Risk of Cardiovascular Disease and Events in Transgender Patients Undergoing Hormone Therapy

The number of transgender individuals currently being prescribed cross-sex hormone replacement therapy (CSHRT) is currently at an all-time high, but the short- and long-term effects that those medications have upon the cardiovascular system remains largely unknown. To examine the effect that CSHRT has on the cardiovascular system, this review synthesizes the results of five different studies on CSHRT and cardiovascular outcomes in transgender individuals. The report also examines differences in cardiovascular outcomes associated with different dosages and preparations of CSHRT. This review notes that transgender women are at highest risk of adverse cardiovascular events, with those taking high-dose oral estrogen being up to 45 times more likely to experience a thromboembolitic event. The evidence surrounding transgender men is less conclusive, but does suggest a slightly increased risk of acute and chronic cardiovascular issues. These results suggest that transgender individuals taking CSHRT may be at an increased risk for adverse cardiovascular outcomes. Healthcare providers working with transgender patients should be aware of dosages and routes of CSHRT that carry fewer risks yet achieve similar patient outcomes. Patients must also be educated on these risks while being guided to develop healthy cardiovascular habits

A protocol for ultra-high field laminar fMRI in the human brain.

Ultra-high field (UHF) neuroimaging affords the sub-millimeter resolution that allows researchers to interrogate brain computations at a finer scale than that afforded by standard fMRI techniques. Here, we present a step-by-step protocol for using UHF imaging (Siemens Terra 7T scanner) to measure activity in the human brain. We outline how to preprocess the data using a pipeline that combines tools from SPM, FreeSurfer, ITK-SNAP, and BrainVoyager and correct for vasculature-related confounders to improve the spatial accuracy of the fMRI signal. For complete details on the use and execution of this protocol, please refer to Jia et al. (2020) and Zamboni et al. (2020).This work was supported by grants to Z.K. from the Biotechnology and Biological Sciences Research Council (H012508 and BB/P021255/1), the Wellcome Trust (205067/Z/16/Z) and European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska Curie grant agreement No 840271

Recurrent Processing Drives Perceptual Plasticity.

Learning and experience are critical for translating ambiguous sensory information from our environments to perceptual decisions. Yet evidence on how training molds the adult human brain remains controversial, as fMRI at standard resolution does not allow us to discern the finer scale mechanisms that underlie sensory plasticity. Here, we combine ultra-high-field (7T) functional imaging at sub-millimeter resolution with orientation discrimination training to interrogate experience-dependent plasticity across cortical depths that are known to support dissociable brain computations. We demonstrate that learning alters orientation-specific representations in superficial rather than middle or deeper V1 layers, consistent with recurrent plasticity mechanisms via horizontal connections. Further, learning increases feedforward rather than feedback layer-to-layer connectivity in occipito-parietal regions, suggesting that sensory plasticity gates perceptual decisions. Our findings reveal finer scale plasticity mechanisms that re-weight sensory signals to inform improved decisions, bridging the gap between micro- and macro-circuits of experience-dependent plasticity

How to Intervene in the Caries Process in Children: A Joint ORCA and EFCD Expert Delphi Consensus Statement

This paper provides recommendations for dentists for the treatment of dental caries in children, with an emphasis on early childhood caries (ECC), primary teeth, and occlusal surfaces in permanent teeth. A consensus workshop followed by an e-Delphi consensus process was conducted with an expert panel nominated by the European Organization for Caries Research (ORCA) and European Federation of Conservative Dentistry (EFCD)/German Association of Conservative Dentistry (DGZ) boards. Based on 3 systematic reviews and a nonsystematic literature search, recommendations were developed. The caries decline has led to a more polarized disease distribution in children and adolescents along social gradients which should be taken into account when managing the caries process at all levels, such as the individual, the group, or a population. The control or reduction of caries activity is the basis for successful caries management. In children, caries management requires adequate daily oral hygiene and fluoride application via toothpaste, ensured by caregivers, and especially for ECC prevention an emphasis on sugar intake reduction is needed. These noninvasive interventions are also suitable to arrest or control initial or even cavitated dentine caries lesions in the absence of irreversible pulpitis. Fluoride varnish or silver diammine fluoride can be added as supplementary agents. In pits and fissures, composite resin materials can be used as preventive sealants and for defect-oriented minimally invasive restorations. In primary molars, preformed metal crowns are more successful than multisurface fillings, especially in caries-active patients. With persisting high caries activity, multiple lesions, and limited cooperation, caries control should consist of robust measures with high success rates, even including extraction in selected cases. This applies especially to treatments performed under general anesthesia

