Characterizing hospitalists' comfort and familiarity with LGBTQ clinical topics.

Objectives: Evidence has shown that lesbian, gay, bisexual, queer (LGBQ) and transgender patients (LGBTQ) experience disparities in health care delivery and clinical outcomes. As the predominant U.S.

Centering equity in a longitudinal health systems science curricula.

What Was The Educational Challenge?: Health inequity impedes care at every level of the health care system. Despite this, health equity is not the foundation for most health systems science (HSS) curricula.

What Was The Solution?: We reframed our HSS curricula to focus on health equity.

The Society of General Internal Medicine's Recommendations to Improve LGBTQ + Health.

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ +) individuals experience bias in healthcare with 1 in 6 LGBTQ + adults avoiding healthcare due to anticipated discrimination and overall report poorer health status compared to heterosexual and cisgendered peers. The Society of General Internal Medicine (SGIM) is a leading organization representing academic physicians and recognizes that significant physical and mental health inequities exist among LGBTQ + communities. As such, SGIM sees its role in improving LGBTQ + patient health through structural change, starting at the national policy level all the way to encouraging change in individual provider bias and personal actions.

ECHO "Bootcamp": An Innovative Training Model to Onboard Providers in the Care of Gender Diverse Patients.

Extension for Community Health Outcomes (ECHO) is a model of continuing medical education meant to connect academic medical center-based specialists with community providers to increase capacity in managing complex health conditions. The purpose of this study was to evaluate the effectiveness of a shortened "bootcamp" ECHO model in increasing participant competence with topics related to transgender and gender diverse (TGD) health care and the impact of "bootcamp" participation on enrollment in an ongoing ECHO series. An ongoing monthly ECHO series was instituted on topics of TGD health.

A Transgender Health Information Resource: Participatory Design Study.

Background: Despite the abundance of health information on the internet for people who identify as transgender and gender diverse (TGD), much of the content used is found on social media channels, requiring individuals to vet the information for relevance and quality.

Objective: We developed a prototype transgender health information resource (TGHIR) delivered via a mobile app to provide credible health and wellness information for people who are TGD.

Methods: We partnered with the TGD community and used a participatory design approach that included focus groups and co-design sessions to identify users' needs and priorities.

Community Engagement in Research and Design of a Transgender Health Information Resource.

Background: Access to credible and relevant health care information is an unmet need for the transgender and gender-diverse (TGD) community. This paper describes the community engagement methods and resulting community priorities as part of a codesign process for the development of a Transgender Health Information Resource (TGHIR) application.

Methods: A lesbian, gay, bisexual, transgender, and queer advocacy organization and an academic health sciences team partnered to establish a community advisory board (CAB) of TGD individuals, parents of TGD individuals, and clinicians with expertise in transgender health to inform the project.

A Novel Multidisciplinary Model of Care for Transgender and Gender Diverse Adults: Program Description and Patient Perspectives.

Transgender and gender diverse (TGD) adults face significant health care disparities stemming from systematic discrimination and stigma in health care. We created the UCHealth Integrated Transgender Program to provide culturally responsive and clinically competent care to TGD adults in Colorado. This article outlines the clinic model and summarizes results from a qualitative patient survey to assess patients' impressions and recommendations for improvement.

Co-design of the Transgender Health Information Resource: Web-Based Participatory Design.

Background: There is an urgent and unmet need for accessible and credible health information within the transgender and gender-diverse (TGD) community. Currently, TGD individuals often seek and must find relevant resources by vetting social media posts. A resource that provides accessible and credible health-related resources and content via a mobile phone app may have a positive impact on and support the TGD population.

What Happened and Why: Responding to Racism, Discrimination, and Microaggressions in the Clinical Learning Environment.

Introduction: Within clinical learning environments, medical students are uniquely faced with power differentials that make acts of racism, discrimination, and microaggressions (RDM) challenging to address. Experiences of microaggressions and mistreatment are correlated with higher rates of positive depression screening and lower satisfaction with medical training. We developed a curriculum for medical students beginning clerkship rotations to promote the recognition of and response to RDM.

The ACLGIM LEAD Program: a Leadership Program for Junior-Mid-Career Faculty.

Background: Junior to mid-career medical faculty often move into administrative and leadership roles without formal leadership training. Many national leadership training programs target senior rather than junior faculty.

Aim: To address the leadership development needs of junior and mid-career faculty.

Early Intervention for LGBTQ Health: A 10-Hour Curriculum for Preclinical Health Professions Students.

Introduction: Individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) face significant health disparities and barriers to accessing care. Patients have reported provider lack of knowledge as one of the key barriers to culturally responsive, clinically competent care. Many US and Canadian medical schools still offer few curricular hours dedicated to LGBTQ-related topics, and medical students continue to feel unprepared to care for LGBTQ patients.

Development of a formula for estimating plasma free cortisol concentration from a measured total cortisol concentration when elastase-cleaved and intact corticosteroid binding globulin coexist.

Cortisol bound to corticosteroid binding globulin (CBG) contributes up to 90% of the total cortisol concentration in circulation. Therefore, changes in the binding kinetics of cortisol to CBG can potentially impact on the concentration of free cortisol, the only form that is responsible for the physiological function of the hormone. When CBG is cleaved into elastase-cleaved CBG (eCBG) by the activity of neutrophil elastase, its affinity for cortisol is reduced.

The role of enzyme compartmentalization on the regulation of steroid synthesis.

