bluuebunny/crossref_metadata_2025 huggingface dataset:
Spare parts allocation of amphibious aircraft based on hybrid two-level repair
Authors: Feng Yun-Wen , Tian Jing , Xue Xiao-Feng , Lu Cheng
Published: February 2021

In this paper, a hybrid two-level inventory allocation method based on multi-echelon technique for recoverable item control (METRIC) was applied to the spare parts allocation of amphibious aircraft. Firstly, the principle of the spare parts inventory configuration model for amphibious aircraft based on hybrid two-level repair was expounded. The mathematical model was established with maintenance cost as objective function and availability and volume of spare parts as constraints. Secondly, marginal analysis was used to help allocate spare parts, the process of solving the mathematical model was discussed, and the calculation formulas of the quantities involved were briefly stated. Finally, with the line replaceable units of landing gear as the research object, the spare parts inventory allocation of an amphibious aircraft was solved according to the method proposed in this paper. This paper provides an approach to allocate spare parts of amphibious aircraft.
Research on Product Failure Prediction Based on TRIZ Theory
Authors: Zhang Y J , Yue Z Y , Jiang G J , Yang X X , Pan D X , Xia X Y
Published: February 2021

Failure prediction at the product design stage can improve product quality and reduce input costs. Many existing failure analysis methods were susceptible to staff brainstorming during failure excavation, resulting in distortion of results. To overcome the shortcomings of the existing failure analysis methods, according to the interaction characteristics of substance attributes from the functional perspective of TRIZ theory, and drawing on the analysis process of anticipatory failure determination (AFD) method, a general model which was suitable for mechanical products and can effectively determine the potential failure modes and causes of components was established. The feasibility of the model was verified by the example of the fixed-bed gas-gas heat exchanger.
Research on Key Techniques of the Warship Equipment Support Capability Design for the People’s Armed Police Coast Guard
Authors: Biao Xing
Published: February 2021

According to the actual requirement and the existing situation of the warship equipment support, the article makes its main research on the People’s Armed Police Coast Guard, and describes the concept and connotation of the warship equipment support design. Finally, it summarizes the project and technological approaches which can realize the support target from the project demonstration phase to the using support phase. The warship equipment support capacity design aims at solving the generated problem of the system of systems support capability, and can improve the logistical support system, innovative the support model, enhanced the logistical support capability.
KKMA - A Calculation Method for KANO Classification Based on User Reviews
Authors: Lu A P , Sun Y F , Lei Z , Li G , Jing J , Liu W , Hu C J
Published: February 2021

KANO model classification is helpful for us to recognize customer needs and to improve their satisfaction. The traditional method uses standard questionnaires to conduct surveys, classifies product attributes according to the survey results. However with the increase of product complexity and the speed of product iteration, the method of survey is more and more unable to meet our analysis needs; coupled with the increasing number of customers who do not want to give feedback for questionnaires, low responds ratio rate leads poor feedback quality which affects the reliability of the research results. Although many studies are about KANO model classification, few of them focus on how to improve responds ratio rate. This article creates a new method for KANO model classification. By collecting customer reviews and rating score, we build up regression model between the score and the degree to which product attributes meet user needs according to their text expression. Based on the curve shape of the model coefficients and the value of the coefficient we can identify which KANO classification will a product attribute belongs to. The experiment study for gaming notebook has proved that this method is efficient and can be widely used in other products. We call this method as KKMA (Kano, K-means, MDS, Ad boost).
Tolerance design of electromechanical products based on self-defined approximate model
Authors: Deng J , Lai J M , Zhai G F
Published: February 2021

Influenced by the uncertain factors in the manufacturing process, the output characteristics of electromechanical products inevitably deviate from the target value, resulting in the uneven quality of batch products. Generally, tolerance design based on a large number of input-output data is used to improve the quality consistency of batch products. As for electromechanical products, the output characteristics are usually obtained by the finite element method (FEM). However, FEM is so time-consuming that it is difficult to be applied to the tolerance design process. In this paper, a new tolerance design process based on approximate model is proposed. The period of tolerance design is greatly shortened. Firstly, a self-defined approximate model based on Taylor expansion principle is established. Then based on this model, the tolerance design with variable contribution rate is carried out. Finally, Monte Carlo method is used to compare the quality consistency of batch products before and after optimization. The accuracy and effectiveness of the method proposed in this paper are verified in the case of a certain type of electromagnetic relay (EMR).
Condition Monitoring of the Aircraft Structural Fatigue Test Based on PCA Algorithm
Authors: Yan C Y , Zhang Q Y , Lin J F , Hou Q Q
Published: February 2021

For the frequent occurrence of structural damage and abnormal conditions in the aircraft structural fatigue test, this paper puts forth a condition monitoring method for aircraft structural fatigue test based on PCA algorithm. First, PCA theory is introduced and its principle is deduced. Second, combined with the characteristics of aircraft structural fatigue test, the off-line principal component model of fatigue test under normal condition is established, in which the static measurement data is treated as the training sample set. According to T2 statistic and statistical test theory, the detection index is constructed to realize abnormal state recognition. Finally, the effectiveness of the proposed method is verified by a test case.
Study of electric field vector, angular momentum conservation and Poynting vector of nonparaxial beams
Authors: Prajapati Chandravati
Published: February 2021

