Preventive care for women. Does the sex of the physician matter?

BACKGROUND: Emphasis on ensuring women's access to preventive health services has increased over the past decade. Relatively little attention has been paid to whether the sex of the physician affects the rates of cancer screening among women. We examined differences between male and female physicians in the frequency of screening mammograms and Pap smears among women patients enrolled in a large Midwestern health plan. METHODS: We identified claims for mammography and Pap tests submitted by primary care physicians for 97,962 women, 18 to 75 years of age, who were enrolled in the health plan in 1990. The sex of the physician was manually coded, and the physician's age was obtained from the state licensing board. After identifying a principal physician for each woman, we calculated the frequency of mammography and Pap smears for each physician, using the number of women in his or her practice during 1990 as the denominator. Using unconditional logistic regression, we also calculated the odds ratio of having a Pap smear or mammogram for women patients with female physicians as compared with those with male physicians, controlling for the physician's and the patient's age. RESULTS: Crude rates for Pap smears and mammography were higher for the patients of female than male physicians in most age groups of physicians. The largest differences between female and male physicians were in the rates of Pap smears among the youngest physicians. For the subgroup of women enrolled in the health plan for a year who saw only one physician, after adjustment for the patient's age and the physician's age and specialty, the odds ratio for having a Pap smear was 1.99 (95 percent confidence interval, 1.72 to 2.30) for the patients of female physicians as compared with those of male physicians. For women 40 years old and older, the odds ratio for having a mammogram was 1.41 (95 percent confidence interval, 1.22 to 1.63). For both Pap smears and mammography, the differences between female and male physicians in screening rates were much more pronounced in internal medicine and family practice than in obstetrics and gynecology. CONCLUSIONS: Women are more likely to undergo screening with Pap smears and mammograms if they see female rather than male physicians, particularly if the physician is an internist or family practitioner.     

Coronary artery disease in women. How customary expectations can interfere with interpretation of test results

Although one in three women in the United States will die of heart disease, traditionally coronary artery disease (CAD) in women has received less recognition as a public health problem than has the disease in men. To assist practicing physicians in recognizing CAD in women, this article reviews sex differences in risk factors and manifestations of CAD as well as strengths and weaknesses of various diagnostic tests in women.     

Remote sensing of canopy light use efficiency in temperate and boreal forests of North America using MODIS imagery

Light use efficiency (LUE) is an important variable characterizing plant eco-physiological functions and refers to the efficiency at which absorbed solar radiation is converted into photosynthates. The estimation of LUE at regional to global scales would be a significant advantage for global carbon cycle research. Traditional methods for canopy level LUE determination require meteorological inputs which cannot be easily obtained by remote sensing. Here we propose a new algorithm that incorporates the enhanced vegetation index (EVI) and a modified form of land surface temperature (T_m) for the estimation of monthly forest LUE based on Moderate Resolution Imaging Spectroradiometer (MODIS) imagery. Results demonstrate that a model based on EVI × T_m parameterized from ten forest sites can provide reasonable estimates of monthly LUE for temperate and boreal forest ecosystems in North America with an R² of 0.51 (p < 0.001) for the overall dataset. The regression coefficients (a, b) of the LUE–EVI × T_m correlation for these ten sites have been found to be closely correlated with the average EVI (EVI_ave, R² = 0.68, p = 0.003) and the minimum land surface temperature (LST_min, R² = 0.81, p = 0.009), providing a possible approach for model calibration. The calibrated model shows comparably good estimates of LUE for another ten independent forest ecosystems with an overall root mean square error (RMSE) of 0.055 g C per mol photosynthetically active radiation. These results are especially important for the evergreen species due to their limited variability in canopy greenness. The usefulness of this new LUE algorithm is further validated for the estimation of gross primary production (GPP) at these sites with an RMSE of 37.6 g C m^? 2 month^? 1 for all observations, which reflects a 28% improvement over the standard MODIS GPP products. These analyses should be helpful in the further development of ecosystem remote sensing methods and improving our understanding of the responses of various ecosystems to climate change.     

Relative performance of tracking versus fixed tilt photovoltaic systems in the USA

Tracking systems can increase the amount of electricity generated by photovoltaic (PV) modules, by actively orienting each module to intercept more solar energy. We find that horizontal one‐axis tracking systems can increase PV generation by 12–25% relative to south‐facing fixed mount PV systems with 25° tilts in the contiguous USA, and two‐axis tracking systems can increase PV generation by 30–45% relative to fixed mount systems. Tracking systems increase PV generation more significantly in arid regions such as the southwest USA than in humid regions with persistent cloud cover such as the Pacific Northwest and coastal Atlantic states. We find that fixed and tracking PV systems have similar interannual variability in their generation profiles, and this variability is primarily driven by project location. Tracking PV projects cost more than fixed tilt systems, per unit capacity, and we explore how much more tracking projects could cost while generating similar levelized costs of energy as fixed tilt systems. We define this as the breakeven additional cost of tracking and find that it is primarily driven by three factors: (i) regional tracking performance, (ii) fixed tilt system costs that tracking projects compete against, and (iii) additional tracking operation and maintenance costs. Using this framework, we explore the relative competitiveness of tracking systems for a range of fixed and tracking PV prices and evaluate how tracking competitiveness varies by region. Copyright © 2013 John Wiley & Sons, Ltd.     

