Lived experiences of transgender and nonbinary people in the perioperative context: a qualitative study.

BACKGROUND: Transgender and nonbinary (TNB) people experience obstacles that create barriers to accessing health care, including stigmatization and health inequities. Our intention was to describe the lived experiences of TNB patients and identify potential gaps in the education of health care professionals. METHODS: We conducted a qualitative descriptive study influenced by phenomenology by interviewing with TNB adults who underwent surgery in Canada within the previous 5 years. We recruited participants using purposeful and snowball sampling via online social networking sites. Audio recordings were transcribed. Two authors coded the transcripts and derived the themes. RESULTS: We interviewed 21 participants, with a median interview duration of 49 minutes. Participants described positive and negative health care encounters that led to stress, confusion, and feelings of vulnerability. Major themes included having to justify their need for health care in the face of structural discrimination; fear and previous traumatic experiences; community as a source of support and information; and the impact of interactions with health care professionals. INTERPRETATION: Participants detailed barriers to accessing care, struggled to participate in shared decision-making, and desired trauma-informed care principles; they described strength in community and positive interactions with health care professionals, although barriers to accessing gender-affirming care often overshadowed other aspects of the perioperative experience. Additional research, increased education for health care professionals, and policy changes are necessary to improve access to competent care for TNB people.

Strong Solar Radiation Forces from Anomalously Reflecting Metasurfaces for Solar Sail Attitude Control.

We examine the theoretical implications of incorporating metasurfaces on solar sails, and the effect they can have on the forces applied to the sail. This would enable a significant enhancement over state-of-the- art attitude control by demonstrating a novel, propellant-free and low-mass approach to induce a roll torque on the sail, which is a current limitation in present state-of-the-art technology. We do so by utilizing anomalous optical reflections from the metasurfaces to generate a net in-plane lateral force, which can lead to a net torque along the roll axis of the sail, in addition to the other spatial movements exhibited by the sail from solar radiation pressure. We characterize this net lateral force as a function of incidence angle. In addition, the influence of the phase gradients and anomalous conversion efficiencies characteristics of the metasurfaces are independently considered. The optimum incidence angle that corresponded with the maximum net lateral-to-normal force ratio was found to be -30° for a metasurface exhibiting 75% anomalous conversion efficiency with a phase gradient of 0:71k0.