The angular momentum (AM) of light, comprising spin and orbital AMs, is conserved and produces a spin-Hall shift in this process for paraxial beams. For nonparaxial beams, the spin and orbital AMs are non-separable and produce many changes in the beams’ spatial profile contrary to paraxial beams. These changes can be manifested as polarization modulation in the transverse plane, and conversion to orbital angular momentum (OAM) structured beams in the transverse and longitudinal planes, which can be estimated by studying the electric field vector in detail. We have calculated theoretically and simulated numerically the electric field vector components in the focal plane, to study the polarization modulation and AM conservation for OAM and Gaussian light beams of circular and linear polarizations and compared the results. Further, we have calculated and simulated the Poynting vector components for the corresponding fields to study the energy flow. We have considered the focusing of light beams using a high Numerical Aperture objective lens to obtain the nonparaxial beam, and presented a detailed theoretical analysis therein. The interpretation studies presented here are new, which may have many applications in nanophotonics and help in understanding the spin–orbit interaction at the fundamental level.
In-situ reduction of silver by surface DBD plasma: a novel method for preparing highly effective electromagnetic interference shielding Ag/PET
Authors: FAN Zhiyuan , DI Lanbo , BU Decai , ZHANG Tengda , ZHANG Xiuling
Published: February 2021

Electromagnetic interference (EMI) shielding composites with good flexibility and weatherability properties have attracted increased attention. In this study, we combined the surface modification method of sub-atmospheric pressure glow discharge plasma with in situ atmospheric pressure surface dielectric barrier discharge plasma (APSDBD) reduction to prepare polyethylene terephthalate supported silver (Ag/PET). Due to the prominent surface modification of PET film, mild plasma reduction, and effective control of the silver morphology by polyvinylpyrrolidone (PVP), a 3.32 μm thick silver film with ultralow sliver loading (0.022 wt%) exhibited an EMI shielding efficiency (SE) of 39.45 dB at 0.01 GHz and 31.56 dB at 1.0 GHz (>30 dB in the range of 0.01–1.0 GHz). The SEM results and EMI shielding analysis indicated that the high performance originated from the synergistic effect of the formation of silver nanoparticles (AgNPs) with preferentially oriented cell-like surface morphologies and layer-by-layer-like superimposed microstructures inside, which demonstrated strong microwave reflection properties. Fourier transform infrared spectrometer and x-ray diffractometer showed that the surface structures of the heat-sensitive substrate materials were not destroyed by plasma. Additionally, APSDBD technology for preparing Ag/PET had no special requirements on the thickness, dielectric constant, and conductivity of the substrate, which provides an effective strategy for manufacturing metal or alloy films on surfaces of heat-sensitive materials at a relatively low cost.
Self-powered graphene phototransistor with high and tunable responsivity and detectivity
Authors: Gebril Wafaa , Manasreh M Omar
Published: February 2021

A few layers graphene-based phototransistor was fabricated and investigated. Graphene layers were mechanically exfoliated and transferred into a p-doped Si/SiO2 substrate to fabricate a graphene field effect transistor. Gold electrodes were deposited to create a drain and source to the graphene and a back contact gate to the p-doped silicon. The device performance was examined by measuring the current-voltage characteristics in the dark and under illumination. At zero drain voltage bias and room temperature, the device operated and achieved high responsivity and detectivity on the order of 2.7 × 104 A W−1 and 5 × 1012 cm·Hz0.5/W, respectively. A ratio of 29 between the photocurrent and the dark current was achieved. The device shows an excellent tunable photoresponse as a function of the applied back-gate voltage, which indicates the domination of a photogating effect produced by the Si/SiO2 substrate.
A classification of pure states on quantum spin chains satisfying the split property with on-site finite group symmetries
Authors: Ogata Yoshiko
Published: February 2021

We consider a set

S
P
G
(

A

)

SPG(\mathcal {A})

of pure split states on a quantum spin chain

A

\mathcal {A}

which are invariant under the on-site action

τ
\tau

of a finite group

G
G

. For each element

ω
\omega

in

S
P
G
(

A

)

SPG(\mathcal {A})

we can associate a second cohomology class

c

ω
,
R

c_{\omega ,R}

of

G
G

. We consider a classification of

S
P
G
(

A

)

SPG(\mathcal {A})

whose criterion is given as follows:

ω

0

\omega _{0}

and

ω

1

\omega _{1}

in

S
P
G
(

A

)

SPG(\mathcal {A})

are equivalent if there are automorphisms

Ξ

R

\Xi _{R}

,

Ξ
L

\Xi _L

on

A

R

\mathcal {A}_{R}

,

A

L

\mathcal {A}_{L}

(right and left half infinite chains) preserving the symmetry

τ
\tau

, such that

ω

1

\omega _{1}

and

ω

0

∘

(

Ξ

L

⊗

Ξ

R

)

