vikram , Varadarajan Srinivasan G. , Zainer Christine M.
Published: September 2013

Chapter 3 contains 51 questions and answers regarding anesthesia and disease states.
Pediatric Anesthesia
Authors: Moss David R.
Published: September 2013

Chapter 5 contains 47 questions and answers regarding pediatric anesthesia.
Acute and Chronic Pain
Authors: Mehta Pankaj , Zaleski Katherine , Peeters-Asdourian Christine
Published: September 2013

Chapter 8 contains 66 questions and answers regarding acute and chronic pain.
Thoracic Anesthesia
Authors: Corcoran William Edward , Pawlowski John
Published: September 2013

Chapter 10 contains 101 questions and answers regarding thoracic anesthesia.
Neuroanesthesia
Authors: Brainerd Tiffany , McCann Mary Ellen
Published: September 2013

Chapter 12 contains 49 questions and answers regarding neuroanesthesia.
Airway Management
Authors: Meltzer Joe
Published: September 2013

Chapter 15 contains 46 questions and answers regarding airway management.
Statistics and Ethics
Authors: Doyle D. John
Published: September 2013

Chapter 18 contains 46 questions and answers regarding statistics and ethics.
Intensive Care
Authors: Wagner Chad E. , Ashby Nathan , Kennedy Jason D.
Published: September 2013

Chapter 20 contains 54 questions and answers regarding intensive care.
Preoperative Anxiety Management
Authors: Hagerman Nancy S , Varughese Anna M
Published: September 2013

Up to 65% of pediatric patients experience anxiety and fear in the preoperative period, especially during anesthesia induction. Reasons for this anxiety include the child's perception of the threat of pain, being separated from parents, a strange environment, and losing control. Anxiety and poor behavioral compliance associated with inhalation inductions have been related to adverse outcomes including emergence delirium and maladaptive postoperative behaviors such as general and separation anxiety, eating difficulties, and sleep disturbances. Fortunately, there are behavioral and pharmacological interventions that anesthesiologists can use to improve compliance during induction.
Upper Respiratory Infection
Authors: Samol Nancy B , Wittkugel Eric P
Published: September 2013

Upper respiratory tract infections (URIs) are common in children, with most children experiencing six to eight episodes per year. Some evidence suggests that the airway reactivity associated with these infections persists for several weeks after resolution of symptoms and increases the risk of perioperative adverse events. Other data indicate that these complications are easily managed and seldom associated with any adverse sequelae. Unfortunately, cancellation of patients harboring URIs is not without economic and emotional implications for the patient, the family, and the operating suite as a whole. Understanding the risk factors associated with administering anesthesia to the child with a URI is important in identifying elements of the preoperative assessment that merit attention and in optimizing the anesthetic plan as a means to limit perioperative complications.
Malignant Hyperthermia
Authors: Ragg Philip
Published: September 2013

Malignant hyperthermia, or malignant hyperpyrexia (MH), is a rare but frightening condition that occurs with an incidence of between 1:6,000 and 1:50,000 general anesthetics. To put this in context, a full-time anesthesiologist is likely to see one case in his or her working lifetime, and a major children's hospital may expect to see one case every 2 to 3 years. Its presentation is nonspecific and the course of MH can be insidious or rapidly progressive.
Anesthesia for MRI
Authors: Mahmoud Mohamed A , McAuliffe John J
Published: September 2013

Choosing an appropriate anesthetic or sedative technique for children undergoing diagnostic procedures can be a challenge. Children presenting for MRI may have significant coexisting medical problems, including airway obstruction, a difficult airway, and sleep apnea. The MRI environment poses a unique set of constraints and potential risks. Therefore, a thoughtful and carefully implemented plan is essential to ensure safety and high-quality imaging.
Laryngospasm
Authors: Goldschneider Kenneth R , Wittkugel Eric P
Published: September 2013

Laryngospasm is one of the most common complications of anesthesia in children. If not recognized immediately and treated promptly, laryngospasm may progress to complete airway obstruction with subsequent hypoxia, hypercarbia, bradycardia, and cardiac arrest. All anesthesiologists who anesthetize children must have a good understanding of when it can occur and how it is managed.
Difficult Airway
Authors: Howe Peter
Published: September 2013

Airway management in otherwise healthy children is normally easy in experienced hands and an unexpected difficult intubation should be uncommon. Predictors of difficult intubation include mandibular hypoplasia, limited mouth opening, facial asymmetry, and a history of stridor or obstructive sleep apnea. Many of these features occur in conditions such as Treacher Collins syndrome, Goldenhar's syndrome, and the Pierre Robin sequence.
Airway Reconstruction
Authors: Hein Elizabeth A , Richter Gresham T
Published: September 2013

