Preferred Means Research Articles

Case report of ablative magnetic resonance-guided stereotactic body radiation therapy for oligometastatic mesenteric lymph nodes from bladder cancer

: Several randomized trials have demonstrated that stereotactic body radiation therapy (SBRT) can significantly improve long-term clinical outcomes for patients with oligometastatic (OM) cancer, commonly defined as 1–5 metastatic lesions. Some lesions, especially those in the abdomen and pelvis, may not be appropriate candidates for receiving ablative dose if daily on-board computed tomography (CT) is used because of limited target lesion and normal anatomy visualization. Magnetic resonance imaging (MRI) inherently provides superior soft tissue delineation as compared to CT and only recently have MR-guided linear accelerators (LINACs) become commercially available. MR-LINACs can also perform daily online adaptive replanning based on the current day’s anatomy, further positioning this novel technology as a preferred means to safely deliver ablative dose, even to targets in anatomically challenging locations. Here we present the case of a 49-year-old man with bladder cancer who underwent cystectomy and developed metachronous disease in 2 mesenteric lymph nodes for which he received MR-guided SBRT with daily online adaptive replanning to a prescription dose of 50 Gy in 5 fractions. He achieved a significant radiographic response and did not experience significant treatment-related toxicity. We discuss unique advantages of MR guidance and novel applications, especially in the context of OM disease.

Use of a Laparoscopic Witzel Gastrostomy Without Gastropexy in Bariatric and General Surgery

BackgroundGastrostomy placement is the preferred means of long-term enteral feeding for patients who cannot eat by mouth. During laparoscopic gastrostomy, it is standard to perform gastropexy, apposing visceral and parietal peritoneum. In some settings, due to altered anatomy from prior surgery, direct apposition of the stomach to the abdominal wall is not possible. This study reports a series of cases where laparoscopic gastrostomy was performed via a Witzel approach without gastropexy.MethodsA retrospective chart review was performed of all patients at a tertiary academic medical center who underwent Witzel gastrostomy without gastropexy over a 3-year period. In each case, an 18-French tube was placed into the fundus of the stomach and secured with a purse-string suture. A 5-cm serosalized Witzel tunnel was created around the tube using running silk suture. No gastropexy was performed.ResultsSix patients underwent 7 Witzel gastrostomy procedures. In three cases, patients had undergone prior major upper abdominal surgery where adhesive disease prevented gastropexy. In the other four cases, the patients had undergone prior gastric bypass with antecolic antegastric position of the roux limb. No patient suffered leak of gastric contents into the peritoneum, and there were no postoperative complications or mortality related to the gastrostomy.ConclusionIn cases where enteral access is necessary, and where the stomach cannot reach the anterior abdominal wall for gastropexy due to prior surgeries, a Witzel gastrostomy without gastropexy is a safe option which resulted in no morbidity or mortality in our series.

Social Media as a Form of Virtual Whistleblowing: Empirical Evidence for Elements of the Diamond Model

This article originally advances the field of organizational whistleblowing by empirically investigating the suitability of the four elements of the fraud diamond as a means to understand the intention to disclose wrongdoing through virtual channels. This article also makes a contribution on the theme of whistleblowing as it relates to customers, an under-studied, however, relevant stakeholder in this field. The main findings of the article are as follows: (a) the four elements of the fraud diamond as they relate to whistleblowing—a combination of pressure, financial incentive, opportunity and rationalization, and capability—can explain the intentions behind customer reports of wrongdoing; (b) online social media channels are customers’ preferred means of whistleblowing; (c) the elements of opportunity and capability are strongly correlated with the use of social media as a method of disclosing wrongdoing; and (d) virtual channels can be useful for whistleblowers in order to avoid potential retaliation. Unique managerial and academic implications of these research findings are also discussed, extending the layers of knowledge on whistleblowing in organizations.

