Focus: Sex and Gender Health: Women and Chest Pain: Recognizing the Different Faces of Angina in the Emergency Department

Emergency departments (ED) in the United States see over eight million cases of chest pain annually. While a cardinal symptom of acute coronary syndrome (ACS), multiple emergent and non-emergent causes can attribute to chest pain. This case-based perspective describes the different sex-specific causes of angina seen in ED patients. Once coronary artery disease (CAD) is ruled out with standard protocols, microvascular dysfunction is perhaps the most prevalent but under-diagnosed cause of non-CAD related angina in ED patients. Additional causes include coronary artery spasm, coronary artery dissection, coronary artery endothelial dysfunction and myocardial bridging. Non-CAD related angina is associated with persistent chest pain causing poor function, quality of life, and recidivism. Clinicians should consider additional diagnostics to routinely screen for non-CAD related causes of angina in patients with recurrent chest pain. Future work is needed to better define the epidemiological, clinical, biological, and genetic correlates of microvascular dysfunction in these patients.     

Focus: Sex and Gender Health: Patient Preference for Physician Gender in the Emergency Department

Despite historical gender bias against female physicians, few studies have investigated patients’ physician gender preference in the emergency department (ED) setting. We sought to determine if there is an association between ED patient demographics and physician gender preference. We surveyed patients presenting to an ED to determine association between patient demographics and patient physician gender preference for five ED situations: 1) ‘routine’ visit, 2) emergency visit, 3) ‘sensitive’ medical visit, 4) minor surgical/‘procedural’ visit, and 5) ‘bad news’ delivery. A total of 200 ED patients were surveyed. The majority of ED patients reported no physician gender preference for ‘routine’ visits (89.5 percent), ‘emergent’ visits (89 percent), ‘sensitive’ medical visits (59 percent), ‘procedural’ visits (89 percent) or when receiving ‘bad news’ (82 percent). In the setting of ‘routine’ visits and ‘sensitive’ medical visits, there was a propensity for same-sex physician preference.     

Brief communication: Gender and sex: Vive la difference

The distinction prevalent in the social sciences between the terms sex and gender is a useful one and ought to be preserved. Sex refers to the anatomical or chromosomal categories of male and female. Gender refers to socially constructed roles that are related to sex distinctions. Use of these terms as synonyms is becoming increasingly frequent in physical anthropology, especially among bioarchaeologists and primatologists. A failure to make the distinction between gender and sex is analytically incapacitating in a field such as physical anthropology, whose strength lies in the integration of biological and cultural information. Am J Phys Anthropol 106:255–259, 1998. © 1998 Wiley-Liss, Inc.     

Focus: Sex and Gender Health: Balance of the Sexes: Addressing Sex Differences in Preclinical Research

Preclinical research is fundamental for the advancement of biomedical sciences and enhancing healthcare. Considering sex differences in all studies throughout the entire biomedical research pipeline is necessary to adequately inform clinical research and improve health outcomes. However, there is a paucity of information to date on sex differences in preclinical work. As of 2009, most (about 80 percent) rodent studies across 10 fields of biology were still conducted with only male animals. In 2016, the National Institutes of Health implemented a policy aimed to address this concern by requiring the consideration of sex as a biological variable in preclinical research grant applications. This perspective piece aims to (1) provide a brief history of female inclusion in biomedical research, (2) describe the importance of studying sex differences, (3) explain possible reasons for opposition of female inclusion, and (4) present potential additional solutions to reduce sex bias in preclinical research.     

Focus: Sex and Gender Health: Beyond the Pap Smear: Gender-responsive HIV Care for Women

Women comprise nearly one-quarter of all people living with human immunodeficiency virus (HIV) in the U.S. and 20 percent of incident annual cases. Though women overall are more likely than men to be diagnosed with HIV and engage in care, they are as unlikely to successfully achieve viral suppression with antiretroviral therapy, suggesting gender-based disparities that should be addressed by gender-responsive policies and programs. Using the socioecological model of health and syndemics theory, we comprehensively reviewed published literature to evaluate reasons for and ways to address gender differences in HIV risk and treatment. We discuss the biologic, sociocultural, interpersonal, and behavioral contexts of HIV risk that affect women, comprehensive healthcare for women with HIV that includes pregnancy planning or prevention, and policy implications.     

