Incidence of High Risk and Malignant Pathological Findings in Transgender and Gender Diverse Individuals Undergoing Gender-Affirming Mastectomy.

BACKGROUND: Concrete, data-driven guidelines for breast cancer screening among the transgender and gender diverse (TGD) population is lacking. The present study evaluates possible associations of gender-affirming hormone therapy (GAHT) on incidental breast pathology findings in trans-masculine patients to inform decision making about breast cancer screening. PATIENTS AND METHODS: This was a retrospective cohort study of patients who had gender-affirming mastectomy or breast reduction at a single center from July 2019 to February 2024. A total of 865 patients met the inclusion criteria. Gender-affirming testosterone therapy and length of exposure were evaluated to seek differences in post-operative pathology findings. RESULTS: The median age at the time of surgery was 27 years [interquartile range (IQR) 21-30]. Most participants identified as female to male (658, 75.6%). A significant portion of the participants (688, 79.2%) were undergoing testosterone therapy at the time of surgery, with the median duration of testosterone use prior to surgery being 14 months (IQR 4-29). High risk or malignant findings were noted in pathology results for 12 of 1730 breasts (0.7%). Ordered logistic regression found that duration of testosterone therapy was not associated with increasing severity of incidental breast pathology. Additionally, patients under 25 years of age were 70% less likely to have any incidental finding on pathological evaluation than older patients [odds ratio (OR) 0.3, p < 0.01, confidence interval (CI) 0.18-0.50]. CONCLUSIONS: The present study found that patients undergoing GAHT should not be screened for breast cancer with increased frequency compared with cis-gender women. Additionally, it may be appropriate for trans women under the age of 25 with normal breast cancer risk to forego pathological breast tissue examination.

Disturbance alters transience but nutrients determine equilibria during grassland succession with multiple global change drivers.

Disturbance and environmental change may cause communities to converge on a steady state, diverge towards multiple alternative states or remain in long-term transience. Yet, empirical investigations of successional trajectories are rare, especially in systems experiencing multiple concurrent anthropogenic drivers of change. We examined succession in old field grassland communities subjected to disturbance and nitrogen fertilization using data from a long-term (22-year) experiment. Regardless of initial disturbance, after a decade communities converged on steady states largely determined by resource availability, where species turnover declined as communities approached dynamic equilibria. Species favoured by the disturbance were those that eventually came to dominate the highly fertilized plots. Furthermore, disturbance made successional pathways more direct revealing an important interaction effect between nutrients and disturbance as drivers of community change. Our results underscore the dynamical nature of grassland and old field succession, demonstrating how community properties such as ß diversity change through transient and equilibrium states.

The cost of self-promotion: ecological and demographic implications of the mentor effect in natural plant populations.

Under the mentor effect, compatible heterospecific pollen transfer induces self-pollen germination in otherwise self-incompatible plants. The mentor effect could be considered a novel mode of reproductive interference if it negatively impacts fitness. Yet to date, this phenomenon has predominately been investigated under experimental conditions rather than in situ. We address this gap in natural populations of the self-incompatible native dandelion, Taraxacum ceratophorum, where selfing only occurs in association with hybridization from exotic Taraxacum officinale. We tested whether self-fertilization rate increases in the hybrid zone, as predicted due to the mentor effect. Using results from these investigations, we created an exponential growth model to estimate the potential demographic impacts of the mentor effect on T. ceratophorum population growth. Our results demonstrate that the strength of the mentor effect in Taraxacum depends on the prevalence of pollinator-mediated outcross pollen deposition rather than self-pollination. Demographic models suggest that reduced outcrossing in T. ceratophorum under exotic invasion could negatively impact population growth through inbreeding depression. We demonstrate the mentor effect is rare in natural populations of T. ceratophorum due to masking by early life cycle inbreeding depression, prevalent outcrossing, and ovule usurpation by heterospecific pollen.

A qualitative study of LGBTQIA+ genetic counselors' experiences while applying to graduate school.

