bluuebunny/crossref_metadata_2025 huggingface dataset:
Broadband light absorber based on porous alumina structure covered with ultrathin iridium film
Authors: Fang Bo , Yang Chenying , Pang Chenlei , Shen Weidong , Zhang Xing , Zhang Yueguang , Yuan Wenjia , Liu Xu
Published: April 2017

In this letter, we propose a broadband absorber with high efficiency by an atomic layer depositing nanometer iridium (Ir) film onto a porous anodic alumina (PAA) template. The average absorption is able to achieve as high as 93.4% from 400 to 1100 nm and the absorption efficiency can reach up to 96.8% for the improved structure of the quadrangular frustum pyramid array. Not only the hexagonal latticed structures of the PAA template but also many similar structures based on gratings or holes with the square latticed or other latticed mode can realize the broadband high absorption efficiency. The light absorbed within the Ir/Glass interface and the sidewalls of PAA by the light funneling effect both contribute to the broadband absorption with high efficiency. This absorber, described in this paper, can be manufactured with a low-cost and large-area manner and has potential applications in fields of light harvesting, imaging, etc.
Increasing spin polarization in Fe3O4 films by engineering antiphase boundary densities
Authors: Liu Er , Yin Yuli , Sun Li , Zhai Ya , Du Jun , Xu Feng , Zhai Hongru
Published: April 2017

We present a systematical study on the evolution of antiphase boundary (APB) densities in Fe3O4 films, which were prepared by pulsed laser deposition and post annealing at different temperatures. By measuring the electron-phonon coupling parameter and using Allen's formula, we evaluate the films' antiphase boundary densities, which show a decreasing tendency with increasing annealing temperature. Consequently, a 50% increase of spin polarization in Fe3O4 films is achieved, and a 110% increase of the magnetoresistance ratio was found in 900 °C annealed Fe3O4 films compared to the as-grown sample. This work could contribute to the effective manipulation of APB densities and spin polarization in Fe3O4 films, which is desirable for the application of spintronics devices based on Fe3O4 films.
Inductively coupled plasma etch damage in (-201) Ga2O3 Schottky diodes
Authors: Yang Jiancheng , Ahn Shihyun , Ren F. , Khanna Rohit , Bevlin Kristen , Geerpuram Dwarakanath , Pearton S. J. , Kuramata A.
Published: April 2017

Bulk, single-crystal Ga2O3 was etched in BCl3/Ar inductively coupled plasmas as a function of ion impact energy. For pure Ar, the etch rate (R) was found to increase with ion energy (E) as predicted from a model of ion enhanced sputtering by a collision-cascade process, R ∝(E0.5 – ETH0.5), where the threshold energy for Ga2O3, ETH, was experimentally determined to be ∼75 eV. When BCl3 was added, the complexity of the ion energy distribution precluded, obtaining an equivalent threshold. Electrically active damage introduced during etching was quantified using Schottky barrier height and diode ideality factor measurements obtained by evaporating Ni/Au rectifying contacts through stencil masks onto the etched surfaces. For low etch rate conditions (∼120 Å min−1) at low powers (150 W of the 2 MHz ICP source power and 15 W rf of 13.56 MHz chuck power), there was only a small decrease in reverse breakdown voltage (∼6%), while the barrier height decreased from 1.2 eV to 1.01 eV and the ideality factor increased from 1.00 to 1.06. Under higher etch rate (∼700 Å min−1) and power (400 W ICP and 200 W rf) conditions, the damage was more significant, with the reverse breakdown voltage decreasing by ∼35%, the barrier height was reduced to 0.86 eV, and the ideality factor increased to 1.2. This shows that there is a trade-off between the etch rate and near-surface damage.
Effect of internal field on the high resistance state retention of unipolar resistance switching in ferroelectric vanadium doped ZnO
Authors: Wu Changjin , Jia Yuefa , Shin Yeong Jae , Noh Tae Won , Chae Seung Chul , Liu Chunli
Published: April 2017

We report the effect of an internal field on the high resistance state (HRS) retention of unipolar switching in ferroelectric vanadium (V) doped ZnO thin films. ZnO thin films doped with 1%, 3%, and 5% of V were found to have an increased internal field as the V concentration increased. The effect of an internal field on resistance switching was observed from the lower set voltage and shorter high resistance state retention time. A physical model was applied to explain the relationship between the internal field and the HRS retention, and a good agreement was obtained with the experimental data. Our result suggested that the internal field can reduce the activation energy of the redox process for generating oxygen vacancies, which subsequently affect the formation of conducting filaments in the resistance switching process.
Effect of anisotropy on stress-induced electrical potentials in bovine bone using ultrasound irradiation
Authors: Matsukawa S. , Makino T. , Mori S. , Koyama D. , Takayanagi S. , Mizuno K. , Yanagitani T. , Matsukawa M.
Published: April 2017

