Outcomes of glenohumeral dysplasia after brachial plexus birth injury using the Sup-ER orthosis.

We investigated the efficacy of the supination-external rotation ('Sup-ER') orthosis, designed as a non-operative treatment to maintain normal anatomical growth of the shoulder, on the progression of glenohumeral dysplasia in patients with brachial plexus birth injuries. The Sup-ER orthosis was fabricated for 20 infants diagnosed with glenohumeral dysplasia after brachial plexus birth injuries and its success in correcting glenohumeral dysplasia was confirmed by objective calculations of the alpha angle on serial ultrasound findings and improvement in Active Movement Scale scores. Of the 20 patients, 14 had successful resolution of glenohumeral dysplasia, confirmed by shoulder abduction, shoulder flexion, external rotation and supination, Active Movement Scale scores and improving alpha angle measurements. Failure to rectify glenohumeral dysplasia, evidenced by worsening ultrasound findings and Active Movement Scale scores, necessitated a change to operative management in six patients.Level of evidence: IV.

Pontine tegmental cap dysplasia: the role of diffusion tensor imaging.

Pontine tegmental cap dysplasia (PTCD) is a rare hindbrain malformation syndrome. Recurrent aspiration pneumonia is a major cause of death during a first year of life. We report the case of month-old child with an inability to suck milk since birth and multiple convulsions. PTCD was identified using tractography and MRI. This case report describes the imaging findings, the role of diffusion tensor imaging in PTCD and its differentiating features from Joubert syndrome and related disorders (JSRDs). The constellation of imaging features in PTCD includes a midbrain appearance resembling a molar tooth, a flattened anterior pontine belly, hypoplastic middle cerebellar peduncles and dorsal pontine tegmental cap. 'Tegmental cap' is a transversely oriented abnormal bundle of fibres with absent superior cerebellar peduncle decussation. Accurate diagnosis with MRI and tractography and differentiating PTCD from JSRD would help the clinician for appropriate genetic counselling and prognosis.

Diabetic Foot Assessment and Care: Barriers and Facilitators in a Cross-Sectional Study in Bangalore, India.

(1) Background: This cross-sectional study aims to highlight the assessment and foot care practices in an advanced clinical setting, the clinical characteristics of the patients, and to understand the barriers and facilitators for effective foot care from the perspectives of healthcare practices, resources, and patients' socioeconomic and cultural practices, and other aspects in terms of new technologies for effective foot care such as infrared thermography. (2) Methods: Clinical test data from 158 diabetic patients and a questionnaire to assess the foot care education retention rate were collected at the Karnataka Institute of Endocrinology and Research (KIER) facility. (3) Results: Diabetic foot ulcers (DFUs) were found in 6% of the examined individuals. Male patients were more likely to have diabetes complications, with an odds ratio (OR) of 1.18 (CI = 0.49-2.84). Other diabetes problems raised the likelihood of DFUs by OR 5 (CI = 1.40-17.77). The constraints include socioeconomic position, employment conditions, religious customs, time and cost, and medication non-adherence. The attitude of podiatrists and nurses, diabetic foot education, and awareness protocols and amenities at the facility were all facilitators. (4) Conclusions: Most diabetic foot complications might be avoided with foot care education, regular foot assessments as the standard of treatment, and self-care as a preventive/therapeutic strategy.

Simple adsorptive removal of crystal violet, a triarylmethane dye, from synthetic wastewater using Fe (III)-treated pine needle biochar.

Untreated and Fe (III)-treated pine needle biochar (PNB) were evaluated at different pH for the removal of toxic crystal violet (CV) dye from synthetic wastewaters. Adsorption kinetics followed the pseudo-first-order kinetics involving intra-particle diffusion process. The adsorption rate constant increased with Fe treatment of PNB especially at pH 7.0. Adsorption data of CV conformed well to Freundlich adsorption isotherms and both adsorption capacity (ln K) and order of adsorption (1/n) of CV were nearly doubled with Fe (III) treatment of PNB at pH 7.0. Desorption of adsorbed CV from both untreated and Fe (III)-treated PNB could be accounted satisfactorily by third-degree polynomial equations. An increase in ionic strength and temperature enhanced dye adsorption onto untreated and Fe (III)-treated PNB. Adsorption of CV was an endothermic and spontaneous reaction with an increase in entropy of the system. FTIR spectra revealed that C = O of carboxylic acid aryls and C = O and C-O-C in lignin residues of PNB reacted with Fe (III) besides the formation of some iron oxyhydroxide minerals. The changes in FTIR confirmed the possible bonding of positively charged moiety of CV with the untreated and Fe-treated PNB. Scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) revealed the porous surfaces of PNB with clear accumulation of Fe (III) after treatment and deposition of CV dye on surfaces and pores of PNB. Iron (III)-treated PNB at pH 7.0 can serve as an ecofriendly and cost-effective adsorbent for the efficient removal of CV dye from wastewaters.

