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Pneumonia is an infection of the lung alveoli caused by bacteria, viruses or fungi. It is one of the leading causes of morbidity and mortality worldwide, representing a clinical and economic burden and a global public health problem. The microbial ecosystem (or microbiome) of the human respiratory tract colonizes different niches. The respiratory tract microbiome is of interest to scientists as it contributes to human health by stimulating the immune system and protecting against infection by pathogens. Scientists from the Institut Pasteur and the CNRS have demonstrated that the microbiome composition, pathogen load and clinical interventions influence the severity of bacterial pneumonia caused by Legionella pneumophila. The results were published in the journal Cell Reports Medicine on August 25, 2023.
In this study, scientists from the Biology of Intracellular Bacteria Unit, led by Carmen Buchrieser at the Institut Pasteur, in collaboration with Sophie Jarraud, Head of the National Reference Center for Legionella in Lyon, analyzed the diversity and composition of the respiratory tract microbiome (bacteria, archaea, fungi and protozoa) in patients with pneumonia caused by the intracellular bacterial pathogen Legionella pneumophila for their entire hospitalization period. L. pneumophila is responsible for a severe pneumonia known as Legionnaires’ disease, which can be contracted by inhaling contaminated aerosols from artificial water sources such as showers, hot tubs or air conditioning systems. The fatality rate for Legionnaires’ disease varies from 5 to 40% depending on the clinical context and the region. Risk factors are old age, pre-existing lung conditions, smoking and immunosuppression, and around two-thirds of reported cases occur in men. Confirmed cases of Legionnaires’ disease in the European Union went from 4,693 cases in 2005 to 10,004 cases in 2021, an increase of 113%. One of the reasons for this sharp rise may be climate change, with higher water temperatures and more frequent and intense floods that allow Legionella to replicate more rapidly and to access human environments.
The team of scientists combined high-throughput bacterial, archaeal and fungal marker gene sequencing with a quantification approach to characterize how the respiratory tract microbiome developed in patients over the course of infection and as a result of hospital-related interventions (such as mechanical ventilation and administration of antibiotics). A unique cohort of 38 hospitalized patients with pneumonia caused by Legionella pneumophila was analyzed. “We discovered complex microbiome dynamics, where commensal and pathogenic microorganisms coexist, and the equilibrium among their abundance drives the microbiome to recovery or dysbiosis,” explains Carmen Buchrieser, lead author of the study and Head of the Institut Pasteur’s Biology of Intracellular Bacteria Unit. The scientists observed that early in hospitalization, microbiome diversity decreased and the pathogen L. pneumophila was killed by the antibiotic treatment. But the empty niche was soon occupied by other opportunistic species, often resistant to antimicrobials — a factor that should be considered in prevention strategies for secondary infections. The respiratory tract microbiomes with the highest bacterial and fungal loads also showed lower diversity and pathogen enrichment, indicating that high biomass could be a biomarker for secondary and/or co-infections. Finally, the scientists showed that Legionella biomass correlates with disease severity and comorbidities, suggesting that pathogen quantification should be included in patient monitoring. Clinical interventions such as mechanical ventilation or administration of certain types of antibiotics influence the microbiome composition and therefore also disease outcome.
“In this study we also discovered that fungi, archaea and protozoa may be resident and not merely transitory in the respiratory tract of hospitalized patients and that they might contribute to pneumonia progression. This requires further investigation. Our research therefore shows that the interaction between respiratory tract microbiome equilibrium, pathogen load dynamics and clinical interventions plays a crucial role in the recovery of patients with pneumonia,” concludes Carmen Buchrieser.

Researchers have developed a non-invasive method for mapping the human auditory pathway, which could potentially be used as a tool to help clinicians decide the best surgical strategy for patients with profound hearing loss.
The findings, published today in eLife, highlight the importance of early interventions to give patients the ability to hear and understand speech, so that their auditory-language network can develop properly and their long-term outcomes are improved.
