Reparative Interventions Research Articles

Equality as a Problem, Greatness as a Solution

The article deals with the issue of equality in contemporary political philosophy. The main purpose is to identify the current state of the academic debate, in which the issue is discussed, and to propose an alternative approach as a solution to the impasses that the main currents of thought around the subject have bequeathed to real politics. We first present the premises of what we call negationist criticism, a tradition of ideas with roots in European socialism that identifies the foundations of inequality in social structures and proposes agendas for total change in society. Next, we present the premises of social democratic neoliberalism, a broad body of ideas and practices that updated eighteenth and nineteenth century liberalism, in order to deal with the problem of inequality in light of the imperative of freedom and meritocracy. This allows for a lateral concern with the economic and social distortions to which redistributive and reparative intervention agendas are dedicated, without modifying the structures of social life. As an alternative to both prevailing paradigms, we hold what we call transformative institutionalism, which identifies inequality as a problem related to the structuring of original advantages in societies, whose therapeutics relies on institutional imagination, whereby changing structures becomes an issue of reorganizing existing institutional arrangements. The ultimate goal is to enable a chain reaction of transformations. This perspective is guided by the ideal of greatness, which, translated into real politics, means the aggrandizement of common people rather than an appeal to absolute equality or supreme freedom as values in themselves.

Role of echocardiography in the management of ventricular septal rupture after acute myocardial infarction.

Ventricular septal rupture (VSR) is a rare and devastating complication of acute myocardial infarction. Early detection, assessment of the hemodynamic impact, and illustration of the pathophysiological context are crucial functions of echocardiography in decision-making for intensive management and reparative intervention. To evaluate this entity, echocardiography exhibits two strengths: its bedside nature and its multiple modalities. This document reviews the comprehensive use of echocardiography in the study of post-infarction VSR.

Mid-Cheek Reconstruction after a Dog Bite: Case Report and Literature Review

The incidence of animal bite injuries affecting the anatomical regions of the head and neck is notably prevalent, particularly among individuals within the younger demographic. Canine species have been identified as the primary source of the majority of bite injuries in the human population, the spectrum of injuries encompasses a range of traumatic manifestations, which may encompass uncomplicated lacerations or punctures, as well as more complex avulsions characterized by the presence or absence of accompanying tissue. The anatomical regions most frequently affected by the condition under investigation include the buccal region, nasal area, and labial region. The acquisition of comprehensive data regarding the vaccination status of both the animal and the patient is of paramount significance in the realm of medical research. Furthermore, it is imperative to duly administer prophylactic measures such as tetanus or rabies prophylaxis, contingent up on the presence of any indications warranting such interventions. The aforementioned wounds necessitate comprehensive assessment, meticulous cleansing, and, on occasion, surgical debridement or reconstruction within the confines of the operating theater. The selection of the appropriate reparative intervention is contingent upon a comprehensive assessment of the precise anatomical site and magnitude of the inflicted trauma, thereby encompassing a spectrum of potential modalities including primary closure, microsurgical replantation, dermal grafting, tissue flaps, and in rare instances, facial allograft transplantation.

Effects of COVID-19 on Population, Economic Growth, Logistics Performance, and Quality Management in Africa: Grey Relational Analysis

The research aims to examine the emerging repercussions of the COVID-19 pandemic on population, GDP (Gross Domestic Product), logistics performance, and ISO 9001 certification in most effected African countries: South Africa, Morocco, and Tunisia. The innovative Grey Relational Grade (GRG) modelling approach was applied to analyze the interdependent relationship between COVID-19, economic growth, quality and logistics performance. Furthermore, the authors implemented the conservative (maximin) approach to identify which one of the top three most impacted COVID-19 African nations had the least intensifying effects. The data utilized in the research was obtained from several databases and examined in 2021. The results indicate that the pandemic has a tremendous undesirable influence and impact on the population, GDP, logistics performance, as well as ISO 9001 certification in all three considerably impacted African nations. Whereas South Africa was recorded the most affected in terms of the population due to a high number of fatalities. Moreover, the country has demonstrated substantial negative correlations between COVID-19 and logistic performance, whereas Tunisia and Morocco's GDP showed a downward negative trend due mainly to global trade flow constraints. Besides, in all the countries covered in this research, the number of ISO 9001 certificates has declined dramatically. The study outcomes generate much-needed policy recommendations for international organizations, decision makers and world governments to consider implementing immediate reparative interventions and emergent action plans to protect economic systems from further losses, as well as to improve the logistics, economic, and quality performances. This research pursues a multidimensional structure and explores the emerging impacts of the pandemic on economic growth, population, logistical performance as well as the process of quality production.