Pediatric airway reconstruction is undertaken to correct airway obstruction, which may be congenital or iatrogenic. Congenital airway obstruction can be located at any level of the respiratory system, from the nares to the bronchi. It can be complete obstruction, such as choanal atresia in a newborn, or incomplete, such as adenotonsillar hypertrophy or tracheomalacia. Iatrogenic obstruction is often the result of prolonged intubation in a premature infant, which results in subglottic stenosis (SGS) after extubation. As these children grow, their airway growth may not keep pace, resulting in restrictive symptoms limiting their activity. Laryngotracheoplasty (LTP) or tracheal resection procedures may be needed to reconstruct and enlarge the airway. If the premature infant has concurrent lung disease, long-term intubation is often followed by tracheostomy placement. The timing of decannulation depends on the patient's airway patency and respiratory reserve. Understanding the process of evaluation and treatment of patients with SGS helps the anesthetist provide safe anesthesia for this challenging group of children.
Laryngeal Papillomatosis
Authors: Prentice Elizabeth
Published: September 2013

The incidence of recurrent juvenile laryngeal papilloma caused by human papilloma virus has been rising (Dalmeida et al., 1996). A child with this potentially life-threatening condition requires surgical resection to avoid respiratory obstruction; this surgery may need to be repeated regularly for many years. Laser therapy to the airway provides specific challenges to the anesthesiologist. In particular, the risks of a shared compromised airway as well as the hazards of the laser itself must be appreciated by all medical personnel. The key to success is thorough preoperative assessment, good continuous communication with surgical and nursing staff, preparation for the management of critical incidents, and familiarity with the surgical and anesthetic equipment.
Intraoperative Wheezing
Authors: Cass Lindy
Published: September 2013

Wheezing is an important sign for anesthesiologists. At the preoperative consult it usually indicates bronchospasm from poorly controlled asthma, though many other causes are possible. Intraoperative wheezing also has many potential causes, including bronchospasm, airway obstruction, anaphylaxis, or aspiration. Intraoperative wheezing is an anesthetic emergency that can lead to life-threatening respiratory and cardiac complications. Prompt action to maintain oxygenation, removal of any trigger factors, and, if indicated, bronchodilator administration will usually result in a safe outcome.
Pectus Excavatum Repair
Authors: Moore David L , Goldschneider Kenneth R
Published: September 2013

Pectus excavatum is a defect in the proper growth of the sternum and adjacent costal cartilages, causing posterior depression of the chest. Pectus deformities account for more than 90% of congenital chest wall deformities. Evidence supports surgical repair, as many patients experience progressive cardiopulmonary symptoms over time. The most common symptoms include dyspnea with exercise and loss of endurance. An increasingly common method of repair is the Nuss minimally invasive technique, in which rigid bars are placed under the sternum and the costal cartilages with thoracoscopic guidance for a period of time until permanent remodeling of the chest is achieved.
Management of Burn Patients for Grafting and Excision
Authors: McDougall Robert
Published: September 2013

Anesthesia management for excision and grafting of burns in a child can be extremely challenging. Early excision of burned tissue significantly decreases morbidity and mortality but often involves procedures that lead to significant blood loss. Burn patients also have a markedly increased metabolic rate secondary to the inflammatory response to the burn. Burn patients may be difficult to monitor, are at risk of hypothermia, and present complex pain-management problems.
Craniosynostosis Repair
Authors: Howe Peter
Published: September 2013

Craniosynostosis is a condition in which one or more of the fibrous sutures in an infant skull fuses prematurely. This may lead to restricted skull and brain growth and elevated intracranial pressure. Many children with craniosynostosis undergo corrective cranioplasty in infancy, an age when the skull is relatively large in proportion to the rest of the body. Depending on the operation, it is common for blood loss to be substantial and exceed the child's estimated blood volume (EBV). Managing this blood loss is challenging and requires careful planning for fluid and blood product administration. Some children also have craniofacial syndromes that are associated with airway obstruction and difficult intubation.
Kidney Transplant
Authors: Smith Ian
Published: September 2013

Renal transplantation is the preferred treatment for pediatric patients who have end-stage renal disease. A successful transplant improves intellectual and behavioral development, quality of life, and survival, with the survival at 10 years being as high as 83% (Kim et al., 1991). We can optimize the chance of success by understanding the pathophysiology involved and applying this knowledge to guide our management of perioperative fluid balance, electrolyte anomalies, anemia, blood pressure control, and comorbidities. Also critical is an appreciation of the effects and consequences of the various immunosuppressive agents that are used. Close communication is required between the pediatrician, surgeon, and anesthesiologist.
Children with Congenital Heart Disease for Non-cardiac Surgery
Authors: Clifford Michael
Published: September 2013

