Search Results (635)

Background: Intimate partner violence (IPV) is a pervasive medical concern affecting millions of people worldwide, with the majority being women. IPV is linked to a number of long-term physical and mental health consequences, including brain injuries and associated persistent post-concussion symptoms (PPCS) and post-traumatic stress disorder (PTSD). Despite the high prevalence of these conditions, there is sparse literature assessing accessible and effective therapeutic avenues specific to IPV victim-survivors. Methods: This narrative review had two aims: to identify therapeutic studies addressing PTSD and PPCS in women IPV survivors, and to provide a narrative overview of potential therapeutic categories, including psychotherapy, mindfulness and meditation, exercise, and pharmacotherapy. A comprehensive literature search was conducted using PubMed and Google Scholar. Inclusion criteria required full-text, peer-reviewed articles published in English, conducted in women with a history of IPV, reporting treatment outcomes related to PTSD or PPCS. Where no IPV-specific evidence was identified, findings from closely related populations including military veterans, athletes, and general TBI samples were narratively reviewed to inform potential therapeutic implications. Results: Nineteen studies addressing PTSD in women IPV survivors were identified, predominantly utilizing psychotherapeutic or mindfulness and meditation-based interventions. No intervention studies targeting PPCS specifically in IPV survivors were identified. Consequently, results for PPCS are largely extrapolated from adjacent populations. Although potential therapeutic avenues were narratively identified across psychotherapy, mindfulness and meditation, exercise, and pharmacotherapy, IPV-specific evidence remains limited, and validation for PTSD and PPCS in this population is needed before clinical recommendations can be made. Conclusions: While 19 studies identified promising therapeutic options for IPV-related PTSD, no IPV-specific PPCS interventions were identified, and implications for PPCS management remain largely inferential. Validation and integrated trauma-informed approaches addressing the intersection of PTSD and PPCS are needed for this understudied population. Full article

Background: The aim of the present narrative review is to synthesize the available scientific evidence comparing periodontal endoscopy-assisted therapy with established surgical regenerative procedures for the treatment of intrabony periodontal defects. While regenerative surgery—including papilla-preserving techniques—remains the standard approach for achieving predictable clinical attachment gain, these procedures may potentially compromise papillary integrity and healing dynamics. Periodontal endoscopy enables enhanced visualization and debridement without surgical access. This review evaluates available studies and discusses whether endoscopy-assisted therapy can achieve outcomes comparable to surgical regeneration while reducing tissue trauma and preserving interdental anatomy. Methods: A comprehensive literature search was conducted using the electronic databases PubMed, Web of Science, The Cochrane Library, and Scopus, supplemented by manual searching. The search was performed up to 1 November 2025. Results: Two studies were included. Overall, there is a substantial lack of RCTs directly comparing periodontal endoscopy-assisted therapy with surgical regenerative procedures. However, EASD (Endoscopic- assisted subgingival debridement) was found not to be inferior to papilla-preservation surgery (PPFS) for treating residual pockets in intrabony defects. Both PPFS and EASD were effective, although PPFS showed more consistent microbial modulation. Conclusions: Periodontal endoscopy-assisted therapy may be considered a promising minimally invasive approach for selected intrabony defects, potentially reducing surgical morbidity and preserving interdental tissues. Although early data suggest that endoscopy-guided approaches may offer comparable clinical improvements with less invasiveness, the evidence base is too small to support definitive recommendations. Robust, well-designed randomized trials are needed to define its clinical indications and compare it directly with established regenerative procedures. Full article

Non-organic (muscle) weakness (NOw) is proposed as a distinct pathological entity characterized by maladaptive neuroplasticity (learning) affecting motor control. Functional deficits are most directly revealed through the manual muscle testing (MMT) break test, which uniquely exposes a muscle’s ability to adapt to increasing external load, potentially serving as an index of motor control integrity. We advance the “muscle-motor-movement PTSD” (mPTSD) model in which learning during pain or stress (trauma) yields chronic avoidance (inhibition) of the associated muscles. In a second stage, compensatory synergies develop, overriding attempts at hypertrophy-oriented training. This non-systematic, integrative review synthesizes clinical reports, learning theories, motor control and pain literature, and objective tests of force and movement over time during MMT. Predictive processing and reinforcement learning offer complementary accounts of how hyper-precise priors and passive avoidance may maintain NOw beyond functional recovery. Unexplained muscle weakness is found in non-specific musculoskeletal disorders and functional motor disorder (functional weakness), but may also contribute to other conditions, such as kinesiophobia. Effective alternative treatments for NOw may act by updating or erasing maladaptive motor learning by disrupting memory reconsolidation, allowing immediate restoration of function. Analogous to psychoneuroimmunology’s role in immune function, we propose “psychoneurokinesiology”, the study of how maladaptive learning affects movement. Full article

