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Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Purpose: Transgender youth face significant health disparities and multiple barriers to receiving quality health care. Gender identity disclosure to health care providers (HCPs) is an important step in creating affirming relationships for transgender youth. The objectives of this study were to (1) determine the prevalence of voluntary disclosure and intentional avoidance to HCPs outside of gender clinics, (2) identify factors associated with voluntary disclosure and intentional avoidance, and (3) elucidate strategies to increase comfort with disclosure., Methods: A cross-sectional survey was administered to transgender youth aged 12-26 years. Bivariate analyses were conducted using χ 2 or Fisher's exact tests. Two logistic regression models for each outcome variable were used to examine factors associated with voluntary disclosure and intentional avoidance., Results: Two thirds (65%) of youth (N = 153) identified as transmasculine, and 57% were under 18 years. Three-quarters (78%) had voluntarily disclosed their gender identity to an HCP outside of gender clinic, whereas 46% had intentionally avoided disclosure. Odds ratios (ORs) of ever having disclosed were lower for participants ≥18 years (OR = .33; 95% confidence interval [CI]: .11-.98), those out to fewer people (OR = .12; 95% CI: .02-.81) and out for <1 year (OR = .03; 95% CI: .004-.31). Odds of intentional avoidance were lower among youth with higher perceived parental support (OR = .83; 95% CI: .70-.98)., Conclusion: A majority of transgender youth reported having voluntarily disclosed their gender identity to an HCP outside of gender clinic, but almost half reported having intentionally avoided disclosure when they felt it was important. Parental support may play a protective role in mitigating avoidance., (Copyright © 2020 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: Increasing numbers of transgender youth are receiving hormone therapy in accordance with national and international guidelines. This study sought to determine the effect of testosterone on body mass index (BMI) z-score in transmasculine adolescents at 6 and 12 months after initiation., Methods: A retrospective chart review collected anthropomorphic data on transmasculine adolescents, aged 13 to 19 years, before and during testosterone use. These measurements were used to create a linear mixed model to explore the change in BMI z-score after initiating testosterone., Results: The increase in BMI z-score in transmasculine adolescents was significantly higher after six months of testosterone use, but there was no significant change between baseline and 12 months., Conclusions: Additional study is needed to understand the full short- and long-term impact of testosterone use on BMI z-score in transmasculine adolescents to provide appropriate informed consent and develop interventions to improve health outcomes., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Body mass index (BMI) is defined as weight (kg)/height 2 (m 2 ). Differences in BMI percentiles between sexes confound the diagnosis of weight-related disorders in transgender youth because choosing the appropriate chart is challenging. Data on BMI measures are needed for transgender youth, but there are no guidelines on how to collect or report this data. We use two theoretical cases to assert that health care providers and researchers should consider use of both male and female growth charts for transgender youth, particularly for individuals at the extremes of weight., Competing Interests: No competing financial interests exist., (© Kacie M. Kidd et al. 2019; Published by Mary Ann Liebert, Inc.)

The number of gender diverse and transgender youth presenting for treatment are increasing. This is a vulnerable population with unique medical needs; it is essential that all pediatricians attain an adequate level of knowledge and comfort caring for these youth so that their health outcomes may be improved. There are several organizations which provide clinical practice guidelines for the treatment of transgender youth including the WPATH and the Endocrine Society and they recommend that certain eligibility criteria should be met prior to initiation of gender affirming hormones. Medical intervention for transgender youth can be broken down into stages based on pubertal development: pre-pubertal, pubertal and post-pubertal. Pre-pubertally no medical intervention is recommended. Once puberty has commenced, youth are eligible for puberty blockers; and post-pubertally, youth are eligible for feminizing and masculinizing hormone regimens. Treatment with gonadotropin releasing hormone agonists are used to block puberty. Their function is many-fold: to pause puberty so that the youth may explore their gender identity, to delay the development of (irreversible) secondary sex characteristics, and to obviate the need for future gender affirmation surgeries. Masculinizing hormone regimens consists of testosterone and feminizing hormone regimens consist of both estradiol as well as spironolactone. In short term studies gender affirming hormone treatment with both estradiol and testosterone has been found to be safe and improve mental health and quality of life outcomes; additional long term studies are needed to further elucidate the implications of gender affirming hormones on physical and mental health in transgender patients. There are a variety of surgeries that transgender individuals may desire in order to affirm their gender identity; it is important for providers to understand that desire for medical interventions is variable among persons and that a discussion about individual desires for surgical options is recommended., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Study Objective: We sought to improve emergency care for adolescents with abnormal uterine bleeding (AUB) by developing a clinical effectiveness guideline (CEG) and assessing its effect on quality of care., Design, Setting, Participants, and Interventions: A stakeholder engagement group designed a CEG algorithm for emergency AUB management. Pediatric residents received CEG training and their knowledge and attitudes were assessed using pre- and post intervention surveys. International Classification of Diseases ninth and 10th revision codes identified electronic health record data for patients who presented to the pediatric emergency department for AUB 6 months before and after CEG implementation. A weighted, 20-point scoring system consisting of prioritized aspects of history, laboratory studies, and management was developed to quantify the quality of care provided., Main Outcome Measures: Descriptive statistics, χ 2 test, Wilcoxon rank sum test, and a run chart were used for analysis., Results: Pediatric residents reported higher confidence and knowledge scores post CEG implementation. Of the 91 patients identified, 62 met inclusion criteria. Median score was 14 ± 7 before CEG implementation and 15.5 ± 6 after. The Wilcoxon rank sum test showed a difference in AUB evaluation and management scores (P = .09) after implementation of the CEG. Run chart data showed no shifts or trends (overall median score, 14 points). Pre- and post implementation, points were deducted most frequently for not assessing personal/family clotting disorder history. The largest improvements in care were with appropriate medication dosing and disposition., Conclusion: We designed a CEG and educational intervention for AUB management in a pediatric emergency department. These findings suggest our CEG might be an effective tool to improve emergency AUB care for adolescents and could increase trainees' confidence in managing this condition, although additional cycles are needed., (Copyright © 2018 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

