Sex reassignment surgery consists of different interven- tions, all with their own possible complications and risks. All these procedures can be performed separately or combined. Performing the mastectomy as a separate first procedure might facilitate the period of real-life testing for the gender dysphoric individual. Adversely, succeeding with the real-life test can be considered as a conditio sine qua non for commencing surgical transition. The latter view being our standard procedure in the first years of our experience, we combined all steps in a 10-h procedure. But, as in all combined operations, the total complication rate is not merely the sum of all individual complication rates: the length of these combined procedures, the extensive wound surface, multiple teams working at the same time and the considerable blood loss may create an exponential increase in the complication rate. After 3 years we began to perform the mastectomy as a separate procedure. In about one-third of these transsexual individuals hysterectomy had already been performed upon referral; the other two-thirds of the patients, however, still had an intact female reproductive
We need more brave individuals like Norsworthy, Kosilek, and Quine to continue to bring challenges and urge their correctional departments to implement these standards and create pathways for transgender inmates to receive treatment. Prisoners have a right to adequate medical care. Denying a certain treatment because it is politically unpopular or unfamiliar is at odds with our constitutional guarantees. Sex reassignment surgery is a medical treatment for gender dysphoria, and often the last and medically necessary form of treatment. There is no denying the constitutionality of sex reassignment surgery in the United States. It is more than just a fight for necessary medical care; it is a fight for the recognition of one’s sexual identity, access to proper health and safety, and, plainly, a fight to be treated as a human being.
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As the DOC doctors responsible for treating Kosilek and the experts who testified on Kosilek’s behalf credibly concluded, sex reassignment surgery is the only adequate treatment for Kosilek’s serious medical need. The DOC’s trial expert, Dr. Chester Schmidt, a psychiatrist from Johns Hopkins, proposed providing Kosilek with psychotherapy and antidepressants, rather than sex reassignment surgery. Dr. Schmidt’s recent work focuses primarily on medical billing procedures rather than treatment of gender identity disorders. Dr. Schmidt does not accept the Standards of Care . . . followed by prudent professionals. His approach to dealing with Kosilek’s condition would not be employed by prudent professionals in the community.
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In our sudy, it was also found that there is no significant association between depression and sex reassignment surgery or illness history after adjusting for covariates. In contrast, most studies, including previous studies from the UK, showed that chronic illness has a significant negative impact on mental health or depression. However, there were differences in methodology, including the design of the study, the operational definition of illness history, the sampling method and also the sample size, between those studies and this current study. Another contrary result is that Dr. Hess and colleagues surveyed 156 people who had all had sex reassignment surgery, and the results indicated that 71 percent of 156 transgender women had a significant association with well-being in mental health after sex reassignment surgery. These results are the opposite of each other because there was a small sample size in our study, which is one of the limitations. In this study, sexual partnership was not significantly associated with depression, but in the findings of a Chinese transgender cross-sectional study, sexual partnership was not only found to be significant but was also shown to play a major role in having depression.
Post-surgery attendance to the patient ranges between six to twenty four months. The transgendered individual must observe regular check-up schedules to be monitored by her physician. If major complications, such as shrinking of the vagina results the sex surgery will have to be repeated. In order to enhance her femininity, the transgendered person may opt for further medical procedures, such as breast enhancement techniques (saline- filled breast implant), returning to female hormone regiment, cosmetic thyroid cartilage reduction (tracheal shaving), criscothyroid approximation(toning feminine voice) or even laser assisted voice adjustment (LAVA) known as endoscopic surgery and other surgical procedures for reshaping of the chin and cheeks, forehead contouring, and rib removal. But it is mandatory that she must go for follow-up medical check-ups annually. 20 In the case of female-to-male surgery, on the other hand, the success rate of sex reassignment surgery thus far has not been encouraging. This is “due to the difficulty of building a functioning penis from the much smaller clitoral tissue available in the female genitals.” 21 In consequence, “in some instances, simply removing the breasts adequately satisfies the female-to-male transsexual. Others use a prosthetic penis that is either glued or strapped on, while yet others choose to undergo a phallic plastid (plastic surgery to attach a penis).” 22 The phallic plastid known as penis construction involves the following procedures 23 :
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31 females with diagnosed hallux valgus deformity who had received operative treatment and reported that the preopera- tive HVA and DMAA were significantly higher in males. Our results showed no significant differences in the preop- erative HVA and DMAA between male and female patients. It should be noted that men and women might feel different- ly about the need for hallux valgus surgery. Therefore, a comparative study of patients who undergo hallux valgus surgery might not accurately reflect gender-related differ- ences in the severity of hallux valgus deformity in the gen- eral population. The power about no differences in the pre- operative HVA and DMAA between the sexes is 0.99 and 0.17, respectively, at a significance level of 0.05. Thus, a study of a large number of patients is needed to identify the difference of DMAA between the sexes.
