Making headway in precision therapeutics with novel fully organic bioelectronic device

As researchers make major advances in medical care, they are also discovering that the efficacy of these treatments can be enhanced by individualized approaches. Therefore, clinicians increasingly need methods that can both continuously monitor physiological signals and then personalize responsive delivery of therapeutics.

Need for safe, flexible bioelectronic devices

Implanted bioelectronic devices are playing a critical role in these treatments, but there are a number of challenges that have stalled their widespread adoption. These devices require specialized components for signal acquisition, processing, data transmission, and powering. Up to now, achieving these capabilities in an implanted device has entailed using numerous rigid and non-biocompatible components that can lead to tissue disruption and patient discomfort. Ideally, these devices need to be biocompatible, flexible, and stable in the long term in the body. They also must be fast and sensitive enough to record rapid, low-amplitude biosignals, while still being able to transmit data for external analysis.

Columbia researchers invent first stand-alone, flexible, fully organic bioelectronic device

Columbia Engineering researchers announced today that they have developed the first stand-alone, conformable, fully organic bioelectronic device that can not only acquire and transmit neurophysiologic brain signals, but can also provide power for device operation. This device, about 100 times smaller than a human hair, is based on an organic transistor architecture that incorporates a vertical channel and a miniaturized water conduit demonstrating long-term stability, high electrical performance, and low-voltage operation to prevent biological tissue damage. The findings are outlined in a new study, published today in Nature Materials.

Both researchers and clinicians knew there was a need for transistors that concurrently pose all of these features: low voltage of operation, biocompatibility, performance stability, conformability for in vivo operation; and high electrical performance, including fast temporal response, high transconductance, and crosstalk-free operation. Silicon-based transistors are the most established technologies, but they are not a perfect solution because they are hard, rigid, and unable to establish a very efficient ion interface with the body. ]

The team addressed these issues by introducing a scalable, self-contained, sub-micron IGT (internal-ion-gated organic electrochemical transistor) architecture, the vIGT. They incorporated a vertical channel arrangement that augments the intrinsic speed of the IGT architecture by optimizing channel geometry and permitting a high density arrangement of transistors next to each other — , 155,000of them per centimeter square.

Scalable vGITs are the fastest electrochemical transistors

The vIGTs are composed of biocompatible, commercially available materials that do not require encapsulation in biological environments and are not impaired by exposure to water or ions. The composite material of the channel can be reproducibly manufactured in large quantities and is solution-processible, making it more accessible to a broad range of fabrication processes. They are flexible and compatible with integration into a wide variety of conformable plastic substrates and have long-term stability, low inter-transistor crosstalk, and high-density integration capacity, allowing fabrication of efficient integrated circuits.

“Organic electronics are not known for their high performance and reliability,” said the study’s leader Dion Khodagholy, associate professor of electrical engineering. “But with our new vGIT architecture, we were able to incorporate a vertical channel that has its own supply of ions. This self-sufficiency of ions made the transistor to be particularly fast — in fact, they are currently the fastest electrochemical transistors.”

To push the speed of operation even further, the team used advanced nanofabrication techniques to miniaturize and densify these transistors at submicro-meter scales. Fabrication took place in the cleanroom of the Columbia Nano Initiative.

Collaborating with CUIMC clinicians

To develop the architecture, the researchers first needed to understand the challenges involved with diagnosis and treatment of patients with neurological disorders like epilepsy, as well as the methodologies currently used. They worked with colleagues at the Department of Neurology at Columbia University Irving Medical Center, in particular, with Jennifer Gelinas, assistant professor of neurology, electrical and biomedical engineering and director of the Epilepsy and Cognition Lab.

The combination of high-speed, flexibility. and low-voltage operation enables the transistors to not only be used for neural signal recording but also for data transmission as well as powering the device, leading to a fully conformable implant. The researchers used this feature to demonstrate fully soft and confirmable implants capable of recording and transmitting high resolution neural activity from both outside, on the surface of the brain, as well as inside, deep within the brain.

“This work will potentially open a wide range of translational opportunities and make medical implants accessible to a large patient demographic who are traditionally not qualified for implantable devices due to the complexity and high risks of such procedures,” said Gelinas.

“It’s amazing to think that our research and devices could help physicians with better diagnostics and could have a positive impact on patients’ quality of life,” added the study’s lead author Claudia Cea, who recently completed her PhD and will be a postdoctoral fellow at MIT this fall.

Next steps

The researchers plan next to join forces with neurosurgeons at CUIMC to validate the capabilities of vIGT-based implants in operating rooms. The team expects to develop soft and safe implants that can detect and identify various pathological brain waves caused by neurological disorders.

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Next-generation flow battery design sets records

A common food and medicine additive has shown it can boost the capacity and longevity of a next-generation flow battery design in a record-setting experiment.

