Standards of Care for the Health of Transgender and Gender Diverse People, Version 8.

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Universal reshaping of arrested colloidal gels via active doping.

Colloids that interact via a short-range attraction serve as the primary building blocks for a broad range of self-assembled materials. However, one of the well-known drawbacks to this strategy is that these building blocks rapidly and readily condense into a metastable colloidal gel. Using computer simulations, we illustrate how the addition of a small fraction of purely repulsive self-propelled colloids, a technique referred to as active doping, can prevent the formation of this metastable gel state and drive the system toward its thermodynamically favored crystalline target structure. The simplicity and robust nature of this strategy offers a systematic and generic pathway to improving the self-assembly of a large number of complex colloidal structures. We discuss in detail the process by which this feat is accomplished and provide quantitative metrics for exploiting it to modulate the self-assembly. We provide evidence for the generic nature of this approach by demonstrating that it remains robust under a number of different anisotropic short-ranged pair interactions in both two and three dimensions. In addition, we report on a novel microphase in mixtures of passive and active colloids. For a broad range of self-propelling velocities, it is possible to stabilize a suspension of fairly monodisperse finite-size crystallites. Surprisingly, this microphase is also insensitive to the underlying pair interaction between building blocks. The active stabilization of these moderately sized monodisperse clusters is quite remarkable and should be of great utility in the design of hierarchical self-assembly strategies. This work further bolsters the notion that active forces can play a pivotal role in directing colloidal self-assembly.

Step Coalescence by Collective Motion at an Incommensurate Grain Boundary.

Using extended time series scanning transmission electron microscopy, we investigate structural fluctuations at an incommensurate grain boundary in Au. Atomic-resolution imaging reveals the coalescence of two interfacial steps, or disconnections, of different height via coordinated motion of atoms along close-packed directions. Numerical simulations uncover a transition pathway that involves constriction and expansion of a characteristic stacking fault often associated with grain boundaries in face-centered cubic materials. It is found that local atomic fluctuations by enhanced point defect diffusion may play a critical role in initiating this transition. Our results offer new insights into the collective motion of atoms underlying the lateral advance of steps that control the migration of faceted grain boundaries.

Electrochemical detection of catecholamines at sub-5 fg levels by redox cycling.

Two simple modifications to a commercially available thin layer electrochemical detector cell permitted the attainment of ultra-low detection levels of two neurotransmitter catecholamines. An ESA model 5041 analytical cell was modified with a glassy carbon embedded ceramic composite electrode to allow the use of a thin 12 microm gasket. Also a capillary HPLC column was connected directly to the detector cell using a 30 microm i.d. fused silica capillary. These modifications permitted the extensive redox cycling of the electrochemically reversible catecholamines. The ensuing amplified analytical signal allowed the detector cell to achieve efficiencies of 1300%. This resulted in a mass limit of detection of 4 fg and a concentration limit of detection of 116 pM for dopamine with an S/N of 3.

A new analytical cell for carbohydrate analysis with a maintenance-free reference electrode.

An electrochemical cell for carbohydrates that uses a completely maintenance-free reference electrode has been introduced. The cell consists of three electrodes: a gold working electrode, a stainless steel counter electrode, and a palladium reference electrode. Other fluid-path cell components are fabricated of PEEK, Kel-F, and Teflon. The solid state palladium reference electrode requires no filling solutions and hence has no additional junction potentials. This versatile, pH-sensitive reference electrode allows the cell to compensate for pH shifts in the gold working electrode, resulting in better reproducibility. The cell functioned well for more than 2700 injections of a glucose standard over 6 weeks without maintenance of any kind. The control module uses a three pulse waveform that allows for selectable potentials and pulse durations as well as an adjustable delay period prior to the acquisition of the analytical signal.

Further consideration of flavin coenzyme biochemistry afforded by geometry-optimized molecular orbital calculations.

Investigation of lumiflavin and several other isoalloxazine ring derivatives has been carried out by geometry-optimized molecular orbital calculations. The results have provided insight into the flexibility of the flavin cofactor in the reduced and oxidized states, the regions of the fused three-ring system that should play an important role in flavin electron transfers, and the structural and functional role of the xylene and heteroatomic portions of the flavin system. The significance of these results is reviewed in relation to the experimentally identified chemical and biochemical properties of the flavin nucleotide coenzymes.