Required Mental Health Evaluation Before Initiating Gender-Affirming Hormones: Trans and Nonbinary Perspectives.

Purpose: Gender-affirming hormones (hormones)-the use of sex hormones to induce desired secondary sex characteristics in transgender and nonbinary (TGNB) individuals-are vital health care for many TGNB people. Some hormone providers require a letter from a mental health provider before hormone initiation. We explore the perspectives of TGNB individuals regarding the impact of the letter requirement on their experience of care. Methods: We conducted semistructured interviews with 21 TGNB individuals who have sought or are receiving hormones. We purposively sampled respondents who were (n=12) and were not (n=8) required to provide a letter. An Advisory Board of transgender individuals guided the methodology. Interviews were transcribed verbatim and coded both inductively and deductively. Results: We identified three themes related to the letter requirement: (1) Mental health: While participants appreciated the importance of therapy, the letter requirement did not serve this purpose; (2) Trans identity: The process of obtaining a letter created doubt in participants' own transness, along with a resistance to the pathologization and conflation of mental illness with transness; and (3) Care relationships: The letter requirement negatively impacted the patient-provider relationship. Participants felt the need to self-censor or to perform a version of transness they thought the provider expected; this process decreased their trust in care professionals. Conclusion: A letter requirement did not improve mental health and had several negative consequences. Removal of this requirement will improve access to hormones and may paradoxically improve mental health.

Stochastic Gradient Bayesian Optimal Experimental Designs for Simulation-based Inference.

Simulation-based inference (SBI) methods tackle complex scientific models with challenging inverse problems. However, SBI models often face a significant hurdle due to their non-differentiable nature, which hampers the use of gradient-based optimization techniques. Bayesian Optimal Experimental Design (BOED) is a powerful approach that aims to make the most efficient use of experimental resources for improved inferences. While stochastic gradient BOED methods have shown promising results in high-dimensional design problems, they have mostly neglected the integration of BOED with SBI due to the difficult non-differentiable property of many SBI simulators. In this work, we establish a crucial connection between ratio-based SBI inference algorithms and stochastic gradient-based variational inference by leveraging mutual information bounds. This connection allows us to extend BOED to SBI applications, enabling the simultaneous optimization of experimental designs and amortized inference functions. We demonstrate our approach on a simple linear model and offer implementation details for practitioners.

Pneumatic computers for embedded control of microfluidics.

Alternative computing approaches that interface readily with physical systems are well suited for embedded control of those systems. We demonstrate finite state machines implemented as pneumatic circuits of microfluidic valves and use these controllers to direct microfluidic liquid handling procedures on the same chip. These monolithic integrated systems require only power to be supplied externally, in the form of a vacuum source. User input can be provided directly to the chip by covering pneumatic ports with a finger. State machines with up to four bits of state memory are demonstrated, and next-state combinational logic can be fully reprogrammed by changing the hole-punch pattern on a membrane in the chip. These pneumatic computers demonstrate a framework for the embedded control of physical systems and open a path to stand-alone lab-on-a-chip devices capable of highly complex functionality.

PIEZO1-HaloTag hiPSCs: Bridging Molecular, Cellular and Tissue Imaging.

PIEZO1 channels play a critical role in numerous physiological processes by transducing diverse mechanical stimuli into electrical and chemical signals. Recent studies underscore the importance of endogenous PIEZO1 activity and localization in regulating mechanotransduction. To enable physiologically and clinically relevant human-based studies, we genetically engineered human induced pluripotent stem cells (hiPSCs) to express a HaloTag fused to endogenous PIEZO1. Combined with super-resolution imaging, our chemogenetic approach allows precise visualization of PIEZO1 in various cell types. Further, the PIEZO1-HaloTag hiPSC technology allows non-invasive monitoring of channel activity via Ca2+-sensitive HaloTag ligands, with temporal resolution approaching that of patch clamp electrophysiology. Using lightsheet imaging of hiPSC-derived neural organoids, we also achieve molecular scale PIEZO1 imaging in three-dimensional tissue samples. Our advances offer a novel platform for studying PIEZO1 mechanotransduction in human cells and tissues, with potential for elucidating disease mechanisms and development of targeted therapeutics.

