Objective: The purpose of the current study was to conduct a large-scale, geographically diverse comparison of health risk behaviors between a broad range of sexual orientation and gender identity ...groups to more fully understand the health risks of subgroups within the LGBT community. Method: A total of 3,279 individuals self-identifying as LGBT (e.g., lesbian, gay, bisexual, pansexual, transgender, genderqueer, and/or another gender or sexual minority) were recruited from across the United States through 2 sequentially implemented online recruitment methods. Participants completed a demographic assessment and the Health Risk Questionnaire (assessing diet and exercise, substance use and smoking, motor vehicle risks, sexual behaviors, violence, and medical risk-taking). Results: Significant differences were found across genders for 18 of the 28 health risk behaviors investigated and across sexual orientations for 23 behaviors. Major differences emerged particularly with relation to diet and exercise behaviors, as well as sexual risk-taking, substance use, and medical risk-taking. Groups with notably elevated health risk behaviors included transgender women (diet and exercise behaviors), cisgender men (alcohol-related risk-taking), bisexual participants (substance use), and both transgender men and pansexual participants (self-harm). Differences between transgender participants and genderqueer or nonbinary participants were stark, indicating that these frequently combined groups have distinct health risk profiles. Conclusions: Results suggest that there are extensive and largely variable levels of engagement in health risk behaviors within the LGBT community. In addition, gender and sexual orientation subcategories that are traditionally collapsed into 1 category (i.e., transgender and bisexual) evidenced strikingly different risks when examined independently. Recommendations for future research and LGBT health promotion efforts are discussed.
In this pioneering study of slavery in colonial Ecuador and southern Colombia--Spain's Kingdom of Quito--Sherwin Bryant argues that the most fundamental dimension of slavery was governance and the ...extension of imperial power. Bryant shows that enslaved black captives were foundational to sixteenth-century royal claims on the Americas and elemental to the process of Spanish colonization. Following enslaved Africans from their arrival at the Caribbean port of Cartagena through their journey to Quito, Bryant explores how they lived during their captivity, formed kinships and communal affinities, and pressed for justice within a slave-based Catholic sovereign community.In Cartagena, officials branded African captives with the royal insignia and gave them a Catholic baptism, marking slaves as projections of royal authority and majesty. By licensing and governing Quito's slave trade, the crown claimed sovereignty over slavery, new territories, natural resources, and markets. By adjudicating slavery, royal authorities claimed to govern not only slaves but other colonial subjects as well. Expanding the diaspora paradigm beyond the Atlantic, Bryant's history of the Afro-Andes in the early modern world suggests new answers to the question, what is a slave?
Virginia’s Readjuster Party was the most successful interracial political coalition in the post-Reconstruction South. Initially arising from a conflict over the payment of Virginia’s massive public ...debt, the new party became a force of liberal reform and democracy in the Old Dominion. It represented an alternative path before Jim Crow segregation and disfranchisement became the norm. While the Readjusters have long interested historians, the significant work performed by Black Readjusters in building and sustaining the always-tenuous coalition has gone understudied. Knowing their white counterparts were anxious about interracial political alliances, Black Readjusters eased these anxieties by using the Lost Cause. Black Readjusters condemned carpetbaggers as corrupt and repurposed the myth of the faithful slave to strengthen the interracial coalition, press for their own demands, and demonstrate their status as true southerners. The strategy and its seeming contradictions succeeded in some cases and failed in others, and its ultimate effects remain unclear. By shifting focus to Black Readjusters’ coalition-building labors, this article centers Black political activism and challenges the presumptions scholars make about interracial politics and white supremacy.
•Children with autism show increased attention to interoceptive cues.•Interoceptive sensitivity negatively relates to rubber hand illusion susceptibility.•A trade-off of attentional resources between ...internal and external cues may exist in autism.•Disproportionate attention to internal cues may relate to core symptoms of autism.
Autism spectrum disorder (ASD) has been associated with various sensory atypicalities across multiple domains. Interoception, the ability to detect and attend to internal bodily sensations, has been found to moderate the experience of body ownership, a known difference in ASD that may affect social function. However, interoception has not been empirically examined in ASD. In the current study, 45 children (21 with ASD and 24 controls) ages 8 to 17years completed a heartbeat perception paradigm as a measure of interoceptive ability. A subset of these children also completed the rubber hand illusion task, a multisensory paradigm probing the malleability of perceived body ownership. Although the heartbeat perception paradigm yielded comparable interoceptive awareness (IA) overall across both groups, children with ASD were superior at mentally tracking their heartbeats over longer intervals, suggesting increased sustained attention to internal cues in ASD. In addition, IA was negatively correlated with rubber hand illusion susceptibility in both groups, supporting a previously demonstrated inverse relationship between internal awareness and one’s ability to incorporate external stimuli into one’s perception of self. We propose a trade-off between attention to internal cues and attention to external cues, whereby attentional resources are disproportionately allocated to internal, rather than external, sensory cues in ASD.