Violence, Criminalization & Punitive Excess

Violence, Criminalization & Punitive Excess

Forecasting the economic consequences of COVID-19 on longstanding illnesses in Wales

IntroductionThe unemployment rate following the COVID-19 pandemic in Wales is increasing and there is a positive link between unemployment and longstanding illnesses. This study aimed to project the percentage of adults with longstanding illnesses and chronic health conditions following COVID-19 associated with the economic consequences.MethodsWe retrieved historical data on the unemployment rates and status of longstanding illnesses among adults from the Office for National Statistics (ONS) and National Survey for Wales (NSW), and used time-series models to project the unemployment rates and percentage of adults with longstanding illnesses and chronic health conditions over a three year period (2020/21 - 2022/23).Results Without reparative interventions, the unemployment rate is expected to increase sharply from 3.8% in 2019 to about 7% in 2020 following COVID-19 and then gradually increase over the projected period.With increased unemployment, longstanding illness (LSI) would be expected to increase gradually following COVID-19, with an estimated increase of around or exceeding 4% over three years depending on the LSI measure. There would be a higher increment in the percentage of adults with limiting LSI compared with adults with any LSI, suggesting implications for wider health and social care services.With current unemployment predictions, the percentage of adults with chronic health conditions is projected to increase following the COVID-19 pandemic over the projected period, with a higher increment for mental health and endocrine/metabolic conditions Conclusions The longstanding illnesses and chronic health conditions are expected to increase in the coming years following COVID-19 pandemic. Therefore, preventative measures for longstanding illnesses and chronic health conditions should be a priority for a sustainable recovery from the COVID-19. Key messages Without reparative interventions, the unemployment rate is expected to increase following the COVID-19 pandemic.The projected prevalence of limiting longstanding illness in adults following COVID-19 suggests implications for wider health and social care services.

Utility of intra-operative flexible sigmoidoscopy to assess colorectal anastomosis: a systematic review and meta-analysis.

Anastomotic leak (AL) after colorectal resection leads to increased oncological and non-oncological, morbidity and mortality. Intra-operative assessment of a colorectal anastomosis with intra-operative flexible sigmoidoscopy (IOFS) has become increasingly prevalent and is an alternative to conventional air leak test. It is thought that intra-operative identification of an AL or anastomotic bleeding (AB) allows for immediate reparative intervention at the time of anastomosis formation itself. We aim to assess the available evidence for the use of IOFS to prevent complications following colorectal resection. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the literature between January 1980 and June 2020 was performed. Comparative studies assessing IOFS versus conventional air leak test were compared, and outcomes were pooled. A total of 4512 articles were assessed, of which eight were found to meet the inclusion criteria. A total of 1792 patients were compared; 884 in the IOFS arm and 908 in the control arm. IOFS was associated with an increase in the rate of positive leak test (odds ratio (OR) 5.21, P > 0.001), a decrease in AL (OR 0.45, P = 0.006) and a decrease in post-operative AB requiring intervention (OR 0.40, P = 0.037). In a non-randomized meta-analysis, IOFS increases the likelihood of identifying an anastomotic defect or bleeding intra-operatively. This allows for immediate intervention that decreases the rate of AL and AB. This adds impetus for performing routine IOFS after a left-sided colorectal resection with anastomosis and highlights the need for randomized controlled trial to confirm the finding.

