bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical Medicine and Rehabilitation: Modalities and Exercise
Authors: Calvino Steven , LaSalle Jacob , Fealey David
Published: January 2021

Function is the marker by which those in the medical profession treating patients with pain strive to improve. The profession of physical medicine and rehabilitation has, at its tenet, the goal of improving or even restoring physical function and therefore plays an integral role in the care of patients with pain. Physical modalities such as temperature therapy with both heat and cold; manual therapies, including manipulation, mobilization, massage, traction, and transcutaneous electrical nerve stimulation; and kinesio taping, are important adjunct therapies often employed in comprehensive rehabilitation programs. Although there is in general a lack of rigorous scientific evidence to support the use of these alternative modalities individually, their low-risk profiles, low cost, and ease of application combined with plenty of anecdotal evidence for their efficacy make them indispensable to the pain practitioner. Incorporating these adjunct therapies in conjunction with appropriate exercise protocols along with pharmacologic and interventional tools may place the pain patient at a distinct advantage, improving function and pain perception. In the following review, we introduce these concepts to allow guidance for incorporation into the treatment algorithm of common pain conditions.

 This review contains 16 figures, 2 tables and 79 references
Key words: cryotherapy, exercise, manipulation, manual, massage, mobilization, temperature, traction, transcutaneous electrical nerve stimulation
Acute Care: Pain Management
Authors: Ranniger Claudia
Published: January 2021

Pain is a chief complaint in more than 50% of emergency department (ED) visits. Injury accounts for approximately one-third of presentations associated with pain; other common diagnoses include neck and back pain, minor infections, abdominal pain, and headache. In the ED, pain is underdiagnosed and undertreated, and existing pain management practices in the ED are inconsistent.  Inadequate pain management is common, and pain remains unchanged or worsens during the ED visit for more than 40% of patients.  Patient satisfaction improves when expectations for pain control are met. This review covers the pathophysiology of pain and the practice of pain management. Figures show the approach to pain management in the ED, an example of a numerical and visual analog scale pain rating scale, field block of the pinna, ultrasound probe and hand position for ultrasound-guided regional anesthesia, regional anesthesia of the face, innervation of the hand and fingers, regional anesthesia of the median, radial and ulnar nerves, innervation of the foot, ultrasound-guided regional anesthesia of the posterior tibialis nerve, regional anesthesia of the sural nerve, and method of regional anesthesia of the dorsal foot. 
This review contains 13 figures, 15 tables, and 71 references.
Key words: Acute pain, Pain management, Oligoanalgesia, Pain assessment, Inadequate pain management, Acute pain management, Pain management in the emergency department, Pain in the ED, Pain presentation
Tenosynovitis Disorders of the Hand and Wrist
Authors: Aversano Michael , Paksima Nader
Published: January 2021

The diagnosis and treatment of patients with tenosynovitis disorders of the hand and wrist are complex and must take into account the heterogeneity and natural history of each condition. Although the goals of management are for the most part universal, the specific interventions and outcome measures used to reach these goals are wide ranging. This review serves to summarize some of the recent publications in the field of hand surgery that have made important contributions to our understanding and care of the patient with tenosynovitis. Updates in the field of hand surgery are constant, and the current level of evidence for the effectiveness of specific treatment modalities in patients with tenosynovitis of the hand and wrist was reviewed. We searched the PubMed database and identified clinical trials, meta-analyses, reviews, and guidelines contributing important findings and knowledge to extensor and flexor compartment tenosynovitis of the hand and wrist. Our understanding of tenosynovitis disorders of the hand and wrist continues to grow and expand. Nevertheless, a paucity of randomized controlled trials and higher evidence research may contribute to the variability in current practices among providers. By elucidating these gaps, we can more purposefully delegate our time and resources into targeted areas of research and treatment.
This review contains 10 figures, 1 table and 86 references.
Key words: corticosteroid injection, de Quervain disease, hand/wrist pain, tendonitis, tenosynovitis, trigger finger
Microsurgical Reconstruction of the Upper Extremity
Authors: Kazmers Nikolas H , Thibaudeau Stephanie , Steinberger Zvi , Levin L. Scott
Published: January 2021

The advent of free tissue transfer has revolutionized upper extremity reconstruction in the setting of trauma, infection, and oncologic resection. Current microsurgical techniques allow for soft tissue coverage, osseous reconstruction, and free functioning muscle transfer. This review highlights perioperative planning considerations in terms of the timing of reconstruction and flap choice, as well as indications and contraindications, for upper extremity microsurgical reconstruction. Many commonly used fasciocutaneous, muscle, and osseous free flap options are reviewed, with specific emphasis on surgically relevant anatomy, flap variations, and pearls and pitfalls. Many of these free flap options are illustrated using case examples.
This review contains 15 figures, 3 tables and 109 references.
Key words: bone defect, elbow, free flap, hand, microsurgery, reconstruction, upper extremity, wrist
Hypopharyngeal, Esophageal, and Neck Reconstruction
Authors: Chinn Steven B , Yu Peirong
Published: January 2021