All patients were discussed and assessed in multi- disciplinary head and neck tumor rounds. Treatment options included either surgery alone or surgery and radiation therapy (XRT) depending on multiple fac- tors including tumor margin status, neck node status, and patients’ general medical health. Surgical inter- vention ranged from a simple superficial parotidect- omy with facial nerve sparing without neck dissection to a total parotidectomy with facial nerve resection and neck dissection. Parotidectomy with facial nerve sparing was defined as complete or partial preserva- tion, allowing for a few branches to be sacrificed as they were either encased by tumor or demonstrated paralysis preoperatively.
This study has several limitations. First, the TRO pro- cedures were not performed by a single surgeon. How- ever, all surgeons who performed TRO were specialized in hip joint surgery. As the operating surgeon or the supervisor was always an experienced surgeon, we con- sider that the particular surgeon who performed the pro- cedure was highly unlikely to have substantially affected the outcome. Second, differences in muscular strength or reported pain between the patients might have affected the progress of rehabilitation. However, it is unclear whether differences in the degree of progress between patients might affect the occurrence of com- plications. Finally, the dose of previous corticosteroid use could not be clearly determined upon review of the medical records, and it is possible that the relationship between current and previous doses of
ment prior to the fixation of loss or gain. The codon remains absent during the intermediate stage of reas- signment until the fixation of a subsequent gain or loss event leads to the establishment of the new code. In that case, the gain and loss events will be selectively neutral, because in the absence of the codon the changes in the tRNAs make no difference to the organism. Therefore, the temporal order of gain and loss events is irrelevant. If the codon does not disappear, the order of gain and loss events is important. In the AI mechanism, the gain occurs before the loss. Two tRNAs can associate with the codon, and hence the codon will sometimes be mistrans- lated, causing a selective disadvantage for the organism. If the loss then occurs, the codon is no longer ambigu- ous, and a new code has been established. However, there is still a selective disadvantage because the organ- Figure 1.—A schematic of the codon reassignment process
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In this article, we assume that the government or planner seeks to assign a price and amount of land fairly and efficiently, and at the same time, to guarantee non-manipulability by reassignment-proofness. In particular, our work can be seen as part of the theory of mechanism design applied to land rental (see Sen (2007) for an overview and Sarkar (2017) for a more recent contribution). We assume there is a single tenant who can be a mining firm, and several lessors who can be a group of communities. Each community has some available amount of land c i with a reservation price r per unit, that
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Host and network factors also contribute to the pattern of strains circulating in the population [3, 4]. The finding of clusters that had no specific geogra- phical location, risk group and age group distribu- tion, may be associated with a disassortative sexual mixing which would enlarge the transmission net- work. Disassortative sexual mixing may be observed among individuals living in urban settings or among bridging populations (e.g. men who have sex with both men and women) [22–25].
The UK Coalition government introduced a raft of welfare reforms between 2010-2015. As part of its response to the financial crisis reforms were designed to cut public expenditure on social security and enhance work incentives. Policy makers are required by legislation to have due regard to the need to eliminate discrimination, advance equality of opportunity, and foster good relations between different people. This Public Sector Equality Duty is an evidence-based duty which requires public authorities to assess the likely effects of policy on vulnerable groups. This chapter explores the extent to which the Department for Work and Pensions adequately assessed the equality impacts of key welfare reforms when policy was being formulated. The chapter focuses on the assessment of the impact of reductions to welfare benefits on individuals with protected characteristics - age, disability, gender, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, and sexual orientation - including individual and cumulative impacts. It also considers mitigating actions to offset negative impacts and how the collection of evidence on equality impacts was used when formulating policy. The chapter shows that the impacts of the reforms were only systematically assessed by age and gender, and, where data were available, by disability and ethnicity with no attempt to gauge cumulative impacts. There is also evidence of Equality Impact Assessments finding a disproportionate impact on individuals with protected characteristics where no mitigating action was taken.
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In this approach, we are looking for a sub-graph in the intended partition, which is appropriate for reassigning to another partition. This sub-graph should have a smaller size compared to the current size of the partition (for example less than 5 percent). The reason behind selecting a small size sub-graph is that such a sub-graph probably has lit- tle chance to grow while transferring it to a partition which some of its vertices have copy there not only increases the integrity in partitions but also decreases the number of the copies totally. In addition, the assignment of an edge that must leave the buffer can be done with minimum copy creation. Therefore, this reassignment decreases the replication factor. Moreover, transferring sub-graphs with larger size is not appropriate because of high computation and communication overheads.
