Consensus Among International Facial Therapy Experts for the Management of Adults with Unilateral Facial Palsy: A Two-Stage Nominal Group and Delphi Study.

Background: Nonsurgical rehabilitation of unilateral peripheral facial palsy (FP) varies globally with controversy regarding best practice. Objective: To develop facial therapist consensus regarding what should be included or excluded in rehabilitation of adults with FP of any etiology. Three clinical presentations: flaccid, paretic and synkinetic, were separately considered. Methodology: A two-stage study was conducted: a nominal group technique (NGT) to develop a questionnaire plus Delphi study. Delphi participants were recruited worldwide, through an experience-based inclusion questionnaire. The final Delphi questionnaire included 166 items for each clinical presentation covering assessment, outcome measures, and interventions, for example, education, eye care, neuromuscular retraining, and electrical modalities. Inclusion/exclusion agreement was set at 80%, indicating participant consensus. Items reaching 70-79% were deemed "near-included/near-excluded." Results: Averaged across all presentations, 24.9% of the 166 items were included, (e.g., Sunnybrook Facial Grading System, patient education and neuromuscular retraining), 26.9% of the 166 items were excluded, (e.g., gross strengthening and electrical stimulation); 48.2% were neither included nor excluded. Conclusion: This study brings together the global community's expertise as a first step toward establishing best practice for specialist facial therapy. It is hoped this will guide clinical decision making, advance research, and optimize patient outcomes in this challenging field.

College Sexual Assault and Campus Climate for Sexual- and Gender-Minority Undergraduate Students.

Sexual- and gender-minority (e.g., lesbian, gay, bisexual, and transgender) undergraduate students are at greater risk for sexual assault victimization than their cisgender (i.e., nontransgender) heterosexual peers. However, few studies have examined how social environments affect sexual assault victimization among sexual- and gender-minority undergraduate students. Nevertheless, this research area was identified as a priority by the Institute of Medicine as well as President Barack Obama's White House Task Force to Protect Students From Sexual Assault. Therefore, we tested the association between college campuses' inclusion of sexual- and gender-minority people and experiences of sexual assault victimization. Cross-sectional surveys were completed by sexual- and gender-minority undergraduate students (N = 1,925) from higher education institutions in all 50 U.S. states in 2010. Our dependent variable was experiencing sexual assault victimization at college. Our primary independent variable was campus climate, measured with items assessing perceived inclusion of sexual- and gender-minority people and witnessing sexual- or gender-minority harassment. We used multivariable logistic regression with generalized estimating equations (accounting for the clustering of students within schools) to estimate the association between campus climate and experiencing sexual assault victimization. Overall, 5.2% of the sample reported ever being victims of sexual assault at college. Controlling for sexual orientation, gender identity, race/ethnicity, and year in school, greater perceived inclusion of sexual- and gender-minority people on campus was associated with significantly lower odds of experiencing sexual assault victimization. Our study suggests that improving campus climate for sexual- and gender-minority individuals may reduce their prevalence of college sexual assault, which has potential implications for college practitioners and administrators as well as sexual assault prevention programs and policies.

School education to increase organ donation and awareness of issues in transplantation in the UK.

BACKGROUND: Over 6000 people are on the United Kingdom organ transplant waiting list, and approximately three people die each day due to a lack of donors. Social deprivation status has been shown to affect registration. The aim of this study was to evaluate the effectiveness of school level education at increasing awareness of the issues surrounding organ donation and organ donor registration, and the effect of socioeconomic deprivation and age has on these outcomes. METHODS: A 15-minute presentation about organ donation and the issues in transplantation was given to secondary school students from the United Kingdom. An optional questionnaire was then distributed. RESULTS: 1155 paper questionnaires were completed from nine schools. The average age was 15.5 (SD = 0.5) years. Before the presentation, 10% of students were on the ODR. Following the presentation, the number of students who were on the ODR or planned to join significantly increased to 56%, independent of age (P < 0.0001). Similarly, there was a significant increase in Likert scores for awareness of the issues in transplantation, independent of age (P < 0.0001). CONCLUSIONS: This early educational presentation significantly increased awareness of the issues in transplantation and planned organ donor registration, independent of age and deprivation.

The influence of campus experiences on the level of outness among trans-spectrum and queer-spectrum students.

This study utilized MANOVA and hierarchical multiple regression to examine the relationships between campus experiences and coming-out decisions among trans- and queer-spectrum undergraduates. Findings revealed higher levels of outness/disclosure for cisgender LGBQ women, and more negative perceptions of campus climate, classroom climate, and curriculum inclusivity and higher use of campus resources for trans-spectrum students. Results also revealed that higher levels of outness significantly related to poorer perceptions of campus responses and campus resources. Implications address the need to foster an encouraging and supportive campus and classroom climate and to improve the relationships with LGBTQ resource centers for trans- and queer-spectrum students.

LGBT Trainee and Health Professional Perspectives on Academic Careers--Facilitators and Challenges.