The aim of this study was to determine the effect of ischemic preconditioning (IPC) on several measures of aerobic function and 4-km cycling time-trial performance. An acute cross-over design was adopted involving eight well-trained cyclists (age 27.0 ± 7.0 years) who completed incremental and square-wave exercise tests for determination of peak O 2 uptake (VO 2peak ), ventilatory threshold (VT) and moderate- and heavy-intensity domain VO 2 kinetics, as well as 4-km time trials. All were preceded by IPC, or sham-IPC, involving repeated bouts of thigh blood flow occlusion, interspersed with reperfusion. There was no significant difference between IPC and sham-IPC with respect to VO 2peak (4.4 ± 0.6 L min -1 vs 4.4 ± 0.5 L min -1 , effect size - 0.01 ± 0.09), VT (3.4 ± 0.6 L min -1 vs 3.5 ± 0.5 L min -1 , effect size 0.07 ± 0.28), cycling economy (4.9 ± 4.9%, ES 0.24 ± - 0.24, P > 0.05) or any moderate-domain VO 2 kinetic parameter. During heavy-intensity exercise, a reduced end-exercise VO 2 , slow component amplitude and overall gain was observed following IPC compared to sham-IPC. Though not statistically significant, there was a possibly beneficial effect of IPC on 4-km time-trial mean power output (2.2 ± 2.0%; effect size: 0.18 ± 0.15, P > 0.05). The observed reduction in VO 2 slow component and tendency for improved economy and 4-km time-trial performance, albeit small, suggests that acute IPC shows some potential as a performance-enhancing priming strategy for well-trained cyclists prior to high-intensity exercise.

The synthesis and structural characterization of a series of lanthanide complexes formed from YbX3 salts (X = NO3(-) or CF3SO3(-)) and the isomeric 4,4'-bipyridine-N,N'-dioxide (4,4'-bpdo) or 3,3'-bipyridine-N,N'-dioxide (3,3'-bpdo) ligands has been undertaken by X-ray crystallography. Depending on the choice of anion, the complexes isolated with L = 4,4'-bpdo yield either an extended 1D linear chain {[Yb(L)(NO3)3(CH3OH)]}∞ or a coordination polymer network {[Yb(L)4](CF3SO3)3}∞ which are isostructural with previously reported compounds using other Ln(iii) metals. The isomeric 3,3'-bpdo ligand yields a similar extended 1D linear chain {[Yb(L)(NO3)3(CH3OH)]}∞ when NO3(-) is used as the anion. However, when substituted by the typically non-coordinating CF3SO3(-) anion, inner sphere coordination yields a coordination polymer {[Yb(L)3(CF3SO3)](CF3SO3)2}∞ with a (2(2)·4(8)·6(5)) network topology. In an effort to rationalize the observed difference in coordinating behavior, DFT calculations of the isomeric bipyridyl-N,N'-dioxide ligands have been undertaken, but revealed no significant differences in the charge distribution of the coordinating N-oxide groups. Lastly, sensitized Yb(iii) emission in the Near Infra-Red (NIR) region operating via the well-known antennae effect has been observed and compared for two of the coordination polymers.

Background: The lesbian, gay, bisexual, and transgender (LGBT) community is a diverse, underserved, and often stigmatized group that faces many barriers to accessing quality healthcare. Not only are few practicing physicians knowledgeable about and sensitive to the needs of LGBT patients, but medical school curricula include limited LGBT-related content. Our goals were to use LGBT-related educational sessions to gauge undergraduate medical students' interest and their perceptions of relevance and to eventually incorporate this topic into the curriculum., Methods: We provided 4 educational sessions to preclinical medical students at the Tulane University School of Medicine: 3 optional, 1-hour didactic sessions and 1 standardized patient encounter. Following sessions 1-3, students completed electronic feedback forms; we then analyzed their responses thematically., Results: THE THEMATIC ANALYSIS OF STUDENT RESPONSES IDENTIFIED KEY THEMES: a current lack of exposure to LGBT content, agreement that LGBT material is applicable to students' work as future physicians, and the relevance of including such information in the medical school curriculum., Conclusion: The study validated the underlying assumption that LGBT educational sessions are meaningful to and valued by medical students.