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Cryopreservation of ovarian cortical tissue is an innovative method for the preservation of primordial follicles for the purpose of restoring fertility. This technique was developed for young female cancer patients enduring chemotherapy. However, there is a limited source of donors, which confines the research on follicular growth after grafting. Research shows that young female-to-male transsexuals, having been on androgen therapy for prolonged periods of time, can be potential donors. This paper explores transsexuality and the options available for making the transition to the opposite gender. Then it will examine the process and effects of patients on androgen therapy and the effects it may or may not have on the primordial follicle pool. Finally, a thorough examination will look at the possibility of using ovaries from those undergoing sex-reversal operations as a source of tissue for research and possible oocyte donation in the future.
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Netherlands Cancer Registry were recruited, 72 of whom were stage IV. The 34 patients who underwent surgery had longer median survival than those did not (median 10 months versus 2 months, P,0.001). This outcome was in accordance with our results that the median overall survival time for the surgery group was 12 months and for the no-surgery group, it was 4 months (P,0.01). Additionally, there is other cir- cumstantial evidence for the benefit of surgery. Simon et al summarized a multicenter retrospective study of the efficacy
. It occurred in a female patient who sustained an intertrochanteric fracture around the stem of a cemented hemiarthroplasty whilst convalescing from the aforementioned operation. A transfixing bolt and wire loop were used to reconstruct and stabilise the femur before reinserting the prosthesis into the reduced femur. Unfortunately, the patient died one month following surgery.
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This study was a retrospective chart review of patients at the eye clinic. A written informed consent was obtained from all patients before LASIK surgery, and an opt-out consent method was used to participate in this study. During the study period, 1,159 patients underwent LASIK (455 men; 704 women; mean age, 34.86 ± 10.61 years; range, 16–67 years). A total of 337 patients underwent either bilat- eral or unilateral surgery and completed the questionnaires before and 1 month after surgery. Of those, 307 patients who underwent bilateral LASIK and completed all questionnaires were included in this study (113 men; 194 women). The mean patient age was 34.34 ± 9.38 years (range, 20–63 years). The target refraction was emmetropia in 301 patients, and in the other 6 patients, a monovision approach was applied, in which the dominant eye was treated for distance vision and the non-dominant eye for near vision. Patients using psychi- atric medication were not indicated for surgery.
It has been frequently noticed that the delayed ACL reconstruction increased the risks of secondary meniscal and chondral injury , and it has been recently reported that delayed ACL reconstruction increased the risks of secondary meniscal and chondral injuries in this population of pediatric patients . Our study also looked into the correlation between the meniscal and articular cartilage injuries and ACL healing potential, but failed to detect the significant difference. Since the risk of meniscal and cartilage injuries was increased with the time after ACL injury, meniscal and cartilage injuries might not be an independent factor to evaluate as a pre- dictor. Further, knee arthrofibrosis is one of the most serious complications that can result from ligament surgery with a reported incidence following ACL recon- struction ranging from 4 to 35 %, and patients with reconstruction within the first two weeks of injury have a significant increase in arthrofibrosis, compared to those surgically treated after three weeks from injury . The early surgical timing may also benefit the pa- tients of less incidence of arthrofibrosis.
Transgender people are frequently denied access to trans-specific healthcare and other necessary supports (including gender appropriate clothing and make-up, hormone treatment, surgery, etc.). This can cause problems for people who have already begun gender transition and are forced to stop or delay the process, but also for those who wish to begin the process once WKH\¶YHHQWHUHGSULVRQ0DQ\Wrans-people also fear negative reprisals from disclosing their status, and choose to conceal their trans-identity entirely or wait to begin formal transition until they are released from prison ± often at considerable emotional stress and anguish. Such emotional trauma is cause for concern, particularly as rates of self-harm and suicide are already high in prison and trans-people have been specifically identified by the prison service DVDQµDWULVN¶JURXSLQWKLVDUHD
I found John Money's papers on amputee attraction at the University of Otago, in Dunedin, New Zealand, shortly after the Falkirk story made the news. Money is an expatriate New Zealander, and he has deposited his collected manuscripts in the Otago medical library. I had come to Dunedin to write a book at the university's Bioethics Centre, where I'd worked in the early 1990s. I have a medical degree, teach university courses in philosophy, and write a fair bit about the philosophy of psychiatry, and I was interested in the way that previously little-known psychiatric disorders spread, sometimes even reaching epidemic proportions, for reasons that nobody seems fully to understand. But I had never heard of apotemnophilia or acrotomophilia before the Falkirk story broke. I wondered: Was this a legitimate psychiatric disorder? Was there any chance that it might spread? Like Josephine Johnston, a lawyer in Dunedin who is writing a graduate thesis on the legality of these amputations (and who first brought the Falkirk case to my attention), I also wondered about the ethical and legal status of surgery as a solution. Should amputation be treated like cosmetic surgery, or like invasive psychiatric treatment, or like a risky research procedure?
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