Discordant conceptualisations of eating disorder recovery and their influence on the construct of terminality.

Eating disorders (EDs) are complex, multifaceted conditions that significantly impact quality-of-life, often co-occur with multiple medical and psychiatric diagnoses, and are associated with a high risk of medical sequelae and mortality. Fortunately, many people recover even after decades of illness, although there are different conceptualisations of recovery and understandings of how recovery is experienced. Differences in these conceptualisations influence categorisations of ED experiences (e.g., longstanding vs. short-duration EDs), prognoses, recommended treatment pathways, and research into treatment outcomes. Within recent years, the proposal of a 'terminal' illness stage for a subset of individuals with anorexia nervosa and arguments for the prescription of end-of-life pathways for such individuals has ignited debate. Semantic choices are influential in ED care, and it is critical to consider how conceptualisations of illness and recovery and power dynamics influence outcomes and the ED 'staging' discourse. Conceptually, 'terminality' interrelates with understandings of recovery, efficacy of available treatments, iatrogenic harm, and complex co-occurring diagnoses, as well as the functions of an individual's eating disorder, and the personal and symbolic meanings an individual may hold regarding suffering, self-starvation, death, health and life. Our authorship represents a wide range of lived and living experiences of EDs, treatment, and recovery, ranging from longstanding and severe EDs that may meet descriptors of a 'terminal' ED to a variety of definitions of 'recovery'. Our experiences have given rise to a shared motivation to analyse how existing discourses of terminality and recovery, as found in existing research literature and policy, may shape the conceptualisations, beliefs, and actions of individuals with EDs and the healthcare systems that seek to serve them.

Incorporating Sex-Diverse and Gender-Inclusive Perspectives in Higher Education Biology Courses.

Inclusive teaching is teaching in a way that reaches all students in the classroom; this is beneficial for everyone and particularly for those with minoritized identities. Instructors play a critical role in scaffolding how students are exposed to and learn science content in the classroom. In this manuscript we discuss how biology instructors can make their classrooms more inclusive with regard to sex and gender diversity content. Many topics in biology are based on androcentric, heteronormative, and oppressive framing, even though those lenses are more reflective of our own history and culture than they are of the diversity we see in nature. Here, we summarize information presented in the SICB 2024 workshop titled "Incorporating sex diversity and gender inclusivity in biology undergraduate classrooms" and provide instructors with a) rationale for why inclusive teaching matters, b) guidance on how to challenge unscientific views and make their curricula more sex-diverse and gender inclusive, and c) practical and easy-to-implement strategies for discussing "contentious" topics in the classroom. Incorporation of this material will be beneficial for students, for science and medicine, and for accurately representing the diversity found across the tree of life.

Guidelines for research with transgender, gender diverse, and intersex individuals with eating disorders: recommendations from trans and intersex researchers.

Further research is urgently needed to address the disproportionately high rates of eating disorders (EDs) among transgender, gender diverse, and intersex (TGDI) individuals in comparison to cisgender, endosex (non-intersex) populations. As TGDI advocates, academics, and clinicians with lived/living experience with EDs, we propose a set of recommendations to guide ethical research specifically about EDs and disordered eating behaviors in TGDI populations. The guidelines included here aim to educate non-TGDI researchers and support TGDI researchers seeking to carry out such research. Considerations for study design, planning, data collection, and dissemination are included.

Sex and Biology: Broader Impacts Beyond the Binary.

What are the implications of misunderstanding sex as a binary, and why is it essential for scientists to incorporate a more expansive view of biological sex in our teaching and research? This roundtable will include many of our symposium speakers, including biologists and intersex advocates, to discuss these topics and visibilize the link between ongoing reification of dyadic sex within scientific communities and the social, political, and medical oppression faced by queer, transgender, and especially intersex communities. As with the symposium as a whole, this conversation is designed to bring together empirical research and implementation of equity, inclusion, and justice principles, which are often siloed into separate rooms and conversations at academic conferences. Given the local and national attacks on the rights of intersex individuals and access to medical care and bodily autonomy, this interdisciplinary discussion is both timely and urgent.

Inaccessibility of care and inequitable conceptions of suffering: a collective response to the construction of "terminal" anorexia nervosa.

