Repair Sequences Research Articles

Adult aortic coarctation discovered incidentally after the rupture of sinus of Valsalva aneurysm: combined surgical and interventional approach

Combination of ruptured sinus of Valsalva aneurysm (SVA), and a coexisting asymptomatic adult aortic isthmic coarctation is extremely rare. The timing and sequence of surgical and/or interventional repair of these two pathologies are controversial. We present a case of a 37-year-old male who was admitted to our department because of severe acute congestive heart failure and signs of ruptured aneurysm of the SV into the right ventricle. Transthoracic and transoesophageal echocardiography confirmed the communication between an important right coronary SVA and right ventricle, bicuspid aortic valve, mild aortic regurgitation, and revealed severe aortic coarctation. Because of the severe dilation of right sinus of Valsalva a surgical repair of the ruptured aneurysm was performed. Aortic coarctation was treated four weeks later by a percutaneous stent-graft implantation. This case report supports the concept that hybrid approach is feasible in patients with ruptured SVA and aortic coarctation in adulthood.

Acquired dysarthria in conversation: Methods of resolving understandability problems

People with acquired progressive dysarthria typically experience increased problems with intelligibility in everyday conversation as their disease progresses. Such problems are likely to impact on both the person with dysarthria and those with whom they interact. If this is the case then we may ask questions not just about the nature of these problems but how it is that such problems are dealt with by participants when they occur. To investigate ways through which problems resulting from dysarthria in everyday conversation are resolved by participants. Further, to examine some of the features of repair resolution, particularly where understanding of self-repair attempts themselves prove difficult. Video data of natural conversation from two dyads were selected for this paper. One dyad features a 58 year-old man with multiple sclerosis and moderate intelligibility problems, the other a 79 year-old woman with motor neurone disease with mild to moderate intelligibility problems. Both elected to be recorded in conversation with their spouses. The dyads were video-recorded at home with no researcher present. Using the methods of Conversation Analysis (CA) a collection of sequences was identified and transcribed. The sequences were analysed with reference to how the participants resolve problems in the understanding of dysarthric speech. It is shown how some problems resulting from dysarthria in conversation can be resolved relatively quickly, particularly where a specific element of a prior turn is highlighted by the recipient as problematic. In other instances, the recipient's understanding problem may be more global. These result in longer repair sequences in which problematic elements are addressed individually. Such a resolution method is ultimately successful but may also be characterised by additional understanding problems. These findings draw attention to an important distinction between intelligibility and understandability. It is concluded that problems resulting from dysarthria in conversation can require extensive repair work involving both parties. This has implications for the assessment of dysarthria in everyday conversation and also the promotion of intervention strategies that encompass the activities of both participants when dealing with dysarthria in interaction. These findings may be usefully employed in informing both direct clinical work and through training those who work with this client group and their significant others.

On the Organization of Repair in Multiperson Conversation: The Case of “Other”-Selection in Other-Initiated Repair Sequences

This article examines a previously undocumented way in which the presence of more than two interlocutors matters for the organization of repair (Schegloff, Jefferson, & Sacks, 1977): when the repair initiation is addressed to—and thereby selects as the next speaker—somebody other than the speaker of the trouble-source turn (“other”-selection, for short). The speaker of the trouble-source turn is ordinarily the one who is selected to repair it (Sacks, Schegloff, & Jefferson, 1974). Under what circumstances, then, is “other”-selection used? The analysis shows that, while rare, “other”-selection in other-initiation of repair is a systematically deployed practice. In selecting somebody other than the speaker of the trouble-source turn to provide a repair solution, the repair initiator orients to two broad considerations (sometimes concurrently): progressivity and social epistemics. The article examines how these considerations play out in a variety of contexts and considers implications of “other”-selection for our understanding of the repair organization.

Teachers’ reproaches and managing discipline in the classroom: When teachers tell students what they do ‘wrong’