The bone fracture healing mechanism of the low-intensity pulsed ultrasound technique is not yet clearly understood. In our previous study, the electrical potentials induced in bone were successfully measured by focusing on piezoelectricity in the MHz range. Bone is composed of collagen and hydroxyapatite and has strong anisotropy. The purpose of this study is to investigate the effects of bone anisotropy on the electrical potentials induced by ultrasound irradiation. For this study, ultrasound bone transducers were fabricated using cortical bovine bone plates as piezoelectric devices. An ultrasound of 7.4 kPapeak-peak (i.e., the peak-to-peak pressure value) was used to irradiate the side surface of each bone plate. Electrical potentials induced in the bone plate were then measured by varying the wave propagation direction in the plate. The peak-to-peak values of these ultrasonically induced electrical potentials were found to vary with changes in the ultrasound propagation direction in the bone sample. The potential was maximized at an inclination of approximately 45° to the bone axis but was minimized around the three orthogonal directions. These maxima and minima ranged from 28 to 33 μVpeak-peak and from 5 to 12 μVpeak-peak, respectively. Additionally, our ultrasound results indicated a change in polarity due to bone anisotropy in the MHz range.
Effects of equilibrium point displacement in limit cycle oscillation amplitude, critical frequency and prediction of critical input angular velocity in minimal brake system
Authors: Ganji Hamed Faghanpour , Ganji Davood Domiri
Published: April 2017

In the present paper, brake squeal phenomenon as a noise resource in automobiles was studied. In most cases, the modeling work is carried out assuming that deformations were small; thus, equilibrium point is set zero and linearization is performed at this point. However, the equilibrium point under certain circumstances is not zero; therefore, huge errors in prediction of brake squeal may occur. In this work, large motion domains with respect to linearization importance were subjected to investigation. Nonlinear equations of motion were considered and behavior of system for COF’s model was analyzed by studying amplitude and frequency of limited cycle oscillation.
An oxidation-last annealing for enhancing the reliability of indium-gallium-zinc oxide thin-film transistors
Authors: Li Jiapeng , Lu Lei , Feng Zhuoqun , Kwok Hoi Sing , Wong Man
Published: April 2017

The dependence of device reliability against a variety of stress conditions on the annealing atmosphere was studied using a single metal-oxide thin-film transistor with thermally induced source/drain regions. A cyclical switch between an oxidizing and a non-oxidizing atmosphere induced a regular change in the stress-induced shift of the turn-on voltage, with the magnitude of the shift being consistently smaller after annealing in an oxidizing atmosphere. The observed behavior is discussed in terms of the dependence of the population of oxygen vacancies on the annealing atmosphere, and it is recommended the last of the sequence of thermal processes applied to a metal-oxide thin-film transistor be executed in an oxidizing atmosphere.
Molecular dynamics simulations of the surface tension of oxygen-supersaturated water
Authors: Jain S. , Qiao L.
Published: April 2017

In this work, non-reactive molecular dynamic simulations were conducted to determine the surface tension of water as a function of the concentration of the dissolved gaseous molecules (O2), which would in turn help to predict the pressure inside the nanobubbles under supersaturation conditions. Knowing the bubble pressure is a prerequisite for understanding the mechanisms behind the spontaneous combustion of the H2/O2 gases inside the nanobubbles. First, the surface tension of pure water was determined using the planar interface method and the Irving and Kirkwood formula. Next, the surface tension of water containing four different supersaturation concentrations (S) of O2 gas molecules was computed considering the curved interface of a nanobubble. The surface tension of water was found to decrease with an increase in the supersaturation ratio or the concentration of the dissolved O2 gas molecules.
Position and orientation correction scheme for current sensing based on magnetic piezoelectric cantilevers
Authors: Xian Weikang , Wang Dong F.
Published: April 2017

A position and orientation correction scheme for current sensing based on magnetic piezoelectric cantilevers is proposed in this letter, offering an insight for the improvement of measurement accuracy. In this scheme, an array of magnetic piezoelectric cantilevers, converting mechanical vibration generated by current induced magnetic force applied on magnets at the ends of cantilevers into output voltages, is utilized. A system of nonlinear equations is established in terms of amplitude of objective current, position, and orientation errors. They are derived by solving the system of equations treated as variables, instead of parameters. As a result, the measurement error caused by position and orientation errors decreased substantially. Experiments of passive current sensing for two-wire appliances prove the validity of the proposed position and orientation correction scheme. The application of the proposed scheme can be further extended to sensors based on the magnetic field sensing mechanism, for achieving higher measurement accuracy.
Enhanced spin-orbit torques in MnAl/Ta films with improving chemical ordering
Authors: Meng K. K. , Miao J. , Xu X. G. , Wu Y. , Zhao X. P. , Zhao J. H. , Jiang Y.
Published: April 2017

We report the enhancement of spin-orbit torques (SOT) in MnAl/Ta films with improving chemical ordering through annealing. The switching current density is increased due to enhanced saturation magnetization MS and effective anisotropy field HK after annealing. Using harmonic measurements, we have found that both dampling-like effective field HD and field-like effective field HF were increased in the temperature range of 50 to 300 K, and the annealing has also enhanced the value of the spin Hall angle. The improved chemical ordering is considered to have enhanced the interfacial spin transparency and the transmitting of the spin current in the MnAl layer. The results suggest that MnAl films with high bulk perpendicular magnetic anisotropy are ideal for a systematic examination of SOT, in which the related magnetic and transport behaviors can be controllably varied with thermally tuned chemical ordering.
Comparison of cost determination of both resource consumption accounting and time-driven activity-based costing systems in a healthcare setting
Authors: Özyapıcı Hasan , Tanış Veyis Naci
Published: April 2017

Objective
The aim of the present study was to explore the differences between resource consumption accounting (RCA) and time-driven activity-based costing (TDABC) systems in determining the costs of services of a healthcare setting.

