Impact on patient satisfaction and importance of medical intake and office staff in a multidisciplinary, one-stop shop transgender program in Indianapolis, Indiana

Background: Historically, the transgender population has postponed seeking primary care due to discrimination within social and medical settings. Very few studies have considered patient satisfaction with transgender care and whether there are differences in staff satisfaction. This cross-sectional study focuses on the satisfaction of transgender patients who receive primary care at a comprehensive, “one-stop shop” program in Indianapolis, IN, USA. Methods: Sixty-two patients completed a patient satisfaction survey. Items consisted of 5-point Likert scales with anchors of satisfaction, caring, competence, and doctor recommendation. Results: Overall, there were positive responses to all items, ranging from moderately high to very high. There was high overall satisfaction in the program’s trans-friendliness, office visits, and “one-stop shop” model. Lower scoring items concerned medical intake with appointment making and timing. There were no statistical differences across age, gender, education, duration at the program, and number of visits in the past 12 months. There were clear differences between how respondents viewed the care and competence of the program’s staff. In particular, the doctor was viewed most positively and office staff least positively with medical staff rated in-between. Conclusion: There is high patient satisfaction with this comprehensive, “one-stop shop” care model among the transgender population. We recommend that transgender programs routinely conduct quality improvement measures, maintain sufficient workforce coverage, and provide cultural competency training which should include appropriate care standards and patient-centered concerns regarding appointment making and burdens associated with timing, traveling, and cost

Effects of Repeated Cue Exposure on Cannabis Craving

Craving is a key element of the cannabis withdrawal syndrome that has been associated with continued use and relapse. Although cue-induced cannabis craving has been established in single laboratory sessions, procedures to sustain craving over multiple sessions are needed. The purpose of the present study was to determine if cue-induced craving responses could be elicited in the same subjects across multiple sessions. It was hypothesized that exposure to cannabis cues would produce more robust craving responses than exposure to neutral cues and that elicited craving responses will be sustained across multiple cue exposures. Five experimental cue exposure sessions (1 neutral and 4 cannabis) were conducted. Craving was assessed with the Marijuana Craving Questionnaire (MCQ) Short Form, Visual Analog Scale (VAS), Subject-Rated Physiological Questionnaire, blood pressure, and heart rate. Results revealed significant effects of initial cannabis cue exposure on VAS craving responses and Subject-Rated Physiological measures relative to the neutral cue exposure condition. No significant differences were found on MCQ composite scores or physiological measures. Craving responses following initial cannabis cue exposure were not maintained across sessions. There is a need for a better understanding of the factors that contribute to continued drug use despite quit attempts

Fractionation of Hydrogen Isotopes by Sulfate- and Nitrate-Reducing Bacteria.

Hydrogen atoms from water and food are incorporated into biomass during cellular metabolism and biosynthesis, fractionating the isotopes of hydrogen-protium and deuterium-that are recorded in biomolecules. While these fractionations are often relatively constant in plants, large variations in the magnitude of fractionation are observed for many heterotrophic microbes utilizing different central metabolic pathways. The correlation between metabolism and lipid δ(2)H provides a potential basis for reconstructing environmental and ecological parameters, but the calibration dataset has thus far been limited mainly to aerobes. Here we report on the hydrogen isotopic fractionations of lipids produced by nitrate-respiring and sulfate-reducing bacteria. We observe only small differences in fractionation between oxygen- and nitrate-respiring growth conditions, with a typical pattern of variation between substrates that is broadly consistent with previously described trends. In contrast, fractionation by sulfate-reducing bacteria does not vary significantly between different substrates, even when autotrophic and heterotrophic growth conditions are compared. This result is in marked contrast to previously published observations and has significant implications for the interpretation of environmental hydrogen isotope data. We evaluate these trends in light of metabolic gene content of each strain, growth rate, and potential flux and reservoir-size effects of cellular hydrogen, but find no single variable that can account for the differences between nitrate- and sulfate-respiring bacteria. The emerging picture of bacterial hydrogen isotope fractionation is therefore more complex than the simple correspondence between δ(2)H and metabolic pathway previously understood from aerobes. Despite the complexity, the large signals and rich variability of observed lipid δ(2)H suggest much potential as an environmental recorder of metabolism

