bluuebunny/crossref_metadata_2025 huggingface dataset:
Penerapan backward chaining untuk meningkatkan keterampilan berpakaian pada anak dengan disabilitas intelektual
Authors: Soebroto Maria Jessica Alexandra , Djuwita Efriyani
Published: January 2021

Objektif: Seorang anak berusia 8 tahun berinisial A dengan diagnosis Disabilitas Intelektual taraf sedang selalu membutuhkan bantuan dalam memakai seragam sekolahnya setiap hari yang merupakan kemeja berkancing. Penelitian ini bertujuan untuk melihat efektivitas modifikasi perilaku dengan teknik backward chaining dalam meningkatkan keterampilan mengenakan kemeja berkancing pada anak dengan Disabilitas Intelektual.Metode: Merupakan penelitian kuantitatif eksperimental dengan desain single-subject menggunakan tipe A-B-A’. Backward chaining dan token economy menjadi teknik modifikasi perilaku yang digunakan dalam penelitian ini.Temuan: Penelitian ini menunjukkan bahwa teknik backward chaining mampu meningkatkan keterampilan memakai kemeja berkancing secara efektif, didukung dengan adanya sesi pra-intervensi yang berupa aktivitas latihan motorik halus.Kesimpulan: Mengetahui efektivitas modifikasi perilaku dengan teknik backward chaining dapat menjadi salah satu wawasan baru bagi para orangtua dengan anak berkebutuhan khusus untuk menstimulasi kemampuan motorik anak dengan cara memecah suatu rangkaian perilaku menjadi tahapan-tahapan kecil.
Hambatan pendidikan inklusi dan bagaimana mengatasinya: Telaah kritis sistematis dari berbagai negara
Authors: Sari Citra Nadia , Hendriani Wiwin
Published: January 2021

Objektif:Artikel ini bertujuan untuk mengulas tantangan dan hambatan yang dihadapi pelaksanaan pendidikan inklusi serta strategi yang dapat dilakukan oleh negara.Metode: Artikel ini merupakan telaah kritis sistematis. Jurnal diambil dari 9 situs artikel penelitian internasional berbeda. Pencarian jurnal diutamakan terbit tahun 2011-2020. Didapatkan 11 jurnal yang merupakan jurnal kualitatif.Temuan:Hambatan yang dihadapi yaitu tenaga pendidik kurang terlatih, stigma negatif, kebijakan otoritas yang kurang aplikatif, kurangnya pengetahuan tenaga pendidik, hambatan aksesibilitas, keterbatasan sumber belajar, dan keterbatasan finansial. Strategi yang dilakukan yaitu peningkatan kualitas in-service training (INSET), awareness programmes, school-based professional development programmes, family support, kontekstualisasi proses belajar-mengajar, dukungan berkelanjutan selama proses implementasi di lapangan, komitmen pemerintah memberikan sebagian prosentase dari GNP sebagai sumber dana, kolaborasi dengan stakeholders, dan kerjasama regional, nasional, maupun internasional.Kesimpulan:Ada beberapa strategi yang dapat dilakukan di Indonesia, yaitu pelatihan kepada guru kelas, menyelenggarakan awareness program, bekerjasama dengan tim Pokja yang memiliki resource center yang mendukung implementasi pendidikan inklusi, penyediaan dana untuk menyelenggarakan pelatihan guru kelas, dan membangun fasilitas umum yang lebih ramah terhadap individu dengan disabilitas.
Water quality index using fuzzy logic Utcubamba River, Peru
Authors: Quiñones-Huatangari Lenin , Ochoa Luis , Milla-Pino Manuel Emilio , Bazán José Federico , Gamarra Oscar Andrés , Rascón Jesús
Published: January 2021

Water is a fundamental nutrient in the life of any living being. Therefore, it is necessary to estimate its quality, because it is an issue of increasing concern countries around the world for reasons such as the health of the population, regional, national and international economic development, and the environmental quality of the ecosystems. One tool that has been used to know the state of the water is the water quality indexes (WQI). The objective of this research was to develop a WQI based on fuzzy logic, which allows for the estimation of water quality in the Utcubamba River. The methodology used was proposed by Icaga in 2007. To evaluate the proposed WQI called "Diffuse Water Quality Index" (DWQI), sixteen points from the sampling conducted by the Research Institute for Sustainable Development during October 2014 on the Utcubamba River and its tributaries were used. To validate the index, it was necessary to estimate the correlation coefficient R2 between the results obtained and those of the NSF WQI wáter quality index reported by the Water Research Center. This new index presented results and reasonable correlation, R2 = 0.81. It is concluded that DWQI can be used as a tool for decision making in the water management of the Utcubamba River.
Sex, Abortion, and Infanticide: The Gulf between the Secular and the Divine
Authors:   St. Edward’s University (Austin, USA), Cherry Mark J.
Published: January 2021

