Review of Outcome Information in 46,XX Patients with Congenital Adrenal Hyperplasia Assigned/Reared Male: What Does It Say about Gender Assignment?

There is ample historical verification of 46,XX congenital adrenal hyperplasia (CAH) patients being born with essentially male genitaliawhile outcome information is scant. Prior to glucocorticoid therapy, most patients died very young from adrenal insufficiency. Most available reports from laterchildhood, contain little information concerning sexual identity. Reports on older individuals lack adequate information about sexual identity and quality of life. The difficulty in assessing the relative impact of multiple dynamic environmental factors on the development of sexual identity, self- and body esteem and overall adjustment to life is clear. Nevertheless, it remains unclear whether those infants whose masculine genitalia at birth resulted in an initial male assignment would have enjoyed a better adult outcome had they been allowed to remain male rather than the female reassignment that most received. Further, one could ask whether a male sex of rearing should be considered in 46,XX CAH infants with male external genitalia. After reviewing available literature, we conclude that because those extremely virlized 46,XX CAH patients who were reared male with healthy social support demonstrated satisfactory levels of social and sexual function as adults a male sex assignment should be considered in these types of infants when social and cultural environment are supportive

The Role of Support Groups, Advocacy Groups, and Other Interested Parties in Improving the Care of Patients with Congenital Adrenal Hyperplasia: Pleas and Warnings

In the era of advocacy groups, it seems appropriate to contemplate how best to utilize them for patient benefit in the management of those with disorders of sex development (DSD), including those with congenital adrenal hyperplasia (CAH). Such interactions, to be constructive, require a spirit of cooperation to optimize outcomes. A traditional view of advocacy groups as a type of defender of patients' rights appears outdated and it is time that the benefits of their participation be fully realized. Open dialogue with all patients/families, including those who feel harmed by prior care are paramount. We discuss several recent examples of interactions that illustrate how dialogue in the name of “advocacy” can have a negative impact on developing a framework for ongoing constructive dialogue and actions. Such approaches completely change the dynamics of subsequent interactions. Physicians involved in the care of individuals with DSD, including those with CAH, and patients should be aware of confrontational techniques and legal implications that may be used by some advocacy groups. Hopefully recent efforts to promote a multidisciplinary care approach for patients with DSD/CAH will continue to foster mutual cooperation between team members, where the common goal is improving patient/family outcomes and quality of life

Methods and apparatus for additive manufacturing of glass

In illustrative implementations of this invention, a crucible kiln heats glass such that the glass becomes or remains molten. A nozzle extrudes the molten glass while one or more actuators actuate movements of the nozzle, a build platform or both. A computer controls these movements such that the extruded molten glass is selectively deposited to form a 3D glass object. The selective deposition of molten glass occurs inside an annealing kiln. The annealing kiln anneals the glass after it is extruded. In some cases, the actuators actuate the crucible kiln and nozzle to move in horizontal x, y directions and actuate the build platform to move in a z-direction. In some cases, fluid flows through a cavity or tubes adjacent to the nozzle tip, in order to cool the nozzle tip and thereby reduce the amount of glass that sticks to the nozzle tip

Does the motor system need intermittent control?

Explanation of motor control is dominated by continuous neurophysiological pathways (e.g. trans-cortical, spinal) and the continuous control paradigm. Using new theoretical development, methodology and evidence, we propose intermittent control, which incorporates a serial ballistic process within the main feedback loop, provides a more general and more accurate paradigm necessary to explain attributes highly advantageous for competitive survival and performance

Water Quality and Herbivory Interactively Drive Coral-Reef Recovery Patterns in American Samoa

BACKGROUND: Compared with a wealth of information regarding coral-reef recovery patterns following major disturbances, less insight exists to explain the cause(s) of spatial variation in the recovery process. METHODOLOGY/PRINCIPAL FINDINGS: This study quantifies the influence of herbivory and water quality upon coral reef assemblages through space and time in Tutuila, American Samoa, a Pacific high island. Widespread declines in dominant corals (Acropora and Montipora) resulted from cyclone Heta at the end of 2003, shortly after the study began. Four sites that initially had similar coral reef assemblages but differential temporal dynamics four years following the disturbance event were classified by standardized measures of 'recovery status', defined by rates of change in ecological measures that are known to be sensitive to localized stressors. Status was best predicted, interactively, by water quality and herbivory. Expanding upon temporal trends, this study examined if similar dependencies existed through space; building multiple regression models to identify linkages between similar status measures and local stressors for 17 localities around Tutuila. The results highlighted consistent, interactive interdependencies for coral reef assemblages residing upon two unique geological reef types. Finally, the predictive regression models produced at the island scale were graphically interpreted with respect to hypothesized site-specific recovery thresholds. CONCLUSIONS/SIGNIFICANCE: Cumulatively, our study purports that moving away from describing relatively well-known patterns behind recovery, and focusing upon understanding causes, improves our foundation to predict future ecological dynamics, and thus improves coral reef management