A research team from the Department of Energy’s Pacific Northwest National Laboratory reports that the flow battery, a design optimized for electrical grid energy storage, maintained its capacity to store and release energy for more than a year of continuous charge and discharge.

The study, just published in the journal Joule, details the first use of a dissolved simple sugar called β-cyclodextrin, a derivative of starch, to boost battery longevity and capacity. In a series of experiments, the scientists optimized the ratio of chemicals in the system until it achieved 60 percent more peak power. Then they cycled the battery over and over for more than a year, only stopping the experiment when the plastic tubing failed. During all that time, the flow battery barely lost any of its activity to recharge. This is the first laboratory-scale flow battery experiment to report more than a year of continuous use with minimal loss of capacity.

The β-cyclodextrin additive is also the first to speed the electrochemical reaction that stores and then releases the flow battery energy, in a process called homogeneous catalysis. This means the sugar does its work while dissolved in solution, rather than as a solid applied to a surface.

“This is a brand new approach to developing flow battery electrolyte,” said Wei Wang, a long-time PNNL battery researcher and the principal investigator of the study. “We showed that you can use a totally different type of catalyst designed to accelerate the energy conversion. And further, because it is dissolved in the liquid electrolyte it eliminates the possibility of a solid dislodging and fouling the system.”

What is a flow battery?

As their name suggests, flow batteries consist of two chambers, each filled with a different liquid. The batteries charge through an electrochemical reaction and store energy in chemical bonds. When connected to an external circuit, they release that energy, which can power electrical devices. Flow batteries differ from solid-state batteries in that they have two external supply tanks of liquid constantly circulating through them to supply the electrolyte, which is like the “blood supply” for the system. The larger the electrolyte supply tank, the more energy the flow battery can store.

If they are scaled up to the size of a football field or more, flow batteries can serve as backup generators for the electric grid. Flow batteries are one of the key pillars of a decarbonization strategy to store energy from renewable energy resources. Their advantage is that they can be built at any scale, from the lab-bench scale, as in the PNNL study, to the size of a city block.

Why do we need new kinds of flow batteries?

Large-scale energy storage provides a kind of insurance policy against disruption to our electrical grid. When severe weather or high demand hobble the ability to supply electricity to homes and businesses, energy stored in large-scale flow battery facilities can help minimize disruption or restore service. The need for these flow battery facilities is only expected to grow, as electricity generation increasingly comes from renewable energy sources, such as wind, solar and hydroelectric power. Intermittent power sources such as these require a place to store energy until it’s needed to meet consumer demand.

While there are many flow battery designs and some commercial installations, existing commercial facilities rely on mined minerals such as vanadium that are costly and difficult to obtain. That’s why research teams are seeking effective alternative technologies that use more common materials that are easily synthesized, stable and non-toxic.

“We cannot always dig the Earth for new materials,” said Imre Gyuk, director of energy storage research at DOE’s Office of Electricity. “We need to develop a sustainable approach with chemicals that we can synthesize in large amounts — just like the pharmaceutical and the food industries.”

The work on flow batteries is part of a large program at PNNL to develop and test new technologies for grid-scale energy storage that will be accelerated with the opening of PNNL’s Grid Storage Launchpad in 2024.

A benign ‘sugar water’ sweetens the pot for an effective flow battery

The PNNL research team that developed this new battery design includes researchers with backgrounds in organic and chemical synthesis. These skills came in handy when the team chose to work with materials that had not been used for battery research, but which are already produced for other industrial uses.

“We were looking for a simple way to dissolve more fluorenol in our water-based electrolyte,” said Ruozhu Feng, the first author of the new study. “The β-cyclodextrin helped do that, modestly, but it’s real benefit was this surprising catalytic ability.”

The researchers then worked with co-author Sharon Hammes-Schiffer of Yale University, a leading authority on the chemical reaction underlying the catalytic boost, to explain how it works.

As described in the research study, the sugar additive accepts positively charged protons, which helps balance out the movement of negative electrons as the battery discharges. The details are a bit more complicated, but it’s like the sugar sweetens the pot to allow the other chemicals to complete their chemical dance.

The study is the next generation of a PNNL-patented flow battery design first described in the journal Science in 2021. There, the researchers showed that another common chemical, called fluorenone, is an effective flow battery component. But that initial breakthrough needed improvement because the process was slow compared with commercialized flow battery technology. This new advance makes the battery design a candidate for scale up, the researchers say.

At the same time, the research team is working to further improve the system by experimenting with other compounds that are similar to β-cyclodextrin but smaller. Like honey, β-cyclodextrin addition also makes the liquid thicker, which is less than ideal for a flowing system. Nonetheless, the researchers found its benefits outweighed its drawbacks.