Journey of vulnerability: a mixed-methods study to understand intrapartum transfers in Tanzania and Zambia

BackgroundTimely intrapartum referral between facilities is pivotal in reducing maternal/neonatal mortality and morbidity but is distressing to women, resource-intensive and likely to cause delays in care provision. We explored the complexities around referrals to gain understanding of the characteristics, experiences and outcomes of those being transferred.MethodsWe used a mixed-method parallel convergent design, in Tanzania and Zambia. Quantitative data were collected from a consecutive, retrospective case-note review (target, n = 2000); intrapartum transfers and stillbirths were the outcomes of interest. A grounded theory approach was adopted for the qualitative element; data were collected from semi-structured interviews (n = 85) with women, partners and health providers. Observations (n = 33) of transfer were also conducted. Quantitative data were analysed descriptively, followed by binary logistic regression models, with multiple imputation for missing data. Qualitative data were analysed using Strauss’s constant comparative approach.ResultsIntrapartum transfer rates were 11% (111/998; 2 unknown) in Tanzania and 37% (373/996; 1 unknown) in Zambia. Main reasons for transfer were prolonged/obstructed labour and pre-eclampsia/eclampsia. Women most likely to be transferred were from Zambia (as opposed to Tanzania), HIV positive, attended antenatal clinic < 4 times and living > 30 min away from the referral hospital. Differences were observed between countries. Of those transferred, delays in care were common and an increase in poor outcomes was observed. Qualitative findings identified three categories: social threats to successful transfer, barriers to timely intrapartum care and reparative interventions which were linked to a core category: journey of vulnerability.ConclusionAlthough intrapartum transfers are inevitable, modifiable factors exist with the potential to improve the experience and outcomes for women. Effective transfers rely on adequate resources, effective transport infrastructures, social support and appropriate decision-making. However, women’s (and families) vulnerability can be reduced by empathic communication, timely assessment and a positive birth outcome; this can improve women’s resilience and influence positive decision-making, for the index and future pregnancy.

Reparative prosocial behaviors alleviate children's guilt.

Guilt theoretically functions to motivate reparative behaviors, which, in turn, theoretically alleviate guilt and prevent depression. Although empirical research supports these theories in adults, studies have not investigated causal relations between guilt and reparative behaviors in children. Thus, this study examined whether guilt motivates children's reparative behaviors, and whether their reparative behaviors successfully alleviate guilty feelings. Six-to 10-year olds (N = 97) were randomly assigned to 1 of 3 conditions. Children in the experimental condition were led to believe they had transgressed to cause a peer's distress. Children self-reported their guilt following the transgression, and then had the opportunity to repair the transgression by giving stickers and writing a note to the victimized peer. Following the repair opportunity, children self-reported their guilt a second time. Children in the experimental condition (i.e., children who felt guilty) engaged in greater reparative behavior than children in a no-guilt condition who were led to believe they had caused a peer's slightly positive emotions. Further, children in the experimental condition reported reduced guilt across the first to second guilt measurement, whereas children in the no-repair condition (who transgressed but did not have a repair opportunity) did not report reduced guilt over time. Results demonstrate that guilt and reparative behaviors function as theorized in middle childhood and may begin to inform reparative interventions aimed at preventing maladaptive guilt and depression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

L-DOPA for Parkinson's disease-a bittersweet pill.

3,4-dihydroxy-L-phenylalanine (L-DOPA) is the gold standard treatment for Parkinson's disease. It has earned that title through its highly effective treatment of some of the motor symptoms in the early stages of the disease but it is a far from perfect drug. The inevitable long-term treatment that comes with this chronic neurodegenerative condition raises the risk significantly of the development of motor fluctuations including disabling L-DOPA-induced dyskinesia. Being unsurpassed as a therapy means that understanding the mechanisms of dyskinesia priming and induction is vital to the search for therapies to treat these side effects and allow optimal use of L-DOPA. However, L-DOPA use may also have consequences (positive or negative) for the development of other interventions, such as cell transplantation, which are designed to treat or repair the ailing brain. This review looks at the issues around the use of L-DOPA with a focus on its potential impact on advanced reparative interventions.