Ruptured cerebral aneurysm in isolated type A interrupted aortic arch managed by transradial endovascular route: A case report with literature review.

BACKGROUND AND INTRODUCTION: Interrupted aortic arch (IAA) is a very rare congenital anomaly carrying high neonatal mortality rate if left untreated. Rarer still, is its presentation in teenage or adulthood. This condition has been found to be complicated with cerebral aneurysms, which is a consequence of hemodynamic stress and hypertension secondary to arch interruption. Cerebral aneurysms can further complicate the clinical course and lead to poor clinical outcomes, especially if ruptured. CLINICAL PRESENTATION: A 17-year-old female presented with ruptured basilar top aneurysm and was considered for endovascular coiling. Transfemoral access was chosen but the catheter could not be negotiated beyond proximal thoracic aorta. A computed tomographic angiography (CTA) of thorax and abdomen was performed, which showed isolated interruption of aortic arch. Subsequently, transradial route was used for coiling of the aneurysm. CONCLUSION: To the best of our knowledge, the index case is one of the only seven cases of IAA with cerebral aneurysm that have been reported till date in medical literature. It also holds the unique distinction of being the first case of IAA with cerebral aneurysm treated by endovascular approach. Our case highlights the importance of transradial access in such pathological conditions.

Expecting the unexpected - Primary mediastinal large B cell lymphoma presenting as huge lung parenchymal mass.

The first possibility considered in the etiology of large lung masses is neoplastic lesions. The differential diagnoses of these masses include bronchogenic carcinoma, pulmonary sarcoma, primitive neuroectodermal tumor etc. Primary or secondary pulmonary parenchymal lymphomas presenting as large mass is distinctly rare. We share the case of a young lady who presented with a large left lung mass almost entirely replacing the left lung parenchyma, with associated intrathoracic lymphadenopathy. On evaluation she was proved to have primary mediastinal large B-cell lymphoma. Treatment with an aggressive chemotherapy regimen led to complete remission of the parenchymal and nodal disease. The uncommon radiological presentation and the excellent therapeutic response despite huge tumor load merit clinical attention.

Leaving and Beyond: Voices of Survivors of Domestic Violence From Kyrgyzstan.

Despite the global nature of domestic violence against women, few studies have examined the phenomenon in Kyrgyzstan. This grounded theory study gives voice to survivors of domestic violence by examining women's experiences of various forms of violence and the complexities surrounding Kyrgyz women's decision making about leaving violent relationships. Findings revealed that survivors move through a three-stage process of leaving: (a) reaching a turning point, (b) implementing the leaving process, and (c) reclaiming self. Participants described "turning points" as critical events or sudden realizations that the violence had become uncontrollable or intolerable, and that the problem was not going to be solved without external support. The turning points fell into four major categories, including epiphanies and moments of truth, losing hope for a change in the abuser's behavior, reaching the point of saturation and giving up, and experiencing fear for the safety of children and protecting self. The main factor that led women to leave was being confronted with the pervasive fear that the abuse would lead to permanent disability or death. In the second stage, the process of leaving was characterized by an iterative cycle of leaving and returning until women were able to weigh the costs and benefits of staying and leaving in the face of cultural, institutional, and systemic constraints. The final stage of leaving involved "reclaiming self," which was the result of cognitive shifts, finding new meanings in their experiences of abuse and attempts to leave, and support received from advocates at the shelter. Results have implications for interventions with survivors and policies addressing the problem of domestic violence in Kyrgyzstan.

"Give Me Proof": A Covert but Coercive Form of Non-partner Sexual Violence Contributing to Teen Pregnancy in Haiti and Opportunities for Biopsychosocial Intervention.

