Purpose: Research shows that individuals with gender dysphoria have body dissatisfaction, particularly during puberty. Body dysmorphia and eating behaviors are closely connected and limited studies ...have shown that transgender and gender non-conforming (TGNC) youth are at higher risk of disordered eating. The purpose of this study is to identify how often TGNC youth experience disordered eating and determine whether there are unique factors specific to this population. Methods: We recruited a sample of TGNC patients from Seattle Children's Gender Clinic. To create a gender diverse sample, we included transmasculine, transfeminine, and non-binary patients at different stages of their medical transition. Twenty-three participants provided consent/assent and completed a survey with questions modified from the Eating Disorder Examination Questionnaire. Semi-structured interviews were conducted by two members of our research team and included an in-depth section on eating and body shape. Audio files were transcribed and coding and thematic analysis was conducted using the web application, Dedoose. Results: Ten of the 23 participants identified as transfeminine (43.5%), 9 as transmasculine (39.1%), and 4 as non-binary (17.4%). The average age of participants was 16.6 (range 13-19). The majority of youth identified as white (82.6%) and were enrolled in school (82.6%). Twelve participants had been on hormone replacement therapy (HRT) for less than 6 months and 11 participants more than 6 months. None of the participants had undergone gender-affirming surgery. For at least 5 out of the past 28 days, 73.9% of participants felt fat, 60.9% had a strong desire to lose weight, 30.4% reported trying to exclude food from their diet in order to influence shape or weight, and 21.7% reported eating an unusually large amount of food and having a sense of loss of control. Key themes that emerged during data analysis regarding disordered eating included: 1) using exercise, food restriction, and/or overeating to be more masculine or feminine; 2) comparing their body appearance to their cisgender peers; 3) modifying eating habits and/or exercise to help participants feel in control of their body; 4) engaging in food restriction and/or overeating when feeling sad or stressed; 5) after starting HRT participants had an increased focus on their body and/or being "healthy"; 6) increase or decrease in disordered eating after starting medical transition. Conclusions: The results of the brief surveys and semi-structured interviews suggest that TGNC youth experience disordered eating thoughts and behaviors. These thoughts and behaviors may be associated with gender dysphoria and the pressure to fulfill societal beauty standards of their gender identity. Restriction and exercise may also act as a means of controlling one's body and/or as maladaptive coping skills associated with mental health disease. There appears to be unique factors that contribute to increased risk of disordered eating among TGNC youth prior to and after starting hormone replacement therapy. More research is needed on this topic; however these factors should be taken into consideration when providing care for this population.
Purpose: Gender affirming treatment for transgender and non-binary adolescents has been shown to decrease depression and suicidality, increase confidence, and reduce anxiety. In this way, gender ...affirming hormones can be viewed as life-saving medications, but treatments have medical and social risks. For example, hormone treatment for gender dysphoria may impact patients' future fertility and child bearing capabilities. In this study, we interviewed transgender and gender nonconforming (TGNC) adolescents and solicited their thoughts on parenting, biological children, and family. Methods: We completed 23 interviews with TGNC adolescents aged 13-19 who had previously been seen at the Seattle Children's Gender Clinic. Research associates recruited TGNC adolescents between ages 13 and 21 to participate in a one on one semi-structured interview. We sought out a diverse sample of interviewees, with attempts to enroll transfeminine, transmasculine, and gender non-conforming/ non-binary patients. Interviews lasted between 15 minutes and an hour and included a number of questions on fertility. Interviews were recorded, transcribed, and uploaded unto Dedoose version 8.0.42, a web application that allows for collaborative transcript review. Two research associates analyzed and coded the interviews according to the theory of thematic analysis. Results: TGNC adolescents have myriad views on fertility, family, and the importance of having one's own biological children. Of 23 participants 11 identified as transfeminine, 9 as transmasculine, and 3 as gender non-conforming. Eighteen of 23 participants expressed interest in having their own families one day, but only half expressed interest in those families including biological children. Participants identified a number of barriers to future fertility including the cost of fertility treatment as well as the fear that reproductive sparing procedures would slow or complicate one's social or medical transition. Many interviewees described feeling as though they had to come to terms with infertility as part of the transition process. Participants rarely described discussing this topic with care providers. Participants also described feeling a sense of discord at having to make fertility decisions earlier than their peers, and a few discussed the hope that future medical advances could allow them to have biological children. Conclusions: The TGNC youth we interviewed expressed a wide range of views on fertility, influenced by both first-hand experience and personal preferences. Given the diverse expectations and goals of this patient population, further study is needed to create a care paradigm that can guide affirming, developmentally-appropriate fertility consultations for adolescents seeking gender care.
