Gene amplification mutations originate prior to selective stress in Acinetobacter baylyi.

The controversial theory of adaptive amplification states gene amplification mutations are induced by selective environments where they are enriched due to the stress caused by growth restriction on unadapted cells. We tested this theory with three independent assays using an Acinetobacter baylyi model system that exclusively selects for cat gene amplification mutants. Our results demonstrate all cat gene amplification mutant colonies arise through a multistep process.

Prescribing the Binary for Intersex (and Transgender) Children.

Robert Perske argued in 1972 that "there can be such a thing as human dignity in risk, and there can be a dehumanizing indignity in safety." Though Perske was referring to paternalistic care for the intellectually disabled, we can extend his counsel to the persistent attempts to impose a different kind of "safety," including efforts to enforce the gender and sex binary, as intersex surgeries were (and still are) meant to do. This article argues that when physicians surgically and hormonally alter the genitals and gonads of intersex infants, shaping their bodies to safely align with typical male and female bodies and gender roles, they unwittingly subject them to a dehumanizing indignity.

The need for a unified ethical stance on child genital cutting.

The American College of Nurse-Midwives, American Society for Pain Management Nursing, American Academy of Pediatrics, and other largely US-based medical organizations have argued that at least some forms of non-therapeutic child genital cutting, including routine penile circumcision, are ethically permissible even when performed on non-consenting minors. In support of this view, these organizations have at times appealed to potential health benefits that may follow from removing sexually sensitive, non-diseased tissue from the genitals of such minors. We argue that these appeals to "health benefits" as a way of justifying medically unnecessary child genital cutting practices may have unintended consequences.

Did Bioethics Matter? A History of Autonomy, Consent, and Intersex Genital Surgery.

This article argues that the rise of bioethics in the post-WWII era and the emergence of the legal doctrine of informed consent in the late 1950s should have had a greater impact on patients with intersex traits (atypical sex development) than they did, given their emphasis on respect for autonomy and beneficence toward patients. Instead, these progressive trends collided with a turn in intersex management toward infants, who were unable to provide autonomous consent about their medical care. Patient autonomy took a back seat as parents heeded physicians' advice in an environment even more hierarchical than we know today.

Measuring Quality of Life in the Speaker with Dysarthria: Reliability and Validity of the European Portuguese Version of the QoL-DyS.

Background: The impact of acquired dysarthria on the person's life and social participation is well recognized and is the key to the process of rehabilitation. Evaluation of the effectiveness of an intervention that addresses this impact is a challenge for clinicians and researchers.

Objectives: The purpose of this study was to evaluate the validity and reliability of the European Portuguese version of the Quality of Life in the Speaker with Dysarthria (QoL-DyS).

A Multicenter Performance Improvement Program Uses Rural Trauma Filters for Benchmarking: An Evaluation of the Findings.

Colorado requires Level III and IV trauma centers to conduct a formal performance improvement program (PI), but provides limited support for program development. Trauma program managers and coordinators in rural facilities rarely have experience in the development or management of a PI program. As a result, rural trauma centers often face challenges in evaluating trauma outcomes adequately.

Freezing Eggs and Creating Patients: Moral Risks of Commercialized Fertility.

There's no doubt that reproductive technologies can transform lives for the better. Infertile couples and single, lesbian, gay, intersex, and transgender people have the potential to form families in ways that would have been inconceivable years ago. Yet we are concerned about the widespread commercialization of certain egg-freezing programs, the messages they propagate about motherhood, the way they blur the line between care and experimentation, and the manipulative and exaggerated marketing that stretches the truth and inspires false hope in women of various ages.

Are Physicians Blameworthy for Iatrogenic Harm Resulting from Unnecessary Genital Surgeries?

We argue that physicians should, in certain cases, be held accountable by patients and their families for harm caused by "successful" genital surgeries performed for social and aesthetic reasons. We explore the question of physicians' blameworthiness for three types of genital surgeries common in the United States. First, we consider surgeries performed on newborns and toddlers with atypical sex development, or intersex.

What Hospitalists Should Know About Intersex Adults.

An intersex condition is one in which an individual is born with atypical male or female external genitalia, gonads, hormones, or chromosomes. Older terms, such as pseudohermaphroditism and hermaphroditism, are controversial, leading the Lawson Wilkins Pediatric Endocrine Society (LWPES) and the European Society for Paediatric Endocrinology (ESPE) to propose in 2006 the expression "disorders of sex development" (DSD), a contentious term in its own right, to define congenital conditions in which development of chromosomal, gonadal, or anatomical sex is atypical. The birth of a child with DSD often prompts a long-term, multidisciplinary strategy, involving an array of health-care professionals.