\omega _{0}\circ \left ( \Xi _{L}\otimes \Xi _{R}\right )

are quasi-equivalent. It means that we can move

ω

0

\omega _{0}

close to

ω

1

\omega _{1}

without changing the entanglement nor breaking the symmetry. We show that the second cohomology class

c

ω
,
R

c_{\omega ,R}

is the complete invariant of this classification.
Quasi-log canonical pairs are Du Bois
Authors: Fujino Osamu , Liu Haidong
Published: February 2021

We prove that every quasi-log canonical pair has only Du Bois singularities. Note that our arguments are free from the minimal model program.
A Sliding Scale Approach to Travaux in Treaty Interpretation: The Case of Investment Treaties
Authors: Shirlow Esmé , Waibel Michael
Published: February 2021

Materials produced during the negotiation of treaties, commonly called travaux préparatoires (‘travaux’), are given formal significance as a ‘supplementary means’ of treaty interpretation under article 32 of the Vienna Convention on the Law of Treaties (VCLT). Travaux present both risks and opportunities for treaty interpretation, and international adjudicators have differed in how they define the rationale for referring to travaux, how they use these materials, and even more fundamentally, what materials they classify as travaux. This article proposes a methodology to guide the more structured identification and use of travaux. Under the proposed sliding scale approach, treaty interpreters assess the utility of material to the interpretive exercise by reference to its precise qualitative features and the context of interpretation, rather than by categorizing materials as ‘travaux’ or not. The article uses the interpretation of investment treaties in investor-state arbitration as a case study to illustrate the proposed approach and its utility. The discussion, including the proposed sliding scale approach, is nonetheless equally relevant for interpreting all manner of treaties.
A stochastic dominance approach to pension-fund selection
Authors: Kopa Miloš , Kabašinskas Audrius , Šutienė Kristina
Published: February 2021

This paper contributes to the research on multi-pillar pension systems with main focus on private pension funds (PFs). In this context, the specific objective of this study is to determine which second-pillar private fund is the best for participants in such systems on the basis of their risk profile. Based on the assumptions on utility functions of the participants in a pension scheme, four types of stochastic dominance (SD) relations are considered, specifically first order, second order, third order and SD generated by utility functions with decreasing absolute risk aversion. We conduct an analysis under two distributional assumptions: empirical and stable distribution of returns. Moreover, the investors for which non-dominated funds are the optimal choices are identified. Allowing for diversification, the efficiency of the PFs with respect to several types of SD is tested. Then, the observed behaviour of participants in the last quarter/year is compared to the results of SD analysis. Finally, the identified SD relations are stress-tested using data originating from a period of turmoil. Despite the focus on Lithuanian PFs, the methodology developed in this work can be employed by participants or PF managers in similar markets of other countries.
Field Recording and the Re-enchantment of the World: An Intercultural and Interdisciplinary Approach
Authors: Jamieson Daryl
Published: February 2021

Nonfictional field recording is a genre of music (sound art) which offers a glimpse of art beyond our late-capitalist age. The ongoing ecocide which we, in a state of abject detachment, are witnessing and abetting calls out for artists to reconnect and reengage with the nonhuman world that has been deemed valueless by our civilization. Countering the disenchantment of nature wrought by scientism, human-centrism, and above all capitalism necessitates a dissolving of the barriers we set up between ourselves and our environment, a task which can be only accomplished via religion or art: an art—like field recording—which affords reconnecting its audience with the enchantment of the ignored world surrounding them. In this article, Toshiya Tsunoda’s exemplary Somashikiba (2016)—recorded in locations forgotten by civilization—will be examined via interpretive tools adapted from Ueda Shizuteru’s Kyoto School aesthetics and Takahashi Mutsuo’s poetics. Ueda’s philosophy offers a way of understanding perception which eliminates the subject-object division. Takahashi’s project of recovering the spirituality of place through poetry is a model of historically and politically engaged art. Looking, as these contemporary Japanese thinkers have done, to the precapitalist, pre-formalist past to rediscover (sound) art’s function as a medium which reconfigures the listener’s perception of reality, I argue for the urgency of sound art such as Tsunoda’s which aids in the re-enchantment of the world to a future beyond capitalist, humanist “civilization.”
Estimating Demand for Third-party Quality Testing in Rural Grain Markets: Evidence from an Experimental Auction for Measuring Moisture Content in Kenya
Authors: Fuller Amanda J , Ricker-Gilbert Jacob
Published: February 2021