Uso de la Web 2.0 en comunidades virtuales de pacientes con enfermedades raras en España

Este trabajo trata de conocer los recursos de comunicación de la Web 2.0 utilizados en las comunidades virtuales de pacientes con enfermedades raras y comprobar si responden a sus necesidades informativas y mejoran su condición sanitaria. El estudio observacional de las páginas web de 80 organizaciones muestra que estas comunidades y sus redes sociales digitales son los medios preferidos para la comunicación en salud y para proporcionar apoyo mutuo. El conocimiento colectivo generado favorece la coparticipación en la toma de decisiones y proporciona un enfoque del cuidado más centrado en sus necesidades.

Demonstrating the effects of behavioral control beliefs on the actual WEEE discharge routes: A case study in South Korea

Since 2008, South Korea has operated the Extended Producer Responsibility (EPR) system, which collects and recycles waste electrical and electronic equipment (WEEE). Although the EPR recycled 305,050 tons of WEEE in 2017, approximately 62.5% remained in the informal sector, posing potential risks to the environment. This study is intended to provide information on consumer behavior regarding the discharge of WEEE and to analyze the causality between consumer beliefs and behavior, using the theory of planned behavior (TPB) model to establish strategies for maximizing the flow of WEEE through the formal sector. In accordance with the methodology, questionnaire data were collected from 2,000 respondents, who were selected through a stratified procedure, using computer-assisted telephone interviews to investigate their behavior related to the discharge of WEEE. According to the results, about 31.50% of the respondents had disposed of WEEE in 2017, and the most frequently discarded item was a refrigerator (35.08%). Local authorities (38.95%) and take back (37.30%) were the preferred means of discarding large- and mid-sized appliances. According to the TPB analysis, norm and control beliefs for discarding WEEE through the formal sector significantly affected behavioral intention (p≤0.001). Furthermore, controlbeliefs directly affected actual discharge behavior (B = 1.351, p≤0.001)and actual discharge routes (B = 0.846, p≤0.05). These results indicate that the TPB can provide political strategies for discarding WEEE through the formal sector based on the causality between consumer beliefs and actual consumer behavior.

Comparing coverage criteria for dynamic web application: An empirical evaluation

Web applications have become popular and a preferred mean for users to do various crucial tasks such as selling and buying goods, doing short tasks, controlling smart houses and bank account management. The correctness of all such applications is important and requires thorough testing. Structural testing is widely used to achieve correctness in traditional software's, however, for web applications, it is challenging because of its dynamic and heterogeneous nature. To achieve desired structural coverage of web applications different dynamic coverage criteria are used as a quality assessment indicator. However, there is a lack of empirical evidence regarding the effectiveness of the proposed coverage criteria. In this paper, we conduct an empirical evaluation by evaluating and comparing the fault detection effectiveness and efficiency of various dynamic coverage criteria by performing mutation analysis. We conduct a series of experiments to assess and compare four widely used coverage criteria on seven open-source case studies including small to large scale applications. We performed mutation analysis by first generating different faulty versions (mutants) for the case studies and then by executing test suites to record mutation score for each criterion. The results from most of the subject applications show that DOM coverage is the most effective and efficient criterion followed by Virtual DOM, HTML Element and Statement coverage criteria.

Paediatricians and trainee paediatricians perspectives on industrial action by medical doctors in Nigeria

Background: Industrial actions have become a common means by which medical doctors attempt to communicate their grievances to the government. Paediatricians are frequently caught between a desire to support the course of their professional association and caring for their patients. The purpose of this study was to assess the opinion of paediatricians and trainee paediatricians regarding strike actions, the likely cause(s) and their reasons for and against industrial actions as a means for communicating grievances to the government.Methods: A cross-sectional descriptive study was conducted using self-administered questionnaires randomly distributed to consenting participants at the 48thAnnual Scientific Conference of the Paediatric Association of Nigeria. Data were analysed using SPSS version 20.Results: A total of 102 respondents from the 6 geopolitical zones in Nigeria returned appropriately filled forms. Fifty-seven (55.9%) were females, 91 (81.2%) were married, 72 (70.6%) were Christians and 49 (48%) were Consultant paediatricians. Poor remuneration (36%), poor working conditions(24.3%) and failure of the government to keep promises to doctors (19.9%) were the top three reasons given for the incessant industrial actions in the recent past. Forty-nine percent of respondents did not support industrial actions, 65% responded that strikes affect the quality of training and practice and (84.3%) volunteer their services during a strike.Conclusions: Industrial actions are not the paediatricians’ preferred means of communicating grievances. Other methods should, therefore, be explored to limit the deleterious effects of industrial actions.
 Keywords: Paediatrician, Nigeria, industrial action, strike, medical doctors, trainee