Measuring Outcomes for Dysphagia: Validity and Reliability of the European Portuguese Eating Assessment Tool (P-EAT-10).

The purpose of this study was to evaluate the validity and the reliability of the European Portuguese version of the EAT-10 (P-EAT-10). This research was conducted in three phases: (i) cultural and linguistic adaptation; (ii) feasibility and reliability test; and (iii) validity tests. The final sample was formed by a cohort of 520 subjects.

Hope Less: How a Healthy Dose of Realism Can Help in the ICU.

The author's father died recently after a sudden heart attack. This essay discusses how the family's experiences in the cardiac intensive care unit surprised her, even though she is a member of the Ethics Committee and the Ethics Consult Team at her local hospital, and how this led her to reconsider the ways in which families and hospital physicians communicate about the process of dying. How should doctors balance their messages of hope and realism when the situation is grim? Important judgment calls needed to be made, yet the family did not fully understand what they needed to know to make good decisions, especially the importance of the timing of their decisions.

Swallowing disorders in nursing home residents: how can the problem be explained?

Background: The swallowing mechanism changes significantly as people age, even in the absence of chronic diseases. Presbyphagia, a term that refers to aging-related changes in the swallowing mechanism, may be linked to many health conditions and presents itself in distinct ways. Swallowing disorders are also identified as a major problem amongst the elderly population living in nursing homes.

Protective factors in the lives of bisexual adolescents in North America.

Objectives: We compared protective factors among bisexual adolescents with those of heterosexual, mostly heterosexual, and gay or lesbian adolescents.

Methods: We analyzed 6 school-based surveys in Minnesota and British Columbia. Sexual orientation was measured by gender of sexual partners, attraction, or self-labeling.

Factors influencing households' participation in recycling.

The success of a recycling programme depends on the active and sustained participation of citizens in the correct separation and collection of recyclable waste. An effective study of strategies aimed at augmenting people's involvement in recycling involves understanding which factors influence the decision to co-operate with a recycling programme. This research investigates the influence of attitudes, incentives, presence of children in household and information through direct media, on households' participation in recycling.

Divergence or disorder?: the politics of naming intersex.

The conditions once known under the umbrella terms intersex and hermaphroditism are now generally being called disorders of sex development in medical settings. The terms might seem synonymous, but in fact there are significant differences with controversial consequences. Hermaphroditism, an older term that can still be found in many medical writings, is vague, demeaning, and sensationalistic, conjuring mythic images of monsters and freaks.

Hazards of stigma: the sexual and physical abuse of gay, lesbian, and bisexual adolescents in the United States and Canada.

Some studies suggest lesbian, gay, and bisexual (LGB) teens are at higher risk than peers for violence at home, in school, and in the community. That can bring them into the child welfare system or services for runaway and homeless teens. This study compared self-reported experiences of sexual and physical abuse based on sexual orientation and gender in seven population-based surveys of youth.

Sexual orientation, sexual abuse, and HIV-risk behaviors among adolescents in the Pacific Northwest.

Objectives: We explored HIV risk behaviors, sexual orientation, and sexual abuse among 5 school-based cohorts in Seattle, Wash (SEA95 and SEA99:N=7477 and N=6590), and British Columbia (BC92, BC98, and BC03 [weighted]: N=239975, N=281576, and N=265132).

Methods: An HIV risk scale of 7 items assessed risky sexual behaviors and injection drug use. Self-identified sexual orientation included heterosexual, bisexual, gay/lesbian, and, in British Columbia only, mostly heterosexual.

Measuring sexual orientation in adolescent health surveys: evaluation of eight school-based surveys.

Purpose: To examine the performance of various items measuring sexual orientation within 8 school-based adolescent health surveys in the United States and Canada from 1986 through 1999.

Methods: Analyses examined nonresponse and unsure responses to sexual orientation items compared with other survey items, demographic differences in responses, tests for response set bias, and congruence of responses to multiple orientation items; analytical methods included frequencies, contingency tables with Chi-square, and ANOVA with least significant differences (LSD)post hoc tests; all analyses were conducted separately by gender.

Results: In all surveys, nonresponse rates for orientation questions were similar to other sexual questions, but not higher; younger students, immigrants, and students with learning disabilities were more likely to skip items or select "unsure.