Organ preservation protocols with radiotherapy have become the primary treatment for stage I to III laryngeal and hypopharyngeal carcinoma. Many pharyngoesophageal defects are the result of salvage laryngopharyngectomy following radiation failure, making reconstruction more challenging. Given the detrimental effects of radiation on wound healing, reconstruction bathed in saliva, and the frozen neck with poor recipient vessels, pharyngoesophageal reconstruction requires great attention to detail to avoid catastrophic complications. In this review, we detail the commonly used flaps for pharyngoesophageal reconstruction, including the radial forearm flap, anterolateral thigh flap, and jejunal flap. In recent years, the anterolateral thigh flap has become the optimal flap for this type of reconstruction due to its minimal donor-site morbidity and excellent functional outcomes. Use of a two-skin island anterolateral flap allows for pharyngoesophageal reconstruction with simultaneous neck resurfacing. The profundus artery perforator flap can be a good alternative to the anterolateral thigh flap, whereas the ulnar artery perforator flap may be a good alternative to the radial forearm flap in certain cases. We discuss recipient vessel selection and conclude by outlining important postoperative considerations.

This review contains 23 figures, 3 tables and 39 references
Key words: anterolateral thigh flap, anteromedial thigh flap, frozen neck, gastro-omental flap, hypopharynx, laryngeal cancer, perforator flaps, pharyngocutaneous fistula, pharyngoesophageal reconstruction, profundus artery perforator flap, radial forearm flap, tracheoesophageal puncture, transverse cervical vessels, ulnar artery perforator flap
Head and Neck Melanoma: An Overview
Authors: Kim Samuel , Narayan Deepak
Published: January 2021

Melanoma is one of the most common cancers in the United States, and its incidence has been steadily rising. Despite the increasing incidence, 5-year survival rates are over 90%, in large part due to early detection and advances in treatment. Head and neck melanomas encompass up to a quarter of all melanomas despite the head and neck making up only 9% of total body surface area. Although under the overall classification of melanoma, head and neck melanomas are distinct in many ways that influence their management. In this review, we provide current concepts in the risk factors, genetics, classifications, diagnosis, surgical and nonsurgical management, and future therapies of head and neck melanoma.
This review contains 26 figures, 9 tables and 123 references
Key words: Checkpoint inhibition therapy; Head and neck melanoma; Imiquimod; NF1; Oncogene-targeted therapy; Parotid-sparing sentinel lymph node biopsy; RAC1; Selective neck dissection
Hand Fractures
Authors: Komatsu Issei , Hughes Jr Thomas B
Published: January 2021

Fractures of the metacarpals and phalanges are common. Clinical evaluation, including eliciting the mechanism of injury, physical examination observing skin integrity, neurovascular status, rotational and angular deformity, and arc of motion and stability in each joint, and review of dedicated radiographs are needed to guide successful fracture management. Most of these fractures can be successfully managed by nonoperative techniques. However, operative fixation is indicated in certain fractures. In this review, we discuss the most representative hand fractures and their management. We also highlight various surgical treatment options, with recent clinical research findings for each fracture pattern.
This review contains 10 figures, 2 tables and 54 references
Key words: metacarpal fractures, phalangeal fractures, thumb fractures
Conduct Disorder and Its Clinical Management
Authors: Barzman Drew , Patel Bianca
Published: January 2021

Conduct disorder (CD), a psychiatric condition that is prevalent in some child and adolescent populations, is defined by the DSM-5 as a repetitive and persistent pattern of behavior in which the rights of others and age-appropriate cultural norms are violated. DSM-5 subtypes include childhood-onset, adolescent-onset, and callous-unemotional presentations. The development of CD is affected by gender, age at onset, environmental factors, and genetic factors. Overall, it has been difficult to identify causative factors because there is such a diverse variety of factors and comorbidities involved, although studies to define specific genetic, physiologic, and neurologic links to CD are ongoing. Common comorbidities in CD include oppositional defiant disorder, attention-deficit/hyperactivity disorder (ADHD), major depressive disorder, bipolar disorder, dysthymia, and substance abuse. The most successful treatment involves a multisystemic approach involving medication, family therapy, educational therapy, and parenting skills. Overall, early prevention of CD through treatment is key because the prognosis is poor and can be associated with the development of more severe comorbidities.
This review contains 3 tables, and 58 references.
Key words: antisocial behavior behavioral issues, ADHD comorbidities, child mental disorders, conduct disorder
Neurobiology of Psychotic Disorders
Authors: Cadenhead Kristin , Joseph Jamie , Kelsven Skylar , Minichino Amedeo , Mirzakhanian Heline
Published: January 2021

