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Transgender and gender nonbinary (TGNB) individuals experience challenges while applying for and completing residency, although limited research exists. An academic panel reviewed best practices for residency programs who interview and match TGNB residents. Program leadership should identify and utilize the affirming name and pronouns for all applicants, not ask gender identity during an interview unless self-disclosed, and ensure that health insurance covers transition care. Programs should proactively educate all residents, faculty, and staff on knowledge gaps regarding transgender health regardless of the presence of TGNB residents. Future studies are necessary regarding experiences of TGNB residents to investigate their specific needs.

Despite an upward trend in research focused on trans youth, how trans youth cope with their gender identity remains relatively unknown. We aimed to gather in-depth information about how trans youth described the developmental process of coping with factors that arise when youth are exploring their gender identity, coming out to others, and navigating institutions and society. We interviewed 20 trans youth, ages 7–18, from the Northeastern, Southern, and Midwestern regions of the United States. Six coping themes, with 23 higher order categories, emerged from the grounded theory analysis: Negotiating Gender, Avoidance, Emotional Relief, Personal Solace, Support, and Active Engagement. Findings underscore the importance of understanding the nuances of coping processes, such that the same coping strategy could be either useful or harmful, depending on the purpose, timing, and context. Results indicate that youth report both subtle and explicit observations of their family members’ coping processes, especially when comparing how family members cope differently on similar issues related to gender identity. Implications for this study include the importance of researching interventions that focus on minority stress for trans youth, as well as future research directions to understand family coping processes.

Background: Transgender people in the United States often lack access to high-quality health care.Methods: A group of researchers and transgender people came together in a community-based participatory research process to survey transgender Wisconsinites about their health care experiences. A multiple regression analysis of survey data was used to evaluate the association between barriers to health care, gender identity, and quality of medical and mental health care provider.Results: Seventy-seven respondents were included in this analysis. Transmasculine respondents were more likely than transfeminine respondents to report barriers to high-quality health care, but having a high-quality medical or mental health care provider was associated with reporting fewer barriers to care across the entire sample.Discussion: This community-based study suggests that health care providers play a key role in facilitating access to care for transgender Wisconsinites in the USA.

Objectives This study aims to evaluate a leadership fellowship program through perspectives of Ethiopian women medical faculty participants. Methods An intensive two-week leadership development fellowship was designed for women faculty from Ethiopian medical schools and conducted from 2011-2015 at the University of Wisconsin-School of Medicine and Public Health in Madison, Wisconsin. Nine Ethiopian women working in early- or mid-level academic positions were selected. Semi-structured interviews were conducted with the fellows. Transcripts were reviewed through qualitative analysis to assess the perceived impact of the training on their careers. Three male academic leaders were interviewed to solicit feedback on the program. Results Eight of 9 fellows were interviewed. Themes describing the benefits of the fellowship included: increased awareness of gender inequities; enhanced motivation for career advancement; increased personal confidence; and improved leadership skills. Fellows provided suggestions for future training and scaling up efforts to promote gender equity. Male leaders described the benefits of men promoting gender equity within academic health centers. Conclusions This paper provides evidence that targeted brief training programs can enhance women's motivation and skills to become effective leaders in academic medicine in Ethiopia. Promoting gender equity in academic medicine is an important strategy to address health workforce shortages and to provide professional role models for female students in the health professions.

Until recently there have been few primary care office-based strategies to reduce the transmission of HIV. In May 2014 the Centers for Disease Control and Prevention published updated practice guidelines recommending the use of preexposure prophylaxis (PrEP) with daily oral dosing of tenofovir/emtricitabine to help prevent HIV infection in high-risk individuals (strength of recommendation, A). Knowledge of PrEP among primary care providers is low, however, and this intervention is likely reaching only a small fraction of eligible patients. PrEP is recommended for certain injection drug users, nonmonogamous men who have sex with men, heterosexual women who have sex with men who have sex with men or injection drug users, and those in HIV serodiscordant relationships. Providers should obtain baseline laboratory values and provide initial counseling before prescribing PrEP. Regular office visits are necessary to ensure adherence, provide ongoing counseling, and monitor for side effects, including nausea, abdominal pain, headache, and, less commonly, increased creatinine. Guidelines and toolkits have been developed to assist in incorporating PrEP into primary care practice. PrEP is gaining widespread acceptance and has become a crucial tool in the fight to stop the spread of HIV.