Methods
A case study was conducted to calculate the unit costs of open and laparoscopic gall bladder surgeries using TDABC and RCA.

Results
The RCA system assigns a higher cost both to open and laparoscopic gall bladder surgeries than TDABC. The total cost of unused capacity under the TDABC system is also double that in RCA.

Conclusion
Unlike TDABC, RCA calculates lower costs for unused capacities but higher costs for products or services in a healthcare setting in which fixed costs make up a high proportion of total costs.

What is known about the topic?
TDABC is a revision of the activity-based costing (ABC) system. RCA is also a new costing system that includes both the theoretical advantages of ABC and the practical advantages of German costing. However, little is known about the differences arising from application of TDABC and RCA.

What does this paper add?
There is no study comparing both TDABC and RCA in a single case study based on a real-world healthcare setting. Thus, the present study fills this gap in the literature and it is unique in the sense that it is the first case study comparing TDABC and RCA for open and laparoscopic gall bladder surgeries in a healthcare setting.

What are the implications for practitioners?
This study provides several interesting results for managers and cost accounting researchers. Thus, it will contribute to the spread of RCA studies in healthcare settings. It will also help the implementers of TDABC to revise data concerning the cost of unused capacity. In addition, by separating costs into fixed and variable, the paper will help managers to create a blended (combined) system that can improve both short- and long-term decisions.
Vita coaetanea / A Contemporary Life / Vida coetánea / Vida coetània
Authors: Llull Ramon
Published: April 2017

Winner of the 2018 Premio internazionale Francesco Saverio Nitti per il Mediterraneo in the category "Storia, Letteratura", awarded annually by Università degli Studi Suor Orsola Benincasa, Naples, Italy.

The Vita coaetanea (A Contemporary Life) is an autobiographical account of Ramon Llull’s life dictated by himself to a friend in 1311 when he was seventy-nine years old. In it Llull reviews his works in the context of a life dedicated to God and motivated by the desire to disseminate the message of the Christian faith among the infidels. Llull, the self-labeled troubadour of books, wrote this account in part as a self-justification of his life and work, in part as self-consolation for his unending toils and travails. It is very likely that he also had in mind the Council of Vienne (1311) which he was about to attend and where he submitted petitions dealing with the establishment of adequate places to study languages for the preaching of the Gospel to every creature and the founding of a Christian military religious order that waged permanent war against the Saracens until the Holy Land is reconquered. Llull wanted to frame these petitions within a well thought-out justificatory account of his life and works that exudes passion, commitment and love for his fellow man.

This volume contains the Latin original, as well as translations into Catalan, Spanish, and English.
Let us now praise Jerry B. Harvey – the Down Home scholar
Authors: Vaill Peter B.
Published: April 2017

This article is an affectionate memoir of the late Jerry B. Harvey by a close faculty associate who saw him daily and collaborated with him on numerous academic projects at George Washington University over a period of twenty-four years. Several key qualities combine to make Harvey,
a Texan to his bones, an unforgettable person. Explanations are offered for Harvey's unique perspective on human behavior in organizations.
Cells of the Nervous System
Authors: Mason Peggy
Published: April 2017

The nervous system is made up of neurons and glia that derive from neuroectoderm. Since neurons are terminally differentiated and do not divide, primary intracranial tumors do not arise from mature neurons. Tumors outside the nervous system may metastasize inside the brain or may release a substance that negatively affects brain function, termed paraneoplastic disease. Neurons receive information through synaptic inputs onto dendrites and soma and send information to other cells via a synaptic terminal. Most neurons send information to faraway locations and for this, an axon that connects the soma to synaptic terminals is required. Glial cells wrap axons in myelin, which speeds up information transfer. Axonal transport is necessary to maintain neuronal function and health across the long distances separating synaptic terminals and somata. A common mechanism of neurodegeneration arises from impairments in axonal transport that lead to protein aggregation and neuronal death.
Developmental Overview of Central Neuroanatomy
Authors: Mason Peggy
Published: April 2017

The central nervous system develops from a proliferating tube of cells and retains a tubular organization in the adult spinal cord and brain, including the forebrain. Failure of the neural tube to close at the front is lethal, whereas failure to close the tube at the back end produces spina bifida, a serious neural tube defect. Swellings in the neural tube develop into the hindbrain, midbrain, diencephalon, and telencephalon. The diencephalon sends an outpouching out of the cranium to form the retina, providing an accessible window onto the brain. The dorsal telencephalon forms the cerebral cortex, which in humans is enormously expanded by growth in every direction. Running through the embryonic neural tube is an internal lumen that becomes the cerebrospinal fluid–containing ventricular system. The effects of damage to the spinal cord and forebrain are compared with respect to impact on self and potential for improvement.
Spinal Cord
Authors: Mason Peggy
Published: April 2017

