bluuebunny/crossref_metadata_2025 huggingface dataset:
Eu vi sobre o rio a pele… sobre a pele, mapa… sobre mapas, vidas...
Authors: Leão Cláudia , Peixoto Luana , Leão Dimitria
Published: January 2021

Este ensaio é constituído de excertos de textos, poesias, imagens, e principalmente das experiências vividas ao longo de mais de seis anos de trabalhos entre os projetos: Navs e Paisagem: diário de bordo entre Belém (2013) e Chaves, Atlas, Paisagem e Pele: Fluxos de Viagem na Amazônia Insular(2015) que integraram o projeto de pesquisa “Sobre a Pele, o rio: a paisagem no território da cultura atravessando o campo da arte”. As ações se estendem ainda hoje, continuando com a força e a colaboração de pessoas, na tentativa de atingir outros circuitos, expandir limites e fronteiras, para além do campo da arte, para pensar especialmente sobre o que foi imposto como projeto de “desenvolvimento” amazônico e para quem, e principalmente pensar as especificidades e autonomias de povos das Amazônias.
Discounted cash flow valuation of conventional and cage-free production investments
Authors: Trejo-Pech Carlos J.O. , Thompson Jada M.
Published: January 2021

This study compares profitability and risk of conventional and cage-free egg production in the United States. Evaluating cage-free production is particularly relevant given ongoing consumer driven changes and new cage-free legislation. Results show that while the Modified Internal Rate of Return (MIRR) for conventional production is above an estimated industry opportunity cost of capital, cage-free production’s MIRR does not fully satisfy investors’ expectations. The MIRR of cage-free investment, between 5.6% (deterministic model) and 8.0% (stochastic) per 15-month flock, is below the 9.4% opportunity cost of capital. In addition, the simulations show that there is a 90% probability of conventional production’s MIRR falling between 18.5 and 20.3% per 15-month flock, and cage-free egg production’s MIRR ranging from 6.8 to 9.4%. In order for cage-free to be as equally profitable as conventional production, cage-free egg prices at the farmer gate should be 74% over conventional egg prices. Such high cage-free egg prices are highly unlikely to occur given recent cage-free price premia and consumer willingness to pay estimates from recent research. This study provides a framework egg producers can use to evaluate the potential effects of changes in their portfolio of products (i.e. conventional and cage-free mix) as they accommodate production schedules in this evolving industry.
Population administration service satisfaction in Lima Puluh Kota District, West Sumatera
Authors: Meironi Meironi , Taifur Werry Darta , Bachtiar Nasri
Published: January 2021

Assessment of public satisfaction with an agency's performance that organizes public services needs to be assessed by involving all service attributes because service attributes cannot stand alone, and performance improvement cannot be made separately. Assessment of service attributes is one way to track consumer ratings so that service providers can understand the causes of service problems. This study uses the Importance Performance Analysis (IPA) method. From this study, it was found that the priority that needs to be improved to improve public satisfaction with population administration services is to increase the discipline of officers in serving the community, certainty of service costs, and speed of service.
The Appearance of an Interminable Natural History and its Ends Foucault’s Lectures on The Birth of Biopolitics at the Collège de France 1979
Authors: Raffnsøe Sverre , Eliassen Knut Ove
Published: January 2021

While the analysis of liberalism fills much of The Birth of Biopolitics, the focus of Foucault’s discussion is on the dynamic, equivocal and enigmatic contemporary condition at the intersection of welfare governance, biopolitics and neo-liberalism of the late seventies. This article examines The Birth of Biopolitics as a prolongation of Security, Territoriality and Population by analyzing how Foucault frames liberalism in the wider historical context of governmentality.

In Foucault’s view, governmentality should be understood as a secular rationalization of the art of government. While the pastoral power of the Catholic Church was wielded against the backdrop of eschatology and the imminence of the end of worldly power, the early modern concept of reason of state brought with it the idea of an interminable history. Governmentality and reason of state spring from an undecided and precarious European balance of power between competing states. In order to measure up to external competition, individual states are required to develop a system of policing that collects detailed knowledge of the body politic. Insofar as the logic of the population as a collection of living beings comes to the fore as a primary target of government intervention, the imperatives of biopolitics and the politics of health arise.

Liberalism forms an important modification of the double heritage of reason of state and biopolitics. This is a rationalization of government that, rather than breaking with the fundamental assumptions of governmentality, critically addresses the basic criteria for good government. Stressing the necessity for good government to acknowledge and incorporate the self-regulation of the population it governs, liberalism thus articulates a new kind of naturalness intrinsic to the population springing from the interaction between individuals motivated by self-interest. As a basic principle for its understanding of governing, liberalism embraces a natural history without any transcendental horizons, a secular and tragic natural history in which freedom can never be taken for granted insofar as its participants constantly constitute a danger for one another. It is also a mode of history in which the art of government is constantly called upon and forced to organize and secure the conditions for the exercise and development of freedom. For Foucault, thus, the liberal art of government is not a position to be affirmed or denied. Rather, the liberal art of government draws the outline of an experience of historicity that is an experience of an ongoing and unsettling, but also unending, crisis.
ADDRESSING THE NEED OF TEACHING ENGLISH FOR SPECIFIC PURPOSE AT SMK KESEHATAN BAKTI ASSYUKUR
Authors: Trimaulana Robby , Efransyah Efransyah
Published: January 2021