Sociodemographic differences in linkage error: An examination of four large-scale datasets

© 2018 The Author(s). Background: Record linkage is an important tool for epidemiologists and health planners. Record linkage studies will generally contain some level of residual record linkage error, where individual records are either incorrectly marked as belonging to the same individual, or incorrectly marked as belonging to separate individuals. A key question is whether errors in linkage quality are distributed evenly throughout the population, or whether certain subgroups will exhibit higher rates of error. Previous investigations of this issue have typically compared linked and un-linked records, which can conflate bias caused by record linkage error, with bias caused by missing records (data capture errors). Methods: Four large administrative datasets were individually de-duplicated, with results compared to an available 'gold-standard' benchmark, allowing us to avoid methodological issues with comparing linked and un-linked records. Results were compared by gender, age, geographic remoteness (major cities, regional or remote) and socioeconomic status. Results: Results varied between datasets, and by sociodemographic characteristic. The most consistent findings were worse linkage quality for younger individuals (seen in all four datasets) and worse linkage quality for those living in remote areas (seen in three of four datasets). The linkage quality within sociodemographic categories varied between datasets, with the associations with linkage error reversed across different datasets due to quirks of the specific data collection mechanisms and data sharing practices. Conclusions: These results suggest caution should be taken both when linking younger individuals and those in remote areas, and when analysing linked data from these subgroups. Further research is required to determine the ramifications of worse linkage quality in these subpopulations on research outcomes

LivestockPlus: The sustainable intensification of forage-based agricultural systems to improve livelihoods and ecosystem services in the tropics

As global demand for livestock products (such as meat, milk, and eggs) is expected to double by 2050, necessary increases to future production must be reconciled with negative environmental impacts that livestock cause. This paper describes the LivestockPlus concept and demonstrates how the sowing of improved forages can lead to the sustainable intensification of mixed crop–forage–livestock–tree systems in the tropics by producing multiple social, economic, and environmental benefits. Sustainable intensification not only improves the productivity of tropical forage-based systems but also reduces the ecological footprint of livestock production and generates a diversity of ecosystem services (ES), such as improved soil quality and reduced erosion, sedimentation, and greenhouse gas (GHG) emissions. Integrating improved grass and legume forages into mixed production systems (crop–livestock, tree–livestock, crop–tree–livestock) can restore degraded lands and enhance system resilience to drought and waterlogging associated with climate change. When properly managed tropical forages accumulate large amounts of carbon in soil, fix atmospheric nitrogen (legumes), inhibit nitrification in soil and reduce nitrous oxide emissions (grasses), and reduce GHG emissions per unit livestock product. The LivestockPlus concept is defined as the sustainable intensification of forage-based systems, which is based on three interrelated intensification processes: genetic intensification – the development and use of superior grass and legume cultivars for increased livestock productivity; ecological intensification – the development and application of improved farm and natural resource management practices; and socio-economic intensification – the improvement of local and national institutions and policies, which enable refinements of technologies and support their enduring use. Increases in livestock productivity will require coordinated efforts to develop supportive government, non-government organization, and private sector policies that foster investments and fair market compensation for both the products and ES provided. Effective research-for-development efforts that promote agricultural and environmental benefits of forage-based systems can contribute towards implemention of LivestockPlus across a variety of geographic, political, and socio-economic contexts

The Target Selective Neural Response — Similarity, Ambiguity, and Learning Effects

A network of frontal and parietal brain regions is commonly recruited during tasks that require the deliberate ‘top-down’ control of thought and action. Previously, using simple target detection, we have demonstrated that within this frontoparietal network, the right ventrolateral prefrontal cortex (VLPFC) in particular is sensitive to the presentation of target objects. Here, we use a range of target/non-target morphs to plot the target selective response within distinct frontoparietal sub-regions in greater detail. The increased resolution allows us to examine the extent to which different cognitive factors can predict the blood oxygenation level dependent (BOLD) response to targets. Our results reveal that both probability of positive identification (similarity to target) and proximity to the 50% decision boundary (ambiguity) are significant predictors of BOLD signal change, particularly in the right VLPFC. Furthermore, the profile of target related signal change is not static, with the degree of selectivity increasing as the task becomes familiar. These findings demonstrate that frontoparietal sub-regions are recruited under increased cognitive demand and that when recruited, they adapt, using both fast and slow mechanisms, to selectively respond to those items that are of the most relevance to current intentions

Consensus on the reporting and experimental design of clinical and cognitive-behavioural neurofeedback studies (CRED-nf checklist)

Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mainstream. Here, neurofeedback researchers present a consensus-derived checklist that aims to improve the reporting and experimental design standards in the field.</p