It is estimated that up to 1 million children in the United States have congenital heart disease (CHD). These children range from those who are essentially normal functionally with anatomically repaired hearts, and hence minimal impact for anesthesia, to those that have had complex and numerous surgical procedures with significant residual abnormalities in circulation and cardiac function, and a range of comorbidities. These latter children have many issues that will affect anesthesia for non-cardiac surgery. When presented with a child with CHD for non-cardiac surgery, the general pediatric anesthesiologist should be able to perform a tailored cardiac preoperative evaluation and plan an appropriate anesthetic with suitable anesthetic techniques, agents, and monitoring. Not every child with CHD has a single ventricle with all its complexity (see Chapter 31), but every child with CHD will offer challenges for the pediatric anesthesiologist.
Tetralogy of Fallot
Authors: Kreeger Renee Nierman , Spaeth James P
Published: September 2013

Patients with congenital heart disease are frequently encountered by the pediatric anesthesiologist for non-cardiac surgery. Fortunately, the majority of these patients have already undergone definitive repair of their cardiac lesions and can often be managed using traditional anesthetic methods. However, given the known association of congenital heart disease with other congenital malformations and syndromes, there is a relatively high likelihood that a pediatric anesthesiologist will encounter a situation involving a child with an unrepaired lesion. With the reported increased mortality rate for patients with complex cardiac lesions undergoing non-cardiac procedures (see Chapter 30), an understanding of the pathophysiology and anatomy, as well as the potential effects of the anesthetic medications and techniques chosen, is paramount to their successful care.
Awareness and Recall During Anesthesia
Authors: Davidson Andrew
Published: September 2013

Awareness is being able to freely recall an event that occurred during a general anesthetic. The phenomenon is well described in adults but, until recently, was poorly described in children. Several studies have now found that awareness does occur in children. It occurs more often than in adults but often has different characteristics to the typical awareness described in adults.
Oncology Patient
Authors: Meyer Mark J , Weidner Norbert J
Published: September 2013

The pediatric oncology population presents challenges to the anesthesiologist. Many of these patients undergo multiple lumbar punctures and bone marrow aspirations as part of their treatment protocol. Radiation therapy is another treatment modality that requires the assistance of an anesthesiologist to be successful for younger children. While seemingly minor procedures, they are a source of anxiety for patients and parents. Furthermore, patients can present with a number of physiological derangements such as anemia, coagulopathies, and toxicities from chemotherapeutic agents. Further, these patients are often infants and toddlers who require attention to their developmental level during anesthetic planning.
Hypopituitarism
Authors: Hosu Liana G , Aronson Lori A
Published: September 2013

Hypopituitarism refers to decreased secretion of pituitary hormones, which can result from diseases of the pituitary gland or hypothalamus. Surgery in the presence of untreated panhypopituitarism is rare. It is important to recognize the presence of hypopituitarism and most importantly adrenal insufficiency, a condition that can result in mortality from adrenal crisis without stress-dose corticosteroid treatment.
Mitochondrial Disorder for Muscle Biopsy
Authors: Jou J. Fay , Aronson Lori A , Morillo-Delerme Jacqueline W
Published: September 2013

Mitochondrial disease (mtD) is a genetically, biochemically, and clinically heterogeneous group of disorders that arise most commonly from defects in the oxidative phosphorylation or electron transport chain involved in energy metabolism. These patients have an increased risk for cardiac, respiratory, neurologic, and metabolic complications from anesthesia. Consequently, there are several anesthetic considerations for patients with mtD.
Exploratory Laparotomy for Necrotizing Enterocolitis
Authors: McAdam Dugald
Published: September 2013

The survival rates of very-low-birth weight (VLBW; birth weight <1,500 g) and extremely-low-birth weight (ELBW; birth weight <1,000 g) infants have increased with improvements in antenatal and postnatal care. These include the use of antenatal steroids, artificial surfactant, and ventilation strategies that have reduced injury to the neonatal lung. As a result, the pediatric anesthesiologist is now more often faced with the task of safely caring for these infants, often in unfamiliar environments, and sometimes during episodes of life-threatening illness. One example is necrotizing enterocolitis (NEC) requiring surgical management.
Former Premature Infant for Hernia Repair
Authors: Frawley Geoff
Published: September 2013