Efforts to prevent or lessen the functional impact of psychosis can be informed by a better understanding of the neurobiological underpinnings at the earliest stages of the disorder. Understanding these processes early in the psychosis spectrum will in turn allow more targeted efforts to prevent or minimize functional limitations among patients with psychosis. Advances in technology have enabled the study of a host of biomarkers implicated in the neurobiology of psychosis offering unique avenues to investigate mechanisms of disease while at the same time shedding some light on more patient-tailored treatments and setting the foundation for personalized medicine in psychosis. Insights into the neurobiology of psychosis are reviewed, including findings from neuroimaging, neurocognitive, and electrophysiologic studies and findings related to the role of hypothalamic-pituitary axis activity and neuroinflammation in the emergence of psychosis. Biomarker-informed treatments are discussed, and potential promising biomarkers and related treatments are proposed.
This review contains 5 figures, 13 tables, and 85 references. 
Key words: attenuated risk syndrome, biomarkers, prodrome, psychosis, schizophrenia, treatment
Overview of Trauma- and Stressor-Related Disorders
Authors: Black Donald W.
Published: January 2021

The chapter “Trauma- and Stressor-Related Disorders” is new to DSM-5 and includes two disorders that begin in childhood (reactive attachment disorder, disinhibited social engagement disorder), posttraumatic stress disorder (PTSD), acute stress disorder, and adjustment disorders. In each condition, the individual has been exposed to a traumatic or stressful event or, in the case of the childhood conditions, early social neglect. The disorders are briefly reviewed, and interested readers are referred to reviews on PTSD and adjustment disorders. 
This review contains 5 tables, and 28 references.
Key words: acute stress disorder, adjustment disorder, disinhibited social engagement disorder, posttraumatic stress disorder (PTSD), reactive attachment disorder, stressors, trauma
Gender Dysphoria
Authors: Naghdechi Lancer , Bakhoum Atef , IsHak Waguih William
Published: January 2021

In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), gender dysphoria (GD), previously known as gender identity disorder, is defined as distress or impairment in psychosocial, occupational, educational, or other areas of life due to a perceived disagreement between a person’s assigned gender, natal gender, and the gender currently experienced or expressed for at least 6 months. The DSM-5 mentions that one’s experienced gender may be outside of binary gender stereotypes. Diagnostic criteria are different for GD in children and in adolescents/adults. This review covers the definition, epidemiology, etiology/genetics, clinical manifestations, and studies/tests/treatments related to GD. Tables list the diagnostic criteria for GD and definitions of common terms.

This review contains 2 tables and 30 references
Key words: DSM-5, gender dysphoria, sexual reassignment surgery
Overview of Legal Issues in Psychiatry
Authors: Gunter Tracy D.
Published: January 2021

Psychiatrists routinely encounter legal and regulatory issues in the practice of psychiatry. This review provides an overview of the psychiatrist’s duties and responsibilities in the doctor-patient relationship and common legal issues arising in clinical practice, with reference to US statutory and regulatory practices. The field of forensic psychiatry is described, and the roles of the forensic evaluator and the treatment provider are compared.
This review contains 2 figures, 5 tables, and 64 references.
Key words: civil commitment, confidentiality, duty to third parties, forensic psychiatry, guardianship, gun ownership, medical decision making, medical marijuana, risk assessment
Priapism
Authors: Anele Uzoma A , Burnett Arthur L
Published: January 2021

Priapism is a disorder of persistent penile erection unrelated to sexual arousal or desire. This pathologic condition is classified broadly into nonischemic and ischemic forms as well as a recurrent ischemic variant. The recurrent ischemic variant is particularly prevalent in patients with sickle cell disease and may commonly progress to major ischemic episodes. The ischemic form represents a urologic emergency because prolonged episodes have an increased risk of permanent erectile dysfunction. Therefore, timely intervention and treatment are essential. In this chapter, the pathophysiology and current management guidelines and strategies of priapism are reviewed. Further understanding of the molecular pathophysiology of priapism has led to the discovery of new potential targets and may lead to further therapeutic advances in the future.
This review contains 6 figures, 6 tables, and 51 references.
Key Words: hematology, high-flow priapism, low-flow priapism, nitric oxide, nonischemic priapism, penile prosthesis, recurrent ischemic priapism, shunt, sickle cell disease, sympathomimetic
Metabolic Encephalopathy - Part I
Authors: Gill Rick , McCoyd Matthew , Ruland Sean , Biller José
Published: January 2021

Encephalopathy can range from the acute confusional state to frank coma, and is broadly defined as a constellation of symptoms and signs reflecting diffuse cerebral dysfunction.  The potential causes of encephalopathy are vast requiring a thorough initial assessment and systematic diagnostic approach.  Obtaining a comprehensive history may be challenging and ancillary sources of information are often helpful in narrowing the differential diagnosis.  The general examination may provide hints as to the cause of encephalopathy and the neurologic examination can guide both acute management and focus the diagnostic investigations on specific etiologies which fit the clinical presentation.  The systemic manifestations of infection and toxic exposures are common causes of encephalopathy.  In sepsis, not only is brain perfusion compromised, multi system dysfunction is common and additional factors related to the specific infection such as hypoxia in pneumonia or secondary CNS involvement can complicate management.  An understanding of the common physical examination findings of toxic exposures can aid in the diagnosis and rapid treatment of reversible toxic encephalopathies such as narcotics, benzodiazepines or environmental toxins.  Cardiopulmonary dysfunction can lead to hypoxic-ischemic encephalopathy and advances in critical care, and particularly targeted temperature management following cardiac arrest, have improved the neurologic outcome in these patients.  
This review contains 2 figures, 3 tables, and 25 references.
Key words: encephalopathy, delirium, ascending reticular activating system, acute confusional state, subclinical seizures, Glasgow Coma Scale, Full Outline of Unresponsiveness (FOUR) Score , hypoxic-ischemic encephalopathy, neuroleptic malignant syndrome, serum neuron-specific enolase
Carotid Body Tumors
Authors: Duncan Audra A
Published: January 2021

