The Creation and Implementation of a Transgender Cultural Competence Nursing Education Toolkit

Healthcare disparities in the transgender populations have been linked to lack of healthcare provider cultural competence (IOM, 2011; Bradford et al., Harbin et al., 2012; Eliason, Dibble, & DeJoseph, 2010; Lim, Brown, & Jones, 2013). Prior research has identified that healthcare providers receive little, if any, transgender cultural competence training during their formal education. A survey of nursing educators at the University of San Francisco School (USF) of Nursing and Health Professions suggested that few educators are providing transgender content or understand the unique healthcare needs of that population. A literature review concluded that little is known about the best way to educate nursing learners on transgender cultural competence. To address the education gap identified at USF, a nursing education toolkit was generated that focuses on transgender cultural competence. The toolkit includes: instructions, a pre-test, an original learning manuscript, video recommendations, teaching recommendations, consent form, six standardized patient simulation scenarios, a post-test and evaluation form. Testing of the toolkit content was completed on the 20th of September 2014 on a group of student volunteers. The results of the testing suggest that the content provided in the toolkit does increase nursing transgender cultural competence and willingness to provide care to transgender individuals. These findings appear to mirror the results of other research that found that providing cultural sensitivity training to healthcare providers does increase transgender cultural competence

The effect of diffuse background on the spatially-resolved Schmidt relation in nearby spiral galaxies

Context. The global Schmidt law of star formation provides a power-law relation between the surface densities of star-formation rate (SFR) and gas, and successfully explains plausible scenarios of galaxy formation and evolution. However, star formation being a multi-scale process, requires spatially-resolved analysis for a better understanding of the physics of star formation. Aims. It has been shown that the removal of a diffuse background from SFR tracers, such as Hα, far-ultraviolet (FUV), infrared, leads to an increase in the slope of the sub-galactic Schmidt relation. We reinvestigate the local Schmidt relations in nine nearby spiral galaxies taking into account the effect of inclusion and removal of diffuse background in SFR tracers as well as in the atomic gas. Methods. We used multiwavelength data obtained as part of the Spitzer Infrared Nearby Galaxies Survey, Key Insights on Nearby Galaxies: a Far-Infrared Survey with Herschel, The H I Nearby Galaxy Survey, and HERA CO-Line Extragalactic Survey. Making use of a novel split of the overall light distribution as a function of spatial scale, we subtracted the diffuse background in the SFR tracers as well as the atomic gas. Using aperture photometry, we study the Schmidt relations on background subtracted and unsubtracted data at physical scales varying between 0.5–2 kpc. Results. The fraction of diffuse background varies from galaxy to galaxy and accounts to ∼34% in Hα, ∼43% in FUV, ∼37% in 24 μm, and ∼75% in H I on average. We find that the inclusion of diffuse background in SFR tracers leads to a linear molecular gas Schmidt relation and a bimodal total gas Schmidt relation. However, the removal of diffuse background in SFR tracers leads to a super-linear molecular gas Schmidt relation. A further removal of the diffuse background from atomic gas results in a slope ∼1.4 ± 0.1, which agrees with dynamical models of star formation accounting for flaring effects in the outer regions of galaxies.</jats:p

A modern look at hypertension and anaesthesia

Hypertension is common among patients presenting for surgery, and is frequently untreated or inadequately treated. While the approach to the patient with hypertension presenting for anaesthesia is controversial, and the evidence base for appropriate clinical decisions is weak, this is a problem that practising clinical anaesthetists face on a regular basis. This article seeks to present a unified approach to the problem of a  hypertensive patient presenting for surgery, and offers suggestions as to the appropriate management options. As far as possible, the recommendations contained in this article have been based on the best available evidence. The authors suggest that moderate degrees of hypertension (up to 180/120 mmHg), without obvious target organ disease, should never be grounds for postponing surgery. Even with greater degrees of hypertension, the relative risk of postponing surgery should always be considered. There is little evidence that, in patients without target organ disease, delaying surgery in order to establish  antihypertensive therapy is beneficial. For very severe hypertension, the benefits of delaying surgery to establish adequate hypertensive control must be weighed against the risk of delayed surgery. Where a surgical delay is considered, adequate time to establish appropriate blood pressurecontrol must be allowed, and there is no place for sudden “cosmetic” correction of blood pressure immediately prior to anaesthesia. Previously undiagnosed hypertension, presenting for the first time at surgery, requires a basic investigation of target organ disease prior to anaesthesia, and appropriate subsequent follow-up referral for further management