An analysis of hydrogen production from renewable electricity sources

Three aspects of producing hydrogen via renewable electricity sources are analyzed to determine the potential for solar and wind hydrogen production pathways: a renewable hydrogen resource assessment, a cost analysis of hydrogen production via electrolysis, and the annual energy requirements of producing hydrogen for refueling. The results indicate that ample resources exist to produce transportation fuel from wind and solar power. However, hydrogen prices are highly dependent on electricity prices. For renewables to produce hydrogen at $2 kg⁻¹, using electrolyzers available in 2004, electricity prices would have to be less than $0.01 kWh⁻¹. Additionally, energy requirements for hydrogen refueling stations are in excess of 20 GWh/year. It may be challenging for dedicated renewable systems at the filling station to meet such requirements. Therefore, while plentiful resources exist to provide clean electricity for the production of hydrogen for transportation fuel, challenges remain to identify optimum economic and technical configurations to provide renewable energy to distributed hydrogen refueling stations.     

Home visitors'' beliefs and practices regarding childhood injury prevention

Although the discriminative properties of cocaine have been examined extensively in rats, and to a lesser extent in other species, there are currently no reports on cocaine discrimination by mice. In one of our experiments, C57BL/6 (C57) mice acquired cocaine discrimination (10 mg/kg training dose) and exhibited dose responsive generalization to lower doses of the drug, which was similar to previous reports using rats. In addition, mazindol, a general monoamine uptake inhibitor similar to cocaine, and nomifensine, which is relatively specific for the dopamine transporter, substituted completely for cocaine, as described for rats. In contrast, there was little substitution evidenced by monoamine uptake inhibitors relatively specific for the norepinephrine transporter (nisoxetine) or for the serotonin transporter (fluoxetine), or by the local anesthetics procaine or lidocaine. In our second experiment, neither cocaine nor mazindol substituted for procaine in animals trained to discriminate the local anesthetic (100 mg/kg) although lidocaine substituted completely for the procaine cue. These experiments emphasize the importance of the dopamine transporter in mediating the discriminative stimulus effects of cocaine in C57 mice. The lack of cross generalization between cocaine and procaine suggests that the anesthetic properties of cocaine contribute little toward its discrimination by this mouse strain.     

The asymptotic theory of gasless combustion synthesis

The gasless, self-propagating, high-temperature synthesis of refractory materials is generally associated with a thin reaction zone that propagates through the material, converting the unburned reactant powders into a product alloy. The reactions themselves are characterized by large overall activation energies, a fact that can be exploited to derive asymptotic models in which the reaction zone becomes an infinitesimally thin sheet. Such models have been derived for both kinetically and diffusion-limited reactions, as well as for the intermediate case in which both chemical reaction and mass diffusion occur on comparable time scales. These models are amenable to analytical analysis, yielding formulas for the propagation speed of a steady, planar combustion wave and, in agreement with experiments, predicting critical parameter values above which stability is lost to one or more nonsteady modes of burning. In particular, nonlinear stability analyses have demonstrated the transition from steady to various periodic, quasi-periodic, and even chaotic combustion modes as a parameter related to the activation energy increases beyond the neutral stability threshold. This paper is based on a presentation made in the symposium “Reaction Synthesis of Materials” presented during the TMS Annual Meeting, New Orleans, LA, February 17–21, 1991, under the auspices of the TMS Powder Metallurgy Committee.     

Metabolic studies in isolated rat liver cells: I. Lipid synthesis

Rat liver cells, isolated by chelate perfusion and extrusion through a tissue press, incorporated labeled acetate into cellular lipids and into lipids released into the suspending medium. Optimal rates of incorporation required supplementation of tris-KCl medium with Mg⁺⁺, Mn⁺⁺, succinate, citrate, nicotinamide, Coenzyme A, NADP and glucose-6-phosphate. The rate of acetate incorporation was markedly altered by changes in incubation media; tris-KCl was the most effective buffer. All the major classes of cellular lipids were labeled. ATP, BSA, inorganic phosphate, Ca⁺⁺, 2,4-dinitrophenol and sodium clofibrate were potent inhibitors of acetate incorporation. When added to the incubation mixture, several hormones altered the rate of acetate incorporation into lipids.