This paper critically explores key aspects of the gulf between Christian bioethics and the secular moral reflections that dominate contemporary bioethics. For example, in contrast to traditional Christian morality, the established secular bioethics judges extramarital sex acts among consenting persons, whether of the same or different sexes, as at least morally permissible, affirms sexual freedom for children to develop their own sexual identity, and holds the easy availability of abortion and infanticide as central to the liberty interests of women. Secular bioethics seeks to separate children from the authority of their parents, placing children themselves as in authority to make their own judgments about appropriate lifestyle choices, including sexual behaviors. As I argue, however, when God is absent, there exists no standpoint outside of our own cultural socio historically conditioned understanding from which to communicate any deeper perspective of reality or the bioethics that such a perspective would secure. Consequently, rather than discerning moral truth, secular bioethics merely affirms its own particular cultural socio historically conditioned ideological perspective. It is a social and political worldview bereft of definitive moral foundation, independent moral authority, or unambiguous content.
The Abortion in Soviet Russia During NEP: Official Propaganda versus Popular Attitudes
Authors:   National Research University Higher School of Economics (Moscow, Russia), Grafova Maria
Published: January 2021

This paper studies the attitudes of the Soviet authorities and society towards the problem of abortion during the New Economic Policy (NEP). In the 1920s, communist ideologists and population still under influence of traditional values based on religious ethics (though often indifferent towards religion and Church) expressed extremely different views on the issue. Even religiously indifferent people used to take part in religious ceremonies such as weddings and christenings. The traditions of the Orthodox Church provided them with moral support in the era of global changes. The ideological message of the Soviet authorities was also controversial. Officially sexual liberty was allowed, as was the freedom of marriage and divorce. Women were encouraged to work, to be involved in social activities, to be educated. However, there was little social and medical help for mothers. Traditional marriage was being destroyed, and an increasing number of abortions, both legal and illegal, was a result. Those who were in charge of the sanitary propaganda were worried and encouraged people to have children for Soviet Russia instead of abortions despite all difficulties. In fact, ordinary people knew that many children meant poverty and poor health for the whole family. There was almost no available contraception, and abortion was virtually only method of birth control. In spite of the efforts of Soviet propaganda, abortion was perceived as a nasty but almost unavoidable part of everyday life. The author concludes that no consensus on the problem of abortion in the Soviet society of the 1920s emerged, and to some extent it could not have emerged under such circumstances.
The Revolution of the Spirits for the Spiritual Brotherhood: Russian Spiritualist Movement and Its Social Ideals
Authors:   Center for the Study of Religion, Russian State University of the Humanities (Moscow, Russia), Razdyiakonov Vladislav
Published: January 2021

The article offers a reconstruction of the social ideals of Russian spiritualists. Main sources include texts revealing spiritualists’ ideas about the structure of the spiritual world; structure and characteristics of spiritual circles; and literary works by spiritualists reflecting their social ideals. Although the social and political views of Russian spiritualists were mostly conservative, their ontological views contained elements of social radicalism. The author distinguishes between the two types of spiritualists — rationalists and traditionalists — depending on their attitude towards the Orthodox Church, Christian theology and their specific views about the spiritual world. All spiritualists viewed the society critically as gripped with disease. Rationalist spiritualism was critical towards Christian dogmatic and practice, and although its supporters advocated the preservation of the social and political status quo, they hoped for both gradual social and political transformation and the realization of social ideals in the spiritual world. The traditionalists, despite their commitment to monarchy and the Church institution, expected a millenarian overturn and thus challenged the social and political order. Overall, the spiritualist social ideals are close to communitarian social projects based upon the idea of Christian brotherhood.
Moral Content, Tradition, and Grace: Rethinking the Possibility of a Christian Bioethics
Authors:   Center for Ethics, Medicine, and Public Issues, Baylor College of Medicine (USA), Engelhardt, Jr. Hugo Tristram
Published: January 2021

Birth, suffering, disability, disease and death were by medicine’s successes placed within a context of seemingly novel challenges that cried out for new responses. Secular bioethics rose in response to the demands of these new biomedical technologies in the context of a culture fragmented in moral pluralism. While secular bioethics promised to unite persons separated by diverse religious and moral assumption, this is a promise that could not be fulfilled. Reason alone cannot provide canonical, content-full moral guidance or justify a moral community capable of binding all persons. Christian bioethics, as part of a way of life embedded in authentic worship, offers content, meaning and understanding where secular bioethics has failed. For Christians, resolution of bioethical controversies will not be found through appeals to foundational rational arguments or isolated scriptural quotations, but only in a Christian community united in authentic faith.
The Christian Foundations of Fritz Jahr’s Concept of Bio-Ethik and Contemporary Central European Perspective
Authors:   Institute of World History of the Russian Academy of Sciences, Beliakova Nadezhda ,   National Nuclear Research University,   Department on the Philosophy and History of Medicine at the Sechenov University
Published: January 2021

The article presents the concept of Bio-Ethik by the German theologian Fritz Jahr (1895–1953) and discusses the reasons of the interest to his legacy in Central Europe. The popularity of Fritz Jahr’s works fits into the specific context of a complex development of bioethics in Central Europe at the turn of the twenty-first century. The appeal to Fritz Jahr’s ideas in the field of bioethics allows us to assess the contribution of Christian thinkers to the articulation of bioethical issues and to raise the question of why in modern bioethics, which is trying to draw upon universal, non-religious values, there was a demand for theological works of a Protestant pastor. The article describes the attitude to bioethics in Germany at the turn of the 1980s–90s, the ideological conflict of the “anti-bioethics” movement and the context of the new reception of Fritz Jahr’s works.
O que é um autor-editor? Provocações acerca das publicações independentes no Rio Grande do Norte (What is an author-editor? Provocations about independent publications in Rio Grande do Norte)
Authors: Muniz Cellina Rodrigues
Published: January 2021

