bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetotransport and thermal properties characterization of 55 K superconductor SmFeAsO0.85F0.15
Authors: Srivastava Amit , Pal Anand , Singh Saurabh , Shekhar C. , Singh H. K. , Awana V. P. S. , Srivastava O. N.
Published: September 2013

This report fairly underlines the magneto-transport, thermal properties characterization and bulk superconductivity in the FeAs-based SmFeAsO0.85F0.1. The phase formation and structure are confirmed by Rietveld analysis of room temperature powder X-ray diffraction (XRD) data. Electron microscopy was employed to unravel the micro structural details, such as perfection of the lattice and the grain morphology including size and boundaries. The electrical and magnetic measurements have been carried out to confirm the bulk superconductivity and understand the nature of electrical transport in the normal and superconducting state. The intra-grain critical current density (Jc) with applied magnetic field is calculated from isothermal DC magnetization (MH) plots using conventional Bean critical state model. Superconductivity is observed at transition temperature (Tc) above 55 K without HPHT (high pressure high temperature) synthesis route. The value of Jc is found to be around 5.26 × 104 A/cm2 at 5 K in zero field. The dependence of thermally activated flux flow energy (U/kB) on the applied magnetic field has been observed. AC susceptibility measurements were performed for 55 K superconducting SmFeAsO0.85F0.15 sample at various amplitude of applied AC drive field and its granular nature is confirmed. The parent compound SmFeAsO is found to be magnetic with Fe spin density wave (SDW) like order below 150 K, on the other hand the F doped SmFeAsO0.85F0.15 sample is bulk superconducting at below 55 K. Both Fe (SDW) at 150 K for SmFeAsO and 55 K superconductivity in case of SmFeAsO0.85F0.15 sample has confirmed by Specific heat [Cp(T)] measurement too. Further Sm orders anti-ferro-magnetically at 4.5 K for non-superconducting and at 3.5 K for superconducting samples, also the entropy change is reduced significantly for the later than the former. Summarily complete physical property characterization for both non-superconducting SmFeAsO and 55 K superconductor SmFeAsO0.85F0.15 samples is provided and discussed in the current article.
Ammonia binding to the oxygen-evolving complex of photosystem II identifies the solvent-exchangeable oxygen bridge (μ-oxo) of the manganese tetramer
Authors: Pérez Navarro Montserrat , Ames William M. , Nilsson Håkan , Lohmiller Thomas , Pantazis Dimitrios A. , Rapatskiy Leonid , Nowaczyk Marc M. , Neese Frank , Boussac Alain , Messinger Johannes , Lubitz Wolfgang , Cox Nicholas
Published: September 2013

The assignment of the two substrate water sites of the tetra-manganese penta-oxygen calcium (Mn4O5Ca) cluster of photosystem II is essential for the elucidation of the mechanism of biological O-O bond formation and the subsequent design of bio-inspired water-splitting catalysts. We recently demonstrated using pulsed EPR spectroscopy that one of the five oxygen bridges (μ-oxo) exchanges unusually rapidly with bulk water and is thus a likely candidate for one of the substrates. Ammonia, a water analog, was previously shown to bind to the Mn4O5Ca cluster, potentially displacing a water/substrate ligand [Britt RD, et al. (1989)J Am Chem Soc111(10):3522–3532]. Here we show by a combination of EPR and time-resolved membrane inlet mass spectrometry that the binding of ammonia perturbs the exchangeable μ-oxo bridge without drastically altering the binding/exchange kinetics of the two substrates. In combination with broken-symmetry density functional theory, our results show that (i) the exchangable μ-oxo bridge is O5 {using the labeling of the current crystal structure [Umena Y, et al. (2011)Nature473(7345):55–60]}; (ii) ammonia displaces a water ligand to the outer manganese (MnA4-W1); and (iii) as W1 istransto O5, ammonia binding elongates the MnA4-O5 bond, leading to the perturbation of the μ-oxo bridge resonance and to a small change in the water exchange rates. These experimental results support O-O bond formation between O5 and possibly an oxyl radical as proposed by Siegbahn and exclude W1 as the second substrate water.
HIF1α is required for osteoclast activation by estrogen deficiency in postmenopausal osteoporosis
Authors: Miyauchi Yoshiteru , Sato Yuiko , Kobayashi Tami , Yoshida Shigeyuki , Mori Tomoaki , Kanagawa Hiroya , Katsuyama Eri , Fujie Atsuhiro , Hao Wu , Miyamoto Kana , Tando Toshimi , Morioka Hideo , Matsumoto Morio , Chambon Pierre , Johnson Randall S. , Kato Shigeaki , Toyama Yoshiaki , Miyamoto Takeshi
Published: September 2013