CTL method is one of the teaching techniques where students work in a group. It is used to improve the student’s skill in mastering and understanding English vocabulary. This study tries to determine the effectiveness of teaching and learning at the tenth-grade students of Vocational School. The main goal of this research is to improve English language skills, especially in vocabulary understanding. The method of this research is classroom action research and the populations are the tenth-grade students of pharmacy which consist of nine students as sample randomly. The data collection was done by pre-test and post-test as research instruments. The results of this research that had been carried out during the study showed that the post-test average score (71,5%) is higher than the pre-test average value (49,3%). It shows that the CTL method is very effective in increasing students’ understanding of English, especially in the homonym vocabulary pronounciation and spelling words. Keywords:  ESP, CTL, Vocabulary, Teaching
AUTHENTICITY AND VALIDITY OF THE IELTS WRITING TEST AS PREDICTOR OF ACADEMIC PERFORMANCE
Authors: Mauriyat Arham
Published: January 2021

The International English Language Testing System (IELTS) has become one of the most widely used measurements of English proficiency in the world for academic, professional and migration purposes. For universities in particular, it is expected that applicants’ IELTS scores closely reflect their actual ability in communicating and doing their assignments in English. This study examines the authenticity and predictive validity of the writing section in the IELTS Academic Module by reviewing relevant research on IELTS within the last two decades. In general, those studies have provided evidence that the IELTS writing test suffers from low authenticity and predictive validity, and is thus an inaccurate predictor of a candidate’s performance in writing real-life academic tasks.
EXPLORING PARENTS’ HOME-BASED INVOLVEMENT IN THEIR CHILDREN’S ENGLISH LEARNING: TRIGGERS AND BARRIERS
Authors: Triutami Cicilia Siwi , Muljani Retno
Published: January 2021

In Indonesian context, English has been taught in elementary school level and parents’ involvement is considered as one of the influencing factors which has contribution to the children’s language learning achievement. The rapid, complex and continuous societal changes in this digital era might impact and alter the possibilities of parents’ involvement in their children’s language learning. The current study explored the triggers and the barriers of parents’ home-based involvement in their children’s English language learning and the features of their involvement. The qualitative research by implementing semi-structured, in- depth interview with four parents of elementary students at one of private schools in Yogyakarta city was conducted. The findings show the three main triggers in parents’ home-based involvement namely: (1) parents’ belief of the importance of English, (2) the implementation of school technological learning tools and (3) parents’ expectation of their children academic achievement. While the barriers that parents encounter in their involvement are: (1) parents’ lack of time, (2) parents’ unproficiency in English and (3) parents’ unfamiliarity with the use of technological tools. As the features of involvement, the study reveals parents’ monitoring, accompaniment, assistances in their children’s home-learning activities, providing some additional English learning media and financing English private course. Keywords:  Barriers, Children’s English Language Learning, Parents’ Home-Based Involvement, Triggers
TIEMPO DE PANDEMIA, TIEMPO DE DESIGUALDADES. DERECHO A LA EDUCACIÓN Y TRABAJO DOCENTE EN EL ECUADOR
Authors: Robalino Magaly
Published: January 2021

Este trabajo recorre algunos aspectos de la compleja situación que ha vivido la educación en el Ecuador en el periodo de la emergencia sanitaria a causa de la pandemia del Covid 19. Levanta temas cruciales que han jugado en contra del derecho a la educación; releva el papel central que han tenido los docentes y las familias; y, coloca algunos desafíos para el futuro próximo orientados a recuperar el sentido de lo público, a reinventar la educación bajo la condición de conectar con cambios estructurales que pongan en el centro de la agenda política del país: la educación, la salud, el empleo y la protección social con un enfoque de inclusión a todas y todos.
The relative importance of stochastic and deterministic processes on bryophyte community assembly changes with scale
Authors: Medina Nagore , Calatayud Joaquin , Ladle Richard , Lara Francisco , Draper Isabel , Mazimpaka Vicente , Hortal Joaquín
Published: January 2021

Studies focused on the drivers of change in species composition often
fail to integrate several aspects of beta diversity and scale. Here, we
assess the impact of species pool, environmental gradients, geographic
distance, and spatial scale on the diversity of epiphytic bryophytes. We
identify biogeographic modules of co-occurring species using network
analyses. For each biogeographic unit we study the effects of
environment, abundance structure of the community and geographic
distance on beta diversity. We analyse two aspects of beta diversity
related to different scales of analysis: between-forests dissimilarity
in species composition and within-forests heterogeneity in species
composition. We show that the structuring of the communities is a
by-product of niche-related and stochastic processes. The balance of
these processes changes with biogeographic region and scale, neutral
stochastic effects are more significant in the most favourable regions
and for small-scale within-forest heterogeneity
Utilizzo del modello Calpuff per la valutazione della qualità dell'aria
Authors: Ferruzzi Annamaira Shara , Rizzo Davide
Published: January 2021