Traders in informal grain markets often lack incentives to sell grain dried to a moisture level that is safe for storage, due to weak regulations and lack of low-cost moisture testing technologies. This study estimated the demand for a third-party moisture testing service in western Kenya that can encourage safe drying and reduce asymmetric information between buyers and sellers. We utilised a Becker–DeGroot–Marschak (BDM) auction to obtain maize traders’ willingness to pay (WTP) for the moisture testing service and compared it with two alternative multiple price list (MPL) mechanisms for eliciting WTP. Traders had the opportunity to bid on the testing service with two different moisture metres. The first was a low-cost hygrometer that measures temperature and relative humidity and costs about $2.50. The second was a commercial moisture metre that costs $170 in USA but provides a more precise reading. Results suggest that the standard BDM auction and both MPL variants produced similar estimates of demand for our moisture testing service. On average, traders were willing to pay $0.28 to have their maize tested with the hygrometer and $0.39 with the moisture metre. An additional take-it-or-leave-it auction for the hygrometer itself revealed that traders were not sensitive to price changes around market price, although only 15% of the traders purchased the device. A service provider model using either device could be a way to make moisture testing accessible in rural grain markets in the absence of a supply chain that sells these devices directly.
Changes in sexual function and serum testosterone levels in patients with prostate cancer after image-guided proton therapy
Authors: Hattori Yukiko , Iwata Hiromitsu , Nakajima Koichiro , Nomura Kento , Hayashi Kensuke , Toshito Toshiyuki , Hashimoto Shingo , Umemoto Yukihiro , Mizoe Jun-etsu , Ogino Hiroyuki , Shibamoto Yuta
Published: February 2021

Since sexual function and testosterone levels after image-guided proton therapy (IGPT) have not yet been examined in detail, we prospectively evaluated changes before and after IGPT. Among patients treated with IGPT with or without combined androgen blockade (CAB) therapy between February 2013 and September 2014, patients who agreed to participate in the study and were followed up for >3 years after IGPT were evaluated. Serum testosterone levels were regularly measured together with prostate-specific antigen (PSA) levels before and after IGPT. The Erection Hardness Score (EHS) and the sexual domain summary, function subscale and bother subscale of the sexual domain in the Expanded Prostate Cancer Index Composite (EPIC) were assessed. There were 38 low-risk, 46 intermediate-risk and 43 high- or very-high-risk patients (NCCN classification). Although serum testosterone levels in low-risk patients did not decrease after IGPT, reductions were observed in the average EHS and the sexual domain summary score of the EPIC. In intermediate-, high- and very-high-risk patients, testosterone and PSA levels both increased following the termination of CAB after IGPT, and the average EHS increased. The sexual domain summary score gradually increased, but not above minimally important differences. In intermediate-risk patients, the function subscale increased from 4.4 to 14.8 (P < 0.05) 12 months after IGPT and reached a plateau after 60 months. The results of the present study would suggest the potential of IGPT, and further prospective studies to directly compare IGPT with other modalities are warranted.
The Role of Expert Witnesses in the Adjudication of Religious and Culture-based Asylum Claims in the United Kingdom: the Case Study of ‘Witchcraft’ Persecution
Authors: BIANCHINI KATIA
Published: February 2021

This article examines the role of cultural expertise in asylum judicial decisions in the UK by focusing on witchcraft-based persecution. The case study highlights multiple challenges to decision-making created by religious and cultural diversity, and the ensuing problems of assessing unfamiliar facts and beliefs against the often lack of corroborating evidence. Drawing on legal sources and a small number of anthropological studies, as well as analyses of judicial decisions, the article discusses how the unique characteristics of witchcraft cases, with their unfamiliar paradigms, are illustrative of the need to analyse and understand asylum claims within their broad cultural, historical, economic, and political contexts. The article exposes how cultural expertise assists judges in appreciating specific contexts and curbing their Eurocentric understanding of culture and religion, and shapes the final outcome of cases.
Common Neonatal Presentations
Authors: Young Kelly D.
Published: February 2021

Parents of newborns, particularly first-time parents, are often concerned that their infant has a physical examination finding or behavior that is out of range of normal. Neonates have a variety of common findings and diagnoses specific to this age group. However, their range of behaviors is limited, and they are unable to communicate, complicating evaluation. Caring for neonates in the emergency department requires knowledge of newborn-specific conditions as well as the range of normal behaviors. Common chief complaints include jaundice, feeding difficulties, vomiting, irritability and crying, breathing difficulty, and rash. Emergency department providers must be familiar with the range of normal behaviors and common diagnoses seen in neonates. This chapter presents an overview of common concerns parents have about their neonates.
Emergent Airway Management in Pediatrics
Authors: Miller Kelsey A. , Nagler Joshua
Published: February 2021

Airway management is the cornerstone to resuscitation efforts for the majority of critically ill pediatric patients. The etiology of arrest in children is more commonly from a respiratory than a cardiac process, and early and effective airway management can be life-saving. However, only a small proportion of pediatric patients ultimately require advanced airway management. In addition to its rarity, anatomic and physiologic differences in children can further complicate performance of this critical procedure. Familiarity these difference and knowledge of strategies to optimize procedural success are essential for every emergency practitioner. This chapter reviews important clinical pearls and pitfalls in the emergent management of the pediatric airway.
Pediatric Resuscitation
Authors: Mendes Matthew , McCormick Taylor
Published: February 2021