Neste artigo, apresento algumas considerações sobre a constituição de sujeitos autores-editores de publicações independentes no Rio Grande do Norte, região do Nordeste brasileiro. A partir de relatos de seis sujeitos sobre seus ofícios, busco compreender que elementos dariam unidade a suas práticas, dos quais destaco o reconhecimento.
A construção da paratopia em crônicas de Manuel Bandeira (The construction of paratopia in Manuel Bandeira’s chronicles)
Authors: Cavalcanti Jauranice Rodrigues
Published: January 2021

Nosso objetivo neste artigo é refletir sobre o conceito de paratopia e, a partir dele, analisar crônicas de Manuel Bandeira (MB). Trata-se de uma pesquisa mais ampla que investiga a produção em prosa do autor tomando por fundamentação teórica as reflexões da Análise do Discurso francesa sobre o discurso literário, em especial o quadro teórico proposto por Maingueneau (2006). O analista concebe a paratopia como um espaço paradoxal e adverte que só existe paratopia se integrada a um processo criador. Em nossa análise, abordamos aspectos ligados à construção de uma identidade criadora que pertence e não pertence à sociedade, as modalidades de paratopia elaboradas pela forma de o escritor MB inserir-se no espaço literário de sua época (o posicionamento modernista), a identificação do autor com os marginais e excluídos, com “personagens” paratópicas e também, o que seria o motor paratópico de sua obra (a doença e a fuga para Pasárgada).
Lymphotropic Sarcomas (Epithelioid Sarcoma and Clear Cell Sarcoma)
Authors: Lopez-Aguiar Alexandra G , Cardona Kenneth
Published: January 2021

Lymphotropic sarcomas encompass a rare subset of soft tissue sarcoma histotypes known for their distinct ability to metastasize to locoregional lymph nodes. Epithelioid and clear cell sarcomas are the predominant lymphotropic subtypes and the focus of this review. The utility of lymph node assessment, whether clinical, radiographic, and/or surgical, in patients with these sarcomas is presented. The role of sentinel lymph node biopsy as well as completion lymphadenectomy in patients with these lymphotropic sarcoma histotypes is discussed. Surgery remains the only potential curative option for these tumors, and advancement in histology-specific chemotherapeutic regimens and biologic therapy options is necessary.
 This review contains 6 tables and 50 references.
Key words: clear cell sarcoma, completion lymphadenectomy, epithelioid sarcoma, EWS-ATF1, limb-sparing surgery, lymph node metastasis, sentinel lymph node biopsy, soft tissue sarcoma
Trauma to the Thoracic Aorta
Authors: Bauer Thurston M. , Farber Mark A.
Published: January 2021

Blunt thoracic aortic injury (BTAI) is predominantly a phenomenon of the 20th century secondary to high-energy deceleration injuries. Prior to the widespread adoption of automobiles, midway through the 20th century, 85% of injuries to the aorta were attributed to penetrating trauma, with 57% caused by gunshots and 25% by stab wounds.1–4 However, BTAI has become more prevalent, with an estimated incidence of 7,500 to 8,000 cases per year in the United States. BTAI is the second most common cause of trauma-related death after head injury and accounts for 15% of all motor vehicle collision (MVC)-related deaths.5 The incidence of thoracic aortic injury among MVC victims is 1.5%.6 Prehospital mortality is 85% secondary to complete aortic transection.7 Approximately 8% of patients survive more than 4 hours, and most of those who survive to reach the hospital have small or partial-thickness tears with pseudoaneurysm formation. Up to 50% of patients who reach the hospital die prior to definitive surgery.8,9 Therefore, expeditious collaborative evaluation by trauma and aortic surgeons at a level I trauma center is necessary to provide appropriate care to these patients who may have multiple life-threatening injuries.

This review contains 13 figures, 8 tables, 1 video and 56 references.
Keywords: Blunt Aortic Traumatic Injury, Thoracic Transection, Aortic Transection, Aortic Injury, Blunt Traumatic Aortic Injury, Blunt Thoracic Aortic Injury, Aortic Tear, Aortic pseudoaneurysm, TEVAR for BTAI, Endovascular repair (TEVAR) of BTAI, Endovascular repair (TEVAR) for transection
Principles of Initial Trauma Management and Evaluation
Authors: Resnick Shelby , Smith Brian , Reilly Patrick
Published: January 2021

Trauma accounts for almost 10% of deaths worldwide and is the fourth most common cause of death in the United States. Treatment of the injured patient requires multiple unique resources, including multidisciplinary teams, surgical subspecialties, and dedicated resuscitation areas. Evaluation and initial management of the trauma patient is performed systematically to quickly identify and treat life-threatening injuries. This review serves as an introduction to care for the critically injured patient. It covers the initial steps for evaluation, resuscitation, diagnosis and treatment of the trauma patient and provides a brief overview of various injury patterns resulting from both blunt and penetrating trauma.
This review contains 6 figures, 6 tables and 49 references
Key Words: blunt trauma, damage control resuscitation, FAST exam, lateral canthotomy, penetrating trauma, primary survey, rapid sequence intubation, secondary survey, trauma systems
Liposarcoma
Authors: Crompton Joseph G , Singh Arun S , Dry Sarah M , Eilber Fritz C
Published: January 2021

