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Background Studies of HIV-related risk in trans (transgender, transsexual, or transitioned) people have most often involved urban convenience samples of those on the male-to-female (MTF) spectrum. Studies have detected high prevalences of HIV-related risk behaviours, self-reported HIV, and HIV seropositivity. Methods The Trans PULSE Project conducted a multi-mode survey using respondent-driven sampling to recruit 433 trans people in Ontario, Canada. Weighted estimates were calculated for HIV-related risk behaviours, HIV testing and self-reported HIV, including subgroup estimates for gender spectrum and ethno-racial groups. Results Trans people in Ontario report a wide range of sexual behaviours with a full range of partner types. High proportions – 25% of female-to-male (FTM) and 51% of MTF individuals – had not had a sex partner within the past year. Of MTFs, 19% had a past-year high-risk sexual experience, versus 7% of FTMs. The largest behavioural contributors to HIV risk were sexual behaviours some may assume trans people do not engage in: unprotected receptive genital sex for FTMs and insertive genital sex for MTFs. Overall, 46% had never been tested for HIV; lifetime testing was highest in Aboriginal trans people and lowest among non-Aboriginal racialized people. Approximately 15% of both FTM and MTF participants had engaged in sex work or exchange sex and about 2% currently work in the sex trade. Self-report of HIV prevalence was 10 times the estimated baseline prevalence for Ontario. However, given wide confidence intervals and the high proportion of trans people who had never been tested for HIV, estimating the actual prevalence was not possible. Conclusions Results suggest potentially higher than baseline levels of HIV; however low testing rates were observed and self-reported prevalences likely underestimate seroprevalence. Explicit inclusion of trans people in epidemiological surveillance statistics would provide much-needed information on incidence and prevalence. Given the wide range of sexual behaviours and partner types reported, HIV prevention programs and materials should not make assumptions regarding types of behaviours trans people do or do not engage in.

Objectives. We examined the extent of nonprescribed hormone use and self-performed surgeries among transgender or transsexual (trans) people in Ontario, Canada. Methods. We present original survey research from the Trans PULSE Project. A total of 433 participants were recruited from 2009 to 2010 through respondent-driven sampling. We used a case series design to characterize those currently taking nonprescribed hormones and participants who had ever self-performed sex-reassignment surgeries. Results. An estimated 43.0% (95% confidence interval = 34.9, 51.5) of trans Ontarians were currently using hormones; of these, a quarter had ever obtained hormones from nonmedical sources (e.g., friend or relative, street or strangers, Internet pharmacy, herbals or supplements). Fourteen participants (6.4%; 95% confidence interval = 0.8, 9.0) reported currently taking nonprescribed hormones. Five indicated having performed or attempted surgical procedures on themselves (orchiectomy or mastectomy). Conclusions. Past negative experiences with providers, along with limited financial resources and a lack of access to transition-related services, may contribute to nonprescribed hormone use and self-performed surgeries. Promoting training initiatives for health care providers and jurisdictional support for more accessible services may help to address trans people’s specific needs.

Research with Pride (RwP) was a community-student collaborative initiative to promote and build capacity for community-based research exploring health and Wellness in lesbian, bisexual, trans and queer (LGBTQ) communities. The event took place at University of Toronto's Dalla Lana School of Public Health (DLSPH) in September 2009, and engaged over 100 students, community members and academic researchers in a full day of discussion, learning and networking. RwP was initiated by a group of graduate students in Health Promotion who identified a gap in resources addressing LGBTQ health, facilitating their further learning and work in this area. By engaging in a partnership with a community service organization serving LGBTQ communities in downtown Toronto, RwP emerges as a key example of the role of community-student partnerships in the pursuit of LGBTQ health promotion. This paper will describe the nature of this partnership, outline its strengths and challenges and emphasize the integral role of community-student partnerships in health promotion initiatives.