Fabrication of Multilayer Molds by Dry Film Photoresist.

Dry film photoresists are widely employed to fabricate high-aspect-ratio microstructures, such as molds for microfluidic devices. Unlike liquid resists, such as SU-8, dry films do not require a cleanroom facility, and it is straightforward to prepare uniform and reproducible films as thick as 500 µm. Multilayer patterning, however, can be problematic with dry film resists even though it is critical for a number of microfluidic devices. Layer-to-layer mask alignment typically requires the first layer to be fully developed, making the pattern visible, before applying and patterning the second layer. While a liquid resist can flow over the topography of previous layers, this is not the case with dry film lamination. We found that post-exposure baking of dry film photoresists can preserve a flat topography while revealing an image of the patterned features that is suitable for alignment to the next layer. We demonstrate the use of this technique with two different types of dry film resist to fabricate master molds for a hydrophoresis size-sorting device and a cell chemotaxis device.

Phase-Optimized Peristaltic Pumping by Integrated Microfluidic Logic.

Microfluidic droplet generation typically entails an initial stabilization period on the order of minutes, exhibiting higher variation in droplet volume until the system reaches monodisperse production. The material lost during this period can be problematic when preparing droplets from limited samples such as patient biopsies. Active droplet generation strategies such as antiphase peristaltic pumping effectively reduce stabilization time but have required off-chip control hardware that reduces system accessibility. We present a fully integrated device that employs on-chip pneumatic logic to control phase-optimized peristaltic pumping. Droplet generation stabilizes in about a second, with only one or two non-uniform droplets produced initially.

They Saw a Debate: Political Polarization Is Associated with Greater Multivariate Neural Synchrony When Viewing the Opposing Candidate Speak.

With rampant polarization in current U.S. politics, it seems as though political partisans with opposing viewpoints are living in parallel realities. Indeed, prior research shows that people's impressions/attitudes toward political candidates are intertwined with their political affiliation. The current study investigated the relationship between political affiliation and intersubject neural synchrony of multivariate patterns of activity during naturalistic viewing of a presidential debate. Before the 2016 U.S. presidential election, 20 individuals varying in political affiliation underwent functional neuroimaging while watching the first debate between candidates Hillary Clinton and Donald Trump. Pairs of participants with more polarized political affiliations were higher in neural synchrony in a system of brain regions involved in self-referential processing when viewing the opposing candidate speak compared with that candidate's supporters regardless of which extreme of the political spectrum they occupied. Moreover, pairs of political partisans matching in the candidate they supported were higher in neural synchrony when watching the candidate they opposed compared with the one they both supported. These findings suggest that political groups' shared understanding may be driven more by perceptions of outgroups than of their own party/candidates.

Applying Sodium Carbonate Extraction Mass Spectrometry to Investigate Defects in the Mitochondrial Respiratory Chain.

Mitochondria are complex organelles containing 13 proteins encoded by mitochondrial DNA and over 1,000 proteins encoded on nuclear DNA. Many mitochondrial proteins are associated with the inner or outer mitochondrial membranes, either peripherally or as integral membrane proteins, while others reside in either of the two soluble mitochondrial compartments, the mitochondrial matrix and the intermembrane space. The biogenesis of the five complexes of the oxidative phosphorylation system are exemplars of this complexity. These large multi-subunit complexes are comprised of more than 80 proteins with both membrane integral and peripheral associations and require soluble, membrane integral and peripherally associated assembly factor proteins for their biogenesis. Mutations causing human mitochondrial disease can lead to defective complex assembly due to the loss or altered function of the affected protein and subsequent destabilization of its interactors. Here we couple sodium carbonate extraction with quantitative mass spectrometry (SCE-MS) to track changes in the membrane association of the mitochondrial proteome across multiple human knockout cell lines. In addition to identifying the membrane association status of over 840 human mitochondrial proteins, we show how SCE-MS can be used to understand the impacts of defective complex assembly on protein solubility, giving insights into how specific subunits and sub-complexes become destabilized.