La legislazione europea e il suo recepimento nella normativa nazionale
incoraggiano lo sviluppo e l’uso di sistemi modellistici di qualità
dell’aria che sono considerati di primaria importanza nelle valutazioni
preliminari di qualità e utili per completare il contenuto informativo
delle misure dirette. Il funzionamento dei modelli di dispersione
consiste nel simulare gli effetti di una o più sorgenti di emissione in
termini di concentrazione degli inquinanti emessi in corrispondenza di
fissati recettori. Il presente articolo analizza il sistema modellistico
Calpuff applicato ad un caso studio sull’impianto di processo di
un’azienda chimica di Ferrara per valutarne il comportamento.
Heart Transplantation - Part II: Aspects of Procedure and Medical Management
Authors: Givertz Michael M.
Published: January 2021

Ischemic time, defined as the period from donor procurement to surgical implantation and restoration of intrinsic allograft function, is an independent risk factor for post-transplant mortality. In general, the ischemic time should be less than 4 hours.  Most programs will accept donor hearts from within their own UNOS region or within a radius of 500 to 1000 miles to minimize ischemic time.  Given the prevalent use of ventricular assist devices (VAD) as bridge to transplant and the increased time required to explant both the native heart and VAD hardware, patients must live within 2-3 hours (by car or air) of the transplant center.  Coordinating the donor harvest and recipient preparation requires close collaboration between multiple surgeons, surgical teams and coordinators.
This review contains 11 figures, 7 tables, and 52 references.
Key words: heart transplant, immunosuppression, allograft rejection, infection, hypertension, hyperlipidemia, diabetes, malignancy, cardiac allograft vasculopathy, survival
Nerve Sheath Tumors: Malignant peripheral nerve sheath tumors, Schwannomas, and Neurofibromas
Authors: Torres Keila E , Wang Wei-Lien , Lazar Alexander , McCutcheon Ian E
Published: January 2021

Peripheral nerve sheath tumors represent a spectrum of entities ranging from benign tumors, such as schwannoma, to high-grade malignant tumors termed malignant peripheral nerve sheath tumors. In this chapter, we discuss current concepts and problematic areas in the diagnosis, treatment, and management of peripheral nerve sheath tumors. We discuss the major categories of nerve sheath tumors including schwannomas, neurofibromas, and malignant peripheral nerve sheath tumors. The different benign variants and their propensity for malignant transformation are highlighted. We suggest useful guidelines for the surgical management of these challenging cases. Finally, we discuss some of the advances in molecular biology that have provided new insights into the nature of the various peripheral nerve sheath tumors and suggest potential novel targeted therapeutic strategies for these tumors.

This review contains 11 figures, 5 tables and 66 references.
Key Words: malignant peripheral nerve sheath tumors, nerve sheath tumor, neurofibroma, neurofibromatosis, schwannoma, schwannomatosis, NF1, NF2
Performance Measurement in Surgery
Authors: Dimick Justin B.
Published: January 2021

With growing recognition that the quality of surgical care varies widely, good measures of performance are in high demand. An ever-broadening array of performance measures is being developed to meet these different needs; however, considerable uncertainty remains about which measures are most useful for measuring surgical quality. Current measures encompass different elements of health care structure, process of care, and patient outcomes. This review covers overview of surgical quality measures, categories of quality measures, structural measures of quality, process of care measures, direct outcome measures, matching the measure to the purpose, improving existing performance measures, and the future of performance measurement. Figures show relative ability of historical (2005-2006) measures of hospital volume and risk-adjusted mortality to predict subsequent (2007-2008) risk-adjusted mortality in US Medicare patients,  risk-adjusted mortality and morbidity for colon resection at individual hospitals before and after adjustment for reliability, variation in surgeon technical skill for 20 bariatric surgeons performing laparoscopic gastric bypass in the Michigan Bariatric Surgery Collaborative (MBSC), and relationship of surgeon technical skill and risk-adjusted complications and resource use after laparoscopic gastric bypass in the MBSC. The table lists primary strengths and limitations of structure, process, and outcome measures.
 
This review contains 4 highly rendered figures, 1 table, and 34 references
Evidence-Based Surgery
Authors: Bilimoria Karl Y. , Brooke Benjamin S
Published: January 2021

The practice of surgery has undergone a dramatic evolution over the last century with the availability of new scientific evidence supporting different surgical techniques and management.  Evidence-based surgery is defined as the judicious and systematic application of scientific evidence to surgical decision making and the establishment of standards of surgical care. This includes efforts to appraise the strength of scientific evidence and evaluate the quality of research studies or evidence, as well as efforts to interpret and apply evidence to clinical practice. In this review, we discuss important methodology and approaches in surgical health services research to accomplish these goals and improve the quality of care in surgery. By providing this overview, we hope readers will be able to navigate the surgical literature and apply evidence-based science to their own surgical practice.
This review contains 1 figure, 3 tables, and 43 references.
Key words: bias, comparative effectiveness, confounding, evidence, external validity, implementation science, internal validity, pragmatic trials, quality, risk adjustment, surgery
Value-Driven Nonemergent Surgical Care
Authors: Sosa Julie Ann , Najjar Peter A
Published: January 2021