Sensorineural hearing loss (SNHL) occurs when the sensitive hair cells inside the cochlea are damaged, or when there is damage to the auditory nerve which transmits sound to the brain. A person with profound hearing loss is typically unable to hear any sounds, or at best, only very loud sounds. Congenital SNHL, or hearing loss that is present from birth, has increased in prevalence over the past two decades, from 1.09 to 1.7 cases per 1,000 live births.
The sound of speech is carried through the brain by nerve fibres in regions known as the auditory pathway, and are processed in a region called the language network. In cases of congenital SNHL, the lack of speech inputs reaching the language network may hinder its proper development, leading to poorer spoken language skills.
Currently, the primary treatments for profound SNHL are cochlear and auditory brainstem implantation, where a device is used to stimulate the peripheral cochlea or the central cochlear nucleus, respectively. Both techniques can partially restore hearing in patients, but their language development outcomes can vary. This is especially true for patients with inner ear malformations (IEM) or cochlear nerve deficiencies (CND), which contribute to 15-39% of congenital SNHL cases.
“Where SNHL is caused by CNDs and/or IEMs, there is a great deal of uncertainty around the best method of treatment. This is due to the difficulty of assessing the condition of the cochlear nerve and distinguishing between certain types of IEM, both of which impact surgical decision making,” says senior authors Hao Wu, a professor and Chief Physician specialising in Otolaryngology at Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, China. Wu also serves as the Hospital Administrator and the Clinical and Academic Lead for the department. “We therefore need a more effective method for mapping the auditory pathway and diving deeper into how IEMs and CNDs affect the development of the auditory-language network.”
In their study, professor Wu’s team investigated the auditory and language pathways in 23 children under the age of six. They included 10 children with normal hearing, and 13 with profound SNHL. In the latter group, seven children had received cochlear implantations, two had received auditory brainstem implantations, and four were candidates for auditory brainstem implantations.

A University of Massachusetts Amherst resource economist finds mandated in-school Body Mass Index (BMI) assessments adopted in varying forms by 24 states to combat childhood obesity have the potential to improve the health of some students while introducing body-image issues for others. The research is believed to be the first to assess these policies as a whole, rather than in single states or school districts.
“In states that passed these laws, overweight and obese teens were more likely to correctly describe their bodies as such, compared to states that do not have these mandates,” says Brandyn Churchill, assistant professor of resource economics at UMass Amherst. “But the unintended consequence is that non-overweight girls were also more likely to describe themselves as overweight. They were less likely to describe themselves as a healthy weight.”
In addition, Churchill finds that overweight teenagers were more likely to report that they were trying to lose weight. He identifies a small but significant decrease in teens’ BMI.
“These changes appear to be coming from students who were right on the margin of being overweight,” he says.
The study did not detect any meaningful changes in exercise or calorie-limiting behaviors linked to mandated BMI assessments. The findings are based on national and state Youth Risk Behavior Surveys between 1991 and 2017.
Churchill points out that the average BMI of children in the U.S. has been steadily increasing over that span, even as more states enacted mandatory assessments.
“It’s hard to look at the change in childhood BMI and say these policies are a resounding success, given the potential unintended consequences for adolescent girls in the form of distorted self-image and body perception,” he says. Prior research has found these issues can lead to shame, anxiety, bullying and eating disorders.

Researchers have produced a comprehensive picture of insulin signalling in mice and suggest that it is shaped by entangled effects of genetics and diet.
The research, published today as a Reviewed Preprint in eLife, is described by the editors as a fundamental study of substantial importance. They say the authors share compelling evidence that sheds light on the interplay between genetic attributes and environmental conditions in shaping insulin signalling in skeletal muscle — a crucial regulator of metabolism. The study also provides a unique tool for assessing the range of phosphorylation in insulin reactions and is anticipated to provide inspiration for further research into metabolic disease and diabetes.