Liposarcoma is a mesenchymal malignancy that predominantly arises in the retroperitoneum, trunk, and extremities. Histologic subtypes of liposarcoma include well-differentiated/dedifferentiated, myxoid/round cell, and pleomorphic liposarcoma. Although liposarcoma is rare and can occur in almost any anatomic location, it is the most common soft tissue sarcoma in the retroperitoneum, and surgery remains the only potentially curative therapy. This review discusses liposarcoma pathogenesis, classification, clinical-diagnostic evaluation, treatment, and surveillance. The cornerstone of treatment is surgery, with the main therapeutic goals of improving survival, limiting local recurrence, maximizing function, and minimizing morbidity. Perioperative radiation therapy may be indicated in patients with large high-grade liposarcomas. Systemic treatment—whether traditional chemotherapy or molecularly targeted therapy—may benefit patients depending on their histologic subtype, location, and extent of disease. For the majority of patients, however, systemic treatment is not curative. Controversial issues in the management of liposarcoma, such as surgical margins and extent of resection, are also discussed.   

This review contains 2 figures, 5 tables and 39 references
Key words: atypical lipomatous liposarcoma, liposarcoma, myxoid liposarcoma, pleomorphic liposarcoma, retroperitoneal sarcoma, soft tissue sarcoma, well-differentiated/dedifferentiated liposarcoma
Substance Use Disorders
Authors: Moeller F Gerard
Published: January 2021

There is a consistent body of evidence showing that substance abuse and dependence can worsen preexisting medical conditions, can temporarily mimic medical and psychiatric disorders, and can themselves cause medical problems, including life-threatening overdose. Substance use disorders are common in young and middle-aged persons: the lifetime prevalence of these syndromes, including alcoholism, is over 20% for men and about 15% for women. This chapter discusses dependence, abuse, substance use disorder, and substance-induced disorders involving depressants, stimulants, opioids, cannabinoids, hallucinogens, N-methyl-D-aspartate (NMDA) receptor channel blockers, and inhalants. Epidemiology, etiology, pathophysiology, diagnosis (including clinical assessment and laboratory tests), and treatment are reviewed. Treatment of intoxication, overdose, withdrawal, and rehabilitation is discussed. A figure illustrates the neurocircuitry of addiction. Tables describe the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) diagnostic criteria for abuse and dependence; frequently misused drugs; neural effects of commonly abused drugs; the natural history of drug dependence; conditions affecting the outcome of urinary drug tests; and pharmacologic options for treatment of drug overdose. This chapter contains 112 references.
Nutrition Management in Mechanical Circulatory Support
Authors: Coyne Dane A , Shah Mitali P , Mogensen Kris M , Klick John C
Published: January 2021

Heart failure is a devastating progressive disease process that is rising in incidence throughout the world. For patients with end-stage heart failure, orthotopic heart transplantation had been the only therapeutic option. Unfortunately, the number of patients requiring such therapy far exceeds the number of available organs. Recent advancements in technology have made implantable cardiac assist devices a reality. Outcomes with these devices are superior to maximal medical therapy and may serve either as a bridge to the availability of a donor organ or as “destination” therapy for the patient with end-stage heart failure. In addition, new technology can also provide temporary mechanical support for patients with acute decompensated cardiogenic shock, allowing preservation of end-organ function until more definitive long-term mechanical support can be coordinated. Patients with end-stage heart failure experience unique nutritional challenges. Mechanical circulatory support adds yet another unique dimension to the nutritional support challenges of this patient population.

This review contains 2 figures, 5 tables, and 29 references.
Key words: cardiogenic shock, enteral nutrition, extracorporeal membrane oxygenation, heart failure, mechanical circulatory support, nutritional support, parenteral nutrition, ventricular assist device
Nonobstetrical Surgical Conditions
Authors: Kim Sun Min , Park Joong Shin
Published: January 2021

Prompt diagnosis and appropriate interventions for nonobstetrical surgical emergencies are important in pregnancy because a delay in diagnosis can result in increased morbidity and mortality to both mother and fetus. Generally, neither anesthesia nor surgical procedures increase the risk of congenital malformations or miscarriage. The diagnosis of a surgical condition is often more difficult in pregnant women than in nonpregnant adults because the traditional signs and symptoms of a specific disorder may not be exhibited due to the anatomic and physiologic changes of pregnancy. Moreover, the surgeon may need to make accommodations and adjustments as a result of the anatomic and physiologic changes associated with pregnancy, which may include limitations imposed by uterine size, unusual clinical presentation, and adjustments to accommodate fetal monitoring and optimize fetal well-being. Therefore, a multidisciplinary team approach (involving obstetricians, general surgeons, anesthesiologists, and neonatologists) is required in nonobstetrical surgeries involving pregnant women.

