Sexual & reproductive health information on minor consent forms for pubertal suppression and gender affirming hormones

IntroductionTransgender and Nonbinary (TNB) youth need specialized sexual and reproductive health (SRH) information and counseling. One avenue for providing this information is the use of informed consent documents before initiating pubertal suppression (PS) and/or gender-affirming hormones (GAHs). This study aims to compare the type and amount of SRH information included on informed consent documents used across clinical sites providing PS and GAH to youth.MethodsAs part of a larger, IRB-approved survey on informed consent, providers of gender-related care to youth uploaded informed consent forms used in clinical practice. Publicly available forms were also included in analysis. Content analysis of these forms was undertaken using published clinical guidelines to inform coding and reflect the SRH implications of starting PS and GAH.Results21 unique consent documents were included in the content analysis (PS = 7, Masculinizing = 7, Feminizing = 7). SRH information on consent documents fell into 4 broad categories: (1) changes in sexual organs and functioning; (2) pregnancy and fertility information; (3) cancer risk; and (4) sexually transmitted infections. Forms varied considerably in the level of detail included about these SRH topics and most forms included implicit or explicit acknowledgement of the uncertainty that exists around certain SRH outcomes for TNB youth.ConclusionsThere was substantial variability in both SRH content and context across consent forms. The role of consent forms in fostering TNB youth's understanding of complex SHR information when initiating PS and GAHs needs further clarification and development. Future research should focus on ways to ensure provision of adequate SRH information for TNB youth

Double-Peaked X-Ray Lines from the Oxygen/Neon-Rich Accretion Disk in 4U1626-67

We report on a 39 ks observation of the 7.7-s low-mass X-ray binary pulsar 4U1626-67 with the High Energy Transmission Grating Spectrometer (HETGS) on the Chandra X-Ray Observatory. This ultracompact system consists of a disk-accreting magnetic neutron star and a very low mass, hydrogen-depleted companion in a 42-min binary. We have resolved the previously reported Ne/O emission line complex near 1 keV into Doppler pairs of broadened (2500 km/s FWHM) lines from highly ionized Ne and O. In most cases, the blue and red line components are of comparable strength, with blueshifts of 1550-2610 km/s and redshifts of 770-1900 km/s. The lines appear to originate in hot (10^6 K), dense material just below the X-ray-heated skin of the outer Keplerian accretion disk, or else possibly in a disk wind driven from the pulsar's magnetopause. The observed photoelectric absorption edges of Ne and O appear nearly an order of magnitude stronger than expected from interstellar material and are likely formed in cool, metal-rich material local to the source. Based on the inferred local abundance ratios, we argue that the mass donor in this binary is probably the 0.02 M_sun chemically fractionated core of a C-O-Ne or O-Ne-Mg white dwarf which has previously crystallized.Comment: 9 pages. Accepted for publication in ApJ. Table 2 correcte

Sequential addition of neuronal stem cell temporal cohorts generates a feed-forward circuit in the Drosophila larval nerve cord

How circuits self-assemble starting from neuronal stem cells is a fundamental question in developmental neurobiology. Here, we addressed how neurons from different stem cell lineages wire with each other to form a specific circuit motif. In Drosophila larvae, we combined developmental genetics (Twin spot MARCM, Multi-color Flip Out, permanent labeling) with circuit analysis (calcium imaging, connectomics, network science). For many lineages, neuronal progeny are organized into subunits called temporal cohorts. Temporal cohorts are subsets of neurons born within a tight time window that have shared circuit level function. We find sharp transitions in patterns of input connectivity at temporal cohort boundaries. In addition, we identify a feed-forward circuit that encodes the onset of vibration stimuli. This feed-forward circuit is assembled by preferential connectivity between temporal cohorts from different lineages. Connectivity does not follow the often-cited early-to-early, late-to-late model. Instead, the circuit is formed by sequential addition of temporal cohorts from different lineages, with circuit output neurons born before circuit input neurons. Further, we generate new tools for the fly community. Our data raise the possibility that sequential addition of neurons (with outputs oldest and inputs youngest) could be one fundamental strategy for assembling feed-forward circuits

Revealing the Dusty Warm Absorber in MCG--6-30-15 with the Chandra HETG

We present detailed evidence for a warm absorber in the Seyfert 1 galaxy MCG--6-30-15 and dispute earlier claims for relativistic O line emission. The HETG spectra show numerous narrow, unresolved (FWHM < 200 km/s) absorption lines from a wide range of ionization states of N, O, Mg, Ne, Si, S, Ar, and Fe. The O VII edge and 1s^2--1snp resonance line series to n=9 are clearly detected at rest in the AGN frame. We attribute previous reports of an apparently highly redshifted O VII edge to the 1s^2--1snp (n > 5) O VII resonance lines, and a neutral Fe L absorption complex. The shape of the Fe L feature is nearly identical to that seen in the spectra of several X-ray binaries, and in laboratory data. The implied dust column density agrees with that obtained from reddening studies, and gives the first direct X-ray evidence for dust embedded in a warm absorber. The O VIII resonance lines and weak edge are also detected, and the spectral rollover below 2 keV is explained by the superposition of numerous absorption lines and edges. We identify, for the first time, a KLL resonance in the O VI photoabsorption cross section, giving a measure of the O VI column density. The O VII (f) emission detected at the systemic velocity implies a covering fraction of ~5% (depending on the observed vs. time-averaged ionizing flux). Our observations show that a dusty warm absorber model is not only adequate to explain all the spectral features > 0.48 keV (< 26 \AA) the data REQUIRE it. This contradicts the interpretation of Branduardi-Raymont et al. (2001) that this spectral region is dominated by highly relativistic line emission from the vicinity of the black hole.Comment: 4.5 pages, 1 color figure, accepted (April 2001) for publication in ApJL, not many changes from the initial submission - updated/added some measuements for the O VII resonance series, and added a discussion about FeO2 grain