Significance

Estrogen deficiency after menopause frequently accelerates osteoclastic bone resorption, leading to osteoporosis, the most common skeletal disorder in women. However, mechanisms underlying osteoporosis resulting from estrogen deficiency remain largely unknown. We report a unique mechanism underlying postmenopausal osteoporosis, and a therapeutic target, hypoxia-inducible factor 1 alpha (HIF1α), to treat this condition. HIF1α is unstable in the presence of oxygen, but is stabilized under hypoxic conditions. However, we found that HIF1α is destabilized by estrogen even under hypoxic conditions. Following estrogen deficiency due to menopause, HIF1α is stabilized in osteoclasts, leading to osteoclast activation. Oral administration of a HIF1α inhibitor protected postmenopausal osteoporosis model mice from osteoclast activation and bone loss. Thus, HIF1α represents a promising therapeutic target in osteoporosis.
Arabidopsis
semidwarfs evolved from independent mutations in
GA20ox1
, ortholog to green revolution dwarf alleles in rice and barley
Authors: Barboza Luis , Effgen Sigi , Alonso-Blanco Carlos , Kooke Rik , Keurentjes Joost J. B. , Koornneef Maarten , Alcázar Rubén
Published: September 2013

Significance

Semidwarf accessions occur at low frequency across the distribution range of
Arabidopsis thaliana
and are mainly mutants of the
GA5
(
GA20ox1
) gene, mutations of which originate from wild-type alleles still present in the regions where the mutants were found. We identified the causal mutations by allelism tests and sequencing and performed a detailed population genetics analysis of this variation. Using Fay and Wu’s
H
statistics, we obtained indications for local selection of the dwarf alleles. Mutants of functional orthologs of this gene have been selected as the so-called “green revolution genes” in rice and barley, thus indicating that
Arabidopsis
natural variation can be a source for the identification of useful genes for plant breeding.
Who commercialises research at Swedish universities and why?
Authors: Borlaug Siri Brorstad , Jacob Merle
Published: September 2013

European universities have been increasingly pressured since the late 1990s to make a more visible contribution to economic development. This policy interest has produced an increasing focus on knowledge transfer generally, and more specifically on measures to promote a research culture which values patenting and firm formation. This paper presents results from an interview study of academic faculty views on knowledge transfer and commercialisation at five public universities in Sweden. Our results show that, despite the retention of inventor ownership at Swedish universities, there is a high degree of knowledge transfer of all kinds. The overriding driver of entrepreneurial behaviour among faculty appears to be the low level of direct funding for research in universities. We find that attitudes to firm formation vary from positive to ambivalent, and that faculty from the humanities and social sciences engage in a higher level of entrepreneurial and policy adaptive behaviour than they report. We conclude that faculty at Swedish universities perceive the role of public servant and entrepreneurial academic as conflicting. This perceived conflict may be one reason for reluctance to report instances of commercialisation of research.
Preoperative Patient Evaluation for Anesthesia Care Outside of the Operating Room
Authors: Jean Sweitzer Bobbie
Published: September 2013

Preoperative evaluation and optimization of medical status of patients are important components of anesthesia practice. Increasing numbers of patients with serious comorbidities undergo procedures that require anesthesia services outside of the operating room (OOOR). Often the location alters the challenges of caring for these patients. Surgical, anesthesia, or nursing personnel who can assist with airway and resuscitation management may not be available; equipment and medications may be limited. Many OOOR locations will not have the usual support of an intensive care unit (ICU), skilled postanesthesia recovery personnel, respiratory therapy, or ready access to an inpatient bed, blood banking, interventional cardiology, or diagnostic services. Many of the patients are elderly, ill, and even unlikely candidates for conventional surgery (e.g., transmucosal resection of gastric tumors, transjugular intrahepatic portosystemic shunts). Yet patients and/or providers may be reluctant to expend time and energy in extensive preoperative evaluation before a seemingly minor procedure. This chapter will outline the basics of preprocedure preparation of patients scheduled to receive anesthesia in OOOR settings.
Recovery and Discharge for Procedures Conducted Outside of the Operating Room
Authors: Zhang Lianfeng , Chung Frances F.
Published: September 2013

Continued advances in procedural techniques, anesthetic pharmacology, and regional anesthesia allow more prolonged diagnostic and therapeutic interventions to be conducted at an increasing variety of locations outside of the operating room (OOOR). However, recovery and discharge process may vary according to the patient’s condition and the specifics of the procedure. Generally, most patients are sent to the postanesthesia care unit (PACU) and ambulatory surgery unit (ASU) or a medical post-procedure recovery unit not staffed by an anesthesiologist, while some patients receive special postoperative care in a step-down or intensive care unit. Therefore, ensuring rapid postoperative recovery and safe discharge are important components following these OOOR procedures.
Management of Staffing and Case Scheduling for Anesthesia Outside of the Operating Room
Authors: Macario Alex
Published: September 2013