Drawing from a corpus of video-recorded classes in 6 and 7 grade groups in an Italian secondary school and in two 3 grade groups in a primary school, the article investigates one specific format used by teachers to reproach students for their untoward conduct. The analysis focuses on cases where, in contrast to other less explicit formats, teachers refer to students’ ongoing behaviour as ‘wrong’ with direct descriptions of the misconduct. Reproaches of this type employ a conditional structure in which the event and its negative consequences are described in detail. The paper argues for this specific type of reproach as displaying similarities with repair sequences in that it operates retroactively ( Schegloff, 2007) to locate in prior courses of actions the source for the reproach (or the ‘reproachable’). Building on a detailed analysis of turn construction, word selection, and sequential deployment, the paper shows that a preference organization is in order in the accomplishment of reproaches. In comparison to prior literature on this topic, and in contrast to other documented way of treating recipients’ untoward conduct as caused by their inability, the paper documents the way in which other peoples’ conduct can be explicitly constructed as wrong and, as such, reproachable; thus holding the recipient as culpable for not having avoided a course of action that is not amendable. The paper argues for further research in the domain of classroom reproaches, as having implications for the understanding both of action formation mechanisms in ordinary and institutional interaction and of the different activities that contribute to the sense of formality of classroom interaction beyond instruction activities and academic talk.

Real‐Time Vehicle Routing for Repairing Damaged Infrastructures Due to Natural Disasters

We address the task of repairing damaged infrastructures as a series of multidepot vehicle‐routing problems with time windows in a time‐rolling frame. The network size of the tackled problems changes from time to time, as new disaster nodes will be added to and serviced disaster nodes will be deleted from the current network. In addition, an inaccessible disaster node would become accessible when one of its adjacent disaster nodes has been repaired. By the “take‐and‐conquer” strategy, the repair sequence of the disaster nodes in the affected area can be suitably scheduled. Thirteen instances were tested with our proposed heuristic, that is, Chen et al.′s approach. For comparison, Hsueh et al.′s approach (2008) with necessary modification was also tested. The results show that Chen et al.′s approach performs slightly better for larger size networks in terms of objective value.

Competitive Repair by Naturally Dispersed Repetitive DNA during Non-Allelic Homologous Recombination

Genome rearrangements often result from non-allelic homologous recombination (NAHR) between repetitive DNA elements dispersed throughout the genome. Here we systematically analyze NAHR between Ty retrotransposons using a genome-wide approach that exploits unique features of Saccharomyces cerevisiae purebred and Saccharomyces cerevisiae/Saccharomyces bayanus hybrid diploids. We find that DNA double-strand breaks (DSBs) induce NAHR–dependent rearrangements using Ty elements located 12 to 48 kilobases distal to the break site. This break-distal recombination (BDR) occurs frequently, even when allelic recombination can repair the break using the homolog. Robust BDR–dependent NAHR demonstrates that sequences very distal to DSBs can effectively compete with proximal sequences for repair of the break. In addition, our analysis of NAHR partner choice between Ty repeats shows that intrachromosomal Ty partners are preferred despite the abundance of potential interchromosomal Ty partners that share higher sequence identity. This competitive advantage of intrachromosomal Tys results from the relative efficiencies of different NAHR repair pathways. Finally, NAHR generates deleterious rearrangements more frequently when DSBs occur outside rather than within a Ty repeat. These findings yield insights into mechanisms of repeat-mediated genome rearrangements associated with evolution and cancer.

A Tutorial on Multiblock Discriminant Correspondence Analysis (MUDICA): A New Method for Analyzing Discourse Data From Clinical Populations

In communication disorders research, clinical groups are frequently described based on patterns of performance, but researchers often study only a few participants described by many quantitative and qualitative variables. These data are difficult to handle with standard inferential tools (e.g., analysis of variance or factor analysis) whose assumptions are unfit for these data. This article presents multiblock discriminant correspondence analysis (MUDICA), which is a recent method that can handle datasets not suited for standard inferential techniques. MUDICA is illustrated with clinical data examining conversational trouble-source repair and topic maintenance in dementia of the Alzheimer's type (DAT). Seventeen DAT participant/spouse dyads (6 controls, 5 participants with early DAT, 6 participants with moderate DAT) produced spontaneous conversations analyzed for co-occurrence of trouble-source repair and topic maintenance variables. MUDICA found that trouble-source repair sequences and topic transitions are associated and that patterns of performance in the DAT groups differed significantly from those in the control group. MUDICA is ideally suited to analyze language and discourse data in communication disorders because it (a) can identify and predict clinical group membership based on patterns of performance, (b) can accommodate few participants and many variables, (c) can be used with categorical data, and (d) adds the rigor of inferential statistics.

Mother-initiated repair sequences in interactions of 3-year-old children

Repair initiated by parents provides their children with corrective feedback of the children’s developing talk.To investigate how the interactive repair process is constructed, this study looked at five mother—child pairs during play interaction, focusing on mother-initiated repair sequences ( N = 163). The mothers used many types of repair initiators from the general ‘What?’ to the more specific interrogatives. They also offered candidate understandings, and made other-corrections. Repair sequences usually comprised of three parts: the child’s turn, the mother’s repair initiation in the next turn, and the child’s response in the third turn. In more than 90% of the cases the children responded to their mothers’ repair initiations. Thus, after mother-initiation the 3-year-old children could already locate the trouble and repair it.