An Analysis of the Relationship between Students’ Scientific Attitude and Students’ Learning Style in Junior High School

The objectives of this study were to profile the relationship of scientific attitude level and learning style preference among junior high school students in Bandung. This study utilized a survey research design with a total sample size of 110 students. A scientific attitude questionnaire and a visual, auditory, and kinesthetic (VAK) learning style inventory were administered in this study. The questionnaire measures five aspects of scientific attitude, specifically rationality, curiosity, open-mindedness, aversion to superstition, and objectivity. The VAK learning style inventory evaluates the preferred means of receiving sensory information. The scientific attitude questionnaire provided consistent results, as indicated by its reliability coefficient (0.896). The results show that junior high school students have an average level of scientific attitude and generally prefer a kinesthetic learning style. There was a medium relationship between scientific attitude and learning style among the students (Cramer’s V coefficient = 0.239). It is concluded that learning style must be considered in implementing a science lesson, especially in the Indonesian context.

Transferring of the Disputes Arising from Arabic Language Rules to the Translations of Qur'an: The Examples of Bayraktar Bayraklı and Mustafa Öztürk's Translations

Bu çalışmada Arapça dil kurallarından kaynaklanan ihtilâfların meâllere ne ölçüde aktarıldığı Bayraktar Bayraklı ve Mustafa Öztürk meâli özelinde incelenmiştir. Çalışmada bu iki meâl; hakîkat-mecâz, çokanlamlılık, zamirin mercii, bazı bağlaç ve edatlar ile ilgili farklı değerlendirmeler, hazif/eksiltili cümle ve takdîm-te’hîr olmak üzere altı dil kuralı açısından üçer örnekle karşılaştırılmıştır. Sonuçta, anlamın özünde ciddi bir farklılığa sebep olmayan ihtilâfların meâle yansıtılmadığı ve dolayısıyla her iki meâlde de bu konuda isâbet sağlandığı saptanmıştır. Zira anlamın özüne etki etmeyen farklılıkların meâle yansıtılması, mealin kapsamı nazara alındığında hem imkân dışı hem de gereksizdir. Diğer taraftan mananın özünde ciddi farklara neden olan ihtilâfların kimi zaman meâle aktarıldığı kimi zaman ise aktarılmadığı tespit edilmiştir. Bu nedenle her iki meâlde de bu açıdan bazı eksikliklerin bulunduğu sonucuna varılmıştır. Çünkü tercih edilmeyen görüşlerin dipnot ya da açıklama bölümünde meâle yansıtılması önem arz etmektedir. Aksi halde âyetlerdeki anlam zenginliği meâle aktarılmadığı gibi tercih edilen anlamın kastedilmeyen anlam olma ihtimâli de mümkündür.

Barriers to Gestational Diabetes Management and Preferred Interventions for Women With Gestational Diabetes in Singapore: Mixed Methods Study.

