Repair Sequences Research Articles

Surgical Management of Panfacial Fractures.

The evaluation and management of a patient with panfacial fractures are multifaceted. Herein, we describe basic facial skeletal anatomy, considerations for airway securing, and common concurrent injuries. Finally, we discuss primary and secondary reconstructions of facial trauma including sequencing of repair, available landmarks, and the utility of intraoperative computed tomography imaging and virtual surgical planning with custom implants.

Range and timing of surgery, and surgical sequences used, in primary repair of complete unilateral cleft lip and palate: The Cleft Care UK study.

To describe the range of surgery used to repair the lip and palate in the UK with specific interest in the sequence/timing used in complete unilateral cleft lip and palate (cUCLP). The Cleft Care UK study, a cross-sectional study of 268 5-year-olds, born from 2005 to 2007, with complete unilateral cleft lip and palate. Information on surgery was extracted from medical notes by surgeons during research clinics and transcribed onto a standardized questionnaire. Surgical data were available for 251 (94%) children from all cleft centres in the UK (n=18). Over a two-year period, 32 surgeons used 10 different surgical sequences in primary repair of the cleft lip and palate. The most frequently used sequence was repair of cleft lip and anterior hard palate followed by repair of posterior hard palate and soft palate (70%). Four surgical sequences were used only once. Most surgeons had a preferred sequence, but 38% (11/29) used more than one sequence during the study period. The timing of repair of the lip, the hard palate and the soft palate varied with surgical sequence, and also between surgeons, even adjusting for the different sequences used. Despite centralization of cleft services in the UK, there remains considerable variation in both the sequence and timing of surgical repair of cleft lip and palate in infancy. Further work is required to understand whether these factors are associated with differences in outcome.

Systematicity in linguistic feature selection: Repair sequences and subsequent accommodation

AbstractThis study examines linguistic feature selection and its relationship with repair sequences in a longitudinal corpus of Japanese–Filipino business ELF interactions. In the corpus, Japanese employees communicate once a month with Filipino employees via computer software to confirm infrastructure status at a Filipino company’s factories. Comparative constructions frequently appear in the corpus because of the nature of the interactions, but the kinds and frequencies of comparative constructions change month to month. This study demonstrates that early in the corpus, the speakers utilized a multitude of comparative constructions, but after 12 months, the speakers have settled on one preferred comparative construction. Furthermore, the preferred construction emerged from repair sequences, which suggests that repair is significantly related to linguistic feature selection. Accordingly, this study hypothesizes that repair sequences do far more than just resolve an interactional problem; repaired linguistic features are more likely to be selected again the next time a similar linguistic feature is relevant to the progression of the interaction.

Modelling cascading failure of a CPS for topological resilience enhancement

This study focuses on the cyber-physical system (CPS) consisting of interdependent electrical distribution and communication networks, where the two networks are mutually dependent. A small disturbance in either of them can trigger a cascade of faults within the entire network. To investigate the failure mechanism, first, two features that affect topological resilience (TR) are defined in this study: adaptation and recovery abilities. Second, the authors model the process of cascading failures that occur in this coupled system by introducing and developing the infrastructure interdependencies simulator. The process of cascading failures is based on percolation theory, and they present a detailed analysis of cascading failure in a standard IEEE 33-bus system coupled with the 33-node communication system. This study proves that the adaptation ability of a coupled system is even lower than a single system. This is due to the interdependencies between systems, and the study of the failure mechanisms helps planers to make a better decision in the recovery process. Finally, the modified shortest path search is used to optimise the repair sequence. Their numerical results validate that the recovery ability of the coupled system is increased through the optimisation, which contributes to the TR enhancement.

The effect of tendon rotation on distal biceps repair

BackgroundThe distal biceps tendon externally rotates from proximal to distal before inserting onto the radius. Our hypothesis is that an externally rotated (anatomic) repair would re-create native supination moment arm and flexion force, whereas an internally rotated (nonanatomic) repair would result in reduced force transmission.MethodsThe mechanical tests performed in this study measured isometric moment arms and elbow flexion force using a validated elbow simulator as previously published. Mechanical testing was performed on 8 native cadaveric elbows (61 ± 15 years). The distal biceps tendons in all specimens were then incised from their footprint and repaired with anatomic and nonanatomic tendon rotations. After each repair, the specimens were retested. The repair sequence was randomly assigned.ResultsGross observation showed repair site bunching with the nonanatomic repairs. There was no statistical difference in the moment arms between the native, anatomic, and nonanatomic rotations for the 3 forearm angles (P ≥ .352). Analysis showed no statistical difference in flexion force ratio for the elbow at 90° (P ≥ .283).DiscussionThe study showed that biceps tendon rotation does not play a role in supination moment arm or flexion force. Twisting the distal biceps tendon around the tendon axis does not change the direction of its applied force on the tuberosity. Tendon bunching in nonanatomic reattachments increases repair site width, which may lead to tendon-ulnar impingement during forearm rotation.

