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Background Gender-affirming hormones do not completely suppress fertility in transgender and gender diverse individuals, highlighting the need for counseling on pregnancy risk and contraceptive options. However, research on current contraceptive care is limited. Studies from the US have identified several barriers to care as well as facilitators, but no studies on this topic have yet been conducted in Europe. This study examined transgender and gender diverse contraceptive care in Germany from the perspective of healthcare providers, assessing its importance and their roles in it, as well as exploring barriers and facilitators. Methods Thirty semistructured qualitative interviews with German healthcare providers were conducted between December 2023 and February 2024. The interview guide included questions on contraceptive care for transgender and gender diverse individuals. Data were analyzed using structuring qualitative content analysis (Kuckartz) with deductive and inductive category development. Results Most interviewees highlighted the need for contraceptive care, depending on various factors such as the type of gender-affirming care applied, sexual practices, and transgender and gender diverse individuals’ desire for pregnancy prevention. Half of the interviewees also offered contraceptive care (depending on their specialization). Numerous barriers to contraceptive care, such as a lack of awareness of contraceptive needs, insufficient research and training programs for medical staff, have been reported, highlighting the importance of facilitators for care such as the implementation of contraceptive counseling as a standard protocol. Conclusion To improve contraceptive care for transgender and gender diverse individuals, the establishment of clear structures and responsibilities, more research, and qualifications among the involved specialties are needed. To gain a comprehensive understanding of the care situation, future research should include the perspectives of transgender and gender diverse individuals. Trial registration We obtained the approval of the Hamburg Medical Council (“Ärztekammer Hamburg”) to conduct our study by means of a “scientific case” (2023-300381-WF, September 11th 2023). Plain english summary Transgender and gender diverse people experience persistent incongruence between their experienced gender identity and their sex assigned at birth - diagnosed as gender incongruence. Many use gender-affirming hormones, such as testosterone or estrogen, to match gender identity and body. These hormones decrease the ability to get pregnant but do not stop it completely. That’s why it is important to give this population information about pregnancy risks and contraceptive options. So far, most research on this topic has come from the US, but little is known about the situation in Europe. This study looked at how healthcare providers in Germany think about contraceptive care for transgender and gender diverse people and how they experience care provision. Thirty healthcare providers (medical doctors and psychologists) in Germany were interviewed between December 2023 and February 2024. Most healthcare providers said they believed contraceptive care was important for transgender and gender diverse people, depending on factors like the type of hormones used and sexual practices, and half of the healthcare providers also offered contraceptive care. Some common challenges included a lack of knowledge about contraception for transgender and gender diverse people, lack of research, and limited training of medical staff. Healthcare providers said that better contraceptive care for transgender and gender-diverse people in Germany needs more research, clear protocols or guidelines, as well as more training for healthcare providers. Future studies should also ask transgender and gender diverse people themselves about their needs and experiences.

A major cause of morbidity and mortality in horses with large colon obstructive lesions is injury to the colonic mucosal barrier from ischemic injury. Since butyrate has been shown to play a critical role in the maintenance of a healthy mucosal barrier, it may play a role in the recovery process. This study’s objective was to determine whether the differences in butyrate concentrations existed between horses with surgical large colon obstructive lesions and healthy horses both during and after surgery. Eleven horses presenting with surgical colic lesions were enrolled; colonic samples were acquired during surgery, and fecal samples were obtained 36 h later. Colonic and fecal samples were also obtained from control groups. Samples were analyzed for butyrate, acetate, and propionate concentrations. There was no significant difference in butyrate content between surgical colonic or fecal samples and controls; however, an alteration in the proportion of SCFAs in relation to one another was noted. These changes in the individual SCFA levels were not statistically significant. The study findings demonstrated that there were no significant differences in butyrate proportions when comparing samples from horses with surgical colic lesions to healthy control horses.