Respiratory failure is the most common cause of cardiopulmonary arrest in children. Early recognition of the critically ill child and aggressive management of respiratory failure and shock are crucial to preventing cardiopulmonary arrest. Although caring for a sick child can be highly stressful for emergency physicians, pediatric resuscitation largely mirrors that of adults, with special consideration of a few key anatomic and physiologic differences. It is important to have a systematic approach to patient assessment, medication dosing, and equipment sizing in order to cognitively offload the emergency provider. The following will help maximize performance in these high-stakes situations: the Pediatric Assessment Triangle combined with the familiar airway, breathing, circulation, disability, exposure approach; an age-, weight-, or length-based medication/equipment system; and routine application of Pediatric Advanced Life Support algorithms.
Evaluation of the Extended Fever
Authors: Mace Sharon E.
Published: February 2021

Fever is a common presentation in children. Fever accounts for 15% of all pediatric ED visits and 30% of all pediatric outpatient visits. What constitutes a fever and the various definitions related to fever are not uniformly agreed upon. Traditionally, normal body temperature has been defined as 37°C (98.6°F) based on an adult study of axillary temperatures in the 19th century in which 38.0°C (100.4°F) was the upper limit of normal. This is the cutoff when considering a serious bacterial infection. Yet for a persistent fever or fever of unknown origin, the cutoff value has been defined as a temperature >38.3°C (101°F). This chapter discusses the incidence, pathophysiology, and common etiologies of fever. The particular focus is the assessment and workup of the prolonged or unexplained fever.
Selected Infectious Disease Emergencies
Authors: Kobner Scott , Rose Emily
Published: February 2021

Fever is common in children, and serious etiologies with significant sequelae must be identified and treated. This chapter discusses the classic and atypical presentations of several important pediatric infectious disease conditions, including bacterial and viral meningitis (inflammation of the meninges that typically occurs in response to an infectious process), infectious encephalitis (inflammation of the brain parenchyma that presents clinically with neurologic dysfunction), retropharyngeal abscess (a potentially life-threatening airway emergency secondary to an infection of the retropharyngeal soft tissue space), and cat scratch disease secondary to Bartonella henselae infection (an infectious lymphadenopathy after exposure to cats or cat fleas). Diagnostic confirmation and treatment of these conditions are also discussed.
Pediatric Respiratory Emergencies
Authors: Rose Emily
Published: February 2021

Respiratory emergencies are common in children, and emergency providers must anticipate respiratory compromise and intervene early. Respiratory emergencies can be broadly categorized into upper and lower respiratory diseases. Sometimes the diagnosis is classic and easily made based on history and confirmed by key physical examination findings. Other times, the diagnosis can be more challenging to confirm, and there may be presentation overlap. This chapter discusses the classic and atypical presentation of many important pediatric respiratory conditions, including croup, bronchiolitis, pneumonia, asthma, epiglottitis, bacterial tracheitis, and anaphylaxis. Key diagnostic features and aids to differentiating the disease from common mimics are emphasized.
Airway Foreign Bodies
Authors: Lim C. Anthoney , Whitney Rachel , Rose Jeremy M.
Published: February 2021

The presentation of an airway foreign body can range from benign to truly life-threatening. Respiratory tract obstruction from an airway or esophageal foreign body is relatively rare but remains a leading cause of morbidity and mortality among children. This chapter discusses the evaluation and management for inhaled and aspirated foreign bodies in the upper aerodigestive and lower respiratory tracts. Using anatomical areas as a systematic approach, common presentations, physical findings, and diagnostic workup including imaging options are reviewed. Treatment modalities including emergent airway management and foreign body removal are discussed, with a focus on procedures that can be performed in an emergency department setting and indications for operative management.
Neurologic Emergencies
Authors: Hartrich Molly , Rose Emily
Published: February 2021

Neurologic emergencies may occur in children and generate a significant differential diagnosis of potentially life-threatening etiologies. This chapter reviews the most common and/or important neurological emergencies, including febrile seizures, first presentation of afebrile seizures, seizure variants, breakthrough seizures in epilepsy, seizures due to toxic ingestion, status epilepticus, altered mental status, headache, migraine syndromes, encephalitis, acute demyelinating encephalomyelitis, acute cerebellar ataxia, anti-NMDA receptor encephalitis, motor dysfunction/weakness syndromes such as Guillain-Barre syndrome, polyneuropathies, transverse myelitis, acute periodic paralysis, acute flaccid myelitis, and neuromuscular disorders such as botulism, myasthenia gravis. The common presentations, atypical presentations, evaluation, disposition, clinical pearls, and pitfalls of these important pediatric neurologic emergencies are discussed.
Common Pediatric Dermatologic Conditions
Authors: Furmick Julie , Woolridge Dale
Published: February 2021