Single-Stage Repair of Aneurysm of the Ascending Aorta Associated with Aortic Coarctation

A 38-year-old man with a history of uncontrolled hypertension was investigated for atypical chest pains and found to have an aneurysm of the ascending aorta and a coexisting coarctation of the aorta. The timing and sequence of surgical repair of these 2 pathologies are controversial. We report an elective single-stage operation in which the ascending aorta was replaced and an extracardiac bypass from the ascending to the descending aorta was performed with excellent results.

Pragmatik und Aphasie

Patients with aphasia primarily show linguistic deficits but they also have pragmatic difficulties. Typical pragmatic challenges of aphasic patients are modified repair sequences, reduced cohesion and coherence, limited information content, unclear thematic structure and different adaptation processes in dialogue compared to healthy control subjects. In German there are 3 categories of diagnostic methods to assess pragmatic disorders in aphasic patients. First of all we use analyses of spoken language where the aphasic speech production is rated along a variety of parameters. Good examples are the Pragmatic Protocol [57] and the Assessment Protocol of Pragmatic Linguistic Skills - APPLS [56]. Questionnaires answered by patients, relatives or speech language pathologists often comparing actual with premorbid pragmatic competence present a second possibility. Finally, there are some test batteries that focus on pragmatic and/or communicative competence like the ANELT [66, 67] and the Right Hemisphere Language Battery [70]. It is difficult to find an appropriate evaluated pragmatic therapeutic program. Specific aspects of pragmatic behaviour are trained by specially developed material. Additionally, we will present the Speaking Out Program by Worrall and Yiu [74]. In conclusion, it is argued that aphasia and pragmatics should still be more connected. In the future we will more often need a pragmatic approach to aphasic disorders. In this context the differentiation between pragmatic and communicative deficits will be discussed. Communicative aspects will be of special importance with respect to functioning and participation in terms of the ICF.

Marking understanding versus receipting information in talk: Achso. and ach in German interaction

This conversation analytic study contrasts the German particles ach and achso. and discusses their form, function and interactional trajectory. It extends Golato and Betz’s (2008) work on ach and achso. in third positions of repair sequences to other positions and actions, and compares it to work on English oh (Heritage, 1984, 1998, 2002, 2005; Local, 1996). Based on the analysis of over 200 instances, I argue that ach so. is used to explicitly mark understanding of a prior action or of the import of the speaker’s own actions while ach functions as a change-of-state token marking the receipt of information without explicitly marking understanding. I discuss the implications of the findings with regard to conversation and cognition and issues of translatability.

Repair sequences in dysarthric conversational speech: A study in interactional phonetics

This paper presents some findings from a case study of repair sequences in conversations between a dysarthric speaker, Chris, and her interactional partners. It adopts the methodology of interactional phonetics, where turn design, sequence organization, and variation in phonetic parameters are analysed in unison. The analysis focused on the use of segmental and prosodic variation found during attempts by Chris to repair a previously identified trouble source. The results indicate that trouble sources were extremely common in the recorded conversations, but that repair attempts were almost always communicatively successful. Analysis of the fragments revealed that repair sequences are often collaborative achievements, with the participant's conversational partners signalling the specific trouble source within a turn, or providing feedback about repair attempts. It was also observed that successful repair attempts were not always simple repetitions of the trouble source, but varied in other linguistic areas. It is suggested that intelligibility repairs should be studied using both experimental and qualitative methods.

In vitro double transposition for DNA identification

We present a double transposition technique that inserts two different transposons into target DNA to act as priming sites for amplifying the region between the two transposons for sequencing applications. Unlike some current sequencing approaches, the genome of the unknown target remains intact in this method. The transposition reaction, DNA repair, and subsequent sequencing were performed entirely in vitro, without the need for transformation into bacteria, and resulted in sequence homology with the plasmid DNA target. This approach can reduce the time required for the assay by more than a day compared with standard techniques and reduces the number of required enzymatic steps. In addition, the in vitro method enables transposition to be carried out in automated microfluidic platforms without the need for significant sample manipulation. As a demonstration of incorporating transposition techniques into high-throughput technologies, single transposition reactions were carried out in picoliter-sized droplets generated on a microfluidic platform.