BackgroundGestational diabetes mellitus (GDM) is associated with risks for both the mother and child. The escalated prevalence of GDM because of obesity and changes in screening criteria demands for greater health care needs than before.ObjectiveThis study aimed to understand the perception of patients and health care providers of the barriers to GDM management and preferred interventions to manage GDM in an Asian setting.MethodsThis mixed methods study used a convergent parallel design. Survey data were collected from 216 women with GDM, and semistructured interviews were conducted with 15 women and with 8 health care providers treating patients with GDM. Participants were recruited from 2 specialized GDM clinics at the National University Hospital, Singapore.ResultsThe patients were predominantly Chinese (102/214, 47.6%), employed (201/272, 73.9%), with higher education (150/216, 69.4%) and prenatal attendance at a private clinic (138/214, 64.2%), already on diet control (210/214, 98.1%), and receiving support and information from the GDM clinic (194/215, 90.2%) and web-based sources (131/215, 60.9%). In particular, working women reported barriers to GDM management, including the lack of reminders for blood glucose monitoring, diet control, and insufficient time for exercise. Most women preferred getting such support directly from health care providers, whether at the GDM clinic (174/215, 80.9%) or elsewhere (116/215, 53.9%). Smartphone apps were the preferred means of additional intervention. Desirable intervention features identified by patients included more information on GDM, diet and exercise options, reminders for blood glucose testing, a platform to record blood glucose readings and illustrate or understand trends, and a means to communicate with care providers.ConclusionsA GDM-focused smartphone app that is able to integrate testing, education, and communication may be a feasible and acceptable intervention to provide support to women with GDM, particularly for working women.

Prevalence and Pattern of Road Traffic Accidents among Commercial Motorcyclists in the Central Tongu District, Ghana.

Background The World Health Organisation estimates that 1.35 million people die as a result of road traffic crashes. Motorcycles as a means of transport are increasingly becoming the preferred and easiest means of transportation for most people in developing countries despite the associated risk. This study determined the prevalence and pattern of motorcycle crashes in Adidome among commercial motorcyclists. Methods A descriptive, cross-sectional study design was used as 114 commercial motorcyclists were recruited to respond to a pretested research questionnaire in the Adidome district of the Volta Region. Data were analyzed using SPSS, version 22.0. Data were presented as simple descriptive statistics. A chi-square relationship was determined using the demographic variables, and the history of accident at a 95% confidence interval with 0.05 was considered as statistically significant. Results The prevalence of road traffic crashes at Adidome was 64.0%. Motorcyclists (74.0%) were reported to have been involved in crashes in the past one year prior to the study. Motorcyclists attributed the last accident to excessive speeding (31.5%) and bad roads (23.3%), this accident as a result of colliding with another motorcycle (50.7%), and slippery surfaces (24.7%). The majority (63.0%) of the respondents had an accident once. The consumption of alcohol was associated with the occurrence of an accident as 34.2% occurred among cyclists who drank alcohol, compared with 29.8% who did not (p < 0.05). Conclusion There should be strict implementation of current road traffic regulations of Ghana by the MTTD of the Ghana Police Service, and penalties should be awarded against anybody caught riding a motorcycle under the influence of alcohol. Helmet and other protective devices must be made compulsory for motorcycle riders to prevent injuries, especially head injuries, if an accident occurs.

The Individual Transport Mobility Gap (ITMG) as an Obstacle on the Road to Higher Rates of Public Transport Use

Abstract Research purpose. The call for higher rates of public transport usage seems reasonable and understandable, given the growing impact of climate change and the high burden of heavy traffic, especially on urban transport structures. A course of Bachelor’s degree students in Logistics explored the issue of satisfaction with individual transport mobility, formulating the hypothesis that there must be a striking difference in the quality behind the use of a private car versus the use of public transport. The hypothesised difference in perceived quality between the two modes of transport was called the individual transport mobility gap (ITMG). Design/Methodology/Approach. The ITMG was considered from the perspective of people who mainly use a car (car users) and who mainly use public transport (public transport users). Both groups were asked how they rate their preferred means of transport and how they rate the alternative mode of transport using an online questionnaire. The survey can be accessed online at: https://fhludwigshafen.eu.qualtrics.com/jfe/form/SV_6JOoxNvlSVxsdDv. Findings. The results of the study confirmed the hypothesis that there is a substantial perceived gap with an ITMG value of 4.0 between using a car versus using public transport for people who primarily use a car. In contrast, the ITMG value for public transport users was only 0.8. Originality/Relevance/Practical Implications. The originality of this approach lies in surveying satisfaction with a mode of transport at a highly aggregated level rather than at the level of individual quality factors, such as punctuality or flexibility. ITMG is defined in this study as a valuable metric that provides a basis for comparison. This quantitative metric can in turn be used to determine the effectiveness of measures to increase usage rates of public transport. The study also provides practical findings by making available its database to other researchers for further evaluation purposes. The study also contributes to scholarly and public discourse on how to effectively reduce the satisfaction gap in the use of private cars versus public transport, thus resulting in improved outcomes for the environment and society.