With proper management weeks to months ahead of time, the groundwork for an efficient (well-functioning) OOOR elective schedule should be in place. This chapter's aims to reinforce that OOOR case scheduling should aim to reduce overutilized time, to identify challenges of scheduling anesthesia services outside of the operating room, to explain that current procedural terminology (CPT) codes for OOOR cases are not predictive of anesthesia times, to recommend that an OOOR service requesting anesthesia coverage receive a block of allocated time provided they average at least 10 hours of cases including turnovers every two weeks (the 10 hour threshold is set high to ensure that the allocated “block” remains filled. Two weeks is a reasonable length of time from the perspective of patient waiting times. An “overflow block” (i.e., first come, first scheduled time) is made available for any spillover cases or services that have less than 10 hour of cases per week), and to encourage the use of computer-based enterprise-wide scheduling so that control of scheduling of OOOR cases is distributed to each OOOR service.
Anesthesia and Sedation Outside of the Operating Room: Outcomes, Regulation, and Quality Improvement
Authors: Metzner Julia , Domino Karen B.
Published: September 2013

Providing anesthesia care in areas outside the operating room (OOOR) has numerous challenges, including an unfamiliar environment; inadequate anesthesia support; deficient resources; cramped, dark, small rooms; and variability of monitoring modalities. In addition, sicker patients are undergoing more complex procedures in areas that may be physically located far from the OR environment. To improve safety of patients undergoing procedures in remote locations, practitioners need to be familiar with development of rigorous continuous quality improvement systems, national and regulatory patient safety efforts, as well as complications related to anesthesia/sedation in OOOR settings. This chapter will identify severe outcomes and mechanisms of injury in these remote locations, national patient safety and regulatory efforts that may be adapted to the OOOR setting, and quality improvement efforts essential to track outcomes and improve patient safety.
Magnetic Resonance Imaging and Ultrasound-Guided Percutaneous Interventional Radiology Procedures
Authors: Patel Bijal , Shyn Paul B. , Tuncali Kemal , Silverman Stuart G.
Published: September 2013

Although imaging-guided procedures are less invasive than surgery, they still have potential complications and can result in patient anxiety, pain, and discomfort. Accordingly, there is an important role for monitored and general anesthesia for patient safety and comfort, as well as for facilitating the technical success of the procedure. Anesthesiologists are often present throughout the entire procedure or may be consulted in cases where intravenous sedation is administered by the interventional radiologist. To select appropriate sedation and analgesia strategies, the anesthesiologist must assess the patient’s current status, underlying medical conditions, and details of the procedure, including the type of the procedure, the expected duration and complexity of the procedure, patient’s position, breath-holding concerns, the anticipated amount and type of pain, and potential complications. Frequent communication before, during, and after the procedure between the interventional radiologist and anesthesiologist is important for delivering sedation and analgesia in a safe, effective manner. This chapter focuses on the various types of interventional procedures performed with ultrasound (US) and magnetic resonance imaging (MRI) guidance.
Anesthesia for Urologic Procedures
Authors: Bottiger Brandi A. , Rebstock Sarah
Published: September 2013

Because more procedures are being performed in outpatient and outside of the OR (OOOR) settings, it is important for the anesthesiologist to not only provide an optimal anesthetic for these patients but also ensure patient and personnel safety. This chapter will discuss anesthesia for common urologic outpatient/OOOR procedures, including cystourethroscopy, ureteroscopy, transurethral procedures except TURP, laser use, percutaneous renal procedures, and extracorporeal shock wave lithotripsy.
Electroconvulsive Therapy
Authors: Ross Lisa
Published: September 2013

Electroconvulsive therapy (ECT) is used in the United States for the treatment of major depression and a limited number of other psychiatric disorders. Patients require general anesthesia and airway management for this procedure, which is most often performed on psychiatric wards or in outpatient facilities. Because many of these patients are elderly and often have accompanying comorbidities, the sudden stimulus to the cardiovascular and cerebrovascular systems during this brief procedure creates the potential for significant cardiac and neurological complications. Despite this, ECT remains a very safe and well-tolerated procedure for inpatients as well as outpatients, as long as proper preoperative evaluation is performed and there is adherence to safe anesthesia practice guidelines.
Pain Management Procedures
Authors: Dragovich maj. Anthony , Maani maj. Christopher V.
Published: September 2013

This chapter will prove useful to anesthesiologists and nonanesthesiologists alike in providing an overview and discussion of several of the most common pain procedures encountered in clinical pain management practices today (including epidural steroid injections, facet interventions, SIJ interventions, sympathetic blocks, spinal cord stimulator, and neuraxial pumps). Each procedure is discussed with an initial description of the strategy, including technical aspects, medical indications, and relevant complications important for the pain management physician to understand. This will be followed by a section on considerations for anesthetic management.
Ultra-Rapid Opiate Detoxification
Authors: Gevirtz Clifford M. , Frost Elizabeth , Kaye Alan D.
Published: September 2013

When used appropriately under medical supervision, hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin), morphine, and similar prescription pain relievers provide indispensable medical benefit by reducing pain and suffering, but when taken without appropriate direction and oversight, these medications can cause serious adverse consequences and produce dependence and abuse. Approximately 324,000 emergency department visits in 2006 involved the nonmedical use of pain relievers (including both prescription and over-the-counter pain medications). This chapter discusses how, when individuals wish to detoxify from opiate dependence, there are several options available, including both conventional and newer, more rapid approaches.
Telemedicine, Teleanesthesia, and Telesurgery
Authors: Murray W. Bosseau , Vaduva Sorin , Berg Benjamin W.
Published: September 2013