Understanding the complex chemistry happening inside the new flow battery design required the expertise of many scientists, including Ying Chen, Xin Zhang, Peiyuan Gao, Ping Chen, Sebastian Mergelsberg, Lirong Zhong, Aaron Hollas, Yangang Lian, Vijayakumar Murugesan, Qian Huang, Eric Walter and Yuyan Shao of PNNL, and Benjamin J. G. Rousseau and Hammes-Schiffer of Yale, in addition to Feng and Wang.

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New fish species discovered after decades of popularity in the aquarium trade

With just a few clicks of a mouse, you can purchase your very own redtail garra, a type of fish that feeds on algae. Information about the fish’s biology, however, is much less easily obtained. That’s because redtail garra, although popular in the aquarium trade since the early 2000s, has until now been unknown to science.

Researchers were peripherally aware of the fish’s existence, but “discovering” a new species requires scientific description based on specimens collected in their natural environment. Redtail garras appear to be restricted to a small stretch of river straddling the border between Thailand and Myanmar. The locality is isolated and difficult to reach, so wild redtail garras have existed in relative obscurity, despite their global appeal.

Larry Page, curator of ichthyology at the Florida Museum of Natural History, has surveyed fishes in Thailand every year since 2007. He recently encountered a few redtail garras while conducting fieldwork along the Kasat River, a tributary of the Ataran River in neighboring Myanmar.

“When we first collected specimens, we thought it must be widespread in Myanmar because of its popularity in the aquarium trade. But it turns out it’s not. It’s only in the Ataran River basin,” he said.

Page and his colleagues published the new species description in the journal Zootaxa. Redtails take their place among nearly 200 additional species in the genus Garra, one of the most diverse and widely distributed fish groups anywhere on Earth. Garra can be found in streams and rivers from the farthest reaches of western Africa through the Middle East, India and southern and eastern Asia, including parts of China. Yet their ubiquity has not resulted in a corresponding amount of research on the group.

“There’s surprisingly little information on their natural history,” Page said. There are few studies that broadly assess diversity in the genus, and little is known about relationships or how various groups within Garra have diversified.

According to Page, basic information about the fishes’ biology is available, but often in the form of studies on individual species or regions. “Most of them live in fast-moving water, and they have a disclike structure formed from a modification of the lower lip, which they use as an adhesive pad to cling to rocks and maintain their position in the water column as they feed,” he said.

Garra primarily subsist on algae and the occasional arthropod, which they eat by scraping detritus off rocks with specialized mouthparts. Like other species in the genus, redtails lack stomachs and have a snout encrusted with modified and hardened scales called tubercles. Similar structures in other fish groups are temporary; they’re used to defend nests but fall off after the breeding season has ended. Redtail tubercles are permanently attached and seem to be used as weapons, based on aggressive behavior observed in aquaria.

Redtail garra can be distinguished by their unique, elongated snout, covered in even more tubercles, which they can raise or lower, ostensibly as a means of intimidating opponents during combative encounters. And, as their common name suggests, their tails are emblazoned in red like a signal fire.

Their unique color pattern and their industrious ability to clear away algae have made them a coveted component of aquarium tanks, but their late addition to the roster of scientifically described species underscores a pressing need to take stock of biodiversity in understudied regions.

Page, who is working on a book describing the fishes of the Mae Klong River basin in Thailand, said the belated description of redtail garra is part of a larger recurring pattern. “Many of the fishes in Southeast Asia are referred to by names given to species discovered in India or Indonesia because they look similar.” People know particular species exist, Page said, but they are mistaken for those from other geographic areas, and their diversity has consequently been drastically underestimated.

Page and his colleagues named the new species Garra panitvongi after the author of another book on Thailand’s fishes, Nonn Panitvong. Lauded as a biodiversity hero by the Association of Southeast Asian Nations, Panitvong is both a businessman and an avid naturalist. He’s nurtured a passion for nature since his childhood days spent translating books about animals written in English with the help of his mom. He developed a special appreciation for Thailand’s aquatic life from his dad, who took him on fishing trips.

“Over the years, I found that in many of the places we went fishing, the environments were getting worse. There were fewer fish overall, and the fish assemblage changed for the worse, with a decreasing number of native species and more invasives,” he said.

Panitvong obtained a Master of Business Administration at the University of North Carolina Wilmington so he could effectively run his family’s sugarcane farm, but when it came time for a doctorate, he opted to study environmental science. After returning to Thailand, he created the website Siamensis.org, an open platform on which nature enthusiasts could share information about Thailand’s flora and fauna and plan excursions to wilderness areas.

In 2006, Panitvong and a friend discovered one of Thailand’s redtail garra populations and helped introduce the fish to the aquarium trade. Now, more than 15 years later, he said the official naming of redtail garra — and the discovery of species like it — help bring the world into clearer focus.

“I like to imagine humanity in a big room, painted in white. As we turned around, we would have no conception of which direction we were facing,” he said. “With each new discovery, a dot is added, a point made, and we know more and more about where we stand as a species.”