Research has shown that lesbian, gay, bisexual, transgender, queer, intersex, asexual and other sexual and gender minority (LGBTQIA+) healthcare students experience discrimination during admissions and training. While several studies have examined the experiences of racial and ethnic minorities within the genetic counseling field, the admissions experiences of LGBTQIA+ individuals have not been explored. Through semi-structured interviews, this qualitative study investigated the experiences of ten LGBTQIA+ genetic counselors and genetic counseling students during graduate school admissions. Interview questions focused on participants' perceptions of the genetic counseling field prior to applying, important factors in choosing and ranking programs, decisions surrounding disclosure of LGBTQIA+ identities, interview experiences related to their identities, and the impacts, if any, of their identities on their overall admissions journey. Transcripts were coded and analyzed utilizing a constructivist grounded theory approach, resulting in the emergence of themes regarding factors that influenced participants' decisions to disclose their identity and how their LGBTQIA+ identity factored into their selection of a training program. This study adds new perspectives to the conversations around diversity, equity, and inclusion within the genetic counseling field. Further, it provides genetic counselors and genetic counseling programs insight into inclusive admissions processes and suggests ways to improve inclusivity in graduate admissions.

Show-Me Resilience: Assessing and Reconciling Rural Leaders' Perceptions of Climate Resilience in Missouri.

Rural areas of the United States play a vital role in coping with, adapting to and mitigating climate change, yet they often lag urban areas in climate planning and action. Rural leaders-e.g., policymakers, state/federal agency professionals, non-profit organization leadership, and scholars - are pivotal for driving the programs and policies that support resilient practices, but our understanding of their perspectives on climate resilience writ large is limited. We conducted semi-structured interviews with 23 rural leaders in Missouri to elucidate their conceptualizations of climate resilience and identify catalysts and constraints for climate adaptation planning and action across rural landscapes. We investigated participants' perceptions of the major vulnerabilities of rural communities and landscapes, threats to rural areas, and potential steps for making rural Missouri more resilient in the face of climate change. We found that most rural leaders conceptualized climate resilience as responding to hazardous events rather than anticipating or planning for hazardous trends. The predominant threats identified were flooding and drought, which aligns with climate projections for the Midwest. Participants proposed a wide variety of specific steps to enhance resilience but had the highest agreement about the utility of expanding existing programs. The most comprehensive suite of solutions was offered by participants who conceptualized resilience as involving social, ecological, and economic systems, underscoring the importance of broad thinking for developing more holistic solutions to climate-associated threats and the potential impact of greater collaboration across domains. We highlight and discuss a Missouri-based levee setback project that was identified by participants as a showcase of collaborative resilience-building.

Addition of multiple limiting resources reduces grassland diversity.

Niche dimensionality provides a general theoretical explanation for biodiversity-more niches, defined by more limiting factors, allow for more ways that species can coexist. Because plant species compete for the same set of limiting resources, theory predicts that addition of a limiting resource eliminates potential trade-offs, reducing the number of species that can coexist. Multiple nutrient limitation of plant production is common and therefore fertilization may reduce diversity by reducing the number or dimensionality of belowground limiting factors. At the same time, nutrient addition, by increasing biomass, should ultimately shift competition from belowground nutrients towards a one-dimensional competitive trade-off for light. Here we show that plant species diversity decreased when a greater number of limiting nutrients were added across 45 grassland sites from a multi-continent experimental network. The number of added nutrients predicted diversity loss, even after controlling for effects of plant biomass, and even where biomass production was not nutrient-limited. We found that elevated resource supply reduced niche dimensionality and diversity and increased both productivity and compositional turnover. Our results point to the importance of understanding dimensionality in ecological systems that are undergoing diversity loss in response to multiple global change factors.

Consequences of ignoring dispersal variation in network models for landscape connectivity.

Habitat loss and fragmentation can negatively influence population persistence and biodiversity, but the effects can be mitigated if species successfully disperse between isolated habitat patches. Network models are the primary tool for quantifying landscape connectivity, yet in practice, an overly simplistic view of species dispersal is applied. These models often ignore individual variation in dispersal ability under the assumption that all individuals move the same fixed distance with equal probability. We developed a modeling approach to address this problem. We incorporated dispersal kernels into network models to determine how individual variation in dispersal alters understanding of landscape-level connectivity and implemented our approach on a fragmented grassland landscape in Minnesota. Ignoring dispersal variation consistently overestimated a population's robustness to local extinctions and underestimated its robustness to local habitat loss. Furthermore, a simplified view of dispersal underestimated the amount of habitat substructure for small populations but overestimated habitat substructure for large populations. Our results demonstrate that considering biologically realistic dispersal alters understanding of landscape connectivity in ecological theory and conservation practice.