Background
After completion of training, practicing surgeons rely on hands-on courses to expand their procedure armamentarium and improve their surgical technique. However, such courses vary in ...standardized teaching methods. SAGES developed the Acquisition of Data for Outcomes and Procedure Transfer (ADOPT) program as a method of longitudinal instruction utilizing standardized teaching techniques, mentorship, and webinars to cover additional techniques. This study examines the adoption of learned techniques and participant confidence before and after an ADOPT course focused on extended-view totally extraperitoneal (eTEP) hernia repair.
Methods
A hands-on course focused on eTEP hernia repair was conducted with enrollment capped at 10 participants. Pre-course and post-course surveys at 3, 6, and 12 months determined implementation of the learned procedure, case volume, and confidence with eTEP skills. A 5-point Likert scale (1 = not confident at all to 5 = completely confident) assessed confidence levels. Survey responses were summarized using descriptive statistics.
Results
Of the 10 participants, 10 (100%) completed the pre-course survey, and 7 (70%) completed at least one post-course survey. Median age was 48.5 years (36,56) with a median of 16 years (2,23) in practice, mostly in the community setting (70%). After the course, 50% had performed an eTEP procedure, and 100% reported considering this technique during surgical planning. Participants reported higher confidence in eTEP-specific skills at three months post-course from pre-course levels. The highest change in confidence was seen for the following skills: accessing the retromuscular/extraperitoneal space for ventral hernia and recognizing when the linea alba has been violated,
p
< 0.05.
Conclusion
This study shows that rapid incorporation of learned techniques can be achieved through the ADOPT format. Furthermore, through longitudinal mentorship and a structured hands-on course, the ADOPT course supports practicing surgeons to attain autonomy and confidence even when teaching a relatively technically challenging procedure, such as eTEP.
Graphical abstract
The Disparities Elimination Summer Research Experience (DESRE) was created to provide hands-on health equity research training opportunities to undergraduate and graduate students, particularly those ...from backgrounds underrepresented in biomedical research. Funded by NIH’s National Institute on Minority Health and Health Disparities, a total of 22 students participated in 4 annual cycles of an intensive, 6-week, full-time, residential research training program consisting of didactics, community immersion experiences, peer mentoring, ethics training, and hands-on health disparities research. Demand for the program was high; by the 4th year of implementation, more than 500 applications were received for the cohort’s six slots. More than half of DESRE participants came from minority-serving institutions and/or identified as a member of a minority group. Students reported a significant increase in self-reported competency across all of the program’s 26 learning objectives from pre-to post-assessment. Further, the program had a 77% success rate in promoting a career in biomedical research and/or health disparities elimination, including 100% of minority participants either entering a graduate program and/or entering careers focused on health equity. Key success factors and lessons learned are discussed.
The production of new neurons in the olfactory bulb (OB) through adulthood is a major mechanism of structural and functional plasticity underlying learning-induced circuit remodeling. The recruitment ...of adult-born OB neurons depends not only on sensory input but also on the context in which the olfactory stimulus is received. Among the multiple steps of adult neurogenesis, the integration and survival of adult-born neurons are both strongly influenced by olfactory learning. Conversely, optogenetic stimulation of adult-born neurons has been shown to specifically improve olfactory learning and long-term memory. However, the nature of the circuit and the synaptic mechanisms underlying this reciprocal influence are not yet known. Here, we showed that olfactory learning increases the spine density in a region-restricted manner along the dendritic tree of adult-born granule cells (GCs). Anatomical and electrophysiological analysis of adult-born GCs showed that olfactory learning promotes a remodeling of both excitatory and inhibitory inputs selectively in the deep dendritic domain. Circuit mapping revealed that the malleable dendritic portion of adult-born neurons receives excitatory inputs mostly from the regions of the olfactory cortex that project back to the OB. Finally, selective optogenetic stimulation of olfactory cortical projections to the OB showed that learning strengthens these inputs onto adult-born GCs. We conclude that learning promotes input-specific synaptic plasticity in adult-born neurons, which reinforces the top-down influence from the olfactory cortex to early stages of olfactory information processing.
Significance The olfactory bulb (OB) receives newly born neurons through adulthood. This process constitutes another means, in addition to molecular or synaptic changes within individual neurons, by which the OB can make changes to its functional circuitry. In this study, we show that adult-born OB neurons display adaptive changes in response to the sensory context. In a restricted domain of the dendritic arbor of adult-born neurons, we found that structural and functional changes are strongest when olfactory cues are associated with a reward. Thus, the recruitment of adult-born neurons should be seen as a form of metaplasticity that strengthens long-range functional connectivity in the olfactory system during learning.