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Elon Musk Aims Below The Belt With Latest Mark Zuckerberg Attack

The swell of enthusiasm around the new app Threads seems to be too much for Elon Musk.

The CEO of Twitter has been lashing out at fellow tech mogul Mark Zuckerberg since the release of Meta’s micro-blogging app last Tuesday, but he truly aimed below the belt when he challenged his rival to “a literal dick-measuring contest” on Sunday night.

Musk’s proposition followed a crass jab he tweeted hours earlier, “Zuck is a cuck” ― short for “cuckold”, which has become a go-to insult for the right-wing set.

Twitter owner Elon Musk attends the Viva Technology conference in Paris on June 16.
Twitter owner Elon Musk attends the Viva Technology conference in Paris on June 16.

Chesnot via Getty Images

The embattled tech CEO has already threatened to sue Meta over Threads, which TechCrunch reports hit 100 million users by Monday morning, just five days after its launch.

Twitter currently has around 250 million active users, but data from internet services company Cloudflare seems to show traffic has been steadily declining since the start of 2023, following Musk’s purchase of the app for $44 billion last fall.

Musk’s feud with Zuckerberg took a decidedly personal turn last month after he challenged the Facebook founder to a cage match. In a surprising twist, the usually mild Zuckerberg tweeted back at Musk, writing, “Send me location.”

Facebook CEO Mark Zuckerberg speaks at the Paley Center in New York on Oct. 25, 2019.
Facebook CEO Mark Zuckerberg speaks at the Paley Center in New York on Oct. 25, 2019.

via Associated Press

Zuckerberg has pitched Threads as a more welcoming alternative to Twitter and its quarrelsome culture.

“The goal is to keep it friendly as it expands,” he wrote on Threads last week. “I think it’s possible and will ultimately be the key to its success. That’s one reason why Twitter never succeeded as much as I think it should have, and we want to do it differently.”

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Everything We Know About The Allegations Against A BBC Presenter

The BBC on Sunday suspended a member of staff following an allegation in The Sun newspaper that one of its star presenters paid a teenager to pose for sexually explicit photos. Neither the star, nor the youth, was identified.

The Metropolitan Police said on Monday there is “no investigation at this time” into the claims.

Later on Monday, the BBC reported on a letter from a lawyer acting for the young person claiming that The Sun’s allegations are “rubbish” and that “nothing inappropriate or unlawful has taken place between our client and the BBC personality”.

The crisis deepened on Tuesday when the BBC’s news division reported that the male presenter had sent abusive messages to a second person, aged in their early 20s.

What are the initial allegations?

The Sun newspaper on Friday reported allegations that the male presenter allegedly gave the teenager £35,000 starting in 2020 when they were 17.

Though the age of sexual consent in the UK is 16, it’s a crime to make or possess indecent images of anyone under 18.

According to the newspaper, the family complained to the broadcaster on May 19, but the presenter was not immediately taken off air.

The mother told the newspaper that the teenager had used the cash to fund a crack cocaine habit.

The family had not requested payment for their story, The Sun reported.

What has the BBC said?

The BBC said in a statement on Sunday that it “first became aware of a complaint in May”, but that “new allegations were put to us on Thursday of a different nature” – a day before The Sun published its story.

The broadcaster said “the BBC takes any allegations seriously and we have robust internal processes in place to proactively deal with such allegations”. It said the corporation had also been in touch with “external authorities,” but did not specify whether that was the police.

“This is a complex and fast-moving set of circumstances and the BBC is working as quickly as possible to establish the facts in order to properly inform appropriate next steps,” the BBC said.

“We can also confirm a male member of staff has been suspended.”

According to a timeline published by the broadcaster, a member of the young person’s family walked into a BBC building on May 18 to make a complaint. The family member contacted BBC Audience Services the next day.

The BBC said it made two unsuccessful attempts – one email and one phone call – to respond to the complainant.

The Sun contacted the BBC seven weeks later on July 6 with different allegations, the broadcaster said on Tuesday, and senior management were informed for the first time.

“The events of recent days have shown how complex and challenging these kinds of cases can be and how vital it is that they are handled with the utmost diligence and care,” BBC Director General Tim Davie told reporters after the corporation published its annual report.

Davie, who said he had not personally spoken to the presenter, said the new information provided by the Sun on July 6 “clearly related to potential criminal activity”.

What has the police said?

The Metropolitan Police said on Monday the force had met BBC bosses earlier in the day and that officers were making further enquiries about the allegations.

The Met said in a statement: “Detectives from the Met’s specialist crime command met with representatives from the BBC on the morning of Monday, July 10. The meeting took place virtually.

“They are assessing the information discussed at the meeting and further enquiries are taking place to establish whether there is evidence of a criminal offence being committed.

“There is no investigation at this time.”

On Tuesday, it asked the BBC to pause its inquiries while specialist officers decide if there is any justification for a criminal investigation.

What did the young person’s lawyer say?