Repair and regeneration of the human endometrium

The human endometrium has the unique capacity to repeatedly repair and regenerate throughout a woman’s reproductive life. Aberrations in this highly coordinated sequence of cyclical injury and repair leads to menstrual disorders. However, mechanisms controlling endometrial repair and regeneration are yet to be fully elucidated. This review provides an overview of the processes involved in endometrial repair after menstruation, including inflammation, its resolution, tissue formation and remodeling. Angiogenesis is fundamental for all these processes and this article examines the research available to date into the control of endometrial angiogenesis. In addition, evidence is mounting for the existence of endometrial progenitor cells, providing an attractive mechanism for rapid repair. Increased understanding of endometrial repair and regeneration will reveal new therapeutic targets for menstrual disorders and may be transferable to pathology in other sites in the body.

The Myth of an 'Invisible Mediator': An Australian Case Study of English-Japanese Police Interpreting

Recent studies have challenged the assumption that the interpreter is an ‘invisible’ mediator and have demonstrated a departure from the ‘conduit’ role often assigned to interpreters in their professional ethics guidelines (e.g. Russell 2000, Wadensjö 1998, 2004; Yoshida 2007). In this paper, I address the issue of interpreter’s role as an invisible mediator through an examination of interactional ‘repairs’, one of the key aspects of interaction management mechanisms in the tradition of Conversation Analysis. The context of interpreting is Australian Federal Police interviews mediated by Japanese-English interpreters. While some repair sequences in interpreter-mediated police interviews followed common patterns of monolingual police interviews, there were also some features of repairs specific to interpreter-mediated discourse. In particular, due to the interpreting of each turn, in some cases, it is not always possible to ascertain whether it was the primary speaker’s turn or the interpreted version that was the source of ‘trouble’ leading to an interactional repair. The paper demonstrates interpreters’ vulnerability to being identified as the ‘troublemaker’ in repair sequences and consequential face-saving strategies. These strategies included modifying the primary speaker’s utterances or providing explanations for why a need to repair was perceived or why a repair sequence failed to rectify a problem. It is demonstrated that in engaging in these types of problem solving activities, interpreters at times shift roles, sometimes pushing the boundaries of their professional ethics. The paper argues that, while interpreters are often viewed as operating within a third ‘invisible’ space between interlocutors, this invisibility needs to be questioned. It is suggested that the expectation of a completely invisible, or neutral, third space is unrealistic, and that interpreters as cultural and linguistic mediators, and as social beings, continuously negotiate their identity with their clients while interpreting.

Inclusion of Hepatic Venous Drainage in Patients with Pulmonary Arteriovenous Fistulas

It is well known that hepatic vein (HV) inclusion can ameliorate cyanosis in patients with pulmonary arteriovenous fistulas (PAVFs) during the sequence of Fontan type repair. Previously, we reported that most patients with bidirectional cavopulmonary shunt (BCPS) have clinical or subclinical evidence of a right to left shunt through PAVFs. We studied 33 patients who already had clinical and subclinical PAVFs after BCPS. All patients have taken Fontan completion with HV inclusion. The state of PAVFs was reevaluated by pulmonary angiogram, contrast echocardiography, and lung scintigraphy 7.7 +/- 2.4 years after HV inclusion. After Fontan completion, the mean oxygen saturation increased from 80.2 +/- 7.4% to 91.5 +/- 9.8% in the entire cohort. Moreover, the amount of right-to-left shunting through the PAVFs, measured by lung scintigraphy, was decreased from a mean of 23.8 +/- 15.1 to 13.0 +/- 8.2%. The degree of severity, for most patients, was decreased as demonstrated by contrast echocardiography. However, 5 patients (16.7%) showed persistent PAVFs, even after the HV inclusion. They all had left isomerism with azygous continuation of the IVC and the conduit was positioned on the contralateral side to the SVC with azygous drainage. Most PAVFs regressed after Fontan completion. Left isomerism with azygous continuation of the IVC had risk for persistent PAVFs when the HV conduit was positioned at the contralateral side to the SVC receiving the azygous drainage. Therefore, appropriate design avoiding unilateral streaming of HV flow should be considered for HV inclusion surgery.