Background Building the capacity of local health systems to provide high-quality, self-sustaining medical education and health care is the central purpose for many global health partnerships (GHPs). Since 2001, our global partner consortium collaborated to establish Family Medicine in Ethiopia; the first Ethiopian family physicians graduated in February 2016. Methods The authors, representing the primary Ethiopian, Canadian, and American partners in the GHP, identified obstacles, accomplishments, opportunities, errors, and observations from the years preceding residency launch and the first 3 years of the residency. Results Common themes were identified through personal reflection and presented as lessons to guide future GHPs. LESSON 1: Promote Family Medicine as a distinct specialty. LESSON 2: Avoid gaps, conflict, and redundancy in partner priorities and activities. LESSON 3: Building relationships takes time and shared experiences. LESSON 4: Communicate frequently to create opportunities for success. LESSON 5: Engage local leaders to build sustainable, long-lasting programs from the beginning of the partnership. Conclusions GHPs can benefit individual participants, their organizations, and their communities served. Engaging with numerous partners may also result in challenges-conflicting expectations, misinterpretations, and duplication or gaps in efforts. The lessons discussed in this article may be used to inform GHP planning and interactions to maximize benefits and minimize mishaps.

A transformation in legal and cultural attitudes toward same-sex relationships is under way nationwide. As same-sex marriage has become legal, the unique social and medicolegal issues faced by individuals in same-sex relationships are evolving rapidly. National organizations have published recommendations for making clinical environments more inclusive of lesbian, gay, bisexual, and queer (LGBQ) individuals and their families. Medical issues for patients in same-sex relationships include a higher risk of HIV infection for men who have sex with men (a majority of new cases of HIV infection occur within relationships), higher rates of obesity among women who have sex with women, and disproportionately high rates of mental health issues and alcohol and drug use. Screening and prevention strategies for reducing these risks include cancer and infectious disease screening, immunization for human papillomavirus, and preexposure prophylaxis for HIV. More LGBQ individuals are becoming parents. Clinicians can assist patients in this process by being aware of local resources for adoption, assisted reproductive techniques, and parenting.

Infection with the hepatitis C virus (HCV) is a common cause of cirrhosis and liver failure and the most common indication for liver transplant in the United States. Based on the prevalence of HCV infection at 1.3% of the US population, there are an estimated 74,000 people living with HCV infection in the state of Wisconsin, the majority of whom are undiagnosed. HCV infections in Wisconsin have increased, reflecting the increasing use of intravenous heroin in the state. This review discusses up-to-date guidelines for screening, diagnosis, and treatment of HCV. New direct-acting antiviral medications have revolutionized the treatment of HCV with significantly improved outcomes. High cost and limited availability of these medications present challenges in overall management of HCV.

Ethiopia faces a dire shortage of human resources to meet the health care needs of its population of more than 90 million people. The government has implemented programs to expand the health care workforce, of which women are a growing and crucial component. Universities are working to identify and address gender inequity to help recruit and retain women.This paper describes and analyzes a multi-institution grant-funded program to promote gender equity at Addis Ababa University-College of Health Sciences (AAU-CHS) in Ethiopia.The primary intervention was to provide intensive short-term fellowships to mid-level female faculty to facilitate their promotion into leadership positions. Secondary interventions included a series of gender equity meetings with students, residents and staff to elicit bottom-up concerns and recommendations for future action, as well as conducting a gender climate survey of female students and staff External consultants assisted with program implementation, monitoring and evaluation of the program.Initial outcomes demonstrate promising career advancement of women who participated in the fellowships. A comprehensive gender equity action plan was developed based upon results from the survey and meeting recommendations. This plan is being implemented by AAU-CHS faculty and administration.This program has been an initial success and may serve as a template for others who are working to promote gender equity.

Dans le cadre du debat opposant le mouvement Whig au republicanisme en Angleterre a l'epoque de la Revolution francaise, l'A. etudie la critique d'E. Burke developpee par M. Wollstonecraft, a partir d'une comparaison de leur interpretation respective du mouvement revolutionnaire et de la reforme politique. D'abord partisans du progres et defenseurs des institutions liberales de la democratie representative, Burke et Wollstonecraft se distinguent ensuite sur la question de la religion orthodoxe et sur la question de la prudence comme vertu de l'experience politique

Background: Protective antiself response to nervous system injury has been reported to be mediated by a T-cell subpopulation that can recognize self-antigens. Immune cells have been shown to play a role in the regulation of motor neuron survival after a peripheral nerve injury. The objective of the present study was to evaluate the effects of immune system augmentation with use of the antigen glatiramer acetate, which is known to affect T-cell immunity, on peripheral nerve regeneration. Methods: Wild-type and nude-type (T-cell-deficient) rats underwent crush injury of the sciatic nerve. Three and six weeks after the injury, the sciatic nerve was examined, both functionally (on the basis of footprint analysis and the tibialis anterior muscle response and weight) and histologically (on the basis of axon count). Results: Significantly greater muscle responses were measured after three weeks in the group of wild-type rats that were treated with glatiramer acetate (control limb:injured limb ratio, 0.05 for the glatiramer acetate group [n = 9], compared with 0.51 for the saline solution group [n = 8]; p < 0.05). Higher axon counts were also found in this group (control limb:injured limb ratio, –0.07 for the glatiramer acetate group [n = 10], compared with 0.29 for the saline solution group [n = 8]; p < 0.05). The nude-type rats showed no response to the intervention after three weeks but showed a delayed response after six weeks. A second dose of glatiramer acetate, delivered forty-eight hours after the injury, did not result in an improved response as compared with the control groups. Conclusions: We found that a single treatment with glatiramer acetate resulted in accelerated functional and histological recovery after sciatic nerve crush injury. The role of T-cell immunity in the mechanism of glatiramer acetate was suggested by the partial and late response found in the T-cell-deficient rats. Clinical Relevance: Peripheral nerve injury may result in severe loss of sensation, weakness, and pain. The recovery is usually not complete with the limited treatment options. The recruitment of an endogenous mechanism, the immune system, to better coordinate the regeneration of nerves after injury is a different approach to this difficult clinical problem.