“Insulin resistance — the failure of insulin to promote glucose uptake in its target tissues — is triggered by genetic and environmental factors such as family history and high-calorie diets,” says lead author Julian van Gerwen, during the study an undergraduate at the School of Life and Environmental Sciences, University of Sydney, Australia. “Although insulin resistance is a major precursor of metabolic disease, including type 2 diabetes, its mechanistic basis remains unresolved.”
Insulin normally tells the body to absorb glucose (sugar) from the bloodstream via a complex and dynamic signalling pathway. These signals are enabled by a process called phosphorylation — the addition of a phosphate group to a protein at a very specific position (called a phosphosite).
It is thought that insulin signalling controls thousands of phosphosites, but many are still uncharacterised. In addition, although it is well known that individual people vary greatly in their physiological response to insulin, it remains unclear how genetics or diet influence the phosphorylation status of cellular proteins — also known as the phosphoproteome.
To address this, van Gerwen and colleagues studied mice with well-characterised but different genetic backgrounds, so they could decipher the specific effects of genetics and diet on insulin signalling. They fed five strains of mice either a normal or high-fat and high-sugar diet, and took samples of their skeletal muscle — the site of greatest insulin-triggered glucose uptake after eating. Then they measured phosphorylation of the thousands of proteins present in each muscle sample using mass spectrometry. Their analysis recovered many well-known insulin-regulated phosphosites, and many more novel sites that had not previously been associated with insulin signalling.
To explore the influence of genetic and environmental variation, the team developed an algorithm to analyse which changes could be attributed to genetics, diet, or their combination. Almost half of all insulin-regulated phosphosites were affected by the strain of the mice when fed a normal diet, either having a stronger or weaker response to insulin. Overall, each genetic background displayed a unique fingerprint of insulin signalling.

Obsessive-compulsive disorder (OCD) is a neurological disorder characterized by repeated behaviors such as cleaning and checking despite clear objective evidence of cleanliness, orderliness, and correctness. Although the disease is often mischaracterized as a disorder of “fussiness,” the disorder actually stems from difficulty in processing uncertainty. However, the neural underpinnings of that aberrant processing remains unknown.
Now, a new study in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, published by Elsevier, uses brain imaging to get a closer look at the underpinnings of uncertainty processing in OCD.
The authors, led by Valerie Voon, PhD, from the University of Cambridge, studied a group of patients with OCD, another group of patients with severe OCD who had undergone a therapeutic surgical procedure called capsulotomy, which is thought to decrease OCD-related brain activity, and healthy controls. In addition to investigating brain processing in OCD, the researchers also wanted to examine the effects of capsulotomy on processing.
Dr. Voon explained, “We used a simple card gambling task like that commonly used in drinking games. Participants faced with an open card simply bet whether they thought the next card would be higher or lower than the open card. At the extremes, with high or low open cards, certainty is high, but uncertainty was much higher with cards near the middle of the deck.”
For the functional magnetic resonance imaging (fMRI) experiments, the researchers focused on brain areas implicated in decision making, namely the dorsal anterior cingulate cortex (dACC) and the anterior insula (AI). Participants with OCD displayed aberrant activity in this circuitry compared to healthy controls while determining certainty.
Dr. Voon said, “Critically, patients with OCD showed slower decision making, but only when the outcomes were more certain. Because these impairments appeared in both the OCD patients and those who had improved after capsulotomy surgery, that suggests this cognitive mechanism might be a core feature underlying why OCD develops, irrespective of how severe the symptoms might be.”
Dr. Voon added, “The imaging data may provide a representation of how OCD patients might struggle with their symptoms. Whereas healthy individuals might be able to say, ‘this is clean’ and stop cleaning, people with OCD might struggle with that sense of certainty, and perhaps spend more time wondering ‘is this still a bit dirty, or is this clean enough,’ and clean further.”
The findings make clear that OCD is not a disorder of over-cleanliness but one of disordered brain processing of certainty.
Cameron Carter, MD, Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, said of the work, “This very interesting study provides an important new perspective on the mechanism underlying the disabling symptoms of OCD and suggests that developing new therapies targeting uncertainty processing in the disorder, as well as the neural systems underlying these processes, such as the dACC and AI, may offer new hope to those suffering from this difficult to treat and disabling disorder.”