God, I can't believe it's going to happen. In a matter of weeks I'll no longer even have the post-surgical bandages to contend with. I'll be putting a shirt on over top of nothing-no bra, no binder, no extra T-shirt-and walking outside. I'll be wrapping a towel around my waist instead of my chest when I exit my morning shower. I'll be able to hug people without them feeling those breasts or binders. I'll no longer be a girl faking it, but a guy legit. My surgeon thinks the hole is likely a result of the infection; even though we caught it fairly quickly, it must have had enough time to destabilize the tissue underneath the nipple grafts. The good news: so I've got a small, pencil-width-sized hole in my left nipple that scar tissue can rebuild. And what would the colour of scar tissue be? Light pinky-red, very similar to the colour of the nipple itself. In the worst-case scenario, I'll have to get the tissue tattooed the right colour. It's not as if I'll be a nipple-hole freak for the rest of my life, after all. I'm okay with this. This was a risk I was comfortable taking. What's most important now is that my health is good, that I keep the incision line clean, that I keep taking care not to lift anything heavy, that I protect and foster my body's healing processes by taking vitamins, and that I get lots of rest. Not that there aren't still issues for me to deal with. People are always wondering, \"Who exactly would want you? You're a man without a dick.\" It comes up a lot-\"Who would ever want that?\" The truth is, I don't know. I don't have an answer. I don't know if many people will, and I have to live with that. If my choices are either to be a person who can't stand his own body but is deemed attractive to others, or to be a person who's much happier with who he is and has to be patient in finding a partner who's truly attracted to him as he is, then it's not a hard choice. I'd rather be happy with myself. God, I can't believe it's going to happen. In a matter of weeks I'll no longer even have the post-surgical bandages to contend with. I'll be putting a shirt on over top of nothing-no bra, no binder, no extra T-shirt-and walking outside. I'll be wrapping a towel around my waist instead of my chest when I exit my morning shower. I'll be able to hug people without them feeling those breasts or binders. I'll no longer be a girl faking it, but a guy legit. My surgeon thinks the hole is likely a result of the infection; even though we caught it fairly quickly, it must have had enough time to destabilize the tissue underneath the nipple grafts. The good news: so I've got a small, pencil-width-sized hole in my left nipple that scar tissue can rebuild. And what would the colour of scar tissue be? Light pinky-red, very similar to the colour of the nipple itself. In the worst-case scenario, I'll have to get the tissue tattooed the right colour. It's not as if I'll be a nipple-hole freak for the rest of my life, after all. I'm okay with this. This was a risk I was comfortable taking. What's most important now is that my health is good, that I keep the incision line clean, that I keep taking care not to lift anything heavy, that I protect and foster my body's healing processes by taking vitamins, and that I get lots of rest. Not that there aren't still issues for me to deal with. People are always wondering, \"Who exactly would want you? You're a man without a dick.\" It comes up a lot-\"Who would ever want that?\" The truth is, I don't know. I don't have an answer. I don't know if many people will, and I have to live with that. If my choices are either to be a person who can't stand his own body but is deemed attractive to others, or to be a person who's much happier with who he is and has to be patient in finding a partner who's truly attracted to him as he is, then it's not a hard choice. I'd rather be happy with myself. God, I can't believe it's going to happen. In a matter of weeks I'll no longer even have the post-surgical bandages to contend with. I'll be putting a shirt on over top of nothing-no bra, no binder, no extra T-shirt-and walking outside. I'll be wrapping a towel around my waist instead of my chest when I exit my morning shower. I'll be able to hug people without them feeling those breasts or binders. I'll no longer be a girl faking it, but a guy legit. My surgeon thinks the hole is likely a result of the infection; even though we caught it fairly quickly, it must have had enough time to destabilize the tissue underneath the nipple grafts. The good news: so I've got a small, pencil-width-sized hole in my left nipple that scar tissue can rebuild. And what would the colour of scar tissue be? Light pinky-red, very similar to the colour of the nipple itself. In the worst-case scenario, I'll have to get the tissue tattooed the right colour. It's not as if I'll be a nipple-hole freak for the rest of my life, after all. I'm okay with this. This was a risk I was comfortable taking. What's most important now is that my health is good, that I keep the incision line clean, that I keep taking care not to lift anything heavy, that I protect and foster my body's healing processes by taking vitamins, and that I get lots of rest. Not that there aren't still issues for me to deal with. People are always wondering, \"Who exactly would want you? You're a man without a dick.\" It comes up a lot-\"Who would ever want that?\" The truth is, I don't know. I don't have an answer. I don't know if many people will, and I have to live with that. If my choices are either to be a person who can't stand his own body but is deemed attractive to others, or to be a person who's much happier with who he is and has to be patient in finding a partner who's truly attracted to him as he is, then it's not a hard choice. I'd rather be happy with myself.