Carotid body tumors (CBTs) are derived from parasympathetic autonomic nervous system cells and are the most common type of head and neck paragangliomas, accounting for 65-80% of lesions.  CBTs may occur sporadically, may be familial with identified gene mutations on the succinate dehydrogenase subunit, or a component of familial neuroendocrine syndromes.  Environments or medical conditions leading to chronic hypoxia can increase the risk of CBTs.  The differential diagnosis of CBT include other neck masses such as enlarged lymph nodes or other neck tumors.  Computed tomography or magnetic resonance angiography is often diagnostic as CBTs cause a characteristic splaying of the carotid bifurcation.  The degree of encasement of the carotid arteries is classified by Shamblin Type I-III, and the higher Shamblin category correlates to highest risk of nerve injury after surgical resection.  All tumors should be removed in healthy patients, with observation or radiotherapy reserved for high-risk or elderly asymptomatic patients.  Tumor embolization may be considered in CBTs larger than 4cm.  Resection, with or without tumor embolization, requires adequate exposure of the distal carotid with consideration of nasotracheal intubation or mandibular subluxation.  The surgeon must be prepared to resect and replace the carotid artery in large CBTs using techniques similar to carotid endarterectomy to reduce stroke risk.   Cranial nerves should be carefully exposed and preserved during a systematic dissection.  Despite careful resection, cranial nerve injury may be as high as 30-40%, although only 5% are permanent.  Stroke risk (1%) and mortality (<1%) are low.
KEY WORDS: Carotid body tumor, succinate dehydrogenase, Shamblin Type, neuroendocrine tumors, parasympathetic autonomic nerve cells, tumor embolization
Penetrating Aortic Ulcer and Intramural Hematoma
Authors: Reed Nanette R. , Oderich Gustavo S.
Published: January 2021

Acute aortic syndrome is a spectrum of three overlapping clinical and anatomic diseases: penetrating aortic ulcers, intramural hematomas, and acute aortic dissections. All three entities are part of a disease spectrum, which is characterized by a disruption of the aortic media to a varying degree. Penetrating aortic ulcer, intramural hematoma, and aortic dissection can occur as isolated processes or can be found in association. Although the clinical presentations of the three conditions overlap to some extent, the diagnosis of each specific disease is largely based on specific imaging findings. All three entities are potentially life threatening, so prompt diagnosis and treatment are of paramount importance. Risk factors include hypertension, male sex, tobacco use, atherosclerosis, previous aortic operations, catheter-based interventions, bicuspid aortic valve, and connective tissue disorders. This review summarizes the clinical presentation, diagnosis, indications for repair, and endovascular strategies in patients with acute aortic syndromes. Tables outline early and late outcomes of contemporary clinical series of endovascular repairs of penetrating aortic ulcers and intramural hematomas. Figures show the overlapping features of acute aortic syndromes, progression of penetrating aortic ulcers, a large penetrating aortic ulcer in the proximal thoracic aorta (including representations before endovascular repair and after stent graft coverage), completion angiography demonstrating the patency of chimney and thoracic stent grafts, pre- and postoperative computed tomographic angiography after endovascular repair of a complicated penetrating aortic ulcer, and the Stanford and DeBakey classification systems.
 This review contains 8 figures, 4 tables, and 73 references.
Vascular Conditions of the Hand
Authors: Ignatiuk Ashley , Mailey Brian A. , Chong Tae W. , Sammer Douglas M.
Published: January 2021

Treating vascular conditions of the hand requires a thorough understanding of the vascular anatomy of the hand and upper extremity. Treatment options include both operative and nonoperative modalities, and may involve a multidisciplinary team including vascular surgeons, hand surgeons, interventional radiologists, medical internists, and hand therapists. This review discusses the vascular anatomy, patient evaluation, and treatment of vascular conditions of the hand. Figures show the large blood vessels of the arm, locations of the bifurcation of the radial and ulnar arteries, the vascular branches of the arm, the vascular anatomy of the hand and wrist, the location of the superficial palmar arch, upper extremity angiography, the clinical appearance and venograms of phlegmasia cerulean dolens, a high-flow arteriovenous malformation involving the right long finger, images of a patient who experienced blunt trauma to his distal palm from a wood splinter, a 28-year-old male who developed forearm compartment syndrome, volar and dorsal appearance of the left hand of a 56-year-old male with Raynaud phenomenon secondary to scleroderma, and intraoperative images of a patient who underwent digital palmar sympathectomies. A video shows a periarterial digital sympathectomy. Tables list the distinction between Raynaud disease and Raynaud phenomenon, comparison of investigational modalities of vascular conditions, interpretation of segmental arterial pressures, Wake Forest classification of vasospastic and vaso-occlusive disease, and Jones classification of vein bypass graft configurations in upper extremity vascular reconstruction.
This review contains 12 figures, 1 video, 5 tables, and 66 references.
Nonoperative Management of Abdominal Aortic Aneurysms
Authors: Davis John P. , Upchurch Jr Gilbert R
Published: January 2021