This chapter is intended as an overview for the anesthesiologist or administrator who is asking the following questions: 1. What changes should we expect from the acceptance of telemedicine practice and technologies in the 2010 Healthcare Bill? 2. Should I consider using telemedicine in my healthcare system? 3. Can I use aspects of telemedicine in my outside-of operating-room sites? 4. Are there any dangers? 5. What are the advantages? 6. If I want to enter the field, what are the implied and/or expected infrastructure costs at both ends?
Health for all Children
Authors: Hall David M B , Elliman David
Published: September 2013

This established and successful resource continues to be essential reading for all health professionals who work with children, whether in the community or at the receiving end of referrals. It also provides vital background knowledge for those charged with the responsibility of planning, commissioning and monitoring alongside the most up to date evidence in a rapidly changing field.
Child health promotion— focus on parents
Authors: Hall David M.
              B. , Elliman David
Published: September 2013

Chapter 2 gives an overview of activities involved in promoting child health, stresses the importance of a holistic approach to working with families, introduces concepts of social support, social capital, and social networks, discusses the challenges of working with families in difficult circumstances, outlines the evidence that social support is beneficial, considers the impact of various adult health issues on children—parents who have mental illness, are cared for by children, have learning, communication or physical disabilities, have HIV infection, are involved in substance abuse, and summarizes the evidence regarding the characteristics of effective programmes.
Growth monitoring and nutrition
Authors: Hall David M.
              B. , Elliman David
Published: September 2013

Chapter 8 reviews the value of growth monitoring (GM), outlines the reasons why GM may be useful, describes the requirements for successful GM, makes recommendations for GM, and examines the value of measuring the head circumference.
Screening for hearing defects
Authors: Hall David M.
              B. , Elliman David
Published: September 2013

Chapter 11 describes and defines hearing loss, summarizes the epidemiology, describes the impact of hearing loss on development, lists and discusses the various approaches to screening, and makes recommendations for practice, monitoring, and research.
Child protection programme
Authors: Hall David M.
              B. , Elliman David
Published: September 2013

Chapter 15 reviews the Children Act 1989, the role of health professionals in child protection, duties of Area Child Protection Committee, designated and named doctor and nurse, categories of child abuse and child protection registers, domestic violence, looked after children, designated doctor and nurse for looked after children, resource implications, private fostering, and adoption.
Implementing the programme
Authors: Hall David M.
              B. , Elliman David
Published: September 2013

Chapter 19 outlines the issues involved in implementing the programme set out in this book, and suggests that the same principles apply whatever the structure and management of the health care system.
Muscle strength
Authors: Farpour-Lambert Nathalie
                J. , Blimkie Cameron
                J.R.
Published: September 2013

This chapter focuses on laboratory-based strength assessment techniques and considerations for the paediatric population. The theoretical and practical considerations underlying strength assessment in adults and children and adolescents have been previously and thoroughly reviewed. This chapter will supplement, with emphasis on paediatric considerations, but not replicate, the material covered in these references. The topic of strength development and its correlates or determinants during childhood are beyond the scope of this chapter.
Effort perception
Authors: Lamb Kevin
                L. , Parfitt Gaynor , Eston Roger
                G.
Published: September 2013

Prior to 2000, most investigators had conducted their research in the same vein as that performed in greater volume on adults, and appealed for progress in this regard. While significant progress has been made in the intervening years, there remains, regrettably, a lack of consensus in terms of how data should be gathered (which tools and protocols are appropriate) and analysed statistically, making interpretations of validity and reliability quite difficult. In the past 10 years existing scales have been refined and ‘new’ ones have been constructed and promoted across a range of exercise modalities. Chapter 11 describes these advances and controversies and present the current status of the application of effort perception research in the paediatric exercise domain.
Exercise metabolism
Authors: Armstrong Neil , Fawkner Samantha
                G.
Published: September 2013

Chapter 16, to better understand the interplay of anaerobic and aerobic exercise metabolism during growth and maturation, compares and contrasts the development of maximal measures of anaerobic and aerobic performance, analyses relevant data from muscle biopsy investigations, reviews studies of substrate utilization during exercise, and explores recent insights into muscle metabolism provided by rigorous analyses of breath-by-breath respiratory gases and 31P-magnetic resonance spectroscopy (31P-MRS) spectra.
Cardiovascular function
Authors: Rowland Thomas
                W.
Published: September 2013

While the critical nature of blood perfusion during exercise is well recognized, many questions remain incompletely answered. What are the mechanisms by which circulation of blood is increased during exercise? By what means is circulatory flow tightly linked to tissue metabolic demands? What limits increases in circulatory flow during exhaustive exercise? By what mechanism does repeated exercise (i.e. fitness training) improve cardiovascular capacity? And—germane to the present discussion—are the answers to any or all of these questions diff erent in children than adults? Chapter 19 considers these issues, summarizing available information in the paediatric population from the perspectives of three different exercise models: progressive treadmill or cycle ergometer exercise to exhaustion, sustained constant-load submaximal exercise (cardiovascular drift ), and isometric or resistance exercise.
Oxygen uptake kinetics
Authors: Fawkner Samantha
                G. , Armstrong Neil
Published: September 2013