A review of COVID-19 studies globally has revealed reductions in breast cancer screening participation during 2020, with differences between geographic regions and healthcare settings.
The findings, published today in eLife, suggest the need for continued monitoring of access to breast cancer screening and early diagnosis services, to help identify if prevention services may need strengthening to increase participation for disadvantaged groups.
Breast cancer is the most common cancer worldwide, with 2.3 million cases diagnosed and 685,000 deaths in 2020. Mammography-based screening programs allow for the early detection and treatment of breast cancer to help improve patient outcomes, but these programs were strained by the COVID-19 pandemic in 2020.
“Previous work on modelled evaluations of breast cancer screening, with a focus on tumour stages and mortality as patient outcomes, suggested that scenarios are likely to differ based on region and the organisation of screening services,” says first author Reagan Lee, a medical student at the Usher Institute, University of Edinburgh, Scotland, UK. “For this study, we wanted to collate existing available data from different populations on breast screening participation levels before and after the first COVID-19 wave, when restrictions were put in place in nations with and without population-based screening programs.” Reagan’s mentor was senior author, Professor Jonine Figueroa, a molecular epidemiologist, Honorary Fellow at the University of Edinburgh’s Usher Institute and Senior Investigator and Distinguished Scholar at the U.S. National Cancer Institute, part of the National Institutes of Health.
In different countries, screening models vary from opportunistic to population-based screening. Opportunistic screening is offered to individual patients during routine medical visits or consultations, and occurs more commonly in private healthcare settings. Settings for opportunistic screening can present different levels of organisation and coordination. For instance, it can be performed according to a documented screening policy, following a defined protocol, system of quality assurance, and so on. Population-based screening is a government program that invites all eligible individuals in defined groups to reach most of the population at higher risk of the disease, according to the national screening policy.
For their study, the team performed a rapid literature review to document and estimate the COVID-19 pandemic’s global impact on breast cancer screening during the whole of 2020. They investigated two primary study outcomes: reported changes in screening volume and screening uptake. They searched Medline, the World Health Organization COVID-19 database and governmental databases. From 935 independent records, they identified 26 eligible studies from 13 countries. These countries had international movement controls in place during the pandemic, including internal movement controls, stay-at home requirements, public transport closures and other measures.
Analysing these studies, the team observed reported reductions in both screening volume and uptake rates among eight countries: Australia, Brazil, Canada, China, Italy, Mexico, the UK and US.

Through study findings published Friday in Cell Reports, a team of scientists at VCU Massey Cancer Center discovered a previously unknown interaction between proteins that is responsible for supplying energy to tumor cells and could hold significant implications for the development of future treatments for colon cancer.
“This study is really exciting because we may be able to use these findings to inform the development of an entirely new cancer drug right here at Massey,” said study author Can Senkal, Ph.D., a member of the Cancer Biology research program at Massey and an assistant professor in the Department of Biochemistry and Molecular Biology at the VCU School of Medicine.
The potential answer lies within a class of fatty compounds known as ceramides. Ceramides regulate a number of vital cellular functions, and many cancer drugs stimulate ceramide generation to help fend off disease. When that production of ceramide is cut off, cancer cells can survive and grow more efficiently.
Senkal and his team began extensively screening cells in the lab to identify what proteins regularly interact with ceramide-producing proteins to identify potential patterns that could warrant further investigation.
Ceramide synthases — the enzymes responsible for the generation of ceramide — come in a variety pack of six different flavors: Ceramide synthase 1-6.
Through their research, Senkal’s team observed that the first flavor, ceramide synthase 1 (CerS1), was highly interactive with a particular protein known as heat shock protein 27 (Hsp27). Heat shock proteins act like chaperones for other proteins to retain their full function; however, an overabundance of them can tip the scales and prevent ceramide synthases from doing their job.