Background: Post-Traumatic Stress Disorder (PTSD) is among the most prevalent and disabling mental health conditions affecting military veterans in Western countries. In recent decades, PTSD has increasingly been conceptualized as a systemic neuropsychological injury shaped not only by individual psychopathology, but also by institutional, cultural, and political contexts, particularly in settings of prolonged conflict and political violence. This shift has given rise to diverse national rehabilitation models that extend beyond symptom-focused care. This narrative comparative review aims to examine national models of PTSD rehabilitation among military veterans and to derive policy-relevant insights for Israel. Methods: We conducted a narrative comparative review of peer-reviewed literature and national policy documents published between 2014 and 2023, examining military and veteran PTSD rehabilitation frameworks in six Western countries: the United States, Canada, the United Kingdom, Germany, Australia, and the Netherlands. Sources were identified through PubMed, PsycINFO, Google Scholar, and governmental repositories. The review focused on system-level rehabilitation structures, including clinical services, peer-based programs, occupational integration, community and cultural components, and national monitoring practices. Results: Across countries, recurring challenges included persistent stigma limiting help-seeking, fragmented service delivery, inconsistent access to evidence-based care and a lack of standardized outcome indicators capturing functional and social recovery. Innovative approaches included biopsychosocial-spiritual rehabilitation models, peer-led interventions, intra-systemic employment pathways, and symbolic forms of social recognition. In this context, the biopsychosocial-spiritual approach refers to integrative rehabilitation models that extend beyond traditional frameworks by incorporating meaning-making, identity reconstruction, and value-based recovery processes. Conclusions: The findings highlight the need to reconceptualize PTSD rehabilitation as a multidimensional, system-level process. In light of the 2023 “Iron Swords” war and the scale of trauma exposure in Israel, the review informs actionable recommendations for developing a coordinated national rehabilitation strategy that integrates clinical care with occupational, community and cultural recovery. Full article

Zone 2 thoracic endovascular aortic repair (TEVAR) frequently requires left subclavian artery (LSA) preservation to maintain vertebrobasilar and upper-extremity perfusion while obtaining a durable proximal seal. Dedicated single-branch endografts were developed to standardize this step and to facilitate a reproducible fully endovascular strategy. Two main device concepts currently shape this field: integrated unibody branch platforms, represented by Castor and the second-generation Cratos, and modular retrograde-branch systems, represented by the Gore TAG Thoracic Branch Endoprosthesis (TBE). The Castor/Cratos evidence base is broader and older, and is mainly centered on type B aortic dissection, with prospective multicenter and real-world data showing favorable branch patency and aortic remodeling. By contrast, TBE evidence is expanding rapidly and is supported by prospective midterm data in arch aneurysms as well as by increasingly large post-commercial series and comparative analyses across zones 0–2. Beyond outcomes, the two platforms differ substantially in branch directionality, potential contribution to proximal fixation, modularity, branch diameter range, proximal landing requirements, access profile, and regulatory/off-the-shelf availability, all of which have direct consequences for anatomical suitability in dissection, aneurysm disease, and trauma. This narrative review synthesizes current evidence and proposes an anatomy-first, pathology-aware framework for selecting between Castor/Cratos and TBE in totally endovascular zone 2 TEVAR with LSA revascularization. Full article

Care home staff are routinely exposed to stressful and traumatic events, increasing risks of psychological distress, burnout, and reduced workforce resilience. Psychological First Aid (PFA), recommended by the World Health Organization, provides an evidence-based framework for delivering immediate emotional and practical support; however, its adaptation for care home contexts is limited. This study aimed to co-produce and adapt an existing PFA training resource for care home staff using a person-based approach (PBA) to enhance contextual relevance, acceptability, and feasibility. A two-phase qualitative design guided by PBA principles was used. Phase 1 integrated stakeholder workshops, semi-structured interviews, and literature review to generate guiding principles, a logic model, and preliminary training content. We adapted the WHO PFA “Look–Listen–Link” framework alongside existing open-access materials. Phase 2 used think aloud interviews to optimize usability and contextual fit. Thematic and sentiment analysis identified key needs: high exposure to traumatic events, inconsistent organisational support, desire for measurable skill development, the importance of transferable competencies, and motivational factors. Participants emphasized the need for flexibility, inclusivity, and realistic care-home-specific examples. Adaptations included bite-sized interactive modules, blended delivery options, and reflective exercises. The final co-produced intervention aligns with trauma-informed principles and organisational realities. Further work is needed to access feasibility, acceptability, and fidelity in real-world settings, offering a transferable model for adapting psychological interventions in other high-stress care environments internationally. Full article