The BBC reported it had received a letter from a lawyer representing the young person involved in the story.

It wrote: “For the avoidance of doubt, nothing inappropriate or unlawful has taken place between our client and the BBC personality and the allegations reported in the Sun newspaper are rubbish.”

The BBC also reported “the young person sent a denial to the Sun on Friday evening saying there was ‘no truth to it’. However, the “inappropriate article” was still published, the lawyer said.

The Sun responded to this claim by stating: “We have reported a story about two very concerned parents who made a complaint to the BBC about the behaviour of a presenter and the welfare of their child.

“Their complaint was not acted upon by the BBC.

“We have seen evidence that supports their concerns. It’s now for the BBC to properly investigate.”

What is the second claim?

BBC News said on Tuesday it had been contacted by a second young person – unconnected to the first – who said they had been approached by the presenter on a dating app.

When the person, who never met the presenter, hinted online that they would reveal his identity, they were sent abusive, expletive-filled messages, the BBC said.

BBC News said it had verified that the messages were sent from a phone belonging to the presenter. It said it had received no response to the latest allegations from either the presenter or his lawyer.

Late on Tuesday, The Sun claimed the presenter allegedly broke lockdown rules to meet a young stranger from a dating site.

Why has the presenter not been named?

The male presenter has not been named by the Sun or any other outlets who know their identity, with the media having to balance the public’s right to know with the legal risks.

Unless there are any criminal charges, there will be two aspects of the law weighing heavily on newsrooms – defamation and privacy.

Defamation

The law of defamation protects an individual’s reputation from the harm caused by lies. Identifying an individual and making false allegations against them that would lower them in the eyes of right-thinking members of society exposes the publisher to being sued if the claims are false.

The principle defence against defamation is that the allegation is true. But the burden of proof is on the publisher, and the bar is particularly high in sexual offence cases.

Two relatively recent cases have had a big impact on editorial decision-making when it comes to an individual’s right to privacy.

In 2018, Cliff Richard won a privacy case against the BBC over the broadcaster’s coverage of a police raid on his home following a false child sexual assault allegation, which has since tipped the balance in favour of privacy over a right to know.

Added to this, the Supreme Court, the UK’s highest court, ruled in 2022 that a person being investigated for a crime generally has “a reasonable expectation of privacy” until charged – turning what was an accepted principle into legal precedent.

In an email to staff on Monday, Davie said the BBC was taking the allegations “incredibly seriously”.

He added: “By law, individuals are entitled to a reasonable expectation of privacy, which is making this situation more complex.

“I want to assure you that we are working rapidly to establish the facts.”

What are BBC presenters saying?

Amid speculation on social media about the identity of the presenter, several of the BBC’s best-known stars spoke up to say it wasn’t them, including Gary Lineker, Rylan Clark, Nicky Campbell and Jeremy Vine.

The laws of defamation apply to social media as much as they do the media, but that hasn’t stopped some people accusing presenters without any foundation.

Campbell addressed the online speculation on the radio. On BBC Radio 5 Live, he opened his programme on Monday saying: “Thoughts with the alleged victim and family.”

He added: “It was a distressing weekend, I can’t deny it, for me and others falsely named.

“Today I’m having further conversations with the police in terms of malicious communication and with lawyers in terms of defamation.”

On his Radio 2 show, Vine did the same, saying: “I’m in that shortlist of BBC presenters who ended up being smacked around on Twitter yesterday and the day before. But what can you do? Are you going to tell me to take out 85 different lawsuits?”

On Tuesday, Vine suggested the star at the centre of the allegations reveal themself publicly.

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Nottingham maternity review to become UK’s largest

A senior midwife leading the inquiry in Nottingham says 1,700 families’ cases will be examined.

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Ian Paterson: Eleven further inquests set to open

Ian Paterson is serving a 20-year sentence after he carried out unnecessary or unapproved procedures.

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If Your Child Wants To Change Pronouns, Here’s What You Can Do And Say

The topic of children changing pronouns has caused quite the stir of late, with one Tory MP suggesting pronouns should be removed from schools to “protect children” and another saying kids should be banned from changing their pronouns at school.

The reality is though that we need to talk about pronouns. So we might as well be sensible about it.

More and more young people are challenging the concept of gender binary, according to family psychotherapist Fiona Yassin. The therapist has seen “a big increase” in the number of young people pausing and assessing their identity.

In fact, the founder and clinical director of The Wave Clinic, tells HuffPost UK around 60% of children and young people who are treated at the clinic request their pronouns are changed from the ones they were assigned at birth.

And in some cases, these children are pre-teens, which can catch parents off-guard.

“At The Wave Clinic, we’re specifically noticing that gender identity and pronouns are being debated by younger children at the ages of around 10-11,” she says.

“Questions of identity: ‘who am I?’ and ‘who do I want to be?’ are very strongly linked to the developing sense of self.”