The spinothalamic and lemniscal pathways carry somatosensory information from the periphery into the brain while the corticospinal pathway carries motor commands from the brain to motoneurons of the spinal cord. Following these pathways through the spinal cord allows the student to infer lesion location from symptoms. To exemplify the clinical importance of sympathetic outputs from thoracic segments, Horner syndrome is described. Similarly, the common problems caused by spinal cord injury on sacral parasympathetic functions are stressed. The contributions of specific spinal segments to breathing, hand and foot dexterity, and micturition are emphasized. Working through the logic of the symptoms caused by spinal hemisection (Brown-Séquard syndrome), pyramidal stroke, and syringomyelia provides the student with a clear framework for understanding spinal function in the clinical context.
Cranial Nerves and Cranial Nerve Nuclei
Authors: Mason Peggy
Published: April 2017

The functions of cranial nerves, conduits for sensory information to enter and motor information to exit the brain, and the common complaints arising from cranial nerve injuries are described. The modified anatomical arrangement of sensory and motor territories in the brainstem provides a framework for understanding the organization of the cranial nerve nuclei. A thorough grounding in the anatomy of cranial nerves and cranial nerve nuclei allows the student to deduce whether a given set of symptoms arises from a central or peripheral lesion. The near triad, pupillary light reflex, and Bell’s palsy are particularly emphasized. The contributions of the six extraocular muscles to controlling eye position and to potential diplopia are described along with the consequences of oculomotor, trochlear, and abducens nerve dysfunction. The potential for lesions of facial, glossopharyngeal, vagus, and hypoglossal nerves to yield dysphagia and dysarthria are outlined.
Forebrain
Authors: Mason Peggy
Published: April 2017

The anatomy and function of forebrain circuits is described. The role of the hypothalamus as the executive center for regulating and protecting the body’s physiology is detailed. The thalamus is a necessary interpreter for subcortical inputs to cerebral cortex, which uses thalamic input to map the sensory world. The amygdala, critical to expressing and interpreting fear, has been implicated in post-traumatic stress disorder. During resting conditions, the basal ganglia suppress movement. Damage to the basal ganglia produces a hypo- or hyperkinetic disorder. The representation of visual fields in pathways from retina to striate cortex is described in detail. The student is then introduced to the invaluable use of visual field deficits for localizing forebrain lesions. Extrastriate, somatomotor, and prefrontal contributions to abstract functions are outlined in a clinically relevant way. Finally, the importance of the hippocampus to declarative memory is discussed, and common memory symptoms are described.
Following the Nutrients
Authors: Mason Peggy
Published: April 2017

Consciousness depends on oxygen delivered to the brain by arterial blood. Compromises to this delivery by an increase in intracranial pressure or decrease in available oxygen can produce syncope. The blood supply to the forebrain stems from the internal carotids that serve the anterior circulation. The posterior circulation is fed by the vertebral arteries and supplies blood to the brainstem. Redundancy to the brain’s blood supply is served by anastomoses, a connection between the posterior and anterior circulations, and by the Circle of Willis. The clinical characteristics of common brainstem and cerebral strokes are described. Similarly, the characteristics and clinical prognosis of different types of intracranial bleeds are explained. The text covers mechanisms that normally protect the brain and the consequences of traumatic brain injury that overwhelms these protections. A description of the production and circulation of cerebrospinal fluid allows the student to understand hydrocephalus.
The Neuron at Rest
Authors: Mason Peggy
Published: April 2017

Neuronal membrane potential depends on the distribution of ions across the plasma membrane and the permeability of the membrane to those ions afforded by transmembrane proteins. Ions cannot pass through a lipid bilayer but enter or exit neurons through ion channels. When activated by voltage or a ligand, ion channels open to form a pore through which selective ions can pass. The ion channels that support a resting membrane potential are critical to setting a cell’s excitability. From the distribution of an ionic species, the Nernst potential can be used to predict the steady-state potential for that one ion. Neurons are permeable to potassium, sodium, and chloride ions at rest. The Goldman-Hodgkin-Katz equation takes into consideration the influence of multiple ionic species and can be used to predict neuronal membrane potential. Finally, how synaptic inputs affect neurons through synaptic currents and changes in membrane resistance is described.
Electrical Communication Within a Neuron
Authors: Mason Peggy
Published: April 2017

Postsynaptic potentials integrate across time and space within a single neuron. The influence of the length constant on spatial summation and of the time constant on temporal summation is described. Whereas passive properties give rise to graded potentials, the voltage-gated sodium channel (VGSC) supports the all-or-none action potential. The action potential can be used to conduct information across long distances and is therefore used in the majority of neurons that have axons. How the inactivated state of VGSCs gives rise to the refractory period and dynamic polarization is described. The meaning of the action potential threshold is fully considered and then applied to understand the clinical condition of hyperkalemic periodic paralysis. Trains of action potentials carry information, and degradation of the spike train compromises the message. The speed of action potential conduction along both unmyelinated and myelinated axons is explored. In closing, an overview of demyelinating diseases is offered.
Synthesis, Packaging, and Termination of Neurotransmitters
Authors: Mason Peggy
Published: April 2017