This review contains 3 figures, 3 tables, and 32 references.
Key Words: adnexal torsion, anesthesia, appendicitis, cholecystitis, laparoscopy, pregnancy, radiation, surgery
Peripartum Cardiomyopathy
Authors: Gray Kendra M , Foley Michael R
Published: January 2021

Peripartum cardiomyopathy (PPCM) is a serious and rare disease of late pregnancy or the early postpartum period. It is defined as idiopathic, nonfamilial, nongenetic, heart failure occurring in the absence of any other identifiable causes of heart disease within the last month of pregnancy or within the first 5 months postdelivery in otherwise previously healthy woman. The incidence in the United States is 1 per 3,000 to 4,000 live births. Left ventricular systolic dysfunction develops, almost always leading to a left ventricular ejection fraction of less than 45%. PPCM is unique in its rapid medical course and propensity to spontaneously resolve within 3 to 6 months of disease onset. The mortality rate is high, up to 10%, and the risk of relapse in subsequent pregnancies is also elevated. Treatment for PPCM varies slightly based on whether the woman is pregnant or postpartum. Conventional pharmacologic treatment includes diuretics, angiotensin-converting enzyme inhibitors (postpartum only), vasodilators such as hydralazine, digoxin, β-blockers, and anticoagulants.

This review contains 5 figures, 5 tables, and 36 references.
Key Words: critical care obstetrics, ejection fraction, heart failure, left ventricular systolic dysfunction, management, maternal mortality, peripartum cardiomyopathy, preeclampsia, pregnancy
Orthognathic Surgery
Authors: Wang Howard D , Yang Robin , Lopez Joseph , Swanson Edward W , Quan Amy , Kumar Anand R
Published: January 2021

Orthognathic surgery describes the surgical movement of the mandible and maxilla to correct dentofacial deformities that result from congenital or traumatic etiologies. Patients with dentofacial deformity often have malocclusion and functional problems related to breathing, chewing, or speech articulation. Furthermore, facial asymmetries or disproportions resulting from dentofacial deformities can adversely affect the psychosocial health of the patient. The goal of orthognathic surgery is to improve both function and form beyond what can be achieved with orthodontic or medical treatments. Some of the most commonly performed orthognathic surgery procedures include Le Fort I osteotomy of the maxilla, bilateral sagittal split osteotomy of the mandible, and genioplasty. Successful outcome after orthognathic surgery should be judged by achieving an improved dental occlusion, enhanced facial aesthetics, and open upper airway. A number of studies have shown that orthognathic surgery leads to significant improvements in the quality of life of patients with dentofacial deformities. Orthognathic surgery also has a significant impact on the upper airway. In patients with severe obstructive sleep apnea, maxillomandibular advancement has the potential to lead to dramatic improvements in the apnea-hypopnea index and lowest oxygen saturation value. With careful surgical planning and execution, consistent outcomes can be expected.
 
This review contains 17 figures, 4 tables, and 32 references.
Key Words: aesthetic surgery, dentofacial deformity, genioplasty, Le Fort I, malocclusion, orthognathic surgery, sagittal split osteotomy of the mandible, sleep apnea, virtual surgical planning
Craniofacial Syndromes Part I: Craniofacial Growth and Development, Craniosynostosis Syndromes, Craniofacial Microsomia, and Craniofacial Dysostoses
Authors: Saldanha Francesca , Resnick Cory M. , Rogers-Vizena Carolyn R.
Published: January 2021

Craniofacial syndromes are a diverse group of congenital disorders primarily affecting structures of the head and face.  Recent genetic advances have improved our ability to diagnosis specific syndromes, understand the molecular basis for abnormal embryogenesis, and anticipate future treatment needs. This is the first of a two-part series exploring the most common craniofacial disorders. This article will provide the embryologic and developmental foundation necessary to understand congenital craniofacial pathology. Clinical characteristics and molecular genetics needed to make an accurate diagnosis and formulate a treatment plan will be detailed for craniosynostosis syndromes, craniofacial microsomia, and craniofacial dysostoses.
This review contains 13 figures, 4 tables, and 42 references.
Keywords: craniofacial embryology, craniofacial growth, craniosynostosis, Apert syndrome, Crouzon syndrome, Pfieffer syndrome, craniofacial microsomia, hemifacial microsomia, Treacher Collins syndrome, Nager syndrome
Transgender Surgery: Female to Male
Authors: Massie Jonathan P , Morrison Shane D , Crane Curtis N , Chen Mang L
Published: January 2021

Gender-confirming surgery is a life-altering and medically necessary set of procedures for some people suffering from gender dysphoria. For transgender men, there are a variety of surgical interventions available for masculinization, including facial, chest, trunk, and genital surgeries. Facial and truncal masculinizations are rarely sought. Chest masculinization is the most common procedure in transgender men and consists of bilateral mastectomy through various approaches dependent on the breast size and laxity with minimal complications. Metoidioplasty and phalloplasty are the most common genital procedures (the radial forearm free flap phalloplasty being the most common) but have significant complication profiles. Up to 40% of those undergoing genital masculinization suffer from urethral fistula or stricture. Current advances consist of neurotization of the phallus and implant placement. Future studies on patient-reported outcomes and long-term follow-up are needed.