Informed by our lived experiences with eating disorders, our work providing direct support to communities underserved by existing healthcare structures, and our commitment to social justice, we are deeply troubled by several aspects of the proposed characteristics for "terminal" anorexia nervosa outlined by Gaudiani et al. in Journal of Eating Disorders (10:23, 2022). We have identified two substantial areas of concern in the proposed characteristics provided by Gaudiani et al. and the subsequent publication by Yager et al. (10:123, 2022). First, the original article and the subsequent publication fail to adequately address the widespread inaccessibility of eating disorder treatment, the lack of parameters for what constitutes "high quality care", and the prevalence of trauma experienced in treatment settings for those who do access treatment. Second, the characteristics proposed for "terminal" anorexia nervosa are constructed largely based on subjective and inconsistent valuations of suffering which build on and contribute to harmful and inaccurate eating disorder stereotypes. Overall, we believe these proposed characteristics in their current form stand to detract from, rather than assist, the ability of patients and providers to make informed, compassionate, and patient-centered decisions about safety and autonomy both for individuals with enduring eating disorders and for individuals with more recently diagnosed eating disorders.

A metastatic secretory gastric plasmacytoma with aberrant CD3 expression in a dog.

A 10-year-old crossbred dog was presented with a 6-week history of hematemesis, melena, anorexia, and lethargy. Clinical evaluation revealed a gastric mass with a regional lymphadenomegaly as well as a monoclonal gammopathy manifesting as hyperglobulinemia. Cytologic and histopathologic analyses were consistent with a round cell neoplasm; neoplastic cells showed nuclear immunoreactivity for MUM1 and diffuse cytoplasmic reactivity for CD3. Polymerase chain reactions performed on fixed and fresh tissue identified a clonal rearrangement with an IgH primer set. An extramedullary plasmacytoma (EMP) was confirmed by cellular morphology and molecular diagnostics. Following an objective response to chemotherapy, the dog was euthanized 8 months after diagnosis, and a postmortem examination confirmed the clinical findings. This is the first reported case of a monoclonal gammopathy secondary to a gastric EMP coupled with aberrant expression of CD3 in an aggressive plasmacytic tumor, and highlights the utility of molecular diagnostics for classifying atypical hemolymphoid neoplasms.

Intracoelomic anaplastic sarcoma in an intersex Madagascar tree boa (Sanzinia madagascariensis).

An adult Madagascar tree boa (Sanzinia madagascariensis) underwent coeliotomy for investigation of a coelomic mass. At surgery, a large mass originating from the peri-pancreatic adipose tissue and involving the gall bladder was removed. The snake did not recover from general anesthesia. A complete postmortem was performed, and samples were submitted to the University of Glasgow for histopathology. On histological examination, the mass was composed of adipose tissue infiltrated with a poorly demarcated spindle cell neoplasm. The neoplastic cells were highly pleomorphic with abundant cytoplasm and frequent clear cytoplasmic vacuoles, suggestive of adipocyte origin. Immunohistochemical characterization of the mass was inconclusive. Metastatic neoplastic cells were present within vessels in the liver, lungs, and brain. As an incidental finding, the gonads contained both maturing ovarian follicles and seminiferous tubules with intact germinal epithelium and evidence of spermatogenesis, along with other features of male and female gonad anatomy. The current report describes a rare neoplasm in snakes within an intersex Madagascar tree boa.

Bronchial auscultation: an effective adjunct to speech and language therapy bedside assessment when detecting dysphagia and aspiration?

Detection of aspiration by bedside examination has frequently been found to be clinically inadequate when compared with videofluoroscopy (VF) as the gold standard. In Doncaster, UK, a new multidisciplinary approach to bedside assessment was devised using physiotherapists (PT) performing bronchial auscultation (BA) in combination with the speech and language therapists' (SLT) clinical examination of dysphagia. In this study 105 patients referred for VF examination of dysphagia were first tested by the BA team. Comparison was made between the results of the VF team and the results of the BA team in classifying the patients as "aspirating" or at "risk of aspirating." A high degree of agreement was found for risk of aspiration (sensitivity 87%), although specificity was low (37%). BA was highly specific (88%) when confirming the absence of aspiration, but sensitivity to the presence of aspiration was 45%. From the 105 patients tested, the BA team would have failed to modify the diet in only one subject who was aspirating and would have unnecessarily modified the diet of 17 subjects. In conclusion, in the sample population of individuals with complex dysphagia, the BA team approach reliably detected patients identified by VF as at risk of aspiration. In the group of patients identified by VF as aspirating, the BA team proved unreliable in detecting the presence of aspiration, although it did reliably identify patients who were not aspirating. BA is a potentially useful clinical tool which requires further research.