There has been a marked improvement in the survival rates of premature infants. Coincident with the increase in survival has been an increase in ex-premature infants presenting for surgery. Hernia repair is the most common surgery in ex-premature infants, with the incidence of inguinal hernias being inversely proportional to gestational age at birth (13% incidence in infants born <32 weeks’ gestation and 30% in those born with a birth weight <1,000 g). Postoperative apnea is a significant complication in this age group. Both awake regional and general anesthetic techniques are widely used for infant hernia repair; the choice often is based more on anesthetic preference than on evidence from prospective randomized controlled trials.
Omphalocele/Gastroschisis Repair
Authors: Stoddart Peter
Published: September 2013

Congenital abdominal wall defects (AWD) comprise gastroschisis and omphalocele (exomphalos). Nearly all AWDs require urgent intervention within a few hours of birth. The current incidence of omphalocele (3 per 10,000) and gastroschisis (4–5 per 10,000) has been increasing over the past few decades; however, improved management of these congenital defects has resulted in a fall in mortality to less than 5%. The anesthetic management of both conditions is essentially the same.
Myelomeningocele Repair
Authors: Boat Anne C , Sadhasivam Senthilkumar
Published: September 2013

Myelomeningocele (MMC) is a spinal birth defect that occurs due to failure in the closure of the embryologic neural tube. The meninges and/or neural structures are exposed, resulting in nerve damage. MMCs are associated with significant direct morbidity as well as with Chiari II malformations and hydrocephalus. The degree of sensory and motor deficits depends on the level of the defect, with bowel and bladder function often affected. Due to the risk of infection with an exposed spinal cord, surgical repair is usually performed in the first 24 to 48 hours of life. Anesthesia for MMC repair presents a unique challenge since positioning of these patients must prevent direct pressure on the exposed neural tissue.
Acute Pain Management
Authors: Chou Jason , Chalkiadis George
Published: September 2013

Age-appropriate pain assessment and management is vital in the care of children with acute pain. Assessment should happen regularly and should be documented clearly; pain should be treated and routinely reassessed. There are both short- and long-term consequences if pain is poorly treated in the acute and postoperative setting. The most effective analgesia plans are multimodal. This chapter focuses on systemic treatments of pain in the acute setting.
Peripheral Nerve Block Catheter for Extremity Surgery
Authors: Prentice Elizabeth
Published: September 2013

Continuous peripheral nerve blockade (CPNB) can provide excellent postoperative analgesia. Many adult studies report the effectiveness of CPNB. Although not as widely adopted in pediatrics, several studies support its use. Its niche lies in provision of analgesia after major unilateral limb surgery with severe postoperative pain expected for 48 to 72 hours. Lower limb surgery of this type is more common than upper limb in the pediatric population. Examples include club foot repair, osteotomy, or resection of sarcoma. This chapter presents two cases where CPNB is a good option for postoperative analgesia.
Complex Regional Pain Syndrome in the Emergency Department
Authors: Lauder Gillian R
Published: September 2013

Acute exacerbation of an ongoing chronic pain can be a diagnostic and clinical dilemma. Chronic pain in children requires an interdisciplinary approach to assessment and treatment. Further, the child must commit to taking an active role in therapy. When this approach is not working, or there is an acute trauma to the affected region, children with chronic pain may present to the emergency department with extreme pain. Acute care health professionals may find themselves unable to modify the pain intensity with standard analgesic medications. The analgesic approach requires careful clinical management and liaison with the chronic pain team supervising the ongoing management of pain.
Down Syndrome
Authors: Lin Erica P , Spaeth James P
Published: September 2013

Trisomy 21, or Down syndrome, is the most common human chromosomal syndrome, with an overall incidence of 1:700 live births. Because of its association with other congenital anomalies, children with this syndrome often present for surgical procedures that require general anesthesia. Anesthesiologists caring for these patients must be familiar with the implications of Down syndrome on perioperative care.
Nocturnal Intermittent Hypoxia Is Independently Associated with Pain in Subjects Suffering from Sleep-disordered Breathing
Authors: Doufas Anthony G. , Tian Lu , Davies Margaret Frances , Warby Simon C.
Published: September 2013

Background:

On the basis of experimental and clinical evidence, the authors hypothesized that nocturnal hypoxemia would be associated with pain reports in subjects suffering from sleep-disordered breathing, independently of sleep fragmentation and inflammation.

Methods:

After obtaining institutional approval and access to the Cleveland Family Study phenotype and genotype data, the authors used proportional odds regression to examine the association between arterial desaturation and four different types of pain, as well as their composite measure, sequentially adjusted for: (1) clinical characteristics and (2) sleep fragmentation and inflammation. The authors also examined the association of selected candidate single-nucleotide polymorphisms with pain reports.