As healthcare expenditures rise, payers and providers have increasingly recognized the importance of measuring and improving value. Surgical care accounts for a significant percentage of total healthcare expenditures in the United States, and efforts to improve value globally must take into account the unique challenges and opportunities specific to elective surgical care. This situation makes it essential that surgeons have a thorough understanding of surgical value, its measurement, improvement, and incentivization efforts predicated on it. Toward that end, this review (1) explores the fundamental concept of value in healthcare, particularly as applied to surgery, (2) surveys the challenges in measuring surgical cost and quality, (3) describes the framework of value improvement, (4) identifies selected tools to help surgeons improve the value of care provided, and (5) discusses the increasing role that value-based competition is likely to play in the American healthcare industry.
This review contains 5 figures, 3 tables, and 56 references.
Key Words: healthcare costs, quality improvement, surgery, surgical value, value, value-based competition, value improvement
Enhanced Recovery Pathways: Organization of Evidence-Based, Fast-Track Perioperative Care
Authors: Feldman Liane S. , Baldini Gabriele , Lee Lawrence , Carli Franco
Published: January 2021

Enhanced recovery pathways (ERPs) are standardized coordinated, multidisciplinary perioperative care plans that incorporate evidence-based interventions to minimize surgical stress, improve physiologic and functional recovery, reduce complications, and thereby facilitate earlier discharge from the hospital. Several perioperative elements contribute to enhance surgical recovery. Preoperative elements include patient education, optimization of medical conditions and functional status, nutritional support, smoking cessation programs, minimization of preoperative fasting and preoperative carbohydrate drinks, avoidance of mechanical bowel preparation when not indicated, and avoidance of long-active sedatives as premedication. Intraoperative elements aim to attenuate the surgical stress response and include regional or local anesthesia; pharmacologic adjuvants, nonopioid analgesics, and maintaining normothermia; intravenous fluid management; and opting to favor small incisions when possible. Postoperative elements include considering multimodal analgesia (opioid-sparing strategies); encouraging early postoperative feeding; stressing the importance of early mobilization; restricting the unnecessary use of intravenous fluids, drains, and catheters; and instituting a discharge and follow-up plan for patients. Tables describe the evolution of intraoperative fluid management, organization of a multimodal perioperative care plan for a specific procedure or group of procedures; key elements to include in developing an ERP; sample multimodal perioperative care plans for elective colorectal resection, esophageal resection, and ambulatory laparoscopic cholecystectomy.
This review contains 1 figure, 6 tables, and 319 references.
Reoperative Pelvic Surgery
Authors: Dozois Eric J. , Chu Daniel I.
Published: January 2021

Reoperative pelvic surgery is technically challenging and carries with it significant potential risk. Pelvic pathology that requires reoperative surgery typically involves recurrent malignancies, complications from ileal pouch-anal anastomoses (IPAA) for inflammatory bowel disease, complications from low pelvic anastomoses, and palliative situations. The goals of reoperative pelvic surgery are resection/repair of the primary indication and reconstruction whenever possible. This review describes pelvic anatomy and operative management for recurrent rectal cancer. Complications following IPAA, low anastomotic complications, and palliative reoperative pelvic surgery are also detailed. Tables outline prognostic factors negatively impacting outcomes following surgery for recurrent rectal cancer, absolute and relative contraindications for exenterative surgery, survival following exenteration for recurrent rectal cancer, intraoperative radiotherapy doses related to resection margin, indications for reoperative pouch surgery, and mobilization techniques for difficult reconstructions. Figures show anterior and posterior exenteration; the anatomy of presacral space after rectal mobilization; vascular exposure and dissection; unicortical transverse osteotomy; placement of Silastic mesh; division of the sacrospinous and sacrotuberous ligaments and piriformis muscle; posterior sacral osteotomy; transperineal delivery of pedicled myocutaneous rectus flap; vertical rectus abdominis myocutaneous flap; gracilis flap; total thigh fillet flap; sacropelvic resection classification; and increasing colon length with primary, secondary, and tertiary maneuvers.
This review contains 18 figures, 6 tables, and 89 references.
Solitary Pulmonary Nodule
Authors: Pechet Taine T.V. , Okusanya Olugbenga T
Published: January 2021

The solitary pulmonary nodule is a common finding that is observed in more than 150,000 persons each year in the United States. Factors influencing probability of malignancy are discussed, including age and environmental factors. Investigative studies are described. Imaging includes chest radiography, computed tomography, and positron emission tomography. Biopsy can be excisional or performed via transthoracic needle or bronchoscopy. The differential diagnosis is broad and can include malignant or benign lesions. Malignant lesions include nonsmall cell lung cancer, small cell lung cancer, pulmonary neuroendocrine tumors, and metastatic malignancies. Benign lesions can include pulmonary hamartoma or inflammatory or infectious nodules. Few, if any, randomized controlled trials exist to direct management. Most clinicians rely on a combination of single-institution studies, a few prospective trials, and clinical acumen to assess a given patient's risk profile to inform decisions on invasive and noninvasive testing. In this review, the tables describe the differential diagnosis of a solitary pulmonary nodule, factors affecting malignant probability of a solitary pulmonary nodule, and the initial assessment of probability of cancer in a solitary pulmonary nodule.
This review contains 5 figures, 4 tables, and 73 references.
Key Words: bronchoscopy, compute tomography, lung cancer, nodule, positron emission tomography, solitary
Paralyzed Diaphragm
Authors: Onders Raymond P. , Linden Philip A.
Published: January 2021