Adolescent girls in low-resource settings account for over 7.3 million births annually (generally unplanned). Unplanned teen pregnancies are increasing in low-resource settings. As part of a funded Round 20 Grand Challenges Exploration project (Healthy Minds for Adolescent Mothers), we investigated unplanned teen pregnancies in Haiti's Cité Soleil shantytown, teens' biopsychosocial challenges, and desirable interventions. Key stakeholders (N = 23): pregnant teens (13-17-year-olds, n = 8; 18-19-year-olds, n = 8) and health providers (18 or older, n = 7), participated by age group and role in focus groups (FGs). ATLAS.ti facilitated the analysis of transcribed FG audio recordings. Ninety-four percent (n = 15) of teens reported "Banm prèv," translated "Give me proof," as a cause of their unplanned pregnancies. Banm prèv describes when teens are propositioned by men who demand proof of their unpretentiousness or virginity. A subtle, covert, locally unchallenged phenomenon that is supported by damaging gender norms, Banm prèv constitutes an illusionary choice between teens' yielding non-consensual control of their bodies and the tacit alternative of gang rape. Banm prèv underscores teens' difficulty discerning consensual from coerced sex. Associated unplanned pregnancies occasion guilt, shame, stigma, depression, anxiety, and trauma in teens. Cité Soleil teens need contextually relevant, community-supported, age-appropriate interventions that challenge existing norms, build on cultural strengths, and include comprehensive sexuality education, including knowledge of reproductive rights. A traditional, contextually familiar, engaging, and humorous story-telling tradition, i.e., krik-krak, packaged in video format, is a useful framework for interventions to reduce depressive symptoms, stress, and anxiety for Cité Soleil teens experiencing unplanned pregnancies.

Experiences of sexual and gender minorities in an urban enclave of Haiti: despised, beaten, stoned, stabbed, shot and raped.

Studies of sexual and gender minorities in Haiti and globally typically involve HIV research and programming with men who have sex with men. We conducted focus groups with individuals in Haiti's Cité Soleil slum whose assigned gender at birth matched neither their gender identity nor contextual heteronormative constructions of gender roles, i.e. transwomen and transmen. The Yogyakarta Principles provided the study framework. Focus group participants offered emic perspectives on overall well-being, identities, biopsychosocial strengths and HIV-protective and risk factors. We found that gender expression that conflicts with contextual norms evoked recurring, humiliating and intentionally injurious sexual assaults against participants, heightening their HIV risk; participants endured beatings, shootings, stabbings, stonings and socio-political violence. Lack of confidentiality and stigma hinder participants' access to scarce HIV resources. Indistinct boundaries between sexuality, gender identity and gender expression merged with traditional gender-based roles to perpetuate sexual violence towards transwomen by cisgender heterosexual men and by transmen towards cisgender heterosexual women. Despite resignation to omnipresent violence, participants showed resilience regarding gender identity. Needed are integrated socio-behavioural and health programmes to challenge existing gender inequities while providing training on human rights and HIV risk reduction for Haitian sexual and gender minorities.

Psychometric properties of a Haitian Kreyòl version of the trauma symptom checklist.

BACKGROUND: In this study, the first to examine psychometrics of a Haitian Kreyòl version of the Trauma Symptom Checklist-40 (TSC-40), we investigated trauma symptoms in survivors of Haiti's 2010 earthquake who reside in Haiti's Cité Soleil slum, a violent neighborhood where non-partner sexual violence (NPSV) is rampant and whose residents are historically underrepresented in research. METHODS: 233 women and 280 men 18 years or older completed the TSC-40. Differential Item Function (DIF) analysis was performed on the TSC-40 responses for women and men. We examined symptom counts by gender, between NPSV victims and non-victims, and by interaction between gender and NPSV experience. RESULTS: We identified a reduced pool of 17-items that exhibited no gender bias. This 17-item index showed acceptable internal consistency reliability (α = 0.87). Employing this index, average symptom counts for women (x¯â€¯= 11.3) did not differ from men (x¯= 11.1). Average symptom counts for NPSV victims was greater (x¯â€¯= 12.5) than for non-victims (x¯= 10.7). The gender by experience of NPSV interaction indicated that women victims had the highest symptom counts (x¯=14.0). LIMITATIONS: We used non-probability sampling, and data were from self-reports collected in a cross-sectional survey. CONCLUSIONS: Observed differences in trauma burden are likely to be misleading if instruments are administered without regard to DIF. We contribute a Haitian Kreyòl Trauma Symptom 17-item index, which offers clinicians/practitioners in Haiti the opportunity to use a valid and reliable measure of enduring trauma symptoms validated in Haiti.