The synthesis, packaging, and termination of action of neurotransmitters are detailed. There are far more varieties of peptide neurotransmitters than there are of low-molecular-weight neurotransmitters. Yet low-molecular-weight neurotransmitters are the ubiquitous workhorses of the nervous system. Acetylcholine, the catecholamines norepinephrine and dopamine, serotonin, glutamate, and GABA are examined in some depth. The vesicular transporters that carry low-molecular-weight neurotransmitters from the cytoplasm into synaptic vesicles are covered. The role of monoamines in affect and mood and the psychotropic effects of monoaminergic drugs are discussed. Principles of catecholamine synthesis are applied to understand phenylketonuria. Uptake of monoamines into neurons is discussed in the context of amphetamine, cocaine, and other drugs of abuse. Stiff-person syndrome, which results from an impairment of GABA synthesis, is introduced. The modes of action for peptide and gaseous neurotransmitters are briefly covered.
Perceiving the World
Authors: Mason Peggy
Published: April 2017

As exemplified by sensory illusions, perception is interpretative rather than faithfully representational of the changes in the world. All perceptual pathways involve stimulus transduction, transmission, and modulation before sensory events are coded by the nervous system. The set of stimuli that humans respond to are a subset of the stimuli that elicit reactions across the animal kingdom. The brain processes visual, auditory, mechanical, and vestibular stimuli by breaking stimuli into their sinusoidal components for neuronal processing. The probabilistic response of sensory receptors to stimulation within a receptive field is described. A fundamental property of sensory perception is responsiveness to a wide range of stimulus intensities over several orders of magnitude. Yet, at any one time, the response to a stimulus is proportional to the background level of stimulation. The concept of labeled line sensory transmission is described, and the reality of multimodal integration is revealed through examples.
Seeing the World
Authors: Mason Peggy
Published: April 2017

Modern life is highly dependent on high-acuity vision, and this chapter emphasizes the mechanisms and pathways that support high-acuity or form vision. Because the most common visual impairment is refractive error, the refractive power of the cornea and lens is described at some length. The processes of emmetropization, accommodation, and far viewing are considered. The participation of the outer retina in phototransduction and the visual cycle are detailed, and relevant diseases, including retinitis pigmentosa and age-related macular degeneration, are introduced. The neural processes that transform different wavelengths of light into color perception and common forms of color blindness are explained. Visual processing within cortex, including processing through the dorsal and visual streams, are presented. The process through which babies learn to interpret the firing in their brains as representing visual objects and the importance of the initial years of life to this process are described.
Audition
Authors: Mason Peggy
Published: April 2017

Hearing loss is devastating because it prevents communication through verbal language and thereby produces social isolation. The experience of hearing loss or deafness is the most common sensory deficit. The experience of affected individuals is highly variable because it depends on age of onset and treatment efficacy, among many factors. The roles of the external and middle ears in conduction and of the internal ear in sensorineural processing are used as a framework for understanding common forms of hearing loss. The contributions of inner and outer hair cells to cochlear function are detailed. How cochlear amplification results from the actions of prestin in outer hair cells is explained. The roles of age, noise, genetic background, and environmental factors in presbyacusis are considered. Approaches to hearing loss, including cochlear implants and sign language, are discussed. Finally, the brain regions involved in speech production and comprehension are detailed.
Somatosensation
Authors: Mason Peggy
Published: April 2017

Under normal circumstances, the somatosensory system contributes more to shaping movements than to perception. Yet damage to the somatosensory system can result in spontaneous pain and other abnormal somatic perceptions. An exploration of the mechanisms and pathways involved in touch perception is slanted toward understanding the contribution of the dorsal column–medial lemniscus pathway to the generation of paresthesia and dysesthesia. Peripheral somatosensory afferents that contribute to the perception of sharp or aching pain, temperature, and itch are described. The properties of transient receptor potential (TRP) channels on nociceptors and thermoreceptors are described. Physiological and pharmacological mechanisms that lead to neurogenic inflammation are considered. How peripheral and central changes triggered by acute injury or disease can lead to long-lasting changes that support chronic pain is described. Persistent pain that occurs independently of any stimulus is termed neuropathic. Mechanisms of referred pain from deep structures including viscera are introduced.
The Vestibular Sense
Authors: Mason Peggy
Published: April 2017

