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Importance: Transgender youth are at an elevated risk for adverse mental health outcomes compared with their cisgender peers. Identifying opportunities for intervention is a priority. Objective: To estimate differences in the association between gender identity milestones and mental health outcomes among transgender youth, stratified by level of family support. Design, Settings, and Participants: This retrospective cohort study compares changes in mental health outcomes among transgender youth who initiate gender identity milestones compared with those who initiate the same milestones 1 year later, stratified by level of family support, using the 2015 US Transgender Survey. The analytic samples included 18 303 transgender adults aged 18 and older who had initiated at least 1 gender identity milestone between ages 4 and 18 years. Exposure: Four gender identity milestones: feeling one's gender was different, thinking of oneself as transgender, telling another that one is transgender, and living full-time in one's gender identity, stratified by 3 levels of family support: supportive, neutral, and adverse. Main Outcomes: Age at first suicide attempt and at running away. Results: Study participants included 18 303 transgender adults (10 288 [56.2%] assigned female at birth; 14 777 [80.7%] White). Initiating a gender identity milestone was associated with a higher risk of suicide attempt and running away from home among transgender youth. This finding was driven by children who live in unsupportive families. For example, thinking of oneself as transgender was associated with a meaningful increase in the overall probability of attempting suicide among those in either adverse families (estimate = 1.75 percentage points; 95% CI, 0.47-3.03) or neutral families (estimate = 1.39 percentage points; 95% CI, 0.72-2.05). Among youth living with supportive families, there were no statistically significant associations between gender identity milestones and adverse mental health outcomes and 95% CIs generally ruled out any meaningful associations. Conclusion: These results demonstrate that without a supportive family environment, gender identity development increases the risk of transgender youth attempting suicide or running away from home. Social services and community resources to establish supportive relationships between transgender children and their parents are essential.

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The de novo design of small molecule-binding proteins has seen exciting recent progress; however, high-affinity binding and tunable specificity typically require laborious screening and optimization after computational design. We developed a computational procedure to design a protein that recognizes a common pharmacophore in a series of poly(ADP-ribose) polymerase-1 inhibitors. One of three designed proteins bound different inhibitors with affinities ranging from <5 nM to low micromolar. X-ray crystal structures confirmed the accuracy of the designed protein-drug interactions. Molecular dynamics simulations informed the role of water in binding. Binding free energy calculations performed directly on the designed models were in excellent agreement with the experimentally measured affinities. We conclude that de novo design of high-affinity small molecule-binding proteins with tuned interaction energies is feasible entirely from computation.

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Objectives. To examine the temporal trends in the transgender-cisgender mental health disparity in the United States. Methods. We used 2014-2021 US Behavioral Risk Factor Surveillance System Survey data with logistic and ordinary least squares regression to document temporal trends in the transgender-cisgender disparity in self-reports of the number of poor mental health days in the past month and frequent mental distress. Results. In 2014, cisgender individuals reported a mean average of 3.68 (95% confidence interval [CI] = 3.65, 3.70) poor mental health days compared with a mean average of 5.42 (95% CI = 4.68, 6.16) poor mental health days among transgender respondents. The size of this disparity adjusted by differences in observable characteristics increased by 2.75 days (95% CI = 0.58, 4.91) over the sample period. In 2014, 11.4% (95% CI = 11.3%, 11.5%) of cisgender adults reported frequent mental distress compared with 18.9% (95% CI = 15.9%, 22%) of transgender adults. By 2021, 14.6% (95% CI = 15.9%, 22%) of cisgender adults and 32.9% (95% CI = 30.7%, 35.1%) of transgender adults reported frequent mental distress. Conclusions. Policies are needed to address the worsening mental health of transgender and gender-nonconforming people in the United States. (Am J Public Health. 2024;114(5):523-526. https://doi.org/10.2105/AJPH.2024.307603).

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Numerous studies from Europe and North America have documented sexual orientation-based health disparities, but due to data limitations, very little is known about the health of sexual minorities (i.e., lesbians, gay men, bisexual individuals, and other non-heterosexual populations) in developing countries. This research note uses newly available nationally representative data from the Chilean Socio-Economic Characterization Survey (CASEN) to explore sexual orientation-based disparities in self-rated health, health insurance coverage, and healthcare utilization in Chile. Our findings indicate that sexual minority respondents report worse self-rated health and greater health care utilization, and that sexual minority men are more likely to have private health insurance relative to heterosexual men. These findings are important in facilitating continued efforts to reduce health disparities in Latin America.