The 1923 Greek–Turkish Population Exchange (Mubadele in Turkish), formalized through the Lausanne Convention, remains one of the most consequential cases of compulsory migration in modern history. This systematic review synthesizes a century of scholarship across political, legal, social, cultural, and historiographical dimensions. Findings indicate that the exchange not only legitimized forced displacement under international law but also reinforced authoritarian state-building in Turkey and exacerbated political instability in Greece. The social consequences included trauma, marginalization, and the emergence of heterogeneous refugee identities, while cultural memory oscillated between nationalist silencing and transnational remembrance. Urban landscapes and demographic structures were profoundly reshaped, producing visible legacies in contemporary cities. Furthermore, assimilation policies formalized the integration of populations, influencing the development of national identities in both Turkey and Greece. Historiographical trajectories diverged, with Greek scholarship emphasizing refugee struggles and Turkish scholarship foregrounding nation-building. Recent studies highlight hybrid identities and transgenerational redefinitions of belonging. This review underscores the necessity of integrating political, social, and memory studies to capture the multi-layered impacts of the exchange, offering a comprehensive account of its enduring relevance for migration, nationalism, and memory studies in Southeast Europe. Full article

Background/Objectives: Damage Control Resuscitation (DCR) is a critical strategy in the management of severe trauma, focusing on the optimisation of the patient’s physiological condition. This study reviews current DCR strategies, emphasizing the mitigation of the “diamond of death”—hypothermia, acidosis, coagulopathy, and hypocalcemia—while addressing complex disturbances like respiratory distress syndrome (ARDS) and (acute kidney injury) AKI in high-ISS (Injury Severity Score) patients. Methods: A systematic review of 59 contemporary sources was conducted, encompassing clinical trials (e.g., CRASH-2), military-to-civilian protocol translations, and guidelines from the C and European Resuscitation Council. The analysis focused on pre-hospital interventions, in-hospital transfusion protocols, and the impact of transport logistics on survival. Results: Evidence highlights that aggressive crystalloid resuscitation (over 5 L) significantly increases mortality, favoring balanced blood component therapy (1:1:1 ratio) or Whole Blood guided by viscoelastic testing like rotational thromboelastometry (ROTEM) or thromboelastography (TEG). Pre-hospital success is driven by rapid hemorrhage control via tourniquets, early administration of Tranexamic Acid (TXA), no aggressive crystalloids, permissive hypotension, proactive calcium supplementation is recommended in early care. Furthermore, the integration of Helicopter Emergency Medical Services (HEMS) is independently associated with improved survival in multi-organ trauma by reducing time to definitive care and facilitating “en-route” damage control. Conclusions: The evolution of rescue strategies focused on mitigating the effects of the diamond of death, combined with the implementation of permissive hypotension and optimized HEMS logistics, constitutes the foundation of a modern model aimed at minimizing mortality in multi-organ trauma. Full article

Atypical joint spaces, such as those encountered in complex segmental bone loss and large structural defects, remain challenging to manage with conventional implants within divisions across orthopedics, including arthroplasty, tumor reconstruction, trauma, and spine. Additive manufacturing advances have made patient-specific implants a possibility, and this promising solution has enabled the creation of implants with customized geometry and controlled surface porosity to enhance osseointegration, reduce rejection rates, optimize biomechanics, and promote longevity. Despite its potential, patient-specific implants are still eclipsed in use by conventional, “off-the-shelf” implants due to their lower cost, documented long-term durability, insurance coverage, and the strength of available clinical evidence supporting their use. This narrative review summarizes current materials and manufacturing approaches for additively manufactured metal porous implants, including imaging and design workflows, lattice and pore architecture, and how the printing process influences implant stiffness, fatigue strength, surface roughness, and porosity. We also discuss the experimental and preclinical data on mechanical performance, fatigue resistance, and osseointegration for new developments in the field. Emerging trends such as material innovation, streamlined digital planning-to-implant workflows, 4D printing and other advanced additive manufacturing concepts, and cost-reduction efforts are examined in the context of clinical practicality. In this review, the integration of engineering principles with early clinical outcomes will provide orthopedic surgeons with a realistic understanding of the benefits and limitations of the future utilization of additive manufacturing in clinical practice. Full article