The researchers also noticed that Hsp27 activity was higher in many colon cancer cells while at the same time CerS1 activity was significantly lower, prompting Senkal and his team to consider if the absence of one was connected to the presence of the other.

Data from wearable health trackers uncover treatment strategies that otherwise might have gone underutilized. Advanced patients would benefit from medication formulations that increase dosing frequency and more efficiently integrates extended-release tablets. The model finds that with a recommended medication strategy using data from wearable sensors, patients could spend almost twice as long each day (82% longer) with well-managed symptoms.Finding the right medication regimen to treat Parkinson’s disease (PD) is a complex healthcare challenge. Wearable health trackers provide physicians with a detailed window into patients’ symptoms, but translating this complex data into useful treatment insights can be difficult. New research in the INFORMS journal Management Science accomplishes just that. Researchers found that combining wearable health tracker data with state-of-the-art algorithms results in promising treatment strategies that could improve PD patients’ outcomes.“Our model identified a Parkinson’s disease medication strategy: Frequent dosing of a slow-release medication formulation that would benefit almost all patients,” says Matt Baucum of Florida State University, one of the study authors.
“In fact, our model uses wearable sensors to predict that patients would spend almost twice as long each day (82% longer) with well-managed symptoms under our recommended medication strategy, compared with their existing medication regimens.”
The paper, “Optimizing Patient-Specific Medication Regimen Policies Using Wearable Sensors in Parkinson’s Disease,” suggests the resulting models can offer novel clinical insights and medication strategies that can potentially democratize access to improved care.
“Our research suggests that combining rich data from wearable health trackers with the pattern-discovery capabilities of machine learning can uncover treatment strategies that otherwise might have gone underutilized,” says Anahita Khojandi, study co-author from the University of Tennessee, Knoxville.
“The algorithms we developed can even be used to predict patients who might benefit from more advanced PD therapies, which really highlights their ability to extract the maximum value from wearable data.”
Baucum and Khojandi, alongside fellow authors Dr. Rama Vasudevan of Oak Ridge National Laboratory and Dr. Ritesh Ramdhani a neurologist at Hofstra/ Northwell, emphasize that this work is groundbreaking for PD patients who may experience improved symptom control through continuous sensor monitoring and a novel AI approach.

New cases say fear and confusion about abortion bans in three states are causing doctors and hospitals to deny medically necessary abortions.Early in her pregnancy, Jaci Statton was in her kitchen when she felt like she was going to pass out and saw that her jeans had become soaked with blood. Doctors told her the pregnancy was not viable and that it could threaten her life if an abortion was not performed soon, she said.But Ms. Statton lives in Oklahoma, a state that bans most abortions. Three hospitals declined to provide the procedure, she said. At the third, “they said, ‘We can’t touch you unless you’re like crashing in front of us,’” Ms. Statton, 26, said in an interview. The hospital’s only suggestion, she said, was “we should wait in the parking lot until I was about to die.”On Tuesday, Ms. Statton filed a legal complaint with the U.S. Department of Health and Human Services asserting that the third institution, Oklahoma Children’s Hospital, had violated a federal law that requires hospitals with emergency departments to provide abortions in urgent situations, regardless of state abortion restrictions.Her case is part of several legal challenges filed Tuesday involving patients and doctors in three states — Idaho, Tennessee and Oklahoma — who claim that those states’ abortion bans are preventing women with serious pregnancy complications from getting abortions, even in cases where the medical need is clear.The cases, filed by the Center for Reproductive Rights, a legal advocacy organization, represent a broadening of legal strategies that abortions rights groups have initiated in recent months, after last year’s Supreme Court decision overturning the national right to abortion.Jaci Statton and her husband, Dennis, before her pregnancy.Rachel Meagan PhotographyWith 14 states to date enacting laws that outlaw most abortions, some abortion rights advocacy groups are focusing on cases involving patients with desired pregnancies that developed serious complications or abnormalities. The cases don’t seek to strike down the bans but instead to gain legal clarity ensuring that patients in these situations should be exempt