The incidences of both breast cancer and obesity are rising in the UK. Obesity increases the risk of developing breast cancer in the postmenopausal population and leads to worse outcomes in those of all ages treated for early-stage breast cancer. In this review we explore the multifactorial reasons behind this association and the clinical trial evidence for the benefits of physical activity and dietary interventions in the early and metastatic patient groups. As more people with breast cancer are cured, and those with metastatic disease are living longer, cancer survivorship is becoming increasingly important. Therefore, ensuring the long-term implications of cancer and cancer treatment are addressed is vital. Although there remains a lack of definitive evidence that deliberate weight loss after a diagnosis of breast cancer reduces disease recurrence, a number of studies have reported benefits of weight loss and of physical activity. However, the limited data currently available mean that clinicians remain unclear on the optimal lifestyle advice to give their patients. Further high-quality research is needed to provide this evidence base, which will be required to optimise clinical care and for the commissioning of lifestyle interventions in the UK in breast cancer survivors.

Objective: To audit doctors’ knowledge of informed consent. Design: 10 consent scenarios with “true”, “false”, or “don’t know” answers were completed by doctors who care for children at a large district general hospital. These questions tested clinicians’ knowledge of who could give consent in different clinical situations. Setting: Royal United Hospital, Bath, UK. Results: 51 doctors participated (25 paediatricians and 26 other clinicians). Paediatricians scored higher than other clinicians (average correct response 69% v 49%). Only 36% (9/25) of paediatricians and 8% (2/26) of other clinicians realised that the biological father of a child born before 1 December 2003 needed a court order or a parental responsibility agreement to acquire parental responsibility, and thus be able to consent on behalf of his child, if he was not married to the child’s mother. Non-paediatric clinicians were unsure or incorrect when tested on situations where people with parental responsibility do not agree, or where young people (<16 years), who are Fraser competent do not want to consult their parents. Most clinicians did not know that the parents of a 20-year-old man with severe learning difficulties are unable to consent to surgery on his behalf, and many non-paediatricians were unclear on who could give consent when a child lived with foster parents. Conclusion: Clinicians who obtain consent for the treatment of children need to increase their knowledge on who is able to give informed consent to ensure best (legal and safe) practice.

In horses, administering a caudal epidural anesthetic into the sacrococcygeal or first intercoccygeal space provides regional analgesia to the tail and perineum, thus facilitating surgical procedures of the vagina, cervix, urethra, bladder or rectum, as well as in select cases correction of a prolapsed uterus; it is also helpful for managing dystocia. A major benefit of performing caudal epidurals in horses is the ability to complete surgery and other invasive procedures with the patient standing; loss of sensory innervation without affecting motor control foregoes the need for and potential risks associated with general anesthesia. [...]the technique accommodates placement of a catheter in the caudal epidural space for repeated dosing of medications and long-term pain management in horses with specific hindlimb musculoskeletal issues or other conditions.

In 2010 the Mozilla Foundation established the Digital Open Badges concept as a virtual incarnation of physical counterparts such as a paper certificate or a youth organisation merit badge. Digital Open Badges offer embedded, verifiable, metadata containing information such as the issuer and award criteria. Open Badges can be used to reward learning, participation or achievement. They can be stored in various online environments, including the Mozilla 'Backpack' and social media platforms. Open Badges have been used to evidence informal learning, professional development, community and voluntary work. This study is part of an ongoing project at a UK Higher Education Institution (HEI) to evaluate the potential of awarding Digital Open Badges in different contexts across the institution. It was decided to trial Open Badges on a programme run by Learning Development staff in the Library to support high achieving students, acknowledging and rewarding soft-skills acquired as part of the programme. Central to the success of the scheme was 'buy-in' from the students themselves; in order that the Open Badges had meaning and value to the recipients, a Participatory Design approach was adopted to engage students in the development process. Participatory Design is an iterative methodology that 'attempts to examine the tacit, invisible aspects of human activity' (Spinuzzi, 2005, p. 164) and incorporates them into co-produced systems. Soft-skills are an important complement to formal education in the 21st Century workplace (Devedzic et al., 2015). Measuring and rewarding 'soft-skills' such as; critical thinking, communication, leadership and team-working, has proved problematic in the past. Key objectives were to establish a set of soft-skills metrics and, a sustainable approach to acknowledging the acquisition of those skills. This presentation will discuss the outcomes from the study, including an assessment of the sustainability of Open Badges as a mechanism for rewarding soft-skills acquisition in an informal setting.