The two main purposes of Chapter 22 are to (i) explore the methodological issues involved in assessing the O2 kinetic response to exercise in children, and (ii) explain the O2 kinetic response to exercise in children and review the literature regarding changes with age and sex and with respect to conventional markers of aerobic fitness.
Exercise testing in congenital heart disease
Authors: Reybrouck Tony , Gewillig Marc
Published: September 2013

Exercise testing in adult cardiac patients has mainly focused on ischaemic heart disease. The results of exercise testing with ECG monitoring are often helpful in diagnosing the presence of significant coronary artery disease. In children with heart disease, the type of pathology is different. Ischaemic heart disease is very rare. The majority of the patients present with congenital heart defects, which affect exercise capacity. In patients with congenital heart disease, exercise tests are frequently performed to measure exercise function or to assess abnormalities of cardiac rhythm. The risk of exercise testing is very low in the paediatric age group.1
Current concepts on the aetiology and prevention of sports injuries
Authors: van Mechelen Willem , Verhagen Evert
                A.L.M.
Published: September 2013

A physically active lifestyle and active participation in sports is important, for adults as well as for children. Reasons to participate in sports and physical activity are many: pleasure and relaxation, competition, socialization, maintenance and improvement of fitness and health, etc. In general, when compared to adults, the risk for sports injury resulting from participation in sports and free play is low in children.1 Despite this relatively low risk, sports injuries in children are a fact of life, which calls for preventive action. In order to set out effective prevention programmes, epidemiological studies need to be done on incidence, severity, and aetiology of sports injuries. Also the effect of preventive measures needs to be evaluated. In the following chapters various authors will describe these aspects of sports injuries in children, regarding specific sports. This chapter describes briefly some current concepts regarding the epidemiology and prevention of sports injuries as a means of introduction to these chapters.
Aetiology and prevention of injuries in physical education classes
Authors: Backx Frank
                J.G. , Collard Dorine
                C.M.
Published: September 2013

Chapter 43 summarizes the available specific information on the epidemiology and prevention of injuries sustained in physical education.
Aetiology and prevention of injuries in youth competitive contact sports
Authors: Verhagen Evert
                A.L.M. , van Mechelen Willem , Baxter Jones Adam
                D.G. , Maffulli Nicola
Published: September 2013

Other chapters in this section have covered the theoretical framework regarding the aetiology and prevention of sports injuries as well as, more specific, the aetiology and prevention of injuries in non-contact youth competition sports. This chapter will focus on sport specific injuries in contact sports. A number of sports where contact with the opponent is intentional or common have therefore been selected.
Biochemistry and genetics
Authors: Bye Louise A.
Published: September 2013

This chapter explores biochemistry and genetics for ophthalmology, including cell structure, cell signalling, cellular processes, connective tissue, extracellular matrix, and cellular interactions, biochemical and molecular biological techniques, biochemistry of ocular tissue, organization of the genome, Mendelianinheritance and population genetics, cytogenetics, the genetic basis of eye conditions, genetic techniques, and the management of genetic disease.
Growth and senescence
Authors: Bye Louise A.
Published: September 2013

This chapter explores growth and senescence in ophthalmology, including ocular embryology (formation of the optic cup, ocular tissues, congenital anomalies, anterior segment), growth, and senescence (degeneration of conjunctiva or cornea, anterior chamber and lens, vitreous, retina).
Obstetric Anesthesia
Authors: Kung Adrienne , Hess Philip
Published: September 2013

Chapter 6 contains 48 questions and answers regarding obstetric anesthesia.
Transplant Anesthesia
Authors: Dohl Douglas , Walton Charlene
Published: September 2013

Chapter 19 contains 26 questions and answers regarding transplant anesthesia.
Acute Fluid Resuscitation for Intussusception
Authors: Fraser Britt
Published: September 2013

Intussusception occurs when a proximal section of bowel invaginates into more distal bowel and is then advanced by peristalsis. It is the most common cause of intestinal obstruction in infants, and untreated can lead to bowel ischemia and perforation. Early recognition and treatment can prevent the need for surgical intervention and complications. Intussusception can also result in significant dehydration due to vomiting and diarrhea. An essential aspect of the perioperative management is to identify and treat dehydration.
Preoperative Fasting in the Pediatric Patient
Authors: Hagerman Nancy S , Wittkugel Eric P
Published: September 2013

Preoperative fasting guidelines are designed to minimize the risk of pulmonary aspiration of gastric contents. As pulmonary aspiration is a rare occurrence, however, few evidence-based recommendations for ideal fasting intervals exist. An understanding of the research involved in the creation of these guidelines is useful in ensuring the maximum safety of patients while minimizing the disadvantages of prolonged fasting.
Difficult Ventilation During Laparoscopic Fundoplication
Authors: König Matthias W , McAuliffe John J
Published: September 2013