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Direct, site-specific methods of protein functionalization are highly desirable for biotechnology. However, such methods are challenging due to the difficulty of chemically differentiating a single site within a large protein. Herein, we propose "metal binding targeting" strategy and develop a Copper Assisted Sequence-specific conjugation Tag (CAST) method to achieve rapid (second order rate 8.1 M-1 s-1), site-specific protein backbone chemical modification with pinpoint accuracy. We demonstrate the versatility of CAST conjugation by preparing various on-demand modified recombinant proteins, including a homogeneous antibody-drug conjugate with high plasma stability and potent efficacy in vitro and in vivo. Thus, CAST provides an efficient and quantitative method to site-specifically attach payloads on large, native proteins.

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OBJECTIVE: The purpose of this study was to determine the anatomical differences among selected individuals with a cleft palate repaired using "The Buccal Flap Approach" during primary palatoplasty compared to aged-matched participants without cleft palate. DESIGN: Observational, prospective. SETTING: Two regional hospitals. PARTICIPANTS: A total of 30 adult males consisting of 15 adults born with cleft palate who received the Double Opposing Z-Plasty plus Buccal Flaps (DOZP + BF) repair at the time of primary palatoplasty and no history of secondary speech surgery or orthognathic surgery and 15 adults without a history of cleft palate. INTERVENTIONS: All participants underwent MRI to visualize anatomy. MAIN OUTCOME MEASURES: Ten velopharyngeal and craniofacial anatomical measures. RESULTS: No statistically significant differences between groups were observed for velar thickness, velar length, pharyngeal depth, NSBa angle, SNB angle, or levator veli palatini length. Individuals with the DOZP + BF presented with a greater effective velar length (p < .001), greater effective VP ratio (p < .001), smaller SNA angle (p < .001), and smaller maximal velar stretch (p < .001) compared to the control participants. CONCLUSIONS: This study suggests that adult males who received the DOZP + BF repair at the time of primary palatoplasty and no history of secondary speech surgery or orthognathic surgery present with a longer effective velar length and larger effective VP ratio in comparison to the non-cleft group. Future research is needed to compare patients with and without favorable outcomes from multiple surgical types to fully understand how surgical techniques alter the anatomy.

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Among US adults in 2013-18, we found high-deductible health plan enrollment to be the lowest among heterosexual and gay/lesbian adults in families with incomes below 200 percent of the federal poverty level and the highest among bisexual adults in families with incomes at or above 400 percent of poverty. Gay/lesbian and bisexual adults in these plans experienced greater financial barriers to health care than heterosexual adults.

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OBJECTIVE: To estimate the prevalence of adverse childhood experiences (ACEs) and their association with mental health outcomes in adulthood by gender identity. METHODS: Data come from 2019 to 2021 US Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, among 17 states collecting gender identity and ACEs. We estimated the prevalence of ACEs and used Poisson family regression to estimate the association between ACEs and mental health stratified by gender identity. Mental health was assessed as current frequent mental distress and lifetime depression diagnosis. RESULTS: The sample included n = 141,615 adults, 556 of whom identified as gender minority (including transgender or gender non-binary). Gender minority respondents were 18% more likely [95% CI 8% to 29%, p < 0.01] to be exposed to 3 or more ACEs relative to cisgender respondents. Among respondents exposed to 3 or more ACEs, gender minority adults were 25% [95% CI 10% to 43%, p < 0.01] more likely to report current frequent mental distress and 26% [95% CI 14% to 40%, p < 0.01] more likely to report a lifetime depression diagnosis than their cisgender peers. CONCLUSION: Using population-level data, we identified higher prevalence of ACEs among gender minority adults than cisgender adults, and greater associations of ACEs and adverse mental health in adulthood. The prevalence of current and lifetime adverse mental health outcomes increased with higher levels of ACE exposure among cisgender and gender minority respondents. Action by stakeholders at the community, health system, and legislative levels are needed to improve gender minority population health.

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Background: Hypertension (HTN) is the leading cardiovascular disease (CVD) risk factor in Haiti and is likely driven by poverty-related social and dietary factors. Salt consumption in Haiti is hypothesized to be high but has never been rigorously quantified. Methods: We used spot urine samples from a subset of participants in the population-based Haiti Cardiovascular Disease Cohort to estimate population mean daily sodium intake. We compared three previously validated formulas for estimating dietary sodium intake using urine sodium, urine creatinine, age, sex, height, and weight. We explored the association between dietary sodium intake and blood pressure, stratified by age group. Results: A total of 1,240 participants had spot urine samples. Median age was 38 years (range 18-93), and 48% were female. The mean dietary sodium intake was 3.5-5.0 g/day across the three estimation methods, with 94.2%-97.9% of participants consuming above the World Health Organization (WHO) recommended maximum of 2 g/day of sodium. Among young adults aged 18-29, increasing salt intake from the lowest quartile of consumption (<3.73 g/day) to the highest quartile (>5.88 g/day) was associated with a mean 8.71 mmHg higher systolic blood pressure (SBP) (95% confidence interval: 3.35, 14.07; p = 0.001). An association was not seen in older age groups. Among participants under age 40, those with SBP ≥120 mmHg consumed 0.5 g/day more sodium than those with SBP <120 mmHg (95% confidence interval: 0.08, 0.69; p = 0.012). Conclusions: Nine out of 10 Haitian adults in our study population consumed more than the WHO recommended maximum for daily sodium intake. In young adults, higher sodium consumption was associated with higher SBP. This represents an inflection point for increased HTN risk early in the life course and points to dietary salt intake as a potential modifiable risk factor for primordial and primary CVD prevention in young adults.