Biomaterials for revascularization and immunomodulation after spinal cord injury

Spinal cord injury (SCI) causes immediate damage to the nervous tissue accompanied by loss of motor and sensory function. The limited self-repair competence of injured nervous tissue underscores the need for reparative interventions to recover function after SCI. The vasculature of the spinal cord plays a crucial role in SCI and repair. Ruptured and sheared blood vessels in the injury epicenter and blood vessels with a breached blood-spinal cord barrier (BSCB) in the surrounding tissue cause bleeding and inflammation, which contribute to the overall tissue damage. The insufficient formation of new functional vasculature in and near the injury impedes endogenous tissue repair and limits the prospect of repair approaches. Limiting the loss of blood vessels, stabilizing the BSCB, and promoting the formation of new blood vessels are therapeutic targets for spinal cord repair. Inflammation is an integral part of injury-mediated vascular damage, which has deleterious and reparative consequences. Inflammation and the formation of new blood vessels are intricately interwoven. Biomaterials can be effectively used for promoting and guiding blood vessel formation or modulating the inflammatory response after SCI, thereby governing the extent of damage and the success of reparative interventions. This review deals with the vasculature after SCI, the reciprocal interactions between inflammation and blood vessel formation, and the potential of biomaterials to support revascularization and immunomodulation in damaged spinal cord nervous tissue.

Radiographic Findings of Distressed Venous Stents and Inferior Vena Cava Filters: Clinical Implications.

The objective of our study was to describe an association between the radiographic appearance of distressed intravascular implants and venous stenosis or occlusion and to determine the success of reparative endovascular procedures. Seventy-eight patients with distressed stents or inferior vena cava (IVC) filters characterized by pursing (short-axis contracture), straightening, longitudinal contraction (long-axis contracture), or fracture were identified from retrospective review of a venous registry for the period from February 2004 to October 2016. Patients originally presented with superior vena cava (SVC) syndrome (n = 25), arm swelling (n = 16), iliocaval thrombosis (n = 21), and lower extremity deep venous thrombosis (n = 16), and stents were initially placed in 65 and filters in 13. Implants were located in the IVC (n = 24), subclavian vein (n = 16), brachiocephalic vein (n = 15), common iliac vein (n = 10), multiple veins (n = 4), axillary vein (n = 4), common femoral vein (n = 3), SVC (n = 1), and internal jugular vein (n = 1). Implants included Wallstents in 63 patients; Smart stents in two patients; and Celect Platinum, Denali, Greenfield, and Trapease IVC filters in two, three, two, and six patients, respectively. Venographic indication, distress type, time from initial normal placement to identification of distress, venographic finding (patent, mild stenosis, high-grade stenosis, or occlusion), treatment, revascularization outcome, and complications were recorded. The mean time to distress was 23 months. Fifty-two (67%) patients underwent venography for symptoms and 26 (33%) for surveillance. Forty-five (58%) implants were pursed; 19 (24%), straightened; nine (12%), contracted; and five (6%), fractured. Venography depicted 48 (62%) high-grade stenoses, 19 (24%) complete occlusions, and six (8%) mild stenoses. Of the 73 patients who underwent an intervention, 29 (40%) underwent angioplasty, 15 (21%) underwent angioplasty and stenting, 15 (21%) underwent sharp recanalization, and five (7%) underwent thrombolysis. Revascularization was successful in 67 (92%). Three minor complications occurred. Distressed intravascular implants are associated with high-grade venous stenosis or occlusion. Reparative interventions are usually technically successful.

Reasons for and Experiences With Reparative Interventions for Female Genital Mutilation/Cutting (FGM/C)

Reasons for and Experiences With Reparative Interventions for Female Genital Mutilation/Cutting (FGM/C)

The Effectiveness of Defibulation and Reconstructive Surgery Following Female Genital Mutilation/Cutting: A Systematic Review

Female genital mutilation/cutting (FGM/C) changes normal genital functionality. Many women experience lifelong complications. There is an increasing demand for FGM/C-related management and reparative surgery. We conducted a systematic review that summarized empirical quantitative research on the effectiveness of reparative interventions for women with FGM/C. The sample consisted of quantitative studies on women who had undergone a surgical treatment option for FGM/C. We conducted a systematic review in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, including systematic searches in 11 international databases and paired screening and quality assessment. We included 61 studies. Almost all of the 5829 women included had FGM/C type II or III. The studies on defibulation overwhelmingly concerned obstetric outcomes while the studies on reconstruction addressed sexuality-related outcomes. The metaanalyses showed few differences concerning antenatal defibulation vs during labor, antenatal defibulation vs none, defibulation vs none. However, there was a reduced of risk of cesarean section in antenatal defibulation vs none (RR=0.51; 95%CI 0.26, 1.00), and a reduced risk of tears when there was defibulation vs none (2nd degree tear RR=0.55; 3rd degree tear RR=0.26; 4th degree tear RR=0.06). Regarding clitoral reconstruction, there were improvements in pain during sex, clitoral function/pleasure, orgasm, and desire for about 43-63% of women. Few studies reported on harms, but they included decreased clitoral pleasure for 23% of women and lower desire for 8%.