Abdominal aortic aneurysms (AAAs) are characterized by dilation of the abdominal aorta at least 1.5 times the normal diameter of the average adult, which is approximately 2 cm in men and 1.5 cm in women. Although the incidence is relatively low, this disease can be devastating, with AAAs accounting for roughly 15,000 deaths annually in the United States. This review covers the focused history and physical examination of a patient with a known AAA, evaluation of small and large AAAs, and surveillance of AAAs. Tables highlight recommendations for best medical management of small AAAs during the surveillance period, and information on nicotine replacement and nonnicotinic pharmacotherapy. Figures show a calcific rim consistent with the atherosclerotic rim of an AAA, a small AAA, a small inflammatory AAA, and age-adjusted effects of lifestyle characteristics and risk of AAA. An algorithm provides an approach to nonoperative management of stable AAAs.
This review contains 5 figures, 3 tables, and 86 references.
Fenestrated and Branched Endografts
Authors: Baig Mirza Shadman , Timaran Carlos H.
Published: January 2021

Multiple clinical trials have established the safety and efficacy of endovascular aortic aneurysm repair, which has resulted in a major paradigm shift from open to endovascular repair for the treatment of most aortic aneurysms. However, juxtarenal aneurysms (JRAAs) and more complex aneurysms involving the visceral aorta pose a significant challenge to the goals of fixation and seal using standard infrarenal devices. The need for branch vessel preservation and the individual variability of their origins from the aorta add significant complexity to the design, manufacturing, and implantation of endovascular grafts. To address these limitations, fenestrated and branched endografts have been developed that allow fixation and seal above the renal or visceral vessels but maintain perfusion to these branches by aligning fenestrations in the endograft fabric to the origins of these vessels or, in the case of thoracoabdominal aneurysms, providing branches. This review discusses fenestrated and branched endografts, as well as their complications and outcomes. Figures show definitions and examples of complex abdominal aortic aneurysm (AAA), features of the Zenith Fenestrated AAA Endovascular Graft, and features of the Cook Zenith P-branch device, an off-the-shelf fenestrated device under investigation for endovascular repair of JRAA. Tables list Zenith Fenestrated AAA Endovascular Graft indications for use and device components, graft and vessel-sized diameters for fenestrated devices, accessories for fenestrated endovascular repair, and results of reports dealing with fenestrated and branched endografts for juxtarenal and suprarenal AAA.
 
This review contains 12 highly rendered figures, 5 tables, and 53 references.
 Key words: abdominal aortic aneurysm, branched endograft, complex abdominal aortic aneurysm, endovascular aortic aneurysm repair, fenestrated endograft, juxtarenal aneurysms, suprarenal abdominal aortic aneurysm
Upper Extremity Revascularization Procedures
Authors: Cull David L. , Gandhi Sagar S
Published: January 2021

Acute arm ischemia due to arterial embolism is relatively common and amenable, in most cases, to simple embolectomy. Chronic arm ischemia is more infrequent. Although endovascular techniques have largely replaced surgical bypass for innominate artery and subclavian artery disease, the rising incidence of diabetes and longer survival times reported in patients with renal impairment have led to increased use of distal bypass procedures in the arm. In this review, we describe a rational approach to emergency and elective arm revascularization, with an emphasis on the technical aspects of these procedures.

Key words: acute ischemia, axillary, brachial, chronic ischemia, innominate artery, radial, revascularization, subclavian, ulnar, upper extremity
Endovascular Procedures for Mesenteric Ischemia
Authors: Moneta Gregory L. , Jung Enjae , Abraham Cherrie Z
Published: January 2021

Mesenteric ischemia is a condition caused by compromised blood flow to the small and large intestines. Patients can present with chronic mesenteric ischemia (CMI), most commonly due to atherosclerosis, or acute mesenteric ischemia (AMI), most commonly due to arterial thrombosis or arterial embolism. Endovascular options for CMI include angioplasty and stenting, whereas options for AMI include catheter-directed thrombolysis and suction embolectomy followed by angioplasty and stenting of the underlying lesion. For treatment of CMI, an endovascular approach is associated with lower morbidity and mortality with good immediate technical success rates but may be less durable than surgical intervention, with reported lower long-term patency and a higher recurrence rate. There are no randomized trials comparing open versus endovascular interventions for AMI. Even after successful endovascular treatment, there should be a low threshold for laparotomy to visually inspect the bowel. Postoperative imaging is important, and close follow-up is mandatory. 
This review contains 8 figures, and 26 references.
Key words: acute mesenteric ischemia, angioplasty, catheter-directed thrombolysis, chronic mesenteric ischemia, stenting (balloon versus self-expandable, covered versus bare metal), suction embolectomy
Surgical Treatment of the Infected Aortic Graft
Authors: Chung Jayer
Published: January 2021

