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\"Intergalactic bounty hunter Lobo has a new job. The evil aliens Kalibak and Desaad have hired him to capture Superman, dead or alive! However, when Lobo finally manages to wrangle up the Man of Steel, the aliens aren't far behind. They don't trust the ill-mannered bounty hunter, and quickly trap him beneath a force field with Superman. Lobo and the Man of Steel must set aside their differences in order to escape, capture the two villains, and collect the well-deserved reward.\"--T.p. verso.

Pediatric pain conditions are not uncommon and may lead to functional disability. The purpose of this study is to examine indirect effects of pain catastrophizing on functional disability through anxiety, depression, and pain in youth with chronic pain. Participants included 197 youth (144 females, M age  = 14.67 years) with chronic pain conditions. Youth completed self-report measures of pain catastrophizing, depression, anxiety, pain intensity, and functional disability. Caregivers also completed a measure of youth functional disability. Using a cross-sectional design, a multiple mediator model was estimated with pain catastrophizing as the predictor, functional disability as the outcome, and depression, anxiety, and pain intensity as mediators. Results supported a mediation model in which depression ( B  = 0.1145, SE  = 0.0528, Z  = 2.1686; B  = 0.1512, SE  = 0.0585, Z  = 2.5846) and pain intensity ( B  = 0.1015, SE  = 0.0422, Z  = 2.4052; B  = 0.0634, SE  = 0.0343, Z  = 1.8484) significantly mediated the effects of catastrophizing on child self-report and parent-report functional disability, respectively, while anxiety ( B  = − 0.0260, SE  = 0.0439501, Z  = − 0.5923; B  = − 0.0637, SE  = 0.0552, Z  = − 1.1540) did not. Theoretical and clinical applications are discussed.

How adults can help children cope with routine and traumatic medical care. Keith J. Slifer, a pediatric psychologist at the Kennedy Krieger Institute and the Johns Hopkins University School of Medicine, explores how adults can help children cope with routine and traumatic medical care. He draws on practice and research to help health care practitioners provide better care for children with chronic conditions and children undergoing rehabilitation after traumatic injury or surgery. By better understanding the behavior, emotions, and developmental challenges of children, health care professionals in practice and in training can solve a range of problems, from getting a distressed child to cooperate with a physical examination or diagnostic test, to teaching a child to adhere to medical self-care. More than 9 million children in the United States regularly visit health care professionals for treatment of chronic or recurrent health conditions. These children experience multiple doctors' visits, trips to the emergency department, hospital admissions, anesthesia, surgery, medications, needle sticks, wound cleaning, seizures, nausea, vomiting, pain, and fear. While most of these children are developing typically in terms of their intellectual and cognitive functioning, many children with intellectual, developmental, and physical disabilities also require frequent medical care, and as chronic health conditions increase, so do the chances of having developmental, learning, emotional, and behavioral problems. A Clinician's Guide to Helping Children Cope and Cooperate with Medical Care will benefit health care professionals and children as practitioners aim both to improve medical care and to prevent the children's behavior from disrupting clinics and distressing and frustrating health care workers and family caregivers. This book is for pediatric psychologists, pediatricians, family medicine practitioners, physician's assistants, nurse specialists, pediatric subspecialists, and students in these fields—and for family members dedicated to helping their children cope with medical procedures and to getting the best possible medical care.

Background: Adolescents are prone to sleep problems that have unique developmental aspects and contribute to physical, emotional, and behavioural problems. Aims: This study evaluated an individualized, multicomponent intervention that considered developmental factors, and promoted age-appropriate autonomy in three adolescent females with disrupted sleep. Method: Adolescents recorded sleep data on daily logs. A nonconcurrent multiple baseline design was used to evaluate a cognitive-behavioural intervention including sleep hygiene training, bedtime routine development, cognitive restructuring, relaxation training, stimulus control, sleep restriction, bedtime fading, and problem-solving, along with clinically indicated individualization. Results: Outcomes demonstrated clinically meaningful improvements and decreased variability in sleep parameters following intervention. Each participant's sleep log data indicated improvement in, or maintenance of, adequate total sleep time (TST), decreased sleep onset latency (SOL), improved sleep efficiency (SE), improvement in time of sleep onset, and decreased or continued low frequency of night awakenings (NA). Anecdotally, adolescents and parents reported improvement in daytime functioning, coping, and sense of wellbeing. Conclusions: These cases highlight the potential for cognitive-behavioural interventions to facilitate healthy sleep in adolescents with challenging sleep problems.