Indian Subcontinent's First Proximal Forearm Level Double Upper Extremity Transplantation.

Introduction Vascularized composite allotransplantation (VCA) has added another step to the reconstructive ladder, leading to a paradigm shift in the approach toward management of cases of upper limb amputations. In this article, we discuss in detail the technical aspects of proximal forearm level transplantation, as well as the immediate posttransplant monitoring and immunosuppression protocols. Materials and Methods A 24-year-old male victim of an electric injury presented with a bilateral proximal forearm level amputation. After the mandatory preoperative psychiatric and immunological evaluation, the patient underwent a proximal forearm level double upper extremity transplantation. He was then put on a stringent immunosuppression and physical rehabilitative regime. Discussion Conceptually, the proximal forearm level transplantation is significantly different from distal forearm level transplant. This transplant “reestablishes” the “donor extremity length,” maintains the normal functional length of the donor muscles, and the functional return happens only after the newly transplanted donor muscles are reinnervated over a period of time. Conclusion As the sequence of surgical repair and associated decision making could be quite confusing for this level of transplantation, it is highly advisable to do mock cadaver surgical dissections in order to standardize the procedure and make the team familiar with it.

Category accounts: Identity and normativity in sequences of action

AbstractThis study investigates the sequentially occasioned provision of what I termcategory accountsin interaction. Category accounts tap into and make use of normative assumptions about identities and membership categories in order to explain away moments of what the participants view as category deviance. To introduce this concept, I focus on sequences in which speakers’ initiations of repair (e.g.Huh?) are oriented to as indicative of a problem of understanding. In the cases examined here, recipients of such initiations of repair treat divergence from some gender/sexuality norm as the source of the misunderstanding, which is revealed through their attempt to resolve the trouble by providing a category account, thereby closing the repair sequence and providing for the resumption of progressivity. These and similar accounting sequences are thus a means through which participants collaboratively normalize momentary departures from normativity, while at the same time reconstituting what exactly constitutes ‘normativity’ and ‘departures therefrom’, and for whom. (Gender, sexuality, identity, membership categorization, Conversation Analysis, Ethnomethodology, repair, social interaction, normativity, deviance)*

Ranking Approach to Scheduling Repairs of a Water Distribution System for the Post-Disaster Response and Restoration Service

: On the maintenance task list of each water distribution system (WDS) operator, determination of the order of undertaken repairs seems quite a typical task. Characteristics of damages, their localization, and other factors that influence repair sequencing have a sound impact on the execution of such tasks. In the case of the most complex cases where numerous failures of different types occur at the very same time (i.e., due to earthquakes), there is a long list of selection criteria that have to be analyzed to deliver an objectively logical schedule for repair teams. In this article, authors attempt to find out if it is possible to define pipe rankings in having obtained the best factors for defined objective functions (criteria), making it feasible to deliver judicious repair sequencing. For the purposes of this paper, a survey has been carried out. Its conclusions made it possible to propose a method to create rankings of pipes and evaluate them using a selected multicriteria decision method: preference ranking organization method for enrichment evaluation (PROMETHEE). The work was carried out for five different disaster scenarios that had been supplied by ‘The Battle of Post-Disaster Response and Restoration’ organization committee. Obtained results might be further used to finetune this sequencing method of undertaken repairs, while conclusions could be useful to model similar events in WDS when required. This article is an extended paper based on the conference preprint presented at the 1st International Water Distribution Systems Analysis (WDSA)/International Computing & Control for the Water Industry (CCWI) Joint Conference in July 23–25, 2018 in Kingston, Ontario, Canada.

