1002 A CASE STUDY OF GENDER DYSPHORIA IN THE ELDERLY

 

The aging Lesbian, Gay, Bisexual, Transgender (LGBT) population is a patient group which has not been extensively researched in terms of its specific clinical needs. There is growing improvement in the awareness of LGBT patients; however there appears to be a disparity between care provided for younger and older LGBT individuals. The LGBT community suffers from disproportionately reduced access to care as well as healthcare discrimination and a lack of specialist medical expertise thereby increasing the risk to their physical and mental health. Combined with the implications and challenges of living with frailty, older LGBT individuals are some of the most vulnerable members of our society.

Our patient

a 90-year-old man with gender dysphoria, falls into this subset. This case study follows our patient’s internal struggle with his longstanding concealment of his transsexualism, issues accessing specialist care, reduced treatment options in view of his age and the repercussions. These include an impact on his physical health by means of a self-inflicted injury resulting in a urethral fistula and his mental health with worsening depression and reduced ability to rationalise his gender dysphoria.

The study presents challenges from both a clinical perspective, in terms of an accurate psychiatric diagnosis, as well as the challenges experienced by the patient in the healthcare setting.

While this case explores both the causes and effects of these difficulties; the specific needs and experiences of older LGBT patients remain largely unknown. Through highlighting this patient’s experiences, we hope to encourage thought and discussion of such issues amongst other healthcare professionals to ensure a holistic approach of care.

Positive reinforcement targeting abstinence in substance misuse (PRAISe): Study protocol for a Cluster RCT & process evaluation of contingency management

There are approximately 256,000 heroin and other opiate users in England of whom 155,000 are in treatment for heroin (or opiate) addiction. The majority of people in treatment receive opiate substitution treatment (OST) (methadone and buprenorphine). However, OST suffers from high attrition and persistent heroin use even whilst in treatment. Contingency management (CM) is a psychological intervention based on the principles of operant conditioning. It is delivered as an adjunct to existing evidence based treatments to amplify patient benefit and involves the systematic application of positive reinforcement (financial or material incentives) to promote behaviours consistent with treatment goals. With an international evidence base for CM, NICE recommended that CM be implemented in UK drug treatment settings alongside OST to target attendance and the reduction of illicit drug use. While there was a growing evidence base for CM, there had been no examination of its delivery in UK NHS addiction services. The PRAISe trial evaluates the feasibility, acceptability, clinical and cost effectiveness of CM in UK addiction services. It is a cluster randomised controlled effectiveness trial of CM (praise and financial incentives) targeted at either abstinence from opiates or attendance at treatment sessions versus no CM among individuals receiving OST. The trial includes an economic evaluation which explores the relative costs and cost effectiveness of the two CM intervention strategies compared to TAU and an embedded process evaluation to identify contextual factors and causal mechanisms associated with variations in outcome. This study will inform UK drug treatment policy and practice. Trial registration ISRCTN 01591254.

Deep tissue bio-imaging using two-photon excited CdTe fluorescent quantum dots working within the biological window

A new approach to deep tissue imaging is presented based on 8 nm CdTe semiconductor quantum dots (QDs). The characteristic 800 nm emission was found to be efficiently excited via two-photon absorption of 900 nm photons. The fact that both excitation and emission wavelengths lie within the "biological window" allows for high resolution fluorescence imaging at depths close to 2 mm. These penetration depths have been used to obtain the first deep tissue multiphoton excited fluorescence image based on CdTe-QDs. Due to the large thermal sensitivity of CdTe-QDs, one may envisage, in the near future, their use in high resolution deep-tissue thermal imaging.

A distinct strategy to generate high-affinity peptide binders to receptor tyrosine kinases

We describe a novel and general way of generating high affinity peptide (HAP) binders to receptor tyrosine kinases (RTKs), using a multi-step process comprising phage-display selection, identification of peptide pairs suitable for hetero-dimerization (non-competitive and synergistic) and chemical synthesis of heterodimers. Using this strategy, we generated HAPs with K(D)s below 1 nM for VEGF receptor-2 (VEGFR-2) and c-Met. VEGFR-2 HAPs bound significantly better (6- to 500-fold) than either of the individual peptides that were used for heterodimer synthesis. Most significantly, HAPs were much better (150- to 800-fold) competitors than monomers of the natural ligand (VEGF) in various competitive binding and functional assays. In addition, we also found the binding of HAPs to be less sensitive to serum than their component peptides. We believe that this method may be applied to any protein for generating high affinity peptide (HAP) binders.

Rolling circle amplification: a new approach to increase sensitivity for immunohistochemistry and flow cytometry

Immunohistochemistry is a method that can provide complementary diagnostic and prognostic information to morphological observations and soluble assays. Sensitivity, specificity, or requirements for arduous sample preparation or signal amplification procedures often limit the application of this approach to routine clinical specimens. Rolling circle amplification (RCA) generates a localized signal via an isothermal amplification of an oligonucleotide circle. The application of this approach to immunohistochemistry could extend the utility of these methods to include a more complete set of immunological and molecular probes. RCA-mediated signal amplification was successfully applied to the sensitive and specific detection of a variety of cell surface antigens (CD3, CD20, and epithelial membrane antigen) and intracellular molecules (vimentin and prostate-specific antigen) within a variety of routinely fixed specimens, as well as samples prepared for flow cytometry. RCA technology, which has an intrinsically wide dynamic range, is a robust and simple procedure that can provide a universal platform for the localization of a wide variety of molecules as a function of either antigenicity or nucleic acid sequence. The use of RCA in this way could enhance the use of markers of current interest as well as permit the integration of emerging information from genomics and proteomics into cell- and tissue-based analyses.