The vestibular system contains semicircular canals that respond to angular acceleration and otoconial organs that respond to linear acceleration of the head. Information is sent to the motor system and, under normal circumstances, does not lead to conscious perception. Yet damage to the vestibular system can result in disequilibrium or vertigo, disturbing perceptions that dominate conscious experience. The shared residence of the cochlear and vestibular end organs in the inner ear can give rise to inner ear disorders such as Ménière’s disease. The effect of gravity on the otoconial masses in the sacculus and utriculus enable detection of static head tilt. Age-related disequilibrium, benign paroxysmal positional vertigo, motion sickness, and alcohol intoxication–induced vertigo are explained. How natural head movements elicit combined canal and otoconial organ responses is described. Finally, the dependence of posture and gaze on vestibular inputs is introduced as a segue to the next chapter.
Reflexes and Gait
Authors: Mason Peggy
Published: April 2017

The importance of proprioception to motor function is revealed by the dramatic story of Ian Waterman, a man who lost function in all proprioceptive and tactile spinal afferents. The circuitry of the stretch reflex, termed the deep tendon reflex in clinical circles, is described in detail. In this context, the student is introduced to load, muscle spindles, Ia afferents,
α‎- and
γ‎- motoneurons, and
α‎-
γ‎ coactivation. The concept of physiological extensors and flexors is useful for understanding the role of reflexes in normal and abnormal postures. The logic and utility of reflex testing is fully explained and the Ib and nociceptive withdrawal reflexes briefly introduced. Primitive reflexes and their modulation across development and in response to stroke or disease are presented. In a final segment, movements produced by central pattern generators and refined by reflexes are illustrated by a close examination of human gait across the life cycle.
Cerebellum
Authors: Mason Peggy
Published: April 2017

The cerebellum uses sensory feedback and information about intended actions to ensure coordinated and smooth movements despite changing conditions. An analogy between the cerebellum and an orchestral conductor is elaborated. The cerebellum’s involvement in forming and executing motor memories is presented. Cerebellar circuits through the cerebellar cortex and deep nuclei and the dependence of cerebellar learning on climbing fiber input to Purkinje cells are briefly described. Sensory reafference and motor efference copy are defined and their roles in coordinating movement introduced. Cerebellar symptoms including ataxia, dysmetria and dysdiadochokinesia, are discussed and a possible model for dysmetria is considered. The specific inputs to and outputs from the vermis, paravermis, and lateral lobes are detailed in a description of canonical cerebellar loops. Finally, evidence that the cerebellum is involved in modulating nonmotor functions such as language, affect, social cognition, and visceral control is presented for the reader’s consideration.
Basal Ganglia
Authors: Mason Peggy
Published: April 2017

The core function of the basal ganglia is action selection, the process of choosing between mutually exclusive actions. Under baseline or default conditions, the basal ganglia suppress movement and prevent more than one movement from occurring simultaneously. The importance of chunking and operational learning is explored through exemplary typing tasks. Pathways through the basal ganglia employ the same input and output ports. Inputs far outnumber outputs from the basal ganglia. Subcortical loops through the basal ganglia are more effective than are cortical loops. The functions of the hyperdirect, direct and indirect pathways to motor control in the skeletomotor loop are detailed. Hemiballismus, Parkinson’s disease, and Huntington’s disease are key basal ganglia disorders. The use of deep brain stimulation (DBS) of the subthalamic nucleus as a treatment for Parkinson’s disease is discussed. Finally, additional basal ganglia loops such as the oculomotor loop are introduced.
Introduction to Homeostasis
Authors: Mason Peggy
Published: April 2017

Three common misconceptions regarding homeostasis are dispelled. First, the brain has the unique ability to mount an anticipatory defense against changes that could potentially push the body’s physiology out of homeostatic range. Such anticipation of needed adjustments is contrasted to the model of homeostasis as a servomechanism. Second, homeostasis depends on many neurons, not just those in the hypothalamus. Yet hypothalamic neurons play a special role in the integration of challenges and coordination of diverse effector reactions. Third, the idea that homeostasis is the purview of the autonomic nervous system is corrected. As exemplified by respiration and micturition, the brain employs skeletal muscle as well as autonomic targets in supporting visceral life. Finally, the allostatic perspective on the brain’s contribution to staying alive is contrasted with the standard homeostatic perspective and illustrated by examples.
Homeostatic Systems
Authors: Mason Peggy
Published: April 2017

The roles of the hypothalamus in regulating fluid balance and supporting the calm affective state needed for maternal care are described. Hypothalamic control of hormone release is reviewed and related disorders such as Addison’s disease and acromegaly are introduced. Basic thermoregulatory principles are presented and the biological danger of ambient heat is emphasized. The concept of set point is explained in the context of fever, antipyresis and hyperthermia. Neural regulation of blood pressure and orthostatic hypotension are briefly described. The patterns and neural circuits involved in breathing during rest or while exercising or sleeping are detailed. A description of neural control of micturition is used to explain detrusor-sphincter dyssenergia secondary to spinal cord injury. The enteric nervous system is briefly described and Hirschsprung disease is introduced. Finally, the neural control of sleep, disorders of sleep-wake control, and von Economo’s discovery of encephalitis lethargica are detailed.
Distress, Adjustment, and Anxiety Disorders
Authors: McFarland Daniel , Holland Jimmie C.
Published: April 2017