PURPOSE: Diversity efforts in the academic medicine workforce have often neglected the identification and inclusion of lesbian, gay, bisexual, and transgender (LGBT) health professionals. Many of these professionals have served as educators, researchers, administrators, and leaders at their academic institutions, but their perspectives on the barriers to and facilitators of pursuing academic careers, as well as the perspectives of trainees, have not been explored. METHODS: We applied a purposeful convenience sampling strategy to collect quantitative and qualitative data among LGBT health care professionals (HCP) and trainees. The authors identified trends in data using bivariate analyses and consensual qualitative research methods. RESULTS: We analyzed data from 252 surveys completed by HCPs and trainees and a subset of 41 individuals participated in 8 focus groups. Among survey participants, 100% identified as lesbian, gay, and bisexual (LGB) or queer; 4.5% identified along the trans-spectrum; 31.2% identified as a racial or ethnic minority; 34.1% identified as faculty; and 27.4% as trainees. Eighty-one percent of trainees were interested in academia and 47% of HCPs held faculty appointments. Overall, 79.4% were involved in LGBT-related educational, research, service, or clinical activities. Facilitators of academic careers included engagement in scholarly activities, mentorship, LGBT-specific networking opportunities, personal desire to be visible, campus opportunities for involvement in LGBT activities, and campus climate inclusive of LGBT people. Barriers included poor recognition of LGBT scholarship, a paucity of concordant mentors or LGBT networking opportunities, and hostile or non-inclusive institutional climates. CONCLUSION: LGBT trainees and HCPs contribute significantly to services, programs, and scholarship focused on LGBT communities. LGBT individuals report a desire for a workplace environment that encourages and supports diversity across sexual orientation and gender identities. Institutional policies and programming that facilitate LGBT inclusion and visibility in academia may lead to greater faculty work satisfaction and productivity, higher retention and supportive role modeling and mentoring for the health professions pipeline.

Effects of bisphenol A in the ring-legged earwig, Euborellia annulipes.

Bisphenol A is a known endocrine disruptor in vertebrates that mimics the action of estrogens by interacting with hormone receptors. It also affects reproduction and development in many invertebrate animals, though mechanisms of action are unclear. Terrestrial insects, despite their abundance and profound ecological significance, have been largely overlooked as a group that might be affected by vertebrate endocrine disrupting chemicals. We evaluated potential effects of bisphenol A on the ring-legged earwig, Euborellia annulipes, as a model for terrestrial arthropods. Dosages of 0, 0.12, 1.2 and 12 microg bisphenol A were injected over a 6 day period into newly eclosed males and newly mated (7-day) females. The lowest dosage (0.12 microg) was most effective in eliciting significant effects including reducing weight gain while increasing testis size and seminal vesicle size; higher dosages were less effective or ineffective. In females, treatment with 0.12 microg bisphenol A enhanced clutch size but higher dosages were required to affect the duration of embryogenesis in offspring of treated mothers. Hatching success and the onset of the second reproductive cycle were not affected by treatments. No gross abnormalities were observed as a result of treatment in the reproductive structures of either males or females. Similarly, injection of varying concentrations of estradiol into males enhanced testis length, though it had no effect on seminal vesicle size. Lastly, we administered bisphenol A in drinking water for up to 2 weeks. Surprisingly, as little as 1 microg/L inhibited testis growth; 100 microg/L inhibited ovarian growth.

Effects of selected neuropeptides, mating status and castration on male reproductive tract movements and immunolocalization of neuropeptides in earwigs.

In earwigs, the male reproductive system is complex, comprising accessory glands and long dual intromittent organs for transfer of materials to the female and for removal of rival sperm. We investigated potential factors altering contractions of the male reproductive tracts in vitro. Tracts from 0-day (newly emerged) males displayed relatively little motility in vitro; however, those from 5-day (intermediate stage of sexual maturity) and 8-day (fully mature) males pulsed vigorously. Both 1 and 100 nM proctolin (RYLPT-OH) stimulated the rate of contraction of reproductive tracts from both 5-day and 8-day males. In contrast, 1 nM and 100 nM FGLa AST (cockroach allatostatin) did not affect pulsations. However, 10 microM FGLa AST decreased activity of reproductive tracts. Mating decreased motility of tracts from 5-day old males, but did not alter motility of tracts from 8-day old males. Castration of larvae significantly suppressed reproductive tract motility in subsequent 8-day old adults compared with those of intact or sham-operated adults. Castration also suppressed seminal vesicle size. Lastly, we assessed the presence and distribution of proctolin-like and allatostatin-like immunoreactivity in tissues. Immunoreactivity to FGLa AST and proctolin was widespread, occurring in the brain and ventral ganglia. Surprisingly, we did not detect immunoreactivity to either FGLa AST or proctolin within the reproductive system; however, proctolin immunoreactivity was evident in nerves extending from the terminal ganglion of 8-day, but not 0-day, males. Collectively, these experiments demonstrate that the male earwig reproductive system is an appropriate model for use in addressing sexual maturation and activities in male insects.

Effects of Manduca allatotropin and localization of Manduca allatotropin-immunoreactive cells in earwigs.

Manduca sexta allatotropin (Manse-AT) was first isolated on the basis of its ability to stimulate production of juvenile hormone in that insect. We examined whether this neuropeptide affects corpus allatum activity and visceral muscle contraction in adult females of the earwig, Euborellia annulipes. We also assessed the presence of allatotropin-like material in tissues using immunocytochemistry. Manse-AT at 1 nM to 10 muM stimulated juvenile hormone production in vitro by glands of low activity from 2-day virgin females. In glands of high activity from 12-day mated females, 1 and 100 nM allatotropin were effective, but 10 muM was not. Similarly, hindguts of 2-day and 12-day females significantly increased in motility in vitro in response to Manse-AT. A monoclonal antibody to Manse-AT was used to demonstrate allatotropin-like material throughout the nervous system of 2-day, virgin females. Immunoreactivity was most pronounced within varicosities of the corpora cardiaca and perisympathetic organs. No immunofluorescence was observed in gut tissue. Lastly, we showed that extract of retrocerebral complexes also enhanced in vitro hindgut motility from 2-day virgin females, in a dose-dependent manner. These results indicate material similar to M. sexta allatotropin in female earwigs and that such peptides may modulate juvenile hormone biosynthesis and visceral muscle contractions. Sensitivity to the peptides may change with physiological stage.