Rickettsial agents are sensed by pattern recognition receptors but lack pathogen-associated molecular patterns commonly observed in facultative intracellular bacteria. Due to these molecular features, the order Rickettsiales can be used to uncover broader principles of bacterial immunity. Here, we used the bacterium Anaplasma phagocytophilum, the agent of human granulocytic anaplasmosis, to reveal a novel microbial surveillance system. Mechanistically, we discovered that upon A. phagocytophilum infection, cytosolic phospholipase A2 cleaves arachidonic acid from phospholipids, which is converted to the eicosanoid prostaglandin E2 (PGE2) via cyclooxygenase 2 (COX2) and the membrane associated prostaglandin E synthase-1 (mPGES-1). PGE2-EP3 receptor signaling leads to activation of the NLRC4 inflammasome and secretion of interleukin (IL)-1β and IL-18. Importantly, the receptor-interacting serine/threonine-protein kinase 2 (RIPK2) was identified as a major regulator of the immune response against A. phagocytophilum. Accordingly, mice lacking COX2 were more susceptible to A. phagocytophilum, had a defect in IL-18 secretion and exhibited splenomegaly and damage to the splenic architecture. Remarkably, Salmonella-induced NLRC4 inflammasome activation was not affected by either chemical inhibition or genetic ablation of genes associated with PGE2 biosynthesis and signaling. This divergence in immune circuitry was due to reduced levels of the PGE2-EP3 receptor during Salmonella infection when compared to A. phagocytophilum. Collectively, we reveal the existence of a functionally distinct NLRC4 inflammasome illustrated by the rickettsial agent A. phagocytophilum.

Calculations of point defect energetics with Density Functional Theory (DFT) can provide valuable insight into several optoelectronic, thermodynamic, and kinetic properties. These calculations commonly use methods ranging from semi-local functionals with a-posteriori corrections to more computationally intensive hybrid functional approaches. For applications of DFT-based high-throughput computation for data-driven materials discovery, point defect properties are of interest, yet are currently excluded from available materials databases. This work presents a benchmark analysis of automated, semi-local point defect calculations with a-posteriori corrections, compared to 245 “gold standard” hybrid calculations previously published. We consider three different a-posteriori correction sets implemented in an automated workflow, and evaluate the qualitative and quantitative differences among four different categories of defect information: thermodynamic transition levels, formation energies, Fermi levels, and dopability limits. We highlight qualitative information that can be extracted from high-throughput calculations based on semi-local DFT methods, while also demonstrating the limits of quantitative accuracy.

The renewable energy industry is heavily reliant on rare earth elements, underscoring the need to develop resources and production. The objective of this work was to estimate coal ash resources and potential for extraction of rare earth elements using data for the US. Data on spatiotemporal variability in coal ash resources and disposition were compiled from various federal databases and rare earth elements levels in ash were compiled from the literature. Results show that ~ 52 gigatons (Gt) of coal were produced in the US (1950–2021). Power plants account for most of the coal use, particularly since 1980. Coal ash (5.3 Gt) represents a mean of 10% of coal by weight, ranging from 6% for subbituminous to 14% for lignite. About 70% of coal ash is potentially accessible for rare earth element extraction (1985–2021) and was disposed in landfills and ponds with the remaining coal ash used onsite or sold. Median values of total rare earth elements are much higher in ashes derived from the Appalachian Basin (median 431 mg/kg) than in the Illinois (282 mg/kg) or Powder River basins (264 mg/kg). Considering the market value of rare earth oxides, potentially accessible ash volumes, and percent rare earth element extraction (30% Appalachian and Illinois Basins; 70% Powder River Basin) results in an estimated $8.4 billion value. This study provides fundamental information on accessible coal ash resources in the US, linkages to coal sources, and preliminary estimates of rare earth element levels for future development within the US.