Bacterial species and evolution: Theoretical and practical perspectives

A discussion of the species problem in modern evolutionary biology serves as the point of departure for an exploration of how the basic science aspects of this problem relate to efforts to map bacterial diversity for practical pursuits—for prospecting among the bacteria for useful genes and gene-products. Out of a confusing array of species concepts, the Cohesion Species Concept seems the most appropriate and useful for analyzing bacterial diversity. Techniques of allozyme analysis and DNA fingerprinting can be used to put this concept into practice to map bacterial genetic diversity, though the concept requires minor modification to encompass cases of complete asexuality. Examples from studies of phenetically definedBacillus species provide very partial maps of genetic population structure. A major conclusion is that such maps frequently reveal deep genetic subdivision within the phenetically defined specles; divisions that in some cases are clearly distinct genetic species. Knowledge of such subdivisions is bound to make prospecting within bacterial diversity more effective. Under the general concept of genetic cohesion a hypothetical framework for thinking about the full range of species conditions that might exist among bacteria is developed and the consequences of each such model for species delineation, and species identification are discussed. Modes of bacterial evolution, and a theory of bacterial speciation with and without genetic recombination, are examined. The essay concludes with thoughts about prospects for very extensive mapping of bacterial diversity in the service of future efforts to find useful products. In this context, evolutionary biology becomes the handmaiden of important industrial activities. A few examples of past success in commercializing bacterial gene-products from species ofBacillus and a few other bacteria are reviewed.     

Signatures of Sex-Antagonistic Selection on Recombining Sex Chromosomes

Sex-antagonistic (SA) selection has major evolutionary consequences: it can drive genomic change, constrain adaptation, and maintain genetic variation for fitness. The recombining (or pseudoautosomal) regions of sex chromosomes are a promising setting in which to study SA selection because they tend to accumulate SA polymorphisms and because recombination allows us to deploy the tools of molecular evolution to locate targets of SA selection and quantify evolutionary forces. Here we use coalescent models to characterize the patterns of polymorphism expected within and divergence between recombining X and Y (or Z and W) sex chromosomes. SA selection generates peaks of divergence between X and Y that can extend substantial distances away from the targets of selection. Linkage disequilibrium between neutral sites is also inflated. We show how the pattern of divergence is altered when the SA polymorphism or the sex-determining region was recently established. We use data from the flowering plant Silene latifolia to illustrate how the strength of SA selection might be quantified using molecular data from recombining sex chromosomes.     

Sex ratio variation in female-biased populations of Notostracans

Females from female-biased populations of the notostracan Triops newberryi produce viable eggs when reared in isolation. Clutches produced under such conditions exhibit sex-ratio polymorphism. One category of females (monogenics) produces only female offspring; the second category (amphigenics) produces clutches with a sex ratio of 3 females: 1 male. The relative proportions of the two categories of females varies significantly between populations and is correlated with population sex ratio. This correlation, and the pattern of offspring distribution in amphigenics, suggests that sex is determined by an autosomal Mendelian gene locus for which the male-determining allele is recessive. Limited pedigree analysis of lineages under selfing support the genetic model.     

Focus: Health Equity: Gender Issues in Obstructive Sleep Apnea

Obstructive sleep apnea has historically been considered a male disease. Although most studies have shown male predominance, obstructive sleep apnea is highly prevalent in women, increasing with age and varying with physiologic status among other factors. Obstructive sleep apnea is associated with significant symptoms and health consequences in women yet remains underdiagnosed in women in part due to differences in presenting symptoms, differences in polysomnographic findings, and/or sociocultural factors. This review will discuss the epidemiology, pathophysiology, clinical presentation, diagnostic findings, and treatment of obstructive sleep apnea, focusing on sex and gender differences.     