from state abortion bans.The groups argue that the vague wording in the laws and the widespread confusion and fear among doctors that they could be prosecuted or penalized, has resulted in the denial of care, with sometimes dire consequences to patients’ health or ability to become pregnant in the future.One legal strategy, initiated earlier this year with a lawsuit filed against the State of Texas on behalf of patients and doctors, seeks clarification about state abortion restrictions to allow doctors to terminate pregnancies for patients with medical emergencies or severe fetal anomalies. The lawsuits filed Tuesday against Tennessee and Idaho echo that approach.Another strategy — invoked in Ms. Statton’s case — asks the federal government to investigate hospitals that have denied abortions to patients with medical emergencies in states with abortion bans. This spring, in a first-of-its-kind action, the federal government told a hospital in Missouri and another in Kansas that they had violated the federal law, the Emergency Medical Treatment and Labor Act, or EMTALA, when they denied an abortion to a woman whose water broke 17 weeks into her pregnancy. That law requires hospitals that receive Medicare funding and have emergency rooms to provide treatment including abortions if necessary to stabilize patients. Ms. Statton’s complaint asks the federal agency responsible for enforcing EMTALA, the Centers for Medicare & Medicaid Services, to investigate Oklahoma Children’s Hospital and issue a finding that it violated that law. The potential consequences include fines and exclusion from Medicare funding.OU Health, which includes Children’s Hospital, said in a statement: “Our health care complies with state and federal laws and regulatory compliance standards.”The Centers for Medicare & Medicaid Services did not provide a comment.In a news conference on Tuesday, leaders of the Center for Reproductive Rights said that the limited exceptions in state abortion bans were written with terminology doctors do not use and that they made it unclear when doctors might be at risk of punishment.“What these laws are forcing physicians to do is to weigh the very real threats of criminal prosecution against the health and well-being of their patients,” said Nancy Northup, the group’s president.Officials from two anti-abortion groups said that state abortion bans already allowed exceptions in life-threatening emergencies and that abortion rights advocates were trying to sow confusion. Dr. Ingrid Skop, vice president and director of medical affairs at the Charlotte Lozier Institute, said that although she never performed elective abortions, “there have been times I have needed to separate a mother from her unborn child in order to preserve her life in an emergency.”In the Texas case, after a hearing in July in which several women gave tear-filled testimony, a judge issued a temporary exemption to the state’s abortion ban that would allow patients with serious pregnancy complications to obtain abortions, but the exemption was blocked when the state immediately appealed. The case is scheduled for trial next year.The lawsuits filed Tuesday against Tennessee and Idaho — which include eight patients, four doctors and an Idaho medical organization — not only ask for clarification about which situations qualify as medical emergencies eligible for abortions but also ask the states’ courts to expand the exemptions so that pregnancies with lethal fetal anomalies can be legally aborted.The plaintiffs in the Tennessee case include Nicole Blackmon, who said she was 15 weeks pregnant when she learned that the fetus had a fatal medical condition. Tennessee’s abortion ban does not include exceptions for severe fetal anomalies, so she could not receive an abortion in the state. Ms. Blackmon could not afford to travel to another state, and at seven months into her pregnancy, after her health was worsening, gave birth to a stillborn baby, she said at Tuesday’s news conference.“That law forced me to carry a baby for months that was never going to live and easily could have killed me,” said Ms. Blackmon, who said that shortly before she became pregnant last year, her 14-year-old son Daniel was killed in a drive-by shooting. “I was left with waiting to lose another child in the same year,” she said.Tennessee’s attorney general’s office said it had not yet received the center’s lawsuit and will review it when it does.In Oklahoma, Ms. Statton, a mother of three, first went to a local Catholic hospital, which told her she was having a miscarriage. The next day she visited her obstetrician-gynecologist, who determined that she had a partial molar pregnancy, a condition in which an egg has been fertilized by two sperm, creating an embryo with too many chromosomes, which cannot survive. The condition can cause the development of precancerous sacs or cysts in the uterus, which can rupture and cause severe bleeding or can develop into