Diaphragmatic dysfunction may be unilateral or bilateral, with symptoms ranging from dyspnea only on extreme exertion to ventilator dependence. The etiology, treatment, and prognosis are quite different in unilateral and bilateral paralysis. A paralyzed hemidiaphragm may occur in isolation or as part of a systemic disease, whereas bilateral diaphragmatic paralysis usually occurs as a result of a traumatic or neuromuscular degenerative process. This review covers clinical evaluation, investigative studies, and management of diaphragmatic dysfunction. Figures show diaphragmatic motion during respiration, a postoperative radiograph from a 55-year-old woman who underwent left upper lobectomy, a postoperative radiograph of a 70-year-old man who underwent left upper lobectomy for removal of a peripheral 3 cm lesion, three chest radiographs of a 25-year-old man with a residual anterior mediastinal mass after treatment for germ cell tumor, chest radiograph showing left diaphragmatic paralysis in a breast cancer patient with malignant adenopathy involving the left phrenic nerve near the left main pulmonary artery, several parallel rows of sutures placed in the muscular portion and central tendon of the diaphragm and tied with the aid of a knot pusher, a laparoscopic mapping probe  held onto the left diaphragm with suction and which receives electrical stimuli from an external clinical station, an electrode implant device that houses the electrode in the needle and is placed into the diaphragm tangentially, and the diaphragm pacing system programmed for conditioning and attached via percutaneously placed diaphragm electrodes in a spinal cord-injured child for early conditioning and weaning from the ventilator. Tables list causes of isolated diaphragmatic paralysis, general causes of unilateral and bilateral diaphragmatic paralysis, and differential diagnosis of elevated hemidiaphragm on chest radiograph. A video shows current technique of laparoscopic diaphragm pacemaker insertion.
 
This review contains 9 highly rendered figures, 3 tables, 1 video, and 22 references
Tumors of the Stomach and Small Bowel
Authors: Wayne Jeffrey D. , Knab L. Mark , Bentrem David J.
Published: January 2021

The overall incidence of gastric carcinoma has decreased in the past few decades, but it remains the second leading cause of cancer death worldwide. Malignant tumors of the small intestine are rare, and account for fewer than 5% of all gastrointestinal tract malignancies. This review details the classification, risk factors, clinical evaluation, investigative studies, staging, management, and follow-up and management of recurrent disease in gastric adenocarcinoma; in addition, it examines nonadenocarcinomatous gastric malignancies and small bowel malignancies. 
This review contains 7 figures, 16 tables, and 92 references.
Keywords:Gastric adenocarcinoma, gastrointestinal stromal tumor, gastric lymphoma, Helicobacter pylori, small bowel adenocarcinoma, surgical resection, staging, chemotherapy, radiation therapy
Pulsatile Abdominal Mass
Authors: Upchurch Jr Gilbert R , Perry Robert J.T.
Published: January 2021

When a pulsatile abdominal mass is found, the patient’s medical and surgical histories, the location of the mass, and the associated symptoms are essential clues to formulating a diagnostic and treatment plan. The underlying condition may range in severity from benign to life threatening. Further evaluation is imperative because, depending on the source of the pulsatile mass, immediate transport to the operating room or endovascular suite may be necessary. Here, the evaluation and management of patients presenting with pulsatile abdominal masses in both the emergent and elective settings are discussed. The careful selection of patients appropriate for repair, an evidence-based approach to imaging and risk stratification, and new techniques in resuscitation of and endovascular or hybrid approaches to patients with ruptured aneurysms are emphasized. Figures show a diagnostic and treatment algorithm for the patient presenting with a pulsatile abdominal mass, computed tomography (CT) image of a pulsatile abdominal mass distorting the anterior abdominal wall, CT image of an isolated right iliac artery aneurysm, CT image of a previous endovascular repair with kinking of the left iliac limb, aortic color flow duplex ultrasound image of a ruptured abdominal aortic aneurysm  following aneurysm repair, a CT image of a ruptured aortic aneurysm, and an aortic occlusion balloon used to obtain proximal control in a ruptured infrarenal abdominal aneurysm. The video shows pulsations in the abdominal wall in a patient with a large aneurysm. Tables list classification of endoleaks, anatomic considerations for endovascular repair of aortic aneurysms using Food and Drug Administration-approved endografts, recommended surveillance intervals by aneurysm size, comparison of factors used to estimate risk in the Revised Cardiac Risk Index and the American College of Surgeons National Surgical Quality Improvement Project Myocardial Infarction or Cardiac Arrest, and risk factors for the prediction of long-term mortality following elective abdominal aortic aneurysm repair.
 