Consecuencias de la Omisión de la Variación en la Dispersión en los Modelos de Redes para la Conectividad de Paisajes Resumen La pérdida y la fragmentación del hábitat pueden influir negativamente la persistencia de poblaciones y biodiversidad. Sin embargo, estos efectos pueden ser mitigados si las especies tienen una dispersión exitosa entre los fragmentos aislados de hábitat. Los modelos de redes son la herramienta principal para la cuantificación de la conectividad del paisaje, no obstante en la práctica, se tiende a usar una visión excesivamente simplista de la dispersión de especies. Es común que estos modelos ignoren la variación que existe entre individuos en sus habilidades de dispersión y que asuman que todos los individuos se pueden mover la misma distancia y con la misma probabilidad. En este estudio, desarrollamos una estrategia de modelaje para (minimizar o aminorar) estas limitaciones incorporando kernels de dispersión dentro de los modelos de redes para determinar cómo la variación individual de la dispersión altera el entendimiento de la conectividad a nivel de paisaje. Como un ejemplo, implementamos esta estrategia en un paisaje de pastizal fragmentado en Minnesota. Omitir la variación en la dispersión generó una sobreestimación sistemática de la robustez de la población ante las extinciones locales y una subestimación de la robustez ante la pérdida local del hábitat. Además, una visión simplificada de la dispersión subestimó la complejidad de hábitat para las poblaciones pequeñas, sin emgargo sobreestimó la complejidad para las poblaciones grandes. Nuestros resultados demuestran que incorporar parámetros que describan una dispersión biológica realista tiene implicaciones importantes en la teoría de conectividad de paisajes e implementación de practicas de conservación.

Trait plasticity alters the range of possible coexistence conditions in a competition-colonisation trade-off.

Most of the classical theory on species coexistence has been based on species-level competitive trade-offs. However, it is becoming apparent that plant species display high levels of trait plasticity. The implications of this plasticity are almost completely unknown for most coexistence theory. Here, we model a competition-colonisation trade-off and incorporate trait plasticity to evaluate its effects on coexistence. Our simulations show that the classic competition-colonisation trade-off is highly sensitive to environmental circumstances, and coexistence only occurs in narrow ranges of conditions. The inclusion of plasticity, which allows shifts in competitive hierarchies across the landscape, leads to coexistence across a much broader range of competitive and environmental conditions including disturbance levels, the magnitude of competitive differences between species, and landscape spatial patterning. Plasticity also increases the number of species that persist in simulations of multispecies assemblages. Plasticity may generally increase the robustness of coexistence mechanisms and be an important component of scaling coexistence theory to higher diversity communities.

Density dependence in demography and dispersal generates fluctuating invasion speeds.

Density dependence plays an important role in population regulation and is known to generate temporal fluctuations in population density. However, the ways in which density dependence affects spatial population processes, such as species invasions, are less understood. Although classical ecological theory suggests that invasions should advance at a constant speed, empirical work is illuminating the highly variable nature of biological invasions, which often exhibit nonconstant spreading speeds, even in simple, controlled settings. Here, we explore endogenous density dependence as a mechanism for inducing variability in biological invasions with a set of population models that incorporate density dependence in demographic and dispersal parameters. We show that density dependence in demography at low population densities-i.e., an Allee effect-combined with spatiotemporal variability in population density behind the invasion front can produce fluctuations in spreading speed. The density fluctuations behind the front can arise from either overcompensatory population growth or density-dependent dispersal, both of which are common in nature. Our results show that simple rules can generate complex spread dynamics and highlight a source of variability in biological invasions that may aid in ecological forecasting.

Disrupt Now for Future Focus.

Health care organizations are challenged by numerous and rapid changes. Although nurse leaders seldom lead the whole organization's response to these changes, most changes impact the nursing workforce. To be prepared and proactive, nurse leaders need to consider the process of disrupting what the nursing workforce does to keep current with what society expects of nursing.

When things don't add up: quantifying impacts of multiple stressors from individual metabolism to ecosystem processing.

