2,109 research outputs found

    How often are clinicians performing genital exams in children with disorders of sex development?

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    Background: We sought to determine the frequency with which genital exams (GEs) are performed in children with disorders of sex development (DSD) and ambiguous genitalia (AG) during routine visits to the pediatric endocrine clinic. Methods: Medical records of children with DSD and AG seen at one large academic center since 2007 were reviewed. Data analyzed included diagnosis, sex of rearing, age, initial or follow up visit, number of individuals present and sex of the pediatric endocrinologist. Repeated measures analysis was performed to evaluate associations between GEs and patient/physician factors. Results: Eighty-two children with DSD and AG who had a total of 632 visits were identified. Sex of rearing was female in 78% and the most common diagnosis was congenital adrenal hyperplasia (CAH) (68%). GEs were performed in 35.6% of visits. GEs were more likely in patients with male sex of rearing (odds ratio [OR] 17.81, p=0.006), during initial vs. follow-up visits (OR 5.99, p=0.012), and when the examining endocrinologist was female (OR 3.71, p=0.014). As patients aged, GEs were less likely (OR 0.76, p<0.0001). Conclusions: GEs were performed in approximately one-third of clinic visits in children with DSD and AG. Male sex of rearing, initial visits and female pediatric endocrinologist were associated with more frequent GEs

    Element distribution and noble gas isotopic abundances in lunar meteorite Allan Hills A81005

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    Antarctic meteorite ALLAN HILLS A81005, an anorthositic breccia, is recognized to be of lunar origin. The noble gases in this meteorite were analyzed and found to be solar-wind implanted gases, whose absolute and relative concentrations are quite similar to those in lunar regolith samples. A sample of this meteorite was obtained for the analysis of the noble gas isotopes, including Kr(81), and for the determination of the elemental abundances. In order to better determine the volume derived from the surface correlated gases, grain size fractions were prepared. The results of the instrumental measurements of the gamma radiation are listed. From the amounts of cosmic ray produced noble gases and respective production rates, the lunar surface residence times were calculated. It was concluded that the lunar surface time is about half a billion years

    Solar wind and cosmic ray exposure history of lunar meteoriteYamato-793274

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    We measured the isotopic abundances of the noble gases in bulk samples and grain-size separates of lunar meteorite Yamato-793274. The presence of relatively high contents of trapped solar wind gases and stable cosmic-ray produced nuclei indicates that Y-793274 consists of submature lunar regolith material, that is, Y-793274 is not quite as rich in solar wind gases as mature lunar soil. The K-^Ar gas retention age is 2800±400 Ma. Breccia formation occurred 500-1000 Ma ago as estimated from a trapped ratio ^Ar/^Ar=2.36±0.10. The average shielding depth of 35±15g/cm^2 during the total exposure to cosmic rays was derived from the depth sensitive cosmogenic ratio ^Xe/^Xe=4.1±0.7. The total exposure to cosmic rays in the lunar regolith lasted for 700±200 Ma and most of this exposure occurred before breccia formation. The concentration of ^Kr is far below the 4π-saturation concentration in space; we calculate an upper limit of 0.12 Ma for the duration of the Moon-Earth transfer. The history of exposure to cosmic rays and solar wind particles for Y-793274 is very similar to that for another lunar meteorite, ALHA81005. Because the recovery sites in Antarctica lie 3000km apart, pairing is not possible. However, the two meteorites may originate from the same ejection event on the Moon although they are mineralogically different and an inhomogeneous ejection site would have to be assumed

    Bicalutamide as an Androgen Blocker With Secondary Effect of Promoting Feminization in Male-to-Female Transgender Adolescents

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    PURPOSE: The purpose of the study was to describe the novel use of bicalutamide in transgender youth. METHODS: This is a retrospective review of patients with gender dysphoria followed in the pediatric endocrine clinic at Riley Hospital for Children. RESULTS: Of 104 patients with gender dysphoria, 23 male-to-female adolescents received bicalutamide 50 mg daily as a second-line puberty blocker after insurance company denial of a gonadotropin-releasing hormone analog. Six patients received estrogen concurrently. Of 13 patients treated exclusively with bicalutamide seen in follow-up, 84.6% had breast development within 6 months, the majority being ≥ Tanner stage III. CONCLUSIONS: Bicalutamide may be an alternative to gonadotropin-releasing hormone analogs in transgender male-to-female youth who are also ready to undergo physical transition

    Hybrid Dissemination: Adding Determinism to Probabilistic Multicasting in Large-Scale P2P Systems

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    Abstract. Epidemic protocols have demonstrated remarkable scalability and robustness in disseminating information on internet-scale, dynamic P2P systems. However, popular instances of such protocols suffer from a number of significant drawbacks, such as increased message overhead in push-based systems, or low dissemination speed in pull-based ones. In this paper we study push-based epidemic dissemination algorithms, in terms of hit ratio, communication overhead, dissemination speed, and resilience to failures and node churn. We devise a hybrid push-based dissemination algorithm, combining probabilistic with deterministic properties, which limits message overhead to an order of magnitude lower than that of the purely probabilistic dissemination model, while retaining strong probabilistic guarantees for complete dissemination of messages. Our extensive experimentation shows that our proposed algorithm outperforms that model both in static and dynamic network scenarios, as well as in the face of large-scale catastrophic failures. Moreover, the proposed algorithm distributes the dissemination load uniformly on all participating nodes. Keywords: Epidemic/Gossip protocols, Information Dissemination, Peer-to-Peer

    Isotopic composition of gadolinium and neutron-capture effects in some meteorites

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    The isotopic composition of Gd in one chondrite, two achondrites, and the silicate inclusions of two iron meteorites has been determined. When corrected for mass discrimination, Gd in all samples except the Norton County achondrite shows the same relative isotopic abundances as terrestrial Gd. These results set an upper limit of 3×10^(15) neutrons per cm^2 on a differential integrated thermal neutron irradiation of the earth and these meteorites. Neutron-capture effects are present in Gd extracted from the Norton County achondrite. These most probably have been produced by secondary neutrons during the exceptionally long cosmic ray exposure of this large stone meteorite. The isotopic anomalies correspond to an integrated thermal neutron flux of (6.3±0.9)×10^(15) neutrons per cm^2. The percent abundances of terrestrial Gd found in our work for Gd^(160), Gd^(158), Gd^(157), Gd^(156), Gd^(155), Gd^(154), and Gd^(152) are 21.863, 24.835, 15.652, 20.466, 14.800, 2.1809, and 0.2029, respectively. Because of the higher precision, these abundances should replace the currently accepted values

    SafeWeb: A Middleware for Securing Ruby-Based Web Applications

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    Web applications in many domains such as healthcare and finance must process sensitive data, while complying with legal policies regarding the release of different classes of data to different parties. Currently, software bugs may lead to irreversible disclosure of confidential data in multi-tier web applications. An open challenge is how developers can guarantee these web applications only ever release sensitive data to authorised users without costly, recurring security audits. Our solution is to provide a trusted middleware that acts as a “safety net” to event-based enterprise web applications by preventing harmful data disclosure before it happens. We describe the design and implementation of SafeWeb, a Ruby-based middleware that associates data with security labels and transparently tracks their propagation at different granularities across a multi-tier web architecture with storage and complex event processing. For efficiency, maintainability and ease-of-use, SafeWeb exploits the dynamic features of the Ruby programming language to achieve label propagation and data flow enforcement. We evaluate SafeWeb by reporting our experience of implementing a web-based cancer treatment application and deploying it as part of the UK National Health Service (NHS)
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