A modern look at hypertension and anaesthesia

Hypertension is common among patients presenting for surgery, and is frequently untreated or inadequately treated. While the approach to the patient with hypertension presenting for anaesthesia is controversial, and the evidence base for appropriate clinical decisions is weak, this is a problem that practising clinical anaesthetists face on a regular basis. This article seeks to present a unified approach to the problem of a hypertensive patient presenting for surgery, and offers suggestions as to the appropriate management options. As far as possible, the recommendations contained in this article have been based on the best available evidence. The authors suggest that moderate degrees of hypertension (up to 180/120 mmHg), without obvious target organ disease, should never be grounds for postponing surgery. Even with greater degrees of hypertension, the relative risk of postponing surgery should always be considered. There is little evidence that, in patients without target organ disease, delaying surgery in order to establish antihypertensive therapy is beneficial. For very severe hypertension, the benefits of delaying surgery to establish adequate hypertensive control must be weighed against the risk of delayed surgery. Where a surgical delay is considered, adequate time to establish appropriate blood pressure control must be allowed, and there is no place for sudden &ldquo;cosmetic&rdquo; correction of blood pressure immediately prior to anaesthesia. Previously undiagnosed hypertension, presenting for the first time at surgery, requires a basic investigation of target organ disease prior to anaesthesia, and appropriate subsequent follow-up referral for further management.Keywords: hypertension, anaesthesia, ris

Mapping UV properties throughout the cosmic horseshoe: Lessons from VLT-MUSE

We present the first spatially-resolved rest-frame UV study of the gravitationally lensed galaxy, the 'Cosmic Horseshoe' (J1148+1930) at z=2.38. Our gravitational lens model shows that the system is made up of four star-forming regions, each ~4-8 kpc^2 in size, from which we extract four spatially exclusive regional spectra. We study the interstellar and wind absorption lines, along with CIII] doublet emission lines, in each region to investigate any variation in emission/absorption line properties. The mapped CIII] emission shows distinct kinematical structure, with velocity offsets of ~+/-50 km/s between regions suggestive of a merging system, and a variation in equivalent width that indicates a change in ionisation parameter and/or metallicity between the regions. Absorption line velocities reveal a range of outflow strengths, with gas outflowing between -200<v(km/s)<-50 relative to the systemic velocity of that region. Interestingly, the strongest gas outflow appears to emanate from the most diffuse star-forming region. The star-formation rates remain relatively constant (~8-16 M_sol/yr), mostly due to large uncertainties in reddening estimates. As such, the outflows appear to be 'global' rather than 'locally' sourced. We measure electron densities with a range of log(Ne)=3.92-4.36 cm^-3, and point out that such high densities may be common when measured using the CIII] doublet due to its large critical density. Overall, our observations demonstrate that while it is possible to trace variations in large scale gas kinematics, detecting inhomogeneities in physical gas properties and their effects on the outflowing gas may be more difficult. This study provides important lessons for the spatially-resolved rest-frame UV studies expected with future observatories, such as JWST.BLJ thanks support from the European Space Agency (ESA) and SC acknowledges nancial support from the Science & Technology Facilities Council (STFC). The research leading to these results has received funding from the European Research Council under the European Union's Seventh Framework Programme (FP/2007-2013)/ERC Grant Agreement no. 308024

Deep subcutaneous application of poly-L-lactic acid as a filler for facial lipoatrophy in HIV-infected patients

Introduction: Facial lipoatrophy is a crucial problem of HIV-infected patients undergoing highly active antiretroviral therapy (HAART). Poly-L-lactic acid (PLA), provided as New-Fill(R)/Sculptra(TM), is known as one possible treatment option. In 2004 PLA was approved by the FDA as Sculptra(TM) for the treatment of lipoatrophy of the face in HIV-infected patients. While the first trials demonstrated relevant efficacy, this was to some extent linked to unwanted effects. As the depth of injection was considered relevant in this context, the application modalities of the preparation were changed. The preparation was to be injected more deeply into subcutaneous tissue, after increased dilution. Material and Methods: To test this approach we performed a pilot study following the new recommendations in 14 patients. Results: While the efficacy turned out to be about the same, tolerability was markedly improved. The increase in facial dermal thickness was particularly obvious in those patients who had suffered from lipoatrophy for a comparatively small period of time. Conclusion: With the new recommendations to dilute PLA powder and to inject it into the deeper subcutaneous tissue nodule formation is a minor problem. However, good treatment results can only be achieved if lipoatrophy is not too intense; treatment intervals should be about 2 - 3 weeks. Copyright (C) 2005 S. Karger AG, Basel

Mitral paravalvular abscess with left ventriculo-atrial fistula in a patient on dialysis

