Prevalence of hormone prescription and education for cis and trans women by medical trainees

PREVALENCE OF HORMONE PRESCRIPTION AND EDUCATION FOR CIS AND TRANS WOMEN BY MEDICAL TRAINEES AUTHORS Madison Meister, BA Candidate; Emily J Noonan, PhD, MA; Laura A. Weingartner, PhD, MS BACKGROUND Hormone replacement therapy is a common healthcare practice for contraception, hormone control, and menopause treatment. Transgender patients may also take hormones to affirm their gender identity, such as feminizing hormones (estrogen), for transgender women. Studying how trainees discuss hormone risks for both cis and trans women can demonstrate if disparities exist and how we may address them to overcome healthcare barriers. METHODS Fifty videos were analyzed of third-year medical students taking patient histories from standardized patients, including 28 cis women and 22 trans women. Students had previously completed LGBTQ clinical skills training, and patients reported taking estrogen purchased online for acne control (cis) or gender-affirming (trans) purposes. Videos were analyzed for the presence and context of hormone health risk discussion, student knowledge, and whether the student agreed to prescribe hormones. RESULTS Of the 90% (n=43) of students who agreed to prescribe hormones, 47% (n=20) prescribed conditionally. Conditions included: pending lab results, desire to research hormones, or checking with attending physicians. A larger proportion of trans women were prescribed hormones (95% or 21/22) compared to cisgender women (79% or 22/28). While similar proportions of students discussed hormone risks between patient groups, students discussed their knowledge or discomfort prescribing hormones more frequently with trans women (27% or n=6/22) than cis women (18% or n=5/28). DISCUSSION We expected students to prescribe combined estrogen-progestin oral contraception to cis women. These data show students more readily prescribed estrogen for gender-affirming purposes, suggesting that LGBTQ clinical skills interventions may help prepare students to provide gender-affirming care

Forces on Dust Grains Exposed to Anisotropic Interstellar Radiation Fields

Grains exposed to anisotropic radiation fields are subjected to forces due to the asymmetric photon-stimulated ejection of particles. These forces act in addition to the ``radiation pressure'' due to absorption and scattering. Here we model the forces due to photoelectron emission and the photodesorption of adatoms. The ``photoelectric'' force depends on the ambient conditions relevant to grain charging. We find that it is comparable to the radiation pressure when the grain potential is relatively low and the radiation spectrum is relatively hard. The calculation of the ``photodesorption'' force is highly uncertain, since the surface physics and chemsitry of grain materials are poorly understood at present. For our simple yet plausible model, the photodesorption force dominates the radiation pressure for grains with size >~0.1 micron exposed to starlight from OB stars. We find that the anisotropy of the interstellar radiation field is ~10% in the visible and ultraviolet. We estimate size-dependent drift speeds for grains in the cold and warm neutral media and find that micron-sized grains could potentially be moved across a diffuse cloud during its lifetime.Comment: LaTeX(41 pages, 19 figures), submitted to Ap

Assimilation of High-Frequency Radar Data in the East Chukchi Sea

The maximum-likelihood ensemble filter (MLEF) is an eficient technique of data assimilation related to both 3D-variational (3Dvar) and Ensemble Kalman Filter (EnKF) methods. We demonstrate the utility of MLEF by assimilating high-frequency radar (HFR) data into a realistic model of the east Chukchi Sea. A set of three radar stations in Wainwright, Point Lay, and Barrow provide two-dimensional resolution of the sea-surface velocity. We use MLEF to incorporate this HFR data into a numerical model constructed using the Regional Ocean Modelling System (ROMS) for the ice-free months of 2012. The resulting analysis can be used as a benchmark for future operational forecasting, allowing for better real-time monitoring and decision-making as this biologically rich region is influenced by industry and commerce

Photoelectric Emission from Dust Grains Exposed to Extreme Ultraviolet and X-ray Radiation

Photoelectric emission from dust plays an important role in grain charging and gas heating. To date, detailed models of these processes have focused primarily on grains exposed to soft radiation fields. We provide new estimates of the photoelectric yield for neutral and charged carbonaceous and silicate grains, for photon energies exceeding 20 eV. We include the ejection of electrons from both the band structure of the material and the inner shells of the constituent atoms, as well as Auger and secondary electron emission. We apply the model to estimate gas heating rates in planetary nebulae and grain charges in the outflows of broad absorption line quasars. For these applications, secondary emission can be neglected; the combined effect of inner shell and Auger emission is small, though not always negligible. Finally, we investigate the survivability of dust entrained in quasar outflows. The lack of nuclear reddening in broad absorption line quasars may be explained by sputtering of grains in the outflows.Comment: 29 pages, 9 figures, submitted to Ap