Steroidogenic enzymes can be compartmentalized at different levels, some by virtue of being membrane bound in specific intra-cellular compartments. Although both 3β-hydroxysteroid dehydrogenase/Δ(5)-Δ(4) isomerase (3β-HSD) and 17α-hydroxylase/17,20-lyase cytochrome P450 (P450c17) are expressed in the endoplasmic reticulum (ER) membrane, these proteins may still be spatially separated within this membrane system. Side chain cleavage cytochrome P450 (P450scc) is anchored to the inner mitochondrial membrane and this organelle is the major source of pregnenolone (P5) feeding steroidogenesis.

Multilevel regulation of steroid synthesis and metabolism in the bovine placenta.

Steroid hormones play critical roles in almost all physiological processes in male and female reproduction. In a normal pregnancy, the concentrations of steroid hormones in maternal and foetal blood vary with gestation in response to changing needs. The placenta plays a central role in producing the appropriate steroids to support the pregnancy by coordinating its own steroidogenic activity with that of the corpus luteum and responding to foetal signals.

Variation in 3β-hydroxysteroid dehydrogenase activity and in pregnenolone supply rate can paradoxically alter androstenedione synthesis.

The 3β-hydroxysteroid dehydrogenase/Δ(5)-Δ(4) isomerase (3β-HSD) and 17α-hydroxylase/17,20-lyase cytochrome P450 (P450c17) enzymes are important in determining the balance of the synthesis of different steroids such as progesterone (P4), glucocorticoids, androgens, and estrogens. How this is achieved is not a simple matter because each of the two enzymes utilizes more than one substrate and some substrates are shared in common between the two enzymes. The two synthetic pathways, Δ(4) and Δ(5), are interlinked such that it is difficult to predict how the synthesis of each steroid changes when any of the enzyme activities is varied.

Developing leadership and advocacy skills in medical students through service learning.

Introduction: Traditional medical training focuses on ameliorating disease states but not on the underlying socially determined causes. The LEADS (Leadership Education Advocacy Development Scholarship) program at the University of Colorado Denver School of Medicine was designed to train medical students to become effective advocates and to promote health at the community level.

Methods: Participants in the LEADS Track complete courses in advocacy skills, perform a summer internship, and complete a mentored scholarly activity addressing population health.

DNA methylation patterns are appropriately established in the sperm of bulls generated by somatic cell nuclear transfer.

The cloning of animals by somatic cell nuclear transfer (SCNT) has the potential to allow rapid dissemination of desirable traits from elite animals. However, concern has been expressed that aberrant epigenetic marks in SCNT-derived animals may be passed onto the next generation, even though the offspring of clones appear to be mainly normal. Here, we compared the DNA methylation patterns at 10 genomic regions in sperm from SCNT bulls with that from normal, naturally conceived bulls and with the nuclear donor somatic cells.

Modest impact of a brief curricular intervention on poor documentation of sexual history in university-based resident internal medicine clinics.

Introduction: Providers need an accurate sexual history for appropriate screening and counseling. While curricula on sexual history taking have been described, the impact of such interventions on resident physician performance of the sexual history remains unknown.

Aims: Our aims were to assess the rates of documentation of sexual histories, the rates of documentation of specific components of the sexual history, and the impact of a teaching intervention on this documentation by Internal Medicine residents.

DNA methylation patterns in tissues from mid-gestation bovine foetuses produced by somatic cell nuclear transfer show subtle abnormalities in nuclear reprogramming.

Background: Cloning of cattle by somatic cell nuclear transfer (SCNT) is associated with a high incidence of pregnancy failure characterized by abnormal placental and foetal development. These abnormalities are thought to be due, in part, to incomplete re-setting of the epigenetic state of DNA in the donor somatic cell nucleus to a state that is capable of driving embryonic and foetal development to completion. Here, we tested the hypothesis that DNA methylation patterns were not appropriately established during nuclear reprogramming following SCNT.

Dickkopf-1 expression during early bovine placentation and its down-regulation in somatic cell nuclear transfer (SCNT) pregnancies.

The precise role of Dickkopf-1 (Dkk-1) during early bovine trophoblast development and subsequent placentation is not fully understood. Using somatic cell nuclear transfer (SCNT) generated pregnancies as a model of poor placentation we have found that mean levels of Dkk-1 mRNA were 1.5 fold lower in SCNT fetal cotyledon tissue at Day 50 of gestation than those resulting from artificial insemination (AI) and 2 fold lower at Days 100 and 150 (P<0.

Epigenetic reprogramming in embryonic and foetal development upon somatic cell nuclear transfer cloning.

The birth of 'Dolly', the first mammal cloned from an adult donor cell, has sparked a flurry of research activities to improve cloning technology and to understand the underlying mechanism of epigenetic reprogramming of the transferred somatic cell nucleus. Especially in ruminants, somatic cell nuclear transfer (SCNT) is frequently associated with pathological changes in the foetal and placental phenotype and has significant consequences for development both before and after birth. The most critical factor is epigenetic reprogramming of the transferred somatic cell nucleus from its differentiated status into the totipotent state of the early embryo.

The dilemma of disclosure: patient perspectives on gay and lesbian providers.

Background: Discrimination toward gay and lesbian patients by health care providers has been documented. No study has determined if patient behavior would change when seeing a gay/lesbian provider.

Objective: The objective of the study was to examine whether a provider's sexual orientation would affect the choice of provider, practice, or preference for a chaperone during genital exams.