High-resolution integrated piezoresistive sensors for microfluidic monitoring.

Microfluidic devices are traditionally monitored by bulky and expensive off-chip sensors. We have developed a soft piezoresistive sensor capable of measuring micron-level strains that can be easily integrated into devices via soft lithography. We apply this sensor to achieve fast and localized monitoring of pressure, flow, and valve actuation.

The Health Access Initiative: A Training and Technical Assistance Program to Improve Health Care for Sexual and Gender Minority Youth.

PURPOSE: This article describes the Health Access Initiative (HAI), an intervention to improve the general and sexual health care experiences of sexual and gender minority youth (SGMY) by providing training and technical assistance to providers and staff. The training consisted of an online and in-person training, followed by site-specific technical assistance. We present the findings of a pilot evaluation of the program with 10 diverse clinics in Michigan. METHODS: This program was developed using community-based participatory research principles. Based on a framework of cultural humility, program activities are guided by the Situated Information-Motivation-Behavioral Skills Model. The mixed method program evaluation used training feedback surveys assessing program feasibility, acceptability, and effectiveness; pre/post surveys assessing knowledge, attitudes, and practices toward SGMY; and in-depth interviews with site liaisons assessing technical assistance and structural change. RESULTS: The HAI is a highly feasible and acceptable intervention for providers and staff at a variety of health care sites serving adolescents and emerging adults. The results from 10 clinics that participated in the HAI indicate strong intervention efficacy, with significant and meaningful improvements seen in the knowledge of, attitudes toward, and practices with SGMY reported by providers and staff at 6-month follow-up compared with baseline, as well as in qualitative interviews with site liaisons. CONCLUSIONS: The HAI is a promising intervention to improve the quality of primary and sexual health care provided to SGMY. Expanded implementation with continued evaluation is recommended. The HAI may also be adapted to address specific health needs of SGMY beyond sexual health.

Cell patterning by surface tension pinning in microfluidic channels.

We present a simple method to pattern multiple cell populations inside a microfluidic channel. The microchannel is partially filled with a cell suspension, and the position of the liquid boundary remains pinned by surface tension. Cells then adhere only in the filled portion of the channel, producing a very sharp boundary. The process can be performed in an unmodified microfluidic channel with only a manual syringe and can be repeated multiple times to pattern cocultures or tricultures. We demonstrate the patterning method with two different mammalian cell types, 3T3 fibroblasts and NMuMG epithelial cells, and channel heights of 1.5 mm and 0.5 mm. We anticipate that this method will be useful for studies of cell-cell interactions where precise control of the fluidic microenvironment is required.

Fetomaternal hemorrhage among pregnant women in Accra, Ghana.

OBJECTIVE: To determine the occurrence of and risk factors for fetomaternal hemorrhage (FMH) among pregnant women at Korle Bu Teaching Hospital in Accra, Ghana. METHODS: A prospective study of FMH among pregnant women without hemoglobinopathies in the second trimester attending prenatal care between October 2015 and May 2016 performed using the Kleihauer-Betke test. Volume of FMH was estimated; ABO and Rh blood groups of participants were determined. A data extraction form and structured questionnaire were used to collect demographic and clinical information, and data on risk factors. RESULTS: Of 151 participants, 32 (21.2%) had FMH. Almost 18% (n=27) had FMH at baseline (16-24 weeks), 10% (10/100) at 28-32 weeks, and 11.1% (11/99) at 34-37 weeks of pregnancy. Volume of FMH was less than 30 mL in 30 (19.9%) women, whereas it was greater than 30 mL in 2 (1.3%) women. No identifiable patient-specific factors were associated with occurrence of FMH. CONCLUSION: FMH is common among pregnant women in Ghana and can occur as early as 16 weeks, without identifiable risk factors. RhD negative women who may be pregnant with RhD positive fetuses should be screened early in pregnancy, not only at delivery, for occurrence of FMH.