Food Resource Awareness and Information Sharing Among College Students at High Risk of Food Insecurity

Abstract Objectives To identify information dissemination needs around food resources available through the university as informed by student representing groups at risk of food insecurity. Methods Eight focus groups with 17 leaders of student organizations representing students at high risk of food insecurity (ie, underrepresented minorities, first generation college students, low income, foster youth, and LGBTQA+) were conducted. Students’ experiences and views regarding awareness of available food resources, barriers and facilitators to obtain information on resources, and group-specific needs to improve communication of available resources was gathered. A codebook was developed and used for inductive analysis of interview data. Deductive thematic analysis was done by engaging in extensive commentary and discussion of the code structure. Results Awareness of resources available on campus was low, especially regarding guidance on SNAP application. Although students were able to name a few available resources, they often described inaccurate details. Social networks (ie, social media, direct peer-to-peer communication) were prominently identified as relevant means to share on campus food resource information. Students often recommended coordinated marketing strategies (eg, flyers, social media presence) and direct outreach via clubs/organizations as solutions to improve resource communication. Students preferred means to receive information on how to improve food security included online content (eg, videos, mobile apps) and in person events (eg, interactive demonstrations). Conclusions Comprehensive dissemination of available resources through relevant channels is key to improving food access, particularly among students at high risk of food insecurity. Promising dissemination strategies include direct outreach in student clubs/organizations combined with well-coordinated marketing campaigns that include a broad social media presence and online content. Funding Sources This research is being supported by the Blum Center for Developing Economies, University of California, Merced; and the Global Food Initiative, University of California Office of the President.

How Effective Were the Beach Nourishments at Cancun?

Beach nourishment is generally seen as the preferred means of rectifying coastal erosion, due to its low environmental impact and natural evolution. The largest beach nourishment project ever carried out in Mexico took place on Cancun beach in 2006, as a response to the most intense hurricane season ever registered in Mexico, in 2005. After Hurricane Dean, in 2009, a second nourishment was conducted, which evidenced flaws in the design and execution of the first project. Previous investigations report that the need for beach re-fills directly correlates with wave energy. However, following a thorough revision of the extreme climatic events that occurred between 1978 and 2018, it has been found that the amount of erosion also depends on the frequency and duration of high energy events. The findings also show that the apparent success of the second nourishment is mainly associated with a decline in the number of extreme wave power events impacting the beach. In the conclusion to this paper, we share the knowledge gained, but not yet applied, in Mexico or elsewhere, regarding beach use, urbanization, and protection in beach planning.

Student Engagement in MacEwan Career Development and Experiential Learning Services

The goal of this research in working with MacEwan’s Career Development and Experiential Learning (CDEL) has been to distinguish the target market so that CDEL can efficiently and effectively promote their services. Having multiple differing variables amongst MacEwan students, our team has analyzed which demographics will respond enthusiastically to marketing efforts. &#x0D; CDEL should develop their marketing strategies around students of all years of study equally. Creating ‘year of study workshops’ may provide long-term interest for students. It is recommended that CDEL run their online advertisements through Instagram, LinkedIn, Blackboard, and Email primarily, as those are the most used and preferred means of gaining information. Creating relationships with students by their preferred means of communication will provide CDEL with the best response and engagement with the services.