Genetics and Genomics of an Unusual Selfish Sex Ratio Distortion in an Insect

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Genetics of sex determination in flowering plants

Most flowering plant species are hermaphroditic, but a small number of species in most plant families are unisexual (i.e., an individ-ual will produce only male or female gametes). Because species with unisexual flowers have evolved repeatedly from hermaphroditic progenitors, the mechanisms controlling sex determination in flowering plants are extremely diverse. Sex is most strongly determined by genotype in all species but the mechanisms range from a single controlling locus to sex chromosomes bearing several linked locirequired for sex determination. Plant hormones also influence sex expression with variable effects from species to species. Here, we review the genetic control of sex determination from a number of plant species to illustrate the variety of extant mechanisms. We emphasize species that are now used as models to investigate the molecular biology of sex determination. We also present our own investigations of the structure of plant sex chromosomes of white campion (Silene latifolia - Melan-drium album). The cytogenetic basis of sex determination in white campion is similar to mammals in that it has a male-specific Y-chromosome that carries dominant male determining genes. If one copy of this chromosome is in the genome, the plant is male. Otherwise it is female. Like mammalian Y-chromosomes, the white campion Y-chromosome is rich in repetitive DNA. We isolated repetitive sequences from microdissected Y-chromosomes of white campion to study the distribution of homologous repeated sequences on the Y-chromosome and the other chromosomes. We found the Y to be especially rich in repetitive sequences that were generally dispersed over all the white campion chromosomes. Despite its repetitive character, the Y-chromosome is mainly euchromatic. This may be due to the relatively recent evolution of the white campion sex chromosomes compared to the sex chromosomes of animals. © 1994 Wiley-Liss, Inc.     

Focus: Sex and Gender Health: Suicide Prevention Interventions for Sexual & Gender Minority Youth: An Unmet Need

Suicide is currently the second leading cause of death in the U.S. among youth ages 10 to 24. Sexual and gender minority (SGM) youth face heightened risk for suicide and report greater odds of attempting suicide than their heteronormative peers. Contributing factors of experience, which are distinctly different from the experiences of heteronormative youth, place SGM youth at heightened risk for suicide. While interventions aimed at addressing suicide risk factors for all youth are being implemented and many have proven effective in the general population, no evidence-based intervention currently exists to reduce suicide risk within this special population. This perspective article discusses this need and proposes the development of an evidence-based suicide risk reduction intervention tailored to SGM youth. Creating a supportive school climate for SGM youth has been shown to reduce suicide risk and may provide protective effects for all youth while simultaneously meeting the unique needs of SGM youth.     

Cobalt- and Chromium-Containing Inclusions in Bacterial Cells

Bacteria belonging to different taxonomic and physiological groups (members of the genera Pseudomonas, Brevibacterium, Rhodopseudomonas, and Lactococcus) are able to form intracellular cobalt- and chromium-containing magnetic inclusions. The paper deals with the structure and the intracellular localization of these inclusions and their similarity to the known noncrystalline iron-containing magnetic inclusions. The possible biological role of the magnetic inclusions is discussed.     

Sex ratios observed in 80 species of parrots

A number of potential evolutionary and physiological factors may be involved in avian sex ratio bias so that under certain conditions a sex ratio bias may favour males or females within a population. In addition different factors may be important in manipulating sex ratio bias through the different life stages. In this study sex ratio bias was examined in a total of 16 570 captive parrots, representing 80 species, many of which are endangered in the wild, using database records originating form commercial laboratories that offer genetic sexing. Within the species examined 72% showed a male bias this was significant in three species, when adjusted for multiple comparisons. This preliminary study is limited due to lack of data on the age of the individuals sampled. However, the large dataset do suggest that this phenomenon should be further considered by investigators working at a species level where such data can be collected.     

