1424RESPIRATORY CARE • SEPTEMBER 2011 VOL 56 NO 9Traditional airway maintenance and clearance therapy and principles of application are similar for neonates, children, and adults. Yet there are distinct differences in physiology and pathology between children and adults that limit the routine application of adult-derived airway-clearance techniques in children. This paper focuses on airway-clearance techniques and airway maintenance in the pediatric patient with acute respiratory disease, specifically, those used in the hospital environment, prevailing lung characteristics that may arise during exacerbations, and the differences in physiologic processes unique to infants and children. One of the staples of respiratory care has been chest physiotherapy and postural drainage. Many new airway clearance and maintenance techniques have evolved, but few have demonstrated true efficacy in the pediatric patient population. Much of this is probably due to the limited ability to assess outcome and/or choose a proper disease-specific or age-specific modality. Airway-clearance techniques consume a substantial amount of time and equipment. Available disease-specific evidence of airway-clearance techniques and airway maintenance will be discussed whenever possible. Unfortunately, more questions than answers remain.

A novel optical biosensor matrix has been developed to exploit the native fluorescence of certain proteins. This matrix uses a gold colloid monolayer attached to an end of a fiber as a substrate for protein attachment. The effect of the gold monolayer size has been investigated through the techniques of fluorescence, scanning electron microscopy, and transmission electron microscopy. It has been shown that the size ofthe gold colloid does produce a marked difference in the fluorescence intesity measured. It is surmised through the use of microscopy techniques that the intensity changes seen in the fluorescence emission are not a result of surface coverage, or availability of sites for protein adsorption, but instead of quenching or enhancement by the gold itself.

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A low-temperature scanning confocal and near-field optical microscope Rev.