T104. PSYCHOTIC-LIKE EXPERIENCES AND PROBLEMATIC GAMING BEHAVIOR IN ONLINE GAME FORUMS

BackgroundPsychotic-like experiences (PLE) are reported in the general population, characterizing a non-clinical psychosis phenotype. Although those who report PLE have a higher probability of transitioning to psychosis, PLE are usually a transitory state, and most individuals will not transition to psychosis. However, PLE samples may experience symptoms such as social withdrawal, social anxiety, or social anhedonia. These symptoms may lead individuals with PLE to choose online gaming as a preferred means of social interaction.ObjectiveThis study aims to examine the relation between PLE and problematic online gaming.MethodsAn online questionnaire was posted in online game forums, on online fan-pages with German-speaking domains and in social media groups. Data from adolescents and young adults (14 to 30 years old; 55.4% males) from Austria and Germany (N=280) was analyzed. Measures: PLE were assessed with the Early Recognition Inventory based on the Interview for the Retrospective Assessment of the Onset of Schizophrenia (ERIraos); problematic gaming behavior was assessed with the Compulsive Internet Use Scale (CIUS) adapted for online gaming; social anxiety was assessed with the Mini-Social Phobia Inventory (Mini-SPIN); preference for online social interactions was assessed with the Preference for Online Social Interaction scale (POSI). Analyses: Problematic gaming behavior was divided into two groups based on the suggested cut-off point of ≥18 on the CIUS (i.e., ≥18 gaming disorder vs. ˂18 no gaming disorder). Multivariable logistic regression analyses were performed and adjusted for sex, age, gaming hours, POSI, and social anxiety.ResultsA total of 63 individuals reached the cutoff for a gaming disorder, while 217 did not reach the cutoff. The majority of subjects in the gaming disorder group were males, young adults (19–24 years old, M=23.1, SD=3.7), single, or had less than high school diploma. Individuals who experienced an increased amount of PLE had a higher probability of reaching the cut-off for a gaming disorder (AOR=1.35 [95% CI 1.19–1.53]). Males were three times as likely as females to have a gaming disorder.DiscussionResults implicate a close relation between the phenomena of PLE and continued problematic gaming behavior.

Directed energy deposition of Al 5xxx alloy using Laser Engineered Net Shaping (LENS®)

Here, we present directed energy deposition (DED) of wrought-like Al 5xxx AlMg alloy by Laser Engineered Net Shaping (LENS®). A transition from an Al 5083 gas atomized powder feedstock to Al 5754 characteristics of the as-deposited material due to selective evaporation of Mg was observed. Density values obtained by X-ray micro-computed tomography (μ-CT) were compared to those obtained by the Archimedes method. The latter indicated a relative density as high as 99.26%. Possible origins of porosity are discussed. The as-deposited material was comprised of both equiaxed and columnar grains with no preferred crystallographic orientation and mean grain size of 36 μm. The Young's modulus, yield stress, ultimate tensile strength, fracture strain, Poisson's ratio, and total ultimate strain energy (toughness) were determined by uniaxial tensile tests combined with digital image correlation (DIC). Fractography complemented the mechanical testing. A pulse-echo ultrasonic non-destructive test was used to obtain more accurate values of the Young's and shear moduli and to adjust the value of the yield strength accordingly. The measured mechanical properties meet the requirements of international standards for wrought Al 5754 in its annealed condition.

Impact of menthol delivery methods on smoker sensory perceptions.