Background: Infective endocarditis in hemodialysis patients is challenging but is becoming more common recently. Case report: A 64-year-old man with end-stage renal disease on hemodialysis presented with infective endocarditis of mitral valve and coronary artery disease after commencing training for home hemodialysis. During a course of antibiotic treatment the patient developed left ventriculo-atrial fistula due to mitral paravalvular abscess. Abscess debridement followed by reconstruction of the mitral annulus with fresh autologous pericardial patch and mitral valve replacement using a mechanical prosthesis with concomitant coronary artery bypass grafting was performed successfully. Conclusion: Timely diagnosis, proper antibiotic treatment and early surgical intervention including aggressive debridement should improve the outcome of this high-risk disease. © 2009 Kitamura et al; licensee BioMed Central Ltd.Tadashi Kitamura, James Edwards, Suchi Khurana and Robert G Stukli

An accurate test for homogeneity of odds ratios based on Cochran's Q-statistic

Background: A frequently used statistic for testing homogeneity in a meta-analysis of K independent studies is Cochran's Q. For a standard test of homogeneity the Q statistic is referred to a chi-square distribution with K - 1 degrees of freedom. For the situation in which the effects of the studies are logarithms of odds ratios, the chi-square distribution is much too conservative for moderate size studies, although it may be asymptotically correct as the individual studies become large. Methods: Using a mixture of theoretical results and simulations, we provide formulas to estimate the shape and scale parameters of a gamma distribution to t the distribution of Q. Results: Simulation studies show that the gamma distribution is a good approximation to the distribution for Q. Conclusions: : Use of the gamma distribution instead of the chi-square distribution for Q should eliminate inaccurate inferences in assessing homogeneity in a meta-analysis. (A computer program for implementing this test is provided.) This hypothesis test is competitive with the Breslow-Day test both in accuracy of level and in power

Negative regulation of syntaxin4/SNAP-23/VAMP2-mediated membrane fusion by Munc18c <i>In Vitro</i>

Background: Translocation of the facilitative glucose transporter GLUT4 from an intracellular store to the plasma membrane is responsible for the increased rate of glucose transport into fat and muscle cells in response to insulin. This represents a specialised form of regulated membrane trafficking. Intracellular membrane traffic is subject to multiple levels of regulation by conserved families of proteins in all eukaryotic cells. Notably, all intracellular fusion events require SNARE proteins and Sec1p/Munc18 family members. Fusion of GLUT4-containing vesicles with the plasma membrane of insulin-sensitive cells involves the SM protein Munc18c, and is regulated by the formation of syntaxin 4/SNAP23/VAMP2 SNARE complexes. Methodology/Principal Findings Here we have used biochemical approaches to characterise the interaction(s) of Munc18c with its cognate SNARE proteins and to examine the role of Munc18c in regulating liposome fusion catalysed by syntaxin 4/SNAP23/VAMP2 SNARE complex formation. We demonstrate that Munc18c makes contacts with both t- and v-SNARE proteins of this complex, and directly inhibits bilayer fusion mediated by the syntaxin 4/SNAP23/VAMP2 SNARE complex. Conclusion/Significance Our reductionist approach has enabled us to ascertain a direct inhibitory role for Munc18c in regulating membrane fusion mediated by syntaxin 4/SNAP23/VAMP2 SNARE complex formation. It is important to note that two different SM proteins have recently been shown to stimulate liposome fusion mediated by their cognate SNARE complexes. Given the structural similarities between SM proteins, it seems unlikely that different members of this family perform opposing regulatory functions. Hence, our findings indicate that Munc18c requires a further level of regulation in order to stimulate SNARE-mediated membrane fusion

Abdominal venous thrombosis presenting in myeloproliferative neoplasm with JAK2 V617F mutation: a case report

<p>Abstract</p> <p>Introduction</p> <p>An unprovoked thombotic event in a patient is cause for further evaluation of an underlying hypercoaguable state. The investigation should include a thorough search, including checking for a variety of known inherited and acquired hypercoaguble states (protein C or S deficiency, anti-phospholipid antibodies, and anti-thrombin III deficiency) and gene mutations that predispose patients to an increased risk of clotting (for example, prothrombin gene 20210 mutation, factor V Leiden, and the <it>JAK2 V617F </it>mutation).</p> <p>Case presentation</p> <p>We report the case of a 38-year-old Caucasian woman with spontaneous, unprovoked abdominal venous thrombosis and demonstrate how testing for the <it>JAK2 V617F </it>mutation was useful in unmasking an underlying hypercoaguable state.</p> <p>Conclusions</p> <p><it>JAK2 V617F</it>-positive myeloproliferative neoplasm was diagnosed. This case illustrates the importance of testing for <it>JAK2 V617F </it>in patients presenting with Budd-Chiari syndrome, even in the absence of overt hematologic abnormalities, in order to establish a diagnosis of underlying myeloproliferative neoplasm.</p