Microfluidic filter device with nylon mesh membranes efficiently dissociates cell aggregates and digested tissue into single cells.

Tissues are increasingly being analyzed at the single cell level in order to characterize cellular diversity and identify rare cell types. Single cell analysis efforts are greatly limited, however, by the need to first break down tissues into single cell suspensions. Current dissociation methods are inefficient, leaving a significant portion of the tissue as aggregates that are filtered away or left to confound results. Here, we present a simple and inexpensive microfluidic device that simultaneously filters large tissue fragments and dissociates smaller aggregates into single cells, thereby improving single cell yield and purity. The device incorporates two nylon mesh membranes with well-defined, micron-sized pores that operate on aggregates of different size scales. We also designed the device so that the first filtration could be performed under tangential flow to minimize clogging. Using cancer cell lines, we demonstrated that aggregates were effectively dissociated using high flow rates and pore sizes that were smaller than a single cell. However, pore sizes that were less than half the cell size caused significant damage. We then improved results by passing the sample through two filter devices in series, with single cell yield and purity predominantly determined by the pore size of the second membrane. Next, we optimized performance using minced and digested murine kidney tissue samples, and determined that the combination of 50 and 15 µm membranes was optimal. Finally, we integrated these two membranes into a single filter device and performed validation experiments using minced and digested murine kidney, liver, and mammary tumor tissue samples. The dual membrane microfluidic filter device increased single cell numbers by at least 3-fold for each tissue type, and in some cases by more than 10-fold. These results were obtained in minutes without affecting cell viability, and additional filtering would not be required prior to downstream applications. In future work, we will create complete tissue analysis platforms by integrating the dual membrane microfluidic filter device with additional upstream tissue processing technologies, as well as downstream operations such as cell sorting and detection.

Outbreak of Salmonella Chailey infections linked to precut coconut pieces - United States and Canada, 2017†.

Foodborne salmonellosis causes an estimated one million illnesses and 400 deaths annually in the United States (US). During March-May 2017, an outbreak of 19 cases of Salmonella Chailey associated with precut coconut pieces from a single grocery store chain occurred in the United States and Canada. The chain voluntarily recalled precut coconut pieces. This was the first time that coconut has been associated with a Salmonella outbreak in the United States or Canada. In recent years, salmonellosis outbreaks have been caused by foods not typically associated with Salmonella. Raw coconut should now be considered in investigations of Salmonella outbreaks among fresh food consumers.

Microfluidic device for rapid digestion of tissues into cellular suspensions.

The ability to harvest single cells from tissues is currently a bottleneck for cell-based diagnostic technologies, and remains crucial in the fields of tissue engineering and regenerative medicine. Tissues are typically broken down using proteolytic digestion and various mechanical treatments, but success has been limited due to long processing times, low yield, and high manual labor burden. Here, we present a novel microfluidic device that utilizes precision fluid flows to improve the speed and efficiency of tissue digestion. The microfluidic channels were designed to apply hydrodynamic shear forces at discrete locations on tissue specimens up to 1 cm in length and 1 mm in diameter, thereby accelerating digestion through hydrodynamic shear forces and improved enzyme-tissue contact. We show using animal organs that our digestion device with hydro-mincing capabilities was superior to conventional scalpel mincing and digestion based on recovery of DNA and viable single cells. Thus, our microfluidic digestion device can eliminate or reduce the need to mince tissue samples with a scalpel, while reducing sample processing time and preserving cell viability. Another advantage is that downstream microfluidic operations could be integrated to enable advanced cell processing and analysis capabilities. We envision our novel device being used in research and clinical settings to promote single cell-based analysis technologies, as well as to isolate primary, progenitor, and stem cells for use in the fields of tissue engineering and regenerative medicine.

