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

Ancient DNA from coral-hosted Symbiodinium reveal a static mutualism over the last 172 years.

Ancient DNA (aDNA) provides powerful evidence for detecting the genetic basis for adaptation to environmental change in many taxa. Among the greatest of changes in our biosphere within the last century is rapid anthropogenic ocean warming. This phenomenon threatens corals with extinction, evidenced by the increasing observation of widespread mortality following mass bleaching events. There is some evidence and conjecture that coral-dinoflagellate symbioses change partnerships in response to changing external conditions over ecological and evolutionary timescales. Until now, we have been unable to ascertain the genetic identity of Symbiodinium hosted by corals prior to the rapid global change of the last century. Here, we show that Symbiodinium cells recovered from dry, century old specimens of 6 host species of octocorals contain sufficient DNA for amplification of the ITS2 subregion of the nuclear ribosomal DNA, commonly used for genotyping within this genus. Through comparisons with modern specimens sampled from similar locales we show that symbiotic associations among several species have been static over the last century, thereby suggesting that adaptive shifts to novel symbiont types is not common among these gorgonians, and perhaps, symbiotic corals in general

Characteristics of the boat inductor for keeping liquid metal in the suspended state

Characteristics of the boat inductor for keeping liquid metal in the suspended state are examined. Behavioral features of the liquid metal, and the suspension boundary of liquid metal in the lower position are discussed. It is concluded that the inductor can be used to crystallize metals in the suspended state

Multi-Impulse to Time Optimal Finite Burn Trajectory Conversion

A novel conversion algorithm is presented that combines the fidelity of indirect optimization methods with the generality of direct methods to more easily solve time-optimal, finite-burn pseudo-rendezvous problems. An algorithm is described that converts a set of multiple-impulses, representing the entirety or a portion of a high- or low-thrust maneuver, to an exact time optimal finite-burn trajectory for a thrust limited, constant exhaust velocity spacecraft. A pseudo-rendezvous problem is one that yields a solution whose final time, position and velocity state is equal to that of the original post-impulsive trajectory. An iterative adjoint-control transformation is used to initialize the optimal control two-point boundary value problem. Examples are shown for both high and low-thrust non-coplanar Earth orbit transfers, as well as a low-thrust Hohmann-type Earth-Mars transfer

Adaption of evolutionary programming to the prediction of solar flares

Adapting evolutionary programming to prediction of solar flare

A Modern Family: The Performance of "Family" and Familialism in Contemporary Television Series.

This dissertation addresses the complexities inherent in contemporary television articulations of family life and organization that construct the discourse on the American family since the mid-1990s. In addition to surveying the history of a number of television genres, such as father-centered series, teen-oriented programming, multigenerational family series, and reality TV, the dissertation uses textual analysis to examine how television frames and constructs “the family,” while also attempting to locate this construction within larger political, social, and cultural contexts. I argue that the socio-cultural evolution and construction of parenthood, marriage, and childhood have led to alternative definitions of “family” in contemporary television programming; however, specific case studies indicate a seemingly resilient commitment to, or performance of, a particular familial idealism. Each chapter concludes with notable case studies that offer an in-depth examination of various depictions of families, the kinds of “family values” they promote, and the way they continue to perform familialism even as they depict modern-day familial realities. The goal of this dissertation was to provide a better understanding as to both why a mythic “ideal” family has inhabited our cultural consciousness for so long, and how recent television series offer a space to question the appropriateness, authenticity, and usefulness of the dominant familial ideology to the twenty-first century family. In the end, what it found was that even amidst a multitude of diverse sentiments and structures of families on television, the most successful images of family continue to be bound to a performance of familialism that reaffirms the values deeply rooted in the nuclear family.Ph.D.CommunicationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/91389/1/fogelj_1.pd

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

Toward autonomous spacecraft

Ways in which autonomous behavior of spacecraft can be extended to treat situations wherein a closed loop control by a human may not be appropriate or even possible are explored. Predictive models that minimize mean least squared error and arbitrary cost functions are discussed. A methodology for extracting cyclic components for an arbitrary environment with respect to usual and arbitrary criteria is developed. An approach to prediction and control based on evolutionary programming is outlined. A computer program capable of predicting time series is presented. A design of a control system for a robotic dense with partially unknown physical properties is presented