Predictive Factors of State Licensure Board Disciplinary Actions in Occupational Therapy.

IMPORTANCE: One primary function of occupational therapy state licensure boards (SLBs) is the discipline of ethical misconduct by licensed occupational therapy practitioners. However, SLB sanctioning is poorly understood by practitioners, regulators, and the public. OBJECTIVE: To identify predictors of occupational therapy practitioner sanctioning outcomes in the United States. DESIGN: Retrospective study; all public final consent orders and database entries provided online by SLBs were analyzed. Supervised gradient boosting machine learning, logistic regression, and contingency tables were used to generate odds ratios for variables associated with each sanctioning outcome. Multinomial testing was used to identify attribute overrepresentation among cases and national practitioner distributions. PARTICIPANTS: A total of 2,400 cases were analyzed across 47 states and Washington, DC. INTERVENTION: None. OUTCOMES AND MEASURES: Numerous complaint and respondent attribute variables were collected from final consent orders and database entries. RESULTS: Complaint reason, practice setting, and complaint source had the highest influence on predicting sanction outcome; geographic region, number of complaints in a given case, and length of investigation in months were secondarily influential. Being male or a certified occupational therapy assistant was associated with higher odds of severe sanctioning outcomes. CONCLUSIONS AND RELEVANCE: Disciplinary actions against occupational therapy practitioners were determined by numerous contextual factors; however, the most influential factors were complaint reason, practice setting, and complaint source. These results provide direction for exploring factors that predict sanctioning outcomes in the United States and also provide occupational therapy practitioners and SLBs a basis of applied outcomes that may improve implementation and education regarding clinical practice ethics. Plain-Language Summary: Occupational therapy state licensure boards (SLBs) are responsible for disciplining licensed occupational therapy practitioners for ethical misconduct. SLB sanctioning is poorly understood by practitioners, regulators, and the public. In this study, we identify the factors that predict the sanctioning outcomes of occupational therapy practitioners. The results may help state regulators, educators, and national associations more effectively act in a way that protects the public faith in occupational therapy services by providing contextualized information on practitioner behaviors that result in specific sanctioning outcomes. The study findings also provide occupational therapy practitioners and SLBs a basis of applied outcomes that may improve the implementation of and education regarding clinical practice ethics.

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.

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.

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.

Leucine metabolism regulates TRI6 expression and affects deoxynivalenol production and virulence in Fusarium graminearum.

TRI6 is a positive regulator of the trichothecene gene cluster and the production of trichothecene mycotoxins [deoxynivalenol (DON)] and acetylated forms such as 15-Acetyl-DON) in the cereal pathogen Fusarium graminearum. As a global transcriptional regulator, TRI6 expression is modulated by nitrogen-limiting conditions, sources of nitrogen and carbon, pH and light. However, the mechanism by which these diverse environmental factors affect TRI6 expression remains underexplored. In our effort to understand how nutrients affect TRI6 regulation, comparative digital expression profiling was performed with a wild-type F. graminearum and a Δtri6 mutant strain, grown in nutrient-rich conditions. Analysis showed that TRI6 negatively regulates genes of the branched-chain amino acid (BCAA) metabolic pathway. Feeding studies with deletion mutants of MCC, encoding methylcrotonyl-CoA-carboxylase, one of the key enzymes of leucine metabolism, showed that addition of leucine specifically down-regulated TRI6 expression and reduced 15-ADON accumulation. Constitutive expression of TRI6 in the Δmcc mutant strain restored 15-ADON production. A combination of cellophane breach assays and pathogenicity experiments on wheat demonstrated that disrupting the leucine metabolic pathway significantly reduced disease. These findings suggest a complex interaction between one of the primary metabolic pathways with a global regulator of mycotoxin biosynthesis and virulence in F. graminearum.

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.

A systematic review of the epidemiology of nonfatal strangulation, a human rights and health concern.

We reviewed the literature on the epidemiology of nonfatal strangulation (also, albeit incorrectly, called choking) by an intimate partner. We searched 6 electronic databases to identify cross-sectional, primary research studies from 1960 to 2014 that reported national prevalence estimates of nonfatal strangulation by an intimate partner among community-residing adults. Of 7260 identified references, 23 articles based on 11 self-reported surveys in 9 countries met the inclusion criteria. The percentage of women who reported ever having been strangled by an intimate partner ranged from 3.0% to 9.7%; past-year prevalence ranged from 0.4% to 2.4%, with 1.0% being typical. Although many epidemiological surveys inquire about strangulation, evidence regarding its prevalence is scarce. Modifying or adding a question to ongoing national surveys, particularly the Demographic and Health Surveys, would remedy the lack of data for low- and middle-income countries. In addition, when questions about strangulation are asked, findings should be reported rather than only combined with other questions to form broader categories (e.g., severe violence). Such action is merited because of the multiple negative short- and long-term sequelae of strangulation.