The shape of the relativistic iron K-alpha line from MCG6--6-30-15 measured with the Chandra HETGS and RXTE

We confirm the detection of the relativistically broadened iron K-alpha emission at 6.4 keV with simultaneous Chandra HETGS and RXTE PCA observations. Heavily binned HETGS data show a disk line profile with parameters very similar to those previously seen by ASCA. We observe a resolved narrow component with a velocity width ~4700 km/s (FWHM ~ 11,000 km/s), that is most prominent, and narrower (FWHM ~ 3600 km/s) when the continuum flux is high. It plausibly is just the blue wing of the broad line. We obtain a stringent limit on the equivalent width of an intrinsically narrow line in the source of 16 eV, indicating little or no contribution due to fluoresence from distant material such as the molecular torus. Variability studies of the narrow component show a constant iron line flux and variable width indicating the line may be originating from different kinematic regions of the disk.Comment: Accepted for publication in the Astrophysical Journal Letter

Magnesium supplementation for the treatment of restless legs syndrome and periodic limb movement disorder : A systematic review

Magnesium supplementation is often suggested for restless legs syndrome (RLS) or period limb movement disorder (PLMD) based on anecdotal evidence that it relieves symptoms and because it is also commonly recommended for leg cramps. We aimed to review all articles reporting the effects of magnesium supplementation on changes in RLS and/or PLMD. We conducted a systematic search looking for all relevant articles and then two reviewers read all article titles and abstracts to identify relevant studies. Eligible studies were scored for their quality as interventional trials. We found 855 abstracts and 16 of these could not be definitively excluded for not addressing all aspects of our research question. Seven full-text articles were unlocatable and one was ineligible which left eight studies with relevant data. One was a randomised placebo-controlled trial, three were case series and four were case studies. The RCT did not find a significant treatment effect of magnesium but may have been underpowered. After quality appraisal and synthesis of the evidence we were unable to make a conclusion as to the effectiveness of magnesium for RLS/PLMD. It is not clear whether magnesium helps relieve RLS or PLMD or in which patient groups any benefit might be seen. (c) 2019 Elsevier Ltd. All rights reserved.Peer reviewe

Socio-demographic variables, clinical features and the role of pre-assessment cross-sex hormones in older trans people

Introduction. As referrals to gender identity clinics have increased dramatically over the last few years, no studies focusing on older trans people seeking treatment are available. Aims. The aim of this study was to investigate the socio-demographic and clinical characteristics of older trans people attending a national service and to investigate the influence of cross-sex hormones (CHT) on psychopathology. Methods. Every individual over the age of 50 years old referred to a national gender identity clinic during a thirty months period were invited to complete a battery of questionnaires to measure psychopathology and clinical characteristics. Individuals on cross sex hormones prior to the assessment were compared with those not on treatment for different variables measuring psychopathology. Main Outcome Measures. Socio-demographic and clinical variables and measures of depression and anxiety (Hospital Anxiety and Depression Scale), self-esteem (Rosenberg Self-Esteem Scale), victimisation (Experiences of Transphobia Scale), social support (Multidimensional Scale of Perceived Social Support), interpersonal functioning (Inventory of Interpersonal Problems), and non-suicidal self-injury (Self-Injury Questionnaire). Results. The sex ratio of trans females aged 50 years and older compared to trans males was 23.7:1. Trans males were removed for the analysis due to their small number (n=3). Participants included 71 trans females over the age of 50, of whom the vast majority were white, employed or retired, divorced and had children. Trans females on CHT that came out as trans and transitioned at an earlier age, were significantly less anxious, reported higher levels of self-esteem and presented with less socialization problems. When controlling for socialization problems, differences in levels of anxiety but not self-esteem, remained. Conclusion. The use of cross-sex hormones prior to seeking treatment is widespread among older trans females and appears to be associated with psychological benefits. Existing barriers to access CHT for older trans people may need to be re-examined

Family physicians\u27 responses to personal protective equipment shortages in four regions in Canada: a qualitative study.

BACKGROUND: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians\u27 (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning. METHODS: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in Canada. During the interviews, FPs were asked to describe the pandemic-related roles they performed over different stages of the pandemic, facilitators and barriers they experienced in performing these roles, and potential roles they could have filled. Interviews were transcribed and a thematic analysis approach was employed to identify recurring themes. For the current study, we examined themes related to PPE. RESULTS: A total of 68 FPs were interviewed across the four regions. Four overarching themes were identified: 1) factors associated with good PPE access, 2) managing PPE shortages, 3) impact of PPE shortages on practice and providers, and 4) symbolism of PPE in primary care. There was a wide discrepancy in access to PPE both within and across regions, and integration with hospital or regional health authorities often resulted in better access than community-based practices. When PPE was limited, FPs described rationing and reusing these resources in an effort to conserve, which often resulted in anxiety and personal safety concerns. Many FPs expressed that PPE shortages had come to symbolize neglect and a lack of concern for the primary care sector in the pandemic response. CONCLUSIONS: During the COVID-19 pandemic response, hospital-centric plans and a lack of prioritization for primary care led to shortages of PPE for family physicians. This study highlights the need to consider primary care in PPE conservation and allocation strategies and to examine the influence of the underlying organization of primary care on PPE distribution during the pandemic