The importance of narrow phonetic transcription for highly unintelligible speech: Some examples

The importance of the use of narrow phonetic transcription in transcribing a variety of speech disorders is emphasized. This point is illustrated with clinical data from the authors’ own research. The examples used are the transcription of a severely disfluent client, a child with progressive hearing loss, repair sequences in dysarthric speakers, a child with idiosyncratic velar articulations, and an adult with progressive speech degeneration. The use of the extended International Phonetic Alphabet (IPA) for the transcription of disordered speech and the Voice Quality Symbols (VoQS) system for transcribing voice quality is introduced and illustrated in the examples provided. The need for training in narrow transcription is discussed as part of a combination of impressionistic and instrumental description techniques.

Intonation as a pragmatic resource in ELF interaction

The investigation of pragmatic strategies in ELF interaction is a relatively new area of research. This paper examines intonation as a pragmatic resource in ELF interaction. There is considerable research pointing to the critical role played by intonational structure in NS-based discourse to establish a state of informational and social convergence (Brazil, The communicative value of intonation in English, Cambridge University Press, 1997; Chun, Discourse intonation in L2, John Benjamins, 2002; Hewings, International Review of Applied Linguistics 33: 251–65, 1995; Pickering, TESOL Quarterly 35: 233–255, 2001; Wennerstrom, Music in everyday speech, Oxford University Press, 2001). The question of whether similar practices can be identified in ELF interaction remains open. In this paper, I review current understanding of the role of intonational structure in NS-based interaction and then examine data from ELF interactions. Using a model of intonation in discourse (Brazil, The communicative value of intonation in English, Cambridge University Press, 1997) to interpret these data, I argue that both pitch movement (tone choice) and relative pitch level (key choice) contribute to intelligibility and interactional success in ELF interaction. Participants appear to orient to pitch cues both as a signal of a possible trouble source and as a means to indicate that negotiation or repair sequences have been accomplished successfully.

The importance of surgical sequence in the treatment of lower extremity injuries with concomitant vascular injury: A meta-analysis

Objective The optimal sequence of surgical repair for lower extremity injury with associated vascular injuries is unclear. Lower extremity injury in our study is defined as femoral fracture, tibial fracture, and/or knee dislocation. Advocates of performing the vascular repair prior to lower extremity fixation argue that reversal of ischaemia in the limb is the most important factor in limb survival and should take precedence. Advocates of lower extremity fixation prior to revascularisation worry that the manipulation during fixation could disrupt the vascular repair and that total ischaemia time is more relative than absolute. Methods A literature search was performed to identify studies with the following criteria: adult population, femoral fracture, tibial fracture, and/or knee dislocation with associated vascular injury, an intervention of fracture fixation or knee stabilisation prior to revascularisation and/or revascularisation prior to fracture fixation, and amputation as an outcome measurement. Results 934 articles were identified and narrowed to 14 articles through exclusion criteria. Meta-analysis of the data shows no statistical difference in regards to the incidence of amputation between lower extremity fixation prior to revascularisation and revascularisation prior to fracture fixation. Conclusion Lower extremity injuries with associated vascular injury are uncommon. There has been a widespread but unsupported belief that manipulation and traction during lower extremity fixation will disrupt the vascular repair. Ischaemic time should be considered a relative, but not absolute predictor of amputation. Soft tissue injury and neurologic deficits have been found highly correlated with disability and amputation. Surgical sequence has not been shown to affect the rate of amputations in lower extremity fractures.

Hepatobiliary effects of 90yttrium microsphere therapy for unresectable hepatocellular carcinoma

(90)Yttrium (Therasphere) microspheres administered via hepatic artery are a valuable option for treatment of hepatocellular carcinoma. This therapy targets tumor nodules while largely sparing hepatic parenchyma. This retrospective study examines liver explants from 13 adult patients with hepatocellular carcinoma who received intrahepatic Theraspheres and subsequently underwent liver transplantation. Histopathologic and laboratory reviews are performed. Theraspheres preferentially migrated to the lobe(s) supplied by the injected artery branches and frequently localized to tumors. Tumors showed a chronology of changes beginning with confluent necrosis typically accompanied by hemorrhage and later by fibrinoid change. This was followed by fibrosis with regenerative activity at tumor peripheries. Adjacent hepatic parenchyma went through a similar sequence of injury and repair that could lead to markedly fibrotic cirrhotic nodules in the vicinity of treated tumors. No consistent pattern of thrombomodulin loss was seen in endothelial cells of the tumors or adjacent parenchyma, suggesting that direct endothelial cell injury was likely not a major contributor to the necrotic process. However, the pattern of injury and repair is suggestive of a localized and subclinical form of radiation-induced liver disease. The pathologist should be aware of these changes to distinguish them from the diffuse "radiation hepatitis" associated with older forms of radiotherapy.