This review contains 7 highly rendered figures, 1 video, 5 tables, and 92 references
Varicose Vein Surgery
Authors: Markovic Jovan N. , Shortell Cynthia K.
Published: January 2021

Chronic venous insufficiency (CVI) is a common vascular disorder that affects a significant proportion of the population in the United States and other developed countries. In its advanced stages, CVI significantly reduces patients’ quality of life and imposes a high economic burden on society due to increased direct health care costs and reduced productivity. Favorable clinical results associated with endovascular ablation techniques and patient preference for minimally invasive procedures has led to a shift in which treatment of vein disease is moving from the hospital to the office, allowing a more diverse group of physicians to enter a field that had typically been the domain of surgeons. This chapter reviews the terminology associated with venous disease, indications for varicose vein surgery, preoperative evaluation, procedural planning, endovenous procedures (endovenous laser ablation, radiofrequency ablation), surgical vein stripping techniques, and foam sclerotherapy. Tables include Clinical severity, Etiology or Cause, Anatomy, Pathophysiology classification; summary of nomenclature changes for the lower extremity venous system; indications for varicose vein surgery; interrogation points in the venous reflux examination; complications associated with treatment modalities used in the management of CVI; and methods of variceal ablation. Figures show an ultrasonographic image of a saphenous eye, placement of a quartz fiber for laser ablation of the great saphenous vein, a typical saphenofemoral junction, surgical stripping  of the great saphenous vein, and microfoam sclerotherapy.
This review contains 9 figures, 6 tables and 73 references.
Injuries to Great Vessels of the Abdomen
Authors: Feliciano David V. , Asensio Juan A.
Published: January 2021

In patients who have injuries to the great vessels of the abdomen, the findings on physical examination generally depend on whether a contained hematoma or active hemorrhage is present. This review covers resuscitation in profoundly hypotensive patients, damage control resuscitation, injuries in zones 1, 2, and 3, injuries in the porta hepatis or retrohepatic area, damage control laparatomy, endovascular therapies, and complications. Figures show algorithms illustrating management of intra-abdominal hematoma found at operation after penetrating trauma and blunt trauma; left medial visceral rotation performed by sharp and blunt dissection with elevation of the left colon, the left kidney, the spleen, the tail of the pancreas, and the gastric fundus; an autopsy view of the supraceliac aorta and the celiac axis, the proximal superior mesenteric artery, and the medially rotated left renal artery after removal of lymphatic and nerve tissue; injuries to the prepyloric area of the stomach and to the supraceliac abdominal aorta from a gunshot wound; a temporary intraluminal shunt inserted into the proximal superior mesenteric artery in a patient who had an adjacent injury to the neck of the pancreas after sustaining a gunshot wound; polytetrafluoroethylene patch repair of an injury to the infrarenal inferior vena cava; right perirenal hematoma and left external iliac artery and vein injury repaired with segmental resection and insertion of an 8 mm polytetrafluoroethylene graft and segmental resection and an end-to-end anastomosis, respectively. Tables list American Association for the Surgery of Trauma abdominal vascular organ injury scale, and survival rates after injuries to arteries and veins in the abdomen.
 
This review contains 9 highly rendered figures, 3 tables, and 89 references
Injuries to the Upper Urogenital Tract
Authors: Vanni Alex J. , Wessells Hunter
Published: January 2021

Traumatic injury to the upper urinary tract usually results from multisystem trauma. The kidney is the most commonly injured urologic organ and accounts for nearly one quarter of all solid-organ traumatic injuries. Ureteral injuries are difficult to diagnose and must be suspected based on the mechanism of injury. These injuries, although rarely fatal, may result in significant morbidity and permanent disability if not promptly evaluated and treated. Modern urologic trauma management with rapid computed tomography and a focus on nonoperative management have dramatically changed the field of urologic trauma. Additionally, improvement in angiography and selective embolization allows treatment of active arterial or delayed renal bleeding. Although fewer injuries require operative management, exploration is still required for hemodynamically unstable patients.
Key words: kidney injury, kidney trauma, upper urinary tract trauma, ureteral injury, ureteral trauma
Injuries to the Lower Urogenital Tract and Genitalia
Authors: Vanni Alex J.
Published: January 2021

Injury to the lower urinary tract may involve multiple organs depending on the mechanism of injury, often requiring the collaboration of both trauma and orthopedic surgeons. Although blunt trauma to the lower urogenital tract and genitalia is much more common than penetrating trauma, both mechanisms of injury can produce life-altering injury. Prompt diagnosis is imperative for optimal outcomes and may require computed tomography, ultrasonography, and urethrography to delineate the extent of injury. The nature and variety of injuries require a combination of minimally invasive, open, and plastic surgical techniques for optimal management. Particular attention is required for possible female reproductive organ injury, particularly in the setting of sexual assault.
 