An ever-increasing number of surgical procedures are now performed via the laparoscopic approach, and it is estimated that about 60% of abdominal surgeries in children can be performed laparoscopically today. The creation of a pneumoperitoneum has significant effects on the respiratory system, particularly in small children. Further, laparoscopic procedures have the potential for unique complications not typically seen with conventional “open” surgical techniques.
Liver Transplant
Authors: Soler Ximena , Aronson Lori A , Derrick Gillian
Published: September 2013

Liver transplantation is an established therapy in pediatric end-stage liver failure. Blood loss during orthotopic liver transplantation (OLT) is highly variable. Massive hemorrhage and transfusion of blood products, with its related consequences, is a well-known complication of this operation.
Open Globe Repair
Authors: Jou J. Fay , Margolis Judith O
Published: September 2013

Ocular trauma in childhood is common and may cause transient or permanent visual impairment. The anesthetic management of children with penetrating eye injuries presents several unique challenges, including potential associated injuries that may take precedence over the treatment of the eye injury, the prevention of aspiration of gastric contents, the regulation of intraocular pressure (IOP), and the prevention of the oculocardiac reflex (OCR). An understanding of the mechanisms and management of these potential problems can favorably influence surgical outcome.
Spinal Surgery
Authors: Mahmoud Mohamed A , König Matthias W , McAuliffe John J
Published: September 2013

The aim of all spine surgery is to achieve surgical correction of a defect without incurring new neurologic deficits. The anesthesiologist caring for children and adolescents who undergo spine surgery must address surgical requirements, the issues associated with prone positioning, optimal conditions required for neurophysiologic monitoring, as well as the pathophysiology related to underlying medical conditions. The anesthesiologist must anticipate potential problems in anesthetizing a patient for complex spinal surgery and be prepared to manage all issues and complications.
Mediastinal Mass Biopsy
Authors: Tomasson Jon , Mahmoud Mohamed A , Spaeth James P
Published: September 2013

It has been long recognized that patients with anterior mediastinal masses (AMMs) have a significantly increased risk of adverse perioperative events. Even asymptomatic patients or those with mild clinical symptoms are at risk for cardiopulmonary collapse and even death with induction of anesthesia, thus highlighting the need for careful preoperative evaluation and decision making.
Diabetic Patient
Authors: Patino Mario , Varughese Anna M
Published: September 2013

Diabetes is the most common metabolic disorder in children, and its incidence is increasing. The rapid development of new, complex regimens for treatment and the availability of many forms of insulin make the management of these patients complex and best conducted in conjunction with a pediatric endocrinologist. Perioperative management of diabetic patients requires knowing the pathophysiology, current treatment, degree of control and compliance with therapy, previous complications, and complexity and duration of the surgical procedure.
Muscular Dystrophy
Authors: Kreeger Renee Nierman , Spaeth James P
Published: September 2013

Gastrostomy tube placement is typically a routine surgical procedure with little concern for morbidity and mortality. However, in patients with Duchenne muscular dystrophy (DMD), this is not the case. Patients with DMD present a unique clinical dilemma since they often do not require gastrostomy tube placement until their physical status has deteriorated to the point that they have respiratory insufficiency or failure and clinically significant cardiomyopathy. An understanding of the pathophysiology of this disorder and a proactive approach to perioperative management are important to ensure a positive patient outcome.
Epidermolysis Bullosa
Authors: Samol Nancy B , Wittkugel Eric P
Published: September 2013

Epidermolysis bullosa (EB) is a genetic skin disorder with multiple modes of inheritance that causes blister formation from shear injury and results in extensive scarring. Children with EB provide an array of unique challenges when presenting for anesthetic care. Anticipation and management of a potentially difficult airway as well as the protection of fragile skin and mucous membranes are high priorities during anesthetic planning. Complications can arise with use of even the most routine anesthesia monitors and placement of a simple peripheral IV line. Thorough preoperative planning and meticulous perioperative care will reduce complications and result in a smooth anesthetic for both patient and clinician.
Emergence Agitation
Authors: Eastwood Charles B , Samuels Paul J
Published: September 2013

Emergence delirium is a common and challenging post-anesthetic complication in children characterized by a brief period of inconsolability, disorientation, and combativeness. Emergence delirium threatens patient safety due to potential self-injurious behavior or by untimely removal of intravenous lines, urinary catheters, and surgical drains. The economic impact of emergence delirium is a consequence of delayed post-anesthesia care unit (PACU) discharge and the need for additional medication administration and increased PACU staffing. In addition, despite the short duration of emergence delirium, its dramatic and frightening presentation can diminish parental satisfaction. Although no consistently effective treatment for emergence delirium has been described, familiarity with this clinical entity and approaches to its management and prevention are important to those who provide pediatric anesthesia care. This chapter will focus on our present understanding of emergence delirium in children.
The Phenomenology of Attention-Deficit/Hyperactivity Disorder in Tourette Syndrome
Authors: Rothenberger Aribert , Roessner Veit
Published: September 2013

