Faculty Bibliography

Background: Null mice raised by mating -/- with -/- showed sustained hyperglycemia & persistent hyperinsulinemia during glucose tolerance test (GTT) vs wild type (wt) raised by mating wt with wt . Insulin resistance by HOMA was increased 8 fold, but HOMA beta cell function was normal. As null mice ate & weighed more, & as caloric restriction abolished these differences, our data support the role of hyperphagia, possibly due to hypothalamic neuron leptin resistance without TRPC1 channels.
Method(s): We studied adipokines, environmental & genetic factors, including gene dosage, in this diabetic phenotype while minimizing epigenetics & hyperphagia in breeders & dams, using only littermates born to +/-breeders.
Result(s): 9-week-old null born to -/-breeders & nursed by -/-dams had severe random hyperglycemia (171 vs. 98 mg %) vs wt born to +/+ breeders & raised by +/+ dams. In contrast, null mice born to +/-breeders & nursed by +/-dams had minimal hyperglycemia (119 vs 171 mg %), implying anti-diabetic effects by a single maternal wt allele. Conversely, wt born to +/-breeders & nursed by +/-dams were hyperglycemic vs wt born to +/+ breeders & nursed by +/+ dams (118 vs 98 mg %), reflecting pro-diabetic effects of maternal haploid deficiency. These wt were as hyperglycemic as null littermates born to the same +/-breeders & nursed by the same +/-dams (118 vs 119 mg %). These data support the role of nongenetic parental influences. From 5th to 30th week, null but not +/-mice were obese vs wt. At 29 weeks, during GTT, both null & +/-mice were equally diabetic, with glucose (in mg %), respectively of 230 & 234 vs. 183 in wt at 20 min, 219 & 229 vs. 155 in wt at 60 min, & 179 & 188 vs 134 in wt at 90 min. These data support the role of both alleles in glucose homeostasis. In null mice, adiponectin was down (5.7) vs. wt (6.4) & +/-(6.2 mug/ml), but leptin up (2.3 vs. 1.3 in wt & 1.8 ng/ml in +/-).
Conclusion(s): We conclude: 1. Diploid TRPC1 gene deletion produces hyperphagia & obesity. 2. Haploid deficiency suffices to produce diabetes, associated with reduced adiponectin & increased leptin. 3. Non-genetic parental factors, via epigenetics & hyperphagia, markedly alter glucose homeostasis independent of genotypes

BACKGROUND:Despite decreasing rates of HIV among many populations, HIV-related health disparities among gay, bisexual and other men who have sex with men persist, with disproportional percentages of new HIV diagnoses among racial and ethnic minority men. Despite increasing awareness of HIV pre-exposure prophylaxis (PrEP), PrEP use remains low. In addition to exploring individual-level factors for this slow uptake, structural drivers of PrEP use must also be identified in order to maximize the effectiveness of biomedical HIV prevention strategies. METHOD/METHODS:Using cross-sectional data from an ongoing cohort study of young sexual minority men (N=492), we examine the extent to which structural-level barriers, including access to health care, medication logistics, counseling support, and stigma are related to PrEP use. RESULTS:While almost all participants indicated awareness of PrEP, only 14% had ever used PrEP. PrEP use was associated with lower concerns about health care access, particularly paying for PrEP. Those with greater concerns talking with their provider about their sexual behaviors were less likely to use PrEP. CONCLUSION/CONCLUSIONS:Paying for PrEP and talking to one's provider about sexual behaviors are concerns for young sexual minority men. In particular, stigma from healthcare providers poses a significant barrier to PrEP use in this population. Providers need not only to increase their own awareness of and advocacy for PrEP as an effective risk-management strategy for HIV prevention, but also must work to create open and non-judgmental spaces in which patients can discuss sexual behaviors without the fear of stigma.

Background/UNASSIGNED:A growing body of research continues to elucidate health inequities experienced by transgender individuals and further underscores the need for medical providers to be appropriately trained to deliver care to this population. Medical education in transgender health can empower physicians to identify and change the systemic barriers to care that cause transgender health inequities as well as improve knowledge about transgender-specific care. Methods/UNASSIGNED:We conducted structured searches of five databases to identify literature related to medical education and transgender health. Of the 1272 papers reviewed, 119 papers were deemed relevant to predefined criteria, medical education, and transgender health topics. Citation tracking was conducted on the 119 papers using Scopus to identify an additional 12 relevant citations (a total of 131 papers). Searches were completed on October 15, 2017 and updated on December 11, 2017. Results/UNASSIGNED:Transgender health has yet to gain widespread curricular exposure, but efforts toward incorporating transgender health into both undergraduate and graduate medical educations are nascent. There is no consensus on the exact educational interventions that should be used to address transgender health. Barriers to increased transgender health exposure include limited curricular time, lack of topic-specific competency among faculty, and underwhelming institutional support. All published interventions proved effective in improving attitudes, knowledge, and/or skills necessary to achieve clinical competency with transgender patients. Conclusion/UNASSIGNED:Transgender populations experience health inequities in part due to the exclusion of transgender-specific health needs from medical school and residency curricula. Currently, transgender medical education is largely composed of one-time attitude and awareness-based interventions that show significant short-term improvements but suffer methodologically. Consensus in the existing literature supports educational efforts to shift toward pedagogical interventions that are longitudinally integrated and clinical skills based, and we include a series of recommendations to affirm and guide such an undertaking.