Pronouns are words we use in everyday language to refer to ourselves or others, according to Stonewall, and they can be an important way for people to express their gender identity. Some commonly used pronouns are she/her, he/him and they/them.

“Whilst conversations around pronouns and identity have become commonplace amongst children, tweens and teens, the topic is unfamiliar to many parents and carers and they may not necessarily feel equipped with an understanding of, or language to talk about, pronouns and gender identity,” Yassin says.

With that in mind, here’s her advice for parents and carers on how to approach a conversation with a young person who would like to change their pronouns.

1. Stay with the information you’re presented with and avoid jumping ahead

“When a young person tells a parent that they are thinking of – or would like to – change their pronouns, parents often become alarmed that there’s also going to be a change in sexuality,” says Yassin.

And although the two can (and do sometimes) go together, it’s important for parents – and indeed, everyone – to understand that gender identity and sexuality are two different things.

She describes instances where young people have started a conversation about pronouns and have then been pressed by parents on whether they’re gay.

“This often happens because parents feel fearful about the transition their young person is wanting to make. In reality, there are many stages to transitioning and all require gentle communication,” she explains.

So, her key advice is to stay with the information you’ve been given, avoid jumping to conclusions and steer away from questioning your child about their sexuality.

2. Respond in an age appropriate way

If you have an 11-year-old talking to you about changing their pronouns, “it would be inappropriate to dive into a more extreme conversation, for example about surgical or hormonal changes,” says Yassin.

“If the conversation does evolve into this then it’s okay to explore this further. But it’s important to meet them where they are at and not get ahead,” she adds.

3. Be curious and actively listen

The charity Mermaids, which supports trans and gender diverse children and their families, says one of the key things they encourage parents or carers to do is to really listen to their child.

This means hearing and respecting what they are saying, giving them time and space to explore these feelings and what they mean for them as individuals, and taking their young person’s lead, says a charity spokesperson.

One of the most important things parents can do is to be curious, agrees Yassin.

“Without being persecutory or pushy, use this as an opportunity to find out what they are considering around their identity and why, and what different pronouns mean to them,” she suggests.

“Exploring this with your young person can be a beautiful moment – it’s likely that you are both navigating this for the first time. As a parent, you are not there to assert judgement or to share your opinion – acknowledge that your child’s feelings, emotions, thoughts, experiences and viewpoints on the world are likely different to yours.”

4. Set time aside to have a conversation where you won’t be interrupted

If you’re not able to listen properly – for example, it’s during the morning school rush or late at night – you need to gently defer the conversation for a time when you can do so.

Yassin advises parents to “acknowledge you’ve heard your young person and set a time aside when you know you can explore this together”.

So, you could say something like: “Thank you for sharing this with me. I really would like to hear about what you’re experiencing and find out more about your views and opinions on this. Let’s sit down together as a family when we get home and explore this together.”

5. Only invite people into the conversation who you know are open and understanding

If there’s someone in your family who you think will react badly or simply won’t be emotionally available or open to the conversation, it’s worth letting them sit this one out.

“It is better to have the conversation and explore this with your young person without someone who is tricky and has less flexible attitudes,” says the therapist.

“If you need to tell friends or family members who have staunch or more traditional views about your child’s change of pronouns, look to have these conversations without your child’s involvement. This helps to protect your young person from volatile and unhelpful reactions.”

6. Be careful about your choice of words

In the heat of the moment, and without the appropriate warning, you might say something you regret – or that comes out wrong.

Yassin urges parents to tread carefully here, as you don’t want to use any words that could minimise their experience.

“Fluidity is everything in these conversations and defining your young person by using words such as ‘queer’, ‘bisexual’ and ‘heterosexual’, may make them feel boxed-in or marginalised,” she says.

“In addition, some parents can get stuck on the notion that ‘they/them’ pronouns do not sound right or fit snugly into the English language. Avoid using language and phrases that can feel shaming and marginalising, such as, ‘it’s not natural to use they/them’.”

Some parents might also assume their child is following a trend or is in a phase when they decide they want to change pronouns.

As Yassin says: “We hear many parents ask ‘who else in your class/school has changed their pronoun’ or ‘who amongst your friends has done this already’. This line of questioning can feel disempowering and minimising to a young person and could cause quite an angry backlash.”

Plus, research is showing that the majority of children over the last decade or so who have changed their gender pronouns do stick with their decision.

7. Steer clear of shame-inducing language

Don’t shame your child for wanting to change their pronouns. The therapist suggests doing so could “cause harm to a generation of children who, because their parents are not accepting or retaining curiosity, shut down or hide parts of themselves”.

“Young people in the early years of identity development are experimenting and trying things out for size and it’s important that as parents, we encourage our young people to be curious and experiment,” she adds.

8. It’s okay to say you don’t know

If your child is asking questions and you don’t know the answers, it’s OK to admit that.

