Sex in and out of Intimacy

The state has long attempted to regulate sexual activity by channeling sex into various forms of state-supported intimacy. Although commentators and legal scholars of diverse political perspectives generally believe such regulation is declining, the freedom to engage in diverse sexual activities has not been established as a matter of law. Instead, courts have extended legal protection to consensual sexual acts only to the extent such acts support other state interests, most often marriage and procreation. Although Lawrence v. Texas altered some aspects of that vision, it reinscribed others by suggesting that sexual activity should be protected from state interference only to the extent it promotes enduring intimate relationships. This sex-in-service-to-intimacy paradigm devalues both sexual activity that lacks intimacy and intimate relationships that lack sex and reinforces a gendered view of sexuality and intimacy – one that assumes that women value intimacy over sex and that sex is the primary avenue through which men can become emotionally intimate. This Article challenges the single vision of sexual intimacy reinforced by Lawrence, arguing that the state should independently protect both intimate relationships and sexual interactions. Other legal scholars have argued that intimate sexual relationships should be protected outside of marriage, or that sex and marriage should be separated from state support for families. This Article extends the deconstructive project to intimacy in general, arguing that sex should be decoupled in the legal sphere from both domestic relationships and other traditional forms of emotional intimacy, thus rejecting the dominant, almost sacred, understanding that the most important relationships between adults should always be both sexual and emotionally intimate. In place of that understanding, the Article explores alternative constructions of the value of sex in non-intimate circumstances and the value of intimate relationships in the absence of sex. At the same time, the Article contends that sex can maintain its relational and generally intimate character even if it is not always tied to emotional intimacy, as sex could become intimate and intimacy could become sexual in new ways. Sex might even eventually lose its status as an exceptional activity with unique values and dangers. As long as sex retains its exceptional status, however, the Article argues that sexual association is deserving of the same protection extended to intimate association. Therefore, the Article concludes by considering how the values furthered by alternative constructions of sex and intimacy could support a constitutional right to engage in consensual sexual activity without regard to intimacy

Sex In and Out of Intimacy

This Article challenges the underlying assumption in Lawrence v. Texas that sex is valuable only when potentially in service to emotional intimacy and proposes a new theory for extending legal protection to a wider range of consensual sexual activities. The current regulation of sex devalues both sexual relationships that lack an intimate component and intimate relationships that lack a sexual component. We argue that the state should independently protect both intimate relationships and sexual interactions because sex can constitute a vital part of individual identity and self-expression even when not channeled into intimacy. We challenge the dominant, almost sacred, understanding that the most important relationships between adults should always be both sexual and emotionally intimate

Sex In and Out of Intimacy

This Article challenges the underlying assumption in Lawrence v. Texas that sex is valuable only when potentially in service to emotional intimacy and proposes a new theory for extending legal protection to a wider range of consensual sexual activities. The current regulation of sex devalues both sexual relationships that lack an intimate component and intimate relationships that lack a sexual component. We argue that the state should independently protect both intimate relationships and sexual interactions because sex can constitute a vital part of individual identity and self-expression even when not channeled into intimacy. We challenge the dominant, almost sacred, understanding that the most important relationships between adults should always be both sexual and emotionally intimate

Long‐term hematologic and clinical outcomes of splenectomy in children with hereditary spherocytosis and sickle cell disease

BackgroundTotal splenectomy (TS) and partial splenectomy (PS) are used for children with congenital hemolytic anemia (CHA), although the long‐term outcomes of these procedures are poorly defined. This report describes long‐term outcomes of children with CHA requiring TS or PS.ProcedureWe collected data from children ages 2‐17 with hereditary spherocytosis (HS) or sickle cell disease (SCD) requiring TS or PS from 1996 to 2016 from 14 sites in the Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium using a prospective, observational patient registry. We summarized hematologic outcomes, clinical outcomes, and adverse events to 5 years after surgery. Hematologic outcomes were compared using mixed effects modeling.ResultsOver the study period, 110 children with HS and 97 children with SCD underwent TS or PS. From preoperatively compared to postoperatively, children with HS increased their mean hemoglobin level by 3.4 g/dL, decreased their mean reticulocyte percentage by 6.7%, and decreased their mean bilirubin by 2.4 mg/dL. Hematologic improvements and improved clinical outcomes were sustained over 5 years of follow‐up. For children with SCD, there was no change in hemoglobin after PS or TS following surgery, although all clinical outcomes were improved. Over 5 years, there was one child with HS and five children with SCD who developed postsplenectomy sepsis.ConclusionsFor children with HS, there are excellent long‐term hematologic and clinical outcomes following either PS or TS. Although hemoglobin levels do not change after TS or PS in SCD, the long‐term clinical outcomes for children with SCD are favorable.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155920/1/pbc28290.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155920/2/pbc28290_am.pd

Further evidence for the involvement of EFL1 in a Shwachman-Diamond-like syndrome and expansion of the phenotypic features.