INTRODUCTIONMenthol can be added to cigarettes in several ways; these different delivery methods of menthol may lead to changes in sensory attributes, as well as perceived risk and appeal of these products.METHODSUsing a randomized, controlled study design, 18 current, established menthol smokers were asked to sample Camel Crush and Camel Menthol cigarette products, crushed and uncrushed. Smoking behavior, exhaled carbon monoxide, subjective ratings, and perceived risk measures were assessed for each product.RESULTSCigarette Evaluation Scale relief of craving scores for participants’ preferred brand (mean: 5.3, SE: 0.3) were significantly higher (p=0.012) than Camel Menthol crushed (mean: 4.6, SE: 0.3) as were the Sensory Scale satisfaction scores (preferred brand mean: 6.9, SE: 0.7 compared to Camel Menthol crushed mean: 5.1, SE: 0.6; p=0.004). In addition, the average Sensory Scale smoke strength scores for participants’ preferred brand (mean: 6.9, SE: 0.5) was also significantly higher than Camel Crush crushed (mean: 5.0, SE: 0.5; p=0.022). There were no significant differences in smoking topography measures, CO boosts, or perceived risk between Camel Crush or Camel Menthol products.CONCLUSIONSThe delivery method and amount of menthol present in cigarettes did not appear to affect short-term smoking behavior, sensory perceptions, or perceived product risk among a small sample of current established adult menthol smokers. It is possible that consumers of cigarette products may be attracted to the innovative technology of the crushable filter capsule as opposed to the taste experience, however, further research is needed.

Reading and Studying on the Screen, and, Addendum: two articles

As distance education moves increasingly towards online provision, and because of the benefits provided by online approaches, students will be expected to engage with more resources available on screen. Contemporary forms of reading from the screen include reading from tablet devices, LCD monitors, and smartphones. However, print remains the preferred means of reading text, and student preference for print is accentuated when reading involves thorough study (Ackerman &amp; Lauterman, 2012; Foasberg, 2014). Education providers face an interesting challenge. Although many learners prefer having access to printed materials, on-screen reading can improve education’s convenience, portability, media-richness, engagement, support, and data-evidenced practice. In this context it is timely to consider the potential for on-screen reading from the perspective of learning design. This article considers studies related to reading on screen, and suggests good practice principles for on-screen-only learning design.In 2016 the article “Reading and Studying on the Screen: An Overview of Literature Towards Good Learning Design Practice” was published. The article overviewed comparative studies related to reading on screen and reading from print, and proposed recommendations for on-screen learning design. This addendum to that article considers additional studies that have been analysed in subsequent blog posts (see “An Update to ‘Reading and Studying From the Screen’” [http://tel-lingit.blogspot.com/2018/02/an-update-to-reading-and-studying-from.html] and “A Further Update to ‘Reading and Studying From the Screen’” [https://tel-lingit.blogspot.com/2018/11/a-further-update-to-reading-and.html]) up to the end of November 2018. As this is an invited addendum, I’ll take the opportunity to adopt a more personal and self-disclosing style to talk more about my own position and experience regarding digital education and on-screen reading. This piece alternates is both scholarly and polemic.

Fertility Preservation in Transgender and Gender Non-conforming Adults [21A

INTRODUCTION: Obstetricians and gynecologists play an important role in providing care to all persons who desire parenthood. However, there are limited studies assessing the preferences of transgender adults in achieving parenthood. We aimed to examine the importance of parenthood and preferred means to achieve it in a transgender adult population. METHODS: A cross-sectional survey of patients aged ≥ 18 years and who self-identified as a gender minority at an urban academic medical center and outpatient primary care center specializing in LGBTQ health. RESULTS: Sixty-two people completed the survey, of which 7 (11.3%) were born male and 55 (88.7%) were born female. The average age of participants was 28.2. Only 2 (3.2%) participants had children, although 52 (88%) reported desiring parenthood. Of those who desired parenthood, 14 (29%) preferred to achieve this using their own gametes, 12 (24%) preferred adoption and 14 (29%) preferred to use a gestational carrier without using their gametes. Only 34 (56%) reported that a healthcare provider discussed oocyte cryopreservation prior to transition. The largest barriers identified to oocyte cryopreservation were desire (33%), cost (58%), and stopping cross-sex hormones (25%). 10 (16.4%) believed their ability to have children was decided without their consent. CONCLUSION: In this survey of adult transgender patients, the majority are desiring parenthood. Barriers previously identified in the literature such as physical examination and provocation of periods/penile tumescence were not viewed to be as significant as cost and stopping cross-sex hormones. This knowledge can improve clinical discussions and identify the barriers that transgender patients experience in achieving parenthood.