The primary goal of treatment in dealing with an infected aortic graft is to save life and limb. This goal is best accomplished by eradicating all infected graft material and maintaining adequate circulation with appropriate vascular reconstruction. This review describes the choice of procedures, including an extra-anatomic bypass, an aortic allograft, an antibiotic-treated prosthetic graft, and an in situ autogenous reconstruction. Once a procedure has been decided on, preoperative evaluation and operative planning must take place. The review describes operative technique from the thigh incision and exposure of the femoral vessels to closure. Postoperative care is described. Outcomes and complications are discussed. Special consideration is given to aortoenteric fistulas.
This review contains 8 figures, 2 tables, and 83 references.
Key words: antibiotic-impregnated Dacron, aortic graft infection, aortoenteric erosion, aortoenteric fistula, axillobifemoral bypass, cryopreserved allograft,  neoaortoiliac surgery
Neurologic Consequences of Electrolyte Disorders
Authors: Vadivel Nidyanandh , McMahon Gearoid M , Seifter Julian L.
Published: January 2021

Characteristically, several fluid and electrolyte disorders have dysfunction of the central nervous system (CNS) as a major complication. The brain, within a closed space, cannot respond quickly or effectively to prevent the acute stresses of osmotic swelling or contraction of extracellular and/or intracellular spaces. Disorders of many other ions and neutral molecules can lead to pathology, including cognitive abnormalities, encephalopathy, falls, and seizures. This chapter looks at osmolar change and brain volume regulation and the importance of sodium (Na), potassium, phosphate, and magnesium. The section on sodium looks at its importance to serum osmolality and discusses hyponatremia and hypernatremia, syndrome of inappropriate antidiuretic hormone (SIADH) and cerebral salt wasting, dialysis disequilibrium syndrome, and the CNS effects of elevated ammonia and altered glucose levels. The section on potassium discusses the ratio between the intracellular and extracellular potassium concentrations and looks at hypokalemia and hyperkalemia. Phosphate plays a vital role in energy metabolism, and this section explores hypercalcemia and hypocalcemia. Magnesium’s role in cell proliferation and energy metabolism is discussed, with subsections on hypomagnesemia and hypermagnesemia. Tables list symptoms of electrolyte disorders, ways to distinguish between SIADH and cerebral salt wasting, risk factors for osmotic demyelination, and expansion and contraction syndromes. Figures include a graph showing serum Na against urine osmolality in a patient with symptomatic hyponatremia, and a chart of a woman with hyperammonemia and severe metabolic acidosis. This chapter contains 2 highly rendered figures, 4 tables, 65 references, 5 MCQs.
Hydraulic modeling of combined sewers overflow integrating the results of the SWMM and CFX models.
Authors: Pulgarín D. , Plaza J. , Ruge J. , Rojas J.
Published: January 2021

This study proposes a methodology for the calibration of combined sewer overflow (CSO), incorporating the results of the three-dimensional ANSYS CFX model in the SWMM one-dimensional model. The procedure consists of constructing calibration curves in ANSYS CFX that relate the input flow to the CSO with the overflow, to then incorporate them into the SWMM model. The results obtained show that the behavior of the flow over the crest of the overflow weir varies in space and time. Therefore, the flow of entry to the CSO and the flow of excesses maintain a non-linear relationship, contrary to the results obtained in the one-dimensional model. However, the uncertainty associated with the idealization of flow methodologies in one dimension is reduced under the SWMM model with kinematic wave conditions and simulating CSO from curves obtained in ANSYS CFX. The result obtained facilitates the calibration of combined sewer networks for permanent or non-permanent flow conditions, by means of the construction of curves in a three-dimensional model, especially when the information collected in situ is limited.
Pohdintaa, selostamista ja tulkintaa
Authors: Paldanius Hilkka
Published: January 2021

Hilkka Paldaniuksen suomen kielen alaan kuuluva väitöskirja tarkastettiin lauantaina 5. syyskuuta 2020 Jyväskylän ylipistossa. Vastaväittäjänä toimi professori Anne Mäntynen Helsingin yliopistosta ja kustoksena professori Minna-Riitta Luukka.

Hilkka Paldanius: Kuka aloitti kylmän sodan? Lukion historian aineistopohjaisen esseen tekstilaji tiedonalan tekstitaitojen näkökulmasta. Jyväskylä Studies in Humanities 227. Jyväskylä: Jyväskylän yliopisto. Väitöskirja on luettavissa osoitteessa: https://jyx.jyu.fi/handle/123456789/70172.
The depression paradigm and beyond
Authors: Helén Ilpo
Published: January 2021