A Combined Repair Crew Dispatch Problem for Resilient Electric and Natural Gas System Considering Reconfiguration and DG Islanding

Resilience is an overarching concept that requires combined efforts from interdependent critical infrastructures to achieve. As the interdependence between the power system and the natural gas system grows, the roles of coordination in post-disaster repair will be unneglectable to improve the resilience of the two systems. In this paper, a combined repair crew dispatch problem for the interdependent power and natural gas systems is proposed. The repair schedule of the two systems is coordinated and co-optimized. Both power system topology reconfiguration and intentional DG islanding are modeled as operational measures to further improve the resilience of the interdependent systems. Case studies validate the effectiveness of the proposed method in reducing load shedding and repair duration, and prove that the interdependence has a significant impact on the repair sequence and crew coordination.

Component importance assessment of power systems for improving resilience under wind storms

Increasingly frequent natural disasters and man-made malicious attacks threaten the power systems. Improving the resilience has become an inevitable requirement for the development of power systems. The importance assessment of components is of significance for resilience improvement, since it plays a crucial role in strengthening grid structure, designing restoration strategy, and improving resource allocation efficiency for disaster prevention and mitigation. This paper proposes a component importance assessment approach of power systems for improving resilience under wind storms. Firstly, the component failure rate model under wind storms is established. According to the model, system states under wind storms can be sampled by the non-sequential Monte Carlo simulation method. For each system state, an optimal restoration model is then figured out by solving a component repair sequence optimization model considering crew dispatching. The distribution functions of component repair moment can be obtained after a sufficient system state sampling. And Copeland ranking method is adopted to rank the component importance. Finally, the feasibility of the proposed approach is validated by extensive case studies.

Closer to the Truth on National Fistula Prevalence After Unilateral Complete Cleft Lip and Palate Repair? The Cleft Care UK Study.

To (1) determine the prevalence of nonperialveolar palatal fistula up to age 5 following repair of unilateral cleft lip and palate (UCLP) in the United Kingdom, (2) examine the association of palatoplasty techniques with fistula occurrence, and (3) describe the frequency of fistula repairs and their success. Cross-sectional study. All 11 centralized regional cleft centers in the United Kingdom. Two hundred sixty-eight children born between 2005 and 2007 recruited by Cleft Care UK, a nationwide cross-sectional study of all 5-year-old children born with nonsyndromic UCLP. Nonperialveolar palatal fistula prevalence up to age 5. Fistulas were found in 72 children (31.3%, 95% confidence interval: 25.4%-37.7%) and had no significant association with palate repair sequences. Twenty-four fistulas were repaired by age 5, 12 of which had data showing 10 (83.3%) successful repairs. The prevalence of nonperialveolar fistulas following primary palatoplasty of UCLP in the United Kingdom was higher than previously reported. This information should be part of the preoperative discussion with families. Prospective collection of the presence of fistulas will be necessary before we can associate the occurrence of fistulas with a surgeon, institution, surgical technique, or protocol of care.

RADAR-seq: A RAre DAmage and Repair sequencing method for detecting DNA damage on a genome-wide scale

RAre DAmage and Repair sequencing (RADAR-seq) is a highly adaptable sequencing method that enables the identification and detection of rare DNA damage events for a wide variety of DNA lesions at single-molecule resolution on a genome-wide scale. In RADAR-seq, DNA lesions are replaced with a patch of modified bases that can be directly detected by Pacific Biosciences Single Molecule Real-Time (SMRT) sequencing. RADAR-seq enables dynamic detection over a wide range of DNA damage frequencies, including low physiological levels. Furthermore, without the need for DNA amplification and enrichment steps, RADAR-seq provides sequencing coverage of damaged and undamaged DNA across an entire genome. Here, we use RADAR-seq to measure the frequency and map the location of ribonucleotides in wild-type and RNaseH2-deficient E. coli and Thermococcus kodakarensis strains. Additionally, by tracking ribonucleotides incorporated during in vivo lagging strand DNA synthesis, we determined the replication initiation point in E. coli, and its relation to the origin of replication (oriC). RADAR-seq was also used to map cyclobutane pyrimidine dimers (CPDs) in Escherichia coli (E. coli) genomic DNA exposed to UV-radiation. On a broader scale, RADAR-seq can be applied to understand formation and repair of DNA damage, the correlation between DNA damage and disease initiation and progression, and complex biological pathways, including DNA replication.