Rash and skin complaints comprise a common pediatric chief complaint and among the top 20 reasons patients present to the emergency department. For this reason, it is important for emergency physicians to be able to distinguish life-threatening rashes from those that are benign. This chapter reviews common dermatologic conditions seen in pediatrics, such as eczema, erythema multiforme, Henoch–Schonlein purpura, scabies, tinea infections, urticaria, impetigo, and ecthyma. For each presentation, the incidence, epidemiology, typical and atypical presentations, diagnosis, differential diagnosis, treatment, disposition, complications, and clinical algorithms are reviewed. The chapter focuses on topics that are clinically relevant to patients seen in the emergency department, including admission requirements, discharge instructions, return precautions, and subspecialist follow-up.
Pediatric Oncologic Emergencies
Authors: Festekjian Ara
Published: February 2021

Children may present emergently with signs and symptoms concerning for an undiagnosed underlying malignancy or may present with life-threatening conditions related to a known malignancy or its therapy. Patients undergoing therapy for their cancer will have compromised immune systems and decreased function of vital organs from chemotherapeutic agent toxicity, sometimes resulting in diagnostic and therapeutic dilemmas and hastening their demise. This chapter reviews common presentations of several pediatric malignancies as well as complications that may arise during their therapy.
Endocrine Emergencies
Authors: Hemmy Davida , Galust Henrik , Bakes Katie
Published: February 2021

Diabetic emergencies are commonly seen in children presenting for emergency care; whereas other endocrine emergencies, such as myxedema coma, are much less frequently encountered. In some cases, the lack of specific or sensitive signs and symptoms, even more challenging in young or preverbal children, can result in treatment delays and clinical deterioration. Despite the complexities of the endocrine system, clinical endocrinology can be approached simply by learning to recognize the signs and symptoms of hormone excesses and deficiencies. In this chapter, the most common pediatric endocrine emergencies are discussed, and a practical approach to diagnosis and management is also presented.
Pediatric Facial Trauma
Authors: Amato Christopher S.
Published: February 2021

Traumatic facial injury may occur in children. The vast majority of pediatric facial trauma is blunt in nature. The most common cause varies by age, with falls the most common cause of injury in younger childhood and blunt trauma or motor vehicle injury the most common causes of injury in older children. Accidental blunt trauma is the most common etiology, and the most commonly injured bone is the nasal bone. Sports-related injury has a higher incidence of midface and upper midface fracture. This chapter reviews the most common facial injuries in children and discusses important diagnostic and management principles in the care of the acutely injured child.
Pediatric Neck Trauma
Authors: Newton Kim
Published: February 2021

Pediatric neck injuries have significant potential morbidity. Any hemodynamically unstable patient with hard signs of neck injury should be taken to the operating room immediately. Assurance of airway stability in all other pediatric patients with neck injury should take first priority. Bedside tests, including the extended focused assessment with sonography for trauma examination and plain films of the neck and chest, are readily available and can provide helpful information. High-resolution computed tomography (CT) with angiogram has been shown to be the superior imaging study when evaluating the neck for vascular or aerodigestive injury. Additional diagnostic modalities are based on clinical suspicion, signs and symptoms, injury location, and CT results.
Oral and Dental Emergencies
Authors: Yamamoto Thomas A. , Cho Nam S. , Yip F. Kyle
Published: February 2021

Pediatric visits to the emergency department for oral and dental complaints are common and may be due to either traumatic or nontraumatic etiologies. Dental or oral–maxillofacial surgery consultants are often unavailable for acute emergency department evaluation. Fortunately, few dental and oral conditions require immediate intervention by a specialist, and basic principles may be applied to their triage and management. A fundamental understanding of the basic triage and management of dental and oral-related conditions, which is the focus of this chapter, is worthwhile for today’s emergency practitioner.
Pediatric Procedures
Authors: Cain Meghan R. , Mannenbach Mark S.
Published: February 2021

Many procedures in children occur less commonly than in adults, but there are a few unique features of performing interventions in children. Indications for these procedures are similar but equipment sizing, landmarks, and method techniques vary compared to those of adults. Bedside thoracostomy procedures including needle, catheter, and tube thoracostomy are critical in the emergency care of children, particularly for those with traumatic injuries. Needle cricothyrotomy is a last-ditch rescue airway for pediatric patients with an obstruction above the cricothyroid membrane that is unable to be ventilated or oxygenated with traditional airway techniques. Lumbar punctures are routinely performed in emergency medicine. Lumbar puncture is typically performed due to concern for meningitis. This chapter reviews both indications and techniques of tube and needle thoracostomy, lumbar puncture, and needle cricothyrotomy in children.
Procedural Sedation and Pain Management
Authors: Holzman Rosalia , Mitzman Jennifer
Published: February 2021