This paper is an analysis of three elements of which depression as the primary target of current Western psychiatry and mental health care is made: the quest of psychiatrists to identify a depressive disease proper; the category of ‘major depression’ as defined by the diagnostic manuals; and the epidemiological view emphasising risk factors of depression. These elements are pivotal to the present understanding and experience of what depression is since they delineate the space of reasoning in which claims about depression are presented, problematised, and disputed. The paper presents how these elements have historically evolved and coalesced, and how depression has been formed and transformed as an object of knowledge and treatment in psychiatry and how the claims about depressive disorders acquire objectivity in the current mental health discussions. The paper also demonstrates how the quest of depression as a neurophysiological disease, consolidation of Major Depression as the diagnostic core of mood disorders, and the central role of the epidemiological notion of risk are both interlocked and discordant with each other in the current depression paradigm. In addition, tendencies of subversion of the depression paradigm are discussed.
Laboratory Work in Changing Society
Authors: Miettinen Reijo
Published: January 2021

No abstract
600 Years of Travelling Students
Authors: Eliasson Pär
Published: January 2021

No abstract.
Shaping Technology as a Means for Transforming Society
Authors: Bender Gerd
Published: January 2021

No abstract
Politics by Scientific Means and Science by Political Means
Authors: Segerstråle Ullica
Published: January 2021

No abstract
De-Commodifying Software? Open Source Software Between Business Strategy and Social Movement
Authors: Holtgrave Ursula , Werle Raymund
Published: January 2021

Focusing on open source software the origin, development and organisation of a process of de-commodification is examined in an industry that usually relies on strong provisions to protect intellectual property. Open source denotes a cooperative and voluntary mode of software development cross-cutting organisational boundaries and transcending relations of market exchange. Starting with the Open Systems Movement in the late 1970s, which was driven by business strategic and industrial policy interests and complemented by a spirit of mutual support in professional communities, a social movement type of collective action has emerged which develops knowledge as a public good. Competent communities share the norms of the hacker culture and cooperate in informal relations challenging the boundaries between private and public goods. But the open source idea has also been transformed into a business strategy by companies who provide basic software products for free and make money with complementary products and services.
Reclaiming Our Centre
Authors: Newson Janice , Polster Claire
Published: January 2021

In recent years, the autonomy of academics in many countries has been progressively undermined by a number of local, national and international developments. The purpose of this paper is to reveal how academic autonomy is being infringed. It aims also to critique the ways in which academics have been responding – both individually and collectively – to these infringements. Specifically, we argue that the ways in which academics have been defending against the erosion of their autonomy actually serves to further advance this process. We attribute this paradox to academics’ impoverished conception of professional autonomy and reassert a more robust conception and practice of academic autonomy as a means of remedying the situation.
Disorganized Knowledge or New Forms of Governance
Authors: Bertilsson Thora Margareta
Published: January 2021

The theme of this paper is a paradoxical problem threatening to afflict modern knowledge societies: how abundance of knowledge can turn into a deficit of knowledge at the same time. Within debates on globalisation, a constantly debated issue relates to the problem of finding new mechanisms of governing societies no longer bounded by the authority of the traditional bureaucratic state. Such concerns typically focus on the weaknesses of national politics and legal mechanisms in controlling the movement of capital in an unrestricted world economy. The point of this discussion is to focus on yet another complex of issues related to the rise of global knowledge societies. Intrinsic to such societies, not the least because of the explosive growth of ICT, is the abundance of communication, information and of unrestricted knowledge. Such abundance not only generates rapid and disorganised movements of capital flows across the world, but, and this is the point of this presentation, it also leads to rapid and disorganised flows of communication and understanding as far as the sciences are concerned.
Standing on Shifting Terrain
Authors: Owen-Smith Jason , W.Powell Walter
Published: January 2021

Drawing on interviews with more than 80 scientists on two university campuses, we create a typology that offers insights into how transformations in the nature and locus of life science innovation influence academic careers and work practices. Our analyses suggest that a strong outcome of increased academic concern with research commercialisation is the appearance of new fault lines among faculty, between faculty and students, and even between scientists’ interests and those of their institutions. We argue that life science commercialisation is driven by a mix of new funding opportunities, changing institutional mandates for universities, and novel research technologies that bring basic research and product development into much closer contact. The rise of patenting and commercially motivated technology transfer on U.S. campuses stands to alter faculty work practices and relationships, while transforming the criteria by which success is determined and rewards are allocated. Through close analysis of interviews with four researchers who typify a range of academic responses to commercialism, we demonstrate emerging patterns of conflict and agreement in faculty responses to commercial opportunities in the life sciences.
Is Intellectual property Right Legislation Constraining the Agrifood Biotechnology Sector in the European Union?
Authors: Diez Maria del Carmen Fernandez , Gil-Delgado Maria de los Reyes Corripio
Published: January 2021

In this paper, we discuss the implications of the recent Intellectual Property Right (IPR) enforcement in the European Union (EU) as a potential factor affecting agrifood biotechnology industry stagnation. After presenting a theoretical framework justifying patents, we describe some controversial questions in the European patent protection related to: a) the distinction between discovery and invention and; b) the morality and ordre public exception to the patentability. Although we provide some evidence about the reduction in importance of agrifood activities compared to that of pharmaceutical areas of application, we conclude that differences between EU and other developed countries IPR legislations are not the principal regulatory controversial factor affecting activities in the agrifood biotechnology sector.
Marriage and Madness
Authors: Giæver Øyvind
Published: January 2021