Radiative Torques on Interstellar Grains. III. Dynamics with Thermal Relaxation

In the previous papers in this series, we found that radiative torques can play a major role in the alignment of grains with the interstellar magnetic field. Since the radiative torques can drive the grains to suprathermal rotational speeds, in previous work we made the simplifying assumption that the grain principal axis of greatest moment of inertia is always parallel to the grain angular momentum. This enabled us to describe many of the features of the grain dynamics. However, this assumption fails when the grains enter periods of thermal rotation, which occur naturally in the radiative torque alignment scenario. In the present paper, we relax this assumption and explore the consequences for the grain dynamics. We develop a treatment to follow the grain dynamics including thermal fluctuations and ``thermal flipping'', and show results for one illustrative example. By comparing with a treatment without thermal fluctuations, we see that inclusion of thermal fluctuations can lead to qualitative changes in the grain dynamics. In a future installment in this series, we will use the more complete dynamical treatment developed here to perform a systematic study of grain alignment by radiative torques.Comment: 54 pages, 16 figures, submitted to Ap

Design considerations for table-top, laser-based VUV and X-ray free electron lasers

A recent breakthrough in laser-plasma accelerators, based upon ultrashort high-intensity lasers, demonstrated the generation of quasi-monoenergetic GeV-electrons. With future Petawatt lasers ultra-high beam currents of ~100 kA in ~10 fs can be expected, allowing for drastic reduction in the undulator length of free-electron-lasers (FELs). We present a discussion of the key aspects of a table-top FEL design, including energy loss and chirps induced by space-charge and wakefields. These effects become important for an optimized table-top FEL operation. A first proof-of-principle VUV case is considered as well as a table-top X-ray-FEL which may open a brilliant light source also for new ways in clinical diagnostics.Comment: 6 pages, 4 figures; accepted for publication in Appl. Phys.

Photoelectric cross-sections of gas and dust in protoplanetary disks

We provide simple polynomial fits to the X-ray photoelectric cross-sections (0.03 < E < 10keV) for mixtures of gas and dust found in protoplanetary disks. Using the solar elemental abundances of Asplund et al. (2009) we treat the gas and dust components separately, facilitating the further exploration evolutionary processes such as grain settling and gain growth. We find that blanketing due to advanced grain-growth (a_max > 1 micron) can reduce the X-ray opacity of dust appreciably at E_X ~ 1keV, coincident with the peak of typical T Tauri X-ray spectra. However, the reduction of dust opacity by dust settling, which is known to occur in protoplanetary disks, is probably a more significant effect. The absorption of 1-10keV X-rays is dominated by gas opacity once the dust abundance has been reduced to about 1% of its diffuse interstellar value. The gas disk establishes a floor to the opacity at which point X-ray transport becomes insensitive to further dust evolution. Our choice of fitting function follows that of Morrison & McCammon (1983), providing a degree of backward-compatibility.Comment: 34 pages, 7 figures. To be published in in Ap

Radiative Torques on Interstellar Grains: II. Grain Alignment

Radiative torques on irregular dust grains, in addition to producing superthermal rotation, play a direct dynamical role in the alignment of interstellar dust with the local magnetic field. The equations governing the orientation of spinning, precessing grains are derived; H_2 formation torques and paramagnetic dissipation are included in the dynamics. Stationary solutions (constant alignment angle and spin rate) are found; these solutions may be stable ("attractors") or unstable ("repellors"). The equations of motion are numerically integrated for three exemplary irregular grain geometries, exposed to anisotropic radiation with the spectrum of interstellar starlight. The resulting "trajectory maps" are classified as "noncyclic", "semicyclic", or "cyclic", with examples of each given. We find that radiative torques result in rapid grain alignment, even in the absence of paramagnetic dissipation. It appears that radiative torques due to starlight can account for the observed alignment of interstellar grains with the Galactic magnetic field.Comment: 34 pages, 21 eps figures, uses aaspp4.sty . Submitted to Ap.