Hypoxic Pulmonary Vasoconstriction Does Not Explain All Regional Perfusion Redistribution in Asthma.

RATIONALE: Regional hypoventilation in bronchoconstricted patients with asthma is spatially associated with reduced perfusion, which is proposed to result from hypoxic pulmonary vasoconstriction (HPV). OBJECTIVES: To determine the role of HPV in the regional perfusion redistribution in bronchoconstricted patients with asthma. METHODS: Eight patients with asthma completed positron emission tomographic/computed tomographic lung imaging at baseline and after bronchoconstriction, breathing either room air or 80% oxygen (80% O2) on separate days. Relative perfusion, specific ventilation (sV), and gas fraction (Fgas) in the 25% of the lung with the lowest specific ventilation (sVlow) and the remaining lung (sVhigh) were quantified and compared. MEASUREMENTS AND MAIN RESULTS: In the sVlow region, bronchoconstriction caused a significant decrease in sV under both room air and 80% O2 conditions (baseline vs. bronchoconstriction, mean ± SD, 1.02 ± 0.20 vs. 0.35 ± 0.19 and 1.03 ± 0.20 vs. 0.32 ± 0.16, respectively; P < 0.05). In the sVlow region, relative perfusion decreased after bronchoconstriction under room air conditions and also, to a lesser degree, under 80% O2 conditions (1.02 ± 0.19 vs. 0.72 ± 0.08 [P < 0.001] and 1.08 ± 0.19 vs. 0.91 ± 0.12 [P < 0.05], respectively). The Fgas increased after bronchoconstriction under room air conditions only (0.99 ± 0.04 vs. 1.00 ± 0.02; P < 0.05). The sVlow subregion analysis indicated that some of the reduction in relative perfusion after bronchoconstriction under 80% O2 conditions occurred as a result of the presence of regional hypoxia. However, relative perfusion was also significantly reduced in sVlow subregions that were hyperoxic under 80% O2 conditions. CONCLUSIONS: HPV is not the only mechanism that contributes to perfusion redistribution in bronchoconstricted patients with asthma, suggesting that another nonhypoxia mechanism also contributes. We propose that this nonhypoxia mechanism may be either direct mechanical interactions and/or unidentified intercellular signaling between constricted airways, the parenchyma, and the surrounding vasculature.

Compartmentalized Culture of Perivascular Stroma and Endothelial Cells in a Microfluidic Model of the Human Endometrium.

The endometrium is the inner lining of the uterus. Following specific cyclic hormonal stimulation, endometrial stromal fibroblasts (stroma) and vascular endothelial cells exhibit morphological and biochemical changes to support embryo implantation and regulate vascular function, respectively. Herein, we integrated a resin-based porous membrane in a dual chamber microfluidic device in polydimethylsiloxane that allows long term in vitro co-culture of human endometrial stromal and endothelial cells. This transparent, 2-µm porous membrane separates the two chambers, allows for the diffusion of small molecules and enables high resolution bright field and fluorescent imaging. Within our primary human co-culture model of stromal and endothelial cells, we simulated the temporal hormone changes occurring during an idealized 28-day menstrual cycle. We observed the successful differentiation of stroma into functional decidual cells, determined by morphology as well as biochemically as measured by increased production of prolactin. By controlling the microfluidic properties of the device, we additionally found that shear stress forces promoted cytoskeleton alignment and tight junction formation in the endothelial layer. Finally, we demonstrated that the endometrial perivascular stroma model was sustainable for up to 4 weeks, remained sensitive to steroids and is suitable for quantitative biochemical analysis. Future utilization of this device will allow the direct evaluation of paracrine and endocrine crosstalk between these two cell types as well as studies of immunological events associated with normal vs. disease-related endometrial microenvironments.