Background: Youth mental health services increasingly encounter adolescents and young adults with complex affective presentations and trauma histories. Dissociation has been proposed as a clinically relevant marker within bipolar vulnerability pathways but remains underrecognized in early-intervention settings. This pilot study investigated the prevalence and clinical correlates of bipolar at-risk (BAR) status in a help-seeking youth sample, with specific focus on dissociative symptoms in this vulnerable population. Methods: A pilot study with a cross-sectional design was conducted in a specialized outpatient clinic for 14–25-year-olds. Seventy-six participants without Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision bipolar disorder completed a multidimensional assessment, including dissociative (Dissociative Experiences Scale version 2 [DES-II], Adolescent-DES [A-DES], Structured Clinical Interview for DSM Dissociative Disorders [SCID-D]), affective, anxiety, impulsivity, and prodromal symptom measures. BAR status (BAR+) was determined via clinical interview according to Bechdolf criteria. Clinically significant dissociation (DES+) was defined by established cut-offs at the DES-II and A-DES scales. Group comparisons, binary logistic regression and exploratory mediation analysis were performed. Results: In our sample, 44.7% of the participants met BAR+ criteria and 42.9% displayed clinically significant dissociation. Patients with BAR+ status more frequently reported familiar history of affective disorders, previous antidepressant use, loneliness, and non-suicidal self-injury. They displayed more severe depressive symptoms and impulsivity, as well as higher scores at all the affective temperament subscale except for hyperthymic. BAR+ patients displayed higher prevalence of dissociative symptoms than BAR− (51.6% vs. 24.2%; p = 0.045). Among the BAR+ subgroup, DES+ youths showed greater traumatic burden, depressive symptoms, and anxious temperament scores. Dissociation was associated with BAR+ status (OR 3.2) after adjusting for age, gender, and loneliness, while attentional impulsivity did not mediate this relationship. Conclusions: Dissociative symptomatology is highly prevalent among help-seeking youths and is directly associated with subthreshold bipolar-spectrum vulnerability. A dissociative BAR phenotype, marked by emotional instability and trauma exposure, may delineate a clinically complex subgroup, supporting the integration of dissociation-focused assessment into youth bipolar-risk staging and early-intervention protocols. Full article

Black Modernist architecture offers a powerful yet underexamined pathway for advancing restorative capacity in American cities. This paper argues that Black Modernism functions as a restorative design methodology, addressing social, economic, and ecological harm imposed on Black communities through slavery, racial capitalism, urban renewal, and infrastructural violence. Grounded in the restorative economics framework pioneered by O’Hara, the paper explores the role Black Modernism plays in sustaining sink capacities defined as the social, ecological, and emotional processes that absorb stress, pollution, waste, and trauma. Conventional economic models ignore these capacities, despite their necessity for economic productivity. Black communities, like all marginalized communities, have historically been forced to provide them without compensation. Situating Black Modernist architecture within this framework, the paper demonstrates how Black architects have designed buildings and landscapes that restore dignity, memory, health, and cultural identity, thereby expanding community sink capacities. Drawing on the works of various scholars, the paper examines case studies from Washington, DC, Atlanta, and Chicago, which reveal how Black communities have borne the burden of unremunerated restorative labor while shaping the American built environment. The paper positions Black Modernism as both a design language and a political–economic intervention, challenging architectural value systems that privilege monumental production over community restoration. It concludes by proposing a Restorative Design Framework that integrates Black Modernist principles with restorative economics, offering policy and planning pathways that recognize cultural labor, emotional restoration, and community well-being as essential components of sustainable urban development. Full article

Background/Objectives: Accurate bone fracture detection is essential for orthopedic diagnosis and trauma management. Manual interpretation of X-ray or CT images can be time-consuming and may lead to inter-observer variability, particularly in subtle or multi-site fracture cases. This study proposes an interpretable Hybrid Selective Feature Network (Hybrid SFNet) to improve multi-site bone fracture detection performance and boundary localization. Methods: The proposed Hybrid SFNet extends the original SFNet architecture by incorporating multi-scale convolutional feature extraction and a semantic flow mechanism to enhance structural representation and fracture boundary delineation. Preprocessing techniques, including Canny edge detection, normalization, and data augmentation, were applied to improve feature quality. Model interpretability was addressed using Gradient-weighted Class Activation Mapping (Grad-CAM) to visualize regions contributing to predictions. The model was evaluated on publicly available multi-site fracture datasets using both standard and class-weighted loss configurations. Results: For binary fracture classification, the proposed model achieved 90 accuracy, 94% precision, 77% recall, and an F1-score of 85% for fractured cases. When class-weighted loss was applied, recall improved to 85%, reducing false negatives from 145 to 94 cases (approximately 35%). Under the weighted configuration, Cohen’s Kappa reached 0.79 and the Matthews Correlation Coefficient (MCC) reached 0.76. Conclusions: The proposed Hybrid SFNet provides an interpretable and effective framework for multi-site bone fracture detection. The integration of multi-scale feature extraction and semantic flow mechanisms enhances detection performance and boundary localization, while Grad-CAM supports clinical interpretability. These results indicate the model’s potential for supporting clinical decision-making in orthopedic imaging. Full article