This chapter deals with anxiety in cancer patients as it presents in distress, adjustment disorders, and formal anxiety disorders. The implementation of distress screening is now used to capture patients who are at risk of a range of psychological complications that are addressed in this book. “Distress” covers the range of responses from the “normal” distress of fear, worry, and anxiety to formal defined psychiatric disorders. Adjustment disorders are the mildest level of psychiatric disorder occurring in relation to the stressor of a diagnosis with cancer or its treatment. Formal anxiety disorders typically antedate the cancer diagnosis and have clear symptom clusters defined by formal criteria. These include generalized anxiety disorder, panic disorder, phobias (e.g., needle, claustrophobia) and anxiety disorder due to another medical condition. These disorders require careful medical and psychiatric workup to identify potential etiologic stressors, agents, or responsible medical conditions.
Recognizing and Managing Suicide Risk
Authors: Watson Maggie , Grassi Luigi
Published: April 2017

Suicide rates for cancer patients are above those of the general population and higher than for patients with other medical conditions. The underdiagnosis and/or misdiagnosis of clinical depression and suicide risk by cancer health professionals emphasizes the importance of training in recognizing, assessing, and appropriately managing suicide risk. This chapter covers evidence on assessment of suicide risk, clinical management, and legal and ethical responsibilities that should help reduce and/or improve management of suicide risk. While oncology professionals may want to share with mental health professionals those aspects of cancer patient care relating to their patients’ mental health needs, the ability to manage serious psychological symptoms and deal with a patient in crisis due to suicide risk often lies primarily within the oncology professional’s domain of responsibility. This chapter briefly sets out information that should be useful in managing these aspects of cancer patient care.
Clinical Syndromes and Differential Diagnosis in the HIV-Infected Patient
Authors: Martagon-Villamil Jose , Skiest Daniel J.
Published: April 2017

Acute HIV infection is often missed but should be recognized. Most chronically infected individuals are asymptomatic. However, some patients with chronic HIV infection may present with certain clinical and laboratory abnormalities prior to the diagnosis of an opportunistic infection. HIV wasting syndrome is infrequently diagnosed in the era of antiretroviral therapy (ART). Recognition of HIV wasting is important because it carries adverse prognostic implications. Management includes a multifaceted approach, including ART, lifestyle and nutritional support, appetite stimulation, and possibly hormonal agents. The newer antigen–antibody test can detect new HIV infection as early as 15 days after exposure. Screening is important because most chronic HIV infection is asymptomatic.
Nutrition
Authors: Fox Grenville , Hoque Nicholas , Watts Timothy
Published: April 2017

This chapter provides a general overview of the nutritional requirements for preterm and term babies, whether provided parenterally or enterally. The composition and prescription of total parenteral nutrition (TPN) are described in some detail, along with complications of parenteral nutrition administration and how to reduce the risk of these. General principles of enteral feeding with breast milk or formula are discussed, with emphasis on the benefits of breastfeeding and contraindications for this, including a list of maternal medications. A section on donor human milk describes indications for, and preparation of, donor breast milk. Data on the composition of breast milk, preterm and term formula, and special formulae are included.
Cardiovascular problems
Authors: Fox Grenville , Hoque Nicholas , Watts Timothy
Published: April 2017

This chapter describes the aetiology, presentation, investigation, and management of congenital heart disease (CHD) and acquired cardiovascular problems. It begins by describing the fetal circulation, transition to the neonatal circulation at birth, and the epidemiology of congenital heart disease. There is a guide to the diagnosis of congenital heart disease using a problem-based approach (heart failure, cyanosis, collapse and shock, heart murmurs), together with general principles of management including the use of inotropes, prostaglandin, and surgery. Types of structural heart disease are detailed and grouped according to functional consequences: left to right shunts, right to left shunts/cyanotic CHD, common mixing, and well and sick babies with an obstruction. Myocardial disease, hypertension, interpreting the ECG in neonates, and arrhythmias are also covered.
Gastrointestinal problems
Authors: Fox Grenville , Hoque Nicholas , Watts Timothy
Published: April 2017

This chapter describes the presentation, investigation, and management of congenital and acquired gastrointestinal problems. It begins with a symptom-based approach giving differential diagnoses for vomiting, haematemesis, bloody stools, and diarrhoea. All common congenital problems are covered including oesophageal atresia, tracheo-oesophageal fistula, intestinal atresia, exomphalos, gastroschisis, malrotation, volvulus, meconium ileus, Hirschsprung’s disease, and anorectal anomalies. There are several pages devoted to necrotizing enterocolitis. Throughout there is a description of the surgical management of relevant conditions.
Neurological problems
Authors: Fox Grenville , Hoque Nicholas , Watts Timothy
Published: April 2017

This chapter includes sections on the neurological examination of the newborn, and the approach to investigation of babies with reduced muscle tone, neonatal encephalopathy, seizures, congenital malformation of the brain, and other common neurological problems in term and preterm babies. There are also detailed sections on various modalities of neuroimaging, electroencephalography, and other neurological investigations.
Infection
Authors: Fox Grenville , Hoque Nicholas , Watts Timothy
Published: April 2017