This review contains 16 figures, 3 tables, and 62 references. 
Key Words: chest masculinization, gender affirmation, metoidioplasty, penile implant, phalloplasty, radial forearm free flap, scrotoplasty, transgender, urethral fistula, vaginectomy
Treatment of Empyema/Bronchopleural Fistula
Authors: Ricci Joseph A. , Orgill Dennis P
Published: January 2021

Thoracic reconstruction represents one of the most challenging situations for a reconstructive surgeon. The resection of chest wall or pulmonary tumors allows for the development of a wide variety of complex wounds, many with significant dead spaces. Additionally, empyema and bronchopleural fistulas, while uncommon, represent potentially life threatening complications. The combination of new technology such as advanced biomaterials, advanced wound care modalities, and vascularized free tissue transfer have allowed these complex problems to be treated with low morbidity and mortality. The complexity of these operations requires a team approach including a cardiac or thoracic surgeon, a plastic surgeon, and intensive care specialists to provide advanced life support measures in the postoperative period. Closure and decontamination of these wounds can be achieved by following these principles: removal of infected necrotic tissue and foreign material via thorough debridement; repair of bronchopleural fistulas with muscle flaps; and minimization of any residual dead space with a combination of flaps and thoracoplasty, as needed. 
This review contains 18 figures, 3 tables, and 31 references.
Keywords: bronchopleural fistula, chest wall reconstruction, intrathoracic dead-space, latissimus dorsi flap, muscle flaps, omental flap, pectoralis major flap, rectus abdominus flap
Venous Stasis Disease
Authors: Alfonso Allyson R , Cuzzone Daniel , Chiu Ernest S
Published: January 2021

Chronic venous disease (CVD) is a chronic and morbid condition with a wide pathologic spectrum. The common denominator is either impaired venous outflow or anomalous (retrograde) venous inflow most often related to a failure of the valvular system. Diagnosis is made with a thorough history, physical examination, and imaging such as duplex ultrasonography. The disease can then be classified using the Clinical, Etiology, Anatomic, Pathophysiology classification system and Venous Clinical Severity Score. Management is based on disease etiology and symptomatic presentation. It is important to first identify the presence or absence of venous ulceration. In venous ulceration, compression therapy with contact dressings is standard therapy, but surgical wound debridement and skin or fat grafting can be necessary for wound closure. Additional operative treatment for those with CVD can include conservative hemodynamic correction of venous insufficiency, vein stripping, and endovenous thermal ablation. With multiple etiologies and subsequent treatment options, CVD requires patient and vigilant care on part of the patient and the treating clinician. Although much is known about CVD, our ability to predict, prevent, and treat is limited by aspects of the disease in need of further study.
 
This review contains 8 figures, 6 tables, and 51 references.
Key Words: chronic venous disease, chronic venous insufficiency, venous ulcer, wound healing, venous physiology, venous ulcer management, compression therapy, wound contact dressings, surgical management
Mindfulness
Authors: Domar Alice D.
Published: January 2021

Most if not all physicians in training report feelings of exhaustion, burnout and inadequacy. Although many of these are normal reactions to an intense and rigorous period in their lives, it is possible to learn behaviors which can counter some of the physical and psychological impact. Mindfulness has been shown to be an effective antidote, and it is possible to incorporate mindfulness into one’s daily routine in a practical and efficient manner. Practicing mindfulness can ease the consequences of stress while simultaneously improving patient care. The key is the amount of practice one engages in; the more times one can practice mindfulness on a daily basis, the more benefits one receives. Physicians are encouraged to learn basic mindfulness skills and incorporate them into their personal and professional lives.

This review contains 11 references.
Keywords: mindfulness, meditation, residents, medical training, stress, depression, anxiety, symptom reduction
Fatigue and Asthenia
Authors: Sabin Thomas D. , Dawson David M.
Published: January 2021

The word fatigue implies a sense of exhaustion, lassitude, or inability to generate drive or energy. In taking a medical history of a patient with fatigue, the examiner should pursue questions of timing and circumstance. A medical or psychiatric diagnosis can be established in two thirds of patients who complain of fatigue, and in many cases, they are remediable. This chapter reviews the history of fatigue, including outbreaks. The clinical picture, diagnostic criteria, special considerations in diagnosis, general medical disorders, prescription drugs, postural orthostatic tachycardia syndrome, neutrally mediated hypotension, Chiari malformation, neurologic causes of fatigue, psychiatric investigation, laboratory investigations, magnetic resonance imaging (MRI) studies, pathophysiology, prognosis, and treatment are detailed. Asthenia is discussed in relation to clinical data, the central nervous system, muscle, and electromyography (EMG). Tables include terms and phrases used for indicating fatigue; definitions, features, and medical causes of chronic fatigue syndrome (CFS); blood tests to evaluate chronic fatigue; symptoms of CFS determined from laboratory studies; MRI studies for detecting CFS; outcomes of MRI studies of CFS; summary of CFS facts; summary of drugs used for fighting fatigue in multiple sclerosis patients; clinical testing for signs of asthenia; considerations when measuring creatine kinase; EMG testing in search of abnormalities; and decisive EMG findings. Figures show maps of sensory loss, an MRI of a relapsing-remitting multiple sclerosis patient, white matter hyperintensities, a diagram of EMG testing, and repetitive stimulation testing for neuromuscular transmission disorder.
This chapter contains 5 highly rendered figures, 14 tables, 74 references, and 5 MCQs.
Diseases of the Aorta
Authors: Booher Anna M , Eagle Kim A
Published: January 2021