Key words: bladder injury, penile amputation, penile fracture, penile injury, scrotal trauma, urethral injury, urogenital trauma
Acute Kidney Injury
Authors: Ebadat Aileen , Bui Eric , Brown Carlos V. R.
Published: January 2021

Acute renal failure definitions have changed dramatically over the last 5 to 10 years as a result of criteria established through the following consensus statements/organizations: RIFLE (Risk, Injury, Failure, Loss of function, End stage renal disease), AKIN (Acute Kidney Injury Network), and KDIGO (Kidney Disease: Improving Global Outcomes). In 2002, the Acute Dialysis Quality Initiative was tasked with the goal of establishing a consensus statement for acute kidney injury (AKI). The first order of business was to provide a standard definition of AKI. Up to this point, literature comparison was challenging as studies lacked uniformity in renal injury definitions. Implementing results into evidence-based clinical practice was difficult. The panel coined the term “acute kidney injury,” encompassing previous terms, such as renal failure and acute tubular necrosis. This new terminology represented a broad range of renal insults, from dehydration to those requiring renal replacement therapy (RRT). This review provides an algorithmic approach to the epidemiology, pathophysiology, diagnosis, prevention, and management of AKI. Also discussed are special circumstances, including rhabdomyolysis, contrast-induced nephropathy, and hepatorenal syndrome. Tables outline the AKIN criteria, most current KDIGO consensus guidelines for definition of AKI, differential diagnosis of AKI, agents capable of causing AKI, treatment for specific complications associated with AKI, and options for continuous RRT. Figures show the RIFLE classification scheme and KDIGO staging with prevention strategies.

This review contains 1 management algorithm, 2 figures, 6 tables, and 85 references.
Keywords: Kidney, renal, KDIGO, azotemia, critical, urine, oliguria, creatinine, dialysis
Hospital Infections
Authors: Dellinger E Patchen , Evans Heather L. , Eaton Erik G. Van
Published: January 2021

Nosocomial infections are a threat to all hospitalized patients. They can increase morbidity, mortality, length of stay, and costs and occur in almost every body site. This review features an algorithmic approach to the risk, detection, and treatment of nosocomial infections. Respiratory infections include pneumonia, tracheitis or tracheobronchitis, paranasal sinusitis, and otitis media. Operative site or injury-related infections include those occurring in wounds, the intra-abdominal space, methicillin-resistant Staphylococcus aureus (MRSA), empyema, posttraumatic meningitis, osteomyelitis, and sternal and mediastinal infection. A review of intravascular device--associated infection focuses on catheter-related bacteremia and its management. Catheter-associated urinary tract infections (UTIs) and enteric infections are also considered. Enteric infections and transfusion-associated infections are covered in depth, reviewing the most important recent advances and studies. A discussion of postoperative fever addresses the magnitude and incidence of hospital infections, UTIs, and catheter duration and pathogens typically involved and considers the associated costs and the risks of acquiring a nosocomial infection.
This review contains 5 figures, 1 table,1 algorithm, and 292 references.
Intra-abdominal Infection
Authors: Sawyer Robert G. , Dietch Zachary C. , Shah Puja M.
Published: January 2021

The basic principles of rapid diagnosis, timely physiologic support, and definitive intervention for intra-abdominal infections have remained unchanged over the past century; however, specific management of these conditions has been transformed as a result of numerous advances in technology. This review covers clinical evaluation, investigative studies, options for intervention, early source control and duration of antimicrobial therapy, infections of the upper abdomen, infections of the lower abdomen, other abdominal infections, and special cases. Figures show an algorithm outlining the approach to a suspected upper abdominal infection, abnormal abdominal ultrasounds showing calculi in the gallbladder and confirming the diagnosis of acute acalculous cholecystitis, endoscopic retrograde cholangiopancreatographies showing a distal common bile duct stone in acute pancreatitis, extrinsic compression of the common hepatic duct by a stone in the Hartmann pouch, and endoscopic sphincterotomy for acute biliary decompression in acute obstructive cholangitis, air outlining the gallbladder and bile ducts in emphysematous cholecystitis, abdominal and pelvic CT scans showing pancreatic findings graded by Ranson into five categories, a splenic abscess, an inflamed and thickened appendix with surrounding fat stranding, appendiceal perforation and abscess formation, diverticulitis with a small amount of extraluminal air, left lower quadrant fluid collection consistent with peridiverticular abscess, diffuse inflammation and right upper quadrant extraluminal air, and thickening of the colonic wall with both intramural and extramural air, an algorithm outlining the approach to the patient with a suspected lower abdominal infection, upright chest x-ray and abdominal CT scans of patients with sudden-onset diffuse abdominal pain, and an omental (Graham) patch. Tables list diagnostic indicators of upper abdominal pain and fever, comparison of acute cholecystitis and emphysematous cholecystitis, Hinchey system for classification of perforated diverticulitis, Centers for Disease Control and Prevention (CDC) guidelines for diagnosis of pelvic inflammatory disease, and CDC guidelines for antibiotic treatment of pelvic inflammatory disease.
This review contains 16 highly rendered figures, 5 tables, and 238 references
Thoracic Outlet Syndrome
Authors: Fugate Mark W , Freischlag Julie A
Published: January 2021