Background: We evaluated the association between admission serum glucose-to-potassium ratio (GPR) and injury severity as well as early transfusion requirements in patients with traumatic pelvic fractures. Methods: This single-center, retrospective cohort study included 84 adult patients with isolated or predominantly pelvic fractures admitted between January 2020 and December 2024. Patients with concomitant non-pelvic skeletal fractures were excluded to isolate the metabolic response attributable to pelvic injury. GPR was calculated from admission serum glucose and potassium levels. Higher transfusion requirement (HT) was defined as ≥4 units of packed red blood cells within 24 h. Receiver operating characteristic (ROC) analysis identified the optimal GPR cut-off using the Youden index. Internal validation was performed using bootstrap resampling (1000 iterations), and model calibration was assessed with the Hosmer–Lemeshow test. The incremental discriminatory value of GPR beyond the Injury Severity Score (ISS) was evaluated by comparing AUC values using the DeLong test, and reclassification metrics including the category-free net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated. Sensitivity analyses were conducted using alternative transfusion thresholds (≥6 and ≥10 units). Results: The optimal GPR cut-off was 34 (area under the curve (AUC) = 0.730; 95% CI: 0.593–0.853; sensitivity 78.8%; specificity 59.0%). Patients with GPR ≥ 34 (n = 43) had significantly higher ISS values (median 25 [IQR: 16–34] vs. 9 [5–17]; p < 0.001), greater transfusion volumes (median 3 [0–6] vs. 0 [0–1] units; p < 0.001), and longer intensive care unit (ICU) stays (3 (0–6) vs. 0 (0–1) days; p < 0.001). In univariable logistic regression, GPR was significantly associated with HT (OR = 1.059 per unit increase; 95% CI: 1.015–1.104; p = 0.008); however, significance was not retained in the multivariable model after adjustment for ISS (p = 0.194). ISS remained the sole independent predictor (OR = 1.128; p < 0.001). The combined ISS + GPR model yielded an AUC of 0.857, representing a modest increment over ISS alone (AUC = 0.849; ΔAUC = 0.009; DeLong p = 0.566). Bootstrap-corrected AUCs confirmed minimal optimism (GPR alone: 0.726; ISS + GPR: 0.847). The Hosmer–Lemeshow test indicated adequate calibration for all models (p > 0.05). The category-free NRI was 0.627 (p = 0.009), whereas the IDI did not reach significance (0.017; p = 0.290). Sensitivity analysis at the ≥6-unit threshold yielded consistent results (GPR AUC = 0.709). Conclusions: Admission GPR is significantly associated with injury severity, hemorrhagic burden, and transfusion requirements in patients with traumatic pelvic fractures. Although GPR does not independently predict transfusion needs beyond ISS, it yields significant reclassification improvement and may serve as a practical, rapidly obtainable adjunct for early risk stratification in the acute trauma setting. Level of Evidence: III (retrospective prognostic study). Full article

Custom-made subperiosteal implants are increasingly used in clinical cases where significant bone loss due to trauma or disease renders conventional endosseous implant placement unfeasible. This study investigated how different internal structural designs affect the deformation and stress distribution in mandibular subperiosteal implants under clinically relevant loading conditions. An idealized implant geometry was defined based on average human mandibular dimensions, and four configurations with identical outer shape and connection features were created, differing only in sidewall architecture (solid, top-relieved, top-relieved with lateral perforations, and top-relieved lattice framework). All specimens were manufactured by metal additive manufacturing and evaluated using cone-beam computed tomography (CBCT). Mechanical testing was performed in two stages: (i) cyclic loading consisting of 500 bite cycles at an overall force of ~326–350 N and (ii) a single static high-load event of 2000 N, applied parallel to the fixation pin axes. CT datasets acquired before and after each stage were compared to detect permanent deformation. No measurable residual deformation was identified in any configuration; the only observed macroscopic change was an adhesive-bond limitation in one case, rather than structural yielding of the implant. Finite element analysis further supported these findings by identifying localized stress concentrations mainly at the implant–prosthetic interface and by revealing the load-transfer zones that govern the mechanical response. Overall, the results indicate that lightweight, perforated, and lattice-based internal designs can preserve global structural integrity across physiological and supra-physiological load ranges while enabling design optimization to improve stress distribution. Full article