Combinations of discourse markers with repairs and repetitions in English, French and Spanish

Discourse markers have a central role in planning and repairing processes of speech production. They relate with fluency and disfluency phenomena such as pauses, repetitions and reformulations. Their polyfunctionality is challenging and few form-function mappings are stable cross-linguistically. This study combines a functional and a structural approach to discourse markers and their combination with and within repetitions and self-repairs in native English, French and Spanish, in order to establish the inter-relation between these three fluency-related devices and to find potentially universal patterns of use. Qualitative coding and quantitative analyses of categories of markers and repairs allowed us to identify discourse markers which are specific to repair sequences and others which are much more pervasive. Combinations with repetitions vary across languages and repair types. Our findings fill a gap in cross-linguistic fluency research, disentangle the overlap between discourse markers, repairs and repetitions, and can be integrated into pedagogical materials.

Second Language Learners' Strong Preference for Self-initiated Self-repair: Implications for Theory and Pedagogy

This study employs a theoretical framework informed by Conversation Analysis to analyse the self-repairs of a particular group of teenage Chinese EFL learners. With an aim to report on the current development of the participants in using English socially in terms of managing repairs, this study explores their second language (L2) discourse in three communicative tasks. Audio-recorded conversations were analysed and searched for the four sequences of repair. Comparison of the participants' preference for repair sequence to native speakers shows that they can manage repairs and maintain conversation interactively and socially just as native speakers. This suggests that they should be treated as normal social beings in the language classroom and not to be interrupted by the teacher when troubles arise from conversational interaction. Thus, this study provides an account of the current development of these young learners in using the L2 interactively and socially, which holds implications for research on second language education as well as for classroom teaching.

Repair receipts: On their motivation and interactional import

This article discusses a less-studied aspect of repair sequences in conversation, that is, their exit phases. It will be argued that while the most common way of exiting is a resumption of the main...

Tumor mutation burden, DNA mismatch repair status and checkpoint immunotherapy markers in primary and relapsed malignant rhabdoid tumors

IntroductionMalignant rhabdoid tumor (MRT) is a rare, aggressive pediatric tumor of nuclear lineage. It is mainly characterized by germline or somatic SMARCB1 (INI1) driver mutations. To characterize the potential for immunotherapy in untreated and treated MRT, current study investigated tumor mutational burden (TMB) and other biomarkers in MRT. Material and methodsNormal-tumor paired whole exome sequencing (WES) and/or immunohistochemistry (IHC) of DNA mismatch repair (MMR) proteins, PD-L1, PD-1 and CD8 were performed in 16 cases, some with both primary and relapsed tumor. ResultsFive cases subjected to WES demonstrated germline SMARCB1 (INI1) mutations. TMB was 0.7–1.07/Mb in 4 of the 5 primary untreated tumors, and 33.81/Mb in one case with pathogenic MMR, POLD, and POLE mutations. Ten cases tested for MMR status by IHC showed retained nuclear expression of the proteins. Eight of the 16 cases (8/16, 50%) showed membranous expression of PD-L1 in 10–70% of tumor cells (tumor proportion score, TPS). Nine cases (9/16, 56.3%) showed high (>2/HPF) tumor infiltrating lymphocytes with PD-1 staining ranging 10–60%, correlating with tumor PD-L1 staining (p < 0.0001). Between post-treatment metastatic tumors and the pre-treatment primary tumors, TMB was similar while PD-L1 TPS was similar or lower. ConclusionMRT has a low TMB. Nonetheless, because a subset of MRT cases have a PD-L1 TPS greater than the cutoff for checkpoint therapy in other malignancies, the utility of immune checkpoint inhibitors should be studied in this patient population.

Open-class repair initiations in conversations involving middle-aged hearing aid users with mild to moderate loss.