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OBJECTIVE: To examine whether the Affordable Care Act's (ACA's) Medicaid expansions affected health insurance coverage for individuals in same-sex couples. DATA SOURCES AND STUDY SETTING: We used data on adults aged 18-64 years in same-sex couples (n = 33,512) from the 2008-2018 American Community Survey (ACS). STUDY DESIGN: To estimate the effect of the impact of the state Medicaid expansions under the ACA on health insurance coverage for sexual minorities, we utilize a standard difference-in-differences approach to leverage the variation across geography and time in expanding Medicaid. DATA COLLECTION: Secondary and publicly available ACS data were obtained from IPUMS at the University of Minnesota. PRINCIPAL FINDINGS: We find that Medicaid expansion significantly increased health insurance coverage among low-income men and women in same-sex couples by 4.9 (standard error [SE] = 1.75) and 6.5 (SE = 1.96) percentage points, respectively. We find increases in the likelihood of having Medicaid and reductions in private health insurance from an employer or privately purchased insurance. Effects on Medicaid take-up are consistently larger for low-income women in same-sex couples as compared to low-income men in same-sex couples. CONCLUSIONS: We provide the first evidence on the relationship between state Medicaid expansions under the ACA and health insurance coverage among sexual minority adults, a group that has been understudied in past research. Our results confirm that sexual minority adults benefitted from the ACA's Medicaid expansions with respect to increased health insurance coverage.

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The de novo design of small-molecule-binding proteins has seen exciting recent progress; however, the ability to achieve exquisite affinity for binding small molecules while tuning specificity has not yet been demonstrated directly from computation. Here, we develop a computational procedure that results in the highest affinity binders to date with predetermined relative affinities, targeting a series of PARP1 inhibitors. Two of four designed proteins bound with affinities ranging from < 5 nM to low µM, in a predictable manner. X-ray crystal structures confirmed the accuracy of the designed protein-drug interactions. Molecular dynamics simulations informed the role of water in binding. Binding free-energy calculations performed directly on the designed models are in excellent agreement with the experimentally measured affinities, suggesting that the de novo design of small-molecule-binding proteins with tuned interaction energies is now feasible entirely from computation. We expect these methods to open many opportunities in biomedicine, including rapid sensor development, antidote design, and drug delivery vehicles.

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Natural metalloproteins perform many functions - ranging from sensing to electron transfer and catalysis - in which the position and property of each ligand and metal, is dictated by protein structure. De novo protein design aims to define an amino acid sequence that encodes a specific structure and function, providing a critical test of the hypothetical inner workings of (metallo)proteins. To date, de novo metalloproteins have used simple, symmetric tertiary structures - uncomplicated by the large size and evolutionary marks of natural proteins - to interrogate structure-function hypotheses. In this Review, we discuss de novo design applications, such as proteins that induce complex, increasingly asymmetric ligand geometries to achieve function, as well as the use of more canonical ligand geometries to achieve stability. De novo design has been used to explore how proteins fine-tune redox potentials and catalyse both oxidative and hydrolytic reactions. With an increased understanding of structure-function relationships, functional proteins including O2-dependent oxidases, fast hydrolases, and multi-proton/multi-electron reductases, have been created. In addition, proteins can now be designed using xeno-biological metals or cofactors and principles from inorganic chemistry to derive new-to-nature functions. These results and the advances in computational protein design suggest a bright future for the de novo design of diverse, functional metalloproteins.

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PURPOSE OF REVIEW: To review the clinical characteristics of paroxysmal hypertension (pseudopheochromocytoma), its previously unsuspected cause, and effective treatment approaches. RECENT FINDINGS: Patients with paroxysmal hypertension experience recurrent, sudden, unprovoked, symptomatic, and severe elevations of blood pressure that occur independently of current stress or perceived emotional distress. Recent findings point to a previously unsuspected psychosomatic etiology, linked in most to a past history of abuse, trauma, or prolonged severe stress, often with repression of pertinent emotions, or to a repressive coping style. Consistent with this understanding, treatment with an antidepressant is thus far the only pharmacologic intervention demonstrated to be effective in preventing recurrent paroxysms, and is effective in most patients. Other treatment approaches are discussed, including medications to acutely lower blood pressure during paroxysms, and, in some cases, the possibility of emotional healing.  Recent findings indicate that paroxysmal hypertension is a psychosomatic disorder frequently linked to a past history of trauma or prolonged severe stress, usually with longstanding repression of pertinent emotions. Data strongly encourage treatment with an antidepressant in patients with recurrent or severe paroxysms. Further studies are needed.