Thoracic outlet syndrome (TOS) is a condition caused by compression of the neurovascular structures leading to the arm passing through the thoracic outlet. The incidence of TOS is reported as 0.3 to 2% in the general population. There are three distinct types of TOS: neurogenic (95%), venous (4%), and arterial (1%). Treatment algorithms depend on the type of TOS. Arterial and venous TOS often present urgently with arterial or venous thrombosis, which is fairly easily identified by thorough history taking and a physical examination. Diagnosis is also aided by duplex ultrasonography. Restoration of arterial or venous flow can often be readily accomplished by thrombolysis. More important, however, is the diagnosis of the underlying structural component involved in the development of symptoms. Although statistically the most common, neurogenic TOS is often the most difficult to diagnose and treat. There are good data indicating that appropriately selected patients benefit from surgical therapy for neurogenic TOS as well. To prevent recurrence of symptoms, patients must undergo first rib resection and anterior scalenectomy, as well as resection of any rudimentary or cervical ribs. Regardless of the type of TOS encountered, proper therapy requires a thorough diagnostic evaluation and multimodal treatment.
Keywords: thoracic outlet syndrome, arterial thoracic outlet syndrome, neurogenic thoracic outlet syndrome, venous thoracic outlet syndrome, TOS, effort thrombosis, thoracic outlet decompression
Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care
Authors: Stafman Laura , Reddy Sushanth
Published: January 2021

In 2005, Terri Schiavo collapsed at home and was found by her husband without respirations or a pulse. She was resuscitated, but suffered severe anoxic brain injury and after 21/2 months was diagnosed as being in a persistent vegetative state. A court appointed her husband as her legal guardian as she did not have a written advance directive and had not specified a power of attorney for health care (POAHC), but heated court battles raged between her husband and her parents regarding who should be making decisions and what the appropriate decisions were. This case highlights the importance of writing down instructions for end-of-life care or designating someone to make decisions in their best interest in the event they could not make these decisions themselves. This review covers advance directives, do-not-resuscitate orders, and POAHC. Figures show an extended values history form, an example of a living will, the California’s Physician Orders for Life-Sustaining Treatment form, components of the CURVES mnemonic to assess decision-making capacity in critical/emergency situations, and activation and deactivation of power of attorney for health care. Tables list the most common types of advance directive and description of each, barriers to the use of advance directives, common themes in surgeons’ attitudes regarding advance directives, general requirements and exclusions for POAHC, and requirements for decision-making capacity in patients.
This review contains 5 figures, 8 tables, and 58 references
Keywords: Advance directives, power of attorney in health care, do not resuscitate order, decision-making, end-of-life, critical care
Evidence-Based Medicine
Authors: Winslow Emily R.
Published: January 2021

Descriptions of “evidence-based” approaches to medical care are now ubiquitous in both the popular press and medical journals. The term evidence-based medicine (EBM) was first coined in 1992, and over the last two decades, the field has experienced rapid growth, and its principles now permeate both graduate medical education and clinical practice. The field of EBM has been in constant evolution since its introduction and continues to undergo refinements as its principles are tested and applied in a wide variety of clinical circumstances. This review presents a brief history of EBM, EBM: fundamental tenets, a critical appraisal of a single study, reporting guidelines for single studies, a critical appraisal of a body of evidence, evidence-based surgery, and limitations in EBM. Tables list strength of evidence for treatment decisions (EBM working group), Oxford Centre for Evidence-Based Medicine revised levels of evidence for treatment benefits , “4S” approach to finding resources for EBM, critical appraisal of individual studies examining therapeutic decisions, reporting guidelines by study design, and key resources for evidence-based surgery.
This review contains 6 tables and 85 references
Molecular Genetics of Cancer
Authors: Kennedy Gregory D. , Lee Christina W.
Published: January 2021

Cancer involves an accumulation of genetic alterations that result in a stepwise progression toward unregulated growth and invasion. Understanding the evolution of a normal cell to its neoplastic state, including knowledge of the precipitating genetic defects, is vital to the development of potential treatments to combat unregulated growth. This review discusses the accession of specific critical properties underlying neoplastic transformation. Specifically, the cell cycle, the primary characteristics of cancer (continuous growth signaling, insensitivity to growth inhibition, evasion of apoptosis, angiogenic potential, immortalization, and invasion or metastasis), and cancer therapeutics are described. Figures show a simplified schematic of the cell cycle, cyclin-CdK complex function during the cell cycle, growth factor binding receptors, the mechanism of oncogene production, various transmembrane tyrosine kinases, the translocation of Ig heavy and light chains to the Myc locus on chromosome 8 in Burkitt lymphoma, a translocation observed in chronic myelogenous leukemia, the INK4A locus, and the apoptotic pathway. Tables include nonexhaustive lists of oncogenes in human malignancies and selected tumor suppressor genes associated with inherited susceptibility.
This review contains 9 figures, 2 tables, and 186 references.
Nature and Clinical Impact of Physiologic Changes Associated with Aging
Authors: Moaven Omeed , Contreras Carlo M
Published: January 2021

This review highlights important age-related changes at the physiologic level and their clinical consequences. Latest societal guidelines and consensus expert opinions on pre- and perioperative management of elderly surgical patients are discussed. Age-related postoperative complications, including precipitating factors and appropriate management, are summarized. The latest advancements in the management of important surgical problems in geriatric populations are outlined.
This review contains 4 figures, 8 tables, and 103 references.
Key words: aging, elderly patient, immunosenescence