Results:

Decreased minimum nocturnal arterial saturation increased the odds for morning headache (adjusted odds ratio per SD = 1.36; 95% CI [1.08–1.71]; P = 0.009), headache disrupting sleep (1.29 [1.10–1.51]; P = 0.002), and chest pain while in bed (1.37 [1.10–1.70]; P = 0.004). A decrease in the minimum nocturnal saturation from 92 to 75% approximately doubled the odds for pain. One single-nucleotide polymorphism for the α 1 chain of collagen type XI (COL11A1–rs1676486) gene was significantly associated with headache disrupting sleep (odds ratio = 1.72 [1.01–2.94]; P = 0.038), pain disrupting sleep (odds ratio = 1.85 [1.04–3.28]; P = 0.018), and pain composite (odds ratio = 1.89 [1.14–3.14]; P = 0.001).

Conclusion:

Nocturnal arterial desaturation may be associated with an increased pain in subjects with sleep-disordered breathing, independently of sleep fragmentation and inflammation.
Morphological and biomechanical disparity of crocodile-line archosaurs following the end-Triassic extinction
Authors: Stubbs Thomas L. , Pierce Stephanie E. , Rayfield Emily J. , Anderson Philip S. L.
Published: September 2013

Mesozoic crurotarsans exhibited diverse morphologies and feeding modes, representing considerable ecological diversity, yet macroevolutionary patterns remain unexplored. Here, we use a unique combination of morphological and biomechanical disparity metrics to quantify the ecological diversity and trophic radiations of Mesozoic crurotarsans, using the mandible as a morpho-functional proxy. We recover three major trends. First, the diverse assemblage of Late Triassic crurotarsans was morphologically and biomechanically disparate, implying high levels of ecological variation; but, following the end-Triassic extinction, disparity declined. Second, the Jurassic radiation of marine thalattosuchians resulted in very low morphological disparity but moderate variation in jaw biomechanics, highlighting a hydrodynamic constraint on mandibular form. Third, during the Cretaceous terrestrial radiations of neosuchians and notosuchians, mandibular morphological variation increased considerably. By the Late Cretaceous, crocodylomorphs evolved a range of morphologies equalling Late Triassic crurotarsans. By contrast, biomechanical disparity in the Cretaceous did not increase, essentially decoupling from morphology. This enigmatic result could be attributed to biomechanical evolution in other anatomical regions (e.g. cranium, dentition or postcranium), possibly releasing the mandible from selective pressures. Overall, our analyses reveal a complex relationship between morphological and biomechanical disparity in Mesozoic crurotarsans that culminated in specialized feeding ecologies and associated lifestyles.
Formosa arctica sp. nov., isolated from Arctic seawater
Authors: Kwon Taeyang , Baek Kiwoon , Lee Kiyoung , Kang Ilnam , Cho Jang-Cheon
Published: September 2013

A Gram-staining-negative, chemoheterotrophic, yellow-pigmented, gliding, catalase- and oxidase-positive, flexirubin-negative, strictly aerobic bacterium, designated strain IMCC9485T, was isolated from a seawater sample collected from the Arctic Ocean. Optimal growth of strain IMCC9485T was observed at 25 °C, pH 7–8 and in the presence of 1.5–2.5 % NaCl. Phylogenetic analysis based on 16S rRNA gene sequences showed that strain IMCC9485T belonged to the genus

Formosa

and was closely related to

Formosa algae

KCTC 12364T (98.2 %) and

Formosa agariphila

KCTC 12365T (98.0 %). DNA–DNA relatedness between the new isolate and

F. algae

and

F. agariphila

was far lower than 70 %, which indicated that strain IMCC9485T is a novel genomic species of the genus

Formosa

. The major fatty acids (>10 %) were iso-C15 : 1G (13.7 %), C16 : 1ω7c and/or C16 : 1ω6c (13.4 %) and iso-C15 : 0 (12.3 %). The G+C content of the genomic DNA was 37.6 mol%. Strain IMCC9485T contained menaquinone-6 (MK-6) as the respiratory quinone and phosphatidylethanolamine, unknown aminophospholipids and unknown polar lipids as polar lipid constituents. On the basis of phylogenetic analyses and differential phenotypic characteristics, it is suggested that strain IMCC9485T ( = KACC 17484T = KCCM 42937T = NBRC 106080T) be assigned to the genus

Formosa

as the type strain of a novel species, for which the name

Formosa

arctica sp. nov. is proposed.