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De novo protein design offers the opportunity to test our understanding of how metalloproteins perform difficult transformations. Attaining high-resolution structural information is critical to understanding how such designs function. There have been many successes in the design of porphyrin-binding proteins; however, crystallographic characterization has been elusive, limiting what can be learned from such studies as well as the extension to new functions. Moreover, formation of highly oxidizing high-valent intermediates poses design challenges that have not been previously implemented: (1) purposeful design of substrate/oxidant access to the binding site and (2) limiting deleterious oxidation of the protein scaffold. Here we report the first crystallographically characterized porphyrin-binding protein that was programmed to not only bind a synthetic Mn-porphyrin but also maintain binding site access to form high-valent oxidation states. We explicitly designed a binding site with accessibility to dioxygen units in the open coordination site of the Mn center. In solution, the protein is capable of accessing a high-valent Mn(V)-oxo species which can transfer an O atom to a thioether substrate. The crystallographic structure is within 0.6 Å of the design and indeed contained an aquo ligand with a second water molecule stabilized by hydrogen bonding to a Gln side chain in the active site, offering a structural explanation for the observed reactivity.

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The 24-hour urine collection is widely considered the gold standard for assessing 24-hour excretion of various analytes. Yet, studies show that >30% of collections are incomplete and hence understate the true 24-hour excretion. We previously validated an equation for estimating an individual's 24-hour creatinine excretion, based on weight, sex, race, and age. The present study examines whether routinely correcting measured 24-hour excretion of an analyte using the ratio of estimated to measured 24-hour urine creatinine mitigates the misleadingly low values that result from undercollection. Ninety-nine participants, recruited from an outpatient hypertension clinic, submitted a 24-hour urine collection for measurement of creatinine and sodium excretion. The urine collections were dichotomized into complete (n = 63) and incomplete (n = 36) collections based on previously described criteria for expected 24-hour creatinine excretion. To adjust for possible incompleteness of collections, the measured 24-hour values were then corrected by multiplying them by the ratio of estimated to measured 24-hour urine creatinine. The mean 24-hour creatinine excretion was 1682 mg/d among complete collectors. Among incomplete collectors, the mean was 1211 mg/d before and 1695 mg/d after, adjustment. Similarly, mean 24-hour sodium excretion was 156 mEq/d among complete collectors, whereas among incomplete collectors it was 121 mEq/d before and 171 mEq/d after, adjustment. Undercollection of 24-hour urines is a common problem and results in misleadingly low values for excretion of analytes being measured. Routine adjustment of 24-hour urine values using estimated values for 24-hour creatinine excretion can greatly mitigate artifactually low 24-hour excretion results.

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Design disciplines have a long history of creating well-integrated solutions to challenges which are complex, uncertain and contested by multiple stakeholders. Society faces similar challenges in implementing the Sustainable Development Goals, so design methods hold much potential. While principles of good design are well established, there has been limited integration of design thinking with sustainability science. To advance this integration, we examine the process of designing MetaMAP: an interactive graphic tool for collaborating to understand social-ecological systems and design well-integrated solutions. MetaMAP was created using Research through Design methods which integrate creative and scientific thinking. By applying design thinking, researchers and practitioners from different backgrounds undertook multiple cycles of problem framing, solution development, testing and reflection. The testing was highly collaborative involving over 150 people from diverse disciplines in workshops, case studies, interviews and critique. Reflecting on this process, we discuss design principles and opportunities for integrating design thinking with sustainability science to help achieve Sustainable Development Goals.

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Discussions about the cause and treatment of essential hypertension usually focus on mechanisms such as sodium/volume and the renin-angiotensin system. Less often discussed is hypertension driven by the sympathetic nervous system, i.e., neurogenic hypertension. In this review I discuss the pathophysiology of neurogenic hypertension, the controversy of renal versus central origin, the clinical clues that suggest neurogenic hypertension, and the interventions best suited in its treatment. Neurogenic hypertension is most likely to occur in patients with labile or paroxysmal hypertension, but evidence of increased sympathetic tone also suggests a neurogenic component in hypertension in patients with severe or resistant hypertension, chronic renal disease, comorbidities associated with increased sympathetic tone, and ingestion of drugs that stimulate sympathetic tone. The importance of combined alpha- and beta-blockade in pharmacologic treatment and the status of renal denervation are discussed. Although there is much that is unclear in its pathophysiology, recognition of neurogenic hypertension is of considerable clinical importance in individualizing drug therapy and achieving blood pressure control.

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