Sister Patricia was a member of the board of directors of the Western New York Presbyterian Homes, the board of theYoung Women's Christian Association of Buffalo and Erie County, New York, and the board of trustees of D'Youville College. In 1997 Sister Patricia was awarded an honorary doctorate in humane letters by D'Youville College; the citation recognized her distinguished academic career and highlighted her intellectual breadth and acute administrative ability Gifted with sharp wit, true wisdom, and endemic integrity, she was one of the college's strongest proponents of the liberal arts tradition. The author of over two hundred articles illustrating the interrelationship between history and theology, he also published American Catholics: A History of the Roman Catholic Community in the United States in 1981. Since 1978 he was a member of the executive board of the American-Irish Historical Society.

Key functions of antibodies, such as viral neutralisation, depend on high-affinity binding. However, viral neutralisation poorly correlates with antigen affinity for reasons that have been unclear. Here, we use a new mechanistic model of bivalent binding to study  >45 patient-isolated IgG1 antibodies interacting with SARS-CoV-2 RBD surfaces. The model provides the standard monovalent affinity/kinetics and new bivalent parameters, including the molecular reach: the maximum antigen separation enabling bivalent binding. We find large variations in these parameters across antibodies, including reach variations (22–46 nm) that exceed the physical antibody size (~15 nm). By using antigens of different physical sizes, we show that these large molecular reaches are the result of both the antibody and antigen sizes. Although viral neutralisation correlates poorly with affinity, a striking correlation is observed with molecular reach. Indeed, the molecular reach explains differences in neutralisation for antibodies binding with the same affinity to the same RBD-epitope. Thus, antibodies within an isotype class binding the same antigen can display differences in molecular reach, substantially modulating their binding and functional properties. Researchers developed an accurate model to analyse bivalent antibody binding. By analysing many SARS-CoV-2-specific antibodies, they found that their molecular reach can predict their neutralisation potency.

Pathogens frequently associated with multi-drug resistant (MDR) phenotypes, including extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) and Acinetobacter baumannii isolated from horses admitted to horse clinics, pose a risk for animal patients and personnel in horse clinics. To estimate current rates of colonization, a total of 341 equine patients were screened for carriage of zoonotic indicator pathogens at hospital admission. Horses showing clinical signs associated with colic (n = 233) or open wounds (n = 108) were selected for microbiological examination of nostril swabs, faecal samples and wound swabs taken from the open wound group. The results showed alarming carriage rates of Gram-negative MDR pathogens in equine patients: 10.7% (34 of 318) of validated faecal specimens were positive for ESBL-E (94%: ESBL-producing Escherichia coli), with recorded rates of 10.5% for the colic and 11% for the open wound group. 92.7% of the ESBL-producing E. coli were phenotypically resistant to three or more classes of antimicrobials. A. baumannii was rarely detected (0.9%), and all faecal samples investigated were negative for Salmonella, both directly and after two enrichment steps. Screening results for the equine nostril swabs showed detection rates for ESBL-E of 3.4% among colic patients and 0.9% in the open wound group, with an average rate of 2.6% (9/340) for both indications. For all 41 ESBL-producing E. coli isolated, a broad heterogeneity was revealed using pulsed-field gel electrophoresis (PFGE) patterns and whole genome sequencing (WGS) -analysis. However, a predominance of sequence type complex (STC)10 and STC1250 was observed, including several novel STs. The most common genes associated with ESBL-production were identified as blaCTX-M-1 (31/41; 75.6%) and blaSHV-12 (24.4%). The results of this study reveal a disturbingly large fraction of multi-drug resistant and ESBL-producing E. coli among equine patients, posing a clear threat to established hygiene management systems and work-place safety of veterinary staff in horse clinics.