Recent evidence has implicated EFL1 in a phenotype overlapping Shwachman-Diamond syndrome (SDS), with the functional interplay between EFL1 and the previously known causative gene SBDS accounting for the similarity in clinical features. Relatively little is known about the phenotypes associated with pathogenic variants in the EFL1 gene, but the initial indication was that phenotypes may be more severe, when compared with SDS. We report a pediatric patient who presented with a metaphyseal dysplasia and was found to have biallelic variants in EFL1 on reanalysis of trio whole-exome sequencing data. The variant had not been initially reported because of the research laboratory's focus on de novo variants. Subsequent phenotyping revealed variability in her manifestations. Although her metaphyseal abnormalities were more severe than in the original reported cohort with EFL1 variants, the bone marrow abnormalities were generally mild, and there was equivocal evidence for pancreatic insufficiency. Despite the limited number of reported patients, variants in EFL1 appear to cause a broader spectrum of symptoms that overlap with those seen in SDS. Our report adds to the evidence of EFL1 being associated with an SDS-like phenotype and provides information adding to our understanding of the phenotypic variability of this disorder. Our report also highlights the value of exome data reanalysis when a diagnosis is not initially apparent

Physician decision making in selection of second-line treatments in immune thrombocytopenia in children.

Immune thrombocytopenia (ITP) is an acquired autoimmune bleeding disorder which presents with isolated thrombocytopenia and risk of hemorrhage. While most children with ITP promptly recover with or without drug therapy, ITP is persistent or chronic in others. When needed, how to select second-line therapies is not clear. ICON1, conducted within the Pediatric ITP Consortium of North America (ICON), is a prospective, observational, longitudinal cohort study of 120 children from 21 centers starting second-line treatments for ITP which examined treatment decisions. Treating physicians reported reasons for selecting therapies, ranking the top three. In a propensity weighted model, the most important factors were patient/parental preference (53%) and treatment-related factors: side effect profile (58%), long-term toxicity (54%), ease of administration (46%), possibility of remission (45%), and perceived efficacy (30%). Physician, health system, and clinical factors rarely influenced decision-making. Patient/parent preferences were selected as reasons more often in chronic ITP (85.7%) than in newly diagnosed (0%) or persistent ITP (14.3%, P = .003). Splenectomy and rituximab were chosen for the possibility of inducing long-term remission (P < .001). Oral agents, such as eltrombopag and immunosuppressants, were chosen for ease of administration and expected adherence (P < .001). Physicians chose rituximab in patients with lower expected adherence (P = .017). Treatment choice showed some physician and treatment center bias. This study illustrates the complexity and many factors involved in decision-making in selecting second-line ITP treatments, given the absence of comparative trials. It highlights shared decision-making and the need for well-conducted, comparative effectiveness studies to allow for informed discussion between patients and clinicians

The impact of dengue illness on social distancing and caregiving behavior

Background Human mobility among residential locations can drive dengue virus (DENV) transmission dynamics. Recently, it was shown that individuals with symptomatic DENV infection exhibit significant changes in their mobility patterns, spending more time at home during illness. This change in mobility is predicted to increase the risk of acquiring infection for those living with or visiting the ill individual. It has yet to be considered, however, whether social contacts are also changing their mobility, either by socially distancing themselves from the infectious individual or increasing contact to help care for them. Social, or physical, distancing and caregiving could have diverse yet important impacts on DENV transmission dynamics; therefore, it is necessary to better understand the nature and frequency of these behaviors including their effect on mobility. Methodology and principal findings Through community-based febrile illness surveillance and RT-PCR infection confirmation, 67 DENV positive (DENV+) residents were identified in the city of Iquitos, Peru. Using retrospective interviews, data were collected on visitors and home-based care received during the illness. While 15% of participants lost visitors during their illness, 22% gained visitors; overall, 32% of all individuals (particularly females) received visitors while symptomatic. Caregiving was common (90%), particularly caring by housemates (91%) and caring for children (98%). Twenty-eight percent of caregivers changed their behavior enough to have their work (and, likely, mobility patterns) affected. This was significantly more likely when caring for individuals with low “health-related quality of well-being” during illness (Fisher’s Exact, p = 0.01). Conclusions/Significance Our study demonstrates that social contacts of individuals with dengue modify their patterns of visitation and caregiving. The observed mobility changes could impact a susceptible individual’s exposure to virus or a presymptomatic/clinically inapparent individual’s contribution to onward transmission. Accounting for changes in social contact mobility is imperative in order to get a more accurate understanding of DENV transmission

Characterization of the severe phenotype of pyruvate kinase deficiency

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162766/2/ajh25926.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162766/1/ajh25926_am.pd