It's complicated: The impact of marriage legalization among sexual minority women and gender diverse individuals in the United States.

This mixed-methods study explored perceptions of the impact of marriage legalization in all U.S. states among sexual minority women and gender diverse individuals. Survey data were collected from a nonprobability sample of individuals 18 years or older who identified as lesbian, bisexual, queer, same-sex attracted or something other than exclusively heterosexual-as well as individuals who identified as transgender or gender nonbinary (for example, genderqueer, trans woman, trans man, nonbinary, or gender non-conforming). The analytic sample included 418 participants in an online survey who responded to open-ended questions about the perceived impact of marriage legalization. Qualitative analyses revealed perceptions of marriage legalization that situated individual meanings in the context of broader political and social factors. Four themes represented the complex perceptions of participants about marriage legalization: 1) establishing a victory in civil rights, social inclusion, and acceptance; 2) creating a paradox between positives of legalization and limitations of marriage as an institution; 3) amplifying concerns for unaddressed safety and rights issues; and 4) contributing to the erosion of queer identity and community. Quantitative analyses revealed several differences by demographic characteristics, such as greater concern about the erosion of community among unmarried participants compared to participants who were married. Findings underscore the importance of policies that advance equality for sexual and gender minorities (SGMs), as well as the importance of research exploring how policies are perceived by and impact SGM subpopulations.

Role of an acute assessment and review area for general surgical patients.

BACKGROUND: Increasing demand for acute surgical services is one of the major challenges facing modern health systems. The aim of this study was to assess the impact of implementing a dedicated surgical assessment and review area (SARA) on patient flow for acute general surgical patients at a major teaching hospital in New Zealand. METHODS: A specific area within inpatient surgical beds was redeveloped and staffed by a dedicated surgical team. Prospective data pertaining to patient flow and outcomes were collected (10-month period) and compared with historical controls (preceding 14 months prior to implementation). RESULTS: During the 24-month period 9182 acute general surgical patients were admitted (3836 [41.1%] post implementation of SARA). Subsequent to the introduction of SARA, 865 (22.5%) patients were referred directly from their general practitioner. Length of stay was reduced in all patients from 2.58 to 2.04 days (P < 0.001) and in those who did not require surgery from 2.56 to 1.96 days (P < 0.001). However, the number of days in which the department of surgery had outlying patients increased significantly from 76.7% to 86.3%, P < 0.001. CONCLUSIONS: The introduction of a dedicated SARA significantly reduced hospital stay and improved efficiencies of the emergency department.

Differential contribution of diabetes and the Ren2 gene to glomerular pathology in diabetic (mREN-2)27 rats.

The effect of diabetes mellitus vs the effect of the Ren2 gene on the glomerular pathology of (mREN-2)27 heterozygous male rats is controversial. As discrete diabetes-induced glomerular lesions may have been overlooked, we performed a detailed morphometric analysis of glomeruli in diabetic and non-diabetic heterozygous male (mREN-2)27 rats and their normotensive (non-diabetic and diabetic Sprague-Dawley) controls. Glomeruli were scored by light microscopy for nine discrete histological parameters, some of which were graded for extent and/or severity. Mesangiolysis, segmental hypocellularity, and severe tuft-to-capsule adhesions were specific to diabetes; severe mesangial matrix expansion, glomerulosclerosis, thickening of Bowman's capsule, and dilatation of the urinary space were specific to the Ren2 gene. Hyalinosis and hypercellularity were associated with both diabetes and the Ren2 gene: the effect was additive for hyalinosis and synergistic for hypercellularity. The histological parameters were then combined with two physiological indices (systolic blood pressure and proteinuria) and principle components analysis (PCA) was used to detect correlations between the variables. Four discrete patterns of pathology were identified; three were statistically associated with diabetes and/or the Ren2 gene. These findings suggest that both diabetes and the Ren2 gene make significant, albeit different, contributions to the glomerular pathology of diabetic heterozygous male (mREN-2)27 rats. Despite defining the contribution of diabetes, our work does not support the (mREN-2)27 rat as a model of diabetic nephropathy (DN). Rather, it suggests that these animals remain useful for investigating a particular and limited constellation of DN features.