There are many conditions in the emergency department that require pain management or procedural sedation due to significant pain or complexity. There are also a number of procedures and conditions that will require pain control or anxiolysis in children due to developmental and behavioral factors. Pain control and procedural sedation in pediatric patients can be challenging. A variety of pharmacologic agents can be utilized to minimize anxiety and control pain. These have a wide range of administration routes, including topical, oral, intravenous, intramuscular, intranasal, and regional pain control via nerve blocks. In addition, many non-pharmacologic adjuncts can be coupled with age-appropriate interaction tips to decrease the medications required. This chapter discusses pharmacologic intervention, including narcotic and non-narcotic medications, non-pharmacologic interventions, procedural sedation, and nerve blocks.
Emergency Care of Children with Medical Complexity
Authors: Pulcini Christian D. , Hogan Annique , Friedlaender Eron
Published: February 2021

Advancements in pediatric care have led to a significant increase in the number of children living longer (or living into adulthood) with medical complexity. Children with medical complexity are generally defined as those with multiple significant chronic health problems involving multiple organ systems, which result in functional limitations, high health care needs or utilization, and often require need for, or use of, medical technology. Although children with medical complexity represent less than 1% of the pediatric population, they account for a large proportion of health care utilization among children, including acute care and emergency department settings. Many of these children receive a majority of their specialty and outpatient care at tertiary care children’s hospitals, but evidence indicates that 80–90% of encounters for emergency care are at community emergency departments. Furthermore, many of the complex, chronic conditions that characterize children with medical complexity are becoming more clinically relevant to all providers as this subgroup of children mature into adulthood. Therefore, it has and will become increasingly relevant for all emergency providers to be prepared to evaluate and manage what have been traditionally pediatric conditions, technologies, and complications among children in this population. This chapter uses a case-based approach to illustrate more common and challenging patient scenarios when evaluating and treating children with medical complexity in the emergency department.
Pediatric Ingestions and Toxicologic Exposures
Authors: Calleo Vincent , Cantor Richard
Published: February 2021

For the majority of emergency medicine providers, one of the most anxiety-provoking patients is a very sick child. This is especially true when pediatric patients present to the emergency department after a toxicologic exposure. Pediatric ingestions and toxicologic exposures are extremely common. Although only a small percentage of toxicologic exposures result in death, severe toxicity is frequently seen and requires substantial medical intervention. This chapter focuses on the approach to a poisoned pediatric patient (including gastrointestinal decontamination and common toxidromes) and common medications ingested by pediatric patients and their treatments. It also briefly discusses some recreational drugs that are commonly used in the pediatric community.
Interpersonal Psychotherapy and Cancer
Authors: Sotsky Jennifer , Pessin Hayley , Markowitz John C.
Published: February 2021

Interpersonal psychotherapy (IPT) is an evidence-based, time-limited, and affect-focused psychotherapy that was developed 50 years ago for major depression and has now been expanded to treat other mood and nonmood disorders, including in patients with cancer, in a variety of settings worldwide. Core principles of IPT include that depression often occurs in the context of major life events and that it is a medical illness that is not the patient’s fault. This chapter will first describe the background and development of IPT, then discuss the research on efficacy of IPT in patients with cancer and other medical illnesses as well as limitations of the existing data. It will outline principles of IPT and illustrate the major phases of treatment with basic techniques through use of the case vignette of “Ms. A,” a patient with breast cancer and depression. Lastly, it will review relevant adaptations of IPT including interpersonal counseling (IPC), an abbreviated version of IPT for less psychotherapeutically trained clinicians that has been studied in psycho-oncology patients. Though data on psychotherapy in patients with cancer remain limited, IPT appears to be a practical and promising option that warrants current use and further study.
Critical Epidemiology and the People's Health
Authors: Breilh Jaime
Published: February 2021

This book provides a groundbreaking approach to critical epidemiology for understanding the complexity of the health process and studying the social determination of health. It presents a powerful critique of Cartesian health sciences; the flaws of the “functional health determinants” model; and reductionist approaches to health statistics, qualitative research, and conventional health geography. It is a consolidated and well-sustained text that explains the role of social–gender–ethnic relations in the reproduction of health inequity, proposing a new paradigm with indispensible concepts and methodological means to develop a new understanding of health as a socially determined and distributed process. It combines the strengths of scientific traditions of the North and South to bring forward a new understanding and application of qualitative and quantitative (statistical) evidence that goes beyond the limits of conventional epidemiology—public and population health. The book presents alternative conceptions and tools for constructing deep prevention. It provides a neo-humanist conception of the role of health and life sciences that assumes critical, intercultural, and transdisciplinary thinking as a fundamental tool beyond the limiting elitist framework of positivist reasoning. It is an important source of fresh ideas and practical instruments for teaching, research, and agency, based on a renewed conception of the relation between nature, society, health, and environmental problems.
Sleep Architecture and Physiology
Authors: Burman Deepa , Muzumdar Hiren
Published: February 2021

