Total phallic construction techniques in transgender men: An updated narrative review

From 2012, the World Professional Association Transgender Health defined a structured therapeutic path and standards of care for transgender patients undergoing genital gender affirming surgery (GGAS). The main goal of GGAS in transgender males is to provide patients with an aesthetically appealing appearance of the neophallus that should allow standing micturition and enabling penetrative intercourse along with erogenous and tactile sensitivity. The optimal procedure should be safe, reproducible and performed in the fewest number of surgical stages. The ideal technique for total phallic construction (TPC) has not yet been demonstrated; TPC remains challenging and, from a functional point of view, it is also make more demanding as yet there are no perfect replacement materials for erectile and urethral tissues. Several procedures and different type of flaps (pedicled and free-flaps) have been proposed and investigated over time to address TPC with significant advances over the years especially after microsurgical procedures introduction. Due to its high complexity TPC is not free from complications. Local tissue ischaemic complications, complete and partial flap loss, donor site morbidity and urethral complications (fistulae and strictures) are reported. This narrative review aims to provide the readers with a contemporary overview of surgical procedures for TPC in transgender males focusing on key surgical steps, as well as surgical and functional outcomes

A Membership Fairy Tale

From fairy tale to fact? It can be done! You, the NSTA member, can make the fiction of today turn into the practice of tomorrow through your eagerness to spread the advantages of membership in NSTA to other educators from the kindergarten teacher to the college administrator

Hoarding and Emotional Reactivity: The Link Between Negative Emotional Reactions and Hoarding Symptomatology

Hoarding disorder (HD) is characterized by difficulty discarding, clutter, and frequently excessive acquiring. Theories have pointed to intense negative emotional reactions (e.g., sadness) as one factor that may play a critical role in HD\u27s etiology. Preliminary work with an analogue sample indicated that more intense negative emotions following emotional films were linked with greater hoarding symptoms. Symptom provocation imaging studies with HD patients have also found evidence for excessive activation in brain regions implicated in processing emotions. The current study utilized a sample with self-reported serious hoarding difficulties to examine how hoarding symptoms related to both general and hoarding-related emotional reactivity, taking into account the specificity of these relationships. We also examined how two cognitive factors, fear of decision-making and confidence in memory, modified this relationship. 628 participants with self-identified hoarding difficulties completed questionnaires about general emotional reactivity, depression, anxiety, decision-making, and confidence in memory. To assess hoarding-related emotional reactivity, participants reported their emotional reactions when imagining discarding various items. Heightened general emotional reactivity and more intense emotional reactions to imagined discarding were associated with both difficulty discarding and acquisition, but not clutter, controlling for age, gender, and co-occurring mood and anxiety symptoms. Fear of decision-making and confidence in memory interacted with general emotional reactivity to predict hoarding symptoms. These findings provide support for cognitive-behavioral models of hoarding. Experimental research should be conducted to discover whether emotional reactivity increases vulnerability for HD. Future work should also examine whether emotional reactivity should be targeted in interventions for hoarding

Detecting extreme mass ratio inspirals with LISA using time-frequency methods II: search characterization

The inspirals of stellar-mass compact objects into supermassive black holes constitute some of the most important sources for LISA. Detection of these sources using fully coherent matched filtering is computationally intractable, so alternative approaches are required. In a previous paper (Wen and Gair 2005, gr-qc/0502100), we outlined a detection method based on looking for excess power in a time-frequency spectrogram of the LISA data. The performance of the algorithm was assessed using a single `typical' trial waveform and approximations to the noise statistics. In this paper we present results of Monte Carlo simulations of the search noise statistics and examine its performance in detecting a wider range of trial waveforms. We show that typical extreme mass ratio inspirals (EMRIs) can be detected at distances of up to 1--3 Gpc, depending on the source parameters. We also discuss some remaining issues with the technique and possible ways in which the algorithm can be improved.Comment: 15 pages, 9 figures, to appear in proceedings of GWDAW 9, Annecy, France, December 200

The Challenges in Gravitational Wave Astronomy for Space-Based Detectors

The Gravitational Wave (GW) universe contains a wealth of sources which, with the proper treatment, will open up the universe as never before. By observing massive black hole binaries to high redshifts, we should begin to explore the formation process of seed black holes and track galactic evolution to the present day. Observations of extreme mass ratio inspirals will allow us to explore galactic centers in the local universe, as well as providing tests of General Relativity and constraining the value of Hubble's constant. The detection of compact binaries in our own galaxy may allow us to model stellar evolution in the Milky Way. Finally, the detection of cosmic (super)strings and a stochastic background would help us to constrain cosmological models. However, all of this depends on our ability to not only resolve sources and carry out parameter estimation, but also on our ability to define an optimal data analysis strategy. In this presentation, I will examine the challenges that lie ahead in GW astronomy for the ESA L3 Cosmic Vision mission, eLISA.Comment: 12 pages. Plenary presentation to appear in the Proceedings of the Sant Cugat Forum on Astrophysics, Sant Cugat, April 22-25, 201

Compact Binaries in Star Clusters I - Black Hole Binaries Inside Globular Clusters

We study the compact binary population in star clusters, focusing on binaries containing black holes, using a self-consistent Monte Carlo treatment of dynamics and full stellar evolution. We find that the black holes experience strong mass segregation and become centrally concentrated. In the core the black holes interact strongly with each other and black hole-black hole binaries are formed very efficiently. The strong interactions, however, also destroy or eject the black hole-black hole binaries. We find no black hole-black hole mergers within our simulations but produce many hard escapers that will merge in the galactic field within a Hubble time. We also find several highly eccentric black hole-black hole binaries that are potential LISA sources, suggesting that star clusters are interesting targets for space-based detectors. We conclude that star clusters must be taken into account when predicting compact binary population statistics.Comment: 19 pages, 5 Tables, 12 Figures, updated in response to referee report, accepted for publication in MNRA