Electron Cryotomography of Bacterial Cells

While much is already known about the basic metabolism of bacterial cells, many fundamental questions are still surprisingly unanswered, including for instance how they generate and maintain specific cell shapes, establish polarity, segregate their genomes, and divide. In order to understand these phenomena, imaging technologies are needed that bridge the resolution gap between fluorescence light microscopy and higher-resolution methods such as X-ray crystallography and NMR spectroscopy.Electron cryotomography (ECT) is an emerging technology that does just this, allowing the ultrastructure of cells to be visualized in a near-native state, in three dimensions (3D), with "macromolecular" resolution (~4nm).^{1, 2} In ECT, cells are imaged in a vitreous, "frozen-hydrated" state in a cryo transmission electron microscope (cryoTEM) at low temperature (< -180°C). For slender cells (up to ~500 nm in thickness³), intact cells are plunge-frozen within media across EM grids in cryogens such as ethane or ethane/propane mixtures. Thicker cells and biofilms can also be imaged in a vitreous state by first "high-pressure freezing" and then, "cryo-sectioning" them. A series of two-dimensional projection images are then collected through the sample as it is incrementally tilted along one or two axes. A three-dimensional reconstruction, or "tomogram" can then be calculated from the images. While ECT requires expensive instrumentation, in recent years, it has been used in a few labs to reveal the structures of various external appendages, the structures of different cell envelopes, the positions and structures of cytoskeletal filaments, and the locations and architectures of large macromolecular assemblies such as flagellar motors, internal compartments and chemoreceptor arrays.^{1, 2}In this video article we illustrate how to image cells with ECT, including the processes of sample preparation, data collection, tomogram reconstruction, and interpretation of the results through segmentation and in some cases correlation with light microscopy.     

Gender variation and the evolution of dioecy in Wurmbea dioica (Liliaceae)

A major obstacle for empirical tests of hypotheses concerning the evolution of dioecy in flowering plants is the limited number of species that possess both cosexual and dioecious populations. Wurmbea dioica (Liliaceae) is a diminutive, fly-pollinated geophyte native to temperate Australia. Marked geographical variation of floral traits is evident, particularly with respect to sex expression. A survey of phenotypic gender in 45 populations from Western Australia (WA), South Australia (SA), Victoria (Vic) and the Australian Capital Territory (ACT) revealed two contrasting patterns. Populations in SA, Vic, and ACT were uniformly dimorphic for gender, containing female and male plants, whereas populations in WA were either monomorphic or dimorphic. In most dimorphic populations varying numbers of male plants produced hermaphrodite flowers (male inconstancy). There was a significant negative relationship between female frequency and the proportion of inconstant male plants. Depending on region and population, male plants produced more flowers of larger size than females. In WA monomorphic populations often occurred on rich, moist soils at high density, whereas dimorphic populations were more commonly found at lower density on shallow soils in drier areas. In an area of sympatry, plants with contrasting sexual systems flowered at different times and were ecologically differentiated. The patterns of gender variation in W. dioica indicate that dioecy has evolved via the gynodioecious pathway. The spread of females in monomorphic populations may be favoured where ecological conditions result in increased selfing and inbreeding depression in hermaphrodites.     

Pseudosynapsis and Decreased Stringency of Meiotic Repair Pathway Choice on the Hemizygous Sex Chromosome of Caenorhabditis elegans Males

During meiosis, accurate chromosome segregation relies on homology to mediate chromosome pairing, synapsis, and crossover recombination. Crossovers are dependent upon formation and repair of double-strand breaks (DSBs) by homologous recombination (HR). In males of many species, sex chromosomes are largely hemizygous, yet DSBs are induced along nonhomologous regions. Here we analyzed the genetic requirements for meiotic DSB repair on the completely hemizygous X chromosome of Caenorhabditis elegans males. Our data reveal that the kinetics of DSB formation, chromosome pairing, and synapsis are tightly linked in the male germ line. Moreover, DSB induction on the X is concomitant with a brief period of pseudosynapsis that may allow X sister chromatids to masquerade as homologs. Consistent with this, neither meiotic kleisins nor the SMC-5/6 complex are essential for DSB repair on the X. Furthermore, early processing of X DSBs is dependent on the CtIP/Sae2 homolog COM-1, suggesting that as with paired chromosomes, HR is the preferred pathway. In contrast, the X chromosome is refractory to feedback mechanisms that ensure crossover formation on autosomes. Surprisingly, neither RAD-54 nor BRC-2 are essential for DSB repair on the X, suggesting that unlike autosomes, the X is competent for repair in the absence of HR. When both RAD-54 and the structure-specific nuclease XPF-1 are abrogated, X DSBs persist, suggesting that single-strand annealing is engaged in the absence of HR. Our findings indicate that alteration in sister chromatid interactions and flexibility in DSB repair pathway choice accommodate hemizygosity on sex chromosomes.