Recreational drug use and chemsex among HIV-infected in-patients: a unique screening opportunity.

OBJECTIVES: While a high rate of recreational drug use (RDU) has been documented among HIV-infected out-patients, particularly in men who have sex with men (MSM), there is a distinct lack of data for HIV-infected in-patients. Hospital admission offers a unique opportunity to engage drug users. We aimed to establish and characterize RDU among new admissions to a large dedicated London HIV in-patient unit and compare it to RDU among general medical admissions to inform clinical pathways. METHODS: A prospective opt-out survey was administered to all new HIV-positive admissions over a 10-week period (cases) and all medical Acute Assessment Unit admissions over two 24-h periods (controls). All provided consent for urine toxicology upon admission. RESULTS: Data were collected in 59 of 65 (91%) newly admitted HIV-positive individuals and in 48 of 54 (89%) non-HIV-positive medical admissions. HIV-infected in-patients were more likely than non-HIV-positive medical admissions to be male (P < 0.0001) (71% MSM), to be younger (P < 0.0001), to report current RDU (41 vs. 10%, respectively; P = 0.0001), to have a positive urine toxicology screen (19 vs. 2%, respectively; P = 0.0091) and to be a drug-related admission (15% vs. none; P = 0.004). Thirteen of 26 HIV-infected current recreational drug users admitted to sexualized drug taking and nine to injecting drugs. Twenty-seven per cent (seven of 26) were known to drug services. Crystal methamphetamine, mephedrone, gamma butyrolactone/gamma hydroxybutyrate and ketamine were exclusively taken by MSM. In total, 13 of 59 HIV-infected in-patients had current or past infection with hepatitis C virus, of whom 92% reported lifetime drug use. CONCLUSIONS: These data strongly support the use of formal screening and drug service referral pathways at the time of admission to hospital to engage HIV-positive drug users.

Sequential Revision of Belief, Trust Type, and the Order Effect.

Objective To investigate how people's sequential adjustments to their position are impacted by the source of the information. Background There is an extensive body of research on how the order in which new information is received affects people's final views and decisions as well as research on how they adjust their views in light of new information. Method Seventy college-aged students, 60% of whom were women, completed one of eight different randomly distributed booklets prepared to create the eight different between-subjects treatment conditions created by crossing the two levels of information source with the four level of order conditions. Based on the information provided, participants estimated the probability of an attack, the dependent measure. Results Confirming information from an expert intelligence officer significantly increased the attack probability from the initial position more than confirming information from a longtime friend. Conversely, disconfirming information from a longtime friend decreased the attack probability significantly more than the same information from an intelligence officer. Conclusion It was confirmed that confirming and disconfirming evidence were differentially affected depending on information source, either an expert or a close friend. The difference appears to be due to the existence of two kinds of trust: cognitive-based imbued to an expert and affective-based imbued to a close friend. Application Purveyors of information need to understand that it is not only the content of a message that counts but that other forces are at work such as the order in which information is received and characteristics of the information source.

Patterning of sharp cellular interfaces with a reconfigurable elastic substrate.

Micropatterned cocultures are a useful experimental tool for the study of cell-cell interactions. Patterning methods often rely on sequential seeding of different cell types or removal of a barrier separating two populations, but it is difficult to pattern sharp interfaces between pure populations with low cross-contamination when using these approaches. Patterning by the use of reconfigurable substrates can overcome these limitations, but such methods can be costly and challenging to employ in a typical biology laboratory. Here, we describe a low-cost and simple-to-use reconfigurable substrate comprised of a transparent elastic material that is partially cut to form a slit that opens when the device is stretched. The slit seals back up when released, allowing two initially separate, adherent cell populations to be brought together to form a contact interface. Fluorescent imaging of patterned cocultures demonstrates the early establishment of a sharp cellular interface. As a proof of principle, we demonstrate the use of this device to study competition at the interface of two stem cell populations.