Intimate partner violence among female service members and veterans: information and resources available through military and non-military websites.

With the expansion of women's roles in the military, the number of female service members and veterans has increased. Considerable knowledge about intimate partner violence (IPV) in civilian couples exists but little is known about IPV among female service members and veterans. Prevalence rates of IPV range from 17% to 39% for female service members, and 21.9% to 74% for veterans. Most service members and veterans indicated using the Internet at least occasionally and expressed willingness to seek information about services via the Internet. Informed by data, we conducted a systematic review of military (Army, Navy, Air Force, and Marine Corps) and non-military (Veterans Affairs and Google) websites to explore the availability and presentation of information and resources related to IPV. The websites search revealed a variety of resources and information available, and important differences between sites with regard to what and how information is presented. Implications for practice and further research are discussed.

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.

Development and characterization of sodium alginate and ß-cyclodextrin nanoemulsions encapsulating betel leaf (Piper betle L.) extract for enhanced antimicrobial efficacy against foodborne pathogen.

This study aims to investigate the physical stability, droplet size, zeta potential, and antimicrobial properties of nanoemulsions formulated with betel leaf extract using ß-cyclodextrin (CD) and sodium alginate (SA) biopolymers. Nanoemulsions with ß-cyclodextrin exhibit superior stability at lower temperatures, with limited droplet size, and strong electrostatic repulsion. Morphological images demonstrate the successful encapsulation of betel leaf extract within both biopolymers, highlighting their potential for antimicrobial applications. Both CD and SA nanoemulsions display inhibitory effects on bacterial strains (E. coli, P. aeruginosa, L. monocytogenes, S. aureus, and B. cereus) and fungal growth (A. brasiliensis, R. stolonifer, F. oxysporum, and C. albicans). SA nanoemulsions show higher antimicrobial activity due to H+ ion release, particularly against A. brasiliensis and C. albicans. These findings underscore the potential of betel leaf extract nanoemulsions, especially those with SA, for various antimicrobial applications for sustainable food packaging, highlighting their significance in addressing microbial challenges.

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.

"I didn't know I could turn colors": Health problems and health care experiences of women strangled by an intimate partner.

Strangulation is a unique and particularly pernicious form of intimate partner violence. To increase the relatively little that is known about strangulation survivors, focus groups and interviews were conducted as part of a practice-research engagement with a domestic violence shelter. All of the participants had been strangled and, among them, almost all were strangled multiple times. The loss of consciousness was common. Participants associated "choking" with use of body parts and "strangling" with use of objects. Although some minimized the assault, most considered strangulation to be serious and reported a variety of medical conditions following the assault. Few sought medical care. Of those who did, few disclosed the assault, or were asked about strangulation, which commonly resulted in misdirected treatment. Implications for improving detection and treatment are discussed.

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.

Prolapsed simple ureterocele: evaluation by transvaginal voiding sono-urethrography.

Prolapsed ureterocele is a rare complication that may present with acute bladder outlet obstruction, generally in female infants. We present a case of prolapsed simple ureterocele in an adult woman, evaluated by transvaginal micturating sono-urethrography. High-frequency transvaginal sonography of the urethra performed during micturation revealed the relationship of the ureterocele with the urethral wall.

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.

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.

Outcomes using a 1470-nm laser for symptomatic varicose veins.

PURPOSE: The aim of this study was to evaluate safety and effectiveness of the laser fiber with wavelength of 1470 nm for ablation of symptomatic varicose veins. MATERIALS AND METHODS: This was a prospective study carried out from November 2007 to October 2009. Seventy-six limbs in 72 consecutive patients were treated by endovenous laser ablation (EVLA). Baseline preprocedural clinical and ultrasonic grading of varicose veins was done. Endovenous laser ablation was done under ultrasonic guidance, and prior superficial venogram was taken if required. After the procedure all the patients were followed up with for 1 year with duplex ultrasound scan, and improvement in grading of venous disease was assessed. RESULTS: One hundred eight treated veins of 76 limbs were followed up on day 2, 1 month, 6 month, and 12 months postprocedurally. At the end of 1-year follow-up, venous occlusion rate and ulcer healing rate were 98.61% and 85%, respectively. The average preoprocedure clinical grade and venous disability score improved significantly at 12 months. Most of the postprocedure complications were transient and self limiting; the most common complication was paresthesia (10.53%). No major complications, such as deep vein thrombosis, occurred. When the authors compared legs treated with linear endovenous energy density below or above 100 J/cm, the paresthesia rate and postoperative pain was significantly higher in the second group, with energy density more than 100 J/cm. CONCLUSIONS: EVLA, using 1470-nm laser, is a minimally invasive, safe, outpatient department (OPD) procedure that causes less postprocedural pain with linear endovenous energy density (LEED) less than 100J/cm.

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.