This chapter provides a problem-oriented approach to investigation and treatment of early and late onset neonatal bacterial infection, including group B streptococcus, meningitis, urine infection, conjunctivitis, umbilical sepsis, osteomyelitis, and septic arthritis. In addition, the prevention and management of congenital infection is covered, including hepatitis B and C, HIV, syphilis, CMV, toxoplasma, rubella, herpes simplex, and chickenpox. Other topics covered are infection control (including MRSA), fungal sepsis, TB, and an overview of immunizations in the first year of life.
Metabolic problems and jaundice
Authors: Fox Grenville , Hoque Nicholas , Watts Timothy
Published: April 2017

This chapter covers problems of glycaemic control in neonates (including investigation and management of hypoglycaemia and hyperglycaemia); management of babies of women with diabetes (infant of the diabetic mother); the physiological basis and rational approach to the treatment of metabolic acidosis in the newborn; the presentation, investigation, and management of inborn errors of metabolism presenting in the newborn; and metabolic bone disease (also known as osteopenia or rickets of prematurity). There is an overview of the investigation and treatment of neonatal jaundice, including physiological jaundice, aetiology, and investigation of non-physiological jaundice and aims of treatment of this; with guidelines for the use of phototherapy, exchange transfusion, and intravenous immunoglobulin. The importance of assessment of prolonged jaundice with reference to conjugated hyperbilirubinaemia is also covered in this section.
Haematological problems
Authors: Fox Grenville , Hoque Nicholas , Watts Timothy
Published: April 2017

This chapter explains the embryology of sexual differentiation, which provides the basis to assessment and management of disorders of sexual differentiation presenting at birth. There are sections on neonatal adrenal insufficiency and pituitary insufficiency, with background information provided on fetal and neonatal physiology relevant to these. Thyroid disorders are explained with particular reference to maternal thyroid disease. Calcium disorders and fetal and neonatal bone metabolism are explained, including the role of calcitonin, vitamin D, and parathyroid hormone.
Iatrogenic problems
Authors: Fox Grenville , Hoque Nicholas , Watts Timothy
Published: April 2017

This chapter gives an overview of iatrogenic problems experienced in neonatal care including problems associated with procedures, treatment, and medication. There are more detailed descriptions (including prevention and management) of the serious or frequently occurring problems of arterial thrombosis, extravasation injuries, infants inadvertently given the incorrect breast milk, and needle-stick injuries.
Neonatal transport
Authors: Fox Grenville , Hoque Nicholas , Watts Timothy
Published: April 2017

This chapter gives an overview of neonatal transport. The introduction includes indications for transfer and key elements of safe and effective transfer. There is a step-by-step description of the entire process including preparation, stabilization, and transfer including the support of families. We have included a referral template and an equipment checklist. There is discussion of difficult situations including when a baby cannot be stabilized, declining transfer, and death during transfer.
Normal values, therapeutic drug levels, and useful formulae
Authors: Fox Grenville , Hoque Nicholas , Watts Timothy
Published: April 2017

This chapter includes data on normal neonatal blood, urine, and cerebrospinal fluid (CSF) biochemistry values; normal neonatal haematology values; and therapeutic drug levels. Values given use SI units and notes are included to explain any changes expected with gestational and post-natal age, along with notes and references to greater detail in other relevant chapters. The importance of minor variance from locally used normal values is noted, along with local recommendations for therapeutic drug levels. Useful respiratory and biochemical physiological formulae are given, along with some used for routine practical procedures including tube length for endotracheal intubation and umbilical catheter length.
Gender, power, and non-verbal communication
Authors: Mast Marianne Schmid , Carrard Valérie , Hall Judith A.
Published: April 2017

In the study of communication between patients and providers, non-verbal behaviours have often been overlooked. Patients’ non-verbal communication is essential for effective care, and providers’ non-verbal behaviour has been shown to significantly influence medical encounter outcomes. Non-verbal behaviours relative to the power distribution between patients and providers have been shown to greatly impact outcomes with more provider dominance being linked to less positive outcomes. Additionally, gender of both the patients and the providers affect which non-verbal behaviours are shown, and how they are perceived and evaluated. In the present chapter, we discuss the effects of non-verbal communication on how medical encounters unfold in light of the gender and power distribution among provider and patient, the implications of these findings for oncological and palliative care are discussed.
Cancer patients’ use of the internet for cancer information and support
Authors: Peterson Emily B. , Shen Megan J. , Weber Jennifer Gueguen , Bylund Carma L.
Published: April 2017

The rise of the internet has dramatically changed the way that patients seek cancer-related information, as well as how they discuss these topics with their healthcare providers. Patients’ increased access to web-acquired information has created a power shift in clinician–patient communication, which may either have a beneficial effect on the relationship (e.g. when patients engage in better shared decision-making) or a harmful effect (e.g. when patients directly challenge their provider’s opinions). This chapter first explores how patients utilize the internet both to acquire cancer-related health information and to seek social support through online forums and support groups. The chapter then draws from facework theories to better understand how clinicians and patients introduce, discuss, and evaluate internet information. The chapter concludes with suggested guidelines and exemplary statements to improve clinician–patient communication about health information found on the internet.