This chapter focuses on the complex epidemiological and phenomenological aspects of attention-deficit/hyperactivity disorder (ADHD) in Tourette syndrome (TS). Research on this topic is relatively recent and has elucidated the importance of comorbidity in TS and the need for an early assessment for ADHD in TS. Several observational studies confirmed that ADHD is the most common comorbidity in TS (present in about 60% of cases), possibly anticipating TS onset and influencing the male gender predominance of TS. ADHD exerts a negative impact on externalizing and internalizing symptoms as well as on psychosocial functioning and quality of life in TS. The impact of comorbid ADHD upon sleep disturbances in TS remains a neglected issue. Approaches to model the coexistence of TS and ADHD are ongoing. Whereas basic neurobiological aspects fit with an additive model, complex cognitive functioning supports an interactive model. Specific pathophysiological features for TS plus ADHD have not yet been identified, but common heritability between TS and ADHD might be explained, at least in part, by the comorbidity of ADHD and OCD. Future studies on the phenomenology of TS plus ADHD should consider not only the core symptoms of TS and ADHD, but also obsessive-compulsive traits, emotional aspects, neuropsychological aspects, quality of life, early risk factors, resilience, and other possible mediators and moderators.
Neurobiology and Functional Anatomy of Tic Disorders
Authors: Greene Deanna J. , Black Kevin J. , Schlaggar Bradley L.
Published: September 2013

This chapter summarizes the highly valuable contribution of magnetic resonance imaging (MRI) to the understanding of the functional anatomy of tics and related disorders. Structural MRI studies have revealed reduced caudate volumes in children and adults with Tourette syndrome (TS), with a negative correlation between caudate volume in childhood and symptom severity later in life. Cortical thinning in sensorimotor cortices was detected in children and adults with TS, with a negative correlation between thickness and orofacial tic severity. Whereas adults with TS show cortical thinning and reduced gray matter volume in prefrontal regions, suggesting a failure in neural compensation to control tics into adulthood, results from children with TS are mixed. Measures of white matter have demonstrated larger volumes and reduced fractional anisotropy in the corpus callosum in TS. Results from functional MRI studies of motor control and cognitive control in TS are generally inconsistent. Putative cognitive control networks seem functionally immature and anomalous in TS, suggesting that functional anatomical abnormalities in TS may not be restricted to cortico-striato-thalamo-cortical circuits and involve cortical networks supporting cognitive control.
The Neurochemistry of Tourette Syndrome
Authors: Singer Harvey S.
Published: September 2013

The pathobiology of Tourette syndrome (TS) involves the complex and integrated cortico-striatal-thalamo-cortical (CSTC) circuits. This chapter systematically analyzes the involvement in TS of all the neurotransmitter systems relevant to CSTC circuits. A major role for dopamine continues to be the most consistently observed neurotransmitter change in this condition. Of the various dopaminergic hypotheses proposed, an alteration of the tonic-phasic neurotransmitter release system appears most viable. However, it remains highly likely that TS patients exhibit dysfunction in several neurotransmitter systems, although new evidence is warranted to better understand the dysfunction of non-dopaminergic systems, particularly serotonergic, glutamatergic, and GABAergic ones.
Immunity and Stress Response in Tourette Syndrome
Authors: Martino Davide
Published: September 2013

This chapter summarizes the evidence in favor of dysfunctional immune responses and stress responses in Tourette syndrome (TS). A generalized activation of immune-inflammatory mechanisms at a systemic level is supported by the analysis of lymphocyte subpopulations and peptide markers, such as neopterin. Co-variations between systemic levels of pro- and anti-inflammatory cytokines and clinical severity in TS suggests an interplay between immunity and behavioral abnormalities in these patients. Moreover, preliminary evidence supports a possible liability to autoimmunity in TS patients (e.g., decreased numbers of T-regulatory lymphocytes and abnormal immunoglobulin profiles). The transcriptome approach is likely to provide new evidence in favor of the contribution of immune-regulatory genes in TS. Finally, patients with TS exhibit an enhanced reactivity of the hypothalamic-pituitary-adrenal axis to external stressors, despite a preserved diurnal cortisol rhythm and normal restoration of the baseline activity of the axis following the acute stress response.
The Differential Diagnosis of Tic Disorders
Authors: Kurlan Roger
Published: September 2013

This chapter focuses on the differential diagnosis of tics and tic disorders. Tics need to be distinguished from other hyperkinetic movement disorders, such as chorea, myoclonus, and dystonia, as well as from movement disorders associated with psychiatric conditions (compulsions, sterotypies, mannerisms, habits). Tourette syndrome belongs to a family of primary tic disorders that include chronic motor or vocal tic disorder and transient tic disorder. However, tics may have different etiologies and can occur secondary to a number of conditions, including neurological disorders and medications, and as a psychogenic manifestation.
Social and Adaptive Functioning in Tourette Syndrome
Authors: Sukhodolsky Denis G. , Eicher Virginia W. , Leckman James F.
Published: September 2013