Background N-terminal peptide of procollagen type III (P3NP) and C-terminal agrin fragment (CAF) are circulating biomarkers that are related to lean body mass in older adults. P3NP is a circulating marker reflective of muscular structural remodeling while CAF is a circulating marker of neuromuscular remodeling. As resistance exercise is an established intervention that can effectively improve muscle quality, we sought to evaluate circulating biomarker changes corresponding to a resistance exercise intervention in older adults. Methods Twenty-three older adults (aged 61 to 85 years) were randomized into an intervention (6-week resistance training) or control group. Resting circulating P3NP, CAF, lean body mass (LBM), muscle cross-sectional area (CSA), muscle strength, and muscle quality were determined at baseline and after the intervention or control period by enzyme-linked immunosorbent assay, dual-energy X-ray absorptiometry, ultrasound, leg extension, and relative strength, respectively. Changes in circulating biomarkers and measures of muscle mass and quality were evaluated with repeated-measures analysis of variance; clinical interpretations were made with magnitude-based inferences, and relationships between variables were evaluated with bivariate correlations. Results The short-term resistance exercise intervention was effective at improving muscle quality by 28 % ( p  < 0.001) despite no significant changes in lean body mass. Baseline circulating P3NP was somewhat lower in older women (4.15 ± 1.9 ng/mL) compared with older men (4.81 ± 2.1 ng/mL). The exercise intervention tended to increase circulating P3NP (baseline = 4.53 ± 1.80 to post = 4.88 ± 1.86) and was significantly correlated with changes in LBM ( r  = 0.422, p  = 0.045). At baseline, women (3.91 ± 1.12 pg/mL) had somewhat higher circulating CAF than men (3.47 ± 1.37 pg/mL). Circulating CAF increased by 10.4 % (3.59 to 4.00 pg/ml) in older adults following 6 weeks of resistance exercise training. Changes in circulating CAF were significantly related to changes in CSA of the vastus lateralis ( r  = 0.542, p  = 0.008). Conclusions Assessment of P3NP and CAF from blood samples may provide minimally invasive and clinically informative measures of skeletal muscle status in older adults. Circulating CAF appears to increase in response to short-term resistance exercise training in older adults to a clinically meaningful magnitude. Changes in circulating P3NP in response to the intervention were less clear but appear to reflect muscle hypertrophy. Further research is needed to elucidate whether P3NP, CAF, or other biomarkers can reflect muscle qualitative adaptations with larger and longer studies.

Purpose The aim of this study was to identify the supportive care needs and unmet needs of women with breast cancer (BC) in rural Scotland. Methods In 2013, a survey of supportive care needs of rural women with BC was conducted using the short-form Supportive Care Needs Survey (SCNS-SF34). Semi-structured interviews were subsequently conducted with a purpose sample of questionnaire respondents. Results Forty-four women with BC completed the survey and ten were interviewed. Over half of participants reported at least one moderate to high unmet need (56.8 %, n  = 25), a tenth reported low needs (11.4 %, n  = 5), and around a third reported no unmet needs for all 34 items (31.8 %, n  = 14). The most prevalent moderate to high needs were ‘being informed about cancer in remission’ (31.8 %, n  = 14), ‘fears about the cancer spreading’ (27.3 %, n  = 12), ‘being adequately informed about the benefits and side-effects of treatment’ and ‘concerns about the worries of those close to you’ (both 25.0 %, n  = 11). Interviews highlighted the following unmet needs: information about treatment and side effects, overview of care, fear of recurrence, impact on family and distance from support. Conclusions Rural women with BC report similar unmet needs to their urban counterparts. Fear of recurrence is a key unmet need that should be addressed for all women with BC. However, they also report unique unmet needs because of rural location. Thus, it is critical that cancer services address the additional unmet needs of rural women with BC and, in particular, needs relating to distance from services.

Rickettsial agents are sensed by pattern recognition receptors but lack pathogen-associated molecular patterns commonly observed in facultative intracellular bacteria. Due to these molecular features, the order Rickettsiales can be used to uncover broader principles of bacterial immunity. Here, we used the bacterium Anaplasma phagocytophilum, the agent of human granulocytic anaplasmosis, to reveal a novel microbial surveillance system. Mechanistically, we discovered that upon A. phagocytophilum infection, cytosolic phospholipase A2 cleaves arachidonic acid from phospholipids, which is converted to the eicosanoid prostaglandin E2 (PGE2) via cyclooxygenase 2 (COX2) and the membrane associated prostaglandin E synthase-1 (mPGES-1). PGE2-EP3 receptor signaling leads to activation of the NLRC4 inflammasome and secretion of interleukin (IL)-1[Beta] and IL-18. Importantly, the receptor-interacting serine/threonine-protein kinase 2 (RIPK2) was identified as a major regulator of the immune response against A. phagocytophilum. Accordingly, mice lacking COX2 were more susceptible to A. phagocytophilum, had a defect in IL-18 secretion and exhibited splenomegaly and damage to the splenic architecture. Remarkably, Salmonella-induced NLRC4 inflammasome activation was not affected by either chemical inhibition or genetic ablation of genes associated with PGE2 biosynthesis and signaling. This divergence in immune circuitry was due to reduced levels of the PGE2-EP3 receptor during Salmonella infection when compared to A. phagocytophilum. Collectively, we reveal the existence of a functionally distinct NLRC4 inflammasome illustrated by the rickettsial agent A. phagocytophilum.