Edmund Burke's involvement in Indian politics forced him to reconsider one of the central concepts of his political thought: his theory of trusteeship. During the course of the debate over India, Burke came to realize that the theory could not work there because the Indians shared few political values with their English rulers and were unable to call those rulers to account. He, therefore, revised his approach to appeal to a natural law standard and to make the English Parliament and people surrogates for the Indians. However, these devices also failed, for the former proved unenforceable and the latter was undermined by the House of Lords' acquittal of Hastings. The theory of trusteeship thus proved to be critically defective, for, without greater popular accountability than Bruke was willing to permit, it failed to provide government which was both effective and responsible.

The interpretation of Edmund Burke as a laissez-faire economist has a long pedigree but is inaccurate. Rather, Burke is best seen as a moderate Whig who believed that governmental social and economic policy should be based on pragmatic and prudential considerations. However, utilitarian rule-making makes most sense when the rules can be formulated in terms of realizing some more abstract goal. This goal Burke obtained from his reading of the Scotch moral sense writers, who convinced him that man has an innate moral nature which can be improved through association with other men in society. Consideration of Burke's writings on a variety of specific economic and social issues, ranging from poor relief and economic reform to the slave trade, confirms this instrumental interpretation of Burke's economic thought.

In his analysis of Plato's Republic, Aristotle objects to his teacher's abstract and psychological method by suggesting that “there is another matter which must not be ignored—the teaching of actual experience. We are bound to pay some regard to the long past and the passage of the years, in which these things…would not have gone unnoticed if they had been really good.” Ever since that time, political theorists have been divided on the question of the appropriate approach to the study of politics, and often, as in the case of Plato and Aristotle, the focal point of the disagreement has been whether politics is best seen through the lens of history or the study of human nature and the development of a consequent psychology. This, for example, is the crux of the argument between James Mill and T. B. Macaulay. Mill is the proponent of a psychological approach; he maintains “it is immediately obvious that a wide and difficult field is presented, and that the whole science of human nature must be explored to lay a foundation for the science of government.” Macaulay disagrees, for he believes that “the style which the Utilitarians admire, suits only those subjects on which it is possible to reason a priori.” Indeed, in Macaulay's view, Mill belongs in the Middle Ages: “of those schoolmen Mr. Mill has inherited both the spirit and the style. He is an Aristotelian of the fifteenth century, born out of due season.” Far better, continues Macaulay, is the inductive historical method which observes the world, examines facts, devotes itself to the careful study of the past, and checks itself “by perpetually bringing the theory which we have constructed to the test of new facts….”

One of the most interesting, and complex, problems in the history of political thought is the development of the modern theory of representative government. In the twentieth century, we have little difficulty in thinking of the paradigmatic form of government as one of rule by representatives elected by, and responsible to, the general public. So widely accepted, in fact, is this view that we have come often to identify it as the only meaningful definition of democracy. Further, we have even questioned whether some of its elements are not indispensable. Thus, a few years ago, Harvey H. Mansfield, Jr., could ask if nonparty government is possible and admit that most political scientists would answer with a resounding no.' Yet, this view is not the only one possible. Before

FOR AT LEAST TWO CENTURIES, the one point of fundamental agreement among students of David Hume's political thought has been that his views may best be characterized as conservative. As one writer puts it, ". . . the age of Whig supremacy insisted that he was, at least, a Tory, and the appellation is still customarily used."' And so it is. Modern students are more careful than the eighteenthcentury critics, but the import of their message is much the same. Mossner, for example, while denying that Hume was a member of the Tory party, insists that the only acceptable application of his skepticism to political problems is conservative.2 Marjorie Grene goes further. She accepts the view that Hume's philosophy has conservative political implications, but also argues that his writings on history support the Stuart cause.3 Other commentators, such as Gladys Bryson, even reject Mossner and Grene's qualifications, which make Hume a moderate Tory, preferring to see him as admirer of absolute monarchy.4 The case, then, seems conclusive: the arguments are consistent, the evidence clear, and scholars agreed. Yet, in my view, a number of factors suggest that it is not really so compelling. To begin with, the agreement is not so complete as first appears. While Bryson sees Hume as an advocate of both the Stuart cause and of passive obedience, Grene agrees that he supports the