Microstructural and microglial changes after repetitive mild traumatic brain injury in mice.

Traumatic brain injury (TBI) is a major public health issue, with recently increased awareness of the potential long-term sequelae of repetitive injury. Although TBI is common, objective diagnostic tools with sound neurobiological predictors of outcome are lacking. Indeed, such tools could help to identify those at risk for more severe outcomes after repetitive injury and improve understanding of biological underpinnings to provide important mechanistic insights. We tested the hypothesis that acute and subacute pathological injury, including the microgliosis that results from repeated mild closed head injury (rmCHI), is reflected in susceptibility-weighted magnetic resonance imaging and diffusion-tensor imaging microstructural abnormalities. Using a combination of high-resolution magnetic resonance imaging, stereology, and quantitative PCR, we studied the pathophysiology of male mice that sustained seven consecutive mild traumatic brain injuries over 9 days in acute (24 hr) and subacute (1 week) time periods. rmCHI induced focal cortical microhemorrhages and impaired axial diffusivity at 1 week postinjury. These microstructural abnormalities were associated with a significant increase in microglia. Notably, microgliosis was accompanied by a change in inflammatory microenvironment defined by robust spatiotemporal alterations in tumor necrosis factor-α receptor mRNA. Together these data contribute novel insight into the fundamental biological processes associated with repeated mild brain injury concomitant with subacute imaging abnormalities in a clinically relevant animal model of repeated mild TBI. These findings suggest new diagnostic techniques that can be used as biomarkers to guide the use of future protective or reparative interventions. © 2016 Wiley Periodicals, Inc.

A concept analysis of women's vulnerability during pregnancy, birth and the postnatal period.

To report an analysis of the concept of vulnerability associated with pregnancy, birth and the postnatal period. The concept of vulnerability during childbirth is complex and the term, 'to be vulnerable' frequently attains a vague application. Analysis about vulnerability is needed to guide policy, practice, education and research. Clarity around the concept has the potential to improve outcomes for women. Concept analysis. Searches were conducted in CINAHL, EMBASE, PubMed, Psychinfo, MEDLINE, MIDIRS and ASSIA and limited to between January 2000 - June 2014. Data were collected over 12months during 2014. This concept analysis drew on Morse's qualitative methods. Vulnerability during pregnancy, birth and the postnatal period can be defined by three main attributes: (a) Threat; (b) Barrier; and (c) Repair. Key attributes have the potential to influence outcome for women. Inseparable sub-attributes such as mother and baby attachment, the woman's free will and choice added a level of complexity about the concept. This concept analysis has clarified how the term vulnerability is currently understood and used in relation to pregnancy, birth and the postnatal period. Vulnerability should be viewed as a complex phenomenon rather than a singular concept. A 'vulnerability journey plan' has the potential to identify how reparative interventions may develop the woman's capacity for resilience and influence the degree of vulnerability experienced. Methodology based around complex theory should be explored in future work about vulnerability.

The Ruptured Supervisory Alliance and Its Repair: On Supervisor Apology as a Reparative Intervention

In what ways do supervisors repair the ruptured supervisory alliance? In this article, that question is considered, with focus given to one rupture repair intervention: Supervisor apology. Apology/forgiveness theory and research are integrated with current thinking about supervision alliance rupture and repair. Using the recent conflict transformation research of Kirchhoff and colleagues (Kirchhoff, Strack, & Jager, 2009; Kirchhoff, Wagner, & Strack, 2012) as a building block, the 10 elements of apology are examined vis-à-vis the supervisory situation, and the applicability of the concepts of simple and complete apology for supervision alliance rupture repair are presented. Eight statements that link apology and forgiveness with supervision alliance rupture and repair conceptualization are proposed, and a case example that communicates the reparative effectiveness of supervisor apology is described. Supervisor rupture identification and repair is viewed as being an important competency that involves a supporting knowledge base, skill set, and values core.

