When Girls Play With G.I. Joes and Boys Play with Barbies: The Path to Gender Reassignment in Minors

Currently, the process of gender reassignment in minors requires parental consent and the approval of a mental-health counselor. The actual treatment can begin with puberty blockers-which stall the beginnings of puberty-followed by hormone injections to transform the minor into the requested gender. The hormone injections are thought to have irreversible features, but the effects of these injections are largely untested. The final step, surgical reassignment, is seemingly limited to those over the age of eighteen. The process of reassignment in minors has seen a substantial increase nationwide over the past decade, although the exact number of those seeking reassignment is hard to define. There are a number of concerns regarding gender reassignment in minors, concerns which come from both sides of the political aisle. This Note will review some of these concerns, namely: the lack of research on the effects of reassignment, the conflicting results of treatment, the possible influence of authority figures, and the proven mental instability and gender fluidity of minors. In response to the increase of gender reassignment in minors and the many concerns associated with reassignment, this Note proposes legislation that would give courts greater oversight in the reassignment approval process. This legislation requires a minor seeking reassignment to petition the court, who would subsequently serve notice and summons to an appointed agency of the governing state. This agency would presumptively oppose the petition in efforts to create an adversarial landscape. The court would ultimately have authority to approve or deny the requested reassignment, with the aid of a Guardian ad Litem appointed to represent the best interests of the child. There may be constitutional roadblocks to the enforcement of such a statute, however, this Note acknowledges those roadblocks and recognizes the ways in which this legislation could overcome them

When Girls Play With G.I. Joes and Boys Play with Barbies: The Path to Gender Reassignment in Minors

Currently, the process of gender reassignment in minors requires parental consent and the approval of a mental-health counselor. The actual treatment can begin with puberty blockers-which stall the beginnings of puberty-followed by hormone injections to transform the minor into the requested gender. The hormone injections are thought to have irreversible features, but the effects of these injections are largely untested. The final step, surgical reassignment, is seemingly limited to those over the age of eighteen. The process of reassignment in minors has seen a substantial increase nationwide over the past decade, although the exact number of those seeking reassignment is hard to define. There are a number of concerns regarding gender reassignment in minors, concerns which come from both sides of the political aisle. This Note will review some of these concerns, namely: the lack of research on the effects of reassignment, the conflicting results of treatment, the possible influence of authority figures, and the proven mental instability and gender fluidity of minors. In response to the increase of gender reassignment in minors and the many concerns associated with reassignment, this Note proposes legislation that would give courts greater oversight in the reassignment approval process. This legislation requires a minor seeking reassignment to petition the court, who would subsequently serve notice and summons to an appointed agency of the governing state. This agency would presumptively oppose the petition in efforts to create an adversarial landscape. The court would ultimately have authority to approve or deny the requested reassignment, with the aid of a Guardian ad Litem appointed to represent the best interests of the child. There may be constitutional roadblocks to the enforcement of such a statute, however, this Note acknowledges those roadblocks and recognizes the ways in which this legislation could overcome them

Western Diet in Adulthood, Timing of Menarche, and Economic Status Among Northeast Ohioans

I studied the age at first menstruation as a predictor of Western diet consumption among adults at The University of Akron and in Cleveland. I used stable carbon and nitrogen isotope compositions of human hair, as well as surveyed consumption of foods important to a Western diet (red meat, sugar, and dairy), to understand whether participants aligned with a Western dietary pattern. Age at survey and adult economic status were investigated as potential confounding variables. My data analysis and conclusions for this project has been completed and approved by my advisor and committee. To maintain collaborators\u27 ability to publish a comprehensive analysis of this dataset, I am not at liberty to publish my results here. Broader analyses of diet composition across lifetime, age at menarche, and economic status represent interesting avenues for future study

Hemoglobin A1c (HbA1c) changes over time among adolescent and young adult participants in the T1D exchange clinic registry

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/122422/1/pedi12295_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/122422/2/pedi12295.pd

Hsp90 governs dispersion and drug resistance of fungal biofilms

Fungal biofilms are a major cause of human mortality and are recalcitrant to most treatments due to intrinsic drug resistance. These complex communities of multiple cell types form on indwelling medical devices and their eradication often requires surgical removal of infected devices. Here we implicate the molecular chaperone Hsp90 as a key regulator of biofilm dispersion and drug resistance. We previously established that in the leading human fungal pathogen, Candida albicans, Hsp90 enables the emergence and maintenance of drug resistance in planktonic conditions by stabilizing the protein phosphatase calcineurin and MAPK Mkc1. Hsp90 also regulates temperature-dependent C. albicans morphogenesis through repression of cAMP-PKA signalling. Here we demonstrate that genetic depletion of Hsp90 reduced C. albicans biofilm growth and maturation in vitro and impaired dispersal of biofilm cells. Further, compromising Hsp90 function in vitro abrogated resistance of C. albicans biofilms to the most widely deployed class of antifungal drugs, the azoles. Depletion of Hsp90 led to reduction of calcineurin and Mkc1 in planktonic but not biofilm conditions, suggesting that Hsp90 regulates drug resistance through different mechanisms in these distinct cellular states. Reduction of Hsp90 levels led to a marked decrease in matrix glucan levels, providing a compelling mechanism through which Hsp90 might regulate biofilm azole resistance. Impairment of Hsp90 function genetically or pharmacologically transformed fluconazole from ineffectual to highly effective in eradicating biofilms in a rat venous catheter infection model. Finally, inhibition of Hsp90 reduced resistance of biofilms of the most lethal mould, Aspergillus fumigatus, to the newest class of antifungals to reach the clinic, the echinocandins. Thus, we establish a novel mechanism regulating biofilm drug resistance and dispersion and that targeting Hsp90 provides a much-needed strategy for improving clinical outcome in the treatment of biofilm infections

