Grimeswillard8003

To define, benchmark, and publicize elements of quality care (i.e., "good practices") for pediatric patients with disorders/differences of sex development (DSD).

Principles of quality care were identified by literature review; consensus exists for 11 good practices and adherence was evaluated through online survey of 21 North American clinical sites.

Strong uptake was observed for many practices, particularly specialty participation (n ≥ 17 of 21 sites for most core specialties); point of contact (n = 18); expertise in gender dysphoria/dissatisfaction (n = 20); and DSD-specific continuing medical education (n = 18). Greater variability was apparent for frequency of peer support referrals (n = 12 universally practiced); standardized questionnaires for routine assessment of psychosocial adaptation (n = 13) and gender development (n = 10); consistently clarifying patient/family values in decision-making (n = 15); genital exam protocols that exclude trainee education as primary reason (n = 15); and internal patient-tracking efforts (n = 5-10 of 20 sites).

This study employed a novel approach to designate DSD good practices and identified areas of consistency and variation in these DSD clinical practices. Good practice benchmarking facilitates quality assessment within and across sites, promotes continuous improvement, and empowers stakeholders in locating and delivering high quality care.

This study employed a novel approach to designate DSD good practices and identified areas of consistency and variation in these DSD clinical practices. Good practice benchmarking facilitates quality assessment within and across sites, promotes continuous improvement, and empowers stakeholders in locating and delivering high quality care.Despite an increasing amount of research devoted to middle-distance training (herein the 800 and 1500 m events), information regarding the training methodologies of world-class runners is limited. Therefore, the objective of this review was to integrate scientific and best practice literature and outline a novel framework for understanding the training and development of elite middle-distance performance. Herein, we describe how well-known training principles and fundamental training characteristics are applied by world-leading middle-distance coaches and athletes to meet the physiological and neuromuscular demands of 800 and 1500 m. Large diversities in physiological profiles and training emerge among middle-distance runners, justifying a categorization into types across a continuum (400-800 m types, 800 m specialists, 800-1500 m types, 1500 m specialists and 1500-5000 m types). Larger running volumes (120-170 vs. 50-120 km·week-1 during the preparation period) and higher aerobic/anaerobic training distribution (90/10 vs. 60/40% of the annual running sessions below vs. at or above anaerobic threshold) distinguish 1500- and 800-m runners. Lactate tolerance and lactate production training are regularly included interval sessions by middle-distance runners, particularly among 800-m athletes. In addition, 800-m runners perform more strength, power and plyometric training than 1500-m runners. Although the literature is biased towards men and "long-distance thinking," this review provides a point of departure for scientists and practitioners to further explore and quantify the training and development of elite 800- and 1500-m running performance and serves as a position statement for outlining current state-of-the-art middle-distance training recommendations.Aberration in the asymmetric nature of the human brain is associated with several mental disorders, including attention deficit/hyperactivity disorder (ADHD). In ADHD, these aberrations are thought to reflect key hemispheric differences in the functioning of attention, although the structural and functional bases of these defects are yet to be fully characterized. In this study, we applied a comprehensive meta-analysis to multimodal imaging datasets from 627 subjects (303 typically developing control [TDCs] and 324 patients with ADHD) with both resting-state functional and structural magnetic resonance imaging (MRI), from seven independent publicly available datasets of the ADHD-200 sample. We performed lateralization analysis and calculated the combined effects of ADHD on each of three cortical regional measures (grey matter volume - GMV, fractional amplitude of low frequency fluctuations at rest -fALFF, and regional homogeneity -ReHo). We found that compared with TDC, 68%,73% and 66% of regions showed statistically significant ADHD disorder effects on the asymmetry of GMV, fALFF, and ReHo, respectively, (false discovery rate corrected, q = 0.05). Forty-one percent (41%) of regions had both structural and functional abnormalities in asymmetry, located in the prefrontal, frontal, and subcortical cortices, and the cerebellum. Furthermore, brain asymmetry indices in these regions were higher in children with more severe ADHD symptoms, indicating a crucial pathoplastic role for asymmetry. Our findings highlight the functional asymmetry in ADHD which has (1) a strong structural basis, and thus is likely to be developmental in nature; and (2) is strongly linked to symptom burden and IQ and may carry a possible prognostic value for grading the severity of ADHD.We encountered 3 cases of acute kidney injury that occurred after treatment with a SGLT2 inhibitor. In case 1, serum creatinine increased from 1.65 to 3.0 mg/dL, in case 2, serum creatinine increased from 1.03 to 1.21 mg/dL, and in case 3, serum creatinine increased from 0.8 to 1.1 mg/dL. 3,4Dichlorophenylisothiocyanate Renal biopsy showed isometric vacuolization on tubules, that was completely negative for Periodic acid-Schiff (PAS) stain in case 1, and was partially negative for PAS stain in case 2 and 3, consistent with osmotic vacuolization. Immunohistochemical analysis showed positive staining for CD138 and CD10 indicating the proximal tubules in the vacuolar lesions. 3 patients were obese with body mass index of more than 30, and showed an increase in serum renin. In conclusion, in type II diabetes mellitus (T2DM), individuals that remain within their standard weight range, SGLT2 inhibitor treatment does not result in osmotic vacuolization of proximal tubular epithelial cells and AKI. However, treatment with a SGLT2 inhibitor may cause damage of the proximal tubules resulting in AKI in T2DM individuals who do not remain within their standard weight range, due to an overdose lavage of sugar in the urine and dehydration.