Sustainable Recycling of Insoluble Rust Waste for the Synthesis of Iron-Containing Perovskite-Type Catalysts.

Insoluble rust waste from the scraping of rusted iron-containing materials represents a cheap, eco-friendly, and available source of iron. LaFeO3 perovskite-type powders were successfully prepared by solution combustion synthesis using rust waste from an electricity transmission tower manufacturer. Solution combustion synthesis enabled introduction of this insoluble iron precursor directly into the final product, bypassing complex extraction procedures. Catalytic activity in the propylene oxidation of the waste-derived LaFeO3 with stoichiometric Fe/La ratio was almost identical to the commercial iron nitrate-derived LaFeO3, thus demonstrating the viability of this recycling solution. The amount of waste iron precursor was varied and its effect on the powder properties was investigated. A lesser stoichiometric amount of precursor produced a LaFeO3-La2O3 binary system, whereas a higher stoichiometric amount led to a LaFeO3-Fe2O3 binary system. Catalytic activity of iron-rich compositions in the propylene oxidation was only slightly lower than the stoichiometric one, whereas iron-poor compositions were much less active. This eco-friendly methodology can be easily extended to other iron perovskites with different chemical compositions and to other iron-containing compounds.

Tracheo-oesophageal fistula in a case of button battery ingestion: CT virtual bronchoscopy imaging.

Foreign body ingestion in paediatric population is a very common problem. Usually the foreign bodies pass through the gastrointestinal tract without any complications; however, certain foreign bodies like button batteries might cause severe injuries like tracheo-oesophageal fistula (TOF), oesophago-aortic fistula, perforation and mediastinitis, vocal cord paralysis and stenosis after suspected perforation. In our case, an infant developed a TOF following ingestion of button battery which was diagnosed with the help of CT virtual bronchoscopy. It also contributed to the decision making regarding suitable operative techniques. Thus, CT virtual bronchoscopy can help in the diagnosis and detection of any complications due to foreign body ingestion with the added advantage of being non-invasive.

Redox signalling from NADPH oxidase targets metabolic enzymes and developmental proteins in Fusarium graminearum.

NADPH oxidase (NOX) is one of the sources of reactive oxygen species (ROS) that modulates the activity of proteins through modifications of their cysteine residues. In a previous study, we demonstrated the importance of NOX in both the development and pathogenicity of the phytopathogen Fusarium graminearum. In this article, comparative proteomics between the wild-type and a Nox mutant of F. graminearum was used to identify active cysteine residues on candidate redox-sensing proteins. A two-dimensional gel approach based on labelling with monobromobimane (mBBR) identified 19 candidate proteins, and was complemented with a gel-free shotgun approach based on a biotin switch method, which yielded 99 candidates. The results indicated that, in addition to temporal regulation, a large number of primary metabolic enzymes are potentially targeted by NoxAB-generated ROS. Targeted disruption of these metabolic genes showed that, although some are dispensable, others are essential. In addition to metabolic enzymes, developmental proteins, such as the Woronin body major protein (FGSG_08737) and a glycosylphosphatidylinositol (GPI)-anchored protein (FGSG_10089), were also identified. Deletion of either of these genes reduced the virulence of F. graminearum. Furthermore, changing the redox-modified cysteine (Cys325 ) residue in FGSG_10089 to either serine or phenylalanine resulted in a similar phenotype to the FGSG_10089 knockout strain, which displayed reduced virulence and altered cell wall morphology; this underscores the importance of Cys325 to the function of the protein. Our results indicate that NOX-generated ROS act as intracellular signals in F. graminearum and modulate the activity of proteins affecting development and virulence in planta.

A national survey of attitudes toward intimate partner violence among married women in Kazakhstan, Kyrgyzstan, and Tajikistan: Implications for health prevention and intervention.