Many children, adolescents, and adults with Tourette syndrome have impairments across various domains of social and adaptive functioning, both as a result of the severity and particular features of tics and existing comorbidities. The relative contribution of tics and comorbid disorders to these impairments is under investigation. A thorough clinical assessment should also include standardized ratings of adaptive functioning. Psychosocial interventions for tics and associated behavioral disorders are constantly improving and show the potential to reduce symptom severity and associated functional impairment.
Psychoeducational Interventions: What Every Parent and Family Member Needs to Know
Authors: Lebowitz Eli R. , Scahill Lawrence
Published: September 2013

It is important for patients and families to understand the complex manifestations of Tourette syndrome so they can cope efficiently with tics and related symptoms. This chapter examines all the different features (temporal fluctuation in severity, susceptibility to contextual factors, academic and social implications) contributing to the complexity of tics and discusses psychoeducational interventions for patients and families. The practical and emotional challenges faced by parents of children with tics are another important aspect of psychoeducation. Children with tics also face educational and social difficulties in school and are often targets of peer victimization. Psychoeducation for school staff as well as peers may alleviate these difficulties. Adults with tics face discrimination and social victimization in the workplace and tend to be underemployed. Psychoeducation for employers and colleagues about tics as well as about the legal obligations toward individuals with disabilities may mitigate such discrimination.
Cognitive-Behavioral Treatment for Tics
Authors: Capriotti Matthew R. , Woods Douglas W.
Published: September 2013

Cognitive-behavioral treatment (CBT) is efficacious in decreasing the severity of motor and vocal tics. This chapter reviews the different CBT approaches; among them, Habit Reversal Training (HRT) and related treatments such as Comprehensive Behavioral Intervention for Tics have the most empirical support. The efficacy of HRT-based interventions was shown to be similar to that provided by some pharmacological interventions in children, adolescents, and adults with various types of tics (e.g., motor, vocal, simple, complex). Attempts to enhance HRT-based treatments by adding cognitively oriented components (e.g., cognitive therapy, acceptance work), however, have not been successful to date. Premonitory urges are very important in the tic-management strategies taught in CBT for Tourette syndrome, and changing patients’ response to them may be a key mechanism of change.
Surgical Treatment of Tourette Syndrome
Authors: Porta Mauro , Sassi Marco , Servello Domenico
Published: September 2013

This chapter presents an overview of the literature on the surgical approach to the treatment of Tourette syndrome (TS) and summarizes current recommendations for the use of this treatment. Attention is given to pending issues related to this invasive treatment, which will need to be addressed in future research. Some technical notes based on the authors’ longstanding experience using this treatment are given at the end of the chapter. Deep brain stimulation (DBS) for TS must still be considered an investigational procedure: it is not curative and in some cases does not improve tics. Drugs in TS are prescribed according to the patient’s symptoms, and although the same tailored approach is conceivable in choosing the best target for DBS, evidence is still insufficient to provide a sound clinical guidance for target selection. The ongoing technological advances in the surgical procedure (e.g., the introduction of the O-arm and other imaging modalities) may improve its safety and applicability in routine clinical practice. A robust treatment algorithm, based on evidence from randomized controlled trials and multidisciplinary experiences from tertiary referral centers, is lacking and is definitely needed.
Information and Social Support for Patients and Families
Authors: Müller-Vahl Kirsten R.
Published: September 2013

This chapter summarizes the current experience on information and psychoeducation, predominantly from a European perspective. Due to the wide spectrum of symptoms associated with Tourette syndrome (TS), patients with tics may seek doctors from different specialties, including not only neurologists and psychiatrists but also general practitioners, ear/nose/throat physicians, ophthalmologists, pediatricians, allergists, speech and language therapists, dermatologists, and even dentists. The delay to diagnosis has among its possible causes the insufficient knowledge and awareness of this condition among professionals. Psychoeducation should always be the first step in the treatment of patients with TS, informing decisions on the best management approach to take in the short, medium, and long term. With respect to treatment, a shared decision-making model is recommended where the physician provides tailored, unbiased, and up-to-date information about the benefits and disadvantages of alternative treatment choices, while the patient makes the decision about whether treatment will be initiated. Knowledge on potential restrictions and limitations regarding daily functioning represent an important aspect of the psychoeducational intervention. The economic burden of adult patients with TS is high, with indirect costs having a greater impact than direct costs; this represents an underinvestigated aspect of this condition.
Information and Support for Educators
Authors: Pruitt Sheryl K. , Packer Leslie E.
Published: September 2013

Students with tics or Tourette syndrome face numerous academic, behavioral, and social challenges. Most of the impairment appears due to associated disorders. Comprehensive psychoeducational and functional behavioral assessments enable the school team to develop appropriate accommodations and interventions. Providing a supportive environment, nurturing the child’s strengths and talents, and providing resources and support for the parents in service of the child can help the student overcome any challenges and have a successful school year. This chapter examines the various issues that teachers and educators should be familiar with when facing the social and academic challenges of Tourette syndrome patients.