The purpose of this study was to compare psychological well-being among transgender women, transgender men, genderqueer/nonbinary individuals, and their cisgender sexual minority counterparts. A ...total of 2,932 gender and sexual minority individuals participated in the online study. While controlling for age, race/ethnicity, employment status, education, and relationship status, there was significant variation between gender minority subgroups in depression (p < 0.001); anxiety (p = 0.003); stress (p = 0.004); perceived social support (p < 0.001); self-esteem (p = 0.031); self-perceived need for mental health care (p < 0.001); family history of mental illness (p = 0.003); personal history of mental health concerns (p = 0.003); and being in recovery (p = 0.004). Overall, transgender women had the poorest psychological well-being across the majority of variables. In contrast to their transgender peers, genderqueer/nonbinary-identified individuals did not significantly differ from their cisgender sexual minority counterparts on outcomes; however, they did differ on stressors. Transgender men appeared to fall between transgender women and genderqueer/nonbinary individuals in terms of risk factors and outcomes. The current findings highlight the importance of considering the psychosocial experiences of the various gender minority subgroups, separate from not only their cisgender sexual minority counterparts but also each other.
PURPOSEPriapism is a persistent penile erection that continues hours beyond, or is unrelated to, sexual stimulation and results in a prolonged and uncontrolled erection. Given its time-dependent and ...progressive nature, priapism is a situation that both urologists and emergency medicine practitioners must be familiar with and comfortable managing. Acute ischemic priapism, characterized by little or no cavernous blood flow and abnormal cavernous blood gases (ie, hypoxic, hypercarbic, acidotic) represents a medical emergency and may lead to cavernosal fibrosis and subsequent erectile dysfunction. MATERIALS AND METHODSA comprehensive search of the literature was performed by Emergency Care Research Institute for articles published between January 1, 1960 and May 1, 2020. Searches identified 2948 potentially relevant articles, and 2516 of these were excluded at the title or abstract level for not meeting inclusion criteria for any key question. Full texts for the remaining 432 articles were reviewed, and ultimately 137 unique articles were included in the report. RESULTSThis Guideline was developed to inform clinicians on the proper diagnosis and surgical and non-surgical treatment of patients with acute ischemic priapism. This Guideline addresses the role of imaging, adjunctive laboratory testing, early involvement of urologists when presenting to the emergency room, discussion of conservative therapies, enhanced data for patient counseling on risks of erectile dysfunction and surgical complications, specific recommendations on intracavernosal phenylephrine with or without irrigation, the inclusion of novel surgical techniques (eg, tunneling), and early penile prosthesis placement. CONCLUSIONSAll patients with priapism should be evaluated emergently to identify the sub-type of priapism (acute ischemic versus non-ischemic) and those with an acute ischemic event should be provided early intervention. Treatment of the acute ischemic patient must be based on patient objectives, available resources, and clinician experience. As such, a single pathway for managing the condition is oversimplified and no longer appropriate. Using a diversified approach, some men may be treated with intracavernosal injections of phenylephrine alone, others with aspiration/irrigation or distal shunting, and some may undergo non-emergent placement of a penile prosthesis.
•Neutrophil-to-lymphocyte ratio (NLR) increases during concurrent chemoradiation.•Higher NLR predicts poorer prognosis in patients treated with and without adjuvant durvalumab.•Higher ...pre-immunotherapy NLR may predict inferior response to immunotherapy.
Elevated pre-treatment neutrophil-to-lymphocyte ratio (NLR) may reflect immune dysfunction and is negatively prognostic in cancer patients treated with immunotherapy, but it is unclear if NLR is predictive of immunotherapy benefit.
We identified stage III non-small-cell lung cancer (NSCLC) patients treated with definitive chemoradiation and adjuvant durvalumab within the national Veterans Affairs system from 2017 to 2021. We compared the prognostic value of NLR measured before durvalumab start to a control group of stage III NSCLC patients treated with definitive chemoradiation alone from 2015 to 2016 (no-durvalumab group) before the approval of adjuvant durvalumab. We estimated the predictive value of NLR through the statistical interaction of durvalumab group by NLR level. Outcomes included progression-free survival (PFS) and overall survival (OS).
The primary analysis for NLR included 821 durvalumab patients and 445 no-durvalumab patients. Higher NLR was associated with inferior PFS in both groups (no-durvalumab: adjusted HR aHR 1.14 per 7.43 unit increase in NLR, 95% confidence interval CI 1.06–1.23; durvalumab: aHR 1.42, 95% CI 1.23–1.64), though this effect was greater in durvalumab patients (p for interaction = 0.009). Similar results were found for OS (no-durvalumab: aHR 1.16, 95% CI 1.09–1.24; durvalumab: aHR 1.48, 95% CI 1.25–1.76; p for interaction = 0.010). Absolute lymphocytes, eosinophils, and basophils were not prognostic in either group. Estimates of durvalumab treatment efficacy suggested declining efficacy with higher NLR.
Pre-treatment NLR is especially prognostic among stage III NSCLC patients treated with adjuvant immunotherapy compared to control patients treated without immunotherapy and may be a predictive biomarker of immunotherapy benefit.
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