To manage conversational breakdowns, individuals with hearing loss (HL) often have to request their interlocutors to repeat or clarify. To examine how middle-aged hearing aid (HA) users manage conversational breakdowns by using open-class repair initiations (e.g., questions such as sorry, what and huh), and whether their use of repair initiations differs from their normally hearing interlocutors. Eighteen 45-64-year-old adults with acquired mild to moderate HL participated in the study. The participants were videotaped in everyday interactions at their homes and workplaces and in clinical encounters with hearing health professionals. Interactions were transcribed and open-class repair initiations of participants with HL and their interlocutors were identified using conversation analysis. The frequencies of initiations were analyzed statistically between the groups, and the contexts and structure of repair sequences dealing with communication breakdown were analyzed. Before acquiring HA the participants with HL reported intense use of open-class repair initiation. After HAs were acquired, there was no statistically significant difference in the frequency of open-class repair initiations between HA users and their interlocutors. The most common means for open-class repair initiation in the data was interrogative word mitä ('what'). Vocalization hä ('huh'), apologetic expression anteeksi ('sorry') and clausal initiations (e.g., 'what did you say'/'I didn't hear') occurred less often. Open-class repair initiations emerged in contexts where they typically occur in conversation, such as topical shifts, overlapping talk and action, background noise, and disagreements. When used, open-class repair initiations most often led to repetition by the interlocutor, which immediately repaired the conversational breakdown. Long clarification sequences with multiple repair initiations did not occur. Participants with mild to moderate HL using hearing amplification initiate open-class repair similarly to their normally hearing conversational partners when the frequency, types, contexts and structure of repair are considered. The findings diminish the stigma related to HL, HAs and the use of open-class repair. The findings suggest that HA amplifies hearing successfully in everyday conversation when the level of HL is mild to moderate. However, the evidence for the benefit of HAs remains indirect.

Improving repair sequence scheduling methods for postdisaster critical infrastructure systems

AbstractThe recovery process of postdisaster critical infrastructure systems (CISs) includes multiple phases, among which the repair phase usually takes the longest time and contributes the largest to system recovery rapidity and system resilience. This article formulates the repair sequence scheduling problem for damaged CIS components under limited repair resources in a general form, and then proposes two novel heuristic methods to enhance its solution performance. To demonstrate the efficiencies of the two proposed methods, typical existing methods are also briefly introduced for comparison purposes, including three component importance‐based methods (CIBMs), a genetic algorithm‐based method (GABM), a time index‐based heuristic method (TIBHM), and a component index‐based exact solution method (CIBESM). Those methods are separately applied into thousands of damage scenarios for three systems, and are then compared in terms of the optimality gap and the computational cost. Results show that the two proposed methods have significantly better performance than existing methods, whereas the first proposed method can be adapted for critical time points‐based resilience assessment and optimization, and the second proposed method can be applied to the recovery of large‐scale CISs with extensive disruptions.

Repair sequences in ‘off-task’ conversations in an EFL university classroom in Japan: Japanese language resources and learning opportunities

ABSTRACTIn this article, I use conversation analysis (CA) to focus on how Japanese language resources are used in repair sequences that occur in ‘off-task’ English interactions in a lower-level EFL classroom at a Japanese university, considering how this may create opportunities for learning. While previous research has found that ‘off-task’ peer interactions in EFL classrooms will often be in the L1, I show how the participants in this study can display an orientation to speaking in English, even when ‘off-task’. However, L1 resources were more likely to be used when ‘off-task’ than when on-task. In ‘off-task’ talk, Japanese language resources were made use of in a number of ways: during other-initiated repair to clarify the meaning of an English word; as a placeholder in a word search; and to elicit help in forward-oriented repair sequences, among others. I describe how an orientation to speaking in English combined with some L1-use allowed for repair sequences that involved translation between the L1 and target language, and how ‘off-task’ talk may provide learning opportunities that occur less often in the on-task interactions in my data. I argue in the discussion that ‘off-task’ conversations may have a useful role to play in the EFL classroom.

‘Well let me put it uhm the other way around maybe’: Managing students’ trouble displays in the CLIL classroom

ABSTRACTThis study is concerned with repair practices that a teacher and students employ to restore intersubjectivity when faced with interactional problems in a Content and Language Integrated Learning (CLIL) classroom. Adopting a conversation analytic (CA) approach, it examines the interactional treatment of students’ verbal and embodied trouble displays in a video-recorded, teacher-fronted geography lesson held in English at a German high school. At the same time, it explores to what extent the repair practices employed are fitted to this specific interactional context. The analysis shows that students’ verbal trouble displays often result in extensive repair sequences, whereas students’ embodied trouble displays are usually met with teacher self-repair in the transition space. In this way, the latter are resolved much earlier and more quickly. The study further reveals practices like reformulation and translation to be especially useful for repairing interactional problems in classrooms in which a foreign language is used as the medium of instruction. The findings may be of interest for prospective as well as practicing teachers in that they provide relevant insights into how interactional trouble can be successfully managed in (CLIL) classroom interaction.