Sleep architecture is organized into nonrapid eye movement (Stages N1, N2, and N3) and rapid eye movement sleep that rotate through a given sleep period in discrete cycles. Each stage has specific characteristics including different electroencephalography waveforms, muscle tone, and eye movements. This chapter reviews those features and specific physiological characteristics of different stages of sleep. It also reviews how sleep architecture varies across lifespan and the importance of the knowledge of normal architecture to understand many sleep disorders. In addition, understanding physiology of normal sleep in different stages and their role in the pathophysiology of various sleep disorders are discussed. Physiological changes that occur during sleep are usually well tolerated in healthy people, but these changes may adversely affect people with vulnerable organ systems.
Pharmacological Management of Insomnia
Authors: Doghramji Karl
Published: February 2021

Insomnia has posed a management challenge for patients and clinicians for centuries. Historically, a variety of compounds have been utilized for the treatment of this common malady, with many of them associated with unwanted side effects. Over the past few decades, however, a variety of agents have emerged for treatment of insomnia with improved safety profiles. This chapter reviews these agents, with attention to their pharmacokinetic profile, mechanism of action, and other, clinically relevant characteristics. It also discusses a rational approach in the selection of each agent to optimize the treatment of insomnia. The chapter closes with a look toward the future of the pharmacological management of insomnia.
Neurodevelopmental Disorders
Authors: Shelton Althea Robinson , Duis Jessica , Malow Beth
Published: February 2021

Compared to typically developing children, sleep disturbances are exceedingly prevalent in children with neurodevelopmental disorders. The diagnostic criteria for many neurodevelopmental disorders includes sleep problems. Sleep disturbance in this population is often multifactorial and caused by the interplay of genetic, neurobiological and environmental overlap. These disturbances often present either as insomnia or hypersomnia. Different sleep disorders present with these complaints and based on the clinical history and findings from diagnostic tests, an appropriate diagnosis can be made. The chapter covers autism spectrum disorder, Down syndrome, Prader–Willi syndrome, Angelman syndrome, Rett syndrome, Fragile X syndrome, Williams syndrome, and Smith–Magenis syndrome.
Pain Disorders
Authors: Roehrs Timothy , Roth Thomas
Published: February 2021

Information and appreciation regarding the role of insufficient sleep in chronic pain is now emerging. This chapter reviews the sleep, daytime sleepiness, and fatigue of people with various chronic pain disorders. The bidirectional relation of sleep and pain is described in this chapter, and the modulating effects of mood and cognitive factors on the sleep-pain nexus are discussed. Central and peripheral mechanisms underlying the sleep–pain nexus are explored. Finally, pharmacological and behavioral treatments for sleep and pain are reviewed with a focus on the association of improved sleep leading to improved pain. It is concluded that further research is necessary to better understand the interrelation of sleep and pain, which may lead to better therapies for sleep and pain.
Eating Disorders
Authors: Narahari Anoop , Baweja Raman , Das Piyush , Chopra Amit
Published: February 2021

Sleep and eating behavior are complimentary homeostatic functions and adequate sleep is fundamental for the nutritional balance of the body. Short sleep duration has been linked to development of obesity and abnormal eating patterns in children and adults. Individuals with eating disorders report significantly higher sleep disturbances of sleep apnea, insomnia, circadian rhythm disorders, and impairment of daytime functioning, as compared to controls. Sleep disturbances have been implicated in suicidal behaviors in patients with eating disorders. This chapters outline the current evidence examining the pathophysiology and comorbidity of sleep disturbance in daytime eating disorders and focus on clinical assessment and management of nocturnal eating disorders including night eating syndrome and particularly sleep-related eating disorder, which is a combination of parasomnia and eating disorder. There is an imminent need to develop evidence-based pharmacological and psychological treatments for management of nocturnal eating disorders and the sleep disturbances associated with daytime eating disorders.
Native-Tissue Anterior Colporrhaphy Versus Transvaginal Mesh for Anterior Pelvic Organ Prolapse
Authors: Rockefeller Nick , Jeppson Peter
Published: February 2021

This article provides a summary of a landmark study in the management of pelvic organ prolapse. This study sought to evaluate if patients with anterior vaginal wall prolapse should be managed with a traditional native tissue colporrhaphy or with transvaginal mesh. This article briefly reviews other relevant studies related to vaginal prolapse and concludes with a relevant clinical case.
Examining trends in dementia incidence and prevalence using an age-period-cohort framework
Authors: Langa Kenneth M , Crimmins Eileen M , Hayward Mark D
Published: February 2021

Dementia, a decline in memory and cognition leading to disability in daily function, is a common and feared geriatric condition. Over the past decade, dementia has been the focus of increasing attention from researchers, clinicians, and policymakers due to the projected significant increase in the number of dementia cases expected to result from the worldwide growth in the elderly population. Given the growing evidence that late-life dementia risk likely results from the summation of risk and protective factors that individuals experience across the life course from birth (even pre-birth) through old age, an ‘age-period-cohort’ perspective which clarifies trends in dementia using each of these different lenses may help in identifying potential causal pathways that affect dementia risk. In this chapter, we review recent literature on trends in dementia incidence and prevalence in countries around the world, discuss hypothesized causes for those trends, and present new data on recent trends in dementia incidence and prevalence in the USA.