Molecular and cellular mechanisms underlying the role of blood vessels in spinal cord injury and repair

Spinal cord injury causes immediate damage of nervous tissue accompanied by the loss of motor and sensory function. The limited self-repair ability of damaged nervous tissue underlies the need for reparative interventions to restore function after spinal cord injury. Blood vessels play a crucial role in spinal cord injury and repair. Injury-induced loss of local blood vessels and a compromised blood-brain barrier contribute to inflammation and ischemia and thus to the overall damage to the nervous tissue of the spinal cord. Lack of vasculature and leaking blood vessels impede endogenous tissue repair and limit prospective repair approaches. A reduction of blood vessel loss and the restoration of blood vessels so that they no longer leak might support recovery from spinal cord injury. The promotion of new blood vessel formation (i.e., angio- and vasculogenesis) might aid repair but also incorporates the danger of exacerbating tissue loss and thus functional impairment. The delicate interplay between cells and molecules that govern blood vessel repair and formation determines the extent of damage and the success of reparative interventions. This review deals with the cellular and molecular mechanisms underlying the role of blood vessels in spinal cord injury and repair.

Damage Assessment and Design of Structural Interventions for Monte di Pietà in Naples, Italy

Several signs of damage—such as cracks passing through the wall and surface deterioration appearing on the façade of the monumental building of Monte di Pietà in Naples, Italy—suggested the need to carry out on-site investigations to check the safety of this monumental structure. The investigations concerned several aspects: i) geometric survey, ii) survey of the crack patterns and of the deterioration distribution on the internal and external surfaces of the walls, iii) in situ measurements of the state of stress, and iv) georadar investigations to detect the geometry and conditions of the external pilasters in piperno stone (a sort of structural frame), which was suspected of being detached from the rest of the wall and therefore susceptible to possible local failures. An advanced numerical finite element method (FEM) analysis was conducted for the evaluation of the static conditions of the structure. A methodological and interdisciplinary experience to analyze and assess the stability of monumental buildings is discussed. The knowledge of historical reparative interventions and, moreover, an accurate knowledge of the geometry and the structural assessment of the façade suggested the need to design some strengthening and reparative interventions and each type of these interventions has been described in detail.

Spinal cord injury: time to move

Progress continues in the development of reparative interventions to enhance recovery after experimental spinal cord injury (SCI) in animal models. 1 Thuret S Moon LD Gage FH Therapeutic interventions after spinal cord injury. Nat Rev Neurosci. 2006; 7: 628-643 Crossref PubMed Scopus (790) Google Scholar Although some of these treatments might be translatable to patients with moderate SCI, and are entering phase 1 or 2 clinical trials, evidence for the efficacy of any intervention designed to repair the injured human spinal cord is still lacking. 2 Dietz V Ready for human spinal cord repair?. Brain. 2008; 131: 2240-2242 Crossref PubMed Scopus (17) Google Scholar Instead, improvement of ambulatory function is routinely observed with activity-based rehabilitation in individuals who retain voluntary movements of the legs after SCI. 3 Dietz V Colombo G Jensen L Locomotor activity in spinal man. Lancet. 1994; 344: 1260-1263 Summary PubMed Scopus (329) Google Scholar , 4 Behrman AL Harkema SJ Locomotor training after human spinal cord injury: a series of case studies. Phys Ther. 2000; 80: 688-700 PubMed Google Scholar However, even intense training programmes have not resulted in functional recovery in patients with clinically motor complete SCI. 5 Harkema SJ Plasticity of interneuronal networks of the functionally isolated human spinal cord. Brain Res Rev. 2008; 57: 255-264 Crossref PubMed Scopus (132) Google Scholar Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case studyTask-specific training with epidural stimulation might reactivate previously silent spared neural circuits or promote plasticity. These interventions could be a viable clinical approach for functional recovery after severe paralysis. Full-Text PDF