“Ask your young person if you can join them on their journey of discovery and learn and research together,” suggests the therapist.

“Assume that if your child comes to you with the conversation, it’s likely they have already done a lot of research online and are talking to people who are in the same position as them. Exploring this together can also help to sieve out misinformation and find trusted resources for support.”

9. Accept that you might make mistakes

Chances are you’ll probably make some mistakes along the way, like using the wrong language or stumbling on their pronouns.

“The reality is, we are all human and despite having best-intentions, you may not get it right 100% of the time,” says Yassin.

“Mark this at the outset and talk to your young person about what will happen if you use the wrong name or pronoun. Being open and honest upfront can help to avoid the issue escalating if mistakes are made.”

Mermaid’s spokesperson says some families don’t use any pronouns for a while, to help make the switch, or they have a pronoun jar (a little bit like a swear jar) where they pay up if they make a mistake.

“Acknowledging that getting someone’s pronouns wrong was a mistake and may have caused upset to them, so apologising and correcting yourself is important too,” they add.

10. Consult a gender positive therapist

If a child is considering changing their pronouns, you might also want to seek outside help to ensure they feel supported during this period of change. Mermaids’ helpline, for instance, provides support to parents and carers during this period.

“For some, the change can bring hefty conflict into the family and for some cultures this shift will be very difficult to accept,” says Yassin.

“Parents should happily consult a therapist, particularly a gender affirming and gender positive therapist, who can help to facilitate a conversation with the family about what’s happening and why it might be happening.

“Having professional support can help to avoid fragments and tension appearing within the family.”

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The One Health Care Provider Most People Should See After Giving Birth, But Don’t

After weekly medical check-ins at the end of pregnancy, most people won’t see a health care provider until six weeks postpartum. At that point, if it looks like healing is proceeding well, they are officially “cleared” to have sex and exercise again.

Following delivery, the focus tends to shift to the baby’s health (how much are they eating, sleeping or crying?) and away from the person who gave birth.

Common postpartum physical complaints such as incontinence or pain in the back, pelvis or genitals are often written off as par for the course, as though pregnancy and birth are expected to do some damage to the body.

While postpartum healing is a process, and most people need some time before they feel “back to normal,” there are things that you can do to support healing and lessen pain and discomfort.

One proactive step you can take is to make an appointment with a physical therapist, who can evaluate you for common postpartum issues and recommend exercises to prevent incontinence and pain.

Postpartum physical therapy isn’t the norm in the U.S., but in other countries, such as France, it’s standard care.

Pregnancy’s impact on the body

After weekly medical check-ins at the end of pregnancy, most people won’t see a health care provider until six weeks postpartum.

Cavan Images / Rebecca Tien via Getty Images

After weekly medical check-ins at the end of pregnancy, most people won’t see a health care provider until six weeks postpartum.

There are multiple ways that pregnancy can put a strain on your musculoskeletal system. The hormonal shifts of pregnancy don’t only affect your reproductive organs.

“What happens is the joints can become a little more loose and lax,” Jenni Limoges, a physical therapist in Nevada specialising in pelvic floor issues, told HuffPost. This loosening helps your pelvis expand to make room for the baby, but it can also trigger pain from a previous back or hip injury or result in new discomfort.

In addition, as your belly grows, your body has to adjust to a new centre of gravity. “It tends to pull people forward. It creates instability,” said Limoges.

Your pelvis tips forward, and the muscles in your back, pelvis and hips all shift, either lengthening or shortening. Your abdominal muscles separate to make space for the baby. Even your feet change, flattening out to support your pregnant body (many people find they go up a shoe size following pregnancy).

Your pelvic floor muscles provide a sort of shelf inside your hip bones that supports all of the internal organs, including the uterus. There are three layers and nine different muscles that work in concert, Limoges explained.

“These muscles help us stay dry,” she said, and play a key role in sexual functioning. The way these muscles have to stretch to accommodate pregnancy and allow for delivery can cause them to become too stiff or too loose, causing pain or incontinence (urinary and/or faecal).

“I often times hear of people saying that they want to opt for a C-section because they think this protects their pelvic floor,” said Ruba Raza, a North Carolina-based physical therapist who also specialises in pelvic floor, pregnancy and postpartum issues. However, Raza told HuffPost that you can still have pelvic floor issues following a C-section.

“Regardless of the mode of delivery, it is important to see a pelvic floor physical therapist if you are having symptoms during or after pregnancy,” Raza said.

“A lot of people do not seek out our services during pregnancy because they
assume that their symptoms will improve postpartum, but with most concerns, these can continue and even worsen if they are not addressed.”

Common postpartum issues

In addition to urinary and faecal incontinence, other common postpartum complaints that can be addressed with physical therapy, Raza said, include: “Sacroiliac joint pain [the sacroiliac joints link the pelvis to the bottom of the spine], constipation, low back pain, pelvic floor pain, C-section scar sensitivity, pain with intercourse and rectal pain.”