Glutamatergic receptor expression is mostly unknown in adults with fragile X syndrome (FXS). Favorable behavioral effects of negative allosteric modulators (NAMs) of the metabotropic glutamate receptor subtype 5 (mGluR5) in fmr1 knockout (KO) mouse models have not been confirmed in humans with FXS. Measurement of cerebral mGluR5 expression in humans with FXS exposed to NAMs might help in that effort. We used positron emission tomography (PET) to measure the mGluR5 density as a proxy of mGluR5 expression in cortical and subcortical brain regions to confirm target engagement of NAMs for mGluR5s. The density and the distribution of mGluR5 were measured in two independent samples of men with FXS (N = 9) and typical development (TD) (N = 8). We showed the feasibility of this complex study including MRI and PET, meaning that this challenging protocol can be accomplished in men with FXS with an adequate preparation. Analysis of variance of estimated mGluR5 expression showed that mGluR5 expression was significantly reduced in cortical and subcortical regions of men with FXS in contrast to age-matched men with TD.

Multiple lines of evidence suggest that a deficiency of Fragile X Mental Retardation Protein (FMRP) mediates dysfunction of the metabotropic glutamate receptor subtype 5 (mGluR5) in the pathogenesis of fragile X syndrome (FXS), the most commonly known single-gene cause of inherited intellectual disability (ID) and autism spectrum disorder (ASD). Nevertheless, animal and human studies regarding the link between FMRP and mGluR5 expression provide inconsistent or conflicting findings about the nature of those relationships. Since multiple clinical trials of glutamatergic agents in humans with FXS did not demonstrate the amelioration of the behavioral phenotype observed in animal models of FXS, we sought measure if mGluR5 expression is increased in men with FXS to form the basis for improved clinical trials. Unexpectedly marked reductions in mGluR5 expression were observed in cortical and subcortical regions in men with FXS. Reduced mGluR5 expression throughout the living brains of men with FXS provides a clue to examine FMRP and mGluR5 expression in FXS. In order to develop the findings of our previous study and to strengthen the objective tools for future clinical trials of glutamatergic agents in FXS, we sought to assess the possible value of measuring both FMRP levels and mGluR5 expression in men with FXS. We aimed to show the value of measurement of FMRP levels and mGluR5 expression for the diagnosis and treatment of individuals with FXS and related conditions. We administered 3-[18F]fluoro-5-(2-pyridinylethynyl)benzonitrile ([18F]FPEB), a specific mGluR5 radioligand for quantitative measurements of the density and the distribution of mGluR5s, to six men with the full mutation (FM) of FXS and to one man with allele size mosaicism for FXS (FXS-M). Utilizing the seven cortical and subcortical regions affected in neurodegenerative disorders as indicator variables, adjusted linear regression of mGluR5 expression and FMRP showed that mGluR5 expression was significantly reduced in the occipital cortex and the thalamus relative to baseline (anterior cingulate cortex) if FMRP levels are held constant (F(7,47) = 6.84, p < 0.001).These findings indicate the usefulness of cerebral mGluR5 expression measured by PET with [18F]FPEB and FMRP values in men with FXS and related conditions for assessments in community facilities within a hundred-mile radius of a production center with a cyclotron. These initial results of this pilot study advance our previous study regarding the measurement of mGluR5 expression by combining both FMRP levels and mGluR5 expression as tools for meaningful clinical trials of glutamatergic agents for men with FXS. We confirm the feasibility of this protocol as a valuable tool to measure FMRP levels and mGluR5 expression in clinical trials of individuals with FXS and related conditions and to provide the foundations to apply precision medicine to tailor treatment plans to the specific needs of individuals with FXS and related conditions.

Children and adolescents who present with various chronic pain experiences and associated functional disability often share common behavioral and clinical features. Caring for these patients is challenging to health care providers and expensive for the medical community. Given the complexity of interrelated medical, psychological, and environmental variables potentially involved, a biopsychosocial conceptualization of assessment and treatment is helpful. Recent research has been able to demonstrate the effectiveness of treating children and adolescents suffering from chronic pain within an interdisciplinary rehabilitation environment. An interdisciplinary inpatient behavioral rehabilitation approach is described in detail along with how it compares to related day-hospital pain programs and outpatient services.

Electroencephalograms (EEGs) and polysomnograms (PSGs) are critical and frequently ordered tests in the care of children with neurodevelopmental disabilities (NDD). Performing studies with this population can be very intimidating, given that the referral reasons and seizure types can be unique, and children with NDD may have any combination of behavioral or sensory challenges that can make it difficult to successfully complete a study. This article presents a variety of strategies that can be used to overcome these challenges through good preparation, patience, caregiver involvement, effective behavioral management techniques, and education about the medical aspects of EEG/PSG in NDD. This Technical Tips article features ideas and experiences from an EEG/PSG technologist, two board-certified child neurologists (one who is further certified in Clinical Neurophysiology, while the other is further certified in Sleep Medicine), and two behaviorally trained pediatric psychologists.

Comparison of behavior problems reported by mothers and teachers of 44 children (ages 6 to 15) with Down syndrome and 44 controls without mental retardation indicated that the Down syndrome children had more behavior problems, in particular attention deficit, noncompliance, thought disorder, and social withdrawal. Life events were associated with mother but not teacher ratings of Down syndrome behavior problems. (Author/DB)