Purpose: Social media and the ubiquity of the internet has made national and international news increasingly accessible for adolescents. With increased exposure to news stories that relate to their ...identity, transgender and gender non-conforming (TGNC) youth may be personally and disparately affected by this information. Our research study aims to understand how TGNC youth react to positive and negative news media stories of TGNC people. Methods: Through Seattle Children's Gender Clinic, we recruited 23 transfeminine, transmasculine, and non-binary youth to participate in semi-structured interviews. Interviews lasted 20-90 minutes and covered multiple topics, with one section focusing on the influence of news stories about LGBTQ+ persons. Prior to interviews, participants provided consent or assent with parental permission and completed a brief online survey with sociodemographic questions. Interviews were audio recoded and transcribed. We utilized the web application Dedoose to apply thematic analysis, as described by Braun and Clarke, 2006. Results: Ages of participating youth ranged from 13-19 with an average age of 16.6 years. Of the 23 participants, 10 identified as transfeminine (43.5%), 9 as transmasculine (39.1%), and 4 as non-binary or gender fluid (17.4%). A majority of youth identified as white (82.6%) and were enrolled in school (82.6%). A key theme that emerged during qualitative data analysis regarding news was participants changing their transition and life plans because of the current political climate. Subthemes on this topic included that participants described transitioning sooner and/or more quickly because of concerns that anti-transgender legislation would pass under the current administration; deciding against enlisting into the military; and halting a social transition because of hateful comments and acts seen on the news. Other key themes included fearing for safety after seeing news of violence against TGNC individuals; frustration that the news provides inaccurate portrayals of the TGNC community; and feeling hope and visibility when seeing positive TGNC news stories. Conclusions: Analysis of the interviews suggest that exposure to negative news about TGNC individuals may increase emotional vulnerability among gender diverse youth. Negative news has the potential to have immediate impacts on the transition process and on youths' goals and aspirations. Fortunately, although TGNC youth may feel more isolated because of negative news, positive news contributes to a sense of belonging to a shared community. More research is needed to explore this topic in more depth, and to determine whether this population may benefit from increased support when interpreting and coping with national and/or local news stories.
The timing of operative treatment for pediatric supracondylar humerus fractures (SCHF) and femoral shaft fractures (FSF) remains controversial. Many fractures previously considered to be surgical ...emergencies, such as SCHF and open fractures, are now commonly being treated the following day. When presented with an urgent fracture overnight needing operative treatment, the on-call surgeon must choose whether to mobilize resources for a late-night case or to add the case to an elective schedule of the following day.
To describe the effect of a program allowing an early operating room (OR) start for uncomplicated trauma prior to an elective day of surgery to decrease wait times for surgery for urgent fractures admitted overnight.
Starting in October 2017, patients were eligible for the early slot in the OR at the discretion of the surgeon if they were admitted after 21:00 the previous night and before 05:00. We compared demographics and timing of treatment of SCHF and FSF treated one year before and after implementation as well as the survey responses from the surgical team.
Of the 44 SCHF meeting inclusion criteria, 16 received treatment before implementation while 28 were treated after. After implementation, the mean wait time for surgery decreased by 4.8 h or 35.4% (13.4 h
8.7 h;
= 0.001). There were no significant differences in the operative duration, time in the post anesthesia care unit, and wait time for discharge. Survey results demonstrated decreased popularity of the program among nurses and anesthesiologists relative to surgeons. Whereas 57% of the surgeons believed that the program was effective, only 9% of anesthesiologists and 16% of nurses agreed. The program was ultimately discontinued given the dissatisfaction.
Our findings demonstrate significantly reduced wait times for surgery for uncomplicated SCHF presenting overnight while discussing the importance of shared decision-making with the stakeholders. Although the program produced promising results, it also created new conflicts within the OR staff that led to its discontinuation at our institution. Future implementations of such programs should involve stakeholders early in the planning process to better address the needs of the OR staff.
