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

Lengthscales and Cooperativity in DNA Bubble Formation

It appears that thermally activated DNA bubbles of different sizes play central roles in important genetic processes. Here we show that the probability for the formation of such bubbles is regulated by the number of soft AT pairs in specific regions with lengths which at physiological temperatures are of the order of (but not equal to) the size of the bubble. The analysis is based on the Peyrard- Bishop-Dauxois model, whose equilibrium statistical properties have been accurately calculated here with a transfer integral approach

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

Indigenous amino acids in primitive CR meteorites

CR meteorites are among the most primitive meteorites. In this paper, we report the first measurements of amino acids in Antarctic CR meteorites, two of which show the highest amino acid concentrations ever found in a chondrite. EET92042, GRA95229 and GRO95577 were analyzed for their amino acid content using high performance liquid chromatography with UV fluorescence detection (HPLC-FD) and gas chromatographymass spectrometry (GC-MS). Our data show that EET92042 and GRA95229 are the most amino acid-rich chondrites ever analyzed, with total amino acid concentrations ranging from 180 parts-per-million (ppm) to 249 ppm. GRO95577, however, is depleted in amino acids. The most abundant amino acids present in the EET92042 and GRA95229 meteorites are the alpha-amino acids glycine, isovaline, alpha-aminoisobutyric acid (alpha-AIB), and alanine, with delta13C values ranging from +31.6per mil to +50.5per mil. The carbon isotope results together with racemic enantiomeric ratios determined for most amino acids strongly indicate an extraterrestrial origin of these compounds. In addition, the relative abundances of alpha-AIB and beta-alanine in the Antarctic CR meteorites analyzed appear to correspond to the degree of aqueous alteration on their respective parent body.Comment: In press; To appear in the December 2007 issue of Meteoritics and Planetary Science, released March 200

National business regulations and city entrepreneurship in Europe: a multilevel nested analysis

This article provides and tests a theoretical framework with a multilevel (country–city) nested model to analyze the relationship between national business regulations (NBRs) and city level entrepreneurship. While public interest theory predicts a positive relationship between NBR and city level entrepreneurship, public choice theory predicts the opposite, a negative relationship. Based on multilevel analysis for a matched country–city panel of 228 cities across 20 European countries for the years 2004 to 2009, the empirical evidence from panel data estimation explains how changes in NBRs influence changes in city level entrepreneurial activity over time

A Deep Learning Pipeline for Assessing Ventricular Volumes from a Cardiac Magnetic Resonance Image Registry of Single Ventricle Patients

Purpose: To develop an end-to-end deep learning (DL) pipeline for automated ventricular segmentation of cardiac MRI data from a multicenter registry of patients with Fontan circulation (FORCE). / Materials and Methods: This retrospective study used 250 cardiac MRI examinations (November 2007–December 2022) from 13 institutions for training, validation, and testing. The pipeline contained three DL models: a classifier to identify short-axis cine stacks and two UNet 3+ models for image cropping and segmentation. The automated segmentations were evaluated on the test set (n = 50) using the Dice score. Volumetric and functional metrics derived from DL and ground truth manual segmentations were compared using Bland-Altman and intraclass correlation analysis. The pipeline was further qualitatively evaluated on 475 unseen examinations. / Results: There were acceptable limits of agreement (LOA) and minimal biases between the ground truth and DL end-diastolic volume (EDV) (Bias: -0.6 mL/m2, LOA: -20.6–19.5 mL/m2), and end-systolic volume (ESV) (Bias: - 1.1 mL/m2, LOA: -18.1–15.9 mL/m2), with high intraclass correlation coefficients (ICC > 0.97) and Dice scores (EDV, 0.91 and ESV, 0.86). There was moderate agreement for ventricular mass (Bias: -1.9 g/m2, LOA: -17.3–13.5 g/m2) and a ICC (0.94). There was also acceptable agreement for stroke volume (Bias:0.6 mL/m2, LOA: -17.2–18.3 mL/m2) and ejection fraction (Bias:0.6%, LOA: -12.2%–13.4%), with high ICCs (> 0.81). The pipeline achieved satisfactory segmentation in 68% of the 475 unseen examinations, while 26% needed minor adjustments, 5% needed major adjustments, and in 0.4%, the cropping model failed. / Conclusion: The DL pipeline can provide fast standardized segmentation for patients with single ventricle physiology across multiple centers. This pipeline can be applied to all cardiac MRI examinations in the FORCE registry

Resonances in the dynamics of ϕ4\phi^4 kinks perturbed by ac forces

We study the dynamics of $\phi^4$ kinks perturbed by an ac force, both with and without damping. We address this issue by using a collective coordinate theory, which allows us to reduce the problem to the dynamics of the kink center and width. We carry out a careful analysis of the corresponding ordinary differential equations, of Mathieu type in the undamped case, finding and characterizing the resonant frequencies and the regions of existence of resonant solutions. We verify the accuracy of our predictions by numerical simulation of the full partial differential equation, showing that the collective coordinate prediction is very accurate. Numerical simulations for the damped case establish that the strongest resonance is the one at half the frequency of the internal mode of the kink. In the conclusion we discuss on the possible relevance of our results for other systems, especially the sine-Gordon equation. We also obtain additional results regarding the equivalence between different collective coordinate methods applied to this problem.Comment: 23 pages, 7 figures, REVTeX, accepted for publication in Phys. Rev.

Automated Analysis of Chest Radiographs for Cystic Fibrosis Scoring

We present a framework to analyze chest radiographs for cystic fibro-sis using machine learning methods. We compare the representational power of deep learning features with traditional texture features. Specifically, we respec-tively employ VGG-16 based deep learning features, Tamura and Gabor filter based textural features to represent the cystic fibrosis images. We demonstrate that VGG-16 features perform best, with a maximum agreement of 82%. In ad-dition, due to limited dimensionality, Tamura features for unsegmented images achieve no more than 50% agreement; however, after segmentation, the accuracy of Tamura can reach 78%. In combination with using the deep learning features, we also compare back propagation neural network and sparse coding classifiers to the typical SVM classifier with polynomial kernel function. The result shows that neural network and sparse coding classifiers outperform SVM in most cases. Only with insufficient training samples does SVM demonstrate higher accuracy