Many of the common postpartum complaints such as pelvic floor pain, C-section scar sensitivity and back pain can be addressed with physical therapy,

Rawlstock via Getty Images

Many of the common postpartum complaints such as pelvic floor pain, C-section scar sensitivity and back pain can be addressed with physical therapy,

Another issue you may have heard about is diastasis recti. A line of connective tissue called the linea alba runs down the middle of your stomach and fastens together on both sides of your abdominal muscles.

During pregnancy, this tissue stretches out and often separates to accommodate your growing uterus. After delivery, it generally closes back up again over the course of eight weeks or so. If it doesn’t close back up, you may notice that you continue to have a belly pouch, as though you were still pregnant. You may also have pain or incontinence.

Because movements like traditional abdominal crunches can worsen diastasis recti, it’s important to work with a knowledgeable provider who can prescribe exercises to help your diastasis recti heal.

What treatment looks like

Physical therapy for postpartum issues generally involves weekly visits.

“The typical model for the pelvic floor is one-on-one for an hour,” said Limoges, adding that you should feel the results as soon as a couple of weeks in.

“I definitely expect within four to six weeks you’re seeing some improvements,” she continued.

Raza said she typically sees patients once a week for six to eight weeks, but of course, this varies based on the nature and severity of the issue they’re dealing with.

“The plan is very individualised to the patient’s concerns or symptoms,” she said. There are a multitude of exercises your physical therapist may teach you and have you practice at home.

Limoges explained that the treatment for pelvic floor issues such as incontinence depends on whether the problem is that the muscles are too stiff or overstretched and lacking in tone.

With incontinence, it’s common to hear the blanket advice to do Kegel exercises (contracting the pelvic floor muscles — the ones you use to stop urination mid-stream), but these can be counterproductive if the issue is stiffness. For this reason, it’s a good idea to have an evaluation with a physical therapist before starting any exercise program to address your problem.

While a good portion of the evaluation involves the physical therapist learning what your symptoms are, and sometimes this can even be done via a remote telehealth visit, if you’re having a pelvic floor issue, an internal pelvic exam is usually necessary at some point.

“I like to tell people, ‘I’m not the gynaecologist’s office, so I don’t use stirrups,’” said Limoges.

“I typically do a scan of tissue first, just to make sure everything looks OK. And then for the internal assessment, I insert my finger vaginally, and I’m checking each layer of muscles.” This internal exam allows the physical therapist to assess the muscle’s flexibility and to see if there is organ prolapse.

Your therapist will likely want to see how long you can hold a contraction of your pelvic muscles (a Kegel). The standard goal is ten seconds. They will also want to see how quickly you can contract the muscles and whether you have any pain.

While a physical therapist may recommend Kegel exercises if they find a lack of tone in your pelvic floor muscles, there are many other types of exercises they may prescribe.

Each physical therapist stressed the importance of finding a way for a new parent to work these exercises into their day in a way that is feasible.

Twenty47studio via Getty Images

Each physical therapist stressed the importance of finding a way for a new parent to work these exercises into their day in a way that is feasible.

Raza and Limoges discussed using breathing exercises with postpartum pelvic floor patients. Other possibilities include stretches, squats, and what Limoges called “self-tissue mobilization,” in which you apply gentle, internal pressure to the layers of muscle.

Each physical therapist stressed the importance of finding a way for a new parent to work these exercises into their day in a way that is feasible.

“I love incorporating exercises into activities that the patient is already doing,
such as adding in a pelvic floor and core contraction every time the patient completes a transitional movement or working on diaphragmatic breathing and pelvic floor relaxation while they are breastfeeding their baby,” said Raza.

Limoges also mentioned feeding/pumping as an opportunity to do Kegels or breathing exercises, as your life during those first few months tends to revolve around these moments. She recalled working with one mom caring for her newborn while homeschooling her older children. She needed exercises that she could do while standing and wearing the baby, so Limoges prescribed some wall sets and lunges she could do.

Postpartum or not, Limoges said she limits treatment to a few daily exercises that a person can work into their routine without too much trouble and works with the patients to address their most urgent concerns within the context of their lives.

A mother of twins, Limoges recalled, was having issues with urgency to urinate. “But she was running into a problem because she couldn’t get the twins in a place that she could watch them and go to the bathroom at the same time.” She padded her bathtub so she could set them safely in it to pee without leaking or holding it too long.

While your body will never return exactly to what it was before pregnancy, Limoges believes that improvement is always possible with any of these physical issues.

“My goal is to get people to 90% at least,” Limoges said. “Can you get yourself to where you’re not hunting for the bathroom or worrying about wearing a pad everywhere you go or [not] leaving your house and those kinds of things? Absolutely.”

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Weight-loss jabs investigated for suicide risk

Europe’s drugs regulator has been alerted to a possible link to thoughts of suicide among some users.

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