Objectives
To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension.
Methods
This was a prospective, multicentre, observational study conducted in 70 ...hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30‐day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6‐ and 24‐h post‐enrolment, time to antimicrobial administration, intensive care admission, organ support and in‐hospital mortality.
Results
A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87–100). Median time to first intravenous antimicrobials was 77 min (42–148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500–3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre‐enrolment to 24 h was 4200 mL (3000–5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in‐hospital mortality was 6.2% (95% confidence interval 4.4–8.5%).
Conclusion
Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy.
Objectives
Efforts to develop and deploy effective vaccines against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) continue at pace. Here, we describe rational antigen design through to ...manufacturability and vaccine efficacy of a prefusion‐stabilised spike (S) protein, Sclamp, in combination with the licensed adjuvant MF59 ‘MF59C.1’ (Seqirus, Parkville, Australia).
Methods
A panel recombinant Sclamp proteins were produced in Chinese hamster ovary and screened in vitro to select a lead vaccine candidate. The structure of this antigen was determined by cryo‐electron microscopy and assessed in mouse immunogenicity studies, hamster challenge studies and safety and toxicology studies in rat.
Results
In mice, the Sclamp vaccine elicits high levels of neutralising antibodies, as well as broadly reactive and polyfunctional S‐specific CD4+ and cytotoxic CD8+ T cells in vivo. In the Syrian hamster challenge model (n = 70), vaccination results in reduced viral load within the lung, protection from pulmonary disease and decreased viral shedding in daily throat swabs which correlated strongly with the neutralising antibody level.
Conclusion
The SARS‐CoV‐2 Sclamp vaccine candidate is compatible with large‐scale commercial manufacture, stable at 2–8°C. When formulated with MF59 adjuvant, it elicits neutralising antibodies and T‐cell responses and provides protection in animal challenge models.
We describe preclinical development of a prefusion stabilized spike protein subunit vaccine for SARS‐CoV‐2. Results include structural resolution by cryo‐electron microscopy, mouse immunogenicity and a hamster protection study.
Aim
To compare HbA1c and clinical outcomes in adolescents and young adults with type 1 diabetes (T1D), with or without celiac disease (CD).
Methods
Longitudinal data were extracted from ADDN, a ...prospective clinical diabetes registry. Inclusion criteria were T1D (with or without CD), ≥ 1 HbA1c measurement, age 16–25 years and diabetes duration ≥ 1 year at last measurement. Multivariable Generalised Estimated Equation models were used for longitudinal analysis of variables associated with HbA1c.
Results
Across all measurements, those with coexisting T1D and CD had lower HbA1c when compared to those with T1D alone (8.5 ± 1.5% (69.4 ± 16.8 mmol/mol) vs. 8.7 ± 1.8% (71.4 ± 19.8 mmol/mol);
p
< 0.001); lower HbA1c was associated with shorter diabetes duration (B = − 0.06; 95% CI − 0.07 to − 0.05;
p
< 0.001), male sex (B = − 0.24; − 0.36 to − 0.11;
p
< 0.001), insulin pump therapy use (B = − 0.46; − 0.58 to − 0.34;
p
< 0.001), coexistence of T1D and CD (B = − 0.28; − 0.48 to − 0.07;
p
= 0.01), blood pressure (B = − 0.16; − 0.23 to − 0.09;
p
< 0.001) and body mass index (B = -− 0.03; − 0.02 to − 0.04;
p
= 0.01) in the normal range. At last measurement, 11.7% of the total population had a HbA1c < 7.0% (53.0 mmol/mol).
Conclusions
Across all measurements, coexisting T1D and CD is associated with lower HbA1c when compared to T1D alone. However, HbA1c is above target in both groups.
Our review of the literature suggests that the effects of GATT/WTO are insignificant or relatively small for participants in general, but potentially very large for groups that make heavy use of it. ...Our empirical analysis suggests that these gains are disproportionately large for the Asia-Pacific countries—perhaps by reducing resistance to the rapid growth and change in trade patterns in the region. We also highlight a potentially important source of future gains through helping to restrain the costly growth of agricultural protection in rapidly-developing countries in the region.
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