Activation of mating type genes by transposition in Saccharomyces cerevisiae

Yeast Saccharomyces cerevisiae may express an a or alpha mating type. These cells types may be interconverted as a consequence of heritable genetic alteractions at the mating type locus (MAT). According to the more general controlling element model [Oshima, U. & Takano, I. (1971) Genetics 67, 327--335] and the specific cassette model [Hicks, J., Strathern, J. & Herskowitz, I. (1977) in DNA Insertion Elements, Plasmids and Episomes, eds. Bukhari, A. I., Shapiro, J.A. & Adhya, S. L.(Cold Spring Harbor Laboratory, Cold Spring Harbor, NY), pp. 457--462], the regulatory information required for switching the MAT locus exists at two other loosely linked loci, HMa and HMalpha. Specifically, the HMa and HMalpha loci are proposed to carry silent alpha and silent a genes, respectively. According to these models, switching occurs when a replica of a silent gene replaces the resident information at the mating type locus and is thereby expressed. These models predict that mutations at the silent ("storage") loci would generate defective MAT loci subsequent to the switching process. Therefore, the behavior of HMalpha mutants during the mating type interconversion was investigated. The results demonstrate that defective MATa alleles are generated by switching the MATalpha locus in HMalpha mutants. Thus, the genetic information from HMalpha is transposed to the mating type locus. These results provide genetic evidence in support of these models

Kink stability, propagation, and length scale competition in the periodically modulated sine-Gordon equation

We have examined the dynamical behavior of the kink solutions of the one-dimensional sine-Gordon equation in the presence of a spatially periodic parametric perturbation. Our study clarifies and extends the currently available knowledge on this and related nonlinear problems in four directions. First, we present the results of a numerical simulation program which are not compatible with the existence of a radiative threshold, predicted by earlier calculations. Second, we carry out a perturbative calculation which helps interpret those previous predictions, enabling us to understand in depth our numerical results. Third, we apply the collective coordinate formalism to this system and demonstrate numerically that it accurately reproduces the observed kink dynamics. Fourth, we report on a novel occurrence of length scale competition in this system and show how it can be understood by means of linear stability analysis. Finally, we conclude by summarizing the general physical framework that arises from our study.Comment: 19 pages, REVTeX 3.0, 24 figures available from A S o

A dynamic systems approach to infant facial action

Journal ArticleWhat does it mean when a baby smiles? Is it an expression of enjoyment, a signal to a partner that rewards effective caretaking, or simply a muscular contraction? Do physically different types of smiles indicate different things? Should the social context in which an infant smiles inform our understanding of the smile? To address these questions, we apply insights and ideas from a dynamic systems perspective to anatomical, social interactive, and neurophysiological data on the development of infant facial action (Fogel, 1993; Fogel & Thelen, 1987; Thelen, 1995; Thelen & Smith, 1994)

First known records of the specialist bee, Colletes aestivalis (Hymenoptera: Colletidae), in an urban area

Here we report on the first known records of the Heuchera specialist bee Colletes aestivalis in an urban area. This bee was found by a participant in a citizen science project in a residential garden in a suburb that abuts St. Louis, Missouri. The females were found only visiting Heuchera richardsonii, and the males were seen scouting for females by hovering over the plants. This finding shows that urban areas can support uncommon specialist bees and the utility of engaging non-experts in cataloging biodiversity

HIV-1 Evolutionary Patterns Associated with Metastatic Kaposi's Sarcoma during AIDS.

Kaposi's sarcoma (KS) in HIV-infected individuals can have a wide range of clinical outcomes, from indolent skin tumors to a life-threatening visceral cancer. KS tumors contain endothelial-related cells and inflammatory cells that may be HIV-infected. In this study we tested if HIV evolutionary patterns distinguish KS tumor relatedness and progression. Multisite autopsies from participants who died from HIV-AIDS with KS prior to the availability of antiretroviral therapy were identified at the AIDS and Cancer Specimen Resource (ACSR). Two patients (KS1 and KS2) died predominantly from non-KS-associated disease and KS3 died due to aggressive and metastatic KS within one month of diagnosis. Skin and visceral tumor and nontumor autopsy tissues were obtained (n = 12). Single genome sequencing was used to amplify HIV RNA and DNA, which was present in all tumors. Independent HIV tumor clades in phylogenies differentiated KS1 and KS2 from KS3, whose sequences were interrelated by both phylogeny and selection. HIV compartmentalization was confirmed in KS1 and KS2 tumors; however, in KS3, no compartmentalization was observed among sampled tissues. While the sample size is small, the HIV evolutionary patterns observed in all patients suggest an interplay between tumor cells and HIV-infected cells which provides a selective advantage and could promote KS progression