This essay focuses on marriage regulation as a eugenic tool – a topic that has received little attention in the literature – in 20th century Norway. Although eugenics was very much the focus of expert discussions prior to the first Norwegian marriage act (1918), a marriage bar for the insane that was included in the act was not mainly motivated by eugenic concerns. In fact, an amendment prepared in the late 1950s brought such concerns more to the foreground. In a final round of revisions prepared in the 1970s and 80s, however, both the marriage bar and the eugenic arguments were firmly dismissed. The essay uses these developments to discuss the relative weight to be accorded technical versus political factors in explaining the decline of eugenics – a decline that came rather late as far as the history of Norwegian marriage laws goes.
Country report
Authors: Lemola Tarmo
Published: January 2021

The paper discusses the transformation of Finnish science and technology policy from the mid-1960s until today. The basic argument of the paper is that, if there is a “Finnish model” of science and technology policy, it was not created in the years of rapid growth in the Finnish economy after the deep economic and societal depression of the early 1990s. The Finnish transformation process in a policy for science and technology is characterized by a gradual change of more than three decades through incremental improvements in policy doctrines, institutions, organizations and instruments. After a short period of diversity at the turn of the 1970s, the pervasive trend has been an increase in technology and innovation orientation of science and technology policy. The policy has been based on national specificities, but more on active adoption of policy doctrines and institutional and organizational models from the countries, like Sweden, which from the Finnish perspectives have been considered successful and legitimate.
Imperial Ecology
Authors: Piper Elizabeth
Published: January 2021

No abstract
National Innovation System - Scientific Concept or Political Rhetoric
Authors: Tupasela Aaro
Published: January 2021

No abstract
Technology Nurtured - Collectives in Maintaining and Implementing Technology for Elderly Care
Authors: Hyysalo Sampsa
Published: January 2021

Elderly care has become an increasingly appealing market for technology producers. Design for the elderly, however, often entails the meeting of two different worlds, one of young male high-tech professionals and one of elderly people and elderly care. This paper focuses on what happens to a new security technology making the transition between the two. Particular emphasis is laid on distributed and collective aspects of implementation and adaptation of new technology: networks of utilization and activities are discussed as pools of resources and interests for sustaining and shaping technology. *Key words*: implementation, networks, elderly care
Nanotechnology in its Socio-economic Context
Authors: Foladori Guillermo , Invernizzi Noela
Published: January 2021

Nanotechnologies are commonly touted as instruments to be exploited for the benefit of developed, as well as for developing countries, and especially for alleviating the problems of the poor. Defenders of nanotechnology argue that it is possible to learn from experience, avoiding the errors made with past technologies. Precaution,however, should not slow down innovation, which is the key factor in solving many of the problems of the poor. Clearly the focus is on innovation, and finding a solution to the problems of the poor is just a mechanical consequence. But it is not necessary,and nor is it true, that the faster the technological path, the narrower the gap between rich and poor. Indeed, judging from past experience, the opposite has usually been shown to be the case. We put forward the argument that nanotechnologies,like any other type of technology, cannot be separated from the socio-economic and political context in which they are generated, commercialized and utilized. Considering the current context, it is highly likely that the nanotechnology revolution will help widen the gap between rich and poor in the world.
The Effect of 'Mode 2'-Related Policy on the Research Process: The Case of Publicly Funded German Nanotechnology
Authors: Wald Andreas
Published: January 2021

Recent reforms in science policy seem to be in line with the archetype of ‘Mode 2’ of knowledge production. This study on publicly funded German nanotechnology research seeks answers to questions concerning the prevalence, the effects and the appropriateness of Mode 2-related policy. The level of analysis is the individual research group. The results reveal that nanotechnology research does not fit into the picture portrayed by Mode 2 literature. Nevertheless, effects of Mode 2-related policies can be observed. Funding schemes often require an immediate relevance for commercial application and collaboration with industry partners. As a consequence, research groups are forced to adjust their research lines and strategies to these needs. The researchers seriously criticize these developments and consider the policies underlying them as harmful for both fundamental and applied research. In the light of the results, the adaptation of Mode 2 elements into science policy and into funding schemes should be considered critically.
Dynamics of Type-based Scenarios of Use
Authors: Konrad Kornelia
Published: January 2021

Designers’ representations of how and by whom a technological system will be used play an important role in the shaping of technologies. Conceptually, this article presents an analytical concept of scenarios of use that is based on the notion of script by Akrich, but adds insights from the interactionist theory of Alfred Schutz. In so doing, we are able to trace how these scenarios for new technologies build on previously established and widespread typified conceptions of technologies and related scenarios of use. Empirically, drawing on case studies in the field of e-commerce and interactive television, this article examines the formation and evolution of scenarios of use across multiple design phases as a result of processes at the level of design projects as well as technological fields. The dynamic patterns observed in the case studies are then discussed. In contrast to the focus on closure of socio-technical variants given in many technology studies, in the present cases we instead observe opening processes, that is, the generation of new variants.