This review covers the major presentations affecting the aorta: aortic aneurysms (abdominal aortic aneurysms and thoracic aortic aneurysms), acute aortic syndromes (including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer), other nonacute aortic processes, and traumatic disease of the aorta. The section on abdominal aortic aneurysms covers screening, clinical presentation, diagnostic evaluation, management to reduce the risk of aneurysm rupture, open surgical treatment and endovascular aortic repair, and the role of medical therapy. The section on thoracic aortic aneurysms also covers pathophysiology, etiology, and inherited and inflammatory conditions. Aortic dissections affect either the ascending aorta (type A) or the descending aorta (type B) and may be classified as acute or chronic. The discussion of aortic dissection describes the clinical presentation, diagnostic steps and decisions, and treatment for both type A and type B dissections. The figures include two algorithms: a potential management strategy for patients with thoracic aortic aneurysm and a logical procedure for the evaluation and treatment of a suspected aortic dissection. Figures also include illustrations, computed tomographic images, and echocardiograms of various aortic presentations. Tables list normal aortic dimensions by computed tomographic angiography and echocardiography, etiology and associated factors in diseases of the aorta, revised Ghent criteria for the diagnosis of Marfan syndrome, size criteria for elective surgical intervention in thoracic aortic aneurysm, and independent predictors of in-hospital death. Also included is a follow-up imaging timeline for acute aortic syndromes.
This review contains 9 figures, 6 tables, and 132 references.
Conservative Management of Male Stress Urinary Incontinence
Authors: Ho Tammy , Lai H Henry
Published: January 2021

Stress urinary incontinence is a demoralizing complication of common urologic procedures such as radical prostatectomy. Basic evaluation of postprostatectomy incontinence should include a careful history and physical examination with a focus on assessing the degree of incontinence and amount of bother and to rule out detrusor dysfunction. Evaluation can be supplemented by a voiding diary, pad test, urodynamics, and cystoscopy as indicated. Management options include behavioral modification, pelvic floor physical therapy, external drainage devices, and occlusive penile clamps. Randomized controlled trials have shown that pelvic floor physical therapy improves continence or enhances recovery of continence in the postoperative period but only when initiated before or immediately after catheter removal. Men who have intrinsic sphincter deficiency can be evaluated for injection of urethral bulking agents, including collagen, carbon-coated zirconium oxide beads, calcium hydroxylapatite particles, and heat-vulcanized polydimethylsiloxane. Injectable bulking agents have the advantage of being minimally invasive and are generally considered safe. However, multiple reinjections are often required due to deteriorating efficacy over time and thus should be considered only in patients with mild stress incontinence or in patients who are poor surgical candidates for slings or the artificial urinary sphincter.
 
This review contains 3 figures and 54 references
Key words: conservative management, injectable urethral bulking agents, pelvic floor physical therapy, postprostatectomy urinary incontinence, stress urinary incontinence
Metabolic Alkalosis
Authors: Chebib Fouad T
Published: January 2021

Metabolic alkalosis is a common clinical problem encountered by the nephrologist. An understanding of the pathogenesis of this electrolyte disorder, which includes a generative and a maintenance phase, is essential to elucidating the etiology and deciding on the appropriate treatment. Metabolic alkalosis is characterized by an increase in pH, a decrease in [H+], and an increase in [HCO3–]. The generative phase of metabolic alkalosis involves either loss of acid (e.g., gastrointestinal losses), gain of bicarbonate (e.g., antacids), or cellular shift (e.g., hypokalemia). The maintenance phase involves impairment of the renal handling of bicarbonate (decreased glomerular filtration, increased bicarbonate tubular reabsorption). We discuss the different etiologies, such as chloride depletion (e.g., vomiting), potassium depletion (e.g., primary hyperaldosteronism), and hypercalcemic states (e.g., milk-alkali syndrome). This review also discusses the symptoms, diagnosis, and prognosis of metabolic alkalosis. A diagnostic algorithm based on volume status and urine electrolytes will help differentiate the different etiologies. Treatment options are summarized based on chloride-sensitive or chloride-resistant metabolic alkalosis.

This review contains 5 figures, 3 tables and 12 references
 Key words: chloride resistance, chloride sensitivity, generative phase, maintenance phase, metabolic alkalosis, syndromes with metabolic alkalosis
Prenatal Screening and Diagnosis
Authors: O’Brien Barbara , Willner Emily
Published: January 2021

Prenatal genetic testing offers patients and providers the opportunity to screen for aneuploidy, genetic syndromes, and congenital malformations during pregnancy. Screening options include taking a clinical history, evaluation of maternal serum markers or noninvasive cell-free DNA, and ultrasound evaluation during the first and second trimesters. Invasive diagnostic testing such as amniocentesis or chorionic villus sampling allows for further investigation of positive screening results and a directed test to identify aneuploidy as well as specific gene mutations and gain, loss, or rearrangement of genetic information. Laboratory methods for testing fetal samples differ by types of genetic abnormalities that can be detected and turnaround time for results; these methods include karyotype, fluorescence in situ hybridization, and microarray.
 