Additive Manufacturing of Optically Transparent Glass

We present a fully functional material extrusion printer for optically transparent glass. The printer is composed of scalable modular elements able to operate at the high temperatures required to process glass from a molten state to an annealed product. We demonstrate a process enabling the construction of 3D parts as described by computer-aided design models. Processing parameters such as temperature, which control glass viscosity, and flow rate, layer height, and feed rate can thus be adjusted to tailor printing to the desired component, its shape, and its properties. We explored, defined, and hard-coded geometric constraints and coiling patterns as well as the integration of various colors into the current controllable process, contributing to a new design and manufacturing space. We report on performed characterization of the printed materials executed to determine their morphological, mechanical, and optical properties. Printed parts demonstrated strong adhesion between layers and satisfying optical clarity. This molten glass 3D printer demonstrates the production of parts that are highly repeatable, enable light transmission, and resemble the visual and mechanical performance of glass constructs that are conventionally obtained. Utilizing the optical nature of glass, complex caustic patterns were created by projecting light through the printed objects. The 3D-printed glass objects described here can thus be extended to implementations across scales and functional domains including product and architectural design. This research lies at the intersection of design, engineering, science, and art, representing a highly interdisciplinary approach.Massachusetts Institute of Technology. Department of Mechanical EngineeringGlass Art Society (Technology Advancing Glass Grant

Assessing relative resilience potential of coral reefs to inform management

International audienceEcological resilience assessments are an important part of resilience-based management (RBM) and can help prioritize and target management actions. Use of such assessments has been limited due to a lack of clear guidance on the assessment process. This study builds on the latest scientific advances in RBM to provide that guidance from a resilience assessment undertaken in the Commonwealth of the Northern Mariana Islands (CNMI). We assessed spatial variation in ecological resilience potential at 78 forereef sites near the populated islands of the CNMI: Saipan, Tinian/Aguijan, and Rota. The assessments are based on measuring indicators of resilience processes and are combined with information on anthropogenic stress and larval connectivity. We find great spatial variation in relative resilience potential with many high resilience sites near Saipan (5 of 7) and low resilience sites near Rota (7 of 9). Criteria were developed to identify priority sites for six types of management actions (e.g., conservation, land-based sources of pollution reduction, and fishery management and enforcement) and 51 of the 78 sites met at least one of the sets of criteria. The connectivity simulations developed indicate that Tinian and Aguijan are each roughly 10 × the larvae source that Rota is and twice as frequent a destination. These results may explain the lower relative resilience potential of Rota reefs and indicates that actions in Saipan and Tinian/Aguijan will be important to maintaining supply of larvae. The process we describe for undertaking resilience assessments can be tailored for use in coral reef areas globally and applied to other ecosystems

Towards a systems-level view of cerebellar function::the interplay between cerebellum, basal ganglia and cortex

Contains fulltext : 170319.pdf (Publisher’s version ) (Open Access)Despite increasing evidence suggesting the cerebellum works in concert with the cortex and basal ganglia, the nature of the reciprocal interactions between these three brain regions remains unclear. This consensus paper gathers diverse recent views on a variety of important roles played by the cerebellum within the cerebello-basal ganglia-thalamo-cortical system across a range of motor and cognitive functions. The paper includes theoretical and empirical contributions, which cover the following topics: recent evidence supporting the dynamical interplay between cerebellum, basal ganglia, and cortical areas in humans and other animals; theoretical neuroscience perspectives and empirical evidence on the reciprocal influences between cerebellum, basal ganglia, and cortex in learning and control processes; and data suggesting possible roles of the cerebellum in basal ganglia movement disorders. Although starting from different backgrounds and dealing with different topics, all the contributors agree that viewing the cerebellum, basal ganglia, and cortex as an integrated system enables us to understand the function of these areas in radically different ways. In addition, there is unanimous consensus between the authors that future experimental and computational work is needed to understand the function of cerebellar-basal ganglia circuitry in both motor and non-motor functions. The paper reports the most advanced perspectives on the role of the cerebellum within the cerebello-basal ganglia-thalamo-cortical system and illustrates other elements of consensus as well as disagreements and open questions in the field

Tissue sampling methods and standards for vertebrate genomics

The recent rise in speed and efficiency of new sequencing technologies have facilitated high-throughput sequencing, assembly and analyses of genomes, advancing ongoing efforts to analyze genetic sequences across major vertebrate groups. Standardized procedures in acquiring high quality DNA and RNA and establishing cell lines from target species will facilitate these initiatives. We provide a legal and methodological guide according to four standards of acquiring and storing tissue for the Genome 10K Project and similar initiatives as follows: four-star (banked tissue/cell cultures, RNA from multiple types of tissue for transcriptomes, and sufficient flash-frozen tissue for 1 mg of DNA, all from a single individual); three-star (RNA as above and frozen tissue for 1 mg of DNA); two-star (frozen tissue for at least 700 μg of DNA); and one-star (ethanol-preserved tissue for 700 μg of DNA or less of mixed quality). At a minimum, all tissues collected for the Genome 10K and other genomic projects should consider each species’ natural history and follow institutional and legal requirements. Associated documentation should detail as much information as possible about provenance to ensure representative sampling and subsequent sequencing. Hopefully, the procedures outlined here will not only encourage success in the Genome 10K Project but also inspire the adaptation of standards by other genomic projects, including those involving other biota