Healthcare Disparities in the LGBTQIA+ Community: A Scoping Review of Community vs Provider Experiences

Background: It is well-established that healthcare disparities exist in the LGBTQIA+ community. The divide is a growing concern exacerbated by recent changes in the healthcare and sociopolitical climate. To eliminate this divide and find ways to deliver better outcomes to the LGBTQIA+ is a dire need. This report analyzes the possible reasons from the community as well as the providers perspective, with a goal to find best practices that could be implemented in both components. Methods: A scoping literature review was carried out as described below to collect perspectives from both sides: patients as well as providers. Results: From patient experiences, positive experiences include affirmation, collaborative interaction and inclusive approach; negative experiences were lack of resources/knowledge, insensitive and less-than-adequate care and loss of trust. From the provider perspective, major problems were due to the attitude, rooted in bias created by heteronormative beliefs. TNB, bisexual and lesbian patients are, very often, most affected by these attitudes. These were exacerbated by lack of preparation and training from UME through residency. Conclusions: Training programs with dedicated hours through all levels and implementation of affirming language are suggested as first steps

Structural insight into transmissive mutant huntingtin species by correlative light and electron microscopy and cryo-electron tomography

Aggregates of mutant huntingtin (mHTT) containing an expanded polyglutamine (polyQ) tract are hallmarks of Huntington’s Disease (HD). Studies have shown that mHTT can spread between cells, leading to the propagation of misfolded protein pathology. However, the structure of transmissive mHTT species, and the molecular mechanisms underlying their transmission remain unknown. Using correlative light and electron microscopy (CLEM) and cryo-electron tomography (cryo-ET), we identified two types of aggregation-prone granules in conditioned medium from PC12 cells expressing a mHTT N-terminal fragment: densities enclosed by extracellular vesicles (EVs), and uncoated, amorphous meshworks of heterogeneous oligomers that co-localize with clusters of EVs. In vitro assays confirmed that liposomes induce condensation of polyQ oligomers into higher-order assemblies, resembling the uncoated meshworks observed in PC12 conditioned medium. Our findings provide novel insights into formation and architecture of transmissive mHTT proteins, and highlight the potential role of EVs as both carriers and modulators of transmissive mHTT proteins