This review contains 5 figures, 5 tables and 43 references
Key words: amniocentesis, aneuploidy, cell-free DNA, chorionic villus sampling, karyotype, microarray, prenatal genetic screening, ultrasonography
Trauma to the Abdomen and Pelvis
Authors: Basrai Zahir , Jang Timothy , Celedon Manuel
Published: January 2021

Abdominal trauma accounts for approximately 12% of all trauma. The evaluation of abdominal trauma is difficult as the patient may have concomitant distracting injuries or alteration of mental status. As a result, a systematic approach to abdominal trauma is needed to ensure that life threatening injuries are not missed. The evaluation and management of abdominal trauma is directed by the Western and Eastern Trauma Association guidelines. Trauma to the abdomen is divided into two main categories, penetrating and blunt. The initial steps in management of both types are determined by the hemodynamic stability of the patient. Unstable patients with either pattern of injury are emergently taken to the operating room (OR) for exploration. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is being used at select trauma centers in unstable patients with abdominal trauma that are unresponsive to standard trauma resuscitation. For hemodynamically stable patient with penetrating trauma, recent data on selective non-operative management has shown promising outcomes. Patients with tenuous hemodynamics and blunt abdominal trauma are resuscitated with blood transfusions while being worked up by a Focused Assessment with Sonography for Trauma (FAST) exam or deep peritoneal lavage (DPL). If the patient stabilizes further work up with labs and imaging is performed. Patients that remain tenuous should be taken to the OR. Hemodynamically stable patients with blunt trauma and evidence of peritonitis on exam can be evaluated with labs and imaging to assess for organ injury. Non- tender patients can be evaluated with labs and serial abdominal exams. The American Association for the Surgery of Trauma (AAST) organ injury scales are used to guide the definitive management of patients with intraabdominal injury. The Young-Burgess Classification System can be used to characterize pelvic fractures and to guide stabilization and definitive management. Tables demonstrate the AAST Injury Scales for the different abdominal organs. Images demonstrate the FAST exam and CT findings for different abdominal organs.
 
This review contains 14 figures, 6 tables and 48 references
Key Words: Abdominal Trauma, Penetrating Trauma, Blunt Trauma, FAST exam, Liver Trauma, Splenic Trauma, Intestinal Trauma, Pancreatic Trauma, Diaphragmatic Trauma, Aortic Trauma, Pelvic Fracture, Deep peritoneal lavage, DPL, Focused Assessment with Sonography for Trauma, REBOA, Resuscitative Endovascular Balloon Occlusion of the Aorta
Interstitial Cystitis/Bladder Pain Syndrome
Authors: Hensley Patrick J , Lai H. Henry , Erickson Deborah R
Published: January 2021

This article describes a practical framework for the evaluation and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS), based on and expanding from the American Urological Association (AUA) guideline. The key points in evaluation are (1) to recognize confusable diseases or comorbid disorders that require separate treatments, and (2) to recognize patient subtypes that require specialized treatment approaches (eg, pelvic pain and beyond, polysymptomatic and polysyndromic types, and patients with Hunner lesions). Treatment begins with education, including diet, stress reduction, and other self-care strategies, which have proven efficacy and are first line in the AUA guideline. Second-tier treatments include oral and intravesical medications. Further, the AUA guideline states that physical therapy should be offered to patients with pelvic floor tenderness if a qualified therapist is available.  For Hunner lesions, the initial recommended treatment is cystoscopy with fulguration or triamcinolone injection. Higher-tier treatments, which involve more risks, include hydrodistention, bladder botulinum toxin injection, sacral nerve stimulation, and oral cyclosporine A. The article includes a practical algorithm to help clinicians organize their thoughts while evaluating and starting therapy for patients with IC/BPS.
 
This review contains 4 figures, 4 tables, and 64 references.
Key Words: bladder pain syndrome, Hunner lesion, interstital cystitis,   polysymptomatic, polysyndromic, pelvic floor dysfuction, vulvodynia
Epidemiology of Male Infertility
Authors: Raheem Omer A , Walsh Thomas J
Published: January 2021

Infertility is a complex and incompletely understood disease that impacts 10 to 15% of reproductive-aged couples seeking to conceive. The World Health Organization defines infertility as the failure to conceive a clinical pregnancy after 12 or more of regular unprotected sexual intercourse. It likely involves the interaction among many variables, including age, race, ethnicity, and geography, that are laid upon the foundation of genetics and chronic medical conditions and further modified by environmental factors. A plethora of contemporary epidemiologic studies have been published detailing the relationship between male infertility, medical diseases, and environmental exposures with the primary goal of better characterizing their association, identifying risk factors, and providing more effective patient counseling and subsequent treatments. In this chapter, we aim to critically analyze available data and integrate the understanding of epidemiology and male infertility in an effort to provide clear guidance to a larger audience of clinicians of various subspecialties that encounter men with reproductive challenges.

This review contains 1 figure, 8 tables, and 62 references.
Key Words: at-risk groups, conditions, definitions, environmental factors,epidemiology, male fertility, racial geographical, variations