Attitudes toward intimate partner violence (IPV) can affect the prevalence of IPV, response of victims' to IPV (e.g., whether to seek help), and the response of professionals (e.g., police, social workers, health care professionals) to IPV. Knowledge about IPV-related attitudes is essential for developing effective social work and violence-related programs. Using data from the 2005-2006 Multiple Indicator Cluster Surveys, this study examines attitudes toward IPV and socio-demographic predictors of these attitudes among married women in Kazakhstan, Kyrgyzstan, and Tajikistan. Women were asked whether they approved of a husband beating his wife: if she goes out without telling him, neglects their children, argues, refuses to have sex, and burns food. The prevalence of IPV acceptance for at least one of the five reasons varied from 12.3% in Kazakhstan to 45.3% in Kyrgyzstan and 74.5% in Tajikistan. Women who were less educated, members of Asian ethnic groups, resided in middle-class urban areas, and lived in specific regions were more likely to accept IPV. Few age differences that emerged indicated that young women were more approving of IPV. Proactive efforts are needed to confront attitudes about gender roles and IPV in Tajikistan and Kyrgyzstan.

"Consent is Good, Joyous, Sexy": A banner campaign to market consent to college students.

OBJECTIVE: This study assessed the recall of, reaction to, and understanding of a brief campus banner campaign promoting consent in sexual relationships, and determined whether campaign exposure was associated with subsequent engagement in activities related to sexual assault education, awareness, and prevention. PARTICIPANTS: A stratified random sample of 1,200 undergraduates was recruited during fall of 2010; 628 (52.3%) participated. METHODS: To account for history and maturation, an experimental research design was employed with an online survey. RESULTS: Direct and indirect campaign exposure was associated with increased action. Students expressed primarily positive reactions to and appeared to understand the consent message. The campaign appealed to and was associated with increased activity among a wide range of students with one exception: a negative effect was observed for business students. CONCLUSIONS: Colorful banners with pithy, upbeat messages hold promise for engaging undergraduates in conversations and proactive activities related to sexual assault prevention.

In their Own Words: Resilience among Haitian Survivors of the 2010 Earthquake.

Social sciences literature highlights the importance of resilience in relation to risk and trauma. The 2010 Haitian earthquake compounded trauma for a nation that has endured slavery/despotic leadership, structural violence and poverty. Since 2010, various sources broadly describe Haitian survivors as resilient. We reviewed definitions of resilience published between 1990 and 2013, comparing them with perspectives of earthquake survivors from economically diverse communities in Haiti who, participated in semi-structured interviews (n=38) and in six focus groups (n=63) between 2010-2011. Haitian resilience accords with some definitions from the literature. It also comprises independent, discrete, and isolated contextual resignation and intentional choice to survive and function-when there is no alternative course of action. Understanding Haitian resilience, can inform health/mental health and policy interventions, if these are taken as cultural resources. Intervention efforts should incorporate survivors' input as key informants on what constitute resilience and reconstruction goals for them.

Adapting an evidence-based intervention for HIV to avail access to testing and risk-reduction counseling for female victims of sexual violence in post-earthquake Haiti.

Haiti has the highest prevalence of HIV/AIDS in the Caribbean. Before the 2010 earthquake, Haitian women bore a disproportionate burden of HIV/AIDS, had lower HIV knowledge, less capacity to negotiate for safer sex, and limited access to HIV testing and risk-reduction (RR) counseling. Since 2010, there has been an increase in sexual violence against women, characterized by deliberate vaginal injuries by non-intimate partners, increasing victims' risk of sexually transmitted infections including HIV/AIDS. Needed is an adaptation of evidence-based interventions for HIV that include HIV testing and counseling for this stigmatized population. We reviewed several features of Centers for Disease Control and Prevention's 103 evidence-based interventions for HIV (e.g., measures used, participant risk characteristics, theoretical framework, outcome variables, and evidence tier) in an attempt to seek a feasibly adaptable evidence-based intervention for HIV that could be used for victims of sexual violence (VOSV). RESPECT, one of the reviewed evidence-based HIV interventions, comprises of one-on-one, client-focused HIV prevention/RR counseling, and RAPID HIV testing. Adapting RESPECT can enhance access to testing for Haitian VOSV and can influence their perceptions of HIV risk, and establishment of RR goals for future consensual intimate relations. Adapting and implementing RESPECT can increase uptake of evidence-based HIV interventions among Haitians and positively affect a region with high HIV prevalence and increased rates of sexual violence.