Best Practices for Virtual Care: A Consensus Statement From the Canadian Rheumatology Association

Objective. To develop best practice statements for the provision of virtual care in adult and pediatric rheumatology for the Canadian Rheumatology Association\u27s (CRA) Telehealth Working Group (TWG). Methods. Four members of the TWG representing adult, pediatric, university-based, and community rheumatology practices defined the scope of the project. A rapid literature review of existing systematic reviews, policy documents, and published literature and abstracts on the topic was conducted between April and May 2021. The review informed a candidate set of 7 statements and a supporting document. The statements were submitted to a 3-round (R) modified Delphi process with 22 panelists recruited through the CRA and patient advocacy organizations. Panelists rated the importance and feasibility of the statements on a Likert scale of 1-9. Statements with final median ratings between 7-9 with no disagreement were retained in the final set. Results. Twenty-one (95%) panelists participated in R1, 15 (71%) in R2, and 18 (82%) in R3. All but 1 statement met inclusion criteria during R1. Revisions were made to 5/7 statements following R2 and an additional statement was added. All statements met inclusion criteria following R3. The statements addressed the following themes in the provision of virtual care: adherence to existing standards and regulations, appropriateness, consent, physical examination, patient-reported outcomes, use in addition to in-person visits, and complex comanagement of disease. Conclusion. The best practice statements represent a starting point for advancing virtual care in rheumatology. Future educational efforts to help implement these best practices and research to address identified knowledge gaps are planned

Taxonomy of the order Bunyavirales : second update 2018

In October 2018, the order Bunyavirales was amended by inclusion of the family Arenaviridae, abolishment of three families, creation of three new families, 19 new genera, and 14 new species, and renaming of three genera and 22 species. This article presents the updated taxonomy of the order Bunyavirales as now accepted by the International Committee on Taxonomy of Viruses (ICTV).Non peer reviewe

Loci influencing blood pressure identified using a cardiovascular gene-centric array

Blood pressure (BP) is a heritable determinant of risk for cardiovascular disease (CVD). To investigate genetic associations with systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP) and pulse pressure (PP), we genotyped 50 000 single-nucleotide polymorphisms (SNPs) that capture variation in 2100 candidate genes for cardiovascular phenotypes in 61 619 individuals of European ancestry from cohort studies in the USA and Europe. We identified novel associations between rs347591 and SBP (chromosome 3p25.3, in an intron of HRH1) and between rs2169137 and DBP (chromosome1q32.1 in an intron of MDM4) and between rs2014408 and SBP (chromosome 11p15 in an intron of SOX6), previously reported to be associated with MAP. We also confirmed 10 previously known loci associated with SBP, DBP, MAP or PP (ADRB1, ATP2B1, SH2B3/ATXN2, CSK, CYP17A1, FURIN, HFE, LSP1, MTHFR, SOX6) at array-wide significance (P 2.4 10(6)). We then replicated these associations in an independent set of 65 886 individuals of European ancestry. The findings from expression QTL (eQTL) analysis showed associations of SNPs in the MDM4 region with MDM4 expression. We did not find any evidence of association of the two novel SNPs in MDM4 and HRH1 with sequelae of high BP including coronary artery disease (CAD), left ventricular hypertrophy (LVH) or stroke. In summary, we identified two novel loci associated with BP and confirmed multiple previously reported associations. Our findings extend our understanding of genes involved in BP regulation, some of which may eventually provide new targets for therapeutic intervention.</p

Clinical Sequencing Exploratory Research Consortium: Accelerating Evidence-Based Practice of Genomic Medicine

Despite rapid technical progress and demonstrable effectiveness for some types of diagnosis and therapy, much remains to be learned about clinical genome and exome sequencing (CGES) and its role within the practice of medicine. The Clinical Sequencing Exploratory Research (CSER) consortium includes 18 extramural research projects, one National Human Genome Research Institute (NHGRI) intramural project, and a coordinating center funded by the NHGRI and National Cancer Institute. The consortium is exploring analytic and clinical validity and utility, as well as the ethical, legal, and social implications of sequencing via multidisciplinary approaches; it has thus far recruited 5,577 participants across a spectrum of symptomatic and healthy children and adults by utilizing both germline and cancer sequencing. The CSER consortium is analyzing data and creating publically available procedures and tools related to participant preferences and consent, variant classification, disclosure and management of primary and secondary findings, health outcomes, and integration with electronic health records. Future research directions will refine measures of clinical utility of CGES in both germline and somatic testing, evaluate the use of CGES for screening in healthy individuals, explore the penetrance of pathogenic variants through extensive phenotyping, reduce discordances in public databases of genes and variants, examine social and ethnic disparities in the provision of genomics services, explore regulatory issues, and estimate the value and downstream costs of sequencing. The CSER consortium has established a shared community of research sites by using diverse approaches to pursue the evidence-based development of best practices in genomic medicine