cancer.Ms. Statton said the doctor told her “it will get worse” unless she had an abortion to remove the tissue, but because the hospital was Catholic, the doctor could not perform the procedure.She transferred Ms. Statton to University of Oklahoma Medical Center, about an hour away in Oklahoma City.There, Ms. Statton, who was about nine weeks pregnant, said doctors told her she should have the abortion immediately, but an ultrasound technician told them that they could not provide it because fetal cardiac activity could still be detected. “They were arguing with the ultrasound tech,” Ms. Statton said, and the doctors ultimately “came back in the room and said ‘We can’t.’”They transferred her to Oklahoma Children’s Hospital, part of the same health system, saying that it had specialty care that might allow it to treat her. When staff at that hospital said they could not provide an abortion until her condition became worse, her husband began to cry, saying, “‘I’m going to lose you, I’m going to lose our baby,’” Ms. Statton said.They drove 180 miles to an abortion clinic in Kansas, afraid that on the way her condition would deteriorate, Ms. Statton said. The clinic performed the abortion. Soon after , Ms. Statton decided to have a tubal ligation to prevent future pregnancies and she recently began taking antidepressants for the first time, she said.Ms. Statton said that when her state banned abortion she didn’t think about it much because “I would keep my baby so I wouldn’t need that.”Now, she said, “I just want other women to know that if they go through something like this, they’re not alone and it’s not their fault.”

The NewsWashington University in St. Louis will stop prescribing gender medications to minors, the school said on Monday, citing “unacceptable” legal liability under a new Missouri law banning such treatments.The change comes seven months after a former employee of the university’s youth gender clinic claimed that doctors there were hastily prescribing the treatments, throwing the center into the cross hairs of politicians trying to outlaw so-called gender affirming care for adolescents.Current patients under 18 will be referred to other providers for these medications, which include puberty blockers and hormones, the university said in a statement.“We are disheartened to have to take this step,” the statement said.St. Louis Children’s Hospital, part of the Washington University hospital system, where the gender clinic opened in 2017.Bryan Birks for The New York TimesBackgroundIn June, Gov. Mike Parson, Republican of Missouri, signed into law the ban on gender-affirming care for new patients under 18, part of a wave of more than 20 laws across the country severely restricting such care.Under the new law, existing patients of Washington University’s youth gender clinic were still allowed to receive the treatments. But the law includes a provision allowing patients to make legal claims against doctors who prescribe hormonal medications to minors. The university said this part of the law made it “untenable” to continue providing this care.Since it opened in 2017, the St. Louis clinic had seen a sharp increase in patient demand, overwhelming its small staff, The New York Times reported last month. Many patients and their families told The Times that the clinic’s doctors provided excellent care, and that the hormonal treatments profoundly improved patients’ mental health.But the clinic’s staff members struggled to give thorough psychological evaluations to patients with serious mental health problems, highlighting tensions among experts over how much screening should be required before giving adolescents access to hormones.This nuanced medical debate has run in parallel to a sweeping political movement to ban gender treatments for minors. Major medical groups have opposed bans on gender-affirming care for minors, as have many of the clinicians who have raised concerns that some children are being rushed into treatment.What’s NextWashington University said that its gender clinic would still provide hormonal treatments to adult patients, and that it would offer education and mental health support to patients of all ages.“Our medical practitioners have cared for these patients with skill and dedication,” the school’s statement said. “They have continually provided treatment in accordance with the standard of care and with informed consent of patients and their parents or guardians.”After the clinic’s former employee, Jamie Reed, went public, Missouri’s attorney general, a Republican, opened an investigation into the clinic’s operations, which is continuing. Senator Josh Hawley, Republican of Missouri, is conducting a similar inquiry.Civil rights groups are challenging Missouri’s ban, which has a “sunset” provision and will be in effect for four years. Last month, a judge declined the groups’ request for an injunction that would have temporarily blocked enforcement of the law.