Ecosystems are exposed to multiple stressors which can compromise functioning and service delivery. These stressors often co-occur and interact in different ways which are not yet fully understood. Here, we applied a population model representing a freshwater amphipod feeding on leaf litter in forested streams. We simulated impacts of hypothetical stressors, individually and in pairwise combinations that target the individuals' feeding, maintenance, growth and reproduction. Impacts were quantified by examining responses at three levels of biological organisation: individual-level body sizes and cumulative reproduction, population-level abundance and biomass and ecosystem-level leaf litter decomposition. Interactive effects of multiple stressors at the individual level were mostly antagonistic, that is, less negative than expected. Most population- and ecosystem-level responses to multiple stressors were stronger than expected from an additive model, that is, synergistic. Our results suggest that across levels of biological organisation responses to multiple stressors are rarely only additive. We suggest methods for efficiently quantifying impacts of multiple stressors at different levels of biological organisation.

Mechanistically derived dispersal kernels explain species-level patterns of recruitment and succession.

Species-level dispersal information can give mechanistic insights into how spatial processes impact plant communities. Unfortunately, field-based estimates of the dispersal abilities of multiple members of a community are often lacking for many plant systems. Here, we provide a simple method for measuring dispersal ability for large numbers of grassland plant species based on functional traits. Using this method, we estimated the dispersal ability of 50 co-occurring grassland species using the Wald Analytical Long-distance Dispersal (WALD) model. Grassland plants species are often used for developing community theory, yet species-level estimates of their dispersal abilities are comparatively rare. We use these dispersal measurements to examine the relationship between species dispersal abilities and successional dynamics using data from a 90-yr old field chronosequence. We find that our estimated dispersal measurements matched field-based establishment observations well, and estimated species colonization, competitive, and establishment abilities. We hope that this method for measuring dispersal ability of multiple species within a community, and its demonstrated ability to generate predictions for spatial ecology, will encourage more studies of the explicit role of dispersal in plant community ecology.

Herbivory and eutrophication mediate grassland plant nutrient responses across a global climatic gradient.

Plant stoichiometry, the relative concentration of elements, is a key regulator of ecosystem functioning and is also being altered by human activities. In this paper we sought to understand the global drivers of plant stoichiometry and compare the relative contribution of climatic vs. anthropogenic effects. We addressed this goal by measuring plant elemental (C, N, P and K) responses to eutrophication and vertebrate herbivore exclusion at eighteen sites on six continents. Across sites, climate and atmospheric N deposition emerged as strong predictors of plot-level tissue nutrients, mediated by biomass and plant chemistry. Within sites, fertilization increased total plant nutrient pools, but results were contingent on soil fertility and the proportion of grass biomass relative to other functional types. Total plant nutrient pools diverged strongly in response to herbivore exclusion when fertilized; responses were largest in ungrazed plots at low rainfall, whereas herbivore grazing dampened the plant community nutrient responses to fertilization. Our study highlights (1) the importance of climate in determining plant nutrient concentrations mediated through effects on plant biomass, (2) that eutrophication affects grassland nutrient pools via both soil and atmospheric pathways and (3) that interactions among soils, herbivores and eutrophication drive plant nutrient responses at small scales, especially at water-limited sites.

Potential negative ecological effects of corridors.

Despite many studies showing that landscape corridors increase dispersal and species richness for disparate taxa, concerns persist that corridors can have unintended negative effects. In particular, some of the same mechanisms that underlie positive effects of corridors on species of conservation interest may also increase the spread and impact of antagonistic species (e.g., predators and pathogens), foster negative effects of edges, increase invasion by exotic species, increase the spread of unwanted disturbances such as fire, or increase population synchrony and thus reduce persistence. We conducted a literature review and meta-analysis to evaluate the prevalence of each of these negative effects. We found no evidence that corridors increase unwanted disturbance or non-native species invasion; however, these have not been well-studied concerns (1 and 6 studies, respectively). Other effects of corridors were more often studied and yielded inconsistent results; mean effect sizes were indistinguishable from zero. The effect of edges on abundances of target species was as likely to be positive as negative. Corridors were as likely to have no effect on antagonists or population synchrony as they were to increase those negative effects. We found 3 deficiencies in the literature. First, despite studies on how corridors affect predators, there are few studies of related consequences for prey population size and persistence. Second, properly designed studies of negative corridor effects are needed in natural corridors at scales larger than those achievable in experimental systems. Third, studies are needed to test more targeted hypotheses about when corridor-mediated effects on invasive species or disturbance may be negative for species of management concern. Overall, we found no overarching support for concerns that construction and maintenance of habitat corridors may result in unintended negative consequences. Negative edge effects may be mitigated by widening corridors or softening edges between corridors and the matrix. Other negative effects are relatively small and manageable compared with the large positive effects of facilitating dispersal and increasing diversity of native species.

Effects of SPEAK OUT! & LOUD Crowd on Functional Speech Measures in Parkinson's Disease.

PURPOSE: This study investigated the effects of the SPEAK OUT! & LOUD Crowd therapy program on speaking rate, percent pause time, intelligibility, naturalness, and communicative participation in individuals with Parkinson's disease (PD). METHOD: Six adults with PD completed 12 individual SPEAK OUT! sessions across four consecutive weeks followed by group-based LOUD Crowd sessions for five consecutive weeks. Most therapy sessions were conducted via telehealth, with two participants completing the SPEAK OUT! portion in person. Speech samples were recorded at six time points: three baseline time points prior to SPEAK OUT!, two post-SPEAK OUT! time points, and one post-LOUD Crowd time point. Acoustic measures of speaking rate and percent pause time and listener ratings of speech intelligibility and naturalness were obtained for each time point. Participant self-ratings of communicative participation were also collected at pre- and posttreatment time points. RESULTS: Results showed significant improvement in communicative participation scores at a group level following completion of the SPEAK OUT! & LOUD Crowd treatment program. Two participants showed a significant decrease in speaking rate and increase in percent pause time following treatment. Changes in intelligibility and naturalness were not statistically significant. CONCLUSIONS: These findings provide preliminary support for the effectiveness of the SPEAK OUT! & LOUD Crowd treatment program in improving communicative participation for people with mild-to-moderate hypokinetic dysarthria secondary to PD. This study is also the first to demonstrate positive effects of this treatment program for people receiving the therapy via telehealth.

Management Strategies for Acute Pulmonary Embolism in the ICU.

TOPIC IMPORTANCE: Acute pulmonary embolism (PE) is a common disease encountered by pulmonologists, cardiologists, and critical care physicians throughout the world. For patients with high-risk acute PE (defined by systemic hypotension) and intermediate high-risk acute PE (defined by the absence of systemic hypotension, but the presence of numerous other concerning clinical and imaging features), intensive care often is necessary. Initial management strategies should focus on optimization of right ventricle (RV) function while decisions about advanced interventions are being considered. REVIEW FINDINGS: We reviewed the existing literature of various vasoactive agents, IV fluids and diuretics, and pulmonary vasodilators in both animal models and human trials of acute PE. We also reviewed the potential complications of endotracheal intubation and positive pressure ventilation in acute PE. Finally, we reviewed the data of venoarterial extracorporeal membrane oxygenation use in acute PE. The above interventions are discussed in the context of the underlying pathophysiologic features of acute RV failure in acute PE with corresponding illustrations. SUMMARY: Norepinephrine is a reasonable first choice for hemodynamic support with vasopressin as an adjunct. IV loop diuretics may be useful if evidence of RV dysfunction or volume overload is present. Fluids should be given only if concern exists for hypovolemia and absence of RV dilatation. Supplemental oxygen administration should be considered even without hypoxemia. Positive pressure ventilation should be avoided if possible. Venoarterial extracorporeal membrane oxygenation cannulation should be implemented early if ongoing deterioration occurs despite these interventions.

Climate and habitat type interact to influence contemporary dispersal potential in Prairie Smoke (Geum triflorum).

Understanding dispersal potential, or the probability a species will move a given distance, under different environmental conditions is essential to predicting species' ability to move across the landscape and track shifting ecological niches. Two important drivers of dispersal ability are climatic differences and variations in local habitat type. Despite the likelihood these global drivers act simultaneously on plant populations, and thus dispersal potential is likely to change as a result, their combined effects on dispersal are rarely examined. To understand the effect of climate and varying habitat types on dispersal potential, we studied Geum triflorum-a perennial grassland species that spans a wide range of environments, including both prairie and alvar habitats. We explored how the climate of the growing season and habitat type (prairie vs. alvar) interact to alter dispersal potential. We found a consistent interactive effect of climate and habitat type on dispersal potential. Across prairie populations, an increased number of growing degree days favored traits that increase dispersal potential or the probability of dispersing farther distances. However, for alvar populations, dispersal potential tended to decrease as the number of growing degree days increased. Our findings suggest that under continued warming, populations in prairie habitats will benefit from increased gene flow, while alvar populations will become increasingly segregated, with reduced potential to track shifting fitness optima.